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192 WELLS PL - Building Permits
PROJECT ADDRESS: 192 WELLS PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 048759 OWNER'S NAME: CHENG—HSIEN YANG ADDREss: 732 TUSTIN AV PERMIT NO: B 048759 PLAN CHECK NO: 04170-90 S ' GOVT: N SUPP : N N.B . CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER: 642-1903 REO.NO.: / ADDRESS: UNIT: JOB DESCRIPTION ; CHANGE OCCUP , OF 1142SF RESID TO MED OFF SQ FT: 1 , 142 PERMITTEE: 1-----% CLAIM VALUE: 11 , 000 . 00 CALC—VALUE: 14,686 . 12 GROUP OCC: B-2 / CHENG—HSIEN YANG (714 ) 642-1903 aoDREss. 732 TUSTIN AVCOMMENTS: X [� pp qq y LICENSED CONTRACT DECIAMTION: Ihereby affirm that lam licensed undcprDvisbn?oil&Aapter9(commencing with Section *********************'**'******x'#**'k*'***'*'***'-- -* '****'********'*'*'***'*************** 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. ZONING REQUIREMENTS CITY LIC.: STATE LIC.: CLASS: SETBACKS Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: ii COMPANY: PARKING REQ• 6 PROV: 6 PARCEL : 42541311 ZNE: CL REF NO' DR-90-12 ,. Certified copy ishereby furnished. ElCenniedcopy isfiled rnmmecity Building D sion. PLANNING NOT INTERIOR ALTERATION TO CONVERT AN EXISTING RESIDENCE INTO A > MEDICAL OFFICE, ate: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed N the permit is for one hundred($100)or less). D E V E L O P: M E N T SERVICES R E Q U I R E M E N T( S I certify that in the performance of the work for which this permit is i sued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws o California. ` ' p _// L (� (" ZONING APPROVED BY ( L)� DATE; g ��7 " 1 a Date' �' Signature: C �/�1 v"�6'°? 1 �" NOTIC f,after making this declaration,you should become et to the Workers'Co nation p isions of the Labor BUILDING APPROVED BY" : DATE: Code,you must forthwith comply with such provisions or this rmit shall be deemed re ked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for '"('' ,q 1 _ which this permit is issued(Section 3097.Civ.C). *****C**I*O***SS*ED*H:*****W********* * * ******************D******C7 ***** **** LENDER: *********************************************************************i*E********** • ADDRESS: LEGALIZATION:N\- F E E SUMMARY STRUCTURAL SEGMENT:Y • OWNER BUILDER ess andDECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECk •R,IC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,Improve,demolish,or �y, repair any structure,prior to Its issuance,also requires the applicant for such permit to tile a signed statement that he/she is licensed PERMIT 16 2 .0 0 , y. — pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7OOO)of Division 3 of the Business .. •1 ," ! ' SM I P/NON—RES and Professions Code)or that he/She is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 1 0 5 . 3 0 • 2 . 20 any applicant far a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE F '. �, ,`I I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK. — TTAL • PAID DUE cl structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through TOTAL S--——> 16 4 , 2 0 0 . 0 0 ( 105 :30, • 269-. 50 269 . 50 , 0 0 his or her own employees,provided that such improvements are not intended or offered far sale.If, however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 164 . 20 OVER/SHORT: . 00 forIIIIP the purpose of sale). - BLDG PMT PLUMBING ELECTRIC MECHANIC ' `Li -FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 162 . 00 2 . 2 0 ❑ and Professions Code: T e Contractors'State License Law does not apply to an owner of property who builds or improves thereon --- .— - / and whocontracts ftheirforsudh Compenss athacontractor(s)houl beepursuant ovidedo the Contractors'State License Law).I am aware ******************************************************************************* �.— / that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.8 P.C. I N D I V I D U A L f r j F `E E ,:r.B R E A K D O W N / for this reason: �� ��� ) / TYPE QTY D E S C R I P T I O 1 UNIT COST TOTAL COST Date: /�"�j�� a 'fp oownet;: I do hereby cer6ry that I am aware of anunderstand the requirements of Calitorni eahh and Safety Code gess 255AR,25533,and SFC 1 1 4 2MED—INT, ALTER TYPE(-;, —N ,a;. —AVER 12 . 86 14 , 686 . 12 ' 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF' FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. "n l .1 Date: Applicant: , 1 I hereby certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. ,{��� // , 01 0006s'26—CD268427 Ta. tEi._� Date: At.9 17 'f� signature: c. y ._v4 ✓!e/1 t DATE: 08/27/90 TUNE: 08:4S Driver's Li nse or Social Security it: 164146 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POSPA APPROVALS Permit #' lb Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Fipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE • ' 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing afro-cy 61ttW' 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Nord' - 34. Final Heating & Air Conditioning - - - - - ' -- 35. Final Gas Pipe-Test 36. Hood or Canopy I CO- L 37. Final Factory Fireplace l/ I I if [• 38. Final Plumbing /'� -s--P ` 39. Water Service-Final v«- • C /' 40. Gas Service-Final i 4 61 Z9/911 9/Qo 41. Solar Domestic-Final �1 -}}��^^"w f 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING /m�5 tr� 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date c/A City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. Building Safety Division P.O.Box 1200 Costa Mesa,California The Building located at ion r 11a Diana has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B2 Occupancy. Use of Building Changed Occuppncy (Medical Office) Legal Description 425-413-11 (See reverse side for Metes and Bounds) BuildingPermit No D 48759 EMP 51666 EMP 51666 Electrical Permit No. Plumbing Permit No. Mechanical Permit No. EMP 51666 Number of apartments • and/or guest rooms ISSUED TO: Building Official Tony C' Da Baca Cheng-Haien Yang 192 Walls Place by •� — Costa Masa, CA 92627 Date Ocbbber 29, 1991 • This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the • Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. . CMF 1015-46 rev.1/83 White-Owner;Canary-Numerical File;Pink -Bldg. Permit File PROJECT ADDRESS: 192 WELLS PI. 0N1T' CITY OF COSTA MESA - BUILDING PERMIT PERM NO: EMP 05166( ewNERSNamE: CHENG-HSIEN YANG ADDRESS: 732 TUSTIN AV PERMIT NO: EMP 051666 PLAN CHECK NO: N GOVT: N SUPP: N N.B . CONSTRUCTION TYPE: PERMIT TYPE; ELE MEC PLU PURPOSE: ALT ARCH/ENGINEER: 642-1903 REG.ND.: ADDRESS: UNIT: JOB DESCRIPTION : CHANGE OCCUP . OF 1142SF RESID TO MED OFF SQ FT: PERMITTEE CLAIM VALUE; CALC-VALUE; GROUP OCC: 8-2 / ADDRESS: CHENG-HSIEN YANG ( 714 ) 642-1903 732 TUSTIN AV COMMENTS: REF 848759 N.D . CA 92663 #*****##IbiC*J is#9E##if###df#**ail iE)F***itif#iE## ##X1F#if#XX.X1 ****X)E#AX##af#Y #X-X-!X##X##iE# #AX LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENT' S 7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: -- MAIN BUILDING ----- ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FR NT: FT IN REAR: FT IN PANT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C).flip LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN DLICY NO.: EXP. DATE: COMPANY: PARKING REQ: PROV: PARCEL; 42541311 7.NF': REF NO: ❑ Cen ified copy is hereby famished. 0 Cenified copy is filed with the city Building Division. PLANNING N T ES> Date: Applicant 96e** K****X3E***3 *Ja-*K****3E************.*****IE*X*)tX#**#*#****SEK*ir*3E#. XX3i3E*X#X*3f**X-* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SS•. E 'R V I C E S , REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner So as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . ' ' DATE: Date: Signature: NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY •: . DATE: _ _ Code.you must lonhwith comply with such provisions or this permit shall be deemed revoked. �� - CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: •�_�S DATE: 2- ii which this permit is issued(Section 3097.Civ.C). k3 *3f*v-M***X.401-:$.***** f3E ( `3E±t� -:n 'Or. . .•3E#r:3 ***-3r 3.****):*k#i(..3c****#ir;. 1 -• ...t. 7n° LENDER: ********if#3E3cif 3*#'k343!**34-ii.3F1Ear.3Eif#343f3f X:** fXiEif , rfiEie3r1f'i.343ffk3F3a#3(-*** cA'?f.k+c-1=l?ek-X+3E3f-?*Yiii•:3Fit16#A- ADDRESS: LEGALIZATION:N F_ E E . U M M A R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELF TRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 8 . 00 4_ 7 J 2 2 50 repair any structure,prior to its issuance.also requires the applicant for such permit to lite a signed statement that he/she is licensed • pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% 50 4 2 5% SMIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 . 00 15 • 00 15 . 00 / I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE �1-1 structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS-----> 78 , 25 33 . 00 0 . 00 111 , 25 111 , 25 . UU does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or offered for sale. If, however the building or ' improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 111 . 25 OVER/SHORT• 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 1 1. . 00 62 . 75 ' 37 , 50 ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of properly who builds or improves thereon ' and who contracts for such protects with a contractor(s)license pursuant to the Contractors'Stale License Law).l am aware **X**Xif#P`*A#if*X4#*100(.*)9if*****3fSir***If*****if*lf*3E**X•**)910E1ii.8O Ifif3E149X3fh:i4.3eiE***191E*X-X..i!.i4*ir#M.*?.1 (hal proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B 8 P.C. INDIVIDUAL F E E BREAKDOWN for this reason: /� /' TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: I'1�9 Owner C Gn --A G -e ELE 15 FIXTURES LIGHTING 1 ST 20 EA. . 75 11 . 25 I do hereby certify that I am aware of and understand the requirements of Calil nia alth and Safety Co coons 255 ,25533,and t 25534 and that t or any future building occupant wilNwill not(circle one)need t co ply with said state c s and the requirements for a ELE 13 RECEPT/OUTLET 1 ST 20 EA. . 75 9 . 75 permit for construction or modification from the Air Duality Management Oistric. esidential construction applications are exempt from ELE 11 RECEPT/SWI TCA 1 ST 20 EA, . 75 8 . 25 these provisions. ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 18 . 50 18 . 50 U NEC 2 REFRIGERATION SYSTEM <= 100 K BTU/H 9 . 00 18. 00 Date: ` •-(1---41 Applicant: MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4 . 50 4 . 50 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county PLU 3 WASH BASIN 2 . 00 6 . 00 ordinances and state laws relating to building construction and hereby authorize reprsentatives of this city to enter upon the above-mentioned PLU 1 WATER CLOSET (TOILET) 2 . 00 2 . 00 property for inspection purposes. END OF FEES Dale'.SG`")-^ q4 Signature N/ "4/22 ,7 Qi 00084791-00034793 '�-a�E-� Driver's License or Social Security p: (• ,- - 164146 White-Building;Green-Code Enforcement Canary-Applicant;Pink-Revenue:Goldenrod-Assessor Q1y4�:' 04/12191 Tlfi'E: 14:14 CONSTRUCTION AND PLANNING I SL& SPA• APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector ;1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,`- 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring hl T 67. Fencing & Access Approval 17. Rough Wiring Sign '1 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑'Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation _-- 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ------ 31. Plaster Brown Coat poi Cr 9. FINAL INSPECTION 32. Electrical Power Meter-Final !D II/ efgafir 0. FOOD CERTIFICATE ISSUED 33. Final Electric *di( D � otes. / 34. Final Heating & Air Conditioning fr a, Gar by at'� 35. Final Gas Pipe-Test 66 R 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing £V-'&-- ( 1&,. 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ,.. ."- 4q. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 192 WELLS PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05194: OWNER'S NAME: CHENG—HSIEN YANG ADDRESS: 732 TUSTIN AV PERMIT NO: B 051943 . PLAN CHECK NO: 01558-91 S GOVT: N SUPP: N N.B. CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH 642-1903 ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : NEW TRASH ENCLOSURE SQ FT: 1 , 500 ADDRESS: UNIT: CLAIM VALUE: 1 , 500. 00 CALL—VALUE: 1, 500 .00 GROUP OCC: B-2 / PERMITTEE: CHENG—HSIEN YANG ( 714 ) 642-1903 ADDRESS: N.B.73TUSTIN AV ********4*****B**************B*D*i*******+Fir****************************at*a6***** B. CA 92663 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions Of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000f of Division 3 of the Business and Professions Code.and my license is in full farce and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Dale: signature: MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: • FT IN REAR: FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C). . POLICY NO.: EXP.DATE: 'COMPANY: PARKING REQ• PROV: PARCEL: 42541311 ZNE: REF NO: Cendied copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > Dale: Applicant.• DEVELOPMENT SERVICES R V I C E S R E Q U I R E M E N T S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). I ceniy Mal in the performance of the work for which this permit is issued.I shall nos employ any person in any manner so as to become ,�}''� sublect to the Workers'Compensation Laws of California. ZONING APPROVED BY : LI DATE: 2-7)1(7 Date: Signature: BUILDING APPROVED BY -... ii" .t► DATE: Sl6 (qt NOTICE:II,atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. / CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: •_ DATE: 6 which this permit is issued(Section 3097.Civ.C). *********************** ** ***Yl *** lE******************** * * **** LENDER: ****************************************** *********************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License law tor the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 35. 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMI P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by P1' 22 . 75 rj 0 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(8500). ISSUE FEE I. as owner of the property or my empfoyers with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Lt structure is not intended or offered foe sale(section 7044.Business and Professional Code: The Contractors State License Law TOTALS----> 35. 50 Q , Q 0 22 . 75 5 8 • 2 5 58 . 25 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 58 . 25 OVER/SHORT: 00 for theepurpt is sold le). one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale/. I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 35. 00 • ' S Q 2 2 75 ❑ and PrhcontraThe Coojectrs'with ate contraseLawdoesprsuatoo owner property who icensorimp.ol improvesthereon •******************************************************************************* and who contracts for such projects with a e License Lawlicense not apply t to the Contractors'State builds or est aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN : ❑ f am exempt under Section: B.&P.C. for this reason: - TYPE QTY DESCRIPTION UNIT COST TOTAL COST Date: 3-- a - 9/ Owner ! i SFC 1500 ALTER BY VALUE COMMERCIAL NOZONE 1 .00 1 , 500. 00 I do hereby certify that I am aware of and understand the requirements of California H and Safety Code Se is 25505,2/ ,and - END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to com with said state codes.••the require nts for a permit for construction or modification from the Air ualily Management District.Residential construction applications are exempt from these provisions. 1 Date. 5 —(n"--91Applicant: ,ea's/ I hereby certify that I have read this application and stale that the above in ation is correct.I agree glomply with;/city and county ordinances and state laws relating to building construction and hereby author e representatives of this cit enter upon I e above.mentioned - properly for inspection purposes. _ _ _ Dale: S b- 7/ Signature: _i✓�/ i — — SATE: 05/06/91 :ME':2 ''.. „1 "4.' Duvets License or Social Security / / • ' / 1641.46 White—Building:Green—Code Enforcement:Canary—'pelican%Pink—Revenue:Goldenrod—Assessor V CONSTRUCTION AND PLANNING ' POS SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement - . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . • :4t-Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' i r ri5. Steel Reinforcement 9 21-gf 6,041 56. Rough Plumbing & Pressure Test _ 6.-,Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE - 7. Footings `' q.-2.q-qi 158. Electrical Conduit-Undrgrnd. 8. Foundation 7; 59. Gas Pipe, 0 Undrgrnd., Test • 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. ' 10. Structural Floor System 61. APPROVAL TO DECK . • 11. Property Sewer Line& House Connection 62. Backwash & Receptor-Final ' • • 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing ' 65. Electrical-Final ' - 15. Rough Electrical-Conduit 66. Solar System-Final - • 16. Rough Electri2Wiring 67. Fencing & Access Approval • , 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING . -- 18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT 20.- Rough Factory Fireplace I - a^. - J S' 'APPROVALS?°Permit# ""-. 't tr.'4. .x S . ; .t .K u. - - - • 21. Ducts, in Structures •• •• r • S r :70. Underground Hydro - 22. Ducts, Ventilating : ti A `r ' c71. Produc(Piping 0 Gas goo 23..Gas P,petRough � Test _Kis ` r �T � - -72. Underground Flusji o: 24.-Roof Framing t : - -* D ? 73' Undergrnd.Storaq�Tank'0 Gas 0 Oil 25. Roof Sheathing it': ?y' t_' i. •r , '74=Overhead Hydro•s 26.-'T-Bar Ceiling (Structural) &:Monocoat _ -n '7 [*1: - 757 Dry_Chemical , I ¢ C 27 Frame and Flashin~9 'r ' .11 '- X ^' ' . _,r r . : - r- , 76. bry StandPi Pe : T, 1. - 28. Lathing;& Siding - 4,-,s.^''C 6.2 x '. 777 FIXED SYSTENM•EINAL, -, n 1; r '29. Insulation .. '' y ' -1 , - . T 761 FIRE PREY. FINAL : � rr X30. Drywall:Nailing .5w -4- - • _I -;l .i u c •HEALTHrDEPT.REQUIREMENT .1:1 m '-,31. Plaster Brown Coat; s r r. } ,H ' j" . 79:FINAL INSPECTION - '' , -.32.,Electrical Power:Meter-Final' r f , E: a -80: FOOD CERTIFICATE ISSUED - .. • I ; x - 33?Finl Electric , T Lt x '' I • f; �Noies: : a. �r34^Final Heating & Ai%Conditionngi : 2. . S •-' r;- _ 35._Final Gas Pipe-Test; :•,'- ' r• •-1 rL 'I - ' J _ J .�• . ,_At 4, f I r`. ..I r ,. 36. Hood or Canopy •-. - ' n•y -, 1- • •.v V : y .. . ., :•1 r 37.-Final Factory Firet3lace„ {" ; .r -38. Fir1a1 Plumbing o „ a _, • *it :39:Water Service-Final' Tr. • • -- • I r �. ♦ .F, , . -,40.,..,Gas Service-final . ,, .r.r - » .T, I •- e. -'= „:% - -41f-Solar Domestic-Final's* .-•. I v. -Lt.1 42:''Backflow Preventer. '. 'f '� I tl '� �� a I atl -LI 43. Backflow Irrigation - x .`,, & `; y i s , l V . „44. Landscape Irrigation System ,•; l z ti r Jx - L. ii C_ C O s'45.:Sound Attenuation �'� '•3 •� t. a rh • . . t _46.:Handicap Regulations • y, '. :, . _ - 47.•FINAL STRUCTURE & BUILDING 0-F4 4w:, : 'i 5c f T 48:'FINAL PLANNING - �; 4 _ - -; 49.-Electric Release to-Edison - - •-I /1+ . .0 ' •,• , , I c. K .� 50. Gas Release to Southern California Gas Co -•I 1 if r ' ,;:.2, - `='�r':., t . t 51. CERTIFICATE OF4OCCUPANCY . ; , i i.-, . ' i . o ' No. Date r 1 l'ROJECTADDRESS: 192 WELLS PL UNIT: CITY OF COSTA MESA — SIGN PERMIT PERM NO: SB 055512 OwNEANAME: ADDRESS: YANG, CHENG HSIEN YANG MEI HWEI PERMIT NO: SB 055513 PLAN CHECK NO: 05173-91 S GOVT: N SUPP: N 732 YANG, NEWPORT BEACH,CA 92663 CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH ARCH/ENGINEER: 642-1903 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : 20SF WALL SIGN SQ FT: PERMITTEE: CLAIM YANG ( 714 )692-1903 CLAIM VALUE: 300. 00 CALC—VALUE: 300. 00 GROUP OCC: B-2 / ADDRESS: ( 1921MWELLS PL (rpp qq COMMENTS: X Off GENERATION: Tdd Ohs�� p�er9(commencing with Section **BP**********Bf*******ifiFIEM1F1 ****1Eif3f�Eiflt**********lfiEa ***lt****ifiEMiFiEik�EEfiElE�FiE1FlF�flflt#*** LICENSED CONTRACT 0 ATION: I hereby affirm that I am licensed uncle r visi 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. 5 I G N INFORMAT ION CITY LIC.: STATE LIC.: CLASS: DISTRICT: 3 TYPE: WALL ILLUMINATION: NON CATEGORY: NEW DIMENSIONS: 3FT OOIN X 6FT 10IN AREA: 20. 005 FT LETTER HT: 5" Date: Signature: STREET FRONTAGE 1 : 60. 00 STREET 1 : WELLS WORKERS'COMPENSATION DECLARATION: I hereby affirm that have a certificate of consent to self-insure or a certificate of Workers' STREET FRONTAGE 2 : 120. 00 STREET 2: CABRILLO Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). PARCEL: 42541311 ZONE: CL LOCATION > FRONT: X REAR: POLICY NO.: EXP.DATE: BUSINESS NAME: HOLISTIC HEALTH CARE > LEFT: RIGHT: COMPANY: OTHER TOTALS GROUND SIGN i l Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. THIS ACTIVITY 20. 00SQFT OVERALL HEIGHT: OFT O I N THIS SITE 20. 00SQFT GROUND CLEARANCE: OFT OIN : Applicant: ITEMS OF INFO 5 PLANTER AREA: 0:OOSQFT EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). ITEMS FOR ACTIVITY: 5 BLDG SET BACK: 20FT - Icertifythatintheperformanceoftheworkforwhichthispermitisissued.Ishallnotemployanypersoninartymannersoastobecome COPY VERBIAGE : HOLISTIC HEALTH CARE ACUPUNCTURE 6 HERBS subfect to the Workers'Compensation Laws of California. (714 ) 642-3888 Date: Signature: PLANNING NOTES: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor *****ffiE3FiFiflElEiflflfiElEaEiE********3F****iF********{E{Ef{{F{Ea ****{(.{M1{F{L****{E{F{(.{F{L{Fy.{L.{P{(.,8(.*{(.*{e*�Faf.11.3L. Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. DEVELOPMENT V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for 3 which this permit is issued(Section 3097.Civ.C). ZONING APPROVED BYficijaAfte‘ DATE: l.1 I l 1 /`I I LENDER: ADDRESS: BUILDING APPROVED BY : DATE: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED BY DATE: i 2(�1 I (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or •- t repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed ******'*******************************•***** *" *********'****'********'** * �* **** pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business LEGALIZATION:N F E E S U M MAR Y STRUCTURAL SEGMENT:V and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADING I. as owner of the property or my employees with wages as their sole compensation, will do the work. and the PERMIT 15 . 00 20.00 IR structure is not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License LawSMIP/NON—RES does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through PLAN 9 . 75 his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or . 50 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve ISSUE FEE for the purpose ol sale). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business TOTALS——--> 35. 50 0. 00 9 . 75 45. 25 45 . 25 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Stale License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. ,REVENUE DIVISION TOTALS--> COLLECTED: 45. 25 OVER/SHORT: . 00 ❑ lamexempt under Section: B.BP.C. ( BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN— HECK lor this reason: q / //�� 15.00 20.00 . 50 9 . 75 Date: Del / 2 �/ / /er / /bf" I do hereby certify that I am aware of and understand the requirf California a th and Safety Code Secti 1MfiYt[5505,255and INDIVIDUAL FEE BREAKDOWN 25534 and that I or any future building occupant will/will not(circle one)need to co with said state codes and e requireme for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST these provisions. Date. Applicant: NO FEES WERE SELECTED FOR THIS PERMIT I hereby certify that I have read this application an tate that the above information is correct.I agree to comply with all city and c i'nty ordinances and state laws relating to building con ruction and hereby authorize representatives of this city to enter upon the above-me oned property or inspection purposes. r / ' i /Driver's License or Social Security a: 1641.46 White—mudding:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor • - r CONSTRUCTION AND PLANNING POOL A APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. _ 53. Steel Reinforcement ._3 geGirriCal Condtii,Utility-Undrgrnd. - 54. Forms 4.'Et coital Conduit'Undrgrnd. • 55. Electrical Bonding `te".eRtlnforcertaetat 56. Rough Plumbing & Pressure Test ' Eltttrical UFER-Grnd. 57. APPROVAL TO COVER•GUNITE -� . 1,--...-. N -rot. j ,7..F''p togs 58. Electrical Conduit-Undrgrnd. -• .,.}. ems. }.]' .'Foundation y - 59. Gas Pipe, 0 Undrgrnd., Test - $r 95 Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK • 11. Property Sewer Line House Connection 62. Backwash & Receptor-Final 12. SeweP Cap 63. Heater & Vent-Final 13. Roof Drains o 64. Plumbing System - Final 14. Rough PlumbiniC 'D 65. Electrical-Final 15. Rough Electricat.Conduit 66. Solar System-Final . a 16. Rough Electric Wiring 67. Fencing & Access Approval ' 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough ElectricSFT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT tJt"^' s , ce It <i. -• C 0-'1-i!t1:-• cc t t-, 20. tRou h Fa¢torli Fireplace-t-+i-•t--'C 0 tr t;H:-^ ''i:+, 0 'APPROVALS ill PeaautlA t+' :4..: cc UJ it *yc. ,u5'LK'1•,tCC:V .-a -I ti ma' r S r� ,r t•C <.:i.•-i •> •7 7 -r -i L.rrtt itti tlt-a N V>, _> S4 H - Y y Cr-Pr $ ,n 21. Ducts,in trtietur * ix strtr,tr.5`.-1 w u :..F S aO.,-)Underground FTIyOt-� S 22. Duct Vltil'eting •ti:- Ct' cC :'r boc )1.15eod'ct Piping Q`G s' 01080 *_ 23.'jas fipei?ottgh&'rest S�, a_- ; rr XIlV •--x. t,. a .12.,'�iiderground Flush- i ,CJ.' f. - ., ,c. ._ . S.S,....C,,.. S.,:C S.1. JK Y. , 24.rRoo&Framing• r 1-- F•-12: i-• ,>•n` 4* > 0 -73. U u%rgr 1.StorageTank da'a• 0011 'r ajrr',-rr(ty tl:-ern :? 1, "'-� I C.: .F 25. Roo�5hilthin a >' ,^�w - --• ;3 . :n to - -.-0 9 s ..',....5:•:.r..,•:`'-' :,:'r T•'-•r r .x ' 74.r }}yerheaa Hydro :r v ` N„ .-. .D r -_ - .S i -t 26.-,VT,-BanCeiling (Structfura l)••&•Monocha- Y: 'D C75.jlty Chomical 1 1 - 27.'Frame anq �TFlashint =D 2_,:,',..,110 " " '' "971-- •-' iv 6.._D`(Y StaZSi�iPerj 't Om t to i•••••= li j •T _ 4.,28.lathing Siding :r r S yin•;.•t vn.ro`^ x F .77. ' IXEDYSTEM F-INAL =S N 29. Insulation o v, r, -toonryov1 -+la x m 78. ORE FINAL 1 to t p tX tr r :a . >, . . �, f u F 30. Drywall Nailing . H 0 �troo� m I a. r 4f EALTH'DEPT•vRfiQUIREMENT 'r; 1111. Plaster B•�own-Coat ,',: tr; y CO 1: `.Sjo.,o, r 71.9. F1N(,tL1NSPECTI(3N� i� +. r.J Q' r;•5 y . S kr r ,.x; x - r t14-t •ty ,- .. . c$2.:. lectrica}•Power Meter-Final -ir',, r-- - ac x co 8J. F(.O©O Cs£RTIFICATE ISSUED 4 'C b3.`sEinal-Electric' o - flUC f ', tri Note `t' '•" cr •' :-.• , m .> :z t-c s 'Sm <C it - ~;tri . -- 3 .v !� i t- Uv t0. - V .ft , n LII >34.-Final-Heating-& Air-Lejtditioning- •,1 * ttii :g- S 'iz v s 3 ti .. .- ^, ♦ F. nl -' , r-rr ', t[1 795.ffinat•Gas PipeTest,y m i; S' y :F I. iv ri n ^4S v. re n ? CJ >, v J :4: i Is ^r . 7 nI G7 36.Hoo¢or Canopy t - I it a. Y il.. '' a -. ^- ..� .>;.- r 5' •r•n. u gI i87.Sinal:Factory Firepl5c�e.H u�'.O n x to:is 1 I a s X :t ,y 1 , .. , spin n'S tr J (-. :F t0 I a .y .u0.� x .'. 38..FindliPlumbing -r <t'7-, tr1t-•F U r V I L S •'0 : z' 1 ; ^ C_ 9. Water Service-Final>. i-: • 56 tvt1: 4 n ..ti.SO :r r a .r. r_• a. •.-0-,•.:;i .T.rn s 7••7 * IX I 1' )+ n: C -, -• 1 . -.1'... rt •y O. .F ir n0.`'; asr$ervice-Fihal t"s`i '• x tit -rt=: -9 ,5 Lr; c41.•Solar Domestic-Final -- c--'- w D'77.1E-1-Dt7 * 23 I I r g tri r• y „lF-,itr r,;-m.tC " I !7 :J�, '-jr-Ir•. C ? 7: 0 it: 42.r�ackf low Preventer» 5 7.K S't: t .Y'W7 '' a ! I tt i-.0 '--' ' 7 •• Nt- [7 .0 a• :,! x'. 1 t.. 0 • 7Y • 7: C =o 43. Backflow Irrigation-c Std '-1 0 r:tz r1 ' F tgt-c-..: .. C ' Y - !II'rtrn;1 r. 4. CO x C' ?44. Landscape Itrrlgatioil'SyS7dA .;fit,!`. ::<74. t tTt O C ;;r X Cu w 'rt.; J, 5 f - .• .,,.^ -S .".1 .0 �.. :: ^^ • ' r - 45.(Sound Attenuation. -S .tt7-• ,. 5: I:'-t .Th , - .. :0-1 4t) CC•S s 6.1Handicap RegulatioOs 1t :_ -.•� Y � tr •• •• -' ••` .r :.t k _ r: tr .R .� • t7 n.• .5 ti 47.•EIN$LSTRUCTURE &BUILDING l-hf..q I I IF '3 int Sb - r 4,.r L 1748. INALPLANNING; `�5ps .r I to M tc t •'J • '49.'EEledfic Release to ddison ' 'tr I fr 5. ; 4 • i - a - I t to,rn crI :1 :- ,;50.,,Gas,ReIease to Southern California Gas Co v. I It _ 0 . 'ri . s C r 51. CERT IFICATE OF:000UPANCY a •-1 > ^ rho s , No. - Date _ PROJECT ADDRESS: UNIT: OWNER'S NAME: 192 WELLS PL CITY OF COSTA MESA — SIGN PERMIT PERM NO: SB 055514 ADDRESS: YANG, CHENG HSIEN YANG MEI HWEI PERMIT NO: SB 055514 PLAN CHECK NO: 05174-91 S GOVT: N SUPP: N 732 YANG, NEWPORT BEACH,CA 92663 CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH ARCH/ENGINEER: 642-1903 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION ; 15SF NONLUMINATED GROUND SIGN SQ FT: PERMITTEE: CLAIM VALUE: 400 . 00 CALC—VALUE: 400. 00 GROUP OCC: B-2 / ADDRESS: CHENG—HSIEN YANG ( 714 )642-1903 192 WELLS PL COMMENTS: X ekAVLc x.v4*-SD95S-ib (` MT,l CA.92 ********************* ****Sc*;Ikr******�P*+ter**ar*+ESF***�P*Sr Sr****+P*SE***�F*�F�F*�F***SF****** LICENSED CONTRACTOR QELCAAATIDN: I hereby affirm that I am licensed under provisions of aper 9(commencing with Section $ I G N I N F O R M A T I O N 7000)of Division 3 of me Business and Professions Code.and my license is in fun force and effect. DISTRICT; 3 TYPE• GROUND ILLUMINATION: NON CATEGORY: NEW CITY LIC.: STATE LIC.: CLASS: DIMENSIONS: 2FT 06IN X 6FT 00IN AREA: 15. 00SQFT LETTER HT: 5" Date: Signature:_ STREET FRONTAGE 1 : 60 ,00 STREET 1 : WELLS WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' STREET FRONTAGE 2 : 120 .00 STREET 2 : CABRILLO Compensation Insurance.or a certified copy thereof(Section 3800.Lab.CI. PARCEL: 42541311 ZONE: CL LOCAT ION > FRONT: REAR: POLICY NO.. ERP.DATE: BUSINESS NAME: HOLISTIC HEALTH CARE > LEFT: X RIGHT: COMPANY: OTHER TOTALS GROUND SIGN Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. THIS ACTIVITY • 15, 005 FT OVERALL HEIGHT: SFT 01 N THIS SITE : 35, 00SQFT GROUND CLEARANCE: 2FT - 6IN uate: _. Applicant: ITEMS OF INFO : 5 PLANTER AREA: 30 .r00SQFT EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). ITEMS FOR ACTIVITY: 10 BLDG SET BACK: 20FT I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become COPY VERBIAGE : HOLISTIC HEALTH CARE ACUPUNCTURE & HERBS ' subject to the Workers'Compensation Laws of California. ( 714 ) 642-3888 :✓' Date: Signature:— PLANNING NOTES: 5 ITEMS PER STREET FRONTAGE NOTICE:II,alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor *************************************************{L**********{(.*.****************.* Code.you must forthwith comply with such provisions Or this permit shall be deemed revoked. DEVELOPMENT SERVICES R E Q U I R E M E N' T S CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for �,n which this perms is issued(Section 3097,Cu.Cl. ZONING APPROVED BY \s-Q,AM DATE: 12:{'(1 ( c LENDER: ADDRESS: BUILDING APPROVED BY : DATE: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED BY• \ DATE: v (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish.or ************************************** ************************** * * �'*' *,* repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADING I, as owner of the property or my employees with wages as their sole compensation. will do the work, and the PERMIT 15, 00 15. 00 'c structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law SMIP/NON—RES does not apply to an owner of a properly who builds or improves thereon.and who does such work himself/herself or through PLAN 9 . 75 . 50 his or her own employees.provided that such improvements are not intended or offered for sale. It,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve ISSUE FEE ' for thepurposeolsale). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business TOTALS----> 30. 50 0 .00 9 . 75 40. 25 40. 25 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware REVENUE DIVISION TOTALS--> COLLECTED• 40. 25 OVER/SHORT; 00 that proof of their Worker's Compensation insurance shouldbe provided to me. ! BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMI P/TOT GRADING PLAN—CHECK ❑ I r this re exempt under Section'. B.&P.l/ Ike �� 15.00,./. 15.00 . 5 0 9. 75 for reason: fl// Date: �E! /, / / / Owner.` I do hereby certify that am aware of and understand the requirements of California and Safety Code 5 fns 255P5, 5533,and INDIVIDUAL F E E BREAKDOWN 25534 and that I or any future building occupant wiNvnll not(circle one)need to corth said state codes d the requirements for a DESCRIPTIO S C R I P T I O N UNIT COST TYPE permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from QTYTOTAL COST these provisions. NO FEES WERE SELECTED FOR THIS PERMIT Date: _ A •licant: I hereby certify that I have read this applicatio and state that the above information is correct.I agree to comply with all city nd county ordinances and slate laws relating to building cLgnature: truction and hereby a thorite representatives of this city to enter upon the abov mentioned property for inspection purposes. y� Crate a"( /2 !/ / 4' A.A. e 1 /7 s. ( ' — Driver's License or Social Security n: / Civ/ • ^4,.t.:- 1641'46 white—Building;Green—Code Enforcement:Cenery—Applicant:Pink—Revenue;Goldenrod—Assessor ... CONSTRUCTION AND PLANNING POO PA APPROVALS Permit# • Date Inspector APPROVALS Permit # Date Inspector • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement „,3-5` I tpiF l Condl¢I,Uktity-Undrgrnd. 54. Forms d: )- I.--•T- al ContlUltc4Undrgrnd. 55. Electrical Bonding T- ,. Ec$ 1-19emforceiiiit 56. Rough Plumbing & Pressure Test ' -T r,I-.r.Lq _� 'ETC74ical UFEer•G[nd. 57. APPROVAL TO COVER-GUNITE 7. :Bootings 58. Electrical Conduit-Undrgrnd. •a- IT•i Itt •,t• 7•t? -• 1'$'..;`rounAation S�' 59. Gas Pipe, 0 Undrgrnd.,Test 61 .E 9S Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line-& House Connection 62. Backwash & Receptor-Final ' -n .t 12. Sew�dCap a 63. Heater & Vent-Final 13. Roof Drains rc 64. Plumbing System - Final 14. Rough Plumbing: sr 65. Electrical-Final 15. Rough ElectricalConduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical=T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '-C e(* I c.-;er.., ,x 20.rf3ouglh Factory Fireplace•.,-,'--;-cc ;.c c:- - .1 w C 'APPROVALS to Pernt6t)#" In - >^ ll- 't' vt 3 r 31c.kr tCtrrU _T,0:r .r-. ' r4. : iK ri).- `i-SJi ” • 21.i�ucn ,inz$iru8tu�Yr !:m7 tl[l, l-S-�,J J',, ,''' :>xn :-. -i0._Ynaergrotd l�ro-"•; ,g * r •- r22 -Ducts, VftntilBting-t f,-- - • n;;-n •CC.ri :x •r 1.•-•Proifbct Piping f Gas! 1:1•041 i 23.t�ias•Pipe ougi&'T@st `-$:.ca Xi-. r- • i. , J 72 -, 1- a ai:30cAS •> - . + :n 7 v, .L $erground Fluih7 4 r,GJi•- * 24._SootFreming• -:-..e.i ;- r•.) ( .x ' c73. Undergrtt'd.StoragdTank13'Bas• 0'Oil &frC _ T•r', • .,n ' Is ft" -a I nes-r, r$la ' •A 25. Roo?Shthing .*F iwST_t[trlJp`- " is L1 � L� 4 t44veeheatl Hydro -i'-` •r v H • : 26..T-Bar,Ceiling (Structuraalif.M00ocott• '.O C75.iOry Chemical • i +27.'Frame and Flashing* •-•••••0 O+-'_ •• •• •' _• ,* a tr.•-- '+ c - q g'. +c+t• SCJ - . J• ,'j6..rDrY StandPiPe" 1.<0 '.c 28. Lath In g 1 '`S rt yeti:-.:^ ... -a; i'A �+ - . t,, -, ,, - ` - g a Siding ^.c,[G--. * 5 •77. ••FIXEOSYSTEM FINAL' t •-29. Insulati o o '' '�:oc:1 ' "- .'•-J -rim - •i ' 4 a co . •.7rr•;• , •• •cs. .r. I 38. kiRE P1EV. FINAL t to t :-• a; to '30. Drywall,flailing . i-' ..pcy`Ga = o 1 e-x I p: 1--HEALTH.DEPT 9i QUIREMENT t'i H '=31. Plaster EgDwp,Coat. t: `C t,• 01 tVO !tit t 19. F1N�LTNSPECTIOtC.,' a _- !' N _t * r• k�t..:•r ��9% J - tri 32._ElectriciPower Meters-Fina] - - f -. •� ,: 0; 1i0. FtoOD G.ERTIFICAI t ISSUED tc; :- • _2 tr ,tp3.'GinaFElectriF! - ' • n�Tr. • * ; dotes'. tr; t-c - y34..FinaHe3�iny'& F,ir,,Conditioning �.y - . I. I( ;.+l x x'35 FinahGa's Pipe-Test• tr •.i ?. t . -4k y I, ti - n r a (': . x36.91104.or,CanopY 41:.. v v - n en I s• `+ 1 i X r'37.:FinaUFactory Fireplace r.,.Xn - t' I ` :_ .. .. -7 T r, - 'r:.0 r•'vs i^ I i yt 'w 4. - :18..Fina1-Plumbin "'rSr- . :U •l Y K v .U- * � .:39.-Wates Service-Final* :.5' • :•-> 7 'r I I .4 >• , • c4...s. r • ;r rn t.- .a T: -n.. i •<'t;-n , r x ,r 1 O a - .-• 240.epas Service-ee1al a - ,:-:(•:.-?; . " J tZ -' -. 7 ' pt ' R G`'• - * n ni .. t I r,'. . .? ,17 - 17.1........u.:.....: r F41.Solar Domestix•Final -.`-tr t0::. .-.7.--; - .rt -r. U I N •moo, '+' --- 1 Q••„-.-,n, •r an1 UAi:, :�; r 42.11ackflow Preventer' ., '-•u: earl: S - 'c •T'' 1 -''v Si '" f41-i Irl vi .r I E+ •?'� • .r J r-. 43. Backflow Irrikation-t ,3,to -, c', sec• a :r 0 (ZE^O 1. C. Landsca Ir?gatio Syste `1 '' A- - C" , 3 ::.44. Rg .� -13' :- •• •• •• - In `-' C •.: ::C CS W :r t.;_ x 4 45.Fund Attercuationr L.Z ;r1,'--. :, -a (-•%= C: - ,-, '.^O U;`; 2; ,r -, •r et-r• Ir rn , t.. r_ „ ,t . HO .. '46.iHandicaf3'Re ulations th(- tr, ,'=' .1 ' to -• 1 'D '•,_, '47..FINAJ LSTRUCTU4E &BUILDING " ., Q / 1 t.. of t''''' O •, '48.,IN4L •PLANNING •' cr. o,. 'r IJ n- • i .� ,- ,•49.tEEIectic Release to tdisby .= ( I , E Z c; T s . i ti- lO' • - "50., as.Release to Southern California Gas CO r I I I : t: 4:, , 7$51. CERTIFICATE OFpCCUPANCY o :, -a rr'„ . No. Date OWNER DORN, DONALD pqG 2 3 1961 DATE2-23-61 JOB ADDRESS 192 Wells Pl. BUILDING PERMIT NO. 13891 GENERAL CONTRACTOR Owner-Bldr. VALUE $ 500.00 AP.No. 717-112-11 LOT TRACT _ FIRE ZONE DESCRIPTION OF WORIbxt.Alter.t° Res. INSPECTIONS DATE E GROUP I & J TYPE V ZONE R1t Underground Soil U.G. Water PERMITS ISSUED La-=;^'-Sground Gas —`— SUBCONTRACTOR DATE NUMBER CV,Tdead Water and Gas Rough Heating Rough Plumbing _ Miscellaneous _ Prop. Swr. Line House Con. St. Swr. _ Sprinkling System Heating, Final - Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring _ Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod _ Bond Beam _ }p. Sheathing D Frame and Flashing P' Lathing, In Out _ P r, brown coat P1. aing Fixtures, Final Electric Fixtures, Final • ar Building, Final .___ n wale I' t _ OCCUPANCY f - Form 210-5M-11-59 5-B P - 13891 FEE RECEIVED 13891 Fad 23 196.1 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT, P, O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING " /2ZBUILDING ADDRESS 2 INEAL-S COSTA MESA. CALIFORNIA� For Office Use Only OWNER pa 4//1L P D 1/I/4N I RECEIPT No, Ilt 3P¢MTX10. MAIL ',/!NELL RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS /91 VI/ E{ LtL S / L (, ,In ,.....--7"-A--1° Ia'-.� .3--G/ I-1 -02 3 -e/ CITY (OJT/9 A/ILS,Q TNO.�/od/// BUILDING ADDRESS ARCHITECT ,�J TEL. -1 COSTA MESA. CALIFORNIA OR ENGINEER NO. �),/ ADDRESS PIRE ' //ZONE TYPE � GROUP ..// CONTRACTOR 0 Y✓IV g/es ABYPROVED?i),,/ozy / DATE .2-o/ 67 ADDRESS .SAM` ojJ ,C/!/ZONING ZONED ` UANS O) UOGhEW CITY LIC.710./4 Jr "+ 9 9 O./J 70 91/ DESCRIPTIONS/ l 7A LEGAL /iii SIZE OF LOT I,0 ' / �5 ` ) I No, op Btnae. Q / X /-AJ n NOW ON LOT 2 A.P.NO. /I/ 7 // )— • / USE OF �x. '�Ag G.` YARDS tt EVES EXISTING BLDGi HO APPROVED ALLOWED SETBACK LINE FROM /� l (( (CENTER LINE ST.) CENTER OP STREET li If REAR YARD 27C•:I FRONT I 777 / ( ' // rrt. SIDE YARD LEFT /4 4:rRIGHT !O B y R.SIDE . IN. DESCRIPTION OF IpIWORK L.SIDET. N. NEW I\y� II ALTERATION I�. II ADDITION I REAR Jr FT. IN. REPAIR I/` II MOVING I u DEMOLISH .I APPROVED j`i �J /.%1 DATE 5-( ,/ SIZE BUILDING /o 20,,TJ / ROOMS k STORIES / (•C -at (� � EXTERIOR WALIb ROOF AlCOVERING `3/UC4 COVERING G C ! t Of . USE OF BUILDING AND WORK TO BE PERFORMEDw ilea,°OP 11--- Ai /'AfOie n- al///y Mita-- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE AND STAVE THAT THE ABOVE IB CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITS ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRU ION. VALUATION SIGNATURE OF 1��( Leettnty PERMIT FEE $ 5 LCC PER M ITTEF v �•' y0 e $ .. (,—(/ , PLAN CHECK $ �� w' AUTHORIZED AGENT 6-0 G - TOTAL FEE - B.