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33
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 121X) COSTA MESA, CALIFORNIA 92626
PAIB
AV11-71tH;rOO1072Tr ***'r79.50
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECE V
DA E; ED
712 )$SUE
/
BUILDING
ADDRESS
PERMIT NO.
OWNER Modular Technol Inc.
A.P. NO.
MAIL
ADDRESS 1104 E. 17th Street
BUILDING
ADDRESS 3Z % U
10
CITY Santa Ana NO`.547-9673
TRACT 661
' LOT' BLOCK
CONSTRUCTION
W
ADD ALTER F19PAIR
LENDER
BRANCH
OWNER Modular Technology, Inc.
ADDRESS
VALUE
s $ 12,023
'832-0860
OR ENGINEER TOU s Engineering NEL
FIRE
ADDRESS 17291 Irvine Ave., Tustin
ZONE TYPE GROUP
APPROVE
CONTRACTOR Owner
By DATE
ADDRESS Same
TEL.
ZONE
NO. OF
Z
USE OF NEW
CITY Same - NO.
—J
PLANS
BUILDING W ��
VARDS
YARDS APPROVED
SIC. No. 2525 B-1 sic No. 1690
MAIIN BUI DOING
ACCESSORY BUILDING
SIZE NO.OF BLDGS.
(FROM C/L STREET)
46 Gwpw
coil
OF LOT NOW ON LOT
FRONT FT.
FT.
USE OF
Onl L� S
EXISTING BLDG.
R. SIDE FT.
FT.
SIZE OF NO. OF
NEW BLDG. ROOMS STORIES
L. SIDE FT.
FT.
EXTERIOR WALL
OF
COVERING
COVERING
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
Tract Block WallMAIN
BLOBS.
ACCESS. SLOGS.
2031 LIF (105' w/retaining wall)
VAR.*
C.U.P.a
DATE
APPROVED
APPROVEDDATE
(�
y
1 hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
SQ. FT.
THE AMOUNT SHOWN UNDER 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 1
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapt 9.
VALUATION
�t
` V
PERMIT FEE $6,3
Signature of
Permittee .^__ - M/LOt/y�—
$ I �O �-+
PLAN CHECK $ V
6'l�
Authorize A enc
TOTAL FEE $