HomeMy WebLinkAbout785 GRAYLING BAY - Building Permits4
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COSTA MESA BUILDING-SAFETY DEPAi2TMENT APPLr ' FOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
R�CEIVED� PE M176 NQ �
For Applicant ro Fill in Completely — Use Ink Only TD 7 a
ADIDRE55 Tract 10626 ,� A•P•N�') 1I� "I`Q 1 Q tTIZ �lJ Z
BUILDING 1 (� � / S
OWNEROR M.D. Janes C.O.� j[�C. ADDRE55 � t�
TENANT
MAILING VNIT OR
ADD0.E55 2950 Airway Ave., D-9 SPACENO.
TR.NJ�D�� LOT BLK.
CITY Costa Mesa No��979-3376 �
OD�6TRUCiION NEW ADD LTER REPAIR MOVING DEMOL151i
LENDER Not selected �
BflANCH N/A
OWNER
ADDRESS N�A VALUE
ARCMITECT TEL. USE S
ORENGINEER Danielian b liS80C.
F � -,
ADDRESS 3848 Cam US DL. N.B, ZONE TVPE GROUP
APPROVED
CONTRACTOR OWI12T BV DATE
ADDRESS B
TEL.
CITY A NO. e
STATE CITV APP0.0VEDSETBACKS
LIC. NO. e LIC. NO. e
SIZE NO.OF BLDGS. (FROM C/LSTREET)
OF LOT 55� � x 334' NOW ON LOT e ROM FT.
USE OF
E%IS71NG BLOG. N A
Separate permits are required for L. SID
electric, plumbing and hea[ing work.
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED PWNNING ACTION
� � /f / � —O A APPROVED � "' 1
i /J � nPVRo� /� ' .�-1 `/ - %
I haraby ecknowletlBe t�et I hava rea0 Shif appliceNon entl rtate
Mat the ebova Informexian Is corract and epree to comply with
all lewe rapulatinp CuiltlinB conrtruction, end 1 shall not omploy ,
any person in violation of tha workmen's compensation lewa of
mo Stata of Calitornia.
I �ereb certif that I am `� 5�. FT.
V y properly Ilcensetl as e controetOr untlar
t�a Stete of Californie Business and Profassions Cotle, Division 3, TME AMOVNT SHOWN VNDER VA�VATION IS FOR
Chepter 9, antl that suth litenses are In tull torca entl effoct, or 1 TNE PVflPOSE OF ESTABLISHING A PERMR FEE ONLV:
am exompt trom t provisiOns of [ha Stete of Celitornia Businas9 VALUATION
antl Protessions Co e, Divi iyn 3, Chapier 9. PERMIT FEE S
/ PLAN CHECK E / D
Sipnature of ��yf�i ^` �
Gar o`ttee / 5(/JJ ��T/•�V TA% f ��m
A�thorizatlAp / D $�17�79 TOTALPAID E'
37 � T.
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• COSTA MESA BUILDINGSAFETY DEPARTM�144fi�-� APPLICATION EOR STRUCNRAL PERMIT;;_„ ^
P.O. BOX 1200 COSTA MESA, CALIfORNIA 92626 ���'�' '' ''
RECEIVEDBV PERMIT
For AppGcant to Fill in Completely — Use Ink Only
BUILDIN�� /O /� / � A.P. NO.
ADDRE55 (� (O
BUILDING
OWNER OR ADDRESS
TENANT
MAILINC UNIT OR
AOORE55 SPACE NO.
TR.NO. lOT B�K.
CITV �\ TEL.
NO.
CONSrR N NEW ADD LTER REPAIR MOVING DEMOLISN
LENDER
BRAN �/
OWNER
ADD ESS VALUE
ARC ITEC TEL. USE S
OR E GINE R
A�D SS =ONE TVPE GROUP "�
APP �Z—/p �
CONTRACTOR BV DATE � T
ADDRESS
TEL.
CITV NO.
STATE CITV EIPPROVED SETBACKS
LIC. NO. LIC. NO.
SIZE NO.OFBLOGS. (FROMC/LSTREET)
OF LOT NOW ON LOT RONT FT.
USE OF
E%4STING eLDG.
Separate permits are required for L. SID Fr.
electric, plumbing and heating work.
flEAR FT.
USE OF BUILDING AND WOHK TO BE PERFORMED PLANNING ACTION
DATE
A7PROVED
APPROVED
I hereby acknowletlBa thet I heva rastl this eppllcation entl rtate
that tha abova iniormatlon Is correct antl agrea to comply wlth �
ell laws raBuletlnp builtllnp consvuction, antl 1 5heli not employ
any porwn in vloletian of the workman's compensation laws of
tho Steta of Celifomia.
I haroby caftify t�ot I em proparly licensatl as e cOnt�attor �ntlor $Q. FT.
Na S[ate of California B�sinesz ontl Profassions Cotle, Division 3, TNE AMOUNT SHOWN UNDER VALVATION IS FOft
C�nptor 9, entl tha such II anses ere in full torce entl atloct, or 1 TME PUFPO6E OF FS'fABLSHING A PERMR FEE NLv:
em axompt trom e Otov' iOnS of the Stata Ot CalitOrnla Buslnat5
VALUATION PERMIT FEE 5 `b •D
antl Protessions , Di �sion 3, Cheprer 9.
Sipnaturo o} AN CMECK 5
Permlriea S TAX 5
or
Authorizetl �1 n ate
TOTALPAID S' D a
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