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97‘OS PI p 9794 6/06 /79 89. 15 TU
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIONPFOR STRUCTURAL PERMIT-
' - P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 _�.,
RECEIVED B'' PERMIT 1�T0 48182
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For Applicant to Fill in Completely — Use Ink Only J ' 1�1 /�
BUILDING A.P. NO. Tl q_o y/-O 9eF-/t)
ADDRESS �� ^ /
OWNERENOR 759,...1.-/.5"
& .—/S DC7 /J6- /t,�/ ADDRESS�/ 71 0...S.4
TENANT 7- T� �f-u
MAILING �/ �s / UNIT OR
ADDRESS/ �r�i /4 Zia" .1 2/� TRAN O.NO LOT BLK.
CITY
/I/awAer JC owiv NOL GP 2.223!
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER
BRANCH 107/6/I ,
OWNER uIZ-69Z '7 G�/
ADDRESS VALUE
ARCHITECT TEL. USE Or7/9D 1/479n > D
OR ENGINEER NO Nr
ADDRESS ZONE,` ITYPE �i'GROUPL
r �w w Ir' �f41� APPROVED
CONTRACTOR�j ��77 SCY`�r4 (_� BY DATE
ADDRESS 3/// e% LiDb 2i/ �p^�
CITY/�p71O Ober f'f N t 73l28Z
F. STATE CITY APPROVED SETBACKS
LIC. NO. 2.96079 LIC.NO.
94 SIZE NO.OF BLOCS. (FROM C/L STRE
A. OF LOT NOW ON LOT FRO
a USE OF
in EXISTING BLDG. _R.SAIF S FT.
rn
^E- Separate permits are required for L.SIDE 3 3 FT.
Cc
electric,plumbing and heating work. REAR o` S Fr.
I_,
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
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7 APPROVIfi�.).� 0• /J
>.. �Y L.G�/F DATE TJ
m HOLD FOR SPECIAL REOUIREMENTS
0 I hereby acknowledge that I have read this application and state '
gg that the above information Is correct and agree to comply with
A. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of 2
W the State of California. 75"
,..sf�IC/J{ SQ. FT. �� mwU
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S ( Jr
3 I hereby certify that I am properly licensed as a contractor under
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the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: u r1-�'
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE S e 1
and Professions Code,Division 3,Chapter 9.
1 ,ems - PLAN CHECK S LL
Signaturetee of /7s�e r g,L///(_/ o
Permittee ` TAX $ rR -IC V
or /
Authorized Agent Date TOTAL PAID S
"TL D 0528 8/08/79 172.00 IL
• COSTA MESA BUILDING-SAFETY DEPARTMENT APPL ATION FOR STRUCTURAL PERMIT
• - P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ---y��.��
REC V rPEj>,012/2N
For Applicant to Fill in Completely — Use Ink Only '/�nRI.�P
BUILDING.I �O •j A/t G�a.�fA A.P.NO.
ADDRESS // �-/,
OWNER OR j� zp. ADDRESS 4[/b _ Iii C b a,c A
TENANT fr..,�c.�S .'f l �'I�S`tV
1 « UNIT N
R
MAILING r/ SPACE NO.
ADDRESS � ' y (� LID o
-- tt 5-C-64--
�,. �L p T/R.NO.p�/ LOT BLK.
CITY AfeW 72-- !d'�r NOTEL63 Zyp /aS/O (
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER /
BRANCH //�
OWNER
ADDRESS VALUE
ARCHITECT TEL. USE $ —ler"
OR ENGINEER NO.
ADDRESS ZONE VPE GROUP JJJ
...sot, COAPPROVED /ill
CONTRACTOR// V,/� > �J6 kJ z'rs BY DATE VP/ill
ADDRESS3'` l I JI 4 J/��LI b-O Sy(//I
CITY/�/��PorRr $CI'f TEc)NO. �1 y
I- STATE CITY
�q APPROVED SETBACKS
LIC.NO. 7/'9 et C. 1 LIC.NO.
Liz SIZE NO.OF BLDGS. (FROM C/L STREET)
4 OF LOT NOW ON LOT FRONT FT.
Q USE OF
VI EXISTING BLDG. R SIDE FT.
to
F Separate permits are required for L.SIDE FT.
electric,plumbing and heating work: REAR FT.
ly
-C USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q
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APPROVED
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7 APPROVED
-.. —ELYOAT E_
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O.0 I hereby acknowledge that I have read this application and state en'
CO that the above information is correct and agree to comply with
4 all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of m
Sthe State of California.
SQ. FT. m
I hereby certify that I am properly licensed as a contractor underw
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR CO
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY;
am exempt from the pro 'sions of the State of California Business VALUATION 1 L7ZWCl Y
PERMIT FEE $
and Professions Code, mon
3, Chapter 9. m
Signature of �( _/J PLAN CHECK $ ' o
Permittee /pu��v ([�r�/S $ TqX g U.
or
Authorized Agent Date D I o (, ` TOTAL PAID s /7 2,to 0
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