HomeMy WebLinkAbout639 RHINE LN - Building Permits 42520 P:.•
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to yFill in/Completelly — Use Ink Only
673Gacn7'af / RECEIVED BY I DA� TE�_�V D DATE��n wU
BUILDING /NE r
ED
ADDRESS
aria L t L A r e//!g e7/D / °a l
OWNER aria ENreate EJ.5-i20 ovary A.P. NO.
Al, /,r BUI DDING4?3 ....&�r �' / ` . \ .
ADDRESS 7 0 NZ// enE� I ADDRES vv77Q ([, I(y n L.�.J
CITY L.A. 9414°21 NO. TRACT 1 Zrl LOT2BLOCK
CONSTRUCTION /f /J Q , NEW ADD ALTER REPAIR MOVING DFMOLISH
LENDER (/ es
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BRANCH /yA/� / //eitzE2 1
OWNER hL
ADDRESS 4'v /(' ®o A/2)O VALUE/5 000
ARCHITECT TEL. , USE C_ ,V $ /
OR ENGINEER N
FIRE
ADDRESS ///L�, / y ZONE PE > GROU
IL GV //giI �F2 t APPROVED jl is /�Am
CONTRACTOR J7U , BY DATE U /rte
ADDRESS
TE �y]E//�� NO.OF . USE OF NEW opI-
CITY NO. 4 a'c-p PLANS 2- BUILDING
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Do
FVAPPROVED
LIC. NO. 2)o 775 LIC.NO. MAIN BUILDING
ACCESSORY BUILDING
y (FROM C/LSTREET)
{r] SIZE NO.OF BLDGS.
a. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
EXISTING BLDG. B.SIDE 5"_rGT '/ FT.
rn N
F Separate permits are required for '„ L.SIDE FT. FT.
electric,plumbing and heating work. ;'! REAR FT. FT.
Ir] USE OF BUILDING AND WORK TO BE PERFORMED
F` DISTANCE BET. BET. MAIN&
-*C
; MAIN BLOCS. ACCESS. BLDGS.
..) ;1 VAR.#` 7.3 77 DATE
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APPROVED
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APPROVED
�t/ DATE 0 // / W
IT OLD FOR PECEi�L REQUIREMENTS
0 I hereby acknowledge that I have read this application and state ' n
Ix that the above information is correct and agree to comply with h m
S all laws regulating building construction, and I shall not employ
m
Z any person in violation of the workmen's compensation laws of
LLI the State of California.
I herebycertify that I amSQ. FT. r
y properly licensed as a contractor under
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 and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
am exempt from the provisions of the State of California Business ii cr
cr
and Professions Code,Division 3,Chapter 9. I VALUATION PERMIT FEE $ 37/DO N
m
PLAN CHECK $ /
/ /` 2 S"/ /5 ^
Signature of [ ^
G. Nrc'Lr2 S.4
Permittee ,` $ /S6e 000 TAX $ M. 9 y
U
Authorized Agent TOTAL PAID $6 21,o7
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