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COSTA MESA BUILDING -SAFETY DEPA T T APdUCRTION FORSTRUCfURAL PERMIT"
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
PAE By P RMIT
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For Applicant to Fill in Completely — Use Ink OnlyB 7 , NB
BUILDING ADDRESS Tract 10626 -d9��pf►�p//J- !g-6.2/'
TOENANTWNER OR M.D. Janes Co., Inc. 6
ADDRESMAILINS 2950 Airway Ave., D-9
LOT BLK.
CITY Costa Mesa o` 979-3376
CONSTRUCTION D LTER REPAIR MOVING DEMOLISH
LENDER Not selected
BRANCH N/A�I��t�_l_4lV IG � C�-
ADDRESS N/A VALUE
ARCHITECT TEL. USE E
ORENGINEER Dan- —
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CONTRACTOR
ADDRESS e
TEL.
CITY a NO. e
F+ STATE CITY
i LIC. NO. e LIC. NO. 8
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SIZE I No. OF . OF LOT 550 t X 3341 NOW ON LOS
GA
Q USE OF
.N. EXISTING BLDG. N/A
to
FSeparate permits are required for
C electric, plumbing and heating work.
Fes„ USE OF BUILDING AND WORK TO BE PERFORMED
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WD. 1 hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
O. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of
Sthe State of California.
3 1 hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the rovisions of the State of California BVsiness
and Professions Cotl Divisi 3, Chapter 9.
Signature of
Permittee
°I8/17/79
Authorized Agent e
a
APPROVED SETBACKS
PLANNING ACTION
DATE /
APPROVED
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION PERMIT FEE E
PLAN CHECK $
TAX f
TOTAL PAID $/-*,-7 4 JTr