HomeMy WebLinkAbout598 GRAND HAVEN CIR - Building Permits� � CITY OF COSTA MESA
`�,O'�pMF,y BUILDING D/VIS/ON
i�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax 014) 754-4856 • www.ci.wsta-mesa.ca.us .�. .
�3��0� FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: M09-00030
PERMIT TYPE MECH STATUS: ISSUED
APN: 41804110 DATE ISSUED: 04I06I2009
ISSUED BY: KJB
JOB ADDRESS: 598 GRAND HAVEN CI CM Suite/Unit:
vicinity:
SQ. FT: 0 � . - .
SCOPE OF WORK: FURNACE CHANGE OUT. NO RELOCATION OF FAU. NO A/C
OWNER: GARCIA, PHYLLIS Address: 598 GRAND HAVEN CIR Unit: . -
PHONE: 714-668-0474 , City/State/Zip: COSTA MESA, CA � -
APPLICANT: DE ANGELIS-, DON � " �� - Address: 202 E STEVENS AVE - Unit:UNIT G
PHONE: 949-279-5575 . - City/State/zZip: SANTA ANA, CA
CONTRACTOR: COASTAIRE LicenseNo. 355425 '�'•���-°��i?�?U�U
Address: 14 SANTA CATRINAUniI: PHONE: 9492795575
City/Stale: RANCHO SANTA MARGERITA � ' - ' � ZipCode: 92688 �
CELL: �
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
,
TOTAL FEES: $38.30
.:/'..:4f
NOTICE: The work authorized by this permif 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 appticable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the ezpiration of this permit.
GOOEY. INSPEL710NTYPE DpTE INTI11RL5 � INSVECTONTVPE OATE INPTIALS
7676 Fixed System Final Fire Prevention 206 Final Mechanical -� -Q �n(
1266 Pool Spa Final 209 Final PlumOing
200 Pinal Re-Roof 210 Final Electriwl �
201 Final 81oCk/Retainin9 Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site "'' i�+
204 Final Demoli�ion 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalry of perjury one o( the following declaretions:
❑ I have and will maintain a certificate of consent to sel4lnsure for workers'
compensation, as provided for by section 3700 of the Lahor Code, for Ihe
peAormance of the work for which this permit is issued.
❑ I have antl will maintain workers' co�npensation insurance, as requiretl by
section 3700 of Ihe Labor Code, for the per(ortnance of the woric for which �his
pertnit is issued. My workers' compengation Insurance carrier and policy
number are: / ,/%
Carrier ��/t�(�"v�`�'��/✓
(This sec(on ne 1 be mmdefetl i/Ihe permrt rs valuetl at one huntlretl Nllars (51 ) oNess./
Policy Number �L�� 6 � Z7 �
❑ I certify that in the pertormance of the vrork for which this permit is
issued, I shall no� employ any person in gny manner so as to become subject
to the workers' compen�n law� California, and agree that if I should
become subject to the v� ers' �a(Pensation pmvisions of Sec6on 3700 of
[he Labor Code, I II f haAlh mply with these provision .
/ /
Applican� ignaWre f�e
WARNWG FAILURE TO SECURE WORKERS' COM ENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF 7HE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm thal I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of lhe �usiness and Professions Code, and
my license is in full (orce and eftecf.
�ic. u � `' J� c�ass tt�-Z/f
�
C I i s naWre Date
.._..—.-'..__
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm ihat there is a Construction lending agency for the
peAormance of the work fa which this permit is issued. (Sec. 3097, Civil Code).
lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hemby affrm Nat under penalty of perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW (or the following reason (Sec. 703t5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior lo its
issuance, also requires the applicant for auch permit to fle a signed statement
[hat he or she is licensed pursuanl [p [he pmvisions o( Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Code) or that he or she is exempt Iherefrom 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 penalry of not more than
fve hundred tlollars ($500).):
❑ I, as owner of Ihe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strucNre 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 vfio builds or improves
thereon, and who does such vrork himself or herself or Ihrough his or her ovm
employees, provided that such improvements are not intended or oftered tor
sale. If, however, Ihe building or improvemen� is sold within one year of
completion, the owner-builder wiil have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner oi the pmperty, am EXCLUSNELY CONTRACTiNG WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Cotle: The contractors license Law tices not apply to an ovmer of
property who builds or impmves thereon, and who contracis for such project with
a contractw(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Si9nawre Dale
305]-46(3/0�)
Owner ID verified by tlrivei � license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ovmership by (rype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or more feet in depth into which a
person is required �o descend, will be made in connection with work authonzed
by this permit, and that no building structure, scaffolding, falsework, or demolition
or dismantling lhereo/, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Cali(omia Administ2live Code).
❑ As owner-builtler, 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 permi[ [o do such work from �ha division.
Applicanfs SignaWre Da�e
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or (uWre building occupant need to file antl
certify a Business Plan for emergency response lo release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California 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 reportetl
year a quanti[y 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 tempereture and pressure).
2. Does or will [he applican[ or present or future building occupant need to file
a registra�ion form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires re9istration with the Costa Mesa Fire Department by
each business which al any one time has on hantl a quantiry of acutely
hazardous materials equal to or greater than a weight o( 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 presen[ or fuWre builtling occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certifica[ion and
filing wilh ihe Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. I( an RMPP is preseMty required, has Section 25534 of lhe Califomia
Health and Satety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applican[ or presen[ or fuWre building occupant require for
Ihe work which is the subject of this application a permit (or such construction
or modifcation from Ihe South Coast Air �uality Management District or from
any olher air pollulion con[ml district or agency? ❑ Yes ❑ No
(Sec[ion 658502 of lhe Califomia Govemment Code requires [hat the requesled
information be fumishetl on applications fa non-residential building permits).
6. Will any part of the facility to be constmctetl under Ihis permit be vnthin
1000 feet from [he outer boundaries of a school? ❑ Yes ❑ No
Qf "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health antl Sa(ety Code).
7. If a permit from the South Coast Air Quality Management District or other
air polWtion conhol distric[ or agency is required for the work which is Ihe
subject of this application, have all o/ ihe tliscbsures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certificate of compliance from the appropriate air pollution
control offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
infortnation given above is correcL I agree to comply with all state laws and
city ortlinances regarding Hazartlous Materials and Emissions.
CERTIFICA7E OF COMPLIANCE AfYD AUTHORIZATION OF EMTRY: i
certify under penalty of perjury tha� I have read this application and state that
Ihe information given is correct I agree to compiy with all state laws and ciry
ordinances relating to builtling constmction, antl authorize representatives of
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree nol to occupy or allow occupancy of any builtling
authorized by [his permit until f(al inspection.
Signalure o! Le Ov �(s) ��e
7
Antlloi Aulb d if Apphc9nl f'Jale �
INSPECiION 1 iE5iIN6 ENGINEERS
CMEMICAI, i PHTSICAI AN�IYSIS
RADIOGRwYHY� %.qAy GAMM� NAY
Y.O. �e• 1) ' 1110 Afrperl W��
Lenq ���ch. C�li(. VOIOI
pu� asuss • �zn� e�d:�b • �n�� u�-w�
June 25, 1970
Sinc. 1898
NESEw0.CM i ENVI0.0NMENTwL TFSTIN6
COPNOSION EN6INEERIN6 ! ANALY515
ULTPASONIC MA6NEiIG � �ENE7RANT
f6���0 N�.rA M..p.r 5�.��r
$�nf• An�, G�lil�r.i• �7)G)
�]N) 611.]016
E:aminatioa: SC70-3565
COMPRESSION TESTS ON GUNITH _. CYIINDERS
Lawrence Sprague
2133 Miramar IJrive
Ba16oa. California 92561
PROJECT
ADDRESS
SAMPLE FROM
1utCNirECT �
FNOINFEA
MIX
DAiE CAST
DA)E TES7ED
CYLINDER NO.
COMPRESSION
TOTAI LOAD, LBS.
t POUNDS. PER SQ. IN.
COMPIIANCE
ROTIAI.D S1�1ITFi - Swim Pool
598 GYand Aaven Cr., Costa Mesa
Deep End - Shallow End - B,B�
6-17-70
6 -24- 70
2
7-Day
86,000
3,040
COMRACiOR
Blue Champagne Poo1a
suecouTp�cToe
Grove Gunite
SPECIFIED
STRENGTN
#2
Size: �4
#6
6-24-70
4
7-Day
93,500
3,310
2,000 psi
6" x 12'g"
6" x 12'�"
6" x 12-1/8"
6-24-70
6
7-Dey
97,250
3 �440
1 - 3 - 5 "HOLDS"
7-Daq test complies with apecificatione.
MADF LT
DFIIVERfD !Y
tlCFIVFD ON
CYLINDERS Sprague - Sama - 6-18-70
�ECE(V�I�
DISf�I W TION:
BWLDING SAFETY DEPT.
City of Co�ta Mesa
nlue Champagne Pools J U N 2 � 1970
163B E. 17th St., SA 92701 C :,�n „ �,M
L, $, Sprague - 3 ,�/]�,) �i?Ci ^ ,
�v � .�l- � 3ja�9�►J�ll,�l2rli2i��4'i�i�
U, ; f� i ` '.-, �.:.:.'
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•L� AE009i6 �RC SVeY1TTC0 �S iMC COMf1O(MT1�� �AOP[RTV O� C�I[HTS. �VTMOAII�TION fOR IUOLIC�TIOM Oi OYR ACPORTS, COMCIU�IOM{. OA [��
TR�CTS fROM OR R[G�qDING TMCY IS AES[RV[D O(ryDING OVA WA�Ti[N �PpROV�L �5 � YUTU�L PAOiCCiIOM TO CLILMT{. TNE PVOIIC �MO OVRtELV[S
J30-12
OWNER SMITH. RONALD DATE 5-14-70
JOB ADDRESS 598 Crand Haven Circle BUILDING PERMIT N0. 1841
A �� 418-041- LOT TRAC1
Ih_. [CTIONS Si non
s011
G AS
W ATEFi
ROUGH PLUMBING
PROP. SWR. LINE � NOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH MEATING ANO AIR CONOITIONING
IINDERGROUND
ROUGH WIRING
TRENCHES �
FLOOR SYSTEM
BOND BEAM �
SNEATNING
POWER
FORMS U STEEL REINF.
STEEL REINFORCE (�
FRAME AND FLASHING
LATHING — IN ❑ OUT n
PV�TER, BROWN COAT
5' iURAL, FINNL
HEn�MG, VENT., REFRIG. AND A.0
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
RIIIIl111J(. FIMGI
13��iTJ�
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
For Aoalican Fill in Comoletelv
P`''o 34.50
GIkY 14-70�M,QOO 66i� *�**
APPLICATION FOR BUILDING PERMIT
RECEIVEO BV DATE RECEIVED DATE ISSUED
� - 7c1 �/t/ —�
OWNEF N..r. rvv. � /0 '� //
MAII BUILDING
Z ADDRESS � ADORES
� U TEL. TRACT �
CITV NO.
f— Z
z a CAN5fRUCT10N w ao
O N LEN�ER
am
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— OWNE
� ADDRESS
m ARCHITECT EL. S �
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APPFOVED
W Z CONTR CT BY
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J � ADORE$
W W T ZO NO.OF
Z� CITV N � �—I PI.ANS G
� STATE CITV �AFDSAPPROVED
y� LIC. NO. ` � �3 LIC. NO. MAIN BUILDING
� O (FftOM GL TRE
OF LOT �G� ��' � 5'�p, �/.�i �C�D � NOW ON LO 5 FRONT F
VSE OF
E%ISTING BLDG. S E
� SIZE OF NO. OF
Z NEWBLOG. O ROOMS STORIES L.SIDE
U EMERIOR WALL ROOF
COVERING COVERING REAR
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET.
MAIN BLDGS.
Q VAR. #`
O C.U.P.�W
� APPROVED
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UI hereby acknowledge that I have reatl Ihis spplicetion antl state
� that Me above iMormexion is correct antl agree 2o comply with
� all laws regulatin8 builtling construct�on, antl 1 shall not employ
� any person in violation of the workman's compensetian laws of
y the State of Calitornia.
zI hereby certit t I em properly licensetl as a contractor untler SQ. F
tha Stere Calitorn Bvsiness antl Protessions Cotle, Divizicn 3, THE AMOUNT
Chapte , antl ihat su licensas are I II force antl etfect, or I THE PURPpSE �
am ex mpt from t�e ovisions ot S te of Calitornia Business VALUATION
antl P ofessions e, Division 3�
5�a�et o� �9ao—
Permittae §
Authorizetl Agant
�J
VAlVS G\ OQ
� OC �
� GROUP
DATE� —
USE OF NEW �
BUILDING �
VARDS APPROVE❑
FT.
BET.I
ACCE;
DATE
b
T. o
SMOWN UNDER VALUATION IS FOR j
�F ESfqBlISHING A PERMIT FEE ONIV: m
� ¢
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PERMIT FEE 5 �
]
m
PLAN CHECK $ '� E
0
LL
TOTAL FEE $ � / D
OWNER 5t�7-�'rri, xV1Vni,u li,
JOB ADDRE55 598 Grand Haven Cr.
GENERAL CONTRACTOR Oorner-Bldr.
' Vo. LOT 1$ T
.�ECTIONS �
SOIL
GAS
W ATER
ROUGH PLUMBING
PROP. $WR. LINE � HOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH HEATING AND FIR CON�ITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND � POWEft �
ROUGH WIRING
TRENCHES FORMS � STEEL REINF.
FLOOR SVSTEM
BONO BEAM STEEL REINFORC@
SHEATHING
FRAME PN� FLASHING
LATHINf. _ IN n OIIT n
DATE '(-1'+-'(0
nui�uin� rtiuni i NU.j[o7S
REZONE VALUE
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFET.Y DEPARTMENT
P.O. BOX 7200 COSTA MESA. CALIFORNIA 92626
lUL 14-70cwsa001229 0***��*5.00
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
REC � D�E FjE VEDO DATE IS V D a
BUILDING � 7 � �� 7
ADORESS
�" PERMIT
OWNER � Li / A.P. NO. " O � �'%���
MAIL 'C BUILDING �
ADDPESS v e ADDRESS
CITY NOLS��;jy� TRACT 7(O LOT BLOCK
CANSTRUCTION N W A D A P
LENDER
BRANCH /
OWNER Q n
ADDRE55 VALUE
ARCHITECT TEL. S' S
OR ENGINEER N
FIRE
ADDRESS ZONE TVPE GFOUP
APPROVED
CONTRACTOR (1.(/�yiy.�t�-� BV �ATE
ADDRESS
TEL. Z�N NO.OF USE OF NEW �_ � it
PLANS BVILDING
CITV NO. �'�"`%
STATE CITV YP.FlDS APPFOVED VARDS APPROVED
LIC. NO. LIC. NO. MAIN BUILDING • ACCESSORV BUILDING
SIZE / NO.OFBLDCaS. - (FROMGLSTREET)
OF LOT s ,Q NOW ON LOT / ROM FT. FT.
USE OF �L
EXISTING BLDG. Q/✓ T ~_ FT. FT.
512E OF OF
NEW BLOG. ROOMS STORIES L. SIDE �r �'f, ( �
EXTERIOR WALL ROOF
COVERING COVEFING REAR FT. FT.
USE F�UIL IN AND9/O.RK TO BE PERFOFMED DI5TANCE BET. BET. MAIN &
� �i�/ MAIN BLOGS. ACCESS. BLDGS.
VAR.# pATE
t� � jJ��y(� C.U.P.� APPROVED
�/ i o � E , � d
< i
F r. ^ _
I hereby acknowledge that I have read [his apP�ication antl state �
Ihat the above intormetion is correct end aptee to comply with -n� � 6
all laws regulatin8 building consvuction, and 1 shell not employ �•
any person in violation of the wo�kman's cOmpensation laws ot
the State of California.
I hereby c¢rtify that I am properly licensetl as a conbactor untler SQ. FT.
ffie State ot Calitornia Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS POR
Chapter 9, antl that such licanses are In ivll torce antl Bftect, or I THE PVFPOSE OF ESTABUSHING A PERMIT FEE ONLV:
am exempt from the provisions ot the S2axe of California Businass VALVATION /�
antl Professio o e, Division 3, Chapt 9. � i FERMIT FEE $ �•�
vil
Signatura o �•
Permittee Y[Y0.i V $��O P�AN CMECK $
Authorizetl Agent TOTAL FEE S ��
`�+1 OWNER SMITH, RONALD
`�JOB ADDRESS 548 Gra
GENERAL CONTRACTOR .
� �. 1 -0 1-10 L(
IN>rECTI0N5
soi�
GFS Q •
WATER /Yt� /�iiw �_.
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CON�ITIONING
TEMPORARY SERVICE OR POL �/ys
UNOERGROUN� POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL REINF.
FLOOR SVSTEM
BOND BEAM r/��STEEL ftEINFORCE �
FRAME AN�FLASHING
LATHING — IN n OUT r
PI � -'ER, BROWN COAT
5 fURAL, FINAL
HEATING, VENT., FEFRIG. AN
PLUMBING, FINAL AND GAS T
ELECTRIC, FINAL
Aiiii niur, ciuni
SCRI
FIRE
C
DATE 5-20-70
SUBCONTRACTOR
NG PERMIT N0.
ZONE
, ,. ,.` 31876 PAI�
�ir�v �o-�o�Msr,00 as9+= �*��39.Q0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIfORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant t0 Fill in Comp/etely
REC I BV DATERECEIVED nn�rc�ca�.icn
BUIIDING� � �-�
ADDRESS .�[ /,
OWNER ♦ �S�%/�/�'/�/l A.P.NO.`7'�C'�O —
��, ���(J BUILDING
Z .
AODRE�JSYv'��i�� ADDRES�I
wa U TE
CIT 5 NO. TRAC
2
Z Q CONSTRUCfION� W A
ON LENDER `'
am 7
J � BRANCH
J �� OWNER
� ADORESS �
J Q ARCHITE .ya S Ll.ijtiJ
N OR ENGI N .
V Q 7 FI
W � ADDRES /\ 20NE TVP
a w � APPROVED /
w Z gV %
J �
m Z
J � ADDRES �, �
W W ZON NO.OF
� CIT �� � — PLANS�
2H
w � STATE �/� �S� CITY � 1'AFOS APPROV ED
�� LIC.N �,� LIC.N MAINBUILDING
� O (FROM C/lSTfiEET)
S12E NO.OF BLDGS.
OF �OTSo� 6.9� D NOW ON LOT FRONT FT.
USE OF
EXISTING BLDG. T
F SIZE OF � A ' NO. OF
Z NEWBIDG. � :�OOM$ STOFIES L.SIDE FT.
UEXTERIOR WALL ROOF
� COVERING COVERING REAR FT.
USE O BUILDING/aND WOPK T E PER FMED DISTANCE BET.
MAIN BLOGS.
Q VAR. #
O C.U.P. �
F APPROVED
�
z
�
VI hereby acknowletlge that I 1+ave reatl this application antl state
� that the above informacion is correc[ antl a0ree to comply wiM
� all laws regulatin0 builtling co�svuction, antl I shall not employ
F any person in vlolation of th6 workman'S compensation laws oi
y the 5[a[e of Celitornia.
zI heroby certity that I am properly licensetl as a contracm� untler SQ. FT.
the Sta[e of California Business antl Professions Code, Divisicn 3, THE AMOUNT SHOWN
Chopter 9, entl that such licen6es are in full force antl effett, o I THE PVRPp$E OF AE
am exempt from th ovisions ot the State ot Calitor)i) Bus' ss VALUATION
antl P ions i'si n 3.C1]ppyf %yp p�� D
v v �•�( � PE
p atura !/�
Itte 5�✓ pL
ulhorizetl Agent, ,
T(
�
VALUE
YARDSAPPROVED
DATE
FT
�
0
IS FOH ^
ONLV: �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 � COSTA MESA, CALIFORNIA YZ8Y6