HomeMy WebLinkAbout616 19TH ST - Building Permits. � .`��-- �
COSTA MESA B IN ETY DEPARTMEM
� P.O. BOX 7200 COSTA MESA� CALIFORNIA YZ828
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JAN 17 1966
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� COSTA MESA BUILDINCrSAFETY DEPARfMENi
P.O. BOX 12M COSTA MEBA, CALIFORNIA Y1EY0
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DESCRIPTION OF WORK
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JAN 17 196
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COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 �
APPLICATIpN FOR BUILDING PERMIT
For Applicant to Fill rn Completely (�
'ADOflESS � RECfji}/�BV D�TE RECEI�D pp$4 �� c 7
BVIIDING � !J O1� � � r<<l - �
PEHM
OWNER / / � A.P. NO. ' � � \
BVILDING /. /F / �
MAIL L ADDRE55 (JT/
Z . ADDRESS `X/� �V I� ' . �/fI{�W R}I�7 •
a U CITV . NOL�jS J g� TRACT LOT �.� BLOCK � �
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O � LENDER
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J � BFANCH � y� .
J fn OWNER r�/�� � �Pri� h
m J ADORESS VALUE
m ARCHITECT TEL. 5 Q � 5
J a OR ENGINEEP N
V Q FIRE
W Q ADDRESS ZONE TVPE GftOUP
�' w APPROVED
W Z CONTRACTOR L(/ BV DATE ��
J Q
m Z
J � A�DRE55
W w TEL. 20NE NO.OF USE OF NEW ��
� = CITV NO. P�� BUILD�NG
ZH
w0 STATE CITV �'�+ADSAPPROVED VAR�SAPPROVED
y K LIC. NO, LIC. NO. MAIN BUILDING ACCESSORV BUILDING
� O (FROM GLSTREET)
� OF LOT SO'' �( / yo � NOW ON LO ROM FT. FT.
USE OF / ,�
E%ISTING BLDG. FT
�" SIZE OF NO.OF CQ�I�%e
Z NEW BLDG. ROOMS STORIES L. SIDE F. FT.
U EXTERIOR WALL ROOF J/
COVERING COVERING PEAR FT. FT.
J USE OF BUIIDING AND WOpK TO BE PERFOFMED DISTANCE BET. BET. MAIN $
a MAW BIOGS. � AOCFSS. 64DGS.
a
a /� O/, IO � I C URP, yF' APPROV ED
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VI heroby acknowletlBo Net I have reatl this application antl state S7q
� that thB ebova intormation is correct entl aBrae to comply wlth
� all laws reBulattn8 builtling consvuc�ton, entl 1 sholl not amplay
F any person in violation of 2he workman's compensallon laws ot
y ma siaeo ot cerfo.�m. a m
e
ZI harBby tertity ihat 1 am pro0atly litensatl as a contractor unAet SQ. FT. O
the Stete of Calitornia Business antl Profauions Cotla, Olvislcn 3, TH� AMOUNT SHOWN UNDER VAIVATI �
Chapter 9, end that such licenses are in full torce entl etfact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
am anempt from the provisions oi tha Stete of Catifornia Businass ¢
antl Professions Cotle, Division 3, Chapter 9, VALUATION � p N
� ` ��� � 0_ V PERMIT FEE 5 ]
SiB^ature of � m
Permittee OJf/YI/�/ /n �y.VI 5 �-�'%O PLAN CHECK $ E
p `o
AvMorizetl Agent l'J' -��' LL
I _ TOTAL FEE $ �
.. .. : �74 � 5
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BVILDING � � / /� 1 . y� /�.(�/
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OWNER � _�IU�C�.� /� - FF�
ADDRESS ���� �'S �����
TE L.
CITV�� ��j.� NO.
CpNSTFUCTION
LENDER
BRANCH
ADDFE55
ARCHITECT TEL.
CONTRACTOR /'„S/ �..�.
ADDFESS ��� �fy—�� ��
� p TEL.
CITV i .�iaC�:(! NO�
STATE ' � �� � � ' CITV
LIC. NO. LIC. NO.
512E � NO. OF BLDGS.
OF LOT I NOW ON LOT
VSE OF ^
EXISTINGBLDG " p��//.�_�,p
SIZE OF NO. OF
NEW BLDG. ROOMS STORIE'�
EXTERIOP WALL ROOF
COVEfiING COVEFiING
USE OF BUILOING AND WORI( TO BE PERFORMED
�
7 i n �eiT—
PAI�
(1C710-73LH5.00 437�` *****5.50
APPLICATION FOR BUILDING PERMIT
RECEIXED�V DATE RECEIVED nnTF issui
BUILDING
AODRESS
L�7
0
NFy / NO.OF
�i PI.Af�15
VAPDS APPFOV ED
VAR. #
C.U.P. #
I he�eby acknOwledga that I heye read this appllcation antl stnte
[hat the ubove intormation is cOrrect antl aptee to comply with
all laws regulatin8 builtlin9 �onz[rutHon, antl I shall not employ
any person in violation of thn Workman's compensation laws ot
the Stata ot Calitornla.
I hereby cer[ity that I am propefly licensetl as a conirecmr untler SQ. Fl
the State of California Businass antl Professions Cotle, Divisicn 3, THE AMOUNT:
Chapter 9, antl thac soch licanses are in tull force antl effect, or I THE PURPOSE OI
am ezempt from tlra p�ovisions Of She State ot Calitornla Business VALUATION
antl Professions Cn�e, Division 3, Chapcer 9.
$Ipnature ot /y � �ifj�
Perm(ttea _��i/li� $ ` //` �
A�thorized Agent �`v
� / � � �
C�j , y v ��
LOT � BLOCK ��
ALUE
$
GROUP
� DATE , / �
USE OF NEW
BUILDING
VARy/�SAPPROVED ,
ACCESSOA`� BUILDING
FT
&
DATE
APPROVED
"__'/A—
� ✓U
TAX
0
DEF VALUATION IS FOR j,
iING A PERMIT FEE ON�V: ¢
T FEE $ �Lr� r'
7
m
CHECK $ E
0
LL
. FEE $ �