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Home My WebLink About1105 RIDGECREST CIR - Building Permits sip - CITY OF COSTA MESA T. 4BUILDING DIVISION ) ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t1 4-7' i •'• S - PERMIT i Ei = Existing: 0 Required: 0 Proposed: 0 1B03-01109 (714)N00-0)3 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 1105 RIDGECREST CI Status: ISSUED Suite: Applied: 07/01/2003 Vicinity: FRONT OF S.F.D. Issued: 07/01/2003 Parcel Number: 42203134 Zoning: Applicant: HABIBE, WILLIAM P , ISSUED BY: Address: 1105 RIDGECREST CIR - ' , " - - , Phone: 949-631-9056 - COSTA MESA,CA - . Zip: 92627-3977 . Owner: HABIBE,.WILLIAM.P ` ' . . ��' Address ,, 1105 RIDGECREST,CIR . - . • /4'�/ i" \\ i -' ' 'Phone: / COSTA MESA,CAN' Zip: 92627-3977 _is - �>�. Contractor: OWNER-BUILDER 'Address: \ i/ '\\ , - Phone: A' Zip: = , License:-- 000000, _ - Arch - , - _Eng: - • Address: / - - -. Address:" . , - , • Phone: Phone: Zip: License: - License: - ' - SCOPE OF-PERMIT- - REMOVE EXISTING SIDING LOCATED IN S.F.D.-S FACIA AND REPLACE,WITH,STUCCO.' -' FEE SUMMARY ' - ' Plan Check: $0.00 - Calc Valuation: - $400.00 Permit: ' $23.50 . Claim Valuation: : ' : $400.00 SMIP Res: $0.50 ,. : ...1 ---.:...,. SMIP Com: , • $0.00 - ' Other: ,.,$0.00 ' ` ' Inspection: \ ,$0.00 _ .` .4 :' \ NTotal: ' $24:00,_ V'; " PLANNING &ZONING r SETBACKS MAIN STRUCTUREvFront 0-0 Rear 0-0 Left - 0-0 • Right '070 . 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 for a 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 and 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 2446-48(6/00) DECLARATIONS f n WORKER"COMPENSATION DECLARATION: 1 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 wilt 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'compensation Insurance carrier end policy number are: Cartier: Policy Number: (Thi ectlon need not be completed it the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the or w•'ch this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Californ d a• at to Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the ons. Applicant Signature: ' V ' 4 4 Date: , — 01-1:3 3 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3106 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.Lic.x Class# Contractor's 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). Lender's Name: Lender's 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 permit 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.). • ❑ I,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) )00nse pursuant to the ContraLir se Laws.). I am e r sec. 11 ■ •I Business and Professions Code for this reason: Signature: ' 1111111514705' Date: '7-0f— 03 Owner ID verified by driver's license. f4 es ❑No Driver's License No. _ _ Expires:N—22—0'7 Verification of Ownership by(type of dac ' I.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(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California 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 ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire 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 Califomia 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 0N (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 required,has Section 25534 of the Califomia 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 a plication aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? la Yes u No (Section 65850.2 of the California Government 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 1000 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally 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 COMPUANC • D ORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is cor ct. I agree to corn with:I s•to - and. .ry ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the ovee-gps)c/ribbeedd prop in.1 ecti.n .es/agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. a2 I,� / - 0H O Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE if INSPECTION TYPE ' DATE INTITIALS CODE# INSPECTIONTYPE DATE 7dEMLS 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1268 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 y 204 Final Demolition _ 250 Final Building/Occupancy 7-M-03Citric- ,Oil 6 CITY OF COSTA MESA 4q BUILDING DIVISION >: DECLARATIONS f 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 wo or which this permit is issued. have and will maintain workers'compensation insurance,as required by section 3toU of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance and policy number are: • / d1 ( -Carder: .5 r gr C / /11‘,__ Policy Number l 3 � , 76 —a — -(This section need not be completed if the permit is valued at one hundred dollars($100)or less.) O 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 gree that if I should become subject to the workers'compensation provisions of ction 300 of the Labor Code,I shall forthwith comply with these provisions. / 1�, Applicant Signature: -C- ///�- .% "( Date: ( ` �j`� )3 WARNING:FAILURE TO SECURE WOR COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL I3(AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(SI%.000),IN ADD 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 forcet andeffect. g Lao.# �! . Classat : # - Contractors Signature: yr_� Date: Ji 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). Lender's 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 fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): o 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.lf,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.). O I,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 sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers 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(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California 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 Fire 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 required,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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? .P Yes E No (Section 65850.2 of the Califomia Government 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 1000 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--scribed p arty f r i sp ction pup s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signa re OI Legal Ow r(s) *,le And/Or Authorize Applicant ate CODE 1 INSPECTION TYPE DATE INTRIAL$ CODE i INSPECTION TYPE - p9IE MEALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Finalf� [7,-IA 63Z__ 208 Final Plumbing 200 Final Re-Roof I- � 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 CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. 6j 9/S DATE 5/ 7/7;7 IAT NO. /de ADDRESS //PS R/OCECSEST C/2c4.c- The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undeersigned, by executing this agreement, acknowledges that (he-she-they) L .4,.I (was or were) /,(J�i� advised that this tract has not been given/f_in'al inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. BA 12,1 1 Cil , ,29-kbie---, Purchase BY ///e20/d9,I/J 2A/zit Developer and/. authorized xepres- ( RECEIVED /`,�` CITY OF COSTA MESA BY i /� ri rrun -_ �. 7 CLende.rti, FEDERAL_ vir:; 5570 1:iLSii:Ra EC'"L r . MAR t?�pR 1 ! IQ%? LOS riel.EJC. C`.L:-C"?iVir: E6US4 AM PM 71819110111112111213141516 w:. r~ �.,1:L WR 16 76P-0� 8F .5 t:k+c -92.81 crl: COSTA MESA BUILDING-SAFETY DEPARTMENT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only i DATE _ A RE EIV D BY DATE RECEIV • DATE ISSUED BUILDING III ADDRESS e � L ► //r�1__ _ OWNER YfYW DC�JI�Z-L i'_`• IMAIL I `PERMIT./.�. BUILDING dy ADDRESS`S' S/f A ,Sr_ ADDRESS ' I Osr I �v�CREST- �//C CITY /`/ � NO�7Z4 /0;. TRACT LOT ' I BLOCK CONSTRUCTION - NEW ADD ALTER REPAIR MOVING -DEMO'ISH LENDER BRANCH • le �ai1a "NE 91 ADDRESS J� L,.. ,!- I OARCHITECT R ENGINEER DkA NOJ.n-�lA US . l‘f LU$ / °. FIRE (/ ADDRESS Q //�/(��} /�/,,/� /��t ZONE PE/ GROUP er"�/"MYc-Sr. a. /ti APPROVED _ CONTRALTO BY DATE ADDRESS >> w /Si J� ZONE � NO.OF USE OF NEW CITY!G7�T7( o NTE`b`fz_�0 R 2...(�/"/� PLANSea_ BUILOIN(re< Q r.. F STATE I� CITY - YARDS APPROVED YARDS APPROVE LIC. NO. LIC. NO. MAIN BUILDING I/�� ACCESSORY BUILDING • (FROM 0. OF LOT ILI SIZE I NOW ON LBLODTS FRONT C/L1 FTT s^ FT. Q USE OF ��/' �. EXISTING BLDG. R.SIDE .7T. FT. CA HSeparate permits are required for L.SIDE 4T. FT. welectric,plumbing and heating work. REAR • 1.5cr, FT. I.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& QQ J�i-i '�/r �7 MAIN BLDGS. - ACCESS. BLDGS.�DG �J DATE Q I 'ezczior nT D G� C,1-A. C URP i�•16--7SAPPROVECe S I C x IyOLn FOR P�AI Id m A 15 w p - I hereby acknowledge that I have read this application and state ' n s. IX that the above information is correct and'agree to comply with m o+ all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of • E W the State of California. i�y I hereby certify that I am properly licensed as a contractor under /o+��/SQ. FT. Z:Y7A N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: "' i us am exempt from the provisions of the State of California Business VALUATION o PERMIT FEE $ and Professions Code, Division 3, Chapter 9. in �J� ,�t m Signature of p li/]JJ� ,�R�ij�1� $4 016". . 4 5 " TAXN CHECK $ fie lAtLip es • gi Permittee j (.I/' t�/ U�'(Jd ��ww�� U Authorized Agent - TOTAL PAID $ pg. ligps ID 417 17 n.n. 28-76F7003 En v `,**160.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ' PP IC- TION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only R:CI. •• V DATE RECEIVED DATE ISSUED BUILDING t r ' r AI/ADDRESS I 0 1. I d _ . PERMIT NO. OWNER A.P. NO. , MAIL BUILDINGS h uYJ piny ` ac 'tap ADDRESS ADDRES TEL. CITY NO. TRACT I LOT BLOCK ` CONSTRUCTION NEW ADD ALTER REPAIR MOVING IIFMOLISH LENDER . BRANCH • OWNER 'v ADDRESS I ^ ARCHITECT TEL S ,,! - u40,t VALUE-•L f $ OR ENGINEER NO. ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR DATE • ADDRESS TEL • NE NO.OF USE OF NEW PLANS BUILDING • CITY NO. F 1. STATE CITY YARDS APPROVED YARDS APPROVED i LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) {,y SIZE I NO.NOW OFON BLLOT DGS. 0. r OF LOT : USE OF .L ( EXISTING BLDG. '' R.SIDE FT. FT. (-1 :3 Separate permits are required for L.SIDE FT. FT. G electric,plumbing and heating work. _EAR FT. FT. E—, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& Q cBLOC'S. ACCESS. SLOGS. 0 Q DATE - APPROVED APPROVED ••TE ..1 i 0. 0 I hereby acknowledge that I have read this application and state in cc .• that the above information is correct and agree to comply with Co G - all laws regulating building construction, and I shall not employ Z any person in violation of the workmen's compensation laws of 2 LL1 ' the State of California. 4 C71. I hereby certify that I am properly licensed as a contractor under • w the State of California Business and Professions Code, Division 3, ' THE AMOUNT SHOWN • • •- ' Chapter 9, and that such licenses are in full force and effect,or 1 --•- - m am exempt from the provisions of the State of California Business ." a'o t; and Professions Code,Division 3,Chapter 9. VALUATION tine• m m PLAN CHECK $ m y, Signature of a o ' Permittee & L) U Authorized Agent • • / / E