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Home My WebLink About598 PIERPONT DR - Building Permits4 JobAddress: S98 PIERPON7 DR Suite: Vicinity: ROOF Primary Occ: R-3 Dwellingsl Cong Res <10 Type of ConsW ction: V-N Parcel Number: 41802334 Zoning: R1 Applicant: SKIRZYNSKI, JOHN Address: 10782 S MEADS AV ORANGE,CA owner: FLATHERS FAMILY HOLDINGS Address INC GARDEN GROVE, CA 13872 WEST ST Contractor. SHARP ROOFING Address: 10782 S MEADS qV ORANGE,CA Zip: 92869 Arch : Address: Zip: Phone: License: Phone: (714) 771-0118 Zip: 92869 Phone: Zip: 92843•3913 Phone: (714) 771-0118 License: 571575 Eng: Address: ISSUED BY: StaWs: ISSUED Applied: 08122/2005 Issued: 08/22/2005 Phone: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 7116" OSB, 1 LAYER OF 15# FELT, GAF, 30 YEAR COMPOSITION SHINGLES FOR 15 SQUARES FOR S.F.D. DOES NOT INCLUDE FLAT ROOF. ' ��, FEE SUMMARY Pian Check: $0.00 Permit: $12525 SMIP Res: $0.55 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Calc Valuation: � � $5,500.00 Claim Valuation: 85,500.00 Total: $125.80 PLANNING 8 ZONING , SETBACKS MAINSTRUCTURE Front 0-0 �". Rear 0-0 Left 0-0 �� Righ� 0•0 � ACCESSORY Front 0-0 . Rear -0-0 Left 0-0 Right 0-0 PARKING Existin : 0 Reauired: 0 Pr000sedc ' 0 NOTICE: The work authorized by this permit shall comply with all applicable 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 not commenced within 180 days, or if work Is suspended or abandoned tor 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 cades, end ell required Inapeetlons end finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 �«o-.o �vw) WORKERS'COMPENSAnON DECLARAnON: - I hereby eflirm untler panelry of pa�lury one oi the following tleclare0ons: ❑ I have end will melniein a certificate at consent to self-Insure for workers' compensation, es provlded for by sectlon 3700 of the Lebor Cotle, for the pertortnence ol the work tor whlch ihis permlt is Issued. ��I'Aave antl will alnteln worKers' canpensatlon insurance, es required �y section 3700 of ihe Labor Cotle, tor the pertortnance ot the work for which this pertnit is Issued. Mywark cro an �n Insu�r}nce carder entl policy number are: `Cartier: F� �U`��/ �P.olicy.Nw��ber._ Z�S dDZ� 2D O� rf7hls sectlon need nof be crompleted ll (he permit ve/ued af e hundretl dollers ($100) or less.) ❑ I certify that in the peAorman of ih o r w�ich is ermit is issuetl, I shall nol employ any person in eny manner so as to become subject to t�e workars' compensatlon laws of it ni , an a become subject to the workers' compensetlon provislons ot Sec lon 3700 of the Lebor Coda, I shall forthwit� mmply with these pr is n. ��r+-':::.' � A�pGcant'SigneN�e: D'ate:_�� —U�% Z— � �� WARNWOrFA1CORE TO SECU WOPKEfiS' COMPENSATIIXJ COVEMGE IS ONLAWFUL AND SFULL SUBJECT AN EMPLOVER TO CRIMINAL PEM10.LT1E5 AND CIVIL FlNES UP TO IXJE HUNDFED 7:~TIOUSAND Dd1ARE (5100,OW), IN ADDITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR W SECTION 31080F THE IABOR CODE, ItJrEREST, AND ATTORNEI"S FEES. LICENSED CONTAACTORS DECLARATION: I hereby aHlrtn t� m,llcens r pja � f Chapn r 9(commencing with Sectlon 7000) of Dlvision 3 oi !he Buslness antl Profes 'ons Code, end my license Is In tull force.aM eHect. Lic. a -- 7 e assl"^ M `p-' .� - 3�C C'�� d�e:.._.r.- - tB: 0.�2 Q)� _ �N_ � CONSTRUCTION LENDING AGENCV: ❑ I hereby ettirtn Ihat there is a�nsiruction lentling aqency for iha pertormance oi the work tor which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lentlers Address: Signature: Date: OWNER-BUILDER DECLARATIONS: � I hereby effirtn Ihat undar paneliy ot per�ury thal I flm E%EMVT FROM THE CON7RACTORS LICENSE LAW to� Ihe following reason (Sec. 7031.5, Business entl Prafesslons Code: Any ciry or counry which requires a pertnit to conslrucL altar, impmve, tlemolis�, or repair any aWCNre, prior to its Issuence, elso requlres the applicant for such permit to fila e signed stetement that he or she is Ilcensetl pursuant to the proNslons of the Cantrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 o1lhe Business entl Pratessions Cotle) or that �e or she is exempt therefrom end the besls for t�e elleged exemptian. Any vloletlon of Sectlon 7031.5 �y any epplicent for a pertnit subjecis the epplicent to e civil penelry af not more Ihen fve hundred dollars ($500).): ❑ I, as owner of Iha propeny, Or my employees with weges es iheir sole compensation, WILL DO THE WORK, and the structure Is not intended or oHered for sele (Sec. 7044, Business and Professions Code: The Contractors License Law does not appty to en owner of property who builtls or improves theraon, end who does such work himselt or herseN or through his or her own employees, providad ihat such improvemenis are not intentled or ottered for sale. II, howaver, Ihe building or improvement is sold within one year of completion, the owner-builder will have ihe burden of proving that he or she ditl not build or impmve tor purpose of saleJ. ' ❑ I, es owner ot Ihe Oroperty, am EXCLUSIVELV CONTRAC7ING WITH LICENSEO CONTRACTORS ro wnstruct Ihe pro�ect (SecJ044, Business end Professions Code: The crontractors Licensa Law does not apply to an owner ol proparty w�o builds or Improvas thareon, and who conirects lor such project with e cron(ractor(s) license pursuent to the Conirectors Licanse Lews.). ❑ I em e:empt under sec. Business and Prolessions Code for this raeson: Signature: Data: Owner ID vBrtlled by dnver'Slicen4e. ❑ Y83 ❑ Na Drivef5 License No. Ezplres: Ved9callon of Ownershlp Dy (type a� document, I.e. - properry taz 6111 or tleed): DIVISION OF INDUSTRIAL SAFHn' PERMR CERTFICATION: ❑ I here6y cenify thet no excavetion five (5) or more feet in depih imo which a person is required to descend, will be made in connection with work authodzetl by this pertnit, and that no building 6�Nctura, scaHolding, falsework, or demolition or disman�ling thereof, will be more than thirry-six (36) teet high. (Chap. 32, Grp 2, Art 2. Sec. 347, Title 8, Califomia Admin�sirative Code). ❑ As owner-bulltler, I wlll not employ enyone to do work which woultl require e pertnit Irom the Division ol Industrial Safery, as noted above, unless such person has e pertnit to do such work irom tha division. Signature: Date: Division ol Industrial Safery Permil Number: ARDOUS MATERIALS AND EMISSIONS CEFTIFICATION: Wlil ihe epplicant or present o� fuWre bulltling occupent neetl to file end tertlry a Business Plan for emergency response to release or Ihreatenetl release of a hazertlous metenel7 ❑ VB5 Q NO (Seciion 25505 of Ihe Celitomia Heaith and Satery Coda requires, with some exceptions, that a Business Plan be tiletl with the Gosta Mesa Fire Depanment by every busineu which has at eny one tima Cunng a reported year a Quantity ot hazerdous matenals equal to or greater than a weighi of 500 pounds, or a volume of 55 gallons, or 200 cuhic teet ot compressed gas at standard fempereture and pressure). ................................................................................................................................................................................................................................................................................_............................................................"'..........._._... Does or will the applicant or p�esent or tuture building occupant need to file a registration fortn for acutety hazardous materials? ❑ Yes ❑ No (Sectlon 25533 oi the Calitom�a Health end Safery Code, with some esceptions, requlres registration with Ihe Costa Mese Fire Depertment by each buslness which et any one time hes on hend e qua��ity of acutely hazerdous materlals equal to or qreater then e welght ot 500 pounds, or e wlume oi 55 qellons, or 200 cu6ic feet of compressed gas et standerd Cempereture end pressure). _...._......_ ................................_. """".._.._._....................................................._.__............_....__........................................................._........_..._............................................................__............_.......... Does or will the aDD�� or present or future Guiltling acupnN neetl to prepare en RMPP (Risk Management entl Prevention Program lor ecutety herardous matedals)9 (Section 25534 of Ihe Callforn�e Health end Safety Code pmvides ihai �he Coste Mesa Fire Depatlment may require ihe preparation, ceRificatlon and filing with ihe Flre bepenment af en RMPP by businesses which are requlretl to register ecutely hezertlous metedels with the Fire Department. 4 It an RMPP is presently requifed, hes Section 25534 0l ihe Calilornie Health end Setety Catle been fully complied with7 ❑�Ves ❑�No ...................._..._._......................_......................................"""—'...........................................................__....................._............................................._..................._.........__..............................................._._.............._......_., 5 Does or will the appllcam or present or future bulming occupent require br the work wNch Is Ihe sub�ect of this e�pplicatlon a permit tor such construdion or modificatlon irom Ihe South Coast Air �uality Managemeni Distrlct or Irom eny other eir pollution con�rol disinc� or egency? �J Yes �J No (Section 65850.2 of t�e Calitomia Govemmem Coda requires Ihet ihe requested infortnetion be tumishetl on aDPlicetions br nomresidential building pertnlLs). ...............................__................................................................__...__......................................................................._......................................................................._......_.._ .............._....... ................................___......�............. 6 WIII any part ot Ihe faciliry to be constructed under this permit be within 1000 feei trom the outer boundaries ot a school7 ❑ Yes ❑ No (If'yes", the faciliry must mee� ihe requirement of Sections 25534 antl 42303 of the Califomia Heelih end Safery Cotle). .......—..........._...._.._...._ ............................. ..................__._.............................................................._'_.....................................................................""'_'___......................................................._.................._.................... 7 It e permit fmm the South Caast Air Oualiry Menagement DisMct or other air polWtion control distnct or egency is required for Iha work which Is the su6ject oi Ihis eppliwtion, �ave ell of the tlisclosures prescnbetl by Celifornia Health antl Satery Code Section 42303 been metle? ❑ Yes ❑ No ......_._..........._..__...._ ........................................._......._"__............................................................."__......_.............._................................................._....._......__.........................................._..............."_.._....__".... B Qf'yes", anach cenificate ot campliance Irom the eppmpriete eir pollmion wntrol otficer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury ihe iniormation given above is correci. I e9ree to comply with all state laws flnd ciry ordinances regarding Hazartlous Matenals antl Emissions. Signeture: Date: CERTIFlCATE OF COMPLIANCE AND AUTMORIZATON Of ENTRY: I cenify under penalty of perjury that I have read Ihis epplication end state that the information given is correct. I egree to comply with all stele laws entl ciry ardlnances relaling to bullding construc�ion, antl euthorize representetives of the Ciry of Costa Mesa to enter upan the ebove-descriDad property for insp�ction puryoses. I agree not to xcupy or ellow occupancy of any building euthorized by this pertnit umil tinal inspection. COpE�, INSPECiIONTYPE 1616 Fizetl System Flnal Fire 7�eventlon 1266 200 201 202 203 204 Pool Spe Finel Flnal Re-Root Finel Blak/Reteining Well Final Factory Fire Place Final Sign Final Demolition OpTE � 2 COUE I INSPECTION TYGE 206 Final Mechanical 20B 270 212 220 222 250 Finel Plumbing Finel Elecirical Finel Flre Prevention Final Planning Approval Final Site Final Building/Occupency � � unrv[rc p�,qi'HP;kiS, A. E. JOB ADDRESS yp� piP,.,,,, UA i C ,�l.-1Z ./J BUILD�NG PERMIT NC 1 :CTIONS Si narure Daee TYPE GROU s� _ cns SUBCONTRACTOR wnrea plum6in ROUGN PLUMBING PROP. SWR. LINE � HOUSE CON. SPRINKLING SVSTEM ii0l1GM HEATING RNO AIR CONDITIONING 'UNOERGROUND U POWER U ROUGH WIRING TRENCHES � FORMS � STEE' F�OOR SVSiEM BONO BEAM � STEEL REINFOR� SHEATNING FRAME ANO FLASHING �r�� ...� „��.., - .�. � ..... PLASTER, BROWN LOAT �� ST^^CTURAL. FINAL ( h IG. VENT., REFFIG. AND A.C., FINA� PLUMBING, FIN>L RND GAS TEST ELECTRIC, FINAL � BUILOING, FINAL i�� - �.� . i�J'.�L� e,�� , _-�� .�� '�L_,�� iPGG / Z �- .5 -7y �fi� g'tG i t -`L- � 4t`?836 COSTA MESA BUILDING-SAFETY DEPARTMENT ��,�./� ,��r 17-7�'�.—.o'I,�n ' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only FE IV D BV D TE RECE E DATE ISSU BUILDING r p O /� � Z� ADDRESS J O .E. /—�AT 7G/4i g �j'� P M O OWNER A.P. NO. MAIL BUILDING ADDRESS �J � /'/GiC'/'dNT ORI �C �+DORESS � g � TEL TRACT LO BLOCK CITV �S'� NO. CAN5TFVCTION r L a W AD ALT P LENDER C. BRANCH OWNE , �. ADDRESS VALUE � ARCHITECT TEL. SE ' $ OR ENGINEER � N . FIRE A�DFESS ZONE TVPE GROUP CONTRACTOR S� L� O� ByPROVE OATE � ADDRE55 � TEL. ZONE NO.OF USE OF NEW � CITY NO. P�� BUILDING �1� STATE CITV �'ARDS APPROVED VARDS APPqOVED LIC.NO. LIC.NO. MAINBUILDING ACCESSORVBUILDING SIZE / i +� NO.OFBLDGS. (FROMC/LST EET) OF LOT !O J � C�/ NOW ON LOT RONT � FT. USE OF /� EXISTING BLDG. T. V FT Separate permits are required for L SIDE FT. � Fr. electric, plumbing and heating work. � REAR FT. FT. VSE OF BUILOING AND WORK TO BE PERFOFMED DISTANCE BET. BEf. MAIN & MAIN BLOCv^. ACCESS. BLDGS. � VAF.# DATE / C.U.P.# FOVED APPROVE . / , . . v I hareby acknowletlpe that I heve reatl ihis application antl stata � r that the above Informetion Is correct and agrea to comply with � all laws re0ulating bulltlinB construction, and 1 shall noi employ any parson in violetlon of the workman's compensatlon lews of , the Stete ot Cnlifarnle. � n , I hereby certity that I em propetly Iicensed as a contrector under 1�� SQ. FT. c ihe State of Californle Business entl Profeuiona Code, Division 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR [ Chapter 9, entl that such licenses ere in tull forca and otfect, or I THE PURPOSE OF ESTABLISHING A PERMIT E ONLV: ' am ezempt from the p�ovlslons of the Stete of California Businesa VALUATION PERMIT FEE 8 � antl Professlons Cotla, DWfsion 3, C pter 9. •�"a � �� l - I/ � PLAN CHECK E `�,d � Slenature of / y ,/ Permlttea �l/ $ 7O "� � TAX $ • �O ' � � t Authorized A Bent � T O T A L P A I D E �I Ff,ATHF:RSi LUP �JOBADDRESS Sq8 Pierc�or �1,-GENERAL CONTRACTOR pwne �� AP No. 418-02�-�4 LOT lt �r�LL,,�cnoNs 3�as `. W ATER ROUGH PLUMBING PROP. SWR. LINE � NOUSE CON. � SPRINKLING SVSTEM ISCELLANEOUS ROUGH HEATING AND AIR CON�ITIONING TEMPORARV SERVICE OR POLE UNDERGROUNO � POWER � ROUGH WIRING TRENCMES � FORMS � STEEL RE FLOOft SVSTEM � BOND BEAM ❑ STEEL REINFORCE I SHEATHING FFAME AN� FLASHING LATHING - IN n OUT ❑ PLASTER, BROWN COAT STRUCTURAL, FINAL HF 'G, VENT., REFRIG. ANO A.C., FI'� PL ,ING, FINAL ANO GAS TEST n ELECTRIC FINAL Dafe ✓�� 11 LV W SUBCONTRACTOR �25.00 i �! _ _ �„ , A- ..u��dL CIIt�� v/-�R�% � , �e �Q �a-� �,� . �[��7/ 1FiV l ' ..�%�-G!' �`�—�F�IP •-� '��t = ,. �e� �`,c"r� °/� 1�- ��.o�-��-@-i TJ'(.V � I � �� ,��'`-�p � .�...��.�. �� .��, �-�P� .��r,. .��.�.Q��. �r �'� � �� - �.� � d �,.u-�� 2�oc�' � � � ,� ' c�cc�� //��'�� -� �� .�..u..C>P ..-�.�� J�-� p�� `'� �� ` �� - �� ,2� �� -�� : � �"" 26577 , `, COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 - COSTA MESA, CALIFOHNIA 92626 For Appilcant fo F711 In Completaly TYPE OR PRINT eui�o�No � O ADDRE88 COSTA MESA. CALIFORNIA ■ MAIL s�ze OF LOT USEOF BUILDINO SIZE EXTERIOR WAWC+-PI � COVERING �\V 1 HERlBY ACKNOWLQDf ANo eTAT6 TH�T TH6 � PLY WITH ALL CITY OR lYILOINa CONBTRULTIG SIGNATtJRE OP P6RM17T66 AUTHORIZCD AG6NT � TCL xo. \ RIOHT OF WORK JAN 30-67 00 931 *��* 12II.25 APPLICATION FOR PERMIT BUILDINf3 Fo� Office Use Only .�.�� o. � h��77 �r - wn nceu c7 � � ipat�7 � /—/ —� u ZONING NO. O� UD[ OR NI �/ /LAIU a OY�LDIXO YARGE MPROV HD MAIN BUILDIN6 � vwFe..# � � iANO SHALL B8 LF88 THAN YARDSAPPROVED ACCE980RY BUILDIN6 nwre +� V I COVERINO V V`IiS.JV e� �/ DAT! //— W04tK`T B P[RRO M[ �� p' i.i� � -A N �. �. A' � TXAT 1 HAV[ RBAD THIB APPLIGTIOH TX8 AMOUMT DMOWN UNDBP VALUATION IB FOR TH6 j iV 1/ CORRBGT ANO AORB[ TO COM• �U0.P08[ OP [BTAGLI6XIN0 A PERM�T PHe ONLY. S U AND RA� R[OIILATINO VALUATIOf� ///�� PERMIT FEH S ��O � _ Is�'16i,� _. ... _..___ .�.�� W UWNtK ,Tj.A`I•PL,RS� DON JOB ADDRESS 598 Pierooni GENERAL CONTRACTOR A��' AP No. none LOT l� `I' ?CTIONS 1�5� GAS WATER ROUGN PLUMBING PROP. $WR. LINE � HOUSE CON. � SPRINKLING SVSTEM MISCELLANEOUS ftOUGH HEATING AND AIR CONOITIONING TEMPORARY SLR�ICE OR POLE UNOERGROUND ❑ POWEft � ROUGM WIRING TRENCMES FORMS � STEEL PE F�OOR SYSTEM BONO BEAM STEEL REINFOACE ( SHEATHING FRAME AND FLASHING LATHING — IN n 01 PLASTER, BROM'N COAT ST""^TURAL, F�NAL N ,G, VENY.. REFRIC PLbm61NG, FINAL AN� G ELECTRIC, FINAL BUILOING, FINAL DATE BUILDING )UP J TYPE' SUBCONTRACTOR - �� 27423 t COSTA MESA BUILDING-SAFETY DEPARTMEPR P.O. BOX 1208 COSTA MESA, CALIFORNIA 926M For App11mM to Fill In Complefdy TYPE OR PRINT COSTA MESA, CALIFORNIA. ucTNo. /�S/02 No�'vr'�%S�/Z/ 6RE ry (J Ho. o� eLDo�. OF LOT �I X z} T] NOW oN LOT U88 OF E%ISTIN6 BLD�. BeTBACK LIN6 PPOp /� CGNTlROPBTpBR IISARYAR Co/ SIOQ YMO I LQFT �/ �r � rl p10NT �� DESCRIPiION OF WORK WALL 1 XBRGY ACKNOWL[DO/ T{�AT.� X�V6 RGO YHIY M�L�GTON I1ND BTwT6 TNAT TXt 11pOVL.IB COqR[C} ANO AORB[ M COM. PLY WITH ALl CITY ORDINANCY AryD �TAit LAW� P OYL�A�TNO GYILDINOCONBiRUCT� ,�Sa�<� 816NATUR! OP � P8RM1TT6 wurHOR�z¢o wa¢rrc i.�;� � , � PdFL � .:.i:i:�8.1�.'C .1UG-9-67�t�y�00 57�:�*... nuc-9-6��.a00 s�cL�::�::.:•:::�.,:. MPLICATION FOR PERMR SUILDING For Offlc� U» Only T R[C[IIT NO. I ��i I -r--- ZONING �usa eun �.sow� YARD6 MPROVED MAIN BUILDINO (FROM C/LYTN6[T) vwrz. # BHALL EH LC86 THAN YAR�9APPROV6D ACCH880RY BUILDIN� �AT6 TN6 AYOUNi /HOWN UHDlq VALUATION 19 FOR iN8 ►URPoB[ O! 661AG48HIN0 A PCIiNIT PEB ONLY. a m � � � � Pi E w° %, tlOV 18-68cMsti�O 789 0 *fi**3.00 2937 � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. 60X 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT ,, For Applicant to Fill in Completely RECEI ED BV DATE R CEIV DATE ISSUEO BUILOING r D �EKPo�vr DT. / ADORESS d �J OWNER DON A �W- ES E � TNER� A'P' NO. � — U — 3 P LS NO J BUIIDING t � 'F a �� MAIL / ADDRESS J 'M/t Z ADDRESS � O ER00 T d U CITV �OS TN /�� E S�. NOL TRACT � LOT BLOCK ZZ Q CAN5TFUCTION W ADD P O N LENDER am � BRANCH OWNER m J ADORE55 � VALVE Jm ARCHITECT TEL. 5 5 a OR ENGINEER N S� U Q FIRE �_ w� ADDFESS ' ZONE TVPE GFOUP aW W Z 0 W C Q APPR VED / — J O CONTFACTOR BV DATE m Z J � ADDRESS w w TE�. Z NO.OF USE OF NEW � � PLANS 'y BUILDING Z � GTV NO. w� STATE CITV �'�+flDSAPPROVED VARDSAPPROVED y� LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BVILDING 7O (FFOMC/LSTREET) �- � � ' SIZE / NO.OF BLOGS. � OFIOT ��'�Q NOWONLOT / ROM FT. F. a USEOF D,b�,u.t3.� 31°�6�1 EXISTING BLDG. � SI T. O FT F SIZE OF NO.OF Z NEWBLDG. ROOMS STORIES L.SIDE FT. �FT� U EXTERIOR WALI ROOF COVERING COVEPING REAR FT. �P'� J USE OF BUILDING AN� WOftK TO BE PEflFORMED DISTANCE BET. BET. MAIN& a MAIN BLDGa. ACCESS. BLDGS. 1 Q ��J VAR.3k DATE � _ltl /- C.U.P.� APPROVED F APPROVED � y Z � 0 UI hereby acknowlatlge that I have reatl this application antl stete � thac the above information is correct antl apree to comply with � all laws .eawa�i�a builtlinp ronsiructlon, entl I shall not amploy � any person in viola[lon of the workman's compansetion laws ot y the State ot California. � zI hereby cer8fy that I am properly licansetl as a cOntractOr untler SQ. FT. O the State of Californle Business entl Protassions Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR � Chepte. 9, antl that such licenses are in full force antl eftect, o THE PURPpSE OF ESTABLISHING A PERM�T FEE ONLV: ¢ em exempt t the provisions of�the Stero o( C' nia 8 ness VALUATION antl Protessi s otle, Division 3, Ghepter 9. W � %� PERMIT FEE S � �/ _ / � 7 SIB^atura of 1 �, ^ m Parmittae >' /T .V § /�y� '� p�qN CHECK $ �� E . _ V� `o Authoriza ga t ,�J LL TOTAL FEE S `J- �