HomeMy WebLinkAbout505 19TH ST - Building Permits:�
COSTA MESA BUILDING -SAFETY DEPARTMENT p,3809 2/21/79 73.20 TL
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 X '
A C TION FOR STRUCTURAL PERMIT'
For Applicant to Fill in Completely —Use Ink Only
R"EVY I DATE REgCE
S�U'E
BUILDING
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ADDRESS
OWNER -5'r/R /f G
A.P. NO. DT
NO.
MAIL
BUILDING
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ADDRESS
ADDRESS
TEL.
CITY NO.CONSTRUCTION
TRACTVii LOCK
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ADD
ALTE PLENDERBRANCH
OWNE
ADDRESS
DARCHITECT
SOR
TEL.
ENGINEER
FIRE
ADDRESS
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CONTRACTOR W,V �)
R / OWNE�Q,
2
APPROVED G DATE
BY
ADDRESS
TEL.
2 E�
OF
USE OF NEW
CITY NO.
PLANS
BUILDING
I
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
t
SIZE
NO.OF BLDGS.
(FROM C/LSTREET)
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OF LOT
NOW ON LOT
RONT T.
FT
USE OF
EXISTING BLDG.
F
Separate permits are required forL.
SIDE F
FT.
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electric, plumbing and heating work.
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN SLOGS.
ACCESS. SLOGS.
VAR.#
DATE
/
C.U.P.
APPROVED
T L eWlcas/�
APP VE G
DATE -2
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
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all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
o
the State of California.
-
I hereby certify that I am properly licensed as a contractor under
SO. FT. 10
a
THE AMOUNT SH N UNDE VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING kPERMIT FEE ONLY �
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am exempt from the provisions of the State of California Business
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sMvf
and Professions Code, Division 3, C ter 9.
VALUATION
PERMIT FEE $ ,w
N
m
PLAN CHECK $ T%
Signature of
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./ /./fir/.
n
TAX $
Permittee
$� W
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Authorized A t
TOTAL PAID $ zle