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HomeMy WebLinkAbout1324 CONWAY AVE - Building Permits ADDRESS OF BUILDING: 1324 CONWAY AV UMTL CITY OF COSTA MESA - BUILDING PERMIT B9g _34? OWNER'S NAME IFIDIONN: SL IKKER, ALBERT L FLOOD : X 46 PERM NO: B 087321 ill ADDRESS: SLIKKER, ELEANOR L • 1324 CONWAY AVE PERMIT NO: B 087321 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA,CA 92626 APPL.MMIDdc ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH I ARCHITECT ORENGNEER: UC NO.: JOB DESCRIPTION : T/OFF REROOF W/ASPHALT SHINGLES SQ FT: 3, 000 ARCH,OR ENG.'S ADDRESS: DHT: CLAIM VALUE: 3, 000 . 00 CALC-VALUE: 3, 000 . 00 GROUP OCC: R-3 /U-1 CONTRACTORS NAME: CONTRACTORSMNUNG COMMENTS: REROOF 2300SF RESIDENCE W/ASPHALT SHINGLES ADDRESS UC NO,: ******************************************************************************* wit ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaky of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. CITYUC.NO.: LIC.CLASS: UC.NO.: EXP : • MAIN BUILDING ACCESSORY BUILDING Dora: Contractor FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN ' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Code:Any city Cr county%hid,requires a pennh to construct alter,improve, PARKING REQ demolish,«repair ay structure,prior to its issuance,also requires the applicant for such permit It;file a Signed statement that he or she Q: 1 PROV: PARCEL : 14103813 Z N E: REF NO: is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES> Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section �. ,f 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than the hundred dollars MOON. ********************************************************************RF 3E********* ❑ I.as owner of the properly or my employees with wages as their sole compensation,will do the work,and the structure is not intended oroffered for sale(Section7044,Business and Professions Code:The Contractor License Law doesret apply to en burnerapropedy D E V E •L- O P M E N T SERVICES R EQU IR EMEN TS who builds or improves thereon,and who does such work Nmsef or herself or through his or her own employees.provided that such improvements ere not intended or offered for sale.W.however.the building or improvement is soli within one yew of completion,the ZONING APPROVED B YDATE: y owner-builder will have the burden of proving he or she did not build or improve for the purpose a sale). N❑ I,as owner of the property,sin exclusively contracting with licensed conhaa«s to construct the project(Section 7044,Business and ' ' Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE: contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). �E Ell am exempt under Section: B.A P.C.,for � � APPLICATION ISSUED BY : DATE: 1l ---r-1 Date: 3 -/6- y 9 owner - C.G %tum ************************************************* ******************.* i******** I do hereby certify that lam aware of and understand the requirements of California Health e Safety Code Section.25505,25533,and LEGALIZATION:N N F E E SUMMARY STRUCTURAL SEGMENT :Y Y d 25534,and that I or any future building occupant will/will not(circle one)need to comply with said state codes end the requirements ler a permit for coretroction or modification from the A:Waegennt Deena.Residential constructer,applctionsan exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 74 . 75 . 50 Dae: Applcant: SM I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following daratens: PLAN ❑ Ihave and'MI maintain certificate aconsent tosegns . ure for workers' n. la compensation ISSUE FEE Code,for the performance of the work for which this permit is issued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Cl I have and wil maintain workers'compensation insurance.es required by Section 3700 of the Labor Code.for Rm.performance of the TOTALS----> 75 . 25 0 . 00 0 . 00 75. 25 75 . 25 . 00 work for which this permit is issued.My workers'compensation insurance carrier and policy number are: Caner: REVENUE DIVISION TOTALS--> COLLECTED : 75. 25 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need nor be completed i the panni is for one hundred dollars(POO]or less) 74 . 75 . 50 o I certify that in the performance of the work for which this permit is®red,I dull not employ any pecan in any manner so as to become subject to the Porkers*compensation laws of CeMmmia.and Wee thm B I should become subject to the wrkers' ******************************************************************************* compensation provisions of Section 3700 a the Labor Code,I shall forthwith comply with those provisions. Date: Applicant: INDIVIDUAL F E E BREAKDOWN Warning:Failure to secure workers'compensation coverage la unlawful,and slWfsut).Cf an employer to stints?penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines Ip to one hundred thousand dollars(5100000),In addition to the cost o/compensation,damages as provided for In sectio 3705 of the Labor Code,Interest,and attorney's fees. SFR 3000 REROOF BY VALUE RESIDENTIAL 'NOZONE 1 . 00 3 , 000 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES x performance of the work for which this perms is issued(Section 3097,Cir.C), l LENDER'S NAME: • ' LENDER'S ADDRESS: I certify that I have read this application end date that the above information is coned.I agree to comply with all city end county ordinances i .a and state taws relating to wilding construction and hereby authorize repesentetivea of this city to enter upon the abovsmentcned property for inspection purposes. ALBERT SLIKKER PnyNam,274.4.; 03-16-1998/10:29 AN/$75.25 gam, Gt��j e /J� e Dal - —' —5'OPERMIT:083721 `� Slgnmure of Owner/Agent/Applicant/Contractor (5151d5.WP) White-Building A Safely:Green-Fir:Carry-Appicent:Pink-Revenue:Goldenrod-Assessor - • -J .< ' CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS . Permit # Date Inspector 1. Temporary Electrical Service or Pole r 52. Pool & Equipment Location , 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3,Electrical Conduit Utility-Undrgrnd. -- 54. Forms -'-.4T Electrical Conduit-Undrgrnd. 55. Electrical Bonding - ' 5..Steel Reinforcement 56. Rough Plumbing & Pressure Test ' , :•s 6: Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '71,7 Fob tings - 58. Electrical•Conduit-Undrgrnd. -a le Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9_ Water Pipe•Undrgrnd. . 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - t 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection : 62, Backwash & Receptor-Final 12. Sewer Cap ' 63. Heater & Vent-Final 1'3. Roof Drains 64. Plumbing System - Final -1'4. Rough Plumbing x , - ' 65. Electrical-Final " .1 15. Rough Electrical-Conduit 1. /• 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. POOUSPA SYSTEMS FINAL 19. -Rough Heating,& Air. Conditioning) .-_,-,_/- ,a cC,. - FIRE'DEPT:REQUIREMENT N _.. 'i - .Y, rr 20. Rough Factory Fireplace %? -4i -;* • -APPROVALS- Permit # ' 21. Ducts, in-Structure_�� .. T, r ',i _• ,-•;; 70.'Underground Hydro c • 22. Ducts;Ventlla£ing3f _1�' . - i• 5 '�", '„ 71. ProduWPipingQ_Gas 0Oil 23. Gas Pi Rough&,Test r J` o ' ,--1: •- pe-._ _ --,- - 72. Underground Flu.-4- g =., 24. Roof Framing f ' ,r .. , t r 1; 73 Undergrrid.Stor'_age Tank D Gas ❑Oil • 25. Roof:Sheathing ll, --i 6, tg'' !`,u /- ' 74t6verhead Hydro'-- .F 26. T-Barj•Ceiling (Struet iral) & Mo`nocoat ' w (h •Yj - 75'Dry Chemical '4_. - `-1 • • ' ...t r^. t T , t , 27. Frame and Flashin t, jr -^ t r 9. --•,,�� r -,.1- 76. Dry Standpipe. . r - 28. Lathing&'Siding .^ Y '_' 2I r.i Y 771 FIXED SYSTEM`:FINAL 29. Insulation' : C•7 - , 3 78 FIRE PR EV. FLNAL ' 30. Drywall Nailing "' - .k `" ^ '% -HEALTH DEPT. REQUIREMENT 31. Plaster BrownCoaa-''4. • 4 i, t 79. FINAL INSPECTION ' •_ m. • 32. Electricat+Power Meter-Eirial x + ' _ 80' FOOD CERTIFICATE ISSUED' '.r, ' _• ' I J y '� .-.rn t 1 , 1. 33. Fina1`Electric c �_, -� __ , - x Notes: -r-, a " 1, 34. ,Final=Hewing[& Air,Conditioning ^-i �- > i c . .-r, r - ^tY 35. Final Gas Pipe-TesiE r - t - •_, 36. Hood.-or Canopy - s. ' I'' -7 7•••••,-' 1: r-, - 1,37. Final•Factory Fireplace. , •, I '' t _3 i r 38. Final'Plumbing •.1 -1 ' ' r I•. • . • c; ... • I 39. Water Ser iicetFinal• It ,b, ^7 11 ;. t• r', f, r • 4" - 40. Gas Service-Final "' .'... ;q _ - 41: Solar Domestic-Final • > J - - 42. Backf low Preventer ,. 1 '-`' - .. rr; rri0- - ,43. Backflow Irrigation >, .4. 44. Landscape Irrigation.System ,D..„.•;:-. .-; - _ 1 - .� _ 45. Sound Attenuation -- "• �" r ' 46. Handicap'Regulations =..' _ � • ., j-2- - - ;; 47. FINAL STRUCTURE & BUILDING --`P?, /� i . 48. FINAL PLANNING ' : . C� ,. - 49. Electric Release to Edison '�; _•':' .i: 50. Gas Release to Southern California Gas Co . J 51. CERTIFICATE OF OCCUPANCY No. Date OWNER COLLEGE-MESA COMPANY DATE 11-20-58 _ JOB ADDRESS 137)1 Conway Avenue BUILDING PERMIT NO. 8016 GENERAL CONTRACTOR The Hale Company VALUE $ 12,599.00" AP. 2,599.00- AP. No. LOT 29 TRACT 2671 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar. GROUP I & J TYPE V ZONE Rl PLAN NO. INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel A g s' /2 .-.1 f Floor System g✓S-4- /2--/9"17 Steel Reinforce Chimney Re-Rod - - . Bond Beam )s-*-& C- ,O,O •j7 Frame and Flashing fyi$iE —Z -.f _ Lathing, In Out P,"S. A -4 • j V Plaster, brown coat fy .3 -q_LSV - - - Underground soil //.✓W/G Pipe Testi,M? L-/4-Sr r Top Out I.2•15:-At _ •Furnace L W . -c--5�` LA., r/.r.•-,.-i,7i i2 Wtct_ /-/3- y-9 /6 9 .5) .._.----•T7 Gas Vents !<• 124/1 r 4/4013 - Rough Plumbing i'<!i/ /- ,26- -e' I -' 1. I _ I • _ 2-S 0 _ I -cS7 Cesspool Septic Tank ry • Prop. Swr. Li�eA Housd 4n, St. Swr. V1.4 V)/)'b' pX.,.....4-.,.....4- & . ,2 -r29-561 i Ls-S-Ls-S- 6 Uf II Sprinkling System ,U Heating Final A £4' 2_90-89 P Plumbing Fixtures, Final "/�// 4 0/ -9011 D. Final Gas Test /HiteA ,54/2 10 Q.. - f �� Construction Pole rL' Underground Power - 7 Rough Wiring - 7 /- te-.r ..4• C. C et-. _ -3o A. 6 . — 17 1 Fixtures, Final a - rv-q ��/ 1 OCCUPANCY - ,r J-.2./-/* 6 i Form 210-5M-1-57 t. 1 8016 SEE RECEIVE® OSTA MESA BUILDING DEPARTMENT II ao S�"- -C �{NANGE DI PT. P.O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING 1324 Conway Avenue BUILDING ADDRESS COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. ee(mt OWNER COLLEGE MESA COMPANY RECEIVED BY DATE RECEIVED DATE ISSUED ADDDRESS P.O.Box 2277,Brookhurst .Station ta.....--2-e-_1�.--- //-- e-C7W0V 9 0 1950 CITY Anaheim • TNO. KE 3-3161 ADDRESS . ARCHITECT Bulot Quigley LIC. OR ENGINEER and Clark • NO. RE 7191 COSTA MESA. CALIFORNIA FIRE ADDRESS 1102 W. 17th St., Santa Ana ZONE CITY LIC. ZONE NO. TYPE // GROUP LCONTRACTOR The Hale Company NO. 7350 14%1 (� ADDRESS 1777 W.Lincoln,AnaheiIuEo: KE 3-3161 BYPROVED DATE LEGALOT CORRECTIONS DESCRIPTION NO. 29 BLOCK TRACT 2671 Lan #3-C A.P. NO. SIZE NO.OF BLDGS. OF LOT 64 x 147 HOW ON LOT None USE OF EXISTING BLDG. • SETBACK LINE FROM C I 70' CENTER DF STREET' 50 REAR YARD SIDE YARD RIGHT 8! LEFT 8' DESCRIPTION OF WORK NEW X ALTERATION I ADDITION REPAIR MOVING DEMOLISH BUILDING 1222- 'Liv. NO.OF SIZE 440' -Gar. ROOMS 5 STORIES 1 EXTERIOR WALL ROOF COVERING aLUCCO COVERING Compo. USE OF NEW BUILDING Single Dwelling w/att. garage • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. CILLEGE MESA COMPANY VALUATION PERMIT FEE $ 30.[]Q °A PERMITTEE .• THE HA CO rANY Gen.Pa „ler �' / $ 12,599 PLAN CHECK 15.QQ -AUTHO- ,G&dhow A // / r TOTAL FEE $ 45.00 „Be OWNER SLIKKER, ALBERT IL. DATE 3-15-60 JOB ADDRESS 13211 Conway Ave. BUILDING PERMIT NO. 11582 GENERAL CONTRACTOR Better Bi lt Const,. Co. VALUE $ 610.00 AP.No. 113-256-13 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Blockwall INSPECTIONS DATE I GROUP TYPE ZONE R-1 Underground Soil U.G. Water PERMITS ISSUED Underground Gas — — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing _ Miscellaneous _ Prop. Swr. Line House Con. St. Swr. Sprinkling System _ Heating,Final _ Plumbing Fixtures _ Final Gas Test Construction Pole Underground Power Rough Wiring _ Trenches Forms Steel E-fes 1 -/8 4 e Floor System Steel Reinforce Chimney Re-Rod _ Bond Beam Sheathing _ Frame and Flashing Lathing, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final Building, Final 4–- 1 29�4o r OCCUPANCY Form 210-5M-11-59 S-B P 11582 • " F 131_582 I=EE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT 3 I ig I to O P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE DEPi', J FOR APPLICANT TO FILL IN COMPLETELY APPLE C�'At(O(V) FORjEPERMIT TYPE OR PRINT . BUILDING BUILDING , ADDRESS/F a 7 (O(>'M.0 IrJ a.L1.- 6;d4-4,-*-- COSTA MESA?CALIFORNIA FOR OFFICE USE ONLY // RECEIPT NO. 1iRMIT8192 OWNER (� (%(,L 7/,��� MAIL � D BY DATE RECEIVE ATE 199U ADDRESS / /7 LCL4_ p �,� d CITY 47 ti �„lI' TNO�'/ S9n ADLDG /3a 4 26,-,.../. . 6,-+ w a.'0._ . ARCHITECT LIC. COSTA MESA, CA FORNIA OR ENGINEER • NO. FIRE ADDRESS ,^ ZONE TYPE GROUP /J ��}- / .Al / T.4$TATE / on ,/ APPROVED r fr CONTRACTOR/Yf�uA'(jv[•�(.OH•�+ LIC.NO./P©/ 7BY ��lVDATE .� �e� //f3;.. .D..- • 4/1- -J(. ADDRESS .�J� ..ye._..P.LO%- C 4.-- •( ZONING LEGAL �2 9 / Jif/ ZONI� / NO.OF USE OF NEW v�4,4 DESCRIPTION I NOT "�^ / BBLOCK Cf A Y I/AQ /PLgN9 -1 / I BUILDING j/(((!!!✓✓✓ A.P.NO. // 3- a. J V ` / 3 BYPROVElkl/ �' ��',P/���/^�/ DATE 3� 7.1 ' SIZE / c % is %l 1. NOW ON LOTS. / YARDS REQUIRED `� ALLOWEDAL LOT ID Y 1 r / / (CENTER IN. USE OF FRONT LINE ST.) '�}+ L-i ` EXISTING BLDG. F+1• SETBACK LINE FROM CENTER OF STREET So REAR YARD-0,/� - R.SIDE FT. / IN. SIDE YARD I LEFT - O I RIGHT - L.SIDE FT. / IN. DESCRIPTION OF WORK REAR ..—. FT. IN. NEW I II ALTERATION I II ADDITION I REPAIR I (MOVING I DEMOLISH BUILDING NO.OF SIZE ROOMS STORIES EXTERIOR WALL (ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED EXPXir - -Puc.-K Q-` 1- l�7c. • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION. VALUATION SIGNATURE OF /f Dei, /1 _ / PERMIT FEE $ PERM ITTEE / W-`- _ /-,'/� $ CCCJJJ PLAN CHECK $ AUTHORIZED AGENT % e4-1 TOTAL FEE $ OWNER 3LnKTSR, A. L. ' DATE 1-27-77 JOB ADDRESS 1324 Conway Avenue BUILDING PERMIT NO. 44398 GENERAL CONTRACTOR Owner—Builder DESCRIPTION of WORK BloCkwall AP No. 141-038-13 LOT TRACT FIRE ZONE VALUE $ 00.00 INSPECTIONS Signature Dote TYPE In GROUP -,1 ZONE R-1 SOIL ' SUBCONTRACTOR PERMITS ISSUED GAS Dote I Number I Signature WATER Plumbing ROUGH PLUMBING ROP. SWR. LINE❑ HOUSE.CON. SPRINKLING SYSTEM TMISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING' TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER 0 ROUGH WIRING 4Heating and Vent. TRENCHES I{ FORMS' STEEL REINF. A Q p-- g'tS(ir7 ( FLOOR SYSTEM `BOND BEAM n 'STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN n OUT n PLASTER. BROWN COAT STRUCTURAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST 7 ELECTRIC, FINAL BUILDING, FINAL RA- S -2A-77 a 4 JUL 27-77PA18003019* ***** 4'38 CMSA S:SD COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT . For Applicant to Fill in Completely —Use Ink Only _ RECE VE V DATE DATE ISSUED BUILDING q/, 7 �f�, ,�, ADDRESS /3cr 7/�Q.�((/Cire-if-- MAIL U�A j A (O C I �/c��G�y�/�j {��/�/� ...‘iii OWNER A,J , .7/I/f /I G'�IL A.P.NO. ` l—{//V+i1 MAIL — BUILDING 1*24.Wm^ ( ^.{�• ADDRESS /3,2y (t Onity/4 L 1qv ADDRESS 77�J�p (X/1`�W/'C -/'gyp go � LL TEL. TRACTI lQ1I I. LOT/...qBLOCK CITY 574. I7 .f/9- NO.4# .,e59O CONSTRUCTION NEW ADD ALTER(REPAIR MOVING DFMOLISH LENDER `/c( BRANCH OWNER pc .L s `', • ADDRESS VALUE /'✓ ARCHITECT TEL. USEangl $ OR ENGINEER NO. ' FIRE ADDRESS ZONE VIDE / GROUP // // APPROVED CONTRACTOR OW yC7L Q(, I•CGYC . BY Af 1 DATE '� r � ' • ADDRESS TEL. ZONE PLANS USE OFN tE CITY NO. PLANS EL BUILDIN IS F•. STATE CITY YARDS APPROVED YARDS APPROVED g LIC.NO. LIC. NO. MAIN BUILDING ACCESSORy BUILDING W SIZE NO.OF BLDGS. (FROM C/.1_$,=AEE�N /��/ D "14„ G. OF LOT NOW ON LOT FRONT+t FII V�fiAI FT. AD USE OF / It crU wEXISTING BLDG. R.SLOE FL D FT, (/ ) [ /�/1 ' 0 Separate permits are required for L.SIDE FT. I O FT.(J electric,plumbing and heating work. I / �� W REAR FT. / FT.O E.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Qn MAIN BLDGS. ACCESS. BLDGS. /f VAR.# DATE APPROVED .'d �.�V. �Y ROVE§F_' r' ' '; DATE I 44'1 / W O I hereby acknowledge that I have read this application and state - 10 a, that the above Information is correct'and agree to comply with m 0+ all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of S the State of California. • . m I hereby certify that I am properly licensed as a contractor under SQ. FT. ry the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses ere In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: n am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ i e end Professions Code Division 3,Chapter 9. • in Signature of / 7 f / ^ 0 PLAN CHECK $ a o Permittee o -� � $ L Il C I TAX $ U. 2 u Authorized Agent • TOTAL PAID $ eb