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Home My WebLink About3087 GIBRALTAR AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3087 GIBRALTAR AV Suite No Vicinity: Parcel Nunmber: 13918315 Applicant: CRAWLEY, BARRY J M TR Address: 3087 GILBRALTAR AVE COSTA MESA,CA Owner: CRAWLEY, BARRY J M TR Address 3087GILBRALTARAVE COSTA MESA,CA Contractor: OWN ER-BU I LDE R Address: Arch / Eng : Address: PLUMBING PERMIT Phone: (714)751-9662 Zip: 92626 Phone: Zip: 92626 Phone: Zip: License: 0 Phone: Zip: License: Status: ISSUED Applied: 06/28/2000 Issued: O6/28/2000 ISSUED BY: Q� SCOPE OF PERMIT REPIACE/REROUTE GAS LINE FROM METER TO THE GARAGE. SUBJECT TO FIELD INSPECTION. ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drein, Floor Drein, Rainwater Drain, Roo( Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 Qn FEESUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Seplic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line 50.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Paol Trap Primer Urinal Vacuum Brkr BkFlow(1-0) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (foilet) Water Heater I vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 30.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 533.30 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authonzed by this permit shall comply vnth all applica6le handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is nol commenced within 180 days, or if work is suspended or abandoned for a penod of 180 days. INSPECTIONS: In order for tha work authonzed under this parmit to be considered legal, such work must comply with all applicable codes, and all requlred inspectiona end final epprovel must be o6tained. Failure to ob[ain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: 1 hereby aflirm under penelry of perjury one of the tollowing declarations: ❑ I have and will maintain a certificate ot conseN to selt-Insure tor workere' compensation, as provitled for by section 3700 ot Ihe Lebor Cotle, for the peAormance of �he work for which this permit is issued. . ❑ I have and will maintain workere' wmpensation insurance, as requiretl by section 3700 of ihe Labor Code, for Ihe pertortnance ot Iha work for which this parmit is issuetl. My workers' compensation Insurence carrier antl policy number are: Carrier: Policy Number: (This sectian need nat be comp/eted il the permit is valued et one hundred dollers ($100) or less J ❑ I cetlify ihat in ihe pedormance of the work for which Ihis permit is issued, I shall not employ any person in any manner so es to become subject to the workers' compensetion laws of Celifomia, end agree ihat ii I should become subjea to the workers' compensation provisions ot Section 3700 of the Labor Cotle, I shall forthwith comply with these provisions. Applicant Signeture: Date: WARNING: FAILURE TO SECURE WORKEPS' COMPENSATION COVEPAGE IS UNLAWFUL ANO SMALL SU&IECi AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND OOLLARE ($100,000�, IN ADDRION TO THE COST OF COMPENSATION, DPM4GES AS PROVIDED FOR IN SECTION 3]O6 OF THE LABOR CAOE, IMEREST, AND ATTORNEPS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I am licensatl untler provisions of Chapter 9(commencing wi�h Section 7000) of Division 3 of ihe Business antl Protessions Code, and my license is in full force and ettect. Lic. tt Class # Contracmr's Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ 1 herehy attirm ihat ihere is a constmction lentling egency for ihe pedormance ot the work br which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Neme: Lendefs Address: Signatura: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm thet untler penalty ot perjury ihat I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or county which requires e permit to consimct, alter, improve, tlemolish, or repair any stmcture, prior to its issuance, also requires the applicant tor such permit to file a signe0 s�atement ihat he or she is licensed pursuant to iha pmvisions of Ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 ot ihe Busineu and Professions Code) or that he or she is axempt therefrom and the basis tor the ellegad ezemption. Any vlolatlon of Section 7031.5 by any epplicant for a permit su6" cts tha applicant to a civil penalty of not mora than five hundred dollars ($500).): [� I, as owner of Ihe Oroperry.:o;my employees with wages as their sole compensation, WILL DO THE WORK, antl the siructure is not intended or oHeretl for sale (Sec. 7044, eusiness end Professions-0ode: The Contractors License Law tloes not apply �o an owner of propeny who builds or improves ihereon, and who tloes such work himseli or herself or ihrdugli,his�o��her own employees, provided that such improvements are not intendad or o%ered tor sale. If, however, the building or improvement is sold within one year of completloo,�Uie owneo-builder will have ihe burtlen of proving tha� he or she tlitl not builtl or improve for purpose of sale.). nc_. ❑ I, as owner oi Ihe property, em E%CL'USIVELY CONTRACTING WITH LICENSED CONTRACTORS to construci ihe project (Sec. 7044, Business antl Professions Code: The coNreciors�License Lew does�no�'eDPly,to an owner of properry who builtls or improves iheraon, and who coniracts for such project with a contractor(s) license pursuant to the ContPactors License Cav+s.)✓/ ❑ I am ezempt der c. ��i Business entl Protessions Coae for this reason: SiqnaWra: ��,. _ _ _ "r e Date: oUc Owner ID ventietl by tl ver's lic se. ❑ Yes � No Driver's License No. �,� � �� Expires: Verification of Ownership by (type ot document, i.e. - propeny �ax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON: ❑ I hereby certity that no excavation tive (5) or more feet in depth imo which a person is requlred to descend, will be matle in connection with work authorizetl by ihis permit and that no building sWCWra, scaHolding, falsework, or demolition or tlismantling Ihereof, will be more than �hirry-six (36) feet hig�. (Chap. 32, Grp 2, Art 2, Sec. 347, Title 8, Celifornia Atlministralive Code). ❑ As owner-builtler, I will not employ enyone to do work which would require a permit from the Division of Indusirial Safety, as notetl above, unless such person has a pertnit to do such work fmm ihe division. Signature: Date: Division of Industnal Satery Pertnit Number: CER7IFICATE OF COMPLJANCE AND AUTHORIZA710N OF ENTRY: I certity under penalry of perjury that I have read this application and s�ate that the information given is correc�. I agre ply with all state laws and ciry ordinances relating to building consWction, and authonza representatives ot Ihe Ciry of Costa Mesa to enter upon the aDove-desc � ed perry tor ir7sp�9�o �oses. I agree not to occupy or allow occupancy of any 6uiltling authonzed Dy �ih�is permit until final inspection. % i �v�...fii... \l �t.�e Zt3 Za� ignaNre Ot Legal Owne s) Date And/Or Authorized Applicant Date CODE t. INSPECTONTYPE 1616 Fixed Syslem Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Placa 203 Final Sign 204 final Demolition 2at&a6 p�g nrtm�� CODE� INSPECTONTYVE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy DATE INTffULS r (714) 754-5273 • Fa�c (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3087 GIBRALTAR AV Suite: Vicinity: HOUSE & GARAGE Farce� Number: 13918315 App�icant: CRAWLEY, BARRY J M TR Address: 3087 GILBRALTAR AVE COSTA MESA, CA owner: CRAWLEY, BARRY J M TR Address 3087 GILBRALTAR AVE COSTA MESA, CA Contractor: OWN ER-BU I LDE R Address: Arch : Address: Zip: Phone: Zoning: R1 R1 Phone: (714)751-9662 Zip: 92626 Phone: Zip: 92626 Phone: License: 0 Eng: Address: ISSUED BY: Status: ISSUED Applied: O6/28/2000 Issued: O6/28/2000 Phone: Zip: License: License: . SCOPE OF PERMIT REROOF - T/O, REPLACE SHTG AS RE�UIRED, INSTALL 2 LAYERS OF 15# FELT AND NEW 25 YEAR COMPOSITION SHINGIE ROOF. Plan Check: $0.00 Permit: $9725 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 tnspection: $0.00 Total: $97.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 LeR 0- 0 Proposed: 0 Calc Valuation: Claim Va4uation: Right 0- 0 Right 0- 0 $3,600.00 53,600.00 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, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned ' tor a period of 180 days. � INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectiona end flnal approval rtiust be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSA710N DECIARATION: I here6y etlirm untler penelty of perjury one of Ihe tollowing tleclarations: ❑ I heve and wlll melntaln e certificate of consent to sefl-Insure for workers' compensetion, es providad for by section 3700 of ihe Lebor Code, for the peAormence of the work for which ihis permit is issued. . ❑ I have antl wiil meintain workers' compensatlon insurance, as requiretl by section 3700 of the Lebor Code, tor ihe pertormance of the work for which this permit is issued. My warkere' compensation Insurance carrier and policy number are: Carrier: Policy Number: (Thls secNon neetl nof be comp/eted il the permif is veluetl at one huntlred dollers ($100) or /ess.) ❑ 1 certity thet in tha pertortnance of the work tor which this permit is issued, I shell not employ eny person in any manner so es to bacome subject to the workers' compensatlon laws of Celilomla, and egree that if I should becrome suhject to Ihe workers' compensation provisions of Section 3700 of Ihe Lebor Cotle, I shell fonhwith compy with Ihese provislons. Applicam SlgneWra: Date: WARNING FAIWRE TO SECURE WORKERS' WMPENSATIIXJ COVERAGE IS UNLAWFUL M1D SHALL SUBJELT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TOONE HUNDRED THOUSAN� DOLLARE (E100.000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED WR W SECTION 3]W OF THE InBOR CO�E, IMEREST, ANO ATTORNEV'S FEES. LICENSED CON7RACTORS DECLARATION: I hereby aHirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Oivision 3 of ihe Business antl Professions Code, and my licensa is in full force and ettecL Lic. a Class # Comractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm Ihel �here Is a consWction lending agency tor the pedormance ot the work for which this pertnit is issued. (Sec. 3097, Civll Code). Lenders Neme: Lenders Address: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby aflirtn �ha� under penalry ol perjury Iha� 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Busineu and Professions Cotle: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any sirucNre, prior to its issuance, also requires the applicaN tor such permit to file a signetl stetement thet he or she is licensetl pursuaM to the pmvisions ot the Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of tha Busineu end Professions Code) or thal he or she is exempt Iherelrom and the basis for t�e alleged exemption. Any violation ot Sectlon 7031.5 Dy eny epplicant for a pertnit sub�ects the applicant to e civll penalry of not more Ihan five hundred dollars ($500).): � I, as owner oi ihe pmpetly, or my employees with weges es their sole compensation, WILL DO THE WORK, antl the structure is not intentletl or oNered for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law tloes not epply to an owner of property who builds or improves thereon, entl who does such work himself or hersell or Ihrough his or her own employaes, provided that such improvements are not intendetl or oNeretl lor sale. If, however, ihe building or improvement is sold within ona yeer of completion, Ihe owner-builder will have the burden of proving t�at he or she did not build or improve for purpose ol sale.). ❑ I, as owner oi ihe properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business antl Pwfessions Code: The contractors LJcense Law does not apply to an owner of property who builds or impmves t�ereon, and who contracts for such pro�ect with a contractor(s) license purevan� �o �he Coniractors License Laws.). ❑ I am exemR Siqneture: � Owner ID verified ❑ Ves ' � No Business and Professions Code br this reason: oate: 00 Driver's Licensa No. Ezpires: Verification of Ownership by (type of Cocument, i.e. � property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIiICA710N: ❑ I hereby ceM1lfy thet no excavation five (5) or more feet in tlepth into which a person is required to descend, will 6e matle In connection with work authorizetl by this permit, end that no building stmcNre, scaffoltlfng, talsework, or tlemolitlon or tlismantling ihereoi, will 6e more ihan thirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Atlministrative Code). ❑ As owner-builtler, I will not employ anyona to do work which would require a permit from the Division of Intlustrial Safety, as notetl ebove, unless such person has a pertnit to do such work Irom ihe division. SignaWre: Date: Division of Industnel Safery Permit Number. CERTFICA7E OF COMPLIANCE AND AUTHORIZATION OF ENTFiV: I ceM1ity under penalty of perjury that I have reetl this application and state that the information given is correct I egr Co� ply with all state laws and city ordinances relating to building consimction, and authorize representativas of the City of Costa Mesa to enter upon ihe above-descr ed 6perty for i �ryoses. I agree not to occupy or ellow occupancy of any building authonzed by t�his pertnit until linal inspection. G.�.�.. ..i� J l.l�te � 2oDv ignature Of Le9al Ow r(s) Data � And/OrAuthonzed Applicant Date COUE �. INSiELT10NTYiE 1fi16 Fizod System Final Fire Prevention 7266 200 201 202 203 Pool Spa Final Final Re-Roof Final BIocWReteining Wall Finel Factory Fire Place Flnal Sign 204 Final Demoli�ion 24aGa6 P9IE 1t�9LS 40�E� LNSPECTIONTYPE 206 Final Mechanical 200 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy Q!fIE INTITIALS �� °� �� a b'ui�� i.uidiac� OWNER-BUILDER VER[FICATION A city or county, which is required to give notice pursuant to Section 19830, shall a[[ach to such notice, and, as a condition precedent to issuing a building permit, require [he completion and require the rewrn of, an owner-builder verification. Attention Property Owner. An `ownerbuilder' building permit has been applied for in your name and bearing your signature. Please complete and retum this information in [he envelope provided at your earliest opportunity ro avoid unnecessary delay in processing and issuing your building permi[. No buildingpermit will be issued until this verifica[ion is received. I. 1 personally plan to provide the major labor and materials for conswction of the proposed propeRy improvement. � Yes ❑ No 2. I(h�/have not) �1 G�rP signed an applicatio� for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address Phone ( ) City — Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address _ Phone ( ) City _ Con[ractor's Lic. No. 5. 1 will provide some of the work but I have contracted (hired) the following persons ro provide the work indicated: Name tOd2�46 (REV.9/9B) Address Phone Type of Work DATE Gibralter Ave. GGNERAL CONTRACTOR L. G. Robinson VALUE$ ZD 319•OO AP. No. LOT 1 TRACT 311 PIRE ZONE DESCRIPTION OP WORK Res & Att gar f `UP TYpE ZONE PLAN NO. INSPECTIONB DATE gUBCONTRACTOR PERMITSISSUED v 6rown cont I' inp Pixtu P,_._. Gas Test � ,i �` 8216 . COSTA MESA BUILDING DEPARTMENT P. O. BOX 3 � � COSTA MESA. CALIFORNIA FOR BUILDING ADDRE55 TO FILL IN COSTA MESA. CALIFORNIA OWNER Mesa Verde EstaTes MAIL I�O� Gisler CJt• ADDRE55 ORCHITENEER .I. R. Shell noo��ss Long Beech 'UEC9� 195�i r�s F,;:'.�:CC QEPT. Cli'r Q� ("�;��\ fiES�l APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY TNO. KI 5-1751 ADDREISS N�o. C-2I7O COSTA MESA. CALIFORNIA rr .. r...i.n FIRE ZONE /{ L. G. Robinson "TY No 1123 i �i AOORE55 f7CI Gisler LEGRI LOT OESCRIPTION NQ 8I B A.P. NO. SIZE OF LOT E%ISTING BLDG. SETBACN LINE FPOM q^1 CErvTER OF STREET JVT TNO. K1 5-1751 BYPROVED TRACT 3�15 C; No.or a�ocs. NOW ON lOT None t. REAR YARD SIDE YARD RIGHT 5�+ LEFT S�'F DESCRIPTION OF WORK NEW %� ALTERATION ADOITION FEPAIit VING DEMOLISH BUIL� NO.OF SIZE 1433 ROOMS 6 STORIES EXTERIOR WALL R��F COVERING S�ULCO C�`/ERING Rock & A� BUELDFNGEW Residence b hitached �arac 1 HEHEBV FCKNOWLEOGE TX�T 1 NAVE FEAO TMIS $Tf�TE TNAT TME l�BOVE I$ CORRECT AI�D RGREE TO CITY OflOINFNCES wN0 STi7E LPW �FEGULPTING BV TION. SIGNATURE OF �,« ,� PERMITTEE ZED DATE CORRECTIONS .._i ___'__"—'_'i"_____ t ?: � .. !-� .`._�'v �. _ �i vAR. ho.��APPROVED L ;UBJ�Cf �:i 6LUG. CEYT. REG., %/ii/ n /_/__ �� Hri r ri rv nHo -- ITH nLL ONSTRUC VALUATION PERMiT FEE $ � c �,h—.. � 5/' 1� 7� ,_ � PLAN CHECK S C `� �� TOTAL FEE 8 C �;. �OWNER FOX� B. A. ,� JOB ADDRESS 3087 Gibralter Avenu � GENERAL CONTRACTOR R. M. Wilson A" `�o.l -18 -1 LOT TRACT \\� I. :CTIONS Si nati \�y SOIL � GAS WNTER ROUGH PLUM0ING PROP. SW0.. LINE � HOUSE CON. � SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING ANO AIR CON�ITIONING UNDERGROUNO ROUGH WIRING TRENCHES � FLOOR SVSTEM BONO BEAM � SHEATHING POWER FORMS U STEEL REINF. STEEL REINFORCE I-I FRAME AND FLASHING � � i � i PLASTER, BROWN COAT 'TURAI, FINAL h NG, VENT., REFRIG. AN� A. PLUMBING, FINAL AND GAS TEST ELECTRIC, FINFL FINAL �L'i��Plq DATE $_23_q2 BUILDING PERMIT N0. RK patio Cove� VALUE S �sn_�n SUBCONTRACTOR _� , COSTq MESA BUILDINGSAPETY DEPARTMENT ,"R ��S_7��a�oOOt 074� *****` P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fi!l in Completely FiECEI E BV DAT�R�CEIVED DATE ISSUED a��o�N� 30 8 � C� bra I te r�if� ' �" ' j s-:�� -7�� ADDFESS q PERMIT NO. OWNER �'�d)( A.P. NO. � �I 03- S MAIL BUILDING �� p ADORESS � 4 I'�� +DORESS d CITV C(J a � No`�pz�y TRACY� S LOT I BLOCK CONSTRUC710N W A LENDER BRANCH OWNER � � ADDfiESS VALUE • � AFCHITECT X NEL. S �� J✓ $C `4��- OR ENGIN ER FIRE ADDRESS 20NE TYP GROUP � A 1' APPROVED q � CONTRACTOR /` (1� w•� ISW�i BY �� DATE �! �%�J -� ADDRESS �(ID S8 7T:1'I�7OY IY`V� Z�ry/��) NO.OF USE OF NE ��W,. No`S3l-Ol�6D V\ P�� UILOING��j �� CITV .�/ VARDSAPPqOVED YAROSAPPROVED LIC. NO. �/ S•S N� LICVNO. MAIN BUILDING ACCESSOPV BUILDING SI2E NO.OF BLOGS. (FROM GL STREET) OF LOT NOW ON LOT FRONT FT. USE OF EXISTING HLDG. �� FT r f FT. SIZE OF NO. OF NEWBLOG, ROOMS STOPIES L.SIDE FT. FT. EXTERIOF WA�L FiOpF n// COVERING COVERING REAR d/ FT. FT. USE OF BUILDING ANO WOftK TO BE PERFORMED OISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. B�DGS. `� / VAR.#� DATE /�V C.U.P.� APPROVED X LG °°P �E , , —a 3-7� H I hereby acknowledg0 thet I have reatl this application antl state that the ebove informetion iz correct antl a8ree to comply wtih all Inws reguleting builtling consttuction, antl I shall not employ any person in violatian of the workman'z compensation lews of the State Of Calitornie. T� � I hereby cerUty that I am properly licensetl as e conttacmr untler 4 FT. o the Sta2e ot California Businass entl Professions Cotla, Dlvisicn 3, TME AMOUNT SHOWN UNDER VALUATION IS FOR � Chapter 9, and Ma[ such licenses are (n /uli forca and et/ect, or 1 THE PURP�E OF ESTABLISHING A PERMIT FEE ONIY: Q am ¢xampy from th visionsof the Steta of California Business VALUATION ��{u antl Professions C a, D ision 3, Chaptar 9, m A/I1 QO PERMIT FEE 5�- j SiBnuture Ot ///'��u•`�(,�� ;,.�-�� m Permittee � $�� PL.AN CNECK S E pd LL Authorizetl ABent TOTAL FEE $ �� __ 344Z9 Z . aU Z ZQ O v~i am J � J N J Q U N Za W � aw wz J Q m Z J � wW 0 z� W � �O H Z Q V i �.03