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Home My WebLink About1173 PRINCESS CT - Building Permits • t` 9 CITY OF COSTA MESA BUILDING DIVISION fn 1, IP• :' /,I DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER PERMIT B03-00065 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa BirLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1173 PRINCESS CT Status: ISSUED Suite: Applied: 01/14/2003 Vicinity: Issued: 01/14/2003 Parcel Number: 41207328 Zoning: R1 R1 Applicant: RON SELL SPr Address: ISSUED BY: Phone: 714-528-1758 Zip: Owner: MELLINGER, BARBARA Address 1173 PRINCESS CT Phone: COSTA MESA,CA Zip: 92626 Contractor SELL ROOFING COMPANY Address: 18032 LEMON Phone: (714)528-1758 YORBA LINDA,CA Zip: 92686 License: 323842 Arch : - - Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT T/OFF AND REROOF 2700SF RESIDENCE W/EAGLELITE LT WT(5.8PSF MAX WT)ROOFING;1030#4660 FEE SUMMARY • Plan Check: $0.00 • Calc Valuation: 58,900.00 Permit: $167.25 . Claim Valuation: $8,900.00 SMIP Res: $0.89 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $168.14 • • 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 NOTES: 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 fora 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 244e-48(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'comp eti o Insuranjacerrier and icy number are: / Carver: .4 !-�7 Policy Number: ! G� L $�,� (This section need not be completed if the permit/s allied et 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' compensation laws of California,and agr t If I should come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: (/h4.77 Date: c--F —0 3 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADOITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisionse5 Fp. ter 9(commencing with Section 7 )of Division 3 of the Business and Profession Cale,and my license is in full force andeffect.LIC.e ?j 2 71 // Class a !�— 3 / Contractors11- Signature: ,y / Date: /U / -O 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.It,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,am 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers 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 bo more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California 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 Safely 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 to 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 then a weight of 500 pounds,ora volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). ._... _ ..._ �. _...._... .__....`_ — 2 Does or will the applicant or present or future building occupant need to filo 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 than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). li— __..____ __r...___..__..._._(..._ _ _. 3 Does r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for eatery hazardous materials)? ❑Yes No (Section 25534 of the California Health end Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and 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 application a,,ppermb for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .__.. _...it__._.1000 feet__._ armories WTI any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If Cee,the facility must meet the requirement of Sections 25534 and 42303 of the California Health end 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? 0 Yes ❑No _...pollution 8 (If yes',attach certificate of compliance from the appropriate air plluticontrol 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 properly for innsre inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. trim Of Le s) / Date/ y / And/Or Applicant G/ Date / —O CODE I SISPECTIOfLTYPE QLIE S'ID9l5 CODE! IWSPECTION TYPE QAIE INT1BALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof /-22n9 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention _ 202 Final Feclory Fire Place 220 Final Planning Approval _ 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 4,66"41/4D CA - Y OF COSTA MESA O Qtk Y CALIFORNIA 92626 P.O. BOX 1200 r CalI- 1 F J �. .4 FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY 4Cceo • Project Address / 1 73 Pj _n4,e7tw.a e/ . Permit # Project Name / // Type Owners Name A L/) L3, P / EL-2M 27i owners Address / / 7, 3r ''�C/K ,ezO � City Use Only Owners Telephone ,53-7—/33O i I , 3 J�(!t/7 Al ��,yl ct.P5 Owner, Contractor, Agent (strike out all except one) do hereby attestahat employment of any person, or persons, is not anticipated at the time of seeking the above-referenced permit. In the event that any person, or persons, are employed under the provisions of this permit, I shall immediately cause a valid Certificate of Workmen Compensation to be filed with the Costa Mesa Building Division. I agree to defend at my own cost, and to indemnify and hold harmless, the City, its officers, agents and/or employees, from and against, any and all liability, damage, costs, losses, claims and expenses, howsoever caused, resulting directly or indirectly from, or connected with the improvement under this permit. I further state that I have read and fully understand the implications and re- sponsibilities of the above statements, and will comply with all provisions of the Contractors State License Law found under the Business and Professions Code, Divisionvi/ 3, Chapter 9, offI the State of California. /�/ 2�3 /a/z / /9 A lCLL-//VC /2., print Name Signature Date CMF 0777-46 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY*OF COSTA MESA P RMIT NO. q ' TRACT NO. LOT NO. •BLDG.NO. 11968 g/I t�6 I I.I6o r t 1 CONSTRUCTION PERMIT CI MC < 6 :031`7 Z5 Project Address b•T 3 7.4'/w+ce a-) Cr. C.IT. TYPE OF CONSTRUCTION / / - - Owner 4 ,bed4 Me//<siq P1 Phone 67-133x❑ NEW ADD 0 ALTERATION //(y�x/�V"/. Address/(73 ?AJ,/cc•55 Cr ((C• 11, ❑ REPAIR,❑ CONVERSION ❑DEMOLISH l - Arch/Eng. License No. 0 OTHER y ZONING REGULATIONS Address DESCRIPTIONOFyWORK 3o5 •A '14o-t eQdh7/a,•• A.P.,-F `-+IZ - n73 Zi Address Contractor /qJ�� Phone ?� .2"Ili snA/ A� - ZONE R_(10 PLNG. REF.4c L/ TYPE OF PERMIT SE BUILDING"' TO BUILDIt 9 /_t / AddressSETBACK C/L$T. PROPERTY LINE IW O� 0 GRADING 0 FOUNDATION 0 STRUCTURAL WARD O/O♦ LICENSED CONTRACTOR DECLARATION • ❑ TENANT 0 ELECTRICAL ❑PLUMBING ❑MECHANICAL LSIEDFET YARD eQ/ I hereby affirm that I am licensed under provisions of Charter 9(con' 0" mencing with section 7000) of Division 3 of the Business and ❑OTHER Professions Code, and my license Is in full force and effect. REAR YARD(TO P/L) f()' O" PQ.FT. DESCRIPTION PKG.SPACE REQ. PROVIDED '-- License Class License No. y Date - - - Signature SQ.FT. 3o-/ .w 2ir.„min.. -- WORKERS' WORKERS'COMPENSATION DECLARATION OCCUPANCY /"�'3 CONSTRUCTION TYPE STREET WIDTH PARK FEES ' I hereby affirm that l have a certificate Of consent to self-insure or a -VALUATION rot-10%-f--ZONE ZONING APPROVED BY Dpr,J r.2 DATE CIIIIi{I / 81 certificate of Workers' Compensation Insurance. or a certified coPY moi! , re f (Section 3800, Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS: . 'V No. /I8ink /SO Company frinrinr7 . .Certified copy is herebythr e REAR Si qw•si�`- J - 71/00�d r r/ 1�� '❑ Certified copy is filed with the city Building Division. `L, .uz car < EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred - - - - - - - (§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 PLUMBING PLAN CHECK ELECTRICAL s Off) PLAN CHECK subject to the Workers Compensation Laws of California. - BATHTUBS SHOWERS UW LLLI N(a (aA HA(aE VA Date Signature SQ FT Soy V' SQ FT s NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE 10-50 KW 50+ KW revoked. . CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP I hereby affirm that there is a constructiorl,lending agency for the per- 'SERVICE SINKS SUMPS . . (INC.SOLAR) ,10-50 HP_50+HP formente,of the work for which-this permit Is.lssued (Section'3097 • - �'t� - , f FLOOR SINKS . FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lender's Name ' - - • Lender'sAddress DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS,.\' � `•' - .. POLE LIGHTS I hereby affirm that I am exempt from.the Contractor's License Law for the following reason (Section 7031.5 Business and Professions Code: .SWIMMING POOL P TRAP ,LUNSI HUI-11UN Any city or county which requires a permit to construct, alter,. POLES METERED SUB improve,demolish or repair any structure, prior to its Issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB quires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS • - :SERVICE AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the • 2--iness and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT •..WI. ` 7for the alleged exemption. Any violation of Section 7031.5 by --. . P miore tfor a than fivermit subjects the hundreddollars ($5applicant to a civil penalty SEWER CONNECTIONS eft? as owner of the property, SOLAR TANK COLLECTORS sel_.eernpewla rOlrlwill do the work, and the structure is not intended or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE _ 3 Contractor's License Law does not apply to an owner of a property � y// fit, / who builds or improves thereon, and who does such work himself or ISSUE FEE APPLICATION APPROVED BY ' DATE /J///�) through his own employees, provided that such improvements are not ` 7 intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK is sold within one year of completion, the owner will have the burden -/SUMMARY OF FEES • of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDINGERMIT § Iy'.5 (� SMTP $ A. 63 o I, as owner of the property, am exclusively contracting with AND DUCTING licensed contractors to construct the project (Section 7044, Business 100.000+ BTU PLAN CHECK .$_41S.,�1 PERMIT and Professions Code: The Contractor's License Law does not apply to ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from such projects with a contractor(s) licesned pursuant to SYSTEM _ . GRADING $ the Contractor's License Law). 100,000 + BTU ,, PLAN CHECK S q _L ❑ I am exempt under Section B. & P.C.for this $ BOILERS BTU ELECTRICAL $ L•+s V reason MICROFILM $ Date Owner SYSTEM REPAIR,ALTERATION PLAN CHECK $ TOTAL FEE$ / V1.11MECHANICAL $ > • I hereby certify that 1 have read this application and state that the above EXHAUST SYSTEM MULTIPLE LESS AD- - information Is correct. I agree to comply with all city and county �f -PLAN CHECK $ VANCE PC $ ordinances and state laws relating to construction,and hereby authorize Re ifre r a— ' representatives of this city to enter upon the above mentioned �" / property fans•Jction pur.. 'sig._ 4 Cy/ FINAL FEE $ ��G' •/ DriverSignats' _ e L � Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL&SPA ' . APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector^a 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn - • 48. APPROVAL TO COVER-GUNITE 7. Footings - 49. Electrical Conduit-Undrgrn . 8. Foundation • 50. Gas Pipe, ❑Undrgrn,Test • • 9. Water Pipe-Undrgrn - • . 51: Backwash Lines. P-Trap. ❑ Undrqrn 10. Structural Floor System - 52. APPROVAL TO DECK - - - - - 11. Property Sewer Line & House Connection • 53. Backwash & Receptor-Final .• • 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55 Plumbing System -Final - ' 14. Rough Electric-Conduit - - _ 56. Electrical=Final 15. Rough Electric-Wiring - /®/-i) ,_ ._ - 57. Solar System-Final 16. Rough Heating & Air Conditioning .. - 58. Fencing & Access Approval 17. Ducts, in Structure • - 59. APPROVED FOR PLASTERING . • 18.. Ducts, Ventilating • _ 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL , • 20. Roof Framing 21. Roof Sheathing 22. Frame and FlashingS c NOTES: �/ / T (S�o eo'�e� (o-6-S/ [��"7 H�� c/a�o�t d�ff'� /'�a ' .„., f.--Z.::•-o--7 23. Insulation y� p.e�-.u�...Lr.«.3• a S C/a'if ' /o-r lc// . 24. Lathing & Siding f c.o-w.o .n„a ...--/--.,...0-..(2. - to- G-.&/a"37 -. 25. Drywall Nailing /.9-8-9/ 7C'yy? / / 4 26. Plaster Brown Coat f� ,aiLe 4.i 4' /O-.3C7-s/ /.'Ct2 fins ' 27. Electrical Power Meter-Final / . 28. Final Electric %/-3-Fl RG 29. Final Heating & Air Conditioning /,-/-$7 TQC.. . 30. Final Gas Pipe-Test 31. Final Plumbing _ - - - 1 32. Water Service-Final 33. Gas Service-Final ' 34. Solar Domestic-Final 35. Landscape Sprinkling System ' 36. Sound Attenuation . - 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING /1-5-V1 iec- _ 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. - - ' 42. CERTIFICATE OF OCCUPANCY _ • . No Date . . r.. j 1 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 * 3807 2/2.1779 342.31 Ti APPLICATION FOS tU F�kikEtMIT 342.31CKTO For Applicant to Fill in Completely— Use Ink Only 81177 rin ,i I9I A MR E D V DA -E-RECEIVED DATE ISSUED BUILDING //?— ADDRESS Tract 10277, Lot 26 PERMIT NO. OWNER McLain Development Co. A.P.NO. 1/42-07/—O }/ • BUILDING MAIL ADDRESS /� ADDRESS 1470 Jamboree Road 7 3 P/wweara,o L.6'4tir TEL. TRACT 10277 LOT 26 BLOCK CITY Newport Beach NO. 640-6800 CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMN1 LSH LENDER \J BRANCH /� /� OWNER 62151/217I a . LDDRESS VA LIEL ARCHITECT TEL. OR ENGIN ER Corbin/Yamafuji NO. 752-5567 OR 4/An: 679, s sq Tv!/ FIRE TtL ADDRESS 3661 Spruce St. , Newport Beach ZONE TYPE GROUR.L V APPROVED CONTRACTOR McLain Development Co. BY DATE ADDRESS 1470 Jamboree Road TEL. ZONE NO.OF USE OF NEW QE CITY Newport Beach NO. 640-6800 PDRm - o PLANS BUILDING /C F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. 273875 LIC.NO. MAIN BUILDING ACCESSORY BUILDING IQ SIZE NO.OF BLDGS (FROM C/L STREET) 0. OF LOT 45 X 100 J NOW ON LOT FRONT .2 S FT. O FT. USE OF EXISTING BLDG. R.$IDE S FT. 0 FT. rA (—• Separate permits are required for L,SIDE S FT.45 FT. A electric,plumbing and heating work. REAR /7r•' - _- - -. - FT. 0 FT. - USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& MAIN BLDGS. ACCESS.BLDGS. DATE :1' Single family residence, cU.PR..# -78'-39' APPROVED 227/7)' .-1 New House ROVED^��[/.W i� DATE /s/79 CC.- w MOLD FOR SPECIAL REOUIREMENT. 0 I hereby acknowledge that I have read this application and state r, N a that the above Information Is correct and agree to comply with m 0• all laws regulating building construction, and I shall not employ House 2190 i Z any person In violation of the workman's compensation laws of m 5 the State of California. Garage • 3 I hereby certify that I am properly licensed as a contractor under 5Q. FT. g 585 ry the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE 1ONLY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ aZ7a and Professions Code. Division 3,Chapter 9. /' in Signature of \I a �C - �// S ‘, PLAN CHECK $ //'/ 50 en TTT��+++ C CJ,1 ((( GGGTTT 'TTT/ o Permittee 1 / t' xn�-/ TAX E 2 Authorized Ag( TOTAL PAID $34Q 3/ U