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HomeMy WebLinkAbout230 SHERWOOD PL - Building Permits • CITY OF COSTA MESA 4. BUILDING DIVISION P y'�'.w,� 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us r __ .'.a. r :t. FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER: P08-00104 PERMIT TYPE PLUM STATUS: ISSUED APN: 42620235 DATE ISSUED: 04/2112008 ISSUED BY: KJB JOB ADDRESS: 230-SHERWOOD-PL-CM it Suite/Unit: Vicinity: '1 SCOPE OF WORK: CHANGE OUT STORAGE TANK WATER HEATER. SAME LOCATION. , OWNER: PAONESSA,EVELYN C TR Address: 230 SHERWOOD PL PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: MIROSLAV P BARNYASHEV Address: • PHONE: City/Stale/zZip: CONTRACTOR: CALIFORNIA DELTA MECHANICAL INC License No. 811114 Address: 1235 GRAND AVENUE PHONE: 800-898-0008 City/State: SPRING VALLEY,CA ZipCode: 91977 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: • PLUMBING PERMIT FEE SUMMARY • PLAN CHECK FEE: $0.00 PERMIT FEE: $35.80 TOTAL FEES: $35.80 • Lit i: aCba� _In DATE /-/3 -1/0( NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE O. INSPECTION TYPE D) IN7111ALE CODEf INSPECTION TYPE pAit !MAID 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's lice Cl Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. int I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Ins ante carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: "�\ rperson is required to descend,will be made in connection with work authorized IC Y� � by this permit,and that no building structure,scaffdding,falsework,a demolition Carrier: c�L� ] or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need norm completer she perms a vs at one Meats($100)or less) 2,Art 2Sec.341,Title 8,California Administrative Code). Policy Number: ( (7 q 7 U 2. ❑ As owner-builder, I will not employ anyone to do work which would 0 I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California. and agree that if I should become subject to th workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code.I s 'north • comply With these provisio 33 Division of Industrial Safety Permit Number: Applicant's Signature Da1P HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS (Section 25505 of the California Health and Safely Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file my license is in full forcend effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# o I , I t-( Class# ' 'lam (Section 25533 of the California Health and Safety Code, with some -t? exceptions, requires registration with the Costa Mesa Fire Department by—2-�—`vo each business which at any one time has on hand a quantity of acutely C actor's ignature Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work fa which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from constrr��y,alter, improve. dem ia or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuandC:'also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the that he or she is licensed pursuant to the provisions of the Contractors requested .,- information be furnished on applications fa non-residential building permits). Licene rw„(Chof ter 9(tom g with Section 7000)of Division 3 of the Busines and Professions Coder that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant fesApermit subjectsrthigeoplicant to a civil penalty of not more than (If'yes".the facility must meet the requirement of Sections 25534 and 42303 five hundr dollars($500) of the California Health and Safety Code). ❑ I, as owner of the pro y, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds Or improves Health and Safely Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for 8. (If"yes",attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and 0 I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. • the information given is correct. I agree to comply with all stale laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sigal Owner /Zit?"' 1 Signature Date "' (/ _ .hl 3057-46(3l07) And/or A orized Ap icanl Date ( I r O'er CITY OF COSTA MESA i ►9 • BUILDING DIVISION •,,,,. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 1 74 . PERMIT J !�'+ ,F 401-01432 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 230 SHERWOOD PL Status: ISSUED Suite: Applied: 09/14/2001 Vicinity: FRONT 8 BOTH SIDES OF PROP Issued: 09/14/2001 Parcel Number: 42620235 Zoning: Applicant: PAONESSA, EVELYN ISSUED BY: /C/ "A___' Address: Phone: 949-548-1398 Zip: Owner: PAONESSA, JAMES T Address 230 SHERWOOD PL Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT A BRICK 8 SLUMPSTONE WALL, RANGING IN HEIGHT FROM 2'6"TO 6'IN HEIGHT(SEE PLANS)ALONG THE FRONT AND SIDE PROPERTY LINES.207 LF FEE SUMMARY Plan Check: $72.31 Calc Valuation: 54,140.00 Permit: $111.25 Claim Valuation: so.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $184.06 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'comperfsation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($1170)or less.) in I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1X,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc.a Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he Or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pem+' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under�sAe.c�,., 1`J Business and Professions Code for this reason: Signature: z- 0 C`Ta'_a--•.XL-s o Date: Q' - 14 - O i Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building Structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Flre Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently require has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Application akPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! U Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within t000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described ry(q inspection purQtiaps.I agree not to occupy or allow occupancy of any building authorized by this permit�until final inspection. 7 Si ature Of Legal Owner(s) Date And/Or Authorized Applicant Date PODS/ INSPEC110NTYPE PAIL MALL OM s 1NSPECTIONTYPE GAIL CMALB 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof �J,( 210 Final Electrical 201 Final Block/Retaining Wall iO/910i r l.� C 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy . . •.: , i • 230 --cr: / t 7-76c-c '•.:: 1 . Cr S'/A )7.1 ..5-e, .'• : DIVISION OF EMLOiNG SAFETY -----.. CITY OF 00StA(ASA APPROVED 7. St______ 1 7 ? ''' NotE •,. : . . .• ---eiiii_kfriot .r•-•::frivErmikitiaatitztri6, . a ADDMONS; .00 DEL&IONS,.612 ' RREIT/ONS SHALL Alo :• clfi Wit- *Pt q tgWreiltdiV 4am igiel iv • • \;) W,glifOiltbite.iiiiittieg: / / — O/ C/30._, .- .- .,-- . BEAPPROViD BY iHEIOLANNINO DIVISION \• ,itInig154..;!ihii.0iiiafil iti.065st15314a Of Ili jig! fel/IS W If?4#11410,- 3O _1:S.b:La iiiiii.,9h al&if/(Si Si.5i::+.NU ilaiggrNiP Ofif OP 4d: I------4 I \', ,1 ', Ii.*8isti i.thirk.. i;E ilcili 3.M,:fiiE I nr sgionsi_ , -, ... 1 ,..., t W iiiiiitiFiliiir friliiiiiit aill‘fil iik)jeY ij iniiiii tN 4 p Eli RiONOU t — 01 q: 6_ •- - 1 _ :•• f . ,• :0 4 c.„, ___. /.7•zit cc \' -;:t.-,) -- 1. giriFficOst:\11JEscki" t'. ' I.- i SLIBJECTPLT AokBNLINDGG.Drif E/Fr. . . , _ , . . . ilV ' • d• 0 f• g . ,/ --- G. RE ")°14-12244'1/4-d , • % --..-4 1 E "S — 63/ E - /ci iirj I i j < \ . •-e-a_ _2..1.______________________ .—...11 i .. t• .. 11..ii , . . •.• ••• t , . .:. .. i V . ..._..._.. ... . .....- . i •-..:. . . ... .,- .— ...,..“, lao _.v.. . 1 -Retin I Vratte . t ' .jIf LI 1.1-f.I.- I . • : . m.,l_y -°1# .'• -,ag" I -1-.) I. 1 :,/ ..„ lv,k) 1,..N 1 ---. _ _.; , !‘ . : -' II.. 7 fit• . • ' rtre i - •-- , - - • - tip:- ' CIS 7 .;-- s. ,tr...— z'cv" Ana it,_ CZLZ , • . .. , • •... . N .. Rey," ‘, ,, ., ( c,.. .! - h ' .- . . .., . .• .. ,..... CD , i 2,169" • , . . . " • . . . . .. . .. •. • • . . ,,,,,,, \..) el i • — •: - • .. , • ,..._ 11.31..../.. .3 011 ii6ZA VA- p'(a stut. _____ t. ipre tnd 6u ini 04 510in 10efr (ma -rtl maK. tch‘q-a__ 42:itecte—conoi (APIA-- tkiktA,L. . . Leci,r i?kepticot ufric., . . 5/2-ckfrupb-101A-c. bt-Ibutti.L., e . 7- 1 I r 0 r g 6. 17‘,1 tS1 IA 12 7 r v a vii LutAg .1:-u Ct.C. 1 TYPICAL 611 CONCRETE BLOCK FENCE • Cement Coping k With Optional.31 0 X11! U, '-- -i 1 1 —I- GENERAL— NOTES Channel Block With 13/8 Horizontal Top of all FenceMORTAR: One Part Plastic Cement, and N. ' � I Three Parts Sand For Fences 5'or Less la GROUT: Ont Part Cement Three and II One Half Parts Stand Vert,Bars 3/8"0 at 4' o"O.C. i a u �� ' COPING: One Part Cement, Three 1Parts Sand For Fences Higher Than 5' CONCRETE: Weil Mixed 1:2-1/2: 3-1/2 Vert. Ban 3/9 0 at 32" O.C. t w_ - - - - �'I cr< IIMaxof 7- 1/2 Gallons at FIII Cells Solid With Grout , > i Water Per Sack of Cement Where Steel Occurs > R mnlnrcin9 Steel Shall II 3 `A GROUT MAY BE POURED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL Cunlorm to Sec.A.15.39 ' W O -- a OCCURS. A.S.T.M. III i ~ —,I - �Sa CELLSE AND TAREAS OF NLEAR. LEA REIN All Steel to Lapped " Lai ~ FREE OFEALL SMORTAR DEBRIS,ETC. 24"or to CodN d Illi fl I .111e 11 me NATURAL RADE `Will Ft v v ill „ �1 TWO LB"O BARS el CONTINUOUS TOP f " , & BOTTOMIII 1--►-WIDTH II TO 16 0 C MAX D SEE CHART b H01212—STEEL MUST BE TIED IN BELOW UC oTH CF EARTHTCOTN PLACE AT TIME OF TRENCH r I ` I/! Tiff HEIOTH OF FENCE INSPECTION. A. A SLOW BOTTOM OF FOOTING -t.. , e 1�a� o" 2.•J SCALE: 1/2" = I' FOOTING REQUIREMENTS CHART WALL HEIGHT 6' S 4' 311 WIDTH . 14" . . I4 . . . . 12". . . 12" THICKNESS10" 10" 6 " 6 " DEPTH OF EARTHTOOTH 24" 20" . . 16" 12" SPACING OF EARTHTOOTH 12' 14' . 16' 16' (till BUILDING DIVISION ra, J • • • •THIS SKETCH IS FOR INFORMATIONAL PURPOSES •SOLID WALLS/FENCES BETWEEN 2.-e&6'IN HEIGHT SHALL ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE. AN ACCURATE REPRESENTATION OF THEIR PROPERTY IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND •SOUD WAILS/FENCES SHALL NOT EXCEED 2'6'IN HEIGHT WITH THE INFORMATION PROVIDED ON THIS SHEET. WITHIN IV OF THE FRONT PROPERTY LINE(NOT CURB LINE). •VERIFY DISTANCE FROM CURB TO PROPERTY LINE AND SHOW ON PLAN. VERIFICATION FROM THE arts ENGINEERING DIVISION IS REQUIRED. CALL(714)754,5343 FOR INFORMATION. I I RK ! \ LeaREM ec �c ,�I«s fim \\\ I I I a g a a g I a t a RE90ECC RE9004CC MESON, RC9DERCE I • Y I CI I I N , W W • MW 0.00E R gf MOt E STREET BLOCK WALL LAYOUT FOR BUILDING PE m MIT PLANNING DIVISION - z( ADDRESS OF BUL C 230 SHERWOOD PL 0M CITY OF COSTA MESA - BUILDING PERMIT OWNERS NAME IF en0 SNAOEf KNOWN PAONESSA, JAMES T PERM NO: M 086123 'DORESS' 230 SHERWOOD PL COSTA MESA, CA 92627 PERMIT NO: M 086123 PLAN CHECK NO: N GOVT: N SUPP: N 548-1398 APPL.MAILING ADDRECONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: OTH ARCHITECT OR EMER: u61.3.: JOB DESCRIPTION : REPLACE F.A.0 SQ FT: RCN OR E140.1 ADDRESS: UM: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / WNTRACTORSNAIt GRAHAM BRO HEATING AND AI ( 714 ) 546-1653 r1l1IRACTOaSaMI21O 2952 CENTURY PL COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT ADDRESS: COSTA MESA CA ucND_ 248604 **+ter**+ *ir:rx******jt******************:r +r*iteE**its************it*:E**:r**iE*x**** itx:E** 92626 we: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penely of perjury that I ern licensed under provisions of Chapter 9 S E TB ACKS (commencing with Section 7000)of Division 3 d the Business and Professions Code,and my license o in full force and effect. CITY UC.NO.:063186 UC.CLASS: 20 ucN 2486 4 -.P : 0 /98 MAIN BUILDING ACCESSORY BUILDING y Dale; /a —.9 —92 Contractor: o- �� / FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN • LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby elfin under penny d perjury that I am exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Cods)Any city or county whish requires a permit to Mann-Mt ser,improve. demolish.or repair any structure.prior to is issuance.a/so requires the applicant for such permit to file a signed NMemeM that he a she PARKING REQ: PROV: PARCEL: 42620235 ZNE: REF NO: is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES> Business end Professions Codel or that he or she is exempt therefrom and the basis for the Staged exemption.My violation of Sadists • 7031.5 by any applicant ton a permit subjects the applicant tea civil esafyora Pnmove than five hundred dollars[$5001). ************************************4 *********************1E****1E*******1k****** CILas owner or the propertyor my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered tor sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en timer of propend DEVELOPMENT S E R _V I C E S REQUIREMENTS who butch or improves thereon,and who does such work himself or hens or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is Bold within one year d completion,the ZONING APPROVED B Y I DATE: ownerbuider will have the burden of proving he or she did not d build or improve for the purpose sale). ❑ 1.as owner of the property.am exclusively contracting with licensed contractors 10 construct the prpjed(Section 7044,Business and i Professions Code:The Contractors License Law does not apply to an owner el property who Wilds or inptoves thereon end who BUILDING APPROVED BY : - r DATE: contracts ler such projects with a mMractorls)licensed pursuant to the Contractors License Law). , C ❑ I am exempt under Section: B.A P.C..for this reason: APPLICATION ISSUED BY: % 2 01• (1 D ale: Owner. ****************************************************4************#***** *iF*iF** I do hereby certify that I am aware of end understand the requirements d Callomia Heath and Soley Code Sections 25505,25533,and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N 25534,end that I or airy haute Wilding occupant will I wIt rid(circle one)need to comply with said state codes and the requirements for • forResidentialapplications BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provi81O0s. PERMIT 13 . 25 Date: Applicant: 2 5% S M I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of penjuy oned the(atoning declinations; PLAN ElI have and ail maintain a certificated consent to se.inaure for workers'connperraion.as provided for by Section 3700 of the Labor ISSUE FEE 22 . 00 Code,tothe performance dthe work for wtihthis permit aissued BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ I have and will maintain worlusrs'°yin:emotion insurenos.es required by Section 3700 dem Labor Code.for the performance of the TOTALS----> ' 13 . 25 22 . 00 0 . 00 35 . 25 35 . 25 . 00 X work for which this permit is issued.My workers'compensation insurance unw end policy number are: Center MTT3 rpAMTT1PV EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 35 . 25 OVER/SHORT: . 00 Polly Number: N01°0/h170 08/01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need nor be completed l the Penni is for are hundred dollars(SIXJ)or less.) 35 . 25 ❑ I candy Net in the pedomance of the work for which this permit is erred,I she rid employ any Person in any manner es es to become abject 10 the merlons'odnVemsalion laws d C ' and arae the In 'bled/7to the"Sal' ******************************************************************************* compensation provisions of Section 3700 of the Labor Code,I cobweb ply with j 9- 97 INDIVIDUAL F E E BREAKDOWN Warning:Failure to Seethe workers•rompertaadon coverage Is unlawful,and shell subject an employer to Cohninaf peruh/es and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars(5100,000),hi addition to the coat of compensation.da ages a provMM for In Section a . 37afmaborcoda,lmwc.ndarconeve/eee. MEC 1 INST FORC-AIR/GRAV FURN <= 100 K BTU 13 . 25 13 . 25 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction boding agency for the END OF FEES performance of the work for which this permit is issued(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: 1 candy that I have read this application and state that the above information is coned.I agree to comply with all city end county ordinances end state laws relating to Wildng construction and hereby authorize representatives of this city to enter upon the ebove'mentioned property for inspection purposes. GORDON GRAHAM 12-433-1937/81:26111/$35.25 nm Name RCPT4:61-0616602 ). 'E�y4 Datwl2_ PERMIT: 086123 Sig sere of or/Agent/Applicant/Contractor (5151.46.WP) Whhe-Building&Soley:Green-Fle:Canary-Applicant;Pink-Revenue;Goldenrod-Assessor • CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. 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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap • 63. Heater & Vent-Final 4 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-I 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 0 Gas 0 Oil 23, Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd:Storage Tank 0 Gas 0 Oil 25, Roof Sheathing 74. Overhead Hydro 26, T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 26, Lathing& Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREY. 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 /2 Ro 57 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 Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49, Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date May 3, 1972 _ Mr. Rich Bassett 230 Sherwood Place Costa Mesa, California Dear Sir: 44 A building permit has b�"" issued to California Pools, Inc. to construct a private sw g pool on your property. In order that your pool will be a safe one and for the purpose of advisi you of your responsibility regarding the requirements of the osta Mesa Municipal Code, we refer you to Section 8107, a co of which is attached. This letter is directed to you in order that you will be aware of ou rdinances and can make a complete safety check of your parea. Sincerely yours, RICHARD HANHART Building Safety Director RH:dh • 1111/111111 ,\2�1111":\ Twining Laboratories of-souffle-7i e-7i �L2��foT,=«=, _Inc. _ j Fd" '0L2 P.O. BOY. 47 • 3310 AIRPORT WAY • LONG BEACH CALIF. 50601 . ?131 A26-3355 • 12131 636-2365 . 17141 828-6432 B3ANG' OFFICES TESTING 1514.3 Nc,•n Harper S,•..• 230,De:,o<f..I.It oq 2955 Eedo.do Are..3080.47 • III.)531 2C45 L.-q Be.cF. CAN 30801 11131 535 1380 May 24, 1972 Examination: SC72-2996 COMPRESSION TESTS ON GUN I TE CYLINDERS John R. Chambers S¢6a)-v 3443 Del Monte Drive, #3 Anaheim, California 92804 PROJECT Swimming Pool for RICH BASSET ADDRESS 230 Sherwood Place , Costa Mesa SAMPLE FROM ill b h A - Deep End: #2 & #2A - Bond Beam #3 & #3A - Shallow End ARCHITECT CONTRACTOR California Pools California Pools ENGINEER SUBCONTRACTOR H. M. Hambers Grove Gunite Co. SPECIFIED MIX STRENGTH 2,000 psi DATE CAST 5-17-72 SLUMP DATE TESTED 5-24-72 I 5-24-72 5-24-72 CYLINDER NO. IA "HOLD" 1 2 3 2A "HOLD" 3A "HOLD" COMPRESSION 7 Days 7 Days 7 Days • TOTAL LOAD, LBS. 95,000 98,000 106,000 POUNDS PER SO. IN. 3,370 3,475 3,760 • SIZE: #1 : 6-1/8" x 12-1/2" #2: 6-1/8" x 12-1/4" #3: 6-1/8" x 12-1/4" COMPLIANCE 7-Day test complies with specifications MADE IT DELIVERED BY RECEIVED ON CYLINDERS J. Chambers JC 5-18-72 Din". BUILDING SAFETY DEPT. J. Chambers - 2 California Pools Grove Gunite MAY 2 5 1972 Costa Mesa Bldg. Dept. / � - ALL REPORTS ARE SUIMITTFO AS THE CONFIDENTIAL PROPERTY OF CLIENTS. AUTHORIZATION FOR PUSLICATION or OUR REPORTS, CONCLUSIONS. OR ES- TRACTS FROM OR REGARDING THE I. IS RISE ROED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS. THE PJSLIC AND OURSELVES. 330.12 10861 I COSTA MESA BUILDING-SAFETY DEPARTMENT RECEIVED P.O.BOX 317 COSTA MESA. CALIFORNIA .fid //� z.,e–_3--f I TOR APPLICANT TO FILL IN COMPLETELY APc igI OAFIFPR PERMIT y�v TYPE OR PRINT uLl BUILDINGY i,� - Sherwood -�++t'�� � CITY �F� ;�1Rv�E � ADDRESS,•1 3 �Q� J COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY Easluo4t, Daglo llexit C er raLion YYY�py�p��L� Y.Flrx>Q= S�rc c,ruFT= n . RECEIPT NO. I �vCJID1 OWNER Mes ttttom'© AMAIL DDRESS 419 E. 17th Street, CostaaeRECEIVED�9 I OAT,RE,C/E1V�7 16u®hTETJS,LT�96 CITY Costa Mesa, Calif.fTNO.� 81159 BUILDING %O�AA,Ci7 ben,71 ll�..rr BUJ 11Lf' ADDRESS L ARCHITECT Larls On & LIC. OR ENGINEER Middlebrook NO. COSTA MESA. CALIFORNIA ADDRESS Garden Grove, California FIRE / Q(� n/ l.. Inc. ZONE TYPE GROUPr\/ l� Dike & Colegrove, nSTATE167293 APPROVED CONTRACTOR, Ec+ n LIC.NO.'"' • BY 'DATE ADDRESS 419 E. 17th St., Costa Mesa ZONING . LEGAL I LOT .'s 4 133(8— ...min 1 / NO.OF .7.-- BUILDING JUSE OF NEWS 'tom DESCRIPTION NO. 3 BLOCK TRACTVI[1�I'PLAANS Y BUILDING /_` �� A.P.NO. BYPROVI DJ' N ( / DATEIO/ .Pi SIZE rvO.of BLDGS' YARDS ���EVES OF LOT 71 x 791I NOW ON LOT 1V One REQUIRED ALLOWED • USE OF None (CENTER LINE ST.) EXISTING BLDG. FRONT .'<eFT. IN. SETBACK LINE FROM 1 CENTER OF STREET REAR YARD D 121 r R.SIDE SFr. IN. SIDE YARD I LEFT 161 I RIGHT 51 / L.SIDE j(4 FT. IN. DESCRIPTION OF WORK �,� IN. REAR NEW' I X II ALTERATION I II ADDITION I . REPAIR I II MOVING I II DEMOLISH I BUNO.OF SIZE LDING �� ROOMS 6 STORIES 1 EXTERIOR WALLL ucco ROOF ,.t, ke COVERING .�(, (COVERING `ake SE OBUILDING AND WORK TO BE PERFORMED SF Single family residence with attached garage Plan X 730D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION. VALUATION nn SIGNATURE OF..._,../20/ PERMIT FEE $ 35.00 PERMITTEE —r n n $ 15,376. PLAN CHECK $ 17.50 Dike AUTHORIZED AGENT & Co grove, Inc. TOTAL FEE 5 52.50 PAIL P7-7���—001190* **lct311.67 _ 34620 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely �I �a'd di-24-7 r/ At RECEIVED rak. ,1,L i-24- V7- LJ E24,-) ``- . BUILDING z9ED d ((//��// U 1 /— ADDRESS . E:( LVee)� oa. ''7 O. OWNER t (' O'-/�2 1 PERMIT €�f1 1IY� A.P.NO. 0 T 2 �/ 1' IG ��s �SS �_� BUILDINGMAIL -.445,2,2,4„,,,,n Z ADDRESS 5zT/He ADDRESS 2 so p--.2PL d U CITY NO01 tli L a TRACT 33781 O LOT 4 BLOCK I- Z GY� f2' Z< CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOLISH -I-I LENDER G/r-Swig O.J D BRANCH / JN OWNER Y?jC91-JSE/ m1.11 J ADDRESS VALUE -CO ) VAcu/M ARCHITECT TEL. USE / ¢C Ba. $ 2e�00' - Q OR ENGINEER NO. U Q FIRE w cr ADDRESS ZONE TYPE ROUP a 41 APPROVED so Ja4/,z- LU Z CONTRACTOR C aL.0 /, P�/s/y/i9 OGS /.t' BY (/`� DATE /- CO Z r4Af,Bo/e CU Lu J ADDRESS Z/S(o S o. ZONE NO.OF USE OF NEW Swt /' TEL., z F 7 �, PLANS L BUILDING CITY As IAA-Mz<f/✓1 NO.J3r-V44,0 ' Po OG LU- O STATE CITY . YARDS APPROV, D YARDS APPROVED D O LIC.NO. .�l6 Z CLIC.NO. c EE ACCESSORY BUILDING SIZE INO.OF BLDGS. (FR /L ST EE ) ` T OF LOT NOW ON LOT FRONT F �t0 FT;" USE OF 7 EXISTING BLDG. R.SIOF T. ( FT. I- SIZE OFNO.OF g Z NEW BLDG. -. Ze) ROOMS STORIES L.SIDE , FT. FT. VEXTERIOR WALL ROOF _ COVERING COVERING REAR F 6 FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE :ET. BET.MAIN& ®j C- Cl. MAIN BLDGS. ACCESS. BLDGS. . # Q {� VAR.# DATE O P/21/4 - ge,(� A.0•1 p/ 0/ C.U.P.# APPROVED( / Nt APPROVED w� _DATE [IAb/7Z 2 0 U I hereby acknowledge that I have read this application and state STATE M that the above information is correct and agree to comply with a. all laws regulating building construction, and I shall not employ / I- any person in violation of the workman's compensation laws of C13 the State of California. / m Zo I hereby certify that I am properly licensed as a contractor under SO. FT. T o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0 cc am exempt from the provisions of the State of California Business and Professions Cod Division 3,Chaptg�9. VALUATION 0.0 te���-i / V _ $ PERMIT FEE $�� j Signature of .'/S�(w'�CLs/!. m Permittee _ l�z /L.0 PLAN CHECK $ / E f/T/ Vlfj o • Authorized Agent TOTAL FEE $ 34871 . . • -i-("° Oo309 ?':- 1:***39.28 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APP 1 ATIO OR BUILDING PERMIT For Applicant to Fill in Completely Tr V BY AT CEIVED ATE IS E BUILDING ? q • �Qyq/E �t1- �/ ADDRESS a`3O SNE FZia.i00 , �C-- A_"` _�� ��'10 -2 ADDRESS //d_ �o 3 x"7-7 RMIT NO. OWNER R • IJ DD A-S S err r— A.P.NO. MAIL ^^ ID BUILDING .�..S O S liF�G.I0 O O Pc ADDRESS d3O Z N t: R W O U' PL • ADDRESS -z p Z ^ TRACT iJ / pl LOT BLOCK Cl. U CITY `�B o, r e*r yvl e S' ft NOL. z C CONSTRUCTION NEW ADD I ALTER I REPAIR 1MOVINfl OEMOI NH LENDER am J U BRANCH R. 2A` .S c TT <N OWNER 03 W ADDRESS ////{III�y✓ w/J _/ m m ARCHITECT TEL. USE I^ / �//(�•VALU$ /e J < OR ENGINEER NO. /�• U C°) FIRE I / W m ADDRESS ZONE TYPE GROUP tJ a IL APPRO E ^,� \/ /- �f/ �77� W O CONTRACTOR QE0.266 DE in 4:-AY BY ��/ �,(/t 4f€�f / DATE (� /'H / co ✓� / ..7., cc ADDRESS )S-/f eaGKLEoGE DQ - Ww p TEL.r ZONE NO.OF USE OF NEW poo L z, CITY'Ut/Y/9 P.4-/i c- NO. ,c '�I� R ' PLANS0_4. BUILDING �v �(/Z WO STATE '4 p CITY YARDS APPROVED YARDS APPROVED to CC LIC.NO. -40 f $Q LIC.NO. MAIN BUILDING ACCESSORY BUILDING D 0 (FROM C/L FREET) SIZENO.OF BLDGS. OF LOT I NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. 1 u`f C L L I ^I- C r R.SIDE FT. FT. I- SIZE OF NO.OF3 Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT. UEXTERIOR WALL ROOF _ COVERING COVERING REAR ,e FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0- MAIN BLDGS. ACCESS.BLOCS. Cl. aDATE O kPbn- .J F0 R. two £. CU.P..# --L. APPROVED Of ,./.7 Z. APPROVED 6 N (tO U eR _HY w L L) DATE v/Z6/7 Z Z T E O I hereby acknowledge that I have read this application and state HOLD FOR SPE L Q SIN S D that the above information is correct and agree to comply with DL all laws regulating building construction, and I shall not employ 1- any person in violation of the workmen's compensation laws of �Y the State of California. i7 ,•I 0? I hereby certify that I am properly licensed as a contractor under (// V SO. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that su licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: of am exempt from th pr visions of the State of California Business VALUATION �/ , h 0-l' ry of and Professions Co a, IVislon 3 hapter 9. (p PERMIT FEE $ O Signature ofI(Q/ m Permittee $ amp'— PLAN CHECK $ A5. 0-0E Authorized Agent �9 u ` TOTAL FEE $ /