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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.n. RnX l2nn cnsTn MFSA. CALIfORNIA 92626
HAR 20-70�KS�OO 543� TM**�34.51
APPLICATION FOR BUILDING PERMIT
Fo� Applicant to Fill in Completely
RECEIV By� DcA�E RECEIVED DA E ISSUED
BVIIDING .7 � � �� � �� "J'
ADDRE55 � �
� � PERMIT NO.
OWNER L A.P. NO.
MAIL Q�� BUILDING
ADDRESS IIa � I � Jf e �+DORESS
CITV u NOLjG%-96 7j �TRACT�b-{ LOT � BLOCK
CANSTRUCTION W A A P
LENDER
BRANCH
OWNER �
ADDRESS �J���
VALVE
ARCHITECT --� TE�.791�4i3 S $ d�
OR ENGINEER tJ N
1`/� FIRE
ADDRE55 ��0� N• Cpl G�(..1 ZONE TVPE GROUP
APPROVED �_ _�O
CONTRACTOR by,/NF BV � DATE
ADDRESS
TEL. Z E NO.OF . USE OF NEW
� PLANS v BUILDING
CITV NO.
LIC. No.25251�i LICVNO. I� 1 O vMA NSBUILDOINGD ACCE SORVPBVIIDiNG
SIZE NO.OF BLDGS. (FROM C/L STREET)
OF LOT NOW ON LOT ROfYT FT. .—�-PT;-7
USE OF (� �
EXISTING BLDG. �L 7 �
SIZE OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE FT. FT--�
EMERIOR WALL ROOF
COVERING C VERING REAR FT. FT.
USE OF BVILDING AND WORK TO BE PERFORMED � DISfANCE BET. BET. MAIN &
�� MAIN BLDGS. ACCESS. BLDGS.
VAR. iW pATE
� Lp C.U.P.ay+ APPROVED
� / APPROVED '�f
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I hereby acknowletlge that I heve reatl this application antl state
that the above information is caYreci antl agree to comply with
all laws regulatin8 builtlin8 constt�etian, antl I shall not employ
any person in vfolation ot the wPrkman's compensation laws of
the State of Celitornia. `
I hereby cerlify that I am proOerlY licensetl as a contrecior �ntler SQ. FT.
the State o( Calitornia Basiness antl Protessions Cotle, Oivisicn 3, THE AMOUNT SHOWN UNDER VA WATION IS FOR
Chapter 9, entl thai such licanses are in tull torca antl effeci, or I THE PURP06E OF ESTABLISHING A PERMIT FEE ONLV:
am exempt trom the provisians of the State ot Calitornia Business VALUATION
antl Professlons Cotle, i rslon �Pter 9. jj
PERMIT FEE $ �
Si nature of � / �p/� o(J /.
Permittee /MC� � u�� S (Y/ p/ S� PLAN CHECK $ //� � �
Authorizetl ABant TOTAL FEE § ..,J �� �
! ��► AUG 13-70Pa��OO 693� �*�*r39.00
� �� I � I LMSA
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
REC � BV DATE RECEIVED DATE I/SSVED
BVILDING � 1 ��� ' � O 8/�' D
ADDFESS V
■ _ PERMIT NO.
OWNER PO \ � �, A.P.NO. Z.
MAIL `/�� ('i BUILDING � 1
ADDRESS 1(V1 c, '� 7�N .4DDRESS �
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dU CITV NO.
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am . � ` �
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J tn � OWNEF .
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m AflCHITECT ' TEL. S � 5 �T"� �
J a OR ENGINEER N. .
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W 2 ADDRESS ( — 20NE TVP GROUP
aw
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Z= CITV ' �. NO.� ^e� — P�� BUILDING
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w � STATE /J �i+� �✓ ,r,j CITV �.4FlDS APPROVED VARDS APPROVED
j O LIC. NO. (� L J ( LIQ NO. � D MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BIDGS. (FROM C/L STFEET)
OF lOT NOW ON LOT ROM FT. FT.
USE OF
EXISTING BLOG. S FT.
F— SI2E OF � NO. OF �
Z NEWBLDG. RppMS STORIES L.SIDE FT. FT.
U EXTERIOR WALL ROOF
COVERING COVERING PEAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFOFMED DISTANCE BET. BEf. IN &
� MAIN BLDGS. ACCESS. BLDGS.
a
Q � . ` / . VAF.�W DATE
� (y {���y C.V.P.qW APPROVED
F � APPROVED J
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UI heraby ecknowletlge chat I have reatl this application antl state
� that tha nbove information is correct antl apree to tomply with
� all laws regulating b�iltling consiruction, entl I shall not employ
F any person in violation of the workman's compensation laws of
y [he 5[are of California. m
b
zI hureby cercify Mat I am pmperly licensed as e contrecror untler SQ. FT. O
the State of California Business ahd Pro�essions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chapter 9, and thet such licensas ara in y� orce antl effxt, or I THE PURP06E OF ESTABLISHING A PERMIT FEE ONLV: ¢
em oxempt from the provisions iha y ete o Calitornia Business VALUATION
antl Profeseions Co �, rvis n, baptpr 9. ��� �� m
O� PERMIT FEE $ j
SiB�amre of \ • r O O m
Pormlttee $� OOD PLAN CHECK $�� E
� � `o
Authorized ABent �� �a LL
TOTAL FEE $