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Home My WebLink About189 FAIRWINDS LN - Building Permits- - • CITY OF COSTA MESA F BUILDING DIVISION F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us �. FOR INSPECTIONS CALL: (714) 754.5626 1 / PERMIT NUMBER:48-00065 PERMIT TYPE MECH APN: 41914211 JOB ADDRESS: 189 FAIRWINDS LN CM Vicinity: GARAGE & REAR OF HOME SQ. FT: 0 SCOPE OF WORK: INSTALL NEW 2.5 TONAC @ REAR OF HOME REPLACE FURNACE W/400 BTU.@ GARAGE 1 220 V 30 AMP. LINE TO SERVICE EQUIP. OWNER: GRAHAM,LLEWELYN PHONE: 714 549.3207 APPLICANT: LEMOND, RICHARD PHONE: _. 951486-0337 '. CONTRACTOR: TELFORDJONES INC Address: 25920 IRIS AVEUnit: STE 13 A400 City/State: MORENO VALLEY, CA ZipCode: 92551 MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.20 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.20 STATUS: ISSUED DATE ISSUED: 05/07/2008 ISSUED BY: YH Suite/Unit: Address: 189 FAIRWINDS LN Unit: City/Stale/Zip: COSTA MESA, CA , Address: 25920'IRISAVE' Unit: City/State/zZip: MORENO VALLEY, CA License No. 856936 PHONE: 951486-0337 _ - CELL: .' 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: 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 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. CODE INSPECTION TYPE DATE INTMAL5 CODE INSPECTION TYPE �I , A�tE, _ INMAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical �/fir �((_�(Q f 1266 Pool Spa Final 208 Final Plumbing U 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 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 perfo ce of the work for which this permit is issued. have and will maintain workers' compensation insurance, as required by 1-sectio6 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carver (This section need not be completed xNe pemrl k valued at one huMred "aa (S100) wless ) Policy Number: ❑ 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, and agree that if I should bec bje t to t�oA@rs' compensation provisions of Section 3700 of e Labor Co (with comply with these provisions. Appllcanl's Slgnaltire_Date_ - 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 ($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 that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Class # Gpnlrador s Signature Date 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: OWNER -BUILDER DECLARATIONS: 1 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 penally 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, 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 contracta(s) license pursuant to the Contractors License Laws.). ❑ lam exempt under sec. Business and Professions Code for this reason: Signature Date 3057-46(3107) Owner ID verified by dri Driver's License No. _ lICL ❑ Yes ❑ No Expires: s . \ 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 vfiich 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, WWI be more than thirty-six (36) feel 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. Applicants 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 forth 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 application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government 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 feel 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 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.:l 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 alth,a4z d by this permit until final inspection. YOw er ( Date �te Authonzed Applicant Date Site PLOT PLAN �f2«JitiQS Rear Property line Phone: 7141101�—�� c a: a a. c o a � b a. cn co Front Property line CD�v.OE;�D(Z CITY OF COSTA ME A PLANNING DIVISI SUBJECT TO BLDG. DE . REG. NOTE: ADDITIONS, DELI TIONS. OR CORRECTIONS SHA L BE APPROVED BY THE PLA iNG DIV. BY. c -!71 f-0(�.,dsa� scrrAn;r�. CITY OF COSTA MESA BUILDING DIVISION i 77 FAIR DRIVE, COSTA MESA, CA 92626 - (714) 754-5273 - Fax (714) 7544856 • www.ci.costa-mesa.ca.0 FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBE - E08-00160 PERMIT TYPE ELEC STATUS: ISSUED APN: 41914211 DATE ISSUED: 05/07/2008 ISSUED BY: JOB ADDRESS: 189 FAIRWINDS`LN CM Suite/Unit: Vicinity: GARAGE & REAR OF HOUSE SCOPE OF WORK: ELECT. MOTOR FOR FURNACE/AC INSTALL. - REF: M08-00065 - IS OWNER: GRAHAM, LLEWELYN '' .. ='Address: 189FAIRWINDSLN Unit: -. PHONE: 714 549-3207 - City/State/Zip: .COSTA MESA CA APPLICANT: LEMOND,RICHARD Address: 25920 IRIS AVE Un1f .�''F'960 PHONE: 951486-0337 City/State/zZip: MORENO VALLEY,.CA CONTRACTOR: TELF•ORDJONES INC - License No. 856936 Address: 25920 IRIS AVEUnit: STE 13 A400 - PHONE: 951486-0337 ' City/Stale: MOR ENO.VALLEY, CA ZipCode: 92551 � - � CELL: _ ELECTRICAL PERMIT FEES . Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $28.25 Reinspection Fee $0.00 TOTAL FEES $28.25 ..00 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: 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 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. CODE S. INSPECTION TYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re -Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition )ATE INTMALS CODES INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy DATE INTMAL 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 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. L a and will maintain workers' compensation insurance, as required by /sdefli 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: CS%3i7Z r[73/i (This section neednot be completed d(he pemrd a valued at one hundred dinars ($10e) or Iess.J Policy Number: o Z•�R-/�r15�i/f O� ❑ 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, and agree that if I should ew ubject to the rs' compensation provisions of Section 3700 of the Labor otle, ith comply with these provisions. Applicant's Signature - -Date , 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 ($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 that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class #15 61Z_ r�oY o rector' tgrrature Date RUCTION 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). Lender's Name: Lender's Address: Signature Dale 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, 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: 3057-46(3107) Owner ID verified by driver's Iia ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property lax 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, falsewmrk, a demolition or dismantling thereof, wait 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, 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. Applicant's Signature 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 application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government 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 ❑ No (If ryes", 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 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 lam and city ordinances regarding Hazardous Materials and Emissions. Signature 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 stale 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. Si Wr eget (S) Date Date ni Authorized Applicant/ "Date OWNER FAIRVIEW ASSOC. DATE 8-16-79 JOB ADDRESS tB9 Fajrwjnds i.ane Unit B BUILDING PERMIT NO. 47862 rFMCOAI rn AITOArrno _ __ __ nCcrolonnu _( Wnov - _ -1 A' No. I, -i l TO TL _ GAS WATER SUBCONTRACTO SPRINKLING SYSTEM MISCELLANEOUS g 5 Z ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER �J11 ROUGH WIRING ��L J� HeCtin and Vent. TRENCHES IJ FORMS STEEL REINF. FLOOR SYSTEM �. BOND BEAM (-1 STEEL REINFORCE SHEATHING FRAME AND FLASHING .. 6� O •�•� 1 LATHING__— IN Fl__ OUT !� e+ PLASTER BROWN COAT .IIS e:~ S TURAL, FINAL H, .IG. VENT., REFRIG. ANO A.C., FINAL �! 5%uAR PN.3ek NA:I, DS 3 t-gam n r , , I , n COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only LDING ADDRESS OWNER OR TENANT taw D Irl 9a I CITY NO. APPLICATION 176MRWOMAE , PERMI'If O I'e25 TU RECEIVED By PERMIT A.P. NO. le -111- *�)// - UNIT Off- SAAGG.PIG T R.NO. LOT BLK. I �52Z NEW I ADD JALTER IREPAIR IMOVINGIDEMOLISHN BRANCH OWNER7 ADDRESS q VALUE ARCHITECT TE . USE .7 E OR ENGINEER I NO. ADDRESS OS ZONE TYPE GROUP V--` 11 APPROVED CONTRACTOR Ct w , BV DATE ADDRESS TEL.Zl CITY QZ NO. .fin STATE CITY APPROVED SETBACKS LIC. NO.26 1 LIC. NO. W SIZE -2:4I 1, NO.OF BLDGS (FROM C/L ST E lY OF LOT — NOW ON LOT O ROM Q USE OF ` Q .�. EXISTING BLDG. y FSeparate permits are required for L. SIDE C electric, plumbing and heating work. REAR USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION D / �DATE Q SI l.i1G PAV�L" S �— /n% FARVED Z/�p> DA E a U4 0 1 hereby acknowledge that I have read this application and state p( that the above Information Is correct and agree to comply with 96 all laws regulating building construction, and I shall not employ I rZ any person in violation of the workman's compensation laws of m U4 the State of California. 3 1 hereby certify that I am properly licensed as a contractor under /D SQ. FT the State of Calif ,a Business and Pr ..ions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and ai s ch lic an are full force and affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt fro the rovisi ns f the tate of California Business VALUATION v and Profession Code, - io 3 t r 9. PERMIT FEE g 5 Signature of PLAN CHECK $ �^ 0 Permittee $�J Cib�/,� TAX $ �i �s U or✓f Jr/i/ .J v Authorized Agent ate TOTAL PAID $ J/) %�] a i� 5� COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR S�RAURAL PERMIT.I 95.00 For Applicant to Fill in Completely — Use Ink Only R PERMIT — - BUILDING1&9/ ADDRESS lr A. O. BUILDING ADDRESS OWNER OR TENANT UNIT OR SPACE NO. MAILING ADDRESS T R.NO. LOT ELK. TEL. NO. G S CITYPbu�_� NEW A ALTER REPAIR MOVING DEMOLISH CONSTRUCTION 54.1 6MDD LENDER BRANCH OWNER ADDRESS VALUE USE $ ARCHITECTTEL. OR ENGINEER N . ZONE TYPE GROUP ADDRESS CONTRACTOR APPROVED BY DATE ADDRESS TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. APPROVED SETBACKS SIZE OF LOT NO. OF BLDGS. NOW ON LOT 1F ROM C/L STREET) FRONT FT. USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. L SIDE T. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED APPROVED By IDATE 1 hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any parson 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 Cal h Business and Professions Code, Division 3, Chapter 9, andth suc licenses areAn full force and affect, or I am exam pt from a pr visions of t tate of California Business and Professions C de, Di "s' n per 9. Signature of Permittee of Authorized Agent Date mi SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION $ PERMIT FEE $ PLAN CHECK $ TAX $ ^� TOTAL PAID $