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P.O. BOX 1200 COSTA MESA, CALIFORNIA 926T6 �
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For Applicant to Fill in Comple[ety — Use Ink Only
OWNER OR
TENANT hZ,D. Janes CO. . IRC.
MAIUNG 2950 Airway Ave, D-9
AO�RE55
TEL.
CITV C'.(1CtA A4PCA. �`�Fi`J.Fi NO.�
BRANCH �
ADDRESS Y'
ORENGINEER Sampieri/Ilg N��:IY
ADDRESS17�22 Sky Park, Irvine
CONTRACTOR Owner
ADOqE55
TEL.
CITV NO.
STATE ' CITV
IIC. NO. LIC. NO.
SIZE . �NO.OFBLDGS.
OFLOT ITTeC�;. NOWONLOT
USE OF m
EXISTING BLDG. Ei
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOF±MED
Unit Condominium &
Attached Garaans,
I he�aby acknowletlge thai I have reatl chis appllcation antl state
ihai tM1e ebove intormation is correct antl agrea to Comply wlth
all laws regulai(ng building canrtruction, antl I shall not employ
any oerwn In violetion of the workman's compensatian laws at
the State ot California.
I he�eby certify ffiat I em p�ope�ly licensetl as a conhactot unde�
the State of Califo�nia Business antl Proteuions Cotle, Division 3,
Chapter 9, antl tha uch licenses are in tull force antl effect, or 1
am axempt from pr visions ot ihe State of California Bus�nen
antl Profassiona C a, v' ian 3, Chapter 9. �
Signatura of
Permlttee
ar
Authorized Aa Date �r'
A.P. NO. �'," '.I 3-v.� i y�
BUILDIN
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UNIT OR
SPACE NO.
TR,NO. 1 LOT ` �
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NEW A�O ALTER fZEPAiR MOVING OEM1
OWNER m•�.c�AA�ES
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JOB ADDRESS 2168 B i scayne Spr i i
GENERAL CONTRACTOR
AP No. L0T 5 T
INSPECTIONS '
SOIL
GAS
W RTER
ROUGH PLUM9ING
PROP. SWR. LINE I� HOUSE CON. �
SPRINKIING SVSTEM
MISCEILnNE0U5
ROUGH HEATING PN� AIR CONOITIONING
TEMPORARY 5EPVICE OR POLE
UNOERGROl1Ntl ❑ POWE0. [�j
ROUGM WIRING
TRENCHES FORMS STEEL REINF. �'
FLOOR SVSTEM
BONC BERM (_J STEEL FEINFORCE ^I
SHEaTMING
FRRME ANO FLRSHING
LATHING — IN OUT
PLASTER, BRO'MN COAT
STqUCTURAL, FINAL
HEr1TING. VENT., REFRIG. ANO A.C.. FIN�L
PLUMBING. FINiL 4ND GAS TEST
ELECTRIC FINAL
BUI��IHG, FiN<L
SPECiAL REOUIREMENTS
SUBCONTRACTOR
G PERMIT N0. art o-4$3q1�