HomeMy WebLinkAbout797 GRAYLING BAY - Building Permits�
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COSTA MESA BUILDING-SAFETY DEPATiTMENT � APPL�CL��FOR STRUCTURAL PERMIT -
P.O. BO% 1200 COSTA MESA, CALIFORNIA 92626 -
For Applicant to Fill in Completely - Use Ink Only
ADDRE55 Traci 10626� �
1/rr�/u/. `�
T�ENANT�R M.D. Janes Co., Inc.
MAILING 2950 Airway Ave., D-9
ADDRE55
cirv Coata Mesa No��979-3376
ODKSTRUCTION Not selected
LENDER
BflANCM N/A
ADDRESS N/A
ARCHITECT Danielian & Assoc. nTio��546-369'i
OR ENGINEER
ADDRESS 3848 Campus Dr., N.B.
CONTRACTOR OWi10T
ADDRESS 8
TEL.
CITV e NO. e
STATE CITY
LIC. NO. e LIC. NO. A
OF LOT 550 � X 334 � NOW ON LO S e
USE OF
Separate permits are required for
electric, plumbing and heating work.
I hereby acknowladpe thet I heve reetl thia epolicexion antl stata
that t�e ebove information is correct end aproa to comply with
ell lows .eguleNnp bvlltling conzttuction, and 1 shall not employ
any percon In vlolation of Me workman'a compensation laws of
xhe Stete of Celifornie.
I hereby tenify that I am Oroperly licensetl as e contractOr �nCer
the Steta of Celiforn(e Business antl Professions Cotle, Division 3,
Chepter 9, antl t�et auch licansas ere in tull force antl aftect, or I
am ezempt from t provisions of the State ot California B�siness
and Professions Co e, Divi i9n 3, Chapter 9.
SlBnoture of /
Permlttee �
or $/17�79
Avthorizetl Ag
A.P. NO. I'�}I�:�'�'�
BUILDING L
ADDRE55 (�y (�
UNIT OR
SPACE NO.
TR.N�Ob.� LOT
NEW ADD LTE
^
OwNER
USE
Fi �
ZONE T
APPROVED
BV
APPROVED SETBACKS
(FROM C/L STREET)
FRONT FT. �
a. sioe . FT. �
L. SIDE
REAR FT.
PLANNING ACTION
N° �
II�
VALUE
E
DATE
APPROVED
THE AMOVNTSHOWN UNDER VA�UATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
VALUATION PERMIT FEE E
PLAN CHECK S � �
5 V� �.� TA% S �.m i
TOTALPAID E %i .��
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• COSTA MESA BUILDINGSAFETY DEPARTMEnhF--� APPL►CATTON EOR,STRUCNRAL PERMIT•.; ^
P.O.BOX1200 COSTAMESA,CALIFORNIA92626 ''��� "��"' '"�''�"
RECEIVEDBY PERMIT
For Applicant to Fill in Completely — Use Ink Only
BUILDIN /D /Z / � A•P. NO.
ADDRESS (O (O
BUILDING
OWNER OR ADDRESS
TENANT
MAILING UNIT OR
ADDRE55 SPACE NO.
TR.NO. LOT BLK.
CITV �\ TEL.
NO.
�TR H NEW ADD LTER REPAIR MOVING DEMOLISH
LENDER
BRANC
OWNER
ADD ESS VALUE
AFC ITEC TEL. USE S
OR E GINEER
A�D SS ZONE TYPE GROUP "�
APP /Z!L/ �
CONTRACTOR BV DATE ( T
ADDRESS
TEL.
CITV NO.
STATE CITV APPROVEDSETBACKS
LIC. NO. LIC. NO.
SIZE NO.OFBLDGS. (FROMC/L57REET)
OF LOT NOW ON LOT FR M FT.
USE OF
EXISiING BLDG. I F
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
1 �eroby ack�owlad90 <hat 1 heva road fhis appllcation eotl State
tha[ t�e ebove information is correct a�tl eg�ea to comply with
ell laws ragulating builtling canSVuction, entl I shall not employ
any Oerson in vl0latian ot Me workma� s compensetion lews oi
the State of California.
I hereby ceriify that I am properly Iicenzatl as e connactor untler Sn' FT'
the Stete of Californla Business ontl Prolessions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chaptar 9, end <ha such li enses are in tull torce entl eftact, or I THE PURPOSE OF ES'fABL15NING P. PERMIT FEE NLV:
am axampt from e prov ions of theState of California Business VALUATION
antl Professlans , Di ision 3, Chaptar 9. PERMIT FEE E!b •O
SiB�ature ot F�N CHECK S
Permlttee 5 TAX S
or ,y
Authorized A n ate
TOTALPAID 5' D a
T: