The URL can be used to link to this page

Home My WebLink About1006 BRIOSO DR - Building Permits City of Costa Mesa ,.- _ ' Building safety Department .. - ' CERTIFICATE OF OCCUPANCY - N9 2981 - . .`s P.O.eoz 1200 :. ' ',Costa Mesa,Californi - ,. _ The Building located-at ' nnnc ts..,:...... r.L.a-n... _..nr+r. . . ... : has,been inspected and found to comply with the provisions of,all City of Costa Mesa Ordinances applicable thereto • • "•for aGroup , L:1---", * . Occupancy. - 3l', . _ AIOr r . Use•Of Building' re,. , ,-• wria1 Ti-;rser31 Orrr4 ert-i?No • enrr .:- T.-.4-.....4r,,. A . 13-..,-.F•i..,.... • . - Legal Description a o. 4.04—Qct_:;& - ' I _ ' , __. r _•yam._n1! .,. . ,...,.r.:.(See reverse side for Metes and Bounds)""--"—"-- ' —`' `' t Building Perm it.No c1^ fe '' Electrical permit No: HQ0 nn O_nco Plumbing Permit --n No.• --' -• '' •• • ••Number of.apartmentb' :n.-1- ' "•and/or"guest rooms _n_� ISSUED`TOi� w Building Official: InITITPT la-htFaan1F' nRVFrfCIPM ?.rf !'fR1x1RA!P'Inv Vi6tor-C. Newton-Dizector Building Div riot • • Date . 77_ 1 BR1 This - Certificate of Occupancy SHALL BE posted i�a tame conspicuous place on the premises,and SHALL NOT.BE removed except by the Building Official of the City of Costa Mesa under Sec 306 le) U.B.C.- Form BU'34 Rev. 11p0 -��•. - - . - - " f� Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA P/�vpI MIT NO. • TRACT NO. LOT NO. •BLDG.NO. - CONSTRUCTION PERMIT / '' 91 t 9 • Project Address /(0(0 • D • TYPE OF CONSTRUCTION 7311 10/14/83 7.00 TI. S Owner Ey/C04 (f one 0 NEW. 0 ADD 0 ALTERATION • !`0 Address /00S - 0 REPAIR 0 CONVERSION ❑DEMOLISH Arch/Eng. License No. loo/I 0 OTHER • ZONING REGULATIONS DE RIPTION OF WORK k r V •_• ai A'P•* Address I i- - IN, I, „1 — t.`0 ��raw' ,,- ZONE PLNG. REF.if Contractor D f,�S J/ _ Phdn.'jd/Sal TYPE OF PERMI BUILDING T'p gtll wG Address �I �.s ate/ SETBACK Cit.ST. PROPERTYLINE �t=/� 0GRADING 0 FOUNDATION 0 STR CTV RAL SIDEYARD LICENSED CONTRACTOR DE LA RATION .i❑ TENANT 0 ELECTRICAL ❑PLUMBING- MECHANICA 5El p RD I hereby affirm that I am licensed under provisions of Charter 9(corn- t '` RIGHT mencing with section 7000) of Division 3 of the Business and 0 OTHER Professions Cod: an license Is In full f. ce and REAR YARD(TO P/L) /��y ,'. PROJECT DESCRIPTION License a- `l��'^'� 7 - AO oA��+n� PKG.SPACE REQ. PROVIDED Date girl.Signature .��. t 1 SQ.FT. - . WORK-RS'C•MPENSATIONDE L•R- •N OCCUPANCY—CONSTRUCTION TYPE STREET WIDTH . PARK FEES _ VALUATION ZONE ZONING APPROVED BY I DATE I hereby affirm that have a Certificate of consent to self-Insure or a i certificate of Workers' Compensation Insurance, or a cert fled copy I thereof( ..C.). /` GRADING CU.YDS. ACRES SPECIAL CONDITIONS: • Icy Nott aj"f K 1` , Company 9&C r l S ^ertified.copy Is hereby furnished. �` REMARKS: - ' • ,° yertl fled copy is filed with the city Building Division. c:iEMPTION FROM WORKERS' COMPENSATION DECLARATION (This E100)5 ctionors)need not be completed If the permit is for one hundred - • - I - . certify that in the performance of the work.for which this permit is issued, I shall not emloy any person in any manner so as to become PLUMBING PLAN CHECK - ELECTRICAL PLAN CHECK subject to the Workers'Compensation Laws of California. - UW tLllrvb (eHHAOE- Date Signature - __ BATHTUBS SHOWERS . SO.FT- GO FT NOTICE: If after making this declaration,you should become subject TOILETS URINALS ' GENERATOR 0-1 KW_1-10 KW • • to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW 50+KW ' revoked, CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0.1'HP 1-10 HP - '' I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+HP formance of the work for which this permit is Issued (Section 3097 Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lender's Name _ Lender's Address DRINKING FOUNTAINS - GAS TUBE SIGNS • OWNER BUILDER DECLARATION - ' INTERCEPTORS CLARIFIERS ' POLE LIGHTS - I hereby affirm that I am exempt from.the Contractor's License Law for the following reason (Section 7031.5 Business and Professions Code:- SWIMMING POOL P TRAP - - LLONS I NUL.I JUry - Any city or county which requires a permit to construct, alter, POLES METERED SUB improve,demolish or repair any structure, prior to its issuance,also re- WATER SERVICE • ALTERATION PANELS MAIN • SUB ' quires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE - AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Is exempt therefrom and the WATER HEATERS BTU OUTPUT i basis for the alleged exemption. Any violation of Section 7031.5 by - - 'my applicant for a permit subjects the applicant to 'a civil penalty SEWER CONNECTIONS ' not more than five hundred dollars ($500). • I, as owner of the property,or my employees with wages as their SOLAR TANK -COLLECTORS - - uIe compensation, will do the work,and the structure Is not Intended or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE �� Contractor's License Law does not apply to an owner of a property APPLICATION APPROVED BY �� DATE/ /)tom who builds or Improves thereon, and who does such work himself or ISSUE FEE through his own employees, provided that such improvements are not • Intended or offered for sale. If, however,the building or Improvement MECHANICAL PLAN CHECK . SUMMARY OF FEES is sold within one year of completion,the owner will have the burdenBUILDING of proving he did not build or improve for the purpose of sale). • HEATING SYSTEM 0-100,000 BTUPERMIT $ SMIP • $ 0 I, as owner of the property, am exclusively contracting with AND DUCTING licensed contractors to construct the project (Section 7044, Business 100,000+BTU — PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to •• ISSUANCE- $ an owner of property who builds or Improves thereon,and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from such projects with a contractor(s) licesned pursuant to SYSTEM - - GRADING $ the Contractor's License Law). 100,000+BTU .PLAN CHECK $ ❑ I am exempt under Section B.& P.C.for thisBOILERS BTU ELECTRICAL $ $ reasonPLAN CHECK $ MICROFILM $ Date Owner SYSTEM REPAIR,ALTERATION /^ TOTAL FEE$ I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ PLAN CHECK $ LESS E ordinaes AD- information is tatrela I Latin to comply with all cityerand county VANCE PC E_ ordinances nt¢s antl state law relating to construction,and hereby authors . representatives of lhi y enj);rA�up sit6eeS •Jo • property for act r es.'7•/f�/�T Q-1�i.7 7— Signature / Date J FINAL FEE $ Drivers'License or S 0 , ISSUE FEE CMF 0865-46 White-Building;Canary-Applicant:Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL&SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement • 3, Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation 50. Gas Pipe, ❑Undrgrn,Test 9. Water Pipe-Undrgrn 51. Backwash Lines,P-Trap, ❑ Undrgrn 10. Structural Floor System 52. APPROVAL TO DECK • 11. Property Sewer Line & House Connection 53. Backwash& Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55. Plumbing System -Final 14. Rough Electric-Conduit -56. Electrical-Final 15. Rough Electric-Wiring 57. Solar System-Final • 16. Rough Heating& Air Conditioning - - b8. Fencing &Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating- 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathing 22. Frame and Flashing NOTES: 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric • 29. Final Heating & Air Conditioning /-c Kr ,. 4 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final , 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation • 37. Handicap Regulations 38. FINALSTRUCTURE&BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date PROJECT/yDRESS:r' 1006 BRIOSO DR UNIT: - CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 067338 OWNER'S NAME: OLEN PROPERTIES ADDRESS: 20 CORPORATE WY PERMIT NO: B 067338 PLAN CHECK NO: N GOVT: N SUPP : N IR CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT 714 ) 728-6238 ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : T/OFF, REROOF W/BUILT-UP SQ FT: 9, 000 CLAIM VALUE: 9, 000 , 00 CALC-VALUE: 9 , 000 , 00 GROUP OCC: 8-2 / PERMITTEE: COMMERCIAL ROOF/H2O-PROOF ( 310 ) 329-7998 - ADDRESS: 13900 S BROADWAY COMMENTS : REROOF 5500SF COMMERCIAL BUILDING W/BUILT-UP LOS ANGELES CA 90061 *****+r**8F3c3F**u*TEFF+ **3F*36*****+e3F*****363x*y6*****y8*******r36*x**+e3r8F****3t***********36* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am li nsed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 70001 0l Division 3 of the Business and Professions Code,and y li ense is in full force and effect. CI LIC.: 75_ 1 STATE LIC.: 2 5 4 2 8 5 -c 9 SETBACKS ram: ' / �Lo Signature:— — MAIN BUILDING ACCESSORY BUILDING KERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN POLICY NO.: PWC210852-00 EXP.DATE: 12/01 /94 comPANy: GOLDEN EAGLE ,+ PARKING REQ; PROV; PARCEL : 00000000 ZNE: REF NO: 0 Certified copy iissThereby furnished. a certified a file twdh the city ilding Division. PLANNING NOTES S • EMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1001 or less). D E V EL O P M E N T S E R V I C E S R E Q U I R E M E N,-T S . I certify that 1n the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become -^ subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . DATE: -' Date: Signature: NOTICE:Il,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; DATE: ' Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y which this permit is issued(Section 3097.Civ.C). DATE LENDER: ************************************************************************ rt****** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 108 . 00 r` repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business :SMIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 1 . 89 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE ... I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL -e. PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'Stale License Law TOTAL S----> 109 . 89 0 . 00 0 .00 109 . 89 ' 99 . 89 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If,however the building or _ improvement is sold within oneyear of completion.the owner will have the burden of proving he/she did not build or improve t 1/h I T t 7 ,rry 1 ej uS �1 L, �, pp forthepurpose of sale). p p g p CTE UBL 6 $M'f 'PL$Mitile-ELECTRIF°ME��AAild FIAE9 '§AIPgI1T8i114/SdRTREING PLAN-CRECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 108 .00 1„'8 9 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon +" and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *.****,**.**,*,*.*.**,*,.N,*,*,**,****,**,*,*,**..k,* , ,*,*,*****,*******,N,**,******,**,******************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for reason: TYPE QTY DESCRIPTION .UNYT COST TOTAL COST Date: Owner: I do hereby cenllythat lam aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFC 9000 ALTER BY VALUE COMMERCIAL NOZONE 1 .00 9, 000 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: 0100161187-00161188 TOT 109.89 hereby certify that have read this application and stare that the abov formation is correct.I agree to comply with all city and county DATE: D5/26/94. TIME: 11:20 ordinances and state laws dating to building construction and he(Cbya horizer entatives of this city to enter upon the above-mentioned I arty or ins ection p' poses. 1,/-jtlL\`J at 9 4- Signature: ____, Driver's License on Social Security.: 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • CONSTRUCTION AND PLANNING I ' I POOL & aPA APPROVALS Permit'# Date Inspector APPROVALS Permit ;: Date Inspebtnr Pt 1. Temporary Electrical Servic or Pole ' ll___- 52. Pool & Equipment LocaCun it 2. Soil Pipe•Undrg•rd. I 53. Steal Reinforcement Electric-el Coisri-it Ut.iity•Undrgrnd 154. 'orms ____ _- - _� -� 4. Electr-ccl Ca^d. t.Utdrwrnd 55. Electrical Et-meting t 5. Steei Ri:,nfo_camcn_ 56. Rough Plumbing & Pi es,we T.st I 6. Erre:- .z' ;;rcF G i ' 57. APPROVAL TO COVFRGVI"ITO 7. Footin.'s • I 58. Electrical Condu•t•Undrgrnd. 8. Foundation . - ' -- 59. Gas Pipe, 0 Undrgrnd.,Test _L - 9. Vater Pipe-Undrgrr.d.- 60. Backwash Lincs. P-Trap, _' Uriu•g•rn r T_ 10. Structu•al Floor System ; - 61. APPROVAL TO DECK • 11. Property Sr.rPr Line & I•bJ,e Connection 62. Backwash & Receptor-Firm 12. Sewer CaP ---_ l - r 63. Heater & Vent-Final M 13. Root Drains 64. Plumbing System • Final -4 14. Roan'. Plumbing 65. ElcctricahFinal --- - - - 15 ROugl- Electnm �' Cordu�t ---�- 66. Solar SVstemFel--- ----i-- --1 '6. Rnugn 5 lectricl'firing -- -i - _-�---- I 67. Fencing & AC^.as APPru'.al I 17, Roush iMrina Sign 68. APPROVED FOR PLASTERING I- 18. Rough Electrical-7 Bar Ce'i.rg {t 69. POOL/SPA SYSTEMS FINAL I i 19. Rout :'.aat;ag & Air Cur. ltioning L FIRE DEPT. REQUIREVE'.V f 20 ?e_c- '=actory Fn.p.ace I APPROVALS Permit _ -- I - 4.--- -i 21 Ducts, Structure 70. Underground Hydro aI 71. Product Pip•ng Fi G... -ai _+. J e3. G.s ° P'-7o..gh & Test ____ 72. Underground Frisk .___ _-__. ___- 24. lac.` Frem.rgi 73. Undergrnd.Storag, lank G.14 . .07 25. Roof Serathing ---- G--(0.-a(l 104.44 74. Overhead Hydro_-_ - --- --- r -- -- _- I 2E, T-Bar Ceiling (Structural) & F'.onocoat T 75. Dry Chernir.al 27. Frame and Flashing 76, Dry Stand?rpe 1 . 28. Lath.ng& Siding 77. FIXED SYSTEM FINAL -- i 29. InsWa•,on 78. FIRE PREV. FINAI. 30. Dryv.a . %ailmg HEALTH DEPT REOUIRE7Er1T 31. P mer 8:o.on Coe'.---- ----1- --- 79. FINAL INSPECTION � --- 32 2iectr c- Pa .er .Teter Find; 31 FOOD CERTif ICr.• E. i5;oii'7 1-33. Fir; eluctric i Notes; I- 14. F--le. r,tdtirc u A'r Coro,tlon,r; _ -___ _-_- -___- __ _ _ __ - _ , 35. Fm.' Get Pipe•Te:t ----- ---- - - -' ---- - -- ---- - - - - - --- -'--- 36, riooe ur CacOPY 37. F,nai Factory Fireplace t 38. Fnal Plumbing ---__ ---- --- 39. Water. Service-Final -- -- -- ----1 40. Gas Sery ce Final -- - - - 41. Solar Co restic•Final --- 42. Backflow Preventer ---_I -_ -- _- - --- --- - y ria. Backflow Irrigation estc-c-e. 44. Lcndseaaa Irrigation System (9 -3-qt'_ w PYA- 5 a --"' _ 45. Sound Attenuation -�_- &I/1i --. 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 6-5-qty Gully- 1 48. FINAL PLANNING _ ----- -_-_ I 49. Electric Release to Edison '5C. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • , No Date - .. t • L Applicant to fill in all spaces except those within heavy border er lines and sign all appropriate declarations. ••airy Y OF COSTA MESA _ • PERMIT NO. : TRACT'NO. ' LOT NO. .TUDG.NO. •- ❑ 4-Pr:- / CONSJRIJ`ION PERMIT . - P- 9roA4 I ' Applicant's Mailing Address , - —• . • - ==� - TYPE OF CONSTRUCTION- -LI NEW L-J ADD_U ALTERATION •U REPAIR L - - Project Address 07 e. - A a1—J •• 0 CONVERSION ❑ DEMOLISH ❑ OTHER. - - ! •( ' �p�� Cr,. 'DESCRIPTION OF,WORK - - . _ Owner's Ne/me ,�}�,'�7�91/� _- ' _r'I�iohe � �j'�l�✓��/L�CJFfj 4j,4, J ' >. -/2 - • 'ZONING REGULATIONS - Addrers' I��to ` ;T'd-0 - - ' TYPE OF PE MIT 'U GRADING (J FOUNDATION STRUCTURAL + • A.P.SI. ZONE Arch/Eng.' _ ' - License No. • 0 TENANT 0 ELECTRICAL L7 PLUMBING 0 MECHANICAL PLNG. REF.!As •- - - • BUILDING - _ Address _. - - :0 OTHER - i TO BUILDING - SFTBACW co ST , 'Contractor's Name !• - ' • PROPERTY LINE . REAR YARD(TO P/U I .�de_ I• . Phoneme St . PROJECT DESCRIPTION SG:FT. IOCCUPANCV - Addresslmailing) 'J& 7..-5-. /lis/' '/• CONSTRUCTION TYPF • VALUATION$ 'LEFT SIDE YARD • RIGHT SIDE YARD -, �` ; ZONE S- GRADING CV.YDS. ACRE ' • PKG.SPACE REG. • , PROVIDED I - I.,. License No. ' ` - - I• �• - LICENSED CONTRACTOR DECLARATION er Remarks< _ STREET WIDTH , - PARK FEE-5 ' 1 • ' thereby affirm that I am-licensed under provisions of Char mmendS 'ng "' - t with section 7000) of Division 3 of the Business and Professions Code,and . ' ` •• t• I i SPECIAL CONDITIONS: . - , • my license Is In 1uJl.•lorce ; . effect. , - , Ucense Class L•-•" License No - r ` PLUMBINGI ' • Date 0" �v Signatur. . a. .rI C —ern., . , ORKERS'COMPENSATION • CLARATION - Bar Silk , _ Sewer Cap r ELECTRICAL T lereby affirm that I have a cart ficate of consent to self-insure or.a certificate_ - - - - -, Automatic Washer ., __ �- ,Meter_0over_100 ampst ! , , 4 Backflow•Preventer - - Sewer Connection— .,/ Workers` Compensation insurance,-or a certified copy thereof (Section • Construction Pole `5800, Lab. C.) : Backflow Irrigation Solar Collectors ' • - Sub Panel _ _ + —+ ' Policy No. ' ' ' • Company 1 . - _ _- _ - , 9 Certified copy Is hereby furnished. Bathtubs Solar Piping . Cooking Unit Sub Pole I , • • Certified copy is filed with the city Building Division. , Dishwasher • I i a-: 'Motors 00.1 HP 01X-8 Date Applicant - - - Clarifiers _ Solar Tank • - , 1 • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher " i Swimming Pool w/Spa ' - Dryers ❑Gas.DElectric' • and.Solar'09-15 HP 016-15+ • ' • less) ection need not be completed If the permit Is for one hundred($100)or . _ , - _ , - Iecertify that In the performance of the work for which this permit is Issued I Drinking Fountains Urinal • � , . , Fan I { `Microwave j , shall'not employ an person In an mann r so as to becomes je o the , - „ ! workers•�orr nsat oh Laws of Ca�fomi Floor Drains' Water Closet f Light1 V I • Date G� y. signature fi��/d'je4V� F NOTI E:If, this declarat n,•you should.become su act to th } 1 Floor Sinks?- --' --+• F.A.U.F A.0 -• - - . - -• 'Rainge. _! _ `._ �,.._..4 . ... .... .,. - Fixtures I /, � _ Workers' Compensation provisions' the Labor Code, you must forthwith Device Boxes , comply with such ,provisions.o this;•permit shall be•deemed' revoked Gas Service ` Outlets ._ •_Water Service ., u� Sign, ; : , CONSTRUCTION•LENDING AGENCY j - I I I Outlets ' ' ' • t hereby affirm that there is a construction lending agency.for the performance j ••• Interceptors l i - J ' 'Standing Sections 1 ' of the work for, �IFr•thl , permit As,issued ;(Section .3097, Civ. C;)! - - --- - - - _ _ __ Lander'sI Name! 00+Na e' - - • - - . . r Kitchen,Sink Switches i i Trash Compactor ,I 1 I I Lender'sAddress'. • , ' i I - l >' 1 1 1 OWNER BUILDER DECLARATION ' • ' '• . , Lavatoriesv Garbage Dis•posal I' Y `` ' 1 - - I J 1 1 I • I hereby=affirm that I am exempt from the Contractors License Caw for the • A -• _ _ _ I Generator 00.5 KW 05-15 KW ` 1 • , ' , • following reason(Section-7031.5-Business and Professional'Code: Any city or . P-Trep� ,.r,; . 1 c { rp • ' i I ` _ ' county which requires a permit,to construct;alter improve;demolish'or repair ' - r - y 1 ..-- Transformer 015-50 KW I I • 1 - I i any structure, prior to Its-Issuance, also requires the applicant for such permit • ' Roof Drains , I i . •- I ; ,to file a'signed statement that he/she is licensed pursuant to the provisions of - ' ; ' - - ' the Contractor's License Law(Chapter 9(commencing with Section 7000)of I - ♦ T .� - - ' 05U+KW• ,Reinspection Fee '� $15' + P Division•3 of the Business and Professions' Code)•or that he/she?is exempt I ` , Showers -i I - 1 Reinspection Fee ; $15 - therefrom and the'basis for the alleged exemption. Any violation`of Section • - I 1 < ) ' ” Y ' - Meter Dup to 100 amps ; l • Issue Fee, ' 1. •$ 3 '`-!17031:5 by;:any applicant for a'permit subjects•the -applicant to a-.civil ' i + ' 1 -, - 1 • •�enalty of not more than five hundred dollars($500). -: l ' I I Service Sink • 1 1 I Issue Fee• ti - $ 3 Zoning Approved By •pate i • I;'as''owner of;the'property or'my employees with wageslas their sole , - + r I 9 ' ' compensation wills do the work,and•the structure Is not intended or.offeretl I 7 j - MECHANICAL 'I ! Applimtion Approved By 'Data I , ' for sale (Section 7044, Business,and Professional Code:-The;Contractor's - - - - - - - - - - - - - - , , License Law does not apply to an owner of a property who builds or improves •• goiter -1 ! 1 ' Refrigeration System S . thereon, and who',does such'work himself/herself or through his or her own • 1 ! - Application Issued By �' -Date /0 /1A . employees, provided that such improvements are:not intended or offered for . - 00-100,000 BTU ❑100,000 BTU " SUMMARY OF FEES / sale, If, however, the building or Improvement Is sold'wlthln one year.of com- .. Dutt t Under.Ground I I • •I ,, pletion,-the owner;will have the burden of proving he/she did not build or im- ' - . • rove for the'purpose of sale). c ; ' Duct-Structural _ I System Repair/Alteration BUILDING PERMIT $ SMIP , $ • , U I,as owner of the property,am excluflvely contracting with•licensed con- - , , i I I I ; , ' . tractors to construct the project.(Section 7044,Business and Professions Code: . - Duct-Ventilating•,_-, - j._.... - _- _ _ ,.r_ •- ,• PLAN CHECK, $ PERMIT r • , The Contractor's'License Law does not apply to an owner of property who - - I p0 ISSUANCE $. builds or improves thereon,and who contracts for such projects with a con- ' Exhaust System 0 Multiple 0 -! 4 . PLUMBING • $ •r ' ', tractor(s) license pursuant to the Contractor's License Law).. 'PLAN CHECK $ I • GRADING $ 0• I am exempt under Section i - i B.& P.C.for th=is reason + " Firepl/Fact.Bit. ICBG# ' • :' • f $ Date - -' I r owner' - 1 Heating System&Ducting - I 'ELECTRICAL, $� I - PLAN CHECK $ MICROFILM i•' $ ' 1 I hereby.certify-that•I;have read-his application and state-that the above . ❑0.100,000 BTU 0100,000BR1=•.--- - Information Is correct. I agree to comp) with all city and county ordinances - I ., . ..•' I ' TOTAL FEE $ : • 'and state laws aline to building co ru ton„antl hereby authorize repro- t - MECHANICAL, $ I • sentatives of' s city to enter ••n , above-mentioned property I% Hand or Type I ❑' • I 'I , , Inspection roses. r, : /_ Canopy) Type II ❑' i Reinspection Fee' $15 'PLAN •CHECK' • $, LESS 1 $ I 1 �,. •/J��• J e� I • ADVANCED PC Signature �•/I//N'c+L' /� - Date�B / V i I I , + Driver • tensa or 55 „- FINAL FEE, $ CMF o 65-46 rev.12/82 White-Building;Canary-Applicant;Pink.-Accounting;Goldenrod-Assessor � '1CONSTRUCTIONAND,PL'AN ING , x .._ . - "'• - �-= - ': POOL&SPA - - - - i;' •� I da- . Date ;•• Inspector Date Inspector' • APPROVAS� Petmit#I ' • '; - - ' APPROVALS; '.Permit#' 'ir.Temporary,Electrieal Service or Pole • -.q ' 1 , - - -52: Pool &Equipment Location ' • • • ,et ;Soil Pipe"Undigrnd: , 7...1;-. 'I' ••• : , , , ; , 53- Steel,Reinforcement , - ` '3. E• lectrical Conduit Utility-Unargrn(1.. -:; _ t...5 ' r 54. Forms - - - -; 4'. E• lectrical Conduit"Undrgrnd'. `- - , " ; t - -55' Electrical Bonding - - •• 5, Steel Reinforcement , , ; ? ` .' A'- - °' `' j', - 56. Rough Plumbing'.&Pressure Test ' • '6: Electrical LIFER Grhd. , a ;• ri ^ -" Cr- - - 57. APPROVAL TO COVER-GUNITE _ 7. Footings ; f;• Co `, •- _ • - 58'. Electrical-Conduit"Undrer_nd- 8. Foundation v -- =59. Gas'Pipe;�0 Undrgrnd.,Test' ' 9. Water Pipe-Undrgrnd.. 1 ' i - - - - 60. backwash Lines,P-Trap;O Undrgrnd. - . • 10. Structural Floor System. ..` i, • • ric , - 61. APPROVAL TO DECK - ' • - . ' 11. Property Sewer Line & House Connection: - -62. Backwash &Receptor"Final 12. Sewer Cap - - 63. Heater&,Vent-Final - • 13. Roof Drains • , ' 't '3 . - • • .,• •64. Plumbing System -Final` 14. Rough Plumbing. ! . .• • b '' . - i 2 : . -65. Electrical-Final • - - 05:Rough-Electrical-Conduit'I. - "'- 1"i . I - --1-I---i -66:-Solar System"Finil -' ! %.16. Rough-Electric Wiring n I 1 ;o -, _ _, _ ; 67. Fencing& Access Approval _ ! 17.,Rough Wiring'Sign i 11 1• i , I r1 `,.11-5. 1.c.'', •; ;68: APPROVED FOR PLASTERING - ` 18:;Rough'Electrical,TBai' Ceiling, 1 ' I. I i 1 + '; i , 69.' POOL/SPA SYSTEMS FINAL � - - ,; 19. ;Rough Heating& Air Conditioning 1 ! ' ; I I 1 I ! , - FIRE DEPT.,REQUIREMENT - . 20. Rough Factory Fireplace_ I i, I' I i 1 APPROVALS' • Permit# - 21. Ducts;in Structure•, • . I I ( 1 I _ I ! ,70.', Underground Hydro 22. Ducts, Ventilating 1. . ; I; I ; I ; 71.1 Product Piping O Gas ❑Oil • 23. ;GasPipe-Rough& Test ' 1 1- _ r--1- ,72.' Undergrounii Flush - 24. 'Roof Framing. , I ;;"1 I I . { •,. : ' ) I • 73. Undergrnd-Storage Tank 0 Gas 0 Oil 25. Roof Sheathing ! " ; '• ;74.1 Overhead Hydro - •26. T-Bar Ceiling (Structural,& Monocoat' • z' . ' c 75 1 Dry Chemical 1 1 • x.27. :Frame and Flashing 1 ' , ; I . I 76., Dry Standpipe , - " - • 28. :L'athing & Siding i ji I I77. FIXED SYSTEMFINAL . • ! - i 29. Illnsulation : ; , ' , It 1 I 1 ' i I 178 FIRE PREY. FINAL • T I � -30- -Drywall Nailing 11 I l ' ' ; i 1 'Notes I ! . • - - , '31. .Plaster Brown Coat % T-i- 1 i _ : 1 __ -- I I ! ! . '32.{Electrical Power Meter-Final • l I I I ' 1 ! - • • r, 33. :Final Electric • ' II.' I I I _ ' i I • I v 34. Final Heating& Air Conditioning ; I I i -; I 1 , I , I I . 35. Final GasPiPe-Testkle; 1,' _i1 I•2Ia „' I - ' : 1 ? , : '- . 36. Hood or,Canopy '1 -ir ,i 'I ' i ' 1 I ,- I ` : ; i I - Is 1 - - _ - - __ ''- I 37. Final Factory Fireplace? , I '.I I - i!: ' = I 1 . 1 I I •! -i I. - ` - ' 38. Final Plumbing 1 i I ; c • I:- I I I : l 1 39. Water Sevice-Finali ( I I I II I 1 • 1 I I,.1 1 • - 40. Gas Service•Final I I I ' 11! I y i AD £]ii<1 41. Solar Domestic-Final I i, I I I -- 1 1 -4-: 42. Backflow Preventer _ I i _--4 - Ii---i ---.-- - . - - - _ - - • , , 43. Backflow Irri ation : ` ;1' I' I ` =I-`_ I ' 9 ��I ' vl l _ 1•d .I I I 44. Landscape Irrigation,System i i ht., "' , ` ' 1.: ' I , 45. Sound Attenuation ;' - ,' e I ' , ; I , „.1! - 1 I. : •-1 I - - : _ 46. Handicap Regulations 1 ' I , I` !, lir l i : . i - - , 47. FINAL STRUCTURE & BUILDING i I I� I 4 ' : I I • 48. Special Requirements Completed) •I i ; I._ `I ; . . • - - 49. Electric Relepseto Edison' 1 ! I- �-1 i I _T--F-- 1-- i - I- 44 ..t . ' • • 50. Gas Release to Southern California Gas Co ' I 1 1 - - •• ' St CERTIFICATE OFOCCUIPANCY I- ,�_•_-{-� _I _� ;_. 4�I _ ,T.I_: .. ,• No Data - ! ; ' Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. 7h/: I / , CITY OF COSTA MESA - I PERMIT NO. TRACT NO. LOT NO. BLDG.NO. - -n - -- CONSTRUCTION PERMIT E se- - 86 Project Address, /FlO(fl iStQio .o-„,2d TYPE OF CONSTRUCTION Li NEW U ADD U ALTERATION U REPAIR r ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Applicant's Mailing Address .A L.. A.P.# • Zone Owner's Name I / OR-no r'Qnvc Co. Phoue6-S7.5-0 DESCRIPTION OF WORK S Main Building: Accessory Building: Z Address 1179'9/ CoC<.t.Ht/ tavi-✓CE O TYPE OF PERMIT LI GRADING U FOUNDATION U STRUCTURAL T Front N Arch/Eng. • License No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear N Address -� �I�� ❑ OTHER ' - Contractor's Name•�. tOOVkS etcC172(L Phone i�6�ts- /aiD PROJECT DESCRIPTION SQ.FT. OCCUPANCY C Right - G Address(mailing)/2�./jt�iM� iviz.�../ N,$, !3n 721,4475 CON ST RUCTION TYPE VALUATION$ g Left R .t\ City License No. _ T=' 7 T 'o) ZONE GRADING CU.UDS. ACRES Ping. Ref.# . Park.Fees $ 0 LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided U i I hereby affirm that I am licensed under provisions of Charter 9(commencing • R with section 7000) of Division 3 of the Business and Professions Code, and • Use of Building: E '..\‘‘. my license is in full force and effect. • License Class�bb —/ Lice PLUMBING I FEES Planning Notes: M 1 Date/0 r/g-Ct Signature S. E WORKERS'COMPENSATION DECLARATION T Bar Sink Showers • T \C hereby affirm that I have a certificate of consent to self-Insure or a certificate Backflow Preventer Service Sink - S 1-Workers' Compensation Insurance, or-a certified copy thereof (Section - 3800, Lab. � Backflow Irrigation Sewer Cap - ELECTRICAL FEES ' Policy No. }SbD —S{'7, Company SI.tTL�F�.l-/7 (Certified copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50 KW Certified c p is filed with the city B i fns Division y )\,r rr• _— Clarifiers Solar Collectors - Construction Pole Sub. 0 50+KW Date/�^/�” 4 Applicant ./.... G ( , EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher Solar Piping Cookin Unit - Meter ❑u to 100 amps (This section need not be completed if the permit is for one hundred ($100)or - 9 P P less). Drinkin Fountains I certify that in the performance of the work for which this permit is Issued, I 9 Solar Tank _� Dishwasher Meter Dover 100 amps shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panes nate Signature — — i_— - . NOTICE:if,after making this declaration,you should become subject to the Floor Sinks Urinal Fan Workers' Compensation provisions of the Labor Code, you must forthwith — — - 1/ Motors 0.1 HP�1'h-8 /�- S comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. Inc.Solar 09-15 HP 016-15+ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater / Fixtures } of the work for which this permit is issued (Section 3097 Civ. C.) �Ap • ! of •Microwave is�.G Lender's Name- Kitchen Sink Water Service Device Boxes Pole Light Lender's Address ' / A OWNER BUILDER DECLARATION Lavatories - `? Outlets .v s;• q Nv Q Range 3 I hereby affirm that I am exempt from the Contractor's License Law for the - - - - - - - following reason (Section 7031.5 Business and Professional Code: Any city or P-Trap Switches ,D Sign / 7 e county which requires a permit to construct,alter,improve,demolish or repair — - . — - , --- / any structure, prior to its issuance, also requires the applicant for such permit Roof Drains Garbage Disposal Standing Sections ' to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 7000)of • Generator ❑0.5 KW ❑515 KW Trash Division 3 of the Business and Professions Code) or that he/she is exempt Compactor ,therefrom and the basis for the alleged exemption. Any violation Of Section - - 7031.5 by any applicant for a permit subjects the applicant to a civil Reinspection Fee - I $ 3 r" 6 C • Penalty of not more than five hundred dollars($500). Pe $25 Issue Fee LJ I, as owner of the property or my employees with wages as their sole -_ Reinspection Fee $25 Issue Fee • $ 3 • compensation, will do the work, and the structuabwis not intended or offered • MECHANICAL FEES for sale (Section 7044, Business and Professions Code: The Contractor's - -- - - --- --- --- - --- -- --- -- -- -- PUBLIC SERVICESREQUIREMENTS: License Law does not apply to an owner of a property who builds or Improves Boiler • Hood or Type I 0 • thereon, and who does such work himself/herself or through his or her own Zoning Approved By Date employees, provided that such Improvements are not intended or offered for - Canopy Type II ❑ • sale. If, however, the buildingor Improvement Is sold within oneyear of com- Duct-Under Ground d Application Approved By Date • platten, the owner will have the burden of proving he/she did not build Or im- ' lthe for the purpose of sale). Duct-Structural Refrigeration System Application Issued By f //1I / Data.b/t s/6� LJ I,as owner of the property,am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES The Contractor's License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ PERMIT ❑ I am exempt under Section - B.Si P.C.for this reason Firepl/Fact.sit. ICBO# PLUMBING $ ISSUANCE $ Date Owner - - Heating System& Ducting PLAN CHECK $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above - 00.100,000 BTU 0100,000 BTL q Information is correct. I agree to comply with all city and county ordinances - _ - , ELECTRICAL $ `T S e t5 GRADING $ and state laws relating to building construction,and hereby authorize repro- PLAN CHECK $ MICROFILM ' $ sentatives of this ty to ent n the above-mentioned property for Inspection pus _• MECHANICAL $ TOTAL FEE $ `S' cs ` Signature Lc-.-.. $Reinspection Fee $25 Issue Fee ' $ 3 PLAN CHECK - ' - CMF 0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - - CONSTRUCTION AND PLANNING POOL& SPA APPROVALS. Permit# -9,ano Date Inspector •APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • • 2.1 Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical-Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit,Undrgrnd. - 55. Electrical Bonding -5. Steel Reinforcement,. ( • . . i • ' 56. Rough Plumbing & Pressure Test 6'' Electrical UFER Grrid.,,7' 57. APPROVAL TO COVER-GUNITE 7. Footings y ;a 58. Electrical Conduit-Undrgrnd. 8: Foundation • i • 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd: 60. Backwash Lines,P-Trdp, l.Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK - f 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer,Cap - 63. Heater & Vent-Final 13. Roof trains 64. Plumbing System - Final 14. RoughPlumbing.'> • 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring • 67. Fencing & Access Approval - 17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough.Heating & Air Conditioning - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# ' 21. Ducts, in Structure 70. Underground Hydro •22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing • 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � /� �Lv Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing - • 39. Water Service-Final 40. Gas Service-Final • 41. Solar Domestic-Final d. - 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed • 49. Electric.Release to Edison , 50. Gas Release to Southern California Gas Co • -•6.1.. CERTIFICATE OF OCCUPANCY _ Date • 7670 2/ 17/SI 50.65 TU • COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 REC Fy4$[�./sy�� Y f ■PERMIT 5 For Applicant to Fill in Completely—Use Ink Only N° 13 7 6 BUILDING /OD/ �j—re#o/ "C // A.P.NO. 'L ADDRESS ( (0 '—r s7✓�{/ �r /// /7 /`� BUILDING/ 066 OWNER OR III ae, tjy -,, ADDRESS r//s/ AV TENANT 7r IXN�- (/r/V R # -c j, MAILING /7`� Ater-- • SPAUNIC N ADDRESS (r� ( SPACE NO. TR.NO. LOT BLK. TEL.027 27 q -CITY &ta •� /lit/ NO. rt CONSTRUCTION - NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER ////''' "jam� aye BRANCH OWNER� / 4T/ _`y • • s ADDRESS ARCHITECT TEL. USE r• ell" — VALUES Woo OR ENGINEER NO. N C ADDRESS ZONE /Y/ I TYPEjerA GROUP • 2. f APPROVED CONTRACTOR •40•41Ler BY DATE 2��7/8/ _" ADDRESS , TEL. CITY NO. F STATE CITY APPROVED SETBACKS LIC. NO. LIC.NO. _ /7 0. SIZE NO.OF BLOT (FROM C/L STREET) (J�(/_ 5 0. OF LOT NOW ON LOT RONT ��r�/ coUSE OF _ /J Al 1/. EXISTING BLDG. R SIDE co �`1 E Separate permits are required for L.SIDE c electric,plumbing and heating work: REAR FT. iW,., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTI N -C - . / DATE a (ria- �jC✓/�:��Clea� � � EU*4.4APPROVED C` ��VG.M•/ A..Vf/riif( Patti �y flOVED//.�J/' `� DATE �J / C (��77/s4J . Lil cefi.0 1 hereby acknowledge that I have read this application and state r. that the above information is correct and agree to comply with B. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of S the State of California. m 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, end that such licenses are In full ,orce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: n am exempt from the provisions of�a Snit Califor/ Business VALUATION PERMIT FEE S Q Q' and Professions de, Division 3, • Ater t['• A Signature of / •PLAN CHECK E / . 3J70o U. Permoofttee •I $ /�L Vv TAX E Os U Authorized ent Date I_ $ J I TOTAL PAID E • SO.