HomeMy WebLinkAbout33 FAIR DR - Building Permitsi�
7305 2/06/81 6.50 TL-
COSTA
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COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRESS 33F g /J
A.P. NO. /
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-4-i2
BUILDING
OWNEROR , / //�
TENANT N�jy%�'% .�,V^�(F
ADDRESS
MAILING
UNIT
SPACE N NO.
ADDRESS
TR.NO. LOT
ELK.
E.
CITY NTOL. �j'.
I ADD ALTER REPAIR IMOVINGIDEMOLISH
CONSTRUCTIONNEW
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LENDER
BRANCH
ADDRESS
US�l1�
RD
ARCHITECT TEL.
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OR ENGINEE N 0.
ADDRESS
ZONE TYPE GROUP
APPROVED/i
CONTRACTOR �L (.Gj
BY
DATE A'
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ADDRESS �7/20� �—p.
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CITY NOLP�
,a �du�v
STATE CITY
APPROVED SETBACKS
LI C. IN LIC. NO.
SIZE NO.OF ELDGS
(FROM C/L STREET)
OF LOT �� (i NOW ON LOT
FRONT FT.
USE OF
EXISTING BLDG. e-l�«'Y
Separate permits are required for
L. SIDE FT.
electric, plumbing and heating work:
REAR FT.
USE OF BUILDING AND WOR K/eylTO BE PERFORMED
PLANN NG ACTION
l~ �tr,
7.j�`s
DATE
APPROVED
APPROVED
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree 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 California.
1 hereby certify that I am properly licensed as a contractor under
SO. FT.
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and affect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
VALUATION
PERMIT FEE $ �!
and Professions Code, D' s Chapter 9.
/
D (j
PLAN CHECK $
Signature
/
Permittee Lf
S /_ D
TAX $
or
(((((CJJJ
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Authorized Agent Date
TOTAL PAID $
ME
MON