HomeMy WebLinkAbout130 17TH ST - Building Permits CIT OF COSTA MF 2-t-
Development Services, Division of Building and Safety
CERTIFICATE;OF OCCUPANCY
This certificate is issued pursuant to the requirements of the Uniform Building Code,Section 308 adopted by the City
of Costa Mesa certifies that at the time of its issuance the building structure herein below described was inspected and
approved for occupancy as follows:
Building Address 130 D S . ` 17th Bldg. PermitNumber 306-01094
Bakery • (800 sf)-
Use
A _ _ V-N
Group Type of Construction ?l+ire7.,t3tfe Use Zone C2
Owner of Building Otthi;lmmmt C. :Doyle Trust Tenant FIVE SWEETS BAKERY
Address 207 Knox St. Apt D , Costa Mesa , CA 92 7
IA • By Huse?BUILDING OFFICL-KhanfrQ, Nguyen, C.B.O. -N 01/24/07 21-t •
Date
REQUIRED TO BE POSTED IN A CONSPICOUS PLACE
Th C6.7
City of Costa Mesa qq
Development Services Department CERTIFICATE OF OCCUPANCY NO. Q 0 a V b s
Building Safety Division
P.O.Box 1200
Costa Mesa.California
The Building located at 13f) FARM 17T4 WOW],
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
fora Group n-3 Occupancy.
Use of Building RRCTATTRAVP
Legal Description 42' -441—n7
(See reverse side for Metes and Bounds)
Building Permit No B13020.1315416 Electrical Permit No. 815460—R16044Plumbing Permit Nop415579.
Mechanical Permit No. 1tM1 S7‘7Q,Ml SRIF Number of apartments /� /and/or guest rooms
ISSUED TO: Building Official /6r ,
MARCEL MICALLEF
by en./3
11-
130 EAST 17TH ST.. COSTA MESA. CA.
Date .-7 U ki it N/ /71.1
p v
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
, yi..stit---,11As7. roit..,cie.9sd,a.ecjinz.:.,,,7 --, —
i-t',bS'--z°&Er' ' X; -'0, 0,Ys:W.,,ct,1,1 Pi 4j,
alta.1.ML. C.49 6tSTPPElenVa'41&-"Wi‘ d Tr- - 341 C
1
d.', ki3t1-91#1,a, it-it.02,- tb,..„,-,0 c6-v•frP og 6
0,40iibukr get , ,. YA• th.,-, . 6,, i j. ,d Iptci,„a A
_ .....,. , cetl."-'6 t ,s. .."1/ cs-,-- ,
Date
CITY OF COSTA MESA
CERTKFACATE OF OCCUPANCY
Building Permit No a.,5-.5. Electrical Permit Nea.74/Plumbing Permit Notfa-Zir
C ' (r- 4 it. -c...
Use of Building
ID/
The building located 2 ar / 3 r — :4 — 4" /7
/4 r v et, 6 /:
r
Lot / 1070,-//1—crW-a2rTract
(See rZerse side for Metes and Bounds)
h-- been inspected and found to comply wjjk the provisions of all City of Costa Mesa Or-
ices applicable thereto for a Group .r Occupancy.
ii
ISSUED A.J. VOLZ -;" 2
` By
(Ovmer or Dcliclini:- .3/4--1 m----Cit"..
iElf..54inCirinfilla
I
t]042inal—Owner 0 1st copy—Gas Co. 0 21; Edison Co. 0 3rd copy—File
•
•.BUILDIdia SAFE?'" sPABTMENT".' 1 1463
P, O. Boa No. 317
Costa Mesa, California
Date MAR 27 /eti /
CITY OF COSTA MESA
CERTIFICATE OF OCCUPANCY
Building Permit No/3 35f' Electrical Permit No Plumbing Permit No
Use of Building R v ri Fr C„ ,y L1 . )3 L b ri ,
The building located at i-7)0 r 17 -r
Legal Description
(See reverse side for Metes and Bounds)
t ''een inspected and found to comply with the provisions of all City of Costa Mesa Ordin-
a,._.s applicable thereto for a Group 7 A Occupancy.
ISSUED TO:
I/ )7-.,•, i✓ • / 4
City Building Official
(Owner of Building) By 'f' Mi °' /
CC: 0 Original—Owner 0 1st copy—Gas Co. 0 2ndsopy—Edison Co. 0 3r copy—File
Form 206 S-B P 1M 1-60
• 1
4
'co .i. . ? ,' ; G DEPARTMENT 4.�_,_._.._._—�'T ' 249 c
*� d��.,.'r' f .c is
-7r < ( (14L1 • t � r--
Date
CITY OF COSTA MESA
CERTIFICATE OF OCCUPANCY
Building Permit NoJElectrical Permit No. Plumbing Permit No -r f
cr./ ii .•/ r'.
Use of Building..._ )! .4, f• .-.-/e•dr e -
The building located at. / =? r "' %- 6 /- // Q.:11.i./ _ 15)
Lot 7/ Blocat. /J �'f-7l..2Tract
(See reverse side for Metes and Bounds)
b"- been inspected and found to comply with the�yprovisions of all City of Costa Mesa Or-
c )s applicable thereto for a Group let.1-'7 Occupancy.
ISS9ED TO (/ ----,, A.J VOLZ
Y'a .Pe-t1/ . ,. •Js. v ��..7:�y {I In. t �,r-g; ,'
ter• . (a t *.) u ii, • r rflr d .1",-44; 44tx-
GC0 en gta-ci+P:P hal�'k 4 >a z r' l • •�, Yti( ii co. alb ' `
Form 2e6�S`7 11) "� r I.: r : � •.i
r, ; 3 . { '.rte _Jr. _.L,
' CITY OF COSTA MESA ) w '
,► BUILDING DIVISION
>4 r, ;..`r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
,4 iris I PERMIT
*otiysrflfl" ' P02-00481
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 130 E 17TH ST Status: ISSUED
Suite No N Applied: 07/23/2002
Issued: 07/23/2002
Vicinity: N /^1
Parcel Nunmber: 42544107 ISSUED BY: `/ '1
Applicant: DOYLE ,RICH
Address: 207 KNOX ST APT#0
. , Phone: 949-645-0660
COSTA MESA,CA Zip: 92627 -
Owner: DOYLE FAMILY DECENDENTS
Address 207 KNOX ST APT#D
Phone: 949-645-0660
COSTA MESA,CA Zip: 92627
Contractor: - •
Address: '
Phone:
Zip:
License:
Arch / Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
UNIT N. INSTALL GAS METER AND REPLACE WATER HEATER.
FEE SUMMARY
AMT QTY - AMT QTY AMT QTY
ISSUE FEE $23.50 . Laundry Tub/Washer $0.00 0 • Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 ' Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 , Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 .0 - Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 . Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $9.80 1 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $45.60
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
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(600)
•
DECLARATIONS •
WORKERS'bOMPENSATION 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 icaued.
My workers'compensation Insurance carder and policy number are:
Cartier: Policy Number:
(This section need not be completed If the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: _, Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MID SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($t00.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Uc.$ Class$
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.Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of 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 pro 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 apd rofess ns 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 is 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,em r•• LUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors U •ase , does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license puns ant to the raotor License Laws.).
•n exam• _.._ =
late:•
- O`2J
r ID verified by driver's licensd✓ es ❑No DIra. ■
Verification of Ownership by(type of d••-•ment,i.e.-property tax bill or deed): (
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to filo 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 Cade 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 aRermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes U No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school?
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 prescnbed by California Health and Safety Cade Section 42303 been made? ❑Yes 0 No
8 (If yes",attach certificate ofrp lance from the appropriate air pollution control officer).
CERTIFICATE OF CO IANCE: 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/Mena andel issions.
Signature: Date:
r r
CERTIFICATE OF CO PUANCE . •: OR P,TION OF ENTRY:I certify under penalty of perjury that I have read this application end tate that the information given is
correct.I agree to cul • wit la&s and ity ordinances relating to building construction,and authorize representative of the Cityof Costa Mesa to enter upon the
above-described prop= or inspec • pbrposes. agree not to occupy or allow occupancy of any building authorized by this p mit until fi al inspection,
71 a t-
Sigma .�'s) / 4D e
And/Or Authorized Applicant Date
;ODEA INSPECTION TYPE gdiE PiD3061.2 POE( INSPECTION TYPE gaff. IIImML4
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 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
it!.4. CITY OF COSTA MESA
4 ►. y BUILDING DIVISION
>•1--„,,,'_` t1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
u, s ) PERMIT /06-01094
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cseUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 130 E 17TH ST Status: ISSUED
Suite: D Applied: 06/29/2006
Vicinity: UNIT D,FIVE SWEETS BAKERY Issued: 09/13/2006
Primary Occ: A Type of Construction: V-N
Parcel Number 42544107 Zoning: 62.
Applicant: MAN, WAI
Address: 6239 OAKBANK DRIVE /
Phone: 626-674-9191 ISSUED BY: �7
AZUSA,CA —"-Zi 91702 ---���fJ
Owner: DOYLE, CLEMENT/C TR%]che94L5M66JN
-Address 207 K{ ST #D- ��
�r
CO44(7:1TA ES , L Zip:'-- 926273743/ ��
Contractor: 6WAI HUNG MAN�a -s --����
,(1 / , � . o AOS
Atldre ;'�62390AKBANKDRIVE� ��\ \�
O Phone: 626-674-9191��A� �
/1st
\AZUSA„CA ,�
Zip: 91702\ O _ License: 684687 \�\ \�
Arch :/ (::5 r7 �f•Eng: \\\ 7 / \\T
Ad�dress� � � Address: _ vA `V A>/ A
/�L� % �� Phone: I �r� 0 /'���� \�.Fhone: -\ \V
r ,, /Zip; ( ✓ �j r LLicense: o��- ,gry'i� I `Vi> 4, I 1'.License7%' '�'\
.j ,rr ( r /11Jl-1, L ? / n (r” _- - --_.- _.o- 1 i VIld\ V -- ��. v
I r J E"...� -' SCOPE OF PERMIT----i':3:.A)n y\ �i)\� 1v�li
; ,�j 800SF TNTERIOR T:I.FOR"FIVE.SWEETS BAKERY",UNIT D.WORK TO INCLUDE:NEW NON-LOAD BEARING PARTITION WALLS;EL;MECH
' "JAND.PL WORKi(/ ',,/ t r '� 1
I � .”`t 116/") - / A�� �ti,A�\ k-1I Al \� I
hI
( II �(' —7' FEE`SUMMARY=) — l i ' '
Plan Checks- $104.69 ccyry (Li/Hi' /( iii r4: /fit P Cale Valuation: IL1;ir i ' /$50,000.00
(l Permit' $644.25 =- ._ __Claim Valuation: II/ I Sso )oo.00
tSMIP,Re :Q1� $0.00 7J / I�i / ;�
..,,!\ SMIP•CoM: N,1 $ ///(IN I ;, _
1 `i Other,\ . $0.00 .4.."-'7:1:3_i 2,7;...s- -1 `° :J "/9r Lam- r1 1
, �� Inspectiori: g,, $0.00 e---- _ _,_- _[ 0 --: '/ - 2 i'�
\ Ur-2
al: (1 $759.44 \/ \ ( r , Ail/
��\ C\ \\ . - 7, I /,//l l ---/ /f111(
•\\,,):.\\ Atm v\ PLANNING &ZONING ,yLb/ r,,
SETBACKS \:c, 'r`�a' r `t;,,, . . %`� C //
MAIN STRUCTURE,Front\'0,0 Rear y]0 0/ _' o� ',Left- 0 0 - Right 1 0-Oi ,', //
VV.\ ✓J a 6 ' r -: 'v a,,�� 1-•\j> r'
ACCESSORY Front 0-0 Rear, , Oe 0=B 0,.Lreft 0 0 , Right\0-0\ r/
PARKING Existinq>/ 0 "~Required .//0,A t °, `Proposed ° 0 7-::---,---7--7.
tb ---,...---z:-_.__.„,_7,-L,T._....t::„,_:,__j; ,o•9' ? ••••o• • .---::::::1,,,,-- 6,-5- c" 0
11 II >/l
r'
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements„ oder Califomia statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned
for a period 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 . ,
2448-48(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑._-f 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.
Myworkg{s'rpmp�2, lnsu ce parrier and policy number are: �_ �`a J 97*
i %Cegier.�1 S"'f//.�`r^J ^!/ P.`olkyNumber:^ r
/(Th/s,eectlon need not be compleitedil 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: ��i Y p/�74t-�- Det 0(/
SWARNING:.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(5100000),IN ADDITION 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 Ilse 9nd p v 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 offect�Lictfr �5'Lv0A / :EFS#J. is
Contractors Signature: tei_S e--`- Date:, D o
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. _ Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by 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 five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_pPermit for such construction or modification
from the South Coast Alr Duality Management District or from any other air pollution control district or agency? U Yes L ll 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? C Yes d 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 ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
_,jir ad ryas -- � /3-06
fAn QlAuuthorized'Applicant
CODE 6 INSPECTION TYPE QAIF 1NRTIALS CODE( INSPECTION TYPE 191E num
•
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing •
200 Final Re-Root 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site (�
204 Final Demolition ,_ 250 Final Building/Occupancy I -It -0"7 RN
I
byte Mac CITY OF COSTA MESA
1‘ BUILDING DIVISION
o` �' DEVELOPMENT SERVICES DEPARTMENT PER I NUMBER
PERMIT
J " E06-00996
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 130 E 17TH ST Status: ISSUED
Suite No D Applied: 09/13/2006
Vicinity: UNIT D,FIVE SWEETS BAKERY Issued: 09/13/2006
Parcel Nunmber: 42544107
Applicant: WAI HUNG MAN
Address: 6239 OAKBANK DRIVE ISSUED BY:
Phone: -626-674-9191, I
AZUSA,CA �,, ,-'Zip 91702__ c - 1�
Owner: DOYLE, CLEMENT C TR - - - '
Address 207 KNOX ST APT#0 - i • , , ,
/, - Phone: 949-645-0660 _ _
- COSTA MESA,CA - '-Zip: - 92627-3743;_ ' -A
Contractor: WAI HUNG,MAN . , . ,
Address: 6239 OAKBANK DRIVE
Phone; 626-674-9191 "
AZUSA,CA Zip: 91702 '
License:684687 •- - ,
, , SCOPE OF PERMIT
- , - ELECTRICAL PERMIT FOR A 800SF TNTERIOR T.I.FOR"FIVE SWEETS,BAKERY'-,UNITE/
REF#:606-01094 ' .
-- V x .A •
WORK TO INCLUDE 15 LIGHT FIXTS,16 OUTLETS,5 SWITCHES,2 MOTORS.
FEE SUMMARY
Quantity - - - Quantity- -
ISSUE FEE $23.50 . Temp Dist System/Lighting $0.00 0
Temp service test $0.00 , .- N. - Busway/100 ft ,‘
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 1 • "
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 /
Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 0, - , / "
Lighting Fixts $16.50 15 up to 50 kva/kw $0.00 0
Recept Outlets $17.60 • 16 - ^ up to 100 kva/kw ; $0.000 /' '
Switches $5.50 5 over 100 kva/kw $0.00 ',0 ' -
Non Res Appl $0.00 0 '' Low Voltage Equipment $0.00 - . -0 ,
Res Appl - $0.00 0 Low Volt Wiring System/Ckt $0.00:. - ,0 '
Service to 200a $0.00 0 _ Misc.Conduit ` $0.00 ,' 0 .
Service to 1000a - $0.00 _ 0 - - Misc.Conductor ' ... $0.00 / 0;' - '
Service over 1000a $0:00 ' • - Circus(gen 0r ride)' ,-$0.00 0'
Motors to 1hp $9.50 , ,. 2 , „, ' ' _Circus(mech ride or lights) $0.00 ` 0 /- -
•
Motors to 10hp $0.00 0 Christmas Tree Stand z$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 __ -��
Communication drops ' . - - $0.00 -./-' 0'- _- - - Investigation Fee. $0.00 --/-* //,/
Sub panel to 200a - $0.00 '- ' - 0- ' -'` ,, . , Plan Check Fee $0.00- j'
Pole Light Pkg $0.00 0 ' Reinspection Fee $0.00
Sign Circuits $0.00 0 - _
Temp Pwr Pole $0.00 - -0 - \ -TOTAL CALCULATED FEES $72.60
Intermed Pole $0.00 - --0 -
rnuuc•rre r oncrrwr rn.rnrrrnue
�/ .
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements {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-+e WOO)
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 wo s' om nation Instance ca er and policy number are:
itta .t
(this section n d not e completed if the pe It 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 prov ons.
Applicant Signature? . – /f IMS' Date�t /3 -0 I
WARMFNG
WARNING: T ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML ANES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDmON 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 licegs u0der Ion of Chapter 9(commencing with Section 7000)of Division 3 of the Business Professions Code,and my license is in full
force'andeffect.Lic.k_' 6fl C( 7 'Class p>
Contractors r�8� - A— �YIM__-� Date'---21—/3-0 0
r
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:My 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 end Professions Code)or that he or 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($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
•
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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 end 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 Flre
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 agermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LI No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 aermit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) te
9/ 3 —D,
And/O`Authorizetl ApDl�cent –" L ate
LODE t ItlSPECIION TYPE PAM IOW LODE( gfsPECTION TYPE PAiF, BMW
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
^•''(w�
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
1
5111 NS CITY OF COSTA MESA
►q •
BUILDING DIVISION
>4 :___ DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER
Te PERMIT M06-00558
4tIvern.,..,s"t
(714)754-5273 • Fax(714)754-4856 • www.cicosta-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
•
Job Address: 130 E 17TH ST Status: ISSUED
Suite No D Applied: 09/13/2006
Issued: 09/13/2006
Vicinity: FIVE SWEETS BAKERY,UNIT D
Parcel Number: 42544107 �J�
ISSUED BY:
Applicant WAI HUNG MAN -
Address: 6239 OAKBANK DRIVE ..)/1.-: _ -
, Phone: 626-674-9191 - _
AZUSA,CA , " Zip: 91702 . , ,-
•
Owner: DOYLE, CLEMENT C TR • -
Address:/.207KNOX ST'APT#D, - - - ,
- - Phone: 949-645-0660 _I\;, = . � �'
COSTA MESA;CA Zip: 92627-3743 - ,
Contractor: WAI HUNG MAN
' Address: 6239 OAKBANK DRIVE
Phone.' 626-674-9191 ' <
AZUSA,CA , Zip: 91702
License:684687
SCOPE OF PERMIT
' MECHANICAL PERMIT FOR A 800SF TNTERIOR T.I.FOR"FIVE SWEETS BAKERY",UNIT D.
I
REF#:B06-01094
WORK TO INCLUDE: 1 HOOT W/MECH EXHAUST AND 1 EVAPORATIVE COOLER. '
•
' -- - FEE SUMMARY -'` . .- . . -:
Quantity - Quantity
ISSUE'FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 ' ' _ - Repair/Alt Refdgeration,Unit - $0.00- 0 +
Inst FAU>100 k BTU $0.00 -0- --' -- - Ventillation System- - $0.00- -0
Repair/Alt Cooling/Heat $0.00 .. 0 • . Evaporative Cooler - - ' $10.65 1 •
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 -
Refrig Sys<100 k STU $0.00 0 Domestic Incinerator $0.00 -0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
1 Gas Piping $0.00 0 Up to 3 hp/100 k BTU •
Factory Fireplace $0.00 0 - 3 To 15 hp/500 k BTU
Hood w/Mech Exhaust $10.65 1 ' 15 To 30 hp/1,000 k BTU ' / ..._ $0.00 0 %
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00; 0
Vent Fan/Single Duct $0.00 0 - Over 50 hp/Over 1,750 BTU $0.00 ; 0
Appliance $0.00 ,0... Boilers -!�;, ) '
Fire Dampers ' ` $0.00 0' ." - Up to 3 hp N $0.00 0
Smoke Dampers $0.00 .0 - '3 To 15 hp - - "$0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp
Air Handlers< 10000dm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm ' . . $0.00- 0 --_ - Over 50 hp • - ' $0.00 0
Floor Furnace - $0.00'; 0 - ' '
\, - Other- Mechanical Fee �,,- /�,�/�
Floor or Suspend Heater $0.00 '0- i _ Investigation-Fee. $0.00
N " _ , PIan.Check Fee $0.00
Reinspection Fee $0.00
-. - _ TOTAL CALCULATED FEES $44.80
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California,statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if woik is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244646 WOO)
DECLARATIONS /`
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑- I have and will maintain a certificate of consent to self-Insure for workers'compensation,es provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑—I haveand will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
�Myworke4opensation Insurer carrier and policy number are: ��
Carrier:' P i Mn Policy Number: ��9�
(This section eed not corn /glad if a permit is valued at one hundred dollars($f 00)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 prov ' ns.
1
;Applicanj Signature: .// L/ 1/9.0L"- Date:i 9�'/ p6
at—
WARNING:FAILURE TO CURE 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 ADDfTION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am IlceryseJ under,prgyisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business ajtcJ,Professions Code,and my license is in full
force end affect,¢Cic.# 68%/" ' 7 't iCless'k5 f7
( SContrar�Signature: Jtt.t„ 9 �HOr-- - Dat ,+/3 —e`)
lc
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: 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 end 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 ere not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
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 apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency) Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPUANCE 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.
Signatu0l Legal Owner(k met— Date�
< '
nd/Or Authorized Applicant:- Data—f
VOCE 1 INSPECTION Din PATE 1NTmALS POOE! INSPECTION TYPE PAIS n AMA&
1616 Fixed System Final Fire Prevention 206 Final Mechanical )'0y-6? _1L
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
CITY OF COSTA MESA
Ca. BUILDING DIVISION
y :/' ,,,,,' ;.4 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
H
1. 1 .
PERMIT
�' `944P06-00743
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca,us . NG PERMIT 77 FAIR DRIVE.COSTA MESA,CA 92626
PL
Job Address: 130 E 17TH ST U Status: ISSUED
Suite No D Applied: 09/13/2006
Issued: 09/14/2006
Vicinity: FIVE SWEETS BAKERY,UNIT D
Parcel Nunmber: 42544107 ___.......4g____
Applicant: WAI HUNG MAN ISSUED BY:
Address: 6239 OAKBANK DRIVE -
Phone: 626-674.9191
AZUSA,CA "
r-Zip: 91702
Owner: DOYLE, CLEMENT C TR
Address 207-KNOX STVAPT#D - - - - _ -
' ' Phone: 949-645-0660 -
COSTA MESA,CA Zip: 92627-3743 ,
Contractor: WAI HUNG MAN
Address: 6239 OAKBANK DRIVE • ,
Phone: 626-674-9191 , -
AZUSA,CA Zip: 91702 '
License: 684687
SCOPE OF PERMIT ,
PLUMBING PERMIT FOR A 800SF TNTERIOR T.I.FOR"FIVE SWEETS BAKERY",UNIT D.
•
REF#:B06-01094'
WORK TO INCLUDE:- FLOOR DRAIN, 1.GAS(1-4,OUTLETS, 1 LAUNDRY TUBMAHSER, 1 FLOOR '
SINK,4 KITCHEN SINK, 1 WATER HEATERNENT. / - '
' FEE SUMMARY
AMT QTY AMT QTY ' AMT QTY
ISSUE FEE $23.50 - Laundry Tub/Washer .$0.00 0 - Sump Pump $0.00 , 0
Backflow irrigation $0.00 0 Landscape Irrigation - - $0.00 0- - '' Swimming Pool ; ' ' $0.00 ' 0
Backflow Preventer $0.00 0 P-Trap $0.00 ' 0 Trap Primer . $0.00 ' 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 `0
Clarifier System $0.00 0 Process Piping(per 101) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors . $0.00 - 0 . Vacuum Brkr Bkflow(5+) ...$0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin: $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo. $0.00 0 Wash Basin Set ; $0.00 0
Drain,Floor $9.80 1 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0, Sewer Private Line $0.00 - 0 Water Closet(Toilet) ' $0.00 0
Drain,Roof $0.00 0 . .Shower ' $0.00 • 0 Water Heater/vent. $12.30 1
Drinking Fountain $0.00 0 - '- Sink,bar ' $0.00 0 Water Piping(Inst or Rep:) $0.00 0
Expansion Tank $0.00 0 , Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 -Sink,Floor $9.80 1 Water-Service ' $0.00 0
Gas(1-4 outlets) ' $6.15 1 - Sink,kitchen $39.20 4 ' Water Softener ' $0.00 0
Gas(Over 4 outlets) $0.00 0 . Sink,service/mop $0.00 0 OTHER / , $0.00
Gas Repipe . $0.00 0: -, ,„_,_ Spa(private) ` ' $0.00 0 VIOLATION • / $0.00
Gas Service ,$0.00 - `0. 'Spa(public) . _ _ $0.00 0 ' , PLAN CHECK% $0.00
Interceptors(Grease,Oil) $0.00 0 ; ' REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $100.75
- -COMMENTS/SPECIAL CONDITIONS- -
//
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) V
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
241646(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑t l;have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,foFthe performance of the work for which this permit is Issued.
—'My
workers'Fomp ion In urance carrier and policy number are:
Cadet r v� t Policy Number/1,123C 7�
(This sec ion need not bb9 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 p/fpvisions.
'Applicant Signature: i�L� -r'7 /°Z4— D :��`%^l —`(?
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(SI 00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am lIceng and r visions of Chapter 9(commencing with Section 7000)of Division 3 o the Business a d Professions Code,and my license is in full
fore-and e 6 ffecCUaa� 4- i7
Contractor's Signature. ct-e-. Date: 9--14.--c,
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business end Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herset 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.).
❑ lam exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,lalsework,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: Data:
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? ❑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 end 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 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 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
............
B (If yes%attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
(And/OrAut�ed APPlicent_. Date
VOCE t INSPECTION TYPE PEE MALI VOoPt INSPECTION TYPE GATE IIIIDALS
1816 Fixed System Final Fire Prevention 206 Final Mechanical /�
1286 Pool Spa Final 208 Final Plumbing )0-31 �0G, _aft_
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
1 culT/�yr ' �� CITY OF COSTA MESA
4 BUILDING DIVISION
0 ry;tis
y , ,,,,,,,,,,,,,,, DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
1. PERMIT B06-01701
,
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.8.1hLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 130 E 17TH ST Status: ISSUED
Suite: Applied: 10/09/2006
Vicinity: Issued: 10/09/2006
Primary Occ: B Eat<50/Office/Bar<50 Type of Construction: V-N
Parcel Number: 42544107 Zoning:
Applicant: CHAPPUE, KELLY
Address: 126 COMMERCIAL WY 1 -1213Phone: 949-548-5569 ISSUED BY:
COSTA MESA,CA - Zip: 92627
Owner: DOYLE, CLEMENTC TO
Address 207 KNOX ST APT#D ' - . - . -
Phone: 949-645-0660 ,
•
COSTA MESA,CA, Zip: 92627-3743
Contractor !G"L RvENTERPRISESINC--DBA CRANK BROTHERS ROOFIN-
Address: ,.126 COMMERCIAL WY - - -
"- Phone: 949-548-5569 .
i'o, ,
-COSTA MESA,CAS
Zip: 92627 - " • License: 828379
•
Arch : ' , Eng: ' -
Address: , . Address: I "
Phone: • Phone: •
'Zip: License: ; - < License:
- SCOPE OF PERMIT' - . / -
REMOVE EXISTING ROOF AND REPLACE WITH BUILT UP ROOF AND GRAVEL FINISH.
• FEE SUMMARY
Plan Check: $0.00 -. . - . - Calc Valuation: $6,400.00
Permit: $139.25 Claim Valuation: $6,400.00
SMIP Res: $0.00 -
-, SMIP Corn: $0.00
Other $0.00 ,
;,V Inspection:- ' $0.00 " ,
' Total: $139.25 .
PLANNING &ZONING ,
SETBACKS - ' ,•
MAIN STRUCTURE Front ,,•0-0 ' Rear 0>0 Left ` 0-0 - Right 0-0
ACCESSORY Front • 0-0, , ,i=c, .Rear 0-0 Left 0-0 ._ 'Right ' 0-0
PARKING Existing:, 0 ‘ Required: - 0 Proposed: 0 ,
- -
, „ - . ,
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. , •
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448.48(8/00)
DECLARATIONS - -
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-insure for 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 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 prov I O l o.
WARNING:
FAILURE T: Y"NSATI N-COVE AG•Q Date:
WARNING:FAILURE TO SECURE WORK RS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT Ni EMPLOYER TO CRIMINAL PE LTIES D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
/force and effect.Lic.# Class#
)LContractor's Signature: J7 AA 1lXvC� Date:
//// CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).): •
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the 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 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,Gry 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 Safely 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 greeter 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 0N
(Section 25534 of the Califomla 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 ap plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: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.
Li/62i
n < '/ ^SiOlature Of Legal Owner(s) r li' 1 n tit'g
/ And/Or A th zed App `/
lieaot� Dat
CODE I INSPECTION TYPE DAIS INTmAL$ CODE! INSPECTION TYPE PATE INTMAL6
•
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final i 208 Final Plumbing
200 Final Re-Roof l/!%i ��� 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 ••
(c CITY OF COSTA MESA •
" BUILDING DIVISION
$ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
fl PERMIT
Itboisoxmw PO4-00017
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 130 E 17TH ST Status: ISSUED
Suite No M Applied: 01/09/2004
Issued: 01/09/2004
Vicinity: UNIT M(COUNTRY GARDEN INN)
ISSUED BY: 4111! .
Parcel Nunmber: 42544107 i - NiMir
Applicant: SIMPSON, KIM
Address: 130 E 17TH ST
STEM Phone: 949-722-1177 •
COSTA MESA,CA Zip: 92627
Owner DOYLE, CLEMENT C TR
Address 207 KNOX ST APT#0
Phone: 949-645-0660
COSTA MESA,CA Zip: 92627-3743
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
•
Arch / Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
INTERIOR 498 SF KITCHEN REMODEL FOR"COUNTRY INN AND GARDEN CAFE CATERING"IN SUITE
M.ALL WALLS,PARTITIONS AND CEILING ARE EXISTING.
1 GAS OUTLET(1-4), 1 GREASE INTERCEPTOR, 1 FLOOR SINK, 1 KITCHEN SINK,1
SERVICE/MOP SINK -REF:B03-01853 ,
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244848 WOO)
•
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 carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
/0 I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and t II I should become subject to the workers'compensation provisions of action 3700 of the Labor Code,I shall forthwith
comply with these provisions. �.Kl!''%
Appifcant'Slgnature:..--� ' .t$. 4s , CD7 ate27t-r-c{ ?r ,2 0411-/
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVI �
GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOU ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.Lic.N Class ft
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,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
•
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($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
.�/4pp""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.).
:__[75'
r I,as owner of the property,em 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 un er sec. j Business and Professions Code for this reason:
tSfgnalure: /A/L.—C.< - 'Zi, .13-11e:.-."--/(414.r. F zOOr-/
Owner ID verified by drivers license. ❑Yes o Drrver censit Expires/ /D S
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,faisework,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 wit 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 Safely 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 end 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 aparmit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes O No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
•
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 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.
Sig azure Legal Owner($) Date
/mutt
9 / Zoo�l
And/OrA d Applicant. „,.` rDaro__,
ODE I INSPECTION TYPE PATE MAO Oat INSPECTION TYPE RA_T ANI ALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical I,{. ��Q�'/�/—��_7"�'�''�"�'
1266 Pool Spa Final 208 Final Plumbing py[z! y
200 Final Re-Roof 210 Final Electrical ((( �w
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
ice •
BUILDING DIVISION
• •,, ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
p PERMIT
7s
MOd_(IfM 1
(714)754-5273 • Fax(714)754-4856 • viww.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 130 E 17TH ST Status: ISSUED
Suite No M Applied: 01/09/2004
Issued: 01/09/2004
Vicinity: UNIT M(COUNTRY GARDEN INN)
Parcel Number: 42544107 ISSUED BY:
Applicant: SIMPSON, KIM
Address: 130 E 17TH ST
STEM Phone: 949-722-1177
COSTA MESA,CA Zip: 92627
Owner: DOYLE, CLEMENT C TR
Address: 207 KNOX ST APT#D
Phone: 949-645-0660
COSTA MESA,CA Zip: 92627-3743
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License:000000
•
SCOPE OF PERMIT
INTERIOR 498 SF KITCHEN REMODEL FOR"COUNTRY INN AND GARDEN CAFE CATERING"IN
SUITE M.ALL WALLS,PARTITIONS AND CEILING ARE EXISTING.
1 REFRIG SYS<100K BTU, 1 HOOD W/MECH EXHAUST, 1 APPLIANCE, 1 EVAPORATIVE
COOLER, 1 COMPRESSOR 30 TO 50 HP/1750 K BTU
REF:B03-01853
•
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $10.65 1
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $14.80 1 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $55.45 1
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $10.65 1 Boilers •
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Fumace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
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. �J
FOR INSPECTIONS CALL: (714)754-5626 / J
244848(8/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for 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 offSection3700 of the Labor Code,I shall forthwith
comply with these provisions. q
cApp cant•Signeture: uF4.1� Date �� 44LGr. ( i 2001{
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOU.ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
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,Civil Code).
Lenders Name: Lenders Address:
Signature: Date: _
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business 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
�Ily50ld 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.). '
�'r'(") 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 undgrsec. Business and Professions Code for this reason: t� /
_Sid ..—e' -r ✓rr.��-ti . ,.,. Del jaiut 4.44/ ! 2001-/
Owner ID verified by drivers license. ❑Yeses 0 No Drivers'LicensejNocdP' , Exp'fies:7 570 g
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 01 the California Health and Safety Cale 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 D0oes Yoor will the occ
applicant or present or future buildingoccupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this 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 pan of the-rally to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required to the work which is the subject of this
application,have all of the disclosures prescnbed 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 end 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.
(f Signetur f Legal Owner(s) // Date
p� • ,vel(' , a7o01-1
And/Or'qutho zed-Appllcanty. LDato7
Qom/ japEFixed Sys TYPE QM JEW poo206 1 Final ecON TYPE •
�)�
1616 Fixed System Final Fire Prevention 206 Final Mechanical s/8,070
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
•
r, CITY OF COSTA MESA
4 ). BUILDING DIVISION
>et.t. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
T t "Ka PERMIT
• B03-01853
y�' +�
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ccVSILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 130 E 17TH ST U Status: ISSUED
Suite: M Applied: 10/24/2003
Vicinity: UNIT M(COUNTRY INN AND GARDEN CAFE CATE Issued: 01/08/2004
Parcel Number: 42544107 Zoning:
et. j
Applicant: SIMPSON, KIM - ;- ISSUED BY: alks.
Address: _
Phone: 949-722-1177
Zip:
Owner: DOYLE, CLEMENT C TR
Address '207 KNOX ST APT#D -_ Phone:Phone: 949-645-0660
COSTA MESA,CA Zip: 92627-3743
Contractor: OWNER-BUILDER
Address: -
Phone:
Zip: License: 000000
Arch : - ,- Eng:
Address: • Address:
Phone: Phone:
Zip: License: License:
-. - - SCOPE OF PERMIT
INTERIOR 498 SF KITCHEN REMODEL FOR"COUNTRY INN AND GARDEN CAFE CATERING'IN SUITE M.ALL WALLS,PARTITIONS AND
CEILING ARE EXISTING.
, FEE SUMMARY
Plan Check: $163.31 --- Calc Valuation: $15,000.00
Permit: $251.25 Claim Valuation: . $15,000.00
SMIP Res: $0.00 •
SMIP Com:, $3.15 _
Other:
Other: $0.00 ,
Inspection: .• $0.00
•Total: $417.71
PLANNING &ZONING '
SETBACKS
MAIN STRUCTURE Front 0-0 - . Rear "0-0 Left 0-0 Right -0-0
ACCESSORY Front 0-0 - Rear 0=0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLA?ATIANS
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 carrier and policy number are:
Carrier: Policy Number:
(This Section need not be completed if the permit is valued of one hundred dollars($100)or less.)
I—Q'/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: .4et ,C D , 20 •7
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE 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.Lie.8 Class 1t
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 o1 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 of she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Busine 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
sub':is 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 uncle;sec. Business and Professions Code for this reason:
Signature: =I-Lr'� t''t-�-dh'�� Date: .J4,4L. S - 20O4{
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: '5 /O 3
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia 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 appemit 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 [3 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 pan 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 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 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.
m/Signatwe Owner(s) • / Date /
tti.. ��G f-L -G/r`� �r�LGL.tM��/ ` r o�PP L/
And/Or Authorized Applicant U Date
CODE/ INSPECTION TYPE Qsg INTRIAta CODE! IItISPFCTION TYPE De1E thom6.S
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 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
2 Final
203 Final Demn •
25e t
204 Final Demolition 250 Final Building/Occupancy /Qr/,•,, t^,i/
Ogre MF9 CITY OF COSTA MESA
4� 9 - • BUILDING DIVISION -
« I DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER
v. 1 � I PERMIT
4r4wino 04-00036
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
FIRE SUPRESSION PERMIT
Job Address: 130 E 17TH ST Status: ISSUED
Suite: M Applied: 02/25/2004
Vicinity: • Issued: 04/01/2004
Parcel Number: 42544107 Zoning: ISSUED BY:
Applicant: STARCHER, JAMEY
Address: 65 PINE AVE. - , • .
STE 176 Phone: (562)429-5211 - -
LONG/BEACH,CA - Zip: 90802 •
Owner:/ DOYLE, CLEMENT CTR .
Address 207 KNOX ST APT#D • ,
Phone: 949-645-0660
' COSTA MESA,CA - Zip: 92627-3743
Contractor: EXECUTIVE FIRE PROTECTION INC
Address: 65 PINE AVE.#176 •
STE 176 Phone: (562)429-5211 '
LONG BEACH,CA - Zip: 90802 •
-
License: 547963 •
SCOPE OF PERMIT
REF B03-01853 &M04-00011; SUPPRESSION SYSTEM FOR HOOD; INTERIOR 498 SF KITCHEN
REMODEL FOR"COUNTRY INN AND GARDEN CAFE CATERING" IN SUITE M. ALL WALLS, PARTITIONS
AND CEILING ARE EXISTING. •
FEE SUMMARY
Plan Check: $43.03 Calc Valuation: $1,900.00
Permit: $66.20 Claimed Valuation: $1,900.00
Other: $0.00 — -- • _ . _.-_
•
Total: •$109.23 - •
•
•
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 WOO)
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 carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit Is valued at the h/-dred dollars($100)or less.)
❑ I certify that in the perfo -nce of the work for hich is pey it is issued,I shall not employ any person in any manner so as to be me subject to the workers'
compensation laws of I la,and agree t ` . subject to the workers'compensation provisions of Sea 37 ofthe Labor Code,I shall forthwith
_.,---comply with these Prov. . c/'si (/
( Applicant Signature: OVI Date' L
i
WARNING:FAILURE TO SECURE•CORKERS'••MPENSATI• COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
/I hherreby�affirm that I am licensgd un p�yls�s of Cha r 9 me, g with Section 7000)of Division 3.offie Business and Pr essions Code,and my license is in full
ace and effect.Lic.# 5� A/ I _Casa- e/
,Co actors Signature: I r Date. i 1 i
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,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.).
'0 I am exempt under sec. Business and Professions Code for this reason:
Signature: • Date:
Owner ID verified by driver's license. ❑Yes 0 No Drivers 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 feel 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, 1 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 W III 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ 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 facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
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 ordina es relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I ,.ree to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signatiu� if Air ,y(� _ ' y 1 /��Date
‘ 944)ai / z
And/Or Au orized App cant�(/y C� r ((( Date
CODE# INSPECTIONTYPI'. PATE ZUM9.1.1 CODF1 INSPECTIONTYPE PAIS =Ma
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical rid-A7 201 Final Block/Retaining Wall 212 Final Fire Prevention .s—�/ //t/,y V /
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
4 41111C-__s,.... ) BUILDING DIVISION
F' ____ DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
� .; PERMIT 04-00021
MO 11
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 130 E 17TH ST Status: ISSUED
Suite No M Applied: 01/09/2004
Vicinity: UNIT M KITCHEN AT COUNTRY GARDEN INN Issued: 01/09/2004
Parcel Nunmber: 42544107
Applicant: SIMPSON, KIM _ ISSUED BY: Ali/ A,{st
Address: 130E 17TH ST
STEM - Phone: 949-722-1177
COSTA MESA,CA Zip: 92627
Owner. DOYLE, CLEMENT C TR
Address - 207 KNOX ST APT#D
Phone: 949-645-0660
COSTA MESA,CA Zip: 92627-3743
Contractor: OWNER-BUILDER
Address: ,
Phone:
Zip:
License: 000000
SCOPE OF PERMIT - -
INTERIOR 498 SF KITCHEN REMODEL FOR"COUNTRY INN AND GARDE_N CAFE CATERING"IN SUITE
M.ALL WALLS, PARTITIONS AND CEILING ARE EXISTING.
2 OUTLETS,3 SWITCHES,2 MOTORS TO 1 HP,2 MOTOR TO 10 HP
REF:803-01853
•
FEE SUMMARY-,
Quantity - _ Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 . 'Standing Section $0.00 - 0
New Res(1-2 units) . $0.00 0 „- { Misc Electrical Equipment $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 $2.20 • , 2 up to 100 kva/kw $0.00 0
Switches $3.30 '3 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0, • Low Voltage Equipment $0.00 0
Res Appl $0.00 , 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $9.50 2 Circus(mech ride or lights) $0.00 0
Motors to 10hp $24.60 , 2 . . 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
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 peripd of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00) Core /
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 carrier end policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit/s valued at one hundred dollars($100)or less.)
' It,
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 provislo s. /� a
Appficanrsrghat zlu�N'L-.4\. Liu CDatei 4A,,,( ! .2004
WARNING:FAILURE TO SECURE WORKERS'COMPENSAT N COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C INAL PENALTIEt AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($10O,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF HE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.N Class 4
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 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
old 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.). '
s owner of the property,em 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.,1 Business and Professions Code for this reason:
Slgnature._.� / as.- •/ „
cjpiFes:. C 08
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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 flied with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ _ __2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 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 then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature end 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 end 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 epplication a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? D Yes Uhl 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 prescnbed 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: Dale:
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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sign re Of Legal Owners) Datey,_22,9Py/
rj cAnd/OT.An .APpfcants Dates
GODS r INSPECTION TYPE PATE IIITIILALS POOEE INSPECTION TYPE PATE `t ,
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing AI
`77/f
200 Final Re-Roof 210 Final Electrical & :i r
li
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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CITY COSTA MESA CONSTRUCTION PERMIT Jj 3 72 7? A.P.# Zone
Projectt Address 130F 17th ST `j S Main Building: Accessory Building:
'' 126 Commercial , C.M. 92627 TYPE OF CONSTRUCTION U NEW U ADDXM ALTERATION ❑ REPAIR E . Z
Applicant's Mailing Address
• 0 CONVERSION 0 DEMOLISH ❑ OTHER T Front D
Owner's Name Richard D^y Io Phone 548-7817 DESCRIPTION OF WORK/USE OF BLDG. 811 front sect inn _remove, B Rear JN
Aldress 130 E 17th ST.m, C.M. 3-apply 1-28I.S - - • • ,
PIPE e C Right N
Arch/Eng. License No. • TV E OF PERMIT • GRADING FOUNDATION STRUCTURAL K — G
Address 0 TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL S Left
R
Contractor's Noma Crank Bros. Roofing Phone 548-5569 0 OTHER jes--2 Ping. Ref.# Parking Req./Provided' E
PROJECT DESCRIPTION SQ. FT. 3,[39 mU I t. Q
Address(mailing) 126 Commercial ,005 C.M. 92627OCCUPANCY
CONSTRUCTION TYPE commercial VALUATION$4.927,00 Planning Notes: M
City License No. 005993 ZONE GRADING CU.YDS. ACRES T
LICENSED CONTRACTOR DECLARATION
S.
•
!.hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: RC-- r�---Q 41with section 7000) of Division 3 of the Business and Professions Code, aid
my license Is in full forcednd3 feet. • 1867 ELECTRICAL FEES
License lass `�11 Licens- • _ _- .
Date '" � galore PTL. r PLUMBING I FEES Automatic Washer . Transformer 0 15.50 KW
WORKERS'COMPENSA ION • tLARATION ' 0 50+KW
[s I hereby affirm that I have a ci" tate of consent to self-insure or a certificate
Bar Sink Showers Construction Pole Sub.,
'Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter Duo to 100 amps
(, ]0, Lab. C.1_ Backflow Preventer Service Sink
\ ✓pricy ab 85/224-�Q�r Company State Fund Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
.4ertified copy Is hereby turnh ed. _ Dryers ❑Gas ❑Electric Sub Panel
?Ce if'e�j opy.ls 1 tl with the cit tain�g Div'sio Bathtubs Sewer Connection
Date/ •f -a ApplicaniY/f'4/� Clarifiers Solar Collectors Fan
EXEMPTION FROM ORKERS'COMPENSATION DECLARATION • Motors 00-1 HP ❑1 YS-8
(Thishsection need not be completed if the permit is for one hundred ($100)orlesDishwasher Solar Piping F.A.U. Inc.Solar 09-15 HP 016-15+
I certify that in the performance of the work for which this permit is Issued I •
Fixtures -
shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes ale Light
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 Outlets / Range
comply with such provisions or this permit shall be deemed revoked. `/
CONSTRUCTION LENDING AGENCY / Switches Sign
Gas Service Outlets / Water Closet 9
I hereby affirm that there Is a construction lending agency for the performance
OI the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater - Garbage Disposal
Standing Sections
Lender's Name Generator ❑0.5 KW❑5.15 KW Trash Com ctor
Address Kitchen Sink Water Service Pa
OWNER BUIL
BUILDER DECLARATION
I hereby affirm that I am exempt31.5from the Contractor's License Law for or Lavatories Auto-Wash
followingwhichreason (Section to Businessnconstruct,and
, Professional Code: Any city or
county r cturequiresta spermitissuance,
c ,al oruct,alter,improve,demolish or repairmitP—Trap Laundry Trays
any er structure,gee, prioratm nt that he/, also requires the applicantto for such perof
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains .
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she Is exempt Reinspection Fee $15 Issue Fee
- q-refrom and the basis for the alleged exemption. Any violation of Section $ 3
'`,'','31.5 by any applicant for a permit Subjects the applicant to a civil
-"Salty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
L1 I, as owner of the propertyor my employees with wages as their sole Reinspection Fee $15 Issue Fee
9 $ 3 Zoning Approved By nate
compensation,(Sec, will do the work,and the structurenis not intended C n offered > -
for sale (Section of Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By .+ A �� •
License Law does not apply to an owner of a property who builds or Improves Date
thereon, and who does such work himself/herself or through his or her own Hood or TypeApplication Issued By � �'�,j•.- i�
employees, provided that such Improvements are not intended or offered for Boiler I 0 Date sj
sale. If, however, the building or Improvement is sold within one year of tom• Canopy Type II 0 SUMMARY 0 FA
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 PERMIT $ 7a SMIP $ •��
toI, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑9-100.000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or improves thereon. and who contracts for such projects with a con• ENERGY P.C. $
tractor(s) license pursuant to sne Contractor's License Law)- I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $
proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ GRADING $
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fart.BIS. ICBO dk Fire Dampers MICROFILM $
Date OwnerHeating SystemDuctingRegistersPLAN CHECK 50% $ 7
& MECHANICAL $ TOTAL FEE $ ( 2 '-Si'
I hereby certify that I have read this ap 'cation /• state that the above DO-100,000 BTU 0100,000 BT11—
$
Information Is correct. I agree to comp) th all i and county ordinances PLAN CHECK 25%
and state I • relating to building co uctlon, •rd hereby authorizerizerepre-
sentatives • •his city to en n e -•• •-••••boned roperty for
inspection p Date �( �(/
Signature •/A.ALA Ls +2� (J/
.— • Reinspection Fee $15 Issue Fee $ 3
Drive dose or SS#
—
01 00025010-00025011 TOT 72.50
086 -46,rev.5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
DATE: 01/25/89 TIME: 11:19
•
{' ;
ttNSTRt1CTION AND PLANNING POOI 'PA
APPROVALS Permit Date Inspector ,APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 7 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement•
3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement �' 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains , f 64. Plumbing System - Final -
• 14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
,16) Rough Egctric 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 O Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurall+& Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
•
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
•
42. Backflow Preventer - "(4.
43. Backflow Irrigation
44. Landscape Irrigation System .
45. Sound Attenuation :�- --
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Snecial 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 except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PERM p TRACT NO. LOT NO. UNIT NO, r
ProjedrAddress 130 E. 17th St. , C.M. ��a7:� 0175 I ( /24/87 ` 95,:.0 .TL
• Applicant's Mailing Address 126 Commercial, C.M. 92627 TYPE OF CONSTRUCTION U NEW U qq ADD L'I ALTERATION U REPAIR
•
Richard Doyle 0CONVERSION ❑ DEMOLISH 0 Owner's Name Y Phone 722-1602 A.P.# .•
.I Zonp
Address 130 E. 17th St. #17 C.M.. 92627 DESCRIPTION OF WORK/USE OF BLDG. re—rnflf sects nn RF' long. $ Main Building: • Accessory Building:'
remoue irasta- ��Y ��ls. 1�/hot asphalt-and gravel .E z
Arch/Eng. License No. TYPE OF PERMIT GRADING Li FOUNDATION STRUCTURAL T Front 0
•
Address C TENANT ❑ ELECTRICAL 0 PLUMBINGMECHANICAL BRearit; Ac N
Contractor's Name Crank Bros. Roofing Phone 548-5569 0 OTHER qC Right - - - N
Address(mailing) 126 Commercial, C.M. 92627 PROJECT DESCRIPTION SQ. FT. 3 440 OCCUPANCY mill t K G
C ON ST RUCTION TYPE rnmmPrri al VALUATION$ 4 977 00 $ Left
City License No. 005993 ZONE GRADING CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION . _ Ping. Ref.# Parking Req./Provided
D
I hereby affirm that I dm licensed .der provisions of Charter 9 (commencing Remarks: . Planning Notes: - M
with section 7000) of Division 3 • the Business and Professio. Code, a
my license is in full fo a .. effect e • ' - T
Licensso lass �-' Lice ri o. S •0867 •
§
b'`e Datde — ara�;SI nature It�r� —on _Ale PLUMBING FEES
'O WORKERS'COMP 'SATION -C • RATION Bar Sink Showers - ELECTRICAL FEES
I I hereby affirm that I have a irate of consent to self-insure or a certificate
Workers' Compensatio ranee, or a certified copy thereof (Section -1
Jo, Lab, C.) Backflow Preventer Service Sink Automatic Washer Transformer'0 15-50 KW
` Policy No. 785/77'-87 Company State PIMA ,Backflow Irrigation Sewer Cap Construction Pole Sub. , 0 50+ KW
❑ Certs i d copy is hereby f rnished. • '
L Cer .s is
the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant Crank Bros. Ponf7^ rn - • —
EX MPTION FRO WORKERS'COMPENSATION DECLARATION 7 , Clarifiers Solar Collectors ,Dishwasher - Meter Dover 100 amps
(This section need not tie completed-if the permit is for one hundred ($100) or —
less). Dishwasher - Solar Piping - Dryers OGas ❑Electric. Sub Panel -
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Fan
Workers' Compensation Laws of California. Motors❑0-1 HP❑1X-B
Date Signature Floor Drains• Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016.15+
NOTICE:If,after making this declaration, you should become subject to the - - —
Workers' Compensatioh provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked. - —
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes r Pole Light
I hereby affirm that there is a construction lending agency for the performance - _
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets , Range '
Lender's Name _ '
Lender's Address Kitchen Sink Water Service ' Switches Sign • -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires-a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor
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 —
Roof Drains
the Contractor's License taw (Chapter 9 (commencing with Section 7000)of .
Division 3 of the Business and Professions Code) or that he/she Is exempt -
'relrom and the basis for the alleged exemption. Any violation of Section . •
11.5 by any applicant for a permit subjects the applicant to a civil
-
laity of not more than five hundred dollars($500). $ 3
LI I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee
compensation, will do the work,and the structure Is not Intended or offered - - - .. i Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his-or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 2:Oning Aroved B
sale, I1, however, the building or Improvement is sold within one year of com- Canopy Type II 0 ppy Date
pletlon, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground • Building Approved ByDate
rove for the purpose of sale).
Uo
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural • Refrigeration System Application Issued By Date /�
tractors to construct the project (Section 7044,Business and Professions Code: —
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF LEES CO
builds or improves thereon,and who contracts for such projects with a con- _ 0 MultipleC
tractor(s) license pursuant to the Contractor's License Law). I am aware that ' BUILDING PERMIT $ J.7 sOSMTP • $ •
proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 System Repair/Alteration
PLAN CHECK $ PERMIT
0 I am exempt under section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers $
_ PLUMBING $ ISSUANCE -
Date Owner Heating System& Ducting Registers . - PLAN CHECK 25% § ENERGY P.C. $
I hereby certify that I h. read this application i .te that the above ❑0-100,000 BTU❑100,0009T GRADING $
information is correct. I (e to comply wi all,' a d county ordinances ELECTRICAL $ -
and state laws relating t. •uilding constr./id-on - d reby aut orize repre- — PLAN CHECK 50% $ MICROFILM $ •
sentatives of this city e r upon .. o - ntioned rap rt r
inspection purposes. �r �� MECHANICAL $ TOTAL FEE $
• Signature ..Lf�� CDz - / ~ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License ori . . — —
CMF 0865.46,rev.'frit White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
,C9N5TRUCTION AND:PLANNING POOL &SPA
APPROVALS .Permit-# Date Inspector APPROVALS Permit# Date Inspector
1.'Temporary Electrical,Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement,_-. 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, ❑ Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 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 Si 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 I 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 I HEALTH DEPT. REQUIREMENT r ;
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
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 .0/ft
-
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY •� ,
. No. Date
1
•
• Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
' CITY OF COSTA MESA • PERUI,T NO. TRACT NO. LOT NO. • BLDG.NO. ,
CONSTRUCTION PERMIT h , oS- //,6.39 y / "5583 3/08/R4 34.52 TL
Project Address ✓i r - n5— TYPE OF CONSTRUCTION LJ NEW LI ADD LJ ALTERATION 0 REPAIR
Applicant's Mailing./1djd�p55 /'� ��`c'� 0 CONVERSION 0 DEMOLISH LJ O'PFIL''R' A.P.4 (Zone
Owner's Name l/�/%/•/jll�I'L . Phone DESCRIPTION OF WOR _ht.7_vL— iiebt /� .�/^� •S Main Building: Accessory Building: Z
Address /3D A./ —#7— �L,7.��1 E 0
i TYPE OF PERMIT,ryiU GRADING 'U FOUNDATION STRUCTURAL T Front N
•
Arch/Eng. License No. 0 TENANT E ELECTRICAL 0 PLUMBING 0 MECHANICALA- Rear - N
Address /,_' 0 OTHER -
Contractor's Name C�s-,esc Q , flPhone "7r 3J(�Y PROJECT DESCRIPTION_SQ. FT. - OCCUPANCY C Right G
Address(mailing) 71 3 So 6 f rilebt '4/•n-izSY / CONSTRUCTION TYPE QW
• VALUATION$ g Left R
E
// ZONE GRADI NG CU.YDS. ACRES •Ref.9f' Park.Fees $ ' Q
City License No, 0,71.‘24) Ping.
LICENSED CONTRACTOR DECLARATION .Oc, /• '3 9_ D [e t• U
Remarks: /• Q T`1 Parking Req./Provided
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 • Use of Building: E
my license is in full force 0 'ft•
License Cl s me ' License N• .1 ''i_• . PLUMBING. I FEES• Planning Notes: M
�, Date l , Signature .— a•e- _ E
n ""IRK RS' -OMPENSATION DE t". RATION Bar Sink Showers N
`b reby affirm that I have a certificate of consent to self-insure or a certificate Backflow•Preventer • Service Sink •
S
I Workers' Compensation Insurance, or'a certified copy thereof (Section ' •
�1 adOO, Lab. C. 2. Backflow Irrigation Sewer Cap ELECTRICAL FEES
.J� Policy No. ,io_V9 �V Co any cfJl .Cf.//till '
N _teeing ipvoPy is hereby furnished. a . Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50.KW
rtifi/ed cop S_fzpetl with the city ng Division. ❑ 50+KW
1 Dale 7 Applicant — Clarifiers Solar Collectors Construction Pole Sub.
EXEMPTION FROM WORKERS'CO - NSATION • CLARATION Dishwasher Solar Piping CookingUnit Meter ❑u to 100 amps'
-
'c (This section need not be completed if he permit is f• one hundred ($100)or P P '
less). DrinkingFountains •
I certify that in the performance of the work for which this permit is issued I Solar Tank • Dishwasher Meter Clover 100 amps
shall not employ any person in any manner so•as to become subject to the
•
Workers' Compensation Laws of California. Floor Drains • ' Swimming Pool w/Spa : Dryers ❑Gas ❑Electric Sub Panel • '
Date Signature '
NOTICE:If dotter making this declaration, you should become subject to the Floor Sinks -_ . - Urinal - - • Fan - Motors"00.1 HP 0115-8 -
Workers' Compensation provisions of the Labor Code, you must forthwith
comply ,with such provisions or this ,permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. Inc.•
Solar 09-15 HP 01515+
CONSTRUCTION LENDING -AGENCY -
I hereby affirm that there Isa co struction lending agency for the performance Interceptors . Water Heater • Fixtures 'Microwave ' '
of the work for which t • mit .is issued (Section 3097 Civ. C.) -
• �. Device Boxes Pole Light
-
L6nder's Name - - Kitchen Sink Water Service '
Lender's Address i Lavatories
OWNER BUILDER DECLARATION _ Outlets 'Range •'
I hereby affirm that I am exempt from the Contractor's.License Law for the P—Trap, •
fallowing reason(Section.7031.5 Business and Professional Code: Any city or , • Switches Sign 7 So
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 r
'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)ofGenerator ❑45 KW 05-15 KW Trash Compactor Gs. Vision 3 of the Business and Professions Code) or that he/she is exempt - -'r •
:efrom and the basis for the alleged exemption. Any violation of Section
'd3'.5 by any applicant for a permit subjects the'applicant to a civil .Reinspection Fee , $25 Issue Fee $ 3 1-
•
natty of not more than five hundred dollars($500).
-4 'I, as owner of the property or my employees with wages as their sole — — Reinspection Fee $25 IssueLFeo • 5 3,
compensation, will do the work, and the-structure is not intended or offered MECHANICAL FEES
for sale (Section 7044, Business and Professional Code: The Contractor's , PUBLIC SERVICES REQUIREMENTS: ••
License Law does not apply to an owner of a property'who builds or Improves Boiler' Hood or Type I 0 _
thereon;and who dolt such work himself/herself or through his or her own Zoning Approved By r veto
employees, provided that such•improvements are not intended or offered for Canopy Type II 0 +
sale. If, however,the building or Improvement is sold within one year of com- Duct-Under Ground Building Approved By •
prove h owner sewill have the burden of proving he/she did not build or Im- Date
rove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By (7)___:
f a - flare
glove
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 SU M RY OF FEES
'The Contractor's License Law does not apply to an owner of property who r
builds or Improves thereon,-and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration - BUILDING PERMIT $ rL SMIP $• 0.so
tractor(s)license pursuant to the Contractor's License Law). • • PLAN CHECK $ //r TZ PERMIT
D I am exempt under Section , B.8 P.C.for this reason Firepl/Fact.Bit.ICBG# • PLUMBING $ ISSUANCE $
Date Owner' - Heating System& Ducting �� T
PLAN CHECK 25% $ ENERGY P.C. $
I hereby • ,at I have read this application and state that the above . - 00.100,000 BTU 0100,000 BTL - - . _ r /� SO GRADING $ .
informa •n is corre I agree to comply with all city and county ordinances ELECTRICAL $ r
and"sta., taws relatin. to building construction,,and hereby authorize repro- . . . MICROFILM $
sentative of this y to enter u•• he above-mentioned prop ty or • PLAN CHECK 50% $ (� p
inspection •os /� MECHANICAL $ TOTAL FEE $ / 2_
Signature i_ / �� Data ,
Drivers'
u• se Or'SS$ MrReinspection Fee • $25 Issue Fee $ 3 _ PLAN CHECK 25% $ -
- -INNS
CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - - ! - - -
_CONSTRUCTION AND PLANNING POOL PA - -
Date Inspector - - Date Inspectors .
.APPROVALS Permit# APPROVALS. Permit# - _
1, Temporary Electrical Service or Pole - 52. Pool &,Equipment Location . ' ' -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - •_
3. Electrical Conduit Utility-Undrgrnd. 54. Forms _ - t
, 4. Electrical Conduit-Undrgrnd. • - 55. Elecirical Bonding 5. Steel Reinforcement - .r 56. Rough Plumbing'& Pressure Test .1- yi
6. Electrical UFER Grnd.. - 57. APPROVAL TO COVER-GUNITE• - _ -
7. Footings-I-3 4-91,14- i 4•L ter-- 58. 'Electrical Conduit-Undrgrnd. -
8. Foundation - 59. Gas Pipe, O Undrgrnd.,Test • . - - , iti
9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd.-+ '
10. Structural Floor System 61. APPROVAL TO DECK - ' r
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final -
12. Sewer Cap 63. Heater & Vent-Final - - - '
1
13. Roof Drains . 64. Plumbing System; Final - - `-
14. Rough Plumbing 65. Electrical-Final - . .
15. Rough Electrical-Conduit 66- Solar System-Final - - 1 • '-- - - -
16.. Rough Electric Wiring - - 67. Fencing&AccessApproval - - ' -.
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 APPROVALSI ' Permit#_ . ' i - 1
21-'Ducts, in Structure 70. Underground Hydro •
F .
22. Ducts, Ventilating 71., Product Piping C Gas 0 Oil ,
23. Gas Pipe-Rough&Test . 72. Underground Flush • i
24. Rolf Framing 73. Undergrnd-Storage Tank 0-Gas 00il., ,
25. Roel Sheathing ' 74. Overhead Hydro - - I
C
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - -
27. Frame and Flashing 76. Dry Standpipe , _
l
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: .:z,9.-$p' 4 y �LC 1).v , 4imEe_. Crime
34. Final Heating & Air Conditioningu ^a C2livA. Alb chews /
35. Final Gas Pipe-Test - -
36. Hood or Canopy .. ' .
37- Final Factory Fireplace
38. Final Plumbing - ; l
39. Water Service-Final -
40. Gas Service-Final ,
41. Solar Domestic-Final --- =--�- - 1
42. Backflow'Preventer - , ' • •
43. Backflow Irrigation li
44. Landscape Irrigation System - - : ' • .
45. Sound Attenuation ' - - - -
46. Handicap,Regulations A , -
47, FINAL STRUCTURE & BUILDING ////j a4g., I I . • - , -
- -
48. Special Requirements Completed , ,
49. Electric Release to Edison i _ ' ._ -
50. Gas Release to Southern California Gas Co ,f , ,
,•
51. CERTIFICATE OF OCCUPANCY -i
-. -
No. Date _ _ 1•`' - - - -
(tit
_ _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CI nT'�pCO/S�TTQ MESA PE MIT NO. TRACT NO. 1 •LOT NO.. BLDG.NO. - -
TRUCTION PERMIT ' j{// 1 3ao`)L - 7 '/ • " 9801 ' • 5/03% 4 PI I .51TL
Project Address 3(7.,�'I ,ss i+j LJ r' . TYPE OF CONSTRUCTION - U NEW 'fl ADD JOIIALTERATION U REPAIR ' - ' t ' - ' • ' '
Applicant's Mailing Address . &AM • - , ` / '❑ CONVERSION ❑ DEMOLISH ❑ OTHER - A.P.# if 2$— 44f'/-. O7 I Zone �. 2�- - .
Owners Name ._,MV
'hone olL/Q DESCRIPTION OF-WORK IRFMCD L-INTea+:Q
•
• S Main Building: Accessory Building:. 2
�A�ddyress z'/-s Lc= 1(9 /�� �,2 -0 TYPE OF PE RMIT�yf U'GRADING�I❑ FOUNDATIONS U STRUCTURAL E Front •�`?�.J,'(/ . 0•
'
•
CErig. l .. 12 sus� --121344License No.' `f J-' ❑ TENANT WIELECTRICAL )C�.PLUMBING CI MECHANICAL B ::r.
l tNAddress 42S 14�W! 731 ❑ OTHER APROJECT DESCRIPTION SQ. FT. OCCUPANCY C t nG
Contractors Nam¢ - K - R
Address lmailing) CONSTRUCTION TYPE e VALUATION$ /58047 S
City License No. - � '-- •
• ZONE ' GRADING CU.YDS. 'ACRES Plhg. Ref.#, � 79'-x/ 6� Park.Fees $ - CI
•
U
LICENSED CONTRACTOR DECLARATION Remarks: C f �,�� '7/ 80` 'Parking Req./Provided - , I ,
I hereby affirm that I am licensed under provisions of Charter 9(commencing -ice -
with section 7000) of Division 3 of the Business and Professions code,and / 11 - &"4 ' Use of Building: ,R •
my license is in full force and effect, - - ' ..... ' i
License Class - License No. PLUMBING FEES Planning Notes: p �)� RFOUIREA4EN'1• MuLe F63 €.Fl E
Date Signature Bar Sink , Showers �, Ki N
L;.;'�C,{00.KER5'COMPENSATION DECLARATION T
t•...1ereby affirm that I.have a certificate Of consent to self-Insure or a certificate Backflow Prev¢nter Service Sink_ - - '- '
?f;, Workers' Compensation Insurance, qr a certified Copy thereof (Section
"'3800, Lab. C.) Backflow Irrigation Sewer Cap'', ' "� ELECTRICAL - 'FEES
Policy No. - ' ' Company ' /,
Certified copy Is hereby furnished. Bathtubs Sewer Connection • Automatic Washer Transformer ❑ 15.50 KW .
A
Certified copy is filed with the city Building Division. ❑ 50+KW
Date - Applicant Clarifiers Solar Collectors Construction Pole Sub. . ..
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION • Dishwasher Solar Piping Cooking Unit Meter pup to 100 amps
(This section need not be completed if the permit is for one hundred ($100) or ,
less). DrinkingFountains Solar Tank Dishwasher - Meter Dover 100 amps
I cetify that in the performance of the work for which this permit is issued I ''.
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California. Floor Drains Swimming Pool W/$Pa Dryers ❑Gas ❑Electric Sub Panel •
Date Signature
NOTICE:If,.after making this tleclarallory,.you should become subject tot he Floor Sinks Urinal ®® Fan Motors 00-1 HP ❑1%-B
Workers' Compensation provisions of the Labor Code, you must forthwith _
comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets. Water Closet • � F,A.U. ® Inc.Solar❑S-15 HP ❑16-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance- interceptors •
. Water Heater M. Fixtures'''. ,r El:Microwave �
of the work for which this permit is Issued (Section 3097 Clv. C.) __ -
Lender's Name Kitchen Sink ' Water Service �,� Device Boxes ® Pole Light _ Il
Lender's
Lender's Address DE •
OWNER BUIi LDER DECLARATION •
- Lavatories Outlets Range '
i hereby affirm that I am exempt from the Contractor's License Law for the
•
following reason (Section 7031.5 Business and Professional Code: Any city or P-Trap - 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
to file a signed statement that he/she is licensed pursuant to the'provisions of
•ihe Contractor's License Law(Chapter 9(commencing with Section 7000)of - '
gf;`Jvision 3 of the Business and Professions Code) orthat he/she is exempt Generator ❑0-5 KW ❑5-15 KW Trash Compactor
ct?erefrom and the basis for the alleged exemption. Any violation of Section -
:11/31.5 by any applicant for a permit subjects the applicant to a civil Reinspection Fee $25 Issue Fee $ 3 ' • `
enalty of not more than five hundred dollars($500).
U 1; as owner of the property or my employees with wages as their soleReinspection Fee ' -$25 Issue,Fee $ 3.
compensation, will do the work,and the structure is not intended or offered MECHANICAL FEES
for sale (Section 7044, Business and Professional Code: The Contractor's - - - - - -- - PUBLIC SERVICES REQUIREM NT
License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I 0 : �E} $C_ �/ LI
thereon, and who does such work himself/herself or through his or her own Zoning Approved By y`•�J if ti Date c s-�
employees, provided that such improvements are not Intended or offered for Duct-Under Ground Canopy Type II ❑ // ,`f{' / 3"----
� ccs/
sale. If, however, the building or Improvement Is sold within one year of com- Building Approved By S✓ se' Date J _.�^g
pletion, the owner will have the burden of proving he/she did not build or im- .
•rove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By nate
_
I.as owner of the property, am exclusively Contracting with licensed con- Duct-Ventilating ❑6100,000 BTU ❑100,000 BTU -
•
tractors to construct the project (Section 7044,Business and Professions Code: - , - _ SU/MMARV_OF FEES
The Contractor's License Law does not apply to an owner of property who - BUILDING PERMIT $ /�zSMIP" $ //d5'
builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple❑' System Repair/Alteration
l - PLAN CHECK $ PERMIT
tractor s)license pursuant to the Con rector's License Law).
01 am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG# PLUMBING $: ISSUANCE $
Date - - J • •- _ • HeatingSystem& Ducting PLAN CHECK 25% $ - _ i ENERGY P.C. $
I hereby certify that I have read.this appllc ion and state that the above ❑Q100,000 BTU 0100,000 BT - - ••
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $- 1 GRADING $
and state laws relating to building construction,and hereby authorize repre- - .MICROFILM $
sentatives of this city t• enter upon the above-mentioned property for - PLAN CHECK 50% $ '
inspection purpose.._ 0,�� .trL MECHANICAL $ ' •NOTAL FEE ,$ �l/r �`5
• Signature - �` Date 7 1T A
Reinspection Fee I $25 Issue Fee - $ 3 PLAN CHECK 25% $ .
Drivers' License or SS#
CMF 0865-46 rev.12/33 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - • -
L0' CONSTRUCTION AND PLANNING , POOL ;PA -'
` - \ . - Date Ins ector +
1 APPROVALS • Permit'#. p APPROVALS Permit# :Date' Inspector
1. TemporaryI c
Electrical Service or Pole 52. Pool & Equipment Location a
2: Soil Pipe-Undrgrnd. - - 53. Steel Reinforcement
3. Electrical.Conduit-Utility-Undrgrnd: "- 54: Forms '
4: Electrical Conduit-Undrgrnd.- - _ 55. Electrical Bonding - --
5t Steel Reinforr&rfierii. - 1 - 56. Rough Plumbing& Pressure Test - . .
6. EleciricahU�ER�GTrod. /I /Ci 57. APPROVAL TO COVER-GUNITE .
7. Footings ••;11/46:14;4414-; 3////4/ //U 58. Electrical Conduit-Undrgrnd. - , '
8. Foundation '' 'jn : . r( T 59. Gas Pipe, 0 Undrgrnd.,Test- - - s _ , , .
9. -Water•Pipe-Undr`grnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. . ,
... .-_c, •-
10. Structural-Floor'System - 61. APPROVAL TO DECK
11. Property Sewer-cil e & House Connection - 62. Backwash & Receptor-Final -
12. Sewdr Cap '^ - 63. Heater& Vent-Final a,
13. Roof Diains., - 64. Plumbing System - Final - - _• a
1. 14. Rough Plumbing "j. 65. Electrical-Final . • • .1'
:15: Rough Electrical-Conduit -' ---- - 66. Solar System-Final ""---
16. Rough Electric Wiring, 67. Fencing &Accesi Approval _ -- . -
I - ' 17. Rough Wiring'Sign, 68. APPROVED FOR PLASTERING- _ '
- ' 18. 'Rough-Electrical-T Bar Ceiling • 69. POO USPA SYSTEMS FINAL `rx
19. Rough Heating& Air Conditioning . FIRE DEPT. REQUIREMENT - .
I .
• 20. Rough Factory Fireplace : APPROVALS Permit# ' '
21. Ducts, in Structure 70. Underground Hydro 0
. - • ♦ L
•
22. Dycts;i_Ventilating .'l.' ' 71. Product Piping 0 Gas 0 Oil '
23.E Gas Pipe-Rough&-lest ' •
'- 72. Underground Flush
24. Roof Framing •J 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing ? . • ' 74. Overhead Hydro
26.FT-Bar Ceiling (Structural) & Monocoat 1c'(shit 1762 75. Dry Chemical • -
27%. Frame and Flashing �' (JJ 76. Dry Standpipe
28. Lathing& Siding �� ✓(/ 77. FIXED SYSTEM FINAL
29, Insulation . . ; ' , 78. FIRE PREY. FINAL I '
30. Drywall Nailing ''i' ' - HEALTH DEPT. REQUIREMENT
.G
31. Plaster Brown Cor- 79) FINAL INSPECTION • .
32. Electrical Power fbbfe'er-Final , ;80. FOOD CERTIFICATE ISSUED i
33. Final Electric Notes: yrntly //gY/ 4044/61 A
34. Filial.Heating & Air Conditioning W O ,
7o p�c✓ aa/E Sii9t- � �sr ✓�j, t
35. Final Gas Pipe-test ' • Alt09 (/ e , - r
36. Hood or Canopy i iv A mt OA/ tieciet �4f�'L/r Ls'
37. Fina(�Facfory'Fireplace C�/✓'/Cr(fo pii✓r/N; At(r/4 at_. ��J,, �����z��,���'
38. Final Plumbing-. ' ; ` • ?4 i4C, r463s'UtC ' 34Sra "%E MA*.
39. Water'Service--Final r . - ' (0r1:, YY vim- . . - '/
_40. Gas Service-Final : . ' ' X -u�J �' �y �e_;-� ,y
41. Solar Domestic-Final - - AG._ _Sq
std-'`-a-///"' ('x�c,ie.
42. Backflow.Preventer' ' _ - �'� � , eft-v ,--� ' '
43. Backflow Irrigation' - �,. ,; . �- �� �.
IEZ9
44. ,Landscape Irrigation,System 3; sAo2 .A14IN{ /4.5'_/"G/ u
45. Sound Attenuation'
O. fU 041si h l Cae//. �q.GtVoo�
46. Handicap,Regulations : - - i tt /'l / "
47. FINAL STRUCTURE& BUILDING /04,M t/� l
48. Special Requirements Completed /OW& eli7
49. Electric Release to Edison. ' ! '/-�`' ,
50. Gas Release to Southern California Gas Co ,
I. 51. CERTIFICATE F OCCUPANCY �/ ;--
No. l� Date' 'oLO � 1 C / `r?
I .
•
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - _ _ - _ _ .
•
CITY OF 47)STA MESA CONSTRUCTION PERMIT PE T NO. TRACT NO. LOT NO. UNIT Nb. •
_ I
Pruett Address 30 E• 11911 51. C6s'tp"MomS8i LI Li
S-A'roE TYPE OF CONSTRUCTION : NEW ADD LI ALTERATION U REPAIR - 075b IC)/2q/Ri,, fa f1• IL
Applicant's Mailing Address
Owner's Name �yjlaa eel Phone 016-3666 0 CONVERSION 0 DEMOLISH ❑ OTHER - A;p• ! I Zone
DESCRIPTION OF WORK/USE OF BLDG.
Address •�^t //�/ 1 S Main Building: • Accessory Building:
Arch/Eng. ,J 5 License No. yr- CI 7 O TYPE OF PERMIT IJ GRADING -U FOUNDATION U STRUCTURAL E Front . -, • . I p
•Address 7� �e✓j1d2}{ �f4A,• Newecast A7/2AC4�j ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - A Rear - N •
,Contractor's Name U Ingc ev'i Ciro c c �•• 'phone 611-P2)3 ❑ 'OTHER - C Right N
Address(mailing) 61 I• LAI • i f 1 i -NQ L] (�•ya�ria 'Tea PROJECT DESCRIPTION SQ. •
'.FT. - - OCCUPANCY K Left G
• 3C . CON ST RUCTION TYPE VALUATION$ s 1 City Lic¢nse No. �.J�Y• , ZONE I GRADING CU.YDS. ACRES , - - R
LICENSED CO NT RACT.OR DECLARATION - - t Ping..Ref.# Parking Req./Provided - E '
'I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: 1" ^ � ( •
PlanningNotes: - Q '
with section 7000) of.Division 3 of the Business and Professions Code,and f ��l� / ���'—` - M
my license is In full tome and of ect i/ 77 �C' t t T
License doss C� s IP { .f C ' LI 'No. S]'/• 0 ! PLUMBING FEES . S
I Date a--. -• - Signature Me eat •' ,
WORKERS'COMPENSATION DECLARATION • - I
I hereby affirm that I have a certificate of consent to self-Insure ora certificate • Bar Sink Showers ELECTRICAL FEES
)f Workers: COmpensation Insurance, or a:certitled copy thereof (Section •
Backflow Preventer - - Service Sink --- - "- - -
3800, Lab. C.) ' Automatic Washer Transformer 0 15-50•KW '
Policy No. Company Backflow Irrigation Sewer Cap •Construction Pole Sub. - • ❑ 50+ KW'
8 Certified copy is hereby furnished. . ,
Certified copy is filed with the city Building Division. •• Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date I Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION , Clarifiers ' Solar Collectors _ Dishwasher __ Metes Dover 100 amps_ _ - _-., ,.
(This section need not be completed If the permit is for one hundred ($100) or --, Dishwasher , Solar Piping Dryers ❑Gas •❑Electric
less).. Sub Panel
I certify that in the performance of the work for which this permit is Issued, I - • '
shall not-employ any person In any m her so as1 to op ome subject to the Drinking Fountains ' Solar Tank ' Fan Motors❑0-1 HP ❑1X-B '
Worker Co nsition Laws of Califo I /I- '�/,LM_'f�_`�. 1 )
. Date i " - 1 Signature 44 f-� Floor Drains • Swimming Pool w/Spa F.A.U.
INOT.ICE: If,after making this declaration, you should become subject to the i _ . _ Inc.Solar ❑9-15 HP ❑16-15+ _
Workers•-ComPensationa provisions of the Labor Code, you must forthwith- I - - ' Floor Sinks-,- -- - - -- Urinal • - -I - - Fixtures Microwavev
'comply with such provisions or this permit shall be deemed revoked. _
• CONSTRUCTION LENDING AGENCY - `• - Gas Service Outlets Water Closet , - Device Boxes •
I I hereby affirm that there is a construction lending'agency for the performance Pole Light
.of the work, for which .this permit' is izsueq (Section 3097.,.Civ: C.) , Interceptors_ ; - Water Heater • ' Outlets Range •
Lender's Name - - - -
Lender,'s Address ' • - •
• - Kitchen Sink - Water Service _ Switches Sign.
OWNER BUILDER DECLARATION s - -
I I hereby affirm that I am exempt-from the Contractor's License Law for the, Lavatories ' • h, - ' Auto-Wash ,_ -
, following reason"(Sectlon 7031;5 Business and Professional Code: Any city or -- - Garbage Disposal ,Standing Sections
county which requires a permit to construct,atter improve,demolish or repair ' , P-Trap ' • ' - Laundry Trays - - ) Generator ❑0.5 KW 05-15 KW
any structure;prior to its issuance, also requires the applicant for such permit: _ _ Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of- I Roof Drains -- - ' •
- L�_
the Contractor's License,Law(Chapter 9 (commencing with Section 7000) of ' ' _' t o ✓"1 me i- . S'
' Division 3 of the Business and Professions Code) or that he/she is exempt - - r
therefrom and the basis for the alleged exemption. Any.violationof Section ' I I -. •
7031.5 by any applicant for a permit subjects•the.applicant to a civil . - ,
eenalty of not more than five'h unfired dollars($500). _
U I, as 'owner of l the 'property or-my employees with wages as their sole Reinspection Fee , ` $15 Issue Fee $ 3 I '
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 I I $15 Issue Fee $ 3
License Law does not apply to an owner of a property who builds or improves r
. thereon, and who does-such work himself/herself or through his or her own • , DEVELOPMENT SERVICES'REQUIREMENTS; ,
' employees, provided that such improvements aremot intended or offered for Boiler Hood or Type I 0
' sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 •Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- . Duct:Under Ground, Building Approved By ' Date '
rove for,the purpose of-sale). - CA
s� •
I, as owner of the properly,am exclusively contracting with licensed con- Duct-Structural Refrigeration System ' 'Application Issued By • --yCJ!(/ • Dat
tractors to construct the,project (Section 7044,Business and Professions Code: J' ,
LThe Contractor's License Law does not apply to an owner of property who _ Duct-Ventilating„ . -' _- 0o-100,000BTU 0100,000 BTU _ SUMMARY OF FEES .
builds or improves'thereon,and who-contracts for such projects with-a con- -
1 tractor(s) license pursuant to the Contractor's License.Law). I am aware that ExhRepair/Alteration aust System 0 Multiple 0 System Rair/Alteration . BUILDING PERMIT $ SMIP I $
. proof of;their Worker's Compensation Insurance should be provided to me. PLAN CHECK •
$ PERMIT
❑ I am exempt under Section B.&P.C.for this reason ' Firepl/Fact.Bit. ICBG# Fire Dampers , PLUMBING $ ' I ISSUANCE $
Date • Owner ' Heating System& Ducting ' Registers •
PLAN CHECK 25% $ ENERGY P.C. ;$
,1 hereby- certify that I'have read this applicationand state'that the-above . 00100,000 BTU 0100;000 BTC " - -•' - - ' -
information is correct. I agree to comply with all city and county ordinances - ELECTRICAL $ '5.c� GRADING $ '
and state laws relating to building construction,and hereby authorize repre- •
' PLAN CHECK 50% '$ MICROFILM $
sentatives of tJIT; ci y tp erste on the above-mentioned property for ,
iinspection pur/�lb s/�' l.// p� ��II)) yU _ MECHANICAL • $ - TOTAL FEE $ • •QC)
'Signature Date/a/ ot-J"O, /
Drivers' License or SS# & • Reinspection Fee $15 ' hale Fee $• 3 ! PLAN CHECK 25% '$ I
_—
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
•
CONSTRUCTION AND PLANNING• • POOL& SPA
Date Inspector. - • Date Inspector
APPROVALS Permit# APPROVALS Permit
.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-Uridrgrnd. . . 55. Electrical Bonding - -
5. Steel Reinforcement I56. 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 •
S.-Water Pipe-Undrgrnd.i. I . . - 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. Rou• gh 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) & Njonocoat 75. Dry Chemical
27. Frame and Flashing • 76. Dry Standpipe
28. Lathing & Siding . 77. FIXED SYSTEM FINAL
29. Insulation . 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ', '
36. Hood or Canopy -
37. Final Factory,Fireplace ,
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final •
41. Solar Domestic-Final - -
42. Backflow Preventer 1 .,. - - • •. '
43. Backflow Irrigation . - ,
44. Landscape Irrigation System .
45. Sound Attenuation ,
•46. Handicap Regulations -
47. FINAL STRUCTURE& BUILDING' •
48. Special Requirements Completed: i
49. Electric Release to Edison - - ,, i
50. Gas Release to Southern California Gas Co i
51. CERTIFICATE OF OCCUPANCY - ,
No. Date . - --
ll
I
I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONST€tUCTIC PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. 8888 9/26/84
Project Address 130 7 i 7` '' . ,til • • ►3 54 (p NE`,e-t�I�e>- II mac� ) I
S3.06 Y.
j` Applicant's Mailing Address 5ii GG1 'e +moi/ //// TYPE OF CONSTRUCTION U NEW I!J` ADD u ALTERATION U REPAIR 1
Owner's Name ' Ml "7 �-. C P.I m/ Pe/brohe `'443``66. 0 CONVERSION 0 DEMOLISH 0 OTRp
DESCRIPTION OF WORK/USE OF BLDG. FlG�,o• a0“. G A # �� 441 - vM` Zone L�
Address / 7 - 2o_ • s.S L.A•aye.�w-,., i._' S Main Building: I Accessory Building: Z
Arch/Eng. / a/ c.-:- ' ri • - icense`N/o. �- Z TYPE OF PERMIT U GRADING il FOUNDATION STRUCTURAL T Front 7..-0 ////// O
Addrf55 Z•' 3�/ Ir. i '!J 0�r - 's 'f 0 TENANT ELECTRICAL 0 PLUMBING 0 MECHANICAL - BA Rearg �� I / N
Contractor's Name ,C/r B� P iGP .•rLphone lhD�Za •-
S'U/fJ U/G-O/ Q.o"*- a.v' /n/e. PROJECT DESCRIPTION SQ. FT. - OCCUPAN C Ri ht 0 ! N
AAdfess(mailing)20R/ / �s.- �.,, K f G
a-VL/ R-4C-A-oft(- .�L! L '-A 1'b K CONSTRUCTION TYPE�' N VALUATION$ t/V �'^ $ Left
7cf R
City License No. - z�� , 1 ZONE GRADING CU.YDS. ACRES Ping. Ref.# �'-4-t O40 Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION - //A /// /l ISS 0
I hereby affirm that Iainlicensed 3 under provisions of Charter 9 (com/nencIngd Remarks:CG' ‘..5- ,...54.....c. ii i1 A 2ra I/ ,T/„ /¢ Planning Notes: i M
with section 7000) of Division 3 of the Business and Professions Code, and "s"��' _ roL /L •^ T
my license is in ful•_force and effect.
License Class �_ I<ense ns s ftntrsnoaet•vm S
.. r/-�vs.0 s v� ?r Y( yy -157-"ea
S fl
Date 7 •
.r Signature �� PLUMBING FEES itnatt � Pier d t}oe p / Z,A e, S I Q
1 WORK RS'COMPENSATION D CLARATI• - / / • Bar Sink Showers— EE
I hereby affirm that I have a certificate of conse ,, 0 - s e .r . I mate _ ELECTRICAL FEES
-of Workers' Compensation Insurance, or a ce ified copy thereof-(Section - Backflow Preventer Service Sink -
3800, Lab. C.) l Automatic Washer Transformer. 0 15-50 KW
Policy No. )�P 'O O� V Company Ftrc.nn n Backflow Irrigation Sewer Cap _ Construction Pole Sub. • 0 50+KW-
yEertified Copy Is hereby furnished.
Certified copy Is filed with the city Building DiviSi.{�n 1 CO , Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date 4 f '2-� Applicant `"U 11 Vlll ,!s t I
EXEMPTION FROM WORKERS'COMPENSATION DECLARATI Clarifiers fern Solar Collectors - Dishwasher Meter ❑over 100 amps
(This section need not be completed if the permit Is for one hundred ($100) or - - -
less). - Dishwasher ' Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, I '
shall not employ any person in any manner;so as to become subject to the Drinking Fountains Solar Tank s Fan
Motors❑01 HP ❑1 yx-8
Workers' Compensation Laws a 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 09.15 HP 016-75+
Workers' Compensation provisions of the Labor Code, you must forthwith - Floor Sinks Urinal Fixtures 1 . -
comply with such provisions or this.permit shall be deemed revoked. _ - MICrOWdV¢ - -
CONSTRUCTION LENDING AGENCY Gas Service Outlets! Water Closet Device Boxes !'
I hereby affirm that there is a constructionlending agency for the performance .� Pole Light
of the work for which this permit is Issued- (Section 3097 Civ. C.) interceptors. Water Heater - -
Lender's Name - Outlets „ -,, ��� Range
-
Lender's s Address Kitchen SinkWaterervce Switches •Si '„•- Sign
OWNER BUILDER DECLARATION - • 'I
I hereby affirm that I am exempt from the Contractor's'License Law for the Lavatories Garbo e-Dis osal - • /
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P .r - 'Standing Sections ,
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Generator ❑0-5 KW❑5-15 KW Trash Compactor
any structure, prior to its Issuance, also requires the applicant for such permit '.1
P
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains •.
the Contractor's License Law(Chapter 9(commencing with Section 7000)of - - ,
Division 3 of the Business and Professions Code) or that he/she is exempt - - ' " '
•
therefrom and the basis for the alleged exemption. Any violation of Section -- _ al" r:
•
7031.5 by any applicant for a permit subjects the applicant to a civil -
nalty of not more than five hundred dollars($500). _ f' ^•
•
_J I, as owner of the property or my.employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 f
compensation, will do the work,and the structure is not intended or offered ' - 1, Reinspection Fee 1'.$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 SERRVL S RE U EMENTS: • ��
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I. 0 U
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type 11 0 Zoning Approved By ea //52±.' Dat ' s#
melon,-the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By AV> ft ti -4/�it?". Date a14 T
grove for the purpose of sale). �{..,
I,'as owner of the property,am exclusively Contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date 1'-'LS
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who - Duct-Ventilating _ poi 00,000 BTU ❑100,000 BTU /' .7 4 tU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- - f m (-�. /�/� /�.,
tractor(s) license pursuant.to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ /'' T).J\ r SMTP $ ' SF-'
proof of their Worker's Compensation insurance should be provided to me.
/[,,,�r,,�,
PLAN CHECK I$ ' •1�'V+s - PERMIT
❑ I am exempt under Section B. & P'C.for this reason Firepl/Fact.Blt. ICBG# , PLUMBING t $1 .. ISSUANCE $
Date Owner Heating System& .PLAN CHECK 'Ducting 25%
ENERGY P.C. $
t
t
I hereby certify that I have read this application and state that the above 00-700,000 BTU 0100,000 BTL , t GRADING $
information is correct. I agree to comply with all cit and county ordinances ELECTRICAL ,$ -
and state laws relati to bu Mg onstr ction, ,�1 hereby authorize repre-
sentatives of his• y to er pon !e al,.7-mentioned pro err/y)or ` MECHANICAL - $ / �J�
y inspection r n� / _ /� y%r�z; / _ TOTAL FEE $ `r I-
•
Signature Date $
Drivers' Licenseor SS Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25%
CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting:Goldenrod -Assessor
CONSTRUCTION AND PLANNING - r POOL&SPA
'APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
_ 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding
•
5. Steel Reinforcement %AUL 10 /�w (Ad 56. Rough Plumbing & Pressure Test
r�
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - QAC. (4,414,2s icilifT (JC/ 58. Electrical Conduit-Undrgrnd.
8. Foundation .J _ `y� uey 59. Gas Pipe, 0 Undrgrnd.,Test '
-9. Water Pipe-Undrgrnd. a 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 '❑Oil
r
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •
27.. Frame and Flashing / 76. Dry Standpipe
28. Lathing 8; Siding KL /' 111/%'�t/ (..2e_-___., 77. FIXED SYSTEM FINAL
29. Insulation ! o 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat• 79. FINAL INSPECTION
32. Electrical Power Meter-Final S 80. FOOD CERTIFICATE ISSUED
33. Final Electric , Notes: . / //JJ
34. Final Heating & Air Conditioning Qtr 5-0 g. et,o or-- /0/til/�(j
FinalPipe-Test I -/ 7
35. Gas, �\ ///�JJJ'''�/`:�Ji „4,-- 412
36. Hood or Canopy • /6- Ze_g ./ Az
37. Final Factory Fireplace 44. P-_/3Gyo �_ - - ��
-s
38, Final Plumbing -
39. Water Service-Final if sl day/ O(� /� 6�/L "1TcV�
40. Gas Service-Final •
• re'/fZ y,Qf ff FNCG . SEraEi drE
41. Solar Domestic-Final - /fr&i//T er�.J/rC£. , • t/. c
42. Backflow Preventer - m I() t) r- / Gni-
/7).
i`tY.E'. 1 6
ritAti-
43. Backflow Irrigation • ,. � CC ,
44. ,Landscape Irrigation System t.•
45. Sound Attenuation
46. Handicap Regulations //
47. FINAL STRUCTURE & BUI LDING fig1 Q/ v" "
48. Special Requirements Completed . 11/1& /IIt4 -
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 except those within heavy border lines and sign all appropriate declarations. •
i' P RMITNO. ISfI,C�.N{J. .� �l���� �O� G�
CITY t A COSTA MESA CONSTRUCTION PERMIT /V\ I LOTy�] UNIT ►
//O 0341 rel A.P.gW Zone
Flnject Address I F �7 <T - 'T r' l S Main Building: Accessory Building:
I.6 TYPE OF CONSTRUCTION U NEW CJ ADD ALTERATION U REPAIR
Applicant�s'Mailing Address S �.
�1 rT 7zz_�i z� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER / T Front _� ZO
Owner's Name ( '«�7�/ �. �� Phone [- / DESC'IPTION e F WORK/ SE OF BLDG. .1 4.- - A. - - IB Rear N
Address --L. ff- /7 sTr �• / ' n i1 - I C Left' N
A
Arch/Eng.RLa9GG SAC° License No. C-/7294' TYPE 0 - RM • GRADING . FOUNDATION II STRUCTURAL 1 K G
Address `//ft SI: t4( V.4M'6i'EG,C4 g26(/7 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left
R
�d,(� Ping. Ref.# Parkin Re /Provided E
Contractor's Name -_t ec.) Dm L.5- one 721'1177 ❑ 'OTHERg q
PROJECT DESCRIPTION SQ. FT. OCCUPANCY Ca pw1./ M
Address(mailing) �� / 7 ref Sr �.'g Planning Notes:
g CONSTRUCTION TYPEW". VALUATION$ ?O/ i X 4^ /, . { � �Yi t seer �ic fc dl / Q
City License No. ZONE GRADING CU.YDS. _ ACRES t / L4•t, {Nf
LICENSED CONTRACTOR DECLARATION S.
I hereby'affirm that I am licensed under provisions of Charter 9 (commencing Remarks: �,/�' Q,(�/t
with section 7000) of Division 3 of the Business and Professions Code, and 44 / t . 7�•Ese_ recon � a. 2r/2igi
my license is in full force and effect. p/� FEES
License Class License No. r_ C.� 4;f144-4;f144--VcP/Q CS ELECTRICAL
Date Signature PLUMBING I FEES Automatic Washer Transformer 0 15.50 KW
WORKERS'COMPENSATION DECLARATION Bar Sink Showers Construction Pole Sub. 050+ KW •
I hereby affirm that I have a certificate of consent to self-insure or a certificate •
workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
'00, Lab. C.) -
r'olicy No. Company Backf low Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
8Certified copy is hereby furnished. r— Dryers ❑Gas ❑Electric ^— Sub Panel -
'h
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant f - Fan I Motors 00-1 HP 01 -8
' _EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • J
(This section need not be Completed if the permit is for one hundred ($100)orF,A,U. - Inc.Solar ❑9-15 HP d16-15+
less). Dishwasher Solar Piping _
I certify that in the performance of the work whichLime
s per- is Issued,I
Shall not em loy ny person in any mann: •• s to o. )act to the Drinking Fountains Solar Tank '•' Fixtures Microwave
Workers' o e s n Laws of Califor
xy pate /I / Signature .%/i. .i-S7JLFloor Drains Swimming PooPw/Spa Device Boxes Pole Light
/
NDTlt7 1,a of king this tleclaratio .You should subject to the
Workers' Co pensation provisions of t - Labor Code, •u must forthwith Floor Sinks Urinal I] Outlets Range
comply with such provisions or this permit shall be deemed revoked. '•S
•
CONSTRUCTION LENDING AGENCY •
Gas Serviee Outlets Switches Sign
I hereby affirm that there Is a construction lending agency for the performance Water Closet
of the work for which this permit is issued (Section 3097 Civ, C.) Garbage Disposal Standing Sections
Interceptors Water Heater •
' Lender's Address Lender's Name Kitchen Sink Water Service - Generator 00.5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION - -
fhereby affirm that Iexemptfrom the Contractor's License Law for the Lavatories Auto-Wash
(
following reason (Sectionon ]031.531.5Business and
Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays -
t .
.-any structure, prior to its Issuance, also requires the applicant for such permit 7
(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)df
Division 3 of the Business and Professions Code) or that he/she is exempt ,
Reinspection Fee ! $15 Issue Fee $ 3
erefrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
pairy of not more than five hundred dollars ($500). - DEVELOPMENT SERVICES REQUIREMENTS: /. G}I-�r
s {��qy I, as owner of the property or my employees with wages as their sole Reinspection Fee 1 $15 `Issue Fee $ 3 W( p— ._sI
�2om pensation, will do the work,and the structure is not intended or offered _ j Zoning Approved By F���� v Date / �s�
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES Building Approved By / Date �('��
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 Application Issued By Date p�6
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ {////
sale, If, however, the building or improvement is sold within one year of com- Canopy Type II 0
pietidn, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground SUMMA Y-QF FEES `'
groove for the purpose of sale). BUILDING PERMIT $ 2C95 0 SMTP • $ Akre
Li I,'as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System •
tractorsto construct the project(Section 7044,Business and Professions Code: PLAN CHECK $ �6 Ota PERMIT
-The-Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00100,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $
builds or Improves thereon. and who contr- s for such oroiects with a con —
-
tractors) license pursuant to the Contras • • License Law). I am aware that —Exhaust System ❑ Multiple 0 System Repair/Alteration I PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation ance should be provided to me. ELECTRICAL $ GRADING $
❑'I am exe -Pt der Section 'A for this reason Firepl/Fact.Blt, I BO 44 Fire Dampers MICROFILM §
pate .'4117/p1 Owner // n ern Erwow- Heating System& Ducting Registers • PLAN CHECK 50% $ /t -7
❑0100,000 BTU ❑100,000BTL MECHANICAL $ TOTAL FEE $ 445 7.0.3
1 here. .cef ify �f nave read .•plicatio an: state that the above $
informer on co ccs. agree to c•p•ly with all city .nd county coda an es - PLAN CHECK 25%
antl°state laws ri ata•• to bus in: onst notion, and hereby pro iz re re •
-
Inspetives of hi iw to a pon the above-mentioned prop rty,tqr _ -
inspection pu/ •s= /✓'/ /7L UV '_ -
gignature Date Reinspection Fee $15 i ? h 'v f' 't . •
- _ - _ caTq• 00;16/x'0 j7
0865-46,rev.5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
SONSTRUCTION AND PLANNING POOL 'A
(. :APPROVALS Permit Date Inspector APPROVALS Permit#
Date Inspector
I"..
1. TAmporary Elactrical Service or Pole 52. Pool & Equipment Location ' ,
2. Soil Pi e-Undr rnd. ! '
P 9 53. Steel Reinforcement _
3: •Electri cal;Cbnduii;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 / 012 to) 58. Electrical Conduit-Undrgrnd. ' I, •
-
' i
8. Foundation ' T . 59. Gas Pipe, 0 Undrgrnd.,Test r ,
9. Water:Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. -
10. Structural Floor System 61. APPROVAL TO DECK . -
11. Property Se-We'? Line'& House Connection 62. Backwash & Receptor-Final
12. Sewer,Cap, •. •- 63. Heater & Vent-Final -
13. Roof Drains .1 - 64. Plumbing System - Final
14. Rough Pldmtiing ' . 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16i Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
181 Rough Electrical-T Bar Ceilit !,'. 69. POOL/SPA SYSTEMS FINAL
• 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace 'H APPROVALS Permit#
21. Ducts, in'Structure .I' 70. Underground Hydro
22. Ducts,Ventilating C : C ' 71. Product Piping 0 Gas 0 Oil
l23/ Gas Pipe;Rough & Test • _4::. 72. Underground Flush
-247-Roof Framing '1, 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Barj
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
P. M11_T NO. TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA rMEESA CONSTRUCTION PERMIT 5 G
1/03
^/�,// A.P.# Zone
Project Address 1'O E ,7T Sir •
C• �0"— ff�� --- -
TYPE OF CONSTRUCTION 1J NEW u ADD U ALTERATION u REPAIR S Main Building: Accessory Building:
Applicant's Mailin• Address �'+ yE Front Z
M r •�77 El CONVERSION El DEMOLISH El OTHER T O
Owner's Name / Cr /I �y/J' ??4'2.:7
� 'h/one 7-s�-C���[7 DESCRIPTION OF WORK/USE OF BLDG. , B Rear - N
Address 4ao F t 7� $ CPPB l* 2J? Q
S 4/611Q-101 ,Z447
6.171 y TYPE OF PERMIT LI GRADING ❑ FOUNDATION ❑ STRUCTURAL ' C Right N
Arch/Eng. l/S �I-.L �d Up License,No. ld K Left G
•V /"e4 ` 7 ❑ TENANT El ELECTRICAL El PLUMBING El MECHANICAL $'
Address z Orme 1,4 ��/�/ �U R
Contractor's Name Phone 0 OTHER Ping. Ref.#• Parking Req./Provided E
PROJECT DESCRIPTION SQ. FT. OCCUPANCY ' planning Notes: • Q
LICENAddress(mai(mailing) /� M
/J CONSTRUCTION TYPE VALUATION
T
City License No. • ZONE GRADING CU.YDS. ACRES -- S.
LICENSED CONTRACTOR D CLARATION ""
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: S4b D � y
with section 7000) of Division 3 of the Business and Professions Code,and - --
my license is in full force end effect. ELECTRICAL
FEES
License Class License No.
Date Signature PLUMBING I FEES Automatic Washer Transformer ❑ 15-50 KW
WORKERS' COMPENSATION DECLARATION Bar Sink Showers Construction Pole Sub. ❑ 50+ KW
I hereby affirm that I have a certificate of consent to self-insure or a certificate •
Workers' Compensation Insurance, or a certified copy thereof (SectionCooking Unit Meter ❑up to 100 amps
30, Lab. C.) Backflow Preventer Service Sink
policy No. - Company .,• Backflow Irrigation Sewer Cap Dishwasher __ Meter ❑over 100 amps
eCertified copy is hereby furnished. _ Dryers ❑Gas ❑Electric III Sub Panel
Certified copy is filed With the city Building Division. Bathtubs Sewer Connection
Date Applicant Fan Motors❑0-1HP ❑1X-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors ,
(Ths section need not be completed'if the perm) is for one hundred ($100) or . ■ p g _. F.A.U. ^^5�IS Inc.Solar 09-15 HP 016-15+ II
less). Dishwasher Solar Pi in .„)&75..z.
yY• f
I certifythat in the performance of the wor hick this per is Issued, I `Z Fixtures , Microwave I '
shall'not empl y any person in any mann•.s to b- o l feet to the .Drinking Fountains • . ■ Solar Tank �! ) 4�
Worker o tion Laws of Californ' r r = -7,'3o
Date _Signature • - - •L'• �-6 Aga SwimmingPool w/Spa Device Bo es 1. Pole Light
Floor Drains P
NOTI Iter making this tleclaratio ,y•u should •:c•me zubje• to.the - -
WorkersCompensationprovisions of the_Labor_Code, y•u must forthwith_ Floor Sinks Urinal Outlets _ Range - .
comply with- such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING'AGENCY Gas Service Outlets Water Closet • Switches Sign
I hereby affirm that there is a construction lending agency for the performance •
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors • Water Heater - Garbage Disposal Standing Sections
Lender's Name
Lender's Address - - - - Kitchen Sink - - • Water Service ' Generator 00-5 KW 0545 KW Trash Compactor
OWNER BUILDER DECLARATION '
I hereby affirm that I anl'exempt from the Contractor's License Law for the Lavatories 'Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or ,
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap - - Laundry Trays
any structure, prior to its issuance;also requires the applicant for such permit '_ 'I''.. - -
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains I 1
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt - - Reinspection Fee $15 Issue Fee i L Vick
6i'•grefrom and the basis for the alleged exemption. Any violation of Section • - -
)1.5 by. any applicant tor,a permit subjects the applicant-to a civil ,
•
tatty of not more than five hundred dollars ($500). DEVELOPMENT SERVICES REQUIREMENTS:
1, as owner of the property Reinspection Fee I $15 Issue Fee $ 3
Zoning Approved By Date
on
aspeneerion, will do the work,and the structure is not intended or offered
for salese (Sectione Business and Professionalf aprCode: Contractor'smroves MECHANICAL FEES Building Approved By _ Date _
License Law not apply to es owner of a property who builds or improves _ _ _.. _ l -- --- - - \��`j-s,}'a -
thereon, and who does such work himself/herself or through his or her own Boiler Hood or. Type I ❑' Application Issued By Dat
employees, provided that such improvements are not Intended or offered for
sale. If, however, the building or improvement Is sold within one year of com- - Canopy Type II ❑ SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground '
prove,tor the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ / PERMIT
tractors to construct the project (Section 7044,Business and Professions Code: - PLUMBING $ (- O
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con-
tractors) license pursuant to the contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration PLAN CHECK 25% $ pe ENERGY P.C. $
proof of their Worker's Compensation urance should be provided to me. ELECTRICAL $ Oy7 GRADING $
❑ 1 am exempt un er Section _r gigB ,C for this reason Firepl/Fact.Blt. ICBG dk Fire Dampers MICROFILM $
PLAN CHECK 50% $
Date � {Q� Owner / i—hN4/---- a Registers SS
I hereb cert that ave rea• ••is applicati•n a d state that the above ■0-100,000 ■100,000 BT
MECHANICAL $ 'TOTAL FEE $ �� �0.� ,
informa on is rr agree to co with a I tit and county ordinances e PLAN CHECK 25% $
•
and state laws rata t• buildi ruction, and ereby author•e y or ■ . S
Inspection
of thi o ¢Oh the above-mentioned •r-.arty for
Inz ection purp•l• . -
Signature / /i,-//.� Lam/ Date
p $15 . Issue Fee $ 3 ■ SQ/CA OI.' 209•' :tlu-9_2 1 -75_q -�--_' y .
Drivers' Licens• - SS •
..
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor V'TEe 39/2?/V j:rJ_. 16+2.1
CONSTRUCTION AND PLANNING POOI PA
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 Gra 57. APPROVAL TO COVER-GUNITE -
7. Footings - i58. Electrical Conduit-Undrgrnd. .
r,
8. Foundation .. ', 59. Gas Pipe, O Undrgrnd.,Test ,
'
9.-Water Pipe-Undrgrnd. ? 60. Backwash Lines, P-Trap, 0 Undrgrnd. - '
10. Structural Floor System �.5' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection . .62. Backwash & Receptor-Final - -
12. Sewer Cap : --.f 63. Heater & Vent-Final
13. Roof Drains . tali' (.tra01 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final •
' 15. Rough Electrical-Conduit /� r 66. Solar System-Final
C:16. Rough Electric Wiring ?, lb, ./ 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 67,1, APPROVALS Permit#
21. Ducts, in Structure .4 - 70. Underground Hydro
22. Ducts, Ventilating L., 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test ,r) 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 042,19! Oa. Notes: qa Erie??
nems .2 et - , iI .4j
' 34. Final Heating& Air Conditioning '
35. Final Gas Pipe-Test • A:;,Ni9-c 1E �0- ®/< S U F,,[1- ,
36. Hood or Canopy II) /2611-ori---/i5 A -i / oISI .4C-
37.
37. Final Factory Fireplace ,-• 1- 11s_6e-&1 1 1--Tc - e_.4)
38. Final Plumbingt(2 Ore*,
39. Water Service-Final .. ;T
40. Gas Service-Final • 1'
IN
41. Solar Domestic-Final C - h•
42. Backflow Preventer • •` 'i" -/. -- i.%
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation • I -)
46. Handicap Regulations ,)s
47. FINAL STRUCTURE& BUILDING
.
48. Special Requirements Completed
49. Electric Release to Edison r „ ..`,-•
50. Gas Release to Southern California Gas Co `ur
51. CERTIFICATE OF OCCUPANCY - -
No. Date :y t I
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
Cl.TY OF COSTA MESA PERMIT NO. TRACT NO. I LOT NO. I SLOG.NO. . ' - --
CONSTRUCTION PERMIT /yam S7/S , .1 :!:6i I2/ rl/� .; I JeU TI
-
Project Address / a 0 17 "1 S'T. .5,6h 0 c6/74-v6(fPE OF CONSTRUCTION .
Owner VV, 7" 54 L V✓`w Phone‘4f " )Q 70 NEW 0 ADD 0 ALTERATION - - - •
Address (41-Ia's••� �❑rREPAIR 0 CONVERSION ❑DEMOLISH v �� -
Arch/Eng, r License No. )31,oTHER 3'4- roe/ esprit( hire. 4-4.4. A P
_ ZONING REGULATIONS
Address DESCRIPTION OF WORK ..
ZONE PLNG. REF.,
Contractor A,, /Q• 1144-644'S to. Phone 6'ce-20$-7 ,,TYPE OF PERMIT -a a 'tp gt/I WG
•
SET:ACK _ T PROPERTYLINE •.
Address I. 4/, /IiC N on(T PILI!' ^" W'°A 0 GRADING 0 FOUNDATION ❑ STRUCTURAL/ SI YARD •
LICENSED CONTRACTOR DECLARATION • - 0 TENANT 0 ELECTRICAL ❑PLUMBING !Yp'IECHANIC• LLSII E YARD • - -
I hereby affirm that I am licensed under provisions of Charter 9 (corn- RIGHT
mencing with section 7000) of DivIsien 3 of the Business and 0 OTHER REAR YARD(TO P/L) . . _ _
Professions Code, and my license is in full force and e feet. PROJECT DESCRIPTION _
License Class C- �0 License No. 3 6 PKG.SPACE REQ. PROVIDED. , ',
Date 1Z`6- SZ Signature •aSewl-.. 'r,
,, T. C - SQ. FT. •• .
WORKERS'COMPENSATION DECLARATION - OCCUPANCY—CONSTRUCTION TYPE, - STREET WIDTH PARK FEE $
I hereby affirm that i have a certificate of consent to self-insure or a ZONING APPROVED BY i DATE
certificate of Workers' Compensation Insurance, or a certified copy VALUATION
•reof (Section 3800, Lab. C.). - GR. c 'G CW YDS. ACRES SPECIAL CONDITIONS:
1 icy No. Company - EPS . ' -
Certi(ietl copy is hereby furnished. REMARKS: / • -
Certified copy is filed with the city Building Division. •- �
❑ -
EXEMPTION FROM WORKERS' COMPENSATION DECLARATIO I L'L✓� .,_ _ / • .„ •
/ -- - - ' •
(This section need not be completed if the permit is for one hundred / . _
(1100) 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 r PLUMBING,•- ' 'PLAN CHECKII ELECTRICAL PLAN CHECK -
subject to th9 Wor ers'Compensation LawS of California. r VWt LLIN& - i.A NAbE - -
/i,.& - ,'L < BATHTUBS SHOWERS_�.i.rO a Cn FT
Date Y Signature - Er / •
NOTICE: If after making this declaration,you should become subject ' TOILETS . • _ ..
_ OwatT LSs ,1 - l� GENERATOR 0-1 KW /
1-10 KW '
t0 the Workers' Compensation provisions of the Labor Code,you must
forthwith comply with such provisions or this permit shall be deemed LAV, 7GR1E DOUBLE LAVStI ' ,I\ 'APPLIANCE . - 10-50 KW�50+KW •/ o
revoked. . . _ - . - - 1l
CONSTRUCTION LENDING AGENCY k.1 -AKS uA % rt(OISHWASH ERS,; L� 'MOTORS 0-1 HP_1:10'HP " ••. ,
(I hereby affirm that there is a construction lending agency for the per- S RVICE SINKS, '), SIYMPS'' - (INC.SOLAR) 10-50 HP_50+ HP •- . ..•
:formance of the work for-which this permit is issued (Section 3097 { ' .. , ••.. -- - 1
. - • FLOR OSINKS a 'FLOOR DRAINS �J AFIXTURES - OUTLETS ,SWITCHES_' ., 1 t
Lender's Name - - _ '"
Lender's Address - OgINKING FOUNTAINS - l GAS TUBE SIGNS - - •
a
OWNER BUILDER DECLARATION IP ERCEPTOR4 CLARIFIERS POLE LIGHTS - - '
I hereby affirm that 1 am exempt from the Contractor's License Law for // LVrvp I Kvt l wry -
•
.the following reason (Section 7031.5 Business and Professions'Code: SW a41IN4+IPOOL�/r/I{�QP.:T•RAp" POLES METERED - SUB •
Anycityor county which requires a' permit to •construct, alter, ---lTTlll Iii -
-imrovedemolish or repair any structure, prior to its issuance,also re- WA ,SERvi CE ALTERATION - PANELS MAIN SUS 't I r
quires the ap,licant'for such permit to file a signed statement that he
h licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS - SERVICE _ _ _ ' 'AMP
(Chapter 9 (commencing with Section 7000) of Division 3 of the -
•siness and Pro/essions Code) or that he Is exempt therefrom and the WATER HEATERS BTU OUTPUT-�• -' - . '- - . .
is for the alleged exemption. Any violation of Section 7031.5 by '- _... - s '
or •
notp Tore tt M1an r five permithundsubjectsed tars (550the 0)plicant to a civil penalty SEWER CONNECTIONS _ '•' _
d-i, as'owner of the property,or my employees with wages ai their SOLAR TANK -COLLECTORS' - ' . '
sole compensation, will do the work,and the structure is not intended
or offerea for sale. (Section 7044, Business and.Professions Code:The SOLAR PIPING SYS. ISSUE FEE . ' •
'a a' :
Contractor's Licensen Law does not apply to aowner of.a property - APPLICATfON APPROVER BY - DATE
who builds or improves thereon, and who does such work himself or ISSUE FEE ,
through-his own employees, provided that such improvements are not —
Intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES '
is sold within one year of completion, the owner will have the burden Q
of proving ho did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU{/�-BSD BUILDING _, '
❑ I', as owner of the property,-am exclusively contracting with AND DUCTING • PERMIT S SMTP S
licensed contractorsd to construct the project (Section 70 44, Business 100,000'+ BTU 44 d 'PLAN CHECK $
PERMIT •
and' n ionssCotlt: TheContractor's
Cocto is License Law does not apply lo • ISSUANCE E
an owner of property who builds or improves thereon,and who con- REFRIGERATION 0100,000 BTU PLUMBING $
tracts from such projects witha contractor(s) !Jenne() pursuant to SYSTEM - GRADING -E
the Contractor's License Law).. 100,000•BTU PLAN CHECK $ 0 •
❑ I am exempt under Section B.6 P.C.for this BOILERS BTU ELECTRICAL $ Lt' 0 - 9
reason ' ' -- - - - PLAN CHECK $ MICROFILM $
SYSTEM REPAIR,ALTERATION MECHANICAL.$ � �
J•OTOTAL FEE$
Date Owner M
I hereby certify that Lhave read this application and state that the above EXHAUST SYSTEM MULTIPLE 2 4 M 'LESS AD-
information is correct. I agree to comply with all city and county PLAN CHECK S VANCE PC E__�
ordinances and state laws relating to construction,and hereby authorize 3 r0 N co...de, ' ,G.q .,O(} • -
representatives of this city to enter upon the above mentioned •
property irk' ]]hien purp0 S Q
Signature .^"� a �'h•' Date iZ� _gL FINAL FEE S_ J•�b •
Drivers'License or SS 3a / ISSUE FEE - 3 OQ - - -
CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
I . i" •
CONSTRUCTION AND PLANNING POOL&SPA .
Date Inspector - - _<: Date Inspector
APPROVALS Permit# APPROVALS_ •• - Permit# • • i
1. Temporary Electrical Service or Pole 43. Pool & Equipment'Location- - : '-` - - - - - ,.
2. Soil Pipe-Undrgrn_ - _ __1 .-‘'...- --.• _. _;, .:•i .• .44,'c,Steel•,Reinforcement - - - - - - - _ _
3. Electrical Conduit Utility-Undrgrn - _ - -_ - _ - 45. Forms - '•`
4. Electrical Conduit-Undrgrn, - __ _ - ' - „ - _ .46.- Electrical Bonding . -
57 Steel Reinforce . - •_ 47. Rough Plumbing& Piessuri:Test
6. Electrical UFER Grn - _ _ 48. APPROVAL TO COVER-GUNITE + -: - ' _. ' ' •:- - • .
7. Footings 49. Electrical Conduit-Undrgrn ,
8. Foundation - - 50. , Gas Pipe, ❑.Undrgrn,Test ,
.9. .Water Pipe-Undrgrn- . . . _ 51. Backwash Lines.P-Trap: 0 Undrern
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. Plunibina System -Final
14. Rough Electric-Conduit - - •- '56. Electrical-Final •
15. Rough Electric-Wiring - _ - - • • - - - 57. Solar System-Final - .. .
16. Rough Heating& Air Conditioning - ' - • b8. Fencing&Access Approval
• 17. Ducts, in Structure _ 59. APPROVED FOR PLASTERING • •
• 18. - Ducts, Ventilating _ r ,
19. Gas Pipe-Rough &Test-• . _ - 60. _ POOL/SPA SYSTEMS FINAL . •
20! Roof Framing _ . . - •
_ .. '
21. Roof Sheathing _
. 22: •Frame and Flashing -- - . . . ._ NOTES: t
23. Insulation - - - _' - : _ - • _
24. Lathing &Siding - - - - - . - . - _ - -
25. Drywall Nailing - . _ . ' _ - ' - _ - . .
' 26. Plaster Brown Coat - - _ __ _ _ '
_ _. _-__ - 1
27: Electrical Power Meter-Final '1_ _ - ' ___ _ _. _ - - __ -
28: - Final;Electric -- - -- - - - - . _ .__ . __ _
-29' FinalHeating & Air Conditioning _ _ - -_ '_ _ _ _ - .. • • ' ' ' ' • ' - ; -
30. . Final Gas Pipe-Test _ . . _ _. ; _ - - _ _ r ' - '
31.._Final_Plumbing _ _ _ ._ . .- .-- _ . - '
32' Water Service-Final . . _ . - 'i
. 33. - -Gas Service-Final - - - "
34. Solar Domestic'-Final'+- • 1 ' ,e ,.I ,,
: 35. Landscape Sprinkling System - • - • _ - _ _ . . - - _
I 36. Sound Attenuation - -
r -
i 37. Handicap Regulations - _ . c . t •
38. FINAL STRUCTURE&BUILDING - . ri
I 39. Special Requirements Completed 1 -- - ' -- -
' ' 40. Electric Release to Edison. ' 3 - „ i.
- - . ' - - - - -
41. Gas Release to Southern California Gas Co. ! I .. _. _ -
42. CERTIFICATE OF OCCUPANCY _ •
' No. 1 . Date - 7 - - -- '
' _ _ _ - • .
II -OPLICATION FOR A BUILDING PEP-'IT
Electrical CO
Tract Block Lot BUILDING PERMIT NO. Permit No. 4500 E. i
�'j Plumbing Building G
Address /3 (J 17 1 ��3 Permit No. to
Cross �.lnT% �I� Mechanical C,
Area Street Permit No. O.
m
��/ ❑ Alter ❑ Addition
tit
Owner /// ,y vg
of Project: El New
Address //l�3 (�x// 2 4 Y-Y Repair ❑ Convert ❑Demo ❑ Occupancy Pmt.
'c(/ LL e 1 Zlp Phone__---- A.P. Sn P•Area
up.Dist./
City C.
Architect/ Zone Sp'.Pmt.No.
Designer License No.
Setbacks P/L Front C/L St. Street Width
Address
Yards Left Right Rear
City Zip Phone
---- Eave Proj. Left Hight _ F.P.
Engineer License No.
,C Parking Spaces Required Provide Covered
G Address
NStruct No.of No.of
m City Zip Phone Height Stories Family
Y LICENSED CONTRACTOR'S DECLARATION Park Fees Yes Fee
I-, Required No C.T. Receipt
m I hereby affirm that I am licensed under provisions of Chapter 9
t (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date
At Professions Code, my license is In full force and . fe t).
Linen CI — •ansa Number — i _.
Date Contractor �
> �a4'—•- a--, -'— a .v--'�—... Misc.
E Address--
? 7 / m y r B L- Proposed Use •
ii: City and Zip / of Structure
/-al �i-- • 'hone .r
N CONSTRUCTION LENDING AGENCY
CA
Le I hereby affirm that there is a construction lending agency for the
1 performance of the work for which this permit is issued (Sec. 3097, Occ. Type Code
_ ' Civ.C.). Class Const. Year
y Lender's Name USE/OCCUPANCY SIZE SO.FT.
E Lender's Address
'1 OWNER-BUILDER DECLARATION
L. I hereby affirm that I am exempt from the Contractor's License Law 1.
Ofor the following reason:
❑ I, as owner of the property, or my employees with wages as their 2.
c sole compensation, will do the work, and the structure is not
•-• intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with 3.
licensed contractors to construct the project.
Lie 0 I am exempt under Sec.io , B&PC for this reason 4.
t3 Date Owner /t2.� o o O
E WORKERS'COMPENSATION DECLARATION Total Valuation
8 I hereby affirm that I have a certificate of consent to self-insure, ,
Encroachment Permit Required ❑ Yes ❑ No
�, or a certificate of Workers' Compensation Insurance, or a certified
C copy thereof. Grading Pmt. Grading
c'4 Policy No Company Required ❑yes ❑No Pmt.No.
.a 0 Certified copy is hereby furnished. Rough Grdding V
Q yr Ce fled o As filed with Orerge County,EMA. r n
pyy�/ �( Approved by: Date
Date--O Applicant �1-L4Q?ili-,--e` /? / 3
• CERTIFICATE OF EXEMPTION r+
FROM WORKERS'COMPENSATION INSURANCE Z
(This section need not be completed if permit is for $100 or less). C
I certify that in the performance of the work for which this permit is 3
Issued, I shall not employ any person in any manner so as to become it
subject to the Workers'Compensation Laws of California. PERMIT FEES
Data Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exemption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with such Special
provisions or this permit shall be deemed revoked. Electrical E Invest. $
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE MENTIONED PROPERTY FOR INSPECTION PUR- Pre-Grade
"{Pp/�$/J�S^ ♦ . ,(fJy7 Inspection $
i5 gn9t�a of ppl Applicant or Age Date /9'gD �e-Grade $ Permit $
RRec.No. Issue
MA rat' (n 's Na
Print Applicant's/Agent's Na ma
All spaces within this box must be completed to process _ Plan n j Approve
eck BY: suanced:
CMF 0335-46(BU-28)rev.6/80
•
Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations.
A ER IT NO. TRACT NO. LOT NO. UNIT NO.
G`qF COSTA ( S� CONSTRUCTION Stt PERMIT �j " I Sri 7� 9619 10/08/84 �,gp p�
Projec .ddress -
Applicant's Mailing Address 7-151 1,11- �A n-�-C- /NE TYPE OF CONSTRUCTION ❑ NEW LI ADD ALTERATION Li REPAIR •
n ❑ CONVERSION ❑ DEMOLISH ❑ OfHEg
Owner's Name I4I^f-42. Phone +•z-V a _ ., t 1 w, A'P'�p Zone
13o C. , It.,v St DESCRIPTION OF WORK/USE OF BLDG. }� IT/ s Main Building: Accessory Building: '
Address
Arch/Eng. License No. • TYPE OFPERMIT L1 GRADING. ❑ FOUNDATION U STRUCTURAL E Front o
Address ww--..''�� //�� --11 / ❑ TENANT El ELECTRICAL TY�tI.PLUMBING 'MECHANICAL BB Rear N
S1e-Vt.' �IJ e:30.6 P On qi-1 -7G ❑'OTHER c Right N
�.�'1 Contractor's Name�s� 9 -
W (�11 1 ) L� PROJECT DESCRIPTION SQ. FT. • OCCUPANCY K.
1� Address(mailing) �f W CONSTRUCTION TYPE VALUATION S _ _ $ Left G
/ 1 City License No. c 7 e? o2..t<j ZONE GRADING CU.YDS. ACRES R
Ping. Ref.# Parking Req./Provided " E..) LICENSED,CONTRACTOR DECLARATION . - • - O
lJ J I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: b 1 �/1 '�'� Planning Notes: • M
with section 7000) of Division 3 of the Business and Professions Code,and - ' v
•
) my license is in full r ,d effect. ^ ((.fir. - r T
�� License Class • - rnT - l '�S •V'I - S.
v Date Signature iN/a/W PLUMBING FEES
FEES
WORKERS'COMPENSATION DECLARATIONShowers
Bar z
I hereby'affirm that I have a certificate of consent to self-insure or a certificate I ELECTRICALWorkers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer -_ _ - -
300, Lab. C]�. ,1�,v Ipe 01A02.4
�1 • 1 .� ce Sink ' 4- - AutomatirWasher, - Transformer 0 15-50 KW
Pgifcy No. CI"
V as ?'� Company}.Urn1�-FmS I'IUN I Construction Pole.Sub. 0 50+KW
® Certified c py is hereby furnished, • "
Date
Certified����ccccSpy is filed with the city Bu'I in jvy'sion. A' I L.' • Sewer Cooking Unit •.a Meter ❑up to 100 amps
Applicant C.J' Y
EXEMPTI FROM WORKERS:COMPENSATION-DECLARAT N i_ _ • ® • • „ Dishwasher Meter Dover 100 amps �,
' (This section need not be completed if the permit is for one hundred ($100) oro
less). I • a. .Dishwasher ■ Solar Piping SAM. Dryers ❑Gas ❑Electric - Sub Panel l 4 _.
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 subj¢Ct to the Drinking Fountains Solar TankFan '
Workers',Compensation Laws of California. ;�, Motors ❑0-1 HP ❑1'h=8
Date Signature j FloorDrainsSwimming Pool w/Spa. PI F.A.U. 1 Inc.Solar 09.15 HP 016.15+
NOTICE:If,after making this declaration, you should become subject to the ,I
Workers' Compensation provisions of the Labor Code, you-must forthwith ( Floor Sinks . Urinal - . -- TFixtures -•
comply with such provisions or this permit shall be deemed revoked.
1
CONSTRUCTION LENDING AGENCY Gas Serviee 5 Outlets Water Closet ® e
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors - 1 Water Heater • - -7• . eI
Lender's Name _
Lender's Address ' ' - - 1 Kitchen Sink I .Water Service ' !+
OWNER BUILDER DECLARATION - '
I hereby affirm that I am exempt from the Contractor's License Law for the , 3 Lavatories (� �� , .:•- Disposal
following reason (Section 7031.5 Business and Professional Code; Any city or • ,
anding Sections
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap 10-1/4d �µe.LQ- f •/ ., Generator 00-5 KW ❑5-15 KW ,
any structure, prior to its issuance, also requires the applicant for such permit - Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains m r 4Q^_ a ••
'the Contractor's License Law(Chapter 9(commencing with Section 7000)of �.-.6R�Y- /{— — _ -
•
- Division 3 of the Business and Professions Code) or that he/she is exempt . -.
-`kberefrom and the basis for the alleged exemption. Any violation of Section 4 S�` r r- r ./6: -2 �J /y / y�.� ,
`i' 31:5 by any applicant for a permit subjects the applicant to a civil /fA...- • J.47 A ' `
< enalty of not more than five hundred dollars($500). II $ 3 `3
U I, as owner of the property or my employees with wages as their sole Reinspection.Fee f $15 Issue Fee .-
ti
compensation, will do the work,and the structure is not intended or offered 1 Reinspection Fee_ I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES . -
License,Law does not apply to an owner of a property who builds or improves ,
thereon, and who does such work himself/herself or through his or her own • 'DEVELOPMENT SERVICES REQUIREMENTS:
•
employees, provided that such improvements are not intended or offered for 80ilar HOOd or Type I 0 -
sale- If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By. Date
pletion, the owner will have the burden of proving he/she did not build or im- Ii 'r , ,
BUilding Approved By • Date
move for the purpose of sale). - / i O
U I, as owner of the property,am exclusively contracting with licensed con-; Refrigeration System Appliration Issued By• Data 1tractors to construct the project (Section 7044,Business and Professions Code: VVVThe Contractor's License Law does not apply to an owner of property who ❑0-100,000 BTU ❑100,000 BTU •� SUMMARVOF FEES
builds or improves thereon, and who contracts for such projects with a con- .tractors) license pursuentto theContractor's License Law). I am aware that ■ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof off their Worker's Compensation insurance should be provided to me.
PLAN CHECKI $X • PERMIT
❑ Iam exempt under Section B.& P.C.for this reason % III PLUMBING $ .3'7• CO ISSUANCE $
Date .Owner • Heating System& Ducting i - ENERGY P.C. $
�j PLAN CHECK 25% L.
'1 hereby certify that I have read this application and state that the above I 00-100,000 BTU ®100,000BTL - T ELECTRICAL $� • GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws rela ng to builds•• •• ruction,and hereby authorize repre- - MICROFILM $
sentatives of thi// y to err m• .n he above-mentioned roperty for - PLAN CHECK - 50% $'
inspection purp.r7. e DatJG1 (9/7 - - 4. MECHANICAL $ -7 CO•
Signature ', TOTAL FEE $
Drivers' License or SS d< -/ - . Reinspection Fee $15 Issue Fee I $ 3 7 PLAN CHECK 25% s. I ..no •SO
. - • _
CMF 0865-46.rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor -
0'
`CONSTRUCTION AND PLANNING ' POOL ,PA
• \PPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' ' k��6/d"f -CD "53: Steel Reinforcement •
3. Electrical Conduit Utility-Undrgrnd. �t 54. Forms
. 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding - •
5. Steel Reinforcement . " - n 56. Rough Plumbing & Pressure Test - . m
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE
•7. Footings .. 58. Electrical Conduit-Undigrnd. • 1
8. Foundation • • - . . 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 144/ .6E0 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"- /Q457'Lj LW 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 O 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: AcA��� O
,// T�`coon ua.�r, .4n")-
34. Final Heating& Air Conditioning BT107C 7 WO
7 t frntr ',al i'lirw eet
35. Final Gas Pipe-Testandeni-ern"! Qin
C.
36. Hood or Canopy -
37. Final Factory Fireplace . . /0/ac/FjY /i7L€c l/fAIcc&1 pp -44
38. Final Plumbing /*Fr G time`7- O'4-S cgArev/k i `e-S
39. Water Service-Final ��ll /J/u �& !S //(0 7-1/rsevere �Q
40. Gas Service-Final f `' ` S-Pso figf e)
/1iG 2-C Yfff/!-!�
41. Solar Domestic-Final - - )(Ce 94 X.(90 -
42. Backflow Preventer /W i /S''l 77 A7-66r5 S 7rn f-OxG '
43. Backflovv.Irrigation ,5�.ec77e J Mft1/Lr(,yf<��/y ,�/�tt�j-
44. ,Landscape Irrigation System // W ��. g TJ !(I&,h _ Ce €
45. Sound Attenuation •• gd. n Derv_ • ( �-t
46. Handicap Regulations liV'^'��
47. FINAL STRUCTURE& BUILDING
48. Special Requirements Completed '
\ 49. Electric Release to Edison
_ .
t 50. Gas Release to Southern California Gas Co
\51. CERTIFICATE OF OCCUPANCY
k:D' Date
J
Applicant to fill In all spaces except'those within heavy border lines and sign all appropriate declarations. -0758 I f3f'C3/U/1
PERMIT N TRACT NO. LOT NO. UNIT NO.. Ue 5O TI
CITY OF COSTX MESA _CONSTRUCTION PERMIT. - �Il � S-g-� •1/2
.
Project Address 13 0 C. 17. J r - '.
Applicant's Mailing Address I b S33 SII twirl S 4'i... earl:mous YPE OF CONSTRUCTION IJ NEW LI ADD LWALTERATION U REPAIR 1 -
❑ CONVERSION ❑ DEMOLISH El OTHER. q,p,# Zone
Owner's Name AAA ra.-6 leans-3644( Phone leans _ DESCRIPTION OF WORK/USE OF BLDG. a-16i A u r2 se T •
Address - - S Main Building: Accessory Building:
TYPE OF PERMIT U GRADING U FOUNDATION ❑ STRUCTURAL • E Front Z
Arch/Eng. License No. 1�I� _ T. O
Address , - III TENANT 111 ELECTRICAL El PLUMBING Lsd'M ECHANICAL $ Rear N '
` Fs 7!-Ie SQ• J ❑ 'OTHER ' A
Contractor's NameTtL M.4ra I PFOV s,c.ra Phone S - C Right , • •- • N
Address(mailing) 1o633 i-I/tKC7.$ {I-v.. .IPar a sMO Cf.-. T PROJECT DESCRIPTION SQ. FT. •OCCUPANCY -_
i EONSTRUCTIONTVPE VALUATION$ K• Left, r G
City License No. - . _ j'. S ( � ZONE • GRADING CO.YDS:- ACRES ft
I LICENSED CONTRACTOR DECLARATION , v Ping. Ref.# Parking Req./Provided Q
V) l I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: I , Planning-Notes: M ,
/1'� •
with section 7000) of Division 3 of the Business and Professions Code,and
Wmy license Is in full force and effect. ! -. , S '
'License Class 'k+3 /Ucense.No.3 S 11.27o
Date J O-.fid `spy Signature p• ft r c.s�e..G I , PLUMBING , FEES • 1 • i
1\...
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink, Shower
— Iof Workers' Compensation.insurance, or a certified copy thereof (Section Backflow Preventer -^' Seivice Sink • - - • ■ s
•
100, Lab. C.)
ali No. 32'7 t l C^ley Company Start c.,...,lo p f$ Backflow Irrigation Sewer Cip •Construction ■ s
;ECertified copy is hereby furnished. 1. ,
L Certified copy is filed with the city gy it ,n�Jf•�1'�slon. Bathtubs Sewer Connection Cooking Unit • I Meter ❑up to 100 amps
Date Ir - a?- & APPlicant Y'lg{- /�nos-f0-�u-� '
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher - _ _Meter Clover 100 amps, - ,
(This section need not be completed if the permit Is for one hundred($100)or - - -
less): . Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the'work for which this permit is issued I ..
shall-not employ any person In any manner so as to become subject to the Drinking Fountains , Solar Tank - Fan - ,
Workers' Compensation Laws.of California. I Motors❑O-1 HP ❑1X-8
.DateSignature ' • Floor Drains . ' Swimming Pool w/Spa I F IA!U, ' I • '
'NOTICE: If,after making'this declaration,you should become subject to the _ • Ina Solar ❑9-15 HP 016-15+
'Workers' Compensation provisions of the-Labor Code, you must-forthwith_ - Floor Sinks - - - -Urinal -' - -' , - '- - '
comply with suchi provisions or, this permit shall be deemed revoked - • Fixtures • Microwave.. , •
;CONSTRUCTION LENDING AGENCY.�� „ r: •• _ - Gas Service- Outlets , Water Closet • , Device Boxes 1 POIe Li ht
I hereby affirm that there is a construction lending agency for the performance - 9 '
'of the work' for which this permit is issued ,(Section ,3097 Civ.. C.) • Interceptors Watel;.Heater _ , , " , Outlets •Range
Lender's Name -
•- f
Lender's Address •` ' - Kitchen Sink . - Waier.Service • ,-. . _ Switches Sign'
•
OWNER BUILDER DECLARATION- , I
-
I hereby affirm that I am exempt from the Contractor's,License Law for the• - . ' Lavatories - Auto-Wash Garbage Disposal 'Standing Sections
-
following reason (Section 7031.5 Business and Professional Code: Any city or -
county which requires a permit to construct,alter,Improve,demolish or repair - P-Trap ' ( Laundry TraysGenerator:❑0-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the appllcant•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 Licenser 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 exemptlon.rAny:violation of Section . _
'031.5 by any applicant for a permit-subjects the ,applicant to a civil . ,• - - '
natty of not more than five-hundred dollars($500). _ I '
, I, as owner of the property or-my employees.with wages as their sole -Reinspection Fee I $15 Issue Fee , ,. S 3
compensation, will do the work,and the structure Is not intended or offered 1 - Reinspection Fee I $15 luue Fee i .$ 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 goiter' • , I Hood or Type I l4i' DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for , Zoning Approved By - '
;sale, If, however, the building or improvement Is sold within one year of com- Canopy Type I I 0 • - 2 TT Date
prove f, the owner will have the burden of proving he/she did not build or im- % Duct=Under Ground _, 3 Ol. Building Approved By _ i ' Date
• prove tort the purpose Dose le): f I ,. --L���/sl/�, ,
❑ I, as owner of the property,am exclusively contracting with ed con- _ Duct-Structural Refrigeration System I I 'Application Issued By Dat 'Z5
'tractors to construct the project (Section 7044,Business and Professions Code:
•The Contractor's License Law does not apply to an owner of property who ' _ Duct,-Ventilating - _ 00.1 00 BTU 100,000 BTU - SUMMARY OF'FEES
builds or, Improves thereon,and who contracts for se,Lawojects with a cont - I '
'tractor(s' license pursuant to the Contractor's License,Law). Iain aware that ' ' Exhaust System 0 Multiple 0 System Repair/Alteration . g) ' BUILDING PERMIT ;$ SMTP ' i $ i
proof of their Worker's Compensation insurance should be provided to me. - - PLAN CHECK $ ' PERMIT ' '
❑ I'am exempt under Section - B. S P.C.for this reason Firepl/Fact.BIL ICBG# ' Fire Dampers' ' ISSUANCE $
' - 4 4 PLUMBING ' I .$
HeatingDucting RegistersENERGY P.C. $
Date • Owner - System& . I I PLAN CHECK 25% $ '
-I hereby certify that-I have•read this application and state that the above '• ' ❑0.100,000 BTU 0100,000 BT • - --- ` - ' I GRADING $
Information Is'correct. I agree to comply with a11'clty and county ordinances ELECTRICAL $ 1
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ • ' MICROFILM $ 1 '
sentatives of this city to enter upon the above-mentioned property for
inspection purposes, .�' - MECHANICAL $ 'CC) TOTAL FEE .$
Signature N, /Lar... . .tn--f Dated -2_3" e
Drivers' License or SS 9?
Pink -Accounting; Goldenrod - Assessor
•
I CONSTRUCTION AND PLANNING - - POOL t A
APPROVALS Permit# Date Inspector . APPROVALS Permit# " Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
I, 2. Soil Pipe-Undrgrnd. _ 1.153. Steel Reinforcement ,
•
3. Electrical Conduit.Utility-Undrgrnd.' p 54. Forms
4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding
5. Steel Reinforcement • - 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. i • 57. APPROVAL TO COVER-GUNITE - -
,
7. Footings I •58. •Electrical Conduit-Undrgrnd. - . .i
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 O Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat • 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL -
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: -
34. Final Heating & Air Conditioning
35. Finaltti�P'94ct 4x4dAir ,trr, / /off :1
36. Hood or Canopy , '
37. Final Factory Fireplace •
•
38. Final Plumbing • I • '
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 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 - , -
I
No. ' Date .
•
w -.,N_ . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTAiciAO COIySTRUC�I.QN RMIT PERMIT NO TRACT NO. LOT NO. UNIT NO. 1 7.225 IL
i ' / M 1 I g 7 0275 10/1 5/84
Project Address JlLi ADD ERATION LI REPAIR
TYPE OF CONSTRUCTION�lL) NEW
Applicant's Mailing Address�,,sJ �• ❑ CONVERSION _Q DEMOLISH ❑ OTHER A.P.# I Zone
Owner's Name ,, r�.p� c �ll J Phone DESCRIPTION•OF WORK/USE OF BLDG.
Address ' "' � '+.� ` - S Main Building: Accessory Building:
TYPE OF PERMIT LI GRADING ❑ FOUNDAT 0 El STRUCTURAL T. Front Z
Arch/Eng. • License No. (I T O
C TENANT ❑ ELECTRICAL ❑ PLUMBING/J[JMECHANICAL B N
Address A Rear
/ 0 OTHER
Contractor's Name f'ill! (-vs. d A �/RPh ne�4�y C Right • N
Address(mailing)ice 5S � (� Z�N�4 g 5 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left
'+ / CON ST RUCTION TYPE VALUATIONS G
City License No. �3/b3 S R
ZONE GRADING CU.UDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION - O
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ' " SLI l 1 ... Planning Notes: - M
with section 7000) of Division 3 of the Buslnes nd Professions Code, and S{ • T
my license is in full?jolt,effect. $
•
License Class C� bens.
Date /0-erliSignature PLUMBING FEES
WORKERS'COMPENSATION DECLA ATION e •
I hereby affirm that I have a certificate of consent to salt-insure or a certificate Bar Sink Showers ELECTRICAL FEES
if Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab. C.) , Automatic Washer Transformer 0 15-50 KW • •
Policy No. Company Backflow Irrigation Sewer Cap - 0 50+KW
9 j Construction Pole Sub.
8 Certified copy is hereby furnished. s
Certified copy is filed with the city Building Division, Bathtubs Sewer Connection v Cooking Unit Meter Cup to 100 amps
Date Applicant _
•
EXEMPTION FROM WORKERS'COM PENSATI• • •EC LARAT Clarifiers Solar Collectors �j Dishwasher Meter Dover 100 amps
(This section need not be completed if the perm' s f•r one h ndr. • 00) or
less). .7 Dishwasher Solar Piping Dryers OGas DElectric Sub Panel
I certify that in the performance of the wor for hich t ' ,r issued I
shall not employ any person In any ma er s• .s to • co / •jest to the Drinking Fountains Solar Tank Fan-
worker omgprtzat ws of Califor - • Motors 00.1 HP 011/2-8
Date `s Signature A....e"- �%� Floor Drains Swimming Pool w/Spa j' F.A.U. • Ino.Solar ❑9-15 HP ❑16-15+
NOTICE: If,after makintthis declarat ou should bec•''eject to the '
Workers' Compensation provisions of e Labor Code, you must forthwith Floor Sinks Urinal• - - Fixtures
comply with such provisions or _this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY,, I Gas Service Outlets - Water Closet Device Boxes Pole Light
- I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater
P Outlets Range
Lender's Name 9
Lender's AddressKitchen Sink Water Service - - Switches
OWNER BUILDER ECLARATION - Sign
D
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - G •
Disposal a '
following reason (Section 7031.5 Business and Professional Code: Any city or 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 ' "
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of -
Division 3 of the Business and Professions Corte) 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 _ •
enalty of not more than five hundred dollars ($$00). '
U 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 -- - Reinspection Fee I $15 Issue Fee $ 3
'for sale (Section 7044, Business and Professional Code: The Contractor's !MECHANICAL I FEES 7
'License Law does not apply to an owner of a property who builds or Improves _ _ - ._ _ ___.
thereon, and;who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler • Hood or Type I 0
sale. If, however, the building Or improvement is sold within one year of com- • Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground .Building Approved By Date _
LIrove for the purpose of sale).
I, as owner of the property,am exclusively Contracting with Ilcens=• co - Duct-Structural Refrigeration System - Application Issued By Date 1
tractors to construct the project (Section 7044,Business and Profess!. s Cose: . (CLL...Illl
The Contractor's License Law does not apply to an owner of p ••• ty ho 4 Duct-Ventilating q , ❑0-100,000 BTU 0100,000 BTU G D0 SUMMARY OF FEES •
builds or improves thereon, and who contracts for such prole I • con- _
tractor(s) license pursuant-t• : Contractor's License Law) e that - . ' BUILDING PERMIT $ SMIP $
proof of their Worker's •mpe cation insurance shout• a vl•e• to me. Exhaust System 0 Multiple 0 System Repair/Alteration , - .
_ PLAN CHECK $ PERMIT
0 I am exempt under ctlon/ for♦ is reason Firepl/Fact.Blt. ICBG# ISSUANCE $
Al• / PLUMBING $
Date Owner Senn He. i g System& Dustin• t-/S �i `+ PLAN CHECK 25% $ ENERGY P.C. $
I hereby certi r I hay- read this applic ton ' f' at the above 1 !sv 00,000 : U ❑tas,a00r GRADING $
Information is a• ee to co wl al my or. ances ���t ELECTRICAL $
and state I. �IE" • to/• deli J>..•- o• • •7' . auth• e r e- — PLAN CHECK 50% $ MICROFILM $
sentatives of .� t y"/-. i..a." : •ne• oper '/ ,y.� r�-
InsPectionpvX�i� O/ f /O��Y E"-l"h S`ls ' ' MECHANICAL $ Up-CO TOTAL FEE $ ICI'z'7
Signature I r•, •. (/ CJ
�A
`��
CMF 0865-- • •v.4/84 White-Burg:Canary-Applicant:Pink-Accounting;Goldenrod -Assessor
CONSTRUCTION AND PLANNING .POOL„ SPA ,
APPROVALS Permit 4 • Date Inspector APPROVALS Permit 4 Date Inspector
Y
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location •
'', 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement -
i
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. . r
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 't 62: Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final • •
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing i 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 /Olfy/ ciao FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace APPROVALS Permit 4
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 1 73. Undergrnd.Storage Tank 0 Gas 0 Oil
. 25. Roof Sheathing - 74. Overhead Hydro
1 26:T-Bat Ceiling (Structural) & Monocoat 75. Dry Chemical -
•
1 27. Frame and Flashing - 76. Dry Standpipe -
28. Lathing&Siding 77. FIXED SYSTEM FINAL
29. Insulation I 78. FIRE PREV. FINAL
30. Drywall Nailing ; HEALTH DEPT. REQUIREMENT
1 :
1 31. Plaster Brown Coat, 79. FINAL INSPECTION
1 32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: / 1
r-i •
34. Final Heating & Air Conditioning ' /07 `/g/ (v ceo 0,,,...35. Final Gas Pipe-Test %/.v 1 .vin 1...
, 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 ,
i 51. CERTIFICATE OF OCCUPANCY .
No. Date
_ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
;; T PERMIT NO. TRACT NO. LOT NO. UNIT NO. ' 9190 )0/I/ 4�e�� TL
CITY COSTA MESA CONSTRUCTION PERMIT �- �L-�/_(�
4roject Address /30 E . "PHA 54• lus1A nnpjm e 1 s ` cs .
Applicant's Mailing Address 5A"A a TYPE OF CONSTRUCTION LI NEW ❑ ADD Li ALTERATION 'U REPAIR ^' ^^ '^/^ ' '^' r
(f/6-36G4 ❑ CONVERSION ❑ DEMOLISH 0 OTHER A.P. # Zone
Owner's Name -//�Z/t,/tRLC�j�1S[ Phone DESCRIPTION OF WORK/USE OF BLDG.
Address, �3 U L .' // /II St- . - S Main Building: Accessory Building: ;
Arch/Eng. /, f/ License No.C " 4'S' TYPE OF PERMIT LI GRADING LI FOUNDATION ❑ STRUCTURAL E Front - - 0
Address 9r1 Alen ottt 41� A.. Aleur oILi B�At y LI TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name Vlil Cel G/PC11QIf I Phone63/-Qa'3 ID-OTHER -
p PROJECT DESCRIPTION SQ. FT. OCCUPANCY__ C Right N
Address(mailing/ '677 w' I1th •sf• 59-6 Cor/4 7#P7A KLeft • - G
p y - CONSTRUCTION TYPE -VALUATION$ $
City License NO. C-/O '5"31' O ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION - - Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: '15 7
I 2,0 Planning.Notes: - , Q
with section 7000) of Division 3 of the Business and Professions Code, and X .
my license is in full force .n• e feet. t /y 9 T
Ucense Class a /ft. • 1 iG nse b.•. (3/ e •
, •S'
Date / ' - Z1 Signature ' Inn.u- h r _ PLUMBING FEES
WORKERS'COMPENSATIONiDECLARATION ' • Bar Sink '
I hereby affirm that I have a certificate of consent to self-insuie or a certificate i Showers ELECTRICAL FEES
, if Workers' Compensation, Insurance, or a certified copy thereof (Section - , - Backflow Pf¢venter Service Sink' - - • -
3600, Lab. C.) IAutomatic Washer - - ' Transformer- 0-15-50 KW • • - ••
Policy No. Company Backflow Irrigation •
Sewer Cap Construction Pole Sub. •
0 50+ KW
ACertified copy is hereby furnished. ,a, . '
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit ! iMeter pup to 100 amps
Date • Applicant -.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION •• Clarifiers Solar Collectors - Dishwasher -t Meter Dover 100 amps I �
(This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping less). P g Dryers ❑Gas ❑Electric / Sub Panel
I certify that in the performance of the work for which this permit Is Issued, I !
shall not employ any person in any manner as o eco_me subje to the Drinking Fountains Solar Tank Fan l
Workers' Co a {loo Laws of California. (�Q)�Qj Motors❑0-1 HP ❑1'h-,6
Date �O - 7 Signature - C/1w" ` 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• - •_-. - -_
comply with such provisions.or this permit shall be deemed revoked. Microwave -
CONSTRUCTION LENDING-AGENCY - - Gas Service Outlets: Water Closet - Device Boxes Pole Light-
I hereby affirm that there is a construction lending agency for the performance - - `-iv 9 B 03
of the work for which this permit is issued, (Section 3097 Civ. C.) Interceptors'' Water Heater
Lender's Name ' - ' tors
p- 0 Outlets ' Range el On
Lender's Address ' Kitchen Sink Water Serviceao Switches Sign ' /
OWNER BUILDER DECLARATION - •c CO
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - DI
following reason (Section 7031.5 Business and Professional Code: Any city or - Garbage 9 Disposal
'Standing Sections i .
county which requires a permit to construct,alter,improve,demolish or repair P-Trap •, - - • - '
•
any structure, prior to its issuance, alto requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor
1-to file a signed Statement that he/she is licensed pursuant to the provisions of Roof Drains -
the Contractor's License Law (Chapter 9.(commencing with Section 7000)of ' - -
Division 3 of the Business and Professions Code) 'or that he/she is exempt '
.therefrom and the basis for the alleged exemption. Any violation of Section - ,
7031.5 by- any applicant for a permit' subjects-the applicant to a civil - .
penalty of not more than five hundred dollars'($500)., _
LJ I, as owner of the property or my employees with wages as their 'sole Reinspection Fee $15 •
Issue Fee $ 3 •
compensation, will do the work,and the-structure is not Intended or offered - - ' Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's . . _ MECHANICAL FEES
License-Law does not apply to an owner of a property who builds or improves •
thereon, and who does such work himself/herself or through his or her own . DEVELOPMENT SERVICES REQUIREMENTS:
.
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I ❑' ZoningApproved
•
sale. If, however, the building'or improvement is sold within one year of com- Canopy Type II 0 - pp roveBy Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date
love for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System . Application Issued By Date_ /i
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License-Law does not apply to an owner of property who Duct-Ventilating , ❑0-100,000 BTU 0100,000 BTU /
a
builds or improves thereon,and who contracts for.such projects with aeon- _ SUMMARY OF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration - BPLAN BUILDING CHECK $ • PERMITDING PERMIT $ SMIP $
❑,I am exempt under Section B.& P.C.for this reason Firep/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 thattheabove ❑0-100,000 BTU 0100,000 BTL
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ 3)1 . 0 GRADING $
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ 1 4- - �.7 MICROFILM $ .
sentatives of c y o scoter poo the above-mentioned property for _
inspection pu O s{}�� ` •
Signature iV L Date/V -l-/ MECHANICAL $ NOTAL FEE $ rr • j
r�(J Drivers' License or 55# � Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor ..
r
•-L}ONSTRUCTIONANDPLANNING POOL«oPA
1 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. �sfy,49 v�i� .54..Forms - -
' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gd.'
rn • _ - 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, 0 Undrgrnd.
10.'Structural Floor System -' 61. APPROVAL TO DECK
11.yroperty Sewer Line & House Connection ' - 62. Backwash & Receptor-Final '
12. Sewer Cap . - 63. Heater & Vent-Final '
13. ROOFDrains' . ' 64. Plumbing System - Final _
14. Rough Plumbing' 65. Electrical-Final .
15. Rough Electrical-Conduit - 66. Solar System-Final - - - . -
16. Rough Electric WiringLJALLy, '''t /0/1 b4 � C 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 1 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final , /!'13/61( 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ,„,/,,2_)6...47, .92tc �ouao-r (�qr, c �'Cti
34. Final Heating & Air Conditioning
07;j/CI fit 4.,1 .0Lt eb..4/-
35. Final Gas Pipe-Test Clirv+'k /Y (� !,F-�
36. Hood or Canopy 74%;-
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 i
51. CERTIFICATE OF OCCUPANCY
No. Date
•
Applicant to fill in all spaces except those within heavy border linesand sign all appropriate declarations. _ _ __ _ _
CITY OF COSTA MESA C NSTRUCTION PERMIT: - PEST NO. TRACT NO. LOT NO'.. 'UNIT NO. -
13 mit, ;s+ i �� 1602 IIL02/84 5a50 : Tl
Project Address - ` - , . . • '� r
' Applicant's Mailing Address ' JAwts e' ' TYPE OF CONSTRUCTION H NEW U ADD U ALTERATION U REPAIR I •
-
�r1 / •/ El CONVERSION ❑ DEMOLISH ❑ OTHER -' q,p,# Zone •
Owner's Name ( •/YY�plx re it/ I Phone 4-9--4 66 DESCRIPTION OF WORK/USE OF,B LDC. - -
Address - - .5Axis _ -, - S_ Main Building: - Accessory Building: ,
Arch/Eng. _ •
License No. TYPE OF PERMIT GRADING U FOUNDATION ❑ STRUCTURAL T Front - - Z
Address •
y - ' C TENANT ❑ ELECTRICAL III PLUMBING ❑ MECHANICAL BB Rear. _ _ - ' N
Contractor's Name /� H LE.(( / /P L'�2'(L Phone G,31--pat; ❑ OTHER C Ri ht _ _ -
)J)�1 et 1441/44 PROJECT DESCRIPTION SQ. FT. OCCUPANCY g
Address(mailing) Y ! 1 Lt'- I •'4 - • K Left 1 - - G
9 r • CONSTRUCTION TYPE VALUATION$ $;
City Llcelnse No_ C-_/G S3 �gR
. . ZONE GRADING CU.YDS. ACRES - •
Ping. Ref. # Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION I r ' , -
!I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: - h 130 ") l i�'I,I ( - - • Planning Notes: • - - _ G
'with section 7000),of Division 3 of the Business and Professions Code, and , - _ M
'my license is in lull for a and lfec . ,lS��g • I - I � I I • • I ._ • S
License Class '— A 1%e o.a� I - - -
'Date - — 14 ' ' Signature ib =A' «. ill k ' ' : PLUMBING I FEES - .
WORKERS'COMPENSATION DECLARATION ' '
I • Bar Sink • I Showers , ELECTRICAL t FEES
v 'a ereby affirm that I have a certificate of consent to self-Insure or a certificate ,
Workers' Compensation Insurance, or,a certlfied.copy'.thereof (Section. ' - - -
v.-iic.q - Backflow Preventer -• -Service Sink - , - _ -- Automatic Washer Transformer ❑ 15-50 KW �'
:..800, Lab. C.)
Policy No. ) 1 Company ' ' Backflow Irri Irrigation - Sewer Ca 0 50+KW • I '
9 P - I Construction Pole Sub. ; I
•A Certified copy is hereby thehed. 1 ; I - •
'
Certifietl copy is flied with the city Building Division. Bathtubs Sewer Connection • Cooking Unit ; Meter Dup to 100 amps
.Date Applicant Clarifiers _Solar Collectors Dishwasher ___ _ _ ___ Meter ❑over 100 amps EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - _ _ .— . .-
. (This section need not be completed If the permit is for one hundred ($100)or - - - a - ,. p
less). 1 , Dishwasher • Solar Piping - Dryers ❑Gas ❑Electric Sub Panel
I l certify that in the performance of the work for sowhich this permit Is issued, I
shall-not-employ any person In any man .!!l��s so to,b�e-com subject to te -' I Drinking Fountains Solar Tank ' 'f 6 Fan i r •
'WorkersjCorppegsnlon Laws'of California. )-/ � • .—r- - - - - - Motors�0-1 HP ❑1%-8 zQ cc
Date: dd CC m Signature v4N .(/1'I/( I ' Floor Drains I t I Swimming Pool vv/Spa • I 1 / F.A.U. I Ina Solar ❑9-15 HP ❑16-15+; �^/^� •
NOTICE:If,after making this declaration, you should become subject to the ' ' ' f.�
Workers' Compensation provisions.of the Labor Code, you.must forthwith - Flobf-Sinks , - • -- -Urinal ' _ - ` '-'-' "Fixtures -: - - --
Microwave""� ' -''
'comply with such; provisions or this permit shall be deemed, revoked. - _ _ - t' '
CONSTRUCTION LENDING AGENCY - - - ? Gat Service' Outlets - Water Closet 4' ' . ' . ' _Device Boxes / POIe Light �^
I hereby affirm that:there is-a construction lending'agency for the performance - , / a., I
of the work for which,this permit is issued ,(Section ,3097--Civ. C.) 't Interceptors ' _ •
Water.Heater - - Outlets '
Lender's •Name - - - ' - _ - - 1 Range ,
Lender's Address: ' ' - - ' •• Kitchen Sink - i , . • Water Service ' ' - • - I Switches r •
OWNER'BUILDER DECLARATION, •- - Sign' 1
I hereby affirm that I am exempt.from the Contractor's License Law for the Lavatories - • , - 1 Auto-Wash _ :I, Garbage Disposal g ,
following reason;(Section 7031,5 Business and Professional Code: Any city,or - - - ;Standing Sections t CO '
' county which•req vires a permit;to construct,alter improve;demolish or•repair P-Trap - - Laundry Trays . „ - • ' s Generator ❑0.5 KW ❑5-15 KW '•
' any structure,-prior to its issuance, also requires the applicant for such permit - _ _ Trash Compactor
•
to file a signed statement that he/she is licensed pursuant.to the provisions o4 , RooPDrains I ' - - _ -
• the Contractor's License Law-(Chapter 9(commencing with.Section 7000)of - - O ' , /-y,
-livision ,3 of.the Business and Professions Code) or'Ithat'he/she,is exempt . - , - _ _, -� N� 6hI�D et Th6ea- / ,w
erefrom and the basis for the alleged exemption. Any-violation of'Section - I -- - X02 /IWA L. '
131_5 by any applicant for„a permit -subjects,the applicant to, a-civil -penalty of of not more than five hundred dollars($500). : ' - - i
'Li I„as owner of the .property or my'employees with wages as their.sole Reinspection Fee $15 Issue Fee $ 3' ' _
•
Compensation, will do the work,antl,the structure Is not intended or offered Reinspection Fee ! $15 „ . Issue Fee - { $ 3
for sale '(Section 7044, Business;and;Professional Code: The Contractor's' .. I - MECHANICAL FEES - '
License Law does not apply to an owner of a property who builds or improves a • - -- -
thereon,and who does such work himself/herielf or through his or her own - - I n, - DEVELOPMENT SERVICES REQUIREMENTS: !
i employees, provided that such improvements are;not intended or offered for . Boiler- ;Hood or Type I ❑ )
•
sale. If, however, the building or improvement is sold within one year of com- Canopy I Type I I -❑ , Zoning Approved By Date
I pletion, the owner,will have the burden of proving he/She did not build or Im- . Duct- Under Ground ' BUil,ing Approved By - •� Date
prove for the purpose of sale). i •
-
I I, as owner of the property, am exclusively contracting with licensed con- ; ', Duct-Structural • Refrigeration System s, • 1+Application Issued By - J' . ' - • Dat
' tractors to construct the project(Section 7044,Business and Professions Code: - - I — • , f/
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- - - - I
t tractor(s) license pursuant to the Contractor's License:Law)- 1 am aveare that ' Exhaust System 0 Multiple 0 'System Repair/Alteration - BUILDING PERMIT $ SMIP ; ,S _ •
proof of,their Worker's Compensation insurance should be provided to me- t ' ` r `
4'L_, l.am exempt under Section B:&P-C.for this reason , Firepl/Fact.Bit. ICBG# . Fire1Dampers I • + I PLAN CHECK j5 PERMIT t ;
I I PLUMBING .$ ' ISSUANCE $
•I Date - - Owner - I - Heating System& Ducting Registers, , PLAN CHECK 25% I$ ENERGY P.C. '5 1
I hereby certify that-I:have read:this-application and-state that the above' - - ❑0.100,000 BTU D100,000 BTL - - _ '- • ' - - - GRADINGS '$ •
.information is•correct, ;;agree to comply with all city and county ordinances ELECTRICAL $ to-- -
,and state.laws relating to balding construction, and hereby authorize repre- - ! MICROFILM $ I
,sentatives of -this c' jIt Yq9J� dnterIu, the above-mentioned property for ' I PLAN CHECK 50% •$ 7 -5� ' s _
inspection purposes I/•1 1 w
Reinspection Fee I $15 Issue Fee $ 3 I PLAN CHECK 25% ,$ i
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING : POO. .SPA • -
Date Inspector Date Inspector
APPROVALS Permit#' APPROVALS Permit#
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 Conduit4Undrgrnd. i . „ 55. Electrical Bonding - -, - '
5. Steel Reinforcement56. Rough Plumbing & Pressure Test _
6. Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. ` .
8. Foundation 59. Gas Pipe, O•Undrgrnd:,Test . - .
9. Water Pipe-Undrgrpd. T I 60. Backwash Lines,P-Trap, 0 Undrgrnd. -
10. Structural Floor System l 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 i - ' 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 r 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical
27. Frame and Flashing $ I' I ' 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation78. 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 - _ _ ////3/�/ CC • Notes: '/16 '�a
34. Final Heating & Aii Conditioning. ( L ( • i- ��
35. Final Gas Pipe-Test ' , '
36. Hood or Canopy, : •- '
-
37. Final Factory, Fifieplace -
38. Final Plumbing I ' .
39. Water Service-Final ' '
40. Gas Service-Final ,
41. Solar Domestic-Final i - - - -
42. Backflow Preventer • i - •
43. Backflow Irrigation .' -
44. -Landscape Irrigation System 1 '
45. Sound Attenuations
46. Handicap,Regulations - - - -
47. FINAL STRUCTURE & BUILDING - ,
48. Special Requirements Completed, ' i . .
i I
49. Electric Release to Edison • ' i - - ' • .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
No. Date - i_ . . _ _ ! - -
- y .- - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
TY OF COSTA MESA • PER IT NO TRACT NO. LOT NO. BLDG. NO. 1124' 10/29/94• 24.'42 Ti.
INSTRUCTION PERMIT •• Tr /cry✓�—�� • ,
•
Project Address 1?�Cl EL• �,m` S�'• TYPE OF CONSTRUCTION U NEW ADD U ALTERATION U REPAIR I
Applicant's Mailing Address , - - - ❑ CONVERSION ❑ DEMOLISH` OTpJER• A.P.# Zone
Owner's Name Phone DESCRIPTSN F WOfRK, "t'!VS?R\ Utf\ce -\b\ - 0 -
ih _ 7-"P t-O t" S S Main Building: Accessory Building: 2p
Address X30' rG• �� S - - E
TYPE OF PERMIT GRADING FOUNienDATION U STRUCTURAL T Front - • - _ - N
Arch/Eng.: License No. ❑ TENANT ❑,ELECTRICAL ❑ PLUMBING ❑ MECHANICALB Rear _ I
Address ' ❑ •OTHER - - A N
• LIIY C Right G
Contractor's Name (�'`ft�-E'e•c nc c:�-Pr4-
()oY\- p ne• '{`ln-,01{7.3 PROJECT DESCRIPTION SQ. FT. - OCCUPAIp�CV K
a Lpil �a,(p` I CONST RUCTION TYPE VALUATIONS T1nn a' $ Left. - R
Address(mailing) / ZONE GRADING CU.YDS. ACRES •
City License No. ' Q 1 Wit A 9-� _ Ping. Ref.# • Park.Fees $• _ D
LICENSED CONTRACTOR DECLARATION I Remarks: • . r Parking Req./Provided ' U
•
1 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 • - Use of Building: t - E
my license is In f I force and effect. --_- - •
License Cies - - ice vNo. - a • - PLUMBING FEES Planning Notes: M
Date sh- Signature - � IR • - E
WORKERS'COMPENSATION DEC 4''ATION Bar Sink , , Showers N
hereby affirm that I have-a certificate of consent to self-Insure of a-certificate - - - - - - •• -- - - T
.f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink S
3800, Lab.(q.)_/ -e7 �� 1� Backflow Irrigation Sewer Cap •
- ELECTRICAL FEES I
Policy No. LC '-1 Company/ A//7. /224C '
Certified copy Is hereby furnished. Bathtubs Sewer Connection • Automatic Washer Transformer 0 1550 KW
il
•
Certified, .p Is filed with the city 'Qleg DIµ�Ion.`(y��,,
Date IO-1C- - Applicant Jl:^^'�- 3� -�•-}/ 0 � Clarifiers Solar Collectors Construction Pole Sub. 0 50:f KW
EXEMPTION FROM WORKERS'COMPS ATION DECLARA'YT ION Dishwasher Solar Piping(This section need not be completed If the permit is for one hundred ($100)or • P g Cooking Unit Meter Pup[01100 amps,
less). Drinking Fountains
•
krI certify that in the performance of the work for which this permit Is IssUetl I g Solar Tank Dishwasher Meter Clover 100 amps
shall not employ any person in any manner so as to become subject to the
/ Workers' Compensation Laws of California. I Floor Drains Swimming Pool w/Spa Dryers ❑Gas DElectric Sub Panel -
Vfl\ Date Signature
NOTICE: lf,iafter making this declaration,you should become subject to the Floor Sinks Urinal Fan Motors❑0-1 HP ❑1'/-B
Workers' Compensation provisions of the Labor Code, you must forthwith - - .
comply with such provisions'or this permit shall be deemed revoked; ' , Gas Service 'Outlets •Water Closet I_ 'F.A:U. - •• , Inc.Solar ❑9.15 HP 016-15+
CONSTRUCTION LENDING AGENCY _ •-
I hereby affirm that there is a construction lending agency for the performance , Interceptors . ' • ' . Water Heater Fixtures.' ,
•
1 of the work for, which this permit is Issued (Section 3097 Clv. C:) = Microwave •
•� Lender's Name ' Kitchen Sink Water Service ' (i Device Boxes Pole Light
Lender's Address - - • -
OWNER BUILDER DECLARATION ' Lavatories , Outlets''y� Y Range
I hereby affirm that I am exempt from the Contractor's License Law for the p-Tre
following reason (Section 7031:5 Business and Professional Code: Any city or p - ,Switches F- _ 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 q Standing Sections
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 Gen ❑65 KW ❑5;15 KW
Division 3 of the Business and Professions Code) or that he/she is exempt erator Trash Compactor •
'herefrom 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). Reinspection Fee $25 Issue Fee $ 3 `,
LI I, as owner of the property or my employees with wages as their sole MECHANICAL • Reihspection 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 REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I 0
thereon, and who does such work himself/herself or through his or her own Zoning Approved By - Date
employees, provided that such improvements are not intended or offered for DLitt-Under Ground Canopy Type II 0 j
sale. If, however, the building or improvement Is sold within one year of com- Building Approved By,. 0
Dat
pietion, the owner will have the burden of proving he/she did not build or Im- putt•Structural Refrigeration System I - • 'A lication Igsued'B� Dat
grove for the purpose of sale).
rt 9 Y PP Y
tractors
I, as owner of the property, am exclusively contracting with licensed con- Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU i.'!
tractors to construct the project (Section 7044,Business and Professions Code:. - _ „G , J'•' ,t - SUMMARY OF FEES '
The Contractor's License Law does not apply to an owner of property who SO
builds or improves thereon, and who contracts for such projects with a con- Exhaust System ❑ Multiple ❑ System Repair/Alteration i BUILDING'PERMIT $ SMIP 1
tractor(s) license pursuant to the Contractor's License Law), ` .• •c ,as.. PERMIT ._ .
- PLAN CHECK $ -
❑'I_am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt.ICBO# .c. I PLUMBING• $ J ISSUANCE $ i
•
Date • Owner Heating System& Ducting v v r ENERGY P.C. $
I herebycertify that I-have read this application and state-that the above ❑0.100,000 BTU 0100 000 BT1T- �•, PLAN CHECK: 25% $
$
Information Is correct. I agree to comply with all city and county ordinances ,I ELECTRICAL( --, $ • GRADING
and state laws relating to building construction, and hereby authorize repre- , t / MICROFILM •
sentatives of'thls cit to en 84 'upon h. above-mentioned property for , v ' . PLAN CHECK"50%..$ i$ a�
inspection p es. • : 4x
s, 1Q�%_� MECHANICAL $
Signature _ - Date " 1 Reinspection Fee •
TOTAL FEE $ a-' I.
Drivers' License .55 �. pa . •' $25 Issue Fee • $ 3 PLAN CHECK 25% $ - �vklA, (p1
CMF 0865-46 rev,12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor • - /1
- r(z-Q_ O)cf. 41 Op--
Z ONSTRUCTION AND,-PLANNING . - :- - -- • L.,POOL .PA • _ -
Date Inspector - ate ' Inspector
_APPROVALS Permit 4K - ` ,: APPROVALS Permit#• -D
1.Temporary Electrical Service or Pole - ' 52. Pool & Equipment Location ` - ' ' .
2: Soil Pipe-Undrgrnd;" ' . • • - • • 53. Steel Reinforcement - _
3. Electrical Conduit Utility-Undrgrnd.1 - Ir - 54. Forms - - "
4. Electrical Conduit-Undrgrnd. -- - 55. Electrical Bonding -
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -
1.• 6. Electrical •UFER Grnd.-•' - - •• .571 APPROVAL TO COVER-GUNITE - -
7. Footings ` = 68. 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. Beater & 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 , r - .-: - - 67. Fencing & Access Approval - • _" ' .
. 17. Rough.Wiring Sign a - . • 68. APPROVED FOR PLASTERING I -
•
18. Rough-Electrical-T Bar Ceiling ' - 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •
_ ,
20. Rough Factory Fireplace _ : i , . APPROVALS Permit# _ 2 ;
i i
21. Ducts, in Structure _ 70. Underground Hydro I I ;
22. Ducts, Ventilating I - 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test .' ' I 1 72. Underground Flush 1 I .
•24. Roof Framing ' 73. Undegrnd.Storage Tank 0Gas '0Oil
25. Roof Sheathing _7_4...Overhead Hydro - ' I
26. T_Bar Ceiling (Structural) & Monocoat C
75.' Qlry Chemical 7/--/S-1
' 27. Frame and Flashing : ' . 1 ;I.e.-Dry Standpipe ' "/
28. Lathing& Siding 7IXED SYSTEM FINAL ) /_/s
29. Insulation ' ' � 78. FIRE PREV. FINAL
30. Drywall Nailing I ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat I
79. FINAL INSPECTION ,
I '32. Electrical Power Meter-Final I 80. FOOD CERTIFICATE ISSUED • , ,
s 33. Final Electric • - Notes:,
34. Final Heating &Air Conditioning TTl Ui�S 1 77 ��ye!/P G�
35. Final Gas Pipe-Test i ' • v j,N f dh �e� /0�9*4? ' '
36. Hood or`Cano PY i ' I - 1 /lei"( 42.nra,e r 'r id. 7747'
37. Final Factory Fireplace, _ t z r7 22j� j -e
o ;jolt��' v ion/
38. Final Plumbing , i i _ " 4
39. Water Service!Final ' I II _ 0-
Totile 0 ���� _
40. Gas Servide-Final 1 ' I
• • eOQa ; l�
41. Solar Domestic-Final - -- - -
42. Backflow Preventer , r • ' _ - ' •
•
I 43. Backflow Irrigation _ .
44. .Landscape Irrigation System ' • -
45. Sound Attenuation , - . _
46. Handicap Regulations ' I • . . - -
• •
47. FINAL STRUCTURE & BUILDING,
•48. Special Requirements Completed _ i ' '
;\ 49. Electric Release to Edison + 1 - -
50. Gas Release th Southern California Gas Co , i i
\51. CERTIFICATE OF-OCCUPANCY - - - --- -- I
b. Date' '
. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
��r ' 1940 I I/OB/04 . 54. 12 IL,
PE IT O. • TRACT NO. LOT NO. UNIT NO.
CITVtOFCOSTAME1SA CONSTRUCTIONPERMIT �" i� ( .7
Project Address _43@ E.. OIL 6T f
•Applicant's My�iiinnpo�A/dd��d��ress 11/21111 .-
, (`fe TYPE OF CONSTRUCTION M NEW U ADD U ALTERATION U REPAIR .
Owner's Name IV1AalrrEi_- Pho"�"r Phon El CONVERSION El DEMOLISH ED OTHER A.P.• .16 I Zone
' AM� DESCRIPTION OF WORK/USEOF BDG. ��y
Address ( �e' 7�, - • ( 1Z' 'Sf-I {:,DCL.- . E Main Building: Accessory Building: Z
Arch/Eng. f•`101ZZ's I —'4At%p& L�ir@eensse (N1o..pls/'4 �/ TYPE OF PERMIT U GRADING FOUNDATION ❑ STRUCTURAL T Front O
Address 4l t M k !c'/ FL-.. MGL4irs;-FH Belicht ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
f_
Contractor's NamPs • -�0t Phone ❑ OTHER A I
PROJECT DESCRIPTION SQ. FT. - OCCUPANc,,Y C Right N
Address(mailing) ("?&2.-4, c' ecea•Low f.U(i0• J C.� S Left • G
CONSTRUCTION TYPE VALUATION$
City License No._ _ -' ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Q
with section 7000) of Division 3 of the Business and Professions Code,and - M
my license is In full force 5 a{(ect. - T
License Class V• Ls License No. - S
Date Signature PLUMBING FEES
WORKERS'COMPENSATION DECLARATION A
Bar,Sink Showers
ereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL • FEES
Workers' Compensation Insurance, or a certified ,copy thereof (Section Backflow Preventer Service Sink - •
4800, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap I Construction Pole Sub, 0 50+KW
Certified copy Is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs • Sewer Connection Cooking Unit Meter Cup to 100 amps •
Date Applicant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps ' , .
(Thissection need not be completed if the permit is for one hundred (8100) or
less): Dishwasher • Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which. s permit I sued, I
shall not employ any person in any anner so as to a sA-.:...f•. to the Drinking Fountains Solar Tank Fan
Workers' mp ssa%pn'Laws of Cal',�r �8 - -_-- Motors❑0.1 HP ❑1'h+6
Date lI Signature //ib�l"LL' t �� Floor Drains Swimming Pool w/Spa F.A.U.
'NOTIC If,after mang this declaration,you should become b .ct to the Inc.Solar ❑9-15 HP ❑16-15+
Workers' Compensation provisions of the Labor Code, you ust forthwith - Floor Sinks - Urinal - -
comply with such provisions or this permit shall be deemed revoked. Fixtures MICrOWdV¢
CONSTRUCTION LENDING AGENCY Gas Service. Outlets Water Closet Device Boxes Pole Light
.I hereby affirm that there is a construction lending agency for the performance g
of the work for which this _permit is issued (Section 3097 Clv. C.) • Interceptors Water Heater Outlets
Lender's Name'- - Range
Lender's Address • -- ". Kitchen Sink •- . Water Service Switches Sign
OWNER BUILDER DECLARATION- - -
I hereby affirm that I am exemptfromthe Contractor's License Law for the Lavatories Auto-Wash ' Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P ;Standing Sections
' county which requires a permit to construct,alter,improve,demolish or repair P—Trap • Laundry Trays 1 'Generator 00-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of , Roof'Drains - -
the Contractor's License Law (Chapter 9(commencing with Section 7000)of -
'ivision 3 of the Business and Professions.Code) or that he/she is exempt n 1 -
erefrom and the basis for the alleged exemption:Any violation of Section r, --
131.5 by any applicant for a permit subjects the applicant to a civil
penalty 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 $15 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 REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler - Hood or Type I ❑
sale. If, however,the building or improvement is sold within one year of com- . Canopy Type II 0 - Zoning Approved By • Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By �N,, 11 Date 1/— -.i
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating) - 00-100,000 BTU-❑100,000 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❑ System Repair/Alteration BUILDING PERMIT $ ��-Co SMIP $ ICO"
d
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ �t• � - PERMIT
0 I am exempt under Section B.&P.C.for this reason �,,. Firepl/Fact.Blt.ICBO# Fire Dampers PLUMBING $ ISSUANCE $ '
'Date Owner Heating System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that-I have read this'application and state that the above 00-100,000 BTU 0100,000BT - GRADING $
Information Is correct. I agree to comply with all city and county ordinances ' ELECTRICAL $
and state laws relating to building onstruction,and hereby authorize repre- MICROFILM $
sentatives of 1 city to entere� ,On ve-mentioned prrope ty for PLAN CHECK 50% $ '/ -f
Ingnatuoglas�Cr" :4 .1(1�•� iii. a ,iL MECHANICAL $ �5`=�.Y
Signature YWY-`' Date- TOTAL FEE $
Drivers' Lice se or SS Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
&---\CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION.AND PL''ANNING POC , SPA
�`- Date Inspector Date Inspector
A
• PPROVALS • Permit#• - APPROVALS Permit #
1. temporary,Electrical Service or.Pole ,1, 52. Pool & Equipment Locationi
\2. So1Pipe-Undrgrnd. . 53. Steel Reinforcement ,%/•
-3:.€iect.icalConduit UtilityUndrgrnd. :2- 54. Forms :%
• •4t;Electrical Conduj Undrgrnd. <`-I 55. Electrical Bonding %l
5. Steel:Reinforcement; 56. Rough Plumbing & Pressure Test _
6. Electrical OFER Grnd. 57. APPROVAL TO COVE R-GUNITE , O
7t-Footings nn ., �-� 58. Electrical Conduit-Undrgrnd. ;�•,
41
B: Foundation ..a Zt -i' 59. Gas Pipe, 0 Undrgrnd.,Test .-;/"•
9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System �r 61. APPROVAL TO DECK
•
11. Property Sewer Line & House Connection I,1�1 - 62. Backwash & Receptor-Final
i i
12. Sewer•Cap.' • 63. Heater& Vent-Final
13. Roof'Drains. -. • 64. Plumbing System - Final
14. RougH Plumbing - 65. Electrical-Final -
15. Rough Electrical-Conduit - 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
1.7."Rough Wiring Sign . I 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 179. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .,t
33. Final Electric (t Notes: �d � � `l„ / _
34. Final Heating & Air Conditioning J - Itl+/"/`w'
(40
35. Final Gas Pipe-Test /�'� /
36. Hood or Canopy -
37. Final Factory Fireplace,
38. Final Plumbing
39. Water Service-Final , '
40. Gas Service-Final , . , •
41. Solar Domestic-Final - - -
42. Backflow'Preventer � ' - - - - - .
43. Backf low Irrigation - •
44. Landscape Irrigation System -
45. Sound Attenuation _
46. Handicap Regulations I •
47. FINAL STRUCTURE & BUILDING /!,! r/ V�i' ' I ,
48. Special Requirements Completed ,
49. Electric Release to Edison • I t I-
50. Gas Release to Southern California Gas Co I _ / A
51: CERTIFICATE OF OCCUPANCY - - , -
No. Date /
•
r
1
�� � • EEE RECEIVED
APR 25 1361
• •
COSTA MESA BUILDING-SAFETY DEPARTMENT o FIN.L1NCE' DEPT
P. O. BOX 917 COSTA MESA. CALIFORNIA .
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ADD EISS /aO if. /7 aiS7.
^r COSTA MESA. CALIFORNIA For Office Use Only
PERMIT NO.
OWNER
I[EITC 7 RNV. a . I RECEIPT NO. I /YD7S—
MAIL f RECEI ED BYI DANS RECEIVED DAT! ISSUED
ADDRESS 224 NY.CcAST Ii I. 0 &t !� ' —2.5 —4 /.S - 3-
-Cc
TEL. BUILDING / /1 ^ / 7-
CITY Flt ne¢ T�FAC L1 NO.
M1I.(.•34ZI ADDRESS rte/ I/ •
ARCHITECT '
. TEL ,/� /R COSTA MESA. CALIFORNIA
OR .INEER NO./y'/k-//7.1 p�_,rr
ADDRESS FIRE M 1 , TYPE `� GROUP r 2
y/ . - ZONE V/E((("��� a
CONTRACTOR .%/.I/j /Jd.[4i/J.,S4/...T/F"/� BYPR 4�S? ,` C24(I V DATE 4/-all -`� /
ADDRESS �ka'-c2i2Vy�q //J'.
By,
A. ZONING �rt�7'�"}
CITY t 'this; I NO.OF USE OF nintiCAA'
/I BUILDING 1
'E / a Lpf� TEL0) I�\\i PLANSNS ,9, -//� 1,� A ,L
LIC.TNO. 4/5/,.? X NO/�/• /Z// LEGAL I,nR ^-fI'1 ! / I'�V' (Lid
DESCRIPTION (fC///
SIZE O I / NO. OF BLDGS. / n /
OF LOT 9O X 2 B?.�U NOW ON LOT A.P.NO. //'/ - U / /
USE OF Viz., E�0 AVfI E/ZC/4 L. YARDS EVES
/// I
EXISTING BLDG. APPROVED ALLOWED
S
ETBACK
LING FROM CX�,( / (CENTER LINE ST.)
CENTER OF STREET S Aar REAR YARD 2S Ey FRONT 370 FT. IN.
SIDE YARD I LEFT .f /04 I RIGHT 0 / SX R.SIDE -,-�FT� IN.
DESCRIPTION OF WORK
y L.SIDE ---Pit- IN.
NEV III ALTERATION I x H ADDITION I REAR ..—FT— ` IN.
/
REPAIR I / `I MOVING I II DEMOLISH APPROVED I /, ATE (1.-0-5-
/ --4J 6'
•
BUILDING /T� NO. OF ) l {9 II
1/1
SIZE g/r'j(j T ROOMS 2I" STORIES /
EXTERIOR WALLROOF .Vx 4j
COVERING I COVERING LA / .W_ "� SCI/
USE OF BUILDING AND WORK TO BE PERFORMED. 1 I_
A t t F.2 . Y T. 4 c pe, R i a r'i.(N.q) ' \ M) S 1 --LAI �,./Li
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE O �j PERMIT FEE $ /4
PERMITTEP ®r� 'f�7 _n
i !!�� Ora
.�uI- /J $ 510 PLAN CHECK $ �i
AUTHORIZED AGENT�11 ��µ.I l.G. E
1 TOTAL FEE S ��5 "' n
--- r - -r' ------HH— — 1
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STERMITRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
e For Applicant to Fill in Completely —Use IInic Only RE Iv lP 8076 e,.sieo5 0 5 4 3o 84 Tlk
BUILDING ADDRESS /,7O i / 7 �L3/: A.P.NO. ITT – D / [ – 4 ,
(� BUILDING �'/ c /
OWNER OR 0 ,/ L ADDRESS 0 /75 1
tC TENANT 1 y!`- / ,`"`'II
s` UNIT OR
MAILING SPACE NO.
ADDRESS / 3 J' Pies
/ 7 Sr TR.NO. LOT BLK.
TEL.
CITY 0 S1 9 NO. NEW ADD ALTER REPAIR MOVING DEMOLISH
•` LENDER r /
BRANCH O L. a-
OWNER
ADDRESS ���/-//y� t y� yVc' UE _�/s
_S ARCHITECT TEL. U' 142 9/�lM G sic
OR ENGINEER NO kJ
\eo
ADDRESS ZONE TYPE kJ-GROUP•
/
1I APPROVED �i/���/•
CONTRACTOR 70si.c rap) c e 2 e i r/r BY DATE U V j
ADDRESS / 7 7S I l /7Gxe./i.6P-19i)1?
•
CITY 1t/'DO {'U' e NaTEL(0 P-/69vFl
-
r •
STATE
LIC.NO. 7 Q CITICY
4
� NOD/ 2. 9V 1 APPROV D S ACKS
(FROM C/L STRE T)
{y SIZE NO.OF BLDG&
0. OF LOT NOW ON LOT FRONT F .
7.4. USE OF
'el EXISTING BLDG. R.SIDE FT.
U,)
(-4
Separate permits are required for L.SIDE FT.
L1 electric,plumbing and heating work;
— REAR FT.
\-....___:---\...
R]
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
41, d
-hes ri)/972'/f}6j'9DATE
APPROVED
>1 APPROVED
} _B_Y DATE
..1
',
W
},
0.. hereby acknowledge that I have read this application and state n
t� I% that the above information is correct and agree to comply with
04 all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of o
the State of California. m
1 hereby certify that I am properly licensed as a contractor under SQ. FT. pi
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m •
Chapter 9, and that such licenses ara in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: r•�
am exempt from the provisions of the State of California Business 'a
and Professions Code, Division 3,Chapt1/4 er 9. VALUATION �Y/. PERMIT FEE $ ��s�
ell
Paganture of �7C � ✓/ $ vO(/ TAXiv r
N CHECK S SO A(j
Authorized Agent Date Or
8 – / 7 V '" ��i ///✓/]]]] t �4� L.U
TOTAL PAID $ y� O
Costa Mesa Bwl .,Sry—_ _ _ IOivlB P —
111 EAST 20th STREET •�4�ygBUILDING .. 1
.•OSTA MESA, CALIFORNIA t
inniment
TO FILL IN
FOR OFFICE USE ONLY
FOR APPLICANT�1Receipt No. Permit No:
Addrin /.5s E. /7>_rG a aGeo
Costa Mesa, California Received-by/ Date Recd. Date Issued
Nearest Q/ - '"%`� - .2 —,20 J a- 0�0 sto
Cross St. ,��c.,' �i�VY' Addrisg
Address
Owner Cyd.-/ �f Costa Mesa, California
Mail i��r�.vJ v /
Address Nearest
'yy,, Tel. Cross St. 1
City /(u,.-w�No. Zones 2 I V No.of Type . / I Group ,T
Architect or Lic. Plans V
Engineer No. Approved I
/ by Date
Address CORRECTIONS
6-4----1.-.4.....
@ �, City Lie. 7. /5L
i 'actor (�(„a-//^n-�f�._s,/
City
��i✓e�. ,.7'/f
Address /?6 �t_�L.o--v /w /
Lot
DescriLegption l I No. I Block I Tract
(Attach Metes and Bounds)
I No.of Bldgs.
Size of Lot Now on Lot
Use of I No.of I No.of - J p
Existing Bldg. Families Rooms I)
Setback Line from Rear Yard 2
Center of Street Side Yard ' 1'y ',-r y
DESCRIPTION OF WORE v • r
New I I Alteration I I Addition I - . - . - -
Repair I I Moving I I Demolish I
Building ^ No.of
Size ms Stories
P e.rior Wall Roof
_ ring Covering APPROVALS
L__of New Foundation Location inspector Date
BuildingForms,Materials, P
1.7 �r ame: Fire to
Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application Lath.Int.
liLi_dnstate that the above is correct and agree to comply
ith all City Ordinances and State Laws regulating Lath.Ext.
uilding construction.
of t� � /.�/J / Plaster,Int.
n- - - --
Plaster, Ext.
d Agt.
Masonry Reinforced
Permit Fee $
Plan Check 5 1 Bond Beam
Total
Fee $ r-T FINAL r 2
I i \A
tz
, • f iA
w
•
y •
C Y , `--:‘
J C
6 :I-
o
o a COST",• o , FEB Z 6PDi ,'432a *::iu•;^1-CO
. L�
- .. %.
- - - - t .. V
.
t .� -CI
t,
— ., r.
. Street- - _ -nt" .1 :.1 ' .. r, ... ,
.. -.a • 1
PLOT PLAN ,_;Show location and distances from -,.'. r,<' . .- .
property line and between buildings. ..
....• — '
.. z.-t141,
I - - _ ---_ _- . - - _. . - - "s !Ir• V-.- .
•
722 rE RECEIV ESD
COSTA MESA BUILDING DEPARTMENT 01-FINANCE DEPT.
P.0,BOX 317
COSTA MESA. CALIFORNIA CITY OF COSTA MESA
• FOR APPLICANTTOFILL IN APPLICATION FOR�LL�� PERMIT
BUILDING /30 E. 17 a 1Ftre 2) r . o-es GL
ADDRESS / r -�� �[ '
COSTA MESA. CALIFORNIA ' L FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
OWNER LI 11777x2u n.+R::.UIa 1.44 z Pv
MAIL ��jj �/ GATE ISSUED
ADDRESSy� 2 KIWOSL, I\1:cP ev Vitt' or/3 _
PUNT %RACn
TEL BUILDING\l //jo `l �o7/ f�0
CITY ELNO. ADDRESSJ L !
OR C H'TELIC.E
N
OR r NEER . COSTA MESA. CALIFORNIA
—
FIRE 3
ADDRESS ZONE
20NE NO.OF TYPE GROUP
or
CITY LIC. /�• PLANS I'
CONTRACTOR OW N F I7♦ NO. L% 'A�//
ADDRESS"LSZ k N e 2 NO.TEL. BY•1'ROVEe.j ' DATE /7S�s
DESCRIPTION -T NO. /100 QT•, BLOCK TRACT LI Slain)
///T77jjj II(14 Ewiri
CII�'�0��'R��-,R CORRECTIONS
A.P. NO. III 'eI
I NO.OF BLOCS. I 1 D
OF LOT gO A 2&Z.ao NOW ON LOT I � {� ®�I E
USE OF
EXISTING BLDG. <am t/tc/4 L. CITY OF STA MESA
PLANNGSETBACKOF LINESTREET FROM `
As Et'S/ • REAR YARD 1931 Y CIIR IFCT TO I EGD
CENTERDEPT. REG.
1 As Exig% 1
SIDE YARD RIGHT 5 LEFT /� c�A'n
DESCRIPTION OF WORK By L(�I�.d"''_ DATE R-/'S-
\/ PIAN TLCF- 7.-1
NEV ALTERATION /1 ADDITION
REPAIR MOVING DEMOLISH
SIZE DING ROOMS 12 STORIES 1 1 r/
EXTERIOR WALL.6LOCC 'ROOF !/f•
COVERING 'wooD•J COVERING Coa po T
USE OFNG NEW I_
As C-7/A a Nil 7 � YM U-1 NI. '7A it .1C 30 !(d 4'.
BUILDI
FR.a/A EiIS/. -'1R.4Llve.e
I HEREBY ACKNOWLE E THAT I NAVE REAL) IIS APPLICATION AND
STATE THAT THE ABO E IS CORRECT AND AGREE O COMPLY WITH ALL
CITY ORDINANCES ANSTATE LAWS REGULATING UILDING CONSTRUC•
TION. VALUATION J
SIGNATURE Q
PERMIT FEE S 3 2z�
PERMITTEE A� .+ : ����0
/ PLAN CHECK $ C
•
AUTHORIZED AGENT TOTAL FEE S V r......„ �1
•
COSTA MESA BUILDING DEPARTMENT
��5 �5'
P.O. BOX 317 FINA(C&4pP959
COSTA MESA. CALIFORNIA r{I;I OF !'pSTnn
•7E,_ I
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING
ADDRESS l•SQ 0, ads BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. 4 P / IT NO. -
OWNER 12.0402 earal ! _
+� ,L RECEIVED BY DATE RECEIVED DAS 1 UI
ADDRESS I3o E . 0 1 -4. S'T • /
a asp/1� L
/1 r TEL. ADD EISS 13 o E / / j
CITY CO S7A �jI ESP NO.��II Z
ARCHITECT '{'J LIC. ...�. COSTA MESA. CALIFORNIA
OR r NEER 1(,\G;L.!/1/�N NO.
ADDRESS i 30 FIRE Al
l'+ Q nS7 ZONE
ZONE NO,OF TYPE GROUP
1, CITY LIC. PL NB 1
CONTRACTORT.UprLocaF.{.Er NO. ,1 C J� `yam
ADDRESS 3o4/daalwe Ida NO.O4-3-47 , BYAPPROVE 'C:2
CLy..� tel Y.
LEGAL LOT \i IJR (�TI�4/•1�
DESCRIPTION NO. 9:./....BLOCK TRACT A1" S.vT� M( •cP D
A.P.NO.// 7- 0 / •: Y
CITY e'; COSTA KAFSA
SIZE NO.OF BLOCS. PLANNING DEPT.
USE of --!!�� -SUBJEIg Tr3LUG . utr'T. REG.
EXISTING BLDG
a S 7Uil.e►� r
/ �- //
SETBACK LINE FROM
F
CENTER R STREET i -- " '-. 41 ■ , - _ �p
SIDE YARD -a'--.A41110; -
DESCRIPTION OF WORK
NEW ALTERATION x ADDITION
REPAIR MOVING DEMOLISH
BUILDING NO.OF
SIZE ROOMS STORIES
EXTERIOR WALL ROOF a '
COVERING Lh�+K..COVERING ✓/� Coot?.
t i
BUILDINGEW�oc iC 7A 1 L LOW WI 4. ilEST.
2>=/AG DE L_
I
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
ST•TE THAT THE ABOVE S CORRECT AND AGREECOMPLY WITHALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRU0.
TION.
VALUATION y/}---
SIGNATURE
SIGNATURE OF (/ PERMIT FEE S (/
PERMITTEE JIB _1 `I t di, i_ �7 /� I •
1 \ S / / /-J/ - PLAN CHECK S
AUTHORIZED AGENT
V `� TOTAL FEE S KZ. — j'"•
•
.• . • 9983 �.._ Jb. -k;. '.- ,, ., ,
Co"•
JUL 281959
COSTA MESA BUILDING-SAFETY DEPARTMENT FIi NIECE DEPT.
P.O.BOX 317 COSTA MESA. CALIFORNIA
Ci I' DF rnern MESA
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT.
TYPE OR PRINT BUILDING
BUILDING JQ LC /7
ADDRESS / a
COSTA MESA, CALIFORNI , FOR OFFICE USE ONLY
IAZ1.4
OWNER �'•iii RECEIPT NO. PERMIT NO.
MAIL 1,30 L /7 i RECEIV D BY DATE RECEIVED DATE ISSUED
ADDRESS JV L I I . 7 —�7--# /]7' l;_�-Y
TEL. • A BUILDING ,( ,op ) -'L//7/
CITY �(/ �. �LL1LtCT /�r� NO.N/.6968/ ADDRESS I ✓ a ` / /
ORART ;NEER 1 • /L.. A...." NOO. COSTA MESA, CALIFORNIA
ADDRESS t / G//7 / FIRE
///��/ _ ZONE ! TY .J GROUP
P/ U
/11/ LIC.NO. BYPR VED 06e 91/_. DATE /eµ6/ `5'/
CONTRACTOR ✓i }l/ ��`MV7---
k�Ost
ADDRESS /JOE. /tit ZONING
LEGAL I LOT I I ZONE 'f/ I NO.OP ' I USE OF NEW .�A
DESCRIPTION NO. (5 /} BLOCK TRACT • PLANS/ e1 BUILDING .(/A%
A.P.NO. // I s `% / '--l9-n APPROVED / q/1j1 //✓ //
BY //�♦ DATE 7 r
N
SIZE �j T .of BCOGB. YARDS EVES
OF LOT 7// ..---1.--.71/ J/� `Nig:oN Loi REQUIRED ALLOWED/
USE OF /� (CENTER LINE ST.Ie2
EXISTING BLDG. // /�..42•iIC.4%21"/kP. FRONT C
IN.
SETBACK LINE FROM .L�/
CENTER OF STREET !rD REAR YARD c)/ R.SIDE ( FT. IN.
/7/ ^ / Tom.
SIDE YARD LEFT /7RIGHT LZ './ L.SIDE ' FT. IN.
DESCRIPTION OF WORK ^
REAR d--` FT. IN.
NE I II ALTERATION I X II ADDITION
REPAIR I I MOVING I II DEMOLISH
BUILDING NO.OF
SIZE ROOMS (0. STORIES
EXTERIOR WALL I ROOF
COVERIN COVERI G
USE OF =/ ILD G AND W•-K TO = P RFORM D
f. - 7
•
I HEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STAT THAT THE ABOVE IS CORRECT AND A.-EE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH LL CITY ORDINANCES D STATE LA + REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING C•,STRUCTION. / VALUATION //
SIGNATURE OF //cry-- 7� � PERMIT FEE $ /(/ Ov '
PE- /y
$ / Y PLAN CHECK $ <J -
AUTHORIZED AGENT �y
TOTAL FEE $ /
I-
•
•
11234 FEL RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT /_ /Z—dtb
P.O.BOX 317 COSTA MESA.CALIFORNIA n FINANCE DEPT.
TOR APPLICANT TO FILL /N COMPLETELY APP&IalAQOOPAEMRMIT
TYPE OR PRINT //��pp BUILDING
AD / 10 /'� /7.2-/q-0
. fj-Jiffy_ ///
ADDRESS COSTA MESA.•CALIFORNIA I/
�/ �h�r FOR OFFICE USE ONLY
OWNER
// A / RECEIPT NO. I // y
/ H R (.
ADDRESSMAIL 2-.-.) ( RECEIVED BY DATE RECEIVED DATE ISSUED
/ IA4�Gn�T � i;7c� /-ice- c•n j ,/- %z-4.c,
CITY 044'41-7490,4 I TEL.L. BUILDING n S /I Sie //
ADDRESS I O `= . � / VVV
ARC 7CT Af;.., v _cm „L. LIC. COSTA MESA, CALIFORNIA
OR NE :ER I K ,O
ADDRESS TORO/
IR ,' / 1 /rY� //71
/ GROUP -.7/
ZO /yr/V/ iT� T !!//
STATE
CONTRACTOR J`L /j/J(, V7Z 14L'C41,77/
IC.NO. BY E� )i DATE
ADDRESS 'Z `fit Ar l C0� �/'�� ZONING 0l„
LEGAL I LOT Q i
7-07 IZQNE� NO.OF USE OF NEW
DESCRIPTION NO. / BLOCK 1 r I PLANS - /'BU ILDING
y/ /I/`/�/ r,
'� , I BBYPROVE•UL / L% I DATE. - - -Y/ c
SIZE \� NO.OF BLOCS. YARDS 6' EVES
m
OF LOT D I NOW ON LOT REQUIRED ALLOWED
, (CENTER LINE ST.)
XEOF
ISTING BLDG. ?c Te" �/q1
FRONT FT. IN.
SETBACK LINE FROM /r� I
CENTER OF STREET /�J[� REAR YARD J,�` R.SIDE _l'��f, FT. IN.
SIDE YARD I LEFT '7'3- I RIGHT d / L.SIDE ,_,i2.---10E-r. IN.
DESCRIPTION OFF 'WORK
WORK n '�
NE I II ALTERATION I XDD IT ION I REAR IN.
REPAIR I II MOVING I II DEMOLISH I
BUILDING NO.OF -
SIZE ROOMS STORIES
EXTERIOR WALL IROOF fI'I
COVERING COVERING ,, /t,, Iii
USE Op,:UILDING AND ORK TO BE PERFORMED V 7/i
�I /' /:..1_ _ vNe-ea .,�' r
( SIL_
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTION. VALUATION // stC.0
SIGNATURE OF ( t.,..-T al (.4.2:0: - PERMIT FEE $ /T,
PERMITTEE UUII O
$ ç-)O U. ) 0 PLAN CHECK $ 7.
AUTHORIZED AGENT TOTAL FEE S olt. '`-O
/:y . . . \
F
_ • 12458
. V! AL.(te ',' !,0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE CED 1
For Applicant to Fill In Completely APPLICATIONCFORCPEu IT.A MESA
TYPE OR PRINT \
BUILDING
BUILDING " O (/7 t/l
I
ADDRESS I
COSTA MESA. CALIFORNIA For Office Use Only
S1/1f€1 FACTO.ac� "&y a/ DuWM I RECEIPT NO. I PERMIT NO. (�
OWNER ^] M/ 7 TI O MIIIW [ V(�
/ 3O J / l _y- - i l Mf/ RECB BY I O 7�8L8 8 I D TS/BB D ` v
MAIL y� /-La..�.,�_ ////// G AG \\`
ADDRESS
TEL. BUILDIN
CITY COSTiJ ,SR ND �F ADDRESS 46 6 , /
ARCHITECT TEL. L
OR ENGINEER NO. TA MESA. /C�/ALLIIFORNIA I
0z
�,I�,/r� ZONE , •r\ (v11 TYPE" GROUP
ADDRESS W/1/ • FIRE •17, \ CC
\I
CONTRACTOR _ BYPRO�I( \` DATE
ADDRESS `AM� ZONING °'
CITY 1NE- ✓ ' PLANE / I BUILDING a
STATEIC. TEL. DESCL 7 U
LIC.NO. NO. IGI / y\Q 1,( ( V
DESCRIPTION ///� HV
CL
OSIZE
LOT NOW OON LOTS A.P.NO. // ' /'�e tI��, 1i
USE OF / YARDS ` EVES D.'
EXISTING BLDG e ' • ` APPROVED ALLOWED O
IL
SETBACK LINE FROM (CENTER LINE ST.) - /
CENTER OF STREET REAR YARD FRONT J!-{/ FT. IN. 0
SIDE YARD I LEFT I RIGHT R.SIDE 0... FT. IN. Y0
DESCRIPTION OF' WORKL.
` r T
FT. IN.
I ALTERATION I VADDITION I REAR E FT. IN.
NEWI /
REPAIR I V MOVING I I DEMOLISH I • APPROVED
BY
1A A /� DATE� ^- / J
BUILDING NO. OF l /` '/) 19
SIZE ROOMS STORIES
EXTERIOR WALL I ROOF
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
9vtae&,, rG LK /,6
�z
-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOO NDER VALUATIO- = FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABL =KING A PER T FEE ONLY.
PLY WITH ALL CITY ORDIN CEO AND ATE LAWS RE•ULATINO it-4"BUILDING CONSTRU ON. / / VALUATION it-4
SIGNATURE OF A PERMIT FEE $e---N• N
PERMITTEE 1 B
! -. r �/Y'- eate `• s `/ L PLAN CHECK $ �'
AUTHORIZED AGENT C� �1 PI, 0
\TOTAL FEE aL 4 r,.--
,/ •
• 13381 1' IC .c. R L. 1 v I.':.c
COSTA MESA BUILDING-SAFETY DEPARTMENT • ; -DEC ? 3980
P. O. BOX 917 COSTA MESA. CALIFORNIA y.
ANCE
For Applicant to Fill in Completely QR( ERM DEPT.
PP P Y APPLICATION�FORGP(ERMIT(A MESP
TYPE OR PRINT
•
BUILDING `` it' �'- /A /� rg(.i BUILDING
ADDRESS I3 O F_ - 1 1— .>T i 1'ei-l/' P-ti • R - ✓
COSTA MESA. CALIFORNIA V, y -, For Office Use Only
M ,( / /is I RECEIPT NO. I PERMIT NO.
OWNER MR • A. GU-;-1, -iJN '
MAIL i l( C E tir7 P IL RECEIVED BY DATE RECEIVED OAT/q ISSSUE
ADDRESS • —7-l-. -- 7 I/7� 7-60!'IA/o'2/,-: �!
TEL. / /�•1 ABUILDING/bK/ .g /7 94-4--
CITY �C3_`.T,n • ES IS NO. �1'b'9CB BUILDING
b
ARCHITECT
GINE r f ) TEL-I/ 1-ZS3•i - COSTA MESA. CALIFORNIA
OR ENGINEER 1G ALpryUI4Y7 d(IT NO.AIt-
ADDRESS 21)1.1 NC. (TIN 54 W7/1 APA PIRE
ZONE -W..,
ONESi/TYPEGROUP/ J
CONTRACTOR C. I.1 AS .C%. Cfl7- itrIECD APPROVED /77.��ATE 1+y�3//�
ADDRESS ?SIT b € I 1 I� l /,ZONING ' �(/d�� .
// ZONB NO.OP USE OF NEW/l Y//4
CITY lis-rt., /AE-st. (' �7/I PLANNQS..-, I BUILDING*/ (Litt),
/)I
LSTATEIC.NO. 3S-1 S S NO. U-k- LL6'Qi LEGAL .!j I' g/'!/Iii^ v -r.j._
DESCRIPTION (t grit"
OFELOT ((C' 4.. TC I> I NOW ON LOTS I // t 7/- &/
I A.P.NO. �—
USE OF YARDS EVES
EXISTIN BLDG COM//1T RCI hC _ APPROVED ALLOWED
SETBACK UNE FROM /_ZT hG•1 LO TO I (CENTER LIN SST.) /
CENTER OP STREET EXIS,•7,L.JC/- REAR YARD iZJI� FRONT �q AJl T.. _e___--72-
SIDE
G/7 - IN.
1
SIDE YARD LEFT �`-S I RIGHT 01 R.SIDE FT. ( ] IN.
DESCRIPTION OF WORK y,/
L.SIDE ,r( S- FT. -q/ ,{ / dIN.
NEW I j/II ALTERATION I I ADDITION HREAR .T7 I�SFT. C(L // 4,-rMt IN.
REPAIR I II MOVING I II DEMOLISH I APPROVED /7, ( ' I 1 DATE / .(-" 2��
BUILDING ' c(O ROOMS 1�..7 STORIES I 4 A
I' ,/ O 4Gi 3'y///
EXTERIOR WALL WALK C. ROOF V1/ GSIA(�O /m5a Ea' „ Q/
COVERING CCO I COVERING a 2Avt•L Z77 Ga PDrj . Z.c-7S
I
®c.d .�r,2./ q 9 / 3� a•
CORRECT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APpLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS _EGULATING
TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLy WITH ALL MT( ORDINANCES AND STATE LAWSVALUATION 442-/ PERMIT FEE $
N
C,L c_
$ 2 t2 / ° 6, PLAN CHECK $ d / J
S
AUTHORIZED AGENT 3 " 0
TOTAL FEE 2
r
A
41028PGG 30-75, -,001176.z 7.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
AP LIC•TION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only - E, IV tY DATE RECEIVED . D T ISSUED ii
BUILDING
R7
ADDRESS r _ -- '' '1 1 - )M
00
OWNEa 4-4-1-1---_—_ - - - -- Ad S/>1 /T A.P. NO � .
MAIL �s J� BUILDING
ADDRESS 5-446• ADDRESS ce _ T
�I �/4 r! nor
CITY Cos j7O /✓( NO.fl/�3y/� -AeT (..r a LO-T'R i BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMO!ISH
LENDER �/
BRANCH ,J�`
ADDRESS OWNER �4/A` _A id / st/
ARCHITECT TEL. USErtfahl°rior air V UE //
OR ENGINEER NO. (�r
FIRE �f
ADDRESS ZONE TYPE GROUP f•'47....
\ / 1 _�t APPROVED nn
JISONTRACTOR 6ccdpaA .—Ru i4_DeA- _ BY DATE1(, J---/5
ADDRESS ZO E NO.OFera USE OF N
CITY NOL .519 PLANS BUILDING1 a /j�/
�_
I STATE CITY YARDS APPROVED YARDS APPROVED
gLIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
w SIZE NO. BLDGS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT FT.
xt USE OF cn t /
EXISTING BLDG. R.SIDE biit... . F ' ,percn
FSearate permits are required for L,SID, FTr
C electric,plumbing and heating work. RE• FT _
[w.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE B . MAIN& / '
0 .,,,e4 A MAIN BLDGS. A„ E .BLDGS.
s �jy ,^ VAR. DATE
Q /�� / s/ —/ !(/��2'��✓/`� *Cif _ C.U.P.,
� DAPPROVED
APPROVE' +V s �� ] A m. DATE / Z.-3 V-77
6":"ce
w
0 I hereby acknowledge that I have read this application and state n
N
tY that the above information is correct and agree to comply with m
4• all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of i
.w=,
the State of California. �V L. FT. /eP✓!, "I a
3 I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3, THE AMOUNT SH N UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ABLISHING A PERMIT FEE qNJ y:
am exempt from the provisions of the State of California Business VALUATION (=3L- a
and Professio - ode,Division 3,Cha ter 9 J• PERMIT FEE 8 7 m
‘ .� PLAN CHECK S C o
Signature / /,
Permittee ( - / $ ///, 0 TAX $ III��� U
Authorized Age nt YYY�WW TOTAL PAID S 7
--1
JAN �
i9I962YC
-• • 16213 �YY
COSTA MESA BUILDING-SAFETY DEPARTMENT TY OF FINANCE DEPT.,
P. O. BOX 517 COSTA MESA. CALIFORNIA CITY Of COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT •
TYPEpp�� G
OR PRINT BUILDING
ADDRESS J 36 -TC( & /7 41-414-
COSTA
1J1COSTA MESA. CALIFORNIA For Office Use Only
,M• n RECEIPT NO. I PBRMIT O.
OWNER"/ •B-LAYa-er .- ( .rr 1 '62 13'
MAIL O� r de-mai t''r_ RECEIVED BY DATE RECCEEIVEED DATE ISSUED
ADDRESS AIP q iv,. Ak...c � /tzv I / —/!--/2 / ` //"-42
app�'''' '''' '''' '''''''' ���� '''' ,,,�//AA..----.... ((�� � TEL. BUILDING
"-
CITYyw-Fut-An ISL y[. NO. ADDRESS
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER NO. /
ADDRESS FIRE y
/J/ - ZONE TYPE / GROUP
CONTRACTOReept-T //I- �/JJfjag,� BYPROVEO DATE
ADDRESS 3 r 6 Z&_ /9 elc,- ZONING n^Y//1�/
-� p� ZO E ' / NO.OF USE OF NEW / I i
CITY ea_ / 77__ /-V`/ `/, �'- ` l PLANS O4-1
I,yB(UILDING 4,4-
LTATE (� TEL. „7'• P_ (j0 y 7 LEGAL �/� R l i A / 47/49/4
LIC.NO. / � S[ NO. i 11 T L DESCRIPTION 7_0
TI"Y-I �" //
SIZE I NO. OF BLDOS. I( / _ /. f (. 2-
OF LOT NOW ON LOT A. P.NO I/ I/ V
USE OF YARDS EVES
EXISTING BLDG APPROVED ALLOWED
SETBACK LINE FROM RR�o/ (CENTER UNE STd ',}}��
CENTER OP STREET //� WL/� R Y D FRONT /1110. .FT. IN.
SIDE YARP I LEFT 4 I RIGHT R.SIDE rl. l IN.
DESCRIPTION OF WORK
L.SIDE ( IN.
NEW I I
II ALTERATION I II ADDITION , REAR t/ �GT�— //N.
REPAIR Ix LOVING I II DEMOLISH I BYPROVED / DATE . f—/9 c �
BUILDING NO. OF (•
SIZE ROOMS STORIES .0+1 -0I
EXTERIOR WALLROOF `_.
COVERING i "�
COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
I R DY KNOWLLEDGE THAT 1 NAV�EAD THIS A LIGATION THE AMOUNT SHOWN UNDER VALUATION IB�Poii.aTHEl_
AND STATE THAT THE ABOVE IS CORRECT AND AG TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF 4, PERMIT FEE $ \ 9_,
PERMITTEE ��,�� ""7yNyAa �j
SI
$ j✓ PLAN CHECK $ J�(y0
�t�I N
AUTHORIZED AGENT TOTAL FEE $ /' rJ
LL
4I.OWNtK SMITH, Don DATt 12-30-75
JOB ADDRESS 130 East 17th Street. Unit T BUILDING PERMIT NO. 41028
GENERAL CONTRACTOR Owner/BIdr. DESCRIPTION of WORK Int Alt
AP No. 1 17-091-24 LOT TRACT FIRE ZONE VALUE $660.00 •
',U' 'CTIONS Signature Date TYPE V GROUP F-2 ZONE C-2
SL SUBCONTRACTOR PERMITS ISSUEDV GAS Date Number I Signature
4WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING Heating and Vent. .
TRENCHES 0 FORMS 0 STEEL REINF. 0
FLOOR SYSTEM •
BOND BEAM 7 STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING — IN 7 OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL Electric
HF G. VENT., REFRIG. AND A.C., FINAL
PL, .ING, FINAL AND GAS TEST 7
ELECTRIC, FINAL ��}� �1 �
BUILDING, FINAL alit/ F47-I`
�
OWNER pwyL,E DATE 8/19/80
JOB ADDRESS 130 E. 17th Street BUILDING PERMIT NO. 50543
GENERAL CONTRACTOR Insurance Repair DESCRIPTION of WORK Repair Fire Damage
AP No. 117-091-21 LOT TRACT FIRE ZONE VALUES 12,000.00
I! :CTIONS Signature Date TYPE F-2 GROUP ZONE
SUBCONTRACTOR PE MITS ISS ED
GAS Date Numbed Signature
WATER PlumbinRg�
ROUGH PLUMBING }..ArSLtAACC& ICX.PAr/L q-e25'70 7('Stf
PROP. SWR. LINE 0 HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING Heating and Vent. •
TRENCHES LI FORMS LI STEEL REINF.
FLOOR SYSTEM '- ,C P 1 R t_ L
BOND BEAM n STEEL REINFORCE 'El Inoompi Ito Inspec;:lons •
SHEATHING - ^.ancel
FRAME AND FLASHING Ilatn _ /��jt� Gia.
CNLATHING — IN n OUT n
fO PLASTER. BROWN COAT '
aSTP''CTURAL, FINAL Electric p C� ��/{��^_(^�/
OH! G. VENT., REFRIG. AND A.C., FINAL $Lc12fFMC'F. lCEPAt 8-/9� " _ I
ZPLu_.dING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILDING, FINAL
•JOB ADDRESS 130 E. 17th St. esiS jr BUILDING PERMIT NO.14332
GENERAL CONTRACTOR Fairfax Sign Co. f`lJ� VALUE S 900.00 —C_(
AP. No.117-091-21 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Groune'Sign
INSPECTIONS DATE I GROUP TYPE ZONE C2
I 'rground Soil U.G. Water — SUBCONTRACTOR PERMITS ISSUED
rground Gas DATE NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing9`/
Miscellaneous
Prop. Swr. Line House Con. St. Swr. 1
Sprinkling System 196,
Heating, Final
Plumbing Fixtures
Final Gas Test
Construction Pole
Underground Power
Rough Wiring *414 y�,,,-6e. •f-3N-6( l�8'ls
Trenches crM Forms Steel ! 2._4 f d - 1
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing
Frame and Flashing
-
T ig, In Out
I .ar, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final �'dlji ir/l(C \
Building, Final y�1 l-
•
OWNER NEWPORT Investment Co. $ DATE 1-24-63 -��-- -
JOB ADDRESS 130 E. 17th St. BUILDING PERMIT NO. 10004/ -
GENERAL CONTRACTOR Santa Ana_Neon Co. VALUE $ 2,000.00
AP No117-091-21 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Elec.Grnd.Sign
I 'ECTIONS Signature DATE GROUP TYPE ZONE C-2
Soil PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water
Rough Corn. Refrig. ❑ Air Cond. ❑ .
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line 0 House Con. 0 St.Swr. 0
Sprinkling System
Construction Pole
Underground ❑ Power ^�
Rough Wiring 1U .(R1'7iU ,v/- ,-nAKY 57
=
Trenches 0 Forms ❑ Steel Reinf. ❑ -Pf14 ?-,4D li3 /
Floor System !"'
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out []
1 tor, brown coat
'r,
Ri,0g. 0 Air Cond. 0 Final _
Heating, Final •
Plumbing g Fixtures, Final
Finalal Gas Test
Electric Fixtures, Final �)/�f�
pp
Building, Final G �(]
OCCUPANCY
FORM BU4-5M — 7-61 i pLn),
Elec. roof sign - Tag 4949
•
OWNER MARTINIS, BILL DATE 9-4-63
JOB ADDRESS 130 East 17th Street BUILDING PERMIT NO. 20500
GENERAL CONTRACTOR A & A Neon & Plex Sign Co. VALUE $ 50.00
kl A o. 117-091-21 LOT TRACT FIRE ZONE DESCRIPTION OF WORK roof sign
t
\IN__ECTIONS Signature DATE GROUP TYPE ZONE C2
ISoil _ PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
\ Water
Rough Com. 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 01
Rough Wiring .l . a . to. 9--<Z--o 3 „a od'ry
Trenches 0 Forms 0 Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
LT"'ng— In Out ❑
P r, brown coat
Rung. ❑ Air Con. .❑ Final
Heating, Final
Plumbing Fixtures, Final
Final Gas Test --__�,,�y_
Electric Fixtures, Final liw9
Building, Final
OCCUPANCY
Form 5U4-6M-3-63--S-B P 20500
OWNER NEWPORT INVEST.CO. DATE 1-19-62
JOB ADDRESS 130 G East 17th St. BUILDING PERMIT NO. 16213
GENERAL CONTRACTOR CharlesM. Sutterfield VALUE $ 1,350.00
AT No. 117-091-21 LOT TRACT FIRE ZONE DESCRIPTION OF WORK xep.lrellam.to
1 !ECTIONS Signature DATE GROUP F2 TYPE V ZONE C2 Gota rB1
Soil - PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water
Rough Com. Refrig. 0 Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line ❑ House Con. 0 St.Swr. C
Sprinkling System
ConstructG rPole
Underground ❑ Power 9-
Rough
Rough Wiring kV". /^25%lz �-S.ry L'J.'>R'L - t 6 7 5 'iv—.
Trenches 0 Forms 9 Steel Reinf. C _ SC
Floor System
Bond Beam ❑ Steel Reinforce ❑ P�
Sheathing _ /.4J-.23 62.
Frame and Flashing " 37-I /-23 -70
Lathing — In 0 Out 0
I 'r, brown coat
fw__ig. ❑
Air Cond. 9 Final
Heating, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final (/` Zw
Building, Final \ `1 l
OCCUPANCY ��-T J.-/3,Cv •
_
FORM BU4.5M - 7.61 1 C21
OWNER GUTTMANN, A. DATE 5-23_01
JOB ADDRESS 130 E. 17th St. BUILDING PERMIT NO. 11,556
GENERAL CONTRACTOR Neon Enterprises VALUE $ (1)12,00
P" No.117-091-21 LOT TRACT FIRE ZONE DESCRIPTION OF WORK , • , ,
u.
'ECTIONS DATE I GROUP TYPE ZONE Cep
Underground Soil U.G. Water — SUBCONTRACTOR PERMITS ISSUED
Underground Gas DATE NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line House Con. St. Swr,
Sprinkling System
Heating, Final
Plumbing Fixtures
Final Gas Test _
Construction Pole
Underground Power
Rough Wiring Mtn•.`Erp riser J=-1c^ T /S027 V
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Br-H1 Beam
hing
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final AA) , (DI \
Building, Final
OCCUPANCY I
-
Form 210-3M-4-5? IliriKh
OWNER BENNETT, B. DATE 1-12-60
JOB ADDRESS 13 0 E. 17th St. BUILDING PERMIT NO. 1123)4
GENERAL CONTRACTOR T. Muntean VALUE $ 5,000.00
AP.No.117-091-21 LOT TRACT FIRE ZONE DESCRIPTION OF WORKAlter Rest,Bar,Batu.
I ECTIONS L the DATE GROUP F-2 TYPE V ZONE C-2
L....erground Soil ittaiU.G. Water/, - • PERMITS ISSUED
Underground Gas /• • ••-, — -- — SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating • e
Rough Plumbing T 2 - k-Ca ,47),/7 «J% •g. e,. _/- . y- 60 _2 S 2 G y/
Miscellaneous //
Prop. Swr. Line House Con. St. Swr,
Sprinkling System
Heating, Final _
Plumbing Fixtures 1-5-(p
Final Gas Test
Construction Pole .
� _
Underground Power N o /-
Rough Wiring � ( a� ey--�'uC j ,�/�.� /---,--lo -&o //,/ZL
Trenches Forms Steel I
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Si thing
I .e and Flashing
Laming, In Out
Plaster, brown coat
Plumbing Fixtures, Final 1
Electric Fixtures, Final 0-7C1,41:-/
Building, Final 2 -SILO --
OCCUPANCY r 2 7-4,/
Form 210-5M-11-59 S-B P 1123)1
OWNER NEON, JAMES E. & RABOTtN, HERBERT SEP 1 4 1960
LSDATE 7-5-60
JOB ADDRESS 130 E. 17th St-. BUILDING PERMIT NO. 121458
GENERAL CONTRACTOR Owner-Bldr. VALUE $ 400.00
AP. No. 117-091-21 LOT TRACT FIRE ZONE DESCRIPTION OF WORK A1ter.Bar
ECTIONS DATE ( GROUP F2 TYPE III ZONE C2
U 3'rground Soil U.G. Water SUBCONTRACTOR PERMITS ISSUED
Underground Gas DATE NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating, Final
Plumbing Fixtures
Final Gas Test •
Construction Pole
Underground Power
Rough Wiring
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Ski^.-athing
F'4/. a and Flashing
Ling, In Out
Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final
Building, Final
OCCUPANCY 77/7:74k;
Form 210-5M-11-59 5-B P 12h58
•
OWNER ROGER'S BAR B ' • DATE —1 — •
JOB ADDRESS • 110 E. 17th St. BUILDING PERMIT NO. RI
GENERAL11CONTRACTOR Pacific Neon Lite VALUE $ 300.00
AP.rNo yl—,Zl LOT TRACT FIRE ZONE DESCRIPTION OF WORK Elec. Roof Sign
'UP TYPE ZONE PLAN NO. 87
PERMITS ISSUED.
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBS; 6
Trenches Forms Steel A I
Floor System . U r
Steel Reinforce Chimney Re-Rod Jr
Bond Beam
Frameand Flashing
Lathing, Out
Plaster, brown coat
nderground soil W/G Pipe Test
Topp Out
Furnace
Gas Vents
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System -
H 'ng final
I yG• Fixtures, Final
(
final Gas Test
onstruction 'ole
Underground Power _
Rough Wiring . J, "4� _7�_ __ �����
Fixtures, Final {r'r ����7/
OCCUPANCY
Form 2t0-5M-1.57 C
OWNER MAR SHELL DATE 11_11_5$
JOB ADDRESS 130 E. 17th St. (Unit 1) BUILDING PERMIT NO. 6599
ONTRACTOR PnwP Nenn Sign Co. VALUE $ 626.00 •
- .- LOT 91 TRACT t6 FIRE ZONE DESCRIPTION OF WORK Neon Sign
UP TYPE ZONE C-2 PLAN NO.
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil W/G Pipe Test
Top Out
Furnace
Gas Vents _
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr. _
Sprinkling System
Y '�g Final
I_ .ing Fixtures, Final
Final Gas Test
Construction Pole
Underground Power
Rough Wiring � � f X21tajt-
��
�d o.-Ya�,_'dt�},,. ;- l't- SAS 6.'?/7, 4-37
Fixtures, Final I- A
OCCUPANCY hit =y!_zt
Form 210-5M-1-57
t
OWNER MORRISON, R: - DATE 1-27-58 _
JOB ADDRESS 130 E. 17th St. BUILDING PERMIT NO. 6346
GENERAL CONTRACTOR Century Sign - VALUE $ 250.00
11/,7-I,�l-Or—LOT 91 TRACT 751 FIRE ZONE DESCRIPTION OF WORK Sign
C_ AUP TYPE ZONE C2 PLAN NO. '
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System - • _
-
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing • G 44..- - ary
Lathing, In Out U i
Plndter, brown it �,/�
UndergroundOsoil WIG Pipe Test
kV
/
Top Out //
Furnace _
Gas Vents 9 /
•Rough Plumbing - Sb
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sp:lakling System A11 //
1: ag Final
PI' bing Fixtures, Final
--Final Gas Test
Construction Pole
Underground Power
Rough Wiring 1i4t rf.c. I-.77-Sr 6a;r
Fixtures, Final L.1e Q.o aj WS�q i��;J ,ty V /
OCCUPANCY
Form 210-5M-1-57 63lt6
OWNER GUTTMAN, J. MAR 14-1958 DATE 12-24-57
JOB ADDRESS 130 E. 17th St. BUILDING PERMIT NO. 6240
GENERAL CONTRACTOR WilsongAssociates VALUE $ 499.00
11PZCo0 LOT 91 TRACTg_ �.PIRE ZONE DESCRIPTION OF WORK _ Z.
,r—OUP TYPE ZONE 02 PLAN NO.
•InoPECTIONS DATE PERMITS ISSUED
SUBCONTRACTOR DATE t NUMBER
Trenches Forms Steel
floor System
Steel Reinforce Chimney Re-Rod
bond Beam
Praire and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil W/G Pipe Test
Top Out
Furnace
Gas Vents
Rough Plumbing _
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System •
Heating Final
Pa'.tyuSing Fixtures, Final
E-4,4 1t Gas Test
Construction Pole
Underground Power •
Rough Wiring
OxFinal �7/it
/ _
.00CUPANCY f�
Form 210.-5M-1.57 l/ 6240
•
. . OWNER GUTTMAN, James MAR 1a119c9 DATE 10-1-57 ____
JOB
JOB ADDRESS 130-136 E. 17th-St. BUILDING PERMIT NO. 5807
G7EN�EA CONTRACTOR Owner-Builder VALUE $ 220.00
1',�71P.ZQo.E0 LOT 91 TRACT FIRE ZONE DESCRIPTION OF WORK Wooden Fence
r IUP F-2 TYPE V ZONE C2 PLAN NO. 5832
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil a W/G Pipe Test
Top Out
-
Furnace
Gas Vents
Rough Plumbing
—
Cesspool Septic Tank _
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
a,in
g Final
'.hin Fixtures, Final
1'tJns'1 Gas Test
-
Construction Pole
Underground Power
Rough Wiring -
Fixtures, Final }
-- -OCCUPANCY �, _ t 4/7 tit
Form 210-5M-1-57 5807
OWNER GIRARD'S BEAUTY SALON DATE 2-13-58 —
JOB ADDRESS 130 E. 17th St. BUILDING PERMIT NO. ((110
Ll
GENERAL Centur Si ri VALUE $ 150.00
P. o. LOT 91 TRACT FIRE ZONE DESCRIPTION OF WORK Sign
' )UP TYPE ZONE C2 PLAN NO.
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel 1 j
Floor System •�
1
Steel Reinforce Chimney Re-Rod Pi'
' ,J#
Bond Beam /
Frame and Flashing /f 7
Lathing, In Out (f
Plaster, brown coat / J n" (91
Underground soil W/G Pipe Test ,gyp' jt' Ji
Top Out / A' flK t/
Furnace •y NI' //' q+t, Y
Gas Vents d' 0 //6. I
Rough Plumbing r( i' / -•
Cesspool Septic Tank 12 ./ Ti 4)
Prop. Swr. Line House.Con. St. Swr. ,��1 \t V
Sprinkling System Vj //
Heating Final Z/Yi /'
' bing Fixtures, Final / .1 I/V
I..gt Gas Test
Construction Pole l
Underground Power
Rough Wiring _
Fixtures, Final
OCCUPANCY
Form 210-5M-1-57 6410
IF
OWNER ' GUTTMANN, FUMING UNITS DATE 7-29-59
JOB ADDRESS 130 E. 17th. Street ( 9 mase-/�I BUILDING PERMIT NO. 9983
GENERAL CONTRACTOR Guttanann a J VALUE $ 5,270.00
AP. No. 1 1 7-Oq1 -20 LOT TRACT FIRE ZONE DESCRIPTION OF WORK alt. Offset° apts.
I ECTIONS1,(/ DATE GROUP I TYPE ZONE C2
Unaerground SoilS.47U.G. Water1,(,ti R&Mir SUBCONTRACTOR PERMITS ISSUED
Underground Gas DATE NUMBER
Overhead Water and Gas
Rough Heating /V
Rough Plumbing l-al $.2-Sef // "._-�„ 7 -I Z-S t__LO_$-re_/ . l 1
Miscellaneous /
Prop. Swr. Line House Con. St. Swr. 0
Sprinkling System "Ti 1
Heating, Final -�
Plumbing Fixtures 57-57-499
Final Gas Test /5 LW./ R-9/- 9
t _ �SW
Construction Pole
Underground Power
Rough Wiringri�a.,4I - j 1 fr_ ma k L.A/4...`i.21,-0-71) u-?-s-Y a A .
Trenches Forms Steel OfeJ z �'—�
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam ' ,
Fr ";.,thing �.ba"'.. ;1 j
l'v("le and Flashing -- 1Y _
Lathing, In ut
Plaster, brown coat
Plumbing Fixtures, Final dig" c��-/-_�_/
Electric Fixtures, Final / 7r/l!r y
Building, Final 4,7.6 r/e/
OCCUPANCY I
Form 210-3M-4-59 V 9983
I• C-
OWNER ' GUTTMANN BULDING UNITS DATE 7-29-59
JOB ADDRESS (.36 F /7;t4- if-IL-
, , BUILDING PERMIT NO. 77.93
GENERAL CONTRACTOR VALUE $
AP No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
In :CTIONS -y/ DATE I GROUP TYPE ZONE
Underground Soil 1 fU.G. Water I,at 71:2.-67_ PERMITS ISSUED
Underground Gas SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas J 't\
Rough Heating
Rough Plumbing n- (/ r_ °22-0.,._o `?1A4f,a. A-1 a.-S`t_ b `/S \7)
Miscellaneous (�
Prop. Swr. Line House Con. St. Swr. _ 4
Sprinkling System `q' t
Heating, Final
Plumbing Fixtures ( Qt4Q
'
Final Gas Test ,4 t/,, 4�2
Construction Pole i
Underground Power yy �/ !
, a. R7.H -
Rough Wiring ,t -5 -.W7---it- C-07C- 7j9 _9514 4/
Trenches Forms Steel J
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
S' ting
F, -e and Flashing St-/tz ? _
Lathing, In Out
Plaster, brown coat ,
Plumbing Fixtures, Final - - . Age- J'-..e/.-S \
Electric Fixtures, Final /(� 4/tii \
Building, Final /y'SN
OCCUPANCY I
Form 210-3M-4-59 O - 9983
OWNER' GUTMANN BUTLDT}G 11NTTS DATE 7-29_59
JOB ADDRESS /3C E, 176-k Ji . BUILDING PERMIT NO. 991/3
GENERAL CONTRACTOR VALUE $
_AP No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
I ECTIONS my DATE I GROUP TYPE ZONE
Underground Soil 4,21U.G. Water t /
le a 12-67 SUBCONTRACTOR PERMITS ISSUED —
Underground Gas DATE NUMBER
Overhead Water and Gas �J
Rough Heating , (1
Rough Plumbing 4 w $jQ-(�p- j _j / S7_ -2j O q,S ' J
Miscellaneous
Prop. Swr. Line House Con. St. Swr. ,'
Sprinkling Systems_
Heating, Final T( f/J
Plumbing Fixtures /Of/ ), 4t g-9�S4# _ WV
Final Gas Test /0. 2, kg, .t-9;.49 , I'
Construction Pole
Underground Power --t '�-jam-- 2
_ppp
Rough Wiring 'k ,�17 $-/6 -1 9 n B-rl . 2- -5 / Air
Trenches Forms Steel J J
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
F 'hing
1 .re and Flashing 5--,41 Jy •
Lathing, In Out
Plaster, brown coat
Plumbing Fixtures, Final 2(Cc/iii-fr Z/_e-� -.'f
Electric Fixtures, Final 7/ -�'JZ,"t(4 g/
Building, Final f 4(./4r DC-
OCCUPANCY
Form 210-3M-4-59 N 9983
•
OWNER `GUTTMANN BU LLDTNG t r DATE A_15_5A
JOB ADDRESS )30 East 17th Street (j) BUILDING PERMIT NO. 7292
GENi27rL NmACTOR Owner • VALUE $ i %,flfR,nn
AP. No. LOT TRACT 1 , FIRE ZONE DESCRIPTION OF WORK ,,, _ . , as: -,t,
_GROUP] TYPE V ZONE 02 PLAN NO. 7292
•
1 ?ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Plashing . -
Lathing, In Out
Plaster, brown coat
Underground soili_. . W/6Rrpe Test/:;- /
Top Out 1 _
Furnace
Gas Vents
Rough Plumbing. . . . ' )0t.,--Jo / //- (, -SW /[[L 9 7
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final (/
Pl^robing Fixtures, Final ,e 1
Gas Test pp ',1 ,
_.------
_,.....----
Underground
nd traction Pole y, ti ../ i/-/
Underground Power ���� •7� ��' flFouur Wiring 7Fixtures, Final (1,-V / i
OCCUPANCY ' ADm
Form 210-5M-1-57 "" -
V 7292
. APT F
OWNER GUTTMAN BUILDING - / DATE A-15-58
JOB ADDRESS 130 'ast 17th Street gJ ` BUILDING PERMIT NO. 7292
GENERAL CONTRACTORpOwner 0T $ 1.3 40f 00
AP. L�o]�0`�.N("L'OT TRACT Npt FIRE ZONE DESCRIPTION OF WORK ‘Remodel bldg '.(c..CCe c.
GROUP TYPE ZONE PLAN NO. •
Ik ?ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER '
Trenches Forms Steel ..,�,_�_,�t//
Floor System - —�— ra
Steel Reinforce Chimney Re-Rod _laillYIA(
Bond Beam —Me1,MIWAN
Frame and Flashing • —a,*'vpT��L ��r.
``
Lathing, In Out —�Y„lJardO'AI�i
Plaster, brown coat —Mira/,
Underground soil W/G Pipe Test —11111.1nrinri
Top Out =� 1
Furnace
Gas Vents --
Rough Plumbing rEgallia e/ / anig ' ‘--
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System —
Heating Final - —_
Pl"mbin. Fixtures, Final _ It,/72T�3' 1111111 ,
• Gas Test— A/o 4 c — a
(..._.struction .ole SJ147 /
Underground Power - - w 1,
•
Rough Wiring it) w .`"rte 17AMIIM _ Jf i (
Fixtures, Final '1' • net; ' ' 11111rakfil \
OCCUPANCY 11 I , I •'p 11111.1.&SW
Form 216-5M—I-57 . APT G / -
-
a2
OWNER GUTTMANN BUILDING • I DATE 8-15-58
JOB ADDRESS 130 Eat 17th St. (() BUILDING PERMIT NO. 7292
•
GENERALCONTRACTOR Owner VALUE $ 13)108.00
AP. 1Qo.�—Uy1 -LUT TRACT Npt FIRE ZONE DESCRIPTION OF WORK Remodel Ridg.( "\
GROUP T TYPE V ZONE CP PLAN NO. 7999
IECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE _ NUMBER
Trenches Forms Steel
Floor
Steelel Reinforce Chimney Re-Rod
).<siti:StA
Bond Beam
FrameFlashing
Lathing, In Out
EA
Plaster, brown coat
Underground soil W/G Pipe Test Y '
Top Out l
Furnace ��
Gas Vents
Rough Plumbing ` 'I
Cesspool Septic Tank
Prop. Swr. Line House Con. St, Swr.
Sprinkling System •
Heating Final /
Plumbing Fixtures, Final N 4,/ G ��- -01)-Ce / 44 (p II462-4
Fk,Y, Gas Test L.rior D4r q /w
( `'":ruction Pole
Underground Power
Rough Wiring
Fixtures, Final
OCCUPANCY
Form 210-5M-1-59 APT E
E 7292 ,
OWNER GUT MANN BUILDING MAR 2 1959 DATE 8-1548
JOB ADDRESS 130 E. 17th Street BUILDING PERMIT NO. 7292
GENERAL CONTRACTOR Owner VALUE $ 13,1108.00
322/7409.1-01 LOT 9 TRACT FIRE ZONE DESCRIPTION OF WORK Apts. Dwell. From Ex. Still.
GROUP I TYPE 5 ZONE C2 PLAN NO.
'ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER. 1,
Trenches Forms Steel C
Floor System ty-
Steel Reinforce Chimney Re-Rod t� Les,
rQ�
Bond Beam t t��
Frame and Flashing• (" ,/ ' f 1
Lathing, In Out ...fff"' /t/� �1
Plaster, brown coat
Underground soil?_ .l$ W/ W pipe Test(- q-7.31 •
Top Out 7 �N'• /. ,1/a</
Cr,1:1 S. i_/31 m trill
7-S-58 / � . - -: ,
Gas VentsKnom.j.,_ tQ � A7'0 M 9-z Sq a -(r'S73 .4
Rough Plumbing ci IS. q3'.S'9{ f71 /•'/f/i/a Nb t�-,,z_9-se _/ 4-o cj Co (/l.y
Cesspool Septic Tank / 1
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final
Plumbing Fixtures, Final
F;; 'y_Gas Test
G Yt3-uction Pole
Unddrground Power
Rough Wiring 4t% /I-S'S' $rNei-n(zo 4 Son! q-Ib' S.4 ‘.,9 S 4 — S')
Fixtures, Final • e _� -��
OCCUPANCY _
Form 210-5rvI-1-57- 72Q2
OWNER (rrmTTMANN BIrTT,DTNC DATE 8-15-58 _
JOB ADDRESS 13n East 17th Stroat. (9) BUILDING PERMIT NO. . 7292
GE9.5.11//--�UYY�lThcflaRACTOR owner VALUE $ 13,408.00
AR 11 No. LOT TRACT Not FIRE ZONE DESCRIPTION OF WORK Remodel Bldg.(yZ)
_GROUP I TYPE V ZONE C2 PLAN NO. 7292
?ECTIONS DATE PERMITS ISSUED
SUBCONTRACTOR DATE NUMBER
Trenches Forms Steel
Floor System _ \
Steel Reinforce Chimney Re-Rod n
t
Bond Beam iJ k
Frame and Flashing g�.`�'
Lathing, In Out `\ U�1 n
Plaster, brown coat �] �7 ,11
Underground soil W/G Pipe Test Cl \I , i
rl
Top Out _ �b
Furnace
Gaster, b
�,\
Rough Plumbing
Cesspool Septic Tank \i'1
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final // tt ��/
Plumbing Fixtures, Final Aid 1_T u-C Lf/L-/"7D Z' 7-nj-S / V 6 '/3
Icy;::"„Gas Test ✓
(??ii;''r',':tuction Pole `
Underground Power
Rough Wiring r -
Fixtures, Final
-OCCUPANCY
Form 210-5M-147 Apr D (292
OWNER GUTTMAN BUTLDTNG DATE A-15-5A
JOB ADDRESS 130 En at 17th Strnnt i7/ ) BUILDING PERMIT NO. 7292 ._
GENERAL CONTRACTOR Owner VALUE $
7-091— L�,110H,00
AP. rem �OT TRACT Npt FIRE ZONE DESCRIPTION OF WORK Remodel Bider. --m
'\
_GROUP T TYPE V ZONE (12 PLAN NO. 7292
PERMITS ISSUED �lf
PECTIONS DATE SUBCONTRACTOR DATE NUMBER
Trenches Forms Steel
Floor System ,\I U
SteelReinforce Chimney Re-Rod
Bond Beam •
Frame and Flashing I
,iii. „
Lathing, In Out
Plaster, brown coat /f
Underground soil W/G Pipe Testy V (lit
Top Out
Furnace \
GasasVents � '1��
Rough Plumbing U
Cesspool Septic Tank %
Prop. Swr. Line House Con. St. Swr.
Sprinkling System •
Heating Final
P'-mbing Fixtures, Final
I Gas Test
Lunstruction Pole
Underground Power
Rough Wiring I
Fixtures, Final
OCCUPANCY
Form 210-5M-1-57 APT H
7292
•
-OWNER AIITTMAN PITTI,TIING DATE R15_5a
JOB ADDRESS' 130 Eact 17th St. BUILDING PERMIT NO. _7292
GENERAL CONTRACTOR Owner. VALUE $ 13,4nR_nn •
AP. X1-.7-091-0k)T TRACT Not FIRE ZONE DESCRIPTION OF WORK Remodel Bldg. '/
_GROUP T TYPE V ZONE 02 PLAN NO. • 7292 1 I P
PERMITS ISSUED
PECTIONS DATE SUBCONTRACTOR DATE NUMBER L
Trenches Forms Steel n4�
Floor System \cit
Steel Reinforce Chimney Re-Rod l� /J
Bond Beam
Frame and Flashing \t�
Lathing, In . Out ^ of / t
Plaster, brown coat
Underground soilA W ``W,/G Pipe TestL 9-1-411 14, nj -
Top Out greet !`
Furnace X ,
Gas Vents
Rough Plumbing e ('-3-o- "
Cesspool Septic Tank •
Prop. Swr. Line House Con. St. Swr. '
Sprinkling System
Heating Final
Ple nbing Fixtures, Final /. (/Y4 9-241-4r (J ^1M/Y,. .1. 944./..t.., . Y'_ 1N-C'E( /4e , .36
'-' Gas Test I-,IN. Q=Q4f"f'ff I , y
ei-;9truction Pole
Underground Power
•
Rough Wiring '
Fixtures, Final
OCCUPANCY Lew- -9-2IF-61fr
^ Form 210-5M-1-57 /
APTym
K 7292
OWNER nirrTMAN At1Turnin DATE 8 15 58
)OB ADDRESS130 wezt 17th St. (r ) BUILDING PERMIT NO. 7292
GENERAL CONTRACTOR Owner VALUE $ 13,408_O0 _
Al'. A17-091-010T TRACTNpt FIRE ZONE DESCRIPTION OF WORK Remodel Bldp.� '
C OUP Z TYPE v ZONE C2 PLAN NO. 7292
PECTIONS DATE PERMITS ISSUED
SUBCONTRACTOR DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod wrr.4
Bond Beam Ealt /
Frame 4and Flashing 1 [['.MW ((r'��
Lathing, In Out ,-I a �`�
Plas[cr, brown coat � r�'L,, t
Underground soil W/G Pipe est nil `i fi,4
-Top Out ,1 �.
Furnace �'nAlilik
Gas Vents IIIIIMMIIIIMISIIIMPlil
Rough Plumbing flit
esspool Septic Tank "
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final ,—
r" -nbin. Fixtures Final _ ' Q/�� i/ f%.///•�• . - .. --
1 Gas Test ar edial,- - e -
Lonstruction 'ole
Underground Power
Rough Wiring
Fixtures, Final
'OCCUPANCY
orm 210-5M—t-57 APT L 7292
op COUNTY OF ORANGE JULIETTE A.POULSON,RN,MN
÷ HEALTH CARE AGENCY DIRECTOR
DAVID L.RILEY
REGULATORY HEALTH SERVICES ASSISTANT DIRECTOR
� , ENVIRONMENTAL HEALTH MIKE SPURGEON
DEPUTY AGENCY DIRECTOR
E'tCClCfCC REGULATORY HEALTH SERVICES
`
tegity STEVEN K.WONG,REHS,MPH
DIRECTOR
'ervIce ENVIRONMENTAL HEALTH
MAILING ADDRESS;
1241 E.DYER ROAD,SUITE 120
SANTA ANA,CA 92705-5611
TELEPHONE:(714)433-6000
FAX:(714)754-1732
E-MAIL: BhtaIth@ochca.cpm
July 19, 2006
John Lau
Ace Fixture Company
7101 Lincoln Ave.
Buena Park, CA90620
RE: Plan #SR0108752, Five Sweets Bakery, 130 E. 17th St, Costa Mesa
Dear Mr. Lau:
Your plans have been reviewed for the above food establishment. The plans are now approved,subject to
the following conditions:
1. All Construction must conform with these approved plans. Alterations or changes to these plans
must have prior approval by the Plan Check Section of Environmental Health.
All construction work must conform to local building codes and have necessary approvals from
the local building and fire authorities.
2. When floor, wall and ceiling finishes are completed, with plumbing, ventilation, and equipment
in place, you must call the Plan Checker assigned to review your plans for a preliminary
inspection. Requests should be made at least two working days in advance.
Upon completion of 100% of the construction, including all finishing work, you must call the
Plan Checker assigned to review your plans to arrange for a final inspection. You will not be
issued a Health Permit until you pass a final inspection. In no case should a final inspection be
requested less than two working days prior to the proposed opening of the establishment.
a
'3, This plan approval is valid for a perioi of one year from the date of approval.
4. i Provide minimum 30 inch wide aisles in traffic areas.
5, Finishes in all areas, other than the customer waiting or dining areas, must be smooth,
nonabsorbent, easily cleanable, durable and light in color. (Note: light colored is defined as
having a light reflectance value of 70%or greater)
Five Sweets Bakery
July 19,2006
Page 2
6. Floor surfaces in all areas in which food is prepared, packaged, or stored, where any utensil is
washed, where refuse or garbage is stored, where janitorial facilities are located, in all toilet and
handwashing areas and in employee change and storage areas shall be of an approved type that
continues up the wall four (4) inches, in a seamless manner, forming a 3/8 inch minimum radius
cove as an integral unit. Some slim foot ceramic, quarry and metal topset cove bases are
generally acceptable. Samples of the proposed cove base must be submitted and approved prior
to installation.
7. Wall surfaces in the food preparation and related areas must be drywall, coated with a light color
semi-gloss enamel; or the equivalent. Greenboard with semi-gloss enamel is strongly
recommended behind sinks. (Note: Iight colored is defined as having a light reflectance value
of 70%or greater.)
8. The ceiling surfaces in all food related areas and restrooms must be smooth, nonabsorbent,
durable,washable and light in color.
9. NSF International standards are used as a guide in the evaluation of food service related
equipment and its installation.
10. All equipment, including shelving, must be supported by six (6) inch high, easily cleanable legs,
commercial castors, or completely sealed in position on a four (4) inch high continuously coved
base or concrete curb to facilitate ease of cleaning.
11. Hoods and mechanical ventilation must comply with all applicable requirements as set forth in
the current edition of the Uniform Mechanical Code, as adopted by the local building and fire
authorities.
Mechanical make-up air shall be provided at least equal to that amount which is mechanically
exhausted. Windows and doors are not approved sources for make-up air.
The cooking equipment must be spaced six (6) inches apart and from adjacent walls, or flashed
together and to the walls, or, the cooking equipment must be equipped with commercial castors
and quick disconnect gas lines.
Flash the exhaust hood to the wall(s)and ceiling.
The canopy-type exhaust hood shall extend a minimum of six (6) inches beyond the outer edges
of the cooking surfaces as measured from the inside edge of the hood.
12. Provide a dry food storeroom or area with a minimum of 32 linear feet of dedicated floor space
for approved back-up storage shelving units. All storage shelving must be accessible with 30
inch aisle clearance.
A shelving unit shall be a minimum 18 inches in depth and three (3) tiers high. For example,
eight (8) shelving units, each of which is four (4) feet long and three tiers high, would equal 32
linear feet of shelving units.
13. Within the designated area, you must provide one locker (12" wide x 18" deep x 36" high
minimum) per employee on each shift.
Five Sweets Bakery
July 19,2006
Page 3
Lockers must be installed on six (6) inch high, easily cleanable legs, cantilevered off the wall, or
on a minimum four (4) inch high continuously coved curb or platform. L-angle legs are not
acceptable.
14. All sinks must be equipped with hot (minimum 120°F) and cold water dispensed from mixing
faucets.
Provide a storage tank-type water heater with a minimum energy input rating of 40,000 BTU's or
9 KW's.
15. All conduit, plumbing, etc., not concealed within walls, must be installed at least six (6) inches
off the floor and 1/2 inch away from walls. All exposed flex conduit is to be "seal-tight" or
equivalent.
16. All equipment which generates condensate or similar liquid wastes shall be drained by means of
indirect waste pipes into a floor sink. Floor drains are not to be used in lieu of floor sinks.
All floor sinks must be at least half-exposed under the curb mounted equipment,or be in line with
the front face of elevated freestanding equipment, and located within 15 feet of the condensate
producing equipment.
17. In areas where food is prepared, manufactured, processed, or packaged, or, where utensils are
cleaned, sufficient lighting must be provided. The intensity shall be at least 215 lux (20 foot-
candles) as measured 30 inches above the floor.
All light fixtures installed over utensil washing, food handling or storage areas shall be equipped
with approved safety covers.
18. All buildings are to be insect and rodent proofed. Compliance will be determined at the time of
this Agency's field inspections.
If I can be of assistance to you, please call me at(714)433-6067 between 7:00 and 8:00 a. m. weekdays.
Sincerely,
Dawn Umemoto-Oh,REHS
Environmental Health Specialist II
Plan Check& Construction Inspection Unit
Environmental Health
DUO