HomeMy WebLinkAbout795 GRAYLING BAY - Building PermitsF�+
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COSTA MESA BUILDING-SAFETY DEPA42TMENT pPPL�C��FOR STRUCTURALPERMIT �
P.O. 90X 1200 COSTA MESA, CALIFORNIA 92626 —
For Applicant to Fill in Completely — Use Ink Only
BUILDING Tract 10626 �J n
ADDRESS � /�)//i/%/(j� 7
�ENAN °R M.D. Janes Co., Inc.
ADDRE S z950 Airway Ave., D-9
Costa Mesa TEL.
cirv No. 979-33
con,sraucnoN Not aelected
LENDER
BRANCH N/A
ADORESS N/A
ARC1i1TEGT Danielian & Assoc. No��546-3fi
OR ENGWEER
ADDRESS 3848 Campus Dr., N.B.
CONTRAGTOR owner
ADDRESS e
TEL.
CITV e NO. e
STATE CITV
LIC. NO. e LIC. NO. e
OF LOT 55� � X 334 � NOW ON LO�T e
USE OF
EXI5i1NG8LOG. N�A
Separate permits are required for
electric, plumbing and heating work.
USE OF BU�LDING AND WORK TO BE PERFORMED
I heraby acknowletlge thax I have reatl ihis epplicexion entl rta[e
that ffie above intormation is rorrect antl aptee to tOmply wiM
all laws retlulatin8 builtling con6t�uction, antl I shall not employ
any Derson �� ��olation of the workman's compensation laws of
the State of Calitornia.
I hereby certify t�at I am pro0erly licensed as a contta<tor unGer
the State o� California Business and Professions Cotle, Division 3,
Chaptar 9, and ffiax such licenses are in full force end eftect, or I
am euempt from t provisions ot the Steie of Calitornia B�siness
antl Professions Co e, Divi �D� 3, Chapter 9.
Sipnature o{
Permittae
°` 8/17/79
Authorizetl �+9 D
A.P. NO.'-{�I�� I�O
BUILDINGn l� 1
UNIT OR
SPACE NO.
TR•N�O�� LOT
NEW ADD LTI
OWNER
�USE
F�K
APPROVEDSETBACKS
PLANNING
N°
REPAIR
t41Z
VNLUE
E
-d9AI DATE
APPROVED
THE AMpUNT SHOWN UNDER VALUATION IS FOR
THE GURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
VALVATION PERMITFEE E
�j PLAN CHECK 5 � D
5 �J� !�G.�'J rnx s �,m
TOTALPAID E % ���
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� COSTAMESABUILDINGSAFETYDEPARTMERYF� pPPLICAT10NE0RSTRU�CTI]RALPERh�IT4�,�
P.O. 80X 1200 COSTA MESA, CALIFORNIA 92626 "� �� '�=
RECEIVEDBV PERMIT
For AppGcant to Fill in Completely — Use Ink Only
ADIDRES� �O(�Z(� 3 A.P� NO.
BU�LDING
OWNER OR AODRE55
TENANT
MAILING UNIT OR
ADDRE55 SPACE NO.
TR.NO. LOT BLK.
CITv �\ TEL.
NO.
NEW ADD LTER REPAIf3 MOVING DEMOLISH
COP6TR N
LENDER
BRANC V
OWNER
ADD ESS VALUE
AiiC ITEC TEL. USE S
OR E GINEER
ADD SS ZONE TVPE GROUP
AP /Z ���
CONTRACTOR BV DATE
ADDRESS
TEL.
CITV NO.
STATE CITY APPROVEDSETBACKS
LIC. NO. LIC. NO.
SIZE NO.OF BLOGS. (FROM C/LSTREET)
OF LOT NOW ON LOT f�fT FT.
USE OF
E%ISTING BLDG.
Separate permits are required for L SIDE Fr.
electric, plumbing and heating work.
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED p�qNNING ACTION
DATE
APPROVED
APPROVED
I heraby ecknowletlge that I have reatl thls apP���ation anC ctate
that the above intormatlan is correct end eBree to comply with
all laws ragulatlnB building construction, antl I shell not employ
any person in violatlon of i�e workman's compensation laws of
Me State of Caiitornia.
1 hereby cenify that I am properly Iicensatl as e contractor untler SQ. FT.
the State of California B�sinass and Profezsions Cotle, Division 3, THE AMOVNT SHOWN UNDER VALUATION IS FOR
Chapter 9, entl tha such li enses are in full forte entl eftact, or I THE PURPOSE OF FSTABL�MING A PERMIT FEE NLV:
am ezampt from e prov' ions ot the Stete of California Buziness VALUA710N PERMIT FEE 5`b •p
antl Protessions , Di ision 3, Chapter 9.
SiB�atura ot CAN CHECK S
Permittee 5 TA% f
or Z
Authorized A n ate
TOTALPAID f' O �