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COSTA MESA BUILDING -SAFETY DEPARTMENT
APPLICA1
P.O. BOX 1200
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COSTA MESA, CALIFORNIA 92626
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ADDRESS17922 Skypark, Irvine 92714
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BUILDING
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ADDRESSBUILOOWNER
CONTRACTOR Owner
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M.D.
Janes Co. Inc.MAILING
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No�379-337TR
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CITY Costa
Mesa 92626
APPROVED SETBACKS
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CONSTRUCTION
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NO. OF BLOGS /mr,
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ADDRESS17922 Skypark, Irvine 92714
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APPROVED SETBACKS
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SIZE
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NO. OF BLOGS /mr,
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Separate permits are required for
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electric, plumbing and heating work:
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USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
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Unit Condominium RL
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Attached Garages
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I hereby acknowledge that I have read this application and state
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that the above Information Is correct and agree to comply with
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all laws regulating building construction, and I Mall not employ
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any Person in violation of the workmen's compensation laws of
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the State of California.
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I hereby certify that 1 am properly licensed as e contractor under
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the Siete of California ,sines and Profession, Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
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Chapter 9, end that h licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.'
am exempt from the rovisio of the State of California Business
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and Professions Cod Ivis n , Chapter 9.
VALUATION PERMIT FEE $
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Signature of
PLAN CHECK f /r
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Permittee
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