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t` 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
r7 RECEIVED BY DATE RECEIVED DATE ISSUED
4.
&1 ADDRESSag( ,).v_e_?weitivorzoix
l FOCI
� y Ai PERMIT NO. ,
I
OWNER /// ` A.P. NO.
,1 MAIL BUILDING //g� 2,4. 6 ' 4 "/
j ADDRESS ADDRESS/ �/ A j'V
11 TEL. TRACT I LOT BLOCK
CITY NO,
CONSTRUCTIONN, EW ADO ALTER REPAIR MOVING DFMDI ISH
LENDER ,
BRANCH yy�t
OWNERJ� J .r/ fo
ADDRESS ALUE
ARCHITECT TEL. USE SLC lam[) S $ (
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE I NO.OF USE OF NEW
-CITY TE PLANS BUILDING
STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
Cee i (FROM C/L STREET)
Gy SIZE 1NO.OF BLDGS,
S OF LOT NOW ON LOT FRONT FT. FT. -
Q USE OF
.,.e EXISTING BLDG. B. SSJDE FT. - FT.
E Separate permits are required for L.SIDE FT. FT.
F'
(,] electric,plumbing and heating work.
REAR FT. FT.
ill
F USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& ;li
G
MAIN BLOC'S. ACCESS,BLDGS.
VAR.# DATE
.7.1 C.U.P.# APPROVED
Q
7 APPROVED
} __ELY OATS
a.
G 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 91--.
6e all laws regulating building construction, and I shall not employ -
Z any person in violation of the workman's compensation laws of
Sthe State of California.
I hereby certify that I am properly licensed as a contractor under SO, re FT, N 0
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o •
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 therovisions of the State of California Business 1p
P VALUATION PERMIT FEE $ 37 R�S� v 1
and Professions Code,Division 3,Chapter 9. m
m
PLAN CHECK $ C
Signature of 4,....,
Permittee $ TAX $ LL '`
U
Authorized Agent TOTAL PAID $ 3ni sz
•
•
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicantic� to Fill in Completely — Use Ink Only RECEIVED BY DATE RECEIVED
fp BUILDING/ ' ,/ •/w �� DATE ISSUED
ADDRESS( Iaf f•� 1� i
PERtinii,,16.:
OWNER A.P, NO. �'` '�
MAIL a BUILDING ore ,) o r,J
ADDRESS
OC 'L�. ADDRESS�I.'Ql, �Z-`/-L'C • ESIt�aQQ �I
CITY T4ji1ff/ TRACT LOT BLOCK
• CO UCn07 / �NEW/ ADD ALTER REPAIR MOVING DEMOLISH
LENDER /
BRANCH _. � / -mss J1
ADDRESS �,/s l OWNER ( I2THUF-C? TycL(/ARO . �``
ARCHITECT 6(�. „r _(/ jt L. ,,,,,- .5 C n 7 - Own VALUE I/ ` 1
OR ENGINEER [ N0.- �� IV 4
FIRE T7 ).�
ADDRESS ZONE TYP GROUP J
�
APPROVED
CONTRACTOR V '�/iCe -7
BY DATE
ADDRESS ZONE IND.OF USE OF NEW
TEL. PLANS BUILDING
CITY
NO.
F STATE 9 CITY YARDS APPROVED YARDS APPROVED
LIC. ND. 2
2,7
LIC.NO, MAIN BUILDING ACCESSORY BUILDING
W SIZE INO.OF SLOGS.
(FROM C/L STREET)
a. OF LOT ice- NOW ON LOT FRONT FT. FT.
G
USE OF
cn EXISTING BLDG. R.SIDE_ FT. FT.
cA
ESeparate permits are Iequired for L.SIDE FT. FT.
electric,plumbing and heating work.
W _REAR FT. FT. 1
F., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
O _MAIN BLOCS. ACCFSS. SLOGS.
Q �Vs y� ail/v I// -V LItQ �l•-rf2 C URP# DATE
APPROVED
7 APPROVED
i_-BY ` II DAT 41
g •_ Li IV I: '^I L1, = '3o rl�1. n9d
oI hereby acknowledge that I have read this application and state 3irer' OJT,;(J. X 137o • y'-- /3c ' Jam.-
c, that the above information Is correct and agree to comply with L
6. all laws regulating building construction, and I shall not employ •
Z any person In violation of the workman's compensation laws of r�� � n• z
the State of California. /J�VS-VW. FT. Z1 Q15-1) lip
[ 59c f \0
3 I hereby certify that I am properly licensed a . contractor under [/(
the State of California :usi .ss end Professi., s Cod , Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR w
Chapter 9, and that s h I .tnses ar- In fulorce a d effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt f • th r ro 1 io of e a of Cal ornia Buslne • p
,I VALUATION PERMIT FEE $
and Prof es- •ns- o•. Dorsi 3, • ep' m
PLAN CHECK $ p�
2 nn
Signature of ' f�/G00 2i a3
Permittee - $ TAX $ '{! `1-e Li t(
Authorized Agent TOTAL PAID E2 7J
0aGeni
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
9jai /� s RECEIVED BY DATE RECEIVED DATE ISSUED
BUADILDING /0 DRESS Q / i ) '•�s'^Cl
dee,ep/02 PERMIT NO.
OWNER • //�✓.A- /a' At._�_.•%-�/L..i A.P. NO.o (}({/ . A / y . s,'
MAIL
ADDRESS�2,4A-411
�'S f S 47 �4/� Zzar ./, ,j,�/ BADDRESS '��f,9 V p, 1t&L t,,.�v
/03
CITY '/(� //) f�''�"'_//"� NO`C y� TRACY bps ry LO wt.f drCK
CONSTRUCTION l�if K�� / NEW ADD ALTERVREPAIR MOVING DEMOLISH
LENDER •
BRANCH c -��2 _
ADDRESS /71 //J77aci1, OWNER • `P'
ARCHITECT TE
Lk) &AC
OR ENGINEER I�� u••••• �J S r' IrkZONE TYPE GRO
s ALU$
2a 7. �// i�%�X) . _FIRE
ADDRESS �4 • UPJir
n' APPROVED
CONTRACTOR Ln fes` BY DATE
ADDRESS
TEL. ZO -L IPLANSZ BUILDINUSE OF NEW W s`
CITY NO. GG/��s rry�`
F STATE CITY YARDS APPROVED YARDS APPROVE
LIC. NOZ�ic2.3 LIC. NO. MAIN BUILDING ACCESSORY BUILDING
SIZE L - NO.OF BLOCS. �.1 (FROM C[�L.}-STT/R�EET)(�
6. OF LOT `J NOW ON LOT �J FRONT FT.
Q USE OF _I/
un
eSCr—
EXISTING BLDG. R.SIDE ,(� F FT.
Col
F Separate permits are required for L.SIDE 40/
( /FTLS+'
(�{� FT.
electric,plumbing and heating work. REAR -,L�"rJ„I'•{�(~ FT.
LW
USE OF BUILDING AND WORK TO BE PERFORMED �I .�� ���
DISTANCE BET. BET.MAIN&
0 A MAIN BLDGS.�J �j� ACCESS.BLOCS. �/ �J'^
Q 1�✓h` ` i I`�"t _C URP.# 61671, � ? APPDATROVED5 ! /' !lY
APPROVED,,00 N4 DATE �/ '
al
�' OLD`F�'PECIAL REQUIREMENTS
w
a. I hereby acknowledge that I have read this application and state
qr that the above Information is correct and agree to comply with m
C. all lows regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of ,S ,,,,}} E
the State of California. / /f�� . / m
I hereby certify that I am properly license• as a contractor undern SQ. FT. y^ /syne/1 eu
the State of California B -mess nd Profe-.Ions Co•e, Division 3, TH AMOUNT SHOWN UNDER VALUATION IS FOR ro
Chapter 9, and t.:t ca. Ilcens s ar: Ir f I force •nd effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
to
am exempt fr. h. .,visio - of a S - . of C. fornia Business a
and Profes '.•ns •of.. `r i lo 3, al. 9 ///JJJ VALUATION PERMIT FEE S
//� / / S en
PLAN CHECK $ ro
It
Signature of (,'`_I/ / o
Permittee TAX S It
U
Authorized Agent TOTAL PAID S
•
• -
CaPI F
� -- -- -I
105,6 10/'01 CITY OF COSTA MESA
IOW `` ? VI $61 igi PARK FEES o - -
+ I Fee Payment Receipt N 248
Project Address/Ot 7 /047 ea kleS crnd Park Area I
A. P. No. N5— —6602—o/1 tea)par o) 0
Building Permit No.
Owner's Name AH1afr 119aja /y
Mailing Address
..tv2ynO 6U . COce,5/ 4et
FEE
Single Family * No. of Units @ $455.20 =
Multiple Family ** No. of Units 6� @ $32132 = 4 •448
Total
lF(�
Fee
—
Planning Department App Iv. t to irp - By l� R ��
Applicant's Signature �/"
• City Ordinance 72-44
•• City Ordinance 72-45
••• City Resolution 74-124 ea Tai
miwhite-Planning;Canary-Planning;Pink-Finance;Goldenrod-Applicant CMF 0174-26 1 t
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