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COSTA MESA BUILDING -SAFETY DEPA T T 7 � APPLICATION FOR�STRUCTURAI. PERM IT> 17. --1 T
- P.'O. BOX 1200 COSTA MESA, CALIFORNIA 92626
C.
For Applicant to Fill in Completely - Use Ink only
R FW BY P RMIT B
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BUILDING
ADDRESS Tract 10626
A9. NONQS%/����Q ��� 18 `21
BUILDING 'p 491
ADDRESS 6
OWNER OR
TENANT M.D. Janes Co., Inc.
UNIT ORN
SPACE NO.
ADDRESS 2950 Airway Ave., D-9
TR.NO.
104-2
LOT
BLK.
CITY Costa Mesa No. 979-3376
NEW
ADD
ALTER
REPAIR
MOVING DEMOLISH
CONSTRUCTION Not selected
LE
LENDER
BRANCH N/A
/ '
OWNER A -"Z -S f_O—
ADDRESS N/A
VALUE
USE E
ARCHITECT TEL.
OR ENGINEER Dan'elian & AgAric NO-5146—IA91F/
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ZONE 3 J
T
TYPE V GROUP 1q, ✓
ADDRESS 3848 Cam
CONTRACTOR owner
APPROVED
BY DATE
ADDRESS 9
TEL.
CITY a NO. e
STATE CITY
LIC. NO. 9 LIC. NO. e
APPROVED SETBACKS
SIZE
OF LOT 550' x 334'
NO. OF BLDGS.
NOW ON LOT A
(FROM C/L ST T
USE OF
EXISTING BLDG. N/A
F
Separate permits are required for
electric, plumbing and heating work.
L. SIDE FT.
REAR f FT.
USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
DATAPPROVED 2 ->O/
APPR
rl _/ _
DATE 1.2
I hereby acknowledge that 1 have read this application and state
that the above Information Is correct and spree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of Californla.
I hereby canify that I am properly licensed as a contractor under
the State of California Business and Professions Coda, Division 3,
Chapter 9, and that such licenses are in full force and affect, or I
am exempt from the revisions of the State of California BVsiness
end Professions Cod Divisi ry3, Chapter 9.
Signature of //
Permittee
o` 8/17/79
Authorized Agent a
'%
O SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
s SQ 7 (Or'z�•
PERMIT FEE E
PLAN CHECK E Sd
TAK E
TOTAL PAID i 61