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COSTA MESA BUILDING-SAFETY DEPA4iTMENT APPLr ' FOR STRUC'fURAL PERMIT
P.O, BOX 1Z00 COSTA MESA, CALIFORNIA 92626
R�C.EIVED/ PE MI'� �
For Applicant to Fill in Completely — Use Ink Only TD 7 � No
AD�RESS Tract 10626 � A'P'NO.�-7-I�v �I�Qq Q '�'�1� �L-I L
BUILDING 1'N � � S
°ENqN �R M.D. Janes Co., Inc. aooaess �
UNIT OR
ADDREss 2950 Airway Ave., D-9 SPACENO.
TR�NPbb� LOT BLK.
ciTv Costa Mesa nTio�979-3376
WNSTflUCTION NEW ADD LTER REPA�R MOVING DEMOLISH
LENDER NOt selected J
/\
BRANCH N/A
N/A OWNER
ADDRESS VALUE
ARCNITECT Danielian (i AS60C, NEL.
USE E
OR ENGINEEF
FI
ADDRESS 3848 Cam US Dr. N.B, zoNe TVPE GROUP
AVPROVED
CONTRACTOR OW[lEi BY OP.TE
ADDRESS e
TEL.
CITY e NO. e
STATE e CITY APPROVEDSETBACKS
LIC. NO. LIC. NO. e
SIZE NO.OF BLDGS. (FROM C/L STREET)
OF LOT SSO � x 334 � NOW ON LOT e OM FT.
USE OF
EXISTING BLDG. N A
Separate permits are required for L SIDE
electric, plumbing and heating work.
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED PLqNNING ACTION
� � � �I �R -� A APPROVED Z /^'� � (
� � , ,�Ro� � ' .?-ly-i
1 �ereby acknoW�etlBe t�at I have roatl this epplication entl rtna
Ma[ 2ha ebova inlormation is correct ond apree to comply wlth
all laws reguleting builtlinp conrtruction, and I shell nat employ
eny parson In violatlon ot Me workmen's compansation laws af
the Stete of Celifornia.
I hereby certify that I am oroperly licensatl az e contrector �ntler `- SQ. fT.
tha State of California Business antl Professlona Cotla, Division 3, THE AMOVNT SHOWN UNOER V.�+LUATION IS FOR
Chapter 9, entl tnat such licenses ere in full totce antl affett, or I THE PURPO6E OF ESTABLSHING A PERMIT FEE ONLV:
em exampt fram t provlsians of the Sta[¢ of California Business VALVATION
antl Profassions Co e, Divi ' n 3, ChaOier 9. PERMIT FEE S
/ PLAN CHECK E � �
Sipnature oi �t
Permittee $ �/� `Qtj,�.�
TAX E ,m
A�thorizetlAp e 8�17I79 / TOTALPAID S�
37 � T:
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COSTAMESABUILDINGSAFETYDEPARTMEM1T�—� pPPLICATI0NE0R.STRUFT,URALPERh�IT�;,,�;
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
RECEIVE�BV PERMIT
For Applicant to Fill in Comple[ely — Use Ink Only
BUILDIN�� IO /� / � A.P. NO.
ADDPESS (Q (O
OWNER OR BUILDING
TENANT POORE55
MAI LI NG UNIT OR
ADDRE55 SPACE NO.
TR.NO. LOT BLK.
CITY �\ TEL.
NO.
��,rq N NEW ADD LTER REPAIR MOVING DEMOLISH
LENDEii
BRANC 1/
OWNER
ADD ESS VALUE
ARC ITEC TEL USE E
OR E GINEEF
ADD SS ZONE TVPE ROUP
APP /Z!�
CONTRALTOR BV �ATE (
ADDRESS
TEL,
CITV NO.
STATE � CITV APPROVEDSETBACKS
LIC. NO. LIC. NO.
SIZE NO.OF BLDGS. (FROM C/LSTREET)
OF LOT NOW ON LOT FROM FT.
USE OF
EXISiING BLDG. E
Separate permits are required for �. sioe FT.
electdc, plumbing and heating work.
REAR FT.
USE OF BUILDING AND WOflK TO BE PERFORMED p�qryNING ACTION
DATE
APPROVED
APPROVEO
1 �ereby acknowletlga ihat I have reatl this applicaxion antl state
ihat tM1e ebove intormation is correct antl agree to comply with
all laws re8ulating building construction, and I shall no<employ
any person in violation ot Me workman's compensation laws of
the State of Calitornia.
I hereby certify that I am properly IicenSetl as a contractor untler SQ. FT.
the State of California Business antl Protessions Cotle, Division3, THE AMOUNT SHOWN UNOER VALUATION IS FOR i
Chapter 9, and tha sucn li enses are in full torce antl etfect, or I THE PVRPOSE OF ESTABLISHING A PERMR FEE NLV:
am exempt fram e prov' ions of the $t2te of California Business VALUATION PERMIT FEE S�b •D
antl Profassions , Di ision 3, Chapter 9.
Signature of CAN CHECK 5
Permittae g !
TAX S
or �
Authorizetl A n ate
TOTALPAID E'D D
s
71