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HomeMy WebLinkAbout170 17TH ST - Building Permits un.Ln zy. , 1XtNA UAIt 9/23/80 JOB ADDRESS 171 a 17th Street, #B BUILDING PERMIT NO. 50727 GENERAL CONTRACTOR Owner-builder DESCRIPTION of WORK Interior Alterations A 'o. 117-0$1-69 LOT TRACT FIRE ZONE VALUE $ 7,900.00 R. iCTIONS Signature Date TYPE V GROUP ZONE Cl SOIL PERMITS ISSUED GAS SUBCONTRACTOR Date I Number I Signature WATER Plumba ROUGH PLUMBING )— f/DAt 00 cote taca4_cD 7YS/7 PROP. SWR. LINE n HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ • / F D. ROUGH WIRING ente(1- .t.. (f-L9--eV Heating and Vent. t A PIOna TRENCHES 0FORMS STEEL REINF. l:^ Ittmplete 'ICC! � FLOOR SYSTEM nLel0-13 r.0--I BOND BEAM STEEL REINFORCE n /]Q,' ) SI� `�SHEATHING Date J�("1Y�OY� FRAME AND FLASHING LATHING — IN n OUT n .9 PLASTER, BROWN COAT Ul :TUBAL, FINAL 0./5Electric t sib'I�1 ._ .ING. VENT.. REFRIG. AND A.C., FINAL 1 JO-i3-elO O4. G H ,,`) PLUMBING, FINAL AND GAS TEST in al ELECTRIC. FINAL C,.0 II-b - cep BUILDING. FINAL OWNER DONNA ZEE (ZEE PLACE) DATE 5/12/81 JOB ADDRESS 171 E. 17th Street, Unit B BUILDING PERMIT NO. 51837 Gr IERAL CONTRACTOR Builder-owner DESCRIPTION of WORK Elec. Canopy Sicm F o. 117_081_69LOT TRACT FIRE ZONE VALUE S. 875.00 INSPECTIONS - Signature DoteTYPE GROUP ZONE C^1 SOIL • SUBCONTRACTOR PE/SNITS ISSUED GAS Dote l Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE in HOUSE CON. 9 SPRINKLING SYSTEM MISCELLANEOUS • ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 9 POWER 9 ROUGH WIRING Heating and Vent. TRENCHES 9 FORMS 9 STEEL REINF. 9 4.3 FLOOR SYSTEM BOND BEAM [1 STEEL REINFORCE n zd SHEATHING It' FRAME AND FLASHING 9 LATHING - IN n OUT 9 ',TER. BROWN COAT JVE, FINAL Electric / HEATING.ING. VENT., REFRIG. AND A.C., FINAL ry/��/ '54%6,7 aPLUMBING, FINAL AND GAS TEST n ELECTRIC. FINAL l/ . C 5-43-c/ BUILDING. FINAL CD[t ‹./Q-$/ 'r UWNtI< Dw^^ rri,D DVO11YLOO t,W. UAIt O—Z1—(4 JOB ADDRESS ' 170 E. 17th St. BUILDING PERMIT NO. 38589 GENERAL CONTRACTOR The Metz Corp. DESCRIPTION of WORK Elec.Wall Sian, A' 'b. U7-112-29 LOT TRACT FIRE ZONE VALUES 600.00 II £CTIONS Signature Date TYPE V GROUP J ZONE C2 SOIL PERMITS ISS4ED GAS SUBCONTRACTOR Date Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE❑ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER 0 ROUGH WIRING Heating and Vent. TRENCHES [J FORMS U STEEL REINF. n FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN In OUT n PLASTER. BROWN COAT "1- _E 'TURAL, FINAL lyertri N, •NG, VENT., REFRIG. AND A,C., FINAL . 'o / b-.2(-79' 27bL PLUMBING, FINAL AND GAS TEST In ELECTRIC, FINAL F' 4* _In, jG 2y7L/ • BUILDING, FINAL -^ 0 "UPI / I (( WUn \Ln HAKE CAC, Jagles VAIL 7 7 /4 JOB ADDRESS 177 East 17th Street BUILDING PERMIT NO. 38369 GFNERAL CONTRACTOROwner-Bldr. DESCRIPTION of WORK Interior Alterations A ,.117-081-60 LOT TRACT FIRE ZONE VALUE $ 1,500.00 ."-N INSPECTIONS Signature Dote TYPE V-1 hr. GROUP F-2 ZONE C-2 SAIL PERMITS ISSUED GAS SUBCONTRACTOR wnTER Date Number I Signature Plumbin �/ DOUGH PLUMBING /74/) T-2((_]5 A '7a0 t rat PROP. SWR. LINE ❑ HOUSE CON. "����^^"11 '^/ SPRINKLING SYSTEM I[ MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES C FORMS LI STEEL REINF. ❑ FLOOR SYSTEM BONO BEAM fl STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN I��oUT n dra,._c Y )0_9* STER, BROWN COAT ,UCTURAL, FINAL Electric HEATING. VENT., REFRIG. AND A.C., FINAL^ PLUMBING. FINAL AND GAS TEST 1 t BUECTRIC. FINAL r BUILDING, FINAL 9 !' 6 • 21 OWNER Evelyn M. Noack DATE 8/22/79 JOB ADDRESS 170 E. 17th St. BUILDING PERMIT NO.48686 GFIERAL CONTRACTOR DESCRIPTION of WORK Electric-Wall- )%b'n✓ i o.117-112-29 LOT TRACT FIRE ZONE VALUE $ 7UU.UU ' l INSPECTIONS Signature Date TYPE GROUP ZONE LL SOIL PERMITS ISSUED SUBCONTRACTOR I I GAS Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE I_i HOUSE CON. - SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER 0 ROUGH WIRING Heating and Vent. TRENCHES ISI FORMS fl STEEL REINF. D FLOOR SYSTEM �'I FILE BOND BEAM FT STEEL REINFORCE 1 FILE .. FRAH IND FL4hJ Q 5 • FRAME AND FLASHINGDA4TF7-sv9_eY St^ LATHING — IN 1-1 OUT I STEP, BROWN COAT UCTURAL, FINAL YYYJJJ Electric n HEATING. VENT., REFRIG. AND A.C., FINAL 00/(45 I �3r/ PLUMBING. FINAL AND GAS TEST n ELECTRIC. FINAL L•C.. io-P-7- BUILDING. FINAL OWNER GUM= DISTRICT DATE 6/23/80 JOB ADDRESS 171 (#A) E. 17th Street BUILDING PERMIT NO. 50285 G" RAL CONTRACTOR ACS Sign Company DESCRIPTION of WORK Elec. Wall Sign A. .o. LOT TRACT FIRE ZONE VALUE E 1,040.00 INSPECTIONS Signature Dote TYPE GROUP ZONE C-1 SOIL PERMITS ISSUED GAS SUBCONTRACTOR Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ROUGH WIRING Heating and Vent. • TRENCHES LI FORMS u STEEL REINF. FLOOR SYSTEM EXPIRED BOND BEAM n STEEL REINFORCE n • Incomplete Insp,:ctiOnS IU SHEATHING ' nrPI FRAME AND FLASHING 1' .THING — IN n OUT n Doty ��3 Sig STER, BROWN COAT {...RUCTURAL, FINAL In leetrir HEATING. NAND A.C., FINAL 4 0 � -2,3-,y6 G 'vV 'F77Sp NPLUMBING. FINAL AND GAS TEST r.IELECTRIC. FINAL a BUILDING. FINAL OWNER CALIFORNIA THRIFT & LOAN DATE 10-29-79 JOB ADDRESS 170 E. 17th Street BUILDING PERMIT NO. 49063 Gr'ERAL CONTRACTOR Accul fight Inc. DESCRIPTION of WORK Non-Electric Wall Sign A a. 117_1 u_2gLOT TRACT FIRE ZONE ' VALUE $ 250.00 INSPECTIONS Signature Date TYPE GROUP ZONE C2 SOIL PERMITS ISSUED GAS SUBCONTRACTOR Dare Number umber I Signature WATER Plumbing ROUGH PLUMBING I PROP. SWR. LINE ❑ HOUSE CON. u SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ED ROUGH WIRING Heating and Vent. TRENCHES U FORMS u STEEL REINF, FLOOR SYSTEM BOND BEAM ri STEEL REINFORCE n �p SHEATHING FILE • FRAMEAND FLASHING NING rOBY_ LATHING n E � ✓D ING - IN OUT DATE� r ER. BROWN COAT .CTURAL. FINAL - Electric MEETING. VENT.. REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST rl ELECTRIC, FINAL BUILDING, FINAL OWNER CALIFORNIA THRIFT AND LOAN DATE JOB ADDRESS 170 E. 17th Street BUILDING PERMIT NO. 48896 GENERAL CONTRACTOR Owner/Builder DESCRIPTION of WORK Non-Elect. Wall Sign 3. 117-112-29 LOT TRACT FIRE ZONE VALUE $ 150.00 IN_.-ECTIONS Signature Date TYPE GROUP . ZONE C2 SOIL PERMITS ISSUED GAS SUBCONTRACTOR Data Number umber I Signature WATER Plumbing ROUGH PLUMBING • PROP. SWR. LINE ❑ HOUSE CON. fl SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES LI FORMS 0 STEEL REINF. 0 FLOOR SYSTEM^ BOND BEAM I I STEEL REINFORCE 7 SHEATHING FRAME AND FLASHING^ LATHING — IN 1 1 OUT n PI -.TER. BROWN COAT IITURAL. FINAL Elertric HEATING. VENT.. REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST fl ELECTRIC. FINAL 1( BUILDING. }�r1/�.'FINAL c..Tc pgDhr,O/31/Z 'OWNER ANTHONY POOLS DATE 4-1-63 JOB ADDRESS 170 E. 17th St. BUILDING PERMIT NO. 19233 • GENERAL CONTRACTOR Osmer-B1dr. VALUE $ 400.00 1 AP No.117—n2-23,214 hOT 25&15 TRACT FIRE ZONE DESCRIPTION OF WORK �]ppi � pp,,a�i�.tt6. 1905 ��,PSTlg �7 `ECTIONS Signature DATE GROUP F2 TYPE V ZONE C2- $o.. PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. ❑ Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con. 0 St.Swr. 0 Sprinkling System Construction Pole Underground ❑ Power ❑ Rough Wiring Trenches 0 Forms ❑ Steel Reinf. 0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing • Lathing — In 0 Out 0 • r ter, brown coat tg. 0 Air Cond. ❑ Final _ Heating, Final Plumbing Fixtures, Final Final Gas Test _ Electric Fixtures, Final Building, Final ez. j� l—Ret, OCCUPANCY FORM 8U4-5M - 7-61 19211 lir Fr CITY OF COSTA MESA , 4 • BUILDING DIVISION > %j ' `i DEVELOPMENT SERVICES DEPARTMENT PERMIT NU R i 11.14111 " PERMIT EO -00 3 Ikkeentroo'll (714)754-5273 • Fax(714)754-4856 • www,ci,costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 170 E 17TH ST Status: ISSUED Suite No 101 Applied: 09/16/2003 Vicinity: Issued: 09/16/2003 Parcel Nunmber: 42541304 • / Applicant: GENE GOBLE - ISSUED BY: < '�i�l V/'/,//✓/, Address: 23015 DEL LAGO DRIVE -Ji-' " " , ' A3 ',: - - Phone: 949-583-9355 - LAGUNA HILLS,- - Zip: 92653 - _ ,y Owner,/J &'J PROPERTIES', �A Address' /170 E 17TH ST SUITE.110 , ' /� N j' Phone: '� ,/ \ , COSTA MESA,CA Zip: 92627 . ?�,. ' \\ - . Contractor ' LETTERS & LOGOS SIGN COMPANY - ' v� , Address: 23015 DEL LAGO DRIVE •• l, ' A3 • Phone: 949-583-9355 , - , LAGUNA HILLS ; - Zip: 92653 License: 703698 - - , ./ ' • SCOPE OF PERMIT Q. ' 9 SFT.SIGN ON E:17TH ELEVATION,89 SQ.FT.SIGN AND 20 SQ.FT:SIGN ON FULLERTON , AVENUE ELEVATION:UNIT 101 "CREATIVE PLAY"REF.:SB03-00093 - , ELECTRICAL TO INCLUDE:2 SIGN-CIRCUITS. •i �, - " ` '-- FEE SUMMARY , - t\ - Quantity / _ Quantity , • ISSUE FEE \ $23.50 Temp DIstSystem/Lighting $0.00 0 - - ' Temp service test \i $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 $0.000 New Res(3«units) Ay $0.00 ' 0 -t Transformers up to 1 kva/kw $0.00::4 0 / Pool/Spa A - -. $0.00 0 . _• -' ' up to 10 kva/kw -. $0.00 0 " , / -7 Lighting Fixts $0.00 :' 0 up to 50 kva/kw- '- $0.00- 0 Recept Outlets' w , $0.00 - 0 up to 100 kva/kw , - $0.00 / 0 Switches \ 50.00 v 0 - • - over 100 kva/kw - $0.00r 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$0.00 /0 Misc.Conductor $0.00 20/ Service over 1000a $0.00 ' ./•-•, 0 ; Circus(gemor ride) -),\ ' $0.00 117-ti Motors to lhp '•$0.00 - 0 .- 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�-- • �' Flreworks'Stano - �--$0.00 0 Motors to 100hp $0.00 ",0_. _,�---_ _ Other.Electrical Fee'' .,-' $0.00 Motors over 100hp $0.00 Communication drops $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(MO) 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 ark for which this permit is Issued. and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for this milt is I•ci led. My works tion ra ole w policy nytnber are: 7 /�/1 �j 3 Cartier. 6,Cl_ � Policy Number: (SP' J (This section n no completed if the rmlt is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this perm' -Lied_,,,„..,,C employ any person in any manner.so as to beco e subj to the workers' compensation laws of Calif° a nee that If I should b= - �(r .orkers'compensation provisions of Se 37 oft r Code,I shall forthwith comply with these provislo� � �r - Applicant Signature: //�� SffcairriDate: WARNING'.FAOW ARE($1 CURE ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MID CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MD ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under p • •y:D Chapter 9(commencing with Secti 000)of Division 3 of the Businessc”P • : Ions Code,and my license Is in full forne actoect.Sig lac.4 '7 % • i�� � Classat :a C'gra Contractors Signature: �� 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,CM Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 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 properly 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. 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(38)feet high.(Chap.3.2,Grp 2,An 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 Safely,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? Ii 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 compiled 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 a plication apenTiTOT such construction or modification from the South Coast Alr Duality Management District or from any other air pollution control district or agency'? 0 Yes L i No (Section 85850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ._.._ _ Oilier Wm 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? ❑Yes 0 No 8 (If'yes',attach certificate of compi 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 ell 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. • f�, �� §ate �j/ i / �2 .,, • yQh:•rrca .// Date LODE I, INSPECTIONTYPF all g{TmAli MEI INSPECTION TYPE PATE �Ailr. : 1816 Fixed System Final Fire Prevention 206 Final Mechanical r`/, u �1 1268 Pool Spa Final 208 Final Plumbing l/.�i 1Y_. r 200 Final Re-Roof 210 Final Electrical _ (sr �F' 201 Final Block/Retaining Wall 212 Final Fire Prevention - if 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - - 250 Final Building/Occupancy • • • • CITY OF COSTA MESA • • BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NU 'BER PERMIT e et 8803 00003 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 SIGN PERMIT • Job Address: 170 E 17TH ST Status: ISSUED Suite: 101 Applied: 09/16/2003 Vicinity: Issued: 09/16/2003 Parcel Nunmber: 42541304 Zoning: ISSUED BY: Applicant: GENE GOBLE , Address: 77' - (�.—; - Phone: 949-583-9355 ,/ l - Zip: Owner % J�&'J PROPERTIES - • Address /170 E 17TH ST-SUITE 110` / \ / Phone: i ',COSTA MESA;CA% Zip: 92627 Contractor.'- LETTER'S 8i LOGOS SIGN COMPANY , • Address: / 23015 DEL LAGO DRIVE A3, i ' • Phone: ' 949-583-9355 _ H LAGUNA HILLS ,,, Zip: 92653 ' , ,License: 703698 - - Arch .-. ' Phone: - N V i Zip: -License: , "SCOPE OF PERMIT 9 SOFT.SIGN ON E.17TH ELEVATION,89 SOFT.SIGN AND 20 SO.F ..SIGN ON FULLERTON AVENUE ELEVATION.UNIT 101 "CREATIVE PLAY" FEE SUMMARY - - Plan Check: ,. $90.51 . Calc Valuation: $6,800.00 $0.00 '/' Permit: f $139.25 -' Claimed Valuation: . ' $6,600.00 SMIP.Com: , $1.43 Other: ,$0.00 .$0.00 i Inspection: , `. $0.00 ' $0.00 • $0.00 Total: $231.19 - -PLANNING &ZONING " • 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 2446-49(6'W) 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. OCI 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 works 'gorppens�a °I cee c/a end policy number are: /79 7 -?DP Q3 Carder. \ ,../9-771 ,//J Policy Number: (11 T r- (This sect! need of be completed if the pe t is valued et one hundred dollars($100)or less.) ❑ I certify that in the performan ,Ark for which this•sits -ted, I not employ any person in any manner so as to become subject to the workers' compensation laws of Calif th t I shout•A ,��es th workers'compensation provisions of Sectigg37 f the La e,I shall forthwith comply with these provisl -• ' 'cjj1 /� Applicant Signature: Date: WARNING:FAILURE TO CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND VIL FINES UP TO ONE HUNDRED 'THOUSAND DOLLARE(SI C0,000),IN ADDrRON 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 lice tl unde ro Chapter 9(commenting wit Section 7000)of Division 3 of the Business Ions Code,and my license is In full force and effect.Lic.0 Class 0 Contractors Signature. C. �� >e7 Date: P7. 1.7% am � 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,CMI 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 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 toe civil penalty of not more than fwe hundred dollars($500).): ❑ I,as owner at 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 UCENSED 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. 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 f We(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: . I 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 Celifomia Health and Safety Code been fully complied will-ir 0 Yes 0 No —_.n 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? LJ Yes 0 No (Section 65850.2 of the Califomia 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 fadlity 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 .._ 6 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally 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 end 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. - //ignature Of L: i� 9 et; //' .G!'. . 'ne.� %r Efate CODE INSPECTION TYPE PAM MAO LODE! INSPECTIONTYPE PATE MALI eci...1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing m 1 . : I 200 Final Re-Roof - 210 Final Electrical p�t�(—�tj1C.C,Tt(T�_ / 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 ;2jG_E=C�� CITY OF COSTA MESA 4 BUILDING DIVISION >.-i � DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER t:1 ^ : 1 • PERMIT k in B03-01402 • (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.�UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 170 E 17TH ST Status: ISSUED Suite: 101 Applied: 08/18/2003 Vicinity: STE 101 (CREATIVE PLAY AND COLOR SALON) Issued: 08/21/2003 Parcel Number: 42541304 Zoning: _.... cf.h.._ Applicant: VANCE ROWLEY - - ISSUED BY: Address: _ _ ,, .<' - Phone; 714-241-8312 - - - i - - Zip: Owner: J &JPROPERTIES _ _ Address /170 E-17TH ST SUITE 110 ' � '- i; \ - - _ Phone: r�'COSTA MESA CA. ' - ` Zip: 92627 ' A / , // < ,,-' Contractor: vROWLEY'RESTAURANT CONSTRUCTION /Address:. 1246 SHELTON ST ' / - Phone: ' 714-241-8312 . - / SANTA ANA,CA , - Zip: ,, 92707 License: °328929 Arch _ ' - - Eng: Address: - Address:_ - •- Phone: I Zip: - , License: - License: SCOPE OF PERMIT . . , , INTERIOR 2500 SF HAIR SALON TI FOR'CREATIVE PLAY&COLOR SALON"IN SUITE 101.WORK TO INCLUDE DEMOLITION OF NONBEARING PARTITION WALLS AND INSTALLATION OF NEW SLAT BOARD WALLS WILL ALSO BE INSTALLED WITH MIRRORS ON THE OPPOSITE WALLS,NEW LIGHTING IN THE ,COLOR SALON.2 NEW SHAMPOO BOWLS AND 1 SALON SINK WILL BE ADDED TO THE SUITE.BATHROOM WILL BE ENLARGED FOR HANDICAP ACCESSIBILITY; FIXTURES TO REMAIN IN PLACE:NO ADDITIONAL SQUARE FOOTAGE TO BE ADDED.ONLY CHANGE TO THE 'EXTERIOR IS INSTALLATION OF GLASS - F DOOR. - FEE SUMMARY - - ' 'Plan Check: • $287.46 Calc Valuation: $30,000.00 Permit: . $442.25 _ ,• Claim Valuation: - - S30,0o0.00 • SMIP Res: $0.00 SMIP Com: ' $6.30,= . - Other: = $0.00 Inspection: $0.00 7 , • , Total:.; $736.01 , ' - - , . - , PLANNING &ZONING ' SETBACKS H MAIN STRUCTURE Front 0-0 '-,` • Rear 0-0- - ,`;Left 0-0 - /Right/ 0-0 ''� • 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 2448-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end 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: Cartier. Policy Number. (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) -$%1-Certify that in the performance of the work for w - this permi ' ued,I shall not employ any person in any manner so as to Decome subject to the workers' __.-compensation laws of Califo .and agree I should •,-.fie subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with N� r.9 AppUcent Signature: ilii<.f (Date: D ' / WARNING:FAILURE TO SECURE WORKERS'COMPENSA COVERAGE IS uMAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES uP TO ONE HUNDRED THOUSAND DOUARE(5100,000),IN ADDn1GN TO THE AA- OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTIOJ 3706 OF THE LABOR CODE,INTEREST,MID ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under rrovsiaggqp of j:'ter 9(commencing with Section 7000)of Division 3 of the Business d Professions Code,and my license Is in full -force'and effect:Llc.0 ��" 7 Class -Contractors•Slgnatu :: __ i (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,CM 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 ally 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 fore 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 properly,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 em 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 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 of 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? i;]Yes ti 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 en 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. en tly equire.. Code .�._. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety obeen holly complied with? ❑Vas 0 No _.joa ion 6 Does or will trAir present or future building occupant requirer for the work which Is the subjectr of this emplication stlon aD Nmt for such construction or modification from the South Coast Air Qualify Management District or from any other air pollution control district or agency? U 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). 8 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: CERTIFICATE OF COMPLIANCE MW 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 pu -es.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Sign,• e• ?'- • mer(s) Date �— •,.:s -•uthorized Applicant Da =IA NSPECTImNTYPE MTh gi1QIALS ODE( gf$PECTION TYPE gAiE HEMS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing •. 200 Final Re-Roof 210 Final Electrical 201. Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Flre Place 220 Final Planning Approval 203 Final Sign 222 Final Site _S /�� 1 204 Final Demolition 250 Final Building/Occupancy ��LSJ • CITY OF COSTA MESA BUILDING DIVISION H•' ' DEVELOPMENT SERVICES DEPARTMENT PER NUMBER • kraal PERMIT �• � B03-01348 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cgys ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 170 E 17TH ST BUStatus: ISSUED Suite: 101 Applied: 08/08/2003 Vicinity: Issued: 08/08/2003 Parcel Number: 42541304 Zoning: • Applicant: ROWLEY,VANCE ISSUED BY: f/ ' tk Address: 1246 SHELTON ST l Phone: 714-241-8312 SANTA ANA,CA Zip: 92707 Owner: J &J PROPERTIES Address 170 E 17TH ST SUITE 110 ' Phone:/ COSTA MESA,CA - - Zip: 92627 Contractor: ROWLEY CONSTRUCTION Address: 1246 SHELTON ST Phone: 714-241-8312 SANTA ANA,CA Zip: 92707 • License: 328929 Arch : - Eng: Address: - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMOILSH INTERIOR NON BEARING WALLS FOR FUTUTRE TI. FEE SUMMARY Plan Check: $0.00 Calc Valuation: S1,000.00 Permit: $38.75 Claim Valuation: $1,000.00 SMIP Res: $0.00 SMIP Corn: $0.50 Other: $0.00 Inspection: $0.00 Total: $39.25 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 • 2446-48(6D0) DECLARATIONS �F /p WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. - ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which Nis permit is Issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) ❑ 1 certify that in the performance of the work for hich this it is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif (a,and agree t ill she become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these s. Applicant Signature: ?,t - /o-z Date: 9r arr 493 WARNING:FAILURE TO ECURE WORKERS'COMPENSATI RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND OCLLARE(5100130),IN ADDITION TO THE 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 p�rrovisi ns/ Chapt (commencing with Section 7000)of Division 3 of the Business d Professions Code,and my license is in full force and effect.Lic.a �r9.� 1 Class a Contractor's Signature:�,it,x y /' Date: r— 2—O5 CONSTRUCTION LENDING AGENCY: v / ❑ 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(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 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 ❑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 Califomia 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 aRPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes LJ No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 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 ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by 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 end state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i -gnature• :•: Owner(s) Date And/• 'Authorized Applicant Date CODE, INSPECTION TYPE • "PATE ' LmTIUL9 , • p00E 1 INSPECTION TYPe PATE =AU 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 /017/3 250 Final Building/Occupancy CITY OF COSTA MESA 4 BUILDING DIVISION c ra. DEVELOPMENT SERVICES DEPARTMENT RMIT NUMBER 1. 1 PERMIT 4• ; • E03-00802 4tbkitario 4s. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT . Job Address: 170 E 17TH ST Status: ISSUED Suite No 101 Applied: 09/05/2003 Vicinity: - Issued: 09/22/2003 Parcel Nunmber: 42542312 Applicant: VANCE ROWLEY ISSUED BY: Vik Address: 1246 SHELTON ST - Phone: 714-241-8312 SANTA ANA,CA - Zip: 92707 Owner: THE VONS COMPANIES INC Address , %COMPREHENSIVE PROP TAX , PLEASANTON,-CA - Phone: 5918 STONERIDGE MALL RD Zip: 94588-3229 , Contractor ROWLEY RESTAURANT CONSTRUCTION Address: 1246 SHELTON ST . • "Phone: 714-241-8312 ' SANTA'ANA,CA ' Zip: 92707 License: 328929 ' , SCOPE OF PERMIT REF B03-01402.5 SUITE 101. - ir , 39 LIGHTS, 16 SWITCHES 1 OUTLET . FEE SUMMARY Quantity Quantity ISSUE FEE $0.00 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 _ •% Transformers up to 1 kva/kw $0.00 - 0 Pool/Spa . $0.00 0 up to 10 kva/kw $0.00 , 0 , .- " Lighting Fixts $35.87 .39 up to 50.kva/kw. - $0.00 / 0 Recept Outlets- $1.10 1 up to 100 kva/kw ' $0.00 0 Switches '$17.60 16 over 100 kva/kw $0.00 " 0 Non Res Appl $0.00 0 Low Voltage Equipment I, $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 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 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(6100) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - • ❑. I have end 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: Carrier: Policy Number: (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 these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.Lia# Class# Contractor's Signature: 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). 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 fora 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 Profession a 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 throw.• s or her• empl• ees 'de that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold wi 'n one year of•• elation,the own) 'bJI'1-r •av: e burden of proving that he or she did not build or improve for purpose of sale.). ' • I,as ow of the prop'rty,am EXCLUSIVE, 7 • NG WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions ode:The• ntractor-License Law does • n• ner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) • -• e pursu: tot : Contractors Licen'. - Z 0L 1 am a •mpt under _. � =, -iness and P.• :' Ions ••: or this reason: _S. gnature: eetIPt/ Date: affillia Verification of Ownershi•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 6,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 compiled 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 application aRgermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes IJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Wit 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 COMP •• CE AND AUTHOR • TIO •-E z-Y:I certify under penalty of perjury that I have read this application and state that the information given is correct.I a'Tpe to tom•y with all state laws a./7••ty• nc: relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri prop: for inspection purpo'r a• := 'of t.occupy or allow occupancy of any building authorized by this permit until final inspection. 3'gn: ura • jairish .) Date q_!J!) et/2 •Or mho. ••-ter • D.te QQDE I INSPECTIONTYPF, all MOM CODE! INSPECTION TYPE PATE• PCMAL4 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing a a 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • CITY OF COSTA MESA BUILDING DIVISION >aj,.,,,. � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER � . PERMIT / " Pacomot J P03-00577 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • Job Address: 170 E 17TH ST , Status: ISSUED Suite No 101 Applied: 09/05/2003 Issued: 09/05/2003 Vicinity: 101 Parcel Nunmber: 42542312 - ISSUED BY: A/ / V Applicant: ROWLEY,VANCE'-\U s Address: 1246 SHELTON,ST.% DECLARATIONS WORKERS'COMPENSATION DECLARATION: 1 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 Ls issued. ❑ I have end will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued. _.>My workers compensation Insurance carrier and policy number are: _-Carder. Policy Number. (nils section need not be completed U the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that In the perfomta of the work f•/hich this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of omla,and agr:.r t Il l shou• •,come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p Ions. F— ApplliCantSignature: .g— // c-Deis:f ` C 3. WARNING:FAILURE O SECURE WORKERS'•• 'ENSATIOtFOOVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADOmT10N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTIONS-7030F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under p Ions of Chapter 9(commencing with Section 7000)of Division 3 of.the.Business and Professions Code,and my license Is in full force.and��Llc:e.-1 ' 9.�Y CCiass a- q f Contractors.Signafu Dale: r'— s" 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,CMI Code). Lenders Name: Lenders Address: Signature: Date: 1 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 em 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,fatsework,or demolition Or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Gm 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 dMsion. • Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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 pusiness which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). _.._y hazardous materials? ❑Ves ❑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). _ _r..f.._...._.._uildi__. ..._._.�. _.. __�..._...._ ._.. 3 :res-o%will theO applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? Ye 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 Ban RMPP Is presently required,has SecBon 25534 of the California Health and Safety Code been fully complied with? C]Yes C]No ..._._ . nt _...._r_. .........._.__.. _.._ 5 Does the will the CoasttcAir or QualityiManagement n building occupant require for me work tr districtone subjector agency?iiiaa�Yesefl0Pemdt for such construction or modification from South Air District or from any other air pollution control Of Ll LJ No (Section 6SR50.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any pert of the facility to be constructed under thio permit be within 1000 feel 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 Oualffyy 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 S (Ices".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 corect.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. Sigma/,Of Lege er(s) Date erre "nt- t /`ayl etl Applicant —Mate CODE CODE rt. INSPECTIONTYPE DATE MALE 2212E1 ltf?ECTION TYPE PATE I,op if 1616 Fixed System Final Fire Prevention _ _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /OZO/3 F" 200 Final Re-Root 210 Final Electrical J 201 Anal BlocklRetaining Wall 212 Anal Fire Prevention ' 202 Final Factory Fire Place 220 Anal Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy 0:1-'Urn,. ! p CITY OF COSTA MESA :y'___ BUILDING DIVISION 0 ' DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER 14:1•PcenTBD.46 E98-01087 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 170 E 17TH ST Status: ISSUED P t Suite No 101 Applied: 10/14/1998 Vicinity: Issued: 10/14/1998 Parcel Nunmber: 42541304 Applicant: BEATTY, FRED Address: Phone: Zip: Owner J &d-PROPERTIES ' • N 'N Address .170 E/17TH ST SUITE 110-' - _ - - / ,,/ " i- Phone: '/COSTA MESA,CA i= - Zip: 92627 / ,/ \.N/ / ; ./ / Contractor: i BLAKESIGN COMPANY INCORP ` Address: 15661 PRODUCER LANE Phone: - • HUNTINGTON BCH CA -• Zip: 92649 1 • .License: 506422 < . /- � • / ' / "I I SCOPE OF PERMIT / ELECTRICAL FOR CHANNEL LETTER SIGN. / / v . 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 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 • up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets '$0.00 0 • up to 100 kva/kw $0.00 0 Switches , - ', $0.00 0 , over 100 kva/kw $0.00 , 0 - Non Res Appl., - $0.00 0 Low Voltage Equipment $0.00 0 - Res Appl . . • $0.00 0 Low Volt Wiring System/Ckt $0.00 0 - Service to 200a . , $0.00.,- 0 • ' ', , Misc.Conduit . ' -.$0.00 0 _ Service to 1000a ,50.00 S, 0 . Misc.,Conductor- " $0.00 ' 0 Service over 1000a ' $0.00 -v 0 . • - 'Circus(gen or ride) - - $0.00' 0 Motors to 1 hp ' $0.00 '-0 Circus(Tech ride or.lights)" $0.00 N 0- Motors to 10hp '$0.00 ' - 0 • . - Christmas Tree Stand .'$0.00' 0 / Motors to 50hp - $0.00' 0 Fireworks Stand $0.00 0 Motors to 100hp -$0.00 "0 Other Electrical Fee $0.00 " Motors over 100hp 10.00 , -.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 $22.00 1 -Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $44.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS EXPIRED DATE 3q O I 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 / V DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued et 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/pro ns. Applicant Signature: V — Qt1 I Date: 1/ 16/ 1140‘ 43 �T WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECmON 3708 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,end my license is in full force and effect.tic.e I � -\l('1 z� Class e I Contractors Signature:Si ^� c-,Ca:\ Date:iJ ( 444 /CIS 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,CMI 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,altar,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.704.4, 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 ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bit 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 wit the applicant or present or future building occupant need to file a registration form for acutely hazardous matertais? 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 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 U 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 ❑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. 11021( II AJ,71/c / w ' nature Legal Owners) '`±SU f '" % Date - — V „V; (OAA-f yK d/Or 'z d Applicant Date ODES INSPECTION TYPE DATE REALS p00EI INSPECTION TYPE PATE INEOALS 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 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 2448-48 14CITY OF COSTA MESA y ..l�' BUILDING DIVISION p' �'•"r 'I DEVELOPMENT SERVICES DEPARTMENT ' J PERMIT ERMIT NUMBER et 5898-00146 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 SIGN PERMIT Job Address: 170 E 17TH ST Status: ISSUED / /A9 Suite: 101 Applied: 10/14/1998 Vicinity: Issued: 10/14/1998 Parcel Nunmber: 42541304 Zoning: Applicant: BAETTY, FRED Address: Phone: - - Zip: Owner: J & J PROPERTIES Address 170 E,17TH ST SUITE 110 -. i - _ Phone:,, . _ , - A , ' COSTA-MESA,CA - Zip: 92627 - - Contractor:, BLAKE SIGN COMPANY INCORP Address: 15661 PRODUCER LANE � ` ' i Phone: , • j-,%,HUNTINGTON BCH CA Zip:, 92649 - , , - License:% 506422 - Arch/Eng: . . " , Address: - • - , . , 'Phone:- - i Zip: License: - , SCOPE OF PERMIT , ,% INSTALL A 40 SQ.FT.,ILLUMINATED CABINET SIGN ON THE WEST SIDE OF AN EXISTING COMMERCIAL BUILDING - FEE SUMMARY i - Plan Check: $22.59 , r' ' i I:,; Calc Valuation: sl,000.00 , $0.00 Permit: $34.75 :ref / Claimed Valuation: $1,000.00 . SMTP Com: $0.50 '. Other: $0.00 - . $0.00 Inspection: - $0.00 ' '$0.00 . ' $0.00 Total: , $57.84 - - _ ' 'PLANNING &ZONING NOTES: - ��'y'\t�e3 0 s _ q� �\�1.� , , ex--) • eJ 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'COMPENSfTION DECLARATION: ' • I hereby affirm under penally of perjtry one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carder and policy number are: Cartier: Policy Number. (This section need not be completed if the penult Is valued at one hundred dollars($100)or lass.) ❑ 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 oyCalit o and agree that I I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these $vlsi s. J r/ Applicant Signature: -.)1 A Date: C (C)KL-4G3 WARNING:FAILURE TO SECURE WORKERS'COMPENSA ON COVERAGE I UNLAWFUL AND SWILL SUBJECT M EMPLOYER TO CRIMINAL PENAL S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLURE($100,0W),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 II ensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business end Professions Coda,and my license is In full force and effect.Uc.4 Class N! Contractor's Signature: O Date: / in/I 1- A8' 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,CMI 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. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.•properly 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: I 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 Califomla 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 Califomla 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 Cade 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? 0 Yes 0 No (Section 85850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 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? ❑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 authoriizzed by this permit until final inspection. v/ C— et r Of Leg I Owners) ..././ ✓✓/ f O/ �_� An r Authorized' ize 1 cant Date GOOF L ULSPFc,TInN TYPF DATE MALE GODE1 INSPECTIDN TYPF BATE R!lmALI 1618 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 2446.48 ri- �1 "19233 FEE RECEIVED C •OSTA MESA BUILDING-SAFETY DEPARTMENT 4PR 1 1863 P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE UEP1. 0 For Applicant to Fill In Completely ClinIfA3( {gF(pMRM1T TYPE OR PRINT BUILDING ADDRESS `O rH rn Pr��1{�x RECEIPT NO. I VLVI COSTA MESA, CALIFORNIA • L�.JI"LJ- Q REGI D BY DAT;RECEIVED 17ATE ISSUED OWNER Rnrrr'fC2Ar I m0'bS. I T'��(off f--/-45 / BUILDING MAILADDRESS ADDRESS 3—Y-7/ F,zs-s 7a NF 8 A✓D FIRE TEL. IEr CITY Son-f-f SAT's NO. ZONE \J GROUP P'AV:• ry^, APS""'TELT TEL. B \ " / DATE r/ 01 'INEER NO. I �!1 Z IN�i "y„� � ADDRESS 107 ..„...).7/Po.LA S I USEIDIOF NEW ,,pp PLANS BUILDING CONTRACTOR OUl/V&rC 8c .A,ba2, LEGAL DESCRIPTION 3,y/ ;—,I2'Ud- ADDRESS V-(p/ .rp ///-J J CITY A.P.NO. l./7_j1 )-- .�3.,.-,1-� .2.0-- • NOTE: NO EAVE OVERHANG SHALL BE LESS THAN /`.5- STATE TEL. 80"TO SIDE S REAR P.L. LIC.NO. NO. EAVES SIZE I NO.OP BLOCS. ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OFMAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (1(7 FTT M[-.e_(' //CJA . (FROM C/L STREET)�T SETBACK LINE FROM FRONT FT.(JAY• FT. CENTER OP STREET REAR YARD /� // SIDE YARDI LEFT I RIGHT R.SIDE FT. v FT. DESCRIPTION OF WORK L.SIDE FT. - - Fr. `/III REAR FT. v FT. ALTERATION ADDITION ' —IIDISTANCE BET. BET.MAIN& MAIN BLDGS, ACCESS.BLDGS, REPAIR MOVING DEMOLISH VAR.# DATE BUILDING NO.OF SIZE ROOMS STORIES C.U.PP.# 'y�q ,/) APPROVEJD/ / EXTERIOROINWALL I ROOF COVERING ' BYPR{.5t. 1 IY /� DATE .j-/ {� .. COVERING USE OF SUILDI NG AND WORK TO BE PERFORMED 12 Fir 0C$ /2/9.2T.T.0NS//V0N _ 3E-Ada,/L6 Apt n. /f Bo✓F ed 076 .LIN FT. _B r f/i 6/f. APP/Zo;e, SD.F7. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION m BUILDING CONSTRU SIGNATURE OF /�v7 �(//� PERMIT FEE $ 3 -i N PERMITTEE / ` da B v �S y/ 0 —"a- PLAN CHECK S ��- 17 AUTHORIZED AGENT . ? n TOTAL FEE $ J . • .`t PROJECT ADDRESS: 170 E 17TH ST "' UNIT: • CITY, OF COSTA MESA — SIGN PERMIT ' PERM NOe SUE 0.44830 OWNER's NAME: WILLIAM JEWELL - • .4.. _, 15 • ADDRESS: 170 E. 17TH ST PERMIT NO: SBE 044830 PLAN CHECK NO: 01338-89 S . GOVT: N $U131S`a` P— COSTA MESA • • CA92627 • a CONSTRUCTION TYPE: 5 PERMIT TYPE: ELE STR SIG PURPOSE: NEW ARCH/ENGINEER: REG.NO.: , JOB DESCRIPTION : • NEW ELEC. WALL' SIGN' • SQ FTi ADDRESS: UNIT: - - , CLAIM VALUE: • • 1, 500 .00 CALC—VALUE: ' 1, 500. 00 GROUP OCC; B'-2 / PERMITTEE: BLAKE SIGN CO. INC. ( 714 )891-5682 . DORE5 — A8: 15661 PRODUCER LN NADA 'COMMENTS: ' H.B . CA 92649 •**�E**+E*+e*ar******+r*aE**�E�E**�E**�r*�e�E�r*�r�E*�E�k*+r*sr+er*****�aar****+ter***xarar***** +r*ie*ak***aa+E LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(comma ting with Section - S I G N - INFORMATIO N moo)of Division 3 of the Business and Professions Code,and my license is in full force and effect. DISTRICT: 1 TYPE: WALL = ILLUMINATION: INT CATEGORY: NEW ' clryuc.:041898 • sTATEuc.:50642 cuss' 45 . DIMENSIONS : 3FT • 00IN X 14FT 00IN AREA: 42 .00SQFT LETTER HT: 12 IN • 7 Signature: e.� '^ STREET FRONTAGE 1 245 . 00 - STREET' 1 : E' 17TH Date: ( ,3 (� $9 ` STREET FRONTAGE 2 : 100 . 00 STREET 2 : FULLERTON WORKERS'COMPENSATION DECLARATION: the affir hat I have a certificate of consent to self-ins e or a certificate of Workers' PARCEL: 00000000 ZONE: C2 LOCATION > FRONT: X REAR: Compensation lny+rapcA,yr,a cgmfie0,gopy the of recti 3.DATE:b.L1_./01 /90 • ' BUSINESS NAME: WESTERN PRINTING > LEFT: RIGHT: POUCY NO.: 1 V.3 U 1 7 / 8 J EXP. 0 , ' O amt STATE FUND OTHER 100,00 GROUND SIGN • \� Certified copy i herebymmished. in Certified co is fid with the /�y ildin Ohrislo . . L/�/ � THIS ACTIVITY 1 . 00SQFT OVERALL HEIGHT: OFT OIN • �� j3 � f'C �` L�^ ` THIS SITE 4 . 00SQET GROUND CLEARANCE: OFT OZN Date: / Applicant: t ITEMS OF INFO 1 PLANTER AREA: 0 ."DOS-QFT EXEMPTION FROM WORKEIIS'COMPENSATION DECIARATI (This section need not be completed if the tis for on unfired MOO)or less). ITEMS FOR ACTIVITY: 1 BLDG SET BACK: OFT .='! I certify that In the performance of the work for which th rmit is issued.I shall not employ any pe on in any manner so as to become ' COPY VERBIAGE WESTERN PRINTING • '. — • subject to the Workers Compensation Laws of Califon . t •• ' Date: Signature: PLANNING NOTES: ' NOTICE:If.after making this declaration,you should become subject to the Wont 5'Compensation provisions of the Labor **'*'*****************'***************'*************'**'*'**************"'*'*'****'******* - Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. DEVELOPMENT SERVICES ' R E Q U I R E M E N T S CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for if i which this permit is Issued(Section 3097,Clv.C). ZONING APPROVED BY. + DATE: •� LENDER: i..'., . ADDRESS: "' ' : ' ' -- BUILDING APPROVED BY : -- -1 . a' i 'DATE: - ' , • L ;w '� Q*/ OWNER BUILDER DECLARATION: hereby affirm that I am exempt from the Contractors'Stale License Law for tie following reason APPLICATION ISSUED B Y: • ► i -DATE: C J • (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,of ********************** '***** ***** **** ** ** *** ************* * * * ** repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed LEGAL I ZAT ION:N - F E E S• U M M A Y STRUCTURAL SEGMENT:Y pursuant to the provisions of the Contractors'State 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.My 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($5,00). . , BLDG PMT PLUMBING -ELECTRIC MECHANIC SIGN SMIP/RES GRADING -1 , as owner of the property or my employees with wages as their sole compensation, will do the work, and the ' PERMIT 35.. 00 — 15 . 00 • 42 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law S 0% •SMIP'/NON—RES ' does not apply to an owner of a property who builds or Improves thereon,and who does such work himself/herself or throughII 'PLAN 2 2 . 7 5 • 5 0 his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or ISSUE FEE 1 5 .0 0 / .improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve forme purpose of cane). BUILDING—DIV—> PERMIT '- ISSUE PLAN—CHECK TOTAL • PAID" •DUE • TOTALS-----> . 92 . 50 15 . 00 : 22 . 75 . 130 . 25 . 130 . 25 . 00 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business t •• r ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon . e - T and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware REVENUE. DIVISION TOTALS——> COLLECTED: - 130 . 25 OVER/SHORT: " 00 that proof otheir Worker's Compensation insurance should beprovidedtome. BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT .GRADING. PLAN—CHECK ❑ I am exempt antler Section: G.8 P.C. • 3 5 . 0 0 30. 00 4 2 .0 0 ' . 5 0 22 . 75 i? for this reason: Date: • Owner. • 'INDIVIDUAL ' F E E B R -E A K D O W N 'T • ' I do hereby certify 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 TYPE QTY D E S' C R I P- T I 0 N UNIT COST -• ' TOTAL COST permit for construction or modification from the Aim Management District.Residential construction applications are exempt from tiara provisions. • ELE 1 SIGNS/OUTLINE LIGHT SYS ON 1 BR CIRC 15.00 - 15 :00 Date: Applicant: END OF FEES r I hereby certify that I have read this application and state tha the above information is correct.I agree to comply with a city and county • _ , ordinances fand insertion relating Duildinprgnstruclion and reby authorize re this tilt oenter upon ntioned - propeM for insp4ction urp05e5. Date: TC (' Signature: • r •• �ki:'•n(i4',yL,'-}Tll!'•77.1;1.-...; Driver's License or Social,Secudty d: • ,. 1641-48 White—Building;Green—Code Enforcement Canerv—Aopllcent:Pink—Revenue:Goldenrod—Assessor • - - - - . • '-. IDS CONSTRUCTION AND PLANNING W PCPA « APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service.or ;_Pole 52. Pool & Equipment Location -. • 2.._Soil.Pipe-Undrgrnd_ ,✓ , .=,r , 53.. Steel Reinforcement • -"•3cE1ec"e{rical Cd....z. 54. Forms ' 0 4r Electrical Condilit-Undrgrnd.- 55. Electrical Bonding _ 5.-Steel Reinforcement _ 56. Rough Plumbing & Pressure Test flr2.6:.Electrical UFER--Grnd. _ , - 57. APPROVAL TO COVER-GUNITE " ci .. ^ 1,7:Footings u • a'' 58. Electrical Conduit-Undrgrnd. , - 8. Foundation `., t 1 59. Gas Pipe, 0 Undrgrnd.,Test -" 9. Water Pipe-Undrgrnd. i 60. Backwash Lines,P-Trap, 0 Undrgrnd. • 10. Structural Floor System _ i ' i 61. APPROVAL TO DECK . I 11. Property Sewer Line& House Conpection • 62. Backwash & Receptor:Final - - 12. Sewer Cap -' •...... •I 63. Heater & Vent-Final v, o 13. Roof,Drains < - I 64. Plumbing System - Final • -1 J 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 S'yD - 68. APPROVED FOR PLASTERING .i 18. Rough Electrical-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL 19,_,-Rough Heating &rAir Conditioning., _ EIRE DEPT..REQUIREMENT., r1 i4: r-,..yv 14,,...• -'r,V „ + rn is r,- - -,", itt" X - 20:,�Ro hF_actoryI-rcolaeesi_Cwr., ;..”..'hn-. - -APPRO,V,ALS: Permit-# - - 21!-Oucts, in'Stractute, wS`I! i �' ori 5k X70 n er round H T r 22:-.Duets, Ventilating r "r„•.-p, c_ - -� C -- : - cJ �71.�PO roduc[ Piping Gas dOil r,. 23.•GarPipe_Rough &:Test -%7=.= S* t; _ „72�Underground Flush •-•,...)1... 24..-RoofFraming * '4 y;:-4. np,;7, it, 4. . 73.,Un_dergind.StorageTankrl7,Gas 0OiI 25 'Roof SI-Teething z -'' ?_ _' E ,� �7q;'Overhead; /4 3.2 -S-6) ---- • Applicant to fill In all spaces except those within beavy border lines and sign all appropriate declarations. • - , ' CITY OF COSTA MESA CONaTet UcTION PERMIT PERMIT Projectddress ND. TRACT NO. LOT NO. UNIT NO. . . 170 East litn st. , Costa Mesa n aagen 0096 2/28/06 760;i IL .. AS . , 4Applicant's Mailing Address 170 East 17th St. , C . M TYPE OF CONSTRUCTION LI NEW LJ ADD 17kALTERATION LJ REPAIR . OWner's Name J and J Properties '457-5551 0 CONVERSION D DEMOLISH a A.P.# . I Zone DRI CON OF WOR K/USE OF p LD Address 170 East 17th 'St. ,Costa Mesa, Ca S Main Building: • Accessory Building: E Z , Arch/Eng License No. TVP F RMIT D G RADI NG LJ UNDAT I MI ST RUCTU RAL y Front • 0 Address TENANT DI ELECTRICAL. El PLUMBING1.-4 MECHANICAL • B Rear N . Contractor's Name E. L. Payne Co . , 6„„„,545-5542 CI OTHER A - 1 • 3005 So. Halladay, Santa Ana PROJECT DESCRIPTION SQ. FT. _ OCCUPANCY C Right • N Address(mailing) 6315 K CONSTRUCTION TYPE VALUATION $ s Left . G R City License No. ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECLARATION . - 0 I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: • ' Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and RECEIVED FEB 2 7 1988 my license is in full fjohc and effect , T ‘..a License Class C./2 License . S e1/4:1 Date2._2.6_8.6__ Signatur .4..-o-T-P . 0, 2 PLUMBING FEES . ( WORKERS'COMPENSATION DECLARAT N IIII III -•••• In Bar Sink Showers hereby affirm that I have a certificate of c sent to se -Insure or a certificate ELECTRICAL FEES ...1 I Workers' Compensation Insurance, or certified copy thereof (Section 3800, Lab. C,...)..., . Backflow Preventer Service Sink Automatic Washer ' Transformer 0 15-50 KW - Policy No. /Z 0377-85 Company State Fund Ins . Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW it Certified copy is hereby furnished. I Meter Lip to 100 amps ' Certified copy is filed with the city apildlpg 41114.1ME Bathtubs • Sewer Connection Cooking Unit • Date 2-26-86 Applicant •o• Lis r CO EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • . Solar Collectors I 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 0Gas 0Electric Sub Panel i 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 its-8 WorkersCompensation Laws of California. IInc.Solar 09.15 HP 016-15+ CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes,Date Signature Floor Drains Swimming Pool w/Spa F.A.U. •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 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.) Interceptors Water Heater ' LOutlets Range ender'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 Garbage Disposal I 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 t1 Generator 00-5 KW 05-15 KVV 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 4porision 3 of the Business and Professions Code) or that he/she Is exempt aherefrom and the basis for the alleged exemption. Any violation of Section - 1 ,ti,031.5 by any applicant for a permit subjects the applicant to a civil • eRnalty of not more than five hundred dollars($500). U I, as owner of the property or my employees with wages as their sole Reinspection Fee I V5 issue Fee $ 3 - 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 REOUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 v - , sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0, . . Zoning Approved By nate pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground prove for the purpose of sale). Building Approved By Date U I, as owner of the,property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System ' ' Application Issued By Date 212-it ilg CO ' tractors to construct the project (Section 7044,Business and Professions Code: • , G. The Contractor's 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 i BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. 0;I am exempt under Section B.& P.C.for this reason Firepl/Fact.sit. Imp 4 Fire Dampers PLAN CHECK $ PERMIT . ' PLUMBING I $ ISSUANCE $ 1.5-.4;27-nr . Date Owner Heating System& Ducting Registers - •a I PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above X 0-100,000 BTU 0100,000 BT information is correct. I agree to comply with all city and county ordinances, . ELECTRICAL $ GRADING $ , and state I.ws relating to buildin• construction,and hereby authorize repro- • ICROFILM. $• sentatives, this city to enteriepon the above-mentioned property for . PLAN CHECK 50% $ •OCY • • . inspect os,r•oses. lets. Note 2-76—RE , MECHANICAL $ •44—fa3a3-1 TOTAL FEE . $ Signatifs- iir.......M. -L. Fleinspection Fee I $15 ' Issue Fee . 1$ 3 pa PLAN CHECK 25% $ i a . CMF 0865-46,rev.10/84 White - Building: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor . lab. -W CCp1STRUCTION AND PLANNING POC SPA . ,• APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector T+Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. 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 t 'I 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final ' 12. Sewer Cap 63. Heater & Vent-Final I13.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 a18. 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 CI 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: i-ZR-os CAMcitt Q,5 PEa&oB.b VMC. C,“34. Final Heating & Air Conditioning / ' 35. Final Gas Pipe-Test i 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final �' i 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 0 43. Backflow Irrigation 44. Landscape Irrigation System;_.t 45. Sound Attenuation 46. Handicap Regulations 4% 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 • - • Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations- 3063 I./ 17/63 7.00 TL J/IT tF`COSTA-MESA - TRACT NO. - LOT NO. DUO.NO:* --. - - - -- ' - --- - . - - - CONSTRUCTION PERMIT /4�/�/J.¢,� } I Project Address [7 �/ [�/(( TYPE OF CONSTRUCTION' da-t• .'.' 'e, Ow0e! '641,1_ % �q/ �� -_PhonPb r ❑ NEW' -0 ADD. ❑ ALTERATION_ (� — - - 4G 'Address -❑ REPAIR-:O CONVERSION ❑DEMOLISH_ • ZONING REGULATIONS Arch/Eng. - -- -- - L-icense No. --•- - !ID OTHER. .) -I 1 Addr¢55 -- DESCRIPTION OFWORK- I 1 Contractor keP,.jres ;. 4. Ph "Sri I -- -- -- `• _• OTJi ±::L -0 1O"GRADING - 'LJ FOUNDATION • O'STRUCTURAL •' LICENSED-CONTRACTOR-DECLARATION./- ' - - _: . - _:O TENANT- O ELECTRICAL -OPLUMBING-AMECHANICA • II,I • - ,I hereby affirm that I am licensed under provis ons of Charter 9(com- i mencing-with-section-7000)-of Division--3-of the Business and• --O.OTHER.- �'- - - - -- - Professions Code, 'and m license is In full force .ntl effect-t •• • • C PROJECLDESCRIPTION•"_-t; - •License C as '-• b- - - License • A's` L - -�- -� - - :_. x.(_. /�.-_. �� . SQ..FT.: f: '''•"' 't' ,_ - . .. I_ Date - '• Signa Cur- - - - - 'WORKERS'COMPENSATION DECLARA-�N .^OCCUPANCY ,`CONSTRUCTION TYPE _ WIDTH- ▪ J • 'I hereby affirm that I have a certificate of consent t0 self-insure or a ."VALUATION' ' ':' - ZONE I • • • • • I certificate-of-Workers' Compensation • ura c . or- certified cosy - - - - _ -.__ - - ,. - _ thereof(Se ,�g 0 ,�ag ). 1 / , 4 Y �i7 GRADING-CU.YDS. ACRES 1- iSPECI'AL-CONDITIONS: - _ . .) - PollcY NO fT-�Y00�Compan• - ... ' __�•^_.__._ _-.._ ._ - - _- r Certified copy.Is iledb yith the city e.....•,... ',.-.,�_C[(.G��Q36f� - - . - _ --- •f Certified copy Is here with the ciBuilding Division. / uplKa/`l'+,!-/C( _ ALIBI 1 '3 T: 1'i EXEMPTION FROM WORKERS' COMPENSATION DECLARATION / - - ' ' - - - f /- Y ($100) or ). not be.completetl if the_permlt-ls for_one huntlretl � _ T-�( - /r/ C = 1 ,. ,,,..7,-.,. ..: :.„„,>, . S5100) or less). , . _ .^. - _. .:. __..- �. :_..:- _ � I certify that in the-performance of the work for which this permit is Issued, I shall not employ any person in any manner so'as to become PLUMBING- ��,. "p,i-PLAN'CHECK ' -'- ,- '- -'-"- - "'ELECTRICAL 7. ,- - '-.PLAN CHECK - '•-- t subject,to.the Workers Compensation-Laws of California.t. _" .._.__ - BA THTUBS'r SHOWERS-- bate ' ' Signature ' I I • - • NOTICE: If after making this declaration, you should become subject• -.TOILETS f? •rill w-)URINALS-`-7--' - ,GENERATOR 0.1"KW ` 2--'to the Workers' Compensation provisions of the labor Code,you must - - 'TRANSFORMER y .: ' forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBL-E'LAVS- '- - -;'APPLIANCE -30.50KW 'S0 KW-- -- •Cvoked. CTION LENDING AGENCU~ - _ KIT'SINKS'- ----"DISHWASHERS`--" j'-"'--- '- ',MOTORS"- '.0-1.-HP 1'40:HP-----' 7- I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS•�s41•,/.SUMPS---• --7- '- ---- .I UNC:SO4AR). �-10-50•HP=-50-{-HP'= -- - 1, formance of the work for which this permit is issued (Section 3097 - . - Crv. C:)C- - -'----'- --- -'-"-- -- --' -' - FLOOR SINKS——FL6OR DR'• S- ' '"- FIXTURES - '-OUTL'ETS--(LETS - --- Lender's Name _ _ _ ____ ___ _ _ _ - - ••antler's•Adtlres5 - - F DRINKING"FOUNrrTAL j PB-----' i - "- -- 'GAS-TUBE SIGNS-•---•'-- _ - :'' OWNER BUI L'DER'DEC LA RATION' 'r'- �- - INTERCEP • •.a y� r ♦ -' -' •POLE LIGHTS - I hereby affirm that I am exempt from the Contractor's License Law for M si C y _ the-following-reason:(Section 7031-5 Business•and-Professions-Code:- IP", /4:Y_ . -y --� --,- rtPOLE$ • • • METERED ' SUB - ' a Any city or, county,,which 'requires a;permit to construct, alter, �•Jt7.1� - • ( Improverdemolish-orrepair any-structure;prior to its issuance,-also•re • - >• • -1-7--- -- ' '(PANELS MAINT ^SUB---'- ' • -- -- •"' 1, quires the apllicanf for such permit to•file a signedstatement-that he - --- ls'licensed-pursuant'to'the'provisions-of the Contractor's'-License-Caw' GAS • (Chapter 9 (commencing with Section 7000) of Division -3 of the - Business-antl Professions-Code)"orthat'he is exempt-therefrom•and the _ • __.. -. "._ - -,.. _._. __- ...,,•__.:: .. = _ i' ,basis for-the)alleged,exemption. Any violation.of Section ,7031:5:by - - i - - - - •- - ^ any-applicant for a permit subjects-the 'applicant to-a civil penalty- • • --F - - .. _ _.__ _ of not m_ore than five hundred dollars ($500). - • i O'1, as owner of-the Property, or mY em Ployees with wages as their • • •• -�- - - -- -,,- --- --- -- -- - -•--r -- - - sole.compensation, will d0.the-work, and the'structure is not intended - - orloffered for sale.,(Section 7044, Business and'Professions,Code: The • -7 -ISSUE FEE - • -_ -- ' - 'I Contractor's Licenselaaw does-not.apply_to,an owner-of a property_ - '6gPPLI�ATION gPPROV ED-B V- who builds or improves thereon, and who does such work himself or "t-- - - -- --'DATE- 1 through his.own employees,"provided that such improvements are"not __ _ '-~ Intended or offered for'sale. If;however,the building or.improvement' • SUMMARY OF:F EES, ! - - - 1 is soldwithinone year of-completion,the:Owner'will''have the burden.' .Fi^lJQ i6�' " _ I of proving he did not build or improve for the purpose of sale). 0-100,000 s +I � �('BUILDING - -• - - ------ - -- - a 1,--as -owner of the- propert am-exclusive) ,PERMIT _ Y,- Ycontracfin9-with • • • _ $ - _- .., 4' - SMIP ? o $--- - ' licensed contractors to construct the project (Section 7044, Business 100,0004 BTU :PLAN CHECK $' - !PERMIT• ,4�-•Y2:14£ 1 and-Professions Code:-The-Contractor's-License-Law does not apply-to ISSUANCE 4��_ an owner of property who builds or improves thereon, and who con- • 0-100,000 'PLUMBING - tracts-from-such-projects-with-a--contractor(s) licesned-pursuant •to. _ •• ••• •PLAN•CHECK S 1•C)RAD(NG--7S�,,i•i plc- the Contractor's License Law). _ D.Yam exerri pt under Section-' - "'-" '- _ `B-&'P:Cfor this' $ ...I :• ''ELECTRICAL reason - ,�---_._ MICROFILM!$••`-^' _ J i - - ---- - - - - - - - ALTERATION 'PLAN CHECK $"• _ - - SYSTEM Date - Owner _ '1= TOTAL�FEE_$1�'17" ti I hereby certify that I have read this application and state that the above MECHANICAL-$ - • information is correct.-I-a 3-agree to"com I-with all- and countyPLAN•CHECK' ,._,• LESSAD-PC- $- '_' � 9 P Y city $• '-, -'LANG EPC" $_" - epes -- ordinances and state laws relating to.construction,and hereby authorize • • ,, t, ("4- . , O., .3 eaarj , represent Ives oY this-city to epter upon the-above enti ned • j ' - proPertY_ " nsPection PurP - - _ _ / a-- - _. ___,I- 0O ' Signature �y�!1 � Dal€ -- • FINAL FEE $ Drivers' License or SS �� ' '- _ CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor t +CONSTRUCTION AND PLANNING . POOL&SPA • '� APPROVALS . Permit# Date Inspector - APPROVALS._ - Permit# - Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location • .2. _Soil Pipe:Undrgrn - 44. Steel Reinforcement - - - - - . 3. .Electrical Conduit Utility-Undrgrn _ _ 45. Forms - - - 4. Electrical Conduit-Undrgrn - 46. Electrical Bonding - - - - - _5. Steel Reinforce _ • 47. Rough Plumbing & Pressure Test •- - - - - 6. . Electrical UFER Grn - - - 48. APPROVAL TO COVER-GUNITE - . .. - - . 7... Footings - _-- - 49. Electrical Conduit-Undrgrn - - • • 6. .. Foundation _ _. . - 50. Gas Pipe,•D Undrgrn,Test • 9. Water Pipe-Undrgrn... - _ _ 51. Backwash Lines. P-Trap, IDUndrgrn' - ' .10. _ Structural Floor System _ 52. APPROVAL TO DECK . _ - ' . . 11. Property Sewer Line & House Connection_._ _ . . _- - 53.. __Backwash & Receptor-Final . . 12. Street Sewer Connection _ . .- - - - - - 54. Heater & Vent-Final' - - ` 13. Rough Plumbing - , - - 55 Plumbing System- Final . 14. Rough Electric-Conduit - - - - -- ... --56: Electrical-Final - . 15. Rough Electric-Wiring - - - -- - • 57- Solar System-Final - - . 16. Rough Heating'&Air Conditioning- 58. -Fencing &.Access Approval • , 17. Ducts, in Structure. - ' - . ' _ _ _ 59. APPROVED FOR PLASTERING 18: Ducts, Ventilating- - ' . _ _ . - - - - - - -. _ 19. Gas Pipe-Rough &Test • - .. - _ 60. POOL/SPA SYSTEMS FINAL ' 20.. Roof Framing • -- - .-- -. ... .. . - _ . - _ - -- -. . 21. Roof Sheathing ' - - - - -- - - - - ' • 22. - Frame and Flashing - - _ - - . . _ _. ' NOTES:r/'_I-efr . - , , ' ' - 23. - Insulation - - - - - - - _ _. _ _ , . - - - /' •, 24. Lathing & Siding - - -- - - - - ir- 'nom -Yeet�i e' - API P,Ad- -tn7 1.l Ageerree/b 25. Drywall Nailing- _ _ .. . _ �, . 26. Plaster Brown Coat - - . - ,1, Merniirrta" .rAt.4I 4e y6Xoea7d id/axe /r 27. Electrical Power Meter-Final - - - .- /J- 'n,7 X91 ;h a 71 4.6 Sail Fenn - 28. Final Electric r - - - '/ 29. Final Heating & Air Conditioning . . ? Perw/r- >'e ntYed -4Y EkeZ 2ci% < 49. 1��.e��.�/ 30. Final Gas Pipe-Test - (f `- • 31. Final'Plumbing _ _ • - / /f.� Y ./� tel., 32. Water Service-Final - . (yc ! `G �//�Y J ' 33. Gas Service-Final-_ _ • - .-' - _ , './ A ����%y. 34. Solar Domes-tic-Final • - - r v ,S, N, 7/A C .4IY.r - • . 35. Landscape Sprinkling System _ 36. Sound Attenuation • - , • - - - 37. Handicap Regulations - - - • - 38. FINAL STRUCTURE& BUILDING - _ -- 39. Special Requirements Completed - . 40. Electric Release to Edison -' -• 41. Gas Release to Southern California Gas Co.' - - . 42. CERTIFICATE OF OCCUPANCY - • - ii No - Date - . - . 7 • ' • 8008 9/12/84 740 TL 102 94 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT - PERMIT NO. I TRACT NO. LOT NO. UNIT NO. Project Address 170 E. 17th St. , 01 ( 51 Co O .. • Applicant's Mailing Address 3o05 s. Halladay St.,S.A. TYPE OF CONSTRUCTION ❑•NEW U ADD U ALTERATION U REPAIR J & J Properties. 557-5511 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.50 Zone Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Address 170 E. 17th Street. , Costa Mesa S Main Building: • Accessory Building: • Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATION LI STRUCTURAL E Front • O, Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL a Rear • N l • Contractor's Name E L Payne Co Phone 545-5543 El OTHER A in Address(mailing) 4005- S. Halladay St., Santa Ana PROJECT DESCRIPTION SQ. FT. OCCUPANCY__PANCV__ C Right N 6315 CON STRUCTION TYPE - _ _ VALUATIONS S Left • R Cc City License No. ZONE GRADING CU.YDS. ACRES Ref.. Parking Req./Provided LICENSED CONTRACTOR DECLARATION Ping. E E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M ( with section 7000) of Division 3 of the Business and Professions Code,and • • my license is in ryyllfpr igntl effect. .,p0319 - S. License Class Li '1 ee(^N,17J� /G Date C3/f3f8li Signature PLUMBING FEES WORKERS'COMPENSATIONe ECIA ATION Bar Sink Showers . ' ELECTRICAL FEES �,hereby affirm that I have a certificate of consent to set sure ora certificate ii-f Workers' Compensation Insurance, or a certified.copy thereof (Section Backflow Preventer l Service Sink - 3800, Lab.t,{C(w'H_f1 Automatic Washer - Transformer 0 15-50 KW Policy No. zi....20321' Compan AmericanHome Assurance , y CompanyAmerican Irrigation • Sewer Cap ❑ 50+KW Construction Pole Sub. Certified copy is hereby futhe cit • Certifiej qy is filed with the city Bui DI +,l• ,a Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date 9/064 Applicant ' EXEMPTION FROM WORKERS'COMP NSATION DE •RATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for • unfired($100) or less). • Dishwasher ' Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which is permit is Issued,i shall not employ any person in any manner so as to become subject to the Drinking Fountains . Solar sank Fan • Motors 00-1 HP 011/2'8 Workers' Compensation Laws of California. - Date Signature Floor Drains Swimming Pool w/Spa F.A.U. NOTICE: If,after making this declaration,you should become subject to the - Inc.Solar ❑9.15 HP ❑16.15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks _ Urinal • Fixtures with such provisions or this permit shall be deemed revoked. Microwave - CONSTRUCTION LENDING AGENCY Gas Service Outlets Water ClosetDevice 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.) interceptors Water Heater e Outlets Ran Lender's Name g Lender's Address Kitchen Sink Water Service OWNER BUILDER DECLARATION. i- Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories • • Garbage Di following reason (Section 7031.5 Business and Professional Code: Any city or - . 9 Disposal 'Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap - any structure, prior to its Issuance, also requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor . to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains +she Contractor's License Law(Chapter 9 (commencing with Section 7000)of i�- 0t.nlvislon 3 of the Business and Professions Code) or that he/she Is exempt Wherefrom 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 _ - for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Reinspection Fee $15 Issue Fee $ 3 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 Of Type 1 ❑ sale. If, however, the building or improvement Is sold within one year of com- Canopy Type I I ❑ Zoning Approved By nate pletlon, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved BY Date Drove for the purpose of sale). ,f j� U ' I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration$ystem Application Issued By ;'sy+ Dat fl_j.� tractors to construct the project (Section 7044,Business and Professions Code: 1x, AO The Contractor's License Law does not apply to an owner of property who Duct-Ventilating IA10-100,000 BTU ❑100,000 BT 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 ❑ Multiple ❑ 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# PLUMBING $ ISSUANCE $ Date Owner Heating System& Ducting - PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT I ELECTRICAL $ GRADING $ Information is correct. I agree to comply with all city and county ordinances and state laws relat .g to building construction,and hereby authorize repre- sentatives of this to n r upon the above-mentioned properly,for - ^ —1.00,!\\ , inspection purposes� 9181 - MECHANICAL $ 1.00 TOTAL FEE $ I•0V Signature • / Date Drivers' License •r SS* • Reinspection Fee $15 Issue Fee $ 3 - PLAN CHECK 25% $ CMF 0865-46,rev.4/84p White-B. tling;Canary-Applicant;Pink-Accounting:Goltlenrotl -Assessor V CONSTRUCTION AND PLANNING PO, -& SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole. 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ) 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4..Elect kal Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel,Reinforcement. 56. Rough Plumbing & Pressure Test • 6. Electrical OF 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 1, 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.e 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: - 34. Final Heating & Air Conditioning ' /ir L y���l 7i v riar tt.,in6a r 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 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. .4./ - 7�j C- �� �a�- 5/05%B2 I -• -L: CITY OF COSTA MESA -- P MIT NO. - TRACT NO. - LOT NO.- - -BLDG.Na._ - - • _ __ _ - -` _ - - • - I,CONSTRUCTION PEMMIT ��� ` - Project A..ress - l7 `�• •„ ,c TYPE OF CONSTRUCTION . • { - .. I Owner • - • ' - - •a --- -Phone+ - ❑ NEW" ❑ ADD ❑ ALTE RgTION =- - - _. -_ .1 1 -Address. 0 _ ❑ REPAIR CONVERSION_❑,DEMOLISH •ArcMEn .- -• - - - -- - License.No.- . ❑ OTHER ZONING REGULATIONS' Address jf�- -- y1-n DESCRIPTION OF WORK _ -_ - _ ZONE - - • REF - ' 1 V-/ - _ _ _ _._ , TYPE OF PERMIT,_ _'_ T_ _ 'PLNG-B ILDING • _- Contractor Phone TToo UL� f �• I SETBACK-6 LST. ' ''7ROPERTV LINE. ' Addr. �� • •/ /_ •"- /�� i/4 •- 1 -❑ GRADING ❑ FOUNDATION-- ❑ STRUCTURAL- ---yE YARD- - - ' -, 1 1-,` :LICENSED.CONTRACTOR DECLARATION-/ ..❑ TENANT ❑'ELECTRICAL-❑PLUMBING. ❑MECHANICA Lg IEOFE VA RD__ 'I hereby affirm that-I am licensed under provisions of Charter 9 (co-m- r RIGHT. `/ mencin9- with •section_ 7000). -of LDivision_3,of the .Business and ❑,OTHER, - -- , - -- - - - 1 /],, Professions Code and my license is in full force and effect. REAR'YA RD(TO la/L) , • Licensed ss - Sd'G'-� License N•--• I�. / ' •' PROJECT DESCRIPTION ,h, , ` ",' )PKG]SRACE-REO. PROVIDED., I Q•=' . • JO. .c Lr_, , . •_'SQ. FT: ^ _ __ _ - 1 Date' •Signature- - - - - - ,WORKERSLCOMPENSATION DECLARAT.IOJ + - OCCUPANCY _ • _CONSTRUCTION TYPE _ - II hereby affirm that I have a certificate of consent to self-Insure or a -- -ZONING APPROVED BY - n-DATE - certificate.of Workers' Compensation.. uran or certified coy "VALUATION _ ZONE .x ` ,)�. iSPEC1AL CONDITIONS - - j thereof (Seco n nc,�y}p � ' j�.�f GRADING CU V05. i ACRES 'ICY Noah' 'nsmpa Compensation,. I - - c'ertlfied copy,is hereby furnished„-.- // -,ertlfied copy Is filed with the city Building-Division. EMPTION-FROM-WORKERS' COMPENSATION-DECLARATION ----- - • -•-- , -- --- - ' .. I ,' ) • rte, ' This section need not be completed if the permit is for one hundred - '” - • ) iq„ 1 ( it 1, ,.f� ($100) ._ _.-._ _ ± _-. -. . - •-.. _ -_. _ . : • _ d 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 :PLUMBING „^7- tPLAN-CHECK• -- - �ELECTRICA subject.to the, on Workers'CompensatiLaws of California_c-l• • •1 . ♦ -- _ BATHTUBS " - " ""SHOWERS'-" ^- �— - - - - ' 0HKA0t._ _ Date • Signature ' e - e NOTICE: If after Makin this declaration, you should become subject -iTOILETS URINALS-- -- --- GENERATOR -__ - 4 9 t _. .. -) -`i'--` - 0=1 KW- l•-10'KW to the Workers' Compensation provisions of the Labor Code,you must 'TRANSFORMER , forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE-LAYS - - • - •APPLIANCE--`-- 10-50-KW - -50-+•KW-1� ) revoked, . _ _ - ;CONSTRUCTION LENDING AGENCY _... '- • KIT:SINKS---- - DISHWASHERS-• ^r--^- •MOTORS•' --'-.=r0-1 Hp_1:10•HP- v -- . S 1 hereby affirm that there is a construction lending agency for the per- SERVICE SINKS. - ,- • SUMPS' --- ----- -._. . ,.(INC:SDL4R) _: 10.SO.HP 5o-lip•' • ' I ,formance of the work for which this permit is issued (Section 3097 -. • Lenders Name FLODR-SINKS FLOOR'DRAINS`- • --- -;FI%TURES-- - OUTLETS—SWITCHES ---- "`-"'Lender's Address FOUNTAINS-^' --•-s-- GAS TUBE SIGNS-' t•� • OWNER BUILDER DECLARATION--- INTERCEPTORS----CdeRIFIERS'--"- - -l""--" ;POL•E LIGHTS- -- _---- - - - - j I hereby affirm that 1 am exempt from the Contractor's License Law for _ - the following-reason-(Section-7031.5 Business-and Professions-Code:- SWIMMING POOL--- --P TRAP------- --- - a e - _ - Any city or county which requires a permit to construct, alter, ',POLES- -""--"-'-""METERED-""'.SOB - - - Improve, demolish or repair any structure, prior-to its-issuance,also-re- -WATER-SERVICE- ' '- ALTERATION--" -. 'PANELS^ quires the aptlicant for such permit to file a signed statement that he is-licensed pursuant•to the-provisions-of•the-Contractor's-License-Law (Chapter 9 (commencing with Section 7000) of Division 3 of the GAS'SERVICE" - -OUTLETS-^"-'-" ^' :SERVICE - -� --- AN1P- - -: • ' 1 Business-and-Professions-Code)-or-that he•is exempt therefrom and the -WATER HEATERS-- ----BTU'OUTPUT- -' - -- •-- • ••-- --- -- _ • basis for the alleged exemption. Any violation of Section 7031,5 by - ' applicant-for-a-permit subjects-the-applicant-to-a civil penalty- -SEWER CONNECTIONS--" - ^— !' - -- - - --- -. N more than five hundred dollars ($500). -- - - - . aS owner f thpropertyor-my employees with"wages'as-their^ SOLAR TANK-- --'--"-COLLECTORS. •- -. .- •-: - --- - _ ._ -. _ soe , Sole r compensation, will do the work,and the structure is not Intended 'I or offered fosale. on 4(Secti704Business and'ProfessionG "-II-y_ _s Code The '-SOLAR"PIPINSYS. - - Contractor's License Law does not apply to an owner of a property :gppLICATION APPROVED BV— -ATE---- - - _ _.i•-____- - who builds or improves thereon, and who does such'work-himself or ISSUE FEE--'-- - it '-- ( - through hisownemployees, provided that such improvements are not _ __ _ _ _ - _ _ E Intended-dr-offered for sale. If, however;"the-building"or:improvement- MECHANICAL PLAN CHECK'Li ,_- - -- - - I Is sold_within one year of completion, the owner will have the burden , - SUMMARY OF FEES,y 1) ,., 1 of proving-he did not build or improve for the-purpose'-of "sale). -' `V -- - - "'PERMIT BUILDING -- - • f Ell,- ds-.owner-of-the property,. HEATING SVST - 0- 00,003 BTU PERMIT y,-am-exclusively_contracting_with, - ND DU ING '1 - ) C _ - _- . _ $ - i _ISMIP 1 $fl • - I licenseq contractors to construct the project (Section 7044, Business �06p 100,000)a BTU LbO. -_r Vrie ,PLAN CHECK ---$' - - PERMIT t• F, I and.Prnfessions-Core.Tho ractori License-Law does.not apply-to. izr• .. _ _ ._ . w IISSU ANC Et $ an owner of property who builds or improves thereon, and who con- RE RIG------ N 0-100,000 BTU ' PLUMBING tracts-from-such-projects with-a Contractor(s) Iicesned..pursuant.to -SYSTEM - --- - - _ -_. .. - J( _ _ GRADING $ the Contractor's License Law). 100 000 f BTU -Y - ;PLANCHECK -$_T_�:is. 1,c,•,5 EH am exempt'under Section"--' " --`" 'Br& P:C.for'this- ' -- -'-" •;'--^• //t(//�'4�J�-_.—r J i ;: BOILERS _ BTU -_ ELECTRICAL �_ $ reason - • - - - - - -- ------ -_ - -- - PLAN CHECK' f MICROFILM $ ' SYSTEM REPAIR,ALTERATION - - _ Date Owner TOTALFEE S. EXHAUST SYSTEM MULTIPLE 'MECHANICAL- iherebycertifythat have agrethis aonand state that the above ' I •I'_. -• i7 CESSAD Information is correct. a relating to complywith all'-city an authors .PLAN CHECK �$ - - -- -:�$.'^_•�_;.' i 9t Y I, ' 'VANCE PC - repordres nta and state ws ' to ter"upon and hereby',mentioned represents 'yes-of-this-city' o 'enter"upon-'the-•above_ enilonetl I' 1 � `•t4��'A. ' =�`• --` - I ''� i i property f in5ppeqtie1� p e . _ _ //rp�� Ga /X/• Signature r• �� , yr -' - Date S"'/a_Z -! ' 1l,, - ,I, FINAL FEE 9/- . 4 briveri• License Or 5 # `- SSUE FEE - 1 - - __ _- - _ _{ s A . • • _• -- --- - -- • - -- -- CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - V CONSTRUCTION AND PLANNING POOL& SPA ,• - ' A „�//''� Date Inspector Date' r Inspector • APPROVALS Permit# Y APPROVALS' Permit# 1. . Temporary Electrical Service or Pole 43. Pool,& Equipment Location - " - . • - • •- - • - • - - -- . - .2. Soil Pipe-Undrgrn . 44. Steel Reinforcement - . - - -3. - Electrical Conduit Utility-Undrgrn - . 45. Forms • - i . 4. Electrical Conduit-Undrgrn - 46. Electrical Bonding • - - •-- - - - - .- ,. 5. Steel Reinforce. 47. Rough Plumbing & Pressure Test • - -. - - 6. Electrical UFER Grn _ 48. APPROVAL TO COVER-GUNITE - - 7. Footings . - 49. Electrical Conduit-Undrgrn ' • - - •• 8.- Foundation- - _- 50. .Gas Pipe, ❑Undrgin,Test ' , 9. Water Pipe-Undrgrn. . . _- 51. Backwash.Lines,P-Trio. ❑Undrgfn - • ' • ' 10. Structural Floor System - • ' " - ' . _- 52. APPROVAL TO DECK - 11. Property Sewer Line & House Connection - - - - • 53. Backwash & Receptor-Final - . 12. Street Sewer Connection .. - - . . -- - • 54. Heater & Vent-Final- - - 13.- Rough Plumbing . _ __ - . _ • 55. Plumbing System -Final - - - 14. Rough Electric-Conduit - '- -- - 56. - Electrical-Final • - - • , 15. Rough Electric-Wiring . - - 57. Solar System-Final - - ' 16. Rough Heating& Air Conditioning - - . - - b6. Fencing&Access Approval , • • - , 17. Ducts, in Structure - -- _ 59. APPROVED FOR PLASTERING ' • 18. Ducts, Ventilating - • i -. - - . . __ r • 19. Gas Pipe-Rough &Test • - . • - - - . 60. .POO L/SPA SYSTEMS FINAL , ' ', - • -20.• Roof Framing - -- - - ; 21!-• -.Roof Sheathing - - • - - - • - '-" • 22: --Frame and Flashing • - -- NOTES: 23. Insulation -- _ . . . - - - 24. Lathing &Siding - - - • - - --- --• - -- - - - - - - • 25. Drywall Nailing -- - - l - - - - - • . 26. Plaster-Brown Coat -. • . - 27. Electrical Power Meter-Final --- - • ... . - - .-.- - . . .. - - • . 28. Final'Electric - ----- - - • - - - 29. Final Heating & Air Conditioning if h^ - €.4 • . 30. Final'Gas Pipe-Test - - - • • 31:- Final Plumbing ' . 32. -Water Service•Final - -- - - - . . _ , • •33. Gas Service-Final . . - _ _ - 34. Solar Domestic-Final•• ' ' • _ „ - - - ' • ' • ,. • 35. Landscape Sprinkling System- - •• - - - '36. Sound Attenuation ? ' ' . -. _ • - • - - 37. Handicap Regulations t - - , ' • - - , 38. FINAL STRUCTURE& BUILDIN? - - • , 39. Special Requirements Completed -' - • 40. Electric Release to Edison "' -'j _ i 41. Gas Release to Southern Californiatas Co. I 42. CERTIFICATE OF OCCUPANCY - - - ' • No ' Date _ .- - •- . - - I • City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. • Building Safety Division P.O. Box 1200 Costa Mesa,California • The Building located at 170 E. 17th St. has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2 Occupanc\ Use of Building five damage Legal Description 425-413-04 (See reverse side for Metes and Bounds) Building Permit No 854619 Electrical Permit No.E55441 Plumbing Permit No.P54965 Mechanical Permit No. M55217 . Number of apartments and/or guest rooms •• • ISSUED TO: Building fficial Tony C' De Baca J & J Properties --Bill Jewel 170 E. 17th St. - } '- by O�f/� Costa Moxa rn o9F9F April 15, 1992 Date ly This Certificate of Occupancy SHALL BE posted in a con .icuous place on the premises and SHALL NOT BE removed except by the \,/ Building Official of the City of Costa Mesa under Sec. 307 (el U.B.C. (11 CMF 1015-46 rev. 1/93 White-Owner;Canary-Numerical File;Pink -Bldg.Permit File PROJ[CT ADDRESS: 170 E 17TH ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM Na: B 054619 - OWNER'S NAME: J & J PROPERTIES ADDREss: BILL JEWEL PERMIT NO: B 054619 PLAN CHECK NO: 02768-91 5 GOVT: N SUPP: N • SAME CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: REP ARCH/ENGINEER: F DAVID CHAVEZ REG.No.: S1819 JOB DESCRIPTION : FIRE DAMAGE REPAIR AS PER R ORT SQ FT: 2, 000 ADDRESS: 7052 OWENSMOUTH AV UNIT: CANOGA PARK CA 91303-2005 CLAIM VALUE: 2, 000 . 00 CALC-VALUE: 2, 000 . 0 GROUP OCC: . B-2 / PERMITTEE: ROBERT MCCARTHY ( 714 ) 546-1130 ADDRESS: 3199 AIRPORT LOOP DR A3 COMMENTS: REPAIR BATHROOMS & CEILING C.M. CA 92626 ***********************************TF*******TF *** ** ,F**+F*TF***TF+FBF************x*Tr LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUI E . E N T S 7000)of Division 3 of the Business-and Professions Code,and my license is in full force and effect. E. T B A C K S CITY LIC.: 054524 STATE Ll , 661.7 c / Date:e).-o1-`Y 1. Signature:__ _ _ _ - MAIN BUILDING ACCESSORY BUILDING • ' WORKERS'COMPENSATION DECLARATION: I hereby affir at l have a certificate of consent to self-insure or a 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 POLICY NO.: 1137076 EXP.DATE: 02/01 /92 iiiDMPANY: STATE PARKING REQ PROV: • `PARCEL: 42541304 ZNE: C2 REF NO: Cenilietl copy— is hereby furnished. Certified cop ted/' city Building Division. / PLANNING NOTES INTERIOR FIRE DAMAGE , REPAIR, ONLY. . Date:_1/>_24 9i Apple Qj{�� / *************************************************ie***************ie***).E********* EXEMPTION FROM WORKERS'COMPENSATION OECLA'' ION: (T 'section need not be completed if t o permit is for one hundred(5700)or less). • DEVELOPMENT SERVICES R EQUIR E M E•^N'LT. S 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 Co 4DATE• . . B-) // Date: ' Signature: '� ' NOTICE:It after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: • Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; 1rT DATE: A42.1 (1,(- which this permit is issued(Section 3097.Civ.C). ****M.*..N..N.*3e**.N.***.y.**.***.x..1F*.tt.*.K.N..*A,-.k.*.***.****.y.****.* * *ie********.***3f.**if., (, * *><•**, LENDER: *******************************************************************JE*********** ADDRESS: • LEGALIZATION:N F E E SUMMARY - STRUCTURAL•/•SEGMENT:Y OWNER BUILDER DECLARATION: hereby affirm matt am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ' ELECTRIC ' MECHANIC FIRE SMI P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 4 5•. 0 0 repair any structure.print 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 700(1)of Division 3 of the Business 5M I P/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 29 . 25 . 50 ' • any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500), ISSUE FEE • 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----> 45 . 50 0 . 00 29 . 25 74 . 75 74 . 7 5 . 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,providedthat such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 45. 50 OVER/SHORT: 00 improvement is sold within one yearar of completion,the owner will have the burden of proving he/she did not build or improve or me purpose of sale). BLDG • FMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/TOT GRADING PLAN-CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45. 00 i . 50 ❑ and Professions Code. The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such protects with a contractor(s)license pursuant to the Contractors'State License Law). lam aware • ************3(.*******.)F********************************************.******,*,*.**•*.**.K. mat proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason TYPE QTY DESCRIPTIO N , UNIT COST TOTAL COST Date: owner: SFC 2000 FIRE DAMAGE/VAL COMMERCIAL NOZONE 1 . 00 2, 000 . 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 will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from . these provisions. Date: Applicant: _ • I hereby certify that Il have read this applicatio nd slate that the above information ist correct.I agree to comply with city and county / 'ordinances and stale laws relating to Building nsiruction aro Dy out rt'v epresentatives of this city to enter uponI eabove-mentioned property for inspection purposes ,� , / j1 _2.•1.x1!4/:?—CJ1C0.34. _ Date:/ __ Si. . /I ir. _ •17 b'4 E 1r;21i T r: _. _ —, . :1 ..1":“• 4 J Driver's License or Social Security v: 2 164246 White—Building,Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor .. • POCONSTRUCTION AND PLANNING-•\ SPA ' I APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector i 1. Temporary Electrical Service Pole '`t' 52. Pool & Equipment Location .t 2. Soil Pipe.Undrgrrid. in �-f 53. Steel Reinforcement n •3. Electrical Conduit Utility-Undrgrnd. (r 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test - 6. Electrical OFERGrnd. 1.. 57. APPROVAL TO COVER-GUNITE j • 7, Footings'= 58. Electrical Conduit-Undrgrnd. /iii 8. Foundation "" f 59. Gas Pipe, 0 Undrgrnd., Test -1 ,. 9. Water Pipe-Undrgrnd. 1'/' • it'Y.') 60. Backwash Lines,P-Trap, 0 Undrgrnd. '' 10. Structural Floor System dri7' ) - n? 61 . APPROVAL TO DECK -%n 11. Property Sewer Line & Houktonnection 2 62. Backwash & Receptor-Finalr > /, Fl 12. Sewer Cap ? tiji 63. Heater & Vent-Final 13. Roof Drains , ,,1, • , ' 64. Plumbing System - Final J 1 14. Rough Plumbing li r- 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 -- • r "70. Underground Hydro 22. Ducts, Ventilating , ' - 71. Product Piping 0Gas ❑Oil 23! Gas Pipe-Rough 8/Test • - , -72. Underground Flush • 24.-Roof Framing • _ •73- Undergrnd.Storage Tank 0 Gas 0 O 25. Roof Sheathing - . 74. Overhead Hydro - 26. T-Bar Ceiling (Structural) & Monocoat •i - 75. Dry Chemical • 27.'Frame and Flashing : ; . 76. Dry Standpipe - 28. Lathing & Siding. •• . 77.- FIXED SYSTEM..FINAL '29. Insulation ' •' .• ' - a 78,.•,FIRE PREV. FINAL _ , 30. Drywall•Nailing - I I: . HEALTH•DEPT, REQUIREMENT .31. Plaster Brown Coat • I i 79. FINAL INSPECTION - 32. Electrical Power Meter-Final • ' � t• . ,80.•FOOD CERTIFICATE ISSUED 33.`Finel Electric f • I li ' Notes: .f _ , 34. Final Heating & Air Conditioning, . • '. 35. Final Gas Pipe-Test i. • ' • 36. Hood or Canopy - - . - I 37. Final Factory Fireplace - '' 1 • 38. Final Plumbing ( • "39: Water Service-Final • • • i 40. Gas Service-Final - - - 41. Solar Domestic-Final .. t • t 42. Backf low Preventer 43. Backflow Irrigation • • 44. Landscape Irrigation System - , - , - • • 45.:Sound Attenuation ' 46. Handicap Regulations ��P . 47. FINAL STRUCTURE & BUILDING q `-� 48. FINAL PLANNING ('�. - 49.-ElectriciRelease to Edison • i ' • 50.,Gas Release to Southern California Gas Co ' -; f' . 51. CERTIFICATE OF OCCUPANCY - - No. Date /" PROJECT ADDRESS: 170 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 054965 ' OWNER'S NAME: J 8 J PROPERTIES ADDRESS: BILL JEWEL PERMIT NO: P 054965 PLAN CHECK NO: N GOVT; N SUPP: N . • SAME CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: REP 646-9663 ARCH/ENGINEER: F DAVID CHAVEZ REG,NO.: S1819 JOB DESCRIPTION : FIRE DAMAGE REPAIR AS PER REPORT SQ FT: ADDRESS: 7052 OWENSMOUTH AV UNIT: CANOGA PARK CA 91303-2005 CLAIM VALUE: CALC—VALUE: GROUP OCC: 3-2 / PERMITTEE: VALCO PLMB . ( 714 ) 636-1133 ADDRESS: 1140 NO. LEMON 3 COMMENTS: REF: B54619 ORANGE CA 92667 ******kE******4#*********+FSE*** * xarkE****>F*** Ear**+F** *** ** * * **x**>E * ******TESL LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC,: 040015 STATE LIC.:445599 711!.3._, /1— 7— Si Signature: / MAIN BUILDING ACCESSORY BUILDING ---04L, FT IN REAR ; FT IN FRNT; FT IN REAR: FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of co enc to self-insure or a certificate of Workers' LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN Compensation Insurance or a c rtified copy thereof(Section 3800.Lab,C). POLICY ND.: 116 /5 0 8—91 EXP.DATE: 01/01 /92 COMPANY: STATE FUND PARKING REQG• PROV; PARCEL; 42541304 ZNE; REF NO: #1 Certified copy is hereby furnished. L31 Certified copy is filed with the city e g Division. PLANNING NCSTES> —7 / eye...____ ************* ****? ********************* *****aria'***** ***************ie********x.* -.Qat_ 1/— / 7 ( Applicant: `y >ll EXEMPTION FROM WORKERS'COMPENSATION OECLARATION: (Ths section need not be completed if the pernut is for one hundred($100)or less). DEVELOPMENT S E R V t' C E S vY E Q U I R E M E N T S 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 tee Workers'Compensation Laws of California. ZONING APPROVED BY - •.,• DATE: Date: youSshre: BUILDING APPROVED BY • ode.NOTICE:It,cuter making this declaration,yh should become subject s the Workers'merempensation provisions of the Labor •_ ( DATE: Gods.you must forthwith comply with such provisions or this permit Shall be deemed revoked. 1 l—i'L•//)/G/ CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• >) ! DATE; (/ /7 �//J�/) which this permit is issued(Section 3097.Civ.C). *******1ETc**it************** '3E'iFfFTFiFiFfEfl +F if iF*w`v** .-Ay.#*****Rif*******9E****-Wthr"*-(-IFF,'r" /{.** LENDER: **************************************r •,*m **iF****iE***aF********iE*************** ADDRESS: • LEGALIZATION;N F E E S 'U M M A R Y ' STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l 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 30,00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SMIP/NON—RES pursuant to the provisions of the Contractors State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and 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 3 . 00 1, as owner of the property or my employees with wages as their sole compensation, wit eo the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 30 . 00 3 . 00 0 . 00 33 . 00 33 . 00 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through himprovr ement ownemployees,one year orovided fcompletion.at such rovements the ownerare nol wilt have theded or on burden of rpmv proving for he/she did not buver ild ore imipngor ove REVENUE DIVISION TOTALS--> COLLECTED • 33 , 00 OVER/SHORT: 00 or meparposeofsale), BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/SOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33 . 00 ❑ 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 projectswith acontractor(s)license pursuant to the Contractors'State License Law).l am aware ****************************************************le************************** 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 Date: Owner: PLU 6 WASH BASIN I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 6 WATER CLOSET (TOILET) 2 . 00 12 . 00 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 2 . 00 1 2 , 0 0 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2 , 00 these provisions. PLU 1 SINKS SERVICE / MOP 2, 00 2 . 00 PLU 1 URINALS, PEDESTAL 2 . 00 2 . 00 Date: Applicant: END OF. FEES I hereby certify that I have read this application and state that the above information is correct.I agree to comply with aft city and county 'ordinances and state laws relating to building construction and hereby authorize represe Ives of this city to enter upon the above-mentioned property for inspection purposes. C .. 31 @3:71—'; n..,r .. -r. — Dale. /( 7 - S. /signature: a r;• - = -. - -., Driver's License or Social Security#: DAT,. 7.:i'^i751. t�•"'' � ` �1 f• 1641-46 White—Buitdmg:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • �_ CONSTRUCTION AND PLANTING . PO(.•PA • APPROVALS Permit# l ate Inspector APPROVALS Permit # Date Insp .ctor 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE . 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 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 Framing 73. Undergrnd.Storage Tank 0 Gas O 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 ."1 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final rl 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy f frU 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE& BUILDING 48. FINAL PI.ANNING ✓. 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. 'CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 170 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 055217 - • ' DWNER'SNAME: J 6 J PROPERTIES ADDRESS: BILL JEWEL PERMIT NO: M 055217 PLAN CHECK NO: N GOVT: N SUPP; N 170 E 17TH ST COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: REP ARCN/ENGINEEN: F DAVID CHAVEZ RED.NO.: S1819 JOB DESCRIPTION : FIRE DAMAGE REPAIR SQ FT: ADDRESS: 7052 OWENSMOUTH AV UNIT: CANOGA PARK CA 91303-2005 CLAIM VALUE; CALC—VALUE; GROUP OCC: B-2 / PERMITTEE: WILLARD MEARS (714 )650-5916 ADDREss: 7591 DON DR COMMENTS: RE: B54619 PRIMARY BLDG• PERMIT, HUNTINGTON BEACH CA 92647 AtAt�E+EAEAt+E+s�E*�E+ESE***+E+r*�E�F�t�s�E****�F�F+r�E�F+t�EAFAr�E*�E*AF�EAE **+E***+e*******+b*****AF* ****Tt****** LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N Gs ERTEBQAUC I KRSE M E N T S 70001 pl Division 3 el the Business and Professions Code.and my license is in lull force and effect. CITY uc.:/006430 STATEUC.:278460 cuss: C-20 �--- Dare: �I r�I�j! signature:__ _ _ MAIN BUILDING ACCESSORY BUILDING WORKERS'COUPENSATION DECLARATION: I hereby axirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN REAR: FT IN LEFT: FT IN REAR: FT IN Compensation Insurance.ar a certified copy thereof(Section 3800.Lab.Cl. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: PARKING REQ_:_ PROV: PARCEL: 42541304 ZNE: REF NO: _�TMPaxr: PLANNING NOES> �'Certified copy is hereby furnished. 0 Certified copy is lied with the city Building Division. > ******************************U****U************U**if*************************** Dale: Applicant: DEVELOPMENT SER-VICES R E r� U I R E M E N T S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permithundred is for one (5100)or less). >,r I cenily that in the performance of the work for which this permit is issued.I Shag not employ any person in any manner so as to became subject oto the Workers'Compensation Laws 01 California. ZONING APPROVED BY DATE: Dale: Thu( y/ sipnamre: GO ,�LP4w / BUILDING APPROVED BY • NOTICE:II,(((ner making this declaration.you should become subject to the Workers'Compensation provisions at the Labor DATE: Code.you must lonhwith comply with such provisions or this pewit shah be deemed revoked. r '�/7/ / CONSTRUCTION LENDING AGENCY: I7erCby Cl.irm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY' f� / DATE: .21J*/ CONS RUCTINN (Section 3097.Ieby CAPPLICATIO *ISSUE**BYUC SELL * �t Y.** * * iF Lir****i4*********Pae *** *** LENDER: *************ULA******************U***U**** * **SIC*U*****iE**CIU****UL**U***U*** ADDRESS: LEGALIZATION:N FEE • S U M ARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the Meowing 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 36 00 repair any structure.Oar to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SMIP/NON—RES pursuant to the provisions al the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 Cl the Business p LAN and Professions Code)or that he/she is exempt therefrom and the basis lot the seeped exemption.My violation of Section 7031.5 by ISSUE FEE 15 .00 any applicant lora permit subjects the applicant to civil penalty of not more than tone hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK 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----> 36. 00 15. 00 0 .00 51 . 00 51 . 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 NS or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 51 .00 OVER/SHORT: 00 40 improvement is sold within one year of carnal¢tion,the owner will Pave the burden of proving noshe did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK lot the purpose 01 sate). i,as owner 01 the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 51 . 00 ❑ and Professions Code: The Contractors'Slate License taw does not apply tto owner of pr who builds or improves thereon ***CU******UU*********UCCiEL*****C***C**CI*******************C***L*CSC********** and sumo contracts for such protract with a eta)xcense pursuant to 1h¢ enlractots'Slate License Law).i am awme that proof of their Workers 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 Date: Owner: MEC 3 REPAIR/ALT COOLING UNIT/SYS W/CNTLS 9 , 00 27. 00 Iso hereby certify than am aware of and understand the requirements of California Health and Solely Code Sections 25505,25533,and MEC 2 VENTILATION FAN CONN TO SINGLE DUCT 4 . 50 9 . 00 25534 and that I Or any future building occupant wilt/will not(circle one)need to comply with said stale codes and the reouirements for a END OF FEES permit for construction or modification from the Air Duality Management District,Residential construction applications are exempt from these provisions. Date: Applicant: Thereby cerldy Thal 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 for inspection purposes. r Date'_(1f�/q( Signature: CG� l—`d - r,�,,: s '•�•r ._ . _ .. . . • Driver's License or Social Security w: t64t-46 Wbne—Bwtdmg:Green—Cade Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ; ( CONSTRUCTION AND PLANNING POr99'PA APPROVALS Permit,# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole �.., 52. Pool & Equipment Location St =" i 2. Soil Pipe•Undrgrnd. _ '„. _ 53. Steel'Reinforcement r' •f• 3, Electrical Conduit Utility-Urthrgrnd. 54. Forms ,,---- 4. 4• Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.:Steel Reinfprcemeni 56. Rough Plumbing & Pressure Test • 6. Electrical LIFER Grnd, 57. APPROVAL TO COVER-GUNITE ' 7. Footings • 58. Electrical Conduit•Undrgrnd. 8. Foundation , 59. Gas Pipe, 0 Undrgrnd., Test l 9. Waier Pipe;Undrgrnd. ke 60. Backwash Lines,P-Trap, 0 Undrgrnd. -'- 10. Structural Floor System . ✓‘ 1� 61. APPROVAL TO DECK Ys 11. Property Sewer Line & Housettonnection •-; 62. Backwash & Receptor•Final 1 12. Sewer Cap ' • `' A i 63. Heater & Vent-Final 13, Roof Drains I (1 64. Plumbing System • Final )1 14. Rough Plumbing - !r I 65. Electrical-Final 1' 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 r _ , - . APPROVALS.-L Permit# 21. Ducts, in Structure - - •:. _ ,70. :Underg!-Duna Hydro 22. Ducts,Ventilating i r _ - 71. Product Piping O Gas D Oil 23.,Gas Pipe-Rough & Test , k 72. Underground Flush - 24. 'Roof Framing : . 73: Undergrnd.Storage Tank'/D Gas D Oil 25, Root Sheathing : _ ' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &Monocoat -- r s 75. Dry Chemical 27. Frame and Flashing y r • 76. Dry Stanffpipe `- 28. Lathing& Siding•; - • • 77: FIXED SYSTEM FINAL 29. Insulation -4.- • 78. FIRE PREY. FINAL • • 30. Drywall Nailing . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coatr 79. FINAL INSPECT pN - 32. Electrical Power Meter-Final ' _ v ; • 80. FOOD CERTIFICATE ISSUED 33.' Final Electric . • ���Q:�;►' Nates: - ', 34. Final Heatintj& Ai4 Conditioning , p�� /��--y�Q=�7.( ' 35.. Final Gas Pipe-Test •' �Y /t ; • ' 36. Hood or Canopy .. • r . , • , 37.Final Factory Fireplace_ % • l.o . 38. Final Plumbing _ . C ` -- -39. Water Service-Final - • r s i _ 40. Gas Service-Final r ` ' ' 41. Solar Domestic-Final - x. : - i 1 42. Backflow Preventei - - ` . ' 43. Backflow Irrigation - . : • C ' r44. Landscape Irrigation System . `, y _ _ , . , t• - 45. Sound Attenuation • 46., Handicap Regulations - = ` - • 47. FINAL STRUCTURE & BUILDING �, 48. FINAL PLANNING /,. , • /v - 49: Electric Release to Edison jl f f, 50. Gas Release to Southern California Gas Co - I 1 %f' , ., 51. CERTIFICATE OF OCCUPANCYi - . - No. Date PROJECT ADDRESS: 170 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 055441 • • 'OAR'S NAME: J & J PROPERTIES `. e '• agaREss: BILL JEWEL PERMIT NO: E 055441 PLAN CHECK NO: N GOVT: N SUPP: N SAME CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE; REP ARCH/ENGINEER: flEC.NO.: ADDRESS: F DAVID CHAVEZ S1$NjT9 JOB DESCRIPTION : FIRE DAMAGE REPAIR AS PER REPORT SQ FT: 7052 OWENSMOUTH AV PERMITTEE: CANOGA PARK CA 91303-2005 CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / ADDRESS: BOYER COMPANY (714 ) 642-2431 1760AMONROVIA AVE A-20 COMMENTS• RE- B54619 PRIMARY BLDG, PERMIT COSTA _MESA CA.92627 **�E�k**+e�E****4 ***** **�E* ** *****�E******* . a6kF�E*�k�E>F>Eek*** �F * **�E*** *�E�E�6********** LICENSED CONTRACTOR DECLARATION' hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 71100)of Division 3 of the Business and Professions Code.and my license is in fug force and effect. SETBACKS CITY LIC.: 4dg49070 STATE LIC.:566902—LASS: C10 Date:_in--/CP 9/ Signature:/at...- MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN Compensation Insurance,or a cendied copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY No.: 113 7 4 2 4—91 EXP.DATE: 04 /01 /92 COMPANY: STATE FUND PARKING REQ: PROV: PARCEL: 42541304 ZNE: REF NO: O Certified copy is hereby furnished. Cd Cenified copy is filed with the city Building Division. PLANNING N TES> > Dale' O�/ Applicant:S---- **************************Ic******3E1}*************x***le***x•*******#******iE***if*** ^ EXEMPTION F WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(5100)or less). D E V E L O P M E N T S E.3 R VICES REQUIREMENTS I certify that i the performance al 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:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : '� � DATE Code.you must tonhwith comply with such provisions or this permit shall be deemed revoked. ; CONSTRUCTION LENDING AGENCY: thereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED ,, r * 0 ' ' **/ * **** ******�**D******)x3/Viii, * which this permit is issued)Section 3097.Chi.CT -0144 it Ti LENDER: FIRE DAMAGE REPAIR ***************>E********+E******** ********** . **************************+ ***** ADOREss: FIRE DAMAGE REPAIR LEGALIZATION:N F E E� SUMMARY STRUCTURAL SEGMENT;N OWNER BUILDER DECLARATION: I hereby allirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 4 9 , 4 Q repair any structure.prior to its issuance.also requires the applicant for such permit to Me a signed statement that he/she is licensed Pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 0 Y SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN • any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15,00 I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the 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----> 49 . 40 1.5 . 0 0 0_ 00 64 . 40 64 . 40 . 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 improvement is sold vothlh one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 64 . 40 OVER/SHORT: 00 for the purpose el sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK o I.as owner al the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 64 , 40 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who budds or improves thereon and who contractsfor 5uth projects with acontractor(s)license pursuant tothe Contractors'Slate License law).l am aware *,*. .x.*1F*1f.*.*1(.*1e*.1E.****.*1F*1(.1(-1ElE**.*1(.1(..x.{(.*.*.*.1(.1E**.1(.*3(.}*****-1F1E.aE************************3:** 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 Date: Owner:• ELE 14 FIXTURES LIGHTING 1 ST 20 EA. . 75 10. 50 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 16 RECEPT/O(JTLET 1 S ST 20 EA. . 75 12 . Q0 25534 and that I or any future building occupant witwill 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 ELE 20 RECEPT/SWITCH 1 ST 20 EA. . 75 15. 00 • these provisions. ELE 2 RECEPT/SWITCH ADDITIONAL EA. . 45 . 90 • ELE 1 SUB—PANEL 11 . 00 11 .00 Date: Applicant: END OF FEES hereby certify that 1 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 fMorriinspection nppurposes. ' Date:-!L/w/ '` Signature:y� '•il —n l r : r .i. '. _ .. . Driver's License on Social Security e: 1 \ 1641-46 White—Building:Green—Cope Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor 1 I 5 ' . C , CONSTRUCTION AND PLANNING - POO ,PA ._ ' ) ,, APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector i 1. Temporary Electrical Service:4r Pole �;� 52. Pool & Equipment Location• 7' 2. Soil Pipe-Undrgrnd. v� 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 . ;/ /i 59. Gas Pipe, 0 Undrgrnd.,Test •/te 9. Water Pipe-Undrgrnd. /4, 60. Backwash Lines, P-Trap, 0 Undrgrnd. / /_ , 10. Structural Floor System :I. it.." 61. APPROVAL TO DECK ✓7) 11. Property Sewer Line& House',ponnection / 62. Backwash & Receptor•Final / 11. Sewer C.31) 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 1c Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 1?. 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 - 4 • 27. Frame and Flashing . 76. Dry Standpipe 28. Lathing& Siding - 77. FIXED SYSTEM FINAL 29. Insulation ; • 78. ,FIRE PREY. FINAL r 30. Drywall Nailing . •;Ct. HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' I 79. FINAL INSPECTION 32. Electrical Power Meter-Final ! ` ! . ,80. FOOD CERTIFICATE ISSUED 33. Final Electric z-f1•Qz r ' N tes: 34. Final Heating& Air Conditioning ._ 35. Final Gas Pipe-Test • • 36. Hood or Canopy L/iJ , : - ' 37. Final Factory Fireplace • ? . • 38. Final Plumbing - 39. Water Service-Final /I st 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation • 44. Landscape Irrigation System ' • . . 45. Sound Attenuation 46. Handicap Regulations ' ' - • 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING / - 49. Electric Release to Edison <ii 50. Gas Release to Southern California Gas Cv I ,/,' 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 170 E 17TH ST UNIT: Y41 OF COSTA MESA — BUILDING PERMIT PERM NO: BE 052581 OWNER'S NAME: J Si J PROPERTIES' k'riO ADDRESS: SAME r U(G° PERMIT NO: BE 052589 PLAN CHECK NO: 02257-91 S GOVT: N SUPP: N I�Jy Z 73 Z CONSTRUCTION TYPE: PERMIT TYPE: ELE STR PURPOSE: NEW • ARCH/ENGINEER: 646-9663 REG.NO.: ` 3( • JOB DESCRIPTION : FOOTING FOR 540SF TEMPORARY TRAILER SQ FT: 2,000 ADDRESS: UNIT: CLAIM VALUE: 2, 000. 00 CALC—VALUE: 2, 000. 00 GROUP OCC: B-2 / PERMITTEE: BENCHMARK DESIGNS ( 714 ) 548-6695 -- • ADDRESS: 711 W 17TH ST F-8 COMMENTS: TEMPORARY TRAILER 1 COSTA MESA CA 92627 **********u+ ****+E****SEEP+E****sE**kE*sE*TE*IE******+E******sE*REr************+E****SE+E***** 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 Proles s Code,and my license is in full force and effect. / SETBACKS • CITY LI 04Q84R1 STATE LIC' 7478 cuss:/$�� Date: �A—'7 f Signature:_� _�/_� v _ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certili le of consent�ell-insure or a 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 POLICY No.: EXP.DATE: COMPANY: PARKING REQ; PROV: PARCEL; 00000000 ZNE• C2 REF NO: PER PLV Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N TES> LOCATE TEMPORARY TRAILER AS A RESULT OF FIRE DAMAGE TO > BUILDING, date: Applicant: 1 ************************ ******************************************JE;*********** EXEMPTION FROM WORKERS'COMPENSATION DEC RATION: (lection need not be completed if the permit is for one hundred 15100)or less). DEVELOP= MENT -- $--ER VICES R E Q U I R E M E NT'T S I certify that in the performance of the work for nth this permit is sued,I shall no employ any personn iinany manner so as to beco _ • tel \ subject?MeWorkers' (�,pjm ensation Laws California. /$ �y��/�� a 20NING APPROVED BY Co rY DATE: c�'o' .1,1�l/ Date: L{''Olg•• 1 Signature: `1/ / �l BUILDING APPROVED BY : -• � DATE: NOTICE:IL alter making this declaration,you should bec me subject I Ih rkers'Comp tion provisions of the Labor .r. Code.you must forthwith comply with such provisions or this permit shall deemed revoked. ,E CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: ' IG&L�-� DATE;; �P •2 which this permit is issued(Section 3097.Civ.C). *******************************t**** * **** *****************4**.* ** * ** LENDER: *******************************.*Yf********************************RF************* ADDRESS: LEGALIZATION:N FEE . S U M M A' R Y = STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby aliirm that l 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 45. 00 15. 00 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 50% SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business . PLAN2 9 . 2 5 ' . 50 and Protessions 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 penally of not more than live 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----> 60 . 50 15.00 2 9 , 2 5 104 . 75 104 . 75 , 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 TOTALS--> COLLECTED• 104. 75 OVER/SHORT; 00 isimprovement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING, ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business • 45.00 30 .00 . 50 29 • 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).f am aware ************************'K'**'*'*'*****'**'**'*'*'*'** ***'****'****'******'*****************'* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN El I am exempt under Section: B.8 P.C. tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFC 20 FOUNDATION BY VALUE PER $100 100.00 2,000 . 00 I do hereby certify that I am aware of and understand the requirements 01 California Health and Safety Code Sections 25505,25533,and ELE 1 TEMP SERV PWR POLE W/OUTL ETS EA. 15. 00 15. 00 25534 and mat I or-any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES ' permit for construction or modification trom the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: - DDlicanl: • I hereby certify that I have read this appllc On and state that the above information is correct.I agree to comply with all city and county ((E••••/// ordinances and state laws relating to buildi construction a0eautho(ze represeitatives of this ci to enter upon the above mentioned/properly fm. inspecli0n purses. 01 E:0009084 06/20/9 ,G91�Edt. '.•_;'^`pert'tr inssp_eeectinpuu i Dat Signature: � ', 11` _ DIE: 06/78/9' Pt"'Pt"' :o:;l Drivers License or Social Security x: 164146 White—Building:Green—Cade Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor _ POOIIPA CONSTRUCTION AND PLANNING APPROVALS Permit# , - Date Inspector APPROVALS Permit# _ Date Inspector 1. Temporary Electrical Servl a or Pole 52. Pool &'Equipment Location , 2. Soil Pipe-Undrgrnd. 4.o.: 0.i - 53. Steel Reinforcement r "_34Electr)±al Condp.irt ility-Tlndrgrnd. 54. Forms c3.'tElectrjtal Conc[t,t_{}Pdrgrnd. - 55. Electrical Bonding t: "3r& Steel weinforce'"i?nl -- 56. Rough Plumbing & Pressure Test •-IU.. �•-)nr rU CD t,•t¢• Electrical UFER;,�r,+.,�d. r� 57. APPROVAL TO COVER-GUNITE a. MLT.: Footings to .: 'v 58. Electrical Conduit-Undrgrnd. 0 :CO Foundation '-,'_ t' 59. Gas Pipe, 0 Undrgrnd., Test - o 9. Water Pipe-Unstrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Linc,& Hopse'Connection - 62. Backwash & Receptor-Final ._ 12. Sewer Cap 63. Heater& Vent-Final 13. Roof Drains ro. 64. Plumbing System - Final - , 14. RQUgh Plumbing (-• 65. Electrical-Final - ; 15. Rough Electri`Sl-Conduit 66. Solar System-Final 16. Rough'Ejectriewiring 67. Fencing & Access Approval x 17:-Rough-Wiring4igh 68. APPROVED FOR PLASTERING c 8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL '19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20,eRoagh Eactotly jreplace I x,rt Q=7 .4-1- 0 D „- * a.yAPPROVA1t9MOPerrJtit# ' >4 ;+ I- rr C T• K Ya. • 'CM" tre * `K J1 rr :k .-t ;c kr IAL-14-4 4-1.. * - fin 21s uc{s,iaSttyya i F:-' 7:S * ^t x 1/4*70. Ste' C n •t D7 'y U 'Al A.Mt i >i" , la ,--t - .a .1 '_• --Ci 22. Ducts, y!entOating* i OS 5 �.. 4--. 1%.:71. Produdi IIping 8@as 13Oil rr 23P Ga-Pip"e'•Roigh &'Test c " 71i- t 72. Under'r'hLnli FIS :tc 2' U' m ?1,-;-],"; .x I tr lr r�.J * 'J N r 1-.V > ri 1, >I G: 24WRoo• Framing ;r,;.; I HE- - e > 0 * 73r UndergrrTd.Storecja-Tank1O Gas O Oih rw _ -, ' n- _ -, I 25.nRobf Sfathing �x 4 - '..'„.4 rl: to r1i7••, Q .SUV' * 74Qveripad`1-iydr t-' c' �„ R m J, .a PJ O. s l.' * 261,T-tar Ceiling (StEyoturall &�Agnocoat'; ... ha rn-. r 7 ,-Dry Chemical '7 * -I C Err- -r ';r' Ss _ > C - ' FF z. :-.,."2- z'27 UFrame and FNash'Ink Ctr) i tj >.n x76-5ry Stanc%e . , xx 5 01 S V' a .25..Lathing We ind < i '-_'-'x tctn• * X �.r a 77c' FIXED &l'9TEM.~�.INALk L' Cu ¢t J O =- `_ ' r ' .' y¢ : ^ 1 ^. . 71 >'29. Insulatkpn c �x 0' - -- >..i.:, M -n i b.• *, 7:-' FIRE PREY. FIN�L * '-itr ',A 'op M% - :r p-30. Drywalf'Nagtng t•:y. s 7 a I F. +: ,liEALf DEPT. R•EQLIIR "}ENT • i.;31. Plaster 9fowMCoat, .c, 1n,rn • * I [; x 79.E FINAL I M;sPECT[gfIT * h r- >'� t-32�Electrica-J Po�er Mete`-Final, rf- 't�/•/j H, t80. FOOD CEf IFicISUEC} ",yc;4 - i'..33 (FinllE1ctric * I b'r ( ,/ r Nit�es: �' `X -! stn r , m n• .-, < ". C• : "5•-t .-r'-± 0P7 * s 7 m rn PJ34rFir l Fiiratin & R, CW1diti14J$ ,^,,-a I - t * x .n,J •S n a z C./a e.; 4 .fr „�. .n r ( ; ra -93 c i . 'v ". :iC 35tnFinel Gas Pipe-Testt '-gin * -b ; not, any; ins * tr. Q:0 -= .. r- ..r .• ,meq: a, • hp-. 36.'H ' ogCanopy * i-'1: Z -N * m • •••n * m ori :n fi ... 1 L*.'_] O'cf l- n ('t - . T nrn -r •r IrJ 1" H37CFin81 Factory Fireplace I sir o :r In 1.-,i . n * omit r 'L' J t_t c-- OC zI t, x .14 *. N `38 Fi Pumbin ` t ••• ••- 0 C 1 t P * LC x c RgI � g N I ctr x I .. r• :, s •-, * tV A.39:)'.Wawr "v,r' ice l.. J, n .Y 1 o -Final I ON 4 Y. om t 'x 0 * Cr f I . ..44. * N C40LGasc'Ser! •ce- ,nal c-ri x N .x s-0 • a .n !r1 t 7 6 •. m cc iv, S:2 -i- tn I P. :!. O-. ' Cuva Lc :L l.... in • ` L .1'r v, -1 .F - .,S < x41.-Solar Otvme&tic-Fint'j ••U * C' - + dl, t-- 44 r4243Backflow Prevent( `• N n ' ' tyt" x '" 0i ' S _ :,J 1.:rr - .! A. .t. 7 F • -- C 2-1;- 43. Backflow litigation t^.:,5 7 * * a' E-0 * 0 ^ Ono may,144. Landscape figati On Syste �tx 'x ..* * r - y • N a 3 0 00 nbtny,D Liz * ,1 C7 a v*'. Y' N N ccf) * N c0 -kg F.: e- C!-+ rrZ c-: r r+ ca rX< * ' ... - w' t • n' rr < • -r_ z 5Han 461:"' dicai Re ulati�ns O S O * to •• .-+t-- ••r y n 9 t-, Om t^ s • cu S 47gFIIA L ST Rit.ICTIr,R E & B .•LD ING r-. AN 1k' 1 N sc a• 't148' FIctAL PLANNING I tr'tr to A. r . !J LC [C 41 L^ .. (- r. H .. ,y) t•. R. ., ;;49,c El44tric Release to-Edison * *. rt• I x - o • - 50 Ga Reigase to So hern Califor ,a Gas Co Y I It -It - a olno./ *• �n' C TIFICATE OctOCCUPANCY '" ^ ? -'0 1.";;51. r * , ti o ..0 T--. 7 - ::::::- No. 'JNo. _ Date ,• Z ! _ Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. _ CITY OF COSTA MES 1C PERMIT NO. TRACT NO.- LOT NO. BLDG.NO. I 4305 2/ 1 5/84 I Gam.73 IL CONSTRUCTION PERMIT 'EP- /�3�3 13 • j- - - ' project Address a• • �/�L� S - TYPE OF CONSTRUCTION LI NEW ❑ ADD LJ�ALTERATION ❑ REPAIR - L.�'"� ' Applicant's Mailing Address . 3Tt r S4N M•4C/00 Ohl ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - ' A.P.' # 41). f) A115._ r'y71- zoneC� - r Owner's Nam•e hone - DESCRIPTION OF WORK T '/ n I ^T _ r, �p - /u �, AL/ � 7�c7/4-LS S Main Building: Accessory Builth g1 Z Address 9,9 73-- —'gt2✓/P_"G r��'IE�•z6F_K Y/yt"S—z TYPE OF PERMIT- El GRADING •❑ FOUNDATION !STRUCTURAL T Front N Arch/Eng.. • License No. ❑ TENANT ❑ ELECTRICAL .❑,PLUMBING ❑ MECHANICAL BA Rear Jr. N Address ❑ OTHER - DD _ Contractor's Name �/e Phone PROJECT DESCRIPTION SQ. FT. - OCC UPANC • 43-2. C Right 1}f�� G Address(mailing) - - CONSTRUCTION TYPE VALUATION$ / 0�� $ Left ,s/ (74, R• , ll E ZONE '" GRADING CU.YDS. ACRES Ping. Ref.4 . 0 City License No. �1 ParkFees $ U / LICENSED CONTRACTOR DECLARATIONRemarks: • Parking Req./Proviped9 1 I hereby affirm that I am licensed under provisions of Charter 9 (commencing / :R with section 7000) of Division 3 of the Business and Professions Code, and pC, ����t-,L s G: �8�f f1 �� se of Building: .r�`, •� � ��,�r]���.-i\ I E - my license Is in full force and effect. ` !( 6u !llrrr License Class License No. • PLUMBING FEES Planning Notes: Scat K I • •M Date Signature ' 1 Jt2T1\ 1�U4L N0�.1� 1KP�C/' �Z aH1Q J� E WORKERS' COMPENSATION DECLARATION Bar Sink Showers 0).12 1 p KTer1AA 9 f r�(i�t_G Wkuct- Ot .4 t v'Si' t 1.49.$ I• f1�'�T I hereby affirm that I have a certificate-of consent to self-Insure ora certificatereventer -• • --'1 •II 11� tt 1 1 /� • , of Workers' Compensation Insurance, or a certified copy thereof (Section Backflo Irrigation �` Service Sink 2 bG 'Y( ..y+ve_ V..e_ G\OD wit IAA (T_sLNC. y _ S 3800, Lab. (' - . Backflow Irrigation - Sewer Cap "- ELECTRICAL EES 1 Policy No.a Jr S?t .rrk mp y �'� • tczRCertlfietl opy is hereby furnlsned. ,� Bathtubs Sewer Connection 2 Of? Automatic Washer- - Transformer ❑ 15.50 KW Certif.) co led with the city - . ••"f•" visi• aii • 1 Date G Applicant, r• Clarifiers Solar CollectorsConstruction Pole Sub. ❑ 50+KW N EXEMPT FROM WORKERS'COMPENSATION DEC fT •N Dishwasher • Solar Piping(This section need not be completed if the permit is for one hundred($100)or P 9 Cooking Unit Meter pup to 100 amps less). Drinkin Fountains I certify that in the performance of the.wo�'k for which - s ••rmit Is Issued,i 9 Solar Tank Dishwasher Meter Dover 100 amp shall not employ any,Per n in any Man ller s to •--•• , ...• • te •••• workers' C gl05xf ws of CaIJJ.er�r la Floor Drains Swimming Pool w/Spa • Dryers ❑Gas ❑Electric Sub Panel - • Date �'--a-�JS/ �� ill Signature NOTICE:li,i iter making thls•declaration,you should beep- e .o ct to the- alFloor-Sinks - ' Urinal - 900 f Fan - . , Motors'00-1 HP,-01%-6 I 00 Workers' Compensation provisions of the Labor Code, y. ust forthwith _ comply with such provisions Or.thispermitshall be deemed revoked. Gas Servide Outlets ' Water Closet F.A.U. Ina Solar,❑9-15 HP 016-15+ s,:r CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance Interceptors - - , / Water'Heater - 0,9%-„... Fixtures 'r 'I-IVlicrowave of the work for which this Re)mit,isftssued (Section 3097 Civ. C.) ��GT' QQ2J Lender's Name A O N Kitchen Sink • Water Service 00 •" Device Boxes Pole Light ' • Lender's Address - _ G�''� OWNER BUILDER DECLARATION Lavatories l'A Dutleti._ �.r " r' • •'Range . ' .ra- • 2 f0 I hereby affirm that I am exempt from the Contractor's License Law for the P—Traps�+� following reason (Section 7031.5 Business and Professional Code: Any city or Switches ,Sign ' ' 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 Roof Drains " ' - Garbage Disposal -Standing Sections i to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 7000)of • Oi • vlsion 3 of the'Business and Professions Code)-or,that he/she'Is exempt - - - Generator 00-5 KW ❑5-15 KW 'Trash Compactor £;`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 civilReinspection Fee I $25 Issue Fee ' $ •3 ' •' • alty of not more than five hundred dollars($500). _ - I, as owner of the property or my employees with wages as their sole MECHANICAL - - Reinspection Fee _ ' $25 -Issue Fee' $ 3 compensation, will do the work,and the structure is not intended or offered FEES for sale (Section 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REOUIfl EMENTS' License Law does not apply to an owner of a property who builds or Improves ' Boiler • Hood or• Type I 0 ✓�V.� /� . • thereon, and who does such work himself/herself or through his or her own Zoning APproved•By - L/1 r--`t06 Data ___ �'' employees, provided that such Improvements are not intended or offered for Canopy Type II ❑ sale. if, however,the building or Improvement Is sold within one year of com- Duct-Under Ground - Building Approved By pletion, the owner will have the burden of proving he/she did not build or Im- /�';( _- Date prove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By �/ r Date - ' i, as owner of the property,am exclusively contracting with licensed con- ❑0-100,000 BTU ❑100,000-BTU tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES / The Contractor's License Law does not app o an owner of property who BUILO/NG'PERMIT $ 7�•SO- SMIP "' •�•(O� builds or Improves thereon, and who cont • for such projects with a ton- • Exhaust System 0 Multiple 0 System Repair/Alteration - , ( $ tractor(s) license pursuant to the Contra • e-Se Law). • • PLAN CHECK • $ • PERMIT" "• a 0 I am exempt under Section -9/E. Boson Firepl/Fact.Bit-ICBG 4 PLUMBING $ /37+000 ISSUANCE•• $• •I Date i Owner„ Heating System& Ducting Of) ENERGY•P.C.'• $•. 1t� the above ❑0-100,000 BTU ❑100,000BT ,PLAN CHECK ,25% $ I hereby certify that have read this applicatioELECTRICAL $ GRADING $ Information is corre• agree to comply with all city and ty ordinances and-state laws rel o bull•, • •-•nstr-coon, and hereby authorize repre ' pLAN CHECK X50% $ '2.2� MICROFILM'; $, " sentatives of thl a y - t - •.•dve-mentioned props y f . r r Inspection purpo / /���ttt ' MECHANICAL= '$ �' 2. 7 • • Signature '� S Date ) / / � TOTAL FEE $; /0 3 • Drivers' License or 55# ' � /\ CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - - - \, 1 • CONSTRUCTION AND PLANNING - • + . , ' . . : POOL ..SPA DateInspector 7 Date Inspector - ,r• APPROVALS Permit# APPROVALS Permit# - - 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - 2. Soil Pipe=Undrgrnd.. .�a//j7Y A 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 1, 5. Steel Reinforcement - 56. Rough Plumbing& Pressure Test ,- 1. •6. Electrical UFER Grnd. .. - 57. APPROVAL TO COVE R-GUNITE ��' 7. Footings - 58. Electrical Conduit-Undrgrnd. ' 8. Foundation . 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. •i - 60. Backwash Lines, P-Trap, 0 Undrgrnd. . 10. Structural.Floor System - • 61. APPROVAL TO.,DECK - -. . . - - - 11. Property Sewer Line & House Connection ::. s. .' - 62. Backwash & Receptor-Final / ' 12. Sewer Cap I 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final . - - 14. Rough Plumbing 74,/ $ '65. Electrical-Final i v -15. Rough Electrical-Conduit ,' i i .. 66. Solar System-Final - - __ - - 16.-Rough Electric Wiring . 3frisit CC 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. •dnderground Flush 24. Roof Framing. 1 - ' • 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. FIREPREV. FINAL HEALTH DEPT. REQUIREMENT �J / 30. Drywall;Nailing .? ./.pN62$%• 31. Plaster Brown Coat / 79. FINAL INSPECTION S-2yity C. Gj2Jw.V 32. Electrical Power Meter-Final - •• = /. .- '80. FOOD CERTIFICATE ISSUED . 1. • 33.,Final Electric . . •::,.. /'yj�ey CC Notes:Q) V Q -rune 'tutu (Looe , z(�,ta4r�ia(/ 34. Final Heating & Air Conditioning • ..-•th#1g v •-7(Am 1 eoq.varos< 35. Final Gas Pipe-Test • .. O ea* QO?.zi. 00c4- SA y1L 4' 36. Hood or Canopy , - • a' ��/^^^1 3 * Mt?, Oda• 37. Final Factory Fireplace _ - g - _ peovrd.. 55444 134QS or 38. Final Plumbing 1• : //MP( L.FD *or4or 7a Oae%.rr. Lu.'fl S'* 39. Water Service-Final 'q., Vf#I(o..f r ' c 40. Gas Service-Final © pea41741Z:r ��r 41. Solar Domestic-Final r r 42. Backflow Preventer - ' .-- lifgr #Ochi/ 44A/tif![1RrL o� 43. Backflow Irrigation t /71 (10414°Z % '`�3 ' (�QE7p r /' _ I 44. Landscape Irrigation System al I�/ao"" •ST ?•Zos Dont cc ric }I 45. Sound Attenuation - 46. Handicap Regulations parr sr ,N / ns4dK f>{CCV 47. FINAL STRUCTURE & BUILDIN • • / y �(1$ � , Si R Coat (A/aro r 48. Special Requirements Completed I r • S• s_n 91 / Ife ,Q�N/d:f 49. Electric Release to Edison 74��•"l•092 *erc � - i- L 50. Gas Release to Southern California Gas Co ` • - ��'777��411 ' `^ F ' ^n J i 51. CERTIFICATE OF OCCUPA�N�Y /...;_ e -21 '••JL-- 2 Ti-- 4�' �q No 000 (7 Date f.7 �c F I .) Y e. City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No.0 0 041 b Building Safety Division P.O. Box 1200 ...a_1‘• a— Costa Mesa,California r,.`,he,Build'iiig' hIocated at 170 E. 17th. Street Suite #115 as been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto . fora Group 8-2 Occupancy. Use of Building SatldwhiCh Shop Legal Description 425-413-04 (See reverse side for Metes and Bounds) Building Permit No -113b3 Electrical Permit NoJHP-11363 Plumbing Permit No -11363 0 Mechanical Permit No. Number of apartments and/or guest rooms /l (SIC ISSUED TO: - BuildingyOffici/ayl � . fJ & J Properties by / . ( _ -.),(a...."46-0„ 2985 Fairview, Costa Mesa. Ca. 64/1..21.1 QK Date {� This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev.1/83 White-Owner;Canary-Numerical File;Pink-Bldg.Permit File -..ECT ADDRESS: 170 E 17TH ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 05932C OWNER'S NAME: J & J PROPERTIES • ADDRESS: 170 F 17TH STREET PERMIT NO: B 059320 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE: ALT i; 771.-0927. JOB DESCRIPTION T/OFF REROOF W/GRAVEL SQ FT: 8, 760 ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: CLAIM VALUE; 8, 760 . 00 CALC-VALUE: 8, 760 . 00 GROUP OCC; B-2 / PERMITTEE: SOUTH COAST ROOF ( 714 ) 537-4312 ADDRESS: 11411 WESTMINSTER AV COMMENTS: * GARDEN GROVE CA 92643 ******#######################+E#####******#####ye#############*################## LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITYLIc.: 033631. s7ATEUC.: 3652 : cuss: C- 39 e`Q—/-92 Signature' _�_Q��✓�,7F�/1// MAIN BUILDING ACCESSORY BUILDING WORKERCOMPENSATION DECLARATION: Iherebya irm that acertificate of consent to sell-insure oracertilicate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN S' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance or certljjLLeaa copy thereof(Section 3800.Lab. POLICY NO.: 556540—`JL EXP.DATE: V4 /01 /9a . COMPANY: STATE FUND PARKING REQ: PROV: PARCEL: 42541304 ZNE; REF NO: TI Certified copy is hereby furnished. 12f Certified copy is filedilwiththecityy Building Olvisio . PLANNING NOTES> te�6'l— Com4 •( G.fle `� > Applicant' #################**#**#########*############1E#########*#####ik##iE##*#**##*###### EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . _ DATE: Date: signature: BUILDING APPROVED BY • NOTICE:u.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor _ , . / DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. p CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• e DATE• JO-1- i� which this permit is issued(Section 3097.Civ.C). ***************##**#*#• • ' ' - ' • • - ' - ' • '*#**#**#**w*********#* LENDER: **************#************************#** ' #*********************#*##******** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: thereby affirm that l am exempt from the Contractors'State License Law for the following reason PERMIT BLDG G8 PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or repair any structure.prior to its issuance.also requires the applicant for such permit to Zile a signed statement that he/she is licensed SMIP/NON-RE'$. pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 1 , 8 4 -'- and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by - any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($50x1). ISSUE FEE `" 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----> 109 . 84 0 . 00 0 . 00 109 . 84 109 . 84 r . 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 TOTALS--> COLLECTED; 109 . 84 OVER/SHORT: 00 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section, 7044,Business 10 8 • O O 1. ' 8 4 ) ❑ and Professions Code: The Contractors'Stale 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 ****#**-*****************************************************************1E****** that proof of their Worker's Compensation insurance should be provided to me, IND I V IDUAL F E E BR E AK DOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFC 8760 REROOF BY VALUE COMMERCIAL NOZONE 1 . 00 8, 760 . 00 I do hereby certify that I am aware of and understand the requirements of California.Health and Salety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said-state codes and the requirements for a I • permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. EXPIRED 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 Incomplete Inspections ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned \ proper/Int inspection purposes. I� 7 /y� ala, Date ._ __ Sig • Date: l0^/ — Signature: Yi �It I, •;l •r - - _- Driver's License or Social Security x: TI Aj `� t 164146 Mute—Building:Green—Code Enforcement:Canary—Apolicant:Pink—Revenue:Goldenrod—Assessor t • CONSTRUCTION AND PLANNINGi• POO' 1PA �- ,� Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# 1. Temporary Electrical Servicebr 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. r1 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 7. 9. Water Pipe-Undrgrnd. L 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 /y.' f4. 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. POOLJSPA 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 � [ .'t HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' .i 79. FINAL INSPECTION 32. Electrical Power Meter-Final t , , 80. FOOD CERTIFICATE ISSUED 33. Final Electric tk Notes: 34. Final Heating & Air Conditioning f•/ ' 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 t 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING -! E-X-P R E-D (i.sm.1- a fns•- titans 48. FINAL PLANNING 49. Electric Release to Edison 38i@ - - '3 Sig 50. Gas Release to Southern California Gas Co / i 1 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 140 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 060220 OWNER'S NAME: TITLE INSURANCE S TRUST ADDRESS: CO TR PERMIT NO: E 060220 PLAN CHECK NO: N GOVT: N SUPP: N TR #25-5443-00-4 i MASSE" RICHARD CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH 770 HILL�REST DR #13 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ADD POWER FOR TWELVE NEW EXHAUST FANS SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / PERMITTEE: PUMA ELECTRICAL CORP. ( 714 ) 544-0620 ADDRESS: 18551 GRAMERCY COMMENTS; NO 'B ' PERMIT INVOLVED SANTA ANA CA 92705 SF***SF:E**:FSE**+F:F***************SFSrSF*SF**:FSE******x:r**:FCFSE*****:E*******:F*******SF*****+E LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions o1 Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my se is in full force d effect SETBACKS CITY LIC.:057131 STATE uc.:6 5 5 2 4 4 • Date✓2 —5- 92 Signature: / / 7� MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a 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 + POLICY NO.: EXP.DATE: I COMPANY: PARKING REQ' PROV: PARCEL: 42544108 ZNE: REF NO: 7 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING Nt7TES> Date Applicant: .2)7 ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section not be completed if the permit is for one hur�W,r�(5100)or less). DEVELOPMENT S E R V I C E S R E Q U I R E M E N T S • I certify that in the performance of the work for which this permit is iss d, hall not e}}}gg9ppptoyer{on in any manneretras to become subiect/W 7the Workers'Compensation Laws of California. In// // / /� ZONING APPROVED BY : DATE: Date:! L� S' 7Z— Signature: ✓/L/ a�—+ NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions'of he Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. r„' C CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance.of the work for APPLICATION ISSUED BY: 1..J a • _/� DATE: 42 � 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 36,00 repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5j 0 t SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN x 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 live hundred dollars($500). ISSUE FEE 3-S. 0 0 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----> 36.00 15.00 . 0 . 00 51 . 00 51 . 00 . 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 TOTALS--> COLLECTED: 51 . 00 OVER/SHORT' 00 orimprovement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/TOT GRADING PLAN—CHECK imp the entis of d t. I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 51 . 00 ❑ 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).I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B. 8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: ELE 12 MOTOR/POWR APPARATUS4%0 — 1 .0 HP 3 . 00 36 . 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 will/will not(circle one)need to comply with said state codes and the requirements for a .fa , permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from . k these provisions. 1 EXPIRED Date: Applicant: te:nspections I hereby certify that I have read this application and state that the a'• -information is correct.I agree to comply with all city and county h `I_ � / 1 ordinances and state laws relating to building construction and here.• Drize repres tabu thi city to enter upon the above-mentioned (] Sig 1.1111 property for inspection purposes. / .XN� — ---- Date /a--S t" T-Z' Signature: - !i _- • - - Driver's License or Social Securitya.' I( 1 . 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor "� , / POOL ,PA . CONSTRUCTION AND PLANNING - APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2.,Soil PVipe•Undrgrnd. 53. Steel Reinforcement t -3.CilptrtralCondg iftility- 7ndrgrnd. , 54. Forms -1 I =7F.:Eteoi ieel ConduirU»drgrnd. 55. Electrical Bonding n 1:-t-,-,‹ t . Steil Reinforcer) acs. 56. Rough Plumbing & Pressure Test �:6; E4ectraealUFCR'Grnd. 57. APPROVAL TO COVER-GUNITE co ,'-1 F 'i s 1� `� 58. Electrical Conduit•Undrgrnd. rt G r. .a. / / V: E- Foundation _ 1, 59. Gas Pipe, 0 Undrgrnd., Test n„s T. Water Pi e-Undigrnd. ' -• ; P < 60.-Backwash Lines, P-Trap, 0 Undrgrnd. iti. Structural Floo;System L ' 61. APPROVAL TO DECK 1_l. Property Sewer Line&'House Connection - 62. Backwash & Receptor-Final y ' 12. Sewer Cap o : 63. Heater & Vent-Final ;,/ 13. Roof Drains N o 64. Plumbing System - Final 14. Rough Plumbi4 "Ll65. Electrical-Final .sI 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric` iring `,,/._,_:(444 //� ,i: S__<-,jl'JS� 67. Fencing & Access Approval 17. Rough Wiring 8ign7 77 =C 68. APPROVED FOR PLASTERING 18. Rough Electricg-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT ,-,. C C' . r.. t . .. '1 to tr.- Z r x :, tK 20.- o�tgh Fctd�l - lace Srr C-. A Et' 5. ; S Sr s.i S -• b.X * 1'j>PPR(}VA S? _.emit # x 'rz- 21 t.Ducts,imStrpctueex .. ,. �S' + S r•1* _ -,70. Undergrolihd'Hyero W 22.Qu s, V nt%atingJ x CJa S ] '' .t %}71. Product;Pi$in 0 0°Oil 23.CGaS 'ipe:Rou;.th 8i,rtest ?rS . . C .Z0* * "72, Undergroc.nd Flush; t Cs t• co 7 _ : • 24.•RodfFlaming Ox 1E- -- ^E- " > 0 's Ar573.=Undergrnd'.StoragC 'ank VGas 0011 "G ^J n ,r, cri C N7. % C •7 �'- % 25. Roo} Shgathing yc,xC . .,,, `r yr .2.- �/4i Overhead Hydro r. _ �- 26f T-Bar Ceiling (Structural) &Slonocoat 'r. J it G inv..) 75,SDry Chemjpal -'j r,- V ` rame apd Flasn w " 27ly h. S .f - .�c CcCtc. x rtr v m> X 76: Dry StandRiPe 26 x 5 t-28.-'Lathing& Siding-X PI -1T.1: -- -• ••, >. * S r 770'FIXED SY_$-..$ •>29. Insulati' ,t �c S _ lc * 78 jFIRE PR EV. FINA-_ 'c > t30. Drywall Nailing _1 M " X HEALTEWEPT;:R-EQtiIREMENT c31. Plaster Brown Coot S I nr I r 79. FINAL IN�PECTl *` r :-32trElectricat Power MefetFinaIt W N tr x c-r80.17F0OD CERTIFICATE ISSUED r 733:�Fin`g] E trig, x !T1 ' 4 TNo s: _ ',34.--Fin Hitmgt& Aie;Condition iqgj r ti .. .,v %'y .. S 35.'Final Gas Pip-lest' 0 c CC r. : fr 0E ? x _ c: x36.rHood ottanopy -.r : x 0 'c x A : ' s - - _, ,_ .. . =, -. x .., .y ,_-37.CFin31 Faptory Fireplace ST v ' ?t X •X . 3^ `� M t '*t 38. Fina{ Plttinbing _ a, x .e. i S i- A s . y .i r u r :39. Wet& Secvice-Final.< 1 -. �` * x C J'n g C _ % F. x i ti } * � t40. Gas Service-Final ;` .4.:D.:0 y' T, r a - CC; r r41. Solar Domestic-Finale; 0 x M * '.:,s r ` 40c " . i, _W = Cr x X. '42 i-8ackfloidPreventer` - * x .....•-•*- A x�` " I K 5 7 � x: C - :J _ .,r 43. BackflowIrrationW '-SJ a X s'- xC ti x y x ;, -: v , ,444. Landsca e l igatiop Systerrnv 1r - r - ' '' - .P r -t - iO Ci- T '. .1J a r. > C L R745."Soun - d Atterbatiore 4C. t,- F% a - -•lA : '' 7 rr r• j .. x n, in `., r :--r _ rti-Z- W ' - 6.Cuandicap.Regulations `� - .c '- - ,. x • - X S CC c 47. FINAL STRUCTURE & BUILDING r t .- y' < x t - -' t ,[ Y �- H Y i .i 48,`FIN7AL PLANNING; t--1.-• r ; -_ .« .r _ .� .= X l =�4 • c49. Electric Release to Edison x : is .. c-,50._.Gas-Release to SouQtern Califo[rlia Gas Co u I I z x - -_- c n Y51. CERTIFICATE OF.OCCUPANCY it ''•< J h f 1- V No. Date -__ _ - -" r �j/ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ • CITY OF COSTA MESA , I `r4 ��PERMIT NO. TRACT NO. •• . LOT NO. BL G.N% r r: • j • - CONSTRUCTION PERMIT .4 p , - �/ -• 4 • ; ' ' I „ ' - ' ' Applicant's Mailing Address i- ' • - "- 'O ' '/� ' ' • .-TYPE OF CONSTRUCTION: I U NEW U ADD U ALTERATION- REPAIR ' ' • - - •' ' ' Project Address ,/WE' X1/7_ St C-5."/re •//5 ❑'CONVERSION ❑ DEMOLISH ❑ OTHER . - - _ - - 39_1!1 :?/(IR/`.I - a^cn lr JaA/L' 6 77 ' ' DESCRIPTION OF WORK ' Owner's Name -lif/!��/4'li7�/�' Phone I - - • , ' ZONING REGULATIONS. ' - 'Address• 3481E — s4, e 2o0 - - - •. a TYPE OF PERMIT- Li GRADING ❑ FOUNDATION- U STRUCTURAL A.P.* 'ZONE -' Arch/Eng. • _ License NO. ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL' - PLNG.REF.#' - .-BUILDING r n r - I Address, I I • - ' - '❑ ,OTHER ,/ • • ' • • TOO UILDINRTY L NE ,fl EAR YARD (TO PILL I• I • • Contractor's NemP' •�/� ' Phone - PROJECT DESCRIPTION SQ.'FT. • - OCCUPANCY ' ._ CONSTRUCTION TYPE VALUATIONS LEFT SIDE YARD . RIGHT SIDE YARD - I . • Address(Mailing) - 1 - - I _ •• ZONE '.GRADING CU.YDS. ACRFS PKG.SPACE REQ. PROVIDED _. Licerise No. ; ' i LICENSED CONTRACTOR DECLARATION { ' • _ Remarks: - i STREET WIDTH I PARK FEE$ 1 hereby affirm that tam licensed under provisions of Charter.9(commencing , I with section 7000) of Division 3,of the Business andProfessions Code,and • - I SPECIAL CONDITIONS: - •' my license is In full force and effect. _ ' '' } - - I '. 1 ' License Class License No.! " I , PLUMBING _ i ) 1 - ! `_ ' Date-- ' Signature ' 1 1 : " I . ELECTRICAL I ' + , I WORKERS'COMPENSATION DECLARATION ! i f 1 Bar Sink Sewer Cap" i i. ` • o Meter Dover 100 amps sreby.afftrm.thzt I have a certificate of.copse tself-insure or.a certificate _ . Beckflow,Preventer •-- - - Sewer COnnettiOn�-- _._ . .. ... _Automatic Washer } , .- Workers' Compensation Insurance, or a certified co Dy thereof (Section _ - , ; adEO, Lab- C:) ; ; Backflow Irrigation Solar Collectors 1 Construction Pole Sub Panel' { , 1 • Policy No. Company '• •' 1 , - _ Cooking Unit Sub Pole i ' • ' �, BCertified copy Ii hereby furriished. ) i I 1 ( I Bathtubs I • Soler Piping t 1 certified copy is filed with the city Building Division- - Dishwasher 'Motors ❑0-1 HP D 1%-e I. ) Date - Applicant _ ; Clarifiers i • . Solar Tank j - • - ( ExEMPTIONTFROM WORKERS'COMPENSATION DECLARATION 7 Dishwasher ' Swimming Pool w/Spa 1 • Dryers ❑Gas -DElectric •Inc:Solar'D9-15-HP•016-15+` '• - - (Thls Section need not be completed If the permit is for one huntlretl (§100) or __ Iless) : ' I 1 • Drinking Fountains Urinal . I Fan( I • I I I certify that In the performance of the work for which this permit Is issued,I g Microwave I shall.not;employ any person In any manner so as to become subject to te - - , /F.A.U- I POIe Light I I ! Workers',Compensation-Laws of California- • Floor Drains. , j ' Water Closet' ,• , _ •/ ' • ' Date - Signature - - 1 - Fixtures I 1 :Range ' ,-NOTICE:If,after making this declaration,—you—should becou must act to the . , FIOor •$i0ks • .. _ _ -_ Water Heater.; - • . Workers' Compensation' provisions of the Labor Code,be deemedst forthwith - ! \ . comply with, such provisions;,or 'this permit (shall revoketl., ' - Device Boxes(� Mp$jg7- Sign _ ! On; p v -- Gas Service. . •Outlets : Water Service '/ CONSTRUCTION LENDING AGENCY , , • - - - I Outlets ' i • >•y.•t I hereby affirm that there Is alconstruction lending agency for the performance • • Interceptors ' , - f} , Standing Sections j ! F`� of the work for which- thin permit is ,Issuetl (Section •3097. Civ. C.), ' - ' - - Lender's; Name. { Kitchen Sink; ;; j • - Switches i TrasP Compactor ' OWNER BUILDER UILreir, t . . , �,. c '7, _ Garbage Disposal ( 1 t I OWNER BUILDER DECLARATION - ' Lavatories I + ..I hereby affirm that I am exempt from the,Contractor's,License Law for the > , - , , Generator❑0-5 KW 05-15 KW + t following reason'(Section-7031.5 Business and Professional:Code: Any city or • , I P-Trap; • , .. z . , , _ I ' - • 4 1 - I I county which:requires a permit to construct;alter,improve,demolish-or repair _ ,.r. Transfornier 015-50 KWI ' ,:any structure, prior to its issuance,'atw requires the applicant.for such permit Roof Drains - • • . I .. - f ' ' to file a signed statement that he/she is licensed pursuant to the:provisions of -. • ( 050+ KW' • _:Reinspection Fee $15 he Contractor's License Law,(Chapter 9(commencing with.Section 7000)of - •' ,ision 3 of the Business and Professions Code)ort that he/she is exempt ' Showers r' ,° ..,, - • I Reinspection.Fee $15 - S' efrom•and the,basis for the alleged exemption. Any violation'oY Section - - Meter Dup to 100 amps , , ' :Issue Fee d 1 •$ 7. I 1 by:any applicant for -a permit subjects•the(applicant to a. civil I 1 •-I 9 jService Sink ' Issue Fee $ • eery�,t8y'ot not more than five hundred dollars(§500).-f , . '+ I i ;, . •. ,, ) Zoning Approved By + i i I Date ' • bl"I, as•owner of:the'(property or my employees with wages as their sole - MECHANICAL' I 4 I I } •' ' i ' compensation will do the work;and the struct ureas not Intended or offered - I - Application Approved By - 'nate for sale•(Section 7044, Business and,Professional Code:.The:Contractor's - ' ) ' License Law does not apply to an owner of a property who builds or improves , Boiler'• •� ' -- Refrigeration System I , 1 I —q7 -J• ' ' , thereon;iand who does'such work himself/herself or through his or her own ' T r - -- ! I I Application Issued By i ' Date employees, provided that such improvements arenot intended or offered for ,1 DO-ioQ000 BTU Dioo000 BTU , .. I Duct-Under.Ground ., I ' sale. If, however, the building1hav -t or Improvement Is sold within one year Im- , I • .• , ( • t SUMMARY OF FEES - I • )teflon,the w111 have the burden of proving he/she did not build or Im- '' - - ! '•I • rave for the purpose of sale)'- - . .. '• • } Duct-Structural System Repair/Alteration • 'I ;BUILDING PERMIT $ - ' I I SMTP • $A • ' U I,as owner of the property,am exclusively contracting with licensed con- - ; " ' tractorsto construct the project (Section 7044,Business,and Professions Code: . _ _ Duct:Ventilating - _ _ (PLAN CHECK $ I PERMIT I The Contractor's License Law does not apply to an owner of property who ) - -' - { , I ISSUANCE ' $ I •• builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple❑, I I PLUMBING $ I - , tractor(s) license pursuant to the Contractor's License law). ' I 'PLAN CHECK i $ I ,1 ' GRADING $.4 - 0 rani exempt under Section B.& P.C.for this reason •i Firepl/Fact:BIt. ICBG 4f' , _ I t l Date Owner 1 I 'I ' Heating System& Ducting - . . It • (ELECTRICAL' $ ♦ - - , i ; .I $ • 1 _ _ PLAN CHECK. • $ 1 MICROFILM $.• I hereby certify-that-( have read-this application and-state that rdi above- ' ❑O-100,000 BTU 0100,000 BTU- - + - -. .s � - •, I ' information is correct. I agree to comply with all cityand county ordinances + i �!~ �- - I . • + TOTALFEE and•state laws relating t 9bulltll ng conslru<tlon,'antlhareby authorize y for I - MECHANICAL $ 1 Sr inspection fives of this,city,to•sam- er. upon the -•ova-mentioned property for Hood o, Type I 0. '- t Reinspection Feel , $15 , + LESS Inspection purposes.i/ -aalla' - • r• I ' Canopy Type II 0. " 1 . • 1 PLAN CHECK I $ I gDVANCED PC $ ' i Signature - ter/ i _ Date - • -A ' 1 r I 1 Registers I Issue Fee . $ 3, r i FINAL FEE' $ 3'"e • Drivers' License or 55 ��rLI. ' , ! I . - .. ___i . .. .__ _ _ .. _ _ CMF 0865-48 rev.12/82 White-Building;Canary-Applicant;Pink_Accounting;Goldenrotl -Assessor '- c'CONSTRUCTION AND�PLANNING v - • _ - -_POOL . ' Date, Inspector :Date Inspector . APPROVALS Permit,# E 6' 6 'APPROVALS •Permit - ' - _ . 1: Temporary!Electrical Service or,Pole - --52. Pool & Equipment Location - -, •, , , 2: 'Soil Pipe-Undrgrnd. - 53. Steel Reinforcement1. - • - fr 3: Electrical Conduit Utility-Undrgrnd. - 54. Forms ' •• - _ - ! • r4. Electrical Conduit-Undrgrnd. . - 55 Electrical Bonding ` ; ` r - • - 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test . _ - - 6: 'Electrical UFER Grnd. 57. APPROVAL TO'COVER-GUNITE. 7. Footings , - 58. Electrical Conduit-Undrarod. - - - 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 - . - ' 3 ' 15.`.IFtough-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 ' . ; , 72 '_-23:Gas-Pipe-Rough &Test." • r. i , .72. Underground Flush• r' '• 24. Roof Framing73, Undergrnd.Storage Tank 0 Gas ❑Oil ., 25. Roof Sheathing ,Overhead Hydro - - , _ ,�26. T-Bar Ceiling (Structura`I)i& Monocoat - . '75. Dry Chemical , " _ . , ':27."Frame and Flashing , ' . I - 76. Dry Standpipe- ^28."Lathing &Siding 77. FIXED SYSTEM FINAL. _ 29. Insulation:. 'r , ' . *. •78. FIRE PREV. FINAL , -,30.I.Drywall Nailing - . ' Notes: 31: Plaster Brown Coat , , . '32.rElectrical Power Meter-Final ' ' • 33.:'Final Electric :-_- - • 'crib Ab - - _ _ - - 34. Final Heating-& Air Conditioning rt. IP',' . 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. Solarpomestic-Final - _'. -. - -__ ._ , _ .� 42. Backflow Preventer t . - 43. Backflow Irrigation _ - •-I - 44. Landscape Irrigation System . . _ - 45. Sound Attenuation - , ' '. - . ` 46. Handicap Regulations . _ 47.•FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 4/ ` 49. Electric Release to,Edison . . ' .. . - _ , ' 50. Gas Release to Southern California Gas Co I 51. CERTIFICATE OF OCCUPANCY ' . .. .._ i ; , r No . Date • ADGRESSaBGLODG 170 E 17TH ST WIT: CITY OF COSTA MESA — BUILDING PERMIT ONNEASNAYEIFIewsnk J & J PROPERTIES PERM NO: B 080579 ''00R 170 E 17TH ST SUITE 110 COSTA MESA, CA 92627 PERMIT NO: B 080579 PLAN CHECK NO: 04900-96 S GOVT: N SUPP: N APPL.NWUND ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH ARCHITECT OR''': BERNARD C. ADAMS ttIC: C10183 JOB DESCRIPTION . 46LF-8FT HIGH WOOD FENCE W/GATE SQ FT; 46 ARDILORENG'BADDREss: 11022 ACACIA PKWY UMT: E G. G. CA 92640 CLAIM VALUE : 460 . 00 CALC—VALUE: 460 . 00 GROUP OCC: B / CDNrRAcrOfl a: PYRAMID FENCE COMPANY ( 714 ) 548-9662 CONTRACTORS IWC 776 W 16TH ST COMMENTS: ENCLOSE LANDACAPED AREA W/WWOD FENCE FOR STAORAGE ADDRESS: C .M. CA nada 313311 ***iE**xi<+L+F********+ + + ***********fkiL************Uk+kfEiE*******+ERE+ *+e**+i•****ti•*******Sr* 92627 WR: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:1 hereby affirm aider Pam*of Pedant that I am Evued under of Chaper P SETBACKS (wnvnendng with Section 7000)of Division 3 d the Buten and Professions Code.and my Borae is in MI and effect. cm UC.NO.:O/yp\6023 UC.CLASS: C 13 �LIG.NO.: 1 v11� E 06 (. MAIN BUILDING ACCESSORY BUILDING Date: 11 7 `c R(./ Canada VVI Q1 (")',"(,moo--_ fin : 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 panaky d Pet sue IMI I em sterna Ina the • a Law for he tdbwhg rason(Section7031.5 Business and Professions Code:Anycty a countywfiich marines a permit to suet Stet,improve. PARKING REQ: PROV: PARCEL : 42541304 ZNE: C2 REF NO: liceensedpursuantolish,a read ttto theprovisionsoftheits rWrnmdasuance.s License Laww(C for oaranerdnglwdtSedmni0001�Dnbsion3d the PLANNING NOTES> 46 LF, 8 ' HIGH DECORATIVE WOOD FENCE CONSTRUCTED NEXT TO AN Business and Professions Codal a Na he ads is exempt thadranand the brae for the soaped eaemptm Any violation d Swint > EX STORAGE CONTAINER. FENCE TO BE PAINTED/LANDSCAPE POTS PROV 7001.5 by any applicant for apermit atheist the applicant toecid penalty dnot more then the hurdled oldie)S.AOD. ******************)E**********************************IE*************-************ o owner of the property i;employees d � Nei imie °' n.uwwork.ard pp structure o �ya ffacedSsale(s on .B, and Professions The Contractors Liaedo appltooanOmer fthoDEVELOPMENT SERVICES REQUIREMENITS who bolds or mamas thereat and who does such teak lbmsef or heed a through he or her own engbyeee•provided that such 1 _ // C imaovernatls are rat intended a offered for sale.II.however,the baldi g a inawanal la sad within one year d completion.N. (AD � � I` "s7'1( L owner-bulder will have the burden d proving he a she fid al to a improve for the purpose d tido). ZONING APPROVED BY lrtrJlO� DATE; ❑ I.as owner d the props y.am eft hely maaairg with Bcenaed contractors to caesium the anted(Sedan 7044.Redness end Professions Code The Cavadas Lease Law does not apply to an owner of palely who baa Or improves thereon and who BUILD ING APPROVED BY : DATE:\ contacts for axN prgeds with a warada(s)licensed pursue:a to the Contrarian Wens.Law). ❑ Iamexempt under Secdnn: BYAP.C..for this reason: APPLICATION ISSUED BY: DATE: 1***** ************************************************ ************ ** Dm.: 1dohrryaertiydmIemawarealemaldrwrod.aairemetaSCdlawNwthwSaltoCedeSectiaaaws.2553.w LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y rearirsrmora lot a p�enne«onstructionnatm from that I or any future buldina Ai3 awill 1 wit nOt(negetWi dneed a.Reo mwooam�adioonnapstele Pcodes licetieWe ears from then BLDG PMT PLUMBING ELECTRIC ' MECHANIC FIRE SMIP/RES GRADING PERMIT 21 . 00 50 Dale: Appficwd: ,•/r SMIP/NON—RES • WORKER'S COMPENSATION DECLARATION:I hereby edam under panty d priory one d Moeda)thMoeda)declarations: PLAN 13 , 6 5 o I have and wil maidei,acertAcmd cassia ds eto euas for wodte&mnaerama.es provM ided for Sadie 3700 d the Labor ISSUE FEE 7 Code,lathpedaa performance of the work for which this p« ohoned. BUILDING > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ IMwerdailmaintainworkers'=nemeeis,insurane.asrequiredbySwa'vn870pdtheLaborCode.btePedamenadthe TOTALS----> 21 . 50 0 . 00 113 . 65 35 . 15 35 . 15 . 00 work for permit is which this permissued.My workworkers.ke •comPaalion romance carrierend poly number era: Carder: REVENUE DIVISION TOTALS--> COLLECTED : 35 . 15 OVER/SHORT: . 00 Pdhcy Numbr. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section reed not be completed iI the;emit u b ono landed dogma(St00(a less.) 21 . 0 0 . 5 0 13 . 65 ❑ I catty that in the performance of the week for with this permit is sled.I shell m empty any peace in err/mew so es to become subject to the workers'mmpersetion taws of Catomia.ed agree thaltl I alnddbecameatt(adtothwvbn' ******************************************************************************* compensation provisions el Swire 3703 d the Labor Cada I shell I Nose ProNdaa. INDIVIDUAL •1',.E E BREAKDOWN w---, Date: 11 '1—c— 4.4:7 Apothem Warning:Faure to Setae ambles'compensation coverage banawA4 and shoatGert an employer to armies penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thous M dollars($tOOO(g),In eddldon to the cost of compensation damper as provided lot In S.ctlon 3706 of b"s Labor Cod Interns,end attorney.lees. SFR 46 RES—PILASTER WITH WOOD,ETC BET/ FT. 10 . 00 460 . 00 CONSTRUCTION LENDING AGENCY:I hereby elfi under penally of perjury That then is a ai ms:M aian wiling agency for the END OF FEES performance of the work for which the perms is issued(Seaton 3097.Civ.C). LENDER'S NAME I LENDER'S ADDRESS: . • I certify that I have read this gpplkalion and state that the above information is cones.l Vee to comply with all dy and county advances 7 . .. and state laws retrain;to bathing corgtedia and hereby eutbce representatives d this dry to seder upon the above-meetksed popery UG l p g - 01 00219779-00219781 TOT 35.15 l��j,, Rid Nam. DATE: 11/25/95 TIhE: 10:11 t-'Vv ct ic- ` A . Date: 1 2-S-- �( SC+ (515146.W P) Wide'-Buildwp 1 Soley:Green-Ale:Canary-Appktant:Pink-Revenue:Goldenrod-Assessor -,-� - CONSTRUCTION AND PLANNING POC SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector • 1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings A�$9s ( . 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 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://3/p, F /14, �y- 4 / CuC t_ .(/O 34. Final Heating& Air Conditioning 2,4:07 /.�//�ydd Len /c'9`el 35. Final Gas Pipe-Test g//S /se-b,%_!./ -c�/O/�y 36. Hood or Canopy 37. Final Factory fireplace 38. Final Plumbing 39. Watet 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 '/q7 48. FINAL PLANNING r/ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date Millir PROJECT ADDRESS: i70 E 17TH ST UNIT: 117 CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 049701 OWNER'S NAME: BILL JEWELL ADDRESS; SAME # 110 PERMIT NO: B 049701 PLAN CHECK NO: 06315-90 S GOVT: N SUPP: N CONSTRUCTION TYPE: V-N PERMIT TYPE: STR ' PURPOSE: ALT ARCH/ENGINEER: 64609663 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : T. I . BEAUTY SALON SQ FT: 1 , 289 PERMITTEE: CLAIM VALUE: 4 , 000 . 00 CALC-VALUE: 44, 728. 30 GROUP OCC: B-2 / ADDRESS: N D QUALITY CONSTRUCTION ( 714 )891-1873 E1�'39'22T CHERRY ST COMMENTS: T. I . BEAUTY SALON N. hnl7if INSnTER. CA 92683 1EifeE#4t1f1E4tBEBtkiE*4**#Rt*aERt•IL•REREREIE*if•Nif«*******iE****if BEBE*iti ****1EtE*4f****BE�t•R@iEBEBE****#Bt*3E*if1E�E LICENSED CONTRACTO ere y affirm that I am licensed under provisions of hapter 9(commencing with Section Z O N I N G R E Q U I R E M E N T $ 7000)of Division 3 xl the Business and Professions Code,and my license is in full force and effect. S E T B A C K $ CITY LIC.: STATE LIC.: CLASS: 051721 477212 B I Date: Signature: MAIN BUILDINGACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell.insure or a certificate of Workers' FRNT: FT IN REAR: FT IN ' ,4‘;11 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 POLICY ND.: EXP.DATE: _ __ COMPANY: --- PARKING REQ• PROV: PARCEL" 42541304 ZNE; C2 REF NO: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the City Building Oivisir PLANNING NOTES> PROPOSED INTERIOR MODIFICATION FOR A HAIR/NAIL/TANNING SALON Dale: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred($1W)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify Thal 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' Signature: DATE: NOTICE:II.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 • �� ��' which this permit is issued(Section 3097.Civ.CI ***,,***,*,*,*,*•*•*,*,*,*,*,****** __._._. *,***D**** * �** * LENDER: **************************************** *************************il-dE.*********** ADDRESS: • LEGALIZATION:N F E E S M MAR Y STRUCTURAL SEGMENT:Y L.': OWNER GUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason ' BLDG PMT PLUMBING ELECTR MECHANIC FIRE SNIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or repair any structure.prior to its issuance.also requites the applicant for such permit to tie a signed statement that helshe is licensed PERMIT 382 .00 pursuant to the provisions oche Contractors'Stale License Law(Chapter 9(commencing villi Section 7000)of Division 3 of Business' • = SMIP%NON-RES and Prolessions Code)or that Pe/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 248 . 30 6 , 71 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, wig do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL e c PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 388 , 71 0, 00 248. 30 637, 01 -• '• 637, 01 , 00 • does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or throughcil his or her own employees.provided that such improvements vet intended or offered for sale. If.however the building or improvement is sold within one year of completion,the owner will ave the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED• 38 8, 71 OVER/SHORT• 00 for the purpose of sale/. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT:; GRADING PLAN-CHECK I.as owner of-the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 382. 00 6 .T7,lo ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ********-*****,*************************.****.*********.********:******************** • that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under section: B.8 P.C. INDIVIDUAL F E E B R E A K D O�`W .N; for this reason: TYPE QTY DESCRIPTION UNIT COST, TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of Califo is Health and Safety Code Sections 25505,25533,and SFC 1289 STO-TYPE V-N -AVER r o... 34 . 70 . .,•.. 44, 728 . 30 25534 and that I or any future building occupant will/will not(circle one)need to imply with said state codes and the requirements for a END OF FE: S permit for construction or modification from the Air Duality Management District. •esidential construction applications are exempt from l these provisions. r I he _ Applicant: I /I I hereby s and that I have td thisapplicationupant wiandisrelating construction and hereby authorize representatives of this city to enter upon the above-mentioned property lot inspection purposes. , 0 \\. \— ---• Date: Canary—Applicant:Pink—Revenue:Goldenrod—Assessor !)) ICONSTRUCTION AND PLANNING , ..OL & SPA APPROVALS Permit# \. Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 1+TReinforcement ,3. Electrical Condulf'_Uillity-Undrgrnd. �/ 54. Forms • :4. Electrical Conduit:Undrgrnd. --/ 55. Electrical Bonding -5;Steel Reinforcerner}ts 56. Rough Plumbing & Pressure Test . 6;iElectrical UFER G Ad. 57. APPROVAL TO COVER-GUNITE ,_ r `7. Footings ,--t,-, ✓ 58. Electrical Conduit-Undrgrnd. c u ; 8. Foundation -,. "{ 59. Gas Pipe, 0 Undrgrnd., Test 't 9. Water Pipe-Undrt-g,-rnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural FloorTSYstem 61. APPROVAL TO DECK 11. Property Sewer'Line:& House Connection , 62. Backwash & Receptor-Final 12. Sewer Cap S n 63. Heater& Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing "- 65. Electrical-Final 15. Rough ElectricaLConduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval *17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical.,-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 7' v 20. ,Rough Factory- Fireplace r p�lr1 '3'i O b ". + APPROVAtS1.j(P,erm t# 'fr '. r) <rr tr<r n. i_, rrr • (1, j r1):-.f-• •-• n 11.1' 21. 'Ducts, in,Structur I ... „ r-+S S k x x-70. Undergrpurid-Hyc ro , to 22. Ductr,, Ventilating�> i tJS S <t'e I..1. ProductlPi-ping Ott ❑Oil i n r +r+.-. 23. Gas Pipe-hough& Test 'r' '' "r - " ..Z2. Under roun'd�Fluih : 24. RoofzFraming•• I r-- ••, y > 0 tr > 273.7Undergrnd;Storage;Tank OGas 0 01 25. Roof Sheathing RI 1 111 to O `'''' ' X74•ro`verh'-d I: dro'- "c. .1' � i. 26..T-Bei-;Ceiling (Structural) & Mx.onocoat �? ' ,+t h t j a 75.Wry Chemical '7 <:I- C u 27. `Frame and Flashing- /q� ' 9 u^,c:s. Es; I �� U� ,� rye n 76.t0i� Siandpi�e O� , `: l-; O 28. Lathin & Sidin s -I -tt.: t _ I �•1 d z ' 9 9 _ ; Cs: M1c) >. -- t -•+ < 77..:FIXED SYSTEM-F:WAL* >4 29. Insulation • ,.,r S I,!h y 78.'.4 I R E PR EV. FIN 46 7 tr.; -30. Drywall Nailing 'j' n " s �l h' : H HEALTHOEPT:REQUIRE1VIENT 131. Plaster Brown•Coat ` _ El] t+ i ''�;. ' ,79,rFINALINSFECTI0Z "' C' tr. I 'r lr• r.0 ♦ r l r 1 t- 32. Electrical:Power Meter,•Final I ' ' C x co 1, I (80.;F,OOD CERTIFICATE ISSUED ,33.`FinaTElectric I I e' 4 Ill I I fr ? -Note's: 'T =' * - _ .r n: a5:_ .. t I.t a t r - -:n: r O 141 - - r" _ - S � y-, '•� t.:V ', 3: I t(; * .. CI till ! ; :34. ,F,inal-Heating& Air lConditioriing• .- „Cy a: I AL * k- s r S L . -- 35.1F-trial-Gas Pi p'e;Test ^ `� =�'• x. - I I Ij:I ' ,,,,: [:,a tRS * t" " - 36. Hood;or Canopy .: .--;e4i "� tr,.-. . ce; x I 'i/ .�Y�� a.�. �6r2 �/` 37. Finar'Factory Fireplace'. i ;I'-r' -' r ( I Ii; `- y .3 ' C ; >. Cr; I ; .y 'a, • 38. -Einal,Plumbing x ,. r '' .iWI _ - i S -t _ w r - .39. ater.Service-Final - ' ' 1 --•O , li I 1 .1 -- � ri . 'y o r. n S I is t 1 " Y re _ i (T+ ' " r ` °' "t40Gas Service-FGial ' l E It. . ' :rl ,.t1•(r .Scr Ot-- .CJ r 41.:Solar Domestic-Final ;S :-.i. .• ‘-•:..Zy '_ I1,,, jir• c 1--; x, 7 `42.`Backflow Preventers ' CO �fS " I ti!"' � �Frc • w • • 43. Backflow Irrigation ,r�"S v ; • - E X P I RCD , r • r. ` :n Incomole a trlSpect10h5 r • 44, Landscape Irrjgatiori System-in-0c u; - ! t7 t7 C ':'•St s o: CO astir -/ p:^ 00.44-Thi c .� y ` - , Date' l sig r 45..Sound Attenuation' a.,, t-- P:t + L..� .-, .. .. .'. rr1 tr, r:19 f F To' r K*,'. f- > 46. Handica Re ulatio s C ,z,...• ; pi `- •• -`r + i t"` • •- p.. 9- 2 OS `f t� S • C- ' S 47. FINAL STRUCTURE & BUILDING .� .+ - --1- I "v _ » - I C v F 48. ;F,INALPLANNING,' F i ni +t p; • 0.! 1Jt, x n .% s. :' 49. Electric Release to Edison - x I ;4. :3 _ L. . rti .r -tl ,50. Gas Release to Southern California Gas Co N. I I LA; C r1 , • 51. CERTIFICATE OF OCCUPANCY' t ?4 5 r No. Date 1 • I .___T. 1 t *4/D0REss: 170' E. 17TH ST UNIT: 117 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: EMP 049702 OWNERS NAME: BILL JEWELL ADDRESS: SAME U 110PERMIT NO: EMP 049702 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE; V—N PERMIT TYPE: ELE MEC PLU PURPOSE: ALT ARC"/ENGINEER: 64609663 REG.NO.: ADDRESS: UNIT; JOB DESCRIPTION : T. I . BEAUTY SALON SQ FT: PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / ADDRESS: N D. QUALITY CONSTRUCTION ( 714 ) 891-1873 11922 CHERRY ST COMMENTS: REF B49701 WESTMINSTER CA 92683 ;E**;E*;ESE***;E***;ESP;E**;Ex;E;E**;E;ESE;E;E**+E:E*;E;E;E***********;r**;E**;E;r;P******;r;E******;r**;ESE** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)01 Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LIC.: 051721 STATE LIC.: 477212 CLASS: B Date: Signature: MAIN BUILDING ACCESSORY BUILDING `WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to selbinsure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN 'ompensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ,OLICY NO.: EXP.DATE: COMPANY: PARKING REQ; PROV; PARCEL: 42541304 ZNE: REF NO: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> . > . Date: Applicant: - ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the perm)is for one hundred(5700)or less). D E V .E L OPMEN T SER V I C E S , R E Q U I R E M E N .•T S I certify that in the performance of the woes for which this permit is issued,I shag 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:If,after 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: 1 hereby affirm that there is a construction lendingagency for the performance of the work for C��� 103'09 3 J� which this permit is issued(Section 3097.Civ.C). g ********MO*********BBYEk ��--- ® *,***D**** ( �`0�(J LENDER: ************************************* *****************************i********i*f7*** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason • BLDG PMT PLUMBING EL 7 CTR I C 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 4,00 0 0 5' 40 9 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN �� 2 5 Z . 0% 25% SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3, 00 15:00 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 18 . 4 0 3 3 . 00 0. 00 51 , 40 51 . 40 . 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 sate.II,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED• 51 . 40 OVER/SHORT: 00 for the purposeof sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 7.00 '2 0. 4 0 )24 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply loan owner of property who bmlds or improves thereon ; and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *************************.*********************•**,*,*•*************,******,****,*,**,*** that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.a P.C. IND I V I D U A L . F EE BR EAKDOWN for this reason: TYPE QTY D E S- C R I P T I O N UNIT COST TOTAL COST Date: Owner. ELE 12 RECEPT/OUTLET ADDITIONAL EA. , 45 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 REPAIR/ALT HEATING .UNIT/SYS W/CNTLS 9 . 00 5 . 40 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 9 . 00 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from PLU 2 SINKS, COMMERCIAL OR �INDUSTRSAL 2 . 00 4 . 00 these provisions. 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 _r I property for inspection purposes. Date: Signature: 0 1 00073124-00073126 TOT `Lti� Driver's License or Social Security o: Applicant:Pink—Revenue:Goldenrod—Assessor -I' CONSTRUCTION AND PLANNINL, ' . .SOL & SPA 4 APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector I 1: Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. 52. Pool & Equipment Location _ 53. Steel Reinforcement 3,tlectriial Conduit'Uiility-Undrgrnd. 54. Forms ._4ff'Electrical Conduit UpStrgrnd. 55. Electrical Bonding 1.5:? Steel Re inforcenV'l,Sjl�j 56. Rough Plumbing & Pressure Test rC.t ( .6y1lectrical UFERIG±nd. (.. 57. APPROVAL TO COVER-GUNITE n' .s. •'7. Footings l>-45-. of 58. Electrical Conduit-Undrgrnd. W •t?8. Foundation `ry "' 59. Gas Pipe, 0 Undrgrnd.,Test `C • 9. Water Pipe-Undnjrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. .10. Structural Floor-System 61. APPROVAL TO DECK It. Property SewerLine-& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap O 63. Heater & Vent-Final cu 13. Roof Drains to 64. Plumbing System - Final 14. Rough Plumbing' LI /x/17`74 65. Electrical-Final 15. Rough Electrica`fConduit 1 6 f 66. Solar System-Final r. 16. Rough ElectricWiring 7�1�/� /� 67. Fencing & Access Approval , (�"y 1" lrr I p ';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..fiou h FactoryFire•lace `•' ° ^1 tr '~W' o' * I- Lill tr g P : IXtn ti'1 0 tr1: z 'APPROVALSOO:Permit# . >, --'lt r• •-• hi rt• S`r , •e'kr• ire. y u £TI* x ^ t_ .-r 011--!r-1 ^., * r, tri r r • 21.,, n t �:•ar I L F >C`: .s: 1-1 y `11: '' _ 5 0 7 ,„ a: tri Du s, in-Struture;.,. cj? �. .,. 1 .. . :-r5 * s a ,y* 1• -70. Uridergroundtlydo ,r. 22. Ducts, Ventitating-r CjS j, \ Kt x c 1 +•, , r~ .+• rt 71. Prod uctPi,pl rig ❑$Ss ❑Oil 23. Gas: -pe7 tou`h &Test �� '� iY t-' ' • ^' ' ' g' 1 MS 1.v.] C .c Cr. i Fr�.2. Underground:Flu5�tj t F 24.(RookFraming: y.- • E.-.C-• ••f- * > 0 V * * t73.bUndergrnd?StoragetTank OGas OOW- Ls - •+ ht T • at • 1T , 25. RoofSheathing '- ' X P1 v Cr` r C `u' t •= PROJECT ADDRESS: 170 E 17TH ST UNIT: 7t CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05261C OWNER'S NAME: WILLIAM JEWELL ADDRESS: 170 E 17TH ST, #100 PERMIT NO: B 052610 PLAN CHECK NO: 02281-91 S GOVT: N SUPP: N C.M. CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH flLM1EN DRESS: REG.NO,: JOB DESCRIPTION : FOOTING FOR 672SF FOR TEMP OFFICE TRAILE SQ FT: 18 p ADDRESS: UNIT: CLAIM VALUE: 1 , 800.00 CALC-VALUE: 1 ,800.00 GROUP OCC: B-2 / PERMITTEE: JAMES SCHABARUM ( 714 )642-4223 ADDRESS: 170 E 17TH ST 213 COMMENTS: TEMPORARY TRAILER FOR 90 DAYS C.M. CA 92627 *******+E**************** ****** ***+E**+ERP***+Ex*+ESE******SE*:Eye**sE****************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Cade,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a 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 POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL: 42541304 ZNE• C2 REF NO: :1 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N TES> PROPOSED INSTALLATION OF A TEMPORARY OFFICE TRAILER FOR 90 > DAYS SO THAT FIRE DAMAGE BLDG, MAY BE REPAIRED. .le: ADDlicam: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: Qhs section need not be completed if the penin is for one hundred WOO)or less). D E V E L O P M E N T S E R V I C E SR E Q U I R E M E"N-T S 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 become1 subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: ' k /c \ Date: Signature' BUILDING APPROVED BY : DATE; ode.NOTICE:If,afterstmaking this dpuith s,you should become i subjectes the Workers' me revoked.abpo provisions of the Labor -. Code.you must forthwith comply with such provisions or this permit shag be deemed revoked. �_r;_., / / CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: - DATE: k�* # which this permit is issued(Section 3097.Civ.C). ***************************************** *********************** * * *** LENDER: *******************************************************************,************ ADDRESS: LEGALIZATION:N F E E S 'U M M A R Y STRUCTURAL SEGMENT:Y • i OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'Stale 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 41 . 00 repair any structure.prior to its issuance.also requires the applicant for such permit to life a signed statement that he/she is licensed SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7003)of Division 3 of the Business 2 6. 6 5 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN . 50 any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(SSW. ISSUE FEE I. as owner of the property or my employees with wages as theca sole compensation, v40 do the work. and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE 04 structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 41 . 50 0.00 26. 65 68. 15 68 . 15 .0 0 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTALS--> COLLECTED: 68 . 15 OVER/SHORT: . 00 improvement is soM Within one year of completion.the owner will have the burden of proving he/she did not build or improve for the purpose otsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK ' I.as owner of the property.am exclusivelv contracting with licensed Contractors to tonSlmd the project(Section 7044,Business 41 .00 . 5 0 26 . 65 ❑ and Professions Code: The Contractors'State License Law does non apply toc an owner of property wino builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ******************************************************************************* that proof of Iheir Worker's Compensation insurance should be provided to INDIVIDUALU A L F E E BREAKDOWN ❑ I am exempt under Section: B.8 P. for this reason: ' , a - / //TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date ' A�� � + �•/ �� t` SFC 18 FOUNDATION BY VALUE PER $100 100. 00 1 , 800. 00 I do hereby certify that jam aware of and understand the requireme is of Cal ornia Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that Ior any future building occupant willhwifl not(circle.ne)nee. o comply with said state codes and the requirements for a permit for construction or modification from the Air1.–bar Manage'ent a trkt.Residential construction applications are exempt from mese provisions V/// Date: Applicant: •` I hereby certify that I have read this applicatio and slate that the above informs is correct.I:gree to comply with all city and coca ty ordinances and stare laws relating to building , ' n and herebyauthorze rep es lativeso .city .enter pon the above-menti ed property for inspection purposes / 01 0009097e-00090980 •P C•2 ru:,.1 ti Z.17--- Sign.. Date: a 4/ e �I4at / DATE: 07/01/91 'ietE- 1A:0/ Driver's License or Social Security n: 1641.46 WnJe—Building:Green—Code Enlorcer�i-nn:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor • CONSTRUCON AND PLANNING POOL A , I APPROVALS Permit# Date Inspector APPROVALS Permll# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement r 1 .� . _•'$ ictrical Concilit.liiility-Undrgrnd. 54. Forms • o.4.nElectrical ConctlnUndrgrnd. 55. Electrical Bonding • o, 1 Steel Reinforcgth'nt 56. Rough Plumbing& Pressure Test viG•;tElectrical UFEittGrnd. 57. APPROVAL TO COVER•GUNITE-- 4442 'C 1740Pootings S� 58. Electrical Conduit-Undrgrnd. a 1,11 8. Foundation k-').."2 59. Gas Pipe, 0 Undrgrnd., Test u 9.'-Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, 0 Undrgrnd. 10.Structural Floor System 61. APPROVAL TO DECK ` 11. Property Sewer Lin&1& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains ry 64. Plumbing System - Final •- • 14. Rough Plumbiyg :� 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric?Niring 67. Fencing & Access Approval ;'1517. Rough Wiring $jg`ti 68. APPROVED FOR PLASTERING ,• 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air ConditioningFIRE DEPT. REQUIREMENT ' ;r'_ r..710"-:- >. c .C.: :. _ 7 C,-itt+F o: a. ;[3 20:r:RocIrgh pctoty F ieplace • Ql~ rt^ x O C tr r.. x *APPROVAL'SbOPetfiit # t >4 IT' cS �}, tt `Z }N x I S�T• 1 S . * :` 'S.• H:. > Ax iT n 21��utls, iM$t fi r,. :"r S x t C h * Li �' . . S x S G H_x r •-70. dergtopn� Hydro s I S: J 0 •h 22. Dusts, V$ntltatirf„Qx 1 :DS xt S i. )5 r'71. Product f ping ®glas Oil n i Q n 7 Hr. A -• I V M 23.;Ga$�ipe"">Roh &•' est i (CS *,fi b' x ..,72. Under r F C 0: : 4 c iei(j 4. a -rr. A X v S., A O rJ J . T :N - 24WRosi Fleming :nX I .•M x > S y* % '73xUndergrru?,StorgcsrankCGas 00iI 25. Ro0 Sljeathin Tx £ r t n`7 O .1* * A G v (-O % 9 C* v •- > Ni, .,. 74;gQ,verrtV HydrgD * .� .r f In ✓.a .i. --• rt J 26,JT-Sar Ceiling (Stetietural) 84;Ionocoat7 * w G Sr,* * .. .. 75YrDry Chemncal • -'I x 1-+ 0 0r r,. 5S .rr r r. 'I. r-* * 76�6'ry ant17.:'k a Fw + 27 °FrameaPd Flash?f* CO O * m * ;.' OS * S in • •-•, 1 1,;74=CC n x C > wok S t 1 � ;e I^rTi, t• J 'U J - a r ,C K • . • ) r. ti [0 ,2B. Lathing& Sidings*r-t 4--.14C-4 'i ru * t ••x * 770 FIXED SYS'tErcl$lNAlt !rt (.. n r '""r'. r`;-el . r ••I to •.c n +1-' t� . , >29. Insulatrn o 224 O :c•-4 *-* " .. .• 7G a; 'I' ' �: t. '-i S � I � ((;: * 78g:FIRE PREY. FINr[�L � ^, Q O Lw J t^ '.. .. .v -' .t. . . j A. x W .✓ -. I " ig 30. Drywall Nait cC* S- * { 1 {'• * H .HEALThtDEPT. R•EQYIREMENT ... 'it ' . o'__.-. l_ • •• le S !VOA. .n q31. Plaster{{`to �7 I E-4 *^ � 797FINAL I.qo ECTup'•t�N ; �' r >4 Fl, "1i : tr tr < • x I + :.ar. �.� i-.. m '.J L-32c Electrical Potter eteD-Final; ,i-^'- o. I � 8Qr,F00D CE�RTE ISSUED :fat 4 _ r n.: • Ci +. ' F` : C .. :^ •7 6x I tY i� ''- t*1 ',.r'. •'hales. C 7S * 335Firr�l E}�ClrtCf r. fi t•Zt� A I r: •- -tr1 -S '.' O :inn 'r1 Ii.0 rr x�: t :r'+ Q:.1 :!' w * -+ ti, cm: *. J n134nFirsl Meatino.&t5.cikt;onditiorui rt r+S :K 4. * ix S nrC +. t e0 r- t >... u" T i •> C A t 1-/ • (-.rC * I1 35t1„Firial : Pr% .Test ,'fx ';, . * •.. . s • 0 n[n tr,S :!. to KO - r (o x �. x t tr1 • ••:l ti( ir1 ni t36'SH 'D ot.Canopy i ^ :t C'•"! „S . it r+ E nrc. * -+:n 1. S .,. .l Y r . t+•7.1 • ' a m 't" n LI, nm _137PFin`dl F§tory Fire�jatrepc Sr cr * Ir; YXiOtt Ji K • . i .. .. V % L - c - -v-138;Firt41 Plgmbing x N ! r.:o• * - A S 1-4 * al !a I C C ry . , 4"C .. 39c"Warr Eat vice<Final,: I •'�!- -i: x . n rots, 1 Q x. --i O 1 Z 1 et x tC . •t CO * x rQ ICa N • 'ito 440.E Gas Se,vice-,Final t. E.,1 <m r s•} .* Iz, I ( it * Qa' •,n, A C .T. t v - a.' • * 4•S S41t-Solar Dbmeaic-FinslS 0t ••O '!r O' I I {{! :K tr y^� II_i * �, _ U! •7 -.4 it rr zc , * . 1 `42r"BackflOS Preventex r+ '1 ntr $ .^- I x H O.. ;f F 'S �. N c,,:1--, ,: :e Q .�� . • * ..i .y - { O. * 43. Backflow IrttAgatiorf •iNS :*t. _ * * i,;5-O * O ^ CU I tgapC 44. Landsce rigatiprQG n Systern gk M 7 e* M '• re N a:0 * .L' 0 z450Sound Attenuation -mi- t"1-- x E E- -' * ' I-+ Inc cc¢ * - rr :x .. r-s x ETI ;T1 •.,f4-_ ,•` •J' a' el; C v S l .. .5... .r . .. .. .. / �.-. ri tp O46`HandicaR RegulatI ns _. •,�,r. x _i Q 'S • Gv s * �}- fir_ 47gFINAL STRUCTLAE & BUSiiDING- T 'II r1 Mme' x/10 • n1 Sc 4. iT tr 1 x * ' /II e _ I ? 4 48�F1 4L PI.FtNNIN j r ' . 7.: •', to S + t> -• .497-Electric Release toxEdison o • 1 • • e * : x i r . ar ;} .r to A. 0 150 "Ga ReIase to Souihern Calif nia Gas Co • �` ' "• - ;51. CEfTIFICATE OF,;OCCUPANCYr. i T :na r47:"._! t- o No. Date 1 . _-- -- -._._—_____,______— r PROJECT ADDRESS: 170 E 17TH._ T UNIT: C7'TY OF COSTA MESA — BUILDING PERMIT PERM NO: E 052611 OWNER'S NAME: WILLIAM JEWELS ADDRESS: 170 E 17TH ST, *100 PERMIT NO: E 052611 PLAN CHECK NO: N GOVT: N SUPP: N C.M. CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : TEMPORARY POWER FOR TEMP OFFICE TRAILER SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 / PERMITTEE: JAMES SCHABARUM ( 714 )642-4223 ADDRESS: 170 E 17TH ST 213 COMMENTS: RE; #B52610 C.M. CA 92627 +F*+e*****4+E**4*** ******+E**********+E****+E***********+ESE*+E*****x************** *+E* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS • 70001 of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: A Date: signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a 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 POLICY NO.: EXP.DATE: • COMPANY: PARKING REQ• PROV: PARCEL: 42541304 ZNE: REF NO: 17 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> , > date' Applicant: *********************************4********************************************* ,l EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(8100)or less). D E V E L O P M DEVELOPMENT T S) E_R V I C E S R E Q U I R E M E N T $ 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 Ihoworkers'Compensation Laws of California. ZONING APPROVED BY . t'r:• fJ.• DATE: Date: youSshulnature' BUILDING APPROVED BY DATE: • NOTICE:1f..2lmr making this declaration, should become subject to the Workers'Compensation provisions of the Labor 'C -' Code.yetimust lorthvnlh comply with such provisions or this permit shall be deemed revoked. �-�X CONSTRUCTION'LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• a DATE• 9 which this permit is issued(Section 3O97.Civ.C). *********************4*********************fE*********************4* ***iF* **9F** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F. E Et 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 1500 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 50$ SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by 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 progeny or my employees with wages as their sole compensation, will do the wprk, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE in structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 15. 00 15 .00 0.0 0 30 .00 30. 00 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. It,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 30. 00 OVER/SHORT: 00 , Iorpthepurpnt is oseollsalei)hinone year ofcompletion,the owner w4lhave the burden glproving he/she did not build orimprove BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30•00 - ❑ 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).I am aware **************************************************************3A.j4*************** . that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E B R E A K D O W i1\-h— ❑ am exempt under Section: B. 8 P. \ vs 40f / .mr(Ns reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: ..-7:-/ —611 Owr /. ' &,Ai t LE 1 TEMP SERV PWR POLE W/OUTLETS EA. 15.00 - • 15. 00 I do hereby certify that I am aware of and understand the requiremen.of Calib rnia Health and Safety Code Sections 25505,25533.)rd • END OF FEES 25534 and that I or any future building occupant will/will not(circle o .)need .comply with said state codes and the requirements for a _ permit for construction or modification from the Air Quality Managem. t Di ict.Residential construction applications are exempt from , these provisions. D Date: Applicant: / I hereby certify that I have read this applicati and state that the above information rrect.I,,.�.T ee to ply with all city and county ordinances and state laws relating to building nstru here authorize re res ryes of it to/ter u/r the above-mentionei property for inspection purpo• Date:2/ --- if_— Signator It .Af ./ i • I 01 00090977-CUO?09'7 "reit Driver's License or Social Security 4: DATE: 07/01/92 TINE: 13:06 1641-46 White—Building:Green—Code Enforcem. canary—Applicant:Pink—Revenue:Goldenrod—Assessor - CONSTRUCTION AND PLANNING POOI A APPROVALS Permit# Date Inspector APPROVALS Permit #- _ Date Inspector 1: Temporary Electrical Service or Pole 7 .. ,t`A /�/�/5/ 2. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ✓� 53. Steel Reinforcement -- , :::......-,- . 4.1r, IActrical Concf it,Uttility-Undrgrnd. 54. Forms ,c.4;,Electrical Concur Undrgrnd. • 55. Electrical Bonding- • tr1*:'Steel Reinforceytii€nt 56. Rough Plumbing & Pressure Test i• C :_&;Electrical UFE18rnd. 57. APPROVAL TO COVER-GUNITE Ls LI N. : XtA;'Footings -..i' 58. Electrical Conduit-Undrgrnd. o )8. foundation ;N7 59. Gas Pipe, 0 Undrgrnd.,Test y`'t 9,-Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, CI Undrgrnd. 10?tructural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line,& House Connection 62. Backwash & Receptor-Final 1r) 12. Sewer Cap 63. Heater & Vent-Final ' v • 13. Roof Drains c 64. Plumbing System • Final �'•�;� 14. Rough Plumbing :-- 15. � 65. Electrical-Final , - 15. Rough Electric I-Conduit 66. Solar System-Final ,3'� 16. Rough ElectriciWiring 67. Fencing & Access Approval 'tea' _' v, ; 17. Rough Wiring i n 68. APPROVED FOR PLASTERING , ; 18. Rough Electric&-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL u 19. Rough Heating &r,Air Conditioning FIRE DEPT. REQUIREMENT I 20rt1RoL1gh cyctotY cplace I �-;.,.4; cft 4 a Ct * '',APPROVALSCoPemlit# x � ''- rr - t.^ rf Y', I C- Tve t rr* * !'I `5l. v'n]'.c_ '� x r NIZ1, Dl{CSS, �$tryuCt� • •• I-+S r S C :-,y x ;70. ,µnd §�tLyri� Hdro ,t • [� -a J ' S'-I- 4 •✓ + ,R !. ti Y It F 22. Du2ts, t�ftntllatirlgr . ':S * S atx Y '`71. produdt'I&bing OGas dOil ?3: Gafl'ipti•Ro h & (est ryaS a tl, >T C* * •' 72. Undergrt,np F > .3 24pRogf Framing h;- : 1-ice -- x: 5 r ' x :, ,•73x'Unclergrrid.StoeeeTankbGas 0Oi1 . ••m . •-- .` -,-v 9 ,. •-• , •14-t., 257-fTo f S!^eathing-Z '3 '" +T T+ cu x •-`7t Overheadvl-Iydr o`-" r, 26t T-ear CeilingISicturall &c ,' ' D1 ' •. •" x. r 1 �(Nonocoat * _ :y J [ar • 75^Dry Chemical ^1 .w- .-• s:, r� 27'.c•Frame and Flashing u '' '1' t K s 78'Dry Stanifp•�e E i : S ti Y ;l r x HMr.2 Cr 't i+l+ 'R a.:-r * v fU 28. 'Lathin Siding r ;: :: o' * .. ..;t * 77,^• FIXED S1tSTE'M$'INAl . . 5"29. Insulat'ipn • •n I * 7l FIRE PREV. FINAL ., x ,� S •• .y •r :Y. :K r U', r C30. Drywaltr�lailing - "" M , j e .IjEAL#H;DEP-6. REQL1IR.FMENT :: 'r. W civ :.c. 3 n31. Plaster Brown Coalt * • 1 I n, . I FI �` T ti.: C('• , . S 1 rr rri s. _ '32. Electric$I Per alter-Final'. :-: -92' �{i," Y r ,.FOOD Cgf f1Ft$�g ISS'ED 331Final ElEctric x : Cr 1-' I-' ! I JN. es: _4' "')7. -' to 5' en .� ::: ni I 5 y" (lie , ,- •7 trin: , * -) t^j to At,,34.-„Fici Fteati4& F,iL easoitipr1n * I [(,^ y. •,+ •, :""rig x 5 --i...7 -C JC . ".V. : ,r, :r . : Y 00 35trlFirsal Gas Piet-Test is s ' G'f 'r .^.ov. 0:`7 nS -t a" CO .7 •• .� I b: a !- •MO C;� ;r. L•q •i ` •;:: I . 'lc * ` v. • ..tl .t tri r, X36 Ho19d oinCanopY x _ •� a yr, ; •..* :; t z ho 3._r. tntr 1. �370FhtYl Fettory Fireplace Si~ 4 * th I * y + t'i Ili 38. Flip) P mbin '' w^ "' t r?: x < cr x r•.;3@. Water Service-Finale n :r r C? t-•'^ r 'X A S• I :a. U: I H. :.- 1 to ,-n40. Gas SeriSice-Final ,`.' rl.t 4,.,r,., V w r-t 'If Y inti'. • * m e, ... 1 00 ON *. 't.. +-• P. rte.-' ;:I - .r. - --X35-�'!-'_ t41. Solar Dzynestic-Finals n •• :r r1 F x <a I-- .n ... m x rt, ,-C tr x T 42=Backflopy Prevente r Cl, ~ -' I; * 1-i �'� S 'll •Y . a '_r'-. Y - .i .r a '1;-...".•43. Backflow Irtagation SSS s * s � * o !1 v ,� x t744. Landscape 7igatign System.;7t-Z rr, - l7 d C7X, :t u; !U co x.•J *. • Ct 0 x45cSound ',tteDUation M T 2: H :-.4 ti* :• o r, I-i ^o.-. c[t-J •, 7' .. .. -a rn 'r rz1* 't `. r• M N. • H Ca. * z.46"Handice?i R�gulati ns S :r to •• •• ••a :. IC i - V-10 ••r•1 9 • ' 47SFIF},4LSTROCTUAE & BIItLDING t I 1 r a 1. C. 5 * _ 48,'aFIfdAL PLAfl1NIN ' rr'CI- ��• t n. I I _#1, a 01 1+1rri 049T'Elgetric Release to.Edison t s. I i "_T * tx I . . - .-ri. ii' K .f} Y: .-.1 ^50 Ga Release to So lthern Callforpia Gas Co F -"r i t' o ox v 7 ^t :51. CEETIFICATEOPOCCUPAM1TOY x a a; vl. . • - Mo x O No. Date