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HomeMy WebLinkAbout220 23RD ST - Building Permits i . te- is:- 4L CITY OF COSTA MESA BUILDING DIVISION 1.1 "--i' ' DEVELOPMENT SERVICES DEPARTMENT, PERMIT NUMBER • . PERMIT E00-00349 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 220 23RD ST Status: ISSUED Suite No Applied: 04/17/2000 Vicinity: MEDIA ONE CABLE T.V. BOX Issued: 04/17/2000 Parcel Nunmber: TPN00027 Applicant: THOMPSON, TOM ISSUED BY: Address: 1835 WHITTIER COSTA MESA,CA Phone: (949)548-1735 SUITE A-12 Zip: 92627 Owner: CITY OF COSTA MESA Address Phone: Zip: Contractor: THOMPSON AND THOMPSON Address: 1835 WHITTIER COSTA MESA, CA Phone: (949)548-1735 SUITE A-12 - Zip: 92627 • License: 550936 SCOPE OF PERMIT INSTALL ELECTRICAL METER FOR CABLE T.V. POWER SUPPLY FOR"MEDIA ONE". 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 0 Transformers.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 Wiring System/Ckt $0.00 0 - Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0:00 0 Motors to 1hp $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 $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 . Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00 Intermed Pole • $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 .r -5 I , 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: ` �!7 Carrier: Sl2- 'C rCW,,O SE1 EZ)."- � Policy Number: l 0! ' 76 ' (This section need not be completed if the parka is valued at one hundred dollars($100)or less.) O I certify that in the performance of the work for which this permit is issued, I shell 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 p�f�1{\15Ig�S �( Applicant Signature: C�- �— Date: Cle- -/ 7- 00 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($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 provisionsyf 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.# C-5-0 9 Oo Class it C.-7 Contractor's Signature: G;c . HJT 42. _ Date: V /7- O C3 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 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. 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: O 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). Doesw _—_orurb __r__ .__— __ sm _)? 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 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 101 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 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 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. C1I lure 01 Legal Owner(s) Date �v-- • nd/or y- 17- co Authorfzed Applicant Date CODE# INSPECTION TYPE INTRIALS CODE It INSPECTION TYPE DATE, INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool,Spa Final 20 Final Plumbing gLy yr,200 Final Re-Roof 210 Final Electrical 4a16,00 201 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 2446-46 . - �� •+ �� ul+ ono uioo Uk(A.N(,E, (MAS1 fib Lei UU1 FAX COVER SHEET .T 'eti SOU1HERN CALIFORNIA EDISON An EI)ISO%INTERNATIONAL-Company HUNTINGTON BEACH SERVICE CENTER TO: Burt Morgan City of Costa Mesa FAX NUMBER: 714-754-4856 FROM: Edison Planning Department PHONE NUMBER: (714) 895-0363 Edison Site Releases For Media One Cable TV Spots P/S 11 Address fp(e6 19 A4 Mtier- -)€1 A / 254 Oe.i 016„e 22A ✓ ZZo Z3rd. CS 3 159 Cat NUMBER OF PAGES INCLUDING COVER SHEET Please notify sender if any pages are missing (714) 895-0244 - PAX 54244 SOUTHERN CALIFORNIA EDISON COMPANY 7333 Bolsa Avenue, Westminster, CA 92683 -FAX:(714) 895-0188 -PAX FAX: 54188 • J ADDRESSOF BOIONG: 220 23RD ST user: CITY OF COSTA MESA - BUILDING PERMIT OYMERS NAME IF IWOMm SCHOOL, COSTA MESA UNION PERM NO: B 074342 ADDRESS: DIST %NEWPORT-MESA UNIFIED PERMIT NO: B 074342 PLAN CHECK NO: 03838-95 L GOVT: Y SUPP: N SCHOOL DIST P 0 BOX 1368 APPL.MMLING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: 0TH ARCKOECTORENONEER: ROBERT L . PEDERSON uc.ND.: UNKWN JOB DESCRIPTION : DEMOLISH & REPLACE ' TOT LOT ' EQUIPMENT SQ FT: 40, 000 ARCILORENWSADDRESS: 20271 ACACIA ST UMT: SANTA ANA HEIGHTS CA 92707 CLAIM VALUE: 40, 000 . 00 CALC-VALUE: 40, 000 . 00 GROUP OCC: A-4 / CONTRACTORS NAME CONTRACTORS MMEBio COMMENTS : THE "LINDBERGH SCHOOL PARK" ' TOT LOT' PROJECT ADDRESS: UC.NO.: ***********************************************************kb******************* OMT: ZONING R E Q U I R E M E N T S LICENSED CONTRACTORS DECLARATION:I hereby all inn under penally of perjury that I em licensed under provisions d Chapter 9 S E T B �' C K S (commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is in lull force and effect. CITY uC.NO.: LIC.CLASS: LIC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING n FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN NER BUILDER DECLARATION:N:ness anby d under penaly of perjury thatcountyexemptquires permite townors License Law forve. PARKING REQ: PROW PARCEL : 11909114 ZNE: I&RS REF NO: lolfowng BUILD(Section ARA Business era PMeseone Code:Any coyer aI am which from a perms to tonsure,seer,improve. demolish.orrepan any structure.prior n is issuanck osis requires the applicant for suchpermn to Rbesgnedstatement that he orshe PLANNING NOTES> INSTALL A NEW TOT LOT AT THE LINDBERGH SCHOOL SITE. 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 Ihel 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 penally of not more than five hundred dollars($5001). *********************************************************************3t********* ❑ I,as owner of the propend or my empbyees with wages es their sole compensation,will do the work,and the structure is not intended DEVELOPMENT SERVICES R E Q U I R E M E N T .S or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply loan Owner of propend who builds or improves thereon,and who does such work Itself or hersel or through he or her own employees.provided that such /� 1�. improvements are not intended or offered for sale.f,however,the building oingm oveeM is sold within one yew of completion.the ZONING APPROVED BY : CO l)K. DATE: <5-23,, 5 V ownerluider will have the burden of proving he or she did not build or improve for the purpose of sale). / Q I,as owner ci the property,sin exclusively contracting with licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED BY : S DATE: /2- /r//'C/ Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon end who contracts for such projects with a canractor(s)licensed pursuant to the Contractors License Law). • ❑ Ieme mptunderSection: B.a P.C.,for APPLICATION ISSUED BY: - - . .m�_ ' . DATE: /z6 0-5� 1 "ZS^aS owner: ( �12. ,- ��_ N******************LE** * * -*. . 4. *. *•********************** — Date: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT: Y I do hereby certify that I am aware of and understand the requirements of California Health end Soley Code Sections 25505.25533.end 25534.and that)or any future building occupant roll/will not(circle one)need to complywth said mate codes andthe requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit Iorconstructdn or modification from the Ai ueD lyty anagement District.Residential construction applications we exemptfrom these provisions. PERMIT 349 . 50 Date: Applicant: PLAN 227. 18 SMIP//NONN-RES 8 . 40 WORKER'S COMPENSATION DECLARATION:h hereby affirm under penalty of perjury one of the following deduction: ISSUE FEE o I have and wil maintain a certificate of consent to seffinsurs fa waken'compensation,as provided for by Section 3700 aegis Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code,for the p.rferperformance d manlh.waktorwh mpermit e h .peased. TOTALS----> 0 . 00 0 . 00 0 . 00 0 . 00 . 00 . 00 I have and coil maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which the permit a issued.My workers'compensation insurance came and policy number are: Carrier: REVENUE DIVISION TOTALS--> COLLECTED : .00 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This aepion need not be completed I the pwmt is for one hundred dollars/$1001 or less.) ,L•7,/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 lawn of California,and ree that if I should bject to the workers' ******************************************************************************* compensationensprovisions of Section 3700 of the Labor Code.I shplI fort th cont with those provi io . t , IND IV IDUAL F E E BREAKDOWN -� Date: C _2.S.-4C Applicant: 1l. L1(.Q.C� '�L Waning:Failure to secure workers'compensation coverage Is unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dd/sn($100,000),In addition to the cost of compensation,damages as provided for In Sectmattorneys SFC 40000 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 40, 000 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES performance of the work for which the permit is'issued(Section 3097.Ciy.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that 1 have read this application and stale that the above information is cored.I agree to comply with all city end county ordinances and state laws relating to building construction and hereby authorize representativestof the city L'0 enter upon the ebove.mentioned property for d insPean Purlaeee. 4-.41-s-1/ '1Lz«MA tee%/aiLl akn /%114---- C3S _ Print Name I (��7 _ _ Date: Z • vis.._ iC fgnatureofOwler/AgenvApplCant)Conuector er mi 0U15097'5-0121599 CS TOT .G0 DATE: 449/_6/95 TINE: 12:05 (5151410.WP) White-Ouid'ag 8 Safely:Green-Fie:Canary-Applicant;Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNINb • • .,OL & 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 i 17. bough 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 ❑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 //9.-5� may_/L / 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date t \ PROJECT ADDRESS: 220 23RD ST / UNIT: CITY OF COSTA MESA — BUILDING PERMIT rnxrL /NU: t. vowl,a + OWNER'S NAME: SCHOOL, COSTA MESA UNION ADDRESS: DIIST SWPORT—MESA UNIFIED PERMIT NO: E 065016 PLAN CHECK NO: N uLV vvi : N Durr : SCHOOL DIST CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH P O BOX 1368 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : TEMPORARY POWER POLE FOR CONST TRAILER SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALL—VALUE: GROUP OCC: B-2 / PERMITTEE: TEMP POWER SYSTEMS (714 ) 632-1999 agDREss: 1111 ANAHEIM TUSTIN AVE CA 92806COMMENTS . TEMP LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G REQUIREMENTS 70001 of Divi ioo t0 usiness and Profen s Co tl my lir lull fart d effect. SETBACKS CITY LIC.: v.3 4 STATE LIC.: °3 e3 C ' C-1 ° MAIN BUILDING ACCESSORY BUILDING Date:___U_172 . Signature: —y� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN WORNERS'CO PENSA ION DECLARATION: I affirm tlhave dicate of consent oo sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation 11suryPcela at?{tdieddcopy thereof(Section 3800.Lab.9i.0/01 /9 4 (' POLICYNO.: STATE EXP.DATE: PARKING REQ; PROV: PARCEL: 42522111 ZNE: REF NO: COMPANY: PLANNING NOTES> ❑ Certified copy is hereby furnished. 15 Certified copy is filed wit Building Division. > �t1 i vy ********D*E*V*E*L*O*P*M*E*N*T***5*E**R*V*I*C*E*S***R*E**Q*U*I**R*E*M*E*N*T*S******* Date. Z2 ICI?, CLAR Applicant_ `�/—� EXEMPTION FR M WORKERS'COMPENSATION DECLARATION: (This Imo need n e template permit is for hundred(as Do)or lose I certify that in the performance of the work for which this permit is issued. shall not employ any person in any manner so as to become ZONING APPROVED BY • subject to the Workers'Compensation Laws of California. DATE Date: Signature: BUILDING APPROVED BY : • DATE: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor q which this permit is issued(Section 3097,Civ.C). Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED B Y: --- DATE: \1 122I �3 CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for *************************************3***************************************** ******************************************************************* *********** LENDER: ADDRESS: LEGALIZATION:N F E E ; SUMMARY STRUCTURAL SEGMENT:N owNERBUILDEROECLARATIDN: Iherebyanirmthat lamexempt aommeContractors'State licenseLawforthefonowingreason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING OWctionNER BUILD Business and Professional here Cy affirm Any city of county womb requiresot a permit to construct,alter,wf rimprove,full wing demolish,or PERMIT 15 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 50% SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 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 more than five hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I, as owner of the properly 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 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 30 . 00 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: TheContractors'State License Law does not apply to an owner of property who builds or improves thereon **.**.*.N,.7(.*,****,)f**.N.*i4.lE*,iF**,****,*****,N,*,lF*****,*,1(,************************************* and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me, IND I VIDUAL F E E BR EAKDOWN o I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: owner: ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 15 . 00 15 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safely 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 Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify That I have read this application and stale that the above information is ei •: I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize repres••. f this city to enter upon the above-mentioned property for inspection purposes. Date':JI / 7 Signature: / 01 00151111-0'0151111 Y4}T 30.00 ``[[ '� DATE: 11/23/93 TIME: 15:31 Driver's License or Social Security it f 1641,46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor A CONSTRUCTION AND PLANNING PUOL & 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, 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 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 "9. FINAL INSPECTION 32. Electrical Power Meter-Final /144b3 • "3. FOOD CERTIFICATE ISSUED 33. Final Electric kk ill... ' otes: 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 11111111111111111 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • / fY OF COSTA MESA - - PERMy NO. / TRACT NO. ' LOT NO. , BLDG.NO. NSTRUCTION PERMIT •• j37Z.34 7}.�/ /y� �`CE� y( • - Applicant's Mailing Address 7 2 : 2 VS nSCt. ccta111f4G TYPE OF CONSTRUCTION - LI NEW -LJ ADD U ALTERATION LI REPAIR , I `�✓ �' �� ./ ,rJ - Project Address 2-2('7 23 CQ'' l'OSV a-netts ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - , �,(^'' .-) •�. (L9 fLSOIV - ' Phone g3'?-24[7D DESCRIPTION OF WORK S 1 l"'� ZONING REGULATIONS';, I / T•_ Owner's Name \ 1 / / / J Address I IS I( 1�fz�Q�'•�-� e ' y� TYPE OF PERMIT U GRADING U FOUNDATIONIOL7 $T RUCTU RAL A.P.•s. 1/ %-o i-/Z ZONE . ( ji /\ -S Arch/Eng. A-r /4 V-/P.. License NO.' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL PLNG.REF.I. BUILDING - . Address • ❑ OTHER TO BUILDING ecrwnrr MI C-1" Contractor's Name t!) /13 Phone PROJECT DESCRIPTION SQ. FT. - OCCUPANCY PROPERTY LINE .REAR YARD (TO P/L) - CONSTRUCTION TYPE VALUATION$ 4/50 .a-� LEFT SIDE YARD RIGHTSIDE YARD . • Address(melting) • ZONEPKG.SPACE REQ." GRADING CU.YDS. ACRESPROVIDED - License No. - - • ' LICENSED CONTRACTOR DECLARATION • Remarks: • STREET WIDTH PARK FEE$ • - • I hereby affirm that I am licensed under provisions of Charter 9 (commencing ' - - • I with section 7000) of Division 3 of the Business and Professions Code,and SPECIAL CONDITIONS: my license Is in full force and effect. , •ense Class - License No. , PLUMBING , :e Signature • WORKERS'COMPENSATION DECLARATION • Bar Sink • Sewer Cap ELECTRICAL :. _ I hereby affirm that I have a certificate of consent to self-insure or a certificate. ' Backflow Preventer - . --- ' -Sewer Connection - - - - Automatic.Washer _ - !Meter Dover 100.amps _ -- of Workers' Compensation Insurance, or a certified cops' thereof (Section • - ' - • 3890, Lab. C.) • Backflow Irrigation Solar Collectors Construction Pole i5ub Panel Policy No. ' Company ; I _ Cooking Unit Sub Pole 8 Certlfletl copy Is hereby furnished. ' Bathtubs Solar Piping , Certified copy is filed with the city Building Division. • Clarifiers Solar Tank Dishwasher Motors 00-1 HP ❑1X48 Date Applicant __ -•-• - _- EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dryers ❑Gas' ❑Electric Inc.SDlar ❑9-15 HP 016-15+ , (This section need not be completed if the permit Is for one hundred ($100)or Dishwasher Swimming POOI w/Spa less). Fan • Microwave , I certify that In the performance of the wo fo which the perm It is Issued I Drinking Fountains Urinal • , shall.not em toy any person in any ma rmf subject to the I F.A.U. Pole Light worker ,C pY§§��v�,,tl�o Laws of Cantor Floor Drains Water Closet • Date ,� t Signature ��� Fixtures Range NOTICE.If,af((((ar making this declarat you should become subject to the Floor Sinks. -Water Heater • - - - - - - 9 - Workers' Compensation provisions o the Labor Code, you must forthwith - Device Boxes comply with such provisions or this' permit shall be deemed revoked. Gas Service Outlets ' . Water Service - Sign • CONSTRUCTION LENDING AGENCY - Outlets ' I hereby affirm that there is a construction lending agency for the performance Interceptors _ - _ .. Standing Sections of the work for which this permit is issued (Section 3097 Civ. C.) - ' - Switches ' Lender's Name __ Kitchen Sink - • Trash Compactor Lender's Address • - arbage Disposal OWNER BUILDER DECLARATION Lavatories. - / • I hereby affirm that I am exempt from the Contractor's License Law for the P-Trap - Generator 00.5 KW ❑5-15 KW ' - following reason (Section-7031.5 Business and Professional'Code: Any city or ' ' - - - , Wounty which requires a permit to construct,alter,improve,demolish or repair . . Transformer 015.50 KW - - y structure, prior to its issuance, also requires the applicant for such permit Roof.Drains $ ' -- ' file a signed statement that he/she Is licensed pursuant to theprovisionsof ❑5U+KW.'The Contractor's'Llcense Law-(Chapter 9 (commencinglwith Section 7000)of 1 -. - - I ,Reinspection Fee $15 Division 3 of the Business and Professions.Code) or.that he/she is•exempt , Showers . Reinspection Fee $15 - • therefrom and the basis for the alleged exemption. Any violation of Section I .- - Meter ❑up t0100 amps ,issue Fee� - -$ 3 • 7031.5 by„any applicant for a•permit -subjects- the' applicant to a'. civil • I - , __ ._ ' malty of not more than five hundred dollars($500). Service Sink•, , Issue Fee • $ 3 :Zoning Approved By �•' J��. 'Date S a 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 • - I I -• MECHANICAL , , Application Approved By Date 2-3 J for sale'(Section 7044, Business,and Professional Code:.Thal Contractor's C License Law does not apply then owner of a property.who builds or Improves ' Boiler Refrigeration System 1 Application Issued By -J Date 4 Z thereon,land who does.such.work himself/herself or through his or her own employees, provided that such improvements are'not intended or offered for , - ❑0-100,000 BTU ❑100,000 BTU , . sale. If, however,the building or Improvement is sold within one year of com- ( Duct.-Under,Ground r SUMMARY OF FEES • • . elation, the owner.will have the burden of proving he/she did not build or Im- . �, • I . 50 1 , drove/or,the purpose of sale). j I I Duct-Structural System Repair/Alteration BUILDING PERMIT $ /Q. ' SMIP i $ I LJ I,as owner of the property,((am exclusively contracting with licensed con- I Thel Contra constructr's projectLicensdoes not apply Bolan owner of property Who 1' 1 Duct-Ventilating _ - - - , - , - - .__ _-I 'PLAN CHECK; $� sn CO I I PERMIT f builds or Improves thereon,and who contracts for such projects with a con- l , Exhaust System 0 Multiple❑l ;PLUMBING . $. ' • ISSUANCE , $ • tractor(s) license pursuant to the Contractor's License Law). I GRADING ! $ ' ❑ I-am exempt under Section ' l B.B•.&P.C.for this reason t . Firepl/Fact.BI[.ICBG# I I • (PLAN CHECK: $ I 1 $ ELECTRICAL' S. • ' Date • Owner • - . Heating'System& Ducting ; I ' i ' - 'PLAN CHECK' $ 1 MICROFILM $ I-hermat ionrtify that I.have read this application acrd state•tiet the above- ' - ❑-100,000 BTU•❑100,000 BT1.�— --• - Information Is correct. I agree to comply with all city and county ordinances 'MECHANICAL $ • TOTAL,FEEI $ ' and state laws relating to building const(:uction,and hereby authorize repro- HOOd O! ' - sentalives of',m city/�'��� �p�ter on the above-mentioned pro rty r I TypeI ❑i . Reinspection`Fee ' $15 PLAN CHECK $, LESS I . inspection pure 5 2 53 Canopy; Type II 0 LESS - ED'PC • $ 5lgnature Date Registers l Issue •Fee l $ 3 I i ; FINAL FEE • $ ' (7.e/---- 11 Drivers' Uteri or SS# - - - g , ' CMF 0865-46 rev.12/82 •White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor �ONSTR UCTION AND PLANNI N,. i;.- _-- -- ' - )L-&SPA - -- -•- • . - , • ' ` -•'Dater Inspector _ - . Date Inspector - s SAPPROVALS Permit#' - - - -'APPROVALS '' -Permit.# tt, !Tempo?ary:Electrical Service or Pole L' ? - - • .52. Pool 8/Equipment Location ' , ' , - -• _ • a 2. I Soil'Pipe-'Undrgrnd >' - _ . '' 1 c ' ^ '53.' Steel Reinforcement - _ ' •- - 1 G 3: Electrical I Conduit Utility-Undrgrnd I - • ;54r' Forms.- I r.Q ei 4. 'Electricsl Conduit-Undr rnd.= >'• ' ' ° 1,1 i _ • . .. 955: Electrical Bonding , - b: Steel Reinforcement ; ` - - u •-_, _' r _ 56. Rough.Plumbing,&'Pressure Test l•- :6. "Electrical UFER,Grnd. t 2 p : t - 57: APPROVALTO-COVER-GUNITE- ' ' ' 7. Footings • ; . - -' , , ' ; ' ' 58. Electrical Conduit-Undrarndr . 8. 'Foundation ' l • - z '59. Gas Pipe,•D Undrgrnd.,Test' 9. .Wter Pipe-Undrgrnd. " - '^60. Backwash Lines,P Trap, ❑'Undrgrnd. ,� ' 10. Structural•Flo_or System i '-',t 'i 1 , , ' •_r ,61. ,APPROVAL TODECK t - 11. Property Sewer Line &jHouselConnectionI ..- 62. Backwash& Receptor-Final - - - 12. •Sewer Cap Ir• 63. Heater & Vent-Final - - 13. Roof Drains ` �. - :64. Plumbing System:. Final - - e 14. Rough Plumbing , , ' -65. Electrical-Final •' ` r . u ,-95'. ,Rough-Electrical-Conduit _, t - ' , .--T-- -- ; ;66. Solai1System-Final`r - -- - -` - .1; 4.16. fR'ough Elediric,Wiring . j I I, -- - 17 - -67.. Fencing&Access Approval - ... 1--- ,- -' -- - - ` ' 17.iRoughiWiring Sign-' ' I •t • 1 ,i :. I -68. APPROVED FOR PLASTERING c c. 4 '18. R6ugh:Electrical-T Bar Ceiling; 4 ' , - I 69; POOL/SPA SYSTEMS FINAL I , - ' ' 19..HR6ugh Heating &'Air Conditioning 1 - ' i FIRE DEPT„REQUIREMENT , _ 20.(Rough Factory Fireplace ! it 1 I ' j APPROVALS, ' Permit# ' ` 1 • 21.(Ducts;in Structure+ 'tt itl , li t I I I 170: Underground Hydro d ' X22. Ducts, Ventilating ` ' r , i ' . I i .71! Product Piping 0 Gas 0 Oil - ' X23. :Gas Pipe-Rough& Test „ .%_ • ( -'; 72. Underground Flush ^ 1=24. tRoof Framing 1., ' • 1 ,. , '•� ' ,. --,• 73. Undergrnd Storage Tank 0 Gas 0 Oil j 25.'Roof Sheathing - j 2 _ t ,, I , _ , 174. Overhead Hydro - r • r26. ,T-Bar Ceiling (Structurally& Monocoat' j ' e ! r 1 ' 75 Dry Chemical - - ' . • -;, 27. Frame and Flashing ' I1 176. Dry Standpipe - . 28. •'Lathing& Siding, • -o ' I j 77. FIXED SYSTEM FINAL • ' u . 29. Insulation ' t• ri 1 it ! 1 I I '78. FIRE PREV. FINAL . , • ', 30. Drywall Nailing i• Notes:'' - '- "31.!Plaster Brown Coat , II •Il • -I I - - - _� - - _ --, 'f32.:�Electrical!Power Meter:Fiinal •' 11 ' i ' ' 1 r I 1 331 •Final Electric '• 1 I , ' ( • 1 I i ' - , 34. Final Heating&'Air Conditioning $ i 1 ' , i • 35. Final Gas;Pipe'Test ' ..i I • ' . - ' ' - - 36. Hood Sr Canopy i ' I = Mir I\ PROJECT ADDRESS: 220 23.AD ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 0:39877 OWNER'S NAME: SCt1OOi , COSTA MESA UNION ADDRESS: DIST PERMIT NO: E 059877 PLAN CHECK NO: N GOVT; N SUP'; N 4NEWPORT-VESA UNIFIED SCHOO:, DIS': CONSTRUCTION TYPE: PERMIT TYPE; ELE PURPOSE: OTI1 P 0 BOX 1368 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION TEMP PO:.,E FOR LINBERG RESEVOIR SQ r:T: ADDRESS: UNIT: CLAIaM VALUE: 370 . 00 CALL-VALUE; GROUP OCC; B-2 / PERMITTEE: TEMP POWER SYSTEMS ( 714 ) 632 -1999 ADDRESS: ilii N. TUSTIN AVE COMMENTS ; TEMP , POWER POLE FOR LINBERG RESEVOIR ANAHiC M CA 92806 +s�F*#####4*#x##Tctt#x*#u##########u###*####*#### ###;u#x#- x#p *,Egk#n#ttx-xx#sz## *#x LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Dtnsion 3 of the Business and Professions Code,and my license is in . . •ffect. SETBACKS CITY u0,: 039: 24 STATE uc.:483413 0-0 ; C-10 Thi \•kb•c17 Signature:. - MAIN BUILDING --•- ACCESSORY BUILDING • i RICERS'COMPENSATION DECLARATION: I hereby affirm that ave a certificate t co enc to self-insure ora certificate of workers' FRNT; FT IN REAR: FT IN t RN'I'; FT TN REAR; F" IN Compensation Insurance.or a certified copy thereof(Section 3800, Lab.C). LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN ( 'eLICYNO.: 736.000i5780004 EXP.DATE: T ^,"v: , ..3 COMPANY: NATIONfIIDE PARKING REO• PROV; PARCEL ; 11909112 ZNE: REF NO: ® Certified copy is hereby furnished. El Certified copy is filed 'th the city Building Divisi• . PLANNING NOTES> ate: IA•30 •C'L Applicant Ja.-..i...._-_______- xxx##########################x#xxx#'.tie#########XST***#####x#####it x#!t#)f##x143!##k#'n 3f EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This tion not be com eted if the permit is for one hundred(5100)or less). DEVELOPMENT - SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is is. ed.I s not emp any person in any manner so as to become subject to the workers'Compensation Laws of California. ZONING APPROVED BY • : • \ DATE; Date: Signature: Irl. NOTICE:It,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY - DATE; Code.you must fodhwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; `� DATE: ��v— �� which this permit is issued(Section 3097.Dv. ###x#######x###xx##x##3filrcit, ,o#rrxiq.f,aail Rlrit R-ar. #toric -ftxsuit*iretfeaex#######xx#x4tlr#x TestastlCX.# LENDER; xxxx###x#####*xx#xx####x*xxxx#i4##x######itis '##x *#it*****##if#s**#it###i***x######Sf t# ADDRESS: LEGALIZATION:N F E E SUMM R Y STRUCTURAL St.GMEN'i;N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from theContractors'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,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 5 0 R SM I P/NON-RES and Professions Code)or That he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031,5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(SSW). ISSUE FEE 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILD INC—Dlv—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE O structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 15 . 00 15 , 00 0 . 00 30 , 00 30 , 00 . 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 on her own employees.provided that suds improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 30 , 00 OVER/SHORT; . 00 for the purposeof sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADJ: I. rofesr of the de; h,amCo exclusively S contracting Lawth licensed not contto an to constructo the project hor ov, thereon 30 . 00 ^1G PLAN CHECK ❑ and Professions Cade: 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 conlractor(s)license pursuant to the Contractors'Stale License Law). l am aware ###xxx##!fxx####x##x##x•x#xx#####xx x###ie#•##x####ii it?eit#it##x#Cr#x.x if###x tt x ifr#:4.#x.x•x##ih#+: 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 TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 1 00 i 5 , 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 END OF FEES permit for construction or modification from the Air Quality Management District,Residential construction applications are exempt from these provisions. Date: _ Applicant: I hereby cerldy that I have read this application and state that the above inform ion is correct.I agree to comp with all city and county ordinances and state laws relating to building construction and hereby authorize r pleseniatives of this city to enter .r the above'menlioned property for inspection purposes. � - ste; -k 1\D•-`Z- Signature; A .._-- Driver's License or Social Security s: 164146 Write-Building,Green-Code Enforcement;Canary-A..licant;Pink-'r Goldenrod-Assessor CONSTRUCTION AND PLANNING r_-iL & 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. Eiectrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. • 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 r 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 I 77. FIXED SYSTEM FINAL 29. Insulation j 78. FIRE PREY. FINAL 30. Drywall Nailing . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat J 79. FINAL INSPECTION 1 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED F 33. Final Electric / 71 111/i Notes: 34. Final Heating & Air Conditioning r I , 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace I 38. Final Plumbing 39. Water Service-Final I I 40. Gas Service-Final I 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 1 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. - Date • e ' .r PROJECT ADDRESS: 220 23RD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 060217 OWNER'S NAME: SCHOOL, COSTA MESA UNION ADDRESS: DIST PERMIT NO: •E 060217 PLAN CHECK NO; N GOVT: N SUPP: Y *NEWPORT—MESA UNIFIED SCHOOL DIST CONSTRUCTION TYPE: • PERMIT TYPE: ELE PURPOSE; OTH P 0 BOX 1368 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; TEMP POLE FOR LINBERG RESEVOIR SQ FT; ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 / PERMITTEE: TEMP POWER SYSTEMS (714 )632-1999 ADDRESS: 1111 N. TUSTIN AVE COMMENTS: TEMP. POWER POLE FOR PUMP HOUSE RE:#E59877 ANAHEIM CA 92806 ***�E:E�r�r�r� *****�E************RE+r***RE*RE******fE+r*r**:E*it*+r*****ReRE***Rr***+E***********:E LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am lice • ' sol Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my lice .e is in fun force a • .nett. SETBACKS CITYLIC.:039124 STATELIC.:48343 LASS: C-10 Date: It'4 ckt_ Signature: A ' __ . _ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I . e acent-ate o consent to sell-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN compensation Insurance.ora certified cop thereat(Section 31300.L...c). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN f DUCT leo.; 73WC0085780004 EXP.DATE' 0 c 9 COMPANY: NATIONWIDE PARKING REQ1 PROV: PARCEL: 11909112 ZNE: REF NO: ® Certified copy is hereby furnished. ❑ Certified spy is Id-.with the city Building Division. PLANNING N TES> Date' tt•R tAz_ Applicant: A ` ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECORATION: (This : is n not be corn ted if Me pentyl is for one hundred($1e0)or less). D E V E L O P M E N T S...,B R V I C E S REQUIREMENTS I certify that in the performance of the work for which this permit is' tied.I not empl any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY -•-. DATE: Date, OTICE :If.after making this declaration.you should become subject to the Workers'` mpensation provisions of the Labor BUILDING APPROVED BY : DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. -e C / r el L CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency lot the performance of the work for APPLICATION ISSUED BY: DATE• 2- ` Sr which this permit is issued(Section 3097.Civ.C). ********************************************* ************************ * ***** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E S U M MARY STRUCTURAL SEGMENT:N OWNER BUILDER DECORATION: I hereby affirm that lam 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: My city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 15 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 fj 0* SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Processions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penally of not more than live hundred dollars(S500). ISSUE FEE 4 • 50 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 on offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 15. 00 4 , 50 0,00 19. 50 19 . 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 Of offered for sale.If.however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED• 19. 50 OVER/SHORT: 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 19 . 50 ❑ and Professions Cede: 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 ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: 8.8 P.C. fpr this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date:_ 0.mer. ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 15.00 15. 00 I do hereby certify that ram 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 wilt/will not(circle one)need to comply with said state codes and the requirements for a permit lot construction or modification from the Air Quality 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 informati.- s correct,I agree comply with all city and county ordinances and slate laws relating la building construction an.hereby authorize re.esentatwes of this city enter upon the above-mentioned property for inspection purposes. Date:_ ,Z'L\ t Cl Signature: — _ _ ��— Driver'sLicense orSocial Security R: 164146 White—Building:Green—Code Enforcement;Canary—Apptcant;Pink—Revenue;Goldenrod—Assessor —_,---_—_ __ -- f ' CONSTRUCTION AND PLANNIN , x --OL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit #• Date Inspector 1. Temporary Electrical Service or Pole S 52. Pool & Equipment Location Soil Pippe-Undrgqrnd." i'7. - 53. Steel Reinforcement .�l.w.,.CT f - ,l•tical Cond'uit_UF;,lity-tindrgrnti~, 54. Forms 1 c1^• - Cci ERL,-.-Dr7.,Bl Conduit•t f3drgrnd. - 55. Electrical Bonding --t; `.'S. Stee±Reinforcefte'i •�''” 56. Rough Plumbing & Pressure Test • =61 E1GA'rieai OF EGFGrnd. r 57. APPROVAL TO COVER.GUNITE s 7 K Fr Ftings 'TF� t- 58. Electrical Conduit•Undrgrnd. k & Foundation 59. Gas Pipe, 0 Undrgrnd., Test ^P f 9: Water Pipe-Unc?ggid. . 60. Backwash Lines, P-Trap, 0 Undrgrnd. 70: Structural Floor System _ 61. APPROVAL TO DECK 11. Property Sewer Linetu & Has'e Conrwttion 62. Backwash & Receptor•Final 1*: Sewer Cap y e 4 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Piumbittg 65. Electrical-Final 15. Rough Electric&-Conduit 66. Solar System-Final 16. Rough Electric-iiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' 18. Rough Electric9l-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 7 r. . . C C'" : -'•- .-"' � I = t" t '1 Cr trr.T-- T _ .r 20.7Ro h E ctdr F eIace t M'7 Q - .< 0 rp i1" _ 1lPPRfg^Vg 93o'er'nit# "• 5- 1 T. �9 S i E t S tr. C. a S - 7 -- fCJJ.. [J t-t F r er tri U �-' 2R t :-•E- .Z. " J 7X .. -A 2 •-•:-.)-.3.. .T7 * 1.t 21�,Dutss,iStracture, t .• .. r-a ;: - c- _-4a. x J0. llndergmtetd:Hyeho r '. - 53 S ... .d Y' 22.SUSS, VPnti tin t C:S % S <s r rrte�'� Cl i. x C• * : a' 0 c-z . .%77. Produc `{ i�9 L s �O'I 23.:taa*ipatogh &" est ` tt' ^` ''` r S 7 < p.r n -72. Undergrotblt� FluOsti . C . T 7- S c. . G�^-M-> 24.rRo67 FramiHng r- l-t's . < > 0 zr F * r 57•- 3.`9Jndergrna?Stori 71-ank ©Gas 0Ort 25' Ros�tt S rl thing cr.t ? ` .rJ 'n t1 N?r ! G '- . a 7+ S v v x ,. > >,c ,74 r;,Overhead Xlydro s. -49 -f - ' r, 3 v. 26.21-Bar Ceiling (Structural) &Slonocoat z ' t1 _rtx r z -. C1 L. ' _ ^ i7x K 75,pry Chem al ••••7 .4 r'1 27.,cframe and Flash r•- r x ` '` `" ' `" 03: ' s ;c 7 •-� z:c r a s x 76. Dry Stang N1� FK� 1.48.r' Lathing Siding 7' ri _.6t n t • •• --- K 77Fr'FIXEDS"r'gEf FNALn , ,, '>29. Insulation 7• in ., < x w 78F-FIRE PR EV. F1104. k > tz x•-30. DrywalrDJailing .r X itr z V -4 HEALTRcEPT>. R€O&IREN1ENT N4 fl- i. t C31. Plaster eicoww,CoitX „ ` - • I; x 79.cFINAL I nigescritErt a C T M •' •-32.rElectric Power MoteA?inaIl t --030.TFOOD CERUE TIFICAT.[ ISSUED 0 . .733.. in 1 Electric, 'S. ,O r y ! - r / ) • ; * ''NoiQi:. •�._. ,2c*i • - C `' r j34.cFi Heotinw& 91rConditioprggr, n /' . x z -'. •S C'`7C z •i --. 2_, ,7 " s 7, .n - c < 11 .-ro -, i c-C x 35.'Final G Pi T-t - r x >< rook On -7 .r t C:� - Piu•r ?. 1 < s � :..0 J- 3: .; .r >. >." tri ,1-36. Hogd ori-Canopy •.c .0_` r x x F_ r o z .-r tr. r: S w .n v r <- •. z _ i••• . n - -c0 T - -" q :37.Qinai Factory Fir#fat€ „ ' -."-c::" `` ' ' 4 F Z C ' 17 x • +: .(< Z x . � ..v, -c.c.: 1 .. .. r.2:4 - t•,r K� y q, .. ,--38. Final Pluj mhing sr x (: s. z 7. S x S :Z9. Water Service-Firialc F :i 2,- : rr rr ir. ""--1 C, - i- 4t. Z r 'S K n z ,-. 1, - :'t X40. Gas Service-Final,;- *tr. 6 r tr S n. :: z Cc. rJ:0 z 547. Solar Domestic-FinalS CC' • r . . _1 VC.1../ x Ir. < r :r yo lit 7e 42.`Backf low Preventer•.. z Ac t .._.•4.-.1 Y 43. Backflow Irrtpatiorrz •* :CIL' t C 'u Vi•a, * .:z .x <-- " .> ,r44. Landscape Irpigation Systern g t - ,.7 N wn x t o C .- EZ .` r F " ". -r S z'45.'Sound Attenuatiort• r•--c -• rr A = "V x :r _ sa Qa: '- -r. z - .. r. ..q .na z 4 -C A -'46... Reiulati4s -•z •` r X 'C Cr:or: S C'o ti - 47.TINA L STRCCTURE & BUILDING < R '7 .L• S is T - .w . L" - .- 46:�FINTALPLA`(VNIN _ r < « ,^ :"q 'd ,• , - ,. .... 'L' i o29.rEleatric Release to Edison >: •. 7, z A. - `50._GasRelease to Southern California Gas Co I ti .. ' G -` 2 , r r o . 51. CEN71FICATE OF,DCCUPANCY - in k E' y �• S CJ tT10 - n F J No. Date