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2930 GRACE LN - Building Permits
MF - CITY OF COSTA MESAID 44 9 BUILDING DIVISION > •r,,;,, , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUM R t •••�. `--.ate �i PERMIT .t, f;; BO - 137 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us NG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 2930 GRACE LN Status: ISSUED Suite: C Applied: 06/22/2004 Vicinity: Issued: 06/22/2004 Parcel Number: 14122118 Zoning: Applicant:s: 29 1 DAVID ISSUED BY: �t�1 Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 Owner: TRICO-TCH LTD Address 201 PAULARINO AVE Phone: COSTA MESA,CA Zip: 92626-3313 Contractor: KNOX BROTHERS CONSTRUCTION Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 License: 580452 Arch : Eng: Address: Address: Phone: Phone: • Zip: License: License: SCOPE OF PERMIT FIRE DAMAGE REPAIR.SCOPE OF WORK TO INCLUDE:REPLACE SECTION OF EXISTING WALL,NEW DRYWALL,REPLACE PORTION OF PANELIZED ROOF,MISC.ELECTRICAL,PLUMBING AND MECH. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $20,000.00 Permit: $321.25 Claim Valuation: $20,000.00 SMIP Res: $0.00 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $321.25 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 . 2446-46(6/00) DECLARATIONS i ( [ ) ) -• WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the f• • •declarations: ❑ a and wi aintain a ce irate of c• s' to self-Insure f• workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the wo for which is permit is C ued. ave and wit a min w. (ars'compo .. on insuran as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers' omp.nsat Insurance :rn: ;.• .. cy number are: Carrier: Policy Number: (This section ne:.not be completed if t :permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Secli 3700 of the Labor Code,I shall forthwith comply with these provisions.nD 0 Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTI AND G IL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTERES ,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic,# Class# Q !rectors Sgnaturei' Date: q /0 CONSTRUCTION LENDING AGENCY: TI LL.17 l/`Ily 0 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): ' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous ' material? 0 Yes ❑No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutelyhazardous materials'? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greeter then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERT1 • • OF COMPLIANCE AND AUTHOR O OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is cor : . I agree • comply with all st to laws an rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the .•.ve-described. ••.rty for inspe on pure gree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature Of gal DACE)cD Is Ard/OrAg orized-Applicant_, Date ;ODE I INSPECTION TYPE. Q6I€ g1ri1IALS ;ODET INSPECTIONTYPF DATE HEMS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �����/ 204 Final Demolition 250 Final Building/Occupancy til-1911 Y/40 `ell 46 CITY OF COSTA MESA BUILDING DIVISION Y• i �riamnis I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER b. i /i ° PERMIT r"� 'o-Pow.4" 4-00336 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,CO A MESA,CA 92626 MECHANICAL PERMIT Job Address: 2930 GRACE LN Status: ISSUED Suite No C Applied: 06/22/2004 Issued: 06/22/2004 Vicinity: Parcel Number 14122118 ISSUED BY: Applicant: KNOX, DAVID Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 Owner: TRICO-TCH LTD Address: 201 PAULARINO AVE Phone: COSTA MESA,CA Zip: 92626-3313 Contractor: KNOX BROTHERS CONSTRUCTION Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 License:580452 SCOPE OF PERMIT FIRE DAMAGE REPAIR.SCOPE OF WORK TO INCLUDE:REPLACE SECTION OF EXISTING WALL, NEW DRYWALL, REPLACE PORTION OF PANELIZED ROOF,MISC. ELECTRICAL, PLUMBING AND MECH. REF: B04-01137. MECHANICAL TO INCLUDE: 1 VENT FAN. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp 50.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the followin•d: arations: ❑ I and will m.'.ta a certificate • consent I. ': -Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the o or which this • it is issued.I have and will mai air orkers'c•I pensation• .- e,as required by section 3700• -... •.e, or t e performance of the work for which this permit is Issued. y wdrkers'cam.:•sati•n Insu = ce carrier,n• .olicy number are: Carrier: - Policy Number: (This section need not be completed i a pe is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Sectio 3700 the Labor Code,I shall forthwith comply with these provisions. 69 17 0 � Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CIVI FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# /// Contractor's Signature: Date: r n /.o � h` I CONSTRUCTION LENDING AGENCY: �-e ` Lil� lJ ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: . HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions.that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ID Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFI OF CO - ANCE AND A •RIZATON O. Y r :I certify under penalty of perjury that I have read this application and state that the information given is corr .I agree to comply Ith all state I: and city or.' . - relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the ve-described property spection• •oses.I a• •e .of •occupy or allow occupancy of any building authorized by this permit until final inspection. L ,_VW. •f Legal Own: (s)� cd C20-70 ate AntlyOr:Atitl1orzed Applicant Date POE t jISPECTION TYPE Qd1E INTnTIAL CODE( )NSPECTION TYPE call J(1I�4@ 1616 Fixed System Final Fire Prevention 206 Final Mechanical i!•w_` 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4` 9 CITY OF COSTA MESA `) BUILDING DIVISION . y(q,r„ ,/" DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t: Ira PERMIT 04-00708 4RVITCO da (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2930 GRACE LN Status: ISSUED Suite No C Applied: 06/22/2004 Vicinity: Issued: 06/22/2004 Parcel Nunmber: 14122118 Applicant: KNOX, DAVID ISSUED BY: Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 Owner: TRICO-ICH LTD Address 201 PAULARINO AVE Phone: COSTA MESA,CA Zip: 92626-3313 Contractor KNOX BROTHERS CONSTRUCTION Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 License: 580452 SCOPE OF PERMIT FIRE DAMAGE REPAIR. SCOPE OF WORK TO INCLUDE:REPLACE SECTION OF EXISTING WALL,NEW DRYWALL,REPLACE PORTION OF PANELIZED ROOF,MISC. ELECTRICAL, PLUMBING AND MECH. REF: 804.01137. ' ELECTRICAL TO INCLUDE: 10 LIGHT FIXTURES, 12 OUTLETS,6 SWITCHES,2 COMMUNICATION DROPS, 1 SUB PANEL TO 200 AMP, 1 ELECTRICAL WALL HEATER. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $18.20 1 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $11.00 10 up to 50 kva/kw $0.00 0 Recept Outlets $13.20 12 up to 100 kva/kw $0.00 0 Switches $6.60 6 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 / NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. , INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) WORKERS'COMPENSATION DECLARATION: In _ I hereby affirm under penalty of perjury one of t -. .'o.'ng declarations: have and• Al maintain a c: ificate of c•n t to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for wh'• this permit-issued. ave and ill i Stain . .rkers'corn•=�satlon insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My work: s'co pens •n Insure and .o'- •• are: Carder: ` Policy Number: (This sectio need not be complet:•if the permit is valued of one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Sect' n 3700 of the Labor Code,I shall forthwith comply with these provisions. l..0/^d/O'- IApplicent:SlgnaWre:,'�• Date: (/.1' k// WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND CIVIL NES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# ClassN /���0� Nr — Datate:: (// CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _.e _ _ am for..acutely 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for achazartlous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materiels with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No _._ _._...a....plica___._ — .a_....... 5 Does e willo the applicant or a or future buildingsoccupant at requirer for the work which is the or age of this application apertnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? (�Yes Ld No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management Districr or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHOR • • dF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is Car rect. -•.ree to comply with all -ate laws :•• ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the ve-desc ,cid p+perry for ins.✓tion pu .•s:-. agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. A .nature Of egal Owner(s D le AndIOr; thorized'Applicant Da CODE I INSPECTION TYPE RATE INTITIA1-5 CODE I INSPECTION TYPt RAN (MAtS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing A 200 Final Re-Roof 210 Anal Electrical © �.1S 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • 4`p5rn its 9 CITY OF COSTA MESA BUILDING DIVISION >y .1r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ft $ PERMIT B04-01060 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 2930 GRACE LN Status: ISSUED Suite: C Applied: 06/09/2004 Vicinity: UNIT C Issued: 06/09/2004 Parcel Number 14122118 Zoning: Applicant: KNOX BROTHERS CONSTRUCTION ISSUED BY: Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 Owner: TRICO-TCH LTD Address 201 PAULARINO AVE Phone: COSTA MESA,CA Zip: 92626-3313 Contractor: KNOX BROTHERS CONSTRUCTION Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 License: 580452 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT INTERIOR DEMOLITON DUE TO FIRE DAMAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: 52,000.00 Permit: $69.25 Claim Valuation: 52,000.00 SMIP Res: $0.00 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.25 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No. 92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446ie(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for w. •:rs'compensation,as provided for by section 3700 of the Labor Code,for the performance of the Ckwfor which this permit is iss ed. ....rork and will maintai .'...ers'••mpen .tion insu -. co,as requi :. .y section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation In r n : 'or:nd pot i number Carrier: L • Policy Number: (This section need not be com.le:• ' -• rmif is value.et one hund:. Ilar $100)or less.) ❑ I certify that in the pe •rmance of the wo ' or which th'-permit d,I shall not em ny person in any manner so as to become subject to the workers' compensation laws of California,and agrt: -t If I s. .uld becom ' ct to the wo compensation provisions of Sec on 37of the bor Code,I shall forthwith comply with these provisions. / ( /?I O Applicant Signature: Date: vI "(1 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND COUARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTO- •- • ON: f t. I hereby affirm that I licensed under pro'' ons of Chap r 9(co :ncing with S:ction 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. c.N A Class it Contractors Signature: Ana Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: _ _ Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY -rtify under penalty of perjury that I have read this application and state that the Information given is correct. I agre: • om• • . th all state aws and ci ordinances . • ng to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc...aid property for 1 --:ctioof urposes.I.gree not I. i„spy or allow occupancy of any building authorized by this permit until final inspection. A Signe 1_ f Ta / L Dale An.'•r Authorize•Applica t Date cone INSPECTION TYPE PAIL LNTRIALS CODE I INSPECTION TYPE PAIL IRTTSA4 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign / ,y/( ���/ 222 Final Site 204 Final Demolition &'i7-9 . 250 Final Building/Occupancy • 4L0 SS.• CITY OF COSTA MESA _ �@ BUILDING DIVISION •rJ �1 $'. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBE F 1 S P;' 6' ERVICESRarso PO4-0 43 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2930 GRACE LN Status: ISSUED Suite No C Applied: 06/22/2004 Issued: 06/22/2004 Vicinity: . Parcel Nunmber: 14122118 ISSUED BY: � . Applicant: KNOX, DAVID Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 Owner: TRICO-TCH LTD Address 201 PAULARINO AVE Phone: COSTA MESA,CA Zip: 92626-3313 Contractor: KNOX BROTHERS CONSTRUCTION Address: 2931 GRACE LANE SUITE H Phone: (714)556-9910 COSTA MESA,CA Zip: 92626 License: 580452 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT FIRE DAMAGE REPAIR.SCOPE OF WORK TO INCLUDE:REPLACE SECTION OF EXISTING WALL,NEW DRYWALL,REPLACE PORTION OF PANELIZED ROOF, MISC.ELECTRICAL,PLUMBING AND MECH. REF:B04-01137. • PLUMBING TO INCLUDE: 1 WASH BASIN, 1 TOILET, 1 BAR SINK. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • FIMIrrirrirrilllin WORKERS'COMPENSATION DECLARATION: I hereby aff rn_uit pa' lainalty of perjury one of the folio in -Insurefions: orw ❑ ave and wit t a' a is is; eta of cons elf-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ork for which t permit is is ed. I have and will air work.''compen - insurance, required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers' / satio urance - ' r and umber are: Carrier: Policy Number: (This section need not be completed if the.ermit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that it I should become subject to the workers'compensation provisions of Sectio 3700 of the Labor Code,I shall forthwith comply with these provisions. =Applicant'Signature:=-. Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL TIES O CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.If Class If ,Contractor s-Signature: Date: V'�n(l] ll) '( CONSTRUCTION LENDING AGENCY: l ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. __ Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present'Dilutive building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....l.i ... ..... .. .. 3 Does or will the applicant or present or future buildingg occupant need too prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No .. e applicant lc..t..r..r.. 5 Does or willthe ap stcAir or present a future building occupant at requirer for the work which isi the subject age of this application aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: • -- • ' •F COMPLIANCE ' . AUTHORENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree t• o ply with all to laws and . Inances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr•.erty for insp-/ion purposes ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 'Ig :pure Of gal wner s / •`_, Date r And/Or' -horized.Applicant Date QODE I. INSPECTION TYPE QAIE 1NTRIAIe CODES INSPECTION TYPE DATE INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical /J '/ 1266 Pool Spa Final 208 Final Plumbing 73-177674E &se- 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4m,-0.-#.:44-.. CITY OF COSTA MESA ei.'. P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 .f�� �- Z Vp; DEVELOPMENT SERVICES DEPARTMENT November 10, 2011 Matt Powers 3100 Pullman Street, Unit A Costa Mesa, CA 92663 c RE: ZONING APPLICATION ZA-11-36 MINOR CONDITIONAL USE PERMIT FOR A PERSONALIZED TRAINING STUDIO WITH A PARKING DEVIATION 2930 GRACE LANE, UNIT K, COSTA MESA Dear Mr. Powers: Review of the minor conditional use permit for the above-referenced project has been completed. The application, as described in the attached project description, has been approved, based on the findings and subject to the conditions of approval (attached). The decision will become final at 5 p.m. on November 17, 2011, unless appealed by an affected party (including filing of the necessary application and payment of the appropriate fee) or by a member of the Planning Commission or City Council. If you have any questions regarding this letter, please feel free to contact the project ' planner, Rebecca Robbins, at 714-754-5609 or rebecca.robbinsa.costamesaca.gov. Sincerely,SiL/L.j -L,L,GU (1/21/) ,---1 — T • BOUWENS-KILLEEN, AICP Zoning Administrator Attachments: Project description Findings • Conditions of approval Applicants Letter Approved conceptual plans cc: Engineering Clayton Worswick Fire Protection Analyst 24 Goodwill Ct. Building Division Newport Beach, CA 92663 Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754.5244 • www.ci.costa-mesa.ca.us November 10, 2011 ZA-11-36 (2930 Grace Lane, Suite K) PROJECT DESCRIPTION Project Site/Environs • The property is zoned MG (General Industrial) and has a Light Industry General Plan land use designation. • The property is one of a four parcel development containing three multi-tenant industrial buildings totaling approximately 51,700 square feet. • The property is surrounded by residentially zoned and developed properties across Mendoza Drive to the east and across the Paularino Channel to the south, and industrially zoned and developed properties to the north and west. Proposed Use • The applicant is proposing to operate a personalized training studio within a 1,368 square-foot suite of an existing industrial building. • A minor conditional use permit is required since the studio is to be located in an industrial zone. In addition, per Code the proposed use requires 14 parking spaces; however, four parking spaces are allotted for the suite based on the industrial parking requirement (three parking spaces per 1,000 square feet). Therefore, a parking deviation is also requested. • The applicant proposes the following operational characteristics: o Monday through Friday: • 5 a.m. to 8 a.m. for one-on-one to small group classes (up to five students maximum) • 4 p.m. to 8 p.m. for one-on-one to small group classes (up to five students maximum) o Saturday: 8 a.m. to 11 a.m. for small group classes (same as above) o Sunday: Closed. ANALYSIS: Justifications for Approval • The peak hours for the studio (5 a.m. to 8 a.m. and 4 p.m. to 8 p.m.) will be, for the most part, off-set from the surrounding industrial uses, which are typically open from 9 a.m. to 5 p.m., Monday through Friday and closed on weekends. Although the applicant is proposing to begin the small group classes at 4 p.m., an hour before the surrounding businesses typically close, staff visited the site during daytime business hours and observed over 20 available parking spaces. Therefore, parking impacts to the surrounding uses are not anticipated. • Although the applicant is not proposing classes during daytime business hours (8 a.m. to 4:00 p.m.), Staff is including an allowance for one-on-one training (maximum one employee and one to two students) during these hours since four parking spaces are allotted for the suite based on the industrial parking requirement. Therefore, sufficient parking exists to support one-on-one training during daytime business hours. November 10, 2011 ZA-11-36 (2930 Grace Lane) • The use, as proposed, should be low key in nature (i.e. no loud music); consequently, the use itself should not impact the other businesses on the subject and surrounding properties. In addition, all business activities are required by Code to be conducted under-roof. Onsite training outside of the building (i.e. parking lot) is prohibited. • To minimize parking and traffic impacts, a condition has been included prohibiting competitions and events at this location. Additionally, a traffic impact fee is required for this use. ▪ The applicant will be required to provide an area within the suite for bicycle storage to encourage employees and students to bike to classes, also minimizing potential parking impacts on surrounding uses. GENERAL PLAN CONFORMITY The use is consistent with the Zoning Code and the City's General Plan because, with the proposed offset hours of operation, limited class size, low key nature, and prohibition of competitions and other events, it should not adversely impact surrounding properties. Additionally, traffic impacts will be mitigated through the payment of traffic impact fees. FINDINGS A. The information presented substantially complies with Section 13-29(e) of the Costa Mesa Municipal Code in that: 1. The proposed personalized training studio is compatible and harmonious with uses on-site as well as those on the surrounding properties. • 2. Safety and compatibility of the design of the buildings, parking areas, landscaping, luminaries, and other site features including functional aspects of the site development such as automobile and pedestrian circulation have been considered. 3. The Light Industry land use designation permits a wide range of industrial uses and allows the approval of conditional uses aimed toward eliminating possible hazards to adjoining properties. The personalized training studio, with offset hours of operation, limited class size, low key nature, and prohibition of competitions and other events, is consistent with the General Plan. 4. The planning application is for a project-specific case and does not establish a precedent for future development. November 10, 2011 ZA-11-36 (2930 Grace Lane) B. The information presented substantially complies with Costa Mesa Municipal Code section 13-29(g)(2) because: 1. The proposed personalized training studio, as conditioned, is substantially compatible with developments in the same general area and would not be materially detrimental to other properties within the area. Specifically, the proposed studio, based on the limited class size, offset operating times, and conditions of approval requiring a bicycle storage area in the suite to encourage employees and students to bike to classes, should not adversely impact parking the subject and surrounding properties. 2. Granting the minor conditional use permit will not be materially detrimental to the health, safety and general welfare of the public or otherwise injurious to property or improvements within the immediate neighborhood. Specifically, due to the low-key nature of the proposed use, the use will have low traffic and parking demands. 3. Granting the minor conditional use permit will not allow a use, density or intensity which is not in accordance with the general plan designation and any applicable specific plan for the property. C. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA under Section 15301 for Existing Facilities. D. The project, as conditioned, is consistent with Chapter XII, Article 3, Transportation System Management of Title 13 of the Municipal Code in that the project's traffic impacts will be mitigated by the payment of traffic impact fees. CONDITIONS OF APPROVAL Ping. 1. The use shall be limited to private one-on-one instruction (one instructor and one to two students maximum) between the hours of 8:00 a.m. and 4:00 p.m., Monday through Friday. Group classes shall by limited to a maximum of five students and shall not occur between the hours of 8:00 a.m. and 4:00 p.m., Monday through Friday. 2. The use shall be limited to the type of operation described in the staff report. Any change in the operational characteristics shall require prior approval by the Planning Division and may require processing of an amendment to the minor conditional use permit. 3. The class sizes and use of parking lot shall be monitored and strictly enforced by the business operator. 4. Competitions/events are prohibited at this location at this location; additionally, no events open to the general public shall be permitted. 5. If parking shortages or other parking-related problems arise, the November 10, 2011 ZA-11-36 (2930 Grace Lane) applicant shall institute whatever operational measures are necessary to minimize or eliminate the problem, including, but not limited to, reduction of class sizes or modification to class hours. 6. A copy of the conditions of approval for the conditional use permit must be kept on premises and presented to any authorized City official upon request. New business/property owners shall be notified of conditions of approval upon transfer of business or ownership of land. 7. The business shall be conducted, at all times, in a manner that will allow the quiet enjoyment of the surrounding neighborhood. The applicant and/or business owner shall institute whatever security and operational measures are necessary to comply with this requirement. 8. The applicant shall provide an area within the suite for bicycle storage to encourage employees and students to bike to classes. CODE REQUIREMENTS The following list of federal, state and local laws applicable to the project has been compiled by staff for the applicant's reference. 'Any reference to "City" pertains to the City of Costa Mesa. Ping. 1. Approval of the zoning application is valid for one (1) year from the effective date of this approval and will expire at the end of that period unless applicant establishes the use by one of the following actions: 1) obtains building permits for the authorized construction and initiates construction; and 2) obtains a business license and legally establishes the business. If the applicant is unable to establish the use/obtain building permits within the one-year time period, the applicant may request an extension of time. The Planning Division must receive a written request for the time extension prior to the expiration of the zoning application. 2. Once the use is legally established, the zoning application herein approved shall be valid until revoked. The Development Services Director or her designee may refer the zoning application to the Planning Commission for modification or revocation at any time if, in his opinion, any of the following circumstances exist: 1) the use is being operated in violation of the conditions of approval; 2) the use is being operated in violation of applicable laws or ordinances or 3) one or more of the findings upon which the approval was based are no longer applicable. 3. All business activities shall be conducted under-roof. Onsite training outside of the building (i.e., parking lot) is prohibited. 4. Permits shall be obtained for all signs according to the provisions of the Costa Mesa Sign Ordinance. 5. Any new mechanical equipment such as air-conditioning equipment and duct work shall be screened from view in a manner approved by the Planning Division. Bus. 6. A business license shall be obtained prior to the initiation of the Lic. business approved under this application. November 10, 2011 ZA-11-36 (2930 Grace Lane) Bldg. 7. Comply with the requirements of the 2010 California Building Code, 2010 California Electrical Code, 2010 California Mechanical Code, 2010 California Plumbing Code, and 2010 California Energy Code (or the applicable adopted California Building Code, California Electrical Code, California Mechanical Code, California Plumbing Code, California Green Building Standards and California Energy Code at the time of plan submittal) and California Code of Regulations also known as the California Building Standards Code, as amended by the City of Costa Mesa. Trans. 8. Fulfill mitigation of off-site traffic impacts at the time of issuance of business license and/or building permit by submitting to the Planning Division the required traffic impact fee pursuant to the prevailing schedule of charges adopted by the City Council. The traffic impact fee is calculated including credits for all existing uses. At the current rate per trip end, the traffic impact fee is estimated at $2,172.00. NOTE: The Traffic Impact Fee will be recalculated at the time of issuance of building permit/certificate of occupancy based upon any changes in the prevailing schedule of charges adopted by the City Council and in effect at that time. SPECIAL DISTRICT REQUIREMENTS The requirements of the following special districts are hereby forwarded to the applicant: Sani. 1. It is recommended that the developer contact the Costa Mesa Sanitary District at (949) 645-8400 for current district requirements. AQMD 2. Applicant shall contact the Air Quality Management District (800) 288 7664 for potential additional conditions of development or for additional permits required by the district. State 3. Comply with the requirements of the California Department of Food and Agriculture (CDFA) to determine if red imported fire ants (RIFA) exist on the property prior to any soil movement or excavation. • The BNT Group LLC dba. BNT CrossFit • c/o Clayton Worswick and Guillermo Flores Phone:760-880-8264 24 Goodwill Ct. Newport Beach, CA 92663 Attn:City of Costa Mesa From:Clayton Worswick/Guillermo Flores Date: October 5, 2011 Re:Application for Minor Conditional Use Permit at 2930 Grace Lane,Costa Mesa—Unit K,1368 sf Hours of Operation:5am-8am&4pm-8pm The subject property will be used as a personalized training studio designed for 1-on-1 to small group(5 people)CrossFit training classes. With a previous training studio located at 2930 Grace Lane,this property has been identified as the ideal location to open a CrossFit Strength and Conditioning studio to be named BNT CrossFit. Co-Owners,Guillermo Flores and Clayton Worswick, are Chapman University alumni and wish to provide the Metro Pointe community with its very first"functional fitness"training facility. Upon initial identification of potential properties that would be appropriate for our business use, one of our major concerns,as well as the City of Costa Mesa's, is whether or not there would be enough suitable surface parking. We believe that we have found such a place in 2930 Grace Lane.We have already had an opportunity to talk with a handful of the current tenants in the building,and have been reassured that our proposed use would be very welcome in the project; moreover,that there is an over abundance of parking at all hours of the day.Seeing how our business model only operates in the early morning and early evening,we further believe that we shouldn't have any parking issues. Furthermore,we choose this location because the"CrossFit gym model"thrives in the Industrial warehouse, no frills type of atmosphere. This can be seen in a number of other CrossFit gyms that are already operating in the City of Costa Mesa and surrounding areas; most notably CrossFit Costa Mesa and Orange Coast CrossFit. We do not create any materials or hazardous waste that might generally be associates with an occupant on an industrial building.There is absolutely nothing that would,or could be, materially detrimental to any of the adjacent properties.We merely provide a service;we do not create material goods. The CrossFit physical fitness model consists of training individuals for"real life"situations;therefore, CrossFit does not utilize any machines or complicated equipment, but rather focuses on gymnastics or"body weight"training,as well as Olympic lifting with free weights. The goal of CrossFit is to create General Physical Preparedness for its athletes; in short CrossFit provides fitness that can actually be used, and not just for show. This approach to fitness has made CrossFit the number one training program for Fire Fighters, Police Officers, EMT's, and the Armed Services. The primary hours of training are one hour classes between 5:00am- 8:00 am and 4:00pm-7:30 pm with a target demographic of working professionals,college and high school students. We look forward to the prospect of opening BNT CrossFit in the City of Costa Mesa and being a part of this community. Respectfully, Guillermo Flores&Clayton Worswick °.'"?�' 11- 02 —lj f ' jTj 31tl0 a I` AS •1d30 9NINNVld VS3W VI SOO AO All3 SNOISIONOD O11O3r2fS . ��_��jdaouo u� 'middy N 1,N3 SflfOV ,y t--SININIdtl /iIv • i Bd'OS 1VNOWnnNJOlilt al2940 Grace Lane 2941 Grace Lane AEIFGIHCID v co W `nH G F EDCB Al d �— z � 0 a ' J ' ThiTUt rThrrn Z V V Wr, ' LJ U I -V q, H �Illll ) HHIIH1H1HIH In 0.1Q Mo H Ih°6° HI 1 1 II I N v F - _ K JHG FE DCB A K JHGFEDCB A . �L� - lr----) 1. ir-'fir- if � . — 2931 Grace Lane 2930 Grace Lane I' 1 T -7t�CO 1J ' 5 2,9 ' 1 —t,tcil FLOOR PLAN 2930 GRACE LANE, UNIT K COSTA MESA, CA -711 • & 99 D �t 41 • Fire Incident# (Ih r 362,2- . • . • C CA MESA FIRE DEPARTMENT Police Incident# 06 • 917 r P.O. BOX 1200 COSTA MESA, CA 92628-1200 (714) 754-5106 RELEASE OF PROPERTY AFTER EMERGENCY INCIDENT The Costa Mesa Fire Department, in the interest of the safety and-welfare of the co( unity at O3ZO (time) - �' 7-`.L (date), assumed control of the property located at -�y/3;O1 r4ct. (.:.NJ LeJ !Tip /�� s c7 The necessity for assuming control of the property was because of S>/lar 2 R C /iR L Pursuant to the conditions contained herein,as of /17 /Se (time) 5 27 J! ,(date),the subject property is released to, and is to be under the control and the responsibility of ��41/- . ,f l7 ' z c 19(.tiA1 1 (name),who is the owner( ),owner's representative( ), tenant(y...). / YOU ARE HEREBY PLACED ON NOTICE OF THE FOLLOWING CONDITIONS(Check applicable conditions): Ty). A rekindle or an additional fire from a hot spot is possible. The Fire Department recommends that a fire watch, with a/ means to extinguish hot spots, should be posted for 24 hours. /! ) The following utilities: electricity(..), gas( ),water( ), serving the property have been shut off It is advisable to contact the appropriate utility company before restoring the service. -(}�). The structure may have been weakened by the incident. Until a structural survey can be made, it is advisable to keep all // unnecessary people out of and away from the building. V) Buildings that cannot be locked or secured by normal means must be secured by alternative means. Barricades and/or fencing are required to prevent unauthorized entry. It may be necessary to provide a security guard. (7Z) Rebuilding and/or repairing the damage will require permits(e.g.,building, electrical,etc.) from the City of Costa Mesa's Development Services Department, Building Safety Division.They may be contacted Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. by calling(714)754-5273. ( 4 The Costa Mesa Fire Department and the Costa Mesa Police Department retain the right to re-enter the property at reasonable hours,should their investigation of this incident require such re-entry. ( ) Other precautions/conditions(specify): • The conditions listed above are not all inclusive. They are intended as guidelines for the City's Fire Department in exercising their discretion in providing emergency assistance advice. Infofmation concerning a copy of the report for this incident can be obtained by calling the Fire Department Business Office at (714) 754-5106, Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m. • You may be entitled to a reassessment and subsequent reduction of your property tax as a result of this incident. For further information contact the Orange County Assessor's Office at (714) 834-2727, Monday through Friday,between the hours of 8:00 a.m. and 4:45 p.m. The OWNER, OWNER'S REPRESENTATIVE, and/or TENANT shall protect, defend, indemnify and hold harmless CITY and its elected and appointed boards, officers, and employees from any an all claims, liabilities, expenses, or damages of any nature, including attorney fees, for injury to or death of any person, and for injury to any property, including consequential damages of any nature resulting therefrom, arising out of or in any way connected with the negligent performance of this Release by act or omission, by or on behalf of OWNER, OWNER'S REPRESENTATIVE, and/or TENANT, or resulting from any violation by OWNER, OWNER'S.REP\NTATIVE,and/or TENANT of any statute, law, regulation,or other legal requirement. Signed: Date: S •1' € Time: Owner( ) Owner's Representative(. ) Tenant V) Costa Mesa Fire Depa meet—..- Signed: / — - Assignment: Officer in Charge 2923.44/,White—Fire Administration.Yellow—OwnerlOwr spresentative/Tenant,Pink—Development Services/Building Safety 1 "Ess OF BUILDING. 2930 GRACE LN INT: CITY OF COSTA MESA BUILDING PERMIT • SNAYEIFIOlON'fk LICATA, LUCILLE E TR PERM NO: B 075112 ADDRESS: 13712 RUSHMORE LN SANTA ANA, CA 92705 PERMIT NO: B 075112 PLAN CHECK NO: N GOVT: N SUPP : N APPL.MMUNO ADDRESS: 538-2269 • CONSTRUCTION TYPE : I—FR PERMIT TYPE: STR PURPOSE: OTH ARCHITECT OR fliGNEER: UC.No.: JOB DESCRIPTION : REROOF UNITS A—I WITH BUR SQ FT: 23, 796 ARCH.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: 23, 976 . 00 CALC—VALUE: 23,796 ,00 GROUP OCC: B-2 / CONTRACTOR'S NAME REES ROOFING ( 714 ) 554-7663 CONTRACTORS MAMAS 517 N FAIRVIEW COMMENTS : T/OFF ALL EXCEPT UNITS F G H /REROOF WITH CLASS A B . U.R. ADDRESS: SANTA ANA CA uc.no.: 291971 **********************************(t*1E*1t#iESEM*iESEiESE****s6#**�6�E�EiE�6#ft4*�E *********** 92703 Wit 200 Z ON ING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty el perjury that I em licensed under provisions of Chapter 9 SE TB ACK S (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. CITY LIC.NO.: 31 0 LIC.CLASS: C 39 D'` 291971 EXP: 01 /96 MAIN BUILDING ACCESSORY BUILDING Dale: "^q. -� 5 Contractor: ` `�" \` FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under parWy el perjury that I am exempt from the Contractors License Law for the Mowing reason(Section 7031.5 Business and Professions Code:Any city or county whop requires a permit to construct,alter,improve, PARKING REQ: PROV: PARCEL: 1412 2118 Z NE: REF NO: -temol'h.or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNINGNOTES>. Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section . 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars 155001). ******************************************************************************* ❑ I.as owner of the property or my employees rash wages as her sae compensation,wit do the wok,and the structure is not intended or offered for sale(Section 7044.Business and Professions Code:The Contractors License Lawdoes not appty to an owner of Konen), D E V E 'L OP MENT SERVICES REQUIREMENT S who builds or improves thereon,and who does such work himself or herself or through his or her own employees.provided that such improvements ere not intended or offered ler sale.If.however,the building or improvement i sold within one year of competon,the ownenbuiler will have the burden of proving he or she did not build or improve for the purpose of sale). ZONING APPROVED BY DATE: ❑ I,as owner of the property,am exdudvehy contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE: contracts for such projeds with a contractor(s)licensed pursuant to the Contractors License Law), ❑ Iemexempt under Section: B.AP.a,for this reason: APPLICATION ISSUED BY: ! DATE: - Date: Owner: *********************************************** * 1E************* * *1:17)(-* I do hereby certify that I ant aware of and understand the requirements of California Heeih and Safely Code Sections 25505,25533,and LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT: Y 25534,and that I or any future building occupant will/Will not(circle one)need to comply with said date codes and the requirements for a permit for construction or modificationfromtheAi Duality Management Diane.Residential construction appicalionsare exempt from Nese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 243 . 00 Date: Applicant: SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby a/on under penalty of perjury one of the following federations: PLAN 5 . 00 o I have and will maintan a certificate of consent to sell-insure ler workers'compensation,as provided for by Section 3700 of the Labor ISSUE FEE Code.for the performance of the work tor wNchthis penteisissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ I have and will maintain workers'compensation insuranoe.es required by SeMion 3700 of the Laker Code,fa the performance of the TOTALS----> 248 .00 0 , 00 0 . 00 248 . 00 248 . 00 . 00 X work for which this permit is issued.My workers'compensation insurance tamer and policy number me: Carder: STATEc1TKTD EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 248 . 00 OVER/SHORT: . 00 Policy Number: 285 95,UNIT00E19 01 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK d (TisseenneednotbecompletedIthepermiia/ronehundred ters($IOO)oken) 243 . 00 5 . 00 o I certify that in the performance of the work fa which this permit is issued.I shall not employ any person in any manner so as to become mpenationect to the vofSein 00 ofon the of C .JiYrt and agree comply HI Id become eybject to the waken' 4E***RE*RERb*SE**1E**3ERE3E9E**dESE****0E*ef*eE***dE*66**)E*4f3E*********************************** compensation provisions of Section 3700 the Labor Cada, e 1 forthwith 'stone. Date: Applicant L INDIVIDUAL F E E BREAKDOWN • Warning:Callum to secure workers'compensation coverage is unlawful,and shall subject an employer to trim/net penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars($104000).In addition to the cost of compensations damages as podded for In Section 37asofthe Labor Labor Code,interest,and allorsley's fees. SFC 23796 REROOF BY VALUE COMMERCIAL NOZONE 1 . 00 23, 796 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there e a construction lending agency for the END OF FEES performance of the work for which this permit N issued(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I ceniy that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state lawn relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. GENE IESE Ci i2),,w-,- :194179TOS -,ic �` � nrName'•- 6(470: t t C, ., 1r'c i.,-: / .1 2,C n Date: of ower..wr:nvnpeinanucontrector 1515146.WP) White-Building A Safely;Green-FileCanary-Applicant:Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING POO. - SPA APPROVALS Permit# - Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or role 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnci. 54. Forms '4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding • - •5.-Steel Reinforcement- 56. Rough Plumbing & Pressure Test 6:-Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation • - 59. Gas Pipe, 0 Undrgrnd.,Test , 9. Water Pipe-Undrgrnd. • 60. Backwash Lines', P:Trap, 0 Uhdrgrnd. 10. Structural Floor System61. APPROVAL TO DECK 11. Property Sewer Line.& House Connection 62. Backwash & Receptor-Final' 12. Sewer Cap - . 63. Heater& Vent-Final - 13. Roof Drains 64. Plumbing System - Final . 14. Rough Plumbing - : 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - APPROVALS Permit # 21. Ducts, in Structure' _ - 70. Underground Hydro 22. Ducts, Ventilating ' - - • 71. Product Piping O Gas 0 Oil 23. Gas Pipe-Rough& Test _ ' - 72. Underground Flush 24. Roof Framin - 9 •73., Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - 1%376"X I r4. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat - .75. Dry Chemical - 27. Frame and Flashing - 76. Dry Standpipe 28. Lathing&Siding . . 77. FIXED SYSTEM FINAL , 29. Insulation-- - 78: FIRE PREV. FINAL • 30. Drywall Nailing , � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - ' - - . 79. FINAL INSPECTION . 32. Electrical Power Meter-Final - 80". FOOD CERTIFICATE ISSUED 33. Final Electric - - Notes: - 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test - 36. Hood or Canopy - ' - 37. Final Factory Fireplace • - 38. Final Plumbing - - . 39- Water Service-Final - - -40. Gas Service-Final - • - - - . 41. Solar Domestic•Finai 42. Backflow Preventer 43. Backflow Irrigation • . - . - - 44. Landscape Irrigation System 1 ...t: - - _ 45. Sound Attenuation 1 - • - 46. Handicap Regulations ' - -. 47. FINAL STRUCTURE & BUILDING /J.3.!2 48. FINAL PLANNING , - /' �" . . '. 49. Electric Release to Edison .. - 50. Gas Release to Southern California Gas Do . 51. CERTIFICATE OF OCCUPANCY - • No Date PROJECT ADDRESS: 2930 GRACE LN • UNIT:c CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 070505 OWNER'S NAME: LICATA LUCILLE E TR ADDRESS: 13712 RUSHMORE LN PERMIT NO: E 070505 PLAN CHECK NO: N GOVT: N SUPP: N SANTA ANA,CA 92705 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH • 538-2269 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL EXTERIOR SECURITY LIGHTS SQFT; ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / PERMITTEE: W D H INCORPORATED ( 714 ) 850-0173 ADDRESS; 17660 NEWHOPE AV F COMMENTS: NO STRUCTUAL PERMIT FOUNTAIN VALLEY CA 92708 ******************Rr+ ************* y6+ *********+ *******ar****+r********ger********** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S CITY LIG.:028803 STATE 110.:40426 uss(� EXP; 05/95 Date:_�_Z-22.`41 Signature: _ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure era certificate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN POLtCYNo.: 93W8812381-94E EXP.DATE: OS/17/95 COMPANY:CONTINENTIAL PARKING REQ• PROV; PARCEL: 14122118 ZNE: REF NO: KI Certified copy is hereby furnished. ❑ Certified copy is filed with thecity—Buildingg Di ion. PLANNING NOTES> Date: I2,-2—Z"gq Applicant Q7i /th641V ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY ,• DATE; Date: Signature: NOTICE:U.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. / CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE: 2�/ � � which this permit is issued(Section 3097.Civ.C). ********************************************* *********************** ** ** ** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 8 , 25 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business O; SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15,00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 8 , 25 15 , 00 0 .00 23, 25 23 . 25 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTAL S——> COLLECTED: 23 , 25 OVER/SHORT• ,00 imprlot theepurrpose of sold one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 23. 25 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such Projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *************************************************{e************.********,**.******.* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR E AK DOWN o I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: ELE 11 FIXTURES, LIGHTING 1 ST 20 EA. . 75 8 . 25 I do hereby certify that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. .V//// Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representative f IhR city to enter upon the abovomentioned Property for inspection purposes. Dl 00174003-00174003 TOT Q 7 cote: I 2--12-2--q1y Signature: 110y'/'P DATE: 12/23/94 TINE: 15:3? 23.25 Driver's License or Social Security x: 1641-46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor ti 1 CONSTRUCTION AND PLANNING ?: POO., a SPA APPROVALS Permit ( Date Inspector APPROVALS Permit Date Inspector • 1. Temporary Electrical Service or Poter;1 J ; 52. Pool & Equipment Location >t ...3 2._Soil Pipe-Undrggrnd.. " .1 mF 53. Steel Reinforcement . • ' T _ r.=•' 54. Forms 7.-L.1.3:,r, rjcal ConduiF•djility-�Clhdrgrnd..-, _ •:**/-9eiectrieal Condlli?Undrgrnd. -Jt --- 55. Electrical Bonding d o:. c, 5:*eel Keinforcefdt =- ._,� 56. Rough Plumbing & Pressure Test - "Jfiii l ,- 0 - 57. APPROVAL TO COVER-GUNITE - •.&oE:.Electrical OF E.R:('-' ,..,Z1�Footings [7=O1 p 58. Electrical Conduit•Undrgrnd. ro m: l'i 8t Foundation ,;; 59. Gas Pipe, 0 Undrgrnd.,Test - 1 912-Water Pipe-Uncij'grnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. ?ail Structural Floor System 61. APPROVAL TO DECK c• - 11. P.Operty Sewer Lin€•& House Connection 62. Backwash & Receptor-Final ' 12. SB ver Cap a, C , 0 l • 63. Heater & Vent-Final 13. Roof Drains I.-- 117 64. Plumbing System - Final 14. Rough Plumbiigg ' 65. Electrical-Final 15. Rough Electrical-Conduit 0 66. Solar System-Final 16. Rough Electric Viring c� 67. Fencing & Access Approval 117. Rough Wiring SSidn 68. APPROVED FOR PLASTERING 18. Rough Electridaj-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '7 t:'C -n v.•n a m p• m•-1 a•:-. .. `c^ t'; 20 t'Roah F3cto!iy Feel lace 1 Tt'1 '':-1 e. s 0 D c y * appRi V/iit PSE F err3iit # ; - -a -fin', -. f _,_. 4*.-1. • i - -r . . • .7 - . . 21..Dupta, in-Gtrpctun`e= - •• i-.4..1: _ SCI r e ` '70. UndergitlChiiHy lro -r _ ._..S ti 4.1 Y 22.,pURI, \e'ntiT ting♦* .:.):1;,'. ' i-i 5 .,Y t 71. Product ij iln Dieis D' ,I 23.'•:Gas2ipeoRou h 8;•test n7<; -, R. 3 a i I-72. Undergrod d HOC) = H 24:'Roar Framing 0e, HH l•H t c' , t -`-73°''Undergrncc.Storefvi-ank QGas 0 0 :Lv L n1 • 1r1 ,i1 JrF fi ,_ - V 1-I 4.4 ' 25. Roof,Sheathing L, • v i r I":" i7• t 74.::Overhead Hydro: • 26. -T-Bas Ceiling (St tUc ural) & b+lvcoat }• O n 14 O ! 75.'7Dry Chemical F,bi * `+ i1a t' <,Y at Y # 1t . • i..♦ 11 L I.. p T. 27.c`Frame and Flashicg, •_1:;tr; * ^ :, _1.r I. 76. Dry Standpipe r p k F ;28. Lathing'& Siding': i '-. '1%1 F ` ••I '' "I- a 77 FIXED S'YStErr1] NAL} _ '29. Insulatio} ;r'a ' _ ., t I I i> = 78.TFIRE PR EV. FINAL -' - -, :. 1 _] - T r .. 530. Drywall Nailing `R i '_' HJ£ALT-n EIPTtREQUIREMENT rr+ -p -. I Y F ; t 0 J , •I s • -31. Plaster 6iaw Coat, . I . - �.� - ', : •_. .� Pt i ,•n. _ .x t'79. FINAL IfPECTION • + ?: ci ie, E32..fElectrical•PoWer Mete?Final ! m /� I�t'80.FOOD CERTIFICATE'ISSUED ,_ .33.._Einay El triol `♦. i; S P 8-7,kr r 1\JofgS: -+y •'f•?7 ♦ :134.^Finet Heatingj& Air ConditioniEll's 1 • • 6a a: -u ••=-• r..1 c S - • ry, -1 n1 4 > It Y. CU 1.-i:.^0 0 1 = -• 35 • . in&TGari Pip`g-Test` ,� I, i •1'Jw otl`1 �j,:. a t-• f . .. 1. rt 6. Hood on-Canopy = ^• n 1 2•1 . '1 I • = : = ` :' -1 `- •- > 1 , rry .n. . f a _ 1.1i; .,:0 • 7-. :,t':7 _ ,)t•1 `,7.'finA]'Factory Firep(aai I E,', • : pi I R t v 3: a OJ --38. Finaf;Pltxabing - ' p• I .- r - t 31 :39. Watep Service-Final^ T i G, .t �, I r' r �1 LL'nt x a: • • �' g n_ Ip - -. - • ^1 tAO. Gas Service-Final -. -,; -n.o+ . ci I la s .:O... .1^: • • :41. Solar Domestic-Final 11 •• ` De I# 4 '. i r42.`Backflow Preventers • * I I+ II 1A' ...'".1•4 = J �t C . . 11 -' .r•, 111(1 r L n:=` 43. Backflow Irrigation' ^' r # a'f� _ 0 ;44. Landscape Irrigation System :;-i♦7 1C t LI0 7 0.r • t: CJ C? 7:(� • Cti r .. ....#....# < ,� r r ' (1 n.. * - :-, -45.'sound Amttertilation' • n; a _tt:F; Cr s T C F 4 * C'. ;+ .- CCI .r ; tn4 + r-+ c• e• < • H e 6. HandicapRegulations _ 0 4. " •• ••a • II; r ' a - r - t a n+ .'1 nK 47.FINAL STRUCTURE & BUILDING = -'. i 0.I •= . n1 a; I E t • - f : I $ _ 48.'_g,INhLPLANINING: i •� s ;., I i ,; ill i E-• .g 1 t x n n n; r % r -49. :EleaEtic Release to Edison I , ' ^ o: i t ' .. .. I t I I '.- F tr; C. I .' _ _ r { ., �� a •$0.-Gas,Release to Southern CalifpraiarGas CQ : I I n r -4 -+ Cf • o:n C0 • 4 4 .. <' '-1 r 0 1 rt./ I.1 s1. CERTIFICATE OF-OCCUPANLy't > r 4 , Cd '*i'. Y No. Date III As ' • ,$OUTN Lot_ 13 0 u PI 0 Alt_i '._� I HcAnt P.wc� \ -----44—r-----... 34(0tti\ • '=i. • • = /' L 2-2oP esti)... . N — " ` . .2930 CGKuv,E ; j • i . _ i � . n < a7£._ � w � • imirr 1$�STING, , MEET lo6Nh. �SDw / •a_ /60' • i ray a= 1 180- -- i(?)-.0,,, ‘ 1 ( • z 941 ./ 1111tn -Nofc.".: e 2940 . w ' /; so-foc ;i � . 2:;tp c,..?_ • .-. GCS LS\N� • a 1/4w ilmt nu Riot t_ , 1.11111111.111111111111,' i: r. Z. II? .-. = , HPS vtAn PAcK. 1 1 — WORTH ter R'OUNDAK9 - Tt - \ Q tr. yoow sips Flco���' ii 3, iw:D.A.{, ?�LoPo. %AL - . - ---- ._-_.. . . . . . ..._..------ -. .. ‘. - • ' 1 y� � 30 I�,/a-G GA/ nE /Zo�yod' Y•3 •• �/Y •PANELN A P 1 �S11QN� a aE�V' BUS MI iso Jb 6 S Howl Moe 64Kffltt- NAownIIto m in c4 1 LOCA((ON VOL IMPS " Ilio PEC MIS CII1OKn A B C 1BKM(CIO MtSOECItto VOl1AMPS .1 WAY Ion /i�14� -i-B i� _ _ _ _ —.—.LI _!.e i C- • r- I 44QC —— -� X '4- -- an 2 ,— 7 )QSO • TS t . L J — �– 4 MI — rTh - - - _- - -5 - - --♦ i'- 6 . — - IV— _ _ I • _ 8 - • — '9_ - - -•-- _18 -- '— ■ - - •• — _ _ 11 _ - 12 - - • — IJ _ -- H —_ - V. - - , - -_ _15 - --.- - _ 16 '� - - i� --� ie - - _ - - - 21 _ - -4- - _ 22 - - -- - .v - - - i3 — - ——• — 24.ii ~— 0 . _ — 51 - --- 28 1 • - - 29 - - - — 30 _--- . 51 miel — 37 •-- 38 39 - – – 18 BA • .(Loo — ma • /oro • BC • _fltNEC1E0 VA • 24.50 .145 4135Z • I. C 3 . 1�a 1ILUoro • — __- ►EE tit •• 33..9 . STATE OF CALIFORNIA c' COUNTY OF ORANGE DECEMBER 2h 1979 E On r before me, the undersigned, a Notary Public in and (or r said State, personally appeared VINCENT LICATA E known to me to be the person whose name iS p subscribed to the within instrument and acknowledged to me - -- __ ,' "'*' OFFICIAL ... 7 that_ hF executed the same.Qy ; f/ ___ {{ y VIRGINIA L CHATI o WITNESS my hand and official seal. 9 ay, NOTARY PUBLIC CALIFO, } .1, PRINCIPAL OFFICE I) crE / ORANGE COUNTY • Signaturer1,67--7c.L/ /!l z 'rE My Commission al) Nov 15 Virginia L. Chatterton Name (Typed or Printed) (This area for official notarial seal) NOTARIZED STATEMENT OF RESPONSIBILITY // TO: WHOM IT MAY CONCERN Building Permit No. 4%p ei3/ This Permit No. (StreetAddress) (AP Number) I, J / f ll Ge in+ L Gwl , as Owner in Title of the above refer- enced property, do hereby authorize: Roe, Co (Name) :- .73-130 9 rs u k-t1 t -1 (Street Address) C,or`k-a, ars d C C L . • 9 - 6.29 (City) (State) (Zip Code) to obtain permits in my behalf, as owner/builder, for the construction, alteration, moving, demolition, or repair of the above referenced property. Should any person become an employee engaged in the improvement of the property, I shall immediately provide Workers Catipensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, catgpany, or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless frau any claim resulting in damage or personal injury to myself or any other� parties. ) [� + (, 7 Q�/ 1 • r T i u I .2 - 26 - l / ! f printed N. (Date) 41 di C- (' ighatur-) Notary's Statement: Z q 36 41 C 12#sCE LN CO STA _ e �F 3 + `Capper S ' /44 \ r PLPE APPROVED 9 Ca c. -- y • t`n-- • �6Dw i City of Cost j- esa uilding Dept. L11t�r7YLn1 _ / /� _ yy��� ._ _ � Iw ��/ I I BY�_.---f/ —._ ._DATE«!- .197. - - THESE PLANS MUST_ BE JOB AI ALL TIMES j ! MAKE NO CHANGES WITH IUT PRIOR APPROVAL I OF DEPT. I THE ISSUANCE OR GRANTING 0( A PERMIT OR APPROVAL - OF PLANS AND SPECIFICATIONS ;IOU NOT BE CONSTRUED TO BE A PERMIT FOR, OR AN AR'IIOVAL OF, ANY VIOLATION STRUCTU'AL APPROVAL ONLYOF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE- - _ SUMING-TO GIVE AUTHORITY TO ;VIOLATE OR CANCEL THE I ' PROVISIONS OF THIS CODE SHALL! BE VALID, EXCEPT IN SO SEPARATE PERMITS ARE REQUIRED i n FAR AS THE WORK OR USE WHICH: IT AUTHORIZES IS LAWFUL. FOR ELECTRICAL, PLUMBING, . THE ISSUANCE OF A PERMIT BASED UPON PLANS AND HEATING, NTAND - -PECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL REFRIGERRATIOATION WWOORK • 20M THEREAFTER REQUIRING THE! CORRECTION OF ERRORS (�N SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING - -I IN ILDING OPERATIOHNSS BELNG CODE ORROFED ON THEREUNDER WHEN Permit # c[Q / z f. ANY OTHER ORDINANCE I _ - 1 Permit / / Y' J/ I VTHE CITY. THIS NUMBER MUST ACCOMPANY I------ - —'F L SPEON REQUESTS sc �l — - -- a In A '• I ,R Or FO.: Bj:LDH:pS ni:ERE PERSONS ARE TO - I • 9 • 1 S BE EMPLOYtt, 'NE SUGGEST THAT THE ! 2 I PLANNING DEPT. SL'dE OF CALIFORNIA DIVISION OF 4 SUBJECT TO BLDG. DEPT. REG. ID i3NAL REQUIREMENTS.BE CONSULTED FOR i ��,� ��� p DDiTiUNAL REQUIREMENTS, BYLJ6LLl./d DATE...` 4�_1 1' f DIRECTOR OF PLANNING II I . 3 eh,1 ;/- llP¢AS :. • ._. sP¢r,V,Ejer !it ye MAW- • - 1i �-1 APPROVED• _ I - l Ia;' ! • COSTA MESA FIRE DEPT. I BUREAU OF FIRE PREVENTION - ._.--- I -- . _ - -- _.-- _ .---- ' ! _ COSTA MESA, CALIF. _ -:- 1 : DATE Z -e BY 4, Ate. . At.. . • ------ -----— • I -- -- - • -e ?T 1_EI-8- I RITE:•*DDtovel .ebpllee to plant sub. • Or mttbd, sod lot eonetncNon indIceS _.I___t_. 11._ ___—..._—____ . . S.pRL�11C1CX1.. lbsteon. Installation: enbjeet to DS s a" O •DecttnB end eRleDhrh Ii j PROJECT ADDRESS: 2930 GRACE LN UNIT: CITY OF COSTA MESA — SIGN PERMIT PERM NO: SB 05161: OWNER'S NAME: LICATA, LUCILLE E TR ADDRESS: LICATALUCILLE E TR PERMIT NO: SB 051612 PLAN CHECK NO: 01206-91 S GOVT: N SUPP: N 13712 RUSHMORE LN SANTA ANA, CA 92705 CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 10 WALL 6 1 GROUND NON LUMINATED SIGNS. SQ FT: ADDRESS: UNIT: PERMITTEE: DICKERSON C SIGNS CLAIM VALUE: 3, 600 . 00 CALC—VALUE: 3, 600 . 00 GROUP OCC: B-2 / & GRAPHIC ( 714 ) 546-8150 ADDRESS: 2930 GRACE LANE A COMMENTS : X ' COSTA MESA CA 92626 ****Rr*** ** * x1<**±E ***; * ********+t+ ******* :*****SP1;*'*r+t•***********************;* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section SIGN INFORMATIO N 7000)01 Division 3 of the Business and Professions Code,and my license is in full force and e0ect. DISTRICT: 3 TYPE; 1 GRND; 10 WALL ILLUMINATION: NON CATEGORY: NEW CITY".: 009700 STATE LIC.: 3151 CLAS .. C-45 DIMENSIONS; 1FT 00IN X 3FT 10IN AREA: 56 , 00SQFT LETTER HT; 12 Date: 9 /9I9( Signati$L, STREET FRONTAGE 1 ; 54 . 50 STREET 1 : GRACE LANE • WORKERS'C MPE ATION DECLARATION: I here allirm that I have a nificate of consent to selbinsure or a cenificale of Workers' STREET FRONTAGE 2 ; 0 , 00 STREET 2 : Compensation Insurance.or a certified copy thereof(Section 3800,Lab. I. PARCEL: 14122118 ZONE: MG LOCATION > FRONT: X REAR: • 'POucYND.: 0638651 -91 EXP.DATE: 04 /01 /92 BUSINESS NAME; MISCELLANEOUS > LEFT: RIGHT; ' COMPANY: STATE FUND OTHER TOTALS GROUND SIGN ❑ Cenified cop is her by furnished, ® Ceniliei yisB•,with the city Bulking Division, THIS ACTIVITY : 56. 005 FT OVERALL HEIGHT; SFT OIN L) THIS SITE : 56 , 00S FT GROUND CLEARANCE: OFT 6IN Date: T����( Apphr:ant�—'� �, � ITEMS OF INFO : 1 PLANTER AREA; 36, 00SQFT EXEMPTION FR M WORKERS'COMPENSATION OECLARATIinvs section need not be completed it the permit isfor one hundred WOO)or less). ITEMS FOR ACTIVITY; 1 BLDG SET BACK; 1OFT I certify that in the performance of the work for which th iermit is issued.I shall not employ any person in any manner so as to become COPY VERBIAGE : GRND; ADDRESS — 18 SQ(�y� ^T, subject to the Workers'Compensation Laws of California. WALL; MISCELLANEOUS TENANTS — BUSINESS NAME ONLY— 3 .8 SF @ Date: Signature: PLANNING NOTES: . NOTICE:If.after making this declarati0n,you should become subject to the Workers'Compensation provisions of the Labor *le******************************li,**************************+******************* Code.you must lonhwith comply with such provisions or this permit shall be deemed revoked. DEVELOPMENTSERVICES REQUIREMENTS CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency l0r the performance 01 the work for which this permit is issued(Section 3097,Civ.CI. r ZONING APPROVED BY 1n./'(to IC DATE: y(`( /`1 LENDER: ADDRESS: BUILDING APPROVED BY : DATE: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED B Y• 1-- DATE: 9 (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or **************1f*TY****.*�F**.***iF fi.3r*************Sidi******.**if***.*******-i9(- . - Y•Y•if iF** repair any structure.prior to its issuance.also requires the applicant for such permit to the a signed statement that he/she is licensed LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)01 Division 3 01 the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(SSOO). BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SM I P/RES GRADING I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the PERMIT 63 , 00 56 , 00 ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law SM I P/NON—RES does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through PLAN 4 0 . 9 5 . 7 6 his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building Or \-__ : improvement sale).hin one year of completion,the owner will have the bur0en of proving he/sheforthepurpose of did not build or improve ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business TOTALS----> 119 76 0 . 00 40 , 9S 160 . 71 160 , 71 . 00 ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts far such projects with a contractor(s)license pursuant to theContractors'State License Law).I am aware REVENUE DIVISION TOTALS--> COLLECTED: 160 . 71 OVER/SHORT• . 00 that proof of their Worker's Compensation insurance should be proyidea to me. BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK ❑ 1 am exempt under Section: B.a P.C. 63. 00 56 . 00 . 76 40 . 95 Ior this reason: ***************************************3(****************************•*********** Date: OwnerINDIVIDUAL F E E BREAKDOWN I do hereby cemfy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for TYPE TY DESCRIPTIO N UNIT COST TOTAL COST construction or modification from the Air Duality Management District.Residential construction applications are exempt from Q these provisions. NO FEES WERE SELECTED FOR THIS PERMIT Date: Applicant: I hereby certify That I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property lot inspect In pur 505. Oates— 9 t/ Signature: —(hitt ivµ—L'--,_ 'J` �-f.�'n:e'(''; 1�. :.. - ... 1 Driver's License or S tial Security//: OTE: E71/469/4/ ,:(�E7�_0 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor POU_ & SPA CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 4,17-4/ 6(AA k 58. Electrical Conduit-Undrgrnd. 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 Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System . 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 4..e/�il "Ak 48. FINAL PLANNING I 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Ess: 2930 GRACE LN \ UNIT: B CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 056832 ME: LICATA LUCILLE E TR I ADDRESS: 13712 t USHMORE LN PERMIT NO: E • 056832 PLAN CHECK NO: N GOVT: N SUPP: N SANTA ANA,CA 92705 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH ' 538-2269 ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : SERVICE UPGRADE SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 / PERMITTEE: MAHER IBRAHIM ( 714 )957-3177 ADDRESS: 788 WILSON COMMENTS: NO STRUCTUAL PERMIT COSTA MESA CA 92627 ****�EkP+EkP�L*�E*�E�E*�E*+E�E�E+E�Pk0�6+EStx>E****** * �E***x ****+E******SE*+Eek*******TE*4c******kE***x LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Dale: Signature' MAIN BUILDING ACCESSORY BUILDING S'COMPENSATIONDECLARATION: I Signabyaffirmthatlnaveacertilicateofconsenttoself-insureoracereilicateofWorkers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR ; FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance,or a certified copy thereof(Section 3800. Lab.C). POLICY NO.: EXP.DATE: COMPANY: PARKING RE • PROV: PARCEL: 14122118 ZNE: REF NO: • 0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: *******************************************************MPF********************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers's'Compensation Laws of California l—. ZONING APPROVED BY DATE: , te: --3-viz. Signature: • BUILDING APPROVED BY NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor I DATE: Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY•` . :AO"j DATE; which this permit is issued(Section 3097,Civ.C). ************************* * *** *- 4'******* - ******************** ** LENDER: ************************************* -****Mit* ' ******************************* ADDRESS: LEGALIZATION:N F E E S ' u A R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT E X P I RI5 000 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed /NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN Incomplete lnsptp g %and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by - any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE Z S-0,3 15. 0/, "'a' • BUILDING-DIV-> PER M3.6 ISgU) :.eA4,1� TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 75. 15:�0""� 1 01 y0, 00 90 . 00 ,00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COL•L EC TED• 90, 00 OVER/SHORT: . 00 improvement hin one year of completion.the owner will have the burden of proving he/she did not build or improve forthepurpose of sate) BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 9 _ ta and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the ContractorsState License Law). l am aware **********************************!E******************************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. / for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST 7- 3 - Z Owner: "a' Cigar ELE 2SERVICES BELOW 600' V & 201- 1000 AMP 37. 50 75 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ,END OF FEES 25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. [t Al ,,1 'y/^ /-• imp 'l • Date: ��3 — ` 2 Applicant: J J4 fr A 1 0 ,Q4m, a, I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county ' ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned - property for inspection purposes. I ad.. 'Y// Date: — �� Signature: - _ - Driver's License or Social Security N: •_ 1641-46 White—Buddino:Green—Code Enforcement,Canary—Aoolicant:Pink—Revenue:Goldenrod—Assessor I POOL ..PA CONSTRUCTION AND PLANNING \PPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit•Undrgrnd. - 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK • 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring. 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26: T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing _ HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINALINSPECTION 32. Electrical Power Meter-Final ( 80. FOOD CERTIFICATE ISSUED J 33. Final Electric _ Notesi $t.2 t - 3 iceQ' /f_L" 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace - • I _. 3B. Final Plumbing i 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer I 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations A 47. FINAL STRUCTURE & BUILDING .48,.'FINAL PLANNING J 49. Electric Release to Edison -"t'- 50. Gas Release to Southern California Gas Co , • 51. CERTIFICATE OF OCCUPANCY No. Date INDIVIDUAL ACKNOWLEDGMENT NO.all Stale of _ •. ✓ at. . On this the Zo.day of /..-...rte iq9a, before me, }SS. Ale,4,Pe-R.._ 6 County of . - .iu, • dersigned Notary Public,personally appeared . r -- -- 6 .c—•..•• OFFICIAL SEAL 6 6 '� HH ly known to me\W" !OWN PUELIC-CAUFCONLa 6 6 ORANGE=NW S 0 proved to me on the basis of satisfactoryevidence • ,• 6 My Commission Eau Jana.two t to be the pars n(s)whose name(s) ! j subscribed to the J 6 withifr2y ,nd acknowledged that executed it. 6 / 6Notary's Signature f 6 ATTENTION NOTARY:Although the information requested below is OPTIONAL,if could prevent frauduent attachment of this certificate to another document. 6 THIS CERTIFICATE Title or Type of Document r MUST BE ATTACHED TO THE DOCUMENT Number of Pages Date of Document f r DESCRIBED AT RIGHT: Signer(s)Other Than Named Above h -- - O NATIONAL NOTARY ASSOCUigN•92311 Rammer Me.•P.O.Box 7184•Canso Ruic CA 91304.7M4 LIMITED STATEMENT OF RESPONSIBILITY Bldg. Permit # TO WHOM IT MAY CONCERN: This Permit # .2930 6eitec Lsa . UNtc -;s 72/- /� Street Address AP Number • I, car--NA , as Owner in Title of the above referenced property, do hereby authorize: 0gR Pn Pttiect, = aaerN-te 5 mrt+ t epi (7/q) 757-3/77 Name / Telephone No. a93o 6-04-69E OA// T 5 Street Address 0S.01 ani ("A 9. 6/026 City State Zip 2 to obtain permits in my behalf, as owner/builder, for P.eU -fC - 00-17-1< (J P6 x.20 6A1W5) at the above referenced property. Should lifry person. become an empinyv.e engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. Zrrtvi. C . //6792-, Printed Name Date / i l ignatu re 1 t BM M l REQUIRED 0779-46,rev.6/87 . . ' pyo' TRWIn.IWO _ • a N „friL. i . i: , i ,: 1--:---i---: ,„.__-qe-... .;- .• ,...-.4:2, ;;;_. , ,.#- 2 . ; . _. En ( r ,— : tr6tfk(4.7".tfit, . • - - _ - , _ R lSE a � GE' - - - - �_ 1'PG7t Tb I % _ _ A; _ . u �3 /'� r — _ — _lb 0IMn ' fd c • , i/ ' _ — —t'— ___*i_-_ i � —4.— �_ - —I-- • �, 'SA... ._ k_09b . su 4b 40 '1 5b �0 I . 0 0 i 1 } 4 • ; ; :_ 4_49. , .1 , , ,, ,F, i i : , , is ;gr4 ' „ I j , tier , , : i• t • .005'Mir fA, C TD LAN,r G; _.• Lona Ler+: — IooR . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA-MESA CONSTRUCTION PERMIT PERM 'NO. TRACT NO. LOT NO. UNIT NO. Project Address X30 �r,4ez ,{N # C 9at>10 �� 3 4110 a • • Applicant's Mail n Address /533 W. .1---WQ.04-o /f TYPE OF-CONSTRUCTION • ❑ NEW ❑ ADD U ALTERATION U REPAIR Owner's Name fid' w. SA—)Co2p Phone /s7-95/Z CI CONVERSION CI DEMOLISH CI OTHER A.P.# Zone SRMF DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: Accessory Building: E Z Arch/Eng. License No. TYPE OF'PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front O Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N Contractor's Name PARS //..P1LUrn6iiutn PhoneV�3y90 CI OTHER A C Right N Address(mailing) /S83 L(/ nC-//UO coo PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left G 19, 11° gam/ CONST RUCTION TYPE VALUATION$ $ R City License No. _-_ v 7��'" ZON GRADING CU.YDS. ACRESE LICENSED CONTRACTOR DECLARATION € • Ping. Ref.4 Parking Req./Provided Q I hereby affirm that I am licensed under provisions of charter 9 (commencing Remarks:' Planning Notes: M b with section ]000) of Division 3 of the Business and ProfessionsqCode, and • [g e Gt'"�, i 1 r 71 9 5. 88 T my license i5 in full(orce�ncL,gfJect. /��//s` ,vs (�G. • L! V V L 2 .� Licens CI s 'a.) - z'n se N0. / J i — S Date La O—k Signature ,t r iMr✓-3 PLUMBING FEES WORKERS'COMPENSATION DECLARATIONorI hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers ELECTRICAL FEES Wk ' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink .C. workers' 0Lab. C.J�'/`// Automatic Washer Transformer 0 15-50 KW , �1 PolicyJNo. (J`1d`1D Company MICR Backflow Irrigation Sewer Cap Construction Pole Sub. • 0 50+KW Certified copy is hereby furnished. ' ;°.Cert, d pope, s lied with the city B dii99 DI ijt / Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Jb-/—• Applicant tif'{ J(��/11-iYY-0 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher - Meter Clover 100 amps (This section need not be completed if the permit is for one hundred($100) or less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'1/2z-8 Workers' Compensation Laws of California. - . - - - Date Signature Floor Drains Swimming Pool w/Spa F.A.U. • Inc.Solar 09-15 HP❑16-15+ NOTICE: lf,after making this declaration, you should become subject to the — — - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Clv. C.) Interceptors / Water Heater Cg 00 Outlets Range Lender's Name Lender's Address • Kitchen Sink Water Service Switches Sign • OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-WashGarbage Disposal Standing Sections ' following reason (Section 7031.5 Business and Professional Code: Any city or • county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit Y Generator ❑0-5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt arefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil ,laity of not more than five hundred dollars($500). . LI I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES License Law does not apply to an owner of a property who builds or improves _ thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 ) sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 Zoning Approved By Date 7 prove , the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building •Approved By Date / /� prove for the purpose of sale). — !/ !/ 0 I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date tractors to Contractor's construct the project (Section 7044,Business and Professions Code( The Cactor' License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ - proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG 4 Fire Dampers PLUMBING $ 5:00 ISSUANCE $ Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ • I hereby certify that I have read this application and state that the above 0o-100,000 BTU 0100,000BT1. ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this city to enter .upon the above-mentioned property for _ • inspection purf�sq / , 1� J �i v Rf/ MECHANICAL $ 00 Signature �'f1 N unit Dateio- Oo Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% TOTAL FEE $ *� ' // / _ r CMF 0865-46, 10/84Building; Canary Applicant; Accounting; DATE: 07/29/38 TIME: 16:24 rev. white - - Pink - Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit# Date Inspector • APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms t. • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement.. 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd:, 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, p_Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil • 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric tes:iZ-21•'V Fcanivesato AS p f,Za3 UPC. LQ 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 • V 41. Solar Domestic-Final 712. Backflow Preventer • 43. Backflow Irrigation • i 144. Landscape Irrigation System • 45. Sound Attenuation -' - ' j 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING c' 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY , i No. Date 1 • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA SA NSTRUCTION PERMIT PERU- NO. TRACT NO. LOT NO. UNIT NO. bjPI 0 ?OO q 3 s/so Project Address�,Lx f�L/ VJ�O� �I� •-' U REPAIR ..mss `A�C�� TYPE OF CONSTRUCTION ❑ NEW U ADD U ALTERATION O• wner's Na Maili O`g-Add'ress` ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone . Owner's Name r I—• - P Phone�-s�-�.��Z . DESCRIPTION OF WORK/USE OF BLDG. Address ` 1d CY� S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT CI GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front 0 Address ❑ TENANT ❑ ELECTRICAL CI PLUMBING ❑ MECHANICAL B Rear N 99a-3413 ❑ OTHER A I -41'2 Contractor's Nam- _ IS V �. • Phone PROJECT-DESCRIPTION SQ. FT. OCCUPANCY C Right G CityAddess License S3`• -- - 3 CONSTRUCTION TYPE VALUATION$ - S Left R City License No. � -. ZONE GRADING CU.YDS. ACRES E LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provldet� ���� I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: s••sC/"['v�� SEP L • M with section 1000) of Division 3 of the Business and Professions Code,1and �(Gl.s... T my license is in full •rc rd effect. ppl i) ' ? $ License las • i•emp No. C / / \ Date -- -1 Signature ELMA . ..... , PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES Q hereby affirm that I have a certificate of consent to self-insure or a certificate Workers' Compensation Insurance, or a certi led copy thereof (Section Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Policy Lab. C.) OVkyD OVER0 50+ KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. Certified copy is hereby furnished. - - I • - Cerjjit��/cd•Q• ,yy ss(ff ed with the city B iy9 �v iop/� - Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps Date tel] ar(-a a Applicant rfl• LA../Li EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors . Dishwasher Meter Dover 100 amps • (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01'/-8 Workers' Compensation Laws of California. - �__ Date. Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 01515+NOTICE:If,after making this declaration,you should become subject to the - - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes • Pole Light • I hereby affirm that there is a construction lending agency for the performance q� of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors J Water Heater oCwr') Outlets Range Lender's Name Lender's Address Kitchen Sink Water Service Switches Sign • OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or • county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays Generator 00-5 KW ❑5-15 KW any structure, prior to its issuance, also requires the applicant for such permit - Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt --- - srefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil • .nalty of not more than five hundred dollars ($500). $ 3 LO I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves • thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: . employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By _ Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date // rove for the purpose of sale). p Ain O I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY F FEES builds or improves thereon,and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple El System Repair/Alteration BUI LDING PERMIT $ SMIP . $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# -- .�•Fire Dampers PLUMBING $ `!•� ISSUANCE $ Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑o-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- - PLAN CHECK 50% $ MICROFILM $ sentatives pofu this city t enter upon the above-mentioned� perry_fof cr� inspection Pur s. / �%40O[L Gf/ MECHANICAL $ TOTAL FEE $ • Signature a CMF 0865-46,rev. 10/84 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor 01 00013667-00013667 TOT 5.00 narE! no/nt/oo Tint. nr•s[ CONSTRUCTION AND PLANNING POOL &SPA rt' Date Inspector - Date Inspector APPROVALS Permit# APPROVALS Permit# t-- 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings �" 58. Electrical Conduit-Undrgrnd" 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 1 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O'Undrgrnd. 10. Structural Floor System 61. APPROVALTO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing &Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ti _ 31. Plaster Brown Coat 79. FINAL INSPECTION '32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final ElectricNot :2_'�gq- Pe�zsntr Exp11zea _ 4 s pert-eag 34. Final Heating & Air Conditioning eC. L.6.0 35. Final Gas Pipe-Test 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final - 40. Gas Service-Final 41. Solar Domestic-Final - i -2 42. Backflow Preventer - _ �-- 43. Backf low Irrigation .• - - - ,IA 44. Landscape Irrigation System . fjl 45. Sound Attenuation L/ 46. Handicap Regulations Q 47. FINAL STRUCTURE & BUILDING � r 48. Special Requirements Completed • 49. Electric Release to Edison • • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY t/ No. Date - t t \`� \ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • (CITY OF COSTA ESA CONSTRUCTION PERMIT - PE�n T c .93 G TRACT NO. • LOT NO. UNIT NO. 5139 10/14/86 5.00 TL Project Address a�3O l;r r�II CO. 0 [Q- Applicants Mailin ess .N W /'Q et— Owner's OF CONSTRUCTION U NEW ❑ ADD LI ALTERATION Ll REPAIR a`(1`.O1l� 151-7 1'1 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Name �� �/1� Phone O�• DESCRIPTION OF WORK/USE OF BLDG. Address /(t7V1 P�� ��II 1111 S Main Building: Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING OUNDATION ❑ STRUCTURAL T Front o Address p. /�/� ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N Contractor's Nam- II to _ , 14j PhonefSQOOc ❑ OTHER C Right - - N ' • ( T, , PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(mailing) 1 .�- K -Left G 5072) CONSTRUCTION TYPE VALUATIONS _s - R City License No. -! (� ZONE GRADING CU.YDS. ACRES Ping. Ref.# • Parking Req;/Provided E LICENSED CONTRACTOR DECLARATION __ a I hereby affirm tht I am licensed under provisions of Charter 9 (commencing Remarks: r a I/ ���� -. { .'��� =4�,3. Planning Notes: • M with section 7000) of Division 3 of the Business and Professions Code, and L T my license Is in full f•r • and effect. • I - •as 1rs�Li Licen C . $ 411 di Al I n • 4 RECEIVED OCT 3 y it S 1 Date r -, "4/ Signature ���.�I y h1�ariL PLUMBING FEES \ WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES •f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink .BOo, l.ab..�f71np�(�//1 y1, (� / �v Automatic Washer Transformer ❑ 15-50 KW Policy No. fat 1`'1[1'-1 /!/tc Company IQ E�LS.�M./L5/v / Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW S.-Certified copy is hereby furnished. / Ce./990)..y filed with the city g 'sion. 'u ria 9 Bathtubs Sewer Connection Dupto 100 amps t� r7 �((uJ Cooking Unit Meter p Dale Applicant] - EXEMPTION FROM WORKERS'COMPENSATION DELL RATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit Is for one hundred($100) or less). Dishwasher ' Solar Piping - Dryers ❑Gas ❑Electric Sub Panel I certify that In the performance of the work for which this permit is issued, I - shall not employ any person in any manner so as to become subject to te Drinking Fountains Solar Tank Fan Motors 00-1 HP 101%-8 Workers' Compensation Laws of California. - Date Signature Floor Drains Swimming Pool w/Spa - F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE: If,after making this declaration,you should become subject to the — Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service OutletsWater Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light • of the work for which this permit is Issued (Section 3097 Civ. C.) r • Interceptors } terHeaier Outlets Range Lender's Name , Lender's Address Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash • following'reason (Section 7031.5 Business and Professional Code: Any city or _ 1 ' Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW1 any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor - to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt- - - • . • therefrom and the basis for the alleged exemption. Any violation of Section , 031.5 by any applicant for a permit subjects the applicant to a civil - - enalty of not more than five hundred dollars($500). ❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $'3 compensation,'will do the work,and the structure is not intended or offered - Rein ' for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL - spection Fee $15 Issue Fee • 5 3 FEES License Law does not apply to an owner of a property who builds or improves - ' thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: ' employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 ZoningApproved • sale. If,-however;-the building or improvement Is sold within one year of com- ype 0 PP By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By ^ Date rove for the purpose the p sale), (5) I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration Application Issued By ld Data �f/'� tractors to construct the project (Section 7044, Business and Professions Code: ' The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 : 0100,000 : SUMMARY OF FEES - builds or improves thereon,and who contracts for such projects with a con- - _ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 BUILDING PERMIT $ - SMTP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT �/��f� ❑ I am exempt under Section B.'& P.C.for this reason Firepl/Fact.BIt. ICBG# Dampers PLUMBING $ - !7 ISSUANCE $ s�" `•f/ Date Owner Heating System& • • PLAN CHECK' _25% $ - ENERGY P.C. $ I hereby certify that I have read this application and state that'the above • 00-100,000 0100,000 BGRADING $ ' information is correct.inI agree ui toi comply cost with all dy and y uth ies ' ® ' ELECTRICAL $ and state laws relating to building construction, and hereby authorize repre- • PLAN CHECK 50W $ MICROFILM $ - • inspection sentatives of his i y to enter upon the ••ave-mentioned Properly for inspection p r 5 / /1�(O -(U 1 (� 2/V_ MECHANICAL $ TOTAL FEE $ Can ' Signature - Date .. Drivers' License or SS# . CMF 0865-46,rev.10/84 White Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms iYi 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 03 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgt,nd. v.• 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap4iEl Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK! 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof.Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas' 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: f-27_87 - RO0266S NOT Cj2.e€c.T; 34. Final Heating & Air Conditioning yC Z�2�-B Cavtc� k6 PEE ZD•t( AS. PEe()Pt. L.rSi 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • City of Costa Mesa • Building Safety Department CERTIFICATE OF OCCUPANCY N? 2711 C P.0. Box 317 Costa Mesa, California The Building located at 2930 Grace Lane has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group F 2 Occupancy. Use of Building ten unit industrial building Legal Description A. P. 9141-221-18 (See reverse side for Metes and Bounds) Building Permit No. 31.845 Electrical Permit No. 31296 Plumbing Permit No. 57072 Floor Load Signs have been installed as Room Capacity Signs have been instaled as required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. Number of apartments and/or guest rooms ISSUED TO: Building Official Sim Hunsaker by 6 f t 4 B - 4191k Dote September 4, 1;70 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. 306 (e) U.B.C. Fo:.n 81.734-1M-11-133—s_B p •,i is1oTE OFTIMMa.- ' n lAud = CER IFICATE OF QLIUCAENLIFIED CONFORMANCE HE UNDERSIGNED MANUFACTURER HEREBY CERTIFIES that the products identified below and on attached sheets Nos. and the principal mem- bers of which ore marked with the Collective Mark of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION (AITC) were manufactured in conformance with applicable provisions of U. S. Commercial Standard, CS 253-63, for Structural Glued Laminated Timber, and that such manufac- ture has been at our plant in Healrt-sbu-rg, CA.litor. a , which plant has a quality control system approved by the Inspection Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION and inspected periodically by such Bureau. The undersigned manufacturer further certifies that the work has been done in accordance with the applicable job specifications. Manufacture of the members complies with the manufacturing & fabricating provisions of Chapter 25 of the Uniform Building Code. RECEIVED JOB NAME: Hunsaker B.tildinq lglK) BUILDING SAFETY DEPT. JOB LOCATION: Grace Lane - Costa Mesa, California 1/ JUN fl 1970 CUSTOMER'S ORDER NO. N-381 DATE MFGR'S ORDER NO. 1-30,41s1 rM a1519113111112111213,415;o 2-(B--1-)-Gru-L-am-Beams-5 a-"-x—I61/2"' x 20 r 0"end-4—(B=2)—G3 i=Lam—Beams 51/2" x 161/4" x 2410". C:nmtTi nation nA1r,_Wa-tar-resi SF-ant-(.C3sejn-) til ue; Industrial Finis SIGNATURE • _ / LA- COMPANY Standard Strnr.e. rtu .5_, Tnr, q tlity Control DirectooroR 9 my creek Rd. DATE 6/5/7(1 for Standard Structures, Inc. A/TC HEREBY CERTIFIES that the said company at its said plant is licensed by the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION to use the AITC Collective Mark in respect of products which comply with applicable provisions of said Standard, that the adequacy of the quality control system in effect at said plant is periodically inspected and verified by the Inspection Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION, and that, in the judgment of the undersigned, said company is capable of complying with applicable manufactur- ing and testing provisions of said Standard in respect of products manufactured at said plant. Conformance with the Standard in respect of any specific or particular product is the sole responsi- bility of the manufacturer; AITC's guarantee hereunder being that the said company is qualified to produce a product meeting the said Standard and that its plant is periodically inspected and verified by the AITC Inspection Bureau. ""` \ AITC Certificate Na 7456 5 Signed for •�`�'� C s4 AMERICAN INSTITUTE OF TIMBER CONSTRUCTION E : 4 L f:.' a.� Executive Vice President Director. Inspection Bureau ' ktiai > ©1965 AMERICAN INSTITUTE OF TIMBER CONSTRUCTION AITC FORM IB-1-65 - The principal members of the job covered by this certificate are stamped with one of the ' following type quality marks. Each qualifir 'ant has an individual qualification desig- nation. The designation "P-143" shown on t. .ypical quality marks below is not assigned to any plant and is used only for the purpose of illustration. A TYPICAL CUSTOM PRODUCT QUALITY MARK P-143 ( AITC designation of qualified licensed plant. • /VaD CS2e53-63 • Indicates that the designated licensed plant . Indicates conformance to U.S. Com- - has-met-all requirements for qualification and' - - - - • .mercial Standard for Structural Glued maintains an"acceptable quality control sys- ^ • - - • .– - - Laminated Timber. - tem'which is'periodically inspected by AITC. --- -- - - - •- - . ` , • , I1 .. -..7 .. . - - ;A :TYPICAL .FION-CUSTOM . PRO-DUCT QUALITY MARK AITC designation of qualified licensed plant. • • P-143 ` = " SPECIES ' ' DUSEgortDsftoniV adhesive, W for WET QUALITY • 0000f ARCH INSPECTEDName of wood species used. CS 253-63 Designates appearance grade. IND— Industrial. ARCH—Architectural. PREM —Premium. Indicates that the designated licensed plant Indicates conformance to U.S. Corn- has met all requirements for qualification and mercial Standard for Structural Glued maintains an acceptable quality control.sys- Laminated Timber. tern which is periodically inspected by AITC. Designates dry use stress. f—bending. — t—tension. c—compression parallel to grain. ' ► For a custom product the specifications covering the desired product are included in the plans and specifications. ► For non-custom products essential detail specifications are included on stamp. CITY OF COSTA MESA ) BUILDING AND SAFETY DEPARTMENT CLASSIFICATION SHEET GROUP DESCRIPTION OF OCCUPANCY A Any assembly building with a stage and an occupant load of THIS BUILDING HAS BEEN CLASSIFIED FOR 1000 or more in the building 1—Any assembly building with a stage and an occupant load of less than 1000 in the building ji ^7 2—Any assembly building without a stage and having an oc- !/ OCCUPANCY. cupant load of 300 or more in the building B 3—Any assembly building without a stage and having an oc- cupant load of less than 300 in the building, including such 3 See also buildings used for school purposes less than eight hours PERMIT NO. Section per week 702 4—Stadiums, reviewing stands, and amusement park structures SIGNED - —O2./— not included within Group A nor Divisions 1, 2 and 3, Group i• ature o>f cant B, Occupancies C Any building used for school or day-care purposes more than DATE / o See also eight hours per week, involving assemblage for instruction edu• Section cation, or recreation, and not classified in Group A or Di- • 802 visions 1 and 2, Group B, Occupancies. I—Mental hospitals, mental sanitariums, jails,prisons,reforma- tories, houses of correction, and buildings where personal • THE CLASSIFICATION OF THIS BUILDING liberties of inmates are similarly restrained D 2—Nurseries for full-time care of children under kindergarten SHALL NOT BE CHANGED WITHOUT SPE- See also age, Hospitals, sanitariums, nursing homes with nonambu• CIFIC APPROVAL OF THE DIRECTOR OF Section latory patients, and similar buildings (each accommodating 902 more than five persons) BUILDING SAFETY. 3—Nursing homes for ambulatory patients, homes for children of kindergarten age or over (each accommodating more than five persons) 1—Storage and handling of hazardous and highly inflammable or explosive materials other than flammable liquids 2—Storage and handling of Class I, II and III flammable liquids, E as specified inU.B.C. Standard No. 9-1-64; dry cleaning plants using flammable liquids, paint stores with bulk hand- See also ling; paint shops and spray painting rooms and shops Section 3—Woodworking establishments, laning mills and box factor- 1002 ies; shops, factories where loose, combustible fibers or dust are manufactured, processed, or generated; warehouses where highly combustible material is stored 4—Repair garages 5—Aircraft repair hangars 1—Gasoline and service stations, storage garages where no Orepair work is done except exchange of parts and mainte- nance requiring no open flame, welding, or the use of highly flammable liquids See also / 2f Wholesale and retail stores, office buildings, drinking and Section l/ dining establishments having an occupant load of less than 1102 100, printing plants, municipal police and fire stations, factories and workshops using material not highly flam- mable or combustible, storage and sales roams for combusti- ble goods, paint stores without bulk handling See Section 402 for definition of Assembly Buildings 3—Aircraft hangars where no repair work is done except ex- change of parts and maintenance requiring no open flame, welding, or the use of highly flammable liquids Open parking garages. (For requirements, see Section 1109.) Ice plants, power plants, pumping plants, cold storage, and • G creameries, factories and workshops using incombustible and non-explosive materials.Storage and sales rooms of incombusti- ble and non-explosive materials H Hotels and apartment houses See also Convents, monasteries (each accommodating more than 10 per- Section sans) 1302 I Dwellings and lodging houses 1—Private garages, sheds and minor buildings used as ac- cessories only when not over 1000 square feet in area 2—Fences over 6 feet high, tanks and towers JOB ADDRESS 2930 T F,race Lane BUILDING PERMIT NO. 49431 GENERAL CONTRACTOR • 1e_ A; • •- DESCRIPTION of WORK Fire S•rinkler AP No. 1^1-221— R LOT 8 TRACT 3878 FIRE ZONE VALUES 11• 11 `ECTIONS — Signature Dote TYPE GROUP u7 ZONE NIG SUBCONTRACTOR P WAITS ISSIED GAS Date Number Signature WATER _ Plumbing ROUGH PLUMBING I ' PROP. SWR. LINE [] HOUSE CON. EI SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER 0 ROUGH WIRING Heating and Vent. TRENCHES [� FORMS 0 STEEL REINF. FLOOR SYSTEM BONO BEAM STEEL REINFORCE n SHEATHING FRAME AND FLASHING - LATHING - IN n OUT in PLASTER, BROWN COAT STRUCTURAL, FINAL _ Elecfri[ NG. VENT.. REFRIG. AND A.C., FINAL P._.AGING. FINAL AND GAS TEST in ELECTRIC. FINAL /' BUILDING, FINAL Pt/9+r/ SPECIAL REQUIREMENTS OWNER KIRKHAM, DAN DATE 10-14=70 JOB ADDRESS 2930 Grace Lane BUILDING PERMIT NO. 32337 GFMERAL CONTRACTOR Ocn er-Builder DESCRIPTION of WORK Interior Al tar (Hanging (-Pi 1 i I ' 141-221-18 LOT 8 TRACTg878 FIRE ZONE VALUE $ 600 00 INSPECTIONS Signature Date GROUP F-2 TYPE ZONE M-1 SOIL'rf t.0 7 ,NSi/. 71 SUBCONTRACTOR PERMITS ISSUED GAS Date Number Signature WATER //� PI binq �g�J//E�� ROUGH RMLINE (�17 - //-.?,5Z' 5R0/7 PROP. SWR. LINE � HOUSE CON. 0 / SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND (J POWER ❑ ROUGH WIRING /2,rf7^ p H tine aannd..V nt. � � �y/ TRENCHES FORMS STEEL REINF. �//'/f/ PcrTJ 74// FLOOR SYSTEM / BOND BEAM D STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN n OUT n• P' ER, BROWN COAT S. rURAL, FINAL E ectri n '' b p HEATING, VENT., REFRIG. AND A.C., FINAL Aly/2 —7o�;ci...,j� �'�/ Kd-n.70 .3i 9f PLUMBING, FINAL AND GAS TEST n a5-/,_-,,--,, 4 ELECTRIC, FINAL II46 /1.2,9.w • , ` • 32337 ocr ,�1-, 00 616 d*****6.00 COSTA MESA BUILDING•SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely r� 0 11 RECFj1VED BY DATE R/Cr EIVEDD DATE ISSUED BUILDING aCI3D G ?c2 Lz.ie , Z,/,_1,1, (/h `Y 7 ADDRESS� ✓� n �•'� �t �D— l '� OWNER NV R. KI,2KH4� A.P. NO./f OCo[/'/ Paoli N.47 MAIL T awnee ez• ADDRES �g� n,� G ADDRESS T✓V /Vt3K/�D„� ryC (�(jC ADDRESS Y ill TE 0- YVVPC 0 CITfinal NOL. LOf77Miff TRACTS/ LOT R BLOCK Z- I- CONSTRUCTION NEW ADD ,ALTFRFPAIR MOVING DFMfI LSH N LENDER it/One O d c0 J D BRANCH11e Jto OWNER x �jirys ADDRESS (a J Q ARCHITECT OR ENGINEER / TEL. NO USE ti VALUE .1 Ay/ N cA/O fili U Q FIRE C w CL ADDRESS ZONE '— TYPE GROUP / -c?• a.Ly APPROVED WZ CONTRACTOR (9L4)n4. .- -au/as- BY DATE 1 CO Z J tL ADDRESS w w TEL. ZONE NO.NO.OF USE OF NEW ice) ZH CITY NO. r/'/ PLANS a BUILDIN dna too STATE CITY YARDS APPROVED YARDS APPROVED to CC LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF SLOGS. (FROM C/L ST ET) OF LOT INOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. Cr-1 / `( ✓, R.SIDF T. FT. I— SIZE OF .� NO.OF Z NEW BLDG. ROOMS 2 STORIES L.SIDE F FT. Q EXTERIOR WALE^' ��/ ROOF • U COVERING O W.0 COVERING REAR FT. FT. ' USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& MAIN BLDGS. ACCESS.BLOCS. t DATE OV rn �ey A/ �jQ7S C.0.P.•Aa APPROVED VHnu/W1 / n.5 / � V APPROVED /'.I L�eL DATF /O” /1-70 Z s/�/`/H'L• 0 UI hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of N the State of California. m ZI hereby certify that I am properly licensed as a contractor under SQ. FT. O the State of California Business and Professions Code, Division 3. THE AMOUNT SHOWN UNDER VALUATION IS FOR • Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R am exempt fro.. ).• provisions of the State of California Business 6279 ^ and Prof ass'• s Cock Division , - apter VALUATION r w / PERMIT FEE S IN Signatur. .f m Permute 1.� . / S // OO PLAN CHECK S •-- E YYY/// ` Authorized Agent / u. TOTAL FEE S / • 0 o OWNER ROE AND COMPANY DATE 11-29-79 JOB ADDRESS 2930 Grace Lane "J" BUILDING PERMIT NO. 49229 GENERAL CONTRACTOR L. Bleeker Sht Mtl Wks DESCRIPTION of WORK Paint Spray Booth / 0. 141-721-18 LOT TRACT FIRE ZONE : VALUE $ 1 ,650.00 INar'ECTIONS Signature Date TYPE GROUP ZONE MG SOIL PERMITS ISSUED GAS - - - -- - SUBCONTRACTOR Date I Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE 0 HOUSE CON. l] SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND [1 POWER ❑ ROUGH WIRING `� Heatin and V t. TRENCHES ❑ FORMS ❑ STEEL REINF. �-+r a Jfl'icy 741-e //;9 7S 173[/0 FLOOR SYSTEM L!//l BOND BEAM STEEL REINFORCE a SHEATHING FRAME AND FLASHING^ LATHING - IN OUT PL,-TER. BROWN COAT S URAL. FINAL Electric HEA I ING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST Il ELECTRIC, FINAL BUILDING, FINAL 7599 II /29/79 28.55 TL_ , COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 •REC Y 'PERMIT AIO 4 9229 For Applicant rto`Fill/in�Com�pletely —Use Ink Only /� s N �/ ADDRESS BUILDING Z J V 6 /re-& LAN` zi./T • A.P. NO. I t '-� 22_ —tis I /, W �L�/7� BUILDING �� / / QUO' Is/ P OWNER OR �• CO' ADDRESS tU_(/n TENANT c Y /' / Lei-j& �� �V UNIT OR ADDRE 52930 Siete_6:- La-4G— IL/ SPACE NO. //G� � Q TEL �/ Z.-`Jr}j.�sR'NO. LOT BLK. CITYC.OS/4 /Z(�SIT NO.575-27 NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER N BRANCH �\ OWNER �_ 4 i ADDRESS ARCHITECT TEL. U$E /4 E$/' �__ OR ENGINEER TE '/j �,,v—s'_' ADDRESS / zQ/ ,/� /� '11�/ ZONE , i TYPE GROUP ...�.�jyy L... l LE- ZLS4 sew. sea WFc APPROVED DATE Of/CONTRACTOR ��(( ADDRESS /0 2,Gg- D4eL4yzz/A` V& �7 CIry £yNuItry O (7[ Ect. F9/7,a, F STATE CITY (( APPROVED SETBACKS LIC. NO. /?7954 LIC. NO�i���I SIZE 'NO.OF BLDG'S. C/L STREET) Q USELOF OT NOW ON LOT FRONT 4:1 /2� 4 ivcA TING BLDG. R.SIDE 9cn Separate permits are required for L.SIDE FT. L1 electric,plumbing and heating work. REAR FT. W F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION eiia'� DATE C d ` APPROVED (] /A } V �V _AP ROVE e/Vv DATE 1(l�-1/( 1 ..1 a La 0I hereby acknowledge that I have read this application and state ed that the above information is correct and agree to comply with B. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of a Gra the State of California. ro I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: La am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ r/ < and Professions Cod vis'on 3,Chapter 9. 1,QQ Ln ////////f PLAN CHECK $ o Signature of � (6 / J � rO Permittee ''!! ( J 9 ry $ / 6,,0.�. TAX $ V O LL or Nd l/ . 2-9 ( ! f Authorizetl Agent Date TOTAL PAID U 72U4 12/28/79 5o50 COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RECE V PERMIT *r0 49431 For Applicant to Fill in Completely— Use Ink Only lv BUILDING Thr: 3 ! Q n eE 1 A.P. NO. I�"'f�Z1 �l ADDRESS -c--.-t-1.7CJ L\. �C..t'� OE NAEhR ORwoe- 4 ADDRESS zg3a 3 @&ACE t-t3 Co� UNIT OR MAILING SPACE NO. ADDRESS ` q CITY CAr/\ OST ^ eSSAI. CA, NOL S�S57ZJ TR.W3.-.7g LOT yBLK. CONSTRUCTION NEW oo ADD TER REPAIR (MOVING DEMOLISH LENDER BRANCH OWNER , ADDRESS ALUE ' ARCHITECT TEL. USE 4iftiH / $ /019, 04, OR ENGINEER NO, M//J ADDRESS '� ZONE r YV ��' PE GROUP �/)(.(� CONTRACTOR Qc�G(J"L(.(CI APPROVED DATE /(� (�e7, ADDRESS TEL. CITY NO. w STATE CITY APPROVED SETBACKS i LIC.NO. LIC.NO. W SIZE NO.OF BLDGS. (FROM C/L STREET) c ( c l I L UOF SEOF I NOW ON LOT FRONT ! ,' (, , t Q .C/1 EXISTING BLDG. 1i�, R.SIDF _ rot HSeparate permits are required for L.SIDE . V.4 • G electric,plumbing and heating work: REAR FT. H USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION t 4,2_,,V /'�"' r!/LJY 1r DATEQ � /dROVED7 APPROVEIrf /) Q�/71 4Si�/L� �V DATE ILt HI c,W O I hereby acknowledge that I have read this application and state on' CL that the above information is correct and agree to comply with C. all laws regulating building construction, and I shall not employ ai Z any person in violation of the workman's compensation laws of x the State of California. m I hereby certify that I am properly licensed as a contractor under 5Q. FT. ,v the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the pr• ns of the State of California Business VALUATION PERMIT FEE $ a and Professions Code, e •n 3,Chapter 9, S. Op n Signature of . �tT--� PLAN CHECK $ `n o Permittee y Q� $ `o0, Ot TAX • $ O' Z) LL Authorized Agent Date /'z`z /7 / TOTAL PAID $ • vSI U 31845D;AY ,5 xlP[M_tz)°oo 695n ***328.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely' meq( ,(�V t BUILDING 2-9 7C l7RAc L,4j AUN175 I RE�,G'O BY 1/4.-5--e�ti5�7d�0.---./te i7a ADDRESS (� T� eQ OWNER SI/In 1( HUNSAKF2 A.P. NO. IGF( -22I - Ib P I}j �f'S MAIL �/n _ / BUILDING [� �/ �Util/TS ADDRESS 107 I^ . CJ't4P �A-Al LE ADDRESS 9 O 6(ZACb Lw, A - 7 LU Z . p p p11 Q 0_ 0 CITY r Le�-roM (At its-No.(979-471p TRACT 3878 LOT (7 BLOCK. ZCONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOLISH a m LENDER X J 0 BRANCH W C lM !, {{ J N OWNER UNSAn-re ADDRESS IARCHITECT / VALUE r� J Q OR ENGINEER keg `'i I M.CS NO. 774 -10 S $ �O��j ow 1 ' �f FIRE Z W ADDRESS 46 I 11 . g2oo,k/4t11LS( l A/tA Pltt ._ZONE TYPE GROUP F2- W Z �J APPROVED /^//A/ J� �j J Z CONTRACTOR OW &162.- - fj LVL17 LCZ— BY // !7\DDATE .6"---/5/O CO Z l Jfr ADDRESS SOW)e__W w ^ TEL. ZONE NO.OF USE OF NEW (-Q• Z 1- CITY NO. /t/t LA PNS 2 BUILDING M/+uo AC..T, -0 STATE CITY YARDS APPROVED YARDS APPROVED I/Wj¢ LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING 00 SIZE / / NO.OF BLDCS (FROM C/,L�tt STREET)rr�� OF LOT 181 ,tJ7x 744- INow ON LOT FROM 8741 FT. N r_ I FT. USE OF n N.* EXISTING BLDG.p �^ '` R.SIDE�2- - FT. IUj i?._ FT. I- SIZE OF NO.OF Z NEW BLDG.ZI / 1C / Z RO MS I U STORIES / L.SIDE 4gLo FT. Lr 12_ FT. VQ EXTERIOR WALLROOF Q� LZ'-(� COVERING COAL(_, COVERING SOIL -U P REAR 251-0"FT. S, FT. • I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. �- BET.MAIN& ',// 1 0t 4,44(•y- �J/]t/ LI 6 (I 1- / MAIN BLDGS. ACCESS. BLOCS. ca. VAR.+ DATE p ,YN OU TIM(it-I-- rsL . MU.64CIVILNS CU.P.# APPROVJEDD y —ELY en-- n 7 DATE -- I C-7 O O_ HOLD FOR SPECIAL REQUIREMENT' ~ I hereby acknowledge that I have read this application and state / that the above information is correct and agree to comply with �E L/�`+' CC all laws regulating building construction, and I shall not employ {q� /rn_ 'y/�j_} '/ ,/�rAL/¢_y F- any person in violation of the workman's compensation laws of 11 Lr[. to, �N.X- p /tl//IN1 97 00 Cn Z the State of California. j�17b8 SQ.FT. m I hereby certify that I am properly licensed as a contractor under o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: S am exempt from the prov sions of the State of California Business VALUATION [� and Professions Code,-Di ' ion 3,C Ng PERMIT FEE $ 2/r 1 02 to N - D ,Signet - • dd p (� m Per ttee "i� $ -// 6ot PLAN CHECK $ A0/r'C0 E o h• Autized A.- t ,. 33241, St!` u. TOTAL FEE $ / / 1 _—