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HomeMy WebLinkAbout958 DAHLIA AVE - Building PermitsADONESSOFBUIlpNO_� ,; .. _w'-_^,.. � "..,," "- s'_'� �.-.�Y- _��+,,.�.` �-�_, .�.;,.CITY OF.._COS,TA._MESAt—_..HUILD,ING_P,ERMIT�,:.,, -. � - • 9.5,8_.DAHLIA- AV , uN* � OWNEXSNMIEI�O�yq. COSTA MESA, CA .._ 92626'._ . _... _.', . PEAMIT NO:,; H .. _ .086191T PLAN CHECK NO: �N . . GOVTO:.. H _., _086191 ._�� _,.SABHAGH MITCAELL FLOOD• AH-38 _ _ _ _ PERM..N 958 DAH�IA "AVE . ' - • � ' . , ' . . _ : N, SUPP: `.N _. ' � � . �cr� �wuwo�oonrss: , _ . � CONSTRUCTION 'TYPE:_ V—N.._._. _:..._ __..._.. PEAMIT_TYPE:_' STR , . _ �:PURPOSE: OTH �� , ,.JOB DESCRIPTION___:__T./OFF__RESHEATH 6, REROOF W/COMP SHINGLES ;SQ ET;' „ 6, 000 'ARCNRECTORF1MdlFER: . " 11C.N0.: � � � ARCX.ORENO:SAOONE54: ' . i UNT: � ' . ' , •. • � . CLAIM VALUE: _ _._6,000.00__CAI:C=VALUE: _, __ '.. 6,000.00 GROUP_OCC::"R-3 /U-1- - comwcrarsxu� STAR COURSE ROOFING CO._ _ : ( 800 ) 954-0,014 ' ^ . . '�.. cwm�croxs�uuw24981..HON...AV__._;___ _.._.__ . �..'_ ...:_..._._ COM*****: ***OOF 2*00** **S*D*NCE'W/*OMP, SMOK* D*T**T*S*RE�UIRED P*R 94UHC . �oo�ssLAGUNA.HILLS . _ ,__CP; _ucxo: .53�2778._�:._,_.. � * *� *+r**+r *■ +t �r „ a+��r*�r* ***��r**** * * * x r�r +r+c�r*** *i�****�r�*** ' 92653�,._ __ _ uxr: __;._ _ ' . _.__Z�„O_ N,I.,N `G R E Q U, I. R E_M E N T_g�Q�E DETECTi�F� �" LICENSED COMRACTORS DECLAfl�TON: I Mreby allim under pen pe�jury thm I em Icaued uMs �,. a cnapa.a � ._ . ''� -_ �....__ __�._. . _� S E T B%, C_ 1( S , � i; _ _'_ (cammaMnB wll� Seabn ]000) d dv6un � d Ihe Buainaea eM P iau Code ' tul aeM elleU. ' : . . . _ � ' � " ' ' �A � pC , �. cmuc.No.:059971 quacuss: C—.39.. _c.No _ 32778 . '_. XP:_08./98_-- -------=----- MAIN_BUILD.ING;_� _------r._..___. ----_: � -- ACCESSORY �O►�A��'f��---=� � ome: �Z.— lG �`� c�a«� — . FRNT; - FT '_. IN_REAR ,_..FT -. IN FRNT:_ FT IN REAR: ��FT IN ` - � � ..LEFT; FT __IN,.�RGHT �FT .. IN ._ __LEFT:: _ FT IN RGAT: FT 'IN: ..OWNEN BUILOEN UECLAP�TION: I heieby effim� u�ider d M� 1 I em examq han �he Comream liceme lew la IM --- •. -: . ~ '- ' .,' '. � idb,.;,��^�^is«+b^�w�.sa,�"^s�^^^''°� °°°°:" r°'°°"^'Y"^'"'°a'"'°'°o°^""'°�"`°"�'.°^«.""p°". PARKING REQ: " ' PROV.:_��___�_ PARCEL:_:4121'8�249 ZNE: ' REF NO: '` I ! demd'eh. a repei+ny nructuro. pna b in oeuenm. re�G��G e epplimM for wch pmmA lo fib e aqiwd a�emmi tlim he a eM ' - i+^" -^'� . , �. n„�„e ��� io m, a��� d m. can� asyblue law [CMpx 9(canmendnp wnh SeGion )000) d Dvuion 3 d Or PLANN I NG . NOT ES >;' - ' � `/� ' .. eua'ms..ne Raea.ons cotlel «�n.1 ne or ehe�ob.�B q �naetrom ene �ne�bads I« u�a dbped uemqo�. anv vidm'nn a seeian . . - �.ls ^ . . .. _ . - --- . -- :.. . . . _. . . I � . . . _ - ��.� . _ . _. . . . . ]03t.sh'�YaGWimMI«eGermnwq«ae�haeVWiramioetivuM�YdnamaamenMehuMreEEdlen�fSooU. lFiEifififlfikifififlkMifikif1k11f1fifikiflkiFlfikififMlfiEiFlfiEiElElFiEififiFlFlEifiFlkikifiklfiEiEiflEiflElklflEiEiFiklFifiFlkiklFikiElk.lfikiFlfiflEikiFiF � ❑ i�o�„«amawooam��mr«�dw�...+n,.��ina:.aa���m�..uiao��.�eub���a�amie�dea � ;D E,V ,E �L' O..P, M E N�_T_ S E R� V' I' C. E S_ R E -' «w«.am,.wls«���a..e��.�aP�a��caaa:m,camrea���.a�.a�.�amW��.��+.,ao�aro�n � . Q U I- R E M E' N. T`�S ' , who W iM a inpow ihmeon, md xtw doee euM waM NmsNl or henel a Waph h's a hm own empbyeee, pwidad �ha� auch - . 1 ' 1 ' � , ; /�,,:� impmrommuvuam�imerdedaWaadloreeb.p,Mwever.�MWiki'painpwemeMuwNwuhinmeymrWmmplson,tla 20NING_APPROVED�yBY__. " � � DATE: �:'i ' � � � owrrr-0uiltler �nll M1eve iha buNen d proviiq he or ehe d'N iwl Wik a impove la iM purpoee af aele). � --+ - ` � � ' ' ' �I. n mmer d iM poGeM. em exdu�ivM/ conirmM wnh limnmd wnuxtas ro conmua tM qqetl (Seain ]D61. Buair�me mE : � . . . � � . ' _ � •. i`) . . � � . • • Prafavune COEe: TM Lontrmas Licenea law dom m� epply w en owner d prapMy who Witls a impwm ihaeon aM who �:B U I LD I NG_ AP PROV ED_. B Y_.: i DAT E: �/:. : mnitecb fa euti� pqacu wil� a mntm]w(e) licenaed WnueN to �M Con�redort L'vseue law). ; , . ){ . , , , /� %�� / � I em e�amq uMm Seciion: ' B. 8 P.C.. br No reason: � . � - • • :• `� I � • ` ' Dele: �Tx . . ' I Eo �ereby unity thel I em ewere d uM urdenlenE iM eaQuiremmd d Cellomia Heellh vd Sefely Cade Sea'ana 25505, 25533. eM ` 25530, eM ihN I a ury Muro WilEirp oowpent vnll / wYl nM (tlrcb me) need to mmply wY� eeid sWe codee eM �he reQuimmanb M' � epermAlacmel�uclionormodifraiionhanlheAi�anepemamDisna.Rewdeniielconst�udioneppffatimeeraexemptlmmNme � a�a�a. , � . � . � - _.. ov.� ' ' nroi��c- , WONKER'S COMPENSATION DECLINATION: I hereby aifiim uMei penelly ot peijury�aw M Ilw Idlawiip dederetoro: ,.�' ' ❑ t I heve end wil meinlein � ceelHicele d mnaent lo eell�inwro fa vrorkein compensalbn, � 0�� Iw by Sedion 3100 d ths Lebar Code, la IM perlormerce M IM v.wk br wNch Ihia permil ie iaeueE. . ', -. . --- _[� I M1ava end wil mantein workere' oompeneeton inaurenro, es requirad by Seaion 9]00 d ihe leEor Code. br iM perlarmenca d tM • ic'- work Iw which thie pertnit ie iauad. My waNe�a compenWion inauraewa certim vd poliry number ere:,�_ i c�.: _EXPIRES � aa�� N�mn«: / O 1/ 9 8. .(Thia axtion neM rrof be compbrod'I the permt ia M one huiMreAddlers /SfOJI a bsa. . . � I cenAy II� in IM perlamence ol tln work lor whch t�ia peimil e issued. I ml em pe in eiry mannm eo n ta bemrm eubptl to Ihe xorkera canpeneetion lewe d CeIE«nie: uM thm X I k ma wbpU to Ihe xoMen' comy' setun parniona W Sedion 3]�i W Ihe Lebor COEe. I fhall i ' h mmpy, ' t . � ' � o�a: / `L" " 1 i — / � �nod�: . . E� Wem/np: F�Uun ro sxun wortsr�'rompslueflon rovxep� la I�i , ma�Mll ueHct an emvloyw ro cNm'rW v�rou a�M clvll flips lp b om ��nOiM flrouHMCWIenlSIOO,P00} M on b tln cwf ol rompauetb�{ Wmeps, /i p/ovltleG rorin � Sxtlon 9)P6 0/ M� laDoiCods. InfwuS �� ettomey'i Isa. . ' . . / CONSTiIUCTION LENDINO A6ENCY: I hereby elfirm uMx paialry d per'ryry ihm �Mre "v e mrvtivaion bMiiq pem.y /a tln � oertormaMe d �n.,� i« rn�m mm w�+ n�,ee �seaion 3oe�. cx. q. . � I LENOEP'SNANE: � �- �. - LENOEWS �DDFESS: - � ICMilythmlhwaroedNu � ' ebova'viiormetionecarrea.lepreetocanplyxilhalldtyeetlmuruyadirerime eMetelekvamk�^41 MconfVumonaMhmebY 'eeepeaeniemesdlheeiiYbenteruW�IMebwe-menloneEqoperly ' 1« imqaion pu . 11�—PRb1H I / I APPLICAT.ION_ISSUED_.BY: DATE• C� ' �e�r��r�e�r�ex��e�r*�r**�e�*�r�r�* ****�r�rx*#*�i��k�* '�� V S U M M,A'..R Y , � STRUC,TURAL SEGMENT; Y ,LEGALIZATION,:N_��,w'��._._,...�,. E E�.E �.,BLD.G�_PMT_._.PLUMHING__.ELECTRIC MECHANIC . FIRE� SMIP/RES GRADING .P.ERMIT„,.__...__...._ 112 25 _�._:_ _ , ,._ ., , ; �._. � 60 __.: ; . _ - ' .- . __ _.: � � SMIP/NON-RES _ , _..� __... . . ,. , . , , �PLAN__,,. .;_i_..._��_•—_,-----__' � � ISSUE _EEE __:._ � ' ' � ,BUILD.ING.-DIV->_.._:_P.ERMIT_,__ISSUE,_'PLAN—CHECK , TOTAL PAID � . � . DUE TOTALS---->_�.,,,,_.___l.l•2..85..,_..�„0.00. ' 0,00 112.85 ' 112.65 . � �.00 ,REVENUE.DIVISION TOTALS-->, _ _ COliLECTED; 112.85 OVEA/SHORT: �.00 .. -BLDG PMT._PLUMBING,ELECTRIC�MECHANIC:., _,FIAE SMIP_/.TOT GRADING PLAN-CHECK _ ;11,2,..25__�_._._.� �_-.c-�_ ,_.�,—_._.... -'.-_ �. _.. .. .60 , . ; 1F14MikifiFltitikkiFltMiElFMiEiF1FiF1EiEififlEikiEiFiEiEifiElEiEiEiEiEfl�f'1flkiEifiFlfiEiFifkiEif ikikMfklEikMMiElE�FiF1klEifMlEiFMiEiiiFifiEiEifiFlk _ . Z_N_D�I V Z 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 ... _6000 ;__REROOF,HY_VALUE_RESIDENTIAL NOZONE 1.00 ` 6,000`.00 � END OF FEES ' . . . ._ . . ; , , ' f _ } ' .D�Z���^��. While-Buiknp 8 Sdety; Grean-Fle; Canery-AppiceM: Pink-Rerenue; Goldenmd-Assasxr 1?-15-1997l12:43 F't(/i112.8� kCRT�:Bt-E51b521 F'ERMIT:086,19i S � s ,,.% ,,, �r - - --�,- - - - V CONSTRUCTION AND PLANNING`� �' � � _-. � , � � _�OL & SPA � . �; j ,_� ; � 3f ' s �Date. . Inspector, � ` Date, Inspector . - APPROVALS �Permit � � APPROVALS� `, Permit # � ,( ` ' ' � - ' - f , 7�. Temporary'Elecirical.Service`or Pole„ . � � �52. Pool & Equipment Locatio� � - � . ' � � "2. Soil"Pipe=Undr rnd. � �'�' �1• � - 53. Steel��Reinforcement� 'F. / -" ' - � . ': a, 9ti v; � a� n, � '1-,���lectrical CondNrt.�f�,tjlitY-Undrqrnd.;. . , . - � 54. Forms � . ., .�,• ,` � �. � G��IectricaPConduit�drgrnd. �- � , . �' i 55. Electiical.Bonding - � �� E�' � ' � r � � - ";%52ee1 Reinfocce<�ii�t_ � 4 i � �� � � � 56. Hou9h Plumbing & Pressure•Test � , -- � � � � . �� , '.F.C[�IectricalUPEWGrnH. � " }' . 57.APPROVAtTOCOVER�GUNITE- �,` ��- �r;��� "_ + �. - .: , _ i na�ootin9s x= ��� ,' 41 � �� '. ' 58: Electrical Cond�rc;Undrgrnd: y�'. �'- . y W � ^';�8: Foundation i� � - . _ j . „ . 59. Gas Pipe, O Ui�drgmd., �Test - � � - "�9. Water Pipe�Un�gmd.^� - � � , � � �60. Backwash Line�`P'-Trap;.C� �Undrymd.. � � � t w ~� 10. Structural Floo?�SYstem'�: _ ;� ' �,-'; ,' . � �61. APPROVAL y DECKf �'�; ' . , . j i . .. , 11.cRroperty Sewer�inr"& Housef,onnection . - - -� � 62. Backwash & ReceptorFinal - ' ' � i 12.;$ewer CaP � - ' � � - . 63: Heater & Vent-Pinal �' � - � • J � � j ,� c`F3. Roof Drains ^ � i ; i � � � ��„ � ' � r ;64. Plumbing SVstem � Final F � � � ' t �4. Rough Plumbirl� ,. t , < - " , ?65. Electiical-Final ' J' � , ' �'i _ =15. Rough Electric3yColid'uit+' J� - �'� ` . . - `66. �Solar 3Ystem-F.Ttral_� e � '° � . _ � � ` �6. Rough Electric�iiri - ' `-' . � " � � -' ` ' ' 'S � � y � � .� .67. Fencing;& Acc}��lnvroval ' . „ i 4 �}7. Rough Wiring �yn � f y � -' � ' • ' ' `'.� : ' 68. APPFOVED F�A�PLASTERING - " -� � � �'� 78. Rou9h ElectricabT 8ar Ceiling � ' - ' ' � 69. POOUSPA 6YSTEMS FiNA�L � � � � " t ----�- - --� - - �------ -� --� . _-- i9.;hiough 1�e�ting &�F,y Conditioqins 7,�, * �;� �-�,�* ,�• FJRE;DEPT.�EQUIREMENS cv � ta `i �v � O cn �r : � tr 20.�io� P3ttor�j F�'e�ilace 1 S:+' cc, � S--+ C�h .. APP�OV��-'3�`•- Pe'rmit #� 'J' °x S �-+ S' �' x'S x ,-i :�K S,�yr,; IT] x a; 21.'r�u , i tr�ctu� ' � `�'� " ~ . " ' �' � � � S�- �� ;J H C"�'� � 70.�-Undergcvwd h3�dro * 22.�ud's, VehtiM}ingo.�: �i i: G C r :-��: c 71�. Prod �"'�i$ing,_.1 us ��OiI ..s. � % :-1:Y. G- i. !4 23. �as iPe- o'h&. st � t^_�'. M m m�: Or� o � +-,:�-+ x - o �'j �+ �, ,,.?� i rr;, C�O � G�s S� 72. Undeigr,o�uAd F�.ushn :� n o� 24. Roo Framing y* �� ;'7 K M >^ H� • 7�1 Undergr�d. StoF ��,7an� Q Gas ❑ Oii 25..�Roqf;Sheathing �r� .Q � � �_� '' " .��verhead Hydrgu .�: ' 28.rt3-Bar• Cei4ing (Str.ucfurall & M�IIZoat x G :+ ��� 7�'-•Dry Che7fiTCal �-'� � �� � r.r.� R� c 3. .- n � 27.°Frarrieaii6 Fla',shi�q¢ =..�'�„� �, .°��. �'' '� ''�'�* 76. Dry Sta � ¢� � O ;L: C �ipe �� 28. Latfiing$Siding;.J�� b�'- O �� f 77,e FIXED�3VSTEAII�FINA'C.'" n� i, 29. insulatio�n V �* S ^ * S j �� 7�$• FIRE PREV. FfNQL �� M� 30. DrywaII�P7ailing .r:: H x F � � S� .ZIIdEAL'RF! DERY. REQUIREP�tEN7 - , n rn � ` 31. Plaster B � w�'Cog�t'k S � `' `T' ' {�, ' 79. FINAL EC ~ N �' `' c 4C �K I Fc-+ s' �Y. � �i . r: •.'_`, !-� [i7 • 32.�-Electric�Power Myie�'�Final ; �n � � � Bti! FOOD CERTIR"JCATE ISSLIEF} x H � 33.�in�f;Ele'&rics 3� x:T' i�, C * I�g'tes: Q �C; �^5 C� ,-'.N�,.R->' � 34.�ina�He} ing� JF�i �Cg�ditionin9� �i-f * > � p �� �i c�C �% u. `'v r+ � n �c- �^i 35.�Final Ga�Pipe=Tes^fx �%' � T � � I � ` �? r�n * � H�" � � � ;` k� � 1 �. y X t � . s.a.. 3C>.- O Ol WnoPY Nx i-i ��.�"± �-K I � ('7 xo � i*5 -::-] _ S T. - 3J. Pinal'Fa�or Fir � " ' '� "' 7� �C i 'r F � kK i Y �'M'�` 1 � * N I' 'c,�r IT' X. S i {�7> N i . . . . . 38. Fina�Pl _birig � �,; ! a �1: ' �---( =+ -+� � � t. .. ' : ' ,. `- " 39. Water Seryic�Firai* S i .v x ` '` `" �:� a: s - . . o :., � � � � �-+ . x m - `� 40. Gas Serv�e-F�pal,'T{* `� ����.., k; � I �g c'', : r�� :� S � . 41. $olar DaP9�estfc-Ftr1al '7 � m �"� c' � %� D , �r � I I �.. pi r S 42. Backfloti}�".,Preu�nterk �� k I I 'x '' :•. v �' � x fJ.; ��:-i!--i # f-i � ET'. [T7!.'O � i-� '-43. Backflow irr%2tid'n�.;�' � y K �= � �' ^'- .'. - n . � . •r, *. , (�� � 3 ll c :1� [:! Y' ..... !�n.�i Q�. 1 i'� X v. \' t' '^f ' ) " �4.,landscap' Irngatid , System,:; `� , .� �,Q ax ,.-: � � ¢ ¢r E z. -, vc x s � . � . .. • -' -, . - � • : .: . . _ .. 45.Sound RTtenuatititr� - �'j..'.. � '� � T�� �' � � • F� ,' �_ ., .,r• ..r i i tia •.�-+ . � . r46. Ha caP'Re ula %`s, ., �- `' � � Y �' .'' • _ ' � 9 �Q, ...�.. 1� ..a .�' ..' 'K ?i�0 CJ . f c97.-FIiVQL STRUCTURE & BUI DING z•. � �. � i .: s: t� ^.-�• i r-m ��j � n G �i � :� 48.�EIN9LP�LANNI�IG�;: i'F`J ,��:i1 i I.- "'` :� �� s .� . c`49. ��lectiic f}elease tO�Edison �. i� I �.. �k : e: •(� :': ~ o ` . f, ;, ox � t-: o � ... : � u:� �: . � �•.��e � r: p• Orr M �� . :50.-6asERelea'se to Sout,�iern Califorya�aGas Co +. S �c x ,U U �51. CERTIFICATEOF' CCUPANCY '" " " No. Da<e \I . . . 4: . . #' w ' ' . . 113 , "� ` . , , 'j , nUG 15-72Pato001061,� *** 142.88 . 3�1 ,` . . �M�a .. ' ' ' WSTA MESA BUILDINGSAFETY DEPARTMENT� �� �� � � " � ' .,.',�, . � �� �� . � L{�LP. P•O.BOX1200 COSTAMESA,CALIFORNIA92626 , . � �i'- -- �'- . • � � - �� - _ P �ICATION FOR BUILDING PERMIT � • � � For Applicant to Fill in Coinpletely _'. ' - �. R EIV D V DATERECEIVED D E�ISS ED - BUILDING ' � �� ' .r�� 7 � / . � � . nooaess '° � S g'.`.Dahlia Avenue n - . � . � . -- ' PERMITNO. � , OWNER�LdYW1R•�SOU'tYleYR Cdllf.. ��•:IIlC. A'P•N�• �� � C � 7 , . BUILDING • Q ' � � � � MAIL 16255 Ventura B�.VCI. - .4DDFESS- /S� ,Z ADDRESS _ �j _ � , ac"'i cirv ERClIlO� Cd11E.. NOL9H6-889 TFACT I Q LOT � e�ocK Z W ADD A R P � Z.Q CONSTRUCTION .: .•. . . . , O� LENDER� L3YWli1 , _ . . . . a-m . � , .. . � . . �� BR„Nc„ � 16255 Ventura Blvd: . I' . J N . . . OWNER �lh+ �C •�iUG . 'mJ., ADDPESS. $1]C1R0 C�I.1P ° ' - . VAWE .m . 'ARCHITECT . . � ^"�' ' . , ' �' TEC.�. . ��5. ' � $ �:• J a � �OR ENGINEER � .LdTW111 N .Z + � .UQ. . -' _,' ' FIRE . . �� W� . ADORESS91OO,W11SY11T2� B2V erly� Hi�l ZONE ' � TVPE� ROUP� ,... d W . . . � . . ' APP OV . �7 � �7 . J O CONTRACTOR Lanvin �Southern �.'3 eV '� �'�� DATE ''H '� / m� AODRESS '162SS Ventura Blvd. /� W W , - ZONE NO.OF USE OF NEW /N F/ � TEl'. �= cirv. �Encino,� Cali.f.'� '. No: 986=88 � R� P�� � BUIIDING �/�,?y�.D A.2 z� W � STATE ' ' . . � �' '�CITV - � ' ; �'AROS APPROVED VAqDS APPROVED `. . (n CL.' LIC. NO. � 191311 . '� L14 NOB-]_�' �� ' MAIN BUILDING ACCESSORY BUILDING' � � � SIZE. � " � NO.OF BLDGS. (FROM GL ST ET)' , - OF LOT (�S X 99" � "' "' . NOW ON LOT �Q FFONT- FT. FT. ' USE OF ' . , . C • . . ' � . �EXI5TING BLDG. ' - J " FT. ' �� SIZE OF ' NQ'OF '..- . .. . , �{ T � � Z NEWBLOG ROOMS STORIES L:SIDE "� F� FT. !EXTEflIOR WALL "- 'ROOF, . � � �% COVEfiING . S'tUCCO. COVEFING'Wd. SYllli 1 FEAR � = FT. . � ' ' ' FT.. ' J. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. � BET. MAIN & '� a MAIN BLDGS. ' ACCE55. BLDG$ ^. -: � a. - . Q ' - ' . VAR.a1E " DATE ' ' . . ' - '- . . . C.U.P.# ' � APPROVE9� �. �. �" � H., . ... ': � � " ;.. .. . , . � APPROVED / / // � � � � ' . y Construct si:n le £amil dwellin t.ti�— . O . , ,.. ` �. �= . ~'- ..I hareby acknowletlge ffiat 1 have reatl this application and state �pi,p FOR SPECIAL 'T �- =r� �' � that'the atiove information is correct andagree'to�comply with" � � all lavus-regulating buildin8 consttuction, antl I shall not employ - � , � � any person in violetion of the workman's compensation laws of ' .. ' y" the Stare ot'Califomia: � ' ', ' , �. '� ; ' ' � ., 1 � - Q . � ' z' I hereby certify'that I am properly IicenseA as a contractor under. SQ. FT. o � � the Sta[e ot California Business antl Protessions,Cotle, Divtsicn 3, THE AMOUNTSHOWN UNOER VALUATION IS FOFi � '" Chaptar.9, antl.that such licenses are in full force antl effect, or I THE PURP�E OF ESTABLISHING A PERMIT FEE ONLV: m am ezempt'trom Me provisions ot the State of Califomia Business _ ¢ 'VALUATION `-' � N antl Professions Cotle,�Oivision 3, Chapter 9. „ . �„lj� , . � � � pERMIT FEE $ .. � , -- � � -Signature of V: . . + • � /'� �/,� q p�� , m Perminee � yj, , D DOWi1S„ $ ////y/// p�,qN CHECK�$ '� E s'r� �� �� . ,= o . Authorizetl Agent , . . . . ' � � TOTAL FEE S. � LL ..