HomeMy WebLinkAbout626 RHINE LN - Building Permits I
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
ADDRESS G2od2?624626 12141 me �/ RECEIVED BY D9- li-7 VrcDt pq•- O•S• 4
BUILDING `//11 ) A 7 76 ■7 8 �1 j
OWNER �EL r2 .2 F rafg�reJ' A.P.NO. y-/�OT�Q/ P -•�J`O
MAIL 74' t/ /A f 4 ADDRES 6^ _ 1626 ^'e `�`,/IC l , .
BUILDING
ADDRESS 4'(/ �1/ C /f ADDRESS -(,QQ l Cs' + `f/r `Y
. L 4^ TEL. TRACT (/ L / LOT / BLOCK
CITY NO.
CONSTRUCTION I1/] D NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER //C.- O y
BRANCH MA/A/ r /, r .
OWNER taetLE2
. ADDRESS
�s VALUE /p/
ARCHITECT TEL. USE aAi/Y O4/ud $ / /�"
OR ENGINEER NO - -
FIRE
ADDRESS ZONE TY
:it GROUP
660 ,4' Lrte2 V 7:11
APPROVED72?/,/ /G0��
CONTRACTOR BY LST DATE
ADDRESS 4 UNIT
TEL. ,
E NO.OF USE OF NEW
f PLANS 2 BUILDING
CITY NO. Ce—NP,D Q
F STATE /GJ^�� ��� CITY YARDS APPROVED YARDS APPROVED
LIC.NO. / LIC.NO. MAIN BUILDING ACCESSORY BUILDING
GC (FROM C/L STREET)
IA SIZE I NO.OFBLOGS.
L OF LOT NOW ON LOT FRONT y'it FST FT.
Q USE OF t
EXISTING BLDG. R-SLOEp`FA^t FT,
rn
bE Separate permits are required for L.SIDE FT. FT.
electricCi- ,plumbing and heating work. REAR FT. PT.
F. USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET. MAIN&
O //�, MAIN BLOCS. ACCESS.CLOGS.
Q ¢ a�lr SA/bp(JQ VADATE
CURP# 73 7 APPROVED
} $APPROVED Y I DATE I/ //y�"760
ce 4OLD FOR 5 ECIAL REQUi REMEN S
0. I hereby acknowledge that I have read this application and state n
I= that the above information is correct and agree to comply with m
0+ all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of
G] the State of California.
= "'
I hereby certify that I em properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business �/ QV e
VALUATION PERMIT FEE $ v
and Professions Code, Division 3,Chapter 9. _
Signature of / //`L�� $ PLAN CHECK $ Z¢// /G
Permittee � d 4 ,56 000 TAX $ /O :J
/a 0
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' Authorized Agent PAID / 7) /J U
TOT•
AL OTAL $ Y ed i
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