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HomeMy WebLinkAbout030-360-01992'.41-717 DEMITRIAL-;,Mary ,,lSu"-e.-' 1616 Biggs Ave,'Orbviile'-' . ;�2, (i,�pods t0've) R ---------- 030-360-019 03-3695 COM CAST CABLE Cont: WEST COAST COMM CATV POWER SUPPLY a IE] r. :%N`.+f'� r'1.+4s: `r'•R.r"'•f -.. +" +T 7. �: e•lr�"+•ct �.,,Z r �� �. ,:� [ r ' s ...� f.t` ,4 „tr.. •.... y .. • __ „ � Ossa• :,a c-�f�:, ( �.-� iC\,�'->-�.� ..t.. `�«. �. ..LI` v .�V. .f�,,••' �•s.,.11,'�:1C�.,_ r^. - 030-360-019 92-4177B DEMITRIAL, Mary Sue 1616 Biggs Ave, Oroville (woodstove) / COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS ^ PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 _ t f/ 7 -2 APPLICATION AND PERMIT 7 ASSESSOR PARCEL NUMBER - 030-360-019 ZONING A2 BUILDING PERMIT OWNER Mary Sue Demitrial TELEPHONE 533.6664 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 1616 Biggs Ave., Oroville 95965 CONTRACTOR'S NAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ 5-c,`a LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ . ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee a . 1616 Biggs Ave., Oroville PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF E:4 Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ® Describe work: WAodstoye Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service LESS 200AORLESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. 1 License No. Classification IZI I, as the owner, or my employees with wages as their sole compen- sation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO 1000AI 37.50 NEW CONST. ( DWELLING OCCUPM 3.64 sq.ft. OR -DONS. ACC. BLDGS.NEW I NON-RESID CONSTR. BRANCH CIRCUITS @ 5.00 (POWER APPARATUS &) SINGLE OUTLET CIR. I Ex. Occup(OUTLETS OR FIXTURES20 76 FIXED •REA.1 3.00 EX. Occup. OUTLETS (RESID 1 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring -15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file' with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. C7f I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X fLli ,� �Lcf /s:�a, Date /1 ...%`'- �.� Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height.2,. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $t►S OO HAz I DFEES I IMP I FLOOD I CDF PARCEL I PD HE ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. CT R PUBLIC WORKS By Date /Z -J- f "- PERMITiEXPIRES Date / Z -I-,F !`' 129864 LFIeceipt No. HITE-O.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT S" r COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, CEilifor7la�95965 - Telephone: 916/538-7541. _ / 7-2 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 030-360-019 ZONING AR BUILDING PERMIT OWNER Mary Sue Demitrial TEI RHONE 53-6664 SQ. FT. OCC. BUILDING VAI UA ION OWNER'S MAILING ADDRESS 1616 Biggs Ave., Oroville 95965 CONTRACTOR'SNAME Owner TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN •Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS Permit fee $ 4 5.00 1616 Biggs Ave. Oroville PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SFU Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W 015.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other ® Describe work:__ Woodstove Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 2000V OR A OR LESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑I am licensed under F prOVIS10nS Of Cha t. 9, Div. 3 of the BUSIne$$ and Professions Code and my license is in full force and effect. License No. Classification y, I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ElI, as the owner, am exclusively contracting with licensed contract - ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO10o0A,. 37.50 NEW CONST./ DWELLING OCCUP.9l) OR ADDNS. l ACC. BLDGS. 3.64 sq.ft. NEW CONSTR. MULTI.OUTLET NON-RESID BRANCH CIRC ITS @ 5.00 (POWER APPARATUS tri SINGLE OUTLET CIR. I Ex. OCCU OUTLETS OR FIXTURES P 20 76 FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.) EA.) 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring -15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. �( I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in conse ence oft granting of this permit. X , % Date 1f �, ��� Signature of pplicant — OwnerA Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee S Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $45.00 HAz I DFEES I IMP I FLOOD I CDF PARCEL I PD HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees T RPUBLIC By PERMIT PIRES Date applicable provi- resolutions to do have been paid. WORKS � Date/Z'/'—f 129864 Receipt .W. WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT T. c "1`'-^".L"�^�.. ; _ � ..,4'�.R.u..,- JTt�.� j"�,;r, , , � " b;! , . �y : � �v 4 �A^ �.N .�`• r COUNTYOF BUTTE - DEPARTMENTOF DEVFLOPMENTSERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER )2 12 ��U tr✓ � �� / 7-/2 14 A. P. No. 0 30 r340 _61)/tel Proposed Building Use 0 D S U� Building Inspector �/ Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted......................................... 2. Plot plans, 3/4 sets, signed by preparer of plans . .......................... 3, Complete plans, 3/4 sets, signed by preparer of plans . ...................... .4. Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. 5. Hazardous Material Form. ......................................... . 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $......................................... 11. Impact fees as shown on attached schedule . ............................. . 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer . ................. . 14. Sanitation and plot plan approval Health Department. ............. 15. City of Chico plumbing permit ...... . 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (construction approval required prior to occupancy). .. . . dest 20. Pre -inspection for required. . toBuild g Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . .......................... 23. Owner -Builder Verification (Given to owner , Mail to owner _)............ 24. Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ........................................ 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ......................................... 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ..................... :.................. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and -(B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . .......... . .......................... . 32. Plan check list . ...................................................... 34. When you issue the permit, process as follows: 6 ---Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicant Ole �=54 Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit'for above items No. 2. Additional items required: Contractor, designer, owner, was advised of above required data by _phone mail Counter by _Date Contractor, designer, owner, was advised of above required data by _phone _mail Counter by _Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder t Copy - Department of Public Works al N COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, Califor_ia„95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER 030 - 3(00 -Di ZONING A ft BUILDING PERMIT OWNER TELEPHONE 6 $O, FT. OCC. BUILDING VALUATION OWNER'SMAI LING A DRES �/ Jb �6 V Ql S J (_ CONTRACTOR S' AME TELEPHONE CONT'RACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 15.00 Permit Fee $ O Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS / / % Permit fee $ vV PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.001 ' Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SFtE�' Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK New❑ Addition❑ Rem/Ddel❑ Utilities❑ Installation❑ Other Describe work: 6( )00d'srin,y( Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect.SINGLE License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ i, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason Main service 200A TO 1000A1 37.50 NEW CONST. (DWELLING OCCUP.✓tl\ 3.64 sq.ft. OR ADONS, l ACC. BLDGS. / NEW CONSTR. ULTI.OUTLET NON-RESIO BRANCH CIRCUITS) @ 5.00 POWER APPARATUS e OUTLET CIR. EX. OCCUp(OUTLETS OR FIXTURES 20 @3 76d FIXED APPLNS. Ex. OCCUp. OUTLETS (RESID )REA.) I 3.00 Temporary service 1 15.00 Mobile Home Facilities 15.00 Misc. Wiring '15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 1 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any wa accrue against said County in consequence of the granting of this per it. X Date d7-4--_ 4--_ Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ 1 An OSHA permit is required For excavations over 5'0" deep and demolition or construct - ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST TYPE I I TOTAL FEE $ G 0 _ HAz 0FEES IMP FLOOD CDF PARCEL PO HO SSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By DatePERMIT EXPIRES Date Receipt No. 4 WNITC•O. P. W., YELLOW-A5e[35OR. PINK -1N SPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, aroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: An 'owner -builder" building permit has been applied for in your name and bearing your signature._ _ Please complete and return this information at your earliest opportunity to avoid unnecessary delay in.processing and issuing your building permit. No building permit will be issued until this verification 'is received. 1. I personally -plan to provide the major labor and materials for construction of the_propcsed_property improvement (yes or. no) ES 2. I (have/have not) signed an application for a buildingpermit for .the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City -Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone .Contractors License_No.: 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address . Phone Type of Work Signed: Property Owner /,Q,ey-SUEiP�/rei�/C- xpw Social Security Number Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit. 1-61�4vim 5 X30, 36d- v(q COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 2 - ASSESSOR PARCEL NUMBER SEE ATTACHED ZONING BUILDING PERMIT OWNER COMCAST COMMUNICATIONS TELEPHONE Sp. FT. OCC. BUILDING VALUATION OWNERS MAIUNG ADDRESS 4350 PELL DR SACRAMM CA 95838 CONTRACTOR'S NAME WESTCOAST COMMUNICATIONS 343-473 TELEPHONE CONTRACTORS MAILING ADDRESS 140 MEYERS ST CEICO CA 95828 CONSTRUCTION LENDER LENDER'S MAIUNG ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER UCENSENO. Filing Fee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ Plan Checking Fee $ BUILDING ADDRESS 10 OROVILLE LOCATIONS SEE ATTACHED Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: PLACE CATV EDUER STIPPT Y Gas piping system t - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 600VOR UE Main Service zo A OR LESS 0 23.00 230.00 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury 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.P License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensatio visions of section 3700 of the Labor Code, I shall fo it comply it a provisions. f (— i r- - z X Date 6 l [� Signa ure of Applicant - ❑ Owner Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO 1000A 46.00 NEW COLT. DW LNG UP. NG SO OR AODNS. ( a ACC. BLDS. 3.5QFT. NEW CONST. MULTI.OUTLET NON-RESID. 97.50 OWER APPARATUS a SINGLE OUTLET CIR. EX. OCCU OUTLET ORFIXTUREs SAL@ 1.00 .50 APP Ex. Occup. u�nF or. (RR=.GER.A 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S 250.00 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 250.00 HAZ. 0. FEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indiLabbove, for which fees have y RMIT EXPIRES O the applicable provisions Resolutions to do work been paid. Da 7A-0 (Dile) Receipt No. WHITE-D.D.S.-B.D. CA AR -ASS S OR PIN PECT GOLDENROD -APPLICANT