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Home My WebLink About1010 CANNONADE CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 ROOF CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Job Address: 1010 CANNONADECI Suite: Vicinity: HOUSE & GARAGE Parcel Number: 41237114 zoning: R1 R1 Applicant: RON SELL Address: 17072 ROSEBUD Phone: (714)993-3328 YORBA LINDA, CA Zip: 92686 Owner: YAP, THEODORE ET AL Address 1010 CANNONADE CIR Issued: Phone: COSTA MESA, CA Zip: 92626 Contractor: SELL ROOFING COMPANY Address: 17072 ROSEBUD Arch Address: Phone: (714)993-3328 YORBA LINDA, CA Zip: 92686 License: 323842 Phone: Eng: Address: / PERMIT NUMBER B00-00608 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 05/03/2000 Issued: 05/03/2000 ISSUED BY: L Phone: Zip: License: License: SCOPE OF PERMIT REROOF - T/O, INSTALL 1/2" OSB BOARD, 2 LAYERS OF 30# FELT AND LIGHTWEIGHT EAGLELITE ICBO#4660 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 FEE SUMMARY , Plan Check: $0.00 Calc Valuation: $8,900.00 Permit: $167.25 Claim Valuation: $8,900.00 SMTP 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 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 I 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' compensation Insurance carder and policy number are: . Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for In this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia d agree that ` should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. % Applicant Signature: Date: — / U / WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CO RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,OD0), 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 un er provis'on 1 Chander 9 (commencing with Section 7000) of Division 3 of the Business and Processions�[ode, and my license is In full force and effect. Lic. # l� Class N Q — ?7 7 Contractors Signature: M 4411 Date: CONSTRUCTION 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).): ❑ 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers 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 feel 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, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response 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 toot 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, hes Section 255-- of the California Health and Safety Code been fully complied with? ❑ Yes [I 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 aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-1 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 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 penally 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 inspectio q rposes. Io t to or allow occupancy of any building authorized by this permit until final inspection. Signature Le al wdarts) ate And/Or Authonzed Applicant Date CODE P. INSPECTION TYPE P9IE INTITALS CODES INSPECTIONTYPE RALE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical U� 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 244646 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations - 'CITY of COSTA MESA CONSTRU TION PERMIT P�'MEIT=°/ "TRACT NO. LOT NO. UNIT NO. 0.230 5/111794 355:58 Project Address ApplicaniSSMailing Address pp TYPE OF CONSTRUCTION NEW ADDS ALTERATION REPAIR ) ' Owrfer'SName Phone �ZB'/ El CONVERSION DEMOLISH OT ER A,P-# 12, / _--' Zone D CRIP ION OF V /,U�EpF J_DGE Address L- V M _ S Main Building: r Accessory Building: Arch/Eng. License No. - TV PEOFPERMIT ' RADING FOUNDATI NSTRUCTURAL T Front 2��_ -' Z "�� O Address - - ❑ TENANT ELECTRICAL P IG ❑ MECHANICAL A Rear _ = / N ❑ OTHER; Contractor's Name' Phone - C Right ! N _ PROJECT DESCRIPTIO SQ. F - OCCUPA CY - G CS Address (mom I'nOl K Left - r CON STRUCTIO VPE UATION$ S , City. License No. - -ZONE - GRADING CU. YDS �� ,ACRES R LICENSED CONTRACTOR DECLARATION - Flog. Ref. # Par kipg R¢q./PrOvid¢d - 0 1 hereby affirm that I am licensed under provisions of Charter -9 (commencing Remarks: Planning Notes: �% ' )'l M y with section 7000) of Division 3 of the Business and Professions Code, and - - T Li my license is in full force and effect. 1^v" ^, ® S. cense Class License No.—` - Date Signature PLUMBING FEES WORKERS' COMPENSATION DECLARATION '- Bar Sink Showers ELECT AL FEES I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation- Insurance,'or a certified i copy thereof (Section Backflow Preventer -- - Service Sink - -- - 3800, Lab. C.) Automatic Washer" Tr sformer'❑ 15-50'KW Policy No. Company Backflow. I rrigation Sewer Cap ! ' Construction Pole Sub. 1 ❑ 50+,KW eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer,Connection x Cooking Unit ( 'Meter Cup to 100 amps Date Applicant ^ • - - l _ 1 EXEMPTION FROM WORKERS'•COMPENSATION DECLARATION 1 Clarifiers Solar' Collectors— Dishwasher Meter Cover 100 amps (Thissection need not be completed if the pe mit is far one huntlretl ($100) or less). Dishwasher Solar Piping _ Dryers ❑Gas ❑Electric Sub Panel 1 certify that in t e Performance of the wo or hi r this perm))f' issued I - shall note toy any person in any man so as became 0 ect t the "Drinking Fountains Solar,Tank Fan. Motors ❑0.1 HP ❑1 % - 8 Workers' t n Laws of Californi - Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP ❑i6-15'+ l OTICE:- f a a frig this declaration, ou should becomes jec o the _ Workers'•C mpensation provisions of the tabor. Code, you t f% Y,with Fl6or Sinks Urinal - - 2 Fixtures. - - -- comply wi h• such provisions or this permit •shall be 'tlee etl voketl. _ rdwav¢ CONSTRUCTION LENDING AGENCY Gas Service Outlets' Water Closet' Device Boxes` �' ra I hereby affirm that there iia construction lending agency for the performance - Pole Light of the work foj�.Wh+" p is d n 3097 v. C.) p L f ar's, Name (. /na ` ,( ]A 71CA� Interceptors - Water Heater _ Outlets - Range I 20' Lender's Address - - Kitchen Sink Water Service _ Switches' Sign Q OWNER BUILDER DECLARATION - - - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - following reason (Section 7031-.5 Business and Professional Code: Any city Or Garbage Disposal 'Standing Sections county which requires a permit to construct, alter, improve, demolish or repair P—Trap any structure, prior to its issuance, also requires the applicant for such permit - Generator ❑0.5 KW ❑5 15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of ROOF Drains - - the Contractor's License Law (Chapter 9 (commencing with Section 7000) of - Division 3 of the Business and Professions Code) or that he/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 _ �� e�d Ita of not more than five hundred dollars ($500). �Q� Reins ction .Fee - $ 3 -r' -^ �" as owner of the property n my employees with wages as their sola Pe $15 Issue Fee compensation, will do the work, and the structure is not intended etl n oiferetl •� ' Reinspection .Fed' $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES 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 - DEVELOPMENT SERVICES RED IR MEN S: employees, provided that such improvements are not intended or oiferetl, for Boller Hood Or Type ❑ ' (�/ IE yxry Vz sale. If, however, the building or improvement is sold within one year of Com- Canopy Type I I ❑ Zoning�ApproveclBy �, I ` I ��r`a Date 1 r pletion,'the owner will have the burden of proving he/she tlitl not build or im- Duct -Under Ground - Building Approved By Dat Eve for the purpose of sale). I, as,owner of the property, am exclusively contracting with licensed con- Duct - Structural Refrigeration System Application Issued By Dat tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct- Ventilating' -, ❑0-100,000 BTU ❑100,000 BTU 2�j e.,�) ARV OF FEES builds or improves thereon, and who contracts for such projects with a con- - i CC .7CJ �LO� tractor(s) license pursuant to the Contractor's License Law). I am aware that' Exhaust System ❑ Multiple ❑ System Repair/Alteration r' BUILDING PER IT SMIP $ �� T proof of their Worker's Compensation insurance should be provided to me. -• PERMLIT PLAN CHECK /3T.$2 r PERMIT am exe pt ntl r Section B. 8 P. C. for this reason Firepl/Fact. Bit. ICBG # _ PLUMBING � $ ISSUANCE $ L� 'ENERGY P.C. '$ Date owner Heating System &Ducting .PLAN CHECK 25%. $ ' I -hereby rt t t I have read this application and state that the above ❑0.100,000 BTU ❑100,000 gT - •Gf� GRADING I $ information is Corr C 1 agree to comply with all city and county ordinances ELECTRICAL $ , and State laws rel g to b yding const tion, and hereby author' e r pre- PLAN CHECK ;50% $ • 3.2.1 MICROFILM. $ sentatives of S to titer, upon 'e above-mentioned ro ert for �¢. Inspection, urpos ` - MECHANICAL" $ ;TOTAL FEE $ Signatur� Date-.� Reinspection Fee $15 • Issue Fee $ 3 1 PLAN CHECK 25% $ Drivers' License or SS # CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor - - -- - CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector _ POOL APPROVALS Permit# - Date Inspector .It. Te(nporary Electrical.Service or Pole 52. Pool & Equipment Location - - '-2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit,Utility-Undrgrnd. 54. Forms - - 4. Electrical Conduit;Undrgrnd. 55.• Electhcal Bonding '• 5. Steel Reinforcement , 56. Rough Plumbing & Pressure Test - 6: Electrical UFER;Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 6. Foundation - - 59. Gas Pipe; 0 Undrgrnd., Test , '. 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System, '61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final ' 12: Sewer Cap _ '" 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System.- Final 14. Rough Plumbing65. Electrical -Final ' 15. Rough Electrical -Conduit 66. Solar System -Final - 16. Rough Electric Wirin 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 0 Gas 0 Oil 23.( -Gas Pipe -Rough & Test 72: Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas EJ Oil, 25. rRoof Sheathing •' 1 C 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - 27. Frameand Flashing ` �� r c( 4, �' 76. Dry Standpipe •I 28. Lathing& Siding it '77. FIXED SYSTEM FINAL • 29. Insulation '78. FIRE PREV. FINAL 30. Drywall Nailing tg{C `ate HEALTH DEPT. REQUIREMENT 31. Plaster:Brown Coat, ¢ GybL 79. FINAL INSPECTION " 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33.Final Electric 'ar� Notes: 34. Final Heating-&Air,Cohditioning- 8a .� 35. Final Gas Pipe -Test' y>- � 36. Hood br Canopy 37. Final Factory Fireplace �Qr 5 38. Final Plumbing D �� 39. Water Service -Final s I eS • S _ io r - 40. Gas Service -Final f/iU O C 41. Solar Domestic -Final 42. Backflow Preventer. 43. Backflow Irrigation i 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING. ' 48. Special Requirements Completed ' 49. Electric Release'to Edison - - 50. Gas Release to Southern California Gas Co , - • - ' r 51. CERTIFICATE OF OCCUPANCY No. Date - - - F bergs Building Insulation The contractor named below certifies that the Owens-Corning Fiberglas Building Insulation used carries the NAHB Research Foundation, Inc. label for assured thermal performance and that the Building Insulation is installed in conformance with- current energy conservation regulations, California Administrative Code, Title24, State of California, in the building located at: I- IC'/O (,AjgAe6Yj'P =- W>?III M 54 Address City Tract Number Exterior Walls Owens-Corning FiberglasType M In` Insulation s'! PIf Thickness R -Value Ceilin�s Owens- orning Fiberglas Type f`' Insulation Thickness R -Value Floors,1.� Owens-Cornina Fiberalas Tvoe Insulation Foundation Walls Manufacturer Thickness R -Value Type Thickness R -Value General Contractor 1� - License No. !/. +tel %t By �'A��L1.,tA1 �--- Title Date en I/W (Signature) - V/ fes— / Insulation Contractor _ ' •�=u t"� y�' IuG+Jr A � y+^ '%.ILicense No. T T / ec By Homeowner Copy (White):' State Copy (Yellow) Builder Copy (Pink) Pub. No. 16 -BL -6995-B Litho in U.5 A:, Jan.. 1982 Copyright P 1982 Owens-Corning Fiberglas Corp. -�0--"— Date OWENs-CORNING FIBERGLAS CORP. Insulation Operating Division Fiberglas Tower, Toledo, Ohio 43659 0 (ol�zc�le4 `�RestR' +It \\7 4 t��V40 .A-,OR��s - loco C�4c� Post Office Box 1200 77 Fair Drive Costa Mesa, California 92626 LOW H9'&I (714) 556-5245 REQUEST FOR OCCUPANCY (Single Family Residential or Condominium Units) Tract No. Date Lot No. /121 Address 141) le el��4,147 119 1&1 117 I*t- e4 -1 - The developer of the above entitled tract cesires to sell the above set forth lot prior to the time that the tract has been completed and. its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that she, they) 4W�as or vverO advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the" City at the time the final tract map was approved. The Cityassumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. R E C E I V E 0 JUL 1978 AM PAI 71819110111,11201 1212141516 By Purcha By D leper and/or Adfhorized Reprosentaltive By Lender r_ - 44967 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ■ For Applicant to FillinCompletely — Use Ink Only BUILDING /0/O Cu,C).✓o,uq C/ ADDRESS OWNER E01EY FAMILY TRUST MAIL ADDRESS 2101 E. Fourth CITY Santa Ana, CA 92705 No`'543-9471 BRANCH 1010 N. Main St. ADDRESS nna rA o,)Ind TEL. ADDRESS /// S. Main iflUb, Orange yLbbb CONTRACTOR FoleyConstruction Co. Inc. ADDRESS Same as above PLAN CHECK $ / Q fb TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE No OFBLDGS. OF LOT NOW ON LOT O USE OF EXISTING BLDG. N/A Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED I 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 person in violation of the workman's compensation laws of the State of California. I hereby certify that 1 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, v' n 3, Chapter 9. Signature o� Permittee P°ID Of,T 21 77-7 308.51 cMSaOO1Q74#* FOR STRUCTURAL PERMIT A.P. NO. oe!(/-UJ/- BUILDING ADDRESS 1010 TRACT 9901 X FIRE rv-fi, PERMIT NO. T2uS DATV/) 'W— ZONE ,e NO.OF USE OF NE /C PLANS Z BUILDING YARDS APPROVED I YARDS APPROV MAIN BUILDING I ACCESSORY BUILDING VAR. # C.U.P. # b FT. FT. BET. MAIN & ACCESS. SLOGS. DATE APPROVED THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY• VALUATION PERMIT FEE $ O /' do PLAN CHECK $ / Q fb TAX $ . ?/ TOTAL PAID $3 57