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P,O. BOX 1200 COSTA MESA, CALIFORNIA 926
APPLICATION FOR BUILDING PERMIT
Forqpplicant to Fillin Completely qECEIyED DATE RECEIVEp DATE ISSUED
ADIDRESS t� � �' � ' ��'� 3-1i -7
OWNER A.P.NO. I�S �q7' ZI P MT O�
�o.PFsr .s� r.
MAI l BUILDING /�
Z ADDRESS Q L� % � ADDRESS "/ O IN • � � � ' .
aU CITV � NOLm�'r-D �% TRACT �/��- LOT�9 BLOCK
~ Z CONSTFUCTION W P
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O N LENOEFi �/
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J � BRANCH �/�p Gp�'��.�%
JN OWNER C(�M%O. r�+�-'^—•
m J ADDRESS �j�� VALUE ,�.�1 s
J� OR EN INE R /JU Ya /� NEI.� � S U�U �c�•� g !/V �
V FIRE
W 2 ADDRESS v ZONE TVPE GROUP
W Z CONTRACTORD���� �/r�� �BYPROVED ATE J—���
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J ¢ ADDRESS
�= CITV C� NO. ZONE D_I PLAN$ Z BUILOINGE UnLI
TEL. �
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w� STATE CITY �'ARDSAPPFOVE VARDSAPPROVED
y� LIC. NO. LIC. NO. MAIN BUILDI ACCESSORY BUILDING
�� SIZE NO.OF BLOGS. (FR C/L STR T� '�Qµ/
OF LOT �� X OO NOW ON LOT ROM FT. Z FT.
VSE OF
EXISTING BLDG. � F [Y FT. � O FT.
F SIZE OF � r � NO. OF n
Z NEW BL �3� � ROOMS STOF3IES 1.51D `� FT.
a EXTERIOR WAL ROOF �( GMOO n
V COVEFING �CaC COVERING R R FT. ''7 FT.
J VSE OF BUILDING AND WORK TO BE PERFORMEO �${qNCE BET. BET. MAIN&
a
a AIN BLDGS. ACCESS. BLDGS. �
Q VAR.aW DATE
O / 'y C.U.P.qJt APPROVED
~ APPR � i
N �—
z SiATE
O
VI heraby acknoWleABe thot I havo reetl [his applltaiion antl stata
� ihat the above �nformetion is correct ontl agree to comply with
� oll laws .oB�lating builtlin8 consvuction, untl I shall not employ
F any parwn in v�olotion o( tha workman's compansation laws ot
� m
Me State of Celilornio. �
z1 hereby certify thot I em proparly Iicensatl as a connactor untler � b SQ. FT. � o
tha State of Cal�fornio Business antl Protessions Cotla, Divisicn 3, TNE AMOUNT SHOWN UNDEP VALUATION IS FOR �
Chaptor 9, antl ��ot suc� licnnsos nro In full forca entl atfact, or I TNE PURP06E OF ESTABLSHING A PERMIT FEE ON�Y: Q
am axempx from tho provisions of Ne State of California Businesa VALVATION m
antl Professionz Cotle, Dlvision 3, Chap/mr j9. PERMR FEE 5/�/ �_ �
° `���.Gi�Gi, �.e�7� � e
si natura ot . O m
Permittee $//�DD, /.�% PLAN CHECK $ 0� LL
/ „ `o
Authorizetl ABent TOTAL FEE S ���—
�esta - �_.�.�-�epar�mtu� �
. ' �i11 EAST 20tb STREET A q
� COSTA MESA, CALIFORNIA ' J�ID
� 1tUR APPLICANT TO FILL IN
a���d,�9 90
4dd�ess
Costa Mesa, California
Vearest < . . '
aeh Metes and
or Lot 6 i
New
Reoair
,
S S
Tel.
No.
�
i hercby acknowledge that I have read this Application
and state that the above is correct and agree to comply
with al] City Ordinances and State Iaws regulating
building construction.
Signatureaf� � } �.,¢s �
permittee _ l.ua-%a
Valu,atiun
$ ��
aM 204 �-H 2M 5-54
Plan Check $ •
Total 3
Fee $
Nearest
Cross St.
P
BU .D,�NG
FOR OFFICE USE ONLY
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Date
CORRECTIONS
ArrRovar.s
Frame: Fire Stops,
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Ext.
vy Refnforced
Beam
Date
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PLOT PLAN •
Show locatlon and distances from
property line and between buildings.
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