The URL can be used to link to this page

Home My WebLink About660 TOWN CENTER DR - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT JobAddress: 660 TOWN CENTER DR Status: ISSUED Suite No Viciniry: ROOF TOP OF PARKING STRUCTURE Parcel Nunmber: 41005144 o.pp�icant VAN EKELENBURG, ERIC - ISSUED Bv: Address: 1590 S MILLIKEN AV , - . - . - - � . � - _ � � �� , � STE H - , �% i ; � Phone: 909-6050872 - �� ONTARIO. CA � � - � � Zip: 91761 � � / � �> `- � \ / -/- �, - '_ . :�. : ' � ` " ' ' - = . � '�- � �� . Owner:�SOUTH COAST PLAZA�%ONE TOWN CENTER DR�ASSOC „ �% � i � : - . -� ` \ �, Address�,jETAL `� � " ' " - � �; '�� j� /, j=� � COSTAMESA;,CA�;i� � Phone: �A � � - �,'�,_ .- ' � :�� - 3315 FAIRVIEW-RD Zi � - Applied: 12/11/2002 Issued: 12/11/2002 �� : � �� /�� \:�>�. P � . , , A . , . , �.�'-� AV ��A� , , , i;'�; . _ A� ',� i ' ` �� - , ., i �` o . _ � � Contrector: ' UTILITIES & C C INC � ' - � _�` ' °�: ` ` . J. - Address: �1590 S MILLIKEN AV � ' � �� ' � ' � " ' . _� A' � � . -��. .,� � _. , .STEH� . ,.� / . �Phone: �909-6060672,.�,,1 , � � �� ; � 1 � ' �.ONTARIO.CA �i � _ - Zip:-'91761 . - _ ��-�� _ � . . . . �: _ - � ' License: 681811 � ,- � -":� �\r . , ' ` � �� . „ �/. - � � . , � ��% �. ��\ . , � � , NEW UMANNED TELECOMMUNICATIONS FACILITY TO�BE LO PARKING STRUCTURE.(ON TOP OF'ELEVATOR'SHAFT). SCOI 9 ROOF MOUNTED CELLULAR ANTENNAS (3 PER SECTOR) P E�UIPMENT; 3 EQUIPMENT CABINETS TO BE LOCATED ON L REF: B02-01851 . . �� % • , "��^ - ', ,. -�-C � ' � `� 1 SERVICE TO 200A — - - _ � - -� - ' � - , .; . . . . // r-. Y..-:, -,• �� ;ATED ON.ROOF LEVEL OF AN�EXISTING � E'OF�WORK INCLUDES INSTALLATION OF .US�.'I GPS ANTENNA AND RELATED � :VEL SIX.. REF: ZA-02-77 � %h;!" � � ,'.J',�?� - , � � _ _ . v , , ,' � , ;' � ' � FEE SUMMARY °�:,� � � � '; ,- � Quantiry '� Quantity ISSUE PEE � � �� 523.50 : "'�Teinp�Dist System / Lighting �.$0.00 '� 0 � � �� Teinp service test `��, $0.00 i�1', Busway /100 ft $0.00�� j0 _ Res: a/c �package ^, ��$0.00 �- �-; ,� SManding Section $0.00 i�' 0 � New Res (7-2,units) � � �.30.00 0 .- - � " Misc Electrical Equipment ;;;� __ _.,$0.00 i 0 � � New Res (3+units) , $0.00 �_ ' - � 0 � � Transfortners up to 1'kva/kw '� � $0.00 0' �� ,�� i � Pool/Spa �• �-;. - ��50.00�� 0 � ,- �...uptol0kva/kw - , y0.00�,�0 .� Lighting Fixts ` �. �. j-� $0.00 � >:��0 � � , _ ..: . ..up l0 50 kva/kw � � "�$0.00'i i�0 � Recept Oullets � � A % .50.00-. �, 0� �� , ' . , �" ..up to 100�kva/kw-' $0.00 � �0 � ` � Switches � � �,� � - � $0.00" � -� �0 - � - � .........:....over 100 k'va/kw /� -$0.00�. 0', �/ Non Res Appl \ .� � $0.00 � ; -'� � 0 � � � Cow Volhage Equipment V�� , ., $0;00' ,� 0 Res Appl � $0.00-, � , 0 � - Low Volt Wiring System / Ckt � �'$0.00 -' �; 0� Service to 200a ��530.50 � ' � ^t - . . ,Misa Conduit - �, �� `- � $0.00�%/�0 Service to 1000a �$0.00� - � 0 ' , _ Misc. Conductor �,, �� /$OAO! 0 Service over 1000a $0.00� _ �- -0 'Circus ( gen or.ride)` . — �i" $0:00 0 Motors to 1hp $0.00 �-- �- �0 -, � ' � �Circus�(mech nde.or lights) � - � $0.00 0 Motors to 10hp $0.00 -0 ;'- - Chnstmae Tree Stind-= � $0.00 0 Motors to 50hp $0.00 0 � ��` Fireworks Stend"� $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This parmlt shall automatically expire and become void if work is not commenced wlthin 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply wi[h all applicable codes, and all requlred Inapectlona end finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. POR INSPECTIONS CALL: (714) 75h5626 �anaan law� WORKERS' COMPENSA710N DECLARATION: . I hereDy aXirm under penalry ol per�ury one of the tWlowing dedarations: ❑ I �ave end will malnWin e certlNcate ot consent to self-Insure for workers' compensation, es provlded for by sectlon 3700 of the Labor Code, lor t�e pertortnance of the work far which t�is pertnit is Issued. �J I have and will meintain workers' compensatlon Insurance, as requiretl Dy section 3700 oi ihe Lebor Code, lor t�e peAortnence of Ne work tor whkh UUs parmil is iswetl. My wwkers' wmpensatian Insurance csrtier arW poC numhe� are: ��J Cartier. �i.1/ C:�n�"S �f/P �i�S. � . PolicyNumber �iY Lt/!%eMP.33SC� (Th1s secf/on need na! 6e (wmpleted if Ne perMf 15 valued et me hu�drud tldlars ($100) or less.) ❑ I cenly Inat in Ihe peAortnence ot tne work lor which ihis pertnit b issued, I shall not employ eny pereon in eny menner so as to become sub�ect to the workers' compense�lon laws ol Celitomia, end apree thet If I shoultl become sub�ect to ihe warkers' compensetlon proWsions of Saction 3700 ot Ihe Labor Coda, I shell foMvrit� comply with these provisi Appllcenl Signeture: 1 �ele: �a�� WARNINO: FAILUAE TO SECURE WORKERS' COh1PEN5FTON C�VEMOE IS UL rWD SIYAl1 SUBJECT AN EMPLOYER TO CFIhllNAL PENALTIES AND GVIL FINES UP TOONE HUNDRED TMOUSANDOd1ARE(5100,000),INADDfTIONTOTHECQSTOFCOMPEN5AT10N, OESASPROVIDEDWRINSECrION37080FTHELABORCODE,IfJrEREST,PNDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATON: I hereby aHirm Ihat I em lorce entl eMecl. �c. N_ Contraaors SlgneWre: oi Chapter 9(commencing with Section 7000) ol DlWslon 3 0l the Business anC Professions CoEe, end my Il�anse Is In full ClassM �i -f%7L �/- — — - — � -s oece: i�Li o � CONSTRUL710N LENDING AGENCY: ❑ 1 �ereby eMi�n that there is e consiruclion Ientlinp egency for Ihe parformance ot ihe work for which Ihis Oermil Is issuetl. i5ec. 3097, Cldl Code). Lenders Neme; Lentlefs AtlOress: Sipneture: OWNER-BUILtlER DECLARA710N5: Data: I hereby aXirtn that untler penalry ot perfury ihet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Buslness an0 Protessions Code: Any city or counry whic� requires a pertnit to consiruct, elter, improve, tlemdish, or repair any structure, prior to Its issuance, also requires the applicent for such pertni� lo tile e signed S�atamem t�at he or she U Iicensed pursuam to the provislons of Ihe Contractors License Lew (Chapter 8(commencing with Sectlon 7000) ot DiWsion 3 at il�e Business antl Protessians Cotle� or that he or she is exempt ihereirom antl the Gasis for the aUeged exemptlo�. Any vblatto� ot Sectian 703t.5 by any applicent tw a pertntt subjects ihe aOGlicant to e civil penalry oi not more then five hunCretl dollars ($500J.): ❑ I, es owner oi ihe properry, or my employees with wages es their sole compensetlon, WILL DO 7HE WORK, antl the structure is not Intentled or oflared lor sale (Sec. 7044, Business entl Professions Cotle: The Contractors LJcense Lew tloes not apply to an owner of properry who builtls or improves thereon, and who does such work hlmself or herself or through his or her own employees, providad thet such improvemenis ere not Intentled or oHeretl for sala. It, however, ihe huilding or Improvement Is soltl within one year oi completion, the ownerbuilder will heve Ihe burtlen of proving that ha or she dltl not builtl or imp�ove for purpose of sale.). - ❑ I, es owner of the property, em EXCLUSIVELY CONTRACTINC WI7H LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business antl Professions Cotle: Thp contractore License Law does not apply ro an owner of property who builds or impraves �hereon, entl who contracis for suc� pm�ect with a contraaor(s) license pursuant to the Contractars llcense Laws.). ❑ I em e:amp� untler sec. Busineu and Pmfessions Code tor this reason: SlgnaNre: Date: Owner ID verifled 6y drivets Ilcense. ❑ Ves ❑ NO Drivef5 Licen58 No. F�cpires: Verificetlon of Ownership ty (type ol dacument, I.e. - property tax blll or tleeA): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATON: ❑ I hereby ceh�iy that na excavetlon tNe (5) or more faef In depih Into which e person Is requlred to tlescend, wlll be ma0e In connection wlih work euthorizetl by this permlt, and Ihat no buildlnp siructure, scaffoltlinp, felsewark, or tlemolltlon or tllsmanUing Ihereol, wlll be more ihen thlrty-six (36) feet hiqh. (Chap. 32, Grp 2, Ari 2, Sec. 3a1, iltle B. Calllomla Adminlslreilva CoCe). ❑ As owner-builder, I will not employ enyone to do wark which waultl require e permlt fram the Dlvlslon oi Indusirifll Sefery, es noteG aDove, unless such person hes e pertni� �o do suc� work Irom Ihe tlivi9�on. Signeture: Date: Dldsion ot Industdal Safery Pertnit Numher. CERTIFlCATE OF COMPLIANCE AND AIJIXORVA710N OF EMRY: I certify under penalry of perjury thet I heve reed this applicetion and stete thet the information given Is correCt. I epree to comDN ��h ell steta lews antl ciry ordinences releting ro bullding conslruction, and euthodze representetives oi the Clty of Cosie Mese to enter upon the ebOVB-descdbed PropeRy for inspectfon purposes. l agree not to occupy or ellow occupanry of eny building euthorized by Mis pertnit until finaf inspectfon. COOE I, lii$P.E%nONnPE 1818 Fixed SyStem Finel Fire PreventlOn 1268 Poal Spe Finel 200 Flnal Re-Roo� 201 Finel BIak�Retalninp Well 202 Finel Fe�ory Fire Plece 203 204 Final Sfpn Final Demdi�on DdIE It�ELB ��Of. �/, �00� . Data �QQ[,( INSPECTONTYPE 206 Final Moc�enical PAg Q�ELS 208 Flnel Plumbing 210 Final Electdcal ��D3 212 Flnal re r 220 Flnal Plenning Appro�al 222 Final Site 250 Finel Building/Occupanry (714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.cBaI.IILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 .lob nddress: 660 TOWN CENTER DR Suite: Vicinity: PARKING STRUCTURE ROOF TOP Status: ISSUED Applied: 10/09/2002 Issued: 12/11/2002 Parcel Number: 41005144 Zoning: Applicant: VAN EKELENBURG, ERIC . ISSUED BY: Address: : �1�: " �. , : - -� � � "�'�� - - - Phone: 90&605=0672 ' -- � _ ,,." - _ . _ _ .. � \ ��' ' � Zip: � i r;% "� '� _ , � , /, i ^ _ i � � Owner. SOUTH COAST, PLAZA:%ONE TOWN CENTER DR.ASSOC \�� Address /ET AL�' � ; ' '� � . - � - - , _ -� � �� : COSTA�MESA,CA� ' - _� Phone: . >:, _�� ', � �� _� � � ' � 3315FAIRVIEW-RD�� - Zip: - ��-A�� '�� i i . : . � .` ,� � % .��: , . � , . "/. . .V� �A �` ,_ �� =��.;'� Contrector. �UTILIT.IES:&GCINC ��;�� -,. , Address: 1590 S MILLIKEN AV � •A� � /" � ' � , , � STE.H�.-� � Phone:=�909-6050872 �� \ �� \ . ' `� ONTARIO.CA • .� ��'� , .- . � . Zip: � 91781�' . License.� ` 681811 � - - � ' - � . Fvch�: - WHALEN B.COMPANY INC '" �'��! � Eng: ALPHA CONSULTING & ENGINEERING INC '� Address: ' CHRISTIAN, DAVID /y > �� -,-' . �' = �� , .. Address,:-- SURESH C SABHLOK ''� �„-. � ' ` ' �TORRANCE,CA - ;' Phone: 310-7157630 � � -SANTA'ANA;�CA�\ Phone: '714541-9980� � 970 W 190TH-ST�; "' 1823 E 17TH-ST �'� � . � � � , �`Zip: 90502� _i � j'-License: C12853 92705 "V � �License: 2838 � \ � �, i � / ' �,� ,��--�,:..r ,,.-; SCOPE:OFPERMIT.:.; ,.`_��,� - , � NEW UMANNED TELECOMMUNICATIONS FACILITY TO BE�COCATED�ON ROOF LEVEL OF'AN EXISTING PARKING STRUCTURE (ON TOP OF ` ELEVATOR SHAFT). SCOPE OF WORK INCLUDES INSTALLATION OF_9 ROOF MOUNTED CELLULAR ANTENNAS (3 PER SECTOR) PLUS 1 , GPS ANTENNA AND REIATED \ ; , � � � � ' EQUIPMENT; 3 EQUIPMENT CABINETS TO BE LOCATED ON LEVEL SIX.. REF: ZA-02-77 �. ' � � - - . . ��. ,�. � _ — - \. _ '__. . . . ' � . ,. �' ._ • � FEE SUMMARY '� - � , ��, . - � j ,� � � ��P,lan Check:` ,. $486.69 � � _ � Calc Valuation: �'%� � � , Sss,000.00 � - Permit: ��- $74875 - '� _ � Ciaim Valuation,;'-� � � $ss,000.00 SMIP Res: $0.00 - - SMIP Com: � � $13.65 '�tix- %,�� /� _ � �_��Other:" '$0;00 ir"�,''';?` - :'� ��%� , , Ins`pection: $000� � � �"'� �;;;�� ,'� �� `� �. � ��•� � c ; _ � ,.`�'_= ' � � ' ' � � �Total. 51;24909� �� i _` � ' �, \ �� /, � � - : �, - �� . '�' /i i�/ ` ��, �, , \\ , �� '. ��; . � -�'` _ PLANNING & ZONWG: . ::� � . � , . SETBACKS �� •�:� � � ' _ MAINSTRUCTURE Fiont � 0.0 �� Rear 0-0 Left 0-0 � "�, Right'��0-0� % � � �, , . „ , . ��,�. ACCESSORY Front 0- 0` � Rear 0- 0- �� ,' Left 0- 0� - � Rigfit� ��0= 0 '- � .�.. . - � _ -�.: PARKING Existina: 0 ��Required:-= 0; - Proposed:�, ��0'�- � INOTICE: The work authorized by this permit shall compry with all applirable handicap access requirements under Califomia statutes and related �� regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period ot 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all , requlred Inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 tas-afi Irvoo) WORKERS' COMPENSA710N DECLARATION: - �' I herehy aHirm un0er penelty of Der�ury one 01 ihe tollowing declarations: ❑ I heve entl wlll melntein e ceniilcate ot consent to sell�lnsure for workers' compensatlon, es provitle0 tor by section 3700 of the La6or Coda, for the peAortnance of ihe �work for which lhis pertnil 19 issuetl. I have en0 wlll maintain workers' compB�satlon Insurance, as required by section 3700 oi Ne LeDor Cotle, for ihe perlortnence af ihe work for which Nis pertnit is issued. My workers' compensatlon Insurence Garrier anC pollcy number ere: cartier. Tlrt�in/L'if/�Li.ei,�Alstrance �'o. q ¢��t/BA'J71��?�iSO Poli Num�er: (Thls secTion need not be complefed!! fhe pB�t !s velued ef one huntlred dollars (5100) or less.) ❑ I cartity that In Ihe pertortnance of iha work tor which Ihis pertnit is Issued, 1 shell not employ eny person in any menner so es to becrome subject to the workers' compensatlon laws oi Callfomia, en0 eg�ee that If I shoulA become suOJect to the workers' compensatlon pmvislons of Sectlon 3700 of Ihe Labor Code, I shell forthwith comply with ihese provisio�n ' /� Applicant Signeture: St_� � PO � /.--i Date: /�/��OZ- WARNING FAILURE TO SE RE WORKEiiS' COMP�ISATION COVEMG MAWFUL AND SHP1L SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO IXJE HUNDFED TFKKISAND OOLURE (E100,000), IN ADIXTION T07ME COST OF CqAPENSqTION, DAMAGES AS PROVIDED fOR IN SECTION 3'7080F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm thet I am torca and ettecf. Lic. M_ Contredofs Signeiure: of Chapter 9(commencing with Section 7000) ol Dlvision 3 of the Buslness entl Prolessions Cotla, and my license is in full Cless p �J - �1 G �� Date: /�////D Z- CONSTRUCTION LENDING AGENCY: � ❑ I hereby aMirm thet there is e conslruction lending egency tor the peAormence of ihe work for w�ich thls permit Is issued. (Sec. 3097, Civil Code). LendeYs Name: LentleYs Adtlress: SlgnaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm ihet under penelry of per�ury Uet I am E%EMPT FHOM 7HE CONTRACTORS LICENSE LAW far the tollowing reason (Sec. 7031.5, Business entl Professlans CoOe: Any ciry or rnunly which repuires e pe�mit to conslrucL alter, improve, tlemolish, or repair eny atrucWre, prior to Its iswance, also requires t�e applicant for such permit ta file a slgneA atetement that he or she is Ilcensed pursuen� to the provisians af the Contrectors Llcense Lew (Chepter B(commencing with SecUon 7000) of DlNslon 3 of the Business end Prolesslons Code) or that he 0� she is exempt theretrom anC the besis tor tha ellegetl e:emption. Any Woletion oi Sectlon 7031.5 by any applicent for a pertnit subjects the epplicem to a cMl penelry at not more Ihan tive hundrad tlollero ($500).): ❑ I, es owner ot Ihe property, or my'employees with wages as their sole compensatlon, WILL DO 7HE WORK, entl the structure Is not Intended or otteretl tor sflle (Sec. 7044, 8usiness end Professions Code: The Contractors License Law does not apply to an owner of properry who 6uilds or improves ihereon, and who does such work himself or herselt ar through his or her awn employees, provided Ihat such improvements ere no� Intended ar otteretl for sale. I(, however, iha builtling or Improvement is sold within one year of wmpletion, the owner-builder will have Ihe burden of proving thet he or she tlid not bulld or improve for purpose of sale.). � ❑ I, es owner of the O�operty, em EXCWSIVELV CONTRACTING WITFi LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business and Professions Catle: The conVectors Licanse Lew tlo05 not epply ta en awner ot Dropeny wha builds or improves therean, entl who contracis for such project with a comractor(s) license pursuent to ihe Contredors Lice�se LawsJ. ❑ I am exempt under sec. Business antl Professions Goda tor this reason: SlgneNra: Date: _ Owner ID venfietl by drivefs license. ❑ Yes ❑ No Drlvefs License No. Expires: Veriilcatlon of Ownership by (type of tlocumen�. i.e. - properry laz bill or deetl): DIVISION OF INDUSTRIAL SAFETV VERMIT CERTIFICATION: ❑ I hereby certlty thet no excevation five (5) or more leet in depth into which e peBon is requireC to Oescend, wlll be mede in connection with work authorizetl by this permil, anE that no building siructure, sCeflolding, talsework, or demollllon or dismentling Ihereoi, wlll be mora then thirty-six (38) feet hlgh. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Celifornle Administrative COde). ❑ As owner-bullder, I wiil not employ enyone to do work which would requlre e Oertnit from Ihe Division of Indusiriel Setety, es nated ebove, unless such person hes e permit to do such work from the tlivision. Signature: Date: Division af Intlustnel Setery Pertnit Number: CERTIflCATE OF COMPLIANCE ANO AllIHOFiIZA710N OF ENTAY: I certify untler penalry of perjury thet I have read this epplication end state that the intormetion given is correct. I egree to comply wii� ell state laws entl ciry ortlinances relating to building construction, end authodze represeNetives ot Ihe Ciry oi Costa Mesa ta enter upon Ihe above-describeO property tor inspection purposes. I agree nm to occupy or allow occupency ol eny building euthanzed by this pertnit until tinal inspection. cooe r. ixsrecnonnve 1616 Fixed System Pinal Fire Prevention 1286 Pool SDe Final 200 Finel Re-Roof 201 Finel BIocWRetaining Well 202 Final FeCiory Flre Place 203 204 Finel Sign Final Damolitlon Q�ff LN�LS .Z�GL- //f �OOa . Date �Ej INSPELTIONTYPE 208 Final Mechanlwl 20B Finel Plumbing 210 Finel Elecincal 272 Final Fire Preventlon 220 Flnal Planning Approval 222 Final Site 250 Finel Building/Occupancy BLiE 1�Lfi Pfl0.1ELTA�ONESS: GGO TUWN CENTER DR owr+Exsxnme: C,J. SEGERSTROM �DOXESS: 5 SONS CO, 611 ANTON BL COSTA MESA 435-2110 AACN/ENGINEEfl: RUOflE55: UNIT: NEG.NO,: UNIT: PEflMITTEE: SECOM INTERNATION INC. ( 310 ) 641-1290 anoeess: 9610 BELLANCA AV LOS ANGELES CA 90045 LICENSEU CONTBRCTOfl DECUIBATION: I hereEy ailirm lhal I am licensea unaer D�ovisions al C�apter 9(commencinp wi�� Section 7000� of Oivsion 3 oi i�e Business an0 Pmlessons Cotle. an0 my license is in lull lorce G effec cin uc.: 0 5 3 3 8 srare uc.: 4 0 7 3 ss: C}�� pa ¢f � • Signai �- / "'�v �� WOPKEBS' COMPENSRTION UECIAPATION: I �eaby a irm t�at I �ave a certifi co sn ent b selbinsure or a ceM1ilicate ol Workers' comcenution ��ra�q3o��ce�i�ee wpv me�eo� ISection 3eoo. �ao. �'9 / O 1/ 9 Z aoucrxo.: REPUBLIC E%P.ORTE: COMPANY: �}/ ❑ Cenilietl copY �s AereUy lurnis�etl. L'1 CetlifieJ wpy is IileG with tAe cily Bui np�iric/�p�/� � ��+v- % /� APVIic�7��/ \/clt`r�� cxEMPTION fflOM WOPIIEflS' COMPENSATION OECtAflRTION: R�is section neetl n01 mqeiea it IAe permit is ta me mmarN 1510q or less�. 1 certily IAaI in Ihe pedormance ol Ihe wark tor w�ith Ihis permil is issu¢4 I Shall noi ¢mpl0y any Derwn in any manner so as to heCome su6jeci�o Ihe WorkeR' fAmDensaGon Laws ol Calilomia. Date: Siqnalure: NO710E: II. afler makinA t�is declaration. you shoul0 become SuDlect to tAe WaMers' CAmpensation prOvisions of the LaUar CoEe. yau musl fohhwith comDly wilh such O�a�sions or this permit s�all be tleemeG revokeA. CONSTBUCTION IENDING AGENCW.' I hereGy allirm �ha� Ihere is a[onSlmCiion IenUing aAe^�Y �or t�e p¢dOrmante a� Ihe wade lar wNcn mis uermitis issuetl (Section 9p97. Gv. C1. IFNDEfl: ^ FUOPESS: i � OWNEB BWLDEB oECIAMTION: I Aereby atlirm t�at I am exempt imm ihe Coniractors' State License Law far Ihe fMlowinA reason (Seclion 7031.5 BuSiness an0 Protessional CoOe: Any ciry of county w�iC� repuire5 a permil to constmcC alfer, improve, demalisA, or repair any simcture, prior to its issuance, also repuires ihe applicant lor such permil to lile a siAned statemenl ihat helshe is licensetl pursuant to Ihe pmvisions ol the Coniractors' State License Law (Chap�er 9(commencing with Section 7000) ol Oivision 3 oi the Business anU Pmle59ans Cotle) ar t�at he/s�e is exempi ��erefrom ana tlle Dasis lar I�e allepetl eeemption. My violation of Section 703L5 by any appliWnt for a permit su6le��s It1e aDPliWnt Io a civil penally of not more t�an live hunGreA tlollars (5500). I. as owner ol the DmDeny or my emyloyees wiN wages as t�eir sole cam0ensation, will tlo Ihe work, antl the O simmure is nol inlenEed or o�lere0 �or sale (Section 70a4. Business antl Prolessional CoAe: The ConVactors' Slaie License Law Ooes nol apply lo an owner ol a pmpeny w�o builEs or impmves l�ereon, antl w�o Eoes such wotk �imsetl/hersell or IhrouA� his or her own em0�0y¢es, pmvitletl I�ai Suth impmvemenls are no� in�enOM of o�tereG �ar sale. II, �Owev¢r ttle Uull�ing af impmvement is so10 wit�in one year of compleiion, t�e owner vnll have Ihe GurOen ol pmving he/she AiA not builtl or impmve far ine puroose oi sale�. I, as owner ol Ihe pmperty, am eMclusively coniractinp witn licensetl coniractors to conslNct the pwject (Section 704a, Business � antl Pmlessians Cotle'. The Comracmrs' S�a�e License Law tloes no� apply l0 an owner ot DfoOerty who 6mIU5 of impmves �hefean antl w�o convacts lor such prolects wiiA a comracmr�s) license pursuant to I�e Coniracmrs' State License Law�. I am aware ihat D�ool ol iM1eir Worker's Compensatian insuranre shoul0 be D�a��tle0 lo me. � I am exempt under Seciion: B. 8 P. C. lor 1�is reason: Date: Own¢c I do �ere�y cenify IAat I am aware o� ana unAerslanU ��e requiremems ol Califomia Health and Sa�ery Code Seciions 25505, 25533, antl 2553a and that I or any IUWre builtling occupanl willlwill not (circle one� neetl to comDty with saitl slate cotles antl ihe reQuirements br a permil lor canslNclion or motli�icalion Imm Ihe Air Duabiy Management �isVici. R¢si4eniial consiruc�ion aDDlications are exempl trom IheSe provisi0n5. Dale: AppliCani: I �ereby cer�ify Ihal I have rea4 ihis aD0liCatiOn anA Slaie Ihal lhe a�Ove inbrmali0n is torr¢d. I aA�ee to tomply wi�� all Cily an0 Couniy ordinances antl s�alelawsrela�ingto building constmction antl hereby aul�oniere0�esenlativ¢s o�ihis city�o e�nl.S�rupon�h¢ ahove�meniionetl prop¢rly lor inspec�ian purpases. /J�� / ) Ucense ar Sociai secudiy 16ai�A6 While—Buileinp: Green—Coae EnlorcamenL Canarv—Aoolicanl; PinF—Revenue: Goltlenroa—Asanssnr CiTY OF COSTA MESA — BUILDING PERMIT c NU: � �� y PERMFT NO; E 055990 PLAN CHECY, NO: N , �; �, CONSTRUCTION TYPE; PERMIT TYPE; ELE PURPOSE: OTH JOB DESCRIPTION : ELE. PERN,ZT FOR PARKING GATE SQ FT; CLAIM VALUE: 10,980.00 CALC—VALUE; GROUP OCC; B-2 / COMMENTS: NO B PERMIT ONLY ELECTRIC WORK!!! x*****+��****�*��*��-*�**�**��*�rx+��***x��****x��r�**��-******�*�**��*�***�*�*�*�* 2 O N I N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT ZN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN PARKING REO• PROV: PARCEL: 00000000 ZNE; REF NO; PLANNING N(ST'ES> � . � iE if iE 1E 1E iE iE iE 1! iF i4 3f iE if iE # iE i! iE iE �F �1E if iE if if 1E �1h if ie 3F �1E 3E �1F'it iF iE iE iElt �E iF 1F 1! iE it iE iEi! iE iF if iE if iF f iE iE i41E ik if �1F i!� iE 1F?4� jF?!� iE iE±F iF �F 3f iF iE IE if D E V E L O P M E N T S E�R V I C E 5 R E Q U I R E M E N T S ZONING APPROVED BY �� DATE; �!'g 9�'' BIIILDING APPROVEP BY ; = DATE; APPLICATZON ISSUED BY: 1^--�'"/^. DATE• � Z� '�l y ifiFiflfifififiEiFil�lEiEiFitiE?fiEiFiEiEiFaE3F3F'TF3F3FiF e3FiF7F3Fif3f3FiF3F3F3F, �FiF'iFiF�iF3c�lFiEiF�fifitafiElE €�F�iFiFiF iEiE*iEiEjE1E�EiF�%�1F3ElE�E)EiE3FiEiElFiEiEifiEffifl4iEififltiEiElE�kiFk3FiEiE ' iFifiEiflf3FiEif�EiFifaEiliFiEifiE)E1FiE�E%ifif3FfEiElE3E�)EiEiEiEifif LEGALIZATION;N F E.E j �' M M A R Y STRUCTURAL SEG,MENT;N BLDG PMT PLUMBING Ei GTRIC MECHANIC FIRE SMIP/RES GRADZNG PERMIT PLAN ISSUE FEE BUILDING—DIV—> TOTALS----> PERMIT ISSUE 17.00 15,00 REVENUE DIVISION TOTALS--> COLL BLDG PMT PLUMBING ELECTRIC ME 32.00 ��Ot SMIP/NON—RES ECK TOTAL PAID DUE .00 32.00 32.00 .00 32,00 OVER/SHORT; ,00 C FIRE SMIP/TOT GRADING PLAN—CHECH # iP iE iE iF iF 1E iE 3h �)E 3E �1F 3F �E if iE iE 3E 1f if IE if iklE iE iE iE A' iF iE �3F 3E �ff ik iF iF �E �f if iE iF iE Ih �lE K iF iF �!f if iF iE if )f iE lFiE �Fi(� jf 3f-1k �1F 1E 3E iE if iE if iF 1f �IE if %ff 1E iF 3E �1F if I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T Z O N [lNIT COST TOTAL COST ELE 2 MOTOR/POWR APPARATUS 0.0 — 1.0 HP 3,00 6,00 ELE i MISC CONDUIT NOT LISTED REO PERMIT 11.00 11.00 END OF FEES , `.j��l% '. " "" ' ��.�t• �il•).'Y_ .1�' �' ' , CON$TRUCTION AND PLANNWG POOL & \ �. APPROVALS Permit #.' J9ate Inspector qppROVALS Permit # Date inspector i i. TemPorary Electrical Service or Pole ' 52. Pool & Equipment Location .� 2. Soi� Pipe-Undrgrnd. � , 53. Steel Rainforcement 3. Electrical Conduit Utility-Undrgmd. - - _r Forms 4. Etect<<ca4 Conduit•Undrgmd. , 1�?n r�1 � 5 Electricel 8onding 6 cl`/�!L• 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Foovngs - 58. Electrical Conduit-Undrgrnd. � 8. Foundation � 59. Gas Pipe, 0 Undrgrnd., Test I 9. Water Pipe•Undrgrnd. ' � 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Strutturai Floor System ' 61. APPROVAL TO DECK . 11, PropertY Sewer Line & House Connection � 62. Sackwash & Receptor•Fina4 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof Drains . � � 64. Plumbing System - Pina� 14. Rough Piumbing 65. Electrical-Final 15. Rough Electrical•Conduit ' 66. Soiar SYsiem-Final 16. Rough Electric Wiring� 67. Fencing & Access ApProval 17. Rough Wiring Sign _ 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Struciure 70. Underground Hydro 22. DuctS, Ventilating 77. Product Piping OGas ❑Ofl 23. Gas PiPe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Srorage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Nydro 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and F�ashing 76. Dry Standpipe 28. Lathing & Siding � 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. Plasrer Brown Coat 79. FINAL INSPECTION . i � _ 32. Elect<ical Power Meter-Final � 80. FOOD CERTlF1CATE ISSUED 33. Final Electric � �lh7 _ otes�l-` Rv 34. Final Heating & Air Conditioning - � `� � � 35. Final Gas Pipe�Test ' � . 36. Hood or Canopy � '�~' 37. Final Factory Fireplace ` � I 38. Final Plumbing ' 39. Wacer Service•Final 40. Gas Service-Final 41. Solar pomestic•Final 42. Backflow Preventer � . 43. Backflow Irrigation 44. Landscape Irrigation SYstem 45. Sound Attenuation 46��. Hand+caP Regofations ' 47. FINAL STRUCTURE & BUILDING � � � ' 48. FINALPLANNING '. �. ' 49. Electric Release to Edison / � 50. Gas Release to Southem California Gas Co 1 1 i,,r , 51. CERTIFICATE OF OCCUPANCY No. Date �I -`I � � PNO1ECiFU0flE5S: (j(jO TOWN CENTER DR OWNEN'SNRME: C S SEGERSTROM aoonEss: 3315 FAIRVIEW RD C.M., CA 92626 546-0110 RNLH/ENGINEEH: RUONESS: flEC.NO.: uxiT: UNIT: PEflMinEE' C.J. SEGERSTitOM & SONS (714)546-0110 aonwess: 3315 FAIRVIEW RD COSTA MESA CA 92626 LICENSEO CONTflFCTOB OECLANATION: I here�y allirm �hai I am licensetl un0er Orovisions ot Chapter 9(commencing with Sec�ion 7000) al �rvision 3 af ihe 9usiness antl Pmlessions Cotle. antl my license is in full brce antl eifeci. CITY LIL.: . STATE LIC.: C1A55: Oa1e: Signamre: wOBNEflS' COMPENSRTION �ELLANATION: I nereUy affirm t1u11 nave a cenifitate of tonsent ta self-insure ar a cenifiWte of Worker5' Compensatian Insurance. or a cenilied cooY ��¢reai (Setlion 3800, LaO. C�. POLICY NU.: EXP. ORTE: LOMPANY: ❑ CenilieC copy is �ere�y fumis�etl. ❑ CetlilieG coDY is IileE xit� IAe ci�y BuilGing Divition. te: ApDlicanf. .EMPTION FNOM WOBIIEHS' COMPENSATION OECIAPATIO is sec�ioi eetl noI be Sample permit i, lor one hundretl (S7IX I cenily ihal in Ine Dedormance ol ihe work for which Ihis mi issu I shal o em y any ny anner so as II subjer,lyf.��o Ihfe�yJ orker ' mpe qqqppyy�� ol Calilomia. Date: v U -� � �� Signature: � NOTICE: II. afler malting this declara�ion. you ShoWd Uecome subj¢ci Io I�e oBers' Compensation pmvisians ol ine L COUe. you must Iart�vnih compty vn�A suc� O�ovi5ion5 of tNs pGrmii 5hall be tleemed revakeC. CONSTflUCTION LENOING RGENCY: I �¢r¢by altirm ��a� Ih¢r¢ i5 a tonsim[Iion lenaing ag¢ncy �Of lhe pedOrmante ol ��e wnicA I�is permii is issuetl (Sec�ion 3097. Civ. C). �exoen: aoosEss: OWNEN BUILUEB oEClA8R710N: I hereEy affirm Ihat I am eremp� irom the Coniractors' State License Law lor ihe lollowing reason �Section 7091.5 Business antl Pm�essional Cotle: Any cily ol couniy which repuires a permii �o tonsVuci, alier, impmve, demolish, or repair any simclure. prior lo ils issuance. also reduires ihe applicant lor sucn permil to Iile a signeA statement ihat he/she is licensetl pursuam �o Ine provisions ol �he ConVaciors' Siate License Law (Chap�er 9(commencing with Section 7000) ol Division 3 0� �he Business anG Piolessions CoOe� or thai he/5he i5 e�¢mp� Iherefmm ana �he ba5is tor ��e alleged exemp�ion. Any vialalion ol 5¢tiion 7031.5 by any apPlicanlfor a permil subjecis Ihe apolicanito a civil penalty ol not more ihan five hunOree aollars (5500�. I, as owner o� Ihe pmperiy ar my ¢myloyees wilh waAes as Iheir 5ole compensafion. will Oo Ihe woM, an0 ihe ❑ simclure is not intenCed or olferetl for sale �Section 70aa, Business antl Pmiessional Coae: T�e Contraclars' State License Law tloes no� apDly lo an owner oi a D�openy who builds or impmves Ihereon, antl who Aoes suc� work himseltl�ersel� or Ihmugh � his or �er awn emDloyees, pmvitled inai suc� impiovemenls aie nol inlentleG ar oflereE lor sale. Ii, �owever lhe builtling or improvement is 5010 wi�hin one year ol completion. Ne owner will have IAe �ur0en o� pmvinA he/she ditl not buila ar improve loi ine purDase of Sale�. . I, as awner ol the pmDetly, am exclusively coniracling with Iicense0 conlractors Io con5imct �he pmjec� (Sec�ion 7044, 6usines5 E dlld Pf01C55i0f15 C042: TIIE CO�VdC�OfS Siale LiCenu Law Uoes n apDlyto an owner olOropetly w�o DuilUS orim0�ove5 lh¢reon antl who coniracts lar SucM1 pmle��s wit� a rAntractar(5) license rsuanl ta the Conirac�ors' State Licen Law�. I am aware I�al D�ool ol Iheir Worker'S Compensalian insuran[e shoula be �� I am exempi un0er $ec�ian: B. 8 P. C. lo�asory� �^^� I �.71.T � Oaie: � l < < Owner. I tlo �ereby cenify t�at I am aware ol antl unaerstana Ihe requiremen�s ol Calilomia Healih and Satery Cotle Sections 25505, 25533. antl 25534 antlihal I or anylulure �uiltling occupanlwilllwill no� (circle one) neetl�o comply w7ih saia s�a�e cotles antl I�e requlrementstor � permit lor cons�mction or mo0i�ication Irom Ihe Air Oualiry Managemenl �isVici. FesiOenlial conslmction applications are exemp� imm Ihesc provisians. Date'. ApDlicani: 1 �¢reby tetlilyl�ai I pave read ��is applitali0n ana Slaie or0inances and siate lax5 relating �o �uiltlmg fAnslNcliOn prooetly_ lar inspe io o��^ J �i� c� �., ,rn �._ o,�r-r k/ Signalure: Orivei's License or Social Security a: ' � - h all cily Ihe abOvi I6Ab<6 Wlnte—Builtling: Green—Cotle Enbrcamem: Canary—Applicam: Pink—Revenue; GolOenroE—Assessor .� _� CZTY OF COSTA MESA — BUILDING PERMIT PERM NO: B 065314 PERMIT NO: B 065314 PLAN CHECK NO: 09$94-93 L GOVT: N�UPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PIIRPOSE; OTH JOB DESCRIPTION. : UPGRADE H.C. SPACES IN PARKING STRUCTURE SQ FT: 1,000 CLAIM VALQE: 1,000,00 CALC—VALUE: 1,000.00 GROUP OCC: B-2 / COMMENTS; UPGRADES ARE FIELD APPROVED BY TONY/VICTOR **�-�efr*�*�x�*�r*******x��+r*it�r+t#�*i��e�t*�r*�t*it�tk**�r**�r*****+�***�ri�*�r*�*r�r�r***********�r*� Z O N I N G R E Q U I R E M E N T S S E T B A C K S , ' ------------ MAIN BUI ' .. ---------- --------- ACCESSORY BUILDING �--------- FRNT: FT IN RE R: FT IN FRNT: FT IN REAR: '�F'F IN LEFT: FT IN RG1T: FT IN LEFT: FT IN RGHT; � FT; IN PARKING REQ• PR V: PARCEL: 41005144 ZNE: TC REF NO: PLANNING NCSTES> REVZSII" KING SPACES ON FIRST LEVEL OF PARKING;STROCTURE > PARKINC HAMPING TO MEET ADA REf�5, NO DECREASE IN PARI{ING' �r+��r***+r��*x��**x��**x�r�r��r �r*�rx�r�r**x��*�r****��*�� ****+�****�***�*****+a�F***��*�*#�� D E V E L O P M! N T S E R V I C E S R E Q U I R E M E N`T S ZONING APPROVED BY _ C�I DATE; �Z�1��4�_ HUILDING APPROVED BY : ZMc..� I V �t�-., DATE: l'1-�l.y �� APPLICATION ISSUED BY; � DATE: `il2�l�(� °� % % % x Y x % % � Y >: % '/ ,. . x,�. ��¥�#�k�r��#�k4rt#�#�##��k�#i��?e��:a�ur.u�uk+��kr *�****+�x�r* ��** L�EGALIZ�TION�N��'��#��#F�E��'�*�5��M�A�R�Y*��#��STfi()C�URAL�5�GM�NT*Y � . �� BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 25.00 PLAN 16,25 SMIP/NO�N—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 25.50 0.00 16.25 41.75 41.75 .00 REVENUE DIVZSION TOTALS--> COLLECTED: 41.75 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADITIG PLAN—CFIECK 25,00 .SO 15.25 i! iF ik �E aE if if fE iE iE 1E it ik iE if if fE iE iE iE iE ik iF iE it iE ff K 1t i! if iE 1f iE 9f 1E iE iE iF 1ElE iE iE fE if 1F fE if fE iFlE iE 3E iE iF if jE fE fF fE 7f �f K iF 3f iE aElf if iE 9f if if * if if jE+f iE I N D I V I D C1 A L F E E H R E A K D O W N E QTY 1�� D E S C R I P T I O N ALTER HY VALUE COMMERCIAL N020NE END OF FEES UNZT COST TOTAL COST 1.00 1,000,00 �1 C�01`2255—��1522`8 �a�a� �2.7; aare: izii.;�� ilrE: 10:03 .� . CONSTRUCTiON AND PLANNING APPROVALS Permit # 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. 3. Elettrical Conduit Utility�Undrgrnd. 4. Ele[trical ConduibUndrgrnd, 5. Steel Reinforcement 6. Elcctrica� UFER Gmd. 7. Footings 8. Foundation 9. Water P�pe-Undrgr�d. 10. Structural Fioor System 71. Property Sewer line & House Connectioo 12. Sewer Cap 73. Roof Dra�ns 74. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electrc4Viring 17. Rough Wiring Siyn 18. Rough Electricai�T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Ro�gh Factory Firep�ace 21. Ducts,in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rou9h & Test 24. Roof Framing 25. Roof Sheathing 26. T•Bar Ceiling (SKucturall & M19onocoat 27. Frame and Flashing 28. Lathing & Siding ",'� 29. Insulation t 30. Dryv:all Nading % � '� I37. Plaster Bro�vn Coat � 32. Electrical Power hleter-F{nal 33. Final Electric 34. Final Heating & Air Conditioning 35. Finai Gas Pioe-Test 36. Hood or Canopy 37. Finai FaGtory FlrepVaCe 38. Final Plumbing 39. Water Service�Final 40. Gas Service�Final � 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape lrriqation System 45. Sound Attenuation 47. FIMAL STRUCTURE & 49. Electric f�elease to Edison 50. Gas Release to $outhern California Gas 51. CERTIPICATE OF OCCUPANCY Date �_: Date . ' Inspector � � �f � POOL & APPROVALS Permit-'rr` 52. Pool & Equipment l.ocation 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. fiough Plumbing & Pressure Test 57. APPROVAL TO COVER�GUNITE 58. Electrical Conduit•Undrgrntl. 59. Gas Pipe, � Undrgrnd., Test 60. B�ckevash lines, P-Trap, � Und�grnd. 61. APPROVAI TO DECK , 62. Backevash & Receptor��inal 63. Heater & Vent•Final 64. Plumbing SVstem � Flnal 65. ElocVipl-Final �i 66. Solar System-Final �'i 67. Fencing & Access AnProval '��. 68. APPROVED FOR PLASTEflING � 69. POOL/SPASYSTEMSFINA� � FIRE DEPT. REQUIREMENT � IIAPPROVALS Permit;r , 70. Underground Hydro �'. 71 . Product Pipin9 C7 Gas ❑ Oil � 72. Underground Flush 73. Undergrnd. Stora9e Tank O Gas ❑ Oil 74. Overhead Hydro ii 75. Dry Chemicai �� 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT.REQUIRE�AENT 79. FINAL INSPECTIO'V I 80. FOOD CERTIFICATE ISSUED I ��. Notus: Date I Inspector � f -- �� • - COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 e For Applicant to Fill in Completely — Use Ink Only BUI�OING /,� NJi//�/ E ADDRESS (/ (/��/C/ OWNE ADDRESS IJ WIEw AV6 TE L. S � �O{ �Q CITY A.. {.( GI�F., NO. CONSTRUCTION � LENDER RV��uT�OL ��5, ��• �i1, ue.i cEuftri . BRANCH ADDRESS ARCHITECT 272A 8/II/78 .�_ _y _ ... , APPLICATION FOR STRUCTURAL PERMIT ECEI �ATE RECEIVED �E ��—� / �"! OWNEfl wav CONTRACTOR C� L• 7 C�K ADDRESS 3303 w�cs�a�a� L(�Y. TEL. 'l,I c�T� (.•A. Gb��F gao No. F STATE CITV � LI0. NO. �' LIC. NO. {� SIZE . NO.OF BLDGS. 4 OF LOT NOW ON LOT a USE OF � EXISTING BLDG. � FSeparate permits are required for 0 electric, plumbing and heating work. (.W. USE OF BUILDING AND WOFK TO 6E PERFORMED Q a OU�1S/1i"y l0! �.�lG � �2l��alG �2ur� � � a w a FIRE 20NE TVPE G APPROVED BY DAT ZON NO.OF USE OF P �� PLAN$ Z BUILDING VARDSAPPROVED VARD MAIN BUILDING ACCES: (FROM'C/LSTREET) , �ISTANCE MAIN BLD VAR.qW . f:I��7 �C�7:7 925.9 T� Z 5000 I IP �l � I APPROVED �RY BUILDII i __�" Q c �r- Fl�- � (�A'^"�' BET. MAIN & ��, ACCE$$. BLDGS. � � - DATE �/Q APPROVED Z ��' /�J O -7� REQUIREMENT` � I he�eby ecknowleCga thet I have read this appl(cation antl rtate a that the ebove Info�matlon Is correct antl agree to comply with a all lews regulatine builtling constt�ction, and 1 shall not employ rz any person In vlolation of the workman's compensation laws of Sthe Staie of California. 3 1 hereby cartify that 1 am properly Itcensed as a conttactor under SQ. FT. Me Stnte of Californie Bustnass antl Profeatons Coda, Division 3, THE AMOUNT SHOWN UNDER VALU Chaptar 9, entl chat such licansas are in full forca antl af£act, or 1 THE PUflPOSE OF ESTABLLSHING A PERP am exempi from the provisions of the State ot California Business VALUATION PERMIT FEE E and Professions e, Dlvision 3, Chapter 9. r PLAN CHECK § Signatura af — //I _ D` ^ /J� OO Permittae W�u�� § G/ TAX E Authorizetl ent TOTALPAID E n m i m N IS FOR m ONLV: n a � 7 m m 0 LL : 2S . � J F � W a Q .N.n h � F O W F a a ..a Q > � x w a O C a z W 5 3 . _ 4��_� COSTA MESA BUILDING-SAFETY DEPARTMENT P O. PY`ZS 1Z00 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely - Use ►nk Only BUILDING nooaess �pi Town Cantor Drive OWNER $EGERSTROM-PRUDENTIAL MAIL CITV CONSTRUCTfON BRANCH ADDRESS ARCNITECT CONTHACTOH ADDRESS 33 crrv Los A STATE LIC. NO. 512E OF LOT USE OF EXISTING BLDG. TEL. NO. TEL. TEL. NO. CITV LIC. NO. INO.OF LB�O('aS. NOW ON LOT Segarate permits are required for electric, plumbing and heating work. OF BUIIDING AND WOijK TO BE PERFORMED I haraby acknowledga that I hava reatl this application entl ztata that iho ebove IniormaUon b correct anG aprea to comply wlih ell lawa reBulating builCinp cohstruction, and I shell not employ any verwn in vlolation of the workman's compensallon laws of Me Staie of Californie. I hareby cartify that I em propariy Iicansetl as a contractor under iha State of Celliornla Busineq entl Profeulonz Code, Dlvision 3, Chaptar 9, antl thac sueh Ilcen�s ere in full forca and aifect, or I am axampt fro tha Orovisions of che Smm of Celifornia Businesa antl Profess� a otla, Dlvision 3. �hapter ,�I SIB�otura of � y Permittee !1�' d 5203 ey20�78 4465.5� APPLICATION FOR STRUCI'URAL PERMIT ) ECEIVED BV DATE RECEIVED naTG �csucn BUIIDING ADDRESS TRACT OWNE FIRE 20NE APPROVED LOT �� IPLANS 'I BUILDING E` �l.Ci VARDSAPPROVED VAR SAPPROVED VAR. qW C.U.P.� ��A APPROVEDpC'��^ �/Q r Q �'� '//� -78 ' ✓� '.� R-in_-xs TME AMOUNTSHOWN UNDER VALUATI THE PURPOSE OF ESTABLISHING A PERMIT VALUATION PERMIT FEE E Z PLAN CHECK 5 1 $ 2,22S,OOO.00 TAX E TOTALPAID E �• N � m �NT� i 0 m N IS FOR m ONLY: � 2.0� m 7.80 a 5.75 � u