The URL can be used to link to this page

Home My WebLink About655 DARRELL ST - Building PermitsPACIFIC INS.ALLERS� INC. 754� �thor�y Avenue Garden Grove, California y264� Director Dept. ofp ilding and Safety City of l�� %71 i.,�-- 1p v . /3,�. /� e o �, --yti„ . Dear Sir: Date �2 ,� J-7� _ Permit No. _� yli��i Type of Pernit �/� e . Dated %��"-�'-7Z Please be advised that as o: %- .�„7 7 Z our rrork on above- named permit has been canceled, and as of that-date we would like the permit canceled; so tnat ous responsibility for any work accomplished at: f1 �� S� ,�00 hhtpY for custcmer: n/G^..Z`Gr,c-;/ will be ended. Jery Truly yours, �/ :r�-.e�.. For. Pacific Installers, Znc. 7541 tinthony Avenue Garden Grove� California State Lic, � �/( r�i1 � City Lic. ;� 9 P.I. 264 Applicant to fill in all spaees except thote wit�in �eavy EorCer Iines antl sign all apo�ooriate aeclarations. CITY OF COSTA MESA CONSTRUCTION PERMIT � - °`°""'T "'n Twncr Nn � nT Nn ��.,�T ..�., Project Address � 5, ��A ,cr F' � L I Applicant's Mailing Address ' Owner's Name MARJ /i�=�� -Sff J('E[/4A Phone a'� Address ArchlEng. - ' License No.� Address Contracror's Name�F-�/� �B/� �G<//f[)/�¢hone � '�"'Y / 2 Address ( mailingl -z C Y� S7.Wi� ft '.C• L'o 5 j A �`! /'K/� City License No. '1 0�/ O S LICENSED CONTRACTOR DECLARATION � I�hereby af(irm that 1 am licensetl untler provisions of Charter 9(comm¢ncing with section �000) oi Division 3 of the Business antl Protessions Cotle, antl my license is in � I force antl Licen C s � � L ense Not3�, S 7/ Odt¢ S' WOR ERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate ot consent to selt-Insure or a certiticate ot Workers' Compenza[ion Insurance, or a.certifietl copY thereoi (Section 3800, Lab. CJ � Policy No. Company �� Certified copy is hereby fumishetl. '-�,�Cer[ifietl copy is tilea with the city Builtling Division. c`:.r. ;� ee AOP�ieant ' '�e5(EMPTION FROM WORKERS'.COMPENSATION DECLARATION (Thi55ection neetl not be completetl if the permit is tor one huntlretl (5300) or less). I certity that in [he performance O � ' erm�t i5 issuetl I shall not emolov anv oerson in a manne as t becom subiec[ to t�e Work s' Compen Con ws ot Ca � a. Date �� — ,`� t��—TSignature � � NOTI[E: It, after makm9 this tleciarabon, you shoultl become sub�ect to the Workers' Compensation provisions ot the labor Code, you must forthwith comoly with such provisions or Ihis oermit shall be tleemetl revoketl. CONSTRVCTION LENDING AGENCV ' I hereby aftirm that there is a construction lentling a9ency for the performance ot the work for which this permit is issuetl (Section 309] Civ. Q) ' Lentler's Name � LenGeYs Atltlress ' OWNER BUILDER DECLARATION ' I hereby atfirm lhat I am exempt from the Contractor's License Law for the following reason (Section ]031.5 Business antl Protessional Cotle: Any Gty or tounty which requires a pe�mit to construct, alte�, imDrove, demolish o� �epair any structure, prior to its issuance, also requires the applicant for such permif „to file a signetl statement thdt he/she is licensetl pursuant to tM1e proviSiOns o( the Contractor's License Law (Chapter 9"(mmmencing with Section 7000) of Division 3 of tne Business antl Protessions Cotle) or that he/she is exempt ' therefrom antl the basis for [ne allegetl exemption. Any violation ot Section 703L5 by any applicant fo� a permit subjects the applitant to a civil �enalty of not more than five huntlretl tlollars ($500). I, as owner of the property or my em0loyee5 with wa9es as their sole •pensation, will tlo the work, antl the structure is not intentletl or.ofteretl sale (Sectiom 7044, Business antl Prof¢SSional Cotle: Th¢ Coniractor'S n5e �aw tloes not apply to an owner of a p�operty wito bulltls or imprOv¢5 weon, antl who tloes such work himself/herself. or through his o� h¢r Own employees, provitletl tM1at such improvements are not Intentletl or offeretl for sale. If, however, the builtling or improvement is soltl within one year ot com- pletion,'tM1e owner will have the burtlen ot proving he/she tlitl not builtl or IT- nrova forthe purpose otsale). ❑ I, as owner of the property, am exclusively Contracting witn IicenSetl Con- tractorslo construct the project (Section ]044, Business antl Professions Cotle: The Contractor's ucense Law does not apply to an owner of,property who builtls or improves thereon. antl who contracts for such oroiect5 with a con- tractor(s) l�cense pursuan[ ro me Contractor's License Law). I am aware that proof of their Worker'S Compensation insurance should be provitletl to me. � I.am exempt untler Section B. & P. C. for t1ii5 reason Date Owner � I �erebvi certifv [hat I have reatl tM1ls aoolication antl state that the above Signature Drivers' License or 55 � �% D l 4� TYPE OF CONSTRUCTIO[11 LJ NEW LJ A�D LJ AI.TERATION LJ REPAIR . ❑ CONVERSION in� DEMOLISH ❑ OTHER � DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT GRADING 'FOUNDATION STRUCTV RAL' '❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � O OTHER PROJECT DESCRIPTION Sci. F7. oCCUaANC^Y /� CONSTRUCTIONTVPE VALUATION$ 'f/Dl l 20NE GRADINGCU.VDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation �rinking Fountains �loor Drains Floor Sinks �as Service QUL12t5 Interceptars Kitchen Sink . Lavamries P—Trap Roof Drains Reinspection Fee $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating � Ezhaust System ❑ Multiple ❑ Firepl/Fact Blt. ICBO # , Heating System & Ducting ❑0-100,000 BTU 0100,OOOBT peinspection Fee � $75 0865-46, rev. 5/88 White - Builtling; Canary - qpp��ant; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar C011ectof5 Solar Piping � Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Aum-Wash - Issue Fee Hood or Typel ❑ Canopy Typell ❑, Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers � Registers Issue Fee N.Y. 9F S Main Building: E T Front A Rear C Right K . Left S Ping. Ref. # Planning Notes: FEES P.utomatic Washer Construction Pole Sub. Caoking Unit Dishwasher Dryers ❑Gas ❑Electric $ 3 FEES $ 3 zone Accessory Building: Parking Req./Provided ELECTRICAL , Transformer ❑ 15-50 KW ❑ 50+KW Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator O65 KW 05-15 KW Meter ❑up to 100 amps Meter ❑over 100 am�ps � Sub Panel : J MotorsO0.1�HPO.LM'-8 � Inc.Solar �9-15 HP��16-15+ Microwave .,^:� Pole Light Range Standing Sections. Trash Compactor FEES O N 1 N G R E Q M T $. � Reinspection Fee !$15 � I Issue Fee I $ 3 I DEVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By � Date � Building Approvad By � Date Application Issued By Data 1� SUMMAqV OF FEES .�y BUILDING PERMIT $ Z-� SMIP � $' b�— PLAN CHECK $ PERMIT � PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ � ELECTRICAL $ �GRADING $ , P�AN CHECK � 50% $ ' MICROFILM $ � � MECHANICAL_ $ TOTALFEE $ %.�� PLAN CHECK , 25% $ , � O1 0002a249—Q�C�23250 Y'4.7'I" . :S. i;t �7RIEs 12l28/S2 7IEtE� 10:46 - CONSTRUCTION AND PLANNING POOL & SPF Date Inspector Date Inspector APPROVALS � Permit # APPROVALS Permit # ;" 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , d• 2. Soil�Pipe-Undrgrnd. i. �' 53. Steel Reinforcement � �`- 3.�Electrical Conduit Uti�ity-Undrgmd. �- 54. Forms : � �. 4. Electrical ConduirUndrgrnd. - 55. Electrical Bonding • � 5tSteel_ Reinforcerrient , 56. Rough Plumbing & Pressure Test • ' 6. Electrical UFER Grnd. �� -`;., 57. APPROVAL TO COVER-GUNITE ' i 7.�,Footings - , � ;� � 58. Electrical Conduit-Undrgrnd. �� 8. Foundation ., �_ t, .' 59. Gas Pipe, O Undrgrnd., Test _ 9. Water Pipe-Undrgrnd. I 60. Backwash Lines, P-Trap, O Undrgmd. ' 10. Structural Floor:System �� ;� � � 61. APPROVALTO DECK � 11. Property Sewer Line�& House Connection � ,, 62. Backwash & Receptor-Final 12. Sewerv Cap - ^ � - � 63. Heater & Vent-Final � ' ' nl 13. Roof'Drains ;�� : � 64. Plumbing System - Final - . � • 14.� Rough Plumbing• - -' 65. Electrical-Final 15. Rough Electrical-Conduit � � - ,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 , FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace '�; APPROVALS Permit # t' 21. D'uCts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating .,, '71. Product Piping O Gas ❑Oil 23. �Gas, ipe-Rough & Test � � �72. Underground Flush . 24. Roof Framing -;�{ - 73. Undergrnd. Storage Tank O Gas ❑ 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. Finaf Heating & Air Conditioning � - 35. Final Gas Pipe-Test � - 36. Hood or Canopy • 37. Final Factory Fireplace . � 38. Final Plumbing 39. Water Service-Final � � 40. Gas Service-Final � � , 41. Solar pomestic-Final 42. Backflow Preventer �'1 43. Backflow Irrigation . � r. � 44. �Landscape Irrigation System � , 45. Sound Attenuation 46. Handicap Regulations � � 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed • 49. Electric Release to Edison - �.� � , 50. Gas Release to Southem California Gas Co � . �; �� . 51. CERTIFICATE OF OCCUPANCY � ,� � No. � Date � '�I . .r��a IOB ADDRESS B[iILDING PERMIT NO. GENERAL CONTRACTOR I}lk2 Fa CAle$rOve VALUE $ 1){�52C.00 AP. No. LOT 13 TRACT 2215 FIRE ZONE DESCRIPTION OF WORK Si17(Tle Res Att ('ar GROUP T Rr .T TYPE V ZONE RI� PLAN NO. INSPECTIONS + DATE � SUBCONTRACTOR Final Gas Test PERMITSISSUED DATE � NUMBEfl ; . r,. '7�raf�ii COSTA MESA BUILDING DEPARTMENT .+ P.O. BOX 31� � COSTA MESA, CALIFORNIA FOR .APPLICANT TO FILL IN ADDREI55 655 W. Darrell St, COSTA MESA. CALIFORNIA OWNER �73jjL8 JS7]$ 1SEiiICII aooREss li1.9 Ee 1'%th St. IARCHITECT ' OR ENGINEER F�E RECEdVE� 9-30 -s�� aira�u� �o-�. �1t �'F Q�TA C�.,'�'i APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY 3� _S-� atr 3 0 1 TEL BUILDING , NO.�� H�11 ADORE55 ��c. COSTA MESA. CALIFORNIA NO. FIRE 1J1 CITV LIC. r1 CONTRACTOR Q j'OV2 j SS1C. �"�- o AOORE55 �9 EO Z/Yll 5Y0 TNU.�• �Eca� LOT oescaiPiior+ NO. 1 BLOCK TRA A.P. NO. NO.OF BLOGS. �IOW ON LOT USE O� EXISTING BLDG. SETBTCK LINE FROM �U� �I [ET REAR YARD RIGHT �j1 LEFT 51 DESCRIPTION OF WORK� . NEW 6 AITERATION ADDITION REPAIR MOVING DEMOLISH BUILDING t� NO.OF � SIZE O$ yy ROOMS 6 STORIES EXTERIOR WALL 1 ROOF COVERING S4UCCO COVERING CO s IlSE OF NEK' n... _. _ .. _ ,. , . I SIDE YARO t71 BV I HEREBV wCMNOWLEDGE TMwT I HAVE RE4O TMIS FPPLIC�ITIOrv Prvo STATE TNFT TME FBOVE IS CORflECT PN� AGREE TO COMPLY W!TFI >LL CITY OROINANCES PN� STq LR�NS ULFTING BUILUING CONSTFUC� SIGNATUREOF �� —� VALUATION PLP CORRECTIONS V •/ � s 71i�526o00 aurHORizeo n�eN�kE & COlegTOVB� TS1C. PERMiT FEE syy.ouU PLAN CHECK �170W TOTAL FEE S•S1oOO 0 �., owx�x OSBORNE, HARRY H. JOB ADDRESS 655 Darrell St. BUILDING PERMIT NO GENERAL CONTRACTOR Q�er—a1dP. VALUE $ 81,00 AP. No. LOT 13 TRACT FIRE ZONE DESCRIPTION OF WORK Block Wall INSPECTIONS I DATE I GROUP J TYPE 3 ZONE R I. and Gas Form SU6CONTRACTOR , � � :�0�$:�� ;. . COSTA MESA BUILDING-SAFETY DEPARTMENT � P.O. BOX 317 COSTA MESA. CALIFORNIA fOR APAUCANT TO f/LL /N COMPLETELY TYPE OR PRINT � ADDRESS T (/A/(�G LL � S/ d� COSTA MESA, CALIFORNIA l0 MA 1 ARCH ITECT OR ENGINEER LEGRI I LOT OESCRIPTION NO. A.P. NO. �— SIZE OF LOT USE OF EXISTING BLDG. SETBACH LINE FROM CENTER OF STREET � � LIC. NO.OF BLOGS. DESCRIPTION OF WORK NEW I IIALTERATION I IIAOOITI REPAIR I IIMOVING I IIDEMOL BUILDING NO.OF SIZE ROOMS STO EXTERIOR WALL ROOF COVERING COVERING USE OF BUIL�ING AND V�ORK TO,BE PERFORME �EE RECEIVED �_3o-s�� vu fINANCE DEPT. APPLICATIONCFaR PP€RMIT BUILDING Fox aFfic� usF oacy I RECEIPT NO. I�/p�ERMIT�t�Q e �ia •be � �ZV'\l FECEIVEU BT OATE�R£GE�VEO� DATE ISSUED /Nnil^/ C/� �/A�.. � � I �1— .� � _ COSTA MESA. CALIFORNIA ' ZONING !� ZONE I NO. OF lISE OF NEW O PLANS HUILDING APPRO � BY � DATE YARDS E REQUIRED ALLOWED (CENTER LINE�ST.) / — FRONT S�T. T R. SIDE FT. L. SIDE � FT. �f '"d I HEREBY ACKNOWLEOGE THAT 1 HAVE READ THIS RPPLICATION ANO STNTE THAT THE ABOVE IS COpqECT ANp qGFEE TO COM� THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLV WITH ALL CITY ORDINANCES AND STATE LnWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLV. eui�o�nc coHsieucii/p_N� /�/ //�� VALUATION 7 SIGNATl1RE OF ,Il�� ! ,�l' ' "" ^- PERMIT FEE $ r�� , �9 PERMITTEE G,.� . $ /� PLAN CHECK � � AUTHORIZED AGENT �'"'� TOTAL FEE S �. — 10BADDRE55 655 Darrell St. GENERAL CONTRACTOR Owner-B1dr. DI AP No. 115- 1-10 LOT TRACT FI INSPECTIONS Signator�� Date SOIL �-� cns I W ATER flOUGH PWMBING PROP. SWR. LINE SPRINKIING SYST MISCELLANEOl1S HOUSE CON. ROUGH HEATING ANO AIR CON�ITIONING TEMPORARV SERVICE OR POLE UN�ERGROUN� ❑ POWCft � ROUGH WIRING TRENCNES FORMS STEEL REINF. FLOOR SVSTEM ' BONO BEFM � STEEL REINFORCE ❑ SHEATMING FRAME ANO FLASMING � LATMING - IN n OUT (� PLASTER, BROWN COAT STRUCTURqL, FINAL HEATING. VENT., REFRIG. AND A.C., FINAI PLUMBING. FINAL AND GAS TEST � - ELECTRIC, FINhL BIIIL�ING. FINAL CGGfIGI CFI1111GfIJ�YTC UAIC ' BUILDING P VALUE SUBCONTRACTOR ER AP ROUGM PLUMBING PROP. SWR. LINE I SPRINKLING SVSTF MISCELLANEOUS ROUGH HEATING AI TEMPORARV SERVI UN�ERGROUNO � ROUGH WIRING A POWER [K�P.11 TRENCHES FORMS U STEEL REINF. FLOOR SYSTEM BONO BEAM � STEEL REINFORCE � SHEATHING FRqME ANO FLASHING LATHING - IN [� i PLASTER,BROWN COAT STRUCTURA�, FINAL HEATING, VENT., REFRi PLUMBING, FINAL AND ELECTRIC, FINAL 61JILOING. FINAL DATE 7-3-69 BUILDING PERMIT N0. JUP J TYPE SUBCONTRACTOR _-- - .�821 � `rn�o00 10.5Q A.PR-1�-7'icr�=n 001�+ t�Ka:; � , ' COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 P LIC TION FOR BUILDING PERMIT For Applicant to Fill in Completely � RE EI ED V DATE FECEIV D DA E ISSUED BUILD�NG S/ Q L S� � ._ I_�Q ADDRESS :J / ! % � / PE T OWNER �� /� A.P. NO. S� I(O � D MAIL BUILDING /' Z . ADDRESS � � � � ADDFESS L a U CITV NOL TRACT �-�i5 LOT � BLOCK ZZ Q CONSTRUCTION W ADD A T R P O � LENDER . n. m J � BRANCH /� /— JN OWNER � {-f I(� m J ADDRESS • %�I VALUE J Q ARCHITECT TEL S ��e D lcJ _ OR ENGINEER N . U Q FIRE • , w� ADDRESS ZONE TVPE _ GROUP d W APPROVEO w Z CONTRACTOR � BV DATE m O z T � [us J � ADDRESS W W TEL. ZONE NO.OF VSE OF NEW �Q�R/�ZG �= CITY NO. I PLANS � BUILOING Q�,,OV { Z F W � STATE CITV �'ARDS APPROVED VAROS APPROVED y� LI0. NO. LIC. NO. MAIN BUILDING . ACCESSORV BUILDING 7O � � (FROMGLSTREET) SIZE NO.OF BLDGS. OF LOT DO NOW ON LOT qONT El.' FT. USE OF a ' - �� EXISTINGBLDG. S � FT. � �FT F �(SIZEOF //�O// � .OF /- Z NEWBLDG. Q%�� ROOMS STORIES L.SIDE �i�j. FT. U. EMERIOR WALL ROOF i/ COVERING COVERING REAR FT. FT. , J USE OF BUILDING AND WORK TO 8 FORMEO DI5TANCE BET. BET. MAIN& a MAIN BlDGS. �— ACCESS. BLDGS. a Q � VAR. # DATE O C.V.P.# // APPROVED r . APPROVED/-'J� � �/_ �J (n Vl!/t � Z � UI hereby acknowledge that I have read this application antl staie � that the above intormation is correct and agree to comply with � all laws regulaBng buildin0 consvuccion, and I shall not employ O any person in violation ot the workman's compensation laws ot ~ the State of California. � T�( � zI hereby certify that I am properly licensetl as a conttactor unGer � SQ. FT, o the State of California Business antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR Chapter 9, and Mat such licenses are in tull force antl effect, or I THE PURPpS60P ESTABLISHING A PERMIT FEE ONLV: Q am exempt from tlie provisions of the State ot Calitornia Business and Profes5lon5 Cnne, Division 3, Cha ter 9. VALUATION t(J � � m - I � ERMIT FEE $ � �/ �� Signatureot" �', �—� % '/ m vermittee T` «'� $ 3iD PLAN CHECK $' .�i♦ o Authorized Agent � ~v LL TOTAL FEE $ , � _ ,3��? � ��. . �COSTA MESA BUILDING-SAFETY DEPARTMENT P.o. eoX 7200 COS7A MESA. CALIFORNIA 92626 Z a cwj Z ZQ O v~i am J7 J � Q W 0] J J m Q UN Z a w � p_ w WZ J Q mZ J � W w � _ Z �— W � 70 9[A —7� �'��QO'' 335s o�:a.iret5:40 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Complete/y REC E V D RECEIV DATE ISSUED ' BUILDING w. - L �3' 7�3�/l" ADDRESS � / / PEFM� hT OWNER A.P.NO. �D O'— O SLJ I MAIL BUILDING j ADDRESS � ADDRESS .; �J�� irU—t - l TEL. � GTV NO. b C 3 p TRACT �. LOT 3 BIOCK CON5TRUCTION ' W ADD A R P LENOER O BRANCH f G� ' OWNER � �� < GtiG�.L AODRESS ///�/J�// � — ARCHITECT TEL. ''/..J�7/ $ D OR ENGINEER N . FIRE A�ORE55 20NE TVPE �� GROUP C APPROVED CONTRACTOR ` _ � � BY OATE � M" ADDRE55 D • ZO r NO.OF USE OF NEW � I, CITV NOL 2 � I P�� BUILDING 4 f / �'��i` . STATE CITY ^7 �'ARDSAPPROVED VAROSAPPROVED LI0.NO. `� �% 'v L10.NO. J 7� MAINBVILDING ACCESSORVBUIIDING SIZE � NO.OF BLDGS. (FROM C/L STREET) OF. LOT � L V NOW ON LOT � FRONT FT. �FT� USE OF EXISTING BLDG. E .. F '� SIZE OP NO. OF NEWBLDG. ROOMS STOFIES , L.SIDE FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED OI5TANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLIX'aS. �� VAq.# . DATE . ,E ,� C.U.P.� APPROVED i � �} ,/ T � / APPROVED /// _ �/ �/ /�./ i /V� l�/ / �/ � 1 hereby acknowlidge that I have reetl this application antl state thai the above information is correct antl ag�ee to comply with all laws regulating building construction, antl 1 shall not employ any person in vio�ation of the workman's compensation laws ot the State ot Califtlrnia. I hereby certify tbat I am properly licensetl as a contrector untler SQ. FT. the State of Califo�nia 8usinass antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and thAt such licenses are in full force antl etfect, or I THE PUflPOSE OF ESTABLISHING A PERMIT FEE ONLV: am exempt from the provisions ot the State ot Califomia Business � VALUATION antl Protessions Code, Division 3, Chapter 9. __ / PERMIT FEE $ Slgnature ot ,- 'j" �j � ,/ Permittee ��"�� /� �//.�.L%� , $ �� p�qN CHECK $ Authorizetl Agent � �� TOTAL FEE $