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Home My WebLink About177 17th St - Building Permits"• • ��vuntta�n cucna a ' ' JOB ADDRESS 177 East 17th Street BUILDING PERMIT N0. 42300 AP No. _pg —12 LOT TRACT fIRE ZONE VALUE 1' �ECTIONS Si naiure Dote TYPE GROU c�s SUBCONTRACTOR W �TER Dl.....l.i.... UNDERGROUNO I� POWER BON� BEPM � I STEEL R SHEATMING FR4ME AND Fl.qSHING .� PL�STER. BROWN CORT Hr P, BWL�ING. FIN4L 10B ADDRESS 177-C E. 17th Street BUILDING AP No. u' I.''�;'`:�iECT10� s.�`-.�,;._ GAS W ATER ROUGH PLUMB PROP. SWR. L SPRINKLING 5 MISCELlANEO ROUGH HEqTIN TEMPORAflY S UNOERGROUND ROUGH WIRING TRENCHES FLOOR SYSTE! BONO BEAM [ SHEATHING FORMS I I STEEL REINF. FflqME AN� FLASHING LATHING - IN rJ PLASTER, BPOWN COA STP�MTURAL, FINAL HI G. VENT., REFI PL�..�BING, FINAL ANC ELECTRIC, FINAL BUILOING. FINAL SUBCONTRACTOR OWNER JOB A[ GENER p" vo. YI. EC SOIL PROP. SWA. LINE I J HOUSE CON�� SPRINKLING SYSTEM MISCEL�ANCOUS AOUGN HE�TING �ND 41R CONOITIONING TEMPOP�AY SERVICE OR POLE UNDERGROIlNO � POWER � ROUGM W�AING TRENCMES FOAM$ STEEL Rf FLOOR S�S1EM BONO BE�M �'� STEEL REINFORCE I SNEATN�NG FRnME �NO FLqSMING PL�STER. BFOwN CC ST �OR�L, FIN1L Ml .G. VENT., RE PLUMBING. FIN4L �I EIECTR�C. FINnL ci�ii �i.�r. ci..n� DATE BUIL[ SUBCONTRACTOR a� owxEx x DATE JOB ADDRESS 1%7 E. 17th StrEet BUILDING PERMIT N0. l)$1 q . GENERALCONTRACTOA Aarkrar Sros_ Nenn VALUE S CM_l1f1 AP. N0. � � �-0Hl —hK LOT THACT FIRE ZONE D IN"�ECTIONS DATE I GROUP 1 rground Soil U.G. Wa[er v.__________, ,.__ ---I SUBCONTRACTOR occurnrrcY I I��'��o/��.�/��.d3 /� ��c� Form 410—SM-11-59 S-B P • � , lI}819 CRAMGR, W.C. I�"'�ECTIONS l ceround Si LOT THACT I DATE ocournxcY L�r � r_ Form 210—SM-11-59 SB P VALUE SUBCONTRACTOR I PERMITSISSUED � AY R owner DATE 2-13-62 VALUE No7.17-Otl1-4S LOT TRACT FIRE ZONG DESCRIPTION OP WORK ?ECTIONS � Signature DAT� GROUP j�'Q TYPE jij $� �l 7.ONE ��'�� SUBCONTRACTOR , : pLR� r C O11IIrt OtvNER FIRE HOUSE TAP ➢EER JOB ADDRESS 17% E. 1'].tYl St, GENERAL CONTRACTOR The M� AP No.117-081—�15 LOT TRACT FIRE ZONE ?�CTIONS ' � Signature � DATE GROUP Soil Gas Frame OCCUPANCY DATE 3-15-%2 6UILDING PEAMIT NO. VALUE $ 350.00 D�scacnTiox oF woRxElec,Facia Sig� TYPE �T 7.ONE C_2 SUBCONTRACTOR OWNER LLOYD�S CLEANERS DATE $_p�jl JOB ADDRESS 177 F.n�+ 1741� At.raat. BUILDING PER2NIT NO. GENERAL CONTRACTOR pdvanced �:lectric & N20n VALUE $ 300.0� Ap No. 117-OS1-�i5 LOT TRACT FIRE ZONE DESCRIPTION OF �NORK Elec.wall 1. .'ECTIONS Signnture DAT13 GROUP TYPE 7,ONF. �� 5�� PERMiTS ISSUGI: naa I I SUBCONI'RACTOR ,,...,., ...,.,.,.. OCCUPANCY lINM GIII .5M _ � ! / /V 7"��2. lO� �E�"�o I77i �lC . - J i9 r�'I �S f�f��2PER. �' � 7 7 t", �, : T.� sl: C'os A��, _SiS� I�� ,, ;� � /...I [d I.__ �1// �,%//s �i�✓.7� CE�/i.�lGr �� I�oo�R � 0 7° dy� _ _ � Q" _ Aa �o --- �I,-- -_-tlJ.-- -- - -�—� 1�- - - - - - � �� _` � s.. t� S�r ��y �JA �/ 0 � ----- ---. � ._- - -0— --- ' - - 4 � -_ _- - -J _ ; �TRUCTURqL -APp �� SEPqRqrE ROVaL QNL ?ERMITS-pRE �8 -�-------FOR ELfCTQICq� REQUIRED _ HEATIN�,-yErt�i�- PLUM�ING, p REFRIGERATION r�NG AND --- --- - --- ----- ..__ WORH .. . . O,_. __ P��r��sdQ � --t'Nr�,.�� -,#� Q- __-. _ ALL INSR(6�IOicp� ��{ �ANY QJ�STS - FD'��kti"- • - - - -- - O BE EM "" � ,._ ^ ��oR � . _. R,�_ a�' y�.v� Beo'fH � °f� pao! TAa/a� �r�i;� srare Q�rtt,' ��'[ SJ,�� TO MAKE FNO PCHANMu-L� �N JOB A�li MES --��i7S]"j�'. --� ' y�' ..�y- T11E� GES WI7HOUi PRIOR � ADDITI Ni �,..r, .�� : SivN �F , . OF DEPT. APPROV.4� ONAL f,�� 1, �. S�(�p FOR � iHE ISSUANCE OR 6- --_ 'J � � Of PLqyS AND GP.ANTING OF A PERMIT OR APPROVAL TO BE q p SNECIeiCATIOqS SHALL NOT BE.CONSTRUED ��` OF qNY OfERMI pROVISIONS rOFATHRS CODEFNON ERM�ITAp EN G ` SUMING tt1 CIVE Al17HORIiY TO V101qTE OR �qIVCEL iHE � O � OF iN1S CODE SHqI� gE y '---- � -p a O O O O O Fart�0O1 � i� �--- — �_'__ ��QK OR USE WHICH Ii AU�ry0R11ES.,�gP�pW�L � SPECIFICqiION�S SHALL Npi PRfVFNTB ryE BUI DINP �- FROM 7t([REq�7ER REQUIRING 7HE CORRECiION �NS qND SAID PIqNS AND SPECIfICqiIONS C O�CIAL �� pERAT10NS BEINC CARRIED OR FROM p F ERR(IRS ��U1A110N OfV THEREUNREVENtING fHE CITy, OF iHIS CODE OR Of pryy �� WH� . OTM� QR01Nnun� � �� 'Doe �F'�/�►��: � ' . . . � ��' ��''�2� � ��'_ CbSYA tdESA BUILbING-SAFETY DEPARTMENT J � P. O. BOX 917 COBTA MEBA. CALIPORNIA For Applicanf fo Fjll In Comple�ely TYpE OR�PRINT COSTA MESA. CALIFORNIA � MAIL GC�.,�..a, 1��-fpQ-�,C. APPLICATION FOR PERM;T BUILDING � For Off7ee Use Only RBCE�PT NO. PR�MIT NO. / COSTA MESA. CALIFORNIA ADDRESS C ZONING 20NE/'� O. OF U86 OP N6W CITY �/� PLANB � au�LnlNa � STATE TEL. J �HawL LIC. NO. O� � NO. {/ DHeCR�rT10N L � SIZE NO. OP BtDG9. c. OF LOT S Q O I Now oN �oi �— q, p, NO. E D '— � U6E OF YARDB EVES EXISTING BLOG. APPROVED ALLOWED BCiBACK LINB PROM �t (C8NT8R YN6 9T.1 ceNTER OP eTNeET 4 � REAR YARD FRONT T. SIDE YARD ILEFT O RIGHT J' R.SIDE �FT. DESCRIPiION OF WORK �/ IBBU=ILDING �y ��o. oF OOMS EXTERIOR WALL , . I ROOF 1 HERBBY AGKNOWiEDGE THAT 1 X/�YE RBAO TX18 APPLIGTION ANO BTATE THAT TXE ABOVB IB CORRlCT AND AGR88 TO COM- PLY WITH ALL CITY ORDINANCe9 AND 8TAT6 L�WB q80ULhT1 O OUILDINO CONBTFWCTION. 81GNATURB OF � PERMI77E AUTHORIZED AGENT i THE AMOUNT BXOWN UNDBR VALUATION IB POR TX! PUflP098 Op H9TABL19HIN0 A PCRMIT PCE ONLY. VALUATION .�( -� I PERMIT FEE g OL $ D / PLAN CHEGK $ TOTAL FEE S �-� . ' `_c:�'iA--•�—y�`=.,.a� « . .: . �. ��o .; � FE� R�C�IV�D ��° / DEC 14196U� ;�75rA MESA BUILDING-SAFETY DEPARTMENT /y1-y�','� J'� � A P pp�� :��...P..O..BOX+91S COBTAMEBA:GCIFORNIAyd`��•.a;p1(' I ✓'a,l.�:`+4' n.x��I��tl�� Il Y U 1�'% CIfi1�� @� 8@9fiA �!€�A For Applicant fo Fil( In Completely �� APPLICATION FOR PERMI TYPE OR PRINT BUILDING DDRE'SS ! 7 � E . I / � S�'F.. � E Y . � . . . .. . . . L . COSTA MESA CALIFORNIA For Office Use Only , �j � ��ItEC61PT NO. P6PMIT NO. WNER. � q!'��.Ft�. • •• �1CHA� �ES�� p.A . . _.. . /.3J: �°�% oo�aEss � �L` "CAM�rNQ• � '"' ' . REC61 D�BY ` � R6CHIV G.J ' DATE IBEU[D/ 3' � �:� .�-/��`1 ��3-c TEL �' �1 BUILDING . . . '-_ � � � � � ITY � E([L ILL � NO��' SISZ ADDRE6S • . : . - . .. _ . _.. RCHITEGT (� •' TE�. �7 COSTA MESA. CALIFORNIA - VGINEER / , f7� NSWGLr NO., I1.�-I�JG � DDRESS I �.�"1.�L ALLNi%:l':. , fAAiNA' . P�RE .. • � ' '' 1=—�.r �+�n �9�// /ZONE "' ' "/�TYPE,�' { ,GR�O7UP'� / oNrnerrno �C1ti�.n.�l� �L1r:Fla'/�n.� .Rxn�%/i.['�. APPROVED-••.��i^�"61�.__..(—��// �lel-n� �'a / r� 98TqACK LINH FPOM ��yr. cwuree ..v n.e�v� �/ O' ��v tl ot�8��y� I NO. OF ewas. DESCRIPTION OF WORK �� 1 II ALTERATION � II ADDITIO X //b e°: I HBREBY AGKNOWL8DG8 THAT 1 HAV6 R6�D THIB APPLJCATION ANO BTATE THAT THE A90VE 19 COpp6CT ANO AGRl6 TO COM- PI,V WITH ALL CITY�Q INANC€ 8 AND 8TAT6 UW8 Ii46UUTIN6 BUIL�INO CONBTfjllGTjqN.`� /��f - � �/ � �� L � � �'��%� �AUTHORIZED AGEN7 �('�y �Jj� �� I ' ":�LVIVIPIV . t �— — ZONl��I NO. OF� I U9¢ OF NCW vI.�NB � CUILD�NO LeGAL ,> � ,�Z .L o fi � D88CRIPTION . e.,,, �l r"1 _ � a� /.. cl S� (CENT[P LIN! 9TJ 0 � � PUPP09E OP CBT�GLI6HIN6 • vERMIT FEE ONLY. VALUATION �q}� /y � � PHpM1T FEE 3 "'�- /' � �� 75 � 9 0� S J PL4N CHEGK $ �. rnr.. rvv a b i ��% t . ;f r�F# ��y wa .._ ��`}t.�.�.�::,i� ...�..�ri . : • ':,. �.:. . . � � -:' , ... r . '�`�:�:��! „�,}jttl3�i�la?'w tiqsi.h.e� s:7�rpt:�� b�� r �� r.^} �' 7� � �n.e�+.i:�:...�y� =ts'�,� hi."-.�i;! 'j:,, ";f�4 . _ HQCD�FOR.SPECIAL REQU7REMENTS Condition of approval: - b•7i� ' (1) That the analysis submitted by the Architect, Robert H. Ainsworth, dated Septamber 19, 1960, which.shows a ratio of 3 sq. Yt. of �parking to. 1 sq. ft. oY building, including the proposed new construct-, ion, and Plot Plsn (Exhib3t "A"), dated September 19, 1960 be made a part of this application. - -- ' (2) That the appl3cant underetands that this reco�endation�Yor approvai,is based upon a continued three to one ratioyi��of park.� to building,and that ar�y_additional proposed construction shall and mu'st be approved by the Coeta Mesa Planning C�ission and the Costa Mesa City Council. . . . : . .. .. _.. � _ " . ; r{ . . _ \ � , • . \ .. . :.._ .. . - - � ! �_ . .. •.. - :' ' a . ,'a ' � '' ; . •t\1 . . . �.• ._._. � i �.' : � �'� �. '.� ; ?fou %ff. 31T -kSl " �i^� �, �nlifarnia_; a � �� 44�[�4 r. � , _� g Q�� _ ( a� i � -' . C'1 ..�..°-._�,..^F.f'_ � �� •� ,. �Date_ . r ��:;1 ��h � QF COSTA lYIEBA �'`��'[:E .�'F' � �=Q ��1.\`� )�f (�'�, �� C�^• p��l �� y i Y �? � ' ./ �"� ,f . u¢ ( ? � a; ' �. �_ �� ,�'�� Yr�;��o _ _ . �r � �w�v t "�"""—og-�^-�=s�"!p "' �,• n Electrical Permit No Plumbing Permit No u� or s�a� /_ � , ,--- r�, tir vi -R „ , L ., . ,� � TL�e bailding Iceated at / i 7 !� 1"� T �� Y (' c Y.a A/I F t A Legal DescripNon (See reverse side for Metes and Bouads) `'s been inspected and found to comply with the provisions of all City of Costa Mesa Ordin- :es applicable ihereto for a Group ��.Y,�_p�cupancy. ISSUID TO: (,yty Bullding Of�cla/l� �.7. � Y c �'[l4ticc (�'� Ar�� '�� .y��.!'�.-� � ' (Owner of Boilding) g ///�� CC: ❑ Origival—Owaer ❑ lst copy—Gas Co. ❑ 2nd�rnpy(�Fdison Co. �3r�d copy—F51e Form 208 SB P 1M I-BO �� . � s �_t��/'J G`OSTA'MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MHBA. GLIPORNIA For Applicanf io Fill In Complefely TYPE OR PRINT BUILDING /�j C � ADDRES9 / / / COSTA MESA. CALIFORNIA 5Zo -QT Iv�4:3&=�.�. LESSEr ■ 912E � BBTBACK LIN6 lROM TEL.� --- NO. � TEL. -� NO. ...�� F -E R�c�iv�o � FEB 131962 �� fINANCE DEPT. APPLICATIOINYFOR PEIFM�IT"E� BUILDING For Offiee Use Only R8C81M NO. PBRMIT NO. ,� � _ l7 � MESA. CALIFORNIA Y , ,—y / ZONE�J � NO. OP Q I U8H OP NEW�%!Jv{f • / �� PLANB BUILDINO ��%� NO. K /l/✓ /� D66CRIPTION � � � , � I No. aP BLDOB. / � O�/� � Now oN LOT q, p, NO. � YARDS EVES �( APPROVED ALLOWEO E/` (c�NiBR LINC BT.) L/U/ � REAR YARO � ur DESCRIPTION OF WORK ■ BUILDING NO. OF 1 XBPEBY ACKNOWLBDOE TXAT 1 HAV6 RH�D TH18 MPLIGTION AND BTATE THAT TH6 ABOVE IB 40PNECT AND AOqEB TO COM- PLY WITH ALL CITY OfiDINANCE6 AND BTARiI.�WB Ii80ULATINO BUILDINO CO TtUGT10N. SIGNATURE O� ' x PERMITTE '� � �'�� AUTHORIZED AGENT n TH6 AMOUM SHOWN UNOER VALUATION 18 FOR TX¢ PUIiP09H OP EBT/�BLI9HIN0 A PHNMIT F66 ONLY. VALUATION � � �PERMIi FEE $ � $� OD� P�AN CHECK $ � � TOTAL FEE S /� ' Pa:L' . . ' - 38204 ��,R ze-��«,s-oa,o,o:r �u��z3.oc .COSTA MESA BUILDING-SAFETY DEPARTMENT .� P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 PP ICATION FOR BUILDING PERMIT For Applicant to Fill in Completely qE eiv V DATE RECEIVED 1 DATE ISSUED BUILDING "7 � � i� � ADDFESS J 'p OWNER �"�\P^ /'1R '\ A.P.NO.'` — � PE I BUILDING �+� � MAIL � ADDRE55 1� �„ �� \ � AODRE55 �1 `� j.� ��.(' p aU CITV v QS'L� NOL ��+AC'h�� '� �OTv BLOCK Z " Z Q CANSTRUCTION W ADD A P a m LENDER I �' ` � � ,J � BRANCH J N OWNER — � AD�RESS VALUE ARCHITECT p — TEL. S O �WLO .$ J a OR ENGINEER � � l N y FIRE //� W Q ADDRESS ( ZONE / TVPE � GROUP I_ Z J O CONTRACTOR CU � � UI '• /� ByPRO E DATE �i'p' m Z J ¢ ADDRESS w w ' TEL. Z�NE NO.OF USE OF NEW EjCT£�j:A Z� CITY NO. GZ- P�� BUILDING �A � w � STATE CITV VARDS APPROVED VARDS APPROVED y� LIC. NO. LIC. NO. MAIN BUILDING ACCESSOFY BUILDING �� SI2E NO.OF BLDGS. (FROM C/L STREET) OF LOT � NOW ON LOT I FROM FT. FT. USE OF EXI5TING BLOG. SI FT H SI2E OF NO. OF Z NEWBLDG. ROOMS STORIES ' L.SIDE FT. U EMERIOR WAL�^ ROOF ' COVERING \ O COVERING S �� REAfl FT. FT. USE OF BUIIDING AND WORK TO BE PERFO EO DISTANCE BET. OET. MAIN & MAIN BLDGi. AOC6S. BLDGS. 4 —_ � /� ' VAR.� DATE O C l� A�P. C.U.P. � APPROVED � APPROVEDn. \ � �2 � �! t/" /T z 0 VI �ereby acknowledBe that I have reatl this aOPlication antl state �'j1PSE � that t�e ebove information is correct antl agree to comply with � all lews repule[ing buildin8 �onsiruction, and i shall not employ F any person in violation of the workman's compensetion laws of the Stata of Californie. m ��[ b Z I hereby c¢rtity that I am properly licensed as a contractor untler SQ. FT. T�"'� o tha Stete of Celifornia B�siness antl Protessions Cotle, Divisicn 3, THE AMOUNT SMOWN UNDER VALUATION IS FOR � Chapter 9, antl Me� such licanses are in full torca antl etfect, ar I THE PURPpSE OF ESTABLISMING A PERMIT FEE ONLV: m em ex¢mpt irom the provisions ot t�e Steie of Califomia Bvsin¢ss � antl P�ofessions Cnue, Division 3, Chapte 9. V ALUATI ON PERMIT FEE $ � � � J SlBnature oi 1 � !�� u Permlttae $ P�.qN CHECK $ — E Authotized AB �t f ��i(iL� � TOTAL FEE S �� o . � 3836 FOSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626 For Applicant to Fill in Complefely BUILDING r ADDRESS _ 1 � i OWNER � s ADDFESS �(,..' � N �✓ �/ Il � CITV �O C � ��Q NOLSYS%%O I BRANCH AODRESS ARCHITECT TEL. CONTRACTOR pk��vcK'- KU//'aCI� ADDFESS ��,0 �/V`'fJ�f�� Y CITV ( � S-, /M �i"/�''3'A' NOL�J¢g�` STATE CITV LIC. NO. LIC. NO. SIZE NO.OF BL�GS. OF LOT I NOW ON LOT VSE OF ExISTING BLOG. S12E OF NO. oF NEWBLDG. ROOMS STORIE: EMERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PEFFOFMED A.P. NO. BUILOING 1 ADDRESS ! FIRE ZONE APPROVED, \ PAiU ,�qY-9-7�:�.�s�00 341"• ,}�'*�Z3.C� N FOR BUILDING PERMIT OATE ECEIVED DATE ISSUI 5- ^ � %-% � �O 1.... 1 � � L >��NO.OF P�� C VAfiDS APPROVEO MAIN BUILDING ROM GL STREET) � VAR. �d+ GROUP //�� DATE � � 1 � �.I USE OF NEW J� BUILDING �A �T • /7 VARDSAPPROVED DATE & I hareby ecknowledBa t�et I hava reatl Nis application antl state thet the above information is eorrect end agree to comply wit� all laws reBule[inp builtlinB construt[ion, antl I shall not employ � ' eny permn in violation of Mo workman's campensation laws of tha Stata of California. T� o� m I hereb cerNf that I em SQ. FT. o V V properly Ilc¢nsatl as a contractor untler [he Siata of Culifornio Businass entl Prof¢ssions Cotle, DlvisiGn 3, THE AMOUNT SMOWN UNDER VALUATION IS FOR ' Chaptar 9, antl that such license5 nre in (ull (orca entl atfoct, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: ¢ am exempt from tl�.a provlzions o( tha Stam ol Calilornia Business and Proleasione Cnuu, Dlvision 3, Chepter 9. VALUATION � �� m PERMIT FEE $ � SIB�nture o � ) ��(,(� �� m Pe�mitta �L�G�� /' $ /�OD P�AN CMECK $ �- E /J SO LL Au[ho 1 tl Agant — TOTAL FEE S oL � , F � W S Q ► y .'L" F C r-� � � � COSTA MESA IL�Df�IFi- � TY DEPARTMENT P.O. BOX.1200 COSTA MESA, CALIFORNIA 92626 ��. 2098 I/IB/79 2098 I'/I8/79 � �24.5o r� Aa '24.50LKT0 APPLICATIOIYF��S�'Rl}�'µU}t4A��ERiy►T �A For Applicant to Fill in Completely — Use [nk Only EC VED LyA��EIVE DATE ISSUED BUILDING � C 7 '� .ST' / / ADDRESS !— � '/ ERMIT NO. OWNER GR 7 ./TOPF9NG �. A.P.NO. I '� J MAIL ��i� �9RK BUILDING / �4 i� / ADDFESS C �.lTv � �. ADDRESS �' ��/ CITV , A � No`.� �79-93on TRACT LOT BLOCK CONSTRUCTION EW AD� Al REP M LENDER BRANCH OWNER � ADDRESS V UE p0 ARCHITECT TEL. OR ENGINEER N FIRE ,)! AD�FESS ZONE TVPE �GROUP +n� CONTRACTOR �� Qlj`. APPROVE / /y,� SO/J, �NC . B�' DATEv 6 O ADOflESS �ip 3 �� TEI.� Z� NO.OF /-� USE OF NEW � CITV G I�NF�OA I�L�-S NO. �-J, � P�� v BUILDING STATE CITV �ARDSAPPROVED VAROSAPPROVED LIC. NO. ��5$% S LIC. NO. . MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLDGS, (FROM C/LSTREET) OF l0T NOW ON LOT � FROM FT. USE OF EXISTING BLDG. C%�`^ H F- R � C NC I F. FT Separate permits are required for �, SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN 8i MAIN BIOCS. ACCESS. BLDGS. - q� VAR. � DATE .�EM�• L.pr�M�RIc�iL p�(Xp• C.U.P.� APPROVED ' ' i1PPROVED I hereby acknowlatlBe thai I heve reatl this application antl state '^ n thet the above Information is correc< anC agree to comply with m all laws re8ulatine builtlinp consttuetion, antl I shall not employ � eny perwn in violation of the workman's compensation lews of m the Staie of Californie. I hereby� cartify that I am properly Iicensatl as a contractor under SQ. FT. a the State of Californle Business antl Professions Cotla, Dlvision 3, THE AMOUNT SNOWN UNDER VALUATION IS FOR m Chapter 9, and that such Iicenses are In full torce antl effeci, or I THE PUFPOSE OF ESTABLISHING A PERMIT FEE ONIV: � am exempt from tha provislons of the Stat¢ af California Businass VALUATION PERMIT FEE S �- d entl Professions Code, Dlvisio Chapter 9. m I,\\ y� PLANCHECK b '^ Slpnature of W ��[� �% � Petmlttee $ ^ �� TAX y � LL if/ � `V Authorizad Agent � TOTAL PAI D $ r