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HomeMy WebLinkAbout1190 BAKER ST - Building Permits . 2610 1(/ 1,4/60 -151n:1e6i.60 Tl.. COSTA MESA BUILDING-SAF DEPARTMENT • APPLICATION FC .fRUCTURALPERMIT P.O.BOX 1200 COSTA MESA,L...IFORNIA 92626 '''''''•���� RECIIFIPERMIT N° - 51007 For Applicant to Fill in Completely—Use Ink Only ll\\ t ,BUILDING A.P.NO. `L-1 ` "! e -A ADDRESS i/q 0 /3AKgad 4 / . 1 BUILDING //7o Ba-KGr SF OWNER OR //� ADDRESS !! TENANT (A All-A„)/ zr�00 4,/A �1/,,e�'T UNIT OR MAILINGSPACE NO. ADDRESS 2 1 q iso. /c c in/up sr' T O. LOT BLK. N TEL. ��j ��� CITY pits ApcA NO. /1 NEW AD ALTER (REPAIR MOVING DEMOLISH CONSTRUCTION LENDER 1t D /� BRANCH OWNER Pam+r% ! Haykte-f- ADDRESS �� VAL E OARCHITECT R ENGINEER VA(r, Mr/A/pH y NOL,'3-7-B73\ USE VeyW-/G 4r e.,..Pidr b,�./LX3E �OJ/JL1J ADDRESS//G ita eLL,f✓j M'0/.fh1flVIA ZONE TYPECAIIGROUP p-2— I ✓ AAPPROVED i-, Q DATE//•/4-pa CONTRACTOR�A?G,.st/� Ir/9NS Y/jx(9t fC.AJ (�y(�` ADDRESS i4 Y,$. S. /^c//aL/fl Ajr t TEL. CITY F STATE"�4��� -JpCITYAI O 77&'70/I1 APPROVED SETBACKS LIC.NO. 22 C!r/'t - LIC.NO. SIZE NO. BLDGS. (FROM C/L STREET) . LI(0. OF LOT NOW ON LOT FRONT FT. N1 USE OFa � • EXISTING BLDG. R SIDE FT. us IE F Separate permits are required for L.SIDE 6 FT. electric,plumbing and heating work: �/ L1 REAR L-6 FT. 14 USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION 4PD/790Ai `on- g.Vtry ..1s 4 y%2� r.0 DATE APPROVED TG /IC fTi. �>. i(x 70 DATE A_j( T tgyam b ,.,1 g. • W GU • 0 I hereby acknowledge that I have read this application and state n pj that the above information is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of a WW the State of California. q/��, ' 3 I hereby certify that I am properly licensed as a contractor under �/2C� SQ. FT. /0�00 (� 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: e am exempt from the provisions of the State of Calif la Business a VALUATION PERMIT FEE $ and Professions Code,Division Chapter ..// SZ- M Signaturermof /f•-J/ //M_.`r�=rL5 /O coo PLAN CHECK $ Q/� . pr /Y VN•/�C.i' [ice 0 Permittee / TAX $ LL Or �t /0 .7�0 Authorized Agent Date ///'/T/r// TOTAL PAID $ $ ,3 tJ APP' •^ATION FOR A BUILDING PERMIT , BUILDING PERMIT NO. Electrical m Tract Block Lot Permit No. c E. Building PlumbingSi Address // qa OAWild 4•-// C/ 0 0 7 Permit No. to Cross (� // Mechanical O. Area Street Permit No. 0- m Owner PA Avs , , Cap �sA ry,.�Y- y�Gr TY Pe of Project: ❑ New ❑ Alter ❑ Addition a Address 2/ q 4 ��y/�'��ODG' ❑ Repair LIConvert ❑Demo ❑ Occupancy Pmt. Sur).DiSt./ PAs A a`�cJA ZIP Phone/4�,j/L A.P. a 'T Ins..Area Architect/ 9. N. dA/FoN y License No. C- 4 q,og. Zone Spl.Pmt.No. DesignerSetbacks P/L Front C/L St. Street Wi• h Address / ( I/G 14/ 02—i ✓(C at Yards Left Right Rear CItY / J' �7/2A/Ad9 ff/A ZIP Phonegr7.Fin I Lave Proj. Left Right F.'. :. Engineer&Anti/Y r!5llA.Qf0Ayicense No. - . - C Parking Spaces Required Provide Covered �. Address CityZip Phone Struct No.of No. •f m Height Stories F. ily u LICENSED CONTRACTOR'S DECLARATION Park Fees 1Ul Yes -ee m Required LJ No C.T. •eceipt E I hereby affirm that I am licensed under provisions of Chapter 9 .0 (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date ,. Professions Code,and my license is in full force and effect). `! License Class / License Number ? Date Contractor Misc. E Address Proposed Use of Structure jy City and Zip _Phone to H CONSTRUCTION LENDING AGENCY etI hereby affirm that there is a construction lending agency for the tl Clas Type I Coder parlor menta of the work for which this permit is issuetl ISec. 3097, Class Const. Year ' Civ.C.). C Lender's Name USE/OCCUPANC SIZE SQ.FT. Lender's Address '� OWNER-BUILDER DECLARATION 1. I hereby affirm that I am exempt from the Contractor's License Law ail Y for the following reason: ❑ I, as owner of the property, or my employees with wages as their 2. sole compensation, will do the work, and the structure is not ✓ Intended or offered for sale. 3. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ,0 0 I am exempt under Sec. , 8&PC for this reason 4• m ,. Date Owner E WORKERS'.COMPENSATION DECLARATION Total Valuation 3 I hereby affirm that I have a certificate of consent to self-insure• Encroachment Permit -eq uiretl ❑ Yes ❑ No or a certificate of Workers' Compensation Insurance, or a certified mC copy thereof.,.✓ v / Grading Pmt. Grading Z Policy No,ps.2f0/)SL 7 Com pony l/N`e..✓A/✓Zi 1`fn/ 17 Required ❑ es ❑No I Pmt. No. .a Mi Certified copy is hereby furnished. Rough Grading I 0. Certifi r4 9° appy is filed with Orange yC�ou MA, Approved by: Date .cs Q Date // /T "° Applicant_//- %6v 41.4.6--x.. ..‘0269----'"L� 3_ CERTIFICATE OF EXEMPTIOIW7/ FROM WORKERS'COMPENSATION INSURANCE Z (This section need not be completed if permit is for $100 or less). C I certify that in the performance of the work for which this permit isQ issued, I shall not employ any person in any manner so as to become dr subject to the Workers'Compensation Laws of California. PERMIT FEES -. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $ Exemption, you should become subject to the Workers'Compensation provisions of the Labor Code, Special you must forthwith comply with such Electrl $ $ provisions or this permit shall be deemed revoked. Invest. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumb' g $ COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mec :nice! $ ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON • THE ABOVE MENTIONEp. PROPERTY FOR INSPECTION PUR- Pre rade POSES. ����( /-3 ////¢/Qt� In.•Graion $ Signatureg/ of Ap licant or Agent Dat !/ Pr- Grade $ Permit $ •ec.No. Issue /2 rGNA 4,2, N' Ci.cJG-4L__ spaces within this box must be completed to process Plan Issuaove All P Check By: Approved: CMF 0335-46(BU-28)rev.6/80 I ADD.RssSwS.O.'R'AMLOMD: 1190 BAKER ST uMr: CITY OF COSTA MESA — BUILDING PERMIT -Nllara_, PMgNN: C J SEG ERSTROM & SONS PERM NO: B 079238 ADDRESS: 3315 FAIRVIEW RD • COSTA MESA, CA 92626 PERMIT NO: B 079238 PLAN CHECK NO: 02981-96 A GOVT: N SUPP : N AP PL.MAILING ADDRESS: CONSTRUCTION TYPE: V—IHR PERMIT TYPE: STA PURPOSE: ALT .niinECTORuc m BOTICH PARTNERSHIP MM.: 16749 JOB DESCRIPTION : INSTALL SEWER EJECTOR, PHASE 1 y SQ FT: 50, 000 ARC1LORENG'sADDRESS: 883 S . ANAHEIM BL carr: ANA CA 92805 CLAIM VALUE: 50, 000 . 00 CALC—VALUE: 50, 000 . 00 GROUP OCC: B / co mActogsNAME: AMERICAN CONTRACTORS, INC ( 213 ) 630-3179 cpGRAcroRADDRES° A303RAM SOMERSET BLVD . *******-S*******************IFE t**+tB*ire*D*************IE***IE�Eif)t�E+E**iFIc�E****it*SERE*It*�E** ADOREss: PARAMOUNT CA �,�, 309863 90723 UM, Z 0 N I •N G R EQU IR EMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am Icensed under provisions of Chapter9 SETBACK S (commencing Section)ODD)of Dinskw 3 d the Business and Professions Code,end my 1.4",•••is In full lace and effect, CmuC.NO.: 29 97 uc.CuSS: C36 uc. 30. 86EXP: 00 /00 MAIN BUILDING --- - ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN �' 2_5 TO Contractor: All/ LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN ISR BUIL ER DECLARATION;I hereby dfum under pet*of -h that I am pt from the Codracton License Law for the carte reason(Seabn7031.5Goalless and Professore Code:Any city or county which rewires a permit lonnsbud.afer.improv. PARKING REQ: PROV: PARCEL: 14114164 ZNE: Cl REF NO: demofah.arePai anyamctue.pdoralbawane.eborxluies teapphanl fa such"nit 1*fbesga nedddenn"dialh che PLANNING NOTES> INSTALL UNDERGROUND SEWAGE EJECTOR BEHIND HOAG HEALTH CENTER is licensed pursuant to the provisions ofca the Contractor'License Law[Chapter 9(commencing with Section 7000)of Dabbs 3 d the Business and Professions Codej o thele adhe is exempt therefrom and the base for the alleged esemgon.Anyvkiehon Of Section > NO NOISE GENERATED BY THIS EQUIP PER A HOPKINS, PLUMB INSPEC 1031.5 by any applicant for a permit subjects the applicant to a chit penalty of not more then fere hundred donde(S.ADj. *********************************************************************'i(.********* ❑ I.rev owns"d the caped or roY employees with wages as their sole compensation.will do the work•and the Ouches is not intended DEVELOPMENT SERVICES R E Q U I R' E M E N 'T S or off eyed for sale(Section 7044,Business and Professions Code:The Contractors License Law does rid appy to an ownerdop [res who builds or improves thereon.and who does cud,work himself or herself or through his a her own emplyaes.provided that such - improvemetsaremlintendedoroferedlaeale.If,however,the building orinpraanedm "Id*Shin ere Ye"do,mplelbn,the ZONING APPROVED BY DATE: - ownen'budder will have the burden d proving he or she did not baM or Improve for the purpose of sale). ❑ I.®°w'endthe propety.aaexdmelyuateallg vSh Eoemed em°ac".1°Ca rid Mep'°"d(Seabn l°"•eu'n"°nd BUILDING APPROVED BY : 6/t�/� DATE: Professions Code:The Contractors License Law does vat apply to an owner of properly who bu"b a inprww thereon end who E/ _ j -) c on°acb for such projects with a contractor*licensed pursuant to the Contractors License Law). J ❑ Iamammo(under Sedton: B.AP.C.,lathis reason: APPLICATION ISSUED BY: a ' DATE: I Date: OwnerLEGALIZATION:N F E E S U M M A R Y STRUCTURAL EGMENT:Y I do hereby unify that I ant aware d and understand the requiremeres d CaUania Meath and Safely Code Sections 25505.2E533.and peenad Mdlamyruehu'M'agmotheA Guakty nor(dmbondtocomply d:II cohsacddemduadlheeriraoMla BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a pantfor eb nctbuhormodificatinfromthe Al OuaYtyManagenatl District.Reeidrtllalcadndion eppEutiansaeaxempt from Mose provisions. PERMIT 574 . 75 Data: Applicant` PLAN 93 . 40 SMIP/NONN RES 10 . 50 WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE F E E F] thaw and w maintain certificate o cased to setinanelor workers'conpensation.as provided for bySedian 3700dlheLabor BUILDING—DIV—> PERMIT ISSUE -PLAN—CHECK TOTAL PAID DUE Code.forthe performance dthe work for which 0ispamtlassued. TOTALS----> 585 . 25 0 . 00 ' - 93 . 40 678 . 65 678 . 65 . 00 I have and wit maiden workers'=venation insurance.as required by Sectim 3100 C the Labor Code.for the performance d the work for Mich this permit is issued.My waken' ion insurance caner end number are: Carrier: REPUBLIC INDLM EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 585 . 25 OVER/SHORT: . 00 Policy Nanhen 3512925 09/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need not be completed if the panne is Mr as hundred dollen;IMO] ba.) 574 . 75 10 . 50 o I eerily that n the ped of the work la which this permit is issued.I"MI nor employ any person in any manner n es to become Mto the workers'compensation lowed California.and that . become subject to the workers' *****************************************************************************if* of Sean"3100 d the Labor Code'I shall " '.provisions. I N D I V I D U A L F E E B R E A K D O W N 1 eats / Applicant: /l. . Mr *ming Fauns 10 secure wanton'compensation coverage Is •,and shit • van employer to ablate/panelist arW TYPE QTY DESCRIPTION UNIT COST TOTAL COST civil lines w to one hundred thousand dollars($104XO),In erddon to die coat of compensation,revs as provided for In Section 370ofthe Labor Code,Interest.and attorneys fees SFC 50000 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 50, 000 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency few the END OF FEES performance of the work for whidh this permit is issued(Section 3097,CN.C). LENDER'S NAME LENDER'S ADDRESS: ' I certify Ihel I have read this appfreton and statecomm.that the aboveomation is comm.I agree to comply with all city and county advances and slate laws relating to building construction end hereby authorize representatives of this city to enter upon the abo e.mW ironed popery fa uspectlion purposes. TOM HE Affei Name 23 1!flW.tla� sik Dale: ,• (5151dtWP) Whte-BugNg 8 Safey:Gran-Fla:Caary-Appkram;Rnk-Revenue;Oddenod-Assessor CN ONSTRUCTION AND PLANI� / 'IOL & SPA - APPROVALS Permit# / _ Date Inspector APPROVALS Permit # .7 Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms I 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ; 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,C Undrgrnd. 10. Structural Floor System ' 61. APPROVAL TO DECK / 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final • 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66: Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑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: G' �/✓/'/r�T &wok- v6/6.,/ �-� 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 P;14.7 48. FINAL PLANNING --- 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co ' • 51. CERTIFICATE OF OCCUPANCY No Date • ADDRESS Of MEM 1190 BAKER ST ton: CITY OF COSTA MESA - BUILDING PERMIT aM✓EWSKtMEWIOCNN: C J SEGERSTROM & SONS PERM NO: P 079599 ADDRESS 3315 FAIRVIEW RD I^ . ' COSTA MESA,CA 92626 PERMIT NO: P 079599 PLAN CHECK NO: N GOVT: N SUPP: N APPL.WARM ADDRESS: CONSTRUCTION TYPE: V-IHR PERMIT TYPE: PLU PURPOSE: ALT ARCHITECT OR BONER: BOT ICH PARTNERSHIP uD to.: 16749 JOB DESCRIPTION : INSTALL SEWER EJECTOR, PHASE 1 SQ FT: MICK OR ENC.'S ADDRESS: 883 S . ANAHEIM BL urn ANA CA 92805 CLAIM VALUE: CALC-VALUE: GROUP OCC: B / comnammmE: AMERICAN CONTRACTORS, INC ( 213) 630-3179 • CONMACTORSMMUNG 7303 SOMERSET BLVD. COMMENTS : "HOAG HOSPITAL OFFICE BUILDING PHASE 1" REF:B-79238 ADORn PARAMOUNT CA 11GNO: 309863 • ******************************************+EAE**+r*+r*itx**********+Eifx-************** 90723 WET: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affrm under penalty of perjury that I am Icensed under provision of Chapter 9 SETBACKS (commencing with 7000)of Division 3 of the Business and Professions Code,and my is in fug force and effect. Clryuc.No. '99 . 7 uc.cu9S: C36 LIC.No.: 3 6EXP: 08/97 MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN 7 v: 9 cprmmorG LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN N ' BUILDER r ECLARATION:I hereby affirm under penalty of perjury NM I am exam ham the Contractor license Lew for the reason(Section 7031.5 Busbess and Professions Code Any city or malty which requires a permit to construct.alter.improve PARKING REQ: PROV: PARCEL: 14114164 ZNE: REF NO: demd'nh.or repo any structure,prior to as issuance,also requires the applicant for such permit to fie a signed stale/nerd that he or she PLANNING NOTES> is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commmesaro lath Seaim 7000)al Derision 3 of the / Business and Prdessum code)or that he or she is exempt therefrom end the late for the alleged exemgon.Aro violation of Swam > 7031.5 by any apprram for a permit at ads to applicant to advlpenagyd not more then five hundred ddlao(S,AOD. ******************************************************************************* 0 I,as owner of the property or mY etalDbYees with wages as thei sole conipensaticc.will do the work end the structure is not imended DEVELOPMENT SERVICES REQUIREMENTS or offered for sale(Section 7044,Business end Professions Code:The Contrctors License law does not apply to an owner of properly who builds or Tprovee thereon.and who does such work himself or herself or through his or her arm empoyees.Prodded That suchnlpa.neraerenamtendedaww eredforsale.II.ha ..erathebwangor:nprommerdeeadwithngeeye. dmmplenal.the ZONING APPROVED BY " - DATE: owner-builder wit have the burden of poring he or she did nor bald or improve for the purpose of sale). O ,..„,„„er of the pmpgrty,ern exclusively contractiv with lioensed contractors to construct the PrWed Mention 70441.&lams and BUILDING APPROVED BY : :r/ DATE: Professions Code:The Contractors License Law does notapply to an maws of property who builds a improves thereon and who - -- - contracts for acdh project,with a contractor(*)licensed pursuant to the Contractors License Law). I ��© / O lamexempt under Section: B.AP.C..for tsremm: APPLICATION ISSUED BY: (('' - DATE: & *************************************** *****4 ************* * Dela' Gamer LEGALIZATION:N - F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby certify that I am aware at and understand the requirements of Callomia Health and Safety Code Swims 25505.25533.and 25534.and to Ice any hture building occupant wig/wi not one)need to comply with said Yate codes and the requirements for BLDG PMT PLUMBING ELECT-RIC-. MECHANIC FIRE SMIP/RES GRADING a permit for conanationor modification from the Aitia y onager etaanc.Residetaconanaanrlappaipn.esxmwfmmtese PERMIT 8 . 75 provisions. Dale: Applicant: 25U.' ',, SMIP/NON-RES PLAN �.- WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedandiora: ISSUE FEE 22 . 00 O IhawanwiamantailacerNiledcomsattosalirsurelr%peke'compenmlen,espovidedforbySwio37ODdthetabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code.for the per+omancaathe work for wHM this pervert is issued. TOTALS----> 8 . 75 22 .00 - 0 . 00 30 . 75 30 . 75 . 00 tj Ihave end l;Emaintan workers'compensation insurance,as required by Swim 3700 d the Labor Code,for the performance of the \\ • w"kfor which gt°°amgsea.d.Mywo '' , kereancgcog andpanumber EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 30 . 75 OVER/SHORT: . 00 Potty Number: 3524071 09/01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADINGdPLAN-CHECK (This section need nor be completed r the permit is for one hundred dews($1001 or leme) ^ so30 . 75 o I candy that in th pednnsl ace a the work for which this permit is is issued,I shall nellpoy any person In any so to I. - becomelawsthat should mn becsubject to the workers' ******************************************************************************* rrr2o � INDIVIDUAL ', F 'EE BR EAKDOWN �((� ApliantVocum works"'conpanstion coverage Is unlit ,,and shall afoot an employer to criminal penalties end TYPE QTY D E S C R I P T I O Nyj UNIT COST TOTAL COST 11 fines to0ag to one hundred thousand dollars($100,000),($100,000),In addition to the cosy of compensation,damages as provided for In j Section 3706 wro the Labor PLU 1 FIXTURE SET/TRAP W/PIPING & BACKFLOW 8 . 75 8 . 75 CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a construction lending agency for the END_,•OF FEES performance of the work for which this permit is issued(Section 3097,Cs.C). LENDER'S NAME: > - LENDER'S ADDRESS: I certify that I have read this application end state that the above information is coned.I spree to comply with all city and county ordinances and state laws relating to building construction end hereby authorize representatives of this city to enter upon the mention property N for inapedlen purpeses. TOM TIG E 01 00215376-00215376 •TOT 30.75 AGATE: 09/20/95 TIME: -13:58Data: Z .igrau e a me �nunvplt re 44 (5151.4a.W P) White-Buildig A Safety,Green-Rue:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor \l,�I ' C CONSTRUCTION AND PLANNI a - ).OL & SPA AVPROVALS Permit # / -7 Date Inspector APPROVALS Permit # r •• Date Inspector -w 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement `- - .3. lectrical:Consult_t.gility-Unirgr rnd. 54. Forms ^ I • ' ` 4.:1ElectricatGon'dbitAU idrgrndi".' 55. Electrical Bonding •- - ;r5: Steel Re tforcemenO 56. Rough Plumbing& Pressure Test - •,` s r• lectrice7<UKEill itiEd. 57. APPROVAL TO COVER-GUNITE to 7-.Footings,^ -tr. . 58. Electrical Condtiit-Undrgrnd. N - r'2.87.'Foundatior ; z.H �- 59. Gas Pipe, D Urgrnd., Test , S: Water Piiie Undrgrnd.- 60. Backwash LinerJP-Trap, 0 Undrgrnd. I. n10. Structural Eloo2'Systern -• 61. APPROVAL TO DECK i -11-property Sewer Line & House`Connection 62. Backwash & Receptor-Final 12.'Sewer Cap s- ¢ 63. Heater & Vent-Final - 13."Roof Drains t 64. Plumbing System -Final ' 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 1 66. Solar System-Final 16. Rough Electric.Wiring 67. Fencing & Acc€sa,Approval k. 17. Rough Wiring Sign ^' - 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling r 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.'-Rough Factory Fireplace r, c, * -' D r• '* APPROVFALE.7 Permit# - -' t n•. : _ - ,-, • a - "nl..�_ * r, 21._Ductss in Strttttu ; F= 'r r. ., Lit ' 70:=UnC2Yrou"hd Mydro ., '' 22. Ducts, Ventilating.% - r ; r :a is - 71.lProductWiping'i7Gas DOil 23-'GaslPipeefoug &•T h est m,. f` _ S _, 72. Underground uih 24.-Root Framing: '-•I- :.1_. K > 2' 1. _: " 73. Undergcnd.Storage flank ❑Gas Q-0il 25. Root'Sheathing e :E.1 r•. r `� r'Jr r . Overhead Hvdro" 11 t 26.7-Bar Ceiling IStructurall &�vlonocoat A. -1r 'n* 75. Dry Chemical, - * -- - Cr 27.'Frame and Flashin :J 1 9" - �� _ ' 76. Dry Sta3dpipe= xo % 5 T 28. Lathing& Siding_,"': >- _•_ - * z ^K 7..7. FIXED YST& E4NAL ' .. _ r _ ?' - 29. Instilati6F4 "1' "' •' '` t' I I 4 ie. FIRE PREY. FINAL v. ` + i t C-i Qd• S - 4, 5 r, - x ;r: 30. Drywall Nailing rrr + 1 X '-, •_t ...,HEALTH DEP•T*REQUIRVEMENT 31. Plaster B?bwn Coat, * I rr 79."-FYNAL ;t(JSPEC1ON ; O' 7 _ ti 32.-Electric4(�Power MakterFinal "" x y I l IT �. > FOOD CETIFI{'ATE ISSUED '7 I i- 33.=Final•Electric o' * ,* n}'p7tes: "s a 3 7 C X m I i' m , 7 `? „'71_1 r ._ `l �'TI 34..Finat Heating& Atr+C3nditiomng`"_ (..-=1 .� cR 'yx, 9.4 2. ',.oittir I7 • 35.t^Eina4Ga51Pip Test* Utz: I -~ �,. T.tn T ,:, 36;1:1°0 or Canopyc•xno- * C I � k ,,: Y: s r 37.CFi nar:Factory Firtace 3'T' 1.* r71 i ' 1 .. r. T •y, 38- Final.Pltl�rbing rr!* Tc� • " " a. c i' �J,y��L�R d i., 7 C' 22,12:, 7 39. Wates Sec-vice-Final; I <. * 1 1r r1 ut-; t: cC t-• 40. Gas Service-Final`: '. - * Itt: " s t1 - •- -r tr S * m tr. �o :'--. r 2 r t ; 41. Solar Domestic-Finast •• * v. t _i•-- r-+ t 42.Backflow PreventerK �' 1;� ((}��,2� •. � .~,y.' Vic" _t', ��y r �; . r-I - T .` T. - Iv 43. Backflow Irrigation SS * rt-• r ct m . . 1. .. K ' r 2 / /' . . F'5,5-, r' nl r :a '_J C.• ' 44. Landscape IrrigatiopSystem... - t,.. C, ti rt F-7. r. ,;,-J - ._ w T G - C _ =-45. Sound Attenuation , z m * Z L. t-. t~ F !- CO sic: -• . .. - r-, ,. .- -it r rr mi t '7' T < . r_.^_. II �16.rHandica�'Re ulatior " S 9. Qs _ is . s cru ; •- '47..FINAL STRUCTURE & BUILDING • n I 1'1 ,y . . s 48...FINAL PLANNING. , 77 ani I ....yc •r .:t _ r-. -49.-Electric Release to Edison C • i°.17� -- x. - t 5.50.-Gas„Release to Southern California Gas Co ,`. ' .•`-': -' C- - `51. CERTIFICATE OF'OCCUPANCY t '• tit - No. Date r AD0RESSOf"w 1190 BAKER ST UMT: CITY OF COSTA MESA - BUILDING PERMIT OWNERS NAME IF IINO'glb C J SEGERSTROM & SONS PERM NO: E 079244 "cm's' 3315 FAIRVIEW RD COSTA MESA, CA 92626 PERMIT NO: E 079244 PLAN CHECK NO: N GOVT : N SUPP : N Aw`.MAIM A°°"Ess CONSTRUCTION TYPE: V-IHR PERMIT TYPE: ELE PURPOSE: ALT ARCHITECT ORENGNEER: BOTICH PARTNERSHIP MONO' 16749 JOB DESCRIPTION : INSTA L SEWER EJECTOR, PHASE 1 SQ FT: ARCH ORENWS ADDRESS: 883 S . ANAHEIM BL WIT: ANA CA 92805 CLAIM VALUE: CALC-VALUE: GROUP OCC: B / cONTpACTORSNAME R L DOUGLASS ELECTRIC INC ( 714 ) 895-4588 CENTRACTORS MARINO 5432 INDUSTRIAL DR COMMENTS: "HOAG HOSPITAL OFFICE BUILDING EJECTOR,PHASE I" , RE: #B79238 ADORES& HUNTINGTON BEACH CA L1c.N0.: 452070 *******x*+E***�r****N-**+ ****N-**sE******�E*x�r****HESE*�r*******�kx-N-**+r***N*RESEx-x-*+E***Rf*** 92649 OTT: ZONING R EQU IR EMENTS LICENSED CONTRACTORS DECLARATION:I hereby aTsm under penally of perjury that I am licensed under provisions or Chapter 9 SETBACKS (commencing with Section 7000)of Dhisbn 3 of the Ruttiness end Professions Code.end my license is in fug force and ectad. CITY UC.NO.: 048474 LIC.CLASS: C 10 ' . " 4520 •• EXP: 04 /97 AIN BUILDING ACCESSORY BUILDING I9-4Z> 11 . g FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Dat ' Y� OatrBtl ' ` LEFT: FT IN RGHT: FT IN LEFT : FT IN RGHT : FT IN OWNER BUILDER DECLARATION:I hereby affirm under prey d• I exempt horn the Contractors license law for dor fofbwkp reason(Sadiron 7031.5 Business and Professions Code:Any ' icA requires a perm)to amswd,eller.improve, demolish.a repair any impure,prior to b issuance,also requires the-••r- Iin. pang tot, eignedaetemw dui he or she PARKING REQ• PROV: PARCEL: 14114164 INE: REF NO: ie cresae pursuant to the prm�pns d the Contradore Limn..Law(Chap. encoring with Section 7003)of Dwebn 3 d the PLANNING NOTES> Business end Professions Code]or the he or she a exempt therefromodvi penally and the basis for the aged exemption.My violation al Sadie > .. • 7001.5 by artyeofhe praepamY emplo es apwith waedoe the pensltyd not more then fweth hundred doles DS30D. ************ikihi6ib****************oft**************it******************************* ❑ Lm owner elhe(Section or my amployeee mils wages as thee vole compensation.wT do the work.ad theymcnre a M waded ProfferedM edeteraf44.Business dose Professions Code:The Confradots Limine L ckiesne apply loan immoral property DEVELOPMENT S 'E R V I C E S REQUIREMENTS who bmdda or inprmes thereon.and ate does such work himself or hereat or dseagh he Or her own empbyaw.Provided that such imprmernents re ro adintendedorafleredfa sale.1,bower.thebrldaor gin"arien i"Id wbhen oresywdoocr ladr ZONING APPROVED BY ,owner-builder will the burden of proving m ing hethe did rot buildim or prov for the Pweee desatowner-builder DATE: ❑ nsssthe property.Mc:ktsively contracting with licensed rfohe blded rt �ProfioCodde:The Contractors LenseLaw does not apply eolawrt sconstructdos Or wwheonv end nim BUILDING APPROVED BY : • DATE: convects for such projects with a contractor(*)licensed pursuant to the Contractors license Lew). . ` 2�! ❑ lameemqudrSadm: B.aP.c..bN112•4171.1 RtiFsreeson: APPLICATION ISSUED BY: DATE: ( 1s Date: Owner *********************************************** ***************** ***** I do hereby certify that am aware aawareeland understand the requirements of CeN« SeleneHeath and Safety Code Sede 25505.25533 and LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT; N a permeMNdlurion future buildipomthenfwlllwiinal(radeons)neeefommpty with said dalsondes ands e enymdramaksbr BLDG PMT PLUMBING ELECTRIC . MECHANIC FIRE SMIP/RES GRADING epens,lacomamvh acme bation ling midpeAk�wact.o e)Tie to iant&comfAY lwmrudiN e°Ades vet eremgImmdsfr PERMIT 333 .00 Data: Applicant: 5 0$ SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affom under penalty d pokey oned the foiowap dtlany:dbPLAN Th ❑ 1 haveos and wit mentos a indicate d lim consent to e. ure for we'kecompensation,es provided for by Satins d 3700 the Labor ISSUE FEE 22 . 00-'- • Code,for the pedamac.althe work for wrath this penult aSued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ ihaw and wm.inter,worker.'compensation insurance,as m,uiredbySoden 3ladweLwaCode,for the performanmof the TOTALS----> 333 . 00 22 . 00 c. 0'. 00 355 . 00 355 . 00 . 00 X work for wiiS,this permit is issued.My workers'compensation insurance carder and policy number we: Crier: rAT.T f ASf1AT.TY EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 355 . 00 OVER/SHORT: . 00 Poky Number. yir900000601 10 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not be completed If the permk is for one hundred dollen(Stool or less.) 355 . 00 -' ❑ I only dor in the performance al the work for which his permit is®mad,I shall not • an person In any manner son to • bemrteadhjecttoiheMacs'compenestlonle • : is,and • -.'- ' - f .beuldbecome subjedtothe wlwe' **************************W***W***W**,*iE**************************************** cam provisions of Section 3700 of Ihe ... 1• mm• .those proicros. Pix . (� INDBREAKDOWN Dae: V �� .V- ) Applicant: Warning:Falun to enure workers'compensation coverage band awl subject an employer fe criminal penalties and TYPE QTY DESCR IP TIO 1‘1. UNIT COST TOTAL COST civil fines rpt to one hundred thousand dollars(8100000),In compensationu coat of compensation es provided for In a ,...--,• ' Secdon 3706 of the Labor Code,Interest,and attorneys fees. ELE 8 RECEPT/OUTLET 1 ST 20 EA. 1 . 00 8 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a constmdion lending agency ler the ELE 10 MISC CONDUCTOR NOT, LISTED REQ PERMIT 16 . 25 162 . 50 pedamemmdthe wk for which this panne aissued(sedan 3097.Cb.C). ELE 10 MISC CONDUIT NOT LISTED REQ PERMIT 16 . 25 162 . 50 LENDER'S NAME: LENDER'S ADDRESS: END�OF FEES 1 v I caddy II have read this application and dale that the above information is cored.I agree to comply l city aand county ordinance yfilm and state lava relating to building construdion and hereby authorize representative of this city to enter upon the above-mentioned Properly .) I . for inspection purposes. _ !' ..y OHN ROBERTS Date:t Name 21JAiLk .! v Signature of OagrfAgeenVApplicenVContrador (5151-46.W P) White-Building&Safely:Green-Re:Cavy-Apptunt;Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNINU i0L & SPA APPROVALS Permit# 'Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service of Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. t Forms 4. Electrical Conduit.Undrgrnd. 94/4 t' Jk� . Electrical Bonding le 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•f nal - 12. Sewer Cap 63. Heater& Vent-Final _ 13. Roof Drains - 64. Plumbing System - Finjal 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-ConduitvLi466. 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-Final22 80. FOOD CERTIFICATE ISSUED 33. Final Electric . -c23 33. Notes: /Y /e �G`_ g-t_""LLL5/0-4-4S17-r. 34. Final Heating& Air Conditioning Pr\ 3/ `{ trr c 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. Backf low Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date