HomeMy WebLinkAbout928 CARNATION AVE - Building Permits�
PpOJECT�00qE55: f328 CARNATION AV
Ol4NEfl'$ NAME: CtIEN, CHAC.HAWAL WONGPHYAT
._ aoon�: CHEN SUSAN P
� 928 �ARNA'fION AVE
COSTA MESA,CA 92626
549-8836
APCHIENGINEEN: flEG.NO.:
nooness:
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PE""unEE: CHACHAWAL CHEN ( 714 ) 546-8836
aooeess: gZg CARNJ�TION AVE
COSTA MESA CA 92626
LICENSEO CONTflALTOH DELLAflATION: I h¢reDy a�hrm �ha� I am IicenSeA under pmvi5ion5 ai C�apler 9(commencing wilh $¢[Iion
7000) oi �ivisfon 3 Of �he Busine55 an0 Pmle55ion5 CoOe. an0 my license i5 in full fOrCe and etteq.
CITY UC.: STRTE LIC.: CLASS:
'I Oale: Signaiur¢:
I WOBKEBS' COMPENSRTION OFLlA8R710N: I here0y aflirm �nal I nave a ceniiiwte al consent m self-insure or a cenilicate af workers'
Comoensaiion Insurance. or a certilied cooY �nereol (Section 3800, LaD. CI.
i POLICY NO.: EXP. DRTE:
COMPANV:
] Cerli�ie0 Copy is �eteDy �Umis�ed. ❑ Cerlilie0 caDY is IileO wi�� Ihe ciry Builtling Oivision.
Daie: ApPlicant:
EXEMPTION FBOM WOflNEflS' COMPENSFTION DECUNATIUN: (This seciion neetl nat be completed it Ihe De�mil is for one huntlretl (5100) or less�.
I t¢tli�y Iha� in the pedormance o� ihe work lor w�iCh ��is permii is i55Ued, I shall no� emDloy any pelson in any manner 5o as �o betome
sublect Io t�e Workers' Compensation Laws o� Cali�omia.
Date: $ignaWre:
NOTICE II. afler making IAis Aeclaraiion, you shoultl become suGle�� m IAe Workers' Campensation pmvisions ol ihe Labor
CoOe. you mus� tarihvnih comDty wi�� suc� pmvisions or IhiS DQrmii 5Aa11 Ue OeemeO revake0.
CONSTBOCTION LENDING �GENCY: I �er¢Dy allirm Iha� Ihere is a mn5imciion IenGing agenry tor tAe pedarmance ol �he woM1 for
wNcll I�is permi� is i�sue0 (Seciion 3W7, Gv. C).
LFNOEfl:
FDOflE55:
OWNEfi BUILUEP OELLAHRTION: I her¢�y aifirm ihat I am exempl Imm t�e Contracmrs' State License Law lar ihe lallowing reasan
�Seciion 703t.5 Business and Prolessional CoUe: Any cily of cauniy whic� requires a Dermit ro constmct. alter, impmve, demolish, or
re0air any stmcmre. prior to its issuance. also repuires t�e applicam far suc� permit to ille a signetl statement �hai hUshe is licensetl
pursuant m t�e pmvisions ol the Coniracmrs' Slate License Law (Clupter 9(commencing vnih Section 7000) ol Divisron 3 of Ihe Business
anJ Prolessions Coee) or ttu� �e/S�e i5 ¢Kempl ltlertlmm antl Ihe Ea56 lOr I�e allegetl eKemptlon. My WOWiion 0� SCtiion 7031.5 Uy
any aDDlicanilor a vermit suelects ine aDClicanl to a civil D¢�aliy of not moro ttun five hunaretl aollars (E500�.
I, as owner of ihe pmpeny or my emyloyees vnih waAes as ineir sote compensa6on, will do Ihe wofk, an0 ihe
❑ slmclure is nol inlenAetl or o��ereG lor sale (Section 70a4, Business antl Pwfessianal Cotle: The Comracmrs' State License Law
Ooes noi applY �o an owner ol a propeny w0o �uiids or impmves �hereon, antl who eoes suc� work himsd�/�ersel� or IAmuBO
Ais or her own employees, pmvitletl t�at SucA impmvemenls are nol in�entle0 or offeretl �or sale. II, however Ihe huilding or
impmvement is soltl wi�hin one year o� com0le�ion. Ihe owner will have Ihe burAen of pmvinq he/she tliE not builtl or impmve
lor ihe purpose o1 sale�.
I, as owner of �he pmpetly, am e�clusively conlracling wi�� Iicense0 conirac[ors ta constmc� �he pmlec� (Sec�ion 704a, Business
m and Pmfessions Code: The Conlractors' State License Law tloes not apDly to an owner oi pmpeny who builOs or impmves thereon
antl who conVac�s far such pmlects with a COntra[tor�s) license pur5uani �o Ihe Contractors' Sta�e License law�. I am awar¢
t�ai pmo� o� Iheir Worker's Compensalion insurance 5houla �e pmvitle� to me.
� I am exemp� un0er Sec�ion: 8. 8 P. C.
�or ��is reason: ��
�Date: � l% —,�(I — �l� Owner. � �"'_`.�,�,�.,1�'a-�s��/�'�7"✓
I Oo �ereby ceriity t�at I am awar¢ al anU untl¢�stantl Ihe repuiremenis ol Cali�ornu Heal�h and Sa�ery CoGe Sections 25505, 55-2 33, and
2553A antl �hat I or any fuiure 6uilUing occupan� will/will not (circle one� nee0 �o comD�Y wilh sai0 s�aie cotles an0 the repuirements lor a
permn lo� consimaion ar moadication imm I�e Air Ouatiry ManaAemenl Disirici. Nesiaemial consimction aDPlications are exemD� ��om
�Aese pmvisions.
Dale: Applicanl:
I hereby certifyihatlnave readinis a0�licaiion an0 slatethatt�e ahoveinlormationis torrect. I agree lo comply wit� allciiy an0 munly
or0inances antl state laws relaling to Euilainp mn9mclian anA OereOy autMr¢e represenUtives ol thit tiry to enler upOn I�e aUove-menGaleO
D�opertY b�Inspeqion -p�u�rpo7ses. � /
"6aie: �V �- 1— � v�SignaWre: /�-�f �'1„"'�/4•—�
� ori�ers �icense o� sociai Secudty �:
16at�afi Whne—Builamg'. Green—Codo Enlorcement: Canary—Applicanf, Pmk—Revenue; Goltlenrad—Assessor
CZTY OF COSTA N,ESA — HUI�DING PERMIT P�RM NO; B 059704
PERMIT NO: B 059709 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PUt2POSt; ALT
JOB DESCRIPTION ; 2600SQ.FT REROOF O/1 LAYER W/COMP SQ FT; 2,600
CLAIM VALUE: 2,600,00 CALC—VALUE: 2,600.00 GROUP OCC; R-3 /
COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
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2 O N I N G R E Q U I R E M E N T S
JC E 1 B%� C K JC
------------ MAIN BUILDING ---------- --------- ACCESSORY BUIt,D'ING --------
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT ZN
LEFT; FT iN RGHT; FT IN LEFT; FT IN RGHT; r'1' IN
PARKING REQ• PROV; PARCEL; 41221228 'LNE; REr NO;
PLAN,yING NUT'ES>
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D E V E L O P N E N T S E R V I C E S R E Q U I R E N, E N T S
20NING APPROVED BY ' DATE;
BUILDING APPROVED BY ; DATE; �
APPLICATION ISSUEll BY; ` DATE• O 2% 'L
if#ifiE1F#jE7(-#ifififlEiFil�jEiE�FlFlf')fiff!#�t�f! le�lF3F'Kac)..tffS�TR��YFlEiCiliFRf�F�'RR�iY�FRTt-1l'ii'##'lEififiFihlfTfeR' .t 1YH#3E
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LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGN,ENT:Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE 5MIP/RES GRADING
PERMIT 54.00 50
PLAN SMIP/NON—RES
ZSSUE FEE
BUILDZNG—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 59,50 0,00 0,00 54,50 59,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 54,50 OC�ER/SHORT: .00
HLDG PMT PLUMHZNG ELECTRIC MECHANIC FTRE SMIP/TOT GRADZNG PLAN—CHECR
54.00 ,50
iE if it iE iE iE iE # iE-IF iE 1! #�IF # iF it 1E'1E If ih # iE IE # iF �)f ## iE # iE �f 9ElE iF iE iE iF IE ## iF ## iF iE �E If 1f IF ## iF !E #%1e # iFlh �7F ##�E #%!f 3F ### IElf if� 1F ih # if
I N D I V I D U A L F E E B R E A K P O W N
�'YPE QTY D E S C R I P T I O N UNIT COST TOTAL CO5T
SFR 2600 REROOF HY VALUE RESIDzNTIAL NOZONE 1.00 2,600.00
END Or' FEES
i ,_
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�
CONSTRUCTION AND PLANNING POG . SPA '
�"�Ai'PROVALS Dermit# Date Inspector qpPROVALS Permit,lk Date Inspector
1. Temporary Electlical Service or Pole 52. Pool & Equipment Locat�on
►
2.'Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electricai Conduit UtdityUndrgmd. 54. Forms
4. Electrical CondwfUndrgrnd. 55. Electriwl Bonding
5. Siee' Re��nforcement 56. Rough Plumbing & Pressure Test
6. Electncal UFER Gred. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundat�on 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgcnd. 60. Backwash Lines, P-Trap, C] Undrgrnd.
10. Structural Floor Svstem 61. APPROVAL TO DECK
11. Property Sewer L�ne & House Connection 62. Backwash & ReceptorFinal
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Piumbing 65. E�ectrical�Final
75. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Eiectric W�ring 67. Fencing & Access ApProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Elect�ical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. DuCts, in Structure 70. Underground HYdro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. floof Framing� 73. Undergrnd.StorageTank QGas ❑Oil
25. Roof Sheathing 74, Overhead Hydro
26. T-Bar Ceiiing (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding i i 77. FIXED SYSTEM FINAL
i
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
33. Final Electric � ;� - Notes:
34. Final Heating & Air Conditioning �
i
35. Final Gas Pipe-Test ��i
36. Hood or Canopy � � �"�\'
37. Final Fac[ory Fireplace
38. Final Plumbing , �
39. Water Service-Final � � �
i
40. Gas Service-Final '
41. Solar pomesticF�nal
42. Backflow Preventer �
I
43. Backflow Irrigation
44. Landtcape Irriqation Sysiem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ���5 ��
48. PINALPLANNING I�i!.
49. Electric Release to Edison �`.
,..
50. Gas Release to Southern California Gas Co ..�
51. CEflTIFICATE OF OCCUPANCY ,
No. Dace
s, State of California
SS.
County of Q�� (tI �t--
On �Ol�%� �� i�f cl Z before me, �� S- �S�JG(Z/�YLL
Notary Public, personall appeared C'/-i(1C �cJ . /- r�-,�
personally known to me (or proved to me on the basis o satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf�jwhich the person(s) acted, executed the instrument.
WITNESS my
Signature
FD-1 (12/90)
deaa.sor�
� 08lICIAL SSAL
J. S. GARTLAND
�SC31� � : NOTIIRV PUBIIC - CAUFORNIA
ORANOE CAUNTY
MyComm Ezpry,lan 8, IB95
�
t
QE'CLARATION OF ..JTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
l'Z� �AaNA�oi✓ �4V�-• �osr� M�'f+ C�A �1z6z6
Street A dress
r
Bldg. Permit #
This Permit # �
�
:,,.
Itl,
1. I(we), ���d4�wAL l^�' �Nc/✓ , declare that I am the Owner of TiUe
of the above referenced real property, and that I(we) hereby authorize:
?�f ✓ N G v y�/
Name
ZOL N
M
�
Streei Address
{:�
to obtain permits in my behalt, as owner/builder, for
at the above referenced property.
�58. aZ62_
Telephone No.
0
2. Should any person become an ��mploy?e er,g2ged in the improvement of the property, I(we) shall im-
mediately provide Worker's Cornpensation Insurance coverage and cause a ceitificate of [hat coverage
to be filed with the Building Division of the City of Cosla Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation. � .
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in tlamage or personal injury to myself or any other parties as a result of work authorized
by the permits from the City of Costa Mesa.
�5� I declare under the penalty of perjury that the foregoing is true and correct.
�
E?cecuted this �d� day of-S���M3�R 19 g�, at �r� M� ,.Califomia.
�. .
`�r1 /�e�9A,✓R t— h/- G�t' � n/ �'I - l6 � /9�'i �
' Printed Name Date
�-������
r �— • � S� '9"� a`� .
\
� NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides
for limited power of attorney to secure this permit in any behalf.
\ '
�
�
NOTARIZATION RE�UIRED
07]9�i6 (fl¢v. 2/911
CITY OF OSTA �S�QUEST FOR OCCUPANCY
�/ �..
7 �� ��- b _
TRACT N0. ��S S / R/jyJ • � / � DATF, p /�I /�
� � /
� � �' : //i�i i '� ��_
The developer of the above entitled tract desires to aell the above aet
forth Iot priar to the time [hat the tract has been cocapleted and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
{he-she-they) �',� � (was or were) �// p,y Q_ advised that this tract has
i
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 City assumes 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 cluim resulting in damage or personal injury to the undersigned by reason
of the aforementioned tincomp2eted conditi
RECEIVED
CITV Of COSiA MESA
P� '��dNl!:G DFPT.
� �EP � �� 1973
AM PM
7�8�9iIDilli12i1�2i3�4�5i6
�
representacive
BY ���'r� ��t.f.%i
�Le d r
��¢'���73
�
�
�
� �i
STRUCTURAL APPROVAL OfVL�G
SEPARATE PERMITS ARE REQUIRED,
FOR ELECTRICAL, PI.U�Y161NG,
HEATING, VE�TILATIP;G AND
REFRIGERATION WORK
p° @�d�{� #—
THIS .cJ i�^ �,;'Si ACCO�r1?ANY
ALL INSPECT10iJ REQUESTS
IFQ:t 6dILD.�lGS .:HE .E PERSOWS ARE PO
BE Ei.�F�O?cD, YYE S�GGEST TH4T 71tE�
ST,�.T€ Of C.LlFJ.�VIA UIV�SfOY OF
:r:�_s-.;�_,� s���rr a� cor:SULTED FOR
' :1a��i,Jii�L REQllIREMENiS. �
�
,
!�
ap
City of �
R
,�JC�D
Building I
THESE PLANS MUST BE ON JOB AT ALL T�MES
MAKE NO CHANGES WITHOUT PRIOR APPROVAL
OF DEPT.
THE ISSUANP.f OR GRANTING Of R PERMIT OR APPROVAL
OF PLA6'S AND SPECIFICATIO4S SHALL NOT BE WNSTRUED
TO BE A PERA;IT FOR, OR F.N APPR04AL OF, ANY VIOLATION
OF AHY 0.` ���t PROYIS10I<S OF THIS CODE. NO PERMIT PRE•
SUMING TO GIVE AUTHORITY TO YIDIATE OR CANCEL THE
PFO4ISIONS OF THIS CODE SHALL BE VALID, E7CCEPT IN SO
FqR AS THE WORK OR USE WHICH IT AUTHORIZES I$ LAWFUL
THE ISSUANCE OF R PERMIT BASED UPON PU1NS AND
SVECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL
FFOM 7HEREAFTER REQUIRING TNE CORRECTIDN OF ERRORS
li: �AIO PU1NS AND SPECIFICATIONS OR FROM PREVENTING
EUItOiMC OPERATIONS BEING CARRIED OfV THEREUNDER WHEN
It7 VIOIATtON OF TNIS CODE OR OF ANY OTHER ORDINRNCE
OF 7HE CITY.
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JOB ADDRE55
GENERAL C0�
A' ',.
IA :CTIONS
SOIL
GAS
WATER
ROUGM PLUMBING
PROP. $WR. LINE
ROIIGH HEATING AND AIR CONDITIONING
TEMPORARY SEfiVICE OR POLE
UN�ERGROUN� � POWER �
ROUGH WINING
TRENCMES � FORMS STEEI RE
FLOOR SYSTEM
BONO BEAM� [� STEEL REINFORCE �
SHEATHING
FRAME ANO FLASHING
LATMING - IN n OUT ❑
PLASTER,BROWN COAT
5T I1RAL, FINAL
DATE
BUILDI
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
SOlARP�o. sox izoo COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applican[ [o Fill in Completely
RECEI V 8 DATE RECEIVED DATE ISSUED
BUILDING �(y /' �A'�O/�% va. / /�' % /—/oz'J3
ADDRESS � ��
�� PEFiM1T NO.
OWNER Larwin SO. C811f. A•P. NO. n.—
MAIL BUIIDING Q� (�.��ON b
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ADDRESS 16255 Ventura BLVd. NODRESS � �.��
d U CITV Encino, Calif. No�986-8890 TRACT LOT BLOCK
Z Q CpN5TRVCTION W .ADD R P
O N LENDER Larwin .SO. C.S�.lf.
am
�� BFANCH 16255 Ventura Blvd, owNea '-U./ �'
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mJ ADDRE55 EhC1Il0� CAL1P. ALUE �
J a OR ENGINEER Larwin NE�273-4464 S �� - 5 �
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aooaess 9100 Wilshire Blvd. Bev Hills zo E TVPE� OUP
d W APPROVED
J O CONTRACTOR L$TWl.il So. Calif. BY DATE
m z
�� nooaess 16255 Ventura Blvd.
w W TEL. E NO.OF^ USE OF W
ZF cirv Ehcino, Calif. No. 986-8890 P�� C� BUILDING�
w � STATE CITY `�AROS APPROVED VAROS APPROVED
N� LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUIIDING
� O (FROM GL 51REET)
$12E NO.OF BLD('>S. G
OF LOT 6O X ZOO NOW ON LOT O FflOfYT �J FT. FT.
USE OF �
EXISTING BLDG. FT.
H 512E OF NO. OF
Z NEWBLDGL ROOMS STORIESL L.SIDE FT. FT.
EXTERIOR WALL ROOF /
�% COVERING t COVERIN O d S Il I REAR 2(C�FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED OISfANCE BET. BET. MAIN &
a MAIN BLOGS. ACCESS. eLDGS.
a
Q VAR. aP+ DATE
Q Construction Sin le Famil Residence c.u.a.,w APPROVED
r / APPROVE / /�'
(n U //
z HOLD FOR $ CIAL REQ ..M
O
UI hereby acknowletlge that I have reatl this applltation antl state
� that the abOve intormation iz cOrrect anG aBrBe t0 comply with
� all laws regula[inq building consttuction, and I shell no[ employ T�(
F any person in violatipn pf the workman's compensation lawz of
the State of Califotnia. °�
z � �
I hereby certity that 1 am properly licensed as a convactor untler SQ. FT. o
Me Stote of CalifoYnia Business antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
m
Chepter 9, antl that such licenses are in full torce antl etfect, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV: Q
am enempt from the provisions ot the S[ata ot Cnlifornia Business
and Protessions He, Division 3, Chapter 9. VALUATION �
PERMIT FEE s 94. 00 �
SlBnature /� �
D. DOWRS •// m
Permlitee �� $�J /_� .6 �i� P�AN CHECK $ 47• �� E
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a�morc:aa aae�c ,. �) LL
TOTAI FEE 5 �C.�'[/
OWNER GREENWOOD, Gary DATE 5-23-75
tiJUe AWKtJJ 928 Carnation Avenue BUILDING PERMIT N0. 40024
� GFNERAL CONTRACTOR p�er-Bldr. DESCRIPTION of WORK Patio Footing� on y
'�! �412-212-28 LOT TRACT FIREZONE VALUES 100.00
GAS
WATER
ROUGN PLl1MBING
PROP. SWR. LINE � MOUSE CON. �
SPRINKLING SYSiEM
MISCELLANEOl15
ROUGH HEATING AN� r11R CONDITIONING
TEMPORAPV SERVICE OR POLE
UNOERGROUNO � POwER �
ROI/GH WIRING
TRENCHES r FORMS � STEEL REINF.
FLOOR SYSTEM '
BONO BEAM � STEEL REINFOFC6�
SHEATMING
FRAME AND FLASHING �
LATHING — IN � OUT �
P' 'ER, BROWN COAT
S �URAL, FINAL
HEATING. VENT.. REFliIG. ANO A.C.. FINAL
SUBCONTRACTOR
' . 4 �
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUIIDING � J
ADDRESS � � .1�d N !id`
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BRANCH
ADDRESS
ARCHITECT ^ _� TEL,
ADDRE55
CONTRACTOfi ��%/^��5���///��'�^,Zi
ADDRESS
T E L.l�
CITV NO.
STAYE CITY
LIC. NO. LIC. NO.
SIZE NO.OF BLDGS.
OF LOT �j� x� rj b NOW ON LOT �
USE OF � ) �
E%ISTING BLDG. /-/-r/)yr }..�_
NEW BLDG.I� X J C� NO.OF _
ROOMS i . TORIES
EXTERIOFi WALL ROOF
COVERING �' COVEiiWG
USE OF BUILDING AND WORK TO BE PERFORMED
I heraby acknowletlga that 1 have reatl this aOPlicetion antl state
that the above intormetio� is correct end aptea to comply with
all laws ragulating builtling consttuction, end I 5hell not employ
any pe�son tn vtolallon of the workmads compenucba laws of
Me SYate ot Califomia.
I hareby certify thet I am properly licensetl es a coniractor untler
the State of California Business antl Professions Cotle, Di�islcn 3,
Chapter 9, antl that suc llcenaes are in fuN f a end aftect, or
am exempt trom tha ro Isions ot tha Stat of alltornia eusin is
antl PrOfe55ion5 CO vi5lon 3, ChaPteN .
SIB^atvre ot
Parm�rtee ��
• �
Authorizetl Agent
Pa:�
".hY 93-75�„..00 96?'` *w'h**5.5�
FOR BUILDING PERMIT
fl
A.P. NO. �J%�Z - Z/Z� L
BUILDING O �A�
ADOFESS Q
TRACT IS�
FI
�U I BLOC
ZONE �/ IP�� 2_ I BUILDING EI!G/10/�D.R
YAROSAPPqOVED VApDSAPPROVED
MAIN BUI�DING ACCESSORV BUILDI
REAH � �
OISTANCE BET
MAIN 8l.DG5.
V AR. qW
C.U.P.rW
S
BET. MAIN &
_ �
SQ. FT. O
THE AMOUNTSHOWN UNDER VAIVATION IS FOR ^
THE PUFPC6E OF E5SABLISMING A PERMiT FEE ONLY: Q
VALUATION - �-C� m
�(� PERMIT FEE $ _ � �
�� 7
m
$ � ' PI,AN CHECK $ E
� O`
LL
TOTAL FEE $