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HomeMy WebLinkAbout3440 WIMBLEDON WAY - Building Permits4 '- AOYliwnt to fill in au soaees excapt tnou witnin neary EorEar Iims anE.si9n all aoo!ooriate aaclanHons. _ _ _ . . __ �'�A -^ ' � . � .. PERMIT NO. TRACT NO. T NO. - BL . . � . . _ � , , ' ION ER IT ' ^ f,� " �O �OZ [� ' , � �, , • � . '6369 ,37�b%83•�'pf'3d7,1U;89i .,u ' ' ' � . - � ��, , ,. . nY5 Meilln�q Address ' � � �" TVPE�OF CONSTRUCTION � NEW ADD� , LTERATION ' REPAbRti, � I - ' ' � l '. ' � �' - � � vro)ecc a.daress s 1 �} �❑ CONVERSION ❑ DEMOLISH 'O OTHER � i . � � _ �.. OWnlfSNem � C� hQ�e .��'J�, DESCRIPTIONOFWORK ����NIA�G' /-dpL�- "�r0%� -OT � NI �G 1 S - � 5 �/� Addre55. . - . � 7YPEOFPERMIT GRADING -FOUNDATION STRUCTURAL - A.P.9W�IL�O Y3 3t. ZONE �� �� ' � /� - . AfthlEng: LitBnsE N. ❑ TENANT JIXELECTRIGAL ❑ PLUMBING, Q MECHANICAI � � �� �� BUILDING, - Addf@W. � � S "e� �,�OTFIER , . : . � ' � TO BUILDING , Contractar's Nam hone � . PRQIECT DESCRIPTION 5�. FT.• � ��,OCCUPANCV PE V I E � AR VARD (TO P/C) �- �LEFTSIOE VARD IDE V � CONSTRUCTIONTVPE VALUATIONE ������ � 1I AddfeSslmailin9) � � , � � � ' PKG.SPACE,REQ. ' � CICBO58 NO. ' . '� � ', ZON� ' GRADING CU. VOS. 'ACRES , � J, LICENSED CONTRACTOR DECLARATION � '� � , � pamarka: � � STREET WIDTH !PA E$ • l�,,� 1 hereby affifm tnat- I' am Iicensetl untler prOWslons o},Cherter 9(tommancing • � , �' i wlth sectlon 7000) DlviSion 3 of t�e BuSine antl ProPossions Cotle, anC . ' ' - � � � , ' � ' � ' SPECIAL CONDITIONS: � � ' _ ' � � � my Iicense Is In fu lo� eD ltec ' _ . ' ' , . , � License clau' a�nsd No. � � PWMBING � , . � Date � Sign tum �'` �- ' BarSi�k ' SewerCaP � • ' ELECTRICAL � ' ; '�RKERS' COMPENSATION DECIANATION � ' - - reGy aftlrm tnat I.have a cartlflCate o/ <onsent to SelNnsure or a rtliitate BeCkflow Prevent9r ' SBWCr ConneCtion -� '- ' Automatic Washer . Meter ❑over 10� amps. - _ -� Workars' Compensatlon Insuranca,ior a c tlileO copy there $ectlon ' ' ConStfuctionPole , � 3600, Lab�-� Backflow Irri9ation Solar Collectors- Sub Panel . .<•: , Policy No mpan � �- � - . � � � �, , �Cartlfletl�co0v �s hereby turNshe . � Bathtubs . ' Solar Piping ' � , Cooking Unit ; Sub Pole ,; CeoG/la c�ov leawlththec y. uli � , Dishwasher � � 'Motors �0-1 HP �1X-8 Date �`�`�� � AOPIIc t � Clarifiers SolarTank � � _ EXEMPTION FROM WORKEpS' C NSA N DECLARATION ' • - DryerS ❑Gas ❑EIeC[fIC (Thissectlon neetl uot Ee tomD�etetl If tha per I5 for one hunOmtl (5300) or � • Dishwdsher � � Swirtiming Pool w/Spa � In0.S018r �9-75 HP O16d5+� less). • - � Drinkin Fountains Urinal ' Fan . ' _ � . ,Microwave ' . � ' � I cartlfy that In tha pertormanca o/ the work for which thls Oe�mR is issuetl I 9, . � �, — shall no[ amD�oy any permn In any manner so'as to becoma 5uD7act. to t�e . . , � - i , F.A.U. '+� � � � ''7 ,Pole�Light ) : [ '. � Workers' Compenmtlon� Laws of',Callfornia.' � � � ' FlOor Dreins. Weter Closet i � � � i . / � Date Siqnature � � � ' � - . Fixtu�¢5 flan e . � � � NOTICE: If, after' making� this declaraiion, you snoultl become subject to'the"�' FI00� SinkS •, -- ,' ^� WetBr HeatEr '-� - ' 9 ' '}[� , '- ' Workars'. Compensatlon provislon5 01 the Laboc Cotla, you mu5t fortnwith� 1 ' . . - ' . ' . , , � . evice �Boxes comply 'Wlth' Snth provisions ar�thii Dermii Shall be COemeE revbkea: ' GasService� � Ouclets- �WaterService i� � 5�9� � CONSTRUCTION�LENDING AGENCV ' ' � - � �'� -'� � • y 9 9 i Intefceptors� Outlets!.-•' Stendin SeCtions I hereb affirm that there is a'canstructlomlentlin a ancy4or tha performance� � . � �: ' b . ' 9 : ot [ne work tor which- this permlt -I5 Issuatl � (Section ' 3097 CIv. C:)' � , .� - witches � � � � l.antler's Nama - , ' ' Kitchen.Sink - � � ' - � _ r - �Trash Compactor � � � Lentler's Atltlress � ' ' � � ' � - � - � p - ar6a9e Disposal � ' � . OWNER�BUII.DER OECLARATION � � ' � - : . LevetOlies ' ' � ' ' � - ` , � 1 ' I hereEy'affirm that I am exempCfrom the�Contractor's Ucense I..aw for tha , � � � enerator. DO-5 KW �5-15 KW . • . . tollowin9 reason-(Sactian' 7031.5 Business antl Professlonal�Cotle: Any dty or P-Trap � _ •. �� i �. � - � � county w�ich �aqulr05 d OG/Tit't0 cOnitruGt, alt!/ ImOrove; Oemolish or repalr ' - , . - - �` ,,, TrenSforT2r ❑75-50 KW � d any struttura' Drbr to Its9ssuance, also requires tRa applicant.for such Oarmit ROOf Drems - - • ', .. , � � �• to file a slgneG itatament that he/s�e Is 11<ensetl purivant [o the provislons oi - � -�5U+KW r � � � Contractor'i lJcense Law (Chaptar 9 (commencing with Sectlon 7000) ot � ,. � � - . � � ' '� ' ' � � ;., � Reinspec[ion Fee . §75 y*^y,lon'3 of Ibe Business antl Pro(essions Cotle) or thaP ha/zhe-ls axampt ' Shawe�s ^ - � _ .. � Reinspectiun,Fee ` �i$15�- . � , n��from anG the basls fo� the allegetl axemptlon. Any violatlon uf•Sectlon ' ' . ' ' , - M¢tEr up.to 100amp5 �Issua Fea, � ''$ 3 '�'y� 5 by, aoy applieant for :a � Parmit �subjects �the ,applicant to a. clvil � � , �; ,.. - - _ _- analty of not moro than flve huntlraG tlollars (5500). i � ' .� S¢rvic2 Sink . , 1 laue Fee � t � -- �. '$ 3 oning'APProred BY . Dats .� I, as�owner at the'proDarty or my�bmployeez witn wa9es�as tneir sole • � MECHANICAL .(' ��r' � � �� t ' ' ' � tompensatlon wlll Oo t�e work, antl lhe ztructure I5 not intentletl ar oTferetl . r � Appl�cdtion ApO�oved By '^at0 � - /or sale•(Se<lion 7044', Businass'antl Professional Cotle: The Contractor's ' . ;t � /J -n � �� �1 License Lsw tloes not avVb co an owner ot a proparty vTo builtls or Improves Boiier ' ' � � i Refrigeretion System : N �- ppp�itltion ISSUBd By ��� • at9 � � tnereon,�antl wno Aoes zuch wark hlmself/�ersalf or through his or har own � � ' d— ' emD�oyees. Provitletl that such-Improvements are�not Intentletl or o�tered for � f 0�100,OOOBTLL.0100,0006LU . - - � - . , ' : sale. If, howaver, tha bulltling or Improvement ls soltl within one year of com- Duct - Under Ground � ; � • '� t�' ' SUMMARV OF FEES ' ! ' � - pleUon, t�e owner'will have the burtlen of proving �e/she tlitl not bW Itl or im- • � � . : . ' � D � r veforthepurposeoT,sale)'. � � � , -� , • ; , � Duct-Structurel � i SyStemRepeir/Alteration � '!BUILDING,PERMIT $'��� : SMIP , ; $ � � !�I, as owne� of tha property, am nzclusivery contracting�.withjlicensetl con-� � � � � � - - �S ' ^ ' , Vactorsto.constructthe'project (Sectlon7044,BusinessandProtasslonsCode:..• . Duct-Ventilating. , _..� ' .-. ._,... . '1' �=, �PLANCHECK� $���=/x--' ' PERMIT � ' � � � The Contra<tor's �Icense Law does not apply to an owner of property who . - "' �^�� � . IS$UANCE , '$� . builtls or Imoroves thereon, antl who contracis tor such pro)etts with a con- Exhaust System ❑ Multiple O . , { '� _ PLUMBING .,� $� � Q. Irac[or(5) Ilcense pursuant to the Conlractor'S Licenia law). ' ". � . � - + , �.PLAN CHECK� $ GRADING � $ , 0 � am exempt untler Settion , B. d P. C. tor this reaion Fi�epl�FaCt. BIt. IC80 9IE ' � . , , T— $ - ' ' ' ' ' ' � - - � ELECTRICAL $ � . I ' Date � ' Owner � � �� ' - � - Heating�System & Ducting ' � �-� t . � t , y � MICROFILM $ Y �I -heraby certHy -IY�ave reatl [his app-'catlon antl state'ttiat [he abova' ' ❑6100,000'BTU �100,000B , - '- - �' � ^ � i PLAN CHECK , $ � ( t � � In(ormatlon is < roc � a9roa to comply th all city ana county ortlinances � - � . ' ` � � Y, ' �'MECHANICAL $ � ; TOTAL�FEE� . $ ; dntl stat0 law eldtlO t0 Euiltl C � [iOn, dOA �eroby authO�iZ9 �epra- ' � ' ' , . sentatives of .tnls cl � to an r ab va-mentlonea pro erty for Hood or Type I ❑� ! ! i Reinspection Fea. ` $75� '� $; ' ' . LESS � � I - •PLAN HECK� � � Insoectlon ou es ' / , Ddt�� � �e�a T - e II ❑� • : _` r ^- . : ' c CED.PC � $ � i Signature Registers ; ; . � laue Fee � ���' i S 3 ^ ,/ V T ,�/ vE�j � � Drivers' LI< se or'S5 � i ti %�/ !�/e�rF.�i/, �/V6 !� FEE' $ � CMF 0865-46 rav. 12/82 W a- Bu1lAing; �anary - Appllcant;�Pink - Ac<ountin9: Goltlanrotl - ASse5lor � � - � \ — ;TRUCTION�AND PL'ANNING. ' . . , . . ,- •' : `: � ' - ' -' - -- . �: ��� - .;- � _ , c . _ P.00/ PA � • -ROVALS - Perinif#� � 'Dater=:lnspectoi �-<APpROVALSc..Permit#' DLte��� �Inspector ' e: � (emporary Electrical Service or Bole � _ :i ° '_ E'� � _'52� Pool &'Eguipment Location' � � ' � u � � ` '' ;., �� ��� � I � E - i,' f. ' - _ - - � i 4 ' ��'. -.. �� � �', . ;rr. _,� -., . - - . . - , . Soil Pipe-Undrgmd_ . _ • - . . �, '�53� Steel Feinforcement' - ' � ' . . . i' �' ' 3. Electrical Conduit Utilitv-Undrgrnd � - �, �54. Forms ".� ' - _. � - � : Electrical Conduit-Undrgrnd� `= . � ; '•� .` � �'55:- Electrical:.Bondin � '- � � ' � • ' � � � i � "A 9 ^>" - , ` 5;.Steel �Rei,nforcenient � � ^ `' � ' :�� � `_ !bl;��;_ ` 6. Rough Plumbing,& Pressure�Test • 6: �Electrical UFER'Grnd. ' � ° ". � � ' � . � ° 57.'APPROVAL�TO COVER=GUNITE' - i - �i � � i , -- - 7. Fo`otings, � • � . �'� ' � �%� _ ' = , :,58� Electrical�.C,onduit-Undrarod: � i' n�m � 8. Fountlation � � � '� �, � "� � �'� p � : • � : ��59. Gas Pipe, � Undrgrnd., Test ° - _ � � 9. Water Pipe-Undrgrnd. . ' � �' ' � � ��60. Backwash' Lines, P-Trap, O Und�grnd. , .` �� ` 10. Struaural Floor System -� ; � � . �61. APP,ROVAL'TO DECK � • 11. Property Sewer Line & House Connection, � , v=- - ! �'" � � � � '" _ - � ~ i ". - � . , � ; � 62. Backwash'&tRecepior-Fival� . . '�..r.� i . 12. Sewer Cap � ' , � ' � I , � � � � � '`63. Weater & Vent-Final � � � • : � : �j : 13. Roof Drains � � `; � � "!�� �'64. Plumbing�System'- Final ` - . -f Y� • � :`• � : 14. Rough,Plumbing � ' . ' ' � �,� ' -. � �•65. Elec'trical-Final' �- � �� � - �'�� .G ` 15. Rou h'Electrical-ConduiT ' " -- � �'!- r- � ' • - - + - . - . ' 9 I � � � _ � :�� �� - !�' 66:� Solar SYstem=Final�, . _ -?- -`r -� � w � F r i' ` 16:,RoughElec[ricWiring� ' �� �'� �. -�-��j'- ','-{-.'�67. Fencing&�AccessAppioval `�-_ "� ' - - -"' 1Z. •Rough�Wiring Sign,? �, �� I ' , ; �' - � � ; � = ' ;: I - � ' � � 68., APPROV�ED FOR PLASTERING � ' ��18.�RoughElecirical-T'BaqCeilingj � ' � !�:� � �.� ;.I .,69.�POOL/SP.ASYSTEMSFINAL � � � ' '�^:- r' . � 19..Rough Heating &'Air Conditioning �� �. �,� ; I j ' � � � � � FIRE DEPT. REQUIREMENT: - � ` � �"�` 20. Rough Factory Fireplace ; � 1 � I ( pppRO,UALS Permit # ._ , � 21. Ducts,��in�St�ucture�; ' � � . ' i ' i � � . � J � . l � 70.� Urideiground Hydro . � _. �12.�Ducts, Ven{ila;ing r ' : � � �� ' � ' ' i 1 � , i 71.� Product Piping O Gas OOiI � - ' � r . 23: Gas Pipe-Rough ffi Test = � � �,,� ;r� � , : � � �- _� ,;�� • T72.� Underground Flush - _ -- - � - - ' - . ----- 24. �Roof Framing= • , � :`� � ,� ' •: { ,� - � , 73'; Uridergrnd. Storage Tank O�Gas rO Oif ' , � t ; ' �- � � . .. . � _ ; . , 25. Roof Sheathin ' � " ' , _ 9 . i ;p- { �� � � f� i � 74. Overfiead HYdro . � , � o � � i � F�;, ;. - � �.., � � , - - � �-� � � ' i� ,26. ff-Bar Ceiling (Structurall. & Monocoat- � �,: y � r'{ � � ' 95.i Dry Chemical � ; - - � . 27.'Frame and Flashing i : � � �: � � I � � � ^ 76.; Dry Standpipe ' -• � � � ' 28,! Lathing & Sidi�ng' ' �� � i i, �� I r i . � 77.� FIXED SYSTEM'FINAL �; � _ " 29. ,Insulation �; � � ' 1 :I ?j � I � � � ( I (78.� FIRE PREV. FINAL � . � � � , � ��30. Drywall Nailin9 - . . � ri � � � ; � 1 i � �Notes:� : . , ' �, 16- Az o- nJ� � � 31. Plaster Brown Coat �' , ; ' � �� ; -- � -� - , � - � -- �- j- �- - i --- - - � -- - - � CI , � , . ; 32. Electrical Power Meier-Final � 1� ' � { ; i ��/ � p- .{, - ��i ' � I I �� !�2' Y, � ,(�e P/4/h'ih - 33. Final Electric ' � ' ' . � . i! � � ' . t , ,i : � cW.� �� . �. . .oa. ' � � �i B q.:.C,/ � �... 34. Final Heating &�Air Co�nditioning � , � j. .�� y ' �' ' � • t , - � C � • �t7:\ � fE" . � A�-- � n'. ,g 35. Final Gas Pipe?Test; �- � � � ? � :' i �. ; �_ ,- �.r �� ' : s. , , i , � c ,, -- . ; ` . s i` � 36. Hood or Cano{�Y: ,: � � � i : � � _ ' � � - • c • a, �- - �. . � i � 37. Final Factory �ireplace._ . i., ; ' � � I '' ! � .�a' � - " �S _$ . _ i c t� 38. Final Plumbing �� � i ' � 2 �y, � � - �. ", i 39. Water Service-Final � ' ' ' � ; � ! � � ' • .I.. �--r ` i � 1 I �. 40. Gas Service-Final : � � � � � i � � � � � `� :.' ; I ;i 41. Solar pomesticFinal' ��. .. . r. - -ti - - - ; . ' . '. . . . 42. Backflow•Preventer, � , . - � � 1 • � � + : � � . . . �, _ r - 43. Backflow•Irrigation, % � . „_ � ` � ' I _ ' � i ` . - � � �:�=i� � i 44. Landscape Irrigation System �� �,-� � `' ' � - . � � , t: 45. Sound,A�ftenuation �:"(�T�;r�, � i ,'� I .� � � � - � ; � � . ' - - - . .. , r 46. Handicap Regulations �; :`� i �, . - ' ' ' � ' ' , � - � _ - - ��i.' � 1 :, , 47. FINALSTRUCTURE & BUILDING �; � ,Zg'gi�I� ; �. ,�� , , I � ' • �� 48. Special Requirements Completed� � . ' � � ' � I � ' � I ; , ; '- ' .� � ; � � 49. ElectricRelesseto Edison� ! � �. _.__ _ J_� � __,__.,_ _� ,: �� ' � ' , �--:. i � . � . � _ � . 50. Gas Release to� Southern Califomia Gas Co � � � , � ; � � j I � . •��� „ � + 51. CERTIFICATE OF OCCUPANCi ,� - .-, - ' "' � _r .! , .' . ,• � , No ' ' � Date . - � � � ' ' COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIi �..,. o.... ��..., ....� �.. �.���.......� ...,�.,., �......, RECEIVED Y PERMIT - 52 For Applican[ [o Fdl in Completely — Use [nk Only N° "�515 3 6�� BUILDING I A.P. NO. — ""� ADORES � BUILDING OWNER OR ADDRE55 TENANT MAILING O SPACENO. ADDRESS TR.NO. OT — BLK. TEL. CITV NO. E ADD ALTER REPAIR MOVING DEMOLISH CANSTRUCTION LENDER � BRANCH ' OWNER /µ C, (�C/D ' /k[,• ADDRESS USE �/�L' �� / VALUE$ j ^ // ARCHITECT EL. LUb OR ENGINEEF V � I��� P y ADORES �J 20NE TYPE GROUP APPROVED CONTRACTOR E GI�T�S BV DATE � Np y ADDRESS Q � p TEI. CITV C� p N0.3 - / APPROVED SETBACKS LIrC N0.38Z(�S� LICVNO�� i SIZE NO.OF BLOGS. (FROM C/LSTREET) OF LOT NOW ON LOT RONT T. USE OF EXISfING BLDG. /� Separa[e permits are required for �, si Fr. electric, plumbing and heating work. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION l O L DATE APPROVED i .-L („ —, a�R � I hareby acknowledga that I heva read this eppllcation enC stete . °i n that the ebove Information Is correct and eprea to comply with � ell laws raguletlnB builtling conatruction, antl I shell not employ � any permn in vlolaSion of the workman's compensation lawe of m the Stace of Celifornla. m I hereby certify that I em proparly Ilcansetl es e eontrecior under ��'6'e. FT. '� N che State of California Buziness entl Professlons Code, Dlvision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and thet such lieenses ere in full force end effect, or I THE PURP06E OF ESTABLISHING A PERMIT FEE ONLV: e am ezampt from the provislons of the Stete of Celifornia Bualne6s � VAI.UATION PERMIT FEE § antl Protesslons Cotla, Division 3, Chapter 9. �n �� m /1/ �[ I PLAN CHECK 5 °' sienature ot 'Jf1G (/ �`� S ��• � ' %' LL Permittee /t -�/''0 � � 1 �, TAX S f Authorizetl Agent Date 3� S� �� TOTAL PAID 5 V °PLICATION FOR A BUILDING PEF �'T BUILDING PERMIT NO. Eiect.iwi Tra<t � 027 Block lot Permit No. Builtlin9 PlumDin9 . Aatlress �/ � '7 � Permit No. Cross FA�R6'IevV '� I � Mecnaniwl ' Area Street c Permit No. 0„,110f r TyPoof Pro)ech ❑ Nnw ❑ Alter ❑ Atleitlon AOtlreu U 1"� ❑ Re air ❑ Convert ❑ Domo ❑ Occupanty Pml. LJ GI�Y � ZIO z660°"°"° A•P• SuP.Dist./ Insp. Aroa Des q'nart/y AN �—JL �L Licansa No. Za o Spl. Pmt. No. AtlUreSs 2z Z Q O 'r O ��� " `�t tki P/L Front C/LSt. Stree[ WIE[h ar La l 9 ear ���y � ZI Vhona ve o. e 9 .. « En9lneor Licanse No. C r ng paces e u re rov e ovare g AtltlIe55 . � m CI[ ZiP Phone Struct No.o! No.o/ y Haight Stories Family Y LICENSED CONTRACTOR'S DECLARATION Paik Fees ve Fee � ReqWretl N C.T. Receipl m I haraby affirm that I am licensad untlar provisions ot Chepter 9 Y (commencing with Secilon 7000 of Division 3 of tha Businau antl Zo���9 APGrovatl Dale Profossions Cotle, antl my li<enae ie in tull forca end ). � Licen,e Clas License NumOar > Dnte ��3��g� ContractoTA�PE� 'r .�.s�uf�'T�5 Mlsc. - E Atldrassic9�n �'/RAGE f'/� �ZlL� ProposeGUse LL ct�� ana zio �5'� /2�� y7676 PhonaJl_i��6 0/ Structure � CONSTRUCTION LENDING AGENCV d I hareby nftirm thai there is a conshuciion landing ogency for the a parformanco of che work for which this permi[ is issuatl ISac. 3097, Occ. Type Cotle ' Civ. CJ. Clais Con Vear y Londar's Nama USE/OCCUPANCV SIZE SU. FT. � LonEer's Atltlress J OWNER-BUIIDER DECLARATION x I hereby eifirm that I am exampt trom ihe Contractor's Li�eme Law �� 1O for tha tollowing reason: � ❑ I, as Owner of [ho proparty, or my employeas with wa8ea as thair 2. sola componsetion, will do tha work, antl the anucture is not w intontletl or offeretl for sale. 3 � ❑ I, oa ownar of tha property, am oxclusivoly contracting wi[h Ilcensatl cOntrectorsto construct tha projaci. �'u., � I am oxomo� under Sec. , B&PC for thia roason 4� d a Dot Ownar E WORKERS' COMPENSATION DECLARATION Total Valuation � I horoby effbm thet I hava x certificate ot mnsent to mH.insuro, Encroachmant Pormit Requlretl Vcs ❑ No O/ a cOrtHicete ot Workeri Comp�nmtion Insuranca, or a cortiflod c �aPV ���ereo�. y GraCing Pmt. Gra ng 8 Poljpy No W� 77Z3�F'Co3�mpany ��C C� Requlretl ❑ Ves ❑ NO Pm . No. 'a LYCorHtlotl copy is hareby turnlshetl. ROuqh Gratlinq G ❑ Certitiotl copy ia liletl with Or�a g�e C�o�u/nty, E(N� qpp�p�etl by: Ddte a Doto 3•S�•8/ APPlicnnt ��+'"��' � d CER7IFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This faction neotl not De completetl if permit is tor §100 ar less). 1 certify tha[ In [ha parformanco 07 [he work for whic� t�is pormit ia Iss�atl, I shell nOt amploy any permn in eny rtanner so as t0 becOme sub�ac�c to�ih�a�f rkeri Companj� xi�on La� s of California. PERMIT Dotn�! ApPlicont /�!/✓��✓�� NOTICE TO APPLICANT: If, attar making this Cerrilita[a ot Structural b Plan Chetk 5 Examptlon, you should beeomo subjeci to the Workeri Compensation provlaions ot tha Labor CoEe, you must forthwith comply with such ElettriWl § SPeclal s provlsiOna ot thb parmit shell be tleemetl ravokotl. Invasl. I CERTIFV TNAT I HAVE READ THIS APPLICATION AND STATE THAT TME ABOVE INFORMATION IS CORRECT. I AGREE TO P�umbin9 S ' COMPLY WITH ALL COUNTV ORDINANCES AND STATE LAWS RELATINGTOBUILDINGCONSTRUCTION,ANDHEREBVAUTH- Macnaniwl S ORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ABOVE MENTIONED PROPERTV FOR INSPECTION PUR- p�e-Gratle P�E' t �^�r` 3—�''0/ InsPectlon S v[rw[l � Pre-Gratle Permit SiBnetura of Ap ment . ABen[ � Print Applicant's/Age Ys Name All s aces within this box must be completed to rocess Pian Issuance P P Chetk By: ApproveG: m n m a a i `�ll