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HomeMy WebLinkAbout1500 ELM AVE - Building Permits w � CITY OF COSTA MESA y �) BUILDING DIVISION ti '--"* ' DEVELOPMENT SERVICES DEPARTMENT L112_ J • PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1500 ELM AV Status: ISSUED Suite: Applied: 03/25/1998 Vicinity: Issued: '05/15/1998 Parcel Nunmber: 13930225 Zoning: Cl Cl Applicant: THOMPSON, JULIUS Address: Phone: HOLD FOR SPECIAL REQUIREMENTS Zip: Owner: JONES, WILLIAM-G TR- , Address 14 DARTMOUTH - Phone: , I - RANCHO-MIRAGE,CA _ ) �' ' '- -Zip: 92270 : - ,`, ,-, j . r Contractor: " 'RELY-ON,SPRAY:BOOTH Address: •'9475 SLAUSON AV -' Phone: 714-6425051 ��,^,�_ ./ ' PICO RIVERA„CA., Zip: 90660 Ate ' License: 506096 Arch/Eng : , Address: - i ' - - Phone:. ' Zip:' - • ./ ;n — �. - Licensed _ _ , • , SCOPE OF PERMIT • INSTALL 2 SPRAY BOOTH'S, PC#1131-98L. ' , FEE SUMMARY .' ; Plan Check: $0.00 , . Calc Valuation: Soto' Permit: ' '$421.75 -..i . ” -I- _ _ . -`' - .,Claimed Valuation: $33,000.00 1 Other: $0.00 B • Inspection: $0.00 `Total: $428.68 . ' • PLANNING &ZONING ; ' SETBACKS MAIN STRUCTURE Front 0-0. .L -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: - , ,_ HOLD FOR SPECIAL REQUIREMENTS 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 / DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the I'7I work for which this permit is issued. \ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier S-r e 7ei- ra^I D Policy Number 75 7 G ay (This section need not be completed lT the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit Is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr sion3, / F Applicant Signature: t.. -6L-1.-rN•-_--, Date: S— /S— V 17 WARNING:FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT MI EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(Et ,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business,agd Pro fes ions Code,and my license is in full force and effect.tJc.a �r5, 0 N(' 9�r� /,{, Class a C'- �p 354 Contractors Signature: )'-zrS1t r+-� 17" -P'�. T- Date: /5—�/r)' CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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 cif penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the DMsion 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 Flre 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 Celifomia 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 epereit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). . 7 If e 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 (I1'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. • Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the a••ve-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date ci...- Tye.- 5---/5"—Si And/Or Authorized Applicant Date SQDLL INePECTWN TYPE DAM IKIWASS TADEII DISPFCTMN TYPF DATE CMS 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 Flre Race 220 Anal Planning Approval 203 Final Sign222Final Site 204 Final Demolition 2500 Final Building/Occupancy Cna 2446-46 ./cy.__ , CITY OF COSTA MESA ,`y' A. BUILDING DIVISION 1-' .'..,- ' DEVELOPMENT SERVICES DEPARTMENT REM-01141R • .4�� PERMIT PERMIT NUMBER • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1500 ELM AV - Status: ISSUED Suite No • Applied: 05/15/1998 Vicinity: Issued: 05/15/1998 Parcel Nunmber: 13930225 • Applicant: THOMPSON, JULIUS Address: Phone: , • Zip Owner JONES, WILLIAM GTR ` Address 14 DARTMOUTH • /�- - Phone: . - "RANCHO MIRAGE,CA - Zip: 92270 1 , - - , 2 - Contractor RELY-ON SPRAY BOOTH Address: 9475 SLAUSON AV Phone:,714-642-5051 • . PICO RIVERA,CA., Zip: ,,190660 f ' •'License:506096" = SCOPE OF PERMIT 5 MOTORS UP TO 1 OHP&34 LIGHTS&3 SWITCHES. - "' ' FEE SUMMARY Quantity ' Quantity ISSUE FEE $22.00 . - Temp Dist System/_Lighting $0.00 0 ' Temp service test $0.00 Busway/100 ft $0.00 0 • - Res. a/c package $0.00 _ Standing Section �/ $0.00 0 New Res(1-2 units) $0.00 . 0 - •• = Misc Electrical Equipment - •' $0.00 0- New Res(3+units) ' $0.00. • - 0 - - - c Transformers.up,to 1 kva/kw $0.00 0 Pool I Spa $0.00 0 -` - up to,10 kva/kw $0.00 0 Lighting Fixts $29.10 34 : 'up to 50 kva/kw $0.00 0 • -Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches 53.00 3 - 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- o ,., - Ciraus(gen or ride). $0.00 0 Motors to 1hp - $0.00' 0 • , Circus(mech ride or,lights) ' "$0.00 0 - Motors to 10hp $55.00 5 Christmas Tree Stand. - . $0.00 0 Motors to 50hp $0.00 0 - • Fireworks Stand _ - $0.00 0 Motors to 100hp $0.00 0 - Other Electrical-Fee - $0.00 . . , Motors over 100hp - $0.00 - 0 - Communication drops $0.00 0 ; • Investigation Fee - $0.00 • Sub panel to 200a $0.00 . 0 Plan Check Fee- $0.00 Pole Light Pkg $0.00 0 • Reinspection Fee , $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 • 0 '- ' TOTAL CALCULATED FEES $109.10 Intermed Pole $0.00 0 - • - COMMENTS/SPECIAL CONDITIONS P • 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. 4 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Carrier: 5 2*7e F'.-i� • Policy Number: 7 S7 6y (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • 0 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,end agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr ons. • �/ Applicant Signature: it*�i54T" Date: -s" /s-70 ✓/ WARMNG:FAILURE TO SE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,(MEREST,AND ATTORNEY'S FEES. CICENSED CONTRACTORS DECLARATION: hereby affirm that I am licensed under provisions oif Chapter 9(commencing with Section 7000)of Division 3 of the Business a0d Profess ns Code,and my license Is In full I force and effect.Lia.ft SO 6 0 9 Class e $///C 6/ D 3'/ Contractor's Signature: -fir✓ y�o-'�/'Lf'-� Dale: t-If=5V 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(commenting 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 live(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: - Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this aaap�plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes ❑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 aermit 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: '- 4— CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon tIre above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ' \ Signature Of Legal Owner(s) Date Q/c 1�' -r�— 5 -/s-sg And/Or Authorized Applicant Date Can L INSPFCTION TYPE OATS IDES =R=Fa INSPECTON TYPE BATE =ALS 1616 Axed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical Cl/I0/) 11 201 Final Block/Retaining Wall ' 212 Final Fire Prevention • 202 Final Factory Fire Place . 220. Anal Planning Approval 203 Final Sign 222 Anal Site 204 Final Demolition . 250 Anal Building/Occupancy 2448-46 4",---- A CITY OF COSTA MESA 0`y' '4 BUILDING DIVISION v• ' ��-::::: ' DEVELOPMENT SERVICES DEPARTMENT P98-00379 . '�"�1 PERMIT PERMIT NUMBER (714)754-5273` • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1500 ELM AV Status: ISSUED • Suite No Applied: 05/15/1998 Issued: 05/15/1998 Vicinity: Parcel Nunmber: 13930225 Applicant: JONES, WILLIAM G TR Address: - Zip: �i �- Owner JONES", WILLIAM G TR , Address 14 DARTMOUTH ', - - - - _ N RANCHO MIRAGE,CA'= Zip: 92270 _ Confractor:i RELY-ON SPRAY BOOTH ,fir, Address: 9475 SLAUSON AV • • Phone:C714-642-5051 PICO RIVERA,CA., • • Zip:----- 90660 -• - • . " • • --license:506096 ' • , Arch lEng: - t. - , " ._ Address: - , Phone: •, • - Zip: N License: ' ' i • • SCOPE OF PERMIT ' ' - -J',";INSTALL•GAS LINE. . - FEE SUMMARY' •1 , AMT QTY AMT' -QTY � " AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer -10.00 -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 i . $0.00 0 Trap Primer - $0.00 0 Bathtub $0.00 0 , Pressure Regulator. - `$26.25 3 Urinal ' $0.00 0 Clarifier System $0.00 - 0 Process Piping-(per,10 ft)' 10.00, 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc)" .$0.00 , 0Receptors, $0.00 ` 0 Vacuum Brkr Bkflow(5+), • $0.00 0 Dental Units $0.00 0 % Septic Tank -. `;$0.00 "0 -Wash Basin ", ' $0.00 0 Dishwasher $0.00 0 Sewer.Cap for Demo ' /• $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 Drain, Rainwater . $0.00 - 0 - -Sewer Private Line - " 1 : DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following dedarstions: • 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: c� Cartier: 5 t7c fl rJ C Policy Number: 75-7 (a 2- (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with mese pro ons. 'f Applicant Signature: ✓'" L`t-r " Date: 2 yr' WARNING:FAILURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. r 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 Profes ions Code,and my license is in full force and effect.Lic.# v E o ?6 Class a ;Y/C6/ 0.16/ �Corttractor's Signature: v�7yr+-o-✓ Date: S / 5 FFJ CONSTRUCTION LENDING AGENCY: In 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No 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). • O As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: • Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes IQ No • (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (if yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date ODES INSPECTIONTYPE DATE MALS CODF INSPECTION TYPE DATE 2IIMAia 1616 Fixed System Final Fire Prevention 206 Final Mechanical )) 1266 Pool Spa Final - 208 - Final Plumbing - S9--V,-9g l`71� • 200 Final Re-Roof • 210 Anal Electrical 201 Final Block/Retaining Wall 212 Final Are Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign - 222 Final Site • 204 Final Demolition _ 250 Final Building/Occupancy 2446-46 \, �,, r• �� CITY OF COSTA MESA it ;,4 '• BUILDING DIVISION OFNI ' DEVELOPMENT SERVICES DEPARTMENT M98-00175 JS PERMIT PERMIT NUMBER - Saiixobrin A (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1500 ELM AV Status: ISSUED Suite No Applied: 05/15/1998 Issued: 05/15/1998 Vicinity: Parcel Nunmber: 13930225 Applicant: THOMPSON, JULIUS Address: _ ' Phone: Zip: Owner JONES, WILLIAM G TR' . _ - Address: 14 DARTMOUTH - - - - , . - - Phone: RANCHO MIRAGE,CA Zip: 92270 N - Contractor: RELY-ON SPRAY BOOTH - Address: ,9475 SLAUSON AV I - . - _Phone: 714-642-5051 PICO RIVERA,CA., Zip: i 90660 •, ' -• - 'License:506096- , .. . Arch/Eng: Address: Phone: . Zip. License: SCOPE OF PERMIT INSTALL MEC. EXHAUST.DUCT. FEE SUMMARY Quantity - . - Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 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 $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $19.00 2 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 i 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 , Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $41.00 COMMENTS/SPECIAL CONDITIONS • 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 end 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. It I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Cartier. S'TR-re" ra Ar D Policy Number. 7 57 t 2- y (This section need not be completed It the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Coda,I shall forthwith comply with these provfsllchs. Applicant Signature:E -`�'�J "r">b",'" Date: s�fs'—/`S1 /J' `�WARNING:FAILURE TO SE WORMERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DO, ARE($1agQW),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. UCENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business d Profe Ions Code,and my license Ls In full force and effect.Uc.N 5 c 4 o '7 6 Class I B/ 6/ 3 y Contractor's Signature: �a-k0-4— L'E'I+"-' 4"f-«.0 Date: S-/ —9,9r C. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that them is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of DMsion 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 end Professions Code:The Contractors license Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.if,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business end Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors Ucense 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 Drivers license No. Expires: Verification of Ownership by(type of document,l.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(38)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 end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or win the applicant or present or future building occupant require for the work which Is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health end Safety Code Section 42303 been made? 0 Yes 0 No , 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: , CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signet Legal Owners)/2u./c. j�And/or Authorized Applicant • .— Date /S /f Date CDDE L INSPECTIONTTPE DATE OHMS 922E1 INSPECTION TPF OM 1616 Axed System Final Fire Prevention 206 Anal Mechanical 4-,u,-9R IV 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Anal 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 Anal Building/Occupancy 2446.46 C. City of Costa Mesa Building Safety Department CERTIFICATE OF OCCUPANCY N° 2637 C P. 0. Box 317 Costa Mew, California The Building located at 35110 EV%&reale has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Groupgrkgs2 Occupancy. Use of Building Auto &stilt Bui=lab Legal Description 139-BOe-16 (See reverse side for Metes and Bounds) • Building Permit No. sm$1 Electrical Permit No. 30584 Plumbing Permit No. 54650 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 BILL JOBB SP #B CENTER by ZZ34n12/L4/i r /2)Com' /'=Y-,����� l/Le` Date November 18, 1969 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. Form 3U24—SHI_tt-8l—tl-B P 'A • •' 30281 PA ID "Al"' 14-69-5(i-4M 864' ***Z27.25 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant w Fill in Completely RECEIVED BY DATt' R CEIVED BUILDING T// _- /^� �•_ 7 f ADDRESS /So-o &.io- 4, 1//� •• PERMIT NO. OWNER Jr LL C. • r CiL `e.ima. � � •� ' MAIL 2 p33 A goo ✓/r ./•n Z AD DR E/S'S� C.. U J /j/�OV IJC,CJ• 10 CITY Li0 7-4 x•12 �`�4 TEL. 61[02145./ • s ' BLOCK Z 7 r•(F//Y NO. � CONSTRUCTION (� ei .-'„l•�r • in O[~n LENDER /' le • 1, `. 0- CO /` /V J O BRANCH J<n OWNE:S< , V / Q w ADDRESS • - m J - /� VALUE ft ARCHITECT Gr.TEL. S / iLi•a� $ /! UN OR ENGINEER O L�J'N�O. �3�'2Z7 - I . in w cc ADDRESS /. ��J G/ l • • r �, -• 4 2 a w � APPROVED J ZZ CONTRACTOR CARS .1/Q00/LSA /!d c ♦ / - a - ' m Z // A J it ADDRESS i 3 / Copo, rn o ,Eye w TEL. Z F CITYL �N I i/ , NO 'b� BUILDING Je i 9 - 0 YARDS APPROVED YARDS APPROVED f IL N¢ • • MAIN BUILDING ACCESSORY BUILD! D O (FROM C/L STREET) OF LOT i Ar i 5 NOWON LOTy RONT • FT. .-i7 ,4." FT. USE OF /� EXISTING BLDG. -- R SIDE v FT. FT, I- SIZE OF a r NO.OF I / C�j! Z NEW BLDG.9/�•'O,. J ROOMS maty'STORIES / L.SIDE -4 FT. L t •• ROOF V C VEEIROI NFU con.c/Irc els, COVVERING�1a p WLY» REAR •0577 FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED a DISTANCE BET. BET.MAIN& a MAIN BLDGS. ACCESS BLOCS. Q 1 Q p VAR.qk 240 \ DATE O 4UTo Nllr r. V PncrS &Z C.U.P..ykgQ /� APPROVED �RIa-Cp CA i1PPROVE O` Ly'! DATE •-- -/ U�-/A/ O KO�LD FO SPE I IL REQUIREMENTS f~.) I hereby acknowledge that I have read this application and state /)�fJ- -s--+V--2t n-f '4 e' / D that the above information is correct and agree to comply with �' Ir all laws regulating building construction, and I shall not employ a I- any person in violation of [ha workman's compensation laws of �/ c- •'� , - N the State of California. 1 m ? I herebycertifythat I am '�/•/CJS O. FT. O properly licensed as a contractor under 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 end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: CC am exempt from the •visio ' of the tate of alifornie Business VALUATION and Professions Cod/ivia�3,•,..n er 9. w L lV PERMIT FEE $/_/, 3-.0 N Signature of // 7 / /-/1 �� ' /n�` n CO Permittee / �D $ / Pt' PLAN CHECK $ / lJ r / E IV. ° C o` Authorized Agent / Z �] u K TOTAL FEE /4 lir 09_6 R OCT 1469�Mf OO 624* ****21.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT Fr A..licant to Fill in.Completely E//y��� �Jf /I 3. _ RECY1�9 / E R /'� jATE I ... . BUILDING. G i r / ADDRESS _ '������ '� � � �i p�-(1 ^j� q� ,^ n /7 -�O PE_4tM I T�AIII..J OWNER 8I L L v/ G r V/a 5_ A.P. NO. J - . JC l MAIL ^'1 D �'1 �j ) D. BUILDING L .•L� �� / b. i z Z ADDRESS p-i 3 3 �F1,2 RD R �l Kt' D. . ADDRESS Jerre =iWSfl's.— •& -3.-- u)W � � ••��dd ' A TEL. Fa? TRAIC u, /1kOT/ 17 BLOC 0 Z CITY Ce sr R /'.J /fig 4 NO. Ijvif (8�ZQ CONSTRUCTION NEW ADD ALTER REPAIROFMOI ISH ONLENDER C. m J 0 BRANCH J N OWNER Q4 L L --\--ThO lt{�S 4 W ADDRESS �1 pie/ 4'Q ARCHITECT TEL. USE yi c/_ i/ 4(/VALUE L 3O. OR ENGINEER NO. CJ /�7 U Q FIRE �,,/r� Z ZONE TYPE fir- GROUP WCC ADDRESS • d W /� APPROVED W /T Z CONTRACTOFC � 5 60 �A/C BY DATE :JCC ADDRESS CC o f r y t o 4 (/h !r-/�"'-K"W�� W W TEL ZONE/ NO.OF USE OF NEJ(y. _ ^/ PLANS BUILDING Z I- CITY O P1/ - 4 - NO.3, - b y;-#:. (1-41./(--, O f . t �rrgr. gr/ STATE CITY YMAI D Y• co CC LIC. NO. LIC. NO. MAI BU DING ACCESSORY BUILDING r0 (FROM C/L STREET) � /` 6p X}T) SIZE NO.OF BLDGS. // /24.-- � QQ OF LOT NOW ON LOT FRONT :a/ FT. be, yyl,`;, 7•F T. (0-4[ //-• USE OF EXISTING BLDG. B-BLIQA B ��-.�FFT. nL/ OFT. I- SIZE OF NO.OF I 9061- - V • /'Z,,y' ��11 2 NEW BLDG. ROOMS STORIES L.SIDE �� FT.JENOc/ /�`d-0 FT. Itt ROOF C._) COVERING WALLRIOR COVERING REAR -10- FTy 1te¢7 0 ETA) 'J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& O. MAIN BLOCS. ACCESS.BLOCS. 0 /� / / VAR.* DATE O a d Gr 2 �q ' //I CAs/ i/t ` ,2'//O C e C U.P..y# APPROVED z /�a- // Y 7-1 AsIf c/Y/./Si✓1eAPPttl EY , a DATE /V --/f- 67 0 • Vt�'ri / UI hereby acknowledge that I have read this application and state ✓ that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ i- any person in violation of the workman's compensation laws of CO the State of California. mb Z I hereby certify that I am properly licensed as a contractor under SQ. FT. O the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR S Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: CC am exempt fro • he provisions of the ate of California Business VALUATION and Professio• de,Division 3,Chap 9. / Cro 'Vie 80 PERMIT FEE $ / ' n w Signature • G�, U �D m Permittee a -lS�!/s $'/ PLAN CHECK $ L7 C E`/ Authorized Ag t TOTAL FEE $ P/✓ C7 U 2 \, • 32270SEP 18-70E„sAOO 480* ****34.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicgpt to F' p /`r�mQJe,ze y 1& l9 Jl L/Y/ S'T !P/ RECEI ED BY tcysTE RECEIVED DATE ISSUED BUILDING / _ A L f / —1/9-70 ' 9/y �/l ADDRESS ' - - i 70 OWNER g. ,.SPdQTir�/,e `� / A.P.NO. MAIL �f �_�j�j /� BUILDING Z ADDRESS J 3 %f ,2n4 aVVt' ADDRESS �. 3 t" 4t—' 0.0 CITY4'f79 ,r s29 la al Zauic NO3-q.o 4q/e TEL. TRACT '�ok'6t,.a.a LO-! /L BLOCK E 2 CONSTRUCTION , / / NEW ADD ALTER REPAIR (MOVING DFMOLLSH Z -m LENDER NU,c1E l ,{y{/ .j BRANCH J IV ADDRESS OWNER CJ JC%��ZCZiYiG-Q.( L/TJ _i V) OWNER VV Q W ADDRESS 4,V/4- _l �/j/y / �,y.���� �.Ey� �q.�/, co m ARCHITECT TEL. USE/ u^Vr`�7`-' +4,2 / !V U &met, J< OR ENGINEER NO �/ V Q FIRE Zii,2 ADDRESS ZONE �� TYPE GROUP E.-4 o t APPROVED ' ,/��J///� f:-.47740t. ' p 0 . J ZZ CONTRACTOR SP/Q�tyri�6/lie-/tF6) BY �/ �J DATE/��0 ,`/ CO Z G CCC...... la illJ¢ ADDRESS Zr/ y0 lic,2a�t fir amp ZONE NO.OF USE OF NE �'✓/ Z1- CITY �O,r�.t/6&c-L�l / NOLer ` _ PLANS ��/ BUILDING w- 0 STATE CITY YARDS APPROVED YARDS APPROVED co O LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT I NOW ON LOT FRONT FT FT. USE OF EXISTING BLDG.e • R.SIDE 4F T. tNO •• FT, I— SIZE OF /170$9164/170$9164 $ NO.OF `` ✓ Z NEWBLOG. 2r'O'r ROOMS / STORfES / L.SIDE FT FT. UEXTERIOR WALL ROOF _ COVERING COVERING REAR FT. FT. —I US OF BUILDING AND WORK TO BE PERFORMED DISTANCE . BET.MAIN& a ,%cczaa oivSU7PitE' chee f7C'�L_ MAIN BLDGS. ACCESS.SLOGS. 0- � . O 247/9/2.77- r5.vie-qy /67170 nt 1,1JY.oE C.V P.# APPROVEDI— /y O g�67/A 6 inset S//Op/ #41,_ sArOVED t 0 �( fri DATE TA 9/70 (~.1 I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ I— any person in violation of the workman's compensation laws of CO 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, Divisicn 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: e CC am exempt from the provisions of the State of California Business VALUATION O A m and Professions Code,Division 3,Chapter 9. • PERMIT FEE $ U (N Signature .�of O Permittee "� �l - /n 3�p: PLAN CHECK $ Authorized Agent � 7�W/.((6�/�C W" o s4 So LL TOTAL FEE $ T• O