HomeMy WebLinkAbout801 GRAYLING BAY - Building Permits4
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COSTA MESA BUILDING-SAFETY DEPA4iTMENT APPL�C��FOR STRUC'I'URAL PERMIT '
P.O. BOX 1200 COSTA MESA, CAUFORNIA 92626 -
For Applicant to Fill in Completely - Use Ink Only
ADDRESS Tract 10626 �
i 1/G �G/U/, nJ
�EWjJqN �R M.D. Janes Co., Inc.
nooaEss z950 Airway Ave., D-9
cirv Costa Mesa No�979-3376
CONSTRUCTON NOt selected
LENDER
BRANCH N/A
nooAess N/A
ARCHITECT Danielian 6 Assoc. No��546-3fi9'i
OR ENGINEEF
ADDRE55 3848 Campus DI.. i`].$,
CONTRACTOR owner
ADDRESS B
TEL.
dTV e Np, e
STATE CITV
LIG ND. e LIQ NO. e
oF �oT 550' x 334 � NOW ON LOTS e
USE OF
Separate permits are requ'ued (or
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby ncknowletlga thet I have reatl th(s epplicetion anC nete
thax the above iniormation is correct antl apree to comply wlt�
all laws re0ulatlnB �uiltlinB eo�st�uction, antl I shall not amploy
any person in vlolation ot Me wO�kmen'a compen5ation lews of
Me Stac¢ of Calitomia.
I hereby certi(y the[ I am properly Ilcensetl es a coMractor untler
the Stata af Californie Business antl Professlons Cotle, Division 3,
Cheptar 9, entl thax suc� licenses ere in tull force antl effec�, or I
am ex¢mpt }rom t provisionz of t�a State of California Bustness
and Protessions Co e, Divi ipn 3, Chepter 9.
/
SiO�at�re of
Permittea � �
�, 8/17/79
Authorizetl Ag . D
�`B7G %` 1��8�6/ N° �
A.P. NO. ITI't/-I I�Q 1� I oi I IT ` IZ �
sui�oiNc`1fY11 � INC� 'f �41..t2S �
ADDRESS
UNIT OR �—
SPACE NO.
TR.NPO�G}/ l0T
NEW ADD LTER REPAIR MOVING DE
�
�USE
F�K
APPqO V E D
VALUE
s
DATE
APPROVEDSETBACKS
(FROM C/L STREET)
PLANNING ACTION
DATE
�J
THE AMOUNT SHOWN UNDER VALU
THE PURPOSE OF 6TABLISHING A GERI
VALUATION GERMIT FEE S
^, PLAN CHECK S
5 U� �L��V TAX S
TOTALPAIO E
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N NV
IS FOR m V�
ONLY: � ^
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� COSO. BOXE 200 UCOSDTIA M SAFCALI ORNpIA 9 62� �PLICA770N EOR.STRU � RAL PE IT� c,�;
RECEIVEDBV PERMIT
For Applicant to Fill in Completely — Use Ink Only
BUILDIN�� /D /Z / �J A.P. NO.
ADDRE55 ( (Q (O .7
BUI LDI NG
OWNER OR qDDRE55
TENANT
MAIL�NG UNIT OR -
ADDRE55 SPACE NO.
TR.NO. LOT BLK.
CITv �\ TEL.
NO.
C01�6TRUCT N NEW ADD LTER REPA�R MOVING DEMOLISH
LENDER
BRANC V
OWNER
ADD ESS VALUE
ARC ITEC TEL. USE E
OR E GINEER N
ADD SS ZONE TVPE GROUP
APP l Z • �` 7
CONTRACTOR BV DATE
ADDRESS
TEI.
CITV NO.
STATE CITY APPROVEDSETBACKS
LIC. NO. LIC. NO.
SIZE NO.OF BLD6. (FROM C/L STREET)
OF LOT NOW ON LOT ROM FT.
USE OF
EXI5TING BLDG.
Separate petmits are required for L. SIDE FT.
electric, plumbing and heating work.
REAR FT.
USE OF BUILDING ANO WORK TO BE PEFFORMED p�,qNNING ACTION
DATE
nwaoveo
APPROVED
I hereby acknowledge that I have read this application entl rtate °'
n
thec the above information is correct end egree to comply with
all law5 regulating building tonstruction, entl I shall not employ �
any perwn in violetion of the workman's compensation lawz oi m
Me State ot Calitornia.
m
I nereby certify thet I am properly licensetl as a conirector untler SQ. FT. �
tha State of California Business antl Profex:iarts Code, Division 3, THE AMOUtJT SHOWN UNDER VALUATION IS FOR m
Cnapter 9, and tha sucn li enses are in full torce and effect, or I THE PURP�E OF ESTABIISHING A PERMIT FEE NLV: �
em eaempt trom e Drov' ions ot the State of Calitornia Business VA�VATION �
and Professions , Di ision 3, Chapter 9. PERMIT FEE S`b •Q N
n
AN LHECK 5 "�
SiB�ature of o
5 LL
Permittee TAX S F
or V
Authorized A n ate
TOTAL PAID S' D a
7l