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PAID
SEP 28-770-4sa001475# *****5,50
44723
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill
in Completely
n—Use
'Ink Onl/y�/r /� RECEIVED BY DATE RECEIVED DATE
f/$�SUE�QL/�
ADIDRESS wG�{v-J•-S/1)/� ! :id 6`f J .. ) c 4 I L' -i /
OWNER, / O () /C-,s( 3c . A.P. NO. agtig Y39ry/ei �'
MAIL /� / �} /� BUILDING ��� _/1 _C `
ADDRESS 9(J///��t7 �( LJ U�[�- <c� ADDRESS '7 J�fli
CITY /0(C — , ` .NO. TRACT 3no ttLO �7 BLOCK
CONSTRUCTION ///J_' NEW ADD ALTER REPAIR MOVING DFM
LENDER
BRANCH r�tt° l,
OWNER2j0°CSC & •
ADDRESS VALVE /}� (�
ARCHITECT ���77 }/o:' 1 TEL53J /r'//�4 USE tharao S 0v//
OR ENGINEERFIRE
X✓' l (M1J,,rr�f��•�� NO. /JC/'(JY ADDRESS dat / ( V • ZONEGROUPCONTRACTOR Atuxi 60[/ �gyPROVENPEI
DATE
�, 7� GCJ. 7� �0C� �/�
ADDRESS _ ZONE n NO.OF USE OF NEW
Oo �' ()`
JF NO.TEL.
CITY K_ PLANS a r
BUILDING DrLp.
F STATE / CITY YARDS APPROVED YARDS APPROVED
LIC. NO. �kb.-3,7 i LIC.NO. MAIN BUILDING
(FROM C/L STR TI ACCESSORY BUILDING
W SIZE I NO.OF BLDGS. /ESE
O. OF LOT I NOW ON LOT / FRON7 /F7 �r� FT.
Q USE OF (1/1 P
.C., EXISTING BLDG. Dein yr(t� t) EL_SIDE . FT. FT.
CID
Separate permits are required for L.SIDE a7it,L y FT.
electric,plumbing and heating work. I
W - REAR FT. FT.
I-., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
O MAIN BLOCS. ACCESS.BLDGS.
..t pont, VAR.xli.
C.U.P•* AATE
APPR
APPROVED
••C ��APPROVE9f--27-229f--27-22_11Y DATE
C.
W
0 I hereby acknowledge that I have read this application and state n
:4 that the above information is correct and agree to comply with --
1:1•• all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of f
rr.Tt the State of California.
m
I hereby certify that I am properly licensed as a contractor under SQ. FT. zv
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of alifornia Business VALUATIONst
and Professions Co •'vision 3,Chapter 9. i
PERMIT FEE $ �!m� in
Signature of en
PLAN CHECK E c
Permittee _ 4-_41 _ • - $ /f TAX $ 2
v • cC?� u
Authorized Ag= t TOTAL PAID $ 5 S'/.7