HomeMy WebLinkAbout2528 ALDER LN - Building PermitsCOSTA MESA BUILDI -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
7912 10/30/78 233.00 TL,
7912 10/30178-233*00CKM
APPLICATION FOW&UCTURAL PERMIT
A
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BV
DATE RECEIVED
DATE ISSUED
BUILDN
ADDRESS
ADDRESS
PERMIT NO.
OWNE
A.P. NO.
BUILDING
ADDRESS MAIL
ADDRESS yam/(/
TEL.
CITY NO.
TRACT
LOT
BLOCK
CONSTRUCTION
W
ADD
A ER PAIR
MOVING
r
LENDER
OWNER
BRANCH
ADDRESS
A UE
S S
ARCHITECT TEL.
OR ENGINEER N .
FIRE
ADDRESS
ZONE TYPE GROUP
APPROVED
CONTRACTOR
BY DATE
ADDRESS
ZONE
NO. OF
USE OF NEW
TEL.
I PLANS
BUILDING
CITY NO.
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
(FROM C/L STREET)
SIZE NO. OF BLOCS.
OF LOT NOW ON LOT
FRONT FT.
FT.
USE OF
EXISTING BLDG.
R. SIDE FT.
FT.
Separate permits are required for
L. SIDE FT.
FT.
electric, plumbing and heating work.
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLOCS.
ACCESS. BLOGS.
VAR. #`
DATE
♦
C.U.P.+
APPROVED
APPROVED
DATE
I hereby acknowledge that I have read this application and state
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n
that the above Information Is correct and agree to comply with
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all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
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the State of California.
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I hereby certify that I am properly licensed as a contractor under
O. FT.
N
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
m
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
a
and Professions Code, Division 3, Chapter 9.
VALUATION
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PERMIT FEE $
Signature of
PLAN CHECK $
TAX $
Permittee
$
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TOTAL PAID $
Authorized Agent