HomeMy WebLinkAbout2338 CYNTHIA CT - Building PermitsAaD���ant to flll In all spaces exeeo< <�ase within heavy Eoraer Iines ana sign all aDProoriate aeclantions.
CIT�Y OF COSTA MESA CONSTRUCTION PERMIT PERMI NO TRACT NO LOT NO
Project nnetess 2338 � i'�i/d �T • _
3' �
Ap�ff}E;PYs.Mailing /Address -��"�� �R
Owner's Name v�'� ��L�'� Phone Z"`3�/
Address �G
Arch/Eng. License No.
Address
Contractor's Nam Phone
Addreu (mailin9)
City l.icense No.
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensetl untler provislon5 Of Char�e� 9(commencing
with section 7000) of Dlvision 3 of the Business antl Protesslons Cotle, antl
my license is in fup force antl effect.
License Class License No.
iate Signature
'ORKERS' COMPENSATION DECLARATION
� hereby affirm tnat 1 �ave a certiticata of conS2nt to Telt-Insure or a certiticate
of Worke6' Compenzation Insurance, or a certitietl cooY thereot (Sectlon
3800, Lab. CJ
Policy No. Company
8 Certitietl wpy is hereby fumishe0.
Certifietl copy is filetl with the city Builtling Division.
Date APplicant
EXEMGTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be <ompletetl i( the permlt is for one huntlretl (5100) or
less).
I certify tnat in the performance of the work or i�this 0 tm�t is issuetl, I
sM1all not employ any persOn in any mann �s�/ s� bec � e bje<t to the
Workers' ��moen3at{qp� Laws of Californi
Date GS �7J Signature
NOTICE: I(, after makin9 this tleclarati you shoultl become subje<t lo the
Workers' Compensation provisions o e Labor Cotle, you muzt forthwith
comply with such 0/ovisions o� pGrmit shall b¢ tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby at(Irm that inere is a construction lentlin9 a9ency tor the performance
of the work for which this permit Is issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILDER DECLA0.ATION
I hereby a/firm t�at I am exempt from the Gontractor•s Licansa Law for [ne
following reason (Sec[lon 7031.5 Butiness anC Profes5ional COAe: Any city or
county wnfch requires a permit to Construct, alter, Improve, demolisb or re0air
any structure, prior ro its issuan<e, also requirez the appllcant for sucn permit
Division 3 of tho Business antl Professions Cotle) or tha[ he/she is ezempt
thereiwm antl the basis tor the allegetl exemplion. Any vlolation of Sectlon
7031.5 by any applitant to� a permit subjec[s the apP���ant to a civll
re�tNar�ti V e-Im}mredeleffms't'E7'OCt.
1, as owne� of tho property
aiieri, will ao Ihe wo�k, antl th¢ TLrUctwe IS OO[ IntBntletl O� off¢r¢tl
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
License Law tloes not apply to an owner of a proper[y who builtls or Improvoz
thereon, antl who tloe5 such wo�k hlmselt/herzelf or through h6 or har Own
employee5, provitletl thal such imProvemen[5 are not intentletl or offeretl for
sale. If, hOweveq [ne builCin9 or improvement i5 Sold wlthln on0 y¢ar ot mm-
pletion, LM1e owne� will hav¢ the burtlen ot prOving he/sh¢ tlitl not builtl o� iT-
prove torthe pur0ose of sale).
❑ I, as owner ot the property, am ezclusively contractln9 witn licensea con-
Vactorsto const�ucl the project ($ection ]044, Businessantl P�ote55ion5 Code:
The Contractor's License L2w does no[ apply to an owner ot P�operty wh0
builtls or imDroves the�eon. antl who conf�acts for such oroiect5 with a con-
tractor(s1 license pursuan[ ro ine Convactor's License w) I am aware that
proo/ o( Ihei� Worker'S Compensation Insuran<8 sho tl b p ovitletl to me.
❑ I am enempt untler Section . d��or tnis reason
Date //'//� �n Owner �
I hereby certify tnat I have reatl tjN appli ation ana state tha ove
Intormation is co�r¢ct. I agree to yGiy ly with all clty antl county ortlinances
antl state laws relating to builtliQD� 5[� i antl hereby au[ho�iEe repre-
sentatives of this City on abOve-mentiOnetl property to�
Inspection pu�poses.
Signature � oate /�Z.3 �
� � D� � UNIT NO. A P�
S Main Buildi
TYPEOFCONSTHUCTION NEW ADD ALTERATION REPAIR E
❑ CONVERSION O DEMOLISH ❑ OTHER T Front
DESCRIPTION OF WORK/USE OF BLDG. A Rear
TVPE OF PERMIT / GRADING FOVNDATION STRVCTURAL I C Right
❑ TENANT GC�I ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � g Left
❑ �O7tiER Ping. Ref. �h
PHOJECT DESCRIPTION 5�. FT. OGCVPaNCV Planning Notes:
CONSTRUCTION TVPE VALUATION $
ZONE GRADING CU. VDS. ACRES
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtu6s
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains "
Floor Sinks
Gas Serviee Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact Bit. iCBO dk
Heating System & Ducting
❑aioo,000 sTu Oioo,000
Reinspection Fee
Ori ers L' „ � �
�Z—
0865-46, rev. 5/88 Wnite - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Warer Heater
Water Service
Auto-Wash
Isue Fee
Hood or Type I ❑
CanOpy Type II ❑
Refrigeration System
❑aioo,000eru ❑�oo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES Automatic Washer
Construc[ion Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas �Electric
Fan
f.A.U.
Fiztures
Device Boxes
� Outlets
Switches
Garbage Disposal
Generator �0-5 KW �5-15
$ 3
FEES
E a
Zone
Accessory
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Meter LJup to 100 amps
Meter �over 100 amps
Sub Panel
Motors �O7 HP �7 %- 8
Inc. Solar �9-15 HP 016-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
FEES
O
N
1
N
G
R
E
Q
M
T
S.
� Reinspection Fee �$75 � � luue Fee (� �s I $g 1
DEVELOPMENT SERVICES REQUIHEMENTS:
2aning Approved By Date
Buildine APP/oved By Date
Appliwtion laued By Date //
SUMMARY OF FEES
BUILDING PERMIT $ SMIP g
PLAN CHECK $ PERMtT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICA L�•,�y.,]r� � �r. —.� GRADING $
PLANCHECK S���J� �� MICROFILM $
MECHA L � TOTALFEE $ �
PLAN�Q� 9L�7 AnAI
..;�.: "_ ��
�, ... . . ,_ . _,
' CONSTRUCTION AND PLANNIN� PuOL & SPA
Date Inspector �� � � Date Inspector
AP�ROVALS Fermit # APPROVALS Permit #,
t�''iemporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement: � i
3. Electrical Conduit Utility-Undrgrnd. 54. Forms � � ��
i�
- 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding : . �
5; Steel Reinforcement 56. Rough Plumbing & F!ressure Test .
6. Electrical UFER Grnd. . 57. APPROVAL TO COV@R-GUNITE � '; ;
�
7. Footings � 58. Electrical Conduit-l�ndrgrnd. �� �
�
8.'Foundation �� "I 59. Gas Pipe, O Undrgr�5d�., Test ��' ��
t
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-T:rap, O Undrgrnd. '�
10. Structural Floor System ' 61. APPROVAL TO DECLC , �'
11. Property Sewer Line & House Connection 62. Backwash & Receptor;Final •. �
12. Sewer Cap I 63. Heater & Vent•Final �
13. Roof Drains � �
64. Plumbing SYstem - Final �
14. Rough Plumbing 65. Electrical-Final •
75. Rough Electrical-Conduit 66. Solar Sys[em-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
!1 �. 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
�20' Rough Factory Fireplace , APPROVALS Permit #
'2,1. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . 73. Undergrnd. Storage Tank O Gas ❑ Oil
250Roof 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
33. Final Electric ' �%. Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test /
36. Hoocl or Canopy
37. Final Factory Fireplace : •b�
38. Final Plumbing �
39. Water Service-Final ' �
40. Gas Service-Final '.
41 . Solar pomestic-Final '
��
42. Backflow Preventer �
- �,i
43. Backflow Irrigation ' r
44. Landscape Irrigation System � �
45. Sound Attenuation
46. Handiwp Regulations •'i"
47. FINAL STRUCTURE & BUILDING ��
48. Special Requirements Completed �
49. Electric Release to Edison - •
50. Gas Release to Southern California Gas Co '{ ..
51. CERTIFICATE OF OCCUPANCY . . . '
No. Date ' .
'� _� .
�� �� U
.> —� '� ADp�Icant lo flll in all s0aces excepl ��ase wit�in �eavy borEor Ilnes an0 sign all aoorooriate aeclarations.
CITY�F COSTA MESA CONSTR UCTION PERMIT PE IT NO. TFiACT NO. LOT NO. UNIT NO.
�ProjectAddress 2338 Cynthia Ct., C.M. 92627 SS ��
� Applicant's Mailing Address 126 Commercial . C. M. 92627 TYPE OF CONSTRUCTION NEw nDD ALTEaA710N REPAIR
❑ ❑ ❑
CONVERSION DEMOLISH OTHER
Owner's Name Gaz'th W].1SOtl Phone 642-6329 A�P� #
2338 Cyr�thia Ct C.M. 92626 W DESCRIPTIONOFWORK/USEOFBLDG. rPci[]Pn ial,�e_roof
Address ��� " S MainBuildi
Arch/Eng. License No. TVPE OF PERMIT GRADING FOUNDATION� STRUCTURAL T
Front
Addr¢ss ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL g
❑ �OTHER A Rear
Convactor's Nom Crank Hros _ Roof i pd Phone 548-5569
ndd�eulmairny1126 Commercial, C.M. 92627 PROJECTDESCRIPTION SQ.FT.�OCCUPAIvCysl� K Right
acY�����:�No. 005993 CONSTRUCTIONTVPE residentia VALUATION$ G J�3 00 S Left
ZONE GRADING CV.`�05. ACRES p�n Ref. �
I.ICENSED CONTRHCTOR DECLARATION 9'
I hereby ailirm that I am Iicensetl untler provislons of C�arter 9(commencing qemarks: Planning NOtes:
with 5ection 7000) of Dlvision 3 ot tne Business antl Professlons Cotle, antl
mv �icense iz in iwi to�ce��a etiect. 408677
lJcense I�5s Uy nse No�� —
Datc ��i7'J (� 5'9 t r% LAu�dC� PLUMBING FEES
WOFKE'RS' C MPENSATION DECLARATION BB�Si�k ShOWE�S
I heraby alfirm titat I bave a ttrtllicate ol tonsent to self-insure or a certlficata
ot Workers' Compensation Insuranco, or a certilietl copy t�ereof (Sectlon
3000, Lan. Backflow Preventer Service Sink
fN�85362466 Fremont Indemnity
voucy rvo. Company Backflow Irrigation Sewer Cap
Cerlifietl copy I5 hereby.fumishetl.
Certiflg py I5 i tl with the Clty By(Id'+�y �ivi:l� 82Lhtu65 Sewer Connection
Oate Applicant (l� ��
EXEMPTIO FROM WORKERS' COMPENSATION DECLARATION Clari(ie�s Solar ColleCtors
(This section neetl no[ be comDletetl If Ino Oarmit is tor one huntlretl (5100) or
loss�. Dishwasher Solar Pipinq
I<ortify that in the performance oi the work for which tnis perm�t is issuoC I
shall not employ any person in any manner so as to become subjatt to l�e Drinking Foun[aini Solar Tank
Worker5' CompensaliOn Laws OI CalitOrnla.
Date Signalure Floor Drains Swimming Pool wlSpa
'NOTICE: I(, after making this tleclaratlon, you shoultl become subject to Me
Workerz' ComOensation provisions ol Ihe ldbo� Cotle, you mus[ fo�thwi[h FI00/ SinkS Urinal
camply wilh suth O�ovlsions or this permit ihall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV G25S¢�VICE Out12L5 Wd�¢fC105¢t
I hereDy af(Irm tM1at there i5 a ConstruGlion Ientling ag¢nty tor the performance
Of lhe work tor whicb this permit is issuetl (Sectlon 3097 Civ. C.) ���¢�C¢ptOrs Weter Heat¢r
L,entler's Name
�enQCr'S Atltlross Kitchen Sink Water Service
OWNER BUILDEH [�ECLARATIOIJ
I noreby affirm tnat I am oxompt trom tho ConVactor's Llcense Law for tho Lavatories Auto-Wash
lollowing reason (Seclion 7031.5 Businast antl Professional Cotle: Any city.or
county which requires a vermit to construct, alteq Improve, Eemolish or reoair P—Trap Leundry Trays '
any structure, prior to its issuance, also requlres the applicant for such permit
to tiie a signetl statement [hat he/she is licensetl pursuant to Me provisions ot Roof Drains �—
the ConlractoYs License law (Chapter 9(commencing with Section 7000) of
�ivision 3 of fhe Bu5ine55 antl Prote5510ns Co4e) or [hat he/she is ezempt —
thcre/rom and the �asls for thc allCgetl exempllOn. Any viola[ion of Sectlon
7031.5 by any applicant fo� a pe�mil Subjects the aOP�lcant to a civll
�endlty of not mo�e than tive huntlretl t1011a�s (E500�.
I, as owner of thC propCrty or my amployc05 with'wages as thair So10 ReinSpBttiOn FBB $15 IZSue FBB a 3
mmponsallon, will �o the work, antl tha struclure Is not intentletl or ofteretl
br sale (Seclion �o4a, 6uslness antl Professional Cotle: The ConVactor's MECHANICAL FEES
Llcen58 Law tloes no[ apply t0 an ownur o/ a property who builtls Or imprOves
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Elec'
Fan
F.A.U.
Fixtures '
Device Boxes
Outlets
$wilCh25
Garbage Disposal
Generator �0-5 KW C
Fee
iC
4061 9/29/86
�
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter �over100amps
Sub Panel
Motors �0.1 HP O1'f, - 8
Inc.Solar �9-15 HP �16-15+
Microwave '
Pole Light
Range
P5.50 TL
FEES
; Standing Sections
5-15 KW Trash Compactor
$15 Issue Fee $ 3
thereon, antlro IUedthat such improvem /nt eara��not intentletl�or otferce for Boiler Hood or Type I ❑ � DEVELOPMENT SERVICES REQUIREMENTS:
em0loyea5, p
sale. If, howeveq me builtlin9 or improvement is soltl within one year of com- Canopy Type II ❑ 2oning Approved By
pleHon, tne owner will have the bu�tlen at proving he/She tlitl not builtl o� Im- DuCt - UntlE� GrOund __�
prove for the Durpose oi sale). Building Approved By _
❑ I, as owner oi the pioperty, am excluslvely contractin9 wIN Iicensetl con- Duct -$ttuctural Refrigeration System Ap
trattors to construct the oroject (SecHon 7044, Business antl Profession5 Cotla: _
Tno Contra<tor's License law doet not apply to an owner of vroperty wno Duct - Ventilating ❑b100,000 BTU ❑100,000 BTU
builtls or Improves tnereon, antl wno conVacts tor sucn Orojec[s wi[n a con-
Vactor(s Ilcensa punuant to ine Conlraclor's License Law). 1 am awaro [nat Exhaust System ❑ Multiple � System Repair/AI[eration
proof o� thelr Worker's Compensatlon insuranco shoultl be provitletl to ma.
❑ I am exempt under SecNon B. & P. C. �or thiz reason Firepl/Fact Blt IC80 # Fire Dampers
Date Owner
I hereby certity that I have reatl this applicatlon antl state thai tha abova
Information is correct. I agrce to compy with all tlty antl county ortlinan<os
antl Tlate laws relating to builtling construcHon, antl h¢reby authoriz¢ r¢pre-
sentatives of this ciry ro enter upon tho above-mentlonea property tor
inspectlon purposes. l
Signaturo �!7 Date - �
Driv¢rs' LlcenSe or 55 � �-
Heating System & Ducting
❑ ai oo,000 aTu O i oo,000
Reinspec[ion Fee � $15
��` ^O�5-a6,�ev. 10/84 Wnite - Builtling; Canary - qppp�ant; Pink - Accountin9: GOIGenrotl � Assessor
Registers
i�wa Faa I a 3
BUILDINGPERMIT $
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
Z
O
N
I
N
G
R
E
�
M
T
S
ES �SMIP $
PERMIT
ISSUANCE $
ENERG�' P.C. $
GRADING $
MICROFILM $
TOTAL FEE $ as. s�
�'C(SNSTRUCTION AND PLANNIfv�. POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
M
i. Temporary 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. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
6• Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNiTE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � 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
76. 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
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StoregeTank 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
33. Final Electric Notes: .
� 34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Facto�Y Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow Irriga[ion �
44. Landscape Irrigation System
45. Sound Attenuacion
' � 46. Handicap Regulations�
"� 47. FINALSTRUCTURE&BUILDING �(J ��'
48. Speciai Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern Catifornia Gas Co
� 51. CERTIFICATE OF OCCUPANCY �
No. Date
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295�0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX1200 COSTAMESA,CALIFORNIA92626
For Applicant to Fill in Completely
BUILDING
OWNER M��
MAIL
ADDRESS !{�
CITV Newgc
CANSTRUCTION
BRANCH I]
ADDRESS '
ARCMITECT
CONTRACTOR
ADDRE55 4(�
cirv Newnn
STATE
LIC. NO.11 C�C�
SI2E
OF LOT TZ'TB
VSE OF
E%ISTING BIDG.
SI2E OF
NEW BLOG.
EXTEFIOR WALL
TEL
NO.
osta Me
CITY
LIC. NO.
NO.OF BLDGS.
NOW ON LOT
NO. OF
ROOMS 6 STOF
O ROOF
rnn COVERINGWOOd S
AND WORK TO BE PERFOFMED
OEC31-68PA�c001128# **TM117.5L
cr;s.
APPLICATION FOR BUILDING PERMIT
BUIIDING
ADDRE55
OWNER
FIRE
20NE
APPROVED
P
VAIUE
DATE/
N NO.OF USE OF NEW �
PLAN$ 'Y BUILDING a.
VARDSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDI
iOM GL STREET) � /� ,,,
VA(i. #
C.U.P.3j'+ = -
-�.-
BEf. MAIN &
0
I hareby acknowledBe that 1 have reetl thiz epplication entl stnia CIULU f'�JR JI'Ll.1Hl � 1CL�(UIKLMCIV 1 J
thet the ebova informetion is corract antl apree to eomply wlth
all laws reBulating b�iltling construction, entl I zhall not amplOy
any porson in violetlon of tha workman's eomponaation laws o(
tha Stero of Colifornia. m
b
I hereby cerUfy thet I am proparly Ilcansetl as a contractor untlar n• FT. o
the Smte ot Cellfornia Businass end Professions Cotle, Divlslon 3, THE AMOUNT S N VNDER VALVATION IS FOR �
Cnepter 9, antl thet cuch Iicenxs are in fu�l forca antl effact, or I TNE PURP06E OF ESTABLISHING A GERMIT FEE ONLV: o
em axempt from t�a provisioni of Ne Smte of Callfornin Busfness ¢
nntl ProteEsion6 Cotle, Oivision 3, Chapmr 9. VALUATION n� ►'� y
PERMIT FEE $ / �
,t[%] A 7
Sipnnture 1 � f c/ /�`S 4 E
Pormktee / V §�/ �� \ Pl,AN CHECK $ �
AUMorizatl ABant � J TOTAL FEE $//� � � LL