HomeMy WebLinkAbout1386 GARLINGFORD ST - Building PermitsApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
CITY OF COSTA MESA CO 1STR CTO PERIVy�T
P R IT 1�0��3
TRACT NO.
LOT NO.
UNIT NO.
A P # - Zone
�y d
_Project Address b GL
4
S
Main Building: Accessory Building:
TYPE OF CONSTRUCTION LJ NEW LJ ADD K ALTERATION L1 REPAIR
El CONVERSION El DEMOLISH ❑ OTHER
DESCRIPTIONO WORK/USEOFB
p.1n.A Q L`i—/'� h l.!
Applicant's Mailing Address
Owner's Name r �J —
Phone
Address '�J
E
T
Front
Z
O
B
A
Rear
N
1
K
Right
G
Arch/Eng. License No.
Address' ,-' �u
CorrRo's Na a hone/$+�a'��
Address (mailing) 302 R! 1i%-<.otir�' ,F.%
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City License No. 9���
LICENSED CONTRACTOR DECLARATION
TYPE OF PERMIT G ADILJ R NG LJ FOUNDATION � TRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑PLUMBING iL'�I MECHANICAL
❑'OTHER
RQJECT DFySCRIPTION SO. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION $
ZONE GRADING CU. YDS. — AC ES
$
Left
R
Ping. Ref. # Parking Req./Provided
E
Planning Notes:
D
M
T
S.
Remarks: rnll
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
ELECTRICAL FEES
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full force and affect. �'/
_
C
rlI
License Class tens No.�L2�L
DatelL7-/ Signature
WORKERS' COMPENSATION DECLAR ION
hereby affirm that I have a certificate of consent to self -Insure Or a certificate
or Workers' Compensation Insurance, or a certified copy thereof (Section
Lab. C.) ✓
I No.1✓C__S -In$i. Company �• s•
Ll 96rtified copy is hereby furnished.
Cert if. i filed with th Bu D' slon�
PLUMBING
FEES
Automatic Washer Transformer ❑ 15.50 KW
Construction Pole Sub. 050+KW
Bar Sink Showers
Backflow Preventer Service Sink
Cooking Unit Meter ❑up to 100 amps
Backflow Irrigation Sewer Cap
,
Dishwasher Meter ver 100 amps
Bathtubs Sewer Connection
Dryers ❑Gas ❑Electric Sub net
Dates Applica =1 -
EXEMP ION FROM WORKERS' COMPE TION DECLARATION
(Thissection need not be completed if the permit is for one hundred ($100) or
less).
Clarifiers Solar Collectors
Fan
_ otors 130-1 HP ❑1 h - 8
Dishwasher , Solar Piping
F.A.U. Inc. Solar ❑9-15 HP El 16-15+
Drinking Fountains Solar Tank
Fixtures Microwave
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 California.
Date Signature
Floor Drains Sw' ming Pool w/Spa
Device Boxes Pole Light
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Floor Sinks rival
Outlets Range
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.)Garbage
Lender's Name
Lender's Address
Interceptors Water Heater
Disposal Standing Sections
Kitchen Sink Water Service
Generator 00-5 KW 1:15-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
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 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 Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7 5 by any applicant for a permit subjects the applicant to a civil
[ y 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 (Section 7044, Business and Professional Code: The Contractor's
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
employees, provided that such Improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of conn-
pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
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
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
proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Lavatories Auto -Wash
P—Trap Laundry Trays
Roof Drains
'
Reinspection Feer
$15 Issue Fee $ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Date
�J��
Apphpti0o Issued By L� �� � Date�z,.�a}••
Reinspection Fee $15 Issue Fee
$ 3
MECHANICAL
FEES
Boiler
Duct - Under Ground
Hood Or Type I ❑
Canopy Type I I ❑
SUMMARY 09 FEEW
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
Duct -Structural
Duct- Ventilating
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
Exhaust System ❑ Multiple ❑
System Repair/Alteration
Firepl/Fact. Bit. ICBO 4Fire
Dampers
Date Owner
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 ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter u on the above-mentioned property for
Heating System & Ducting
0-100,000 BTU ❑100,000 BTL.TOTAL
r
Registers
MECHANICAL $• 170Z 00
FEE $
PLAN CHECK 25% $
inspection purposes. 1
Signature �`�-� %��- • Datp/o i,�t�9
" --�
Drivers' License or �
Q}. 90e44?j3'0Q1iY550 707
Reinspection Fee
$15
Issue Fee
$
DATE: IW 16/85 TIME: 13756
0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor
CONSTRUCTION AND PLANNING I
APPROVALS Permit Jate
Inspector
POOL & qPA
APPROVALS Pei. #
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
4. Electrical Conduit-Undrgrnd.
t
55. Electrical Bonding
,
5. Steel Reinforcement -
56. Rough Plumbing & Pressure Test
16., Electrical LIFER Grnd.1
57. APPROVAL TO COVER-GUNITE
7. ,Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, Undrgrnd., Test
9. Water Pipe-Undrgrnd.
f
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
1.8. Rough Electric Wiring
67. Fencing g & Access Approval
'17. Rough Wiring Sign•
A
68. APPROVED FOR PLASTERING
18. Rough Electrical-T$ar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating ;j
71. ,Product Piping LJ Gas LJ Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. RoofFraming ._
73. Undergrnd. Storage Tank ❑Gas 11 Oil
25. Roof Slieathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural)& Monocoat
75. Dry Chemical
27.'Frame and Flashing
76. Dry Standpipe
28. Lathing Sing. 1W
o
77. FIXED SYSTEM FINAL
29. Insulatirn �'
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
Notes:^I
34. Final Heating & Air Conditioning
/
Geg
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
i
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
-
51. CERTIFICATE OF OCCUPANCY
No. Date
- '
70cnsa00 ?_44
CITY OF COSTA I,T1SA PLANNINa DEPARTMENT I
A. P. No. *" 141-021-03
Bldg.
Permit No. 2- 6
PARK AND RECREATIONAL FEES
- Apartment
Developments
Project Address
Fee Payment Receipt
1386 GARLINGFORD STREET
Owner's Name GERALD BAGWELL
Bachelor or 1 - Bedroom Units 1 (ONE)
2 - Bedroom Units
3 - Bedroom Units
$25.00 = 25.00
@ $40.00 =
@ $55.00 =
4 -'Bedroom Units @ $70.00 =
5 - or more Units
Total number of Dwelling Units 1 (one)
$75.00 =
Total Fee
25.00
Flaming Department Approval, Date 6 NOVEMBER 1970arkk Area NNoo. 1
By 771,,,r,..L'ys-- Applicant's Signature_e"I
CITY OF COSTA I•i:SA PLANNIh, DEPARTMENT
A. P. No. 141-021-03
Bldg. Permit No. 32642
PARK AND RECREATIONAL FEES -
NOV - vAto
6 70CHSA00 2448<'****25.
Apartment Developments
Fee Payment Receipt
Project Address 1386 GARLINGFORD STREET
Owner's Name GERALD BAGWELL
Bachelor or 1 - Bedroom Units 1 (ONE) @ $25.00 = $25.00
2 - Bedroom Units
3 - Bedroom Units
@ $40.00 =
$55.00 =
4 - Bedroom Units @ $70.00 =
5 - or more Units @ $75.00 =
Total Fee $25.00
Total number of Dwelling Units 1 (ONE)
Planning Department Approval Date 11-6-70 Park Area No. 13
By Brooks Applicant's Signature
OWNERgAGWEU Gerald DATE 11-6-70
JOB ADDRESS 13 Garlingford Street BUILDING PERMIT NO. 2
�. 141=021-03 LOT TRACT FIRE ZONE VALUE$ 5,915.00
INSPECTIONS
Signature Data
GROUPI & J TYPE
V ZONE —
SOIL
SUBCONTRACTOR
PERMITS ISSUED
GAS
Data Number Si nature
WATER
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER ❑
ROUGH WIRING
Heating and Vent.
TRENCHES A FORMS KI STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
�' .J
LATHING — IN OUTAwl
P. ER, BROWN COAT
S. .LURAL, FINAL
HEATING, VENT., REFRIG. AND A.C.. FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL ,-"f /l L'7/
BUILDING. FINAL.
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32462
NOV-6-70PAIB00 242+
cnsa
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVED BY
//�-70
DATER CEIVED
DATE ISSUED
ADDRESS 301, G,q_LiNGFord S -t,
OWNEflc-e.4 Z_0 #9 & Lf--,
A.P. NO. 14 \ "- 67-1'— '3PERMIT
NO.
AMAILDDRESS I3e' Gfi-ei ln✓ ���
BUILDING
ADDRESS I39(o 10 TI AL C9 r0 fLD ST -
. S-�GX�`
)54 NOL
CITY COSI-11 �
TRACT 4 -39.5 LOT
I6 BLOCK
CONSTRUCTION
W
ADD
ALTEB
REPAIR
LENDER
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BRANCH
OWNER �
ADDRESS
-7 1 VALUE
S V $
ARCHITECT TEL.
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OR ENGINEER
FIRE
ADDRESS
ZONE TYPE GROUP -�
SEL r
APPROVED /
/
CONTRACTOR /�
GATE
;,7
ADDRESS
ADDRESS
TEL.
ZONE
NO. OF
USE OF NEW ry.Nt �r O
CITY NO.
PLANS
BUILDING
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE//Q NO.OF BLDGS.
(FROM TREET)
OF LOT J • T NOW ON LOT
PONT FT , t-
FT.
USE OF o
D E NC F„
EXISTING BLOG.p �qS/
R.SIDET.
FT
f`
SIZE OF NO OF
I0 l
(�
NEW BLDG. ^ r ROOMS STORIES
L. SIDE FT. IL-
FT.
EXTERIOR WALL/
Srut� a
J_
ROOF wM -S/ O%'
R,
COVERING
COVERING OC
REAR ZO FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. '
BET. MAIN &
MAIN SLOGS.
ACCESS. SLOGS.
r Ly If- 4
VAR. .i'+ '
C.U.P.#
DATE
APPROVED
APPROVEDDATF
O
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and 1 shall not employ
any person in violation of the workman's compensation laws of
r > 7� Cl-
3;SO. FL -L J 2 I
the State of California.
I hereby certify that I am properly licensed as a contractor under
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the Stat, of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or 1
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
VALUATION
O-6
PERMIT FEE S r
Signature of
Permittee lILL���"'"''�✓�����, ,I
$ ..J/ /
PLAN CHECKS C� r O v
,��
Authorized Agent
�r..�
410
TOTAL FEE $ r
OWNER AAR130R-HALL OF FAME HOMES[ INC.
JOB ADDRESS 1386 uarltngford-' -
DATE DEC 1 1 1962
1o. LOT 16 TRAC'14355 FIRE ZONE DESCRIPTION OF WORK Res.w/att.Gi
INSPECTIONS
Signature
DATE
GROUPI & J TYPE ZONL 1
Soil
—L
SUBCONTRACTOR
PER LITS ISSUED
Gas
DATE
NUMBER
Water
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line ❑ House Con. St. Swr. ❑=(-
Sprinkling System
Construction Vote
Underground ❑ Power E!
Rough Wiring
i'�
1
_
42,-720
_
'Frenches Q Norms Steel em. ❑
11t1nfz9
Floor System
-;-:o? - 63
Bond Beam ❑ Steel Reinforce ❑
Sheathing
Fr-rne and Flashin
-/-i'
1 ng — In Out l8�
_
-21-6
P...ereq brown coat
-18^6�
Refrig. ❑ Air Cond. ❑ Fina
Heating, Final
_
Plumbing Fixtures, final
�3 3
8
COSTA MESA BUILPING-SAFETY DEPARTMENT Lot 16,
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
pTYPE /OR PRINT
BUILDING
ADDRESS �3 cT to C^Qr�i♦ fOv� �j�
COSTA MESA. CALIFORNIA
FEE RECEIVED
/�3 � DEC 11 1902
Tra, rIiYHIY���t'1.1-p
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
Fame Homes, Inc.
RECRIPT NO. T,
QR:iT�.Q
uu
OWNER Harbor Hall of
JJ
MAIL
RECEIVED BYI DAT! ISSUED
DATAREC81 !D
ADDRESS' P.O. BOX 2066 -
6 z� DEC 1 1 196'
CITY Santa Ana ryE0KI 9-2204
BUILDING
ADDRESS
ARCHITECT TEL.
OR ENGINEER JBmisDL1 NO. 5 44-004
COSTA MESA. CALIFORNIA
ADDRESS 225 11D1t St., Tustin
FIRE
ZONE TYPE GROUPY
CONTRACTORUfetlme Residential Bldg COry
APPROVED DATE
ADDRESS 2131 So. Artesia
ZONING
ZONE
NO. OP
Z
I
USE OF NEW i�+f A, + O
SUIWINOSTA
CITY Santa Ana -
R -I
PLANS
208676 KZ 9-2204
LEGAL L leJ—
LIC.TNO. NEO.
DEECRIPTION o�'-
SIZEM/1, NO. OF BLOTS -0
6000
OF LOT NOW ON LOT
A. P. NO.
USE OF
EXISTING BLDG None
YARDS EVES
APPROVED ALLOWED
SETBACK LINE FROM 48, ?O.4(�
ceNreR OF STREET YU REAR YARD Jl�� ]]
(CENTER LING BT.)
FRONT / e FT. IN.
SIDE YARD I LEFT 5' I RIGHT 51
R. SIDE S FT. IN.
DESCRIPTION OF WORK
L. SIDE r FT. IN.
NEW X ALTERATION ADDITION I
Joh
REAR '3✓ �� FT.
IN.
REPAIR I MOVING I DEMOLISH
APPROVED
/d/-fCe�
DATE
BUILDING NO. OF
8 1
SIZE i400, ROOMS STORIES
EXTERIORW L ROOF
Shake
COVERING ter COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Single family -residence
I HEREBY ACKNOWLEDGE AT 1 HAVE READ THIS APPLICATION
THE AMOUNT SHOWN U DER VALUATION IS FOR THE
AND STATE THAT THE ! IS CORRECT AND AGREE TO COM-
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY CES AND T WE7ULATIN0
VALUATION
BUILDING CONSTRU
SIGNATURE O
_PERMIT FEE S .S
6
e k
PERM—/�/
�rJJ
S
PLAN CHECK S
AUTHORIZED AGENT
TOTAL FEE
jOWNER BAGWELL, GERALD DATE 5-8-69
UJOB ADDRESS 1386 Gagagford Drive BUILDING PERMIT NO. 30244
UGENERAL CONTRACTOR Owner -Builder DESCRIPTION of WORK Comm. Blk. Wall
kR . 141-022-03 LOT 16 TRACT 4355 FIRE ZONE VALUE $500.00
IN..r ECTIONS
Signature Date
GROUP J TYPE
ZONE
SOIL
SUBCONTRACTOR
PERMITS ISS ED
GAS
Dat. Number Si nature
.WATER
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND Ej POWER ❑
ROUGH WIRING
Heating and Vent.
TRENCHES FORMS 0 STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT
Pt. -TER, BROWN COAT
5 !URAL, FINAL
Elect,ic
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
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30244
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O.BOX1200 COSTA MESA, CALIFORNIA 92626
P4I0
-8 69c.95A 525 d*****5,00
�LL
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVED BY
DATE RECEIVED
DATE iS$�J EQ
BUILDING 'j Cf
ADDRESS st 0 C.
//�� � �
OWNER �iC'Ki/L-F� [f^"�.fELL_
n
A.P. NO. /Os�K–�J
PERMIT NO.
v(1`
MAIL '] / /'� n/' ./ /'�v�/�
�7 ('P
ADDRESSTEL
ADORBUILDES
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–�(
CITY .n / �/ M�•S// No. S /� )6
TRACT
LOT BLOCK
CONSTRUCTION
NEW A A P
LENDER
BRANCH
OWNER Al
ADDRESS
ALUE
USE $
ARCHITECT TEL.
OR ENGINEER N
FIRE
ADDRESS
ZONE TYPE GROUP
/�
Op �1.% L- �/
APPROVED
CONTRACTOR I, (�tJ
BY DATE
ADDRESS c3 41A4�=
TEL.
ZONE
NO. OF —/ USE OF NEW &jp
PLANS `7 BUILDING
CITY NO.
STATE CITV
YOR&gs4PPRA'rE) YARDS APP ROV ED 1
LIC. NO. LIC. NO.
10640 BH+bCLpiG CC ESSoRY BUI LD I NQ/
SIZE NO. OF BLOCS.
(FROM C/L STR E
OF LOT d XNOW ON LOT
FRONT
USE OF
EXISTING BLDG.
R. SIDE T. FT.
SIZE OF NO.OF
NEW BLDG. ROOMS STORIES
L. SIDE FT. FT.
EXTERIOR WALL
ROOF
COVERING
COVERING
REAR FT. FT. /)
U F UILDIN AND WORK TO BE PERFORMED
DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
VAR.+ DATE
C.U.P.#' APPROVED
E , p
APPROVED
LpATr
I hereby acknowledge that I have read this application and state
that the above information. is correct and agree to comply with
all laws regulating building construction, and 1 shall not employ
any person in violation of the workman's compensation laws of
z /
the State of California.
I hereby certify that I am properly licensed as a contractor under
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
Code, ivision 3, Ch 9.
VALUAT
and Professions pter
P IT FEE $ S
Signature of /Zt
/gyp)
i
Permittee ///
PLAN CH E VS/
I
Authorized Agent
TOTAL FE
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