HomeMy WebLinkAbout3545 HARBOR GATEWAY - Building Permits� .. _ y .� - ,__.. - ,..�
'� c��p o f�o5ta 7Y� �c �
Development Services, Division of Building and Safery
'�*rv , CERTIFICATE OF OCCUPANCY
This cerrificate is issued pursuant
adopted by the City of Costa Mesa c
below described was inspected andl
Building Address
.�
Use ���
Group n-2
Owner of Building'!
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e of Construction iitta Fire
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Address 3315 P�TapI� gpnn; rncTe "bmce', r.n'
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BUII.DING OFFICIAL-�Otlp\��,mC �(TG(I -'t • � �V ,c.f =i—: B t
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REQUIRED TO BE POSTED-IN A CON;
Building Code, Section 308
the building structure herein
Permit No. �8569
Use Zone �DI
� �ALTH CARH"
PLACE
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, � c���p o f �o5ta 2�J�a �
Development Services, Division of Bui�ding and Safety
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� CERTIFICATE OF OCCUPANCY
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This cerrificate is issued pursuant to�the�requirements of.�the Uniform Building Code, Section 308
adopted by the Ciry of Costa Mesa cerrifies�.thatat th'e rime of-its issuance the building structure herein
below described was inspected and�approved�for occupancy:as follows:
� %���%`�� ��°��
Building Address 3545 HABBOE GATEidAY STRSET Ot7IT T03�, Bldg. Permit No. Bb5846
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use o�cg 0 t„I,i, ,,�� '__r-r%- �� a� v� „�
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`4. j�(� :��ij% ���)��a��'� --1 �
Group B—Z Type of�Corist`ruct�on Iii—p Fire�Zone,�'- �=_ �� Use Zone �I
;�, ;� • �� ; ' �i;Cs o: .::.: i:F7�t3Q2 ;3t�' .;I i '-� al
Owner of Building C_.l_ �SF.GSRSTROM 6 SOIdS-'" Tenant "�B��$� �LTg ����
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Address � 3315 �AIVIHti ROAD. CQSTA I�ffiSA.! CA ! 92626" �� �J/ yy�—�,/I
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oF�cwi.-"�tonp �'�
REQUIRED TO BE
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PLACE /
,
Ciiy of Costa Meu
Development Services Department
Building Safety Division
P. O. Box 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY No. �O��3T
The Building located at 3595 Harbor Ga[e�av
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group ��� Occupancy.
Use of Building Warehouse
Legal Description 415-081-34
(See reverse side for Metes and Bounds)
Building Permit No B a$8%0 Electrical Permit No. E 3�5764 p�umbing Permit No.
Mechanical Permit No. Number of apartments and/or guest rooms
�ire Preva Permit No. F 33192
iSSUED TO: Building Official William T. Ho�ard
C. J. S�]qecstrom �.
3315 iaicview Road by • '�.�. �-
Co:�ta c�7Qsa, CA 92626
pate October 27, 1986
This Certificate of Occupancy SHALL BE ported in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the Ciry of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rav. 1/83 White-Owner; Canary - Numerical File; Pink - Bldg. Permi� File
City of Costa Mesa
Development Services Department
Building Safety Division
P.O. 8on 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY No. �0���9
The Building located at aana�c .�.-�ti.,.- r�r�...�..
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group n� Occupancy.
Use of Building 6dasehou�e
Legal Description G1.R�A81-34
(See reverse side far Metes and Bounds)
Building Permit No T� ���F� Electrical Permit No. E. 32287 Plumbing Permit No.
Mechanical Permit No. M��z�7 Number of apartments and/or guest rooms
ISSUED TO:
BuildingOfficial F1111iam T. HoHard
C_ .7_ Sc�ancflY.rom �
3315 F'airview Roae7 by �-� � ��.�'�_ -
rn4rA r•�a�,:�, CA 92626
Dace Januarv 10, 1989
This Gertificate of Occupancy SHALL BE ported in a conspieuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 3015-46 rp�, �/83 While -Owner; �anary - Numerical File: Pink - Bld9. Permit File
�• i
City of Costa Mesa
Development Servires Department
Building $afety Division
P. O. Box 1200
Costa Meu, Califomia
CERTIFICATE OF OCCUPANCY No.��y�}���
The euilding located at 3545 Harhnr C,at�u:9v South #101
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group L:-� Occupancy.
Use of Building Tntc�ri�r Al}r�ratirmc — C?Efict?
Legal Description A15—OR1-3d
(See reverse side for Metes and Boundsl
Building Permit No $"8526 Electrical Permit No. E-8%28
Mechanical Permit No. r=`$�96 Number of apartments
ISSUED TO: Building Of
c.. ,7_ S�rrstrom arxi Sons
by �
_Plumbing Permit No._
��— and/or guest rooms
icial
P—II597
�
3315 Fairvis'rt �, Co.sta N�sa• CA Date ��S ��/, ��
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 (e) U.B.C. �
CMF 3015-46 rev. 1/83 White � Owner; Canary - Numerical File; Pink � Bldg. Permit File
City of Coeta Meu
Development Services 6epartment
8uilding Safety Division
P.O.Box 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY No. OOZ.9�J'�
The Building located at 3Sf'S H3CbOC GBtAwdV� Unik 1Q2
has bee� inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group � Occupancy.
Use of Building Da�a Proces:.ina
Legal Description 415-09-04
fSee reuerse side for Metes and Boundsl
Building Permit No B 30800 Electrical Permit No. E 30819 p�umbing Permit No.
Mechanical Permit No. � 30824 Number of apartments and/or guest rooms
ISSUED TO:
C.J. Seqorstrom
33I:5 �airview Road
Cos�a i�ic]oa, CA 92626
BuildingOfficial WilliamTT. Horia[d
.
by -
November 10, 1987
This Certificate of Occupancy SHALL BE posted in a conspicuous ptace on the premises and SHALL NOT BE removed except by the
Building Official of ihe Citv of Costa Mesa under Sec, 307 (e) U.B.C.
CMF 1015-46 rev, 1/B3 White -�wner; Canary - Numerical File: Pink - Bld9. Permit File
City of Costa Meu
Developmem Servfces Department
Buildin9 Safety Division
P.O.Box 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY No. (jJ(,��1��
The Building located at ZtiA� u:,,-t,..r r��.
has been inspected and found to comply with the p
for a Group �2 Occupancy.
Use of Building
Legal Descriptio
Office Warntmu$e
415-OS1-34
of all City of Costa Mesa Ordinances applicable thereto
o T�;
` ISee reveru side for Metes and Boundsl
E-8828 �� `Z
Building Permit No � Electrical Permit No. E-8996 Plumbing Permit No
Mechanical Permit No. Number of apartments —0— and/or guest rooms -0
ISSUED T0: BuildingOfficial �. /� � �
C. J. Secresstra[t and S�1s bY�/ C_ ��,����-
_ `, � �,
3315 Faixvi�w Road. Costa N�sa. Gl Date �C/ �(.-�'i/, �9 �
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 Meu under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File
I
Ciry of Costa Mesa
Development Services Department
Building Safety Division
P. O. Box 1200
Costa Meu, Calitornia
CERTIFICATE OF OCCUPANCY No.
The Building located at 9545 A�.-h„r r�ro..,�.. C.,..rt,
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group n� Occupancy.
Use of Buildin
Legal Description 61S_n7�—nR �
(See reverse side for Metes and Bounds) �
Building Permit No n<o�no n��rn�_Electrical Permit No. F��qa� v��oavPlumbing Permit No. n conan
Mechanical Permit No.
ISSUED TO:
Hone Ti Neoc _
201 Princeton Drive
Costa Mesa. Cti 92626
Number of apartments and/or guest rooms
Building Official 'r�..,, r�ns n4..�
by ' ,
Date nntnhnr� 9(. tooz
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 (e) U.B.C. �_
CMF 1015-46 rev. 1/B3 White -Owner, Canary - Numerical File; Pink - Bldg. Permit File
�
�.
PNOJECT RDOflE55: 3 S 4 S HARBOR GATEWAY S
OWNEN'S NAME: C J SEGERSTROM & SONS
nonness: 3315 FAIRVIEW RD
COSTA MESA,CA 92626
APCN/ENGINEEX: TOM COMPOSS ASSOCIATES
aooness: 1809 WESTCLIFF DR
N,B, CA
PEHMITTEE: CO—WELL CONTRACTORS
aoosess: 3506 W. LAKE CENTER
SANTA ANA CA 9
LICENSED CONiBALTON OECUNIITION: I �ere�y aifirm that I am lice etl unUer O�ovisi
700�) of Divlsion 3 oi �he Business antl Professions Cotle. and my lic is in tull I
UNIT:
flEG.NO.: C—i4944
f� uuir: 2 7 5
(7]�)540-3771
�// B
�,,., ii�U 0 9 2 9 2���STpTE 11C., 514 9 8 2 —�
��a� 12_ Signamre
NEPS' COMPENSATION OECIABATION: I hereby aftirm � � I have a cenifica consem ro
Comvensafon h�o���aj �cc[ti��copy inereo� (Section 3804 Lab. f�). � 1�
voucv wo.: gTATE FUND E%P. ORTE:
� COMPpNV: �(
Ce�ilieE WOY is her¢Dy �umi5he0. L1 C¢tlilied CODY �5 lile ciiy ivisit
$" Z3 -9�
9 (commencing with Section
: 07/95
a certificate of WOAers'
aie Npplicani: -
E PTION FHOM WOHNEflS' COMPENSFTION OECLl�BATION: (This seclion need not �e c mpletea ii the Oermit is lor one Auntlretl ($100) or less�,
cetlify Iha� in I�e Dedormance ol �he work for whic� this permit is i55ue0, I shall noi employ any person in any manner so as �o become
Sub�ect lo Ihe Workers' Compensalion Laws ol Calilomia.
Date: Signature:
NOTICE: Ii. aller making �his Aeclaration. you 5hou10 become suble�� �o �Ae WOBers' Compensation D���isions oi Ihe labor
CoOe. you must forthwilh comply with such pmvisions or ihis permit shall �e tleemetl revoked.
CONSTNUCTION LENOING AGENCY: I hereDy affirm �hat ihere is a consimction IenOing agency for the De�ormance ol ihe work lor
w�ich Ihis permit is i=.sued �Sectian 3097. Civ. C).
LENOEB:
RDOHESS:
OWNEN BUILOEfl OECLAflPTION: I hereby allirm Ihat I am exemp� �rom the Contractors' State license Law for �he following reason
(Section 7031.5 Business antl Pro�essional CoOe: Any ci�y o� couniy which requires a pe�mi� to conSVuct, alter, impmva. demolish, or
repair any stmtlure. prior �o ils issuance, alm repuires the aOPlican� lor SucA De�mi� �o lile a signea Slaiemen� thal he/s�e is IicenSed
pursuam �o Ine provisions o� ��e ContracloK S�ale License Law (Chapter 9(commencinq vrilh Sec�ion 7000) ol Division 3 0l �he Business
anU Pmlessions CoOe) or Ihat he/she is exempl Iherefrom antl ihe basis for the alleAetl exemption. Any violation of Seciion 7031.5 by
any apphcanl lor a permi� suDlec�s the aDPlicant to a civil penal�y o� no� more than Irve hunAreA aollars (5500).
I, as owner at tAe propeny or my employees with waAes as [heir sole compensation, will tlo t�e work, and the
� stmcmre is not inrentled or ofiered lor sale (Section 7044, Business antl Protessional CaEe: The Conlractars' State License Law
tloes nol apOry to an owner oi a pmperty who buitas ar impmves thereon, anU who tloes suc� work himsell/herself or ihroup�
his or her own employees, pmvidetl Ihat sucA impmvements are no� inlenOeA ar aifere0 br sale. I�, however Ihe builtlinq or
impmvement is sola wi�hin one year o� compleiion, �he owner vnil have ihe hur0en ol provinp he/she Eid no1 huiltl or improve
for ihe purpose of sale�.
I, as owner of the proDerty, am exclusively coniractinA with licensetl wniractors to consimd the Orolect (Section 7044, Business
❑ antl Pro�e55ions Cotlel The Contratiors' S�ate License Law Oces no� apply t0 an ovmer o� pmpe�y who bmlds ar imprOveS �hereon
and wha conVacts lor such pmlecls wii� a conVacmqS) license Dursuant lo Ihe Contracmrs' Slate License Law�. I am aware
tlwi pmol ol lheir Woiker's Lampensation insurance 5�oN4 Ce pmviaetl Io me.
� I am exemp� unAer Section: B, 8 P. C.
lar Ihis reason:
Oate- Qwner
I tlo �ere�y cenJy that I am avrare at an0 unGerstand �he requiremenis a� Calilomia Health antl $afery CoGe Section5 25505, 25533, antl
2553C antl t�al l or any INure buil0ing occupanl wilVwill not (citcle one) nee0 to compN `M�h said stale cotles an0 ihe requirements tor a
permil lor consimction or moaificaiion Imm Ihe Air �uali�y Managemen� Disinc�. ResiEeniial consimciion aDDlica�ions are evempi Irom
these pmvisions.
Oale- pDD�itani:
I hereby ceridy Ihal I have read I�is aDPLcaiion anE 5tate �Aai Ih �ove inlormaiion is correc� a b comply vnlh all city anA counry
orainance5antl51atelaw5relaiing�obuildingconslmclionanah Oyau��or¢erepresenlali� �1 cityloenlerupontheahove�mentioneG
propetly lor ins^peciion purposes.
'D e: /��L3^/� SignaWre:
Onver s License o� Social Security x:
�6at-a6 � Wnne—Builtlinq: Green—GOEe EnlorcemenL Canary—ApP�iwnl; Pink—Revenue; GOltlenroC—Agsasaor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: 8 068569
PERMIT NO; B 068569 PLAN CHECK NO: 02751-94 A GOVT: N SUPP; N
CONSTRUCTION TYPE: IIIN PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; INTERIOR 11405F OFFICE T.I, SQ FT: 1,140
CLAIM VALUE: 10,000.00 CALC—VALUE: 14,147.40 GROUP OCC: B-2 /
COMMENTS: INTERIOR 1140SF T,I. FOR "AHBEY HOME HEALTA CARE "
****+��t*x��r**+t***�r�r�r*+r�r+��*x�****+r�r*�r�r**�t�r�t****+r*+�****+�+�**+r*****�r**+�+r�r�c***x�*s*�����-
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING,=--------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR• FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV;� PARCEL; 41507108 ZNE: PDI REF NO;
PLANNING Nt5TE5> INTERIOR ALTERATION FOR ABBEY i-IOME iIEALTH CARE
, .
��,�*��,����*,�,�**,��w,�,���.,�*�*��,���,�,�,�� �,�*��*�������*�,�*�*�.*,�����,�,������,�,�*����***,�
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T
20NING APPROVED BY ��— DATE: 2Pi Cj
BUILDING APPROVED HY : ��fi DATE; ly
APPLICATION ISSUED BY:
�r*�r�r�r�r�r��r***+rx+r+r�r+tx��r�r�r�F�FT�T��F���FTr�FTr�T�� ��F3F�F�F3Fi�'iF'�r��FiF�r�r�r+�D*��ir+r x � ��-
4iliEklt�llEltklfiflElFkk�tlEifiEililf!lEifkfEfffffEflitifiliflE!lfFfflfifikftlkitlFiEiEflfliFikikltiEfffElEffiflEiEitiElElEifififiEifiEi! itillEikiEiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
HLDG PMT PLUMBING ELECTR�IC MECHANIC FIRE SMIP/RES� GRADING
PERMIT 162,00
SMIP/NON—RES
PLAN 26.33 z,9-7
ISSUE FEE '
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK PAID DUE
TOTALS----> 164.97 0,00 : 26,33 1.3 191.30 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 164,97 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE S P/TOT GRADING PLAN—CHECK
162.00 2,97
f! fF i!!F ft k 1! �f ik if 1t i! 4 iE 1E ft 1! fE ff f! i! i! it 7tlE 1f 1f it if i! 1! fE 1E 1Elf !E i! if 1!!F!F ft M1it it
I N D I V I D U A L • F E E�—
TYPE QTY D E S C R I P T I O N
SFC 1140 OFF—INT, ALTER TYPE III—N
SFC 1140 EQU—ALT COMM, AIR COND
END OF FEES
✓
l�,IF1Flt k 1tlf ii if fE fE!! k iElf 1k it ff ff 1E iE 1! if iE 1f �E iE iE if ik �! iF 1E
B R E"A K D O W N
UNIT COST TOTAL COST
—AVER 11,72 13,360,80
—AVER ,69 786.60
� ��� D
�AUG 2 � 1994
D
� o� cosr� �a��►
LJ
CONSTRUCTION AND PLANN4NG � � POOL & SPA
qPPROVAl.S Permit# _.bate Inspector p.ppROVAIS Permit# Date Inspuctor
i. Temporary Elecvicai Service or Pole 52. Pool & Equipment Locacion
2. SOiI Pipe�Undrgmd. � -, 53. Steel Reinforcement .
3. Electricat Co�duit Utility-Undrgrnd. 54. Forms
4. Electrica� Conduit�lindrgmd' .. � 55. Electrical Bonding
�. Steel Reinforcement - 56. Rough Piumbing & Pressure Tzst
6. Electricat UFER Gmd. 57. APPROVAL TO COVER-GUP:ITE
'7. Footings 7 58. Electrica� Cunduit�Undrgrnd. -
'�8. Foundation ' ' . 59. Gas Pipe, O Undryrnd., Test
9. Wacer Pipe�Und{grnd, � - S0. Sackwash Lines, P�Trap, O Undrgmd.
1�0. Strucwr2l Floor System 61. APPflOVAL TO DECK
71. ProPerty Sewer Line & House�Conpectiop� 62. Backwash & Recepior•Final
12. Sewer Cap . ' ' fi3. Heater & Veni�Final
73. Roof Drains � �. 64. Piumbing System � Final
74. flough Plumb;ng '�� 65. Electrical-Final
15. Raugh Electrical-Conduit_ 66. Solar SYstem�Pinal
16. Rough �IectriaWiring - 67. Fencing & Access ApP�oval
>
V. Rough Wir'ing �ign 68. APPROVEp POR PLASTERING
18. Rou9h Electrical-T Bar Ceiling fi9. POOLlSPA SYSTEPAS FINAL
T9. flough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
. �
20. RaUgh Factory Fireplace - . _ iAPPROVALS ���� Perinit # '
,�.
21._Oucts, in Struct�e. ,. .. � - - � _ 70. t�nderground Hy,dro '
22. DUDts, Ventiiati�g -. � � 77. Product Plping O Gas � Oil
23..Gas'Pipe•Ro�gh &'jest ' . � � 72. Underground Flysh . ". �
24. Roof Framing - i . �• 73. Undergrnd. $torAge Tank O Gas ❑ Oil
25. Roof Sheathing ,� � '� � ' 74: Overbead Hydro�� �
26, T�6ar Cefling (Struciurai; & Monocoat i Z���� 75. Dry Chemical ' - � .i �
27. framea�d Hashin ^ L �'� � , � �
� , , � 7,� �9 C� . 76.� Dry Standpipe ,r ,. , F
.28. Lathing & Siding. . -t �. �• 77;i FIXED SYSTEM FINAL
29. Insulation �' : � " -� � ' � � 78; FIRE PREV. FINAL � � �. �
30. DrYwaIl:Nailing �� '�I'j�q� /%�_ - - � HEAITH DEP�. REQUIREMENT
l LI ' '
31. Plaster Brown Coai . � , 79.' PINAI IN'SPECTION ' �
,32�Electrical Poivar Meter-�inal � � SO.�FOOD CERTIFICATE ISSUED -c�
33-Final Elechic � _ � Notes: 3 g ��', �C - ['Prrt>y
'34. FinalHeSting&Ai�Conditioning - � . t/- ����, �,�p��T'
35:'Final Gas Pipe-Tesr ' ���' ' � � '�
, .
.36.�Hood or!Canopy� , ` . - , - � � '
„
37. Final Factory Pireplace ' ,
r a. . .. . . --_
,38. Final Plumbing , � � ' • _ - ' •
i �
39. Water Service•FinaP - � � � •
• � �
40. Gas Service-Final ' � � � , �-. �
� 41. Solar pomestic-Final � .. ; � ..f ' � . . . :
� ` r•-
42,' Batkflow Preventer - � I ', � � . . . � -�. � �"'f~'" '
�
43. Ba4kflow Irrigation - ' � ' �-' . , , :. ��
a �^-�
44. �andscape Irrigation SYs,em. �� _ . . . � � ' . ' ' ��
45:.Sound Aitenuation ' ' , '� . � ; � � �"
46.,Handicap Regulations 1 �. . .- � l , 1�
47. PINAL STRUC7URE & BUILDING S�j lj �:/ . ,
f
48.'F�NALPLANNING � ' � � � • '��'- �- �
. � �.
49. Electric Release to Edison •; J' � '
50. Gas Release to Southern Califof.nia Gas Co - -, � .. �
51. CERTIFICATE OF OCCUPANCY " .
No. Date
1
�
� �
PNOJECT RDUflE55: 3 S�I S HAABOR GATEWAY S
owNen•sNnme: 331SSFAIRVIEWMRD SONS
aoonEss: COSTA MESA, CA 92626
UNIT:
RPCH�ENGINEEfl: TOM COMPOSfi ASSOCIATES aec.xa.: C-14944
aoosess: 1809 WESTCLIFF DR uNiT: 275
N,B. CA 92660
PEqMiTrEE: CO—WELL .CONTRACTORS {— 40-3771
aoonEss: 3506 W, LAKE CENTER DR B
SANTA ANA 9 4
ULENSEO CONTPAC70F DECLABFTION: I hereEy aifirm t�at I am licens n on haD�er 91�omm¢ncinp wii� Section
70001 0� orv�oAn ZoLtn2e gusiness ana Pmie�ioln4co9aea, z my �ic i� � e 4 gXP : 07 / 9 S
c�ir Llc.: 9 U�LgT(pTE LIL.: 5:
�� �� I SiAnaWre: _ —
HS' COMPENSRTION DECLABATION: I �ereEy atiirm �hat 1 Aave a ceniticaie ot c n ta 1-insure or a certificate af Warkers'
ompensalion I�e���oj �e(Ii��copy ��e�¢OI �Section 3800. LaE. f�) O� O �
aoucr eo.: S TAT E FUND E%P. DFTE:
. camraar: �(
Cenifie0 coOY �s nereby fumis'he/tl. lJ Cetliliee copy is file0 uiltlinp Divis�on.
Oa�e'. ✓ �V _ � " FpPlicant
TIONFPOMWOBNEflS'COMPENSATIONOfCIANpTION: (ThiSSCCliannee0nolbeCompleleEi�IbeDermi�isloranehuntlr¢A�51W�orl¢55).
I ceriily Iha� in Ihe Oehormante o� Ih¢ work for w�ith Nis permd is iS5Ue0, 15�a11 nol ¢mplay any p¢r5on in any fnann¢r 50 as lo �ecome
subjen m tne Workers' Comoensation Laws ol Calilomia.
Oale: Sipnalure:
NOTICE: I�, afler making IhiS tleclarati0n, y0u S�oWE �emme SU�IeCI l0 the Warkers' CAmpenSa�ion OmNsi0n5 01 IA2 Lahor
Code. you musl torlAwitO cOmply wi10 sucn pmvisions or Ihis permit shall be tleemea revoketl.
gONSTPUCTION LEN�ING pGENCY: I �ereby sllirm that ihere is a constmction lentling aAency lor ihe pedormance ol �he work for
W�ich this oermit is issued (Seclion 3097. Civ. C�.
LENOEfl:
AODflE55:
pWNEP BUILDEN OECLFPA710N: I here�y alfirm ihat I am exempi Iwm t�e Contractors' State License Law for Ihe lollowing reason
(Section 7031.5 Business and Pmlessional Cotle: Any city of counly which reduires a permit to conslmct, alteL improve, demolish, or
r2Dair any simcWre. D�ior lo its 4suance. also repuires ihe aD0licanl lor such permil to lite a 5igneC sta�emenl I�at he/she is IicenseA
pursuant�at�e pfovision5 Ofl�¢ Contrac�or5 Siale License Law�C�ap�er 9(commencinp wiih Section 700p)o�0ivi5i0n 3 o�l�e Bu5ine55
an� Pmlessions Code) or Ihal he/she is eKempl iherelmm and Ihe Dasis for the alleqee eKemption. Any Malation of Sectian 7037.5 �y
any applicanl lor a Dermit subjeQs lhe apPlicanl to a civii penalty of not more ihan five hunEreO Eollars (E500�.
I. as owner of ihe o�opehy or my employees witn waAes as iheir sole compensation, will Oa ihe work, an0 Ne
❑ simcture is not intentletl or offere0 for sale ISection 70a4. Business and Pmlessional Cotle: The Coniractars' State License Law
Ooes not apply lo an owner oi a D�openy who builas or improves t�ereon, antl who tlaes wch work Aimselt/Aersetl or t�muq�
his ar he� own emo�oyeei pmvidea that sucn impmvemen�s are not intentled ar onere0 tor sale. II, however ine Oviltlinp or
improvemenl is so10 within one year o� tomplelion. Ihe owner will have ��e �ur0en o� pmvinp he/she Oi0 nol builtl or impmve
for ihe purpose of sale).
I, as Owner OI the pmpetly. am extlUsively Conirat�ing wilh IicenSed tonttatlOrs t0 COnSVutl t�e prole�� (SeClion 709d, 8usine55
Q ana vm�essions Coee: Tne Contracmrs' Slate License Law aces not apDN �o an owner of properry wlw CuilAs or impmvu ihereon
an0 wha contratls lor suc� D�ole��s vni� a conirac�or(S�1icen5e pursuant to �he ConVLclors' SWte License Law�.l am aware
Ihai proai ot t�eir Work¢r'S Compen5aiion insurance 5�au10 0¢ pmvitle0lo me.
p I am exem0� under Seclion: 8. 8 P. C.
lor Ihis reasan:
pa�e: Owner. _
10o nereoy cenity tlwt I am aware af and unaerstana ihe reauiremenis of Caldort
p5534 ana ��at 1 or any future Guiltling accupani �IVvnll noi �circ�e one) nee0 to [
permil br conslmclian or motlilicatian irom I�e Air Oualiry Management Oisirict.
IPese pmvisions.
dale'. ApplicanL
1 �ereby cetlitythai I have reatl IniS appli[ali0n antl ilate�ha��� ve m�or tl
prgjnances an0 sla�elavrsrHaiingto buflding consimtlion anG Uy aul �
er�s ticense or Social Securi�y K:
anA Sa�e ctwns 25505, 25533. ane
s ate cades an equiremenis Por a
ial constNclion apDlicalion are exempt fmm
;tTagreeto comply wit� all city and county
af �his dry Io enter upOn �IIE aGwe-mentioneE
16���46 wnne—Buliaing; Green—CoEa Enlorcemenr, Canary—n00bcanC Pink—Revenue; GolOenroE—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: M 068571 PLAN CHECK NO: N
CONSTRUCTION TYPE: IIIN
PERMIT TYPE; MEC
PERM NO; M 068571
GOVT: N SUP : N
PURPOSE: ALT
JOB DESCRIPTION : INTERIOR 1140SF OFFICE T,I. SQ FT;
CLAIM VALUE; CALC—VALUE: GROOP OCC: B-2 /
COMMENTS: REF: H-68569
1FiEif�tiE*iEit�EiE**iFir.�F�F*1F*iE*iE'�F*iEiE+tiEiEiklF�r.it�FiFx�+t*iFitar.riFiFiE�tiFiEiF*fFK7E*iEr*+t�F�E*+tit7F****it�E�Fit*�F�F****
Z O N I N G R E g U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCES50RY BUILDING ---------
FRNT; FT IN REAR• FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 41507108 ZNE: REF NO;
PLANNIt3G NOTES>
�
iE if iE fF it ft iE I! fF it it iE i! fF iE it if 7E 1F it iF it it it 1k it if if iF itlf it if fE 1E iF if iF 1E k iE 1E iE ik fF it fF it iE ff if 1E it ik iE if 1F if fE if iE iE i! fFlF it iE iE it iE iE if iF 1!!f ik iE it iE
D E V E L O P M E N T S E R.V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY; `�� DATE; �'
it+tit�titftf��titif�tit�t*i�itft�t�rft�kitTriF'iF3F3F�t�FiF3F3F3F3FiF '3F3F'iFiF3FiF'iFiFir it�* �tititititx+tit** **'
lFifiFitf!!litfF1F1E1EiEiFitiEik7l7f7kftifllkkkiFililitifitifititiEillEiflfiEfklhikklEfFikkkifilltitififiEitlfiElEiEiEfFlfiffkifikiEff il1Elfitfl3Fitik
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT � 9.00
" 25Y SMIP/NON—RES
PLAN
ISSUE FEE - 15.00 �1
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 9,00 15,00 0.00
REVENUE DIVISION TOTALS--> COLLECTED;
BLDG PMT PLUMHING ELECTRIC MECfiANIC
24.��
� /24,00
IRE S1�
PAID DUE
24.00 .00
� OVER/SHORT• 00
IP/TOT GRADING PLAN—CHECK
**+r�rir�r�t�r*�r*�r�t�t�r+��e�r�r+r*�r+rir*�r+�****x��r**�r�r�r*�r****�*��r*x�*�r�***�r**�t*x�rxx�*+rx�*�r+r*�r+�+r�r�r*
I 4J D I V I D U A L <F E E B A E A K D O W N
TYPE QTY � D E S C R I P T I p N UNIT COST TOTAL COST
MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9,00 9,00
END OF FEES
,,
D � �
, AUG 2 21g94 �
arr oF eo�ia ru�m
�
CONSTRUCTION AND PIANNING POOL & SPA ' �
APPROVALS Permit# D�te Inspector qppROVA�S Permit# Date Inspector
7. Temporary Elecaiwl Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgmd. . _. 53. Steel Reinforcement .
3.' Electrical Cqhduii �tility�Undrgrnd. 54. Forms
�
.,4. Hectrica! Conduit•Wndrgmd. - 55. Electrical 8onding
•�5. Steel Reinforce�ment -� 56. Rough Plumbing & Pressure Test �
"'6. Etectrical UFER�itnd. _ 57. APPRQVAL TO COVER�GUNITE ,_
. 7.�Footings � ' . 58. Electrical Conduit�L'ndrgrnd. �
��8, FoundaTion - 59. Gas Pipe, O Undrgmd., Test
� 9. NJater Pipe�Undrgmd. , 60. Backwash Lines, P-Trap, C7 Undrgmd. �
ia. Structurdl Floor�ystem �. !� 67. APPROVAL70 DECK
7 7. P.operty Seeyer t,irte & House�Conpection 62. Backwash & Receptor�Pinal �
12. Sewer Cap ' ' 63. Heater & Vent-Final
13. Roof Drains� " 64. Plumbing System - Final
14. Raugh PlumBing - �' 65. Electrical�Final
75. Rough Electrical-Condua 66. Solar System�Final
16. Rough Electr'rc Wiring - 67. Fencing & Access Approval
17. Rough Wi�jng Siyn 68. APPROVED FOR PLASTEfliNG
18. Rough Eiectrical•T Bar Cei�ing 69. POOL/SPA SYSTE4�iS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT (
2Q ;Rouyh F.actory �ireplace ; �1 •-1 � -' � : 'APPROVALS � :? Permit � ` -
h • �
2L�Du�cs, in Structure .. .. - . � 70. Undergroand Hvdro
22. Ducts, Ventilatin4� ���'� •� 77. Product P1pi�g OGas ❑Oil
23.'Gas'Pipe;Rough & TNst �. - . ' .. �, 72. Underground Flusfi � "
24. Roof Fram�ng i •� � "73:' Undergrnd.StoraqeTank OGas �Oil
25. Rnpf Sh�athin9 i . 74., Overhead Hydro
26. T�84r Ceil��g (Structurall & Monocoat � 75: Dry Chemical ' � ' I
27. Frame and Flashin9 , ' . 76. Dry Standpipe ,- � ' .
�28.� Lathing & Siding. � .. � -. � . 7T.' FIXED SY$TE0.h FINAL , '
'29. Insulation ' . .. . � ' I , I � 76� FIRE PREV. FIN.9L . i
�30. Drywall Naiting � � ' � �•� - �HE�ALTHiDEPT. REQ�IIREMENT
'31. Piaster BFown Coat � I .]9, FINAL INSFECTIQN -" �
J �
� � ..r�
32.�Electrical Poy.�er Metec�Final � � � � 80.'P000 CERTIFIEATE ISSUED , �
33..Final Electric " � �� � � No(es: � ; ;; -
34. ,Finel Heating & Air Conditioning� � _ � "
35. �Final Gas P�ce-Test •t' ' � ' �� ���--'� `
i� )
� 36.'Hood or CanoPY � - . � � � . � • . , _ .
�37. Final FaCtory Fireplace , ' i . '� ,. � � I
�38. Final Plumbing , � ; ' � � + •
39. Water Service�Final ' � � � • - � � .
_ . ,
40. Gas Service�Pinal . , � � ',. �
-41. SolarpomesticFinal�: � •� ' ' - , ,.
� � �
42. Backflow Preventer - , � •• - _ - • _'�
43. Backflow Irr�igation -; _ - � ' , ' � � �'-� x
� a= >;+"'.: .^.
44. Landscape Irrigation System- � � - � • - . � � - �'
--r
45.•Sound Attenuation ' .. ' , . � ;,-
.46. Handicap Regulations ' � . � - \ "' r".r
�.y
47. FINAL S7RUCTURE & BUILDING . ' . _ •- �.
- _. � •
46. PINAL P4ANNING � - � • • -
49. Electric Release to Edison • , � � -� � ' � �
� -._
50. Gas Release to Southem Catifornia Gas Co - " _ '
51. CEflTIFICATE OF OCCUPANCY ^ � �
No, Date �
�
�PflPJECTk00HE55: 3S�IS AARHOR GA'fEWAY S
OWNEN'S NAME: C J SEGERSTROM & SONS
aooaess: 3315 FAIRVIEW RD
COSTA MESA,CA 92626
�N�r: �03
AHCNIENGINEEH: TOM COMPOS6 ASSOCIATES nec.xo.: C-14944
nooncss: 1809 WESTCLIFF DR uNir: 275
N.H, CA 92660
eenminee: ��506LW.C�LAKEACENTER DR ��14)54083771
noos¢ss: SANTA ANA CA 92704
LICENSED CONTNACTOB OECNflFTION: I nereby ailirm �ha� 1 am Iicense0 un0er pmvisions o� ChaO�er 9(commencing with Sec�ion
700�� of Div io o t usiness antl Pmle ions C Oe antl my license is in lull brce an0 effect.
��T����.�f aa���Q�(� STRTELIC. �14�$Z cuss: H-1 EXP: 07/95
a� /I � � ` / Signa�ure: /�
NREFS' COMPENSFTION �ECIAflATION: I �¢reby af�irm ��ai I have ertifit e ot tp�sery� o Selbin5ure 0� a terti�icate o� Workers'
omoensaeon I�oye��c1 �centl,�.�covv tnereo� (Section 38oU. L. � F)Q n 4L �/q
POLICY NO.: qTLTF �nein E%P. Up�i �i
wmram:
�tlitie0 copy is he�e�y iurinsfietl. Cehitie0 copy l
oe l sr'-Z�f —9N AOP���a��
EMPTION FBOM WOPNEBS' COMPENSATION DECUPRTION: (T�is:
I cerlily iha� in �he petlormance oi �he work lor w�ich this permit is
subject to the Workers' Compensation Laws ol Califomia. /
Date: Signamre: � J
NOTICE: I�, atter making ��is tleclaration, you shoul0 6�oml
Coee. you mu5i fotl�with compty with suc� pmvisions or I�
CONSTNUCTION LENDING AGENCY: I hereby at�irm Ihai �here i
whicn �his permii is issuetl (Set�ian 3097, Civ. C�.
LENOEP:
noonEss:
olNsioa.
I il �he permi� is for ane �unOretl ($100) or less).
any person in any manner so as m hecome
�, Workers' Compensaiion provisions o���e Labor
be OeemeE revokea.
n IentlinA aAency for the pedarmance olihe work for
OWNEB BOILOEfl DECLABpTION: I �er¢Gy a��irm Ihai I am exen�pi Irom �he ContraCtoK State License law for the I011owinA �eason
(Sec�ion 7031.5 Business and Pmfe55ional Cotle: Fny ci�y ot cou0ry whic� requires a permil Io cons�mci, alter, impmve, tlemolish, or
repau any s�mc�ure. prior Io iis issuance, also repuires �he applicant �or such permii lo lile a signetl statemen� ihat he/5M1e is Iicen5e0
pursuan� Io Ihe pmvisions of ��e ConVac�ors' State License Law (Cnapier 9(commencing with Sec�ion 7000) ol Division 3 oi Ihe 9usiness
and Pm�essions Cotle) or Ihat he/she is exempt �here�wm antl the basis for �he allegeU exemg�iun. Any violation o� Seciion 7037.5 by
any applican� lor a permi� sublects �he aDDlicant lo a civil penalry of no� more than �ive �untlred dollars ($500�.
❑ I. as owner o� �Ae pmperty or my employees wit� wages as Iheir sole compen5aiion, will Ao ��e work, antl the
s�mclure is noi imentled or oflere0 for sale (Section 70ad, Business antl Pmfessional COae: The Con�rac�ors' Sta�e license Law
tloes nol apD�Y lo an owner o� a pmpe�y wha builds or imP�oves �Aereon, an0 who tloes Such work him5el�/h¢fseli or throUA�
his or her own employees, pmviaed Ihal such impmvemCnis are not intentle0 ar aiferetl for sale. It, however Ihe �uilding or
impmvemem is soltl withm one year oi compleiion, the owner will have Ihe hur0en of pwving he/she dia noi Uui10 or improve
for ihe purvose of salel.
I, as owner of �he prope�y, am exclusively contracting wi�A IicenseU contractors to consimct the pmlec� (Section 7044, Business
❑ and Professions CoOe: The Conlraclors' State License Law tloes not apply to an owner of pmperry who bwl0s or impmves thereon
and who contract5 �or such pmjecls wi�� a conVactm�s)li[ense pursuan� lo Ihe Confractors' $tate License Law),I am aware
tha� pmof ol iheir Worker's Compensation insurance sho�ld he pmvide0 �o me.
� I am evempt unaer Section: B. 8 P. C.
lor Ihis reason'.
Oa�e. Ownec
I tlo hereby cehily Ihat I am aware ol antl unOerslanU the requiremems o� California Neallh and Salety Cotle Sec�ions 25505, 25533, and
2553a antl Nat I or any IUWre buil0ing occu0ant will/will no� (circle one) neeU to comply with said Slaie codes and Ne requirements for a
Oermit �ar conslmc�ion or motlilicaiion Imm ��e Air Oua6ry Manaqemeni DislncL ResiEenlial cons�mction applications are eeempt imm
ihese provisions.
oate: applicant: _
I hereby cetlify�hat I have reatl this application and s�a�e lhai
ortlinances antl slaie laws relaling to huiltling cons�mction antl h
a H ' � Signamre:
license or Sociai Securi�y x:
apree to comply with all ciry antl county
is ciry �o enter upan the ahove�mentionetl
tfi4646 Whne—Builtling: Green—Code EnforcemenL Canary—APplicant; Pmk—Revenue; GOltlenro0—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 068573
PERMIT NO: E 068573 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: IIIN PERMIT TYPE: ELE PURPOSE: ALT
JOH DESCRIPTION ; INTERZOR 1140SF OFFICE T.Z. SQ FT:
CLAIM VALOE: CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: REF: B-68569 .QC3L�2� �Ni�
�t**x�**�r**fr****x�*+r**f�*x�***+�fr*i�**x�*x�**it+��x-x�*****x�*��*��*+��r�r*+tx��**+r*****x�rr*�*******
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HOILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN AGHT; FT IN LEFT: FT IN AGHT: FT IN
PARKING REQ: PROV; PARCEL; 41507108 ZNE; REF NO;
PLANNING NOTES>
�
1E k if iF it it iE it fE iE 1E iE iE iE iElE iF if if i! iE iE iE if 1E iE it 1E iE iE iE if if if if ikif 1! jF 1E fE if �ElE ik iE iElE fE iE %%i! iE iE if �E it it it iE iE iE if iE iE 1t �E iE iE iE iE it iE iE iE it 1E iE
D E V E L O P M E N T S•E R V I C E S R E Q U I R E M E N T S
20NING APPROVED BY ,
DATE;
HUILDING APPROVED BY ; �. DATE; ��
s ,A,�
APPLICATION ISSOED BY• �1p`
DATE;
iririr�r*�rx��rfc�*�r�r*iritit�titir��r�r3F3F�r3F�FiFiFiF3FiF3F�,3'i��r"�'�'iF�flF�FiFiFi�3F'��FiF3F�-ic�frx�*+t+rx�*�r �r*
iFfEitiEilifififffil�liliFkkititkiEiElEiEiEftiE�kitifikiEiEillFiEiFikitiEiEilifitkitiFiEiEiEiEitltiEitiEifitifiliEiEitiElEiEit�EiFlEifiEi! 1EitititititiE
LEGALIZATION;N F E E S U M M A R Y STROCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 56.75
SOR SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 56,75 15,00 0,00 , 71.75 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 71,75 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE / —
�TOT GRADING PLAN CHECK
71,75
i! it �E ik i! if if iE iE 1E if if it iE if 1t it 1F i! fE iE fE 1E it it k 1! it i! iF if iF 1f iE ik it �F �k iE if if ik �f it iE iF iE iE if iflf fE iE i! fE iE iE ik iF if M iE k 1f tf iE iE iE if it if iE iE iE if 1F ik �F if
I N D I V I D U A L F E E 'B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 15 FIXTURES LIGHTING 1 ST 20 EA, ,75 11.25
ELE 2 RECEPT/OCTTLET 1 ST 20 EA, ,75 1.50
ELE 4 MISC APPARATUS NOT LISTED REQ PERMIT 11.00 44.00
END OF FEES Q
�° �-, � D
{#UG 2 21994 �
�l�% OF COSTA MESA
�
CONSTRUCTION ANO PLANNWG � POOL & SPA �
APPROVALS Permit # Date Inspector qppROVAIS Permit � Oate �nsgector
� L Temporary Electrirai Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � ' - 53. S(eel Reinforcement �
.3. Electricel Conduit Utility�llndrgrnd. � ' S4. forms :
,, ,4. Electrica� Conduit-Undrgrnd. 55. Electricai Bonding
.=5: Sieei Reinforcemeni 56. Rough Plumbing & Pressure Test �
6.. Electrie�l UFER Grnd. , 57. APPRQVAL TO COVER-GUNITE
7: Footinqs '- � 58. Electricai Conduit�Untfrgrnd.
8,. FoundatjOn ' � � 59. Gas Pipe, � Undrgmd., Tesc
9. Waier Pipe�Undrgrnd. � 60. Batkwash Lines, P�Trap, O Undrgrnd.
; 10. Structur�l Floor Svstem �� � �� 61. APPfiOVRt TO DECK
- i
,1'1. Pvqperty,Sewer Llne & Nouse Connection � 62. Backwasli & Receptor�Final
12. SAwer Cap �' 63. Heacer & Vent-Final
73. Roof Drains �� � 64. Plumbing System - Final
74. Rough Plum6ing � - 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar Sysrem-Final
16. Rough CJactric Wiring ��� /�. 67. Fencing & Access ApProval
17. Rough Wiring Sign ' CL'�`- APPROVED POR PLASTEflING
18. Rough Electrical�T Bar Ceiling � �a�j/9�I. � �,,9. POOL/SPA SYSTEMS FINAL
_ 7
19. Rough Haating & Atr Conditioning FIRE DEPT. REQUIREMENT
' i l L • ".I
2Qr Roogh Factory Firepiace ¢ . � � �APPROVAL'S - �: Permit # � �
, i
21�.�Du,�,ts, in Structuye .. . - � : �- � � 70. Undergroon� Hydro � ��
22.Ducts,Ventilating. ' _ '71.ProductP_iping�Gas DOiI
23.,Gas'Pipe,Rough & Tes _. , ' . 72. Underground Flush
24.,Roof Fram�ng � � � � � � -73:' Undergmd.Stora'gC,Tank OGas ❑Oii
25. Roof Sheathing '" � �� ' ' � 74' Overhead Hydro � .
26. T�Bar Ceiling (Structural) & Monocoat � J � 75, Dry Chemical - � '
27. Frameand Flasfiing 76� Dry Standpipe } �" '..:
i28.' Lat�ing& Siding �- i.. ' ^� � 77. FIXED SYSTEM fINAL
� . ;,.
� 29. Insulation ' '�� ". ' � • 78�: FIRE PREV. F�NAL �
�30. DrywallNailing � � � � �, � HEALTHtDEPY.�REQUIRE14tENT
�. . � , �
; 31. Piaster Btown Coat� . � ,79: FINAL INSPECTIOf�
32. Electrical Power Meter Final /� � SO�FOOD CERTIFICRTE ISSUED
�33.-Fin�i Electric , � . �/2/q(� �K.,,/' � Notes; . � � � . � .,
�_�� ��,.��t�
�34. Finat Heating & Aic-Condhioning ( ( `, - ��
� � �
^35. Finai Ga3 P�Ge-Test.. ,. ? I � =- i ' � - ' ; � ' � '
��36. Hood or Lanopv _, ' � � I , : ' . � ' • ' � � .
, - r n
� .
�37. Final FaGtory Fireplace i - - � - - , ' ,
38. Final Plumbing - ' � � � ' � � . � .,
39. Water Service�Final ., i � � � ' • �
40. Gas Servite-Final . ., � �. _- �. � . .
'41. SolarpomestirFinai ' i � I � �'�� � �
a2. Backflow Preventec � � . -,._s5
r:::: ��
43. Backflowirrigation • _ ; . . t�--�•� �
: �-
44. Landscape Irripatior Sysiem -- . � � - • �
'45. Sound Attenuation . : . ' j' �•' ., "
46. �Handicap RegulatiQns � ' � ,. . . '
47. FINAL S7RUCTURE & BUILDING � � � - i . � , -
�� -
48. FINAL P4ANNING - � - }- � � -. ._. . . ��=
49. �Electric Release ta Edison i, .' � "4
�i �
50. Gas Release to Southem Califomia Gas Co , � � �•
51. CERTiFICATE OF OCCUPANCY -
No. Date '
MONEasa Gatowo: J 7 H� HH2Ctl Vlt Cr -� ��'T M�'� </ uxi: 1 v
oxxexsxuieicaawr�C.J. SEGERSTRO S SONS � FLOOD: AH-
. �oo�ss 3315 FAZRVIEW RD
' COSTA MESA
'A �2626 (714)596-0110
�vr�. Yuwa mo�sa
uxxrtEer on �[�n: ue xo,
pCH OB ElA'4 ADDXE53: UNT:
����T�� CO290LUNI�VERSITY�DR INCOR (714)540-3771
cwm�cra%�NEWPORT HEACH CA ��, 514982
92660 �,,,, 150
UCENSEO COMRRCTONS DECUP1110N: I hneb/ ellim uMa paWy d perjury Net I em licanesd under proNebn� d Cheqw 9
(wmmwMnO wilh 9anbn ]aM d Oiwion 3 d Ihe &mirov eM Prdx4m� Cads. eM m 4canw o i M1ID b,s eM Mlae.
ya� c.No.:04292� uc.cuas: B uc.No.: 1 2 E7 �: 07/98
'om.: � a cmv.na
O EP BUILDER �ECLMATOry; � �yepy dliim vqx pwWy ol perjry Nel I un ammp hom Ns Camedm liuue lew la tla
aw�iro rwm (saecn �oa�s &�s:wa ene Fmeeuoia coee: AmW a mvur.hd� r.a�+ e o�a �o awwn. enx. imwa..
.lunofen, a rapei mry+vuuue. Pior m m ewvioe. e6o iW�6m Ihs �V�mY �« wM pertM lo fJe e ripnd attla�wa Rw M«�ha
' iKm�d wmem �o me n��.�+ a me cavrenas uosne ie. �ch.q« s Im�+o wnn swun mool a u.eon a a m.
�mm end PeMmioro Codel a thet M o de u wmq Ovdmn ad tM Esa la Ne �Mped eanqion. /�M vioW ion d Senion
/W 1.5 b/ eiry appGcem In e permq sdipm �M appfuru �o � tlN pe�uR� d nal mws tAm fxe MVMeE Aolu� �S.AOp.
� I.e�oxnxdtMpapenyaryyanpb�w�rnhwqp�nllwidewmpa�WintNdoRerakrdlM�Wcrosend"vtlsMeE
n Msod la Wa (Ss�vi ]Ma. Bimmsend PmlaadauCada: Tha Coramfon lioana Lew doea naepW'/toen owiwrd VaPoM
.,no e�ae.> mo� ma.m..�a.no m...�.on� rn,wt«n«.e/ a u.d,y� ne «n. o.m «roew.. aoww mn,Kn
impovemenb ua nd iMendM u uRxaE Iw vele. tl. Mwam.IM WOJinp o inpovemeN o wltl wi�lmi an Y� a�GIMbn. the
owrwLuitler wiG �+n+�+buhn d poviq M a dn diJ m� dNtl a'vnqwa ta Ne pupua d Wel.
� I. n oxmr d �M D'WMY. em mtl�dY mutean0 rKh fw�ued convecw� b mtf4W Ihs p9� (Swion )OH� BwMs� ud
aia.niwv coaa: rn. commaa. �;cw �.w m. na mvN m m, o.,w a ww�r ••+�o dati. « impwo nwem .�e wro
convew M vxA piqeae wdn a mNredar(e) IivmM punueM to iM Camreqas lioenae Isw�.
� I em eRempl �Mer Seciion: B. 8 G.C., tar Nu �aeson:
Dala: �
I Ao M1aaEY ceNIY Ne� I em awaro d md uNrswd Ns'a�uanWs d CaOmve ibslh W Se1MY Gods 9Miau AS505. 255�. vd
255�. end Ne� 1 a anY Nun Md.{ p ompuC wYl / wY m� (mcb ane) nesU ro wmdY Nh mC tlela cada� end ih �pwmnwNs br
eD�etamubunionancddce�ontramNsAi�Y a^�Ye^+b0ivria.RariUMmlmmtwione00�'nuenaxrnqhomiMp
pwiaidv.
Das: �Dp���
WOPKER'S COYVEN4�TION Op�up�TION: I MreOy df�m �uNv psiWy d pa�y wr d Ne b0ow'vp Jsdertliom:
� Ihewardnilme'v4ewsewlp'rJtedmwKlo�Waiwabworkrimrqa�umion.upwideElnbySwim9]OOdtMlebor
COM.Ia �M palmnv�c� d yy rak tor Wirl� Ne penro "s MuM.
�] �n....nd.+�mmN.�.akrYmmo.�on:m,renw...ncw.dMswbnamoame�.ec.coes.rorm.oe��+�ain.
.,,nea.na,e:.o.mmm�,.e.w•�•5����`www�s••�•: EXPIRES
c.M..:
rwn. N�„,n,, o i- 10 / 01 / 9 8
mi. seion msi rot b m*PwW / iM ns'm] e M am hw�drM Eo9en 13�a01 a IsoJ
� I eer11Y Ihm in iM peAwmeny d �M wak M whkA tAu permE b 6ewd. I�heY ro� rnpby en �+eno arry menew o m lo
bscome �uEjw m tM v.Mds� oonpnnemion Isvn M Cafdom�. epE epn IW ! I kwl xo a�Ej�u m �M woM1en'
mpsnavl n prtrviei n� d$eyqn �]00 d iM LeEa Code. I Yull IhwlA �f ry pa ' 1 s
) �
Deu: / �pp4raN:
mlrp: Allun ro ucun rohw'rortpw�uetlon rov�np l� NrNI, �bWll ub/cl �n w�plqw ro cMNNI p�nWw �iM
GHI Ilw W ro ww nWrH tlq��y�p AWbn lJtQ}IXpA h tltltivn m IM mul oI cenpru�WR Grtipa u prvvlCW br In
s�caon �ros u� m.l�eo, cee.. �m...c.�e.rcorm✓. �....
crn+sraucnoN twwwa �aEncv: � i+wr e� wdr vnW a o«iw mr m.. u e mm'Nac� w.�,a m«cr ra me
penamxse d tM wek br whiN ihe ow� b'su�ed (Sseion J0A1. C'r+. el.
LENDEP'9 NqyE
LENOEN'S �DOFE55:
1 unM tAn I hws nd Ne eW�4an md �s IM Ihs ebw�'vdanrotian u mnw.l qae b canGN we� N aiY end mwY ad'v�vaa�
anE nm� kvn MmiS w bwldiq canmuebn.id herabY uNnce rtpawMa�iw� d �hu av w am« w� �ha eEws-mwcned wcoeM
���""�w�D� ERCt USHER
Dma: /�a�l9S�
(5151 �O.WP) Whne-By�yiq 8 SefUy: areen-Fb: Cene�y-4ppiram: Pink�lmmue: Cialtlenio�Naaw
CITY OF COSTA MESP+ - BUILDING PERMIT
PERMIT NO: B 086761 PLAt� CHECK NO: N
CONSTRUCTION TYPE: 3-N SP PERM(/I3' TYPE: STR
JOH DESCRIPTION : DEMOLISH NONSTRUC7URAL WALLS & T-HAR
CLAIM VALUE: 750.00 CALC-VALUE: 1,000.00
�� - �3
PERM NO: B 086'161
GOVT: N SUPP: N
�Pi7RPOSE: DEM
SQ FT:
GROUP OCC: B /
COMMENTS: CEILING, FOR FUTURE T.I.
r�t�rtE**�x�****��;�**�a�*x�*�*�*x�r�+�*��****+��**� ��****�*x�r***�*��*�*�***�***at#***�r.-*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ----------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN
--------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: Fi' IN
PARKING REQ: PROV: PARCEL: 41507108 ZNE: REF NO:
PLANNING NOTES> �
> r
iE if if if ik i6 i(� iE iE if jE 3E iE iE �E iE iE jf iF jf 1E k if iE iE iE iE iF iE �F 1E �E iE iF iE jE iE if if iE if if if iE 3E iE if iE iE if iF iE aF if !(� if it iF if ifY`if iE 3E iF iE iE jF,if !f # iF iF iE iF ii ik iE iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S
ZONING APPROVED bY . DATE: "t
BUILDING APPROVED BY :
APPLICATZON ISSU£D BY:
�Eik�E3EiklE3E3l1t1Effk1F1E1EiEiFiE�EiFi6iE 1t
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMHING ELECTRZC MECHANIC
PERMIT 34.75
PLAN
ISSUE FEE
HUILDZNG-DIV-> PERMIT ISSUE PLAN-CHECK
TOTALS----> 35.25 0.00 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMHING ELECTRIC MECHANIC
34.75
_ DATE: •" `' i !
�-�*+�**D***** , � *U�
STRUCTURA�, SEGMENT:Y
� Yl.
FIRE SMIP/RES GRADING
SMIP/NCiN-RES
.50
TOTAL PAID DUE
35.25 35.25 .00
35.25 OVER/SfiORT: .00
FIRE SMIP/TOT GRADING PLAN-CHECK
.50
iE if iElf iE iF if !f ik �Y �E dE ik iF iFlk if 1t 1E k if if iElf ik 1tlf iE jE iE ik 1E iE 1E �f i! ik 1E iE iF 1t iF iE iElt if ik iF �1e if ik 1f iFlE if iE if if iE if iF iE �F iE �Y 1E 3E �f 3f iF iF iF dk it if iE it i! ik
I N D I V Z D U A L F E E B R E A K D 0 W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
NO FEES WERE SELECTED FOR THIS PERMIT
81-27-1998/11:85 NIVf35.E5
RCPT11:81-8@18768
PEkP9IT a 986761
� _ ^y .
'CONSTRUCTION AND PLANNING � POOL _ oPA
APPROVALS Permit �P � Date Inspector AppROVALS Permit #' Date Inspector
1: Temporary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil Pipe•Undrgrnd. . 53. Sceel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
i1
4. Elec[rical Conduit-Undrgrnd. - 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electr�cal UFER Grnd. 57. APPROVAI TO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water PiPe�Undrgrnd. . 60. Backwash Lines, P-Trap, Q Undrgrnd.
10. Structural Floor SYscem � 61. APPROVAL TO DECK •
11. PropeltY Sewer Line & House Connection 62. Backwash & Recepror-Final
12. Sewer Cap � 63. Heater & Vent�Final •
13. Roof Drains 64. Plumbing SYstem - Final�
14. RougN Plumbing 65. Electrical-Final � '
15. Rough Electriwl-Conduit 66. Solar SYstem•Final
16. Rougn Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL �
79. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Raugh Factory Fireplace APPRQVAIS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Oucts, Ventilatfng 77. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Tett 72. Underground Flush
24. FooS framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof &heathing 74, Overhead Hydro
26. T-Bar Cei�ing (Structurall & Monocoat 75. Dry Chemiwl
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulatio� 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 60. 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 Pomestic-Finai
42. Backflow Preventer
43. Backflow irrigation '
44. Landscape irriyation System
45. Sound Attenuation . � ?
:�
46. Handicap Regulations V •�.
47. FINALSTRUCTURE&BUILDING ��� l � , «�
48. FINALPLANNING . =��-�'
49. Electric Release to Edison -- - '
50. Gas Release to Southern California Gas Cn "
51. CERTIFICATEOFOCCUPANCY �
No. Date
��
nuonEssa euiano: 3 5 4 5 HARB OR B L �
ovmexsru�eiriwwm:EMULEX CORPORATION
" ' �oo�ss:SAME
�vv�. �u�ma �oonEss:
,wcxrtecT ox �m�+:
`..
urT: B
FLOOD: AH-37
uc. rio.:
11MX.OH FNfi.'S IOONE55: UNT:
ca+m�cTarsx,u�GEORGE LINE CONSTRUCTION ( 714 ) 968-0703
ca+m�croxs�miwa19552 WESTWINDS LN
,�ooqEu;HUNTINGTON HEACH CA �,�,; 615352
92646 uxr:
LICENSED CONTRRCTONS DECLfPATION: I hareby eRirm under pareXy W perjury IIW I am IbmeeE uMm qovieions ot Chep�e� 9
(mmmendnB �h Senion 1000) d Drvision 3 0/ lhe Bueinese arM Prdesaiona Cade, eM my liunea ie in lull lorce eM eXxl.
cmuc.No.�57789 uc.cuss:H 3 2 EXP: 00/00
Dete: — l` Z T �\ i. Convaa
OW NEfl BUILDEN UECLARATION: 1 hemby elfiim under penelly d perNO' �h I � exemq Irom iM Comretlwe Licenae Lew la the
lolbwinp reeaon (Sedion 1�J1.5 Bueimm� enE RWexiona Code: Any cily a wt�idi rpuime e permd �o muwn, el�er, impova,
demoloh, a repeir eny e�ruclure, priar io Xs 6euence, eleo requirm �he epplirent Iw euch pam�n io fila e eg�d elalemant iMt M w nM
IiranaeE W�ueni io ihe panaiana d Ne Conlreclae Licenae Lew �Cheqm 9(cwnmeia�q wnh Sepon )OW) d D'voion 3 d Iha
�sinea end PrWesaone Cada� or IMI ha a eha is exemp therehom eM Ihe beaie la Ihe elbpeE exemqion. My violatbn d Setlon
/W 1.5 by enY aODlicent lar e permd eubpna Iha epd�� to a civil peneXy d mt more Ihen /'ve huMrad ddlen �55W11�
� I.aamvmrdNepopeMamymmpbyeeawYhwapeaavlM1eieobmmpe'we�ion.WldolMwork.eMtMnruclureb�wlinteMeE
a oReeed lor aeb (5eciio� ]OIA. Busmsa vd PMeavons Cada: The ConUeeae Lkmas lewEoee mt xpWyto en owiwr d papeny
who Wide w inqoves Iheiem, mM Wn Ems eueh xoek IimeeM a Mne� a Ihrwph hu a her oxn amployme. provideE Ihel euch
imprtrvemmia ua nd inle�Med «ollered ta sab. H, howa.er, tho buitliip a'vnpwaneru u eoltl wn�in one ymr d campbtion. ihe
owror-0uilder will heve tM WMen d pwi�q M or sM Ek ral Wik a imqo-re In IM WT�e d eebl.
❑ I. m oxiwr d �M V�WeM. am extluvrveN mn�reeme wuh li�anaed convanwe io cwm�ua iM pqed (Setlion 1041. Bua'vima eM
Pm/wau COCe: The Comrmon Lieense lew daee m� epply io an awes d qopany Mro bu0tle a impwm Iherean aM who
conirecb la wdi prqaea wiU e wm�afa�s) 4censeE Wnuenl lo Ihe ConlraGan �imnes Law).
� I em uemp uMer SMion: B. 8 P.C.. M Nb reeaon:
ceniry ihY I em ewere W vd uManteM IM repuiremenb d CelCanu Maell� eM SWty G
thv I a eny Mura Wiki�q ocwpem will / wll m� (arcb aie) need io canply wlh eeid aete
oma: now��:
WOPKER'S COMPEN9�TION DECLAR�TION: I Mraby e/firm uMer penelly d parjury aro d ihe lollovnry dedve�une:
� I heva vW wip meiniein e cerlAcele d coneanl to aeM�insure for wakers mmpaneatbn, m povided fa by Sedion �]00 d �ha Lebor
Coda, lor �he pa�fwmencs ot IM wak Iw which ihia pertnX is ixuad.
� I hew uM xitl meinleii waken' mmpenaelion inaurarce, ea reQuired by Saeim 3)00 d Ihe lelm COEe, br tM peRormence d Ihe
work lor xhich ihie permil ia iaaued. My workers mmpenutbn inwrence famer eM pdiry number ars:
c�.,:
va�rr+�mna,:
(mis e«+;on nsw na bs cand�eo-1 me ro�x ia ro. w. nvndred dw�ers R�aol o. rme.)
� I cMAy ihel in the pMormeme d IM w«k la which thb permtl ia iseued. I eheltml empby airy penon in any menrier w n lo
becoma eubjea io iM xaM1an' compeneation lewa d C' ie. en ee OieTil I ehauk become wEjea io iM xorks�s'
romGeriaelion m�aiona al9neaian 9M0 d tln leb« . I ahell IonM1nilh mP,r r�i y�ovi4one.
om.: �� Z � � l. i. �wp�: ��—�
Wam/ny: F�llun ro ucun woM'r�' nnpwetlon eovereps l� unlewNl, ene �I rb/�ct �n rRvlqw fo ulMrol puuMs� eM
clH/ lln�� ap ro om h,ndM fMuund dW/+n fSiGO,OW), In eWltlon ro fh� aw ol rompwwtbn, Mmep� e� prvHCM br In
Sxtlon �R16 0l tl�� LWOr Cotls. /ntwt. IM eHomsy� /ssa
CONSTNUCTION LENDINO A6ENCY: I Mmby elfilm uMx penelly d perjurv �� �Mro u a oonetrud'wn bndi�p eparcy br Me
peAmmeriea W iM xoek fw whitli �hc P�I ie oaad (Seaion 309). CH. C).
LENDEP'S NAME:
LENDEWS ADDNESS:
I eeM'dy Ihet I heve reed thi� epplieelbn enE atete ihe� �he ebove inlammion ia mneq. I epees to wmply wnh ell dly end munry ordinenroe
erW eiata lewe rNelinp to buildvp cwwuabn enE Mreby eWhor¢e repremnietivea W �hie tlty to enter upon IM ebova�mentioneE qopeny
��`� '°�'"'GEORGE LINE
De�a: S-Z-T ` l�
�5151�CE.WP) WhnsBuiWinp 8 Stlery; Greeo-Fle; Cenery-AppFrant; Pink-Pevenue; Oddenra�Aneaaor
CITY OF COSTA MESA — BUILDZNG PERMIT
PERM NO: IB 077815
PERMIT NO: IB 077815 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE; III—N SP PERMIT TYPE: OTH STR PURPOSE: OTH
JOH DESCRIPTION : FINALIZE EXPIRED PERMIT #H64890 SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B /
COMMENTS: "� LOGIC CORP" OFFICE T.I. EXPIRED PERMIT
�r�x�x�x�*x�x�*x�+r x�x��r*�x�*��x-x�*�x�**x-�r�r**�x�x�x��r��****x-x��r****�**�r**����+���r+�**�r�**x���rx�+�***
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL; 41507108 ZNE; REF NO:
PLANNING NOTES>
i
1F�F�EfEiEfEiEiE1ElEifiFlkikif1E1E1E�E1E1EiE1E1E1EiEiEiFfEiEiEfE1E1E1k1ElE1litlklElflkiEiElfiFlEifiFlFlElkfEiEjEiEiEiEfE1E1E1EfE1EfEfEfEfE��E1E.lE1El6iFiE1E1EiE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T,S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE:. �'
1
APPLICATION ISSUED BY: � DATE:.``�.2,r ��'lG
9E1EiElElflElElE1E1E1E1Eif1E1fiflEiF�EiElEiE3f��F3F�if7F�F3F�F3FiF�TF±F�FiF3F3F�F3F 3f��'fF��1E9fiF1FiF!(�iFiEiF1E 3EdE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAli.-SEGMENT:Y
� . �
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE .SMIP/RES �. GRADING
PERMIT 42.00
�^PvF�J � �J`T I�D:i�^1
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 42.00 0.00 0.00 42.00 42.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 42.00 OVEA/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
42.00
if 1E iE 3F iE 1E iE iF �E 1E iE 1E iE IE IE 1E IE if �t iF iF iE iF iE iF jE iE iE 1E iElE 1E iE iE 1E iE if iF if iE 1E 1E 1E �E iE 1E iE 1E iE 1E iE 1E 1E 3F iE iE iE jE 1E 1E 3f if if iF * iE iF if iF iF iF ff if iE �E 9E iE if iE
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
INS 1 BUILDING RE—INSPECTION FEE 42.00 42.00
END OF FEES
u�� n)20',::o='-DQ�EJ2:,4 'f s" � .
�.','�c __ . a5 'f�f" t._:%,;
.��'.`� .i.. � � - i �
CONSTRUCTION AND PLANNING � POOI t� SPA � �
,•'APPROVALS Permit# Date fnspector qppROVAIS Permit-# Date , Inspector
1. Temporary Electrical Service or Pole 52. Pooi & Equipment Location . � I �_
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcemeni � ��"
�3: ElectricalConduit�`UtilitY-Undrgrnd.� 54. Forms � `��
•4. Electricai Conduit-Undrgmd. ._. � 55. Electrical Bondiny . ( � �
- 5. Steei Reinforcement. - 56. Rough Plumbing & Pressure Test � �
'.�6. ElectricalUFER'6rnd. 5Z. APPROVAITOCOVER-GUNITE�
Y7. Footings -= 58. Elearical Condvit-Undrgmd. �
��� 8, Poundation ��� ��� - ' S9. Gas Pipe, � Undrgrnd., Test
_9. Water Pipe-Undi9rnd." � � � 60. Backwash Linee, P�T�ap, Q Untlrgmd.
� ,�
70. Structi6rai Floor Syscem • �,� 67. APPROVAL TO DECK . �
11. Propeity Sewer�tine & House�Con�ection 62. Backwash & Recepmr-Final '
72. Sewer Cap _"'-'� . 63. Heater & Vent-Final , �
'13. Roof Orains - �� 64. Piumbing System - Pinal �
14, Rough Plum6ing, F 65. HectricabFina4 � •
75. Rough ElectricabConduit � � , 66. Solar System�Final ' �
i
'16. Rough Electric Uliring �_ 67. Fencinc� & Access Approval ^ 3
]7. Rough Wiring Sign � 68. APPROVED FOR PLASTERING �`
78. Rough Electricaf-T Bar Ceiling 69. POOL/SPA SYSTEhAS FINAL �
19. •Rough Heating &,Air Conditioning� • v, x . r' F1�RE'DEPT. REQUIREMENT -
20. Rough Factoty F7aplace _�_ � - '� ` � APPROVALS_� �= Permit #
27. Ducts, in 5tructur.�. .. r �- :� i- .` - 70. � UndergroiR+�d Nydro y
c ��
22. �Ducfs, Ventilating•' � _ ``-' �`�" � 7�, Produsi'Piping-��Gas OOiI a
�
23. Gas Pipe-Rough & Test � . _ - �� - _ 72, Underground F.tush �
24. iioof Framing _ "' � .y �;, �: J3. Undergrnd.Stotage'Tank �Gas ❑Oil
25. RooE•Sheathing � � . h - 74.�Overhead HYdro -'
26. -T�Bar Ceiting (Structuraq & Moncienat `�' T � y 75.'Ory Chem�cal `_ . ' - '. i
z7, Frame and Fiashing., _ _,. '>' r' ''� . � 76. Dry Standpipe�- � � . '
28. Lathing&Siding" -- '"'- � *' '�" 77. FIXEDSYSTEM�FINAL.^ ' '
29. Insulation - - r�' � ,+ 78, FIRE PREV. FINAL �
30. Drywall Nailing �� �^ '' S �HEALTH DEPJ...REQUIREMEN7
T � c "
, 31. P�aster Brown,Coat,,; ` � T r �� �9. FINAL �NSPECTION =
32. ElectricaP?owzr Meter�Pinal � ;' � �� � 80� F000 CERTIF�ICATE i$SUED' �
33.'Final Electric =� .- ' ,_ - � t - � ��, Notes ;; -r; r � `
34. ;ffnal-�tieiting=& Air Conditioning ' - � �* �
.- � �
35. Final Gas�Pipe-Test. 4 �� . -. - . ;� ... .. . �.
. 36. Hood or CaooPY ' . cr :: � ' - _ . -. '� - -
_ ,
� 37. Pinal'FactorV Fireplace.� . .. _ ,x, �I , '< < _ . � .
` I
- 38. Fi�al Plum6iag ' +� r +' � '� � - '. ' �--
�
39. Water Service-Final ' `� „ ° � � ` - ., . -
- 40. Gas Service-Finai � � �- -- _ � � � -
- 41, Solar OomesticPinal_ � i- 'x '
42. Backfiow Preventer .. ; : - t .- . 7�� : ' -
r �
43. 8ackflow irriqation ' ' s. - i� x+. ' , C.
� , .. . .� „ .. ., ._: " : '. . ^ . � I
44. LandscaRe irriqation System ��.:: o� <. '" '��� : ' � � �'
r-. x -•
45. Sound Aftenuation � � ' !' .: r � �� ' . . '
` F • /�
46. Handicap Regulations - � - -' �
47. FINAL STRUCTURE & BUILDING ��� + � � ' . �
48. FINALPLANNING- l � Y � •
49. Electric Reiease to Edison � ,'� -
r: -
56. Gas Release io Southern Catifornia-Gas Cq � _ -" � -
51. CERTIPICATE OF OCCUPANCY
No. Date
li �
PflOJECT AD�XESS: 3 S 4 S HARBOR B L
� OWFEB'SNAME: EMULEX CORPORATION
nooeess: SAME
UNIT: $
ty.:.
AHCMIENCINEEH: PACIFIC BUILDING CONCEPTS NEG.NO.: C
nooxess: 18102 SKY PARK SOUTA uxiT: A-1
IRVINE CA 92714
veammee:GEORGE LINE CONSTRUCTION (714)968-0703
nooness: 19552 WESTWINDS LN
HUNTINGTON BEACH CA 92646
LICENSEO CONTHPCTOfl OECIABATION: I hereGy aifirm I�atl am Iicen5e0 under O�ovisions of Chapter 9(commencing wi�h $ec�ion
7000� of Division 3 oi the Business and Pmfessians Code, and m license is in fullforte and e. tfect.
ciTvuc.: 057789 srnTeuc.:6153 � ss: p �
�
oa�e �J - Z '�l 3 Signamre: _ �
Z40BKEPS' COMPENSFTIUN OECLl�NpTION: I hereby affirm ��a� I �ave a certific le oi consen� [a selFinsure or a cehilicate of WoBers'
Compensation I s ce c �iliep� py thereoi (Sec�ion 3800. Lab
POUCYNO.: �'������-7� E%P.OFTE: 7�OZI94
comPnxv: STATE FUND,�(
❑ Ce�ifie0 copy is hereby WmiSheU. L'1 Cenifiea 't� ihe ' Buildng Division.
q` p i
Oaie: ``' , Z �` 3 APPlicanL l v��
E7(EMPTIONFBOMWONNEFS'COMPENSPTIONDECLABATIUN: R�iSsectionneeU atbecampleteUi�Ihepermi�isfaronehunOreO(51W)arless�.
I cerory Iha� in �he periormance o� the work for which �his permit is i55ue0, I s� II not employ any De�son in any manner so as to 6ecome
sublect to the Workers' Compensa�ion Laws of Califomia.
Daie: Signamre:
NOTICE: II. aller making this Oeclaralion, you s�auld 6ecame suDlect m the Workers' Compensation pmvisions of ihe Labor
CoOe. you musl �onhwith comply wilh such provisions or ihis permit shall �e Oeemetl revokea.
CONSTqUCTION LENOING RGENCY: I �ereby aifirm Nat ihere is a constmction lending aAency for [he pedormance of ihe work for
wnich this permit is issue0 (Section 3097. Civ. C�.
LENDEN:
nooAess:
OWNEN BUIL�ER DELLl�BF710N: I hereby affirm ihat I am exempt irom ihe Contracmrs' State License law for ihe tollowing reason
(Sec�ian 7031.5 Business ana Professional COAe: Any ciry ol counry whic� reQuires a permii m constmc�, al�er, improve, tlemolisR or
repair any stmcNre. prior to its issuance. also reQuires the aDPlicant lor such permit to lile a signetl statement ihat he/she is Iicense0
pursuam m �he pmvisions oi �he Con�ractors' Sta�e License Law (CM1aD�er 9(commencing with Sec�ion 7000) of Division 3 of ��e Business
antl Pmfessions Cotle) or ihat helshe is eKempt Iheretrom and t�e basis for the allege0 e�emption. Any violation oi Section 7031.5 by
any applican� br a permit sub�ec�s Ihe apPlican� lo a civil penalry of no� more �han live hundred dollars ($500).
I. as owner of ine pmpeny or my employees with waAes as their sole campensation, will Ao ihe wark, ana tne
❑ slructure is not intended or ofiered lor sale (Sectian 7044. Business antl Protessional Cotle: The Contractof5' State litense Law
doe5 nol aD01y �o an owner of a pmpeny w�o buii05 or impmve5 ihefeon, an0 who 00¢5 5uth wOrk �imSel�/hef5el7 of IhroUAh
Ais or her own employees. proviaea Iha� such impmvemenis are noi inlen0e0 ot ofleretl for sale. If, however �he builtling or
impmvemeni is soltl within one year ot comple�ion, �he owner will have the bur0en oi Oroving he/she Oitl noi hui10 or impmve
for Ihe purpose o� sale).
I, as owner ol Ihe property, am exclusively conVacting wi�h IicenSeU contractors to constmc� the pmlect (Sec�ion 7044, Business
❑ an0 Prolessions COAe. The Contrac�ors' S�a�e License Law Aoes nol apDly to an owner of pmpeM who 6uilds or improves �hereon
an� who coniracts lor such pmlems wi�h a coniractor�s) license pursuant to ihe Coniracmrs' State License Law�. I am aware
tha� Dmof ol t�eir Worker's Compensation insurance s�oultl be Omvide0 to me.
� I am eKemD� unaer Sec�ion: B. 8 P. C.
lor ihis reason:
oale: Ownec
I do M1ereby cenify that I am aware ol and untlerstand ihe requiremenis oi Calitomia,Heallh an0 Safery CoOe Seciions 25505, 25533, anA
25534 antl Iha� I or any INure building occu0an� willlwill no� (circle one) neetl �o comply wiih saitl s�a�e codes antl �he �equi�ements for a
permi� �ar cansimclion or moddica�ion imm ��e Air Ouali�y Managem¢nt OiSUicL Nestlential con5imction applicaiions are exemp� irom
Ihese pmvisions.
Daie: Npplican�:
I hereby cer�ity t�a� I have reatl ihis application antl sta�e Ihat tM1e a6ove in�ormation is correct I ag�ee �o comply wiih all ciry antl couniy
orUinances antl state laws relating lo building consimclion a ere y!p 2e reprejeu ves f this ciry to enter upon the above-mentione0
pmpetlY �or inspeclion purposes
Oaie: ��— I Z`� 3 Signalure: �'2s�
oriver's �icense or sociai sewriry r:
1641�46 WM1ue—Butltling�, Green—COCa En�orcemenl', Canary—ApP�icanl; Pink—Revenue; GaltlenroC—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM tJO: H 069890
PERMIT NO; H 069890 PLAN CHECK NO: 04325-93 A GOVT: N SUPP: N
CONSTRUCTION TYPE: III-N SP PERMIT TYPE: STR PURPOSE: ALT
JOH DESCRZPTION : 1062SF OFFICE T.I. SQ FT: 1,062
CLAIM VALUE: 20,OOU.00 CALC-VALUE; 13,529.88 GROUP OCC: B-2 /
COMMENTS: "Q LOGIC CORP" OFFICE T.I.
**�****+r****�**�t�*****+��*�c**+�*��+�*��t***+�**�t*****s+��**+�**+��c�c****�c*�c�c�*****�***+�*
2 O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 41507108 ZNE: PDI REF NO:
PLANNING NOTES> INTERIOR ALTERATIONS FOR EXISTING TENANT (EMULEX)
> .
�r*+r�***�***�**�r**�r*�r****x�*�***�*��*****+�***********�r**�*�r+r*+�*�*�*�****�*�u*�*+�
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N-T S q
ZONING APPROVED BY ;��� �/ DATE: � Z�I�
HUILDING APPROVED BY : 'R,S�� nATE: _/� O c4� )�
APPLICATION ISSUED BY; �� DATE; I� L� ��
�r***�r�t**�r*�t**rt******�r*'���i� ��**iFiF7F*��xiFiF�F���r+��r�-**�t****x��*+r�F �iF'x�'iF**
iF iE if �E �f * �f 3E iE if if if iF iF �t k iE it iF i! 9f if �F if k �E if if iE it #: if iE iP if aE iE a(. iE if it iE iE 1E if iE jf ik it if i! iE iF iE 9f iF it it iE iF �)E iE jf 9E if iE 9f 3F if #' if i4 iE }f if if k iE iE
LEGALIZATION;N F E E S U M M A R Y STRUCT[JRAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 153,00 �
,`.. SMIP/NON-RES
PLAN 29.86 � 2,gq
ISSUE FEE �
BUILDING-DIV-> PERMIT ISSUE PT,AN-CHECK TOTAL PAID DUE
TOTALS----> 155.84 0.00 29,86 180.70 180.70 ,00
REVENUE DIVISION TOTALS--> CObLECTED; 155.84 OCTER/SHOP.T; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRALIZNG PLAN-CHECK
153.00 `: � 2.84
it it if iF iF iF it ik it it 1F iE iF iF �t it if k if 1E #F?t if it fk k it ik 1!� iF iE iE jE jE it jE iE iF it it if iE iE 1E # iE if # ik iE iE iE iF iE iE iE if k �E if iE 1E iE iE .i° 1E 1E �t M�1F it *%iE if iE iE k aE
I N D I V I D U A L� F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O�N UNIT COST TOTAL COST
SFC 1062 OFF-INT. ALTER TYPE III-N . -AVER 11.72 12,996,64
SFC 1062 EQU-ALT COMM. SPRINFtLEA SYS -Al'ER , 33 350.46
SFC 1062 EQU-ALT COMM. AIR COND -AVER .59 732,78
END OF FEES
EXPIRED
1 mp ete lnspe�tions � , , ��
�at6 � G O � Sf� --� ' ,
�i oo�sos�h-oo�sos�� T��� .�s.�aa J
D"nTc: 1?/:�,'9y TiME; 3,:a9
�
r��
CONSTRUCTION AND PLANNING POOL & SPA
,�' APPROVAt,S Permit # Date Inspector qppROVALS Permit # Date lospector
t. Temporary Electricai Service Dr Pole - 52. Pool & Equipment Location _'
2. Soil Pipe-Undrgmd. ,� 53. Steel fteinforcement _
3. Electrical Conduit Utility-Undrgmd. 54. Forms
4. Electricai Conduit-Undrgmd. � 55. Electrical Bonding �
5. Scee! Reinforcemenc 56. Rough Plumbing & Pressure Test
6. Electricat UFER Grnd. 57. APPROVAL TO COVER�GUNITE
Z Footiogs 58. Electrical Conduit�Und�gsnd.
8. Foundation • �t, 59. Gas Pipe, O Undrgrnd., Test � � I
i
9. Water Pipe�Undrgrnd. !- ' 60. Backwash Lines, P�Trap, C Undrgmd. �
10. Structyral Floor System '� � •... 67. APPROVRL TO DECK
17. Propartv Sewer Line & House �onnectiori `� 62. Backwash & Receptor�Final •�`
.
12. Sewer Cap .�" . � 63. Heater & Vent-Final ��
73. Roof Drains - 64, Plumbing System - Final `,
14. Rough Plumbing � 65. Electrical-Final
15. Rough Elec!rical�Conduit 66. Sofar System�Final
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wirinq Sign 68. APPRQVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEPAS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace APPROVALS Permit #
21. Duccs, in Structure 70. Under9round Hydro
22. Ducts, Ventilating 71. Product Piping OGas �JOiI
23. Gas Pipe-Rough & Tes: 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil • _
x
25. Roof Sheathing 74. Overhead Hydro � �
m .
26. T�Bar Ceiling 1Structuraq & Monocoat 75. Dry Chemical x 7; - �
r..
27. Frame and Flashing 76. Dry Standpipe '
28. Lathing & Siding 77. F tXED SYSTEM PfNAL ' t} ••
_c
29. Insulation 78. FIRE PREV. FINAI ' ,
30. Drywali Nailing HEALTH DEPT. REQUIREMENT ��� �
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED
33. finai Elec:ric ; ._.� • Notes: /� �" qt�
, _i'»�(_!_f_K �Scvt� !ss / z I/.[ j
34. Final Heating & Air Gonditioning - ..
35. Final Gas Pipe�Test ' '
36. Hood or Canopy � t �^�'�� 1�
, �__ 1� � i V�
37. Final Factory Fireplace
38. Final Plumbing � 13 S- �l. �i�i �� 1 R �
39. Water Service�Final
40. Gas Szrvice�Final
47. Soiar �omestic�Final
42. Backflow Preventer
43. Batkflow Irrigation
44. Landscape Irrigation Sysiem
45. Sound Attenuation -
46. Handicap Regulations
47. FINAL STfiUCTURE & BUILDING � �
:�yyp- - -
46. FINAL PLANNING �
49. Electric Retease to Edison " ._
50. Gas Release to Southern California Gas Co . ��
51. CERTIFICATE OF OCCUPANCY
No. Date __
��
�
�'
PXOJECT POOflESS: 3 S 4 S HARBOR B L
OWMEF'SNAME: EMULEX CORPORATION
A�ONESS: SAM E
UNIT: $
AXCH/ENCINEEH: PACIFIC BUILDING CONCEPTS pEG.NO.: C
aooxess: 18102 SKY PARK SOUTH �x�� A-1
IRVINE CA 92714
PEflMITTEE: GEORGE LINE CONSTRUCTION ( 714 ) 968-0703
aooness: 19552 WESTWINDS LN
HONTINGTON BEACH CA 92646
IICENSEO CONTHACTOB DECLAflFTION: I hereby aifir Iicense0 unUer pmvi5ion5 of Chapter 9(commencing wi�� Sec�ion
700o) ol �ivision 3 0� ihe Business and Pmlessions de, antl my li e is in full �orce and eflec�.
ciTxuc.: 057789 STATELIC.:61� 3S2 c ss:� f .
Date'. ��_% Z `S3 Signamre: — --���'�—
WOHHEBS' COMPENSATION DECLABpTION: I hereby aifi�m Iha� I �ave a c ificate o� consent to self-insure or a certifica�e of Worke�s'
Compensalion s ce �ifiep, pY �hereo� (Sec�ion 3800, La�
POUCYNO.: ����§1-7� El(P.ORTE: �/OI/94
comenxr: STATE FUND,1(
❑ Cetlifietl copY is hereby lumished L'J CeM1ified c y is ie ' h the ciry Buil�ing Di isio(�.
ozie: 1/• 1 Z' i 3 nooi����:
EXEMPTIONFNOMWOflNENS'COMPENSATIONOECUBATION: Qhisseciionneea IbecompleteEi�IheDe�mi�isforonehuntlrea�E100)orless�.
I certily Ihat in Ihe pedormance o� �he work lor whic� Ihis permi� is issued I sh II not emDloy any Derson in any manner so as �o become
su�le�� �o ihe Workers' Compensation Laws of Calitomia.
Daie: Signawre:
NOTICE: I�. aller makinp ��is tleClaraiion, you Shoul� DeCome Subjec� m �he WOfkers' Comp¢n5aiion D�ovisians of Ihe Labor
Cotle. you musl �orlhwiih comply wilh such pmvisions or Ihis permit shall �e deeme0 revoked.
CONSTHUCTION 1EN01NG RGENCV: I hereby affirm ��ai I�ere is a tons�mc�ion lentling agenCy for ihe pertOrmanCe oi the work for
w�ich Ihis permii is issuea �Seciion 3W7. Civ. C).
LENDEN:
aooaess:
OWNEfl BUILUEB OECIAflRTION: 1 hereby a��irm ihai I am exempt Irom Ihe Contrac�ors' State License Law �ar fAe follovnnp reason
(Section 7031.5 Business an0 Professional Code: Any ci�y oi counry wAich requires a permit m wnsimct, alter, improve. aemolish, or
repair any stmcWre. prior �o i�s issuance. also requires Ihe applicant for such permi� �o file a signea statemen� ��a� he/she is licensetl
pursuam ro ��e pmvisions of ��e ConVacmrs' State License Law (Chapler 9(commencing wi�h Section 7000) oi �ivision 3 of Ne Business
antl Pmiessions Cotle) ar �hat helshe is exemp� ��ereimm an0 ihe basis �or t�e allegetl evemption. Pny violalion o� Section 7031.5 hy
any aDPlican� �or a permit suble��s ��e applicani to a civil penalry ol not more Ihan live hundretl Oollars (5500).
I. as owner of the property or my employees with waBes as iheir sole compensation, will Oo ihe work, and tAe
❑ StmcWreiS no�in�enUetl oroiferetl �orsale (Sec�ion 7044, Business antl ProtessionalCade: The ConVactars' State License Law
Ooes no� apply to an owner o� a pmDeny who builtls or impmves ��ereon, antl w�o tloe5 such work himself/herself or thmugh
his or �er own emDloyees, providetl Ihai such imOwvemenis are no� intentletl or oflereG lor 5ale. II, however �he Ouilding or
imOrovement is soltl wiihin one year ol comple�ion, the owner will have �he burtlen of pmving he/she Uitl nol builtl or impmve
for Ihe purpose al sale�.
I, as owner ot the pmperty. am exclusively contracting with licensetl conVacmrs m con5imc� �he pwle�� (Section 70ad, Business
❑ an0 Prolessi0n5 Cotl¢: T�e CAniraCtofs' State license Law dces nol apply to an owner af pmDenY w� bwitls or impmves tAereon
and who contrads br such pmlects with a convactor(s�license pursuantlo the Contractors' State License Law),I am aware
thal pmol of ��eir Worker's Compensa�ion insurance shoultl �e D�oviOetl lo me.
� I am exempt under Sec�ion: B. 8 P. C.
for �his reason:
Daie: Ownec
I tlo hereby cenily Iha� I am aware o� anA untlers�antl �he requiremen�s of Cali�amia Healih an0 Safery Code Sec�ions 25505, 25533, antl
25534 an0 Ihat 1 or any iNure huilding occupant will/will nol (circle one� nee0 lo comDty wit� said s�a�e to0es antl the reQuiremenls for a
permil for consimction or mo0ilicalion Imm �he Air Ouatily Management Districi. Fesiaential consimdion apPlications are eaemp� �mm
Ihese pmvisions.
Date: Fpplicani: _
I here�y cerlityl�al I have reatl t�is applicalion antl s
orUinances and Slalelawsrelalingio �uiltling consir Iion antl he
pmperry for inspection purpocses. �
Daie: I L` I Z��l 3 SignaW �
oriver's �icense or Socia� Security a:
iniormation is correct. I agree ro comDW ��h ail city antl cowty
'i4e re� niptives o� I�iS Ci�y �o en�er upOn [he above�men�ioned
I �
164��06 W�ite—Bmltlmg; Green—CoCe Eniorcemem: Canary—ApPlicam: Pink—Revenue; GoldenroE—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
F�ERMIT NO: M 064892 PLAN CHECK NO; N
CONSTRUCTION TYPE: III—N SP PEAMIT TYPE: MEC
PERM NO: M 064892
GOVT: N SUPP: N
PURPOSE: ALT
JOB DESCRIPTION ; 1062SF OFFICE T.I. SQ FT;
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: "Q LOGIC CORP" OFFICE T.I. , REF: B-64890
*+��r��*�r******�c*��c******�i�***±c*�***�:�c�r**�******+�+��x*****�c��c*�c**�r**�c�c�+t�a��c**+�***a�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HOILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PAAKING REQ; PROV; PARCEL: 41507108 ZNE: REF NO:
PLANNING NOTES>
:
�t***�ri��e***�t*�r****+r�r+r***�r�*+r�tx��r*ir+t***ar*+r�r�r*+t**;��r*****�r+��r******+t�**+r*****+��r***�r*r
D E V E L O P M E N T S E R:,V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY _ DATE:
BUILDING APPROVED BY : PATE: _
APPLICATION ZSSUED BY: �� DATE: L(/— _�/ Z ��
� �EititiEil�EjEitilitiEififitiEififiEffitifiM1lEiEiEiEitit�ltiEiEiE#�+?rc�:iFaE3faf�k%iEitifiFiEk�EiEiF�FiFiFic�EiFiFaEiFiFiEif�+tiEiEiEiFiE ri/�iFiEiIiE�EiFiF
if it itlE 1E �f �f iF iE if 1f iE ff 1E iE iF it iE fElE iE iE it iF iE iE if 1E 1E if 1f if iflf �F iF iE iP if i! 1ElE iE 1E 1Elf iE iE iE 3E fP iE if if ik if iE iE if iE �F if if iF iE af !F iE �t 9f if iP 1E iE aE jf !F iF iE
LEGALIZATION;N P E E �S U M M A R Y STR[JCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/RES GRADING
PERMIT 18.00
25� SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 18.00 15.00 0.00 33.0� 33.00 ,00
REVENUE DIVISZON TOTALS--> COLLECTED; 33.00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE 5MIP/TOT GRADING PLAN—CHECK
33.00
1E 1f �f ff 1E iE iE iE iE iE �E i! it 1E K iF �f it if af 1E i!!: if if iE if ik if if if iE �1f iE iE if 1E iF jf iE iE 1f iElf fE �E 1E aE Yr if if iE if �)E iE if if K K if #4 iF iE if iE if iF 1E if iF jF if jE iE # jt 9E?f if
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I d N UNIT COST TOTAL COST
MEC 1 REPAIR/ALT COULING UNIT/SYS W/CNTLS 9,00 9,00
MEC 1 REPAIR/ALT HEATING UNIT/SYS W/CNTLS 9.00 9.00
END OF FEES
:�? OOlS��i7i—��15t}575 TLiT
llRit: 1_i{1��/i5 �liit: 1��904
CONSTRUCTION AND PI.ANNING POOL & SPA
i'APPROVALS Permit # Oate Inspector qppROVALS Permii # Date Inspector
i. Temporary El6ctrical Serviceb� Pole �: 52. Pool & Equipment Location �-
2. Soil Pipe�Undrgrnd. : . 53. Steel Reinforcement '"'
3. Elearical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
5. Steel Reinforcemen[ 56. Rough Plumbing & Pressure Tzst
6. Electrital UFER Grnd. 57. APPROVAL Tp COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd. ,
8. Foundation �j .` 59. Gas Pipe. O Undrgrnd., Test '
9. Water Pipe�Undrgrnd. � �� 60. Backwash Lines, P-Trap, � Undrgmd. �
10. Structural Floor System ,- ' 61. APPROVAL TO DECK � '
71. Property Sewe� Line & Hotr;e Eonnectiort _. 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. Rough Electrical•Condult � 66. Solar System�Final
16. Rough Electric Wirinq 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEP;7S FINA�
19. Rough Heating & Air Conditioning �,`�r�1 FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure J0. Underground Hydro
22. Ducts, Ventilating 77. Product Piping ClGas ❑Oii
23. Gas Pipe•Rough & Test 72. Underground Flush
24. Roof Framing 73. Underymd.StorayeTank OGas ❑Oil
25. floof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling fStructurel) & Ntonocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Star.dpipe I
28. Laihing & 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 Aleter�Finai 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Air Conditioning l�l�� : r�z_�
� `�_n_ev.�c ��t
35. Final Gas Pipe•Test
36. Hood or CanopY
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
4}, �tar pomesticFinat
42. Backflow Prev¢nter
43. Backflow Irrigetion
44. Landscape IrriAation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING .
48. FINAL P�ANNING �,
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PflOJECT AOOXESS: 3 S�I S HARH OR B L
OWNEN'S NAME: EMULEX CORPORATION
� � � p00HE55: $}�NjE
uxir: g
AFCHIENGINEEH: PACIFIC BUILDING CONCEPTS NEG.NO.: C
ADDPESS: iB1Oi SKY PARK SOUTH UNIT: A-1
IRVINE CA 92714
PEflMITTEE: GEORGE LINE CONSTP.UCTZON ( 714 ) 968-0703
aooaess: 19552 WESTWINDS LN
HUNTZNGTON BEACH CA 92646
UCENSEO CONTflRCTOP OECLAHATION: I hereby affirm �ha� I am licensed un�er provisions oi Chapter 9(commencing wiN Section
7000) ol �rv�sion 3 af Ihe Business antl Pm�essions CaDe. 2ex� is in �ulliorce an0 eltect.
— ciTvuc.: 0157789 psTa-�reuc.:6153`. 2 cu��: B ,
Date: —I_7 " � Z — {1 Signamre:
WOBKEHS' COMPENSATION DECtA8ATI0N: I Aereby ailirm Uat I �ave a certif ate of consent to seli-insure or a certificate ol Workers'
Compensalian Iqsy�prye�o4a9cQ�ilieycppy �hereof (Section 3000, La6. C�.
POLICY NO.: 1 L b .3 O E%P. DRTE: V 7/ O 1/ 9 4
COMPANY: STATE FUND,i
❑ Certified copy is hereby �umished. L? CeM1ified opy i5 �ileA Ihe�e�ty Bu�g Oivision. _
q 'iC
aate: C�" I L� (� ApplicanP. I` _,9_.--� �
E%EMPTION FROM WOflNEHS' COMPENSPTION OECLABATION: (TAis sec�ion ne A no��e completetl if Ue permit isfor one hunUred (3100) or less)..
I certity that in t�e Dedormance of �he work for whic� �his permit is issued, shall no� employ any person in any manner so as to became
sublect �o Ihe Workers' Compensa�ion Laws ot Califomia. �• ,
Date: Signature: �
NOTICE: II. aiter making ihis Oeclaration, you shoula �ecome su�ject to the Workers' Compensation provisions oi�ihe Labon �
CoOe. you must forl�wil� comply witA such pmvisions or ��is permit shall he tleeme0 revok¢d. ,, �
CONSTPUCTION LENOING RGENCY: I hereby aifirm that ihere is a consimction lending agency for t�e performance oi t�e work for
which �his permit is i=5ued (Section 3097. Civ. C�. ,
LENOER:
AUOXESS:
OWNEP BWLOEfl OECLRMTION: 1 hereby affirm ihat I am exempt Imm Ihe Coniracmrs' State License Law tor ihe following reason
�Seclian 7031.5 Busmess antl Pmtessional Code: Any cily o� county which requires a Dermi� �o consnuct, alter, improve, tlemolish, or
repair any S�mcWre. pri0t i0 its i55uante. also repuires Ihe applitant for SUth permii Io �ile a Signetl 5�alem¢nt thal he/she is licensed
pursuanl io �he pmvisions a� t�e Comracmrs' State License Law (Chapter 9(commencing wi�� Seclion 7000) ot Division 3 0l lhe Business
antl Pmiessions Code) or thal �e/she is exempt iheretmm an0 Ihe basis for the alleAed exemption. Any violation oi Section 7031.5 by
any applicani for a permit suEjects ��e applicanilo a civil penalry oi noi more t�an five hun�retl Oollars ($500�.
I. as owner of ihe pmperty ar my employees with wages as �hei� sole compensa�ion, will do �Ae wo�k, and Ihe
❑ stmmure is not intentled or olleretl for sale (Section 7044, Business an0 Pmiessional Cotle: The Contractors' State License Law
tloes nat apply lo an owner of a pmpeny who builds or improves ihereon, ana who does such work himsell/herseli or ihmugh
his or her own employ¢es. pmvitle0 tha� 5uch imD�Ovement5 are not inten0ed or Oflered �or Sale. II, �owever ihe huildinp or
improvement is soltl wit�in one year of comple�ion, �he owne� will �ave ��e burden o� proving he/she Uitl nol builtl or improve
lor the ourpase of sale).
I, as owner of ��e propeny, am exclusively conbac�ing wi�h licensed con�rac�ors �o coretmc� lhe prole�� (Section 704d, Business
❑ antl Pmlessions CoOe: The Contracmrs' State License Law tloes not aOPty to an owner of pmperty wha GutlAs onmD�a�es ihereon
and who comracis for suc� pmjec�s with a canVamor�s) license pursuam Io �he Comrac�ors' State License Law�. I am aware
��at pwol o� Iheir Worker'S Compensation insurance should be provided �o me.
� I am e�emp� under Sec�ion: B. 8 P. C.
for �his reason:
Oaie: Ov+ner:
I do hereby cenily �hat I am aware ol antl understand I�e requiremems o� Calilornia Heal�� antl Sa�ery Cotle Sec�ions 25505, 25533, antl
25534 and thai I or any lu�ure huilding occupan� will/will noi (circle one) neetl Io comply wiih said state codes anA Ihe requiremen�s �or a
permi� br conslmction or modificalion Imm Ihe Air �ualiry Managemeni Dis�ricL Resideniial constmc�ion applications are exempt �mm
Inese pmvisions.
Date: ApplicanC
1 h¢re�y c¢tli�y Ihai I have reatl �his applicaiion and SI eHMea e informati0n is correti. I aA�ee �o tomply with all Ci�y anA Coun�y
or0inances and slaie laws relaling lo builAing conslr ion antl hereby aut � ase atives of this cilyto enter uDon t�e above-mentionetl
pmperty lor inspeclion purposes. _
oate: t�- I L'�L�. SignaWre.
Dd�er's ucense or Sociai Security a:
l I 164L46 Whne—Butlaing�, Graen—Coda Entorcemen�', Ganary—Applicant; Pink—Revenue', Goltlenrotl—Assassor
l
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 06489]
PERMIT NO: E 064891 F'LAN CHECK NO: N GOVT; N SUPP: N
CaNSTRUCTION TYPE: III—N SP PERMIT TYPE: ELE PURPOSE: ALT
JOH DESCRIPTION : 10625F OFFICE T,I, SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: B-2 /
COMMENTS: "Q LOGIC CORP" OFFICE T.I. , REF; B-64890
�itit*x**�**��r+E***�t�*�+t+t*�r*�+�iEx*xx*�t�if*u***�*�**��**��it�*+��+rx*iE***x**+F*iF*at�**�*�*
Z O N 2 N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REO• FROL': PARCEL: 41507108 ZNE: REF NO:
PLANNING N(ST'ES>
>
�titat**�it**jt+t+titititftttitit�t*�r*�r�at#*ifit*itiff;�*it*it�eet;rititit*�r�r*�r**�+t*+r�r**�**�rit*���ririf�f***it*�r*+t
D E V E L O P T9 E N T S� E Fi V I C E S R E Q U I R E M E N T S
ZONING AFPROVED BY DATE;
BUILDING APPROVED BY ; DATE: Q
APPLICATION ISSUED BY: DATE: �i/ l�
�t**�t***********�*****x��� ��***�***��/��/�'�r**
iE iE 3F if if iF 3k ## iE iE 1E if �E �lE iE �Ih iE iE 3f if iE if if iE iF iE iE jE iE iE �lf iF iE iF iF iM1 iF it iE iF iF 3E if if if iE iF iE+f if� iF iE if �)f iF if iF iE iE �E if tF iE iE iF aF jE 9F±f # iE �1f?F �'/iF if if iE
LEGALIZATION;N F E E S D M M A R Y STRUCTURAL SEGMENT:N
BLPG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING'
PERMIT 33,15
50$ SMIP/NON-RES
PLAN
ISSUE FEE 15.00
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 33.15 15,00 0.00 48.15 48.15 .00
REVENUE DIVISION TOTALS--> COLLECTED; 48.15 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
48.15
iE iF iE k iE if it it iF iF iF f(� if iE jf if iE 7F it it iE jk iE iE it if if if if 1E iE if if it it if iE iE iE if if ik if if if if iE if iF k it it±f it iF if if it iE iE iF jE �E if iE+E iE iE #' if !f jE if 1E 1E #' iE+f 1f
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 16 FIXTURES LIGHTING
ELE 20 RECEPT/O�JTLET
ELE 2 RECEPT/OUTLET
ELE 7 RECEPT/SWITCH
1 ST 20 EA
i sr 2o EA
ADDITIONAL EA
1 ST 20 EA
END OF FEES
75
75
45
75
�I OC•iF.�C?;7�-OOl�0i7E T�'�T
���TE: 2?!1`.�/93 TICIE: i`:40
12,00
15.00
.90
5.25
:CONSTRUCTION AND PLANNING POOL & SPA
��'APPROVALS Permit �`r Date Inspector p�ppROVALS Permit # Date lospector
t. Temporary Electrical Serviceor Pole 52. Pool & Equlpmant Location �-
2. Soil Pipe�Undrgrnd. - . 53. Steel fleinforcement
3. Electrical Conduit U����ty�Undrgrnd. � 54. forms
4. Etectrical Conduit-Undrgrnd: , . 55. Electrical Bonding �
5. Steel Reinforcemenc 56. Rough Plum6ing & Pressure Tzst
6. Electrfcai UFER Grnd. 57. APPROVAL TQ COVER-GUNITE
7. Footings , 58. Electriral Conduit�Undrgrnd.
8. Foundation � 59. Gas Pipe, f� Undrgrnd., Test �i
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P�Trap, CJ Undrgrnd. i
10. Sxrucmral Floor System ,, � 6t. APPROVAlTO DECK . :� '
11. Property Sewer Line & House Connection - 62. Baekwash & ReceprorPinal �
12. Sewer Cap ,, �..1 63. Heater & Vent-Final
�
73. Roof Drains 64. Plumbing System � Finai �
14. Rough Plumbing � 65. Electrical-Final
15. Rough Electrical�Conduft 66. Solar SYstem-Finat
16. Rough Electric Wirin9 ��3 q(/ �,,,� 67. Fencing & Access A�proval
���
57. Rough Wiring Sign 68. APPROVED FOR P�ASTERING
78. RoughElectricai�TBarCeiling � J7 �/ 69. POOL;SPASYSTEt�iSFINAL
! 7
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Fattory Fireplace APPROVALS Permit �
27. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product PiPing � Gas ❑ Oil
23. Ga5 Pipe�Rough & T&st 72, Underground �lush
24. Roof Framing 73. Undergmd.Srora9eTar.k OGas �Oil
25. Roof Sheathing 74. Overhead Hydro _
26. T�Bar Ceiling (Strucaral) & Monocoat 75. DrY Chem�cal
27. Frame and Flashing 76. Dry Standpipe
, 28. La:hing & Siding 77. FIXED SYSTEM FINAL
29. Insufation 76. FIRE PREV. FI�!AL
30. Oryavall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED _��__
33. Finai Electric /�d Notes:
/
34. final Heating & Air Conditioning ��
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Faciorv Firepl�ce
ial
inal
:er
on
tion System
ion
tions
URE & BUILDING
��G
o Edison
wtbern California Gas Co -
�F pCCUPANCY
_, Date ,
r
CITY OF COSTA'MESA �
Project Addres4 �
Qpplicam's Mai��ng Ad9ress '
Owner's Name / �-�
Address ���5� ��
No.
r
�.
Aop�icant to fill in all soaees except those within heavy Dortler Ilnes ana sign all appropriate aeclarations.
�J M'2S�' 7o T/�876 LOT NO, UNIT NO:
TVPE OF CONSTRUCTION , rvEw aoo
� O CONVERSION ❑ DEMOlISH ❑ OTHER
Address !GV /w/N wU.UI� ^ nIc/'��`deG Cy�,,, �
Contractor'sNam 1GL�r'��,/�u� ' Phone� �
Address (mailing) ✓77p7 'g�p�� ��K ��
City License No. ' '3 / �� O �
• LICENSED COI`�TRACTOR DECLARATION
I he�eby aftirm that I am licensetl untle/ Provizions of Cha�tet 9(�ommGnting
wiih�section ]040) oi Dlvision 3 of the Business antl Protez5ion5 Cotle, antl
� my license is in �ull t ce ana eHect.
�License Clazs , Lic e No �
Date � � Si9nature � �
� W00.KER5' COMGENSATION DECIAFATION
� I hereby afiirm that,l have a certificate of consent to salLinsure or a certi(icate
ol wo�kers' Compensation Insurance, or a certifietl cooY thoreoi (Section
3800, lati.��_/ ��e 'L+_ n
� PolicY No. T, CXO���� ComPanY / � 1/VJO\
ti(ietl copY is heretiy furni5hltl.
Certifie o Tiletl with the city I mg D' '�nn /•� _�J
• Da(e '�' S,-- P.PPlicant �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thizsection neRtl not be Lompletetl if the permit is (or one huntlr¢tl (5300) or
Icss). +
I certity that in the� pertormance of the work tor wnich this perm�t it issuetl, I
_ iball not emploY any'per5on in any mdnne� 50 a5 to become SubjeCt to th¢
Workers' CompE�sation I.aws ot California. �
Date • - � Signatura '
_. NOSICE: If, aft¢r.mak`iug this'tleclaration, youshoultl �ecome subject to the
Workers' Compensa[ion provislonvof the Labor Cotle, you must �orthwith
, comply with such�'p�ovisions or this Permi[ Shall be deeTetl ruvok¢tl.
, CONSTRVCTION LENOING AGENCV •
I hereby atfirm that there is a constructio� lentling agency for, the Oerformance
of [ho work •fort,yrjr)'�� tQhl_s_ permlh is i55uetl (SectlOn 309] Clv. C.)
Lentler's Name li�C�{
. .Lentler'SAtldress_ ' ' �
� OWNE0. BUIIDER dECLAf2ATION '
1 herebv affirm thdl.l' am e%emDt ftom tbe Contractor'S Lic¢nse Law tOr the
or
any 5[ructure, priOr•t0 its i55uance, also require5 the applicanl tOr
to tile a siqneE statertfent that he/sne is licensetl pu�suan[ to [he f
the Contractor'S License Law (Chapter 9,(commencing witn Sectlon 7000) of
- Division 3�of [he-Business antl Professions-,Code) or that he/she-is ezempt
theratrom antl the basis for [he allegedexemption. Any vlolaflon of Section
� 7031.5 by any applicant for a permit subjects tne applicant [o a civil
,� enalty o( not tt�ore than'f�ve huntlietl tlollars ($500). '
I; a5� Owner ot the property or my employee5 with wage5 a5 their Sole
e tompensation, ++ill tlo'the wnrk, antl [ha s[ruc[ure is not intantletl or offeretl
' for sale (SectiOn 7044,.Business antl Professional Cotle: The �ConVactor's
l.icense Law tloes not appty to an owner of a�property who builtls or Improves
� l the�eon, antl who tloes such wo�k M1imselt/ne�self o� throu9h M1I5 or ner own
employ¢es, provitletl that such improvement5 are not Intentletl or otferetl (or
sale: If, however, tne builtling or improvement is soltl within on¢ Year of com-
O�ation, Ihe'ow�er wilPhave the bu�tlen Of proving he/she Oltl nOt builtl or Im-
��ov! fo� the p�/pose of sale).
I, as owne� ot the p�oDerty, am exclusively contratting with Ilcensetl con-
.[ractors to wnitruct the Oroject (Section �044, Business antl Protesslons Cotla:
The Contractor's-License Law does not apply to dn owner of Prop¢rty wh0
builtls or ITprO�es,thereon, antl who conVactS tor sucb projects wl[h a con-
tractor(sl.ucense pursuant to the Contractor's License .�aw). 1 am aware that
prooi of their Worker'z Compensation�insurance shoultl be provitletl to me.
❑ I am exempt unaer�5ection , � B. & P. C. for thls reason
Date� Owner - �
I h¢�¢by certify that I have �eatl ttiis epplication and SWte that th¢ above
IMormdtiOn;is [orrecL I agree t0 comply with all city dntl CountY O/tlindnces
antl state laws telating to builtlin9 �onstruction; antl hereby autnorize repre-
sen[ativns of thit citv to.erLLer uoodNe above-mentinnetl orooertv tor
inspect�on pur �
Signature - - .�� Date �
O=ivers' Llcense or 55 � • � � _
ON IJ REPAIR
r . .._
TVPE OF PERMIT LJ GRAOING LJ FOUNDATION LJ STRUCTUR.qL
, �TENANT ❑ ELECTRICAL � ❑ PWMBING ❑ MECHANICAL
❑ OTHER, � � .
PRQIECT DESCRIPTION Sq FT � oCCUapg�.N.Cv '
CONSTRUCTInNTycF � VAWATIONSY�"�SZ7 ��
ZONE ���� � GRADINGGU.YDS. ACRES
ReMarks: � ��� �Q�,,.., (JJ / A �
i i f> f•�
. - - �PLUMBING ' FEES
low Preventer
low Irrigation
Dishwasher �
Drinking Fountains
FloorDreins
Floor Sinks � '
GasService • ,Out
Interceptors �
Kltchen Sink. _
Lavatories .
Roof Drains ' �
Rainspection Fee
Service Sink -
Sewer Cap � ' '
Sewer C neciion
Solar Colle tors
Solar Piping .
Solar Tank . '
Swimming-P ol w/$pa -
U�inal
Water CI set `
Water, eater �
' Water Service _ . _. .
.4uto-Wash
'Lsundry Trays
$15
Boiler � �
Duct - Under Ground
Duct - Strucmral
Duct - Ventilating
ExhaustSystem-❑ �Multiple❑
FirepUFact. Blt. ICBO #
Heating Syitem�& Ducting
❑ ai ao,000 eru O i oo,000 sr�
Reinspection Fee ' � $15
Issue Fee
Hood or Typel 0
Canopy Type I I ❑
Refrigeration Sys[em
❑0-700,OOOBTU ❑100,0008TU
System Repair/Alteretion -
Fiie Dampers �
Registers - .
_ � ��.._ �__ "_ i - . -
$ 3
A.P. �`-
S Main Buildi
E
T Front
B Rear
A
C Rlghb
K Left
S
Ping. Ref. �
Plannin9 Notes:
Automatic W:
Construction�
Cooking Unit
_
1
� � ��
�
� •
"(� /� ///
�
— �
s����`i— a/�_4%i�il//.i��;I/lii.'�/..�/_�_(_
iJ�( ../IJ/� .fidc •
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Merer ❑up ro 100 amps
Meter ❑over100amps
' Sub Panel ' �
Fan � ' Motors �0-1 HP �fX � 8
F,A.U. ' " ' ' Inc.Solar �9�15 HP �76-15+
Fixtures �
Device Boxes , •
Outlets !
Switches - �
Garbage Disposal �
Generator �0-5 KW 05-15 KW
0
� Reinspection Fee � $15
DEVELOPMENT SERVICES REnI
Zoning Approved By�
, Building Approved BY —/dL
Appliotian laued By
FEES
Pole �ight
Range
Sign', -
Standing Sections �
Trash Compactor . .
luue Fee
$ 3
' ' SU MARY OF FEES
BUILDING PEFMIT $ �O SMIP $ O..�O-
�o PLAN CHECK , $ 7• 23 pERMIT � . . `
PLUMBING . $ ISSUANCE $-_ ' .
PLAN CHECK 25% $ ' ENERGV P.C. �$ . � �
ELECTRICAL 5� GflADING $ �•
PLANCHECK 50% $ � MICROFILM $ '
. MECHANICAL $ .TOTALFEE $ . SZr 23
PLAN CHECK 25% $ � �
�
CONSTRUCTION AND PLANNING
APPROVALS Permit#
1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electricel Conduit Utility-Undrgmd.
4. Electrictl Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. �Footings �
8. Foundation � , "
9. Water Pipe-Undrgrnd.
10. Structural Floor System �
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
1�4. Rough plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
i8.� Rou9h Electricat-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
�'ry Ducts, in Structure
`Ducis, Ventilating-
� ' �Gas Pipe-Rough & Test
;oof Framing
ioof Sheathing
� Bar Ceiling �Structural) & Monocoat
Irame end Flashing
� thing & Siding
�)rywall Nailing
i
�laster grown Coat �
o`
"„ "lectrical Power Meter-Final
�
a �
a
=inal Electric
o .
2 � inal Heating & Air Conditioning
v
9
� ; inal Gas Pipe-Test
°� ;-lood or Canopy
C '
� Final Factory Fireplace
¢ �Final Plumbing
si
a Water Service-Final
� ;IGas Service-Final
Q
Q ''ISolar pomestic-Final
� IBackflow preventer
u 'Backflow Irrigation
a I Landscape Irrigation System
m � Sound Attenuation
'r � Handicap Regulations
3 �. FINAL STRUCTURE & BUILDING
,a.�
o ; Special Requirements Completed
d�'Electrie Release to Edison
� �
? Gas Release to Southern California Gas
� �
o `ERTIFICATE OF OCCUPANCY
LL Date
u � ..
Date
POOL & SPA
Inspector APPROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding ,
56. Rough Plumbing & Pressure�Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
� 59. Gas Pipe, O Undrgrnd., Test:
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVALTODECK -� .
62. Backwash & Receptor-Final
63. Heater & Vent-Final ,
64. Plumbing System - Final - �
65. Electrical-Final
66. Solar System-Final .
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro �
. 71. ProductPipingOGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro �
b� 75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: ' ' •
u
Date � Inspector
CI7Y uF:coS7A MESn CONST1RUCTION ER IT . \
ProjectAtldress 3�`f� �"�sRbn,! ����, Rfce�u�utl
Avplicani's Mailing Address J o'� at ,�w, pa_ �_
Owner's Name � � f Q hone �-L� "«09
Address 3 s� r �'AR L n1t (3� .�
Arch/Eng. License No.
Address
Contracror's Name� �+ E�'� hone qF7'48w
Address(m�'i'�gl �O'�� L �✓w. �f_ ' N
City License No. A'r D�2L3
LICENSED CONTi2ACTOR DECLARATION '
1 bereby alfirm that I am licensetl untler provi5iOn5 of Charte� 9(commencing
wit� section ]000) of �ivision 3 of the Business antl Professions Cotle, antl
my Iicense is In fu11 torce antl nffect.
�icense Ciass - icen No. 4 8 Y 7 P�--
�ate A'�� p 8 Signature
WORKERS' COMPENSATION DECLARATI N
I hereby aifirm Nat 1 nave a certificate of mnsent to selbinsure or a certiflcate
of Wo�kevs' Compensation Insurance, Or a,ce�[Ifietl copy thereof (Sac[lon
3800, Lab. C.) , ,
Policy No. Company
8 Cmtl�ietl mpy ishereby tumishetl.
Certltietl copy is tlletl with the city Bulltling Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tnis section neetl no[ De tompletetl if lha permlt is for One huntlretl (8100) or
less).
I certlfy that in the pe�formance ot the wo�k tor which fhis�perrO�t I5 issuotl, I
snall n0[ employ any pe�son in any mdnne� 50 as bec me sUbjecl to tha
WOrke�s' Co�{OensaHon LawS Of Cdliforylae��
�ale �^Y—O8 Sl9ndtu�¢ ��__
NOTICE: H, aiter makin9 ihis tleclaratlon, you sho3�tl-becoma subje<t to the
Worker5' Compensation O�o��sions of the Labor Cotle, you must torthwith
comply wlth Such provi5ion5 or tltis p¢rmit shall be tleeme0 �evokeC.
CONSTRVCTION LENDING AGENCV
1 h¢reby a�9�m that [h¢r¢ i5 a ConztruGtlon lentling agency (o� tne perPo�mant¢
Of [M1e work tor which Ihis permit is issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress� '
OWNER BUILDER UECLARATION
I hmeby affirm that I am exempt from the Contractor's License Law for the
following reason (Section ]031.5 6usine55 antl Protessional Cotle: Any city, or
county which reqWres a permit to construct, alter, improve, aemolish or repair
any structure, prior to its issuan<e, also requires [he applican( for such permit
to flle a Signetl statement that he/she IS IiCenS¢tl pu�suant to lh¢ provision5 ot
the Contractor's License.Law (ChaO�er 9(commencing with Section 7000) of
'Dlvision 3 of the Business antl' Professlons Cotle) or that'he/sne is axempc
IhG/¢Irom antl the basis fo� lhe alle9Gtl ezem0��on. Any violaHon of Sectlon
, 7031.5 by any applicant for a permil subjects tne applicant to a tivil
�enalty of not more than five-nuntlretl tlollars (E500).
LJ I, a5 owne� of the ProperlY or mY empl0Yee5 with wages az their sole
cori�penSdtiOn, will tlo [he wolk, antl Itte stluctute i5 nOt intentletl ol ott<f¢tl
for sale (Section 7044, BuSin¢ss antl Professional Cotle: �The Contractor'S
LiCenSe l.dw tloes not apply to an Owne� ot a prOperty who builtl5 or improves
thereon, antl who aoes such work himself/herself or throu9h his ar her own
employee5, provitletl that SUCh improv¢men[5 a�e not intendetl o� offeretl (O/
sale. If, nowever, ihe builtling or improvement is soltl within one year of com-
- pletion, tM1e owne� will have the bu�tlen of p�oving he/she tliE not �ulitl or IT-
�ove for tho purpose of saie). ,
I, as owne� of the pro0e�ty, am axcluSivCly contraGting wlth liGensotl con-
[ractors to conSV uct the projec[ (5ection 7044, Business antl Protesslons Cotle:
The Contractor's License Law does not apply to an owner of property who
bullds or improves thereon, antl who mneracts tor such projects wrth a con-
Irdctor(s) Ilcenze pursuant to the Con[�actot's Litense Law). 1 am awar¢ that
proot of tn¢ir Worker'S Compensation InSuranGa shoultl be providetl to me.
❑ I am exemp[ untler Section B. & P. C. to� thi5 r¢d5on
AOO���ant to fiil In all ipaces except those wit�in heavy OorCer Iinos ane si9n ail aDvropriate eeelaretions.
PER�T NO_ � � . , TRACT NO. LOT NO. UNIT N6.
Date Owner
-Driver5'�
iat I have reatl this applitatlon antl state that the above
ecL I a9ree to comply with all city antl county ortlinancas
ting to builtling constructlon, antl hereby authorize repre-
yy�y t� en�pon t�e above-mentione� property 1or
!
Datie -� —� '8a
ss � - -
TYPE OF CONSTRUCTION LJ NEW LJ qDD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHEN
DESCRIPTION OF WORKIUSE OF BLDG.
TVPE OF PERMIT IJ GRADING LI FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
O OTHER
PROJECT DESCHIPTION SQ. FT. OCCUPANCV_
CONSTRUCTION TVPE ' VALUATION S
ZONE GRAOINGGV.VOS. ACRES_
Remarki:
Sink
Preventer
Irrigation
Dishwasher . �
Drinking Fountains
Floor Drains
Floor Sinks
GasService . Outlets
1 nte�Eeprors
Kitchen Sink
P—T�ap
R oof. D
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar�Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater�
Water Service -
Auto-Wash
EES
Reinspection Fae I $15 I I . Issue Fee I $. 3
Boiler
Duct-UnderGround
Duct - StrucWral
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.8lt. ICBO #
Heating System & Ducting
❑ 0.100,000 BTU O 7 00,000
HeinspeMion Fee � $15
CMF OB65-46, rev. 30/B4 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Hood or Type I ❑
Canopy Typell ❑
Refrigeration Sys[em
❑aioo,000sru Oiao,000
'System Repair/Alteration
Fire Dampers
Registers
luue Fee
$ 3
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
$
Ping. Ref. #
Planning Notes:
Automatic Washer �
Construction PoleSub.
Cooking Unit '
Dishwasher
Oryers ❑Gas ❑Eleci
Fan
F.A.U. '
Fixtures
Device Boxes
Outlets
Zone
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Meter pover 100 amps �
Sub Panel '
Motors�0.1 HP�1h-8
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Light.
awiccnes - -� Sign
Garbage.Dispoul Standing Sections
Generetor Da5 KW OS-15 KW Trash Compactor
� Reinspection Fee '$15 � � luue Fee �
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Appliration luued By
FEES
$
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $. PERMIT .
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ � ENERGY P.C. 5
ELECTRICAL $ Ig•D� GRADING $��
PLAN CHECK 50% $ �" MICROFILM '$-
MECHANICAL $ TOTAL FEE $ l8".DO
PLAN CHECK - 25% $ �
♦q,
DATE: Q8/04/88 TI11E: 12:3<
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CONSTRUCTION AND�PLANNING � POOL & SPA
APPROVALS Permit.# � Date Inspector . AppROVALS Permit# Date Inspector
1: 7emporary 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-Undrgmd. �
8. Foundation � 59. Gas Pipe, O 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 Orains 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 Strucmre , 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test ' 72. Underground Flush
24. Roof Framing� � �73. Undergmd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro - �
26. T-Bar Ceiling (Structurap & 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 � f� � /� Notes: ..
34. Final Heating & Air Conditioning � - � � !. U
35. Final Gas Pipe-Test
36. Hood or Canopy � `,; ;l.,��.
37; Final Factory Fireplace r • .
3$� Final Plumbing
�f �:
39" Water Service-Final � •� � - '
�-
:i.�.. .•
40. Gas Service-Final 'Q" , '
41. Solar pomestic-Final .(�;.� ..� � � � "
�
42. Backflow Preventer � �� � - � , .,. ,
'43. Backflow Irrigation - "'i ,�� � ' -� a
_ i�.
'�44. Landscape Irrigation System _^ . �� '-• , ,
.'�� ".
`457 Sound Attenuation �� � � r.�. �- > -' •" �
�
�g6i�Handicap Regulations , � f �� _ ��
y
47. FINALSTRUCTURE&BUILDING ', �; �:, "� , ti .
48. �Special Requirements Completed �" ,. �� '
49.+ Electric Release to Edison 't • :�>
�
50. Gas Release to Southern California Gas Co ��� ��. '�
51. CERTIFICATE OF OCCUPANCY �
., �
No. ' Date _ �i
AoO���ant to fill in all spaees exeeo< tM1ose within heavy'bartler lines ana sign all appropriate tleclarations.
Ci7v OF c�oS7A MESA fCONSTRUCTION PERMIT
Pro1ett Address � � y 7 d'�u� AeA �We 'A^ d�A�73 /'
'Applicant'SMailinaArlrlraca �V3 r114'p�V%L p� y. �ES,U
�l U t coz� r
Owner's Name �Phone '
Address .3S �S �/� � v`. � '
Arch/Eng. License No.
Address
Contractor'sNama�W°�'��yv SI��G/L�S?S phone� 3
Address (mailing) 3=� � //'a'e��1- gL/�0 �% � 3� C.`
Ciry License No. N3 �O 2.�
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensetl untler provisions of Charter 9(commencing
with section �000) of Division 3 of the Bu5ine55 antl Profe55ion5 Cotle, an0
my Iicense is in tu/l�l force antl eitect. L
LJCEf15¢ d55 ` �CE �
�ate.���� Si9naWre �'
WORKERS' COMPENSATION D CLARATION
1 hereby affirm tltat I have a certificate of consent to sel/-insure or a certificate
f Workers' Compensation �nsurance, or a certifietl copy tnereof (Sectlon
300, Lab. C.) [
licy No. ��27�-�Q _�� Company , �..T_. _D.
�Cettitietl copy is he�eby fu�nishetl.
Certifi copy �5 (iletl with the city Bui g D� -��
Date i2 Applicant Lf �
EXEMPT ON FROM WORKERS• COMPENSATION DE ARATION
(This section need not be completetl i( the permit is for one �untlred ($100) or
Iess).
I certify that in the performance o( th¢ work fo� which tttis p¢rm�t is I55ueQ I,
shall noi employ any person in any manner so as to become subject to lhe
Workers• Compensation Laws of California.
Date Signature
NOTICE: If, atter making this tleclaration, you shoultl become subject to Ne
Wo�kerz' Comp¢n5dtion provision5 O! the Labor Cotle, you must fortbwitb
comply with such p�ovisions o� tM1is Oe�mit snall be Oeemetl �evoketl.
CONSTRUCTION LENDING AGENCV
I herety affi�m tnat there iz a consttuction lentling agency tor the pertormance
of the work for whiCh thi5 permit is issuetl (SettiOn 3097 Civ. C.)
Lentler'z Name
Lentler's'AEtlre55
OWNER BUILDEN �ECLARATION
I hereby atiirin that I am exempt from the Contractor's Ll�ense Law for the
following reason (Section �031.5 Business antl Professional Coee: Any tity or
county whiclt requires a Permit to const�uct, alt¢r, imptove, tlemolish or tepai�
any structure, prior to its issuance, also requires the aoP�icant tor such permil
to file a signetl statement that he/She is licensetl pu�suant to the provi5ion5 of
the Contractor's License Law (Cnapter 9(commencin9 with Sectlon �000) of
Division 3 ot the Bu5ine55 antl Protessions Cotle) or that he/she i5 ex¢mp[
thereirom antl Ihe basis for the allegetl ex¢mption. Any violalion of Sectlon
7031.5 by any applicant for a permit subjects the applicant [o a civil
�nalty of not more than five huntlree tlollars ($500). .
LJ I, as 'owner of the property or my employees witn wages as meir sole
compensation, will tlo tne work, ana the structure is nof intentletl or offeretl
tor sale (Section ]044, Business antl Profassional Cotle: The Contracto�'s
License Law tloes not apply to an owner of a property who builtls or improves
thereon, antl who tloes such work himself/nerself or through his or ner own
employees, provitletl that such improvements are not intentletl or ofteretl for
sale. If, howeveq the builtling or improvement Is soltl wlthin one year of com-
pletion, the owner will have the burtlen ot proving he/she tlitl not builtl or im-
�rOv¢ forthe purpose of zale).
�I, as owner ot the pioperty, am exclusivery cont�acting with lic¢nsetl con-
tractors to conseruct the project (Se<tion 7044, Business antl Professions Cotle:
The Contractor's LicenSe law tloes noLapply to an owner ot property who
builtls or improves the�eon, antl who cont�act5 (or Such proj¢cls wltn a con-
tractor(s) imense pursuant to the Contractor's Liwnse Law). I am aware that
proof ot their Wo�ke�'S Gompensation insu�ance snoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date Owner
I hereby certity that I have reatl tnis application antl state that the above
information is co�reci. I agree to comply with all City antl county ortlinances
antl state laws relating builaing constructlon, antl hereby authorize repre-
sentatives of this ci o entef yyy onj� e�j bove-mentionetl p�operty for
inspectionpu�poses ljp/�//_// � C�/Ll��i'rj
Signature �a.Es�/ /YjLeen.�. ate
Drivers' License or'S5 � < < � -
� 3319Z *� � � _
TYPE OFCONSTRUCTION .NEW ADD ALTERATION L1aEaaiq
❑ CONVERSION ❑ DEMOLISH ❑ OTHER _
DESCRIPTION OF WOFK/USE OF BLDG. �
TVPEOFPERMIT LIGRADING LIFOUNDATION LISTRUCTURAL
❑ TENANT ❑ ELECTRIGAL ❑�PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION $O.FT. OCCUPANCV
CONSTRUCTIONTVPE' VALUATION$�
ZONE GRADINGCU.VDS. ACRES_
Remarks: /� (`_ � _ /� �3 / L� P_ ` � i.n LL��
Sink
Preventer
Irrigation
rinking Fountains
loor Dreins
loor Sinks
as Service Outlets
Kitchen Sink
Lavatories
Roof Drains
Reinspection Fee � $15
Boiler
Duct� Under Ground
Duct � SVuctural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
FirepVFact Blt. ICBO #
Heating System & Ducting
❑ 0-100,000 BTU O 100,000 BT
Reinspection Fee I $15
CMF 0865-46, rev. 10/84 Whife - Building; Canary - Applicanh Plnk - Accounting; GOltlenrotl - AsSessor
FEES
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Sola� Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee � $ 3
IANICAL : FEES
Hoodor Typel ❑
Canopy Type II ❑ .
Refrigeration System
❑o-�oo,000eTu ❑ioo,000
SVstem Repair/Alteration
Fire Dampers .
Registers
Issue Fee � $ 3
A.P. # -
S Main Buildi
E
T Front
B Rear
A
C Ri9ht
K Left
S
Ping. Ref. #
Planning Notes:
9�15 4/22/80 54oU� li
�6 5� �o �.
Parking Req./Provided
ELECTRICAL
Automatic Washer Transtormer ❑ 15-50 KW
Construction Pole Sub. � 50 + KW
Cooking Unit
Dishwasher
Dryers��Gas ❑Electric
Fan
F.A.U.
F ixwres
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW �5-15 KW
Zone
Meter ❑up to 100amps
Meter ❑overi00amps
Sub Panel
Motors 00.1 HP �1'f, - 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Si9n
Standing Sections
Trash Compactor
FEES
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T
S
��Reinspeition Fee �$15 � � luue Fee' � $ 3 �
DEVELOPMEN7SERVICESREQUIREMENTS: �
Zoning Approved By Date
Building Approved By Date
Appliption Issued By � Data
- - SUMMARV OF FEES . S'O
BUILDING PERMIT $ _S�_ SMIP $ ��.
PLAN CHECK $ PERMIT �
" PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ �� ENERGV P.C. $ ,
ELECTRICAL $ GRADING $
PLANCHECK 50% $ - MICROFILM $ _�_
MECHANICAL $ TOTALFEE $ �4 �-
PCAN CHECK 25% $ -
CONSTRUC710N ANDPLANNING - . _ POOL&SPA � � !
APPROVALS Permit# ,Date Inspector AppROVALS Permit# � Date Inspector
.. I
1~Temporery Electrical Service or Pole . � 52. Pool & Equipment Location � . ' �-'�� '
:
2. Soil Pipe-U�drgmd. � 53. Steel Reinforcement � � , �
3. Electrical Conduit Utility-Undrgmd. 54. Forms " ,.
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � ,� �;`
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -
6. Electrical UFER Grnd. ' 57. APPROVALTO COVER-GUNITE • � ,
7. Footings , 58. Electrical Conduit-Undrgrnd.
8. Foundation " " -- 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Liries, P-Trap, � Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection - _62._Backwash & ReceptorFinal
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 - _. _
76. Rough Electric Wiring � 67. Fencing & Access Approval .. .
77. Rough Wiring Sign � - 68. APPROVED FOR PLASTERING �
18. Rough Electrical-T Bar Ceiling 69. POOI/SPA SYSTEMS FI NAI.
. 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' -
20. Rough Factory Fireplace APPROVALS Permit # - '
' 21. Ducts, in Structure , � 70r'Underground Hydro �
22. Ducts, Ventilating � � � 71. Product Piping O Gas ❑ Oil .
23. Gas Pipe-Rough & Test 72. Underground Flush , . �
24. Roof Framing � 73. UnBergrnd. Storage Tank � Gas ❑ Oil
25. Foof Sheathing � 74r Overhead Hydro � . ,.
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical `
27. Frame and Flashing ' 76. Dry Standpipe �• � �
28. Lathing &$iding 77. FIXED SYSTEM FINAL �-��
29. Insulation - 78. FIRE PREV. FINAL ZZ�
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION '
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED -� . "
33. Final Electric Notes: � �
34. Final Heating & Air Conditioning , ,r
35. Final Gas Pipe-Test � � ��
36. Hood or Canopy ° _ _ -
37. Final Factory Fireplace � . . �
38. Final Plum4ing � „ ! � �� - � .
39�. Water Service-Final � , . �� - .
+•-- • -
• 40. Gas Service-Final � � , �`• ' . ;' - , � � �
41. Solar pomesticFinal . � � , " ! � � �,r � % -
42. Backflow Preventer � ' � "� ' ' �
� . .-
� 43. Backflow Irrigation � � ' ! �
� • �_�
V.
�.44. :Landscape Irrigation SYstem � �, . .' ; , �
� 45. Sound Attenuation ' � � i `�� � % .
� �� ,
� . � .
46. Handicap Regulations •>r , . , ;
47. FINALSTRUCTURE&BUILDWG ' � � ` '� "
� ;, t.�
�48. Special Requirements Completed' . � `� � � �
49. Electric Release to Edison ' . ;' , �
50. Gas Release to Southem California Gas Co � �� . °�
t
51. CERTIFICATE OF OCCUPANCY . .. . �
No. � Date � � � '
^ _ - .
a
�
CITY OI
Projec� �
Applicai
Owner's
Address
Arch/Em
Address
Coniractor's Nam ' �p Phone �
Address (rma '�g� , �.J� L�V✓�l ark Dhtie. rauite P
I CityLicenseNo. ��Q��
� LICENSED CONTRACTOH OECLARATION
� I M1eteby aftirm thal 1 am licantetl untl¢/ O�ovl51on5 ot Chdrter 9(COmmencing
' with section ]000) of Division 3 oi the Businou antl Protessions Cotle, ane
I my Iicense is In t II for<¢ antl eHect. • ���n�^
Licen Class Ice e No. �� �.�
Dale� Si9nature
WORKERS' COMPENSATION DECLARATION
I he�eDy afti�m that I have a certitiGdt¢ Ot consent lo SeINOSur¢ Or d CG�tl7i�'ate
ot Workers' Compensstion Inzurance, or a certlflea copy tnereot (Sectlon
3800, Lab. CJ 1r� (�/� l..i..l-e C�� n
PoIiCY NO. ���w'� L�L COmPanY �1(.i'1 � Ot
r[ifietl copy is hereby furnisnetl.
Certifie cop filetl with the city ii ng 'Sio�NI^
Date �• ��'� APPliwnt �'W'� )
EXEMPTION FROM WORKERS' COMPENSATION OECLARATION
(This section neetl not be completetl it the DGrmit Iz fOr One nuntlretl (5100) Or
less).
I cerlify that in the p¢rformance o1 tM1e wOrk IOr which Ihls pe�m�t is i5iuetl, I
shall not employ any person in any manner so as to become subject to tho
Workers' Compensation l.aws ot California.
Date Signature
NOTICE: It, after making lhis tleclaration, you ihoultl become subject to tha
Workers' Compensation..provizions ot the Labor Cotle, you must forlhwith
comply with such p�ovisions o� thi5 pCrmlt shall be tle¢matl tnvokatl.
CONSTRUCTION LENDING AGENCV
1 hereby aHitm tha[ t�e�e is a conSlruCtiOn Ientling agency tor tha perlormanco
Of iho work for w�iph' t�s pGrmlt Is issuetl (SeGtiOn 3097 Clv. CJ
Lentler's Name p�JL'�
Lentler's Atltlress
OWNER BUILDEN UECIARATION
I hereby afiirm that,t am ozampt Irom tha ContractorY Licensa Law 1or lho
following reason (SecUon 7031.5 Buiiness antl Profo551onai Cotlo: Any Uty or
county wmm� �equirCS ape�mil to ConSt�uct, dlt¢q ITprova, tlemoll5h or �epdir
any structura, prlor to Ils issuance, also reqWres the apP���ant tor sucb pormit
[O lile a signetl itatement lhdt he/ihe IS II<Pn58tl pur5uant t0 thU ploviSlDns ol
the Contracto�'s LlcanS¢ L, w �Cnapter 9(commancin9 wilh $aClion 7000) of
Olvlsion 3 0l ine Bu5ine55 antl P�ofO55ions Cotle) Or that na/5h0 is axampt
therelrom ana lhe basis for the allegetl exemplion. Any vlolation ot Sactlon
�]031.5 by any applicant for a Permil subjncts the apP��canl to a civll
�enalty of not more than tive huntlretl tlollars (5500).
LJ I, as owner oi the property or my employees witn wagos as tneir solo
compen5ation, will tlo the work, antl Ne ztructure Is not intonactl or olferetl
for Sale (Section ]044, Business antl Prolesslonal Cotlo: Tha Conlydtlor's
�icanse l.aw tloes not apP�Y to an owner of a property wlio builEs or ImOrovoz
tnereon, ana who tloes sucn work himsclt/harself or through his or her own
employoes, provitletl tnat suth improvemenls are not intenaetl or ottaretl for
sale. If, however, tha builtling or improvamen[ is soltl witnin ono year o1 com-
pletloq the owner wlll have the burtlen of provin9 ho/sha Ola not builtl or im-
- prove tor the purposo ot sale).
❑ I, as owner ot tbe property, am exclu5ivety contracNng wilh Iicansetl con-
[ractors to <onsVucl th¢ project (SecUon 7044, Buslness antl Proles5ions Cotle:
The ConVactor's License Law doe5 not apply to an owner of property who
builtls or Improves thereon, antl who contracl5 fOr Such profects wilh a con-
t�actor(s license pursuant to th¢ CanVactor'S LlcenSa Law). I am aware that
proof o� their WOrker's Compensation insutance shoultl be prOvltleC lo me.
❑ I am exempt untler Section B. & P. C. for ihls reason
Aop��cant to flll In all sDaees axceo� ��ase wlenin neavr �oraer Iines ana slgn a11 aDDrovriate Oeclaratlons.
fiM1T NO. - TRACT NO. LOT,N . UNIT NU
Date
I h¢r¢by certity that I
Vnformation is correCL I
antl State lawz �elating t
SCl1(dlIVCS Of (�115 LII
inspec ' oses.
Si ur
nvers' �icense or 5 �
Owner
ng
tate that the abova
tl county ordinances
;by duthorize repr0-
loned property for
Date � ��
� 3Zz 6 Z lo¢,�J� `-r� ��
TYPE OFCONSTRUCTION NEW A�D ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTIONOF}N�RK/US�OFBLDG. F�"�( ��n� TC7
TVPEOFPERMIT LIGRADING LJFOUNDATION LV�S7RVCTU
❑ TENANT ❑ EIECTRICAL ❑ PLUMBING ❑ MECHANIGAL
❑ OTHEN
PROJECT DESCRIPTION SQ.FT. OCCUPANCI
CONSTRUCTION TVPE VALUATION 5 �J
ZONE GRADINGCU.VDS. ACRES_
Remarkf:
Sink
Preventer
Irrigation
Drinking Fountains
Flaor Drains
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Foa � $15
Boiler
Duct � Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑ ai oo,000 sru O i oo,000
Reinspection Fee � $15
White - Builtling; Canary - ApPi�cant; Plnk - AccounUn9: Goltlanrotl - A55essor
ShOWers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimmin9 Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
luue Fee
Hoodor Typel 0
Canopy Type II �
Refrigeration System
❑aioo,000eTu ❑iao,000
System Repair/Alteration
Fire Dampers
Registers
Isue Fee
$ 3
$ 3
A.P. —
S Main Building:
E
T Fron[
B Rear
A
C Righi
K . .
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW �
I Reinspection Fae
DEVELOPMENTSER
Zoning Approved By—
Building APProvad By
Appliption Issued By_
tIS3W 111S0� �0 Jlll�
Zane
Req.IProvided
ELECTRICAL
Transformer � 15-50 KW
❑ SO+KW
Meter LJup to 100 amps
Meter ❑over100amps
Sub Panel
Motors �0.1 HP �1'/,-8
Inc. Solar �9-15 HP ❑16-15+
Microwave
Pole Light
Range
FEES
Standing Sections
5 KW Trash Compacror .
$15 luue Fce $ 3
I�EQUIREMENTS: ^ ii_�_
�[tl L
SUMMARV OF F
BUILDINGPERMIT $ �3•�
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
P�AN CHECK 25% $
Z
O
N
I
N
G
R
E
�
M
T
S
ca �SMIP $ �
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING S _
MICROFILM $ �/�,�,�yy�
TOTALFEE $ .f'L—L
' CONSTRUCT14N AND PLANNING �OL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
• �. ,,
1: Temporary Elec'trical�Service or Pole 52. Pool & Equipment Location ' �
, i
2. Soil Pipe-Undrgrnd.' � 53. Steel Reinforcement � �
3. Electrical Contluit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcemeni + A 56. Rough Plumbing & Pressure Test .
6. Electrical UF�R Grnd:•i 57. APPROVAL TO COVER-GUNITE
i�
7. Footings ' � ' ' 58. Electrical.Conduit-Undrgrnd.
8. Foundation �- ��.' 59. Gas Pipe, O Undrgmd., Test � �
9. Water Pipe-Und�rgrnd� �� ' 60. Backwash Lines, P�Trap, O Undrgrnd. '
. i
10. Structural Floor System�"�� 67. APPROVAL TO DECK
17. 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 PLASTEFING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FiNAL '''•+'� `
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . l �
J . �' .
20. Rough Factory Fireplace APPROVALS Permit #�' � .
21. Ducts, in Struc[ure 70. Underground Hydro � '
22. Ducts, Ventilating �71. Product Piping �Gas ❑Oil ( �
23. Gas Pipe-Rough & Test 72. Underground Flush . �� ��'
r'
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil '
25. floof Sheathing 74. Overhead Hydro �` +
26. T-Bar Ceilin Structural� ^'
9 ( �-�naG¢� 75. Dry Chemical �
27. Frame and Flashing Z Z� � 76. Dry Standpipe `�� �
28. Lathing & Siding 77. FIXED SYSTEM FINAL ' -
29. Insulation 78. FIRE PREV. FINAL �j
30. Drywall Nailing HEA�TH DEPT. REQUIREMENT • '' �
31. Plaster Brown �at 79. FINAL INSPECTION ��+ '
,�
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED -� '
�_
33. Final Electric Notes: � -- �,,;
34. Final Heating & Air Conditioning '
r. .'
35. Final Gas Pipe-Test f'
36. Hood or Canopy , - -
. �
i
3Z. Final Factory Fireplace � . _ i • , .
38�. Final Plumbing . � - � � •
I
39. Water Service-Final � ' • ' .
. , �
40. Gas Service-Final � , .
41. Solar pomestic-Final � � �
� 42. Backflow Preventer ' " .
;.43. Backflow Irrigation " � . �
�
�"44: Landscape Irrigation System � ` � ' ; 4 . � , �
45. Sound Attenuation „ , . •' - � � ; ,
46. Ilandicap Regulations , � • ', ,,
47'FINALSTRUCTURE&BUILDING �� " � "•. , ��
�•
48. Special Requirements Completed � � '' � ' �
;� �
49. Electric Release to Edison ;' ' • � .
50. Gas Release to Southern California Gas Co . • �.
51. CERTIFICATE OF OCCUPANCY . �
No. Date
- - i �. l ' i / ,.
�
ADo���ant to flll in all soaces exeeo< <hose within neavy Eoraer Ilnes ana sign all aoo�oDriate Oeclaratlons.
CITY OF COSTA�7MESA/� C/o�,,,NSTRUCTION PERLMIT�dO PERMIT NO. �7 -THACT NO. LOT NO. UNIT NO.
ProjecyAddress Z��7 I„'�bor�aTG4..A/ 7/� M 32��(�
�Applicant'S Mailing Address � TVPE OF CONSTqUCTION NEW ADD ALTERATION REPAIR
,�— ❑ CONVERSION ❑ OEMOLISH ❑ OTHER q,p,q�6
Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG.
Address S Main Buildi
E
Arch/Eng. LiCenie No. TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL T Flont
Address � ❑ TENANT ❑�ELECTR�CAL ❑ PLUMBING �MECHANICAL A Reer
�Contractor'sNam �, 1 ���0 PhoneQ.7[! ZF_rCU � OTHER C Right
Address (mail'ngl �� Y(' ed�l� �r PRQIECT DESCRIP710N 5c�. F7, oCCuaANCv K
�O� �� CONSTRUCTIONTVPE VALUATIONS g LeTt
City Licen52 No. ZONE GRADING CU. VDS. ACRES
LICENSED CONTRACTOR OECLARATION Ping. Ref. sW
I hereby affirm that I am licensatl unOer proy�slons of Charter 9(commencing Remarks: ^'� �J � 7�� . Planning Notes:
wit� section 7000) of Division 3 ot t�e Bualness anC Prote55ions Cotle, antl
my license is in ull force antl eftect. �
Lice CI ���% Llcense No.Z I S'�O
Datr}=�= Si9nature
WORKERS'COM7ENSATION DECLARAT N
I hereDy aHi�m thdt I hdve a certificat0 Of co05ent to SGH-inzure or a certificate
if Workers' ComOe����on Insuranca, or a certlt etl copY thereof (Sectlon
I800, Lab. )
Poiicv rvo. ���14` %2 Company
�C¢�tifietl coOY ii hereby furnisnetl.
Certifie o y Is tile�yyth the city Builtling Dlvision.
Date�"'� �4Ppltcant
EXEMPTION FROM WORKERS' COMPENSqT N DE ARATION
(Tnissection neetl not be completetl if tha permit is for one huntlretl (5300) or
less�.
I certi(y Ihat in th¢ perfOrmance of lbe wOrk tOr wblch Ihls pefm�t IS ISSuetl, I
shall no[ emplOy any pe�son In any Tdnn¢� so as lo becomG Tubject to lhe
Workers' Compensa[lon Laws ot Californla.
Date Si9nature
NOTICE: 1f, atter making this tleclaraHon, ypu shoultl become subject [o [he
Workers' ComOensatiOn provlsions ot lhe Lybo� Cotle, you mus[ tort�wi[n
comply with such p�ovisions or [hls pe�mit Shall ba U<emetl revokGtl.
CONSTRUGTION LENDING AGENCV
I hereby aifirm that l�ere it a Const�uctlon leqtling dgGncy fOr lhe periormdnCC
of the work far, which this permll is Issuetl (Sactlon 309� Civ. C.)
Lentler's Name
Lentler'z Atltlress
OWNERBUILDEH bECLARATION
I nereby aHirm lhat I am exampt lrom tha Contractor'S Liconso L.aw for tho
following reason (Section 7031.5 �Buslness antl Professlonal Cotlo: Any tlty or
couniy wbith roqulres a permit to construct, alter, Improve, tlemolisb or ropatr
any sVucture, prior to its issuan<e, also req4lres lhe applicanl for suth permll
to fiie a signo0 statement tnat he/s�e I5 IlcPny¢tl pursuant [o tho provisions ol
the ConVacloYS Llcense Law (Chapter 9(cornmuncin9 with SoCtlon 7000) oi
Division 3 of the Busine55 ana Profosslons Coeo) or tha[ he/iha is oxempt
there/rom antl the basii tor tha alle9ntl exetnpHon. Any violation o� Sectlon
]031.5 by any uppliwnt fur d Pcrmit SVDfOCtS Ih0 dppliCdnf f0 d UVII
�enalty of not more than Bve huntlretl tlollars (5500).
I, a5 owner of Ihe properly or my omployeas witM1 wag05 as thoi� Solo
compensation, will Oo lhe work, and the slructure I5 nat IntenOetl or oHeretl
for sale (SecHon 7044, Businass antl 7rof¢ssional Cotle: The Contractor'S
License l2w tloez not apPly to an owner ot d proporty who bullds or Improves
tharoon, antl who CoeS such wo/k nimiolt/herSelt or thrOugh hls or hOr own
em0loyee5, p�ovitl¢tl thal such ImprovOmoniS are not Intentletl Or ofiutetl for
sal¢. 11, hawevCr, [he builtling or ImprovOmqn[ It Soltl wlt�in Ono Yaar of COm•
ple[ion, lha owner will �ave tho bu�tlBn ot prOving ne/S�e tliU not builtl o� Im-
��Ove tOt [he purpOm ot Shca).
I, as owne� oi lhn p�operty, am uxclusivoly mnt�acting with Iicensetl Con-
tra<tOfs to consttuct the project (Section 7094, BUSin@55 dntl Pfotes5lon5 COtlO:
The Con[ractor's License Law does not apply to an owner ot property who
builtls or improves th¢reon, antl who contr}«s for such pro�ects wlth a con-
[ractor(5 I¢ense pufsuant t0 the ConVactoYi Llcons0 ldwj. I am awafe tllat
O�ooi o� tlteir Work¢r'S CompenSatlOn ins4rance ShoulA bo provltletl l0 me.
❑ I am exempt untler 5¢ctlon 8. d P. C. for this reason
Date Owner
I hereby cer[ity that I �ave reatl ihis appliwtlon antl state t�at tne above
intormation is correcL I agree lo com0ly with all Uty an0 counly ortllnances
antl ztate laws relating to builtlin9 construc�ion, antl hereby autnorize reore-
Sentativ¢5 ot this cily to enle� upon Ihq aDOve-menliOnatl prOperty for
ins ection ur oses.
0 o p_ �
Signature l ' Oat��
Drivers' �icense or 5_ �
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
I nterceprors
Kitchen Sink
Lavatories
P—Trap
Roof Drains �
Reinspection Fee $15
Duct- UntlerGround
Duct - SVucmral
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact.Blt.IC60# '
Heating SVstem & Ducting
❑ ai oo,000 eru � i oo,000 ar
ReinspeRion Fee � $15
CMF OB65-46, rev. 10/84 Whi[e - BWltling; Canary - Appllcant: Plnk - Accounting; Goltlenrotl - Assessor
FEES
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool wlSpa
Urinal
Water Closet
Water Heater
Water Service
AULO-W85�1
Issue Fee � $ 3
�
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers OGas ❑Elec
Fan
F.A.U.
Fix�ures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW [
Fee
5769 2/B6/88
Zona
Acceuory Buildin9:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 700 amps
Meter ❑over 100 amps
Sub Panel
Momrs �0.1 HP �1 Y� - B
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections .
7rash Compactor
$15 � � luue Fee
34o3f: il
FEES
S3
Z
O
N
I
N
G
R
E
�
M
T
s
Hoodor Typel ❑ DEVELOPMENTSERVICESRE�UIREMENTS: �
Canopy Type I I ❑ 2oning Approved By Date
Building Approved By Date
Refrigeration System Appliratian Issued By Date Z.� .�
�0.100,000 BTU ❑100,000 BTU EO SUMMARV OF FEES
System Pepair/Alteration BUILDING PEFMIT $ SMIP S
PLAN CHECK $ PERMIT
FireDampers PLUMBING $ ISSUANCE 3-
Fiegisters PLAN CHECK 25% 3 ENERGY P.C. S
ELECTRICAL S GRADING S
PLANCHECK 50% $ _�_ MICROFILM S _��
MECHANICAL $ TOTAL FEE 5 �
laua Fee PLAN CHECK ZS% g�
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1.qTemporary 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. Eleclrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grn'd. 57. APPROVALTO COVER-GUNITE
. 7., Footings '� 58. Electrical Conduit-Undrgrnd.
i . ,
' 8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9�. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Gonnection 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
�79. Rough Heating & Air Conditioning z_�„�� �) FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72, Underground Flush ;
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil �'
25. Roof Sheathing . . 74. Overhead Hydro - '
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and F�{eehing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL ,
29. Insulation 78, FIRE PREV. FINAL �,
30. Drywall Nailing HEALTH DEPT. REQUIREMENT ,
r�
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 �7 c�, �� `� . ' _.
35. Final Gas Pipe-Test
36. Hood or Canopy '
J './
37. Final Factory Fireplace • � �
38. Final Plumbing � i � � �
39. Water Service-Final •
: �
40. Gas Service-Final I ' �
�
.41. .Solar pomestio-Final . � t
;42: Backflow Preventer •
. •
'43. Backflow Irrigation , ,
'4�4. Landscape Irrigation System ' J'.�.',
� 45� Sound Attenuation ; � � � �
� 46. liandicap Regulations ' � - � � ;2 , - �
47. FINALSTRUCTURE&BUILDWG ,+'.' - � �' -�`�� ' .. ' �'
� �,
48. Special Requirements Completed ` � '
49. Electrie Release to Edison . - �;,, J
50. Gas Release to Southern California Gas Cn p. ; �
57. CERTIFICATE OF OCCUPANCY ,
No. Date _ _ � � i. .
r
Applicant to fill In all soaces exceot those within neavy EorCer Ilnas ana si9� a11 aooropriata Oeclarations. �
PERMIT NO. __.... _ TRACT NO. LOT NO.' UNIT NU.
CITY OF COSTA�ME,$A l.�N��UI.) Q i7��� rvi�e�
P:o�ec;Address ����` EZ -�-,�.1
' Applicant's Maili�^9Ip. ddre/}�s �� ������ .�--�=�//NE
Owner'sName I`��K^�� Phone
Address
Arch/Eng. _Licenu No.
Address
Contractor's Nam �L nPh, neZ� 9b�0
Addresslmailingl��� 1lQ�E%���-� :1-KJ���NE
Ciry License No. ���7-'���"
LICENSED CONTRACTOR DECLARATION
I hereby alflrm Ihat I am licensetl unae� provision5 0l Chdrt¢r 9(Commencing
witn section 7000) of DivlSion 3 Ot the Business antl Profe551on5 Cotl¢, antl
my Ilcense is in /uryIlforce antl etiect. 2
Licens I s u�� LicenseNo. J�In� '
Da[c Si9nature
WORKERS COMPENSATION OECLARATION
I hereby allirm that I have a certiliwte ot consent to selt-insure or a certHiwte
�f Workers' CompenSafion Insu�ance, or a c¢rtifie0 copy t�e�eof (Section
;00, Lab. [Ct) R��
oliGy No. !��� Company
�Cer6tietl copy is hereby (urnisnetl. �/ /� • �
Cer it' c s filetl with the city B�QtlinG 0'v i
Oate APPlicant i' lA
EXEMP ION FROM WORKERS' COMPENSATION DECLARATION
(Thi55ectlon need nol b! complete0 if the permit iz fOr One huntlretl (SI00) or
Icss).
I Cer[i1y tna[ in th¢ perlormance ot the wOrk fOr which this p¢�m�t Is I55uetl, I
shall no[ employ any person in any manner so as to becoma 5ubjeC[ to tM1e
workers' Compensation.Laws of Catitornia.
Date Signature
NOTI[E: I(, a(tar makin9 this tleclaratlon, you shoultl becoma subject to tho
Workers' Compensatlon provision5 of the ldbor Cotle, you must forthwi[n
comply wlth such prOvislons o� tbis permit Shall be tlaemetl rovoketl.
CONSTRUCTION LENOING AGENCV
I hereby aillrm thal thero Is a construction lentlin9 a9ency for tne pertormance
ot iho work for wnicM1 tnis permit is issuetl (Sec[ion 3097 Clv. CJ
l.entler•s Namo
�nntler's AEtlreis
OWNER BUILDER UECLFRATION
I horeby affirm tM1at I am nxompt trom the ConVac[or's Licenio Law !or the
tollowing rCason (SettiOn 7031.5 BuSiness antl Professional Cotle: Any Nty or
county whlcti rCquires a permlt t0 cOnsl�u[t, alteq improvo, tlemolish Or repair
any structura, prior to ils issuance, also reqWres the applicant for such parmit
to Ille a Slgnetl Slal¢mGnt Ihat he/ih¢ is Ilcen58tl pu�sudnt t0Ih0 ProvlSiOns of
ine Contractor's Licensn Law (Chapter 9(commencing witn SocUon ]000) ol
Dlvision 3 of the Business antl ProteSsions Cotle) or thdt h!/She Is <xCmO�
ther¢trom antl the basis for the alleqetl exemption. Any vlolatlon of Sectlon
'031.5 by any applicant fOr a pe�mit subjlcts �ba apP����< <o a Civll
tnalty ol not more than Iive �untlretl tlollars (E500�.
� 1, as owne� o� tha prope�ty or my emPloye85 wiln wages a5 IhOir Sole
compenSaUon, wlll tlo the work, antl the sVuttura Is not Intende0 or oHeretl
1or wle (Section 7044, BuSiness and Prolessional Cotln: Thn Gontractor's
License Ldw tloes not apply to an owner of a property who bulltlz or Improves
thereon, antl who tloes su<h work himzelf/herseli or through hls or her own
employeos, provitlatl [hat zuch improvements ara not intentlod or oilared tor
sa18. It, howevOr, Ihe builtling or improv¢ment is soltl within on0 yoar Ot COm-
pletlon, tne owncr wlll have tne burtlen ot proving ne/sne altl not builtl or im-
ptOve for lh0 purpo5o ol sale).
❑ I, as owner of tho property, am eztlusively contractlng with Iicensetl con-
tldClORlO COOSbUCt [M1¢ P�ojCCt (Section �044, Business anU Prolessions Cotle:
Tba Contractor's Littnse Law doez mi aOP�Y to an owner oi prOperty who
bulltl5 or Improves lhereon, antl wlto con[�act5 for such projaGts with a cOn-
tractor(s) ucense pursuant to tne Con[racror's License Law). I am aware [hat
proof of thelr Worker'S Compensation insuranca snoultl ba provitleC to me.
❑ I am axempt untler 5ettlon B. 8 P. C. lor thls reason
Date Owner _
I hereby certity that I have reatl thls
information is correct. I agree to compl
antl state laws relaHng to builtling cons
sentaUves ot t is ty to entar uoon
�inspectlonpm se
Siqnature
Drivers' License or 55 � ���• �
TVPE OF CONSTRUCTION lJ NEW LJ ADD lJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER p.p, �6
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E
TYPE OF PEflMiT�} GaAOING FouNOA71oN 57RUCTVaAL T Front
❑ TENANT Ifi7 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reef
❑ OTHER
PROJECT DESCRIPTION 54. F7. oCCUaar�Cv C Right
K left
CONSTRUCTIONTVPE VALUATIONS S
ZONE � GRADING CU. VDS. ACRES Ping. ReL #
Remarks: /y (��, /}/) ry` /i-2'?'J G.,7 Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
�rinking Fountains
Floor Drains �
FIOOf�$ink5
ud5$2NICB DUIIC�S
Interceptors �
Kitchen Sink
Lavatories
P-Trap
Roof Dreins
Reinspection Fee $15
Boiler
Duct - Under Ground
Duct - SVuctural
Duct - Ventilating
Exhaust $ystem ❑ MWtiple ❑
FirepUFacL BIt. ICBO #
Heating System & Ducting
❑ ai oo,000 eru O i oo,000 sT
Reinspection Fee � $75
CMF 0865-46, rev. 10/84 White - Builtling; Canary - AOPlicant; Pink - Accounting; Goldenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
W3tCf C1052L
Water Heater
Water Service
Auto�Wash
Laundry Trays
laue Fea
Hood or Typel ❑
Canopy Type I I �
Refrigeration System
❑aioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
5596 2/�3/B3
Zone
ELECTPICAL
Automatic Washer Transformer ❑ 15-50 KW
ConstructionPoleSub., - �50+KW
Cooking Unit
Dishwdsher
Dryers ❑Gas ❑Electric
fan
F,A:U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Gencrator �0.5 KW 05-15 KW
Metef ❑up to 100 amp5
Meter ❑over 100amps
Sub Panel
Motors 00.1 HP � 1 h- B
Inc. Solar �9-15 HP �76-15+
Microwave
Po1e Light
Range
Sign
$tending Sections
Trash Compacwr
g� —
Reinspection Fae $15 Issue Fee
FEES
DEVELOPMENT SERVICES HEUUIREMENTS:
Zoning Approved By
Building Approved By
Aooliwtion Issued Bv
5 3
SUMMApV OF FEES✓
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE S
PLAN CHECK 25% 5 ENEFGV P.C. S
ELECTRICAL S Z.%�JO GRADING - $
PLAN CHECK 50% $ G•JO MICROFILM - S
MECHANICAL $ TOTALFEE $
PLAN CHECK 25% $ .
3300(: Tl
FEES
.4.'
Z
O
N
I
N
G
R
E
Q
M
T
S
�CONSTRUCTION AND PLANNING ! � POOL & SPA -
APPROVALS Permit# Date �, Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location �
2, Soil Pipe-Undrgrnd. � 53. S[eel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Elec[rical 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, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 6p. Backwash Lines, P-Trap, O U�drgrnd.
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-Finai
76. 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 APPROVAIS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. RoofFraming 73. Undergrnd.StorageTank�Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Svuctural) & Monocoat 75. Dry Chemical
27. Frame and Fiashing � � 76. Dry Standpipe
28. Lathing & Siding � ' 77. FIXED SYSTEM FINAL
29. Insulation � � 78. FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT ,,,
37. Plaster Brown Coat . 79. FINAL INSPECTION -�
32. Electrical Power Meter-Final � �� � . FOOD CERTIFICATE ISSUED .. �,
33. Final Electric 3,J 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 pomestic-Final -
42. Backtlow Preventer
43. Backflow Irrigation
44. Landscape Irriqation 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 � r-
51. CERTIFICATE OF OCCUPANCY '
No. Date _ - .
• ' . � Applieant to 1111 in all spaeas e:cap! thom witNn heavy borEer Iines anA s15n all ap0�ooriata tlecGnuons. - �- —'�6h3 jj��(�/ J,� ' •• �• -
CITY'OF COSTA MESA `� �"- ' pea T NO. TRACTFIO� _ LOT NO. B. � �f � '
�.
� CONSTRUCTIONPERMIT . - � . � �oZ�o . �� /�3' l�� �.. � . � s�ri'� �O� �.� ` � � . : � f
�Applicent's Meiling Addfei5 ' � , ,'I�iPEiOF CONSTRUCTION� � � NEW ' ADD ALTERATION� REPAIR' . • , ; '� _ .
`' Projeqt Address 3�%r� ������Ay�•, � Ul l�� � ❑ CONVERSION '❑ DEMOLISN ❑ OTHER.. ' � ' � �
,Y OWnBPs,Neme � ��• �5���� �hona �� �O ' � DESCRIPTION OF WORK -��KT...� MPLiwErl(�.0 ' ' ` ' � � �
v\ . � . , �. i . � ` � . I G� GU .
�" Address p
j5 � � -1 � � � ' TVPE OF PERMIT ' � GRADING � FOUNDATI STRUCTURAL r A. P: qp� ' -'Op ^ , ZONE � ' � � � •
(�� Alch/Eng.; O �N ' � Lice No. G�2�� �;TENANT �ELECTRICAL �LUMBING �MECHANICAL � � PLNG.REF.�9W ' ' . ��.BUILDING .- ' + • �,'
V� Addrett 'A� TD�1.� ND �1,7flN.�Y �': _i�(ZANAE' -. ' .Q,�pTMER - r ( ,. ' '- 1 '� � - � • , . TO BUILDING 1 ' ' . ._
.R R VARD (TO P/U � -� � %.
COOLfBC[Ol 5 N8T �� ' ' , hone q �S-O�f] I: PRQIECT DESCRIPTIONI SQ. FT. '�' OCCUPANCV '��Z� - P . v � '
Addres3lmailing) Z5O'f7 MllJr�6LSON k-i �r-`uN6 � � CONSTRUCTtONT.VPE � VALUATION$ g�0�" ' LEFTSIDE VAiiD i�� RIGHTSIDE V RD '' �°��_`(�"
35t5499 ZON� GRAOINGCU.YDS. �ACRE� � PKG.SPACE REQ. � ' OVI ED �� , � -
License No. B- I � �. -
LICENSED CONTRAGTOR DECLARATION : � ' :' ' Remarkf: � � � . O;� STREET WIDTH , � �PARK FEE $ � .' i
I`hereCy aNirm that J: am Ilceaua unaer orovislons of'Charter v(commenuny CL8 L2�2ATED- �f.e � Gt'i'�Gi. � � ; �
with sectlon 7000) of Dlvlslon 3 Of the Business entl Professlons CoAe, dntl �� ', �� �� : sj��6 �; � ' ' ,SVECIAL CONDITIONS: , � i , I* - =�
my IlGensa'IS In full orce anE eHect. . 1 . -
� I�cen c�a�t � � ^ ' 0 4 i , � , � ' PLUMBING . • � . . . � � � I , . .; � '� ' '
Date Signature • � 1 . � � ' 1
qRKERS' COMYENSATION DECLARATION � . I � Bef Siak � � . SBwa� Cap � � . ELECTRICAL ' ` �
. hareDy atRrm tnat 1 nave a CertlfiCate of consent ta SelNnsure or a certHlWte � ' ' • Automatic Wffiher • �` ''Metel over 10� amps _ ;•�� ,
o! Workers' CompenSdtion � Insurance,� or a � carHiletl mvv tnereoi (Sectlon � ' B�kfloVv PreVenter _ r. _. � _ $9yy¢r COnnCCtion � - _ . _ . _ .1 _ . . . . _ __ `
Construction Pole � Sub Panef j
3800, Lnb. CJ . � ' � � � Backflow Irrigation $plar Cqll2c[ors � ' � � '
POII�Y No. �S 847� 3� ComPnnY INDV>TR�►L INDEMNiTY � . - -- - . . , . .'. � : .
�Certl/iea�wpy is nenby turnishea. ' � � - ' ; Bathtubs ' ' • � Solar Piping ' , Cookinq Unit , � �Sub Pole � � � , , , � � ,
CB tlflep o0y,,_�i IeG With tlle'tlty Itlln D 1e- . r/ � . r�
,C,j � , Dishwasher ,Motors �0-1 HP �1'hB � I� 1'
Date 7�7 �^� AOPlicant � , . � Clarifiers ' � � Soiar Tank•� . , ' : . . _. . .�
-EXEMPTION'FROMWORKERS•�CO ENSATIONDECLA ATION � '� , Di5hN25h2r � F ; - � ; Dryers OGas;�OElectrim�•.- Inc:Solar�O9�15HP'�,1645+ � �" :
,(Thissectlon neetl not be compleleE If tha permlt Is To��ona huntlretl (5300) or � }. ' Swimming_Pool w/Spa�:
� lasz). . � �' � I � �, ,• Fan- Microwave ; : •
1 cerHiy that In the parformanca of the work for,whlch this parm�t Is IssueA I, Drinkiny FOunt2in5 . � � U�inal � � � . � '., , i
shalP not emD�ov any person In any mannar so �as to become sublect. to t�le : '. - Fy �y(� � F.A ,U. Pole'Li ht � �
:Workers•Compensatlon;LawSotGllfornla.� ( � � . � FIOOtDiains� i � WEte�qOSGcp� " � 9 F •`1 � � �� �
' Date ' � �Ignature - � � � ♦ �� - � . �- � -�-, � � Fixtures � � �qan�e ' �� � � �
�. N0710E: It, after makluq. thls tlatlaration,.you ShOu10 OeCGme Subjett tO.the - � .�_!; FIOof Sinks ,,� .. � _ _ I__ _ .; _ _ „ , _ _ WateI,H22te% . :,_, _� _,: � . _ . _. , _ . � .� � ' 9 i � {
' Workers', ComDensatlon proNSionS o1 the labOr COtle, you must fort�with ' �" � • � � .� '
comply withi such �provlsians'- or this••permit ' zhall be'tleemetl� revokeC. Gas Service� � -OutIBtS � ��� Water Service �, � � i Device Boxes � 'S�y�' � � �
� . CONSTRVCTION.LENDING"AGENCV• '' ' - � � �' '' ' - " ' ' - � � � .. � ; �
I hereby etflrm that there IS e.tOnstruttiOn IenGing aqency torShe perTormante i Interceprors � _ _ � � � � '.� � �utlBts '� � � � � Standing SeCtiOns j� � � •
ot the work for vA�icn this� pe�rm1L I Izsuey,,, (Sactlon`•309TCiv C) - � . � � �
Lentler's Name � �'�'�COQP.' fG��. tS1'b7'G- . . • r + " ; i ' �� . y , SWitthes _ � : ' '.TraSh COmpactor � ' ,
:I � 'AuroN •'BLVD. "�STi. 77d 'Ce57AiN Kiuhen Smkf ti , �
Lenaer's Atltlrais; �� � i -� � _ x _ -- � � � ', GartiagaDisposal f � � � � � � �'
OWNER BUILDER DECLARATION' � �� i •' I � - ' '! ' ' � ' ! �yetOfieS- ��_ . � � � :_ � � . •
1 hereby�dfflrm that I am�dxempt trom the'Contractor's Ucense Law fOrthe' i , �- P_ - .,. � . t,. � . Generetor OO-5 KW �5�15KW � i ' , t
. followin9 reason (Sectlom ]031.5 Busineis antl ProTe551onal�Cotla: Any Gty or , �T�aP �,F - 1 � � • � • � � - � �
'. <ounty whi<ti roquiros a permlL[o COnstrutt, alter ImproVe, aemolish,or repalr i� , � . � . . . i � - , � . TrenSfOrrtief � 15-50 KW � � � �
� any struchre; prior to Iti Izsuance,•alw requlrei tl�e-apPllcanEfor such parmit � ROOf Dr2in5 � (- � � ' � • ' �
y�.$o flle a 5I9neG statament'that �e/she Is Iicensetl pursuan[ to [he�OroviSions of ; � - ; ; , , . , _ � . - „� , 05U+KW. � .Rein c[ion Fee
�.�A�e Contractor•s-LJcense Law, (Chaptar 9(commencing wlth:5ettlon 7000) ot '' � . . � � a15'
'!:'7lvislon �3 •ot lhe �Buzlness antl; Protassians Cotle).or that he/she� Is exempt � _ , Show2�5 , ' �� � ; � Reinspection{Fee ' t 516 - , ' .
' `��erefrom antl the, basis !or the alie9etl eaemption..Any ,vlolation. of Section ' ' � ' , � � ' ' - Metet �Ou to 100 am s ' $ 3 :
'�7031.5 by'any aDO����t for.a pBtmit �subjects' the�apP�i�ant to a. civil � ' , �' P P � � �IAUB FeB +
enalty o1 not more man nva nuntlretl Oollars (E500�'. ��.. . • ' Se!viCe Sink 1?-' �� �' � '� Isue Fee -�. � S 3 � .
� r. .- + , . - � . . � . Zanin9 dPPrawd BY � � ' � Dat� �
� �„as�owner ot the�proper[y or"my employees with wages'as thelr sole . - . '� , ' /� i . t ,
' compansatlon' wlll'do tha work, ana the.structure is aot Intentletl oroiferea � i.(�: j�'�n j- MECHANICAC � � ; ppp��ption �O�oved By ���'L "�'�� Date ' ' �
� for wlel(Secfion 7044, Buslness;antl;Professlonal'�Gotle:�The•Cantrattor'S � � - � . , �
LlcenSe Law Eoes not aOP�Y to;an owner of a property who bulltls or Improvas ' Boi�a� .(` ' :-' Refrigeretion System � r� • � � '
' theraon„and :who'tloes� such work �Imself/herselT or tbroU9h his or �er own � � - • � ' = � � � ! � i � �' '' . . 1 Application laued By �� ' � 1 • Date ��6 ��
' employe¢5, piovltletl thtt such ImpWveTBntS d�B;nOt IntentleA Or ofte�¢E f0/ ' . ❑aIOO,OOOBTU ❑100,OOOBTU' ^� � -
ule. If however, t�e bulltling or improvement I5 soltl wlthin ona yeariot com- j • Duct - UndecG�Ound t ,, � � , ; ' • � • f SUry1MARV OP FEES � � ��
' O�etlon, tha owner;will hava tha burtlen of proving he/she tlitl nol buil0 or Im- � - � . . ' � ' �� � ; ��7�J� , i
;.�rova for me purpoze of saie)�. , i + ;' i � ; ; { � Duct -Structural , . System Repair/Alteietian � ; I • �BUILDING PERMIT $ �_ � SMIP , � $ ' �' 9.�
u I, es ownei of t�e property, am exclusively contractlng•with:llcensetl con- . 1 � i �q�7 i
� tractonta construct tha'pro)acl 1Settion 7044, eusiness antl Professions Cotle: � Dutt - Ventilatin9 l(� , J •.PLAN CHECK� $_L:�_ � PERMIT � �
' The Contractor's'License Caw-does not apply IO an owner of property who ': ' '-- - - - - ' - � ' j � ' j ISSUANCE' � $ . �
builtls or Improves theraon, antl who tontracts for such Oro)ecis with a<on- . . Exhaust System ❑ Multipl2 ❑ �� � � PLUMBING • . $ � • �
tractor(s)-Ilcensa pursuant to tha Contractor 5 L�cense Law): , , - - � ' � ' � S � . � � •
. 0''I'am axempt untlar Sactlon � B. 6 P. C. tor this reason � � Fitepl/Fact. BIt. IC80 �k � � v ' l � ' �PLAN CHECK, � $, i i GRADING ' i$ i ; �
� � .ELECTRICAL� $ � � � � �
� Date ' ' � � Owner; � � � • � � ' ' ' ; � Heating System & Ducting ; i ( � � � . � . , , I . . , � i
J. hereb cerGify,. that I�.have.reaa.thls appllWtlon antl.state. that the.above ' � � �PLAN CHECK• � $ � j i MICROFI�M �$' i
y . ❑Q100.00OBTU.�10�.�OOBT _ � . : . . �
Information is correcL I agree to comD�Y �+��h all city antl county ortlinances 1 � � i � i i : ! � ' • � "� ' ' i .1 ,'% � � � � � � � TOTAUFEE� , � $' .
an0 state �aws relating to bulltling constructlon, antl hereby authoriza repre- i • � � , , �MECHANICA� � $ � , :� : � �
-sentatives ol;t �ciry{[ er:up t e above-mentioneG proDerty for � � Haodof Typel ❑f , , j � � � � i � , � r -
inspectlon ou es � . i Cano � T e II ❑i � ReinspecNori Fee� '$15� , � . � LESS t , , ,
� � - � r t 'PLAN CHECKI $. � -• qDVANCED PC �; $ '
' Si9nature te 8��'a3 ' ; ! � ( , , � ' 1 i � � � � , ��j
. Drlvers' Lice se o � 5 ' '� f I Fiegisters i � � � Iswa Fea � S 3 a��o , •C , � ' - ' , FINAL �FEE{ ;$ j [�!'
. . . . . . . . , _
.
�CMF 0865-46�rev. 12/82 Whlte - Bulltliny: CanSry - AOPlicant; Pink • Accountlng(Goltleniod - Asseisor ' -� ` "� ' - - � � �-^ ^ � -�"
� ` .z -. �
. • ° "CONSTRUCTION AND PLAN �NG � ' y � o t ` , £ � %: , PO� _ eY SPA , , � , ,
c 'Date Inspector v �- � �`" � - � , � Date=' Inspector� �,
• �APFROVA6S � Permit # jS, _ � . _ � APPROVALS ;'� Permrt il� � .
, c . rv I, .. rs 7 - ' o
' (•i�. ,iemporary� Ejectrical Service�o�� Bole'�� _ '� f ; : ;_�: ; � : i ; ', ' 52-. �Pool & EquiPment Location..;: ` - � ' `-_� ,.,, � ` �
- ��
u �2. f Soil Pipe-Untligmd? � � V z, �,; � � � ' r'��' r; Y� "53 Steel„Reinforcement . - . �. ��� ' �
_ , r
7. Footing's r'
.r.,.,,, ..
B.iFoundation
9.�lyatier Pipe,
i .
10. �SYru'ctural �F
11. �Proper4y�Se
r:.
12.1Sewer�a
�=*i_P
13.fRoo'f D�rain�
14. jRougfy'Plun
` . 15 wRough'Etec
o=1,6i ,flough-Ele'c
p .r,e i r
- F 17.)�Rough_Wirii
,
, 16�.vRough,Etec�
y .
� 19.'RougFi Heat
, �0.,!Rough.Fact
�
" 21."D'ucts;:i�n;St
_22. �Ducts,'Vent
,,.. -
23:'Gas�Pipe,Rc
� ,•. . ,
' jj4.,�Roof �Frami
r�5,}j Roof' Sheatl
.�
26.;T-Bar7Ceilin
i-
` �27.'�F.rameand�
,i .
,i ; 28.' Lxthiiig 8i�i
29. - Insulation':
_ � _
'>30.rDrywall Nal
° ��_�31:'P�Iaster�Brov
'?32.�Electrical Pi
� � 33. Final Electr
� 34.�Final�Heatir
, .
35ti'Final Ga"s Pi
36. � Hood��or'Ca
37. Final �Facto�
3�:� Final Plumt
39' WaterUServi�
� 40. Gas Service�
� '
� ' 41. Solar porrie
I �_r. .
42. Backflow P.�
..Ii -
I 43. Backflow li
44. Landsca"pe,
45. Sound,,AttE
A �-.
46. Handicap R
47.� FINAL STF
L_ 48. Special Req
49. Electric Rel
50. Gas Release
nduit Ufilit4�Undrgrnii ��'' � ;; � �� Y� I_'54! �Forms' , - �:� - � _ � i
r v c. li
ndUit Undrgrnd � 1 � G � - � � ` � '55 Elet•t[ical Boridin� . � � .� �� � �
ci .i i ��n .n . . . »o: a. - .� g' -
;cemerit ,`:, � :"`: ! ; �;.� - '�� = v'' o;P � �:56. �Rough`Plumbing�&PressureTest_ ` ,:��' '��1� -
.c. -
c.ER�Grnd:���� a ;; °� : �� �? ` _ a' ^ �- � 57 -APPROVAL TQCOVER-GUNITE. = F y :"%'
-.
� ,_j 'r�� � � : ;, ` ` � p "i ��y ^ ° � 158. rElec[rical-Conduit-Undraro�{;. - ' , _ ;`� � _
�' { I t'j �' 't �g r ' „ � � =59 Gas P,ipe:O Undigrnd Test� - � ,
' 'i �
IndrgrndJ � � � .�� � ,� � �.; c:� � ','.60 �Ba�kwasfi'Lines, P-Trap, O Undrgrnd. ' � .;
,... < < - � d I , .-�
oofSyStem � '�+ -'' :s "' '� -�5 r� i,;6L�ARPt�OVALTODECK' - . � u. ' rJ''
J� i;
1} n .� . � ���� . .
u r �.ine & House'Conneation, - � � � x i ; . � t62. Backwash & Receptor-Finaf � " � . - '�y�
� � '�' �;' .-.1 � � . �� � -63.',Heatef & Vent-Final - ; - .. � ' �., .i, ' -
,` ,.I ��i , . � I - � � � - :c�
'; .; .•,�. �t � - - ,�-i � - - � .. .64. !Pluiri6ing SYstem�:'Final ._ _ �� ' , �
F'' .
�'= . _ c ; � : o - ., . ,
�ing� . • � p - ,.. - � =65.'ElecVical-Final ^� - - � • - .
�ical-Conduit ; - -f�-�- - - _ , ..-r _ ; . -� -'f � -- ..-- - , - - - . - -- -
, . i :,, i �' �� � � 66i �Solar� System-Final ; - , i ,
.. ;:. �-- -' '_ . . `
�ic Wi�in9 i E ,_ �j ! - �"; � �, ; �n ; ._ -�"-� � m '-'�67! Fencing &�Aecess:APDroval" : i �:,--� � � : �" . '=";f-��-�
g:Sign� h r i '� � r !' !-; � ` � ' I ; I � � '68'. APBROVED;FOR PLASTERING - 1 � �-. �;i .,
ical;T. Bar Ceiling , �� i� 1;`- � i ' �.!:�;' 69� P00'L%SPA SYSTEMS F.INAL �' � �
ng & Air',�Coneiitioning i' +' � . G � ; j ; I ! � FIRE DEPT. REQUIREMENT, ' , � : ' _
"` -- � - i � 1 I „t.
ir=y Fireplace ��1 { 1; �� � j � �. AP,PROVALS, Permit# � �` '' I
- - !,';f a � i- � � d
uc[ure� �'' � i ',t � "i � ��; . � , ; � . ; i � ; 70[ Underground HYdro . � � � : ' � ' � �
lating ;; : f .�� ` '� j� � � j � � � � �71? Produc[ Piping,�Gas �OOiI � � . ; � '
�,h & Test� � ��;c ��� -�- �� �- �-- � -- �- - �' -�72� Underground Flush � �t� - - - � �� -- - � -
9 _ �� -1 :. � i i _ � .
ig '�� � .j � , ��.o � � ' � � h � << - � - � 73� Undergrnd. Storege�'Tank'O Gas ❑ Oil ' � ' ' ' �
- . . i 1 _ . - t . ._ i . � : i
ing ��-� i> �� � v�� i�.. �. i�• i o �� :• � I . i. I 74: Overhead Hydro �' ,- .��, .
i
I�IStructura1lV&ivlon'ocoat' ; ; ��f �� � 75� D,ry Cheinical � •. - � ` � � . .� • �
� ,
tashing �� �}' �, � ; � `.g '76: Dry Staridpipe �� ' - � � '
Iding �� .,-� �; � � i �� I � - � � ' 77. FIXED�SYSTEM FINFIL � ' _ '
_ I''� n I � �i '� f I i I. I � � 178: FIRE PREV. FINAL ' � .�,
I F i
ing I:"„ ' I (, no 3;� I� � Notes , j �
ir:i , - � � -�--- - -- - -�r-� ^ --i---... . ... ' -i-
n Coa � :. r { if i i � � � . � � , - - - - - - � �
wer Mete�-Firlal � �i �� i i �' � � � � � i �� . . � i o�
' � I ' 1 �I �; 1 � ' � . � . � � ! � ' , ' � , • '� ; �
_ 1....4. ..J.. ' i. x i- �
3 &,Air�Co�dition'�n9` ��x � �� t � � � � �;. %O'%'1�'� L -'C . C'
��
�e-T2`st'-���.;�:�i=' i� I;I_'. . + ��_�Ti.: .���-�y,-S'3... � 11 •. �.o . . . .
. .��� -�� �z �i � � � ��- . . � ] . � . _
oPWy �.i.� �f� i � _t : �Yi '1 � ��: 0:%7/`�%:D�g'�.3� ((�.L'� �� LIiAs.�a" + •
t � • _ � s � � : � o i y . i - i : ( . .
y �FirePla_"ce� - o { . � : � �,. � i _ i ' . , • . , n .. •
i i � ;� � I•! I 1 �� �
n9� ^i . � � 4� � � : �•' � � '' ! I ! � � ; �t -. i . '_ ' • .. -
:-Final,' �� � � V� r �� � � ' � I � � ' 1 � " �
t r I ' i, �
�inal � j I i il I I I � � � ; �_ i,.
[ic�Final �' � � I � I � J'. - � 'i•-- - '- ` .�' � .... � . � .
�vente�ll � � I ��n� _ � � � i � ' � . . � � • �
' 1 -�f'.� �-t't'r �_" -I � �
i rl � . � - � �'� I i ..
igation ? I , `, �- ; ,;n � �� -, �'g �, - � : ' n . ; . � .
, t.. � I � �
ngatwn:$YsfOm' � ti. i `- i y , ' 3� �. � ' �° ��� - l ' ' ' , ', �: ...
ivation' �;� � '�.1. � ,i , � .. � - ; � i . � - � � ; . . � - . _- �_ �
r. ' � a-. � I� � - ' -
gulations� ^ i .. � i � �` �i ' ; _ � ' ; j � � .. _ . - _ ,- �
i i � 1
JCTURE�& BUfLDING'� I^ I� I3 �j� I? '� >. '
irementsCompleted ii. I � � ��� 'j� � � � � , i � ,�: � � . . ,
ase to�Edison � . � � �-� I-+"4 - -�--�_ �� . _ % -, -� �_ } _�_ � ^ � � . -�;
:o Southem California Gas Co I ! I I � �
� i � � ( i � ; ; ' ' ' � -
� I � � 1�
TE OF.00CUPANC " - � - �- � - - � -1- -. - � � ,' -I - - " , �. ,
2�i=. �Date l ' .�? ' � I T i r , � '-. ' . f
�L..,,,_ -� _i,_L.' _I�
\ " A07��Gnt to flll in all sDaeas e:cept t�ou wlthin �aary Eortler Ilnes anC sign all approDriate Eaelaretions.
� , ,
i CITY,OF�COSTA MESA'� t i 1�� � � � PE IT NO. . TRACT NO: LOT NO. , BLD � � � , ' ; � 49�� 8/3f /83�" 42.(JJ ,� �
�.CONSTRUCTION P.ERMIT,,�'DG�o'.S `Q '� ' . ' �;�- - � �• _ � � v. . . D� ' . . , ; . , . _ , ' - 'i i
M ApplitBnt a M2ilin Add�f¢/� � � N �'y " ' 4 � . Ti�PE OF CONSTRUCTION . , � NEW ADD� � ALTERATION ' REVAIR'_ '� � ' � �' � : �;� `� +, '� ( � - �� - � � .
(� � " �S / H V ' AI��A� ❑ CONVERSION Q DEMOLISN O'OTHER',� _ , . � � �
,yo ' Project Addre�u /�
� _��'• �E �ST/�D�hon2 ' - ' DESCRIPTIONqF WORK , , � ' _ ' � " I G EGU � - - �� �
( Ownei s Name _ � � +- . : � - � ,. . . : � . � , . �
� Addfess� ^ � - ' ''7VpEOFPERMIT GRADING FOUNDATION STRUCTURAL A.P:.#e � � � r ' � ZONE � ' � ' �� .
QAIC /Eng�� ' Sr�' Licen No., , v � TENANT O�ELECTRICAL O PIUMBING� Q�MECHANICAL f PLNG. REF. ME_ ' • .BUILDING �.. � _ 7 r.
� , AHdrMs. �'%7 ����% �/• ' ��vw _ OIOTHER , �. : : i , i . _ r
TO BUILDING� REAR VARD (TO P/U ���
.r 'lA/li1ALi _7F ) 1 'P PE Y IN �- i i
�.YGT��KI��C '��� rh i z��y PRQIECTDESCRIPTION SQ FT.' OCCUPANCv' -�
Cantiactor's Namt ^ - �/ . � �
Add�M5Ime11i0g) ��' u D�LE �*'�OWN�I ' CONST,RUCTIONTVPE � VALUATION$ ,LEFTSIDEVARD � RIGHTSIDEVAflD � ' . - '�
- � ' ', . ' " ' . � � f � 20N€ GRADING CU.VDS. iACRE� ?KG.SPACE�,REQ. . � PROVIDED
. : � ^ '
. � '
Licenm No. . . . . , ' .� . . . - � �
LiCENSED CONT0.qCTOR DECLARATION � . . ' ' ' ' Ramarkf: - ' � � ` . , ' _. �STFEET WIDTH � � . � PARK FEE'S �
' I�he�eby alfi�m t�at 1 am IlcenseE untle� p�ovizlons of �Charter'9 (commencing - � � � � � � �
'� wltR sectlon 7000) ot. Dlvlsion 3 oT tha Buslness an0 P�ohStions CoUe, anA � ' � � � � � 6PECIAL CONOITIONS: ' � � i ' - t
' Ty IlCense'IS In tY1110ft d � feC2. ' ' � ' ' ' ` � ' � - ' r - , � '
. L'Jcen cYe � . ` <en N �'J a ' j ' ' ' PLUMBING � � j �' � i � � . . � � � � �
Date -�7` ' . 519nat� � ('����eG� , . • � � � � � ��
4VORKERS' COMPENSA710N DECLARATION + • 4 Ber Siok � � 1 j Sevuer Cap- j '� � � ECTRICAL ;
�?,�ereDy�affirm that 1 hava a�erHtiwte o� consent to selfansure or a certificate. ' ' ' I :_. Automatic Washer i EL'Meter ❑over 10b emps 1. i
>u" Workers' Compensatlon lnsurance, or a certlfletl! copy tnereof (Sectlon, ' ""'v Backflow Preventar .�_._. _ _SeW2r CAnn2Ction _ ' ' _. C __ . - . - ' � . . _ _- _ _ ' _� �
�� e , • • � Construction Pole.' i � � 'Sub Panel. ' �
��00, Lab ) -9 �,,y �7 " '/ /�.�/� /1 �%� • : Backflow Irrigation • � i Solar Cdll¢ctors � i {
PoIICY No �"�e(s✓// ��G/ ComPanY/7�IC/Z��(l �"c-'• .. ; _ .., } . , . ' , { :
' i � Ba[htubs : � � Solar Pi m � Cooking Unit �:�� � ;Sub Pole � i 1 , � i j
'� Certlfletl�toOY is hereby furnlsbeC. j I ' �� �� /f� , . � P 9_ � ' ; i .
Cer{ le I wirn tne city Bup�[] Iv�i;l�on. ��/�'�''� r'� � � � Dishvrasher iMorors DO-0 HP �1X$ ' �
'� Date_�P��_ APPlicant � /IAL//lY.f:!/ ��:i�J�� ��;; � Cl9rifiefs , 1 � � ' Sotar Tank = � � . . . . . ,
iEXEM "7`IONiFROMWORKERS'COMPENSATION'UECLARATION"� i � DiShwdShef : . � � '� SwimmingPoolw/Spa - ' Dryerr OGas'�OElectric.:.• � t- -�Inc:Solar��9;15'HP-01645r'-�t'� "^�- '^'
�, (T�Issection nee0'not Ee complatetl if the parmit Is tor.ona huntlratl (5300) or - . — . . ' . . � , ' (
� lass): � 1>%i � .: . I � � `� . . 1 � - Fan' ; � i� � , .Microwave ' i � ! �
1 cerUry�that In:the performance of tne work for which this parmit is issue0 I°' ; Drinking Fount2in5 i � j z Urinal ; ` � �� � � � � - � � i
! shall�noc employ�any person In any manner solas to become suE�ect.to t�e� � . . -� ; - � ;
, Workers'�ComDensationlLaws ot California.: • I 1 I, :` � Fluor Drainsl � � I � Water�Cioutf � � � i � F.A.U. � ' y. � � 'Pole,Light 7 j , � ' •
� Date { ' ° Signatdre ' ' � ' ' • "� � . � � � i � _ Fiztures : ; � '; , i �. �Fiange � ' � �
�,NOTICE:.If.ai[er_making.thi5.tlatlafatlon� you shoultl.bacome zub)ect.to.tne. �. � I F.loor Sinks.___ . _ j ___y �_J , tWa`ter. Heateri. _ _. __ ; _. i _. .; __ , - � � . ! � �
� Worken' Compensatlon provlSlons of d�e l.abof Cotla. You must forthwlth � ' - , - , . �- � Device Bozes i I ' � � � � � �
comply,�withf tuc� �provisians�or(this!!parmit+snall bettleemeG� revokeO. ��) i GasServicej? �Outlets� �` �„ Water;Service R f�-. � r 1 e � 4j : I ISigm � � � �
'� CONSTRUCT,ION�IENDING�rAGENCV - ' ` � " � -� � ' " - ' � `' � � ' • ' i i
� I heretiy afTlrm that there is almnstructlon lentling agency Tor the�performa? ceL �� i Inte�ceptOR � " • I- � �^ �.y !_ I � '�' I OuUetS � ' � ' � � �Standing Sections � �
• ot the work '}or which this permRUs �issuetl :(Section, 3097• Clv C, ' - � ' � - �
. } � _y - t j. - - 1 • i I �'n ?� ; � ' .Trash Compactor (
t�enaer�s Name; . . ,. ` -. e c , ' . ,c . Kitctien!Smk � ` � � ; '�. , y. ' x . � 'w � Switches ` 1 � ' , �
, LnnAer's AOCressS _ ' "- t f . �° 1 ST' � i? .. ' � 1 - i - . _ } . � � ?' " j ! ' il' " � ,( Garbe9e DisPosal � �� � : � ' 1 � i
'. OWNER'BUILDER OECLARATION -� ` � ' . `;� $ � q- � C � 3 I ' �-�'et011es - � j � � � : � L� � , , � � � '
I heraby�affirm�that I am�exempt irom [h'e�Contractor'rLicense L'aw forthe F, . _ ,� . , i �f Generat0} �0�5 KW 05-15KW ' � �
' tollowing reason-(Sectlonp7031.5 �,BuSiness anC-Professlonal�COCe: Any city or 1 ` ` P �T�ap� Y h, � ; + � � : ' i y` . � . . . . 1 . ! �I
,<ounty wnlc�'raquires a permit to construct, alter improve, tlemollsh or repair ' - - �, � - � T�ansfo�rti2r ❑ 75-50 KW � � � �' � � � {
�any ttructure' prlor to its�lssuanca,.aiso requires t�e applicant for such parmit � . ROobDiambF '� �'. (' �,,. I � ' � � t
� �t0 tlle a sign¢tl statemenPthdi he/she is Iicensetl puisuant to the'proviSiOns Of ' ' " ' , � � J - -'_ � � �� � O5U+KW � ' -
�e Contiactoi'S Ucense Law;(CFaDter 9 (commencing,wltn;Sectlon.7000) of , � l " ' F 4 .,� } t ��' 4 � � „ �r. � � � - , .,'_ � � � � ; �Reinspection Fea ; $j5� [
a ivislon�3:of the;Businessantl"ProfeSZlonS.Cotle)+or�that he/she-is�examv� . Showers ? �' Reinspecbon Fee' $15;, ; -
�'`"•retrom anG tne' basis for the alle9e0 exemption:.Any violatlon'�of Saction � , - ' ' i � � �' � '" �" ' ' ' � - ' � Meter �Dup to 100amps � +155ue Fee! � '$ 3 �
*�''J31.5 by_any ap0��cant for a.permlt'subjects.the'aOPlicant to a-civll • ! � - ' � � �. ' � ! f ` '�� � ..- �� ��
� enalty of not more than five huntlretl tlolla�s 5500 . � � • • , , ; Service Smk i - .` . � � :? �. � laue Fea �'. � i . S 3 � ' ' ' , - : V
( ) . • � , _ 2onmg APProvad BY � Date
� �� i; �as �owner of, the �property or�:my �employeas'with wages� as theit iole � �� . , � � . '� ` � � � . (
" compensailon' wlll: tlo the work, anQthe structure I5 not (ntenGetl or offeretl , , � � .,, . " �� � I ,: MECHANICAL` ( � !' qpp���tion Approved By � ' • � � ^ate � '
. for sale.(Se<�ion 7044, Business antl"Professlonal Cotle:;The'Contractor's � _ q' . . ' . i '
LJcense Law tloes noi apply to,an owner ot a property:who builtls or improves BOile� ' p„�? �! - j Refrigeretion System • i t�' �- :' �� !�� � � �-�,1 ��'. 1
the�eon,�antl �whO,tloes�, such wo�k hiTSelf/bersElf o� through his or hnr own � � � - t �'� • � ' _' Appliratmn Istued By , . ` ' � DatO
. emploY eaz, prp viaea that suchYmprovements arelnot Intentletl or ottare0 for : j Duct- Under,Ground� � -❑0-100,OOOBTU ❑100,0008TU, � � , -
� sale. IT, �oweG+q tha builtling or improvamant is soltl within one yearrot com- , . . 1 � j ,' ; , ; ' t .� , : j j � SUMMARV OF FEES � � •� � 1
plGtiOn, the ov,�ner'wlll have the burtlan of proving ha/sha tlitl not builG or Im- . - . .. �, ,� I � j . �: � �
roveTorthepprposeofsaie). .. '�� , �� �, �� i f � , � Duct-Structural � � SystemRepair%Alteiation � ; r.e ;.BUIL�fNG,PERMIT $ i 1 SMIP [ � ' $ �
� I, as owner of the property, ain exclusively conGacting'with Iicensetl con ' � . � ,� ' ' "' ' � , ' �
tractors to construct me projact (Sectlon 7064, Business antl Protessions Cotle. ; Ddct - Ventilating ' f '_ I . i f ' PLAN CHECK, �. $ • PERMIT �
'The Contractor's Litenze-Law does not apply"to an owner oT property-who � . -' - . , �7% —
� bulltls or improves thereon, antl-who contracts Tor su<h ro ects with a-con- ' � � � ' � o� � , ISSUANCE � �$�
P 1 ' �� ExhSustSystem�❑ Multiple❑, � ; , • , � �� r., � PCUMBING , � $,
tra<tor(s),Iicensa pursuant to the Contractor s License Law)1 i � �, ' ' / ' � ' � � � GRADING ; $ • �
�� �-fam exampt unaer Sectlon ` B, h P. C. for this reason ' � Firepl/Fa[t. Blt. ICBO $ ( ' � �� (' r I � " yn� PLAN CHECK'' $� � j i, i $,
,. . . � , � . � � t . ' � �ELECTRICAL 7 $ { i � � � i �
Date. � � ` ' owner � - � ' ' � ' � Heating System & Ducting L � � � � • ' � .-� •
.i.hareby.carfi/y,that I.have reatl enis appllwtion.aritl ztate tnat.tha aoove_�.._.. �p100,000.BTU 0.100,000BT� . . _ _ . . .. � '� PCANCHECK� $'. i MICROFILM � $ �
Intorma[ion is correct. I agree to compty with ali <Ity antl county ortllnances � � � ���• � ' � '�� _' " � , } ; TOTAL FEE��- 1 $ :
antl.state laws relating •to builCing constructlon,.antl heretiy authoNze repra- � - HUOd o4 ` � . ' � - � � MECHANICAL � $ �
santatives of t' •clbi to ente ;up n th a y mentlonetl r erty ar . � Type I ❑. , j Reinspaction Fee� '�/$15. � ' ' . IESS - � � ° �
Inspectlon our � � Cs�no . T e II ❑ . . . . !'. �,PLAN QHECK i $� . � ADVAf�CED PC � $ ; '
, 519na[ure ' ' Oata . i � ' I ,� � /y ' i � f � �
i DnverY �ucense or�55 � — " � � Registere � � . Iswe Fee . $ 3( •i _,,� ! FINAL FEE, � $ I �
�
CMF0885-4firev.12/82 White-BuilGin9�Canary-ApPlicant:Pink= -'-"" --'"" - y'-... �.� � . •� --' " ' " .- . . �"." ' ""'"-'.. ...._.^.•^"�- -^"
Accounting;GOltlenroE�-.Assesior � �� ' �� � � �-�� �
. _. --- - - - - - --- -
• d :+C�ANSTRUCTION AND PLANNING � . ; q• r � � �r , c ^ .. .�.. �. POOL ,PA. , ,.. ... . . .. - '
" � � - ' ' � y � -<Date,, , AnspeetoF� � � - �- -� ' <Date' Inspecmr' •
�APPROVACS?_ Permit.#� _ .�,,��;,APPROVALS��__Permit��-'" , ,�,
.� .
•,� 1�. �TemDorary� Electricpl Service or'Pole ,'� y. �„ .� ,.,,.,i � ` 5E o ''52'. �Pool &�Equipmen4 Location ' - � � F .- ' � . "
� t2. �Soil:Pipe-Undrgrnd:� . ' .- �Y _ � ` q / �J' - �.• . � � � . ' .. - - _ - � ~ �
� , , 63_'SteeLReinforcement .
t3' �- _� � ,
} , • �Electrical Conduit.Utilitv �UndrgrnA • ! � ,� � � , �.54. �Forms;, . -, , � �
' '
� �4. �Electrical Conduit-Undigrnd ° ' ^' { ; � : � ' � %� �, ^ � E:�; ; ;� �55: Electrical Bonding C - , _ " , - _ � �
5. �Steel�Reinforcemeni . � � � �" � ' ;�� ` = ° j�� ��� _ _56. ;Rough�Plumbing.&�Pressure Test - •� � �
�6. � Electrical UFER Gr'nd! `� � °• � ° ° ` ' � �" ' � . � � ��
� � �, ��; a� ;„, j ' y57, ,APPROVAL TO COVER-GUNITE,
�
7: jFoofings � , � � � . � � `: ` ' ,i ; ' 58. '�Elec[rical Cqnduit-Undramrl. _ � � � • �
c
8: iFoundation � � � , � } � - ,i . .^ " ; ' • � _ = � a - �59.1Ges Pipe, O� Undrgrnd., Jest=. ' - i �
� -
9:!Water Pipe-Undigrnd: 1 � � ' �. o �, ° � � � � _ � !' �.'gp. �gackwashlLines, P-Trap, O`Undrgrnd:. - � � ' �
.�
10. �Struaural Floor Sysfem I �� -;j � . � ` � 61. 'APPROVAt TO..DECK "- ` � - .
11.';Propertq SeweF. Line & House�Connection. - � i ; ' � ,62. ;Backwash & Receptor-Final = ' • , ' ' �
"Z: �Sewer Cap� � '; ' " � o ,� ; � ' 63. .Heater & Vent.Final _
� 1 ' . . , . . . . : � , �
13. Roof D�airis � �-� G ° � � � .,� � � �, � zgq. ,plumtiing Systemt;�Final-_ .� :
� 14.�R'ough Plumbing' '. - t '-,o . � '' � • .� � . -65. �Electrical-Final' '� ' - � � � �• ! �
= � • .. ._.T.-- - - -'--- - -
� ,- 15. ,Rough'Electrical=Conduit i * ' i i. '-'-"-" ` � "66: $olar System-Final-- � ;'-� - � -"� ' - " '"
,. � I� i i�T I. f '
' " ��16.�Rough�Elec[ricWi�ing , E i � f o � ' z-!ii, _i t-R -� {67:`Fencing�&AccessApproval`- -'t' -- - ";r'� -'
i. i {� i ��: �. „ %�` i� � - .
17.�Rough Wiring Sign? N',^ I •I �:= �; o i'� �; ;�� �� j n i�� APPROVED'FOR PLA$TERING �'
18.„�6ougti�Elec'tr cal'-T Bar Ceiling j�� {: I-� ! � • � ; I'� �-� � 69: POOUSPA SYSTEMS FINAL, `. �'= � y�
� 19.��Rough Heating & Air�Conilitioning �• � ' �� , � � { .,' ' ' � � FIRE DEPT, REQUIREMENT ' �. i '
� . t . ,
r; 20.y Rough: Fac[ory Fireplace � i� ,� � � ! ' ' �� ; f APPROVALS ' Permit # � � } � j � . �
c� > ( i� � ! � �
21 �,Ducts, in;Structure! �`' ' � � �I ,� � � � . � � � �70� Underground Hydro ' � ' r � I '
,
K22.��Ducts,�Ventilating; � n, ti I: �. I � � � � j , �7�; produc[Piping�OG,as OOiI • `
� "23.��Gas Pipe-Rough & TestG 1 ���.-'� ; (^ � I �, .� ; :, ! 72; Underground F.lush •�, � ' ( i �
' 24. �Roof Framing . , � 4 � ��;. �,,, � � �� i � , .' � � ., � � ' 73� Undergrnd. Stoiage�Tank -O Gas ' O�OiI . �
` 0 25 '; Roof $heaihing i i I ' p � '' g � ; I �. � .: � �� E E l � 1 �. � 74� O�verhead Hydro ' � ' � _ �
�26.��T-Bar Ceiliug�IStiuctural)i'& Monocoaf i ` ' � � 2�; � r � i t j p � 75: Dry Chemical � : � ' . - �
. �;27. �Frame��and�Flashing , �, � ` �� �• I _ 1 ` I � `' ' � � 76� Dry Standpipe' � � , � s _ � i
I' r� 28.� Lathing & Siding �; �; � Il II• I I �' ;; , � i � 77. FIXED SYSTEM FINAL . - , � �
� _29 u, I�sulation� '- �� ° ^ ,� t ' i� I 1 � � � , ' I78. FIRE PREV. FINAL ' . . ' � ; -
G� � Y �, 9 � r I I L �� � � 1 I � I � � P�OtBS: . i i � � � . , �
�30.�Dr wall Nailin > y i � �. � �
(. (� i _r . A
... � ,-.31:-Plaster Brown Coat� � ; � � �i � - i �- �-'-- --I --'- � i 1 � .? � G.Q. (vdQQ - -� -� - _
- � � . � i � .. � .. � / I �� . � . .
• 32. Electrical Power Metei-Final � `� � � � � I� �
�
_ 33.� Final Electric � �j � �� � � i� I ( I j_ j ' � � � � � ' ! -
q: � . ._....---".-_- -' .�..__,�. . -,1-. _ _ . . ' r .
34. Final�Heating.&.AirConditioning � � i� . �� . -
-.�,� >.
y�~ �_i•. � .� �� � � �" ' � .Ir- �T � _ �, - .,
35. Final Gas Pi Test % ��- � _ - -
� .NIM1� IC� , In CIf'�ILI.fI�'� "I� ���
36. Hood'or�CanoPY�� ��.` �-:i o� ,� � ` ; I �' � .� � `'� �,' - � _ ,�
' 37. Final;Factory Fireplace: � F-:, a• � i �= � L j � �� .', � � »' " ` - " . . ' �
38. Final �Plumbing� f � ( � � o; � =, � ' i. � � � i '- � ; - :. � -, � . -
39. Water°Service-Final ; I ,'�� i � I j' I � , ' ' ,- '
� I � �� � 1 � �
40. Gas Seryice-Fina� � � ! I � � � � , � i � ' � � �
,i � i
41. Solar4DomesticFinal' ' � i fl _ _ _ ___ � � _ _ ' _____ _� ' . . �
' '-- -F -� - : �--�.
42. Backflow Bieventei , � � � �mi- _�- � _� ,� -! -� - I - - -'. . -
�
.r-, , 9� �� F-I. I C}��- r''T f,_ u c � �-� I'�- �
43. Backflow Irri ation - � � �
��� _ i
44. Landsc-�ape Irrigation SYstem� � a'' � � � � � ,. i � ; , i � � ' ' _ '
� u.� �-,� -' � � �. �� I � i � �:..- ; I� � . .
45. Sound; Attenuation; ��^ �,t j I � I� I �''I ' � I i i'�! � '� i'
46. Handicap Regulationsl �� � j `� �< : � t'� I ��j �!
� 47. FINA'L STRUGTURE & BUILDINGi � •,, ; ��, �: �� i ; � � i ' ` '
48. Specisl Requirements�Completed '� � � �� � : � : � j � : � r '. h ' � � - ..
49. Elec[iiclRelease to Edison ' , �. _ _ ' � � ' � _ _ � _ � _ _ � , _ __ ' . � ' ,
n � i � f - ;-' � T -''- - '�^ � 1
� ; - � r �. � i . � ' i � - .. � ,
50. Gas Release to Southern California Gas Co � i � I � � , � � p�.." � � ,� . �
51. CERTIFICATE OF OCCUPANCY �' ' ' ' ' ' '' ' �
I� � � � � i �- - - , -, - �
� No ' � �Date ' � � � �{ ' . �
� - - --`..., - - - - -�^---.1. �- � - � I -� - - * � - .�! _
, " . Applicant lo fili In all spaces except those within heavy bortler Ilnes ana sign a11 aoora0��ate tleclarations. .
CI7Y OP COSTA�MESA � � PERMIT NO. TRACT NO. LOT NO. • BLDG. . � _ . . . . _ . . _ _
CONSTRUCTION FERMIT
• PrOject Address � r0
Applicant's Mailing Address /I 90/ w.Es7n�ws?�t.r �f,roe;v�
' Owner's Name SFG,E,�f?iPoH ahone
(�/� : Address _ - �
�,J ArrhlEn"g. , License No.
tl.. .
`1J Address ' �� �(�����
, Contractor's Nam�h� �^�e� F�cf phone��21
� Address (mailingr/9G� iN'%THp/.✓S7.L.f y�/� l'�l/D/CN �GI/2
1 City License No, U 3 O y E/
� IItENSED CONTRACTOR DECLARATION
\ I hGreby d1fl�m Lhat I am lic¢nsetl untle� provi5ion5 01 Charter 9(commencin9
w��h sectlon 7000) of Division 3 ot lhe Business antl Pro(essions Cotle, antl
my pcense is in full force antl effect.
LJcense Class — LI<e se No.
Da[e9'� �'f�N� Signature
h'ORKERS' COMPENSATIO LARATI00 �
! ihere�y aftirm tbat I have a c¢r itica[e oi consent to salLinsure or a certificate
. ,i Workers' Compensation Insurance, or-�a certlfletl cooY thereot (Sectlon.
38p0, Lab. C.) '
vouev Na..vA47oSaNY coma,,,v ('u.�h v.�.ro.v
�Cartitio� copy is hereby fumisM1etl. �
Certitietl copy is fileiJ with the city Bui tlin9 D ision.�
Date v—��� �� Applicant -
EXEMGTION FROM WORKERS',CO SATIO CLARATION
(Thissec[ion neetl not be completetl if the permit is for one huntlretl ($300) ar �
less). ' ' � � t
I cetUty�that in [he pertormance of th0 wo�k tor which th15 perm�t is issu¢tl I
snall mt employ any person in any manner so'as to become subject to t�e
WUrkurs' Compen5ation Lawz ot Calitornia. � '
. Da(e $ignature
. NqTICE: 11, atter making this tleclaration, you shoultl become subject to Ihe
'�'Orkcrs' Compensatlon provisions ot [he Lnbor Cotle; you must forthwith
' comply with Such O�ovi5ion5 or this permlt; shall be tleernetl revOketl,
' �QNSTRVCTION�LENDING,AGENCV. '.�
I hereby atfirm that t�ere is a tonsVuction lentling agency for the perlormance
• of the work for which this Oermit ,is issuetlr(SecHon 309] Civ. �CJ ,
Lxntler's Name� �
Lantlor's Atltlresr
OWNER BUILDER DECLARATION , ' � • ~' '
I hereby af(irm that I am ezempt fiom the Contracror's LlcenSe Law for th¢
followin9 reason (Section �031.5'Business antl Professlonal Cotle: Any tlty or
county wbich requires a permit to construcq alter irnprove, Cemolish or repair
' any structure, prior [a its issuance, also requlres t�e applicant for such Oermit
�to til¢ a,slgnetl Statement that he/she is IiC¢nsetl putsuant t0'the provi5ions of
the Cont�atto�'S License Ldw (ChaDt¢r 9 RommenClne wtth Sectton ]000) o(
/031.5 by any applicant for a permlbsubjects-tbe apPlicant to a<ivil
��nalty of�not more than five huntlretl tlollars (g500J.' . �
I, as, owner of the' pmperly or my employeez wlth wages as their sole
tompensation, will tlo the work, ana tne structure is not intentletl or oHeretl
fo� SdI¢ ($¢ctiOn 7044, B�Sfness antl PrOfesSiondl Cotle: The Contlactof'S
��cense Ldw tlOeS not appty to an owner ot a prop¢rty who builGs or impmves
thereOn, antl who tloes such wo�k him5¢If/he�self or through his o��h¢r Owp
eR�ploy ees, proviCetl that sucn improvements are not intentletl or otteretl'for
sale. N, Itowev¢r, th¢ builtling or Improvemen[ is soltl within onC year of com-
P�eHon, the owner will'have'the burtlen of proving he/sM1e Oltl not builtl or im-
�rova for the�purpose of sale).
I, as owne� of the propCrty, am exclusivoly Cont�acting witb lic¢nsetl COn-
trectoR t0 construct tne projec[ (Seciion 7044, Buslbe55 antl Prote55lon5 Code:
.Th¢ ContraCtor's LJcenSe Law tl0¢s not aOPly_to an owner of prop¢riy wh0
bpiltls or Improves thereon,�antl who contracts for suth projects with a con-
tra[tof(5)IicenSe pur5uant to the Gontlactor's LiCenSe liw).
Q I am exempt untler Sectian . g. & P. c. ior this reason �
Date � ' Owner. '
� hereby certi(y tnat I have reatl this aoP�ication antl state that the atiove
��tormation is correc[: I a9�ee to complY with all city antl county ordinances
ana state laws relating to builaing conztructlon, antl hereby authorize repre- .
santalives o( tnls' ciry to enter upon the above-mentionetl pmperty for
inspectlon p rpos
.S�gnature � oa��,y�-1'r3
TYPE OF CONSTRUCTION L..I NEW LI ADD_ LI.ALTERATION- L� REPliIR.,. —
❑ CONVERSION ❑ OEMOLISH ❑ OTHER � � A p # �
DESCRIPTIONOFWORK TiS FL.�CT �
' � S Main Building:
E
TYPEOFPERMIT GRADING FOUNDATION STRUC7VRAL T FIOnt .
❑ TENANT �� ELECTRICAL ❑ PLUMBING ❑ MECHANICAL .' B Rear
GO OTHER � %r
PROJECT DESCRIPTION 5q. FT. oCCUPArvCv' C Fight
K Left
CONSTRUCTIONTVPE VqLUATION$ $
ZONE GRADING CU. VDS. qCRES p�ng. Ref. #
Remarks: � a 6 Parking Req./Provided
' � � UseofBuiltling:
PLUMBING � FEFc Planning Notes: .
Ber Sink
Backflow Preventer
Batkflow lirigation
Bathtubs
Clarifiers .
Dishwasher
Drinking Fountains
Floor Drains�
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories : .
P=Trap,
' Showen
� Service Sink,
Sewer Cap
Sewer Conneition
Solar Collectors
�� Solar Piping , -
� Solar Tank • '
Swimming Ppol w/Spa
- � Urinal � �
Outlets Water Closet �
Water Heater '
Water Service
. t
� � . ' .. . ' . . . i
Reinspection.Fee $25.
BOiler
ou�c- u�a�. c�o��d
Duct-Ventilating '
Ekhaust Sys[em ❑ Mul[iple �'
FirepVFacL BIL IC80.# �
Heating System & Ducting '
❑0-100,000 BTU 0100,000 BTI
Qrivers' nse o 55 ' I' I ReinspeRian Fee ,
CMP 0865-46 iev. 7/83 � White - 6ulltling; Canary - Appliwnt; Pink - Accountln9; Goltlenrotl - Assessor. .�
$25
' laue Fee _ 1
Hood or Typel ❑ . .
Canopy Typell ❑ '
Refrigeration System
❑0-700,000 BTU ❑100,000 BTL
System Repair/Alteretiori • -
i
Issue Fee
m
Automatic Washer
Construction PoleSub.
Cooking Unit , .
Dishwasher � `
Dryers ❑Gas ❑Electric
Fan ' �
F.A.U.
Fixtures �
. n
Device Boxes • - �
Outlets •
� a
Switches �
I
Garbage Disposal �
Generator �0.5 KW �5-15
' 5707
zo�a
� . ' 'Accessory
Park.Fees $• ,
0
ELECTRICAL ' �
' �Transformer ❑ 15-50 KW
�50+KW
- Mater ❑up to t00amps .
� Meter over 100 amps 600
3 Sub Panel �
Moiors QP 7 HP C] 1 S4 - 8
Inc.Solar 09-75 HP �16-15+
i t% � Microwave •
�D Pole Light
L �% : I Aange � .
Standing Sections �
Tresh Compactor
$.3 'i : '3 C! C�
Reinspection Fee $Z5 Issue Fee
FEES
PUBLIC SERVICES REQUIREMENTS:
2oning Approved By
.Application Approved By
.Appliption Iuued By-
S 3
0
� 3 3
�
1 '
Z
O
N
1
N
G
R
E
Q
U
I
R
E
M
E
• ' � . SUMMARV OF FEES ' . '
. BUILDING�PEFiM1T � $ �SMIP • $
PLAN CHECK § ' PERMIT
PLUMBING $ �ISSUANCE � $ ,
PIAN CHECK � �$ ENERGV P.C. 5
ELECTtiICAL $ �tij�i� GRADWG $ '
PLAN CHECK � $ .Zy �MICFOFI�M • $ � �
MECHANICAL S TOTAL PEE $ �_�
PIAN CHECK ' $ ' ' � � _�_
T�
CONSTRUCTION AND PLA�NN,„IN,�,G�� •
� APPROVALS �Permit#L�!-�
1. Temporary Electrical Service or Pole,
2. Soil Pipe-Undrgrnd. . .
3. Elettrical Conduit�Utility-Undrgrnd.
4. Electrical Conduit Undrgrnd.
5. Steel Reinforcement,
6. .Electrical UFER Grnii. '
7. Footings � , ' �
8.<Foundation �
9. Water Pipe�Undrgrncl. .
10. Structural Floor System .
11. Property Sewer Line & House Connection
12. Sewer Cap . � .
13..Roof Drains ,�, � 1
,
14: Rough Plumbing��, - �
15. Rough Electrical-Conduit -
16. Rough Electric Wiring �
17. Rough Wiring Sign •
18. Rough Electrical-T Bar Ceiling
19'. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. DuCts, in Structure .�
22. Ducts, Ventilating � .
23. Gas P.ipe-Rough & Test � . �
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. lathing & Siding
29. Insulation
30. Drywall Nailing -
31. Plaster Brown Coat .
32. Electrical Power Meter-Final
33. Final Electric
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 pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. �landscape.lrrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING.
48. SpOcial Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
I� 57. CERTIFICATEOFOCCUPANCY
No, Date "
�� � POO. _SPA '
Date� Inspector qppROVALS Permit�
. 52. Pool & Equipment Location
� . 53. Steel Reinforcement
' 54. Forms � .
_ 55. Electrical Bonding
56. Rough Plumbing & Pressure Test �
. 57. APPROVALTOCOVER�GUNITE
� - 58. Electrical Conduit-Undrgrnd. �
59. Gas Pipe, O�Undrgrnd., Test
, � 60. BackwasH Lines, P-Trap, O Undrgrnd.
67. APPROVAL TO DECK
r
62. Backwash & Receptor-Final
� 63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final -
- 66. Solar System-Final
�N 67. Fencing & Access Approval
68. APPROVED FOR PLASTERING�
�� 69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
, APPROVqLS � Permit #
70. Underground Hydro
71. ProductPipingOGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMEIVT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
f
e
J
Date � Inspector �
_ . ADYliunt to till in all spacaf eaceD< <�osa wN�in
CITY OF C TA MESA �
CONSTRUCTION PERMIT
Applicant's Mailing Addrea �
ProjettAddrea 3345 HR.f6a�C �✓lrF+✓AY Sov7N s�/o/ �
' Owner's Name C� T -t��'�S1Xefi Phone
aAddrea
� Arch/En9. , License No.
� Address
�A,, Contrector i Nem���OGCT Ct.✓O/T/G.UG/! (`A php�q �-J i�
' � Addresslmailingll�y��ED 64rn3% �NA/1F/.-,
License No: �S�OJ.
I� UCENSED CONTRACTON OECLARATION
1-nereby affirm that I am Ilcensetl untler provislans of Charter 9(commenUng
. wlth sectlon 7000) oi Dlvislon 3 of the Buslness antl Professlons Cotla, anC �
Ty IICBni! is In 1u11 force dnE'B}Tett ; �y '
LJcensa Class ' � llcan No. ��.rJ O,"'
Data �•� �� Signature .
WORKERS' COMPENSATION DECLARATION '
�ereCy afflrm that I have a certlflfate of consant to selNniure or a certlfirate.
Workers' Compansatlon Insurance, or a certifieE topy thareof (Section
Ia800, Ldb. C.) � I •
voncv t�ou/Pf3 /YO�/iS . companv�f�°/✓T �n/A[+7n.✓iiY '.
LJ Certlilea copy Is heraby Turnishea. i
JIQ Cartj(IeE ryo�� 81etl wlth the cItY.BWITin9 D�Islon. �
tM1e Perfolmance of the
,TI N DECLARATION
nit z tor one hunEretl (5300) or �
1or�whi<h thli perm�t is �Issuetl I
so,as to become subject to t�e �
NOTICE: If,-a/ter makin9 this tleclaration, you shoul0 become SUDject to the '
Workers'� ComOe�sxtlon provislons oi the Labor CoOe, you musLforthwith,
comply,with suth provislons or this„permit �shall be �tleame0. ravoke0. '
CONSTRUCTION LENDING-AGENCV• � � •�
I hareby aftirm that there Is a conitruttlon lentling a9ency tor.the�performanca '
oi tne work for . whlchc�tJ95� permit Js •Isiuetl �(Sectian 30BZ Civ. CJ,
l.enGePs; Name A�L�N _
Lantler'S Atltlrass -
OWNERBUILOER DECLARATION-- ' ' �
I hereEy.affirm that I am exemp[ from the Contractor's Licenza I..aw Tor Ihe
following reason (Sectlon 7031:5 8usine55 antl Profasslonal Cotle: Any city or, ;
grove ror�ne puroose
LJ I. as owner of the
lJ I.am exempl
Date '
to tne•
permn suo�ec[s [ne appucan[ [o a avn •
1reC tlollars ($500). ` � -- ; � �
or'my am0�oyee5 with wagez,as thelr sole �
m0 the.itructure iz not IntentleC or oTferetl
� antl' Proteuianal GoOe:' The, Contractor's
owner of a praperty w1�a bullds Or ImprOveS ;
k himself/herselt or through �I5 or her own
provements are'not Intentlea or offeretl for :
mprovament Is soltl wlthin one year of <om-
urAen of proving ha/she GIG not DuiIG or Im-
„e„�i��a„ai,.����.a�u�o�wun�u�a�inncnn- i
Jcense Law tloas not apD�Y to an owner of praperty wno
Ihereon, antl who contracts for suth projec[s with a con-
irsuant to lhe Contractor's License L.aw): � '
tlar Sactlon � B. & P. C. f0� th15 rea5on ;
— Owner •
hat-I'�are reaE�this�ap0licatbn anG•stata that the above �
act. I agree to comply wi[� all city anA county ortlinances
itlng to bulltling constru<tlon, ane hereby authoriza repre- ,
.clty to enter upon the abova-mentlone0 proDerty for
�^ / . �
u. / /-Y.�.-� • Data ��3 �
orivers' ucense or i�'� �� �� '
CMF 0865-46 rev. 12/82 White - Builtling; Canary - ApPlirant;
anG sl9n all aDo�ooriate Oeclarotions.
O. B�O�
NC� bV /�P I I � �
TYPEOFCONSTRUCTION NEW ADD ALTERATION � REVAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESGRIPTION OF WORK h%�% s�� 4'�O/7/c:��GXS Y- �iLLtr ^
t[ � .✓G
TVPE OF PERMIT GRADING FOUNDATIO�pN - STRUGTURAL .
❑ TENANT ❑ ELECTRICAL ❑ VLUMBING Id MECHANICAL
O, �OTHER
PRQIECT DESCRIPTION SQ. FT. OCCUPANGV_
bONSTRUCTION TYPE VALUATION $
ZON� � GRA�INGCU.VOS. ACRES_
Remarks: . � � ,
Bar Si�k
Backflow Preventer �
Backflow Irrigatian
Bathtubs • ��- '
Clarifiers �
Dishwasher I ,;
Drinking Fountains •
Floor Drains, '� '
Floor Sinks '
Ga's Service' ' ' Ou'
Interceptors
Kitchen Sink - ' �
Lavatories � �-
P-Trnn �
✓aers '.
�ice Sink � � ' '
:r �
[-UnAer.Ground 1
' Duct : Ventilating, '
Exhaust System ❑ M1
: Firepl/Fact.Blt.IC80
� Heating System & Duc
. ❑P700,000 BTU �1
' Hood or Type I C
; I Registers
GolOenrotl - Assessor
Solar Collectors �
Solar Piping � � '
Solar Tank
Wacer pout
-Water Heater�
�Water�Service .. �
�
Reinspec[ion fee .
," � : laue Fee �.�
PLNG. REF. sR�
LEFTSIDE VAfiD
PKG.SPACE REQ.
STREET WIDTH
, ' Construction Pote
'. Cooking Unit
. ,'� Dishwdsher
� , Dryers ❑Gas• �Electric
� i ,. Fan' � ' � i
' �i F.A.U. . ' .
Fixtures
, Device Boxes � �
Outlet5 � � �
, Switches ' .
Gerbaae Disaosal
$15
$ 3
, mnye�auw� oYs�mn .
a�oo,000sru ❑�oo,000aru a —
System Repair/Alteration � '
o-- �
_ _ . .' � I
Reinspection Fee �
Issua Fee •
$15
S3
= 4966 8/31/83 - 21oUu i,
, �� •
zONE
' BUILDING •
CCTGAI`Y /`/1 CT
REAR VARD (TO P/L) .
RIGHTSIDE VAHD •
, PROVIDED , ' � ,.
� PARK FEE $ - ;
; v
C4IRIVNL
�Meter ❑over IOO.emps �
Sub PaneL ' � .
Sub Pole' � ' '
Motors ❑0-1 HP ❑7X$
,InaSolar,�9-15HP 016-15+ '
'Microwave ' - '
Pole Light � �
Range.. y _
Sign', �
StandingSections ' •
Trash Compactor . ;
I.
Generator �0�5 KW �5-15 KW �, � � �
i
Transformer ❑75-50 KW � I i '
, � �5U+KW Reinapection Fee $j5�
Meter ❑up to 100'amps � I ;laue Fee' ''$ 3
2oning APVroYed BY � � Date
� . � �
ApPliption Appraved BY -n ��ate ' . :
Application Isiued By ^ � � �. . � � Date �/-?��� "3
• � i . � SUMMARV OF FEES � � � �
�
�BUILDING PERMIT $ � SMIP � i � $ ! �
: �
PLAN CHECK� � $ � PERMIT • •
,PLUMBING . $ ' ISSUANCE' � $ � � �
PLAN CHECK � $ r � GRADING I ,$ I ,
ELECTRICAL . $ � � t • $ ' ,
PLAN CHECK� r $ � ; MICROFILM $ '
MECHANICAL � $ �S► ; TOTAL�FEE.' � $ ' ' �
� � �
,PLAN CHECK . $ --�— , ADVANCED PC . $ r � {
, � i . � . ' � : FINAL FEE ; � $ . �� r
r
�
i
� CONSTRUCI`ION AND PL'AN I G a �.' � - '"� ' �' ?' �OL ,PA ; _ - � . � .
-- . . , . . .. . > . . . .
,}�iqppROVALS Permit�#�_��. �.Date 2 --lnspector APPROVALS --� Permit•#�= ' Vi Date �nsPector
��� �i f (. '1 � _ _ � _
'r 1; Temporary Electnical Service or;Pole . �� � c � � ' ' � ,52d Pool &:`Equipment Location . .=,
t� - �. ^� .. � � - . I -.
- _ �._ ^' _ " " _ : "
} 2: ,Soil Pipe-Undrgrnd. . F _�., i i , � :° - �,53c- Steel Reinforcement��� . ,� ". - , , . ' �
: - _ s
.�3' Electrical Conduit Utilitv-Undr rnd - s � ^ . ' � � � :54r' �Forms , � , _ , `.' - ' ` . • " i � ^t
9 � w Y
� •� 4: Elect,ical Conduit-Undegrnd� `�� � . _ - � e � � - 55 : Electricel Bonding ' ` F„���- � � � � ..
r.
b7 Steel �Reinforcement i ,� � , m � ; 'i� j ' _ ' " , 56.. Rough Plurribing & PressuFe',Test � � '
6. �Electrical UFER Grnd.: � -' '= � � ' ` � 57.� APPROVAL'_TO COVER-GUNITE
��
7. Footings , i � • �� �; o� , �I ` � ;, - ' �' : ' ' -�58� `Electrical CpnduiY=Undromd. - � ' � '' �
8. Foundation _ � , �, � � ' � � � � _ , ' 59. Gas�Pipe, O Undrgrnd , Test - .: , • „ "
I
9. Weter Pipe-Undrgrnd. ,. - _ � �'.60. Backwash Lines; P-Trap,�O�Undrgmd.`� �
�
10. Structural Floor $ystem ;°� - � � � � ['� l` ' :.67. APPROV!\L"_T,0 DECK °- '- " ' , � �
11. Property Sewer Line &'Hous 4Connection. . -- ' , ' 62. Backwash & Receptor-Final- . � ' '
�
12. Sewer Cap , � � - � � � B3. Heater & Vent-Final � -
i I � ' '
13. fioof�Drains , � •� , . _ ` , ' _ ; �gq. Plumbing,System - Fina1- - - . . - -
�
74. Rough Plumbing' �' � ; �: ' � � � - � �� 65. Electrical-Final- �- � - �' = -
�'15. Rough'E�ectrica�=Conduit-�'� �--� '" �'", f ', -'� ' '-' 66.� Sola� System-Firial-� -^ -�-i '-�--' - �� - � � �
i i
�-16.;Rouh.ElecfricWirin �;� � -"�-'--�_''- �_-.--; ' �- -" � . ' - -- --� - -
• 9 9, �� � - ; � �� _ - � � ��67. Fencing & AccesS�APProval . ��r � - . .
'17. �Rough Wiring'Signw � rt � � N P+';» � I- = I' 1-! '68., APPROVED F�OR PLASlERING , � �
= 18. (ftough Electrical-T;Bat Geili�g'� ,� I , i -., i ' ' ' '.' ' ; ,69., POOVSPA SYSTEMS FINAL - � ,
C .. .
- ��, 79.'Rough�Heating & Air�Conditioning �� I�G-� � FIRE DEPT. REQUIREMENT_ . _
� 20. �Rough.Factory Fireplace; I ' ;'; � ; � i , , � ; AppROVALS' � Permit # � '� i t .
<
_'� 21. �Ducts �in Struc[ure:� ' � � '' i � � �70 ; Undergrounil Hydro ' �
� t 1 1' il�� �� .. i
n�;�22.�Ducts;�Vent_ilating; - ; ��� ! ! � i ' �71.IProductPiping�Gas �Oil � �
- � . �:: P 9 � I � -. t� ? j � -- ' . � ;72. Underground Flush'. . . �� . .._ .__• .
z 23. Gas Pi e-Rou h& Test : .
< - , , , . . . , _ _ . .
� 24. Roof Framing� ,� � . ;;� � �� o• � � � `'' I �� i ;,� ' -;' I; ,73.� Unde�grnd. Storage Tank O Gas ❑ Oil , � �
; ,, 25. �Roof Sheatfiing � ; � � - i, i o � � � ' � -- 74.� Overhead Hydro � ' , �
�, 26. T-Bar Ceiling (Structural) & Monocoat i � � . I . x - ' �� � �' ,75., Dry ChOmical - � '
, � � � - i
`+'.27. Frame and Flashing = ; i � !I � � � ' � � ' � 76. Dry Standpipe � ' - , � � , � .
`;� 28. �L'`athing & Siding� � � i i � �. � i j � � � � 77. FIXED $YSTEM'FINAL .
_ ° 29. Jdsulation . � rt " a � ' 1, ; � 1 I I '` i I i ,78�• FIRE PREV. FINAL � � . ' ' '. �
�' 30. �Drywall Nailing , � � j j (� �; I � � � I i ' �Notes:� ' . . • � . .
r � ,31. ;Plaster Brown Coat ; � � i - � - � �- . --� - - � -��� � . . , ' - �- . -' ' . - - -
� , 1 � � � { � I i � � - - - ' i � i
' _ � ' , � ' i ,1 � � • � � . - . . - � � - ,
L 32..Electrical Power Meter-Final � � , � � ' • � ' �
' - i � i � � � ' � . � � .
' 33._Final Electric � ! � � , i � � . � .r � ' •
: r- 1.. .
' 34. Final Meating &�Air Conditioni�g � �Q � ��i . , , � ' ;. i
, � . , , r . ,- ,. ;. � _ � . .
35. Final �ias Pipe=Tos4' �- • .. , ' � - ' , c � �_ � -� - ' � - - -
N Q
36. Hood or CanopV=„ � I � .. � ;' � � � : I . � � , � , , � ,r - ; . -. . _ -,
I_ �T -I r.1 i{! �� � �I . .
37. Final �actory Fi'replace= . ' � ;• ( � � I � , ' ' � i j _ ' . . � .; . ' ' ''7 � . x
38. Final Plumbing � � � � � ,�� � � ' ; � � � � ; i 1 � y �- - „ - .. � -
u u
39. Water^Se�vice-Final' � ' � .•� ,� I � i � � ) i � i � , � , . �� ' �
40. Gas Serv�ce-Final � � � ! ! I I i � � ' � - , , .
�
41. Solar pomesticFinal , �, � '� 1 _, � .. � _ ' ' _ _ ' ' : , . � ' , � +�� ,,,, ,
42. Backflo6v Preventer ..- � � i � , Y' Y� � � � _ _ � � ; � ' - � �
43. Backflow; lrrigation �_ � I � , t � � � � - �'� � - - � .. � . i ., � I ! . `.
.
44. LandscaPe Irrigation=SYstem i � :,i;: - � � t ' ' .` �.� � . . , �. - 1 . . : � . _ - . - - ,,..
' � , E- i - , : . i - , . � � - � _ . � .. . -
45. Sound� Attenua'tion � �'" � ` � 'i � � ~ I = i � � ='' - � ' ' .
46. HandicaP�Reguletions' � . � I �i (` i � �' I �� � � I j ... �� � . . . c•'� � �� :� : '. .i
47. FINAL $TRUCTURE & BUILDING �i � ` � � �- � -'; , � � � ; � � `-� � � � .
i . . � . �
48. Special Requirements Completed � � ' � ' I � , � ` ' � ' � � - . � .�
i � � i i � � I � !
�� � � � _ , � ; �
1 49. Eiectric Release�to �Edison� ' � ..L.�_ �. _ _ .. _ .__ -. _T_; _� _- �. : . ' - � . �
�
, 50. Gas Release to Southem California Gas Co � j i � � � � I � � � ,. ,„ ' i�. � �
�
IFICATEOF;OGCUPANCY ' ____- ,_� ; ' �--r _----_•�.''� '� . ' '
� � , • „
� Date � '� � � ' i � � � � i �
+ -;, -.-.�- :�. -�- -
�_./ �____ i- _ _ -e —"ADI
, �Ch�Y OF COSTA MESA
' COF,r:S,TRUCTION PERMIT . (Z a, D ('p ,
+ Project Address ?°�5 1"� Ai' PDR C.�li� W A,' $O[i �7'�
AppliwnYs Mailing Address 3��5 FA �R V 1 EH/ �. L: NI �
Owner'sName �+ • �F�S��M a���hone�•o��
Address ��� ,�A'��VI�.UI�' M.
Arch/Eng. MR�! HI"��A.l�i N 1_ _ License No. L�2411
Add�ess a%�' �CJfJ � �o��NT£`�, 0 2ftNGE ZI �
Contractor's Nam �U � �N Phone�i5���
Addreulmailing) �SQ� M�LH�L�ON)I/ZJ��,i{,'
�o � �=T-,' 022 q 3A
City �LicPnse No.
UCENSED CONTRACTOR DECLARATION . ' �
I hereDy affirm that I am Iicensetl unaer provislons of Charter 9(commencing
with sectlon 7000) of �Ivision 3 of Iha Businesz an0 Professlons Cotle, antl �
my license is in fuil force a effect. �F
License Clazs �' � ✓� • �•icen 6 �
�ate �� 3� Si9nature
WORKERS' COMPENSATION DECIARATION �
1 he�eby atfirm [hat I have a Ce�tlficate of con5¢nt to S¢It-Inw�e o� a CB�tlficaf¢
of Workers' Compensatlon 'Insurance, or a certl(latl <opy thereof (Settion
3800, Lab. C.) � ,
Policy No. ��47��9.% comPa�y �N�s'r2lA-IUOFMN1iY '
�Certifietl copy is nereby fumishetl. '
Certifietl copy' /f'�letl with lhe city B ng i 5i�✓fA
Oate ;�3d�7 Applicant ��'�S
EXEMPTION FROM WORKERS'.COMPENSATION OECLAR ON -
(Thizsection neetl not be completeU 11 the parmit is for one hunEratl �E100) or
less): ' • ' �
I certiry Ihat in the Oertormdnce Ot [he work for which thi5 permR is ISSuetl I
shalP not employ any person in any manner so as to become subj¢ct to [�e '
Woikers' ComOe�sxtion laws of Califomia.. ,
Date Signature i
NOTICE: If; after making thi5 tleclaration, you snoultl become sub�e<t to the -
Workers' COmpensation provisions of lhe ldbo� Cotle; you mu5t torthwith
comDly wlth such vrovlslons•or this oermit shall be'tleemetl revoketl. �
CONSTRUCTION LENDING AGENCV' '
I hereby atfirm [hat there is a conztructlon I¢nUing agency for the pertormance
Of the work 'for wNch ihi per it Is i uatl (SeeHon- 3097 Civ. 'C.) �
L.enEer's Name G�r1�� � ��TF '
�enders .aaares� 6fl 'l1NTDN WO. .57�77n-� Ce' evANlfs�
f9
OWNER BUILDER DECLARATION ' ' '
I hereby afBrm that I am exempt from the Contractor'S LlcenSe Law (or Ih¢
following reason (Section 7031.5'Buslnass antl Professlonal Cotle: Any clty or
county whV<h requires a permit to constru<t, alter, improve, tlemolish or rapalr
any scructur¢, prior to its issuance, also requires the apPlicant for su<h parmit
to (ile a signetl statement lhat he/she is Iltensetl pursuant to'[he provisions of
�[he Contractor's License Law (Chapter 9(commencing wltn Secllon 7000) of '
Divisiom 3 of tne Business antl Professlons Cotla) or that he/she Is exempt t
•theretrom antl Ihe ba5i5 for the allegetl exemptlon. Any violation.of Sectlon
]031.5 by' any applicant tor a permi[ subjects tha,-applicant to a tivll
�enalty o( not more tnan flva huntlretl tlollars (E500�. '
I, as Owner of tM1e property or my Bmployee5 with wages as thair zole
compensa[ibn, will tlo tha work, antl the stiucture is not intentletl or offeretl
for sale (Section ,7044, Business and Professional Cotle: The Gontractor's
License Law tloes not appry to an owner of a property who builtls or improves �
the�eon,� antl who Ooes such work him5elf/ne�5elf o� tivough hi5 or M1er own
employees, provitletl that such improvements are not intentletl or offeretl tor
sale. If, howaver, ine builtling or improvement is soltl wlthin onn year of com-
pletion, tne owner wlll hav¢ the bu�tlen Of proving he/she tlitl not bulltl o� Im-
��ove fo� the pu/pose of sale).' i
I, a5 owner of tne property, am ezCluSively contrac[ing with Iicensetl <On-
tractors to construct fhe project 15ecNon 7044, Business antl Protessions Cotle:
The Contractor•s License Law does not apply to an owner of proper[y who
builtls o� Imp�oves theroon„antl who cont�acts for such p�ojects wlth a con•
tractor(s) Iicense pursuant to the Contractor's License Law).
❑ I am exempt untler Section B. & P. C. tor this reason
Date
Drivers' License <
CMF OB65-46 rev:
. Owner _
have reatl th
fill In all s
-i���ii'��
borGer Iines antl sign all aOP�opriale tleela�ationz.
TYPE OF CONSTRUCTION LI NEW L� ADD ,r .wLTERATION IJ REPAIR
❑ CONVERSION ❑ �EMOLISH ❑ OTHER
DESCRIPTIONOFWORK 'T�N'�wi'r �MPLDVEM'��'�:T
TV,PpE� OF PERMIT LJ GRADiNG
IG-TENANT �ELECTRICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT.—
CONSTRUCTION TVPE ��ry VALUATION 5
GRADING CU. VDS- = AC
J FOUNDATION IZiSTRUCTURAI.
PLUMBING �INECHANICAL .
Sink
<flow Preventer
<flow Irrigation
1tU65
ifiers .
rviasher", ' '� "
ikiny Fountains
)f �f21f15
9
Service Sink
Sewer Cap1 ..,'.
$2W¢f COn02CtiOn
Solar Collectors. �
Solar Pipin9�
Solar Tank� _
FIOor Sinks : � U�inal
Gas Service � Outlats Water Closet
Interceptors ' Water Heater �
Kitchen Sink� � Wa[er Service �
Lavatortes � � �. , . - � ,
Roof Drains
� Reinspection Fee
i '
' ' �
' $25� .
Duct - Under Ground
Duct - Structural
Duct - Ventila[ing
Exhaus[ System ❑ Multiple
Firepl/Fact. Blt. ICBO�#
Heating System & Ducting
❑ ai oo,000 eru O i oo,000
� � I I Flainspec[ion Fee I $25,
White - Builtling; Canary - Appllcanq Pink - Accounting; Goltlenrotl - Assessor
pa
1
FE
` 1 "' _
Issue Feo ' $ 3
Hood or� Typel ❑
Canopy Typelf ❑
Refrigera[ion System
❑0-700,000 BTU ❑100,000 BTU
System Repair/Alteretion _
IsSue Fee
0
a.v.;w y/S -LJX/ - :
S Main Building:
E
T Front
A Rear
C Right
S Left �
Ping. Ref. # .
Parking Req./Provided
Use of Building: c (JC�O
Planning Notes: ' r�/7:
Auromatic Washer
ConstruccionPoleSub. '
Cooking Uni[ ,
Dishwasher �
Dryers ❑Gas ❑Electric
Fan ' �
F.A.0 �
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �65 KW
5� 15
7736 3/30/84 ' .IB5.81 TL
Zone �
Acceuory Building: Z
O
N
I
N
G
R
E
Park.Fees $ � - � �
— u
. ' , �
R
E
a ' m
- E
N
ELECTRICAL
❑ 75-50 KW
❑ 50+'KW
' ' �Meter LJup to'100'amps -' �
� ;Meter ❑over100amps �
Sub Panel
, MotorsO0.1HPO1X-�8 �
'Inc.Solar �9-15 HP �i6-15+
�� Microwave
Pole Light
Range
Standing Sections
Trash Comoactor
FEES
Reinspection Fee 525 Issue Fee $ 3
FEES
PUBLIC SERVICES REQUI�2EMEQJ�� , o, �/
Zoning Approved By `���w� Date.l(i�(Y�
Application Approved By � Date �
Appliration laued By Date
� S MI�IARV O EES , ' � �'�-/
BUILDING PERMIT � SMIP • $ �
PLAN CHECK �� � � 7S PERMIT �
PLUMBWG $ ' ISSUANCE $
• PLAN CHECK $ � ENERGY P.C. $
� ELECTRICAL $ - GRADING $
PLAN CHECK � $ MICROFILM $ p
MECHANICAL $ TOTAL FEE $ ��s o �
$ 3 PLAN CHECK $
• CONSTRUCTION AND PLANNING �� -- POOL & arA
t APPROVALS� Permit# Date Inspector qppROVALS �Permit# Date Inspector
.1.� Temporary Electrical Service or Pole. 52. Pool & Equipment Location
:�
�' 2. Soil Pipe-Undrgmd. � - �" . 53. Steel Reinforcement '
i,.
..3. Electrical Conduit Utility-Undrgrnd; � �- �- -^ � - � � 54. Forms . �`i�
4. Electrical Conduit-Undrgrnd.-� ,' ' �_� - � � � 55. Elgcfrical Bonding - � %�
5. $teel Reinforcement' -�• : 56. R6u�h Plumbing & Pressure Test . �?�'
6. 'Electrical'UFER Grnd.,_ , 57. AgFROVAL TO COVER-GUNITE
7. Footings � � : .� •i ' � 58. Electrical Conduit�Undrgrnd. ' �
.S, Foundation . ' � � : = -• ' .. 59. Ga's;pipe, O Undrgmd., Test 'r
9�.' Water Pipe-Undrgrnd. �`�� �' - 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System; '- �=� �'r ' 61. APRROVAL TO DECK -
17.� Property Sewer Line�&�House Connection : - - 62. Backyvash & Receptor-Final "
12. Sewer�Cap - � - _ ' 63. Heater & Vent-Final � '!•�
13.: Roof Drains - � � ' - `� 64. Plumbing System'- Final ''��
- i i..
14.� Rough Plumbing . � - � 65. �Electrical•Final -. • �
15. Rough Electriral-Conduit • � � - � ' "- "66. Solar System-FinaP - �
i 6. Rough Electric Wiring -- � " 67. Fencing & Access Approval .. �"
17: Rough Wiring Sign � • � - 68. APPROVED FOR PLASTERING
�'18. Rough Electrical-T,Bar Ceiling • 69. POOUSPA SYSTEMS FINAL
19. Rough Heating &'Air. Conditioning . FIRE DEPT. REQUIREMENT
1
20. Rough Facmry Fireplace � � � . � ;APPROVALS Permit# �
2'� Ducts, in Siruciure ' � 70. Underground Hydro
�
22�'Ducts, Ventilating c. . � 71�. Product Piping 0 Gas ❑ Oil
23`Gas Pipe-Rough & Test ,. , 72. Underground Flush
24. Roof�;Framing '; ; � �„ . . ' 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing ,�� �. � " 74. Overhead Hyd�o ' .
26. T-Bar'•Ceiling (Structural) & Monocoat �_� /�/$r %yJ 75. Dry Chemical
��
27. Frame and��Ftashing ��!nQ�'^'a"� 5, ��F.�c_ (3� 76. Dry Standpipe
28. Lathi'ng €i�Siding , � 77. FIXED SYSTEM FINAL
29. Insulation - 78. FIRE PREV. FINAL
30. Drywall Nailing � ro�p�( �� � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Co.et��• ' � , 79. FINAL INSPECTION
32. Electrical Power fyleter-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 pomestic-Final � _ . .
42. Backflow-Preventer � , '
43. Backflow Irrigation � ' � � '
44. Landscape Irrigation System . � .
45. Sound Attenuation i _
-46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING � y' B�� .
48. Special Requirements Completed '
49. Electric Release to Edison ' , ' � � � - � �
50. Gas Release to Southem Califomia Gas Co - � , �
51. CERTIFICATE.OF OCCUPANCY' � ' . � .
No. Date .
�1
AVP���ant to fill In all spaces e%cept those wit�in heavy Gortlet Iines antl si9n all app�op�late tlecla�ationz.
CITY OF COSTA MESA - ,
�OIWS'PRUCTION PERMIT
. Prolect Address N/ OL/
Applicant'sMailin/g��Address ��y�/��%�r[Lr� ST �IV✓f//F/�
Owner'sName Ey �� --s�''aS]�aY'�1� ' phone
Addrets' . . FM u � ��( .
Arch/Eng., License No.
Address
Contractar's Name.��/��7T �'�,/O/r/on//.t/F phane ' B' �
Address (mailing) [[ �O ��% (�C/FI S% /TYI.:�%fF/Lr']
CityLicenseNo. ����77
LICENSEDCONTRACTOR qECLARATION �
I'hereby-aifirm tha[ I am licensetl untler provi5ion5 of Charter 9(commencln9
wlth seCtiOn ]000) ot DlvisiOn 3 of Ihe Busine55 antl Professlons COtle, antl •
my Iicense is in tW I t`,�orce and effect. 2(SaVZ
License Class� � �i�ensa No.
Date �7 5'9 t --
WORKERS'COMPENSATION DECLARATI N .
I hereoy aftirm Mat I have a certifiwce of conzent to salHnsure or a cartlfiwte
of Workers' Compensation Inzumnca, or a certifiatl copY thereof (Sectlon
9800, Lab. C. �
Policy Nof.V Yy/4o49T Gompany F�E/�ld�T
�Cer[ifiea copy is �ereby turnisM1etl. .
CerUfietl copy is filetl with the city F�/y�n9 O)'v/"sio .
Date j-30—XS%� Aoplicant�i�(2(/��L(_ �---� '
EXEMPTION FROM WORKERS' COMPENSATION OEC ARATION
(ThiS section neetl not be [omp�etetl if lhe permit I5 for One huntlrltl (y300) or
less�.
1 certiry t�at in the per(ormahce of lha work �or:wnlcn this perm�t is iszuetl I
- shall noi em0�oy any perzon in any manner so as to become suGject to t�e �
Workers' Compensation Laws of Califomia. • �
Dato Si9nature
NOTICE: If, after making this tlecla�aNOn, you shoultl becortle subjett lo lhB �
Workers'.Compensation'provisions of the'Labor Cotle,-you'mus[ tortnwith''
comply wlth suc� provisioqs or� this permlt shall be tleemetl revoketl. '
CONSTRVCTION.LENDING AGENCV ' '
I bereby affirm that there is a Construction lentlin9 agency for the performance
oi t�e work for which t j� p¢rmit is issuetl (SecHon 309] Civ. C.p
LRntler's Name !n
Lentler's Atltlress �— '
OWNER BUILDER DECLARqT10N . ' �
I heroby affirm that I am exempt from the Contractor's License L.aw for tho
followinq reason�(Section �031.5 Buslness antl Professlonal Cotle: Any city or
county which requires a permit to construct, alter, Improve, tlamolish or re0air
.any structure, Orlor to its issuance. also reauires the aoolicant for sucn oe•mit
permrt suo�ects cna apo�lcan[ ro a
(ive hOntlretl tlollars IS500).
�':LJ I, as. owner oT the property or my employees with wages as thelr sole
�compCnSation, will tlo the wo�k, antl the st�uctu�e is not IntenAetl oY offe�etl
for sale' (5ection 7044, Buii�¢ss antl Protessional Cotle: The Contrac[or's
License Law tloes not apply tp an.owner of a property who builtls or improves
thereon, antl who tloes such work himself/herSeH or throu9h his or her Own
employees, provitletl that such improvemen[s are not in[entlea or offeretl for
sale. If however, the Guiltling or improvement is soltl wlthin one year ot com-
pletio�, the owner will have the burtlen Of prOvin9 he/Sh¢ tlitl n0[ Duiltl o� im-
�rove forthe purpose of 5ale).
I, as owner of the property, am exclusively contrac[ing wlth Iicensetl con-
trattorsto consVuct the projett (Section ]064, Business antl Professions Cotln:
The Contracior's Licansa LaW does nOl dpply to an Owner of property wh0
builtls or improves thereon a�tl who contracts for such projects with a con- :
tractor(s) Iicense pursuant to the Confractor's License Law). �
❑ I am exempt untler Section 8. & P. C. (or lhls reason
Date Owner
I �er¢by rertiry Ihat I have reatl Ihiz application anC state that the above
intormation is mrrecL I agrea [o mmply with all dty"antl county ortlinancei
antl state laws relating to bui�tling construcNon, antl hereby aut�oNze repre-
Sentatives of�this <ily to e�ter upOn the above-Tentlonetl p�ope�ty fOr
inspectlon pur / ,
S�gnature LC' pate�
Drivers' Licenze or 55 $
_. .._ __. _. .--_ — _-
�i�a�a�
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ , A.P.# '
DESCRIPTION OF WORK
� . S Main Building: '
E
TVPE OF PERMIT GRAOING FOUNDATIO�-/N STRUCTURAL � T Ffo�t
'❑ TENANT ❑ ELECTRICAL ❑ P�UMBING dSJ MECHANICAL B Rear
❑ OTHER A
C Right
PROJECT DESCRIPTION Sq. FT. oCCUVAivCV K
CONSTRUCTION TVGE VALUATION $ g Left
20NE GRADING CU.VDS. � ACRES p(ng. Ref, #
Remarks: �O s/ Parking Req./Provided
� . Use of euilding:
: � '� � PLUMBING � - � FEES Planning Notes:
Sink Showers "
kflow Preventer Service Sink
kflow Irrigation Sewer Cap -
nubs ' . Sewer Connection
�ifiers • Solar'Collectors
� Dishwdsher ' . " Solar Piping
Orinking Fountains Solar Tank
Floor Drains.' -� . Swimming Pool w/Spa
. Floor Sinks
' Gas Service .Outlets �
Interceptors
. Kitchen Sink � �
Lavatories � - �
P—Trap
Reinspection Fee, -� $25
Boiler �
Duct - Under Ground
Duct-Strucmrol '
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.Blt.IC90�k .
Heating System & Ducting
❑4100,000 BTU �100,000
Reinspection Fee I $ZS
CMF 0865-46 rev. 7/g3 Whi�e - Bulltlin9: Canary - Appliwnt; Pink - Accoun[in9: Goltlenrotl - Azsessor
Water Closet
Water Heater �
Water Service - -
. ! � � �
Issue Fea
�ANICAL
Hood or Typel ❑
Canopy Typell' ❑
Refrigeration System
�10-]OO,OOOBTU ❑100,000
System Repair/Alteration
laua Fee
Automatic Washer
Construction Pole Su6.
Cookin9 Uni[ -
D(shwasher
Fan
- F.A.U. ` � �
Fixtures
Device eoxes
Outlets i
Switches
Garbage Disposal
Generaror 065 KW OS75
, �
� 8022 4/05/��
Zone
Accessory Building:
Park. Fees $
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Meter ❑up to 100 amps "
Meter ❑over 100amps
n
Sub Panel • � �
Motors �0-i HP O1 %� 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light �
Standing Sections
Trash Compactor
�a.zA ;T
_ Z
O �
N -I
I
N
G
R
E
O
U •
I
R
E
M
E
N
T
♦ S .
FEE$
$� �
Reinspeaion fee $25 �aue Fea �� $ 3 �
FEES
PUBLICSERVICESREQUIREMENTS: , � .
Zoning APProved BY nate
Appliwtion Approved By �ate
Applimtion I�sued By Dat�
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK � � $ PERMIT
PLUMBING $ � ISSUANCE $
PLAN CHECK $ ENERGV P.C. $
@LECTRICA� $ GRADING $ _
P�,qN CHECK . $ �_ MICROFILM $ �
MECHANICAL $ 0� TOTAL FEE $ � /Z'
$ 3 P�AN CHECK $ / � �
� r
' CONSTRUCTION AND PLANNING .' ' - � � POOI. A� .
. APPROVALS Permit # Date �Inspector_ AppROVALS Permit # Date Inspector
' 1.. Temporary Electrical Service or Pole � � 52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. - � 53. Steel:Reinfo[cement ''
� 3.IElectrical Conduit Utility-Undrgmd. � 54. Forms;
4. Electrical,Conduit-Undrgrnd. ' � 55. Electrical Bonding ,
5. Steel Reinforcement � � � - �� � �� - - . 56. Rough Plumbing &�Pressure Test
6. Electrical UFER Grnd. -� 57,. APPROV'AL-TO'COVER-GUNITE
7. Footings , �. _ - 58. Electrical Co,duit�Undrgmd. �
8. F,oundation �. � 59.. Gas Pip O�-Undrgrnd., Test -
9. Water Pipe-Undrgrnd. � - _ 60. Backwash Lines, P-Trap, O Undrgmd.
10. StNctural Floor System � , 61. APPROVAL TO�DECK
i t. Property Sewer Line & House Connection _• ° 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final �
13. Roof Drains 64. Plum6ing�System - Final ,
14, flough 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 PCASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL �
19. Rough Heating & Air Conditioning � [{ ��/ (�� FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace � . APPROVALS Permit #
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test �.� 72. Underground Flush -
24. Roof Framing -� _. 73. Undergrnd.StoregeTank OGas ❑OiP
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 Condi[ioning Yla1�� (��� . .
35. Final Gas Pipe-Test - . • � � - � . .
36. Hood or Canopy � ' ' � ' ' , • .
37. Final Factory Fireplace . � �
38. Final Plumbing ,
39. Water Service-Final • ' '
40. Gas Service-Final � ' . �
47. Solar pomestic-Final � � . ,
42. Backflow Preventer , � � � �
43. Backflow Irrigation . � - � , . '
44. ,Landscape Irrigation Sysfem � - -
45. Sound Attenuation � ' ' . '
46. Handicap Regulations � � - .
47. FINAL STRUCTURE & BUILDING , . ,
48. Special Requirements Completed � � . . , -
t
49. Electrie Release to Edison . , - - �� ' -• .
50. Gas Release to Southern California Gas Co � • •
51. CERTIFICATE OF OCCUPANCY _ . �� '
No. � Date - � �
ApPllcant to fill in
CITV�OF COSTA MESA
: CONSTRUCTION PERMIT A G
�Projeti lYddress
Applicant'sMnilingAddreu, ���/G/ (.v�SS7i�i�STN_i4 G � !r•
Owner's Name . _� � S S �� � � S7'Rc.w�,one �
P,ddreu
Amh/Eng. License No. '
Address ' �
Cantractor'sNam TA'% �TO/fiL��oN f(,/2[rphone �
Addreu;Imailingl��QG/ -L✓�i7'.�r/.r.S/�.LiP �AO/EN�
City License No. O�O� E'i 9
CICENSED CONTRACTOR DECLARATION �
I hereby atfirm that I am IlcenseU untler provislons ol Cnarter 9(commencin9
wlth section 7000) ot DlviSion 3 of the BuSinass ana �rofesslons Cotle, xntl .
my Iicensa is in full /orce antl affect.
Llcenie Class' — � License N ��..,�69t�
Oa[eF�'�Y� $i9nature
WORKERS'COMPENSHTION�LARATIp
I her¢Dy.attirm thdt I �dve a cer i(I<dfe of cong`¢nt l0 selftinsure or a certlficate
t Work¢rs' CompensaHon Insurance, or a certifietl copy thereot (Sectlon
800, lab. Ca '
volicy rvo. /�/lO�Y'� Company�l/�T�� IvNt%
�Certifietl cooY Is hereby furnishetl.
Certifietl copy IS fllep wltn lne Nty Builtll p�DiviSion� �
Date� — 7 — �`� APOlicant
EXEMPTION�FROM WORKERS�CO PENSATIO CLARATION
(Tnis section neetl not be comple[etl� t th¢ parrn�t 1 or one huntlratl (5300) or
less).
1 certlfy�that In tbe parfOrTance of the work }o� whlch th15 p¢rm�t is issuetl, I
shall not omploy any person In any manner so as to become subject to the
Workers', Compensation Lawi ot CaIHorNa. ,
Date $i9ndture
NOTICE: If,iaftet makipg t�is decla�aUOn, You ihoultl blCOme suD�ect lo the
Work¢rs' CompensatiOn provl5iont 01 t�a WbOr Cotln, you musl torthwith
comply with zuch provisions or this Oermit shall ba tleem¢tl revokeG.
CONSTRUCTION LENDING AGENCV
I neraby aHirm tnal there is a wnstructlan Ientlin9 a9ency /or tne pertormance
ot tho work for wnich this permil is �bsueU (Sectlon 309] Clv. CJ
LanCer's Name -
�
Lentler'S Atldresi
OWNER BVILDER DECLARATION
1 heraby a711rm thdt I am e%ompt Irom tho Conttactor's LlcenSe Law fOr the
fotlowing reason (Sectlon 7031.5 Builnass any piofe55ional Cotle: Any city or
�munly w�lch reqWres a Da�mlt to construtt, elter, ITprove, tlemollih or repair
any structura, prlor to Its Issuance, also roqulres tha applitant for su<n Dermil
to file a 5lgnetl statement that hn/sne Is Ilcen¢gtl pursuant to tne provisions of
the Contractor's Ucanse Law (ChaO�er 9(commencing wllh Section 7000) o(
OIVISiOn 3 0l Ih9 BUSIn055 antl P�OfO5510ns Cotle) or that h8/Sh8 75 Bzempt
�erafrom antl the Dasls ior tho allogetl exerription. Any violatlon o/ Sectlon
)31.5 by any appllCdnl for a parmit subjects tha appliwnt to a civll
enalty ot not mora than tive huntlreG tloilars (5500).
d 1, as ownur of Ihe property or my omp�oyaes with wa9as as their sole
compensaUon will Oo the work, antl tha.itructuro Is not intentletl ar offereE
tor sale (Secflon 7044, Busineii antl Profeisional Cotle: The Con[raclor's
Llcensa Law Coos noc apply to an owner of a property who bulltl5 or improves
thBreOn, anU wha tloe5 Suth wOrk hlmsell/hB�sel/ or throu9h hi5 Or h¢t own
amploy eas, proviaea tnat such Impravaments are not Intenaetl or offeree for
salo. If, howaver, the Dulltling or improvameqt is soltl wit�in one year ot com-
pletlon, lhe owner will have Ihe Durtlan ot proving ho/ihe tlitl not builtl or Im-
�ove for the purpose ot saleJ. � •
LJ I, as owner ol the proparty, am excluslva�y conlractln9.with Iirensetl con-
tractars tb construct tha projec[ ($BCSIO� ]044� BUSI�855 d�C PrOt¢551005 COtlB:
The Contractor's Licansa Law doos nOt app�y {O an owner of property who
Eulltls or improves thereon, antl who conlraCts tor such pro7ects witn a con-
tra<tor(s�license pursuantto the Contractor's Llcense lawl.
❑ I am exempt untler Soctlon B. & P. C. (or [hls reason
Date
axTept tnosa wlt�ln �eavy Do�Ce� Ilnes anE sign all aOV�op�Iate EQclara�ionf.
TRACT NO. LOT NO. . BLD . .
TVPE OFCONSTRUCTION LJ NEW ES.lADD LJ ALTERATION. LJ REPA�R
O��CONVERSION ❑ DEMOLIS�-I�O/OTHF��
DESCRIPTION OF WORK �if.�7`e lt'
TYPE OF VERMIT LI GRADING LJ FOUNDATION LJ STRUCTURAL
❑�TENANT �'ELECTRICAL ❑ PLUMBING ❑ MEGHANICAL �
❑ �OTHER , ' -
PROJECT DESCRIPTION 5�. FT. - � oCCUPANCv_
CONSTRUCTION TVPE VALUATION S
ZONE � � GRADINGCU.VDS. ACRES—
Remarks: , . � / 3 /1 �i � '
Bar Sink
Backflow Preventer
Beckflow Irrigation
Floor Drains
FloorSinks .
Gas Service Outlets
InterceptOrs
Kitchen Sink ' '
Lavetories �
P—Trap
Roof Drain¢
ShoWeri
Servite Sink
SewerCap
Sewer Connection'
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal �
Wacer Closet -
Warer Hearer
WarerService
Rainspoction Fae I $25 � � Issue Fee I 5 3
Boiler '
Duct - Under GrOund
Duct - Svuctural
Duct � Ventilating
Exhaust SVstem ❑ Multiple ❑
Firepl/Fect. Blt. ICBO 5W
Heating System & Ducting
❑0.100,OOOBTU 0700,OOOBT
InSPectlon P�T a � f �'��
Slgnature � �_ /H Date 7—
Driver5%Llpense or 55 ��? - _ Reinspec[ion Fee
CMFO865-46 rev.12/83 W�ite-Builtling;Cgnary-ApVliwnt;Pink-Accounting;Goltlenrotl-Assessor
$25
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System .
�aioo,aooaTu ❑ioo,000er
System Repair/Alteration �
laue Fee
3
A.P. �
S Main Buildi
E
T Front
B Reer' -
A
C Right
S' Left
Ping. Fief. dp
Parking Req./Pi�
Use ot Building:
Plenning Notes:
Y
Automatic Washer
Construction Pole S
Cooking Unit
Dishwasher
Dryers �Gas ❑E
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KN
lectric
I 2one
Accessory Building:
Park.Fees $ . .
- . .� .. . . _ .
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter �up l0 100 amps �
Meter �over 100amps
Sub Panel pG /fM�
Motors �0.1 HP 01 h- 8
Inc.Solar �9-75 HP �16�15+
� � Miuowave
Pole Light
Fange
, Stending Sections
5-15 KW Trash Compactor
FEES
� Reinspection Fee � I$y5 I �stue Fee I $ 3 I
PUBLIC SERVICES REQUIqEMENTS:
Zo�ing Approved By �ate
Buildine APP�oved•By Data
Applintion laued By � Date � '
SUMMARV OF FEES
, BUILDINGPERMIT '$ SMIP $
, PLAN CHECK $ � PERMIT ,
PLUMBING $ ISSUANCE $ ,
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ c� i � GRADING $
PLAN CHECK 50°,6 '$ � �..3 MICROFILM $
MECHANICAL $ TOTAL FEE $ �o,ya
PLAN CHECK 25% $ _ . _ .. .. . . .
O
N
1
N
G
R
E
U
I
R
E
M
E
T L.
� COYJSTRUCTION�AND PLANNING ' � - POOL, A _ -
' APPROVALS Permi4# - ' Date Inspector qppROVALS Permit# Date Inspectoi
'� 1: l�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�. .' , 55f- 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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK -
11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final ..
12. Sewer Cap � - 63. Heater & Ven[-Final
13. Roof Drains 64. Plumbing System - Final �
14. Rough Plumbing _ ' � 65. Electrical-Final
15. Rough Electrical-Conduit �-� � � S G�. 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 , N �69. POOUSPA SYSTEMS FINAL . .
19. Rough�Heating & Air Conditioning FIRE DEPT. REQUIREMENT�
20. Rough Factory Fireplace . APPROVALS Permit # ,
21. Ducts, in Structure , 70. Undergraund Hydro
22. Ducts, Ventilating - ' 71. Product Piping O Gas ❑ Oil �
23. Gas Pipe-Rough & Test ' 72. Underground Flush �
24. Roof%Framing � , 73.� Undergrnd. Storage Tank O Gas ❑ Oil ,
25. Roof Sheathing .� . � 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme 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..E�ectrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED
33. Final Electric • y� 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 pomestio-Final � � � -
42. Backflow Preventer. � �
43. Backflow Irrigation � .
i
44. .Landscape Irrigation System � . � '
45. Sound Attenuation � �
46. Handicap'Regulations �
47. FINALSTRUCTURE&BUILDING '
48. Special Requirements Completed�, . '
49. Electric Retease to Edison i � � � '
50. Gas Release to Southern California Gas Co , '
51. CERTIFICATEOFOCCUPANCY• '
. �
No. Date '
�
��
PflOJECTRU0flES5: 3SAS HARBOR GATEWAY S uNiT: 103 CITY OF COSTA MESA — BUILDZNG PERMIT PERM NO: M 06603`_
OWNEfl'SNPME: C.J SERGERSTROM ' ' • •� �
nooaess: CSMS HARBOz�zETEWAY #i G � , PERMIT NO: M 066035 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: Z—FR PERMIT TYP6: MEC PURPOSE: ALT
AflCH/ENGINEEX:
nonxess:
flEG.NO.:
uxiT:
PEHMITTEE: BLAKE AIR COND, 6 SERV, (714)630-6412
FOOPESS: S1iS N. OSPREY CIRCLE
ANAHEIM CA..92807
LICENSEo CONTBACiOB OECIABATION: I here�y allirm tlWt I am litet5etl unaer o�ov6wns of CAaD�er 9lcommencing vnln Section
7IXI0� ot Uivision 3 0l Ine Busine55 anE Pmteuions COOe. anE rtry licet6! is in iW Iwce an0 eflKt.
cmuc.: 02 026 srnTeuc.:396109 cuss: r-20
t'� /' �
Ua�e'. _o�- �� Si9natu�e: �� ��—l.��x
WOPNEBS' COMPENSRTION oECIAMTION: I hereey aflirm ihat I tiave a cenilicate ol consent m sel4insure or a cenificate of warkers'
Comoensation Inwrance, or a certiliea copy �nereol (Stttian 3800. laG. C).
roucrxo.: PWC242269-00 E%P.ORTE: O%/OSI94
comrnr+v: GOLDEN EAGLE
� CenilieJ tOpY is �eqby WmiS�eG. � CeM1ifieU mpy is liled vdlh Ihe ciry Building OiJtsion.
['/�,/ `�� i� � .�
Da�e'. ��7�— MDlicant Q
E%EMPTION FflOM WOPNEXS' fAMPEN5ATI0N UECLRMTION: (iNs secuon neetl not Oe completeE i� the perm� ¢ for one AunAreU (5700) or less�.
1 cerlily ��al in Ihe pe�brman[e al t�e work IOr whic� I�is permit is it5ue0. I 5hail not employ any Derson in any manner so as �o b¢come
subject lo Ihe Workers' Compensalion Laws oi Caiibmia.
�a1e' SignaWre:
NOTILE: II. afier making Ihis tletlaration, yrou shoul0 Oecome suCle�� �o t�e WOMers' Compensation provisions ot t�a La�or
Code. yau must IonAwit� compry wit� suc� pmvisions or Itus perrtut shall he OeemeO revaked.
CONSTPUCTION LENOING �GENCY: I her¢Gy atlirm tlw� lhere a a canslruction IenOing agency �or the pedormance ot I�e work lOr
whic� Ihis Oermil is i55u¢tl ($ectian 3097. Gv. C�.
LENOEfl:
AOONESS:
OWNEB BUILDEB OECUFA710N: 1 hereW allirm ttut I am e.empt imm tAe Comactars' SWte License Law lor I�e Idlowin0 rcamn
(Sec�ion 70J7.5 Busineu an0 Pmiesvonal COAe: My uty al counry wNU repuires a pemtit to construc6 atter, impmve, tlemolis4 or
reDair any stmcture. odor to i6 iuuance. also �rouire5 tne aDo��nt lor wcn perrtYt ta file a Siqnee statement tlui ne/sna is IicenseA
pursuan� io ��e pmvisions at ��e Camractors' Slaie License Law (Clupier 9(mmmencinq wii� Seclion 7000) al �ivision 3 0l ��e Business
ane Pmlessions Coee� or iAai �e/s�e is exempi iherelmm anG i�e Easis tor t�e aOeqM exemptron. My violatian ol Section 7031.5 Uy
any apD�icani for a pCrmii wCl���s IM aODliqni Io a Gvd penalry ol irol mOR ltun live IwMreE GdlarS (5500).
ro
1, as owner of tlle D�aveny ar rtry em loyea rnlh wapes d5 ineir Sole compen5ation, will Oo Ina wOrk, an0 ine
❑ s�mcmre is not intenaM or al7erea lor sale I�tron 70ad. Business anU Prolexional CoGe: T�e fAmraciors' Slate Littnse Law
Goes nol aDVN �o an Ovmer ol a proptny wro OuilOs w im0�we5 t�ereon, and wM tices SWi w0A Nmutl/herself or tllmuph
�6 ar �er own employtts, pmviGM tlat wch improvemenis are nol intenGeG or oHereO far sale. II, Iwwever IM OuilOinp or
� impmvemenl is SWG wit�m one year 01 rAm0leli W, I�! owner vrill Mv¢ I�e Durtlen o� provinp �e/S�e AiU no� UUild ar improve
�nr ��e vurpote ol Sale�.
I, as awner at t�e pmpeny. am eycWsively contractin0 �N IicenseE canlracmrs Io canswcl l�e pwjtti (Seciion 76ad, Business
❑ an0 Pmlession5 CoEe: The Comracmrs' Slate Liceirsa Law Uces m� a00N �o an ownei ol propeM � �wl0.s or improves tnereon
ana wno contratls lor sucn prqttts witn a coniracior(g liceme vursuam m tne Comnctwi State Laenu Law�. I am aware
Ilui p�o01 01 I�eir Workei 5 fAmp¢n5ation inSuranCC SMub he WmdOeC IO me.
� I am exem0� untler $tttian: 8. 8 P. C.
lar I�iS �eason:
Date: Ovmer.
I do �ei¢Ey c¢nily Inal I am aware al an0 un0er51anG I�e repuirements o� California Heal�h antl Sahry CoGe Setiion5 25505, 25533, antl
25534 an0l�at I or any �uiure Ouiltling aCupan� vnlVwill noi (GrUe one� n¢eG lo compy wit� saitl siate w0es antl ��e repuirem¢ni5 �or a
permn lor conslmtlion or mOGilita�ion Iwm ��e Air uahly Managemenl Orstrict. Fesitl¢ntial canslmciion apDlications are exempl �mm
these pmvisions.
pale: pDP�icanl:
I here�y certity inat I have reaU Ihis a001ication an0 slate ihal l�e a0ove information is correcL I agree to compty wirtl all city ana county
ortlinances anA Slaie laws relaling lo �uilEmp [onslmction an0 �ereGy aullwrae r¢presen�alives of Ihis ciry Io enter upon ihe above�mentione0
prope^rty fo�r ins'De��ion p(u�rposes. / /�
�ate:Q4�L�( � SigreWre� � �` l�p^"'
orive�'s License or Sociai Secunty x:
I6aLafi W�ite—BwWmg; Green—CoOe Enla¢ement; Canery—Applrant: Pink—Revenue; GokenroE—Assesaor
JOB DESCRIPTZON ; MECHANICAL FIXTURES
SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: B-2 /
COMMENTS; ONLY MECAHNICAL WORK
rarir�ririrrrx-�r�tit�tr�r*+r�rjt�r*er+F�rir**ftr�t+t*+e�x-�-��tmtit�tet�t�t�rir�-�tit�*�t***�tirater+t�r*arit*ir*+tit-�tit�tit�tx�x+t+t*it�r
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILPING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING RE • PROV: PARCEL; 41049101 ZNE: REF NO;
PLANNING N TES>
, >
����**,������*��,�*,«�«��,«���**���*��,«��«�**�*�*�,�*����*����*��******�*����������***
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
'fi��NtfiE� p��+t��+ti+��a �Y e ' nare:
"BUILPING APPAOVEP PY : • DATE:
APPLICATION ISSUED BY; DATE; �L ��l
�iFifiEifffifiElFikiEiEifflifiFKkiffFiEifif . ikiEiEfkjfafafiEitiF'£iF3F �YiF
if k if iF fE if iF it ik iE M iE iF if iE if if iF if iElE 1E if if if %if iE if if iE if it it iF if 1F 1f iE if if ik iE k iE if it ik 1F iE iE �E �E if if it if if 1F iF jE 3f iE if iE iE if i! 1f iF 1ElE iE %iE iF iF if iF
LEGALI2rT'ffON:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/RES GRADING
PERMIT 49.50
, 25t SMZP/NON—RES
PLAN � "
ISSUE FEE ' 15.00
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 49.50 15.00 -� 0.00 64.50 64.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 64.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
64.50
i! it k 1ElE if 7f !f 1E k ff iElE 1f M k k?F i! iE M iF iE it iE k iE 1f fE 1ElE it k if if it k 1E 1f iF iF if if !! ik it ik if 1E 1f it ff ff ff !f iE 1f if it it k if 1Elf 1E it'lE iF if if if ik k i! i! iE i! if iF
I N D Z V I D U A L ; F E E B R E A K D O W N
l
TYPE QTY D E S C R I P T I O N` `' UNIT COST TOTAL COST
/
MEC 5 REPAIR/ALT COOLING UNIT/SYS W/CNTLS 9.00 45,00
MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4.50 4,SOH
END. OF FEES
�' .
�J1 QO1S5's35-00155335 TO T 54.50
DATE: 02/14/94 TItIE: 09:27
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Daxe Inspector APpROVALS Permit# Date Inspector
1. TemDorary Electrical Service or Poie 52. Pool & Equipment Location
2. Soil PiOe�Undrgrnd. _ � 53. Sceel Reinforcement
3. Electrical Conduit Utiliry�Undrgmd. ` 54. Forms
4. Electrical Co�duit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure 7est
6. Electrical UFER Grnd. 57. APPROVA� TO COVER�GUNITE
7. fo�d�gs 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd.. Test
9. V�ater PiPe•Und�grnd. _ 60. Backwash Lines, P�Trap, � Undrgrnd.
� 10. Structural Floor SYstem 61. APPROVAL TO DECK
17. Property Sewer .Line & House 6onnection 62. Backwash & Recep[ar�Final
72. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing System � Final
74. Rough Plumbing � � 65. Electrical-Final
15. Rough Electrical�Condu�t 66. Solar SVstem-Final
1S. Rough Eleciric Wiring 67. Fencing & Access ApProval
t;•. Fiough Wising Sign 68. APPROVED FOR PLASTEflfNG
,
78. fiough Electrical�T Bar Ceiling 69. POOLlSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ,_ ��j.p� ��L FIRE DEPT, REQUIREMENT
_:� _
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Siructure 70. Underground HYdro
22. DuctS, Ventilating 77. Product Piping C1Gas OOiI
23. Gas PiPe-Rough & Ten 72. Underground Flush
24. Roof Framing 73. Undergrnd. Stora9e Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ce�ling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Ftashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailin9 . HEALTH DEPT. REQUIREMENT
31. Piaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter�F�nal 80. FOOD CERTIFICA7E ISSUED
33. Finat Electric Notes:
34. Final Heatin & Air Conditionin + q_ �
9 9 � 4. �, z�r� -�-: ��-.��,- ,.��:�=. ,, .r_
35. Final Gas Pi e-Test
p �/t�� �D 3�SQYi�S7p%+t:�r�_� pJ•C.r' _"�'.i,
36. Hood or Canopy
3�- � fi- �y��_C � - -
37. Final Factory Fireplace �
38. Final P�umbing
39. Water Service-Final
40. Gaz Service-Finai
41. Soiar pomesticPinal -
42, Backfiow Preventer •"?
43. Backflow Irrigation '
44. Landscape Irrigation System
45. Sound Atrenuation �
46. Hand��aP Re9ulations
47. FINAL STRUCTURE & BUILOING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Retease to Southern Calffornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
0
Pfl0.1FLTADOHESS: 3SQS HARBOR GATEWAY S
.�OWNEfl'SNFME: C,J SERGERSTROM
nooeess: 3555 HARHOR GATEWAY k G
C.M. 92626
FflCNIENGINEEfl:
aoosess:
xEG.NO.:
UNIT:
���
uxrt:
venmirree: HLAKE AIR COND, S SERV. ( 714 ) 630-6412
noosess: 1175 N. OSPAEY CIRCLE
ANAHEIM CA 92807
LILENSEU CONTHPCTOfl OECIABATION: I nereDy allirm Inai I am IicenSeG under provision5 ai C�apter 9(commencinp with Seciion
7000� of Division J oti�e Business anG Pmlessions CaGe. an y hcen m IM force anE efiect.
ciTr 026026 sT^TEuc.:396109 cuss: �-20
Oaie: _ 7— y—�j�— SipnaWre: —�
E85' COMPENSRTION UECtABRTION: I nereby atiirm tna� 1 have a ceniticare of consem ro sell-insure or a cenilicata ot Workers'
Compensalion Insurance. or a cenilietl Copy thereaf (�ciqn 3800. Lab. C).
voucvNo.: PWC292269-00 E%P.ORTE: O7/OLI99
comanxr: GOLDEN EAGLE
❑ ea caOY is hereey IurnisAeU. � Cendiea covY �s lil witA t '
. e� , � � ~ l AODlican�:
E%EMPtIONFPOMWOflNEHS'COMPFNSATIONOECIAflATION: (ih¢seclionn¢ediwib
Icenily Natinihe Oedormance aitne workforw�ic�tNs permitis rssued,ls � n�
su0iect �o �he Workers' ComDensation Laws o� Calilomia.
oate: SignaNre:
NOtILE: II, alier making inis aeclaration. y0u shoul0 betome suEiect to �n
Coae. you must lort�wil� comply wit� Such D�avrsi0ns or iNs permii Shall E
CONSTflUCTION LENOING PGENCY: 1 hereGy aflirm IMI Ihere is a ConSinntian
I w�ich ��is Oermit is i55u¢tl (Stttion 3097. Gv. C�.
LENUEN: �+
ADUPESS: 1
Oivision.
�ot
CITY OF COSTA MESA — BUILDING PERMZT PERM NO: E 065957
PERMIT NO: E 065957 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE; I—FR PERMIT TYPE: ELE PURPOSE: ALT
JOB DESCRIPTION : ELECTRICAL OUTLET
SQ FT:
CLAIM VALUE; CALC—VALUE; GROUP OCC; B-2 /
L (�C: C7�i�l L 'p/ /
COMMENTS : ONLY M£�L WORK ��, �. Cj S lf�j- l�
��t�r��r�e��r*-��r**��r*+r�rxx�r*�r�r�r�r**x*�r�r+r�t�r �r�rx�r+r�t+r�r�r��r+r+r*�r��e�r***x�r+e�*�r�+r�+r�r-�r���t�r+rx+rir**
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDZNG ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 41049101 ZNE: REF NO;
PLANNING N6'I'ES>
>
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ING APPRO��ED BY DATE:
I ING APPROVED BY : DATE:
APPL CATION ISSIIED BY: DATE:
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G ZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
OWNEBBWLUEPOECU8R710N: I�ereGyatfirmllullameKemptimmt�e o a��'S1�te�ichh%�awl ason BLDG PMT PLUMBING ELECTRIC MECHANIC FZRE SMIP/RES GRADING
ISec�ion 1071.5 Bu4ness anU Pmiesvowl CoAe: My dty ol counTy wNc� re0 re oeumt m , , imDrwe, aemoiisn, ar p ERM I T $, 2 S
rzpai� any simcmre. priar io i¢ issuance. aLto repWtts tne applicant for such p � . �pnetl statemem that �Nshe is licensea S 0 S
pursuanl �o me Dmv¢ians al me Comracmrs State License Law ICnao�e� 9(�mmencinp witn Section 7UW) ot Oivision 3 0l t�e Business SM I P/ NON — R E S
anC Pmlessions Coee) or that �e/sne is e�emD� ��emlmm an0 i�e Gasis lar ��e allepeG eeemptian. My Molation ol Section 7031.5 Gy PLAN
any a00�icanl lor a pBrmit SUDl��S I�e applkani lo � riuil pEnalry ot mi rtrorz ltun Irve hunO�eA Odla�t (5500�. I S S U E F E E 1 S, 0 0
i, as owner o� me ompeny o� my emVmyees min wapes as ineir wle wmDensation, win ao ine waa. ane ine BUZLDING—DIV—> PERMIT ZSSUE PLAN—CHECK TOTAL PAID DUE
❑ svucwie is nat imenaea o� offere0 br sale (Section 70aa, Business anA Pmlessional COAe: 7�e Coniracmrs' State License Law TOTAL S---- > 8. 2 S 1 S. � 0 �. 0 0 2 3. 2 5 2 3. 2 5 , 0 �
Uoes no� apOM �o an owner ol a pmperty wM DuilUs ar imprwes t�ereon, an0 who Eoes such xod �imsell/hersell or t�rouph
1¢s ar ne� own employees. Dro�� ��� suc� improuemenB are �ro� mtentletl o� oBereG for sale. II, Mwever tAe huiltlinp or
�� Ior�meeou�rooseoi�saejninoneyearalcomD�eiian,ineownerwinnavetne0urtlenolo�ovino��/sneaitl�oiouaeorimorove REVENOBLDG��PMT�PLUMBZNG ELECTRIC�MECHANDIC FIRE3�SMIP�/TOT/SGRADING PLAN-CHECK
I, as awner ol I�e pmpetlY. am eeUutivel9 wntractinp wim rcensea contractors to consimct tne pmiect (Section 7oaa, Business 2 3. 2 5
❑ and Pmlessions CoOe: IDa Coniractori State License Law aces nat aoeN �a an ovmer of Drooerry wlw �wlEs or Impmves t�emon
antl w�o comratls br suc� pml��s wit� a conirattoqs) Ikense pursuan� Io ��e Contractors' Stata License Law�. I am aware
t�ai piool of ��eir Worker's Compensation inwrance SMWd Ge OrmiAeA to me.
� I am eeempt unGer Settion: B. d P. C.
lor I�is r¢ason:
Oa�a Pxnec
I �o �ereOV �eniiy ihat I am aware ol an0 unaerslanC itle reQuiremenls ol Calilamia Healih antl Safety CoOe Seclions 25505, 25539, and
2559� antl t�al I or any IWure OuilUing occupant vnlVwill noi (circle ane) neeC to compty with Said state cOtles an0lhe aquiremenis lor a
ne�mi� lor con5lmc�ion or motliliulion Imm I�e Air uah�y Management Oistrict. HesiGential constmction appliwtions are eeempt Imm
ihese provisians.
Daie: Applicant:
I here�y certify I�al I �aw rea0 INS appli[aiian antl Slate Ilul l�e above iniormaiion is mrretl I agree �o [omO�Y wii� all ciry anA Coun�y
or�inances and slate laws reW�ing Ia �uil0inq con5lmtlion an0 �ere0'aulMrrsp.�ep25enfaiive5 0� ��is city to en�er Upon �he a0ove�m8nli0ne0
br insDec�ion purposes. � N
Da�e' �' U 1� S9naiure: A ;
Lirense or Social Securi�v r:
t6a��46 W�i�e—BmlOi�g: Green—COEe Eniwcement; Canary—ApplicanL P�nk—Revenue;
it it iE if 1f k k if iE it iE 1t it ft 1f iE iE 1f it ff k 1E 1E it iF if 1klf iF if 4 M k 1! iE i!!f if i! 1E if it it if if it if iF it 1E iF if if iF 1E fE if fE iE iE iE 1f M M it i! 1! it 1f i! 1k 1E if iE if if if it if
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
I�ATE-Z�/ � S
D E S C R I P T I O N
1 ST 20 EA.
TUS 1,1 - 10,0 HP
END OF FEES
UNIT COST
.75
7.50
TOTAL COST
,%S
7.50
I �� �
p,. " J=�- �,Py� 01 �0154977-00154D77 T O T
�'-��-�,� OATE: 02/04l94 TIItE: 11:49
;tip�y�a.e(
\
'2'a.'14
' CONSTRUCTION AND PLANNING POOL Tu SPA
APPROVALS Permit# Date Inspector APPROVA�S Permit# Date lnspector
1. Tempora�Y Electriwl Service or Pole �„ 52. Pool & Equipment Location
1
2. Soii Pipe-Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. r' S4. Forms
4. Electrical Conduit-Undrgrndr 55. Electrical Bonding
5. Sreel Reinforcemenc _ 56. Rough Plumbing & Pressure Test
6. Electr'�cai UFER Gmd. 57. APPROVALTO COVER�GUNITE
7. Pootings 58. Electncal Condwt•Undrgrnd.
8. Foundati0n 59. Gas Pipc, � Untlryrnd., Test
9. Water Pfpe-Undrgrnd. b 60. Backwash Lines, P�Trap, Cl Undrgrnd. �
10. Structural Floor System � . 67. APPROVAL TO DECK
17. Properiy Sewer Line & House Connection ' 62. Backwash & Receptor-Final
. . t
12. Sewer Cap _' 637fNapter & Vent•Final
73. Roo( Drains 64: •Pymbing System � Finai
14. flough Plumbing ,,;,',� �:�'�•l ' 65 ectricai•Final
55. flough EVearica{-Conduit >; �l, r;� i 66. $olar SVstem-Final
,�_• � .
16. Roogh Electric Wiring �� " + � fy7, Fencin
�;: :,: • , a g & Access A�proval
,17. Rough Wi�ing Sign d'�.-�;-�- � j �8s APPROVED FOR PLASTERING
78. Rough EI¢ctrical•T Bar Ceiling ip�^ ;;,_ t �9; POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning 'r? I T�E ,t �� FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace .`= 1"f= A.PROVALS Permit # -� � y
\;
21. Ducts, in Structure �-.�_. � 0. Underground Hydro ` , �� .
22. Ducts, Ventilating 71. Product Piping C]Gus OOiI - ' � �
23. Gas Pipe�Rough & Test 72. Underground Flush �: .`� �
24. Roof Framing 73. Underymd, Sroraye Tank O Gas ❑ Oi�i --• -
25. Roof Sheathing 74. Overhead I-IYdro --�"•
26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chomlcal --. ��
27. Frame and FlasM1ing 76. Dry Standpipe ) - '
28. Laihing & Siding,,, 77. FIXED SYSTEM FINAL � -� '
29. Insulation - 78. FIFE PREV. FINAL � '
30. Drywall Nailing ' HEALTH DEPT. REQUIREM�NT , •�
�.
37. P�aster Brown Coat 79. FINAL INSPECTION .__ .---
32. Electr�cai Power Meter�Final 80. FOOD CERI'IFICATE ISSUED
33. Final Eiectric Notes:
34. Fina� Heating & Air Conditioning •� �
35. Final Gas P�De•Test .
36. Hood or CanopY �
37. Final Facxory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Servite-Final'
47. Sotar pomestirFinal _."
42. 8ackflow Preventer �"�
43. Backflow Irrigation - �
44. Landscape Irrigation System
45. Sound Atcenuation � .
45. Handicap Regulations , �
47. FINAL S7RUCTURE & BUILDING ;� .
46. FINALPLANNWG � - �.
V
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY �' .
No. Date •
. .. ApPlicant to /ill in all s0aces except those wil�in �eavy CorEer iines anE slgn all apP�opriata tleclarotlons.
� ,
'GTY�OF COSTA MESA - � " PERMIT�q; / TRACT NO. . L-0yNO. BLD . .'
CONSTRUCTION PERMIT Q 7 l(o �
�n PrOjeC[ Addf¢55 ' O SU U TYPE OF CONSTRUCTION - NEW ADD AITERATION REPAIR
"O Applicant's Maiiing Address, I/�U/ WRS1h/nif?ifi( Oi/A'QCC/:M�i/�I�K � CONVERSION' ❑ DEMOLISH ,� OTHER
i
\ Owner's�Name ; L�T� SL�6r�STiPaH P�OnC DESCRIPTION OF WORK
� Address� ' �
TVPEOFPERMIT�j{ GRADING FOUNDATION STRUCTV0.AL
Q AfCh/Eng. _ J LiCCnSC Na. , � ❑ TENANT i� ELECTRICAL ❑ PLUMBINO ❑ MECHANICAL
. � �
� Address .-❑ o7tiER
� Cantrecm�'s Neme� M TvH/�i✓�%«C 7 vhone�-sy-� 7/i PROJECT DESCHIPTION 5ci. F7. OCCUaANCv
Addresslmeilingl��7�� W�Siry/A�%.�If G/9QO<N�^r�I✓L CONSTRUCTIONTYGE ' VALUATION$_
��„/� � 20NE GRADINGGU.YDS. ACRES_
Ciry Lic?nse No. Jr O '
LICENSED CONTRACTOR DECLARATION Remarks: '
I h¢reby affirm tbal 1 am IiCCnsetl Untler provislon5 ot Chdrt¢r 9(COmmincing .
witn section 7000) o( Dlvision 3 of tna Business antl Prote551on5 COtlO, dn0 • i '
my�iicense is in full force anC elfact.
License C�ass ' U � Icense o. �� 9/� ' PLUMBING
Date ��� � 7� ��i9nature .
ORKERS' COMPENSATIO CLARA _' Bar Sink . Showers
here�y affirm that I have a certificate o( con5ent lo self-insure or a certlfiwte gackflow Preventer � Service Sink �
�O( Wo�kets' Compen58tiOn -InSurance, o� a certi(1 t� e A�' �th«e9 f($ectl/�n -- - -
3800, Lao. C.� , t�O , n 3 ' /(y. ��' 7_ �/ � Backflow Irrigation ' $¢yuer Ca �
P
PoIICY No. Y a CompanYi•"'"^.�' 't���� , ' .
�Certifletl copY is hereby tumisheC. • � - ' Bath[ubs � � Sewef Connection '
Cerfifletl copy Is flletl with the tit BuilOi 9 Olvis on. ' � , . �
Date �� -7 -S� Applitant ' Clarifiers Solar Collectors �
-EXEMPTION FROM WORKERS'� 7ENSA DECLARATION - " DiShwasher �-- '
(This section need not be comple {f the perm is (or one huntlretl (E100) or . Solar Piping
less)' � ' Drinkin Fountains
I certity'that in the pertOrmdnCe O/ thB work for which Ihi3 perT�t is issuetl, I 9 SOldr Tank
shall.not employ any person In any manner so as to becoma 5ubject to [he . - �
Workers' Compensation; Laws ot Califomla. . ' Floor DrainS � � Swimming Pool wlSpa
Date ' ' �I9natura ' ' � . , . .
NOTICE: Ii, after making this Oeclaration, you shoultl become su07ect to the . � Floor Sinks � � Urinel �
Workers" Compen5ation'provlslons oY tno LaDor Cotla,'you must torthwkh � �
comply with 5ucI1 , pf9N5Ion5 Or �thls pelml[ shall ba � tlaemBtl %¢vOkeO. � � G85 $CfVIC¢ , Out12I5' WStff CIOSEt
CONSTRUCTION�LENOING�;AGENCV�- ' ' . . . , ,
I hereby atfirm tlial thare iz a construclion Ientling agency for tha porformance Interceptors � � Wate� HeatE� .
of the work �for whicn• this permlt Ii issuetl (Soctlon 3097 Civ. �C:) • - � - .
Lentlar's Nama: '- , Kitcfien Sink - Water Service -'
Lender'S Atlaress' � ' -' � � ' '' • � � �- • _ . C . r '
OWNER BUILDER DECCARATION ' � •- ' , •' �' ' � • -. � Lavatolie5; _. � � ' .
I hereby affirm.that I am e%einP[ from the Contracldr's Licanse �l.aw torthe p_T�e �� "
lnunwL.n rnaann'�[w�11nn >031� SIRu<�nwccantl Prniocslnnnl Gntle: Anv tlN oi ' P�� � '� ' �� . ..
that
31.5 by�any dpP���ent (Or a�perTit subJects Ihe�LPPlitdnt t0 d<ivil
ialty of not moro tban flve buntlretl tlollars (y500j. '
I; as� ownar Of tho' plopefty OI Ty Omployeai wllh waga5 a5 [helf Solo
npensatian, will tlo the wbrk, Bntl tha 5trutWm is not IntanEatl or o/feretl
sale� (Section 7044, Busiueis antl Pro/assional Cotla:, Tho Contractor's
ense l.aw tloes not appty to an owner of a properW wlio builCs or Improvai
�eOn, dntl �wh0 tl005 such Wo�k hIm5811/�e�selt o� through hIs or h0� own
ploy ees, provitletl [hat 5uth�ImProvamenl5 are not Inlen00tl or oHeretl for
�. If, however, the �ulltling or ImOrovemant Is soltl wlthin ono yeai o/ com-
tion, tho owner, will'hava the burtlen of Drovin9 hc/she tliG not butitl or im-
rva forthe purposa ofsale). •
1, as owner a/ tha Droperty, am exclusivety conlracling wiM Ilcense0 con-
ctors to construtt the Oroject (Sectidn 7044, Businezi an0 Profestlohs Cotle:
D COO[racto!'i �LlcanSo Law �dOai nOt appty Ia an ownar ot plOParty who
Itls or Improves thereon„antl who conVacts br such pro�ects wlth a con-
Ct01(5) IIC¢O58 pU�SUd�[ IO Ib0 COM�BCtOf'S Ucanse Law). . �
l am �exempt untler Saction B. & P. C. for this reason
� � .�- '
CMF��O865-46��ev.
' � Roof Drainr �- � ' �
. . �� � � � ' � , �
. ^
� Reinspeciion•Fee ,
Boiler '
Dutt'- Under Grc
Du[t , Structural
Exhaust System LJ Mul
Firepl/Fact. Bit. ICBO'#
Heating System & Ductin�
. I �
laue Feo
m
Hood or Type l� � I ,�
Canopy Type I I ❑
Refrigeration System ;
❑0.100,000 BTU 0100,000 B
System ReoaidAlteration '
I nave reatl thif aOPlicatlon ana ztate that Ine abow LJ0.100,OOOBTULJ7UU,UW81
'I'agrea to compty witb all city antl county orElnances - ' ' ' ' -' . ' - '
to buileinq constructlon; ana"nereDy authorize revre- • � .
� to enter� on lhe abova-mentlonetl property 'for , .
. � �
OateL-%-.�1� � '
�� , � Reinspection Fee $ZS
- White - BuilGing: Canary - Appliwnl; Pink - Actounting; Goltlenrotl - Assessor -- - �-
?
Issue Fee
—r
S�
FEES
�
$ 3
A.P. �p
S ,Main 8�
E
T Front '
B Rear
A
C Rieht
g Lef[
Ping. fief. dp
Planning Notes:
�
i
Automatic Washer '
Construction Pole Sub.
Cookin9 Unit �- ' '
Dishwasher
Dryers OGas ❑Elet
F.A.U. i
FixCures ' '
Device Boxes .
Outlots ' � �
Swiiches' ' �
Garbage Dispoul
6947 I U/ _7/"'�
2one . '
� Accessary Building:- - Z
� O
' N
�
N
� G
' R
' E .
Park.Fees $ n
U
. 1
R
' E
M
E
' N
T
: S :
, ELECTRICAL . FEES
� Transformer ❑ 15-50 KW
— , ❑ 50+KW
' � Meter �up to 100 amps- � - --
Meter ❑over 100 amps , -
�� Sub Panel � '
1
� �Moror5�61HP�1'h-8 � �
� Inc.Solar��9-15HP�76-15+ �
�i
KW L15-15
'Pole'Light � �
Range
• Sign � Q �
� Stariding Sec[ions
' Trash Compactor ,
� Reinspection Fee �$25 � laue Fee
PUBLICSERVICESRE�UIREMENTS: �
2onin9 APProved By '
AOPlication APProved BY —�
Application laued Bv '
$ 3
' � SUMMARV OF FEES
BUILDING PERMIT $ SMIP ' $
PLAN CHECK $ ' ' PERMIT �
PLUMBING $ � '��UANCE $ � .
PLAN CHECK � � $ � ENERGV P.C. � $ �
ELECTRICAL � $ GRADING . 5
PLANCHECK , $ MICROFILM $ .-�j' �
MECHANICAL 5 TOTAL FEE ,$ jf '�
PLAN CHECK � $ '
. ,
- CONSTRUCTION AND PLANNING • PO. 3 SPA
£� c� y' � Date Inspector Date Inspeetor
� APPROVALS Permit # APPROVALS Permit #
1. Temporary Elec[rical 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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
70. 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'. Rou9h 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 O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑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 pomestic-Final �
42. Backflow Preventer �, • �
43. Backflow Irrigation • �
44. .Landscape Irrigation System � �
45. Sound Attenuation '
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co � ' '
51. CERTIFICATE OF OCCUPANCY ,
No. Date � � ' �
• Aoolicant to fiil In all sDaces except thote wilhin neavy EorOer lines antl sign a11 apvrovriate Oeclarations.
' CI�Y G�F COSTA MESA� - - PERMIT N ' TflACT NO. LOT NO. "BLD �
�- CONSTRUCTION PERMIT • �a 8 . ��D ���i
� Pfoject Addre55 � •*� 4 TVPE OF CONSTRUCTION NEW ADD ALTERATION
Applitant's Mailing Addreu ���gGI W/crf%HiNf/.L� i�Ti ir ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
/�-� Owner's Name �� J S/Lfr2Rf7iPo�^ � Phone DESCRIPTION OF WORK
�J ACldfeu, �� , ' TVPE OF PERMITpy � GRADING FOUNDATIO�NI STRVCTU
AYCF/Eng. _, Lic¢n52 No. � ❑ TENANT !�I ELECTRICAL ❑ PLUMBING CJ MECHANICAL
� Addr¢55 - ' ❑ ,OTHER . " \ . ..
\� COntracior's Name T� Sa%���"� ����� PhontL'f5 y 77�5, PROJECT DESCRIPTION 5ci. FT. � ' � oCCUPaNC�
O Addresslmailing1��90� A.i,�S'1HLvfT/L.'T?1%�iNAa-�6.���� CONSTRUCTIONTVPE - VALUATION$_
Ci�Y.LiCense No. Q'�CL� ��l ' ZONE � ' GRADING CU. VDS. ACRES
\ LICENSED CONTRACTOR DECLAHATION Remarks: . . '
i�pere0y�atfirm that 1 am liceosetl uader Owvisloas of.Chartei 9(tommencing �' �
�y�[h section 7000) oi DlviSion 3 of the Busine55 antl Professfons Cotle, ane �� � � " . . ' ' '
my ��cense is in full force antl et(ect. , ' -
I.Jcense Class ' Licensa N.��'69�� • PLUMBING '
Date9—� G^��3 Signature � � . . - �
pRKERS'COMPENSA7I�N LARAT BarSink Show2ri
nereDy'affirm thal I have a cerU(itate ot consent to selttinsure oi a certlficate � Backflow Preventer Service Sink � � •
ot �`/�orkers' Compensation InsurSnce,.or a certifletl� copy thereo( �(Sectlon � -- - -
3800, Lab. C.) . � , � ' Backflow Irrigation y, Sewer Cap
Po11cY No.�A//I�I%OS�d�%� . ComPanY �d.N�. � !/�lAi�✓ .
❑ Certi}Ied coPY fs hCr¢by fumisheA. ( ' � � � Baihtubs � � � � Sewer Connection '
[�Certifletl copy is }lletl with the city uii ng Div7si � ' - • • � �
oateGJ�=��'S`� APPIIcS�l* � dy • Clafifiers � . SolarC011eCtorS , ,
EXEMPTION�FROM.WOFKERS' CD�PENSAT14f DECLARATION -- t' DiShWdShCf"' ' � `- . ' ' - +' '
(Tp�ssection neetl not be completetl it the permit 6 for one huntlretl (E300) or � . ; � Sola�'Piping-`
Iessl. r � ' 1 � � , . ' . ' •
I certify that in the oerforman<a of tne work for'whith this perm�t is issuetl, I ' Drinking Fountains 1 I SOlar Tank '
sb?fl not employ any person fn any manner so�as to �e<oma suCject to tha .
Workers' Compensation Laws of California.. � . • • Floor Drains� ' Swimming Pool w/Spa � •
Oate � Si9nature .
NOTICE: If; atter making thi5 tleclaratiOn, y0u shoultl become subjedt to the i FIOOf $inks � � Urindl ' '
WprkerSl�Compensation proWzions-of �the��Cabor Cotle, yau must tortM1witb�
cof�p�Y "�'��h� zuch . provBfons o� tnis permit , shall be � tl¢¢metl revOketl. G35 S¢Nic2 OU[I¢t5 . � WeLC� CIOSEt - � -
CONSTRVCTION�LENDING�AGENCV� ' .' , ' i ' - ' ,
I hereby afflrm that there Is a<onstructlon lentling a9ency for t�e performance' In4erceptors' -• � Water Heat¢� .
of the work �or� which thiz permit i5, Issued �_(Se<Hon' 3097 Civ. �CJ; ' ' ^ � ' � - - _ .
�enEer's Name � Kitchen Si�k � • � Water SerJice � � �
. �'. t � r '. , . , .
L¢nEer's AtltlYessi - - ' LaVatofle5 - j - ' - ' - - � ' '
OWNER BUILDER DECLARATION - 1 •- � i � ' ' '� . . ' - ,
� per¢by aHirm t�at 1 am�eaempt tiom the CdnVactor•s Licens¢ Law for t�e � � - ��
�opowing reason (Section �031.5 Bus��ess antl ProfessionallCotle: Any city or 1 P-T�ap� '� � �� ' �
county whlGh �equires a pe�mit to co05t�UCt, alter, ImO�ove, d¢molish o� �epair ' .. _
.'enY_st�uctu�e; prlOr to ItSissuanc¢, als0 �eqhires tha applican[ for Such permit � Roof'Drains - , . _ �� , � ,
antl the basis for the allege0 er
� anv applicant tor a Oermlt •
no[ more than (ive huntlretl tlolL
wne� ot [he orooertv oi-TY�e
a
tof sme �5ecuon iunn, tl�siness ano�, rro�essionai wae: inn wnua�w� �.
Li4ense Law tloes not apply to an owner of a property who bu�itls or imp�oves .
thBreon,�antl who'does SUch work�himself/h¢rself'o� througlt h15 0� her own ,
erOP�oyee5, O�ovitletl thdt Such Improvemen[s ar¢ not Intentletl o� otferetl �fo�
sale. If, how¢ver, the bullEing or Improvement is soltl within one year of com- .
pl6tion, the owner will have the burtlen o1 proving he/ihe tlitl no[ builtl or im-
�rOve�for tha purpose ot sale). '
I, as owner of the property, am exclusively contracting with licensetl con-
tra�torsto construtt the D*oject (Section 7�44, Business and Protessio�s CoGe: .
.T�o Contractor's License.�aw does not apply to an owner of property who -
bu�ltls o� Improves Ihereo�, antl who contracts TO� suGh p�ojCtts witn a con-
tractor(5) Iicenze PurSuant to t�e Cont�dclo�'s Licens¢ Law).
❑ ISam exempt untler Sec[ion , , B. & P. C. for this reason
� I
Da1e � � Owner � ' �
I nereby certlfy that 1 hLve reatl this application antl state that the above
inrormation is correct. 1 a9ree to comply witn all city�antl�caunry ortlinances
anC state laws relating to bulldln9 constructlon, antl hereby authorize repre-
sentatives of this'cly.to en[erppon the above-mentionetl property �or
InsPectlon p rpos �t A • ,
S�gnature i�C.C�--• � oate2%�'��
Dri�ers I nse ar 55� .
CMF 0865-46�rev. 7/83 White • Builtling; Canary - APOlican4 Pink - Accountin
�
' I Reinspettion �Fee
� f
Duct - Under Ground �
Duct - Structural : 4
Duct - Ventilating
- Ezhaust SYstem ❑ Multiple
Firepl/Fact. Blt. IC80 #
Heating System & Ducting :
❑0.100,000 BTU 0100,000
; � .
I Reinspection Fee �;
Goitlenrotl - Assessor
Isue Fae
p
Hood or Type I s � � ,�
Canopy Type II� 0 � •
Refrigeration System �
❑0-t00,0008TU ❑700,0006'
System Repair/Alteration
Isue Fee
REPAIR
A.P. $`
S� Main Building:
E
T Front
ARear
C Right
gLeft - .
Ping. Ref. � ' �
Parking Req./Provided
Use of Building:
Planning Noter. �
. �.,in ' �i:•r.ic�^
•. . . - Zane .
_ Accessory�Building:
Park.Fees $
i
� ,
; � ELECTRICAL � , i
Automatic Washer , 'Transformer ❑ 15-50 KW
ConstructionPoleSub.. � ❑50+KW
CookingUnit'' -- ' ' ' ' Meter-Dup-to�100'amps -'` �-',
Dishwasher � � :Meter ❑over100amps , ;
Fan;
- f.A.U.
Fixtures
' �
- Device Boxes '
' � Outleti .
� Swiiches, � �
� �Garbage Dispoul ¢
, Genera[or �0.5 KW �5-15 KW
$ 3 L UG
Reinspection Fae � ' $
FEES
�PUBLICSERVICESRE�UIREMENTS�
2oning Approved By
Appliwtion Approved By
S3
,Sub Panel
�MotorsLJO-1HPL�iX-8 ,
'Inc. Solar'09-i S HP � 16-15+
� Microwave � '
Pole.Light � � '
Range
� Sign �
' Standing Sections
�Trash Compactor �,
i
'Issue Fee. �
:.�,r T
Z
O
N
I
N
• G
R
E
. Q
U
� 1
R
E
M
E '
' N
. T �
S
FEES
.
aliption Issued By � � Date -%-.�G✓ %�
+ � SUMMARY OF FEES . �
BUILDING PERMIT $ SMIP $ :
PLAN CHECK � $ PERMIT � � �
PLUMBING �, $ � IISSUANCE . $
PLAN CHECK ; $ ' ENERGY P.C. $ �
r ELECTRICAL ; $ � GRADING $ '
PLANCHECK � $ - iSi� MICROFILM $ �
; MECHANICAL $ TOTA�FEE $ �
� PLAN CHECK $
, ' .w • � � ` ... �� • �
�
. �CONSTRUCTION AND PLANNING� , .. � � PO� t SPA .
' APPROVALS. 'Permit#P�Ba.k � :Date � Inspector �.��APPROVALS � Peimit#� Date Inspector
1, 1. Temporary Electrical Service�or�Pole - " ,52. Pool & Equipment Location ' '
�. 2. Soil Pipe�Undrgrnd. � ' � � ' � - • '53. Steel Reinforcement
- ._, = �
3. Electrical Conduit�Utility-Undrgrntl.' > � - • - 54. Forms� , � �_ . � ,
4. Electrical Conduit�Undrgrnd.. � � ' -� 55. �Electrical Bonding ' ' -
' 5: Steel Reinforcement � ; , � , _ � �56. �Rough Plumbing & Pressure Test _ - -
6. Electrical UFER Gmd. - � '� 57 APPROVAL TO COVER�GUNITE ��
7. Footings^ � � � � , � :' ' - �. 58.� Electrical�Cpnduit-Undrgmd. . ' -
8. Foundation ' ' . � � . ' � L = � 59r. Gas Pipe, D,Undrgrnd., Test �
9. Water Pipe�Undrgrnd:� �: ' , '-60. Backwash Lines, P-Trap, rJ Undrgrnd.
10. Structural Floor System • �� � �: i-. 61. APPROVAL TO DECK �
11. Property Sewer Line^�& House Connection " �, -� 62. Backwash�& Receptor-Final �' �
12:.Sewer Cap 'i � ,, � ' . -. 63.�Heater & Vent-Final � '
13.�RoofDrains ', �� � � � ' � ��64. PlumbingSystem-Final '
14. Rough Plumbing . . ' �- ' � - - � 65. Elecfricel-Final � � ' �
15. Rough Electrical-Conduit- �-• -. �, � � �' -' '66. Solar System-Final . " � -
16. Rough Electric Wiring - _� � � . _ i .; �- � 67. Fencing & Access Approval ' "� -
'17. Rough Wiring Sign � � � , ' -: 68. APPRO,VED FOR PLASTERING � �
i8. Rough Electrical-T Bar Ceiting -� . �� , ' 69.�POO VSPA SYSTEMS FINAL - �
. 19. Rough Heating &:Air Condition;ng '• ' . � � FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace� �� � ' � ' APPROVALS � Permit # �
21. Ducts, in Structure , . ' � . • 70. Underground Hydro
:' 22. Ducts, Ventilating � ' . �� � ' , , � �
;� � i 71. ProductPipingOGag ❑Oil
' 23. Gas Pipe-Rough & Test_ � '�� � ' • � � ' 7Z, Underground Flush
� 24. Roof Framing � � � � 73.: Undergmd`. Storage Tank � Gas ❑ Oil
��
25. Roof Sheathing '' � �' " � 74.�Overhead Hydro
26. T-Bar Ceiling (Structurall & Monocoat � � � 75. -0ry•Chemical �
27. Frame and flashing ' � � ' � � 76. Dry Standpipe . . '
28. Lathing & Siding _ � � 77. FIXED SYSTEM FINAL .
29. Insulation� �� . . � '. ' 78. FIRE PREV. FINAL
� 30. Drywall Nailing' ' , I � � :. HEALTH DEPT. REQUIREMENT
31�. Plaster Brown Coat • � 79 FINAL�INSPECTION �
"32. Electrical Power Meter-Final •i� � � ' 80. FOOD CERTIFICATE ISSUED � •
�..
,33. Final Electric � ' �� � /e(� � Notes: . �
r 34. Final- Heating & Air Conditioning ; � � � � � �
.
35. Final Gas Pipe-Test ' -- � . ' ' - � , _ i '- - " :
36. Hood or Canopy � . � � - ; � � �� . ' '� �
� .
37. Final Factory Fireplace � . - � ' ' � " - . � -
38. Final Plumbing : ' � � ' � � � .
39. Water Service�Finil � . ' - � • . � .
40. Gas Service-Final � � , ' ' � � . � , � . � " • � �
41. Solar pomestic-Final � � � ' � � � � � . �
� ' � ' - - . .._... .: - . .
42. Backflow Preventer � � ' ' , � � � � �
� . . _ . .
43. Backflow Irrigation ' � � � � • � � - �
44. .Landscape Irrigation System � . . � � ,
.�
45. Sound. Attenuation i � � , � , ' � � � � � -
46. Handicap Regulations - � � � � � ' - • � �
47. FINALSTRUCTURE&BUILDING ' . � � . �. ' . , •
48. Special Requirements Completed ' � ' - � , ' �
i �
49. Electric Release to Edison � � � � � � - - . ' - � .
�
50. Gas Releaseto!Southem Califomia;GasCo �� ' ' � i � � ' , � .i �
51. CERTIFICATEOFOCCUPANCY_, � � � . _.. . .. � . _ _ ; � . .
No. � -' ' Date - � � ' , � ' '
, •' \
ApPlieant to fill in all s0aces ceot those within heavy enraer lines anO sign alt avPropriate tleclarations.
P MIT NO. TR C O. ' LOT NO. UNIT NO. '
CITY OF COSTA MESA CONSTRUCTION PE .MIT ,�� � 5 102 ' � � . 7888 10/21 /87 ' 233a23 � Tl
Prol:ctAddress 3545 Harbor' Gateway Sou�h 30��'� , . -
_' Applicant's Maili dfe a� r�� eW r'. > .. TVPE OF CONSTRUCTION NEW AOD ALTERATION REPAIR
Z�-�. �egers rom Qn$ ❑ CONVERSION ❑'DEMOLISH ❑ OTHER Iq�2P11LA�tpratinn AP # ,�� Q � b zo�a
Owner's Name Phory� DESCRIPTION OF WORK/USE OF-BLDG. � �" �
naa.ess �3315 Fairvtew, OStB e$a `J � S MainBuilding: AccessoryBuilding:
Arch/Eng. 'Narriini R Ctanlov' LicenseNo.��=LQSS4—, T�'P�OFPERMIT GRADWG FOUNDATION ' STRUCTURAL T Front ' � ' ' p
Address Q�6 Tawn� � Ceuntry, �r�ngp 97�6R U TENANT ❑ ELECTRICAL � O Pl.VM81NG � MECHANICAL A Rear (' N
fp-Wall fnntrartnrc ' ptione �i40-3771 , � OTHER
� Cont�acmi'sNam< ' 4%3 � oCCUPANCv' �C Right' � ' ' � N
, PROJECT DESCRIPTION SQ. FT.�� � K • - - G
� Address�mailing) ��4 RIICII'les$ G�rk nY'. �.M_ ; CONSTRVCT ryTTVPE �5N VALUATION§%OrO.O� OO S Left � � � �
City LicenSe NO. �_�� � ZONE ��• � GRAOING CU. VDS. ACRES � � ' � . ' � � ' ' , R
LICENSED CONTRACTOR �ECLARATION ' Ping. R¢f. # Pa�king Req./P�ovidEd E
1 hereby affirm that I am licensetl untler provisions ot Charter 9(commencin9 Remarks:'. �# .� . � f. Planning Notes: � -� ' ' O
with'section ]000) of Division 3 of the Business antl Professlons Cotle, and � , M
my IicenSe is in full f�j rce antl e(fect. � ' - � ' � ' - ' i ' S
License Class � /5 "/ ' �. " " . " ', � . . � • � ' -
oate ����-8% Signature � - PLUMBING : FEES � �
�WORKERS' COMPENSATION DECLARATION ' � ' . , i - ' ' . ' '
I hereby aHirm that I have a certiticate ot conzent to seli-insure or a certificate Bar $ink Showers ELECTRICAL ' FEES
�ot workers' Compensation Insurance, or a certified covY tnereoi (Sectlon gackflow.P.rev2ntel ''' • ServiceSink • � � ' ' �
3800, Lab. C.) 1 . AutomaiicWasher Transformer ❑ 75-50KW
. Polic No. 7���1%86 ' Company .�4>P .�in/o Backflow Irri ation Sewer Ca � ' ' . ❑ 50+ KW
y 9 n P. Construction PoleSub.
�]�Certitietl copy is hereby fu�nlSM1etl.
� LYCertifiea co is filetl with the city Bu�^� g ivisio Bathtubs � � � Sewer Connection f- }• Cooking Unit •.. . Metec �up to 100amps
1`�1 Date�7.4��7 APplicant /��+� ��✓
� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION CId�iliC�s � '. $012� COII¢ct0t5 - _� . Dishw25hC� - � � M2L¢f �Ov¢� 100�dmp5
(Thi55ection neetl not be completetl if the permit is tor one huntlretl ($300) ar � - .
less). Dishwasher � ' Solar Pipin9 ' ' - Dryers ❑Gas ❑Electric � Sub Panel � '
I certify that in the perfo�mance of the wo�btor which thi5 pe�m�t i5 i55uetl, I . - - -' ' '
shall not employ any person,in aoy manner so as ta become subject to the , Drinkin9�Fouritains Solar Tank ' ' ' Fan Motors DO-1 HP O1'h - B �-
Workers' Compensation Laws of Califomia. • . � , - I
Date � Signature � � FloorAreins� . Swimming Pool w/Spa . � F.A.U. ' ' '
NOTICE:If,after making this�tleclaration, you Shoultl become subject to t�e _ Inc.$Old� �9-15 HP �16-15+
' Workels' Compen5dtion pfOvision5' Of the Ldbor Code, you must tofthwith FI00! Si0k5 � - • U�iOdl � FixtufES' MiclOw3v¢ '
comply with-such provisiOns or this pe�mit shall'be tleemetl revoketl.
CONSTRUCTION LENDING' AGENCV Gas SefviCe OudetS ?' Watef CloSet ' ' Devite BOxeS PoIE Li ht
I hereCy affirm tnat there is a conSV uction lentlin9 agency for [he performance � ' 9
of ihe work for •which+[his permit is i55uetl (Section 309] Civ. CJ �nt¢fce LOfS WdtEfH23tef '
Lentler's Name -�' ` P � +' � Outlets , Range
Lenaer's Aaaress �" � � ' Kitchen Sink ' - I Water Seivice _ __ Switches ' ' � - . - -, . .
OWNER BUILDER'DECLARATION ' ' Sign
I hereby affirrtl that I am exempt from the Contlactor'S Lic¢n5e� Law for the � L3vdtOfieS � � � - �• AutO�W85h � Gdlbd ¢ DIS OSdI
following reason (Section ]031.5 Business antl Professional Cotle: Any city or - - - 9 P Standing Sections
county which requires'.a�permit to construct, alter, improve, demolish or repair P—Trap ; . � Laundry Trays { ' Geneiator �0.5 KW �5-75 KW �
any slructu�e, prio�'to�its i55uance, also requi�es tne applicant (or such permit T�dSh COmp3cto� � _
to file a si9netl statement tilat he/She is licensEtl pursuan[ to the plovisions ot ROOf DfdipS • •
the Contractor's Cicense Law (Chapter 9(mmmencing with Section 7000) of ' • �
Division 3.of-the Business antl Professions Cotle). or.that he/she is exempt _ , -. -- - - � , -- - � .
� therefrom antl the basis fo/ the allegetl exemption. Any violation of Sectinn � � , - ' .
�i �]031.5 by any applicant for a permit subjects tM1n appliGant to a civil �
enalty ot not more tnan.five huntlred dollare ($500). ' ' $� 3 i '
�� I, as owne� of the� p�operty Or my employe¢s wkh wagez a5 thei� sole REin5p0ction Fe¢. $15 �,� � Issu¢ Fee ,
' compensa[ion, will tlo the work, antl the Structure is not intentletl oI offeled ' � ReiOSpeGtiOn Pee $15 ISsu¢ F¢B ' � $ 3
for sale (Section 7044, Business'antl Professional Cotle: The Contractor's , MECHANICAL� ' � .FEES �
' LicenSe Law tloe5-not apply to an owner of a p�ope�ty who builtls o� imp�oves ' -
thereon, antl who tloes such work himselt/herself or throu9n his or her own � . ' � ' DEVELOPMENT SERVICE$ REQUIREMENTS: �(
emD�oyeeS, provitletl tha[ such improvements are not intentletl or ofte�etl (o� � BOiI¢� HOOd o� � Type I ❑ _ � �
sale.�lf, nowever, tne builtling or improvement is soltl within one year oi com- . Canopy Type II ❑' . Zoning Approved By DateO� ��_
pletion, the owner will have tne burtlen of provinq he/she tlid not builtl or im- Duct - Under Ground � � Building Approved By Date
' rove for [he Oarpose of sale). ". �
�,I, as owner ot the property, am exclusively contractin9 with licensetl con- ' Duct-Structural ' , • Refrigeration System �� Appliption Issued By ' Dat
Vactors to cons[ruc[ the project (Section ]044, Business antl Protession5 Cotle: - , . -' ^
The� Contractor's.License Law aoes not apply to an owner ot property.who Duct - Ventilating ❑0-t00,0006TU ❑100,000 BTU . � � SUM ARV P F S� � �
builtls or Im0/oves tbereon, antl who contracts�tot Such p�ojects with a con- � - '
tractor�sl ucense.pursuant to the Contractor's License Law). I-am aware that -' BUILDING PERMIT $ ��ftl�S� �$Mlp , $_ �. �O.
proot of thev Worker'S Compensa[ion insuranre shoultl be provitletl fo me. Exh2u5t SySt¢Rt ❑.MW[iPl2 ❑ System�Repair/Alteration
� - PLAN.CHECK $ .�f /.33 PERMIT �. -
❑� I am exempt untler Section , B. & P. C. for thii reason . Firepl/Fact: BIt.�ICBO # Fire Dampers PLUMBING ' $ � ISSUANCE $i ,
; Date � owner � Heating System & Ducting. � Registers _ � . ENERGV P:C.� $ ' '
' � � - . PLAN CHECK _25% $ - .
. I hereby certity mat� i have reatl this aooiication antl state that the above ❑4100,000 BTU �100,OOOBT ' � � ELECTRICAI - ` GRADING � $ -
�, iniormation is wrrect. 1 agree to comply with all city antl county ordinances � -' ' $
antl state laws relating ro builtling'construction, antl hereby authorize repre- , . }'' -� � PLAN CHECK 50% $ � � MICROFILM $ � �
sentatives b( this city to enter upOn the above-mentionetl �property for. , .
inspection'purpo . ��j� ' �Yl - ' ' " - � � -' � � � MECHANICAL , $ . TOTAL FEE $ 1��3•�
Si9nature �o�'= l �� ' �a[e/Os7/•�J � . ' � � .. .
Drivers' License or 55 � - / Heinspection Fee , $15 . I Issue Fee , . � $ 3 PLAN CHECK 25% $ ' . � .
CMF 0865�46, rev. 10/84 White --�Builtling; Canary - Applicanq Pink - Accounting; Goltlenrotl - qszessor i
CONSTRUCTION AND PLqNNING POOL & SPA I
APPROVALS Permit# Date Inspector pppROVALS 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 �
1
7. Footings 58. Electrical Conduit-Undrgrnd. `• �
8. Foundation -' 59. Gas Pipe, O Undrgrnd., Tesi, �!
9. Water Pipe-Undrgrnd. 60. Backwash Lines; P-Trap, O Undrgrnd. ..
10. Structural Floor System 61. APPROVAL TO DECK
17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final � �
i' i
. �
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 �
79. 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 O Gas ❑ Oil �
, 23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
� 25. Roof Sheathing .- 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �
27. Frame and Flashing �e L 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 ERT�F CA ISSU D
33. Final Electric Notes: G
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 pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System ,
45. Sound Attenuation �
46. Handicap Regulations � I
47. FINAL STRUCTURE & BUILDING ({ �
48. Special Requirements Completed
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY � .
No. Date
�
1
M
Applicant to fill in all spaces except those wit�in heavy Eoreer Iines antl si9n all appraDriate tleelaretions.
Ci7v oF COSTA nnESA CONSTRUCTION PERMIT PE T N TRACT NO. LOT N0. UNIT NO. �990 10/Q3/f17 14e�5
c �08��%
PrOjett Address ��f � � �
u `' TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
Applitant'SMailingAddyreS�S'/_ �I.i /Z�'� ❑CONVERSION ❑DEMOlISH ❑OTHER q_p,qp. . . 2on8
Owner's Nam� ��Jt�z�� Phonepj� DESCRIPTION OF WORK/USE OF BLDG. . . g Main Building: Accessory Building: �
Address �_��% p!p�q� E Z
Arch/Eng. License N���^ TYPE OF PERMIT GRADING FOUrvDA710N STRUCTV RAL ' T Front' p
Add�¢55 � ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING � MECHANICAL A Rear . � N
❑ OTHER �
Contractor's Nam � � hone��.Q-�3�o , C Right G
( � (� PRQIECT DESCRIPTION SO. FT. OCCUPANCV K
AddresslmailingllL � yT �h7p��/ ��(' CONSTRUCTIONTYPE ' VAWATIONS S Left R
Ciry LiCen52 No. ��� 7 ZONE GRADING CU. VDS. ACRES -
LICENSED CONTRACTOR DECLARATION � Ping. Ref. #` .Pe�king Req./Provided E
�
1 h¢r¢by a/lirm thal I am Iicensetl untler provi51on5 ot Cha�te� 9(commancing pemarks: Planning Notes: M
with uction 7000) of Dlvlsion 3 of the Business antl Professlons Code, an0 .
my Iicense Is in fun tor e antl efteck ,Ll� O^� � � Q , S
License Class � License No. S(/ �
Dater� u (� Signature � � PLUMBING ' FEES � � '
WORKERS' COMPENSATION DECLARATION Ba�Sink �� ShOw¢�5 . E�ECTRICAL FEES
I hereby aHirm that I �ava a cerU/iUte of consent to SOIf-inture or a certlfiWte . - .
ot Workers' Compensatlon Insuranre, or a c¢rtlfletl topy thereot (Sactlon BackflowPreventer . ServiceSink
AutomaticWasher Transformer'0�15�50KW
3aoo. �b. .��ys��_ R�p vb/'c
' Policy No. Company / Backflowlrrigation SewerCa ❑ 50+KW
P Construc[ion PoleSub. '
❑ Certi(ietl copy is nereby fumishetl. -
j�Q Certifietl c� Ith tne tlty euiltli���j� Bathtu6s Sewer Connection Cooking Unit ' Meter ❑up to 100amps
Date � AOPlicant ,
E%EMPTION FRO WORKERS' COMPENSATION ECLARATION Clafifi2l5 ... $olar ColleCtOrs Dishwasher � � Me[er� Oover 100amp5
(This section neetl not be compbietl if [he permit Is for one huntlretl ($100) or �
less). Dishwdsher - Solar Piping Dryers ❑Gas ❑Electric Sub Panel .
I certify tha[ in the pertormanCe Of [he work fo� which Ihis p¢rm�t i5 issuetl, I
shall not employ any person in any manner so as to become subject to the Drinking FounW ins Solar Tank Fan MOtors 061 HP �1'h -�8 �
Wo�ke�s' Compensatlon Laws ol Californid. - -
Date Signatura ' Floor Drains Swimming Pool wlSpa F.A.U. InaSolar �9-75 HP �16�15+ _
NOTICE: Ii, alte� making IM1IS tleCla�atiOn, y0u shOUltl becOme sUD�ec[ to Ine
Worker5' COmpenShcion prOVISiOns o� tlle LdDof Cotle, you must forthwltb FIOOf $ink5 Ufin21 Fi%tuf¢S '
cOmply wit� such prOvlslOns o� thi5 permit Shall ba tlelmetl revokoa. Microwave
CON5T0.UCTION LENDING AGENCV GasService OutlCLS Wet¢f CIOS¢t Device Boxes � -
1 horeby aHirm tha[ tnere I5 a conSVuction Ientling agancy for the performante POI¢ Light
of tbe work tor whith thls pe�mit is Issuetl� ($Gttlon 309� Civ. C.) IO[Cro¢pt0�5 Wet¢� H¢dt¢I OuUets . - Range '
Lentler'S Name
Lontler's Atltlress - - - � Kitchen Sink -- ' Water Service Switches ' ' gi9� ' '
OWNER BUILDER UECLARATION ' � '
I hareby alflrm that 1 am exOmPt 1�om lhe Contrdct0/'s LlcenSe Law fOr Ihe LdvdtO�i¢5 AutO�WeSh Garbage Disposal Seanding Sections
followin9 reason (SacUon 7031.5 Business ana Professlanal Cotle: Any city or
county wnlch requires a permit to construct, alter, improve, tlemolish or ropair P-Trap Laundry Trays Generator �0�5 KW �5�15 KW Trash Compattar
any sl�ucture, pdOr lo Il5 I55udnCO3 also reqWr¢S the applican[ for Su<h pe�mil '
to filo a signetl statement that he/sne Is IlcenSatl pursuant to the provisions ot Roof Drains
lhe Contractor's LicenSu Law (ChaO�er 9(mmmencin9 witb Section �000) oi �
DlviSiOn 3 ot Ihe BusineST antl Prof<i5ions Gotle) Or that he/zhe ii extmpt
thcrotrom antl the basls lor tho allegetl exemptlon. Any violalion ot Sactlon
. 7031.5 by any applicant tor a parmit zu�jects tha applicant ro a civil
��enalty of not more [han tiva huntlretl tlollars (5500).
LJ I, as �wnor of tha property or �ny employe05 wiln wages d5 their Sole RBinSpactiOn Feo , $15 IssuB Fee g 3
compenSdtiOn, wlll tlo Ih0 wolk, dntl the StrIICtUlO Is not Inl¢ntl¢0 aI oflerCtl RBin5p8CtlOn F88 $1$ ISSuO FB0 $ 3
ior salc (Section 70a4, eusinoss antl Professional Cotlo: The Contractor's MECHANICAL FEES
LICenSa Ldw tloes not applY l0 an own¢r Of a p�opa�ty wh0 builEs o� ImprOves
thercon, antl who tloes such work hlmself/hersell or through his or hor own � DEVELOPMENT SERVICES REQUIREMENTS: .
empioyaes, provitletl that sucn improvements are no[ Intentletl or otferatl for Boiler . Hood or Type I ❑ Zaning Approred By Date
sa10. 11, however, the Dulltling or improvemenl IS Soltl wlthin One year o1 Com- CanOpy Type II ❑
plotlon, lho owner wlll have tha Durtlen o( proving ho/she tlttl not bullO or Im- Duct - Under Ground Building Approved By Dat�
p�ov! lo� the purpOic o� sale). .
❑ P, as owner of the property, am ezclusively conlractin9 with IlcenSeU con- Duct � Structurel flffrige�ation Sys[em ' Appliration Issued By Da[
lraCtoR t0 Conitfuct tna profett ISCc6on ]044, BUSInCis and PfOfe55iOns Cotle:
Tha Contractor'z License Law does not apply to an owner of prooerty who Duct - Ventilating ❑0.100,000 BTU ❑700,000 BTU �
bWltls or Imvroves thoreon, antl wno wntracts for such projects with a con- SUMMARV OF FEES -
tractm(s) bcense pursuant t0 Ihe Con[�acto�'s Llconsa Law). 1 am aware that Exhaust System � Multiple.❑ System Repair/Alteratian BUILDING PERMIT $ SMIP $ -
D�oot O( their Worker's Compensation'insurance znoultl be proviaetl to me. PLAN CHECK $ PERMIT
❑ I'am exempt untler Section e. d P. C, for fhis reason - Firepl/Pact. BIt. IC80 # Fire Dampers PLUMBING $_ ISSUANCE $
Date Owner Heating System & Ducting Registers � pLqN CHECK 25% 5 ENERGV P.C. $
i nereby certiry that � have reatl this aoP���ation and state that the abova ❑0.100,OOOBTU �100,OOOBT ELECTRICAL g GRADING $
iniormatlon is corr¢ct, t a9ree to comply wiN a11 city antl tounty ortlinantes .
antl state laws relating to builain9 constrvction, antl nereby authorize repre- PLAN CHECK 50% $�D�ICROFILM $ l� , r
sentativ85 0l Ihis city Io ¢ntar u0on the dbOve-mentionetl Orop¢rty 't0� - '
in5p¢CtiOn pulpo5 5. p • '
519nature ' DaizLO�i'�'dJ MECHANICAL .S TOTALFEE $
Drivers' �icense or 55 � Reinspection Fee $15 laue Fee ' S 3 PLAN CHECK 25% $ !yZ�
CMF 0865-46, rev. 10/B4 White - BUiltling; Canary - ApP���ant; Pink - Accountl0g; Goltl¢nrotl - Assessor
.GONSTRUCTION AND PLANNING POOL & SPA
�i " Date Inspector �� " Date Inspector
APPROVALS Permit # APPROVALS Permit #
t:[Temporary ElectricafService or Pole � 52. Pool & Equipment Location � "
�- •
2. Soil Pipe-Undrgrnd.�� 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' •
4. Electrical Condui[-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. � �
,
S.�Foundation 59. Gas Pipe�, � Undrgrnd., Test
:"9;Y,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. Electrica6Fina1 -
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 O Gas ❑ Oil .
23. Gas Pipe-Rough & Test � � 72. Underground Flush � ,.
24. RoofFraming 73. Undergrnd.StorageTankOGas ❑Oil .
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structuraq & 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. Electriql Power Meter-Final 80. FOOD CERTIFICATE ISSUED � �� ��
�
33. Final Electric Notes: ' •� -_ � � '
34. Final Heating & Air Conditioning �0.�,� �,� � . ' , � �. �
35. Final Gas Pipe-Test � , /,, � � � , '
36. Hood or Canopy
37. Final Factory Fireplace � � s �
.��
38. Final Plumbing - . ��" � �•
'G
39. Water Service-Final �'; � • � ��� • . �
4
40. Gas Service-Final � � ., :
41. Solar pomestic-Final � • �
� ' � l
.42. Backflow Preventer . . � • - ' • - ,
�:43. Backflow Irrigation ' - ' � . ...� � I
.44. Landscape Irripation System � , .
45. Sound Attenuation ' � � ,' ` � . , � " � �
�46. Handicap Regulations � , . l ; " '
r',
47. FINAL STRUCTURE & BUILDING � , : - • . ..'
48. Special flequirements Completed • • � ' • � , . �
49. Electric Release to Edison , - . ��+
50. Gas Release to Southern California Gas Co - . ,
57. CERTIFICATE OF OCCUPANCY _ , ,
No. � Date � ' � � �
' - _' ' I
Aoolicant to fill in all soaees exceot thosa within heavr borOer Iines anE sian all aoorooriate aeclarations. "
�_J
CITY OF COSTA MESA �G ONSTR U TION PER�I IT PERMIT NO TRACT NO. LOT NO. UNIT NO. , �
%'rojectAddress �. 45i�.�A7�4�1 `—A � 7961 10/22/87 6aG0 1
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR �
Applicant'S MBilin AddreSi _� ��� ❑ CONVEi2510N ❑ DEMOlISH ❑ OTHER q,p, # � ' 2ona
i
Owner's Name� �-' L�..�.���.n�� Phone DESCRIPTION OF WORK/USE OF BLDG. ;-i.`�—���- � ��� `�
^ Address ��e- �'`�� �' � - S Main Building: Accessory Building:
Arrh/Eng. License No. TVPE OF PERMIT GRA�ING FOUNDATION STRVCTVRAL T Front �
�lqdfe55 ❑ TENANT �ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL A Reaf . � N
COn[rattor'S Ndm' � Phon2 D � �THER _ ,
y/��,�/��� �� ��, PROJECT DESCRIP710N SQ. FT. OCCUPAryCY K Right G'
Aqdless�mailing�]�VGKQLT / CONSTRUCTIONTVPE ' VALUATIONS S Left R
City LiCense No. ���5� 2pNE ' GRAOING CU. VDS. aCRES Ping. Ref. # '- Parking fleq,/Provided ' EQ
LiGENSED CONTRACTOR DECLARATION '
1 ryereby affi�m [Itat I am licensetl untler prOvi5ion5 of Charter 9(Commentin9 Remarkz: �� �m � 3�$0O ' Planninq Notes: M
with section �000) ot Division 3 of the Business antl�Professions Cotle, antl .
my Iicense is m ful or e na eftect. �� t'O6� � � T
LJCense ass ' _ enSG No. � 5
Date Signature PLUMBING FEES - '
WORKERS' COMPENSATION DE RATION Bd� Siflk ShOW¢�S ELECTRICAL � FEES
1 hCreby a/fi/T that I have a certlfi of consent to 5 I insure or a ce/NficatC '
� of Wo�ke�5' Compensation Insurance, o� d ce�tltie copy [he�eof (Section
3800, Lao. C�.! ,n �.,,�� Backflow Preventer Service Sink Automatic Washer Trensformer � 15-50 KW
� VJi`�5��� 4�7eFw� ❑50+KW
Poncy rvo. Company • Backtlow Irrigation � Sewer Cap Construction Pole Sub.
�Certitietl <Opy i5 hereby tumishe
C rt'fi o riiea with tne ci B udinq Di � . Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Ddte� Applicant
� EXEMPTIO�RKERS' CO ENSATION DECL ATION Cleri(i2f5 - Solar ColleCtors Diihw35hef _ Meter ❑ove� 100 amp5
(This section neetl mt be completetl i e Oermit is for one ntlretl (5300) or
` �¢gs�, Dishwasher Solar Pipin9 Dryers ❑Gas �Electric . Sub Panel .
\ � Cer[ify tM1a[ in th¢ Oertormance of the wo�k /Or which Nis pe�m�t i5 ISSUetl, I
snall not employ any person In any manne� so as to becorne Subject to the Drinking Fountains ' Solar Tank � F2n
•\ Motors �0-1 HP O1 %- 8
��� Workers' Compensatlon 1_aws ot Califarnia.
�� Date Si9nature Floor Drains Swimming Pool w/Spa F,q,U. Inc.Solar �9-15 HP 016�15+
^I NOTICE: Ii, after making this tleclaralion, you should become subject lo the
x Workers' Compensa[ion provlsion5 of tM1e Labor �otle, y0u must forthwith FI00lSiOkS Urinal ;� Fi%tu�ES Microwave
�\ camply wi[It such O�ovisions or tnis p¢rmit shall be tleemetl �evOketl. '. _
1��bNSTRUCTION IENDING AGENCV Gas Sefvice Outlet5 Weter Closet �D¢vic2 Boxes Pole Li hb ,
� � hereby a(/irm thai tnere is a construttion lentlin9 a9ency tor the pertormance 9
of [h¢ work fot whictt thi5 Pe�R�it I5 issuetl (Section 309] Civ. C.) ��terceptors WBf¢f HEdt¢� �uLIEtS
Lentler's Name Range
Lentler'sAtltlress - KitchenSink • WaterService Switches g�9�, � -
OWNER BUIIOEN �ECLARATION -
I hereby altirm t0al I am exempt from the Con[ractor's Licenze �aw for the Lavatories Auro-Wash - Garbaqe Disposal Standing Sections
�011owin9 reason (Sectlon 7031.5 Buslnessantl Professional Cotle: Any city or ' -'
county wnicn requires a oermit to construct, alter improve, aemolish or repair P-Trep Laundry Trays ' F' Generator �0-5 KW �5-15 KW Trash Com a�tor
aryy st�ucture� prio� to IfS i55uanc¢, dlso r¢quires t�e applicatl[ for such pe�mil , P
tp file a Siqnetl statement [hat he/she is Ilcensetl pursuant tD the p�ovisions of Roof Drains
the Contraclor's License Law (Chapter 9(<ommendng with 5ection 7000) of
I Division 3 of [he Busin¢ss antl Prof¢ssions Coqa) or that he/she is ex¢Tpt
� IhCrefrom antl Ne basis for Ihe allegeC ¢zemption. Any viOlation ot Section
/ �03L5 by any appllCant fOr a permi[ subjeCts the aOPliCant to a civil
' �enalty of not more than five buntlretl tlollars ($500).
U I, as owner of the pro0erty or my employees wHh wages as tbeir sole ReinSpBction Fae $15 ISSu6 Fea $ 3
�om0ensation, will tlo Ihe work, antl the Structu�¢ Is not in[entletl or Ofte�ed
�or sale (Section �046, eusiness anE Profezsional Cotle: Tne Contractor's MECHANICAL Reinspection Fee $15 I�ue Fee $ 3
FEES
t,icense law does not apply to an owner ot a property who builtls or improvez
�hereon, ana wno tloes sucn work himself/herself or through his or her own . DEVELOPMENT SERVICES REQUIREMENTS:
employees, Provitletl that such Improv¢ments are not intentletl or offered for BOIIC� HOOd 0/ Typ¢ I,❑ ,
sale. If, however, the builain9 or improvement Is soltl within one year of com- Canopy Type I I ❑. Zoning Approded By Date
Pletion, tne owner wlll have lhe bu�tlen ot proving he/she tlltl m[ builtl or im- DUC[ - Und¢f i�i�0u0d BUilding Qpproved By Date
prOm fo� tho purpose Ot sale).
❑ I, as owner of [he property, am exclu5ivery tontracling with,lirensea con- Duct - Structural Re(�igerati0n System Appliwtion Issued By Dat
lraciors to construct the prolect (Section 7044, Business antl Professions Cotle: .
7he Convactor's License taw tloes mt appty to an owner of proPerty who Duct - Veniilating ❑0�700,000 BTU ❑100,000 BTU - , � -
builtls or improves ther@on, antl who contracts for such orojects with a con- SUMMARY OF FEES
tracior(s1 iicense pursuant to the Contractor's License Law). I am aware that Exhaust $ystem ❑ Multiple ❑ System RepairlAlteration BUI�DING PERMIT. $ SMIP $
proot of their Worker'S Compensation insurante shoultl be provitlee to me. _ PLAN CHECK � $ PERMIT -
� I am exempt unGer Section e. & P, C. tor this reason Firepl/Fact BIL ICBO # Fire Dampers PLUMBI NG $ �SSUANCE $
Date � � owner Heating System & Ducting Registers �. � PLqN CHECK y5% $ ENERGY P.C. $
i hereby certity that i have read this appiication ana state that the above ❑P100,OOOBTU �100,OOOBT ELECTRICAL $,�.� GRADING S
iry/ormation is corract. I agree to comvly with a11 tlry ana �ounty ortllnances - /�
antl state laws relatin9 t ulltlin9 tonstNctlon, antl hereby authorize reore- � , - PLAN CHECK 50% $�%�.{�__ MICROFILM $�
5¢nta[iv¢5 [his clty en[er upon tne above-mentionetl pwperty }o� . ,
�nspectlan u oses. �ZZ_ � MECHANICAL -$ � TOTALFEE $
$ignatwe Data . .
Orivers' LI e se or 55 � Reinspection Fee $�5 Isue Fee $ 3 PLAN CHECK 25% $ .
CMF pg65-46, rev. 30/84 Whl[e - Builtling: Canary . Applicant Pink - Accounting: Goltlenrotl - Assessor .
CONSTRUCTION AND�PLANNING . POOL & SPA
APpROVALS Perrtiit# 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-Undrgmd. 54. Forms I
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 Condult-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test I
9. W�ter Pipe-Undrgrnd�' 60. Backwash Lines, P-Trap, � Undrgrnd.
r .•
10. Structural Floor System 61 ' APPROVAL TO DECK '
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
i,
12. Sewer Cap � 63. Heater & Vent-Final ,
13. Roof Drains � 64. Plumbing System - Final �
14. Rou9h 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
i
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test '72. Underground Flush
24. Roof Framing 73. Uhdergrnd.StoregeTank ��G9s ❑Oil `�
25. Roof Sheathing -� � 74. Overhead Hydro . � ,
26. T-Bar Ceiling (Strucwral) & 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 = i.
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED "
�.
33. Final Electric i3�ay' � � 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 , r '
40. Gas Service-Final � '
41. Solar pomestic-Final � �. :
�.
''42. BackflowPreventer �-' ' '�� r ,
�.. ' L .
•43. Backflow Irrigation � - • � ''
I. '�
44. Landscape Irrigation System ` � � . " �
45. Sound Attenuation - ' � � ".
b
�46. Handicap Regulations ' � -- . - .
47. FINALSTRUCTURE&BUILDING . r �• ',
48. Special Requirements Completed , .. -'`� �� •� ' I
49. Electric Release to Edison . • .- I
50. Gas Release to Southem California Gas Co � '� � �.
51. CERTIFICATE OF OCCUPANCY ..
No. Date ' '
_,
AOP���ant to fill in all spaces within heavy Oortler lines ana sign al� aOG�ooriata aeclarations. '
�� GTY OF COSTA MESA PEgq� I'f NO. TRACT NO. LOT NO. BLDG. NO. - ' ' ' ' '
; CONSTRUCTION PERMIT Y o�o� C7 S � , • � I 62' I�04/82• "' - 5.00 ; Tl
Project Address j L�! JC � .T�.,V(PE OF CONSTRUCTION � - -y �� ' ' � � • ' �� r � � �
OWnerS� � Phone ' IJSI NEW ❑ ADD ❑ %1LTERATION � "
Addl255 - ' " ' ' ' ' - ' - � REPAIR ❑ CONVERSION ❑DEnnOuSH 2ONING REGULATIONS , -
Arch/Eng.' - � License Na: � � orHER . _
Addl¢55 � � � -' . , _ OESCRIPTION OF WORK A'P' � � � -
' ZONE PLNG. REF. � ,
� Contracmr ' Phone '�TVPE OF PERMIT � 5E78AC C 7. ��OBP���v��rvE �
Address �_��� , � - " � - -' ❑GRADING ❑ FOUNDAT�IOyN ❑STRUCTURAL 51 VARD - - ' ' -
GCENSED CONTRACTOR DECLARATION � -� '� TENANT-O ELECTRICAL' yoPLVMBING ❑MECHANICA L5IDE VA - - -
I hereby affirm tM1ct I am litensetl untler provizions of Charter'9 (com- � � � - - . RIGHT .
menUng with Settion 7000) ot Dtvislon 3 ot lhe -Business anG- � 0 OTHER� - . _
Protessions Cotle antl my Ilcense is In full forte antl effect. �� - REAR YARD (TO P/L)
�} PROJECT DESCRIPTION.
License Class /, ''�� LicenSe No.����a !� , �, � PKG. SPFiCE RE�. PROV IDED -
Date ' - • 519nature' ' ' ' _ SQ. FT. ...., ' .- ' ' . . . _
I STREET WIDTH PARK FEE $
' WORKERS'COMPENSATION�DECLARATION - - - � � OCCUPANCV_CONSTRVGTIONTYPE _
I hereby attirm that I have a ceitlfiwta of <onzent to selt-insure or a. VALUATION ZONE -` � Z�NING APPROVED BY DATE_
`certifitdte'of Wolkefs' Comp¢nSdtiOn'InSu�ancel'ot-a-certltietl copy"- - - • --
Ihereof (Sec[ion 3800, Lab. CJ. , � /� A �' .GRADING CU. YDS. ACRES SPEdALCONDIT10N5: -
IICYNo./O//.JO E ComPSnY�l.Alli��v �' � it : - - . " ' . '
Certltietl copy is hereby�turnishetl. -- � - -.- - �. �. REMARKS: ' . � �
Certifietl copy is filea with the city Builtling Divizion. � _ - . ' . , ( �
- %EMPTION FROM WORKERS' COMPENSATION DECIARATION � --' - ' " "- ' - - ' - ' - -
(This section neetl-mLbe,completeC it.the pe�mit B.fo� one huntl�etl _ _ _ .. . ._ .. . _ _ _- _ � _ ' '
(����� OI IC55). ' � '. ( r. . J -.: � ' .. . _ " " ' '
-L cerbfy thaf In-t�e.p¢rtormance�Of the wo�k fo� which this pe�mit is __ ._ _.
Issuetl, I shall not employ any person in any manner so as to become ',PLUMBINGJ � � PCAN CHECK � ELECTRICAL PLAN CHECK
subje<tto tne Workars' Compensation taws of. Ulifomla. '_ _ . . _ ' " _ . . ._ _
- Date Signature� BATHTUBS SHOWERS - -
NOTICE: If after;makin9 this tleclaration, you shoultl become iub�eci ' TOILETS ?' � - URINALS � GENERATOR 0-I KW=1-30 KW,
to the Workers' Compensation provislons of the Labor Cotle, you mus[' � TRANSFORMER -�
forthwith comply�with such prov�sions or this permit shall be tleeme0 LAVATORIES DOUBLELAVS -� APPLIANCE - 30-50 KW=50 + KW' -''
revoketl.— -.. _ ___ _.. _ . - . _ . -- �� - ' KIT. SINKS � DISHWASHERS - -' - - - MOTORS' - -' - -"'� '
CONSTRUGTION LENDING AGENCV . 0-1 HP_1�1'0 HP _^I
I her¢by aifftm tbat [here is a con5truction I¢ntling agency 1or the p¢n - -- - pNC.50�AR)- 30-50 HP_^50-*'HP ' ��- ��
formance of the work for whlth this permi[ is izsuetl (Settion 309] SERVICESINKS I"�.:_ SUMPS'� ' '�
Civ: C.)- ' - -- -- - ' " "' - --- ' � FLOOR SINKS FIOOR DRAINS - � FIXTURES OUTLETS SWITCHES � � �
Lentler's Name ' � �
Lentlef's AtltlIe55
� � --'� �DRINKINGFOUNTAINS '�� � y�� � '� � - � GASTUBESIGNS-- ' `- --"`
'OWNERBVILDER-DECLARFTION' "'--- - ' INTEftCEPTORS CLARIFIERS POLELIGIiTS - � � - � - - " -
I hereby aHirm t�a[ I am exempt trom [he Contractor's Llcense Law tor
Ihe following reason (Settion ]031'.5'Business antl Professlons Code:' SWIMMING VOOL � P�TRP.P-� � - -- - ' - �- ' " -- �- - - -
Any city or county which reqWres a permit to construct, alter, POLES METERED • UB' • 1
improve, tlemolish or"repair any'struc[ure, prlor to I[5'issuance, also re= -yyqTER SERV ICE � ALTERATION � � PANECS �— - MAIN - SUB .'- --- --- —
qWr¢5 tM1C ap4���ant lor SUCh perml[ to tile a signetl Stdt¢m¢nt Ihat he (
is Iicenietl pursuanl [o the provislons ot the'Contractor's License Law GAS SERVICE � OVTlETS SERVICE �'� -' -'- AMP ' ''- �
(Chapter 9(tommencing with Section 7000) ot Dlvision 3 oi [he �^
9uslness'antl Prolessions Cotle) or [hat he'is exempt therefrom and tne yyqTER HEATERS BTU OUTPUT - -� - - ' - -"� ""' -' " _ ' '- 1
asis for [he allegetl exemption. Any violatlon ot 5ection 1031.5 by
applicanC for a'permit'suD�etts [he applicant to a clvlf penalty' -SEWER CONNECTIONS ' ��� ' ' ' � -' " ' - -- - ' ' ' +
nol more than five nuntlretl tlollars (55oo). n
I, as owner of the Oroperty or my employees with wages as their -SOLAR TANK � � � COLLECTORS � �� - - - " ' " " " ' ' '
olo.compenwtion, will.tlo-lhe�walk, aOtl thC 5[luClurC i5 nOt intCntl¢� , _ ��'
or otferetl lor sale. (Sectlon 7044, BuSiness an0 Prolessions CoCe: The SOIAq PIPING SVS. . �SSUE FEE � � �� � . -"
Contrdctor'S Licenza Law tloe5 not apply to an owner oi a property _ _ . _ _ _
who builtls or improves [hereon, antl who tloes suth work himself or ISSUE FEE ' APPLICATION APPROVEO BV '- " DATE'- ^
-cn.ouyn his Own.¢mployees,.provitl¢tl_[hat suCh.ITprOvemen[s a�e noL
intentletl or offeretl for sale. It, however, the bWltling or improvement MECHANICAL PLAN CHECK SUMMARV OF FEES •
is soltl withln ono year of completion, the owner will have.the burtlen �
of provin9 he tlitl nol builtl or improve for (tte pur0ose of sale). BVILDING' - --' ' ' " ' �" �
iF1EATING SVSTEM 0:300,000 BTU PERMIT S ��SMIP' S
'0 1,' a5 own¢r Ot 'the property, aT ezclvzivery con[racting- with ' AND DUCTING �� � � - � ' - " -' ' '-
licensetl contractors ro construct the project (Section ]044, Businesz ]OO,OOO+BTU PLANCHECK S . PERMIT = ,.f,
'antl Protesslons Cotle: The-ConVactor'r Cicanse I�w tloes not apply to � - _5- �n -- - ISSUANCB E - ^ .
an owner o( property who build5 or improves thereon, antl who <on- REFRIGERATION 0-300:000 BTU PLUMBING b .�
tracts -from'such-projects with a contractor(s) licesnetl purSuanP [o � SVSTEM " - "- --�-- - - - - - -- - � -� � GRADING ��S - 1
theContractor'sLicenselaw). 100,000+BTU PLANCHECK.S" r: ,, .;f� ,�;�, �
❑ I am eicemp[ untler Seclion - B. & P. C.�for [M1li gOILERS H7U ELECTRICA� y , - s� �
. reason '" '- -' - " "' - '" - . - ' - - ' . MICROFILM E.
SVSTEMREPAIR,ALTERATION �PLANCHECK E . , � 1
�Da[e - - - Owner - � - - - - - - - -• .. ' TOTAL FEE S � 'n`� �
J hereby certitythat.l bave reatl lhis a EXHAVST SVSTEM MULTIPLE � MECHANICAL E v" .
pplication antl.state that the,above_ _ _ ' LE55 AD "
Information is correcL I-agree to comply with all city antl county - "PLANCHECK $' � �VANCEPC E_ �
ortlinances antl,state laws relating to Wnstruction, antl hereby authorize_ �1 . r „ , -� -� . .�; `
representatives of thi5 city to ente� upon the above meniionetl i -' ' "� �
.prooerty..for i eC fpnb yuryp�oses. _ � L 1
Signatu�e �� ��C.G' �A�-'--' Date l� -�� kl - '� � � �- _ FINAI FEE b �
Drivers' licen5e or 55 � �� /� " ' ' ' ' ISSUE FEE"' '- � '" ' - --' - ' ' - - - ' ' - '- " - - - " - -. .
CMF 0865-46 White-Builtling; Canary-Applicanq Pink-Accoun(inq; Goltlenrotl-Asseszor
' o CONSTRUCTION AND PLANNING . POOL & SPA �
APPROVALS Permit# -2L� Date Inspector' qppROVALS Permit# �� Date Inspector
1. Temporary Electrical Service or Pole ' 43. Pool & Equipment Location - -- - � • - -- -- - -• •-
Soi ipe-Undrgrn 44. Steel fieinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bondin9
. tee ein orce 4). Rou h Plumbin & Pressure TEst � �
6. Electrical UFER Grn � 48. APPROVALTO COVERGUNITE -- � -- �
7. ootings ' 49. Electrical Conduit•Undr rn �
6. Foundation � 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgm 51 . Backwash Lines P-Tra ' fl' n r r -�
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House Connection / �Z 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. RoughPlumbing • � """"-""" - '^"' •'
14. Rough Electric-Conduit � � �56. Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final
16. Rough Heating & Air Conditioning � encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test - 60. POOL/SPA SYSTEMS FINAL ,
20. Roof Framing �
21. Roof Sheathin
22. Frameand Flashin -. - NOTES:
23. Insulation '
24. Lathin & Siding
25.. Drywall Nailing � � ��
26. Plaster Brown Coat � � -
27. Electrical Power MeterFinal � '
28. Final Electric
29. Final Heating & Air Conditioning �
30. Final Gas Pipe-Test �
31. Final Plumbing '
- 32. Water Service-Final
33. Gas Service-Final : � _
34. Solar pomestic-Final
35. Landsca e S rinklin S stem '
36. Sound Attenuation
37. Handicap Regulations _
38. FINAL STRUCTURE & BUILDING -
39. Special Requirements Completed �
40. Electric Release to Edison ' ' -
41. Gas Release to Southern California Gas Co. -
42. CERTIFICATE OF OCCUPANCY
' � No Date - -
- = c. •,
Applicant lo till in all
CITY OF COSTA MESA '' aeRnniry�
CONSTRUCTION PERMIT Y�
wltnin heavy b r Iinas ane zi9n all aDPrapriate aeclarations.
' TRACT NO. LOT NO. � BLDG. NO.
rm�eci nuwcv,>3 S f�iJi /�40' 30� T�.V/PE OP CONSTRUCTION
Ownef ���,� - � P one �' qLNEW ❑ ADD '❑ ALTERATION ' ' --
Addf2ss " ' ' � ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
Arch/Eng. ' - License�No. � ❑ OTHEft
DESCRIPTION OF WORK
� Address " ' -' � - - ' � � � - �
Contrecmr � Phone .� �3S TVPE OF PERMIT � �
�AddlKs �!'�,J r � +-Gsv- ❑ GRADING ❑ FOUNDATION ❑ STRUCTVRAL
LICENSED CONTRACTOR DECLARATION � - � TENANT O ELECTRICAL I�PLUM6ING� OMECHAN
I hereby atfivm that I am Iicensetl untler provisions of Charter 9(com- .
menCing with SeCtlon 7000) of DlVislon 3-of the Buslness antl ❑ OTHER - --
� c = .`=y
ZONE
Professions Coda, 'antl my Ilcense is in tull torce antl e(fect. REAR VARO (TO
PROJECT DESCRIPTION
Litense Class - �� I�icense No. � � . . ' PKG. SPACE REQ.
Date �'��'���- Si9nature �:'" 54; FT. - . . . .. . _
WORKERS' COMPENSATION DECLARATION OCCUPANCV_CONSTR V CTION T.V PE
I hereby affirm that 1 have a tertificate of consent to self-inzure or a. VALUATION � ZONE � �
tertifiwte of Workers' Compan5ation Insurance, or a certi�ietl�mpy - �- �- -�
thereof (Sec(ton 3 00 Lab.s J. ' -f���.r .,� � GRADING CV�.�VDS. ACRES
�cy No. /[J� o.�n F Company//t'c'ci[i-^Q�%v
ertifletl copy is hereby furnishetl. -� -- - REMARKS:
Certifletl copy is filetl with the city Bulltlin9 DlviSion. ,
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � ' -' '
(This 5¢ction neetl nOt b¢ Comple[¢tl.if the permit iifor_one huntlred
S$300) or less). � � - � �
certiry that in the parformance of the work for which this permit Is __ _
issuetl, I shall not employ any person in any manner so as to become PLUMBING •.. , -PLAN CHECK '
subject to the Workers' Compensation laws of California. .__ _ .
Date Signature B/�THTU85 SHOWERS
NOTIGE: If after �riaking this tleclaratlon, you shoultl become subject. TOILETS' " VRINALS' '� -�
to thB WOrkers' Compen5ation proviSiOns Ot th¢ Labor COtle, you mus£ .
torthwlth comply with such provisions or this permit shall be tleemetl LAVATORIES DOUBLE LAVS
revoketl. � -- - - � .
CONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS"
1 hereby affirm tha[ there Is a constructlon lentling agenty !or the per- SERV ICE SINKS , ' SUMPS � -�
tormance of the work for whith thiz permit is Issuetl (SecNon 3097
Civ. C.). � � FLOOR SINKS � FLOOR DRAINS �
Lentler'S Name _
LenOer's Atltlress �RINKIfVG FOUNTAINS ���i,�,���'
OWNER BUILDER DECLARATION � � � � � � - � �NTERCEPTORS � CLA IFIERS
I hereby affirm that I am exempt from.the Contractor'S License Law for
the following-reason (Section 7031.5 6uslnes5 antl Professlons Coae: SWIMMING POOL � P TRAP " - '
Any city or wuniy wbich requires a permit to construcq alter,
Improve, tlemolisM1 or repair any structure, prior to its issuante, also re- yyqTER SERV ICE ALTERATION
quires the applicant ior such permrt to file a si9�etl statement that he
is licensetl pursuant [o the proviiions of the Contractor's License-Law GAS SERV ICE OUTLETS
(Chapter 9(commencing with Section 7000) of Division 3 of•the
8u5ine55 antl P�ofession5 Cotla) or that he IS ex¢mpTfh¢refrortl antl th¢ yyqTER HEATERS BTU OUTPUT
is for the allegetl exemptlon. Any Nolalion of Sectlon ]031.5 by
applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
ot more than five huntlretl tlollars ($500).
1, as owner of the property, or my employees with wages as their SO�AR TANK COLLECTORS��- '
sole compensation, will tlo the work, and the structure is not intentletl
or offeretl for sale. (Section 7044, Business and Protessions Cotle: The SOLAR PIPING SVS. �/ty,!p� ,/'�'
ConVactor'S License Law tloes noi apply to an owner.of a property _ .
who builtls or improves thereon, anG who tloes such work himself or ISSUE FEE "" U' ' �
through his own amployees, provltletl tM1d[ sucb imp�Ovemen[5 are not
IntenaeE or offered for sale. If, howeveq the bWiding or improvement MECHANICA� PLAN CHECK
Is Soltl within on¢ year-of completion, the owner will hav¢ the burtlen
of proving he tlitl not builtl or improva for the purpose of sale). HEATING SVSTEM 0-300,000 BTU
❑ I, as owner of tne property, am exclusively contracting wiih �AND DUCTING '
licensetl rontractors to construct the prolect (Sectlon 7044, Business 100,000+BTU
antl Professions Cotle: The Contrattor's LiCense Law tloernot.apyy to
an owner of proper[y who builtls or Improves thereon, antl wno <on- REFRIGERATION 0-100,000 BTU
tracts from such pro�ects with a-contractor(s) Ilcesnetl pursuant to SVSTEM ' ' �
the Contractor's License Law). 100,000 + BTU
❑ I am exempt untler Section B. &" P. G. for this BOI LERS BTV
reason
Date - Owner SVSTEM REPAIR,ALTERATION
�I hereby ceriifythat I have reaC this appliration antl state ihat the above. EXHAUST SVSTEM MULTIPLE
informa[lon is co��eCt. I agr¢e t0 comply wltM1 all city antl county
ortlinances antl stafe Iaws.relating to.construttion, antl hereby authorize
rep�esentaUves Of Ihis city t0 entEr upon Ih¢ above mentionetl
prope�ty for Sp6ct pu�poses - . - r'
J
Signature. ' � � �"� Date � q Q /
Drivers' License or 55 #�� �SSUE FEE
CMF 0865-46 White-Builtling; Canary-Applicant: Pink-Accounting; Goltlenrotl-Asse55or
LATIONS
ZONING APPROVED BY
SPECIAL CONDITIONS: �
ELECTRICAL - P�AN
IDED
FEE
K
�.
GENERATOR 0-1 KW_1-30 KW �
TRANSFORMER � ��
�APPLIHNCE -10-50KW_SO+KW -'
MOTORS' 0-1 HP_1-30 HP '
(INC.SOLAR) 30-SOHP SO+,HP- - �
�FIXTURES�� � OUTLETS SWITCHES -
GAS TUBE SIGNS ' ' -
POLE LIGHTS � " ' .
PANELS MAIN SUB
ISSUE FEE '" " - I I .
APPLICATION APPROV ED BV -- DATE
SUMMARY OF FEES � �,
BUILDING ' - � - � -
PERMIT $ SMIP $
PLAN CHECK $ 'PERMIT
�y��, ISSUANCE $ '
PLVMBING $SOJ1L'� . �
GRADING $
PI.AN CHECK $ , ,
ELECTRICAL $ "� $
PLAN CI-IECK $' MICROFILM $
MECHANICAL $" TOTAL FEE.$
PLAN CHECK $ - LE55 AD� .
VANCE PC'S _
• FINAI FEE $ (,y��
Tl.
CONSTRUCTION AND PLANNING POOL & SPA - ,
APPROVALS Permit# ���� Date Inspector qppROVALS Permit# Date�� Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location �
i ipe-Undrgrn � � 44. Steel Reinforcement
3. Electrical Conduit Utility,-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
tee ein orce 47. Rou h Plumbin & Pressure Test
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE •
7. Footings - 49. Electrical Conduit-Undr rn
8.' Fouridation. � 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Unilrgrn " 51. Backwash Lines P-Tra �� ndr rn -
10. StructuralFloor.System. 52. APPROVALTODECK ' '
11. RFepeFt�y�Sew H �(s � � 53. 8ackwash & Rece tor-Final
12. Street Sewer Connection ' 54. Heater & Vent-Final �
13. Rough Plumbing. ' - ' -
14. RoughElectric-Conduit - ' � •�•56. Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final
16. Rough Heating & Air Conditioning - • encing & Access Approval
17. Ducts in Structure • APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing '
21. Roof Sheathin
22. Frame and Flashin NOTES:
23. Insulation � -'
24, lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final '
28. Final Electric �
29. Final Heating & Air Conditioning
� 30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations -
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed '
40. Electric Release to Edison
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATEOFOCCUPANCY
No Date
AGO���ant to fill in all s
CITY OF COSTA MESA PERMIT NO.
CONSTRUCTIONPERMIT ` "�''
Addrea
within naavy bortler Iines ana si9n all apD�ooriate eeclarations.
' TRACT NO. LOT NO. �BLDG. NO.
TVPE OF CONSTRUCTION
'hon �EW ❑ ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
No. ❑ OTHER
�. i _ _ DESCRIPTION OF WORK
Contrecror ��.1 �V�y}� Phone ]r�/!i TYPE OF PERMIT
� Addreu � lh9_ ❑ GRADING ❑ FOVNDATION ❑ STRUCTURAL
� LICENSED CONTRACTOR DE0.ARATION ❑ TENANT�ELECTRICAL OPLUMBING ❑MECHAN
1 maniiny awitn sectlon 7000j se�tl uOIVI5lonov3siot5 the nBusln si�a tl ❑ OTHER �1 ..
�' Protessions Cotle, antl my Ilcense Is in tull (orto antl eriect.
� ucensepoCI z�—�� i s N PROJECT DESCRIPTION . .
O � �//X/ a,.�.n�.oC� _ ��� SQ. FT.
Date -
V WORK RS' OMPENSATIONDECLARATION - OCCUPANCV_CONSTRUCTIONTYPE
I hereby atfirm tnat I have a certificate of consent to sel(-Insure or a ,VAIUATION ZONE
certiflcate of Workers' ComDensation Insuranca, or a certifletl copy -- � � ..
thereof (sgq tion 3800, Lnb. C.). GRADING CU..VDS. ACRES
olicY No CSkGVO-c'Ah ComPanv � '
Certlfietl <opy is hereby turnishetl. -� - - � REMARKS:
rtifietl copy is filetl with the city Builtling Divislon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' � �� '
(This section neetl not be mmpletetl if the permit I5 for one huntlretl . , _ - • _ ,
�.4SOO� OI IQ55). . . �`
ClrLfy.that.ln the performante Ot [he work tor which this permit I5-
Issuetl, I 5hall not employ any person in any manner so as to become PLUMBING �'� PLAN CHECK �
tubject to the Workers' Compensation Laws of_�alifornia. - ' ,
�ate Si9nature BATHTUBS SHOWERS
NOTICE: It atter making fhis tleUaration, you shoul0 become subject TOILETS . . URINALS
[o the Workers' Compensation provisions of the Labor Cotle, yau mus[ LAVATORIES DOUBLE LAVS
fOrthwith mmply with suGh provisions or tnis permit shall be tleemetl
revoketl.
CONSTRUCTIONLENDINGAGENCV KIT.SINKS� DISHWASHERS
I hereby afflrm that there Is a construction lenaing agency tor the per SERV ICE SINKS � ' SUMPS "
formance of the work tor which tnis permlt is Issuetl (Settlon 309]
���� �•�• FLOOR SINKS FLOOR DRAINS
Lentler's Name
Lentler's Atltlres5 DRINKING FOUNTAINS
OWNER BUILDER OECLARATION � � INTERCEPTORS CIARIFIERS
I hereby atfirm [hat I am exempt from tne Contractor's Llcense Lnw for
the �ollowing rea5on (Sectlon 7031.5 Business antl Protesslons Cotle: SWIMMING POOI ' P TRAP ' '
Any city or County whlcM1 repW�es a permit to cOnStruGt, alte�,
improve, tlemolish or repair any ztructure, Prlor to it515suance, also re� yyqTER SERV ICE ALTERATION
quire5 the appllcvnt tor zu[h perml[ to file a slgnetl Statem¢nt that h¢
Is Iicensetl pursuant to the provlsions of the Contrac[or's License Law GAS SERV ICE OUTLETS �
(Chapter 9(commencing with Sectlon 7000) oi Olvision 3 ot tne
Business antl.PrWessions Cnae) or Ihal he Is exemp[ [M1¢�lf�om antl tne yyq7ER MEATERS BTU OUTPUT
basls for tM1e allegetl eaemption. Any vlolatlon of 5ectlon ]031.5 by
appllcant for a permit subjects the applicant to a Uvil penalty SEWER CONNECTIONS
not more than Iive hundretl tlollars (E500).
1, as owner of (ne property, or my employees witb wages as thelr SOLAR TANK � COL'LECTORS -'
SOIB COmpenSdtion, wlll tl0 tha wofk, antl lhe StruCture iz nOt Intentletl
or offered for sale. (Section 7044, Bu5ine5s and Rotezsions Cotle: Tne SOLAR PIPING SVS.
Contractor'z LI<ens¢ Law tloe5 not apply to an ownet of a property , .
who buiitls or improves thereon, antl who tloes such work hlmself or ISSUE FEE '
throu9h nls own employees, provitletl [hat such improvements are not
intentletl or ofleretl tor sale. It, however, the builtlin9 or Improvemeni MECHANICAL PIAN CHEGK
Is soltl withln one year ot completlon, the owner will have the burtlen
of proving he tlltl not builtl or imorove for tne purpose of sale�. HEATING SVSTEM 0-100,000 BTV
❑ I, as owner ol tne property, am excluzlvely contractin9 with ANDDUCTING
li<ensetl contractors to construct the projeci (Sectlon 7044, Business ]00,000 + BTU
and Profe55ions Cotle: The Contracror's License Law tloes not apply to ,
an owner of property wno builtls or improves thereon, antl who con- REFRIGERATION 0-100,000 BTU '
trac(s from su<h pro/ett5 with a contractor(5) IicesneU pursuant lo SVSTEM - !
the Coniraclor's License law). 300,000 + BTU '
❑ I am exempt untler SecOon B. 3 P. C. lor this BOILERS BTU
reason -
Date Owner SVSTEM REPAIR,ALTERATION
1 hereby certify that 1 have reatl tnis application antl state that the above EXHAVST SVSTEM M VLTIPLE
Informalion is co��ect. 1 ag�ee [o comply with all city antl county
ortlinances ana state laws relatinq to construction, antl hereby authorize
rep�esentatives of lI]Is city yo enter upOn th¢ above ¢ntionetl
property. fo�ns �'{an-�}uruyo5es. . � LU �
Sl9nature ��✓/A Date �
Drivers' License or 55 x� . ISSUE FEE
CMF 0865-4fi White-Bulitling; Unary-Applicant; Pink-Accounting; Goltlenrotl-Assessor
� '= -: '
ZONE
REAR VARD (TO
PKG.SPACE REQ.
y764 a/��nj^�1
ZONING AGPROVED BV
SPECIAL CONDITIONS:
PLNG. REF, qf
PROVIDED
PARK FEE E
ELECTRICAL P�AN cHEc
GENERATOR p-1 KW_1-lO�KW _
TRHNSFORMER .
APPLIANCE 30-SOKW_SO+KW_
MOTORS 0-1 HP_1-10 HP _
(I NC. SOLA0.) 30-SO HP SO + HP _
FIXTURES � OUTLET53 SWITCHES
GASTUBESIGNS ' -
POLE LIGHTS '
PANELS MAIN SUB
SERVICE ' ' AMP
F�25 TI
ISSUEFEE � `�j �—'
HPPLICATION APPROVED BV DATE
SUMMARY OF FEES ,
BUILDING
PERMIT S SMIP' S
PLAN CHECK E PERMIT .
� ISSUANCE 8
P�VMBING S
GRADING S
PLANCHECK b
ELECTRICAL E� b
PLANCHECK' g' MICROFILM $
MECHANICAL $ ' TOTAL FEE y
PLHN CHECK E " LE55 AD-
VANCE PC $ _
FINAL FEE § �+ '
CONSTRUCTION AND PLANNING POOL &"SPA •
APPROVALS Permit# -F I Ia5 Date Inspector qppROVALS Permit#'-_ Date Inspector
1. Temporary Electricai Service or Pole • 43. Pool & Equipment Location ' ' •
. il ipe-Undrgm 44. Steel Reinforcement ' - � -
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn v_$,� 46. Electrical Bonding -- '
. tee ein orce 47. Rough Plumbin & Pressure Test ` '
�6. ElectricalUFERGrn 48. APPROVALTOCOVER-GUNITE �
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Wa[er Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn �
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection - 54. Heater & Vent-Final
13. Rough Plumbing - �
14. Rough Electric-Conduit �56. Electrical-Final
15. Rough Electric-Wirin � li �J 57. Solar System-Final
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure • APPROVED FOR PLASTERING �
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. Frame and Flashin NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. Final Electric �
29. Final Heating & Air Conditioning �
30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final �
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40.' Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date -
�
Aooi�cant m fill in all soaces exeeot those witnin heavy OorEer Ilnas anE si9n al� avoravriate aeclarotions.
� � PERM T O� TRACT NO. LOT NO. UNIT NO.
CITY OF COST MESA CONSTRUCTION PERMI�T •
Projec[ Address ��f ��^bi�. /rwTa T�i/qv
Applicant'S Mailing Add�25S��yORe��VM 5/� AAio�i:Ld TVPE OF CONSTRUCTION NEW ADD � ALTERATION REPAIR �� '
❑ CONVERSION ❑ DEMOLISN ❑ OTHER q,p, q�b ���� 4�� ZonB
qb
Owner's Name ���� •�� Q�+feuLaef Phone DESCRIPTION OF WORK/USE OF BLDG.
Addreu �A �"`� S Main Building: 1` Acceuory Building:
Arch/Eng. Licenie No. TVPE OF PERMIT GRADING FOUNDATIO�,�N7 STRUCTURAL T Front `r �.�.v' � p
Addre52 ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING .nj MECHANICAL B ReUr � , � N
Convacmr'sName�"'d'✓T�►ti�.�/bo�->C� ahoneG3�-32Ov � orHER C Right ! �-�� ��R - N
Addresslmailingl�� �����"+ �+oie:K r✓ts 42966 PROJECTDESCRIPTION So.F7. oCCVPnrvcv K ' G
6/ 7 7 i CONSTRUCTION,TVPE VALUATION $ S �e« y T 1
CityLiCenSeNo. 20NE GRADINGCV.YDS. ACRES q
LICENSED CONTRACTOR DECLA0.ATION Ping. Ret. �lp Pa�king R¢q./P�OvidCd E
� I ne�eby allirm that I am IlcenseU untle� Orovlsions of Cha�ler 9(comm¢n<ing qemarks: g 1 �� � � — 6 ' Planning Notes: �
(L, with section ]000) of Divlsion 3 ot me Business antl Professions Cotle, antl M
r my licensa is in tull torce antl eitect. o ' T
� Licens CI � =� License NozfS +�Z _ S
(�'D Date _%Signature •- PLUMBING FEES
� WORKERS' COMPENSATION DECLARATION Bar Sink Showers ' ' ELECTRICAL FEES
ereby aff�rm thal I hdv¢ a certlfica[e ot consent ro self-insure or a CerUfiGate
Worke�s' Compen5ation InSurance, o� a'ce�titietl copy the�eof (Section 68CkfIOW P�¢v¢nt¢f ServiceSink
o, Lab. C n � P.utometicWasher Transformer�� 75-50KW
volicy rvo. �G9ANS'72 Company K�b��J�i�G Backflowlrrigation - SewerCa � ❑ 50+KW -
P Construction Pole Sub.
❑ Certifletl capy is hareby /umishetl. -
�3[ Certifiea is ti n,.,ith the <ity Bw m9 Division. Bathtuhs Sewer Connection Cooking Unit Meter ❑up to t00amps
Date �1 �� =�-`/ Applicant �� �
EXEMPTION_- FROM WORKERS' COMPENSATION DECLARATION Cldrifi¢r5 - Solaf CollectOrS . DiShwaSh¢r M¢t2r ❑Over 100 dmPS
(This sectlon neetl nOt b0 comptetetl It tne pe�mit Is for one huntlretl (E100) or
iess). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I cerlHy ihat in th¢ pCrformance of Ine work for whith thi5 perm�[ i5 itiuetl I - .
shall not employ any person in any manner so as to become subject to tf�e Drinking Fountains Solar Tank Fan Motors �0.1 HP �t Ye - 6
Worker5' Compentalion Lawi of CalitOmia.
Date Si9nature Floor DrainS Swimming Pool w/Spa F.A.U.
NOTICE: 11, alter making thii tleclaratlon, you shoultl become subject to the In[. Solar �9-15 HP �16�15+
Workers' Compenution proNzlons ot the labor Cotle, you must torthwith Floo� Sinks Urinal Fixture5
comply wilh sucb provislons or lhi5 perm(t Shall be tl¢¢mrta revoketl. MitroWav¢
CONSTRUCTION LENDING AGENCV Ge55ervice Outlets WaterCloset �I DeviC28oxCS Poleliht
1 hereby aifl�m lhal th<ra i2 a Conitructlon IenOing agency fo� [ne perfo�mdnc¢ 9
oi tne work fOr whlch this permlt is issu¢tl (SeC[ion 3097 Civ. CJ Int¢rC¢ptOrS Wat¢r H¢alEr Outl¢t5 Ran e
Lentler's Name 9
Lantler's Htltlress Kitchen Sink _ Water Service . Switches Sign
OWNER BUILOEH DECLARATION
I he�eby aHIrT Ihal I am Uxompl �rom [he ConVdctO/'S UcenSe Law 10� ttte LdvdtO�i25 AutO-WeSh GB�ba C �i5 0521
toliowin9 rcason (Sectlon 7031.5 8usiness antl Professional Cotle: Any city or � 9 P Standing $ections
county which requlros a oermlt ro construct, alter, improva, tlemolish or repair P-Trap �.¢undry Trays Generator �0�5 KW �5�15 KW
any SINc[ule, prlOr lo Ils ISSuanCO, also fequlres Ihe applicant for SUGh pelmit Tf85h COfflpdC[Of
l0 tile a Slgn¢tl itatomCnt thdt he/ihc IS IICanSCtl pufsuant to Ih8 pfOvl5lon5 ot ROOf Df0in5
tM1¢ COnt�dClOf'S UC¢n50 Llw (Chapter 9(commencin9 with Sectlon 7000) ot
Division 3�ol the Business antl Piolessions Cotle) �or that he/sne Is exampl
erofrom antl lha Casis for [he alle9etl ezemption. Any violation of Sectlon
31.5 by any applicant tOr a pe�mit subjects [Ite applicdnt to a clvil
alty of no[ moro than /ivo huntlratl tlollars (y500). . g
lJ I, a5 Owno� of lhe p�operty or �ny emplOye¢5 with wa9ei ai thoir solo Roinipection FBB §75 ISSUe Fee 3
componsalion, w111 tln tne work, ana tna structure is not Intentlatl or otteratl Rainspection Fee $15 luue Fae $ 3
tor salo (Saction 7044, Business antl Professional Cotle: The Contraclor's � MECHANICAL FEES
License Ldw �005 not apply to an ownOr ot a property who builtlz Or Improve5
thereon, antl who tloes sucn work himself/herself or tnrough his or ner own DEVELOPMENT SERVICES REOUIREMENTS:
employeas, provltletl tnal such improvemen[5 are not intentlo0 or o((eretl for Boiler, ', HOOd or Type I ❑
sale. If, hOwever, the builtlln9 o� ImprOvoment i5 Sold wlt�in on0 Year of com- ' CanOpy Typ¢ II ❑ Zoninp Approved By DetB
pletion, tne ownor wlll �ave tho burtlen of proving he/sne tli0 not bulltl or im- Dutt - Under GrOund � Building Approved By Dnte
��Ove for th0 pu�poSa oi Shce). �
I, as ownar ot lha vroperty, am exclusively contractin9 wlth Iicensetl con- Duct - Structural Refrigeration System Appliwtion luued 8y / Dat
tractors to construct t�n Oroject tSectbn ]044, Business antl Profeisions Cotlu:
The Contractor's Litense Law does not apply�ro;an owner of proverty who Duct- Ventilating y�aioo,000sru ❑1 ,000 BTU � D SUMMARV OF FEES
builtls or imprOvos.11tereon, antl who mntractsfor Sucb p�oject5 with a con-
tractor(s) I¢Bn58 pursuant t0 Lhe Cont�ac[o�'S License Law). I.am aware that Exhaust SyStem ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP -§
proOf of tneir Workar's Compensation insurance sho�ltl be provitlatl to me. PLAN CHECK $ PEFiM1T
❑ I am exempt untler Saction , e. & P. C�or this reason Firepl/FacL BIL ICBO � Fire Dampers PLUMBING $ ISSUANCE $
Date Owner Heating System & Duc[ing Registers �6 ' P�qN CHECK 25% 5 ENERG�' P.C. $
I hereby certlry tnat I have reae this application anA state that t�a above ❑6100,000 BTU �100,OOOBT GRADING S
informaUon is wrrect. I a9ree to comply with all city antl county ortlinancos ELECTRICAL S
antl state laws relaHn9 to builtling construction, ana hereby authoNze repre- $ MICROFILM 5
sentatives o1 this Uty to enter upon the above-men[ioned proper tor . PLAN CHECK 50% ��— ,
Inspection puroo e ' � 7 MECHANICAL $_- al� V4] �.OD
Siqnatu�e .� Date -''1 a�T� TOTAL FEE $
Drivers' License or 55 � - Reinspeetion Fee $15 Issue Fee $ 3 PLAN CHECK 25% $_J v_
CMF 0865-46, rev. ]0/B4 White - Builtling; Canary - Appliwnt; Plnk - Accounting; Goltlenrotl - Aszessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector �
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. ElecVical Conduit Uti�ity-Undrgmd. 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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. 8ackwash Lines, P-Trap, O Undrgrnd.
70. 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 P�ASTERING
18. Rough Electrical-T Bar Ceiling . 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �3_�•T L�� FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �Gas OOiI
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 - 3��y7 („ ��� ��
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Firepiace
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison , �
50. Gas Release to Southern California Gas Co '
;-
51. CERTIFICATE OF OCCUPANCY
No. Date ;'
/
Aop�icant to till in all spaces except those within heavy borEer Ilnes ana sign all aoo/oo/�ate Oeclarations.
,� CITY OF COSTA MES C NSTRUCTION PERMIT ' PE MIT NO. TRACT NO. LOT NO. - UNIT NU. 3I ZB 3/02/87 . 5e5O �
Project Address � '� • ����� : ' '
��� TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
Applicant's Mailin Address ��
�/ � r �h�. , ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# Zone
Owner'sName '"' h DESCRIPTIONOFWORK/USEOFBLDG. , �
Addreu S Main Building: Accessory Buildin9:
E Z
Arch/Eng. License No. TVPE OF PERMIT GRADING FOUNDATION STRUC7URAL T Front 0
Addre55 ❑ TENANT ❑ ELECTRIGAL PLVMBING ❑ MECHANICAL B Rear N
.��f"� ❑ OTHER ' C Riyh� N
Contractor's Nam Z �z A_ '. ` Prone� /� pROJECT DESCRIPTION Sp. FT. • OCCUPANCV K _ G
Address (mailing) SJ! �–�' ('�i� . _
COfVSTRUCTION TVPE VALUATION $ g Left
City LicenseNo. a6y��' 20NE GRADING CU. VDS. ACRES R
LKENSED CONTRHCTOR DEGLARATION Ping. Ref. # Parking Req./Provided E
�I hereby affi�m that I am licensetl untle� p�ovisions ot Cha�te� 9(commenLinq Remarks: a Planning Notes: �
� with section ]000) ot Divizion 9 of the Business antl Professions Cotle, antl M
my license is in full i rce aj�tl eife . T
\ License class _�_���E_— � n No. �� � S
M�' Date.� �`5.� Si9nature PLUMBING FEES
� J WORKERS' COMPENSATION DECLARA N �
hereby aifirm that I have a certifiwte ot c nsent to self-insure or a certi(icate Bar Sink . Showers ELECTRICAL PEES
� Wo�ke�s' Compensation Insufance, or a certitjetl coOY �h) eot Sectlon
00, Lnb. ,r��JQ p A / Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW .
0 olicy No. � b' V �a�� Compa`ry�7JL�Fv� � � Backtlow Irrigation . _ Sewer Ca . ❑ 50+ KW
�ertifietl Copy is heteby tuTishe � P COnStfuCtiOn P012Sub.
Ce�ti(�i�etl cj�61{ is (iletl with [h8 ���Y u in9 i rsi�J /'� �i Bathtubs Sewer Connection Cooking Unit Meter ❑up to 700amps
Da[F �"�.y_a / AppliGan� S�f+�i�'G
F'g
EXEMPTION FROM WORKERS' COMPE TION OECLARATION Clarifiers ' ' Solar Collectors �IShwdShE� . M¢t¢t ❑Ov¢f 100 am
(This section neetl not be com0�etetl if the rmit Is fo� one huntl�etl (5300) or
less). Dishwasher . Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify tnat �in the periormance of the work for which this Derm�t is issuetl, I -.
shall not employ any person in any manner so as to become subject to the Drinking Fountains � Solar Tank Fan
Workers'CompensationtawsofCalitomia. _ MOtors❑ HP�IYa-8
oate tiqnature Floo� Dreins Swimming Pool w/Spa F.A.U. '
NOTICE: 1f, after makin9 this Oetlaration, you sltoultl Decome subject to.tha 1nGS r fl9-15 HP �16-15+
Wo�ke�s' Compensation p�ovisions o( the Labo� Cotle, y0u must torthwith FI00�$inki � U�in21 FixIW2S
comply with such p�ovisions Pr this permit Shall be tleemea �evoketl. � �Ow2vC
CONSTRUCTION LENDING AGENCV GasService Outlet5 WaterCl05e[ � DeviCeBoxes p
I hereby af9�m that there I5 a mn5truction lentling agenCy (or the per}orma�ce OI¢ Light
of the wofk tor � which this Pelmit is isSueU (Section 309Z Civ. C.) Int¢lC¢ptOfS Wdt¢I H2dt2f ' OutIEtS
�entler's Name ' � � Range
. �enAer's AOErezs �� Kitchen Sink Water Service - Q Switches Sign
OWNER BUILpER �ECLARAT�ON -. '
I hereby atOrm that I am ¢xempt from the Contractor's Llcense l.aw Po� the Lavarories AUIO-WdSh
following reason (Sectlon 7031.5 eusinezz antl Protessional Gotle: Any citY or Garbage Disposal Standing Sections
county whi<h requires a permit to construct, alte�, imp�ove, tlemolish or r¢pair P-T�a •
any structure, prior to its izsuance, also requires the applicant tor zucn permit P Laundry Trays Generator �0.5 ❑5-15 KW Trash Compactor
to file a siqnetl Statement that nC/she is IicenSetl pur5udnt [O the prOvisions ot ROOi DldinS
tne Contractor'S License Law (Cbap[er 9(mmmencinq witn Section 7000) ot
ivision 3 Of the'Buziness antl PrOte55ion5 Cotl¢) or that ne/she is exempt
ereirom antl tne basis for the alle9etl exemption. Any violation of Section •
031.5 by any applicanf tor A Pe�mit 5ubject5 [he applicant to a civil
.nalty of not more lhan five huPdretl tlollar5 (5500). .
I, as owner o� the property or my employees with wages as tneir sole Reinspection Fea $15 laue Fee ' $ 3
com0e��tion, will �o tM1e work, antl tlte structure is not intentletl or ofteretl
tor sale (Section �044, Business antl Profezsional Cotle: The Contractor's MECHANICAL � FEES Rainspection Fee $15 Inue Fee $ 3
License Law tloes not appty to a�� owner of a O�operty wM10 builtls or imprOves
tnereon, antl who aoes such work himselt/nerseli or through his or ner own DEVE�OPMENT SERVICES REQUIREMENTS: .
employees, provitletl that such imP�ovements are not intenaetl or oiferetl for Boiler Hood or Type I ❑ ,
sale. If, noweveq me builtlin9 or imorovement is soltl within one Year o( com- Canopy Type 11 ❑ Zoning Approved By Date
pletion, the owne� wlll �ave the burtlen of provin9 he/She tlitl not builtl or im- DuCt - Und¢� ii�OUnd �
prove for the purpose ot sale). • Buildin8 Approved By Date
❑ I, as owner ot the praperty, am exclusivery contractin9 with Iicensetl con- Duct - Structural Refrigeration System ' Appliption Issuad By L • � � Data a3 i�%
tracto�s to construct the project (Section ]044, Business antl PrOfessions COtle: �
The Contractor's License Law does mt appry to an owner oi property who Duct- Ventilating ❑0-100,000BTU ❑7 00TU
builtls or improves tnereon, antl wno contracls (or such projects with a ton- ' . SUMMARV OF FE S
tractor(s) iicense pursuant to the Contractor's �icense Law). I am aware that Exhaust System ❑ MWtiple ❑ System Re Iteration BUILDING PERMIT $ SMIP $
prooi of their Worker's' Compensation insurance shoultl be provitleG to me. PLAN CHECK $ PERMIT �
❑ 1 am exempt unaer Section B. & P. C. for this reason Firepl/FacL BIL ICBO # F' ampers ' PLUMBI NG $ �� �0 �SSUANCE $
oate � Owner Heating System & Ducting Re9isters
I hereby certify that I have reatl this application antl state that the above �❑p�100,0006TU �100, T PL.P.N CHECK 25% $ I�� ENERG�' P.C. $-
information is correct. I a9ree to �omply witn al1 city antl county ortlinances ELECTRICAL $ GRADING $
antl state aws �elating to bui tli09 Construction, antl he�¢by authorize repre-
sentatives f his city o ter upon the above+mentionea oroperty for - PLAN CHECK 50% $ MICROFILM $-
inspectlon P s. . MECHANICAL $
Signature �' Data3�'� TOTALFEE $ S•�
Reinspection Fee ' $75 Issue Fea $ 3 PLAN CHECK z5% $
Drivers' License 55 �
CMF Od6S-46, 12v. 30/B4 WF1122 - f511�lOing; CdOdry - HppllWpt; VIOH - HCCOunLing; tiOlOBf1I0O - q55C550!
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qPPROVALS Permit# Date Inspector
1. Temporary Electrica� 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 ReinforcBment � 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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd, - � 60. Backwash Lines, P�Trap, � Undrgrnd.
70. 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 Dreins � 64. Plumbing System - Final �
14. Rough Plumbing 65. Elec[rical-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 O Gas ❑ Oil
23. Gas Pipe-Rough & Test , 72. Underground Flush
24. Roof Framing� .� � � . 73. Undergmd.S[orageTank �Gas ❑Oil
25.' Roof Shea4hing � � � . �� -� 74, Overhead�Hydro ' � - .
26. T-Bar Ceiling (StructuraD & Monocoai ' � 75. Dry Chemical� �
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � 77. FIkED SYSTEM FINAL p'
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 � , Nates: � . � . �
34. Final Heating & Air Conditioning ' � ',
35. Final Gas Pipe-Test � - ' ��
36. Hood or Canopy ' �
37.�Final Factory Fireplace . , '
38. Final Plumbirag. . -� 3„�(,YZ (�1�u , � � � .'
r i, •
39.'�Water Service-Final � � � � ' � , � � � " . , ' ;
. �
40. Gas Service-Final - . � � ' � ' >, �
41. Solar pomestio-Final � � ,. � � �' �
42. Backflow Preventer � ' � ��� a �-
o �'
� 43. Backflow Irrigation � - , , '
�'44'. Landscape Irrigation System - � j � � - • '
� 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 -
51. CERTI FICATE OF OCCUPANCY � `�
No. Date
/
Aov���ant to flll in all soaces except those within neavy"oortler lines ana sign all aoorovriate aeclarations.
i
� PERMIT NO. TRACT NO. � LOT NO. UNIT NO. �
i oF coSrA� MLESa` CONST1R1UC`TION PERMIT �(/ no µ 9095 1 I/05/87 29.37 TI
�Project Address J1 �J !if! p�b�,.^'..Y� VYh � � I � � � V �% 'r 1'. `o� _ . _ . ... . ,
Applicant'SMailingAddre55 43�-o Vnrt �Y/?Q/J 1V� Q1�E� TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER 2one
Owner'sName •SS . • S hone � <<% � A•P'# `'��'�' �� � Z' - �b
,1 DESCRIPTION OF WORK/USE OF BLDG.
Address 3�ss�ry�.� q� W � � S Main Building: � Accessory Building:
1 �, E
ArchlEng.L,f,(n":iGd- �CC. LicenseNo. TYPEOFPERMIT GRADING FOUNDATION STRVCTURAL T Front O
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 8 N
Address'13i(a�� �StCeKl2e�si�e 2.30 (t,9l�i11S q21�3 . A Rear
Contrector'sName ����a� �KJ� �'t[6� ❑ OTHER - - �
--�— Phone-c�a1..t7 pROJECT DESCRIPTION Sq. FT. OCCUPANCv C Right N
Addresslmailing) �iZ�LO J�l� �.LHrhoN IV � �(tip G
� G6 qs CONSTRUCTIONTVPE VALUATION$ �.�0 g Left
City LiCenSe No. ZONE GRADING CU. VDS. ACRES . R
LICENSED CONTRACTOR DECLARATION � Ping. Ref. # Parking Req./Provided E
Q
I hereby atfirm that I am lican5etl untler provizions of C�arter 9(mmmencing Remarks: Planning Notes: �x� - ry�
I wit� sectlon 7000) of Division 3 of the Business antl Professions Cotle, and , T
my Iicense is In full ce anU effecL [' I1G, .
License Class Lice��lo�� � 77T7� S
oato1� S % Se t L- PLUMBING FEES -
WORKERS' COMPENSATION DECLARATION Bar Sink � Shower5 ELECTRICAL FEES
I hereby attirm Iha� I have a ce�tlficate of consent to self-Insure o� a ce�tititate
of Workers' Compensation Insurance, or a ceriifietl cooY thereof (Sectlon BackflowPreventer Service$ink ❑ 15-50KW
3800, Lao. �3• �C� �,IG1 /' Automatic Washer Transformer
poiicy No. �IV CP "•� `� / J CompanylJL, �w.�G /NS. Backflow Irrigation Sewer Ca ❑ 50+ KW
P Construction Pole Sub.
�Certifietl copy is hereby furnisnetl.
��ererutiee c�py� }IIyc�With the city By�il g Division 88[htub5 Sewer Connection Cooking Unit Meter ❑Up f0 10� 2mp5
oate L�'- 'fC / AOPllcan[ / ���
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers $plar ColleCtolS Diihwa5hef Meter ❑Over 100 amps
(This section neetl not be wmpletetl i( t�e permit is for one huntlretl (E300 or .
less). � Dishwasher Solar Piping Dryers �Gas ❑Electric Su6 Panel
I cerUfy thal in [h¢ pGrfOrmance o( the work for which t�ls OermR i5 issuetl I
shall not emo�oy any. person in any manner so as to become subject to t�e Drinking FOuntains Solar Tank Fan Motors DO-7 HP �1'h- 8
Wo�ken' Compensatlon Laws of California.
Date Si9nature � FloOr Drains Swimming Pool w/Spa F.A.U. InaSolar �9-15 HP �16-15+
NOTICE: 11, af[er making this tleclaration, you shoultl become su0je<t to the
WOIk�rS' CompGnSdtSOn provisions of the Ldbor COEe, you mus[ fOrthwith FI001$ink5 Ulindl � FiXtUf¢5 MiC�Ow2v¢
comply wlth sucn'provisions or Ihis permit shall be tleemetl revoketl.
CONSTRUCTION.LENDING AGENCV GasService Outlels WatefCloSel DeviGeBOxes PoleLight
I hereby atflrm lhat tM1ere is a construction lentling agency tor the performance
of tne work for which this permit is issuetl (Sectlon 309] Civ. C.) InterceptOrs Water Heater OutlEtS Ran e
Lxntler's Name 9
�ender's Atltlress Kitchen Sink Water Service Switches Sign
OWNER BUILDEN �ECLARATION
I hereby affirm ttiat I am'"exempt �rom the Contractor'S License Law for the Lavarories Auto-Wash Garbage Disposal Standing Sections
following reason (Sectlon 7031.5 Business antl Grofessional Cotle: Any clty or
county whith requlres a permit to construct, alter, improve, tlemolish or repair P-Trep Laundry Treys Generator �0.5 KW �5-15 KW Trash Compactor
any� sl�uC[ure, prlor tO�its i55uanC¢, also require5 the applicant for SUCh permit
to f0e a si9netl statement tnat he/she Is licPnsea pursuant to the provlslons ot Roof Orains
the Contractor's License Law (Chapter 9(commencing with 5ection 7000) ot
Division 3 of the Business antl Professions Cotle) or that he/she is axempt
therefrom antl the basis for Ihe allegetl exemption. Any vlolation o( Sec[ion .
]031.5 by any applicant for a permit subjects tM1e applicant to a civil
penalty of not more than tive huntlred tlollars (E500). $ 3
❑ I, az owner of the property or my employees with wages as their sole ReinSpBttian Fee $15 ISSue Fee
compensation, will tlo me work, antl the structure is not intentletl or offeretl Reinspection Fee $15 luue Fee $ 3
tor sale (Section 7044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES
License Law tloes not apply lo an owner of a property who builtlz or improves
thereon, ana wno tloes such work himseH/herself or throu9h his or her own DEVELOPMENT SERVICES REUUIREMENTS:
empl0yoe5, prOvitl¢tl that such impfovemenls are not intentletl or off¢retl for 80112f HOOd OI Typ¢ I ❑
sale. II, however, tne Duiltling or Improvement is soltl within one year ot com- Canopy Type II ❑ Zoning Approved By_r__�- Date � S
Pletlon, the ownar will have tha burtlen of proving he/she tlitl not bulltl or Im- Duct - Under GrOund guilding Approved 9y A Date
�ove fo� the pu�pose of sale). p� �
LI I, as awner ot lne property, am ezclusively contracting with Iicensetl con- Duct - Structural Refrigerotion System Appliption Issued By I ' Dat
tractors [G construct the projec[ (Section ]044, Business antl Profeszions Cotle:
Tha ConVacror4 Llcense Law does not appty to an owner ot pwperty who Duct - Ventilating ❑a700,000 BTU ❑100,000 BTU SUMMARV FEES
builtls o/ imprOv¢5 thereon, antl who mM�acts for SucM1 Drojectz with a con- '� �� ,� �
tractor(sl ucense pursuanf to tne Contractor's �icense Law). I am aware that BUILDING PERMIT $ SMIP $
proo/ o( thev Worker's Componsation insurance shoultl be provitletl to me. Exhaust System 0, Multiple ❑ System Repair/Alteretion 1 1 �
PLAN CHECK $. �� PEfiMIT
❑ I am exempt untler Section B. & P. C. tor this reason Firepl/FacL BIL ICBO # Fire Dampers PLUMBING j ISSUANCE $
Date owner Heating System & Ducting Registers pLqN CHECK 25% $ ENERG� P.C. $
I hareby certify [hat I have reatl this appliwtion aotl state that the above ❑6100,OOOBTU �100,0006 ELECTRICAL $ GRADING $
Information Is correct. 1 a9ree to comply with al1 city antl county ortllnances
antl state laws rnlatlng to builUin9 �o� n ption, antl hereby authorize repre- MICROFILM $ -
sentatives ot lhis G[y enter up fe dbove-mentioneA pmperty tor PLAN CHECK $0% $ �
Inspettion purpose //� �� MECHANICAL $ TOTAL FEE $
� �f �' , �
�
CMF 0865-46, rev. 30/04 Whi[e - Builtling; Canary - Applican[; Pink - Accountin9; Goltlenrotl - Assassor
CONSTRUCTION AND.PLANNING PO SPA �
�APPROVALS .Permit# Date Inspector AppROVALS Permit# Date Inspector
t. Temporary Electrical Service or Pole . 52. Pool & Equipment Location �
/
2. Soil Pipe-Undrgrnd. � , 53. Steel Reinforcement � �
3. Electriral Conduit Utility-Undrgrnd. 54. Forms %
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinfarcement " . � 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, O Undrgmd., 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
i
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 6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Elearical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
.�
20. Rough Factory Fireplace APPROVALS Permit # J �
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil •
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O 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 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 r. -. ��.
� ''
37. Final Factory Fireplace � „, - i -�
38: Final Plumbing � � -� � � �
�:
39. Water Service-Final ' , •
40. Gas Service-Final ". � t '_ �
'41. Solar pomestic-Final ! , ;�� � .
�•.42. Backflow Preventer ' � ' �-
•'�43.,Backflow Irrigation ''� � +r . �
i .a % 1/
� 44. Landscape Irrigation System � �� �'
; 45. Sound Attenuation - �;,�•_' _ i V��
� „
46. tiandicap Regulations � ^ � ' ' .� - � •
47. FINALSTRUCTURE&BUILDING / � .. - , - ,.
48. Special Requirements Completed � �' ' ��, • �
�9. Electric Release to Edison . ��` � : ' ( �
50. Gas Release to Southern California Gas Co ' .
51. CERTIFICATE OF OCCUPANCY 1.
No. Date
��
�
AODlicant to fi11 in all spaces except tnose within heavy boraer Ilnes ana sl9n all apvroo��ata Oeclarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. 7RACT NO. LOT NO. •UNIT NO.
�S , �,� a ����-� 4��42, -- � ,
Project Address ' 1 Ei Q695 ?/?3 F7 �i v� c�
Applicant'S Maili Addre55 �IS A7Q' ��w.�� TYPE OF CONSTRUCTION EW ADD ALTERATION REPAIR � TL
Owner'S Na ���^�- �hone �.CONVERSION ❑ DEMOLISH ❑ OTHER _�J I
�OIIO DESCFIPTIO F WOFiK/USE OF B DG. '4'P''� � S' O � Z Zone �
Address ��« �e"`� D �jiiA �iA � � � �/-� 9 Main Building: • Accessory Building:
• Z
A�ch/Eng. � LicenSe No. TYPE OF PERMIT GRADING FOUNDATION TR RAL T Front O
Addre55 %�o ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear N
Contractor's Nam hone � � -" � ' / � OTHER � N
Address (mailingl � -� � 26 3. PROJECT DESCRIPTION 50. FT. � OCCUaArvCv i' M J 'K Right ' G
/ � -CONSTRUCTION TVPE�- VALUATION $ (C1� d fsG S Lefd R
City License No -
LICENSEO CONTRACTOR DECLARATION ZONE , GRADING CU. VDS. ACRES Ping. Ref. # � Pafking Req./Provided E
O^ �
I hereby affi�m that I am licensetl untler provi5iOn5 ot Chart¢r 9(commencing Remarks: C � .� p PldOning NOL¢5: �(�j s M
with section ]000) 01 Divlsion 3 of the Businass antl Professions Cotle, antl T
my license is in full rce antl effect. A `' o � S
Ucens Class � ' Lic qe ���r7T�3
oate �"Z-3' � 51q t ,� � PLUMBING FEES $ � '
WORKERS' COMPENSATION DE ARATION Ba! Sink ShOwefS ELECTRICAL FEES
I �ereby atfi�m tbat I have a cer[IflGa[e of COnSent to self-insure or a certiticate
oi Workers' Compenzation Insurance, or a certifietl <opy thereoi (Soction Backflow Preventer Service Sink
3800, Lab. C.�� ��^ y�� � " Automa[ic Washer Transformer' � 15-50 KW
Policy No. W�� nr�T Company Backflowlrrigation SewerCa ❑ 50+KW
Certifietl m P Consvuction Pole Sub.
py i5 here0y furnishetl.
ertitietl o i fuetl with the Uty u" a Bathtubs - Sewer Connection � Cooking Unit Meter �up to 100 amps
D te /^2��� APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers • $plar ColleCtOrS '� Di5hwa5hef Meter ❑over 700 am �
(This section neetl not be com0letetl it tne permit is for one nuntlretl (g100) or
less). . Dishwasher - Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certlfy that in the periormance of the work for which this oermR is iszuetl, I
sha11 not employ any person in any manner so as to become subject to tne , Drinking Foun[ains Solar Tank Fan Motors ❑ HP �1i4- 8
Worker5' Compensa[ion Ldws Of CdlitOrnia.
Date. Signature Floor Drains Swimmin ool w/Spa F.A.LL Inc. r �9-75 HP �16-15+
NOTICE: If, after making this tleclaration, you 5houltl become subj¢ct to tha
Worke�s' Comp¢nsation provisions ol the LabOr Cotle, you must torthwith � FI00t Si�ks U�i '
com ly with such rovisions or this Fixtutes crowave
p p perml[ shall be tleemeC revoketl.
CONSTRUCTION LE�JDING AGENCV ' GasSeNiCe Outlets, etefCloSet DeviCeBOxeS PoleLight
I hereby affirm that th¢re is a conitruction lentling agency (or the pertormance
of the work for('w�pich Nis permit is issued (Section 309] Civ. C.) Intereepto�s Water H¢ater Outlets Ran e
Lentler's Name 9
�enaer's Atltlress i� Kitchen Sink �.- Water Service Switches � Sign "
OWNER BUILpER OECLARATION
I hereby a�tirm that,l am exempf'irom the Contractor's License Law for the Lavatories Autn�Wash Garbage Disposal Standing Sections
following reason (Sec[ion �031.5 Business antl Professional Cotle: Any tlty or
tounty which repuires a permit to construcq alter, improve, Cemolish or repair P-Trap Laundry Trays Generator DO- W �5-15 KW Trash Compacror
any st�ucture, prio� to itS�issuance, al5o require5 the applitant (or Such pe�mlt
to tile a zignetl statemCnt that h¢/She iz Iicensetl pursuant m the orovisions oi Roof Drain
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
Division 3 oYthe'Business'antl Professlons Cotle) or that M1e/she is exempt
Iheretrom antl the basis for the allegetl exemp[lon. Any violation of 5¢CtiOn
7031.5 by any appli<ant tor a permit subjects tM1e applicant to a clvil ' .
�¢ndlty of not'mor¢ [han five huntlrCtl tlollars (E500). -
I, a5 owner of lhe p�op¢rty o� my employee5 with wage5 a5 their sOle R¢inSpBMiOn Fee $15 Ist�e Fee $ 3 '
compensation, will Go the work, antl the structure is noc intentlea or olteretl Reinspection Fee 515 Issue Fee $ 3
tor zale (Section ]044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES
LicenSe l2w tloes not apply to an own¢r Ot d prOperty who builtls or imp�oves
thereon, antl who tloez such work himself/herseli or throu9h his or her own DEVELOPMENT SERVICES RE�UIREMENTS:
employ¢es, provitletl tha[ such improvemen[s are noi intentletl o� offeretl for BOiI¢� HOOd O� TypE I ❑ �_� l�_�%,�
sale. H, howeveq the builtling or improvement is soltl wit�in one year of com- , Canopy . Type I I ❑ Zonin9 Approved By —Date
pletion, the owner wlll have the burtlen of provinq he/she tlitl not bu110 or Im- Duc[ - Under Ground
prove tor the purposa of sale). Buildin9 Approved By ����� Oate 'Z'� °� —B7
� 1, as owner ot the property, am exclusively contractin9 witn Iicensetl con- Duct -SVuctural Refrigeration Syste Appliration Issued By �++� �%w0'� Date 'L��q- 87
tract0/s to construct Ihe projeGt (SCttlon 7044, Business antl Profe55ion5 Cotle:
The Con[ractor's. License Law does not apply to an owner of o�operty who Duct- Ventilating ❑0-100,000 ❑t00,0006TU SUMMARV'OF FEES
builtls o� improves thereon, antl who coniracts fo� such Oroject5 with a Con-
tractor(s1 I¢ense pursuant m the Contractor's License Law). I am aware that Exhaust System ❑�Multiple ❑ Syst epair/Alteration BUILDING PERMIT $ ��' SD SMIP : $ � 7d
pvoof of tneir Worker's Compensatlon insurance snoultl be provitletl to me. PLAN CHECK $ -���� PERMIT
❑ I am exempt untlor Seccion B. & P. Gtor this r¢ason Firepl/Fact. BIL ICBO # ire Dampers PLUMBING § �SSUANCE $
Date Owner Heating System & Ducting Registers pLqN CHECK 25% $ 'ENERGY P.C'. $
I hereby certity that I have read this application antl state that the above 00.100,OOOBTU �100 BT EIECTRICAL $ GRADING $
informa[ion is cg �rect. I agree [o comp� /�j[I�WII city antl countyortlinan<es '
antl state laws rel3S'nq ta builtling co Str tlod, antl hereby authorize repre- - PLAN CHECK 50% $ MICROFILM $
sentatives of Ihis c y. nter o e 6ove-mentionetl roperry for � /
inspection p;pa es. % ''�,�� �'j] MECHANICAL $ TOTAL FEE 5 / 33� S�
Signature � Dai�/�.�� s0ection Fee $15 laue Fee $ 3 PLAN CHECK 25% $
DriverY �icense or SS �
CMF 0865-46, rev. 10/84 White - Bulltling; Canary - ApDlican[; Pink - Accounting; Goltlenrotl - Asse55or
CONSTRUCTION AND PLANNING � P� '4
APPROVALS Permit # Date Inspector qppROVALS 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. APPROVAI TO COVER-GUNITE
7. Footings SoC Z 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, � Undrgrnil., Test
9. Water Pipe-Undrgrnd. �� 60. Backwash Lines, P-Trap, O Undrgrnd. ,
10. Structural Floor System �. 61. APPROVAL TO DECK �
11. Proper[y Sewer Line & House Connection 62. Backwash & Receptor-Final ,
72. 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 � Gas ❑ Oil �.
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O 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 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 � � � � �� � r � ��
39!Water Service-Final � ' � '
40. Gas Service-Final • ' . �
i �
�41 t Solar pomesticFinal �,� . ��' � � . � � ' �:
'42. Backflow Preventer � ' ' " � �
� l
r43. Backflow Irrigation _ r .��. �' • ,`
�.�
..44. Landscape Irrigation SYstem �� ' � • . �
��45.�Sound Attenuation � •' ' � � ����
• � 1'
t' , {.
46. Fiandicap Regulations � � . , . �
l:
47. FINALSTRUCTURE & BUILDING '. . � 3
�., I � Ir.
48.. Special Requirements Completed . � :,� - , �S -, '
49.' Electric Release to Edison ' • :�• ���
50. Gas Release to Southern California Gas Co ' ,
51. CERTIFICATE OF OCCUPANCY !
No. Date /
�
PN0.IECT ROOflE55: ` 3 S 3 S H.�+.�BGR �L UNIT: A �
awNexsenme: C.J. SEGERSTROM G SONS
nnoness: 3315 FAZRVIEW RD
COSTA MESA
CA 92626
AflCMIENGINEEfl: � 7 1 q s S 4 6— O S 1 O NEG.NO.:
PACI.IC BUILDZNG CONCEPTS C
aoonEss: 18102 SKY PARK S u"�r A-1
IRVINE CA 92714
PEflMITTEE: GF���F ?,INE CONSTRUCTION ( 714 ) 968-0703
aooxess: 19552 tivESTWINDS LN
HUNTSNGTON BcACH CA 92696
LICENSED CONTNRCTOB OECUMTION: I hereby a��irm �ha� I am Iicen5e0 under prwision5 0l Chapt¢r 9(rAmmenGnp xi�h Section
7000) ol Ursion 3 ot i�e Business antl Pmfessions CaOe, and rtry licenu is in iutl force and ettttt.
CITY LIC.: STRTE PC.: ( 1 S ] 2 "' �
Oale: �— � I �CI 3 Signamre: _ _
WOBREHS' LOMPENSP710N DECLAFlA710N: I Aereby alfirm Ihal I �ave ertificate of consent lo sel4insure or a cenificate oi Workers'
Compensation Insurance. or a cenifieJ Copy ihereoi (Section 3800, Lab. C�.
voucr No.: 12 6 3 3 9 2— 9 3 E%P. OFTE: O%� O S� 9 4
�cornrnxv: STATE FUNA
IC] Cenilie4 coOY �s hereby Wmishetl. Q Cenifietl c ',�he ciry uilding Oivision.
Daie: R � � � � � � Applicant' �7.�+
E%EMPiION FflOM WOBRfPS' fAMPENSAT�ON OECUBATION: (This section ne iw� he comple�eU if IAe permii is lorone hunGreG �510D) or less�.
I certity I�al in I�e Oe�armante 01 lh¢ wo�k fOr whit� �his permi� is issUetl. I Shail not employ any DersOn in any manner so a5 to become
su�leci �o �he Workers' Compensation Lavrs o� Cah�omu.
Oate: Signamre:
NOTICE: If. after making Ihis Ceclaration, you s�oNC 0¢COm¢ Su01etl �o �he Worker5' Camp¢n5alion pravisions ol I�e Labor
Cotle. you musl lotl�wit� comply Wi�h suc� provaion5 Or 1➢i5 p¢rmit s�atl te deeme0 rBvok¢0.
CONSTBUCTION LENDING RGENCY: I �ere�y aflirm Ihal t�ere is a consimction lentling aAency for Ihe perlormance oi ihe work for
whic� i�is De�mi� is issue0 (Section 309�. Civ. C�. ' �
LENOEfl:
nooxess:
OWNEfl BUILDEP OECIABATION: I hele0y aliirm Iha� I am eKempt imm �he ConlratYars' State License Law lar ihe lallowing reason
(Section 7031.5 BuSin¢55 ana Prafessiond� Coae: Any ciry o� counry whith requires a permit ro con5imct, alt¢r, impmve, Oemolish, or
repair any siNcture. O�ior �o its issuanc8. als0 reduires I�e aOVlicant for such permit to file a sipnetl statement tAat he/she is IicenseA
pursuan� to Ihe pmvisians oi IAe Cantractors' Slaie License Law (Ctupter 9 �commencing vni� Section 7000) o� Oivision 3 0l t�e Business
antl Prolessions Cotle) or I�al �e/she is exempt I�erelrom antl Ihe Uasis lor t�e allegetl exemption. Any violation ol Section 703L5 hy
any aOVlican� lor a permit suGjecis �he PPDlicant lo a tivil penalty ol nol more Ihan �ive hundre0 Oollars (5500�.
I, as own¢r 01 �he proDe�y o� my ¢mployees wit� wapes as ��¢ir 5ole tOmpensalion, wlll Ao IA! wOrk. and Ihe
❑ stmcmre is not intenCeO ar o11ere0 for sate (SeClion 704a, Busineu and Pmteuional CaUe: The Contractors' Siate License law
' does not apD�Y �� an awner ot a propeny who Euilds or impmves inerean, and who aoes sucn xroM1 himsell/nerself or ihrough
11is or Aer own emDloyees, pmvlded tllat sucA improvemenis are no� intentlea or ofle/e0 lor sale. II, �owever t�e builtling or
� imDmvemenl is sold wilhin one year 0� comple�ion, �he owner vnll �ave ihe burden ol pwving �e/she tli0 no� builtl or impwve
for I�e purpose ol sale�. �.
I, as ownef ol Ihe pmpetly, am e%ClUsively conVactinp with licensetl conimctors to consimcl lhe pmject (Section 7044, Business
❑ an0 Pmlessians Cotle: The Contfaclors' S�ale Litense Law tloes nol aODly Io an owner ot pmDetlY who builas or imDroves �hereon
antl who ConVatlS �or 5uch pmj¢cis wit� a contractor(s�license pursuan�to the CanVac�or5' Slate License Law�.l am aware
lhai 0��� a� ��eir Worker's ConlDenutian insuranre ShoulE �e proviEetl �o me.
� I am exempl wGer 5¢c�ion: B. d P. C.
br ��is reason:
Da�e: Ownec
I tlo here0y cenily I�al l am aware ol anA un0erslanC t�e repuiremem5 0l Cali�omia HeaU� and Salety CoGe Seclians 25505, 25533, antl
2553C ana I�ai I Or any Iuiure builEing oCCuDani will/will noi (Cirtle ane) nee0 �o Compty wi�� 5ai0 5�aie wtle5 ana t�e requirtmenis lar a
permii lor consimclion or mo0ilicatian trom I�e Air Oualily Managemem Dislrict. Resitlential constmctian aDPliwtions are eeempt imm
mese pwvisions.
Date: pOPlitani:
I nereby cerlily Ihal I haue read I�is aDPlicalion and slate t e.�6¢�e informa�ion is corred. I a0ree �o [omply with all ci�y an0 counry
or0inancesantlslalelawsrelating�obuiltlingconslmction dherebyau��ri esen tivesofi�isciryloenterupontheabove�mentionea
pmpetly ior'mspeclion pur0ose5.
p p �
Oate: /1' � �� 1� Signamre:
orroers ��ce�se nr soci:i sec�m� a:
16C1-C6 W�ile—Builtling: Green—CoCe Enlorcemen�; Canary—AOoli[anl: Pink—Ravenue; GolOenrotl—Asseswr
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06395�
PERMIT NO: B 063959 PiAN CricCK NO: 02869-93 A GOVT: N SUFP: N
CONSTRUCTIUN 3YPE: I2i—N SP PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPiION : 2200SF OFFICE T.I. S�i FT; 2,200
CLAIM VALUE: 25,000.00 CALC—VALUE�• 28,028.00 GROUP OCC; B-2 /
COMMENTS: "EMULEX" 0:�: T�'F T. T
�r��r*�t�t��r**�r;r�*�r�r�r*�r�r*�;�#**�r*+�i��r***x .���r�r���r+rir�r*�r*u�*�*u��e#x��*x#*#�r#�*#�r�t�rx�r#�e*+�
Z O N Z N G R E Q U I R E M E N T S
5 E T B A C K S
------------ MAIN BUIiDING ---------- --------- ACCrSSORY BUZLDING ---------
FRNT: FT IN REAR: FS ZN FRNT: FT IN REAR: FT IN
LEFT; FT II3 RGHT: FT IN LEFT; FT ZN RGHT: FT IN
PARKING REO• PP.OV: PARCEL; 41507103 ZNE: PDI REF NO•
PLANNING Nt�TES> ZNTERIOR AiTERATIONS TO EX. BUILDING SHFLL FOR EMULPX CORP.
n
�*�x�*�±r**�****�r�**#��**�r�****��r���r�r�r**�#�*�*�t���**�#**� *****�t#�#*��r*��r�#��***�r
D E— Cr E�L':O P M E"N T S E R V I C E S R E Q� U S R E M E-Ny''T S
ZONING APPnOVED BY : C C� DATE;���/I�73
BUILDING APPROV2D HY ; S L DATE� I !t �,j�
�!_�
APPLZCATION ZSSU�ED BY; , DATE: -rR'��l I)
i!1Eif?FiFiciEiE3EjE?EiFiE�1E3Eif�ftiEilkitiF x� t xirx � +r� i c� r+e � it �r x t� trfryriF#iEiFif1E#dEi!Ofu n�exx ifi%
ifitff�EiE3EiFif�flf?Eififififif�IfiEififiFiFifiElElflFi4?EitififlFlfiEitif3EiEiEiEjE�F7tM1Eik�lflE .IE�IEil�lE3E�Eififl4iFlflEiE#%�if�3El.F�1E�EiElEifiEi4ifiF�liE
LEGALIZATION:N F E E S U M.M A Y STRUCTi73iAL S�GMENT:Y
3LDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP R£�S GRADING
PEAMIT 278.00
r' SMIP/NON—RES
PLAN 45.18 � � .c`' ;,g9
ISSUE FEE �` ' '
BUILDING—DIV—> PERMIT ISSJE PLAN="CHECK �i TOTAL PAZD DUE
TOTALS----> 283.89 0.00 .•"95.18 ,„ 329.07 329.07 ,00
REVENUE DIVISION TOTALS--> COL•LECTEII: 283.89 OVER/S?iORT; 00
BLD78PM�o PLUMBING ELECTRIC MECHANIC FIRE SMIPST09 GRADING PLAN—CHECR
iP iE iE ?f if if 1F iE?f ic iF iE ii� iE ik #�If it if if 1k 1f iE iE if ik iE iE if iF iF 3E fE iE'�E !F if 1f i't if dE if iE i! 9f-!E i�' if 9f ff� if 1f ip iE iE iElf i! if 1E it ## ii iE if 1E if !f ftlE if iE iE if #t 1E 1! fE
I N D I V I D U A.' b F E E.� H R E A K D O W N
TYPE QTY D E S C R I P T I� O N� -; >:" UNIT COST TOTP.L COST
�. � �
SFC 2200 OFF—INT. ALTER TYPE III—N -''.JiVER 11.72 25,784.00
SFC ( 2200 EQU—ALT.COMM, SPRINHLaR.SYS —AVER .33 726.00
SFC I 2200 EQU—ALT COMM. AIR:COND —AVER .69 1,518,00
/ END OF,FEES ,
i� .. .
. �Y' . � .
�� L: Q014ti738—OOi44739 T C�T 2�3.54
� GATE� OS/11/43 TIHE: OS:aS
J
CONSTRUCTION ANDPLANNING � P��PA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
+ �. _.
1. Temporary Electrical Service pr Pole ' 52. Pool & Equipment Location _..
2. Soil Pipe-Undrgmd. _ '" " 53. Steal Reintorcement
, 3. Electrical Conduit Utilitv-Undrgrnd. ' . 54. Forms y-�
' 4. Electrical Conduit�Undr9md. 55. Electrical Bonding
' 5. Sieel Reintorcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings �•- �.� 58. Electrical Conduit-Undrgrnd. �
6. Fo�ndation , p � 59. Gas Pipe, O Undrgrnd., Test .
9. Water Pipe-Undrgrnd. '� 60. Backwash Lines, P�Trap. O Undrgmd. �.
10. Structural Floor SYsiem �� �� � I 61. APPROVAL TO DECK ~
11, Property Sewer Line & House�;Connectiom -� 62. Backwash & ReceptorFinal 1.' "
12. Sewer Cap � 63. Heater & Vent�Final f
�
13. Roof Drains , • 64. Plumbing SYstem - Final
74. Rough Plumbing � 65. Electrical-Fina� �
15. Rough Electrical-Conduit 66. Solar System-Final
16. Fough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrica6T Bar Ceiling 69. POOUSPA SYSTEMS F{NAL
19. Fough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Facto�Y Fireplace APPROVALS Permit #
21. DuCts, in StrUeture 70. Wnderground Hydro �
22. Ducts, Ve�tilating � � 71. Product Piping O Gas ❑ Od '
23. Gas Pipe�Rough & Test ' ' '� 72, Underground Flush
24. Roof Framing . . � 73. Undergmd. Storage Tank O Gas O Oil
25. Roof Sheathing -� ' 74. Overhead Hydro �
26. T�Bar Ceiling (Structuraq & Monocoat Z�/p3 75. Dry Chemical
{
27. Frame and Flashing , 76. Dry Standpipe
28. Lathing & Siding � 77: FIXED SYSTEM FINA� �
29. Insulation '� - 78. FIRE PflEV. FINA�
30. Drywall Nailing ��� (�,� � i� HEALTH DEPT. REQUIREMENT
31. PlasterBrownCoat ' _•� �_'. 79. FINALINSPECTION
32. Electrical Power Meter-Final �� , 80. FOOD CERTIFICATE ISSUED
33. Final Electric' . ' Notes:�j�.f� ` �� ��� F�Cr
34. Final Heating & Air Conditioning , �+lp� �
Yr
35. Final Gas Pipe•Test _
36. Hood or CanoPY ' �;�� Cyip�1 �y Cv/J Lei % Li
37. Final Factory Firepiace � -.�
38. Final Plumbing , I' ` �� /����
� fv�
39. Water Service�Final �
40. Gas Service�Final � '
41. Solar pomestic•Final � �
42. Backflow Pre�enter ' ,
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Atrenuation
46. Handicap Regulations � �
47. FINALSTRUCTURE&BUILDING
�G-�°� : - -
48. FINALPLANNING - ' '
49. Electric Release to Edison " �`�
50. Gas Release to Southern California Gas Co "`'''_
_J
51. CERTIFICA7E OF OCCUPANCY
No. Date
�
PROJECT RODflESS: • 3 S 3 S � HARBOR BTa UNIT: �
awxex�sxnrne: C.J. SEGERSTROM 6 SONs
naoness: 3315 FAIRVIEW RU
COSTA MESA
CA 92626
RflCH/ENGINEEfl: � 71 4� S 9 6— O S S O NEG.NO.:
PACIFiC BUILDING CONCEPTS C
nooness: 18102 SKY PARR S ux" A—i
IRVINE CA 92714
PEflMITTEE: GEORGE LiNE CONSTRUCTION ( 714 ) 968-0703
aoneess: 19552 WESTWINDS LN
HUNTINGTON BEACH �A 92645
LICENSEO CONTMCTOB OECtAMTION: I here0y aflirm �ha� I am licenseG unCer pmvisions ol ChaD�e� 9(commencing with Sectian
7000� ol Dirvon 3 ot I�e Business anE Pmlessions Cotle, antl my license is in �ull �o¢e antl e��eci.
c�rr uc.: C,� srnre uc.: 615 3` ss: p
Dale: �� L I` `�S Signamre: _ y�
WOPKEBS' COMPENSR710N UECtAPAT10N: I Ilereby aflirm t�al I �ave a cenih ate af consent �o sell-insure ar a cenilicate o1 Workers'
Compensation Insurance, or a cehilietl copy ihereof (Section 3800. Lab. C).
PoucrNo.: 1263392-93 E%P.DRTE: O�J�OL�94
LOMPANY: STATE FUND
CerlifieA coOY'�5 Aereby Iurni5he0. � Ce�ifietl copy i N wi¢�I� �TiE'e� dmg D' ision.
Dale'. a � � \ ` ` � ApplicanC ��
E%EMPTION feOM WOflNEBS' COMPENSATION OECUMTION: �This sectio�ple�eA if �he Oe�mi� is Im one huMrcd �E100) or less).
I certily that in the pedormance o� Ihe work lor which ��is permii is is5ued. I shall not employ any person in any manner sa as lo �ecome
subiect to ihe workers' Campensalion Laws ol Califomia.
Oaie: Sipnamrt:
I n W Ber ' Com ensation rovisions of Ihe LaDor
NOTILE: II, al�er making Ihis declara�ion, you 5h0u tl beCOme Su61et� fo � e o 5 p 0
Coae. you must lonhwil� comply wilh such pmvisians ar ihis Dermit shall be tleemeE revokeA.
CONSTBOCTION LENDINC RGENCY: i hereby allirm Ihat there is a constmction IenAing agency for t�e pedormance of ihe work lor
• wNcn tnis oermil is issuetl �Section 3097, Cro. C�.
LENOEfl:
RODHESS: �
�
OWNEfl BUILDEfl DECLAMTION: I �ere�y allirm �ha� I am exempt from the Contracbrs' Siate License Law tor t�e fallowinA �easan
(5ection 7031.5 Business anE Pmfessional CoOe: Any ciry al counry wlliCh r¢qUires a permit to con5irud, alter, improve, aertql511, ar
repair any slmcNra O�ior to i�s i55uance, alm repuires ihe applicant for suc� permit to file a sipnetl statement t0a1 he/slle is Iicense0
Oursuam ta i�e pmvisions ol �he Coniractors' State �icense Law (COapter 9(wmmencing vnt� Senion 70W) ol Division 3 0l t�e Business
ana Prolessions Coee� or ��at �e/s�e is exempt �herefmm an� the Gasis lor t�e aileAeO eeemption. Any violation oi Seaion 70.31.5 by
any aOP���nt 1ar a permit su0lects Ne appliWnt �o a civil penairy ol nat more tAan live huntlretl tldlars (`3.�W).
I. as owner of Ihe prOperty or rtty employees with wages as tAeir 5ole fAmpenSation, will tlo ihe work, anA Ihe
❑ stmcmre is not intenUetl or ollereG for ute (Sectwn 7044, Buvness anE Pmiessional COAe: The Coniractars' State License Law
eoes not ap01y to an owner of a pmoeny who ouil�s or improves ihereon, ana who aoes sucA wofk himtell/hersell or Inmuph
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; M 063461
PrRM?T NO: M 063461 PLAN CHECK NO: N GOVT; N SUPP: N
CODISTRfJCTION TYPE: ZI:—N SP PERMiT TYPE: MEC PURPOSc: OTH
JO� DESCRIPTION : 2200SF OFFICE T.Z. SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: H-2 /
COMM�NTS: "�'fiiULEX" OFFICE T.I. / RE: B63959
+t��t�e�rxx+t�t�***ttu*�#*�r�r��r*�t#��r�r**�*�r�r�r�r��rtt�r�t*�t*#��r#*��r**+t##x�r#####*#�r##��#�##*�r�r�r
Z O N I N G R E Q U I R E M E N T S
sETaAcxs
------------ MAIN BUILDZNG ----------
FRNT: FT IN REAR: FT IN
LEFT: FT ZN RGHT: FT IN
— ACCESSORY BIIILDING — —
FRNT: FT IN REAR: FT IN
LEFT: F2 IN RGHT: FT IN
PARKZNG REO• PROV: PARCEL; 41507103 ZNE: REF NO:
PLANNING N(STES>
� ��
iEiF�1E�}E�7fiFiEiEiEiEfEifiEif�lEifiEiEiE�lFif�lEiE#iF�)fi(�ibdkitiFifi!#ilik�4EAF3E�1FiE#iEifififiEiE#F�1E�1fiElEif#3FiffF#if3f�IEit#�lEjE�lElfikiEiF##ifiE#iElfif -�
D E V E L O P M E N T S E R�,V Z C E S R E Q U I R E M H N T S
ZONING APPROVED BY . �'�/ DATE:
BliILUING APPROVED BY :
APPLiCATION ISSUED BY:
ii it if if af af if iF 1f iE iE 3E iE if iE 3FiE iE iE if aE �I
iE fE if if iF �f iE if iE iE iE ik �E iF iE iE af iE fE?E if� il
iEGAi?ZAiION:N
�� DATE:
i
t�/ � �� � �� � �
A'3F �eTciFI.viFiF7F 3F'i��ev i�%{iF'iF�'�'�iFiF�3F�Ejk1E�EDlfiEiF#if z x/t x iFiE
if IE iE if iE iE iF iE iE i(� iE if iE �IE iE a�J�'tf iFi(�lEiE �lE iE iF iE # if 3E 1E iE 3E iE i(� if 1E # iE IE ik fE ih iE �E k if #�1E if iE
F E E � U M M A R Y. STRiICTURAL SEGMENT:N �
BLUG PMT PLDMBING ELECTRIC MECHANZC FZRE SMIP/RES GRADING
P�'RMIT
PLAN
ISSUE rEE
BOZiDING—DIV—>
TOTAiS---->
PERMIT ISSiIE
l8.00 15.00
18.00
zsi
SMIP/NON—RES
is,00
PLAN—CHECR TOTAL PAID DUE
0.00 33.00 33.00 00
his or �er own employees, provitleJ that sutliimprovemenis are not mtentleE ar oflered tor Sale. II, Mwever ihe buildmp or
improvemem is sola wnnin one year ol comoletion, tne owner will have Ihe oumen oi pmving he/she Oi0 not builtl or improve R E VENUE D Z V I S T_ ON TOTAL S--> COLL ECTED •
m�inevmaosea�s:re1. BLDG PMT PLUMEING ES�ECTRIC MECHANiC
I. as owner of the pmDerty, am eKclusivety COnlfattinA ��h licensed cOntractofs �o ConSirut� �he pmj¢ci (SetliOn 7044, Bu5ine55 3 3. 0 0
❑ antl Pmlessions Coae: Ttre Coniratlars Stare License Law Goes not appty ro an owner of pmperry who OmWS or improvt9 llrereon
S
33.00 OVER/SHORT: 00
FIRE SMIP/TOT GRADING PLAN—CHECR
antl who cunVacis �oi suc� pro�ecis wii� a conVacior�s) license pursuant �o I�e ConVaciors' faie License Law�. I am aware if iEif if 3EiE�1f iE �F iE ii iEiE !E iE iE iE iE# iE jf�lFif 1F 1E iE iF# if iF�lE iE1f iFiE�IEiE IEiE if if ifiE iEfEif�7FiE #iE if�f-1E1F f(�#iEif �E�lE�1f�lEiE lE�Ififjt*�f fF # if�if�lEiE�lfiElEiF
thai Droal ol t�eir Worker's Campensatian insurance shoulU be pmviAeO to me. 1 N D I V I U CT A i F... c. B R E A K D O W N
� I am exempl untler Sepion: e. 8 P. C.
iormis�eason: TYPE QSY D E 5 C R I P T Z O N UNIT COST TOTAL COST
Date: Pxnec
I Oo nere0y cehily Ihat I am aware ot anA untlerslantl I�e requiremenis ol Califomia Health and Safery Cotle Sections 25505, 25533, antl
2553a dna �nai I m any IWure builtling occupanl will/will nol (circle one) neeA Io comply wilh said sla�e cotles anU Ihe requiremenls lor a
permit lor consimciion or mo0ilication hom t�e Air Oualiry Manag¢ment OisVict Fesideniial consimction applicaiions are exemOl hom
IheSe provisions.
Da�e: ADPlicanl:
1 �¢r¢Ey cerlily Ihal I have reaE I�is aDPlita�ion anU Slaie e a o ' brma�ion is correcL I agree m compry wiN all city anC counry
ordinancesan4stalelawsrelalinglobuildingconsimctio naherehyaulhori p �a�i so��Aisciryloen�erupon��eabave�men�ione0
property for insp¢C1iion pur0Qose5.
. Date: � � ``� `� Sipnature:
j od�ers �icense o� Sociai Seariiy x:
t5a1<6 Whne—Buileing; Green—CaEa Eniorcemonl: Cnnary—ApPliwn�; Pink—Revenue; GOltlenraE—Assessor
MEC 1 R£PAiR/ALT COOLING UNIT/SYS W/CNTLS. g:00 9.00
MEC 1 REPAIR/ALT HEATING UNIT/SYS WlCNTLS
END OF FEES
O1 00144740-00144740 T Q T 'a3.00
DATE: 08/11/93 TIME: 08:56
CONSTRUCTION ANDPLANNING N , PGNpA �
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electriwl Service.or Pole . 52. Pool & Equipment Locatian '�
2. Soil Pipe�Undrgrnd. " ' 53. Steel Reinforcement _
3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms �-
4.ElettritalConduit�Undrgrnd.�• � 55. Electrital8onding
5. Steel Reinforcement . 56. Rough Piumbing & Pressure Test
6. Elearicat UFEA Gmd. 57. APPROVALTO COVEA�GUNITE
7. Footings, ; 58. Electrical Conduit�Undrgrnd. �
S. Faundaiion' �. • 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrg'rnd. , � 60. Backwash Lines, P�Trap, O Undrgrnd.
70. Structural Floor System 67. APPROVAL TO DECK
�
11, Property,.Sewer Line & House �onnectiory . 62�. Backwash & Receptor�Final �
12. Sewer Cap ��. 63. Heater & Vent•Final ti
_ �
73. Roof Dreins. . 1 . 64. Plumbing System � Final �,
.
14. Rough Pfumhing . � � . 65. Electrica6Final �
55. Rough EVectrical-Conduit ' 66. Solar System-Final
76. Rough Electric Wiring �- 67. Fencing & Access Approval
77. Rough Wiring Sign � 68. APPROVEq FOR PLASTERING
18. Rough Electricai�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating � Air Conditioning FIRE DEPT. REQUIREMENT
20. Fough Factory Fireplace . • � APPROVALS Permit #
21. Ducts, in Structure - � � 70. Underground Hydro
22. Ducte, Ventilating 77. Product Piping 6Gas ❑Oil
23.'Gas Pipe�Rough & Test : ' 72. Underground F14sh
24. Roof Framing �, � . 73.' Underqrncl. Storage Tank � Gas ❑ Oil
25. Roof Sheathing `� ' 74: Overhead Hydro �
26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme and Flashin9 76. Dry Standpipe
28. l.athing & Siding � 77: 'FIXED SYSTEM FINAL
29. Insulation '� � 78. FIRE PREV. FIfVAL
30. Drywall Nailing ��., HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ' • �' 79. PINAL INSPECTION
32. Etectrical Power Meter•Final ti;� 80. F000 CERTIFICATE ISSUED
33. Final Electric � r��.
,� Notes:
34. Final Heating & Air Conditio�ing �y7
!/
35. Final Gas Pipe•Test ' � � �'
36. Hood or Canopy �.�i��
37. Final Factory Fireplace � �
38. Final Plumbing . � ' �
i~
39. Water Service•Final i - � �
40. Gas Service•Final ,
47. Solar pomesticFinal �
I i
42. Backflow Preventer ' � � � �
43. Backflow Irrigation
� 44. Landscape Irrigation Svsiem �
45. Sound Attenuation
46, Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING �� ' .
49. Elec[ric Release to Edison �
�
50. Gas Release to Southern California Gas Co ,�,
51, CEFiTIFICATE OF OCCUPANCY
No. Oate
i�
Pfl0.1ECT RDOflE55: . 3 S 3 S� HARHOR B 1+ UNIT: A
awxen�searn¢: C.J. SEGEASTROM S SONS
nooness: 3315 FAIRVZEW RD
COSTA MESA
CA 92626 .
(714)546-0110
ANCN/ENGINEEN: F1ACIYIC BUILDING CONCEPTS REG.NO.: C
nooeess: 18102 SKY PARK S ux'T: A-1
IRVINE CA 92714
PEXMIiTEE: GEORGE LINE COI�iSTRUCT20N ( 719 ) 968-0703
nooness: 19552 WESTWINDS LN
HUNTINGTON BHACH CA 92646
LICENSED CONTNRCTOfl �FLLAPR710N: I hereGy allirm tAat I am IicenSeG unaer pmvisions ol CAapter 9(commencing with S¢ction
7000� o� DiNvon 7 oi I�e Bu ' ess an0 Prolessions Code. and m license is in lull force anG effect.
CITY LIC.: , s,eTe uc.: 615 3 � G � A 1 ,
Oaie: � ' SignaNre: _ _ -hs. —
WOBREflS'COMPENSRTIONDECIABRTION: Illerebyallirm�hail�aveate ilita�EalConSen�IoSeIFinSureoraCertitiW�eolWorkef5'
Compensation Insurance. or a cenifie0 coOY ��ereol (Section 390U. LaD. C.
eoucrxo.: 1263392-93 E%P.ORTE: %�OS�94
�carnraxr: STATE FUND
�LJ Cenilie0 cooY �s here0y IumisheA. �. Ceniliea cop �e�e0.v�\ih tne ciryr �Bui10' 0 ahsion.
Date: D' � �' 1 3 APPlicant: �t l\�.���
E%EMPfION iPOM WOBMENS' COMPENSRTION OELIABATION: (iAis seciion ne ol be completeA i� �Ae permit is for one hmkreE (5100) o� less).
I cerlify ihat in �he DeAormanc¢ ol Ihe work for which IhiS pefmii is issuetl, I Shall noi employ any person in any mannel so as to become
subjecl to ine workers' CAmDensation Laws ol Califamia.
Oate: Sipna�ure: ��
NOTICE: II. after makinA ihis tleclaration. you s�oultl Uetome SuUlect to t�e Worker5' ComDensation pwvisions ot ihe LaOor, %
CoOe. yoU mu5tl0tlhwii� comply wilA SUCh O�ovisi0n5 or I�is Oermil Shall �e tleemeA revOkeO. 1`
CONSTflUCTIUN LENOMG RCENCY: 1 here0y allirm I�a� there is a con9mclian IenUinp agenry lor ihe peAormance ol t�e vroM-br
w�ich ��is permil is issue0 �Section 3097. Civ. C�, ' n
LENOEH: �5 �
AOOflESS:
OWNEP BUILOEP UECLAHRTION: I nereby af�irm I�a� I am exempl Imm ihe Comracmrs' S�a�e License Law br the following reason
�Semion 7031.5 Business an0 Professional Code: Any city al county whicA requires a Dermit m constmcL alter, impmve, tlemolish, or
repair any slmcWre, Orior to its issuance, also reduires Ihe aDPlicanl for suc� Oermit Io �ile a signed s�atement Itlat he/she is licensetl
pursuam to t�e pmvisions of Ihe Contracmrs' State License Law (Chapier 9(commencing wi�h Section 7000) of Oivision 3 oi the Business
and Pro�essions CoOe� or ��at Ae/s�e is e�empi t�erelmm anA Ihe basis lor ihe a11eAe0 exem0�ion. Any violation ol Section 7031.5 �y
any applican� for a permil su�lecis ��e aOD�icant to a civil penal�y ol noi more �Aan live hundretl tlollars (E500�.
I, as avmer of ihe O�oDeny or my employees wilh wapes a ev sole campensation, will do the wark, anA Ne
❑ stmcmre is not intenEee or oHereO for sale (Secuon 70da, Business antl Pmlessional Cotle: The Caniractors' State License Law
Ooes not aODly to an owner ai a pmDehY w�o builtls or im0�oves ihereon, antl who aaes such work �imsetl/Aerseli or thmugh
�is Or �er awn employ¢C5, pmvided Iha� SUth improv¢meni5 ar¢ nol intenG¢E Or Ofl¢re0 lOr sale. If, however IAe buil0ing or
improvement is saltl witnin one year ol completion, Ihe owner will nave ine Ouraen of Omving he/she aitl not bui10 or imOmve
1or ihe pur0ose ol Sate1.
I, as awner of the O��Pehy, am eMCWsively conVac�i g wii� lice conirac�ors �o constmci IAe D�ojec� 4Sec�ion 7094, Busines5
❑ anA Pmtessions COEe: The Caniractors' State Luense law s not aODN �a an owner of propeM � DUA0.s or improves Nereon
antl w�o conlrac�s �or suc� pmjecis wiin a comracmqs) licrose Oursuam to the Coniracrors' State License Law). I am aware
t�at proot ol Iheir Worker's Compensation insurance stloultl Ue provitletl to me.
� I am exempl un0er Section: B. d P. C.
; lor ��is reason:
Oaie: Owner.
I Da nereDy cenity inat 1 am awart ot ana untlerstana Ine requirtmenls ol Calilomia,MealtA ana Sdfety CaCe $ecti0n5 25505, 25533, aM
� 2559a antl Inai I or any Imure DuilCing occupam will/will noi (circle one) neetl lo comply vnlh said slate co0es and Ihe reQuirements for a
. permit far constmction ar mo0ilication Iwm ihe air uahty Managemem Disirict. He40entul constmctian ap0liwtions are exempt tmm
Ih¢Se provisions.
Date: pGO�wan1:
I here0y certify Inal I nave rea0 inis aoolicalian ana slale � ormation is cor2ct. I aA�ee to comply vnth all ciry ane county
or0inances anG staie laws relating io EuiiEing cansvuci antl �ere�y amlronz preuntaY 5 0l this ury to emer upan lhe ahove-mentionetl
property far inspeclion purpQoses.
� Daie: � � �' 1 � `� Signamre:
or�ver3 iicense ar sociai Securi�y x:
16aL46 White—Bmltlino: Green—CaCe Enlorcemenl: Canary—AoO�kan1; Pink—Revenue: GOIEenrod—Assessor
CZTY OF COSTA MESA — BUILDING PERMIT
PnRh!iT NO: E 063460 PLAN CHECK NO: N
CONSTRUCTION TYPE: III—N SP PERMIT TYPE; ELE
PERM NO; E 06346C
GOVT; N SUPP: N
PURPOSE: OTH
JOB t�ESCRIPTION : 22005F OFFICE T.I. SQ FT;
CLAIM VALUE: CALC—VAiUE: GROUP OCC; B-2 /
COMMENTs: "EMJi.EX" OFFICE T.I. / RE; H63459
ux�******��e*+�?�*���r*����**���r**#��r�r*�*}*��r�###�r*****�r�#*�r***x*��********�r���#***
Z O N I N G R E Q U I R E M E N T 5
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUiLDING ---------
FRNT: FT IN REAR; FT ZN rRNT: FT IN REAR: � IN
LEFT: FT iN RGHT: FT ZN L£FT: FT iN RGHT: r'T IN
PARKING REQ: PROV: PARCEL: 41507103 ZNE; REF NO:
PLANNING N6TES>
>
iE ik �F 3f±e+�?E iE iE iE iE if 1f iE iF iF if if �3E if iE if iE if �lf if iE if ?E iE if iE iE iE iE ih �E if �lE iE if iE �lE �IF if if iE iE iE iE if i(� # if iE i! iE iF i(� if if iF iF iE if # iF iF iF if iF iE ##�lE if iE iE 1F
D E V E L O P M E N T S�,R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY ��� UATE;
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: �,�,� i^ DATE: $���
�F*-1FjEaEiEiEiEiElE3fiEiEiFlfiFiEitiEitiEiF7FiFi iF3FiFir fT'it�.. �.FS�i�' �iFiFyTiFiFir n iF�Fif'iFi�Fit�-�tx �if3Eff3Fic-1f-lFibiEif�iF�it1E
iEiEifiEi!?fiFiEikiE?EiEifiEiFdfifiFifiF1(��fifikif�lfif�EiElEi(�iE�fiE�lEkifjk:rti.�jF�IF�IE�. ' iFiE�l(�if##jEi6iEififiEiEiEik±ElfifiFifiEiFff#iFiE#fElfiEiElf�fif
LEGALI2ATION;N F E E S U M M A R Y STRIICTURAL SEGMENT:N
BLDG PMT PiUMBING ELECTRIC MECAANIC FIRE SMIP/RES GRADING
P=RMIT 87.±0
ir 50� SMIP/NON—RES
PLAN
ISSUE FEE :15.00
BUILDiNG—DIV—> PERMZ3 ISSUE PLAN—CHECK TOTAL PAID DtiE
io�a�s----> s�.io is.00 '•. o.00 ioz.io ioz.io .00
�,
REVENDE DIVISION TOTAI,S--> COLLECTED: 102.10 OVER/SHORT; .00
3LDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMZP/TOT GRADING PLAN—CHECR
1 0 2. 1 0
iE 3E iE x if ?F if ?f if if if �lE iE iE 9F iE #�!E!E iE iE 1F iE if iE N� dE 1E IE iE �lt iE if iE'd(' iE IE �f iE if iE iE �1F iE iE �1F iE 3F #*iE iE iF iF 3f-# 1Ei41F 1E 1F iE iE iE # if ib iE if iE if it it fE # 3f if i(� iE
I N D Z V I D O A L F E E B'R E A K D O W N
TYPE QTY U E S C R I P T I O N UNI3 COSY TOTAL COST
ELE 20 FZXTURES, LIGHTiNG" 1 ST 20 EA. .75 ?5.00
ELE 3 FZXTURES LIGHTING' ADDIiIONAi EA. ,45 1.35
ELE 20 RECEPT/OGTLET - 1 ST 20 EA. .75 15.00
ELE 40 RECEPT/OUT�ET ADDITIONAL EA, ,45 18,00
PLE 11 RECnPT/SWITCH 1 ST 20 EA. .75 8.25
ELE 1 SERVICES HELOW 600 V 6 BELOW 201 AMP 18.50 18.50
EL= /'� i M2SC APPARATUS NOT LISTED REp PERMIT 11.00 11.00
��0� ��� END Or FEE5
P �� � 01 4D144737-00144737 T C�T 102.10
.� _�� �pTE� 08/11;93 TIt1E: OE:55
� ( . . f
�
CONSTRUCTION AND PLANNING�� ' PL' ' `� �PA
APPROVALS Permit# Date I�spector qppROVALS Permit# Date Inspector
t. Temporary Electrica� Service or Pole �. 52. Pooi & Equipment Location �
2, Soil Pipe�Undrgrnd. „-� -, � 53. Steel Reinfo�cement .�
3. Etectrical Conduit UtilityUnd[gmd. - 54. forms
' 4. Electrical Condui[-Undrgrnd. 55. Electrital Bonding '
5. Steel Reinforceme�t 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAI TO COVER�GUNITE
7. Footings 58. Etectricaf Conduit-U�drgrnd. �
B. Foundation .� 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash �ines, P-Trap, � Undrgrnd.
10. Structural F�oor System �� j� 61. APPROVAL TO DECK ��_
11. Property Sewer Line & House_Connection �:�� 62. Backwash & Receptor�Final � '
72. Sewer Cap � � 63. Heater & Vent-Final -�C
13. Roof Drains i 64. Plumbing System � Final ��
14. Rough Plumbing � 65. Electrical-finat
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 $a3� �� 69. POOUSPA SYSTEMS fINAL
19. Rough Heating & Air Conditionin9 FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � � APPROVALS Permit #
21. Ducts,in St�ucture � � 70. Underground HYdro
22. Ducts. Vent�lating 71. Product Piping OGas ❑Oil .
23. Gas Pipe�Rough & Test , 72. Underground Flush - � ��
24. Roof Framin ^
9 73. Undergrnd. Storage Tank O Gas O Oil =' ,,�
25. Roof Sheathing 74, Overhead Hydro ''� '
26. T-Bar Ceilin9 (Structurel) & Monocoat 75. Dry Chemical �
27. Frame and Flashing 76. Dry Standpipe '
28. Lathing & 5�ding 77. FIXED SYSTEM FINAL
29. �nsulatlon i-. :. 78. FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . � 79. PINAL INSPECTION
32. Electrical Power Meter•Final ,' 80. FOOD CERTIFICATE ISSUED
33.'Final Electric � �( Q� �y/� Notes: $�6-Q� Ov'ESif��-° W4.l�S OA�� �`�"'
34. Final Heatir+g & Air Conditioning � .
35. Final Gas Pipe-Test• � ,
36. Hood or Canopy, , ' �
37. Final Factory Fireplace _ ' �i�: �
38. Final Pl�mb�ng . � 1/f
39. Water Service-Final :
40. Gas Service�Final � �
41. Solar pomestic•Final i
42. Backflow Preventer
43. Backflow Irrigation '
� 44. Landscape Irripation System �
45. Sound Attenuation
46. Handicap Reg�lations
47. FINAL STRUCTURE & BUILDING �
i:
48. FINALPLANNING �-
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co ' .
51. CERTIFICATE OF OCCUPANCY
No. Date
Pfl0.1ECT AOOPESS: • 3 S: 5' HARHOR B L uxiT: A
owNex•sxnme: C.J. SEGERSTROM & SONS
aooeess: 3315 FAIRVIEW RD
COSTA MESA
CA 92626
ANCHIENGINEEfl: � 7 S 4� S�I G—O I 1 O pEG.NO :
nooxess: PACIFIC HUILDING CONCEPTS C uxiT:
18102 SKY PARK S A-1
PEflMITTFF: IRVINE CA 92719
SELECT FIRE PROTECT�011 �714)921-2870
aoosess: ��A—`.-..,T,:,-.,•� ncrr 2qs
oa�--S�-��' cA�9�ss�9z��'�
LICENSEO LONTflpCTOB OECIABATION: I hereby allirm I�al I am IicenseU untler provisions ol ChaD�e� 9(commencing with Sec�ion
7000� ol Division 3 al I�e 9usiness antl Prafe55ians CoOe. anC my license is in lull brce antl effect.
cin uc.:A 518 4 STRTE LIC.: S 8 3 Z 7 �r� cu�s�s: C�-1�6•
oate: D^3 ��'�3 Sienature: `�,/� /�?
WONI(Efl5' COMPENSR710N OECIAflRT10N: I nereby aflirm I�al l have a cenilicate ol conunt to self-insure or a cenifiWte of Workers'
ComDensation Insurance. or a cenilietl copy ihertol (Section 3800, 1a0. C).
PoucrNo.: WP9350873203 EZP.o"TE: O1/O1/94
cornraxr: FREMONT
❑ Ceni�ied c Y�s De�eDy IurNshetl. C� Cettilie0 copY is lileC yii�/p �Ihe� cily Bul dlnq Oivivon
Date: � l ���� Applicant: __-�`:G�� //`-�L'�� "`�`�.
EYEMYfION FflOM WOPRENS' fAMPEN5RTI0N OECIAflATION: �This se¢�ion neeG iroi Ge comDleteO ii Ihe permit is �or one AunOreA �5100) or less�.
I ce�ily I�at in Ihe Derlormance ol I�e work lor w�i[� I�iS De�mi� is i55ueG. I shall nol employ any per5on in any manner so as �o become
sublect Io I�e WOBeri Com0en5aiion LawS o� Catilomia.
Da�e: Sipnature:
NOTICE: I�. aRer making ��is tleclaralion, you shoultl Oecome gu�lecl to Ihe Workers Compensalion provisions of Ihe Labor
Cod¢. you mu51 fo�hwil� Compry with 5uth O�Ovi5ion5 ar �his p¢rmii 5hall Ee Ueemetl revoked.
CONSTflUCTION LENDING RGENCY: I hereby affirm I�al �here is e construction lending aAency �or the Oertormance of �he work for
whicn Inis permiiis issuetl (Sectian 3097. Civ. C1.
LENUEfl:
ADDflE55:
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; F 06373
PERMIT NO: F 063736 PLAN CHECK NO: 03007-93 S GOVT; N SUPP: N
CONSTRUCTION TYPE: III—N SP PERMIT TYPE; FIR PURPOSE: AI.T
JOB DESCRIPTION ; 2200SF OFFICE T.I.(FIRE SPRINKLERS) SQ FT:
CLAIM VALUE: 1,520.00 CALC—VALUE: GROUP OCC: B-2 /
*�******i��t�t******�t�r�***�*�r�***4�e*******�r***+t�t****�*�*�*****�*�*** rt�rB******x��r�r
Z O N I N GS ERTEBQAUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARRING REQ• PROV; PARCEL: 91507103 2NE: REF NO:
PLANNING N01'ES>
�
�f 3f k if �f �f if if k k if if ik ik iF�f �k1! �f if if if if k 1k if iE iE fE it iF iFiE ik if it iFiEif it �E �! k�f IElt iF�f IE �f ik if 1Fiflf �E 1F k itlF fk 1E it i! iE iF if if if if ik if if it�E if i! 1f If
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY : � � C�'��"i3� DATE: � 3� 3
APPLICATION ISSUED BY: DATE: .3t�
illtiE�Fif�FififkKlEiF�Flkifil�Eifk1l�fiE ifiFl67t�FiffflElti! ifit
�E iF ik �f k iE �f k k k it it 1E it iklk iF M 3f if iF ik if k if it �f �f iF it!! �t if itlFlE �F 1t iF 1F iF �FlF iFlE�F k!f ft iF i! k k if iklf if 1Ei! iF iFlk 1E iE if if �1f if ilik ik 3f if it iF k fF �f f!
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
OwxexBWt0EB0eCu�nnnON: �herebya��irm�ha��ameeemp��mm�heConvac�ors'S�a�elicenseLawfor�he�o��owinpreason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES i'iRADING
(Seciion 70.31.5 Business an0 Pmlessional Cotle: Any city of county wpic� requires a permit m consimct, alter, impmve. Aemolish, or P ERM I T 3 7 0 �
r¢pair any slmCWre. prior Io ils issuance. a150 mQUireS ihe appliCaq� tOr SUch permii to file a Signetl Sia�emen� �ha� he/She is licensed
pursuant to Ihe pmvisions ol ihe Coniraclors' Sta1e License Law (Chap�er 9(commencing vn�h Sec�ion 7000) ol0ivision 3 0l �he Business � 5 Y' SM I P/NON—RES
ana Pmlessions Coae) or inai helshe is ezempl t�eretmm ana t�e Aasis lor t�e alleped exemption. Any violalion of Section 7031.5 hy pLAN � 2 9. 0 5
any applicant lor a Oermit suhle��s Ihe applicani m a civil penalry qf nat more ihan five hundreA tloliars (5500). ISSIIE FEE
i, as owner o� IAe D�opehY or my emyiayees witn waees as ineir soie compensation, wi�� oo ine work, antl Ihe BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID DUE
❑ s�mclure is nol imenaeU or oflered lor sal¢ (Secuon 704a, 6qsiness an0 Professional Cotle: The Comractors' State License Law TOTALS--- —> 3%, � � �. 00 2 9, 0 5 61 . 0 5 61 , � S . � 0
tloes not aOPty to an owner ol a OwOeny who builUs orimproves ihereon. and who does such work himself/herself orthrouAh
his or her own employees. D�aviOetl that sucA impmvemen�s are not inten0e0 or otteretl for sale. II, however ihe buil0ing or I
impmvemem is soltl within one year oi completion, tAe owner will �ave the hurUen of pwving �e/s�e Aia not 6ui14 or impmve REVENUE D I V I S I ON T�TALS--> COLLECTED ; 3%. � 0 OVER / SHORT ; , 0 0
fanheDurposeolsale�. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I, as Owner o� the O�oOerty, am extlusively coniractinq wiih I�c¢nseU contractors to constmct ihe pmlect (Section 70da. Busineu 3%. � �
❑ antl Professians CoOe: The Comracmrs' State License Law G� �oi aOPN �o an ovmer of O�operly who EmIGs or im0�u Nereon
anU who coniracts for suc� D�olects with a comraclor(s) license pursuant to the Contractors' State License Law�. I am aware *,*,*,*,*,*.**,*,�*.K.,K.*,*,*,***.**.*.**.*,K.**.�,K.*„K.*,*,K.*.*,*.�,K,**.�*„�,K,�..�.X..�,�.x„�*.,k„�.�,K.***,�**,*,X„K„�*,*„X,*,*„K,*,K„�,��,
��at pmol oi t�eir Worker's Compenution insurance s�oultl Oe pronaea to me.
� I am erem0� wGer Seciion: B. 8 P. C.
lor lnis reazon:
Oa�e: Owner:
I Oo nereby cenify inal I am aware of and unUerstana ine reauirements oi Cdlilornia Heatth antl Safery COae Section5 25505, 25533. atb
25534 an0i�at lor anyluiure Uuiltling accupanlwilVwillnoi�circle one� neeato complY �^�� ��0 sta�e catles anEthe requiremenlslor a
permil lor conslmtlmn or moAilitaiion irom I�e Air Ouali�y ManaAelnenl DiSVitt. fle5iaeniul WnSVutlian appliwtioni are exemD� ��om
I�ese pmvisions.
Oale' AOPliwni:
1 nere6y ceridy ttut I nave reaa Inis aoV�icalbn antl stale tAal t�e aCpve inlotmdtim is correCt. I aqree to wmoN ��� all Gry antl counry
ordinances an� slale laws relating to builAinp conslmction anA �ereby dut�orke reO�esEn�atives of ihis ciry to enter upon t�e a�ove-mentioned
pmDerty IorinsDeclion ourposes. ��
� Da�e: �'��v �� Siqnalure: - ���L�LI.t.-�.�—
Oriver'S LicenSe or Social $ecurily M:
�6ai<6 Wnne—Buiiainq; Green—Cotle Enlorcemem: Canary�Aoolicam: Pink—Revenue: Goidenrod—Ascesmr
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
FIR 37 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 37.00
END OF FEES
• 'i
� i
(• '� 01 00146DD0-0014600D "f O T 37.00
') ��' DATE� Q8/31/93 TIME: 16:12
CONSTRUCTION AND PLANNING � PO�PA
APPROVALS Permit # ` Date Inspector p�ppROVALS Permit # �ate Inspector
1. Temporary Electrical Servicp.or Pole 52. Pool & Equipment Location '�
2. Soil Pipe�Undrgrnd. . �, � 53. Steel Reinforcement •
3.; Elect'ri'cal Cbnduit, Ut�lity-Undrgrnd. - 54. Forms
'�4. Elecirical.Condui2�Uqdrgrnd. 55. ElectricalBonding
5: Steel Reihfortement � 56. Rough Plumbing & Pressure Test
�. :
6. Electrical UFER Grnd. _ 57. APPROVAL TO COVEq�GUNITE ��i
' 1. Footings � " � 58. Electrical Co�duiFUndrgrnd.
,8. .Foundatioil '�, �. � � ' 59. Gas Pipe, � Und{grnd., Test i,
9.. Water Pipe-Undrgcnd. '/ 60. Backwash Lines, P-Trap, O Undrgrnd. �•
70: Structural Floor $ystem � "; 61. APPROVAL TO DECK �
11: Property�Sewer•�ine�& HouseConnection � 62. Backwash & Receptor�Final � �
72. Sewer Cap -' - 63. Heater & Vent•Final
73. Roof Orains �. . - 64. Plumbing System � Final
14. Rough Piumbing ' � 65. Electrica6Final ..
15. Rough Electrical,Conduit . 66. Solar System-Final
76. Rough Electric Wiring 67. Fencing & Access Approval ��
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough ElectricAl�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- .. . . . : c.' u' ar�[- v. r �
20..Aough Factory Fireplace � ��ai rC•7 . O ; � �rz� + �IiPPROVA'LS� "��Permit # " �•
�.r u' d - i� ir x$ i - I ��
21.' uC2s, in Stru �tu(C.;r � t•f . X:.i e �' � i '7� r q � � � 1•i . ^7
�Q F ir i .... i +>, + � �J �-+:. �: �-.f0. Underground NYdro
22.�Ducts, Ventilating •:, i �j:�, « y � a• � c�i. ProducYPinirig ��Gaq OOiI
23.'Gas�Pjpe-Rough &'T;est � `- '` �� '�'' ` F72, Under r � � � � �`� r
� � � i .,i� .e i�t r� .t �: - � 9 ound�Flu3�l: �`
� : . � � . � . . ,_ .
24.�Roof;Framing ^n� i [�•r- ��•' � rr �+� =:73.'UndergmA.-�StoragB:Tank �Gas ❑aih
�
25. iiodf Sheathin9 'a f °'� ' `'� � � 'j ` "` �74.iOverhead ;'�r,c..^' � Gj,�s '�
26. T-Bar,Ceiling (Struciural) & Monocoat � -� 75.� Dry Chemical "�� •
27.!FrameandFlashing .''.4._ ,�:�J, `' _�x�' 76.�DryStandpipe • �� "
;28. Lathi�g.&Siding; - • ��;" i; . �� 77..^•FIXEDSNSTEMFiNALA �
•29. Insutation ' � r� �'. - " r.� �' ` ; 78. FIRE PREV. �If�AL - dj�z1,C�3
i30. Orywall Nailing � �` � ��� �� 6lEALTH-0EPT. REQUIREMENT
' 31. Plaster Brown Coax ` � � " '' „79.' PINAL INS�ECTION � ' ,
�32.,ElectricalPowerMe{er;Final� ��� �:���. •�80.��Fr00DCERTIFIEATEISSUED
33. Fin2rElBctric . i„ J # 'k . c ' 1
, - � i r ! �,, I �.. r. _ r.Nofes: � � ;� .
i+ x • � i
34.. Finaj� Heating.& l}ir�CoRditioning � � S . � _
35.�Final�Gas'Pipe�Te'sC` '� � I . • �� , �..� *�;' . !��
�� , r ��.:�: • � ��.
36.'Hood or CanoPY ; , _ t � i . � � , � � ' '` � . �- .•
'37.�Fina1•Factoryfireplace� � • - ' � � � ` � '' ' 'r1
� �� . .v x �- ,.
� .. . : �,. . i .... i� .. I , i.._. . -
38. F.inal Plumbing •� � . ' • .
.39. �Watec Service-Final � i - � Y � � � � • �_ '
�_ .
'40.'GasService�Final� •' � _, , r. �' , - �-;-_ ' �.
i.
41..SolarpomesticFinal-. , •� � _• , �
42. �Backflow Prevente'r' ' � '�' ' � �
t I ,L . • '�,
43. Backflow Irrigation � -.5' � � '� �� , � ��' ' ' _ �
� .:, .
44. Landscape Irripation System "'`; ' - , � , � �, . �. �
.�., .�
i " ,
45. ;Sound Attenuation i • cay �• � � - i� • � � . �
+ � i . .. . � �
46. �Handicap Regulatior�s . ,� . -
' 47. FINAL STRUCTUR�E & BUIL•DING � �� � .. , '
48.:FINAL PLANNING' ' ' ` � �, � "" " � � �
49. Electric Release to.Edison • � -
50. Gas Release to Southern California Gas Co . `" ' � .
I . I F ,. . c� ..
51. CERTIFICATE OF OCCUPA, Y " . , ,j . _ ' ,
No. Date
Ap0lieanl l0 fill In all ipaces extepl Ihose wilhln heavy Do�Ee� Ilnnf anE sign all aDProO��ale tleclantions.
F COS7A MESA CONSTRUCTION
Address 35 45 Np2gcn c�ais Wc
¢ipplicant's Mailing Address �w�' •
Owner's Name pQ 2 wp� Phone
Address �,tPo.t2`IQ �1.��7�. �-.�1 .
Arch/Eng. V ti �OfL(�- License Na. �
Address 3545 _ ronticn Csy�1�4.aA�l so�7id-
Comraccor's Name � � V ��� ' Phone
Addresslmailing) S/�-�+� �S �AoJd'•
City License No.
LICENSEO CONTRACTOR DECLARATION
1 herCDy a11i�m [bal I am litensed untler provlzlons at ChartCr 9(CommGnNng
with section 7000) of olvision 3 of the Buslness antl Professlons Cotle, antl
my Ilcense is In lull torce antl eHect.
License Class license No.
Date Si9nature
W00.KER5' COMPENSATION OECLARATION
1 hereby afOrm tnat I have a certlflcate of con5ent to self-insure or a certliicate
Workers' Compensa[ion Insurance, or a certifietl coOY thereot (Section
00, Lab. C.)
volicy No. Company
eCertitietl topy is hereby furnishetl.
Ce.titietl copy is filea with the city Builtling Division.
Date Apo�icant
EXEMPTION FROM WORKERS• COMPENSATION UECLARATION
(Tltif section n0¢tl not be campleteG if Ihe parmlt 75 for On0 hunEretl (E300) or
less).
' I certify that in the pertormance of the work /or wbich thls perm�t is issuetl, I
shall not employ any oerson in any manner so as to become zub�ect to Iha
Workers' Compensalion Laws o! Calitomia.
Datq� SI9naWre
NOTICE: If, aller making thls tle<Iaration, you ihoul0 b come subjett to t
Workeri' Compensation provi5ions ot tha Labor Co ou must f th
comO�Y �+��h such prOvizions o� thi5 0¢rmI be tle0m00 vo
CONSTRUCTION LENDING AGENCV
1 hereby afflrm thal there is a construction len agen t n
of lho wo�k for wM1ich Ihis permit is ISs On iv.
LenCer's Name
Lenticr's Adtlress
OWNER BUILDER DECLARATION
I heroby aHlrm lhal I am exempt from tho Contr or's LI<ense Law for the
following reason (Soctlon 7031.5 BuSiness antl Protesslonal Cotle: Any cltY or
Counly whicn �equi�es a p<rmit to Cons[�uCt, dlter. Im0�Ov0, tlemolisn o� �apol�
any structure, Orlor to Its issuance, also requlres tha applicant for such permit
rn eiln a cionatl statem¢n[ Ihat h¢/She Is litln5etl purSOant to lh¢ plovi510ns o(
031.5 by any apD���ant for a permit sub7ects tbe appucam co a crvu
enalty o1 nol more than tive huntlretl tlollart (E500).
� 1, as ownar o1 tha Property or my amployaes with wages as tholr sale
compensation, will Co the work, antl the structum Is not Intontletl or oHar¢C
IOr sal¢ (Section �044, Business antl Professlondl Catla: The COntractor's
License law tloos nol apply to an awner of a proPerty who bulltls or improves
therBOn, antl who tlot5 such wo�k hiTself/horzell Or tn�ough his or he� own
employoes, provitletl tnat such Improvements are not Intentla0 or ottere0 tor
sale. It, hOwavlr, tha builtling or ImprOvement ii sOltl wlthin ana year Of com-
plotion, [ho owncr will have the burtl<n of proving he/Sho tlltl nOt builtl or iT-
nfOVG 10f th0 OUfpOT! Of Sd10).
❑ 1, as owner of the property, am exclusively contracting wlth Ilcensetl con-
traetors to eonsV u<t tM1e projeet ($¢Cfi0e1 7044, B119fIB55 d�G PIO(8551005 COCe:
The ConHaclor's Lltanse Law does not applY to an owner of property who
bulltls m Imoroves [nerean. antl who contracts for such oroiect5 with a r.on-
tractor�t Lcense pursuan[ to [ne Contractor•s Llcense Law). I am aware that
prOoi o� In¢Ir WOrke�'s Compensatlon insU/anca ShOWU be provltle0 to mG.
❑ I am exempt un0er Sectlon B. & P. C. �or this reason
Date Owner
I bereby <erUry tnat I �ave reatl tnis appii<atlon antl state t�at the above
In/ormation is correct. 1 a9ree to comply with all clty antl <ounty ortlinances
antl state laws relatln9�to builtlin9 conslruction, an0 hereby authorize repre-
5entative5 of this city to enter upon Ihe above-mentionetl ProDerty for
InSDection OurOoses. � �
Slgna W re Date
Drlvers' Litenu or 55 �
, �„�.�� � �.... ��.V �l/l V3 A.P. qW .
S Main Building:
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR E
❑ CONVERSION ❑ DEMOLISH ❑ OTHE T Front
DESCRIPTION OF WORK/USE OF BLDG. ' A Aear
TVPE OF PERMIT GRADIrvG FOVrvDATION 57RUCruRAL I C Right
K left
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL S
❑ -OTHER Ping. Ref. #
PROJECT DESCRIPTION 50. FT. OCCUPANCV Planning Notes:
CONSTRUCTIONTVPE � VALUATION$ 3� 0��� �
20NE GRADING GU. VDS. ACRES
Remarkt:
Sink
Preventer
Irrigation
Gas Service
Interceptors
Kitchen Sink
Fee
Outlets
$15
Boiler
Duc� - Under nd
Duc[ - Structure
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/FacL Blt. ICBO #
Heating System & Ducting
❑ 0�100.000 BTU � 100.000
Reinspection Fee � 515
0865-46, rev. 5/88 White � Builtling; Canary - APPllcant; Pink - Accounting; Golaenrotl - Assa55or
ShOwers
Servite Sink
Sewer (:ap
Sewer Connection
Solef CollectOrS
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Wpyr Heeter
Leundry Tra'ys
�Type I ❑
Type I I ❑
Refrigeretion System
❑4100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Isue Fee
FEES P�urometic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Oryers �Gas ❑Elec
Fan
F.A.U.
Fix[ures
Device Boxes
Outlets
Switches
Garbage Disposel
Generaror OO-5 KW C
5 3
FEES
S a
3
2one
Atcessory Building:
Z
O
N
I
N
G
R
Perking Req./Provided E
O
I M
T
S.
ELECTRICAL
Transtormer � 15-50 KW
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over700amps
Sub Panel
Motors OP7 HP O1 h- 8
Inc. Salar 09-15 HP �16-15+
Microwave
Pole Light
Rnnge
Standing Sections
5-15 KW Trash Compactor
FEES
I Reinspedion Fee !§15 � I luue Fea I S 3 I
DEVELOPMENT SERVICES REUUIREMEN75:
2oning Approved By �ate
Building Approved By Date
Application laued By nata
SUMMAqV OF FEES A
BUILDING PERMIT $ „L.�4-_.s� SMIP $ "'�•.�
PLAN CHECK $ PERMIT _
PLUMBING $ �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING S
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $
PLAN CHECK 25% $
r
STRUCTION AND PLANNING - POOL SPA �,�
PPROVALS Permit# Date Inspector � AppROVALS Permit# Date Inspector
;-,1.;Tempoiary.,Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
� ' 3'�Electricel Conduit Utility-Undrgmd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5., Steel Reinforcement 56. Rough Plumbing & Pressure Test
6._ Electiical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Foo4ings � ' 58. Electrical Conduit-Undrgrnd.
8.' Foundation ,- 59 Gas Pipe, O Undrgmd., Test
9. Water Pipe-Undrgrnd. �60. �k�sh Lines, P-Trap, �'Undrgmd.
10. Structural Floor SYstem � 61���A��ROVAL TO DECK
11. Property Sewer Line & House Connection 6. ackwash & Receptor-Final
12. Sewer Cap 6�Heater & Vent-Final
. ..---
13. Roof Drains 64, Plumbing System - Final
v
14. Rough Plumbing f �^�El�ctrical-Final
15. Rough Electrical-Conduit "66. Solar System-Final
1-6. Rough Elec[ric Wiring �7. Pencing 8; A� s�Approval
' 17. Rou h Wirin Si n i '��'�� �
9 9 9 68. APPROV,ED FOR PLA�,STERING
18. Rough Electrical-T Bar Cei�ling ��, 69. POOL/SP�S�,yEMS FINAL
19. Rough Heating & Air Conditioning � ` FIRE DEPT. RE UIRE ��,,
20. Rough Factory Fireplace '- ��;,� APPROVALS� P c it #-�
�
� 21. Ducts, in Structure "� `• � 70. Undergrour�d„�-lydro ��t �.�'�
22: Ducts, Ventilating ';,� Jv '�� 71. Produc 't�'ing 0 Gas ❑ Oil��� �
23.� Gas Pipe-Rough & Test - 72. Und�rgrohn Flush � f�.
24�RoofFraming 73. Unde,�,gr�d.StorageTank �"Ga�OOil
�
25. Roof Sheathing :.T' 74. e�head Hydro 5
,26: T-Bar Ceiling (S[ructurall &��Monocoat 75. Ory� emiral f
r--
27.'.Frame and Flashing „s 76. Dry Standpipe
28. Lathi�g & Siding � 77. FIXED SYSTE}1� M1I�AL
29. Insulation 'U 78. FIRE PREV. FI�NaAL
30. Drywall Nailing �J -� HE,�jt�H�DEPT. REQUIREMENT
n .�..��
31. Plaster Brown Coat n �"� 79. FINAL INS�T�ON~
32. Electrical Power MeterFinal•� 80. FOOD CE :fI�IC'nATE ISSUED
33. Final Electric ';� ���: Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
r
37. Final Factory Fireplace
�
,38. Finai P�umbing • -
'.39. Water,Service-Final ��
40. Gas�Service-Fina� '-! �
41. Solar pomestic-Final ! �
�42. Backflow Preventer r. �+
�
r
43. Backflow Irrigation•.,, •
44. landscape Irrigation SYstem '%
. 45. Sound Attenuation .
46. Handicap Regulations
47. FINAL�STRUCTURE & BUILDING
48. Special Requirements Completed
i
.A9. Electric Release to Edison
�5p. Gas Release to Southern California Gas Co I�'
51. CERTIFICATEOFOCCUPANCY i;�
No Date
� • PROJI�TPDOPESS: 3 rj Q '�j
� OWNEA'S NRME: C S,
aooRess: 3 3 1 5
C.M.,
HARHOR GATEWAY ST
SEGERSTROM
FAIRVZEW RD
CA 92626
850-1540
RflLM/ENGINEEX: TOM �Ai"�P�JC
noonEss: 1809 WESTCLIFF DR
N,B.
PENMIiTEE: CO—WELL CONTRACTORS
aoosess: 3506 W. LAKE CENTE
SANTA ANA
'ENSEO LONTBACTOfl DELIAflFTION: I �ereEy allirm Ilai I am li sei
70�Wsion 3 0l t�e Bus�ness anA Pralessions CoGe. anE my ense
'"y�[1L/� 4 0 sT e uc.: 514 9 8 2 �
le: J � _ -9 � Signaiure: _ — . _ /
Campenution Ins ra�c t cenuie coDY �neteol R��an ;itlw, Lai
roucr eo.: ��16 � Y�— 9 E%P. OATE:
camrnxr: STATE FUND
❑ i ie copy i5 �ereby tumis�etl. � Cenilie0 copy a lile�
���TC!�� .�— Mvfwm:_
ION iflOM WOFIIEXS' COMPENSITION OEWIIATION:
ihat in the pedormance ol I�e wark lor whic� t�i5 V
�o I�e WOtkers' Comp¢n5alion Laws ol Calilomia.
UNIT: 103
HEG.NO.: C�
uNn: 2 7 5
CA 92660
(714)540-3771
CA 9 704 /f B
e� ormn� C�aote/l�6mme(rinn wiN Seclion
�IfpYEonienl to sell-in5ure af dJ,enil' te of Woders'
OS/99 s
dnpkt� it tlre pErmA ¢ iw ale huMr� (5100) or lessl.
emo��' any person in any manner so as m �ecome
Oa�e: Siqnaiure:
NOTICE: II. alter makinq t�is aeUara�bn. you 5Aw10 Cecome su0jttt m the Workers' Compensation Drovisions oi the LaCor
� Cotle, you musl �onhwi�� compty wit� suc� O�ovisions or tks permit shall be OeemeG revokeA.
CONSTNUCiION LENUING RGENLY: I �ereby a�lirm I�al lnere is a canSlmCiion lentlinq aAen�y lOr IOe Dertormante o� fh¢ wOB for
wnich tnis O¢rmil is issuea (Section 3097. Civ. C�.
LENOEfl:
ADONESS:
OWNEP BULLDEP UECLABRTION: I here0y atfirm Vai I am e.empl tmm t�e Comractars' State License Law for t�e follawinp reason
(Sec�ion 7091.5 Busineu anU Pwlessional Cade: Any cily o� toMty w�ich reQuires a p¢rmit �o canslmcL atler, impmve, Aemolish, or
repaii any stmcmre, prior to its issuance. also aauires ine aDP�iunt lar such permit to lile a sipne0 staiemem tAat ne/s�e is licensetl
pursuani to I�e pmvisions oi IAe Contractors' Siate License Law (Chapter 9(commencinq with Section 7000� oi �ivision 3 oi t�e Business
ana Pro�essions Code) m Ihal hels�e is CxemO� ��er¢Irom anG I�8 OasiS b� I�e all¢peG erem0�i0n. Fny Wolalion Of SeClion 7031.5 by
any aOV�ican� for a permil wEietls tlle applicanl �o a tivil Oenally ol not more t�an live �unCreO Gollars (5500).
❑, I, as owner ol �ne pmveny ai my employees vnih wapes as tneir sole compensation, wlll Oa ine work, and ihe
stmcmre is no� imenCea or oilered loi sale (Secuon 70a4, 8usiness ana Professianal CoOe: T�e Comractors �Slate License law
Goes not apDW to an ownei ol a O�oDerty wlw OuilCs or imDmves I�ereon, and wAo Jaes suc� work �imseli/�ersell or NwuAh
�is on c�r own employces. pmvNeO I�at sucA improvemenis are not inlen4eG oi ollered lor sale. II, however tlle 6uiltlinp or
� impmvemenl is Saltl vn�hin one year ot tOmpleiion, I�2 OwnBr vnll have I�e OurG¢n 0� O�oNnO he/She Oi0 noi Guild Or imD�Ove
lorlhe purpose ol salel.
I, as owner ol ine pmDerty, am evclusively comrac�inA wii� licensetl comracmrs �a conslmcl �he pwlect �Section 7044, Business
❑ anA Pm�e55ion5 CoE¢: TAe Conlfatiors' Siale Lit¢nSe Law Oces no� appN �0 an Ovmerol pmpetly wh0 OuAES ar improves Iher¢on
• antl who coniracls lor such prqecis wit� a wnVapOr(5) license pursuant lo I�a ContractaK Sla�e license Law�. I am aware
I�al pmot ol I�eir Worker'S ComOensation insurance SOONa �e D��4� �o me.
� I am eKempl under Sec�ian: B. 8 P. C.
lar �nis reazon:
oate: Owner. _
I eo nere0y cenily �nat I am awdre oi an0 unCerstana tne eepuiRmenlS al Cdlilorf
255Ja antl I�at I or any tulure Ouiltling occu0anl wiiVwill not (circle one� nee0 to c
perrr�l loi codsim[lion or m00ditalion bOm I�e tit Ouabty ManapGmtni DiSlriCi.
Ihese O�ovisions.
�a�e: Appli[ani:_
Iher¢Dy Cetliiyl�al Ituve rea0l�i5 aD0licaiion aM Slaie llul I�¢
orUinances an0 slaie laws relating lo OuAGmg conslNCGon anG nerel
�icense a� Saial Secudry +:
6
i505. 25533. ana
!quirement5 �or a
dfC EMC111pi If001
wmply vnlh allp�y an0 county
enlerupOnlnea�Ove-mentione0
164L46 W�i�e—BuilOing: Green—CWe Enlorcemonl; Canary—ApplicanC Pink—Revenue: GoMenrotl—Asseswr
CITY OF COSTA MESA — BUILDING PERMZT
PERMIT NO: H 065846 PLAN CHECK NO: 00213-94 A
CONSTRUCTION TYPE; III—N PERMIT TYPE: STR
JOB DESCRIPTION ; 12000SF OFFZCE T.I,
CLAIM VALUE: 100,000.00 CALC—VALUE;
PERM NO: B 06584
GOVT: N SUPP: N
PURPOSE: ALT
SQ FT: 12,000
158,488.11 GROUP OCC: B-2 /
COMMENTS: "ABBEY HOME HEALTH CARE" OFFICE T,I.
it*�r+t�t�r�titx�xftir�rx�i�it�tx�r�titi�ft*�t�t*it*��t**rt�r*iE*�ritit**iritit�t*i�+riti�it�tft�t*****�x�*+r�ir*ifitit�tirx�rir�tir�t
Z O N I N GS ERTEBgAUCIKRSE M E N T S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT; ET IN LEFT; FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 41508134 ZNE: PDI REF NO:
PLANNING NOTES> INTERIOR ALTERATION FOR ABBEY MEDICAL SERVICES IN AN
> EXISTING EUILDING IN HARBOR GATEWAY.
�tir+t**�**�t�r*�r�r*�txx.r+r*ft�t�ir*'ir��tx�*�r+r*�r+e�t+�*�ri�**+�**x��r*�x�+t*irir+r*�**+r*�****�r*x��r*�t�r+r**�r**�r
D E V E L;.O P M E N•T S E R V Z C E S R E Q U I R E M E N.T S
ZONING APPROVED/BY ' V`J�� DATE: � Z1 �r1
BUILDING APPROVED�HY : .� DATE:
APPLICATION ISSUED BY; `� S� DATE: �i�% �LN
klfiEifitillfitiElE�ElF1f1F1FiE.itiFitiEikif iEiEiElfiFiEiEiEifit ifiE
iE 1E iE 1! i! 1f k iF i! iElE iE iE if if�1E 1f if ik ik if iE ik M 1f 7f iF 1! iE ik if iE M if 1f if fE if iE if if if it if if 1k if it iE M if ik iE if ik k iF if 1E ff If ib if i! M ik if fE K 9f if k if ft i! ik 1! iE iE
LEGALIZATION:N F E E .S U M• M A R Y�y: STRUCTUR'AL SEGMENT:Y
�% r'�. X f
BLDG PMT PLUMBING ELECTRIC� MECHANIC, � FIRE SMIP/RES GRADING
PERMIT 846,00 ^ . �: r'�
/ SMIP/NON—RES
PLAN 137.48 • �'i • .. . . � . 33.28
ISSUE FEE y � '
bUILDING—DIV—> PERMIT ISSUE PLyAN—CHECA , �TOTAL PAID DOE
TOTALS----> 879.28 0,00 j'137,48 • 1016.76 1057.14 —40.38
REVENUE DIVISION TOTALS--> COLLlECTED;' 879,28 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANI'C' FIRE; �,MdP/TOT GRADING PLAN—CAECK
846.00 : r, � ,, j. 33. 28
., �,. . r .
iE 9f iE 9f iF 1f ff iF ff if 1f af if it iF if if ik if it if if iE if 1E k 1E If if 1E i! �E 1F iE iF 1Flf if iElf !! iF�iF fE iP.if iF iF if iF�iF iE:# fF �f 1E 3f If IE iF k iE K if iF if M if if if M fE i! iP iF iF 1E if iE
Z N D I V I D 0 A L F�E E B R E iP./K D O W N
.�'f �
TYPE QTY D E S C R I P T I-O Nr -- �' �:i UNIT COST TOTAL COST
r � / � �' • �
SFC 12771. OFF—INT. ALTER TYPE Z'II`=.N �—AVER✓� 11.72 149,676.12
SFC 12771 EQU—ALT COMM. AIR COND:�� —AVER ,69 8,811.99
END'� 6�'• FEES '
, sr : -
/ '� �. /
_ ` � ,� .
.+
�� f .
' ;� y. /,� nl lQ.5T443—OR'_�4444 ��i T
• vATE: D112�/44 TII'E: i4:'�8
:%i..
,
CONSTRUCTIOfi ARD PLARRt(�G i
APPROVAL� Permit � Date
'i. Temperary C!ectncal Se•vicr or Po�c
� 2. 50:� P"p��Urtd•£ri,�.
3. Etectri4� Co�dult Utiit•; �U^.drgrn�l.
I+4. Eiec!r Ce' Cand�.�.!�Undry�r:l. --
� b� Strc� rla�o+o�c'�mi�nt ----- �
� �. F. ct���_.� LFEr r.�.� __-__
i 7. foot�ng, --�- - - --- '-
i 8. Foundation
Inspector
POOL � _rA '� '
AP?ROVAIS Permit � _ � i
52. Pooi & Equipment Locauon
53. S�e.�i qc�nforeement
54. Porrns
Date I Indpector ,
� -�---- --�
55. E1=ctric�l Bond�ng I .
y--5-G,- Aoc.�h Plumbing & Pressure Test I �-{-
I 57 qvnROVAL TO COVFR�GUilITE � I `^'
� --I -+----�
-� 5R. Electrical Cqnduit-Undrgrnd. � �
59. Gas P�pa, O UnJrgrnd., 7est � �!
- - -�
I 9. �'.�ter P�pe-UNrqrn:�, ' 6�. BaCic'NOSh Li�cS, P•T�ep, �� �lncirgtr.d. -r
i10. Stru[tw;+� F�cur $ystcrt J � 61. AFPROVAL TD DECK -�� '
1? F-oPo`.ti S+'. r ��: C� F'�:..tiBCOnnt^tt�nit -�--�-,___ _�
�- 62 Haclavash & ReteptorFinal � �
i 12. Scr:zr C.i�� --- -- -�- -���3. Heatcr & Vt•nt-Final - � --�-- -- -__ -+
�--------- -J - -
� '7. Ro:,�.^,ia��, � • - -�
. 6�. Plumbing System � Fmdf �I • �
� _-'_________'_-_ ' _-� _"�
� i4. Reup � Ph�mi�m9 65, ElcctriCal-Final �� I
;�5 Pc_�n Elcctnai�Co�d:. r �66. S��ar System•Fina! � - I
�----------- ---J--- --- - - -
�u. ��-.. �-� -�,;ctr c!:'�� .n� ( 67. Fenang & Access ApProval _f-
1�--- - - --------- �--i--- - --
'� V. Fo�..�,��. .�1 •r•a S;nn �
. - ( � � 68. APPROVED FOR PLASTERi^;G �� �
j'� ": t-��' �'. j:'�`..�' � 69. POOLlSPASYS;Ef.iSF!NAL ' i
�----------- J . � --- --
� 4 Ri.:;r� �-, a'�.�c � A'� Cc•�d-:��omn9 , FIRE DEPT. REQUIHEf45EN-( --�� ---�',
� �:' �---- ' : a� -�_ . -r--�.aPPP.OVALS� Peraiit;: __.�
�--,-------�--- I --i - -----�------ ---
� . . �.r.: - Sv,�cr� � , � 7p, Underg�cuno Hydro
�?�-1 - -- --- --�- -t--t- --i - ;-- - -
-.� ,• , P�ad��t PiP�;r.q '. Gas C 0�.�
__ -'_'.-._______ _ �- _ �._____.�.-_ _ -____ -____"-1_ _ --�
� GJ..' . P p' iC_ - h`LSS ,
_ .._ �-_,__ _.�-. __ _ i i2. UnU�'9�ouhri Fiu�i� ____. __. _ _ __ ._ . _ __
:' ;;:.of :�.: �� � � ---T - - - � ! 73. Ur.dorgrnd. S!oraq� Tc^!c '� G. ; _' 0 � '
---- - ------ -- -----!�---�---- �-- -- '----'- --- - �- - - -
i i�. n.' . �i-. � i /J � 7G 0 erY.aa rlvarr, �
- - -- -- - - - - - // --�/v" t
�.l. I H l�irl r tu,.. � i'�'�L'9� __�/�////Y � j J5 Il �! nr��l -__. _'__ __"__ _- - � _
� __ _ _ . _ ' ! 7 '• _ - -- . _: _ _ _
-7. �- ,i . i�' � ,i-..�. i I 7G ,.r� o..'t p�o;
_'._- _ _ __ _ __-' -_ _' _ _ _ � ' _ � _ "_ ).__- _' _' '-- _ ___ _ - ' ' ' ' '
i 7H. L,th "� L ��,d�.,9 ' � � 7l c�Y,[D �l'STE^� FIP:AL �
-----------� ---- ------- - - --- -
Z, _ , -� --- -i- - -
--' �_ �e H�- i•atv Firv�,� , �
_d0 f? y�� , .:.-.i,,.o - - --- - �/g/9Y-!,� -�- -- -HEALTH���PT. R::QJri i -,.,-T- - - -
31. ?�r �!t� iii�t .� . . 74. '�I':,11 II•�c��ECT10`�
--- � - •- - - -- -- - -- - � '- -'--i-- -------' --- - - -- -� -+ - �
32 c4ctr�t,.1 P,�,^.ei ;�; t,���Fii,,: � � 80. �OGU CENT1�14ATE ISSUEJ �
i
T_ _ _
:i3. i-ii-„I EI� r.!r_f __. _'__ . _ -_- - '___J_ _�._�-- � iVcte _ _ _ _ _� _ -___ �_ _ _ � � _ ,
I � /
�----� - - � _ -�.C�s..✓(.- e%/p�v'' . �s/ oT � .
I "i4. =���iN�,t .:lar.^.ona!�[���n�� -��-
i-. -- - - - - - - --- -- - --- � - _ - /�� cetG/ ai-t--/(o.� Fi2.h/'!r� Fi'' � �'I/;
35. F�na� G..r P p_�7.:s� � '
�-- - - - - - --- -------- �- ---% -'-���- _-- F/.C. _4.ior.r /����'✓
� �-. 1 ._ „- r �� v - ------ --I--- - I ---�----- - - - - -- �r. ��
� 37.=�i JI F':t.tar�:_Fir,�n dCt __-- l I r! i .� � � R� �O�/ .
i �
�' ?9. F-;I� _-'-�,'-'__- � ___
09. C:�ter Smvic��F�nal �
' a�. ..�• �_� «�,�,i : -7 -
� qt. s�lai ccmcsn�.p,���------- - i --
iJ12 5.c':'!c::P.,.nt:r -_ ,--.___._
-- --- --- --�- --�-
�43. �. �.flc.. ,r .�'<t.o�� i i
--- -- - - - - -- - -- - - - - -+--- --+ -- --
i�4. L� ^d:[.,.. !�. �:�„r S, [r�o: � I
._ __'__f^ --.___-_'_".- . t_--�-'-„-
�W5 S,�- : q't.^u. tior i
4E. F�a�d��r_.{+�Fl:^v'�t�o••- --- - ---t---�� --- -
- ---------- - - � --- t_ --
r47. F!':A!_Sir,�JC�L'�=� ��!_D��,C � �
5 �S/y � U�
- --- -- - - - ---� - -
_9'a_G�j•s ._ ,'...../�� '
48 "\P.L P� !:'�N�^IC r � -' I
, r.�9. E: . �ic . n :u Gd:�--- - --------i -�--�-t -----�--
- - - - -- - ----- -- --�-%-' -
$0 Gn� `�elu.�5� tu $outiitrn G�Itfnm�d Ges CA I
51. CEflTIF!C : i � 0� CCCUPA�!CY
Ro--------,:�!c - - -I�-
`
----- �- - - - -- -
' PHOJ4�.'fRODNESS: 3S4J HARBOR GATEWAY ST uxiT: 103
owN¢nsxame: C ,J. SEGEASTROM
aoosess: 3315 FAIRVIEW RD
C.M., CA 92626
850-1540
AHLNIENGINEEP: TOM CAMPOS AEG.NO.: C O
nooecss: 1809 WESTCLIFF DR 0N1T 275
N.B. CA 92660
PEflMIT�EE: ELZTE PLUMBING (714)722-0379
nooness: '775 W. 17TH ST Q
COSTA MESA CA 92627
LICENSEO CONTPACTOB OECIANATION: I �ere0y allirm Ilui I am Iicen5e0 un0¢r pmvision5 0l CAaO�er 9(cammen[inp wit� Sec�ion
7000� ol Dinsion 3 of I�e Business aM PmleStions CaGe. an0 my licenu i in tull brte and e�hct.
cirruc.:0 6 sTpTEuc:539786 � S C-36
ale _ � Signature: — . _ _
W REBS' COMPEN R710N oECLAMTION: I nere0y aflirm I have a c ni �Cate of consent to ull-insure or a certifiwte of Workers'
ompensation Insurance. or a certilieG coD ��ereol (Section . La�.
raucrno.:046-94UNIT�207 E . RTE: O �OS�9S
camraNr: STATE FUND
❑ Certilie0 coDY is �ereby fumishetl. m Cerli�ieG toDY � ��letl vnlh I� tiry BuilOing Division.
�Oat "� Applicant:
MPi10 FflOM WOPI(EXS' COMPENSATION OEClA1L1TI0N: � - n n t ee mmqetea ii ine pxmt b Iw me Aunarta 1f100� a less�.
Yt¢Nty l�ai in Ihe periormante ol lhe work Ior wNt� tNs Oer 't' iSSueG. I II noi emDbY any person in any manner so az to b¢come
subletl Io I�e Worker5' ComDensalian Laws al Califomia.
Oaie: Signa�ure:
NOTICE: It. atler makinA t�is Oeclaratian. yrou stwuM Eecome SUGject ro t�e Waders' ComDenutpn O���s ol t�e la�or
COde. you must fo�Rxith compty wit� suc� prav2ian5 or tlris permil Shall Ce CeemCE revakeJ.
CONSTBUCTION LENDINC RGENCY: I hereby a8irm iMt �here is a conswction IenOing a0ency br t�e pedormance of Ihe work for
w0ic� Ihis permit i5 �<suea �Section 3097. Civ. C�.
LENDEP:
ADOPESS:
OWNEB BWLUFP OECLl�PRTION: I �ere0y atfirm Oui I am esemp� imm tAe Cont2ctors' State License Law for iha lollovrinp reason
�Seaion 7037.5 Busineu an0 Protessional CoOe: Rny qty ol county whic� repuires a permit m wnstmct. alter, im0«. Oemolish, ar
revair any s�mctuw. o�iar �o i¢ issuance. a6o repuires the apDUwnt lor sucA Dermil to ide a 9pn¢E snrement tlwl he/she is licenua
pursuanl lo t�e Dmvi5fon5 0l t�e Conlraciors' State Lianse Law (C�aD�er 9 �cammencinp vrit� Secuon 7000) of OWisian 3 ot tAe Business
ane Vroles5ians Code) or Itwt twJshe 6 evempt �neteltom ana ine Ga5i5 lor tlu allegEO eRemptbn. My vplatlon al SepiM 7071.5 oy
any aODlicant br a permit suGjects tlle apD��nt to a civil De�ally of nol more t�an liva �unEreE Oallars (5500�.
I, as owner al the propeny or my empIOyees �nN wd0es u their Sde ComDenSdtion, will Eo ihe work, ana itla
❑ simctwe is not imeiMeO or olfereG for ule �Section 70aa, Business anE Pmfessional CoEe: TAe Cantracrors' State License Uw
Goes nat apply to an axnet ol a pmpeny wtp OuBUs or imprPttS tllere0n, arW wtq COCS sutll w'afk NmuJ�/�ersell ar I�muph
�is or �e� own empoyees, O�ovitle0 i�at suc� imD�wemenls are not imenCeO or offereE for sale. II. however lhe huilUinp or
im0�ovemen� ¢ mIG xiiNn we year ol com0letion, t�e wmei vnll tave Ne OurOen al prowip Aals�e OiU not OuilU or impwve
lor ine ourpose ol Sale�.
1, as owner ol I�e pwceny. am e*tluvve1y wntraciinp wil� Iimnse0 Canlractors to constmct l�e project ISection 71NE, Business
❑ an0 Protessions CaOe: Ttce COniraztws' $Iate Lke�e L�w Oces not apph/ to an ovmer ol O�M�ty ���I65 Or imprOve5lnere0n
antl wno contratls br wc0 Drqecis vrit� a comracmr�s) littnse Dursuant to ihe Coniractars' S�am Licenu Law�. I am aware
inai D��� ol Neir Worker's Compensation insurance s�oNO Ee D«+a� to me.
� i am exempt untler Section: B. 8 P. C.
lor I�is rea5on:
Date: Mmer.
I Oa �ereby [etlify I�al I am aware oi and un0er5iana Iee repuiremenl5 OI CalilOmia Meali� 2nG $atery CaEe $ections 25505, 255J3, anG
255�C atb ItW� I or any WNre Uuiltlmq a[u0an1 wiNwill not (urtle one) ntM ta mmply wilh Sditl sWte mtl¢S anOl�e rCQuiRmenis lor a
permil lor consimclion or moailicalion irom ine Air Ouality Management USirict. qPsiGential fAnsimclion aOVlications are eKempl imm
inese pmvisions.
Daie: AppliWnl:
I�ereGy cetlAylAall�ave rea01�i5 aDP�ication ana 51alei�a� I�e a0oveinformationi5 torr¢cL lagr¢B t0 tomply wiih all cily an0 coun�y
ory'�ca,ces ana state laws relatinq to eud0ing caratruction anE ne�:Gy autrorRe�epresentatives oi ih6 ary to enter upon the aGwEmentimM
� SignaWre:
or Saiai Security M:
�6ai�n6 wnne—Builaing; Green—Coae Enmrcement: a� Applicant: Pink—Revenue: GOMenroE—Assesmr
. CZTY OF COSTA MESA — BUILDING PERMIT PERM NO: P 066235
PERMIT NO: P 066235 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE: IZZ—N PEAMIT TYPE: PLU PURPOSE: ALT
JOB DESCRIPTION : 12000SF OFFICE T.I. SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 /
COMMENTS: REF; B-65846 6 SUPPLEMENTAL P-65887
*****�ti�*it�t*�t**�*�r*+c�+�*�r+r�r+t�t��**�r*x�x��**+�******�**�*�t****x+t**�**+�**x�***�r+�*r�**�**�x�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 41508134 ZNE: REF NO:
PLANNING NOTES>
>
i� iE if �1! iE M �E if iE ik iE iF it if iE iE iF if iE iE if iE iE iE iF if if ik tf fElf if 1E iE iE iE it if if if iE iE iE if if it 1E it iE 1f?E iF i! i� iF 1f iE if iE iF iF if �f af if if iF iE iE jf iE iE iE 3E iE iE if if iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE:
APPLZCATION ISSUED HY: 4
�*+���r*�r*�r�r�r*x�r*xx+rr*+���r3�3F�F�r�iF��+ iFiF,�� �R���fF�iF�F*+�**D***�� � *I
iEifiFififiEiEkiFiffEiEif+fifiElE!litltlEiEiflPKilifiFlEiEit�filafiEltiEiFifiFlFiEfFiFlfi:iEifiFiflF%iFifififiEklFiFifitlF%lfiffflfiFiE?F iE3f ifiF?EiF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMZP/RES GRADING
PERMIT 21.00
25i SMIP/NON—RES
PLAN
ISSUE FEE 10.00
HUILDZNG—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 21.00 10,00 0.00 3,1,00 31.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 31,00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
31,00 •
iE if itlE 1f 1f iF it if it if if iE i! ik 1E i! iE i� iE it iF 1! iF k i� if if it 1k i1 it if i�lE if if iE if if i: M if fE if 1E 1E M if ihlE ff if if if IF if iF if 7f it if iE if iE i! iE ih i:1E 1E iF if If if if k 1f i!
I N D I V I D U A L F E E B A E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST
PLU i WATER HEATER AND/OR VENT 7.00
PLU 1 SZNKS, SERVIC$ / MOP 7,00
PLU 1 FIXTURE SET/TRAP W/PIPING 6 BACKFLOW 7.00
END OF FEES
0
TOTAL COST
7.00
7.00
7.00
Q1 00156?86-00256T36 TC�T 31.00
DATE� 03/O1/9S iItIE: 14:11
CONSTRUCTION AND PLANNING POOL a.,PA
4�
APPROVALS Permit# Date Inspector qppROVALS Permit,$' Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipmenc Location
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Uti�ity-Undrgrnd. 54. Forms
4. Electritai Conduit•Undrgrnd. 55. Elec[rical Bonding
5. Steel Reinforcement 56. Rough Plum6inq & Pressure Tesi
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Found2tion 59. Gas Pipe. O Untlrgrnd., Test (
9. Water P1pe-Undrgrnd. 60. Backwash Lmes. P�Trap, d Urdr9md.
70. Structural Floor Svstem ' 61. APPROVAL TO DECK
1 i, Propersy Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Gap 63. Heater & Vent�Final
13. Root D�afns 64. Plumbing Systc�m • Fina1
74. Aough Plumbing 65. Electrical�Final
15. Rough Electrical-Condu�t 66. Solar System•Final
76. Rough Electric Wiring 67. Fencing & Access Approva�
17. Rough Wiring Sign 68. APPROVED FOR PLASTERiNG
18. Rough Electrical�T Bar Cefling 69. POOUSPA SYSTEP,iS FINAL
19. Rough Heating & Air Co�ditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Duces, �� Structure 70. Underground Hydro
22. Oucts, Ventilating 71. Product Piping 17Gas OOiI
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Root P.aming 73. Undergmd,Stora9eTank OGas �Oil
25. Roof Sl�eathing 74. Overhead Hydro
26. T�Bar Geiling (Structurall & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Laching & Siding 77. FIXEO SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Orywall Nailin9 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. F�NAL INSPECTION �
32. Electriwl Power Meter�Final 80. FOOD CERTIFICATE ISSUED
33. FinaV E�ec;ric Notes:
34. Pinal Heating & Air Conditioning _ A s
't _ -�1��V ' /
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Finaf Factory Fireplace
3S. FinalPlumbing ,1K��
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestirfiaal �
42. BackfloW Preventer ,
43. Backflow Irrigation '
44. Landscape IrriGation System '
45. Sound Attenuation �.
46. HandicaP Regulations '
47. FINAL STRUCTURE & BUILDING �
46. FINAL PLANNING
49. Electr'ic Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY - •
No. Date
�aEEtnooness: 3545 AARHOR GATEWAY ST uxir: 103
r owxen s xamE: C, J, SEGERSTROM .`- ,.
nooness: 3315 FAIRVIF'W RD .
C.M., CA.92626 "
.
850-1540
AHCHIENGINEEfl: TOM C�i%'�P�S flEG.NU.: CO
PDONESS: iHO9 WESTCLIFF DR uNir: Z�5
N,H. CA 92660
PENMITTEE: ELITE PLUMHING (714)722-0374
nooeess: '7'7 5 W. 1 7 TH S T Q
COSTA MESA CA 92627
LICENSEO CONTBpCTOfl DELLNMTION: I hereGy allirm IAat t am IicenseU unAer pmvisions oi CAapter 9(commencing wilA Section
70001 0� Div6ion 3 0� ��e Business an0 Pmlessions Coae, antl my licen e is in lull far e an0 eflect.
ci 09 6 sTareuc.:539786 5 -
ale ' � Signa�ure: _ _
' WO � fl5' COM ENSR ION OECLAf1AT10N: I �ereGy allirm � I I �av a Cefiilita 0 o eni to Sell�insur¢ Or a certilitafe ol WOfkers
penlalianlOn4��6Ce���4UNIT�2Q07�secuE%P��.�O1/ 1/95
eoucr No.:
IcomraNv: STATE FUND
L� cen�ree cao is ere�y fumished. � CehifieU copy is filed ilh �he ci� 'Iaing Division.
ate: _ / AODlicant:
ION FBO Y70flNEfl5' COMPENSpTION OECUBATION: his tion nee0 no complete0 i� lAe permil is lor one �unGr¢J �5100) or less).
I cetlify IM1a� in the pedormance of ��e work lor whic� �his per i� is i 5ue0, I s�al ot employ any De�san in any manner sa as �o b¢come
suUle�� �o I�e Workers' Compen5aiion Laws of Califomia.
Oate: Siqnawre:
NOTICE: il, atler making t�is tleclaration, you shoNA hecome su01e�� �o ihe Workers' Compensation DrovAsians of t�e Lahor
Catle. you mus� �onliwith compty with such pmvisions ar lhis permit shall be OeemeO revoke0. "
CONSTPUCTION LEN�ING AGENCY: I hereby afiirm Ihai �here is a Coretmt�ion IenAinp ag¢nty for ihe p¢dormant¢ oi th¢ wOrk for
whicn ihis permii is issuee (Section 3097. Civ. C).
LENOEB:
AODflE55:
OWNEB BIIILDEF OECIAflATION: I hele�y a��irm Iha� I am exem0� ��Om the ContraClOrs' State license Law far ihe following reason
(Seclion 7031.5 Business and Pwiessional Code: Pny city of county wttic� reQuires a permii to cons�mc6 alter, imprOve, tlemolish, or
repair any s�mc�ure. prio� to its issuance. also reQuires I�e aOVlicanl for 5uc� Oermil �o lile a signeG slalemeni ihal �e/s�e is licensed
Dursuam to the pmvisions ol t�e Caniracmrs' S�ate License Law (Chapter 9(commencing wilA Seclion 7000) of Divisian 3 of Ihe Business
antl Prolessions Coee� or Ihat he/she is eeempt iherefmm antl the basis lar Ne allege0 eKemption. Any dolation oi Section 7031.5 Oy
any aDD�icanifor a vermil subie��s ihe aDP��cant lo a civil penalty ol nol more Inan liva nunOreO Oollars 1�500).
I, as owner ol Ihe pmpe�Y a� my emVloyees witn wages as ineir sole compensation, will tlo ihe work, antl ihe
❑ slmcmre is noi intenOeU or offereA for sale 15ection 7044, Business anU Pmfessional Code: The Contractors' State License Law
Uoes noi appN �o an owner ol a pmDerty wM Euilas or impmves rtlerton, an0 who Goes suctl work Ilimself/hersetl or throuqh
his or �er own employee5. providetl ��al such impmvemen�s are no� inlen4eA or ofleretl for Sai¢. 11, howevef l�e Uuiltlinp or
imOmvemeni is 5014 within one year o� tompl¢�i0n, the owner will hav¢ Ihe 6uf0¢n Of Dravinp A¢/5�¢ aiA nai �ui10 ar improve
loi Ihe purpose ol sale).
I, as ovmer ol iAe pmperty. am exclusively coniracting vnth Iicense0 conlractars to constmct ihe Orolect �Section 704a, Business
❑ an0 Prolessions Code: T�e Coniractors' S�ate License Law Goes not ap01y to an owner oi pmperry who buil4s or improves tAereon
an0 who conVacts lor such pmle«s wit� a convac�or(s�license pursuani to t�e CanVactors' Stale License Law),I am aware
Ihal pmol 01 I�eir Worker's COmDenSa�ion insurance S�ouIO be pmvia¢a to me.
� I am exemp� un0er Sedion: B. 8 P. C.
lor Ihis reason:
Da�e: Orvner.
I Qo �ereby cenify Ina� I am aware al ana unaerstantl Ihe reQuiremen�s o� Calitomia Healih antl Safery Cotle Seclions 25505, 25533, antl
25534 antl �hal I or any lu�ure builtlmg occupani willlwill not (circle one) neea �o comO�Y wi�h saitl sia�e coaes anA l�e reQuirements �or a
permil im construc�ion or motlilica�ion Imm �he Air Oualily Managemeni Oi5Vic1. Fe5i0en�ial constmclion applications are exemp� Imm
inese pmvisions.
Date: Applicani:
I hereby ceriify I�al I have reatl �his appliw�ion antl Slale Iha� ihe a�ov¢ informa�ion is carreti. I agr¢e l0 ComDly vn�h all Ci�y anA Coun�y
ordinanresands�at( laws�relalinglo0uil4ingconstmclionanOhereby ��onzeref�¢emativesoflhiscilyioen�erupon��eabove�memionetl
pro0erry �or iryWB��W� Dlr�oiCs� .. / �')
'���e; O I I /� Signawre:
� er's Cmense ar Sociai Secumy a:
16<La6 Wh��e—BuAEinq: Green—Cotle Enlarcamen�: Canary—Applicant; Pink—Revenue: GOI4anroE—Assassor
.1
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: P 065887 PLAN CHECK NO: N
CONSTRUCTION TYPE: IIZ-N PERMIT TYPE: PLU
JOB DESCRIPTION : 12000SF OFFTCE T.I,
CLAIM VALUE: CALC-VALUE:
PERM NO: P 06588-
GOVT; N SOPP: N
PURPOSE: ALT
SQ FT;
GROUP OCC: B-2 /
COMMENTS: REF: B-65846
x*�*�+�+t�r�****�t�r****�*x*x*****�t*****�t�+��r****�t�***x�***�t****+�*****�*****�t******�r*�r
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT ZN LEFT: FT IN RGAT: FT IN
PARKING RE • PROV: PARCEL: 41508134 2NE: REF NO:
PLANNING N TES>
i
x�r�r*+�+r�r�rx��r***i�x�*�rxx��r**�r*�r�r+r*�r�r*�r�r****�t*+�x�**�r*�***�+r�*+t*x�***�r�r�+�**+r*****�*xx�+r**u�
D E V E L O P M E N T S E R V I C E S R E Q[J I R E M E N T S
ZONING APPROVED BY DATE:
BUILDZNG APPROC�ED HY ; , DATE:
APPLICATION ISSUED BY: �,%�-[ ' DATE: � �
**i�*fr�t**+��t*+t*+c-+�+�****+��t �r�* +r��F** � **+�*�t��**�r� *+r+�**+�****�**+� �r* * *
�t�tx��t�rit�ritet�ritxit�t�r*it�r**�r*it�r�ri��rx**�r�r*it*�r*�*it*it*�r*�t*+t�t�r+rx+r+t******x��r+r�.****** *** *+�*�t
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 19,00
252 SMIP/NON-RES
PLAN
ISSUE FEE 20,00
BUILDZNG-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 14,00 20.00 0.00 --3 39.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 34.00 OVER/SftORT; 00
BLDG PMT PLUMHING ELECTRIC MECHANIC FI IP/TOT GRADING PLAN-CHECK
34.00
1E iE iE ff if %iE 1f if iE i! if iE iE if iElE 1E �E it if 1t 1F!!!E if 9t 1E iE if !E if i! 1f iE iE �F if jE fE iE 9E jf iF if if 1E if iE iE iElE if fE if fE iF aE it iE iF iE iF?f if ik iE �F iE it-iE iE iF iE iE �E 1E iE 1E
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 SHOWER 7,00 7.00
PLU 1 SINK, BAR 7,00 7,00
END OF FEES
�
O1 OOI`4564-Od?54664 T f� T 3y,pp
DATE� 02i01l94 T11'IE1 09E35
� CONSTRUCTION AND PLANNING POOI m 5PA
• t APPROVALS Permit # Date Inspector APPROVALS Permit �k Date Inspector
�
i. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 2-L<;4. 53. Steel Reinforcement
3. Elearicaf Condu�t Utifity-Undrgrnd. 54. Forms �
4. Electrica� Conduit-Undrgrnd. 55. Electrical Bonding
5. Stg:l Reinforcement 56. Rough Plumbing & Pressure Test i
6. Etectrical UFER Gmd. 57. APPROVA� TO COVER�GUNITE � i
7. rootings 58. Electricai Conduit�Undrgrnd. �
8. Feundation 59. Gas Pipe, O Undrgmd., 7est �
9. Water Ptpe-Unds9rnd. 60. Backwash lmes, P-Trap, L7 Undrgrnd. �
10. Structural Floor SYstem . ' 61. APPROVAL TO DECK •
t}. Property Sewer Line & 4ouse Connection 62. Backwash & Receptor�Final �
12. Sewer Cap � 63. Heater & Vent-Final
73, Roof Drains 64. Plumbing System � Final
14. Rough Piumbing Z-Lf�y--. �� 65. Electrical-Final
15, �iough Eleciriwl•Condult 66. Solar SYstem•Finat
18. ftough Electric Wiring 67. Fencing & Access ApProval
77� Rqugh Wiring $ign 68. APPROVED FOR PLAS7ERING
18. Fiough Electricai�T Bar Ceiling 69. POOUSPA SYSTEh�iS FlNAL
13. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Duc:s, in Struttu�e 70. Underground Hydro
22. Duc;s, Ventilating 71. Product Piping OGas ❑Oii
23. Gas Pipe�Rou9h & Test 72. Underground Flush
24. Roof �raming 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing , _ 74. pvechead Hydro
26. T�Bar Ceiling (Structurall & Monocoat 75. Dry Chemical �
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Sidinc� 77. PIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywali Nailing HEALTH DEPT. REQUIREMENT
31. Piaster Brovvn Coat 79. FINAL INSPECTION
32. Electrical Pow2r Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Elec:ric Notes:
, � I
34. Final Heating & Air Conditioning ' Z�/ _4,l�. �11�Gt�C�i' %4Q"CZC�-�
(
35. Final Gas Pipe-Test _Z -- •� ';J.Qy'�n �T�Jr_�' Z)(,- L
36. Hood or Canopy � -� �¢ q-. , ��� �� �
�LLG �+-��'
37. Finai Factory Pi�eplace (� ���
38. Final Plumbing 3 !
39. Water $ervice-Final
40. Gas Szrvice-Fina�
41. Solar pomestic-Final
i
42. Backflow Preventer '��� I
43. Backflow Irrigat�on . '
44. Landsca0e Irrigation Sysiem
45. Sound Attenuat�on •
46. Handicap Regulations .
47. FINAL STflUC7URE & BUILDING "
48. FINALPLANNING � �
49. Electric Release to Edison _
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Dace
�
�
PflOJF�`I�AOOflESS: 3SqS HARBOR GATEWAY ST
owaensearne: C .J. SEGERSTAOM
nooness: 3315 FAIRVIEW RD
C.M., CA 92626
u"R: 10 3
850-1540
AXCNIENGINEEfl: TOM CA%'ip�s flEG.NO.: CO
nooness: 1809 WESTCLIFF DR 0N1T' 275
N.B. CA 92660
PE"miTTEE: E. I. E. ELECTRIC ( 714 ) 222-0999
aooness: q2qz CAMPUS DRIVE D
NEWPO EACH C 666
IICENSED CON7PRLTOfi DELIA TION: 1 �ereEy a n s un0er m' ions ol er 9(commencinp wit� Section
7000� ol OiNsfon J ol I�e Buvness a�d Pmtession5 COCe. 0 i in I r 0 effeet.
ciTruc.: pb79�:695 s:
oate: ) I� a g � Signamre: _
WONKEBS'`OMPENS TION CLAliAT10N: I�¢rebyaitirmttu veaCertili[aie0imn nlla5el6in5ure0raCerli�italeolWOrkerS'
Campenuli�n Insurance. or a ceniliea caoY ��ereol ISection 3800. Lab. CI.
roucrr+o.:1315272-93 E%P.OATE: OSIOSI94 '
comeaxr: STATE FUND
❑ Ce�ilieC c py is here y fumishetl. � Ceriilietl, 5 hle0 vnt� IAe ciry BuilGinA Oidsion.
�a�e: r� � poo�,�a�,�„ 1 I: p���,�, � ��
E%EMPTIONF OMWOHNE 5'fAMPENSIPONOECIAPATION: (�h55¢tlqnneeGM�Eemmpl¢INilNepertmiclwrnehwEretl�5700�ak5s�.
�, 1 cenify ihat in t�e pedormdnce ol the work for w�iUi iNS Dermit is i55ued. I 5tW11 not emDloy any ce�� in any mdimer So a5 ta become
5uqt[I lo t�e Workers' omp¢n5aiion Laws o� Califomia. ' , �
�
oaie: � a' � 9 Signamro: '
NO71C : II. alte� king t�R GeGan�ion, rou SlioWa Cewme suDjttt to tM Wohers' CAmpenShcion provisians oi tAe Labar ��
COCe. you must fannwitn comO�Y ��h wcn pmv6ion5 or ttit perrttil Shall oe AeemeE revok¢E. �• .
CONSTBUC710N LENOING RGENCY: I �ere0y aflirm tAat there is a consimction IenEinq a0en�y for t�e peAormance al the waM loi
wnich inis permit is issue0 (Section 3097, Civ. CI. - ��
lENOEfl: . ' '
RODflE55:
OWNEH BUILDEB OECtAPATION: I �ere0y atlirm ilwl I am exemD� ��om t�e Convactars' State Lieense Law for the lollowinp reason
(Seciion 7031,5 Business antl Pmfesuonal CoAe: Nny nty ol couniy whic� repuires a Dermit to constmct, alter, imDrove, demolis�, or
ieoair any sirutture, prior W�Is i55uance. al5o repuires �he apptiWnt lar suCn perrttit to lile a sipn¢E statement ihat �Pls�e Is licensed
pu�suam to ine providons ot �ne tontracmri State Licenx Law (Chapter 9(commmanp witA Sectron 7000) of ONision 9 al tAe Business
an0 Pmle55ian5 Cotle) ot t�at Irelshe rs esemD� tnemlmm anE t�e Oasis lor t�e allepeE exemption. My violation ol 5¢tti0n 7031.5 by
any applicant lor a permit w�iec6 the applitint to a civY pMalty of not mOre Ihan �ive nunarW Odlars (350U).
I. as owner ol ine pmpeny or my employees with wapes i5 ineir Sale compen5dtion, will tlo ihe walk. an0 Ine
❑ simmure is not intenae0 or oflema lar sale (5ection 70aa. Busineu anA Professional CoGe: Tne Coniractors' State Licensa law
Ooes nol aOV�Y to an owner ol a O�oDeny w�o UUiIOs or impmves I�er¢On, anU who GOCS suctl wnfk Aimsell/�erseil or Iilroup�
�is or ner own em0loy¢es. DroviCeO t�ai suc� imOrwements are not imendeE or ollereE br sale. II, Oowever t�a Euiltlin0 or
impmvement is soltl wt�in one yea� ol completioq t�e ovmer will have ��e EurOen ol provin0 ��s�e aitl not Oui10 or Impmve
Ior ine putDase af Satel.
I, as owner ol Ue pruperiy, am exclusively contractinq wilh licensetl coniraclors to con5imcl IAe O�olecl (Seclion 70Ed, Businoss
❑ antl Pm�essions Code: The ConVactors' Slale License Law Ooes no� apply lo an owner ol D�aDerry whu �wlds or im0�oves Inereon
anA w�o coniracts br 5uc� pmjec�s vnl� a con�ractor�s)license Oursuanl m IAe Caniraclors' State License Law�.l am awaie
I�al pioai ol their WOrker'S Compensalion in5uranCe sMu10 Ue O�ONOeO Io me.
� I am eRemO� unCer $etlian: B. 8 P. C.
lor Ihis reason:
Date: Umer.
I aa hereby remly ItWt I am aware ol anC un0erstan0 ine r¢puiremen6 0l Caiilornu Mealtn ana Shcety Cotle Section5 255f15, 25533, and
2553A an0l�at I or any IUWre OuilGinq otcupant vnNwitl nol (GrUe one) neetl ta comON ��� ��4 state codes antl lhe repuiremenis for a
permit lor conslmclion or modilicalian Imm Ine Air Ouabty Management Di9rici. FevOen�ial conslmtiion aDD���alions are aeem0� ��om
Ihese provisions.
�ate: _��
I �ereby cerlitylhat I have rea0 ihis application antl
or0inancesan statelamrelatinglo�uiamgconsim
pmpetlY �ar specptio�n uGrposes.
Oa�e: _� � e I Sign¢
D�ive�'S L enu o� Saial Securiiy a:
dy with all ciry and county
upon lhe above-memlonetl
ibat�a6 Whne-Buiiaing: Green-CoOe En�orcemem; Canary-Appiicant: Pink-Revenue; GdGaneoE-Asaessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO; E 06586
PERMIT NO: E 065866 PLAN CHECK NO; N GOVT: N SUPP: N
CONSTRUCTION TYPE: III-N PERMIT TYPE: ELB PURPOSE: ALT
JOB DESCRIPTION : 12000SF OFFICE T.I., RE;�B65846 SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 /
COMMENTS: "ABBEY HOME HEALTH CARE"'OFFICE T.I,
ititit*+t*itirat*���r**+t��*�it+tiFit*it�+t+�at***�r+tx�ifrif*+r+�+t�iF�***+�*it+t*it*icit�it�**+r*irir�r*�it**it�+�et+t
2 O N I N G R E Q 0 I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEET; FT IN RGHT: FT IN
PARKING RE(� • PROV; PAACEL: 41508134 ZNE; REF NO:
PLANNING Nd'I'ES>
>
*����x�*,�,�******��,����**�,�*,��*��,��,���,��,�**,�����**���*�����***��,�*��*��,�*���.����
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY : DATE:
HUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY: DATE; �� C_1�
x�r*�rxx�rir�r*irx�r**�r�r*�r�r*+t��F���Tr�'�r�r3F��Tt**'iF�r�rx- *�r �rx���r��t�t�F'iF�**rx�****** +t +t +r�t *+�
ifltiflllkltik7fiEltikihffifiFiEifiFlkififikkik�f�Eillf4kilfliE�!!flftkifMkMtE1flfffjl�!lflfiflfilffifltlkkMkklf7titflk3kihiliflElffflflflkiFiEiFit
LEGALZZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 117.45
SOS SMIP/NON-RES
PLAN
ISSUE FEE 15.00
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 117.45 15.00 0.00 132.45 132,45 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 132,45 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN-CHECK
132.45
1E if iE iE iE iE iF ff i! it iF k it iE 1E fF it iE it it if iF ik if 1! if it 1t it iF ik ik it iF it if iE iE iE it 7E iF it iE 1F iF 1E if it 1E iE fE 1F it if 1f if if if it i! it iF iElE 1t iF iF if iF iE k if 1f M iE iF it iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE
ELE
ELE
ELE
ELE
ELE
ELE
ELE
ELE
QTY
2�
79
20
33
20
9
1
1
D E S C R I P T I O N
FIXTURES, LIGHTING 1 ST 20 EA.
FIXTURES, LIGHTING ADDITIONAL EA.
RECEPT/OUTLET 1 ST 20 EA,
RECEPT/OUTLET ADDITIONAL EA.
RECEPT/SWITCH 1 ST 20 EA.
RECEPT/SWITCH ADDITIONAL EA.
MOTOR/POWA APPARATUS 0,0 - 1.0 HP
SIGN/ OUTLINE LIGHT SYS ON 1 BR CIRC
END OF FEES
CTNIT COST TOTAL COST
.75 15.00
.45 35.55
.75 15.00
,45 14.85
.75 15.00
,45 4.05
3,00 3.00
15.00 15.00
DI OO1S4520-00154520 TO T 132.45
DATE: OL/31/94 7IhE� 15+44
+ �
�� CONSTRUCTION AND PLANNING POOL a,.PA
`--�� APPROVALS Permit# Date laspector qppROVALS Permit# Oate Inspector
1. Temporary Electrical Service or Pole 52. Poo( & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3, Electrical Conduit Utility•Undrgrnd. 54. Forms
4. Electrica� Conduit-Untlrgrnd. 55. Electrical Bonding
5. Steel Reinforcemenc 56. Rough Plumbing & Pressure Test
6�. Elecvical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footing5 58. Electrical Condurt�Undrgtnd.
8. FoundaT�on 59. Gas Pipe, O Undrgrnd., Tesc
9. Water P�pe•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
73. Roof Drains 64. Plumbing System � Finai
14. Rough Piumbing 65. Efectrical�Final
t5. Rough Electrical•Condu�t w�� ���/q�/�� 66. Solar System-Final
f��
16. Rough Electric Wiring 67. Fencing & Access Approval •
77. flough Wiring Sign 68. APPROVEO FOR P�ASTEFING
18. Rough E�ectrica�-T Bar Ceiling ��i��J /L�,C 69. POOUSPA SYSTEP.4S FINAL
y��,._ _
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducis, in Structure 70. Underground Hydro
22. Ducts, Ventiiating 77. Product Piping OGas OOiI
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergmd. Srora�e Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead I-lYdro
26. T�Har Ce��ing (Structural) & Monocoat 75. Dry Chemicat
27. Prame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FiNAL
29. Insulati0n 76. FIRE PREV. FINAI.
30. Dry�vall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED
33. Fina� Electric 3/�(f %� Notes:
34. Final Heating & Air Condition�ag ( /
35. Final Gas Pipe-Tesc �
36. Hood or Canopy .
37. Final FactorY Fireplace '
38. Final Plumbing � �
39. Water Service-Final
40. Gas Service-Final . _
41. Solar pomestioFinal � o
.,c
42. Backflow Preventer :.:
43. Backflow Irrigation - ' �'
44. LandscaPe Irrigation System '
45. Sound Attenuation
r
46. Handicap Regulations
47, FINAL STRUCTURE & BUILDING � ,
48, FINAL PLANNING
49. Electric Reiease to Edison �
50. Gas Reiease to Southern Califomia Gas Co -..
51. CERTIFICATE OF OCCUPANCY
No. Date
" 7HOJle! pODflE55: j S 4 S HARBOR GATEWAY ST uxir: 10 3
owxensxarne: C .J. SEGERSTROM
aooness: 3315 FAIRVIEW RD
C.M „ CA 92626
850-1590
AHCM/ENGINEEfl: TOM CAi"�i��s REG.NO.: CO
RDOflE55: SBOS WESTCLIFF DR uxir: z�5
N,H. CA 92660
PEflMITTEE: C W ELECTRIC ( 714 ) 586-8738
aoonEss: 2q666 AAGUS DR
MISSION VIEJO CA 92691
UCENSEU CONTNACTOB OECLAHATION: I �ere�y a��irm ��ai I am licensetl under pmvisions ol Chapter 9(commencing wi�� Seciion
7000� o� Oivision 3 al ��e Busine5s and Pmlessions Cotle. an0 my license is in full force an0 e�fect.
cirruc.: p6� �7 3�J�sraTeuc.:690069 f�s�' C—�
� Date: �' _(l�—� Signa�ure: _��/_i�
WOflKEflS' COMPENSATION UECLABATION: I hereGy aflirm I�al I hav¢ a rertifitale ot tonunt Io Sel4in5ure or a terlificaie al WorkErS'
Compensa�ion �nsurance. or a cenilie0 copY thereol (Section 3800, Lab. C).
POLICY NO.: E%P. OpTE:
COMPFNY:
❑ Cetlilie0 topy is hereby lumi5�¢4. ❑ Certified copy is tiletl wit� t�e cily BuilEing Division.
u
�
/ I
Jate: ADPlicani:
E%EMPTION FpOM WOPREflS' COMPENSA710N UECLAflPTIUN: (This section neeA nat be completetl ii the permil is for one hunUreE (5100) or less�.
I certify Ihal in Ue perlormance ol Ihe work �or whiCh �his permii is is5ue0, I 5�all noi employ any Deaon in any mann¢r So as to beCOme
suble�� �o ��e WorQkerY CoGm�p'eyn�sption Laws oi Califomia. //�� /// � j����/ �
Dale: —�_� r, ! J SignaWre: / .G� 9A ��'" " " "
NOTICE: If. alier makinp I�is tleclaralion. yau shoultl ec�u��l �o the Worker5' Campensalion provisions ol the La�ar
Coae. you musi iannwith compy with such provisions or ihis Dermit shan be AeemeO revokeE.
CONSTNUCTION LENOING AGENCY: I �ere6y affirm �hat ��ere is a cons(mction lenaing apency far the petlarmance ol tAe work for
wAicn Ihis permi� is issued �Sectian 3W7. Civ. C).
LENOEH:
aoosess:
OWNEB BUILOEB DECLABRtION: I �ere�y affirm that 1 am exempt tmm the Comracmrs' State license law for tAe Pollowinp reason
(Setlion 703L5 BuSine55 anA PmIe55ional CoOe: Any tiry o� tounry whitA require5 a permii IO ton5imtl, alter, improve, G¢moli5�, or
repair any slmcture. prior lo its issuance. also repuires the apD�icant for sucn permil to file a signetl statement that he/sne is licensed
Dursuant la Ihe pmvisions ai lhe Comracmrs' Staie License Law (Chapter 9(commencing vnt� Section 7000) ol DNision 3 0l 1�e Buvness
ana Pmlessions Caae) or inat ne/she is eaempt tnertfmm and ihe basis lor ihe alleA� exemp�ion. Any violation al Section 7031.5 ey
any aDDlicantlor a permil su61e��5 ihe appli[anlio a civil Oenalry ot nol more than five hunOreO dollar5 (55110�.
I. as awner ol t�e D�operly ar rtry employees with wages as their 5ole compensation, wiil Eo the wafk. antl t�e
❑ svucture is not imendeA or aHereU lar sale (Seciion 70a4. Business and Pmfessional CoUe: IDe Contracmrs' State License Law
aoes not ap01y io an owner ol a pmDe�Y who butlds or imDmves thereon, and who does suc0 woh himself/hersell or IAmuOh
�i5 ar her own employee5. p�ovitle0 ihai Such improv¢menis are not intentl¢0 or o��ered �of Sale. I�, �owevEr Ihe �uiltlinp af
imD�ovemen� is soltl wit�in one y¢ar ol completion. �hB owner vnll have �he EurEen o� O�ovinA ��s�e Citl noi builG or imDmve
br t�e purpose oi saie�.
I, as owner ol Ihe pm0erry, am eeclusively conlractinB wi�� licensed coniractors to conslmct Ihe prolect (Section 70Cd, Business
❑ ana Pmtessions Catle: TAe Comraclars' State License Law does not apply to an owner al Ompenp w�o OutlEs or impmves Iherean
anE w�o comraas for suc� pmlecis wit� a cantracmqs) license pursuant Io �he Contrac�ors' Slale LitenSe Law�. 1 am awdre
I�al prool ol Iheir Worker'S Compensalion insurance 5hould be pwvitled to me.
� I am eKempl under Seclion�, B. 8 P. C.
br Inis reason:
Oa�e: Owner.
I do here�y cenily ihal I am aware ol ana untlersland Ihe requiremen�s of Cah�omia Heal�h and Sa�ery COAe Seclions 25505, 25533, and
25534 and lha� I or any Iuiure �uilding occupant willlwill not (circle one) nee0 �o comply with saitl stale cotles an0 �he requiamen�s for a
permi� br constmqion or motlilicalion Irom Ine Ai� Ouahly Managemeni DisVic�. ResiUen�ial conslNc�ion aDPlica�ions are exempi �mm
IAese provisions.
�ate: Applicant:
I �¢reEy [erlity Ilwl I have reatl I�iS appboalion antl Slale Iha� Ihe above inlormali0n is mrreti. I agree �a tomD�Y'M�h all ci�y an0 toUnty
orainances antl state iaws relaiing �o builaing wns�mction aM �ereby authonze reD�esenW( es at tNs dry to enter upon t�e ahove�mentioneA
pmpetly fo� inspeclion purposeqs. ////// -I^/- /
�ate: �_l Q_! � Signamre: � � -PN�' VV
ti �
ori�ei's �¢ense o� sociai Sewriiy x:
16a1-a6 Wbite—B�AOing: Gre¢n—CoOo Enlorc¢men�; Canary—AppLcant Pmk—Revenue; GolOenraE—Asseswr
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: E 066116 PLAN CHECK NO: N
CONSTRUCTION TYPE: III—N PERMIT TYPE: ELE
PERM NO; E 06611E
GOVT: N SUPP: N
PUAPOSE: ALT
JOB DESCRIPTION : 12000SF OFFICE T,I „ RE:#565896 SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: ELECTRICAL RETROFIT 6 COMPUTER MODULARS CONNECTIONS
**�r**+r*�r*+�*+�*�-*�t*+e�r�r**�r�r�r�*****�r�r�r�r�+t****x-*�r******�+r+�*�r�ir+�+t*�-x�***�t**x-�***�*x�t*+r
Z O N I N GS ERTEBQAUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ; PROV; PARCEL: 41508134 ZNE; REF NO:
PLANNING NOTES>
>
*�r+�x�r+�*�r*�**xx��r����*+r�r+r�r*�r�r*�r****+�*��r*x�*********+��+�+r*��*����r*�r�r**+�x+��r******�+r+r
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVEP BY DATE:
BUILDING APPROVEP BY :
DATE:
APPLICATION ISSUED BY; DATE; 2 I
*ir�+��rit*+t+r�r*+tx*�r*x�*+r�r*x �*�rx�*�r�*rtir � � �x
iF iI' if'� iI' if if it'I!!I' if iE')i'!f iE iI' iE ik iI' fE iElF'1! 1E N' fl' if if'If'IE'k'If iE'M' iE'Ih 1E if !f 1t'1E iF iE if iF ih Y if If �E iE'If iF N' if'K' iE iE if if IE if iM1 II"IE iE 1f 1f'M' i'I' iE iE iE 1E fE 1E iE if �f
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 168.95
50�
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 168.95 15.00 0,00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMHZNG ELECTRIC MECHANIC
183.95
SMZP/NON—RES
TOTAL PAID DUE
183.95 183.95 .00
183,95 OVER/SHORT; .00
FIRE SMIP/TOT GRADING PLAN—CHECY.
if ih iE if i� 1k if if 1E iE iE if it ff it if iF i! iFlf k if k if iE if it #k #' �f iF iE iF 1F if iE iE if iE iF if iE ik iE iE iE aE iE iE iE if iE if jE ik if 1E if iE if it if iE ih iE 1f if iF 1E iE iE 1f 3E if ik iE 1E if if
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 20 FIXTURES, LIGHTING 1 ST 20 EA. .75 15.00
ELE 171 FIXTURES, LIGHTING ADDITZONAL EA. ,45 76.95
ELE 7 MISC APPAAATUS NOT LISTED REQ PERMIT 11.00 77.00
END OF FEES
UI 00155702-00155702 T O T 183.9i
DATE: 02/22/94 TIME: 15:?2
�, CONSTRUCTION AND PLANNING POOL a..r'A
fi-
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1, Temporary Electrical5erviceor Pole 52. Pooi & Equipment Location
2. Soi1 Pipe-Undrgrnd. � 53. Stael Reiniorcement
3. Electrical Conduit Utiiity-Und'rgrnd. 54. Forms
4. Electrical Conduii-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. ftough Plumbi�g & Pressure Test
6. Electricai UFER Grnd. 57. APPROVA� TO COVER�GUNITE
7. Footi�gs 58. Etectrica� Cq�duit-Undrgmd.
$, Foundation 59. Gas Pipe, O Undrgrnd., Test -'
9. Water Pipe•Undrgmd. 60. Backwash Lines, P�Trap, O Undrymd.
10. Structural Floor SYstem 67. APPROVAL TO DECK '
17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ��
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbiny System � Final
14, flough Plumbing 65. Electrical�Final
15. Rough Etectriral�Condult 66. Soiar SYstem�Final
16. Rough Elactric Wiring 67. FencintJ & Aceess Approval
17. Rough Wiring Sign 68. APPROVEO FOR PLASTERING
78. Rough Electrica�-T Bar Ceiling 69. POOL/SPA SYSTEPAS FINAL
19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Roogh Factory Firep!ace APPROVALS Permic #
21. Ducts, in Structure 70. Underground Hydro
22, pucts, Ventilating 71. Product Piping OGas OOii
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roo4 Sheathing 74. Overhead Hydra
26. T-Bar Ceiling IStructuraq & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Sidin9 77. FIXED SYSTEM FINA�
29. Insulation 78. FIRE PREV. FINAL
3p, pry�vall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. E�2ctricai Power MeterFinal 80. FOOD CERTIFICATE ISSUED
33. final Eleciric �Q�9� Notes:
f1
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Nood or Canopv
37. Final FactorY Fireplace
38. Final Plum6ing
39. Water Service�Final
40. Gas Service-Finat
41. 5o�ar pomestioFinal �� �
42, 6ackfiow Preventer
43. Sackflow Irrigation ' �
44. Landscave Irrigation System .' -
45. 5ound Attenuation ,
46. Handicap flegulations �
47. FINAL STRUCTURE & BUILDING ,
46. FINALPIANNING �
49, �lectric Release to Edison
60. Gas Release to Southern Califomia Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PflOJECTRODflE55: • 3S�IS HARBOR GATEWAY S �N�T� 102
OWNEN'S NAME: C�J� SEGERSTROM S SONS
RODflESS: ��
pPCHiENGINEER: TOM4 CAMPOS S 1 O REG.NO.:
aooness: 1809 WESTCLIFF DR N��' 275
PENMITTEE: NEWPORT HEACH CA 92660
nooness: C�3T1y5SFMAFSR�VIEWM�& SONS ( 719 ) 546-0110
LICENSED CONTppCTORdFC[AARfIO�I -The�rreby a��irm �na� � am �icense0 uneerCpr�oNsio9nsZo��iaprr 9(commencinA wilh Section
7000� of Division 3 0l I�e eusiness ana Pmfessions Code. antl my license is in full lorce antl ellecl.
CITY LIL.: STATE IIC.: CLASS:
Date: SignaWre:
WOBNENS' COMPENSF710N DECLABATION: I �ereby affirm tAat I have a cenificate ol consent to selbinsure or a cenilicai¢ ol Workers'
Comoensa�ion Insurance, or a ceniliea cooY �hereof (Section 3800. La�. C).
POLICY NO.: EXP. DRTE:
COMPANY:
❑ Centliee copY is here�y fumishee. ❑ Lertilietl copy is liletl with Ne ciry Builtling Oivision.
Daie: ApPlicanl:
E%EMPTIUN FROM W�NIIEflS' COMPENSATION UECUNRTIUN�. (This secl eA �wt he completeA i� the pe�mit is far we hu�Uretl (S1U0� ar less�.
I[erlity tha� in Ihe oedormanCe 01 t�¢ woB for Whith Ihis permi e0. I Shallp I¢�p loy any p Son in any manner 50 as �0 6ecom¢
sublecl iql e Wtl�ke�rs'1 Com ensation Laws ol Calilomia 1\�,��/�/�/�Y �)��
Date: v� Signalum: � /� 1 �'' / / `�� .(.Yf�/i�%�
NOTICE: II. a��er making ihis Oeclaration. you shaula become suhlect to t�e Warkers' Compensation pmvisions of the LaOor
CaEe, you must fon�with comOW ��h such pmvisions or lltis permit sAall Oe GeemeE reroketl.
CONSTBOCTION 4ENUING RGENCY: I hereGy aflirm Ihat 1�¢r¢ is a consirutlion 1¢ntlinp agency �ar IAe pedOrmance al Ihe work tor
which Ihis permit is issuetl ($eciion 3097, Civ. C�.
lENOEP:
POOflE6S:
OwNEB BWIOEB DECUBA7ION: I nereby aflirm inat I am eKempt irom Ihe Conlractors' State License law br ihe followinA �eason
�Seclion 7031.5 Business anE Pmiessional Cade; Any city ol counry whic0 repuires a permit to constmct. alter, impmve, tlemolish, or
revair any siructu�e, Drior to its issuance. also repuires ihe aoPlicant (or such D¢�mi1 lo Iile a siBneC statement ihat ne/sne is licensed
Dursuam m Ihe pr0�i5ion5 oi �he Contractors' S�a�e Litense Law (Chapter 9 �Comm¢nCinp wi�� $ection 7000) o� Divisi0n 3 0� Ihe BuSinesS
anE Pmtessions Cotle) or �hai �e/she is exemp� �here�mm antl Ihe basis �or Ih¢ allegeU exemption. Pny viola�ion a� Section 7031.5 by
any applicant for a permi� subjec�s Ihe ap0licant lo a civil penally af not more Nan live huntlre0 tlollars (5500�.
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 06359
PERMIT NO: B 063598 PLAN CAECK NO: 03125-93 S GOVT: N SUPP; N
CONSTRUCTION TYPE: III-N PERMIT TYPE: STR PURPOSE; ALT
JOH DESCRIPTION ; INTERIOR ALTERATION TO EXISTING OFFICES SQ FT: 783
CLAIM VALUE: CALC-VALUE: 8,331,12 GROUP OCC: B-2 /
COMMENTS: THE "P.I.A." SUITE ��-
k k if iF 1f 1t fk M iF iF M iF ft !k 1f 1f �t if if if if �t M it it it M if 1k iF k if ik iE �E k k k if iF if iE �f 1t iF iF it if iF if 1k k M 1F 1F k if if M it 1E M if !t �t M iF if �E �f k k if M if iF if k k
Z O N I N GS ERTEBQAUCIKRSE M E N T S
------------ MAIN BOILDING ----------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN
PARRING REo • PROV; PARC.
PLANNING NOTES> INTERIOR ALTE ATIONS
--------- ACCESSORY BUILDING ---------
FRNT• FT IN REAR: FT IN
LEF"I`� FT IN RGHT; FT IN
41507108 ZNE• PDI REF NO:
g ADDITIONAL O�'FICE SPACE IN .AN
> EXISTING—OFFIC�7WARfiHOUSE BUILDING, .�r-"
��r�r+rr+e�r*�**�rx�r�r**�r�e�e**�e*r�e*�r*�r�e+e�r+r�r*�e*r*�e�rx+r�r�rrr�*�rr***�r�e*�e�x�+r�r*�r�r�r�ri���r*
D E V E I, O F MS E N T S E R V I C E S R E Q U I R E M E 13% T 5
ZONING APPROVED BY , �.. _ DATE; � r/�
HUILDING APPROVED HY ;� p DATE:••��$ =
n �'n '
I.EGALIZATION:N
BLDG PMT
PERMIT 108,00
PLAN 70.20
ISSUE FEE
F E E S U M M A R Y
PLUMBING ELECTRIC MECHANIC
c "-
**
STRUCTURAL� SEGMENT:Y
FIRE SHIP/RES GRADING
SMIP/NON-RES
1.75
�. as owner oi me owcenv ar my emplayees vntn wages as ineir sme campenution, wiu aa the wone. ano ihe �(�_� �i_3 t� ti��- � r 'j'j� PAID DUE
stmcWre is not in�en4etl or olleretl for saie (Section 70C4, Business antl Pmfessianal Cotle: T�e Coniractors' State �icense �aw ���� , (�, �� �]�, �� 1%$. 9 rj 1'J9 . 9 5 . 0 0
� ---- �
does no� sV�ly to an owner ol a pmpeny who builtls or impmves tAereon, and who does suc� work bimself/Aerseli or tAmugh /„�
�i5 or her own employees. Dmvidetl �ha� SUch impmv¢men�5 are noi ini¢ndetl or oflere0 br Sale. II, howevef IAe Uuilding or i.
Improvemen� is SoIA within one year ol tomple�ion, I�e owner will Oave I�e bw�en ot pwving �e/she Uitl not huila or improve REVENUE D I V I S I ON TOTAI,S--> COI:LECTED • 179 , 9 5 OVER / SHORT • � �
• io�ineoo�oaseo�saie�. BLDG PMT PLUMHING ELECTRIC MECHANIt FIRE SMIP/TOT GRADfNG PLAN-�HECK
�1. as owne� al ihe O�operty, am eKclusively cantractinq wi�� Iicense0 con�rac�ors Io canstmci Ihe prole�� (�«ion 70C4, Busine5s 1 0 8, � � /� j,'] 5 '] Q, 2 �
anG Prole4sims CaCe: 7he Contracmrs' State L'¢eise Law Eces not apDb �o an owner oi properrywho bwlEs or improves ihereon
an0 wh0 Goniratts lor SutA prol��s vnlh a rAntratlar�s) litense pursu3n1101�¢ ContraCl0r5' $la�e LK¢nse Law). I am arrdre *******************************************************************************
�hai pmoi a� tAeir Worker's Compensation insurance shoultl be pmvi0e0 lo me.
� I am eremP� untler Section: B. 8 P. C.
for(�i/his r¢/a�son�:) q' / �///j �J��j
Uale: 1 //.��.0 � Uvner' /�� y��l... .Y,Y(.���%�
I aa nereby cenily ��at I am aware of anA untleRtanO ihe reQuirertrents al Calilomu Health ana Safery CoOe Seclions 25505, 25533, an0
2553a an0 i�al I o� any Imure huilaing occu0ant wilUwiil noi �circle one) neetl lo compty vnth saia state cotles anG the reQuiremenis for a
permil lor con9m��ion or moAifica�ion Imm Ihe Air �uality Managemen� DisVicL R¢sitlen�ial consiruction applica[ions a�e exemp� �mm
Ihese pmvisions.
Date: FpPlican�:
I hereby cenilytnAl I have rea0ihis apo�ication antl slale IhailOe aboveinlormalionis torrecl.lapree lo compry vnih allGily an0 counry
orainancesantlsta�elawsrelatingmbwlaingconsimctionantl�ere� e ¢p�esenta�iueso�IhiScilyloen�erUPon�hea�ove�m¢ntione0
9fOpCM1y IOt NISp�C«J/i0n �OWpOSfS. / � / �// //n
Dale: -1' O�� / Signaiure: � �L�- � C'C /Y�.C�.��/��
Oriver's License 0� Sacial Se[urity N: �� �..� �
16<L<6 Wnim—BuilEing: Green— e Enlo�cemem; Canary—nppiicam; Pink—Revenue;
I N D I V I D U A-L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFC 783 OFF-INT, ALTER TYPE II-N -AVER 10,64 8,331,12
� E/ND OF FEES
L'
�
01 0014�5416-401f5413 TO T 1?p,5�g
DqTE: 03/23/93 7II1E� 15:25
CONSTRUCTION AND PLANNWG : POOI u��PA �
� APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
�9. Temporary Electrical Service or Pofe 52. Pool & Equipment Location � � -
2. Soil Pipe-Undrgmd. � . t' 53. Steel Reinforcement ,
3.' eFt"����y�� �t`H�ity�Undrgmd. . 54. Forms �
..J�e �2W' �"i-.:..��.'
. ��_.,,I .�,....
-4. �le�tttca�, yit-Uitdrgrnd. � 55. Electriwl Bonding �
,�6��e�F,�i�� M¢Ct�_�� 56. Rough Plumbing & Pressure Test -`-'
;, eytri� �riej. 57. APPROVAL TO COVER-GUNITE '
���Fbotin tiC�Ni� 58. Etectrical Conduit•Undrgmd.
�� Y
�F.oundatior� �"s 59. Gas Pipe, � Undrgrnd., Tes[ "
^9aWater Pipe-i7ndagr'oU. 60. Backwash Lines, P-Trap, O Undrgmd. '
��Structurai Floor,�`ystem . 61. APPROVAL TO DECK
71�;!Property Sew�r,_ � ne�& House Connection � 62. Backwash & Receptor-Final
72. Sewer Cap 63. Hea[er & Vent-Final
ti
13. Roof Drains •o � . - 64. Plumbing System - Final � ,
14. Rough Plumb;n� '� 65. E�ectrical�Final
15. Rough EI ctrica - onduii 66. Solar System-Final '
76. Rough E[ettric Wiring 67. Fencing & Access Apuroval
v
.f7. Rough Wir`Ufig S'�n .. 68. APPROVED FOR PLASTERING ,
18. Rough Electrical T Bar Ceiling 69. POOL/SPA-SYSTEMS FINAI
19. Rough Heating & Atr Conditioning FIRE DEPT. FEQUIREMENT
20. u FqUtor Fi . ... `� "' o��� a{-� tr, ', � ��
� �a rgpface i�nt G"y r C J tr� . dPPRO�AtSa «.�P..erriAa #
T. -r a' -� .. ♦ � N- f p� '
�$ ''}ur �. i HF :CS # H "7 '7� SJ': ^ �7 + M
21. �uC�, in Tru� �x �.. .. h,s � S V ti�; ��`-,�0. Undergred��lycZ{o ,�
22. uc61 VeOtil3sinq�e � CJS * � S Q.t . �77, product��ieny O�GeT3 OOiI
23. 'G'as Pipe�t� ou�y, & T �st � « �' '�' �',r " Fy '*' i r_+-�
• ra iJ '�5' � � MS t� M'.7' S G+� �. a42• UndergroG�}i iFlu�j�-�p R F l�
24. $1ao�fr�aaing.� ;r.:� � FE� ••E� >�> O �r � �3.4JndergmdsStora �• a�ic �Gas OOiV
25. RooS,Sh{�thing : k � v � � � ,`�j � c�* • -Sjq, ;�j�erhead Flydro �F`� �
26. - fBarCei�ing (StrucGural) & (�onocoat r+.qa m �7 [h? 75. �Bry Chemical � � ? �^ J p
27. �FFameand Flashin ` 'b ` !-'�-'x " a; ,c n n r'jF_ �• S tTl LT
a� r+ �+ .� :��x r•�n%� cr r cn,: 76.'DR SfandP,��, �.m �
� � � •n .--i: s � -� . .... • ..,
�. �atfiing &.Siding c nt t: y<,Cr cr,�-� -.a� S_ �• r� 77. oFIXED SY�S4'fM:NVAL *� V S
., .
�19. IntuFtio7� �x C S�" "`^ n�x �'' - 7$,�IRE PREV. FINA;l3 #�.� � X
r. x
��.A. Drywall iling �-.s � ;ra. � x> �-� HEALTH qEPT�RiEQUIREl1 ENT
�31. Plaster B wn at ` � "'": . ` �. �9. �INAL INSPE�TIC1�9 '`" d tT ``'
i i >, I m r '^�rr k x �
�i r- ¢ x i !-i � > � �
2. iHectriwi-Qowgr Meter�inal � F x.0 *>;$0. ,F,OOD CER IFIQAtF�E ISStJED F
3. ffinal�EleE6ric � x� � i a�� �� a� *+�FJot� : J a l• � 7
� •r i S...s;x� a it� �%''� � 7_'�m �Fnt'�iL �:n. ; �i c��i`'� �
`r�Fina�-led n Air�ori tio �i~`i S• '�.' � � �
• � � 3' � t� n �s n � �c �` �� � � ��`v
35. �Finai-Gas PipMTest x � ti0� * C� i � -iS x C*' � O
rl '-+ : rh N i N ,�� •30 C7 -I � S 1*'
3S. 1ioo,�7�or�fanoPY � 4 .• �� J `.� • •� � � .
7- � 1;"y a�S h(l . F : i. rs Y�
3�J. 'Einat�Faciory Firepl2cN- � S?' r��.. pn �?; ' _ C1 ?� !n
�_ �, i c.:-. � r�'fc s. S '' N
38. `Fjnel Pll�i�bin9 .s xN �•• •• 'L-+ Or: r Y S �-+ w s i
Q8. YJatec.Service-Final r. � � �^sri C� t-'*f a:X '
« z >: --° n +� :n
�P. Z'i'as Servis�e�F�fie� i,; .1;r„ S •> m ��a.� n�z; .. �
:41. Snlar pomestio-Finak S C:� � * C•• t� �� '
K' k '7. •_ 7 �. .T 7
�42. B1ackflo�Preventer ` f-� v a'F � ` x • t� �' ��: •' .
_r, �J aC' # 'T. 'F' 3' G �
43. Backflow Irri�- tion z. � xSS '' fi. � xF'� * G �
y+ x F" x 1 N i !' fl •
�.4. Landscap�Ir�atiorj.SysiemyM� S x?; y+ ��# �:v -v -+ ;:C M� N s
., , � .. - . .. .
�5. �und AttenQation* .-�x�' ', x � �' i-' � � � '^ �-' e`-' `,��G 3' `
.. �. . x � s v� a, .�v ¢
-� r� �. : r, e i i... 'yJ: ..'.y �
jTGT6. �andicap;Requlatior�s `� L, :; S• v�L S
u
47. �IN L STRWETURE & BUI�OING �Z2 �� �^� S' x
� n ,- t � <
,� i �.•.,. ,.--- -1. � :o .c •' .
48. F�NAL PLAMNING, ;�_. : n; � f< s.�t M K * �^ -
.R9. � lec�ryic Release to Edison i f x Z'^� � � ':+ ��
rr � •i .'_. w
50. Gas Rele„�3e to South�em Califpr�ia Gas Co � -� � o:s, : x -
'� i,'�-� M � i U T
51�. CE ,IFICATE OP _, CCUPANC x x : �. ;i {qo �o . [- � :
No. Date
PH0.1EC7 RDOflE55:
OWNEfl'S NFME: 3 5 4 5
noosEss: C�J,.
�i
uNir: 101
FHCM/ENGINEEfl: � 7 S A� S�i G—O I I O pEG.NO.:
RODNE55: T�8O9 WESTCLIFF DR N��' 275
PEflMITTEE: NEWPORT BEACH CA 92660
aoosEss: C J. SEGERSTROH 6 SONS ( 714 ) 546-0110
(`(�]S3�1p5 FMA}�IRyVIEW RD (�9(�
❑CENSEO LONTMCTOIitlECL1A�'(IOtf: �Thesreby allirm thal I am licensed wCer p or �'o9s��Z'�aprr 9(commencing wit� Section
7001q ol �ivsion 3 al Ihe Business antl Pmfessians CoOe. an0 my license is in �ullforce anG efl¢ct.
CITY LIC.: ST�TE LIC.: CIASS:
Daie: Signature:
WOBNEBS' COMPENSRTION OEClAMT10N: I hereGy aflirm that I have a tenifiWte af fAnsent to se0-insure or a ce�ilitate of Workers'
Compenutian InSurance. ar a ceni�ietl copy ihereaf (Seciion 3800. Lab. C�.
PoLICY NO.: E%P. ORTE:
COMPFNY:
❑ Cerlilie0 copy is hereby tumis�e0. ❑ C¢rtifieG copy is lile� wit� Ihe city Buildinp Oivision.
�, Date: Appliwnt:
EIIEMPfION FBOM WOflKEflS' COMPENSRTION OELLi1flRTI0N: (Tliis secUan n nal be mmpleteG it I�e petmi is for we huMteO (5100) or kss�.
I cenily ��at in ihe Dertormance ol ��e work for which ihis permi '- ,- tull noi D��rmpin any m�o Oecome
su�ject lo e Warkers'j'pm0ensation Laws of Calilornia.
v� I%/i A . ii
Oale: ' �� Signature: �
NOTICE: II. aner making ihis aeclaration, you slwulC Oewme suGject ro t�e Warkers' Compensatian pmvisions of the LaAor
COAe. you mus� �oNiwilA comDN'Mlh SUth pwvisions Or IOiS permil Shail b¢ OeemeO revokeC.
CONSTNUCTION LENUING RGENCV: I hereby affirm ��at t�ere is a conswction IenAing agency for the Oedormance oi t�e work lor
w�ich ihis Oermi� is issueG (Sxtion 3097. Liv. C�.
LENOEfl:
RODPE55:
OWNER BWLDEB �ECIABRTION: I nereLy allirm inat I am evempt fmm the Cantracmrs' State License Law for the Iallowin8 �eazon
I'h
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06359
PERMIT NO: B 063599 PLAN CHECK NO: 03126-93 S GOVT; N SUPP; N
CONSTRUCTION TYPE; III—N PERMIT TYPE: STR PURPOSE: ALT
JOH DESCRIPTION : EXPAND OFFICE AREA 6 ADD NEW REST ROOMS SQ FT; 580
CLAIN VALUE: CALC—VALUE: 6,171,20 GROUP OCC; B-2 /
CONMENTS• THE "VANDAL ALERT" SUITE
�r+t�t�t�t*�tit�r�r�t�t�r*�rr�e**�t�r�e*�tr�t*�t�t�t�t�t�e�tk�t�r�r***�t�t�e�tx*�e*****�e�t�t�r*�e�t�r�t�t�t**�r�r�t**�r**��e**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ HAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN AGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING RE • PROV; PARCEL: 41507106 ZNE: PDI REF NO•
PLANNING N i'ES> INTERIOR ALTERATIONS TO ADD THREE ADDITIONAL OFFICES AND
> A�BATHROOM:� !"
■x*r�er*r�t*�e�r�e�e�r�r*��r�t*�t*�t**�t�t�t�*�t�t�t�t�tr***�r�e�t***r�r�t*�e**x�t*�r�r+tr�t�t�t�t*�r�r�*�+t�t�t�r�r*�e*�r�r
D E V E'L� P H E NiT S E R V I C E S R E(J U I R E M E"� ..S
ZONING APPROVED HY G E DATE: �� �`f3
BUILDING APPROVE/DrBY ; DATE��1: l20
APPLICATION ISSUED BY: DATE;.� $ �
M1FifMiFiFiFiFiFMkiFkkiFMMifkifkk iFiflfiFifiFfflflkM ifiF
fFiF1F1FM�tiflf1t1t1tM1tkM'iFlflfkMlflFifM`M1fkItiFMiFltiflflfifft�tiFM�fiflfiF !flflf�f�fMkfFiflFklk�fMkikfFkikiFiflf,lfif!litiFififitiflE
LEGALIZATION:N F E E S U N H A R Y STRUCTURAI. SEGMENT;Y
,� - �
�S¢ction7031.5Bu5�ne55anOPmieSsionalCoEe. Myaryalcounrywh¢�repmresapermiliacon5truct,alter,impmve,tlemou.ar BLDG PMT PLUMBING ELECTR�IC MECHANIC FIRE $HIP/RE$ GRADING
repair any S�mtlure. prior �o its isSuanCe, also reQuires th¢ aDDlican� lor 5uch ptrmi� Ia /ile a SigneO Statem¢nt t�ai �PJ5h0 iSlltensetl PERMIT 9Q , 00 ��
pursuam m tAe pmvisions of I�e ConVac�ors' S�a�e License Law (ChaD�er 9(commencing wit� Section 7000) ol Division 3 oi Ihe 8usiness � " $M I P/TjOTj—$$$
and Pmlessfons Coee) or Ihat he/stie is erempi ther¢Irom an0 t�e CaSiS �or t�e allege0 exemption. Any nolation ol Seciion 7031.5 Ey P L� rj 8, rj 0 ' ' 1, 3 �
any apD�icant lor a permi� suUlects tAe apD���nt ta a civil penalry oi nm more ihan (ive �untlre0 Gollars (5500�. jSSUE FEE ''
�, as owner o� me pmpeny or my emp�ayees with wages as their sole compensalion, will tlo Ihe work, and �Ae BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DU$
❑ slruciure is no� in�enae0 ar o��erea �or sale (Section 7044. Business anC Pmiessional CaOe: The Coniractors' Slate license Law TOTALS ----> 9 i, 3 0 �, 0 0 '"S 8. 5 0 14 9, 8 � 14 9. 8 0 . 0 0
aoes no� aD�ty ta an owner o1 a propeny w�o 6uilds or impmves thereon, antl who Goes such work Aimsell/hersetf ar ihraup� �
his or her own employees. D�o�itled that suc� impmvemenis are not intentle0 or oiferetl fo� sale. II, however ihe huiltlinA or '/.'
impmvement is solU w�thin one year ol completian. tAe owner vnll have t�e �uraen ot Droving he/she did noi 6uilU or im0�ave REVENUE D I V I S 1 ON TOTAI.S--> COLLECTED ; 14 9. B 0 OVER /SHORT : , D O
�onnev�rposeo�u�e�. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
�I, as awner o� Ihe pi0perty, am exclusively conlrac�ing with licensed coniractors Io constmct Ihe pmject (S¢clion 7044, Business 9 �, � 0 '� 1. 30 5 8, 50
and Pmiessiorts Cotle: 7�e Cantraciaes' State License Law tloes not appN to an owner al Oroperty who Euiltls or impmres I�e�eon ��
an0 who coniracts for such D�ojecis with a contracmr(s) license Dursuant lo the Contracmrs' State �icense Law). I am aware ***************************,**********.******************************************
�hat proof ot �heir Worker's Compensa�mn insurance s�ould be D�ovitleU to me.
� I am ezempt under SeMion: _ B. 8 P. C.
tor�lhnis RaSon: �� �� _ . //
'� Daie� x�/� Owne �
I ao �ere�y cetlity t�a� I am aware ol antl unders�ana IAe requiremenis o� Calilornia Healih an0 Safety COAe Sections 2550.5, 25533, and
25534 anU Iha� I or any future buil�ing occuDant will/will not �ci¢le one) need to comply with SaiG state co0es an0 the repuirements lor a
permii for con5imciion or mo0ification Imm I�e Air �uah�y Managemeni OiSMci. Hesiaenlial constmc�ion aDP��calion5 are exempi imm
��ese pmvisions
Date: Applicant:
I her¢by certity Ihal I have read IhiS aD��iCaiiOn and S�ale �hal lhe above iniormalion is torfeCL I agr¢e lo comply wit� all ci�y and Couniy
or0inancesandsta�elawsrelalinglo6uiltling[onslmciionantlherebyauthan r¢pr¢sentativeSOltAiscitytoenteruDontOeaDove�mentionetl
pmpetly lo �nSpetlion purposes. � � r /%�N /�����
7�� ��
Daie: I � Signalure. l� b
Driver'S License or Social Seturily p:
1641-46 White-0uiltling; Green—Catle EnlorcemenC Canary—Applicam; Pink—Revenue: Goltlenrotl—Assessor
I N D I V I D U A L f F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O.'N", UNIT COST TOTAL COST
SFC 580 OFF—INT. ALTER TYP,E II'—N —AVER 10.64 6,171.20
END=OF FEES
C� �
j s
/'
O1 00145413—D0145415 T �7 T 149.8Q
i�AiE: G8/23/93 TIflE: 15:24
CONSTRUCTION ANDPLANNING
��APPROVALS Permit�#
�' i, Temporary Electcical Service or Pole
' 2. Soil Pipe•Undrgrnd.
-Cl „
� 3,€je�c'F�y31�'c�i�,`,t�l7lityUndrgmd.
FH
,1�;.+Property Sew�n?.jne;$� House Connection
�
72. Sewer Cap _
a�
�
13. Roof Drains � �
14. Rough PlumbiFlEr '�
15. Rough E trica�onduit
16. Rough ECettricY{�iring. �
ro
`�. Rough Wlr �Yy�i Siq�
18. Rough Electrical•�f 8ar Ceiling
�
19. Rough Heatin9 & Air Conditioning
20. �, u� F�toryiFi�9place i�� y�
<:.
21. �uC� inatrt� ur � 1 E`(� '�`r'
�� �� � . HS
�-Q .,
22. bucu7 Veatiiyking ac � CJS
23.�tas�ipe�ou�&T@st � MS
24. �oo raming.. x.� � Nc» -.F.
25. ftoo�h�hing �` �- �.
c s: e; v v.
26. �BatyCeiling (Strutbural) & �lonocoat .�1�
27. �Yameand Flashir4�X ��x "�
4, �: � x c , .�
i2p. `L'atFNn9 &�Siding x v� �y.=�,' t��,�;
�19. Intu�tio�r� mA � sT' ' � J.
.
r30. Drywali I�ailing ��.�,� �' ��
��7. Plaster BR�Twn Coa�� � �.�„r �
v ^] v: i �. F. -
;.s2. �fi+iecirica, owryr M1Aeteq�Final � � -
�--: ,
3. AinaVEle'�'jric� �`�^ r � ¢S
'1,�j4. ,F�inat'He',d{ning`� Air �on tio �i "�' �"'�" ;
�-�
L� ��S Ci
35• �naB-Ga4'?iP�est � r5� `y .
��6. F�ioo�,or�noP4 +��" � my e• .
�=-�� � -
�7. Eina'P'Factory Firepizce-� � SR" `� �
x i h-' ' O
^ .. .. � F �. t .. .. V ,
3a. Final�Plu'�bin9 * �,, � �.;, .
C39. Water:Serxice-Finai + � i x,• .
111 �1
�: a +'. F 1
�0. �r,as Servrc�-Ffial �' "i "
. Y - * a1 �2[<'!�' S -
A:1. •Solar pomestic�Finat: S i � � �� !-• '
n r,
'42. Backflow�Preventer.�`� �'"' iV �C �
Y
43. Backflow trriQ3tion * � �:5� _ -
POOL 75 SPA .
Date Inspector '� Date Inspector
. - APPROVALS Permit #
, . 52. Pool & Eguipment Location • � � ,
' 53. Steel Reinforcement �
54. Forms . .
55. Electrical8onding � . -
� 56. Rough Pfumbing & Pressure Test �
ro
� 57. APPRQVALTO�COVER-GUNITE �
n,
58. Electrica! Conduit-Undrgmd. , U
� 59. Gas Pipe, O Undrgrnd., Test �:
60. Backwash Lines, P-Trap, O Undrgrnd.
� 61. APPROVAL TO DECK � �
. � 62. Backwash & Receptor�Final ' '
� 63. Heater & Vent-Final
64. Plumbing System - Final �
65. Electric8l-Finai _ '
66. � Solar System-Final �
67. Fencing & Access Approval .
68. APPROVED FOR PLASTERING
- 69. POOUSPA SYSTEMS FINAL '
FIRE DEPT. REQUIREMENT
"i tr' L+�r�tn;• IY. t �-. n}
,: O � a'M . APPROx1AL•S:L%D2'errC�t # � �+ �*"
�-1 X g C'� v'^ �� H '� Y U' (�
� S C� i-+a '�i0. Updergrobr�iy�o * ��
� S a:x .. �71. Product Pi � �R+ ❑. il
m
i M r_7i• ,Q ,-_�j��,. r�2. UndergrouNdjFlu� �y, � �..�'., �,
K� O tr' uM � 53. �Jndergmd:5tora��'za�k � Gas ❑ 01D
x
T Dl 'C � N# .- , � Hf-•7 �.
tc � �+ ,Ux '�4.�vWerhp�d F�ydro �-� x
�7 ,. . _ �
��� .;'� . 75. �Dry Chemical "'� n:y b O
i. _-X. - � '• .r
?' p� � C7x ' 76.'D�j S{��dp.IP�• OH� � S t�7 T
aT .•x:' 77.�FIXEDSY`S��EM'ff.`,SVAL?� �� 5
,,, .
��' 78.�IRE PREV. FWA.k; r ti
;: �3
r �, K6ALTH p,EPT.iRiEQUH3EMENT
� . �79. `�INAL INS'�',.ECTI ,Q�1 * � � �
�;� X � �S,O.;F,OODCEFi IFIQA�T�EISSUED � (-»
,�+. �anuicaV,e, irµgauory,ays[em;�ri� ;�,^ * r� �
t J J� � • --��
i45� Sound Attenllation� .-+xea [�[� _ E'
,L ^
A6. Ftandicap'Aegulatior5s G S` � '� ••
� �-; O C t.
r�?47. FIN� STRUCTUFiE & BUI:L'DING � �K ,�
48.F.�NALPLANNING„ �`_r, L �` _ � �
v
�48. .Heci`�ic Release to 6dison � '
� �
5�U, Gas fielea5e to South`em Calif¢m1a Gas Co * ,
1. CER ,IFICATE OP OCCUPA�1�11" �
lo. Date
�. E i
� . S_. (1
: ,
dt .. $
C1
, Y %-
.. a
r
r
` R i�
# F J�
Y
x : ;U
x : �.
�R x v n�
iy '.�S :� 1+ ti
�
n v r. +'
r�• ..,. x
x R7
x !+J
t
-i r 2 i
K
a. ii Y �Y. 7
y �c T
r'� t
Oa� 00: r
�� #.�
Ka, ra M
':O T ? T
,��, x � �
1r. • �' H -1
wc4
-^. i'-' O ' O �
i * 1 •
:V �
-. z i � �� ^3 -
� a, cc 2 �' .^
Q • e-� � a
�,.» ••r, ;
�O S �
'�' x -
. �
`' ) (-' '�
I � : '-+
•c^ -. . �-
�.r.i � v --
TG .$'.i .� L- 7
aooness:' 3545 HARBOR GATEWAY 5
'�s"""'E: C.J. SEGERSTROM 6 SONS
aooecss: 3315 FAIRVIEW RD
COSTA MESA
CA 92626
(719)546-0110
u"�' 101
RHCH/ENGINEEH: TOM C�POS AEG.NO.: NO
nooxess: 1809 WESTCLIFF DR ��` 275
reaminee: NEWPORT BEACH CA 92660
aooness: ELITE PLUMHING ( 719 ) 722-0374
1760 MONROVIA C-12
COSTA MESA CA 92627
LICENSEU CONTBACTOP DECLAHNTION: I hereby affirm Ihal I am Iicense0 untler pmvisions oi Chapter 9(commencing wilh Sec�ion
7000) o� Division 3 0� Ihe Business and Professions Code, anU my license is in tull force and eflect.
ciTr 4uc.: 5 sTaTe uc.:539786 q C�} C-36
�ale: J � Signamre: _ / Il1 /
WOBREflS COMPEN ATI�N DECIABBTION: I hereby aifirm a� I�av� a�e li 1 nsent m selbinsure ar a ce�ilica�e oI Workers'
ComOensation Insurance. or a cetlilie0 coOY �hereof �Sectio 38011 La�. )
roucrNo.:046-93UNIT3207 P�pE O 01/94
coMvaxv: STATE FUND
❑ Cenilie copy is ereby furnis�etl. � Ceni�ie0 cop is li � wi�h �he - Building Division.
Oate'. v Applicant:
E%EMPTI FXOM WOBNEBS'COMPENSATION �ECIAflRTION: �isse�mn nee ot ecampletetlii�he permi�isforone �unUre4�S100�or1e55).
I certity Iha� in �he performance of the work for which this per i� is is ued. I 5 al nol employ any person in any manner so as �o Oecome
su��ec�to Ihe WorkeiSiCompensation Laws of California. �
Date: SignaWre:
NOTICE: tl, aRermaking I�is tleclaraiion, you s�oultl Gecome suble�� �o ihe Workers' Campensa�ion pmvisions o� ��e Labor
CoOe. you must Iorl�wiih comply wilh such pmvision5 or Ihis permi� shall be Jeemed revoketl.
CONSTflUCTION LENUING FGENCY: I hereby atfirm Ihai ��ere is a constmc�ion lending aBency �or ��e Oehormance o� lhe wotk for
which Ihis permit is issuea �Sec�ion 3097. Civ. C�.
LENOEfl:
aooeess:
OWNEfl BUILOEN UECLAflFTION: I �ereby aftirm that I am eeempt �mm �he ConlracloK $ta�e License Law for �he following reason
(Section 7031.5 Business and Pmlessional Code- Any tity o� counly which requires a permil b consiruct, alter, impmve, tlemolish, or
repair any simc�ure. prior lo iis issuance. also reQuires lhe aOPlican� for such permil to lile a signe0 s�atemen� �hal �e/5he is licensed
pursuanl �o Ihe pmhsions of ihe Coniractors Slaie License Law (Chapler 9(commencing wilh Section 70W) ot Division 3 0� Ihe Business
ana Pmfessions Cotle) or ihal he/she is eKempt iherefrom antl ihe basis for Ihe allegetl exemD�ion Nny violation of Section 7031.5 by
any apphcan� �or a permi� suble��s Ihe applicantlo a civil penally of no� more �han Irve hunU�ed tlollars (5500�.
I, as awner of t�e propeny or my employees with wages as their sole comDensation, will do ihe work, an0 Ihe
❑ stmcmre is noi intentletl or oiferetl for sale (Section 7044: Business antl Prolessional CoOe: The Conlractors' State License Law
Ooes nol apply �o an owner of a pmperty who builds or impmves �hereon, an0 w�o tloes such work himseli/hersel� or Ihmugh
his or �er own employees, pwvi0etl �hat such improvemenls are no� in�en4eA or oiferetl �or sale. If, however lhe builtling or
impmvemen� is soltl wiihin one y¢ar of comple�ion, t�e owner will have the hur0en o� O�oving he/she tlid not 6uiltl or imOrove
for t�e purpose of sale�.
I, as owner ol tne pmpeny, am exclusivety coniracling with licensed con(ractors to constmct tAe pmie�� (Section 7044, Business
❑ an0 Pmfessions Coae: T�e ConVac�ors' Sia�e Licenre Law tloes noi apDty to an owner o� pmDeM who builOs or improves Ihereon
and who coNiacis �or such pwle��s wi�h a conVac�or(5� bcense pursuant�o Ihe Contractors' Staie License Law�.l am aware
that pmoi of Iheir Wnrker's Compensa�ion incuranr.e xhnul� he pmvided m me.
� I am exempt under Seciion'. B. B P. C.
br this reason:
Oate'. Owner
I do hereby cenify Ihal I am aware nl znd undersiantl ��e reQuiremems o� Califomia Heallh ana Sa�eiy Code Sections 25505, 25533, antl
255Ja an0 ��at 1 or any INure OuilOing occupan� will/will nol (circle one) neetl to com0ly wit� 5aid state co0es antl Ihe reQuirements lor a
permil lor con5lmclion or moUifica�ion imm �he Nir Ouali�y Managemeni DiSlricL ReSideniial con5lmction applications are eeemp� �mm
Ihese pmvisions.
�a�e'. FpplicanP.
I �ereby certify iha� I have reatl �his applicalion and s�a�e I�a� Ihe above
ortlinances antl slaielaws Blatinglo bwltling cans�mc�ion an here�y aWh
properly lar - speclion urposes.
Date: � Signamre:
Driver's License or ocial Security x:
16ab46 Whne-9uiltling�, Green—Code
is correcl. I agree �a comply wiih all cily antl counry
nla�ives a� Ihis cily Io enter uDon ��e abaue�mentioned
Pink—Revenue; Goltlenrotl—Assessar
CITY OF COSTA MESA — HUILDING PERMIT PERM NO: P 063920
PERMIT NO: P 063920 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: III—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : EXPAND OFFICE AREA S ADD NEW REST ROOMS SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: TAE "VANDAL ALERT" SUITE / RE: B63599
+r*�r**�r***�t**�********��t�r*****�t�*�**� ****�t�***�**�*�r**�*�t*�r�r�***� *x ** rt*�**�t�r*�+t�*
-- Z O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL; 9150710,8 ZNE: REF NO;
PLANNING N6TE5> �"�
� '. i
iE iE iE �f �l6 iE iE if iE iF iF iF if if iE iE iE iEiE iE iE iE iE iE iF iF iE iE iE iE 1! it iE iE iE iE iE iE iE iE iE iFiE iE k"iE.3E �E iE iEiE 1E iE iFiE iE iE if 1E iE iF �E iE if jF if �FjE iFiF iE iE iF iE k iF iE jF it
D E V E L O P M E N T S E R V I C E S'--•R E Q U I R E M E N T S
�i.
ZONING APPROVED BY �.- DATE;
BUILDING APPROVED BY : , � DATE:
/�,. �.
APPLICATION ISSUED BY; DATE: g I.3
ilitiEiEif1liEiF-0EififiEiEililiEiEiEiEiFlEif lEiEikiEiEiF1E1EiFif iE1F
3Eit�E�kifi4iflEifififiEififiEiFkiEif3k3FiF�Fif3F�Eif�EiE1EiE1EiF1fiF�FiElEifiEiEififiE'�E�iFitiE iFiEiEiElFiEiElElEiFifiE3E1E1FiE�E�F�tiEiEiEiFiEifiE�kiliE
LEGALIZATION;N F E E S U M�M P.�R STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 77,00 -t'
258 SMIP/NON—RES
PLAN . . %
ISSUE FEE 20.00 t.: 1
BUILDING—DIV—> PERMIT ISSUE PLANtCHECFt TOTAL PAID DUE
TOTALS----> 77.00 20,00 ,l"� 0,00 97.00 97,00 .00�
REVENUE DZVISION TOTALS--> COLLECTED; 97,00 OVER/SHORT: .00 \
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECH
97.00 -
. %
k ik iE iE iE 1E iE fE iE iE i! i:1E fE iE iF iE ik iE iE if iE if iE if it if �E iE iE iE 1E ik 3f 1f if iFiE �E IF�F fF 3E iE 1ElF iklf 1E jEiE iE iE 1E 1k iE 1E if iE 1E 1F 1EjE iE iF iElE 1EiElE iElE iF iE !f fE iF iE iE
I N D I V I D U A L-• "^_F E D O W N
TYPE QTY
PLU
PLU
PLU
PLU
PLU
D E S C R I P T I
BATHTUB
SINK, HITCHEN
WASH BASIN
WATER CLOSET (T I
WATER HEATER AN /
FLOOR DRAINS
URINALS, WALL
NS��C�IDN�
''' CA��
RTVENTa54•5626
.,
,,: .j'� O�
BND OF .�E��'
� ��r
IT COST
%,�0
7���
7.00
% , � �
%.�0
7,00
7.00
TOTAL COST
%,0�
7,00
14.00
21.00
7,OU
14,00
7.00
02 0014673� 90146T6 TC1T ?7.Q�
DATE- 09/13/93 TIME: 10:42
CONSTRUCTION AND PLANNING
� APPROVALS Permit #
' 1, Temporary Electrical Service or Poie_ �
2. Sod Pipe-Undrgrnd. �
3. H�ectrical Conduic Utility�Undrgmd.
' 4. Efectiical Conduit-Undrgrnd.
b. Steei Reinforcemant
6. Ei�ctr�tal UFER Grnd. '
7. footings � . .'
" 1L Foundatio�
9. Nratzr Pipe�Undrgmd. .
74. SCructural Ploor SYstem
i i. Property Sewer Line & House Cpnnection
12. Sev✓er Cap .
13. Roaf Drains �
14. Rough Plumbing
15. Rouqh Electricai-Conduit
16. Rough ElActric iNlring
77. Rou9h Wiring Sig��
18. Rough Elearicel�7 Bar Ceding
19. Rcu9h Heating & Air Cu�ditioning
i,
20. Rough Factory Fireplace ' � ` .'
21. Ducts, in5tructure � �• •� �
22. Q��s, Ventiidting�. ' �
i
23. �Gas Pipe•Rouyh & Test � .
24: Rooi Framing , ' ' ' . ' ,
25. Roaf Sheathing . �.
26. T-Ba+ Ceiling {Svocturall & M19onocoat
27. Frar�e aqd Flashi�lg ', � _
28. Lathing�& Siding . ' ' ' ` � .
29. Insulation � �•
30. Dry�rrali Nailing .
i
37. Plaster Brow,n,Go2� � . �
32. Electnwi Power Meter�,Final i
33. Firdl E�ectric ' i �
34. Final Neating 8� Air Condrtioteing . ��
i
35. Finat Gas PipE-Te52 � .r
36. Hoed or Canopy � � - '
i
�7•,Final, Fatto�y FirCP�ace - ; �
38. Finat Plumbing ^ - � �
i
39. lVater Service-Fina� ,
4Q. Gas Service-Fi�ai +
41. Soi;r OomesticFinal � ' '
42. 8ackffow Preventer �
43. 8ackflow Irrigation �
44, La�dscape Irripat�on System • . � �-
45. Sound Attent�atiU� -
46. Handicap Regulations
47. FINAL STRUCTURE & BUILD�NG
48. FINALPLANNING
49. EVectric Release tp Edison
50. Gas Release to Southern California Gas Co
No
Date
Date � Inspecco
0
� � ,
POO L & �SPA
� APPROVAIS Permit # Date
52.�Pool & Equipment Locacion
.
53. Steei Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAI TO COVER-GUNITE
58. Electrical Conduit•Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash l.ines, P-Trap, O Undrgrnd.
67. APPROVAL TO DECK
62. Backwash & Receptor�Fi�al
63. Heater & Vent-Final
64. Piumbing.System � Fina! �
65. Electrical-Final
66. Solar System-Final
67. Fencing & Accesi APP�ovat
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEP7. REQUIREMENT
� APPROVALS ., Permit � � ' �. � ' ; ,
7Q. Underground'Hydro
� �77. Product;PipEng C1Gas ❑ Oil
-1 �----- . . - -
J2. Underground Flush, •
,73. 1Jndergrnd��Storag,e7ank nGas ❑Oil ' ' ' ' '
�A. Overhead Hydro �
75. Dry Chemical ' . �
76. Dry Standpipe .
77;'�FIXEp S,'Y'STEM'F(NAL , , � , �
InspeCtor
78.� PiRE P.FEV. FINA�L - . � .
' ' 'HEALTHDEPT.REQUiREPo1ENT' • �
� �.�79. �FI�NAL.INSPECTION � �
B0. �F000 CERTIFICA7E ISSUED� ��
No�S: y�,�����-- ����`�a''D,/r•
� ���fe/L �...�� �:/,�L il�� �
' - �
-- :ti .
�' T_-
�
:
i-i
PNOJECTRDOflESS:, 3545 HARBOR GATEWAY S ux�T: 101
owNea s xarne: C, J. SEGERSTROM 6 SONS
ADOflESS: 33SS FAIRVIEW RD
COSTA MESA
CA 92626
(714)546-0110
RNLHIENGINEEfl: TOM Cii�"�p�s eEc.xo.: NONE
aooness: 1809 WESTCLIFF DR uxir: z�5
NEWPORT BEACH CA 92660
PEflMITTEE: E. I. E. ELECTRIC ( 714 ) 222-0999
aoox¢ss: qZqZ CAMPUS DAZVE D
NEWPORT BEACH C 2666
LICENSED CONTBACTOfl OECLABATION: I he Ilirm ��at I am Iicense0 unaer O�ovisions hap�er 9(commencing wilh $ec�ion
7000� ol Drvision 3 0l ��e Business anA Pm ssians , e is in full fo¢e antl eii
ciTruc�.:j'Q57410 sraTeuc.:6456 �
oale: !�LY.�� Signalure: _ I — � _
wOBREBS LOMPENSRTION oEClA8ATI0N: I ne�eby affirm iha� i have a cehifica�e o consent to sell-insure or a cenitiwte oi Workers'
CamOensati0n Iqs�qc�o��q(ulie4cypy inereof ISeaion 3800. LaU. C].
POLICY N�.: 1 1 C 9.3 E%P. DATE: O 8/ O 1/
camraer: STATE EUNDrv
❑ CertAieO /cypy is hereby Wmishetl. �1 Ceriified copy ' wi �h ciry ui in �ivision.
Oate: R/[/�� Y pvPlicant:
EXEMPTIONhPOM ONREBS'COMPEN511TIONOECLAPRTION: (ihissec�ionneeAnotbecomple�e0illhepermi�islaronehundre0�S100�arless�.
I ceNty tha� in �he OeAormanc¢ a� tlfe work for w�ich �his p¢rmit is issued. I s�all noi employ any per5on in any manner so as �o become
subletl �o I�e Workers' COmpensalion Laws o� Calilomia.
Date: Signawrt:
NOTICE: If. a�ter making Ihis Ueclara�ion, you 5�ould 0¢come SUEjeci Io I�e Workers' Compensa�ion prmisions ai Ihe LaUor
Code. you must lorthwith com0ly wit� such O�ovisions or t�is Oermit shall be tleemetl revokea.
LONSTBUCTION LENOING AGENCY: I her¢Oy ailirm Ihal there is a consimction lentling ap¢nry lor �Ae Dehormance ai lhe work lar
which ��is permii is issued (Sec�ion 3W7. Civ. C),
LENOEP:
AD�NE55:
oWNEfl BUILOEB oECUPATION: I hereDy atfum ihat I am exemD� �mm Ihe Comracmrs' State License Law br ihe following reason
�Secuon 7031.5 Business and Prolessional CoOe: Any cily of county which requires a Oermit to construct, alter, imD�ove. JemalisR or
repair any 51ru[Iwe. prior Io its issuante. atso repuire5 ihe apDlitant for SUC� permil to lile a Signetl 5�a�emenl iha� �e/s�e i5liCenSM
Oursuantlol�e Dmvisions olihe Coniraqors' $Iale Lic¢nse Law�C�aO�er 9(commencinB ��� Seciion 7q10� oiDivision 3 alt�e Business
ana Pmlessions Code) or Ihal he/she is evempi therelrom ana t�e Gasis �or I�e allepeU evemption. Any Wolaiion oi Seciion 7031.5 by
any a0�licanifor a permi� suble��s l�e aD�liwntla a civil penalry of noi rtwre lhan �ive �unareG dollars (SSf10�-
I. as owner ol ine pmpeny or my employees with wages as iheir sale com0ensation, will tlo ihe work, ana tne
❑ slmcture is not intenaetl or otferetl br sate (Section 70a4. Business antl ProfesSional CaOe: T�e Coniractors' State License Law
Does noi ap01y to an owner ol a DmpeM1y who �uiies or impmve5 i�ereon, and who do¢S SucA work himsell/hersel� or throug�
his or �er own employees. provide0 Ihal such imOmvemen�s are nol inlentletl or o��ereE lor sale. I( however lhe builtling or
improvemenl is soltl within one year ol comDletion, t�e owner yy�ll Ila�_e the burtlen ol O�oving he/sAe did nol builtl or improve
for Ihe pWpose ol sale�. ' .
I, as owner al ihe O�op¢rIY. am exclusively contracling with licensetl contractoR to con9mct t�e pmlect (Section 7044, Business
❑ anE Pm�ei5ion5 CoOe: T�e CAnlraciors' S�al¢ Li[en5e Law Uoes no� appty to an owner o� pmDeM `�o bui105 anmpmve5 ��¢2on
ana who contrac�s lor suc� pmle��s with a conlraclaqs)Iicense pursuant to Ihe Coniraclors' Slale License Law),I am aware
�hat O�oo� o� t�eir Worker's Compensation insurance should be pwviaetl to me.
� I am eRempt unEe� Section: B. 8 P. C.
lor I�is reason:
Oale: Ownec
I eo nereey cenify Ina11 am awate ol an0 untleistana ine reyviremenis of Califomia Health ane Salety Cotle Sections 25505. 25533, antl
25534 and t�a� I ar any lulure buil�ing occupanl willlwill not (circle one) neetl lo comply wilh SaiA slale codes antl ihe requiremen�s �or a
permil ior cons�mction or modificalion imm Ine Air �ualily Management �iSVict ReSitleniial cons�mction apDlications are exemp� Iwm
Nese provisions.
Oaie: AD�I¢a .
I M1erehy cenity IAaI I �ave rea4 ihi5 applicaiion and Siale Iha e a in�arm �io t 1. agr¢e to t ply wil��
ominancesaneslalelawsrela�ingm0uildingcons�mclionan iere a r re n�ati sol isciy enie Oonlheabove�men�ioneG
pmp¢ny lo� m50 Aion �po)ses.
Oale: �' � �L__ SignaWre:
Driver's tuens or Sociai Security w:
�64bC6 W�i�e—Builtling; Green—Coae Entorcemem: Canary—ApPlicanl; Pmk—Revenue; Goldenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 063962�
PERMIT NO: E 063962 PLAN CHECK NO: N GOVT�N SUPP: N
CONSTRUCTION TYPE: IZI—N PERMIT TYPE: ELE PURPOSE: ADD
JOB DESCRIPTION : EXPAND OFFICE AREA S ADD NEW REST ROOMS SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: RE:63599
***w***r+c+rw+r�r*rt*****r*****r***+rrr�r***+r*******w****rrw**w*********+r*+r*****rx**�c**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ • PROV; PARCEL; 41507108 2NE: REF NO;
PLANNING Nb'PES>
i
*r***r*�e*r�*r*r**�r*��*r�r+r+r«**+r«+r******�r«***+r**rr�r**r�r*�rw*+r+r**r**w*+r****+r«+�****
D E V E L O P M E N T Si-H+�R V I C E S R E Q U I R E M E N T S
20NING APPAOVED HY -�� DATE:
BUILDING APPROVED BY ; �. DATE;
APPLICATION ISSUED BY; DATE:
».***»**..*.*»****.*�� � .�**.**.x,�������3
If MMNM1FMNit/tMMMMfflf Mk7flfilltltMlfMlfMlfifMlFif MMiFMlf �f M!f!flfiFMif4iflkMMifMMMlFiffklFM4it1tMMlFlFiFlFif MMlF�Flfif NKM
LEGALI2ATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
HLDG PMT PLUMBING ELECTRIC MECHANIC FIAE SMIP/RES GRADING
PEAMIT 22,50
SOt SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 22,50 15.00 0.00 37.50 37.50 .00
REVENUE DIVZSION TOTALS--> COLLECTED: 37.50 OVER/SHORT: ,00
HLDG PMT PLUMBING ELECTAIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
37_50
��f*i��iF�F**iF********�f**lklfjFiF�F�FiF�FjFiFiFiF3F1FlFifikiFM**iF�F*iFaFikl�i(�*iNMNiFMiFiFiFMMNMiFK1fMM7FMMiFMMK1tM1t
I N D Z V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 12 FIXTURES LIGATING 1 ST 20 EA. .75 9.00
ELE 12 RECEPT/Ot1TLET 1 ST 20 EA. ,75 9.00
ELE 6 RECEPT/SWITCH 1 ST 20 EA. ,75 4.50
END OF FEES
�1 0014b8bb—OD146866 T D T 37,gp
DATE� 09/14/93 TIME: 11:OE
� CONSTRUCTION AND PLANNING POOL & SPA
-� APPROVALS Permit # Date Inspector APPROVAIS Permit 5'k�
1. Temporary Electricai Ser�2e.or Pole : 52. Pool & Equipment Locatlon
� _in�
v .-
2. Soil Pipe-Undrgrnd. c• -:v; 53. Steel Reinforcement
-�++t=.; l..-�.'=.�,�F�--'.:,�>
;.�'--F,���:_g.�"�t��y(�E£ti4i[Y�ndrgmLr?,m 54. Forms
� r a.,: �f=r'-�..�o-' _
�.� 4• 6k+�dh�.�1*.�f(c7ttal�ndrgrnd. i`; 55. Electricai 8onding
f! [a=F•a�-•Ce-G:-•-..•-"-
���'�.'Q`e.�_?f�ai-:�Ft m�+k +'�� 56. Rougb Piumbing & Pressure Test
�;1 '*��:G.Ti• �V� r•
.,��.` `l'� � r T
Date Inspector I
I ^
�rc � ect�,�c.� ,��.e�,y�d 57. APPROVAI TO COVER�GUNI E r;
- �-!--e��� Aa.rt .
�FT.YFootir�s �Clt�.^s,� � 58. Electricai Condu�bUndrr•nd. �� '',
v...
� ��.�Foundatio� ,�� '• °' �, 59. Gas Pipe, Cl Undrgrnd., Test ;' �� I
� - I
C� ��. Water PipA�l.lntlr^_`�nd. ' + 60. Bacl<wash Lines, P:Trap, � Undrg�nd. '
i;(�. Structural Floor System _ � 61. APPROVAL TO DECK �
n�f,�y Property Se��aqr Liqc�& HfpvseCon�gct�on � 6.. Backv.ash & Receptor�Finat -" �
12. Sower CaP 2 u� �'. o� � -�
63. Heater & Vent-Final �
13. Roof Drairs� 64. Plambing System - F�na� '
74. Rough Plurtr�in�q ''� • 65. Electricai-Final �'
75. Rough �ctric3l-Condurt 66. Solar System�Fina! y
- 16. Rough E��actris^Niring 67. Fencing & Access Ap[+roval j
p 7. Rough Wi�n9 $j 68. APPROVED FOR PLASTERING
�. _
78. Rough ElectriF9-T Bar Ceiling 69. POOUSPA SYS7EPdS FINAL �
19. Rough Heating & A�r Cond�non:ng FIRE DEPT. REQUIREMENT �
?-i,r^t--T^ t• O•.-�:n;-. OG t :- Irirrtln
20t�J�oU9h F�ccc�aY �L�UaPlace � r.,cn �.,7 �. � �i " . . �PPRBVlt1�JOPe[mit n � ^��-+.}� '
t ..i �"# i rD•�_-.� a -�a } L!CJt-if-. '� .._::y� �
21�u�s, in.Str.uctt�i; �`;", �s } ; rJ h* ;`70. �de7'g5o�n!j Hglro i P1
.-,;-Y=�.,-:--r � 1
22. DuCi5,t11nt�e;tirS-� i�� • � Ev =�71. Produepi�ying �SC�s !?� il ___ ,
23�,t'ia iP''�o ^ h &'test � �. _. �.T ^ �'" # F72. Under '1 �{, FI�" J `"f - -.
� k-� � 1 I .��.:. * M C' �h (JY. t j-� 9f�/'i� 7�4S�1 �f F
-z--"�-
24t.�o� Fg�mi�3 p,���r�;� ::F. >. ^. �i r. ��� 73NU� ndergrna�.Storerc*Tank�EGas ;7?i + o -- .
� S ^+ 1 i N S �(: '
25. Ro'S�' SIZ�athing ;� �, ^ �1 '� m ,�..�. O N� �''74�.'�-�OverheadyFiydro�F' .�
26.�07'� � Ceding IStt;�sturall 8� ;a;.ccoat 4 c7 c+ ms � 75��.�Orv Chemicai �� •� c3 s�•a: •: -~. -
__ . a� 3y .. � . �- n� �y� +k � �S:A '_
27o�Frame nd Flashin � • '� '� � " �� ':= �n '��']'
v-, �n � �a;•.^, , t„ w��$ a 76 Dry Stana.#�`,tl�e F.� ♦ F:�i'•:
t • ? .f r+. .. � � . . . 2--c;, =7' .-:'�:,-.C*-�T . -'
�8: 'La�hinc�� Siding �i s� �-i.^, �� �a s ••�t t 77^ FIXED .`'.-i''.�'++TEto751NALt x�-' �
��-�=qc�--F� c •��. � .xi � ..
�"29. InsViati� � �� �'. " " k'' I * k 7giFIRE PREV. FI�VF,�L ; �- -�Lp� �-��- I
r30. Dryevall�lail�ng .a � �' -�. I �i i t�-i M`iS�ALT�-�'�-,7EPTt'P-£O�NIR .Ey'tR[4dT -�
?' �.ti:.+-il:.i 't -x�T.Ll----�- ---. .
`�37. Plaster p7ow Coat' � �+ ' ' ' 79`�PINAL IC':l�' eCTI`+"+Y� " � �� .
Ci r-i � y�: i �^�T' i .t 7 J'.� f� . .+ �;
pi ��} S �+::. fi 9T�FF� t^�5 __'
�.32pElectritp7 Po,yer Mst�7Final� ` y z� � i� ,;BO�FOOD C�`FTIFtGfu'tk IS�UED'W y� _
-, ^!- r.-t-=: a_ _ � __-.
_.33rFirt�l Ei¢C«�; x ; c*� '� '�.5 r��N�r:,s. cr H�: a C� �
cc i , s r 7-:.� �-� m <�y n ri
y�r � H �-, :: : �r- x � . � �y ��7'� -
7134: f�n$i H ti q& Ai4Cd�:iticn.;.i�. .� � � �j
¢P "�i i �i e � , r iC_ i�s t
-E'u : .-F.�=i : � ' . � _�.� . � . �.. .. - �
�35:TFirtri G8F PiFT�TesF 'n `� ' + ' : .c.� _;: • m�; � '+' J
- .. x ('r. .. . �--� I . a :Ca c'J-� �.s NN^t�n �
� . � � r �h : -. ,:;-�F�--
.�36.xt-lo jd OFCanOPV . � � p' `y a -:l � Ia y^ :.r C O . rt� �
_ ^ '7 �-.=,_i cx'� ` � .. � ��v,�m_-- -- - -
`37CFin31 Fa,s[ory Fire�,�lacti: ; F.r" o t•" � I: t `t: :x' _`�,v
r . .. -r y .r : .. .. �. s r� � i -�+-i- -- - t
,.,38. FirM PI'�r�{ttbin9 a i i I -� � i� � 'r �'
�-M-t-! � w Cra � -,
::39. Wat� Sa{vice•FinaG .o • i �! � . � w;r� .c ;;
x^ s S � ' '* + r �• 'f I*]MI*!
`'40. Gas Sero e-Final ` ' `O " . "' � i�-�1 `�-
n7 =x a. m 1b•: '. [� � �-i a OL- •..-.7 .f . . .
w-i .-..-�.s' ..�
'r. _
�41. Solar DdmestiaFinalS ;' •� * Ca ' i �Sn� �-+ Y
.� rr ' �t 4 - '"1p l" % 7: J
` 42.-$ackflo� Prevente� `" .0 k '� � � ' ;� � F, � p .y '
' -� � ! .-. ;*76 * i
43. Backflow Ir�tyation� �: :� s k��- `-�`-� '�+ I
a cr -_ : ti : { n .• J
:;A4. Lands e i atiii� S sce �;'� ' - -,w � �T K `- ✓Tr� - �
cap �a v �t;t x * � � -� � = n� ^. . �-: v w f4iJt.
'�R5.�6ound Atteff�atio�-n-�:�'.�N v' •� F^ E F+ ; r+ ^•� n'Jy�-' �
� � •� = n t x ., '^ : . a
c " .. .. _ ; ;Y .. . ..i i � : r.t�. �..,.y .
�;46.E1-landic�3 R�cjulat�f�ns � ` , � � � ; �.p •� �
47��It$Al STRiiCTURE & B DING � � � I ++ r '1 .: � �' �
• s • '.. 3 ; C' • Y
48'�t IPtAL PLAt�N W,a� ![� r e a- . s � 1
J v `� I FF� ' CJ � �•- T.: � P7 r; s F
- �__ 3-�J-ft: :: •
cA9rElefyric Release to:Edison x � (,. .}« x c-., �, � ,
•1 i
Tq0_Ga�ReleasetoSou�hernCal�fp,4ru�GasCo z -�`Y �� `�"' y �� va.._
OY � � �s f i' C% • UR7 i ;l •••
51. CE , IFICATE O xOCCUP , PICY x � �-�o�-� - ;-. c�
I► No. Date
�
""�
PHOJECTp00flE55:� 354� HAABOR GATEWAY S �"�T' 102
awx¢xsnarne: C,J. SEGERSTAOM S SONS
nooxess: 3315 FAIAVIEW RD
COSTA MESA
CA 92626
(714)546-0110
APCMIENGINEEfl: '1'�M C�F10Cv' flEG.NO.: NO
nooness: 1809 WESTCLIFF DR �� 275
NEWPORT BEACH CA 92660
PE""uTTEF: E. I. E. ELECTRIC ( 714 ) 222-0999
FDUNESS: qZ4'1 CAMPUS DRIVE D
NEWPORT HEACH CA 92666
LICENSED CONTflRLTOB OECIAflRTI0N�i41+erttyali' t I am lice�setl er prOvisions al C�ap (commencinp wil� Section
7000� ol Drvision 3 0� ��e Business antl�wo�euions CoOe. an se � in lull mrce an0 ellect.
cirriiq�57 10 sureuc.:64568 ss `
Oale: _ Signaiure: _ _ _ _
WOHNEB COMPE SATIONDECIAPATION: IAereOyalfirmthatl cenilicateofcons itosel4insurearacertilicateofWorkers'
Comoensalion Insurance. or a certiiied cooY thereol ISeclion 3800. Lab. C).
eoucrr+o.: 1315272-93 E%P.OPTE: OB/O /94
camraxr: STATE EUN
❑ Cenifie0 c y is �e by furniSAe�. � Certilietl cop � e ci Bui in [ visi .
�aie: �I , �� qpplicanC I
E%EMP710N FNOM WON EflS' COMPENSATION OECIAMTION: (Ilris sec neeG mi he compkleE i� perrtil is �a one huMrM (5700� oi less).
I cetlify t�at in t�e �edarmance o� t�e vrork lar wNch tN5 permii is issue0. I slull noi employ any Oerson in any manner w�as �o become
suaie�� �o tne Woders' Comoe�sation Laws ot Calitomia. • �/
Oa�e: Signawre:
NOTItE: iL at�er makinq t�is declaration, you slwula hecome su0lect to t�e Workers CAmpensa�ion Dmvi5ion5 01 IAe Lahar ji
eoee. ro� m�st ionirvnin mmoN ��n sucn W���s w�� ce��� stun oe eeemM revoke0.
CONSTXUCTION LENOING AGENCY: I �emUy atlirm tlut I�er¢ is a con5lrucqw ImGinq ap¢ncy lof l�e pehOrmante 0� I�e wad lar
which �nis permit is issuetl (�ciion 3097. Civ. C1. �� '
LENOEN: � •
ROUflESS:
OWNEB BUILDEN DECIAflPTION: I OereUy altirm t�at 1 am exem0� �mm Ihe ConVactars' Slaie License Law lor I�e Ioilowing reason
(Section 703t.5 9usiness an0 Pmlessmnal COCe: pny ciry of coumy which repuirts a Dermit to construq, alter, impmve, Aemalis�, or
re0aii any SlmclurF O�ior to it5 istuan[¢. also �epuires ��e appliWnt IOr such permit �o �il¢ a 5i0neA s�alemenl �hal �Us�e is IicenSeA
pursuam to Ihe orovisions al Ine Contraaors' State License Law (ChaD�er B kommencin0 ��� Sec�ion 7000) 01 Division 3 of Ihe Business
ane Pmlessions Co0e) or inat ne/sne is exempllherefrom ana ine Dasis lor ine aile0ee exemptian. Any violatian ol SeGtion 7031.5 hy
any applicanl lar a oermit suoietls ine aDoliWnl to a civil Oenaliy oi noi rtrore Iiun Irve AunUreA Oallars 135001.
I, as awner ol t�e DmOeny o� my employees wiih wages as Neir sole compensaiion, will tla Ihe work, an0 t�e
❑ stmcWre is nol intended or ollereA lor ute (section 70aa, Businea antl Proleuianal Coae: TAe Coniractors' State Litense Law
tloes not aovly lo an ownei ol a o�oDeny wno buil�s or imo�aves inereon, ana who Oaes suth work himsellltlersell or Inrough
�is ar �er own emDloyees, DrovitleE t�al such im0�ov¢menls are not intenG2E ar allere0 tor sate. 11, �owever tAe Ouilding or
impmvemenl is so�a wilnin one year ol comptetion, ine owner vnll nave ine Ouraen of Orovinp ne/sne tlitl not ouilA or improve
lor t�e Durpose ol sale�.
I, as awner of tAe O�oDeny, am eMclusively contracling wi�h licensea comracmrs to cons�mct t�e pmlect (Section 7044, Business
❑ ana Vrolessians CoOe: T�e Contraclor5' Sta�e Liceiae �aw Eces noi apply to an o-xner al property who EuilEs or improves Ihereon
an0 w�0 comncls lor suc� pmjecis vntn a wnuactoqs) ticense Durswnt Io Ine Conirac�ors' Stata License Law�. I am aware
I�al piool ol I�eir WorkeYs COmp¢n5aiion in5uranCe S�ou10 Oe Omd0e0 �o me.
� I am e.emD� untler Seciian: B. 8 P. C.
lor Inis reason:
Oate: Owner.
I do nereW cenily ttW� I am aware al anA unaerstan0 tne repuirtmenLS of Calilwtud Hedttn anE $alery CaOe Salions 25505, 25533, and
25574 an0 I�al I or any Iuiu�e DuilOinp acupani wilVvnll noi (tirUe one) neM Io fAmpty wilh SdiO siale Ca�es an0lhe requiremenls lor a
petm�l �or conslmctian or m00ilicaiion hom I�e An Ouahiy Managemeni Oistnct. fle5identidl conSirutli0n aOVlica�ion5 arp eKempi Irom
inMe provisians.
Dale'. �C'�
I heie0y cetlily ihal I �ave rea0 ��is aD0licalion ane s�ate tlul nlor lio r . agree �o con wil� all ciiy and county
oremanw5anO5�atelax5relalingloGuilOingeonSVuclianan4� e0yau �' ere re enla�V soll rscilyloenie�up �eabove�mentionetl
pmpe�iy Im � Spetli a D.�urpo5e5.
Daie: �� Signature'.
Oriver's License ot sociai secuniy x:
16aLn6 W�ile—Building; Green—Cade Entorcemenq Canary—Appliwnt; Pink—Revgnoe: GolOenrod—Assessor
CITY OF COSTA MESA — BUILDING PEAMIT PERM NO: E 06396
PERMIT NO: E 063963 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: III—N PERMST TYPE: ELE PUAPOSE:. ADD
JOB DESCRIPTION : INTERIOR ALTERATION TO EXISTZNG OFFICES SQ PT: �
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
*�*wwww��i�tw**ww*�i*wwir****�*+Erir**wB***+9t*+rrr*r**it*r***xw****rrw**r�**w*xr+�**w�rr***
Z O N I N G R E Q U I R E M E N T S
S E T B A C H S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING RE • PROV; PARCEL: 41507108 ZNE: REF NO:
PLANNING N ?ES>
>
ir***ir*r*rr+r+�w**r**ititxitwritx�exirr�r�rxw*�r*rw*rrititrit+tit*r�*+r*x�r�r**rx*+trwr**w*�*�r*r*x**
D E V E L O P M E N T S E�R V I C E S R E(7 U I R E M E N T S
ZONING APPROVED BY % ' DATE: ,
t�
•✓
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: ��i9 C� ****D�***x�������+�r*
������'���������*���1�*�
��F���F*1FIF�FiFfFIF#iF�FIFlt*1FMlFit1FIFIF*MMifiF�F*iF4*itifif*r****if*iF*iF+t+tifr*rt*iF+tiF+rww*rrww*wirwrww*r*** �
LEGALLZATIONcN F E E S U M H A R Y STRUCTURAL SEGMEN� �—
PERMIT ���� ��� pLUMBINtl 6LE�'�'Et��' ML"CHANIC FINE SMIP/Rff5 GRADING �
SOt SMIP/NON—AES r,L..
PLAN
ZSSUE FEE 15.00
BUILDING—DIV—> PERMIT ZSSUE PLAN—CHECK TOTAL PAID D�1E
TOTALS----> 19,50 15.00 0.00 34.50 34.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 34.50 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
34.50
MMMMMifMihM4MilMMMMMMMMMMMMMMMMMMMMffiFif MMMMMMMMMMMM%1lMiFMMMlFMMM1f 1fMKMM1FM1tMMMMMMMMMMMiF
I N D I V I D U A L F E E B R E A K D O W N
TYpE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 10 FIXTURES, LIGHTING
ELE 13 RECEPT/OUTLET
ELE 3 RECEPT/SWITCH
1
1 ST 20
1 ST 20
1 ST 20
END OF FEES
EA. .75
EA. .75
EA. .75
02 00146 0'-0014b367 T Ll T
DATE: 09/14/ 3�TI11E: 11:08
7.50
9.75
2.25
"s4.50
' � CDUSTRUCTIOti AND PLANNIRG
I j APPROVALS Permit � Date Inspector
I i. Temporary Electncal Serv� cr Po�e ,U
i ^�-.
2 Soil P�p�•Undrgrnd. ... �rr�
1 .i_ .n,-�..,c., . �; ^ � =.aE,._
I��.�j.�`�'c�',��f'� �' 1`�iai�li!Y'Cndigrr.c�"' .
�;^, i 2�".�S„ .
..r=�-c .:.-cTa--.z-�----_^n- �
� 4. EvZ:1r�31�",fio".Jdr.�.c'iG.?;hgrnd i J I
r_�uc�r . '*' ^,S-�--�
-s���¢i'.��i?o��-�';''�r�ce¢,%i,Y .•���+:I I
�
Qv
C.Q!'OunOdSit;SY ,ls
-�
"�. Water Pipi�UndreLlid.
,,Hj. Struetural Floor System
R�-
:U F-op.^�;v Se�',sr LirC& Hqqsc
� '-' --"-' --' ,.. s•
' � 13. Hoof Drains�ti v
1.� -r�
� 14. Ro�gnPlumbi� �' --
15 Ro�gh [i'gct!'c�7•Co�dwt
,_ cn-
16. Rough Bectr�c+�Mlfnng
o�
��, 7. Rough Wi,r`}'nA pn
18. Rough EVecvic.�%i-T Bar Cz�hng
79. Ro�agh Heating & Ikr Cordi!!om'ng
" r-v'�t
20�THo�h �.�ctoa� Fi�,.�place .r,m
7• ![� •+' 7;r i ^rr
r� a � E�F
POOL & SPA
APPROVALS Permit �
52. Pooi & Equipment Location
53. Steel Reinforternent
54. Forms _ _
55. Elrctritai 8ond�ng
56. Rough Plumbing & Pressure Teet
57. APPROVAL TO COVFR�GUN'TF
58 Electrical Corduit•Urdrg�nd.
59. Gas Pipe, '.� Undrgmd., ?est
� 60. Backwash Lines, P�Trap, � Undr���N.
67. APPROVAL TO [][CK
62. Bac:<t+ash & R��ceutor•Final
63. Hcater & VenFFinal
64. Plumbing Systam � Final
65. Etectricel•Finai
63. Solar Syttcm�F.oal
67. Fencing & Acccss Apprpvai
68. APPROVED FOR PLASTERING
69. POQLISPA SYSTEP:iS FINAI
FIRE DEPT. REQUIREMEIIT
..� �� ,..'' W F S, � i^ l� cTl
.J c'•'• • t'7"PRCrVk'CS:.�C:Per!tit �# � '��
Date Inspector
�:
:�
='�-y
o,
-��'1
oi
-1._;
�U I
21.�u�5,i'�rStrwctu�� �.... ,�� a � �y �.,, �: �0. U�Jde�9[�iUr�dJHXgro x I � I
-tr.-�i. _"� 1 =;«. .-z. aa-<�.x-+<�' +-+!�-e-7- � •
22� Du�s, Vanti.�tmFr�t i CJS: * �; T'� -�------i
t' l , �i hi. � -, n. ,- . `�'; ��1. Produc�'y�i�i9 i��'�.` s C��Oii � I
L___-!
23.';}i�S�ip��o�h Si��(est ; t�i'_: t C-7 C' �� Q Ct :��7. UndergS`��*,:4 Fl�y j k i�"-� 'i I �
_�.T�_.S�'��J r.,_�, � I
24.�Flo� F�min; �•- •F � :� c� t��3.� � ndcrgm!�'StorS�ji'Tank fJ Ga: � l3%�. � �'
ti � �
25. Ro`g,fi Sii�athing ' � �.; '. � n: �� N�a t � .. -�F� ,
: # �S � •a :J , P��C < 4.�Qverhead�'IYdroC ,� I
� r. -D
26:�T•@7T Ccding (Stn.�lural) &1*iH�rjCDat r �i p i�1v . 75.;Fllry Chemical 7 n-, ' ;•� � '.
y x a �-� � a �-_E•.:�_•
27 °�.�� aHe anli Flashir'�� �s r, a^.. � � s � 76. `Dry S!anc�icie �x .. S � � i-� �� - �
a • i F?,7� - -_x-.-�`s-r . _:R_�Cy_.�,..,� _ _�
�.�8.`Lai4nr.�Siding : .� �-;�,.. e� = • • ' 77.:fIXEO�'..�''P&TFP;J.�^�f�AL' �`" �
Cci ° - �,1�-1 'r.:� Mn *..�.t�•iAl,�
''79. Insvlati�i,il �-�jy `� � �� �� ', � �." � F .� 78.�IRE PREV. FIN,Q��. u �. ,r: �Jj� � �
U v � - �r']-y--___-_'Y -__-�
t�30. D.ywal'Nailing F+ � > �� NE?�LThM>EPT�R£Qy1RC1.'EEJT
�ty.ia�_t__ - -N.'� _.'_a.i �' - - riLti.i- - - ----�
G37. ?��ster ,.��-``.��i�.;ACwt� 5 i�nM j � °��9. 'FIP;AL Ifvj:.j.CT!.,f''L.� i G O' T F+�: -- �
07_'�-"_.•_-_-1_F=F- ' � .T -�-r7 -t'C7� -H-H�- -- - - -� - - - - '
;-32r.Gltctnc�7Po+iler h7ata+dFirali ; n� �� �i -�0.:500D CERTIf Ip�i� 155UE7 �^ i '
=�7 ":-r�-�.�- ` • '-: ^7- _ -:J " , _�-t. - =_1_- �-
� .�3.;�in.?a El�ctriy ws :7 i S Q�T �i�j�y�+ i`hlotu� ��7 �rj k�. �� n � I
. _ .,
p��, .� .^., rlii:l : .l NF+-�T. .1 i - T.S--'41("�-'r-__ _-�___� _-_1
4� �.ny.+ HZat�ng.& �'1t�qCo�p�t�p�n+$ �^1 r � 'Gr Y •^ .•U ..� f�m r ; C� 1�
... �•��K�..�__-•m 1-- '( .. [l L_--�,�� • __...�_-----�
35.�`Firi6: Gas Pi�.n-Test� ,�'y `� r � ,^r,... :.�T� •r,.5 t;n ��
#'-+ .f . � , O C7ti t V(+i.•th'
7-r%t" ��- a' - s 1 r � `i -.-'_••'1_fi_irl_' .� � � -- _ ___ .
y36. Hopd or`'CanoPY � 7 � � �rti a t : � ' � : <: r �:� { cr �,
,. ... ;� � .- , ...m� • � = =� : nt �SCi:1�L7----- -'
�37.`.fin5? F3�tory F�reR?ai2.,, i E F c� i�� � � ��� 4' 1: } oo:.��n ;
t-',: > : i .... - ' . _ -m-r---- �------ I
�.38. Fin�j PIF:�nbi�g t iv � -• + � I x� - r-i s¢�
�' l�* LC 7
��9. Ll'a�r $�vic6�Finala � s' • a , , •-�+�'S n �
n fi s � x- R•�• .� • mc*� �
:,;40. Gas Serwce�F�nal � .;; �;..,.�, :' i � � � � _ �-�-T- S�t�- ,,
-: :. � C,�= �vn� .
^: . � ..-. ^S C -�
�iit. Solar D�fiesiio-Fintil �': •• �F � w^� H y
1-t r. s �f (� �7-� C r;+; J
~42.`flackflo��jP�ov2nter# �� =�'� � - r; c�,,.�� ,. p �y �-
- ~--:.El-k �- ---�
�3. Backflo�:• Irr'��atio^k -:"S + ' a:H '' O . . .
. ;, K c.. , . � u � t �
�I4. Landscape I�ipatio.�SVsterrMn� i: i ;n � � '+r . .t+ �x :�- N �.z+�� . �
r' -___1
'�--i�----�-�•fia.�--eR- .. : ' =-:z r_ - s ' --
gA5 �und Atteiluatior9 .��"F-+ T . g `^ � �•• �'' � � " �'�' � 'F ^ �
� ;r , x '7 • f m R r'Ia l- i• U� •`, • i-�� �'!
�- � �� 1 + ,� . . ..� � � . -4�-:. _�___�
S6-iiandic�+,Regulatio�s ,., � .� y�m ��,, y -'-, - �
47.�ftWL STRGJCTUWE & BUItDiNG ; F ir y ���_- s-� [-» �
C I �n,r t ' t .. . � _'d-__-
'GB.�Ify�AL PLAIVNIN(y' � �--;- ? n� �- �i; -, �:; c .. F:
-U--a-- --a-�v-='i S s •L-
:1i9.aElecr,ric Relea:eto �dison i • •� T � � # '�
- .. .. Y� IRCP+A Gas Co � � � . Y `�'-E#-'-`'-x ` -� '`-cc''
i'a0..1�a:�Aelease to Sou ern Cali , , . . � .r� • -,Ri i ij • • •
1.CE�TIFICATEO O UPq�tCP : •' . � � ��'o `r. . (-�.-��rt�r.
Date
I
PXOJECTAOOHE55: 3S�IS HARBOR GATEWAY S
'�OWNEfl'SNAME: C,J SERGERSTROM
nooxess: 3555 HARBOR GATEWAY # G
C,M. 92626
AflCH/ENGINEEfl:
R�OflE55:
flEG.NO.:
UNIT:�
(0 3
IINIT:
PEHMITTEE: BLAKE AZR COND. 6 SERV. ( 719 ) 630-6912
aooxess: 1175 N, OSPREY CIRCLE
ANAHEIM CA 92807
LICENSED CONTBACTOP OECIAPRTION: I nereGy allirm inat I am Iicense0 untler vmvivons ai Cnao�er B(�ammencing with Section
7 � Div.sion 3 ot �Ile Business anE Pmlession5 COEe, and my license is in tull forte and ettec�.
�� .: 026026 sTnreuc.:396109 cuss �-20
IOa� Signalure:
OPNEBS' COMPENSATION OECLANA710N: I nereby aifirm that I have a cehificate ot consenl to sel4insure or a cenificale of Workers'
Comoensation Insurance. or a cenilied copy ihereol ISection 3800, Lao. C�.
roucrno.: PWC242269-00 EXP.DRTE: O%/OI/9'i
comrar+r: GOLDEN EAGLE
ified capy is �ereUy fumis�eG. � Ceriifiea coDY � ��IeO vrith t�e city BuilOinp Division.
�Oa ApDlicanC
EMPTION FBOM WOPREflS' COMPENSATION OECUNATION: (T�is seclion neetl not be camDle�eU il�he
Ip¢riity Ihal in IM1e pedormanre ol �he work �or w�iCh �his p¢rmit is issuetl. I shall no� em0 Y 0'
subjec� to Ihe Workers' ComOensation Laws ol Calibmia.
Oaie�. Siqnamre:
NOTICE:II, afler makinq ihis aeclaralion, you shoulJ �ecome subjecit o Com
Cotle. you mu51 latl�wil� mmply wilh SUth pmvisions a� Ihis p¢rmil 5h � � rev04
CONSTflUCTION LENUING FGENCY: I hereUy aliirm I�at Ihere is a conslmctio agency
which Ihis permit is issued (Seclion 3097, Civ. C).
LENOEX: �
nooness:
OWNEX 6UILDEB OECLABRTION: 1 nereU auirm tnat I am exemo� �mm th C tr t �aA L aw for the ��on
Y
�Sectian 7031.5 Business an0 Prolessional Coa¢; Any city o� counry which re ui s mi �onstm v¢, tlemalish, or
reDair any simcture, Drior lo its issuance, also requires ihe apDlicanl for such e to 1il ' ement ihat he/sne is Iicense0
pursuam to t�e pmvisions ol the Coniractors' Siate License Law (C�apter 91com - ection 7000) of Oivision 3 01 tAe Business
antl Pmlessions Code) or ihal he/5he is e�empt Iherelrom antl Ihe basis for �he allegea e�emD�ion. Any violaiion o� Sec�ion 7031.5 by
any applican�for a permil sublec�s ��e applicant lo a civil penalry ol no� more t�an �ive AunOreO tlollars ($500).
I, as owner al IAe O�oDe�Y or rtty emyloyees wit� waAes as iheir sole compensation, will Oo the woM1, and the
❑ stmcture is not intenGeO or olleietl fo� sale (Section 70C4, BuSineu an0 Pmfessional CaOe: 7he Contrattols' State License Law
does no1 apDly to an owner of a D�openy wta builtls arimproves ��ereon, and wM Uaes such work �imul�/herself orthroug�
his or her own emDloy¢eS. pmviAeO Iha� Suth imprwemen�5 are no� in�entle0 or OflereO far 5al¢. If, hawevef Ihe OUiltlinq or
imOwvement is saltl wi�hin one year al compl¢Iion. Ihe awn¢r vnll have lhe Ouraen 0� D�ahng he/she tliG nai Euiltl or improve
lor ine purpose ol salel.
I, as awner o� t�e pmDertY. am exclusively conVactinB wilh licenud contrac�ors lo conSlmci �he pmlect (Section 7044, Business
❑ an0 Prolessions CoUe: TAe Comracmrs' Slate license Law tloes not aOPly to an owner ol pmpeM �a bml0.s or improves thereon
and who conVaciS �or such D�ole��s with a coniractor�5�license Dursuanlio �Ae ConVac�ors S�ate LRense Law�.l am aware
t�al D�ool ol t�eir Worker's CompenSation insurance s�oula he OrOviEed to me.
� 1 am exempl un0ei Seciion: B. 8 P. C.
lar Ihis ieeson:
Daie: Ownec
I ao nereby cenily Inat I am aware ol antl untlerslana the reQuiremems ot Califomia Healtn and Salety CoOe Seqions 25505, 25533, and
25534 and Ihat I ar any Wlure ouileing acuoanl wiluwill not (crtcle one) neea to comvly vnih saiU state todes antl t�e requiremenis for a
permn br mnslmclion or motliliwtion imm Ihe Air Oua6ty ManaAament Oislrict. FeLEenlidl con5imction apDliwtions are exempt tmm
I�ese pmvisions.
Oaie: 0.pplitanl:
I here�y cetltly I�al I have read I�is ap0�italion ana Siate Ihal Ihe above inlarmalion is torrecl. I aAree lo comply wiih all ciry anA Counry
ortlinances an0 slale laws relating �o builAinp consimclion an0 nereby aWhorize represen�atives ol lhis city �o enter upon Ihe above-men[ione0
t�pytlY IOIIOSpCC1100 pUfpO5E5.
SignaWre:.
�icense o� Sociai Seadiy +:
16d1-46 While—Bmlding; Green—Code EnlorcemenC Canary—Appl¢anl; Pink—Revenue: Goltlenratl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 065951
PERMIT NO; M 065951 PLAN CHECK NO; N GOVT: N SUPP; N
CONSTRUCTION TYPE: S—FR PERMIT TYPE: MEC PUAPOSE; ALT
JOB DESCRIPTION : MECHANICAL £IXTURES SQ FT:
CLAIM VALUE: CALC—��ALUE: 'Q rnQ(,1!� G GROUP OCC: B-2 /
COMMENTS; ONLY MECAHNICAL WORK 1`�E�' y S v T
�r+r�r�c-�r�x-�ir�t��r��r�r��rx��r�x-�r�r�r�*�r�r�t*x-�r****x�r�rer*�t+t�t+t�t+r*�r�r*�r�*�t*�r+t��t�r��r*ar�r�r�r�r�t**�r�r.*��r�r�r�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PAOV; PARCEL: 41049101 ZNE; REF NO:
PLANNING N6TES>
>
iE if i! iE 1f ff if fE ff if 1E if 1f 1! 1E fE ff 1E 1E i! if 1E IE 1! �f k 1t if fE 7E iE 1f !f iE iE if iE iE iElf 1f 1E iE iFlE iE �f iE iE it if iElf 1E �f iElF if 1E 1f iE iF iE if iE iE 1tlE �f iE dE iF 1ElE ik if fE iE
D E V E L O P M E N T S E R V I C E 5 R E Q U I�F� E M E N T S
ING APPROVED BY - DATE;
UI DING APPROVED BY : /l DATE:
APPL CATION ISSUED HY: ( DATE: �
16iEiFif lfifif9Efflfif�EiFififiEiEiEifikik����iFi��3F����'F�3F�3F��'�7'f3Fir3F3f��Fif�lEifiFlhifif9fiFiF ltiE
iE��IF 1EitiEi4ifitiEiElEififiEiEikitiEiEiEiEiliPiEififiEiEiEifif%iEiEiEiFlFiEiPifiEifjE1(�ifkiFlfifiFifiEifitlRififiEiFiE1E9E3EiEfEifit jEiEjE 1fiEiEjF
"L�G IZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/RES GRADING
PERMIT 12.00
25t SMIP/NON—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 12.00 15.00 0.00 27,00 27.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT; ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CAECK
2%,��
ik if ih iE if it if 1f Hk ik 1k tE if if M� 1t if if iE if 1t if �f !f if iE i! if iElE 9E 1E ff if �k 1Elf i(� iE iE fE 1f 1k iE jE 1E 1E iE 1E �lE iM1 ik i! iE it !E jE if fF it iE 1h 1E iElE 1E if ik 1E iF iE iE iE fE if if 1E 1E iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
MEC 1
MEC 1
D E S C R I P T I O N
UNIT COST
REPAIR/ALT COOLING UNIT/SYS W/CNTLS + 9,00
GAS PIPING SYS 1— 4 OUTLETS b 3.00
END OF FEES �
♦n M�IWst� ._.,.������....
��A����
f�
� s
M� p �I
'b,�:� G`:v5:xs
,
`?) F �—���j�/.'.'i::�_:�' _
• --
s n �
�
:w�–a
// i � , �
/'�'
.� �,
TOTAL COST
9.00
3.00
01 Q0254975-00154975 T O T 27.00
DATE� 02/04/94 TIItE: 11:4E
� CONSTRUCTION AND PLANNtNG • POOL . ,PA
APPROVALS Permit# Date inspector APPROVALS Permit# Dace Irispector
1. TemPorary Electncal Service or Pole 52. Pool & Equipment Locarion
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. . 54. Porms
4. EleGtricai ConduirUndrgrnd. 55. E16cVical Bonding
5. S[eEl Reinforcement 56. Rough Plum6ing & Pressure Test
6. Electrical UFER Grnd_ 57. APPROVAL TO COVER�GUNITE
7. Foo��ngs 58. Electricai CondmrUndrgrnd.
8. Foundation 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, � U�drgrnd.
10, Sv�cturel Floor Svstem ���., rfr1...9?PROVAL TO DECK
11. Property Sewer �ine & House Connection � 62..6:rt:kbvash & Receptor�Final
12. Sewer Cap "" - �
. 63: Hea,ier & Vent�Final
t3. RoofDrains :.` �.4;'p}�b�ing5ystem-finaf
74. Rough Plumbing �� r��� �' 65.� Eleccricai-Final
15. Rough Electrical-Conduit ,-v:. - 66. Solar System-final
, n �
16. RoU9h Electric Wiring �`� '<�' -
j 67. Fencinq & Access ApProval
17. RoUgh Wiring Sign ""���C"'+•'i 68.rAPPROVED FOR PLASTERING
� �' 3'.'. r . � �
78. Rough Electrical•T Bar Ceiling ;.,�c. 4> `7�.;; ; s9j POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning '.'j,'��' f" FIRE DEPT. REQUIREMENT
4c�_ ' , �
20. Rou4h Factor Fire lace ��x�M�' `�,v �
Y P .-,�,.✓ A�PROVALS Permit #
21. Ducts, in Structure � . �"� ��0. Underyround Hydro .
22. Ducts, Ventilating 77. Product Piping OGas Li0i1 ;'�,
23. Gas PiPe�Rough & Test . 72. Underground Flush -
24. Roof Framing 73. Underymd. Stora9e Tank O Gas Q Oil � -1
25. Roof Sheathing ' 74. Overhead Hydro
26. T�Bdr Ceiiing (Structuraf} & Monocoat 75. Dry Chemical ...
27. Frame and Plashing . 76. Dry Standpipe . � �
28. �athing & Siding � 77. FIXED SYS7EM FINAL '
�� �
29. Insulation 78. FIRE PREV. FINAI "
30. Dry�vall Nailing HEALTH DEPT. REQUIREMENT ' •
31. Plaster Brown Coat 79. PINAL INSPECTION
3Z. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED _ ,,
� -
33. Fine� Eiectric Notes: ,
34. Final Heating & Air Conditioning �
35. Final Gas Pipe�Test ��
36. Hood or Canopy ' .
37. Final Factory Fireplace
38. Final Plumbing
39. Wattr Service-Finai
40. Gas Service-Pinal
41. Solar pomestirFinal _,� �
•,i
42, Backtlow Preventer
�i :.
43. Backflow Irrigation ' �
44. Landscape Irrigation Sysiem � '
45. Sound Attenuaiion � � ��
46. Handicap Regulations � �
47, FINAL STFUCTURE & BW LDING � �
48. FINAL PLANNING "' ��'.
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY '`'
No. Date
�I
I�
.00p�sso�B�o: 3545 HARBOR BL uNT:
ox*+�n'ar+�EiF�u�o^'r+:C.J. SEGEASTROM & SONS FLOOD: AH-37
��pE�3315 FAIRVIEW RD
•` COSTA MESA
A '32626 . (714)546-0110
wv�. �,vuxc �ooness:
uc. xo.:
AIMH.OP ElM.'S.IDDXE55:
urn:
c«rtn�crarsru�:GEORGE LINE CONSTRUCTION ( 714 ) 968-0703
c«+m�cmxs�uiwa19552 WESTWINDS LN
�no�ssHUNTINGTON HEACH CA ucwo.: 615352
92646 urn:
ucviseo cornnncrons oecun�noN: i ne� en.m wa. w�.�v a o«i�r mm i� ir.�a �m« now.w�. a cnaq« e
(mmme�fq wnh SMion ]0001 d Oiwion a d IM Businms levebn aM Y licmns o in Iu0 brce eM ellea.
cmuc.r+o.p577gg uc.cuss:g uc.No.:6 2 EXP: 00/00
o,�,. s— t�� — 9� �o�„
OWNEN BUILDEfl DECUNATION: I he�eby dfimi u�Mx penely d perj,ry ihet � n eammpl hom iM CoMretlas Lkaus Law ta Me
Idbv.+q ieavm (5adion'lro1.5 Bwiroas enE Prdeas'au Cotle: AMW a caunb whidi �W��b a Wrtnu b mumcl. etls.'vnVave.
damd'eh. a repv ary evupive: p'v m u eweMe, ebo �eqwm tM eppGram la arli pemm to fJe e eqneE etmemem tlW he a sM
'. fvvW pumant �o �Ae pwvom d tlr Canretlas License lew jChaqx 9(cammancnp r.'vA Seaion ]OW) d Di+eion � d ihe
�smsa eM Prdeviom Coaal or ihu M a ehe u exemq thadmn end iM beau fa the eYaO� mmmNion. Mf'vialmion d Seeion
,I�t.5 b/ eny epWiuni la a pemN euEjafe ihe epplceN to a dvY penelry d nal mae ihen fxe hundred do0en �SSW�).
� I. ea owmr d Ihe popenY or my empbyeee wih weges av �Iwi ede oompenulion. will do Ihs xwk. eM Ihe n�ucturo u nd inteiMeE
a dtered Iw aela (Seclion ]paJ. Butlm�s eM Prolesswna Cada: TM Comreewa Limnsa lnwdoee not eppyto en oxnerd peopeery
wM10 buiEs a inD�'N �herean. ane wlw doae suM wwk Nmeell or Iwne� a Mraph he w tror own emplvpee, pmvkeE thm wch
imqwemmla are m� imandeE a Wemd la eeb. tt. however.Ihe Witliip w'vnpwemeN b voN wilhin wn Y� b�Dlnion. Ne
owrerbuilder will Mw �M buedmi d poviep ha or ahe dk M builE or impova lor iM WNae W aele�.
❑ �. u mme, w �he omoero..m ..tlueH.ry oonireane wGn �imneae eanrei.,w. m cmmua ine eAl.a (seaion>a.. an'uicv ene
Prdes+'via Code: The Gantemde Lkeme lew tloea iM eVWY w en owrcr d pW�Y rAw builtls a"unVp+o �heson entl who
mnvacn iv aW� prqwa wiN e caurwor(e) Icamed Wnuenl to iM CaMretlan Limnae Lawl.
� I em ssemp uMer SMion�. 8. d P.C.. M ihia �eemn:
Dma: ��
I Ao hereby eanJy Ual I em awue d end uMsaieM tha �ap�ieanam d Callomia NaeM enA Selery COEs Setliam 25505. 2555'i. erd
255J1. enE Ne� I n em' haun ddkm0 �^�. �•iA / v.il'wl (e�cb aro) �weE lo candY w�M1 eaid qms mdee enE �M m�uimmenb br
e G�e frcomtWe�on a mod'dmionhvmlMAr�enpemem Oipntl. Rsfksviel emLiutlon eGG�bmaee nimmq hwn Nme
a�.
Dete: APW�eM:
WORKEH'S CONPENSATION DECLAfl�TION: I hereby effirtn unEer penel�y d parjury aro d �he lollowinp detleretone:
� I heve enE vril mantein e cand'sle d mneent io aeX-irouro br workers' compenealion, ev pmAded Iw by Saaion 3)00 d tha leEar
COEe.Ia IM1a pe�loimence d �M1e wk la wlich Ihis pa�mh u msued.
❑ � n.ve ena x�� meimen woika.• wmv�on ireuranro. m �.a��e M sedia, alao a m. t.wo. coee. la. ine ro�a� a in.
wuk la W�rli Nu Ve�^� e usueE. MY Wwtsn' mmV�+mion "vwrv�cs arier ud O�Y wmbr me:
c.m..:
va:y rmmn.:
hic senion rreeE irot be cu*defeJ / IM pmmR e Mr are hunCieC Edbrs /S1P0/ w bra.)
�] I unty Nm in iha pMormerce d tlw work br whch Ih' imil is e�ued, ppl m Iq eery peraon in eny menrwr eo av to
become wbjed b iM Mwkxs mnV^nution lexa Celtl«nie. eM roree i� i� oua become wbi� m �M waM1en'
<omo�+.��a, w�soos a sac� aioo a me �nor e. i.ndi .mn �pi ..n n oes m�+uom.
u�,: �- 2�} -il. �w -
Wam/np: F�N�n ro sxun rohwi rompxwtlon eovxap� Is unbwM, an /l WD/eef en wmploysr ro eNMml p�n�ltla eiM
c/vll flnu �q ro om huMrM flrouuM oalMn (SIOO,OOOA M eWltlon b fM ol romp�rwfbrt ��p� � P'o��� br In
S�cHon iIOK a/ tlro IwEor Corls. /ntwsif. �M etromsy's Iww
CONSTRUCTON LENDINO RGENCY: I Mieby elfirm under prWry d psjury Ihm Ihen u e canst�udion kMirq epanry tar tM
peAwmanm d tM r.wk lu Mutl� �hu pemii u uweC (5eaun �OB]. Ci. C).
LENOEF'S NRME:
�plOEP'S ADDNE55:
I cenM �� I heve reeE tho epplicelian erd paie iMt Ne ebo+a iNamelion u oortM. I epree to comply wnh ell ay xM couMy adiiwicec
eM etete lewa relelinp Io buiMinO ��upion W hmeby euUwua mpreeenieiivee d ihia dly io emar upon ihs ebove�meniioneE poperry
loriropedion putposas.
�— ��EORGE LINE
(5151J6 WP)
om.: Ci" Z�: `
Whne-Buikip 8 SdetY: OraeirFb: Cenery-Appirant: Rnk-Revenue: OONenm6-bs�aor
CITY OF COSTA MESA - BUILDING PEAMIT
PERM NO: IH 077816
PERMIT NO: IB 077816 PLAN CHECK NO: N GOVT; N SUPP; Y
CONSTRUCTION TYPE: 3-N SP PERMIT TYPE: OTH STR PURPOSE: OTH
JOB DESCRIPTION : LINALIZE EXPIRED PERMIT #H56907 SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: B /
COMMENTS: THE "EMULEX CORP." TENANT IMPROVEMENT EXPIRED PERMIT
�****�***��x����*x **x **�rx�**�r�r*x �*x��*x ��x�*x ***� x�*��x�****�r�r**+��rx *�rx�***�r*�x�*��rx x **�
Z O N I N G R E Q U Z R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 91507108 ZNE: REF NO:
PLANNING NCSTES> � :
i
14 iF 1E iE iF if iE iE iF 7E IE iE 1E 14lf'IE iE iE 1E'IE fE iE iE IE fE 1E 1E iE iE iF 1E 1E fE if ik 1E 1E 1E IE iF 1f 1F 1f 1f iE 1E 1E 3E iE 1F 1E k i41E 1E 1E 1E iI-1(-!E IE if 1E 1E iF 1E 1ElE if iF iE fE iE iE 1E'k 1E iE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T�S
ZONING APPROVED BY . DATE:
BUILDING APPROVED BY : DATE: �
APPLICATION ISSUED BY: �- DATE: �
1ki4iElk k1E1E1h1EiE1flElEififiklkiElElfiEiEiFiFi�iFiFiFiF�iFiF3FiF3FTF�F�F�f3FiFifTF 7F3FiFifiF3Fif3F3F7F7F3FiFif�E1E1E1ElEiE1ElE aEiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL�SEGMENT:Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 42,00
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 42.00 0.00 0.00 42.00 42.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 42.00 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
42.00
QTY
INS 1
1k �E 1E iE iE'IE'IE 1E iE 1E 1F �E 1E �E fE iE 1E IE IE IE 1E 1E 1E iE if if� i! ik iE 1E IElE 1F fE iE If 1E 1E iE 1E iElE iE iE 1E iE 1E �IE iF iE iE iE 1E 1E IE 1E if 3E iF 1E 1F dF 1f
I N D I V I D U A L F E E B R E A K D O W N
D E S C R I P T I O N UNIT COST TOTAL COST
BUILDING RE-INSPECTION FEE 42.00 42,00
END OF FEES
� ' ; i � _ , .. . . _ . .
. -- •
CONSTRUCTION AND PLANNING POOI A
AP7ROVA4S Permit # Date Inspector pppROVALS Permit # Date Inspector
7, Temporary Eiectrical Service or Pole 52. Pool & Equipment Location •
.` _
2. Soih Pipe�Undrgrnd. _ - 53. Steel qeinforcement '
3., Elecuical Conduit�Ut'tlity-UndYgrQd. 54. Porms �� - �
4�Electrical Conduil•Undrgrnd. '� 55. Electrical Bonding � '
5. Steel Reinforcement 56. Rough Plum6ing & Pressure Test '
��6. �Electricai UFEfi-�Grnd. 57. APPROVAI TO COVER-GUNITE
�� �-9,' Footings � - 58. Electrical Conduit�Undrgrnd.
g, Foundation �'- . 59. Gas Pipe, O Undrgrnd.; 7est •
9. Water Pipe�Undr,gind. `_ � ' , y 60. 8ackwash Lines, P-Trap, CI Undrgmd.
- _.:; � - '� t ,
10. Stcuctural FloorSYstem � . I ` 61. APPROVAL TO DECK .
�-
11. Property Sewer Line & House Con iRction 62. Backwash & Receptor-F.inal �� �
� '
12. Sewer CaP �- . .� �
63. Heater & Vent-Final
Y3. Roof Drains � 64. Plumbinc� System - Final '
74. Rough Plumbinc�' , � � 65. Electrical�Final
75. Rough Electrical-Conduit 66. Solar System-Final �
1'6. Rough Electric LViririg 67. Fencing & Access Approval __
17. Rough Wiring Si§n ; 68. APPROVED FOR PIASTERING
18. Rou9h E�ectricahT Bar Ceiling - 69. POOUSPA SYSTEMS FINAL
tg, ftougA Heating & Air Conditioning . � - . FtRE OfiPT: REQUIREMEIVT -
- - - - _ _-c: .• '. '
20. Rough FActory' FiFgplace ' � ` - � ' ;APPflOVA!$ �"� Permit # � '
) Y_ '- Y' 1� �J-
21. Duc[s>in�StNcture_;, � � _ , � � � ��.70.:UndergroundHVdro
22. Duct"s, Ventilating" ' '� • -`� 71. Product Piping O.Gas ❑Oil
23. Gas Fipe�Rough & Test rr - ". 72. Underground Flush� . �
24. Roof framing � '' ' 'rr � -`. 73.: Undergrr��l.StoFa�Sank dGas �Oif
O�r
25. RoofSheathing ° ' � �' 1 " ; '
:y;, in, 74:�Overhead Hydro� �
26. T-Bar Ceiling (Structvrall & Modocoat "' � ` �_ � 75;'pry Cherpicai .'- '
Z7, Frame and Flashing "� 76. Dry Stan�pipe r� . �
_ 28. Lathing &,Siding +� . - _ y h � ' 77; FIXED SY�9T�M FINAL �' � -
29. tnsulation - �a .: �� - _.
�; •- � p 7� FIRE PREV. FI.NAL
3p, Drywall Nailing - '� - ' � �'� �; �HEALTH DEPT.rREQUIREMENT
-. 31. Plaster 8towrt�l)oaf,; _ ;, �' � ` 79. FINAL 1,4USQECTION •- .. ,;
^' 32. Electrical:PoWer RAecer�Final r� � �� 80' POOD CERTIF"ICATE ISSUEQ� �
r
...� ..� �, . - -
' 33. Fina! Electric� -' .. _ � . , Notes: q „ . � -
� 34. Fina�Heating$ A�r Conditionin'g � ;-t a ' '. - �
� �� -
35. Final Gas Pipe•Test� F � � � "� '-� ' " '� , �' �� �` , "
�r m � -
36. Hood or Canopy r - - - .. � � �,+ �r . � ^ �
37. Finai'Factory Firepiace �� ' - . ;, - �. � - ,�, "
38. Pinal�Plumbing � - � � � � 'z� '
39. Water Service�Final � � ' ' ' �' - �
� F. . r
� � 40. Gas Service-Final -� �� ° _ - � , ' � a
41. Solar pomestioFinat ^' � � ` '
�.
42. Backflow Preyanter-:, , - _ �� �- . ;.; r.:� -
.
43. Backfiow Irriqation��- � � � t * �' n� ' - �
� < ,
44. Landscape Irrigation�5ystem = : ' . � � ;, = 4 � ._ � •- � " -
.�. �
45. Sound Attenuation * _ " ' ?. r ' ' . ' „�
46. Handicap�Regulation's . � . n ., ±.
47. FINAL STfiUCTURE & BUILDING 6 � � � � .. �
tY
48. FINALPLANNING, ._ �. •
4g, E�ectrie Release to Edison �* '' ' `
, - �'
50. Gas Release to Southern Cali}or'nia_Gas Co ,; �s `• - .' "
51. CERT{FICATE OF OCCUPANCY
No. Oate
�
�'
1 �
`� onEss: 3595 HARBOR BL uxir:
� wNensName: C.J. SEGERSTROM 6 SONS
nooRrss: 3315 FAIRVIEW RD
• COSTA MESA
CA 92G26
(714)596-0110
FflCH/ENGINEEfl: S PAC E, T NC , nec.xo.: NON E
�ooness: 1017 S, HATHAWAY uxiT:
SANTA ANA CA 92705
PENMITTEE: VS CONSTRUCTION ( 714 ) 668-9100
noonEss: 2701 S, SUSAN
SANTA ANA CA 92704
ULENSED CONTflRCTOB OECUBATION: I hereGy allirm t�at I am licensetl untler provisions o� C�apter 9(cammencing wi�� Section
7000) oi Oivision 3 ot IAe Busineu antl Pwfessions Cotle, anG my license is in lull lorce and ett¢tt.
CITY UC.: 0 4 0 7 4 STpTE LIC.: 3 6 3 2 S S CUSS: �
Oate: 5�9nature: _
WONKEPS' LOMPENSR710N OECIAHFTION: I here�y ailirm t�at I �ave a certi te of consem ro II-insure or a certilicale of Workers'
'mDensa�ion c }ce e0 CODY �h¢reol (SetliOn 3800. LaE.
iLICY NO.: ��� ��] � 1 E%P. ORTE: 5� O S� 9 2
camrnxr: STATE FUND
I❑ Ceni6e0 cooY is heceby Wmishe0. � CenifieA copy is IileU vnlh ihe ciry Builain0 Di ' on.
.aie: P7Dlicant: �(��� �
E%EMPf10N FBO WOBNEBS' fAMPFNSOTION OECIAPRTION: (This section neeA IA1 be camplete0 il ihe mit B lor we hunOreE (5100) w Nss�.
I ceniiy �ha� in Ine pedormance o� t�e xrork for which I�iS permit is issue0, I shall no� employ any person in any manner so as l0 6ecome
Suble�� �o the Workers' Compen5alion Laws o� Cali�omia.
Dale: Sipnature:
NUTICE: II. alter making inis tleclaration. you s�oulE Decome subject to the Workers' fAmDensation D�ovisions of t�e la0or
Cotle. you mus� fon�wit� compry with such pmvisions or I�is Oermit shall he deeme0 revake0.
CONSTNUCTION LENOING RGENCY: I hereby a�lirm I�ai I�ere i5 a cOnSVUtlion lentlinp agenty br Ihe Oe�Ormante oi lhe work fof
wnich ihis permi� is issueA �Seclion 3097. Civ. C�.
LENOEX:
aooness:
OWNEB BUIL�EP OECLABRTION: I �ereby allirm t�at 1 am exemD� �mm ihe Contractors' State License Law for the Ioilowing reason
(Section 703t.5 Business anU Professional Code: Any city ol county which requires a permit ta canstNct, alter. improve, tlemolisn, or
repai� any simcture. prior lo ils issuance. also re0uire5 Ihe applicant lar such permil �o lile a signetl 5taiement Ihai helshe is licensed
pursuam m the Omvisions ol lhe Comracmrs' Stale License Law (C�apter 9(commencing wilh Seclion 7000) ot Division 3 of t�e Business
an0 ProleSsionS COAe) or �hal he/She is exempl thereimm ana Ihe Ea5i5 lof Ihe allepetl eM¢mpiioa My vi0laiion Oi Set�ion 7031.5 by
any applicantlor a permii suble��s �he applicanl Io a civil penalry ol no� more �han �ive hundred Aollare (5500�.
�
I
0
❑�
I, as owner of Ihe pmpeny or my employees with wages as iheir sole compensation, will do ihe work, antl the
stmcwre is not intentleG ar ollered for sale (Secuon 7044. Business antl Pmlessional Code: The Contractors' State License Law
tloes not aDPty to an owner ol a OmOany who Gudas or improves ihereon, antl w�o tloes such wark himself/Aereeii ar iNough
his or her own emDloyees, provitletl that such imDmvemenls are nol intentlea ar atteretl for sale. If, twwever the builAinA or
impmvement is salU vnthin one year ol comple�ion. iAe owner will Aave tAe Aurden oi provinA he/sne tlie not euiltl or impmve
for ihe ouroose ol sale).
I, as owner ol Ihe pmpeny, am exclusively conVactinp wi�h licensetl contraciors m conslmci tAe pmlec� (Sectian 7044. Business
and Pmfeuions CoOe: The Contracmrs' Sta�e License Law Oces not appry to an mmer ol Dmperry who UuilOs or imprwes Ihereon
anA w�a ConVatlS �or SUch projetls wiih a conimttof�s� litense DursUan�lo lh¢ ConVaciors' Slaie License Law�. I am aware
�Aat pmoi al ��eir Worker'S Com0en5aiian in5uran[e 5hou10 be D�oviOetl �o me.
I am exempt unUer Sedion: B. d P. C.
lor IhiS reasan:
oale: Ownec
I Oa nereoy cenify tlidt I am awdre ol ana unaerstana the requiremen6 0l Calilomia Healih ana $afety Cotle Stttqns 25505, 25533, an0
25534 and Ihat I or any �uWre buileing occu0anl will/will not (circle one� neea lo comply wilh 5ai0 s�ale co0e5 anU Ihe r¢Quir¢ments tor a
permii for consimcli0n or mo0ilicalion Irom �he Air Ouality Managemenl Uisiricl. F¢SiGenildl fAnSlmciion apDliGliWls are eaempi Imm
ihese provisions. �
Oale: ApplicanL
I hereGy cenity ihat I nave reaa inis aoDlicalion ana slate ihal tAe a�ove intormation is correct. I agree to comvN ��� atl city antl counry
orainantes antl Slaie laws r¢W�inq lo buibing COnSimtlion an0 here�y authOr¢e reDreS¢nla�ives a� �N5 a�y �o ¢n(er upOn Ilie a�Ove�mentiOneG
pmperty lo� insp¢cli n purposes. �/�JJJ
Oa1e: Signawre: .����e-+r.a.-----
i�Oriver's License or Sac�ai Securiiy x: v
I6aL46 WM1ite—Builaing; Greun—COEe Enlorcemanl; Canary—NpPlican�; Pink—Ravenue; GOIEenroC—Assessor
CITY OF COSTA MESA — BUZLDING PERMIT
PERMIT NO: B 056907 PLAN CHECK NO: 04257-91 L
CONSTRUCTION TYPE; 3—N SP PERMIT TYPE: STR
JOB DESCRIPTION : 28909 SQ FT COMMERCIAL OFFICE T.I
CLAIM VALUE;
PERM NO: H 05690i
GOVT; N SUPP; N
PURPOSE: ALT
SQ FT: 86,727
CALC—VALUE; 342,860,79 GROUP OCC: B-2 /
COMMENTS: THE "EMULEX CORP." TENANT IMPROVEMENT
+��r��*�r�**�r�*�r*�r*�*+r**��r�r�**�*****����r*�r�r��****��***�r**���r+��r**�******�r***��***�c*
Z U N I N G R E Q U I R E M E N T S
5 E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT ZN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REp• PROV; PARCEL; 41507108 ZNE: PDI REF NO;
PLANNING Nt3'I'ES� PROPOSED 2E1,909 SQ,FT, T.I, TO EXISTING OFFICE BLDG,
iF * IF iE �t if If IE iE aE iF i! iE iE i! 1E jF If iF iF �k iF iE iE i(� 3F iE iE if iE iE if if if iE3E if iE ik i(� 1E jE iE iE iE iE iF iE iE fE if iE iF �t it 1Ei! iF iE if 1E 1ElF * iE IF �lf if �E iF iE iF ic iE *# iE 1E #
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S
7.ONING APPROVED BY ;�A—. E, DATE; 2,,
HDILDING APPROVED HY ; p S DATE�e %� 2
APPLICATION ISSUED BY• DATE; �G /
iFiFiEifiElEMik�FiElfiEiEiEiFik1E�E1FiF1t1E 'R�'�F"�{FiEiEiFitif�iE1ElEifik . iEiE
iF�EiFiFlFiEiE3flt1fiE3EiFiEifiFiFiEiFiEiFiEiEiEifiFlE�EfFiEiEaEiflElkilaf iEaE 3fiEiEjEiFiFiffEiEifiE)EifiEi(jklEiEifiF�FitiE3FifiFififfElEiE�fFiEiF1EiF�f
LEGALIZATION;Y F E E S U M,�M A,R X,� ,t STRUCTURAL,,.�SEGMENT;Y
� 1 ' 4:! s; • i.' "'' ' '�� rG /+
Hi,DG PMT PLUMBING ELEC'tR�IC v�A!ECHA�IQ.` �`�I�E % SMIP/RES,� GRADSNG
PEkMIT 2,980.OU ,[ •�
� �% �f �_'' ;� . �.' SMI'P/NUNLLRES
PLAN 1,937.00 -� K , �.72�,00:
I55UE FEE �" � � `-: : '�r �'�-• r'. /•
HUILDING—DIV—> PERMIT ISSUE PLAN=CHECK -TOTAL ; � !
TOTALS----> 3052, 00 0, 00 ;968, 50 ! 4020', 50 ���,' �4020A50 D00
I f il
REVENUE DIVISION TOTALS--> COLLECTED:1',� 305R,. q,O.�OVER%SHORT;�� �, 00
BLDG PMT PLUMBING ELECTRIC MECHANIC�� F�RE�� Sf�IP/�OT- GRADING PI,AN—CHECK
2980.00 ', , ;�. �� � ,� �72'.00 %�
r
*�r�***�r**�r+r**+��**�***�*�***�**+t**�e*f**�+r�t*�****Q'��****�t*��t�u+t�x�**�'*�.x!*��*�+�**��x+�
I N D I V I D U A�I,- F E•iE �• Rr•Ei A�kC D' O/W N�. `i �"�
TYPE QTY D E S C R I P T I O N � `-� i� ; UNIT COST �, !�i'OTAL COST'
V�
SFC 28909 OFF—INT, ALTER TYPB III—N 'AVER �� IQ�,92 � 315 686.28
SFC 28909 EQU—ALT COMM, SPRINKL'ER SYS •�;�.VERi� �y"• � 30 i' ^.. 8� 672, 70
SFC 28909 EQU—ALT COMM, AIR COND, `���,.AVER� �_ ";64 "' �„i18,501.76
END.OF FEES !, ', •
E X P I R E D ; <,� �� . _ '; : '• ��' �/ .� �
I compiete InspecGons � - ' - " , � ' '
/ ` '�' � • '' � / �;
�ate � � Sl� : .,, ,�/., , � . . `
_ .�
'i� l�'' _N i
.��:' a� .
'. r
�
CONSTRUCTION AND PLANNI�
APPROVALS Permit,#
i. Temporary Elecirical Service oF Pole
2.� Soil PiPe-Undrqmtl. ' ,
3. Electrical Conduit Utfiity-Undrgmd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electricel UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe-Undrgrnd.
10. Structural Ftoor System .
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Dreins
14, Rough Plumbing
15. Rough Electricai-Conduit
i6. RoughElectritWiring
17. Rough Wiring Sign
18. Rough EVectriwV•T 8ar Ceiling
19. Rough Heating & Air.Conditioning
20. Rough Factory Fireplace �
21. Ducts,in Struct�re
22. Dutts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing . '
26. T�Bar Ceiling (Structurall & Monocoat
27. Frame and Flashing
28. �athing & Siding .
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electriwl Power Meter-Final
33. Final Elec:ric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test '
36. Hood or Canopy
37. Final Factory Firepiace '
38. Final Plum6ing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final -
42. Backflow Preventer '
43. Backflow Irrigation
44. Landtcape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUtLDiNG i
48. FINALPL'FINNING
49. Electric Release to Edison
S
50. Gas Re�ease to�5outhem California Gas Co
No. Date
Date
f
JlL A
Inspector APPflOVALS Permit#
52. Pooi & Equipment Location ,
53. Steel Reinforcement
54. Forms
55. Electriwl Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrgmd.
. 61. APPROVAL TO DECK
62. Backwash & Recepior�Final
� 63. Heater & Vent•Final
64. Plumbing System � Final
65. Electricai-Final
66. Solar System-Final
67. Fe�cing & Access ApProval
68. APPROVED FOR PLASTERING
69. POOUSPASYSTEMSFINAL
FIRE DEPT. pEQUIREMENT
APPROVAIS Permit #
70. Undergiound Hydro
71. Product Piping O Gas O Od
72. Underground Flush
'/3. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Sta�dpipe -
77. FIXED SYSTEM FINAL
", , 78. F�RE PREV. FINAL
� HEALTH DEPT. REQUIREMENT
'� � 79. FINAL INSPECTION
i-
-- � 80. FOOD CERTIFICATE ISSUED
' Notes:_ J_:z n,,... _ G/ /� .
ri�
�� I:�
��
��-
!! Lc • s,� i
. s��/ �?l P
�✓��
Date � Inspector
�
::
�
��
.\
�
�
PXOJECT p00flES5: � S 4` :iARH UR B'
OWNEfl'S NAME: C. _ ,�.– ..
AOONFSS: � •:�GVL. jl��:'�. �. G�:ls
. 3^.:� �a,av��.�: a�
=C�:'n XESA
CA 9�626
�` !7^_4)S�i6-01:0
AflCHIENGINEEfl: BEG.NO.:
AOONESS:
uNiT:
UNIT:
PEXMITTEE:Pi2Zi'Q:.'.:i.SCr A.� J�YJr.�:.Jr �%.4)53=-3030
aoosess: i O 7 E 1 ? 3ACO�i AV
GAR'�Eti GROV� CA 926�i 3
LICENSEO CONTBACTOB DECIAFll.T10N: I �ereCy affum iha� I am licensea un0er Dmvisions al C�apter 9(cOmmencing with Sec�ion
7000� ai Division 3 0l I�e Business antl Pmlessions CoOe, and my license is in lutl �arce an0 eBeci.
cirruc.:�>1528 s,nTeuc.:568056 c s =_70
oate: S� Z f-�%S Signa�ure: _ __ _
WOBKEflS' COMPENSATION OECIABATION: I �ere�y aflirm Ihat 1 have a cerli�icate ot consenl to sell-insure or a ceriifica�e of Workers'
Compensa�ion Insurance. or a cenitiea copY Ihereol (Sectian 3800. Lab. C).
POLILVNO.:""9:892-93 E%P.OpTE:O`4IO�/94
LOMPpNY:S : ATE
'0 Cenilie0 copy is Aere��is�etl. ❑ CenifieA copy is fi@G vrith the ciry il0i����
date: �i� 2.�j" nppiicanc s —
E%EMPfION fHOM WUBREN$' COMFENSATION OECIAMTION: (iAis seclian n¢eU iw� be wmpleteJ il �he perm� a lor ane huntlreE (5100) ar less�.
I certify ��at in Ine periormanre oi Ihe work br w�ich ihis permit is i55ueE, I s�all nol employ any person in any manner so as �o Oecome
su�lett lo I�e Workers' ComOensation Laws of Calitomia.
Daie: S Signamre:
NOTICE: II, alier making Ihis Oeclara�ion. you shoultl b¢com¢ suhleci �o Ihe Workers' Compensa�ion D�ovisions oi �he La�or
CoOe. you mus� fOtlhvnlh compry with 5uth O�ovisions Or INS permii Shall De tleemeE r¢vakea.
CONSiflUCTION LENOING FGENCY: I hereDy allirm I�a� there is a can5lmciian IenOing aAency im ��e pedormance ol Ne work lor
which ihis Dermilis issue0 (Section 3097. Civ. C�.
LENOEfl:
aooeess:
OWNEB BUIlOEN OECIAPRtION: I �ere0y affirm that I am exem0� ��om ��e Contractors' S�ate License Law lor ��e following reason
(Seciion 7031.5 Business and Prolessionai Cade: Any cily af couniy which repuires a Detmi� lo conSVuti, alier, impmve, demolish, or
repair any 5lmtiu�e, O�ior IO it5 i55uance. al5o repUir¢5 Ihe appliWnl lor Sut� permi( to �ile a 5igneA S�a�emen� Iha� he/She is liC¢nsed
pursuam �o Ihe provisions ol Ihe Comracmrs' Slaie License Law �C�apt¢r 9(commencing wi�� Section 7000) o� Division 3 0l Ihe Business
antl Pmlessions Cotle) or I�al Oe/she is e�emp� Ihere�mm anA the bas¢ �or Ihe allegetl exempiion. Any violation ol Section 7031.5 by
any applicanlior a permil suhlecls Ihe applicanl to a civil penai�y ol nol more IAan five hunOreO tlollars �E500�.
l as owner of i�e DmDeny or my employees with wages as t�eir sole comDensation, vnll tlo t�a woM, and t�e
❑ stmcmre is not intendea ar ofleretl lor ule ISection 70aa. Business an0 Pmlessional CaUe: The ConVactors' State License Law
Ooes not apDly to an owner ol a pm0eny who builas or impmves �hereon, an0 who Eoes suc� work �imseii/herself or ihwuA�
�is or �er own emD�oYees. pmviaed Ihal Suth improvements are nol inlentlea ar offeretl for sale. Ii, however ihe builtlinp or
impmvement is sola wit�in one year ol comple�ian, t�e awner vnll have t�e 6urAen ol O�oving �e/she did not bui10 or imD�ove
lor ihe puroose ol sale).
I. as owner ol Ihe O�operiy, am eeclusively coniracting wit0licensetl conVacbrs �o conSlmci Ihe Dmjec� (Sec�ion 7044, Business
❑ ana Proteuions CaOe: the Comracmrs' Siate License Law aoes not aDPN �o an ovmer ol propeny who UuilOs or imD�oves Ihereon
. an0 who coniratls lor sucn oroieds wilh a conlrattorlslliCense pursuantla Ihe Coniractors' State license Law�. I am aware
tha� O�oof ol ��eir Worker's Campensabon insurance ShoNE be pmvbe0 ta me.
I� I am eKempt under Sec�ion: B. 8 P. C.
lOr Ihis r¢ason:
�ate: �wnec
I Do �ere�y cenily I�al I am aware of an0 untlerstana Ine reQuiremenls of Calilornia Health ana Sa�ery Cade Sec�ions 25505, 25533, anU
25534 antl �ha� I or any fuWre builtling occupani wiIVwAI not (circle one� neetl Io comply with said slate coaes an4 ihe requiremen�5 for a
p¢rmil br constmc�ion or modilication irom I�e Air Oualily Manag¢meni Disincl. NeSiCenlial consimc�ion ap0lica�ions are exemp� Imm
IhQSC pf0Vi5i0n5.
Oale: NpplitanC
hereby cerury�hat I have read I�is aDDli<ation an0 siale�hatt�e aboveinformation is correcl. I agreeio comDly wilh all ci�y anA coun�y
Ordinancesantl5lalelawsr¢Wtinglo�uJamgtonSUUt�ionanAherebyaultqnzere0re5eni ivesol -scilytoenteruponihe e-mentianea
pmperty �or inspectian purpases.
oate: S Z�� 9j Signalure:
�rive�'s License or Social Securiiy u: �
t64L46 W�ite—Builo'mg�, Green—Cotle Enlorcemem: Canary—App6cant; Pink—Revenue: Goltlenmtl—Assessor
CITY Ot CGS:'A �1E.C,A - B:J::.DIItG ?E�:{�: :tR.': "0: :' ,^6=__"
PEk?'=. ?:0: :: CE23?6 ?'_,A�: CHECi: ti0: \ �•�V-. .. :.::�?: :.
CO?`S:°::C�=O?' ::'?E. 3-�: 5P PER::=. TYPc: ?:EC ?;:R?^�_. A:..
,:GB ,�ESCRI?.-�0\ : EY.IiA::S': HC�D G FA:v ALTERA:iO.� °Q F_.
C:,AZ:! VA;,;.`E: �A:.C-VAL'JE: GRG;1P CCC: B-2 /
COP�'."r:E2:T5• T$t "Ey;J'EX CORP." �:O STRUC�L`aAL PEP.a:I''' O�v F:LE FOR '"H'S P£R.`:."
iE 1f 7f ?R?f ±F?f # if if ?� #±c iF±F ?F a= i(�?f !c # if ?E iF iF iF #�iE iE?f M iE �1f ?E iE iF � jc 3F iF±f ?f 3< �## i: # if 3F it # i'r?F #?F �## ff� # t a:; ##..` M# Y�': ..' a�at t..:
Z 0„ � ti G R E O U" R E?' E:` . S
S E': B`A Cy:t S
------------ 'r:A�" Pu��DI:�:G ---------- ACC_S..CRY b••_-D�1G
---------
FRNi: t; IN REAR: FT IN FR*IT: F: �!d 'Z�AR�: FT----':;
„EFT, r � �\ RGY::. _ . IN LEFT. F: :U ,�GH':. . �.:d
PAT?I{ING RE¢� PROLT: PARCEL: 51507108 ZNE: REF ti0:
PLA.�:\ItiG nd:Es>
>
ic i?F iE 1i if i4 3E 1E if?E?� ?f iE } iE # iE iE iE?E # jf #�lE 4 ie?E iE?F jE ?E if'!-iE?f iE icdf 1F if iE ### iE ## iE ###?E ### IE }# iE iE iF iF if jF?F #### ii !E #?F -k ?E � iF'i.
D E CJ E L G P:� E ti i S E rZ �'iI = C � S R E O U� R E X E N, S
.J .
ZOtiING APPRuVED BY � DA�'E:
9UILDING APPROVED BY : �� DATE: ! ,,�
AP?i.ICA??O?] iSSliED EY: ' DA:=: ,� � ('"�_.
+� -----z- - �
ii'±Fi't'1f3fil�iEiei't'1fiFifiE};{f�'�FiEif.'1E3E'1Fil.TtiFif'hlt�XitlFit�+r3F,i`iFx'1t�t�Ftizi�.23.3T#,.�if'�#ifif#�1faY1':'.".-xRr:fihf:�t }..##
if iE 3f iF iE } if if if !E 9FlE iE+E jf if ic e� iF # Yc � iF # iE !E 3E iE # 1f #?f iF jf 3c IF �F?F+f if ?F # Y� �.' ## Y iE i� Y- i+ 3F �?f K iF ie iF # 3'� k it }' K iE f, #�k �E f: #: # fc # i"- ,: i� ic +'F
iEC•ALIZATiON:N F E E S U v:! A R Y STRJCTIIRAL SEG::Eti'::�:
Bi,DG P�!: PL'uN.BItiG EL'cC:RiC ;�IECAA:vIC FIRE S:!:P/RES G�2AP=?:�-
PERN:IT 6. 50
25T $�1F��:\��1—t�.t,s
PLAV
ISSJE FEE i5.G0
9li2:.DItiG-D�V-> PED.`�'..'' _T '.SSJE PLAN-CHECFt TOTAi PAI� .�;,'E
TOTAiS----> 6.50 15.G0 0,00 21.50 21.50 .00
REVEnuE U�i�ISIO\ TOTALS--> COLLECTEL: 2?.50 OVER/SHGRT: ,OC
Hi.DG PMT PiIIvBI\G E:.ECTR=C :�EIHANIC FIRE SXIP/:O:' G:2AD�tiG �:,A.ti-Ci?EC::
2�.5�
3f iE Y?F 3E } IF'IE }�!' {F if if ?F'Sf' # 3f iE iF iE # if iE 3f iE if jf jE if iE iE iE if if' iE if'1F iF'lf 3I' ii' �E rY�'IE �!' 1E # 3f if K if # if'JE #�''N"1f if ##'�E iS i!�?f #�# IF iE'R #)l• if if if ie?f 1f
I N D� V Z D U A L F E E B R c A X D O'.•I ;:
TYPE Q'Y U E S C R I P T I G N UNIT COST :OTAL �OS:
MEC 1 INST HOOD W/DUCTS FED BY N.EC £XHAliST 6,50 �,50
EDin O: FEBS )
/'
01 Q0139787-Qp134787 TQT 21,50
DATE: 05/25/93 TINE: 12:SE
CONSTRUCTION ANDPLANNING
APPROVALS Permit �`r -
1. Temporary Electncal Servic�or Pole
2. $oil Pipe-Undrgmd, � !
3. EleCric:,l �ondui[ UT.�ity•Undrgrrtd.
-=r-
4. Electrical Condwt�U�d�9rnd.
5. Stezl Rc�nforc�.nenc
G. Elec;rica� UFER Grnd.
7. Footings
8. FoundaUon �
/i
9. 4':�atur Pipe�Undrprnd. '
10. Slwet�rai Floor $YSter� � �
/y.
11. Property Selver Line & Hoa wnnection
�i�
12. Sewer Cap
r
`
�- � POOI . �A �_� . � ----
Date Inspector ppq VALS P '# Oate I Inspector
ti
�
�
13. Rooh Cr;.:ns '% �
14. Ro��h Plumo�ng � �-�-
(..
15. flough Electrical-Cortdwt% �
76. Rough Electric4Viring
77. Rough!^JiringSign
18. Roogh Electrical�T Bar CeiLr.g
19. Rough Neating & Air Condit�oning
20. Ro�4h Factory Fireplace
21. Dutts, in S+,ructura
22. Ducts, Venti�atmg
23. G�� ?ipa�Rough & `est
24. Roof Ftaming
25. Foot �F�athing
26. T�6<�r C�dmq (Structurall & ;.:or.ocpat
27. Fiame end Flasning
28. Lathing & Siding
29. InsWat on
30. Drywail Nading
37. Plaster Brown Coat
32. Electnc:,i Power Meter�Plnal
33. Findi Electnc
34. Final Hiat�ng � Air Conditioning �t
35. Final Gaz Pipe-Test '
36. Nood or Canopy
37. Fina� Factory Fireplace
38. Finai PlUmbing
39. Water Strvice-Final
40. Gas Service�Final
41. Solar Oomcstic•Fina�
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripacion System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
No. Date
�
A O ermn
52. Poot & Equipment Location
53. Stecl Reinforcament
54. Forms
55. Electricdl Bonding
56. Fouyh Plumbing & Pressuie Test
57. APPROVA� TO COVER�GUNiTE
58. Electrical Conduit�UndrgrnA.
59. Gas Pipe, O Undrgrnd., Test
t�--
' 60. Bacl;wash Lines, P�Trap, O Undrgrrd
6� i. APPROVAlTOOECK
62. BackLvash & ReceptorFinal
63. Heater & Vent-Final
64. Plumbing System � Final
65. Elucuical•Final
66. Soiar SVstem•Final !
_�
67. Fencing & Access APproval �
68. APPROVED FOR PLASTERIRG
69. POOL/SPASY$TEh7SFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit �
70. Underground Hydro
71. ProdutTP�Pin9C7Gas ❑Oil
72. Under�round Flush
73. Undergr�tl. Storage Tank � Gas � 01�
74. Ovenc�ad Nydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SVSTE�11 FINAL �
78. FIRE PREV. FINAI.
HEAITH DEPT. REQUIRE11Ef�T
79. FINAL INSP[CTION
80. FOOD CERTIFICATE ISSUED
Notes:
♦
""""""""' 3545 HARBOR BL
owxee•snnMe: C.J. SEGERSTROM & SONS
auoeF,ss: 3315 FAIRVIEW RD
COSTA MESA
CA 92626
AflCH/ENGINEEH: � 71 4� 54 6—Q 11 Q
SPACE INC,
aooness: 1017 � S . HATHAWAY
uNiT:
flEG.NO.:
NO�,
PENMIREE: SANTA ANA CA 92705
aoosess: VS CONSTRUCTION ( 714 ) 668-9100
2701 S. SUSAN
SANTA ANA CA,92704
ULENSEU LONTflRCiOfl UELUfl11TI0N: I here0y atlirm I�ai I am Iicense0 unGer Oravisions .ammencinp wit� Sttlion
70001 of Dir3ion 3 al ine Bu5'uleu ane PmIe55ions COtle, antl y litense is in full la¢e an eftect.
cm uc�� sfTere uc.: 3 6 3 2 S 5 cuss:
Oate: _ ` Sipnawre: _ - — _ - _ _ _
WONKEPS' OMPE �TION UELlA8RTI0N: I �ereGy a��irm I�at I �aue a cetlili[ale ol consent to selbinsure or a certi/icate al Workers'
Compensatbn Inwrance, or a cenilieE rApy IAereo� �Settion 3000, Lab. C�.
roucvxo.: 531885-92 E%P.DRTE: O6IO1
carnrexr: STATE FUN1Z
❑ Cendie0 py R Irere—�j� Certilie0 i5 filed wjlh �he Ciiy B Ob0 DiviSion.
ate: � Applican,
EIfEMifION FI10M W NNEXS' COMPENSATION OELLAMTION: (fhis sttWn metl rot Oe wmpleleA il fhe puml B Iw ane hpqretl �f1W) or kss).
I ceNly Nal in �he petlormante ol I�e woA lor w�itA I�is Oermii i5 i55ueG, I s�all no� emDlOy arry persan in any manner 5o as to Decome
suDjttt lo ine workeri COmpetrsation Laws ol Cdtilomia.
Date: SiqnaWrz:
NOTICE: It, atter makinp t�i5 Geclaraiion, you stwNA become subject Io ihe Work¢rs' ComDenSalion Dmvisions of IAe LaEor
CaGe. you must IanMntA compry wit� swli pravisians w llns permit shall be deemeE makeG.
CONSTPOCTION IENDING RGENCY: I hereby ailirm Itia� 0ere ¢ a can5irtction IenOinq apenq tor Ihe pertarmante of IM woM1 �or
wtti[n miS �ermil is i55ue0 (Section 31197. Gv. C�.
IFNOEN:
ROOflE55:
OWNEB BUILOEB OECLAMTION: I here0y atlirm iha� I am e�empl lrom Ihe Contractars State L'¢ense �aw tor t�e followinq reason
(�ciion 7037.5 Business an0 Prole55ional Coae: My 6ty of county whicn r¢Quires a pertnil to consimct, alter, improve, tlemofisn, or
rro�r airy stmnure. prior to i¢ issuance. also repuires the apptiwnt lor suc� permit to lile a signeE statement ��at hrls�e a Iiunse0
W�wam ro tlie provisions ol t�e tontractars' Stale Lkense Law (CAaDttr 9(commencinA ��h Section 7000) of Dividon 3 oi Ne Business
an0 Pmfessians fAOe) ar ihd111PlsAe 6 erempt t�erelrom an0 Ihe �asis lar i�e allegetl exemption. My violation ol $ec�on 7037.5 by
any appkanl lm a perrtti� wbl��s tAe apD���< <o a civil penalry of irot rtqrz than five hUntlreJ tlaDars (SNq�.
I. az avmer ol ��e pm0erty or rtry employees wi�h wa0es as Neir mle compenuiion, vAI do ��e wotle. antl Ne
❑ Slruciur¢ is noi inleMeE ar 011ereG lar sale (Setlion 70a4, Busness anC Pmlessional Cotle: The Conl2Clors' State Licenu law
'. Eoa wi apOH �o an ovmer of a propeny wlp OlrilOs or improves thereon, and wtw tices such nnrk himseif/trerself ar tivough
j N5 or �er own employe¢5. pmviCeG Ihai Such improvemenis are no� Nfentle0 or OH¢retl fOt sale. II, troweve! �he buA�inA Of
imrywement is sd0 witNn one year of completian. ihe ovmer will have t�e Uurden of pmving he/she Oi0 not 6ui10 or improve
� iN Ine purpo5e ol Shcel.
I, az ovmer ol ine properry• am e.tlusiveh cantractinq witn licensee coniractors to construct ihe orqecl (5ection 7064, Business
� antl Professbns Cotle: 7tre Contrzclors' State Lzense Law aces not appy ro an ovmer al propeM � D�il� w improues fhereon
anE wlro Conlracis for such D�oRcts wii� a conlracior�s) licen5e pursuani �o the Conirac�ors' S�a�e Licens¢ Law�. I am awaze
��, tlut prool ot t�eir Worker'S Compen5aiion irtturante ShoNG Ge pronde0 lo me.
��., � I am emmpt unOer Section: B. 8 P. C.
i Im lNsr¢ason:
'I Oate: Umer.
�, I Oo nereUy ceNty Itut I am aware ol anE mMerslana t0e RQuirtmenis ot Califomu Mealih an0 Salety COOe Sectbns 25505. 25533, a�
'� 2553A aM It1at I or any Iuiuro OwlAinp acupant wilVwill not (tirUe one) nee0 to wmply with SdiG state mEes anE the redui2ments lor a
�� permil lor con5im[Ibn or mo0ilicaiion trOm I�e An Oualiiy Manaqemenl Dislrict. ResiOen�ial cansimtlion applicaiions are ¢xempt �mm
�, IIceSe prOv5i0n5.
�� Dam: pppticant:
I Mr¢Oy ttrlilylAai IlWve reaa I�is aDO��iion an0 S�ale�haIlhe abovl�nl0rmaiian is c r¢ti.l aqre0 IO C ��y wil� alltii an0 CaUnty
or0inancesanOs IeWwsielalinp�o0uil�inpconstmclionana�er��yaulhorke'rCpreSenia vesollh' lyl en�eruDonlhea�o �mentioneG
properiy r m� cUo purpo�s, /
�/1 A /
Daie:� � SiqnaWre� ���Y��r
Oirvei 5 Litt 5e Or�dal Setutily N:
16aLa8 WM1iie—Bwltlinq; G�een—CoOe EnlorcemenL Canary—Aoolicanl; PinM—Revenuo: Goltlenrotl—Assnssnr
`
CITY OF COSTA MESA — HUILDING PERMIT
PERMIT NO: M 057615 PLAN CHECK NO: N
CONSTRUCTION TYPE; 3—N SP PERMIT TYPE: MEC
PERM NO: M 05761
GOVT: N SUPP: N
PURPOSE: OTH
JOB DESCRIPTION : 28909 SQ FT COMMERCIAL OFFICE T.I. SQ FT:
CLAZM VALUE; CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: RE• B56907 PRIMARY HLDG. PERMIT.
**�er***rr*�t*it*�e*�r+tr*�*x�r***r*�r�r**�*�r�t*�e�rrr**��r*��r�r***�t�r�r��t+t�r�e�r**�r�t�e�+t�t***�r*+t*r�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL: 41507108 ZNE: REF NO:
PLANNING Nt31'ES>
�
ititifkkiFiFiFiEiFMMikkMlfitlFklfMiFMMMMMMMItitifkMlEMrIF.MiFkiFffifififMlflfifitMMikifkiFikk�tlfffifif�FitkMMkilltkikifiFMiFkit
D E V E L O P M E N T S E R�V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY '• � DATE:
BUILDING APPROVED BY.: —r DATE;
LEGALIZATION:N
F E E S 0 M M'A A Y
PERFfIT BLDG PMT PLUMBING ELECTRIC MECi9iA9N00
'15=
MkMiFiFkM�kIFk1FIFlfkifMkMklf�fifkMif
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 99.00 15.00 0,00 114,00 114,00 .00
REVENUE DIVISION TOTALS--> COLLECTED• 119.00 OVER/SHORT: 00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CAECK
119.00 .�:
kMkkkititikMMiFikkkiFkMklkftkiflFMitkiFififMk�FMiFiFMMkkk�klfM�fiFMkitikkklFifitifMMiFMiFkkiFlflFafMMkkitiliFif��F�f
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
MEC 11 REPAIR/ALT COOLING UNIT/SYS W/CNTLS 9.00 99.00
END OF FEES
/�
�
CONSTRUCTION ANDPLANNING POOL >
APPROVALS Permit # Date Inspector APPROVALS Permit # Oate Inspecto�
1. Temporary Electrical Servie�e'qi Pole,R .-' . 52. Pool & Equipment Lowtion .- -
�
.. ,-- �' � _.
2. Soil Pipe�Undrgmd. _�� '� 2 "` 53. Steel Reinforcement
�.
.:3j�Et�cciicar�ned�ru;sr+cv-G�yr����� 54. Forms '
' 4. ElaCicicel�Coridtlft-l��drgrnd. y.^ ' S5. Electrical Bonding
�9.`���t'F�einfoi�et�¢�tS '".,; 56. Rough Plumbing & Pressure Test �:
n6.�E19ctrital�tlF�fbfernd. 57. APPROVAI TO COVER�GUNITE rv
r
r7;i�oat{��5 ^ t� �- 58. Electrical Conduit-Undrgrnd. c
�B.�Foundatiorg S� �. 59. GasPipe,OUndrgmd.,Test �
9. Wacer Pipe-tJndrgrnd. . � I� 60. Backwash Lines, P-Trap, O Undrgmd. �"
10. Structural Floor System _. %e j- 61. APPROVAL TO DECK ��
11. Property Sev10r Line'$� Hoase'CO�nection � 62. Backwash & Receptor-Final
J '�
12. Sewer Cap ' �
y y ;� 63. Heater & Vent�Finat
13. Roof Drains.� V ' � 64. Piumbing System � Final .
14. Rough Plumbiri� - ' 65. Elecuical-Final
15. Rough EfectricabConduit ' 66. Solar System-Final
76. Rough EtearicWiring 67. Fencing & Access Approvai
17. Rough Wiring �jgn _._ 68. APPROVED FOR PLASTERiNG �
18. Rough Electri� T Bar Ceiling 69. POOL/SPA SYSTEMS FINA�
19. Rough Heating & Air Conditionin9 FIRE DEGT. REQUIREMENT
- - - � 7.-�:D: :. >. S.
20..�Rou�h Factor F7eplace i �['� G' + O D':,"x + tAppRUT/A�5���er�iiit # '� '' �
n� > Y 1 S n r-! C'x � l; x N��i- c a'
� .: t .r . 7C ♦ �-t . �r > . ,-
21 . �uCts, in $tructucB �� i ,. .• � � S �. 5 p ;...i.� »� ^ 0. �dergro�pd:Hy$ro *
22. Dutts, VentitMin9'* � �� � i...� T �'� ��• 1. ProducC- i�ing CY`(y�s O'�il
23. •Gas Pipe�Rough 8i �ast � :.� ; � M � ,Q `�`, x j7Z, Undergrovnd Fluslj i
24.Y3ooi.Framing (�7+ � .-F JT *? � � � 8 y� 573.aUndergrncPStorAqyi,- ank [�1Gas,O011
25. Roo $h athin ' £ N'�.h C Nx x i v �-+i-� �
� G 9.,., �;, v• t p 1 N* a� /4d�°erhead Hydrop .c
26. �T�Bar Ceiting (Strnctucall &�{Ylonucoat � ?;'� �r 75.�'Dry Chemical A '-• _ '�
- > ir
27. �Frame and Flash�ng' ��� t. .r �.n� F 76.rbry Stand�ige �m � S '`' '
�
.28. Lathjng:& Siding7x � 7.t5 � � s' :.fi Y 77?FIXED SYSTEN�-'69NALa �•v �
� �� � 1
29. Insulation _ .• • ' '¢
' z.�� `� S .. >'� ( Y � 78�FIRE PflEV. Flf�l� .� > x -�
�30. Drywall Nailing a;* �� s�� � fi r .-+ HEALTFt�EPTgREQFJIREMENT
n
'31. Plaster Brow0.Coat', S � n„�,. � � «„79.'•FINAL IN�P�.JECTI�N '` �" '
x
32.{lectricat Power ���r;Finalt `�� �,: � w x s$0.?fOOD CE�RTIFICATE ISSUED� -
�3.-�ina7 Electric .` " . ,� "`7 ` : � .R T '�' 7S_ r ;�
� ,� , i, ;y :t . r Notes: ,-�i*f - D �+7
n34. Fin��HeSting:& r,Conditioni495 n Z.�q?J. � * i.K 5 !-��c--� :r r S JC
. ., _ . . � ,� � �
35.f¢in7YG35 Pip�-Te�tx �y�' �! � I ` . ^ IT�,S • r r,r r..�:�
f -as , r N ��I�'�+ � ?7C �''-+C .l. • r
.�.i6. HOOd or C3noPYra O '[r'-; s y' ^ �. a � ; 10 � :Y � Ni�•
_ ' �
37. Final'Fac4ory Fireptace�„ ' S�' o y�`9 �� x E '� ! �Vv7
� t� w. :� G� �. T N
�38. Fina)-Plumbin � ,� � ''
9 r ;.' 7. j ..� S•L' -i 9 u: i
�- �
:39. Watet Service-Final � � m * I •� :'10+. o -.cn r�r S
I '✓ V: I .� 7• �a a �, (-.
40. Gas Service•Final ' "' ' '
+�*^ �c*n' s x,�� I I * ba ow � ni
� .�47. Solar pomesticFinal S � •• +� C` � k � •to �r-� *
v ( � �.� m '70 ? t+
� 42. Backflow Preventer,` - �,� y =� ' � �` � '�' j: � � V
43. Backflow Irrigationt � X�SS �� � x �� xF- r C o,
�. . ;. . * v � . r -
-44. L.andscape Irtigatiop Systerr�Mn � 1.q ' �;,q: . tu ot � C:. ; x N o
T45..Sound Attenuation �-l�(-� c�' na. F- - ,-+_�C' '+ `a �-a aCv� : �-
- �-y .. r � r •�t h a L*' O' ti • F.. .i
�I6. Handicap Regulati 's �- ti � �t • • ••. a� � / H'. ••.-1 .
� .+ l: # l� :� ir, 'x S C J S �
47. �FINAL STRtdCTUf#E & BU �DING �• � f .. ± iv S � r
, k r-. ' x� i C Y F
48. _gINAL PLANNING' "tr :� ` " • 4J
_ .,�� v{� � f *.n tr � e-
49.� Electric Release to Edison i ? � ��,� .�. S ii; � r � t: y
, . � , » � .� ..•K a�
y. ' '�� F IL \ L Gi r. � :
,`50. Gas.Release to Souihem California, Gas Co , , k��. ,., J•= h� . J
51. CERTIFICATEOF'OCCUPANCY' :� *, .s �� „'.� �: , - _,
No. Date
�
h
i
PflQIELT AOUXESS: 3 S�i S HARBOR BL UNIT:
OWNEH'SNFME: C J. SEGERSTROM 6 SONS �
aooeEss: 3�15 FAIRVIEW RD
COSTA MESA
CA 92626
ANCN/ENGINEEH: � 7 S A% S 4 E— O S S O qEG.NO.:
p00NE5S: SPACE, INC. NO�:
1017 S. HATHAWAY
PEflMi„EE: SANTA ANA CA 92705
nooness: VS CONSTRUCTION ( 714 ) 668-9100
$p2j7�0y1 S��,jySUSAN
LILENSEO CONTBpC761f DEC��ATIOd: I�fieieoy amrm thai � am �icensee unaerCpmvisi9 � 7 n�ao ei r 9(�ommencing wi�� Sec�ion
7000� o� �ivision 3 0l I�e eusiness ana Pmiessions COEe. antl ylicense is in lullforce
pTY LIC.: O � suTe uc.: 3 6 3 2 5 S� C1A55:
�aie: Signamre: <
WOFKEXS' PPEIS IOVOECIAMTION: InerebyailirmttutlluveacenificateolconsenitoselbinsureoracenilicateofWaMerS'
Compensation Insurance, or a certifie0 caDY ��ereof �Section 3800. LaE. C).
POLILYNO.: S31BSS-9Z EXP.UATE: OG�OSI
cornraxv: STATE FUND
❑ Cenilie0 c �OY is hereby lurnishetl. � Cerlilie0 co i IileJ wiN the ciiy Bui ing Div' '
.aie. � NpplicanC
E%EMPTI� OM WOfl BS' COMPENSIITION UELLAPAiION: (ihis secUon nee0 no� be completeA il Ihe permil is �w one AuMrtE (E700) a less�.
I cenily ihat in Ihe pedormance of ine work for wnicn Inis permit is issuea, I shall nol employ any Derson in any manner so as to 6ecome
5u�leC1 ID Ihe WOMers' Compensation Laws of Califamia.
Date: SignaNre:
NOTILE: Ii. atter makinp Ihis tleclaralion, you shaulU hecome SuEj¢ct to t�e Workers' Compensatian proNvons ol the Labor
COUe, you musl �ortAwilh tomply wilA Sut� proNsions or INS permit SAall E¢ deem¢tl fCvokeO.
CON578UCTION LENUING AGENLV: I �ereDy attirm t�at t�ere is a conslmciion IenOing aBency lor t�e Dehormance ai ihe work for
w�iC� I�is permil is issuetl (Section 3W7. Civ. C).
LENDEP:
RDOflESS:
OwNEfl BUILDEfl �EClABA710N: I Aere�y aflirm Inat I am e�emp� irom ihe Coniractor5' State License Law lor the lollovnnq rea5on
�Seclion 7031.5 Business ana Pmlessional Cotle: My ci�y of counly whicA requir¢s a permi� to con5imct, altef. impmve, demolish, or
repair any sVuclure. prior �o i�s issuance. alsa repuires Ihe applicant for such permi� �a lile a 5ipneA Slaiement ttut he/she is lic¢nSed
pursuant �o Ihe D�ovisions of the Coniractors' Stale License Law (Ctwpter 9(commencing wit� Section 7000� oi �ivisian 3 al t�e Business
antl Pmtesvons Cotle) or that �e/s�e is erempt therelmm and the basis for the allegetl exemption. My violation of Section 7037.5 by
any applicani lor a permit subiec�s I�e applicani �o a civil Denalry ol w� more than five AunAretl Oallaa (SSW�.
❑ I. as owner of the property or my employees with waqes as iheir sole compensation, vnll Oo the vrork, anU the
strucmre is not inten0e0 ar offere0 far sale (Sectqn 7044, Business antl Professional CoOe: The Contractors' State License Law
tloes not apply to an owner oi a vmverty w�o huilCs or imprwes tAereon, anA who does such woM AimseltlAerself or tAmugn
his ar her own employees. O��detl ihat suc� impmvemenis are not intenaed or oflered for sale. tl, Aowever t�e �uilGing or
impmvement is soltl vntAin one year ol com0�etion, t�e ovmer will have t�e 6urden of proving he/she did not buile or improve
br ��e pUrpose ol Saie).
1, as owner oi ihe pwperty, am evclusNery cantroctinp xith IicenseE wnbactors to consimct t�e prolec� (Section 7674, Business
J an0 Pmlessions CoOe: The Comranors $tate Licrnse Law tloes nol appry to an w.vner of O�opeM ��ilEs or improves thereon
anA who contracis Ior sucA O�oiecis with a comracioqs)license Dursuantto tAe Contraciors' Stata License Law),I am aware
Ihat proof ol ��eir Worker's Comp¢nSaiion insurance staultl be DmviAeA Ia me.
� I am exempt under Senion: 8. d P. C.
lar t�is reason: �
Date: pwner.
I Qo �ereby ceriify �hat I am aware ol ana unGer5�an0 ihe repuir¢men�s oi Califomia Heallh and Salery Coae Sections 255Q5, 25537, anG
2553a anU Iha� I or any lulure Uuiltling occupanl will/vnll noi (circle one� neeC lo comply wi�h saiA s�ate co�es antl ihe reduiiemen6 1or a
permil lor cons�mclion or modilication Irom Ihe Pir Ouabry Managemen� Dislricl. qesidential constm[lion appliwlions are ex¢mpl �mm
�hese pmvisions.
Da1e' Applicani:
I her¢�y cerlily Ihat I have reatl Ihis aDPlicati0n antl 5�ate Iha Ihe hove intorma�ion is rrec�. I apree y wi�� all ciry 0 couniy
ordinances antl state laws rela�ing �a builtling con5lmciion an eret a a i y ro enter upon Ihe ahave ntioneE
property I in ion rposes.
Daie: � Signature:
Driver's Lice se or 5 ��ai se��diy n:
16a1-a6 While—Butlaing'. Graen—Cotle Enbmam¢m; Canary—Applitant; Pink—Revenue; GOltlenroE—Assessor
f
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: E 057614 PLAN CHECK NO; N
CONSTRUCTION TYPE: 3—N SP PERMIT TYPE: ELE
JOH DESCRIPTION : 28909 SQ FT COMMERCIAL OFFICE T,I.
PERM NO; E 05761
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: H-2 /
COMMENTS: RE: B56907 PRIMARY BLDG. PERMIT.
�r****+��r�t�t****r*�r*r*�t**+t�r*r*�t�t�t�t+t*+t**�t�t�t�t***r*�r*��r�r�tx**�r******�r�t****�t*+t�r�r+t***�r*
2 O N I N G R E Q U I R E M E N T S
sszBAcxs
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT ZN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING AEQ• PAOV; PARCEL: 41507108 2NE; REF NO;
PLANNING NiSTES>
M�fMMMkitikkifiFititit�FMMftIFIFM1F�flfit�E�f1F1fM�FifltkkiFiF�fklF�fkifiFlfMK�FiFltkkiflFMifiFifififiFMiFMIFkif�tlkMiElEMMifkiFifit
D E V E L O P M E N T S E;,�R V Z C E S R E Q U I R E H E N T S
20NING APPROVED BY DATE:
BUILDING APPROVED BY : � DATE:
APPLICATION ISSUED HY: ��. DATE•
****�r**r��r�r�r�r�+�*�e*�e*�e�r ��F��r�r*�er�err�r* ��*
MMiFikMlfff�ffflflfNitMafMkMif�fititMlFkMiFMMlfitkiflFlFiFMMkiFMMiFiF iFkiFiFitiF�fMltkMifiF�fififkiklFffififMiFltifMlf%3fitiF�F
LEGALI2ATION;N F E'E1 S U M M A R Y STRUCTURAL SEGMENT:N
�
PERMIT BLDG PHT PLUMHING ELE74RiC� MECHANIC FIRE SMIP/RES GRADING
SOt SMIP/NON—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR
TOTALS----> 79,10 15.00 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
89.10
TOTAL PAID DUE
89.10 89.10 .00
89.10 OVER/SHORT; .00
FIRE SMIP/TOT GRADZNG PLAN—CHECK
kiFiFifKifitififiFMiFifiFklfMMifiFltitMMMMIfMMififiFiflhif�f�llfMafilMkkiFiFklFiFk�FkitiflfitMifMffkMkikiEifif3EMiEitifkkif�tiFikik
I N D I V I D U A L F E E B R E A R D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 20 RECEPT/OUTLET 1 ST 20 EA. ,75 15.00
ELE 87 RECEPT/OUTLET ADDITIONAL EA, .45 39.15
ELE 20 RECEPT/SWITCH 1 ST 20 EA. ,75 15,00
ELE il RECEPT/SWITCH ADDITIONAL EA. .45 4.95
END OF FEES ; i•,"'Cl io; 27 -�t �.- -,
C�YIiL• LL� 11..' �� ' - � • -
� c ~ POOL �
CONSTRUCTION ANDPLANNING
- APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Servit� or�-Polg��� .,. -- ' - 52. Pool & Equipment Location � ''
2. Soil Pipe-Undre�rnd. '� '' `�;S . 53. Steel Reinforcement � ��
� m
��;.�t�gt�i'��-C�,qr�u 8�l)�lity-U`ndrgrnd;°� 54. forms
^'4. EI�R.Rricet�ConIIfu�t�Nl4drgrnd. i c�D . 55. Electrical8onding �
n• �-
i$'�'���¢}���`��(� G.,. 56. Rough Plumbing & Pressure Test
.zi "�IectriZttf�UFE67m'rnd. rc 57. APPROVAL TO COVER-GUNITE .
-, , ,
"��ootir�s � ya ,`v' 58. Eiectrical ConduibUndrgrnd. �;
� `� 59. Gas Pipe, � Undrgrnd., Test � r�
-;(�,'-.�oundatio6 � . - -•�
3•i Water Pipe%t5ndrgrnd. '� -' 60. Backwash Lines, P�Trap, O Undrgrnd. -
l�tj Structural Floor System "� r�p 67. APPROVAL TO DECK �
7 iJ Property Se�7 Line"'& HoaSA Conn�tion . 62. Backwash & Receptor-Final '
P �
12. Sewer Ca ,�, • o; ' . 63. Heater & Vent-Fioal . '
13. Roof Dreins 1-- t- � 64. Piumbing SYstem � Finat _
� � �
14. Rough Plumb�}rtq; '' 65. Electrical-Final �
15. Rough ctricaLConduit ' 66. Solar System-Final
76. Rough Efectric�i",iring 67. Fencing & Access Approval
77. Rough Wiring $qn g$. APPROVED FOR PLASTERING
78. Rough Electric�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- -- - -' 7 7`r-x�- tC � F trt� .�: r
20.t4kou�,h Ractoty Fic4place t �X?1 �t^- �+ C D �* * �pPR4P/AC;S�^Q'er{fit # '� �' `-'� �
�A 'i� 4, F_� ! SlT' C[ X S H Qa: x Y, .�Nr.�-+ .� x ':1 16.^
21. uc�ts, ifr6trqctuie:r �•� ^�S �' S C �--'� Y 0. Ur+dergr,�mft7d;Hy�o � �^
22.�Dud"td. uBntiC�ting�:. � :�s fi ^ S �t* Fcy 1. Product� ;�i�'g �''x, �.. il
ef ��•�. � !'+ + r! �'1 x # d 'Y �
23.`fiasEPi e o & 1" st ! a' :t `�:} r: F` m � w
P -� � � - ;�75 * t�' �4 O'� ? ��Z• Undergroi{nt{ Flus�j g
V
24.�,RodtiFraming� mY �=�-- ��T x> ' c^ -¢ 4;$r3.'jlndergmd�Stora�� ank �Gas .00FP� �'
25. Roo`#,Sh:�thing �s T �� ?. *i :�- n,a r v �-i,- f�
a v �rr p;> rya a i4• verhead Hydro` y
26.iT•BanCeiling(Strttcturaq&,hlonucoat � u% C� C�tY?� 75. ryChemical �- `'--' ���a
:� z -' X r n�^
27.`Rrame an� Flash ;ri�� `L u 'D .r + � F nt� 03 '+.� � �: c"' :"' -.
< .�[,cc� a. C >• m# ��. 6. Dry Stan�iQe �,� :� b:��- ,m,•r
'-28.� Lat�ng.& Sidingc+� •r, �� x 6; r T. •'" � 77.tr'FIXED SYSTEM=F;jNAL�" � -�
,-. � . r� . � �. � x _
t1. .-a t � .�. . .. �j w. (.� H :! ._.. . . .'r '� � ,L' S
�29. Insb't�ation �i S' .. t ; ,-y 78.�IRE PREV. FIf�A{� . y ir ;j,_ 33
V .o
:60. Drywali'Nailing tr= + � �- HEAlTHCOEPTtRfQW+R2GtERt�T
I" M. "�
�1. Plaster �rowC�.Codt�r `. i lt,�n y. . �. � ,�79.`fINAL INSP.FCTI(�1�; �' � � � '�"'x
��32..:Electrica�Po�r MeteGfinal � � r .� ,�7 �" . x ;$0 CF000 CERTIFICA"FE%ISSUED r
s33.�5in�El�ctri�. ^'t :r i ¢ � ./�i�p., •Nota� � �.7 ^is1 >.� i -�
� �
a �'E� �- - . . ,:
� 4.�fina_He2ting• ,QtfwConditioni�S �; : I � : ir,�.-� :Y ^� . S � '
� -
35.� �n"at'Gas�Pip€?Te * A "'� " � �: t fou O�l „S t R^ �;.� '
I � �? �t �^' :1 F- � . v J '.CO ��N v. lJ �+lV..•�•
r a � . ..t. .. r.�..-. � .
�26.�FIod¢ or CanoPY •� � I t*' : a v: (� > E Z (1� x -+- � �r
T rn +- �r
� 37.`�in51?Fay�ory FireP�ce �, ' s}, u * M `� ° E `� x o��.:� ..
S +
. '• y * J
�38. Fin@I�Pl�mbing .r , t i .. .. -V. .r. � ( �� ♦ � � ,�� :i ;zf -
=39. Wat@9 Service-Final' � � � � � : �o[� r x
� � 7: i ic V: � ( b .i �. n� �k ,nn�rn�n
:{}0. GasService�Final ' ' �'" � � , , , ,
». i+7 K.!'i.� S t i*1 I 4 W 01� �N x
Ai. Solar pomesticFinai 5 � -� r. ^� I � '�.:t Q•. ^-� *
'+� - x • [r � O �' a r
�d2.�ackflow Preventer', � N .'k I * � � ��ti i _
43. Backflow Irrigation� � � : S # � y �t � cc;-� _ .
N i
',44. Landscape Ir�igatioo System�.l.t�j,-�j ,� .� M C C* a� ac :v W .C�" �. i-�vV��
+l5.Bound AtterGiation` �,a:F Ir rZ: 'r+ H '.-x:�C` �+ +-, a:v ,�•q -��c
rr t ir �q k'^'A?F 7' �L i-O '
��i6. iiandicaq Reqylations � 1 x' � " '` � : �" ..'- '
a � w ..v: :. �:�C ��; �' Go S . �.
47.�INAL STRUCTURE & BUfLDING T � I ir �"7 .� 'S ^
�l1 _ 1 7 � P I 7�
48.�If�AI PLAN�JiNG: � `F?� . „� I ; � in n� d > (
, - - �
c49.�-Electric Release to Edison i �s. ;��. + i a; ( �n y
_ ::_ (. �� r .-� 4
�50..Gas-Re�easetoSout�emCaliP,o[piaGasCo r. � n. _ _ � ,� .�,� �..
t. � I (� . ,� . n :T� .. . .
:51. CEF171FICATE OF�DCCUPAjJCY' . . , ,S „ i�7:: r - , cni.=:-.
No. Date
�
�
�I
�
PH0.IECT ROOPE55: j S�I S!-IARBOrZ BL
OWNEX'S NAME: (` J. S�GERS 1 ROM E SONS
aopwess:3315 r'AIRVIEi3 RD
' COSTA MESA
CA 92626
(7?9>S�i6—0110
AflCN/ENGINEEfl:
AOONE55:
HEG.NO.:
UNIT:
UNIT:
PEflMITTEE: ('URREN� ELEC:'R�C ( 714 ) 532-0168
aooxess: z340 DANA AV
ORANGE CA 92667
LICENSEO CONTNACTOP DECLANATION: I here0y allirm I�al I am licensed untler provi5ion5 0l ChaO�e� 9(commencinp wit� Seclion
7IXI0) ol Division 3 0l Ihe Business and P�olessions Cotle. ntl my I en^e is in iull Wrce ana ettect.
CITY LIC.: p� STATE LIC.:4 8 8 2�j� — LLAS—^ 1 Q
Daie: �-) � � —L � Si9namre:
WOfiI(EHS' LOMPENSRTION OECLANAYION: I here�y aHirm t�at I �ave a certilicale ol consent to self-insure or a cetliliwte al Warkers'
Compensatian InSurante. or a ceni�ieG CaPY I�ereol �Seciion 3800, La�. C)
eouereo.:0743067-93 ezv.oare:01/O1/94
camraxv:STATE FUNL�
❑ CenifieA caoY is hereby fumishetl, � Cenihetl topY is -le ihe city ' g �i sion.
Oa�e: ��\�' —\ J AODiicant:��
EXEMPTION fPOM WOHKEflS' COMPFNSRTION OELUIIRTION: �T�is seclion neeJ iro1 De campleleJ il Ue perml ¢ Iarone �unCrM �5100) or 1e55�.
I ce�ily Iha� in ��e pedormance ol Ihe vNrk for whic� this Oermit is issuea. I shall not employ any person in any manner w as lo Oecome
sublect Io tne Workers' ComOensation Lavrs ol Cali�ornia.
�ale: Signature:
NOTICE: II. atler making t�is Oeclaiation, you S�oNA become Subleci to �he Workers' Compensation pmvisions of IAe Labor
Cotle. yau must toMwitn comO�Y wilh sucn provislons orihis permit shan be Oeemea ievokea.
COkSTHUCTION LENOING RGENCY: � �ereby allirm ihat there is a consimction lending a0ency lor ihe Derformance al ihe work for
w�ich I�is Oermil i5 i55ue0 (SetiiOn 309�. Civ. C).
LENOEfl:
ADDPE55:
OWNEN BUILOEB OECLABRTION: I h9�eby allirm Ihat I am e�emp� trom �Ae Contractors' Slate License Law lor Ihe tollowing reason
(Seclion 7031.5 Business and Pmfessiodal COAe: Any city ol counry w�ich requires a permit lo consimct. al�er, im0�ove, tlemolish, or
repair any simclure. prior �o i�s issuance, also requires Ihe applicani lor such permit Io file a signe� s�atemen� Ihal M1elshe is licensed
Oursuan� to I�e pmvisions of Ihe Coniradors' Sla�e License Law (C�apter 9(commencing wi�� Seclion 7000) of Division 3 0� Ihe Business
antl Pmlessions CAde) or inal helsne is exempt iherefrom and lhe basis Ior Ine ailegetl exemo�ion. pny violation ol Section 703L5 by
any aDDlicanilor a Dermii suble��s ��e apP���an�io a civil penal�y ol not more than �ive hunGreE tlollars �5500).
1, as owner ol ine pmpeny oi my emoloyees wiln wages as their sole compensation, win tlo Ihe work, an0 ihe
❑ stmclure ¢ not in�endetl or oil¢reE �or sale (Sec�ion 70C4, Busmess and Pmlessional CaUe: IDe Contractors' Slale License Law
do¢5 nol aDPty Io an Owne� 01 0 DroDe�y who builds ar impmve5 i�ereon, anU w�o tloes SUCh woM1 himsell/�ers¢II or IM1mugA
�is or her o�vn emDloyees. pmv�0ed tAal such impmvemenls are nol intentletl or offere0 tor sale. If. Aowever t�e huilaing ar
improvement is soltl wiNin one Year of completion, Ihe owner will have Ihe Durden o� Dioving he/she did not �uild or impmve
lor Ihe purpose a� sale�.
I, as owner ol ihe propetly, am C�clusively canVac�ing wiN licensea contracmrs m conslmct ��e pmleci (Section 7044, Business
❑ anU Pmlessions CoOe: T�e Con�raclors' S�a�e License Law Goes not appty �o an owner 0� pmpehY � 6uiIE5 or improve5 i�ereon
an0 w�o canira[�5 for suc� O�ole��s wil� a coniracloqs�license pursuan��o Ihe CantraCtors' State License Law�.l am aware
I�ai O�oot of Iheir Worker'S CamOensa�ion insurance ShoWC be prohUetl to me.
� I am evempi UnOer Seaion: B. b P. C.
lai �nis reason:
: Sections 25505. 25533, and
les antl �he reduirements �or a
aoGlications are evempt Uom
�aie:
I do herehy [etlily Ihat I am aware oI antl Untlerslantl ihe req
2553d antl �hal I or any �ulwe GuiltlinA occupam willlwill no (
permil loi con5imclion or moGi�ica�ion immi�e Air �valiry
�Aese D�a��5ian5.
Da�e: � • �O' � � Applicam: �
I �ereby reriity I�at I havereadihis appGcaiion antl sia�e�hal
ordinances an0 5taielaws relalinglo building conSlruciion and h
O�operly tor inspeclion purposes.
�a�e: _�L� � ` � — SignaWre: I
odver's ucense or saiai secuniv +:
Ownec
nis y Calilomia Health antl S
inelldeetl tmomolv wiih saia
comply with all cily anG county
en�er u0on the ahove�men�ione0
164Ln6 W�i�e—BuilEing; Green—C�e EnlorremenL Canary—AppliwnL Pink—Revenue; GoWenroE—Assessor
CiTY OF CUSTA N.ESA — 3iJ:iUT_�G P�RX�P P=R�: �:G: E 062'_10
PERN.IT Nu: E 062? 10 P�AN CHECK h0: � GOVT; ti S;;PP; ;ti
CONSTRUCTiON TYPE: 3—N SP PER'.�"YT TYPE: ELE Pi'RPC1��: �,.T�i
JOB DESCkIPTiON ; EXHAJ5T FA:d FOR EQUiPMENT SQ �T:
C�AZN. VALUE: CALC—VALuE: GROJP OCC: B-2 /
CO:^.NENTS: THE "�MJiEX CORP." NO STRliCTuRAL PERN,IT O� F'LE r'GR TEiS PER+::T
��?r*�t�r*;�**�*�*�#�*��#*******�**�******�±��t**�*��t�r*������#�*x*#�*�x�x#*#��sr�rx�#r�*u��
Z O N� N G R E Q U I R E M E N T S
S E T B A C H S
------------ MAIDI 3liIi,DING ---------- --------- ACCESSO?tY BU=�U+NG ---------
FRN�: F? IN REA.Tt: FT IN FRUT: FT IN R�AR: F; 'N
LEFT: FT IN RGHT: FT IN LEFT: FT ?N RGHT: ^T Z;v
yARRING REQ: PROV: �PARCEL: 915071G8 ZVP; REF NO;
P�ANN2NG Nz3TES>
>
iE?E iF E ie?f ?E ic ii iE+c if � it iE 12 ii # �E �E �!E if 1E iE �lE iElF?f -1Flf ?E � ie iPiE�1E iE iE if iElE if iF 3E iE ## iF iE # iE i: IE 7! �f # k## ## �E iE if � if if #f ?E +: 1C ;: # K� iE?!� if iE ir
U E V � L O P M E N T 5-t. }R � I C E S R= Q U: R E;✓, E N T f,'
ZOIvI13G APPROVED BY DATE:
BUILDING .APPROVED BY : DATE:
APPLICATION :SSilEU BY: ` � DATE: (u���.
iFiF�EiEiE�lfifiE!E?fiEjF?fiElfiEiE?E#jfiEiF e . .. . . � �ex: ra�iEiFiEiEifiEifiEiE#u,rxuuxit:�xxjEiE
� iE?E � 3f if �1F �1f if if if iE ie �E if # 3f 3E 3E �)F �IE if 3E 3F iE?f ?f 3E i: <?E iF 3E?f if?f ie 1f?E iE if ?f jE 3F iF iE# ##!F iE #�IE iF i(� if iE iE?f iF# iE ###�!F if iF iE iE ### iE if ?E ic <�
i,EGAiZZATiON:N F E E S U M h; A R Y STRUCTUAAL SEGXEN;:ti
BLDG PMT PLUMHING ELECTRIr' NECHANIC FIRE SMIP/RES GRA..n=NG
PERMIT 7.50
508 SM_TP/tiCIN—RES
PLAN
ZSSUE FEE 15.00
BUIiDING—D?V—> PERMIT ISSJE PLAN—CHECR TOTAL PAID �JUE
TOTALS----> 7.50 15.00 0.00 2?.50 22.54 ,00
REVENUE DIV=SZON �03AiS--> COLLECTEU: 22.50 OVER/SHORT: .00
BLDG PMT P�UMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADI�G PLAN—CH�CR
22.5�
'1 if'� ?%i% if *'� �f iE �(' *?f �-�f'#?f if if if if } iR j(- if'K � jf jf jl' ��'� if i! jf *� �f if �' �I"� � if if')i'i("� if ji' if i�' if �c iE �' if *if if' ii' {i if'�'� i(' #� i(' # if i�' 3E if Y if �' L'
: N �1 I V Z 17 U A L r E E H R E A H � O W N
TYP't �iTY D E 5 C R I r� T i O N UNT_T COST TOTAi. COST
�LE 4 RcCEPT/OtiTLET 1
ELE 2 RECEPT/SWITCH i ST 20 EA,
ELE 1 MOTt�R/POivR APt�ARATUS 0.0 — 1.0 HP
EN� OF FEES
V
, 75 ? . 5C1
3.00 3.00
O1 00135858-00138358 T C7 T 12.`0
QATE: OS/10/93 TI17E: 14:33
r
� �
C:INSTRUCTION AND PLANNING
APPROVALS Permit �
1.•Temporary Electrical Service.or Pole
2. Soil Pipe�Undrgrnd.
3. Electrical Conduit Ut.lity-U��sdrqm��.
4. Eiecvical Condurt•Undrgrnd.
5. Steel Rainforcemen�
6 Electn;,al UFER Grnd
7. Foot�ngs .
8. Foundation
9. Watei Pipe�Undrgrnd.
10. Structuraf Floor System
11. Property Sev�er Line & HoJ?a�Conr.ect�on
13. Roof Drains
14 Rou�h Plumbir,g
15. Rovch Electrical-Cor.durt
16. Raugn ElBctric6Viring
1%. �ou3h LV��irg S.gn
18. Ro�gh Electrical-T Bar Ce�l�nq
79. Ru�gh Hec[�ng iS� Au Co�ditioninq
20. Rough Facmry Firep�ace
21. Ducis, in Structure
22. DuKs, Vent'��atiog
23. Ges P�pe�Rouqh & Tast
24. Rob! Framing
25. �cof ShcaY�iing
26. T�3ar Ceding (Sv.:r.,.�a�„ L :%orocn�c
27. Frsr^e erd Flash�ng - -
28. Lat:�ing 3� Siding ---
29. Ins�lat.en
3'�. .�iryt.ali A!diLng --
31. Plaster &o�vn Coat
32. Electnw! Pa�:.er � St:er c�ra: ----
33. Fir�l ElPctric - -�'-_-��-����
34. °ir..:; HcaLna & A.r CorJ,tiCnrp
35. F�ral Gas P�pe�Test
36. Houd or C�r.opy
37. P,nzl Facto�v F're�'ac_
38. Final Piumbing
�39. Ylater Service�final �
40. Gas Sernce�Final
41, Solar pomesnt�Fina'
t2. Backflov� Preventer
43. Backflow Irngation
44. LnndsccFe IrnqaLon SysteT
4�. $ound Attenuatior �
46. Handicap Regulaticns
47. FINAL STRUCTURE & RUILDING
4a. FINALPLANNIiVG
49. Electric Releasa to tdis�n
50. Gas Release to Southem California Gas Cn
Date
D2te Inspector
POOL & SPA I
APPROVALS Pennit� Date Inspector '
52. Pcol & Equipment Location ,
i
53. Sieei Rein(orcement �
54. Fo�ms � � �
55. Elecirical8ond�ng �- '
56. r�ough Plumbing & PresSute Test �,
57. APPROVAI TO COVER�GU�iTE �
58. Eleotricai Conduit�Undiyrncl.
59. Gas P�pe, C Ur.tlrnrr.d.. Test ' ' �
60. Backwash Lines. P�Trap, [� L'rorgm.o. _�
67. APPROVAL TO L'ECK I ( _i
I
62. Baeke.ash & Rece;.t�r�Finai � �� � �
- -i
63. Heater & VenCFi•�ai ' �
,-�
64. Plumbing Syscem F�^ai � ;
65. Efectrical�Final .
66. Solar SVstem-Fin;.' -
67. Fencing & Access App� u���l � �
68. APPROVED FOR'Ll�STERING �.
69. POOL,�SPA SYS�E^."S FINAL
--i- i----
FIRE DEPT. REl7U�RElJENT
APPROV/�LS Permit � � ! I
70. Underground Hy..�o �
71. Product P.ping � G,�s C� Oii ' �
-- --`- ��--
72. Underqrou�c F��s:, �
- - � � -
73. Undergrnd.Sto:c�:•izrlc �'G�5 -� ���I ', � �
� -�--- - � . �
74. Occrhead NYdre � ��
' --------'----�� -- ---
75. �ry Chem�,cai I
76. Dry StartdP:ue I
77. FIXED SYSTE�.1 FINAL
-��--
78. FIRE PREV. FINAL I
HEALTH DEPT. REQUIRE>.iE��d7
7�. FI�AL IidS� FC"7�v - -�-- --� --- - - �.
B0. FOOU CFR7.='.C�TE ISSUED -- -- ~-� -�-�-�--- I
- --- --�-- ----1--- i
Notes:
- ---�
-- �
�
r
»9� riHnCVK eL
rno�ecTnooxess: C,J, SEGERSTROM & SONS uxiT:
OWNEN'SNAME: 3315 FAIRVIEW RD �
aooeEss: COSTA MESA
" CA 92626
(714)546-0110
AflCH/ENGINEEH: ' BEG.NO.:
RODNESS: UNIT:
GENESIS FIRE PROTECTION (714)257-0266
PENMITTEF: 6SS BERRY ST A
nonsess: gREA CA 92621
LICENSEO LONTflACTOB OECIAflRTION: I hereUy ai�irm �hai I am licensetl untler pwvisions a� Chapier 9(commencing with Seciion
7000� ol Div�jus �c6�� �siness ana ProleB�q���e��e mY i�e �s m i in���ene��.
CITY LIC.: % / STRTE LIC.: n� CNSS:
Oate: ��! ��D ( G � Signamre: ' • ���=
WOflKEflS' COt�pFJ1$AT1 OypE�LqpA TION: I �ere0 allirm ��ai l �ave a ry�it3tpo(�op5p�i,�a sel4insure ar a ceni�iwle af Warkers'
Comp¢nuiion (asd�4d[A08EkE11�G toDY I�ereol I�fion 380D. La�. �.L / V L/ 7 L
roucvxo.: CA INDEM INS CO El(P.ORTE:
COMPRNY: X
❑ CertifieG coDY is �ere0y furnis�eG. ❑ Cetlifiea copy is tleA with t�e ciry B Emg Di%vi%'an.
oa�e: (p �l(.p ��i? Ap0licant: `��} �,� 16 �,��/.�Af'.(�.�
E%EMPTIONiBOMWOflHEflS'COMPENSIITIONOECUMTION: RhisstttionneeGnolEecompleteAifNepermtisforonehunOrM�E100�orless�.
I cenify ihat in ihe pedormance ol Ihe work for w�icA this De�mit is issuea. I shall not employ any oerson in any manner so as to become
su�jecl to t�e Workers' Compensation Laws ol Calilomia.
Date: SignaWr¢:
NOTILE:If, afler making IAiS aetlaralion, y0U S�oultl G¢come SuEletll0 Ih¢ Workers' Compensa�ion D«Ons o�lhe LaGor
COUe. you must tonnwitn comply witn such provi5ions ar iNs permit shall Ge AeemeA revake0.
CONSTNUCTION LENOING RGENCY: I Aere6y ailirm I�at I�ere is a consiruclion 1¢nGing agenry tor lhe petlormance o� lhe wnrk �or
wnic� I�is permit is i5suetl (Section 3097. Civ. C).
LENDEN:
RODflE55:
OWNEP BUILOEB OECIANpTION: I here6y affirm ��at I am exempt imm ihe Conlracbrs' State License Law for ihe following reason
(Section 7031.5 Business an0 Professional Cotle: Any ciry ol county whic� repuires a De�mit to consimct, alter, impmve, demolish, or
re0aif any SVutlUre. prior �o iis iisuante, a150 requires �h¢ applicani �Or SUCh Dermii Io file a Signetl sta[em¢ni Ihat he/5he is litensetl
pursuant lo I�e pmvisions ot ��e Comractors' Slate License Law (ChaD�er 9(commencing wilA Seclion 7000) ol Division 3 of t�e Business
and Pmlessions Code) or Ihat �e/s�e is ecempl ��erelwm anC I�e Easis lar Ihe allegetl exemp�ian. Any violation al Sec�ion 7031.5 by
any aDOlicant lor a permil subie��s Ihe aDPlitant Io a civil penalry oi not mare ihan five huntlrea aollars (5500�.
I, as owner of ine D�oDeny or my employees with wages as Iheir sole compensatian, will Oo ihe work, ana the
❑ sVuclure is no� inten4eE or oilered lor sale (Sectian 70C4, Business antl Pmlessional Coae: The Con��ac�ors' S�ate License Law
aoes no1 aODly lo an owner ol a pmpeny w�o �uiltls or impmves IAereon, antl w�o tloes suc� work himselt/�erseli or Ihmugh
�is or Oer own employees, D�oviAeO �hal such impwvements are no� in�entled or ofleretl �or sale. It, however t�e DuilUing or
improvement is so10 within one ycar al completion, ihc owner will havc Ihc burtlen of proving he/she Gitl not builG ar impravc
far Ihe purpase of sale).
I, as owner af the pmperty, am exclusively contracting with licensetl comracmrs m consimct the D�olect (Section 7044, 8usiness
❑ antl Prolessions CoGe: Tl�e Contractors' State License Law tloes not apply lo an owner of D�opeM who bml0s or imOroves tAereon
anA w�o canlrac�s for Such Dmle��s wi�� a comracmr�s) license Oursuani to the Contracmrs' State License Law),I am aware
I�al O�ool of Iheir Worker'S Compensation insurance 5houlA Ce Dmvitletl to me.
� I am eKempt unEer Section: B. 8 P. C.
lor t�is reason:
Daie: Umer.
I Go �eie0y cetlily I�at I am aware ai anG un0erslanU ihe repuiremen�s ol Californu Healih and Safety Code Se[Iions 255115, 25533, an0
2553A an01ha1 I oranylu�Ure �UilOinp otcupanlvnlUwillnoi�cirtle One) neeA l0 tomDly vnih 5aitl Sta�e co0e5 antl�he re0uirementsfor a
permil lor con9mction o� moAdicalian �mm Ihe Air Oualiry Managemenl Dislrict. flesi0ential conSVuction apDliwlions a�e ¢x¢mpllmm
inese o�ovisions.
Uale: Ap0licanl:
I nereCy rertity ihat I have reaE I�is application anU state tlut tAe aEove inlorma�ion is correct I agree ta compty vnt� all city an0 cauniy
otEinance5 ana slaie IawS reWOng �o OUilOmg CO�RINdion anC hereby Nlrorite eDreunia � of IN5 tiry ta enier upOn Itle aUMe-menli0n¢d
pmoeny lorinspeclion purpo5es. I
Date:�tp_��-2. �
Oriver's License or Social Secumy x:
16<1�46 W�ile—Builtlino: Green—COEe En�orcemenl: Canarv—Aooliwnt: Pink—Revenue: Goltlenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT ��
PERMIT NO: F 057795 PLAN CHECK NO; 01768-92 L GnVT• *� Gr7nn•_t�
CONSTRUCTION TYPE; PERMIT TYPE; FIR PURPOSE: ALT
JOH DESCRIPTION : COMMERCIAL T,I, (OFFICES) SQ FT;
CI,AIM VALUE: 5,500,00 CALC—VALUE; - ' GROUP OCC: B-2 /
COMMENTS: THE "EMULEX CORP." / RE: B56907
***�t+�*+t***x�*�t+t*��r*�***+t***�r**��r****�**�t*+t****�t�r+�x *�***���+tx�+t***�t+�*�r*�t�***x�*+�***
Z O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REp • PROV; PARCEL: 4150710B ZNE; REF NO:
PLANNING Ni5'1'ES>
>
�t**�e*x*�**�t**�r�***�*�r*�r�r***�r�rx*��r*�**�r**��r�r*�t*�e+t�t*x�*�t�r**�r*****�t+r***�r��r*���*�t�r�r�r
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
20NING APPROVED BY , DATE:
BUILDING APPROVED BY :
DATE: �C f'}L
APPLICATZON ISSUED HY: � DATE; �
�filkilikifikikiklFlk�EifiFkiEkikififkiF ikiE�fifiEif3f1ElF1f it
itifikfE�fikifikitiEjFik3fififlfifiFiFklfiFikifkklkkififiEiFifikiF3F3E�k3fiE1FlE�kiFif if1E�EitkiFiFlFifikifiEiEafkififillFffiFifiFiFiEifk��flEiFiE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT �165t SMIP/NON—RES
52.65
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> � 81,00 0,00 52,65 133,65 133.65 ,00
REVENUE DIVISZON TOTALS--> COLLECTED: 81.00 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
81,��
1F�lk �lk �If lE �)f iE iE iFiE il�ikiFlf� �If if if �lE �11� if iE �)f iEif-�)f iE �lE �IE �E iE iE if iE if if # 3f �lf �If k�!E 1i iE �lE iE �1F iE�F 1E iF �1F if 1E•%lE1Eif if if iE �)hif �lE 1E iEit if if iEiF�3FiF �lF iF �IF iFif �IE 1k
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C A I P T I O N UNIT COST TOTAL COST
FIR 81 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1,00
END OF FEES
PLAN
ISSUE FEE
81.00
;�
CQNSTRUCTION AND PLANNING �. _ -, POOL a.,rA
APPROVALS Permit # - - Date Inspector qppROVALS Permit # Date Inspector
i -
L� emporary Eiectrical SeFvice or Pole • . 52. Pool & Equipment Location -
2. Soil Pipe-Undr9md. �c i.�� � 53. Steel Reinforcement - �
3. El�ctricaiConduit'Utility-Undrgrnd:; � - 54.•Forms . .
� 4. Electrical Conduit-Undrgrnd. � ->' 55. Electrical Bonding
� 9. Stgel ReinforcerPent � 56. Rough Plumbing & Pressure Test
���G _�lectrical UfER Gmd. 57. APPROVAL TO COVER-GUNITE -
� 7, Footings ' - � 58. Electrical Conduit-Undrgrnd. -�
� 8. Foundaiion � �. 59. Gas Pipe; O� Undryrnd.,,Test
� 9. Water Pipe-Uhdrgrnd. _ � 60. Backwash Lines, P�Trap, O Undrgmd. �
�10. Structurel Floor System _. 61. APPROVAL TO DECK '
. 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final �
12. Sewer Cap , �- ; - 63. Heater & Vent-Final ,
73. Roof Drains . ' � � 64. Plumbing System - Final '
14. Rough Plumbing " � 65. Electrical�Final �
15. Rough Electrical-Conduit 66. Solar System-Final
i 6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough WiringSign 68. APPROVED FOR PLASTERING
18. Rough ElecViial�T Bar Ceilin9 69. POOUSPA SYSTEMS FINAL
� 19. Rough Neatiog & Air Conditioning FIRE DEPT. REQUIREMENT
- - x .
20. Rough Factory;Fireplace � .. � � : � . APPROVA"CS� _ Permit #' -
x. r -
21. Ducts, in Siruciuie „ '- . , � _ 70.,Underground HYdro
22. Ducts,YentilaTing. � - � 71. ProductPiping'�Gas OOiI
23: Gas Pipe-Rough & Test � ^ � _ � ", � 7y, Underground Flush �� "
24. Roof Framing -: � . � , _ �1 � � 73. Undergrnd.StorageTank OGas O�OiI
25. Roof Sheathing ' ' ' �" ' 74. Overhead �4-'s
- �o �la-Ci � ��
26. T-.Bar Ceiling (Structuroll & Monocoat � 75; Dry Chemical -, = �
27. Frame and Plashing � � 76. Dry Standpipe :1; � ' 1
, 28. Lathing & Sid��g . -.�.r,.i: •� 7T. FIXED SYSTEM FINAL _ (�_ ��(_4 w
' 29. Insulation^ ; � '� � - � 78, FIRE PREV. FINAL • : .�_ c�,
� 30. Drywail Nailing HEALT�H DEPT. REQUIREMENT
31. Plaster Brown Coat . � . 79. FINALiNSPECTION � �
32. Electrical Pbwer MeterFinal -c '%`�- � �. 80. FO00 CERTIFLCATE ISSUED -
. 33. Final Electric ' � _ ' � ��,. - Notes: � � � � _ _
1 ! i.. ', : � - j . . , . -
� 34. Final Heatirig & Air Conditioning - . . . . . :
35. Final Gas Pipe-Test _ '-- . ' � - � � _
.. : � .
, i 36. Hood or CanoPY �� . . - . ' - .
� 37. Final Factory Fireplace _ ' _ . . � � ; � -
�. 38. Final Plumbing , • � � � �' � � �
"��. 39. Water Service�Final -- � - " ' -
. � � . ' .
- 40. Gas Service-Final. r , - . - ' '
41. Solar pomestirFinal ' . - • �
42. Backflow Preventer �'' - � , .. , '.
, 43. Backflow Irrigation ' � - � �
44. Landscapezlrrigation System,. � - . , , . • - - i -.
45. Sound Atfenuation �•A �� . � � - �
- 46�. Handicap Regulations _ �`• � � . ' �
47�. FINAL STRUCTURE & BUILDING '
48. FINALPL'ANNING '-` ,; ;,.�y ' �
49. Electric Release to Edison � �: % �� � �
50. Gas Release to Southem Califomia Gas Co � . ( '.`•��� ' " - , , _
51. CERTIFICATE OP OCCUPANCY
No. Date
Y ' . �.
� CITY OF COSTA MESA
� Buno�N� �nr�s►oN
F .� DEVELOPMENT SERVICES DEPARTMENT 89$-00941 i�
�� PERMIT PERM�T NUMBER
�� .
(774) 754-5273 • Fa�c (714) 754-4856 gUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
,lob nddress: 3545 HOWARD WY
Suite:
Vicinity:
Parcel Nunmber: 41511220
Applicant: HERRING, JIM
Address: 17910 SKYPARK CIRCLE #201
Owner.
Address
Contrector:
Address:
Arch / Eng :
Address:
IRVINE, CA
Zoning: MP MP
Phone: (949)263-7920
. Zip:. �92614. �
Status: ISSUED �j�
Applied: 06I01/1998
Issued: O6I1511998
SCENIC LOAN ACQUISITION � �
PARTNERS. % ��'. -' - ` ' . , � ' _
�.; .
NEWPORT.BEACH,CA - �, �. � � Phone:., , ��, _ , ,
P O BOX 1549� � / - - 2ip: . 92859 _- - . ,� � •_ _-�
" : - - c . - , - - = �.:. : - � -� '.,i
- -' .- ' '- � - , . �, ..; ��� . � ' ; A���;� �
ADVANCED�CONSTRUCTION SOLUTIONS INC� � �� � ��
17910SKYPARKCI "%'� � :�� ��-� � � %� `�� �
v,, ; (
UNIT 201 ' .� ; � � Phone: 9492631920 ��; ` :- �� � � �'�; �`.
i
IRVINE;CA ' �� Zip: 92614 \ ;� � �.� `
, License:�� 734391 �� ^.'. ;"� � . .
BROWN, KEN ��;+-�, �V�, :,j. '•
22992�ELTORORD ' 'Y� I , -.. . .: ' -� -
_ i
- '�' Phone:., 714•85&1136 ,, � �
�,`_,� .
LAKE FOREST, CA � - � �-, 2ip� - 92630 , � � ,
. . � 0 �� � �. ._ , _ _ , .. . �
� � Jl,r?, � -LicenSB`:- � � . , .
i �
_ �,. /
SCOPE OF PERMIT %
6090SF SECOND FLOOR OFFICES TENANT IMPROVEMENT FOR "�ST ENVIRONMENTAL"
� � � �. - � . . - . , � .
FEE SUMMARY - _:
Pian Check: $209.18
Permit: $1,287.25
SMIP Res: $0.00
SMIP Com: $37.80
Other: $0.00
Inspection: $0.00
Calc Valuation: iso,000.00
_ Claimed Valuation: iao,000.00
z
Total:- $1,534.23 � �� � - � � . �
� � , , , - �' PLANNING 8 ZONING �
SETBACKS � � � � � � : �� �
MAIN STRUCTURE Front 0. 0 "Rear -� 0. 0, ' Left � 0. 0 - Right 0- 0- -
ACCESSORY Front 0-0
PARKING
NOTES:
Existina: 0
Rear 0- 0 Left 0- 0
�
Required: 0 Proposed: 0
Right ' 0- 0
EXPIRATION: This permit shall automatically expire and become void if work is not commanced within 180 days, or if work is suspended or abandoned
tor a period ot 780 days.
INSPEC710N5: In order for the work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all
requlred inapeetlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I hereby effirtn unOer penalry of perjury one of Ne following declaretfons:
❑ I �ave end wlll maintain e cenificere of wnsent to seR-insure ior woAcars' compensetlon, es provitled tor by section 3700 of ihe LeDor Cotle, for ihe peAortnerrca of Ne
vroik tor which ihis permlt is issuetl.
❑ I heve arM will meintain workers' compensation insuranca, es required by section 3700 of ihe Lebor Code, for the peAortnence of the wo�1c for which th'tq pertnil is issued,
My workers' compensetlon Inwrence certier end policy number ere:
Cartler: Poliq Number.
(1h/s secNon neeC not be comp/etetl !f the perm/t fs va/ued et one hundred dollers ($f 00J or less.J
❑ I ceNfy thet In the pertar ance of the wark tor which this ermit is issued, I shall not employ any person In eny manner so es ta became sub�ect to the workero'
eompensatlon laws oi Ifomle, entl egree that if I shoul ecame sub�ed ta tha workers' compensetlon provlslons ol Seclion 3700 af the Lebor Code, 1 shall torthwlth
compty wlt� t�ese pro ions. / _�
AppOcant Signa re 1'' � � � Da�e:. �i� — ! 5 �
WARNINO.'FAILURE TO S}wRE WORKERS' COMPENSATION COVERAGE IS UN FUL AND SW1L1 SUBJECT AN EMPLOYER TO CFIMINAL PENqLTIES AND pVIL FlNES UP TO ONE HUNDRED
T/qUSAND DIX.URE (§(OD,000), IN ADDRION TO TME COST OF NMPENSATION, DAMAGES AS PROVIDED FOR IN SEC�ION 37080F THE LABOR CODE, INfEREST, AND ATTORNE'fS FEES.
LJCENSED COHTRACTORS UECLAPA710N:
I hereby ettirtn Ihet I am licens�d under provlslons oi Chepter 9(rpmmendng with Sectlon 7000) ot DMslon 3 of Ihe Business entl Professions Cade, end my license is in full
torce end eNect. LJc. p � � ciess a , i
CONSTRUCTION LENDINO�C�ENLY:
❑ I hereby affirtn that there is e construction IenGing agency for the peAortnance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Neme: Lentlers Atltlress:
Signature:
Date:
OWNER-BUILDEH DECLARATIONS:
I hereby eflirtn that under penelry ot Derjury thet 1 em E7(EMPT FHOM TXE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business end Professions
Code: Any ciry or county which requires e pertnit lo construcl, alter, improve, demdis�, or repeir any structure, pdor to its Issuance, also requlres ihe epplicant for such pertnit
to file e slgnetl stetement that he o� she is Ilcensetl pursuflnt to Ihe provlsions ot iha Conirectors License Lew (Chepter 9(commencing with Sectlon 7000) af DlNsion 3 of Ihe
Business end Professions Code) ar thet he or she is e:empt �herefrom and ihe basis for Ihe alleged axemption. Any vlola0on of Section 7�31.5 6y eny epplicenl for a pertnit
sub�ects the applicent to a clvll penelry ot not more than Ave huntlre0 tlollars ($500)J:
❑ 1, es owner ot Ihe property, or my employees wlth wages as their sale compensatlan, WILL DO 7HE WORK, end the structure is not Intentled or aHeretl for sele (Sec.
7044, Business end Protessions Cotla: The Gontrectors License Law does not eppty to an owner o1 properry w�o bullds or improves thereon, entl who does such work
himself or herself or ihrough his or her own emplayees, pravitletl ihet such Improvemenis are not Intended or atfered tor sele. tl, however, the builtling or Improvement Is
sold within one year oi completlOn, the owner-bullder wlll have the burtlen of proving thet he or she did not bullO or improve for purpose of sele.).
❑ I, es owner of the property, em EXCLUSIVELY CONTAACTING WfTH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professfons
Cotle: The cantractors License Lew does not appH to an owner of properry who builtls or imprwes t�ereon, end who contracis for such pro�ect with e conirector(s)
Iicense pursuant ta the Contradoro License Lews.).
❑ I em exempt untler sec. Buslness end Protessions Cade far this reason:
Signeture: Date:
O.vner ID venfied by dnvers license. ❑ Yes ❑ No Drivefs License No. Ezpires:
Vedllcatlon ot Ownerohip by (rype ai document, i.e. - properry tez blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIPICA710N:
❑ I hereby certlly that no excevation flve (5) or more teet in tlepth Into whic� a person is requlretl to descend, will be matla in connectlon wlth work euthadzetl by thls
pertnit, entl t�et no bullding sWcture, acattoldlnp, talsework, or tlemolitlon or dismentling ihereof, will be more then thirry-six (36) teet high. (Chap. 32, Grp 2, An 2, Sec.
341, Tille 8, Calitomia Administretive Cotle).
❑ As owner-builder, I wlll not employ enyone to do work whic� woultl require e pertnit lrom ihe Divislon ot IndusMel Safery, es noted ebova, unless such person �as a
pertnit to do such work hom t�e tliWsion.
Signature: Data:
Divislon ot Indusirial Safery Pertnit Number:
CEfiT1FlCATE OF COMPIJANCE AND AUTHOHRATION OF EMAY: I certify untler Denalty of perjury thet I heve reatl ihis epplication end state thet ihe infortnetion givan is
cortect. i egree to wmpty with ell slate laws end ciry ordinances relating to bullGing wnsWction, and eu�hodze representetives ot �he Ciry of Cos�a Mesa �o enter upon �he
above4escnbed ploperty for inspection purposes. I eg�be not to occupy or allow occupancy ot any building euNorizetl by �his permit until final inspection.
cooe �.
1818
1266
200
201
202
203
204
244&49
Fixed System Finel Fire Preventlon
Pool Spa Final
Finel Re-Raot
Final BIocWReteining Wall
Final Factory Fire Place
Final Sign
Fnal Demolitlon
QAiE II�ALS
CODE I INSPECTION TYPE
206 Flnel Mechenical
208 Flnal PIum6ing
210 Flnal Eleciricel
212 Flnel Flre Preventlon
220 ' Flnal Planninp Approval
222 Final Sile
250 Fnel Bullding/Occupanc
QAff UIi�ElB
CITY OF COSTA MESA
sva��N� o►v�s�oN
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
eaa-oo�ss �
PERMIT NUMBER
(714) 754-5273 • F2�c (714) 754d856 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT �
Jobaddress: 3545 HOWARD WY
Suite No
Vicinity:
Parcel Nunmber: 41511220
npp�icant: IANTPRNO, JOHN
Address:
Phone:
Zip
Owner. SCENIC LOAN ACQUISITION
Address PARTNERS � .
NEWPORT BEACH,CA '. _ , Phone: -
P O BOX 1549 - .. . - - -� Zip: 92659 �- '
Contraaor: J.P. INTORNO ELECTRIC CO
Address: 13 CHRISTAMON EAST
' � , Phone��731-5383
� � IRVINE, CA Zip: y�92620
, ' . , license: 338155 � �' '
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+unils)
Pool / Spa
Lighling FiMs
Recepl Outlets
Switches
Non Res Appl
Res Appl
Service to 20oa
Service to 1000a
SeNice over 7000a
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Motors ta t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intertned Pole
SCOPE OF PERMIT
ELECTRICAL FOR T.I.: 12 FIXTURES, 29 REC., & 19 SWITCHES.
522.00
50.00
50.00
$0.00
so.ao
$0.00
E72.00
$25.85
579.00
ao.00
E0.00
50.00
50.00
$0.00
50.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantlty
0
0
0
12
29
19
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
SWtus: ISSUED ��
Applied: O6li 6/1998
Issued: O6I16/1998
, ��
,� � ' , ,
�;' .,
��.�.
/� .
, '�� � � �
Temp Dist Systam I Lighting
Busway/100ft '
Standing Section �
- Misc Eledrical Equipment
- Transformers up to 1 kva/kw
.............:..uP to 70 kva/kw
.............:...up to 50 kva/kw
...........:.....up 10�100 kvalkw
..................over 100 kva/kw
Low Voltage Equipment
Low VOIt Wiring Syslem / Ckt
, Misa Conduil
� Misa Conductor
. � Circus ( gen or ride)
� Circus (mech �de or lights)
ChrisVnas Tree Stand '
� Fireworks Stand
- Other Electriwl Fee
Investigation Fee �
Plan Check Fee ,
Reinspection Fee
TOTAL�CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
$0.00 0-
$0.00 0
$0.00 0
$0.00 0
$0.00 0
ao.00 0
$0.00 0
50.00 0
$0.00 0
50.00 0
$0.00 , 0 .
30.00 0
$0.00
$0.00
$0.00
$0.00
E78.85
EXPIRA710N: This permit shall automatically expire and become void ii work is not commenced within 180 days, or If work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work euthorized under lhis permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetiona end flnal epproval must be obtained. Failure to obtain inspectlons end tinal epproval will result In lhe expiration of �his permit.
FOR INSPECTIONS CALL: (714) 7545628
WORKERS' COMPENSATON DECLARATION:
I hereby aHirtn under penalry af perjury one ot the follawing dedaretions:
❑ I �eve end wlll meinteln e cenificate of mnsent lo setl-Insure lor workers' compensetlon, es provitletl for by sectlan 3700 ot ihe Lebor Catle, for Ue pertormence of the
; work for which this pertnit is issued.
❑ I heve enA wlll maintein workers' mmpensetion insurence, es requlred by section 3700 of Na Letwr Code, for ihe peAormence ot tlie work tor w�ich ULs pemtit is issuetl.
My workers' compensaUon Insurence carrier antl pollry numCer ere:
Certier.
(Th sectlan need not be con
I�certly thet in the peA
/comDensaHon laws ot
comp�y wl�n mese p
ApPliceni Slpnature: � .
��—
WMMNO: FAILURE WRE
THOUSMlD /00.000�.
LICENSEDCON7RACTOR3
I hereby eNirm thet 1 em Iicen:
force end eflect. Lic. p�
Comractore Signeture:
�, Palicy Number.
orless.)
ot the work for whitJ{�his Derml4/s issued, I shell not employ any person In eny menner so as to hecome sub�ect to ihe workera'
anq,agree t� If I/ould beco 4 sub�ed to the workers' compensation provisions of Section 3700 of t�e LeDor Code, I s�all IoMwlih
�� � oa�a ��G���i
� COM COVEMGE IS UMAWFUL AND SMALL SUBJECf M! EMPLOVER.TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED
IN TO THE ODSi OF COMPENS4TION, DMIADE5115 PRON�ED FOH IN SECiION 31060F THE IRBOR CODE, IMERESf, ANO ATTORNEV'S FEE$.
wlih Sectlon 7000) 01 Divisian 3 0l t�e Business and Professions Cotle, entl my Ilcense is In tull
Class # °
CONSTRUCTON�ENDINQ AGENCY:
❑ I hereDy aflirtn Iha� t�ere Is e constructian lending apen�y tor the paAormence ot the work tor which Nis Dertnit is Issued. (Sec. 3097, CINI Code).
Lendafs Neme: Lentleta Atldress:
Signeture:
OWNER-BUILDER DECLARATIONS:
Dete:
I hereby eMirtn �het untler penelry ot perjury Ihat I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Buslness end Professions
Code: Any clry or counry which requires e permlt to cansiruct, elter, Improve, tlemalish, or repelr eny siructure, pdor to its Issuance, elso reQuires the epplicani for such pertnit
to file e slpned stetement ihat he or she is licensed pursuam m the provisions ot the Contractors LJcense Lew (Chepter 9(commencing with Sectlon 7000) of D'Msion 3 of t�e
Buslness and Professions Cotle) or thet he or she is exempt therefrom enO Ihe Desis tor the elleped e:emptlon. Any Wolallon of Seclion 7037.5 by eny epplicant far e pertnit
sub�ecta Ihe epplicent to e dvll penfllry oi not more then frve hundred dollars (5500).):
❑ I, es owner of the property or my empioyees wiN wapes es Ihelr sole compensaUon, WILL DO THE WORK, and the structure is not intended w onereE tor sale (Sac.
7044, Business end Professioro Cotle: TTe Cantrectors llcense Lew tloes not eppy to an owner o1 property who bullds or Improves Nereon, end who does such work
himsetl or hersett or ihrouph hls or her own employees, proNded Nat such Improvemenis are not intendetl or oHereA lor sale. II, �owever, Ihe builAing or improvement Is
soltl wlihin one yeer o1 campletion, the owner-bWltler vrill have Ne burtlen of provinp ihet he or she did not build ar imprwe for purpose of sale.).
❑ I, es owner of Ne Droperry, em EXCLUSIVELY CONTRACTNG WRH LICENSED CONTRACTORS to construct Ihe pmject (Sec. 70A4, Bus(ness entl Professions
Cade: The contractors License Law does not appry to an owner ot properry w�o builEs or improves t�ereon, end who contrects tar suc0 project with a contreqoQs)
Iicense pursuaM to Ne ConVaqors Ucense Laws.).
❑ I em exempt untler sec. Business entl Protessions Cotle lor this reeson:
Signature: Date:
Owner ID verifletl by drivefs license. ❑ Ves ❑ No Drivefs License No.
Vedficatlon of Ownership by (lype of tlocument, i.e. - pmperry laz DIII or Aeetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICA710N:
Expires:
❑ I hereby certify ihat no excavetlon Iive (5) or more leet in Eepth Into which e Derson Is requireC to tlescen4 wlll be metle In connectlon wllh work eut�orizetl by this
pertnit, end Ihet no builGing sirudure, scattdding, falsework, or Cemolitlon or tlismentlinp Ihereof, will be more Ihen Ihirly�six (38) teet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Califomla AtlmlNSVeWe Code).
❑ As owner-builtler, I will not employ anyone to do work which would requlre e pertnit trom Ihe DlNsion of Industrlel Safery, es notetl eDove, unless such person hes e
permit ro do such work trom ihe division.
Signeture: Dete:
DMsion of industrial Satey Permlt Number.
CERTIFlCATE OF COMPLIANCE AND AUTHOR¢ATON OF ENTHY: I cartity unCer penelry at perjury that I heve read this applicetion end state t�at the infortna[ion given is
correct. I egree to comply with ell slete laws end dry ordinances relating to bulltling construction, entl authodze representetives of the Ciry of Coste Mesa to enter upon t�e
ebove�tlescdbed properry Jpr inspection purposes. �ree not �o occupy or ellow acupancy af eny building euthodzed by ihis pertnit until linel inspection.
INSPE[iqM iYVE
1 8 Flxed System Flnal Flre Prevenlion
1288 Pool Spe Final
200 Finel Re�Raof
201 Final BIocWRetelning wall
202 Finel Fedory Fire Place
203 Final Sign
204 Finel Demdltion
2MBJ0
peg �eLq iRpEl n+svecnoNTrve
208 Finel Mechenicel
208 Flnal Plumbing
210 Flnel Elecirlcal
212 Final Fire Preventlon
220 Final Plenning Approvel
FY�'3
250
Flnel Sile
Final BuilGinp/Occupenq
�oa�a � q�_
oe�e
CITY OF COSTA MESA �
BUILp/N6 pIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
nnaR_nma� !/
PERMIT NUMBER
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DIiIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
JobAddress: 3545 HOWARD WY
Suite No
Vicinity:
Parcel Nunmber: 4'1511220
Applicant: BREESE, BRYAN
Address:
oW�er
Address:
Inst FF
Inst FF
Repair
Inst / F
Refrig
Status: ISSUED
Applied: 06/17/1998
Issued: O6/17/7998
�.�Phonei".;,`-'=� �'� �-���
�Zip. - � ��-��� ----
` ` ;i ��, 1 � i / � � \�.
N� I J� �
`� �'�7�� (�� '� �/ /`� _ �t:
�� � � � _ � ----' �� /�� � �
�".Phone��cy�:� � ` �`� ��
� _ : �-��- \�
Zip: 92659 _�\\� \ /i��\\
ING �A �`� �
�� A��
Zip: II
License
�����
Phone:
Zip:
License:
�� � i-� ��
n��,��. � i u
� ---��=',��� `� . � �
: _.���.��
' ' (i` ' ` ;
:�: �� , �}
S
�a��•�,� �, \, "
�_Lo ���/ � a . '
�_�l ��'�,�, •
==SCOPE OFPERMIT=
<'- '__
�j , p f �� , - � �7 r �, ,,� .,; '�\
�, ADD�I6�REGISTERSCONNECTEDTQ,1 SYSTEM: - �
� J',l�n��, ., JL�u„��J4./✓o 1��._��:_�1. J
•_� -` ���'�`�'!n �� \,
�
�, ' ',,�
N-'
,�,.er„ ,�`�l
Gas Pipingl,�•�� �� �
Factory Fireplace� t�..r
Hood wlMech'Exhaust �-�
VAV Box \��,
Vent Fan / Single Dud
Appliance ���
Fire Dampers �'
Smoke Dampers -
Inst or Relocate Appl Vent ��
Air Handlers < 10000cfm
Air Handlers > 10000dm
Floor Furnace
Floor or Suspend Heater
FEE SUMMARY
$22.00 ;:``�._„__.-�-�--i=�_:
$0.00 '
$0.00�
$12.25 1
$0.00 0
$0.00 0 ,
$0.00 0
$0.00 0 �' ��
�� �
, ,r, , „
^� �' �"�r„t�'�
Repair % Alt Absorbtion Unit
Repair,l AlbRefrigeration lJnit
Ventillation System ��
Evap'o�ative;Cooler ��
Comme7oia l I ncine rator
Domestic Incinerator �.
�$0.00 0 „�� � q�F� 3 To 15�hp / 500 k BTU ��
�$0.00 0 �1„,�d',l,d��i�15To30.hp,/r1000kBTU/���
$0.00 0' ,, aL ���' ���7"`� G/�Over50 hpP Ove501 750 BTU /\�
% $0:00 �0 :�S'. /J � %-� �- . �✓,� �
���� : j$0.00 \01\ �` �,,�� � ,'� 'Boilers � � :' ,��/� �� v�
� � $0:00 0V�� � � � /
�1 / �� ��� �, �Up to 3 hpc�, � / ��/�,. .
- � $0.00��0 �` _� � `�.= � �-:,3 To15 hp ��- C���iJ , v ,/�
� ;\ �50.00 i0 /� -__ —�15 to'30 hp � ; .l�
����$O.W�iO���%��,� 30;t050�hp��� �. ����%i �
�� $0.00 0� �� 1 �_i a�' l�� Over 50�1ip l t v.� %/��
�$000: �0 � ��._, � � ��OtheiMechanicalFee-jiij
$0.00�: ti' �, _ - � ` ��� � • Investigation Fee �/i ��
� � �- _ - �" • • � PIan�Check Fee�.-
` � `' -,�!� _'���Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
�
- � � ', , ;,�� .
i: ,
,,
; , _` 4uantiry"
1,;�'�s6.00 o r;};
��, � $0;00_� �0 �i I �
�� i $0:00�� 0. ���
��/ -$0:00� 0 �, /
�/ � $0:00� 0���
' , '$0.00 �0 '
� � ���'�
$0.00 -i/ 0
��-. $0.0,0�0
� . 50:00 0
�$0.00 0
/i $0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
E3a.25
EXPIRATION: This permit shall automatically explre and become void if work is not commenced wlthin 180 days, or if work is suspended or abandoned
for a pariod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such vrork must comply with all epplicable codes, and ell
requlred Inapeetlone and finel epprovel must be obtained. Failure to obtain Inspections and final approvel will result In the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 75Y5828
WORKERS'COMPENSATIONDECLARATION: , .
I hereby attirm under penelty of per�ury one of Ihe following tleclaratlons: ' � �• �
� I heve entl wlll mainteln a certlflcate of consent ta seM-Insure for workers' compansatlon, es proNtled for by sedion 3700 of the Labor Cade, for ihe pertarmence of t�e
�_/ work tor which INs pertnit is IssueO.
j� I heve end will melMein workers' compensetian insurence, as required by seMion 3700 of �he Lebor Cotle, for ihe perlortnance of ihe woAc for which �hls permlt i9 issued.
M w ers' m %� tlo�n Insu�r�e1n rtier entl pQliry nu er ere: / '/ �
Cerrier.y . A�.�l_�F.fwvYJ�V�S_ '�'li PolicyNumber. �E'� v�
(Th/s secHon neetl nof be comp/e(etl fhe pertnit is valu6 et one %lundred dollers ($100) or /ess.)
❑ I cerGly ihet In ihe pertortnence of ihe work far which Ihis pertnl� is issued, I ahall not employ eny person in any manner so as o become sub�ect to the warkars'
campenset�p ews of Celitomla, antl agree ihat it I should become sub�ect to t�e workere' compensetion provlslons of Sectl 370 of Me Lebor Code, I shell fonhwlt�
� ns.
/lpplicent Signeture: - � te: .
WARNINO: F TO SEWRE W KE0.S' Q7MPENSATION WVEMGE IS UMAWFUL ANO SNr1LL SUBJEGf AN OVER TO MINAL P NALTI S AND CML FlNES UP TO IXJE HUNORED
DOLURE (5100,000�, IN ADIX710N TO THE CO6T OF COMPENSATION, DAANaES AS PiqVIUED FOR IN OF THE L�B(Xi CODE, IMEREST, AND ATTOqNE1"S FEES.
LICENSED CONTRACTOHS OECLAHATION:
I hereby aflirtn Ne� I em Ilcensetl untle1provisions M
force a�d. Lic. M
with Section 7000) of D'Msion 3 M the
Catle, end my Ikense Is in tull
CQNSTFiUCTION LENDINO AGENCY:
❑ I hereby eHirtn t�et Ihere is e construction lending agency for the peAortnance of Ihe work for which this pertnil is issued. (Sec. 3097, Civil Code).
Lendar's Neme:
Signeture: _
Lenders Address:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby eftirtn ihat untler penelry of perjury thet I em El(EMPT PROM THE CONTRACTORS LICENSE LAW for Ihe following reesan (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which requires a pertnit to consiruct, elter, improve, demolish, or repalr eny siruqure, pnor to its Issuence, elso requlres ihe epplicent for such permit
to flle a signed stetement Ihet he or s�e is Ilcensed pursuent to ihe provlsions at �he Conirectore Llcense Lew (Chapter 9(commencinq with Sectlon 7000) ot Dlvision 3 of the
Buslness end Prolessions Cotle) or thet he or she is e:empt theretrom and the basis for Ihe elleged exempllon. My Ndation o1 Section 7031.5 hy any epplicant tor e pertni�
sub�ects the eppllcant to e Gvll penalry of not more Nan five hundred dollers ($500).):
❑ 1, es owner of the property, or my employees with weges es ihelr sole campensation, WILL DO THE WORK, and the sVucture Ls not intanded or oHeretl for sele (Sec.
7044, Business and Professions Cade: The Coniractors LJcense Lew does not appy to an owner oi Droperty who builds or improves Nereon, and who does such work
�Imselt or �erselt or Ihrough hls or her own employees, proviAetl thet such Improvements are not intended ar offeretl for sele. If, however, �he bulltling or improvement is
sold within one year ol complellon, the owner-builder wlll have tha burden of provinp that he or she tlitl not Dulltl or imprrne far purpose of sele.).
❑ I, es owner ot ihe properry, am EXCLUSIVELY CONTRACTNG WIiH LICENSED CONTRACTORS ro construa the pro�ect (Sec. 7044, Business entl Professions
Cade: The contredors License Lew does not eppty to en owne� of properry who bulltls or Improves thereon, and who contrects for such pro�ect with a wntrector(s)
Iicense purouant to the Conlractors License Lews.).
❑ I em ezem0l unOer sec.
Signature:
Owner ID vertlietl by dtivels Ilcense. ❑ Yes ❑ No
Business and Professlons Code for this reason:
Vedficetlon of Ownership by (type o1 document, I.e. - property tex 6111 or tleeA):
DrNefe Ucense No.
Dete:
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFlCATON:
❑ I hereby certlly that no excevetlon Me (5) or more feet In tlepth Into which e Derson Is requlretl to descend, will be metle In connedlon with work euthotlzed by thls
permit, end Ihet no building struclure, scaHalding, felsework, or demolitlon or dLsmantling thereat, witl ba more than ihirty-siz (36) feet hlgh. (Chflp. 32, Grp 2, Art 2, Sec.
341, T1Ue 8, Celifomia AdminisiretNe Code).
❑ Aa owner-builder, I will not employ flnyone ta do work which woultl require a pertnit irom ihe Dlvislon of Industriel Sefery, es noted above, unless such pereon hes e
pertnit to do such work from ihe division.
Signature: Date:
DMsion of IndusMal Satery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORQATION OF EMIAY: I certify under penalry W peryury thet 1 heve read this epplication end sleta Ihet the Infortnetion given is
corred. I epree to comply with all state laws and ciry ordinences releting to 6uilding consfruction, antl euthorize representetives ot the Ciry of Coste Mesa to enter upon the
ebove-dexribetl property far inspectlon Durposes. I egree not to occupy or allow occupenq oi eny building authorized Dy Nis permit until tinel inspection.
LODE �. INSVE[TONTYVE QAIE It11ID�L8
1616 Flzed System Flnel Fire Prevention
1288
P00
201
202
203
204 ;
zs4a4e
Pool Spe Flnal
Flnal Re�Roof
Final BIocWReteining Wall
Flnel Fectory Pire Plece,
Flnel Sipn
Finel Demolitlon . ,
FQJ�j IXSPELTIONTYPE 1
\
208 Finel Mechanicel
20B Finel Plumbing
210 Finel Electdcal
272 Flnal Fre Preventlon
220 Finel Plenning Approvel .
Y22 FInalSite
250 , Final Buliding/Occupancy . _
0
(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3545 HARBOR GATEWAY S
Suite:
Vicinity: ROOF
Parcel Number: 4`I507108
Zoning:
Applicant: LARRY DORMAN
Adtlress: 2550 E MIRALOMA WY
S7E 100 . Phone: 774-632-6929
ANAHEIM, CA Zip: 92806
Owner: C J SEGERSTROM & SONS
Address 3315 FAIRVIEW RD �
' Phone:
COSTA MESA. CA � - Zip: 92626
Contractor: MESA ROOFING CORPORATION
Address: 2550 E MIRALOMA WY
S7E 100 ' Phone: 714-632-6929
ANAHEIM,CA
. Zio: 92A06 liCense: 564151
Arch :
Address:
Phone:
Eng:
Address:
Status: ISSUED
Applied: 11/17/2004
Issued: 71I17/2004
��� a
�: ��
Phone:
- Zip: � License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 4 PLY-CAP SHEET FOR COMMERCIAL BLDG. 228 SQUARES.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other.
Inspection:
' Total:
$0.00
$748.75
$0.00
$13.65
$0.00
$0.00
$762.40
SETBACKS , "� � °
MAIN STRUCTURE Front 0- 0 ,�� Rear 0- 0
�, . �
ACCESSORY � -
\ Front � 0. 0 _ . Rear 0. 0
PARKING Exisunq: 0 Reaui2d: o
NOTES:
FEE SUMMARY
� Calc Vatuation:
� Claim Vatuation:
PLANNING R ZONING
Left o- o
Left 0. 0
Pr000sed: 0
� �
, ,Righl" .0, 0
Right � 0. 0. � .
$65,000.00
$65,000.00
r
INOTICE: The work authOdzed by ihis permit shali comply with all applicable handicap access requirements under Calitomia statutes and ralated
regulations. (Ord. No. 9248, § 1, 12•21-92)
EICPIRATION: This permit shall automatically explre flntl become void II work Is not commenced withln 180 days, or if work is suspended or abandoned
for a padotl of 180 days.
INSPECTIONS: In order lor the wark authorized under this permit to be considered legel, such work must comply with all appllcable codes, and all
requlred inapeetlone and final epproval must be obtained. Failure lo obtein Inspectlons end final epproval will rasult in the expiratlon of this permit.
FOR INSPECTIONS CALL: (714) 7545628
asaee Ia�oO)
WORKERS' COMPENSATON DECLAHATION: � • ,
I hereby eHirtn under Denalry of perjury one ot t�e lollowing Oeclaretions:
❑'I have end will malNain e ceM1iticete ot consent to selt-Insure tor workers' compensatlon, es pmvidetl for by section 3700 of the Labor Code, Iw the peAartnance of Ihe
work for whlch thl9 permli Ls issuetl.
7 heve end will malntaln workers' campensetlon insurflnce, as requiretl hy sectlan 3700 af Ne Labor Code, tor Ihe pertortnanca of Ihe work for which Nis pertni[ Lq issuetl.
�MY workera' com0ensatiarWisurance tarder antl oolicv number ere:
one
�IfcyNumher�'`-�0 -QS/ (/Ni / OOG� �Q Z
-- . . . . _ . orlessJ �
❑'I cenity Ihat In Ihe peAortnence ol tha work for which this permit Is Issued, I shell no� employ eny person In eny manner so as to become subject to Ihe workers'
compensetlon laws ol CelHarnla, enC egree thet if I shoultl �ecome sub�act to t�e workere' compensation provlslons of Section 3700 of lhe Lebor CaCe, I shall torthwlth
comply with these Isions. �
L
ApPIiC6nl.Signelure' ' �� f i%7/liLN rDele: � ��
WARNIN(i.FMLURETO SEGURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT M' EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE NUN�RED
TYIOUSANO OOLURE (5100.000�, IN ADDfTION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SELTION 3]W OF THE tABOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECIARATON:
1 �ereby eMirtn Ihat I am Ilcensetl untler proNslons of Chapter 8(commencing with Sectlan 7000) ol DlWslon 3 of the
SlqneWre:'
Cade, end my Iicense Is In tull
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirtn thet Ihere Is a canstruction lentllnp epency lor the pertormance ot the work tor w�ich NIs permit is issueC. (Sec. 3097, Civil Cotle). .
Lendels Name: Lendefs Address: '
Signature: Date: �
OWNER-BUILDER OECLARATIONS:
1 hereby eftirtn thet under penalty ot perjury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu entl Prolassions
Cotle: Any ciry or counry which requires a permit to conswd, elter, improve, Aemolish, or repair any structure, pnor to its issuance, also requires the appliwnt For such pertnil
to file e slpned stetement that ha or she u Iicensetl pursuam to the pmNsions ol the Contrectors LJcense Lew (Chapter 9(wmmencing with SecUon 7000) ai Divislon 3 ot the
Business entl Profeuions Code) or thet ha or she Is e:empt Iherelrom end t�e basls for t�e alleged exemption. Any violetian at Saction 7037.5 by any appllcant tor e pertnit
suDjects tha appliwnt to a civil penelry ot not mare than five hunOreO tlollars ($500).):
❑ I, as owner of Iha property, or my employees wl�h weges as their sole wmpensation, WILL DO THE WORK, and Ihe structure is not intenCeG or ofterad for sele (Sec.
7044, Business and Protessions Cotle: The Contractors License Law dces not appty to an owner of properry who builds or improves t�ereon, entl who does such woAc
himself or hersetl or through �is or her own employees, provitled �hal such Improvemenis ere not intendetl or oHeretl tor sale. It, however, the huilding or Improvement Is
soltl within one year of wmpletion, �he owneo-huiltler will have t�e burden of proving that he or she tlitl not build or improve for purposa ot sale.j. '
❑ i, as owner of the properry, am EXCLUSIVELY CONTBACTING WITH LICENSED CONTRAC70RS to consiruct the projea (SecJ044, Business antl Professions
Cotle: The comractors License Lew Aoes not eppty to en owner oi property who 6uilds or improves Iheraon, and who contracts tor such prqect wlth e comracmqs)
licensa pursuam ta the Contrectors License LewsJ.
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID venfieC �y tlnvers license. ❑ Ves ❑ No Orivers License No. Eapires:
Verification ai Ownere�ip by (rype ol documenL i.e. - properry tac bill or tleeA):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICA710N:
❑ I hereby certity ihat no exravatlon Me (5) or more feet in tlept� into w�lch a person Is required to descand, will be made in connection with work euthorized by this
permit, entl �het no bulltling siructura, scaMoldinp, falsework, or demditlon or tlismantling ihereof, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2. Art 2, See.
341, Tlile B, Celifarnia AtlmInlSlrelive Code). �
❑ As owner-builtler, I wlll no1 employ enyone to do work which waultl requlre e permit from the DlNslon of Indusiriel Sefety, es noted ebove, unless suc� peraon hes e
permit to do suc� work from the diNsion.
Sipnature: Date:
Divislon ol Intlusirlel Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUiHORPJITION OF ENTAY: 1 certily unCer penalry of perjury that I have read this epplication and state t�at Ihe infortnation gNen Is
correct. I egree ro compy with ell stete laws end ciry oNinances relating to building constructlon, entl authodze representatives oi the Ciry of Costa Mesa to enter upon the
ebove-0escribed pmperty tor inspectlon purywes. I agree not to occupy or ellor, occupency of eny building euthorized by this pertnit until final inspeclion.
CQOE 1, INSGECiIONTYPE
1676 Fized System Finel Fire Prevention
1266 Pool Spe Final
200 Finel Ra•Root
201 Flnel BIocWReleining Well
202 . Flnel Factory Fire Place
203 Finel Sign
204 Final Damolltlon .
PdIF It�ELS
f
m � i%
/��
�E,( INSPEC710NTYPE
206 Final Mec�enical
200 Final Plumbing
210 Final Eledncal
212
220
Final Fire Preventlon
Final Plenning Approvfll
222 Final Site
250 Finel Building/Occupency
PLIF II{�LS
�ONESSOiBNLOPIO: UNT: � �l��p(�Y �
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�foanp rsevon (Swion lW 1.5 &unn� md FMmvm� CaJe: MY W a`� uM' Yhirh �p�'mu e v�Y �o mrowct. ed«.'vn0�ore.
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viamrim. coe.: m. com�eem u�wu. �.�. ao.. m ewN m en o.,w a o�w�r w,o ewie w u�wo.s+ maeon w wno
mweeu la wM peqWs xiih e mNrada(e) IcrueA pwsueN lo IM CaMratlar� lisue Lew).
� I em memq indx Seclbn: B. 8 P.C.. tor this rmaon:
Dne: �++�
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/Lvmoenution aowioro W Setlbn 3'!W d IM lebor CoJ�. I du0lonhv.HA wmoN •eM1 tlww pmvme.
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LENDER'8 NAYE:
LENDER'9 AUONE44:
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r CONSTRUCTION AND PLANNING � � POOL & SPA
�. APPROVALS Permit # � Date Inspector qppROVALS Permit # Date Inspector
.
'l�,TemDorBry Electrical Service or Pole 52. Poot & Equ9pme�t l.ocatioo
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit UtilityUndrgrnd. 54. Forms
4. Electrica� Conduit•Undrgrnd. - 55. Electrica� Bonding
5. Steet Rei�forcement 56. Rough Plumbing & Pressure Te:t �
6. Electrical UFER Grnd. 57. APPFOVAL TO COVER-GUNITE
7.� Footings 58. Eluctrical Conduit�Undrgrnd.
8. Foundat�on 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe•Undrgrnd. - 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System ' 67. APPROVA4 TO OECK .
� 17. 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 6lectrical•Conduit .. � 66. Solar System•Final .
16. Rough Electric Wiring 67. Fencing.& Access Anproval �
17. Rough Wiring Sign . 68. APPROVED FOF PLASTERING �_
78. Rough Electrical-T Bar Ceiling . 69. PQO�(SPA SYSTEMS FINA�
19. Rough Heating & Air Co�ditioning . FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPFiOVALS • Permit�# ,
21. Ductt, in Structure ,�� � - � 70. Underground Hydro
22. Ducts, Ventilating �� 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . . 72. Undergro�nd Flush
24. Roof Fr3ming _ - ' 73: Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing '� � 74. Overhead Hydro
26. T-Bar Cei�ing (Structurall & Monocoat � 75. Dry Chemical � �
27. Frame and Flashing - ' ,�//,/� 76. Dry Standpipe
26. Lathing & Siding � � 7�. FIXED SYSTEM FINAL
29. Insulatio� ' � 78. FIRE PREV. FINAL �
30. Drywall Nailing -%%'J �� HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat ' 79. FINAL INSPECTION
32. Electricai Power Meter�Finai � 80. FOOD CER7IFICATE ISSUED �
33. Final Electric. .� . Notes: /L Y y7 ��U� ,
34. Final Heating & Air Conditioning � Z�l �'� OY ` •
35. Final Gas Pipe•Test
36. Hood or Canopy , � �.-'.
37. Finai'FactoryPireplace ti,�
- 38. Final PlUmbing . . � _ �
G"
� 39. Water Se�vice•Final � - , ' '
40. Gas Service-Final � '�
41. Solar pomestic•Final •
42. 8ackflow Preventer .
43. Backfbw Irrigation '
44. LandscaPe Irrigacion System � � -
45. Sound Attenuation '
�
46. Handiwp Regulations �
47, FINAL STRUCTURE & BUILDING ��
48. FINALPLANNING
49. Electric Release to Edison �
50. Gas Release to Southern Calitornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
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LENDEfl'S AODRE99:
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CIIY OF COSTA 6tlESA
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%�CONSTRUCTION AND PLANNINGr , POOL & SPA
• 1APPROVALS Permit # � Date Inspector qppROVALS Permit # ' Date Inspector
_�
1< Temporary Electrital Service or�Pole 52. Pool & Equipment Location .
i
2. Soil Pipe-Undrgmd. ' 53. Steel Reinforcement �
3. Electriwl Conduit Utility-Undrgrnd. 54. Forms '
• 4. Electrica� Conduit•Undrgrnd. 55. Electrical Bonding ' --�
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test •
6. Electricai UFER Grnd. 57. APPROVA� TO COVER�GUNITE
7. Footings. ,, 58. Electrical Conduit�Undrgrnd. �
8. Foundation ' 59. Gas Pipe, O Undrgrnd., Test '
9. Water Pipe�Undrgrnd. 60. Backwash Lines,P-Trap, ❑ drgrnd.
10. Structural Floor SYstem � 67. APPROVAL TO DECK �
i t. 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 Piumbing . � ' 65. Electrical-Final
.15. Rou9h Electriwl�Cooduit : _ , , , $p{ar System-f'ihaV
16. Rough Electric W�ring . l/ /�q' 7. Fencing & Access ApProval
�-Ll�-iL
17. Rough Wiring Si9n , - 68. APPROVED FOR PLASTERING �-
18. Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS fINAL
79. Rough Heating & Air Conditioning , . - FIRE �DEPT. REQUIREMENT
.� -
20.� Rough Factory Fireplace - � � . � �. APPROVALS' Permit #
21. Ouccs, in Strutture , ��� � � � . 70. Underground Nydro
22. Ducts, Ventilating _ " 71. Product Piping.�Gas OOiI
23. Gas Pipe-Rough � Test , - � ,, � � � 72. Underground Flush � �
24. RoofFraming � � � )3. Undergrnd.StorageTankOGas ❑Oil
25. Roof Sheathing , � �. , 74. Overhead Hydro,-
26. T-Bar Ceiling (Ssructurell & Monocoat •_ • - 75. Dry Chemical '
27. Frame and Flashing, '� � , 76. Dry Standpipe , . � �
28. Lathing & Siding � � ' ' � � � � 77. PIXED SYSTEM FINAL � �
29. Insulatio� r' ,_ �. � 78. FIRE PREV. FINAI �
30. Drywall Nailing � � • • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat; ` '_ ' ' 79. FINAL INSPECTION ,
32. Electrical.Power Meter�Final 0. FOOD CERTIFICATE ISSUED
33. Final E�ectric ' Notes: - �� ' �
34. Fina� HeSting & Air Conditioning r �. `� '-
35. Final Gas Pipe•Test ' . ' , � ' � < � =
36. Hood or CanoPY . , � . ; .. ' .
37.'Final'Factory Fireplace � ° '"' , � 1
38. Final Plumbing � _ ' � �
f�
39. Water Service-Final' � - . � � . - �
40. Gas Service-Fina� - . � � . .
41. Solar pomesticFinal � � �• ' � �
� �
42. Backflow Preventer . � ' , . - .
43. Backflow Irrigation ' '
44. l.andscape Irrigetion System � � - -, . � � •
45. Sound Attenuation • ' �
46. Handicap Regulet�ons . �
47. FINALSTRUC7URE&BUILDING � -
48. FINA�PLANNING . .
49. Electric Release to Edison •�
50. Gas Release to Southem Catifornia Gas Co � �
51. CERTIFICATE OF OCCUPANCY
No. Dace
�oonasaeundxo:. ]�v� xAttHVx eSLG-�/r,�•
o'mErc�yUYEIFIWMY�C J SEGRESTROMS
� � f ' ��COSTAFMESAIECAR92626
.
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wcx ox e�a•s �noxffss:
uc. no.:
uNr:
7
c�aar5ru� C0 WELL CONTRACTORS INCOR U14 ) 722-2880
����� 2240 UNIVERSITY DR
„�� NEWPORT HEACH CA ucra.: 514982
92660 �,�: 150
IJCENSED COMpARORS OECLAX�TION: 1 Mmby ellfm uds pe�Wy d pmjury tlet I mn fcwisd under prw�iao d Cheqx 9
(cammenaiq xiih 5e��ion ]OW) d Oivision 3 d IM Bueinen uq Pmleeuma Cada, ud my Iqmae a in INl lacs eM eNed.
cm c.r+o.:0A�2/920 uc.cuss:B ucf.�No.:514982 l,E,X�P• /�07/98
oma: o'-n com�a«: ���X�,.IX )
auaoex oeeun�non: i nawv �� wa« a�r a inm i� a�q mm m. wm uo�,a �w �> m.
IaYoxvq nnpn (SMlbn lW1S &aneaa end Pralanbro Cotle: MY JY a mwly Mi[� �aq�um e Ve�� to mvbud. P4x.'vnVwa.
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'v licemetl W�ent lo IM >wieiam d iM Coniredae licaroe lew �CMqer 9(�mmiiq xil� Sodion ]000) d 0"v'nbn J d the
Wei�rea erM Rde+s'vu CaAeI a ihet M a ehe b axemq Ihereliam eM �he batis ta tM e1b0� exemqion. Am' viobtion af Seaon
roat s M env roW�uni �a. v�n siApn� �ne eod'e.m �o. wd pe„e�ry a na ma. �h.n r. nw�dne emen �swop.
❑ I.movmardlnepapeMamY�dW��hwepaseaiheieoboompemmim.mlldotMxark.arMlMslructureeiatimmded
or olleraA la e� (�Ibn ]Oad. Binimv eM Proleesione Coda: The Convaqws Licuwe Lnw Eoev mi epplyto an ovmarol Drope�y
who Wide v YnVo� �Mreon. erA Ma Eom �uM wak h"unmtl rc ha�M a Nraph hc a her oxn smDM�. p�� Ihet euc�
imP��eeu ua mi imardad a aflseC la ub. !. Mwewr. �he dupinp a inpaa^an u eold wnhm ans Ym d eam0�nn. iM
own..ti,'aa....m n.,e m. cvm, a v�orvw n. « d.e m �a wue «imaw. �« n» wwa• a w.f.
� 1. m oxner M Ila D'W�Y. am uduervely oonVadYq vNh lioan9ed convacron ro ca�etruil IM pNa (S«tun MM. Bwwsa eM
Pmleaime 0�: The CaqreCm licanee lew doee nol aDd'1 m en ovns d V�V^�Y wM bu� a'urymw iMew� entl Wo
mntrecb br Mdi D�N�� wh a mnmtlaP) lir.amad W�+� �o IM CoNndm lioeme LerA.
� I an axemq N�der Sec�io�: B. d P.C., lor tliw ree�on:
Dde: �*KK
� Eo Mraby cMM �� I em eware d aM uMenteM Me ieyuiremenb d Cd/omia Heellh eM Selely COEe 9sqion� 25505. 25539. eM
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WOPI(Efl'S COMVdS�T10N DEC WIATION: I hareb/ dfum �uder priMy d prpry dr al the bOOMiq dedvetiom:
� I heva uM wiY �nten e cenifraia d cwnem to �eM-inwn br xaksn' compenu�ion. n pwided la Ey Satlian �)00 d iM labor
Cada, lor �M p+�ame�re M Me wak �ar w1Jch ihie pa�mu e iaeued.
• 11 I hm ud xiY mmruen wvkna' mnV�+�ion Imureme. m nC�'usd W Swim �]00 d Ihe Lebor CoM. br tM OM�^�b^ d �M .
7�' work In whiM Ihn Wrmil ia imued. MY wakan' com metbn inw�erica umr eM W�Y number ero:
c�»�: ST�TE FUND EXPIRES
vwry r�n« - S O/ O 1/ 9 8
Ti, s.a:m mad ro/ es comd.�� r w ro+�/ u ra a» nulMnd do0u. lslaol n wa.1
I cenh � M�h^ O�o^^�a d IM wwk la whch thu {rme b iaaiwtl. I Me0 M ampby e�y paaan A ury meruier eo m lo
abjW lo iM xohms' miwnwbn k�w d GlCartie. W ap�w UW A I�hwdd beeome wEjw �o tM �wrken'
••^t p�'uion+ d Smian 9)00 d iM Lebor Coda. I ehap IaNrA� mmpy Mth qwmm�.
�.�,: � AadK��: ��� �
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9nu i.p b oM ��� thouwp do/Nn /}IP4000J, M M11tlon b th� cwt o/ rompewtbM1 Gmep� u pov/Wtl br In
consrnucnoN �.F++mNo naewcr: i�r .� wb.. o�M d oawr �nr m«s e.�m�w� w�mp .o...y m. n»
pen«maMe d ine .�x m. wnitli Na o�� u ew.e (swiw, aon. cw. cl.
LENUEN'S NAYE: .
�pIDEF'S AODPE55:
I cenify Ihq I liew Me �M10 eppliraiion eM nma ihm iM ebova iMormetion b cortep. I ap�ee Io oompy wn� NI rdy vq counry adinarioes
� endatetelexvreleti�ptobuildin9conslrudioneMherabyeNhorixerepreeemmivaedlhietltyloenteruponlheebovo-menibnedpmpa�ty
j ��"spBtl�'W`D°"'f[ATHLEEN HYTZEL
Dme: ��/�a
(StSteB.WP) WMe-9uiW�q 6 Selery: arrrFk: Ceiwy-Appirant: Rnk-Ra.enue:OddenioC-Mroewr
__ . CITY OF COSTA MESA -_BUILD.ING PERMIT_:
PERMIT NO: B 087129
PLAN CHECK NO; 00529-98 A
CONS?RUCTION TYPE: IIZ-N PERMIT TYPE: STR
JOH DESCRIPTION : 6650 SQ FT INTERIOR T.I,
CLAZM VALU£;
- - �
PERM NO: H 087129
GOVT: N SUPP: N
PURPOSE; ALT
SQ FT: 87,000
87,000.00 CALC-VALUE: 87,000,00 GROUP OCC: B /
COMMENTS: HUCKLEY FRIEDMAN
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Z O N Z N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT ZN REAR: FT IN FRNT: O FT •IN REAR: FT IN
LEFT; FT IN RGHT: __ __ FT IN LoFT: FT IN RGHT: FT IN
PARKING REQ: PAOV:. PARCEL; 41505104 ZNE: PDI REF NO:
PLANNING NOTES> TENANT IMPROVEMENT FOR OFFICES; INCLUDES 4 SKYLIGHTS,
% ;�
ifkitikififMikifkififMlEiFMikiEMk1f1k1EiFifiEMlFifififMiFiliElkiflEifltiFMlFifiE�Fkifkll'MifififiFMlFif%iFMkMMiE1(�*ifikiElfifikiFikiF�lFkik
D E V E L O P%M E N T; S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY �' : �Cit DATE; y
BUILDING APPROVED BY�: —��A DATE: ' I� �
APPLZCATION ISSUED%BY: DATE:
Mi1�MiEiFikififMMikMiEM'lEiEififMMMiF MiEifMiFlEfFMikfk 3EM
LEGALZZATION:N F E E__ S U M M A R Y STRUCTURP.L SEGMENT;Y
HLDG PMT PLUMBING ELECTRIC �'MECHANIC FIRE SMIP/RES', GRADZNG
PERMIT 806.00 �'• � :
' � SMIPJNON-R£S
PLAN 130.98 lg,Z7
ISSUE FEE J � i , � � �
BUILDING-DIV-> PERMIT ISSUE PL'AN-CHECK� TO'fAL PAID pUE
TOTALS----> 824.27 0.00 130:96% 955.25 955.25 ,00
REVENUE DIVISION TOTALS--> COLLECTED;'�-: 824.27 OVER/SHOAT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC '� FIRE SMIP/TOT GRADING PLAN-CHECK
806.00 ' ' j. 18.27
M k ik if ik ik iE M 1f Y it M M aF iF iF iF it if 1f M if ik k iF iF'!f k iF k 1F iF iE ik�if if_iF if if ff 1F M ik ik iF M 1E 1t if M iF 1f M M iE'k if M ik 1F M iE if iF 1k ak ik M ff i! M iF ik iF 1f 3k iE iF if
I N D I V I D U A L' F/E E'; B R E A K D O W N
�, .
TYPE QTY D E S C R I P T I O�N � UNIT COST TOTAL COST
. i •�!
SFC 87000 ALTER BY VALUE COMMERCIAL'y N020NE 1.00 87,000.00
END OF FEES
I' �
82-2fi-199B/11:84 NNlf824.27
RCDTp:01-6�1cdIB0
fsi129
1_
� . __ , , � --
-y �.
�ONSTRUCTION AND PLANNING • ��� "'Aa
. `�'�4PPROVAL5 Permit # � Date Inspector qppROVALS Permit �k � Date Inspactor
1. •�emporary Electrical Service,or Pole 52. Pool & Equipment Location- ."
n�2'.:Soil Pipe•Undrg�nd� � 53. Steel Feinforcement
-.,��CElectricalCondutvL.i�ility-Urnirgmd. 54. Forms � � �-�'.
"� `•U 4'�lectrical Condgrt�l)�drgrnd. 55. Electrical Bonding "7
r•;:�
'��u`.;j.Syteel Reinforcemgn't . 56. Rough Plumbing & Presture TeSt 5
" --
'�'� SElectrical UFE'��r�d. 57. APPROVAL TQ COVER-GUNITE = �.
�'1 �� .J �� �1
�j�.,�Footings �;�;; 58. ElectricalCon�ii'�`�Undrgmd.
'%'$. oundation ^E- 1 59. Gas Pipe, O Uxtlrgrnd., Test_. � -�
9.;.�Vater Pipe•Un�nd..�'',' . �. - '- 60. Backwash Lin�,�-Trap, O'Undrgrnd.
10 �TStructural Floor Svstem �� ' , 61. APPROVAL T�C%i DECK
11. Property Sewer�in�& HouseConneciion 62. Backwash & Receptor-Final ,
12. Sewer Cap ,� N 63. Heater & Vent-Finai ,
;'�3. Roof Drains ;, � 64. Plumbing System � Final .
�4. Rough Plumbiq8 �, y• 65. Electrical-Final '
•i5. Rough Electricaf-Co�aduit ^ � 66�. Solar System-f"�i -
6. Rough Electric`dUiri�j'g;� � ' � 67. Fencing & AccasaApproval '
c��.17. Rough Wiring Sign c� 68. APPROVED FnJ�7 PLASTERING
�
18. Rough Etectri�-T Bar Ceiling 69. POOI/SPA SYSTEMS FINAL
19.�iiovgh Meati(tg F{Air Conditiotrinyg cr� +- [G 6i:'- a q��p7�yEQU1REMENT �
20.�iou�h F£ctd� ��lace "r' �� * S�'-"�` n APP�O�kACS''F" p��mit # � " n
� T � Lr � . u� '{: i"1 `] `i ii .'�� J� ] C� ' i�'.'� ��
21.. u�,inr!$tiuctu�x � � i� �. . '+ ^* � 70:'Vnderyrae"rr3d �jdro ;
-. c� w -
22r u<�s, V ntif"�tin * � �J x C ¢ [J c-�* C � � . .." � . x
. , ..�� .� 4:� cC ,Y r r.j: �. 71. ProdU�cf�'ip�nc�'?�as p Oil ,� �
23. GavPipeJRo�h Eyy�est j-t� QO � x 5�: O 72. Undergro�d Eiusla'� � ��
24. Roof Fr�ming X,� 1. .v x,*, [r p N� S 7�o„Un�(grgr�nd.Stq};�an� OGas OOiI
.x �� � ���,. ��� �
25.�too''�Sh'€ath�ng r;x ...; t� n 7�x 74.'tOvcthead Hyd�l�' t�
26.�-Bar Ceiling (Su'uCturall &.Mon�coat r• x � y T� �G. h� al �
� m t O %� �K }--�i�. �Y`�C ,2(J,j,7� Oi v 5 M Ey-
t�
: 27 �ra¢�ead�1 FYash�,`. �,-,j�; � 5�?/i?�� �,x 76. Dry Sta�ipipt�ti r_: N -.
� 28. LatMingr&5���9Tin �S� �� 4� ; � � 7�. FIXED��YST��,�FIN/�rL"�' �� jT',
' 29. Insulation o�x: s C. C x � � I �r: 7E. FIRE PREV. F-0tx4L �: "� >
.. 30. DrywallFNailing x^ . • �3r�^� � �` S NF7fAL�Pi DEPT.AE�UI�EMENT
i ^
r. il �� I i�'f�' iT1 X 4 � [. �� .
; 31. Plasier 6cpwCtCoat� �:,:, E* �,. � 79. fINAL�SPEC7�ON .r: p H
. ��----!.
-32.`EleTMtricat•Po�� Meter�F�al � -� �, ( I �+ Sa. FOOD C,�,.FRTIF=ICATE aSs�"UED' �
� . , �s � - �; � i: - � / �/ � . `� �i �S�.� �
r� 33.-Fin�El¢ytri� x,;; � �--i �= : c � i. � -otes:3/Z%�'D',:,�1� /r/���' !/ .. G✓O'//�
34.�ins1 He`azin�& AinCm�ditioning iT±r � � � ' �r � r-�( �-r• -� r: �.
.- ,z -. # ,�. Ol�, - � �rS k rr ClU
�-%
35.�in�,l Gas,Pipe-TestK ^'.� ���'�r• i � � ; � �M_I/��'Y /v'~� � .
% r.�, �J
36.�ioQd or CanoPY s JC`. ;'r.�n •.. y� � i �* .3i�%8 �/y�.✓t v m �/!✓
Fire i �-r-� at-! �: . � : x f "' :u
37. 'Final'FactorY P� V?"� .. .. r�!U �: ni .� �� t:.: �,' � t* � 5
� 38.�in2kPlumbing Y p7,v � C� o :r. .. i • � � -�r :: ...,� * y :n �
�. 4 - n cn•r: s �
39:�Water Servic�inal� � ' � '^ t °J " �
� �' '•i: � i-;V r M r:,
' � 40.-�'.�as Service• inal ,� " -;F;, �� ' ,: �: . c, E ;: �
� � K
� 41. $olar pomesf+c-Fin�i m '" 7� j �" � � �"" �' � =
E. �.' x[-., ti S C3 .k .^. 1 � r. �J i-+ .fi S
42. Backflow Prev,�nter;; n; p_�: r-�ia. 'x. r� � � �R ;; ;Tl:�:n !' � F
,�3. Backflow IrrjSation` �''` `� '� �` �' • �^ * � '
= c, G �: y: , ro ;: 3 ,�
�44. �Landscape Irrigatioo Systerr� 4�� t� ;��� �i Q K x~ E f U C x :Y s,
45.-5ound PEttequation� V �"' $� �; ^ �� � '�r. ; ^ C-� �t^� F� �
- ,r / / ;u �-�N ••H �K
l '� � �
J :"'
.46. Handicap�Reg�latioqs s - * � i � � -� ;,;.. n �
'1 �' 4'
�.�t7.NINALSTRUCTURE&BUILDIrtN,G .'G l,.gi �-i'' � ,'`�'7 * �� � '
t
48.�IffF�LPLANNINCx . �r� x•:� i �.C' ,^.� �^: 5 - ¢' �•
�.�; "r: �- � ., .,
=49. Electric�Releaseto Edison k C - f� ` � '�1' ° � -
% a: � "� • .I� � 'J : �
.�0.'Gas�Rel ae se to Southern Cali4orriiaGas Co ;� - - <`. ,� � o �ii x ,`v o
�51. CERTIFICATE OF-OCCUPANCY
No. Date
" s
�oonasaew�ou+c 3545 HARHOR •'aiGO�iMk(y 50U%� �NT� 102
aru�Ei�a�m C.J. SEGEkSTRUM & SONS FLOOD: AH-37
, �� 3315 FAIRVIEW RD
/� COSTA MESA
92626 (714)596-0110
,` . Yuimo �ss:
,�acxrt�cr on v+aamin:
uc no.:
uxr:
c«+m�,crarsru�: CO WELL CONTRACTORS INCOR ( 714 ) 540-3771
cwm�croxs�uuxo 2240 UNIVERSITY DR
wo�u NEWPORT BEACH CA ucra.: 514982
92660 uxr 150
LICEN9E0 CONfRACTON3 DECLGflAT�ON: I hereby efl'rm under penetly d pe�jury ihet I am I'renaed undx paneioro d Cheqm B
(mmmanaM hil� Seciion )000) d Oivoun 3 d ihe Buriroa eM VNeeeians CoEe. erd mY lienee u in tu0 d eM aNetl.
cmuc.No.:042920 uc.cuss: g uc.No.: 'g g� ,1{p p7/g$
De1e: � Comrmoc V� y�
IER BUILDEP �ECUN1T10N: I Aqepy d( m uMx peWy d perjry tlut 1 am ezamp hdn iM Catl'etlm liwma law la IM
IaYoxiq remm (5ed'pn lW 1.5 Bu+nes� md Ndw�on Code: Mf' W a mauY r.t�idi nV�e+ e V�C lo m�M�c�. Ms.'vnVoro.
dsmd'eh. a npei eiry slruciuie. prior b ia uwence, deo reQures ihe epplirem ta wcli pamA 10 fib a eqrrd etelement Nm M a ehe
u IioeneeE p�nueru to ihe pwisime d yn Comredns Lioenee lnw �Chaqr 9(mnmanenp xilh Soaian �Oao) N Diveion 9 d �he
Bu�'vwn vd Pralmacm COEeI a �hm he a sM w wmq �herNmn end IM Datia la Ihe e0eped kemqion. Nry vidmion d benion
]W t.5 � enY aOD�^� fa a pmmu auEjatla �ha eppliuN lo e erd pmely d M mm tAen fxa huMred tlopv� �5500D.
❑ i.�ow�wdm.wownv«mv�pme,,...nwwe�.mmin.:.d.mmo.���.wuieomewo�x.d,em..wrn,,.u�a�mm,e.a
a ofleeed la �eb (Setlion 1011.8utimsaeM Pminvm� Catle: The Coniredon licanee Lew dm� �at epplyto en ownerd propaM
wla Wids a inqwm Ilwreon. erq xfio dou suM v.ark limeell a henN a thraqh hb a her mm emplqese. povked ihet aM
Mwwem.m...e �a �me�aaa «mmea �o..de. n. mwewr. �n. d,Jihq «mwo�*mem i,.da .nnio on. vw a oomW+on. u,e
owrorb�ika will haw tM W�den d parirp he w aha d'd rwt drik or impow lor iM puryoes d eeb).
� I. ee owiwr oi iha O�M. � e�dyaray �nirMinB �h liceneed conVm�on b wnnrwl IM Pql� (Sedion ]01A. Bueinme eM
Prdsuiww Gada: The Gw�treeae licawe lew d�m ml N4�Y to en owner d pwMY xAa buitls a ImNo+n tAsrew enE who
cpnygcli Ip pd� poptla xVh e aVtl�etlw(e) liceneed puvuv�l lo IM CONtetlm LioensB Lewl.
� I am naemp undar SMion: B. 8 P.C., la Nis eeeson:
�ale: . OwMr:_ _ __
i eo n.�+nr �«wv mn i�..,.s d.�a �i,�d u,e ��+m, a cw� H..en �e smay coa swo� aws. usv..oa
P55�, aM thet I a anY Murs bwlJvp ooy�pyy vNl / wil m� (ercY one) naed lo wmPN wih oid mis ooEm end iM �N���ew br
eW�m�lawutructianamoEifretionM1hntMRi�ty eneC��Diunri.RmdraielomsNitlioneGV��iaueneRemNlmmYw
a�.�..
om.: Mv��+:
W OflNEN'S COMPFNSATION DECLAR�TON: 1 Mraby effim� uMa psnMy d prjury one W Ihe Idbwinp ddumioro:
. � IM1ewenEr.Ymeime�ecetilr.mea�pwmto�ellimu�abrxvkan'mmpenWlon.mprwidadtabySWianJ]OUdtMLeba
i Code. la IM perlmiunce ot IM wyk la which Nn pamY o iwusd.
,p inN.�e»���m.�.«+�•w��m�m.�,�.�..m�.m��.ae;sw�arooam.�e«coe..i«m.c.�«md+«ain.
�� wak la which thie peimn ia isueA, My waken' campenW ion imurence rartier eM paliry number ere:
c�..: STATE FUNU EXPIRES
aa� r+�mn« 10 / O 1/ 9 8
�rnie a«.�n nsee �wr w mmdaree r m. w�� u ra a�e h�d�e ediers Rraol w bs..�
� I wNY IMI in ihe pMorme�e d �he wk /w whlh �hle peimN u ueueJ. I ahell rwl emqq enY Ge� In am/ mannx vo m �o
bacoms wEjetl b the xaken' �m�pe�uatpn lewe d CaWamiq erd eprae thu tl I slwW to IM xalun'
��mipenation pvrii d Saqion 3]OU d IM leEw Cods. 1 diell l wah ' spp�s
I.o�d I �Z�i � .� AodF.m: ��/ /
r.. 1 lip FW row. xcun rvaikon'�bnpeivatlon roverap Is unlnvM, md slWl �u6JM �n w�nplyx ro e�IMiul pxultla aM
l 9M Ilw W b em �inCrW WuvM JWW (7104PGUA N�Edtlon b tln mf ol compsiwLbM1 LunP� Y P'bvkM! br In
s.caon 9sa o� m. Lmo, cew, �mwt w.rcorm✓, �.u.
CONSTtiUCf10N LENDINO �GENCY: I hxeby dfirm uMer peneX/ d pa}vy ihel lhere o e mM�udion WNinp epsncy lar iM
peelamem tl tM xak br xhirh the Po�i e uwod (Senon �081. CN. C).
LENDER'S NIJIE
LRIDEF'4 �D�RE55:
�«'"9pptlqnpUfpO'°' ER�C USHER
Dme:
(5151�el.WP) WM1ue-Buadiq85de�y(Lw�Fb:Cenmy-Appfu'tl:Pink-Rwa�ue:Gddavo6-baenor
CITY OF COSTA MESA — BUILDING FEkMT'T of
PERM NO: B 086762
PERMIT NO: H 086762 PLAN CHECK NO: N' GOVT: N S[7PP: N
CONSTRUCTION TYPE: 3—N SP PERMIT TYPE: STR PURPOSE: DEM
i
JOB DESCRIPTION : DEMOLZSH NONSTROCTURAL WALLS 6 T—HAR SQ FT:
CLAIM VALUE: 750.00 CALC—VALUE: 1,000.00 GROUP OCC: H /
COMMENTS: CEILSNG, FOR FUTURE T.I. �'
�-�*�*-x��r��xr�ir��-x��r���*�*���r**+r*�r�r*�r�*�*x-�r�-+r+��r-�t�-x�**�x�r�t�t***���r**�-*-�*�t�t-u-*�t***i�+r-x�-�t*�t�x-�*
Z O N I N G R E Q U I R E M E N T S
S E T H A C R S
------------ MAIN BUILDING ---------- -------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT ZN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 41507108 ZNE: REF NO:
PLANNING NOTES> .
% i^'
iE if if 3E �)E �1E �E 3E 1F jk iE iE if iE iF iE iE fE iE iE it iE �E 1E jE iE if ik if 1E-)E iE 1E iE fE 1E iE iF if ik 1k 3f 3f jE iE ik iF if if 1k �E iE 1f iE jE if iElf iE �F jf �E iE iE iE fF iE if �.jf.3i iE iE iE 3E if iE iE if
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N,-T�S
Y
ZONING APPROVED BY DATE: '�
BUILDING APPROVED BY : DATE: � f'- p
APPLICATION ISSU£D BY: ! � DATE:' � �1
iFafafiFitiflf/fifihiEiFihitiflEifiEiFlFiEiEiE�Fi��FiFiF3fiFif�SFiFi�iFiF�riFiF3i'iF3F3�iFi� '�sF�TFiFiF�FiFiF3FiF#ifaFjEifi('iFi'ifif,�. iEa4
LEGALIZATION:N F E E S U M M A R Y STRUCTUItA �SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMZT 34.75
PLAN SMIP/NOO—RES
ISSUE FEE
HUTLDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 35.25 0.00 0,00 35.25 35.25 .00
REVENUE DIVISION TOTALS--> COLLECTED: 35.25 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
34.75 .50
!E 3E iE dE jE aElE 9E 1E 1f iE iE 1k iE �f iE if iF iE 1E 1E iElE �1E jE �E iE if iE iF iF i!!F iE if !E 1E it �F �)E �)f �E �E iE jE 3E i! iE iE iklE �E iE iE if if ik iE iE iE iF iE iE i� 3E iE �E �E 1E ff iE IE ik 1E if if iE �E �f
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
NO FEES WERE SELECTED FOR THIS PEAMIT
81-27-1998/11:84 Ntl/f35.25
RCPT9:81-8918767
PERPI I T : 08676�
-�-_.
CO�TRUGTION AND PLANNING ` - POOL a� SPA
� APPROVALS Permit # Date Inspector pppROVALS Permit # Oate Inspector
1.'Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. . 53. Steel Reinforcement .
3. Electriwl Conduit Utility-Undrgrnd. . 54. Forms ..., '
4. Electrical Conduit�Undrgrnd. 55. Elettrical Bonding �
5. Steel Re�nforcement 56. Rough Plumbing & Pressure Test
6. Electriwl UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd, �
8. Foundation 59. Gas Pipe, O 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 �
52. Sewer Cap , 63, Heater & Vent-Final
- 13. Roof Drains � 64. Plumbing System � Final � �
14. flough Plumbiny � � 66. Electrical-Fina� ' • �
15. Fiough Electrical-Conduii � 66. Solar SYstem-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval -_
17. Rough Wiring Sign � "� 6$. APPROVED FOR PLASTERiNG -
i
18. Rough Electrical-T Bar Ceiiing � �69. POOVSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
Z0. Rough Factory Firepiace � � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. D�cts, VeniS�ating � � 71, product Piping C] Gas O Oii
23. Gas Pipe-fiough & Test . - 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oii
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling IStructuraq & Monocoat 75. Ory Chemical � '
27. F�ame and Flashing 76. Dry Standpipe . �
28. Lathing &$iding 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Orywall Nai�ing HEALTH DEPT. REQUIREMENT
37. Plaster Brown�Coat 79. FINAL INSPECTION �
32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED
. 33. Final Electric Notes:
34. Finai Heati�g & Air Conditioning
35. Final Gas PiPe-Test
36. Hood or Canopy
37. Finaf Facto�V Fireptace .
38. Final Plumbing �
39. Water Service-Final � '-- �
40. Gas Service•F�nal . �
41. Solar pomestic-Final
42. 8ackftow Preventer
43. Backflow Irrigation
44. �andscape irrigation System .
45. Sound Att¢nuation � = .r
-„
46. Handicap�fiegulations . � '� '�
47. FtNAI. STFUCTURE & BUIIOWG ,� � � "' '
�
48. PINAL PLANNING - "
::•�
49. Electric Refease to Edison ^"`�'
50. Gas Release to Southem California Gas Co , �' '.
51. CERTIFICATE OF OCCUPANCY -
No. Date
�
�
�ooncssaem�ar+o: 3545 HARBOR �d g/tf"'�-�'1� `J� °NTi 102
o""Eas""'e"'Q'°"r�C J SEGRESTROMS FLOOD: AO-37
" �°°"�' 3315 FAIRVIEW RD
• COSTA MESA, CA 92626
�vx.�utao,�sx
�acxrt�nonwowvn:
uc w:
uNr:
��T�e� MADDOX ELECTRIC (909)613-0799
���Ta��� 3873 SCHAFER AV
�%%CHZNO CA ��= 517458
91710 uNT: I
LICENSED COMN�CTOP4 DECIAN�TION: I Mreby dl�m uMr prely d pajury thu 1 em liconead uMx prowiom d CMqx 9
(aommmcM wAh Seeion )000) d Oivoion ] d the B�av end Pmlwdom Cods. ud mY Ymroe o n tWl laca rd eflea.
cmuc.No.:070426 uc.cuss:C 10 uc.Ho.:517 5 EXP; 07/98
Dele:� � Z� �� CaVretlor ��/�����
OWNEN BUILDER DECLAN�710N: 1 Miaby elfvm udr prW y d perjey Ihel I em wnq hwn �M CaEiedm lioema Lew la tM
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CAL COMP EXPIRES
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r „�a�„�� � ��,��a �,�, �he �, n �,��, �.��.�,.
• LEN�ER'SNAME:
' LENDEN'S �OONE59:
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(5�51�18.WP) WhCs�Buid(qd5alelY•G�semFde:GuwriACV�d:PinkJisveve:CkNe+oA-Meaaa
CITY OF COSTA MESA — BUZLDING PERMIT
PERMIT NO: E 087142 PLAN CHECK NO:
CONSTRUCTION TYPE: III—N PERMIT TYPE; ELE
JOH DESCRIPTION ; 6650 SQ FT INTERIOA T.I,
CLAIM VALUE:
CALC—VALUE:
N
P6RM NO: E 087142
GOVT; N SUPP: N
PURPOSE: ALT
SQ FT:
GROUP OCC: H /
COMMENTS: BUCKLEY FAIEDMAN OFFICE TI RE:B87129
**rr�e*x�rrxr�e��r*rrrr�rrr+rr*�r*r�r�rx**(�xx�r*+r*+e�r*r**r*�e***r��r*****��**+e*x�r***r****
2 O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY HUZLDING ---------
FANT: FT ZN REAR: FT IN FRNT: FT ZN REAR: FT IN
LEFT: FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PAOV; PAACEL: 41505104 ZNE: REF NO:
PLANNING NZSTES>
�
iflfifMitiFiFkitikiFiFlFiFlFiflFftlt�tifkltifMifkMkkiFiEiFiFMififMaFikitlFMifitMiFMMMMMiEMMiflEiFiFiFikMiFifiFiFikiFiFiFM1FiFMififikiFiE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY . �
BUILDING APPROVED BY :
APPLICATION ISSUED HY:
ififKiFifiFifiFiFiFMitifMlFMMMMMIFM
LEGALIZATION:N
BLDG PMT PLUMBZNG
PERMIT
F E E'• S U M M A R Y
ELECTAIC MECHANIC
10050Y
DATE:
DATE;
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
PL� SMIP/NON—RES
ISSUE FEE 22.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 100.95 22.00 0.00 122.95 122.95 .00
REVENUE DIVISION TOTALS--> COLLECTED: 122.95 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADZNG PLAN—CHECK
122.95
MfFfFitMkMffMMMiFikMlfifiliFillfMffl4iFiFifMMMMiFMMikkiFMMMMMkiF1FlEffMMMMMMiFk%MMK�FMMIi1fkMlEifMMM1FiF1FiFififMiFlk
I N D Z V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 20 FIXTURES, LIGHTING 1 ST 20 EA. 1.00 20.00
ELE 63 FIXTURES LIGHTING ADDITIONAL EA. .65 40.95
ELE 18 RECEPT/O{ITLET 1 ST 20 EA. 1,00 18.00
ELE 11 RECEPT/SWZTCH 1 ST 20 EA, 1.00 11.00
ELE 1 MOTOR/POWR APPARATUS 1.1 — 10.0 HP 11.00 11.00
END OF FEES
82-27-1998/11:56 AM/f1�2.95
RCDT9:01-A8�8236
PERMIT:087142
. �� . � �
`'• POO L t� SPA � ' . �>
.'�CONSTRUCTION AND PLANNING
APPROVALS Permit # Date Inspector pppROVAIS Permit �h Date InspGctor
1+TemDorary Electrical Service w Pole 52. Pool & Equipment Location •
2. r$oil Pipe•Undrg�,rd.n �: 53. Steel Reinforcement
,u.i
; 3���Iectriwl Cond�o��WitY-Un�f9rnd. 54. Porms
'��4. �E�ectrical CondJ'it'-U'Gtlrgrnd. �� 55. Electriwl Bonding J i - i
, �� ��y�eel Reinforceme,�t 56. Rough Plumbing & Pressure Test �--�
����?t6lectrical UPER:G�nd. ^ 57. APPROVAL TO COVER�GUNITE
` •���F.00ti�gs �� 56. Electrical Con�iCUndrgrnd. '
� y;i�8r, oundation f�� -+ v 59. Gas Pipe, O UA'dr rnd., Test
�.
9. ?�ater Pipe•Undrgmd. � 60. Backwash LinaL; B�Trap, � Undrgrnd.
10. Structural Floor 5Ystem v 67. APPROVAL TO 9ECK
� 11. Property Sewer Lin `� House�Connection 62. Backwash & ReceptorFii�al
� 12. Sewer Cap �-��• ' 63. Heater & Vent�Final �
�'3. Roof Orains ^ 64. Plumbing System � Final �
r�4. Rough Plumbin� •� � y.. � 65. Electrical-Final
f6. Rough Electrica�Go�duic :• - 3� �' �'6. Solar System-F�Zfyyj • .
'i6. Rough Electric Ndiri�
.,� � � 'J� c�' 67. Fencing & Accns�ApP�oval •
•,.1;7. Rough Wiring Sign a: � 68. APPROVED F�R'PLASTERING '
18. Rough Electrical"f Bar Ceiiing 69. POOL/SRASYSTnEMS FINAL
19. Rough F{getirg,& fdc:Conditiqreing �� K �,; s a;�: - r R9R8��DEPTGREQUIREMEtd�T nn.• T�*;
7 '+[li ^ Q [Tl R: Y `:'7 ` ' �'7
20. �oug`G Factor4Fi^ tace 1 S^ �G `� ��-' �� qpp AV,�;yu�"�"' P mit# * '� `"'�' ` �'
.,; --i �� F H -, S +K '-+ '7 : � � _ .:1`7'�. �l �-r,-
21. ;Auttz ir�tructur�#: � S�-+ !� rJ �--� !�� - 70.`4lnder rotGid 'dro �'
Y • �' 1
22. � uc� V�tila�ingNr � ^�` ;� � n H* ` 77. Prod�it�PipingtfjJ�as �]Oi1 d.
23. �as �'pe�ou�j &¢T4st � � z, Q,� ,'�� q � ��t 72. Underground Pfuih . >+ .r�
24. Roof Fr ing n� �' x ;� x"'�` ' 7� Undergrn�J.Stc�pggTanC�`�Gas ❑Oil
y: s_ i� . n 7 r� �_
25. oo h42thin ' ' �
� g a1.+ F- t�7 n Dk 74. Overhead HydcQT �x
26. T Bar•Ceil'rng (Stru*t'Kual) & Mondaoat � � �' � d'* 7� Dry Ch�ii_�al �` � � � x�i �� ' '
. 27. �ar� an� Flashir�:;; ^ ^
k 7= ... ; -. x - r .. - ..�.
., -.T,t'„ a' zc :nx 76. Dry StaailPiPeC,�--! K b cu �� tr�z
.. 28. Lath� g&�Siding Cr ✓� CG� ;, � 3. M � �.'� 7� FIXEDESI`ST�I�INA�"' n my� ��`
29. InsulatipNnJ, '. S K,� S.• f S (« 7� FIRE PREV. FYfdAL � •�r.
' 30. Drywall Nbiting O� �+ � �:- � � �� s �IEAL7�i'��DEPj�iE�,UIq,�N' II
1 Y' S � 'r... t ',� ; �
.�31.PlasterBFqwr�,Co�g .c��c, y�r ' �t. 79.FINAL[�jl�P�rC'�?N �:� H yS
' 32. E'lectriCaFPoodBr M6cErFidal ! T •_ j ��' 8,7`FOOD C RTIf�i�TE I�SEIECJ' �` �
r -> c = r�; r: � nc �n � .m �� _ _ �-:
�r33.F�inal.K£le�(ric;C :��,� �„ � '�{o,tes: u.2 �1t1 y; ��,�
= 34. ,�ina�lieating� Air ��ortditioning" ;r� .T ; l+: �. �-,c�o oV ��y x � -•0�-- ~
c.., �+' � ") U^a O C� h7 S i: M �� O
y Y: l} .. Y �. '# ' C� ti ti u-"-�
' 35. �narGaf'Pipe=TesY?X � �; , � � � . ..�� T �,; FFe^F •
i 36. iloodror CanoPY a�M C� ��-a " � � .`�: ;_; ;.o �k m c.�O:nca n .
. c I 'Y. ` Cl � 050o i
' 37. F'inal'Factory Firep#�es^ i�F c ��� I � � �;. a: .; ...,,.
S 38. Fina lumbing ?� t- y � O 'K � �t rti '�cC W •
�1M k
1 39. Water Service�Final ti � . , * ^ � '�' :' �"' "' '� t''�''•`^r �
p; �-.-t r.;T; �C<tLT.
� I v _. r. ?
' 40. Gas Service-Finai ' ,^�iF•�• � ,. `� r v�
i l'
l 47. Solar pomestioF(na; F i '�' k �'" y"�' � "• S �
� � r� r;.
42. Backflow Preyenter .r, „7 ;�;=t..± e.-� ;r, m� -t r
4,3. Backflow Irrig�tion * >' _ R x *� n; �� C or�000
� yv. it�andsca(ie;lrr gatiorqS4stem � s�� ;r; x�� C, <<t:� : g � ✓ O�C W S i-�
45. Sound P(Ren�a[i0n � `'r' •• � K ;n M t�f'` � o' o' 'a: • F h *
1: S .K M / / .'�1'L ••H l�:
`4&. Ffand_icap�Aeguiation� � `.: .;. S kx r � J � � CJ .�
7Y1. FIN � STRUCTUR� & BUILOIN.G * `' � ik � ,'� � '� �
48. F-�N�. PLANNING� ' �. �� � i r,, c� s` 3 C
'R8. Electric Release to Edison � �y �y ''' `� `�""„"" �
z � Ir• O oS: - i �c�:�-�-�
��. (�ias RElease to Souttiem Califormr,GasCo +. � i � �o f� x '� : �oo:.
r c. , � �
57. CERTIfICATEOFOCCUPANCY
No. Date
�nonwaeu�m'm 3545 HARBOR � GATEWAY S
�ONNER8W1yEliqqNTtC J SEGRESTROMS •
•' �o�s%3315 FAIRVIEW RD
, , COSTA M�SA, CA 92626
�wL. YAIIDq 1DDRESA
r
AIiCXRECT 011 fNtlNFEA:
AqCN, OP Flq.'b ADDPESS:
UNT: 1 O Z
FLOOD: AO-37
ucuo:
UNi:
cor+m�cTarsxu¢HLAKE AIR COND/SERVICE CO (714)630-6412
��p�T��y� 1175 N OSPREY CIR
�sxANAHEIM CA ��= 396109
92807 u�*:
UCIXSED CONfR�CTORS CKLAPATION: 1 IwaCy aRrm uder prxfy d prjwy Ntl 1 mn 1'esisetl uMs pav�n� d Chaqa 9
(oomme�q wuh Sectiai 1000) W Owuion J al tM &�ao md Pedaeoeu Code. eM ml' &wee u 4� hA bm eM Maa.
m.No.:026026 �0 °�g C 20 uc.r+o.: 39n610 � //EXP • O1 /99
DNe: u CaMeaa ��i11�w � - / �
N BUILOEN D CUF�TON: I haetr/ e1@m uMx prWy a1 perjlry Ihtl � mn azemq Imm iM Cwn�rfon licema lew Iw Ms
1 'nY rwmn (5epian ]031.5 &nira� end Rdm�'vm Cods: � f�1Y a mw�Y MJN �Mu4w e D�R lo omabuct. Mm. im0�an.
demd'eh, a ropai em/ sVuctura, priar b b awenro, ebo rpwm tM epp4uN fa wch psrmu to fYe e dpned sWemeN Ntl M a oM
ia �ica�we wnweu m me aw�av a ur cwreaas um�m �aw Icneqr s(mmm.�no wun seeion �000l a o�veia, a d �he
9u�inasa vd FrMeviore Codel a IMt !r a aM u uemq theehan eM �M base la Ne elbpsd ssamNun. My videlion d Ssaun
IW1.5 by eiry epWicem In e pemN e�p1+ ilr eppfraM lo a wi psuly d m� mas IMn fxs hued�ad Eopxa �5,50pn.
� I.novmardthepopanyamyanqbYwMthwepeamtlsaolemmpemmm.w9EONerM.endiheeWcnnaumliNeMed
ar ollaed br eele (Saction'lDu. Bu�meb end Pmloeim+COEe: The CaNreGm liares lew dom �a ewN �o en owiwrd pWeM
.,m w�e. «mc�« �na.m..oe �+a aoe..w�.on� i:�e a n«w «m� ns o� n. a.n «�mrr. a� w�.Kn
unqaanmta ero nol'vtladed a M�wM la ub. tl.lwa�w. tM W11m0 a inP�� u mtl WEAvn wrYaa d mmdaion. tlr
wnr�dutlr xi0 Am Ne Mvtlen d prov'vp M a tlw 6E nd hAi a'vnP� la 1M ROWes d�eNl.
� I. n ox�wr d tln P�W�Y. em mdueWy mqeee�9 w's� 6nved mmxV� b mmutl tlr P4� (Swbi 10u. Bw'vre mA
FMavdu Code: The CaLMan licMs lew dom ml RdY m em m�r d D�Y Wa bu1L a vnpwp �Iwson ud Mw
ooN�ecls be wtli V�MeCe wdh e m+meMU I'sanssd R�� to Ns CaNrapa� liorua ler.t.
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Dete: �+�✓�
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255J1. enE tlw 1 a enY 1Uive Mikeq omPrm �ri9 / w0 m� (ortle one) neaE ro canqY NA uid tlete code� eM iM �ayiuiamw�b 1or
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pwbvu.
Dms: �oV�
WORKER'8 COYPENS�TON OECWUIIpN: I MrWy dRm uder pa'u!y d pr�uy wr d Yr b0oiwp ddveion:
❑ �nm..�a.ame'vv.w.c.+srs.amm.io..o�:v..b..vk.;m�nWc�..sa�ro.Ms.mm3�oowtn.l.m
GOM. tu tM pMamvice d Ne Yak Ia wNN Nu paem'v u mued.
_ 1"I � n....�a w mmn.�.nAca+• mmomm:n:vw.nm... � M seeion ��oo a me �emr coa.. a m. vennmenoe a m.
i� .ioM1 �« wtiA tiv� wmu : muaa. Mr.vw«.• odnpeuYion:w.M. mrri. w wp.r mm,w, u.:
c�»� STATF' Fi7ND EXPIRES
PofcyNumbr. �����n-a� 10/OS/98
Tn�,..nron ,,..e na es canw.�.e, �n. wm� a ro. m. nunmw ema,. mool a wo.)
� I mnN Nn in Yw VNwmenu d IN wak M r.hc� ihu P� u castl. I du0 mi amMW �Y w*� in enY menna w u io
become �ublw �o �M wM1se' mrym�aian lew� M Celdmie. end eYna tlW A I�hwk becams nmjatl to tM waFen'
cpnpane bnpwi'omdSWianTUpdiMlaEUCob.IWlll w9hw p1/wvhl
pW O AppliuN:�� �� � � �
w �m: uun ro.�w..onrr: �mp�u�tlon cw�np b unYrRtl. ad �IWI ulMel �n rnPlonr ro alMnl pn�ltlr uW
vn nw w ro ar. n�nene rrow.ne Msn frru4oaoA ti.emdon ro m. ewr oi nnv«�wuon eur,e�r n pera.e ror in
9.etlm ]�06 0l M� l�Eoi to01, INr��L W�tEwm�Y Hn
C�JNSTRUCTION IENDINO �OENCI': I ly��py elfvm Wer psutly d pr'Fry tAn iMn o a mnawion 4M'vp aponc/ lor Ne
pd�ormerr! d Ihs xork la xfiiM 1�'s pem�1 u uwd (�� ��. Giv. GI.
' LENDER'S NPYE:
' LENDEN'9 �ODHE34:
I conih �hei I lime ned me eCD��'mim enE aeu tIW IM eEova "vdormetion u canW.l epres to mnPN rrilh a0 d1Y aN oouniY ordineMs�
and �leb kwe �elmM ro huddiq rnwtrueq md heratr/ ei01v¢a nP���vu al �M r<Yb Wx Won tM ebo.e�m�ntionad pW�H
�IX YH�ltlIM OWPWa�
LESLIE VALENTINE
tiP om,: 3� �
,
(515tJE.WP) N'M1���^085�1ery;O�eer�Fle:Ceeury-Appiuitl:Rnk�Wnue:OdEmio�Atseav
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: M
(p
08725
PERMIT NO: M 087256 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: III-N PERMIT TYPE: MEC PURPOSE: ALT
JOB DESCRIPTION ; 6650 SQ FT INTERIOR T,I. SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: B /
COMMENTS: BUCKLEY FRIEDMAN,REF:H-87129
af �F iF3k iF iF iE i! it it ik �k �f 1t it it ik iEiF if �t �F iF ik ik It IF if ik ik iFiF iE if iEaEiFjF1t it M IE �k if �E it it if ik ik 1t if it iF iFik M iFif if �f ik if it iFiF iF1! iF if if i! ik iE 1k aE 1E iF ik
Z O N I N G R E Q U I R E M E N T S
S E T B A C R S
------------ MAIN BUILDING ---------- --------- ACCESSOAY BUILDING ---------
FRNT; FT IN REAA: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: . FT IN LEFT; FT IN AGI-IT: FT IN
PARKING REQ: PAOV: PARCEL: 91505104 ZNE: REF NO:
PLANNING NOTES>
� R!
iE if it if ii 1k 1E iE iE iE ik if iE iF iF if if iF ik iE iE iE iE iE 1E it 1F iE if if iF 1E 3E if if if k if iE k iE if if iE i! 1E �)E iE k if iE 9F M ik �f Ik±f 1E iE iF 3k iE if af if �k iF 1f iF iF M�)F 1F 1E If iE iE 1f iE
D E V E L O P M E N T S E A V,•I C E S R E Q U I R E M£ N T S
ZONING APPROVED BY "' DATE:
HUILDING APPROVED HY ; „� DATE:
APPLICATION ISSUED BY: `� DATE: � � �
1EiEK1f1E1flfifiElfiflflFfEff�f�flf�Fklflf M1f1flEiE%ihlflEif ikk
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
. ... �n j
BLDG PMT PLUMBING ELECTRIC,'.MECHANIC FIRE SMIP/RES GRADING
PERMIT "�a26.50
G � ,�. �i" ~ 252 SMIP/NON-RES
PLAN � � _ •
ISSUE FEE '.�22.00
BUILDING-DIV-> PERMIT ISSUE PL-ANrCHECK TOTAL PAID DOE
TOTALS----> 26,50 22.00 - 0;00� 48,50 48.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: : 48.50 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC MECHANIC -� FIRE SMIP/TOT GRADING PLAN-CHECK
'.;98.50- '
� �.
�l
ik fk k k 1f ik k if if 1k ik k 1E iF �t ik 1F 1t �f k iF if if M 1f if k 7F fE iE k k 1E it 1k if.�E if if M ik It k iF M 1t 1t it M M!t it 1f 1f M 1f k ff iE 1f �f 1E if M!E ik if k iF If if if IF iF ik It ik if if
I N D I V I D U A I: � F.'H E' B R E A K D O W N
TYPE (JTY D E S C R I P T I O�N �"�� , UNIT COST TOTAL COST
MEC 2 REFRZGERATION SYSTEM, r<= 100 K HTU/H 13,25 26,50
END OF FEES
/ r�. �.
K ��
. l ' ' _
I� .
� '1 -
03-IB-199A/�4:32 P!I/E48.58
kC7Tq:31-63e37�1
1-'Ekhl i T : 0g?c;iE,
•� tiONSrfRUCT10N AND PLANNING POOL � „PA ,_
APPROVALS Permit �h Date Inspector qppROVALS Permit # Date Inspector
� L �`emporary Electrital Service or Pole 52. Pool & Equipment Location
. 2. Soil Pipe•Undrg�nd. " ' 53. Steel Reinforcement ��
3.'Electrical Condyi2 Utility�Undrgmd. 54. Forms �
- �4. �Electrical Cond�itllndrgmd. 55. Electrical Bonding �
;-5. Steel ReinforcetnAdt' S8. Rough Plumbing & Pressare Test
�' �•6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
���� 7J Footings .. 58. Eloctrical CondUit•Undrgmd. -
�`�8.� Foundation � 59. Gas Pipe, � Updrgrnd., Test
�� � 9. ;Wa[er Pipe•UndtB�d� " 60. Backwash Liness P-Trap, O Undrgrnd.
10. Structural FIooFSVstem _ 67. APPROVAL TO DECK
- 11. Property Sewer Line�& Housc�Connection 62. Backwash & Receptor•Finai
12. Sewer Cap - _. � 63. Heater & Vent-Final
�?3. Roof Drains - 64. Plumbing SYstem � Finai
�f4. Rough Plumbing r 65. Electrical-Final
15. Rough Etectrical•Conduit •• 66. Solar SYstem-P�ina� �
,�6. Rough Electric Wiring ,: . 67. Fenciny & Acc��Approva�l ;
�-i.,,17. RoughWiringSegn =. 68. APPROVEDFOR'PLASTER,iNG
18. Rough Electricat>T Bar Ceiling 69. POOUSPA SYS'f�`MS FINAL
79.-Rough F{eating &�Air, Conditiorl+n4 - i _ e ^ FtF�Et�EPT.REQUIREMENT �
- = - - - - : r3 : r*� r -
20.��,iough Fa'ctory Fiieplace ��' �'= � S �'- � APPi30VA`liS` ,, P`�rmit #T�
r. �-- •t-" ti '-, ;� .�
21. Ducts, in�5trutture . -- � �� - .�t � 70.�Underground Hpdro �
22.Ouas,Ventil�ting:� � _ � � '= � �% �,;, 77, prodtl�rPiRing.�as QOii :�
i.
23. Gas'PiPe-9ou h & T�est _ �•±-; • „' J •y .�' ` ,_, � �'- «
9, G�O T � .:"r ; 72. Underground F{ush . �
24. Roof Framing - �^ a_ � -� �� � 7� Undergr�d.Sta"r'p§eTank�Gas ❑Oil
25. Roo£Sheathin � �' � '� -� " "" � -
9 . � f7 :>� 74. Overhead Hydrp�
26. 7�Bar Ceiling (StruCtural) & MOd6coat a_ "�� `� r'�'� 75•. Dry Che�r'piyal `"? `_ r
, 27. ��rameand FlashinyT �r;� - , ' � •; 76. Dry Stan�pipe r,.� ,.. : ,� -�
28. Lathing & Siding:_y _ � `� � 7J! FIXED'S9ST�AA FINAL ' �
� 29. I�sulation • - �� �; - � �� 7�. FIRE PREV. FJN�AL + � -
30. Drywall Nailing T ^ ^' � �� � � �{� ; • �HEALTH OEPT. REoUIREMENT
, , .
.; 31. Plaster Brown,Coai,4 ` - . � � .;� � 79. FINAL 4NSPECT.ION � -
' 32. Eiectriwl-Power MeterF.Inal • " BD! FOOD CERTIF.ICATE ISSUED� �
: 33. FinaT:Electric; `'�" .. ' _,.., .� ..,y � � : Note '+1^Or_8 ./�QRD�G LOn/_ ���_�� )_Q
� J � !S !J .
• 34. F�SCHeaiing & Ait Conditioning �: �� �
, . _ 3-3i�� QM;: 3-a7-�$ �:Qrv,s�A r��. P� _N
35. ,�inal GasPipe-Test . - � ' ` ' � [, �
_ � � � �X � 3_30�4�..:�/�l_or� ftC.AQY �.��
36. Fiood�or Cano �� J - •� � � � ��s: ..c � ��^ R r
_ Pv _r �� : $=31-48_F�nNrq�/zr "�, ►� �
y 37. Final'Factory Firepl�c.e: r;�- ' � N ' • '��^ � �r �
� 38. Final�Plumbing �- '� . i �i^,;-� o - + '�+
-� ,� c
39. Water Service-Final '_ � * '• j `rt = =-' � �
r f� -'
- : i.} . . i., � ;. . .. - _
-40. GasService-Final „ ,� �; �; j � .�,,� p- . ��.- p.t
.
� 41. Solar pomesticFinal �, � ! '"' " -�- ' '^ . �
c � � .
y 42. Backflow Pre�venter , _ M �. � * , , i,; - ��
.�,_ n
43. Backflow Irrigation� ' - t ;.' � . � �� _�
44. 'Landzcape Iriigation,System�,'%'� �; � ' .;, �t - < n. ` , :�
45. .Sound Attenuation. � �. .. ': " �•� � ''� '- ' � rm• r �_ •
_ 4, r :�1 ..r ^ �i-. .. _ r
r- - � _ �
Q6. Handica0 Regulatia�s � . �, , � . `- r iq =
=47. FINAL STRUCTURE & BUILDING � � • `
48. FINAL PLANNING . t - -• � � -1:
�
�49. Electtic Release to Edison � ' • - ' , K
�50.'Gas Release to Soazhem Calitornia•Gas Co K , - - ---� J-� •
Y
51. CERTIFICATE OF OCCUPANCY
No. Dare
.r.�
�
�
�noncssopea�m�o 3595 HARHOR GATEWAY S °MT 102
a�acr+"eEiF�u�v"":C.J. SEGERSTROM & SONS FLOOD: AO-37
f �op�%3315 FAIRVIEW RD
� COSTA MESA CA 92626
�qx. Yuia�c.00aEss
1714)596-0�10
i11MNRECT OP F!!fdlFFP:
.1NCX.Ofl FHO.'SAUDHE53:
I1G NO.:
UNT:
coxmncrarswu� RPC PLUMBING, INC. ( 719 ) 375-7343,
Cdf1111CTOR3YNlW�1%S12 GKIFFIN LANE
�oo�ss HUNTINGTON HEACH CA �G� 655225
92647 �M: 3
lJCFNSED CONTNACTORS DECIAP�TION: I hereby eflim uMer peraly d pe�wy ihtl I em 4ceneeE urder powiwu d Cheqm B
(�M wEh SR�� 1000) d Oimian J d Na Busron uM Pmlaeaons Code. end mY 4ceme u m IUA lau vd Nleq.
cmuc.No.: uc.cuss:C-36 uCNO� S EXP:
UB�B: �I�-�1�\Zi fiMllfVlIX:�
OWNEN BUILDEN �ECI,APATION: 1 haeby tlfi'm uMer penNy N pw�iry �Mt I em exemp ham IM Gonlradon Liroiue lew la IM
tolbxino �� (�ion ]a31.5 Buniwss end Profeatione CoEe: AnY cYY a�+n1Y �idi rquiree e peimn to oonewct. Mx. impova.
damd'sh, ar repai MY eVudure. p'w b ia'vwenoe, aleo reyuim IM eppliraN br euch pwmil lo fib e rp�wE eletemam ihel M a aM
m i:.wae w� m m. a�• a �ns cav�.m, u�.e t�w Icnaa. s(eommamro wan seeo� r000l a a.eo� a a m.
Buvirwas eM PralMan Codal or ihm M a ehe is uemq Iherelmn vd IM bew lar the slb9� acemqian. MY videtion W Swion
)OJ1.5 by ury epp4rM� la e pe�mil wEpCt IM eppli[anl lo e evY perotly d rol mp� ihen Me MUWed EdWa �3.500D.
� 1. n owner d tM pAp?�Y a my emWyme vnM1 wpeo n �hei mle oompr�wcn. xillAo Iha xwk. eM Ne �wmne e�'vqaded
«MueE /« ede (Secuon )oM. Buvrimend vroleviana cada: The CaNredae licenea law doea na epplyto en owrwr a propeny
who Wffi a Mqa'� Iheieon, eM who dros auch wak NmeMl a henN a Nrpqh he a hm own anployeas. povideA i1W vuch
impmvemeMs Ne nal iMarMed n oHaed /w eeb. X, howewr, ihs WiMi'q a inparemam ie wld wnhin oro yeer d campinion, tlre
o.�«awe., »an neve in. w�aen a o��o ne « ene eie na nwa a i�ww+�« ine wmo.. a.del.
❑ �.mu.m.am.wwenv..mmbuiWvmm�en:ro.ri,nbmn.acmv.cw,mmrauw,hewawis.c'vi)a..9ueiw.ena
. Peda�w Code: The Coeureem Licenae Law Eon na eDVN �o en oxrier d o�WeM who WiMs a imP�'�s+thason md who
conveco w..n crvne+.w . am�mM,) Ican..e w�.�.m io �na cdvnm. uo.d. �.M.
� I em exemq uMer Seclion: B. 8 P.C.. br Nu meaon:
I Eo Iw�eM ro�M NN I em ewara d eM undenleM the ie0u"vanws M Cdlamie Ilsellh eM Sde�Y Cods Sed'vu 25505.2551�. enE
T5511. enE tlet I a P^Y Mwe W�ld'vq mvqaM wil I wa m� (acb ane) neeA m cm�' wih wid pete uAu erd iM �apxwnW b
epwmnf«mreouetiaiamoEifrslionM1anlMAiai yxi�aeepemsu0ivmf.RevidaNielmnavwioneppirm'vaanmanphamRma
Vo�mu.
Dele: APduM:
WOHKEN'S COYPEN4�TON DECLARATON: I hraby effirtn uMr peneM1y d prjuy ans d Ms Idbxirp Eedeietioro:
� I Mw eM wiI meinien e cMfctla d cmnnt io vepinwn br warkeis canpevetion. p prwidetl M by Sad'an 3]00 d iM lebor
Cods. b tM pM�a d the vuk ta wlirh Ne pamb u o�ueE.
❑ � ns. ena M� ma�m.�.mk.n� wmv�� �„er¢e. u nw� W seaon aroo d Ma tebar coe.. ror �ne ro�a� d �n.
}�- wak lar wfiiN Mn O�W u issuW. MY waYen' eanW�+�bn imueacs an4r uM GdKY mimber as:
c�»,: Cp rnnno EXPIRES
Pdm/N°'^e": 6977343263 07/O1/98
,,,� �mis sea�m �mea �a w wmv� r w c.�� � b. om nu�e�ee edrers R�aul a wo.l
� I mrliy tlW in �s pMmrerca d tM woh lor xfiich �hb pe�mA o eeusd. I JWI M employ ury pa�on m ury memer o m to
Eecome aEjed lo IM wahws' mnpenWion laws d CeNorttie. vd epne Nq L I slquk become vdjaC lo tM MGrFen'
�omv�'°� w^�•�+• d sw� a�ao d m. �n« coae, i.n.o tpin ' w�..
o�.: �121 i r1ii �cp's.�n: ��.
W�m/np: FWun ro�un workai eorrp�ru�tlon co✓xp� la �nlawlu( �ntl �IWI wbficf �n wAvloy�r ro eMMn�l pm�M�� �ntl
e/Hl 11�'p b aN �tlrM tivuuM Jdhn ISfOqOWA M�Ctl/tlon ro M� eaf o/ rompru+WM1 dem�p� u prorMW br In
9setlon J]O6 0l tl�s �orCOM. Infwut, �ntl etlomH's /wa
corurnucnoH �R+anc �neeicr: i n.w� mr,� wb. od�r d wdw �nm u,«. o a oo�r�wim w�q .o.�.v n m.
penamanoe d iM v.«k 1« �.hiai ihe oe�mi u'vauee (Seaion a081. cM. cl.
LENDEN'S NAME:
LENtlEN'9 AUDRE54:
I cMAV IM1et I hew �sad Nu eGO�ic�on aM nne ihm Uw ebow iNartWbn e corted. I epise Io camON wu� eY mY end cauM' ad'uw�
erd nma lexs nlaip to Gdkip oonwueian eM hareDy wNa¢a npraeemauws d Ilve tlry io xux upon iM ebow�mauiwrd prwe�ry
laf i�repettion Wryreea.
KEVIN CONLISK
Pn�u Neme
Dete: Z �
ipr�ure dO.mer/qpenUApphfanVConlratla
(St51�l.WP) ���mq 8 Selery: G�eemFb: CenW-Appiratl: Pink-Rm�w�e:OddavoA-�aeeaor
PERMIT NO; P
CITY OF COSTA MESA — bUILDZNG PERMIT
087481 PLAN CHECK NO: N
CONSTRUCTZON TYPE: III-N PERMIT TYPE: PLU
JOB DESCRIPTION ; 6650 SQ FT INTERIQR T.I.(PLUMBING)
CLAIM VALUE:
CALC-VALUE:
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT:
GROUP OCC: B /
COMMENTS: THE "BUCKLEY FRIEDMAN" TENANT IMPROVEMENT RE:B87129
**it******+�*******+r*�t**�r**�tie***+�************�t****�x�**+�******x�**+t****+�***�+r***�t**
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT iN RGHT: ET IN
PARKING REQ: PROV: PARCEL: 41505109 ZNE: REF NO;
PLANNING NOTES>
� Gll
�F if iE 1f �f if �k iE iF iF iE 1E ff 1E iElf iF if 1E fE �E 1E iFlf 1f ff fE iE IF if iF k ik iE 1E �E 1f iF 1t if if IE 1E iElE f! �ElF iE it if i! iE ff aF iE iE �E aE 1t iF ik iE fk iE iF iE iE ff if iE 3E iE iE dk if 1E iE iE
D E V E L O P M E N T S E R V I C E S�=R E Q U I R E M E N T S
20NING APPROVED BY � DATE:
BUILDING APPROC�ED HY : DATE;
APPLICATION ISSUED BY; � .� DATE: ���F�
9kiEiFiEiElE9titit%itiF*iEiEkiFiFiFitiEiF i ifaFiFifiEiEiEifiFiE e'iF�F'3FiFiF�f3F�t*
LEGALIZATION:N F E � S U M M R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 70.00 '-�-
25R �_' SMIP/NON-RES
PLAN , �`
ISSUE FEE 22,00 '
BUILDING-DIl7-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 70.00 22,00 :r..-�0.00 92,00 92.00 .00
,1 ��
REVENUE DZVISION TOTALS--> COLLECTED: 92,00 OVER/SHORT: ,00
bLDG PMT PLUMBING ELECTRIC MECHP.NIC FIRE SMIP/TOT GRADING PLAN-CHECK
92.00 ? "`
��
M iE iF if iE if iF iF fE 4 ik 41E 9f iF iE iF �f 1E iElE iF iF �! iE iE IE �E 1f iE if if if iF jf 3k ik iE iE iE iF 1E if iE k�E iF if iE 1F �)F iF if 1E fE iF if iE ib iF iE if iF ik 3E iE iF iFlE fE iE iE iE iE k!E �)E iE jE
I N D I V I D U A L :.F' E E H R E A K D O W N
��
TYPE QTY D E S C R I P T I O'�N�"•, UNIT COST TOTAL COST
.' 1
PLU 2 WASH BASIN "l" 8,75 17.50
PLU 4 WATER CLOSET (TOILET�) 8.75 35.00
PLU 2 URINALS, WALL > 8.75 17.50
END OF FEES
,�"'
The work authorized by this permit shali C
comply with all applicable handicap �
access requirements under Califomia µ
statutea and related regulations. `,
(ord. No. s2•zs, § 1, 12-21-92) �"
03-27-1998/H2:49 P�q/�9,.Cb
kCRT�:b1-OG215e2
PEkI`7I T : 087481
z•CUNSfRUCTION AND PLANNING . POOL & SPA
� APPROVALS Permit # Date Inspector APPROVALS Permit # Date In�ector
, �
i. Temporary Electricai Service or-�Po�e 52. Pooi & Equipment Location .
2. Soil Pipe•Undrgrnd., _. 53. Steei Reinforcement - _`
��3. Electrical Conduit Utility-Undr9rnd. 54. Forms .� �
4, Electrical Conduit-Undrgmd. 55. Electricai Bonding '
5. Steel Reinforcement 56. Rough Plumhing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAI TO COVER-�GUNITE
7. Footings . -: 58. Electrical Conduit�Undrgmd.
8: Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgmd. ' 60. Backwa:h Lines, P�Trap, � Undrgrnd.
10. St�utturel Floor Svstem �- � 61. APPPOVA� TO OECK , .
Tt. Property Sewer Line & House Corinection 62. Backwash & ReceptorFinal ��
12. Sewer Cap �t, � - 63. Heater & Vent-Fina� �' �� �
13. Roof Drains ' 64. Plumbing SYstem � Pinal ,
74. Rough PWmbing 65. Electrical�Fina� .
75. Rough Electrical�Conduit . 66. Soiar System-Final
16. Rough Electric Wiring � 67. Fenci�g & Access.AnProval --
� 17. Rough Wiring Sign � � '68. APPROVED FOR PLASTERING
1B. flough Elettrica�-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ' F4RE DEPT.REQUIREMENT
20. Rough Pactory fireplace . - .APPROVALS Permit # � F, m N�
2i. �ucts, in 5tructure . • 70. Undergrountl HVdro °� w��?
22. Ducts, Ventilatiny : _ - � 77. Product Piping CJ Gas � Oil =_ � m U
23. Gas Pipe�Rough & Test . � . � 72. Underground Flush - ' � `� �
- 'r � :i
24. Roof Framing ' , -' 73. Undergrnd. Storage Tank � Gas ❑ Oil i c w
� W O G: '
25. Roof $h8athing - � 74, Overhead Hydro- �a � c� �-`,'� .:
26. T-BarCeiling (Structural) & Monocoat � 75: Dry Chemiwl � '_� �� � _ �
27. Frame and Flashing � 76. Dry Standpipe ��� � � n� u
28. Lathing & Siding '. � ' 77.. FIXED SYSTEM19 PINAL .. ^ �'c '�
29. Insulatio� . � � ' 78.� FIRE PREV. FINAL - � ,r `. � -.
30. Drywali Nailing � � : HEALTH DEPT. REQUIREMENT �
31. Plaster Brown,Coa4 ' 79. FINAL INSPECTION
32. Electriwl Power MeterFinal - S0. FOOD CERTIFICATE ISSUED'
33. Final�Eleciricf . „ ' . � �, Notes: _3�Q(+/.''K0� ftFA_p� Q�
r6 �-n
34. Final Heating & Air Conditioning '. .�-.31-Rp_{ I���� Z F/� �� A/
. �J iV
35. Final Gas P�Pe-Test _ , ' ,. . . {
36. Hood or CanoPY ' . . . � .
�
37. Final Fadtory Fireqtace - , , - � � ' ,
38. Final P�umbing � • 3'3I'ctg ,Y � �
39. Water Service-Final , ,
. 40. Gas Service-Final - ' � � ' - � . - .
41. $olar pomestic-Final � , .
42. Backfiow Preventer , � . � -
43. Backflow Irrigation ' � � �
, .i . � , . . � -
44. Landzcape Irripation System � . - _ . •
45. Sound Attenuation - , , . '. ; .
46. Handicap Regulations - -
47. FINAL STRUCTURE & BUILDING � ' �
48. FINALPIANNING •
49. Electric Release to Edison ' . . �
50. Gas Release to Southern California Gas Co � �
51. CERTIFICATEOFOCCUPANCY
No. Date
INDHE540iBUILqNO: .�]4� HIi2lHVK�
qttlERS1UYEIFRlMIIt �LGGIC COkPGkAT
:ooxEss yj45 ril�tnGn bL
�vv�. wuww �no�ss:
COSrA MEsA, CII '�ZbLb
uhr:
lLVVL; F1ri-3%
uicxirccron�ffn: �LTlMA LtJllitV GKVI�Y ��' l—L.7bt34
.ncxoneno•s�oon�ss: yqbi wA7ERFkGNT Lk °NT`
HUN7INGTuN bEAC.ii CA 52b4o
caxm�crarswu� A C YLIIS i714i774-57"v7
c«rx�ciars�u�mc LLLZ E wIN57GN kU
�u ANAHEIM Cli �NOi bZb4LV
JLFfVb UM: F•
LICENSED COMNRCTORS OECL1fl�TI0N: I MreEy aRim uMm pyasy d pmjury ihet I em IicaraeE uMm pwieiane ol Cheqer 9
(mmmaid�Y wuh Sepion 90W) d Oivoion J tl Na Busnms eM VNfasaima Cods. uk mY 4oxu u in Iu0 brce eM elletl.
cm uc. No.: ^^ uc. cuss: 4c. No.:
��d� b C-20 l0 0 EXF: GGiuv
o.�: //-1 Y- 9 � ��� ,� �l - ��zu_�
OWNEP BUILDEP OECIAN�TION: I hereby elfirm uMx perely W perjury �hm I em exmmq liam I s Canlradas Licanee Lew lor ihe
Idbv.'TY ese+m (Setlian ]W I.5 Bw�nea enE Ndeuiau Coda: Mry dY rc muMY W�di nV���� a M�u to mmvucl. edr.'vnVm+.
eama'vn, «rw.� mn.�Nnxe. c� m m:.uenm, e6o �aoan. �M wd�� �« wcn v� �o fik. Wned amemml mm n. o..ne
e rKa,aed w� m �ne awidom a u,. cavreau. limro. Lew ICAea� 9(�«cnu .un swion ]mo) M U.eion a a In.
B�u'ums vd Pralea�ian Codal «�hm he a�he u evmq �hsd�an end tM beao Ia Ne eAeP� mamNnn. Mf'videtion N Seaion
�IXi1.5 by erry �pp5ura �n e permu a�bpris �M �pWicW to e tivi p�ryy d nd man IMn fne Imdnd do0v+�5.50UU.
,] I.moxiwrdiMpWaMaim'�f�wihraWnihs�demm0�ion.wiAAotMwak.andihsemxaunenoliMentled
«onm.a �«.eie �s«w��a.. eucnee. �a v,aeeam.caee: n,e comreau. umn.e ierm« na moh�o d+�«d wow�n
wlp EuiEa a inP�'� Ihenm. aM Mp Em� �uc� xqk IimWl a henN a tivaqh he a Me own anCbRes. D�b Ihet arh
imqwemaN� re rM'vaadd a dtreA la ub. tl. lwwewr. �he buJtlieq a in0��'v wltl w4hin aa Y� d mm0�ion. Ne
awmr.WYs wiY hm tM WNm d pwinp M a Me Aid na Wyd a'unpwa la �hs puryroa d etlel.
❑ 1. m ow�er d tha pW�Y. em uMi�Ny mmmChO wdh liwmsd mwaea+b mmue IM p9� (3ad'vi 1M.. &s"vm end
PMaceoro Coda: Ths CaMroean l'swa lew tloes na1 app�y b en owis d D�D„Y wM dck� a impww thweon xd Mo
coMrecte la wtli qqMs xi�h a mMretlor(e) licenwd Wnuer� b IM CaMretlas Liwnss law�.
❑ I em aRemq uMx :stion: B. 8 P.C.. br Iqu ���n: �
�a1e_ Onrr
i eo ndwv �«wr mm i.m aw�. a m,d �.i.oe u,e ��art. a cwo�:. �..en w sdw coa. s.a:.,. zsws. zssa�. m,e
255�. vd ihet 1 a eiry Mun drikiry ocapeni will / wil m� (rircb py) � lo compf� wih veid ptla mdas end �M nQuirtmaM la
ape�miilawvvudanamoEACNionhwniMAi�i y�enepsmentDiqrin.ReddemielmmtiuGoneppiretiproanexamqlromtheee
a��.
Deb: /Wd�
WOPKEP'S COYPFNS1Tip1 DECL�RATION: I hwab� alfmm wWy paW�y d pspry ons d iM blbw'vq dedere�uns:
� I have eM wil maintan s cMAkma d ooneenl to �oM+iw�s br worken' cdnpemetbn. m prwkatl Iw bry Seaion J]OU W t�s Lebar
COEe, ta iM partamelwe d ihe xurk Iw wMch thie peimn u ibueA.
LI � nnv. ena.J meimen wwkers� mnw�� ��wi.nw... npuL.a M saian a]ao a u» len« cae.la. �n. v��. a �n.
]i .�oa� �a wn� me w�n a�a. My..oiw. �ro�.m:.� �.w.ze w�«.m wkv o�n« e..:
c.� Il�SI$rj PACIFIL EXFIAES
PdcyNumCr. i,G77L u� G7/29/98
Rhis seRion med rwt be comWereJ / Ne plmk is /w a�e hundrad aW/en /S1Wl a bas.J
] I cen'�y I�et in Ne perlaimerce d the wok br v.lich thie prr�� h iawM, I Null ml ampby e�ry pereon in eny menmm � ea lo
� becmis ab�ea �o iM xorkera �ompenWion �exs d CeNp�V. � p� �p� +��I elwk becone wbjefl to tM Mvken'
canG�+mion pwuiom d Setlion 3]00 d iM Lebor Code. I thetl� I�oom %• Mqqpmrisaro.
o�,: //- d Y-97 ��: / -�.Ll....,
Wam/rp: FsAun ro ucun MoArsn'rompxustlon roverp� l� u�pw/W, ��e �II �WJ�cI en loyn b crlMiul pmeMu en0
elv/l flro� up ro ons huntlrM tM�urM dolMn lS10q000A M eddltlon b fh� ewt ol romvewtbn, Mmopu �� provWsd Aor In
Sxtlon 9106 0l tlro LeOor COM, Infxwt, �rrd �ttomsy i/ww
CONSTNUCl10N LENUINO ADENCY: I Mreby aHim unEer qnyry p� pwNry Ihet IMn u e canetiudion bMieq epancy br tla
perlormeiwe d IM xvrk lar whidi Ih's pmmi u banE (Sedion JOB>, CH. C).
LENOEN'9 NAME:
LENOEfl'S ADOFE%:
I ceMity Ihet I heve reed thie epplicetion vd tlme ihel iM ebwe inlwr�� y corted. I ep�ea to canply v.il� ell ary end munty rcEinenoee
aM steb 4x+relmiq lo Wikiq connrutlion vd MraEy euiharhe iep�i�ys d tM riry to enis upon �M eEwe-meMianed propMy
Iw imG�� W�W�s. -.
SrEV'E FAQUIN
Pnnt Neme
ll. o�, l�lk-9�
(5151-IB.WP) Whue-Buikiq 8 Sdsiy: Diaer�-Fb: Guwy-�pp��l: Hnk-Rwamie: (3alEenrad-Neeeva
N� 5���� � CIiY GF CGSIA MESA — bUILLING PEkMZT
FtHMI7 NG: M u8�514 FLAN CHt�R NV: N
YtltM NU; MI VH�514
l>VVf: fV SUYY: N
CGNSiktiCTIGN iiiFE: III—N PERMI7 iYPE: MEC FiiitrOSE: Aii
3Gb uESCkIri3G1v : 1025 SF OFF TO bkK kM i MECHANICAL S� Fi:
CLAIM VALUE: CALC—VALUE: GkOUF OCC: b i
CGMMENIS: "QLGGIC CGkP ", AEF b-83115
siviseseieieiei''se'seitieiiiiiiwiiiii4iFiiiFiiiiiiiiiiiiiiiiiiiiifiisesiieiiieiiiesisiwiiKsfwiiieieitwwiiiiwwi'ti'tiiwvtwiiitwi'rif#ieiri'tiei'tiiitiFw
l u N I N G k E{a U I it e. M E N T S
sEr�Acxs
------------ MAiN bUILLING ---------- --------- ACCESSGkY" buYLL3NG ---------
FkivZ: FT I13 REAx• FT IN FANi: FT IN h�.Ak; FT iN
LEFr: FI IN AGHr: FI IN LEFT: FT II3 hGAi: Fi IN
FF�FiKING kEQ: PkOV: Ft1FcCEL: diSG7i"v8 ZNE: hcF NO:
FLANNING NvTES>
1
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F E E 5 U M M A R it
LH1C:
LATE:
L��t: /1—Z
1�1t1rftfll�ltltH TT'}T1Yl'11'R
57nUCTUkAL SEGMENT:N
bLLG PMI PiOMbING ELECIhIC MECHAiVIC FIRE SMIP/kES GkALING
FHRMIi • 3b.i5 �
25t SMIFiNGN—FtES
PLAN
ISSiiE rEE 22, "v0
bUILLING—LIV—> PEkMiI ISSOE PLAN—CHECK ?GZAL FAIU LUE
TGZALS----> 30.75 22.'v"v G.GG 58.75 58.75 ."v"v
kEVENUE UIVISIGN IGIALS--> CVLLECTEL: 58.7� OVEkiSHGhI: .G�
bLUG YMI FLUMbING ELEC7RIC MECHANIC FIkE SMIP/?GT GkALIN� FLAN—CHECri
58.75
ii iF ii ie ii ii ii iF it iF if iP ii iF iF iF iF ie iF i'r i'r iFie ieii'se iF ie ie ie ii ii iP iP ie ie ii i' ie ii ie ie ie ie x ie ii if ii ie w 9e ii ie ii'vi ii* ii ii ii ii ie ie'st ii iF iF iF ir i'r iE �E if iF ie iF ii� if ie
I N u 2 V I u U A L F E E b h E A A L G W N
IILYt {11Y L L'. S l: !t I Y I I V IV UIV1T l:VS7 1111AL l'.VJ1
MGC } t(t,YAlt(%AL1 COOiIN� UIV11%JYS WiCNTLS IL.L> >b. l�
ENu iiF FEES
11-Z4-1997/�3:31 PR/f�8.7�
kCPTq:61-fl0153s8
PEkMIT:085914
� CONS7RUCTION AND PIANNING PO'OL & o. .+
�� APPROVALS Permit # Date Inspector � qppROVALS Permit # Date Inspector
�1.. Temporary Electrical Service gr Pote 52. Pool & Equipment Location, �
�.,
�! Soil Pipe�Undrgrnd. • . 53. Steel fleinforcement .
"t l 'Y rt'
� �3:� EleCtrical �o'nC'yit.Uqtity-Un�Ggrnd. 54. Forms � ';. '
���-4. EleCtrical��o�duit-Velndrgmd. 55. Elettrical Bonding �
°� 5i St I Reinfo�b�r��Ttt� 56. Rough Plumbing & Pressure Test - �� I`�
L l �;' �te. ., �-.
'•t6� ElettricahUF�ji F�nd. 57. APPROVAL TO COVER-GUNITE = �
,� N Foptings ��s", z iv ,� 58. Electrical Cond�ie�Undrgrnd. •a
.= �.' Fo ndati �`' � �'' " �-•"
3 p,ji„-, ,s ;,, 59. Gas Pipe, O Undryrnd., Test
z9. WaYer Pipe-Undrgr'nd. �� - 60. Backwash Lineg„�Trap, O Undrgmd.
10. Str�ctura�Floor System �D � 67. APPROVAL TO,DECK '
i 11. Property Sewer, line.& Housei;onnection 62. Backwash & Re�eptor-Final .
12. Sewer Cap .` `^' . . .
,v .� 63. Heater & Vent-Final
�h3. Roof Drains �o�- • 64. Plumbing System - Final �� "
;}4. Rough Plumblrlgi G _ !K ' � 65. ElectricabPina� , . 1� _.
t5. Rough ElQctrirarConduit :. 66. Solar System•F.ic�31 � �
;L'&. Rough ElSctric Wiriru�ir �� - � g7. Fencing & Accc3s�pproval , .
1,7. Rough W�ing Si�n ;.j 68. APPROVED FpiR PLASTERING ��
18. Rough ElectricaNT Bar Ceiling ' 69. POOUSPA SYST�EMS FINAI
19. ftough He�ting�& Air�Conditioning .Y�p K �� ro Z k�• r.^ FI�R6:AEPT.:REQUIREMEN7 ,£
-, , . . _ .-.. i;� -�R;7O iT1 �" ?+ I�1
20. Roug� F�tory FiBpface i S'n ��Z�: .p S �T�i. � APPHDVQ6S-+�-� PeTmit # r �r ��
Ill ...'�I �:C I�I ?.,�7�� �T] .K i�
-a . 1� 'T]'.Y ( �.. .. 11 �S � .S y l�. f. ' i {P. .
21. ;puctc� �n Stru�tur�..� � ;5�� r ,� �� i� r, 70. bWndergrourSd Ijlydro �.
22..BuctS}V6ntilaZingUt � Y'7 `� •� ��K .7�_ produ;��Pi{Sing� �as [C]Oil _
�� 1 �T7,S .K IT7 'T '+... '� �: P i �� I -��^, k �-�
23. Gas P?Pe;�o�,��'j &.T�St � �:.�_� �;,� :g i: �. �,.{. , 72. UndergrpLOd F�aush F •N
_ �
24. � oof'Fraaaing y.� � � i* �� � '� �� ��r • 73� UndergrAd.Sroia�eTank'OGas ❑Oil
e r N+ i-i n n e. � i.� � e
25. �ooP�She�thing i� Y- �-`' J y;'7 1l tTi ;� K � Y�� e
74. Overhead H dr8�r ,:
26. �T-Bar.'.Ceilin9 �Structpra�) & oII¢coat +� •� �+ J �7 r 75� Dry Chc+ra'iical ��,� ��' �*! � �
i� ,� - r
� 27. Ftarrme an¢ Fiashing r '�•R'� �t' �.^ .r '� K 76. Dry Sta'^.� ���� k `"
.c .-� � �:k .�;c•J iT k :N K �PIPeQ � k �7 �v �-
.;28. Latliin9&�Siding� g � •7�xi+ � :i: ' ..� ..�+ 7P7 FIXED3YSTEM�FINAl.'-' .� �%
, 29. Insulatio� . k - ;S .. ` ~ � � `` ` -� �T` �7
k 5 ,� K � �� 7� FIRE PREV. F,jIVy�L �:
�� 30. Drywa�� Nailing in�;c �-� , R� !i: S ��Jd@ALT:W DEP�'. REQUIREMENT
. r� .-,
� 31. Plaster B�6wn Coa� r � ! r � % � �; ' ' 79. FINAL IIiISPECT�ON ; ,� , y
r 32. �Electriwl-Power Nlgter��roal j r� � { fr , 80� FOOD CERTIF�CATE ISSUED+ �
33. �6ina'P�le�ric'� :"��` �r � y � I 1� Nntes: '� ��"' k �7 '� �'�
�r �:i: �" I - ��+ � �Y. -h i- "-L �*!il .K 5
': 34. Fina�}leaii�g& Aii �oaditioriing' irt/ � �,� : , , ,y ��i t• r '' y•''
� -
� 35. •F�inal Gas�Pipe�Test ° '�� .' ; �-� ! ( K . '=`� `�'�+:� K . � �"
r t K 1*: • •.i nv � IT1
' 36. �IoocCtlr CanoPY t'=;� I�^.I-i 'K', ' �Y i� T�� 61O +�KI
I
=37. FinaPfac2ory FireplacB � ' "' '� `� ~ � � "'•� 'n ! v
� k�V ( Y .�•� �A
; 38. FinakPlumbing x�,;�� , •� I I �i ` �t�:� �.� r + ��
� 39. Water�5ervice-Pinal �- � � � K 's: f� : � - n ~ � ~ �-�
� .� t r �:v • � � 7
h 40. Gas Setvi�-Final ��r, �,-�r ' r i*± i % v�.�+ �i� �� :
i} t- ' V .,r. �
1 I
�� 47. $olar pomesticFinak �� �7 ^ A J I i t +T '7�� -^ t �z =
� . - } t �� f. :� � i �
42. Backfl0�' PrevCnter � 'v � r �z , •�� r � �
I i t
:J 'F ll ' 1'-4 -i K'.H i IT 1%]'� Y '�
.h �
-43. Backfl0w Irrigation r. w� ! '� i. � t � ' •� •
t [ t 1 '"V K 3 ..� :.1
it .
'44. .Landstape,iriipation;System r;�`r ,�j _K'� �r .^ ,�:� �_{ � ;g L 'jx � ,� �J
'. : �. T = - . � w.�
45. Sound Atte�uation �. 7 � •• �*7 i*7 ��'.. � "r' _ � �-�'7 F
rt C a:r •• k� I i '-+ - 5
'46. Hanc�,cap'RegQlation�s �� ��. j. � ..� ..� �K - �T''1 ��� _ V .. J. �
4�7. FINA,t STRUCTUR� & BUILDING K•-�� � I' � � .` �
.
r I Ik . 1 1 � �
48. �FINA� PLANNING � ��`� K'' I �. �" �;� u � « .y
�39. Etectric Release to Etlison j r � �e ; i ; • `i .r , _
�. � r. � � ��
� I' [ � �-1 l . ��P c .
�50. �6�as 9elease to Soutt�em Califorp'i�-Gas Co k � S ��� � -
, �
51. CERTIFICATE OF OCCUPANCY ` ` " '
No. Date
(�i4) �54-5D3 • Fax (�ta) 75a•ae56 • www.ci.costa-mesa.ca.us ii rnihi unrvt, cu�iv. meaH, ch azozo
Job Address:
Suite No
PLUMBING PERMIT
3545 HARBOR GATEWAY S
Vicinity: VALL�Y CREST LANDSCAPING
Parcel Nunmber: 41507108
Applicant: BOWERS, JOHN
Address: 1306 � EDINGER AV
SUITE C
SANTq ANA, CA
Owner: C J SEGERSTROM 8 SONS
Address 3315 FAIRVIEW RD
COSTA MESA, CA
Contractor: SNEpEN AND BOWERS INC
Address: 7306 ff EDINGER AV
SUITH C
Arch / Eng :
Address:
ISSUE FEE
Backflow irtigation
BackFlow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Orain, Floor
D21n, Rainwater
SANTq ANA, CA
Phone: 714-883-5172
Zip: 92705
Phone:
Zip: 92626
Phone: 714-838-4112
Zip: 92705
License: 811856
Phone:
Zip:"
License:
Status: ISSUED
Applied: 12I23I2004
Issued: 1 27/ 0
/
ISSUED BY:
SCOPE OF PERMIT
INTERIOR 12,771 SF OFFICE TI FOR "VALLEY CREST LANDSCAPING' WORK TO INCLUDE
INTERIOR DEMOLITION OF NONBEARING PARTITION WALLS AND CONSTRUCTION OF NEW WAILS AND
ELECTRICAL WORK. REF: B04-01969 - � '
.� �_
PLUMBING TO INCLUDE: 1 FLOOR DRAIN, 12 BAR SINKS, AND:LWATER CLOSET. .
AMT
$23.50
50.00
50.00
50.00
50.00
30.00
50.00
50.00
$9.80
50.00
FEESUMMARY
QTY , AMT
- Laundry Tub / Washer 50.00
0 Landscape Irrigatlon 50.00
0 P-Trap 50.00
0 Pressure Regulator $0.00
0 Process Piping (per 10 ft) 50.00
0 Receptors . 50.00
0 SepGc Tank � 30.00
0 Sewer Cap for �emo $0.00
t Sewer Connecl " $0.00
0 Sewer Private Line $0.00
Qn
0
0
0
0
0
�0
0.
p '
0
0
SumpPump
Swimming Pool
Trap Primei �
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr BkFlow(5+)
Wash Bas'rn
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
59.80
QTY
0
0
0
0
0
0
0
0
0
1
N0710E: The work authorizetl by tnis permit shall comply with al! applicable I�andicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•g2)
EXPIRATION: This permit sha11 automatically expire and become void if work is not commenced within 180 days, or it work Is suspended or abandoned
for a period ot 180 days. /
INSPEC710NS: In order tor the work authorized under this permit to be considered legal, such work must comply with ell applicable codes, e all
requlred inapectlons and final epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration ot this pe
FOR INSPECTIONS CALL: (714) 7545826
zaaaae (eAo�
WORKERS'COMPENSAnON DECLARAnON: �
I �ereby aHirm under penalty of perjury ane of tha following declaratians:
❑ I heve end wlll meintein e cenificate ol consent to self�lnsure for workers' compensation, es provitled lor by section 3700 oi the Lebor Code, lor the peMormence ol the
work for which INs pertnii is luuetl.
� I have and will malncain workers' compensatlon Insu2nce, as reqvlretl by section 3700 of Ne Lebor Code, for �he peAortnance of the work for which Nis permit Is issuetl.
My work cop�pensation Insurance car � entl poliyy number ara:
Cemer. > i A Tt rr a1 Policy Number: i%O a Z z 9 2 z� Z�
(This se need nof be cam0/eted il the permif is velueU at ane huntlred tlollers ($100) or less.)
❑ I nity that In ihe pertortnence of the work for which this pertnit is issued, I shell not employ eny person in eny manner so es to becoma suDJect to the workers'
compensetion laws oi Ce�if�mia entl egree t�et if I shoultl bewme suDject to t�e workers' compensatlon provlsions ot Section 3700 of lhe Lebor Cotle, I shell lorthwith
comply with ihese provjsi ns.
Applicant Signemre:
� Date: i 7 — % % ' a�
WARNING: F/ILURE TO S� RE WORKERS' WMPENSATION COVERAGE IS UNLAWFUL PND SF1ML SUBIEC� AN EMPLOVER TO CRIMIWLL PENALT�ES AND GVIL FINES UP TOONE HUNDRED
T!K%ISAND OOLURE (51 .000�, IN ADOITION TO THE COST OF COMPENSATION, DNMOESlS PROVIDED F-0R IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby aHirtn lhet I am
force and effect Lia a_
Contrecmfs Signeture:
Chapter 9(commencing with Section 7000) of Division 3 of tha Busine5r,,and Professions Code, antl my licensa is in full
Cless N �
Dete: ! 2^ Z 7— OY
CONSTRUCTION LENUING AGENCY:
❑ I hereby altirm that thera is a consiruction lending egency for ihe pedormance of the work for which this permlt Is issuetl. (Sec. 3097, Civil Cotle).
Lendefs Name: Lender's Address:
Signature:
OWNER-BUILDER DECLARAT10N5:
Date:
I hereby aHirtn thet untler penelry oi per�ury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe lollowing reason (Sec. 7031.5, Busineu and Professions
Code: Any city or county whic� requlres e permit �o construct, elter, improve, demollsh, or re0eir eny slmcWre, pdor to Its issuance, elso requlres the epplicant for such partnit
to file e signetl statement Ihat he or she Is Ilcensetl pursuent ro Ihe pmvlsions of lhe Contrectors License Lew (Chapter 9(commencing with Sectbn 7000) of Dlvislon 3 of tha
Business entl Professions Cotle) ar thet he or she is exempt thereirom antl t�e basis tor tha elleged exemption. Any doletion oi Section 7031.5 by any epplicent for e parmit
su6�ecis the applicent to e civil penalry oi not more than live hundred dollars ($500).):
❑ I, as owner of the property, or my employees wit� wages as thair sola compansation, WILL DO THE WORK, and tha sWCWre Is not Intendad or oflered for sale (Sec.
7044, 8usiness and Professions Cotle: 7he Contractors License Lew does noI apply to an owner of property who buiids or improvas thereon, and who tloes such work
himself or herself or through his or her own employees, providetl thet such improvemenis are not intended or oHered for sale. If, however, tha building or improvement Is
sold within one year ot completion, the owner-builder will have Ihe burden o( proving Ihat he or she did not buiid or improve tor purpose of sale.). '
❑ I, a5 owner of the property, am EXCLUSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS to construct the pro�ett (Sec. 7044, Business and Profession5
Code: The contracmrs Llcense Lew does not epply to an or.ner of pro0eny who builds or improves Ihereon, end who cantrects far such pmled w�th a rnntrector(s)
license pursuant to the Contrectors License Lews.).
❑ I am exempt untler sec. Business antl Professions Cotle tor t�is reeson:
SigneWre: Date:
Owner ID verifiad by dnver's license. ❑ Ves ❑ No Driver's Liwnse No.
Verificetion of Ownerehip by (rype of document, I.e. � property tex bill or daed):
OIVISION OF INOUSTRIAL SAFEN VERMIT CER7IFICATION:
Eapires:
❑ I hereby certify that no excavatlon tive (5) or mora taet in depth Into which e person is requirad to descend, will be made in cronnection with work authorized by �his
pertnit, and that no building sWcture, scaflolding, falsework, or Oemolltion or dismantling lhereof, will be more than thirty-sIx (36) feet high. (C�ap. 32, Grp 2, Ar12, Sac.
341, Titla B, Calilomla AtlmlNstretive Cade). �
❑ As ownerbuiltler, I will not employ enyone to do work which wouid require e permil from ihe Division ot Industriel Sefey, es noted ebove, unless such peraon hes e
pertnit ta do such work from Ihe division.
Signature: Date:
Oivision ot Industnal Safery Pertnit Number:
�� CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I cenity untler penalry ot perjury that I have read this applicetion end state that ihe inlormatlon given is I
correct I agree to comply wlth all stete laws and ciry ordinances releting to building wnstruction, end authonze representatives ot ihe Ciry of Costa Mesa to enter upon ihe
above-descnbed property for inspection purposes. I egree not to occupy or allow occupancy ot any building authorized by Ihis Dertnit until finel ins0ec�ion.
COOE t. INSYECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Flnal BIocWRetelning Well
202 Flnal Fectory Fire Place
203 Flnal Sign
204 Final Demolitlon
� Z- Z 7- o Y
Date
�g �S� �QQFy( INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Finel ElectriCal
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Finel Building/Occupancy
QAIF U�leLfl
/ 3_�
Job Address:
Suite No
Vicinity:
MECHANICAL PERMIT
3545 HARBOR GATEWAY S
VALLEY CREST LANDSCAPING
Parcel Number: 41507108
Applicant:
Address:
Owner:
BOWERS,JOHN
1306 E EDINGER AV
SUITE C
SANTA ANA, CA
C J SEGERSTROM & SONS
Address: 3315 FAIRVIEW RD
COSTA MESA, CA
Contractor: SNEDEN AND BOWERS INC
Address: 1306 E EDINGER AV
SUITE C
SANTA ANA, CA
Phone: 714-883-5172
Zip: 92705
Phone:
Zip: 92626
Phone: 714-838-41�2
Zip: 92705 �
License: 811856
StaWs: ISSUED
Applied: 12/23/2004
Issued: 12127/2004
ISSUED BY:
SCOPE OF PERMIT
INTERIOR 12,771 SF OFFICE TI FOR NALLEY CREST LANDSCAP�NG.' WORK TO INCLUDE
INTERIOR DEMOLITION OF NONBEARING PARTITION WALLS AND CONSTRUCTION OF NEW WALLS
AND ELECTRICAL WORK. REF: B04-01969 �
MECHANICAL TO INCLUDE: 18 VENT FANSISINGLE DUCT.
ISSUE FEE
Mst FAU <100 k BTU
�nst FAU >100 k BTU
Repair / Alt Cooling/Heal
Inst / Rep. Recess Wall Htr
Refng Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Boz
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Venl
Air Handlers < 10000cfm
Air Handlers > 10000cfm
Floor Furnace
Floor or Suspend Heater
523.50
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$130.50
$0.00
$0.00
$0.00
$0.00
$0.00 -
$0.00
$0.00
$0.00
Quantity
0
0
0
0
0
0
0
0
0
0
18
0
0
0
0
0
0
0
0
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair I All Re(rigeratlon Unit
Ventillation System
Evaporative Cooler
Commercial I ncinerator
Doinestic Incinerator
Compressors / Absorption Svslems
Upto3hp/100kBTU
3To15hp/SOOkBTU
15 To 30 hp / 7,000 k BTU
30 To 50 hp / 1,750 k BTU ,
Over 50 hp / Over 1,750 BTU'
Boilers � - - �
Upto3hp
3To15hp � � � -
15to30hp_,
30 to 50,hp ; ' -
Over 50 hp
Other Mechanical Fee
InvestigaUon Pee
Plan Check Fee
Quantity
$0.00 0
so.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00
$0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 9248, § 7, 72-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and ell
requlred inepectlone end (inal epproval must be obtained. Failure to obtain inspections end final approval will result in tha expiration of this permit. .
FOR INSPECTIONS CALL: (714) 75456Y6
zana+e �aoo�
DEC-LA AR TIONS]
WORKERS' COMPENSATION DECLARATON:
I hereby ettlrm under penalty ot perjury one ol Ihe following declaretions:
❑ I have entl wlll melnteln a certllicete of consenl to self-Insure tor workers' compensatlon, es proNded br by section 3700 of ihe Lebor Cotle, for the peAormence of Ihe
work for which Ihis pertnit Is issuetl. �
$f I �ave entl will melntein workers' compensetlon insu2nce, as requiretl Ey sectlon 3700 ot Ne Lebor Cotle, for Ne peAortnanca of ihe work for which Nis permit la issued.
�� My warkers;aem ensatlon Insur'a\nce carder e polcy numbar ere:
Certier. ��-'T� i–U.�.� PollcyNumber: d�U �Z� Zz–OZ'Z
(Thls sectlon neetl nat Ee completed 7! fhe permll l val�ed et one hundred dW/ars (5100) w less.)
❑ I cenify that in the performance ol the work for which ihis pertnit is issued, I shall nat employ eny person in eny menner sa as Io become sub�ect to the workers'
cnmpansation laws ol Celifo antl agree thet il I shoultl become suD�ect to the workers' compensetion provlslau o1 Section 3700 of Ne Labor Cotle, I shell t6rt�with
comply with the59 provl5lo
/ `
ApplicaniSignature: � ` Date: Z — Z % —0'
WARNINp: FAILUPE TO SE� WORI(ERS' COMPENSATION COVERAOE IS UNLAWRA AND SHALL SUBIECT Ml EMPLOYER TO CRIMINAL PENPLTIES AND GVIL FlNES UP TO ONE HUNDRED
T}KK1SW D OOLURE (5100,�0). IN AODf(ION Tb THE COST OF GtlMPEN$ATION, DMIAGES 0.S PROVIDED FIXi IN SECTION 31O80F THE UBOR CODE, IMEREST. rW0 �TTORNEYS FEES.
LICENSED CONTRAC70RS DECLARATION:
1 hereby aHirm that I em
larce antl ettect. Lic. a_
ContrectoYs Slgnature:
9(commendng with Section 7000) ol Dlvisian 3 ot the Busine� and Professions Code, entl my license Is In full
Cless p
Date: � 2� 9 7 — O�!
GONSTRUCTION LENDING AGENCY:
❑ I hereby attirtn ihat ihere is a wnstrucNon lantling agency for fhe pedortnance of Ihe work tor whic� ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Lendef5 Neme: lentler5 AtlAr855:
Signeture:
Date:
OWNER•BUILDER DECLARA710N5:
1 hereby aHirtn thet undar penelry ot perjury thel I em EXEMPT PROM 7HE CONTRACTORS LICENSE LAW tar the follawing reeson (Sac. 7031.5, Buslness entl Professlons
Code: Any ciry ar counry which requires e permit lo consiruct, alter, improve, tlemolish, or repair eny structure, prior ta its issuance, elso requiras tha epplicant for such pertnit
m tile a signeE statement that �e or s�e Is Ilcensed pursuant ro the provisions oi Ihe Conirenors License Lew (Chepter 9(commendng wiU Sectlon 7000) 01 Divlslon 3 of t�e
Business entl Professlons Code) or t�et he or she is e:empt therefrom entl the Dasb for ihe elloged exemptlon. Any violetion o1 Sectlon 7031.5 6y eny epplicant for e pertnit
sub�ects Ihe epplicant to e civil penelry oi not more ihen five hundred tlollers (5500).):
❑ I, es ownar o1 t�e property, or my employees wit� wages es thelr sole wmpensailon, WILL DO 7HE WORK, and the siructure Is not intentled or otleretl for sale (Sec.
7044, Busineu and Professions CoOe: The Coniractors License Lew does no� epply to en owner ot property who builtls or improves thereon, flnd who does such work
himsetl ar �erself or through his or her own employees, provitled that such improvements are not intended or oflered for sele. If, however, Ihe building or improvement is
sold within one year ot completion, the owner-builtler will have the burden oi proWng thal he or she did not Duild or improve for purpose of sale.). '
❑ I, es owner ol Ihe propoM, em E%CLUSIVELV CONTRACTING WITM UCENSED LONTRACTORS to wnstmct t�e prolect (Sec. 70d4, Business end Pmfessions
Cotle: The contractore Licensa Law tloes not epP�Y �o en owner ot Droperty who bullds or improves lhareon, and who contrects br sutli prol�� M'��h e contractor(s)
license pursuant ta Ihe Cantrectore Licensa Laws.).
❑ 1 em exempt unAer sec. Busineu and Pmlesslans Catle lar this reason:
Signature: Date:
Owner ID venfie7 by OrivaYs Ilcense. ❑ Ves ❑ No Orivefs License No.
Vedlicatian ol Owners�ip Dy (rype at document, i.e. - properry taz bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMI7 CERTFICATION:
E:pires:
❑ I hereby cenity that no excavetion tive (5) or more feet in tlepth into which a person is required to tlescend, will be ma0e In connectlon with work eut�orized by this
permil, and that no Dullding siructure, scaflolding, falsework, or demolitlon or dismentling thereol, will he more �han Ihirty-slx (36) teet �igh. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celitomia Atlminis[retive Gode). �
❑ As owner-Culltler, I wlll not employ enyone to do work which woultl require e pertnl� Irom the Divlslon ol Industnal Satety, es nated above, unless such person �es e
permii ta do such work Irom the division.
Signeture: � Date:
Division oi Industrlal Sefety Permit Number:
ICERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTFiY: I certify under penalty oi perjury thet 1 have reetl this epplication and stete Ihel Ihe infortnetion given is I
correcl. I egree to comply wlt� ell stete lews end ciry ordlnances reletinp to building constructlon, anE authodze representetives of the Ciry af Coste Mesa to enter upon the
ebove-described property for inspection purposes. I egree not to xcuDY or allow occupency of eny building euihorized by this permit until linel insDection.
COOE 1• IXSYECTIONTYPE
I678 Fixetl System Final Fire Prevention
7268 Pool Spa Final
200 Finel RaRoof
201 Final BIaWRetefning Well
202 Finel fedory Fire Place
203 Final Sign
204 Finel Demolition
Date
� Z — 7i 7 '� �
Data
�g �� j�QQ� INSPECTIONTYVE
206 Final Mechanicel
20B Finel Plum6ing
210 Final Electdcal
212 Finel Fire Preventlan
220 Final Plenning Approval
222 Final Site
250 FinalBullding/Occupancy
(7�a) 75a3273 • Fax (��a) �5a-ae56 • www.ci.wsta-mesa.ca.us 7! FAIM UMIVt, 1iV51A MGAA, GF BLCLti
Job Adtlress:
Suite No
Viciniry:
Parcel Nunmber:
Applicant:
Address:
Owner:
ELECTRICAL PERMIT
3545 HARBOR GATEWAY S
VALLEY CREST LANDSCAPING
41507108
BOWERS, JOHN
1306 E EDINGER AV
SUITE C
SANTA ANA, CA
C J SEGERSTROM & SONS
Address 3315 FAIRVIEW RD
COSTA MESA, CA
Contracror. SNEDEN AND BOWERS INC
Atldress: 1306 E EDINGER AV
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
LighGng Fixts
Recept Outlets
Switches
Nan Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 7000a
MolorS l0 1 hp
Motors to 10hp
Molors to 50hp
Molors to 100hp
Motors over 100hp
SUITE C
SANTA ANA, CA
Phone: 714-838-0112
Zip: 92705
Phone:
Zip: 92626
Phone: 714-83&4112
Zip: 92705 �
License: 811856
Status: ISSUED
Applied: 12123/2004
Issued: 12/27/2004
. : �1� ��
� .
SCOPE OF PERMIT
INTERIOR 12,771 SF OFFICE TI FOR NALLEY CREST LANDSCAPING.' WORK TO INCLUDE
INTERIOR DEMOLITION OF NONBEARING PARTITION WALLS AND CONSTRUCTION OF NEW WALLS AND
ELECTRICAL WORK.
4 LIGHT FIXTURES, 14 OUTLETS, 8 SWITCHES
REF:804-01969 � �
$23.50
$0.00
$0.00
$0.00
$0.00
30.00
34.40
515.40
58.80
$0.00
50.00
$0.00
50.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
Quantity
0
0
0
4
14
8
0
0
0
0
0
0
0
0
0
0
FEESUMMARY
Temp Dist System / Lighting
� Busway/100ft
Standing Section
Misc Electrical� EGuipment
. Transfortners up to 1 kvalkw-
................up to 10 kvalkw
.................up to 50 kvalkw
.................up to 100 kva/kw
" ..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misa Conduit , �
Misa Canductor_
Circus ( gen or nde)
Circus (mech ride or lights)
Chnstmas Tree Stantl .
Fireworks Stand'" �
Other Electrical Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
ao.00 0
50.00, 0
50.00 0
50.00 0
30.00 , 0
50.00 0
30.00 , 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
So.00 0
so.00 0
50.00 0
$0.00
NOTICE: The work authorizad by ihis permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12•21•92)
EXPIRATION: This permit shall automatirally expire and become void if work is not commenced wlthin 180 days, or if work Is suspendetl or abantloned
for a pedod of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all appllcable codes, end ail
required Inepections and (inal epproval must be obtained. Failure to obtain Inspections and final approval will result In the expiralion of this permit.
FOR INSPEC710NS CALL: (714) 7545626 �
zaae�ae �eroo�
WORKERS'COMPENSAnON DECLAHAnON:
I hereby aMrtn under penalry of per�ury one of the following GeclereLons:
❑ I have end wlll mainteln a certllicate ol consent to self-Insure for workers' compensetlon, es provide0 for by section 3700 0l Ihe Lebor CaAe. tor the peAormance ot the
�wOrk tor whith thi5 permit is issuetl.
I heve anG.Oiill meintain workers' compenSeUon inwrance, es requireG Oy saUon 3700 of the Lebor Code, for Ne peAormarrca ot Ihe work for whkh this perMt Is Issuetl.
My wod . pense�tli Insurence carder e`n� pollty num er are: y�.y7
Certier �,�0 %/4- %L 7� YJ N� Poliry Number. C�c�(/ � z 9'7 2 p2 Z
(Thls sectld�! need nof be comp/eteC!! Ne perml! Is veNed at one huntlred dollars (5100) or less.)
%
❑ 1 cbrtity Ihet In t�e peAa ance ol Ihe work lor which this pertnit Is issue4 I s�all not employ eny persan in eny menner so es lo become sub�ect to the workers'
compensatlon laws of � III mla, enA egree thet II I shoultl Decome sub�ect to Ne workeB' compen5e0on Drovislons o1 Section 3700 oi the Lebor Coda, I s�ell IorthwlN
compty wit� these pro I � s, / /�.�
Applirant Signatura: � Date: __ / Z— z 7 —�'1
WARNING: FNLURE TO IX1RE WORKERS' COMPENSATION OWEMOE IS UNLAW FUL AND SHRLL SUBIECT Ml EMPIOYEF TO CRIMINAL PENN.TES AND CML FlNES UP TO ONE HUNDRED
T110USPND OOLLARE 00,000), IN AD�ITION TO THE COST OF NAIPENSATION, DPMAGES AS PROVIDED FOR IN SECf10N 3]OB OF THE IABOR CODE, IMERE5T, AND �TTONNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereDy ettirm Ihel I ert
toroe end ettect. Lic. a,
Contractors Signature:
Chepter 9(commendng wli� Section 7000) of Divlslon 3 ot the Busine�s end Prolessions Code, and my license is in tull
Cless a /�
- — Date: / 2— — / 2—O(%
CONSTRUCTON LENDING AGENCY:
❑ I hereby ettirtn t�et there Is e construction lendinp epenty lor the peAormance ol the work for which Ihis permit Is Issued. (Sec. 3097, CMI Catle).
Lentle/s Neme: Lentler's Atltlress:
SignaNre:
Date:
OWNER-BUILDER OECLARATIONS:
I hereby eHirm Ihet under penalry of per�ury that 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW lor Ihe tollowing reeson (Sec. 7031.5, Business entl Protessions
Cotle: My ciry or counry which requires e permlt m construct, elter, Improve, demdish, or repelr eny strucWre, pdar to Its Issuance, also requires the applicant for suc� permit
to file a signed stetement t�et he or she is licensed pursuent to the provlsions ol lhe Contrectors License Law (C�apter 9(commencing with Section 7000) at DlNsion 3 oi ihe
Business and Prolessions Code) or thet he or she is exempt thereirom end the besis tor the ellepad eaemptlon. Any violetlon of Seclion 7031.5 by eny epplicant for e Dermit
sublects the epplicant to a ciNl penelry ol not more Ihan INe hundred tlollars ($500).):
❑ I, as owner af the property, or my employees with wages es Iheir sole compensatlon, WILL DO THE WORK, end the structure is not Intended or otteretl for sele (Sec.
7044, Business end Professions Catle: Tlie Comractors License Lew tloes not apply to en owner ol property who builds or improves Ihereon, and who tloes such work
himself or herselt or through hIs or her own employees, provided that such impmvemenis ere not Intendetl or oMered far sale. It, howaver, the bulldinq or improvement is
sold wlNin one year of wmpletlon, ihe owner-builder will heve tha burden ol proWng ihat ha or sha did not build or Improve for purposa ot sala.). '
❑ I, es owner af the propOrty, em E%CLUSIVELY CONTRACTINO WITH LICENSED CONTRACTORS to conStruCl the prolect (Sec. 7044, Bu5ine9s end Protesslon5
Cotle: The conirec�ors License Lew does not apply to en owner ol propeny who bullas or Improves ihereon, entl w�o wntrects tor such pwject with e coniractor(s)
license pur5uent to Ihe Conirattors Litense Lews.).
❑ I am exempt untler sec.
Signature:
Owner ID veritiad by drivers Iicense. ❑ Ves ❑ No
Business Bnd Profe55ions Cade tor Ihis reeson:
Verification of Ov+nership 6y (rype o1 document, i.e. - pmDerry tax blll or deed):
DIVISION OF INOUSTRIAL SAFE7Y PERMR CER7IFICATON:
Drlvofs Liconso No.
Date:
Expires:
❑ I hereby certlty that no excevetion Ilve (5) or more feet in depth Into whlch e person is requiretl Io tlescend, will be mede in connaction with work euthodzed by this
pertnit, end Ihat no bulldinq sWcture, scaHolding, telsework, or tlemolltlon or tlismantling Ihereoi, will be more than t�irty-slx (36) teet high. (Chep. 32, Gry 2, An 2, Sec.
341, Title B, Callfomla Adminlsirellve Code).
❑ As owner-builder, I will not employ enyone to do work which would require a pertnit from Ihe Division oi Intlusinal Safery, az noted ebove, unless such person has a
pertnit to tlo such work trom iha Civision.
SignaNre: Date:
Division of Industrial Salery Permit Number:
CER7IFlCATE OF COMPLIANCE AND AllTHORRATION OF ENTHV: I certify under penelty of perjury iha� I �ave rea0 Ihis eppiicelian and stata thet ihe intormation given is
correct. I egree to compty with all stete laws end dry oMinances relatlng to bullCing wnsimction, and authonze reDresentatives o� Ihe Ciry ot Costa Mesa to enter upon the
ebove-described proOeM �ar inspection puryoses. I egree not to occupy or ellow accupancy of eny building au�horized by Ihis permit until tinal inspection.
��' i.. �'
I616 Fixed System Finel Fire Prevention
1266 Pool Spe Final
200 Flnel Re-Rool
201 FIneI BIacWReteininB Well
202 Final Fectory Fire Place
203 Final Slgn
204 Finel Demolili0n
Da1a
� z-z�-oY
Date
�g �$ �QQg! INSPECTIONTYiE
206 Finel Mechanical
20B Final PlumDing
210 Final Electrical
212 Final Fire Preventlon
220 Finel Planning Approval
222
250
Final Slte
Final BuiWing/Occupancy
PAff. It�Li
i-s r
(7ta) 754-5273 • Faz (7ta) 754-aess • www.ci.costa-mesa.ca.us 77 rnih oHrvt, cosin nnt�n, cn szbzb
BUILDING PERMIT
�ob ndtlress: 3545 HARBOR GATEWAY S
Suite:
Vicinity: VALLEY CREST LANDSCAPING
Parcel Number: 41507108
Applicant: BOWERS, JOHN
Adtlress:
Owner: C J SEGERSTROM & SONS
Address 3315 FAIRVIEW RD
COSTA MESA, CA
Con4actor. SNEDEN AND BOWERS INC
Address: 1306 E EDINGER AV
SUITE C
SANTA ANA, CA
Zip: 92705
Arch :
Address:
Zip:
Phone:
License:
Zoning:
Phone: 7�4-883-5172
Zip:
Phone:
Zip: 92626
Phone: 714-838-4112
License: 811856
Eng:
Address:
Status: ISSUED
Applied: 11/19/2004
Issued: 12/27/2004
ISSUED BY:
Phone:
License:
aa.vr� vr r�nm�i
INTERIOR 12,771 SF OFFICE TI FOR NALLEY CREST LANDSCAPING.' WORK TO INCLUDE INTERIOR DEMOLITION OF NONBEARING
PARTITION WALLS AND CONSTRUCTION OF NEW WALLS AND ELECTRICAL WORK.
Plan Check: $115.99
Pgrmit: $713.75
SMIP Res: $0.00
SMIP Com: $12.60
Qther: $0.00
Inspection: $0.00
Total: $842.34
SETBACKS
MAIN STRUCTURE Frant 0. 0
ACCESSORY Front 0-0
PARKING Existinq: o
Rear 0- 0
Rear 0• 0
Required: 0
FEE St1MMARY
PLANNING & ZONING
Left 0- 0 .
Lek 0- 0
- Proposed: 0
Calc Valuation:
Claim Valuation
R�an� a o /
Right 0- 0
560,000.00
Sso,000.00
NOTICE: Tha work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced withln 180 days, or if work is suspended or abe
tor a pedod of 780 days. /
INSPECTION3: In order for ihe work authorized under ihis permit to be consideretl legal, such work must comply wlth all epplicable c�
requlred inep�ctions end final approvel must be obtainad. Failure to obtain inspections and final approval will result in the ezpiration of this i
FOR INSPECTIONS CALL: (714) 754-5626
�
all 1
WORKERS' COMPENSATION DECLARATION:
I hereby eMirm under penalry of perjury one Ot the tollowing tleclaratlons:
� I �eve end will meinteln e cenlficete at consent ta self-Insure for workers' crompenseNon, es provided lor by sedlon 3700 ot the Lebor Code, br the peAortnence of the
�� ork for which this pertnit Is issued.
(3' )I heva entl will meintaln workere' compensetion insurence, es required by sectbn 3700 of Ihe Le6or Code, for the pertortnance of the work for whiU NLq pertnit is issued.
/ My workere' compensatbn insure cerrler erW policy number ere:
Eeiri-eQ^, S���%� ���1v� PolityNumbe �O zZ g 22 01 Z
/nnnmAnnlAnmmn/nlMl/Mnnn in/i�alnlnnaA�inNroriM//er�/S�MIn�/neel
❑ I cenity thet in t�e pertormance of Ihe work for which t�is pertnit is issued, I ahall nm employ eny person in eny manner so es to become subject to the workere'
compensetlon laws of �Ilfomia, entl egrae Ihat I�I s�oultl become sub�ect to t�e vrorkere' compensetlon provislons o1 Sectlon 3700 0l Ihe Lebor Cotle, I s�all farthwith
�� . : _ �,•.--�--_ ��/Z - �? 7 - O y
FAILURE TO S URE WORI(ERS' COMPENSATtON COVEMGE IS UNLAWFUL AND SIW.L SUBIECT Ml EM NAL PENALTIES M!D CMl FlNES UP TOONE HUNORED
� OOLURE 00,000), IN A�DRION TO THE C0.ST OF COMPENSATION, DAALIGES AS PROVIDED FIXi IN SECTION 3)OB OF THE LABOR OOOE, INTEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
Chepter 9(commendng wlih Sectlon 7000) ot Dlvision 3
CONSTRUCTION LENUING AGENCY:
Professions Code, end my Ilcense is in tull
❑ I hereby aflirtn that there is a canstruction lending eqency for Ihe peAormance ol ihe work for which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lentlefs Name: Lendefs Atltlress:
Signature:
Date:
OWNER•BUILDER DECLARATIONS:
I �ereby eMirtn thet under penfllry ol per�ury thel I flm El(EMPT FROM T11E CONTRACTORS LICENSE LAW for ihe IallaWng reason (Sec.7031.5, Business entl Professlons
COAe: My ciry or counry which requlres a permit to construcl, elter, improve, demdish, or repair eny struciure, prior to its issuanca, elw requires t�e applicam tor suc� permit
to fle e signetl atetement thet he or she is Ilcensetl pursuant ta tha proNsions o1 Ihe Coniractors License Lew (Chapter 9(commendng wlth Secllon 7000) of Dlvision 3 of Ihe
Business ana Professions Cada) or t�at he or she is exempt t�eretrom and ihe basis for Ue allegeC exemption. Any violation of Section 7031.5 by eny epplicent for e pertnit
sub�ecis the applicaM to e clvil penalry of not more than Ove hundred tlollars (5500).):
❑ I, es owner oi Ihe properry, or my emplqrees with wages as Uelr sole compensaclon, WILL DO THE WORK, and tha struciure is not Intended or oNeratl tor sele (Sec.
7044, Business and Protessions Code: The Coniractors License Lew does not epON �o en ownar ot properry who builds or improves thereon, end who tloes such work
himsell or hersetl or through his or her own employees, providad thet such improvements are not intended or oHered tor sale. If, howevar, the builtling or improvement Is
sold w1l�in one year of completion, Ihe owner-�uilder will heve the burden of pmving that he or she tlid not Duild or imprave tor purpose of sale.). �
❑ I, as owner of t�e Oroperry, em E%CWSIVELY CONTRACTING WI7M LICENSED CONttiACTORS m construct the prqect (Sec. 7044, Businesa end Professians
Catle: The croniremors Llcensa Lew does not epply to an owner ol property who bullds or impmves thereon, and who contrecis lor such pro�ect with e contractor(s)
license pursuent to the Contractors License Laws.).
❑ I am axempt under 5ec. Business end Profe95i0ns Code fOr thi5 r085on:
Signeture: Date:
Owner ID verllied by tlrlveYs license. ❑ Ves ❑ No Oriver's License No.
Vediicatlon of Ownership by (rype of tlocument, i.e. - properry ten blll or deetl�:
OIVISION OF INOUSTRIAL SAFE7Y PERMIT CERTIFICATION:
Expires:
❑ I hereby certify that no excavetion five (5) or more teet in tlept� Into which e person is required to tlescend, wlll be made in connectlon with work euthodzed by this
pertnit, antl Ihat no huilding structure, scalloltling, felsawork, or demolition or dismamling thereof. will be more ihen ihirry-sIx (38) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title B, CaIlPomla Adminlsirellve Cotle). �
❑ As owner-builder, I will not employ anyone to do wark which would require e portnil lrom the �Ivislon ol Industnel Sefety, es notetl ebove, unless such person hes e
pertnit to do 5uch work tmm the tl'rvision.
Signeture: Date:
DiWsfon of InOustrial Salery Permit NumEer
CEpTFlCATE OF COMPLIANCE AND AllTHORVATION OF EMRV: I certify untler penalry of perjury that I have read this eDPlicetlon end stala thel lhe infortnation given is
correct. I egrae to comply with ell state laws end ciry ortlinences releting to Gullding consWcllon, end euthodze reDresentatives of the Ciry of Costa Mese to enter upon the
above-tlescribed property lor insDaction purposes. I egree nol lo occupy or allow acupency of eny building euthonzed by this permit un�il linel inspectlon.
PAIE
I618 Fixetl System Finel Fire Prevention
1266 Pool Spa Final
2pp Flnel RaRool
201 Final BIocWReteining Wall
202 Final Fectory Fire Place
203 Final Sign
20d Finel Domolillon
� CODE� INSPECTONttPE
206 Finel Mechanicel
20B Final Plumbing
210 Final Elettrical
212
220
222
250
Flnal Fire Prevention
Final Planning Approval
Final Slte
Final Building/Occupanq
Date
PAIE II�LB
(714) 754-5273 • Fex (714) 754-4856 • www.Ci.CoSla-mese.ca.us 77 FAIFi DRIVE, GOSTA MESA, GA 92626
BUILDING PERMIT
.lob Address: 3545 HARBOR GATEWAY S
Suite: 103
Viciniry: FUTURE 7ENANT: VALLEY CREST LANDSCAPING
Parcel Number: 41507108
App�icant: SNEDEN, KENT
Address: 1081 ST REGIS PL
SANTA ANA, CA �
Owner: C J SEGERSTROM & SONS
Address 3315 FAIRVIEW RD ,
" COSTA�MESA, CA ' `
Contractor. SNEDEN AND BOWERS INC
Address: 1306 E EDINGER AV
STE C
SANTA ANA, CA
Zip: 92705
Arch :
Address:
Phone:
Zoning:
Phone: 714-838-4� 12
Zip: 92705 � �
Phone:
Zip: 92626 � : .
Phone: 714-838-4112
License: - 811856
Eng:
Address:
Status: ISSUED
Applied: 11/76/2004
Issued: 11/16I2004
ISSUED BY:
. ,
Phone:
Zip: License: � "License:
SCOPE OF PERMIT
INTERIOR 13,000 SF OFFICE DEMOLITION OF NONBEARING PARITION WALLS AND LIGHTING IN PREP FOR FUTURE TI FOR'VALLEY
CREST LANDSCAPING' IN SUITES 103 AND 104. : , , i� �. � .
, FEE SUMMARY '.
Plan Check: $54.11 ,' „ ;, Calc Valuation: 52,500.00
Permit: $83.25 - - ' � Claim Valuation: Sz,soo.00
SMIP Res: $0.00 �
SMIP Com: $0.53
Other: $0.00
Inspection: $0.00
� , TotaL•� $137.89
SETBACKS
MAINSTRUCTURE�Front 0-0
ACCESSORY ' Front 0- 0
PARKING Existinq:, 0
, PLANNING & ZONING
� Rear ._ 0-b Left� 0. 0
Rear 0. 0 Left 0. 0 �
Required: 0 �Proposed: �0
Right
Right
NOTICE: The work authorized by this permlt 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 explre end become void if work is not commenced within 180 days, or If work Is suspended or abandoned
. tor a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapections and flnel epproval must be obtained. Failure to obtein Inspections and final approval will result In the expiratlon of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626
we-.0 �uw�
WORKEflS' COMVENSATION DECLARA710N:
I hereby affirtn untler penalry ot perjury one oi ihe tWlowmg Aecleretlons: ' �
❑ I heve and wlll maintein e certilicate ot wnsent ta sell-Insure lar workers' compensation, es provitletl tor �y seclian 3700 of the LeDor Code, tor the Dertortnence oi �he
work for which Nis Dortnit is Issued.
� 1 have anC will melntain workers' campensatlon Inwrence, as requiretl by sectim 3700 of Ihe Lebor Cade, fw the peAortnanca of ihe work for which Nis permlt is issuetl,
My work ' compensation I nce carrler and policy number ere: Q
Cartier. ��T� �� �I� PoliryNum�er. �^� ( m,�Za G?�
(This sectlon need not be comp/ete0 il f perml( is velued el one �undred ddlers ($100) or less.)
❑ I certity ihat in the peA rm ol t�e work for c th permit Is issuetl, I shall not employ eny person in eny manner so as to become sub�ect to the workere'
compensatlon lews o i omle, and egrea t become suDjacl to ihe workers' compensation pmvislons oi SecGo 3700 f ihe Lebor Code, I shall IorthwNh
comply with t�e
Applicent Signeture: Date: � O
WARNINO: FAILURE TO SECURE. COVEMGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYEP TO CRIMINAL P NALTIE ANO IVIL FlNES UP TOONE HUNDRED
TMOUSAN� Dd1ARE (5f 00,000�, IN DfiION TO THE COST OF COMPENSATION, DAMAGES AS PflOVIDE� WR IN SECTION 3)OB OF THE IABOR CODE, INTEREST, AND pTTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I he�eby eHirm that I am
force end eHect. Llc. q_
Contractofs Signeture:
e(commencing with Sectlon 7000) af Divislon 3 ot t�e Businee�jnd Professlons Cotle, end my licensa Is In lull
Class N 0
�ate: __ _ (/ (,:+ D
CONSTRUCTON LENDING AGENCY:
❑ I hereby ettirm ihet Ihera is a constmctlon lending agency for ihe perfortnance of iha work for which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lenders Name: Lender's Adtlress:
Slgnature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby eltirm thel untler penelry af per�ury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lar the lollowing reeson (Sec. 7031.5, Business en0 Prates5ions
Code: Any ciry or counry whic� requlres a permll to construcL alter, improve, demolish, ar repeir eny structure, prior to its issuance, also requires tha flppllcant for such pertnic
to file a signetl stetement thet he or she Is Iicensed pursuem to t�e provisions of Ihe Comrectors License Lew (Chapter 9(commencing wit� Sectlon 7000) of Dlvision 3 of t�e
Business and Protesslons Code) or t�at he or she is exempt theretmm and the besis for Ihe elleged exemption. My violation ai Seqion 7031.5 by any applicent tor e pertnit
subJecis the applicant ta e clNl penalry of not more ihan tive hunEretl dollars (5500).):
❑ I, as owner of ihe property, or my emplqrees with weges es Iheir sde wmpensation, WILL DO 7HE WORK, antl the slructura Is not Inientletl or otlered tor sale (Sec.
70a4, Business entl Professions Code: The Contractors License Lew tloos not epply to en owner oi properry who builds ar improves thereon, antl who does such wark
himself or hersell or through his or her own employees, provided that such Imprmemenis are not intended or oflered lar sale. If, however, the bulltling or improvement Is
sold within one year ol completion, Ihe owner-6uiltler will have ihe burden of proving that he or she did not build or imprwe lor purpose ot sale.). '
❑ I, es owner of the pwpeny, em EXCLUSIVELV CONTRACTING WITH UCENSED CONTRACTORS to canstruct the praJect (Sec. 7044, Business end Prolessions
Cotle: The contractoro License Lew does not apply to an ownar of proparty w�o builAs or Improves �hereon, and who cantracts tor such project with e conirector(s)
license pursuent to the Comractors License Lews.).
❑ I am azempt untler sec. Business and Professions Coda for this reason:
Signawre: Date:
Owner ID verilietl by Orivers license. ❑ Ves ❑ No Drivefs License No. Explres:
Vedfication ol Ownership by (rype of documem, I.e. - O�operry ta�c bill or tleetl):
DIVISION OF INDUSTiiIAL SAFETY PERMR CERTIFICATION:
❑ I hereby certlly Uet no excavatlon Ilve (5) or more teei In tlepth Into which a person is require0 to tlescentl, will be matle in connectlon with work euthorizetl by Nis
pertnit, antl that no 6ullding structure, scaNdtling, talsework, or demditlon or tlismantling Ihereof, will be more t�an thirry-slz (38) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Tltle 8, Callfomia Administrative Code).
❑ As owner•builder, I wlll nat emplay enyone to tlo work which waultl require e permit from tha Division ol Intlustnel Sefery, es notetl ebove, unless such person hes e
pertnit to do such work from the tlivislon.
Signature: Date:
Divlsion of Indusirial Setery Permit NumOer:
CERTIFlCATE OF COMPLIANCE AND AUTHORQA710N OF EMRV: I cetlity under penalry ot perjury that I have read t�is applicalion and state that Ihe InformaUon gNen Is
wrrecL I agree to co�p1y with ell siate lews erM Gty ordinances relating to building construdion, and authorize represeniatives ot I�a City of Costs Mese la enter upon the
ebove-tlescrit�tl prypSrTy tor insRection purposes. I egree not to occupy or allow occupenq ot any building au�horized by Ihis permi� until Mel InsDec�ion.
COUE I. INSPECIIONTPE
1616 Fiaed System Finel Fire Preventlon
1266 Pool Spe Finel
200 Finel Re-Rooi
201 FInaI BIocWRetelning Well
202 Finel Factory Fire Place .
203
204
Final Sign
Finel Demolition
PAIF It�LS
COOE I INSVECTION TYPE
206 Final Mechanicel
208 Final WumDing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Appraval
222 Final Site
250 FinalBuilding/Occupency.
PAIE
1I�Lfl
(71a) 754-5273 • Fex (7ta) 754-aB58 • www.ci.coste-mesa.ca.us 77 FAIF DHIVh, GOSiA MtSA, cn aztizti
Job Address: 3560 HYLAND AV
Suite No
Vicinity:
Parcel Nunmber: 41509101
Applicant: PEREYRA, MICHAEL
Address: 1570 CORPOR4TE DR
UNIT A-2
COSTA MESA,CA
Owner: C J SEGERSTROM & SONS
Address 3315 FAIRVIEW RD
COSTA MESA, CA
Contracror: AMP MECHANICAL
Address: 1570 CORPORATE DR
UNIT A-2
COSTA MESA,CA
Arch / Eng : _
Address:
ISSUE FE�
Backflow irrigation
Backflow Preventer
BaNtub
Clarifier System
Connect (Ice,Soda,etc)
Denlal Units
Dishwasher
Drain, Floor
Drain, Rainwater
D2in, Roof
Drinking Fountain
Expansion Tank
PLUMBING PERMIT
ISSUED BY:
Phone: 714-247-1769
Zip: 92626
Phone:
Zip: 92626
Phone: 714-241-1769
Zip: 92626
License: 799431
9 - -
Phone:
- Lp'
License:
Status: ISSUED
Applied: 03/Ot/2004
Issued: 03/01/2004
SCOPE OF PERMIT
TENANT IMPROVEMENT FOR REPLACEMENT OF ROOF MOUNTED BOILER, E�UIP. BEHIND EXIST.
SCREEN ON ROOF. REF 804-00290; PLUMB. PERMIT FOR MAKE UP WATER LINE FOR BOILER.
AMT
$23.50
$0.00
$0.00
50.00
50.00
50.00
50.00
50.00
$0.00
50.00
$0.00
50.00
SO.OD
QTY
FEESUMMARY
AMT
Laundry Tub / Washer 50.00
Landscape Irngation $0.00
P-72p $0.00
Pressure Regulatw $0.00
Process Piping (per 10 ft) 50.00
RecepWre 50.00
SepticTank 50.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower 30.00
Sink, bar " $0.00
Sink, commercial $0.00
an .
0
0
0
0
0
0
0
0
0
0
0
0
0
SumpPump
Swimming Poal
Trap Primer
Urinal
Vawum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash BaSin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Waler Piping (Inst or Rep.)
Water Re-pipe
AMT
$0.00
ao.00
ao.00
30.00
$0.00
ao.00
$0.00
$0.00
ao.00
$0.00
E0.00
50.00
$0.00
on
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorizetl by this permit shall compty with all applicable handicap access requiraments under Califomia statutes and related
regulations. (Orcl. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 7 BO days, or if work is suspended or abandoned
for a period of 180 deys.
INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all appllcable codes, and all
requlred Inspeetlona and final epproval must be obtained. Fellure to obtain Inspections and final approval will result In ihe explration ol this pertnit.
FOR INSPECTIONS CALL: (714) 754-5828
c«o-�o �aw�
WORKERS' COMPENSATION DECLAiiATON: ' —
I hereby aHirtn under penelry ot Derjury ona af the followinq decleratlons: ,
❑ I �eve entl wlll meintein a certllicate ol cansent to sell-Insure lar workere' compensatlon, es proNCed lor by sealon 3700 ot the Lebor Code, tor Ihe pertortnence ol the
work tor whiCh this pelmli I9luuetl.
❑ I have en0 wlll malntaln worlcers' tompensetlan Insurence, as reqWrea Ey sectlon 3700 ot the Lebor COtle, lor Ihe pertortnance of the wark for whkh this pertnit is Issuetl.
My workers' campensetlan Insurence carrier antl pollcy number are:
Cerner: Pdiry Number:
(Thls sectlon need not be canplefed il the permll /s valued et one huntlred dol/eis (Sf00) or less.) -
,� I ceM1ity ��et In t�e pertormence ol ihe work lor which thls pe ' issued, I shall nol employ eny person In eny mennar so es to bocome subJect to the workere'
campensatlon laws at Cellfa {q�nC epree t If I shoul c me sub�ect to the workers' compensatlon proWslons of Sectlon 3700 ot Ihe Lebor Cade, I s�all forihwlth
comply with these provi ' r� l G/
Applicant SigneNre: Dete: � —/ �� /
WARNINO:FAILURETOSEWAEWORI�RS'COMPENSATION EMOEISUMAWFULMIDSHFLLSlIB1ECTMlEMPLOYERTOCRIMINALPENPLTIE$ANDCMLFlNESUPTOONEHUNDRED
T/10USAND OOLUFE (5100,000), IN ADDITION TOT1E COST COMPENSATION, DAAWGES AS PROVIDED FIXi IN SECTION 3108 OF TME UBOq CODE, INfEREST, rW D ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eMirtn that I em
force entl eHect. Llc. p_
Conirectors Signeture:
with SeMion 7000) of DlNsion 3 oi Ue Business antl Pro�ssions Co�B, entl my Iicense is in tull
_ Claxv a L ��
_ Date: �7 — —OS'
CONSTRUCTION LENDINO AGENCV:
❑ I hereby enlrm tnal tnere is e consWctlon lentlinp egency tor tne pertortnance ol the work tor wnich tnls pertnll Is Issued. (Sec. 3097. Cfvll Code).
Lendefs Neme: Lendals Address:
Signature:
Date:
OWNER•BUILDER DECLARATONS:
I hereDy eHirtn t�at untler penelry ol per�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW la the follawing reeson (Sec. 7031.5, Buslness end Professians
Code: Any dry ar counry which requires e pertnit lo construct, elter, improve, tlemolish, or repair eny strucWre, pdor to its issuence, elso requlres the applicant for such pertnit
lo file e signed statement Ihat he or she L9 Iicensed pursuent to the provisions oi ihe Contradors IJcense Lew (Chapter 9(commencinq with SecUon 7000) of Dlvision 3 of the
Business and Protesslons Code) or that he or she is azempt thereiram end Iha basis for the alleged exemption. My Nolation of Senlon 7031.5 �y eny epplicent for a pertnit
subjects the eppliCant lo e cMl ponalry ol not more then IWe hundred dollars ($500).):
❑ I, as owner ol Ihe property, or my employees wilh wages es their sole compensatlon, WILL DO THE WORK, flnd tha structure is not intended ar aHeretl tor sele (Sec.
7044, Business and Professlons CoOe: TTe Contractors Llcense Lew tloes not apply to en owner of properry who bullds or improves thereon, end who does such work
himselt or hersetl or through hls or her own employees, providetl ihat such improvemen45 are not IntentleC or ofleretl for sele. If, however, Ihe building or Improvemen� Is
soltl within one year af completion, the owner-builtler wlll �ave Ihe burden ot proving Ihet he or she dltl not 6uiM or improve lor purpose of sale.). •
❑ I, es owner o1 the property, em EXCLUSIVELY CON7RAC71NG WI7H LICENSED CONTRACT08S to wnstruct the pro�ect (Sac. 7044. Business and Pmtesslons
Cade: The contractore Ucense Lew tloes not eppy to en owner of property who bullds or improves thereon, end who conirecls for such pro�ect with e contrector(s)
license pursuent to t�e Contrectors License Lews.).
❑ I am exempt untler sec. Business end Profeuions Code lor lhis reason:
Signeture: Date:
Ownar ID verifietl Dy tlrlvera Ilcense. ❑ Yes ❑ No Drivers LJcense No.
Vedficetlon ot Ownership by (type ol Eocumen6 I.e. - property taa blll or deetl):
DIVISION OF INDUSTiiIAL SAFETY PERMIT CER7IFICATON:
Expires:
❑ I hereby Certity thet no excevetlon INe (5) or more teet In depth Into which e person Is requlred to tlescen4 wlll be made in connectlon with work authorizeA by Ihis
pertnit, end thet no bulldinp structure, scaHoltling, felsework, or tlemoll�lon or tlismantlinp thereoi, wlll be more Ihen thlrty-sla (3fi) feei hlph. (Chap. 3.2, Grp 2, Art 2, Sec.
341, 71t1e B, Cellfamla AdminlstretWe Cotle).
❑ As owner-builtler, I will not employ enyone to do work w�ich woultl require e pertnit from Ne Divislon of Intlustriel Sefery, es notetl ebove, unless such person has e
pertnit to do such work from the dMsion.
Sipnature: Date:
Dlvision of Intlusinel5efery Pertnit Number:
CERi1FlCATE OF COMPLIANCE AND AUTHORWTON OF EMAV: I cehify under penalty of perjury thet I heve reatl thls eppllcation entl stete that the InfortneHon given Is
conect. I egree to comply wl -911 stete s end ciry orCinan aling to building conslructlon, end euthorize representetives ot �he Clty ol Coste Mesa to enter upon the
ebove-descn Ypro r Inse ' rpos� g�/ acupy or allow occupanty ol eny building euthorized by Ihis pertnit�i�nal i=spe� �
i!i' /i/ ?
igneture OI Legel r(s) Date
MNOr AUNorizeG Applicam
400E �. INSPEClIONT'VE
1816 Fixed Sys�em Final Fire PrevenUon
1266
200
Pod Spa Final
Final Re-Raot
201 Finel BIocWRetalninp Well
202 Final Fectory Flre Place
203 Final Sipn
204 Finel Demolillon
polF. It�L3
400E1 MSPECTIONttPE
208 Final Mechanical
208 Finel Plumbing
210 Finel ElectAcal
212 Finel Flre Preventlan
220 Finel Plenning Apprwfll
222 Finel Site
250 Finel Bulltling�Occupanry
PAIE
/ S� i�
(714) 754-5273 • Fex (714) 754-4856 • www.ci.coste•mesa.Ca.us 77 FAIR DFiIVE, GUS �A MtSA, GA 92ti1ti
BUILDING PERMIT
Job Address: 260 KNOX ST
Suite:
Viciniry:
Parcel Number: 42516303
Applicant: JONATHAN REINEHART
Address: 260 KNOX ST
Zoning:
ISSUED BY:
Phone: 949-64&9763
COSTA MESA, CA Zip: 92627
Owner: GRILLIOT, JANE M& JONATHAN REINEHART
Address 260 KNOX ST
COSTA MESA, CA
Contracior: O WNER-BUILDER
Address:
� 2ip:
+: .
�T
Arch :
Address:
Phone: 949�6469763
Zip: 92627
Phone:
License: 000000
Eng:
� Address:
Status: ISSUED
Applied: 12/13/2004
Issued: 12/13I2004
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF INSTALL 1-15 LB FEIT , REPAIR PLYWOOD AS NEEDED AND INSTALL 30 COMP. SHINGLES. 1500SF
Plan Check: $0.00
Permit: $97.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
SE76ACKS
MAIN STRUC7URE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NO7ES:
Rear 0. 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Lefl 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0-0
Right � 0- 0
$3,300.00
$3,300.00
NOTICE: The work authorized by this permit shall comply with all applicable handicep access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire end become vold if work Is not commenced within 1B0 days, or If work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorizeci under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepeetiona and Iinal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
aas�aelerop)
WORKERS'COMPENSATON DECLARATION:
I hereby eHlrm unaer penalry oi perjury one ol Ne tollowing Coderetions:
❑ I have enG will malntain e cenificate ol cansent to self-Insure for workers' cnmp�qsatlon, es provided br by secNon 3700 of Ihe Lebor Cade, tor the pertormence oi Ue
work for w�ich lhi5 pertnil is i55vetl.
❑ I have end will maintain workers' compensatlon Inwrance, as required by section 3700 of the Lebor CoOe, for the pertoimance oi Ne work ta which Nis permit Is Issued.
My workers' compensallon Insurenca carrier entl policy numDer are:
Cartier. Policy Number:
(Thls secNon need nof be completeU tl Me pemJt ls velued ef one hundred dWlers (5100) or less.)
❑ I certify thet in the pertartnance o1 the work tor which thls pertnit is Issue4 I ahell not employ eny person in any menner so es to bernme suE�ect to the workera'
compensatlon laws af Celifomle, en0 epree I�aI tl I should becwna sub�ect to Ihe workers' compensatlon provlslons ol Sectlon 3700 ot t�e Lebor Cotle, I shell lart�with
cnmply with ihese provisions.
Appllcant Slgnature: Date:
WARNINO: FAILURE TO SECURE WOfiKERS' COMPENSATION CAVERAGE IS UNLAWFUT ANO SNALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES rWD CML FlNES UP TOONE HUNDHED
TqUSIWD DOLLARE (5100,000). IN ADDITION TO THE W5T OF COMPEN54TION, DPN.4GES FS PROVIDED WR IN SECTIIXJ 3)O60F THE UBOR CODE, IMEREST, AND ATTORNEI"5 FEES.
LICENSEO CON7RACTORS DECLARATON:
I hereby eHirm Ihet I em licensetl under proWsiore o1 C�apter 9(commendng wit� Sectlon 7000) ol Division 3 at Ihe Business end Protessions Catle, end my license is In tull
�ome a�a enec�. u�. x aass a
Contrector's Signature: Date:
CONS7RUCTION LENDING AGENCY:
❑ I hereby ettlrm t�al Nere is e consWClion lending egency for Iha pedortnance ot t�e woB for which ihis pertnli is issueC. (Sec. 3097, Civil Code).
Lentler's Neme: Lenders Address:
Signature: Dete:
OWNER•BUILDER DECLARATIONS:
I �ereby attirm thet under penelry af par�ury ihet I em EXEMPT FROM TNE CONTRACTORS LICENSE LAW tor the I011owing reason (Sec. 7031.5, Buslness and Professions
Code: Any ciry or counry which reQuires e pertnit to consiruct, elter, improve, demolish, or repair any structure, prior to its luuance, alsa requires the applicant for such pertnit
to flla e signed stetement Ihat he or she Is Ilcensetl pursuent to t�e provlsbns af t�e Contrectors Ucense Lew (Chapter B(commencing with Seclion 7000) ot Dlvision 3 of the
Business end Professions COAe) or thet �e or she is exempt therefrom end the besla lor the ellepetl avemptlon. Any vblallon ol Sectlon 7031.5 by eny epplitent for e permil
sub�ects the epplicant to a civll penelry of not mora than INe hundred ddlars ($500).):
❑ I, es owner ot t�e D�WenY� ar my employees with weges as iheir sole compensatlon, WILL DO THE WORK, antl iha structure is not intentleC or otteretl for sale (Sec.
7044, Busineu antl Professions Code: The Coniractors License Law does not apply to en owner of properry who Duilds or improves ihereon, and who does such work
himself or herself or through his or her awn emplayees, pmvided that such impmvements are not intended or oHered tor sale. If, however, ihe building or improvement is
sold within one year of completion, tha owner-builder wiil have ihe burden ol proving that he or sha did not 6uiltl or improve tor puryose of sale.). '
❑ I, es owner of the property, am EI(CLUSIVELV CONTRACTNG WITM LICENSED CONTRACTORS to construct the prolea� (Sec. 7044, Busineb5 and ProlesSions
CoOe: T�e contrecrors Licensa Lew does no� eDPly to en owner at pmpany w�a bullAs or Improves thereon, end who comracts for such proJect with e coniractar(s)
A(lic^nse pursuant to� Coniractois License Lews.). �
am
Owner ID venfie�y drivers license.
VedflcaUon of Ownership by (rype ot
Business entl Professlons Cotlo tor this reason:
Ves ❑ No �
TF.e-- property taz bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT LERTIFICATION:
❑ I �ereby cenity thet no eacavetlon flve (5) or more faet in depih Ima which e person is required to tlescend, will be mede In connectlon with work authodzed by this
permit, and ihat no building siructure, sceflolding, felsework, or tlemditlon or dismantling thereot, will be more Ihan thlrty-siv (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Title 8, Celitomla Adminisirative CoAe).
❑ As owner�builder, 1 wlll not emplay enyone to tlo work which woultl require e permit trom tha Division ot Indusirial Sefery, es natetl above, unless such person hes e
permit to tlo such work from Ihe diWsion.
Slpnature: Date:
Division ot Indusinal Sefery Pertnit Number:
CERTIFlCATE OF COMPLUWCE AND AUTNORIZATION OF ENTTiV: I certlty untler penalty of perjury tha� I have reatl this epDlicatian and sWta that Ihe Infortnetion given is I
conect I egree to wmpy wit� ell steta lews end ciry ortllnances relating to building cronstructlon, anC authadze representatives of Ihe Ciry ot Coste Mesa to emer upon the
ebove-tlescnbed propeM tor inspection purposes. I egree not to accupy or allow accupanty ol eny building authorized Dy IMs permit until final inspection.
COOE I. INSVECTIONTYVE
1616 Flxed System Final Fire Preventlon
1268
200
201
202
203
Pool Spe Final
Flnal Ra-Roaf
Final BIOCWRetaining Well
Final Factory Fire Place
Finel Sign
200 Finel Demditi0n
Q�jg IMRULS
COOE I INSPECTION TYPE
206 Final Mechanicel
20B Finel Plumbing
210 Finel Electrfcal
212 Finel Fire PrevenUon
220 Final Planning Approval
222
250
Final Slte
Finel Builtling/OxupenCy
PdIE It�lL&
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
BUILDING PERMIT
Job /+ddress: 3545 HARBOR GATEWAY S
Suite:
Vicinity: BLDG RD 6(HARBOR GATEWAY BUSINESS CENTE
Parcel Number: 41507108 Zoning:
Appiicant: HALL, JEFF
// hHIM ultivt, I:VJ I H MWN, t+A tl[ozo
Status: ISSUED
Applied: 03/26I2003
Issued: OSI28I2003
ISSUED BY:
Address: , — .. _, ,. , --
i ,
� -� � �Phone: 714-632-8333 ' " -
�' ._ - Zip: , ,
.� ��.���, , � _ ' . , - -- . _
Owner. C'J SEGERSTROM 8 SONS_. ' � �
Address / 331�5 FAIRVIEw RD � ' � � " - - - `��
� ; �. . . �, � . � Phone: • _ _ _ .
: �
� � � �jCOSTA MESA, CA"�'� , 2ip: 92626 . � � / , �, �. ��
C6 t acror: SPSlNC. �� �`' \; �
� ��� ��:
i Address: 3000E�MIRACOMAAV �-,�--'� ���A�,
� , ��"�./ Phone: (714)632-8333 �. -' - - �
� ; : ANAHEIM.CA _ � . . �
Zip: .92806 , License: 309472, " � �
Arch : � � ' - - Eng: - -
Address: " - - � ` ' Address: �
' � -� � � Phone: - � � � , � Phone: �
��Zip: � � "'License: ��� License:
�. ,'�,.
SCOPE OF PERMIT .
VOLUNTARY SEISMIC UPGRADE'HARBOR GATEWAY BUSINESS CENTER" BLDG RD-6 �� � �
� FEE SUMMARY
Plan Check: $418.76 Calc Valuation: SSo,000.00
Permit: $64425 Claim Valuation: Sso,000.00
� SMIP Res: $0.00 � � /i -
� SMIP Com: $10.50 � . � � '
Other: � $0.00 ' " �. '
�,
, � Inspection:�,, A .� $0.00 � �
� ..c, . �
�� �: �Total: - $1,073.51 ' � � "
� ��;, � i �
�� '
�� ��- �' � PCANNING & ZONING � �- . �
SETBACKS - ' � �
MAINSTRUCTURE Front 0-0� . Rear 0.0 Left 0-0 Right, �0-0
.� � . _ � ' - . . - . - . � - " ,
ACCESSORY �Font�,0=0'_ .,;Rear_ 40 Left 0-0 . Right�:.0-0' �,%�
PARKING Existinq: � 0-- -' Required: 0 Proposed: �0 � �
NOTES: � � � . . . , "' �
NOTICE: The work authorized by this permit shall compty with ali applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire end become void if work is not commenced within 180 days, or il work is suspended or abandoned
for a period ot 180 days. -
INSPEC710NS: In order for the work authorized under this permit to be consitleretl legal, such work must comply wlth all applicable codes, and ell
requlred Inspections end tinal approvel must Oe obtained. Failure to obtain inspections and Final approval will result in the expiratlon of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
aeae �eroo�
WORKERS' COMPENSA710N DECLARATON:
I here6y eXirm untler penalry ol perjury one of the following tledarelions:
❑ 1 �eve entl wlll meintein a ceNlicate oi consent to self-Insure tor waMers' compensetlon, es proNded lor by sactlon 3700 oi the Wbor Code, tor Ihe pertarmance ot Ne
�work for whlCh this pertnit is issuetl.
I��have antl will maintaln woA�ers' compensation Insurance, as requiretl by section 3700 of Ihe Labor Code, lor the pertarmance ol the work ta which Nis pertnit lv issuetl.
My workers' compensaTtipn Ipsurence cap�ye'r1 endr�p lity number ere: �`1 p/(�
Cerner. � S L.�Y,' �'T 1.` �• PoliCy Number.. 1��I �� IX, V V d.
(Thls sectlon neetl nof be comp/efedll the Oe�mitls va/ued et ane huntlied dollers ($100) ar /ess.) '
❑ I cenity Ihat In the peAormanca of the work tor w� ch t�is permit is IssueO, I shell not employ eny pereon In eny manner so as to become subject to the workers'
compensetlon lews oi Celitomia a r thet s ould bewme sub�ect to t�e workera' compensatlon pmvislons at Sectlon 3700 oi the LaDor Code, I ahell torthwith
comply with these provlslons. O� q
ApplicantSigneWro: Date;i� � � ��.,h �✓�
WARNINO: FAIWRE TO SECURE WORK .' O`APENSATION COVERAGE IS UNUWFUL AND SNALL SUBJECf AN EMPLOVEF TO CRIMINAL PENALTIES AND GVIL FlNES UP TOIXJE HUNDRED
TTIOUSANDOOLURE(5100,000),INADDI I THECQSTOFCOMPENSATION,DAMAGESASPRWIOEDWRINSECfION3]080FTHELABORCODE,INfEREST,ANDATTORNEI"SFEES.
LICENSED CONTRACTORS DECLARATON:
I hereDy eNlrm that I em
force entl ettect. Llc. N_
Cantractofs Slgnawre:
CONS7RUCTON LENDING
with Settion 7000) ol Divlslan 3 ot the Busineu�d P�role,ssions Cade, end my Ilcense Is in full
_ CIB99N� �-
_ Dete: _ _ S'a.' �0 `f
❑ I hereby eflirtn t�at t�ere Is a CanSW ction lentlinp epenty for Ihe OedortnenCe ot the work lor whlch this permit is issuetl. (Sec. 3097, Civil COtle).
Lentlefa Neme: Lentlefs Atltlreu:
Siqnature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby atlirtn Ihet undar panelry of perjury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe lollowing reason (Sec. 7031.5, Business entl Professlons
Cotle: Any city or county which requires e permil to consiruct, elter, Improve, demolis�, or repair eny siructure, prior ta its issuance, alsa requires Ihe epplicant tor such pormit
Io file e signed statement Ihet he or ahe is liCensed pursuflnt to the proWsions of Ihe Contrectors LiCense Lew (Chapter 9(commencing with Secllon 7000) of Divislon 3 of Ihe
Business entl Prolessions Co�e) or that he or she is ezempt therelrom entl the Eesis lor t�e ellegeA e:emptlon. Any Nolation of Section 7031.5 Dy any epplicant for e pertnit
subjacts the applicam to e civil penalry of not mora than tive hundred dollars ($500)J:
❑ I, as owner ol lhe properry, or my employees wlih weges es their sole compensallon, WILL DO THE WORK, end ihe structure is not intended or oHered tor sele (Sec.
7044, Business and Prolassions Cade: The Contractors License Lew does not apply to an owner ot property who buiids or improves ihereon, and who does such work
himsell or herself or thraugh his or her own employees, provided ihat such improvements ere not Intended or oHered lor sele. If, however, Ihe building or Improvement is
sold within one year ot completion, the owner-builder will have t�e burtlen oi provinp �hat he or she did not build or improve for purpose oi sale.). '
❑ I, as owner of the D�Werry, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Professlons
CaAe: The contreclors License Law tloes noi apply Io en owner ol property who bulld5 or Improves Ihereon, and who conlrecls lor such projeCt wlih B conlrettOr(S)
liCenSe pur5uent to the Conlrec�or5 LicenSe Laws.).
❑ I am exempt under sec. eusiness and Professions CoOe for ihis reason:
Signature: Date:
Owner ID veAfietl by Ariver'S1lcense. �Yes ❑ No Driver'S License No. Expires:
Vedlicatlon of Ownerehip by (rype ot doam t, i.e. - properry tax blll or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICATION:
❑ I �ereby ceNfy t�at no excaveilon tive (5) or more teet in Aepih into which e person is required to descend, wlll be made in cornecilon with work authorizeC Dy this
permil, entl that no �uildinp siructure, sceflWding, talsework, or tlemolition or dismamling Ihereof, will be more ihan thirty-six (36) feet high. (C�ap. 3.2. Grp 2, Art 2, Sec.
341, Title 8, Califomle AdministretNe Cotle).
❑ As owner-bullder, I wlll not employ enyone lo tlo work which woultl requlra e permit trom the Dlvislon ot Industrial Setery, es noted aDove, unless suU peraon hea e
pertnit to tlo such work trom tne division.
Signeture: Date:
Divislon ot Intlustdel Safery Permil NumDer.
CERTIFlCATE OF COMPLIANCE AND AUfXORIZATION OF EMFiY: I certity under penelry oi perjury that I have read this epplication and stele thet ihe informetion given is
correct. I egree to wmply wtlh ell state laws en0 dry ordinences relatlng lo bulldinp constructlon, and euthodze representetives of the City ot Caste Mesa to enter upon the
ebove-descdDed property for inspeciion pmposes. I��gree not to accupy or ellow oaupancy of eny building eu�horized by this permit unlil finel inspaction.
COOE �. INSPELTONTYPE I IU �g ��
1616 Fixed Syslem Final Fir reventlon
1268
200
201
202
203
Pool Spa Final
Final He-Roof
Finel BIxWReteining Well
Final Fectory Fire Place
Finel Slgn
204 Finel Demdltbn
COOE1 INSPECTIONTYVE
208 Flnal Mechanical
200 Finel Plumbing
210 Finel Eleclrlcal
212 Finel Fire Prevention
220 Finel Planning Approval
222
250
�.oate-
�'�.h �U`�.
Dafe
Finel Slte
Finel Builtling/Occupanty
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.r��LDING PERMIT n FAIF DRNE, COSTA MESA, GA 92626
�ob Address: 3545 HARBOR GATEWAY S
Suite:
Vicinity: OPEN OFFICE AREA
Parcel Number: 41507108 .•`� Zoning:
Applicant: LINE, GEORGE
Address: 15761 EXETER ST
, � - Phone: (714) 418-1142
WESTMINSTER, CA Zip: 92683
Owner: C J SEGERSTROM & SONS
Address 3315 FAIRVIEW RD
ISSUED BY:
Status: ISSUED �
Applied: 07/17/2000
Issued: 08I04/2000
. � . Phone: ' � � .
COSTA MESA, CA Zip: 92626
Contracmr. GEORGE LINE CONSTRUCTION � � JC(�
Address: 15761 EXE7ER ST �y � O 03
- Phone: (714) 418-1142 �. �� � � �
WESTMINSTER, CA � � QA�' . �
Zip: 92683 � License: 615352 oP►� ;
Arch : ULTIMA DESIGN GROUP eng:
Address: 9462 WATERFRONT DR ' � � Address:
Phone: (714)968-1640
HUNINGTON BEACH, CA
2ip: 92646 License:
TI - CONSTRUCT (719 SF) SIX OFFICES IN OPE�
Plan Check: $27.18
Permit: $167.25
SMIP-Res: $0.00
SMIP Com: $1.81
Other: $0.00
Inspection: $0.00
Total: $196.24
SETBACKS` �.'
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: 0
NOTES:
� ,Rear . 0-0
Rear 0-0
� � Required: 0
AREA FOR EMULEX.
FEE SUMMARY
PLANNING R ZONING
LeR 0- 0
Left 0- 0
Proposed: 0
Phone:
License:
Calc Valuation:
Claim Valuation:
�
ij
.- Right ; 0- 0 _ � � f�
Right - 0- 0 �
�$8,626.00
so.ao
NOTICE: The work authonzed 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 ermit shall automaticall expire and become void if work is not commenced within 1 BO da �
p y ys, or if work is suspended or abandoned
tor a period of 180 days. -
INSPECTIONS: In order for tha work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaaaas (am)
WORKERS'COMPENSAnON DECLARAnON: -
I hereby atfirtn under penalry ot perjury one ol ihe following declarations: -
❑ I heve entl will maintaln e cetliticate of wnsent to self-Insure for workers' compensation, as providad for by saction 3700 ot Ihe Lebor Cotle, tor Ihe peAormance oi the
work tor whiCh Ihis partnit is issued.
�.I�heve and will maintain workers' compensation insurance, as requiretl by section 3700 of ihe lebor Code, tor the perfortnance of the work tor whlch this pertnit Is LsweO,
My workers' compensation Insurence cartier and pdicy numbar ere:
Carrier.r "�I�A�i_ Q'O NZj (Potity.Number.-7_�_ • T'oZ 1 y. \ 1e
�(Tlris section need not be comp�ered i! (ne permir �s velued et one nundred dollars (S1oo) or less.) �-- —
❑ I ceNiy Ihat in Ihe nce of the work tor which this permit is issued, I shall not employ eny person in any manner so es to 6ecome subject to the workers'
compensetian la s of Calllor � tl gr�t II I shoulC became su6ject to che workere' compensation provisions of Section 3700 ot the Lebor Catle, I shall torthwith
comply with thes ro �
A�pplicamSigneWre:. �\a � �ate-'-�-- Q"y"Oa
WARNING:�FAILURE TO SECURE WORKERS' COMPENSnT1IXJ COVERAGE IS UNUWFUL AND SHALL SUBJECT AN EMPLDYER TO CRIMINPL PENALTIES M'D CML FlNES UP TO ONE HUNDRED
TTKKJSAND �OLLARE (5100,000), IN AODRION TO THE C0.ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3lOfi OF TME LABOR CODE, ItJrEREST, AND ATTOHNEVS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirtn that I em licensed under rovisions of Chepter 9(commencing with Section 7000) ot Division 3 oF ihe Business and Protessions Cotle, and my license is In tull
force and effecL,Lic. N. � � 2_ `Class 7 �
Gontractors�Signature: �t Date:--.- S.t{ •rn
1 � I
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm ihat there is e construction lentling agency tor the peAortnance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lendefs Name: Lender's Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby effirm Ihat under penalty ol perjury Ihet I em E%EMPT FROM THE CON7RAC70R5 LICENSE LAW lor ihe following reason (Sec. 7031.5, Business antl Professlans
Cotle: Any ciry or county which requires e permit to constmct, elter, improve, demolish, or repair any stmctura, prior to its Issuance, also requires ihe epplicant tor such permit
to file a signed statement t�at �e or she Is Ilcensetl pursuent to the pmvisions of the Contractore License Law (Chapter 9(commencing wi�h Sectlon 7000) of DiNsion 3 of the
Business end Protessions.Code) or ihat ha or she is exempt ihe�elrom entl the besis for Ihe elleged exemption. Any violation of Sectlan 7031.5 by eny epplicant for e Oermit
subjects the epplicanLlo'a Gvil penelty ol nat more than live huntlred dollars ($500).):
"•-tnl'J,'�.y� -,
❑ I, es owner of iheproperty, or my�employees with weges as thair sole compensation, WILL DO THE WORK, end the strucWre is not intended or oMereG tor sele (Sec.
7044, Business and Pr'ofessions Cotle:'The Conirectors License Law does not apply to an owner of property who builds or impmves thereon, an0 who does such work
himselt or hersetl or tlirough�his;ocKe�own,employaes, provided that such improvemems are not intendetl or oNeretl br sale. If, howaver, ihe building or improvement Is
sold within one year,of complelioq Ihe owner-builder will heve the Durden ol proving that he or she tlid not builtl or improve for purpose oF sale.).
❑ I, as owner of the property, em E%CLUSIVELV COMRAGTING WITM LICENSED CONTRACTORS to construct the project (SecJOC4, Business and Pmtessions
Cotle: The contractors Llcensa,Lew tloes not appy to en owner ot property who builtls or Improves thereon, antl who coniracis tor such pro�ect wlth e contredor(s)
license pursuant to Ihe Coniractors Ucense Lews.).
❑ I am eaempt under sac. - °�•. 1 Business end Pmfessions Code tor t�is reason:
Signature: Date:
Ownar ID verifietl by tlnvefs license. ❑ Ves ❑ No Oriver's License No.
Verificatlon oi Ownership by (type af tlwument, i.e. - pmperty tex blll or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N:
❑ I hereby cenify Ihat no excavetion tive (5) ar more feet in depih Into which a person is requiretl to tlescend, will be made in connectbn with work authorized by ihis
permit, and Ihat no building structure, scaHolding, talsework, or Cemolition or dismantling Ihereot, will 6e more Ihfln thirty-six (36) feet high. (Chap. 32, Gry 2, An 2, Sec.
341, lltle 8, Calilomia Adminisirative Cade).
❑ As owner-builder, I will not employ anyone to tlo work whic� would require a pertnit from the Division of Intlustrial Safery, as noted ebove, unleu such person has a
permit ro Oo such work Irom the tlivision.
Signature: Date:
DiviSion of InduStnal Sefe�y PBrmii Number:
CERTIFICATE OF COMPLIANCE AND AUTHORVATION OF EMRY: I cenify under penalry of perjury that I have reaa this application and state that the inlortnation given is
conect I egree to comply with all steie laws and ciry ordinances relaiing to building construciion, end authorize representatives of the City ot Costa Mesa to enter upon Ihe
above-descnbed properry for inspection purposes. I egrae not ro occupy or ellow occuDancy ot any building authonzed by �his permit until fnal inspection.
COpE �. INSPECTIONTYPE PAIE L�IEL�a
�
1616 Fixed System Final Fire Praventlon
1266 Pod Spa Flnal
200 Finel Re-Root
201 Final BIocWRelaining Well
202 Final Factary Fire Place
203 Finel Sign
204 Finel Demolitian
Daie
�x� y �,co
���a,; _._ -
CODE I INSPECTION TYPE
206 Final Mechanital
208 Final Plumbing
210 Final Electrical
212 Final Fire Preveniion
220 Final Planning Approval
222 Final Site
250 Finel Buiitling/Occupancy
P�IE 1I�4
(714) 754-5273 • F2�c (714) 754-4856 • www.CI.CA5l2-mOSe.C2.U5 / / rNin �niv�, �.vo � �+ mwn. �.n acvco
ELECTRICAL PERMIT �
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
3545 HARBOR GATEWAY S
NEW OFFICES
41507108
LINE, GEORGE
15761 EXETER ST
WESTMINSTER, CA
C J SEGERSTROM & SONS
Phone: (714)418-1142
Zip: 92683
Address 3375 FAIRVIEW RD
Phone:
COSTA MESA, CA Zip: 92626
Contractor: GEORGE LINE CONSTRUCTION
Address: 15761 EXETER ST
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a , �
Service to t000a
Service over t000a
Motors to 1hp
Motors to 10hp
Motors to SOhp
Motors to t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
� Phone: (714)418-1142
WESTMINSTER, CA � Zip: 92683
� License: 615352
ISSUED BY:
Stams: ISSUED
Applietl: OB/04/2000
Issued: 08I04I2000
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR T.I. FOR "EMULEX". INSTALL 12 LIGHT FIXTURES, 12 RECEPTACLE
OUTLETS, 12 SWITCHES, 8�1 SUBPANEL �
REF:B00-01059
$23.50
50.00
$0.00
50.00
$0.00
$0.00
51320
$13.20
573.20
$0.00
50.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
530.50
50.00
$0.00
$0.00
$0.00
�uantity
0
0
0
12
12
12
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
...............:uP l0 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw -
..................over 100 liva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand .� '
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantiry
$0.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
so.00� o
$0.00: . 0
$0.00 0
$0.00 0
$0.00 0
$0.00 . 0
$0.00 0
$0.00 0
$0.00 0
so.00 � o
$0.00 0
$0.00 0
' $0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E93.60
COMMENTS / SPECIAL CONDITIONS
NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandon/ed
tor a period of 180 days. . �`
INSPECTIONS: In order for the work euthorized under ihis permit to be considered legal, such work must comply with all
requlred Inspectione and finel approvel mus[ be obtained. Failure to obtain inspections and final approvel will result in ihe e�
FOR INSPECTIONS CALL: (714) 754-5626
24a&e8 (flN0)
�le�codes, and all
of this pertnit.
WORKERS'COMPENSAnON DECLARAnON:
I hereDy ettirm under penalry of perjury one ot Ne fWlowing dedaratlans:
❑ I have antl will malntain e certificate of consent to setl-Insure lar workers' compensation, es proviCetl lor by section 3700 0l Ihe Lebor Code, for Iha peAortne�a of the
work lar which this pertnii is issued.
�_I a e arW will maintain workers' compensation insurance, as required by secUon 3700 ot Ne Lebor COUe, for Ihe pertortnance oi Ihe work for whitli UUs pertnit is issued
My workers' compensation Insurance wrrier entl poliq number are:
on9
Llicy.Number.-2Z.9 - O� 2 1�. I�
or/ess.) .---- -
❑ I certity thet in the peAormence oi I�e work br which this permit is issuetl, I shall not employ any person in eny manner so as to becoma subject m the workers'
compensetion laws Ifomt and e ree Ihat il I s�oultl becomo subject to the workers' compensetlon provisions oi Sectlon 3700 of the Labor Cotle, I shall forthwit�
cromply with Ihese p visi p
AODllcem Signeture- — - Date: t� '�.� � ��
WARNINO: FNLl/RE TO SECURE WO CE GYMIPENSATION COVEMGE I$ UM.AWFUL AND SHP115UBlECT AN EMPLOVER TO CRIALNAL PENALTIES AND CML FlNES UP TppJE MUN�RED
T110USANDDOLURE�5100,000),IN�DD ONTOTMECQSTOFCOMPENSATION,OMNGESASPRONDEDFOfiINSECilON3�O80FTMEUBORCODE,INTEREST,qNDATTORNEYSFEES.
LICENSED CON7RACTORS DECLARATION:
I hereby ellirm that I am Ilcensetl unCer Orovisions ol Chapter 9(commenGng with Saction 7000) of Divislon 3 oi the Business entl Professions Catle, antl my license Is in full
lorce antl eHacl Llc. p �O � Z. Class a�� Q
.�— —
ContractoCs.Signawre:— - � Date: $- • �O
r --
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirtn that Ihere is e consiruction lentling eqoncy lor the peAortnance ot t�e work for whic� this permit is issued. (Sec. 3097, Civil Codej.
LendeYs Neme: Lendefs Address:
Signeture:
OWNER•BUILDER DECLARATIONS:
Daie:
I hereby afllrm Ihat under penalry ol per�ury that I em EXEMVT FROM THE CON7RACTORS LICENSE LAW for Ihe follawing reason (Sec. 7031.5, Business an0 Pratessions
Code: Any ciry or counry which requires e permit to consWcL alter, Improve, tlemolish, or repalr any structure, prior m its Issuance, elso requires the applicent for such pertnit
to flle e signetl statement t�et he or she Is Iicensed pursuant to the proWsions of tha Contrectors Llcense Lew (Chapter 9(commencing with Secllon 7000) of Division 3 of the
Bu9ine9s end Professions Code) or Ihet he or 5h8 is exempl Iheretrom enA the ba5is tor tha alleged exemption. Any violetion o1 Section 7031.5 Cy any epplicent for e pertnil
subjects the eppliwnt to e civil penalty ol nat more than frve hundrad dollers (5500).):
� I, es owner ol Ihe property, pr my employees with wages es their sole compensation, WILL DO TME WORK, and Ihe siructura is not intentletl ar oHeretl tor sela (Sec.
7044, Business and Prolessims Cotle: The Contrecrors License Lew tlaes not appy to an owner ol pmperry who Guilds or impmves thereon, and who does such woAc
himself or herself or through his or her own employees, provided that such improvements are not intendetl or ofteretl for sale. If, however, the building or improvement is
sold within one year ot comDletion, ihe owner-builder will heve t�e burden of Oroving that he or she tlitl no� build or improve for purpose of sale.).
� I, as owner oi �he property, em E%CLUSIVELV COMRACTNC WITH UCENSED CONTRAGTORS to construcl �he project (Sec. 7044, Business antl Professions
Cotle: The contractors License Lew tloes not eppy to an owner ol property who buil�s or Improves Ihereon, and who contracts tar such projec� wiN a con(ractor(5)
license pursuant to the Coniractors License Laws.).
❑ I em exempt under seC. Bu5in855 Bn0 Profe55ion5 Code lor this reason:
Signaiure: Date:
Ownar ID verilied by tlrivefs license. ❑ Ves ❑ No Dnver's Licanse No. Expires:
Vedficetlon of Ownership by (type oi tlocument, i.e. � praperty lex bill or tleetl):
DIVISION OF INDUSTRIAL SAFE7V PERMR CERTIFICATION:
❑ I hereby canify Ihat no excavetion tive (5) w more leet in depih into which e person is required to descend, will be matle In cannectlon with work authoAzetl by Ihis
partnit, and ihat no building atructure, sCaHWding, falsewoM, or tlemdition or tlismantling Ihereol, will be more than t�irry-six (36j teet high. (Chap. 32, Gry 2, Atl 2, Sec.
341, Tltle B, Califomia Adminisiretive Cade). ,
❑ As owner-builder, I will not employ anyone to tlo work whic� would require e permil Irom Ihe Division ol Intlustrial Selety, es noted ebove, unless such person has e
pertnit to do such work Irom Ihe division.
Slgneture: Date:
Division at Industnal Satery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AIJfHOR¢ATON OF EMAY: I certity untler penalry of perjury ihat I have read this application and state that the inlortnation given is
correct. I egree to comply wlth ell slate lews antl Gry ortlinences relating to builtling constmction, entl authorize representelives of Ihe Ciry o1 Costa Mesa to enter upon Ihe
ebove-described praperty lor inspection purposes. I egree not to occupy or allow oaupancy of eny building euthorized by ihis permil until final inspection.
Signature OI Legal Owner(s) ' 1 Date
' � � • `y�' 0� _
�MNOr Authorized Apolwnt _ � __ __ ' Date -
CO�E �, INSPELTIONTYVE
7616 Fixed System Finel Fire Prevention
1266 Pool Spe Final
200 Finel Ra-Rool
201 FInaI BIocWRetaining Well
202 Finel Factory Fire Plece
203 Final Sign
204 Final Demoliti0n
Qe¢, ��$ COpE� INSPEGTIONTYPE
208 Flnel Mechanlwl '
20B Finel Plumbing
270 Final Eleciricel
212 Final Fire Preventlon
220 Finel Planning ApDroval
222 Finel Site
250 Final Builtling/Occupency
PAg 1t�L$
— �OC7 �
(7ta) 75a-5273 • Fax (77a) 75a-4B56 • www.ci.costa-mesa.ca.us 77 FAIH UHNt, GUS IA MtSA, GA 82bZ0
� MECHANICAL PERMIT ' ,
Job Address: 3545 HARBOR GATEWAY S
Suite No
Vicinity: NEW OFFICE AREA
Parcel Number: 41507108
Applicant LINE, GEORGE
Address: 75761 EXETERST
WESTMINSTER, CA
Phone: (714)478-1142 '
Zip: 92683
Ownec.', C J SEGERSTROM & SONS �
Address: 3315 FAIRVIEW RD
Phone:
� COSTA MESA; CA Zip: 92626
Contractor: GEORGE LINE CONSTRUCTION `
Address: 15761�EXETERST .
Arch / Eng :
Address:
WESTMINSTER, CA
Phone: (714) 418,1142
, -2ip: �92683
License: 615352
Status: ISSUED
Applied: OS/04/2000
Issued: 08/04/2000
ISSUED 8Y:
Phone:
Zip:
- � l:icense: �� ' � - - • � �
SCOPE OF PERMIT �
MECHANICAL PERMIT FOR T.I. FOR "EMULEX". ALT/REPAIR 1 HEATING/COOLING SYSTEM.
REF: B00-01059 - - - _ � - - � - _ _ � - - ,
ISSUE FEE ��
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair / Alt Cooling/Heat �
Inst / Rep. Recess Wall Htr
Refriq Sys <100 k BTU
Refrig Sys >100�k BTU
Gas Piping ' -
Factory Fireplace ,
Hood w/Mech Exhaust `
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 70000cfm
Floor Furnace
Floor or Suspend Heater
Quantity
$23.50
$0.00 0
$0.00 0
$13.70 1
$0.00 0 .
$0.00 P - .
$0.00 0
$0.00 .0
$0.00 0
$o.00 o =
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
FEESUMMARY
' Quantiry
Repair/AltAbsorbtion Unit ' $D.00 0
- ' - � Repair / Alt Refrigeration Unit . � \ $0.00 0
� �VentillationSystem . . $0.00 0
� - Evaporative Cooler � � $0.00 0
Commercial�lncinerator-. , ' $0.00 0
, Domestic Incinerator � � � - � � $0.00 0
Compressors / Absorption �Svstems ` - "
Up to 3 hp / 100 k BTU'-" ', /�50.00 0
3 To 15 hp I 500 k BTU ='� �,�" � $0.00 0
�15 To 30 hp / 1,000 k BTU " , . J � .$0.00 0
30 To 50 hp / 1,750 k BTU -�- ' $0.00 0
Over 50 hp / Over 1,750 BTU � $0.00 0
Boilers
� �Up to 3 hp �. . � " $0.00 0
3 To 15 hp -� �: ,- - $0.00 0
15 to 30 hp -� $0.00 0
30 to 50 hp � � $0.00 0
"Ove(50 hp $0.00 0
Other Mechanical Fee
Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee 50.00
TOTAL CALCULATED FEES 537.20
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: 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 pertnit to be considered lagal, such work must comply with all applicab�odes, and all
requlred Inepeelions end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permi�.
FOR INSPECTIONS CALL: (714) 754-5626
24a6-481fl�W)
WORKERS' COMPENSATION DECLARATION:
I hereby eHirm untler penalty Of perjury one of ihe following declarations:
❑ I heve end wlll malnteln e cenificete of consent to self-Insure for workers' compensetion, es provitled for by sectlon 3700 0l the Lebor Cotla, tor the pertortnance of ihe
_work tor which ��is perrriit Is issued.
,8l—bhava end will maintaln workers' compensation insurence, as required by section 3700 oi the LaDor Code, tor the pertormance of the work for w�icli this pertnit is issuetl.
M_ y_workers' campensetlon Insurence carriar antl policy number are:
�a���a�: ��AT���a� PolicyNumber... ZZq —O�Z..��I Ip
(Thls"section need nof be cromp�efed // fhe permit is veluetl at one hundretl tlollars ($100) or Iess.J
❑ I certily that in the perlomiance of the work for which this permit is luued, I shell not employ eny person in any menner so es to becoma subject to the workers'
compensation lews af Celifomla, and egree that It I shoultl become subject to the workers' compensation provlsions oi Section 3700 of the La�or Code, I shell forthwit�
comDb' �+'ith ihese Dro io s. l`
ApPlicenPSlgnaNre: - — � Date�"'—'-'� C �T � � �
WARNWC: FA0.URE�70 SECURE WO ' COMPENSATION ODVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
THOUSAND OOLLARE (S10J.000), IN A�DI ON TO THE O0.5T OF COMPENSATION, DPfMGES l5 PROVIDED FO{i IN SELTION 3]OB OF THE LABOp CODE, INTEqEST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby efllrm thatd�em Ilcensed under provisions ol Chapter 9(commencing with Sectlon 7000) ol Dlvision.3 o6the�8usin� nd Professions Code, antl my license is in full
�a�ce aoa eneo��u�_a—.Jfo1c� g�� Lclass.x._ �
^--`-__,_....--..__. , . c� __..�. � .. - -
CONSTRUC710N LENDMG AGENCY:
❑ I hereby effvm that there is a construction lending agency tor the peAormance ol the work for w�ich Ihis Oertnit is issuetl. (Sec. 3097, Civil Code).
Lendets Neme: Lentlers Atltlress:
SignaNre:
Date:
OWNER-BUILDER DECLARAnONS:
I here6y eNirm that under pene�ry oi perjury that I em EJ(EMP7 FpOM THE CON7RACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business enA Pmtessions
Code: Any ciry or wunty whicq requires a permit to construct, alter, improve, demolish, or repair any stmcNre, prior to its issuance, also requires the applicant lor suc� permit
to file e signetl stetement that he ar she Is Ilcensed pursuani to the provisions ol the Conirectors License Lew (Chapter 9(commencing wit� Section 7000) of Dlvlsion 3 of ihe
Business and Professlons Code) or ihet he or she is exempt therefrom and tha besis for the alleged ezemption. Any violation of Section 7031.5 by eny applicent 1or e permlt
subjects ihe applicam to e civil penalty of not more than five hundrad dollers ($500).):
❑ I, es owner of Ihe Droperry, ar my employees wl(h wages es their sole compensation, WILL DO TME WORK, and Iha swcWre is not intentle0 or ottered tor sele (Sec.
7044, Busineu end PrWessions Cotle: The Coniractors License Law dces not apply to an owner of propeny who builds or improves ihereon, and who does such work
himsetl or hersell or thro�9h his or her own employees, provided thet such improvements ere not Intentled or oflered for sale. N, however, ihe builtling or Impravement Is
sold within one yeer of cOmpletion, ihe owner-builtler will have the burden ot proving that he or she did not builtl or improve for purpose oi sale.).
❑ I, as owner of the propedy. am E%CLUSIVELV CON7RAC71NG WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business and Professions
Cotle: The contractors Llaense lew does wt apP1Y to an owner W prope�ty wtw �ulltls or improves thereon, end who contracts tor such prqed wiih a contrectrn(5)
license pursuant to the Cantractors License Wws.).
❑ I am exempt under sec. Busineu and Professions Code for Ihis reason:
Signature: Date:
Owner ID verifietl by dAvefs IiCensa. ❑ Yes ❑ No Onver's License No.
Veriflcetion ol Ownership by (rypa ot Aocument, i.e. - property tax bill or deed):
Expires:
DIVISION OF INOUS7RIAL SAFETY VERMIT CERTIFICA710N:
❑ I hereby certiy Ihat no excavation five (5) or more feet in depth into which e person is requlretl to descend, will be mede in connection with work authorizetl by thls
permit, entl thal no building siructure, scattddinq, lalsework, or tlemdition or tlismentling thereoi. will be more then thirry-six (36) feet high. (C�ap. 3.2, Grp 2, Art 2, Sec.
341, Title B, Califomia Adminisirative Code).
❑ As owner-builtler, I will not employ enyone to tlo work which would require e permil from ihe Division ot Industnal Satety, es noled above, unless such person hes e
permil to da such work irom the division.
Signature: Date:
Division of Industnal Salety PeR�it Number:
CERTIFlCATE OF COMPLIANCE AND AUTMOHIZATON OP ENTRV: I ceniy under penalry of perjury Ihat I have �ead ihis application and state that the intortnation given is
correct. I egree to comply with all state laws and city ordinances releting to building consiruction, antl authorize representatives ol ihe Ciry of Costa Mesa to enter upon the
ebove-described omoertv for inspection purposes. 1 agree not to wcupy or ellow occupency of any huildinq euthorized by Ihis permit until final inspection.
CO�E�. INSiECTIONTYPE PAIE I�LS
1616 Fixetl System Final Fi�e Preven�ion
1266
200
201
202
203
Paol Spe Final
Final Ra-Rool
Final BIocWReteining Wall
Final Factory Fire PIaCa
Final Sign
204 Finel Demolition
COOEI INSPECTONTYPE
208 Final Mechanical
208 Finel Plumbing
210 FinelElecirlWl
212 Finel Fire Prevenlion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
�_1. JIII..
r -� i
pia»sa-s2�a • Fa: (�ia� �sa-aess
CITY OF COSTA MESA '
BI/ILpING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
MECHANICAL PERMIT
JobAdd2ss: 3545 HARBOR GATEWAY S
Suite No
Vicinity:
Parcel Number: 41507108
App�icant: STEVE PAQUIN
Address: 2221 E WINSTIN RD #P
ANAHEIM,CA
Phone: (714)774-9707
Zip: 92806
Ownec .0 J SEGERSTROM & SONS _ .
Address: � 3315FAIRVIEW RD . � � " �
. � � � - Phone:
� COSTq MESA; CA Zip: 92626
Contractor. A/C PLUS
Address: - 2221 � WINSTIN RD #P
ANAH�IM,CA .•
Arch/Eng: � � �,
Address: : - � -
REF:B00-00272
Phone: (714)774-9707
- - Zip: 92806
�License: 616420
Phone:
Zip:
License:
SCOPE OF PERMIT
7 REPAIR/ALT COOLING/HTG SYSTEM AND INSTALL 2 VENTS FOR EMULEX.
y . ,
� , a -
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >700 k BTU
Repair / Alt CoolingMeat
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan I Single Dud
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocale Appl Vent
Air Handlars < t0000cfm
Air Handlers > t0000cfm
$23.50
$0.00
$0.00
$13.70
$0.00
50.00
$U.00
50.00
$0.00
$0.00
so.00
$14.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
PERMIT NUMBER
M00-00104
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 0 311 4/2 0 0 0
Issued: 03I14I2000
ISSUED BY: �_�
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercial I ncineretor
Domeslic Indneraror
Compressors I Absorption Svstems
Upto3hp/t00kBTU
3 To 15 hp I 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp I Over 1,750 BTU
Boilers
Up to 3�hp - ,
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
, Quantity
$0.00 0
$0.00 0
so.00 0
80.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$D.00
50.00
$0.00
so.00
$0.00
$0.00
$0.00
�
�
�
0
0
0
0
0
NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order for the work euthonzed under this parmit to be considered legal, such work must comply with all epplicable codes, and all
requlred Inapeetlons antl (inal epproval must be obteined. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 �
WORKERS'GOMPENSAnONDECLARATION:
I hereby afrirtn under penalry o� perjury ona of the following tleclare�ions:
❑ I hava end will melntain a certificate of consent to setl-Insure for workers' compensation, es provided tor by section 3700 of ihe Labor Code, for the pertormence ot the
work for which this pertnil is issuatl. '
j�/ I have antl will maintain workers' compensation insurenca, as required 6y section 3700 of the Labor Code, for the pedortnance of the work for which Nis Dermit is issued.
My workers' compensation Insurenca carrier and policy numbar ere:
Carrier: Policy Number.
(This section need not be comp/eted i! the permit is ve/uetl et one huntlred dallers ($100) or less.)
❑ I certity Ihet in the peAormenCe of �he work for which this pertni� is issueQ I shall no� employ eny person in any menner so as to became subject �o Ihe wOrkers'
compensation laws oi Califomla, end agree thet if I shoultl become subled b ihe workers' compensation provisions of Section 3700 of the Labor Code, I shall torthwith
comply with thesa pro/v�isi ns. o �/
Applicant Signature: �(� � � C �.GC� Date: �' �7 ^ � �
WARNINC:FRILURETOSECUREWORKERS'COMPENSA IIXJCOVEfiAGEISIINLAWFULANDSFNLLSU6IECTANEMPLOYERTOCRIMINALPENA�TIESANDCIVILFINESUPTOONEHUNDRED
THOUSAND DOLLARE ($100.000),IN AODITION TO TME COST OF COMPENSATIIXJ, OAMAGES /5 PROVIDED WR IN SECiION 3IO60F THE LABOR CODE. INTEREST, AND ATTOPNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby attirm that I am licensed under pmvisions of Chapter 9(commencing with Section 7000) ot Division 3 ot Ihe Busine and Pmtassions Code, antl my license is In full
force and eflecL Lic. M � Gass k � ZO
Comreciofs SignaWre: - � Date: ^ /�/- U'J
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirtn that there is a construction lending agency for the perfortnance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Atldress:
Signature:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm thet under penelry of per�ury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE U1W for iha following reeson (Sec. 7031.5, Business antl Pmfessions
Code: Any ciry or counry which requires a permit to constmct, elter, improve, demolish, or repair any slrucWre, pnor to its issuance, also requires ihe applicant for such permit
to file e signed stetement thet he or she is licensed pursuant to ihe provisions of the Contractors license Law (Chapter 9(commencing wlth Secllon 7000) of Division 3 af the
Busineu end Professions Code) or the� he or she is exempt theretrom and the basis for �he alleged exemption. Any violetion of Section 7031.5 by eny eppllcant for a permit
subJects the applicant to a civil penalry of not more Ihan tive hundred dollars ($500)J:
❑ I, as owner of the property, or my employees with weges as iheir sole compensetion, WIt,L DO 7HE WORK, end the structure is not intentletl or oHeretl for sele (Sec.
7044, Business and Professions Code: The Contractors License Ww Does not apply to an owner ot property who 6uiltls or improves thereon, end who doas suc� work
himself or herself or �hmugh his or her own employees, provided that such improvemems are not intended or oHered for sale. If, however, the bulltling or improvement is
soltl wil�in one year of completion, the owner-builder will have ihe burden of provinq ihet he or she did not build or improve far purpose of sele.).
❑ I, as owner ol the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7064, Business entl Professions
Code: The contredors License Lew tlaes not epply ta an awner ot praperty who builtls ar improves ihereon, and who coNrects for such project wl�h a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am ezempt under sec. Business ana Professions Cotla for this reason:
SignaWre: Date:
Owner ID venfietl by tlriver's licanse. ❑ Ves ❑ No Dnvers License No.
Venfiwtion oi Ownership by (type ol document, i.e. - pmperry tax bill or deetl): �
DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CER7IFICA710N:
Expires:
❑ I hereby ceritly �hat no excavation five (5) or more taet in depih Into which a person Is requiretl �o tlescen4 will be matle in connection with work authorized by this
pertnit, antl Ihat no building structure, scalloltling, felsework. or demolition or dismantling thereot, will be more than thirty-six (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Calitomla Atlministretive Code).
❑ As owner-builtler, I will not employ anyone to Co work whic� would require a pertnit irom ihe Division of Industnal Safery, as noted above, unless such person has a
permit to do such work irom the divisian.
Signature: Date:
Division oi Intlustrial Safety Pertnit Number:
CERTIFICA7E OF COMPLIANCE AND AUTHORVATION OF EMAY: I certity untler penalty of perjury Ihat I have read this appliwtion end state that the information given is
correct. I agree to comply with all stete laws and ciy ordinances relatinq ro huilding wnstruction, antl authorize representatives ot Iha Ciry of Costa Mesa to enter upon the
above-descnbed property for inspection purposes. 1 egree not ro occupy or allow occupancy of any huilding authorized by this permit until ilnal inspection.
COpE �. INSPELTION TYYE
1676 Fiaotl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining W ell
202 Final Fectory Fire Plece
203 Finel Sign
� I 204 Final Demolition
zaas as
�jE INTIfIALS
? - /�/� o0
Date
COpE� INSPEC110NTYPE
206 Final Mechanicel
208 Final Plum6ing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approvel
222 Final Site
250 Final Building/Occupancy
(714)754-5273 • Fex(714)754-4856
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
��
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT,
PERMIT
ELECTRICAL PERMIT
3545 HARBQR GATEWAY S
41507108
Applicant: GINA ELM
Address: 27 SPECTRUM POINTE DR #309
LAKE FOREST, CA
Owner: C J SEGERS7ROM & SONS
Address 3315 FAIRVIEW RD �
COSTA MESA; CA
Phone: 949-5883777
Zip: 926660
Phone:
Zip: 92626
Contredor. CURRENT ELECTRIC
Address: 27 SPECTRUM POINTE DR #309 � -
LAKE FOREST, CA
� Phone: 949-5883777
Zip: 926660
License: 488263
NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Stams: I SS U ED
Applied: 03/21/2000
Issued: 03/27/2000
SCOPE OF PERMIT
15 OUTLETS, 5 MOTORS TO 10 HP, 1 100 AMP OVEN/410 VOLTS, 1 MISC. CONDUIT AND 1 MISC.
CONDUIT FOR "EMULEX' TI. - � � �
REF:B00-00272
ISSUE FEE
Temp service test
Res. a/c package
New Res (7-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motors to 1 hp
Molors to 70hp
Motors to 50hp
Morors to 700hp
Motors over t00hp �
Communication drops
523.50
50.00
so.00
$0.00
$0.00
$0.00
50.00
$16.50
50.00
$0.00
$0.00
so.00
50.00
50.00
$0.00
$67.50
$0.00
$0.00
50.00
50.00
�uantiry
0
0
0
0
15
0
0
0
0
0
0
0
5
0
0
0
0
FEESUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
...............:uP to 10 kva/kw
.................up to 50 kva/kw
.................up l0 100 kvalkw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misa Conduit
Misc. Conductor
Circus ( gen or ride)
Cirws (mech ride or lights)
Christmas Tree Stand �
Fireworks Stand
Other Electrical Fee
investigation Fee
Duantity
$0.00 0
$0.00 0
$0.00 0
$18.20 1
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
818.20 1
$18.20 1
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under CaliFomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire end become void if work is not�commenced within 1 BO days, or if work is suspended or abandoned
for e period of 180 deys.
INSPECTIONS: In order tor the work authorized under this pertnit to be considered Iegal, such work must comply with all applicabie codes, antl all
required Inapectione end final epprovel must be obtained. Failure to obtain inspections end tinal epproval will result in the expiratian ot this permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMPENSATION DECLARATON: � _
I hereby attirtn under penalry o1 perjury one ot the IWlowing tledarations:
❑ I have and will melntain a certtlicate at consent to setl-Insure for workefa' compensatlon, es provided br by sectlon 3700 oi Ihe Labor Code, tor ihe peAortnance oi the
wo or which this pertnit is issued.
have and vnll maintaln workers' compen5ation insurance, as reQuiretl by seclion 3700 oi Ne Lebor Code, lor Ne peRormance ol (ha work tw wNch fhis permit Ls iswetl.
My worker ' compqe tia� Insurance caMer antl policy number era: `' C,
Carder. �.�G�/1� PoIlcyNumber. NG/Go o S SS
(Thls sectlon neetl not be compfeted l7 the permlt is ve/uetl af one huntlretl dallers (Sf 00) oi /essJ
❑ I certity thet In the peAorma �e of tha w�for which this permit is issuetl, I shell nol employ eny person in any manner so as to become subject to Ihe workers'
compensation laws oi C¢IXo Oa, en h9t if I should �ecome sub�ect to the workere' crompensation pwvislons of Sectio 3700 at the Le6or Code, I shall foM1hwith
comply wlth ihese prov $i�
Appllcam Signeture: � � / Dete: ���� /�O
WARNIN(3: FAILURE TO W ORKERS' COMPENSATION COVERAGE IS UMAWFUL M'D SMALL SU&IECT PN EMPLOVER TO CRIMINAL PENALTIES AND qVIL FlNES UP TO ONE HUNDRED
THWSANDDOLLARE( 100,000),INMDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDF-0RINSECTION3]OBOFTHELABORCOOE.IMEREST,ANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn Ihat I am license n r r'sL
lorce entl aflect. Lic. a �
Contractor's SigneWra:-
9(commendng with Section 7000) of DMslon 3 at Ihe Buslne end Protessions Code, entl my Iicense is in tull
Cless q � /�
— — Date: :� �r llG
CONSTRUCTION LENDING AGENCY:
❑ I hereby ettirm that there is a canstruction IenAing agenty for the peAartnence of l�e work tor whlch �hls pertnit Is issued. (Sec. 3097, Civll Cotle).
Lender's Neme: Lentler's ACtlress:
Signeture:
OWNER•BUILDER DECLARA710NS:
Date:
I hereby aflirm t�et untler penalry ol per�ury Ihei I am EXEMPT FROM TNE CONTRACTORS LICENSE LAW tor �he following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or wunry which requires e pertnit to wnstruct, alter, improve, demolish, or repair any sirucWra, pdor to Ils issuance, also requires the epplicaN tor such pertnit
to tile e signed stetemem that ha or she is licensetl pursuant to the proNsions of Ihe Cantractors License Law (Chepier 9(commencing with Sectlon 7000) ot DiNsion 3 of the
Buslness end Prolessions Code) or Ihet �e or s�e Is exempt therefrom end the basis for t�e alle9etl exemptlon. Any violation of Section 7031.5 Dy eny epplicant for a pertnit
subJects t�e applicent to e civil penalry at not more than Me �untlretl tldlars (E500).�:
❑ I, as ownar of the propeny, or my employees with wages es thelr sole wmpensatlon, WILL DO THE WORK, antl the structure is not Intended or oXeretl for sale (Sec.
7044, Busineu and Professions Code: The Cantractors License Lew does not eppty lo an owner ol propeny w�o builds or improves thereon, antl who does such work
himself or herself or ihrough his or her ov+A employees, provided that such Improvemen�s are not intendatl or oHaretl for sale. If, however, the bullding or improvement is
soltl within one year of compleUon, ihe owner-builder will hava the burden oi proving that he or she did not build or improve for purpose oi sale.).
❑ I, as owner of ihe properry, am EXCLUSIVELY CONTRACTiNG WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Pmfessions
Code: The contractors License Lew tloes not appry to an owner oi Oroperty who builds or impmves thereon, antl who wntracts for such pmject with a conirector(s)
license pursuant to the Contractors License Lews.).
❑ I am exempt under sec. Business end Pmfessions Code for this reason:
Signewre: Date:
Owner ID veniied Dy dnvers license. ❑ Yes ❑ No Drivers License No.
Verification of Ownership by (type ot tlocument, i.e. - properry tan bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Expires:
❑ I hereby certlty that no eacavatlon Ilve (5) ar more feet in depth into which e person Is requlretl �o descend, wlll be metle in connection wlih work authorized by this
pertnit, end ihat no builtling swcWre, sceNWtling, lalsewoAc, or tlemollUon or tlismantling thereof, will ba more Ihan thirty-six (36) feet high. (Chep. 32, Grp 2, Atl 2, Sec.
341, Title 8, Celifomia Atlministretive Cotle).
❑ As owner-bulltler, 1 wlll not em0loy enyone to tlo work which would requlre a pertnit from Ihe Dlvlsion of Intlustrlel Sefety, as notetl aDove, unleu such person has a
pertnit to do such work trom the division.
sianew�e: oaie:
Divisian at Intlustrial Salery Permit Number:
CERTIFICATE OF COMPLIANCE AND AllTHORIZATION OF ENTAV: I certily under penalry ot perjury Ihat I have read Ihis epplicatlon end stete that the information given is
correct. I agree to comply with ell stete lews and dry orUinences releting to building consiruction, and authorize representetives of ihe Clty of Coste Mesa to enier upon Ihe
above-descnbed property lor inspectbn Durpases. I�ee nat to occupy or ellow occupancy ot any Dullding eu��orizetl �y Ihis partnil until Ilnal Inspection.
GODE �. INSPECTIONTYPE
1616 Fixetl Sy918m Flnel Fire PraventlOn
1266 Pool Spa Final
200 Finel Ra-Roof
201 Flnel BIxWRetaining Well
202 Finel Fectory Fire Placa
203 Final Sign
204 Final Demditim
2a6&a8
�j ate��
�- —
—7' ete
�g ��¢ �Qyf,� INSPECTIONTYPE
206 Final Mechanicel
208 Final Plumbing
210 Final ElecMcal
212 Flnal Fire PrevenUon
220 Final Planning Appraval
222 Final Site
250 FinelBullding/OauDancy
PLg ItiiID�LS
% �i
(714)754-5273 • Fax(714)754-4856
.�
CITY OF COSTA MESA `
B!/ILDING DIYISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
Job Address: 3545 HARBOR GATEWAY S
Suite:
Vicinity: EMULEX
Parcel Number: 41507108 Zoning:
ApplicanY. UNK �
Address:
Phone:
Zip:
Owner. C J SEGERSTROM & SONS
Address 3315 FAIRVIEW RD � �
i.�. � - " � - " �
, -. Phone: '
' COSTA MESA, OA - Zip: 92626
/ i/ � �
Contractor: � GEORGE"LINE CONSTRUCTION
- Address: 15761 EXETER ST
Phone:
, WESTMINSTER CA
� 2ip: " 92683� License: � 615352
Arch : ULTIMA DESIGN GROUP �'" _ Eng:
Address: 9462 WATERFRONT DR ;�" �� � Address:� �.
� ' Phone: 71496&1640 �
PER NUMBER
00-00272
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 03/03/2000
Issued: 03/08/2000
ISSUED BY: �I�
Phone:
� HUNTINGTON BEACH, CA
� �'� Zip: 92646 � � , License: C23684 � License:
� SCOPE OF PERMIT
• � DEMOLISH INTERIOR NON BERAINCa WALL TO.CREATE t OFFICE AREA, AND FILL UP INTERIOR DOOR AND DOOR.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$99.61
$153.25
$0.00
$1.68
$0.00
$0.00
$254.54
SETBACKS
MAIN STRUCTURE Front
ACCESSORY Front
0. 0 Rear 0- 0
0. 0 Rear 0. 0
PARKING Existin : o
NOTES:
Required: . 0
FEE SUMMARY
-- . ,
j. ,
Calc Valuation:
Ciaim Valuation:
PLANNING 8 ZONING
Left . 0. 0 . Right
LeR 0. 0 Right
Proposed: 0
0.0
0.0
se,000.00
$B4O00.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis 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 1B0 days, or if work is suspended or ebandoned
for a pariod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with ell applicable codes, and ell
requlred Inepeetlone end final approvel must be obteined. Failure to abtain inspections and final approval will result in ihe expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545628 /
WORKERS' COMPENSATION DECLARA710N:
I hereby aNirm under penalty of perjury one of the followinq declarztions: . . -
❑ I have antl will maimain a cenificata of cronsem to selF-Insure lor workers' compensation, as provided tor by section 3700 of ihe Lehor Cotle, for �he Dedormance of Ihe
work tor which this permit is isaued. �
[ij' I have end will maintain workers' compensation insurance, as required by section 3700 of Ihe Labor Code, for the peAortnance of the work tor which �his pertnit is issuetl.
My workars' compensetion Insurence carrier and policy number ere:
Carner: Policy NumDer.
(This section need nof be compleretl i/ the pemut is ve/ued af one huntlreU dollers ($100J or /ess.)
❑ I ceniy thet in tha pertormanqe of the work for which this permit is issued, I shall not employ any person in any manner so as ro become subject to the workers'
wmpensation laws ot Califomia, and agrea Ihat ii 1 should become subject ro the workers' compensation provisions of Section 3700 of ihe La6or Code, I shall forthwith
comply with these v" io . ' � �
WAR'N NG: FA UFErTO SECU WORK�q�pEN�ON COVERAGE IS UNL4WFUL PND SHALL SUBIECT AN EMPLOVDER TO CR� �PENALTI�AND C VI �NQES UP TOONE HUNDRED
THOUSAND DOlL4RE (5/0D.000). IN A�Dl�pry TO iHE WSi OF COMPENSAiION, DAMACaES AS PROVIOED FOR IN SECTION 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLqppTION:
I hereby aflirm lha� I am
force and ettect. Lic. a_
Con�rectors Signature:
of Chapter 9(commencing with Saction 7000) of Divislon 3 of the Busir�tqss antl Prolessions Code, antl my license is in tull
CI25S k �J
�1.� oate: M/}R FS :2 c/ 0 c
CONSTRUCTION LENDING AGENCV:
❑ I hereby aMirtn that there Is a cOnswction lending agency for �he peAortnance ot Ihe work tor which ihis permit Is issuatl. (Sec. 3097, Civil Cotle).
Lender'S Name: Lentlefs Atltlress:
Signeture: Date:
OWNER•BUILDER DECLARATION5:
I hereby ettirm ihat under penalry of perjury that I am EXEMPT FROM 7ME CONTRACTORS LICENSE LAW For the following reason (Sec. 7031.5, Business antl Professions
Cotle: Any city or counry which requires a permit to consiruct, alter, impmve, demolish, or repair any siructura, pdor to its issuance, also requires Ihe applicant tor such permit
to file a signed statement that he or Sha is licensed pursuant to ihe provisions of ihe Conirectors License Law (Chapter 9(commencing with Section 7000) of Division 3 ot the
Business and Professions Cotle) or that he or she is exempt Ihereirom end Iha basis for Ihe allegetl exemption. Any violation of Section 7031.5 by any applicant tor a permii
subjects the epplicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the propeny, or my employees with wages es their sole compensation, WILL DO THE WORK, and the simcture is not intended or oRered lor sale (Sec.
7044, Business and Pmfessioqs Code: The Contractors License Law does not apply �o an owner of property who builtls or improves thereon, and who tloas such work
himsetf or herself or through his or her own employees, provided that such improvements are not intended or oHered for sale. It, however, ihe buiiding or improvement is
soltl within one year of completion, Ihe owner-builder will have �he burden of proving that he or she did not build or improve for purpose oi sale.).
❑ I, as owner oi the property, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business antl Professions
Code: The contrectors Licens6 Law tloes not apply to an owner of properry who builds or improves thereon, and who contracts for such pmject with a contractor(s)
license Dursuant to ihe Contracbrs License taws.).
❑ I am exempt untler sec. Business antl Protessions Code for Ihis reason:
Signature: Date:
Owner ID venfied by drivels license. � Yes ❑ No DriveYs License No.
Venfication at Ownership by (rype of document, i.e. - pmperry ta�c bill or deed�:
DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION:
Expiras:
❑ I here6y cenity ihat no excavetion live (5) or more feet in depth Into which a person is requiretl to descend, will be matle in connection wiih work authorized by ihis
pertnit, antl ihat no building str�cNre, sceHolding, telsework, or demolition or dismanUing thereol, will be more than ihirty-six (36) teei hlgh. (Chap. 32, Gry 2, Art 2, Sec.
341, Tltle 8, Celitarnie Administwtive Code).
❑ As owner-builder, I will noi employ anyone to do work which would require a permit from the Division ol Industriel Safery, as notetl a6ove, unless such person has e
permit to do Such work from ih� division.
Slgnature: Dete:
Division of Industrial Safery Permit N�mber:
CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTAV: I cenily under penalty of perjury that I have read t�is application entl s�ate that the information given is
correct. I agree to compty with all state laws and ciry ordinances relating to 6uilding construction, and authodze representetives of ihe City of Costa Mesa to enier upon ihe
above-tlescribed properry for inspection purposes. I egree not to xcupy or ellow occupancy of any builtling authorized hy this permil until ilnal inspection.
i netu Oi Legal Owner(s) Date
��,,,f�,,, ��,�.c,� MA 2 SI a u o a
—� AnNOrquthorizedApplicant Date
COpE �, INSVECtIONTYGE Q�jE INTIf1�l5
1676 Fiaed System Final Fire Prevention
1266
200
201
202
203
Pool Spa Final
Finel Re-Roof
Final BIocWRetaining Wall
Final Fectory Fire Place
Final Sign
204 Final Demolition
2a46a6
yO�E� INSVECTIONTViE
206 Final Mechanical
20B Finel Plumbing
210 Finel Elecincal
212 Finel Fire Prevention
220 Finel Planninq Approval
222 Finel Sile
250 FinalBuilding/Occupancy
PAIE INi1TIAL5
/ _ - � _
�� . Applicant to fill in all Sp3ces ex4e0t ��ose wilhin heavy bortler Iines anE sign aii approoriate tlectantlons.
ICi7YOFCOSTA'MESA C�O�N�,�S/T�R�UCTIO•�N,�P,E�,R,�MITSC� �
L Projec[ Address �� Y�(.�X. �Y1 �-lM�^n��� �•
ApplicanYs Maili�g /+ddrnac �F SV�I:�BI l�'f .L*W��E
Owner's Name ���5�� Phone
Address '
Arch/Eng. , License No.
Address
1 Contrecror'sName �L Phone��61�.i
I� Addresslmailingl, v����LT
GlyLicenSeNo. ���7��
�LICENSED CONTRACTOR DECLARATION �
I hereby aHirm [nat I am licensetl untler provisions of Cnarter 9(commencing
� witn section 7000) of Division 3 of the Business antl Professions Cotle, antl
my Iicense is in tull force and eitect.
ucense ass � — ce seNo. �3���"
I Dat��'"� 'if% ce�ae'.e r w. '
\ WORKERS' COMPENSATION DECLARATION � .
' nereby affirm [hat'1 have a c¢rtificate of cons¢nt [o self-insu�e o� a ce�tlficate
� Workers' CompensaHon Insurance, or a certlfietl copy thereof (Sectlon
� pol��ic�y Ndo. w�J�I—IS • ComPanY Y�.U�
CertiTietl copy is•hereby turNshetl. - �
�Certiti tl c y is Iletl with the city By il g vis on: n '
Date" � APplicanl/- • ���/y��C '
EX MPTIO�RKERS' CGM7 NSATION DECLAR ION
(Tnis section nee0 not be complatetl if the permit is tor one huntlretl ($100) or
Iess). I
I certify tha[ ln tn pe�fo�man<e o/ the work fOr whi[h this pC�T�t is i55Uetl, 1
shall not employ an Oerson in any manner so as to become subject to the
Workers' Compensatio Laws of California.
Date� ' Signature
�NOTICE: It; atter makin9 t .tleclaratlon. You shoultl become�subject to�the
Workers' Compensation prov ns ot Ihe Labor Cotle, you must for[bwith
comD�Y "/��h such p�oviSionS th{s pe�mlt ihall , be tleemetl �evoketl.
CONSTRUCTION LENDIfYG AGE
1 heraby affirm that there iz a constructlon Eing agency tor the pertormance
of tne work ror which tM1iS permlt is � etl (Section 309� Civ. C.)
Lentle�'s Name
—Lentler's Aearess— - - - �
OWNER BUILDEH �ECLARATION
I he�eby a1(I�m that I dm ¢xempt i�om;the Conl�actot'S LicenSe Law �ot the
tnunwina reason (Section�7031.5 Business and Professional Cotle: Any city or
�i
�I
to (il¢ a SiqnPlStat¢ment that he/she IS licensetl Ou�suant to the
antl: [h¢ B br UIC :
any ap0�� � �o� a
n01 mo�e lhan 've nun
wnei of Ihe oro rlv
an
IOtC551005 �CO�¢J Of [na[ ne/sne I5 exempe
Ilegetl exemption. Any violation of Sectlon
Oe�mi[ Subjects tne appliCant to a civil
Iretl tlollars (y500).
or my employees wltn wa9es as thelr sole
mtl the structure is not intentletl or otferetl
'antl Protessional Cotle: The Contractor's
ner of a property wbo builtls or improves
< h self/nerSClf o� th�ough his or h¢r own
proye nts are not intendetl or offeretl Por
sale. It, noweveq tne bulltling or imprOve nt is soltl wlthin one year ot com-
pletlon, the owner wlll nave the burtlen of p ving he/she tlitl not builtl or im-
��ove for tho putpose o1 Shce).
I, a5 ownec of lhe property, am extlusively ro racting witn Iicen58tl con-
tractorsto construct the project ISection 7044, Busi s and'Protessions Cotle:
The Contractor's License Law does not apply to an ner of property who
bWltls or Improves thereon, antl who mntracts for such projects with a con-
tractor(sl ncenze-pursuant to the ConVactor'S License Law). 1 am aware that
proot oi tholr Worker's Comp¢n5atlon Insurance Shoultl be prOvidetl to Te.
❑ I am exem0t untler SeGtlon B. & P. C..for thi{ reason
Date Owner
I hereby certHy that I have reatl thls aoPli<atlon antl state that the above
information Is correct. 1 agree to comply with aIl city antl county ortlinances
antl state laws relatin9 to builtlinq <onstructlon, antl hereby authorize re0re-
Sentative5 ol_�his�lty to ¢nter upon [he abOve-mentionetl ptoperty forJ
l� � 1 / ! / '
TYPE OFCONSTRUCTION � NEW ADD � ALTERATION REPAIR
'❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' A p �6
DESCRIPTION OF WORK/USE OF BLDG. I���'�-�
� • S Main Building:
E
TVPEOFPERMIT GRADirvG FOVNDATION STaUCTVaA� T Front .
❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Roar
O OTHER A
C Right
PROJECT DESCRIPTION �5�. FT. � oCCUaanCY K _
CONSTRUCTION TVPE VALUATION 5 ' g LeFt
20NE ' ; GRADING CU.YDS. ACRES Ping. ReL #
Remarks: f j�'0�1C•_' [rJR1L� � . Planning Notes:
Bar Sink
Backflow Prevznter
Backflow Irri9ation
Bathtubs
Clari(iers �
Dishwasher
Drinking Fountains
Floor Dreins
Floor Sinks ,
Gas Service'
Interceptors:
Kitchen Sink
Lavatories
P—Trap
Roof Drains �
Reinspaction Fee
Showers
- � , ServiceSink ( �
' • Sewer Cap '
' $ewer Connection
Solar Collecrors
Solar P,iping .
Solar Tank �
' Swimming Pool w/Spa
Urinal �
Outlets - Water Closet I
� Water Heater
- �Water Service
� • Auto�Wash
Laundry Trayz
$15
Boiler
Duct - Under Ground
Duct-Struc[ural �
Duct � Ventilating �
Exhaust System � � Multiple
Firepl/Fact. BIC ICBO #
Heating System & Ducting
❑aioo,000 aTu Oioo,oao
- Drivers' Llcense or 55 �
I � I Reinspection Fee
CMF 0865-46, r¢v. 10/84 White - Builtling; Canary - Applicanf: Plnk - AccOuntin9; Goltlenrotl - Assessor
S15
Issue Fae
n
,
,9830 II/18/97
Zane
Accessory Building:
Parking Req./Provided
'. : i �� � r r v v�LC-4J �'� /•nJ
FEES � ' '
�� I _ ' , : � �ELECTRICAL . � .
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-700,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers . -
Issue Fee
i
Automatic Wesher
ConstructionPoleSub. �
Cooking Unit
Dishwasher : � . �
Fan
Fixtures '
Device eoxes �
Outlets
$witCh¢5 ' -' '
Garbage Disposal
Generator OPS KW �5-75 KW
i
Transformer � 15-50 KW "
❑ 50+��K�W,�,.V
Meter �up to 100 �4"'`
Meter ❑over'100amps
Sub Panel . -
Motors�0.1 HP�ih-6
Inc. Solar 09-15 HP 016-15+
Microwave '
Range
Sign "
Standing Sections
Trash Compattor
$ 3
Reinspection Fee � : $75 luua Fee
FEES
�DEVELOPMENT SEPVICES RE�UIREMENTS:
Zoning APProved By � '
Building Approvad By �
Application laued BY
$ 3
210�^ TL
Z
O
N
I
N
G
R
E
�
M
T
$
.� SUMMARVOF.FEES � ' . � ��
BUILDING PEFiM1T $ SMIP � $
� PLAN CHECK : $ � ' - PERMIT � �
� PLUMBING : $ � ISSUANCE � �$� �
PLAN CHECK 25% �$ ENERGV P.C. $
ELECTRICAI - $' ZI•JJ GRADING . $�
PLAN CHECK 50% $� - MICROFILM $ ^
MECHANICAL S � TOTAL FEE $� -yl "� �
PLAN CHECK 25%� $ � �
�
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 & Pressuie Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd. '
8. Foundation 59. Gas Pipe, O 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 � . �
76. Rough Electric Wiring ' " 67. Fencing & Access Approval '
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
- 78. Rough Electrical-T Bar Ceiling � 69. POOUSPA 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 O Gas ❑ Oil
�
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing � 73. Undergrnd. Storage Tank O 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 PREV. FINAL � � '
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37: Plaster Brown Coat � •. 79. FINAL INSPECTION . � ..
32. Electrical Power Meter-Final j 80. FOOD CERTIFICATE ISSUED I
�, ;
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 pomestic-Final � . -
42. Backflow Preventer � � '
�
43. Backflow Irrigation . . , ,
- 44. Landscape Irrigation System • '� � - - � � � "
45. Sound Attenuation � ' • ' -� �
46. Handicap Regulations , .. � . _
47. FINALSTRUCTURE&BUILDING � �'� ";� . .
48. Special Requirements Completed . , " � '
49. Electric Release to Edison - , • � �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY - �
i
N0. Date ' � _
__ �