HomeMy WebLinkAbout3141 Country Club Dr - Building PermitsCITY OF COSTA,MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Permit No. p ctq • C) Icl i )q
Property Address 3 �r
Owner Kle in el- C k A1C
Contractor bW fJ _ ���14 'R� 0�'(
State Contractor License Number `� °�"� Classification 12
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform
Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of
the manufacturer.
�T I further certify that I am the owner of the property. (Owner -Builder permittee only).
❑ I further certify that I am:
K Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this
certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
Company or C orate Name
4 0 �l�l�t—rte{ =moi
Address
Received by Building Division (��--
By:
Signature Date
Initial Date Printed or Typed Name
0990-46 MW 9/97 White - Building Div.; Canary - Contractor; Pink - Owner / 2 5-