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CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS,ELECTRICAL UTILITY RELOSE FORM
TRACT
LOT
ADDRESS
GAS
ELEC.
NO.
UNITS
NO.METER
OUTLETS
NO.METERS
RELEASED
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X,NEW CONSTRUCTION ❑ REWIRING ❑ OTHER
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CMF 0))146
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
, v
THESE INSPECTIONS AREA RESULT OF: (CHECKONE;
IEW CONSTRUCTION ❑REWIRING ❑ OTHER (EXPLAIN)
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CMF 077146
C
f
t CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS OR ELECTRICAL UTILITY RELEASE FORM
THESE INSPECTIONS ARE A RESULT OF: (CHECK ONE)
NEW CONSTRUCTION ❑ REWIRING ❑ OTHER (EXPLAINI
Dem leextl ,
CMF 071146
Signa
NO.
NO. METER
NO. METERS
LOT
ADDRESS
GAS ELEC.
UNITS
OUTLETS
RELEASED
TRACT
V
� 1)
THESE INSPECTIONS ARE A RESULT OF: (CHECK ONE)
NEW CONSTRUCTION ❑ REWIRING ❑ OTHER (EXPLAINI
Dem leextl ,
CMF 071146
Signa
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COSTAMESABUILDI iSAFETY DEPARTMENT APPLICA -N RUCT{iRi1`i.PERMI'668.65
P.O.BOXI MI COST.r,akSA, CALIFORNIA 92926
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For Applicant to Fib in Completely —Use Ink Only
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ADDRESSLDI
Tract 1 /�
BUILDING
OWNEROR
TENANT M.D. Janes CO. IIIc.
ADDRESS N �A
MAILING
UNIT OR
SPACE NO.
ADORE- 2950 Airwy Ave. D-9
TRA �/� LOT
BLK.
TEL.
CITY Costa Mesa No. 979-3376
e
CONS<RULIIONR
NEW
AOD LTER
REPAI
MOVING
DEMOLISH
LENDER Not selected
BRANCH N/A
OWNER
ADDRESS
VALUE
USE f
ARCHITECT TEL.
R INFER N.546_369
a
,
ADDRESS 3848 Cam LLB Dr. N B
ZONE
TYPE GROUP
APPROVED
CONTRACTOR OWner
V DATE
ADDRESS
TEL.
CITY ID NO. e
STATE CITY
APPROVEDSETBACKS
LIC. NO. B LIC. NO. e
812ENO.OF
1391 359'
BLDG
(FROM CIL STREET)
OF LOT x
NOW ON LOr A
FT
USE OF
N/A
EXISTING BLOG
Separate pemlits are required for
1. 2199 r
electric, plumbing and heating work.
REAR FT.
USE OF BUI LONG AND WORK TO BE PERFORMED
ACTION
Piq 0111f
'P}/j
09
�/LAANNING
-12-6/75
APPROVE
DATEZr
1 hereby acknowledge that I have read this application enc spare
that the above Information is correct and epee to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compenutlon laws of
the State of California.
I hereby certify that I am prowly licensed as a connector under
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the Sura of California Business and Professions Code, Division 3,
Chapter 9, and that such Iicanws are in full force and affect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
VALUATION
PERMIT FEE f
and Professions CoW, Division 3, Chapter 9.
PLAN CHECK a
Blpnatun of �(�—
PermoH
� M�
S ¢ LVV
TAX S
Q
T.
TOTAL PAID Ss6B•
Auuorlaed Ap d' alill 749
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