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SUBCONTRACTOA
. 24575
COSTA MESA 9UILDING-SAFETY DEPARTMEM
' P.O. BOX 9I] COSTA MCBA� CALIR'ORNIA
For Appllcunf to Fill in Complefely
TYPE OR PR1NT
BUILDINO �
ADDRESS
COSTA MESA. CALIFORNIA
■ ARGHITECT
OF LOT (� /� I No, o� pLpo9.
NOW ON 1 T
USE OF
E%ISTING BLOG. ^
96TBACK LINE FROM C � �. .
EFf � I RIGHT �
DESCRIpTION OF WORK
BUILDIN6
SIZE
E%TERIOR
w \ • � �/ \O
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1 XRHHBY ACKNOWLHO08 THAT 1 NAVe RBAC TH� APPL�CATION
/�NO BTATB TNAT TH AOOVB 10 COP R AND pH8 TO COM�
PLY WITM ALl <ITY DINANC08 AND TATB qBOULATINO
BUILDINO CON9THU ON.
81ONATURE OP
PERMITTE
AUTHORIZED A6E
�CITY OF COSTA MESA
AUG 19 1965
APPLICATIO F PERM
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ZONING .
BHALL B6 LE88 THAN
YARD3APPROVED I YARDSAPPROVED
MAIN BUILDIN6 ACCESSORY BUIlDIN6
D19TANCE BET. I BET.1
MAIN BLDGS. ACCE
VAR.# _ DATE
TN8 �MOUNT BNOWN ONOlR VALUATION 18 POp TXH =
PUNPOSE Op HBTABLI6HIN0 A PEHMIT P8H ONLY. 0
VALUATION pQ � o
PERMIT FE8 �
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s2��u'�� 3.�� p
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TOTAL FEE $ �I I
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G. F.
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LOT TRACT FIRE
PROP. SWR. LINE U HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ftOUGH HEATING AN� AIR CONDITIONING
UNOERGROUND U POWER LJ
ROUGH WIftING
TRENCMES � FORMS � STEEL REINF.
FLOOR SYSTEM
BOND BEAM � STEEL REINFORCE �J
SHEATHING
FRAME AND FLASHING
L i
PLASTER, BROWN COA
DATE
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
NAR —3-71cnsn00 093 0****=•7.00
ForApplicani to Fill in Completely APPLICATION FOR BUILDING PERMIT
PECEIVED� V D RECEIVnED DATE ISSVnED
ADIDflESS�sv3T�P�✓ERs� D2 �� ~��/ �"'3^ /
� �/ _ � PERMIT NO.
OWNER I � E/:IjII - I�' (i A.P. NO.� '�
MAIL '( AD�FE S ST3 / R/T (J K 2 s� D•�
ADDRESS �T 3� A���-S t O�.
CITV
C• /'/' NO�.�%yd�Q TFACT�� �� LOT ��� BLOCK
CONSTRVCTION . /���
LENDER �V
BRANCH
OWNER �,�,��'.� J
/
ADDRESS VALUE /�'0
ARCHITECT ,��U � NE`��.ZS/D% S � C� $ lo
OR ENGINEER 7
FIRE \
ADDRESS �U� R N ZONE TYPE I ROUP �
(// APPROVED
CONTRACTOR L U j C Bw �. OATE ^�
AODRESS 37�3 .S /���L Sf
L /� TEL ZO��/ NO.OF USE OF NEW �
CITY � �7 NO. P�� � BVILDING��I
STATE CITV YARDSAPPROVED VARDSAPPROVEO
114 NO. ��O O�D LIC. NO. MAIN BUIIDING ACCE$$ORV BUILDING
SIZE NO.OF BLDGS. T
OF LOT O O, Q NOW ON LOT / � FT.
USE OF
EXISTINGBLOG. W L � /j,¢ F. FT.
SI2E OF � 7� RO. OF
NEWBIDG. J OOMS STORIES / 1.51DE FT. FT.
EMERIOR WALL RDOF
COVERING CpVERING L lJ REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFOFMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
N S�A LL /Y L t/ M A � D CO V EL C URP # APPROVE�
APPROVED �3 ��
I hereby acknowletlge that I havg reetl this application antl state
that the above inio�metion is cohreci antl eBree to comply with
all laws regulating builtlin8 constYunion, antl I sholl not employ
any Derson in violation ot Me workman's compensation laws of
Me State ot California. a
�4
I he�eby ca�tify that 1 am p�operly ���ansetl as a conheeto� �ntle� SQ. FT. '
[he Stata of Calitornia Buziness entl Profauions Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
C�aptar 9, entl Net such licenses ere in full torca antl effxt, or I THE PURPOSE OF ESfABLISHING A PERMIT FEE ONLV: a
am exampi trom tna provisions of the State ol CalHornia Business VALUATION �� a
end Ptof85slons Cotle, Division 3, Chap�ar 9. PERMIT FEE $ � �
Sipneture ot !'� a
Pa�mlttee Ci $// PLAN CHECK $-_ E
%l� `
Auihorizatl Agent � �� LL
TOTAL FEE $ �