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COSTA MESA BUILDING-SAFETY DEPAfiTMENT APPI.� ' FOR STRUCTURAL PERMIT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
R CEIVED PE MIT
Fo� Applicant to Fill in Completely — Use Ink Only � 7(0 / 76 No �
ADDRESS Tract 10626 .� A'P' N��' ` I— "�_Q� Q t 41Z ILJ Z
BVILDING C (N `}' / S
�EWjdqN °a M.D. J&nes Co., Inc. aooaess v
UNIT OR
ADDRE55 Z950 Airway Ave., D—�I SOACENO.
TR.N���� LOT BLK.
ciTv Costa Mesa No�979-3376
NEW ADD LTER REPAIR MOVING DEMOLISH
CONSTRVCTION Not aelected
LENDEfi �
BRANCN N�A
OWNEF
ADDFESS N/A VALUE
ARCHITECT TEL. USE S
ORENGINEER Danielian t4 (i660C. —
F�� -,
AD�flESS 3848 Cam US Dr. N.B, zoNe TYPE GROUP
APPROVED
CONTFACTOR OWRBr BV DATE
ADDRESS 8
TEL.
CITV e NO. 8
STATE CITV .47PROVED SETBACKS
14C. NO. e UC. NO. Q
SIZE NO.OF BLOGS. (FROM C/L STREET)
OF LOT .5.5� � x 334 � NOW ON LOT e ONT FT.
USE OF
EXISTING BLDG. N A �
Separate permits are required fm L SIDE
electric, plumbing and heating work.
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED PLp.NNING ACTION
� y- I (f � 1 —d 11 APPROVED�i "' � (
i /� o � �Ra„ /� ' .?-1 `/ - 7
1 he�eby acknowletlge ihet 1 nave reatl this eppllcailon antl s[nte
that tha ebove Info�mation is correct and apraa to comply with
eii laws rapulatin9 buildin8 �onsvuctlon, antl I ahall not employ
any person in violation Of Me workman'a compenaation lewa of
t�e State of California. (�
I he�eby certify that I art� PrOp¢rly Iicensetl as e cO�tracto� untlet �$Q. FT.
[he Siate o} Calitornia BJsiness and Professions Cotla, Dlvision 3, THE AMOUNT SHOWN VNDER VALUATION �5 FOR
Chapter 9, anC ihat such licens¢s are in full force entl effect, or I THE PVRPO6E OF 67ABL6NING A PERMIT FEE ONLV:
em ezamDi trom t prov�sions of the S[ete of Celitornia Buziness
and Protessions Co e, Divi i9n 3, Chapter 9.
VALUATION PERMITFEE S
/ C� . �
PLAN CNECK 5
Sipnamreof �� �M �J
Permittae 5 /�v1J TAX S �m
AuthorixedAg o e 8�1���9 / TOTALPAID s%
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� COSTA MESA BUItD1NGSAFETY DEPARTMEIO�� APPLICATION EOR STRUFTURAL PE iT: _
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 'r u'•.' i r �%�� �-"' �• J
RECEIVEDBV PERMIT
For Applicant to Fill in Completely — Use Ink Only
BVII.DIN �O /Z / � A•P. NO.
ADDRESS (0 (O
BUIIDING
OWNER OR qDDRE55
TENANT
MAILING UNIT OR
ADDRESS SPACE NO.
TR.NO. LOT BLK.
GTV �� TEL.
NO.
OONSTRU N NEW ADD LTER REPAIR MOVING DEMOLISH
LENDER
BRANC V
OWNER
ADD ESS VAIVE
ARC ITEC TEL USE S
OR E GINEER
ADD SS ZONE TVPE GROUP
APP � /7�/��
CONTRACTOR 8Y DATE ( �•' �
ADDRES$
TEL.
GTV NO.
STATE CITV APPROVEDSETBACKS
LIC. NO. LIC. NO.
512E NO.OF BLDGS. (FROM C/L STREET)
OF �OT NOW ON LOT ROM FT.
USE OF
EXISTING BLDG.
Separate permits are required for L. SIDE FT.
electric, plumbing and heating work.
REAR FT.
VSE OF BUILDING AND WORK TO BE PERFORMED pWNNING ACTION
DATE
APPROVED
APPROVED
I �ereby ecknowletl9e thai I have reatl this eppllcation antl stata
that t�e aGove information is correct antl aerea to comply with
ell laws repuleting building conrtructlon, and I shall not ampioy
eny Derson in vlolation of ihe workman's compensetion lews of
the State of Celifornia.
I hereby cenHy t�et I am properly Iicensetl as e contractor untler SQ. FT.
the State of California Business antl Professions Cotle, Division 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR
Chepter 9, entl tha such licenses are in tull force entl effect, or I THE PUFPOSE OF ESTABLISHING A PERMIT FEE NLV:
am ezempt from e prov' ions o/ the Stet¢ ot Celitornla Businass VALVATION PERMIT FEE E!b •Q
antl Professions , Di ision 3, Chepter 9.
Si9^atvre of AN CHECK S
Permittee 5 TAX S
or
Authorized A n ate
TOTALPAID S' D D
Tl