HomeMy WebLinkAbout781 GRAYLING BAY - Building PermitsF
C
a
a
�
�
2
F
G
W
F
6
G
:]
Q
>
r
�
�
m
a
�
C
a
Z
Li7
S
3
G
�,.-`R, C�raYIlv18�9�f 77577?9�8�8�85�8994�3�9��4��Bo�o,
LaN9s Bay 3o�i�93��5�77 2�i� S7•z853 9/I�/79 125.97 T:
COSTA MESA BUILDING-SAFETY DEPAfiTMENT APPL�C�'�,bQpl FOR STRUC7'URALPERMIT -
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 _ LY!/.F-
For AppGcant to Fill in Completely - Use Ink Only
AD'DRESS Tract 10626��/
/al/Lbl/JI �J
OWNEROR M.D. Janes Co., Inc.
TENANT
MAILING 2950 Airway Ave., D-9
ADDRE55
Costa Mesa TE�'
cirv No. 979-33
CONSiRUCTION Not selected
LENDER
BRANCH N/A
ADDRESS N/A
ARCMITECT Danielian S Assoc. No��546-36
OR ENGINEER
ADDRESS 3848 Campus DT., i1.$.
CONTRACTOR OWR2L
ADDRESS B
TEL.
CITY e NO. e
STATE CITV
LIC. NO. e LIC. NO. A
OF LOT 55� � X 334 � NOW ON LO S 8
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I heraby ecknawletlBe that I �ave reetl this application antl rtate
that tha above informaxion Is correct and aB/ee to comply wiih
all laws repulating builtlinB consvuction, antl 1 shail not employ
eny pe�son in violation ot Me wo�kman's compensation lews ot
Me Stata ot Celifornie.
I hereby certity that I am proOeNy licensetl as a conttactor untler
the $tate of Calitornia Business and PrOtessions Cotle, Oivision 3,
Chaptar 9, entl that such �icenses are in full force entl effect, or 1
am ezempt trom t provisions of the State of Calitornia Business
antl Professions Co e, Divi i0n 3, Chapter 9.
/
Sipnatura of
Permittae � �
or i�l%�%9
Authorixatl AB D e
�e`7G �' I"�si�/ N° �
A.P. No.141-oq I—a9, lo.l I t 412-1
VNIT OR
SPACE NO.
TR.NP��.�! LOT
I L-V
NEW ADD LTER REPAIR MOVI
^
OWNER
�VSE�
� r i:.�.
VALUE
S
AVPROVED
BV DATE
APPROVED SETBACKS
(FROM C/L STREET)
RONT FT.
�
- �,
L SIDE
REAR FT.
PLANNING ACTION
� � 1 —Q / 11 APPROVED Z �
nwRov5B3 . , /J �'3' /7_ � U -
THE AMOVNT SNOWN UNDER VALUATION IS FOR
TNE PURPO6E OF ESTABLISHING A PERMIT FEE ONLV:
VALUATION PERMIT FEE E
�l PLAN CHECK S � �
5 V� �OL.l1V TA% S Q/,m
i�
TOTA�PAID E 7 .Q �
n
c �`
m �
� �m
� e
N \
n �n
0u ,�
f��l
U �v
F
�
tr]
4
Q
h
h
LS
F
C
W
F
Q
❑
..1
a
>
%'
..1
C
�
0.
�
�
L
z
W
��
3
COSTA MESA BUILDINGSAFETY DEPARTMER'F-�� APPLICATION EOR.STRU TURAL PE IT4`�;;
P.O.BOX1200 COSTAMESA,CALIFORNIA92626 ��-����' �= '�"'
RECEIVEDBV PERMIT
Fot Applicant to Fill in Completely — Use Ink Only
BUI�DIN�� /D /Z / � A•P• NO.
ADORESS ( (0 (O
BUILDING
OWNER OR AODRE55
TENANT
MAILING UNIT OR
ADDRE55 SPACE NO.
TR.NO. LOT BLK.
CITV �\ TEL.
NO.
COWTRU N NEW ADD LTER REPAIR MOVING DEMOL�SH
LENDER
BRANC V
OWNER
ADD ESS VALUE
ARC ITEC TEL. USE E
OR E GINEER
ADD 55 ZONE TVPE GROUP
AP /Z ���
CONTRACTOR BY DATE
ADDRE55
TEL.
CITV NO.
STATE CITV AP7ROVED SETBACKS
LIC. NO. L10. NO.
SIZE NO.OF BLDGS. (FfiOM C/L STREET)
OF LOT NOW ON LOT FRONT FT.
USE OF
EXISTING BLOG. I E F
Separate permits are required for L. SIDE Fr.
electric, plumbing and heating work.
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED PLANNING HCTION
DATE
APPROVED
APPROVED
I hereby acknowlatlge that 1 have �ead this a�P�iwtion and rtate
that the above Information is cor�ect and aBrae to comply wlth
all laws ragulating builtling consttuction, and I shall not employ
any perwn in violation of 2h¢ workman's compensetion laws oi
Me State ot Calitomia.
I hereby cenify 2het I am proparly licensetl as a conaacmr un0er SQ. FT.
the State ot California Businass antl Protessions Cotle, Division 3, THE AMOVNT SHO�^1N UNDER VALUATION IS FOF
Chapter 9, antl tha such li enses are In f�ll force and etfaci, or I THE PVRPpSE OF ESTABLISHING A PERMIT FEE NLY:
am exempt from e prov' ions ot tha State of Calitornia Business VALUATION y`b •D
and Profassions , Di ision 3, Chapter 9. PERMIT FEE
SiBnature of AN CHECK S
Permittae $ . TAX f
or
Authorized A n nte
TOTALPAID j' O D
T�