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HomeMy WebLinkAbout1784 ORIOLE DR - Building Permits • - CITY OF COSTA MESA BUILDING DIVISION O qr \. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER .t wrier rIWIliFi PERMIT B02-01453 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1784 ORIOLE DR Status: ISSUED Suite: Applied: 09/10/2002 Vicinity: ROOF Issued: 09/10/2002 Parcel Number: 13962222 Zoning: R1 R1 Applicant: ELIASON, DEBORAH ISSUED BY: Address: 417 ASSOCIATED RD A-225 Phone: 714-529-0440 BREA,CA Zip: 92821 Owner: O'NEILL, KATHLEEN M Address 1784 ORIOLE DR - Phone: COSTA MESA,CA Zip: 92626-4842 _ Contractor: SANTIAGO ROOFING Address: 417 ASSOCIATED RD A-225 Phone: 714-529-0440 BREA,CA Zip: 92821 License: 576276 Arch : Eng: Address: Address: . Phone: - Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING SHAKES.INSTALL OSB, 30#FELT,40 YR GAF TIMERLINE ASPHALT SHINGLES.3600 S.F. INCLUDES ATTACHED GARAGE. - • FEE SUMMARY Plan Check: $0.00 - ' _ - - Calc Valuation: •$7,000.00: Permit: $139.25 Claim Valuation: $7,000.00 SMIP Res: $0.70 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $139.95 • PLANNING &ZONING SETBACKS • MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 _ Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 , Right 0-0 PARKING Existing: 0 Required: 0 Proposed: •0 NOTES: 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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARAt/ORSF i"`, WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ,.-, work for which this permit is issued. R21I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued, ._.l My.worke4rinprsatio9josura7ce carrier and policy number aro:Cel c� rrier:� L�rL Policy Number.Oc fJ�-�2 60.3-2_2-(07 (This section need not be completed it I e permit is valued at one hundred dollars($100)or less.) f ❑ I certify that in 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 Car :- ia,/d/ree the I If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provis• - 9--/0-0 -/�^I Applicant.Slgnature: 4. _ s. _ a _ Dater / !L'~Q Z WARNING• :FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER T CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,OW),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I^ereby.affirm'lha46amtlicense�.ugder provisions of Chapter 9(commencing with Section 7000)of Division 3 of.the.Business and Professions Code,and my license is in full forceandffecLLic # J /(oa-7 (gases c-3.7 Cont•ract lr_=Sl-tura' 0,I //4 ( , \ rOa(e:--• g"10*-n L• IA CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Dale: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or 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 to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or 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 one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,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 property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire 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 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apennit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? fJ Yes LL No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of 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. n re al OwRer(s) Date (eSE) And/Or nzed., wan--r- _ rDate_-ts CODE/ INSPECTION TYPE PATE JNTRIALE OODEN INSPECTION TYPE PATE PlM111AL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 9-17-84. 44,1- 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory,Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204, Final Demolition 250 Final Building/Occupancy CI'. iF COSTA MESA REQUEST FOR OCCU1....CY TRACT NO. e5j7.7nci- DATE / n 'ch' X77 z LOT NO. j 2 ADDRESS //2'f c9ic- .= ,47/d The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he-she-400 (was ore advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. BY /4/ Pur aser BY ccoc-,0 0°. es. G -4 Developer and/or authorized /representative agaeti BY L%� fQF/��/ SY Lender . . . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF;COSTA sip/, /(���Nj(sTR CTION PERMIT PER N TRACT NO. LOT NO. UNIT NO. •Project Address/9 7 (5 1 �VL� / --ll ' - • • - Applicant'sMailin/y�A dJddrr/g55/ /533/ • tO-L/iUyyynyq0(A) TYPE OF CONSTRUCTION L NEW ❑ ADD L.ALTERATION U REPAIR ' Owner's Name _(�l//1/6/VT Phone/a2 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# - _ Zone DESCRIPTION OF WORK/USE OF BLDG. Address • S Main Building: • Accessory Building:, Z Arch/Eng: • License No. • TYPE OF PERMIT ❑ GRADI NG�y❑gOUNDATI ON ❑ STRUCTURAL T Front , _ _ 0 Address 9 ❑ TENANT ❑ ELECTRICAL L7 PLUMBING ❑ MECHANICAL B Rear N Contractor's Nam: • II; ( e Phon ❑ OTHER .. _ A . . N. C Right Address(mailing) 1/45-.3..kPR N(?OL� PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G ^� CON ST RUCTION TYPE VALUATION$ • S Left • City License No. \ +7 r ZONE GRADING CU.YDS. ACRES - ' ' E LICENSED CONTRACTOR DECLARATION /, 1�+-� /�. /1-�-.[' k s�pr[' Ping. Ref.# Parking Req./Provided I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: bt_J/ALLiO /j )4 G i? ea.TER___C Planning Notes: _ - - M • with section 7000) of Division 3 of the Business and Professions Code,and - _ T my license is in fu or nd effect. + �//s� �//� - '� S Licens- Cass -- - L e _e'NoN 2669 .. • "• • _ an N. 7 ,,, PLUMBING FEES ) \ Date ��•7• Signature . TRKERS' OMPENSATION DECLARATIONBar Sink Showers ■ • FEES :reby affirm that I have a certificate of consent to self-insure or a certificate Workers' Compensation C tioInsurance, or a etJ.Wnrl co�/ ;whereof (Section ':Backflow Preventer Service Sink ®�, Automatic INasher • Transformer 0 15-50 KW , ackflow Irrigation . 1I " :ttia 3800, Lab. C.0/1,0,4/0 Cl?V 2II sPolife No. Company copy is hereby nerwith the Y Bu/8ih ' IikuIIur 0 amps 'Date ..(.. � �5 ' �EXEMPTiOO WR dOMhp N Don(This section neetl not be comilletetl if the permit isfor one hundretl ($100) orless). • • ■ •Sub Panel I certify that in 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 • , ■ Fan 11111 Motors DO-1 Workers' Compensation Laws of California. Date Signature , Drains' ■, . NOTICE with such making thisideclaration, you t should become subject to the �, Device 1 • Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • UrinalFixtures Microwave• Gas Service Outlets Water Closet • comply with 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 which this permit is issued (Section 3097_ Clv. C.) Interceptors , VVater Heater ' (32 11, Outlets Lender's Name Range ' Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Disposal Standing Sections - following:reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair any ontr cto 's prior its issuance,walso requiresmthei applicant St for n 0 permit .11Ecxu,zaisrnar.3.'raluIaInyI • In file a signed statement that he/she is licensed pursuant to the provisions ofRoof Drains . Contractor's License Law(Chapter 9(commencing with Section 7000)of ;ion 3 of the Business and Professions Code) or that he/she is exempt afrom and the basis for the alleged exemption. Any violation of Section v1.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). $ 3 Reinspection Fee $15 Issue Fee I, as owner of the property or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law 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 DEVELOPMENT SERVICES REQUIREMENTS: • employees, provided that such improvements are not intended or offered for Hood or Type I ❑ Zoning Approved By Date sale. If, however, the building or improvement is sold within one year of corn- Canopy • Type II 0 • pterion, the owner will have the burden of proving he/she did not build or im- • Building Approved By Date 'prove for the purpose of sale). - •_ - .Z ❑ I,as owner of the property, am exclusively contracting with licensed con- • Refrigeration System -Application Issued By - Date_ tractors to construct the project (Section 7044,Business and Professions Code: - The Contractor's License Law does not apply to an owner of property who • 00-100,000 BTU 0100,000 BTU . SUMMARY OF FEES - builds or improves thereon, and who contracts for such projects with a con- . ' tractor(s) license pursuant to the Contractor's License Law). I am aware that ■Exhaust System 0 Multiple ■ System Repair/Alteration BUILDING PERMIT $ SMIP $ . proof of their Worker's Compensation insurance should be provided to me. • PLAN CHECK $ PERMIT. 0 I am exempt under Section B.& P.C.for this reason III :• IllFireDampers PLUMBING $ �J,✓" ' ISSUANCE $- • Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 1- 00.100,000 BTU 0100,000 BTL ELECTRICAL $ ' GRADING $ • information is correct. I agree to comply with all city and county ordinances and state laws relating to building.construction, and hereby authorize repre- - MICROFILM $ sentatives of� ity en r upon the above-mentioned pro err rPLAN CHECK 506 puy. / MECHANICAL $ TOTAL FEE $ `S 06'. . Signature Reinspection Fee $15 Issue Fee PLAN CHECK 25% $ - CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor 01 00018_116-00018116 TOT 5.00 n.a rr. an inn rr.o rr«:r. sn.+n CONSTRUCTION AND.PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector N _ 1. Temporary Electrical.Service or Pole - • 52. Pool & Equipment Location I 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings V) . 58. Electrical Conduit-Undrgrnd. • 8. Foundation! , 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. r 60. Backwash Lines, P-Trap,;0 Undrgrnd. 10. Structural Floor System • 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 1 • 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 1 30. Drywall Nailing HEALTH DEPT. REQUIREMENT '� 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .n, 33. Final Electric • - Notes: 34. Final Heating & Air Conditioning - - /-i 35. Final Gas Pipe-Test • ,jt 36. Hood or Canopy ;6• - 37,. Final Factory Fireplace 3B..Final Plumbing q-./...yy c, _ 1- 39: Water Service-Final • - •' 40. Gas Service-Final - - 41. Solar Domestic-Final - , • i . 42. Backflow Preventer . • 43. Backflow Irrigation Llf '44. Landscape Irrigation System • • 1, 10: 45. Sound Attenuation 46. Handicap Regulations •� . O' 47. FINAL STRUCTURE & BUILDING i - . O 48. Special Requirements Completed a -• 2- 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co - - 51. CERTIFICATE OF OCCUPANCY . No. Date L ✓ . _ _ _ _ 300 ._ . PA SEP 14-71E717500 354'+ ***159. 15 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT ,ra, For Applicant to Fill in Completely $i'P RECEIV 0 BY DEITE 'ECEIVED' [j.9"� IT VJ�p. • BUILDING ! .D .y.. - • 1 • � � WE IDtY • ADDRESS C / ., . _... - - aY� I . PER T�)• .� OWNER /V( A.P.NO. //////'�— �J MAIL N(/z �� J///�� ADIDRESS /��4Z.Ste:exzv a�• ADDRESS 6 ; O ,cA 1,14,.K.W W W / TEL. (otlU TRACT LOT.J r� BLOCK d0 CITY (:� _, xo0 NO. .2,5'13/4 ZZ Q CONSTRUCTION I NEW ADD ALTER REPAIR MOVING DFMOLLSH O co LENDER /7 YIh /-- JCA BRANCH OWNER ! �� Q((A- (. C L[� ll��G J N m J ADDRESS /�it �LUE etr . ARCHITECT /,//� TEL.p USE r $3// Lse/ J C OR ENGINES '//� /�`<3p(�Np. p�IO�`�5�S-Z - T t�-(���/® FIRE W w ADDRESS07,6- T`4 � e/LQ ly.va, ,-t C,tJlgs ZONE TYPE GROUPJ- " /J W Z / '� -VRQ _ �pL✓ 'dyh� cL� APPROVED (f mO CONTRACTOR �/tiC.f�'�r�o-'.—t- BY DATE r Z 7' / eel'f,1-!�t .c-f .71 CC ADDRESS S O AGRasi rw W W �/ ,/ ZOCi NO.OF '7 USE OF Nt`' O= CITY Nn._._p .�i NO.6310-SP33 \ Yom( PLANS P2, BUILDING ( ' Z r"'ti"�Sv• "1 O STATECITY YARDS APPROVED YARDS APPRO r ED W CC LIC.NO. j S-‘) Cif Z3 LIC. NO.p`I.O83 MAIN BUILDING _ ACCESSORY BU t DING — D O (FROM C/L$T.REET) SIZE ��- //6 �/ I NOW ON LOTS / o y� b FRONT t9 UFT. FT. • OF LOTLJ USE OF . EXISTING BLDG. - R SIDE FT. FT. I— SIZE OFc • NO.OF Z NEW BLDG. efx-//D S ROOMS �/ STORIES / L.SIDE FT. I FT. U EXTERIOR WALL,_�/ I ROOF �. p t� T COVERING `o r COVERING REAR ,y.� FT. _, FT. ` J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0- MAIN BLDGS. ACCESS. BERGS. 1 VAR.# DATE / O .i C.U.P.# p APPROVED /� /J NAPPROVED• 1 ' , _ DATE 7 n h3/ / O • 44q tl ~ I hereby acknowledge that I have read this application and state Dthat the above information is correct and agree to comply with HOLD FOR S ECIAL REQUIREMENTS cc all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of Nthe State of California. f) / m O`% 446 '9 zI hereby certify that I am properly licensed as a contractor under S' SO. FT. OS o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER V UATION IS FOR .Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0 am exempt fro the provisiothe State of California Business - 7T Cc and Professi ode, • visio'-hapten 9. VALUATION G J V of PERMIT FEE $ J OV/ D D Signature o' `/-�S� m P uthori e en �/ �� Cy PLAN CHECK $ v'•� �' E 0 111 u. Authorird •gent J /. TOTAL FEE $ / f i..— .."