HomeMy WebLinkAbout1004 NANCY LN - Building PermitsCity of Costa Mesa Plan Department
Post Office Box 1200
77 Fair Drive
q� (� Costa Mesa, California 92626
6J�19�� (714)556-5245
J0 25 '78 4M
REQUEST FOR OCCUPANCY
(Single Family Residential or
IQ a2 Condominium Units)
i
Tract No. 3d�P Date
Lot No.
Address
The developer of the above entitled tract desires to sell the above
set forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he, she, they)�((was or were)LJ)A--:, advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the
City at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless
from any claim resulting in damage or personal injury to the undersigned by
reason of the aforementioned uncompleted condition.
By
Ply aser
ay �
bevel per and/or Authorized
Representative
CMF 0569-26
OWNER BAIALIS & PIGNM DATE 4-26-77
JOB ADDRESS 1000.1002.1004 Nancy Lane BUILDING PERMIT N0. 43572
AP No115-021-11 LOT TRACT 0601 FIRE ZONE VALUE 5120.200.00
INSPECTIONS et al
Si noture Dote
ITYPE v GROUP
ZONE jErp
SOIL
2ig
'SUBCONTRACTOR
Date Number I Si nature
GAS
WATER 677
Plumbin
ROUGH PLUMBING
•�Lii
PROP. SWR. LINE HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
_
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER E]
ROUGH WIRING
G
eatin a Venl
TRENCHES FORMS a STEEL REINF.
..(T.,
y
FLOOR SYSTEM
-�
BOND BEAMSTEEL REINFORCE
SHEATHING
0
FRAME AND FLASHING ,
LATHING — IN El OUT IZJ* 10-11- -J
PLASTER, BROWN COAT
STRUCTURAL, FINAL
Electric
A
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
OVIZ
ELECTRIC, FINAL
BUILDING. FINAL
SPECIAL REQUIREMENTS
4
t
t -
1
?1 41,O
43572
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O.BOX1200 COSTA MESA, CALIFORNIA 92626
A ION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only RE 1 E Y DATE RECEIVED
DATEISSUED
ADDRESS O O - OOZ- OO 411410CY &"F,
/y„I gN PERMIT NO.
OWNER tni-i5 A.P. NO�
MAIL BUILDING
ADDRESS OS 4L,60l1 bLVQ. ,�, V//jA/DDDDRESS 000
CITY A/C.L/O/iT 11Ed r.! NOLO%t'fJ� /�" I /TR ACT OT B OC
BRANCH
OWNER L L/�
ADDRESS pp/C'ts VALUE
ARCHITECT ,. _ L ._.__..TEL.-,, USE,3_.41�/feM VA/ITS
$,
I hereby acknowledge that I have read this application and state
APPROVED
CONTRACTOR
By DATE
ADDRESS
TEL.
Z NE
NO. OF
USE OF NE
CITY NO.
PLANS
BUILDING
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE
NO. OF BLDGS
(FROM C/ RE
the State of California Business and Profession$ Code, Division 3,
OF LOT
NOW ON LOT
ONi F f
FT.
USE OF
'p
VALUATION
EXISTING BLDG.
F
FT
PERMIT FEE $
n
Signature of
Separate permits are required for
L. SIDE
FT.
Permittee
$/
electric, plumbing and heating work.
REAR FT.
FT.
USE OF BUILDING AND WORK T BEP RFO IM ED
DISTANCE BET.
BET. MAIN &
(/N G , L76,
MAIN BLDGS.
ACCESS. SLOGS.
VA
CURP+FT_�•f�- J IV!
DATE / �J �J
APPROVED / ��/-'/�
I hereby acknowledge that I have read this application and state
n
that the above Information Is correct and agree to comply with
m
_ _
R - r" t R
D FOt. SI�L�.Ir
i r , �M - "' - ^. a
1\_ti
all laws regulating bulitung construction, and 1 shall not employ
any person In violation of the workman's compensation laws of
Vi�� i`t•+1 d
o
%,
D 3S
the State of California.
I herebycertify that 1 em
y properly licensed as a contractor under
SO, FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Profession$ Code, Division 3,
m_
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the visions of the State of California Business
the
'p
VALUATION
end Profossions Code ivision 3, or9.
PERMIT FEE $
n
Signature of
�
O
PLAN CHECK E �
Permittee
$/
LL
0, 20
TAX $
Authorized Agent
- -
TOTAL PAID iil. Vj
0