HomeMy WebLinkAbout286 CECIL PL - Building Permitsv
(714) 754-5273 • Fan (714) 754-4856 • www.ci.cos�a-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job nddress: 286 CECIL PL
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 42608315
Zoning:
Status: ISSUED
Applied: OS113/2002
Issued: OS/13I2002
ApplicanC CARR.4LEJ0, GEORGE _ ISSUEo eY:
Address: 8218 PEPPER CIRCLE ; ""���; ii'�'-'" '�� ` � � ;
.-; �/i'%. � _ �Phone: 714-952-4958 - -- -; �
BUENA PARK; CA,,—, - - , ' Zip: 90620 � �� . " ,
, i
Owner. GREEN;,ADRIENNE � �! , - � ",�:�� ��
Address ,286 CECIL PL', , � , -, � - � , � „ `� ��
� ,
',-' ; �. �' � _ Phone: _ , . • �. � � � �
' - COSTA MESA, CA � . - � Zip: 92627 . � � �. � ��
" .. , - i � / ��V.
Convactor: GEORGE AND SONS ROOFING �,� ��
Address: 8218 PEPPER CIRCLE �
� � Phone:-:714-952-4958 � � , � �
� ��, BUENA PARK, CA - , ' �
Zip: 90620 � ' License: 443547 � � ; . ,
Fvch : . . � " ' . _ - , Eng: . " � , . �
Address: ' � . - � � � � ' - Addre'ss: � ' � -
" . � . � � � Phone: - . . , . Phone: �. , .
� Zip: i � ' i License: , � � '��License:
�- ; , ,
' REROOF: T/O EXISTING WOOD SHAKE, 7/16' OSB
FIBERGLASS SHINGLES.' 20 SQUARES
Plan Check: $0.00
�� Permik $111.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: -' $0.00
�..
��, iotal: � 5111.75' ,
SETBACKS, ,
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0- 0
PARKING Existin :
�� . .,
Rear 0. 0
Rear 0- 0
TG, FECT PER MFGR'S SPECS,�APPLY'30-YEAR GAF ,
FEE SUMMARY„ = � -
- � ' ' �� ' Calc Valuation: i ,
` � ��,�' � Claim Vaivation: ,'
PLANNING & ZONING
Left 0-0 Right 0.�0�
Left 0--0 �' Right 0. 0 �-
0- Required: � 0 Pr000sed: - 0�
NOTES: " -- - �
Es,000.oa
Ss,000 00
NOTICE: The work authorized by ihis pertnit shall comply with all applicable handicap access requlrements under Califomia statutes and related
regulations. (Ortl. No. 92-28, § 7, 1241•92)
EXPIRATION: This permit shall automaticalty expire and become vold if work is not.commenced withln 180 days, or If xrork is suspended or aDantloned
for a period of 180 days. '� •• '.
INSPECTIONS: In order for the vrork authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all
�equlred Inepectlons and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
zas+s �aoo�
. .
WORKERS'COMPENSAnON OECLARATON: . . '
I �ereby affirtn under penelty at perjury one oi t�e idlowing tleGaretlons: � ' �,
❑ I have end will malnteln e certiflcate ot consem to self-Insure lor workers' mmpensetlon, es provide0 tor by sectlon 3700 0l the Lebor Cotle, lor t�e pertortnarice ol t�e
work for which Ihis perml� is iuued.
❑ I heve end will meintain workers' compenseUon insurence, es requiretl by sectian 3700 ot Ne Labor Code, tor Ihe peAortnence of Ne work tor which Ihis pertnit Is Lssued,
My woMers' comp�nsatlon Insurence certler antl policy numbar ere: ,
Certiar: Policy Numy�r:
�(Thls s9ctlOn need nof be comp/eted I/ thB pertnl IUBd et one huntlretl tld/ars (3f 00) w 1e55.) i
• � I cartity that in Ihe pertor a e ol the ork lor hich thi ermlt is Issuetl, I shall not employ eny person in eny manner so as to become subject to Ihe workers'
—" compensatlon laws of C' ia, entl gree t t it I sho C becrome subject to t�e workers' compensation provisions ot Secli n 3700 t the LaCor Code, I shell forthwich
comply wiN these pro ' lo s. ;
�A\pprtcant Signatur'e: � CDerol � l � � � '
WARNINCi: FAILURE TO SECURE ORKERS' COMPENSATIIXJ EMOE IS UNUWFUL M'D SHALL SUBJECT AN EMPLOVEfl TO CFIMINAL PENALTIES AND CIVII FlNES UP TOONE HUNDRED
iMOUSAND DOLLARE (5100,000), IN ADDITION TO TNE COST OF CqAPEN$AiION, DMUDES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CODE, IMEREST, AND FTTORNEVS FEES.
LICENSED CONTRACTORS DECLARATION: i
I hereb afllrtn that I am II n I s �
y p� Dter 9( o mencinp with SecUon 7000) oi Divislon 3 0l ihe Busi a��ions Cotle, and my II i nse is In tull
torca en0 ettectFtClc.— Cle a
�-Carmacto�s'Slgnetura�� Dat� ` �'3 6 Z 1
\ � i
CONSTRUCTION LENDING AGENCY: I
❑ I hereby aHirtn that there is a construction lending agency for Ihe pedortnance of t�e work tor which this pertnit is issuetl. (Sec. 3097, CiWI Code).
Lentlers Name: Lendefs AAdreu: �
Signaiure: � Date: !
OWNER-BUILDER DECLAfiAT10NS: i
1 hereby ettirtn Nat under penalry ol perjury that I em E7(EMP7 FROM 7ME CONTRACTORS LICENSE LAW for the tollawing reamn (Sec. 7031.5, Businese flnC Professlons
Code: My dty or counry which repuires a pertnit ro construct, alter, Improve, tlemolish, or repeir eny siructure, pnor to its issuance, also requires the applicant br such pertnit
to tlle e signetl stetement thet ha or she b Ilceneetl puBueN to the pmvislons of Ne Contradoro lJcense Lew (Chepter 9(commendng with Sectlon 7000) ot Dlvislon 3 01 Ihe
Business entl Protessions Cotle) or that he or she is exemD� Iheretrom and the Oasis for the elleped e:emption. Any violation of Sectlon 7031.5 by eny epplicant tor e permlt
subjects Ihe applicant to e clvil penelry oi not more then fiva hunAretl dollers ($500) J:
❑ 1, as owner of the properry, or my employees with wages as their sole wmpensetion, WILL DO THE WORK, and the structure is not intended or offeretl tor sele (Sec.
7044, Business and Professions CoOe: The Conlractors LJcense Law does nat apply to an owner ot properry who builds or imprwes [hereon, and who daes such work
himselt or herselt or through hls or �er own employees, D�a�tle0 �hei such imprwemenis are not intended or oHered for sale. If, however, Ihe buildingpr imprwement is
sold within one year of wmpletion, ihe ownerbuiltler will have the burden oi proving that he or she did not build or imprwe for purposa ot sala J. �
❑ I, as owner of the D�opar�y, am EXCLUSIVELY CONTRACTINC WITH LIGENSED CONTRACTORS to consWct che prqect (SecJ066, Business arW Professions
Code: The comranors Ucense Lew does rwt epply m an owner ol property w�o builCs or imprwes thereon, end who contracts tor such project with e'contractw(s)
license pursuent lo the Coniractore Licensa Lews.). �
� I em exempl under sec. Business end Professbns Catle for this reason:
Signature: Data:
Owner ID verified by drivers Ilcense. ❑ Yes ❑ No Drivefs Licensa No. Expires:
Vedfication af Ownership by (rype of Aocument, I.e. - properry tez blll or deed):
CERTIFlCA7E OF COMPLIANCE AND AUTHORQ/1710N OF ENTRY: I cenly under penalry of perjury that I have reatl this application en0 state that t�e intortnatlon given Is
cortect. I egrbe to comply w II s;ete lews end dry ardinances relating to bullding construction, anC authonza represenWlives of the Ciry of Caste Mesa to enter upon the
ebove-descnbed prope r ins ection Qurposes. I egree not ro occupy or ellow occupanry of eny building authorized by this pertnit until finel inspection.
COQE �' R15YECTONTYPE `�
1616 Fiaetl System Final Fire PrevenUon
1266 Pool Spa Final
200 Final RaRoot
201 Finel Block/Reteining Well .
202 Final Fectory Flre Place
203 Finel Sign
204 Final DemGition
PAiE V�l64
�Z �
WOE� INSPELTONIYPE
206 Final Mechanlcal
208 Final Plumbing
210 Final Elettrical
212 Final Fire Preventian
220 Final Planning Approval
222 Final Site
,250 FinalBuilding/Occupancy
6�lLS
ADO���ant to till In all svaces except tnose within neavY Doraer Ilnes antl sign ail aovroo/iate tleclarations.
CiTY oF COS7A MESA CONSTRUCTION PERMIT PF$MIT NO. _ TRACT NO. LOT NO. UNIT NO.
. Project Address 2 �� �� C- � L %L.�}C � _ _ .
Appliwnt's Mailing Address S��'� - � /���., �,�-.��r�
Owner'sName �j/ �--�ee Pho�nyefP161il�/
. Address �24" �� �� ` ' �
Arch/Eng. License No. '
Address -
Comracto' N . R IN� Phone L_�53��
Address (ma i"�a1 - • � � - 7� 'LZ i�t% �.l�dT1171 �STF�
City License No. � � ZZ'�'�y � 3
LICENSED CONTRACTOR DECLARATION
I M1ereby affirm fhat I am licensetl untle� p�ovi510n5 ot Chdrte� 9(mmmencln9
WILh 52C�10l1 J�Q�) O} p1VI5I00 3 Of IhG BUSIIIE55 dOd Pf0}QSSIOOS COEC� dllG
my Ilcense is in fJ�I(°5c antl efj� t � b
License lass l� y}�(' C'�i•i �- .�N l��Z-
Date j��b'v SI9na[ure _ fP'��
- -'1RKE 5'���aOM NSATION DECLARATION
�eby af(irm that I have a certiticdte ot consent to self-insure or a certlticate
Workers' Comrp�en'rsa/tion Insurance, or a certifletl copy thereot (Sectlon
Pol�'�cY No. C.I� l I l"� ComPanY ��L ."
Certif tl copy is �ereby turnishetl. ,
� Date �f O roPY is filetl wAOPhc���Y B,� 5.59 �l'+isioy T �G�
,l�G /�ez�f
' EXEM ION ROM WORKERS' COMPENSATION DECLARATION ��
,(This section neetl not be completetl if tne permit is (or one hunarea (E700) or -
(�,� Iess�. � '
\� I ce�tify that in the performdnGe ot Me work tor which thls pe�m�t is issuetl I
. shall not employ any person in any manner so as to become subject to t�e
� Workers"Compensation Laws of Calitomia. , '
Date, Signature
�./� NOTICE: It, after makin9 this tleclaration, you shoultl become sub7ect to the
� Worker5' Compen5ation provislons o1 the Laboi Cotle, you mu5t torthwith �
' compty with suc� provisions or lhis permit 5hali be tleemetl revoketl.
�CONSTRUCTION LENDING AGENCV _
I hereby atOrm [hat t�ere is a construction lentling agency tor Ihe performan<e
ot the work for which this permit is istuetl (Sectlon 3097 dv. C.)
Lentler's Name
L.entler's Atltlress -
OWNER BUILDER DECLARATION '
I he�eby atfirm L�at 1 am exempt (rom the Conlractor'S License Law fOr the
following reason (Section 7031.5 Business antl Professional Cotle: Any city or
' county which �equirez a pe�mit t0 cOnst�uct, alt<r, ITptove, tlemollzh o� �e0dir
any structure, pNOr [o It5 Isivance, also requires [he applicdnt f0/ such p¢/Tit
t0 file a signetl Statement Ihdl ne/ihe is Iicensetl oursuant to tne orovisions of
-he Convactor's �icense Law (Chap[er 9(commentln9 with Sectlon 7000) o(
'vision 3 ot [he Businezz antl Pro(essionz Cotle) or tha[ he/she is exempt
,erefrom antl tne ba5i5 for the alle9etl exemption. Any violation ot Section
/031.5 by any applitant tor d pe�mit subje<I5 Ihe applicant [o a Civil .
���enalty o1 not more tnan five huntlretl tlollars (5500).
I, a5 Owne� of the p�o0erty o� my ¢mployeei wiM wd9es as lheir sole
.�compeniation, will ao tne work, anA the ztructure is not intentletl or.o(feretl '
� lor Sale ($ection 7044, Business antl Profestional Cotle: The Contraclor's
� License Law tloes nol apply to an ownar Ot a O�operty who bulltl5 Or Imp�oves
lhereon, antl who tloes such workTimself/nerzelf or tnrough hls or her own
employees, prOvitletl lhat suGh imprOVGmentS drB nOt'Intentletl OI otteretl /Or
Sale. If, howeve�, the builtling or imp�ovement Is soltl within One year Of com-
ple[Ion, tM1e owner' wlll have the bu�tlen O� P�oving he/She ditl not bulltl or�im-
' nrova Por the purpose ot zala). �
C' 1, as owner of the property, am ezcluslvely tontractin9 with licensetl Wn-
tracrors to construct the project (Section 7044, Buziness antl Protessions dotle:
The ConVactor's License Law tloes not apply to an owner of oroperry who
"bulltls or'improves thereon. antl who conVac[5 for Such oroiecl5 wi[n a con-
tractor(s1 I�cense pursuan2 m me ConVactor'S License Law�. 1 am aware that
� ptdof ol thei� Worke�'S Compen5a[ion insUrance shoultl be provitletl to me.
❑ fam exemp[ untler Section B. L P. C. for this reason .
Date Owner _
I herebp certify tnat I have reatl this
information is correct. I a9ree to com0�
antl state lawi r¢lating to builtling cOnf
sentatives of this city ent r upon
� ip5 ¢CtlOn 5.
P Py%Oy3y_
Sigriatura'�Y�'�� �
Drivars' License or55 9f �
above
TVPE OF CONSTRUCTION LJ NEW IJ ADD .LJ ALTERATION
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTIONOFWORK/USEOF_BLDG., _ , �q ,
TYPE OFPERMIT LJ GRADING �I_I /FOUNDATION LJ $TRVCTVRAL
❑ TENANT ❑ El_ECTRICAI ud'�LUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION S�.FT. oCCVaarvCV
-CONSTRUCTION TYPE VALUATION $
ZONE GRADING GU. VDS. ACRES
Rema�ks:
Preventer
Irrigation
king Fountains
�r Dreins
ir Sinks '
Service
Kitchen Sink
Lavatories
P-Trap
Roof Dreins'
f�BinSPBt[iOn _FBB
$15
Boiler
Duct - Under Grountl
Duc[ - Structural
Duct - Ventilating �
Exhaust System ❑ Multiple
Firepl/Fact.BILiCBOdk .
Heating System & Ducting
❑P700,000 BTU 0100,000
Reinspection Fee � $15
0865-46, rev. 5/88 White - Builtlin9; Canary - Applicanp Pink - Accountin9: Goltlenrotl - Assessor
PLUMBING. �
Showers
Service Sink
Sewer Cap •
Sewer Connection
Solar Co�lectors '
Solar Pipin9
Solar Tank
Swimming Pool w/Spa�
Urinal
Water Closet
- Water Heater
Water Service
Auro-Wash
laue Fea
Hoodor Typel ❑
Cnnopy Typell ❑
Refrigeration System
06700,OOOBTU ��100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
A.P. �p
S Main Buildi
E
T Front
B Rear
A
C Right
K
g . Left
Ping. Ref. #
Plannina Notes:
FEES P.utomatic Washer
Construction Pole Su
Cooking.Unit�
Dishwasher
Dryers ❑Gas 'DEIi
Fan ,
F.A.U. : "
Fixtures
Device Boxes '"
OIlUCLS
Switches
Garbage Disposal
Generator �0-5 KW
Fee
Zona
Building:
Parking Req./Provided
ELECTRICAL .
Transformer ❑ 15-50 KW
❑ 50+KW
� Meter ❑up to 100 amps
Meter �over.100 amps
Sub Panel ,
Motors �61 HP �1:5.8 '
� Inc. Solar 0&75 HP 016-15+
Microwave '
Pole Light �
Range ,
� I Standing $ections
5 KW � I Trash Compactor .
$15 I• I IuueFee
$ 3 DEVELOPMENTSERVICESRE�UIREMENTS:
2onin8 APP�ovad By
FEES Building AVProved By n
$ 3
FEES
$ 3
' • SUMMARV OF FEES � �
BUILDING PEFMIT' $ SMIP $ �
PLAN CHECK , � $ � PERMIT
PLUMBING $ � ��UANCE $
PLAN CHECK .25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50%�, $ ' MICROFILM $ C�
MECHANICAL $ � TOTALFEE $ J'�
PLAN CHECK 25% $ �
1
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c�i ooazi�it�-IJilII2i21p TriT'. `,O�
DATE: ?2105/8R �TiiE: L;:¢5
�' . 7�
I
� CONSTRUCTION�.ND PLANNING • ' PC & SPA � �
APPROVALS Permit # Date Inspector AppROVALS Permit # �Date Inspector
,
i. Temporary Electrical Service or Pole ",.� ' 52. Pool & Equipment Location �
�
� 2. Soil Pipe-Undrgrnd. * ' 53. Steel Reinforcement '
�
3�� Electiical Conduit Utility-Undrgrnd. 54. Forms �
4.'Electrica�l Conduit-Undrgrnd. � 55. Electrical Bonding ;'� ,
5.'Steel Re��nforcement ' , . 56. Rough Plumbing & Pressure Test �
� 6.I Electrical UFER Grnd. �. � 57. APPROVAL TO COVER�GUNITE '
7.�Footings - ' � , 58. Electrical Conduit-Undrgrnd. ' . I�
8.1 FdundaYion '- _, �; 59. Gas Pipe, O Undrgrnd., Test '"
9;Water Pipe-Undrgrrid. , � �� 60. Backwash Lines, P-Trap, O Undrgrnd. ��,( �
�;
10..Structural Floor System ' 61. APPROVAL TO DECK
1•1 . Property Sewer Line & House Connection �, � 62. Backwash & Receptor-Final
12. �Sewe� Cap ',,_ _ -, - � 63. Heater & Vent-Final
13. Roof�Drains '' �� 64. Plumbing System - Final '
. , y'
14. Rough Plumbing, . 65. Electrical-Final �
15. Rough Elec[rical-Conduit 66. Solar System-Final -
16�. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING i
18. Rough Electrira6T Bar Ceiling � 69. POOUSPA 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. 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. Final Heating & Air Conditioning
35. Final Gas Pipe-Test -
36. Hood or Canopy
37. Final Factory Fireplace � -
38. Final Plumbing (L.6 �� (�� '�
39. Water Service-Final � � � �
40. Gas Service-Final ,' •
41. Solar pomestic-Final ' � �
42. Backflow Preventer �
43. Backflow Irrigation ' ' � j '
44. Landscape Irrigation System � � �; �
45. Sound Attenuation �
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING �
48. Special Requirements Completed ;
49. Electric Release to Edison �, i
50. Gas Release to Southern California Gas Co � ` ' +„
51. CERTIFICATE OF OCCUPANCY 1 ' �
No. Date ;� '
OWNER SUTFERFIEI,D� CHArles M. et al DATE 4-21-
JOB ADDRESS Cec P ace BUILDING PERMIT
GENERAL CONTRACTOR er- r. DESCRIPTION of WORK Res.W
�AP No.11S-163-06 lOT
INSPECTIONS
SOIL
GAS
WATE f Q .� a9-�i
ROUGH PLUMBING
PROP. $WR. LINE � HOUSE CON. �
SPRINKLING SVSTEM
MISGELUNEOUS
ROUGH HEATING FND AIR CON�ITIONIN
TEMPORARY SERVICE OR POLE
UNDERGROUND � POWEH �
ROUGH WIRING
TNENCHES � FORMS � STEEL 1
FLOOR SYSTEM
BOND BEAM � STEEL REINFORCE
SHEATHING
FRAME AND FLASMING
LATMING - IN OUT %
PLPSTER.BROWN COAT
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P O. ROX 7200 COSTA MESA. CALIFORNIA 92626
����Pp10�1022�* **� 111.00
sa
APPLICATION FOR BUILDING PERMIT
ForApplicanttoFillinCompletely RECEIVEDB D TERECEIVED
% DATEISSUED
ADDRESS � lO� — �" �� �' '�j- �
//Q^ .��—O� P RMITNO.
OWNER � A.P. NO. J
MAIL ' BUILDING � � /
ADOFESS �(�
A�ORESS �
CITV NO` {{y0�` RACT ' LOT/� BLOCK
CONSTRUCTION w AD A T P
LENDER
BRANCH
OWN �
ADDRESS � VAL ri
ARCHITECT TEL USE �� � ��
OR ENGINEER ' NO. �
FIRE
ADDRESS ZONE TVPE ' GROUPI
APPROVEO
CONTRACTOR BY DATE
ADDRESS �� �
ZONE NO.OF USE OF NE �
CITY NOL3 ����� PLANS BUI I
STATE CITV �'AFDSAPPROVED VARDS PROVED
LIC. NO. %3 (' � S � LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE - NO.OF BLDGS. (FROM GL STREET) /
OF lOT Q 6 NOW ON LOT Yyy.,L, FRONT � FT. l � FT.
USE OF
E%ISTING BLOG. O FT.
SI2E OF NO. OF
NEWBLDG. ' FOOMS STOFIES L.SIDE S FT. FT.
EXTERIOF WALL ROOF p
COVERING COVERING REAR o FT. FT.
USE Of BUILDING AND WOftK TO BE PERFORMED DISTANCE BET. BET. MAIN &
� MAIN BLDGS.r� ' ACCESS. BLDGS.
L(/ Q'H-G.�ZF��lI-3Z APROVEO�"�Z'�7
• APF'ROV n _/�_ /
(K
{I
I hereby acknowledge that I have reatl this application antl state
that the above intormation is correcS antl agree io comply with
all laws regulating builtling consttuction, antl I shall not employ •
any Oe�son in violation ot the workman's compensatiOn laws of i
ffie State of California. �1
I hereby certify that I am properly IicenseE as a contractar untler �y v SQ. FT. �
the State ot California Business antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UN Eq VA�UATION IS FOfi
Chapter 9, antl that such licenses are in tull force antl atteci, or 1 THE PURPpSE OF ESTABLISHING A PERMIT FE ONLV:
am exempt from ffie provisions of ffie State of California Business VALUATION . ' 1�'
antl Professions Code, Division 3, Chapter 9. .. ��
////// PERMIT FEE S �
Si naturaof� � /'� .� , 2 q %'t'
Permittee ` �. �� $//d �(1� PIAN CHECK $ ✓ /• �-�
� /JJ. °""
Authorized ABent TOTAL FEE $