HomeMy WebLinkAbout620 TERMINAL WAY - Building PermitsPN0.IECTROOflESS: 62O TERMINAL WY
owxee�s xnmE: GREYSHOCK ROSE A TR
noaeess: 1130 PESC�DOR DR
NEWPORT BEACH,CA 92660
ABCHIENGINEFfl: � 7 1 4� 6 3 S— 4 S 9 7 pFG.NO.:
aooness:
UNIT:
uxiT:
� PEflminEE: SKYLIGHT SPECIALTIES ( 714 ) 645-8645
aooeess: 3�16 r0 I NCL I NADO
LICENSEO CONTHACTOAOEC-i�7xnT��f+EMENT�E that I am licensee uneeC r�'ohsio9nsZo��7p3r 9(commencing with Section
7000) of Division 9 of Ihe Business antl Prolessiom 6otle. antl my yli �e is in lull fo¢e and eilect.
ciTruc.�ZKy�^srnTeuc.:3955�r, /- cuss:
�.
oate: Z�J �� SigreNre: ��_ _
WOPKEHS' COMPENSATION OEUANATION: I �ere6y i�rm Ihat I h rlificale ol consent �o sell�insure or a ceriilira�e of Workers'
Campen5alion Insurance. or a ttni�ieG roDY ��erto� (Seciian 38 . C).
voucrxo.: 0638915-93 ExP. E: 04/O1/94
COMPRNY: STATE FUNIL
,� Cenilietl coDY �s here�y Wmis�etl. L�C Cetlifietl copY %%is �i ed il� ci�y Buildinp Divi5i0n.
ozie: ��2��� aoor�amiG�/
EYEMPIION FNOM WOflI(EBS' COMPENSR110N OECIA :(TAis seciion neeG no� 6e COmpkleU il IA2 pErmit b tor Oire hmqrttl (511p) or less�.
I certily Ihai in I�e pedormante oi t�e wOrk �or whi�h lhi5 Dermii is ¢5ued. I Shall nol employ any person in any manner 5o as to beCome
su�ject to I�e Warkers' ComDenSaiion �aws of Catilomia.
Date: Signature:
NOTICE: II, al�er making t�is aeclara�ion, you shoWA Uecome suble�� �o Ihe Workers' Compensa�ion provisions ot �he Lahor
CoOe. you mus� lotlhwilh comDly wilh such Dmvisions or this permit shall Ge tleemed revoketl.
CONSTHULTION 1EN01NG RGENCV: I here�y afiirm ihat ihere is a conslmction lentling aAency for ihe performance oi the work for
which t�is permii is issue0 (Seclion 3W7. Civ. C�.
LENOEX:
AOOflESS:
OWNEP BUILOEB OECUNRT10N: I nereey aflirm ihat I am exempt imm Ihe Coniractars' State License Law lor Ihe following reason
(Section 7q31.5 Business anU Pmfessional Cotle: Any ciiy al county which redui�es a permil Io con5imc�, alter, impmve, tlemolish, or
repair any SlrucWr¢. pri0r la iis isSuanC¢. aI50 r¢puires the aDP�kani tOr Sut� Dermii IO �i10 a SigneO 5lafemeni Ihal hpJs�e is IitenSeU
pursuant to t�e pmvisions oi iAe Coniracmrs' State License Law (Chapter 9(commencinp wilh Section 7000) ol Oivision 3 of ihe Business
anE Pratesvons Cotle� ar Ihal �e/s�e is ¢Kemp� ��erefmm ana Ihe �asis �or Ihe allegeE ¢�¢m0�ion. My nola�ion a� Stt�ion 70.31.5 6y
any applkant for a permit sublK�s ttre aDP�iunt to a civil penalry of not mort ��an five AundreA dallars �5500�.
I. as owner ol the propeny or my emyloyees witA waAes as iheir sole compensation, wiA Uo �he xrork, anA the
❑ s�mcWre is not inlen0ed or ofleretl lor sale (SecUon 7W4, Busmeu antl PrOfessional COEe: T�e Comrattor5' Slaie License Law
tloes nol aOPly Io an owner ol a D�oDeny wno builOs or improves thereon, an� wM tloes such work nimself/herselt or through
�is or her own employees, O�ovi0e0 Ihal such impmvemenis are no� inlen0etl or ofleretl for Sale. If, tww¢ver �he builtling or
� impmvemen� is sol0 within one year of completion, ihe owner will nave ihe UurUen of proving he/she Oid not buil0 or improve
for Ihe ourpOse of sale).
I, as own¢r a� �Ae pmperty, am extlusively tontracling with licensed tontratlors �o tOnS�mc� Ihe pmleci �SeCtion 7044, Busine55
❑ and Pmlessions CoCe: T�e Con(ractors' S�ate License Law Ooes not apply to an owner ol DrODCr1y who EuilOs or improves thereon
antl who conlrac�s for suc� pmjec�s wi�� a coniractor(5) license pursuant �o Ihe Conlraciors' $tate License Law). I am aware
�hal D�aol o� iheir Work¢r'S CamDensa�i0n insurance shoultl be pmvidetl Io me.
� I am eremp� untler $ec�ion'. B. 8 P. C.
�or Ihis reason:
Oa�e: Ownec
I Qo �ere�y cerli�y Ihal I am aware ol an0 un0ersland Ihe requiremenis oi Cahlomia Heal�h anE $alery Code $ections 25505, 25533, antl
2553E an0 i�a� I or any Iuiure Ouilding ptcupanl wilVwill not (circle one) neeA Io comply wit� SdiA staie EOA¢5 anA Ihe reQuirements �or a
permil �or consimclion or moUdicaiian irom Ihe Nir Ouabty Management DiSlrici. He5i0¢nlial con9mtli0n applicaiions are eeempi �mm
th25P pf0V151005.
Date:
1 here�y cenity �Aal I �ave rea0 ihi5 ap01ica1
o�dinances an� statelav5 relalinplo Duildingi
propertGy br—in7sp�ec,uon� Ourposes.
Dale'.ti �!_CT,��
oriver's license or Saial Seariiy
Applicant; Pink—Rovenua; GolOenroe—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06358
PERMIT NO: B 063584 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; CHANGE OUT SO SKYLIGHTS (EXIST.OPENINGS) SQ FT; 1,675
CLAIM VALUE: 1,675.00 CALC—VALUE: 1,675.00 GROUP OCC: B-2 /
COMMENTS• REPLACEMENT ONLY USING EXISTING OPENINGS/ WEIGHT APPROX. SAME
�r�e*r*�t�t*�t�t�**�t�t�t**r�t�r �r***�t�t**�r**�rr*�t�t �e�*�t�t*�r*�t+r *�t*�e*�t�t �t�e r�t�t�x�r�t�t�t�t�r�r*�+r�rx�*�r�r*x �e
Z O N I N GS ERTEH�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAA; FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL; 42428108 ZNE; REF NO;
PLANNING N01'ES>
>
MMkkif 1hMMlkkkMilitiFiflfkkkiFkiFkkifkMMkMkkk�fifiFklfifkiFitM�flFlEftkikfFlFkifiFiFitkikififkfFif�E�fififikikiFkitifitMikitk
D E V E L O P M E N T S E R V I C E S R E Q U I R E H E N'T S
20NING APPROVED BY DATE: •`�:
BUILDING APPROV&D BY ; DATE: "'
APPLICATION ISSUED BY• � DATE: � �� Y�
kkiFkMitMMifkMMMMlfkiflflfiFikltifif'iF'�Fi ikitikiFifitkiFitif iFk
�FkMMNMkM1f�tlf�FiklF�klf�tlfi!lklfitikft�tititMikiFMk�Fkiklf�fitif�fitikMdFif ifltifitiliFlkifififklf�klFit�kfflkiflfMiflf�t�fikkiF�flfiFif
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 39.00
SMIP/NON—RES
ISSUE FEE a .50
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 39,50 0.00 0,00 39.50 39,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 39,50 OVER/SHORT; 00
BLD39PM��T PLUMBING ELECTRIC MECHANIC FIRE SMIP/TS�T GRADING PLAN—CHECK
kIFM1tMMMkif1F1f1FiFlkifkMlfMlEk�f�FlfiFlkkitif�fifMiF�f��F�f1FMMMifiFifMMIfMMikMiFif iFkif�F�fititM�fifififiFiFMMMlf�tk�fffik�f�k�fiF
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 I O N UNIT COST TOTAL COST
SFC 1675 ALTER BY VALUE COMNERCIAL N020NE 1.00 1,675,00
END OF FEES
J /
O1 00145356-00145357 T��T
OATE: 03/20i93 T:ME: 11:02
39.50
/�
�`' �" PO� � SPA
CONSTRUCTION ANDPLANNING �
APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date inspector
.�
1. Temporary Electrical Servi�e�0� Pol o.t '52. Pool & Equipment Location .,
2. Soil Pipe-Undrgrnd. r.� , �: 53. Steel Reinforcement
„3YElectrical Conduy�;t��ity-ll'�drgrndy�� 54. Forms .
:�,.�lectrical Condukd-J(nlrgmd. �° 55. E�ectrical Bonding
-,
_5� SteEl ReinforceTeg�? °''� 56. Rough Plumbing & Presiure Test �-
����Electrical UFER �n . o, 57. APPROVALTO COVER�GUNITE �
`-7:�Fdatings ?':�tn �- • , 58. Electrical Conduit-Undrgmd. ��
r
���yndation Y. � " � 59. Gas Pipe, O Undrgrnd., Test �' ��
%-9a Water Pipe�UndEgrnd. 60. Backwash Lines. P�Trap, O Undrgrnd.
16�StructuralFlooi`�,System . � 61. APPROVALTODECK
7 i. Property Sewer Ling& Ho ��onnestion 62. Backwash & ReceptorFinaf
12. Se4�;er Cap y a 63. Heater & Vent•Final
73. Roof Drains v 64. Plumbing System - Final
14. Rough Plumbing� � 65. Electricai�Final
75. Rough Electrica -Conduit 66. Solar Syttem-Final
16. Rouc�h E�ectric bViring 67. Fencing & Access Approval
77. Rough Wiring Stt,�n 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOI/SPA SYSTEMS FINAL
19. Rough Heating & Air Cond�tioning - FIRE DEPT. REQUIREMENT
'7 7' CH�+F �C �r' H N
20. ,Rouqfi Ffl�m��n Fi@place � v:t*t �T"J k � p rr F.. rWPRONAtSt7��2errtAt # r r^'
�' � T Y H Ci H�'1 y�l f �T ri
2i.'DUCf$� 1� H :� I HF :[5 a: �-• `� `�� 9 ai� Y�3�+ �` p7
� : � , n-$tructur�j� i • HS � S •J �+� 0. �der r r
22.�DuctS„Veu�til3tincya: � i"JS � S a:<avj�,Productmi�n�� ❑0il
�' � i �C �� U' Hx . i i r G x: O-
23.6as��pe�Roug�&'Tgst i �S .%� ,1, d�p �Z, Undergro(�iiFluL�jrj�„ f f.., -�
24. �Aoo�Framing•� ;,j. � HF ••i-+ i� 7 p a' ��.�3. WndergmcFStorae�eTaric �Gas ❑Olu
M
25. RoOfr$h�ethin �]�. � N � h! pt O Nx� .-+; �o a
9 ,j �� x C � ;� ' S/4.�erhead fiydro 1 *
26. �-BarCeiling (Stri�Lural) & oaecoat x CD j•,J-.ta: 75.:Drq Chemical " ?� � G �:
27. Frame and Flashin�� z' ` CD " 76. tD�j Standpq� OE: x S [�7 i-�
cc (� + t :7C.:Q n7T i' u�x W ): t*..
� ' �-. y. n r: � ? r • .. ,
�8. �athing Fi Si�g ,� �.� �-7 = x :. � ••. , 77. ef IXED S'r'�'S�EM� F.FiJAL x
.-, . r.
%29. Insulatidn " S�� O �-' ..•. x.y � 78.�IRE PREV. FINP�kj �>' ._ •
`7 �. 5 �
0. Orywall d"ailitig }s y � a �-+ HEALTH�qEPT.=R�EQWREI�ENT
�7. Plaster Brdwr�..Coa�� _ i . � �` � �79. �INAL IN�Q,�CTI�N ° d � �
'1 ''S 3: M
r..s2. ��IectricahPowgr n�teEeFfinal � F ',v. c� K;�$0. �FjOOD CE IFICRfiE IS5iJE0 �
�i3. ��in F'Elecjric� yx .n � a X � � � ` �7-llot"Y' G GO, .� � �/( �j? sl-r'3 ._
�.,-+�-. .. r � , .
�4. �F,inal'Hea'iiny� A�g �on€iitio��gq.a � : x ' r r S :-� ;, i� ,� ;r,�
35..Fin�FGas:Pipe�Temx � "7 x r r � ('� !1 �i1�' n .;^ (1�J
i � Y H �. S O O�-. �k r+ :'
�36.'Hoo�'.oriGano �• •.`y :, ; � J . � � .
i PY � 1 r^; n. x Cl .£ 2' Clo �x � 1.T
�37. Pinaf'Factory Fir€EI3ce' � ��� �` � ^� ` f �� �` ~ •'�
x i x S A
38. Final F'lumbin � � x ' � F �' �' `
9 Sx�. �n! > x � H r:7 rJ'.. _
f�.9. Water,Service�Finei�'- � � --, * z � ~ r1 .�[+: � 'i7 O
�;,� 5 z+` n. x S
.`�0. GasService-Ffal��,,, QMi� S x� ?� CW vN r., .
;41. Solar pomestin-Fir'aal� - C� •. A O� x k �:�v r+ :< `
- 1 *' -o a' T �
�. ��. ^, x �. x,. .-� � x J
•�i2. Backflow�revent6i � - :� , F x � , � � r,
� �. -
43. Backflovrirrigationr � F� = h' � �� '<<^� x �- � �.
^,. .. N i .x ;� •
,4. Landica e Ir � �r( �"` °L ': . � „
�5 R„ tj9at�o�SYstem.:!r,f� r.T� G C� iJz . x :J �.) � N o
�45. �$ound AitenQetioP•' �sF T fi f 2- i�-� :->� � �i �-+ �- b'o� 'Xs x
- � .r: T .T r•.., a
_ . :.� . .... � . , :� .
�6. Handicap:Reg`�latid" '. � *� � u x.� z S• Jo S
47. F1NA� STRIiCTI,k�E & BUIG ING �U ! $'" 1,o T �
l!/
i r-� r .�
48. f�INd'L PLAN�JIN(;�. ��. #: r+ � q p: - � - - �
+j9. Elec?(ic Re�ease to Edison t . . � - ' T ; 4'- - , �
_ i`�. r r
'S0. Gas Release to SoutAem Calif r i�_Gas Co * ` � � ' -- " � ' ".
b 4 ? ��c �. • o.n
�1. CEHFIFICATEOF „CCUPANCY� R .�;.". �, � tr� ;� � F, �
No. Date
(714) 754-5273 • Fax (714) 754-4858
� CITY OF COSTA MESA � �
' BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
Jobnddress: 620 TERMINALWY
Suite:
Vicinity: .
Parcel Nunmber: 42428108 Zoning:
Applicant: JESLEE, ALFRED
Address: 2569 FIDELIDAD DR.
CA Phone: � 626.3307919 �
HACIENDA HEIGHTS , - � Zip: 91745-4812 �
�
PERMIT NUMBER
77 FAIR DRIVE; COSTA MESA, CA 92626
Status: ISSUED IJ”
ApAlied: 05/01/1998
Issued: 09/10/1998
,
Owner. GREYSHOCK, ROSE A TR ' _
i
Address 1730 PESCAqOR�DR - � � � �
,;�� ' - ; � , � . � � �.A
j � ',. .� ',, •. - P,hone: - . .. ., � , .'. _ .
�
' NEWPORT BEACH,CA " Zip: 92660 � � � �� . � ' ' \ �� �.
. . . . _ _ . . . � � .
Contracror. � DONLEE DEVELOPMENT CORP. � - � , �
Address: 8957PEBBL� BEACH ,.
' � - . CA � , , � ' Phone: 714.8972157 . .
. - WESTMINSTER Zip: � 92683
� � License:�� 510150
Arch / Eng : � � � � _ - � ' �
i �'
Address: • �� �
, . �Phone: _- - ..
' Zip:
. � License: '
SCOPE OF PERMIT
� � '�INSTALL PRHFAB SPRAY BOOTH FOR "WET OKOLE�HAWAII, INC." �
. FEE SUMMARY ,, %
Plan Check: $0.00 _ �. , - , - ' �`. � /! ;,, Calc Valuation: ge,azi.00
' . Permit: $112.25 - — _ �%' � , Claim Valuation: -. $s,e2i.00
SMIP Res: �, $0.00 ' ,
SMIP�Com: $1.22 =°� � •
Other. $0.00
Inspection: $0.00
Total: $113.47 � � � _ �
- PLANNING & ZONING
SETBACKS �
MAIN STRUCTURE Front 0- 0 Rear 0. 0 ' Left � 0. 0 Right 0. 0 " � .
ACCESSORY Front 0- 0 Rear 0. 0 Left 0. 0 Right 0. 0
PARKING Ezistinq: 0 Required: 0 Proposed: 0
NOTES: - '
�i EXPIRA710N: This permit shall automaticalty expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
�� lor a perlod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetiona and final epproval must be obtained. Failure to obtain inspections and final approval will resull in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5628
�
WORKERS' COMPENSA710N DECUIRATON: '
I hereby eifirtn under penelry of perjury one of the tollowing tleclaratlons:
❑ I heve entl will melniein e certificate W consent to sell-Insure br workers' wmpensetlon, as provitled for by sectlon 3700 of the Lebor Cotle, for the pertormenca oi tha
work for whiCh IhiS pertnit Is Issuetl.
Q� I heve end will meintain workers' compensetion insurence, es requiretl by section 3700 of Ihe Lebor Code, for iha peAortnence of fth'7e work for which tl pertnpit ips i Sued.
'\ My warkers' compensetlon Inis-u-�ra�nce cartlBr entl policy number are: '' 3/�"-8 S G� 1 1
Cerdec �T�–T� 'rv�1 �i Policy Numhec
(This sectlon need nat be completetlll fhe permif is va/uetl et one hundretl tlollare ($ f00) or /ess.)
❑ I certity ihat in ihe p rmance of I�e wo�k for which this permit is issued, I shall not employ any person in eny manner so as to become sub)ect to tha workers'
compensetlon lew f Ce fomle, entl egr ihet N I shoultl become subject to Iha workerg' compensallon proNslans ai Sectlon 3700 of the Labor Code, I shell tonhwith
wmply with the pravisi ns. O�' O�� �
AppllcanlSlgneture: � �T Date: 1
WAqNINO: FAILURE TO SECURE WOR RS' COMP A ION COVEMGE IS UNUWFUL AND SWBL SUBJECT AN EMPLOVER TO CRIMINFL PE T1E5 AND GVIL FlNES UP TO ONE MUNORED
THWSANDOOLLARE($100,000),INF ITIONTOT�ECO TOFCAMPENSATION,DAMAGESASPROVIDEDFORINSECTIIXJ3]OBOFTHEl�1BORCOOE,INTEREST,ANOFTTORNEI"SFEES.
LICENSED CONTRACTORS
I hereby ettlrm ihat I em licen
torce antl eNed. Lia x G
CoMractors Signature:�
of Chepter 9(commencing with Sectlon 7000) ot Division 3 of the Business antl Professions Code, entl my Ilcense is in full
Class a _�
�� . G e9.+T oate: __ 9 1 O 4.Q
CONSTRUCTION LENDING AGENCY: —
❑ I hereby affirtn that there is e construction 19nding egency for ihe peAortnance at the work for which this permlt is issued. (Sec. 3097, Civil Code).
LentleYs Name: Lenders Atltlreu:
Signature:
OWNER-BUILDER DECLARATIONS:
Dete:
I hereby eHirtn thet untler penelry ol perJury that I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for the Iollowing reason (SecJ031.5, Busineu end Pmtessions
Cade: Any ciry or counry which requlres e permit to construct, elter, Improve. demolish, or repalr eny strucNre, prior ro its issuance, also requires the epplicant for such permit
to file e signed stetement �het he or she Is IlcensBd pursuant to ihe provisions oi t�e Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the
Business end Professions Cotle) or that he or sha Is ezempt theretrom and tha basis far Ihe ellegetl e:emption. Any violatlon of Seclion 7031.5 by any applicant tor a permit
sub�ects the epplicent to e civil penalry oi not more than tive hundred dollars (5500).):
� I, es avner oi Ihe pro0erry, or my employe�s with weges es Ihelr sole compensatlon, WILL DO THE WORK, antl t�e siruciure is not intended or ottered for ule (Sac.
7044, Business and Professions Code: The Gontractars License Lew does not epply ta en owner of pmperty who Duiltls or improves thereon, antl who does such work
�imselt or herself or ihrough his or her own emplayees, proNdad Ihet such Impmvements ere not imentletl ar oXered for sale. If, however, ihe building ar improvement is
sold within one year oi completion, the owner-builder will have the �urden of proving thet he ar she tlld not build ar improve for purpose of sale.).
❑ I, as ownar ot tha pmperty, em EXCLUSIVELY CONTRACTING WIIH LICENSED COMHACTORS ro wnstruct the project (Sec. 7044, Business entl Professions
Code: The Contrectors License Lew does not epply lo an owner of property w�o 6uiltls or improves thereoq en0 who contracts for such prqed with e wniraqor(s)
licansa pursuant to tha Contrectors License Laws.).
❑ I am exempt under sec.
Signature:
Owner ID verifed by tlrivels Ilcense. ❑ Ves ❑ No
Business and Pmfesslons COCe tor Ihis reason:
Vedficatlon of Ownership by (type ol document, I.e. - property tac bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
Drivefs License No.
Date:
Ezplres:
❑ I hereby certify that no excevatlon live (5) or more feet In depth Into which e pereon is redulred to descenq wlll 6e mede in conneclion wlth work authorized Dy this
pertnit, end that no builtling swcture, sceflolding, telsework, or demolition ar tlismantling thereol, will be mare t�an thirty-six (36) feet hig�. (Chep. 32, Grp 2, Art 2, Sec.
341, Tltle B, CaOfartda-Administretive Catla),
❑ As awner-builtler, I wlll not emp�ay enyone to do work which would require a pertnit trom ihe Division ot Indusinal Safery, as noted abova, unless such person hes a
permit to tlo such work irom the 26Wsion.
SignaNre: Data:
Division of Intlusinal Sefery Permlt Number:
CEHTIFlCATE OF COMPLIANCE AND AUTHOR17�TON OF EN7HV: I cenify under penalry ot perjury Ihat I have read this epplication and state that the infortnation 9ive� �s
cortect. I egree to comply with all state laws end ciry ardinances relating to building consWdion, end authonze represente�ives of �he Ciry of Coste Mesa to enter upon Ihe
above-dexn6ed property lor inspection purposes. I egree not to occupy or ellow occupancy of any 6uilding authonzed by Ihis permit until final inspection.
SR➢E.L
1616
1288
200
201
202
203
Fxed System Final Fire Prevention
Pool Spa Final
Flnal Re-Rooi
Finel BIocWReteining Well
Finel Fectory Fire Plece
Flnel Sign
204 Flnal Demoll�on
zaae-ae
„ 1/Q�� ryDate
yl x
�-�
oate
CODE 1 INSPECTION TYPE
206 Fnal Mechanical
20B Final Plumbing
210 Final Electricel
212 Final Fire Prevention
220 Final Planning Approvel
222 Final Site
250 Final Builtling/Occupency
OAiE Q�lLS
� f CITY OF COSTA MESA �, /`/
; _ � BUILpING DIVISION
� DEVELOPMENT SERVICES DEPAFTMENT
� `
���, PERMIT PERMI BER
F98-00109 ��
(714) 754-5273 • Fax (714) 754-4856 77 FAIFi DRIVE, COSTA MESA, CA 92626
FIRE SUPRESSION PERMIT
JobAddress: 620 TERMINALWY
Suite:
Vicinity: .
Parcel Nunmber: 42428108
npp�icant: JACK EVANS
Address:
Owner: COX, GARY K
Address COX, DANIELLE S
BALBOA ISLAND,CA
P 0 BOX 5863
Contrector: RIGOLI FIRE EQUIPMENT CO
Address: 02526 N LOMA AV
SO EL MONTE CA
Zoning:
Phone:
2ip:
Phone:
Zip: 92662
Phone:
2ip: 91733
.License: 524249
SCOPE OF PERMIT
INSTALL FIRE SUPPRESSION SYSTEM FOR SPRAY BOOTH., RE:898-00796.
FEE SUMMARY
Plan Check: $26.16
Permit: � $40.25
Other: $0.00
Total: $66.41
Stalus: ISSUED
Applied: O5It411998
Issued: 09/0911998
Calc Valuation: So.00
Claimed Valuation: S�,2oo.00
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 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
required Inapeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATON DECLARA710N: _
1 hereby aHirm under penalty af perjury ona at the tollowing declarations:
❑ I hBve end will maintain e certiticete ol consent to self-InSure for worker9' compensatlon, as provitletl for by sectlon 3700 of tha Labor Code, for Ihe performence of the
work for which this partnit is issuetl.
❑ I have antl will maintain workers' compensation insurance, es raquirea Dy section 3700 of the Lebor Code, for the pertortnance of the work for which ihis pertnit is issuea.
My wor�s c ensetlon Insurence cartier end policy numher are: �]
carrier: � dnt/P q�2/J �/2S Z � policy Number. _ 7� 2����'SZ �
(This secfion need not 6e c p/efed i/ (he permit is valued et one hundred tlollars ($700) or Iess.J
❑ 1 certity ihel in the peAo ance he work for which ihis permit is issued, I shall not employ eny person in any menner so es to become subjact to ihe workers'
compensation laws oi C II �mla, 0 egrea thet tl I should become subject to the workers' compensetion provlslons of Section 37o0 ot the Lebor Cotle, I shell forthwith
comply wiM ihese provi o s. Q p m p,
Applicam Signeture: v Date: 7� /� / u /
WARNINQ: FAILURE TO SE WORKEFS' COMPENSATIIXJ CAVERAOE IS UNLAWFUL AND SHALL SU8IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE MUNORED
iliOUSAND Dq1ARE (51 W ). IN AODITION TOTME COST OF COMPENSATION, DMMGES AS PROVIDED f-0R IN SECTION 3108 OF THE UBOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirtn thet I am licansed under provisions of Ghepter 9(commencing with Secti n 7000) of Divislon 3 0l the Business ey d Professions Code, end my Iicense is in fYIF
torca and ettect. uc. x �. 2 S�.�Y � i c�ess a � t�
Contractor's SignaWre:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm �hat there is e construcuon IenAing egency tor t�e peAo�mance of the work for which Nis pertnit is issuetl. (Sec. 3097, qvil Code).
Lentlefs Name:
SignaNre: _
OWNER-BUILDER DECLARATIONS:
Lender'S Atltlress:
Date:
I hereby alfirtn that under penalty of perjury ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the Iollowing reeson (Sec. 7031.5, Business end Professions
Code: Any ciry or counry w�ic� requires e pertnit to construct, alter, Improve, tlemolis�, or repalr flny sWcture, pdor to Its issuflnce, elso requires tha epplicent for such permit
m fla e signetl statement ihat he ar she is Iicensetl pursuant to the provisions oi the Contrectors License Lew (Chapter 9(commendnp wlth SeMlon 7000) of Division 3 ot the
Business and Professions Cade) or that he or she is exempt Iheretrom and (he basis for the elleged e:emption. Any violation ot Section 7031.5 by eny epplicant tor a permit
suDjects Ne applicant to a civil penalry oi not more than Ove hundred Collars ($500).):
❑ I, es owner of the properry, or my employees wit� wages as their sole compensation, WILL DO 7HE WORK, end the structure is not intentletl or ottere0 for ule (Sec.
7044, eusiness and Professions Code: Tha Contrectors License Law does not apply to en owner of properry who builtls or imprwes thereon, and who tloes suc� work
himself or herself or throu9h his or her own employees, proNtletl that such improvemenls are not IntenGed or oMered for sale. If, hov.evar, the bulltling or improvement is
sold within one year ot completioq tha ownerbullder will heve the burden of proving that he or she tlitl not bulltl or improve tor purpose of sale.).
❑ I, es owner ol ihe properry, am EXCLUSIVELY CONTRACTING WITli LICENSED CONTRACTORS to wnstruct the projed (Sec. 7044, Business end Protessions
Cotle: The contractors License Law does not epply to en owner of pmperry who bullds or Impmves thereon, and who contracts lor such pro�ect wlth e contractor(s)
license pursuant to ihe Contractors License Laws.).
❑ I am exempt undar sec. Business entl Protessions Code for ihis reason:
Signeture: Dete:
Owner ID verifietl by driveYs license. ❑ Yes ❑ No Dnvefs License No. Expires:
Verification of Ownership by (rype at document, i.e. - pmparty tac bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth Into which e person is reqWretl lo descend, will be mede In connection with work euthodzed by this
pertnit, and that no building structure, sceffolding, telsework, or Aemolition or tlismentling thereof, will be more then ihirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, lltle B, Callfomia Atlministretive Cotle).
❑ As owner-builder, I will not employ anyone to do work whlch woultl requlre a permit trom �he Division of Indusinal Sefery, as nated ebove, unlass suc� person �es a
permit to do such work trom the division.
Signeture: Date:
Division of Industrial Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AIJTHORQA710N OF EMAV: I certity untler penalry of perjury thet I heva read Ihis aDPlication end state Ihat Ihe informeiion given is
conect. I egree ro comply with ell state laws and city oMinances relating to building consiruction, and amhorize represematives ot the Ciry of Coste Mesa to enter upon ihe
above-descriDetl D�Werry tor inspectlon purposes. I agree not to occupy or allow occupancy of any building aulhoAzed by ihis pertnit uniil linel inspeIXion.
CODE �. INSVECiIONTYPE
1616 Fixed Syslem Finel Fire Prevention
1266 Pool SDa Final
200 Fnel RaRoof
201 Finel BIocWRetaining Wall
202 Final Fectory Fire Plece
203 Final Sign
204 Final Demolitlon
24dbd8
cs� � 9 y�
mt
GAjE Ii�E�$ LOLEj INSPECTIONTYPE
208 Flnel Mechenical
200 Final Plumbinp
210 Final EletldCal
212 Final Fire Preventlon
220 Finel Plenning Approvfll
222 Flnel Site
250 Finel Builtlinp/Occupency
�g ��$
1 � -.2A•''rSl �
��ia) �sa-s2�3 • Fax (�74) 754-4856
� CITY OF COSTA MESA . �
BIIILDING DIVISION
DEVELOPMENT SEFiVICES DEPARTMENT
PERMIT - -
Job Address: 620 TERMINAL WY
Suite No
Vicinity: INSIDE INDUSTRIAL BLDG.
ParcelNunmber: 42428�08
Applicant: JESLEE, ALFRED
Address: 2569 FIDELIDAD DR
CA
HACIENDA HEIGHTS
Owner: GREYSHOCK, ROSE A TR
Address: 1130 PESCADOR DR
NEWPORT BEACH,CA
MECHANICAL PERMIT
Phone: 626.330.7919
Zip: 91745-4812
Phone:
Zip: 92660
Contractor: DONLEE DEVELOPMENT CORP.
Address: 8951 PEBBLE BEACH
CA Phone: 714.897.2157
WESTMINSTER � Zip: 92683
License: 510150
ArchlEng:
Address:
Phone:
Zip:
License:
PERMIT NUMBER
M98-00515
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 11/06/1998
Issued: 11 /O6/1998
SCOPE OF PERMIT
CONTRACTOR PERMIT: MECHANICAL PERMIT FOR PAINT SPR4Y BOOTH INSTALLATION. INSTALL
HOOD W/DUCTS FED BY MECHANICAL EXHAUST.
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >700 k BTU
Repair / Alt Cooling/Heat •
Inst / Rep. Recess Wall Htr -
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping '
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent �
Air Handlers < 10000cfm -
AirHandlers> 10000cfm
Floor Furnace
Floor or Suspend Heater
$22.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercia l I n cineretor
Domestic Incinerator
Compressors / Absorption Systems
Upto3hp/100kBTU
3To15hp/500kBTU
75 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Upto3hp �
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Quantity
$0.00 0
$0.00 0
$0.00 0 .
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00
$0.00
$0.00
E31.50
EXPIRATION: This permit shall automatically expire and become void if work is not commenced wiihin 180 days, or if work is suspended or abandoned
for a period of 180 days. _ .
INSPECTIONS: In order for Ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inapectlons and finel epproval must be obtained. Failure to obtain inspeclions and final approval will result in the expiration of this permit.
FOR INSPECTIONS CAII: (714) 754•5626
WORKERS' COMPENSATION DECLARATION:
I hereby eNirm untler penalty of per�ury one of 1�e following declaretions:
❑ I heve antl will melntain a certllicete ol consent to selt-Insure for workers' compensetion, es provitleA for by sectlon 3700 of ihe Labor Code, for the pertormence of t�e
�work br which this Oermlt Is Issuetl.
I have anC will malntain workers' wmpensetion insUrence, as required by section 3700 ot Ihe Lebor Code, for ihe pertormance of ihe work for which this pertnit Is issued.
My workers' compen58tlon Ins nce certier end policy number are: I I���S �
Carner: STR��E �UN� PolicyNumber.
((his section need nof be canp/eted ll the perm/l is va/uetl et one hundred dollars ($ f00) or less.)
❑ I certify thet in the peAormance of the work tor which this permit is issued, I shall not employ eny person in eny menner sa as to become subject to tha workers'
compensetion lews ot 3Ra nle, antl egree that i� I should become subjec� to Ihe workers' compensation provislons ot Seclion 3700 ot the Labor Cotle, I shall fort�wlih
comply with thesa p vision . ,�( �(
Applicen� Signe�ure: � 1"r Dete: �' /G � � "
WARNINp: FAILURE TO SECURE WORKE MMPEN TIO �I CpVER4GE IS UNL4WFUL PND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENA�TIES AND GVIL FlNES UP TOONE HUNDRED
TTIOUSANDDOLL4RE�5100,000),INADDIiI TOTHE T COAIPENSAiION,DAMAGESASPqOVIDEOWRINSECTION3]O60FTHELA80RCODE,INTEREST,ANDATTORNEY'SFEES.
LICENSED CONTRAC70RS DECLARATION:
I hereby effirtn thet I am Iicensetl untler provisions ot Chapter 9(wmmencing with Section 7000) ot Divislon 3 of the Busi� and Protessions Code, and my license is in full
iorce antl eHect. Lic. q qass»
Conirector's Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I here6y aMirm Ihet Ihere is a consiructlon lenai ency tor the pertortnance oi Ihe work lor w�ich t�is permit is issued. (Sec. 3097, Civil CotleJ.
Lenders Name: Lentler's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eMirm Ihat unde� penalty of Der�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the following reasan (Sec. 7037.5, Business end Professlons
Coda: Any ciry or counry which requires a permit to construct, alter, improve, tlemolish, or repalr any stmcture, prior to Its Issuance, also requires iha applicant for such pertnit
to tile e signetl statement ihat he or she is licensetl purs�ent to the provisions of the Contrectors License Lew (Chepter 9(commencing with Section 7000) of Division 3 oi tha
Business end Pmfessians Code) or thet he or she Is exempt theretrom and ihe besis for the alleged exemption. Any violetion oi Section 7031.5 by any applicant tor e pertnit
suhlects the epplicant to e civJ Denelry ot not more then fve hundred dollars ($500).):
❑ I, es owner of ihe D�aPerty, or my employees with weges as �heir sole compensation, WILL DO TNE WORK, end Ihe strucNre is not intended or olteretl for sele (Sec.
7044, eusiness end Professions Code: The Contraaars License Lew does not apply to an owner ot property who builtls or improves thereon, and who does such work
himself or herself or through his or her own employees, provitled thet such ImD�ovements are not intended or otteretl tor sale. It, however, ihe building or improvement Is
soltl within one year ot completion, ihe owner-builder will have the burtlen of proving thet he or she did not build or Improve for purpose oF sale.).
❑ I, as owner ot Ihe property, am E%CLUSIVELY CON7RACTNG WITH LICENSED CONTRACTORS to consiruct ihe prolect (Sec. 7044, Business antl Proteuions
Code: Tha contrectors License Lew does not apply to an owner of properry who builds or Improves Ihereon, entl who wntracts for such project with e comrector(s)
license pursuant to �he Contrectors License LawsJ.
❑ I em exempt under sec. Business and Professions Code lor this reason:
Signature: Date:
Owner ID venfied by drivers license. ❑ Ves ❑ No Drivefs Licensa No. Expires:
Ventication ot Ownerehip by (rype of tlaument, i.e. - property tan bill or deeC):
DIVISION OF INDUS7RIAL SAFETV PERMR CER7IFICATON:
❑ I �ereby certliy that no azcavation five (5) or more teet in tlepth imo which e person is requireA to descend, wlll be mede in connection with work authodzed by this
pertnit, end ihat no bulltling structura, ScaXolding, falsework, or demolition or dismantling t�ereat, will ba more Ihen thirty-six (36) feet hig�. (Ghep. 32, Grp 2, Art 2, Sec.
361, Tltle B, Calllarnie Administretive Code).
❑ As owner-buil0er, I will not employ anyone to Oo work which would require a perml� irom Ihe DlNsion of Indusirial Sefery, es noted above, unleu such person hes e
permit to tlo such work from Ihe division.
Signeture:
Division of IndusMel Sefery Permit Numbec
Date:
1 WIII ihe appp��li m or present or fu�ure 6uilding occupaM need Io file end cartity e Buslness Plan for emergency resp.mse to release or Ihreatened releese of e hezertlous
me�edal9 7qYes ❑No
(Sectian 25505 of Ihe CalNarnle Health end Sefery Cotle requires, with some eviceptlons, that a Business Plan be filetl with ihe Coste Mese Fire Depertment by every
business which hes et eny one Ume Curing e reported year a quantiry of hazerdous meteriels equal to or greater then a weight oi 500 pounds, or e volume oi 55 gallons,
ar 200 cubic leat of compressed ges et stantlartl rempereture and, pressure).
.............................................................................. ..... . ......................................
2 Doee or wlll the epplicent or present or tuture building ocapant neetl to file e registretlon brm br ewtely hezerdous materials? Yes ❑ No
(Sectlon 25533 01 Ihe Cellfomla Healt� entl Setery Code, with same exceptlons requires reglsiretion with the Costa Mesa Fire Depertment by eech business whlch at eny
one time hes an �antl e Quentity at acutely hezerdous materlels equal to or greeter ihen e weight of 500 pounds, or e volume of 55 gellons, or 200 cublc feet of
compresseC pes et atendeM temperature entl pressure).
..................................................................................................................................................................................................................................................................................
3 Does or wlll Ih applicant or present or futura buildinq occupant need �o prepare an RMPP (Risk Menagement and Prevention Program for acutely hazardous materiels)7
❑ Yes �No
(Section 25 01 Ihe Gelifomia Health end Setey Cotle provides Ihal Ihe Casta Mesa Fire Deperlmeni may require Ihe preparation, certificatlon end tiling with Ihe Fire
Depertment oi en RMPP by businesses which ere requiretl to register ecutey hazeMous materials with Ihe Fire Depariment.
..................................................................................................................................................................................................................................................................................
4 If an RMPP is presently requiretl, has Section 25534 of the Califomia HeaIN antl Safery Code been tulty compllad wiN? ❑ Yes ❑ No
. .................................................................................................................................................................................................................................................................................
5 Does or will Ihe epplicant or present or tuture building occupent raQuire tor Ihe work which Is the sub�ect of thi@ epylication a gertnit for such construction or motlificetlon
iram the Sout� Caest Alr Ouality Manegemem District or tram eny other air pollution conirol tlls�dct or egencyl �H Ves �J No
(Section 658502 of the Celifomia Govemment Code requires that the requestetl iniormation be tumished on eppl'icetions for non-residentlel building permits).
.......................................................................................................................................................................................................................... .. . .......... .....................
............ .
6 Will any part of ihe taciliry to be constiuctetl undar this permit be within 1000 fee� from the outer bounderies of e school7 ❑ Yes o
(It yes', the taclliry must meet the requirament ot Sections 25534 antl 42303 of the Calitomie Health end Safery Gode).
.................................................................................................................. _.......................................................................................... _.............. _..................................................
7 II e pertnit irom the South Coest AU �ualiry Management District or o[her elr pollutlon contml tlisirict ar agency r quiretl for the work whlch is �he suD�ect of ihls
appliwtion, heve all of the disdasures prescnbed by Celifornia Heelth end Sefery Cade Sectlon 42303 been matleP �Ves ❑ No
. . . ............................................................................................................................................. ...... ............................................................................
B (If yes", atlec� certiticaie ol compliance trom the appropriate air polWtion control oHicer).
CERTIFICA7E OF LIANCE: I cenify ihet untler penelty ot perjury the Iniormation given above Is corract. I egrae to comply wit� ell state laws end city ordinences
regertling Hazar us Mat �n1als end E ss ons. e.�l p�(
Signewre: _ � Y,�,� D n"T Dete: � �� 1�+
CERTIFlCATE OF COMPLIANC�D A ORVA ON OF EMiiY: I certity untler penelly of perjury thet I heve reed ihis applicetion antl state thet ihe intormation given is
correc�. I egree to comply with e stete laws d' ordinances ralating to building wnsfruction, and authorize reDresentatives of the Ciry of Costa Mesa to enter upon ihe
ebove-describetl D�aPerry for Inspection puryoses. I agree not to occupy or ellow xcupancy of eny Duiltling authorized by ihis permit until tinal inspection.
COUE 1. INSPECTIONTYVE
1616 Fixed System Final Fire Prevention
1266 Pool Spe Final
200 Finel Re-Rooi
201 FIneI8locWReUining Wall
202 Final Factory Fire Place
203 Final Sign
204 Finel Demolition
2a46J6
OAB It�d64
' I �6 �� �Date
Date
COOE� INSPECTIONTYPE
206 Finel Mechanical
20B Finel Plumbing
210 Final Electrical
212 Finel Fire Prevention
220 Finel Planning Approvel
222 Final Site
250 Final Building/Occupancy
� �m�.
v • • `7Y
(714) 754-5273 • Fax (714) 754-4856
Job Address:
Suite No
Vitinity:
CITY OF COSTA MESA
BUILDING DIYISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
620 TERMINAL WY
INSIDE INDUSTRIAL BLDG.
Parcel Nunmber: 42428108
Applicant: JESLEE, ALFRED
Address: 2569 FIDELIDAD DR.
CA
HACIENDA HEIGHTS
Owner: GREYSHOCK, ROSE A TR
Address 1130 PESCADOR DR
NEWPORT BEACH,CA
ELECTRICAL PERMIT
Phone: 626.330.7919
Zip: 91745-0812
Phone:
Zip: 92660
Contractor. DONLEE DEVELOPMENT CORP.
Address: 8951 PEBBLE BEACH
CA Phone: 714.897.2157
� WESTMINSTER Zip: 92683
License: 510� 50
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switthes
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to 50hp
Motors l0 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
PEf1MIT NUMBER
E98-01170
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED ��
Applied: 11I0611998
Issued: 11/O6/1998
SCOPE OF PERMIT
CONTR4CTOR PERMIT: ELECTRICAL PERMIT FOR PAINT SPRAV BOOTH INSTALLATION FOR "WET
OKOLE HAWAII, INC." ONE LIGHT FIXTURE, TWO SWITCHES AND ONE MOTOR 0.0 TO 1.0 HP.
$22.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1.00
$0.00
$2.00
$0.00
$0.00
$0.00
$0.00
50.00
$4.25
$0.00
$0.00
$0.00
$0.00
$0.00
So.00
sa.00
$0.00
$0.00
$0.00
Quantity
0
0
0
1
0
2
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Li9hting
Busway /100 ft
Standing Section
Misc Electriwl Equipment
Trensformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kvalkw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System I Ckt
Misc. Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
50.00
TOTAL CALCULATED FEES 529.25
COMMENTS / SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 1 BO days. .
INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspectiona and finel epproval must be obtained. Failure to obtain inspeclions and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DpCLARATION: !
I hereby aHirm under penelry of perjury one oi the tollowing Oeclerations:
❑ I heve end will meintein e cenificate of consent to seN-Insure for warkers' compensation, es provided for by section 3700 of Ihe Labor Cotle, for the peAormence of the
work for whlch t�i5 permit is issuetl.
� I heve entl wlll malntein workers' compensetion insurence, as requlred by section 3700 of the LaDor Cotle, for the peAortnence of the work for which this permit is issued.
My wo ompensation I ance cartier and policy number ere: �L G
Cerrier: / �i� �1t�11� PolicyNumber. / � 37TV �
(Thls secfion need nof be comp/eletl il the permif is velued et one bundred tlo/lars ($100) or less.)
❑ I certify that In the perf �nce of Ihe work tor which Ihis permit is issued, I shall not employ any person In eny manner so as to become subject to the workers'
compensatlon lews alito ie, and egree tha If I should became subject ro the workers' compensetion proNsians of Section 3700 of the Lehor Code, I shell Iorthwith
comply with these ovisio S
ApplicantSigneture: � oa�a: l/I6IQc�f
WARNINO: FAILURE TO SECURE WOqKER COMPEN$ TION COVEMGE IS UNLAWFUL rWD SH4LL SUBIECT AN EMPLOYER TO CRIMINAL NALTIES lWD GVIL FINES UP TOONE MUNDRED
TFIOUSAND DOLLARE (E100.000), IN ApDfil TO THE (DST O COMPENSATION, OAhNGES AS PROVIDED FOR IN SECTION 3�OB OF THE tABOR CODE, IMEREST, AND A7TORNEYS FEFS.
LIGENSED CONTRACTORS DECLARATION:
I hereby aflirm ihet I am licensed Under provisions ot Chapter 9(commencing wiN Sectlon 7000) ot Dldsion 3 at the Business end Professiars Code, and my license is in tull
torce antl eNect Lic. A Class N
Contractafs Signeture: — Dete: I 1 (p� q
CONSTRUCTION LENDING AG�NC
❑ 1 �ereby atfirm ihat ihere is a construction I ding e ncy br the performance of the work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Address:
Signature: Date:
OWNER-BUILDER DECLARA7IQNS:
I hereby eHirtn that untler penalry pt perjury thet I am E%EMP7 FROM THE CONTRACTORS LICENSE LAW lor t�e tollowing reason (Sec. 7031.5, Business end Proleulons
Cotle: Any ciry or wunry whic� requlres a permit m construct, aller, Improve, demolish, or repair eny structure, pdor to its issuance, elso requires Ihe applicant for such permit
Io lile a signed stetement thet he Or she is Ilcensed pursuant to the pmdslons of tha Camractors License Lew (Ghepter 9(wmmencing with Sedion 7000) of Division 3 oi the
Business end Professions Code) br Ihat he or she is e:emp� therefrom and the basis for ihe elleged e:emption. My violation o1 Section 7037.5 by any epplicant tor e pertnit
subjeck tha applicant ro e ciml penalry of not more than flve �undretl dollars ($500).):
❑ I, as ownar oi lha properry, or my employees wllh wages as ihelr sole compensation, WILL DO THE WORK, antl ��e siructure is not intendetl or oflered for sele (Sec.
7044, Business and Pmtessions Cada: The Contrectors License Lew does not apPh to en owner of property who builds or improves thereon, and who does such work
hlmself or herself or ihrough his or her own employees, proNtled Ihai such improvemanis are not inlended or oftered for sele. tl, however, Ihe Duiltling or improvement Is
soltl within one year oi completion, ihe owner-builder wlll heve the burden of provinq ihat he or she did not bulld or Improva for purpose of sale.).
❑ I, as owner of the pmparty, em EXCLUSIVELV CON7RACTING WITH LICENSED CON7RAC70RS to construct the project (Sec. 7044, Business end Professions
Code: The cantrecrors License Ww tloes not epply to an owner of property who builds or improves thereon, end wha camracis for such pro�ect wlth e conirecbr(s)
license pursuant to ihe Goniractors License Lews.).
p I am exempt untler sec. _ Business and Profassions Code tor this reason:
Signeture: Date:
Owner ID verifietl hy drivefs licen�. Q Ves ❑ No Drivers License No. Evpires:
Verification ot Ownership by (type of document, i.e. - praperry tex bill or deed):
DIVISION OF INDUS7RIAL SAFETy PERMR CER7IFICATION:
❑ I �ereby certity ihat no excavetion tive (5) or more teet in tlepth inro which a person Is requiretl ta descend, wlll be matle in connection with work euthodzetl Ey this
pertnit, entl thet no Dulltling atructura, scattolding, falsework, or demolition or dismantling thereoi, wlll be more Ihen thirty-si: (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifomle Atlmiqistretive Cotle).
❑ As owner-builder, I will not employ enyone to tlo work whlch woultl require a pertnit from ihe Dlvislon of Indusinel Selery, es noted above, unless such person has a
pertnit to tlo such wark trom (he tlivision.
Signeture: Date:
Division of Industnel Sefery Permil Numher:
MAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII Ihe aPPPPII��66m or present nr tuture bulltling occupam need to file an0 certity a Business Plan for emergency respunse to release or threetenetl release oi e �aierCous
mBIBr1819�Ye9 ❑ Np
(Sectlon 5 of Ihe Celifomie Health end Safery Code requires, vnih some exceptions, that a Business Plen be filed with tha Costa Mesa Fire Deparimenl by every
business which has et eny one time Ouring e reported year e quentiry ol hazardous materlals equel to or greeter than e weig�t of 500 pounOs, or a valume of 55 gallons,
. or 200 cubic leet of compressetl gas et standartl tempereture en0 Oressure).
......................................................................................................................................................................................._......... .. ..........................................................
2 Does or will the aDPlicent or present or future building occupant neatl to tile e registration torm tor ecutely hezerdous metenals7�Yes ❑ No
(Sectlon 25533 of Ihe Celifomia Health entl Satety Code, with some exceptions, requires reglsiretlon wit� the Coste Mesa Fire epa ment by each business whiih at any
one time hes on hand e qugntiry of acutely hezerdous meterlels equel to or greater t�en e weight of 500 pountls, or e voluma of 55 gellons, or 200 cubic feet of
compressed pes et etentlartl temperature entl pressure).
.................................................................................................................................................................................................................................................................................
3_ Dges or will the epplicant or present or future building occupant neetl to prepare an RMPP (Risk Managemem end Preventlon Program tor acutely hezerdous meterials)7
25534 of ihe Celifornia Health entl Safery
ent o1 en RMPP by 6usinesses which ere i
an
Nat the Costa Mesa Fire Depanment mey requlre Ihe preparetion, cartitication entl liling with the Fire
tar awtety hazerdous matenals with the Fire Department.
..................................................................................................................................................................
iia Heelth anG Satery Code heen tully complied with7 ❑ Yes ❑ No
Does or wlll ihe applicant or present or tuNre bullding occupent requlre for the work which Is the sublect ot this Ilcation e permit tor sucn constructlon or motliticatlon
from Ihe South Coasi Air Ou��iry ManaBement DisMct or trom eny other elr pollution conirol disiria or agency? �Ves ❑ No
(Sectlon 658502 ot the CalitOrnia Government Code requires Ihat the requested infortnation be tumished on eppliceuons for non-residential builtling permits).
.................................................................................................................................................................................................................... ...
...............................................
WJI eny pert of the feciliry to be constmcted under this permit be within 1000 feet from the outer boundades of a school9 ❑ Yes o
(tl yes", the faciliry must me0t the requirement of Seclions 25534 antl 42303 oi the Califomie Health end Setery Cotle).
.................................................................................................................................. _...................................................___............................................................................,
If e permil irom Ihe South Coest Air �uellry Menegement Dlsidct or other eir pollution control tlistdct or egency S r uired for the work w�ich Is Ihe sub�ect of IhiS
applicetion, have all of Ihe digclosures prescnbetl by Celifomia Heelih and Satety Code SecOon 42303 been madeP Yes ❑ No
.... . . . ............................... . . . . ......................................................................................................................... ... ............................................................................
(If yes', enech ceM1iilcete oi Compliance trom Ihe appropnate eir pollutlon control offcer).
CERTIFICATE OMPLIqNCE: I certilY lhet untlar Oenelty 01 perjury I�e inlormation given aDove is Correct. I egrae to comply wi�h all state laws end city ordinenC05
regertling Ha rtlou Mate' Is a Er�(a\sio�na,,� �� [�I '
Signature: _ �,�---\,_/ �IENT oete: � ) 6 � � Y
CERTIFlCATE OF COMPLIAN�E pND O OA710N OF ENiRY: I certify under penalry of perjury Ihet I �eve reed this appliwtion end state that the infortnation given is
correct. I agree lo comply with alI state la d ciry ortlinances releting to building constmction, antl authodze representatives of ihe City ot Cosle Mese to enter upon the
above-tlescribetl propeny for in50ection purposes. I egree not to occupy or allow occupancy of any building authodzed by ihis permit until tinal inspeclion.
QppEy INSPECTIONTYPE V \
1616 Fixetl System Finel Fire prevention
1266 Pool Spe Final
200 Finel ite-Rool
201 Finel BIocWRetaining Wall
202 Finel Factory Fire Place
203 Final Sign
204 Final Demolition
266616
�ff I��
11IGIQ� Vtl�n
7'—' Date
COOE� INSPFCTONTVPE
206 Final Mechenicel
20B Final Plumbing
210 Final Electdcal
212 Final Fira Preventlon
220 Final Plenning Approvel
222 Final Site
250 Fnal Bullding/Occupancy
. �
� -`" g��_�s
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C06TA MESA. CALIFORNIA
For Applicanf fo Fill In Complefely
YYPE OR PRINT
BUILDING
AODRESS � O �
COSTA MESA. CALIFORNIA
■ STATE
TEL.
NO.
� �/O I NO. OF BLD68.
NOW ON LOT
USE OF r
EXISTING BLDG. ' L' L F! T/f T//!'
98TBAGK LINB PPOM
ceNTCR oP eTrteei REAR YARD
SIDE YARD I LEFT I RIGHT
DESCRIPTION OF WORK
.c.�ay
EXTERIOR WALL
COVERING
USE OF BUILDING
FE,E RECEIVED
�' AUG 141961
.. FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
PECEIPT NO. / PER� TJ
�
BY I O �fi EI ED I pAi�188
O
COSTA MESA, CALIFORNIA '
APPROVED
ZO £` NO.OF
vLANB
LEGAL 1�
ING '
YBE OF NEW
BUILDING �
7WEi
�R
�IN�/. �
Y V �
� HEPEBY ALItNOWL8D08 iMAT 1 HAV6 READ THI9 APPLIGT�ON {ryg AMOUNT BXOWN UND6R VALIIATION IS FOH THE
ANO BTATE THAT TNE ABOVE IB CORPEGT ANO AGREH TO COM-
PUflP08E OP EHTABLIBNINO A PENMIT FEE ONLY.
PLY WITH ALL CIiY ONOINANCEB AND 9TATE LAW6 REpUUTNG
sU��n�Ha CONBTRucilON. VALUAT{ON
�y
SIGNATURE OF ' 'PERMIT FEE $ � !
PERMITTE m
$ I � PLAN CHECK $
AUTHORIZED AGENT � � � 0 '
TOTAL FEE y
�: � ����
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C09TA MI:BA. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
n�oRess / �D �Q H / riAL �WAf/
COSTA MESA CALIFORNIA
1 ARCHITECT
� SIZE
TEL.
NO. OP BLD�B.
NOW ON LOT
SHTBACK L�NE FROM
GENTCa OP sineei REAR YARI
SIOE YARD ILEFT IRIGHT
DESCRIPTION OF WORK
tlU1LO1NG ) / rvV. U;
SIZE )( �Z ROOM,
EXTERIOR WALL IROOF
COVHRINO COVE
USE OF BU�LDINCzAND WORK TO
FEE RECEIVED
fINANCE D�EPT. ��� � ��
CIiY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
P£CE1VT NO. VLRMIT f10. �
COSTA MESA. CALIFORNIA
FIRE
ZONE TVPE GROUP�
APPROVED 7
BY DA
Z NING
ZONE �, I NO. OF � I lIBE OF N
PUNB 9111LOING
�ecw�
oeecx�rr�oH
A. P. NO. O�7 .� �L ��. ,
YARDS EVE�—
APPROVED ALLOWED
IC¢MEF LINE BT.1 _
APPROVED
�-,
G
1 H8R8BY ACKNOWLeOOe THAT 1 HAV6 Re�O THIB �PPLIWTION qry¢ AMOUNT BHOWN UNDER VALUATION IB POR THE
AND BTATH TNAT TME ABOVE 19 CORIiELT AND AGRE¢ TO COM-
PUPP086 OP E9TABLIBHING A PBRMIT pEE ONLY.
PLY WITH ALL CIYY ORpINANCE6 BTATE LAWB qBpUUTINO
9UILDINO CONBTRUCI'I VALUATION /�
91GNATURE OF � PERMIT FEE $ �[ '� a
PERMITfE Qy o
' S / S ♦ PLAN CHECK $ ��—
AUTHORIZED AGENT � �� o
TOTAL FEE 4
s,
. r 15`�3S
COSTA MESA BUILDING•SAFETY DEPARTMENT
P, O. BOX 917 COBTA MEBA. CALIFORNIA
For Applicant fio Fill In Completely
TYPE OR PRINT
BUILDING O / AL W
ADDRESS
COSTA MESA. CALIFORNIA
SIZE `, y ` O NO. OP BlDG9.
OR LOT ._� 7 S �� NOW ON LOT
USE OF
EXIBTING BLDG ES
BLTBACK UN8 PROM
csHiea OM �+eei REAR YARD
SIDE YARD I LEFf I ftIGHi
DESCRIPTION OF WORK
� eui
�.L X �� �Q�� ROOMS STORIES
WALL ROOF
COVERING
I�LDINC�ND WORK TO BE PERFORMED,
ri' Tn..u.i- �-mndLT��ii
�
BUILDIN�
ADDRE6 �
FIRE
ZONE
APPROVED
BY
°"�-�- I
LHOAL I
�EE RECEIVED
�OCT 2 51980'
FINANCE DEPf.
CITY OF COS1A MESA
APPLICATfON FOR PERMIT
BUILDING
For Office Use Only
COSTA MESA. CALIFORNIA
` QcONING
NO.OP �uae ov New
PLAN9 BUILDINO� ,
A. P. NO. /I U —�vV � � �
YARDS EVES
APPROVED ALLOWED
(C8M6R LINH YTJ (i�, .�
�
- z-e
1 HERBBY ACKNOWL8D08 TXAT I HAV6 q6AD THI9 APPLIGTION }H6 AMOUNT BXOWN UNO¢N V�LUATION IB FOR TH8
AND OTAYB TXAT TH6 ABOVE 18 LORRHCT �NO AORHE TO COM- pypp098 OP EBTqBLIeHINO A P¢qMIT F!H ONLY.
PLY WITH ALL CITY ORDINAN 6TAT8 L./�WB N60ULATINO
BUItDINo CONBTRUCTION VALUATION
61GNATURE OF � PERMIT FEE $ � • ���
PERMITTE i..(� _
S `/� PLAN CHECK $ �
AUTNORIYED A6ENT f� V' t_ p
70TAL FEE y
��