HomeMy WebLinkAbout180 20TH ST - Building Permits •
3533 ( AUG 30-72fM;�002196 o*****5.00
-- COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RE 1V D BY ERF IyED DATE ISSUED
BUILDING /� ') �" ,p(A / (/J�_ 7
ADDRESS /co g. r� .� be--; U �O / '3O-'7.1....-
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OWNER //d �/L ���L�p���rt///yA A.P.NO.
MAIL Y`-!'_/` �^ BUILDING it, d RO "�
ADDRESS /�/�+7 Yi "2 ADDRESS
Z !!! 7
d U CITY NOL TRACT LOT BLOCK
Z 'C CONSTRUCTION NEW ADD!ALTER!REPAIR j MOVING DEMOI ISH
—I- LENDER0 u) 3 �jt..///�
_17 BRANCH �' i
<ta - OWNER 1
m J ta ADDRESS !(//I� '�t, p �� ' VALUE (C/1 A/
JQ ARCHITECT TEL. !ICF/I ICY�Y s1 A!•/Wit s �sI/ �—
N OR ENGINEER NO WJJr�
U Q FIRE
w K ADDRESS ZONE TYPE GROUP
a'w APPROVED
JO CONTRACTOR sit..,e,e....errfT yam„ 1 BY DATE \
CO Z
JCC ADDRESS -���y7�p 1
w w � �� { TEL. ZONE NO.OF USE OF NEW �o
ZH CITY �� P NO. PLANS BUILDING
STATE CITY ,�yy q� YARDS APPROVED YARDS APPROVED
to CC LIC. NO.�6 e7ry. NCC.ONO/445 ) (FROM MAIN
C/ BUILDINGSTLDACCESSORY BUILDING
SIZE
OF LOT SAX/`.3 F BUMS.
NOW ON LOT ` FRONT FT. FT. / '
USE OF 1 1
EXISTING BLDG. R SIbE FT. FT, �J_.
I— SIZE OF NO.OF '
Z NEW BLDG. _ ROOMS STORIES • L.SIDE FT. FT.
IaEXTERIOR WALL ROOF
.1
_ COVERING I COVERING REAR FT. FT. •
J USE OF BUILDING AND WORK TO BE PERFORMED -
d DISTANCE BET. BET.MAIN&
6. MAIN BLDGS. ACCESS. BLDGS.
Qy/ VAR.$ DATE
O —L€ , G C.U.P..�s APPROVED
H � APPROVED
to RY DATE --
V I hereby acknowledge that I hove rood this application and state 7.--
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✓ that the above information Is correct and agree to comply with ' / . �
CC all laws regulating building construction, and I shall not employktEi ///--- ///!!!///"""
F„ any person in violation of the workman's compensation laws of
N the State of California. m
? I hereby certify that I am properly licensed as a contractor under SQ. FT.
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses ore In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: It
am exempt from the provisions of the State of California Business VALUATION
re
and Professions Code, Divi, n 3,Chapter 9. PERMIT FEE $ (,--t,� el
Signature of 614/ m
Permittee —a-aa)+ $ 0 PLAN CHECK $ �— E
te. �� p
Authorized Agent u
TOTAL FEE $ a