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APPLICATION FOR BUILDING PERMIT
RECEIVED BY
I DATE RECEIVED
DATE ISSUED
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A.P. NO,/
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PERMIT NO,
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' COSTA
MESA BUILDING -SAFETY DEPARTMENT
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P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
BLOCK
DISTANCE BET.
For Applicant to Fill in Completely
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iii VALUE $61
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the State of California.,.wsI
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THE AMOUNT SHOWN UNDER VALUATION IS FORChapter
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Profession. Coda, D{vislon 3, Chapter 9.
SIZE
/ NO. OF SLOGS, 2
mPERMIT
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DGi / S NOW ON LOT J
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USE OF
PLAN CHECK $
EXISTING BLDG.
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1111.22-75cl 00?_16V ***1A0.06
APPLICATION FOR BUILDING PERMIT
RECEIVED BY
I DATE RECEIVED
DATE ISSUED
/
A.P. NO,/
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PERMIT NO,
LDING
ADDRESSI��
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p
REAR . FT.
TRACT
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LOT
BLOCK
DISTANCE BET.
BET. MAIN &
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OWNER �• L(J
ACCESS. BLDGS.
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iii VALUE $61
F
VED
ZONE t NO. OF USE OF NEW
` PLANS �J BUILDING �;2? ; i
ef
YARDS APPROVED TYARDS APPROVED
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SIZE OF NO. OFid
NEW BLDG. Ia U ROOMSSTORIES
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L. SIDE �00-FT.
FT.
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EXTERIOR WALL /(�./
COVERING
ROOF s(d °
COVERING(( V
REAR . FT.
FT.
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USE OF BUILDING AND WORK TO BE PERMED
DISTANCE BET.
BET. MAIN &
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a
MAIN SLOGS.
ACCESS. BLDGS.
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VAR..{'.
DATE
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C.U.P. Ms
APPROVED_
NAPPROVEHOLD
FOR SPEC
AL EMENT
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hereby acknowletlBe that 1 have read thislceHon and statethat
the above information is correct antl to comply withell
laws regulaUnB building conrtrucUOn, ahall not employany
person in violation of the workman's ensation laws ofy
lip
the State of California.,.wsI
hereby certify that I am properly licensedcontractor under
iJ(JSO. FT.
Othe
THE AMOUNT SHOWN UNDER VALUATION IS FORChapter
State of California Business antl Professoda, Division 3,
9, antl that such licenses are In fulle antl effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:R
am exempt from the provls(dns of the $tetellfprnia Business
VALUATIONend
Profession. Coda, D{vislon 3, Chapter 9.
mPERMIT
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FEE $
PLAN CHECK $
Signature ,
Permittee
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Authorized Agent
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TOTAL FEE $
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COSTA MESA BUILDING.SAFETY DEPARTMENT O GPAIU
alP.O.70x1200 COS rAi.IES.I.CALIFORNIA92626 ,Ili la'75<A- OO 798gd+*--*
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APPLICATION FOR STRUCTURAL PERMIT
eta Applicant to Fill in CompletelAL.-
RECEIVED BY
DATE RECE)Rt'�E--O GATE IJ>ucD
BUILDING _: /.
,;'-/C./_/l
ADORESS
rS �/PERMPTavD.OWNER
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NO. Y JY.. e.
BUILDINGMAIL
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ADDRESSADORE55
v ;�TRACT
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LOT BLOCK
CcrwTRUCTION ^
Ann
ALTFR
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LENDER
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OWNER LG . / • iv
ADDRESS
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ARCHITECT / TEL.
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OR ENGINEER is - vq,t a•9 N
ADDRESS
TYPE
GROUP 167
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CONTRACTOR `'. •�1L' Fes-
BYDATE
ADDRESS C. L!p �!'.L/!.
TEL. i
NO. OFUSE
OFNEW
G1TY fT .lam t N0.�3;a /7jfPLANSBUILDINSTATE
CITYp
VFIRE
APPROVED
YAROS APPROVEO
LIC. NO, i 19/• ; ? LIC. NO. ? TJ .%BUILDING
ACCESSORY BUI LOING
ZE .. NO.OFSLOGS
STR EE TOF
LOTNOW ON LOT �-'FT.
FT.
USE OF�EXISTING '-FTFT
SLOG, / •
Separate permits are required for
FT.
FT.
electric. plumbing and heating_ work.
?EAR FT.
FT.
USE OF SL'ILDING AND WORK TO BE PERPOR%IED
DISTANCE BET.
BET. MAIN &
M. N BLDGS.
ACCESS. BLOCS.
ltif
VAR.f
DATE
/Z
C.U.P.
APPROVED
------'-yyy-----
APPROVED
DATE
I hereby a/9tnowleoge :hat I have read tnls aoiall¢ation and 1tJre
that the above information is correct and agree to comply wan
all laws regwating building construction, and 1 tlwu hot emctov
Orly person in siolatiOn of the worNman's compensation laws at
the State of California.
I hereby certify that I am orOparly licensed as a contractor under SO. FT.
the State of Caliiurnie Business and Protessiom Code, Division a, tj THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such li[enses�(LtC.�cull force and effect, or I THE PURPOSE OF ESrASLISHING A PERMIT FEE ONLY:
am e.emot from the pcovRl6'is of the SzAe of California Business
c•�
VALUATION PERMIT FEE S
and Pr Ofessiom Codi'. Divisiowz;. Chapter 9. `
.mss
• �� / ^--f PLAN CHECK S
Signature a/
Permittee/✓� w� — S �r TA% Is
Authortied e'en: // TOTAL PAID S <� I
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