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Home My WebLink About124 EUCALYPTUS LN - Building Permits• - r CITY OF COSTA MESA BUILDING DIVISION P MIT NUMBER DEVELOPMENT SERVICES DEPARTMENT °•�; PERMIT B00-00402 (714) 754-5273 Fax(714)754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 124 EUCALYPTUS LN Status: ISSUED Suite: Applied: 03/29/2000 Vicinity: Issued: 03/29/2000 Parcel Number: 43917258 Zoning: Applicant: COONER, LYLE ISSUED BY: Address: 23015 DEL LAGO Phone: (714)583-1858 LAGUNA HILLS CA Zip: 92653 Owner: LAUREL POINTE HOA Address 124 EUCALYPTUS LN Phone: COSTA MESA, CA Zip: 92627 Contractor: PRO -TECH WEATHERPROOFING Address: 23015 DEL LAGO Phone: (714)583-1858 LAGUNA HILLS CA Zip: 92653 License: 620476 Arch : Address: Eng: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT T/OFF INSATLL COMP. SHINGLES ,FOR BUILDING 3;' INCLUDED UNIT 126, 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 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 FEESUMMARY Plan Check: $0.00 Calc Valuation: $3,400.00 Permit: $97.25 Claim Valuation: $3,400.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 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 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 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to salt-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' compensation Insurance carver and policy number are: Carrier: Policy Number: (This section need not be completed If the permit is valued of one hundred dollars (5100) 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 agree that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these rovisions. Ap I lLre: Qi/ ate: J 'AWNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT ANE IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm t sed under provisions of Chapter 9 (commencing with Section 7000) of Di ess and Professions Code, and my license is in full force a t. Lic. b `(� Class k < -39 Cont ors Signature: Date: a� C TION LENDING AGENCY: ❑ 1 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). Lenders 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).): ❑ 1, 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, 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 contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, California Administrative Code). ❑ As owner-builder, 1 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 to release or threatened 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 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? ❑ Yes ❑ 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). 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 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? ❑ Yes ❑ 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 a ermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Coda 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 ❑ 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 ❑ No ............ ........... ... ......... ................ ......., ................. ........... ., ..........., .., ....I..... ... .......... _ .,..,.. _.........__ .___.. 8 (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penaity 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. Signature Qf Legal Owners) Date And nt a CODE r. INSPECTION TYPE DATE INTITIAL$ CODE INSPECTIONTYPE INTDIALa 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Finals 208 Final Plumbing 200 Final Re-Roof 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 2446.46 1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY O� COSTA MES NSI RUCTI IV PERMIT PERM I O TRACT NO. LOT NO. UNIT NO. Project Address Jflqq Applicant's Mailing A dress ero -fi L- ��-�r-�_� Owner's Name lame, 5 hone sF' 53_5,10 Address LE_Sme, Arch/Eng. License No. Address r Contractor's Name /�1 hone Address (mailing).a� } City License No s •gr LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full fgcJl�nd effect. Lic¢n5¢ lass CC..��ii NM Y'C/ Date )�. Signature"I WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof (Section 3800, Lab.C �/k 4 Policy Nov_/��r1 Company �' �^7- " Inl�ertif ietl copy is hereby furnished. ld Cer ietl cqqpp � is filed with the city Bys In v S ,at. -X—v — ApplicantT�/ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed If the permit Is for One hundred ($100) or less). 1 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair Division 3 of the Business and Professions Code) or that he/sne 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 .enalty 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 (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds Or improves thereon, and who does Such work himself/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 com- pletion, the owner will have the burden of proving he/she did not build or im. Ufor the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for Such projects with a con- traclor(s license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city t enter upon the above-mentioned property for inspection purp s. - Signature Date Drivers' License or SS jr y/ Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps TYPE OF CONSTRUCTION LJNEw LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. LJ ALTERATION REPAIR A.P. qµ, Zone S Main Building: 'sF I)UtIgccassoreui�ding:Ktt-Cb r' 1 TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL 00 THER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS ZONE GRADING CV.YDS. ACRES T Front nATF' t/17/ARV •TT%F: f1R•113 BA Rear Sign C Right Generator 00-5 KW 05.15 KW KLeft $ Ping. Ref. # Parking Req./Provided Remarks: Planning Notes: Sink Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash FEES Reinspection Fee I $151 I Issue Fee I$ 3 I Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICSO # Heating System & Ducting 00100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type I1 ❑ Refrigeration System ❑0100.000BTU ❑100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00.1 HP ❑ 1''A - 8 F.A.U. Inc. Solar 09.15 HP ❑16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 00-5 KW 05.15 KW Trash Compactor FEES O N I N G R E Q M T S Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date SMIP $ SUMMARY O BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE S '6-ey .r D CONSTRUCTION ANPLANNING APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date Inspector 1. Temporary;Electricar,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 UFER Gtnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undr'grnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd'.,-Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O 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 -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas 0Oil . 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 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 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ' 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED y\r, 33. Final Electric Notes:/0-2/.S8 6Eft G'A2A LZ. r) 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing !( 10 gr &i97 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final- 42. Backflow Preventer 43. Backflow Irrigation ' 44. Landscape Irrigation System J 45. Sound Attenuation % �j 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ,r) 48. Special Requirements Completed - I 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ t - a 4,6jqo"1 l24 -i-12& COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 7795 .10/27/75 .1.11.96 TT 7795 10/27/78 111.96 . 7795 "000114469 57 """14 '- APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BV EC IVED PATE ISSUED 6/7 � BUILDING/'- :�. ADD RESS+ OWNER A.P.DIN - ' ,, J BUILDING y 2^ Lw S ADDRESS ADD ADDRES O 5 .0 G 4/V TEL. Q1" CITY Newport Beach No•752-507 BLOCK CONSTRUCTION NEW IADDIALTFR P I LENDER BRANCH O NER ADDRESS ALUE I� $ ARCHITECT Brion Jeannette L SSOC. OR ENGINEER FIRE Oi V sgw ADDRES�Ie WPort eac ZONE TYPE GROUP \ APPROVED CONTRACTOR BV 1W GATE L ADDRESS TEL. ZONE NO. OF USE OF NEW CITY NO. PLANS L BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF SLOGS. tFROMC///LS�T/p EET) -O� OF LOT NOW ON LOT Ni ! FT. FT. USE OF J EXISTING BLDG. /FT FT Separate permits are required for L SIDE Ztr FT. FT. 2 electric, plumbing and heating work. REAR -FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & New Tow homes Project MAIN SLOGS. ACCESS. SLOGS. VAR. qW / DATE .t 'r,(,J- APPROVED 77 ��• APPROVERV V..,JQ //J.a ', _7 DATE MOLD FOR I hereby acknowledge that 1 have read this application and note that the above Information Is correct and agree to comply with all laws regulating building construction, and I shell not employ any person in violation of the workman's compensation laws of ?-SO. FT. Me State of California. I hereby certify that I em properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the State ofCalifornia B siness and Professions Code, Division 3, Chapter 9, an t licenses are In full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt f r Visions of th to of California Business VALUATION PERMIT FEE $ and Professl o W S. i t fbe Signature of PLAN CHECK y �s/t� D e Permittee s637&6 G TAX E YYY Authorized Agent TOTAL PAID E COSTA MESA BUILDING -SA ETY DEPARTMENT 7924 -j P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 7MI7 IC For Applicant to Fill in Completely —Use Ink Only APPLICATION FOI3t9W¢UQU RECEIVED BV I DATE RECEIVE[ BUILDING ADDRES OWNER (�• A.P. NO. MAIL BUILDING ADDRESS ADDRESS G TEL. TRACT LOT CITY NO. CONSTRUCTION N W ADDIALUA!A�PAIR IMC BRANCH ADDRESS ARCHITECT TEL. 7 - Z7. I hereby acknowledge that I have read this application and nate that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee Authorized Agent THE AMOUNT SHOWN UNDER VALUATION THE PURPOSE OF ESTABLISHING A PERMIT FEE VALUATION PERMIT FEE $ PLAN CHECK $ $ TAX $ TOTAL PAID E Wi .=KT 7 m LL ADDRESS TYPE GROUP CONTRACTOR DATE ADDRESS NO. PLANS USE OF NEW BUILDING TEL. CITY NO. STATE CITY APPROVED YARDS APPROVED LIC. NO. LIC. NO. BUILDING ACCESSORY BUILDING STREET) SIZE NO. OF BLDGS.IRREARFT. OF LOT NOW ON LOT FRONTFT. FT. USE OF EXISTING BLDG. T. FT Separate permits are required for FT. FT. electric, plumbing and heating work. FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. SLOGS. VAR.* DATE C.U.P. 4 APPROVED APPROVED I hereby acknowledge that I have read this application and nate that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee Authorized Agent THE AMOUNT SHOWN UNDER VALUATION THE PURPOSE OF ESTABLISHING A PERMIT FEE VALUATION PERMIT FEE $ PLAN CHECK $ $ TAX $ TOTAL PAID E Wi .=KT 7 m LL