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CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS S ELECTRICAL UTILITY RELE FORM
TRACT
LOT
ADDRESS
GAS
ELEC.
UNIOTS
O.ME TER TS
NRELETERS
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ItJ.NEW CONSTRUCTION ❑ REWIRING El OTHER (EXPLAIN)
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CMF 077116
CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS OR ELECTRICAL UTILITY RELEASE FORM
TRACT
LOT
ADDRESS
GAS
ELEC.
NO.
UNITS
NO. METER
OUTLETS
NO. METERS
RELEASED
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THESE INSPECTIONS AREA RESULT OF: ICHEGK URtl
�4NEW CONSTRUCTION [I REWIRING ❑ OTHER (EXPLAIN)
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CMF 077146
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CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS OR ELECTRICAL UTILITY RELEASE FORM
TRACT
LOT
ADDRESS
GAS
ELEC.
NO.
UNITS
NO.METER
OUTLETS
NO.METERS
RELEASED
13 -._/
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.T++.H,�ESE INSPECTIONS AREA RESULT OF: (CHECK ONEI
L, *W CONSTRUCTION Cl REWIRING Cl OTHER
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Den Released Signed ",
CMF 077146
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t CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS OR ELECTRICAL UTILITY RELEASE FORM
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T
++H��ESE INSPECTIONS ARE ARESULTOF: (CHECKONE)
(n4i.EW CONSTRUCTION ❑ REWIRING ❑ OTHER (EXPLAIN)
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Date Releasetl
CMF 0771-06 _.
NO.
NO.METER
NO.METERS
ADDRESS
GAS ELEC.
UNITS
OUTLETS
RELEASED
TRACT
LOT
L v
r
T
++H��ESE INSPECTIONS ARE ARESULTOF: (CHECKONE)
(n4i.EW CONSTRUCTION ❑ REWIRING ❑ OTHER (EXPLAIN)
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Date Releasetl
CMF 0771-06 _.
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BUILDING
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A.P.
I hereby acknowlMae that I have ram this application and Nate
ADDRESS Tract
BUILDING
WA
that Me above Information is correct and spree to comply with
ADDRESS 0 N
OWNER OR
TENANT M.D. Janes CO. Inc.
UNITOR
ell laws regulating building constructl.n, and I shell net am Ploy
the workmen* compenaution laws of
MAILING
ADDRESS 2950 Airwa Ave. D-9
SPACf NO.
TR.N /^ / LOT
BLK.
CITY COBLH Mesa iso. 979-3376
a (oCJ�
ryEW pDD LTER IREPAIR MOVING DEMOLISH
ION Not selected
the state of California.
LENDER
)L
3:
BRANCH N/A
OWNER
O n
0
the State of Calllmnla Business end Profession. Code,
VALUE
ADDRESS
USE
$
ARCHITECT TEL.
546
m
INA -369
OR E
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1
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ADDRESS 3848 Cam lie Dr. N B.
zo
u� TYPE
GR UP
024
APPROVED
DATE
It /NV TAX s L•O
Y
CONTRACTOR pAAy[{er
ADDRESS V
/1
oM-+T.�
TOTALPAID $54g,
TEL.
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CITY D no. 6
APPROVED SETBACKS
CITY
STATE e LIC. NO. B
LIC. NO.
(FROM C/L STREET)
SIZEN0.0FBL
139' x 359' NOW ON LOToT B
FT.
OF LOT
USE OF
N/A
EX No BLOC
Separate permits azo required for
I s
electric, find heating Work.
plumbing
REAR FT.
USE OF BUILDING ANO WORK TO BE PERFORMED
PLANNING A TION
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79
ki
rl
A ROVE jW —
1
W
I hereby acknowlMae that I have ram this application and Nate
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that Me above Information is correct and spree to comply with
'e
(i
ell laws regulating building constructl.n, and I shell net am Ploy
the workmen* compenaution laws of
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any person in violation of
/7y/��,
0
the state of California.
SD. FT.
P 1
3:
1 hereby ..rtlfy Met I am Properly licensed as a canaria, under
Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
O n
0
the State of Calllmnla Business end Profession. Code,
rHE PURPOSE OF ESTABLEHIN0 A PERMR FEE ONLY:
Iran. ere In full force entl e
Chapter 9, and that soon ffect, or I
m
emet Irom she Provisions of the Ste- of California Business
VALUATION PERMIT FEE S
and ProfesOons Co , Division 3, Chapter 9.
PLAN CHECK S 51�- (e,
024
of f�j/./+�
It /NV TAX s L•O
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Peamittee ze' +
/1
oM-+T.�
TOTALPAID $54g,
AUlhorizm Atl- r