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Home My WebLink About1502 ORANGE AVE - Building Permits CITY OF COSTA MESA "r-- ' s' BUILDING DIVISION ; 1. F.i :.�I� 77 FAIR DRIVE.COSTA MESA,CA 92626 (714)754-5273 • Fax(714)754-4856 • www.ci.wsta-mesa.q.us �.4 FOR INSPECTIONS CALL: (714)754-5626 •e.no PERMIT NUMBER B07-00911 PERMIT TYPE B_ROOF2 STATUS: ISSUED . DATE ISSUED: 08127/2007 .. ISSUED BY: RMD JOB ADDRESS: 1502 ORANGE AV CM Suite/Unit;-" ,i--,-, - Vicinity: DUPLEX AND GARAGE ROOF Const Type:' . 77.. 1. • SQ. FT: 3200 ,-" Valuation: $0. 0 , .. SCOPE OF WORK: TEAR OFF(E)ROOF MATERIALS, INSTALL 1 LAYER OF-15#.FELT ON 04:12.0R GREATER PITCHED ROOF AND REROOF WITH 30 YEAR GAF SHINGLES ON A DUPLEX AND . .- ;We. 4 ATTACHED GARAGE,APPROX 32 SQUARES. REPAIR AND REPLACE SHEATHING AS;NEEDED. �•',yp,�� - I,`u'N.§ LiE x.• *.��i: 'bA,.";d ' '!!g' t+ OWNER: SZE, PEARL Address: :---fia =briFir0.BOX-2561",Unit: PHONE: City/State Zip:�`r<,.' 5-1`•a.: " ;NEWPORT BEACH,'CA";',''51. • APPLICANT: SKIRZYNSKI,JOHN / IUs' '}4f r 'Li.:rig.:-.....Addressiti, 10782 S MEADS AV Unit: PHONE: 714.7714 48 -r. y. 1r : •...City/State/zZip:, ; ORANGE, CA ' CONTRACTOR SHAT ROOFING! • . / r License No, 571575 Address: 10782 MEADS AVUnd- "PHONE: 714-771-0111k i;'17.• n City/State: - •. ORANGE CA ..,,,:f..,.,ZipCode: 92869 .-+.: . �, irar-ZCELL: �� P ( ° -.t ARCHITECT: ` \'vj, CA. - I License No.' h'-- i PHONE: •ENGINEER:;' ` ' License Not I - PHONE: t 4t- . :ti. �i{' r '.. }' { •o'� • /. - . ... ! ' LAY•; • FEE SUMMARY----; , -- , : -:.y Reroof.Plan Check: • - / -- '$0.00; _' -) Reroof Permit Fee: ' ' : '$181:25. ,r" Y Reinspeclion Fee: $0.00�"— TOTAL FEES: • ; $181.25 y • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No. 92-28, §1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. POQE L--IWSPECNOM t1'PE pLIE--- ---_, musts Eau 1818' Fixed System Final Fire Prevention 4.: - .\ 208 Final Mechanical . 1268 Pool Spa Final' �1-� /-- , 208 - Final Plumbing, ' .200 - r Final Re-Roof` 1.. : t �I—y y — G . 210_: Fnal Electricals " 201 i Final Block/Retaining Wall ; . • • 212 - . Final Fire Prevention 202 5 Final Factory Fire Place - ' 1 17 ' • 220 Final Planning Approval 203. , Final Sign j = ` 222 : Final Site - 204 Final Demolition'. - - - 250, Final Building/Occupancy f WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive. ase. 0 Yes 0 No I hereby affirm under penalty of perjury one of the fc .ig declarations: Drivers License No. Expires: ❑ t have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and wit maintain workers'compensation insurance,as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffdding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp firs seem need not be completer rhe perm is valued at one hundred dolars(5100)a ressl 2,Aril Sec.341,Title 8,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in•the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California. and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Dale the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: gpdiranrs Signature Da1B HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No Lic.# Class# (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which al any one time has on hand a quantity of acutely Contractor's Signature Dale hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct. auo tm�n.,e, do ngsh. or repair any stn,rmro pn�. to its any , n.rod;nn cent..!dict.:,!. nYet: n xu. issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential buildingits. License Law(Chapter 9(commencing with Section 7000)of Division 3 of the perm ) Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Ouality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes',attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. t agree to comply with all state taws and city ordinances regarding Hazardous Materials and Emissions. ❑ I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penally of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature of Legal Owner(s) Date Signature Date ]e9-<6110]) Andlpr Aumonzed Applicant Date • �� l AAy • . t d I \ .. yoT: . (5. 1_141 -\ 1' l'tZo • aa„..,‘"pl e: 1 i �--) ! k "_ � fri to } l i � �3 J y 3 9 per_ __z� I . , nu . ibi I y STRUIjORAI APPROVAL ONLY. i i ' Cr of Co. Testi Buildi:. Det !—'—"�~ I F s , BY r._ . oATE.. ... _IC. 41A- -i--- SEPARATE QG c a F t r I �I S - FOR ELECTRiCAI, P'_UPfl81NG, J THE PL NS MUST BETON JOB T LL TI ES �'� �� HEATING, UEP1T''LATING AND ` 1 JJ MAKE '-1° CHANGES ITHOUT P• .: - f -�. ., REFRIGERATIOM WORK OF DEPT. I .... �_ - i. I „,,(( F •'L THE I OWE DR OR^?TC1C ' A P 11T OR ""RDVAL ° • �_.� �� i OF PLANS to 0 SPECIFICATlt'IS SHALL NOT BE CO�LSTRUED F� �i. U r TO BE A PtRMIT FOR, OR AN APPROVAL OF, ANY VIOLATION • Pw Oa4 IjPANY i OF ANY OF;THE PROVISIO�(S OF THIS LODE. ND PERMIT PRE- I I i THIS s.0 .l3"R • BONING TO GIVE AUTHORITi TO VIOLATE OR CANCEL THE ALL INSPEC110 1 4.-Q I i,.., 1 PROVISIONSI OF THIS CODE SHALL BE VALID, EXCEPT IN SO _ - , -ice”""" G' CL--- I FAR AS THEORK OR USE WINCH IT AUTHORIZES IS LAWFUL. _ _ _ -- _t-_— _ _ . . < - :'S ARE TO LlE ISSUANCE F A PEYMT BASED UPON I ' FI L ""•�'��- • thU4fF O.g'�D -' `g _ Si THAT THE SPEgPIeAT O c:.1 :?E BUILDING OFFICIAL I HUNG THE COOF ERRORS FROM PREVENTING .7 tND�$T,Ir. £T' 6 1 • ` »INU•>' ++c="7NS BEING CARRIED ON THEREUNDER WHEN I ---"'� C' CAC: AOOITiONAL REOUIREMENT� , L. ( .INlWl4UlLOP1 CODE QR OF-ANY-EITH-ER-ORD(A7gr 1— OF THE 1KTY: / �,, . i . 9-7L- 471/ /30 /iz,‘ E 7529/1. — (% /4) C—as 1;1 c rIt f -4x/2--- f `` ��4cec t/6 E2�� 4_._L______/ �f // it E,Cat 2/D6F �� SQx2 F06. ILe..4A;uo. lad - tis VWIVCR DISCATZri) nicDAtwU H. L/AIC `J-•LL-I`t JOB ADDRESS 1502 Orange Ave. BUILDING PERMIT NO. 38977 Gr--ORAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORKLega_Lize Storage ]slag. A. .117-141-01 LOT TRACT FIRE ZONE VALUE 31300.00 INSPECTIONS Signature Dote TYPE V GROUP J ZONE SOIL SUBCONTRACTOR GAS Date PERMITS ISSI Number I ISSUED Signature WATER Plumbing�dLL t ROUGH PLUMBING (Ci-ee /Ii Lief - �'//7*'/ 64P- PROP. SWR.PROP. SWR. LINE El HOUSE CON. fl SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING • TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER [� ROUGH WIRING Heating and Vent. TRENCHES I] FORMS STEEL REINF. LI FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN IIS OUT • P1. R, BROWN COAT - STh,._(URAL. FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL ,4i'7111.)Aeai ,_ 9-1/- 7 77.77✓ PLUMBING, FINAL AND GAS TEST n f S *.2r ELECTRIC, FINAL Are - • BUILDING, FINAL /I I 9-,27-74t aa- w 8 77ID SFP 11-7LIEii OO 498* ****20.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • A P CATION FOR BUILDING PERMIT For Applicant to Fill in Completely R V DAT E V D DATE IS UED BUILDING tOa /�^_�1Ce ^VC B DR NS lV,//�f 2 /! ys �"] 1 OWNER X%%ne ,47 &J et—c /C:_, _ A.P.NO.I I l —l 41�-/O'�sl�,N,r Ole C/�•• BMAIL V/// ..'6 77 a& /-- ADIDRIESS �(.s-'� L�1Cf/[.(JC ' G ADDRESS -7 •J ��• ryoC . W W 1 /' n /� /- TEL '/ Nw RtgCT ESS. I LOT I3, BLOCK 0 () CITY//Ewf9V tf dc4 62. ;i_ NO.(4C/6-/J"/T CONSTRUCTION NEW ADD ALTER I REPAIR r MOVINfi DFMOI ISH Z H- LENDER o-BD ><� Jy BRANCH r/J �/ J N OWNER5/6/71,4721) 4. (c_s.UE'Zc W ADDRESS m J ��/yyy///ff� �j/ � p^ VALUE „ a. y J QARCHITECT TEL. ^rl'(�6 $ OR ENGINEER NO. Z a FIRE W a ADDRESS � ZONE Ulf GROOjjjUP �yW ZCONTRACTOR t.._ "'�� BYPROVED % (' �� ' CO z BY T E //USPE�TE//0/e[ !ettle t_. J a ADDRESS ' W TEL. ZON r7 NO.OF /n USE OF NEW sty,,' O t CITY NO. t PLANS c-� BUILDING ibka), C Z 1„ ��(?. WO STATE CITY YARDS APPROVED YARDS APPROVED to CC LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING D O (FROM C/L STREET) SIZE INO.OF BLOCS. I FT. OF LOT NOW ON LOT FRONT FT. USE OF ...C v 6 r ' EXISTING BLDG. e 6 C R.SIDE FT .2FT. `1 , 1- SIZE OF Z NEW BLDG. 20 X f7"t4 ROOMS / STORIES ( L.SIDE FT. G FT.4 Q EXTERIORWALLSLOGIC ROOF .aspeftrI� _V COVERING (o,,c#CIe COVERING /20eal"C _REAR FT. L1.FT. J .UtSTE OF BUILDING AND WORK T9 BE PERFORMEP DISTANCE BET. BET.MAIN& n'O. lel SI RAJ EXt s}l s v.t.sa Si_ , MAIN BLOCS. ACCESS BLDGS. Q ((JJ �” i {G C.U.VAR.* DATE a g,LAI PR,co(L 4-, C( I l S w W F.�lj.{7M•�C.U.P.# APPROVED r \ APPROVED �,p(o,� Q to �// ' y'';.:. I I J rBY UT'Hy DATE 1-11 2 VV p -TG a r: • I hereby acknowledge that I have read this application and state 'i Dthat the above information Is correct and agree to comply with CC all laws regulating building construction, and I shall not employ 113( I— any person in violation of the workman's compensation laws of N the State of California. -�.\ to ? I hereby certify that I am properly licensed as a contractor under �3 Cl SO. FT. O the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR b• Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: I[ am exempt from the provisions of the State of California Business VALUATION A-(r and Professions Code,Division ,Cha 9. J �`_' N /�� y� PERMIT FEE $ (/ Signature of ` _d"O J� m Permittee . $/3107 / 10 7 PLAN CHECK $ E Authorised Agent u NsTOTAL FEE $ a CITY OF COSTA MESA N° 295 PARK FEES Fee Payment Receipt Project Address /529)2 04-e2-7(-7 (21i-e ' tS Park Area 3 A. P. No. / Liz-AO // / �7— 0 Building Permit No. 4"Y 6 S Owner's Name Re/+4-, 1-1-054,11 ,, 1 _ `7� / Mailing Address / 0 CO CL.:4 V�ti J€ ,, 4V&ip orL c= Gh FEE Single Family • No. of Units @ $455.20 = Multiple Family ** No. of Units I @ $321.32 = • Total Fee 3'2/•.3 Planning Department Approval D to O� By .)� r 6 Applicant's Signature L. ' • City Ordinance 7244 •* City Ordinance 72-45 "•* City Resolution 74-324 n I�'}i �� White-Planning;Canary-Planning;Pink-Finance;Goldenrod-Applicant CMF 0174-2610' J YIN ?1r -- 2--CM393 v* t 15.(�igg -77Piu COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only n RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING jjyeitipso. 7 .//J:))4ADDRESS / / y /,�[.�.1�r-f/�// / • PERMIT NO. OWNER /+ A.P. NO. ,,�J ��/ —ADIL BUILDING (� /� G L% � �IJ ADDRESS ADDRESS/ Q.f'vL i't � TEL. TRACT LOT BLOCK CITY NO. CONSTRUCTION NEW ADD ALTER i REPAIR I MOVING DFMOLISH LENDER III BRANCH ' / //� OWNER-1 / , . / ADDRESS !r11 y ARCHITECT TEL. USE / /'N/'Ia �i/y 5'Vi S� OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP 4611/1,66,---ai BYPROVED CONTRACTOR AP DATE ADDRESS ZONE INO.OF USE OF NEW TEL. PLANS BUILDING CITY NO. F. STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE I NO.OF BLDGS. (FROM C/1.STREET) 4 OF LOT NOW ON LOT FRONT FT. FT. USE OF cif EXISTING BLDG. B.SIDE FT. FT. con FSeparate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. W REAR FT. FT. F. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& QMAIN BLOCS. ACCESS. BLOCS. . �` / l/ titJi VAR.2/4 C.U.P.$ DATE APPROVED Q 7 APPROVED ,7. _eY ATE ..1 aI hereby acknowledge that I have read this application and state N C4 that the above Information is correct and agree to comply with m 4 all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation lows of !..1 [zl the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. H the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business / /67:7---n' p VALUATION PERMIT FEE $ and Professions Code, Division 3,Chapter 9. / m PLAN CHECK $ 0 Signature of jf o Permittee SA TAX $ lz2 lz Art/ U Authorized Agent TOTAL PAID $ //J //�`J • .r 44055M4Y31-77PAieO01439k ****59.3? 59.3? COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Appl'eant to Fill in mpletely— Use nk Only' RECC��1. D B V DATE RECE��'yyy�EE ppp BUILDING j/A(./ `):y / DATE ISSUED ADDRESS// -/J ,{/ (/J/ /� J`f- /� // OWNER /f e f { " ! 0 S {/ 4 L A.P.NO./I�I/I O/ PE i �� OWNER, BUILDING + t MAIL ADDRESS �, t - ' I ' • ADDRESS �/ , i fl i! S sty=�rt�� / // ...;_-....4.7< �L .r1 �; �j CITY idem__ / n it !P CC/&NO. 5 7 'V RACT y / /s BLOCK CONSTRUCTION .t/O ,I¢_ NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER �V '4 . /� BRANCH � Keir goSneLe. OWNER ADDRESS Q�� VALUE ARCHITECT 777777� // TEL /"�/��USE s • $ OR ENGINEER ((1 G� H'O rNO.�I V' .1 IRE ADDRESS d Q W d' re / ZONEATYPE GROUP CONTRACTOR (J Cu h e \ Hu It j_ BVPROV ED DATE ADDRESS ZO�yg CT INO.OF� VSE OF NEW TEL. /L/ pIp,NS BUILDING CITY(-I STATE // NO. YARDS APPROVED LIC. NO. �/�/,7 �7 Y LIC. NO. YARDS MAIN BUILDINGD ACCESSORY BUILDING W SIZE ��t✓JJJ ��fyINO.OF BLDGS (FROM CSyF,YEET) G. OF LOT NOW ON LOT FRONT /C/'y/ter T. FT. ti EXISTING BLDG. R—b e t-4 c R.SIDE (] /(SFT./ FT. cn // Cd FSeparate permits are required for L.SIDE /(rf. // ��GyCET. electric,plumbing and heating work. . // (/ CI _REAR (9 FT. /� `,t�� FT. E,. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. �B� ET.MAIN& <Q MAIN BLDGS. ACCESS BLDGS. Q VAR.# DATE 1 0 ..Z. -r � teZ / " tEN C.U.P.41' (� APPROVED 1 APPROVE• I °r — ,v i __ �_._ Samoan • '' • ' 'ECTAL RE•UIR i/ 0 I hereby acknowledge that I have read this application and state n cg that the above Information is correct and agree to comply with n. O. all laws regulating building construction, and I shall not employ �'7/O co Z any person In violation of the workman's compensation laws of `� g C3 IMthe State of California. m 0 I hereby certify that I em properly licensed as a contractor under SQ. FT. N I • the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and affect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the pr visions of the State of C Iifornle Business a '1/4..... VALUATION PERMIT FEE $ and Professions e, vision 3, h to y- m PLAN CHECK $ h ^r {� Signature of / ./ c Permittee 0.e..-7c.-LJ� ` $ f40MOMO TAX S 6j,Qr-Uk0 Authorized Agent TOTAL PAID $ 0• 3.Z