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HomeMy WebLinkAbout1812 HUMMINGBIRD DR - Building Permits • PROJECT ADDRESS: 1812 HUMMINGBIRD DR UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 06971E OWNER'S NAME: BURGESS, NANCY LEE ADDRESS: 1812 HUMMINGBIRD DR PERMIT NO: B 069716 , PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA, CA 92626 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: OTH J ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESTH & REROOF W/COMP . SHINGLES SQ FT; 4 , 900 ADDRESS: UNIT: CLAIM VALUE : 4 , 900 . 00 CALL-VALUE: 4, 900 . 00 GROUP OCC: R-3 /M-1 PERMITTEE: COASTAL ROOFING ( 714 ) 921-9451 ADDRESS: 5354 E WESTRIDGE COMMENTS : SMOKE DETECTOR( S ) REQUIRED PER 91 UBC, REROOF 2550SF RESIDENCE ANAHEIM CA 92807 ****************************** *+Ax-Bc-*******x-Br*+F -**jr- -******************* *** LICENSED CONTRACTOR DECLARATION: I hereby aflirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R E Q U I R E M E N Tr+ v [V, 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S A:��vIOKE CITY LIC.: 004535 STATELIC.: 58752 ' /•SS: C 9 EAS 9/'A no�� ��'�(�� Date:_ _ "R • ( Signatur ',/sem 4a� MAIN BUILDING ACCESSORY RR)Ut ED WORKERS'COMPENSATION DECLARATION: thereby. •. Ihay•a -nlficate of consent to se -insure or a cenificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN Compensation Insurance.or a certified copy thereof(Sec ion 3800.Lab.C). LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN POLICY NO.: 1 2 2 20 27-9 4 EXP.DATE: 09 /01 /95 • COMPANY: STATE PARKING REQ: PROV; PARCEL: 13960119 ZNE: REF NO: Certified copy is hereby furnished. ®C Certified cop filed i• the city Bu'ding Divisio. `%tr-,•�� PLANNING NOTES> Date: AL U. / Applit. Air-errwr ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLAR' I.. (This section need not be completed if the rmit is for one hundred(8100)or less). DEVELOPMENT S E R V. I C E S REQUIREMENTS I certify that in the performance of the work for which is 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:If.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: DATE;** Iaq G( which this permit is issued(Section 3097,Civ.C). ******************************************* ******************** ] ��FF**it#** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION ; N F E E SUMMARY , STRUCTURAL SEGMENT :Y • OWNER BUILDER DECLARATION: I hereby aflirm that I 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 72 . 00 . 50 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 PLAN • SM I P/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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I, as owner of the progeny or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 72 . 50 0 . 00 . 0 .00 ; - 72 . 50 72 . 50 . 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 REVENUE DIVISION TOTALS--> COLLECTED': 72 . 50 OVER/SHORT: 00 • improvement of sae). one year of completion.the owner will have the burden of proving he/she did not build or improve • fortheBLDG PMT PLUMBING ELECTRIC MECHANIC , EIRE SMIP/TOT GRADING PLAN-CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 • 0 0 5 0 ❑ 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).Lam aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. IND IV IDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: OwnerSFR 4900 REROOF BY VALUE RESIDENTIAL NOZONE' 1 . 00 4 , 900 . 00 I do hereby cenify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I of any future building occupant wilVwill not(circle one)need to comply withebaid state codes and the requirements for a permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from • these provisions. • Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county c: cD 1� Tina T r_E T %2 rQ ordinances and state laws relating to building construction and hereby authorize re esentathres of this city toe • pon t •above-mentioned DATE: 11/01/94 TIME: 14.05 property for inspection purposes. 4#/r/ Date: ' ✓nsOr / Signature' Drivers License or Social Security x.: 1641.46 While—Building:Green—Code EnforcemenC Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POC, & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms a" 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 - 58. Electrical Conduit•Undrgrnd. ' 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, 0 Undrgrnd. r ' 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 ./ r 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. Underyrnd.Storage Tank 0 Gas ❑oll 25. Roof Sheathing 74. Overhead Hydro ' 1 i 26. T-Bar Ceiling (Structurall & Monocoat - - 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29, Insulatidn ' 78. FIRE PREY. 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 Notes": cad oa "C/c_ /feet. ekerM1.� 34. Final Heating &Air Conditioning C(/y der 35. Final Gas Pipe-Test • 36. Hood or Canopy • 37. Final Factory Fireplace /i n lel 04. Qny �to © w- 38. Final Plumbing ! Ii -/6 `v/f 39. Water Service-Final 4Gas Service-Final3/ /Q5- filer 41. Solar Domestic-Final - 42. Backflow Preventer ' 43. Backflow Irrigation • • 44. Landscape Irrigation Sxsternr. , 45. Sound Attenuation 1 t ';_l ' 46. Handicap Regulations, ' '.-,, - 47. FINAL STRUCTURPr&16 ODING 3 V 9J -,�� 48. FINAL PLANNING j i j ni i 49. Electric Release to Edison r, i t . 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF 4O4UPANCY • No. Date • • // CITY OF COSTA MESA REQUEST FOE OCCUPANCY• - TRACT NO, CO 75- DATE LOT NO, ADDRESS 7g, _� 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. ' 4 .1 The undersigned, by executing this agreement, acknowledges that the-mise-t ) 4461106'4 -advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Y.esa as having complied with the conditions of approval which were imposed by the city at the tine the final tract map vas 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 �� Purc]Saser velopan6F r authorized representative BY Lender - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE IT NO. TRACT NO. LOT NO. UNIT NO• . CITY of COSTA MESA CONSTRUCTION PERMIT A.P.# - - Zone Project Address lP/o2 f{i,�rr��ntrrgihI . Dr • - �,9 Y 7(0 t rn// 2?/0 rites eco l TYPE OF CONSTRUCTION ❑ NEW U ADD LJ ALTERATION KJ EPAIR S Main Building: Accessory Building: `Applicant's Mailing Address V q C E Front Z //11 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER. ' T 0 Owner's Name • 2trae'_�LS Phone DESCRIPTION OF WORK/USE OF BLDG, B Rear N Address n'(`-- TYPE OF •PERMIT ❑ GRADING �1FOUNDATION ❑ STRUCTURAL I C Right • N Address g. License No. � '" K G Address ❑ TENANT ❑ ELECTRICAL LQ PLUMBING ❑ MECHANICAL $ LeftR •Contractor's Name -.�� �! Phone Oy��/M//17� ❑ 'OTHER Ping. Ref.# Parking Req./Provided E o q " RP'i E '(1 PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: M Address(mailing) //1t` a Q CONST RUCTION TYPE VALUATION$ • City License No. ZONE GRADING CU.YDS. ' ACRES T LICENSED CONTRACTOR DECLARATION S. I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force„ • effect. • t ELECTRICAL FEES License I.s _ / I •ns- No. at 49 _6�I e...Q� a 7 PLUMBING FEES /Q Date / Signature Automatic Washer Transformer 0 15-50 KW ZKERS' COMPENSATION DECLARATION Construction Pole Sub. 0 50+ KW reby affirm that I have a certificate of consent to self-insure or a certificate Bar$ink Showers Or Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter Duo to 100 amps 3800, Lab. C /L /B Backflow Preventer Service Sink 1 Policy No. �gfgay'gq Company 6 Backflow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps _— \ �ertified copy is hereby furnished. - Dryers ❑Gas ❑Electric Sub Panel Cer�}fi$�c Is filed with the city B ' g Bathtubs Sewer Connection Date-(•- Applicant C..l�j�� �� - Fan EXEMPTION nFROM d WORKERS'COMPENSATION pSATiON D onLA ( Clarifiers Solar Collectors Motors❑0-1 HP ❑1'/:-8 (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A.U. less). Inc.Solar 09.15 HP 016-15+ I certify that in the performance of the work for which this permit Is Issued, FixtufeS Microwave shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Workers' Compensation Laws of California. • Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE: If,after making this declaration, you should become subject to the Outlets Range Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater - ., Garbage Disposal Standing Sections Lender's Name Lender's Address . Kitchen Sink - Water Service Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish Or repair - P-Trap Laundry Trays - 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 Roof Drains - - . '- he Contractor's License Law (Chapter 9(commencing with Section 7000)of livision 3 of the Business and Professions Code) or that ne/she is exempt Reinspection Fee , $15 Issue Fee $ 3 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 penalty of not more than five hundred dollars($500). I DEVELOPMENT SERVICES REQUIREMENTS: ❑ 1, as owner of the property or my employees with wages as their sole Reinspection Fee l $15 $ 3 Issue Fee compensation, will do the work, and the structure is not intended or offered . Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - Building Approved By Date 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 Boiler Hood or Type 0 Application Issued By Dat employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - proveforthepurposeofsale). - BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ ERMIT 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 Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ 4— s •ch.-ISSUANCE $ builds or improves thereon. and who contracts for such oroiects with a con-- • tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration - PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ ❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBO dk Fire Dampers MICROFILM $ PLAN CHECK 50% $ Date Owner Heating System& Ducting • Registers _ MECHANICAL $ TOTAL FEE $ Sgv I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTI. - - , information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for • inspection pur••ses. Q - • - Signature ..e. ..-..11. Date yes - - - _ _ _ .. a/ `` ( Reinspection Fee ' $15 Issue Fee $ 3 _ _ - Drivers' License or$5 - �T 0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING ,' PL ,& SPA, APPROVALS Permit# Date' Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 7. 53. Steel Reinforcement Electrical Conduit Utility-Undrgrnd. - 54. Forms 4'rElectrical Conduit-Undrgrnd. - -3- 55. Electrical Bonding ., 5. •Steel'Reinforcement,j, ;, 56. Rough Plumbing & Pressure Test to 6.',Electrical UF ER Grrid.; 57. APPROVAL TO COVER-GUNITE 7 Footings • -, r 58. Electrical Conduit-Undrgrnd. , S.Foundation .., 59. Gas Pipe, 0 Undrgrnd.,Test it r. 9.jWater Pipe-Undrgrnd. - n) 60. Backwash Lines, P-Trap, 0 Undrgrnd. j' 10!Str,uctural Floor System ^ i 61. APPROVAL TO DECK 11!. Property Sewer Line1& House Connection I7 .) 62. Backwash & Receptor-Final 12. Sewer' ti Cap � , , •'T. 63. Heater & Vent-Final 13./Roof Drains ri-; •', 64. Plumbing System - Final 14. Rough Plumbing= 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final �)6. Rough Electric Wiring 67. Fencing & Access Approval LI Rough Wiring Sign 68. APPROVED FOR PLASTERING C8" Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20T 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 .- r 33. Final Electric Notes: 5.7, sl t✓f%TGio/Lo- [. . Q 34. Final Heating& Air Conditioning /l./(o_gi r IEICP?260 qts pa.20.3 U(tLCO 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 . 42. Backflow Preventer 4,, 43. Backflow Irrigation '-h- FJ 44. Landscape Irrigation System , r~. 1/45 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ' • fi✓ 50. Gas Release to Southern California Gas Co `f 51. CERTIFICATE OF OCCUPANCYe,• No. Date 'L• 29994 0111-69i7,FA7000 8991 ***18935 A COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECE D B DATE RECEIVED DAM IS4UJ:Di BUILDING a6 //Cl/ br ADDRESS 1812 Hummingbird Drive PERMIT O. OWNER Jamaica Const Co A.P.NO. 000 /4 MAIL AN-BUILDING � �-' ADDRESS 2850 Mesa Verde Drive ADDRESS � . , ,f//}/It/96/+ •OS' W til O. O CITY N9. 5490395 TRACT 6757 I LOT 19 BLOCK Z Costa Mesa z Q CONSfRUCTIQ(�y ) �./tM NEW ADD ALTER REPAIR MOVINf: nFMOLISH — 0- 03Otp LENDER "'Lr/fiLC'.l/^ _"'.n'.eL".� \ / �,/�,,,,� .,�,.,y //�J�� ,, Y /may, J D BRANCH awe L CGIdAG• 111/ /OWNER l x/7,149_10 -/ ///✓V/ • �-rr� . JCO n V// mLU J ADDRESS cNtfi -Aw-s.r.-- 90a yea -CO VALUE a�J,// 11 ARCHITECT TEL. USE /VA W t[{Ct/(/ $r-.A/ 77 o- JQ OR ENGINEER Kaltenbach N . 5478046 U Q FIRE -#3 ,/ % ///1 J W Q ADDR ESS1823 E 17th . , S A ZONE LJ TYPE(/ GROUP�-i' d W APPROVED LU Jo CONTRACTOR Jamaica Const Co BY DATE m Z .J li ADDRESS 2850 Mesa Verde Drive W W ZONE INO.OF USE OF NEW S1n91 tam. Z CITY Costa Mesa NoL5490395 R-1 PLANS 2 BUILDING w/ att. gar W- O STATE CITY YARDS APPROVED YARDS APPROVED D O LIC.NO. 1 931 27 LIC.NO. MAIN BUILDING ACCESSORY BUILDING SIZE 70 x HRH 105 NO.OF SLOGS. 0 (FROM C/L5-STREET)FT. OF LOT I NOW ON LOT FRONT 0 FT. FT. USE OF EXISTING BLDG. R.SIOF ITT. .[,. FT. I— SIZE OF NO.OF �A �/'I/ `�' _o 2 NEW BLDG. 2760 sq f tRDOMS 9 STORIES 2 L.SIDE FT. V . CLALe-ter T. Q EXTERIOR WALL, A. ROOF V COVERING w /Stl1C CLOVERING wood REAR ; FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& as single family residence MAINBLDGS. ACCESS.BLDGS. < w/att garage VAR.+ DATE 0 C.U.P.# APPROVED I— APPROVED fn Plan 276 — C _BY W T TA,. DATE 4-10-69 2 a.444 0 I— C.) I hereby acknowledge that I have read this application and state O that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ F„ any person in violation of the workman's compensation laws of (n the State of California. A a t]/S d��( Awl /V7 ' ZI hereby certify that I am properly licensed as a contractor under /(O 50. FT. 0 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Z Chapter 9, and that such licenses are In full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business is VALUATION and Professions Code, Division 3,Chapter 9. /026.156 � vSQ C4aPERMIT FEE $ O Signature ] / CO Permitteedamaica Construction Company $3/1 791 PLANCHECK $ `ter O2 E Authorized Agent 75" u- � TOTAL FEE $ t'//