HomeMy WebLinkAbout632 RHINE LN - Building Permits 1..k.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
BUILDING 42B43D 432'634636 6138 k,vigF RECEIVED BY DATE R.EC EC �ED -ao-76
ADDRESS
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OWNER A.P. NO. lie` Ol/ 0/
j�yjtiE�,/-///Z�t('F�wrfQn d G BUILDING / `1z:MAIL7! o 4 , /4 A'G� ADDRESS —0938(al�?"I
ADDRESS `
n TEL. TRACT g 24! LOT Y BLOCK
CITY Lsl( , NO.
CONSTRUCTION /I//p NEW ADD ALTER REPAIR MOVING DFMOLISH
LENDER �,y(/[zb v
BRANCH 1A//LI /Jv r
I" OWNER get tzeg
ADDRESS Lutz utz VALUE fl
f ARCHITECT TEL. USED twit
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OR ENGINEER NO.
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APPROVED Pte/ K20 4
CONTRACTOR BY DATE CC�)
ADDRESS
TEL. 7yOfy� Ir.OF USE OF NEW/Vplr
CITY NO. \J JVl! PLAN BUILDING egir
F STATEQe CITY YARDS APPROVED YARDS APPROVED
LIC. NO. 27o 275- LIC.NO. MAIN BUILDING ACCESSORY BUILDING
I:.1 SIZE INO.OF BLDGS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF ^�))
-,I. EXISTING BLDG. R.SIDF FT.
CA
.. Separate permits are required for L.SIDE /4.4^s FT.
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electric,plumbing and heating work. REAR FT. FT.
lal USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS. BLDGS.
VAR.91E ''] ACCE
ill
Q j tains— O4J$O C.U.P.dh 7��/ 7 APPROVED
7 APPROVED 8-
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} BY DATE vJ
a -lOW Fv c at ck..i:::_ ..:..._; s 3
•a. I hereby acknowledge that I have read this application and state n
c4 that the above information is correct and agree to comply withco
a all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of o
trJ the State of California.
I hereby certify that I am properly licensed as a contractor under SO. FT. j
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
om exempt from the provisions of the State of California Business e
and Professions Code, Division 3,Chapter 9. VALUATION PERMIT FEE $ 188.DO n
- Signature of 4 tJELtttd-- PLAN CHECK $ q/7�Z� "�
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Permittee A % $ 2� 000 TAX $ //e3 LL
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Authorized Agent TOTAL PAID $RV O
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