HomeMy WebLinkAbout1864 PARKVISTA CIR - Building Permits CITY OF COSTA MESA
49@ BUILDING DIVISION r '
F •
.,,, = �I 8, DEVELOPMENT SERVICES DEPARTMENT PERMIT IAJ MBER
J PERMIT V
Sbenuarsp4" B04-01249
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1864 PARKVISTA CI Status: ISSUED
Suite: Applied: 07/12/2004
Vicinity: GARAGE ROOF Issued: 07/12/2004
Parcel Number: 42431113 Zoning:
Applicant: MARTIN ARROSAGRAYS ISSUED BY:
Address: 2508 BOWDOIN PL
Phone: 714-556-8867
COSTA MESA,CA Zip: 92626
Owner: O'MALLEY, JOHN.R
Address " 1864 PARKVISTA CIR
Phone:
COSTA MESA,CA Zip: 92627
Contractor MARTIN ARROSAGRAYS ALL SEASONS ROOFING
Address: 2508 BOWDOIN PL
Phone: 714-556-8867
COSTA MESA,CA
Zip: 92626 License: 622480
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL TORCH DOWN ROOF SYSTEM FOR FLAT ROOF ONLY,28#FIBERGLASS FACE SHEET,8
REPAIR/REPLACE SHEATHING AS NEEDED.700 S.F.FOR ATTACHED GARAGE ONLY.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: 51,400.00
Permit: $50.95 Claim Valuation: $1,400.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
•
Total: $51.45
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
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
2446-48(6/00)
,444W41r711L•la
WORKERS'COMPENSATION DECLARATION:
I hereby eHirm under penalty of perjuryone of the following declarations: -"
O 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.
�'&�)I have and will maintain workers'comps sation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My worlk��.r(y c,_o gppsatio urance rrier and policy number are: 2
`Gruner: ✓1 " `� (J� Olicy Numbei: `A7 f J -'0 L
yrzuv-tsect/dn need no be completed it the permit is valued at one hundred dollars($100)or less.) �-
❑ 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'
compensationppyylaws of Calllor ie th I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
corn h these pr vvv'''���111
AppllcantjSignature: - Date: r
1451'
.FAiLURE'TO SECURE WORKERS'COMPENSATION COVERA S UN FUL AND SHALL SUBJECT AN EM RTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(Si 00,000),IN ADDITION TO THE COST OF COMP T10 AMMGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license u er ro s hapter 9(commencing with Section 7000)of Division 3 of the Business Pr Code,and my license Is in full
forforce end eH"—` t edt.Lic.q-' / Class q r �i
at
GpntradorslSigriatdreri al"( Det'e�'"/ i'--Cl
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).
Lender's Name: Lender's Address:
Signature: Date:
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 for a 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,em 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.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's 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,Califomla 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 t0 release or threatened release of a hazardous
material? ❑Yes 0 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 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 then 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 end 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 a plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No
(Section 65850.2 of the California Govemment 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? ❑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? ❑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.
Sig re Of Legal Owner(s) Date
Lata._ilia • i >• —
Z.,id/OrAOtho ze hp ta=-
/ppi�b_N�_ - Da
CODE t IySPECTION TYPE I frAIL INTITIALs VODE` INSPECtION TYPE BATE R!$QIALS
1616 Fixed System Final Fire Prevention �.J 206 Final Mechanical
1266 Pool Spa Final / /, 208 Final Plumbing
200 Final Re-Roof 7-2-/-Cy( 4-4nt. - 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
IADDRESS OF WILMS: 1864 PARKVISTA CI UNE CITY OF COSTA MESA — BUILDING PERMIT
LRNERSIMMEIFggMt:LAM, CHEONG KWONG TR PERM NO: B 076715
ADDRESS' 211 AMTHYST
f BALBOA ISLAND,CA 92662 PERMIT NO: B 076715 PLAN CHECK NO: N GOVT: N SUPP: N
APPL,MAlUNOADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCNOECT ORE1KatEER: LIG.NO: JOB DESCRIPTION : T/OFF REROOF W/ HOT MOP SQ FT: 3, 500
MICW OR END'S ADDRESS: WIT:
CLAIM VALUE: 3, 500 . 00 CALC—VALUE: 3, 500 . 00 GROUP OCC: R-3 /
•
CONTRACTOR'S NAME:RAY JU ( 714 ) 962-2334
CONTRACTOR'S MAIM 9801 OCEANCREST DR COMMENTS : REROOF RESIDENCE 2400 SQ FT
ADDRESS:HUNTINGTON BEACH CA uc.No.: 470673 *****'****'*****************a'****** ****NNS'********'******rt*************-***********
92646 UHT: Z O N I N GS ERTEHQAUCIKRSE M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am tensed under provisions of Chapter 9
(commencing with Section 790Sof Division 3 d the Business and Professions Cod my license is in full force end effect.
CITY LIC.NO.: 5(01 tag LIC.CLASS: uC.NO. 0673 EXP: MAIN BUILDING ACCESSORY BUILDING
3—7-qc)� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dae: / Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under Penal'of perjury that 1 am exempt from the Contractors License Law for the
fdlowi,greaeon(section7O3lsBaa:.asandPmleae aCode:AnydvacountywhldhrsgaraapermittoorSVecl.ater.imprOVe. PARKING REQ: PROV: PARCEL: 42431113 ZNE: REF NO:
swish.«repai any structure,prior to its inn also
requires the applicant f«such permit to file a signed sslement that he or she PLANNING NOTES>
a licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)of DNeion 3 of the
ii
Business and Professions Code[or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant for penalty
a permit subjects the applicant to a civil penalty of not more then fore hundred dollars poop. **************d!*****************************************************3E*'*****1E***
❑ I.as owner d the Property o my empoyeea with wages as their sole compensation.%ill do the work.and the structure is not mended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Coda:The Contractors License Law does not apply to an owner of property
who Weds or improves thereon.and who doessuch work himself or herself or through he or her own employees,provided that such a '
improvements are not intended or offered for salewa
.E.however.the building or inprnem a on
sold within e yea d completion.the ZONING APPROVED BY DATE: '-.T-
owner-0wild«will have the burden of proving he or she did not Wild or improve for the purpose of sale).
ElI•as""n.ramd'
eLope .amexdmvay°°'madingw'ihEceaedccmtr.a«eNoom.Uadmeprated(sedmn'O"•Businessend BUILDING APPROVED BY : DATE: .'Jy
Professions Code:The Contractors License Law does not appy to an owner of property ego WNds or improves thereon and who
contracts for auth projects with a mmtedor(s)licensed pursuant to the Contractors License law). '
❑ lamexempt under Section: B.a P.C..for this reason: APPLICATION ISSUED BY: F FiF DATE: �E #
—e5-1
************************************************ ************** * ** **
Date: owns: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of and understand the requirements of Caiomle Health end Safety Code Sections 25505,25533.and
25534,and that I or any future building occupant will/wit not(circa one)need to compywih said state codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for conseu«ion or modification from the Air Quality Management District.Residential construction appications are exempt from these
provision& PERMIT 63 . 00 . 50
Date: Applicant: SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby aNnn under penalty of perjury one of the following dederalions: ISSUE FEE
❑ Ihave and will maintain acertificate aconsent toself-insure for w«kencdnpenwmn,as provided for bySwion3700ofthe Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,for the performance athe work for which the pendt is issued. TOTALS----> 63 . 50 0 . 00 0 . 00 63. 50 63 . 50 . 00
❑ I have and NI maintain waken'compensation insurance.as required by Section 3790 of the Labor Code,for the performance of the
work for which this permit is issued.My waken compensation insurance carrier and policy number are:
Gather: REVENUE DIVISION TOTALS--> COLLECTED: 63 , 50 OVER/SHORT: .00
Policy Number. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
at(�Th-nis section need nor be rompbfed/the permit is ler one hundred dollars(51001 or Ice.) 63 . 00 . 50
ra.J I candy the]in the pedormance al the work for which the permit is issued.I I not employ any person In any manner so as to
\ _ become subject to la workers'emanation tees d California:andf 1 should beome abled to iM workers' *******************************************************************************
X compensation provisions of Section 3700 o the Labor Code,I shall fort with those provisions. I N D I V I D U A L F E E B R E A K D O W N
Date:acorns
-7- Applicant:
Warning:Failure ro.sare ora,t.r.'eomo.rhe.aon coverage i.ant.cow,and.Ih.yt.ml.ar.n employer to criminal penalties:ne TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil lines w to one hundred thousand dollars($104000A In addition to the roar of compensation,damages as provided for In
Saacnon37O5oymeLaborCods,Intwastandalromeyslees SFR 3500 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 500 . 00
• CONSTRUCTION LENDING AGENCY:1 hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the parol is issued(Section 3097,Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS: '
I ceniy that I have read this application and stale that the above information Is corned.I agree to comply with all city and county ordinances tit 21 1 ,...1;"'_ h ' — - -
and stale laws relating to buildi construction and hereby authorize representatives of the thy to anter upon the propertyaboveL..-:ioned ., ._, -
for inspection purposes. J`` - -11' r _.
\)) R JU
/ Print Name --8.--.
Dae: 7
gnat of OwrNdAgenVApplfmnUContrect«
(5151-A0.WP) White-Building&Safety:Green-RI.:Canary-Appfunl:Pink-Revenue:Goldenrod-Assessor
M
CONSTRUCTION AND PLANNING PDL ,v 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 • •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
- 7. Footings 58. Electrical Conduit-Undrgrnd.
a. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 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 67. Fencing &Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-I 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 OGas 0O�1
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas Q Oil
25. RoofSheathing 3 L0- 6o-dr, 74. Overhead Hydra
•
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 7S. ARE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power Meter-Final k 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes;
34. Final Heating Air Conditioning a - r 4
& •
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
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations - -
47. FINAL STRUCTURE & BUILDING 7.2b,,.G]G �CQk
48. FINAL PLANNING LLCC�� •
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co _
51. CERTIFICATE OF OCCUPANCY
No Date
CITY Or COSTA MESA REQUEST FOR OCCUPANCY
•
TRACT NO, 7 )I,L3 - DATE y' X.,/777
, LOT• NO. .57.
/� /J •
• ADDRESS i
44007
v��.ci 2 c2
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 exe siting this agreement, acknowledges_
that (he-she-they) (was or were] 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.o
$Y�12r r/ 1,4 !hJ
Pu baser
• B& 'i_ .
'evelope ' .. oAGthorized
repres ntative
BY —
?`3r24 DEC -z-700 175* ***144.75
7, COSTA MESA BUILDING-SAFETY DEPARTMENT
- P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
/arc For Applicant to Fill in Completely APPLICATION)1FOR BUILDING PERMIT
ABUILDINGDDRESS �4 ��S RECEIVSD DATE RECEIVED�. FISSUEDD
/ /�/� i*.� ,-..../<e••••
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MAIL J / a BULDING
ADDRESSI / (p y /1� � J
ADDRESS �jy �/y /'�/ �� ll
w WTEL./ TRAC'�JQq� LOT BLOCK
a- U CITY `! `rev/'0 fP / Reit- N° .4.23'.3/.7712....I- 2
2 Q CONSTRUCTION �� NEW ADD ALTER REPAIR MOVING DEMOI ISH
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Q w ADDRESS �/ ``` �t
mm ARCHITECT v�ce4 ��-7 NOLg/77yG USE /,� � /r�N\.�
U N OR ENGINEER/J f//� ,s/ /� FIRE ✓ • q \/
W ADDRESS c..31-.:3�- 1 - DQa/j Ti///�/J ZONE TYPE ,iGROUP..7F(
p,W 1 -� APPROVED
JO CONTRACTOR ' �i ///zy1497// /./f BY DATE
m2 . C /
J m ADDRESS 21/3
so/ /R/' 7,% - �—i
W W TEL. ZONE NO.OF USE OF NEW7L/Oio.W/
ZI- CITY 4(t�a ,PT-- /�r„�/ `•NO�.#405133 jl PLANS BUILDING an- , /
W O STA E CITY YARDS APPROVED YARDS APPROVED
N K LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
7 O - , (FROM C/LAS^TREET)
SIZE /DOQ 4 /. INOW ON LOTS � FRONT i-CJ FT. r-/� FT.
^OF LOT b
USE OF
EXISTING BLDG..... -..,
LDG. R.SIDE `� J FT. FT.
I- O.OF
SIZE OF . /Ai a ROOMS 7 STORIES ^L.SIDE ✓ 6 FT' FT.
ZQ _NEW BLDG. �1
EXTERIOR Al ROOF �p��
U _COVERING /(JCIO COVERING �� �_, REAR U FT. FT.
•
d USE OF BUILDING AND WORK TO BE PE ORME DISTANCE BET. BET.MAIN&
1 - /�Th MAIN BLOCS. q� ACCESS.BL/OGSS.L
E
Q ��(-�i��L-C �� C UR51PQD�I��//�9 3'2O APPROVEDl1O /J--7d
V) _I— v//�// �r / =fry l l/V E.f .ISL / _DAT E /C -1—7 0
O
UI hereby acknowledge that I have read this application and state, HOLD FOR SPECIAL RFQUIRr'MFNTk
D that the above information is correct and agree to comply with
Ir all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of .L�,�J
co
Z the State of California. /g./.3 SO, FT. /�i�� '9
I hereby certify that I am properly licensed as a contractor under , o
the State of California Business and Professions Code,rDivislon 3, THE AMOUNT SHOWN UNDER A UATION IS FOR •
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A ERMIT FEE ONLY:
CC
am eye from`the provisions of the State alifornia Business VALUATION �D
end ofessions Code,DIvision 3,Chapt v�J7/ N
PERMIT FEE $ / YJ d
FormSIgnaa m
Perm a m0 L.'%%�J �' ` $ \ PLAN CHECKS E
///n/777 M�/\7/ / O
Authorized Agent /�C/Ui TOTAL FEE $ .......--a-
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