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JOB ADDRESS 789 W. 17ti
GE'' �'AL CONTRACTOR pt�
aP .ii6-26o-u LOT(Pc
INSPECTIONS
sm�
GAS
W ATER
ROUGH PLUMBING
PROP. $WR. LIN�j�I
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AN� AIR CONDITIONING
UNDERGROUND
ROUGH WIRING
TRENCHES �
FLOOR SVSTEM
BOND BEAM �
SHEpTHING
POWER
FORMS Lf STEEL REINF.
STEEL REINFORCE I-I
FRAME ANO FLASHING
LATuiNG - IN ❑
Pl R, BROWN COA
BUILOIN6, FINAL
DATE 7_
BUILDING P
0
FiR'3K�7: i l:Zi�l C�L•1
Jfj.UIL7)ING SAFETY DEPARTMENT �TD J ��M �
P: O. Boa N0. 317 1�� 1 �
Costa Mesa, Californta
De�e�.� n�� ��.._ ia � yG:�
CI7'Y OF COSTA MESA
CERTIFICATE OF O,CCU�PANCY
Building Petmit No ^S' lectrical Permit No�lqtpbing Permit Nq ���,/
Use of Build3n� - / s . —1.�t� `f 9' �%% / O�.G �.e�d���
Le8a1 De�r�ptio " 'T /U � — An ..!/'//f!✓ / — .Gr —�./n/1 '
(See reverse side for Metes and Boun �
h^- been inspected and found W comply with the provisions of all City of Costa Mesa Ordin-
. .x applicable ihereto for a Group � Occupancy.
ISSII ,1'O: ��.,�G���r�� Y � g
r�� c�� � ain orn� �
ir .oa_
COwner of Building) B7'� _ �
CC: ❑ Original—Owner ❑]st copy—Gas Co. O Znd copy—Edis �n Ca ❑ 3rd c�py—File
Form 208 SB P IM 1-8D '
`' � .� � 7599
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9�7 C08TA MEBA. �AL�FORNIA
For Applicant fo Fill In Completely
TYPE OR PRINT
BUILOING
ADDRE68
COSTA MESA CALIFORNIA
IEER
��
TOR "'-- D W I
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U6E OP O�� ��
EXIBTING BLDG.
88TBACK LINB FPON � 7 I
`
I NO. oF BidGB.
DESCRIPTION OF WORK
NEW I II ALTERATION I/` A ADDITIO
REPAIR I IIMOVING I IIDEMOLI:
BUILDING � I NO. OF
81ZE �� ROOMS ' STOF
EXTERIOR WAL /����rl ROOF �
COVERING 7 O COVERING
U6E OF BUIL�IN AN WORK T BE PHRFORM
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�ND BTAT6 THAT THH
PLY WITN ALL CIiY a
BUILDINO CON9
BIGNATURE OP
PERMI7TE
AUTHORIZED AGENT
�EE RECEIVEQ
JUL 'e3i962
fINANCE DEPt.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
aeceivr Ho. ncpptir� o..��,
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er � owTyqec[tiveq ,� p�r[ �ssuen
COSTA MESA.
ZONING
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'i�H7�V8' REA� THIB MPLIGT�ON TMg �MOUM BHOWN UNDHR VALUATION 19 PON THH
IB COPRECT AND AOMH TO COM- pURP088 OP ¢BTAHl16MIq6 A veAMIT P88 ONLY.
:Es wNo 9TATH 1.�w9 peOUlATNO
, r VALUATION �—
J�D� � PERMIT FEE S
S /I� PLAN CHECK $ ��
TOTAL FEE ✓ �`
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fil! in Completely
AD1DRESS �V ( � /�� �
OWNER Z�LaM-a�2 ��G'%��
AODRESS / / / V" I / � J,
pTV
C�175P� NLBR,q . nTio�fi�%�,— %
CONSTRUCTION
LENDER
BRANCH
ADDRESS
TEL.
ADDRESS
CONTRACTOR �%LRS I✓�%�L��!�'\�
�J �}•2 Q� �
ADDFiESS `/'/„JZ �(�w1�02y �LV,�
CITV
CosvA Nt�sA "o`,S4S-94ti
LIC. NO. `179�`� LICYNO.
S I Z E i NO.OF BLDGS. ONF
OF LOT NOW ON LOT
USE OF /Q��
EXISTING BLDG. (L
SIZE OF NO. OF
NEW BLDG. ROOMS i` STORIE��
EXTERIOR WALL ROOF
COVERING �� COVERING �_
USE OF BUILDING ANP �'�'ORK TO BE PERFORMED
�ut �t-6�OO�oot ���*��9•00
APPLICATION FOR BUILDING PERMIT
RECEI ED BV DATE FECEIVED DATE ISSUED
f�% -�i'G // � �
A.P. NO. I I��Z O— I I PEflMIT�i
BUILDING � �('^�
ADDRE55 p
Ne���T �3 '�LOT��/ BLOCK—
FIRE
20NE
APPROVED
VALUE
DATE
ZONE NO.OF J� USE OF NEW
�' `L PLAN$ (J BUILDING I �/�%'i.O.—
VAROSAPPROVED VARDSAPPqOVED
MAIN BUILDING �+CCESSORV BVILDING
(FROMC/ISTREET) /
OISTANCE BET
MAIN BLOGS.
VAR. #
I hereby acknowletl8e tnet I �ave reatl this application antl state
that the ebove intormation is correct end upree to comply with
ell lews ragulating builtli�B �onstruciion, entl I shell not employ
any person in violation of ihe workman's compensation laws of
Me State of Celifomie. .
I hereby certity that I erh Properly licensetl as a contractor untler SQ. FT.
the State ot Calitornia Business and Professions Code, Divisicn 3, THE AMOUNT SI
Chepter 9, and that h �lcanses ere in full torca entl effeci, or I THE PURPOSE OF
am exempt from e o�Mions ot eState ot Celltornia Business VALUATION
antl Professions ode iV lon 3, apt
$ipne[ura ot r �
Permlttee $ G`�/G i
V ���
Authorizatl Agent
BET. MAIN &
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VALUATION IS FOR '
A 7ERMIT FEE ONLV: �
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- 5 7
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$
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° COMPLAINF- INV�'STIGATION
Received by
M d"�a e yy':` I "'� � � ���•+-o Address
Ageinst:��/�� Address ,L,�
Directions:
Nuture of Complaint:
0
a ; o ��
Date ��' a � b 1[
Complete: Yes
No
Complainant Yea By:_
Interviewed:
No Date:
�,
. i�
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City of Costa Mesa
Fire Departrrent
::�� y • I �_ : � : :144171
T0: , COSTA MESA BUILDING DEPARTMENP
Section �: ��� %/�G �jy � �
Location '7 ��/ �t1 • I ;�c� 6 ~ �Al� �R
This is to inform you that an apparent hazard exists at the above address as
follaas :
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