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W ATER
LOT
PROP. $WR. LINE U HOUSE CON. U
SPRINKLING SYSTEM
MISCELlANE0U5 �iy �; �/
ROUGN MEnTING ANO AIR ONDI ONING
TEMPORARY SERVICE OR POLE
UNOERGROUNO � POWER �
ROUGM WIRING
TRENCHES FONMS STEEL REINF.
FLOOR SYSTEM '
BON� BEAM � STEEL HEINFORCE ❑
SHEATHING
FRRME RN� FLASHING
LATHING - IN � OUT [�
PLASTER, BROWN COAT
5�""TURAL, FINAL
H, G. VENT., REFRIG. �N� �.C., FINAL
PLUMBING, FINAL AND GRS TEST n
� ELECTRIC, FINAL
BUILOING, FINAL
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SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILOING � /���
ADDPESS A ,�/��p� � .
OWNER
/ I
MAIL
ADDRESS ` �Z/J 6�
CITV //y/�++�/�/XJ TO.
BRANCH
ARCHITECT TEL.
ADDFESS
CONTflACTOR ' � �
ADDRESS SIS�y �
TEL.
GTY � NO. yQ�'
STATE �Zs �/// CITV
LI0. NO. �' LI0. NO.
SIZE iNO.OF BLDGS.
OF LOT NOW ON LOT
USE OF
ExISTING BLOG.
SI2E OF NO. OF
NEW BLDG. ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF BUILDING ANO WORK TO BE PERFOFMED
u
I heraby ecknowladBa Nat I hava reatl this application and rtete
that tho abova information is correct and apree to comply wIM
oll laws re9ulaUnp builtlinp construction, antl I shalt not amploy
eny penon in viOlation of th¢ workman's compansation laws af
tha Stata ol Colilomia.
I hereby tertify that I am pro0erly Iicensetl es a contractor untler
tha Stata of California B�sineas antl Profess(ons Cotle, Divisicn 3,
Chapter 9, antl chat such lieanee� ere In full torce end affeci, or I
am axempt from tl e provlilons o( tha State of Calif 8usinau
ontl Protossione Coue, D on 3, Chaptar 9.
.
sie�e��,o o�
Perminaa
Authorizatl Apant
BUILDING
ADDRESS�J
TRACT
FIRE
ZONE
APPROVED
IF
PA[0
OEC-4-73�N�,00 �08�'• ***-*5.50
ON FOR BUILDING PERMIT
LOT
NE NO.OF � USE OF NEW
/%� PLAN$ BUILDING
L
VARDSAPPROVED VAF�D AI
VAR. aW
C.U.P.y�
VALUATION
�oo'�
$
&
OATE
APPROVED
BLOC
BUILDING
<. ��
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VA�VATION IS FOR �
A PERMR FEE ONLV: o
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