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�' CJ)STA MESA B' 71NG- AFETY DE�ART�EN� pPPI � TTON F9�t�Rl�L'�rtAL PERMIT�25• 97 Ti
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P.O. BOX 1200 TA MESA, CAIIFORNIA 92626
A a� P���6� N° �
For Applicant to Fill in Completely — Use lnk Only
ADIDRESS 6�L A..NO. Gt"I�QQI�Q Q�1^}4�-I�1�
BV�LOING I� ���,;ra 8
OWNER OR qODRE55 (J1
TENANT M.D. Janes Co. Inc. uNiroa �J
MAILING SPACE NO.
ADDRE55 z950 Airwa Ave. D-9
TR.t�Oo / � LOT BLK.
ciTv Costa Mesa No� 979-3376 ���
NEW ADD LTER REPAIR MOVING DEMOLISH
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BRANCH
ADDRESS
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ADDRE55 3848 Campus Dr. N.B.
CONTRACTOR OWS12I
ADDRESS e
TEL. �
CITV e NO.
STATE CITV
LIC. NO. A LIC. NO. e
SIZE NO.OF BLDGS.
OF LOT 550' x 334 � NOW ON LOT
USE OF
EXISTING BLDG. N�A
Separate permits are requued for
electric, plumbing and heating work.
USE.OFEUIL"DiNG AND WORK TO BE PERFOflMED
I heraby acknowletlge 2hat I have reatl this epplicetion end stam
that the ebove information is correct antl eprae to comply wlth
ell laws repuletinp buildin8 construc�ion, entl I shell not amploy
any person in violatian of the workmen's compensation laws of
tha Ste[e Of Celifornia.
I hereby certlfy Nat I am properly licensatl as a conttactor untler
the Stata oi California Business antl Professions Cotle, Division 3,
CM1apter 9, entl that s�ch licensez era in full force antl eftaci, o- 1
am GxBmpt irOm t�� provi5iOn5 oi Me $tete o} Celifornle Businep
antl Profezs�ons Coy , D��Vyv/n 3, ChaPtar 9.
Signe[ura of /� �T'
Permittoe
or
AuffiorizetlAB �.�D�� R�����Q
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USE 3
E J ITVPE ✓ GF
ROVEO
DATE
APVROVED SETBP�CKS
(FROM C/L STREET)
P�P,NNING ACTION
' G �"i �GJ� DATE —7�^� i �
�li ' l ( APPROVED / L b
nwao pv •
2-/y- �
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m
SQ. FT. �+ �
THE AMOUNT SHOWN UNDER VALUATION IS FOR m
THE GURPOSE OF ESTA8L6MING A PERMIT FEE ONLV: � fn
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VALUATION PERMIT FEE S N
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/ PLAN CHECK b G�1 �f .7/� o
SCGSR �.� TA% E / �, f �.%�
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TOTALPAID S j ��0'
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COSTA MESA �"" ��INGSAFETV DEPARTME
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APP�_..A7'ION FOR S7'RUCTURAL PERMIT
.•_•_V...__V VVV•^..._V^•v.`_.•V•..••^V_V`V RECEIVEDBV PERMIT
For Applicant to Fill in Completely — Use Ink Only �
BUILDING-'� 7 A,P_NO.
ADDPE55 G.
BUILDING
OWNER OR ' I AODRE55
TENANT
MAILIN UNIT OR
AODRE SVACE NO.
TR.NO. l0T BLK.
TEI.
CITV NO.
CONST N NEW ADD ALTER REPA10. MOVING DEMOLISH
LENDE
BRANCH
OW NER
ADDRESS VALUE
ARCHITECT TEL. USE S
OR ENGINEER
ADDRESS ZON TVPE GROUP
CONTRACTOR BVP DATE Z ^/7 /
ADDPESS
TEI.
GTV NO.
STATE CITV APPROVEDSETBACKS
LIC, NO. LIC. NO.
SIZE NO.OF BLOGS. (FROM C/L STREET)
OF LOT NOW ON LOT ROM FT.
USE OF
EXISTING BLDG.
Separate perntits are required for �. si E FT.
electric, plumbing and heating work.
REAP FT.
USE OF BUILDING AND WORK TO BE PEflFORMED PLqNNING ACTION
oaTe
APPROVED
APPROVED
I hereby acknOwl¢tlpa thet I have reatl inis application antl sta[e �
Nat the abore information is correct anC a0ree to comply with
ell laws reBulatin8 buildin8 conrtruction, entl I shall not employ
any person in vlolation ot the workman's compensation laws of °
Me Siaie of Californie.
m
I he�eby cartify Shat 1 am ptaDe�ly licensetl es e conttacior unaer SQ. FT. �
the State of Califor la Bvsioess ana Professioos Cotle, Division 3, THE AMOUNT SHOWN UNDEF VALUATION �S FOP m
Chapter 9, antl th such licanses are in tull force antl eftect, or I THE PURPO6E OF ESTABLISHING A PERMIT FEE ONLv: �
am exemDt fram a prov' ons of che State ef Calitomia Busine55 a
antl Pro1¢ssions "'on 3, Chapter 9.
VAlUAT10N PERMIT FEE E 6_Qp m
SiB^aiure o PLAN CHECK E o
Permittee 3 TAX E LL
or p U
Aothorizetl nt Date L TOTliLPAID E/b �