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� APPRO�D
CITY OF COSTA MESA '
� PLANNING DEPT.
i SUBIECT 70 BLDG. OEPT. REO. '
GA2AGE
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� PIANNING DEPARTMENT
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STRUCTURAL APPROVAL ONLY
SEPARATE PERMITS ARE REQUIRED
FOR ELECTRICAL, PLUMBING,
NEATING, VENTILATING AND
REFRIGERATION WORK
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THIS NUiviBER PA'JST ACCOMPANY
ALL INSPECTION REQUESTS
STATE OF CALIfORNI
INDUST IAL SAFETY BE
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�JOB ADDRE55
GENERAL COP
AP No. 139-2
INSPECTIONS
SOIL
GRS
W ATER
ROUGH PLUMBING
PROP. SWR. LINE
SPRINKLING SVST
MISCELLANEOUS
ROUGH MEATING AND AIR CON�IiIONING
UNOERGROUNO
ROUGH WIRING
TRENCHES h[J FORMS U STEEL REINF.
FLOOR SVSTEM
BON� 6EAM [] STEEL REINFORCE ❑
SMEATHING
FRAME ANO FLASMING
NEAT
BROWN CORT
AL, FINAL
VENT., FEFftIG. AND A.0
, FINAL RN� GAS TEST I
UILOING, FINAL
F INAL
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use lnk Only
� BUILDING ,� � � � � � ' � � , 1�
OWNER
MAIL
CITV �'�}lC.� 4 VY �PG A NO.
BRANCH
ADOFES5
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TEL.
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AD�RESS
TEL.
CITV NO.
� STATE CITV
� LI0. NO. LI0. NO.
g,� SIZE . NO.OF BLDGS.
0. OF LOT NOW ON LOT
a VSE OF
„�„ EXI5TING E�LDG.
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� Separate permits are required for
� electric, plumbing and heating work.
[.W.. USE OF BUIIDING AND WORK TO BE PERFORMED
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l�llt-3-76cri�n�� 14ia� :�-f'•:��.50
FORSTRUCTURALPERMIT
A.P. NO./ J 7 ��C�
BUILDING n �J
ADDRESS �J / 7
TRACT�� /
OWNER G
SE �
FIRE
ZONE i
APPROVEO
BV
ZONE NO.OF
� / I Puivs '
VARDSAPPROVEC
MAIN BUILDING
DISTANCE BET.
MAIN BLDGS.
VAR #
����PE N �
� �/ /
�� BLOCK
I
N
VALU�S
� GflOUP ��
DATE �� �] �(�
USE OF
eUILDI�
VAR
BET. MAIN &
ACCESS. BLD
DATE
Q I heraby acknowledge that I have read this application antl state �
a thet the aCove informeUon is correcT and aprea to comply with
m
d all laws regulating builtling consiruction, entl I shall not amp�oy
i
�any Oersor+ in violetion of the workman's compensation laws ot �
x the State of California. m
3 I hereby cErtify that I em prope�ly IicenseA as a eonttactor untler SQ. FT. �v
ihe State Of California Business antl Professions Cotle, Division 3, THE AMOVNTSHOWN UNDER VALUATION IS FOR m
Chapter 9, antl thet such licenses are in full torce and effect, or I THE PVFPp$E OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt from the provisions of tha State of allfornia Business VALUATION PERMIT FEE a
antl Pro7as4ions Cotle, islon 3, Chapter 9. $ in
n
, PLAN CHECK § m
Signature o1 /;��/) // o
Permittae $ J✓ V TqX $ LL
f
V
Aothorized /aBent TOTAL PAID $
�• �. • ���U�
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
FOR APPUCANT TO F/LL /N COMPCETELY
TYP� OR PRINT �
BUILDING � p972 Bimini Place
ADDRESS
COSTA MESA, CALIFORNIA
MAIL BOX 6J '
ADDRESS
CITV 1�n1W'd IS�.�jd�C3�Y• TNO
ARCHITEGT LIC.
OR ENGINEER . NO.
�ADDRE55 B� 65, �alboa� Island,Cali£.
ILEGAL LOT �1
oescaiPnorv I NO. ��0�� I 9LOCK I TRAC�T��
I� USE OF
7WO I NOW ON LOTS O
LINE FROM
�F srrseeT � REAR YARD 2
RD ILEFT � IRIGHT �
DESCRIPTION OF WORK
I R II 41.TtOGT1l1A1 I II G!llllTlllN
IR I II MOVING I II DEMOLISH I
JING �1.1/�,I,L RQOMS 9 STORIES 1
4 /44v
iIOR WAIiL � �, I ROOF
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1 HEREBY ACKNOWLEOGE T{�q} � HqVE READ THIS APPLICPTION
ANO STATE THAT THE ABOyE IS CORRECT AND AGREE TO COM-
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILOING CONSTRUCTION.
SIGNATURF F.� ��E HO!"r.'• INC•
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APPLICATION FOR PERMIT
BUILDING
BUILDING
fo,e afficF usF oNcy
� PECEIPT NO. I �P6
DATE
COSTA MESA, CALIFORNIA
ZONING
NO.OF USE OF
� / PLANS � I �IGO1�
(CENTER LINE 6T.)
THE AMOUNT SXOWN UNDER VALUATION IS FOR THE
PUNPOSE OF E6TpBLISHING A PERMIT FEE ONLY,
VALUATION
��^/ I� PERMITFEE $�'�6 —
1/ y
$ % � / PLAN CHECK $ � ��
TOTAL FEE 8 � 7'�'