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TEMPORARV SERVICE OR POLE
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P,O. BOX 7200 COSTA MESA, CALIFORNIA 92626
PP IC TION FOR BUILDING PERMIT
For Applicant to Fill in Completely
flE V Y DATE RECEIVED DATE ISSUE
HUIlO1NG ��/ � I A� � i
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w� STATE CITV VARDSAPPROVED
j O LIC. NO. 2 Z S ��/ ��C. NO. MAIN BUILDING
SIZE � NO.OFBLDGS. (FROMC/LSTREET)
Of LOT NOW ON LOT FRONT FT.
USE OF
EXISTING BL�+� S
F- SIZE OF NO. OF
Z NEWBLDG. ROOMS STORIES L.SIDE F.
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COVERING COVERING REAR FT.
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a MAIN BI.DGS.
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OI hereby ack�owledge that I have read this application antl state
� that tha abo�e information iz correct and e0ree to comply with
� all laws regulatinq builtling consttuction, antl I shall not employ
F any person i� violation of Me workman's compensation laws of �
y the State of California. -'
zI hereby cert�fy ffiat I am properly licensetl as a conttactor untlar� SQ. FT. -
ffie State ot Calitornia Business and Protessions Code, Divisicn 3,� THE AMOUNT SH01
Chapter 9, aPtl that such licenses are In full force an fect, or I- THE PURPOSE OF E5
em exempt trom tFe p visions of the State of Cal' rn' Business VALUATION
and Professions Coo , D ision 3, Chapter 9.
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Signamre of I �7 � /
Permittee $ /�n
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Authorizetl ABent '
VAWE '� �
$� $
GROUP .�J
DATE Z �'7� �
USE OF NEW
BUILDING
VAROS APPROVED
ACCESSORVIBUILOING
BET. MAIN &
TRX �
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UNOER VALUATION IS FOR �
LISHING A PERMIT FEE ONLV: v
¢
m
FMIT FEE $ �
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m
AN CHECK $ E
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LL
�TAL FEE $
� �� 3Z643
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING �^ ��� `
AD�FESS c /v
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STATE CITV
LIC. NO. 2�j '�f� LIC. NO.
51 ZE NO. OF BLC
OF lOT NOW ON L(
USE OF
EXISTING BLDG.
$IZE OF NO.OF
NEW BLDG. ROOMS STOF
EXTERIOR WALL ROOF
COVERING COVERING
USE OF BUII�ING AND WORK TO BE PERFORMED
I hereby acknowledBe that 1 have reatl this npplication entl cmre
tha[ the above informeiion is correct antl aproe [o comply with
nll laws reguleHng builtlinB co^sbuction, antl I ahall nOt amplOy
any person In vlotaUon of Ma workman's compansation lews of
Ma Stero of California.
I haroby cerNly thot I am proDarly Iicanzatl es e eonVncior under
the State of CalHornia Businezs antl Profettiona Code, DlviAcn 3,
Chnpter 9, antl thac me� licenses are in full force an t, or 1
om eaempt from U�e p visions Ot [he S[aie o eli rnia uainoss
nntl Profezsionf Cnu , D ision 3, Chapter 9
519�aare of
Permittoe
Authorizetl ABant
A.P. N
BUILDI
ADDR
FIRE
20NE
APPROVED
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PPID .x. 5ki.''1��
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�ON FOR BUILDING PERMIT
D T� RE IVED DATE ISSUED
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f� NO.OF USE OF NEW
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VARDSAPPROVED rdRDSAP� PFOVED
VAR. 3j'+
C.U.P.q�
THEAMOUNTS
THE PURPOSE OF
VALVATION
, �J
$ ,� j �
BET. MAIN &
ACCESS. BLD
DATE
APPqOVED
��� m
0
VALUATION IS FOR j
A PERMIT FEE ONLV: m
¢
E $ �� j
:K S E
� � LL
$
" � 37644
COSTA MESA BUILDING-SAFETY DEPAi
P.O. BOX 7200 COSTA MESA, CALIFORNIP
Fo� Applicant to Fill in Completely
BUIIOING _ '_!� � �' t�i � .
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ADDRESS
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CONTRACTOR ' �U�ljfj
ADDPESS S/yy � ji��
TEL.
CITV �o. yz-
$TATE �2� yy/ ��T�
LIC. NO. LIC. NO.
SI2E i NO. OF BLDGS.
OF LOT NOW ON LOT
USE OF �
E%ISTING BLDG.
SIZE OF . NO. OF
NEW BLOG. ROOMS STORIE:
EXTERIOR WALL ROOF
COVERING COVERING
USE OF BVII.QING AND WORK TO BE PERFORMED
I hereby acknowletlge that I have reatl [his application antl sta[e
Mat tha above information Is correct and agree to comply with
all laws reg�letinB buildin8 eonsiruction, antl I shail not amploy
any person in vlolation of the workman's compansation laws af
Ma Stata of Califomia.
I hareby certity that I em proparly licensed es e contractOr untle�
the State af California Business antl Profasstons Cotle, Div"cn 3,
Chapter 9, and t�a� suc� lironses ara In full torca antl e, or I
am exempt from tl�¢ pr 'ons ot the Stete of f nia siness
antl Protessions Coue rvii n 3, Chapter 9.
1
$IB�etUre 0(
Permittea
Avthorized Agent
A.P. N
TRACT
u
!] : -4-73�n�r • ir�a•;-,t
�r 00 � i �_• 5.50
�N FOR BUILDING PERMIT
DATE RECEIVED neTo icci n
� . NO.OF
i PLANS
VARDS APPROVED
MAIN BUILDING
DISTANCE BET.
MAIN BLIX'S.
VAR. #
C.U.P.ak
DATE
USE OF NEW
OATE
R
FT.
��
m
�
54. FT. o
THE AMOVNTSHOWN UNDER VALUATION IS FOR �
THE FUFPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
¢
VALUATION � m
PERMIT FEE $ �
�/ m
S �� � PLAN CHECK $ E
0
LL
TOTAL FEE $