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HomeMy WebLinkAbout2431 RUE DE CANNES - Building Permits • CITY OF COSTA MESA �,a4144"'F,P BUILDING DIVISION I �( 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 0 PERMIT NUMBER: P11-00115 PERMIT TYPE PLUM STATUS: ISSUED APN: 43913230 DATE ISSUED: 07/06/2011 ISSUED BY: CAC JOB ADDRESS: 2431-RUEDE CANNES CM—• � Suite/Unit: Vicinity: --'�----`.J SCOPE OF WORK: 1 SHOWER • OWNER: FEREIRA,VIRGINIA ANN Address: 2431 RUE DE CANNES PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: RANDY COLE Address: 405 STATE HIGHWAY 121 BYPASS :A-250 PHONE: 214-488-6300 City/State/zZip: LEWISVILLE,TX CONTRACTOR: US HOME SERVICES License No. 768707 - )0V:5 Address: 405 STATE HIGHWAY 121 BYPASS A-250 PHONE: 214-488-6300 City/State: LEWISVILLE,TX ZipCode: 75067 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $33.30 A 250 TOTAL FEES: $33.30 • 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 A. INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTn1ALS 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 7 IS.$2•a7 EN WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive...,dcense. 0 Yes 0 No . I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: O 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 pe ormance of the work for which this permit is issued. I have and will maintain workers'compensation insurance, as required by tan 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: pe '/= issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a n T.�'[}rS}"�fe' person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,ar demolition QKAbe ,c erC-f �.J-rAdatonCIV or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,G p sect n need not be completed if the permit is valued at one hundred dollars less) "7/ / — 2,Art 2,Sec.341,Title 8,California Administrative Code). P icy Nu er: lr C q 0 As owner-builder, I will not employ anyone to do work which would 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 the workers'compensation provisions of Section 3700 of the Labor Cod III.-• •. •• ply i • these provisions. Applicant's Signature Date -ale &7 _......------/lira / Division of Industrial Safety Permit Number: i •.plica ' Signature D.to 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 ❑ No (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety 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 - tion 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 e is iq fuuu,force a�n1d ff)ect. 2 /_ are registration form for acutelyhazardous materials? ,. /U 7V�/ J V 9 11 Yes 0 No • !S/ (Section 25533 of the Califomia Health and Safety Code, with some Sa�r�i/�� exceptions, requires registration with the Costa Mesa Fire Department by i© each business which at any one time has on hand a quantity of acutely contractor'.SignatureCla 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). O 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 for 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 Califomia OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ 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 construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Cade requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 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? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars(5500).): of the California Health and Safety Code). ❑ I, as owner of the property, 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 Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for 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 ❑ 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 ❑ I am exempt under sec. the information given is correct. I agree to comply with all state 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. Signature•f Legal Owner le Signature Date .�� Lee _� //' 3057.46(3/07) i UUU/ Anton'uihonzed A.. yme y`Jt CITY OF COSTA MESA • i ytait BUILDING DIVISION t' ..„..,.....4 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT / PERMIT NUMBER b+ " oens* v M98-00469 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT • Job Address: 2431 RUE DE CANNES Status: ISSUED Suite No Applied: 10/13/1998 Issued: 10/13/1998 Vicinity: Parcel Nunmber: 43913230 Applicant: DEANGELIS, DON Address: , • Phone: Zip: f - - Owner FEREIRA„VIRGINIA ANN i Address: -2431 RUE DE CANNES- - Phone: "COSTA MESA,CA - Zip: 92627 v - Contractor: COAST TECH SERVICES Address: 14 SANTA CATALINA - Phone:. 589-6592 ' - . RANCHO SANTA MARGERITA •. Zip: 92688•- - . License: 355425- '\ Arch/Eng: N '• -t , ' -,-' , - Address: . Phone: ' Zip: • License: " ' SCOPE OF PERMIT ' ' ELECTRICAL&MECHANICAL FOR A HVAC SYSTEM, HTG.&A/C AND A MOTOR. FEE SUMMARY ' / " I '" 1 • ' Quantity - i// Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $13.25 Repair:/-Alt Refrigeration Unit $0.00 0 ' Inst FAU.>100 k BTU $0.00 Ventillatiori-System $0.00 0, Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler • ' $0.00 0 Inst/Rep.Recess Wall.Htr $0.00 0 • ,.- Commercial Incinerator $0.00 , 0 Refrig Sys<100 k BTU - $13.25 1 • -- -.Domestic Incinerator . ' $0.00, 0 Refrig Sys>100 k BTU $0.00 0 = Compressors/Absorption Systems Gas Piping J - •$0.00 0 , '-/Up to 3 hp/100 k BTU moo, 0 Factory Fireplace - $0.00- 0'- . '3 To 15 hp/500 k BTU - $0.00 0 Hood w/Mech Exhaust " • $0.00. r0' "-15 To 30 hp/1,000 k BTU - . /, /10.00 0 VAV Box $0.00 :0 ' ' 30 To 50 hp/1,750 k-BTU - "$0.00 0 Vent Fan/Single Duct $0.00 0 '' ' Over 50 hp/Over 1,750 BTU , $0.00 0 Appliance - $0.00 0 ' ' • • 'Boilers Fire Dampers - $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 , 0 3 To 15 hp . . . $0.00 0 Inst or Relocate Appl Vent $0.00 0 ' 15 to 30 hp . $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $48.50 • COMMENTS/SPECIAL CONDITIONS • 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 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'compensation Insurance carrier and policy number are: Carder: Policy Number (This section need not be completed if the pe . - valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of ork 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 at California,a.: :. ee the If I should become subject to the workers'compensation provisions of Section 37 of the LLaappppr Code,I shall forthwith comply with these ravision� /K' 7„ f' !Sm Applicant Signature: � Date: 7 ��-jjf WARNING:FAILURE TO SECURE •- -: COMPEN ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37080F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro ' io of Cftdpler 9(commencing with Section 7000)of Division 3 of the Business and Proles ' ns Code,and my license is in full force and effect.Lic.# / Class rP / Contractors Signature: y N Date.✓ C/V,`/ 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ 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 properly 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) license pursuant to the Contractors License Laws.). ❑ l 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 Flre 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 afrermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 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 California Health and Safely 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 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: J CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application an. - e that the information given is correct.I agree to comply with all .re laws and city ordinances relating to building construction,and authorize representatives of the n of Costa Mesa to enter upon the above-described property for II...: tion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit f nal Ins ion. //�/��,,�rro' Legal Owner(s) •I �v_ t n - /3 -f l di V Ater Authorized Applicant V sate CODE I. INSPELTON TYPE DATE BMA'S D06E t INSPECTION TYPE /p�ATE INTIDeLS ! 1616 Fixed System Final Fire Prevention 206 Final Mechanical I `-9)11 PT 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIocWRetaining 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 2448-46 • CITY OF COSTA MESA y- �4BUILDING DIVISION i " " 'i' ' DEVELOPMENT SERVICES DEPARTMENT • J., Pc, PERMIT PERMIT NUMBER 'aoamm se E98-01077 V (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2431 RUE DE CANNES Status: ISSUED n`� Suite No Applied: 10/13/1998 Vicinity: Issued: 10/13/1998 ParcelNunmber: 43913230 Applicant: DEANGELIS, DON Address: ' Phone: , Zip: Owner: FEREIRA, VIRGINIA ANN Address 2431:RUE DE CANNES _ - . Phone: - - ` ` COSTA MESA,CA, '- Zip: 92627 Contractor " COAST TECH SERVICES Address: 14 SANTA CATALINA Phone:i.589-6592 RANCHO SANTA MARGERITA -• Zip:1 92688, 7 : I License: 355425 ' - , SCOPE OF PERMIT • ELECTRICAL&MECHANICAL FOR A HVAC SYSTEM, HTG&A/C AND A MOTOR. • FEE SUMMA_RY N Quantity Quantity ' ISSUE FEE - $22.00 ._ Temp-Dist System'/Lighting, $0.00 0 - ' Temp service test $0.00 Busway/100-ft" $0.00 0 ' • , Res. a/c package $0.00 - - ` Standing Section $0.00 0 • 1 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers_up to 1 kva/kw $0.00 0 • • Pool/Spa $0.00 0 up to 10 kva/kw $0.00 -0 - . Lighting Fixts ' $0.00 0 up to 50 kva/kw $0.00 0 -l Recept Outlets • • $0.00 0 - up to 100 kva/kw $0.00 - 0 . Switches ' - $0.00 0 - over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00, 0 - , • - Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00' , 0 ' ' Misc.Conduit $0.00 0 Service to 1000a ' $0.00 \ , \, 0 Misc.,Conductor $0.00 0 Service over 1000a. - $0.00 ' -:0 , , 'Circus(gen or ride) : " ' $0.00` ' 0i Motors to 1 hp $0.00 . 0. • - , • `Circus(mech ride or lights) $0.00 0 Motors to 10hp $11.00 - 1 . Christmas Tree Stand $0.00 - 0' , Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 - - -0 Other Electrical Fee $0.00' Motors over 100hp '$0.00 0 Communication drops $0.00 - 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee • $0.00 Sign Circuits $0.00 0 - Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $33.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 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'compensation insurance carrier and policy number are: Carrier: Policy Number. (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the ork 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 r that i should become subject to the workers'compensation provisions of Section 00 of the Labor Code,I shall forthwith comply with these provisions. / //L ! Applicant Signature: Date:V !S/' WARNING:FAILURE TO SECURE W RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES D CIVIL F& UP TO ONE HUNDRED THOUSAND DOU.ARE(5100,000),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 • .visio.- of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.LJc.P / Class 4 / Contractors Signature: ��� Date: V 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: 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).): 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 end 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) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: • Signature: Date: Owner ID verified by drivers license. 0 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,faisework,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? ❑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? 0 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 aermit 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 end 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 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 la s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection rposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Jr 'gn e Of Legal Owner(s) / Ja/ le rid/ r Authorized Applicant l[ ler DDDEE DISPECTON TYPE DATE =ALS f;00E! INSPECTION TYPE gel'E EMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical /'27-7? 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/Orr,ipancy 2448-46 • '- - M >' CITY OF COSTA MESA :24° 't BUILDING DIVISION PERMIT NUMBER / h "" �r " ' DEVELOPMENT SERVICES DEPARTMENT / °*� �,,,• PERMIT v 699-01736 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2431 RUE DE CANNES Status: ISSUED Suite: Applied: 10/27/1999 Vicinity: Issued: 10/27/1999 Parcel Number: 43913230 Zoning: Applicant: COOTER, LYLE ISSUED BY: _(„„AC----- Address: 23015 DEL LAGO Phone:' (714)583-1858 _, LAGUNA HILLS CA , / - ' , ' Zip: 92653 - ' Owner: BRITHANYVVOODS HOA Address 2431 RUE DE CANNES - - Phone: 949-583-1858 'COSTA MESA CA - Zip:- 92627 �� Contractor 'PRO-TECH-WEATHERPROOFING Address: v,23015 DEL-LAGO" ; =/�? Phone: (714)5831858 LAGUNA:HILLS CA e' ' Zip:, 92653?,-; License:- 620476 " •Arch : ' : : ' � ' Eng: Address: •' Address:- ' - - -Phone: c — _ , - Phone: • - - Zip: - -, ' License: % `;License: SCOPE OF PERMIT ' _ ` GO OVER EXIST.WOOD SHAKE WITH STONE STELL METRO SHAKE ICBO#ER 5218, 1.4LBS.TO INCLUDE OBITS 2433,2435,2437&2439. , , 5.1Cd\ ' , .. _, FEE SUMMARY ' Plan Check: , $0.00 ---- - - , '-, /.:,,, Calc Valuation: ' $21,000.00 Permit: , $335.25 1- ' - ,' ' - Claim Valuation: , • $21,000:00 SMIP Res: • . $2.10 - -- -- ' i / - SMIP Com: $0.00 ' Other: ' $0.00 — Inspection: ' .,$0.00 - . I Total:' $337.35 • PLANNING &ZONING SETBACKS , . " MAIN STRUCTURE Front 0-0 Rear 0-0 Left" 0-0 Right :0-0 , ACCESSORY N Front 0-0 Rear 0-0' - • - Left 0-0 Right 0-0 PARKING Existing: 0 Required: ' 0 Proposed: 0 • NOTES: N. 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 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< 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'Compensation Insurance Carder and policy number are: Carrier: //.w NO Policy Number: h tat./ 74. (This section need not be complete it the permit/s valued at one hundred dollars($100)or less.) ❑ 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 Califomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith co 4� n these provision A attire: D.S /'a Z 7 G: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($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICEN C TRACTORS DECLARATION: I h eby a 'm th t I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 01 the Bu ' ess and Professions Code,and my license is in full rce an effect ic.# / C Contractor's ' nature: its./ Date: in , 7 9 7 CONSTRUCTION LENDING AGENCY: O 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 for a 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.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.). 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's 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: O 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). • O 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,ora 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? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ 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? ❑Yes ❑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 ❑No B (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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of egal Owner(s) Date And/Or Au pllcant /1) 2(7 gi CODE 1 INSPECTION TYPE / DATE INTITIAL$ CODE INSPECTION TYPE DATE JNTITIALS 1616 Fixed System Final ' ration 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof /—C/' 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 2446-46 GtiL CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. 10148 DATE February 22 1979 LOT NO. 29 Chi C. CDS:A MESA in::m2 DEPT. ADDRESS 2433 mm (90 fann<a AM PM 7 ;81fl 12 '11213141516 The developer of the above entitled tract desires to cell 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 undersigned, by executing this agreement , acknowledges that (he-she-they) (was or were) advised that this tract has not been given final 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. BY ‘e, Purch n BYL Developer and/ authorized representative BY Lender L - LDG # ' '11' PAID DEC -7-77„SF00 379* ****84.65 t • COSTA MESA Bill DING-SAFETY'E ARTMENT • f P.O.BOX 1200 COSTA MESA,CALIF.RNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely - Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING act 3 a �, � _/4._tg ADDRESS ,(l y ,{�{r- y,-yy� / ERMIT N A. OWNER Mariners Savings & Loan ASSOC. , A.P. NOf �"�r�/���fJ ,rt J y.'8't �,/l MAIL p BUILDING .�77 ADDRESS 1515 Westcliff Dr. ADDRESS .07(10 C. /.(..R rX0 .a CITY TEL. Newport Beach NO. 642-4000 TRACT 10148 LOT BLOCK CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOLISH LENDER Same as above BRANCH ' '�i /IL/at / /OWNE / /LEA ADDRESS �1/� �' ARCHITECT Roy later TEL' 549-4002 usE�G.Jt / •••”. ///��� „,���pppL its-1SrX"1� OR ENGINEERI Suite H FIRE j ADDRESS 17931 Sky Park Circle, ,Irvine ZONE T// E fI' CONTRACTOR WOOdtree Dev. Co. APPROVED C/J� DATE 3-00-1, I ADDRESS 1665 Placentia Ave. TEL. , ZON NO.OF USE OF NEW CITY Costa Mesa NO. 646-1164 IPLANS.S BUILDING L-t4t i,t.... E” STATE CITY YARDS APPROVED YARDS APPROVED Sa LIC.NO. 336725 tic.NO. 14664 MAIN BUILDING ACCESSORY BUILDING ii SIZE NO.OF BLDG (FROM C/L STREET) G. OF LOT Various [ . NOW ON LOT FRONT 27 FT. FT. Q USE OFtrl EXISTING BLDG. R.SIDE .7 7 6 FT. 94g7/In FT. In FSeparate permits are required for L.SIDE 20 FT. I FT. electric,plumbing and heating work. W ,REAR [// �FT. FT. (.. USE OF BUILDING ANO WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& O Tn}al Uri to .- 1 MAIN BLDCS. ACCESS BLDG9. VA .• DATE �j �7 aTn}al = 1902 C.VR.P.F �/ APPROVEQr/j >. tel Gar. = 8 sqa ft. AYROVFn /0O m7e �0'� a l • [SOLD FOR GSP(iCIAU REMITRFNMFNti'S A. O I hereby acknowledge that ave read this application and state n p' that the above Information Is correct and agree to comply with m 04 all laws regulating building construction, end I shall not employ Z any person In violation of the workman's compensation laws of o 14 the State of California. m 3 I hereby certify that I am properly licensed as a contractor under SO. FT. .v the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt fro e rovislons of the State of lifornia Business '‘'D- am VALUATION u PERMIT FEE $ it and Profession od ivislo Chapter y9. o u. Signature of GOOD ry. 421 n/ ,�r� PLAN CHECK $ ��s (,tel o Permittee LJ V`tet/ $ (/�//`V(? R. ,JO V Authorized Agent TOTAL PAID $ V LA li�^ � 7139 3/10/78 12700C D w a </ 7139 3/10/78 127a0001(A0 COSTA MESA BUILDING-SAFETY DEPARTMENT 7139 001104451 84 IA J P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING ���,t�/,rC��/,}!� ADDRESS /��O I� I PERMIT NO. OWNER IP/, I (� A.P.NO. MAIL BUILDING ADDRESS ADDRESS TEL. CITY NO. TRACT I LOT BLOCK CONSTRUCTION NEW ADD ALTFR REPAIR MOVINfi DEMOLSH LENDER BRANCH OWNEADDRESS . r�„��f,�frta ARCHITECT TEL. • ��(� OR ENGINEER NO. FIRE ADDRESS . ZONE TYPE GROUP �CONTRACTOR / BYPROV ED DATE ADDRESS TEL. ZONE NO.OF USE OF NEW PLANS BUILDING CITY NO. .F-• STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING I.K SIZE NO.OF SLOGS. (FROM C/L STREET/ Cu. OF LOT NOW ON LOT FRONT FT. FT. et USE OF czZ EXISTING BLDG. R.SIDE FL FT. Ca F Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& AMAIN BLDG. ACCESS BLDGS. ' VAR.# DATE Q e / C.U.D.'i' APPROVED APPROVED .-1 Cd ee-BY _DATE lU W p I hereby acknowledge that I have read this application and state n Cd that the above information Is correct and agree to comply with C a all laws mediating building construction, and I shall not employ m Z any person In violation of the workman's compensation laws of .4 SSW the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. co 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 lull force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the of California Business VALUATION PERMIT FEE 3`��y Y and Professions Coda, OWltion 3,Chapterer 9.9. /I re S. f PLAN CHECK es Signature ofqw/ $ U. o Permittee / TAX E Authorized Agent TOTAL PAID S I aH� i.—