HomeMy WebLinkAbout924 CROCUS CIR - Building PermitseoonEssa emtawo: 9 z 4 CROC US C I
OWNERBWWEIfqqNN:MINEO, JOHN R
' �ouness:9zq CROCUS CIR
r � COSTA MESA,CA
754-1851
APPL. IIAltINO AODNES9:
�
L�I
ANCNRECT OR FNdNEFA:
wam�crarswu�:PAUL GARCIA
coNm�croxs�uiwa15061 OAKWOOD LN
�oonFss�C M
urr: CITY OF COSTA MESA — HUILDING PERMIT
FLOOD: AH-38
92626 PERMIT NO; B 076703 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR
ue. no.:
UNT:
(714)774-9036
CA ���.605061
. • 91709 u�:
LICENSED COMXRCTONS DECLAflATION: I hereby elfrm ivMer pere�y d par'ryry Nm I em Iceved under prwidona d Cheqer 9
(mmme�np xiih Seciion ]000) W Di�nsion � d �ha Business end Profnebns Cade. d my lioema u in lull iwce vM e/lad.
cmuc.No.: uc.cuss:C-39 uc.r+o.: 61 EXP:
oma: 3—�'9% c�v.a�:
OWNEH BUILDEP UECIARATION: I hareby aHrm uMar panely d perNrv �� I em uamq from �he Con�reqae
lollowiq �enwn (Seaion )W 1.5 &niima vd Prdeeeioiu COAe: AM W a muruy which reyuim e pertnn to cunvun. eM1er. imPrwe.
demolsh, w repei eny avucture, p'v io n�'swerce. elso reQuves tM applirent Iw auch peimN to Ne e sg�E atalamem ihel he «aM
Is �icensea w��m io �na wamiom d me comreaas liceme ler Icheq« s(mmmmdne wnn seeiw, �000) a owubn a w �he
euslrresa ene Prdessions codel «mm ne «sne e ezemq mardmm ene �ne msis �« me elboee e,amqon. Am •idmon a seaun
1IXi1.5 by enY eGP��I ta e pB�Til eutjetla Iha epplir2nl lo a tiW p0n011y OI �M mae Ihen (rve huMred da0en �$SW]).
❑ i. m�e, a ine wow�r«mr.�,vMeea wn �e? m ine:,de ox,re��+..m do me..om. e�a ine m�a�,.e e �a mm�dee
a olfered lar nele I`��ion ]Oa4. Bueiirs eM ProfesvonaCoda: Tha Comreawa Limme Lew doae mt epplyto en ownarof prapany
.ro wus «mww�. ma,�,. �d .ro aoas.ucn �wx ��eu «ne�.ee «wa,M w«n« own emWweea. w� inm sucn
imqwamenls ere ml inieMed a aflereE la ule. p, however, lhe WiNiiq a'vnpwement ie eold wil�in aie yeer d mmpletion. ihe
owmrbuilix xill heve tM buNm d pmi�q M« ehe did rc� ddd n impo.a fv IM WNma d aelal.
❑ �. e. ombr a ine wwenr..�, e.�,weN convac�o .an emmee cmvenan m cmmua �na wuroe lseatn �a.. a,ainma ene
PrWessions COCa: TM Cam�vawa license law Joes mi epply to en owinr d piopeny who Wika a imqwm �Mreon eM w1w
���i, i« .�ww, pa� wnn a rov�e«�a� r a�a v��v m ma can�, u� �.,�.
� I em uamW uMx Sacuon: 8. 8 P C., br Nb rea+on:
PERM NO: B 076703
GOVT: N SUPP: N
PURPOSE: OTH
B DESCRIPTION : T/OFF RESHEATH 6 COVER W/COMP SHINGLE SQ FT: 2,995
AIM VALUE: 2,995.00 CALC—VALUE: 2,995.00 GROUP OCC: R-3 /U-1
MMENTS: 21 S�UARES /RE—ROOF RESIDENCE/ SMOKE DETECTORS RE�'D PER 94 UBC
**�x+�*****�* ***+�x�**��*+�*��+�+�***�**x*�***�r��**+r�******+�** +��+r*x�***����+��+�*+�**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 41218320 ZNE: REF NO;
PLANNING NOTES>' •'
i
iE iE iE iE iF if ff iE iE ik iE if if if iE'iE iE if iElF iE ih if if ib iE if !F iE 3E iE iE iElE 1ElE 3E iE iE IE iE if IE iE iE 9F 1E if iF 1E ik iF iE 3E IE fE fE jE iE iE iE iE IE iE IF �E iE iE fE,iT �E iE iE 1E if 1F iF iE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED^BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: �� ��****D**H** �'��*
STRUCTURAL SEGMENT:Y
FIRE SMIP/RES GRADING
50
SMIP/NON—RES
o�'° °w"°` ILEGALIZATION:N F E E S U M M A R Y
i do na,enr �en�ry me� i� e.aa a.�w wsR�a u» �a��� a cmaome �nn �e smmy coas sea� zssos. us�a. �e
25Sla,endRuilaenyMurebuiNmpomqeniwill/willm�(ticbaw)needtocwnplyw�huNnmacadaudiharopuirameniela BLDG PMT PLUMBING ELECTRIC MECHANIC
eparmnlormmweiionwmodifreiianhanlhaA'�ae�ementUmriq.ReaiJen�ialeongeupioneppiratbnsemezemqimm�hme pERMIT 5�i.�0
provisiom.
oe�e: �op�:
WOHI(EP'S COMGEN911TION OECLAR�TION: I Mraty elf'vm unJer pero�y d pxj�vy an d tM bibwi�q dedereiuna:
� I M1ew vd hil meiMe� e ceMule d mruenl �o fepivun b MMcen' cdnpenm�ion. m qwWed tu by Setlun 3]00 d �M lebar
Code. la itw penrnmema d tM xwk lor wlvc� �ho peimn ie iuued.
❑ i ne� e�e wie me�men woaen� mmoemmo� ��w,erce. m r.e��a M s«a:n a�oo w a» tena eme. i« mn w�ro,�,� d m.
wak Iw wl�'rh thie pamn o iaued. My waMen' mmpenve�ian imurar,a wner W pdiry numEer va:
c��:
ad�r N�mna,:
(m;s e«+ion n.ed na ee m„daree i u» w�/ a re, on. ww�ed adw= /s)a 1•�.7
i{[] I canAy thm in Ihe peAomxncs d �M wak Irc whch �hu pwmu 6 i9�ued dl mi mplvy eny pavon in eny maru�er eo m to
becoms euden io �M wwMre• can0e^�ion kxs a Gelaame/en ree Net il enouk b¢mie wbpa Io the wwken'
wmpan.aibn provisiwu d Seeian ]l00 M �M lebor Cade. I eh f lo ' h odnpty v.n Nme pmviwna.
oeie: 3 - (� " 9 (i �cw�:
Weminp: F�llm ro��cun woAa�'rompwwtlon rnvenp� 1 n4wN1, �nd �Iu1HUE�c1 en wnp/oyw foWMrol peneNs� erW
c/vll 1/nu �.y ro an� h,nCM tlnuuM Go/Yn (S1pp,OW/, M�Cd/tlon ro tln m�� ol romp�nutbM1 Eam�p� u qovltlM br In
Swtlon ]l06 0l Ms Lebor Cotl�, InINu4 entl ettomsy'� Ms.
CONSTqUCTIaN LENDINO AOENCY: I hareEy dfirtn uMm penMy d par'µy ihm �here e e oonneuaun bMirq egeM.y Iw iM
paAarmarim W ihe hork fa whiM Ine pxm� u eweE (Sedun �OB]. Cv. C�.
LENDEH'S NA1IE
LENOEN'S ADOHESS:
I<aniy Ihe� I M1eve reatl It�is epd�� ���e IM1a� Ne ebora iniwme�ion i� m�rea. I q�ree to compty wilh dl rny end munty ordinencee
eiMeieielawarel B�abuJinBcmarwionerdhmebYeuiharce�enesametireadthudlYtoentauC��Mebwa-mamionetlV�M
1or inspeclion s���� l, � � � r r
o�<: 3"�' -1�
(515t<e WP) Whno-9uildip 8 Sa/ey; GreeMFb: Canery-40P���: A�k-Reven�e; Gddenrotl-Reaemr
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 54.50 0.00 0,00 54.50 54.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 54.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
54.00 ,50
IE 1F If !E!f!E 1Flf if 1E 1E 1E IE if 1E 1f 1E iF K 1f IE 3E IE IE 1E IE 1E IE 1f iF iE 1f 1f-if iE �E 1f Ik �E if 1f iE 1f !E ih if� iE iE iE IE ik iE iE 1E iI� 1E IE 1E �F 1E iE iElE if 1E iE 16 �E IE iE IE iE iE 3F 1E IF if if *
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 2995 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 2,995,00
END OF FEES
�A _ 1 � � _ "
J: ::: _ ' .. � ' , .0
V
CONS7RUCTION AND PLANNING POUI & SPA .
� Date Inspector Date Inspector
APPROVALS Permit # APPROVALS Permit #
1. Temporary Etectrical Serv'�ce or POYe 52. Pool & Equipment Locatio� �
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrqrnd. 55. Electrical Bonding
5_ $teel fleinforcement 56. Rough Plumbing & Pressure Test
s� Electr�cal UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footin9s 56. Electricai Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test „
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor Svstem 61. APPROVAL TO DECK ��
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Neater & Vent-Final - �
�13. Roof prains 64. Plumbing System � Finai
74. Rough Plumbing 65. Electrica6Fina1
15. Rough Elect�icabConduit 66. Solar SVstem-Finai
16. Rough Electric Wiring 67. Fencing & Access Approval
17. RougN Wiring Sign 66. APPROVED FOR PLASTERING
18. RougM Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �- FIRE DEPT. REQUIREMENT
20. Rougb Pactory Fireplace - � - APPROVAIS Permit #
27. Ducts, inStruCture � 70. Underground HVdro
22.'Ducts, Ventilating - , ��- 71. Product Piping QGas OOiI
23. Gas PiPe•Rough & Test � 72. Underground Flush
24. Roof Praming 73. Undergrnd.SmrageTank CGas ❑Oil
25. Roof 5heathing 3-%��j �,�� 74. Overhead Hydro
26. T�Bar Ceiling (Structurall & Monocoat � 75. Dry Chemical .
27. frarr�8 and Ffashing 76. Dry Standpipe �
. 28. Lathing & Siding': " 77. FIXED'SYSTEM FINAL
29. Insulation � .- � - 78, FIRE PREV. FINAL
30. Dryeva�l Nailinq � HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat . . . 79. FINAL INSPECTION
32. Elnctrical Power Meter-Final ' 80. FDOD CERTIFICATE ISSUED
33. Final ��ectric . Noces: , ,
34. Fina1 Heating& Air Conditioning • , .
35. Final Gas Pipe�Test � ' � ` -
36. Hood or Canopy � ' " . ^ . -
37. Final Factory Fireplace - �
38. Finat Ptumbing _ -
39. Water Service�Fin21 � � .
40. GasService-Final, �,. � _ -
41. Solar Pomestic-Final � . �
42. Backflow Preventer' _.
43. Backflow Irrigation
44. LandscaPe Irripation SYstem � _ - -
45. Sound Attenuation •
46. Handicap Regulations
47. FINAL STRUCTURE & Bl11LDING 3-$-�� .
48. FINAL PLANNING
49. Electrie Release to Edison '
50. Gas Release to Southern California Gas Co
51. CER"iIFICATE OF OCCUPANCY
No. Date
Mr. Ray Trevetha, Jr.
924 Crocus Circle
Costa i�esa� California
m
92626
Febx�14, 1975
Dear Sir:
A building permit has been sued to Anthony Pools to construct
a private swi�ning pool on yo property.
In order that your pool iaill be a safe one and for the purpose of
advising you of;y ur�responsibility regarding the requirements of
the Costa DIesa Mu ipal Code, we refer you to Section 8107, a
copy of which is at ched. '
This letter is directed to you in order that you will be aware of
our ordinances and can make a complete safety check of'your pool
area.
Sincerely yours,
RICHARD HANHART
Building Safety Director
RH:cb
�
CITY COSTA MESA REQUEST FOR OCCUPA.
TRACT N0. �� I�
v
LOT N0, 0 �
ADDRESS -(�y \' � FC�n i
DATE a1, 3L>
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract hae been completed and its streecs
accepted by the City of Costa Mesa.
The undersigned, by executing this agreemen:, acknowledges that
(he-she-they)� (was or were)� ���o. � advised that this [tact has
not been given fina in pection 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 claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
BY�� /t�_.��«� `�'`L
Purchaser
/� �
BY /.E�Z�f• ���'-�2(�
Developer and/or authorized
representacive
BY i��CticG'L� �Ol�nu
Lender
�
- � 3510�
` COSTA MESA BUILDING-SAFETY DEPARTMENT
�FOLBR P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applica�nt to �Fill in Completely
BUILDING _///�� /, _
Z .
W W
aU
y— Z
za
o�
am
J �
J N
Q W
(y7 J
- ¢]
J Q
U N
Za
W �
aw
W Z
J Q
m Z
J �
w w
O
Z H
W �
� �
H
z
Q
U
J
d
a
a
�
F
N
z
�
H
U
�
�
F
N
Z
OWNER
MAI l
CITV
CONSfRUCTION
LENDER
BRANCH
ADDRESS
AFCHITECT
ADORESS Qln(!
CONTRACTOR �y�
ADDRESS ]_(�'Zj
cirv Enci
STATE
LIC. NO. 1(�17
oF�or 58 x 90
USE OF
EXIS7ING BLDG.
size oF 1784
NEW BLDG.
EMERIOR WALL
COVERING SCL
USE OF BUIIDING A�
TEL
NO.
TE
i�UG 15-77Pa1o00703nr ¢*"142.88
�HSA
TION FOR BUILDING PERMIT
DATE RECEIVED pq-rF�gU
d� 7
�� PERMQ�LQC
A.P. NO.
BVIIDING `
ADDRESS
TRACT
R
LOT
VALUE
DATE �� Z�'
Y TEL ZONE..� NO.OP VSE OF NEW 5/(v Y/Il� 1 �� L �
No. 986-8890 �- P�-4� � BUILDING '( /Ct(/� •a�ic
CITY �'ARDSAPPROVED YAROSAPPROVED
LIC.NO. B_1 MAIN BUILDING ACCESSORV BUILDING
INO.OF BLDGS. (FROM C/L STRE{E T) [J
NOW ON LOT O FRONT -J—a� FP.�+� 1 FT.
NO. O F
ROOMS STOF
ROOF WC
COVERING Sh
K TO BE PERFORMEO
1
VAR. �
C.U.P.aW
HPPROVED 1 �„ �/1 �S
� IJ
MAIN &
I hereby acknowletlBe tho[ I hnve �eetl [his applicetion entl state HOLD FOR SPECIAL RE U�
Ma[ tne above iMormation is corratt antl aBroa to comply wl[h
nll laws reBu�ating builtl�ng consvucxion, antl 1 shall not amploy
any porwn in viola[lon p� the workman's compansation laws ot
tha Stata of Californie.
I heraby certity [hat I am prOperly iicenutl as a connacror untler
SQ.FT. �
tha Stnte oi Culifomia 8vsinoss entl Prolossiona Cotle, Divlsicn 3, THE AMOUNT SHOWN UNDER VA�
Chopter 9, antl that auc4 Iicanses are In full forco antl effoci, or I THE PURPpSE OF ESTABLISHING A PI
amexemptlromthoprOvisionsoftheStnxeolCulltornlaBosinoss VALUATION
ontl Professlona Cotlo, Division 3, Chaptet 9. � PERMIT FEE $
Si8^emta of �/� Q
Permlttee �//!XL _ D. DOWRS $��/QO PLAN CHECK $
A�thorizetl ABant TOTAL FEE $
Q/ m
r� 7- '°
/ o
ONISfOR j
FEE ON�v: Q
� � N
7
7 ��"�' m
E
� ` - LL
r
ER
ROP. SWR. LIHE I I HOUSE
ROUGH
UNDERGROUND � POWER
ROUGH WIRING
BOND BEAM U 5T
SMEATHING
FqAME ANO FLASHING
LATHING - IN n
PLASTER. BROWN COA
HEATING, VEI
PLUMBING, F
ELECTRIC, F
BUILOING, FI
DATE
LDING PERMIT N0.
Patio Cover
RE ZONE VALUE
GROUP J TYPE
SUBCONTRACTOR
i
.
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING �
ADDRESS �
OWNER A �% T /
MAIL �_ „ . � � . � /
Z .
d U
Z
zQ
� N
d. m
J �
J N
Q W
p� J
J m
Q
U �
Z Q
W ¢
aw
WZ
J Q
m Z
J �
W w
� _
ZF
w�
N �
�O
H
z
Q
U
J
a
a
Q
0
F"
N
Z
O
H
U
�
�
H
N
z
crtr �OSf f �C(F
CONSTRUCTION ND
LENDER
BRANCH
AODRESS
ARCHITECT
!1R CNI:INFFR O
ADORE55
CONTRACTOR �
ADDRESS
❑TV
STATE
IIC. NO.
512E
OF LOT
USE OF
EXISTING BLDG.
SIZE OF
NEW BIOG.
EXTEFIOR WALL
COVERING A
USE OF BUI�DING
�
L.
TEL.
TEL.
NO.
CITV
LIC. NO.
INO. O LBF�DGS.
NOW ON LOT
NO. OF
ROOMS v 5
ROOF /y
COVERING �YtI�I
WORK TO BE PERFOFM
I heraby acknowledge that 1 have reatl chis application antl stace
that the above intormation is correct antl aB�ee to comply wiih
all laws regulatin8 builtlin8 construction, and I shall not employ
any pereon in �iolation ot the workman's compenzalion laws of
the Stare of California.
I hereby certify that I am properly licensed as a convactor untler
the State ot Calitornie Businass antl Protessions Cotle, Oivisicn 3,
Chapter 9, antl that such licanses are in full force ond etfect, or I
am exempt trom Llie provisiOns ot the State of Cellfornia Business
and Professions Cnoe, Division 3, Chapter 9.
SiOnature of A „•, /%J f� �j
Pe�mittae � /LGCL C.� �jl�/
Au[horizetl ABent
Pa'o 7.50
!UL30-73chse�02877� *****
TION FOR BUILDING PERMIT
- -�n �
BUILDING �,/
ADDRESS L�.�
TRACT'/�JIrT l0T
OWNER
SE
FIRE
ZONE
APPROVE
DATE
)NE NO.OF USE OF �
PLANS BUILDING
YAROSAPPROVED VAR�
MAIN BUILDING ACCESf
ROM GL SS5'EET) _ .
//
DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BID�
VAfi. # DATE
C.V.P.� APPROVED
APPROVED�,)� � P� /j
m
�
SQ. FT. T o
THE AMOUNT SHOWN UNDER VALUATION IS FOR �
THE PURPOSE OF ES7ABLISHING A PERMIT FEE ONIV: m
¢
VALUATION �
� PERMIT FEE $ ,� �
7
/ m
5/� � PLAN CHECK 5 E
�(� O
LL
TOTAL FEE 5
OWNER TREVE'PHAN,
JOBADDRES rocus
GENERAL CONTRACTOR n
AP No. - - LOT
�INSPECTIONS
Pool Location
Forms
Main Drain _
Steel Reinforce
Elec. Bond _
Approval to Cover
Underground Electric —
Gas Piping Test
Filtering System Lines —
Backwash Lines anii Recep.
Electrical Final
Heater and Vent Final _
Filter System Final
Backwash and Recep. Final
Fencing Final
JR. DATE2-�3-75
BUILDING PERMIT
0o S DESCRIPTION of WORK W1111 00
TRACT FIRE ZONE VALUE $ 3� 00.
Si n eure Date GROUP TYPE
- - J SUBCONTRACTOR F
Date
Electric
- D-
3-
� I�'�'J�� Plumbing
J�/'-� %Y y 75� �' �'l.�- :
%�1�� '>' 3 % 7 � . - c�p.
%�L�� �Y�c,�ii
�
Z .
aU
Z
ZQ
� N
am
J7
J �
Q W
0] J
J m
Q
U�
Za
W �
aW
W Z
J �
m Z
J ¢
W w
0
z�
w�
�O
39606
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
FAi� �
�EB 1.3-75�,,<r�� 33�� �'***39.50
APPLICATION FOR BUILDING PERMIT
ForApplicant to Fillin Completely REC V BY DATE CE VED DATE ISSUED
ADDRESS 92 cxocus czR � a"��
-�_t���� PERMITNO.
OWNER RAY TREVETHAN JR. P..P. NO.�
BUILDING (�2 CROCUS CIR
MAIL ADDRESS 7
ADDRESS o
CITV NO. TRACT ���V BLOCK
CONSiRUCT10N C��h AD P
LENDER
a
BRANCH RAY TREVETHAN
OWNER
ADORE55 VALVE
APCHITECT TEL ��m pOOl g 3� �
OR ENGINEEF R K N
FI(iE
ADDRESS ZONE TVPE GROUP
ll APPROVED
CONTRACTOR �yy'j�[� POOZS BV DATE
ADORESS 5871 Firestone B��•
TEL. ZO NO.OF USE OF NE
cirv South G8to No. Sp32210 P�� � eui�oiNc'jSppL
STATE [� r� CITV �'AROSAPPROVED VAqDSAPPROVED
LI4N0. 170�/y, LIC.NO. MAINBVILOING ACCESSORVBUILDING
SI2E NO.OF BIDGS. (FROM C/L STREET)
OF lOT NOW ON LOT FROfYT FT. FT. �P
USE OF p /
EXISfINGBLDG. PBS��yBRCe and ara e F �IOFT
SIZE OF NO. OF � � �/
NEWBLOG. ROOMS STORIES L.SIDE FT. � FT.
EXTERIOR WALL ROOF � �
COVERING COVERING :aEAR FT. � FT.
USE Qf��111.LILNG ANJ]yYpR�(IQ9E PrcFjFOPMEO_ DISTANCE BET. BET. MAIN &
�ll'lYLi GB S W1L1 �1U01 lLl i"C�l' MAIN BLOGS. ACCESS. BLDGS.
of single famllq dwe111ng C URP # APPFOVED
APPROVEDt,' J � _I�2_>�
�V J /
I hereby acknowletlge that I have reatl this aDP�ication and state ST
that the above intormation is corract antl agree to comply with
all laws reg�latln8 Ouiltl�ng consttuction, antl I shall not employ � D \
any persOn in violation of the workman's compensation laws ot �
the State ot Calitornie. (
1 hereby certity that I am properly licansetl as a contractor under SQ. FT. �
the State ot California Business end Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VA� ��A71.Od'IS FOR
Chapter 9, and Mat such licenses are in full t ntl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
amexempitr rovisionsottheStata tCel ornieBusiness VALUATION
and Professi s Cotle, Diyi ion 3, Chaptar . �� y
� �� PERMIT FEE $ ♦ (I�V
Signature yq
Permlttee $ �Q PLAN CHECK $ /V ` �
Authorized ABent V O"��
TOTA� FEE $ � � ��
m
0