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HomeMy WebLinkAbout190 23RD ST - Building Permits rct _.!r !1 A • } es I wi " 1 f I t • �w r t1 :- ,. -C_etzttaf _LMfE et utcfi of Co to GI4Esa ROBERT M.BENGSTON, Pastor 190 Twenty-third Street FRED MARTIN, Youth Pastor Costa Mesa, California 92627 Phone 645-5050 Costa Mesa Planning Dept. June 3, 1974 77 Fair Darive Costa Mesa, Ca . 92626 Dear Sir: In response to your call this morning, we are sending this binding letter: The Central Bible Church will not occupy the new sanc- tuary until the final inspection by the City Building Department and Planning Department. The release of the new underground wiring for the Power Company hook-up will enable us to connect our present four older buildings . This will allow the Power Company to re- move four meters and four sets of overhead lines . We would like to thank your department for the cooper- ation in this matter . in ely, i4. RECEIVED J . Leonard King Trustee Board CITY OF COSTA MESA Vice—Chairman P1 finiwf nrPT JLK:jb JUN 3 1974 AM PM 718190001112111213141516 I I 1 11 I I 1 1 II • I I II I 1 .1 ! 1 L__1 . , I I , 1 I ' it tf I 1 I I- - . I - --I- _-II- I- �_ ._ _ Y I i I I 1 ,! " I I !/ I !— I _ _I f i 1 - 1 H/rH j I _L. i- t- 1- I - . 1 ! 1 / I � I � 1 1 1 --- i —1—I I '- I -4--I ---i - j- -'- L I --I I j 1 j — I I I I 1 i ! 1 1` j 1 1- , 1 — !—_+ ! ! i I t I I _ l—L� L. 1 _ _ I I 1_ 1 1 . 1 T— I 1 1 1 i i I _II !;_j____-_1- 1 1 1 - 1 —_ _ _ __ 1 I__I 1 j I I — III h _ -i - - Hill }. I (II� _ I j .- ` _1__._L-I_ I 1j-1.-_�.-.-_ ._ _ L__ _i_ I -_i_ — h . 1111 1 �I - I Lr. ' inn • I , 1 �l ! i_ I I I- '�( �Illmm01 1 I- 1 ! 1 j 11 ;_ j L- I I I �- - ' i , I CODE ' h , �_ I .I I _ t—i I 1 -- L— l__ �� � 1 I . — —� 1H - HtH i--f --ITi- ip ii___Lx•______ Il ri- I 1 i _y _i I i � 1 i ti. R� 1 L_ I 1APPROy�AL0El.7 E i -I j V1 ' 1-I-'�v' -'__1 _� `j_ L PLAN DES jI _ _ +---r----- 1 _ r 1 ' CITY, OF I iNOT CON�TlTJTEI AR�ROVAL o 1 �- - -- 1 1 1 i�CflSFa fvt ( 1 F PLUMBING, ELcCTPICAL1R --(--;-'� I --I- 1 1 1 I , , - - 01iTINGLIb 1 NSTALLATl10N . -3 - -�- ' r I 1 � � I-"I x 4 IEfJHlt 1 1 unlit - - IA L I : ion WoA'TE-, ::4i til FS--VVI ON JAT Akt1. I --- I_ I ' i TROUT PRIOR {MSI I ' -Tow-Burp --vr -._-- 1 — i— FMP_LAYE� V E SO: 11,1T1 TNF 1 R:GRANTIN i TATE OF ALI '01. IA DI':I �Y 0 1 1__�I—L__ If_;-'--'--- inci IDN3— 8RM1TrOR-APPR- I - NDdSTRIAt SAFE-Y E- N T F.O;t_ __1—_.' __I i 1 f OR'AN• 1 BRILL NOT BE CONSTR Y I —�'-`-----..__ r� I� ;i - —'--i—'---i— �U D- _ADDITIONAL REQU REMEN:.. , 1 . 1 ( I ' �PPR0.VAL — s1GRAs OEillialc00' ANY VIOIATI N 1 1 1 1__-. .�_— ,—t-- ---'t I —. � 11 -- ;-i-- 4±TE±tpt -L11_�__. — ' 1 - OT PREVE I I 1 i I I i `1 -(-•- , - -�� . _- L RINGE NN. NQ. LJ__.i --i-- • ..<---• —I—L-- -- --�-- - 1 10ATIOs0 ONOFERORS ! 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I i I I � I I1 1 • I .1 I of PLA Is Ali sP. ---i I I I 1 — - Y 1 j -- -I r--I - I -1,_____L_1 ' i I. __ } + i 1 I —I—; I —I Tn d e iiV L�r9 P�' 1 L--L •• TO-BE' T F -r----- I , - , OF ANI1 OF HE RO ' I -y I I I I ! . , 1 1 1 SU ORN-TO-LIVE, AI —T 1 -- I I I I I -�. _ t_ -I._-.1.. ! _ 1 PROVISIONS THIS I i 1-1� -- -- 1 I 1- 1 . — r. — ; - —.L._I_ -4 _ E—.....-_, .-L- I .FAR AS 7dE ORK!OR , � - -` I I I I I 1 1 j _..T----, I , • Td� slfAFvE_I ___L—_..—_.—L_ i I _ , ! I.I SPECIFI6ATIONS SHAH' ' 1 1 -- 1_ j I_ --I_I_ '1 _I _ 1 I I ! FFOM TTHEREAFT€k REQ; ( . . r I , ;-1-1-1- I I j r I SAID PIANS_ANO .s,__' r- .z_.__:_._.— I II I ! 1 I . ! BUILDING OPERATIONS E 1 --1' f 1 I ' I 1 l ' • I--.-�.• ! 1 _ -. • _IN;YIOlAT1O7.OFtins C • ' • 1 1 I or,THE,OITY, I t i ! t ` I I I I . a i COSTA MESA BUILDI. SAFETY DEPARTMENT NOV 7.6 73PA,;00 906Ra* =***38.00 P. OX 1200 lir • Costa esa, California j' • • SING PERMIT APPLICATION PERMIT NO. TRACT NO. RECD. BY II-4 � � e CONTRACTORA _co/JL OM Bii,!/r/' LOT NO. • /DATE ISSUED • Address .2 0 9 J n-e„ S- /'.:'r:�B`I/GING . / //�.a( -73/ • City /ULyditrd4' Tel. No.5 ).5(t ADO REI55 / / D /{L A 3 IP, I- • State License No. 3 39fg Class./0 5 COSTA MES/A. CALIFORNI NEAREST A /� 0w City License NoJ C. CROSS ST. / � \\ I— OWNER Mai 41 Q NUMBER TYPE OF FIXTURE OR ITEM/ FEE MAIL 1. ' . Water Closet(Toilet) ./ '(f AODRE55 ,..w..��/J.�t I Bath Tub CITY /• J . d iu STEL. NO. Shower I here y acknowledge that I have read this application !n Lavatory(Wash Basin) Y Cat' and'state,that theiabove is correct and agree to comply >. / Kitchen Sink / 5-0 with1ail%,City Ordinances and State Laws regulating CC Laundry Tub or Tray plumbing., J. • Lit s I certify that I possess the above valid state of Cali- / Service Sink / �'' ‘tf{rnia classification or I am the legal owner of the resi- 0 . 3 Floor Sink 7 .IZA1 ' fdential property described above. �/1 • [[ - Floor Drain T' �pi/. e �J��J✓R�-EZYf d t,.p Permittee of Dishwasher -�4-� a' / Permittee Z - r]( Drinking Fountain / 1/2 +x' 4j/ w i Urinal '— f'�' • INSPECTION RECORD • Garbage Disposal .t `rt1`'-k\ y Automatic W'ashing•Mi'ch. 1.. . , Water Softener\ #t \t I,. 7/ _:5 water Hente'r R'Nem e h'c - 5 tea// t ->L CC Rec"cptor%.,r - ' LU d Swimt,Pool Filter System CC I Gas System . .'S. Outlets / / -Nei M Lawn Sprinklers / 0 Installation or Alteration ' Water Piping v, Baek Flow Preventer APPROVALS N Prop. Sewer_ ft. INSPECTOR DATE • Houk Sewer Conner n U/G Soil - Z Cesspool, Septic= kink U/G Water Services—Water 0 Gas 0 Miscellaneous Rough Plumbing Sprinkler System / bid PT:/.',.r7c f-r...atir l JC! Gas • Property Sewer Pool Receptor Filter System Pool Heater Miscellaneous • Issuing Permit 2 00 c Final Ges - - TOTAL FEE �0 Plumbing Final Utility Co. Notified t� ' POSH eu-n BLDG. PERMIT NO. "',/t`5 9` —< C'F CITY OF COSTA MESA O. • BUILDING DIVISION F 4- 41 DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER PERMIT at" I B04-01480 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite: Applied: 08/23/2004 Vicinity: CHURCH Issued: 08/30/2004 Parcel Number: 43926131 Zoning: Applicant: OMAR RASCON ISSUED BY: Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 Owner CHURCH, CALVARY NEWPORT Address -MESA COSTA MESA,CA Phone: 190 23RD ST I Zip: 92627-1754 Contractor: SUPERIOR DEMOLITION INC Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 License: 797170 Arch : - Eng: Address: • Address: Phone: Phone: Zip: License: License: • SCOPE OF PERMIT DEMO CHURCH BLDG AND 5 ADMINISTRATIVE BLDGS ON SITE.REF.:804-01481 THRU B04-01485 APPLICANT WILL CONTACT A.Q.M.D.PRIOR TO DEMOLITION. O.2' FEE SUMMARY Plan Check: $0.00 Calc Valuation: $15,000.00 Permit: $251.25 Claim Valuation: $15,000.00 • SMIP Res: $1.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $252.75 • 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 Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this2ermit shall comply with all applicable handicap access requirements under California 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 180 days,or if work is suspended or abandoned fora 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 Inspections 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)754-5626 2646-46(6100) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. k}' I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier:c S�` �n�5"� Policy Number: /G,93---a/2 - ectyce (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,end agree that If I sh. . .- ...,subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature' -. _-_ _ Date: a - SO-G y WARNING:FAILURE TO SECURE • RS'•. -- • ON•. RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# d Class N Ce e Contractor's Signet -- E Date: .A - Srj — o �/ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig-- ure Of Le,- •wner(s) Date ..licant Date ;ODE# INSPECTION TYPE PATE INTRIALS CODE INSPECTION TYPE PATE INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing - 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign ('� ��p 222 Final Site 204 Final Demolition ,�(/// _ 250 Final Building/Occupancy • CITY OF COSTA MESA , ° BUILDING DIVISION Y%4 ,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ip.Witt. �. I!A PERMIT / ikbeou■arw V B04-01481 (714)754-5273 • Fax(714)754-4856 • www.ci,costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite: Applied: 08/23/2004 Vicinity: - Issued: 08/30/2004 Parcel Number 43926131 Zoning: • Applicant: OMAR RASCON ISSUED BY: Address: PO BOX 3306 { Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 Owner: CHURCH, CALVARY NEWPORT Address MESA COSTA MESA,CA Phone: 190 23RD ST Zip: 92627-1754 Contractor SUPERIOR DEMOLITION INC Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 License: 797170 Arch : Eng: Address: Address: Phone: Phone: Zip: , License: License: SCOPE OF PERMIT DEMO CHURCH BLDG AND 5 ADMINISTRATIVE BLDGS ON SITE.REF.:B04-01480,B04-01482 THRU B04-01485 APPLICANT WILL CONTACT A.Q.M.D.PRIOR TO DEMOLITION. O•12- FEE SUMMARY Plan Check: $0.00 Calc Valuation: $15,000.00 Permit: $251.25 Claim Valuation: $15,000.00 SMIP Res: $1.50 SMIP Com: $0.00 Other: $0.00 - Inspection: $0.00 • Total: $252.75 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 Existing: 0 Required: 0 Proposed: 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 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 Inspections 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 2448-46(WOO) DECLARATIONSi - WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: 57.1,77-6. ice .-� Policy Number: /4 9S-672- ZOp y+ (This section need not be completed/OM-permit Is valued of one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and a re come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi Applicant Signature. Date: 8 30 - O-y WARNING:FAILURE TO SECURE WORKERS' SATION'GOVERAGE IS UNtAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.A Class k 02 • Contractor's Signatur Date: art_rel CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,end who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Wit the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...._ 6 Will any part ofthe facility to be constructed under thisp ermit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 Na (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signa ure Of Legal• •ner(s) Date — ^OY- :rOr A. .."1”--r.Applicant Date 000E 0 tfSPFCTION TYPE DATE UITRIALS CODE INSPECTIONTYPE BATE INTRMLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy •gt11 M CITY OF COSTA MESA / ► BUILDING DIVISION >• „,;'> DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 is I PERMIT 'Prom,*. 04-01482 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite: Applied: 08/23/2004 Vicinity: Issued: 08/30/2004 Parcel Number: 43926131 Zoning: Applicant: OMAR RASCON ISSUED BY: Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 Owner: CHURCH, CALVARY NEWPORT Address MESA COSTA MESA,CA . Phone: 190 23RD ST Zip: 92627-1754 Contractor: SUPERIOR DEMOLITION INC Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 License: 797170 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMO CHURCH BLDG AND 5 ADMINISTRATIVE BLDGS ON SITE.REF.: B04-01480/1481, B04-01483 THRU B04-01485 APPLICANT WILL CONTACT A.Q.M.D. PRIOR TO DEMOLITION. 0 V. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $15,000.00 Permit: $251.25 Claim Valuation: $15,000.00 SMIP Res: $1.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $252.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 I Rear 0-0 Left 0.0 Right 0-0 PARKING Existing: 0 ' Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 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 Inspections 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)754-5626 2446.46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'+7s+compensation Insurance carrier and policy number are: Carrier: , s . n n-. Policy Number: 76 9'6-?/7- (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this•ermit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,end at r:: - . subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: - _ Date: 8 -30 -o'- - WARNING:FAILURE TO SECURE W•-, 'L ••^G-." : CITY OF COSTA MESA 4 BUILDING DIVISION ori • F ( ;.,s,,,,., DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 0 7a PERMIT lzbeeer,`s4` 04-01483 (714)754.5273 • Fax(714)754-4856 • vnvw.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite: Applied: 08/23/2004 Vicinity: Issued: 08/30/2004 Parcel Number: 43926131 Zoning: Applicant: OMAR RASCON ISSUED BY: Address: PO BOX 3306 . Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 Owner: CHURCH, CALVARY NEWPORT Address MESA COSTA MESA,CA Phone: 190 23RD ST I Zip: 92627-1754 Contractor: SUPERIOR DEMOLITION INC Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 License: 797170 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMO CHURCH BLDG AND 5 ADMINISTRATIVE BLDGS ON SITE.REF.:B04-01480/1481/1482/1484/1485 APPLICANT WILL CONTACT A.Q.M.D.PRIOR TO DEMOLITION. p '' FEE SUMMARY Plan Check: $0.00 Calc Valuation: $15,000.00 Permit: $251.25 Claim Valuation: $15,000.00 SMIP Res: $1.50 i SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $252.75 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 Existing: 0 Required: 0 Proposed: 0 - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 180 days,or if work is suspended or abandoned fora 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 Inspections 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)754-5626 2446-4e(MO) DECLARATIONS ( j WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. RE I have and win maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: � � Card ��9 LJ V Carrier: _ �' Policy Number: St t:7 ' !p-1,0 C/ (This section need not be completed If the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued.I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California.and agree that If I •. • .... a subject to the workers'compensation provisions of Section 3700 of the Labor Cede,I shall forthwith comply with these print • s. Applicant Signetun,00%.7ly - � � - _._. Date: g— — 0 y' WARNING:FAILURE TO SECURE WORKERS'COMPS SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TOONE HUNDRED THOUSAND DOLLARE(5100,0X),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Llc.4 - /7d Class N r 2 I Contractors Slgnatu, , _____ _ . Date: , ' — 4a —o A--( CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will bo more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,litle B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with tho Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _._ __._ _._ .....a.. ...._.. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? TI Yes ❑No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). _ _......_....___ __— 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a schoohoc 0 Yes es ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). permit h al_.__.._. Distr.___ _.. 7 a a nathe South Coast s prescri ed Management a eal or dhSr airtpollution ooncontrol 3istragency is required for the work which is the subject of this epplicatlon,have all of the disclosures prescribed by Celifomia Health and Safety Code Section 42303 been made? ❑Yes 0 No 6 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �/ Sign tura Of L-•- % ner(s) Date et.- viii. --"— rilirtn•u I••licant Date DDOE I INSPECTION TYPE PATE QhIU845 900Et INSPECTION TYPE DATE ui=mALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval _ 203 Final Sign /J 222 Final Site 204 Final Demolition . 250 Final Building/Occupancy 6011 ' CITY OF COSTA MESA BUILDING DIVISION F� !•,_►I DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 4 PERMIT %,ems lt B04-01484 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 190 23RD ST - - Status: ISSUED Suite: Applied: 08/23/2004 Vicinity: Issued: 08/30/2004 Parcel Number: 43926131 Zoning: Applicant: OMAR RASCON ISSUED BY: Address: PO BOX 3306 1 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 I i Owner CHURCH, CALVARY NEWPORT Address MESA COSTA MESA,CA Phone: 190 23RD ST , Zip: 92627-1754 Contractor: SUPERIOR DEMOLITION INC Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 License: 797170 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMO CHURCH BLDG AND 5 ADMINISTRATIVE BLDGS ON SITE.REF.:B04-01480/1481/1482/1483/1485 APPLICANT WILL CONTACT A.Q.M.D.PRIOR TO DEMOLITION. O?, FEE SUMMARY Plan Check: $0.00 1 Calc Valuation: $15,000.00 Permit: $251.25 Claim Valuation: $15,000.00 SMIP Res: $1.50 SMIP Corn: $0.00 Other: . $0.00 Inspection: $0.00 Total: $252.75 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 Existing: 0 Required: 0 Proposed; 0 - - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 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 inspections 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)754-5626 244646(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'corn ensati Insuranc carrier and policy number are: Cartier: C i-.�i Policy Number: .."6,476•76 /7- _zQ'�1/44 (This section need not be completed i1 the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree the bject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: _ Date: eS—a0-�etc_y WARNING:FAILURE•• r- ORK _ •TION COV ' FY. LAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND Civil_FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic. 77) Class# Ce2/ Contractors Slgnatur __ —�e�� Date: s CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignature Of Legal•' .r(s) Date . -• .. plicant Date CODE I INSPECTION TYPE 257E INRTIAL$ CODE( INSPECTION TYPE DAIS MALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Be 204 Final Demolition 250 Final Building/Occupancy R 9 CITY OF COSTA MESA BUILDING DIVISION > •4 ..,.,'�: , DEVELOPMENT SERVICES DEPARTMENT PER NUMBER P. IIPPt PERMIT 04-01485 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite: Applied: 08/23/2004 Vicinity: Issued: 08/30/2004 Parcel Number: 43926131 Zoning: Applicant: OMAR RASCON ISSUED BY: Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 Owner: CHURCH, CALVARY NEWPORT Address MESA COSTA MESA,CA Phone: 190 23RD ST Zip: 92627-1754 Contractor: SUPERIOR DEMOLITION INC Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 I License: 797170 Arch : ! Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMO CHURCH BLDG AND 5 ADMINISTRATIVE BLDGS ON SITE.REF.:B04-01480 THRU B04-01484. APPLICANT WILL CONTACT A.Q.M.D.PRIOR TO DEMOLITION. 02 FEE SUMMARY Plan Check: $0.00 Calc Valuation: 515,000.00 Permit: $251.25 Claim Valuation: $15,000.00 SMIP Res: $1.50 SMIP Com: $0.00 Other: $0.00 - Inspection: $0.00 Total: $252.75 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 Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 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 Inspections 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)754-5626 2448-46(8100) DECLARATIONS .) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carder and policy number are: Carrier: - V pan Policy Number:4 9 C16 e "— ZD p y. (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so es to become subject to the workers' compensation laws of California,and agre ' ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: $ — ----Cy WARNING:FAILURE TO SECURE WORKERS' ENSATIOrTCOVERAGE IS UNLAWFUL MD SHALL SUBJECT M EMPLOYER TO CRIMINAL PENALTIES AND OWL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Llc.B 797/7n Class a C Z/ Contractors Slgnatu•-= - - Date: s CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with somo exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure), 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the Calif omia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE MD AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 7 Legal Owner(s) Date Ah• •r ArdlidlzeA ppllcant Date CODE 1LISPECTION TYPE 2ATE MAO CODEC INSPECTION TYPE PALE MALS 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Firo Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition Y0•94. 250 Final Building/Occupancy ' CITY OF COSTA MESA - ✓ - AyBUILDING DIVISION Y • `� DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER 1. 11.1.4 . PERMIT + 604-01669 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite: Applied: 09/27/2004 Vicinity: HALF MOON LANE Issued: 03/09/2005 Primary Occ: Type of Construction: Parcel Number: 43926131 Zoning: ' / Applicant: CASTLES, STEVE ISSUED BY: Address: Phone: 714-792-2581 Zip: Owner: SHEA HOMES LTD Address 603 S VALENCIA AV Phone: BREA,CA Zip: 92823 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: TIMOTHY MALLIS Address: Address: 4510 RUTILE ST Phone: Phone: 909-685-1521 RIVERSIDE,CA Zip: License: 90509 License: C31925 SCOPE OF PERMIT CONSTRUCT A 1624 LF RETAINING WALL FOR"HALF MOON LANE,"A FUTURE NEW TRACT OF HOMES. REF:G04-00010 • FEE SUMMARY Plan Check: $636.84 Calc Valuation: $97,440.00 Permit: $979.75 Claim Valuation: So.00 SMIP Res: $9.74 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,626.33 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 Existing: 0 Required: 0 Proposed: 0 NOTES: KUBOT_BJ 09/30/2004 GAVE 1 SET OF PLANS TO ENGR(JC) FOR NOTICE: The work authorized by This permit shall comply with all applicable handicap access requirements under California 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 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 Inspections 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)754-5626 2446-46(6/00) DECLARATIONS u • "u Q .. t WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) XI certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' N.compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thes visions. pr it t ipnature: ate:So C WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES uP TO ONE HUNDRED THOUSAND DOLLARE(5100,000).IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.SI Class R Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion.the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) r license pursuant to the Contractors License Laws.). O I am exem under sec. Business and Professions Code for this reason: Signature: Pate: r UT Owner ID verified by driver's license. 0 Yes 0 No Dr vl e s LTehieltr-/ £ x�pi Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials end Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE MD AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature Of Legal Owner(s) Date, An row TlzedAppliddnt ilDaie J CODE!, IffSPECRONTYPE PAM INTDIAL$ CODE' INSPECTIONTYP$ BAIL INTmAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • DECLARATION OF AUTHORITY Bldg. Permit# FOR AGENTS OF PROPERTY OWNER This Permit# TO APPLY FOR PERMITS Street Address: HO 23 " ,4(E AP Number: 1. I (we), HOM Ed ‘,//4/rep / 1,Aq'lE/2-0`W7 , declare that I am the Owner of Title of the above referenced real property, and that I (we)hereby authorize: q 1Name: STEf� CA S7z f Telephone Number: '7J 792 —259/ Street Address: ir!03 .41'C. ity<" 73R609- 1 C.¢ z ',26 23 to obtain permits in my behalf, as owner/builder,for el-ICA 1-4 oME5 at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa • Mesa,as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this 43 tk day of Kilo at' 20 or , at /f' , California. Print Name: N\Afat Makii\ Signature: erri-cinv /'- �/'l,•lT` Date: 'AML, door • Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 077946(rev.11/00) , CITY OP COSTA MESA ' BUILDING DIVISION or '. 'MIT NUMBER ER DEVELOPMENT SERVICES DEPARTMENT f F , PERMIT 17 0. Ptah 77 FAIR DRIVE,COSTA MESA,CA 92626 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa._____.hHLDING PERMITCOST: ISSUED C Job Address: 190 23RD ST Applied: 11/23/2005 Suite: Issued: 12(12/2005 Vicinity: Type of Construction. Primary Zoning: Parcel Numbber:er: 43926131 Applicant: GARY WILLIAMS Address: 1450 N TUSTIN AV Phone: 714-245-9760 X24 ISSUED BY'. SUITE 105AZip: 92705 SANTA ANA,CA Owner: SHEA HOMES Address 603 S VALENCIA AV phone: 714-985-1300 Zip'. 92823.'`. Contractor. MACHESTER LOCK AND SUPPLY - Address: ,1043W MANCHESTER BL, phones 2136496222 INGLEW00D,CA,:, f License: 481574 7,.. Eng:Address:Address. t o Phone: - - License'-_" I �F 'License' - •Zip , SCOPE OF PERMIT INSTALL 4 LIGHT POLES ON PRIVATE STREET FOR"SHEA HOMES' • ''` FEE-SUMMARY -e Calc Valuation $16000'00 $1 Plan Check t $26 2 a Claim Valuation 6000,00 , Permit. $265 2 - - SMTP Res: $000 - SNAP COM ';"` $.3:3,6 b6 ;-_ Other $0 00 Inspection ''r:;$0 00 ` , '`Total: ,ao $311.t1' PLANNING &ZONING SETBACKS `� Rear 1Ceft }0 0., Right 0--0 _ MAIN STRucTURE 'Front 0 0 _ _ s , - -` ACCESSORY PARKINGstm 0 'Required 0 P,4-p-51§,—.-i.,:-.4,„,d0 ix "' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Caiitomia statutes and related regulations.(Ord.No.92-28,§ or it work Is suspended or abandoned EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, , for a period of 180 days. required Inspections tor the work approval must be obtainedthorized under '.Fas iluretto be to obtain Inspect onsdered gal, such and final apprk must comply with oval will result in heaelxpirafio_r O h1IS permit. all FOR INSPECTIONS CALL: (714)754-5626 v 244646(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:- • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) I cedNy;ihat in the performance of the wor•for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agr:: t .t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these•rovis'i s. of Sign T.,—s- Dat :_g�o2 tZ T ���Ataa 105 LWARNYIOPFFILURE •SECURE OR ERS'COMPENS• •"•VERAGE IS UNLAWFUL AND SHALL SUBJECT AN SECTION 37 TO ORIMI PENALTIES AND CIVIL RNES UP TO ONE HUNDRED LTHZUSAND DOLLARS . r NA•'MON TO THE •c •F COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: - Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication apPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with at state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. [N—•ti_ matSi•nfur/Of Leg. Owner(s) . ' . ._ —t_ Il/IZri "c-atscLa � .the I •Appll : Tifirt -.Abbler YODEL ' CTIONTYPE `-- IZAl ' ItII1JP_LS CODEI INSPECTION TYPE 1616 Fixed System Final Fire Prevention ~_ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site 204 Final Demolition 250 Final Building/Occupancy I I I i HARE ASSOCIATES Fax:714-245-9761 ........ Dec 9 ')005 15:49 P.04 - . 10:39 SFEA hoMES OF S/tALIFORNIA. 4 92493761 NO.639 DEW IL, :HpRE ASSOCIATES Fax:714-245-9761 ! Dec 118 2005 9:09 .04 Ji 1 I • FROM :etre PA< . t714 754 dm, ' ! Dec. 07 2e05 00:37rim P3 fie OsTA PrM71 KL i • , I . , • • • I ,DOLARATION OF„AUTHOICI i i 014 Penal if : . ?F. con/wawa OF PROPERTY OWNER.] I I , I , 1, • ' This arms To APPLY FOR PERMITS ‘i. • , 11.: 1 ,0 1 , , i l';• 1 0 e i :1! t '15" -2-b14 54r-c6f. _ Ap Number: , 'Stoat astoliS 1 1 i : f, If tea : r I e IeN 9 • h.144.1;Cu.fen ' ! __, dense itnat I am the Danarapf lik of MI6 abaft ' I • 1 garnasen4-14 i . irdefwatteed ftal papery,and Mat I Otititfoby authoiner . • , 1 . . (Nome ..,Vora L.firt5r: Car+e2- Tsfapheae monism /Mr>CIi I' (90 it .V•1 . • . . . , : : • 1 staxparg4t Sp) Up - Tc4-54-(" Aim Si-ei. 15-Q I ' 7co-1 . : • i S.OkAlth Pir‘A • stab: ...L.U3 • • I;ii . , 111;1 ; • 1 • 1 tft ehtsin paWits in esti DAC as aotteoirumer.ibr 4-lait4 in a 01?‘ .1.0i-rt 42.-. • elm nan.4 istereneed ocepedy. 1 ' - I: i 2. &odd an,Oman beam en eespespe engaged In Mt ifStfibvernafit Of the anlirtf,I(ie)tall infiditrir24 MSc sefralraro compress triamenne cowman and wag 0 eawneste of that coveraint ea be fikai with the&aft DO*,of the Ci as y ci Co' ' 1 . - vase,as efigarao to'state ot coaamta Ws 1 ' li . i : 3_ As orsommilijosor ts ter, I eartentpers arm at mat my Inosixthsbitithis co not trans* to woo s orlon. oornoary or , i i .ooroonnoril , . 7 • • ,...A . H 4: •cadres as raeinnoy and hold de czy ea coin Mow and ts smpbyeas of alum Priam tem affy earrn?Bislang in a/nage or . I mimeo 410 to fore or any flax woo=.ao a maul of work authorized byte permits from the Ms of Cali Mesa. 1 .• I I I 1 • • ! : G. i*Ude*Same can*of MO,that the fenCleng is tfas awl CiOnlet. • accuse ii'its. 5344 day a Ther_cteslo er 20 Orli- !at . 1 ,Callaffia. • : :• • ii :kJ • „ . . II i PAN Nal,: rn an Or li• iThit rc..uth I ., I.. , ' agewnse rez4/19?-' Pi? -71,1461110.--- h • 1.• ii , oat _ i 4-1-as' • ' i 1 i • • . i .. , ii •'! -4... --gyp.---N&Mwataarnrizazanta porearm mo iota as ma, a eddy armetate la:frame oohs of More b arrant*tent El any behalf .: :. : — . 1 •: ' . 1 •,, i : ... 4 11 •.... . - - -- -- ..• . ... . . ' - 1 �� CITY OF COSTA MESA 4 (SaY>. BUILDING DIVISION /!'�,...• F ( �4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • PERMIT J Cls•o-.an�'"�, /04-00927 -R (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 190 23RD ST Status: ISSUED Suite No Applied: 08/23/2004 Vicinity: Issued: 08/30/2004 Parcel Nunmber: 43926131 Applicant: OMAR RASCON ISSUED BY: Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 Owner: CHURCH, CALVARY NEWPORT Address MESA COSTA MESA,CA Phone: 190 23RD ST f Zip: 92627-1754 Contractor SUPERIOR DEMOLITION INC Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 License: 797170 • SCOPE OF PERMIT DEMO CHURCH AND 5 ADMINISTRATIVE BLDGS ON SAME PROPERTY.CAP ELECTRICAL AND SEWER CONNECTIONS.REF.:B04-01480 THRU 004-01485 . APPLICANT WILL CONTACT A.Q.M.D.PRIOR TO DEMOLITION. FEE SUMMARY ' Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 • " , Standing Section $0.00 0 New Res(1-2 units) $0.00 0 - Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0Transformers up to 1 kva/kw $0.00, 0 Pool/Spa $0.00 . 0 up to 10.kva/kw ` $0.00 0 Lighting Fixts , $0.00 ' 0- up to 50 kva/kw $0.00 0 Recept Outlets $0.00 ' 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 ' 0 . Low Voltage Equipment $0.00 0 . ' Res Appl $0.00 . 0 Low Volt Wring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 , Service to 1000a $0.00 ' 0 Misc.Conductor $0.00 "p- Service over 1000a ' $0.00 0 Circus(gen or ride) $0.00 '7 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00' 0 - Christmas Tree Stand -'$0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 • - Other Electrical Fee $9.80 / Motors over 100hp $0.00 0 - Communication drops $0.00 0 Investigation Fee $0.00 NOTICE: The work authorized by this'permit shall comply with all applicable handicap access requirements under California 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 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 Inspections 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)754-5626 244646(6/00) DECLARATIONS 1/4, ) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. .—+have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: .. . Z. n Policy Number: ./S9S6/2-7,epy (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,an. .• d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi Applicant Signatu _=— — Date: F4—$O--OCv WARNING:FAILURE TO SECURE WORK •- •MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Mt EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR 000E,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.tt Class ft CZ? Contractor's Signatu • Date: a aa.-.nY CONSTRUCTION LENDING AGENCY: o I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ature Of Legal Owner(s) Date f ate Lf e An.r• -. -rized Applicant Dale • CODE 0 INSPECTION TYPE QAIE INTRIAL$ CODE# INSPECTION TYPE. QZTE MAU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 20 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ---- CITY OF COSTA STh M7 ON P :0:0NiU2MiBiER BUILDS'SDEPARTMENT DEVELOPMENT' EVELOPME SERVICES DE � �A PEflMIT dillirris ' TA MESA,cA 92626 .�/;� _ 77 FAIR DRNE,COS 'tcodour.° a �'�TRICAL PERMIT Status: ISSUED 714)75x4656 •• www,ci.costa•mes Applied-_ 117171200 6)75a-5273 • Fax( issued: 11117!2005 Job Address: 190 23RD ST Suite No '�' r��f Vicinity'. bi 43926131 ... ISSUED BY: Parcel Nunmber' LECLP Applicant SHASTA E Address: 665 BREA CANYON RD Phone: 909-59a-23a1Zip 91789 - W ALNUT,CA Owner: SHEA HOMES " 7985.1300 Address 803 S VALENCIA AV . phone... hone = .14-92823 - - Z+P ' - .I Contractor= `SHASSp, ELECTRIC'LP 665 BREA CA NYON RD Phone: 909 859x•231 Address: Zip: "91789 • License°663876 + s _ -- - -WALNUT,GA " gCO - ' PERMIT :. PEtt HEA.HOMES - r "pRANGE MpoN 1p,NE=AND • ESTALS AND'1 TRAFFIC SIGNAL FOR RALF HALF MOON LANE AND 2 ON 31 ELECTRICAL PEDTED ON 23RD ST AND 1 PEDESTAL LOCA Quantity SUMMARY y Is SYstem-1 Ugpting 8000 0 Quantity - _ Temp 1100 t1 $0.00 Busway - + $2350 e. -- Standing Section Q merit $54610- 3,�„ �` - IEgwp $0.00° 0 ISSUE EEE $0.00" ... MISG EI%lets u to 1 wow/ .. $0 00 - -' Transforrnars P � seN+ce test �` �$O.OD. 0 - -. 10.10 kvalkW . Temp 000 - ..._. �uU>p tp 50 kva/kw $0.00 : 0. New Res(1-2 umts) $0.00 .. 0 up kvalkw ; New Res Murata): _ `$0.0 0 _ ovte 1pp kvatkw $$0 Q ^ PoolLighting (Spa _ $0 00 0 e Equipment $0.00, Lighting Fats $000 '' ' 0 - -Lbw Volla9 irin SYstem t Ckt ,$0.00 0 t Outlets „ 1$0.00 0 Low Volt W . 9 $0p0 0 Recep MSC COndU+t - - 0 Switches .r uotor" - -s000 Non Res APPi $0.00 0 ,Misc'Cond � i .$0"00 t -, an bi ride) •$0.00 0 ..„.- Service ice t 0 _ C.6r:u4(9=ch tide or.lights)" " $0:00 '',0 zsCircus(me .,$0.00 0,: Service to 200a ,,;, _$0 00 'Chnstmag Tree Stand Service to 1000x: 0 s Stand $O;Q� ovar 1000a- " Firew ork„ Service 0 , ribel Fee ° -$0 OD -.D _ Other Elect 7 �� Motors to 10 $000 0 $p;00 Motors to 1 00 ation Fee Investig kFee J" '$0.00 hp Motais to over ;„..$ 00 , ' -, ;" 0.,• g.Planchec Motors to er l O cotton Fee , 100hP '' 000 p ,fn is '' Reins _ _ $78.10 Motors p over drops `$0 00 TEDf, ¶ 0MDII%ONS . " �` irementsunderCaiilornia statutes and relceha :::::: atutendedndre%aor it work isspaltshallcoY workauthodzea void if work is rwi comrn180 days NOTICE: The 92.28,§1,1221.92) livable codes•d Ord.No. expire and become must comply with all app regulations.( such work expiation of this pain This permit shall automatically considered Jogai' bnal approval will result m the exp EXPIRATION: it to be tions and for a period of 180 days' Failure to obtain inspec �...� INSPECTIONS: In order for the wo cval must ba obta++Weds pe required InaP�ti°ns and tlnal aPP r--- ran rNSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will this ea is issiuete of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the TOUTfor which this permit is issued. t� I have:and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. 1My/others'compensate n Insurance cafier and policy number are: camer: G � titvtitrt.C'AvFIOML Palicy•Number:_jo(, y. wr1 GTis'eectlon need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and:.ree at If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these ovisions. / / /./ ./—c �Applicant.Signature:- �1 /✓ t `1`f'^4"JO� pwnRNING:,EA4.U11E TO S, URE WORK RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLQYER.TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED _l4DIDSAND DOLLARE($1X,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I ereby.affirm.tha61 amJicen ed u der•rovisions of Chapter 9(commencing with Section 7000)of Divisio0 3.of.the.Bus' ess and Professions Code,and my license is in full force and effect.,Lic, xiR i 1 \a t Class a �7G Con�sSignature •._-,. � ' I {- .—Date,i "7- CONSTRUCTION CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • re Of Legal Owner(s) 11 wners) - 1 A� Date T'r!:rta+;"Arid/Or 000E I iff$PECTION TYPE OATS INTRIAL$ CODE It INSPECTION TYPE PLEINTI1IAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy pSTA " CITY OF COSTA MESA 4 BUILDING DIVISION . : DECLARATIONS WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (T is section need not be completed it the permit is valued at one hundred dollars($100)or less.) 4 rl.fertify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' coTpensation laws of C ifomia,and agr t t if I should become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr i ns. A plNi ',FAILURE— ," Date: Rt N LE Ao T1E- Q WA D DOL RE -SECU W KERS'COMPENS TION ERAGE IS UNLAWFUL AND SHALL SUBJECTFOR�f TO NAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED F USAND DOLLARS($10 ,000),IN DDITICN TO THE PENSATION,DAMAGES AS PROVIDED FOR I SECTION3706 OF THE LABOR 000E,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# x Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' O I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes D No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health end Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. c-75.___ SV:VOr.natu — aI Ow (s) l2 9ate rAnNOr Aut nzed A Ican1 ,.?' J�9 BL— CODE I INSPECTION TYPE RbIE INTIIAI$ CODE I INSPECTION TYPE PAIS INTmIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing CCJJ q 200 Final Re-Roof 210 Final Electrical //�! 4 <1 -- 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy . 4`#0CITY OF COSTA MESA 11*9 BUILDING DIVISION °arkPERMIT NUMBER F ( pl. I DEVELOPMENT SERVICES DEPARTMENT tb. MKS • PERMIT SO+Ponals"`" G04-00010 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 GRADING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite: Applied: 06/11/2004 Vicinity: 23RD ST AND ORANGE AV Issued: 12/16/2004 Parcel Nunmber: 43926131 Zoning: ISSUED BY: i Applicant: REISCHL, JOHN Address: EVERHART,ERIC Phone: 562-370-9311 562-370-2217 Zip: Owner: OLSON -737 COSTA MESA 1, LLC Address 3020 OLD RANCH PKWY STE 400 Phone: SEAL BEACH,CA Zip: 90740 Contractor: Address: Phone: Zip: License: Eng: ALAN R SHORT Address: Phone: Zip: License: PE30873 SCOPE OF PERMIT CUBIC YARDS GRADING ACTIVITY IN CONJUNCTION WITH THE CONSTRUCTION OF A 25- UNIT, 2-STORY, SMALL LOT SUBDIVISION. CUT: 600 CY AND FILL: 8300 CY OVER EXCAVATION (4'AVE): 18,500 CY ONSITE IMPROVEMENT WILL INCLUDE: PAVERS, CURBS AND GUTTERS, CONCRETE DRIVEWAYS, WALKS. DRAINAGE IMPROVEMENTS WILL INCLUDE CLEANOUT, CATCH BASINS WITH CONNECTIONS, INLETS, STORMCEPTORS, MANHOLE. REF: TT-16600, T-03-06, PA-03-47. SEWER CONNECTIONS REQUIRE A SEPAARTE PERMIT. 18500 FEE SUMMARY Plan Check: $66.00 Calc Valuation: 260,490.00 $303.00 Permit: $391.00 Other: $0.00 $0.00 Inspection: $0.00 $0.00 Total: $760.00 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 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 Inspections 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)754-5626 2446-46(6/00) • DECLARATIONS . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) 121. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' - compensation laws of of California, r uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi / Applicant Signature: 1 Date: I q"i ita/CIY WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the ontr ctors License Laws.). ❑ I am exempyl/rt Business and Professions Code for this reason: Signature: -W -q�Expires: Z`7('47a Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j�No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'lyes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit ��uujntil,,ffiQinal inspection. An.Or Authonzed •:.licant Date ' - LODE' INSPECTION TYPE Prig INTTMLS CODE PNSPECTioN TYPE DAM JNRRALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval . 203 Final Sign 222 Final Site 6731/D& PT/rnr 204 Final Demolition 250 Final Building/Occupancy SPP 1.2/131/2005 TUE 15:17 FAX 4535354 ENGDOWN -.-w Costa Mesa Releases ( Q tlO1/001 ! '• I i1 1 ,I, n ...... O I a ; I Rllm1R ICrtN1mAmx1nDISTRICT I 'i 15600 Sand Canyon Ave.,P.O.Box 57000,WMne,CA 92619-7 (949)453-5300 I I I December 13,2005 I R16600_()) 1 SD1. 16600 Ref.Code: 4166 Mr. Rick Brown ; ' City of Costa Mesa I Planning Department 77 Fair Drive iI Costa Mesa, CA 92628 I 1 Subject: Release for Residential Use 1 Dear Mr. Brown: ' Irvine Ranch Water District hereby releases Lot Nos. 13 through 19 and 21 throu 24 of Tract No. 16600 for the following: RELEASE FOR OCCUPANCY-Water meter has been installed by developer. I I , Yours truly, 21----"--"7--", ' , Mike Jack • Construction Inspection Manager MJ/fc ! . cc: Developer—Shea Homes I IRWD Inspector—Craig Ervin ; IRWD Developmental Services IRWD Customer Service(2) Chron TOTAL NUMBER OF UNITS FOR BUILDINGS RELEASED THIS DA I : 11 1 • , APPL. PA-03-47NT-16600 /70 ,2_,3f G1 bt 21 . Homeowner's Association CC&R's shall include a requirement that oresidents park in garages. 22. The hours of operation for construction shall be limited to 8 a.m. to 6 p.m., Monday through Friday, from 8 a.m. to 2 p.m. on Saturday, and there shall be no construction conducted on Sunday and Federal holidays. 23. A screen shall be provided at a reasonable height to ensure construction dust and debris are contained as much as possible to prevent impacts from construction on neighboring properties. Ms CITY OF COSTA MESA BUILDING DIVISION 4it > • i_., DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER f t �s PERMIT `IR"o"111� nano PO4 0582 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite No Applied: 08/23/2004 Issued: 08/30/2004 Vicinity: ISSUED BY: Parcel Nunmber: 43926131 Applicant: OMAR RASCON Address: PO BOX 3306 Phone: 626-312-2711 ' CITY OF INDUSTRY,CA Zip: 91744 • Owner: CHURCH, CALVARY NEWPORT Address MESA COSTA MESA,CA Phone: 190 23RD ST Zip: 92627-1754 Contractor: SUPERIOR DEMOLITION INC Address: PO BOX 3306 Phone: 626-312-2711 CITY OF INDUSTRY,CA Zip: 91744 License: 797170 • Arch/ Eng : Address: Phone: Zip: License: • SCOPE OF PERMIT DEMO CHURCH AND 5 ADMINISTRATIVE BLDGS ON SAME PROPERTY.CAP ELECTRICAL AND SEWER CONNECTIONS. APPLICANT WILL CONTACT A.Q:M.D.PRIOR TO DEMOLITION. FEE"SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump,Pump. - $0.00 0 • Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool - $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkfiow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 •0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $9.80 1 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line _ $0.00 0 Water Closet(Toilet) $0.00 0 ' Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 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 Inspections 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)754-5626 2446-46(6/00) • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. jz- I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carder: —�/eTiarla Policy Number: ,./4 9,171 2- ZOO (This sect, need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree t LI-s e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provis' Applicant Signet • ��� Date: e r "E0- WARNING: -WARNING:FAILURE TO SECURE S'COMP SATION CO LAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES uP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N 797/70 Class It Lzts Contractor's Signatu .• —... Date: s -30 mai CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500),): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: - Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or futute building occupant need to tile and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora volume of 55 gallons, or 200 cubic feet of compressed gat at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to tile a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ...ispr..e presently q ie.,hits. to.. 54 of Health Safety Cdeb been c... le.. 4 If an RMPP is presently required,hds Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermit for such construction or moditicatlon from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct, I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /wOf Legal Owner(s) Date — nal And/Or Auu lm5fl etmkpplicant Date CODE 0 INSPECTION TYPE PATE INTRIALS CODE I INSPECTION TYPE PAI 1NTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing IO-5'c9 l@W 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy +� MESA v 4 CITY OFCOSTAM S .4 P O BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 22628.1200 ��. :*Y� a, a azvcc a-r>r=v.c�--ra_t.s'saasysmrnr.•arx_vr —s-a— '1- O �J DEVELOPMENT SERVICES DEPARTMENT January 10, 2005 To: Building Safety Division Comcast Cable Code Enforcement Newport-Mesa Unified School. Dist.(2) Communications Pacific Bell County Clerk Police Dept. - Planning & Research County Planning and Dev. Services Sanitary District Engineer County Registrar of Voters Sanitation Division Office County Tax Assessor So California Edison Company Engineering Division (2) Southern California Gas ESRI State Board of Equalization Fire Admin. - Training Officer U. S. Post Office - AIS Fire Admin. - Mark Brown (Station 6) U. S. Post Office, Adams Fire Prevention Thomas Brothers Irvine Ranch Water District File (2) Mesa Consolidated Water District OLD ADDRESS NEIN ADDRESSES A. P. NO 170 and 19023` Street 186 and 190 23`d Street 439-261-05 2337 Orange Avenue 2301, 2303, 2305, and 439-261-09 2337 Oranoe Avenue 439-261-31 2300-2321 Half Moon Lane' Your cooperation in this matter is appreciated. Sincerely, Willa Bouwens-Killeen Principal Planner c: Kimberly Brandt Steve Castles Shea Homes 603 S. Valencia Avenue Brea, California 92823 * New street Bolding Division(714)754-5273 • Code Enlorcemeni(714)754-5623 • Planning Division(714)754-5245 eov n,e,75n.ne;F . Tnn Din,]SAAJnn ..,.,..� mna...oaa�a nv { i, I 1`-1 y i i ! , I , .„. Z3� '�a 8305 �23ot : i H±1 /7- : :1 #2-32/- 12i°3 .23 - j.123" 23/ -23H L_,.'14` `<v,:;-Tm; -- ` HALF 9VIOON L N _- .> :`'-\ IT - i i ti ��.. — ll -- rem - 4 Ti:P 12302,-NL3 I L. .. ;i,TT .t-. { , ^2300 c -j&0r- ` L g 23/b 23•Z 23.40 I ©� L — 1i I LOf In r r I:rj?I>:` I t. _ i Jl ) tI : L , \ I i / I, 250/ 13x3 2505-mi f • I __ 1 .____ I__ _L _ — -- — — — --i--- — ------- - - -f -J�i- ^ - - ORANGE AVENUE — w / • 04p ts.. CITY OF COSTA MESA O' , ,t.fit. P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 /j Y ' 117 DEVELOPMENT SERVICES DEPARTMENT January 24, 2005 To: Building Safety Division Comcast Cable Code Enforcement Newport-Mesa Unified School. Dist.(2) Communications Pacific Bell County Clerk Police Dept. - Planning & Research County Planning and Dev. Services Sanitary District Engineer County Registrar of Voters Sanitation Division Office County Tax Assessor So California Edison Company Engineering Division (2) 'Southern California Gas ESRI State Board of Equalization Fire Admin. - Training Officer U. S. Post Office - AIS Fire Admin. - Mark Brown (Station 6) U. S. Post Office, Adams Fire Prevention Thomas Brothers Irvine Ranch Water District File (2) Mesa Consolidated Water District OLD ADDRESS NEW ADDRESS A. P. NO 190 23rd Street 188 23rd Street None at this time (Address change affects only the one lot at the corner of 23rd and Orange Avenue) Your cooperation in this matter is appreciated. Sincerely, Willa Bouwens-Killeen Principal Planner c: Kimberly Brandt Vi Pham Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754.4856 • TDD(714)754-5244 • www.ci.costa-mesa.ca.us 1 3C— 2io3 2305 .: —r ..113�iLt = r I—__-. `'• . `M. •M._, HALF MOON LAN E - ` Y � }_-1GIQ=-.. ..Yll�7i��p�e6. 1.y 1 kf D��GlbdYC fq.-_, ~ :'i , ,—,..---4-. .: 111 :\_2302 is ... .`Z3 ��',Q r _. w(f'+ _ I' .I�^ � ! ,,,-1 I i :�° `1 . - 230, '. 1 — 2:34 '23' _ — kY+2 � 23/ CDT 'Z3 ll° n LOTk :1I � f '- j Q r I > �� r rThr. 1 �R8 I= zips ti F-1.::- 233f , � .. _r F. - •K I.. . f ) , ter '_• -.r.-.. L-�-- -- - - - ---i- - --- - - - - - I �—i — — — ORANGE AVENUE K n.n. Ip PROJECTTADDRESS:., 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: IB 069065 OWNER'S NAME: CALVARY CHURCH NPT/MESA ADDRESS: 190 23RD ST PERMIT NO; IB 069065 PLAN CHECK NO; N GOVT; N SUPP : Y C ,M. CA CONSTRUCTION TYPE: V PERMIT TYPE : OTH STR PURPOSE; OTH 645-5050 ARCH/ENGINEER: SUPERNEAU DESIGN GROUP REc.xo.: 000 JOB DESCRIPTION ; REINSTATE B-62834 SQ FT; ADDRESS: 165 S WOODLAWN DR UNIT: ORANGE CA 92669 CLAIM VALUE: CALC—VALUE: GROUP OCC: B-3 / PERMITTEE: DENMARK CONSTRUCTION ( 714 ) 777-4450 minus: 20005 CLEAR RIVER LANE COMMENTS : DEMO INTERIOR PARTITIONS & STUCCO & REINSTATE EXPIRED B-62834 YORBA LINDA CA 92686 ############################# ##################******************************* LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am ensed under provisio S of Ch ter 9(commencing with Section ZONING R EQU I R EMENTS 1' 7000)of Division of the Business and Professions Code,and m ense is in full force d elle SETBACK S LIC.: STATE LIC.:61 7 2 0 8 class: B •nate: o �/1 Signature: Cl MAIN BUILDING ACCESSORY BUILDING W ERS'CO Ex5AT10 DECLARATION: I hereby affiant I have a certificate of con ent to self-insure oracertilicxte of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN mpensationlsu a me Ireofyalfiron ao LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN J.za"f7 lg P 81 /01 /9 POLICY NO.: EXP.DAT PANY STATE FUND ' PARKING REQ: PROV: PARCEL; 43926131 INE; REF NO; nixed co is hereb furnished. (5 Certified copy is f -i with the city Builth . r visio.. PLANNING NOTES> i > ale _J Applicant: �� I is' ***** t*********± ************************************#****E******************** MPTION FR M WORKERS COMPS SATIDN DECLARATION: (This action need not be comple•d if the perces for one hundred(St00)or less). DEVELOPMENTSERVICES REQUIREMENTS I certify that in the performance of the work for which this permit i issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE; Date: Signature: BUILDING APPROVED BY ; NOTICE:II.atter making this declaration,you should become subject to the Workers Compensation provisions of the Labor �-k DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. r ,/ '^ !� CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY- ' Y; ;r/O _ ---E DATE; S-.. � ' which this permit is issued(Section 3097,Civ.C). ***#************************#******* ####*******#*****#*#*#*##**#* #.1/4:\ LENDER: ###*#**#*****#***#*#######*#***###***#**************#****************** ***#*** ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 30 , 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sale compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE / ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 30 , 00 0 , 00 0 , 00 30 , 010 30 , 00 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED' 30 . 00 OVER/SHORT; 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 , 00 ❑ and Prhcntra stlf The Contractors'withState contraselaw doesrsutoonhe Cotictors'ty akens La ).improveslathereon **************#*************#*#********#*********#*#*#****#******************** and who contractsnCo for such ntract with a e LicenserLawidoesenot pursuantly to o Contractors ofaprope'Stateh builds or aware that proof of their Worker's Compensation insurance should be provided to me. IND IV IDUAL F E E BR EAKDOWN ❑ I am exempt under Section: B.&P.C. Lor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: INS 1 BUILDING RE—INSPECTION FEE 30 , 00 30 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/wig not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. EXPIRED • Dale: ' Applicant: L In I hereby certify that have read this application and state that the Love information is.,7 ' to comply with all city antl county �o q names and maa laws relating to building construction and her:i authorize represer a to enter upon the above.mentionea DA + 01 00168722-00168722 TOT rpro a yforginsp 170uybGoses.' ..r.--. — DATE: 09/30/94 TIME:- 14:26 DO.GG Da 1 JJ7 Jl/ 1( Signature. /� k ` r\ �9rlver's Licens or Social Security it: N641-46 White—Building:Green—Code Enforcement: anary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POG_ .4 SPA , APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P?rap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection . 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas D011 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0Gas DOil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' • _ 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat • 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final i 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • PROJECT,ADDRESS: , 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 062834 OWNER'S NAME:CALVARY CHURCH NPT/MESA ADDRESS: 190 23RD ST PERMIT NO: B 062834 PLAN CHECK NO: N GOVT: N SUPP: N C.M. CA CONSTRUCTION TYPE: V PERMIT TYPE: STR PURPOSE: DEM 645-5050 ARCN/ENGINEER:SUPERNEAU DESIGN GROUP REG.NO.:000 JOB DESCRIPTION : DEMO INTERIOR PARTITIONS 6 STUCCO SQ FT: ADDRESS: 165 S WOODLAWN DR UNIT: PERMITTEE:ORANGE CA 92669 CLAIM VALUE: 1 , 000 . 00 CALC—VALUE; 1 , 000 . 00 GROUP OCC; B-3 / DENMARK CONSTRUCTION (714 ) 777-4450 ADDRESS: 20005 CLEAR RIVER LANE COMMENTS; DEMO INTERIOR PARTITIONS 6 STUCCO YORBA LINDA CA 92686 ******************* FEE****TETF***********SE*****iE*kr**l *****LP******x********+PSE****** LICENSED CONTRACTOR DECLARATION: I hereby altirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 0l the Business and Professions Code.and m license is in toll tort and '0e t. $ E T B A C K $ CITY LIC.: STATE LIC.6 17208 CLASS:B —.-0,Ig__ 3a Signature: _ �— — MAIN BUILD'ING ACCESSORY BUILDING WORKERS'COMPENSATI N DECLARATION: I hereby al km I I I have a certificate of onsent oselhinsure or a ceniticate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 00.Lab.CL LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN POLICYNO.:1277729 EXP.DATE: 01 /01 /94 COMPANY:STATE FUND PARKING REQ PROV; PARCEL: 43926131 2NE; R2 REF NO: 0 Certified copy is hereby furnished. ilri Unified copy isfit 'ththe city Builtli iyisi PLANNING NOTES> INTERIOR RENOVATION, REMOVAL OF NONBEARING WALLS lL3Applicant: > EXEMPTION FROM WORKER COMPENSATION DECLARATION: (This on need not be ample ed if the perm)is for one hundred(5100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit i issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY /14 DATE; 6 3© 3 Date: Signature: / NOTICE:If,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; S DATE: D SID s3 Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction / /'lending agency for the performance of the work for APPLICATION ISSUED BY; V DATE; u`"/ �� ?S which this permit is issued(Section 3097.Civ.C). *************************** *** * ***- **** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION; N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter.improve,demolish,or PERMIT 25 . 00 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031,5 by PLAN . 50 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 15500f. ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 25 . 50 0 , 00 0 . 00 25, 50 25 . 50 . 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.II,however the building or ' tortheepurposeofsae�hinoneyearofcomplelion,the owner wit have the burden olproving he/she did not build orimprove REVENUE BLDGDIVISION PLUMBING ELECTRICCOLLECTED: IC FIRES SMIPO/TOT/SGRADING PLAN—CHECK I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 25 , 00 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *.**************.******************************************k**************le****** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN o I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Dale: Owner: NO FEES WERE SELECTED FOR THIS PERMIT I do hereby certify that I are aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and 25534 and that I or any future building occupant wilgwit not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the An Quality Management District.Residential construction applications are exempt from these provisions. T Date: Applicant: B)(P kt — I hereby certify that have read this application and slate that thea re information la correct. agree to comply with allcity and county lyY" ordinances and state laws relating tobu(ding construction and hereby Itwtii2 rEWesent fl carry to enter upon the abOve.menlfoned ;_.,• property for inspects n pure es. D. �Signature' � ° Dan �y , a 01 DATE: T 106//30/9314TIIME: 14:0752 25.50 . Drivels License or Social ecurity' Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ' .111 ` CONSTRUCTION AND PLANNING Pot 1 SPA • APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. .' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding i 5. Steel Reinforcement56. Rough Plumbing & Pressure Test j 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE {I 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test _ 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - _ 12. Sewer Cap - _ - 63. Heater & Vent-Final - _ 13. Roof Drains 64. Plumbing System - Final • . 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final I I 16. Rough Electric Wiring67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING I 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIf9E DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # • 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush �Y, Z 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 72.•Oil ?S{ r 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical r 27. Frame and Flashing 76. Dry Standpipe ."f 1 1 28. Lathing & SidingI 77. FIXED SYSTEM FINAL 29. Insulation I I t 78. FIRE PREY. FINAL 30. Drywall Nailing I I HEALTH DEPT. REQUIREMENT 1 31. Plaster Brown Coat 'I 79. FINAL INSPECTION 32. Electrical Power Meter-Final - •- I I 80. FOOD CERTIFICATE ISSUED 1 33. Final Electric j I Notes: 34. Final Heating & Air Conditioning I I 35. Final Gas Pipe-Test 36. Hood or Canopy I 37. Final Factory Fireplace 1 38. Final Plumbing 1 i --- 1 39. Water Service-Final 40. Gas Service-Final 41, Solar Domestic-Final . 42. Backf low Preventer I 43. Backflow Irrigation 44. Landscape Irrigation System I 45. Sound Attenuation 46. Handicap Regulations • • 47. FINAL STRUCTURE & BUILDING ' • 48. FINAL PLANNING I 49. Electric Release to Edison I 50. Gas Release to Southern California Gas Co I 51. CERTIFICATE OF OCCUPANCY No. Date 1 ' • PROJECT HEIRESS: 190 23RD ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NU; E Obi' 11 OWNER'S NAME: CHURCH CENTRAL BIBLE OF ADDREss: COSTA MESA PERMIT NO; B 063111 PLAN CHECK NO; 02060-93 A GOV'f: N SurP ; N 190 E 23RD' ST COSTA MESA, CA 92627 CONSTRUCTION TYPE; . PERMIT STR PURPOSE; ALT 845-5050 1. ARCH/ENGINEER: LANGSTROM & ASSOC REG.NO.:C29373 JOB DESCRIPTION : EXTEND RECEPTION AREA 430SF, 528SF PATIO SQ FT: 20, 736 ADDRESS: 1600 E 17TH ST UNIT: 101 S .A. CA 92627 CLAIM VALUE: 81 , 000 . 00 CALC-VALUE: 47, 016 . 00 GROUP OCC: A-3 / PERMITTEE:DENMARK CONSTRUCTION (714 ) 777-4450 aoDREss: 2OCLEAR RIVER LANE xO#kMH*x**+E#• #*** #ADE *iem�6#B*******x(r#*x****#****D*x#K#####################%#%•##### YORBA • LINDA CA 92686 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMENTS 70001 of Division 3 of the Business and Professions Code.and my license is in lull lo ce and elect. SETBACKS CITY LIC.:-••�� STATE LIC.:6 1 7 2 0 8 CLASS:R ---- Date:_L / J Signature: C_ 4 _� MAIN BUILDING ACCESSORY BUILDING WORKEBS'COMPEN aTION DECLARATION: Thereby affirm) tlhave acenilicate fconsent to self-insure or a cenificate of Workers' FRNT; 20 FT IN REAR: 124 FT IN FRNT; FT IN REAR; FT IN WORKERS'COlnsur c �]ECLRcopythereat(Section DO Lab LEFT. 138 FT ZN RGHT; 20 FT IN LEFT'; FT IN RGHT; FT IN CompensationPOLICY NO.: i L I i lathed EXP.DATE: V A /01 /94 cgMPANr:STATE FUND PARKING LARREQ.NOTES> ENCLOSEEXOPENENTRY; UPGRADEBATHS; SMALL ADDITMOD FOR AN 43926131 I / . ❑ Certified copy is hereby furnished. EJ Certified copy is file to the city Builtlin suis' n./ PLANNING > OFFICE & STORAGE AREA F/ EX CHURCH, x#### ######�E##########################%##%###•#### �E #####%#### ###%�E####*###�E�E#% Date: --ill--43��1 Applicant- C. +r ' DEVELOPMENT SERVICES REQUIREMENTS EXEMPTION FRORKERS COMPENSATION DECLARATION: (This - need not become ted if the permit is for one hundred(5100)or less). I certify that in the performance of the work for which this permit i issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY J DATE; 7 'Zoo//f3 Date: Signature: BUILDING APPROVED BY : LU;I(dr�- DATE: -7/120/9.3 NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor Code.you LEtDINGwAGcomply I herh such provisions er ms pa cnsrhaineddmearency tor APPLICATION ISSUED BY: It C� DATE: CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ie which this permit is issued(Section 3097.Civ.C). #######################% x########### ####ie io %##-k####################%xk#### LENDER: ################******************************X******************************** ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Processional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 4 01 . 5 0 - ' repair any structure.prior to its issuance.also requires the applicant far such permit to tile a signed statement that he/she is licensed SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 6 5 . 2 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by 9 . 87 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE - - I. as owner of me property or my employees with wages as their cote compensation, win do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK . TOTAL PAID DUE ❑ structure is not intended or offered for safe(Section 7044.Business and Professional Cade: The Contractors'State License Law TOTALS----> 4 1 1 , 3 7 0 . 00 65. 25' 476 . 62 4%6 , 6 2 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her awn employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED ; 41,1 . 37 OVER/SHORT; 00 improvement oseot sold le)nin one year Cl completion,the owner MX nave the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SMIP/TOT GRADING PLAN-CHECK for the purpose ff sale). 401 . 50 9 . 87 I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ' ❑ and Professions Code: The projects state License Law does not apply to an owner of property wino builds or improves thereon ################%#######%#############%#%#########!h#######Wits(-#################% and Prof contracts for such projects whin a e License license pursuant to the of property State License Law). am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E B .R EAKDOWN o I am exempt under Section: B.&P.C. • tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Ther: SFC 430 CHU-TYPE V N • -AVER 55 . 00 23, 650 . 00 I do hereby certify that l am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and SFC 306 CHU-INT, ALTER TYPE V-N -AVER 11 . 00 3, 366 . 00 25534 and that l or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a SFC 20000 ALTER BY VALUE COMMERCIAL ' NOZ ONE 1 . 00 20, 000 , 00 permit for construction or modification from the Air Ouahty Management District.Residential construction applications are exempt from END OF FEES these provisions. Date Applicant: EXP ,15_143_, I hereby certify and that I laws tin this building s and tion Inst thea a information is coned.I agree to comply with all city and county ordinances and state I hav relating to b application construction and hereb Ihor¢e repre4eruPonteabove.mentionedoc tIr s ly to enth property for ins ction p poses. / I� '- l Q , -- Date: l.e� Signature: L � l DATE /V 4 �J'"" Driver's Lice a or Social Security,: - 01 00143172-00143173 TOT 411.3? DATE: 07/20/93 TIME: 09:43 1641-46 White—Building:Green—Code Entorcement.Canary—Applicant Pink—Revenue:Goldenrod—Assessor c - CONSTRUCTION AND PLANNING 1 POO_ .. SPA Mite I Inspector Date • Dalrne.:ct.rr _ APPROVALS Permit 4,4 APPROVALS Permit C- r I 1 + 1 1. Temporary Electrical Service or Po:a 52. Pcoi & Equipm;nt Locator • 2. So•' Plc L''drorrd. , 53. Stee1 Raelio.r..'ment - }_-__-.J.__-._f______ _- _ __. ___ -_ _ _- .-__ _ __ -_i 3 E._rtnr i C. t i.t h'tc-U'.r,rorr.d. i 1 I 54. Firm. _____ - ___ - __- _--_ F'---____ - ---- 1. ' r. C'. .u' ..'•'.4 rn : � 55. E ectned' 0ar,ci ar, Ir 'a r�.C.m.N^ I 56 , I-- -_ _ -- -. _-_ __ _______ --.--- .-i- u Li r.. , t.' ERR 3'rd I 1 57. (.r1PPUVAI TC COVER GU'.1TF ! F-c.un,. 1.-- -- --- ' 58. E:ect•4AICor.tIut-uno:grec. I I - - - -- I 0 f t.5Li I I 59. Gas Roo, Cl Unrlrnrrd., Test I L' ..-rt_ '.p� Undrgrr.o. I�-- _- _____ _ CO. °.G::✓ash i�nu;. P Tr;,p, L'.t :.. :.r�_ .�___-- _{_ -_ - t;l. S.' t. S e-- - f -�-* _-- -. 61. APPROVAL 1') )ECIC _- - - - -- jI + i 11. Pont 7 Si r Lin': e, nu,, � Co.^-r..ct in 1 62 6.r[- . I''1 & Pet .:.•o c,n..11 I I 03. 1-la Ala Fi Vunt-I-ina. '3 '10 I+ ❑rzmc _I-- - -I G4. Plumbing Sy.'•rm Fm.:l -___., 1 _. _ -_, -__ _____ __� _ _.�. _ _ __ _ _ __ _ ---_�__.- .-, 14. Lc'...7 , Piur`o,ng j 65. E actrical•Feral 'S F . ;- c .._=ca'-Ca`° .; _ -- I I L 66. Sol_ 5.' ' m- n_F _--____-- I ---- r -IC. ;1o.1 Ern!! r.'.: nrg I R � � _______,I68. APPROVED FOR PLASTERi..G _- 18 'tc -«, Eltc'-ica'-T Bar Ce : r- �- - ' + 69. POC L!SPA SYS'. E.:S F'NAL j k19 Rouwh Healing & Alr Cardillo/14,g 1 FIRE DEPT. REOUIFiLMENT I .--- -- ..c1nr': f ---- - - - --�APPRUVAI.S Prrmrt :- --- - -- --- - - 77. i...✓c, ;Lr y ' 71. Pro(.Lr..t P-p,rq .J Gas -. O.. (- ..n 'rr:" 7 17r.]'h i -'7.,7it --1-- -___* _ _ _I %Z. ri, .j'U'.,.ni F�u�_• - -_ .4, L • - - 1 _,-- . .-- _ -_-_ --__ -_ --�_ __ _ _ _ -. J, 74 Roo! Fr:m:^ -- = 9 r 73. Undrrgrnd.Storm:. Tank "G 9 I I 1 74. Overl,rdd Hymn - -' I -al :/, T I _ -rn 'Struc`j .r_ r . r '' 1- _ ._.I 15.n-1 .r . , , _ - - - - I2/. - , h _ ,-4'.h ,, 76 r , - - _ ___ .. 1 • ; 78. . ;h_ :'F'.V. r.Nr. i 30. Dryc.,l i f•„dmg -' _1 t FIFA! TI-1 DEPT. RI-- •-' �iF''T -7, - -- - T -- -I - - � 31. .,. tto '-�CO-. - _ 1 -.I I ' 1 79. FIN/11 IN:L1't.CT IO-: __ "- - I ' 80. F C( R I r':-• :t rrr, - _ _ __ - . - _ _- _ - _4-4 '._ _. _ _ _ __,/_ _- .. ._- rlac3 H�• �it'l�itf� CQysvl I d1 .t.'-y N,. Cr,. I '?�ZT/ 9Sr.Y/ r fr- . -. _ . I , 33. F' Gn . P O- Tr t. 36. H.,.rd Or Canopy t I X c • p') n . CO_ CQKSuj* 7/L1/ 77 37. Fhcul F;ctorl' Fireplace --- - - - -1 - I I--- - - + ,o 7J I 3E. Fin;,', Piumtarng ! I /i42//101 iereedi+rin( s c - / (/ro+-rs. -3g. ':...tc Sr v.cc-Final ! Il _ ✓--- ----- -- - - - `C. '3d; Srr vctF1nal I r41. Solar ,^nrnCstrc-Final I -�- _--- - --- Fn3. P,.cl:flo�:r :rri„anon -- - -14 �__--- ---- - ------- -- - - - - '- -- -- - • ! ..ndsf. •4=1rrr7+Lien Syef ' _ _ _ -_- _ _ _ So. ':.: '. ;.'.lath.^.^ t __ _ __ _ ___ _____-_1--___ + __I_.___ _ _ _ __ - _ _ - _ _ _ . f 'ii. i-r?:Ai- STRUCTURE & B..ILDIt:C 43 I_i\F' 'LANNING k ` r". F;.-rine Release to Ed's° I F __- - '--- - -- I - ----- - --- - - - - -- -- - - - - - -1 I or, e1-as( tO Southern Cz,:fOrr d Gas CO 51. '::.RTiFtCATE OF OCCUPANCY :7 -- - D_t. NE_ORT UNIFIED SCHOOL Di.,TRICT .- ' o CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: ( GIr City of Costa Mesa Plan Check No. ( ) City of Newport Beach • ( ) County of Orange District Receipt No. Applicant: CAL_-UPM1-`f C4 ciLc..h1 N6wPbrCr /Mecfl Address: Ito Z,3r_ 51- Telephone TTelephone Number: (-Mg ) (ouf s-----So5 D Tract/Parcel and Lot Number(s) : Location of Project: C' A-1-JJAL-•'( C4 0 i NESP plZ-f / N 1 FiSA rlpq_. Number of Square Feet of Residential Space x $1. 65 Total Residential/ Sr. Citizen Space x $ . 27 Total Commercial and / / n/ & ' Industrial Space `!!! O. x $ .27 Total • ,'pfp l R&D Space x $ . 2652 Total r Warehouse Space x $ .2953 Total Commercial/Industrial Project is : (Check One) Warehouses Motel Preschool R & D Bank - Auto Repair Movie Theater Neighborhood Shops Hospital Mini-storage Racquet/Health Large Office Heavy Industrial - Hotel - Office Bldg. Regional Shops - Medical Office Restaurant Light. Industrial - Office Park - Fast Food This project is exempt because /q-da/////7/TY /S to e%iirr / • This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995 . The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. BY: ../.2,/ .r thorize Reprsentative The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified. Date: 7 f.3 Appli ant PROIECIADDRESS:, 190 23RD ST UNIT: CITY OF COSTA MESA – BUILDING PERMIT P RM No; d Ub3LLU OWNER'S NAME:CHURCH CENTRAL BIBLE OF ADDRESS:COSTA MESA PERMIT NO: • B 063110 PLAN CHECK NO: 02061-93 -A Guy i : IN JUre: N 190 E 24RD ST COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT 645-5050 ARCH(ENGINEEA:LANGSTON & ASSOC BEGMo.:C29373 JOB DESCRIPTION : ADD 933SF PATIO,—H.C. RAMP SQ FT: 66, 000 ADDRESS: 1800 E 17TH ST UNIT:101 S ,A. CA 92701 CLAIM VALUE: 66, 000 , 00 CALC–VALUE: 66, 0 , 00 GROUP OCC: A-3 / PERMITTEE:DENMARK CONSTRUCTION (714 ) 777-4450 ADORESS:'20005 CLEAR RIVER LANE , COMMENTS: ENLARGE CLASSROOM H.C. BATHROOMS T *' YORBA LINDA • CA 92686 ********* **************Itis*4***************** ********************************* • LICENSED CONTRACTOR DECLARATION: I hereby affirm That I am licensed under provisions of Chapter 9(commencing with Section ZONING y.R E Q U I R E M E N T S 7000)of Division 3 of the Business and Professions Code,and my ense is in lull tort and fact. S 'II TBACKS CITY LIC,: STATE LIC.61 7208 CLASS:B �– Date:�_ signature:_ C...--. _ MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: 20 FT IN REAR: 220 FT IN WORKERS'C MPENSAT ON DECLARATION: I hereby affirm tha have a certificate of c nsent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: 26 FT IN RGHT: 80 FT IN Compensation/nwta rc :yr t�mfied copy thereof(Section .Labrch POLICY ND.:1 G / J / 7 EXP.DATE: /0 1 /94 COMPANY: FUND PARKING REQ• PROV: PARCEL: 43926131 ZNE: R2 REF NO: O Cembeewy¢here furnished. 6cerulteacopy ispl ilhmecity epumng this' PLANNING NOTES> INTERIOR ALTERATIONS/NEW EXTERIOR CONCRETE STEPS/LANDINGS W/ > GUARDRAILS • GENERAL MAINTENANCE REPAIR• Applicant. .r ys l ********************M*****#**************#*************X*#********ft*******3**** Date: DEVELOPMENT SERVICES REQUIREMENTS EXEMPTION FROM WORKS S'COMPENSATION DECLARATION: (This cation need not be comp) ed if the permit is for one hundred($100)or less). I certify that in the perlormance of the work for which this permit i issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY W cc DATE: 742- ' .?• Date: Signature: BUILDING APPROVED BY : (AJ. DATE: 7 f2a/r'3 NOTICE:It.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor Code.you EN NG G with such firm that This permit shall be deemed no. 11 I C C_ '{� DATE• 7 (20/93 CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: kJ — ` which this permit is issued)Section 3097,Civ.CI. ***********************% ******'*******# * • R##*x ***#*#************* i<**Ft xH-*** LENDER: ***************************************** ********Se**************************** ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031 5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or P ERM I T 486 . 50 repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is Ikensed • I SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 01 the Business p LAN 79 . 06 . . 13 . 86 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by • any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(3500). ISSUE FEE BUILDING–DIV–> PERMIT ISSUE PLAN–CHECK . TOTAL PAID DUE ❑ I. as owner 01 the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 500 . 36 0 . 00 '79 . 06 . 579 . 42 579 . 42 . 00 stricture is not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through ' - i his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: t 500". 36 OVER/SHORT• 00 improvement is sold vnthin one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN–CHECK for the purpose at sale). 486 . 50 13 . 86 I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ' ❑ and who ProfessionsCode: The Coprojects wtSIale contractor(s) not pursly uant to towner ontrctors'sate builds .oI improves thereon re *******************#*********************************************************** and who contracts for such owith a eLicense ice seLaoulense to Contractors'State License Law). am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E B R E A K D O. W N ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N . • UNIT COST TOTAL COST Date: Owner: SFC 66000 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 66, 000 , 00 I do hereby cemty that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Aim Management District.Residential construction applications are exempt from / these provisions • �''1�\ Date: Apptcant: EXPIRED 1 hereby certify that I have read sirs application and slate that the above' formation is correct,I agree to comply with all city and county Ll J.J •7 ordinances aMstate eclion relating to building construction and hereby au ifl7e reDresemdlly' rl lhil� to enter upon the above-mentioned DATE � (Q� �' , pm0eny Nu m pttlron rposespYA/ • Date 1 ���1�1� Signature' 444-"-- =�. ONT00143120/3143171tint¢ 09:43 500.36 SQA.36 Driver's License or Social Security. . 1641.46 White—Building:Green—Coda Enforcement:Cana —Applicant:Pink—Revenue:Goldenrod—Assessor ' - CC-:S T RUCTIOX AYD PLANNING I I NUL -. Sr'A Date In,picior 1 mite I imper Li. APPROVALS ?nen; . . — _ r I APPROVALS Pr!mrt -- �- . .. - _ ___ _ _ _ _ _ _ - _ _-____._ . _ _ _y - - - _ ___ _ _. _ -- _- - - - � _�_ r, _ - L --_-_-__ - - _ i. _ ---_--- T- - - - <i55 i \ .t' i--, 0nr o o;i 1 5. 5r-; R;,,r:t urc.. -... I Lu. 7;0_, 1 ' ,.n r.; .. -.r,_ T. . 1 a_- _, .:r I:rJ . - - -_ __ _ -- - -- - -- - ./ ?.Par n„ I n,:E°_0-- - - -- -- - - -t -'-'- ' __ 7 Fortin?? .' _ �___--_� _____ I 58. L •:c:' Co; di. • Li-U. nu I -- , 1--- 8. 7a.rria Lon -__ —_ 5D. G.._ P,pr. .i, c- d..T:,. _ —._ _ -- __ ' - - - _ o Il t- -- ':.a:er P.pe L'_.r;-rc. 1 .... -- --f -I 1-__--'-- ' Sr.-Jr.-re: E'er- Sy”. _• i- - ` - ---- --- 61. A'oRL,rrn' TO LEC{ 4 ---I- - -- -t-- -+------ P-cpe.,y Scv.:, Lre e ro:.sr. Correction 1 I 32 fltc'.-^ & gree.;r rI – — — l iI "3 °o.` 2r. - - - ___I-___47— - - — - 14 '4a_3 ocmr. 1, r 1 I 55. F'a^tric;l F ' 4 1 I —_ - -_t-- 1 'S '-iG_, ..er^...-. -C: I 11 E5. 5a'..' Syit:r. I ^ i. .r. : 17. •k.. : r APPROVED T.1R P... S' "i' - I tE F{u.;Gn E:nr:J., I E.:- ' '.nq_- ~ --. I I b9. POOL'S°A SVST SFI `,I 1. - - i - - - T FI;iE Dr.Fr . RE.OL,R_.L,-. I i APP.IOVALF 2 . . - ----- - - ---- --- - - :--- .. 1 .. . . t— /I r.i.r r- - P.r'.) . . I y - - . tom _ I :rII } - 23. Lr crar' ^, I I 177. FX.!D5vc' . = ':ASL 1 1 7 � ocS,. Pron -- - - - _ S V t 71r FIRr r'nt V. FI .-HL- -- - - -- - 1 ---- I t i HEALTH DEPT REGLiki ERT ---_ -_ - -Cf- i-- _:- y.= 7° FI 'AL ..E EC" .. . - -. ._ . . _I ._ - 3:, Fc c;• _. �'n . ,tr - I1 5" . EODU CER -'r STE _5. E I i E / / Glf. Fr_ OhN SLerr 35 1: .7.... C , I- r _ � -r I T _ __ __ . — G • • ��/r✓ L F�� c t 94,- ol- /.6 " , .r I ' r lie, _ Con Sv7 _a�77ff F, mr .- L - .j. 1 I IWC_ Con $u//�+_L°//'//_p7 /f /�Q ,t S I,ir: F r1- -- --- �- I ��c Ceti/ On Q/*✓ SAesj!- 6A. 0% 00, IC, r s•nir r-. -• -,- - - - - - ---- - -- ---- -- - --- - ML c, .. J°_ - off.- - - - - - -- � — - •1- = - : 43 Fi.uct.a:: In :,.- 0•I - -- _ _.I �. - : ^ L- _. I - Fj: : f..t - frig . .3 i=C. .,'Pi 6.,i 1-LIi.O I I I - -- -_ _ r- I —._ __--r -- --- _ .- - _ — ._ - - - - - _ '-- — —4=--L ..o .--G- ---- - — 5C. Ga,, Rchuase to Southern Calrtornia Gas Co ---- - J 51. C3R T IFICATE -F OCCUPANCY I - ----� ---- N?. DIM: I R/ PR C ^TADDREss: 190 23RD ST UNIT: ' ITY OF (;(3STA MESA — BUILDING PERMIT PERM NO; IB 069068 OWNER'S NAME: CHURCH, CENTRAL BIBLE OF ADDRESS: COSTA MESA PERMIT NO; IB 069068 PLAN CHECK NO; N GOVT; N SUPP; Y 190 E 23RD ST COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE; OTH STR PURPOSE; ALT 845-5050 ARCHIENGINEER: LANGSTROM S ASSOC REO.NO.: C29373 JOB DESCRIPTION : REINSTATE EXPIRED B-63111 SQ FT; ADDRESS: 1800 E 17TH ST UNIT: 101 S.A. CA 92627 CLAIM VALUE: CALL—VALUE; GROUP OCC; A-3 / PERMITTEE: DENMARK CONSTRUCTION ( 714 ) 777-4450 ADDREss: 20005 CLEAR RIVER LANE COMMENTS : UPGRADE H.C . BATHROOMS, OFFICE REMODEL, REINSTATE EXPIRED B-63111 YORBA LINDA CA 9268 . +F##*##*##*#s6#x###aF##########*###### ####**####yF##lc##******##*#*###########+ *#*# LICENSED CONTRACTOR DECLARATION: I hereby affirm that I a we .ed under proWsioi of Ch.pte 9(commencing with Section ZONING R EQU IR EMEN TS 7000)0l Division of theBusiness and Professions Code.and m licen e is in full force . r effec S E T B A C K S C Y LIC.: STATE LIC.: 617208 uAss: B • LIC.:__ 3� qy u— A _ MAIN BUILDING ACCESSORY BUILDING _ __mF1 Signature:—_ PANT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN 'KERS'C ENSAT N DECLA ATION: I hereby affirm that I h. :a certificate 01 copse to self-ins..ear a certificate of Workers' ompensation IrisApapg d till I copy thereof(Section 3500. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN POLICY NO.: 1 /���� EXP.of 1 /01 /95 /1 COMPANY:STAT FUND1` / PARKING REQ: PROV: PARCEL; 43926131 ZNE: REF NO: ' ID Certified coo, is here iy turned. L' Certified copy•• Ih the city Buildin, r PLANNING NOTES> e: 136 C Applicant: �� D E V E L O P M E N T SERVICES R V I C E S R E U IREMENTS EXEMPTION FRI WOW'S'COMPE SATION DECLARATION: (This secti.n need not be complete.if the permit is for one hundred($11X11 or less). REQU certify that in the performance of the work for which this permit is iss ed.I shall not employ.ny person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE; Date: Signature: BUILDING APPROVED BY __ ode.NOTICE:It.oumaking this declaration,wiyou should become orsubjectmithe Workers'meempensation provisions of the Labor : DATE: Cptle,you must forthwith comply with such provisions or this permit shall be deemed revoked. ` r CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION' ISSUED BY: DATE. J �F' which this permit is issued(Section 3097,Civ.C). ***********************#********** -** ***W***********************#3c'1TrF'., iF�*3r//{* LENDER: {***#***# ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 30 . 00 repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7003)of Division 3 of the Business PLAN SMIP/NON—RES and Professions Code)or That he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($503). ISSUE FEE as owner of the property or my employees with wages as (heir sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 30 . 00 0 , 00 0 . 00 30 , 0 0 30 . 00 . 0 0 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED; 30 . 00 OVER/SHORT: . 00 improvement le sold within one year of completion,the owner will have the burden of proving he/she did not build or improve fororthe purpose Off sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ct tion I, rotes of s the eTh.amCo exclusively' ate License Law licensed not contractors otan to frpthe project hor ov, ereon 30 . 00 ❑ and who cones Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such protects witbacOniraclor(s)license pursuant to the Contractors'State License Law).lam aware #*#*************#**##***##*****##********#*#####****#*****#***********SE*****##* that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. lor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: INS 1 BUILDING RE—INSPECTION FEE 30 , 00 • 30 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant wifUwill not(circle one)need to comply with said state codes and the requirements for a permit or construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I 1I I hereby certify that l have read this application and slate that lb'i.rye information is co-`ct to comply with all city and county EXPIRED / ordinances and slat' awn tela-g to building construction and he ,y'uthorixe represent . to enter upon the above-mentioned property for inspe.Ion purp. es. s_ 01 00168725-00168725 "TEj� ,Le, � Dalea 3 0 Signature' e___-- - �i. L DATE g(O DATE: 09/30/94 TINE: 14:2? /t'ier's Licens or Social Security a; 1641-46 Wh'le—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor • •1 CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 11 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, C Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas C Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas C Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL • 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric e. Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test . . 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY �^No. Date PROJECT ADDRESS: 190 23RD ST UNIT: OF COSTA MESA — BUILDING PERMIT PERM NO; IB 069067 OWNER'S NAME: CHURCH, CENTRAL BIBLE OF ADDRESS: COSTA MESA PERMIT NO; IB 069067CITY PLAN CHECK NO; N GOVT; N SUPP; Y 190 E 23RD ST COSTA MESA, CA 92627 CONSTRUCTION TYPE; PERMIT TYPE; OTH STR PURPOSE; ALT 645-5050 ARCH/ENGINEER: LANGSTON 6 ASSOC REO.ND.: C29373 JOB DESCRIPTION ; REINSTATE EXPIRED B-63110 SQ FT; ADDRESS: 1800 E 17TH STUNIT: 101 S ,A, CA 92701 CLAIM VALUE; CALL—VALUE; GROUP OCC; A-3 / PERMITTEE: DENMARK CONSTRUCTION ( 714 ) 777-4450 ADORESS: 20005 CLEAR RIVER LAN • COMMENTS: ENLARGE CLASSROOM, H.C . BATHROOMS T . I • REINSTATE EXPIRED B-63110 YORBA LINDA —A 9 /68•• ***********er*#**********#######ars6sE*d6a6#*#####aEx##**##a6#x-####***###***e6###+r-#x** # LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensee er prom • of b:• > 9(commencing with Section Z 0 N I N G R E Q U IRE M E N T S 7000)of Oivisio 3 of the :usoness and Professions Code.and my license full to of SETBACK S 11 ATE LIC.:617208 - P • ; . O 1 -` MAIN BUILDING ACCESSORY BUILDING Signature: FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN Compensation C•MPENSA ION�DEC •RATION: I hereby affirm that I hay ace Bicate of con-Mtto sell-msu-or a certificate of Workers' LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN Compensation IRswde¢e� /iheBrtilied copy thereof(Section 3800. 1�.v.1 /0 1 /• 5 POLICY NO.: 1 T / L 7 EXP.DA'• COMPANY: STATE FUND PARKING REQ• PROV: PARCEL; 43926131 ZNE; REF NO: ❑ Certified opy is he-by furnished. Q Certified copy i 'th the city Buildin• x' .io, PLANNING NOTES> Dal ' 0 Applicant: e---- c,� ***********************************.*******************************************# MPTION ROM WOR RS'CO PENSATION DECLARATION: (This ection need not be campler'if the permVfor one hundred MOO)or less). DEVELOPMENT S' E R V I C £ S REQUIREMENT S I certify that in the performance of the work for which this permit i issued,I shall not employ any person in any manner so as to become , subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE; Date: signature: BUILDING APPROVED BY ; DATE: 1374. .#1NOTICE:II,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shalt be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for AP PL I CAT ION ISSUED B Y; DATE; 41IC ''which this permit is issued(Section 3097.Civ.C). *************************************i " fir. ************************** T� *LENDER: **# ADDRESS: LEGALIZATION; N F E E SUMMAR Y STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm shat l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or P ERM I T 30 , 00 repair any structure.prior to its issuance.also requires the applicant for such permit to tile a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN $MIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ISSUE FEE any applicant for a permit subjects the applicant to a chit penalty of not more than live hundred dollars(5500). I. as owner of the property or my employees with wages as tneir sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> 30 . 00 0 ,0 0 0 , 00 3 0 , 0 0 30 . 00 , 0 0 does not apply to ad owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or offered for safe.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED • 30 . 00 OVER/SHORT. 00 improvement ie soldwithin one year of completion.the owner will have the burden of proving he/she did not build or improve fororthe purpose of sSale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 . 00 ❑ and Professions Code: The Contractors'StateLienseLaw does tapply toorowner tfctorsah builds or improvesthereon and who contracts fr such projects with a contraserLaidoese pursuant to the Contractors'State License Law).lem aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F E E BR E AK DO W N ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCR IP T ION UNIT COST TOTAL COST Date: Owner: INS 1 BUILDING RE—INSPECTION FEE 30 , 00 30 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District,Residential construction applications are exempt from these provisions. 7 Date: Applicant: I hereby certify that I have read this application and state that thea•• J information ist come 0 mepfy with all city and county ordinances ane tate laws r Nling to budding construction and her• •rRe eepresentatb .. o ter upon the alcove-mentioned 01 00168723-00168723 T fJ T 30.00 property for on oration p repose DATE: 09/30/94 TIME: 14:27 3° —V Signater. _ , i J; .vers Lir se or Social$ecus y 0: 1641-16 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor 7/ PO. h SPA CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines. P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final '/tea /J 80. FOOD CERTIFICATE ISSUED 33. Final Electric ioly J i4OI4 Notes: 34. Final Heating & Air Conditioning / (/� 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date \\ PROJECT ADDRESS: 190 23RD ST UNIT:OFFIC CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 063133 ',.' OWNER'S NAME:CHURCH, CENTRAL BIBLE OF ADDRESS:COSTA MESA PERMIT NO: B 063133 PLAN CHECK NO: N GOVT: N SUPP; N I 190 E 23RD ST COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT 845-5050 ' ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : T/OFF REROOF W/COMP SHINGLES SQ FT: 5, 000 ADDRESS: UNIT: • CLAIM VALUE: 5, 000 . 00 CALC—VALUE: 5, 000. 00 GROUP OCC: A-3 / PERMITTEE:DENMARK CONSTRUCTION ( 714 )777-4450 ADDRESs: 20005 CLEAR RIVER LANE COMMENTS : REROOF SUNDAY SCHOOL BUILDING YORBA LINDA CA 92686 :ESEx:r**Nxx *>E***TE:E+r1E>ft**xrE**** ***N>E>f***********************A**>FTE**%******* E**** LICENSED CONTRACTOR DECLARATION: I hereby affirm That I am licensed 'der provis4ncingwith Section ZONINGSERTEBQAUCIKRSEMENTS 7000)of Dmsio 3 of the Business and Prolessions Code,and my lse . full forceCITY LIC.: STATE LIC.6 17208Date: / UI�} Signature: � MAIN BUILDING ACCESSOkY BUILDING WORKERS' MPENSATION DECLARATION: I hereby affirm thal I have a I'nilicate of conure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN CompensationsV[anCB_Gr,4 rifled copy thereof(Section 3800.Lab i /01 /94 LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.:l L / / //7 EXP.DATE: ,A COMPANY:STATE FUNDVV, PARKING REQ: PROV: PARCEL: 43926131 ZNE: REF NO: ( CICenifie copy is reby furnished, l`J Cenified copy is filed with t , Building Di io . PLANNING NOTES> > Date. N Applicant: , ******************************************************)4-****+*!4***3+33+*$****3f***** DEVELOPMENT T S E• R V I C E S R E U I R E M E N T' S EXEMPTION ROM WORK RS'COMPENSATION DECLARATION: (This section neer 01 be completed if tb'permit is for one hundred($100)or less). Q I certify that in the performance of the work for which this permit is issued,I .hall not employ any person in any manner so as 10 become / subject to the Workers Compensation Laws of California, ZONING APPROVED, BY • DATE; Date: Signature: BUILDING APPROVED BY ode.NOTICE:If.alterstmaking this dpy with s,you should sCoome subjectemithe Workers' rempensalion provisions of the Labor : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. cal C,/L CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• DATE- lit.`.�' .� E/V which this permit is issued(Section 3O97,Civ.C). **************3f*N-*****313E**********3E********* .'-. *K-**fF*3F***1p*3F****** *,�** fr 9E 3rff*.* LENDER: ******************3f*********************************IE-3f***3E*3t*****i(3¢*36*-3E*****3t*3t ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL.. SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 . 00 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business P LAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by 1 0 5 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 73. 05 0 . 00 0 . 00 73, 05 73 , 05 . 00 does not apply to an owner of a property who build)or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale. It,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 73. 05 OVER/SHORT: 00 orimprovementose of satef.none year of completion, owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the puenis of sale). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 , 00 1 ' 05 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware **************************************************************************3t**** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAKDOWN ❑ I am exempt under Section: B,&P.C. tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFC 5000 REROOF BY VALUE COMMERCIAL NOZONE 1 , 00 5, 000 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES and That I or any future building occupant will/will not(circle one)need to complyy with said state codes and the requirements for a permit for construction or modification from the Air Oualily Management District.Residential construction applications are exempt from (hese provisions. Date: Applicant: I hereby certify that I have read this application and slate that the a•rve information is co ea gree to comply with all city and county ordinances and late laws elating to building construction and here. .uthorize repres •5 o h� ity to enter upon the above-mentioned proper in suction p .poses. Dale: v, �3 Signature: —� 01 00143286-00143287 TOT 73.05 /l Driver's License or Social Security+: DATE: 07/21/93 TIME: 13:22 164146 While—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor • • C NSTRUCTION AND PLANNING POL SPA APPROVALS Permit # - Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or'Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility•Undrgrnd. 54. Forms r 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Tet 6. Electrical UF ER Grnd. 57. APPROVAI. TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. • , 60. Backwash Lines, P-Trap, rJ Undrgrnd. ! 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Lina & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final I} 13. Roof Drains - - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final ' 15 Rouyn Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough EleetriaLT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20 Rough Enters( Fireplace APPROVALS Permit# 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas L Oil 23. Gas °ip+-Rough & Test 72. Underground Flush 24. Roo` Framing 73. Undergrnd.Storage Tank F-12 Gas 00. _ 25. Roof Shrath•ng 74. Overhead Hydro 26. T•3ar Ce.1.eg (Structural) & ieonocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe -, 28. Lath'nn & Siding t 77. FIXED SYSTEM FINAL 29. Insulation j 78. FIRE PREV. FINAL j I - 1 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 1 �- - _� 31. Piaster Brown Coat $ 1 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED _ _ ti 33. Final Electric Notes: 34. Final Heating & Air Conditioning I }} 35. Final Gas Pipe-Test i I 1 36. Hood or Canopy -- r-r- ---- - 37. Final Factory Fireplace 38. Final Plumbing - ------- --- �- _ � I 39. Water Service-Final j 40. Gas Service-Final I - 1 41. Solar Domestic-Final $ I 42. Backflow Preventer 43. Backflow Irrigation y • 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING "/l, "1131° _ 48. FINAL PLANNING 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECTAODRESS: 190 23RD ST ma: CITY OF COSTA MESA — BUILDING PERMIT PENM NU: E Ub1474 1 OWNER'S NAME:CHURCH, CENTRAL BIBLE OF - ADDREss:COSTA MESA i r PERMIT NO: E 061454 PLAN CHECK NO: N t;UVT : N EU1'Y: N 190 E 23RD ST COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL 200 AMP SUB—PANEL & 4 EXT, LIGHTS SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC : / PERMITTEE:JOHN ELLIS ( 714 ) 248-0183 ADDRESs: 32811 MERMAID CSR COMMENTS: ELEC WORK ONLY DANA POINT CA 92629 ********4*#*+t***#**#* ****+E**#*****xx>E-x* x>txx*xxxx***xxxxxxxxx-xitxxx#x:tx*x*xxx** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUIR EMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS CITY LIC.: STATE LIC:5 5 812 9 CUSS:C—10 Date: Signature: MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR : FT IN FRNT: FT IN REAR: FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). POLICY NO.: EXP.DATE:COMPANY: PARKING RE • PROV: PARCEL; 43926131 ZNE: REF NO: • ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N TES> > ****************************************************-k*********X'**************** °ate: Applicant: DEVELOPMENT SERVICES REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). I certify that in the performance of the work for which this per i- -sued, hall no plo n person in any manner so as to become subject to the W kers'Compensation Laws of California. / ZONING APPROVED BY _ DATE: -- Date: 3 .;3/ !pe3 Signature: BUILDING APPROVED BY ' NOTIC If,alter n{eking this declaration,you shout• e subject to the Workers'Compensation provisions of the Labor DATE Code,you must forthwith comply with such pro r this permit shall be deemed revoked. 411,CONSTRUCTION LENDING AGENCY:,f hereby affix• at there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• , I' DATE: L Z which this permit is issued(Section 3097.Civ.C). *******%*****************' *tE*** * - *****# {**# ***)tivi.sF***7E*-*****N-ft****7e.: ** LENDER: *****************************iE*******!f******x*} *•****7EIf*x**x*1Ex-*****#*******#* ADDRESS: LEGALIZATION:N F E E SUMMA Y STRUCTURAL SEGMENT:N r OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 4}}00 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 7 0% SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 1.5• 00 any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars(5500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 14 • 00 1 5 . 00 0 . 00 29 . 00 29 . 00 • 00 ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law • does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLCEC'�ED • 29. 00 OVER/SHORT; 00 t orimprovementpis SOlds tel. one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 29 , Q 0 r ❑ and Professions Code: Thesuch projects with License Law does not apply to an owner of property who builds or improves thereon *****,**,x,**!e*****lE*******#**fE**Ie***tE*****x#****IP*********!E****!E*x*#1f*#**x*#)f*#3E* and who contracts for such projects with a eonteacse La license pursuant to the of property State License Law).t am aware that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L. • IF E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. mr this r ason: IF TYPE QTY D E S C R I P T Z O'N UNIT COST TOTAL COST Date: // 3 Owner ELE 4 FIXTURES LIGHTING. 4' ST 20 EA, . 75 3 , 00 I do hetet) certify that I am aware of and understand the requirements of'. is Health and Safety Code Sections 25505,25533,and ELE F 1 SUB—PANEL 11 . 00 11 , 00 25534 and that I or any future building occupant will/will not(circle one '•• o comply with said state codes and the requirements for a d END•,OF FEES permit tot construction or modification from the Air Quality Managem ' listrict.Residential construction applications are exempt from N these provisions. l Date.- Applicant: ' EX—P ( RED . ,1 I hereby certify that I have read this application and state that the ab.,•information is correct.I agree to comply with all city and county , Mete Inspection ordinances and state laws relating to building construction and her ¢e r-. esenL31Wfo•this ' to enter upon the above-mentioned property for insp Ilion pure ses. e Date: . 3 93 Signature: a� u _a vl Driver's Li nse or Social Security n: .` _ ._- ..�•— . 1646 White—Building:Green—Code Eneorc -nt:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ' 47- jI ICONSTRUCTION AND PLANNING POOL & SPA 1.. APPROVALS Permit m Date Inspector APPROVALS Permit m Date Inspector 1. Temporary Electrical Service or Pole - ' 52. Pool & Equipment Location 2. So.! Pipe-Undrgrnd. 53. Steel Reinforcement i 3. Electrical Conduit Utility-Undrgrnd. 54. Forms I 4. Electrical Conduit-Undrgrnd 13 115 I .,5. Electrical Bonding 1 I5. S:.2:., Reinforcement 56. Rough Plumbing & Pressure Test r 6. Electrical UFER Grnd 57. APPROVAL TO COVER-GUNITE r 7. Footings 58. Electrical Conduit-Undrgrnd. 1-- 8. Foundation !T' ! 59. Gas Pipe, 0 Undrgrnd.,Test i 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, C! Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK . . .. 11. Property Sevier Line & House Connecton r62. Backwash & Receptor-Final 12. Sewer Cap i 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final i 14 Rough Plumbing 65. Electrical-Final " 6 Hrugh Electrical-Conduit 66. Solar System-Final ~-,! I 1 bs'Rough Electric Wiring 67. Fencing & Access Approval 1 17. Rou h WiringSign 968. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL I 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure _ 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 123. Gas Pipe-Rough & Test 72. Underground Flush 1 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas "Oil 25. Roof Sheathing 74. Overhead Hydro _ 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • I 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 1 l I 77. FIXED SYSTEM FINAL 29. Insulation I 78. FIRE PREY. FINAL 1 30. Dryv.all Nailing II I HEALTH DEPT. REQUIREMENT I\ 31. Plaster Brown Coat $ 79. FINAL INSPECTION I 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric • t Notes: y-/92. 3 A_`/e„/ - /- 34. Final Heating & Air Conditioning i { / 4 (lL ! tai Cp ':.ivlC� pho.oe 4,10:7 / 35. Final Gas Pipe-Test 1 I 36. Hood or Canopy • r • 37. Final Factory Fireplace 38. Final Plumbing ' ' . 39. Water Service-Final i ' I I 40. Gas Service-Final 41. Solar Domestic-Final i I 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations I 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date i PROJECT ADDRESS: 190 23RD ST UNIT: NURSE CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 056956 OWNER'S NAME: CALVARY CHAPEL NP/MESA limns: 190 23RD ST PERMIT NO: B 056956 PLAN CHECK NO; N GOVT: N SUPP: N COSTA MESA CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT ,ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O EXISTING, APPLY COMPOSITION SHINGLES SQ FT: 1, 200 ADDRESS: UNIT: CLAIM VALUE: 1 , 200. 00 CALC—VALUE: 1 , 200 . 00 GROUP OCC: R-1 / J PERMITTEE: COASTAL ROOF DESIGN ( 714 ) 583-9038 ADDRESS: 24236 LARKWOOD LN COMMENTS: REROOF THE ' NURSERY' BUILDING, EL TORO CA 92630 ********�6>ESE*�d �c*�E�E�E�Ex�E�F*****>F�F�L**DE**�E**4**x>E>ESE***+E******+F**** ************N*>E** LICENSED CONTRACTOR DECLARATION; I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMEN TS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACK S CITYLIC.; 048456 STATE LIC.:570302CLASS: 9 • Date. y—/3-9Z Signature: Vast._ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: Ihereby altirm0all have acertificate ol consent toself-insure oracertificate ofWorkers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN Compensation( syr died copy thereof(Section 38110.Lab. POLICY NO.: fI5�� EXP.DATE: �7/O1 /92 COMPANY: STATE FUND,,;;,t PARKING REQ• PROV; PARCEL : 43926131 ZNE: REF NO; 1❑ Certified copy is hereby furnished. t_1 Certified copy is filed with the city Bui ing Division. PLANNING NOTES> u > Date' —[—i5— 97 Applicant Ott .,�� *********************************************************************if********* EXEMPTION FROM WORKERS'COMPENSATION FIGURATION: (This section need not be completed it the permit is for one hundred WOO)or less). DE VEL OPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE; Date: signature; BUILDING APPROVED BY NOTICE:If,alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor a DATE; - Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• w • _ DATE• - '2 which this permit is issued(Section 3097.Civ.C). **'*'*'**'**'*'x'****'***'*'***** 4* * ' • * *** -. **************4* • 1E*70 * LENDER: ************************************** *** ':*********************************** ADDRESS: LEGALIZATION:N F E E S U M A R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/RES GRADING (Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 29 ,00 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed • $MIP/NQN—RES pursuant to the provisions 01 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business p LAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by • any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the ropen or my employees with wages as (heir sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044. Business and Professional Code: The Contractors'State License Law TOTALS---—> 29 , 50 0 , 0 0 0, 00 2 9 , 5 0 29 . 50 0 0 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 29 , 50 OVER/SHORT• 00 for theepurpsea of sold lei)hin one year of completion,the owner will have the burden of proving rte/she did not build or improve for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM IP/TOT GRADING PLAN—CHECK the purpose sale( 29 . 00 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business • 50 ❑ and hProfessionsCode: ch projects withrs'State ntracteLawiens rsutoonhCotfctors'ly akens La ). limproves thereon ******************************************************************************* and who contractsCforsuchTContract a e License licenset pursuantly to the Contractors ofapropS Stateh builds t em aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: • SFR 1200 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 1 , 200, 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and ' END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Ouxlity Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to budding construction and hereby authorize representatives of t's city to enter upon the above-mentioned 1 property for inspection purposes. . 01 O9112t95—i�:1•_69s --77--,.' _ _ _ Date: 4—);— 47 Signature:_ MLL i DATE: [14%13, 92 T -iF: tr•••_ Driver's License or Social Security N.- • 1641-46 Whine—Budding;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor I CONSI;4UCTt0-N AND PLANNING - POG . SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector . 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical ConduitvUndrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains I 64. Plumbing System - Final 14. Rough Plumbing I 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation • 78. FIRE PREV. FINAL 30. Drywall Nailing ' . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � ) 79. FINAL INSPECTION 32. Electrical Power Meter-Final % ' 80. FOOD CERTIFICATE ISSUED 33. -Final Electric - - ( Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 'o_gL o'r _4L 48. FINAL PLANNING - 49. Electric Release to Edison - • 50. Gas Release-to Southern California Gas Co i ' 51. CERTIFICATE OF OCCUPANCY No. Date • City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. Building Safety Division P.O.Box 1200 Costa Mesa,California The Building located at 190 23rd St. has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group A-2'1 Occupancy. ,. Use of Building church oanaition Legal Description 439-261-31 (See reverse side for Metes and Bounds) E57081 Building Permit No_BE50898 Electrical Permit No. BE50898 Plumbing Permit No. Mechanical Permit No. 1451991 Number of apartments and/or guest rooms ISSUED TO: Building Official 'BonY Cry'- Baea Central Bible Church of Costa Mesa 190 E. Zsrd St. 1 Costa aesa, CA 92627 Date June 25, 1992 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 le) U.B.C. CMF 1015-46 rev.1/83 White-Owner;Canary-Numerical File;Pink .Bldg.Permit File • PROJECT ADDRESS: 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BE 05089( OWNER'S NAME: CHURCH, CENTRAL BIBLE OF • - ' ADDRESS: COSTA MESA PERMIT NO: BE 050898 PLAN CHECK NO: 00047-91 A GOVT: N SUPP: N 190 E 23RD ST ----- COSTA MESA CA 92627CONSTRUCTION TYPE: PERMIT TYPE: ELE STR PURPOSE: ADD (714 ) 645-5650 REc.ND.; C29373 JOB DESCRIPTION : 931SF CHURCH ADDITION S FT: 931 p ARCH/ENGINEER: LANGSTON & ASSOC Q ADDRESS: 1800 E 17TH ST , UNIT: 101 7 PERMITTEE: S.A. CSI BUILDERS CA 92707 ( 714 ) 838-1509 CLAIM VALUE: 90, 000 . 00 CALC—VALUE: 47, 853 . 40 GROUP OCC: A-2 . 1 / ADDRESS: 1047 AMBER § INC.T. COMMENTS: * ' ORANGE CA 92665 ************************************ >E+E*>E**>E> ****xsE****3E**>ERF*RF**RF**ycx>E*SE*RF*R6*RF* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I ensed under provisions or Chapter 9(commencing with Section Z ONING REQUIREMENTS , i 7000)of Division 3 of the Business and Professions Code,an. ense is in I II force and eifec SETBACKSS • • CITYLIC.: 031618 STATE LIC.: 40371CLASS Date: — 4— signature' MAIN BUILDING ACCESSORY BUILDING ORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certifica a of Workers' FENT: 2 0 FT IN REAR: 20 FT IN FRNT: FT IN REAR: FT IN LEFT: 8 FT IN RGHT: 13 FT IN LEFT: FT IN RGHT: FT IN ompensauonlAs a ! /tinedd,,GGpppythereof(Section3800,Lab POLICY NO.:-+ 4171 EXP. D! 01/01 /92 COMPANY: STATE FUND,V PARKING REQ 125 PROV: 127 PARCEL : 43926131 ZNE: R2 REF NO: PA=S90-123 7 Certified copy is hereby furnished. IX.Certified copy i :: with the city Building Division 4I y.(/1,(/// PLANNING NOTES> PPROPPOSBY SED EXPANSION OF THE EXISTING CENTRAL BIBLE CHURCH • Date'. �'�•1 ( Applicant: `/ • ' - i V laN✓" j.' ************************iE**** **************************1E***********IE*36******** DEVELOPMENT -7123 1 CREQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($10)or less). I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become ► - • ' subject to the Workers'Compensation Laws of California. ZONING APPROVED BY : \r_ iP — DATE: Date: Signature: BUILDING APPROVED BY • A NOTICE:It,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor • s S - DATE: /.(�J/ Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. _ n • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• f— i' DATE: .Z— whichthispermitlsissued(Section 3097.Civ.C). ************************ * • / ** ** * ***** *****************' ' ' - ' - - - ** LENDER: *********************************,*3E******* 3E3E******3E*****3E******************* ADDRESS: LEGALIZATION:N F E E S U M , ARY STRUCTURAL SEGMENT:Y • , OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING EL ECTRI CI1 MECHANICt E SMIP/RES GRADING._ (Section 7031.5 Business and Professional Code: Any city of county which requires a perritto construct,alter,improve,demolish,or PERMIT 401 . 50 3 3,. 90' . repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5 0.8.•," SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 65. 25 - • and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE' FEE - - 15 . 00 - 7 . 18 y applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). • BUILDING—DIV-> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE r1 I. as owner of the property or my employees with wages as their sole compensation, will go the work, and the TOTALS----> • 442 . 58 15. 00' -6'5 . 25 522 . 83 522 . 83 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 457. 58 OVER/SHORT: 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 401 . 50 48 . 90 7 . 18 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business , ❑ and Professions Code: The oojectsr'State LicenseLaw does tapply tpo owner of property whbuilds improvestheree. and who contracts for such projects wa contractor(s) ontrase licensepursuant pappat the Contractors' oprope'StateLicense Law). lem aware *************************************x***************************************** that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F' E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST • • Date: Owner: SFC 931 CHU—TYPE V—N —AVER 51 . 40 47, 853 . 40 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 20 FIXTURES, LIGHTING 1. ST 20 EA. . 75 15 . 0 0 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 12 FIXTURES LIGHTING ADDITIONAL EA. . 45 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE 12 RECEPT/OUTLET '1,r,.ST 20 EA. ' . 75 9 . 00 these provisions. ELE 6 RECEIPT/SWITCH 1 •ST 20 EA. . 75 4 . 50 / Date: Applicant: END!OF FEES °// I hereby certily that I have read this application and state that the a,. information is correct.I agree to comply with all city and county . .F ordinances and state laws relating to building construction and here orize representatives of this cit to•nter upon the above-mentioned - I t property for inspection purposes / t 1.i • Date: i�g �� Signature: _�L /.�/ / ♦ ` �I✓�L ./ 81 40O?539,= GGC17C19 Driver's License or Social Security#: DATE: '''� '" O '-- uJ:,_ ; Y "SLUE: .7 1541.46 Willie—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANN...a 00 . SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd:. 54. Forms •-• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test 6. _,Electrical•UFER Grnd. . - 57. APPROVAL TO COVER-GUNITE '7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation , . - 59. Gas Pipe, 0 Undrgrnd.,Test . 9. Water Pipe-Undrgrnd.- - - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System ` - , 61. APPROVAL TO DECK -' 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap • 63. Heater & Vent-Final 13. Roof Drains , 64. Plumbing System - Final 14. Rough Plumbing ° ^ 65. Electrical-Final 15. Rough Electrical-Conduit �s 66. Solar System-Final }; 16. Rough Electric Wiring 1 - 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . 20. Rough Factory Fireplace I - • APPROVALS' n 'Permit # • - ' " 21.'Ducts, inStructu're, , - , , : ; : . • ,70. Underground Hydro , 22. Ducts, Ventilating.. ' ' 71. Product_Piping 0 Gas ❑Oil ,Gas,Pipe,Rough &Test ' ' • " 23. . ,72. Underground Flush - 24.. Roof Framing ' , 'i - •• ' 73. Undergrnd.Storage Tank•D Gas ❑Oil 25. Roof Sheathing - ` 74. Overhead Hydro_'t - 26. T-Bar Ceiling (Structural) & Monocoat • . • - 75. Dry Chemical ' • ' ' ' 27. Frame and Flashing ; ' �r - , _ 76. Dry Stantlpipe 28. Lathing & Siding + i • -- -+ • 77: FIXED SYSTEM FINAL ' , 29. Insulation ' , ' „ ' ,� , ,!' ' 78. FIRE PREV. FINAL - - - - 30. Drywall Nailing ' I - ,.-,! - ;1 . I ;HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' • .-j� € ,i, • ; 79.•FINAL INSPECTION, 32. Electrical Power Meter-Final- ,. I 80.. FOOD CERTIFICATE ISSUED • ' 33. Final Electric Z/%9'71 Notes: . 34. Final Heating& Air Conditioning -, `/ I �{ i _ - �/ 35,. Final Gas Pipe-Test ! '• ��. I/ I y / �� • G� //� G , t !! 36. Hood or Canopy - . 1 i -I .1, - - - ' 37•. Final Factory Fireplace - - - I i I - 38. Final Plumbing . 39. Water Service-Final t 40. Gas Service-Final _ I I It 41'. Solar Domestic-Final : - I i ` ft.42. Backf low Preventer • - i ' b . - 43. Backflow Irrigation - ' -•44. Landscape Irrigation System - . . 45. Sound Attenuation 46. Handicap Regulations - - - , 47. FINAL STRUCTURE & BUILDING (tee?!•0' ' - 48. > S���C� L2�, ,49: Electric Release to Edison _ I 71, - - /I . 50. Gas Release to Southern California Gas Co , e- I I I• , - - 51. CERTIFICATE OF OCCUPANCY - : , , - -. No. Date • r'TY OF COSTA MES CALIFORNIA 92628-1200 P.O.BOX 1200 Insulation Certificate Number and Street City County Subdivision Lot Number Description of Installation ROOF Material Brand Name Thickness(inches) Thermal Resistance(R-Value) EXTERIOR WALL Material CTS Brand Name © 4L.iEMS--�Ft4N-inu'C Thickness(inches) 3 Y2. Thermal Resistance(R-Value) IZ - 4 CEILING Ban or Blanket Type eack-T1-- Brand Name QW elt! S- N./WG Thickness(inches) 60 t� Thermal Resistance(R-Value) 2 — 30 Loose Fill Type Brand'Name Contractor's minimum installed weight/hi lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value) RAISED FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) SLAB FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Width(inches) FOUNDATION WALL Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Administrative Code. G j x (03—? lS tor_Bu� ,fid Are_ A.- /- OG gdicenseNumber -� Signature and Till' Date Sub-Contractor(Insulation Installer) License Number Signature and Tide Date ossa MFS CITY OF COSTA MESA 4 9 . CALIFORNIA 92626-1200 P.O. BOX 1200 tei ).x • �OQPORIIf'7.1% a DEVELOPMENT SERVICES DEPARTMENT 2 • J(\(O� t toc. y." /��� �Lv L( 4*-4e-C{4 Cps. C1/42101 PQ E �C4SuT — l4�ofzESS ` C,SaN t a5A164 �s2 - utt PEAS LE.� IMPORTANT NOTICE Governor Pete Wilson recently signed legislation, AB 1576 which requires an employer with employees to provide proof of valid workers' compensation insurance or a current Certificate of Self- Insurance at the time application is made or renewal of a business tax certificate. If you are self employed with Do employees, you are required to sign the certification below. If this documentation is not provided with your business tax certificate application or renewal, your business tax certificate will not be issued until you have complied with this requirement. Should you have any questions regarding this matter, please feel free to contact the Business Tax Certificate desk at (714) 754-5234 or the Code Enforcement Division at (714) 754-5623 . Thank you for your cooperation. I certify that in the performance of work for which this license is issued I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California. Note: If after signing the certificate, you hire any employee, you become subject to the workers' compensation provisions of the California Labor Code, and you must immediately comply with the provisions of Section 3700 or your license immediately becomes rev ed. 12,6:14 Staiazi-er 2/ 10/ q2 si•nature Date .ignatur- / Da e GGG 77 FAIR DRIVE Building Division(714)754-5626 • Code Enforcement/Business License(714)754-5234 • Planning Division(714)754-5245 FAX(714)556-7508 • PROJECT ADDRESS: 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 051891 OWNER'S NAME: CHURCH, CENTRAL BIBLE OF er— ADOR i3S: COSTA MESA PERMIT NO: M 051891 PLAN CHECK NO: N GOVT: N SUPP: N • 190 E 23RD ST • COSTA MESA CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH (714 )645-5650 ARCH/ENGINEER: LANGSTON & ASSOC REG.No.: C29373 JOB DESCRIPTION : 931SF CHURCH ADDITION' SQ FT: ADDRESS; 1800 E 17TH ST UNIT: 101 ''= S.A. CA 92707 CLAIM VALUE: CALC—VALUE: GROUP OCC: A-2 . 1 / PERMITTEE: CSI BUILDERS INC. (714 ) 838-1509 ADDRESS: 1047 AMBER §T. COMMENTS: RE: BE50898 PRIMARY BLDG. PERMIT, ORANGE CA 92665 :E***+E:P:t:tsE*sE:r�E:E**�P+E+H**:E:E:r:E*:Er***:E:E*�E******:E:E:E* *:ESE***+t•*****:E**:r:t******:E**+r****+P* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Profession Cade.and my license is in lull force and effect. SETBACKS . CITY uc.: 0 1618 STATE LIC.:40 37 Liss: Date:. Signature:_ _ MAIN BUILDING ACCESSORY BUILDING FENT: FT ' IN REAR: FT IN FENT: FT IN REAR: FT IN WORKERS'COMPENSATI DECLARATION: thereby affirm that I have a certificate oil! f consent seu-insure oracertificate of workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation 4152a3:e41 aitifieA Toy thereof(Section 3800,Lab.R 1 /01 01 /9 2 POLICY NO.: S 11 11 EXP.DATE: COMPANY: STATE FUND,yy PARKING REQ: PROV: PARCEL: 43926131 ZNE: REF NO: 7•Certified copy is herebY furnished. G Certified copy is filed withII cityB(y}ing Division. PLANNING NOTE$> Date: ��, ( "/ Applicant: rL// *************************************3k***************************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be corn: ed d the mit is for one hundred($100)or less). DEVELOPMENT S E R V I C E $ REQUIREMENTS- I certify that in the performance of the work for which this permit is issued.I shall not employ any p rson in any manner so as to become ZONING APPROVED BY '1' subject to the Workers'Compensation Laws of California. DATE: Date: - Signature: BUILDING APPROVED BY NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor • ' ' DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED BY:• 4 • DATE• ��� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction tending agency for the performance of the work for ************************ ***** ** ** *** 4*** **** *********** ** which this permit is issued(Section 3097.Civ.CI. LENDER: *********************************************** ' ******************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18A 0 0 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 15% SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 15. 00 any applicant for a permit subjects the applicant to a civil penalty of not mare than five hundred dollars(s500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE L as owner of the property or my employees with wages as their sole compensation. will do the work, and the TOTALS----> 18.00 15 . 00 0. 00 33,00 33 . 00 . 00 ❑ structure is not intended or offered for safe(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 33.00 OVER/SHORT• 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/TOT GRADING PLAN—CHECK for the purpose of sale). I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33. 00 ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of Property who builds or improves thereon ***********,************************,******************************************** and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Stale License Law).I am aware that proof of their worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: MEC 1 REPAIR/ALT COOLING UNIT/SYS W/CNTLS 9 . 00 9 . 00 I do hereby certify that I am aware of and understand the requirements of Catilornia Health and Safety Code Sections 25505,25533,and MEC 1 REPAIR/ALT HEATING UNIT/SYS W/CNTLS 9 . 00 9 . 00 25534 and that I or any future building occupant will/wilt not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date. Applicant: 1 hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to buittlmg construction and hereby authorize representatives of this city to enter upon the above-mentioned01 —,-Zr: _ property for insp'ctian purposes. / _SRR •_r• - I ���rpo I DATE: 05/01/91 VII E: 1+:5_ Date: /i l J Signature: I - _ _ A / Driver's License or Social SecuritySa: / ,V/ 164 1-46 white—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ' CONSTRUCTION AND PLANNING . PO. SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector •, 1..Temporary Electrical SerSiee or Pole ,. • . 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. o - 53. Steel Reinforcement _,3,:Etactiia Conduit Utility indrgrnd.' 54. Forms :/14erElectricalCondtut-Ondrgrnd. 1 .: 55. Electrical Bonding !r.� STSteg3:Reinforce"runt "� 56. Rough Plumbing & Pressure Test 7 i'6.-LElectrical'-UFER.j3rnd. c 57. APPROVAL TO COVER-GUNITE i` ;a7. Footing '? J • 58. Electrical Conduit-Undrgrnd. 8. Foundation 1 59. Gas Pipe, 0 Undrgrnd., Test , _,.1 ••,9. Water Pipe-Undrgrnd. , 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System • . 61. APPROVAL TO DECK 1 i. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 1r2. Sewer Cap , 63. Heater & Vent-Final 13. Roof Drains- t 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric-Wiring 67. Fencing & Access Approval 17. Rough Wiling Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20r.Rough Eactoty Fireplace i 11 4^ •t 0 7. * "APPROVALS COPeernit # a - 11 t S. S. _r :C5-4 i Sr:' iC•S 'r :4 - J•4 :, . , CC vL a - . .. 5 - .I �. -. .a - -. . - ..' -1, > J•: ].y n 4 -r 21;.",Ducts, in Stcuctufe'r r .. .. -,� y i-x * --70. Underground Hydro 1 22. Debts, Ventilating .^.-S i ^ 5 :* « :r 71, Product\Pip'•ng 06as q Oil 232Gas-Pip,>F•Rough&Test ;-� ,- r q r '.72 . UndergroundFluiK �. 247=Roof Framing P1v r1-[- ar C Cr :x ',: :739 Undergrrid.Stor Tan 4'u Gas Doi 25. Roof S Bathing X N ,t ` { 'C 4 :t, = t v .' _ �- r .y v s. u p;a .. 74v Overhead Hydros q 21.-,T-Bar Ceiling (Structural) &Monocoat i m _ t'a ; 75.,Dry Chemical r - ` -t .. .. yr 7. m. 'r 1 it-r. 27'-Frame and Flashing a7 n r �' = � .,� .,, .., 0tgC.: .t s r joa r 76.E Dry Stan4ipe t7..:1; ,,(,._ 28. Lathing& Siding : •`.:r~t. ^ 4. r , ••a• ;Y 777'. FIXED SY TEMFINALr .r I--C '29. Insulation s: ' D •' ? * t1' i '' a 7&= FIRE PREV. Fl'JAL w q•= 30. Drywalailing _ * ~ , a -r •HEALsa TH• LNDEPT. REQUIREMENT 31. Plaster'Brown Coat;' s ' r' ° t 79. FINAL INISPECTIIN ' C' ` `,`r 32rElectrical Powe_ rMeter-Final n N I t t ;180.,IFOOD CERTIFICATE ISSUED -33 cFinal Electric 't'a _ -, r m tr. 1 Noies: p' '7:! \. ;;r. ,•34-FirZsl Heating& Ait,Conditioning; ;ten_ cl�pp!; » .' ;; -i., s � : 7 35,1„-Final Gas Pipe-T s ' 1 S I �' • t:5 - ,r . 36.•Hood orCanopy-y ✓_ s ^ .. .1. a ^ 1"t:it -, _ ..5. no vin- 'r Y%• R T .- 1' -'37:�Final Factory Fireplace .1;it.•"- * -• . --Cr x : CI Y ",3 r ,, c eI t .t y-. s . i .J . •• ••38. Final Plumbing .r. ILI .r r 'r- a.a• y :939. Wirer Service-Final- * 7 rhit .`o- 0 '`'v-. :. '.0 S t - 3,. rt: ' -it w i 40. Gas Service-Final F ,t `,:-, ;;, • , 541. Solar Domestic-Final C' •. i C- Ii: 'r •C‘-7"., '• r c i. ,- I r •10 7 4 'C .-42Backflow Preventei N a I 4 ; h y� C- . -' 43. Backflow Irrigation C -• - si' 1. - CD.1• ,. ] - 44. Landscape Irri ation Syste : ' 'Li ` `" 't:45:•Sound Attenuation • 4 •• S '4 ' • ' -, J' -7:,4 ° •. . - . .. .. , 1. rr' ,r . v A t - . 4 • C".•• \ :46: Handicap Regulations _ 1 it , 47.-FINAL STRUCTURE & BUILDINGr II 6i s 48.;FIPIAL PLANNING :� _ ; c I T,. -tt t al - 49.'-Electric Release to-Edison i t ' I �•, + i>; i i :50.,Gas•Release to Southern • California Gas Co ' I I I' •e ' 't' � • t 2•51. CERTIFICATE OF•OCCUPANCY t c I ; i; it;j y t . 00 No Date I PROJECT ADDRESS: 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05 /081 ' OWNER'S NAME: CHURCH CENTRAL BIBLE OF limns: COSTA MESA PERMIT NO: E 057081 PLAN CHECK NO: N GOVT; N SUPP: Y • 190 E 23RD ST COSTA MESA CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ADD ( 714 ) 645-5050 ARCH/ENGINEER: LANGSTON & ASSOC REG.NO.: C29373 JOB DESCRIPTION : 931SF CHURCH ADDITION SQ FT: ADDRESS: 1800 E 17TH ST UNIT: 101 S,A, CA 92707 CLAIM VALUE: CALC—VALUE: GROUP OCC: A-2 , 1 / PERMITTEE: CSI BUILDERS INC, (714 ) 838-1509 �,� ADDRESS: 1047 AMBER ST, COMMENTS; EXTERIOR LIGHTING BE50898— PIM !r V � 17. ORANGE CA 92665 ********* +F ****** ** *er****eFa6****+rat*�F�ETrTE�F�F*acx* eEpNr�Ea6*e6>E***uaE**********TF*eE******* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provision of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS CITY LIC.: 031618 STATE LIC.: 403715 fuss: Date:H� Z( - 92 Signature:_ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate Iconsent fps sure or a cerUficate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Igsq;aoce4 or astfiecppy thereol(Section 3800Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: l L / `11 EXP.DA COMPANY: STATE FUNDrriiI7 PARKING REQ; PROV; PARCEL: 43926131 ZNE: REF NO: Certified copy is hereby furnished. L9 Certified copy is filed wit the city "Wing Division. PLANNING NCSTE$> [/ 2l 4Z > ate: ( _ Applicant: ****************************************************************************If** EXEMPTION FROM WORKERS'COMPENSATION OFCLARATION: (lit seam need not be pldted if the penin o Intone hundred(5100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit issued.I all not oy any person in any manner so as to become subject to the Workers'Compensation Laws of Califon ZONING APPROVED BY DATE; T�Date:4 21-1'Z Signature: (�/ BUILDING APPROVED BY DATE: NOTICE:II.alter making this declaration,you should become subject to the Worke4'Comae rovisions of the Labor Code.you must forthwith comply with such provisions or this permit shag be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: L— Imo_— _ DATE: p1 7�-14 2 which this permit is issued(Section 3097.Civ.C). **********************• +- x+c- " >« " * **********kit** Te it ** LENDER: ************************************* ***************************************)e* ADDRESS: LEGALIZATION:N F E E - U M M A R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELE RIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct.alter,improve,demolish.or PERMIT 6 75 repair any structure.prior to as issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section MOO)of Division 3 of the Business PLAN 131% $MIP/NON—RE$ and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 4 . 50 L as owner of the property or myemployees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not Intended or altered for ale(Sectionect7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 6 . 75 4 , 50 0 . 00 11 , 25 11 . 25 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTALS--> COLLECTED• 11 . 25 OVER/SHORT• 00 improvement is sold within one year of completion,the owner wig have the burden of proving he/she did not build or improve or the purpose olsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 11 . 25 and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).lam aware ***X.********************************************************************it****** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.a P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: OwnerELE 9 FIXTURES, LIGHTING 1 ST 20 EA, , 75 6 , 75 I do hereby certify that tam aware of and understand the requirements of Cabfornia Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant wiliwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is c rect.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby autM1M1M1ggq're represen 01 this city to enter upon the above'mentioned r i property for inspection purposes. /J : l y i�- Date, amu— !T2- Signature. .�I �,/y C, r� ._ _ Driver's License or Social Security a: 164646 White—Buildino:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING I POOLSA APPROVALS Permit# Date Inspector APPROVALS Permit 916 Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection , / 62. Backwash & Receptor-Final • 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0011 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final __/// 12 80. FOOD CERTIFICATE ISSUED j 33. Final Electric /,t/ ,,kkee5 Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date I PROJECT ADDRESS: 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05189C OWNER'S NAME: CHURCH CENTRAL BIBLE OF ADDRESS: COSTA CHURCH, PERMIT NO: B 051890 PLAN CHECK NO: N GOVT; N SUPP; N 190 E 23RD ST COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : CONSTRUCT NEW TRASH ENCLOSURE SQ FT: 300 ADDRESS: UNIT: CLAIM VALUE: 300. 00 CALC—VALUE: 300. 00 GROUP OCC; R-1 / PERMITTEE: CSI BUILDERS INC. ( 714 )838-1509 ADDREss: ORANGE1047 AMBER T. CA 92665 ********iF****+rB******;,E********B*D*iE***+Rr*********:F**********:EBF*****+E***;'F+t*+tit*+r46* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS ' 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS col,LIC.: 031618 STATE LIC.:4037 liCLA B Date'. Sir / Signature: ,..� y -� FRNT; FT MAIINBRREAR: FT IN FRNT: FTACCESSORY REAR:YLDING FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a cemf ate of enc to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ' cenilled Compensation saIL r� i rgtdie ropy thereof(Section 3800, LabLICPNO.: LrNEXP.DATE: 1 IO 1 I92STATE FUND PARKING REQ• 125 PROV: 125 PARCEL; 43926131 INE; R2 REF NO: cop is hereby furnished. C Certified copy is Bled with the city Building Division. PLANNING NOTES> OBTAINING PERMIT FOR TRASH ENCLOSURE FOR A PREVIOUSLY • �p > APPROVED AUDITORIUM REMODEL Date: ` lApplicant' Q . DEVELOPMENT SERVICES R E U I R E M E N T S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not bEcpmple ilthe permit is for one hundred(MOO)or less). �^+ Q I cerlity that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become ZONING APPROVED B Y : sec ��`( /�/ subject to the Workers'Compensation Laws of California. DATE: Date: Signature: BUILDING APPROVED BY : U S NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE: /i Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. r CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: A , DATE- _ ' -, which this permit is issued(Section 3097.Civ.Cl. *'******* '*'*'*'*'*'*'**'*'*'**** *' ' ** g�S****************4* - - - - ' ' ' ' ** **************4*************************** ****4****************************** ADDRRESS: LEGALIZATION:N F E E SUM ARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 15. 00 ,50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7D00)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 15 . 50 0. 00 0. 00 15 . 50 15 . 50 OO ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License LawOil does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale. It,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 15. 50 OVER/SHORT: 00 improvement is sold within one year or completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). I.as owner Of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 15• OO 50 , ❑ and Prwho cntra sdfo Theh Contractors'with Mate contratocense law doesrsutoo the Coofprorsftyatbuilds Law). l amawre *********************************4********************************************* and Prof contractsCode: he Contract with a eontracmgawidoesenot pursuantly to the ner faprope:StatehLicense improves em aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.S P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFR 300 ALTER BY VALUE RESIDENTIAL NOZONE 1 .00 300. 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant ill/W will rpt(circle one)need to comply with said state codes and the requirements for e • permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. , 7t,� Date. Applicant: • I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county 9 :\49\-8 ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for in. eclion purposes. / Date:��l j sigdature: \ .. a . \ O i 00084352-1101"6333 7.3_ —7 : . .. Driver's License or Social Security b: / DATE: 05/01/91 T)11F: 11:57 '/ 164r-46 White—Building':Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor y - • CONSTRUCTION AND PLANNING' POt SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Serviee.or Pole 52. Pool & Equipment Location 2. Soi(,Pipe-Undrgrnd.. -• -'•' 53. Steel Reinforcement ;-R 3 ' .i;El'e`ctrical Conli'uwU -' tility-Ondrgrn��' 54. Forms •4"Electrical Cond-uuit•Uhdrgrnd. I : 55. Electrical Bonding 'I:'R. ' 5'Stegl Reinforcement C 56. Rough Plumbing & Pressure Test - :6..Electrical UFERhGrnd. t 57. APPROVAL TO COVER-GUNITE • .�.. 'Z. Footings 58. Electrical Conduit-Undrgrnd. .. C. 8. Foundation ` • 59. Gas Pipe, O Undrgrnd.,Test ' ',-9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, C Undrgrnd. 10. Structural Floor System _ 61. APPROVAL TO DECK 11. Property Sewer Link& House Connection • 62. Backwash & Receptor-Final 4 12. Sewer Capel . 63. Heater & Vent-Final 13. Roof Drains cc 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric-,Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _FIRE DEPT. REQUIREMENT • -. _ _ . „ -- JI 'c 9 - .V 20.1RoTgh Factory Fireplace : •tern `S"= *. C ..:1S • x ,_APPROVALS D :Periinit# i 5_" I $tr' '5;.,: :P .$ r• ?s .t- t:t - -4 r> :a V, 'r I .+r l:.. .. m L � ' - ..• r4 y 1 21_;Ducts,in;Structure, , „ ,.S - S G -< a _70. Underground Hydro z 22. Duets, Ventilating ' 1 *a "-t ? S" z '71 Produq Piping 0 Gas ❑Oil 23.;Gas Pipe Rough &Test t S "7 Q - r ? 72. Underground Flush.•. 24.oRoof Framing r - r i-' -:r '4-1 > J yx .S73r Undergrri3.Storage.T nkydOGas 0 e 25. Roo-f Sheathing `._ V ' ''7 nl - r`''' + ' " " y-•0 .r, v , :, _ ci - 1 -74;�Overhead Hydro_ y 26_T-Bar Ceiling (Structural) &iM• cnocoat.1- - ' - n' t 75.5 Dry Chemical * '- - •r. 27 Frame and Flasf in` Z ._c,t z - t;t --, �2 27.7:Frame .itr. 5..-, :?' ., . 76. Dry Stangpipe _ q ;. .n, 20JLathing.& Siding Y ,. -'C ^S. < •• ••1 -It Y 77;7 FIXED SYS,TENI FINAL* - , r I '429. Insulation .' ~ ' ., ...7.----:.-.. 'n ; ° r . S • �;. . ( • �._ .r 78.,FIREPREV. FINAL4. *'30. Drywall-Nailing r: .Tcl= I I i HEALTHDEPT. REQUIREMENT •r, • re- , _ 11 i r s- c 'rl,l • 31. Plaster Brown Coat n $-• 1 % -4; y ,.79'"FINA L INSPECTION 32. Electrical Po�ilverMeter-Finali ` • F-`:� V i X;r X180*.FOOD CERTIFICATE ISSUED .s.33:=Findl Electric . 7'r:3•-• t` 4 `'Noies ' _. 7, -t " rS 7i ' ,,j34,,-.Final Heating& Air. Conditioning; - . _ 1:. .i. u: S '• . y., n ' ..:6 r. nJ 35.1,Final Gas Pipe-Test' •^ {; r, :CS. • ` "' _ .c L..-- •••-tC 11 - /11'1 to 7r a 1-p• _036.'Ho`od or'Canopy,_: ` 1 tr.-, .. . I .t j:•. r t' 5: ..--1::* .• y.., _ _:37.-:final Factory Fireplace,_ 1 1''n , Y '- • ' ni •- r : 5 K t< :t • I _38. Final Plqmbing V j.f s s L • u . 39. Water Service-Finat ? I I '_ T. .1 -m x Fr. I a r v r• .� -40. Gas Service:Final I' F .;•7 "41 ` . Solar Domestic-Final . .- • r 1 ' .77 h * 't u - • -42/Backflow Preventer, ' ',. :, + ( • ;K X 43. Backflow Irrigation - t.=e _ •t:-0 ` - ' ,. _ * 3- - r / l I.II; 44. Landscape laigation System- n„r - r - - - u CO c1; ' .+ 0 a 5. Sound .'4Attenuation X46.:Handicap Regulations j r • •-47.-FINALSTRUCTURE & BUI'LDING -, O.'7i°' = •7�=`• J p�j2.-., , + : 48. FINAL PLANNING I ( I xi �f ,. r - 49=Electric Release to Edison .,...1 : /•- t -'X - I I •T . rz :r -'50.,Gas-Release to Southern California Gas Co I I l` •• , , ` , i • '.51. CERTIFICATE OF OCCUPANCY ,; o I No. Date S 0 S 38 IB 39S I O Type of Sign City of Costa Mesa roject Address 190 �. ' �_p�R-0 ❑Electric tNon-electric SIGN PERMIT e j/p Applicant's Mailing Address �l�L//"���-,y}.' /� Description Programs Owner's Nagle LVrf a'"'I.�t'W/W"' Phone£)TCSC� ❑ Shopping 7r 43 �V ❑ Canopy Center/Integrated dev. Address •/� ❑ Attraction Board ❑ By Owner/or 0 b City 01 00011546-00011549 TOT 104.60 Arch/Eng. License No. ❑ Advertising Statuary Date letter sent: p ff ice Use Only - - Address 0 so 10 Other "'Z' . . a 2 dr ❑ Tract Sign (Security& Right of ❑ Variance Contractor's Name -t' i:-- ' Property F+ . 5�� � Entry Agreement p 2191- al �j Address(mailing)G✓��i�re �.J� ren. ❑ Planned Signing �'3 l - 2191- 3 12-G.. ❑ Special Event(Request form submitted) A.P.No. Zoning City License No. Q Chan e of Co C.U.P.No pp Q g py(amortization) Sign Dist. Date Received!) LICENSED CONTRACTOR DECLARATION Ground �/ Illumination I hereby affirm that I am licensed under provisions of Charter 9 (commencing Q Wall .....1a*-- CJ Non-Illuminated Received by with section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. El Roof Roof Interior Illumination Street frontage: n � ^, n _ License Class License No. ❑ Projecting Exterior Illumination q /� /�f V i4-v-e Date Signature ❑ Construction ❑ Front: LLO Ft. Street:` • o- 'RKERS'COMPENSATION DECLARATIONRi9 ht: Ft. Street: ❑ Convenience . Z32.0 . reby affirm that I have a certificate of consent to self-insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section ❑ Super Graphic Left: 2.40 Ft. Street: 3800, Lab. C.) Rear Ft. Street: Policy No. Company 9 Certified copy Is hereby furnished. Building set back from ultimate right-of-way ft. Certified copy Is tiled with the city Building Division. -ELECTRICAL FEES INSPECTION APPROVALS Date Applicant �� 1 �,. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Fixtures Sign Date ..d'l,P"" _ Sign Location (This section need not be completed if the permit is for one hundred($100)or 1! (� less). Front X Rear Right Left I certify that in the performance of the wo or which this .-r t' issued, I Device Boxes Underground Conduit 9 shall not employ any person in any ma o as to be e •lett to the Work C i s on Laws of Calder!. � - I✓..• Outlets Sign Description Dat L Signature -.44, !/ .,....ft NO IC : If,after eking this declaration 1•u should become subject to the Switches Sign Dimensions Area Letter Height Workers' Compensation provisions of t .bor Code, you must forthwith rr comply with such provisions or this •ermit shall be deemed revoked. r r7 / /y CONSTRUCTION LENDING AGENC Sign Foundations 3 Z _ I hereby affirm that there is a construction lending agency for the performance (1) % - ' sq.ft. of the work for which this permit is issued (Section 3097 Civ. C.) Standing Sections tender's Name Lender's Address (2) x = sq.ft. OWNER BUILDER DECLARATION Rough Wiring -I hereby affirm that I am exempt from the Contractor's License Law for the (3) x = sq.ft. following reason (Section 7031.5 Business and Professional Code:Any city or . county which requires a permit to construct,alter,improve,demolish or repair any structure, prior to Its Issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions of Items of Information: (1) (2) (3) Contractor's License Law (Chapter 9(commencing with Section 7000)of Framing rision 3 of the Business and Professions Code) or that he/she Is exempt Total for Activity arefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Issue Fee $3 ^f- ^ D^ of not more than five hundred dollars($500). CA i Nary (—Ai uv-dA. as owner of the property or my employees with wages as their sole /t Copy Verbage / p /� compensation,(Section ec, will 0 the work,antl the or scion i5 ddt :n Tn Cd n ractortl Vdl Dation $ '( �� Fib81 Electric I G 1 1 11'1Ot meso` • cor paleti ,wi 7044, Buork, and structure Code: The Contr actor's ff red f I �„t_�/`^'v License Law does not apply to an owner of a property who builds or Improves . thereon, and who does such work himself/herself or through his or her own G /�`/�, - employees, provided that such improvements are not intended or offered for Planning Fee $ I S. `l9,y sale. If, however, the building or improvement is sold within one year of com- ttt���r i ♦ ,, .- pletion, owner will have the burden of proving he/she did not build or IM- Building Permit $ Sy _ ro r the purpose of sale). C� Ground Sign: Overall Height 1 Planter Area as owner of the property, am exclusively contracting with licensed con- Plan Check $ Ri /nal Planning I I Electrical ! tractors to construct the project (Section 7044,Business and Professions Code: $ Ground Clearance - The Contractor's License Law does not apply to an owner of property who 4 ,(ter.+ builds or improves thereon, and who contracts for such projects with a con- Plan Check 50% $ �S.•� "SA / '6 / tractor(s) license pursuant to the Contractor's License Law). I am aware that .7- '(� / Total Sq.Ft.of All Signage proof o their Worker's Compensation insurance should be provided to me. SMIP $ Final Sign 0 I am exempt under Section B.&P. C.for this reason // TOTAL FEE $ IQy b0 'J' This activity Total Site Date �u��—u=�� OwnEr Jr .i.- / �..�' 1 :..ca meq,� o ,'� I hereby certify that I have read this applicy ion and state" hat th• above / ��� Notes: t Ir(--/itAke.1- Cr�information is correct. I agree to comply wit a at city and county ordinances •� <J � r _ 3/2" and state laws rela o building construct'. ,antl hereby authorize repro- DEVELOPMENT SERVICES REQUIREMENTS: R Qas SS 3/9 sr s _ „.. `M 40 sentatives of this city to enter upon th. ..eve-mentioned property for PlanningApprovedCr Date B' S' S V lQ..t.'"�w inspection purpos s. pP y: -- Signature 'a. �,a.." a Enforcement;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor LIMITED STATEMENT OF RESPONSIBILITY Bldg. Permit # TO WHOM IT MAY CONCERN: This Permit # /90 c. �3 G 2x627 Street Address AP Number ,/ JAMES' /i/`fheu6/! (v,Q Cl v49k�/�'Z,PGi, , as Owner in Title of the above referenced property, do hereby authorize: °Fy"0°rr MEr 9,),;,7 A , .0" 72 Z—OSS 7 me Telephone No. g$D W /f Atz_e Street Address ,2‘27 City State Zip to obtain permits in my behalf, as owner/builder, for ,S7a/'(/ at the above referenced property. Should airy oersoq become an empinyee engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- . son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. • J9-mfcl- vte 4 print d Name Date Si tura • • r r • r 0779.46,rev.6/87 1 i- 5 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. � CITY OF COSTA MESA CONSTRUCTION PERMIT RM T NO. TRACT NO. LOT NO. UNIT NO. 9438 7/15/86 1.6.00 Ti,. . Project Address 190 E. 23rd ` ►6 /� qss� I`� - Applicant's Mailing Address 5413 E. La Palma-Anaheim 92807 TYPE OF CONSTRUCTION LI NEW L2 ADD H ALTERATION UREPAIR Carolyn Polley Phone 642-7443 ❑ CONVERSION CI DEMOLISH 111 OTHER A.P.# Zone. Owner's-Name DESCRIPTION OF WORK/USE OF BLDG. _ _ Address 190 E. 23rd -Costa Mesa 92627 -- - _ I_ _11 - _ - - . S Main Building:. - , , Accessory Building: •Arch/Eng. License No, • TYPE OF PERMIT '• GRADING II FOUNDATION E Z pp--1l ❑ STRUCTURAL T Front 0 Address ❑ OTHERENANT ® ELECTRICAL ❑ PLUMBING KI MECHANICAL B• A Rear - - N Contractor's Name PRO -HEATING & AIR •Phone 779-6868C Right N 5413 E. La Palma-Anaheim 92807 • PROJECT DESCRIPTION SQ. FT.' - OCCUPANCY K - G Address(mailing) CONST RUCTION TYPE VALUATION$ S Left R City License No. 35251 ZONE GRADING CU.YDS. ACRES - • • LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req,/Provided E { `�((j Q ' '-hereby.affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: ' ' Planning Notes: RECEIVED JULf V 1 Ogg M • with section 7000) of Division 3 of the Business and Professions Code,and my license is In full force and effect T S License Clas - a l r/ License o. d6J637/ • - Date 7 86 Signatdre;-! C� - - .L�' -/ PLUMBING FEES J WORKERS'COMPENSATION DECLARATION Bar Sink Showers — hereby affirm that I have a certificate of consent to self-insure or a certificate ; ELECTRICAL FEES , • of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer •_. Service Sink _. _ 3800, Lab.'CJ }�}�ytg}}((yy W64-06392 Automatic Washer Transformer 0 15'-50 KW • PolicyNo. �Y" CompanyHomeland • Backflow Irrigation Sewer Ce ❑ 50+ KW 9 P Construction Pole Sub. • ❑ Certified copy is hereby furnished. - L}[Certi f{� is filed with the city e}��pn�-�nn�r}�t��j(�}P�},rr Bathtubs l Sewer Connection 1 • Cooking Unit Meter ❑up to 100 amps Date / ff90'6' Applicant r+�� +++'�++"� & AIR - ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar• Collectors Dishwasher .Meter Clover 100 amps • • I` (Thissection-need not be completed if the permit is for one hundred ($100) or vp less). , • DishwasherSolar Piping I Dryers OGas. El Electric 'Sub Panel 1 1 certify that in the performance of the work for,which this permit is issued, I - . shall not employ any person in any manner so as to become subject to the t Drinking Fountains Solar Tank -- Fan' Motors❑0.1 HP.�1'/x-6 • 2 00 Workers' Compensation Laws of California. _ Date Signature I Floor Drains' , Swimming Pool w/Spa F.A.U. 'Inc.Solar❑9-15 HP ❑16-15+ , l 'NOTICE: If,after making this declaration,you should become subject to the - _ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal . Fixtures Microwave comply •with such provisions or this' permit shall -be deemed revoked. ' • CONSTRUCTION LENDING AGENCY. Gas Service Outlets . Water Closet Device Boxes ' 1 hereby affirm that there is a construction lending agency for the performance - Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors • Water Heater •- Outlets Ran e Lender's Name - g Lender's Address • Kitchen Sink Water Service • Switches Sign - OW NE.R.BUILDER DECLARATION _._ - - .-- _- _ _ - I hereby affirm that I am exempt from The Contraacctor's License Law:for the ) ' 'Lavatories- ' Garbagesal--- , _ ,StandingSections following'reason (Section 7031.5 Business and Professional Code: Any city or Disposal ' _• _ county which requires a permit to construct,alter,improve,demolish or repair P-Trap . - - LaundryTrays . any structure, prior to its issuance, also requires the applicant for such permit y Generator ❑0-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • - ' .the Contractor's License Law (Chapter 9(commencing with Section 7000) of_ . • Division' 3 of the Business and Professions Code) or that he/she is exempt • - .— - - -- therefrom and the basis for the alleged exemption. Any violation of Section - _ - 4 7031.5 by any applicant for a permit subjects the.applicant to a civil ' - — penalty of not more than five hundred dollars($500). ' . : _ '_❑ I, as owner of the property.or nty'employees with wages as their sole - Reinspection Fee ' $15 - Issue Fee I - $ 3 ' • compensation, will do the work,and the structure is not intended or offered r for sale (Section 7044, Business and Professional Code: The Contractor's . - .MECHANICAL ' FEES - Reinspection Fee I $15 Issue Fee $ 3 License Law does not apply to an owner of a property who builds or improves - • thereon, and who does such work himself/herself or through his or her own Boiler • Hood or' Type0 DEVELOPMENT SERVICES REQUIREMENTS: • , employees, provided that such Improvements-are not intended or offered for - ZoningApproved ' sale. If,-however, the building or Improvement is sold within one year of com- Canopy ' Type II ❑ • pp By Date pletion• , the owner will have the burden of proving he/she did not build or im- Duct-Under Ground •• _ Building Approved By Date ' Drove for •the,purpose of sale). ^7 dr��o I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • '• - Application Issued By Date tractors to construct the project (Section 7044,Business and Professions Code: 1 t The Contractor's License law does not apply to an'owner of property who Duct-Ventilating X10-100,000 BTU 0100,000 BTU • 4 OO SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me.i - - / PLAN CHECK $ PERMIT• �� • ❑ I am exempt under Section B.&P.C.for this reason ' Firepl/Fact.Blt, ICBO# ' I Fire Dampers • PLUMBING $ 'ISSUANCE $ • Date • Owner Heating System& Ducting . RegistersENERGY P.C. $ PLAN CHECK 25% $ • I hereby certify that.1 have read_thisapplication and state that the above EX0-100,000 BTU 0 100,000BTL - • 4 00 .j' ELECTRICAL $ :BOO • GRADING $ information is correct. agree to comply with all city and county ordinances i and state laws relating to building construction,and hereby authorize repre- - PLAN CHECK 50% $ MICROFILM $ sentatives of Is city' to enter. on the above-mentioned property for inspection p rp sesz/ �>y�i/ , 78/86 • l I TOTAL FEE $ 16.00 -Signature .Z"-�"� Date • % MECHANICAL $ �- Drivers' License or SS# • Reinspection Fee I $15 : Issue Fee $ 3 • -• PLAN CHECK 25% $ - . CMF 0865-46,rev, 10/84 White - Building; Canary -Applicant; Pink --Accounting; Goldenrod - Assessor - ' - - • - - - - .,,♦ CONSTRUCTION AND PLANNING . POI..L &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.;Test .'9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater& Vent-Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval .. 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:y/4( s /4r, ' I- 97t-mel 34. Final Heating & Air Conditioning yr- 3 35.'Final Gas Pipe-Test / 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final r r i 40. Gas Service-Final i. 41. Solar Domestic-Final • 42. Backflow Preventer • X43. Backflow Irrigation 4:44. .Landscape Irrigation System-- �45. Sound Attehuation 46. Handicap Regulations -j 347. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to.Edison -050. Gas Release to Southern California Gas Co 2.51. CERTIFICATE OF OCCUPANCY ' No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 2453 10/17/135 SoO'r it. (0-) . • GTYAF COSTA MESA CONSTRUCTION ERMIT PE NO. TRACT NO. LOT NO. UNIT NO. Address Igo e _ a-3v Gt //'" ` I 9. .6j —'1 05���1� r I •.4 19' E a� VSO G 571/?-1 TVP�F CONSTRUCTION LI NEW 1J ADD U ALTERATION LI REPAIR v cant's Maili g Address e( tJ t /fir �y� CONVERSION ❑ DEMOLISH ❑ OTHER A.P.46 Zone Owner's Nam- x a� �/ P7 18 Phone�Pt}�!-^07 Otk"C,� G p DESCRIPTION OF WORK/USE OF BLDG. Address -i`��I�+,�1 �`0s—"�3�. U r /1677 - _ S Main Building: Accessory Building: Arch/Eng. Him - -.- License No. TYPE OF PERMIT ❑ E GRADING H FOUNDATION ❑ STRUCTURAL T Front - - - - - Z O ❑ TENANT LI ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N • Address A Rear Contractor's Name N�� Phone CI -OTHER C Right N * . PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(mailing) CONSTRUCTION TYPE VALUATIONS K Left G City License No. ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION ) `we (/./)� _ Ping. Ref.# Parking Req./Provided E I hereby affirm that am licensed under provisions of Charter 9 (commencing cin �� �� G U yl rn_lrs�t'"f j ✓'JI �•' �"_� g LS.� M ( 9 Remarks: V ,VY `-�P )/ Planning Notes: 0 with section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. - T License Class License No. S Date Signature PLUMBING FEES WORKERS' COMPENSATION DECLARATION Bar Sink Showers • 1 hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) Automatic Washer Transformer 0 15.50 KW Policy No. Company Backflow Irrigation Sewer Cap )Construction Pole Sub. • 0 50+ KW 8 Certified copy is hereby furnished. L Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit / Meter cup to 100 amps /( Date Applicant y/ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - Dishwasher Meter Driver 100 amps (This section need not be completed if the permit Is for one hundred($100)or - less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance oft 9 or fo which t permit is issued,I shall not employ any person in any nn oast come subject tq the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-8 Worke qp eR�y ws of Call • nia. �o� Date 1/U /7 Signature - FU Floor Drains Swimming Pool w/Spa F.A.U. ({�,j' Inc.Solar ❑9-15 HP 016-15+ 'NOTICE: If,after making this declr ion,you should be a subject to the Workers' Compensation provisio' •f the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Micro Wave comply with such provisions •r this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance 9 of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater e Outlets Ran Lender's Name 9 Lender's Address - - Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION - - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash - - Garbage Disposal 'Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or ' - - - county which requires a permit to construct,alter,improve,demolish or repair ' P-Trap - any structure, prior to its issuance, also requires the applicant for such permit Laundry Trays Generator ❑0-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section ' 7031.5 by any applicant for a permit subjects the applicant to a civil en y of not more than five hundred dollars($500). - I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 I Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered ' - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under GroundBuilding Approved BY /� Date prove for the purpose of sale). —- - - - - (�f�J ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ` i nate /0 tractors to construct the project (Section 7044,Business and Professions Code: . The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with•a con- - tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration - BUILDING PERMIT $ SMIP $ proof o their Worker's Compensajn insurance should be provide• to me. PLAN CHECK $ PERMIT • ❑ I am exempt under Section yI: P. a fo is reason Firepl/Fact.Blt. ICBG# Fire Dampers /^1 / - PLUMBING $ ISSUANCE $ Date 61 (/rl J Owner ;_ t� -, ! .- Heating System& Ducting Registers ENERGY P.C. $ . - y PLAN CHECK 25% $ I hereby certify that I have re.. his application and state that above 00.100,000 BTU 0100,000 BTL GRADING $ informatio/s correct. agree • omply wit -all city and county .rdina nces _ ELECTRICAL $ �O and state F- s relating to • 1 •in§ c•nstr t •n, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives • this city t•i u••n ,s.. above-mentioned pro ert for (� inspection urposes. I J 73 MECHANICAL $ • TOTAL FEE $ 6 t Q� Signature .rpos:..� �'='" ' Date O Drivercense or SS . Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ _ CMF 086546,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor TRUCTION AND PLANNING POI. i SPA ;OVALS Permit# Date Inspector APPROVALS Permit# Date Inspector - '1. emporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final •12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. •Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough&Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final /0 -fr� C� 80. FOOD CERTIFICATE ISSUED 01:133. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test • 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison / 50. Gas Release to Southern California Gas Co /A lt°s 51. CERTIFICATE OFOCCUPANCY .rl� No. Date • Applicant to fill in a s acesin heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PEFAIT O. TRACT NO. LOT NO. BLDG.NO. _ - . - CONSTI;U6TIGN PERMIT QC 340 ' 5.1 95 4/28/82 • 1' 57.60 II.Address 1�O 13 s} I - TYPE OF CONSTRUCTION / -- - _ AOwner v FD t1OW IL. Phone G4cS cD 0 NEW 0 ADD ALTERATION - _ 1 - Address-,id1 O' F 7 --Ji ••E*. --_ _ _._ .__ __-_ _0 REPAIR-❑ CONVERSION ❑DEMOLISH. 4 •- I Arch/Eng, ., ' e _ L f, License No. ❑OTHER ' - A P ' ZONING REGULATIONS. DESCRIPTION OF WORK !'t4 )• SNS 9 -- - - • - j/t-0.._is..fi irkat— /Iea✓„20 •ZONE �� PLNG- REF,- '• Contractor -TYPE OF,PERMIT Y - - - - �� --- /BUILDING TO BUILDING ._ ,,�,,, � .SETBACK C/L ST. PROPERTY LIN ••• - ❑ GRADING ❑ FOUNDATION (JSTR VCTV RAL LIDE VARD �.- LICENSED CONTRACTOR DECLARATION ❑ TENANT ❑ ELECTRICAL ❑VLUM GING ❑MECHANICA SIDE VARD I hereby affirm that I am licensed under provisions of Charter 9 (corn- ' RIGHT /`� mencing-with _section 7000) of Division 3 of the Business and 0 OTHER '- _ 'Professions Code, and my license is In full force and effect. 1 REAR YA TO P/L) - • -" PR O.IECT DESCRIPTION y _ - PKG.SPACE REQ.' - - PROVIDED 'Daenie Class - License No. - 1. - Date Signature - - �.FT. a �'.j] - - __ - • WORKERS'COMPENSATION DECLARATION _ •'. OCCUPANCY Z''7� $,RUCTION TYPE $TR EET'WI TH ?ARK FEE$ '1 hereby affirm that I have a certificate of consent-to soli-Insure or a VALUATI OIO ZONE Z'Z ',ZONING APPROVED B D _E Q - certificate of .Workers' Compensation Insurance, or a certified copy Jf/ �/� I �`" • thereof(Section 3800, Lab.C.). GRADING CU.YDS. 1, ACRES• •2._5 —SPECIAL CONDITIDNS: - - -' Policy No.' - - - CompanY - - - . . _ . . . -. . . I ] Certified copy is'hereby furnished. - - - REMARKS: I __ _ _ _ _ a Certified copy Is filed with the city Building Division. r - - -� - r ! •- �- - - ; EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Cad .J-.kf e Jrf-ar -fit,ri/�/OihS- - '(This section need hot be completed If the permit Is for one hundred ` ` I r., t; .; � :. f , '($100) or-less): - _ _ - _ - - - . • _ - __ __ - __ _ ll certify that In the performance of the work for which this permit is Issued- I shall not employ any-person In any'manner so as to become PLUMBING- - PLAN CHECK- - - ;ELECTRICAL - - - PLAN CHECK -• - - _ - I subject to the Workers'Compensation Laws of California. • UW tLLING bH HA(aE ,Date - Signature - BATHTUBS - -SHOWERS - - • '--- - -- - ---- _ - - - e - I .NOTICE: If after making this declaration, you should become subject TOILETS . URINALS .- GENERAT.OR--- -0-1 KW=1-10 KW- • -- -- -' to the Workers' Compensation provisions of the Labor Code,you must - 'TRANSFORMER t - .forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS-- :APPLIANCE- -- 10-50 KW_50 + KW _ - - revoked. I - - •- CONSTRUCTION LENDINGAGENCY - - - -' - KIT,SINKS - , DISHWASHERS- - 'MOTORS. - . 0-1 HP_1-10-HP - . - - ------ .� Il hereby affirm that there is a construction lending agency for the per- SERVICE SINKS . SUMPS- --- I(INC„SOLA R_), 10-50.HP 50.+ 41. ' 'r`.._- _ ;formance of the work for which this permit is issued (Section 3097 - Civ. _ - - - ' -- —FLOOR SINKS - -FLOOR-DRAINS --• • SFIXTURESV•''- i•OUTLETS 1 SWITCHES Z I 22- dig .1 ,Lender's Name Lender's Address - _ - - • - DRINKING FOUNTAINS . -- - - GAS TUBE SIGNS . .-- • .__. ..- 'OWNER BUILDER-DECLARATION - - 'INTERCEPTORS- - CLARIFIERS 'POLE LIGHTS - I hereby affirm that I am exempt from the Contractor's License Law for - - - • i •the-following reason (Section 7031,5.Business and Profossions.Code:.. -SWIMMING-POOL----P-TRAP.. -- LUni I HUL I WIN - -- Any city or county which requires a permit to construct, alter, ---- - 4POL'ES- - - -=`METERED r--.:SUB- - - - - -- - 1 improve,demolish or repair any structure, priorto its-Issuance,also re- WATER SERVICE ALTERATION- -- PANELS • - MAIN SUB - - quires the apilicant for such permit to file a signed statement that he is-licensed pursuant to the provisions of the-Contractor's License Law. -GAS SERVICE --- OUTLETS - -- - SERVICE. - _ ._- gryip- (Chapter 9 (commencing with Section 7000) of Division 3 of the - I Business and Professions-Code) or that lie is exempt therefromandthe WATER HEATERS - BTU OUTPUT --- - __ -- . - • _- Basis for the alleged exemption. Any violation of Section 7031.5 by - ry applicant for a permit subjects--the-applirant.to a civil penalty SEWER CONNECTION$ ,- -- -- - ..P - -_- . _ ..,not more than five hundred dollars ($500). ' ' - ,�L'l-I', as owner of the propertypo it SOLAR TANK - - COLLECTOR$- - - _ --- - - .- -- . _ -.I and the structure is not intended or offered for sale:(Section 7044, Business.prR, and Professions Code:-The- -SOLAR'PIPING SYS. - - • -- • -- - ISSUE FEE. • / - `3 'Contractor's License Law does not apply to an owner of a property :APPLICATION.APPROV ED.BY • .DATE ,,Zp ' 2 who builds or Improves thereon, and who-does-such work himself or ISSUE FEE - - - .i..-&.i..-& Ai through his own employees, provided that such improvements are not intended or offered for sale:ii, however, the building or Improvement - MECHANICAL- PLAN CHECK -- SUMMARY OF'F EES -- �` is sold within one year of completion, the owner will have the burden of-proving he did-not build or improve for the purpose of sale). BUILDING- •T -_ - `'-'� ❑. I,_as.owner of the_property, am exclusively. contracting with HEATINGSVSTEM 0-100,000 BTU 'PERMIT $ s3�•s.STD SMIP• o $ ,fv -AND DUCTING • • licensed contractors to construct the project (Section 7044, Business 100,000+BTU I PLAN CHECK $ al.,3,. 1 PERMIT. I and.Professions,Code: The_Contractor's License Law does not apply to - _ _ ' ISSUANCE` '$ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ - tractsfrom such projects with a contractor(s) Iicesned pursuant ,to SYSTEM _ '' GRADING- $-.. the Contractor's License Law). , . - ' 100,000�+BTU - PLAN CHECK- $ -' - - 1 ❑ I am-exempt-under Section • - B.& P.C.for this. ELECTRICAL '$ 3,y X $ , •1 sBOILERS „ BTU - , reason, .MICROFILM $ SYSTEM REPAIR,ALTERATION --7 CHECK -$ -- Oate Owner .TOTAL FEE$ 7 .�j'0 I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE iM EC HANICAL-$ LESS AD-. t'. Information is correct. I'-agree to comply with all city and county 'PLAN CHECK $ - VANCE PC Si, ordinances and ate I.ws relating to construction,and hereby authorize ,_ representative •f tits it to •nter upon th• above mentioned ' property for ape, o. •A••sjf • - / Signature L • y� # � } /� - - - Date I • ®■ I FINAL FEE $ Drivers' ' - se or SS / 'TI _ - ISSUE FEE - 7I• 0 =MF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor - • CONSTRUCTION AND PLANNING POOL& SPA • Date Inspector Date Inspector APPROVALS Permit # APPROVALS Permit# _ 1. Temporary Electrical Service or Pole • 43. Pool & Equipment Location , ' 2. Soil Pipe-Undrgrn 44. Steel Reinforcement . . . 3: Electrical Conduit Utility-Undrgrn 45. Forms - 4. Electrical Conduit-Undrgrn _ . - 46. Electrical Bonding 5. Steel Reinforce _ - 47. Rough Plumbing & Pressure Test - ' 6. Electrical UFER Grn ' 48. APPROVAL TO COVER-GUNITE 7. Footings . . 49. Electrical Conduit-Undrgrn 8. Foundation .. 50. Gas Pipe, ❑ Undrgrn,Test 9. Water Pipe-Undrgrn _ _ 51. Backwash Lines. P-Trap. ❑ Undrgrn 10. Structural Floor System `` 52.' APPROVAL TO DECK 11. Property Sewer Line&.House•Connection - - 53. - $ackwash& Receptor-Final 12. Street Sewer Connection - 54. Heater & Vent-Final 13. Rough Plumbing 55 Plumbing System- Final 14. Rough Electric-Conduit - - •56. Electrical-Final • 15. Rough Electric-Wiring _c/0-82, (I; '57. Solar Systein-Final 16. Rough Heating & Air Conditioning - • 58. Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating • - 19. Gas Pipe-Rough &Test . - 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing - . - , 21. Roof Sheathing - - • - . 22. Frame and Flashing q,K .,}; 44. ,r�.� S £0 -2S-fi NOTES: 23. Insulation f • - - - - • 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat - 27. Electrical Power Meter-Final --,,,,II 28. Final Electric X0/331 ' eQ 29. Final Heating & Air Conditioning - I 30. Final Gas Pipe-Test - - 31. Final Plumbing • - -• - . 32. Water Service-Final 33. Gas Service-Final • ' 34. Solar Domestic-Final ' 35. Landscape Sprinkling System: :. 36. Sound Attenuation ' • • 37. Handicap Regulations - , 38. FI NAL STRUCTURE & BUILDING -- /// ��'�,',"��`'��,Q�,/�''�, �e'`''' ' 39. Special Requirements Completed . . • �" 1" 50 $� IQ6•tl use #4 40. Electric Release to Edison _ 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date - - - Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. WY OF COSTA MESO.. PERMIT NO TRACT NO. LOT NO. BLDG.NO. • - •, I/ j CONSTRUCTPoN PERMIT Se 12-Po &OD 99 Project Address 19� n � Z 3 St TYPE OF CONSTRUCTION Owner r0 N1 s'Lm4p Ell 0„,,,,.4, Phone 64 s-e J'b 0 NEW 0 ADD 0 ALTERATION Address C. 0 REPAIR 0 CONVERSION' ❑DEMOLISH >) ZONING REGULATIONS' Arch/Eng. N License No. 0 OTHER ' 4p ri --- \ _. Address ONG - ,J- DESCRIPTION OF WORK'�� s-�y� -�y�^ ONE V / '/(pI LNG • / l (../s l/U✓�/C_. LPE OF-!Lr M IT Co4i2, A'L/ Ee. /O eFPC6 ZONE —? PLNG. REF.4F `/%,'r`(J/s�J�,Y,s_/ Contractor Y Phdnee/S SOSa TVPE OF PERMIT BUILDIN W BUI / SETBACK C/L ST. OPE E Address 0 GRADING 0 FOUNDATION 0 STRUCTURAL • SIDE YARD LICENSED CONTRACTOR DECLARATION - LEFT5g, I hereby affirm that I am licensed under provisions of Charter 9(com- ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICAL RIIGHTARD mencing with section 7000) of Division 3 of the Business and 0 OTHER I • Professions Code, and my license is In full force and effect. REAR YARD(TO P/L , PROJECT DESCRIPTION Cf., License Class License No. PKC.SPACE REQ�1' �� -,RO 11 I. t •n Date Signature _ SQ. FT. 4�� Ii,70A, WORKERS'COMPENSATION DECLARATION OCCUPANCY CONSTRUCTION TYPE STREET WIDT PA* FEE $ I hereby affirm that I have a certificate of consent to self-Insure or a VALUATION tae° ZONE ZONING APPROVED BY Dm+be I DATE'O 0)51 certificate of Workers' Compensation Insurance, or a certified copy IJ 1 A)1�J V V GRADING CU.YDS. ACRES SPECIAL CONDITIONS: thereof(Section 3800, Lab.C.). ' alicy No. Company - - - - _ _ w l� _ • J Certified copy is hereby furnished. lir e a — A Y REMARKS I e, r n ❑ Certified copy is filed with the city Building Division. C q1 EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (,L(D. n, 1 ,.y,�if2 —/e , /i2A-tlte�ll (This section need not be completed if the permit Is for one hundred J - - ($100) or less). I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK • subject to the Workers'Compensation Laws of California. • UW ELLI rvm UMHMUE Date Signature BATHTUBS SHOWERS SO FT SO FT NOTICE: If after making this declaration, you should become subject TOILETS . URINALS GENERATOR 0.1 KW_. -1-10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE 10-50 KW 50+ KW ' revoked; - ' CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+ HP - formance of the work for which this permit is Issued (Section 3097 Civ. C.). Lender's Name Nn11FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS? SWITCHES/ 3 Sb 2 . Lender's.Address DRINKING FOUNTAINS GAS TUBE SIGNS , OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS d� �� 4Q I hereby affirm that I am exempt from the Contractor's License Law for - ir the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAPLONS I NUL I ION Any city or county which requires a permit to construct, alter, POLES METERED SUB improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB quires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS . SERVICE AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the •- nusiness and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT • Isis for the alleged exemption. Any violation of Section 7031.5 by y applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS ..f not more than five hundred dollars ($500). L • ❑ I, as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS sole compensation, will do the work,and the structure Is not Intended or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEEciti SC Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself or ISSUE FEE APPLICATION APPROVED BY DATE/O�S/8/ through his own employees, provided that such improvements are not - Intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES is sold within one year of completion, the owner will have the burden ofproving -he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDING ❑ I, as owner of the property, am exclusively contracting with PERMIT E �D•eo SMIP $ Os cc AND DUCTING ` licensed contractors to construct the project (Section 7044, Business 100,000 + BTU PLAN CHECK $ 4.Zr' PERMIT and Professions Code: The Contractor's License Law does not apply to - ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ • tracts from such projects with a contractor(s) licesned pursuant to ,SYSTEM - ' GRADING $ the Contractor's License Law). - - s 100,000 +BTU ' PLAN CHECK E ❑ I am exempt under Section - - B.&IP.C.,for,this BOILERS • BTU _ ELECTRICAL $ /G rra $ reason PLAN CHECK $ MICROFILM $ - SYSTEM REPAIR,ALTERATION Dale Owner - TOTAL FEE$ I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ Information is c recl I agree to comply with all city and county PLAN CHECK $ LESSANEAPC P Y VANCE PC $ ordinances and s to I relating to torsir and hereby authorize - representatives f d on the ter on abdv¢ /en ioned property for sp on (/�/' /� Signature ,� Date FINAL FEE $ -71579 ZJ • Drivers'License or SS 9+ /✓ ISSUE FEE ' CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor P CONSTRUCTION AND PLANNING POOL &SPA `S APPROVALS Permit# Date Inspector •APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole T 43. Pool & Equipment Location ' • 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn „ • • - ,- . .•46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing & Pressure Test - 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation 50. Gas Pipe, ❑ Undrgrn,Test 9. Water Pipe-Undrgrn 51. Backwash Lines.P-Trap. ❑Undrgrn 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53.- • Backwash & Receptor-Final • 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55. Plumbing System -Final 14. Rough Electric-Conduit .56. Electrical-Final 15. Rough Electric-Wiring - - 57. Solar System-Final 16. Rough Heating &Air Conditioning b6. Fencing &Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING • 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing • 21. Roof Sheathing 22. Frame and Flashing NOTES: 23. Insulation, 24. Lathing & Siding • 25. .Drywall Nailing. - 26. Plaster Brown Coat _ 27. Electrical Power Meter-Final I-28. Final Electric 10/ ` 2t( 29. Final Heating & Air Conditioning I 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final • 33. ' Gas Service-Final 34. Solar Domestic-Final 35. . Landscape Sprinkling System. .- 36. Sound Attenuation ' 37. Handicap Regulations / n • 38. FINAL STRUCTURE & BUILDING 7/// o b�.�.,-Y A �R.. 39. Special Requirements Completed !!! 0 3� (Yi88 0 B Q P-if- 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. • 42. CERTIFICATE OF OCCUPANCY • No Date i' 4 ✓ ,r -Fy ,r I ♦ ."f •' Sums.taro: 1 ;j 1. 1 . • % [ `.. . ... . .. .. Is l' - 1. - ail • r— — =. spy . - 1 1 , ...1 / • Y;4 ' - Il — . • u i '" ....... ..... . ,•, s h • I I .L. ,,.�,.. t. • -•;-- _ .-I. :1_-- r il'::::::L: 'N . 2 f _ _2.6LTi�M T.RES! [BTS9.S,?;� • ..{I I •.vii . ,:i :.• '/ 1. . 9 iR� • l,' w'..-. 1 St. '1 I� I ' 1 __ • 1 I . ' LLL--- f�j{� • V�r'ek, 'A11Y1 I 1 - Cai . . 1 `:I.• -Y. : I'.:74., •..• 7.dy: y;i __ i� II :.--1---„:- 7 L4! ..nal f Ii4Lu111 7 Ste. • : .� _ LL♦ _ yi ; 1 . .:_.. . _ .._,.._..• 1 - -.T-- !!aY'�. ate....-..—_ r.4—......i-74..7- 'c. F Dr 0T D. _a_ ..a -S_P._t_c --._-,—.__—_ ____..____. .--__ sivLP _A q ..,.♦. ZS2 _ r ,. -� : .... I••;�.;I-.-L n._, , .u,x:. SkncuM Y I ,cf ices.. . - pi - :- * 1 el • M. = ta._c,n. :.r...•.w. _ ..mom. — t CITY OF COSTA Ad • r_." __- wHTnft . CIwt/UR1-nF. "__ CENTRN.:C�IL..tCriL.RCl :.. _ A'3' { /]A ', - (dJ:M:'LI Nluw cm S . C ma+a . U.n,.urv(, DEPT. / SUBJECT TO BLDG. DEPT. REG' / %° I •.. -.. ..a i1P t�-r%.47v�. Lb ?.:.L.'.. . l •F EY biic _. DATE....10/6AV DIRECTOR OF PLANNIN zC —8I —/53//x'-Cf 2.E - 8i-is3 /i p-sr—oy 6 APPROVED City of Costa Mesa Building Dept. BY DATF iO/r IP. THESE PLANS MUST BE ON JOB AT ALL TIMES MAKE NO CHANGES WITHOUT PRIOR APPROVAL OF DEPT. THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE- SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SD FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL • THE ISSUANCE OF A PERMIT BASED UPON PLANS AND SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS IN SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN IN VIOLATION OF THIS CODE OR OF ANY OTHER ORDINANCE CF THE CITY. J J ` .4..--- ExtsT. -5r0o., s-r'vcco, Plti-scr ¢ :sr2ve_ruae N( (•,,,,. .... Exist LIOu5k , 0 lNSrALL (o - 4 ' 51NC& LE Tv(t,£ yt " = 1 - 011 LITH ' FIxTUIZES 5usrC.Nnf0 FRoMN CE IL. IN(r ---�. eEMDVE EKttt. C, k24L, E Doo. _ REPLACE- 3 Te IN5 LL DA IE.LINCt ON - k-nIH Zx4 L-> •1 �/ Ix SrRIh1iL ON AIL- iIhtreR:o :2 :-sl STvos k/t2E Vkl 5 I `1LATHE �. I 1 I x I cr✓cC-o, j ( NsrALL Cr NII 3 xc. A LvNI SASH WIN:>J-c t i di INrl\LL FALSE:). ALSE. cal-i{•t ( - CS 6 ' CLEA.2AN. c 4 c ,.�� Fant-4 Ex\ S1ThMc, PLS-irCIt FusE CEtL % M(s (. ‘3 ' C. AI) Bo)/ Bo . m E C' LEC , 2x C \.x/INDoW %-,.,,,, a VALLT [ �- l I __�I - H20' - 2 " >I 1 N STALL i DUPLEX IIDV CECrnrtcALES V.Itri4 20 RIGID coNDvIr GAtitisGE CDrlVE-2Siwrl Lr I9a c 2S sr2E.E'r Foca OFFIC_C # Srnc7 Acre U G. 1-1A25a12 FELIWV4SHiP MULE CIj.. Q r ea 44 • i STRUCTURAL APPROVAL ONLY n UE SEPARATE PERMITS ARE REQUIRED City of Costa Mesa Building Dept. FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING AND BYA_.._. _.. DATE /0,.r I,_$I REFRIGERATION WORK THESE PLANS MUST BE ON JOB AT ALL TIMES MAKE NO CHANGES WITHOUT PRIOR APPROVAL p� !Z� OF DEPT. Permit # O THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL THIS NUMBER MUST ACCOMPANY OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED ALL INSPECTION REQUESTS TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE• SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE FOR BUILDINGS 'r":HE,ZE PERSONS ARE TO PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO BE EMPLOYED, WE SUGGEST THAT THE FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL STATE OF CALIFORNIA DIVISION OF THE ISSUANCE OF A PERMIT BASED UPON PLANS AND INDUSTRIAL SAFETY BE CONSULTED FOR SPE IFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL ADDITIONAL REQUIREMENTS. _ FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS IN SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN IN VIOLATION OF THIS CODE OR OF ANY OTHER ORDINANCE 1 OF THE CITt . 'r . J"_ . C 3TA MESA BUILDING r-PARTMENTI 6� 3 I t�E ,;h.0��1.9 P. 0. BOX 317 • • COSTA MESA CALIFORNIA f C) - GL's • gs p&I Tax;;, SP FOR APPLICANT T C.L. OF STREET----- BUILDING jigr J �IE$A BUILDING ADDRES lf,�' II •'-�iPROP LINE � Owner (/JLi[Q( !(•t=1X// 61 -10 FT. FOR 60 FT. STREET(�r12 FT. 61 IF-. FSR ' 1 Mail Add ss �`CJ'Q of i? I 150 FT STREET !� City Ph. No.)/_i 2J r I i Contractor fr•i ,.� ) Ph. NoI . Address I �50 FiI I FRONT City Lic. No. State Lic. No. F PROP ~ "R?� d•5 150 FTS A w Size of Lot' T P No. // K— O S/ i H`— w . Setbacks: C/L Street star Rear UJ co z lJp J IL Side Yard - Right r— -Left �� . r a� 0 Type of Fence 4_Z*2t -4.10A (f' ALLEY OR PRC P, LINE\ a 0 0, a �:-'.- w -1 V I hereby acknowledge that I have read this application and state jaLL Z that the above is correct and agree to comply with all City Ord- 1 r inances and State Laws regul in buildingco truction. cop pi ?Jo" G3-i i ;� u� 9 4 U y \ �• + 0 cn j a `- Signature � ��C-�'+1�1 1 ((b' 10 of PermitteeCO ate• L ° FT Agent uI FOR OFFICE USE ONLY 37 6 IN. a r FT � ' rri z 40 w .24Z U n FT J 1 a N Permit No. CI: I ' m 623 3- 60 FT ST. Received byDate Received Date Issued I' I + 1--- I �Y`"� 6-- ,0-71)--s-:47 S d) S8 50 FT. ST. 1 F t _�iPROP•_LINE —� i— _ _ _ - - I , I VALUATION - \\- //// Permit Fee $ i 0 y I I $ / 0 3- Plan Check $ C.L. OF STREETS I aup + TOTAL FEE $ ''' ' MAXIMUM 4 FT FENCE MAY BE PLACED ON DOTTED LINES -- — --- MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS 41111• yrs 9 CITY OF COSTA MESA 66 BUILDING DIVISION •4 � DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER / PERMIT • V. ' 01-01899 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 190 23RD ST Status: ISSUED Suite: Applied: 12/03/2001 Vicinity: LOBBY AREA ONLY Issued: 12/03/2001 Parcel Number: 43926131 Zoning: Applicant: PATOCKA, NICOLE ISSUED BY: Address: 1653 SUPERIOR AVE • Phone: (949)642-7222 COSTA MESA, CA '' • Zip: 92627 Owner: CHURCH, CENTRAL BIBLE OF Address COSTA MESA COSTA MESA,CA Phone: 190 E 23RD ST Zip: 92627 Contractor LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 • License: ' 349686 , Arch : Eng: Address: _ Address: ' Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF LOBBY AREA OF EXISTING BUILDING FOR"CALVARY CHURCH OF NEWPORT MESA"(14 50).TEAR OFF EXISTING ROOFING&INSTALL NEW BUILT-UP,4-PLY WITH ROCK ROOF. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,500.00 Permit: $111.25 Claim Valuation: $4,500.00 SMIP Res: $0.50 • SMIP Com: $0.00 • Other: $0.00 Inspection: $0.00 Total: $11115 - 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 Existing: 0 Required: 0 Proposed: 0 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 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 Inspections 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)754-5626 2448-48(8/00) eECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the //work for which this permit is issued. cil have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensati n Insurance carder and policy number are: �/7 (� ,Q Carrier- �-4[.L t-e._ Policy Number: �^ll (� (This section need not be completed if the perm/t is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. ''�rO Applicant Signature: . - li^-rte Date: 2 v 3-0 ( WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensA mdp,.provisions of Chapter 9(commencing with Section 7000)of Division 3 of-the.Business_and P pssions Code,and my license Is in full force and effect.Lic.N - ^C['93(Q Class k C Contractors Signature: 'b/ ��t /� � Date: / CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5.Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic Leet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present er future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant requile for the work which is the subject of this application aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (if yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No pollution control ............................. B (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /-17\ V vl Sl.nature Of Legal Owner( / Z — Uy v�te An.Or Authorized Applicant Date -- CODE P INSPECTION TYPE PAIS PIUTALS CODEC 1NSPECTIONTYPE PSIE USTmeu 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final t / 208 Final Plumbing -. 200 Final Re-Roof `/l2/---fo( &C4 -- 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy C9' PRG7FLfADDRESS: 190 23RD ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT t•tnro Nu; t uo iii 3 OWNER'S NAME:CHURCH, CENTRAL BIBLE OF ADDRESs: COSTA MESA PERMIT NO; E 063113 PLAN CHECK NO: N &uva ; £4 Suri ; N 190 E 23RD ST COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE; ELE PURPOSE: OTH 845-5050 ARCHIENGINEER:LANGSTROM 6 ASSOC REG.No.:C29373 JOB DESCRIPTION : EXTEND RECEPTION AREA 430SF, 528SF PATIO SQ FT: ADDRESS: 1800 E 17TH ST UNIT:101 S.A. CA 92627 CLAIM VALUE: CALC-VALUE; GROUP OCC; A-3 / PERmITTEE:DENMARK CONSTRUCTION ( 714 ) 777-4450 • ADDRESS: 20005 CLEAR RIVER LANE COMMENTS ; UPGRADE H,C. BATHROOMS OFFICE REMODEL / RE: B63111 YORBA LINDA CA 92686 ************************ +tar***ifX k** ************ustx***ELTt****T¢#*******#**s¢****TF* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed neer provisions of Chap er 9(commencing with Section ZONING REQUIREMENTS 7000)0l Division 3 of the Business and Professions Code,and my license ,in lull force and fle I SETH ACKS CITY LIC.: STATE LIC.517208 ss:B • Date:— Signature' _ MAIN BUILDING ACCESSORY BUILDING �'� FRNT: FT IN REAR; FT IN FRNT; FT ZN REAR; FT IN WORKERS'C MPERSATIONDECLARATION: Ihereby affirm that lhay acertificate olcense ttoself-InsureoraunificateofWorkers' LEFT; FT IN RGHT; FT IN ' LEFT; FT IN RGHT; FT IN Compensationjnwrance..yr�gibed copy thereof(Section 3800.L df /0 1 /9 4 POLICY NO.: 1 EXP.DATE: COMPANY: STATE FUND PARKING REQ; PROV: PARCEL: 43926131 ZNE: REF NO: r3 Certified�opy is herpy wmishedPLANNING N TES> �s rl q-F Certified copy is tiled '•'the city BUBding I '.0 I > 1 / W IJ Applicant C�� �� ****Ft****************************-N,'1C********it*************it*********ar***at******* - Date.• DEVELOPMENT ST,.-R V I C E S R E Q U I R E M E N T S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This seth n need not be comp et••it the permit is for one hundred(5100)or less). I Certify that in the performance of the work for which this permit is i ed,I Shall not employ any person in any manner so as to become /� subject to the Workers'Compensation Laws of Calitomie. ZONING APPROVED BY i- DATE Date: Signature' BUILDING APPROVED BY : DATE: NOTICE:II,alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor - Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the pertormance of the work for APPLICATION ISSUED BY': L_CCi; i DATE: 74-4: 1,3 which this permit is issued(Section 3097.Civ.C). ************************* ********,******* -*mit* - ** ***************4e-r****Sc**** LENDER: ********************************,ata **.******************************************* ADDRESS: LEGALIZATION:N . ! ; F E E i S . U M M A BY , STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT .PLUMBING ELECTRIC !MECHANIC 'FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT . 15. 00 repair any structure.pro to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5 1)% - SNIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 m the Business p LAN and Protessions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15,00 • BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 15 . 00 ' 15 . 00 ' 0 . 00 30 . 00 30 . 00 . 00 ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through • his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED; 30, 00 OVER/SHORT; 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SNIP/TOT GRADING PLAN-CHECK I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business • 30. 00 ❑ and ho contracts otsdfo The projectso 'statcoicenceLawdoes sutoo o the owner of ns improvesLa ) lathereonr ********************************************%**_W*************_**.('***_************ and who ssionsCo e: such ntra ts with a eLice serLawidoesenotpursuant apply an Contractors'eState License Law(.j m aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner ELE 4 FIXTURES LIGHTING 1ST 20 EA; . 75 3 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and EL E 8 R EC E P T/OUTLET 1 ST 20 EA. . 75 6 , 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 8 R EC E P T/SWITCH 1 ST 20 EA. . 75 6 . 00 permit for construction or modification Iron the Air Duality Management District.Residential construction applications are exempt from these provisions. END OF FEES Date: Applicant: • I hereby certrly that I have read this application and state that the above information is carrec I agree to comply with all city and county ordinances and state laws relating to building construction and hereby aut lie representatives this rater upon the above-mentioned property'Mr ins os ction puoses. c Date: ! �'a J 1 Signatures `k—...— Driver's License or Social Security a: 01 00143175-00143175 TOT 30.00 DATE: 07/20/93 1111E: 09:44 1641.46 White—Building:Green-Code Enforcement:Canary-Applicant:Pink—Revenue:Goldenrod—Assessor ' CONSTRUCTION AND PLANNING POOL .PA 1 APPROVALS Permit n Date Inspector APPROVALS Permit Date inspector ; 1,. Temporary Electrcal Service-or Pole 52. Pool & Equipment Location 2. Soil Pie-Undrgrnd. 53. Steel Reinforcement 1 3. Electrics' Conclu:t Ut.r ty.Ui drgrnd. M. Form; I 1__ - -_ 4. Electrical Condo t•U'dr•- .d 55. Electrical Bol ding � _--- ---- - I 5. Steel Reintorcam.n� .. - i 56. Rough Plumbing & Prcci are T ,, -- -J, -_--- 6 Electrical UF ER Gird 57. APPROVAL i 0 COVEH GI •••11: i 7. Footings i I ! 38. E'ectncal Cordur•Und.-rr: - - -- - --- - B. Foundation ! 59. Gni P,pe, __] Uru;r- -,1 . Tc'.• t 9. Vteater Pipe•Unorgrro. M. is:-cicyd.ah Law:, F•Trdf._ _ _ ____ _ - i 10. Structural Floor Syste.ri ! 1 61. APPROVAL TO DECK i 11. Property Sewer Line d, Hou:r Connection ' 62. B-rk.vcsh & Reccpt• een ' 12. Sewer Cap _____I - 63. H.eter & Vent.F, ..---- - 1 - - - I I -- _- --(_- ___ 13. 13. Root Dia r 04. alumo:ng System F • - 14. Rouse Piumb,ng 65. Electrical Final 15 Rough Electrical-Conourt I 66, Solar Systam-Huai ! h Electric Wring ! -� 16. Rough 67 Fe & Accas Anp•a.a' - 17. Rough!.:4 1"g Sign 68. APPROVED FOR ? STER1-,G . ---- ' - 18. Rough Electrical-T Bar Ce ire 69. POOL/SPASYSTE:"S FINAL - _ - 19. Rough Heating & Air Cordit caning I i FIRE DEPT. REQUIRE'.'E: 1' • I 20. Rough Factory F!rep'ace I ' APPROVALS Perm-• -__ -__ - -1- 21. D,.cr, .n Structure ---- I I --- - ------ --- --- -- - 1 Untle:groi,rc' Hyt.,e - 22. Curt:, Vent :at"; 1 71 Product " ping ' ,G,,' r 23 Ga: Papa-Rouge L Tc: ---- 72. Undrgrcund Fon^• -- - --- - - - - ---- -- - -- -- - - --1- --- - - - ----- - -- -- - - - - - 24 Roo' Fra ,.e ' ; 73. L'rdu•rrrl 5.. . - • __ 26. ;o::; $�..,.at, n4 `h4r . C'.' 'nuo i4vc; 26. T6.ir Cc.,i , 'S: __._ _ c -'o ou+t �I IE. Cry Chcr�,.ca. 77. Fame and nF lasnena - - ----- l - --- ---- - ----- - - -- --- - -- - - T' 76. Dry Star:Ir.c ' 23. .l,t^:+? & 5d- - --- __----j- --' __ I 77. .:ErJ S\'S-c. _ _ I____. _ _ f _ E 29. nsu!atpn - 4- - 4� _ 7E Fir_ P,ry' I 20. Dryv.aiNa.'ro I 1 1-.SO.LTH DEPT. REUUIRLi , i • 31. Past-r Bro:. . C- . y.- ' i� _j- ' 79. F!'�.. I` ''' -'-'1 .0% r - - - --' ///pv�'//-t/' I-- -IN- 33_F E c c- - - -II1017l-Il-VI' 0 8- 3_ �1,�rC11:. �O-# a 33. Fr�ricatrgr<• nrCo-- -- 1 - t - -- -- -- - - - - - 0- - -eux- - 35. F rzI Gas P,ae-Tett I !T t 37. F,ncl Factory F -et..c_ I -- ' 38. Finai Plumb-cg 39. Water Service-Fine' i 40. Gas Serves-F re: I - - -- -- - 41. Soar Dcmcs:'c F - ! 42. 3accfloe: Precantu - - - - 43. Backflow Ir. Paton ----_--- - -- -_- -- - - 44. Landsc-pe 'rr.S3t r c _ . it -_- -- --- --- --- - - 1 C. Sound Att_Hutt _-- I - - - - --- --- ---- -- - -- - - -I - J- 46. Handi^ cap cqu Ears 47. FINAL ST',UCTL:RE & F.:',•_D'ING ! ' l --- ---' -- ------ - - - _._ _ 40.48. EINAL PLAN7v11•:1:3 -1 E'.rctric RL'eu51 t: n,. I -- - __ - -- --- - 5C. Gas Release to Southern Cntorrua Gas Co 51. CERTIFICATE OF OCCUPANCY (No. Date I I 1 PROJECT ADDRESS: 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 063114 OWNER'S NAME: CHURCH, CENTRAL BIBLE OF ADDRESS: COSTA MESA PERMIT NO: M 063114 PLAN CHECK NO: N GOVT; N SUPP: N 190 E 23RD ST — ' ' ' 0,0.4 COSTA MESA, CA 92627 CONSTRUCTION TYPE; PERMIT TYPE: MEC PURPOSE: OTH 845-5050 ARCH/ENGINEER: LANGSTROM & ASSOC REG.NO.:C29373 JOB DESCRIPTION : EXTEND RECEPTION AREA 430SF, 528SF PATIO SQ FT: AOORESS; 1800 E 17TH ST UNIT: 101 S.A. CA 92627 CLAIM VALUE; CALC—VALUE: GROUP OCC: A-3 / PERmITTEE:DENMARK CONSTRUCTION ( 714 )777-4450 ADDRESs: 20005 CLEAR RIVER LANE COMMENTS; UPGRADE H.C. BATHROOMS OFFICE REMODEL / RE: B63111 YORBA LINDA CA 92686 ###############iE###### # #######k*#>E#BENE####HE##*##*###########**>Ext*HEHL########### LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am lice ed under provisions o Chapter 9(commencing with Section Z 0 N I N G REQUIR EMENTS 7000)of Division 3 of the Business and Professions Code, and my li a is in lull force and feet. , SETBACKS CITY LIC.: STATE LIC.:6 1 7208 CLASS:B Date:� u� /93 Signature: J IMAIN BUILDING ACCESSORY BUILDING WORKERS'CCOMPENSATION DECLARATION: I hereby affirm that I ave a certificate of manse- to self-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN Compensation Jnsgragc yr1yrtified copy thereof(Section 38 ,Lab._C4 /01 /94 LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN POLICY NO.:11 LL // L``JJ COMPANY:STATE FUNDPARKING REQ' PROV: PARCEL: 43926131 ZNE: REF NO: - --❑ Cethy, EXP.GATE: 0 ed c y is her by furnished. G Certified copy is filed th a city Building - sion. / PLANNING NOTES> G <y�. jv > -Da V 9, Applicant: 7- lEik##iFik#dE###iEiE#####1f#####iF####iE######1F'###iE######lE##3EiE##########RE1E-###iERE####i(-###%# EXEMPTION M WORKERS'COMPENSATION DECLARATION: (This'secli need not be complete if the permit is for one hundred($100)of less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is iss ed,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY .• DATE: • Date: signature: BUILDING APPROVED BY : DATE: • NOTICE:It.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or Ihis permit shall be deemed revoked. /��. QQ ��f/f CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• Ll_- r U :5 1/ DATE; 7/Zb �7± which this permit is issued(Section 3097.Civ.C). ###)E#############****4*#- ******##### ##### ##f####iEiE##RE****#-%##### ,f##friiiFFF is'** LENDER: ###################################### •################################JE####### ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N ' OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC 'MECHANIC FIRE SMI P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 9 . 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5 t SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN — and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15. 00 I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered forsale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 9 , 00 15 , 00 0', 00 24 , 00 24 , 00 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 24 . 00 OVER/SHORT: 00 improvement is sold within one year of tompletmn,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 2 4 0 ❑ and Professions Code: The projects with License Law does not to erofpropertyate Liens Law).ola aware #########lfitiFiE-)E##1Ei(#####lffE****#k#itit#!E##iE****if�k#####!Ei(-###*##*###***t ** 3E***##**** and who contracts for such projects with a e License license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should he provided to me. INDIVIDUAL ;F .E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N ' 1 UNIT COST TOTAL COST Date: Owner: I MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00 I do hereby certify that I am aware of and understand the requirements of California.Health and Safety Code Sections 25505,25533,and END -OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a , • permit lar construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. 1 • . • Dale: Applicant: I hereby certify that I have read this application and state that the above information is correct.I ogre:to comply with all city and county , , ordinances and state laws relating to building construction and hereby au irize representative fthi i to enter upon the above-mentioned properly for insIectlon our ses �M1— �� r— Date: lZ-or� Signature: 1) - f' Driver's License orSocial Security a: / .v 01 00143174-00143174 TOOT 24.00 DATE' 07/20/9.3 TIME: 09:44 2 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor / CONSTRUCTION AND PLANNING POOL .PA ! APPROVALS Permit# Date Inspector APPROVALS Permits Date Inspector 1 i 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location I 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement el , I+II 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electr'cai Conduit-Undrgrnd. 55. Electrical Bonding 5. Stee' Reinforcement 56. Rough Plumbing & Pressure Test i 6. L,ectr.c'i UFER Grnd. 57. APPROVAI.TO COVF.R•GUNITE 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation I 59. Gas Pipe, O'Undrgrnd.,Test I I 9. Water Pipe-Undrgrnd. . _ i 60. Backwash Lines, P-Trap, Li' Undrgrnd, { 10. St'ectura! Floor System 61. APPROVAL TO DECK 11. P-operiy Sewer Line & House Connection 62. Backwash & Recep•ur-Final 12. Sewer Cap 63. Heater & Vent-Final .. I13. Root Drains 64, Plumbing System Final 4. Rough Plumbing 65. Electrical-Final i 15 Rough Electrical-Conduit 66. Solar System•F mal 16. Rough Electric Wiring 67. Fencing & Access Approval I 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL v_ 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 2C Ro...in Factory Fireplace APPROVALS Permit 21 Ducts, in Structure ?0. Underground Hydro I 22. Ducts, Ventilating 71. Product Piping 1:Gas_'Oil 23. Gas Pipe-Rough & Test 72. Underground Flush I 24. Roof Framing J 73. Undergrnd.Storagi. Tank 7 Gas ❑Oil Mi I 25. RoLt Sheathing 74. Overhead Hydrn 2E T_Ear Ceiling (Structural) & ulonocoat 75. Dry Chemical 2/. Fame and Flashing 76. Dry Standpipe } 28. Lathing & Siding i I 77. FIXED SYSTEM FINAL 29. Insulat!on - 78. FIRE PREV. FINAL I 30. Drywall Nailing HEALTH DEPT. REQUIREMENT I ------ -' - L i 31. Piaster Brown Coat I 79. FINAL INSPECTION I 32. Electriea1 Povver Meter F•nal 83. FOOD CERTiF'CATE ISSUED I 33. Final Electric ���ii Notes: 1 34. Final Heating & Air Conditioning .9ZZ 2 -24 1 * 35. Finai Gas Pipe-Test t i 33. Hood or Canopy 37. F:r•al Factory Fireplace i - - - - 38. Final Plumbing i 39. Water Service-Final i .I- -- ----- --- 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer -_-----� -- 11 43. Backflow Irrigation J 44. Landscape irrigation System • 1 45, Sound Attenuation 1 46. Handicap Regulations -1 1 47. FINAL STRUCTURE 8i BUILDING i - 48 FINAL PLANNING { 49. Electric Release to Edison I 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' PROJECT ADDRESS: 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PLAIN NO: P voin a OWNER'S NAME: CHURCH, CENTRAL BIBLE OF ADDRESS: COSTA MESA _ 4 • 'n� J, PERMIT NO: P 063115 PLAN CHECK NO: N uuvi : J* burr ; N 190 E 23RD ST 1CJA41 COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH -',4 845-5050 ilis ARCN/ENGINEER:LANGSTROM & ASSOC REG.NO.:C29373 JOB DESCRIPTION ; EXTEND RECEPTION AREA 430SF, 528SF PATIO SQ FT; ADDRESS: 1800 E 17TH ST UNIT: 101 S .A. CA 92627 CLAIM VALUE; CALL—VALUE: GROUP OCC: A-3 / PERMITTEE:DENMARK CONSTRUCTION (714 ) 777-4450 AOss: CLEAR RIVER LANE *M**** **** .DEHCB**H* ** O** CERE*ODE* BN YORBA LINDA CA 92686 ** e ** *** K*6fEi * ** 1 * ** ** *##**** ***##****************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of apter 9(commencing with Section Z ONING REQUIREMENTS 70001ITY0l Division 3 of the Business andEIC.:6 17208 7 Code,and my fie s`jjj^^^a is in full force And y11 SETH ACK S CITY LIC.: STATE LI0.b 17 ur 0 B CLASS:B lMIIj_'_•—' L MAIN BUILDING ACCESSORY BUILDING Date: rLV q3 Signature: FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN WORKERS'CMPENSATI N DECLARATION: I hereby alfirm that I ave a certificate of co sent to Insure or a certificate Ot Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN CompensationlIw nrare'ryr�grtified copy thereof(Section 38 (Arc), /0 1 /94 94 POIICY NO.: LL E%P.OATE: V 1 COMPANY:STATE FUND PARKING REQ: PROV; PARCEL: 43926131 ZNE: REF NO: 0 teamed c y is he by furnished. Certified copy is hied the city Buildmg W an PLANNING N TES> �2 *****x*****************************fE********** ******:***!f****#*,E****iE********IE* Date: G� Appliwm: ex---- D E V E L O P M E N T SER VICES ' REQUIR EMENTS EXEMPTION PR M WORKERS'COMPENSATION DECLARATION: (TMs sec on need not be completed the permit is for one hundred($100)or less). I cemly that in the performance of the work for which this permit is i ued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY. DATE; Date: Signature: BUILDING APPROVED BY : DATE: NOTICE:Il.alter making This declaration,you should become subject to the Workers'Compensation provisions of the Labor /Gf Code,you must DINGwAGcomply Iwith esuch provisions thic herma cnsrutinending agency to. APPLZCATION ISSUED BY: �c ./�' � -2/„„ St ? CONSTRUCTION LENDING AGENCY: I hereby alfirm that there is a construction lending agency for the performance of the work for' TE* DATE which this permit is issued(Section 3097.Civ.C). *'******* e******************* ***#****- * *##**' ****#*****#******x ****# x** LENDER: /z *************************************************#**i(*********3E********IfA***)c*** ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;N OWNER BUILDER DECLARATION: thereby affirm that I am exempt from the Contractors'state License Law for the following reason BLDG PMT PLUMBING ELECTRIC , MECHANIC FIRE SMI P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 5 6 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5% SMI P/NON—RES pursuant to the provisions of the Contractors'Slate License Law(Chattier 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 20. 00 } any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN-CI1gCK TOTAL PAID . DUE I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 56 . 00 20 . 00 0 . 00 76, 00 76 , 00 • 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves(hereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 76. 00 OVER/SHORT: 00 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 76 , 00 • I.as owner of the property.am exclusively contracting with licensed contractors la construct the project(Section 7044,Business ' ❑ and Professions Code: The Contractors'State License Law dries not apply to an owner of property who builds or improves thereon ***,***.******,***,*****,***************************,***************#*******1f******** and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F 't E BR E AK DOWN ❑ I am exempt under Section: B.8 P.C, i for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Dale. Owner: PLU 4 WATER CLOSET (TOILET) ' .'_4' 7 . 00 28 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and PLU 2 DRINKING FOUNTAINS 1 l 7 . 00 14 , U0 •25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a PLU 2 URINALS, WALL 7. 00 14 . 00 permit for construction or modification from the Air(Malay Management District.Residential construction applications are exempt from END OF 'FEES these provisions. Date: Applicant: I hereby certify that I have read this application and stale that the abr e information is corre 1.I agr e )comply with all city and county ordinances and state laws relating to building construction and hereby thorize representative, t this y 3 enter upon the above'mentioned property for insppgion poses. Date' ' 19-S Signature' �] e— 01 00143176-00143176 1—CYT 76.00 Driver's License or Social Security DATE: 07/20/93 TD1E: 09:45 1641.46 white—Building:Green—Code Entorcemem:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor A CONSTRUCTIONaANDPLANNING POOL 'PA APPROVALS Permit ;? Date I Inspector APPROVALS Permit'x Date Inspr for _4 1. Temporary Electrical Service or Pole 52. Pool & Equipment Locat on 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3 Electric' Co^.nu t Ut! ,tv•U^drarrc. 54. Form; 4. Electrical Conduit-Und•g'nd. 55. Electrical Bonding 5. Stee': Reinforcement 56. Rocgh Plumbing& Pressure Tes! i- - - - 6. Electrical UFFR Gerd 57. APPROVP L TO COVEP-G'.''"i-E • 7. Footings 58. Electrical Condu`t•Undrg'nu. I 8-Foundation 59. Gas Pipe, Li Ucci gird , Tcst 9..Water Pipe•Undrgrnd, 60. Backwash Lines, P-Trap, Li Undrgrnd. L - 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ___f 12- Se ver Cap 1 __i _---_-� ---; 63. Heater & Vent-Fin:. - 13. Root Dia 's � 31. Plumbing System • Final • td. m Rough o�ut.no 749/ff-} XI'/9'/-- 35. E!e:trical-Final .-- 15 Rough Eicttnra -Co rid,r, T -1 66. Solar System-Final 16. Rough E,ectr'c Wiring 67. Fencing & Access Approval 17. Roughs'.•ing Sign 68. APPROVED FOR PLASTERING 1 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTE_,1S FINAL f 19. Rough Heating & A.r Cor_ditening FIRE DEPT. REGUIREviEnIT 20. Rough Factory Fireplace APPROVALS Permit s7._- __- 21, Ducts, in Structure _ - 70. Underground Hydro i 22. Ducts, Ventilating 71. Product ? ping .73 Gus a i I - - __ -1-- 23. -- 23. Gas Pipe-Rough & Test i /2. Underground Flush - t_-_ _ _.. _._ _-_ __ - 1. - __ -- 24 Roof F•aMine 1 73. Urdergrnd.E'j t Tar'. _ Cii.i ., 25. Roof Sheathunq , 74. Ove•ncad ti rirn 26. T-Bar Ceiling 1St urc... : s 'o_ocoat i1 _-_ 1 1d. Dry Cher,'c..--_- ---- - 27. Fame end Fleshing ! I 75. Dr' Starup.n^ I 28. Lathing & S'd:ngi 77. FIXED SYSTE 21 FINAL 29. Insulation ± i 1 /E. FIRE PREY. FIFA_ 1 - 30. Drywall Nailing I HEALTH DEPT. REQUII;Fr;,"!r i- - - 31. P•astcr Brown Coat _-- 70. FINAL I?:SPECTIC-CJ _ i ---f l -+- -+- F 32. Electrical Power Meter Final I 180. FOOD CERTIFICATE ISSI IED I - -+ --- 1 - - ----- -- -� -- -1---- - - - 33. Final Electric Notes: 34 F rel Heating 8 A.r 'T -- --- _-- - - -- - _ - - .a 35. Final G.,s Pipc•T^st ' I _!-t• _T7-22-7‘4,- - i_. VeT 33. H_od ca. Cir py -- --� - - . - ---- - - - - -- - __ -- 37- Final Factory Fireplace i 38. Final Plumbing !_u r7 --- -- - -- - -- -- -- 1- 39. Water Service-FM-is! 40. Gas Seraies Fina I ; . --- - ---- - --- - - - -- 41. Solar Domestic-Final i 42. Backflow Preventer - 43. Backflow Irrigation -- --- - - - - - ---_ i44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations -f-i-. 47. FINAL STRUCTURE & BUILDING -- - - - - -- .• 48. FINAL PLANNING 43. Electric Release to Edison i 5C. Gts Release to Southern Catifo-nia Gas Co 51. CERTIFICATE OF OCCUPANCY - INc.- -! ate Ia I i PROJECT ADDRESS: 190 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; IE 069069 OWNER'S NAME: CHURCH, CENTRAL BIBLE OF ADDRESS: COSTA MESA PERMIT NO: IE 069069 PLAN CHECK NO: N GOVT; N SUPP ; Y 190 E 23RD ST COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE OTH PURPOSE: OTH 845-5050 ARCHIENGINEER: LANGSTROM & ASSOC REG.NO.: C29373 JOB DESCRIPTION : REINSTATE E-63113 SQ FT; ADDRESS: 1800 E 17TH ST UNIT: 101 S .A. CA 92627 CLAIM VALUE: CALC—VALUE: GROUP OCC; A-3 / PERMITTEE: DENMARK CONSTRUCTION ( 714 ) 777-4450 ADDRESS: 20005 CLEAR RIVER LANE COMMENTS: UPGRADE H.C . BATHROOMS, OFFICE REMODEL / RE: B63111 YORBA LINDA CA 976. 6 ******************u+ear+r****TFaE+r**ar****aEyE+t**********ar+r****Tear**Te****,E*Tr#**aEic-+r****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am tic ,.under or. .f C pt (commenting with Section Z O N I N GS SETBACKS EQUI RE M E N T S 7000)of Division 3 of the usiness and Professions Code.and my A : is in lull force : : eft C L : S ATE LIC.: 617208 • -ss: B Date 1 Signature:_ 1..---' s , MAIN BUILDING ACCESSORY BUILDING ,RKERS'CO PENSAT NDEC RATION: Ihereby Arm Y ay..certificate ofconse osetf-ine or acenilicate of Workers' FRNT; FT IN REAR; FT IN FRNT : FT IN REAR; FT IN Compensation ls Ap riedcopytnereof(Section3B00.t :. LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT ; FT IN 3"1"r`9°'I'1c� L�'1 /o /9' POLICY NO.: EXP.0 COMPANY: STATE FUN ' PARKING REQ PROV: PARCEL; 43926131 INE: REF NO: ❑ Certified co y is here:, furnis ed. Q Certified copy d with the cit r•, a ": _ PLANNING NOTES> �F. Applicant ��� PTION Ffl I M WORKEi6'COMPE SATION DECLARATION • : sedan need not be •mpteted i1 me permit is for one hundred(5100)or less). DEVELOPMENT SERVICES REQUIREMENTS petrify that in the performance of I work for which this per is issued,I shall trot employ any Denson in any manner 50 as Io become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY • DATE: Date. Signature: BUILDING APPROVED BY NOTICE:II.after making this declaration,you should become subject to the Workers ;Compensation provisions o1 the Labor DATE: Code.you must forthwith comply with such provisions or this permit shall De deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the performance of the work for AP PL ICAT ION ISSUED BY; DATE; O C`L�= which this permit is issued(Section 3097.Civ.C). 'N•**'*' **'**'3Ht***'********************** 'W5af �e**********************************a***R' Vx it_ **** ***** * ** f"�I;FaF ; \ LENDER: ******************************** **** ** ADDRESS: 1+(..�J/1 L.L u/�1 L<l�i t\( • esti tf ll N F E E SUMMARY STRUCTURAL SEGMENT;N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELEj R6& MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter.improve,demolish,or PERMIT u repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed S(-.)% SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of OMsion 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, wit do the work. and the TOTALS 30 . 00 0 , 0 . 00 30 . 02....// 00 30 . 00 . 00 ❑ structure is not intended or offered fpr sate(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himselUlersell or through his of her own employees.provided that such improvements are not intended or offered for sale.It,however the building or REVENUE DIVISION TOTALS--> COLLECTED; 30 , 00 OVER/SHORT; 00 improvements of sate). sold withn one year of completion,the owner win have the burden of proving he/she did not build or improve for the pumpo5eBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with acontractors)license pursuant to the Contractors'State License Law).I am aware ****'*******************'******************************************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.5 P.C. forthisreason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: ELE 1 ELECTRICAL RE—INSPECTION FEE 30 . 00 30 . 00 I do hereby cenily that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES 25534 and that I or any future building occupant willwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification Iron the Air Duality Management District.Residential construction applications are exempt from / these provisions. Date: Applicant: I hereby certify that I have read this application and state that the e information is corn I a e I comply with all city and county •` TnT ordinances ands le lawsr acing to building construction and here thorize represent -tn ctyt enter upon the above-mentioned DA E: 24-00168724 14:27 30.00 property for inst coon pu ses. DATE: 09/30/94 TIME: 14:27 - ate1D�4 Signature: 1{.:-.--.----- / +en's Licen ee or Social Security e: 164146 Mute—Building:Green—Code Enforcement Can y—Applicant:Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6 Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric in/fig, ad Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe•Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final - 40. Gas Service-Final 41. Solar Domestic-Final 42. Backf low Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS a WINNE 190 23RD ST LINT: 3 CITY OF COSTA MESA - BUILDING PERMIT ONNERS NAME IF I 'CON: CALVARY CHURCH NEWPORT/ME PERM NO: F 085682 m • 190 23RD ST PERMIT NO: F 085682 PLAN CHECK NO: 03199-97 L GOVT: N SUPP: N COSTA MESA, CA 92627 714-2501988 APPL.MIJLIIO ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: FIR PURPOSE: ALT ARCHITECT OR MOWER: MC NO.: JOB DESCRIPTION : ADD FIRE ALARM TO BUILDING SQ FT : ARCH.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: 250 . 00 CALC-VALUE: GROUP OCC: iy / c0NmACToxSNAlo: SERVICE FIRST ( 714 ) 631-3164 CONTRACTowsuM dO 336 CHERRY TREE LN COMMENTS : SMOKE DETECTORS INSTALLED IN EACH ROOM se 0 » 5•" www****biiieseiiiriiiiiei4iiiiiieiiiiiiiiifiiiiiiiririFifirii•ieieitieiiiiwifiewvilesFiiiFiiiiii•iriiiiariisiiriFwia•ieiexiesti4iiii-itiiieii rFiiiiiiiiii ADDREsx NEWPORT BEACH CA Limo,Limo, 81 92660 MT: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby Nim under penely of pied that I am Nand under provisions d Chapter 9 SETBACKS (commence with Section 7000)of Oinks,3 d the Business and Probative Code,and my loess b In hal bhp and alba. CITvuc.No.: 047646 uC.Cuss: C-20 uC.NO.: 556812 EXP: 05/98 MAIN BUILDING ACCESSORY BUILDING Date: if, 7- 9 7 cadredn ike------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN KGB': FT IN LEFT: FT IN RGHT : FT IN OWNER BUILDER DECLARATION:I hereby affirm under lonely d perjd then am eumpl horn the Coreedoa Linn•Lew for the ldlowrp noon 703t3 Busies* Prolusions Any thy orcasyOath require, Peen b tarns,Ne,irraeve, PARKING REQ: PROV: PARCEL: 43926131 ZNE: REF NO: latmsaj twines the anion (such peen commencing heciotied 3o she PLANNING N V T ES> iceesedpedant to he prothe Catadors Lew(Chapter witSwn litm)DiSiion the dusben end Profession Code)a the he of she is exempt therefrom and the bait la the aided eaerdar.My Notation d Soak" ) 7031.5 by any eppkum ba a peal tubed the epdred to ardvd penalty of rel more then Tore handed dollen 1S500D. AAAA.... ..•............................................................ _ .... ....... ..... ..... AAAA ........... xxxx bib xxxxxxxxx xxxxxxxx xxxx xxxxxxxxxx xxxxitxxia de ivxxx xvi ii ii ie ii xiexxxxxir dixie if ii ie ie ie ii iv ie ie ii ii ❑ I,as owner d the prawn or rnY endless wth wawa as gin de oompermation.d do the work.end the sedum e no intended DEVELOPMENT SERVICES R E or offered br sale(Section 7044.Edens ed Pdleasbss Canons Camon Lienee Law does not appy to an owner of popery Q 1.1 I R E M E N 'I S who builds or improves thrad and atm does such work Flnsel or heath a through his or her own enebyees,Provided the such improvements ore est added a offeree for sale.9.howew,the building a infused b sold within one yew d ooaebetvk the ZONING APPROVED BYa-0dDATE: ownutder win have the burden premor e heshe did not or boldimprove for the pdpose of sate). ❑ I,as owner d the prapeny,enn ertlhmveiymdradie aim loused wsadai tonnNha the proles(Section 7044,Business and BUILDING APPROVED BY : DATE: Professions Code:The Contractors License Law does est apply m en oar d property who bode a improves thereon and who contracts for ash projects with a nmada(a)Ecraed WAWA to the Cadedas Liesrse Law). ❑ q APPLICATION ISSUED BY. DATE: II 7 -97 Ian rum under Section: B.8 P.C..ben this noon: - ................ ......W.... �. xxxx xxxxiixxxie iexx xxxxirxxx xxx xxxx xxxxxxxxxxxxxxx xxxxxaixx xxiv iixxir ie iix ie iixxitxxxxxxxiiit D ene: Oder LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby artily that I am aware of end understand the reeraement,d Cellons Heat and Safely Code Sedlas 25505.25533.and 25534,and the I or any Mae building cocoonwll/wit not(circle ore)need to odd with eek sea cods and the requirements for a permitter mmuudion a mod/dike banpe As Canty MeneyenrA DistrictRaddwabl catemoon dukedom ea exempt horn Nov BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/RES GRADING porau. PERMIT 21 . 00 O rd Amidst PLAN 1365% SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:Ihaste affirm under penalty d perjn teed the blowfip ddmdiae: ISSUE FEE ❑ Have ed NI meintaii a certificate d cored lo se/Odra br workers'compensation,es provided for by Section 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code,la the wisdom*d the work tor which this permit b issued. pIhave adwit aidenwrkaa'o,mpeebn eialeam..esAmoredbySedn3700dthLaborcode,fathepdan maadIhe TOTALS - > 21 . 00 0. 00 13 . 65 39 . 65 34 . 65 . 00 ask for at to pari b issued.My wakes'oornpenWion inuranca came and pokoy number we Carom: LEGION INS EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 21 . 00 OVER/SHORT: . 00 Polity Number NL_l Uiu4]u 11 /11 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (Tab sedion need nor be completed lune permit e kr one hundred dollars f5;00)or less) 21 . 00 ❑ I caddy that in the pedorrnance of the wok for with this pith is issued,I shag not employ any person In any manner so 05 la become imbed to the workers'nmpenutian be d Cafdcmb,aha ped 2 I should became to the workers' ' . ' ' ... * .........**" - . ....... . ... AAAA .............. ....... dee vF irx iixii iiia4 titxiaxirxicxxxxxxxic itxxxia irx irxxxxx xxxxrvxxxiexiixxiewii><x ieii levels ie;rxiExxtir ii til x;r iexie;r ie ii vi ii nrrhleneiarh provisions of Section 3700 d Na Caber cos..I � un with those ovation. Dee / . x - 97 Appfra : - INDIVIDUAL F E E BREAKDOWN Warning:Faure b•acue wort..:compensation coverage Is unlawful,end she sub*,en employer fo MMmWpwldes and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil it,. ens to ns hundred thousand dollars(swaoo0A In adddon to the cost of caeoensatfoe damages as provided for In Sacdnanm Code, »sm.rarFIR 21 FIRE EQUIP FEE ( FROM BLDG VAL TABLE) 1 . 00 21 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under pcalty of Period that there S•aorMnMion lending agency br the END OF FEES performance d the wed for which this nerd is issued(SedSi 3097.Civ.C). LENDER'S NAME • rte Le red R'S ADDRESS: ....t!''' Gs del '^^N Icedry Nat Chaise read thisapplicationcaed use the shore verepreonboonsd.l are l9 comply with Nay end county ordinances .• D e nd stale laws relaid to bidding construction end hereby adhn¢e representatives d this thy to enter Upon the ebov marded paper ,•!' for inspection purposes. r TONY VACCARO - PdN ,-• ,�7, NOV 0 71997 C��i � f . 7 -27 u—�.�° Dat.: f Signature el• �j(��,' da . 00pnraI 15151.46.WP) White-Suddirq&Sided;OrpmFrb:Curvy-AppiuN:Pink-Revenue:Goldenrod-Addy CONSTRUCTION AND PLANNING POG SPA 'APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1't Temporary Electric& Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. • 53. Steel Reinforcement ,B. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE ~ 7. Footings . ' 58. Electrical Conduit-Undrgrnd. •8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines. P•Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap63. Heater & Vent•Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval I 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING , 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT 20. Rough Factory Fiselace ; - .. • : APPA'OVA.LS : . Permit# ; 21. Ducts, in Structure r . •• _ 70. Underground Hydro I ' 22. Ducts, Ventilating' ' t, ; . 71. Product Piping O Gas (5 Oil 23. Gas Pipe-Rough &'Test 72. Underground Flush 24. Roof Framing - ' T. - r 1 , 733 Undergrnd.Storage Tank.O Gas 0 Oil 25. Roof.Sheathing i : 74. Overhead Hydro 26. T-Bar Ceilin (Structural) & Monocoat ' 9 1 75. Dry Chemical 1 27. Frame and Flashing = 1 76. Dry Standpipe ' 28. Lathing & Siding S 6 .. , ••• •' r 77. FIXED gYSTEM-RINAL II/77Q/7 � 29. Insulation •• r 78: FIRE PREY. FINAL !r'l /� 30. Drywall Nailing - ' - t I .HEALTH DEPT. REQUIREMENT ry I 31. Plaster Brown Coat Si _ . I. • 79-. FINAL INSPECTION 1 D.----- 1 32. Electrical Power Meter-Final8G. FOOD CERTIFICATE ISSUED. 1 33. Final Electric - Notes: '` I 34. Final Heating & Air Conditioning . •• • 35. Final Gas PipeTest ; I _ j 36. Hood or Canopy i . r - I 37. Final Factory Fireplace 1.`_ • - 1 _-1 38. Final Plumbing , 39. Water Service•Final ' . • 'i! 40. Gas Service-Final .- - . ' 41. Solar Domestic-Final . . 1 42. Backftow Preventer . 1 43. Backflow Irrigation ; - - - I 1 44. Landscape Irrigation Systemt ' 45. Sound Attenuation, . 46. Handicap Regulations • . 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING; - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' • 51. CERTIFICATE OF OCCUPANCY • No. Date ADDRESS OF BUILDING: 190 23RD ST um 4 CITY OF COSTA MESA — BUILDING PERMIT an,EWSNUE MIO+MWM CALVARY CHURCH NEWPORT/ME PERM NO: F 085683 , BESS 190 23RD ST PERMIT NO: F 085683 PLAN CHECK NO: 03198-97 L GOVT: N SUPP: N —OSTA MESA, CA 922627 714-2501988 APPL.SWUNG ADORESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: FIR PURPOSE: ALT MCNNECT ORENGINEER: UC.NO.: JOB DESCRIPTION : ADD FIRE ALARM TO BUILDING SQ F T : ARCA OR ENG.'S ADDRESS: WC: CLAIM VALUE: 250. 00 CALC—VALUE: GROUP OCC: B / CONTRACTORSNAME: SERVICE FIRST ( 714 )631-3164 CCNIRACTORSMMUNG 336 CHERRY TREE LN COMMENTS: SMOKE DETECTORS INSTALLED IN EACH ROOM ARs NEWPORT BEACH CA ucNo_ 556812It i< rriv hi iiietieieieeiie ieeiiiii ie ieeiiiaeieeeeeeeieeeiieeiiieiiicieiciciciciiiiiiiiiiiirieiiiiFiEriiit icii `J2bbU DMT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby alum under panty of perjury this I am Icenm6 under provisions of Chapter 9 SETBACKS (commend®with Section 7000)of Division 3 d the Business and Professions Code,end my limn is in fan force end Sled. cry uC.NO.: 047646 UC.CULSS: C-20 UC.NO.: 5 5 812 EXP: 05/98 MAIN BUILDING ACCESSORY BUILDING /�� _ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Dae: ��' 7"97 Condor (//r� u "` LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty d perjury that I am exempt born the Contractors License Law to the Mowing reason(Sedian 7031.5 Business and Plessors Cade:Ave city or county which requires a penult to Construct aver,improve. PARKING REQ: PROV: PARCEL: 43926131 Z NE: REF NO: "demolish,or rami any shmture.prior to as issuance.also requires the applicant for such permit to Se a signed statement that he or she a licensed pursuant to the provisions d the Comrades License Law(Chapter 9(commencing with Sedsn'7000)of Division 3 d IM PLANNING NOTES> Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemgion.My violation d Sector > '7031.5 by any applicant fora pend sibieds the applicant to a cei penalty of not more than fire hundred dollen)$5001). ............................................................... . X ii'R-fi'le'Iix X Xx xrtrtxx X xx x X p.. — Xx xx XX9t-x-'Rxatxx-XXx-T'x X— XX XXrt XrtltXrt9trtrtii'R isle 9i'le Yi-Jt'R iC ie ii ii is ❑ I,mownerdthe property or my Business es win wages mlhen oda opmpemm ors Lcer do the work end the strudunerw intended D E V E L O P M E N T SERVICES R E U I R E M E N T S or offered for sale(Section 7044.Business and Profess naCole:Tr Coloradan license Law does a apply lo an Saw d properly who Odds orfrenotinproves thereon.and who does le,If work tinsel baits herself m through hO' m her Own employees,provided that allot improvements are rot intended or offend la sale.B,howevr.thedoiavetotthepu is sold within one year d competon,the ZONING APPROVED BY DATE: owner-builder will have the burden d proving he or and did not bald or'mirrors for Purrs s of sale). ❑ I.as owner of the property,am exclusively conhadng with licensed contndon to canNud the propq(SMun 7044,Burins and Professions Code:The Connectors License Law does not apply to en owner of property who builds or imp wes thereon and who BUILDING APPROVED BY DATE: contracts for such projects with a contrado0e)licensed pursuant 10 IM Contractors License Law). �J ❑ IameemgandrSection: B.iP.c..MMsaea : APPLICATION ISSUED BY : DATE: - -9? ,rtsleii'Rliitle ie tele...it leleielele'Ifexz X......x It it frit it rtrtx Xx zz x IN—It vr ir it iv le se x et er li'XRleille'lilf II-7 z x X It*Ye a It Int Data Owner LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby candy that I em aware d and understand the requirements of California Health and Sally Code Sections 25505,Peak,and 25534,end thin I or any future building compost will/wi not(circle ons)need to comply wih said state coda and the mpuinmens for a permit la drutruction or modification'rotate Air anagemerM District Residential construction eppirtlons are exempt homilies. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/RES GRADING provisions. PERMIT 21 . 00 Date: Apricot 654 SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby a&Ennu under panaby d perjurry e of the foBwi otg dedmatiom: PLAN 13 . 65 ISSUE: FEE ❑ I hem and will maintan a certificate al mama lo sellineure for workers'compensation,as provided for by Realm 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Cade,la the performance d Ow Vida to with the peewit a issued. Q Ihave and wilmm mwnt,nwotker., mmdnnimmn nr.n .aswdid, ieebySe3ToodmeLabor Cole.tmmd the TOTALS— — > 21 . 00 0 . 00 13. 65 39 . 65 39 . 65 . 00 work or which this permit is issued.My workers'compensation insurance carrier and poicy number are: Carder LEGIOlJNN] NS EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 21 . 00 OVER/SHORT: . 00 Pricy Number. WCT 03045U 11 /11 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (fit,section need not be completed if the permit S tor one hundred dollars IS1w1 or Wel 21 . 00 ❑ I certify that in the pedormance of the work for which this penny is Sued,I shell ed employ any person in any manner so an to beran,au 10 lb. workers'mw.enaatian See d California.and that f I*haat become to the wmato& .. ............. .. ... bpd agree _ aubled it irxtii ie ie it ie ie it ie if ie ii ie ie xis ieir*hi ii ie ii iF iezitrtrtzzrt rt'Rii><ie ie ie ii ie ie ie*x ie ie ii ii iixir ie ii ie ie ie it ie ii iixxxir it ie 1111 it ii ie ie ie ie iCX compensationN. provisions d Section 3'7W d the Labor Code,I shell I with comply h those prwiaw. Dale;//" 7" 97l a — I N D I V I D U A L F E E B R E A Fi D O W Ti Applicant: Warning:Failure m sawn workers'c.nrwwtlen coverage la unlawful,and shall ambled an employer to criminal penalties and TYPE . QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up erre hundred thousand dollars(5100,000A In addition to the cost of conpansatbry damepea ea provided for In Sedan 3106 oI the Labor Cob,Wrest,are attorneys ten FIR 21 FIRE EQUIP FEE ( FROM BLDG VAL TABLE) 1 . 00 21 . 00 CONSTRUCTION LENDING AGENCY:I hereby dfinn wider penalty of perjury that there is a construction lending agency for the -END OF FEES performance of the work for which this permi is issued(Section 339'7.CN.C). LENDER'SNAME l •j LENDER'S ADDRESS: _,.....--<.< •J, B�s�r�Q I ndrtata suSangconstruction stmnlhmethe ebowire repress afives f lascto compuponhl tibove'mounyadiopeee �r !/' and state levee reWkq to building m muldioru and hereby awlwca nepeaemeuvm d this city enter upon the ebwe-nwmiouad property for inspection purposes. r TONY VACCARO -'e - R.v0�t071997 Print Nene //' 7 -, 7 1 'r dor a-( Date: l / Signature of Ownee tru picanLCaumd i �:•,w.. .,.0 .w.�.e. . .....:;'. (5151-46.W P) White-Building&Safety;Green-Fl;Gamy-Appimnt;Pink-Revenm;Goldenrod-Assessor • CONSTRUCTION AND PLANNING POO- SPA i. Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# , . Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UFERGrnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit:Undrgrnd. 8. Foundation 59. Gas Pipe, O Untrgrnd.,Test „9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & HouseConnection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace : APPROVALS Permit# 21. Ducts,in Structure . ' 70. Underground Hydro • 22. Ducts, Ventilating,•i71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test - + 72. Underground Flush 24. Roof Framing • - , ; 73. Undergrnd.Storage Tank 0 Gas LT Oil 25. Roof Sheathing . i 74. Overhead Hydro • 26. T-Bar Ceiling (Structural) & MonoCoat . 75. Dry Chemical 27. Frame and Flashing I 76. Dry Standpipe • 28. Lathing& Siding • 77. FIXED SYSTEM FINAL 11/7/97 - 29. Insulation i 76. FIRE PREV. FINAL / r -^ I� 30. Drywall NailingHEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ., „ 79: FINAL INSPECTION • 32. Electrical Power Meter-Final 80.. FOOD CERTIFICATE ISSUED 33. Final Electric _ , - r Notes: • 34. Final Heating& Air Conditioning 35. Final Gas PiPe-Test • 36. Hood or Canopy I, • 37. Final Factory Fireplace' _ , . ,: - _ _ ^ 38. Final Plumbing 1 - 39. Water Service-Final " 40. Gas Service-Final I - 41, Solar Domestic-Final •• l 42. Backflow Preventer 43. Backflow Irrigation • 44. Landscape Irrigation System • .i 1 45. Sound Attenuation .. . ;, 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - _ , 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF DUMDUM: 190 23RD ST °MT' 5 CITY OF COSTA MESA - BUILDING PERMIT OWNER'S NAME IF M10M: CALVARY CHURCH NEWPORT /ME PERM NO: F 085681 • . theRE55: 190 23RD ST PERMIT NO: F 085681 PLAN CHECK NO: V.G2UU-7 / L GOVT : N SUPP: N -OSTA MESA, CA 92627 714-2501988 APPL.MLLWG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: FIR PURPOSE: ALT ARCHITECT OR ENGINEER: UC NO.: JOB DESCRIPTION : ADD FIRE ALARM TO BUILDING SQ FT: ARCH.OR ENG.'S ADDRESS: OMT: CLAIM VALUE: 250 . 00 CALL-VALUE: GROUP UCC: B / CONTBACTORSN mE, SERVICE FIRST ( 714 ) 631-3164 CCNIAACTORS MNUNG 336 CHERRY TREE LN COMMENTS; SMOKE DETECTORS INSTALLED IN EACH ROOM DDRS: NEYPORT BEACH CA IS NO. 55b L ..xxxxxxxxxxzzxzxxxzzxzzzxhxzxxzxxhhxxzzxxxxhhxhx xxxxxixxx xx hirhhhie t s ie t t thh hhx 7200v UMT: Z ON ING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaly of perjury that I am licensed under provisions al Chapter 9 SE TBACKS (commencing with Section 7000)of Dnision 3 d the Business and Professions Code,and my license is in full force end effect. CITY LIC.NG: 04 7646 UC.CLASS: C-20 LC.DatNO.: "55,6812 EXP : 05/98 MAIN BUILDING ACCESSORY BUILDING //'-i-e'7 con. 19471Weaetee FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penely of perjury that 1 am erring nom the Contractors License Law for the following reason(Section 7031.5 Buemess and Professions Code:Any city or county which swims a Permit a 000110001,after.improve. PARKING REQ P RO v: • PARCEL; 4 9 L 6 i'3 1 G NE: REF NO: -i.,- emanh,«repo any thestmdure,pin m issuance.also requires the applicant 1«such permit to fda a°fined statement NM he a end U -Sensed pursuant to the proesiwth d the she is License Law(Chapter 9(commixing g with Soria,7000)of Demon 3d the PLANNING NOTES> 4'7usiress and Professions Cade]or that he or she is exempt therehan and the basis for the alleged dre dollars Any Oft. n d Section > 9031.5 by any applicant for a permit subjects the applicant to a civil penalty a not more than fee hundred dollen 155001). ;.................................**ire........ ..... ... .... .. z zxxxxx zz xz xzxzzz xz xz xz x x xxxxxxxxxx altx ll'xzzzxxxxlRxh'lr it lr hlt It it hh hlF'lt'h N 1!'-1t h1t'h'Irh it iEhir iF itx ❑ I.mowrordths aleSecenyamy°minessewith WSW ssionsleiwlecompercorsLiensedwork kand die°0uctureis ofproot nded DEVELOPMEN T SERVICES R E or offered for sale(Sectimreon,Business and Professions Code:The ContractorLicen a Law does nes applyto en owner property u U I k E M E IN 1 S who bolds or Imes thereon,and who does such work himself or heneE or through he or her own emplolaes,provided the such improvements are not intended«offered la sale.IL however,the building or anathemapurposeo within coo yew a companion.the ZONING APPROVED BY owierm.,will of have the burdenproving he or she didnest build«improve for the of sale). buDATE: E ❑ Las oww of the properly.am esrbN ey contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contesters License Law does not apply to an owner d property Wes builds Or ingoves thereon and who BUILDING APPROVED BY : DATE: contracts for such projects with a contractor(*)licensed pursuant to the Contractors License Law). ❑ tem APPLICATIONexemptexemptunder SectionSection: bon: B.d P.C., tde : ISSUED -_.„„, wig it J DATE: ifr r- 7-9'7 itl'lt'fY ft'll1l lF lt'1l'T'llR1t1tw1l1fx1r 1thx xxxxxxx xxxxxxx......x xxxxxx it wet wine irk Wiest*hit It T'x niter*wrist xxll It De OwnerLEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby codify that I am aware of and understand the requirements of Callomia(Math end Safely Code Sections 25505.25533.and 25534,and that I a any future building occupant will I wil nes(date one)need to comply with said pate codes end the requirements for apeme formnUWion or mod/catkin berme Ai Duey Management Dienid.Residential mnstmaicn ape/Nations are manna Ins Nem BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions PERMIT 21 . 00 Dale: Applicant: 65% SMIP/NUN-RES WORKER'S COMPENSATION DECLARATION:I hereby eunder penally of perjury one the faltering declarations: P LAN 13 . 65 affirmd ISSUE FEE ❑ I have and MI mainsail a masts al camera to seNirsure for workers'compensation.as provided for by Section 3700 al the Labor BUILD ING-DIv_> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code.for the pedormanceoftr work is wYdch this permit is issued. TOTALS----> 21 .00 0 . 00 13. 65 34 . 65 34 . 65 . 00 pI have and cep maintain workers'00mperne kit insurance.as required by Section 3700 of the Lobar Coes,for IS performance of the 1C work for which this panto Sued.My workers'compensation insurance carrier and parry number are: case: LEGIQ ' Iz S EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 21 . 00 OVER/SHORT: . 00 Perry Number: WCT viv4nv 11 /11 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TUI GRADING PLAN-CHECK - ma section need ea se completed l the parol S base one hundred dollars 15100)or less) 21 .00 ❑ I Daly that in the performance of the work for which this permit is issued,I shag nes employ any person in any manner so as to become skied to the workers'compensation taws d CaMmta.and that d I should become to the waken' ***********************************************************ii Nree .. hhit ii it ithxit T'lt lt'R iY'It x'It'R it:** compensation provisions d Swion 3)00 a the labor Cods shelf wtn mm with ter.awakes. Dae: if' 7” 77 Apo .nt: S INDIVIDUAL F E E BREAKDOWN Warning:Failure tosedum women'compensation coverage Is unlawful,and shall subject an employer to criminal penaNss and TYPE QTY L t S l N 1 Y 1 I u N UNIT COST TOTAL COST civil fn up to ate hundred thousand dollen($1040 00).In addition to the out of camprwtlon damages as provided for he Seddon3706 of Me labor Code,Interest,ardatfomaye feet FIR 21 FIRE EQUIP FEE ( FROM BLDG VAL TABLE) 1 . 00 21 . 00 CONSTRUCTION LENDING AGENCY: I hereby elfnnn under penalty of perjury the there is a construction lending speedy for the END OF FEES performance of the work for which the pest S Sued(Section 3097,Cir.C). LENDERS NAME: / i / 97 ` LENDER'S ADDRESS: I certify that I have and this a building icor^end eels that the above information b cores.I agree to comply with ell cry and enlion d as 72 nt and stale laws tulip to mrsuucim and hereby authorize representatives of this dry to enter upon the above-mentioned property .� fa impaction parpora. NOV 0 71997 TONY VACCAkO V y Prot Name .1 0447l�eu'�� Date://- 7 - 9 7 (' e MESA Signature al Chi /float/ pgoard/Cordraa« C� i 1 v:h v..r h Fir I h (5151.46.WP) Whke-Buidig 8 Safety:Gree-Rea:Cnary-Applrav:Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING - POO SPA 'APPROVALS Permit# Date Inspector APPROVALS Permit Date inspector 1; Temporary Electrical Service or Pole . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3.• Electrical Conduit Utility-Undrgrnd. 54. Forms - i 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5..Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd, 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test i 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P'Trap, 0 Undrgrnd. 1 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Anal '' 1 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing- 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring, 67. Fencing &Access Approval , I 17. Rough Wiring Sign , 68. APPROVED FQR'PLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL • 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace • - • ` .' APPROVALS Permit 4 • r, _ - ,r - t 21. Ducts,in Structure I .. • ''' . - I 70. Underground Hydro -,r 22. Ducts, Ventilating 1 ' °;' 71. Product Piping Cl Gas 0Od 23. Gas Pipe-Rough & Test _ 72. Underground Flush 24. Roof Framing c, ; ' ' . 737 Undergrnd.Storjge Tank 0 Gas ',Oil 25. Roof Sheathing ;;! r - •, 741- Overhead Hydro- 26. T-Bar Ceiling (Strdetural) & Monocoat - - 75. Dry Chemical 27. Frame and Flashing i . . i, i. 76. Dry StandPige / 28. Lathing &'Siding - ,, 77; FIXED SYSTE�M FINA>_ ��/ 7/ 29. Insulation i - .. 41/4/9 ,1 a• 78: FIRE PREV. FINAL /re • 30. Drywall Nailing _ I ,HEALTH DEPT. REQUIREMENT 31. Plaster Brown-Coat„ . I :, 79. FINAL INSPECTION , 32. Electrical-Power Meter-Final i.. 80. FOOD CERTIFICATE ISSUED , 33. Final,Electric - 1 Notes: 34. Final Heating$ Air,Conditioning , - _ . . . r r 35. Final-Gas.Pipe Test • ,• , t 36. Hood Or Canopy , - % - , 37. Final Factory Fireplace . • - 38. Final Plumbing - `-- . . r 39. Water Service-Final _ - , 40. Gas Service-Final . • '. - 41. Solar Domestic-Final' : _ - 42. Backflow Preventer , • . _ - 43. Backflow Irrigation ' - - 44. Landscape IrrigationSystem . I ' 45. Sound Attenuation - " 46. Handicap Regulations • 47, FINAL STRUCTURE & BUILDINGit ' 48. FINAL PLANNING _ . 48. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co • 51'. CERTIFICATE OF OCCUPANCY • No. Date .,AUDR1.46.SuILteG: 190 23RD ST LINT: CITY OF COSTA MESA — BUILDING PERMIT OWNER'S NAME I`KNOWN:CALVARY CHURCH NEWPORT/ME PERM NO; E 082371 Am''190 23RD ST PERMIT NO: E 082371. PLAN CHECK NO: N GOVT : N SUPP : N OSTA MESA, CA 92627 714-2501988 APPL.'UJUNG HESS' CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ALT ARCHDECTORENcoEER:HASTINGS PARTNERSHIP ucto: C-11600 JOB DESCRIPTION . CHANGE STORAGE TO OFFICE/UPGRADE RESTRM SQ FT: ARCH.OR ENG.'S ADDRESS: 5031 BIRCH ST LINT: A NEWPORT BEACH CA 92660 CLAIM VALUE; CALC—VALUE : GROUP OCC : B / coxmACTOR'SNAME:BACCHUS DESIGN ( 714 ) 642-1327 CONTRACTORSMNUNG 1961 SANTA ANA AV COMMENTS : "BUILDING A AND B REMODEL" REF:B-82370 ADORESS:COSTA MESA CA uc.ND.: 597272 *****iE*SLSL*****************its*ic**+ESE******* *#****x* (*** *******************;H;E**>E 92627 LINT: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury dual ern licensed under provisions of Chapter 9 SETBACKS (commencing with Section 1000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. C•- .NO: 478 UC.CLASS:B uc-No.: 597272 EXP : 0 /97 - ----- MAIN BUILDING ACCESSORY BUILDING — — i� Contractor: 8/1-Y414.--tf^ SL�4 ( FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN UILDS DLEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN 'ER BECLARATION:I hereby elfin under penalty of perjury that I em exempt from the Contractors License Law lar the following reason(Section 7031.5 Business end Professions Code:Any city or county which requires a permit to construct,alter,improve, PARKING REQ: P RO V; PARCEL : 43926131 2 N E; REF NO: demolish.or rept any structure.prior to is issuance.also requires the applicant for such permit to file a signed statement that he or she Q licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Minion 3 of the PLANNING NOTES> amass end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > ,031.5 by any applicant for sperms subjects the applicant toe civil penalty of nd more than We hundred dollars l$5001),''• ******************************************************************************* ❑ I.as owner of the property or my employees with wages as tht sole compensation,will do the wink,and the structure is not intended or offered for sale(Section 1044.Business end Professions Code:The Contractors License Law does no apply toes bwherof propertyDEVELOPMENT SERVICES R E U I R E M E N T S Q who builds or improves thereon.and who does such wok himself or boreal or through his or her own employees,provided that such improvements are not intended or offered for sale.ft.however,the building or improvement is sold within one year olcompbtion,the ZONING APPROVED By DATE: owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). • ❑ I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business end Professions Code:The Contractors License Law does not apply to an owner of property who buade or improves thereon and who BUILDING APPROVED BY : DATE: contracts for such projects with a contrector(s)licensed pursuant to the Contractors License Law). 1 . !) ❑ Iamexempt under Section: 0.8PC..for this reason: ,;/ APPLICATION ISSUED BY; ' �tq� DATE: r4 Date: Owner: S. **************************************** * *** ******************* ' * LEGALIZATION: N F E E S U M M A I do hereby certify that I eaware d and understand the requirements of Camila Health and Safety Code Sections 25505,25533,and R Y STRUCTURAL SEGMENT: N m 25534,end that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for e permt for cantructionor modification fronnth Ar ueity aragentent Ditdct.Residentidmrmnnioneppicatbmere exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING pro^aionst PERMIT 4725 . Date: Applicant: 5 0% S M I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN ElIhave and veil maintain acertificate of consent toself-insure for workers'compensation,as provided lotbySecion3700of the Labor ISSUE FEE T— 22 . 00 Code,for the performance dnnnisissued. BUILDING—DIC the > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ I have and will maiman workem'compensation insurance.as required by Section 3700 of the Labor Code,for the performance of the TOTALS————> 47 . 25 22 . 00 0 . 00 69 . 25 69 . 25 . 00 work for which this permit is issued.My workers'compensation insurance carrier and policy number are: Canter: REVENUE DIVISION TOTALS--> COLLECTED : .' 69 . 25 OVER/SHORT; . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/TOT GRADING PLAN—CHECK as section need ref be completed I the porta is for one hundred dollars($100)or Mee) • 69 . 25 3 I certify that in the performance of the work for which this permit is hes ed.I shalt not em•• en person in any manner so as to subject to the workers'mnpensalpn laws of Califon.: : vee� . ytgw, bribe workers' ***************************.************************************ **************** provisions of Section 3700 o the LaboCode,I .r y • g • "ilkiuy�pe 1ias INDIVIDUAL FEE BREAKDOWN amino:Failure tos ore workers' compensation coverage unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil linea up to one hundred thousand dollars($100,0001,M edrlion to the cost of compensation,damages as provided for In Section 3106 of the labor Cads,Interest,udatromsys teas. ELE 7 FIXTURES, LIGHTING 1 ST 20 EA. 1 , 00 7 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the ELE 10 REC EPT/OUTLET 1 ST 20 EA, 1 . 00 10 _ 00 performance of the work for whidtthis permit bissued(Section 3O97.CN.C). ELE 3 RECEPT/SWITCH 1 ST 20 EA. f10 3 . 00 LENDER'S NAME: ELE 1 MOTOR/POWR APPARATUS �t ? -, -00 1.1 . 00 LENDER'S ADDRESS: F�haII ELE 1 MISC APPARATUS Ttt�>NoLk } � yJ' >? 6 . 25 { 2r 16 . 25 I certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county ordinances cOm tp 1.4 0th aitappl$agle tan )Cap APR , 91 and slate laws relating to building conuuction and hereby authorize representatives of this city to enter upon the above-mentioned propend pv7 C n7 for inspection purposes access requirements under California !997 purposes. `i- �� ��% ` statutes and related regulations. /�aar&.. 4410, Date: Aqg/9 9 (Ord.No. 92-28,§ 1, 12-21-92) CITY OF COSTA MESA ,� gnature d Owner/Agent/Aro : • tract• II (5151-46.W P) White-Building&Safety:Green-Rb;Canary-Appkrant;Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL 'A 'r ) APPROVALS Permit # late Inspector APPROVALS Permit # Date Inspector • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd-. 54. Forms 4. Electrical Conduit-Undrgrnd. - • 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. - 57. APPROVAL TO COVER-GUNITE • 7. Footings _ 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test • 1 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System • 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ' • 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final - - 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 36. Solar System-Final 16. Rough Electric WiringS/Sfq 67. Fencing & Access Approval 17. Rough Wiring Sign I• . 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test • 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe , , . 28. Lathing&Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final /�J/� 80. FOOD CERTIFICATE ISSUED 33. Final Electric /7 lb" Notes: (� 34. Final Heating & Air Conditioning ((((���-lll! _ 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service-Final - _ • - 40. Gas Service-Final 41, Solar Domestic-Final E' 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. FINAL PLANNING • • 49. Electric Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date , , �C 1•0u1 U5ti�f7 th.A. iii: J F.+\ 714 A' ' 0797 E .. wuax v-1x�a NYORT 64 33 791 6480 07 ACTIVE 09/01/66 ICA 49,0 E 23RD ST MTR TP705-004005 FSR 70 CREW RATE I GS-2 CSTAMESA CA 92627 1C007 714-645-5050 GACI GPRC :SR/PLAN_ j !) * * ACCOUNTS BILLING HISTORY * • • * *i • PAGE 2 • READ DEMAND DEMAND FACILITIES TIME j DATE READ KW DEMAND KW BILL KW 11 04/18/97 1 . 36 54 . 4 54 . 0 54 . 0 i ' 12 03/19/97 1 , 37, 54 . 6 : 55 . 0 55 . 0 1 )3 ,02/20/97 . 1 . 39 55 . 6 56 . 0 56 . 0 )4 01/20/97 1 . 21 48 . 4 46 . 0 . 48 . 0 )5 12/19/96 1 . 10 44 . 0 44 . 0 44 . 0 . )6 11/18/96 1 . 35 54 . 0 54 . 0 54 . 0 ' )7 10/18/96 1 . 00 40 . 0 40 . 0 40 . 0 )8 09/17/96 • 2 . 00 80 . 0 80 . 0 e0 . 0 . 9 08/16/96 35 . 0 35 . 0 0 07/18/95 35 . 0 35 . 0 1 06/17/96 35 . 0 35 . 0 2. 05/16/96 1 . 75 70 . 0 70 . 0 �7 3. 04/17/93 1 . 70 68 . 0 68 . 0 68 . 0 EACTIVE METER NUMBER- - MULTIPLIER- � / . FCWH MULTIPLIER- 40 LATER TRANSACTION CODE OR PAGING REQUEST- // . • 1 • N1fa11JS 'vo)e� LIW grne4y - - - ----------- .r"----Y --. c3 AL a3 �. t41P s . tc.�1. iz-o a -i 14 ineriiir,> c l0 b -1 Rr.c F crfC �_� Toca'C A-e1 5 W'J. 2.. A.n�,s 1 Y.3 J I 7 C,.Ci G, 7" , k 0 • - L &l-46-Q C u tc� IA ISO EAST 23RD SI. ) tarok. Coa4 I4C7 A4,4p - Cos-sA Plic.'S A, CA2oCvnp b.ISCoNuc:t 6\1(42:7 Ale, t4 44np .zz.o i q 0 — - - • t . _±.„.." .,/- ."" ' C7>) -EP- C suizoizc8 1 6I \\ , i t1Ai4 i1) 1 r .- r--—-44. 5 , 41177 - 7 tba i _r, T ff \c< . .. � r>\ \ {T. I�JO�TL -- > AUII, ��r- w). iti ):L i 7' AAI A. 7 0 i . • / . -firMITITIAIMMOrtilliri4r711717111.11.111111111.111111011411M1 PROJECT NAME DATE/, r� tJ 401 P_�SPL ALCIGHTINGPOWER LUMINAIRE NUMBER OF WATTS PER LUMINAIRE CEC DEFAULT TOTAL NAME DESCRIPTION LUMINAIRES (Includng Ballast) • Y N' TTS il-To Qesti r 2 x 40 : l9 II C ❑ II SUBTOTAL FROM THIS PAGE PLUS SUBTOTAL FROM CONTINUATION PAGE LESS CONTROL CREDIT WATTS (FROM LTG-3) ]' ( 'II not using the CEC Default value.pease provide supporting doa+mentaton. ) ADJUSTED ACTUAL WATTS ALLOWED LIGHTING POWER(Choose One Method) .:•- _: - _,,..• ..:,.,-::_„ -. . . .. : ..'::•:,c;••• COMeGETE BUILDING:METHOD `. BUILDING CATEGORY(From Table 2-SSM) WATTS COMPLETE ALLOWED PER SF BLDG AREA WATTS �F�rUg 7, C 34-/- 5.2.--a AREA"CATEGORY`METHOQ " ^� _ AREA CATEGORY(From Table 2-53N) WATTS AREA ALLOWED PER SF (SF) WATTS 11 1 TOTALS AREA WATTS TAILORED.OR`:P.ERFORMANCEMETHOD TAILORED n PERFORMANCE TOTAL ALLOWED WATTS (From LTG-4 or from computer run.) -Nonresidential Compliance Fort December 19911 M.agRleTek , ' . TNo. Line Calal Input Watts Line Min. Wiring . pe I o1 Voting!) Number Sid.Lamps E.S.Lnmp9 mAmps Slott. Dog. Noloe Lamps - Tap. Pogo 9 FIXT I ANSI FIXT I ANSI Nom. Max- r--- SERIES ax.SERIES RAPID START For use with 112 or T10 lamps, 3 or 4 feet in length. 120 81401120 .26 .29 • F30T12 1 277 81401277 27 29 23 24 .11 .12 50°F .,1 b,h . (3') 2 720 82401120 56 58 48 49 .23 .26 50°F 2 b,h (25 or 30 277 • 62401277 _ 120 63401120 .76 .85 watt). 3 277 83401277 81 85 67 69 .33 .37 50°F 3 b,h /9 4.\ 1 120 81401120 _ 35 37 27 28 .32 .36 50°F 1 b,c,d,h F40T12 /` 277 ;1aaT97 .14 .16 2 120 277 82401120 f 64 ( 59 .26 .29 50°F 2 b.c,d,h (34 or 40 _ • watt) 3 120 83401120 97 103 0 85 .90 1.01 50°F 3 b,d,h 277 83401277 .39 .44 1 120 81401120 37 39 .34 .38 50°F 1 b,h F40T10 277 8140T277 .15 .17 (4') 2 120 82401120 67 72 .63 .71 50°F 2 - b,h 277 82401277 .27 .30 1 (40 watt) 3 120 83401120 102 • .95 1.06 108 50°F 3 b,h 1 277 83401277 _ .41 .46 PARALLEL RAPID START For use with T12 or T10 lamps, 4 feet in length only. F40112 120 8240R120 .65 .73 ' • (4'or U) 2 277 B240R277 69 74 59 63 .28 .31 50°F 2 a,b.c,d • (34 or 40120 84402120 1.24 1.35 watt) 4 277 64402277 133 141 116 ' 121 54 .60 50°F 4 a,b,d,h 120 82402 120 .67 .75 F40110 2 277 82402277 72 76 .29 .32 50°F 2 a,b,ll 4 This application is not recommended. . I • INSTANT START SLIMLINE For use with Slimline lamps, 4 to 8 feet in length. .120 62751120 .65 .73 • F48112 2 277 82751277 - 70 73 62 64 .28 .31 0°F 5 a,b,h F72112 2 120 ' B2751120 1.03 100 104 .92 0°F 5 a,b,h 277 62751277 .54 .60 • 120 82751120 1,24 1.39 • F96T12 2 277 82751277 - 135 141 108 113 54 .60 0°F 5 a,b,c,h HIGH OUTPUT(800 mA)• For use with T12 high output lamps, 6 or 8 ft. In length. i. t. 120 82110SR120 1.50 1.68 F72T12HO 2 • 277 B2110SR277 157 169 .65 .73 -20°F 6 b,h F967121-10 2, 120 8211052120 -J 193 209 167 178 1.83 2.05 -20°F 6 b,c,h • 277 8211082277 .79 .88 Notes: j. a.Parallel lamp connections allow remaining lamps Io stay fully lit if companion lamps tail. b.CSA(Canadian Standard Asociallon)certified(120 volt model only). c. Regulated by and exceeds requirements of Federal B.E.F.standards d.Not recommended for use with F40T12(32 watt)lamps. i I. Due to the slightly higher operating voltage associated with F401IO lamps,they are not recommended for use with the 84402120ar64402277. Ir.Minimum stalling temperature Is(or standard tamps.Energy saving lamp atm ling lnntpntMut n pnr Int q r intuit llnclntnen npncillcatlun. \' 1 Hi SdFE the k .A hl+. 4 ... .. T ARMS*BUILDING: 190 23RD ST DIT: CITY OF COSTA MESA - BUILDING PERMIT . "IpvtiarsNAMEIRIMAMN:CALVARY CHURCH NEWPORT/ME PERM NO: B 082370 ADDRESs:1 9 0 23RD ST PERMIT NO: B 082370 PLAN CHECK NO: 01390-97 A GOVT: N SUPP : N COSTA MESA, CA 92627 714-2501988 'PPE MMUNG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT ARCKrECTOREfGNEES:HASTINGS PARTNERSHIP 11CN1: C-11600 JOB DESCRIPTION : CHANGE STORAGE TO OFFICE/UPGRADE RESTRM SQ FT: 5, 400 ARM OREfa'SADDRESS: 5031 BIRCH ST WIT: A NEWPORT BEACH CA 92660 CLAIM VALUE: 5 , 400 . 00 CALC-VALUE: 5, 400 . 00 GROUP OCC: B CONmACTarSNAMEBACCHUS DESIGN ( 714 ) 642-1327 Cm(TRACTOWSMNIDG 1961 SANTA ANA AV COMMENTS : "BUILDING A AND B REMODEL" AoonssCOSTA MESA CA Lmm, 597272 *************+SSE+fi+fi******* -x-*** -*** -+BRE*RS#+[**+S****** -*rE****** -*** -*******rtifi*- ***** 92627 IMT: ZONING REQUIREMENTS UCENSED CONTRACTORS DECLARATION:I hereby elfin under penalty of perjury tlla I em licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Diaisun 3 of the Business and Professions Code,and my license is in full force and effect u .Nopi/1 $$$ uC.CusS:B UC.No.:597272 EXP : 3/97 MAIN BUILDING ACCESSORY BUILDING L// �/ �5� �f•�� FRNT : E'T TN REAR : FT IN FRNT: FT IN REAR: FT IN Dae: !( / Caa.da: LEFT : FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN O ER BUILDER DECLARATION:I hereby aMIno under gamely d perjury that 1 erre exempl from the Contredaa License Law la the dnwng reacon(seaion 7031.5 Baenessand Prolessbne sue.:Am=hvamumy whlrA rpuireaepenme to axno-ad,aha.improve, PARKING REQ• PROV• PARCEL • 43926131 ZNE• R3 REF NO• vmolah,or repair any structure:prior to its issuance,also requires the applicant for such permit to file a signed statement Mat he or she IicemedpursuemlolheprovnionsdtheConhedorsU elawiChalHa9(oommendngwtthSrdion70OO)dDiviion3dthe PLANNING NOTES> CONVERT 346 SQ. FT. OF EXISTING NURSERY SCHOOL TO SCHOOL ...Snots and Professions Code)or that M or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > OFFICE: . -:t 7031.5 by any applicant for a permit subjects the appicad to a civil penalty of not more than Me hundred dollars[S5001). ***********************************************************iE*********iE-k******** o I,as owner althe promnyormyemplyees with wages astheisole compensation,will dothe work.and the structure inot intended D E V E L 'O P ML'E N T V.S E R V CES R E U I R E M E N�T% 5 or offered for sale(Section 7044,Business end Professions Code:The Contractors License Law does not appy to an Ownero properly Q who buids or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such r i . �.` • improvements are not intended or offered for sale.ff,however,the building a improvement is sold within one year of completion,the ZONING APPROVED BY •' • J \ DATE: M ownenbuiler will have the burden of proving he or she did not build or improve for the purpose of sale). --- ❑ I,as owner of the property,am exclusively contradng with licensed contractors to construct the project(Section 7044,Business and Professions Coda:The Contradom License Law does not appy to an owner d property who builds or improves thereon and who BUILDING APPROVED It:Y:_ : ', n :• 4 DATE: ,,La contracts for such projects with a o>arador(s)licensed pursuant to the Contractors License Law).I am exams(under Section: B.SP.C.,for this reason: APPLICATION ISSUED ,BY ' t-' AlLDATE: Owner: ****************Si** ** *. . . . . . . . . . • . " ' ' . . . .******************* ** IDatdoohereby certify that I ant aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and LEGALIZATION:N '� •� JF E E S /U, M M• A R Y STRUCTURALt SEGMENT:? 25534, for nstn rylNurebuiltinro theAir uaN717ngem aw)nd.Residential mtywhhsegdaacodeaendtee emptfromthforse BLDG PMT PLUMBING ELECTRLC r MECHANIC FIRE SMIP/RES GRADING • 2tad thatI or anofmoeibcalinhorntheA'r (wilt rot(demeoneineed tomlywihdad'onapcodeiornere aemgemethesa provisions. PERMIT 112 . 25 I !' i.t Date: Applicant: SMIP/NON-RES • WORKER'S COMPENSATION DECLARATION:I hereby storm under penalty of perjury one of the following declarations: PLAN 18 . 24 t 1 . 13 ILANE FEE .' : ' ❑ I have and wil maintain a certificate el consent to selLinsure for workers'compensation,es provided for by Section 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code,for the performance of the work for which this permit is issued, TOTALS 113 . 38 0 . 00 18 , 24 131 . 62 131 . 62 . 00 ❑ I have ani wit maintain workers' e compensation insurance,es required by Section 3700 of the Labor Code,forlhe performance d the • work for which this permit a issued.My workers' compensation insurance ismer and policy number we: Carrier: REVENUE DIVISION TOTALS--> COLLECTED:e - 113 , 38 OVER/SHORT : , 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC •FIRE SMIP/TOT GRADING PLAN-CHECK .. (This section need nabecompleted ithe semi:lsfor one hundred dollars fsfroiaIMO 112 . 25 1 . 13 X❑ I certify that in the pe andrca of the work for which this permit is issued.I shall not , em Na any Person in.„ anew®as to • bied10 the wakersa,mpensaianaws5CaWorn Iiagrse 4 / r? . ti the workers' *****************I**N*U**-1( *-**V********fie D U A*L*'****F*************E £******B**R***E*A**K**D**O**W***N **************** he Lora Code.I py ,/L71V ' Appl�nt:euredsecur.w0Maiconpayetlon coverages unlawful,andshallsWpclsnemployertoalmirelpemsftlesend TYPE QTYU E S C R I P T I O/ N • UNIT COST TOTAL COST civil lines r4 to one hundred thousand dollars($100,000),is sddtUon to the cost of co psnsatbn,damages as provide for In Section 3706 of the Labor COW,Interest,and attorney's feet SFC 5400 ALTER BY VALUE COMMERCIAL NOZONE y al:3_ l 5, 400 , 00 - CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there lea cordndi n lending agency for the END OFg FEES' pedamarw'e d the work car whd,that pared a issued(sedan 3097,Civ.c). The work authorized by this permit shall LENDER'S NAME: comply with all applicable • LENDER'S ADDRESS: PP able handicap , e i` /- �1 4(Arlq accessrequirements h A.\ h. la7r T icemt end dyandadntyordrances California faara18aawere �heikumadstrudionand hereby aathorizereaasentmiveadthaciryt0entaupontheabove-mentioned propaM stetutesandrelet�,'iegulation3. ; r ,t All U ..,fii► _— • (Qrd. PJo.9228,�. ) CITY Di v.:eit. II:!r1H "atm / 21-82 ,�/,L/L9, tmfirc .� Date: .... �� v — Sig : 's—.dtgenuApprcant/C. tract. . '— ... .. .. - A (515l'4a.WP) White-Building 5 Safety;Green-File:Canary-Applicant;Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING P00 WA 111 APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52.- Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. .. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUN ITE • 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval ' I -. 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -• i 20. Rough Factory Fireplace - APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat „eve 75. Dry Chemical 27. Frame and Flashing ' ir/ I _/�I 76. Dry Standpipe 28. Lathing & Siding k�i/k1/27��-�/177. FIXED SYSTEM FINAL 29. Insulation Y 'Y/� „,I ' 78. FIRE PREV. FINAL 30. Drywall Nailing / HEALTH DEPT. REQUIREMENT ! - - 31. Plaster Brown Coat y j-79. FINAL INSPECTION • 32. Electrical-Power Meter-Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric Notes: /t�7 D,dyreace I' `4.4 34. Final Heating & Air Conditioning - - 35. Final Gas Pipe-Test / :eief:7; ;'6.02o,ii e....,�g _ -tel/ ' J__ 36, Hood or Canopy .- 37. Final Factory Fireplace c -f 7. 7-77-vi�lL�o7 woof-rel I 38. Final,Plumbing GG 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 1 47. FINAL STRUCTURE & BUILDING ofre 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date • N - A 4 1. �1 : HASTINGS PARTNERSHIP. INC.. . . . •• • • ARCH ITECTURE. &PLANNINC '- February 4, 1998 ) - - • .. / / \ C ! -- ..�� .. I. . Mr. Ed Petros, Building Inspector , /, `..., , t City of Cos[a.Mesa ? ' - • 1 . Department of Building & Safety - , ' f ; l 77-Fair Drive Costa Mesa, Ca. 92627 ., y , Re: Calvary Church Newport Mesa, 190 E. 23rd Street, Costa Mesa - . • Plan Check No. B-82370 \= - ✓ , < • - Dear,-Mr. Petros, ) . In, regards to your inquirey concerning the Handicapped accessability to the 'above - mentioned project, I offer the following. The retrofit of the existing restrooms in -. • said structure was maintance oriented, (removal of dry-rot , replacement of -damaged - plumbing lines & fixtures, etc.) , In the coarse of said retrofit, it was my professional opinion: that ,the restrooms be reconfigured to allow, for access 'at a future date. , r Again, I hope this- claifies`,the intent. If (you 'have- further questions, please do not . hesitate in contacting this office. -_ - Sincerely, , ' -S . , � . v . . \ 1, s , h ORIGIi�At Ralph LL1•Hastings AIA - ` _ Principal RHL:ja a • Jg/�� , - ' _ r ' - i/7t . ' _ - Architecture & Planning `; , 5031 Birch Street,--Suite A, Newport Beach,'CA 92660'-Phonet(714) 250-1988 Fax (714) 250-1640 . 4, n L - . , • ADDRESS Cr;BUILDMO: 190 23RD ST DMT' CITY OF COSTA MESA - BUILDING PERMIT DMNERSNAMEMIONOMI:CALVARY CHURCH NEWPORT/ME PERM NO: P 082373 ¶R'190 23RD ST PERMIT NO: P 082373 PLAN CHECK NO: N GOVT: N SUPP; N 'OSTA MESA, CA 92627 714-2501988 (S - I APPL.YAWNS ADD CONSTRUCTION TYPE : V-N PERMIT TYPE; PLU PURPOSE : ALT AROHRECTOREtaIEER:HAS TINGS PARTNERSHIP ''Nair C-11600 JOB DESCRIPTION : CHANGE STORAGE TO OFFICE/UPGRADE RESTRM SQ FT: ARCH.DR ENG.'S ADDRESS: 5031 BIRCH ST DMT' A NEWPORT BEACH CA 92660 CLAIM VALUE: CALC-VALUE: GROUP OCC; B / oamucTORSNAJIeBACCHUS DESIGN ( 714 ) 642-1327 CONTRACTORS MAKING 1961 SANTA ANA AV COMMENTS : "BUILDING A AND B REMODEL" REF:B-82370 AODRES&COSTA MESA CA ucxo.: 597272 ************************************-x-*BE*+EUt*Ut**** -**aEitlt****x-SEBEIt*at*it*+r*SESE*-x-***iEtt* 92627 UNIT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby elfin under penally of perjury diet Ism licensed underS LICENSED of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. I :R 4 86 41 UC.CIASSB UC.N0^.: 5_9-7�.272 EXP: 03/97 MAIN BUILDING ACCESSORY BUILDING ♦ eer: j �` FRNT ; FT' IN REAR ; FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT; F'f IN LEFT; FT IN RGHT: F'f IN DER DECLARATION:I hereby affirm under penally of perury that I am exempt from the Contractors License Lew for due n(9edion703t.5 Business and Prolassions Code:Any"yercounty+"'i`Irequires'p°""a'°mre°'.:''°"er'""p,"'°' PARKING REQ: PROV: PARCEL: 43926131 ZNE; REF NO; demolish,or repair any struclure.prior to its issuance,also requires the applirent for such permit to file a signed etatement that he a she licensed pursuant to the provisions d the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 d the PLANNING NOTES> ,Usines and Prclejjions Code)or that he or she is exempt therelmm end the basis for the alleged exemption.My violation of Section > 1031.5 by any applicant for a permit eubiads the applicant toecivil penally of not more than five hundred dollars 185008. ******************************************************************************* ❑ theI. U I R E M E N T S or offered for sale(Section 7044,B sines end Professions Code:The Connector'License Law does not apply Men owner of property D E V E L O P M E N T S E R V I C E S R E Q who bolds or improves thereon.and who does such work himself or hornet or through his or her own employees.provided that such provements're nal intended or offered for sale.I,however,the building or improvement is sold within one year of completion,the ZONING APPROVED B Y DATE; owner-budder will have the burden d proving he or she did not build or improve for the purpose of sale). ElI,as owner of the properly.ern exdusively contracting with licensed contractors to construct the project(Section 7044.Business end ' Professions Code)The Contractors License Law does not apply to an owner of property who builds or improves thereon end who BUILD I NG APPROVED B Y : DATE: contracts for Such d projects with a contra er(s)licensed pursuant to the Contractors License Law). - ❑ Iamexe pt under Section: B.AP.C.,lotthisreason: APPLICATION ISSUED BY: *� DATE; : 1 - owner: **************************************** * * R'*********************** rig ** DateLEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT: N I do hereby certify that I sat aware of and understand the requirements of California Health and Safety Code Sections 25505.Pccmi.end 25534.and that I or any Mure building occupant will I will not(circle one)need to comply with said state codes and the requirements her apernit for construction or modificationbornthAs OualtyManagement Diatrid.Residential conanwioneppfulbrs are exempt from Mese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING pfovsons. PERMIT 74 . 50 Date: Applicant: 225% SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN s 1. ❑ I have end wit maintain a certificate consent to see-insure for workers'compensation,as provided for by Section 3700 of the Labor ISSUE FEE 22 . 00 Code,forthepedormancedthewrkforwNchthispermiisissued. BUILDING-DIV-> PERMIT ISSUE dPLAN-CHECK TOTAL PAID DUE ❑ I have and MI maintain workers'compensation insurance,as required by Section am of the Labor Code,for thepafwm„K,o the TOTALS----> 74 . 50 22 . 00 0 . 00 96 . 50 96 . 50 . 00 work for which this permit is issued.My workers'compensation insurance carrier and policy number we: carrier: REVENUE DIVISION TOTALS--> COLLECTED : r- 96 . 50 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK his section need not be completed Y the pemM is for one hundred dollars/51001 or less) 96 . 50 1{❑ I certify that in the performance of the work for which this perms ' ued T. not employ any manner so as to : abject m!he dkectlon37Wdin Nebo'Cole, hwth �e lsl, �.41%4..• toII"waks's' ******************************************************************************.* • pen. t, :� °eI N D I V I D U A L F' E E B R E A K D O W N na Applicant Ar.♦ J .:Failure to secure workers'compensation coverage is unlawful,and shall subject an employer to cdnsrW PflWea and TYPE QTY D E S C R I P T' I 0 N UNIT COST TOTAL COST rpt to core hundred thousand dellen($004000),In add/don la the cost of rompenssfbn,danYR/a as provided for In ' .on3706 of the Labor Code,Interest,and attorneys fsas. PLU 3 WASH BASIN �� 8 . 75 26 , 25 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a conatmdion lending agency for the PLU 3 WATER CLOSET (TOILET') 8 . 75 26 , 25 performance of the work for which the permit isissued(Section 3O97.CW.C). PLU 1 SEWER, CONNECTION TO' B ING EACH 22 . 00 22 . 00 LENDER'S NAME: LENDER'S ADDRESS: The work authorized by thgtn TEES t:RE and stythatIs havelreadi buildingu applicationouiddeanthateb above icor prsentcorrs of Iagree mcampyponall allyand county erdinanrly access with •all applicable Handicap ®/ 1t and state laws relating toAconstruction and hereby authorize representatives°the city to enter upon the abovementioned propend cocomply with aement8 UndeYC ifolTlla , la inaped'• r•^- 1 Allik DAt� oWLER� t eguiations. —• 997,�� sta isles and related r I R§ 1, 12.21=92) CWi /W H, ,��� y�$J� (Ord.hNo. 92.28, CITY1�.� .._pp •.n Date:.�� Bignaterep er ee App : . traderCOSTA MESA (5151.46 W P) While-Building&Safely:Green-Rh, -,am-Applicant;Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING _ POOL 'A APPRO1ALS Permit # Date Inspector APPROVALS Permit # _ Date Inspector ,Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil%pe-Undrgrnd. !J' `/! / /n) 53. Steel Reinforcement 3. Electrical Conduit Utility•Undrgrnd. (` ��✓/ 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE • 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60- Backwash Lines,P-Trap, ❑ Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK • 11. Property Sewer Line & House Connection _ 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater& Vent-Final 13. Roof Drains 64. Plumbing System - Final • 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED - - 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test • 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 04? le 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backf low Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No Date ADDRESS ioBMLODK+: 190 23RD ST LINT: CITY OF COSTA MESA - BUILDING PERMIT \ 1 owxERSN.MEtmm CALVARY CHURCH NEWPORT/ME PERM NO: M 082372 ! 5st190 23RD ST \ PERMIT NO: M 082372 PLAN CHECK NO: N GOVT: N SUPP : N COSTA Mg$A, CA 92627 714-2501988 APPL.IIAIUNDAD0fliS: CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: ALT ARCKITECTORmpa0:HASTINGS PARTNERSHIP UCNO: C-11600 JOB DESCRIPTION : CHANGE STORAGE TO OFFICE/UPGRADE RESTRM SQ FT: ARCH OR Eycs ADDRESS: 5031 BIRCH ST it A NEWPORT BEACH CA 92660 CLAIM VALUE: CALC-VALUE: GROUP OCC : B / coxmACTORSNAIIEBACCHUS DESIGN ( 714 ) 642-1327 Ca4IRACTORSMAJUIC 1961 SANTA ANA AV COMMENTS : "BUILDING A AND B REMODEL" REF: B-82370 ADORESS:COSTA MESA CA mw, 597272 ***#*******************************************************#******************* 92627 WIT: ZONING REQUIR EMENTS LICENSED CONTRACTORS DECLARATION:I hereby slim under penalty of perjury that I am licensed under provisions d Chapter 9 SETBACKS SO, nth Section 7000)d Chalon 3 dthe Businessteend Professions Code, d my license a in lull late end effect. q 6 LlC.CLASS:B uc.NO.:597272 EXP /97 --- MAIN BUILDING -- --- ACCESSORY BUILDING cared«: Li// C� (rFRNT: FTIN REAR: FT TN FRNT: FT SN REAR : FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ILDER DECLARATION:I hereby affirm under penalty d perjury that I am exempt from the Contradas License Law for the . reason(Se°mnTO3t.SBusies,end Professions Cods:MyWacounty w^imrequiem apermit tosalsmn".eler,'^'pro'e. PARKING REQ: PROV: pARCEL: 43926131 ZNE: REF NO: demolish,«repel any structure.prior to its issuance.oleo requires the applicant for such permit to file a signed statement that he or she licensed pursuant to the provisions of the Conrado,license Law(Chapter 9(commencing with Season 7000)dee Dlon 3 d the PLANNING NOTES> ',licensed and Professions Code)or the he«she is exempt therefrom and the basis for the alleged exemption.My vitiation of Section > 1031.5 by any applimnl for epermit subjects the apPfiGmtoecivil penalty dna more than live hundred dollen($500D. ****************#****************#*********#*#*#***************#******#***#*#** ❑ I.asearner dthe properlyor myenployeeswebwagesastheirsolecwnpeneatop,wi0dothework,andIMstmaureisndweided DEVELOPMENT SERV ICES REQUIREMENTS or offered ler sale(Section 7044,Business and Pldessons Code:The Contractors License Law don not apply to anovmee of property who holds or improves thereon.end who does midi wait Nmsel or herself or through he or her own employees,provided That such knprovemeds era nd mended a#lend l«sele.1,however,the buMng a knprovemed is cold withinone yeas d coerpldhe ZONING APPROVED BY ion,tDATE: ownerbuider win have the burden d Proving he or she did not build or improve for the purpose d sale), ❑ I.as owner of the properly.am extlushely contracting with licensed contractors to construct the propel(Section 7044,Busness and Profession* mor ons Code:TCentrs Lianas Law doss net toy to en owner d property Mo tads or improves thereon and who BUILDING APPROVED BY : DATE: contracts for suds projects with a centr dor(s)licensed pursuant to the Contractors License Law). 1 ❑ l am exempt under Section: B.APC..for this reason: APPLICATION ISSUED BY: [ �� DATE: \ \1 Date: Owner: #****####*#**#*####****#*********************+ ++ 3sn�l t ######***#*#*# ** LEGALIZATION: N F E E SUMMARY STRUCTURAL SEG ENT:N I do hereby cect4Y that 1 em aware of and understand the regdraments of Catornia Health and Safely Code Sections 25505,PMcan,and 25534.and that I or any future building occupant will/wit not(circle one)need to comply will said state codes end the requirements for e permit for caatma ctionmodfmionfran the Ai a anagement District Residential maWio nnn appitelbroare emend Nem fBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provis1ons. PERMIT 19 . 75 Date: Apwo.nl: 25t SM I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of oneperjury d the following declarations: PLAN Elve mini"'haKM a cent"..c°"°°""°self-insure ler wakwiwmPenesbn.apvil lroedfaby Section 3T00o d the Lab°r NG- 22 . 00 Code.for thepedmeeddiewokforwithtispermn'Sued. BUILDING DIS > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE am ❑ Ihave and wnwidaiiworkers'cmpensationaaumrte as e,Mihethe requiredbySection3700oft the TOTALS > 19 , 75 22 . 00 0 , 00 41 , 75 41 , 75 00 work for which this permit is Sued.My waken'compensation insurance carrier and policy number aro: Career REVENUE DIVISION TOTALS--> COLLECTED: ^ 41 . 75 OVER/SHORT: . 00 Policy Numbs: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK )cis section need m be completed I the penal is ra ale hundred dollar MOO)or la,.l 41 , 75 ' X❑ I abecemcomleNan he pthe wkewrsd amIM pweannekalewLaichr tCodedheCprd eImia e-/74100071,, ;dr"I/cot�" " �a� entetherer waeno i**#**************##**#********#*#**#****####****************## *******#*#*#****1/1 � mg "autn3dhewspt roteo /j40IAINDIVIDUAL FEE BREAKDOWN Fedor sto secure workers'conpensalon coverage la unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up b omits hundred thousand dollars(1100,000A In addition to the cost of competed/or;damages as provkled ler In Section 3704 of the Labor coir,Interest,and attorney*afoes. MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H , 13 . 25 13 . 25 • CONSTRUCTION LENDING AGENCY: I hereby effinn under penally of perjury that then e e constriction lending agency ler the MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 6 . 50 6 , 50 pedamanoe of the work for which this panel is issued(Section 3081,Civ.C). END OF FEES LENDER'S NAME: ADDRESS LENDER'S ADDRESS: end'ism this application coned' all The work authorized by this permit shall end state laws reWig to building cananwion and hereby adhodce representaivee d this city to enter upon the above-mentioned property f«inspection Wryest,. comply with all applicable handicap , a DAV • FOWLER y access requirements under California 1 1 7;1 81997 Pci t � /(Xj statutes and related regulations. .4, a s 1\�.44L1//�/..r��� Dae: LE8M/ sag „ - , --.pp. , ej tra„ �7 (Ord. No.92-28,§ 1, 12-21-92) CM' Or ' TL' MESA h.• (51s14a.WP) White-Building A Safety:Green-Ric Canary-Applicant;Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL °A APPROs%ALS Permit# Date Inspector APPROVALS Permit # Date Inspector LTempoiary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil,ipe•Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd, • 60. Backwash Lines,P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning ,'9'; FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL .- 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION • - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: • 34. Final Heating& Air Conditioning ��// ,C20UGyt - D C! (1/4711 e r. 35. Final Gas Pipe-Test _ 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final - 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison - ' 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No Date TYPICAL 611 CONCRETE BLOCK FENCE Cement Coping Optional - ism. GENERAL- NOTES Channel Block With 1-3/8 �� — I. 0 Horizontal Top of all Fences MORTAR: One Part Plastic Cement, and 6° Concrete Block Fence Il' �',-_ ThreeePartse Sand = GROUT: One Part Cement Three and For Fences 5' or Less f '� 1 One Half Parts Sand Vert. Bars 3/8" 0 at 4'-O' O.C. cc o COPING: One Part Cement, Three For Fences Higgher Than 5' S� 0 '� IParts Sand Vert. Bars 3/8•' 0 at 32" O.C. ' w CONCRETE: Well Mixed 1:2-1/2: 3-1/2 Provide Inspection and �' > III— 1111 Max. of Per Sack/2 Go Ce of Z Water of Cement Cleanout Hole at Location a - of Vert. Reinforcement HI 2p SN -1 REINFORCING STEEL SHALL CONFORM TO Fill Cells Solid With Grout w o L SEC. A-Is-3s A.S.T. M. Where Steel Occurs ALL STEEL TO LAP WHERE SPLICED, 2=O' II w n I' 'I i MINIMUM. GROUT MAY BE POURED FROM TOP OF H 'MMII=EMI HOLESN CELLS WHERE STEEL A OCCURS. SHALL EL SE CLEAR, EEAND FREE OF ALL MORTAR, DEBRIS, ETC.,WITH NATURAL GRADE INSPECTION HOLES AT BOTTOM. /. ` ^"•' %"••'�•%"Weli9 V4444 it i BONDS SHALL BE PROVIDED BY LAYING /7--4-,::�• \ aj/�it • _ 4 • e o •' - •� •' •e• . e - • BLOCKS IN STRETCHER COURSES SO j >.'. ..4 . _o ti _o .e e . THAT p THAT VERTICAL JOINTS ALTERNATE IN TWO 3/8" 0 BARS EACH COURSE. CONTINUOUS I - -- -+i WIDTH TO 16' O.C. MAX. c SEE CHART . • STEEL MUST BE TIED IN • 9 BELOW , DEPTH OF EARTHTOOTH PLACE AT TIME OF TRENCH I• • I til ° 1/3 THE HEIGTH OF FENCE INSPECTION. ? . I, L' BELOW BOTTOM OF FOOTING. 10" toe 2.• -- SCALE: 1/2" = 1' CHART HEIGHT 6 ' 5' 4' 3' WIDTH 14" 14" 12" 12" THICKNESS 10" 10" 8 " 8 " DEPTH OF EARTHTOOTH . . . 24" 20" 16" 12" SPACING OF EARTHTOOTH. . 12' 14' 16' 16' • OWNERS NAME: City of Costa Mesa, California JOB PERMIATDDRESS: : Building Department SIGNATURE: I. FORM 0U25-2M-B-132 i STRUCTURAL APPROVAL ONLY a k o vEo . 4i City • �%% j SEPARATE PERMITS ARE REQUIRED CO 'a eso Building p@ FOR ELECTRICAL, PLUMBING, Dept. HEATING, VENTILATING AND THESE �.BY DgTE. /� REFRIGERATION WORK MAKE P 5 6.1,71.1./2.. .‘ / 'U' NO CHANGES EON JOB AT A 9.. .f OF DEP! ES WITHOUT E TIMES T PRIOR APPROVAL Permit .il. OF THE ISSUANCE OR junROar tiIS Num ErTO gE 6S AND CRAA7ING OF THISNUGBERIw�IST iccO 1!PANY OF ANVgOF�RMIT SFFCIFICATIUrySSFI^I� RMI7 tlR AppgpVAr ��/- ALL INSPECTION REQUESTSSLIMING TO OR' OR AN APP,., ur 6E COtV«TRUfO - - Nf PROVISIOpiS pF `' .L DF, �N; VIOLATIONCITY GPLOSTA PROVISIONS GIVE AUTHORITY TNIS CODE. PLANNING DFPT. OF THIS TO VIOLATE NO PERMIT PRE, FAR AS THE WORK OR CODE SHALL CANCEL mama T BLD°. DEPT. REG. . J. u.,dU.:,�S dH: .c PE.SONS AREl USE WHICH DE VALID, E"%CIPT TNF, THE T AUTHORIZES I� m p0 G BE EMP�O �U, WJE S G tSi THAT T SPECIFICATIONS LAWFUL, 8*(1, i— DATES X7'7 ST:;TC_ OF C LII- 'MA DI91Si0N FROM THEREAFTER SHALL NOT P PERMIT BASED UPOfJ ® INDUS'' AL S FETY BE- E CJNSJLTEU F IN SAID F TEN R REVE,IT LID PLANS AHD DIRECT OP PIANNIN6 ctAt REQUIRING i WALING ADDITiOfi 1L REQUIREMENTS. IN SAID OPEN tATIONS AND SPECIFIC'ATIC,II, OK CORIINV CIhlfl NOF ESEITINV R.S IN NOF THE CITVN F THIS CODEC Le ANY OTHER ollo AD LID III,HILAWILF cta 0 is �I �� RESIDENCE RESIDENCE RESIDENCE RESIDENCE 6. W W W IV Rlt "1 f " O�ysfE STREETth- K OWNER CENTRAL Bible Church DATE 6-6-74 trJOB ADDRESS 190 East J Street "WILDING PERMIT NO. 38507 GENERAL CONTRACTOR Owner-aldr. DESCRIPTION of W1,..ri Demolish Res. AP No. 119-051-56 LOT TRACT FIRE ZONE VALUE $ 100.00 INSPECTIONS S9nature Dote TYPE T GROUP ,y ZONE SOIL ` PERMITS ISSUED GAS SUBCONTRACTOR Date I Number I Signature WATER P'l1umbin• _s ROUGH PLUMBING � V 017. • • i• IA 11/ PROP. SWR. LINE❑ HOUSE CON. 9 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING • TEMPORARY SERVICE OR POLE UNDERGROUND 9 POWER 9 ROUGH WIRING Heating and Vent. TRENCHES 9 FORMS ❑ STEEL REINF. ❑ FLOOR SYSTEM BOND BEAM 7 STEEL REINFORCE 9 SHEATHING FRAME AND FLASHING LATHING — IN ❑ OUT ❑ PLASTER, BROWN COAT STRUCTURAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST 9 • BUECTRIC, FINAL ���34� 9BUILDING, FINAL �a5C7 —fi-� �PA I,.00 319 5.50 / Irric I r ir:r t}{r t} .................. COSTA MESA BUILDING-SAFETY DEPARTMENT . P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely a II'���nt r REC.�IV D BV D/aTE RE/2131 DATE I SUED/ BUILDING 1%V 2 d _d-,r ADDRESS(..84.441,-J (�lj (t,1( I� / t� (� 0alIhQ .N V , A.P. NO. 11q �O5 ��Sb I PERMIT�QCII r OWNER7j-fl MAIL BUILDINGDRS / /` F s / _23rd St Z . ADDRESS ( Z c ADDRESS O T CI-O ` J CITY p (Ul. 40-1o 3NO``j455(.250 TRACT 300 IV til TE . 'LOT 1q BLOCK Z 4 CONSTRUCTION r NEW ADO ALTER REPAIR MOVING f)FMOI ISH O y LENDER Ir 1 �/1��� I Jco 7 BRANCH OWNERCQyi L( ��JN•Q dt UVG _/ J J 4 J ADDRESS /� VALUE -CO ARCHITECT p' I' A _ TEL. USE L.IO V $ J Q ' OR ENGINEER L /fS Sb NO. Z 3 Sa(Syl �^ U N Q FIRE w CZ ADDRESS t'5 S3 lb, ^DV Lu�.#le� ZONE TYPE GROUP-Co . J O CONTRACTOR �M,Q,y h i'-st By DATE DATE(� l `74 7J ir ADDRESS OF.) (` Z. 3 g-1— W Ui / TEL. ZON NO.OF USE OF NEW or CITY f t-'^l NO.04� ,u5 O -L PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED CWn K LIC.NO. '` LIC.NO. MAIN BUILDING ACCESSORY BUILDING D SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT I NOW ON LOT 7 FRONT FT. FT. USE OF EXISTING BLDa e e- __f3.SIDE ET. FT, F- SIZE OF NO. OF 2 NEW BLDG. ROOMS STORIES L.SIDE FT. FT. UEXTERIOR WALL ROOF ' COVERING COVERING 4 D- ' REAR �- FT. FT. �_/ LDING pE DISTANCE 1 USF�F BUITV-e. `+in%.5,' -01 E�L.,Lax—Lf het MAINIfiBLOCST ACCESS. BLDGS. 2 (d,c,,.�� ! 1 VA Q O C.U.P.# APPROVED I— APPROVED& )/ S —' /.t.. C/) _BY WiC. DATE —r/' / 2 0 I— C.) I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with 5i'1 CC all laws regulating building construction, and I shall not employ LV/ F„ any person in violation of the workman's compensation laws of N the State of Califorr la. co ZI hereby certify that I em properly licensed as a contractor under SO.FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a CC am exempt from the provisions oft a State of California Business C7 O� gl and Professions Cn ,D' inion 3, C pier 9. VALUATION — PERMIT FEE $ n 7 Signature of / OHO co,....-- Permittee S 100 PLAN CHECK $ ,, J E Authorized Agent Ste! LL TOTAL FEE $ • ?M82b COSTA MESA BUILDING SAFETY DEPARTMENTNAR 27-67�f15AOO 886 u*****2.CO P.O. BOX 1200 COSTA MESA, CALIFORNIA 52626 •a' For Applicant to Flu In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only BUILDING /20 .23'^I St ADDRESS L CALIFORNIAtiRECEIPT NO. p(Ry TpO2� COSTA MESA. AG6(�rttA n �{. _//� ///��� ®,. RI D T 'DA RED IVID GATEISEflO OWNER CeN/ .Q/ZL. £[ /CC C4Lif 4 DAJI/� 3/4 / 7 1/.Z 1( /'7 MAIL BU IEDIND �9 ADDRESS 1 4 A ,�CFIRE�y�- ADDRESS CITY l ,/IS ( � �L45.9 NOL,514° �� ZONE r� GROUP/� �T� APPROVED 3 2 / 6 7 OR ENGINEER A/O Ne NO. BY ATED /LiY C/ ZONING ADDRESS I.P / // IZE NO.OF USE OF NEW r E�,�LI+�f ��J I PUNS 2 BUILDINGyp lu CONTRACTOR ,460/6/ Skit( G� �/J A Y ,� ADDRESS DESCNmoN /'L2. 10/ .7T1 �2. � A.P.NO. II CITY 5 �CIs / `S-Q NOTE: NO[AVE OVERHANG SHALL BE LESS THAN STATE TEL Sr TO SIDE A REAR P.L LIC.NO. NO. EAVES SIZE I NO.or',Loos. I ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW On WT / YARDS APPROVED YARDS APPROVED USE OF ,'^ ,.[ MAIN BUILDING A CESSORY BUILDING EXISTING BLDG. �v�q.y .SC/in�/ (FROM C/L STRICT/f IITBFCKO LF FROM { 3O / CENTER OF STREET /50 • REAR YARD FRONT FT. / FT. A SIDE YARD I LIFT RIGHT J R.SIDE PT. FT. DESCRIPTION OF WORK L.SIDE FT. PT. NEW _ ALTERATION IV ADDITIQN REAR PT. FT. I DISTANCE BET. BET.MAIN Q ti REPAIR _MOVING -DEMOLISH MAIN BLOCS. ACCESS.BLDGS. I.' BUILDING.2I / ENO.OF �(J VAR.# DATE SIZE ,.i X ROOMS /J STORIES 2I C.U.P.# APPROVED EXTERIOR WAtti ROOF ��II APPROVED// /J/� G COVERING /Q(� I COVERINGS3ki Alc. BY /r�[K �/Q/ DATE A)'z /F77 USE OF BUILDING AN ORK TO BE PERFORMED a :'BLIND A, �c of Pa,o4'i S . m 3. .1fL4L6-r1u,ENr 4r LC!)n,.,ec '-to M,C -t (n n e . SQ.FT. $ . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO . PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. R1 .� PLY WITH ALL CITY ORDINANCES AND STATE LAWS REOULAT G l= BUILDING CONSTRUCTIO VALUATION M'V 2 c20 r% X. PERMIT FEE 5 SIGNATUREO P PERMITTED' • W $ /0O PLAN CHECK $ j AUTHORIZED AGENT ((( CC TOTAL FEE $ uwNER CENTRAL Bible Chunrch DATE 3-24-67 JOB ADDRESS 190 E. % '1' St. BUILDING PERMIT NO. 26826 GENERAL CONTRACTQR OWnei .1dr. DESCRIPTION OF ,RK widen 5 doors s AP No, 119-051-50 LOT TRACT FIRE ZONE VALUE § 100.00 INSPECTIONS Signature Date GROUP B-3 TYPE V ZONE R-2 Soil PERMITS ISSUED y1 Gas SUBCONTRACTOR I Date I Number I Signature Water Plumbing Rough Plumbing Prop. Swr. Line 0 House Con.0 Sprinkling System . Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 Rough Wiring Heating and Vent. Trenches O Forms 0 Steel Reinf. 0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing—In 0 Out 0 Plaster, Brown Coat Structural, Final Electric Heating, Vent, Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final i7 Building, Final / / 2W�7 f1(l PAID <- l3J JUL 20-67-001440 0*:*•,:*2.0( Cf ISA COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 - COSTA MESA, CALIFORNIA 92626 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING Bu1LDING ^a For Office Use Only ADDRESS /9D L p-cl- RECEIPT NO. PCS NO. COSTA_� �� MESA.JCALIFORNIA I( /y [ATE q(. /y.7 . /.}. � OWNER aC4CAYO-L_. , bie c/(cr Ya RECEIVED RAI' / `/9- r-I ? / -D 9' °7 / j� BUILDING /90 a3i MAIL /9.0 L z Y 1 ' ADDRESS !!! ADDRESS�Y / C/ ` FIRE :' CITY[ ?0 5-hi 1'( (o Sa i NO.y Lf rev ZONE TYPE GROUP APPROVED `// µ�//q DATE �J ARCHITECT TEL BY . QQ /� /.0!.lam• /' OR ENGINEER NO. ZONING ADDRESS • 1 E I HOOF US[OFN ^ LAY CONTRACTOR&/, -,t. .c -4- C :az U I BUILDDIND .V�JQV LII`�.N AD4R888 '`'�-��1 D69CRImON oU6 Lor ( % '" 3 0 O CITY A.P.NO. i/ 7-O c/- .5-7) NOTE: NO HAVE OVERHANG SHALL SE LESS THAN STATE TEL Sr TO SIDE IS REAR P.L. LIC.NO. NQ. EAVES SIZE ( NO.OF SLOGS. ALLOWED .(U.B.C.REQUIREMENT) . OF LOT I NOwpN WT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. . ' (FROM C/L STREET) SETBACK LINE FROM CENTER OF STREET REAR YARD FRONT FTt R. SIDE YARD I LER RIGHT R.SIDE FT R. DESCRIPTION OF WORK L.13101 R. R. NEW ALTERATION _` ADDITION k REAR R. R. DISTANCE BR. BET.MAIN e _.11REPAIR MOVINQ _DEMOLISH MAIN BLDG*, ACCESS.BLDGS. BUILDING NO.OF VAR. DATE SIZE IS x ROOMS STORM* / C.U.P.* / / APPROVED p' / /� EXTERIOR WALL I COVERING grown ( I / ,I��A�TC I/ /1 y 1`7 / m COVER �/lVV/666 1 11 8 OF BUILDING AND WOR TO BE PERF RM'�EQq Ia m ol_/ 5 . o41 A i -e - NOA epowaAI — --- SQ.R. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT PEE ONLY. ,URL BUILDING CONSTRUCTION.PLY WITH ALL CITY AND STATE LAWS REGULATING VALUATION /}'� i STSIGNATURE OF01--e/ 1/� PI PERMIT FEE S ✓ 1/ p !�� 9, s / PLAN CHECK S AUTHORIZED AGENT /9� TOTAL FEE S V/� VI/Mb/fp t..tawrtuu, table Church DATE 7-19-D7 J , JOB ADDRESS 190 E. 23rd -treet BUILDING PERMIT NO. 27309 v GENERAL CONTRACTOR Ovine. ,ldr. DESCRIPTION OF RK Demolish Res. 'SAP No.119-O5t-50 LOT TRACT FIRE ZONE VALUE $100.00 INSPECTIONS Signature Date GROUP I TYPE V ZONE R-2 Soil _ I PERMITS ISSUED Gas SUBCONTRACTOR Date I Number I Signature Water Plumbi Rough Plumbing -.4__Ca -4 e". a S4 tinitte Prop. Swr. Line❑ House Con.0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground ❑ Power fl Rough Wiring Heating and Vent. Trenches 0 Forms U Steel Reinf. ❑ Floor System Bond Beam 0 Steel Reinforce ❑ Sheathing Frame and Flashing Lathing— In ❑ Out ❑ Plasters Brown Coat Structural, Final Electric Heating, Vent., Refrig. and A.C., 'nal Plumbing, Final Electric, Final Building, Final la OWNER BEARDSLEY, JAY E DATE 5-28-58 _ JOB ADDRESS 190 23rd Street BUILDING PERMIT NO. 6833 GENERAL CONTRACTOR�r� Owner—Builder VALUE $ 183.00 AP. No.118-051te4 TRACT FIRE ZONE DESCRIPTION OF WORK Chain link fence GROUP TYPE ZONE PLAN NO. 6833 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel Floor System • Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil W/G Pipe Test Top Out Furnace Gas Vents Rough Plumbing Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final Final Gas Test Construction Pole Underground Power Rough Wiring Fixtures, Final OCCUPANCY 7y76/ 6833; Form 210-5M-1-57 1466 FEE RECEIVED ' COSTA MESA BUILDING-SAFETY DEPARTMENT 1 a... _ to l — 0 1 P. O. BOX 917 COSTA MESA. CALIFORNIA Applicant to Fill In Completely FINANCE DEPT. For P Y APP��PAjJpl$ Wil SIT tC 3c9'PE OR PRINT �Q St BUILDING ADDRE Woe", /`/i �C(-LA__ COSTA �MESA. CALIFORNIA For Office Use Only Only qcp OWNER Cef�1�/ Jl�a/ 5//81 ,/ fC.N/U/[ (,f I RECEIPT NO. Ii_ f7ua_3 ADDRESS 23-I.Gi S/ Az-r- on/7-. , RECEIVED BY 1 DATE RECEIVED 1 DATE ISSUED ,�yvJC/ ‘,-/d-6 / It--/6.7 -/ / �, ,e A 1;g1.1.fS33 BUILDING m CITY OJ�IM ib S ^A/Sit dd J`� ADDRESS 3 C / 6t—L_. ...1 - �'-.`'4- . OR HITENEER M4 . I/1/ S i� TEL./ g7f COSTA MESA. CALIFORNIA ADDRESS ! / I/ ;IOW flee BLIP COSTA FIRE ON. TYPE GROUP CONTRACTOR Lf IN�j�i/e B 'IIf / • gl b�ATE ,' yl•o�.KP ADDRESS •r Lf��0' Z. N NG ,_�,,,1},L CITY INO.OF USE OF 14 ,P�L�ANS 2_I BUILDING STATE TEL. LEGAL Pal �, / Off/ �n 7�' LIC.NO. NO. ✓�V ( -��C'� ( / ✓R 3 DESCRIPTION 1 SIZE 7C� G x /83 I NO. OP BLDOS.at /� OF LOT •/ NOW ON LOT ` A.P.NO. 11 9 0 �/— 3 CY/ USE OF // YARDS EVES EXISTING BLDG C Hv/' APPROVED ALLOWED SETBACK LINE FROM ye,/ ^1,9 (CENTER LINE ST.) CENTER OF STREET 7 REAR YARR�D`2/ FRONT FT. IN. SIDE YARD I LEFT /Q I RIGHT D- F R.SIDE FT. IN. DESCRIPTION OF WORK L.SIDE /�T. IN. NEW I II ALTERATION XI ADDITION 1 ._REAR - .0" �/ /'SFT. //_ IN./ REPAIR /J/A J110VVIINGG �qI DEMOLISH I DYPROVED It /JI ey L 0 • DATE (F/�I?_(4 SIZE BUILDING �1 AX,, - ROOMS `+' STORIES / I N ,t,,,717„ /1' l7 /yl/� EXTERIOR WAM., n IgE \ / COVERING by !/ COVERING USEED C.-ki.Ui;DsIJGG ND WORK TOA'TRF....i y Mel"r SADA t- refer ' 7/ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONOTRU VALUATION ry SIGNATURE OF PERMIT FEE $ D{ • 6'Q PERMITTEE ✓LR'Ht �� "" "_ R $ `0 Q PLAN CHECK $ F AUTHORIZED AGENT ` a-0 E TOTAL FEE $ 0 � . 25936 JUL 22-66 001319 n 3_*****5.00 A COSTA MESA BUILDING-SAFETY DEPARTMENT i. P.O. BOX 1200 COSTA MESA, CALIFORNIA 92520 . For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING D � ((�� For Olfke Use Only SU ILDING ADDRESS ---023m1----. RECEIPT NO. PERMIT NO. COSTA MESA. CALIFORNIA ,y T /� /y'/'',,,P// RECEIVED BY �DDATE RECEIVED DATE ISSUED OWNER £1&TTiv/42_�,frgz i yl�zzax1:![ ! X22 64e 7 Z2-4 ) BUILDING .-- MAIL.ADDRESS JoI en,r4 � GC Alt ADDRESS �/�f�/�/ // ^7'�,I t f/ T TEL- ZONE TYPE GROUP ./1.- L FIRE CITY LO,S/ /T /(C�y� NO.�g. o3 _'// 0/,'"A' ARSNIT NEER ����C/G TO. BYAPPROV6D /Y/l� DATE/ £ � 4 '' /, ZONING Cti e. ADDRESS _ l17 /p) ,/ ZONE No.or USE OP NEWS CONTRAOTOR ✓ liii e" �) PLANS /y, - SUILLPI(N�� ADORES LEGALIPTION�(�Y'•--1-(1-✓• L ! , IG _ CITY A.P.NO. //7 — to S /.._ ww�-� J� NOTE: NO SAVE OVERHANG SHALL BE LESS THAN STATE TEL. DO'TO SIDE a REAR P.L. LIC.NO. NO, EAVES SIZE I no.or wan. ALLOWED (U.B.C.REQUIREMENT) OP LOT NoW ON LOT YARDS APPROVED YARDS APPROVED USE OP MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L STREET) SETBACK LINE PROM FRONT 5#1 FT.C3/.- -,e2AI• CENTER or STREET REAR YARD �/� ,p SID$YARD I LEFT RIGHT R.SIDE J7FT, /L /- `- DESCRIPTION OF WORK L.SIDE Cr"PT. Ki149-4-t' Pr. F. NEW ALTERATION ADDITION REAR Kr. Pr. DISTANCE BET. BET.MAIN a REPAIR MOVING _DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING NO.OF VAR.# DATE SIZE (ROOMS STORIES C.U.P.# APPROVED EXTERIORWALL I ROOF SY i tVE . 7,� '] //_ COVERING I COVERING AP I• P . y DATE / O-6(., USE OF BU ILDINS AND WORK TO BE PERFORMED ..- p, 9 eo ,1477E e iio d or uh'FLL 1v,77/ ,LLv7424-'47C 0 '0 /'S P/4NEL .rie-a o.Pr. 1 x I HEREBY ACKNOWLEDGE TMAT.1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE O AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CRY ORDINANCES AND ETA LAWS REGULATING VALUATION BUILDING CONSTRUCTION. SIGNATURE OF rn �, J COB. PERMIT PEE a / w PERMITTER //j�' Che,' el C/u rill 0), ti (iO PLAN CHECK S 9. AUTHORIZED AGENT ...5,OO a.,. ,r+- .. -p:.,. . .•.�:•. .. :-:� -.-, TOTAL PEE PAIL /�. "CT 30-73�tL-001167;t• ***177 -7. 11111.1111n • • • // �/ ^ PAIL' ✓ / 4` OCT 30-73PAs,001162R-d***177.4 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECE�-1j EfjlrBV DATE RECEIVED DATE ISSUED BUILDING /p �j Si- (=�� 7-n-71 3 a ADDRESS 9(/ /L/�(/�\jG{..T`//nJ /nom/ /// OWNER t{n/ rc /-//f//e C�/!I ie • - y. -E:,.; A.P. NO. -ItBUILDING // . ,A/ MAIL ADDRESS /70 �, ,2,9 i, - Z H ADDRESS L -aLi/L11 _ 0 U CITY `�S / �7os� NOL/dYS SOST0 TRACT 300 LOT�L BLOCK , ZQ CONSTRUCTION / { > NEWW4G: rain,ALTER REPAIR MOVING LSH O N LENDER n[(J4j �/ 2 m J U BRANCH O J to OWNER , �'/.(��r.G[/stil�/ 03 J ADDRESS //�J� ALUE a m ARCHITECT / / / / / •TEL.'/ ',t USE/ �/` s, orBD'fl-' J(15 N OR ENGINEER,(.../L�/ d if/ eea t-int/CVO.Ll.LI f prow Uri Z Q /S-9.35 z`7knki-V / U /Utff v.0�E TYPE //� Z , FIRE W 2 I ADDRESS I GROUP IS CLL 39-'2 W Z APPROVED eat.-- J O CONTRACTOR-',/I �//Q 4/-(J(G-fa BY /(J[l�/ DATE lD ` W W ADDRESS 8/04 / 40.7 Pi/Q E? IL/e ZON NO.OF USE OF NEW`e/lu � TEL. Z I- CITY �./4. Gr Ku / NO. J 2- PLANS BUILDING���t /� STATE CITY YARDS APPROVED YARDS APPROVED to CC LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING 7 O (FROM C/L STREE _------ OLOT IF / NO.OF BLDGS. �-z � a/Y,v/ 370 X 2 6 I NOW ON LOT 5 FRONT G /FT '2L 5-7, FT. USE OF / _ / ! �/y/ p�_'1 EXISTING BLDG atie _S.SIDE ' VF C1- 1rjef/6lef•A" fifer I- SIZE OFNO. OF 2 NEW BLDG. / .A I09 _ ROOMS 9 SJyORI S / L.SIDE 2:14. FT. Q EXTERIOR WALL ROOFI / r � 1 V COVERING lPLLO O.VERINGA6P4 -541•17449 REAR ,57/FT. -- FT. / J USEPS BUILD! G AND WORK O BE PERFORMED DISTANCE BET. BET.MAIN& a. t L,////- t S�t I'cJ'- MAIN BLDGS. ACCESS.BLDGS. a Q VAR.# ..75/2.15/ATE O 4 Az- /?-K 50N1 y LLr2 / C.U.P.# 'V/ ^-APPROVED I-0 ,/ APPROVED Z _flY DATE o N (914/7447 (~.1 I hereby acknowledge that I have read this application and state - � / D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ NOLO FOR SPECIAL • • II: .'1.,:°..� F, any person in violation of the workman's compensation laws of ��I+ co the State of California. / rt „ /-I to I hereby certify that I am properly licensed as a contractor under ^ SO. FT, o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: V am exempt fro the provisions of the State of California Business IL and Professio Cm a, 'vision 3,Chapter 9. VALUATION ,�{{ n �PE/I✓'� ^ Permittee a —z- $ /510100X.-•A• to/yr PLAN CHECK/ en S E VVV / +V o Authorized A nt n am./y7. lu 36767 AN8 73Ensa00 737* ****30.50 • • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely , RECEI D ER 1 D D E}}8�§Uf/� ADDREBUILDISS G /9 6 ELS " ',L �O /��J/ Q .... •F_M_ /�J�/5y OWNER G�� K//�zG�✓iaatl ass,,„4„:C� A.P. NO.///-007-5-g. �f ,r/ 369 MAIL BUILDING /70 ^ � Z ADO R ESS �petrOfgr�- ADDRESS CL 0_ U CITY c$ 1rrr ,�tu iii 5 NO.548-57e.3..' ?? TRACT O`D LOT BLOCK Z CONSTRUCTION NEW I ADD ALTER REPAIR MOVING f1FM01 ISH OI- LENDER 40/...7G� `// o- co J D BRANCH - `-T Jtn OWNER C6Nro"L6ece arccfr - •rt LB Oil J ADDRESS VALUE m ARCHITECT -� / // 'n TEL. S C.00�C SOS $ J N OR ENGINEER/ °l/ rg�(.!// Cr. NO. 4.9V-1124• — U Q • FIRE }y�� -3 W M ADDRESS � ZONE 3 TYPE,.....-A- 'c/ aw // '/ /i APPRO,. _,_. •I W Z CONTRACTOR - - ii i BY 1_ • _ iv DATE _i -10 ' co Z �.�{ /' / r LL W ADDRESS JO��/�n Az,..c.+��TEL.i/49 / ZONE EEJ NO.OF USE OF NEW/CFCaC.ar Z H CIT�,c """777^^������"""���"""”' NOSr.J-�o9 K'' _ PLANS BUILDING 416cC- STATE CITY p g/ LIC. NO. YARDS APPROVED YARDS MAIIN BUILDING ACCESSORY BUILDINGUVED (r)CC LIC. NO.t3Sr//96 D O (FROM C/L STREET) SIZE NO.OF S. OF LOT NOW ON LOT FRONT S FT. L FT. USE OF 4 / �J /J�j�' EXISTING BLDG. Fi B.SIDE `T/ FT4FT. I- SIZE OF NO.OF 2 NEW BLDG. ROOMS STORIES L.SIDEO���JJSFT. FT ccTA-TE\ EXTERIOR WALL ROOF L� \ _ COVERING ICOV EKING REAR / FT. T. -I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& A' ba a a MAIN BLDGS. ACCESS. BL Q ,J _ / / VAR.* DATE TAX O �. e. L 3 Z�ya,/.7$--" L'l/OOCI C.U.P.# APPROVED F- APPROVED/ to .LT/� PFJ �strF HY !401 DATE�� o .e0T ' - 1 .LD FOR : •. REgUIRE VTS ii UI hereby acknow edge that I have read this application and state 1 D that the above information is correct and agree to comply with -kr ' rj.rer all laws regulating building construction, and I shall not employ � � F any person in violation of the workman's compensation laws of . ' , i' /rya/•....sp � 1...�/ !'A the State of California. - �i Q d to ZI hereby certify that I am properly licensed as a contractor under / SO. . . o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0 am exempt from the provisions of the State of California Business VALUATION a and Professions Cr a vision 3,Chapter 9. �/ CO COPERMIT FEE $ 20 3 Signatur. '7 ,..,/,.. n J'� m Permitte'.t/-. __-- �� $ 2000 PLAN CHECK $ 7 E 0O ° Authorized •gent .3E9 u. TOTAL FEE $ `-: ' 28984 1 ' . COSTA MESA BUILDING-SAFETY DEPARTMENT APR 2F, G7�I; O011155'k r = + 13,50 P.O. BOX 1200 COSTA MESA, CALIFORNIA 92620 • For Applicant to Fill In Completely APPLICATION FOR.PERMIT ,,e, TYPE OR PRINT BUILDING - ,] ,For Office Use Only 1 ADDREISS /%®O.' tT Ys' i- !ter ..•• •^^ q(pT, � CI ] RECEIPT NO. I PTE U[ COSTA •MESA; CALIFORNIA _ . , 1 RICE- 1:0 EY - CE E• DATJ�q B o OWNER • '.. - i JP I I -a . -. I �/I S ~ /3 „•, ICDING ' ,9, lII MAIL 77�, l to J .) 5--f�• .. ., ADOREBQ' /.'D �(� �) ADDRESS Y� 7Jf- TBL. iJ .FIRE". i Lf 1 1 ,G CITY at..:191..?- .• "NO. , , 1 , . E •ROU"""P��/ ,y ARCHITECT - V•'' `) •r 'n7.' 'TEL. APPROVED /��//J y'`y_/� 0 a BY / DATE / o (o OR ENGINEER NO. _ . •' 1:- ZONING . ADDRESS ' ZONE - NO.OFt'' U[[OFN[w' CDUCATW AL dales., f /,] , i i L ..�_2,I Pu•ns .0 I BUUDIND U Al I T CONTRACTOR(Q}L,^, f✓/-) -4(V�//SIJ c ADDRESS �(f/ €.`.l�•rd� I.3J A n , 1 _ D[YCR11PT1ON P. V. . , 9 •T! Ng 3« {{.. r'. . - I t.L.: CITY � ,L///�7. A.P.NO. I 19 - 05-I -' SD STATE TEL. NOTE: NO SAVE OVERHANG SHALL BE LESS THAN 8O'TO SIDE&REAR P.L. LIC.NO. NO. SIZE Q0 X AGO NO.OF SLOGS. / VES ALLOWED (U.B. REQUIREMENT) OF LOT SArt-7��a)iL I NOW QN 40T YARDS APPROVED YARDS APPROVED USE OF //@ 5 MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. /C ie.-fru ,{ /�/� (PROM C/L STREET) SETBACK CENTER OPINE STREETN4O ' be1 I REAR YARD g 1 FRONT ?92- PT. I .,..021 Mile Fr. SIDE YARD! LEFT / 1 f 1 RIGHT .d L/ R.SIDE 2,0S PT. ¶ 1�'Y FT, DESCRIPTION OF WORK I..SIDE'2-'�? rr. FT. NEW ALTERATION ADDITION REAR Ill RT. DISTANCE BR. 40 BET.MAIN B REPAIR _MOVING X_DEMOLISH MAIN BLDQ4S ACCESS.SLOGS. VAR. Bldg. Moving DATE BUILDING (0NO.OF 11539 4-17-67 SIZE ��x 1 ROOMS es, C.U.P.# APPROVED ' EXTERIOR WA I.� ` ROOF APPROVE COVERING '.J�Y.(Aen COVERING 77 , SA-1 a C'S' ?/ eY �n tR- DATE 4— $—( 7 USE OF BU ILDIIR AND W,,QQRK TO BE PERFORMED O. +01.4•..."I..]FIE -H.,r vflVenuC .�,,, -i L FOR SPECIAL 2EQUIREMENTS T /E1 � SEE REVERSE S-DE SQ,FT. C 1 HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT TEE ABOVE IS CORRECT'AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. AND STATE WITH ALL CITY ORDINANCES AND LAWS REGULATING VALUATION PI BUILDING CONSTRUCTION. /]/ (I�, SIGNATURE OF /n� ? �/n���f PERMIT FEE $ / /vTLJJ PERMITTER (�lPlLY`�M�LYl ^�/]///,�,/�//{/�/y/� AUTHORIZED AGENT L!i �$`-T/`i `i �/ PLAN CHECK $ 5O R' - .: ......,a„.,.,y- TOTAL FEE 5 /3.50 o- SPECIAL'REQUIREMENTS:' 1. Bond in the amount of $2,000.00-to tie provided. " "- - ' 2: "---Fire Department and-Police°Department -must.be notified of - exact. route_ to be-taken_and the time, that- the moving will - occur.': -- - - - • 3. "Building"must-be 'inspected andapproved before re-location. _ _. . 4. Completion.within.-si*ty .(60) days after date of delivery. 5'. Shall meet, all the requirements of Title 19, Health and Safety Code; shall-meet`all -requittlenss- of. the Uniform Fire_.. . _` _" _ ._Code,-_1961 -Edition; all occupancies .for proposed move-in . to have 'two exists exits directly to-outside; additional - 4 -tire extinguishers as per Fire Department requirements. 6.„_-Arrangement. for_additional on-site parking to be provided for the interim, period• until the Master-Plan- is executed '- -- - -under-the-direction'f' theDirectorofPlanning. • _, - - . -- -- - . -- - - . _ 1111 IIIIF PAId [1.0.; ".9Y 17'7l'PAL; , 724 ; ,ttd-I8.50 38419 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 / • • ' IC•TION FOR BUILDING PERMIT For Applicant to Fill in Completely RE• - e • :6 D; E RECEIVE; DATE ISSUED BUILDING ,( Sr �7 ADDRESS ///�f��r�' /d"3 ' 5------ --y ie ��#F— U�-A PE- `,� e.1. OWNER / - A.P.NO. # — © -...54-, 1111 a MAIL /� BUILDING i ADDRESSSS�fa C' a ?� era--C ADDRESS /90 S. �� �. • S/. �CC.9 ' ' NOL' TRACT 3 fDO LOT / 9 BLOCK Z . CCCiii/// F� IL W CL Z0 CITY �p Z CONSTRUCTION NEW ADD ALTER REPAIR MOVINQ f7FM01 ISH Z - cn LENDER J D BRANCH �j eh J N OWNER �P./ne tea'/ X4 / h/7d, Q W ADDRESS mQ ARCHITECT TOL USE /QC / /�ct//VALV$ ra60 ..,' U to FIRE 7/I (� W¢ ADDRESS ZONE / TYPE „ GROUP J Z CONTRACTOR-CD QL0 4 BY !Mr A'v. DATES f 9-7 •—/ /(L m Z (617 i s - /zeecr _Tiill ill ADDRE q f�-� L _ ZF CI !.i!/7I-j4�� NEL. 591;i7 ZO � PLAO BUILDING /OGiC �C[�� STATE / Y 6 YARDS APPROVED YARDS APPROVED to 2 LIC.N -5777-16 LIC.NO /7 MAIN BUILDING ACCESSORY BUILDING D 0 / (FROM C/`L/S7 REST) /+ ���J/ OF LOT SIZE INOW ON LO FRONT '7 O FT. e , 23FTS/- USE OF R.SIDE 'VC FT. Oa�CFTE/ EXISTING BLDG. F SIZE OF NO.OF 2 NEW BLDG. . ROOMS STORIES L.SIDE 0 FT. FT. / UEXTERIOR WALL ROOF t _ COVERING COVERING REAR 0 FT. FT. \__ J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 1 MAIN BLDGS. ACCESS.BLOCS. /' _....e/-:-/ VAR.* DATE O (0 � $E' -to('-t _ C.U.P.yp APPROVED H / /i -��, APPROVED/6W) Ter- z ( J�� /1�7� �Y DATE �)7�7/ I 0 CIE. `�CU1 hereby acknowledge that 1 have read this application antl stalethat the above information is correct and agree to comply with `1Cr all laws regulating building construction, and I shall not employ r, any person in violation of the workman's compensation laws of N the State of California. to Z mI hereby certify that I am properly licensed as a contractor under SO. FT. a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, an at 3' licensesare in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am euemp rom ro the rovisionsOf of he State of California Business VALUATION and Prof sions Cno ,Division 3 apter n m PERMIT FEE $ �G N D Berm lttee $3.-25 7� JPLAN CHECK $ {/�� E lk Authorized AgentIlk /J `� �/)yj — o — — (/f 0y / LL TOTAL FEE $ • L, .-71,14‘‘ • '‘ 35992 — *** Ia '- 7306:00 19-7 06:00 950') 2 �.'S6 r COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APP IC ION FOR BUILDING PERMIT For Applicant to Fill in Completely �I i-. R /V Bi 7TEpiElV�Q DATE ISSUED BUILDING ADDRESS nI r%U)L j� Z S� C/ I M 7.J( OWNER (met- `k'. I I-11 k (Lw ire bit A.P.NO. PERMIT NO. MAIL BUILDING ( q fr n bre- ADDRESS jCd&V.e' ADDRESS I l� L J �� Lilts;Z / 1 _ d U CITY (j ) (V��j<' A. TEL.p/. S�L�'+ TRACT LOT BLOCK Z Q CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOI ISH O N LENDER N J 0 BRANCH //'� �/) /� 1 (/J� / Jtn - OWNERI NVPA-L 1. NGLa Li-kW-c- c W ADDRESS0L CO J /� .p."� VALUE/35.6W ARCHITECT ll I TEL. USE tALA $ J < OR ENGINEER ./`.':V tel N\t, Y • NO. ' UQ FIRE �/ ,- WA^ M ADDRESS ZONE TYPE: 1 IGROUP n_W APPROVED .JJI ✓ W Z CONTRACTOR BY DATE Jp IYI Z J CC ADDRESS W W ZONE I NO.OF USE OF NEW 01CITY TOL PLANS BUILDING ZF- _ W O STATE CITY YARDS APPROVED YARDS APPROVED NCC LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING D U SIZE I NO.OF BLDGS. (FROM C/L STREET) OF LOT 143 X `� NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. C_ It irilaC-11. It SIDE FT. FT. 2 NEW BLDG. 7O X i LS ROOMS I Z- STORIES Z L.SIDE FT. FT. Q EXTERIOR WALLROOF ' o COVERING 6I Uc-C-t COVERING CU-LY1'7 . , _REAR FT. FT. -- - J USE OF BUILDING NWORK Tr PERrI.ORMED DISTANCE BET. BET.MAIN& 1 CA,, r[ 1.\ .,�� q C r.,,i S,L` I II ik L MAIN BLDGS. ACCESS. BLDGS. a — Q /� fI VAR.# DATE Q -yvt Or i4_. �i-�"1 .•P+ I - W�1-n,�. - C.U.P-# APPROVED I- / I APPROVED CO Seir\/tC-.05 RY DATE 2 O S • .2a � l UI hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ F- any person in violation of the workman's compensation laws of the State of California. re Z I hereby certify that am properly licensed as a contractor under SizEil -Q. FT. // 0 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN.t NDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exempt from Vie pfovisions of the State of California Business VALUATION 2 and Professions Code, ivision 3,Chapter 9. °: �/ /761 �-7PERMIT FEE $ Signature of � Permittee /////�/////SSSSSSI��///!!!!!!( $ ��®®� PLAN CHECK $�� ��F Authorized Agent (((///��� LL ...\ ,. TOTAL FEE $