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Home My WebLink About560 19TH ST - Building Permits�� " CITY OF COSTA MESA ` '' BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnN.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 � PERMIT NUMBER: S607-00113 PERMIT TYPE B_SIGN '(j�,�� Z� STATUS: ISSUED ��`.y �� DATE ISSUED: 11I2912007 Y � �� - ISSUED BY: RMD 94' JOB ADDRESS: 560 C W 19TH.ST CM , Suite/Unit: � C Vicinity: ' ' � � � SQ. FT: 0 " � Valuation: $2',090.00 ,,, . �:` -- SCOPE OF WORK: INSTALL:ATION OF A 3',X3' WALL SIGN FOR "BABY CAKES", UNIT D WITH 1�SIGN CIRCUIT. ' �� OWNER: GARVIN DRIVELTD �: �Address: PARTNERSHIP.� UnitENCINO, CA PHONE: (618) 501-0145; � . Ciry/Stale/Zip: 16485 GARVIN DR � ��. APPLICANT: MITCHELL, GERLINDE %. �' . - Address: 9702 BOLSA Unit:UN1T 122 PHONE: 714-556-9900 � ., . _ � City/State/zZip: WESTMINSTER, CA : �" CONTRACTOR: GERLINDE MITCHELL ,--� License No. ,542190 ,,. Address: 970260LSAAVUnit:��UNIT122 - PHONE: 714-556•9900 `��•' City/State: WESTMINSTER, CA � ZipCode:.92682� CELL: � ; � i. _ ARCHITECT: - ENGINEER: �- � ^ SIGN PERMIT FEE SUMMARY PLAN CHECK FEE: $54.11 HOURLY PC FEE: � - r- $Oi00 PERMIT FEE: � � �� $8325 ELECTRICAL FEE: � $48.10 SMIP FEE: . � $0.50� OTHER: . ��`$0.00 INSPECTION: <" $0:00 ' TOTAL FEE: License No. License.No. . . "':. -,', .� . .,__, .' '' $137.86' �' PHONE: PHONE: �r '' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulafions. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply vrith all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. LOUEp, INSPEC710NTYPE UF7 INTITA COPEp INSPELl10NTYPE �RjF� INTIIIRL 1618 Fixed S s�tem Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electncal 201 �Pinal BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 FinalSign . 222 Final Site 204 Final Demolition ' 250 Final Builtling/Occupancy WORKERS' COMP6NSATION DECLARATION: I hereDy aKrm under penalty of perjury one ol the (ollowing declarations: ❑ I have antl will maintain a certifcate of consent to sell-Insure for vrorkers' compensation, as provided for by section 3700 of l�e Labor Cotle, for the peAormance of the work for which this permit is issued. ❑ I have antl will maintain v.orkers' compensation insurance, as required by sectbn 3700 of the Labor Code, for the peAormance of lhe unrk for which ihis pertnit is issued. My vrorlSers' compensation Insurance carrier and policy number are: Ca r (in¢ secfqn neetl rat ba mmpletetl a1l�e /x�m/ is valuM at me nuMratl tldlars (5100) wless.) Poi m r: �I certify ihat in the peAortnance of ihe work for which this permit is issued, I shall not employ any person in any manner so as to bewme subject lo lhe vrorkers compensation laws of Califomia, and agree that i( I should become subject lo the vrorkers' compensation provisions of Section 3700 of lhe bor Code, I shall fort with comply with these provisions. �' � Appllwnl'S 51 41 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION OVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAFiS ($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 aKrtn that I am licensetl untler provisions of Chapter 9(commencing vrith Section 7000) of Division 3 of the Business antl Professions Code. and my license is in full force and eHect. � n� �-, "1 la� ss # `�— �� ' . ' //, ��c.�.L�/. / e �Gwroctoi s Sipoa re "`� - te `-' / CONSTRUCTION LENDI G AGENCY: ❑ I hereby affum that there is a crosWction IerWing agency tw Ihe peAormance of the vurk for which this permit is issued. (Sec. 3097. Civil Cotle). Lenders Name: Lender's Address: Sipnawre Daie OWNER-BUILDER DECIARATIONS: I hereby aKrtn that under penal[y of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW (or the following reason (Sec. 7031.5, Business and Professions Code: Any city or counry which requires a pertnit [o construct, alter, impmve. demolish, or repair any strucNre, prior lo its issuance, also requires the appliwnl for suc� permit to file a signed statement that he or she is licensetl pursuanl to the provisions of lhe Conlractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he or she is exempt Iherefrom 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 penauy of not more than fve hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the strucNre is not intendetl or offered for sale (Sec. 7044, Business anC Professions Code: The Contrac[ors License Law does not apply to an owner of property who builds or improves thereon, and who does such vrork himself or hersel/ or lhrouqh his or her ovm employees, provided that such improvements are not intended or oHered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have ihe 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 consWct the project (Sec. 7044, Business and Professions Code: The contractors License Law dces not apply to an owner of pmperty who builds or improves lhereon, and who contracls for such project with a conlractor(s) license pursuant to the Contrectors License Lavrs.). ❑ I am exempt under sec. Business and Protessions Code for ihis reason: Signalure J057�46(3/01) O�mer ID verified by driver s h� .. ❑ Yes ❑ No ��I �river's License No. Expires: Verifcalion of Ownership by (type of document, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ 1 hereby certAy that no excavation frve (5) or more teet in dep[h inlo v.fiich a person is required lo descend, will be matle in connection with work autlrorized by this pertnit, antl that no building sWcture, scaffdding, falsework, a demolition or dismantling thereof, will be more than thirty-siz (36) leet high. (Chap. 3.2, Grp 2, M 2, Sec. 341, Ttle 8, Califomia Administrative Code). ❑ As owner•builtler, I will not employ anyone to do vrork which vrould require a permit (rom the Division ot Industrial Safery, as noted above, unless such person has a pertnit to do such work from the tlivision. poP�iranCs SlgnaWre Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or presenl or fuWre building occupant need to file and certify a Business Plan for emergency respon5e lo release or threatened release of a hazardous material? ❑ Yes ❑ No (Sec[ion 25505 of Ihe Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantily of hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas al standard lempera[ure and pressure�. 2. Dces or vnll the applicant or present or fWure building occupant need to fle a regisiration (orm for acutely hazardous materials? ❑ Ves ❑ No (Section 25533 of ihe California Health antl Safery Code, with some exceptions, requires registretion with the Costa Mesa Fire Department by each business which a[ any one time has on hantl a quanlity of acutely hazardous materials equal to or greater than a vreight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure). 3. Does or will the applicant or present or future building occupant neetl to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials�7 ❑ Yes ❑ No (Section 25534 of Ihe Califomia Health and Safery Code provides that the Costa Mesa Fire Department may require the preparetion, certification and filing with the Fire Department of an RMPP by businesses which are required to register awtely hazartlous malerials vrith lhe Fire Department. 4. If an RMPP is presently required, has Seclion 25534 of the Calitomia Health and Safety Code been fully complied with7 ❑ Yes ❑ No 5. Does or vrill the applicant or present or future building occupant require for the work which is lhe subject of [his applicalion a permit for such cons[ruction or modification fmm the South Coast Air Quality Management District or (rom any other air polWtion control district or agency? ❑ Ye5 ❑ No (SeUion 65850.2 of lhe Califomia Govemment Code requires that the requested infortnation be fumishetl on applicaCrons fa non-residentlal buildirg pertnits). 6. Will any pan of the facility lo be constructed under this permit be within 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No Qf "yes", lhe faciliry must meet the requirement of Section5 25534 and 42303 of the Califomia Health and Safety Code). 7. If a pertnit from lhe South Coast Air Quality Manaqement District or other air pollution control tlistrict or agency is required for the work which is the subject of this appliwtion, have all of the disclosures prescribed by Calitomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance from the appropriate air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the infortnation given above is correct. I agree to comply vrith all slate laws and city ordinances regarding Hazardous Materials and Emissions. Slgnawre Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this applicalion and stale lhat Ihe infortnation given is correct. I agree to comply vrith all s[ale laws and city ordinances relating ro building consWction, and authorize represenWtives of the Ciry of Costa Mesa [o enter upon the above-tlescribed pj� �yy f r inspec[ion purposes. I agree nol to occupy or allow occupdj��y�SfA��ll � g aulhorized by this permit until fnal inspeclion. ° � � Sign u o1 Legal Owner(s) / � ate O � r M a Au1��C A ican(i, - City of Costa Mesa Building Safefy Deparfinent P. O. eox 317 Cosfa Mesa, Colifornip CERTIFICATE OF OCCUPANCY N� 2346 C �'LZ� � The 8uilding located at �j!� 1QA� �S�¢��'Z has been inspected and fo�nd to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 1�°�^1 p�cupancy. ' - Yrf hr. i c�� ''t .! �,.�_ r s-L a:�".'l'l` Legal Description �Z.2.•3�%��7� �g � � (Soe ravene �ido for MaMt and Bound�) Building Permit No. ��{�a� Elecirical Permit No. G�� Plumbing Permit No. �� Floor Load Signs have been installed as Room Capacity Signs have been instaled os required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. � 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment ho�se, hotel, or lodging house shall be used or occupied unt�l the owner or operator has been issued a valid certificaTe of occupancy by ihe enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or porfion thereof 2) The numbe� of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guesf rooms as required under $ec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8, N�mber of apartments and/or guest ISSUED TO: ,i;�:f. �m+►t er �3�� Building Offitial � Date "�1�Pb'� 1� � This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed excepf by the Building Official of the CiTy of Costa Meso under Sec. 306 (e) U.B.C. Fo� sva�—iM—v-ea-s-a r (714) 754•5273 • faz (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, CASTA MESA, CA 92626 MECHANICAL PERMIT JobAddress: 560 W 19TH ST Suite No D Vicinity: UNIT D Parcel Number: 42210320 npplicanr. VAUGH, JACK , " i -'�� , Address: 7728 W 9TH.ST : � ,. �. , � � ' Phone: 909-949-7334 � UPLi1ND, CA , ' Zip: 91786 _ _ � �' "' . _ . ', - . owner. � JEFFREY A. FISCHER Address: 17337 VENTURA�BLVD #205 � , " Phone: (818) 501-0145 ENCINO,:CA - Zip: 91316 Contrecror. HIGHCAND CONSTRUCTION Address: 1726 W 9TH ST / Status: ISSUED Applied: 08/10/2001 Issued: 08/10/2007 ISSUED BY: ' Phone: - UPLAND; CA � . . ��Zip:- 91786 " - , , License:711712 , � - ` �, i � _ ,. " SCOPE OF PERMIT REF: 801-00991. "EL CHINACO" MECHANICAL TO INCLUDE: 1 REPAIR/ALT TO EXISITNG SYSTEM, 1 REFRIG SYSTEM, 2 EXHAUST HOODS, 1 EVAP COOLER. -, � � �, ., ��. FEESUMMARY ISSUE FEE Inst FAU <700 k BTU Inst FAU >700 k BTU Repair / Alt Cooling/Neat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping , Factory Fireplace Hood w/Mech Exhaust � VAV Box Vent Fan I Single Duct � Appliance - � Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfrn AirHandlers> 10000cfin . Floor Furnace Floor or Suspend Heater Quantity ; � 523.50 � � - , " - 50.00� �0 - - -- - - - - $0.00 0 $13.70 1 $0.00 0 $0.00 0 $1820 1 so.00 0 sa.00 o ' ' � 521.30 2 � 50.00 0 $14.50 2 $0.00 0 50.00� 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 � , 30.00 0 , � Repair / Alt Absoibtion Unit Repair I Alt Refrigeration Unit Ventillation.System � Evaporative Cooler C om mercia l I ncinerato r Domestic Incineretor Compressors I Absorption Sys�ems , �Up to 3 hp I 100 k BTU � 3 To 15 hp I 500 k BTU � 15To30hp/1,OOOkBTU 30 To 50 hp /=7,750 k BTU .., , Over 50 hp / Over 7,750 BTU Boilers Upto3hp 3To15hp 15 to 30 hp , " . � , 30 to 50 hp Over 50 hp , � � , Other Mechanical Fee � ' Investigation Fee,� , . � Plan Check Fee Reinspection Fee - ��" � - � TOTAL CALCULATED FEES COMMENTS I SPECIAL CONDITIONS � Quantiry $0.00 � � 0 30.00 0' $0.00 0 $10.65 1 $0.00 0 ; $0.00 0 $0.00' 0 so.00 0 $0.00 0 $0.00- � 0 $0.00 0 � $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 5101.85 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes antl related regulatlons. (Ord. No. 9248, § 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 consldered legal, such work must comply with all app�lcable codes, and all requlred Inapectlona end flnal epprovel must be obtained. Failure to obtain Inspections and final approval wili result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 754-5828 2a4&e8l&00) WORKERS'COMPENSATON DECLARAPON: � I here0y ettirm under penelry of perjury one ol ihe follawing decleretlons: � � I heve end wlll mainteln e Certlticete ot coruent to eelf-Insura for workere' compensetlon, es provided lor by aeccion 3700 ot the Lebor Cotle, lor t�e peAarmance ol the v/pfk for which Ui9 permit La issued. _ I heve Cartier. (This s Inwrmxa, as required by se�tlon 3700 of the Lebor Cotle, lw the pertormance of the vroAc fa which thls pertnH is IssueA. pdiq number are: Poliq Number: ue0 et one hundretl tlollars ($100) or less.) � I cerlify tha� In the peAortnence e work for whicli tNs permit is LtSueA, I shell not employ eny person in eny menner so es to becnme sub�ed to the workers' compensatlon lews ot Celtlor I, end egr het If I should become sub�ect to Ihe workers' compensation proNslons ot Sect�lo/n��/ /Ap�� Labor Cotle, I shell fonhwlth wmpty with these 0�5 � �/ (`��a 1 Applicent Slpneture: �" Date: WARNINO: FAILURE TO SECU WORKERS' CDMPENSA ON COVERA�E IS UMAWFU� M1D SFLW. SU9IECT AN EMPLOYER TO CRIMINAL PENALTIES rW D CML FlNES UP TO ONE MUNDRED TIIOUSANDWLLARE(5100, .INADDITIONTOTHEC0.iTOFCOMPENSATION,DAMAGES�SPROVIDLDFORINSECTION31080FTHEUBORCODE,IMFAE5T,rWDFTTORNEI"SFEES. LICENSED COMAACTORS DECLARATION: I hereby afllrtn t�at 1 am Iicensed untle groNsions ot Ghepter 9(commendng wIN Seciion 7000) of Dlvision 3 of Ihe Buslness entl Profeuion Coda, entl my Iicense is in full force ena eMact. Lic. a' ' � -�� Class N_ Contracrofs Signature: �(—� Date: � f CONSTRUCTON LENDING AGENCV: ❑ I hore6y eXirm Ihet thefe Is e wnslructlon IBnGing e0enq lar lhe pertormBnce ol Ihe work for which Ihls pertnit I9 issuetl. (SeC. 3097, Civll Cotle). Lendefe Nflme: Lenders Address: Sipneture: OWNER-BUILDER DECLAHATIONS: Date: I hereby eHirtn Ihet under panalry ot per�ury that I em EXEMPT FROM THE CONTF1AC70R3 LICENSE LAW for �he fdlowing reeson (Sec. 7Q31.5, Buslness end Professions Code: My clry or counry which reduires e pertnit lo construct, alter, Improve, tlemdish, or r8pair eny struclure, pdor lo Its issuence, elso requlres 1he epplicent for such pertttit to tlle e sipnetl stetement Ihet �e or s�e Is Ilceruetl Durauent to ihe proNsions of Ue Contreclom Litense Lew (Chepter 9(commendng wlth Secllan 7000) of DMsion 3 ot Ne Businusa antl Professions CoGe) or thet ha or s�e Ls ezempt Iherelrom entl Ne besb for the elleged exemptim. My Wdetbn af Section 7037.5 by eny applicant lar e pertM' sub�ecte Ihe eppllcant to e dvll penalry of not more than Me hundred dollars ($500).): ❑ I, es owner of Ue property. or my employees with wages es thelr sole compensatlon, WILL DO THE WORK, end the structure is not intentletl or offered for sale (Sec. 7044, Business end Protessions Catla: TTe ConlreMore Ucense Law does not eppiy to en owner of property who builds ar imprrnes thereon, anC who does such work hlmself ar hersetl or throuph hls or her axn employees, proviGed ihat suU Improvements ere no� Intentletl or oHeretl tor sele. It, however, ihe building or improvement is wld within one year ot completion, the owner-builder will heve I�e burCen oi Oroving that he or she did not builtl or Improve for purpose of sele.). ❑ I, es owner of the proporty, em EXCLUSIVELY CONTRACTING WIiM UCENSED CONTRACTORS to construd ihe proJect (Sec. 7044, Busineu antl Protesslons Cotle: The contractors LJcense Lew does not appy lo en owner of properry who builtls or Improves thereon, and who comracts tor such proJect with a cnmrectoqs) license pursuent to the Coniractore LJtenSe Lews.�. ❑ I em exempt untler sec. Sipnature: Owner ID verllletl by tlrlvers Iicense. ❑ Yas Vetlflcetlon of OwnersMp by (type o1 document, i.e. Business end Professlons Code for this reeson: ❑ No DrIveI9 LiCen9e No. properry tex bill or deed): Date: F�plre9: DIVISION OF INDUS7RIAL SAFETV PERMR CER7IFICATON: ❑ I hareby ceNfy Uat no excavation fNe (5) or mora feet in depth Into which e person Is requiretl to descend, will be made in connecUon with work euthonzed by this pertnit, antl Ihat no buildinp structura, scaHdtlinp, felsework, or demolition or tllsman�ing thereot, will be more lhan thirty-six (38) teet �iqh. (Chep. 32, Grp 2, Art 2, Sec. 341, Tlile 8, Cellfomia Administretive Cotle). ❑ As awner-builder, I will not em0loy enyone to do work w�ich waultl require e pertnit Irom the DiNsion ot Industriel Salery, es noted ebove, unless such person �as e permit to do such work Irom the dlNslon. SlpnaWre: Date: Dlvision ollndustrial Safery Pertnit Number. CEHTIFlCATE OF COMPLIANCE AND AUfHORQA710N OF ENfAY: I certiy unCer penelty o1 perjury thet I have read Ihis application end state iha[ t�e Information given is wrrect. I aqree to compy wIN ell stete lews and ciry ortlinences relating to bullding construction, and euthoriza representatives ot Ihe Clry of Costa Mese to enter upon the ebove-0escriDed O�oPerry for inspection purposes. I egrea not to occupy or nllow occupancy of any building authonzed by Nis permit until fnel inspection. COOE I, INSYELiIONTYPE 7618 Fivetl System Final Fire Preventlon 1288 Pool Spa Final 200 Finel Ra-RoOf 201 FIneI8locWRetelninp Well 202 Finel Fectory Fire Pleco 203 Flnal Sign 204 Finel Demolition �O � �ate Date pe¢ �f��$ j�Qyf�j INSVECiIONTYPE 206 Final Mechanical 20B Final Plum�ing 210 Final EleMrical 212 Finel Flra Prevention 220 Finel Planning Approvel 222 Finel Site 250 FinalBuiltling�Ocwpency ` 111. : � • /Iy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFiIVE, COSTA MESA, CA 92626 ELECTRICAL PERMtT Job Address: Suite No Vicinity: Parcel Nunmber: 560 W 19TH ST D UNIT D 42210320 Applicant: VAUGHN, JACK Address: 1726 W 9TH ST -" ,,�,�., % i.. �- � � UpLAND, CA ;� -' - " - ' � , _ , Owner: ',JEFFREYA. FISCHER / Address �17337 VENTUF2A BLVD #205 -' . . ENCINO,CA��, � Contractor: 'HIGHLANDCONSTRUCTION Address: 1726 W 9TH ST UPLAND,CA� , � � �.Phone: 909-949-7334 Zip: 91786 ' status: ISSUED Applied: OB/10/2001 Issued: 08I10/2001 ISSUED BY: '\ ,�� -`.,� ' � � �� : � � ��\ �' � �� =\�� ;� i \ � ; �.. ., � � �� . - � �� .� Phone: (818) 501-0745 �� - - � Zfp: 91316 � ` . �-,�,'� . � ' � ; �� /' � �� `. .. - .. , � . � , � ,.��. �. ,Phone: ., .. ; . . . . " �� '. , •� �..Zip: 91786 . . . . � . License: 711112 . . A . ' ' \ .� . � � \ � SCOPE OF PERMIT RpF: B01-00991. 40 LIGHT FIXTURES, 36.OUTLETS. 13 SWITCHES, 3'MOTORS, 2 COMMUNICATION DROPS,�2 SIGN CIRCUITS. - �- -� -' � •- � � � -- ' "EL CHINACO" ISSUE FEE Temp service test Res. a/c package� New Res (7-2 units) New Res (3+units) � Pool / Spa Lighting Fixts Recept Outlets - Switches Non Res Appl Res Appl . � � Service to 200a Service to 1000a , Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communicalion drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole $23.50 so.00 $0.00 $0.00 $0.00 � $0.00 $36.60 $33.68 $14.30 . , $0.00 $0.00 $0.00 $0.00 $0.00 � $1425 $0.00, , $0.00 . $0.00 � $0.00 $2.20 $0.00 $0.00 $49.20 $0.00 $0.00 Quantity 0 0 0 40 , -' 36 13 „0 p. 0 0 0 3 ; 0 0� 0 0 2 0 0 2 0 0 �-' . �fEE SUMMARY - � ,, � � �,/� Quantity , , Temp Dist System / Lighting $0.00 0 Busway I100 ft so.00 0 Standing Section � 50.00 � 0� � �. ;MiscElectricalEquipment $0.00 ' 0;� , -. - Transformers up to 1 kva/kw 50.00 °, 0 � � ................up to.�10 kva/kw $0.00 ,. - 0 , .................upto50�kvaikw . $0.00.'/ 0� - ." ...__..........up l0 100 k'velkvi" -- 30.00� 0: . ........_........over 100 kva/kw $0.00 ; �. 0 , Low Voltage Equipment $0.00 ; , 0 Low Volt Wiring Sygtem / Ckt - $0.00 � 0 � , � Misa Conduit " - $0.00 0 � � Misc. Conductor - � - $0.00-� ,-0 �, Cirw's ( gen or ride) � � � $0.�00 %� 0,� � . Circus (mech ritle or lights) �� $0.00 � � �,- 0 Christmas Tree Stand - �50 00 �� 0 � Fireworks Stand ' � �- . $0.00 0 � " ` �Other Electrical Fee , = $0.00 - ��= � - " Investigation-Fee -� $0.00 Plan Cfieck Fee $O.OU Reinspection Fee $0.00 TOTAL CALCULATED FEES 5173.73 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt 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 tor ihe work authorized under this permit to be considered legal, such work must comply with ell applicable codes, and all requlred Inspeclions enq final epprovel must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 za+v-es (erool ... WORKERS' COMPENSATION DECLARATION: � I hereby ettirtn untler penalry of perjury one of ihe fdlowing declarations: ' a ❑ I heve e will meintain e ceNficete ot consent lo selt-Insura tor workers' compensetlon, es proNdetl tor by sedlon 3700 of Ihe Lebor Cade, for ihe peAortnenca of the \ wo r w�ic� NIS pertnit is issueC. �f have and witl m; My workers' Corr Cartier: (Thfs secNon need not es requireA Dy secUon 3700 ot Ne Lebor Cotle, for Ihe peAortnance of the work lor which this pertnit Is iswed. umber ero: / Policy Number: ne hundrod dWlais (5700) or less.) ❑ I ceRify Ihet in the pertortnence of Ihe work 1 r H ich thls permit is Issued, I shell nol employ eny person In eny menner so as to become subject to the warkers' compensation lews ai Ca�Qmia, end egree tl t t I should become subJect to Ihe workers' compensation provislons of Sactlon 370 of Ihe Labor Cotle, I shell forthwlth comply wlth these pro ' ns. �9�a � a � Applicent Signeture: Dete: � f� WARNINO: FAILURE TO SE RE WOHICERS' COMPENSATI 1 COVEMOE IS UNLAWFUL M1D SHALL SU8IECT AN EMPIOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE NUNDRED T}IWSAND OOLLARE (51 .00O�.IN ADDITION TO TNE WST OF COMPENSATION, DAMAGES AS PROVIDED FOH W SECfION 3]O60F THE LABOR CODE, IMEREST, M!D ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn Ihat I em I', brce end aHect. Lic. N� Contrector'sSigneWre: � CONSTRUCTION LEN6ING AGENCY: Chapter 8(commencinq with Section 7000) of DlNsion 3 0l Iha Buslnass and Protessions Code, end my Ilcense Is In tull Cless N �L-- J� Date: ❑ I hereby effirtn that Ihere is a consW ction lending agency tor the peAortnance of ihe work for which this permit is Issuetl. (Sec. 3097, Civil Code). LentleYs Neme: __ Lendefs AdGress: Signetura: OWNER-BUILDER DECLARATONS: Date: I hereby eHirtn ihet untler penelry of perJury that I am E%EMFT FROM THE CONTRACTORS LICENSE LAW lOr the following reason (Sec. 7037.5, Business entl Professlons Cotle: Any ciry or counry which requires e permit to consWct, elter, Improve, tlemolish, or repeir eny slructure, pdar to Its Issuance, also reqWres the epplican� for such pertnit to file a slgneC stetemen� that �e or sha Is Iicensed pursuent ta the provisions ol the Contrectors Llcense Lew (Chapter 9(commencing with Sectlon 7000) 01 Dlvlslon 3 01 Ihe Business end Professions Coda) ar ihet he ar she Is exempt therefrom end the basis for the elleged exemplion. Any violetion of Section 7031.5 by eny epplicenl for e pertM: suG�ects the applicent to a civil penalry of not more then tive huntlred tlollors ($500).): ❑ I, es owner af t�e property, or my employees with weges es thelr sale compansation, WILL DO TME WORK, and t�e slrucNre Is not intended or oHeretl tor sflla (Sec. 7044, Business antl Pmfessions Cotle: The Contractors License la�.v does not apply to en awner of properry who builds or impmves thereon, and who does such work himself or herself or ihrough his or her own emD�oyees, providetl that such improvemenis ara not Intendetl or oMered lor sele. If, however, iha building or improvement is solO within one year of completion, the owner-Dullder wlll �ave ihe Ourden of proving ihat he or sha did not build ar improve for purpose oi sale.). ❑ I, es owner of ihe property, em E%CLUSIVELY CONTRACTING WIiH LICENSED CONiAACTORS to cons(ruct the projed (Sec. 7044, Business and Professions Code: The canirectors License Lew tloes not eppty to en owner of Droperry w�o builtls or Improves ihereon, end who cantracts for such project with e contrector(a) license pursuant to ihe Comractors LJcense Laws.). ❑ I am exempt under sec. Business and Prolessions Cada tor Ihis reason: Signeture: Date: Owner ID verifled Dy tlnver's license. ❑ Yes ❑ No Driver's License No. Expires: Vedfication ai Ownership by (rype of dxument, I.e. - properry tvc bill or deed): OIVISION OF INUUSTRIAL SAFETV PERMIT CERTIFICA710N: ❑ I hereby certity thet no excavation five (5) or more feet in tlepth into which e person is required to descend, will be mede in connectian with work euthorized by this permit, entl thet no builtling sWcture, scaHoltling, falsework, or tlemolition or tlismanlling thereot, will 6e more then Ihirty-six (36) feet high. (Chap. 32, Caip 2, Art 2, Sec. 341, Tltle B, Celifornia Adminisiretiva Code). ❑ As owner-builtler, I will noi employ enyone to do work which woultl require a pertnit irom the Division ot Intlusirial Safety, es nated above, unless such peroon hes e pertnit to do such work from the division. . Signature: Date: DlWsion oi Intlusirial Sefery Pertnit Number: CER7IFlCATE OF COMPLIANCE AND AU7HORVATION OF ENfAV: I cenity untler Denelry ot perjury thet I heve read this epplication and state that Ihe informatlon givan is correct. I agree to comply with ell stete lews end city ordinences relating to Cuilding constructlon, end authotlze representatives of the City oi Costa Mesa to enter upon the ebove-descnbed praparry far inspection purposes. I egree not to occupy or ailow accupancy ol any building authorized by this permit until finel inspection. ifil6 1266 z� 201 202 203 INSPELTION TYPE Fixetl System Final Fire Prevention Pool Spa Final Flnal Re-Roof Flnal BIacWRetaining Well Final Fectory Fire Place Finel Sign 204 Final Demolition PAIE ItliliipLS i/ /v �/ Date X Date CODE� IXSPECTIONTYPE 206 Final Mechaniwl 208 Finel Plumbing 270 Finel Electrlcal 212 Flnal Fire Preventlon 220 Final Planning Approval 222 250 Final Site Flnel Bullding/Occupancy �.1 JIII. f � � j�,�, .. _� (714) 754-5273 • F� (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 560 W 19TH ST Suite No D Vicinity: UNIT D Parcel Nunmber. 42210320 _ � - ISSUED BY: Status: ISSUED Applied: 08/10/2007 Issued: 08/10/2001 ,�� "'`' - - � . - - . Applicant: VAUGHN, JACK �:= `�� - " "� � ' ' ��_ > � �� Address: 1726 W 9TH 8T� _ � � ' , � . \ , � � � ', � . � ', . Phone: 909-949-7334 �i /�.� . • � UPLAND, OA - . _ Zip: 91786 � , � ��- i � . � ��i ��\ � , , ' - " -' � .`��-.� , ; � i . . � . _ _ . , ; _ � _ � . ' - ` . . , i :A �. , `. . .. � _ , �_ Owner: JEFFREYA: FISCHE�2 � ,��? �;� %' ' �;:�\ Address -77337�VENTURABLVD#205 ��,��r, �� ' - � Phone: (8i8) 501-0145 � � " �'��,�� : -. "� ` , ENCINO, CA Zip_- 91318 �c �� , '� �, . - c � . 't\.'. � . . . ' . .. , � - i . ' Contractor. HIGHLAND CONSTRUCTION ;cr - ,. � , Address: - t726 W 9TH ST ' , . , ' . ' . ' ' " �' � ' �� _ ' \ ' _ � . r � , ' �. �-' . � Phone: �-. , , � S-,A � � „%'� - . � 1 �UPLAND,CA; Zip: 91766 � --� \.�-� . ��' \� �� . �, � ' \ . � , , ' . ,. � �� ' License: 711112 , , . ` , , . _ _ . _ - � ' � � � Arch/Eng:, ' , i-ti�rr-r .�- i"",� ; �- ��r. �. � ,>�a .•�.; �� , _ � .l; . �l � '�'--� -- � ' • . �t -.--..,. .`l � �� Address: - " - -- - . , . -�' . � . Phone: �� . , . " " _. -. Zip:, . � - .. . , , - � � _ - License:- �� ' ` � - . : � ` ,� " . � SCOPE OF PERMIT � . REF: 601-00991. "EL CHINACO" PLUMBING TO INCLUDE: 1 BACKFLOW PREVENTER, 5 FLOOR � -, ' � � DRAINS, 70 GAS OUTLETS, 2 COMMERCIAL SINKS, 5 FLOOR SINKS, 1 MOP SINK, 1 HANDSINK,= ,. . 1 6REASE TRAP, 2 TRAP PRIMERS, 1,URINAL? 2.WASH BASINS, 2 TOILETS, 1 WATER HEATER:�� ,t, � � - � / � _ FEE SUMMARY� � : ,-.-=. °� � � „; � AMT � - QTY �-� � � - � � � � AMT � QTY - � � � � AMT ISSUE FEE �� - $23.50 �- �Laundry Tub / Washer - $0.00 0 , � Sump Puinp '; $0.00 Backflow irrigation _ �� $0.00 �� 1 . :� Landscape Irrigation $0.00 0 - � � Swimming Pool / �� / $OAO Backflow Preventer, - $9.80 - �0- , �� P-Trap - - , � $0.00 0 �. " Trap Primer ' ; , $19.60 Bathtub $0.00' - 0 Pressu�e Regulator $0.00 0 � �Urinal "� � � $9.80 Clarifier System ��$0.00 , 0. Process Piping (per 10 ft) $0.00� 0 ,�� Vacuum Brkr,Bkflow(1-0) $0.00 Connect (Ice,Soda,etc) � $0.00 0 � Receptors $0.00 . �0 ' � Vacuum-Brkr Bkflow(5+) $0.00 Dental Units $0.00. � � .0 � � SepticTank , $0.00 0 � Wash�Basin' $19.60 Dishwasher $0.00 ,� 0 � � �� Sewer Cap for Demo � $0.00 �0 � �. - Wash' Basin Set $0.00 Drain, Floor $49.00 5, -- � Sewer Conned ,� .$0.00 0 �-' �,-- Waste and Vent System $0.00 Drain,Rainwater $0.00 0 �� SewerPrivateLine� $0.00 �0„-' � WaterCloset(Toilet) $19.60 Drain, Roof $0.00 0 �' - SFower , - - , $0.00- ! �0 � Water Heater / vent $12.30 Drinking Fountain $0.00 0 Sink, bar - _ .$0.00 0 WaterPiping (Inst or Rep.) $0.00 Expansion Tank $0.00 0 Sink, commercial $19.60 2 Water Re-pipe $0.00 Gas Earthquake Valve $0.00 0 Sink, Floor $49.00 5 Water Service $0.00 Gas (1-4 outlets) $6.15 1 Sink, kitchen $0.00 0 Water Sokener $0.00 Gas (Over 4 outlets) $6.60 6 Sink, service/mop $9.80 1 OTHER $9.80 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) $79.90 1 REINSPECTION $0.00 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: 5284.05 on 0 0 2 1 0 0 2 0 0 2 1 0 0 0 0 0 - GUMMtN I S/ SYtI:IAL I:UIVUI I IUNJ NOTICE: The work authorized by this permit s a comp y wi a app ica e an icap access requiremenis under California statutes and related regulations. (Ord. No. 9248, § 1, 12-27-92) � 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approvel must be obtained. Failure to obtain inspections and final approval will result in the axpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 - i 244838 (8�00) � /. / V WORKERS' COMPENSATION DECLARATION: � I hereby eHirtn under penelry ot perjury one of the tollowing declerations: ❑ I have end will maintein a certificate of consent to setl-Insure for workers' compensation, es provided for 6y section 3700 ot the Lebor Code, for t�e peAormence of the �vNork fory�Nicfi this permit is issued. _ , Carrier. (Ih/s secNon as reqWred by section 3700 0l the Lebor Cade, For Ne pertortnance of the work for which this pertnit is issued. �mber ere: " � Policy Number: ar one Orless.) ❑ I certity Ihat In the pedormance r,� the w rk for which Ihis permit Is issued, I shell not employ any person in any manner so es to become sub�ect to ihe workers' compensatlon laws ot CaIHo� � d r e th� houltl beca�^9 subJact to t�e warkers' compensatlon praWsions ot Sectlon 3700 of the Lebar Cade, I ahall forthwlth comply with ihese provi 'ef�s. �i��% I/ e�--� /_� /�� Applicant Signflture: Dete: �X�— V� WARNINO: FAILURE TO SECUR ORKERS' COAIPENSATION COV fiAGE IS UNLAWFUL FND SHALL SUBJECT AN EMPLOVEP TO CRIMINAL PENALTIES A D CIVIL FlNES UP TOIXJE HUNDRED nni isnun m i aRF ISim. . IN a�olT� TO THE COST OF COMPENSATION. OAMAGES AS PROVIDED FOP IN SECTION 3)O60F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirtn thet I am licensed und rovis' force end efted. Lic. # _--�4 Cantractofs SigneWre: (commencing wit� Section 7000) oi Division 3 of the Business and Protessions Cotle. and my Ilcense is In full — Class q _ Dete: CONSTAUCTION LENDING AGENCY: ❑ I hereby aKrm that there is a construction lending egency for the pertormance oi the work for which ihls permil is issued. (Sec. 3097, Civil Code). LenOels Name: Lenders Address: SigneWra: Date: OWNER-BUILDER DECLARATIONS: I hereby atfirtn thet untler penalry ot perjury thet I am EXEMPT FROM THE CON7RAC70F4 LICENSE LAW far the following reason (Sec. 7031.5, Business end P�otesslons Code: Any ciry or county which requires e permit to construct, aller, improve, demolish, or repeir eny structure, pnor to its Issuance, also requires the epplicant tor such permll to file e slgneC stetement that he or she Is Iicensed pursuent to Ihe pmvisians af the Cantrectors llcense Lew (Chepter 9(wmmencing with Section 7000) of Division 3 of the Business and Professions Cotle) or thet he or she is exempt �herefrom and the basls for the allegetl exemptian. Any violation at Sedian 7031.5 by any epplicent for e parm�' sub�eds ihe applicant to e civil penalry of not more then Ove hundred dollars ($500).): ❑ I, as owner of ihe property, or my employees with wages es [heir sole compensatlon, WILL DO 7HE WORK, and the structure is not intended or oflered for sale (Sec. 7044, Business ana Professions Code: The Contractors License Lew does not apply to en owner ot property who builds or improves thereon, and who does such work himself or herseN or through his or her own employees, providetl t�at such improvemenis are not intanded or oNeretl for sale. If, however, Ihe builtling or Improvement Is soltl within one year of comD�etion, Ihe owner-builder will heve Ihe burden of proving that he or she did nat build or improve for purpose of sale.). ❑ I, as owner oi iha properry, em EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business end Professions Cotle: The contractors License Law tloes not appty to an owner oi property who builds or improves ihereon, end who contrecis tor such project with a comredor(s) license pursuant to ihe Contradors License Laws.). ❑ I am exampt under sec. Business and Protessions Code tor this reason: SignaNre: Date: Owner ID veritied by dnvers license. ❑ Ves ❑ No Dnvers License No. Venfication of Ownership by (type of documen�, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: Ezpires: ❑ I hereby cetlify that no excevetion five (5) or more teet In depth into which e parson is required to descend, will be made in connection with work euthonzed by this permit, and that no builtling structure, scattolding, falsework, or demolltlon or tlismantling thereoi, will be more ihan ihlAy-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Atlministretive Code). ❑ As ownar-bullder, 1 will not employ enyone to tlo work which would require e pertnit from Ihe Divislon ot Industriel Safety, as noted above, unless such person has e pertnit to tlo such work from Ihe division. Signature: Date: Division ot Indusirlal Safety Partnit Number: CEHTIFlCA7E OP COMPLIANCE AND AUTHORVATION OF EMRY: I certify under penalry ot perjury that I have read this application antl state that the infortnation given is corract. I egree to comply with ell state lews end ciry ordinances relating to building construction, end authorize representetives ot ihe Ciry of Cosia Mesa to enter upon the ebovadescnbed Droperty for inspection purposes. I agree not to occupy or ellow occupancy of any building euthonzed by this pertnit until final inspection. 7616 7266 200 201 202 203 INSPECTION TYVE Fi:ed System Final Fire Prevention Pool Sp0 Final Final Re-Root Finel BIocWRetelning Wall Final Fectory Fire Place Finel Sign 204 Final Demalition QdjF� INfRIALS g /o)°�el 1r Date COpE1 INSPECTIONTYPE Q�jg 206 Final Mec�anical 20B Final Plumbing /0/y/j� � 210 Final Electncel 212 Final Fire Prevention 220 Final Planning Approvel 222 250 Final Site Final Building/Occupency I:11117�F "L� (714) 754-5273 • Faz (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 FIRE SUPRESSION PERMIT Job Address: 560 W 19TH ST Suite: D Vicinity: STE D(EL CHINACO MEXICAN RESTAUR4NT) Parcel Number: 42210320 ZOning: Applicanc NIELSEN, FRANTZ ;. Address: P.O. BOX 3008- ;= " � , - . � �, Phone: (909) 398-1591 / i MONTCLAIR; CA � � 2ip: 91763 , owner. JEFFREY A.'FISCHER � Address 17337VENTURABWD#205 � � � Phone: (818) 501-0145 � --ENCINO, CA .' Zip: 91316 � �.,. , Contractor: V FIRE SYSTEMS CORPORATION Address: P.O. BOX 3008 . MONTCLAIR, CA Phone: _ (909) 398-1591 2ip: 91763 License: 779913 Status: ISSUED Applied: 09/18/2001 Issued: 10/i112007 ISSUED BY: ' SCOPE OF PERMIT HOOK•UP FOR HOOD 8 DUCT FIRE SUPPRESSION SYSTEM FOR TI AT "EL CHINACO MEXICAN � �� RESTAURANT' IN STE D. REF: B01-00991� � , ' '� ��, ' � 'FEE SUMMARY " ` � Plan Check: $31.14 Calc Vatuation: St,2so.00 ' Permit: $47.90 Claimed Valuation: Si,2so.00 � Other. $0.00 � � � ,�" , � � � Total: $79.04 � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutas and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt shall aulomatically expire and become void II work is not commenced within 180 days, or ii 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 requlred Inspeetions end Iinel approval must be obtained. Failure to obtain inspections and tinal approval will result in the ezpiration of this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 z+as-es (srool WORKERS'COMPENSAnON DECLARATON: I hereby eHirtn under penalry ol perjury ane ol the lollowing tleGeratlons: � ❑ I end will malntein a ceNllcata ot consent to sell-Insure br workers' compensalion, es prwldetl tor by seCtlon 3700 0l ihe LeDor Cotle, tor t�e peAortnence of the ork br wNch Ihia pertnit Is Issuetl. I heva eM will meintaln workeB' compensatlon Insurence, es reqWreA by section 3700 W Ne Lebor Code, for Ne pertortnence of Ne work br which IhL9 peimit is issued. M work pen/5etlon Insurance carrier end II numher er0: Certlor.Y �� 1 Drt1� S S �� PolicyNumher. �67'y'Q� (7hls seclion neetl nat�fed 1! t p rm/f Is veluetl eI are hu dred dW/ar5 ($100) or less.) ❑ 1 certity that In the pertortnanc f t wodf�r which ihis o t Is issued, I shell not employ eny petson In eny manner so es co become sub�ect to the workers' wmpensetlan lews o1 Califp egr � that If I s� tl come sub�ect to the workers' crompensatlan proNsions of Section 3700 of the Lebor Cotle, I shell forihwlih comply with these provisiatf � ApPllcanlSipnature: � �A'�l'0{ Dete: WARNINO: FMLURE TO SE W 7 I COVERA�E IS UNLAW FUL AND SHFLL SIIBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO IXJE HUNDRED TFqUSANDDOLLARE(51 � ),INA D TOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFIXiIN5ELR10N31060FTHEUBORO00E.INfEREST,PNDFTTORNEI^SFEES. LICENSED CONTRACTORS DE I �ereby aHirtn Nat 1 em licensed torce antl eflect. Lic. a Contractors Signature:� (wmmencing with Sectlon 7000) of D'Msian 3 ot the Business antl Professions Cotle, anA my Ilcense Is In full Cless p Dete: LO-ll-dt GONSTAUCTION LENMNG AGENCY: ❑ I hereby affirtn Na1 ihere is a conslrucUon lending egency for the peAortnance ot the work br wNch Uis permil is issued. (Sec. 3097. Civil COCej. Lendels Name: Lendefs Address: Signature: Date: OWNER-BUILDER OECLARATIONS: I hereby etllrtn Ihet under penelry ot per�ury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reasan (Sec. 7031.5, BuSinesS end P�ofesslons Cotle: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or repair eny strudure, D�or to its luuance, also requires the epplicent for such permit lo Nle e signed stetement that he or she Is Iicensetl purauant to Ihe provislons oi the Contreaors Licensa Lew (Chepter 9(commenpng wIN SecUon 7000) of Dlvlsion 3 W ��e Business entl Profeuions Code) or thet he or she Is exempt therefrom and tha besis for the elleged exemption. Any violetion of Section 7031.5 by eny epplicent lor e pem+^. suh�ens Ihe applicant to a civil penelry ot not more ihen live hundred dollers ($500).J: ❑ I, es owner of tha proDerty, or my employees with wages es t�eir sole compensatlan, WILL DO TIE WORK, end the structure is not intentletl or ofleratl for sele (Sec. 7044, Business antl Proteuions Code: The Contrectors License lew does not appty to an owner ol properry who builds or improves Ihereon, entl who tloes such work �imsalt ar herself or throuph �b or her own employees, provitled ihat such Imprwemenis ere not InientleG or oHered lor sale. It, �owever, the building or Improvement Is sold within one year ot completion, the owner-bullder will heve �he burden of Droving ihet he or sha ditl not builtl or Improve for purpose ot sale.). ❑ I, es owner ot ihe property, em EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct tho pro�ect (Sec. 7044, Business enA Protessions Code: The contractors Llcense Lew Does not epply to an owner al pmperty who bullds or Improves thereon, end who canirects tor such prqect with e contrector(s) license Dureuant to the Conlractora Llcense Lews.). ❑ I em exemp� unCer sec. SlgneWre: Owner ID verltied by tlirvers IlCense. ❑ YB9 ❑ No Busineu antl Professians Cade lar Ihis reflson: Verllkailon of Ownership by (rype of tlaumenL i.e. - property tav �III or daeC): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: DriveYs License No. Date: Expires: ❑ I �ereby certily tha� no eacevetlon five (5) or more feet in Oepth into which a person is required to Oescend, wlll ba metle in connection with work eut�oAzetl by Ihis permi6 end that no building strucWre, sceHoltling, felsework, or tlemolition or Cismantling t�ereol, wlll De more Ihen Ihirry-si: (36) leet high. (C�ap. 32, Gry 2, Atl 2, Sec. 341, Tule B, CaliFomia Atlministretive Cotle). ❑ As owner-builder, I will not employ enyone Io tlo work whic� woultl requlre e Dermit trom the Dlvision ot Intlustnal Selery, as noted eDove, unless such person hea a pertnit to do such work trom the tlivision, Slgnaiure: Date: Divislon of Intlustrial Safery Pertnil Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF EMRY: I cenify under penalry at perjury that I heva reatl thls epplication entl state t�et Ihe intortnetion given is conect I egree to compty wlth all stete lews entl ciry ordinances releting to builCing construction, end euthodze representatives ol the Ciry ol Costa Mesa lo enter upon t�e ebove-describe0 properry for inspoytiaf�purposes. I�gr9e not to occupy or ellow occupanq ol eny builtling authorized by Ihis permit un�il flnel inspection. CppE /. RlSVECTIONT'VE Qe¢, � 1616 Fixed Sysiem Final Fire Prevention 1266 200 201 202 203 Pod Spe Final Fina� RaRoof Final Block/Hetaining Well Finai Fadory FIrB PlaCe Final Sign 204 Finel Demolition SOOEt INSGECiIONttPE 206 Finel Mecheniral 208 Flnal Plumbing 270 Finel ElectAcal 212 Finel Fire Prevention 220 Final Planning Apprwal 222 Final Sita 250 Final BuiltlinryOccupancy -ll-ol Date QAI�. �L$ �n�-/�-O/ W� (714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vcinity: Parcel Nunmber: 560 W 19TH ST SHELL BUILDING 42210320 npp�icant: VANOOSTENDORP, DAMON Address: P.O. BOX 3033 NEWPORT BEqCH, CA Owner: JEFFREY A. FISCHER Address 17337 VENTURA BLVD #205 ENCINO, CA Contractor: JETfY EL�CTRIC Address: P.O. BOX 3033 NEWPORTBEACH,CA Phone: (949)646-5062 Zip: 92659 Phona: (818) 501-0145 Zip: 91316 Phone: (949) 646-5062 Zip: 92659 Licanse: 677322 ISSUED BY: Status: ISSUED Applied: 05/21/2001 Issued: OS/27/2001 . ' SCOPE OF PERMIT _ " ELECTRICAL pERM1T FOR�NEW DEMISIWG WALLS FOR NEW MULTI-TENANT COMMERCIAL SHELL BWLDING. INSTALL 1 l.IGHT, i6 OUTLE7S, 1 SVN7CH, M070R 70 1 HP, & 4 MISC CONDUCTORS. � -- . REF:800.00846 - " �� . ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fizts Recept Outlets � � Switches Non Res Appl � Res Appl Service to 200a Service to 1000a Service over 1000a Motore to 1 hp Morors l0 10hp Motors to 50hp Motors to 100hp Morors over t00hp Communiwtion drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole FEE SUMMARY - , �'-- Quantity - Quantiry � $23.50 .-- Temp Dist System I Llghting 50.00 �%,0,% ; �, $0.00 ,. � Busway I100 ft 80.00 �! 0 � �$0.00 � - � Standing Section $0.00 - '-�0 - " � '$0.00 0 _ - - " Misc Eledrical Equipment E0.00'� 0 � " $0.00 . � 0 , . -Trenskrmers up to t,:kyalkw; � '�50.00' 0. , � � � $0.00., ` - 0 . . ...........:....up l0 10 kv�a/kw � � .50.00 ; � 0 �i $1 10 .��A � 7 . _ . � .................uP ta 50 kvalkw� j%,50.00; � 0 i . � i $17.60 \�;16� _ , .. - � . `........'up to 100 kva/kw� $0.00 � �'0 / j � ....over100�kvalkw � 50.00��0 %�� 51�10.: '�i�_�:�, , � . $0.00 0 Low , , ....... . � - � � Voltage Equipment -� �'� 50.00 -0 ' -' � � �� , Volt Wiring System / Ckt�-' ;50.00 - 0� ' $0.00`�, � 0 MisaConduit -, --1 �,- $0.00�,; ,-0 $0.00-, - 0 � � Misa Conductor �; �.'� � ,$0.00 0 80.00 0 Circus ( gen or nde). -� ;; 50.00 0 $475-�- , � ��t � ` Circus (mech ride or lights)��`,-$0.00 0 $0.00 -. 0 Chnstmas Tree Stand=' "'� $0.00 0 $0.00 0 ' - - Fireworks Sland - $0.00 0 $0.00 0 Other Electrical Fee 50.00 $0.00 0 $0.00 0 Investigation Fee 50.00 50.00 0 Plan Check Fee 524.02 $0.00 0 Reinspection Fee 50.00 50.00 0 $0.00 0 TOTAL CALCULATED FEES E72.07 $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply wiih all applicable handicap access requirements under Calitornia 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 abandonetl lor a pedod 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 reQulred Inapections and (inal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this�rmit. FOR INSPECTIONS CALL: (714) 7545626 za6e816W) - . . . ,.a ;:, , � . WORKERS' COMPENSA'{ON D:�ARATON: �' I hereby efllrtn under penelry of per�ury one oi Ihe following declarellons: ❑ I heve end vAll malnteln a cenificate oi cansenl to selt-Insure br workere' compensetlon, as provided tor by section 3700 ot the Lebor Code, lor ihe pertortnance at the work tor which thLs pertnit Is issuetl. �I heve ar�tl will melnialn wwkera' compensetlon Insurence, as requiretl by secUon 3700 ot Ne labor Code, tor Ne peAomiance ol Ihe work lor which Ihis pertnit Is IssueC. My workars' compe�nysetlon Insurenc%� rtier enC�j olicy number are: ,�^ p7! Certier. ! �i (/Q' �� f v��{� Pdk�NumDer . �✓ �S/J'J'On 17his sectlar need Oe oomp�eted!! nie pertMtls velued et one hundred dd/ers (5/00) w IessJ `—" --- -� � I Cerllly thet In Ihe pertortnence o� Ihe work tOr which Ihis pertnit i5 i55ued. I shell no� employ eny person in eny mannor ao es to bocomo aub�ect to t�e workara' compensetion laws of Celitomia, end apree that N I should become sub�ac� to lhe workers' compensetlon provisiom oi Sectlon 3700 ot the Lebor Cotle, I shell lanhwlth compywithNeseProvis! ,l . //'—_ � ApPlicant Sipnature,:_ � ; �Date: WARNINO: FNWRE TO SEWRE WORKERS' COMPENSATION COVERAGE IS UMAWFUL N1D SHALL SUBIECf AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED RIOUSMID WLLARE (SIOO,OOO�.IN ADdTION TO T1E CO6T OF G�APENSATION.OAMAGES AS PfiG��UED FOR IN SECTION 37080F THE LABOR COOE.IMEAEST, AND ATfORNE1"S FEES. LICENSED CONTRACTORS DECLARATON: I hereby eHlrm thal I am Ilcensetl untler provisions of Chapler 9(commencing wiih Section 7000) ot �ivision 3 of Ne Business and Professions Code, end my Iicense Is In tull mrce ana ettecl, uc. a ��o 'T �l 3 2. 2 ( qess x � Cri O Contraaio?s Slgneture:—� �""� Dat_e: � S Z/ � O� 1—__ _. _ CONSTRUCTON LENDING AGENCY: ❑ I hereby effrtn thal there is a construction lentling agency for the perfortnance of the work for which this pertnit is Issuetl. (Sec. 3097, Civil Catle). LenAefs Name: Lender's Atltlress: SigneWre: Date: OWNER•BUILDER OECLARATONS: I hereby atfirtn lhel undef penelly ol perjury thel I em E%EMPT FROM THE CONTRACTORS LICENSE LAW far Ihe tollowing reesOn (Sec. 7031.5, BU51ne55 entl Prafessions Code: Any ciry or county which requires e permit to construct, elter, impmve, tlemolish, or repeir any siructure, pdor to Its issuance, also requires Ihe applicent for such Dermit to tile e signed stetemem thet he or she Is IlcenseA pursuent to the provlsions ol the Contradors Llcense Lew (Chepter 8(commencing with Sactlon 7000) 01 Dlvlslon 3 01 t�e Business enC Protession9 Cotle) ar �het he or she is exempt tharefrom entl t�e basis for ihe alleged exemp�ion. Any Nolatlon ot Sedlon 7031.5 by eny epplicant tor e permit sublects the epplicant to a civil penelry ol not more ihan live hundratl tlollers ($500).): ❑ I, es owner ol ihe property, or my employees wit� wages es Iheir sole compensation, WILL DO THE WORK, end Ihe structure is not intended or oHeretl tor sele (Sec. 7044, Business end Professions Code: The Conirectors License Law does not appy to an owner of properry who builds ar Improves theroon, antl who does such work himsetl or hersell or through his or her own employees, providad ihat such improvements ere not Iniended or aflered for sele. It, �owever, Ihe bullding or Improvament Is wltl wit�in one year of campletion, Ihe owner-builder wlll have the burden of proving tha� he or 5he did not build or improve lor purpose ot sale.). ❑ I, es owner ol the proporty, em E%CWSIVELV CONTRACTING WI7H LICENSED CON7RACTORS to wnstruct the projoct (Soc. 7044, Business and Professions Gode: The contrectors License Lew does noI eOPly to en owner of pmpeny w�a bullds or Improves Ihereon, end who cantracts lor such proloct wilh e contractor(s) license pursuant to the Comrectors License Laws.). � 1 em exempt under sec. 8usiness entl Professions Catle lor this reeson: Slgnature: Date: Owner ID vertlieA Ey tlfiveYs Iicensa. ❑ Ves ❑ No Drivofs License No. ExD�ros: Verllicatlon of Ownership Dy (type ol document, i.e. - property tac bill or deetl): OIVISION OF INDUSTRIAL SAFETY VERMIT CERTFICATION: ❑ I hereby �enity thet no excevation tNe (5) or more feet in tlepth Into which a person is requlretl to Aescen4 wlll be mada in connection with work euthoAzeA Dy this pertnil, end that no builtling structure, scattdding, felsework, or Cemolition or dismaniling t�ereol, will De more lhan Ihirry-sl: (38) leet high. (C�ap. 32, Grp 2, Art 2, Sec. 341, Title 8, Calitomia Atlministretive Cotle). ❑ As owner-builder, I wlll not empby anyone to tlo work which woultl reduire e permit from t�e Division of Intlustrial Selery, as notetl ebovo, unless such pereon hes e permit to tlo surr wark Irom Ihe diWsion. Signature: Date: DiNsion of Intlusirlal Sefery Permit NumDer: CEHfIFlCA7E OF COMPLIANCE AND AIfTHORPA710N OF ENTTiY: I canity un0er penalry ol perjury that I have reeC Ihls epplication antl state that t�e information given is conecc I egree ta compy with ell stete laws entl ciry ortlinences relating to building conslruclion, enA euthodze representatives of the Clry ot Casla Mesa to enter upon Ihe ebove-descnbed pmperty tor inspecGon purposes. I egree not to occupy or ellow occupancy ot eny building euthonzed by t�is pertnil until Mal inspeclion. COUE I, INSPECTpNTYPE 1618 Fixed System Final Fire Prevention 1268 Paol Spa Final 200 Final Re-Roof 201 FInaI BIocWRetaining Wall 202 Final Factory Fira Place 203 Final Sign 204 Final Dem0lition � Q�¢ INTIf1�L5 '� Z/—Q/ Data � CppE I INSPECiION TYPE 206 Finel Mechanicel 20B Final PlumDing 210 Final Eleciricel 212 Final Fire Prevention 220 Final Planning Apprwal 222 Final Site 250 Final euildingiOccupancy � �Y /L� IC1111I.� � CITY OF COSTA MESA � Development Services, Division of Building and Safet� CERTIFI�CATE;O�F.00CUPANCY , , ,, • � _; : _ �,. � , `,, � ;: � This certificate is issued pursuant to the reqairements of the Uniform"Building Code, SecHon 30S adopted by the City ,�� , i �� . � � � � �� of Costa Mesa certifies that at the hme o6�ts �ssuance the 6uilding structu re herein below described was inspected and � /„�// \/":y � \��`�\ ,. approvedforoccupancyasfollows �l �i �_ � � ,, ��y � ��' �� ' � J��,j i�,r /✓ r� \*�� /J Q\ . '� Building Address 560 W./,,i9th ,Street Unit "D" . -- B18g Permit Number BO1-00991 �. �":; . _ lry" �'� i;t� � �'a ,, '� �� !, h � ,p1�A� t�?�A� �'� Use Restaurant �;'I �-%�j�r� , �.l,��! �"`_ - ��'��(l� ��,� :'-��!`:1 � ..., .� J� �� , ,r., t V�� 5V�, Group $ Type of ConstrucHon�-a07��r, aeM � Fire'Zone �'� Use Zone _. '--- ` . _�it �,,', f �d' Jeffrey��Ai�1F�i'schei.,,��.,�/'�T-1 t"ELfCHINACO MEXICAN RESTAURANT" Owner o Bw mg � � -- - 4�- � enan -. �� t��. �>'�., � �/ � /r' ;,�. 17337 Ventura B1vd. i1205 ;Encino�, CA =91'316 � ,/�' ;/�' Address �� 1 ��= � �� i � ,_.�- _ v' e ��\ �\�\� . . J . 1 B t ;.. )( I��l. av�LDi�rc oFFiccnt-Rick A� Brown C B O� Y � � ��%�;� -_ -� p t ��c10%1�9/O1 � \�`�_ � _.- 9i i,, / \''-eJ.� `�,�',�.i�� ..,/ - `-'l� .. �� ..�;.�:��., � � �iiQ% , ._�'il__" REQUIRED TO BE POSTED IN A CONSPICOUS PLACE J (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 560 W 19TH ST Suite: D Vicinity: EL CHINACO MEXICAN RESTAURANT (STE D) Parcel Number: 42210320 Zoning: Applicant VAUGHN, JACK Address: 1726 W 9TH ST - � �, . - - ' - - . . � .Phone: 909-949-7334 i UPLAND. CA-- - -i ;' �� _- . Zip: 91786 ownec FISCHER,:JEFFREY A'� Address 17337 VENTURA BLVD #205. - ENCINO, CA Contracmr: �HIGHtAND CONSTRUCTION Address: 7726 W 9TH ST " �" � UPfAND, CA Zip:, 91786, Arch : Address: Zip: Phone: License: Status: ISSUED Applied: O6I28I2001 Issued: 08It012001 ISSUED BY: ' \ , \ � � �_ � ' �� .V � A � _,/��. Phone: (818) 501-0145 � - � ` - � � � � Zip: 91316 _ , . . . � �� Phone: - License: 711112 Eng: • - ' Addressr � � ' �; . � ' - ` � �� .� � ,�� V� � . . . ��- � . - -. . . '�'� , ' � � � Phone: � ��License: \ a SGUPt Uh PtNMI l� . , ' . � , 1499 SF INTERIOR TI FOR "EL CHINACO�MEXICAN RE§TAURANT" IN STE D. ;' r��`� �� . � '� � REF: TA-01-19 � . _ . � �� - . . . . _. � � � FEE SUMMARY , � Plan Check: $623.�9 Calc Valuation: sss,000.00� Permit: $958.75 Claim Valuation: 5es,000.00 SMIP Res: $0.00 SMIP Com: $19.95 Other. �0.00 Inspection: , $0.00 Total: $1,601.89 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0•0 Rear 0- 0 Rear 0-0 PLANNING & ZONING LeR 0- 0 Lefl 0• 0 Right Right o- o 0- 0 PARKING Existing: 0 Required: 0 Pro osed: o NOTES: TENAC P 07/02/2001 STOPWORK ORDER NO APPROVED PLANS NO PERMITS CONTRACTOR/FORMAN REMOVED ACCESS TO ROOF NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulatlons. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire end become vold if work Is not commenced within 180 days, or if work is suspended or abandoned tor a period af 180 days. � INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepeeliona end flnel epproval must be obtained. Failure to obtaln Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zanaae �flroo) WORKERS'COMPENSATONDECLARATION: I hereby elfirm under penelry ot per�ury one of Ue toilowing tlecleretlons: I �eve antl will meintaln e ceNflcate of tonsent to setl-Insure for workers' compensation, es proNded for �y section 3700 ot Ihe Lebor Code, fa the peAormarke of Ihe work for which this pertnit is issued. vB Br1d wlll meintein warkers' Campen5fltlon InwrenCe. HS r8quirBtl by Sectbn 3700 01 the Labor CodB. lw Ne peAortnenCe ot ihe vrork for whiCh W9 pertnit I9 L4wed. My wo compensatlon Insu/�n�5g cerrler enE policy number are: // /' ,/ Cerrier: �f/�%� l_.o/�^/P • POIiryNumberl'SQ�Y��I6 ! �07�'y rnlnplBtBOI/ tl1e pBm1/t!9 veWBO Bt a1e ❑ I certify t�at in ihe perto 3nce of the woA or which this pertnit is issued, I shall not employ eny person in eny menner sa es to become sub�ea to Ihe workers' compensetion laws of Homia � r t�at it I shoultl becrome subJect to the workers' compensetlan proNslons of Sadlon 3700 oi t Lebor Code, I shall torthwith cromply with ihese slons. / O� � I Appllcant Slgnature: � Date: WARNINO: FAILURE TO S RE WORKERS' COMPENSA ON COVEMOE IS UNIAW FUL M1D SNALL SUBJECf Ml EMPIOYER TO CRIMINAL PENALTIES AND CML NES UP TO ONE MUNDRED TIIOUSANO DOLLARE (El ,000), IN FODITION TO TNE WST OF COMPENSATION, DMMCaES AS PROVIDEO FOR IN SECfION 3708 OF THE UBOR CODE, IMEREST, M1D ATTORNEI"S FEES. LICENSED CONTAACTORS DECLARATION: I hereby afllrtn thet I em Iicensed un r provlslo lorce entl eXect. Lic. a �" � Coniredofs Slgnature: 9(commencing v�ith Sectlon 7000) of DMsion 3 0l the Buslness and Professi� ns Cade, end my Ilcense is In tull Cless p � Date: / . � CONSTRUCTION LENDING AGENCY: ❑ I hereby atfirtn Nat ihere is a constructbn Iending egency tor ihe peAortnance ot ihe work for wNch Ihis pertnit is Issuad. (Sec. 3097, Civil Cotla). Lentlefs Name: �entlers Adtlress: Signeture: OWNER•BUILDER DECLAFiAT10NS: Da�e: I hereby efllrtn �hat under penaly ol pehury Uei l em E7(EMPT FROM 7HE COHTNACTORS LICENSE LAW for Ihe lollowinp reeson (Sec. 7031.5, Buslness end Protessians Code: Any ciry ar counry whic� reQuires e pertnit to canstruct, elter, improve, demolish, or repair eny structure, D�or to its luuence, also requlres Ihe eppllcant lor such permit to flle e signetl stetement Net he or she is Ilcensed purauent to iha provisions of Ihe Contrectors LJcense Lew (Chepter 9(commendng with Seclian 7000j ol DlNsion 3 0l t�e Business end Professions Code) or that ha or she is ezempl therefrom end tha Casb for Ihe ellegetl exemption. Any Woletion of Sectlon 7031.5 by eny eppllcant tor a perm�' sub�ects the applicent to e cidl penelry of nat more than flve �undred dollers ($500)J: ❑ I, es owner of t�e properry, or my employees wlih weges es Ihelr sole compensetlon, WILL DO THE WORK, end the structure Is not IntenCed or oHered for sale (Sec. 7044, Business end Professions COAa: The Cantractors Licensa Lew does not apply to an owner ol proporty who bullds or improves thereon, enC who Caes such work hlmselt or hersell or Urough hls or her own employees, provitled that such imprwements are noI IntentleA or oMeretl for sele. II, however, Ihe buildlnp or ImprOvement is sold within one year of completion, the ownar-bullder wlll �eve Iha burden of provinp that he or she OIO not builtl or Improve for purpose of sale.). ❑ I, es owner o11he properry, em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business end Professions Catle: The cantractws lJcense Lew tloes not epply to en owner ot property who bullds or Improves ihereon, enA w�o contracts for such project wilh e contrector(e) license pursuant to ihe Contractws lJcense LewsJ. ❑ I am exempt untler sec. Business entl Professions Code lor this reason: Signeture: Date: Ownar ID veritied by tlrivefs license. ❑ Ves ❑ No Drivers License No. Venflcation of Ownere�lp by (rype o1 tlaument, i.e. • properry ten bill or tlaetlJ: Expires: DIVISION OF INDUSTRIAL SAFETY VERMR CERTIFICATION: ❑ 1 hereby certity Ihat no e:cavatlon tNe (5) or more leet In depih into which e person is requlred to descend, wlll be mede in connection with work euthorizeA by this pertnit, and that no building structure, scaHoltlinp, talsework, or demolition or dismantling theraol, vrill be more then thirly-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Ttle B, Califomla AdministreWe Cotle). ❑ As awner-bulltler, I will not employ enyone to do work whlch woultl reQuire e pertnit Irom the DiNsion of Industriel Sefery, es notad ebove, unleu such pereon hes a permit to do such work Irom the tlivlslon. Signature: Dele: DiNsion of Indusirial Setery Permil Number: CERTiFlCATE OF COMPIIANCE AND AUTHORVATION OF EMRY: 1 certity under penalry ot per�ury that I have read this epplication and slate ihat ihe infortnatian given is cortect. I agree to compty with all state lews and dry ordinances relating to building conslruction, end euthorize representatrves of the Ciry ol Costa Mesa to enter upon the ebove-described property lar inspeclion purposes. I egree not to acupy or allow occupency ol eny building euihonzed by Ihis permit until finfll inspeaion. CO�E I, INSPECTONTYVE 1616 FIxeO System Flnel Fire Preventlon 1288 Pool Spa Final 200 Finel Re-Raof 201 Finel BIocWRetaining Well 202 Final Fectory Fire Place 203 �� Final Slgn Final DemolWon PAIE ItR�I$ 8 /� �e/ �� Date WOE� INSPECf10NTYVE 206 Final Mechenical 208 Flnel Plumbing 210 Finel Electrical 212 Flnal Fire Preventlon 220 Flnel Plenning Approvel 222 Finel Site 250 Final BuiltlinryOccupancy QAIf. I!{�EL$ (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT 1ob Address: 560 W 19TH ST Suite No D ViCinity: UNI7 D- EL CHINACO Parcel Nunmber: 42210320 Applicant: KEVIN SZABO Adtlress: 2737 S CROD�Y � STE D SANTA ANA, CA Owner. GARVIN DRIVE LTD Address PARTNERSHIP ENCINO, CA 16485 GARVIN DR Phone: p14)241-1414 Zip: 92704 Phone: (818) 501-0145 Zip: 91436-3636 Contractor: COAST ROOTER PLUMBING HEATING & AIR CONDITIONING Adtlress: 2737 S CRODDY STE D � Phone: (714) 241-1414 SANTA ANA, CA Zip: 92704 � � License: 529127 ' Arch / Eng : Adtlress: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher D2in, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Phone: Zip: License: SCOPE OF PERMIT C/O OF WATER HEATER. "EL CHINACO" RESTAURANT. AMT $23.50 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 , FEE SUMMARY_ orr nMr Laundry Tub / Washer $0.00 0 � Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator 50.00 0 Process Piping (per 10 fl) 30.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line � $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 Status: ISSUED Applied: 70/1&2003 Issued: 10/76I2003 ISSUED BY: �� i ', . .�A QTY AMT �0' , � � = Sump Pump � - 50.00 0 �'- � �- Swimmiog Pool $0.00 0 Trap Pomer' 50.00 0 Urinal ' � 50.00 0 Vacuum Brkr�BkOow(1-4) 50.00 0 . Vacuum Brkr Bkfiow(5+) $0.00 0 � , � Wash Basin /" 50.00 0 . Wash Basin Set � $0.00 0 Waste and Vent System $0.00 0 Water Closet (Toilet) $0.00 0 Water Heater I vent $12.30 0 Water Piping (Inst or Rep.) $0.00 0 � . Water Re-pipe 50.00 0 Water Service $0.00 oTv 0 0 0 0 0 0 0 0 0 0 1 0 0 0 NOTICE: The work authorized by this permit� shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1. 12-21•92) E%PIRATION: This pertnit shall automatically expire end become void if work is not commenced wlthin 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 inspectiona end finel epproval must ba obtalned. Failure to obtain inspections and (inal approvel will result in the expiration of this permit. FOR INSPEC710NS CALL: (714) 7545626 20a8d8 (N00) WORKERS'COMPENSAnON DECLARAnON: ' � I hereby ettirm untler penalry oi perjury one of the followinp declarations: ❑ I h e end will mainiain e ceniflcate ot consent to sell•Insure for workers' compensatlon, es provided for by section 3700 ot the Lebor Gode, tor Ue peAormance ot the ork for which this permit Is issuetl. I have end will melntain workers' mmpensatlon insu2nce, es requiretl by section 3700 oi Ne Lebor Code, fw the peAortnance of tha work for whkh Ws permit is Lswetl. M work 5' com ensstion Insu�ance carder end oll number ere: I�// �� n Certier.Y �T�T� �r i �J i� P � Polity Number: �� l / D � ( / � (This secflon need nof be completed i/ fhe permit Is velued ef one huntlred dollers ($100) ar /ess.) ❑ I certity Ihet in ihe peAarmance oi Ue work f which this permit is issued, I shall not employ any person in eny manner so es to became sublect to tha workers' compensation laws t lifomla, fl ��e t at It I shoul0 become sub�ect to �he workers' compensatlon provisions ol Section 3700 oi ihe Lebor Code, I ahell torthwith comply with Ihese 'sions. /� Applicent Signature: Date: � V� ��` �� WARNINO: FAILURE TO SECU �RNERS' ODII,P 5�1T1IXd CWE W1GE IS UNLAWRIL AND £HRLL SUBIEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE MUNDRED T/qU$ANDOOLLPAER��. �INADDfiIONTOTHEWSTOFCOMPENSATION,OAMAGESASPROVIDEDiORINSECilON3)090FTNELABORCODE,INfEREST,ANDATTORNEYSFEES. LICENSED CONTRACTORS DECLARATON: I hereby aHirtn thel I em IlcenseA untler provisia force end eMecL Lia a �Z�I ��1-'� Contrectofs Signeture: 9(commencin Ith Sectlan 7000) oi Division 3 0l the Business and Profession5 Code, end my Iicense is In full Classp C3/Q 4f7 L �ace: / h • � '7 — �� CONSTRUCTION LENDING AGENCV: � , ❑ I hereby ettirtn thet there is e wnstruction lentling epency for the pertortnance ol Ihe work for which this permit is Issuetl. (Sec. 3097, Civll Cotle). Lende/s Neme: Lentlefs Atldress: SigneWre: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn Ihet under penalry af pe�ury thet I em EI(EMPT FROM 7ME CON7RACTORS uCENSE LAW tor ihe following reeSon (Sec. 7031.5, Buslness and Professions Code: Any clry or counry which reduires a permit to construq, alter, improve, demolish, w repair eny structure, prior to Its issuence, elso raquires Ihe epplicant for such permit ta flle e signad statemen[ that he or she is �Icensed pursuant ta Ihe provislons af the Camrectors Llcense Law (C�apter 9(commencing wit� Sectlon 7000) of DMslon 3 ot tho Business end Protessions Code) or that he or she is exempt theretrom and Ihe basLs tor ihe allegetl eaemptlon. Any vloletion oi Section 7031.5 by eny epplicant for e pertnit sub�ecte the epplicant to e clvll penalry of not more than ilve huntlred tlollars ($500).): ❑ I, es owner at the properry, or my employees wl�h weges es thelr sole compensatlon, WILL DO THE WORK, antl the stmcture Is not Intentletl or oXaretl for sale (Sec. 7044, Business end Professions Code: The Contractors License Law does noI epply to en owner ot properry who bullds or Improves thereon, and who does such work hlmself or herself or ihrough his or her own employees, providad that such improvements ere not Intended or oHered for sele. If, however, the building or improvement Is sol0 wilhin one yeer o1 campletion, ihe owner-builder wlll have the burden o� provinp t�at �e or s�e tlitl not Duild or Improve lor Durpose ol sale.). ' ❑ I, es owner ol the praperry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTFiACTORS ro cronstruct the pro�ect (Sec. 7044, Buslness flnd Protesslons Cotla: The comrectors Llcense Lew Coes not epDly to en owner ot propeny who builda or Imprwes theraon, and who contmas tor such project wIN e contrector(s) license pursuant to the Contrectors tJcense Lews.). ❑ I am exempt unOer sea Business and Prolesslons CoCe tor IIJs reawn: Signature: Date: Ownar ID verilletl by tlrivefs license. ❑ Yes ❑ No Drlvels LJcense No. E�Wires: Vadllcation oi Ownerehip by (type of document, i.e. � propeny tav DIII or tlaetl): DIVISION OF INDUSTRIAL SAFETY GERMI7 CERTIFICATION: ' ❑ 1 hereby certify Ihet no excavatlon tNa (5) or more feet in tlepth into which a person Is required to descend, wlll be metla In connectlon with work authorized by this permit, end thet no 6uilding structura, usffoltling, lalsework, ar demolition or dismentling Ihereof, will be more ihen thlrty-six (38) ieet high. (Chap. 32, Grp 2, Ah 2, Sec. 341, Title B, Celilamia Administ2tNe Code). ❑ As ownar�builder, I wlll not employ enyone to do wark which woultl requlre e permit trom the Division ot Indusirial Sefery, as noteA above, unless suc� person hes e permit Io tlo such work trom the tlivision. Slpnature: Dale: DiWsion af Indusirial Satety Pertnit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the epplicant or preseM or tuture bulltllnp occupant need to tile end cerliy e Buslness Plan br emergency response lo releese or I�reetenetl releese oi e hezertlous materlal7 ❑ Yes ❑ No (Sectlon 25505 of Ihe Celitomia Health end Sefery Code requires, with some esceptions, Ihet a Business Plan De filetl wlth Ihe Casta Mesa Fire Depariment Dy every busineu which �as at any one time tluring e reporfed year e quantiry of heiardou9 materials equel to or greater �hen a weight of 500 pounds, or a volume o155 pellons, or 200 cubic leet of wmpressed gas et atanCard temDereture and pressure). _" ..........................._............... _ �_...__'_"".....................—. . __.._........................."""_""' '....... _.. ............. 2 Does or will Ihe applicant or presem or future bullding occupent need to file a repistretlon form for acutey hazerdous metedals7 ❑ Yes ❑ No (Sectlon 25533 ot the Calitomia Healih antl Safery Catle, with soma exceptions, requires replstratlon wlih the Coste Mesa Fire Departmem by each business w�lch et eny ane time has on hand a quantiry oi ewtey hazardas meterials equal to or greater then e weight ot 500 pountls, or e volume of 55 gallons, or 200 cuWc feet ol compressed gas et stendard temperature and oressurel. 3 Uoe9 0l Wlll Ifle eppllCant of pfBSeni Of NIufB OUIIOIn9 OCCUP2nt nBOtl (0 pr8P2lB 3n HMYY (HISk M2negemenl entl PfBVen�lOn Pt0yf2m tOf 2CUIBIy 112SHt00U51112t0tl315)7 ❑ Yes ❑ No (Section 25534 ot the Califomla Health and Sefety Code provides ihat the Costa Mesa Fire Deperiment may requlre ihe D�eDeretion, ceNficatlon and tilinp with Ihe Flre Department of an RMPP by Ousinesses whlch are reqWretl to register aately hazertlous materials wlth ihe Fire DepartmeN. _ .................�._.............. ....... a If en RMPP is presenUy requlre0, �es Sectlon 25534 of Ihe Califomle Heall� and Sefery Coda been tulty complied wIIh9 ❑ Ves � ❑ No .............................._._...._.............._"'... ...___....................__.............'—_'_"'_ .._...............__..............._..............__........"' "'_""___.... 5 Does or wlll the applicam or present or future bullding occupem raqulre lor t�e work w�lch Is Ihe sub�ect of this e plicatlon e germit lor such construction or modlficetlon irom Ihe Sauth Coest Air Dualiry Menagemenl Dlstdct or Irom any other eir pallution crontrol tlistdd or epencyl � Ves LJ No (Sectlon 658502 of the Califomia Govemmenl CaOe requlres that the requested Inlormetlon be Iumis�ed on appllcatlons for non-resldential bullding pertnits). .........................................�.........................._'_'..........................................................,..........................._................__..................__......._...................................... ............�.... .................._�......................... 8 WIII eny part of the Iaciliry to be constructed under this pertnl� be within 1000 feat Irom tha outer bountleAes ol e school? [� Yes ❑ No Qf yes', Ihe tecility must mee� t�e reQuirement ol SecNons 25534 antl 423W ol ihe Calltomla Health end Safery Code). ....'_'.........._.__._.. _._ ..............._"_ __'.........._....._._ .._. _ 7 If a pertnit frwn the Sauth Coest Air Oualiry Menegement Distdd or other eir polution contml distdct or eBency Is requlred tor Ue work whlch Is the sub�ect of thls appllcation, heve all of the tlisdosures prescdbetl Dy Caltlomia Heelth end Salery Code Sectlon 42303 Eaen metle7 ❑ Ves ❑ Na 9 (If yea', ettecli certi/icate ol compllance from t�e epOroptlate air pollution conirW otticer). CERTIFICATE OF COMPLIANCE: I cenity thet under penalry ol per�ury the informatlan given ebove is cartect. I egree to comply with ell stete laws and dry orOinences regarding Hazerdous Materials antl Emissions. Slgnature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I certity under penalry at perjury that I have reatl Ihls appllcatlon end state that the Infortnation glven Is correCt. I egr6e to comply with ell stete laws fln0 ciry ordinances releting to 6uiltling constructlon, and euthoriza reprasentetives of t�e Ciry o� Costa Mesa to enter upon ihe ebove-descnbed property for inspecUon purposes. I agree not to occupy or allow accupancy of eny building authonzetl by ihis permit until final inspection. COOE /. INSYECTIONttVE 1618 Fixed System Flnal Fire Prevention 1288 Pool Spa Final 200 Finel Re-Roof 201 Flnel BIocWReteining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition Pdff. /�'� /—� � Date �{�j COpEt INSVECiIONTYPE 208 Final Mechenlwl 208 Finel Plumbing 210 Finel EleIXrlcal 212 Finel Fire Preventlon 220 Flnal Plenning Approvel 222 Final Site 250 Final Building/OCCupenCy PAg Q�E64 � a -8- 03 l�rv _ '�`i. �` - . _ , ..." � . , BUILDING PERMIT JobAddress: 560 W 19TH ST Status: ISSUED Suite: Applied: O6/09/2000 Vicinity: WHOLE BUILDING - Issued: OB/24/2000 Parcel Number: 42210320 _ Zoning: � � ` � � �� , ,4pp�icant: MONTAGNA, VIC ISSUED BY: Address: 16225 VANOWEN ST � � SUITE 208 ' Phone: (818) 787-6310 VAN NUYS, CA Zip: 91406 � ownec GARVIN DRIVE LP Address 16485 GARVIN DRIVE , � � � � Phone: - . ' . - � ENCINO, CA . � Zip: 91436-3636 . � ' � Contracroc SOUTHERN CALIFORNIA DEVELOPMENT CO INC Address: 16225 VANOWEN ST � � , SUITE 208 Phone: (818) 787-6310 � � VAN NUYS, CA -- Zip: 91406 � License: 330340 - � - � Arch : STOCKTON, KEN Eng: Address: 31225 LA BAYA DR � Address: SUITE 103 . Phone: (818) 991-1040 � � ' , Phone: � WESTLAKE VILLAGE, CA • � Zip: 9t362 License: � License: _ SCOPE OF PERMIT ._ _ - CONSTRUCT NEW 6850 SQ�FT SHELL COMMERCIAL-BUILDING. - � . . . . . _ . . . . _ . � � . . . FEE SUMMARY Plan Check: $1,122.78 Calc Valuation: $2so,iso 00 Permit $1,727.35 — -- - - Claim Valuation: 80.00 SMIP Res: $0.00 " t SMIP Com: $48.33 Other. $0.00 _ . Y Inspection: � $0.00 , � � " - � � Total: $2,898.46 - � , ;:;._ � � PLANNING & ZONING " � ' �� - �� , SETBACKS � �'' i'� i,; � � ; "� 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 Existinq: 0„ Re uired: 0 Proposed: 0 , NOTES: „ NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Galifornia statutes and ralated regulations. (Ord. No. 92-28, § 1, 12-27-92) 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 780 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 requlred Inspeclions and final approval must be obtained. Failure lo obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � 2446�4fi16/00) � '' �, V WORKERS'COMPENSAnON��CLARAnON: ' "` ' I hereby attirm under penelry ot perjury one oi the tollowing dedaretions: ❑ I h end wlll malnlain e tertiflcete ot consent ro self-Insure for workers' compensatlon, as provided br by section 3700 ot the Lflbor Code, tor Ihe pertortnance ot Ihe rk tor which Ihis pertnit is issued. �I�heve entl wlll maintain wwkera' compenseGon insurance, es reduired by sectlon 3700 oi Ne Lebor Code, for the peAormance ot Ihe work tor which this pertnll is I5we0. � My worke ' co en ti lysuienee wmer an icy number are: Gartier.�f�� i~� Policy Numtier:—^��ii'� � O"C� ' �s sectlon neee nat be complefed il the permit is velued at One hundred dM1eB ($100) of 1e55.) /��7'1/�% y` DB L 6 �Ii1B �7� '�� ❑ I certify thet In the performance of the work tor which this pertnil is IssueC, I shall not employ eny person in eny manner so es to come s DI �i orfiers' wmpensatlon laws oi Ilfomle, end eqree Ihat it I should become sublect ro the workers' compensetlon provislons of Saction 3700 0l the Wbor Cotle, I shall forthwlth comply with these p visio �� AppllcanlSigneture: j,�'-- �� Date__�/��00 WARNINO: FAILURE TO SECURE WORKERS' COIAPENSATION COVERAGE IS UNLAWFUL AND SNALL SUBJECT AN EM OVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE MUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF CAMPENSATIqJ, �AMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR CODE, INTEREST, AND ATTOFNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby e force and untler i wit� Section 7000) of ' Date: Professions Code, and my license Is In full CONSTAUCTION LENDING AGENCY: ❑ 1 hereby eMirtn that there is e construction lending agency for the peAormence ot t�e work tor which this pertnit is issued. (Sec. 3097, Civil Code). Lentler's Name: Signetura: OWNER-BUILDER DECLARAT10N5: Lenders Atldress: Oate: I hereby attirtn thet untler penalry oi perjury Ihet I am E%EMPT FROM TME CONTiiACTORS LICENSE LAW lor lhe tollowin9 reason (Sec. 7031.5, Business antl Professlons Code: My G�y or Coun�y whic� require5 e permit to construct, elter, imprOve, tlemoli5h, or reDalr flny Slructure, pnor �o its issuance, alw wquiws Ihe applicant bt such pertnil to file e signed statement t�et �e or she Is licensed pursuent lo the praWsions oi the Contractors LJcense Law (Chapter 9(commencing wlth Section 7000) of Division 3 ot the Business end Pmlessions Cade) ar thet ha or she is eaempt therefrom end the besis tor the allegetl exemption. Any violation oi Secllon 7031.5 6y any eppllcant for e Oertnit subjects the epplicant to e civil penalty of nat mare Ihan Me hundred dollars (5500)J: ❑ I, as owner ot Ihe property, or my employees wiih wages es �heir sole compensatlon, WILL DO THE WORK, antl the structura is nol intended or oHeretl for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Lew does not apply to en owner of properry who builds or improves thereon, antl who tloes such work himself or herseN or Ihrough his or her own employees, provitled ihat such Improvemenis ere not intended or oflered tor sale. If, however, ihe building or Improvement Is sold wilhin one year oi completion, the owneo-builder will have the burden of proving ihat �e or she did no� build or improve for purpose oi saleJ. ❑ I, es owner af Ihe Oroperty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to cons�ruct the proJect (Set. 7044, Business end Professions CoOe: The contractors License law tloes not epply to an owner ol property who bullds or Improves thereon, antl who contracts tor such project with e conirador(s) license pureuent to the Contracbrs License Laws.). ❑ I am e.empt untler sec. SignaNre: Owner ID verified by tlnvefs Ilcense. ❑ Yes ❑ No Business and Protessians Code for this reeson: Vedfication oi Ownership by (type of tlocument, i.a. - pmperry tac blll or Oeetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Driver's License No. Date: Expires: ❑ I hereby certify tha� no excavation five (5) or more teet in depth into which a person Is required to descend, will be mada in connection with work aut�arizetl �y this permit, and that no 6uilding structure, scattWding, talsework, or demWition or tlismantling t�ereoi, will be more than thirty-si: (36) teet high. (Chep. 3.2, Gry 2, Art 2, Sec. 341, Tltle 8, Califomla Administrative Cade). ❑ As owner-builtler, I will not employ enyone to do work which woultl require e permit tmm Ihe Division ot Industrial Safery, as noted above, unless such persan hes a pertnit to do such work trom the division. Signe�ure: Da�e: Division of Industnel Satety Permit Number: CERTIFICATE OF COMPLJANCE AND AUiHORIZA710N OF ENTAV: I certify under penalty of perjury tha� I have read ihis epplication antl stata thet �he Iniormation given is correct. I egree to comply with ell stete laws and ctiry ortlinances relating lo buildinp consiruction, and euthonze representatives of tha Ciry of Coste Mesa to enter upon the above-descnbed property tor Inspection purposes. I agrea not to occupy or ellow occupancy of any building euthorized by this permit until finel inspectlon. WOE I. INSYELTIONTYPE , Q�¢, � 1676 Fi�etl Sysiem Final Pira Prevenlion 1266 200 201 202 203 Pod Spe Final Final Re-Root Flnel BIocWRetaining Well Flnal Factory Fira Place Finel Sign 204 Final Demolitian COUE1 INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbinq 210 Finel Electrical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Si�e 250 Final BuiltlingiOccupancy PAIE Q�E64 (714) 754-5273 • Fax (714) 754-4856 • www.c�.costa•mesa.cBaUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH $T Suite: Viciniry: NEW TRASH ENCLOSURE Parcel Number: 42210320 Applirant: MONTAGNA, VIC Atltlress: 16225 VANOWEN ST SUITE 208 VAN NUYS, CA owner: JEFFREY A. FISCHER Address 17337 VENTURA BLVD #205 ENCINO, CA Zoning: Phone: (818) 787-6310 Zip: 97406 Phone: (818) 501-0145 Zip: 91376 Contractor: SOUTHERN CALIFORNIA DEVELOPMENT CO INC Address: 16225 VANOWEN ST SUITE 208 Phone: (818) 787-6310 VAN NUYS, CA Zip: 91406 License: 330340 Arch : Address: Phone: Eng: Address: Status: ISSUED Applietl: OS131/2001 Issued: 05131/2001 ISSUED BY: �' � ui,i ' i y, Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 55 LINEAL Ff OF 6' HIGH BLOCKWALC, TO CREATE NEW TRASH ENCLOSURE FOR NEVJ COMMERCIAL SHELL . BUILDING. � REF: B00-00846 , . FEE SUMMARY Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $o.00 $41.80 $0.00 $0.00 $0.00 $0.00 $41.60 . � SETBACKS MAIN STRUCTURE Front ACCESSORY Front � � 0- 0 PARKING Existin : 0 NOTES: ��. Rear 0= 0 Rear 0-0 LeR Left Calc Valuation: Si,�oo.00 - Claim Valuation:, :- so.00 � - .. . %;= �'��, �/� / " ,�j� �i , 8 ZONING � � . � � � ., 0= 0: ' Right _- 0- 0 0.0 ,Right��"�0-0 i Required: 0 � Proposed: 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Oro. No. 92-28. § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor t�e work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlone and final approval must be obtained. Failure to obtain inspections and fina� approval will result in the expiration of this permit./i // fOR INSPECTIONS CALL: (714) 7545626 �/ 2446d6 (8�00) WORKERS'COMPENSAnON DECLARATON: . " . I hereby eflirm under penalry ol per�ury one of the I011owinB doclaretlons: � , ❑ I heve end wlll r�alnteln e certificata of consenllo self•Insure for workers' campensatlon, es proNded lor by section 3700 oi the LeDor Cotle, tor Ihe peAortnance oi the /�°ork tor which Ni9 pertnit Is Issued.� '�' ,e( I have flntl will melntain workers' compensetbn insurencu, es requlretl by sectlon 3700 0l t�e Lebor Code, tor Ne peRom�ence of Ne work for whiCh Ihis pertnit Is Issued. My workers' compenset� Insurdrnce c'e��de1r d policy number ere: - ^ �Z Certier: � r�N � Poliry Number'�—I S� 1�, l S (This sectbn neetl irol De canp�eted It fhe permit (s valued ai one hundred dolfars (5100) a 1euJ ❑ I certily ihet in tl�e pertartnence of the work for whlch this pormit is lssuetl, i s�ell not employ any person in_eny manner so as to become sub�ect lo Ihe workers' cwnpensation laws qYC&T2mla, entl egree that i� I ahould become sub�ect to Ihe workers' compensatlon provlsbns ol Sectlon 3700 o Ihe Lebor Code, I shall torthwlih comply with se PrtLvlslons. ' ..�;, ..� ,; , : _ - : ��/��/ �AppllcantSipneture: ��"� i'�e1e: � WARNIN(3: FAILURE TO SECURE WORKERS' COMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBIECT EMPLOYER i0 CRIFllNAL PENALTIES AND CNIL FlNES UP TOONE HUNDRED TII(%1SFND DOLL4RE (5��.�). IN ADDfT10N TO TME COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]080F THE UBOF CODE, IMEREST, AND ATTOfiNEYS fEES. LICENSED CONTRACTORS DECIARATON: �,. . �.. . . . I hereby aHirtn that I am licen�der pry�islgps Qf Chepter 9(commencing wlih Sectlon 7000) of Division 3 ot Ihe Business and (�otessj�ns Cotle, end my license Is in full fwCe entl eifett. Lic. d_ contraaors signemre� CWss M Dete: _ CONSTRUC710N LENDING AGENCY: ❑ I hereby attirtn ipat t�ere Is a wnsiruction lentling agency br ihe perfortnance oi Ihe work tor which this permit is issued. (Sec. 3097, Civil Code). LenCefs Name: LenOer'S Atltlfeu: Signemre: Date: OWNER-BUILDEP DECLN7ATION3: 1 hef0by flRlfRl lhdt UndOf pBnHlty �f qe�ury Nat 1 em E%EMPT FROM THE CONTRACTORS LICENSE LAW tOr NB lolloWing fea50n (Set. 7031.5, BU510855 e0tl PfOfB5510f14 Cotle: nny ciry or munry which requires e permit to construct, elter, Imprwe, Cemolis�, or repair eny &tructure, prior to its issuance, also requires ihe epplicant br suc� permit b file a slgnetl statement thet he or she is Iicensetl purouant b tha provisions ol the Cantrectors Llcense Lew (Chapter 9(commendng vrith SecUon 7000) ot Divislon 3 ot ihe Business and ProfesslorSs'Code) or Ihet he or she Is exempt Iherefrom end the besls tor the ellegetl e:emptlon. My WWatlon of Section 7031.5 by eny epplicant For e permit subjects Ihe ep0�lcent to.a'�civil0enelry of not more then ilve hundred dollers ($500).): ' � a i., i r.._r ❑ I, es owner of Ihe property, or my employees wlth weges as their sale compensatlon, WILL DO THE WORK, antl �he siructure is not IntenAed or oHereC tor sele (Sec. 704t, Business and Pmfessbns CaderThe Contractors IJcensa Law does not appty to en owner ol properry who Cullds or improves Nereon, and who tices such work himselt or hersefl or Ihrough his o[fiei,own�employees, providetl thet such improvements ere not intentletl or oXered �or sele. If, however, Ihe hulltling or improvement Is sold within one year of completion, the owner-builder will heve the burden of provinp ihat he or 5he did noi builtl or improve tor purposa ot sale.). ❑ I, es owner ot the properry, em EXCLUSNELV COMRACTING WI7H LICENSED CONTRACTORS to consiruct tha prqect (Sec. 7044, Buslness and Pmfessions Cotle: The conlr9ctoB lJcense Lew Ooes no� eppy lo en owner ol property who Dullds or impmves thereon, end who convacts for such project with e contractor(s) liten5e pursuent �o ihe ContreC�orS LiCensa LewS.). ❑ 1 em e:empt under sec. 9usiness ane Protessions Code for this reason: Signaturo: �ate: Owner ID verifietl by tl��efs Iicenso. ❑ Ves ❑ No DrlveYs Ucanse No. Vedflcatlon ot Ownership by (rype ot documem, i.a. - property te� blll or deed): DIVISION OF INDUSYAIAL SAFE7Y PERMR CERTIFICATION: Expires: ❑ I �ereby certity tnet no excavetim tNe (5) or.more �eet In tlepih Into which e person is requiretl to desterW, vrill be mede in connection with work eut�orized by this permi�, and Ihat no building structure, sCefloldinp, felsework, or tlemolition or dismantling thereol, vrill be more Uen Uirty-six (36) feet �igh. (Chap. 32. Grp 2, Ar12, Sec. 341, Ttle 8, Califomla ACmINSlretive Code). ❑ As owner-buildeL I wlll not employ enyone to do work whlch would requlre e permlt Irom t�e Division of Intlustdel Sefety, es noted ebove, unleu such person hes e permit to do 5ucn work from Ihe division. Sipneture: Date: DMsion of Industrial Safery Permit Number. CERTIFlCA7E OF COMPIJANCE AND AUTHORIZA710N OF EHTAY: I rsrtily under penalry ol per�ury ihat 1 have read ihts eppliwtlon end stale that Ihe Informetlon given Is cortect. I egree Io comDN w��h ell state laws en0 ciry ordinences relating to builtling conslruction, enC eut�odze reDresenlatives of t�e Ciry ol Costa Mesa to e�tar upon the eDove-descAbed propehy for inspection purposes. I agree noi Io occupy or ellow occupancy of eny building eutharized by �his permit un�il tinel inspection. COOE I. INSPECTIONTYPfl 7816 Fixed System Flnal Flre Preveniion 1266 Pool Spa Fina� 200 Final Re-Root 201 Finel 81ocWRe�aining Well 202 203 Flnal Fectory F��e Place Final Sign 204 Final Demolltltln OAg ItQ�➢E6$ COUE I INSPELTqN TYFE 206 Final Mechanical 20B Final Plumhinp 210 Finaf EledriCat 272 Finel Fire Preventlon 220 Final Planning Appro+al 222 Final Site 250 Final Building/Occupancy , —. � ' �ob Address: 560 W 19TH ST Suite: Vicinity: . . , . Parcel Nunmber: 42210320 Applicant: MONTAGNA, VIC Address: 16225 VANOWEN ST SUITE 208 VAN NUYS, CA Owner: GARVIN DRIVE LP Address 16485 GARVIN DRIVE GRADING PERMIT Zoning: Phone: (818) 787E310 Zip: 91406 Phone: ENCINO, CA Zip: 91436-3636 Contractor SOUTHERN CALIFORNIA DEVELOPMENT CO INC Address� 16225 VANOWEN ST � SUITE 208 � Phone: (818) 787-6310 VAN NUYS, CA Zip: 91406 License: 330340 E�g : Address: Phone: Status: ISSUED Applied: O6/20/2000 ' . _ Issuetl: 08/24/2000 ISSUED BY: �_ �� Z�p: License: SCOPE OF PERMIT CUBIC YARDS GRADING FOR FUTURE 6850SF COMMERCIAL BUILDING. � � 460 Plan Check: Permit: Other: Inspection: $33.00 $0.00 $107.00 $0.00 50.00 $0.00 $0.00 FEE SUMMARY / Calc Valuation: � $o.00 Total: $140.00 � � � � � .. . _ � ': , � � � � PLANNING & ZONING " � � /�� - � NOTES: ACHAM CN 08/10/2000 PLEASE STAMP PLANS WITH MY INITIALS AFTER VERIFYING THE FOLLOWING: 1. 3 SOILS REPPRTS WITH WET STAMP AND SIGNATURE. 2. PLANS SHOULD REFERENCEHANDICAP REQUIREMENTS TO ARCHITECTURAL PLANS. 3 ARCH. PLANS TO INCLUDE IN ADITION TO HC. REQ. THE HANDRAIL DETAILS FOR RAMP. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 1247-92) EXPIRATION: This permit shall automatically expire and become void lt work is not commenced wi[hin 1H0 days, or if work is suspended or abandoned for a period of 180 days. , - ' INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all � requlred Inapeetlona and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. i FOR INSPECTIONS CALI: (714) 7545626 � za+wa (dao) v � ,..�..,..,. --. '.._ ' WORKEHS'COMGENSAnON DECLARArON: I hereby aflirtn untler penalry ot per�ury one ol the tollowing dedaratlons: ❑ I lieve wlll malntein e ceNticete oi cansent to setl-Insure for workers' compensatlon, es proNded lor Cy secllon 3700 01 the Lebor Cade, lor ihe pertormence of Ihe w r which thls pertnit Is Iuuetl. I hevo eM vrill malntain workers' Compensetlon insurenCe, es required by soctlon 3700 af t�e Lebor Gotla, for Ihe peAomience o1 tho work far wnich this permlt Is issuetl. My workers' saYtion– �Ins�uren cartler end policy number ere: � Certier. �! LL�%��✓/� PdiryNumber. �T�� f � �� (7hU secUan need ror be completed ll �he permif s velued er one hundretl dollers (3100) or less.) ❑ I cerUly Ihat In Ne poAortnance ol Ihe work tor which tMs permit La Issued, I shall nol employ eny person In any manner so es to become SUD�ect to Ihe workers' compensatlon lews oi Celit la, en0 egree lhet If I s�auld becomo sub�ect to Ihe workers' compensatlon proNsions oi Sacllon 3700 0l the Lebor Code, I shell forthwit� comPN wilh lhese Provi 5. � � `/y� / Applicent Signature: Date: �� LLv WMMNO: FAILURE TO SECUFE WORKE0.5' COMPENSA W FUL AND SNNL SU61E AN EMPLOVER TO CRIMINAL PENALTES ANU CML FlNES UP TO ONE MUNDRED TFqU.WJD DOLURE (5100.000),IN ADOITIIXJ TO TME WST OF ODMPENSATION, DMNOES PS PROVIDED FOR IN SECfIIXJ 37080F THE IABOR CODE, IMERE5T, PND AITORNEV'S FEES. LICENSED COMRACTORS DECLARATON: 1 hereby ettirtn thal I am Ilcensed under rovlsions ol rorce ana ettect. uc. a a Contrectofs SipneW�: CONSTRUCTION LENDING AGENCY: with Sectlon 7000) of DMsion 3 0l Ihe Busineu entl Professions Cade, end my Ilcense Is in full Glass a �� C— oa�e: yY�a►u � I hereby aRirm that there is e construction lending egency for Ihe peAortnance of t�e work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lentlefs Nema: Lendefs Address: Signeture: OWNER-BUILDER DECLARATIONS: Dare: I hefeby efllrtn Ihef ufldef penelry of pefjury lhet I em E%EMPT FROM THE COHTRIICTORS 110EN5E LAW tor Ihe fdlowirg reasOn (Set. 7031.5, BuSiness flnd Pro}eSslOnS Codo: My dry or counry wnich requlres e pertnil ta consWct, alter, imprme, demolish, w repair any shucture, prior to im issuance, also requires ihe epplicant for such pertnit lo file a signed statemem Net he or she Is Iicensetl pursuent to the provisions ot t�e Contrectoro License Lew �Chapter 9(commendng wlth Sectlon 7000) oi Dlvislon 3 of ihe Business antl Pratessions Cotla) or Ihat he or she is e:empt theretran and Ihe basis lor Ihe allegeC exemption. My violation o1 Section 7031.5 by any epplicant tor a pertnit sub�ects the appliwnt to e cMl penalry of not more Uan five hundred dollars (5500).): ❑ I, es owner ol the properry, or my employees wlth weges es their sde compensetlon. WILL DO THE WOHK, end the structure is not IntenOetl or otteretl for sale (Sec. 7044, Business end Prolessions Code: Tha Conirectors License Lew tloes nal apply to an owner of Droperry who builds or imprrnes Ihereon, enO who tloes such work �imsell or herself or lhrough his or her awn employees, provitletl Ihat such imprwaments ere not intentletl or otteretl far sele. lt, howevar, tha building or ImprovemeM Is sdtl wifhin one yeai ot iumpletlon; ihe or.nerbuilder will heve the burden oi proving that �e w slie tlitl not build or improve Iw purpose of sale.). �. rt ❑ I, as owner of Ne Droperry,-em EXCLUSIVELY.CONTRAC7ING WI7H LICENSEO CONiRACTORS ro construd Ne pra�ect (Sec. 70aa, Business end Professions Cotle: Tho contractors Llcense Cew does no(appy to en owner at propeny w�o builCs or imprwes thereon, end who contracts for such project with e coniractor(s) license pursuem to the Coniractoro Liiense Cews J! ❑ i em exempt under sec. � ~ti Business end Pmtessions Code for Uis reason: S{gnature: � ��^+ Date: Owner ID verifled hy drivefs Ilcense. ❑ Yes �� No Dnvers Ucense No. Expires: Verllicatlon of Ownership 6y (ty{�e of tlocument, I.e. • property tax blll or tleed): DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICATION: ❑ I hereby ceNly thet no excavatlon Ilve (5) or more feet in tlepth Into w�ich e person b required to descend, will ba mede in connectlon wIN work euthorized by this permit, antl t�at no building structure, scaHoltling, �alsework, or Cemolition or dismaniling Ihereot, will be more than thirty-sia (38) teel high. (Chap. 32, Grp 2, An 2, Sec. 341, Tiile 8, Cellfomia AdminislretNe Code). ❑ As owner-builder, I will not employ anyone lo tlo work which woultl require a permit trom t�e Division at Industrial Safery, es noted ebove, unless such person hes a permit to do sucti work Irom the tlivision. Signeture: Date: Dlvision oi Industrial Safery Pertnit NumDer: CERTIFlCATE OF COMPLIANCE AND AIlTTfOHVA710N OF ENTRV: I cenity untler penalry ot perjury Ihat I have reaE Ihis epplicatlon end state Ihat the iniortnation given Is cortect. I egree to compy wlth all slate laws entl ciry artllnances reletlng to building conswction, end authodze representeUves of Ihe Clry of Costa Mesa to enter upon the ebove-deurlbad property tor inspection purpaaes. I egree not to occupy ar ellow occupancy ol any bullding euthorized by this pertnit uniil final inspectlon. W OE �. INSPECf WN TYPE 1616 Fixetl System Final Fire Preventlon 1268 'Pod Spa Finel 200 Final Re-Root 201 Final BIocWRetaining Wall 202 Final Feqory Fire Plece I 203 �� 204 \ Final Sign Finel Demolillon IdS1�I;iiill.l4� WOE� RISPECTIONTPE 208 FNeI Mechenkel 208 Final Plumhing 210 Final Electrical 212 Finel Fire Prevenilon 220 Final Planning Approval 222 Finel Site 250 Final Buildimy0aupency ate Pz�(m� ate (714) 754-5273 • Fex (714) 754-4856 Job Address: 5s0 N/ 1 JTH $T Suite: Vicinity: Parcel Nunmber: 42210320 CITY OF COSTA MESA BYILDIN6 DIYISION � DEVELOPMENT SERVICES DEPARTMENT PERMIT npplicant: BOB MITCHELL . Address: SIGN PERMIT Zoning: � Phone: 310-523-9500 � Zip: Owner. GARVIN DRIVE LP Address��16485GARVINDRIVE , . . ' - Phone: � .i,. , -'_ - ENGINO CA / - : Zip: 914363636 / � � �� Contractor. AD ART/ELECTRONIC SIGN CO �i•Address> 19603'FIGUEROAST � � - , � �� '. Phone: 213 523-9500 � - - CARSON, CA Zip: 90745 ' � i , � � License: 711214' � Aich / Eng : - , Address: , , ' - � ; Phone: �, ' i . _ -� , Zip: * �� , - License: 0 PERMIT NUMBER 77 FAIR DRIVE�COSTA MESA, CA 92626 Status: ISSUED Applied: O6/14/1999 Issued: O6/14/1999 ISSUED BY: /° � j • SCOPE OF PERMIT � ' � � - INS7ALL 2-40 SQ.Ff. ILIUMINATED WALL SIGNS - 1 ON THE SOUTH & 1 ON THE WEST , , a . ELEVATION OF A PROPOSED BUILDING. "LUCY'S LAUNDRYMART'. FOR DRAMING REFER TO ' ' � S89g-00080. . . FEE SUMMARY Plan Check: $72.96 '' Calc Valuation: , Ss,000.00 ` $0.00 Permit: $112.25 ClaimedValuation: �. Ss,000.00 '��, SMIP Cam: $1.26 ' ' Other: � � $0.00 _ � � �, . � $0.00 Inspection: ' . $0.00 $0.00 - $0.00 Total: $186.47 NOTES: PLANNING & ZONING NO710E: The work authorized by this permit shall compty with all epplicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall eutomatically expire end 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 ihis permit to be considered legal, such work must comply wilh all applicable codes, and all required Inapectlona end final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545828 WORKERS'COMPENSAnON DECLARAnON: I hereby aHirm untler penalry of perjury one a<<�e following declurations: � ❑ I heve and will maintain a certiflcate o� ��sent to selt-Insure tor workers' compensation, es provitletl for by section 3700 of the Lebor Code, for the pertormance ot the �Por which ihis permit Is Issuetl. I have antl will meinteln workers' compensa6on insuranca, as required by SecUon 3700 of thg.Lebor Code, for ihe peAortnance ot the work tor which this pertnit Is issued. M workers' compensetlon Insurence Carner nd olic number�e_ / Q/�, LLL,,,� Cefnef:Y � P Y � . / PolicyNumber: /�i�Ql () C l.i�� (Th/s sectfon need not be comv�eted!! the p�t is va/ued at one hundred dollers ($700) or less.) � I certity t�at in ihe peAortnence of lhe work for which IhlS pertnii Is iuued, 1 shall not employ any person in any manner so es Io become sublect to Ihe workers' compensation laws oi Calilomia e at it s ou e subject to the workere' compensetion provisions of Saction 3700 ot �he Lebor Code, I shall forihwith compty wlth ihese provista � `� ` ' � � � / � Applicant Signeture: � �� Date: �'� WAANING: FNLURE TO SECURE WORKERS' WMPENSATIIXJ COVEMGE IS UNLAW FUL AND $HALL SU6IECT AN EMPLOYER TO CFiIMINAL PENPLTIES AND CML FlNES UP TO ONE HUNDRE� TNOUSAND DOLLARE (5100.000). IN ADDITION TO TME C0.ST OF COMPENSATION, DMIAGES AS PROVIDED FOR IN SECfION 37060F THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES. � y LICENSED CONTRACTORS DECLARATION: I hereby eHirm ihat I em IicenseC under proaisions ot force and eHecL Lic. a Conlraclofs Signature: � of Division 3 of the Business antl P�roi¢sslo�Code, and my license is ClassN . C`��—/. � �n, CONSTRUCTON LENDING AGENGY: ❑ I hereby ettirm that Ihere is a construcllon lentling egency lor the pertormance of the work tor which this permit is issued. (Sec. 3097, Clvil Code). Lentler's Name: Lentlefs Address: Signetura: DL�e: OWNER-BUILDER DECLARATIONS: I hefeby B1fiRn Ihat undef penalty ot per�ury lhet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Profes5ions Coae: nny city or counry which�.requires a pn�it b consWct, alter, improve, tlemolish, or repair any stmcWre, prlor to its issuanca, also requlres ihe applicant for such permit to flle a signetl statemen� Ihet he br s�e Is IlCensed pursuent to Ihe provisions of Iha Contractors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of Ihe Business antl Pmfessions Codepor�tliet he or she is exempt ��erefrom and the basis far ihe elleged examption. Any violatlon of Section 7031.5 by eny flpplicant tor e permit sub�ecis the applicant to e dvil penalry�ot not more than five huntlreA tlollars (5500).): CV/ \V/�l-. ❑ I, es owner ot the propeny, or my emp�oyees with wages as thair sole compensation, WILL DO THE WORK, and the structure Is not intentletl or oHered for sale (Sec. 7044, Business antl Professions Code: The_CoNiectors License Lew does not apply to an owner o� Droperry who builtls or improves thereon, and who tloes suc� work himself or herself or ihrough his or her own employaes, provided lhat such improvements are not intentletl or oHereC for sale. If, however, the building or improvemen� is sold within one year ol completlon, ihe owner-huilder will have ihe Durden ot proving ihet ha or sha did not build or improve for purpose ot saleJ. ❑ I, es owner af ihe property, am E%L4USIVELY�CONTRAC7ING WITH LICENSED CONTRACTORS to consiruct the praject (Sec. 7044, Business and Protessions Cotle: The contractors license Lew does not apply to an owner of properry who 6ulltls or improves ihereon, and who crontracts for such prqect with a coniractor(s) license pursuant to the Conirac�ors License Laws.). ❑ I am exempt under sec. Signalure: Owner ID verifletl by Arivefs license. ❑ Yes ❑ No Business and Professions Code for ihis reeson: Vedfication of Ownership by (type oi document, i.e. - properry tax bill or daetl): DIVISION OF INDUSTHIAL SAFETV PERMIT CERTIFICATION: �nvaf5 LiC6n5e No. Dete: Expires: ❑ I hereby certify ihat no excavation fivB (5) or more feet In tlepih into which a person Is requlretl to tlescend, will be made in wnnedlon wlth work authonzed by Ihis permit, and ihat no �uiltling structure, s�eftolding, telsework, or tlemolition or dismantling Ihereot, will be more than thlrty-six (36) feet �Igh. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Adminisiretive Goda). ❑ As owner-builder, I will not employ anyone to do work which would requlre a permit irom ihe Division of Industrial Safery, as noted ebove, unless such person hes e permit to do such work irom ihe division. SlgnaNre: Dete: Division of Industnal Safery Pertnit Number: CERTIFICATE OF COMPLIPNCE AND AUTHORIZATON OF EMRY: I certity under penalty of per�ury ihat I have read this application and state that the information given is correct I egree to comply vrith all state laws and ciry ordinences relnting to builtling construction, entl euthodze represen�atives ol the City of Costa Mesa lo enter upon ihe ebove-descri6ed proparly lor Inspection purposes. I agree not to occupy or allow occupancy oi any bullding authorizetl by thls permit unlll finel Inspection. COOE �. ItlSPECTIONTYPE 1616 Fixetl System Finel Fire Prevention 1268 Pool Spa Finel 200 Final Re-Roof � 201 Flnal BIocWRetaininp Wall 202 Finel Fectory Fire Place 203 FInaI5lgn 204 Final Demolition PAIE It�A4fl Dete �`1�� 1 INSPECTON TYPE 206 Finel Mechanicfll 208 Final Plumbing 210 Finel Electricel 212 Flnel Fire Prevention 220 Final Planning Approvel 222 Finel Si1e 250 Final Bullding/Occupancy �� % (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 560 W 19TH ST Suite No Vicinity: Parcel Number: 42210320 ,4pp�icant: DON RICE Address: / / , ' � " � Owner. -. GARVIN DRNE LP Address:" . 16485 GARVIN DRIVE � � , ENCINO, CA= �� Contractor: �. ALL AMERICAN AIR ' Address:,' 12601�BR4NFORD -, � - � PACOIPAA,CA _ - i MECHANICAL PERMIT Phone: 818-830-1213 Zip: Phone: Zip: 914363636 -.Phone: 818-830-1213 � Zip: 91331 License: 447794 Status: ISSUED Applied: 04/12/2001 Issued: 04/12/2001 ISSUED BY: �/`� SCOPE OF PERMIT INSTALL 4FAU AND 43-15HP COMPRESSORS FOR A/C UNITS FOR SHELL.BUILDING, NO DUC,TS i, � AR PIPING, RE:B00-00846. � � . � - -. � . � _ ' -� - � -- '. .. _. . �'- : �� ', 19SHE FEE Inst FAU <100 k BTU - Inst FAU >,100 k BTU � Repai� / Alt� Cooling/Heat Inst / Rep. Recess:Wall'Htr Refrig Sys <100 k BTU � � Refrig Sys >100�k�BTU� Gas Piping `� � � ' Factory Fireplace . Hood w/Mech Exhaust � � VAV Box V��'� � " ;�� $23.50 $5920 $0.00 $0.00. $0.00 $0.00 $0.00 so.00 $0.00 � � �� $0.00. Vent Fan / Sin91e'Dud �� ' Appliance � � � i � � �' �i �/ Quantiry� 4 - - 0 0 0 0 0 0 0 0 ' '-"0 ,.;x` _ 0 � 0. ' ' ,. FEE SUMMARY ', Fve Dampers J � au.uu u. � , , Smoke Dampers � �� . ��$0.00 0 �� ^�� , _ � Inst or Relocate Appl Vent�� , �$0.00 �0 Air Handlers < 10000cfm�� . - � $0.00 � 0 � AirHandlers> 10000cfm '��"��$0.00 ��0� � �� , Floor Pumace � $0.00 � 0 �, �, - - � Floor or Suspend Heater - ��$0.00":: -0 � == c i , „ � , nu Repair/AltAbsorbtion�Unit ,'��$0.00 '0 � Repair / Alt Refrigeration Unit �� %$0.00� 0 Ventillation System �� j $0.00 '� -�0 Evaporative Cooler _ �� / $0.00 �0 %4 i � Commerciallricinerator � $0.00.,,,�0 Domestic Incineretor �� $0.00� 0 . ' Compressors / Absomtion Systems �� Up4o�3 hp / 100 k BTU ' � �� $0;00 �� 3 To�-15 hp / 500 k BTU $0 00 0 - 15 To 30�hp'/;7 000 k BTU � i�� '� } 50.00�� 0 _- -30 To 50 hp l�7 750'k BTU �.!/ -ti $0.0�0 - Over 50 hp / Over �1 750 BTU� /" �, $0.00 0 �_ , Botlers '� `� ` '� r /� Up to 3 hp � ,� � /�— � �� $�0:00 0 ' �3To-75hp=' � / ��i�J �$708.60 4 � 15 to 30 hp - - �<<L�� C/� � $0.00 0 30to50hp ,�� `��/ - ��$0.00 0 Over 50 hp � � ��- � .- i ! $0.00 0 - � Other Mechanical'Fee �.�� % Irrvestigation Fee`� � lJ `/�� $0.00 � Plan Check Fee " %�� -� $0.00 Reinspection Fee�J " $0.00 � '�� TOTAL CALCULATED FEES $191.30 COMMENTS / SPECIAL CONDITIONS ' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetlons and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaasas (arool WORKERS'COMPENSATON DECLARATION: ' , � - I hereby aNirm under penalry of perjury one of the following declara�ions: ❑ I have and will mainiain e certificate ot consent to selbinsura for workers' compensation, as provided for by section 3700 ot ihe LeDor Code, tor the peAortnance of the work tor which this parmit is issued. ❑ I have end will maintain workers' compensatlon insurance, as requiretl hy section 3700 of ihe Labor Code, for the peAortnance of ihe work for which this pertnit is issued. My workers' compensetion Ins ranca er and policy numbar ere: I ` 1 ? Carner � �N �-� � �- • .--1-✓ � � Polioy Numher: N �`-� �-C� 4 Z D � �— f (This sectlon need not be completed il fhe permit is valued et one hundred tlollars ($ 0) or less.) ❑ I certify that in ihe pertormance oi the work for whiCh Ihis pertnit is issued, I shall not employ eny person in any menner so as to become subieq to tha workers' compensetion laws of Cellfomia, entl agree ihat if I should become sub�ect to the workers' compensetion pmvislons of Section 3700 of the Labor Code, I sha0 forihwith comply with thesa provisions. � Appliwnt Signeture: / Date: WARNING: FAILUfiE TO SECURE WORKERS' COMPENSAiION COVERAGE IS UNLAWFUL AN SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE H DRE TFIOUSAND OOLLARE �$100,000), IN ADDITIIXJ TO THE COST OF CAMPENSATIqJ, DMMGES AS PROVIOED FOF IN SECTION 3'/O60F TME tABOR CODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensed under provisi ns oF Chapter 9(commencing with Sedio 0) ot Division 3 ot the Business an�of� � Code, and my licanse is in tull torce and eHecL Lic. # � Class N � Contractors Slgnature: /' Date: —� f 2 � O � CONSTRUC710N LENDING AGENCY: ❑ I hereby aNirtn that Ihere is a construction lending agency tor fhe peAormance ol ihe work for which this permit is issuad. (Sec. 3097, Civil Code). Lenders Neme: Lender's Adtlress: � Signa�ure: OWNER-BUILDER DECLARATIONS: Date: I hereby eHirm thet untler penelry ot perjury thet I em EXEMPT FROM THE CONTRAGTORS �ICENSE lAW for Ihe following reason (Sec. �031.5, Business entl Prafessions Code: Any ciry or county which requires e permit to construct, elter, improve, tlemolish, or repair any stmcture, prior to its issuance, also requires Ihe applicant tor such pertnit to file a signed stetement ihat he or she Is Ilcensed Dursuent to ihe pravislons ot ihe Contractors License Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 ot the Business and Professions Code) or that he or she is exempt iherefrom end the basis for the alleged exemption. Any violation ot Section 7031.5 by any apPlicant tor a pertnit subjecls iha appliwnt m a civil penalry of not more than five hundred dollars (5500).): ❑ I, as owner of ihe property, or my employees wi�h weges es their sole compensatlon, WILL DO 7ME WORK, and Ihe structure is not intended or oHered for sale (Sec. 7044, Business antl Protessions Code: The Contractors License Law does not apply to en owner of property who builds or improves thereon, end who does such work himself or hersetl or ihrough his or her own employees, providod that such improvements are not Intended or oflered for sule. If, however, ihe building or improvement is sold within one year of completion, iha owner-builtler will have the burden of proving ihat he or she did no� build or Improve for purpose of sale.). ❑ I, as owner ot ihe property, am EXCLUSIVELV CONTRACTNG WIiH LICENSED CONTRACTORS to wnsWct the pmject (SecJ044, Business antl Professions Coda: The contractors License Law does no� apply to en owner of pmperty who builtls or impmves ihereon, and who coniracis lor such pmject with a contraqor(s) license pursuant to the Conirectors Licanse Laws.). ❑ I am exempt under sec. Business end Professions Cotle for Ihis reason: Signawre: Data: Owner ID venlied 6y drivers license. ❑ Ves ❑ No Drivefs License No. Vanfication ot Ownership by (rype of tlocument, i.e. - proparty taz bill or deed): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby certify i�at no excavetion live (5) or more feet in depih into which a person is required to descend, will be made in connection with work authorizetl by this permit, and thaf no building strucWre, swttolding, falsework, or demolition or tlismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Californie Atlminisiretive Code). ❑ As owner-builder, I will not employ enyone to do work which woWtl require a permi� from the Division of Indusirial Satety, as noted abova, unless such person has a pertnii to do such work irom Ihe division. SignaNre: Dale: Division ot Indusirial Safety Permit Number: CERTIFICA7E OF CO I AND AllT}iORIZATION_OF ENTRV: I certity untler penalty oi perjury �het I have read this application and state that the infortnation given is correct. I egree to c mply wl�h a state laws entl ciry ortlinances releting to building constmdion, antl authorize representatives of the Cily of Costa Mesa to enter upon �he ebove-described pr perty for insp ction puryoses. I ag�o occupy or allow occupancy ot any building euthorized by this permit until final inspection. tfi16 Fixed System Final Fire Prevention 1266 Pool SDa Finel 200 Final Re-Roof 201 FInaI BIocWRetaining Wall 202 203 Final Factory Fire Place Final Slgn 204 Final Demolition PAIE' IHmULS U I INSPELTONTYPE 206 Final Mechanical 208 Finel Plumbing 270 Final Elecirical 212 Finel Fire Prevention 220 Final Planninq Approval 222 Final Site .250 FinalBuilding/Occupancy Date / -/ L - O , Date � � �l0-9 -03 �' . . • �\ �.._ � �.� . .• B. NO Job Address: 560 W 19TH ST Suite: Vicinity: DEMISING WALLS Parcel Number: 42210320 Applicant: Address: Owner. Address �� l i BUILDING PERMIT Status: ISSUED Applied: 03/22/2001 Issued: 03/22/2001 Zoning: JEHHERY FISCHER -- " �-_ ISSUED BY: 17337 VENTURA BL - � �GJG' __��-� � � r� ��`-.� �-�^,`. 205 / � i; �. �' _Fhone:� 818-501-0145-. ��c-_ �-,� ENCINO CA /� !- ,J ` � � 1 Zip 91316 � � �/�� -� � �� \ . � 1 � � ii i� / � ` � � �� GA VIN VE LP �� \) , ` �` j � _ -/v�� f �� 16485 GARVIN DRIVE. �: : -- �= - ��- �", �-�\,`��" (� 1 �� J1//' \ , v/ j��-. - �- ��,: � J � � //� A�� ., /� i;_ ' -Phone '��OAV��.i � -' \�C\ ENCINO,CA,_� j''��`'� Zip: 914363636 ��"��; �� j �� i��.:�% � �:��\ � � �A �\ l� `:��,A� �� i i��a ��`.. ,�� '\ ��i'�� \�,\ i � . � � � �ii / lf� � fi� Phone:�'� ��`��A �l �\ � //fj%i .� , � _ Y`` ``;l � J �,� Zip:T � /1�I� _ _ �•License:"'� , � � � � �, ��. ` i/ ��/,' �% ,--�' ,�� _ � A � n -_�� vArcli � �` % �l�t �", � ,1 �, �� i ��Eng:� i . � � � \\ ✓�� Address: � -�� , � j �(�. � �`;J ' _ - � - - - �Addresa�i �' ' , � �� ._ � \ �� . —y� ii - --�- �� ! ��v� �- �; � , - _, °-� Phone:` �_ �_ ,�� Phone:�, ' �� , .� r ��,, �/ "��..-� � �� ,' 1 � =- �I ; �� I \2ip: �� '-.� �/ License: �� License:�, L�'� _, , . � i � / 1 ��,-' i i - -- ---- - - -\ f '�!I�il .--� i �� .� ��'�I;- ' i il�'�j �'�,(� ,'/1� SCOP,E OF'PERMIT'/�� ri�C�� Ir_�� I I� � I l�, CONSTRUCT DEMISING WALLS`TO�CREATE SEOERATE UNITS�FOR FUTUTRE SENATS. TESES WALLS ARE PART OF UNI ,` �\ D �RIZED UNDER"THIS PERMIT. PLUMBING SHACL BE�ISSUED AF;TER PCUMBING PLANS ARE j f; �) � - ' \ r�� i �/i�1J � � � r--��.'a... .>,- -_ -.. r`.�, //�11 __ ! �:�K�]� % n �Ii�,.��.��-- �_ , $99.61 �$153.25 i '-' j � � Calc Valuation_ s! ,�_:; Claim Valuation(: i -.,_ � �_.�.. . /, ;��e,.� ��,�� r.,sla,� `��.,. , r�4;, Inspection: � $0 00`\�� -� � , � 'i -.�- �� '✓J \\\ \ �J.a-- � o� 'o o v ( � �r' � o �. }�:.�a r � , �- Total• 5254.54� �, o �''�,, � ri ° �uo f�o � �.o' � �� %/ ln�� ;` p� � � � -o �U o 0 0�0 �� "�� _V`PLANNING:&:ZONING� SETBACKS�� fO��=�`��= � �. - -____ — _ MAW STRUCTURE FionE=`0-�`�Rear ��0-0 � --�Left 0-O�r'� C� / r ` �`v� ACCESSORY Fron�O-�O�b R�rf`-0 �0 ��J �� LeB� 0,�0 �/ ��?�� _i 1JL�� /, PARKING Ezistinq: a NOTES: � � NOTICE: Tha 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 1 BO 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 requlred Inspaetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.ot this permit. FOR INSPECTIONS CALL: (774) 7545626 � r 244fi-48 (N00) WORKERS' COMPENSAT�ON DECLARATION: � I hereby effirm under penalry ot perjury one of ihe following declarations: ❑ I have and will maima�n a certifiwte of consent to self-Insure for workers' compensetion, es provitled for by section 3700 of the Lahor Code, �or the pedortnance of the work for which ihis pe�� is issued. . ❑ I have and will maintai� wa�kers' compensation insurance, as reduired by section 3700 oi Ihe Lebor Cotle, for the perfortnance of the work for which this pertnit is issued. My workers' compensetlon Insurence cerrier end policy number ere: Carrier: Policy Number: (This section need not be cwnp/eted i( the permit is veluetl at one �untlred dollars ($100) or less.) ❑ 1 cerlity [ha[ in ihe pedortnence W the woAc tor which this perinll is issueQ I shalf not employ sny person in any manner so as lo become sub�ect to the workers' compensation laws ol Cellfomia, and egree ihat iF I should become su��ect to the workers' compensallon provisions of Seclion 3700 of Ihe Labor Code, I shall forthwith comply wit� Ihese proWsions. Applicant Signatura: Date: WARNING: FAILURE TO SECUPE WORKERS' COMPENSAiION COVERAGE IS UNLAW FI/L AND SFULL SUBIECT AN EMPIOYER TO CRIMINAL PEWILTIES AND GVIL FlNES UP TOIXJE HUNDRED TTIOUSAND DqlARE (E100,00�1� IN ADDITIIXJ TO iHE CQST OF COMPENSATION, DAMAGES AS PROVIDED WP IN SECTION 3105 OF THE UBOR CODE, INTEREST. MID ATTORNEY'S FEES. LICENSED CONTRACTOqS DECLARATION: I hereby aHirtn that I am IicBnsed under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of �he Business and Professions Code, and my license is in full force and eHect Lia N Cless N Contractor's Signeture: Date: CONSTRUCTON LENDING AGENCV: ❑ I herehy attirtn that t�ere is a construqion lending agency lor iho peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code). Lendar's Name: Lenders Atldress: Signature: Date: OWNER-BUILDER DECLpHATIONS: I hereby atfirtn �hal untler penalry oi pehury ihat I am EXEMPT FROM TXE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Businass antl Professlons Code: Any ciry or counry wnich requires a permit to constmct, alter, improve, tlemolish, or repair any simcWre, prior to its issuance, elso requires Ihe applicant for such permit to file a signed statement iPet he or she is licensed pureuem m t�e provisions of Ihe Conirectors Llcense Lew (Chapter 9(commencing wlth Section 7000) of DlNsion 3 ot ihe Busineu end Professions Code) or thet he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Sectlon 7031.5 by any appliwnt for a permlt suDjects the applicent ro a civll penalry of not more than five hundred dollars ($500).): ❑ I, es owner of Ihe property, or my employees with waqes es iheir sole compensation, WILL DO THE WORK, and ihe structure is not iniended or oHered for sale (Sec. 7041, Business and P�ofessions Code: The Contractors Licenso Law does not apply to an owner of properry who builds or improves ihereon, and who does such work himself or herself or through his or her own emD�oyees, provided ihat such improvemeNs ara nol intended or oflered br sele. If, however, Ihe builtling or impmvement is �Id within one year o� wmple�ion, the owner-builder will have the burden of proving ihat ha or she did not build or improve for purpwe ot sale.). as owner of ihe property. am EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS b construct the project (Sec. 7044, Business and Professions Cotle: The cont ctorS Llcense Law does not apply to en owner ol property who bullds or Improves thereon, antl who contracis for such pmject with a conirac�or(s) license p�a te�tha Contre tor � ense La�s.). ❑ I am exe t r sec. 1'1/ Business and Professions Code tor this reason: __ , _ Owner ID verifi nver license.� ,,,¢s ❑ No Drive�s License No. Venfication of ship y(rypa oi tloc ent, i.e. - propeny tas 6ill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify Ihet ntl excavation five (5) or more feet in tlepth into which a person is reqWred to descend, will be matle In connec�ion with work authorizetl by this permit, and that no builtlinq structure, scaffolding, talsework, or tlemWNion or dismantling thereot, vriif be more ihan thirty-si: (36) feei hlgh. (Chap. 32, Gry 2, An 2, Sec. 347, Title 8, Califomia Administrative Cotle). ❑ As owner-builder, I wlll not employ anyone to do work which viould require a permit irom t�e Division ot Industnal Safery, es noted ebove, unless such person hes a permit to do such worN from the division. � Signature: Date: Division of Industnal Safe�y Permit Number: CERTIFlCATE OF OMP /WCE AND AUT}fORIZATIONOF ENTRV: I certity under penalty of perjury thai I have read this appliwtion antl stale Ihat the infortnation given is correct I agree t co p� � ih ell state laws an ciry ortlinances relating to builtling consimction, entl authonze representatives of �he Cily of Cos�a Mesa to enter upon ihe ebova-descnbad p op f inspection p rp ses. ee no b occupy or allow occupancy of any building authonzed by this permit ntil final/�nspection. � �ZZ(6 I �Sign�l re.Ot, aal. ner(s) y COpE �. INSPECTIONTYPE 1616 FixeG System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 207 Finel BIocWReteining Well 202 Final Factory Fire Plece 203 Final Siqn 204 Final Demoli�ion ' Qd¢,' 1[1iITIALS SODE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Appiovel 222 Final Site �250 FinalBuilding/Occupency OATE INTRI�LS (714) 754-5273 • Fax (714) 754-4856 •�+v+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 SIGN PERMIT .lob nddress: 560 W 19TH ST Suite: Viciniry: Status: ISSUED Applied: 72/06/2001 Issued: 12/O6/2001 Parcel Nunmber: 42210320 Zoning: _ _ - - - - - - - _ ISSUED BV: � i��„-'c'c y =. � _ npp�icant: HENRY ESTRADA �l� � � - - � ' � �-, Address: -' / �— �- ` � , —, 1 ' :__ �, � �=� j %/i _ � . ' Phone: 323-888-1935. � / /AV�� , j ,� _ , � . , . ; Zip � . ' � / � � / �i �� '� � . _ _ i . - � �A�� . \\\ Owner. �EFFREY-A.�FISCHER� � � � i\v \�� Address ' 17337VENTURABLVD�#205 =� --�" � !�� `�' � ,A - ,� A�AV� '" . ; � � `• : � Phone: (818) 501-0145 � � '� �� / ` �� 1 � �, , ; ," �.ENCINO.CA j,� � � � Zip: 91316 V�V �i� ��.AA� : � ,/...i/- ��`✓� \ ��. ,, ;, ��.�� Contracror: MARTINEZ ELECTRIC � �� ' V �' � .' - Address: 825 5 MAPLE AVE � � � `�� /� , . ` �'��'�, � , � .- UNI7 B � . Phone: � 323-888-1935 _ A; A�� .,A / � � �� ` - ,� � , MONTE8ELL0, CA - _ � Zip:; 90640.. .' �= . . - ; � P' `` `' ` � �� ', � �� ' . . . . - - ,Licensei =432339�� - ' �; �� '� . �, . � � , ,��1, Arch / Eng : . ' , � - � _ _ � - - , � � = � �- � V' � � , : � Address i � � - - -�- . - _' � . . , • � � �� '�, . ..� / � _ � - Phone: � \ ��j �� `��t 1 � \ � � � . , � � _ Zip: � -� � , _ , � � ' ' License: A �, � . .. � . / " ' - - - � - - � � , - � � - - - �. I ., ' � �, . i " . ,. / „ , �JGVNt VI-lNtKMI I"; �l/ AV' V � � � , . 13.5 x 14 sf" PAYROLL ADVANCE"illu �inated wall sign�for check�ca`shing business . �- - i '„ � , .::� ' Plan Check; � Permit: SMIP Corri: Other: inspection: Total: � NOTES: $41.05 �- $0.00 "' $63.15 $0.50 $�.�0 $0.00 �$0.00 �$0,00 .. �. $0.00, �='. �$104.70 � � � �- - -FEE-SUMMARY/,'r�^.-_ _ ��;� ',.� � -,� - - � � ;� - �' Calc Valuation � : $i,soo 00 � � , � �, _ � ,' ; � ,�� ' Claimed Valuation. ;�„ `$i;soo.00 � , _. . . , i � � , ;.i ! ,,. , -•• i �� T . % '/� ` - � , �;� �,-; ;::�_ �%� ). �' '% � , � _. , ,'� � : � / • �/ i� � i �� , ..�.'% � /l�\%/' ��%/� ; � � %-��/ PLANNING & ZONING A�`�� - �' ,%ii � � �, , � �� ' �, , 'ii�, ' .. `,�., . . -" -ii,"- ,. , _. -� . - � 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 wilhin 180 days, or if work is suspended or abandoned tor a period ot 180 days. INSPEC710NS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapectlons and final approval must be obtained. Failure to obtain inspections and (inal approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 zaauae (aroo) WOHKERS'COMPENSAnON OECLARAnON: - � . - I hereby aHirtn under penalty of perjury one oi the following declarations: ' � I heve end will maintain a certificate ot consent to selt-Insure tor workers' compensation, es proviCetl for by section 3700 ot Ihe Lebor Code, tor the pertortnance ot Ihe work lor Which this pertnit is issuetl. ' ❑ I have end w�� maintain workers' crompensation insurance, as required by section 3700 ot Ihe Labor Code, for the peRortnance of the work for which Ihis pertnit is issuetl. My workers' wmpensation Insurence carrier antl policy numbar are: � Cerrier: Policy Number: / is section nBed not be completed if the permit is veluetl at one hundred dollars ($100) or less.) .- 1 certity that in the pertortne af the work Por 1'ch this pertnit is issueA, I shall not employ eny person in eny manner so es to become subleM �o the workers' compenseiion laws of Calit mi , end agrea Iha if should become sub�ec[ to Ihe wo rs' compensation provisions ot Section 3700 ot the Labor Code, I shall fanhwith camply wi�h these io s. �ApplicantSigna�ure: �iCi Dete: ��EL�� WARNING: FAILURE TO SECURE WORKERS' CAMPENSATIIXJ COVERAGE IS IINUWFUL PND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN GVIL FINES UP TOONE HUNDRED THIXISPND DOLlARE (5100,000), IN ADDITIIXJ TO THE C0.5T OF COMPENSATIDN, DPAUGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATfOqNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I I here6y aHirm ihat I am licensed under provisions ot Chapter 9(commencing with Section 7 00) of Division 3 of Ihe Business a�d i r� ssions Code, and my license Is in full fome and eflect. �c. # �/i Class k � ComrectolsSigneture: � / oata: 'j�^ �'d� � e CONSTRUCTON LENDING AGENCY: ❑ I hereby ah�� that there is e construction lentling agency for the peAormance of Ihe work tor which t�is permit is issued (Sec. 3097, Civil Cotle�. Lender's Name: Lender5 Address: Signature: Date: OWNER-BUILUER DECLAHATONS: I hareby aHirtn Ihel untler penalty ol peQury Ihat I em E%EMPT FROM TME CONTHACTORS LICENSE LAW lor Ihe tollowing reason (Sec. 7031.5, Busin¢ss end Proleaslons Cotle: Any ciry 0� counry which requires a pertnit to construc4 alter, impmve, demolish, or repair any slrucWre, pnor to i�s issuance, elso requires the applicant for such pertnit to file a signed 5�atement ihet �e ar s�e is licensed pursuant to the provlslons of the Contrectors IJcense lsw (Ghepter 9(commandng with Section 7000) of Division 3 of the Business and Professions Code) ar thet he or she is exempt therefrom and t�e basis for Ihe elleged axemption. Any violation ot Section 7031.5 by any epplicant for a permit sub�ects ihe epplicant to e civil penalty of not more than five hundred dollers ($500).): . ❑ I, as owne� of the property, or my employees with wages es their sole wmpensation, WILL DO THE WORK, and the structure Is not Intended or otteretl for sale (Sec. 7044, Business and Prolessions Cotle: me Coniractors License Law tloes not apply to en owner ot Droperry who builds or improves Ihereon, and who tloes such work himself or herself or through his or her own employees, provi0etl that such improvements are not Iniended or oHered for sale. 11, however, the builtling or improvement Is sold within one year of completion, the owner-builtler will have the burden of proving that he or she did not build or improve lor purpose ot sale.). ❑ I, es owne� o� the property, em EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct Ihe project (Sec. 7046, Business and Professions Code: The comractors License Lew does not epply to en owner of Oropeny who builtls,or Improves thereon, antl who conirects for such prolect with e contractor(s) license pu�suan� to the Contrectors LiCense lews.). ❑ I am e:empt under sec. Signature: Owner ID verifiad by tlrivers license. ❑ Ves ❑ No Business and Pmfessions Code for this reason: Verification ot Ownership by (rype ai tlocumenL i.e. - property tac hlll or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATON: Drivers License No. Date: Expires: ❑ I hereby cBrtify that no excevation five (5) or more feet in depth Into whlch e person is required to descend, will be made in connectlon with work authodzed by this permil, and �hat no building sirucWre, scallolding, falsework, or tlemolition or dismantling Ihereof, will be more than thirty-six (36) leet high. (Chap. 32. Grp 2, Art 2, Sec. 341, Title 8. Califomia Atlministrative Code). ❑ As owner-builder, I will not emplay enyone to do work which wo�ld require a parmit trom Iha Division oi Industrial Sefety, es noted above, unleu such person hes e pertnit to tlo such woAc Irom the tlivision. SignaWre: Date: Division of Intlus��al Safery Pertnit Number. ICERTIFlCATE OF COMPLIANCE AND AUfHORVATION OF ENTAY: I cenity untler penelty ol pehury ihat I have read this ap0licetion entl slate that Ihe inlortnation given Is correct. I agree to com ly with ell te lews and city ortlinances relating to Ouilding wnstmction, en0 euthonze representatives ot iha Clry ot Caste Mesa to enrer upon the above-descnb�o� rt tor inspe urp�ses. I egree not to occupy or allow occupancy of eny building authonzad by Ihis pertnil un�il linal inspection. cooe �. �NsvecnpNTYPE 1616 Fi:ed System Final Fire Preventian 1266 Pool Spa Final 200 Finel Re-Root 2U1 Final Bla�klRelaining Wall 202 Finel Fac�ory Fira Place 203 204 Final Sign Final Demolition �� — �� Date �NfRIALS 90DE1 INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbinq 210 Final Electncal 212 Flnal Flre Preraniion 220 Final Planning Approval 222 Flnel Site 250 Final BuiltlinyOccupancy PA7E �� 1�Lfl (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 560 W 19TH ST Suite No Vicinity: Parcel Nunmber: 42210320 Applicant: JEFFREY FISCHER Address: Owner: GARVIN DRIVE LP Address 16485 GARVIN DRIVE ENCINO, CA Contractor. . .. - Address: Arch / Eng : Address: ISSUE FEE . BackFlow irngation \ 8ackflow Preventer . -. Bathtub Clarifier System Connect pce,Soda,etc) Dental Unils Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Founlain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oi Interceptors (Sand Auto Phone: 818-501-0145 � 2ip: Phone: Zip: 9143G3636 Phone: Status: ISSUED Applied: 05/03/2001 Issued: 05/03/2001 ISSUED BY: � Zip: � License: � � _' -� . , , ' . ._. _ l .' _.�,Z' . � . r" � _ _ �' f- � . " _ . _ . .. . . _. . . . .. l i .. Phone: ' �.,-'„ _ ' i . � --- --_ --Z�P� -- - - � - - �-- , .. _ c. " ��^-' _ __. License: ' ' � � . SCOPE OF PERMIT ' %_ INSTALL 1BACKFLOW FOR IRRIGATION AND 1 IANDSCAPE IRRIGATION FOR NEW BUILDING, RE:B00-00846. - • -i � � � FEE SUMMARY � � ' _ AMT ..�QTY - �' : . ',. ' �. � ' AMT �,QTY �� -^'-7 �%j', i5725 ��-� � -Laundry•Tubl-Washer� �-„ $000 „0 ,i 8ump : 5980 � 0' � , 1� Landscape)rrigation - -.„$14:80 :. 1'�� Swimn �5000/"1� ��\:P_Srap�% : . � $0�00 0�/ Trap�F $0.00��; �0"� '--PressureRegulator ' $0:00�'�0!� /.Uririal� 50.00 . . 0 % � � Process Piping (per 10 ft) �- �-30.00 0 ��.\�Vacuu .$0.00, 0� . �� ; �Receptors - $0.00 � 0 ,`� � ��, Vacuu $0.00 ` 0 "( SepticTank -$0.00 '�0 � � � Wash; " IERqAL , _ ` ' � / C � / i � � � � AMT � � / $0.00 � � $0.00 � : �� 50.00 � /, _ � $0.00 kflow(1-4) 50.00 kflow(5+) $0.00 $0.00 $0.00 -� .�0 �-� -- _ Sewer Cap for Demo � $0.00., - �0 � 'i Wash:Basin Set $0.00 $0.00 ' �0; .,_-, Sewer Connect � �, � 50.00_ -- 0 � .,�GWaste and Vent System $o.00 $0.00 0 � �Sewer Private Line " � $0.00 _ 0-, y.%; .��VJater Closet (Toileq $0.00 $0.00 0 � Shower , _ -$0.00-�%!0� = ' - Water Heater / vent 50.00 $0.00 0 Sink,- bar � - " ` ' . �_ $0.00 - "-0 Water Piping pnst or Rep.) $0.00 $0.00 0 Sink, wmmercial $0.00 0 Water Re-pipe $0.00 $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 I) $0.00 0 REINSPECTION $0.00 ) $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: E31.85 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlons and (inel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2ae-as �aroo) WORKERS'COMPENSAnON DECLARAnON: I hereby eflirm undar penalry of per�ury one of t�e �ollowing tledarations: . ❑ I heve end will maintain e ceNficate of con4ent to selbinsure tor workers' compensatlon, es provitletl for by sedion 3700 of Ihe Lebor Cotle, for ihe pertortnence at the work for which Ihis permit is luuetl. ❑ I have and vrill maintain workers' compensetion insurer�ce, es requireG Cy secUon 3700 ot �he Lebor Code, for ihe peAortnance of the wak for which this pertnit is Issuetl. My workers' compensation Insurence cerrler entl poliq number are: .. Certier. Poliry Number' (This sectiar need nof be canpleted il fhe permitls velued af one hundred dollars ($100) or less.) ❑ I ceNiy that in Ihe pertormanca of the work lor which ihis permit Is issued, I shell not employ eny person in any manner so es to become subiect to the workere' compensetlon laws oi Califomia, end egree thet If I shaultl become subjecl to tha warkers' compansation proNSions of Secllon 3700 of ihe Lebor Cotle, I shall fort�with comply with these provlsions. Applicant Signeture: Date: WARNINO: FAILURE TO SECURE WORI(ERS' CDMPENSATION OD�ERAGE IS UNV.WFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND qVIL FlNES UP TO ONE HUNDRED TFIWSAND DOLURE (E100.000), IN ADDITION TO TNE �T OF COMPENSATIIXJ, �MNGES PS PROVIDED FOR IN SECr10N 3]OB OF THE UBOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS OECLARATION: I hereby atlirtn t�et I am licensed under proNsionS ot C�apter 9(commencing wi�h Section 7000) ot DiWsion 3 oi ihe Business and Protessions Code, antl my license Is in tull torce end ettecL Lic. # Class q Contractors Signetura: Date: CONSTRUCTON LENDING AGENCY: ❑ I heraby ettirm thet ihere is e constmctlon Isntling agency for the peAormence of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). Lendera Nema: Lendefs AddreSs: Signelure: Dete: OWNER-BUILDER DECLARATONS: I hereGy effirm t�et untler penalry ot perjury that I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe lollowing reeson (Sec. 7031.5, Business entl PrOfeulons Code: Any city ar county which requires a parmlt to construcL alter, improve, d8moli5h, or repair any structure, prior to its issuence, elso requlres the epplicant for auch peRnit to flle e si8netl statemem that he or she is Ilcensed pursuaN to Ihe prodslons ot the Comrectoro License Lew (Chapter 9(commendng with Section 7000) ot DiWsion 3 0� the Business and Protassions Gode) or thet �e or sde Is exempt thereirom antl I�e basls br t�e elleged exemption. Any NoleHon oi Section 7031.5 by any applicant for e permit subjeds the applicent to a civil penelty ot not more then five huntlretl Aollare ($500).): ❑ I, es owner of iha properry, or my employees wlih weges es their sole compensation, WILL DO THE WORK, end the structure Is not intendetl or oHared for sale (SeG. 7044, Business and Professlons Code: The Contrectors License Law tloes noI apply to en owner ot property who 6uilds or Improves Iheraon, and who Uoes suCh wo�k himself or hersetl or ihrough his or her own employees, provided Ihat such Improvemenis are not Intended or aHaretl tor sale. If, however, the building or improvement is sold within one year o1 completion, the owner-builder will have the burden of proving that he ar she did not builtl or imptove lor purpose of sale.). ❑ I, es owner af ihe properry, am EXCLUSIVELV CONTRACTNG WITM LICENSED CONTRACTORS to cons�ruct ihe O�alect (Sec. 7044, eusiness end Proteulons Coda: Tha contractors License Lew tloes no� epply to en owner ot properry w�o bulltls or Improves thereon, antl who contreds for such project with e contrectoqs) license pursuent tp.t nirectors License Laws.Z ❑ I am eaempt untl�r �. Business antl Prolessions Coda tor this reason�� _ � ISigneture: \ Owner ID veritied by d e cens . Y ❑ No Drivefs License No. Vedticetion of Ownersh� (rype I documem, I.e. - properry tax bill or daetl): DIVISION OF INDUS7qIAL SAFETY VERMR CEAnFICATION: Expires: ❑ I hereby certify that no excavatlon five (5) o! more teet in depth into which e pereon Is required to descend, will be made in connection with work euthorized by t�is permit, and that no builGing structure, sceH0lding, telsework, or demolitlon or dismantling thereof, will be more than thirty-six (38) teet high, (C�ap. 3.2, Grp 2, Ar12, Sec. 341, Titla 8, Califomia Atlministrative Cotle)� ❑ As owner-6uilder, I will not employ enyone to do work which would require e permi� trom Ihe Division af Industrial Sefery, es noted ebove, unless such parson has a permit to do such work irom the division. Signeture: Date: Division of Indusirial Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTTIOH17AnON OF ENTRV: I certity under penalry ot perjury that I have read this appliwtion and stete that the information given' correcL I egree t�o�q mply with ell stete laws entl ciry ordinances releting to building consiruction, and euthodze representatives oi ihe Ciry ol Costa Mesa to enter u the abova-descdBpQ;ldidY� for in9pe ' urpps�es. I egree not to occupy or allow occupan any builtling authorized by this permit until final inspection. XY � S �� l n�+ I —/�, %� 51 atu Of Legal Owner(s) —�' /— Date yOUE t. INSPECTIONTYPE 1616 Fixed SyStem Final Fire Preven�ian 1266 Pool SDe Final 200 Finel Re-Raol 201 Flnal BIocWRetaining Well 202 Final Fectory Fire Placa 203 Flnal Sign 204 Finel Demolition Q�¢. �$ �� INSPECTIONTYPE 208 Final Mec�anical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Flnal Planning Approval 222 Final Site 250 Final Builtling/Occupancy P�I& L�Lff % �� (714) 75a-5273 • Fax (714) 754-4856 • wviw.ci.costa•mese.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 � 1ob Address: 560 W 19TH ST Suite No B Vicinity: PAPA JOHN'S PI77J1 (UNIT B) Parcel Nunmber: 42210320 Applicant: O'KEEFE, JIM Address: 75007 OXNARD ST VAN NUYS, CA Owner: GARVIN DRIVE LP AtldreSs 16485 GARVIN DRIVE ENCINO, CA PLUMBING PERMIT Phone: 818-781-9481 ' Zip: 91411 Phone: Zip: 914363636 Contractor: BLUEWATER RLUMBING 8 FIRE PROTECTION INC Address: 15007 OXNARD ST VAN NUYS, CA ` Arch / Eng : ' Address: � Phone: 818-781-9481 Zip: 91411 License: . 598461 - - - - . . . �- �. � ♦ _✓/�_ . .�1 _ � .W �' -. �. Phone: ---��P� - - ' - � � � • _ _ License: � - ',�� / Status: ISSUED Applied: 04I132001 Issued: 0 411 3/2 0 0 1 ` ISSUED BY: SCOPE OF PERMIT "-- �i,' � � ' -� �� SUPPLEMENTAC PLUMBING PERMIT FOR TI AT "PAPA JOHN'S PIZZA" IN UNIT B. 1 WASH BASINr ,�� j 1 WATERCLOSET. :-- --. - � .��: ' �, -' � i � ; - - REF: P00-00590 8 B00-00846 ,' �� ' i /'� `� / - � , . , . . " � - i'% . �!. . i-•--_-';�.. ..� FEESUMMARY ., r.;�-�,-'._ ..� , AMT �.�TY� . �� . � ' -� �. AMT pTY ISSUE FEE :\ �, $7 25-� A:�� Laundry TubY Washer �„ $0:00 - 0 ��` Backflow irrigation� �j $0 00� '0 � Cendsce e Irn alion � � � �. , �:�._ P 9 l� _3000 0,/i, BackBowPreventer '� $000 / 0� . �P-Trap� � , � _ $0�00 =-0% Bathtub ' �� $0 00 -,,� ,0� � � Pressure Regulator � $0.00� 0 Clanfler System , $0.00. '0��. �, �- , Process Piping (per 10 ft) $0.00 .-, � 0�� Connect (Ice,Soda,etc) �50.00 � ,0 , Receptors , , �, $0.00 . �; 0, A Dental Units 50.00� ".0� , � Septic Tank i, 50.00. :',0 `�% Dishwasher 50.00 �'�0 - � Sewer Cap for Demo - - ` $0.00 -� "0 ' ; �, rain, oor . � , ewer, onnad .00 - �6//" Drain, Rainwater 30.00 0 � -Sewer Private Line - ,:30.00 "- �0 -� � Drain, Root 50.00 0 Shower ._=_ _-- 50.00 0 Drinking Fountain 50.00 0 Sink, bar $0.00 0 Expansion Tank 50.00 0 Sink, wmmercial $0.00 0 Gas Earthquake Valve 50.00 0 Sink, Floor $0.00 0 Gas (1-4 outlets) 50.00 0 Sink, kitchen $0.00 0 Gas (Over 4 outlets) 80.00 0 Sink, service/mop $0.00 0 Gas Repipe 50.00 0 Spa (private) $0.00 0 Gas Service 50.00 0 Spa (public) $0.00 0 Interceptors (Grease, Oiq $0.00 0 Interceptors (Santl Auto ) $0.00 0 . �;, = i � �%� //\ i,> / �Sump,PumD�j �J � Swimming Pool �� „ ( Trep Brimer� � ` V� Unnaf � � Vacuum Brkr Bkflow(1-4) �- Vacuum Brkr Bkflow(5+) Wash Basin Set Wasle and Vent System Water Closet (Toilet) Water Heater / vent Water Piping pnst or RepJ Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $9.80 ao.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CAICULATED FEES: 526.85 QTY 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 NOTICE: The work authorized by lhis permi� shall comply with all applicable handicap access reQuirements untler Calitomia statutes and related regulatlons. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 / 2aa8-a6(6�o0) WORKERS' COMPENSATION DECLARATION: I �ereby etfirtn untler penalry ot per�ury one ol the following decleratlons: ❑ I hava end wili meintain e certificete of cansent to sell•Insure br workers' compensation, es provltleG br Oy seclion 3700 ot the Lahor Code, for the peAormence of Ihe work fa wNch Nis pertnit is issued. �I here arM will malntaln workers oompensatW� Insurance. as repuiretl by sectbn 3700 af the Lebor Code. tor Na peAormence of Ne work for whkh Ihis pertnit is issuetl. My workers' comp9nsation ip5urence cerd r and Ilry number ere: Ql-.4--ri Cartier. �c�ar.•�.�•ca /y%� t �e� �..�5. �O PWicyNum6er A/ �..1 C. O! Z.S S�—O�D (Thf9 BBCfbn nBBdOOf bB COrt1pIBfBd I! NB pBrtl1/N9 VBWBC B! dIB undred dollars ($�0(!f or less.) ❑ I Cenify that In t�e DeAormance oi Ihe work �or w�lch Ihis permll Is issuod, I shall nat employ eny person In eny menner so as to become sub�ect to the workem' compensatlon laws of Celitomla, end epree �he� II I should become sub�ect to the workera' compensellon proNslons ot Sectlon 3700 0l Ihe Lebor Code, I shall fon�wit� compty e praNsions. � � � _ / ApPllcamSlgneNre� L�--��/1J--- oa�e: � /3-�/ WMNINO: FNLURE TO S$ �M'OFNEFS' COMPENSATION CAVEw�yE IS UNLAWFUL AND SMALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES PND CIVIL FINES UP TOONE MUN�RED T/qUSPND OOUARE (S�ll%1,000),`iN ADDRION TO THE C�T aF C�DMP�fJSATION, DNMGES AS PflWIDED WR IN SEC71pJ 3%OB OF iHE UBOR CODE, IMEREST, AND ATTORNEI^S FEES. UCENSED CONTRA TO �ECLARATION: I hereby atfirtn that I em Ilcensed under provislon4 a� Chepter 9(commencing wilh Sectlon 7000) of Division 3 ot Ne Business end Professions Code, and my Ilcensa Is in lull torce entl ettect. Class p Contractofs5igneNre: Date: �/.� O/ I CONSTRUCTION L DING GENCY: i ❑ I hereby eiti that th is e construction Ip�tling egency tor the peRortnance ol Ne work tor w�ich this pertnit is i55ued. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Address: SlgneNre: Date: OWNER-BUILDER DECLARATIONS: I hereby etflrtn Ihal untler penfllty oi per�ury thet I em E%EMPT FROM THE CONTfiACTORS LICENSE LAW lor t�e tollowing reawn (Sec. 7031.5, Business end Professlons Code: My Gry or counry which requires e permit ta construct, alter, Improve, tlemolish, or repeir eny structure, prior to its issuance, elso requires t�e epplicent tor such po�it b tile e signed statement thet he or she Is Iicens�d pursuent to ihe proNsions of the Contrectors Llcense Lew (Chepter 8(wmmencinq with Section 70W) of DlNslon 3 01 the Business entl Professions Cotle) or thet he or sha Is exempt Iherefrom end tha basis for the elleged exemption. Any Ndatlon ot Section 7031.5 by eny epplicant for e De�it subjects the applicant ro e civll penalty of not more than tive hundred dollers ($500)J: ❑ I, es owner ot Ihe properry, or my amployees wilh wages es Iheir sole compensatlon, WILL DO THE WORK, enE t�e structure Is not imantleC or ottered tor sele (Sec. 7044, Business and Professions Coda: The Contrectore License Lew does not epply to en owner ol Oroperty who builAs or Improves ihereon, antl who does such work hlmseli or �erselt or through his or her awn employees, provided ihat such Improvements ere not IntentleA or offered lor sele. II, hawever, ihe building or improvement is sdd within one year oi completion, the owne�-builder will heve lhe burden ot provinp Ihat he or she did no� buil0 or Impmva tor purpose oi sale.). ❑ I, es owner of the property, em E%CWSIVBLV CONTRACTING WITH LICENSED CONTBACTORS to consWct the projed (Sec. 7044, Business end Prolessions Cotle: The wntracrore lJcense Lew tloes no� eppry lo en owner ol property who �uiltls ar improves thereon, end who comracts lor such pro�ect wilh a contractor(s) license Oursuant to t�e Contreaors License �ews.). ❑ I am exemp� unOer sec. Signature: Busineu end Protessions Cotle br ihis reason: Owner ID ve�itietl by tlrivefs Ilcense. ❑ Ves ❑ No Drivers License No. VeAficetion ot Ownership by (rype ot Cocumenl, i.e. - praperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CkAnFICATION: Date: Expires: ❑ I hereby certily thai no escavation tive (5) or more leet In depih Inio which e person is requlred to descend, wlll be me0e in connection with work euthoAzetl by ihls pertnii, and ihat no building struCture, sceflo�ding, telsework, or demolition or Cismantling thereol, will he more Ihen �hirry-slx (38) feet hiph. (Chep. 32, 6rp 2, Art 2, Sec. 341, Title e, Celitomla AdminlstreHve Catle), ❑ As owner-Duiltler, I wlll not employ enyone �o do work which woultl requlre e permit from the Division of IntlusMal Sefery, es notetl above, unless such pereon �as a pertnit to do 5uch WOrk from lhe tllvision. SignaNre: Date: Divislon o1 Industrial Safety Pertnit Number: CER7IFlCATE OF COMPLIANCE AND AUTHORI7A710N OF ENfTiV: I certify untler penelty of perjury thel I have reatl �his epplication entl s�ate ihat the inlormatlon given Is conect. I egree to wmpty with all state lews end ��7 or0inences relating to huiltling constructlon, end euihodze representaiives of t�e Ciry at Casta Mese to enter upon Ihe ebove-descnbed property for Inspection puryoses. I egree not to acupy or allow accupency ot any building authonzed by this pertnii until linel inspec�ion. ��7.�I�I:Iiii/PF9 Fi:etl 3vstem Final Fire Prevention 1266`AeOfSDa Finel 200 Final RaRoot 201 Flnal Biock/Retaining Well 202 Final Faaory Fire Place 203 Final Sign 204 Final Damolition 'i7� � �'D ! _ _-_ � Data CO�E� INSVECfIONTYPE 208 Final Mechanfcel 208 Flnal Plumbing 210 Final Electncal 212 Final Flre Preventi0n 220 Final Planning Approval 222 Final Site 250 Final Building/Oaupancy �eg Ir�ELi o- •03 � (714) 754•5273 • Fax (714) 754-4856 . www.ci.costa-mesa.ca.us TI FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite: $ Vicinity: Parcel Nunmber: 42210320 npplicant REZAC, GARY ' Address: - � - � . � ', i ' � . Owner:/ARVIN DRIVE LP Address . 16485 GARVIN�DRIVE - ' - ENCINO, CA, �'�- Contreaor. � SWAIN SIGN INC. Address: 1384 E 5TH ST. ," / `� � � ONTARIO, CA . Arch I Eng : Address: SIGN PERMIT Zoning: Phone: 909-460-2530 . . Zip. � Phone: Zip: 974363636 Phone: , (909) 460-2530 _ � 2ip: � 92714 � � License: 643004 � � � � Phone: Zip: � License: Status: ISSUED Applied: 02/OS/2007 Issued: 02/05/2001 ISSUED BY: . � � � \��, � \��A ��\ ` " . A ` � � . _ SCOPE OF PERMIT � _ _ ; � ' � � " ,� INSTALL (Z) 22.5 S.F. WALL SIGNS (1 ON EACH ELEVATION) FOR PAPA JOHN'S PIZZA TENANT. �� ELECTRICAL BY GENERAL CONTRACTOR PER APPLICANT. ' .> � ' ' % i � �- - � FEE SUMMARY,' . � � h � � � � � _ �, � , � � , PIan�Check: $54.17 � Calc Valuation: ��ss,000.00 `� A , ' , $0.00 '�� ' � .� % l l�AJ � � .� •. .. � , - . ir � : � �, ri c�. Permit: $83.25 -_ . Claimed Valuation: / 53 000:00 � SMIP�Com: ��, $0.63 � i��5 <�� 'Other:i $0.00 ;''"� � ;�i � l, � , � V � � � ` , . $O.OD - ; �i� / / ` _. $O:Op � � �� -- • �i ;� � � / � -$O.OD�� . ,. , _ � ;�� '-�. 1 � � �i,� / ��j$O,OD' � � � , � . . . ��-�� `��\ </ � �` �\��. � �., .� � ��(/ .�� Total. A ��:A 5137:99 � � ' - _ ' �j� � �� / �� _��, �; /;`^1 _ � - ` �- _ ' , � _ �� / ;i,�i ` � �� ; � PLANNING & ZONING � V�, `- � /�i NOTES: \ '� \ � . / �; , \ 'i , . -' / j/ � ,/ � < i' � b NO710E: The work authorized by ihis 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 suspentled or abandoned for a period of 180 days. INSPEC710NS: In order for tha work authorized under this permit to be considered legal, such work must comply with all appiicabte codes, and all required inapections and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiratiortof this pertnit. FOH INSPECTIONS CAIL: (714) 75d-5626 z++sae ls�oo) WORKERS'GOMPENSATONDEG�AnON: - , � � I �ereby aKrm under penalry ot perjury o�e ot the following tlecleretlons: ❑ eve end will malntein e certi�cate ol consent to sell�lnsure lor workers' campenselion, es provldetl tor by section 3700 of Ihe Lebor Cade, tor the pertortnence of Ihe work tor which Ihis permit is Is5ue0. I have end will mflintein xroAcere' comPensetion �nsurence, es requiretl by section 3700 al the Lebor Code, tor Ihe peAortnence of Ihe wwk lor which Ihis pertnil is issuetl. My workere' compensetion Insurance cerrler a7 d pollcy number ere: Cerrior. S%�� I'✓ h U NU Policy Number. O t% �I � I�J R�� — � v (lhls sectlon need not be comp/oted I/ rhe permlNs velued er ono hundretl dol,'ars (5100) or less.) ❑ I cenity t�et In the perfortnence o1 Ihe work for which ihis permll is icsued, I shall not employ eny person in eny manner so es to bewmo subject to the workere' compensatlon laws of Cellfom�a, end egree thet II 1 shoultl Oecome sub�oct to Ihe workers' compensetion provislons ol Sectlon 3700 0l t�e Lebar Cada, I shell fonhwith com Iywith.theseproNsions./' j �1 ApPlicent SlgnaNre;� / �"1 �-Vi �GLL�/ Oata: � S/ V� WARNING: FN i7EUL�0 SEd1RE WORKERS' , S4TON E IS UNUWFl1L AND SHALL SU&IECf AN EMROYER TO CRIIAWIL PENALTIES r1ND CML FlNES UP TOONE MUNDRED T11dISANDDOLLARE(S10p,000�.INADpmOf�1T0 EWSTOFWMPE TIIXJ,DANAGESASPROVIDEDFORINSECf10N3%OBOFTHEUBOHCOOE,IMEREST,ANDATTOfiNEY'SFEES. LICENSEDCONTRACTORS DECLARATION: I here6y aflirm thet I am Ilcens�under provisions of Chapter B(commencing wtlh Sectlon 7000) of Divislon 3 ot the Business antl P�ofessiorns Code, an0 my licanse is In full brce end ettect. ��c. a 4' � O o�{ n Class 8 G` 4 j Contrecmrs Sfgnatu�: l,�a�J i1.f'� Dete: _� � CONSTRUCTON LENDING AGENCV: ❑ I hereby aKrtn Uat there is a c�shuction lentling egency tor the peAormance of the work for wNch this pertnit is issued. (Sec. 3U97. Civil Code). Lendefs Name: Lendefs Address: Signature: Date: OWNER-BUIL�ER DECLARATONS: I hereby eMrtn thet under penalry of Perjury that I am EXEMPT FROM THE CONTFiACTORS LICENSE LAW lor tha following reason (Sec. 7031.5, Business and Professlons Code: Any city or caunry which requires e pertnit to canstruct, elter, Improve. tlemolish, or reDalr eny structure, pnor to its issuanca, elso reqWres lhe applicant for such pertnit to file a signed stetemem Ihet he or she Is Iicensed pursuent to the provisions oi the Coniractore License Lew (Chapter B(wmmencing with Section 7000) of Dlvislon 3 of Ihe Business and Professions Code) or t�et he or she is ezempl therelrom end the �asis far Ihe elleged exemption. Any violatlon ol Section 7037.5 by eny applicent tor e permit sub�ecls Ihe epDlltent to e Clvll penalry ol not more than tive hundred dollers (5500).): ❑ I, as owner o� Ihe property, or my employees with weges es thelr sole compensetion, WILL DO THE WORK, and the structure is not intentleG or oflered for sale (Sec. 70aa, Business and Prolessions Code: The Contrectors License Lew does not epply to an owner ol property who builtls or improves thereon, and who does such work himselt or hersetl or ihrough his or her awn employees, provided thet such improvements ere rrot Intended or oHered for sale. II, however, the building or improvement is sdd within we yeer o1 comde��on, the or.ner-builder wlll have the burden ot proving Iha� he or she did no� build or Improve tor purpose ot sale J. ❑ I, es owner of Ihe proporry, am El(CLUSIVELV CONTRACTING WITN LICENSED CONTRACTORS Io construct t�e prolocl (Sec. 7044, Businass end Professlons Code: 71ie comredors Uceree L.ew tloes not eppty ro en owner of pmperry who builds or Impmves lhareon, end who contract5 �or such prqect with e conirector(s) Iicense pursuenl to �he ConlreGtors License Lews.). ❑ I am exempt untler sec. Signeture: Ownar ID venfietl �y tldver's Ilcensa, ❑ �es ❑ No Business and Pralessions Cotle tor Ihis reason: Vedfiwtlon of Ownership Dy (type ot tlocumenL i.e. - propetly tex blll or deod): DIVISION OF INDUSTAIAL SAFETY PERMR CERTIFICATON: Dnvers License No. Date: Expires: ❑ I hereby certity that no excavetion tNe (5) or more leet In tlepih into which a person is requlretl to descend, wlll be matle in connectlon with work authodzatl �y ihls permit, and Ihat no building siN�lure, scalfolding, lelsawork, or demolition or dismantling t�ereol, wlll 6e more than thirry-slx (38) Ieet high. (Chap. 32. Grp 2, Art 2, SeC. 345, Title e, Celifomla AtlmInlS�retive CoOe). ❑ As owner�Duilder, I wlll nol ert�ploy anyone lo do work which woul0 requfre e permit trom the Division ot Industrial Selery, aa notetl ebove, unless such person has e pertnii to do such work trom the division. Signeture: Date: Division af Industrial Sefey Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRV: I certiy undar penelry ol Dorjury Ihet I have read this epplicetlon entl state ihat the infartnetlon given is conect. I egree to compy with all stA�e laws entl clry ortllnances releling to builOing consiructian, enA euthorize represeniallves ot the Ciry ot Costa Mesa to enter upon �he �� 7�aPeM �o� ��P��^ Purposes. 1 epree not ta accupy or ellow occupancy oi any building euthorized by Ihis pertnit until linal inspection. COOE �. INSVEC710NTYVE 1616 Fixetl System Final Fire Pre�entlon 1266 Pod Spe Final 200 Final Re-Rool 201 Finel BIotWReleining Wall 202 Final Fenory Fire Placa 203 204 Final Sign Final Demolition �� C�t% �� Daa PLIE' 11iI�L5 �Q�,( INSPECTIONTYPE 206 Final Mechanical 208 Flnal Plumbing 210 Final Electrical 212 Final Flre Preventlon �—�/�� 220 Final Planning Apprwal �r(�' V 222 Final Sita 250 Finel Building/Occupanq QdIE II44�IAL$ CITY OF COSTA MESA BYILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fax (714) 754-4856 . www.c�.cos�a•mesa.��SLDING PERMIT Job nddress: 560 W 19TH ST Suite: C Vicinity: UNIT C Parcel Number: 42210320 App�icant: FISCHER, JEFFREY Address: 17337 VENTURq BL #205 ENCINO, CA Owner: FISCHER, JEFFREY Address 17337 VENTURA BLVD #205 ENCINO, CA Contractor: OWN ER-BUI LDER Address: Zip: Arch : Address: Phona: Zip: !2EF: B00-00846 License: 2oning: Phone: (818) 501-0145 Zip: 91316 Phone: (818) 501-0145 2ip: 91376 Phone: iicensa: 0 Eng: Address: � � SCOPE OF PERMIT - INTERIOR STORE TI TO CREATE'A BATHROOM�FOR UNIT C. ��' '' A -00847 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: O6/08/2001 tssued: O6/08/2001 Phone: License: , . . „ , T FEE SUMMARY , _ � , Plan Check: $54.11 � ��,,�" Calc Valuation: �, gz,soo.00 Permit: $83.25 Claim Valuation:,� � , � gz,soo.00 SMIP Res: _ $0.00 - _ ,�j�� , ,. , SMIP Com: $0.53 - :- � � . , Other.� $0.00 - � � ��. � � ` � � �, � ,; ; Inspection: $0.00,- - . . � - .t � � . ' i � � - , � ;%�% � �, , i � .� �: � „ ��,�-�,., -. � , , Totel: $137.89` ^ � � � - � - � � . �i .� �;��, , � '\ � �� ii .,�� _ SETBACKS � � , MAINSTRUCTURE Front , 0-0 � �; �Rear 0-0 ACCESSORY Front 0• 0��. ��Rear 0- 0 PARKING Existing: 0 Required: o NOTES: � �, �/i i> �i�, VNING&ZONING ;�� -��`,'��' �" � J� /�/ , � -.' ; �� , ., � , - � Left 0.0 : " - � Right��/0-0�-, ' � �' - : � � ;�/' ., Laft 0.0, �� Rlght��,0-0 Proposed: : 0 � �-' � " /, , NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements untler California statutes and related regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced vrithin 180 days, or if work Is suspended or abandoned tor a period of 180 days. INSPEC710NS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapedione and final approvel must be obtained. Failure to obtain inspeclions and final approval will result in the expiration of this permit: � i FOR INSPECTIONS CALL: (714) 7545626 � 2aawa (amol WORKERS'COMPENSAnON DECLARArON: I hereby eflirtn under penelry ot per�ury one a<<�e following declarations: ❑ I heve entl will meintaln e ceNficeta of �nsent to sell-Insure tor workers' compensatlon, as proNOetl lor Dy secUon 3700 oi Ne laDor Cotle, for the pertortnance ot Ihe work lor whiCl� INs pBrtnil Is issuetl. ' ❑ I heve ari0 will malntaln wwkers' compe�setbn insurence, es reQuired by section 3700 ot Ne Lebor CoAe. Ia Ihe peAortnenCB ot the vrork tor whlCh this permlt is Issued. My workere' comDensation InsurenCe Gerrler entl policy numDer ere: Cartier. Policy NumDer. (Tiiis sectlon need nor be comp/eted ll the pe�it Is ve/ued ef one hundred dollers (5100) a less.) ❑ I certity t�et In the peAormenca of ihe work tor which Ihis pertnil Is issueq I shall na� employ eny person in eny manner so es to bocorne sub�ect to tne workors' campensetlon laws ol Celifomla, end agree Ihel II I should become sub�ect to the workere' campensetlon proNsions of Section 3700 of ihe Lebor Code, I ahelllorihwlth comply wII� t�ese Provisions. Applicant SlpnaNre: Date: WAqNINO: FAILURE TO SECURE WOPKER$' OO�.dPENSATON COVERA�E IS UNLAWfUL AND SHFLL SUBIECT AN EMPLOYER RJ CRIMINAL PENALTIES AND CML FlNES UP TO ONE MUNDRED TlIOUSAND DOLLME (f100,000�, IN ADDRION TOTHE ODST OF ODMPENSATION, UAMAGES 0.5 PfiOVIDED FOR IN SECTION 3708OF THE UBOR ODDE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I �ereby ettirtn that 1 em IicenseC under O�ovisions at Chapter 9(commendng wIN Section 7000) ol Division 3 oi the Buslness and Professions Code, and my Iicense is In tull farce and eflect. LJc. a Class a Contrattors Signeture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby atfirtn thal Nere is a constructfon lendinp egency lor the peAormance of Ue work for which Ihis permii is issuetl. (Sec. 3097, Civil Cotlej. LenOefs Name: Lendefs Atltlress: Signature: Date: OWNER•BUILDER DECLARATIONS: I hBreDy efllrm t�flt under Denelty of periury that I em E%EMPT FROM 7HE CONTRAC�ORS LICENSE LAW for Ihe fallawing r88Son (SBC. 7031.5, Bu51ne5s 0ntl PfatesslOns Code: Any dry or counry which repuires e p9��t lo construct, el�er, imprOve, demolish, or repeir eny structure, prior to Itg issuance, elso requires �he ap0licant for such portnit ro file e signed stetement t�et he or she is IiGenseA pursuant to tha proNsions oi tha Comractars Lkense Lew (Chapter B(commendng with Section 7000) of Dlvision 3 of the Business an0 Protessions Code) or that ha or she is exempt therefrom end the besis tor Ihe elleped a:emptlon. My vldatlon oi Sectlon 7031.5 by any appllcant for e permll sub�eqs Ihe applkant ta e chril penalry of not more Ihan Iive hundred dollers ($500).): ❑ I, as owner of Ihe properry, a my employees wilh wages es thelr sole compensation, WILL DO 7NE WORK, en0 Ihe sirucmra Is no1 intendetl or oflered for sale (Sec. 7044, Busineu antl Professions Cotle: The Comrectors License Lew does not epply ta an owner ot Oroperty who DuiWs or Impmves Ihereon, antl w�o Uoes such work hlmseli or herself or through his or her own employees, providetl Ihet such improvaments ere not Intentled or oHered lor sela. II, havever, Ihe building or Improvement is sdtl wit�in one year of completion, t�e �'ner-builAer will heve the burtlen ot Drovin9 Ihat he or she tlitl rwt build or improve lor Duryose ot sala.). i Y es owner ol the property, em E%CWSIVELY CONTRACTING WITH LICENSED CONTAACTORS to consiruct the pro�ect (Sec. 704d, Business enO Pmfessions �, Gotle: The co Irecrom Llcense Lew does nat apply to en owner ol propeny who Dullds ar Improves thereon, end who cantrecta tor such project wlth a wNrector(s) license rs t to ihe� cto License Lews.). ❑ I am ex nder sef. � Business end Professions Code lor this reason: SlpneNre: . � `.Date: Owner ID ve' e d rs Iic se. ❑ Yes ❑ No Dnvefs Licensa No. �/�� ]_' ,_Expires: ^�^ Verllicatl t reh by (rype ol tlocument, i.e. - praperty tex blll or tleotl): � DIVISION OF INDUSTRIAL SAFETY PERMIT CEHTIFICATON: ❑ I �ereDy ceN1y Nat no exwvation Me (5) or more leet In depth into which e person is requiretl to tlescend, will be mede in connectlon vnth work euthor�zed by this pertnll, entl that no building struMure, s�efloldinp, felsework, or demolltion or dismantling Ihereot, will ba more than ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Califomla AtlministraWe Code). ❑ As owner-bulltler, I will not employ any�e to do work which woulC requlre e permit irom Ihe D'Mslan ol Intlustrtal Safety, es notatl above, unless such person hes e permlt to do Such work Irom the tlivision. Signature: Date: Dlvision of Industrial Sefery Pertnit Number: I�y INSPECTIONTYFE Qa¢, �§ COpE� �SPECTONTYPE p� �� I 1616 Fixetl System Final Fire Preveniion 206 Final Mechenical 1266 Pool SDe Final 200 Finel Re-Rool 201 FInaI BIocWReleining Wall 202 Final Fectory Fire Place 203 Final Sign 20a Final Demolition 20B Finel PlumEing 210 Finel Electdcal 212 Finel Flra PrevenUon 220 222 250 Final Planning Approval Final Site Final Building/Occupancy (714) 754•5273 • Fax (714) 7yi-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite No C Vicinity: UNI7 C Parcel Nunmber: 42270320 Applicant: FISCHER, JEFFREY Address: 17337 VENTUR4 BL #205 ENCINO, CA Owner: FISCHER, JEFFREY Address 17337 VENTURA BLVD #205 ENCINO, CA Contractor: OWNER-BUILDER , Address: Arch / Eng : Address: PLUMBING PERMIT Phona: (818) 507-0745 Zip: 91316 Phone: (818) 501-0145 Zip: 91316 Phone: Zip: License: 0 � .Phone: � � - � 2ip•; .� : _ ' � License: ' � � ISSUED BY: Status: ISSUED Applied: O6I08/2001 Issued: O6I08/2001 SCOPE OF PERMIT� ' _ � � � � � INTERIOR STORE TI TO CREATE A BATHROOM FOR UNIT C. �„'� �. �,� � � 1 WqSH BASIN 8 1 WATER CLOSET - � � �� - � ' ' REF; BOt A0847 8 B00-00846 , , � - � �� ; � %� � � , - � - - ' ' , � "�.,�_ /i%�. . , � .. , FEE SUMMARY % '%' �. '; > - � � . AMT �QTY� �� - " AMT �tt // ! �. = 'i AMT QTY ISSUE FEE � - \ � $23 50 ; � � � Laundry Tub / Washer � � 50,00 = 0 r j� Sump Purrip� � �� ;/ $0.00 0 Backflow irrigation _�� '$0 00 ;� 0� -,Landscape Irrigalion E0.00 0�� Swimining Poo� „� 50.00 0 BackBow Preventer - ' � $0.00� � 0 � P•Trap' � � 30.00 �, 0 , i.Trep Pdmer , $0.00 0 Bathtub �$0.00 0 �� Pressure Regulator $0.00 - 0 ;��;\ Urinal " $0.00 0 Clanfier System 50.00. 0 �' � Procesa Piping (per 10 ft) 50.00 , 0�`. �� Vacuum Brkr BkBow(1-A) $0.00 0 Connect (Ice,Soda,etc) 50.00 -. 0 �- Receptors - 50.00 ', 0� ��. �� Vawum Brkr Bkflow(5+) $0.00 0 DentalUnits E0.00 �-0 - � SepticTank 50.00 0:� ,-Wash'Basin $9.80 7 Dishwasher a0.00 -0- - � Sewer Cap tor Demo 30.00-- � 0 �i, �-� Wash Basin Set $0.00 0 Drain, Floor $0.00 0 . �Sewer Conned � $0.00 _ 0�; � .-' Waste and Vent System 30.00 0 Drain, Rainwater 50.00 0 Sewer Private Line -$0.00 �"' 0�- Water Closet (Toilet) $9.80 1 Drain, Roof $0.00 0 Shower - . �. .$0.00 -0 Water Heater / vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar E0.00 0 Water Piping (Inst or Rep.) $9.80 1 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Vatve $0.00 0 Sink, Floor 50.00 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 outlels) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) 50.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) 50.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptore (Sand Auto ) $0.00 0 TOTAL CAICULATED FEES: E52.90 NOTICE: The work authodzetl by �his permit shall comply with all applicable handicap access requiremeMs under Calitornia statutes and related ragulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit ahall automatically expire and become void if work Is not commenced within 180 days, or ii work is suspentled or abandoned for a period ot 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 requlred Inapedions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. / FOR INSPECTIONS CALL: (714) 754-5626 �j zaase6l�) WORKERS' COMPENSATION DECLARATON: � I �ere�y eKrtn under penalty ot perjury one of t�e lollowing dedaretions: ❑ I heve end wlll malnteln e certlllcate ot consent to selt-Insure for workers' compensatlon, es provldetl tor by seciion 3700 oi the Lebor Cade, for tne peAormence of the work lar which this pertnit is Issuetl. ❑ I heve and wlll melntaln workers' compensetion insurence, es required Dy soctlon 3700 of Ne Lehor Code, lor ihe pertormance ot Ihe work for whiU Nis pertnit Is issuod. My workere' wmponsetlon Insurenco cerrler end pollcy number ere: Cartier. Pdicy Number: (Jhk secNon neetl rrot Oe complated I/ tho permit Is velued et one hundred dWlers ($100) ar less.) ❑ I ceRify Ihat in t�e pertortnance of Ihe work br which IMs permit is issuetl, I shell not employ eny person In any menner so es to become wbJact to tne workers' compensetbn laws of Calltomie, end epree that if I s�oulA becqne sub�ect to the workers' wmpensetion provislons ot Saction 3700 0l the LeWr Code, I shall torthwith compy with Nese ProvLsiore. Applicent Signeture: Dete: WARNINO: FAILUflE TO SECURE WORNERS' COMPENSr1TIIXJ COVEPAGE IS UNLAW FUL AND SNAIL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED TFqUSAND OOLLr1RE (E100,OOO�.IN ADDRION TO THE CQST OF COMPENSATION, DAh41GES AS PROVIDED FOR IN SECiION 31080F iME LABOR CODE, INTEREST, AND ATTOHNEV'S FEES. LICENSED CONTRACTORS DECLARATON: I hereby affirtn ihat I em Ilcensed unAer provisions of Chepter 9(commencing with Sectlon 7000) ol DlNslon 3 ot t�e Business and Professions Code, end my Ilcense Is In tull force antl ettect. LJc. a Class p Contractafs SignaNre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aMirtn Ihat there is e consiruction lending egency for the pertortnance o11he work for which Ihis permil is iuued. (Sec. 3097, Civil Code). Lendefs Name: Lenders Address: Signature: Date: OWNER-BUIIDER DECLARATONS: i hBfOby eflirtn ihat Undef pBnelry Of per�ury Ihel I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for che iollwring rea50n (SBC. 7031.5, Bu51nBss enA Pf0lessiOnS Code: My ciry or counry which reQuires e pertnit to consWc�, elter, improve, demolish, or repeir eny sWcture, ptlor m its issuance, elso reQWres �he e00licant for such portnit to file e signeO stetement ihet �e or she Is Iicensatl pursuant to the proNsions o1 tha Contrectom llcense Law (Chapter 9(commencing with Sectlon 7000) af Division 3 of the eusineu end Professions Coda) or thet ha or she is exempt t�erefrom and the besis tor the elleped axemptian. Any vidation of Section 7031.5 by eny epplicant for a pertnit sublects the epplicant to e chAl penelry ot no� more than tive hundrad dWlers (5500).): ❑ I, as owner ol the properry, or my employees with weges es their sole compensatlon, WILL DO 7ME WORK, antl ihe sirucNre Is not intended or oNereG br aele (Sec. 7044, Busineu end Professions Code: The Contractors License Lew tloes not apply to en owner at properry who Euilds or improves thereon, and w�o tloas such work himseli or herselt or throug� his or �er own employees, provided ihet such Imprrnements era not Intended or oXered tor sela. tl, however, the bulltling or Improvement Is sold withln one year ol compleUon, Ihe owner-builder will have Ihe burden of proWng thet he ar she did not 6uild or improve for Durpase of sele.�. � I, es owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to canstruct the pmJect (Sec. 7044, Business antl Prolessions `-' �Gotle: The cop�rectora tJcense Lew daes not epply to an owner ot propetly who bulltls or Improves thereon, and who contracts for such pro�ect wl�h a contrector(s) licensqpqrs�f�t to the Conti�ctors Liconse Lews.). ❑ lam Signeture: Owner ID' ❑ Yes ❑ No Business end Prolessions Code tor this reason: License No. Expires: tlocument. I.e. - properry tax blll or Oeed): --- DIVISION OF INDUSTRIAL SAFETV PERMR CER7IFICA710N: ❑ I hereby cerUfy tha� no excevetlon five (5) or mora teet in dapth into whlch e person is requlred to descend, vrill be mede in connaction with work euthoAzetl by Ihis permil, entl thet no DUIlding structure, sceNolding, telsework, or demWition or tllsmflnUing thereol, will be more Nan iNrry-six (38) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomie Administretive Code). ❑ As owner-builder, I will not employ enyone to do wark which would require e permit trom t�e D'Msion of Intlustrial Selery, es noteE ebove, unless such person has e pem�it to tlo such work Irom Ne ClWsion. Signature: Date: Division of Industrial Selery Pertnit Number: CERTIFlCATE OF CO �LIANCE ANU A ORIZATION OF ENTRY: I certily untler penalry of per�ury thet I heve reatl this epplication antl steto thellhe informetion given Ia CORBC�. I 9AfB 0 �ly with all sret aws ntl city orCinances releting to bulldfng construction, entl authadza representatives ol ihe City ol Coste Mesa to enter upon t�e ebove-tlescrib tl p � lor insp CINn pu seS`! e not to occuOY or allow occupancy ol eny building authorized by this permit until nal i'spection. / Siig� _ a.0 Legal Owner(s) L�p�' / AnNOr Authonzed Applicant Date GOOE t. MSPECTIONTYVE 1616 Fixed System Final Fire Prevention 1266 Pod Spa Final 200 Final Re-Roof 201 Finel Block/Retalning Wall 202 Final Factory Fira Place 203 Final Sign 204 Final �emolition . �.�� SOUE� INSPECTIONT'PE 206 Final Mechanical 20B Finel Plumbing 210 Final ElecMcal 212 Flnal Fire PrevenUon 220 Finel Planning Approval 222 final Site 250 Final BuilAingiOccupancy �. t .1111. ' , , � �� (714) 754-5273 • Fax {714) 754-4856 • www.ci.costa-mesa.ca.us 77 FA1R DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 560 W 19TH ST Suire No Vicinity: Parcel Nunmber: 42210320 Applicant: HENRY ESTRADA Address: , �,��i,i�%':i=�- _ � � �� Phone: 5 �i i '/ Zip: /, �, � . � -:; � ; �, � � ,,, ,,, �. Ownec� JEFFREYA.'FISCHER', i . �, ..- Address 77337 VENTURA BLVD #205 � � . � - �� -. � � Phone: � � i � ' ENCINO, CA, ,� Zip: i i Contractor: � MARTWEZ ELECTRIC � Address: 825 S MAPLE AVE . - � UNIT B / ,_ _ � ; �., _ `�iPhone: :MONTEBELLO, CA � � '/ \ \ „�� > ISSUE FEE Temp service test Res. a/c package New Res (i-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches � � � , NonReaAppl_� ' Res Appl ` � Service to 200a � , Service to 1000a �� Service over t000a Motorstolhp � Motors to 10hp Molors to SOhp Motors to 700hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Zip: License: Status: ISSUED Applied: 12/06/2007 Issued: 12/O6/2001 - � - ISSUED BY: 323-888 1935 � / � � � �� / ��.;�\\ � . % ' '�� \ �� , _ � � . � ,�\ : �� ' �� ; � �; `��\ 1, , ,A =` � `� ��i ;� ��,�� ,_,<� �,:�� (818) 501-0145 ,Q\,;� �/ \ ., 97318 �� `� ��/ ��,A .� .� �;\ � `� •,�� •' _ V ��A� � ��_ . . \ � � .. - �,_� ` '�y . � - ,,., �� - � �� - . �� ,� �� _.; , ., ,, `� , ., 323-888-1935� � � � _ . �� ;� . , A,1 ,, -90640. " ,�"� � . � ='� : .. ' ' 432339 � ��-=1'�v�� .�, � _ � , �• � � C \; i \ \ .. � � . SCOPE OF_PERMIT ; .,_, �__.,_. �� ' , ICLUMINATED WALL SIGN FOR��"PAYROLLADVANCE" WALVSIGN, REt,S807-00132 � � ' ` .�. . _ �_i. .. _..._o .r.__........� � V � � , , FEE SUMMARY' , �;,,,�� _� Quantity _ "" _ : - ' � �_ ' �_ � , . c `�� J Quantity �� '- � ' $23.50 " �- � .� 7emp Dist System I Lighting - 50.00 0 ' � , � � $0.00 Busway/t00ft' $0.00 0 �- , -� � $0.00 _ Standing Sedion _ $0.00 0 � , ; � � ' .� ' $0.00 0 Misc Electrical Equipment � $0.00 0 : � , - ' � $0,00 0 Transtormers up to 1 kva/kw $0.00 �-0 ,� � �; .., $0.00 0 �' � - - �2 .... :.:.........up to 10 kva/kw , $0.00 ' ,:0' / � �-: . � ' $0.00 0 � " � �........,.up to 50 kvalkw $0.00 ��' 0 �� ' ' � �� 50.00 0 .............:...'up to 100 kva/kw 50.00 ��,� 0 � , ,: :� '� �. � - .� ' ��50.00 . 0„=; ..... .....overd00kvalkw-� .�5000� 0"� . � � �50.00, � " ` 0�" �_ - Low Voltage Equipment ��- � $0 00 0� � � � � .$0.00�'= � 0 - , �Low Volt W ring System / CkL�/ $0:00/ �, 0 j � � � � � $0.00 -� � '� 0 " _ Miec.Conduil ;� i�"�$0.00��0 �,, �/ . $0.00 , �� - �0= - Misc ConduUor - $0.00 � ,� 0 ' , 50.00 , 0 -- - Circus ( gen or ride) , - � %„ 50.00 , � 0 ; �� - $0.00 � 0 - � Cireus (mech ride or lights)- �� '� $0.00' 0 ' � � $0.00 - � 0 Christmas Tree Stand � \ � , ;50.00 - /0/ S0.00 - � 0 % - , Flreworks Stand � � - � 50.00'� %0 � 50.00 � 0 , � Other Electrical Fee ; � -$O.bO! $0.00 . � 0 � � , - 'i:. �. $0.00� � � -0- - � � �� Investlgation Fee - -�� ; ��$0.00 50.00 �'--0, Plan Check.Fee ' � � 50.00 50.00 0 _ Reinspection Fee � 50.00 $24.60 1 50.00 0 TOTAL CALCULATED FEES 548.10 $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applirable handicap access requirements untler Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: Thls permit shall automatically expire and become voltl it work is not commenced within 180 days, or If work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In orqer for ihe work authorizad under this permit to be considered legal, such work must comply with all appliwble codes, and ell requlred inspectlons end final approvel must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 za+we (sioo) WORKERS'COMPENSAnON DECLANATON: ' . . I hereby aHirm under penalry ot perjury one of the tollowing declarations: �'� • ❑ I heve entl will maintain e certilica�e ot consent to sel4lnsure for workers' compensaUm, es provided tor Dy sec�ion 3700 of �he Lebor Cade, for the peAortnence ot the work for which Ihis permit is issu07. ❑ I have entl will mainlaln workers' c�pensetion insuranca, as reqWreO Dy sec�on 3700 of ihe Labor CoAe, for the peAortnance ot the work tor whit7i Nis pertNl is issued. My workers' comp�nsation Insurence wrtler end policy number are: / - Cerrier. � Policy Number: (Thi ect�an need not be completed i! the perm/t is ve/uetl a( one huntlred ddlers (57G0) or less.) I certity Uat in the pertortnance o� the work w�ich this pertnit is issued, I shall not employ eny person in any menner sa es to become suD�en to the workere' wmpansailon laws of Califo la, end epr t� t if I should become sub�ect lo the workers'-compensatlon provisians of Section 3700 of t�e LeOor Cotle, 1 s�all fonhwlih com7ly vrith these pr ' . �Appllcant Signature: Date: �.-�— �o �� .� W ARNIN6�. FAILURE SO SECURE WORKERS' �PENSFTON COVEPA(3E IS UNLAWft1L M10 SHALI SUBIECT AN EMPIQYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE MUNORED TIqUSAND DOILARE (5100,000), IN ADDfi10�'� TOTHE COST OF COMPENSATION, DAMA�ES PS PROVIDED WR IN SECTIIXJ 3108 OF THE IABOR CODE, INfEREST, AND ATTOFiNEV'S FEES. / I� LICENSED CONTRACTOBS DECLARAnON: I here6y eNirm thet I em licensetl untler �ons of C�ao•/�n'g (cammencing wlih Sactian�000) of D'Msion 3 at tha Buslness$� tl Pr9IASSIonS Code, and my Ilcense Is In fu force end ettec�. Lia a l' Class p C�—` U � � ContractoYs Signeture:� � �� Da�e: , — �� / � CONSTRUC710N LENDING AGENCY: I❑ I hereby eltirtn Ihat there is a construction lentling agency for the peAortnance oi 1he work tor w�ich t�is permit is issued. (Sea 3097, Civil Code). - ILender's Name: Lender's Aa�ress: ISignature: Da�e: OWNER-BUILDER DECLAHA710N5: 1 hereby affirtn Ihet under penelry of peljury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, 8uslness enE Professlons Code: Any dry or counry which reduire5 a permil to construd, elter, improva, damolish, or rapair any siructure, prior to its issuence, elso roquires the ep0�� er such permil b Nle a signetl stetement thet he or shd L9 Iicensetl pursuaN to t�e provislons of Ue ContraMors License Law (Chepier 9(rqmmenGng wilh SeUlon 7000j oi Division 3 0l Ihe Business and Professions Coda) or Ih9� he or she is exempt Ihereirom end ihe basis br ihe alleged exemptlon. My vidatlon of Sectlon 7031.5 by any appllcant for e pertnil suDjects ihe epplicent to e chril penalry ot not more than Me hundred dollars (55W).): ❑ I, es owner ot the properry, or my employees wlih weges es Iheir sole wmporuation, WILL DO THE WORK, anC ihe siructure is not InteiWetl or ottered lor sele (Sec. 7044, Business end Professions Goda: The Contractore License Lew does not apDN �o an owner ol Oroperty who builds or Improves thereon, and who does such work himsell or �ereelf or through his or �er own employees, provitleC t�et such Improvements ere nol Intended or offered for sale. It, howeve�, ��e bulltling or Improvement Is sold wilhin one year oi completion, ��e ov+neo-builder will have Ihe burden at pmving Ihet he or she did not build or improve br purpose o� sele.). ❑ I, es ownar of t�e proparty, am E%CWSIVELY CONTRACTING WITM LICENSED CON7RACTORS to conslruct the project (Sec. 7044, Business and Profeulons Code: The comrectors Llcense Lbw tloes not apply to an owner of propeny who �uilds or impraves thereon, end w�o contrecls for such prolect wilh a comrector(s) litense pur5uent to lhe Contratt0l9 License Laws.). ❑ I em exempt undar sec. eusinoss and Prolessians Code tor Ihis reason: Signature: Date: Owner ID veritietl by drivers license. ❑ Yes ❑ No Drivets License No. E�ires: Venlication of Ownership by (type oi document, i.e. - property lax blll or deetl): DIVISION OF INDUS7RIAL SAFE7Y VERMR CERTFICATION: ❑ I hereby cerlify that no excavetion live (5) or more 5ee1 in tlepih into whicti e person is required to descenC, wfll be mede in wnnection with work euthorized by this permil, and ihat no builtling siructure, scettolding, falsework, or tlemolition or dismantling thereof, will be more ihen ihlrry-si: (36) le9t high. (Chap. 32, Grp 2, An 2, Sec. 341, Titla B, Califomia AtlminiSireC�'e Code). ❑ As ownerbuiltler, I will not employ enyone to do work which would require a pertnit frwn the DiWsion of Industrial Selery, es noted ebove, unless such pereon hes e pertnil la do such work trom the tlivision. Signeture: Date: Division af Intlusiriel Sefery Pertnit Number: CERTIFlCA7E OF COMPLUWCE AN� AUTHORPJITION OF EHTAY: I coniy under penalry of perjury �hal I have reatl this epplication antl stele Ihat Ihe inlortnation given is cortect. I egree to comply with all sate laws flntl dry ordinances relatinp to building construqion, end authorize representatives ot the Ciry ot CosW Mesa to emer upon t�e above-tlescribed properry foj.iespection purposes. � agrae not to occupy or ellow occupanry of any building authorizetl by Ihis pertnit untl fnal inspection. Legel CODE 1. INSPECTION TYPE 7818 Fixetl System Flnal Fire PrevenNon 1288 Paol Spe Final 200 Flnel Re-Rooi 201 Final BIocWRetalninp Well 202 Flnel Fac[ory Fire Place 203 Final Sign 204 Finel Demolition QdjE INTRULg COUE 1 INSPECTION TYiE 208 Finel Mecheniwl 20B Final PlumDing 210 Flnal Electrical 212 Finel Fire Prevention 220 Final Plenning Approval 222 Finel Si1e 250 Final Builtling/Occupency PAg �� Itii�LS ��ia»sa-s2�s . Fax (�ia� �sa-aess Job Address: 560 W 19TH ST Suite No Vicinity: Parcel Nunmber: 4221 Q$20 App�iynt: BOB MITCHELL Addrpss: Owner:� �'GARVIN DRIVE LP Atldress � 16485 GARVIN DRIVE � �� ENCINO, CA � � � . . . . , CITY OF COSTA MESA BUILpING DIYISION � DEVEIOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Phone: 310-523-9500 Zip: Phone: 2ip: 914363636 Convsomr: AD:ART/ELECTRONIC SIGN CO Address: 19603 FIGUEROA ST �� ISSUE FEE . Temp service test Res. alc paCkage New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fixts Recept Outlets Switches Non Res Appl� Res Appl Service to 200a � Service to t000a Service over t000a Motors to 1 hp Motors to 10hp Morors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole CARSON,CA Phone: Zip: License: 213 523-9500 90745 YiiP�iC! SCOPE OF PERMIT ELCTRICAL FOR 2 WALL SIGNS FOR "LUCY'S LAUNROMAT', RE"SB99-00079. $22.00 50.00 $0.00 50.00 $0.00 50.00 50.00 50.00 50.00 $0.00 50.00 50.00 $0.00 50.00 50.00 50.00 30.00 50.00 50.00 $0.00 50.00 30.00 544.00 50.00 50.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway /100 ft i Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up l0 50 kva/kw .................up to 100 kvalkw ..................over 700 kvalkw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conducfor Circus ( gen or ride) Cirws (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee PERMIT NUMBER I E99-00503 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: �SSUED Applied: 06/1 411 9 99 Issued: O6/14/7499 ISSUED BY: U G I � '�� •�� '�� 0 � •' Quantity 50.00 0 50.00 0 50.00 0, 30.00 0 $O.W 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 . 0 so.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES $66.00 COMMENTS I SPECIAL CONDITIONS NOTICE: The work eulhorized by this permit shall compty with all applicable harWicap access requiremants under Califomia statules and related regulations. (Ortl, No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall eutomatically expire end become void if work is not commenced within 180 days, or if work is suspended or abendoned tor e period of 180 deys. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all epplicable codes, end all requlred InapeCtlone end final epproval must be obtafned. Feilure to obtain Inspections end final epproval will result in the ezpiretion of this permif. FOR INSPECTIONS CALL: (714) 754-5626 WORKERS'COMPENSAnON DECLARAnON: � � I hereby atfirtn unGer penelry ot perjury one oi Ne tWlovring tledaielions: ❑ I ve e�W wlll maintein e ceNticate of consent �o self-Insure for workers' compensatlon, es provided for by sectlan 3700 oi t�e Lebor Cotle, for the pertormance af the ork for whiCh �hi9 permi� Is ISSuBC. I have arW will melntein workers' compensatlon insurance, as requiretl by seMion 3700 af Ihe Lebor Coaa, fw Me peAortnance of Iha work tor which thlv pertnit is Lssuetl. My workera' co ensatio Insu en cartie'r. enpd poli number ere: ) / � Cerrier. ��1�-'�� Policy Number. �� I�D . C�� (Th/s section need nof be crompleted!! the perm/t Is ve/ued et one hundred dollers ($100) w loss.) ❑ I certity thet In the performance ot Ihe work tor which this permit Is issued, I shell not employ eny person In eny menner so es to become sub�ect to the workers' wmpensalion laws of Calilornia, entl ' come sub�ect to lhe workers' compenSatlon provl3i0ns of Sectlon 3700 at the Labor Cotla, I shell forthwith comply with these provis l l,!,_ ,C � Applicent Signewra: � � ----- Date: �Q �� WARNING: FAILURE TO SECURE WOHKERS' COMPENSATIIXJ COVERAOE IS UNLAWFUL AND $HALL SUBJECf AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED THOUSAND DOLLARE (5100.000). IN ADDfiION TO THE WST OF COMPENSATION, DMMGES 0.S PROVIDED FOfl IN SECiIIXJ 3706OF THE LABOR CODE, IMEREST, AND ATfOFiNEI"S FEES. LICENSED CONTRACTORS DECLMATION: 1 hereby eMlrtn Ihet 1 am Iicensetl untler provi ic �orce end ercec�. uc. a Contractofs Signeture: _ wlih Section 7000) of Division 3 of Ihe Business and Prof ssions C� erW my Iicense Is In tull Classp �.✓� ` _ CONSTRUCTON LENDING AGENCY: ❑ I hereCy ettirm lhet t�ere Is a construction lending agency lar lhe pedortnance of lho work for whic� this pertnit is Issued. (Sec. 3097, Civil Code). Lendefs Name: Lendefs Adtlress: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hareby eNirm ihat un0er penelry ot perjury ihai I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor tha tollowing reason (Sec. 7031.5, Business end Pmtesslons Code: My ciry or counry which requiraz a permit to wnstruct, elter, Improve, demolish, or repair any strucWre, prior to IIs Issuence, elso requires tha epplicant for such pertnit m fiie e signed stetemeN t�et he or she is Iicensed pureuant to the provisions ol the Contraciore IJcense Lew (Chepter 8(commendng with Sectlon 7000) of Didslon 3 af the Business end Prolessions Code) or ihat he or she Is exempt theretrom end I�e hasis lor Ue e0eged exemptlon. Any violellon ol Section 7031.5 by eny eppllcan� for e permlt sub�ects the appliwnt.to e clNl penelry of not more Ihen Me hundred tlollars ($500).): i� � ❑ I, es owner�ot the;propetly, or my amployees with weges es Iheir sole compensatlon, WILL DO THE WORK, antl t�e strucWre is not Intantled or oXereC br sale (Sec. 70a4, Buslnass:entl�Piolesslons COOe: 7he Contrecbre Llcense Lew Ooes not appy to en owner of property who Dullds or Imprwes thereon, end who does such wark �Imself or �erselYor.throdgli Iiis or her�own employees, provitletl that such improvements ere not imended or ofleretl lor sele. II, however, ihe building or impmvement Is soltl witNn one yeer oi completlon,.ihe oviner-builder will have Ihe burden at pmving that he or she did not Dulld or Improve for Durpose oi sale.). ❑ I, es owner o1 t�e properry, am E7(CLUSIVELV CONTHACTING WfTH LICENSED CONTRACTORS to construcl ihe pro�ect (Sec. 7044, Buslness antl Protesslons Cade: The contrectors License Law does not eDPh �o en owner ot pmperry who builds or ImO�oves ihereon, antl who conireds for such project with a contractor(s) license pursuant to the CONrectors.license Lews.). ❑ I flm exempt undar sec. �� Business entl Professions Cotle for this reason: Signe�ure: Dete: Owner ID verifletl by dAvefs Iicense. ❑ Yes ❑ No Dnvels License No. Espires: Venfication oi Owners�ip by (type oi tlaument, I.e. - propeny tac blll or deetl): OIVISION OF INDUS7RIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereby certily thet no excavatlon tNe (5) or more feet In tlepth into whlch a person Is requlred to tlescend, will De maOe In connectlon wlth work euthorizetl by this permil, end t�et no buliding structure, scattolding, taLsework, or demolition or dismentling thereof, wlll be more than thirty-slx (38) feet high. (Chep. 3.2, Grp 2, Ar12, Sec. 341, Ttle 8, Califomia Atlministretive Cotle). ❑ As owner-huilder, I will nat emplay enyana to tlo work which woultl reduire e permit from ihe Division of IntlusMel Sefery, es noted ebove, unless such person has e permit to do such work irom tha division. Signeture: Date: Division of Intlusidal Safety Permit Number. CERTIFlCATE OF COMPLIANCE AND AIlTMORPATON OF ENTBY; I certify under penelry of perjury t�at I heve reed Nis appliratlon entl state tha� the inlormadon given Is conect. I epree to comply with ell stete laws fln0 dry ordinances ralating to builtling conshuction, end amhodze represenlatNes ol the City of Caste Mesa to enter upon t�e ebova-descAbetl property for Inspection purposes. I egrea not to accupy ar allow occupflnty af eny building euihorize0 by Ihls pertnit untll final Inspectlon. 1816 1266 200 201 202 203 204 ewo-aa Signatu alOwner(5J �� nNOr Authorized Applicant INSPECTIONTYPE � Flzetl System Finel Fire Prevention Pool Spa Final Finel Re-Roo� Flnal BIaWRelelning Well Finel Factory Flre Plece Finel Sipn Finel Demolilion PAIf. ��, t ' Date /j� y� ( TD_ a e It�l4S cooe� ixsrecnoNTrve 206 Finel Mechanical 20B Final Plumbinp 210 Finel Electricel 212 Finel Flre Prevention 220 Flnal Plennlnp Approvel 222 Final Slte 250 Finel Builtling/Oaupanq P9IE (714) 754-5273 • Fax (714) 754-4856 ~1 CITY OF COSTA MESA ` BIIILDING DIYISION � DEVELOPMENT SERVICES DEPARTMENT PERMIT ,lob nddress: 580 W 19TH ST Suite No Vicinity: Parcel Nunmber: 42210320 npp�icant: BOB MITCHELL Address: ELECTRICAL PERMIT Phone: 310-523-9500 Zip: i i i%; ' --.' , Owner:��GARVIN DRIVE CP Address � 16485 GARVIN DRIVE / , . - . , , . - Phone: - '-ENCINO, CA - Zip: 914363636 , � �„ ��._i ContPacmr. AD ART/ELECTRONIC SIGN CO � Address: 19603�FIGUEROAST _ � . � � Phone: . CARSON, CA � " . Zip: License: �. r � j ; � . � ISSUE FEE Temp service test Res. a/c package New Res (7-2 units) New Res (3aunits) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a � Service to 1000a �' Service over t000a Motors to ihp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 213 523-9500 90745 7�12'l4 PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: O6/14/1999 Issued: 06/1411999 ISSUED BY: �-yr �1� ,5�5� . Y . . �\ `:.�. q a �� . � "��, . 04'� � � � � SCOPE OF PERMIT � , ' ELCTRICAL FOR FREE STANDING SIGN FOR "IUCY'S LAUNROMAT', RE"S699-00080. INSTALL 2 BAILASTS. . � - � . $22.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $44.00 $0.00 $0.00 Quantity FEESUMMARY Temp Dist System / Lighting Busway /100 ft � Standing Section Misc Elecfrical Equipment Transformers up to 7 kvalkw ................up to 10 kvalkw .................up to 50 kvalkw .................up to 100 kvalkw ..................over 700 kvalkw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit ' Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Chrislmas Tree Stand Fireworks Stand O�her Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 30.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES 566.00 COMMENTS / SPECIAL CONDITIONS � NOTICE: The work eulhorized by this permit shall compty with ail applicable handicap access requirements under Calitomia stetutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This permit Shall automaticelly expire end become void if work is not commenced within 180 days, or if work is suspended or abandoned for e period of 180 days. INSPECTIONS: In order l4r the work authorized under this pertnit to be considered legal, such xrork must comply with all applicsble codes, and all requlred Inepeetlone end tlnal approvel must be obtained. Failure to obtein inspections and final approval will result in the axpiration of this permit. FOR INSPECTIONS CALL: (714) 7545828 WORKERS'COMPENSAnON DECLARAnON: � I hereby aflirtn untler penelry ol pe�jury one ot Ihe fWlowlnp CeUeretions: ❑ I heve and will melntain e Certlllcate ol consem ro selt-Insure tor warkere' compensatlon, es provitletl tor by sectlon 3700 of Ihe Lebor Cotle, tor the peAortnence of Ihe fof W�Ith this pertnil Is Issuad. I heve entl will melntein workers' compensatlan Insurence, aa requlretl by secUon 3700 oi Iho Labor Coda, fw tho peAortnence o1 ihe vrork for which Ihis permit Is iuuetl. My workers' compe Insurence certie anA icy um6er ere: ' t%� /_/ _�J /� n�—� Carrler. � � �� Policy Number. <' Lli �J C C1G � (This section need not ba complered!l Me perm/t Is velued et one hundred tld/ars (S�oo) or less.) ❑ I certily Ihat In ihe pertortnance oi t�e wa wh-Cria-pa �iit is issueC, 1 shall not omploy eny person in any manner so es to become subJect to the workers' wmpensetion laws o1 Calilomia, e ee Ihet H I shoultl become3ti6�ect to the workers' compensatlan provisions ot Sectlon 3700 ot t�e Lebor Code, I shall foMwii� comply with these provisions � /' ,�/, ! � /� Applicant Signature: � ---�� Date: �'Q 6Gf f WARNINO: FAILURE TO SECURE WORNERS' COMPENSRTIOM COVEMOE IS UNlAWR1L AND SMAIl SUBJEC7 AN EMPLOYER TO CRIMINAL PENALTES AND CML FlNES UP TO ONE HUNDRED T/IOUSAND DOLLARE (51 W.000),IN ADDfiIIXJ TO THE COST OF COMPENSATIIXJ.OMNGES 0.S PROVIUED FOR IN SECTION 3)O60F THE LABOR CODE, IMEREST. AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aXirm Ihat 1 am licensetl under provisi� torce end eNect. Lic. M % Conirectofs Signeture: / wi�h Section 7000) of Division 3 at tha Buslness and Professions � nd my license Is in full Class p C-`��- _ De�e: ., �-L _ CONSTRUCTION LENDING AGENCV: ❑ I here�y ettirm thet there Is e consiructlon lending egency for the pedortnance of the work for which this pertnit Is issuetl. (Sec. 3097, Cldl Catle). Lentler's Neme: Lentler's Atltlress: � Signature: Da�e: OWNER-BUILDER OECLARATIONS: I hereby ettirm I�at untler penalty of per�ury t�et I em EXEMPT FFOM THE CONTFiACTORS LICENSE LAW lor the following reeson (SecJ031.5, Business antl Professions Code: Any Gty or counry which reQuires e pertnit �o wnstruct, elter, improve, demolish, or rapelr eny siructure, prior to Its Issuence, also requires I�e eppllceni tor such permit to flle e signed stetemem thet he or she Is Iicensed pursuam ro the provisions ot the Contractors llcense Lew (Chepter 8(commanGng wlth Sectlon 7000) ol DlNsion 3 0l the Business entl Professions Cotle) or I�at he or s�e is exempt iherefrom end the besis tor the allegeG e:emptlon. My Noletion of Sectlon 7031.5 by eny epplicam for e pertnit subJecis ihe applicant lo e dJll penelty ot.not more than five hundred dollars ($500).): �•, r�� , i,,� ❑ I, es owner ol ihe property„or my.empbyees wlth wages es thelr sole comDensetion, WILL DO 7HE WORK, end Iha structure Is not intentletl or oNeretl for sele (Sec. 7044, Business entl Professions'Code:�The Conirectora License Lew tloas nat epply to en owner ot proporty who builtls or improves thereon, and who does such work himself or hersell or ihrough his or hai own employees, providad that such improvements ara not iniended or oHered tor sele. It, howaver, the building or Impmvement is soltl wiihin one year ot completion, ihe ownar_Duiltlei will have the burden of proving that he or she tlid not build or improve tor puryose ot sale J. c��.� ❑ I, es owner ot ihe property, am EXCLUSIVELY�CON7RAC71NG WITH LICENSED CONTRACTORS to conswct the pro�ect (Sec. 70a4, Business and Pmfesslons CoOe: The cantrecrors Licensa Lew does �notapply to en owner of property who builds or ImO�oves Uereon, and who contrects tor such O�olect with e contractor(s) license pursuam to Ihe Contrectoro License Leivs.). ❑ I em exempt under sec. Business and Prolessions Codo for this reason: Signeture: Date: Owner ID verllled by tlrivals licensa. ❑ Yes ❑ No Drivers License No. Veritication of Ownarship by (rype af Cocumem, I.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATON: , Expire,a: ❑ I hereby certily thet no excevetion INe (5) or more teet in depih into which a person Is requlretl to tlescentl, will be matle in connectlon with work euthorized by tNs pertnit, and [�at no EullAing strucNre, scaHOlCing, talsework, or demolitlon or dismantling ihereol, will be more than thlrtyslx (38) teet �ig�. (Chep. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Celifomia Administretive Code). ❑ As owner-bulitler, I wlll not employ anyone to do work which wauld require e pertnit from the Divislon ot InOusMal Salery, es notetl ebove, unless such pereon has a permlt to do such work Irom the divislon. Signeture: Date: Division oi Industrial Sefery Permil Number: CERTIFlCATE OF COMPLIANCE IWD AUTHORQATON OF EMAV: I cenify under penalry of perjury Ihat I have reatl Ihis applicatlon and stete that Iha infortnation given is wrtecc I agree to compry with ell stete laws end dry ortlinances relaung to building conswciion, flnd euthodza representatives of ihe Ciry ot Coste Mesa to enter upon the eDove-described property tor Inspection purpo.es. I agree not to occupy or ellow accupanry oi any builtling authorized by ihls pertnit until final inspection. SlgnaNre OI Le e (s) a e �� AnNOr Authodzed AppliCent at •�_.. �.'.MI•�\I' 1616 Fixetl System Final Fire Prevention 1268 Pool Spa Finel 200 Finel Re-Rooi 201 FInaI BIocWRetelning Well 202 203 204 2a6-48 Finel Fectory Flre Pleca Flnel Slgn Final Demolition �g �� COOE� INSPEC710NTYPE 20fi Final Mechaniwl 208 Final Plumbinq 210 Final Electdcal 212 Final Fire Preveniion 220 Final Planninp Approvel 222 Finel Site 250 Flnal eulldinp/Occupency PAff. pt4) 754-5273 • Fau (714) 754-4856 • www.ci.costa•mesa.Ga�LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 t3 Job Address: 560 W 19TH ST Suite: C Vicinity: C ' Parcel Number: 42210320 ApplicanC VAUGHN, JACK Address: 1726 W 9TH ST --' - UPLAND.CA-�i;•�-�'- - . y �. "� . . Owner. GARVIN DRIVE LTD `, Address PARTNERSHIP .� � �ENCINO,CA, �; j - - = 18485 GARVIN DR . :� , i Cont�racror: HIGHLAND CONSTRUCTION Atldress: 1728 W 9TH ST � � . _ UPCAND;CA Zip: 91786 Zoning: Phone: 90&5451213 Zip: 91786 - � Phone: (818) 501-0145 Zip: 914363636 Phone: License: 711112 Status: ISSUED Applied: OSI22I2003 Issued: O6/26/2003 ISSUED BY: Arch : WARREN K ROBINSON, AIA ' , Eng: Address: 1530 N WALNUT S7 � ' �� .� ' Addressi' . � � , . " . Phone:. 562-690-7638 . � � Phone: - . i LA HABRA. CA � . ,. � � . . � � Zip: 90631 . ' License: C16877 � � �License: ' ' � ., �� . SCOPE OF PERMIT . INTERIOR 1351SF EXPANSION FOR PAPA'JOHN, UNIT C. -: � �� .� �: ' . AREA TO BE USED FOR PIZZA PREPARATION ONLY \ NO CUSTOMER WAI7ING OR SERVICE AREA PROPOSED. / , FEE SUMMARY , Plan Check: $127.36 Calc Valuation: 5�0,000.00 � Permit: $783.75 �-' Claim Valuation: ,"� s�o,000.00 ` SMIP R ' $0 00 - � � � es. SMIP Com: � Other: Inspection: �� Total: $14.70 $0.00 $0.00 5925.81 SETBACKS ` � MAIN STRUCTURE �Front 0- 0� - Rear 0- 0 ACCESSORY Fronf��0-0�� ' ,Rear '0-0 PARKING Existin : 0' Repuired: b , PLANNING & ZONING Left 0- 0 , Righl 0- 0 � i Lek 0- 0 �� Right 0• 0-' Proposed: 0 " , INOTICE: The work authodzed by this permit shall comply with all applicable handicap access requirements under Califomia staNtes anC related regulatfons. (Ord. No. 92-Z8, § 7, 12•21-92) EXPIRATION: This permit shall automatically expire and become void ii work Is not commenced wlthin 180 days, or II work is suspended or abantloned �Ifor a period of 180 days. INSPEC7tONS: In order tor ihe work authorizetl urWe� this permlt to be consideretl lepal, suct� wofk must comply with ell epplicable codes, end all . requlred Inepeetiona end flnal epproval must be obtained. Failure to obtain inspections and finai approval will result In the expiratlon of lhis pertnit. IFOR INSPECTIONS CALL: (714) 754-5626 zaaeee (aw� WOPKERS'COMPENSAnON DECLARATON: ' I hereby ettirm under penalry oi perjury one of Ne tollowing declaretions: ❑ I have and will mfl(ntein a cenificate of consent to setl-Insure far workers' compensetlon, es provided for by section 3700 0l Ne Lebor Code, tor Ne peAormence of Ne work For whlch thls pertnii i5 issuetl. (ihis n insurance, es requireA by secllon 3700 W Ne labor CaCe, for the peAortnanw of the work for whkh this pertNt is iswed. antlpollCynumberare: _ __Q�/D��/�O� 7 s ' � Polic'y Number:= : velued et one huntlred tlallers ($ f00) or less.) ❑ I certity thet In the OeRortnance of t�e work lor which this permit is issued, I shall not employ any person in eny manner so es to bewme sub�ect to the workers' compensatlon laws ot C tD� la, d epree��..��++ f I should ecome sub�ect to Ihe workers compensatlon provisions oi Seclio1Y 3700 0l the �eybor ,Code, I shall forthwlih comply with ihese p N 6ns��e� � I �✓ � v J Applicent Signeture: � �" Dete: �r WAflNING: FAILURE TO S� �RE WORICERS COMFENSATI� COVEMGE IS UNUWFUL AND SMALL SU6IECT AN EMPLOYER TO CRIMINPL P T1ES AND CML FlNES UP TOONE HUNDRED THOUSrW D DOLUqE (5 ,OOO�.IN ADDRIIXJ TO TME WST OF COMPENSATION, DNMGES AS PRO��DED FOR IN SELTON 3'1080F THE LABOR ODDE, IMEREST, PND �TfORNE1"5 FEES. LICENSED CON7RACTORS DECLA(iATION: I hareby ettirtn ihat I em Ilcens der pJovi� ions�( Chapter 9(commencinp with Section 7000) ot Division 3 oi l�e Business tl Pro slons Catle, end my license Is In tull rorce aoe eneci. u�. u � ? �%/i1/ _ �r . Gaess.a. � — � C ContractoYs SlgneWre: �.s�_ Date: � CONSTRUCTION LENDING AGENCY: ❑ I hereby alfirm that t�ere is e consiruction lentlinp egency lar the pertormance oi t�e wark far which this permit is issuad. (Sec. 3097, Civil Cadej. Lentlers Neme: Lentlefs Atltlress: Signature: �ate: OWNER-BUILDER DECLARATONS: I hereby eMirtn thet under penelry of perjury that I em EXEMPT FROM TME CONTRACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Business flnd Professions Cotle: Any city or counry whlU raquires a pertnit lo construct, elter, improve, demWish, or repair any structure, pdor to Its issuence, elso requlres the epplicant for suc� permil ta file a signetl ateiement that he or she is IkenseE pursuent to the proNsions o1 the Contrectors tJcense lew (Cliapter 8(commendnp with Sectlon 7000) oi Division 3 af the Business anO Protessions Code) or Nat he or she Is ezempt theretrom end the basis fa Ihe eOegeC exemption. Any violalion oi Sectian 703/.5 by any epplkant tor e pertnil subjecls ihe eppllcam lo e Uvil penalry of nat more than flve huntlretl dollers (5500)J: ❑ I, as owner ol the property, or my employaes wlih weges as thelr sole compensetlon, WILL DO TME WORK, antl t�e structure Is not InterMeC or ottered for sele (Sec. 7044, Busineu end Protessians Cade: ThB Coniractors Llcense Lew does no� epON �o fln owner ot proPerty who builtls or improves lhereon, end who does such work himsetl or �ersell or through his or her awn employees, proNtleG Ihei such Imprwements are not Intentletl or aflered for sale. It, however, the bulPoing or Improvemem Is soltl within one yoar of completion, the ownerbuildor will heve�the burAan ot provinp that he or s�e tlitl not build or improve lor purpose at saleJ. - ❑ I, es owner ot t�e praparty, am E%CLUSIVELY CONTRACTING WITM LICENSED CONTFiACTORS to construct the prolect (Sec. 7044, Business and Professlons Cotle: The comrectors Llcense Lew tloes not epply to en owner ol pmpeny who bulltls ar Impmves Ihereon, ena who contracis for suc� pro�ect wit� e contrenor(s) Ilcense pursuant to the Contractors License Laws.). ❑ I am exempt unAer sec. Business antl Proleuions Cade lor ihis reason: SignaturB: Dete: Owner ID veAfietl by tlriver's Ilcense. ❑ Ves ❑ No Driver's License No. Veritication of OwnersNp Ey (type at documem, i.e. � property tex bill or deed): Explres: OIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: � ❑ I hereby certlly Ihat no e:cavation five (5) or more teet In tlep�h into whlch e person Is requiretl to descend, wlll be metle in connection wilh work authonzeC by Uiis permit, end thet no building structure, sceHoltling, falsework, or demolition or tlismantling Nereof, will be more than thirry-six (36) leet high, (Chap. 32, Grp 2, Ar12, Sec. 341, Title B, Celltomia AdministratWe Code). ❑ As owner-builder, I wlll no� employ enyone ro tlo work which would require a pertnit trom the Division ot Intlustdel Sefery, es noted flbove, unleu such person he9 e permlt to do such work trom the division. Signature: �ate: Division ol Intlustrial Selery Permit Number. CEHTIFlCAiE OF COMPUANCE AND AUTHOH¢A710N OF EMRV: I cenity untler penalry ot pe�ury Ihat I �ave read ihis eppliwtion an0 s�ate Uat ihe information given Is cortecL I agree to comply with all state laws erM dry orUlnances relating to building constnxtion, and euthwize representetives ot the Ciry ot Coste Mesa to enter upon the above-dexribed properry tor inspection purposes. I egree not to acupy or ellow occupancy of eny building euthorized by �his permit until final inspection. COOE 1. INSPEC710NTYPE 1618 Flaed SyStem Final Fire Preventlon 1268 Pool Spe Final 200 Finel Re�Roof 201 FInaI BIocWRelaininp Well 202 Final Fectory Fire Plece 203 Final Sign 200 Finel DemoliNon Q�¢ �Q £QQF.,( INSPECTIONTYPE 206 Finel Mec�anical 20B Finel PIum0lnp 210 Flnal Electdcal 212 Flnal Flre Preventlon 220 Finel Plenning Approval 222 Finel Site 250 Final Building/Occupanq 17.II�I:ImI.14a (714) 7y1-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: 560 W 19TH ST C Parcel Nunmber: 42210320 Applicant: VAUGHN, JACK Address: 1726 W 9TH ST ",- i'�Y �� UPLAND, CA �/ ; � i; �i;. — � , i �� % � Owner.,�GARVIN DRIVE LTD � Address'�,PARTNERSHIP; �� -- ; � - ' -� ENCINO,�CA��. ,� � - 18485 GARVIN DR \i, /;=, / Contractor. HIGHIAND CONSTRUCTION Address: 1726 W 9TH ST UPLAND, CA � " " � � i , Phone: 909-545-1213 Zip: 97786 . . , � '� Phone: (818) 501-0745 Zip: 914363636 Status: ISSUED Appfied: O6/26/2003 Issued: O6/26/2003 ISSUED BY: I�� Phone: Zip: 91786 . License: 771112 � . . � SCOPE OF PERMIT REF: 603-00858. EXPAND'PAPA JOHN'S' P7ZZA�INTO ADJACEtJT SUITE. IN7ERIOR 1351SF EXPANSION FOR PAPA JOHN. UNIT C. -� - ' -� ELECTRICAL TO.INCLUDE: 18 UGHT FIXTURES, 30 OUTLETS, 6 SWITCHES, 2 MOTORS TO 1 HP. AREA TO BE USED FOR PIZZA PREPARATION ONLY -- NO CUSTOMER WAITING OR SERVICE AREA PROPOSED. ' � - � . ISSUE FEE ' 7emp service test Res. a/c package � New Res (1-2 units) � New Res (3.units) Pool / SPa � , Lightlng Fixts , Racept Outlets \ , , Switches \� Non Res Appl � Res Appl SeMce to 200a Service to � OOOa Service over 1000a Motors to thp Motors [o tOhp ��,�$23.50 �-.$0.00 $0.00 $0.00 . � i $0.00-� � $0.00 $19.80 $29.30 $6.60 $0.00 \ $0.00 ' $0.00 $0.00 so.00' � _ $9.50 $0.00 Quantity 0 0 0 18 30 6 0 � 0 , 0 0 0 2 , � FEESUMMARY Quantiry Temp�Dist System / Lighling $0.00 ' 0 Busway It00 ft . $0.00 � 0 � Standing Sectlon ' $0.00', 0 t � ,' Misc Electrical Equipment' �- $0.00 0 � Transformers up to 1 kvalkw 30.00 , 0 �� ................up to 70 kva/kw � $0.00 � D � � .................up to 50 kva/kw � $0.00 0 � .................up to 100 kvafkw $0.00 0 ',� ..................over 100 kva/kw� �. $0.00 -0; �� LowVoltageEquipment . . �$0.00 "�0�� Low Volt Wiring System / Ckt -$0.00 c �0 Misa Conduit � -$0.00 ;' 0 Misc. Conductor �. � � : $0.00 0 Circus ( gen or ride) �- �" i$0.00 0 Circus (mech ride or lights)- �� $0.00 0 � Christmas Tree Stand $0.00 0 NOTICE: The work authodzed by this permit shall comply with all applicable handicap access requiremems under Calitomia statutes and related ' regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIpATION: ThIs permlt, 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. ' IIJSpECTIONS: In order for the work authorized under this permit to be tonsidered legal, such work must comply with all applicable codes, end all required Inspeetlons and finel approval must be obtained. Fallure to obtain inspections and tinal epproval will result in the expiration of this permlt. FOq INSPECTIONS CALL: (714)1545626 z++o-as�aroo� DECLAR/1T/ONIS WORKERS' COMPENSATON DECLARATION: I heroby eflirm under penelry o� perjury one of (he following tledaretlons: � I �eve end will malntein e certllicete ot tonsent to self-Insure for workers' compensetion, es proviEed far by sectlon 3700 ot t�e Lebor Code, tor the perlortnence of Ne fOf whlCh 1h19 portnit is is5uetl. I heve entl wlll meinialn wwkers' campehsetbn inwrence, es required by secllon 3700 01 the Lebor Code, for the peAormance of Ihe vrork for whlch lhis permlt Lv Issuetl. �y,wOrke �e/n�setlon �n5urence ce er end polit,y number ere: Cflirier: ��T %'LP �d /� P PWicy Number: �i��0� � S�O.� (ihis sect/on need rrot be cwnpleted i! fhe Oermif is valued at one hundred dollars (Sf 00) a leu.) ❑ I ce�iy ihat in [he perto ce of the vrorN compensetlon laws ' omia, tlggt�i comPty with th m' ions. t � Applicent Slgneture: WARNINO: FAILURE TO S RE WORKERS' OOMPFI T1qUSMlDDOLUFE .W%,IN/�DfiIONTO7HE IICENSED CONTRACTORS DECLARATON: I hereby eHirtn that I em licen rorce antl etfect. Lic. a_ Canlraclols Slgnamre: _ CONSTRUCTION LENDING whkli Nis pertnit is Issueq I shall not employ any person in eny manner so es to become suD�ect to the workers' it II t should become su��ect ro Ihe woMers' campensellon provisions of Se 3700 ot the Lebor Cotle, I shall forthwith Date: �� OdJERACaE IS UMAWFUL N1� SMALL SUBIEGT AN EMPLOYER TO CRIMINAL NALTIES N!D CML FlNES UP TO ONE MUNDRED R OF COMPENSATION. DAMAGES AS PROVIDED FOP IN SEGfION 37080P TME IABOR CODE, INfEREST, PND FTTORNEYS FEES. wIN Seclian 7000) of Division 3 of the Bi Gass a Date: Cotle, end my license is in tull ❑ I horeby eHirtn thet Ihere is e Construalan lentling egency for the pedortnance of t�e work for whicli thb pertnit is Issuetl. (Sec. 3087, CINI Cotla). Londer'e Neme: Lenders ACAress: Signe�uro: Date: OWNER-BUILDER OECLARATIONS: I hereby eNlrtn Ihet untler penalry of perjury that I am EXEMPT FROM THE CONTHACTORS UCENSE LAw br the tWlowing reeson (Sec. 7037.5, Business end Protesslons Codo: Any ciry or counry whic� requires e pertnit to construct, elter, imprave, demolish, or repeir eny strunure, pnor to its issuanco, also requiros ihe epplicanl br such permit lo Ille e signed statement Ihet he or she is IlCensad pureuan� to the proNslons of Ue Contredom IJcense Lew (Chapter 8(wmmencing wlth Section 7000) of Dlvlslon 3 of tne Businoss end Prolessions Code) or thet �e or she is exempt therefrom and tha Dasis for Ihe nlleged exemption. Any vidatlon af Section 7031.5 by any eppllcant lor e permit sub�ects Ihe eppllcant to e Gvll penelry a� not more then fiva hundretl tlollars (5500).): ❑ I, es owner of the properry, or my emplvyees wlih weges as their sole compensatlon, WILL DO TME WORK, entl the structura Is not Intentle0 ar oflered for sele (Sec. 7044, Business end Professions Cotle: The Contractors License Lew doe5 not eppy to an owner af properry who bullds or Improves ihereon, antl who tloes such work himself or hersetl ar Ihrough hls or her own employees, provitletl ihat such improvemenls are not iniended or ottered for sele. If, however, the building or improvement is sold within one year ol completion, ihe owner-builder will have ihe burden of proving that he or she did not Duild or improve tor purpose of 5ala.). ' ❑ I, es owner of the property, em E%CLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to construct Ihe pro�ed (Sec. 7044, Business end Protessions Code: The comrectors LJcense Lew tloes not epply to an awner ot propeny who bullds or Improves thereon, end who coniracts lor such pmject wtlh e contrector(s) license pursuant to the Contrectom License Lews.). ❑ I am e:empt under sec. Business enC Professions Code for ihis reason: Signewro: Date: Owner ID vedileC Dy tliiveYs Ilcense. ❑ Ves ❑ No Drivefs License No. Expires: Verlficatlon ai Owners�ip by (rype of tlocument, i.e. - properry te:� bill or Eeea): DIVISION OF INDUSTRIAL SAFETY PERMIT CEFiT1FICATION: ❑ I hereby ceNfy Ihat no excavation live (5) or more teet in depih into which e per5on is requlretl to descentl, will be made In wnnectlon with work euthonzetl by this permit, antl �het no huildinp sWcture, 9callolGing, telsework, or demolition or dismantling thereof, will be more than thirtysix (36) feet hig�. (ChaD� 32, Grp 2, A� 2, Sec. 341, Title 8, Calilomis Adminlstretive Cotle). ❑ As owner•builtler, I will not employ enyone to tlo work which would require e pertnit trom the Division ot Intlustrial Safery, es noted ebova, unless such pereon hes a permit ro tlo wch work Irom I�e Civision, Sipnature: Oe�e: Division ot Intlustriel Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE IWD AUiHORPJUION OF EMAY: I certify under penalry oi perjury that I �ave reatl t�is epplicetion entl stete that the infortnation given is correct. I egrea to compty with all stete laws end ciry ortlinances relatlng to builtling constructlon, entl euthodze re0�esentotives oi the Ciry of Costa Mesa to enter upon the above-tlescriDetl properry ior inspection purposes. I agree not to occupy or ellow occupancy oi eny building euthorized by this pertnit until finel inspection. j�� INSPfCT10N T1PE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Root 201 Flnel Blxk/Retaining Wall 202 Finel Factory Fire Place 203 Final Slgn 204 Final DemollUon �.: / i / �� c�i : Qd¢, �$ f�Qy� INSPECiqN TYVE 206 Finel Mechankel 20B Final PlumDhg 210 Flnal ElecMcal 212 Flnal Flre Preventlon 220 Final Plennirig Approval 222 Final Slle 250 Finel Building/Oc�vpency QAff. II�Lfi S-ol-o/ R�,_ (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92826 ELECTRICAL PERMIT � Job Address: Suite No Vicinity: Parcel Nunmber: ApplicanC Address: Owner: Atldress 560 W 19TH ST C 42210320 VAUGHN,JACK 1726 W 9TH S7 UPLAND,CA. GARVIN DRIVE �TD PARTNERSHIP ENCINO, CA � 16485 GARVIN DR Contractor. HIGHLAND CONSTRUCTION Atldress: 1726 W 9TH ST �- ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to 1hp UPLAND, CA Phone: 909-545-1213 Zip: 91766 Phone: (818)501-0145 Zip: 91436-3636 Phone: Zip: 91786 License: 717112 ISSUED BY: Status: ISSUED Applied: O6126/2003 Issued: O6/26/2003 SCOPE OF PERMIT REF: 803-00858. EXPAND "PAPA JOHN'S' PIZZA INTO ADJACENT SUITE. INTERIOR 1351SF EXPANSION FOR PAPA JOHN. UNITC. - - � ELECTRICAL TO INCLUDE: 18 LIGHT FIXTURES, 30 OUTLETS, 6 SWITCFiES, 2 MOTORS TO 1 HP. AREA TO BE USED FOR PIZZA�PREPARATION ONLY -- NO CUSTOMER WAITING OR SERVICE AREA PROPOSED. . REVISED 07/31/03: ADD 200 AMP SERVICE $23.50 50.00 $0.00 $0.00 $0.00 $0.00 $19.80 $29.30 $6.60 $0.00 $0.00 $30.50 $0.00 $0.00 $9.50 Quantity 0 0' 0 18 30 6 0 0 1 0 0 2 FEE SUMMARY Temp Dist Syslem / Lightlng Busway f100 H ' - � Standing Section Misc Electrical Equipment Transfortners up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Winng System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circ�s (mech ride or lights) Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0. So.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work aufhorized by this parmit shall compry with atl applicabte handirap access requirements under Calitornia statutes arM related regulations. (Orcl. No. 92-28, § 1, 12-21-92) EXPIRATION: This permft shall automatically expire and become voitl if work is not commenced within 1B0 days, or if work ts suspended or abandoned for a period of 180 tlays. INSPECTIONS: In order for the work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all requlred Inepeetions antl final approval must be obtained. Failure to obtain inspections and finai approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2648-66(N00) WORKERS' COMPENSf.nON`1OECLARAnON: � (r� I hereby eHirm under penalry oYperjury one ot the following declaretions: �� ❑ I have e ill meintain e certificete ol consent to self-Insure for workers' wmpensetion, as provitled for 6y section 3700 0l lha Lebor Code, tor ihe peAortnance ot the w r which this permit is issueC. I �ave entl will maintain workers' com�nyetion Insurance, as required by sectlon 3700 of Ihe Lebor Cotle, tor Ne peAortnance of ihe work lor wh�h ihis permit is issued. My worker ' mpensation Insure}�° yerrle^r �e,n-tl �pojliq num /ar��f'� ��j+, L� �/� O Carrier: ' �%� % {f�� ( � / "'�// � _ 1 �1� y� Policy Number. � l �W /O �� m.;< <a.,.;,,.� �n �� oletee /l t e uerm/t Is v lued et one huntlred dollars (3100) or less.) ❑ I certity that in tne peAormence ol the work for which this pertnit is Issued, I shell not employ any person in eny manner so as to become subject to the workers' compensetion laws ot Califomie, entl agree thet tl I s�ould become subject to Ihe workere' compensatlon provisions ol Section 3700 ot Ihe Labor Code, I shell toRhWl�h compty wit� these proNslons. Applicent Signature: Dete: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNOREO TIqU$AN� DOLURE (E100.000�. IN ADDITION TO THE COST OF COMPENSATION, UAM4GE5 AS PflOVIOED FOR IN SECTION 3)OB OF THE LABOR CODE, INfEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I em licensed r prov's ons ot Chepter 9(commencing wlih Section 7000) ot Division 3 of ihe Business rofe I� C4De, end my license Is In tull force and eHect Lic. M � Class a � Cantractors Signature: Date: CONSTRUCTION LENDING AGE CV: � I hereby attirm thet there is a consiruction lending egency for ihe pedormance ot the work for which ihis permi� is issued. (Sec. 3097, Civll Code). Lenders Name: LentleYs Address: Signeture: Dete: OWNER-BUILOER DECLARATIONS: I hereby elfirtn that untler penelry ot per�ury that I em EXEMPT FROM TXE CONTRACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, eusiness end Prateuions Cade: My ciy or crounty which requires e permit to wnstruc4 alteq improve, aemolish, or repair any sWCNre, prior to its issuance, also requlres the eppliCent tor such pertnit �o tile e signetl statement thet he or she is licensed pursuant to Ihe provlslons of ihe Contrectors License Lew (Chapter 9(commencing with Sedlon 7000) at Division 3 of the Business end Protessions Cotle) or Ihet he or sha is axempt thereirom end the 6asis lor the ellegad exemption. Any violetlon of Sectlon 7031.5 by any appllcant for e Dermlt subjects the apDlicant to a civil penalry oi not more than five huntlred tlollars ($500)J: ❑ I, es owner of �he property, or my emplayees with wages as Iheir sole wmpensation, WILL DO THE WORK, entl t�e siructure Is not intended or ottered for sale (Sec. 7044, Business and Protessions Coda: The Coniractors Liconse lew dces not apply to en owner of properry who builtls or improves thereon, end who does such work himsell or hersell or through his or her own employees, provided ihal such Improvements ere not Intended or oNeretl tor sale. If, hov.aver, the buliding or improvement is sold within one year ot completion, the owner-bullder will heve ihe burden oi proving that he or she diA not build or imDrove tor purpose ot sale.). � ❑ I, as owner ot the propeny, em E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct iha project (Sec. 7044, 8usiness and Professlons Cade: The contractors License Lew does not apply to en owner ot properry w�a builds or Imprwes thereon, and who comrects for suc� project with a contractor(s) license Dursuant to the Comractors License Laws.). ❑ I em exempt untler sec. Business entl Pralessions Code tor this reason: Signature: Dete: Owner ID verllied by Crivers license. ❑ Yes ❑ No Drivefs License No. Verificetion ot Ownership by (type of Cocument, I.e. - pmperty taa DIII or deetl): Expires: DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereby cartity that no exwvation tive (5) or more feet in tleplh into which e person is required to descend, will be made in connection with work euthorizetl by this permit, and that no builtling siructure, sceNolCing, lelsework, or tlemolition or dismentling Ihereof, will be more ihan ihirry-six (36) fee� hig�. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Titla 8, Califomia Atlministrative Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which would require e permit from the Division ot Indusirial Sefery, as notetl above, unless such person has e parmit to do such work trom the division. Signature: Da�e: Division of Indusirial Salery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIfTT10RQAT10N OF EMRY: I cenity under penalry of perjury ihat I have reatl t�is applicetion an0 state that the information given is correct. I agree to comply with all s�ate laws entl ciry ortlinances relating to bullding consWction, end authorize representatives of the Ciry ot Casta Mesa to enter upon Ihe ebove-described proper,y for inspection purposes. I egree not to occuFy or allaw accupancy ot any Duilding euthonzetl 6y Ihis permil until finel inspection. COUE I. UNSPECibN TPE 1616 Fixad System Final Pira P�evention �� 1266 Pool Spa Final 200 Finel RB-Rooi � 201 Final Block/Retelning Well 202 Final Factary Fire Place 203 Finel Sign 204 Final Demolition pAIE 1[i�y$ �Q,QF1 INSVECiIONTYPE � ' 206 . Final Mechaniwl 20B Finel Plumbing � ' 210 Finel Electrical 212 Final Fire Prevention 220 Final Plenning App�ovel 222 Final Site 250 Finel Building�Occupancy PAIE 1 j . 1t�L@ Y (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite No C Vicinity: Parcel Number: 42210320 npp�icant VAUGHN, JACK i� ` Address: 1726 W 9TH SL '� / . � . UPLAND, CA � ' _ MECHANICAL PERMIT ,�." _� '-_, .. , . , Phone: 909-545-12�3 Zip: 91786 ownec� � GARVIN DRIVE LTD' � Address:. �PARTNERSHIP-� - � � �ENCINO, CA . , " 16485 GARVIN DR Contractor: HIGHLAND CONSTRUCTION Address: 1726 W 9TH ST UPLAND,CA Phone: (818)501-0145 Zip: 9143G3636 Phone: Zip: 91786 License: 711112 Status: ISSUED Applied: O6/26/2003 Issued: 06/26/2003 ISSUED BY: ✓� SCOPE OF PERMIT � �. - REF: 803A0858. EXPAND "PAPA JOHN'S" PIZZA INTO ADJACENT SUITE. INTERIOR 1351 SF EXPANSION FOR PAPA JOHN. UNIT C. -� - � MECHANICAL TO IIJCLUDE: 1 REPAIR/ALT OF EXISITING SYSTEM, 7 HOOD W/EXHAUST, 2 VENT FANSISINGLE DUCT, 2 FIRE DAMPERS, 1 EVAP COOLER. � � AREA TO BE USED FOR PIZZA PREPARATION ONLY — NO CUSTOMER WAITING OR SERVICE AREA PROPOSED. � � � - ' - - � � FEE SUMMARY/ ' ISSUE FEE Inst FAU<100 k BTU � - _, Inst FAU >100 k BTU. ' Repair I Alt �Cooling/Heat ' ; � Inst I Rep. Recess Wall Htr -� Refrig Sys <100 k BTU �� Refrig Sys >100 k BTU � Gas Piping � � � Factory Fireplace � Hood w/Mech Exhaust � VAV Box � - � ' Vent Fan / Single Ducl� �� Appliance �, � � Fire Dampers Smoke Dampers � Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Fumace Quantity $23.50 $0.00 0 $0.00 0 $13.70 1 $0.00 0 $0.00_. .;0 ,. ,' � $0.00 0 $0.00 � . 0 $0.00.�� 0 . $10.65 1 $0.00, � 0 '- $14.50 2 $0.00 0 , 314.50 2' so.00 0 so.00 0 $0.00 � ,0 . � $0.00 0 --- - � $0.00 0 .i ;�7,. ' � Repair/AltAbsorbtionUnit , Repair / Alt Refigeration Unit - 'VentillationSystem ,��'�: Evaporative Cooler ��, `; Commerciallncinerator � Domesticlncinerator,�_ = , � ; Compressors / Absorption Svstems Upto3hp/100kBTU - , , 3To15hp/SOOkBTU - 15 To 30 hp / 1,000 k BTU � � 30 To 50 hp I �,750 k BTU � Over SO�hp / Over 1,750 BTU " Boilers � , . , ' i � Upto3hp 3To15hp 15to30hp . , - " 30 to 50 hp -- �- � Over 50 hp � -' Other Mechanical Fee $0.00 ' , $0.00 $0.00 $10.65 $0.00 $0.00 $0.00 ao.00 $0.00 , $0.00 � 50.00 $0.00 ao.00 $0.00 so.00 $0.00 Quantity 0 0 � 0 ; 1, 0 0 0 0 0 0 0 0 0 0 0 0 NO710E: � The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomla statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This pertnit shall automatically axpire end become vaid if work is not commenced within 780 days, or If work Is suspentled 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 ali applicable codes, end ell requlred Inepeetiona end flnal approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration ot lhis pertnit. FOR INSPECTIONS CALL: (714) 754-5826 2aae-181N00) WORKERS'COMPENSAnON DECLARATON: 1 �ereby aXirm under penalty of per�ury one oi tha followinp declaretions; . ❑ I heve entl will meinteln e certlticete of consent to selt-Insure tor workers' compensetlon, es provitled lor 6y sectlon 3700 of the Lebor Code, for the peAormence ol ihe �work lor whiCh Ihis pertnll Is i95uod. have and wlll malnteln workero' compensatlon Insuranc�e, es requiretl �y sectlon 3700 of the Lebor COCe, tor Ne pertortnance of Ihe work lor which this pertnit Is i55ued. My workers' compe Hon Insurance cerder enA p number are: '// Cerr�er� - 'y �%�.�`.t '� � I� �PdicyNumber.�7�i�T �(iAk secNon need e i! Ne permlt /s velued aI one untlred dollers (5100) or IessJ ❑ I tBNly that in Ihe pertormance ol the work for whlch t�is permit is Issuetl, I shall not emplq eny persan in eny manner so es to Detome suD�ecY to t�e workeB' compensation laws oiLLyy lifomia, nC e�we�r�tII I should ome suD�act to Iha workars' compensation proNslons ot Sectlon 370 ot lhe Lebor Code, I shell torthwith comply wlth Ihese ;;vv ((sions. � �// ///� � w /' � Applicent.SigneturPl��Y��- !/ Date: � 4' ��—[� / O� WARNINO: FAILURE TO CUFE WORNERS' dJMPENSATIG COVERAOE IS UNIAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND pVIL FlNES UP TOONE HUNDRED TFVOUSAND DOLLAR IOO.00OI. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTIIXJ 3%OB OF THE LABOR �DE, IMEREST. AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby amrm Nat I am II ed un ej�r°i� ot Chapter 9(commendng with SeMlon 7000) ot DMsion 3 o11he Buslness flnA Prol ssio�i s Code, end my Iicense is In full force end ettect. Lic. lt �� !�/ /�� Gms p� - / C— Conirectofs Slgnawre�- — �-- Date: n�� T � 7 CONSTRUCTION LENDING AGENCV: ❑ I hereby ettirtn that ihere is e construction lending agency for the pertormanca of iha work lor w�ich this permit is issued. (Sec. 3097, Civil Code). Lentlefs Nama: Lender's Address: Signalure: Date: OWNER•BUILDER DECLARAT10N5: I hereby efllrtn ihel unCef penelty oi pefjury IhOi I am EXEMPT FROM THE COMRACTORS LICENSE LAW lor lhe tdlowing reason (Sec. 7031.5, Bu51ne55 flntl Pfolesslons Cotle: My ciry or counry which roqulros e permit to construc6 alter, improve, demolish, or repair any struMure, prior to Its Issuance, fllw reQWres the epplicant for such pertnit Io Ille e signetl stetament that he or she Is Iicensed pursuent to tha D�a��slons of the Contractoro LJcense Lew (Chepter 9(commendng with Section 7000) of Divislon 3 of the Business end Professlons Gode) or Ihat ha or she is eaempt iherefrom end the basis for the elleged exemption. Any violatlon oi Section 7031.5 by eny epplicent for a pertnll sub�ects Ihe epplicent to e civil penalty ol no� more than five �witlreA tlollars ($500).): ❑ I, es owner ot tha property, or my employees wit� weges as lheir sWe compensetlon, WILL DO THE WORK, entl the sWClure is not In�ende0 or oNeretl tor sale (Sec. 7044, Business end Protessions CaOe: The Contractors License Lew tloes not apply to en owner of property who Cuilds or improves t�ereon, antl who tloes such work himself or hersell or through hls or her own employees, provitled �hel such improvements are not Intentletl or oNeretl tor sale. If, however, the building or Improvement is sdd within one year of completion, the owneo-builtler will have�t�e burden of provinp thnt he or s�e tlitl not build or ImDrove for purpose ol sele.). � ❑ I, es owner of Ne property em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prqect (SecJ044, Buslness and Prolessions CoCe: The cantrecrora License Lew tloes not epply ta en awner ol pmpeny w�o builtls or Improves t�areon, antl who contrects tor such pro�ect wlth e contrector(s) Iicense pursuent ro the Conirectors License laws.). ❑ I em exempt under sec. Business entl Protessions Code for Ihis reason: Signeture: Date: Owner ID veAfied by drivers license. ❑ Ves ❑ No Drivefs License No. Expires: Vedflcetlon al Ownership by (type of dacumem, i.e. - praperty tex blll or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby ceNiy that no ezcavaUon flve (5) or more teet in tlepth into which e person Is required to descenA, will be matle in connectlon wit� work euthorized by this permit, antl �hat no builtling siructure, sceNoltling, telsewoN., or demolitlon or dismflntling thereof, vnll he more Ihan Uirty-six (36) teet hlph. (Chep. 3.2, Gry 2, Art 2, Sec. 341, Title 8, Celitomle AdminlstraNve Code). ❑ Aa owner-Dulltler, I will not employ enyone to tlo work which woultl require e permlt Irom Ihe Divisian of InAusMel Setery, as noted aDove, unless such person hes e pertnit to do such work irom the tlivision. Sipnature: Date: Division of Industrial Safety Pertnit Number: CERTIFlCATE OF COMPLUWCE AND AUTHORIZATON OF ENTRY: i ceniy untler ponalry ol perjury Ihe� I heve reatl Ihis epplicetion enC state t�al the Intortnation given Is wnect. I agree to comON with ell state laws end ciry ordlnences releting to buildinp construdlon, entl authorize represenietfves of Ihe Ciry ol Costa Mese lo enter upon the ebove�descnbed property lor inspection puryoses. 1 epree not to occupy ar allow occuDency ot eny building authodzetl by thls pertni� unlil Mal inspectlon. WOE I. 1616 1268 200 201 202 203 F�Ced System Final Flre Preventlon Pod Spe Final Flnal Re-Rooi Finel BIocWReteinlnp well Final Feclwy Fire Place Final Sign 20a Final Demditlon PA7E Qf�EL3 COUEI INSPECTONTYPE 208 Finel Meclianicel � �� 3 208 Finel Plumbing 270 Finel ElecMcal 212 Pinal Fire Preventlon 220 Final Planning Apprwal 222 Final Site 2W FinalBuilAing/Occupency / 1 (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92628 Job Address: 560 W 19TH ST Suite No C Vicinity: Parcel Nunmber: 42210320 Applicant: VAUGHN, JACK�, �/ �' Address: 1726 W 9TH ST-� � -� i i; .=. �� UPLAND, CA �'•., \ , � � / �/ ' . ` ' �; ��'�� .; , .- . Owner: !,GARVIN�DRIVE LTD�- ,, AdHress ,PARTNERSHIP-��- �� /.i. � " ENCINO, CA,� ` i. , / ; 16485 GARVIN DR Contractor: Address: PLUMBING PERMIT HIGHLAND CONSTRUCTION ' 1726 W 9TH ST � . � � Phone: �� Zip: 91786 License: 711112 Status: ISSUED Applied: 06/26/2003 Issued: O6126/2003 ISSUED BY: / �. ' � � Phone: 909-545-1213 %� - - , . �� Zip:� 91786 - ,� ., . �:.'�� . . ` ��` -.-�� . �� . `\ �� \ � � �,� / A��_ � i � :��, Phone: (818)501-0145 � `,\ � a� ; Zip: 91436-3636 � , � , � �� "UPLAND,CA � A. Arch / Eng : , � '. -, . , - - ' - - ' , � , . - .+' � , �"v� � . - � . � Address: �-' _,- -. ., _ . _..--. ..._,�.\.{'.,. P Phone: � 2ip: � � . License:, - �— � ' - . � SCOPE OF PERMIT- ? " � � � �REF: B03-00858. EXPAND'PAPA JOHN'S' PIZZA WTO AD'JACENT SUITE. INTERIOR 7351SF; - - .. EXPANSION FOR PAPA JOHN. UNIT C. . PLUMBING TO INCLUDE: 1 GAS (1-0) OUTLETS,.7:GAS SERVICE, 1 BAR SINK, 2 WASH BASINS, �� '� 1 TOICET, 1 CAP SINK. ,-;.,�' ��' � !�� , � _ ; i � AREA TO BEUSED FOR PIZZA�PREPARATION ON�Y — NO CUSTOMER.WAITING OR�SERVICE AREA ,� PROPOSED., , ! �� ': �. _ , . . . ,- ' . _ - ," � . . , ��. � � _ . � , � . , � . ., �� " .� �" FEE SUMMARY � �� , AMT' - QTY � AMT - QTY . . � � ISSUE FEE � ,$2350 � - i , ' Laundry Tub / Washer $0.00 0 � � � Sump Pump - � Backflow irrigation �$0.00 � 0. , Landscape Irrigation $0.00 0 . � Swimming Pool/ Backflow Preventer 30.00 � . 0 � - , � P-Trap� . $0.00 - �� 0 � � --Trap Primer. %� Bathtub 50.00 _ 0� , Pressure Regulator 50.00 � b�, Urinal • Clarifier System 50.00 �� .0� ,� Process.Piping (per 70 ft) $0.00 0 , Vacuum 8rkr BkFlow(1-4) Connect pce,Soda,etc) 50.00 0` - Receptors � $0.00 0 '.�Vacuum Brkr BkFlow(5+) DentalUnits $0.00 0 �,SepticTank $0.00�.0%�: � WashBasin Dishwasher $0.00 0 Sewer Cap for Demo � $0.00- - 0� Wash Basin Set AMT $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $19.60 $0.00 QTY 0 0 0 0 0 0 2 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia slatutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire end become vaid if work is not commenced within 180 days, or if work is suspended or abandoned for a pedod 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, end ell required Inspeetlons 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 244&48 (fl/W) WORKERS'COMPENSAnON DECLARAnON: I hereby eNirm under penelry of perjury one oi the tollowing dedarations: I have nd will maintain a certlficeta ot consent to self-Insure for workers' compensation, as proWded tor by sectian 3700 of Ihe Lebor Cotle, tor the pertortnance of t�e w or whlc� Ihis permit is Issued. I have and will maintaln warkers' campensation insu2nce, as required 6y section 3700 of the Labor Code, for the peAortnance ot ihe work br which this pertnit is issued. My workers' en�j ation Insurencef�jrler and policy numDer ere: 7 Cerrier. ��/f"%� l�o/`lI� PolicyNumber: �`DBC�ID�r� ��„J (Thls secNon need not be canpleted il fhe permlf Is velued at one hundred dollers ($100) ar less.) . ❑ I cenity that In Ihe peAormpnce of Ihe work for w�ich ihis pertnil Is Issued, 1 shall not employ eny person in any manner so es to become subject to Ihe workers' compensatlon laws of tomla, flnd agree hat if I should become sub�ect to the workers' compensatlon provisions oi Secllon 37 t the Lebo Gode, I shell fonhwlth complywithihesep sions. �/'_ O� ApPlicant Signature: " � A-- � Date: � �.p WARNING: FAILURE TO CURE WORKERS' COMPENSAilO DVEMGE IS UMAWFUL AND SHALL SUBIECf Ml EMPLOVER TO CRIMINAL PENPLT ES AND CML FlNES UP TO IXJ�E NUNDRED TIqUSANDDOLLARE� 00,000),INADIXiIONTOTMECOSTOFCOMPENSATIIXJ,OAMAGESASPROVIDEDFIXiINSECilON3l080FTHEUBORCODE.INfEREST,ANDATfORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn thet I am license der rovisic force end eMact. Lic. u Comractofs Si9nature: 8(commencing wit� Section 7000) of Division 3 of the B Class N Code, and my license Is In full CONSTRUC710N LENDING AGENCV: ❑ I hereby aXirm that there is a conswction lending egency lor Ihe pertormence ot the work for whlch this permit is issued. (Sec. 3097, Civil Code). LenOers Name: Signature: _ OWNER-BUILDER DECLARATIONS: Lenders Address: Date: I hereby afll�m Ihet under penalry of par�ury lhat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (SBC. 7031.5, Bu5ine55 entl Pfot8551on5 Code: Any city or counry which requires e permit to construct, elter, Improve, tlemolish, or repair eny slrucWre, pnor to its issuance, elso requires ihe epplicant br such pertnit ta flle a signed statement ihet he or she Is licensed Dursuant to Ihe provlslons of Ihe Conirectors LJcense Law (Chepter 9(wmmencing with Sectlon 7000) of Dlvisian 3 ot ihe Busineu end Professions Cotle) or that he or she is ezempt Iherefrom antl I�e basis Por the ellagetl ezemption. Any violatlon af Section 7031.5 by any applicant for e pertnit sub�ects Ihe applicent to e civil penalry of not more ihan five hundred dollars ($500).): ❑ I, es owner of Ihe prope�ty, or my employees with wages es iheir soie wmpensatlon, WILL DO THE WORK, entl t�e strucWre is not Intentletl or oHered for sale (Sec. 70aa, Business and Protessions Code: The Gontractors License Lew tloes not appty to an owner of property who builds or improves thereon, and who does such work himselt or herself or through his or har own employees, provideC that such improvements era not Intended or offered lor sale. II, however, the building or Improvement is sold within one year af completion, the owner-builder will have.the burden oi proving that he or she did not build ar improve for pur{wse af sale.). � ❑ 1, es ownar of the Oroperty, em EXCLUSIVELV CONTAACTING WITH LICENSED CONTRACTORS to cansiruct the pmiect (Sec. 7044, Business and Pmfessions Code: The Conirec�ofs LltenSe Lew tloe5 not apply to an owner oi proDeny who builds Or Improves Ihereon, and who conlrects tor 5uth pro�ec� wilh e contrector(9) license pursuent to the Conirectors License Laws.). ❑ I em exempt under sec. SlgnaNre: Owner ID venfatl by tlnveYs license. ❑ Ves ❑ No Business antl Protessions Code for Ihis reason: Veritication of Ownership by (rype of Gocument, l.e. - properry te: 6ill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMR CER7IFICATION: Drivers License No. Date: Enpires: ❑ I hereby cenily that no excavetion five (5) or more feet in Aept� Into which e perwn is required to descend, will be made in connectlon with work aut�orizeE by Ihis permit, and that no building siructure, scattolding, talsework, or demolltlon or dismantling thereof, will be more ihan thirty-si: (36) feef high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ As owner-builder, I wlll not employ enyone to do work which would require e permit trom tha Divlslon af Indusiriel Satety, as noted above, unless such parson hes e pertnit �o do such work from the division. Signeture: Dete: Division ot Indus�nal Safery Pertnit Number: CERTiFlCATE OF COMPLIANCE ANO AUfHORPJ1T10N OF EMAY: I certify under penelry of perjury Ihe� I heve read Ihis epplicalion end stete Ihat �he intormation given Is correcL I egree lo comply wlth ell stele lews antl ciry ordinences releting to bulltling conslruction, end authorize representutives of Ihe Clty of Costa Mesa to enter upon the above-described property br inspection puryoses. I agree not to occupy or allow occupancy ot eny building euthorized by this permit until final inspection. cooe �. 7616 1266 Fixed System Final Fire Preventlon Pool Spa Final 200 Final Re-Roat 201 FIne181ocWRetelning Well 202 � Flnal Fattory Fire PleCe 203 Final Sign 204 � Finai Demolition � II4�LS � / .� � �.: � CODEI �Nsvecraxrne 206 Final Mechanical 208 Finel Plumbing 210 Final Electdcal 212 Finel Fire Pravention . 220 Final Planning Approvel 222 Final Site - 250 Final Building�Occupency �7.�1 .1111.. ' , �� ' �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 SIGN PERMIT Job Address: 560 W 19TH $T Suite: Viciniry: Parcel Nunmber: 42210320 Applicant: KEMP, KATHY Address: 4652 KATELLA AVE Owner: Address Zoning: ISSUED 8Y: , .Phone: 562-592-5838 LOS ALAMITOS, CA - � Zip[ 90720 - � - � - - - - - ___ �-�� .�'� __.�"_ . "_� '- GARVIN DRIVE'L-TD � .- ' � PARTNERSHIP' � � � � - ' � � '� �� ` �, .i i' -'�� ENCINO,�CA' � - �� , � Phone: {818) 501-0145. ; , � �� .� ��c � � �16485;GA\INDR = �� _- Zip.�-�91438-3836- `_. � � � l�f�... �l/%� \ � i � _ � ��, �� Y i �ABSOLUTE�SIGN-INC � ' `,c�� Status: ISSUED Applied: OB/07Y2006 Issued: 08/07I2006 Address:�� POBOX478�!c'/;�,=" ��-�, J��,�y�� / - A ,� '.� �i' ' Phone: 562-592-5838 �V��A� �% �� ,�� .. //„ii� ��\ ��\/� � �� , SURFSIDE; CA-� Zip: 90743 \�� / � . / � - ' i�� ,'.� � ";' License: 782551 �' � � -� •', � Arch /-Eng : � � ; �, \ \\� `':� ' `�i�� A� �i,�\ � ��. ,�� Address:� �'��.' ' . _ �' � ��` ., . , .. Phone.> _ �. - . � \\� `i". � �\ \ � . �, � �� . �Zip:� � , "� � �. � '•� �� . _ , . -License: � , , �' %� � � � ' � � � � � — � ' : �-; -�_ SCOPE OF PERMIT � � = .�. _� ; f� � , � �, i 25 SQ� FT ILLUMINA7ED CHANNEL LE7TER WALL SIGN FOR E CASH EXPRESS" \ ,ti,�� _�� „ �/ �V � :-'� � � �� ,�1 ` � `" �' FEE SUMMARY V `� � �� i , � �, Plan Check r � $54.11 r„ ,�. ; ,,_ _ r. � _. � . ��,,,�.Calc Valuation � ss,000.00 � �. �� ' v � ; \ � - $0.00 � , , l % / � 4 � '� � �\� �: ; , �, � �, Permit:, � $83.25 � � - �- Giaimed Valuation: i ' � sa,000.00 ' � ; � � � SMIP Com:'�' $0.63 �� 1 '; '; �' ` ' ; � � �, Other: $0.00 • i � �� "� ./; . , . -' = � � � � ' $Q.�Q '__ _ �� 1 ! _� � C �- �� -'1 � ��I ' � !�� . `_ ` Inspection: $0.00 .. . _ . _ _ ' / i - — � , ,, 1 , � � � �` "' $0.00 ' '' .;�-' ; � -, ' � $0.00 � � - .• � � �ii; ' _7� ' �� ,A .. ', � _ , �„� � � , , �,, �� + �� '�� , I :�, �� ,i, � � Total:; �; 5137.99 � - � % �� / � ` � . � _�.n. _ , � ;// / � � `,� � � PL4NNlNGBZONWG �� '� �� ,� �,' �� ✓� ��; e-•. ,�. . ___" i'• �.�; i� �� i� \� ^ �,�� ' '�lij� �� .�� i , � :,, � � � � �. _ . � , . � ,� ti . �i� _!%j /, 6' i �� .,i �.� —, , � _ �%� �j'' �;� �� _ '_ �, � �� `<i' D �`�� c�� __� �� ,� / 0 �, , , _ .'' `'� ,�! ,� , , ��,-- � � � � � ' — . ; � � • �, , � ' ; — �l�" - � _. �%' , NOT�CE; The vrork authorized by this pertnit shall comply with all applicable handicap accesa requirementa under Calitomia statules and related regulations. (Ord. No. 92-28, § 1, 12-21•92) E7(PIRATION: This permit shail automatically expire end become void if work is not commer�Ced wlthin 180 Cays, or If work Is suspended or ebandonetl � lor a period of 180 days. .;. IMSPEC710MS: In order tor the work aufhodzed und9r this permit to be considered legal, sueh vrork must compty with all appliCable codas, arW all requlred Inepeetlona end final epprovel musl be obtained. Failure to obtain Inspectlons and final approval wlll resutt in ihe ezpiralion.of tliis pertnit. ��/ I FOR INSPECTIONS CALL: (714) 7545828 2a48J8 (e�W) WORKERS'COMPENSATON DECLARAnON: � 1 �ereby ettirtn under penalry of perjury ona N Me iWlrnving 6ederelVons: �• � ❑ I heve arM will malnteln e ceNticate of consent to self-Insure tor workera' compensation, es provided far �y sectlon 3700 0l tha LeDor Cotle, tor Na pertortnence of the work for whlch Ni9 pertnit U issue0. workers' compensatbn Insurance� es reQuiretl Dy secUon 3700 of Ne LeOor Cotle. iw Ne peAartnence o1 the xrork ta wh�h Ws Pertnit Lv Lswetl. Ilon Insuranca certier gntl poliq numGer ara: one Fdlcy Nu�v 6Y1� �� • ca��l �!� or less.) ❑ I certtly tliet In 1he pertormance of Ne worK lor which Uis pertnil Ls issued, I sha0 no� empby erry person in eny menner eo es to become subjecl to Ne workera' compensetlon lews ol Callf mia, erM epree thet H I s�oultl Eecome suD�ecl to Ihe workers' campensatlon Drovisions of Secllon 3700 of Ihe Lebor Code, I shell twt�wlN compty wi�h Nese provis � �% / qpplManlSign te ure 9f1 nf.ad% ,;Date:�. _�,�Y/�-(n f�u:�c^"-. Ni .. .� � i+. W/,HMINk'FAILURE TO SECURE WORKE ' OOMPENSAT OOVEMOE IS UNLAWFUL AND SHALL SUBJECT AN EMPIAYER TO CRIMNAL PENALTIES PND L FlNES UP TO ONE HUNDRED TMDUSPND DOl1AflE (5100.000� W ADOITION TO THE ODST OF ODAIPFNSFTION, DAAUOES AS PRONDED WR IN SECTION 3/080F THE UBOR CODE, INiEflE5T, AND ATTORNEYS FEES. LICENSEO CQNTNACTORS OECLARATION: I hereby alfirm thet I em Iicensed under provisions oi Chepter 8(commencing with Sectlon 7000) ol Divlslon 3 of Ihe Business end Professions Code, entl my Iicense is in full orce aM�.eHectr�r / Cla. '� Contr__toraSlgnewre: i�u-,� Dat �\ � 7iI/r _ __ CONSTiiUCT10N LENDINO AGENCV: ❑ I heraby aHirm that there Is e construction IeiWing egency ior the peAortnance oi t�e work for which this pertnit Is issued. (Sec. 3097, Clvil Code). Lendefs Neme: Lentler's AOtlress: Slgnature: De�e: OWNER-BUILDEfl DECLAIiAT10NS: 1 hdreby ettirtn thet u�er penalry Of perjury Net I em E7(EMPT FROM THE CONTRACTOHS LICENSE LAW tor Ne following reeson (SBC. 7031.5, Busin055 end Profe55ion5 Cotle: My ciry or Counry whkh reqWres e pormit to conswcl, elter, Improve, tlemdish, or repalr any sttuIXure, prior to Its issuanca, elw reQuires the appllceN fw suc� pertnit io f�e e slgneE statement Nat he or ahe b Ilcen9ed pursuent ta Ihe proNsions of Ihe Coniractars Ucense Lew (Chepter 9(commendng wilh Seclbn 7000) of OMslon 3 of the BuB�ness end ProtessVons Cotle) or ifiaf he or ahe is ezempt Urefehom aiM the basb im the ellagetl exempUon. My viWatbn ot Seclion 7031.5 by ercy epplkaM ta e pertnit sublecle the aDPlicent to e dvll penalry o1 not rtrora than tNe huntlretl tlollers ($500).): ❑ I, as owner o� the property, or my employees with wapes os thelr sole compensetlan, WILL DO THE WORK, entl the stmcture is not InterWetl or oNered for eale (Sec. 7044, Buslness end Professions Code: The Contractors License lew tloes not epply to an owner of property who bullds or improves thereon, end who tloes sucli wOAc hlmself or �e�sell or Nrouph his or her own employees, proNdeC Uet such ImprovemenLq are rrot IntendeA or oXered for aele. II, however, Ihe bulldinp or Improvement Ls 9old wi�hin one yeflr o1 completbn, the ownervbuiltler wlll heve Ihe burtlen of provinp ihat �e or she did not builtl or Improve for puryose ot sale.j. • ❑ I, es owner o� the O�aOertY• em EXCLUSIVELY COMAAC7ING WRN LICENSED COMAACTORS to construct the D�aled (Sec. 70d4, Buslness enE Profesaioro Cotle: The contrectoro Llcense Lew Ooes nat epply to an ownar oi property who bulltls or Improves thereon, and who cantracls ior such pro�ect wlth e wnirector(e) Ilcense Dursuant to the Contredors Ucense Lews.). ❑ I em exempt under sec. Slgnature: OWner ID veAlletl by tlriver's Ilcense. ❑ Ves Veflflcatlon o1 Ownershlp by (type ol tlocument, I.e. Husiness antl Pratessions Code lor thb reason: ❑ No Drivers License No. properry lM bill or deetl): Date: E�ires: DIV�SION OF INDUSTRIAL SAFETY PERMR CER7IFlCATION: ❑ I hereby cartity ihat no excavetlon frve (5) o� mora teet in deplh into which e person Is requlred to tlescend, will be matle in connecllon wilh work euNorized by NI9 permit, end thet no bullding sirucNre, scaHdding, talsework, or demdltlon or d'umantling Meraoi, will be more than thirry-s�C (38) feet hlp�. (Chep. 32, Gry 2, Art 2, Sec. 341, T1tle B, Cellfomia Administrative Code). ❑ As owner•bu�ltler, I wlll not employ enyona to Oo work whlch woultl requlre e pertnit trom the Divislon at Industrial Selety, as notetl ebove, unless such person has e pertnit to do such work from Ihe d'rvision. SlpneNre: Date: Dlvlsion of Intlustriel Selety Parmil Number: CEfn1FlCATE OF COMPLUWCE AND AUTHORIZAiION OF EMAV: I certiy WMer penalry W perjury Mat 1 have read ihis apD��e�lon enC stata Ihat Ihe infortnatlon give� L5 cortect. I agree to compty wiN ell steta laws en0 dry ortlinances relatlng to bullding crosWction, end euthodza representeUves of Ue Ciry of Coste Mesa to enter upon the ebo+e-descnbed property tor inspecllon purposes. I agree not lo occupy or ellow xwpency of eny builtlirp euthorized by Ihis pertnit unta fnal inspectlon. f�� INSPECTIONME 1616 Fixetl Syetem Final Fire Prevention 1266 Pod Spe Finel ppp FInBI Re-Rooi 201 Fine181ocMRletalning W efi 202 Final Fectory Flre Place 203 Flnel Sign 2p0 Finel Demd�tlon , , PAg lt� COOE� INSVECTIONTYpE 206 Final Mechenicel 208 F4ie1 PlUmbing 210 Final ElectAcal 212 Flna1 Fire PreverAion 220 Finel Planning Approvel 222 Final SI[B ., 250 , Final Bullding/Occupency, Q� � �� , p14) 754-5273 • Fex (714) 754-4856 • wWw.ci.coata-mese.c�L�CTRICAL PERMIT , n FAIR DRIVE, COSTA MESA, CA 92828 t � .lobAddress: 560 W 79TH ST Suite No Vicinity: ACE CASH EXPRESS � . Parcel Nunmber: 42210320 App�icant: KEMP KATHY Address: 4652 KATELLA AVE ISSUED BY: Bhona: 56&592-5838 LOS ALAMITOS, CA � - � �, �'.Zip- "_�'80720r � � - _ �,;�i--�`- ' � „ -� ' . '��-�_ , � �� Owner. GARVIN�DRIVE"LTD�� ' ��V�� Address PARTNERSHIPVA ��'� � 1 t -. - � �A �' ' �� - V ' � `. �/ � ., �-� � �ENCINO; CA�� " �� `-, ,phone:�(818) 501•0145 � .: i � ��,; % \� � �6!1 5 GARVIN �� jj� .� _=_Zip: - 914383636�� A�� , A :� � � ,' �� :�✓i �" �'��.� . Contrado'r: `.ABSOLUTE'SIGN INC \ �'` \� l � � � � Status: ISSUED Applied: 08/07/2006 Issued: 08I07/2006 ; Address: P�0 BOX 478"% • • ' � '�+ , ' �V�� , � :,:�� '� � • ��. i , � � � i�;, ,� Phone; -562-592-5838 � � � / � � � � ' / ; / � � SURFSIDE, CA Zip: - 90743 ��,�A ! �� "� . � _, �� : =` % • Licensei 782551 - --� , A � � �.� �" ` � �� . , , , � _ _. � - _ � -:� -. `�� -� . ., . . � - . • , , ., .�', . � \� , i ` �SCOPE OF PERMIT ` " � ' -� , ; ,'�sicNciRcuir�oR-�1�' �Ilwo.��a+-cdG{-iann�l {,�!¢,i��(�ql�5i�� '�PG�G.�S{'�`C-i��O�cScSs. - � , ' REF#: SB 06-00079 , � �.. � � . , „ ,- -. ' ' V � � i '� <-� � �� v � 1. -, r I V I , ' -- FEE SUMMARY _- \ `' � / � ' -�- _ ._, � � i; � � - �� ,� � � / i �uanOry;-:-,��. ��'. • : .; , �, � , , ��, �� r'�� uantiry�� - ' ' �,� , ISSUE FEE $23.50 , _ - � � �- � � • � Temp �Dist System I Lghting , 50.00 0 ' �� n �� ' '• Temp service test 50.00 . � - Busway /100 fl ` - � � 50.00 0 I � � �- � ' �� I �- Res: a/c package 50.00 � ,.� Standing Sedion`� ;- � $0.00 0 � �- � � ' v � NewRes(1-2units) -� $0.00 ,�0, -�,- � Miac,E�etldcal,Equipment $0.00 0 �. %' ' � '' �� ' New Res�(3+units) � - 80.00 � �0 _ '=` � ; � Transfomiers up to 1��kvalkw�^� $0.00 0 ; �i'� , ' ''� = � �1� ( Pool'I SPa . . 30.00 , ,0 � - -- - -...up to�10 kva/kw -- � 50.00 0 � �- � '- � ' , � � LighGng Fixis - � 50.00 �� - 0 � - - " ............ .:..vP l0 50 kvalk�w $0.00 0 % ' , � � _ ' ' � i Recept Outlets � � ; $0.00 0 ....... ......L:up to 100 kvalkw � $0.00 0 f � � � ; ;� � .' Switches . - 50.00 � 0 � '...over 100 kvalkw �- SOAO 0�� . � ` � , ............... � i � � / � i Non Re's Appl �� \�� , � 50.00 � 0 Low Voltage�Equipment � 50.00 0� /�� J�„ �� Res'A I, � � � pp � � �'', $0.00 i 0 Low �lolt Wiring System / Ckt , $0.00 �0 ^ , � J '� ; Service to 200a , 50.00 0 - - �� Misa Conduit ' $0.00 j � %0 �� " � Serviceto1000a �� 50.00 0 " �� Misc.�ConduCdr � �50.00�;,/0 �_! ;','�"/ Service'over 1000a \ . $0.00 0 . _ , . Circus ( gen or�ride) , $0,00 �i 0 ,- �� ' Motors to'�1fip � � \50.00 0 . • � Circus (mech ride'or lights), -,, � -_ SO 00� 0�' � . /; Motors to 10hp �� 50.00 0� " '. Christmas Tree Stand : SO 00 0'�. � Motorsto50hp�� /� $0.00�, � 0� �- �,;. � FireworksStand �/3000i 0 n'/� Motors to 100hp, � � � �� 50.00' �A 0'- � �" Other Eledrical Fee- � ,i/50.00 j � �� Motors over t00hp � � ��- 50.00-, � 0� _ � " . . -'�. ��i � �� - � CommuNwtion drops � A �/ $0 00-, 0 '-„ � Investigalion Fee;, - � 50.00�� Sub panel to 200a `� �� $0.00/�� 0 �' - -,� `-�Plan Check Fee::� � � �' 50.00� � PoleLightPkg \��50.00<, �/��0� -� '-- ---ReinspectionFee �,� i$0.00 �0 SignCircuits .`-$24.60�.�; ��1'/�� . •�• �� ' �-�� /.�/ Temp Pwr Pole � _50.00- � � � '0� � %, � �TO7AL CALCUI:ATED FEES ._ f48.10'�� Intermed Pole $0.00• �� 0 � � - � � . • � _ � �� `�COMMENTS 1 SPE ACCONDITIONS . NO7ICE: The work authorized by this p6rmit shell comply with ell applicable handicap accesa requlrementa under Califomia'statutes and reiated regulations. (Ord. No. 92-28, § 1, 12•21•92) EXPIRATION: This permlt shall automaticelly expire end bacome void if vrork Is not commenced withln 180 da r If work Is suspended or abandoned for a period of 180 deys. INSPECTIONS: In order for the work euthorized urWer this pertnit to be wnsidered legal, such work must compty wlth all epplicable codea, arW all required Inspeetions end tlnel epprovel must ba obteined. Fallure to oblain Inspections and final epproval will result in the ezpiratlon of lhls permlt. FOR INSPECTIONS CALL: (714) 754-5628 2M&W (6W) WORKERS' COMPENSATION OECLARATION: � . � I �ereby eflirtn unEer penalry of perjury one of Ihe tWlowing dedaretions: . . ❑� I have erM wlll malntein e certiflcete af consent to setl-Insure for workers' compensetlon, es provlded tor by seclion 3700 W t�e Lebor Cotle, for Ne peAormance o1 Ihe wOrk for which Ulv pertnit is issued. 5' compensetbn Insurence, es requiretl by sectlon 3700 af Ne Lebor Cotle, tor the pertoimence of Ihe woAc fw whlch Ws pertnit Lv Issued. wrence rtier end pollcy number are: ' " '�,�� `�';":PaGcy.Number. /p2v4'J /N�uP i!! fhe rmlt Is velued et one hundred dallars (5100) or less.) ��-► ❑ I ceNty Ihet in the pertormence of Ihe work for which Ihis pertnll Is I55ueQ I s�all not employ eny person in eny manner sa es to become aub�ect to Ihe workers' cornpensa)lon lewa o1 Ca lomle, and eQree thei II I shoultl Decoma sub�ecl �o Ihe workere' tompensetlon proNsions of SecUon 3700 ot lhe Lebor Cotle, I shall torthwlt� complywit� t�ese Dro ,// � �J rIAp�ilcan1�51gneture: �A �fiNn.� Da`�`�e:✓ ��10 `VJARMN(I: FNLURE TO SECURE W Wb1PEA1 TION COVEPAGE IS UMAWFlIL M1D SIUL� SUBIECf Ml EMPLOVER TO CWA9NAL PENALTIES M10 CML FlNE$ UP TO ONE HUNDREO T/qU$M!U DOLLARE (5100.000� IN MIXiION TO THE CO^.aT OF COMPENSATION. DPl.NGES AS PROVIDED FOR IN SECiION 37080F 1HE UBOp COOE, INTEREST. M1D r1TTORNEY'S FEES. LICENSED COMAACTORS DECLAHATION: I hereby afflrm t�et I�^ Iicensed untler provislons ot Chepter 9(commenGrig with Seclbn 7000) ot DMsbn 3,oh(h� enC Professbns Cotle, and my Iicense Is In NII t«co,e„a�enea'u`�7l �Class'A,:_ - - l�?r `co�niiector;s:�Slgne��ure~ � . i�ta�° oater�-t- 1 �%C� t•.wsa�— CONSTRUCTION LENDING AGENCY: � � I hereby attirm that t�ere is a construction IenOing agenq tor Ne pertormance oi the work tor which this pertnit is issued. (Sec. 3097, Civil Code). Lenders Neme: LentleYs Atltlress: Si9nature: Date: OWNER-BUILDER DECLARATIONS: I hereby eKrtn Ih9t unEer penalty of per�ury thet I em E%EMPT FROM THE CON7RACTORS LICENSE LAW tw Ne tdlowhg reason (Sec. 7031.5, BuSiness eiM ProfBS510nS Coae: nny Ury or caunry whlM requires a permit �o construct, eltar, improve, demalis�, ar repair eny structure, prior to its iuuence, elso requires the epplioant tor such pertnit to file e signeO stetement Ihst he or she is Ilcensed pursuent to the provisions ol the Contrectwa License Lew (Cliapter 9(oommend� wIN Section 7000) of Dlvlslon 3 0� the Buslness end Professlons Code) or Nat he or aha is exempt t�erefrom antl t�e besls br t�e allepeA exemptlon. My viWetlon W SecUon 7031.5 by eny epplicenl for e permit sub�ects the eppllcant to a thnl penelry of no� more Ihen five hundred ddlers (5500).): ❑ I, es owner o1 thB properry, or my employees wllh wepes es Ihelr sole compensation, WILL DO 7HE WORK, entl the structure is not Intentletl or ofleretl 1ar eele (Sec. 7044, Business end Professions CoOe: The Contractors Llcense Lew does nol epply lo en owner o1 property who builds or Imprwes thereon, enA who Coe9 suCh work hlmself or hersell or Nrough hLs or �er own emD�%'ees, DroNdetl Uat such improvements ere not Intentletl or ottered for sele. 11, however, Ne builAing or Improvement Is sald withln one yeer of completion, Ihe owner�Dullder wlll heve tho burden of proving Ihe� he or she did not build or ImD��'e lat purpose Of sale.). ' ❑ I, es owner of ihe properry, am El(CLUSIVELY CONTRACTING WRH LICENSED COMAACTORS lo consiruct Ue pro�ect (Sec. 7044, Business end Professl0ne Code: TTe contreIXors LJcense Lew does not epply to en owner of pmperty who bulltls ar Imprwes thereon, entl who contrects for such proJect with e contrector(e) Iicense pursuant to ihe Coniraclore IJcense Lews.). ❑ 1 am exempt uiWer sec. Business end Protessions Cotle tor Ihis reeson: Signeture: Date: Owner ID verlHed by drivefs Iicense. ❑ Yes ❑ No Drivets License No. E�ires: Vedllcatlon of Ownershlp Dy (rype ot document, i.e. - properry Ia: blll or tlee0): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: ❑ I �ereDy certlly Ihat no excevetlon Ilve (5) or more teet In depth Into whlch e person is requlretl to descend, wlll �e mede in connectlon wilh wark euthaAzetl by this permit, end Ihet no building siruCture, SceHolding, telsework, or demolitlon or dlsmanlling I�ereot, will be mora than thlrty-slx (38) teet hlph. (Chep. 3.2, �rp 2, AM1 2, See. 347, T1pe 8, Celllomle AtlminislretNe Cotle). ❑ Ae ownervbuiltler, I will rot employ enyone to do work which would reQuire e permit from iha Dlvlsion at InduStdel Selety, es noted ebove, unless such person hea a pertnit to tlo such work from the division. Sipneture: Date: Divislon ot Intlus�del Safery Pertnit Number. CERfIFlCATE OF COMPLJANCE AND AUfHORVATON OF ENiAY: I certlty under penalry of per�ury that I hava read thls epplication end stele thet the Infortnatlon glven Is conect I egree to compy with all state lawa end dry ordinences reletinp to Oui101np constructlon, end euihodze representetNee of the Clty ot Coste Mesa to enter upon t�o ebovedescribed property lor inspection purposes. I apree not to occupy or allow occupancy ol eny bullding eulhorized by thls permll until Ilnel Inspection. __ . u� � vi: , �r 1618 Fixetl System Finel Fire Prevention 1288 Pool SOe Final 200 Finel Re-Roo1 201 Finel BIocWReteining Well 202 Finel Fectory Fire Place 203 Final Sign 204 Finel Demolition . 40oE� INSPECiIONTYPE 206 Finei MechaNcsl - 20B Final Plumbing 210 Flnal Electricel 212 Flnal Fire Preventlon 220 Flnel Plenninp Approvel 222 Flnel Site „ 250 Finfll Builtling�0aupenc Q� �� (714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.u�qlGN PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite: Viciniry: Parcel Nunmber: 42210320 npp�icank KATHY KEMP Address: Owner: GARVIN DRIVE LTD Address PARTNERSHIP �� ENCINO, CA 16485 GARVIN DR Contracmr: ABSOLUTE SIGN INC Address: P 0 BOX 478 , SURFSIDE, CA Arch / Eng : � Address: Plan Check: Permit: SMIP Com: Other: Inspection: Total Zoning: Phone: 562-592-5838 Zip: Phone: (818) 501-0145 Zip: 91436-3636 � Phone: 562-592•5838 Zip: 90743 License: 782551 SlaWs: ISSUED Applied: 08/21/2006 Issued: 08/21/2006 ISSUED BY: �Xp1 �� DA,�523 Phone: Zip: License: SCOPE OF PERMIT 25 SaFT ILLUMINATED WALL SIGN, CHANNEL LETTERS FOR "ACE CASH EXPRESS", APPROX 10' LONG X 2'6" HIGH. - � $54.11 $0.00 $83.25 $0.63 $0.00 $0.00 $0.00 $0.00 $0.00 $137.99 FEE SUMMARY _ Caic Valuation: Claimed Valuation: � PLANNING & ZONING �- ' $3,000.00 $3,000.00 NOTICE: The work autnorized by this permit shall comply with all applicable handicap access raquirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: This permit shall automatically expire and become void if wak Is nbt commenced within 780 days, or II work is suspended or abandoned for a period ot 180 days. � ' INSPECTIONS: In order for the work autharized under this permit to be consldered legel, such work must comply with all applicable codes, end ell requlred Inspeetions and final approvel must be obtained. Fellure to obtaln inspactlons and final epproval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 � zaavas(doo) WORKERS'COMPENSAnON OECLARAnON: . . I hereby aMirm untler penalry ot perJury one of ihe following tleclarations: � � '' � ' ' . ❑.I have and will maintain a ceRitiwte oi consem lo selGlnsure tor workers' compensatlon, es provitletl for by sedion 3700 of Ihe Labor Cotle, tor tha peAortnance of the work for whith lhis pertnit is IsSued. ❑ I have and will maintain workers' compensation insurence, as requiretl by section 3700 oi the Lehor Code, for the peAormance oi Ihe work tor which this permit is issued. � My workers' co ensation Insurenc cerrlar an policy number ere: /' � . Camer. ��M � / PolicyNumber: QUO� /yc��GQ�` ` (ihis sectirn need ot comple ed il the permit i valued et one hundred dWlars ($loo) or less.) � 1 certity that in Ne peAortnence o1 Ihe work for which t�is permit is issued, I shall not employ eny person in eny manner so es to Decome subject to the workers' compensetlon laws of Caltlomia, entl egree t�at if I should become suD�ect ro Ne workers' wmpensation provislons at Sectlon 3700 ot Iha Labor Code, I shall torthwit� comply with these pravision . Applicent SigneWre: �iJffi./ �JALt.�� Date: �/GZ/ 0�/ i WARNINO: FAILURE TO SECURE WORKERS' PENSATION VERAGE IS UNUWFUL AND SMALI SUBJECT AN EMPLOYER TO CRIMINAL PENALiIES M1D CIVIL FINES UP TOONE HUNDRED TFIOUSAND DOLIAFE (5100,000�. IN ADDITION TO TME COST OF COMPENSATIqJ, DAM4GES AS PROVIOED WR IN SECTION 3108 OF THE LABOR CODE. INTEREST, AND ATiORNE1"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I am force end ettect. Lic. p_ Cantracmr's SignaWre: of Chepter 9(wmmencing with Se�iien 7000) of Division 3 ot the Business antl Professions Code, and my license is in tull � Cless p e. yu� . ✓ a(Qpr,� 7 �� Date: Ai�A //� e CONSTRUCTION LENDING AGENCV: ❑ I hereby aMirm that there is e consimction lending egency for t�e OeAortnance of Ihe work tor which this pertnit is issued. (Sea 3097, Civil Catle). Lendals Name: Lendafs AdGress: Signeture: Date: OWNER-BUILOER DECLARATIONS: I hereby aHirm t�et untler penelry of pehury lhat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for lhe following rea5on (SBc. 7037.5, Buslne55 antl Pfofe55i0n5 Code: Any city or counry which requlres e pertnit to construct, alter, improve, tlemolish, or repalr eny siructure, pnor lo its issuance, also requires Ihe epplicant tor such permit to file a signed stetement �hat he or she Is Iicensea pursuent to t�e provisions of ihe Contrectors License Lew (Chepter e(commencing with Section 7000) of Division 3 of the Business end Protessions Cotle) or that he or she is exempt thereirom end tha 6asis tor the elleged examption. Any vialation af Sactian 7031.5 by any epplicant for a permlt subjects the appliwnt to a civil penalty of not more than five huntlred tlollers ($500)J: ❑ I, es ov.ner ot the property, or my employees with wages as Ihelr sole compensation, WILL DO 7}1E WORK, and Ihe siructura Is not intentled or oHeretl for sale (Sec. 70a4, Business and Professions Cotle: The Coniractoro Ucense Law tloes not apply to an owner of properry who builds or improves thereon, flnC who tloes such work himsetl or herself or thmug� his or �er own employees, provitletl that such impmvements ere not intended or oHered tor sale. It, havever, the builtling or improvement Is soltl wit�in one year oi completion, the owner-builtler will heve t�e burtlan ot proving ihat he or she did not builtl or improve for purpose ot sale.). ❑ I, es owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to cronstruct the project (Sec. 7044, Business end Professions Code: 7�e contractors License Lew tloes not apply to an owner ol propeny who builtls or Improvas ihereon, antl who contracts for such project with a contractor(s) license pursuent to iha Cantractors License Laws.). . ❑ I am exempt untler sec. Business antl Protessions Cotle tor t�is reason: - Signature: Date: Owner ID verified by tlrivers license. ❑ Vas ❑ No OriveYs License No. Expiros: Venfiwtion ol Ownership by (type ol tlacument, i.e. - pmperty tau bill or tleetl): CERTIFlCATE OF COMPLIANCE AND AUTHORQATON OF ENTAY: I cenity under penalry ol perjury ihat I have read ihis application end state ihat the infortnation given is correct. I egree to comply with ell stete lews and city ortlinances relating �o building construction, antl authonze represen�atives of ihe Ciy of Cos�a Mesa �o enter upon the ebove-tlescnbad property tor inspection purposes. I a9ree not to occupy or ellow occupancy ot eny building authorized by this permit until final inspection. I ,/� gnaWre Ot Legal Owner(s) / �/ � Date �� !�� . y An r Authorized Appliwnt Date COOE 1. 1616 126fi Fixetl System Final Fire Prevention Pool Spe Final 200 Final Re-Raof � 201 Flnel BIocWRetaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Domolition CO�EI- INSVECTIONTYPE � 206 Final Mechanicel 208 Final Plumbing 210 Final Elecidcel 212 Final Fire Prevenllon 220, Final�PlanningAppmval 222 Final Site 250 , eeg �r�e�i (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa�t�sCTRICAL PERMIT �� FAIR DiiIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite No Viciniry: ParcelNunmber: 42210320 Appliwnt: KATHY KEMP Address: Owner: GARVIN DRIVE LTD Address PARTNERSHIP � . ENCINO, CA 16485 GARVIN DR Contractor. ABSOLUTE SIGN INC Address: P O BOX 478 SURFSIDE, CA Phone: 562-592-5838 Zip Phone: (818)501-0145 Zip: 91436-3636 Phone: 562-592-5838 Zip: 90743 License: 782551 Status: ISSUED Applied: 08I212006 Issued: 08/21/2006 ISSUED BY: `-�� EXpZ�� V�`� SCOPE OF PERMIT �� ECEC7 FOR ILLUMINATED WALL SIGN FOR "ACE CASH EXPRESS", RE:SBO6-00090. ISSUE FEE Temp service test Res. a/c package New Res (7-2 units) New Res (3+units) Pool /�Spa �ighting Fixts Recept Outlets Switches Non Res Appl Res Appl , � , � Service to 200a Service to t000a Service over t000a Motors to 1 hp Motors to 10hp . Motors to 50hp' � Motors to 100hp � � ""c;crs over t00hp ' Communication drops Sub panel to 200a � Pole Light Pkg Sign Circuits Temp Pwr Pole � Intermed Pole Quantity $23.50 50.00 $0.00 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 , 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 so.00 0 $0.00 0 , $0.00� � - ---� � : _� , � $0.00�� 0 ° �� $0.00� .'�..:�.� 0 _ � BD.GG-_ � ��,^0A, � $0.00 ��0 � � ' $0.00 � � 0 - �- �, ` $0.00 � 0 � �. . -$24.60 1 ' �`�.$0.00 0 , $0.00 � p �s � COMMENTS I SPECIAL CONDITIONS FEE SUMMARY Temp Dist System / Lighting Busway/100ft Standing Sedion , Misc Electrical Equipment � Transformers up to 1 kva/kw � ................up to 10 kva/kw ...............:.up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kvalkw Low VOltage�Equipment Low Volt Wiring System / Ckt � � Misa Conduit ` Misc. Conductor Cirws ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand ' � Fireworks Stand - Other Eleclrical Fee , Investigation Fee Plan Check Fee Reinspedion Fee Quantity $0.00 0 $0.00 0 $D.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0, $0.00 0 . so.00 , o , $0.00 0 50.00 0 $0.00 0 50,00 0 $0.00 0 -,$0.00 , „ 0 ; $0.00 �� : 50.00 $0.00 $0.00 , TOTAL CALCULATED FEES 548.10 NOTICE: The work authoriz9d by this pertnit shall comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) , ��_ EXPIRATION: This permit shal� automatically expire and become void if work is not oommanced within 780 days, or if work is suspended or abandoned for e period of 180 days. � � INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comp�y with all applicable codes, and all required Inepectlons and fingl epproval must be obtained. Fallure to obtain inspections and final epproval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zsaaas (erool I / WORKERS'COMPENSAnON DECLARArON: • . . , � I hereby aHirtn under penalty of perjury one oi Ihe tollawing declarations: ' . ' � . ❑ I hava and will maintain e cartiticate ot consent to self-Insure for workers' compensation, es provided�for by section 3700 ot t�e Lebor Code, tor the pertormence of ihe wark tor which this permit is issued. . . - ,' ❑ I have and will maintain workers' cwripensatbn insu ce, az required by secUon 3700 of the Lahor Code, for Ne pertortnence of Ure work tor w�ich Nis pertnit is issuetl. My workers' compensatl n Insuran�cerrier antl Iicy number ere: Cerrier. / � � L(.v1/1 � � Policy Number. ��JLyc3'� (This secfion�not be cromp/eterl il Ne� valued et one hundred dollars (8100) or less.) � ❑ I certify t�et in the peAormence oi ihe work lor whic� this permit is issued, I shall not employ eny person in any manner so es to Oecome subject m the workers' compensation laws of Celifomla, and egree that it I should become sub�ect to Ihe workers' compensatlon pmvisions ot Sedlon 3700 of the Labar Cade, I shall forthwith comply with these provislons.� � / �/7 /'� . ^ % Applicant Signature: �I/ X'lal�A—� y� Date: X/e%T% . WARNIN(3: FNLUFE TO SEWRE WORKERS' ENSATION EMGE IS UNLAWFUL AND SHFLL SU61EGf M! EMPIOYER TO CRIMINAL PENALTIES M1D GVIL FINES UP TO IXJE H DRE THOUSANO DOLLARE (E100,000), IN ADDITIIXJ TO THE WST OF WlAPENSATION, DAMAGES AS PiiOVIOED FOR IN SECTION 3106 OF THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLAFiAT10N: I herehy aHirm that I flm Iicensed under provisions ot Chapter 9(commencing with Sectio 00) ot Divlsion 3 of the Business and Protessions Cotle, end my licensa is In full force entl ettecl. Lia M Class # ContwctoYs Signature: A�F/�s i �y� � Date: f.� 7/�A� CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm that there is a construction lending egency tor t�e peAormanw ot the work for which this permit is issuetl. (Sec. 3097, Civil Code). Lentlers Name: lendefs Adtlress: SigneWra: OWNER-BUILDER DECLARATIONS: Dete: I hereby eflirm t�at untler penelry ai per�ury thet I am EXEMPT FROM 7HE CONTAACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Buslness antl Ptofessions Coda: Any ciry or County whiCh requir85 8 permit l0 con5iruct, elter, impmve, tlemoli5h, or rep0ir any 5wtture, prior m its issuance, elso raquires the epplicant br such partnit to file e signed statement that �e ar s�e is Ilcensed pursuent to ihe provisions ot the Contractars License Lew (Chapter 9(commencing with Section 7000) of Divislon 3 of �he Business antl Professions Code) or thet he or she is e:empt Iheretrom anC the basis tor tha elleged eaemption. Any violation o1 Section 7031.5 by any epplicant for a pertnit subjecis ihe epplicant to a ciWl penalry of not more lhan five huntlretl tlollare ($500).�: ❑ I, es owner oi Ihe property, or my employees wlth weges fls �heir sole compensation, WILL DO TTIE WORK, end the structure is not Intende0 or oHered 1or sale (Sec. 7044, Business and Prolessions Code: The Conirectors License Law tloes noI apply to en owner of property who bullds or Improves ihereon, antl who tloes such work himseH or herseN or through his or her own employees, provitled that suc� Improvemenis are not Imentletl or ottered lor sele. II, however, iha building or improvement Is solA within one year af completioq Ihe ownerv6uilder will have the burden of proving that he or she did not build ar improve for purpose of sale.). ❑ I, as owner of the proPerry, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS �o construc� �he D�aleci (Sec. 7044. Business end Professions Code: The con�ractors License Lew does not appty ta en owner oi properry who builds or improves thereon, and who coniracls tor such projact with a contracmr(s) license pursuant to the Contractors License LawsJ. ❑ 1 am exemp� under 58C. Signature: Owner ID veritied by tlrivets Ilcense. ❑ Ves ❑ No Business and Professions Code lor Ihis reason: Verificetlon ot Ownershlp by (type of document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION: Driver's License No. Date: Expires: ❑ I hereby certiy that no excavation fiva (5) or mora tee� in depih Into which e person is required to descend, will be made in connection wllh work euthonzad by this pertnit, end that no builtling strvcNre, scalloltling, talsework, or tlemolition or tlismantling t�ereof, will be more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia ACministrative Cotle). ❑ As owner-builder, I will not employ anyone to do work which would requlre e permit irom ihe Division of Indusirial Safety, as notetl above, unless such person hes e permit to do such work Irom the division. SignaNre: Date: � Division ot Industnal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF ENiAV: I certify under penalty of per�ury ihat I have read thls epplication antl state Ihat ihe infortnation given Is correct. I egree to comply with all state laws and city ordinances relating to bullding construction, enG euthonze representatives of ihe Ciry ot Coste Mesa to enter upon ��e above-descnbed pmperty for Inspection purposes. I egree no� to occupy or allow occupancy of any builtling authorized by this permit until finel inspaction. � I �i Sjgpe� re Legal Owner(s) � a/ Q Date � �� /r � / �P AnNOr thorized Applicent Date COOE �. INSFECTIONTYPE 1616 Fixetl System Final Fire Prevention - 1266 200 201 202 203 204 Pool Spa Final Final Re-Rooi Final8locWRetaininp Wall Final Factory Fire Place Final Sign Final Demolition ,� .. � � CODE 1 INSVECTION TYPE 206 Finel Mechanical 208 Final Plumbing 270 Final Elecirical 212 Flnal Fire Prevention 220 Finel Planning Approval 222 Flnel Site 250 Final BuiltlinyOccupancy PA7E � . . � 1tl7ID9L$ � �� (na) �sa-sn3 • rax p14) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Number: Applicant Atltlre55: Owner: Address: Contractor. Address: MECHANICAL PERMIT 560 W 19TH ST B 42270320 HOOPER, DAVID . _' � � � � 1314 PEBBLE SPRINGLN • � i i GLENDORA,.CA �� . - ' - JEFFREY A: PISCHER �.. ' 17337 VENTURA BLVD #205 ENCINO, CA� � SI WI- 1314�PEBBLE SPRINGS LANE GLENDORA,CA Phone: � 62&9637643 ' Zip: 91740 ' i / ' Status: ISSUED Applied: 11I06/2001 Issued: 17I06/2007 Phone: (818) 501-0745 Zip: 97376 Phone: 626-963-7643 Zip: 91741-2350 License: 513099 _� ` � , . ' .. - � . . � SCOPE OF PERMIT REF: B01-00929. TENANT IMPROVEMENT FOR DRY CLEANERS. "ELEGANT CLEANERS". MECHANICAL TO INCLUDE:'1 GAS PIPING SYSTEM„ 1 COMPRESSOR�UP.TO 3HP/100 K BTU, 1 BOILER 3 TO 15 HP. , � � - ' . _ _ _ _ , `, �� REVISED 1/28IO2: ADD 7 VENT FAN FOR RESTROOM. SUPPLEMENTAL ISSUANCE FEE. - , � . . . . . �., . ISSUE FEE Inst FAU <700 k BTU Inst FAU >700 k BTU Repair I Alt CoolingMeat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >700 k BTU � Gas Piping � Fadory Fireplace , Hootl wlMech Exhaust VAV Box Vent Fan / Single Duct . Appliance � Fire Dampers . � Smoke Dampers � Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnaca Floor or Suspend Heater �uantity $23.50 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 .�g8.15 �-1 . $0.00 0 50.00 0 $0.00 0 $725 i $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00. 0 $0.00 0 , $0.00-� - � 0 $0.00 0 ' � FEE SUMMARY _ _ ; � ' ` � ij .. _ Repair / Alt Absorbtion Unit Repair / AII Refrigeration Unit Ventillation System , Evaporalive Cooler - ' ` Commercial Incinerator � � � � Domestic Incinerator � � CorripressorslAbsomtionSvstems;�,' i i i Quantity so.00 0 50.00 0 $0.00 0 �50.00 � 0 � � $0.00 .'0 ;' 50.00 , 0, � � � Upto3hp/]OO�kBTU - � - -'S7470 ��7 3 To 15 hp I 500 k BTU ", � $0.00� 0 15 To 30 hp / 1,000 k BTU �� 50.00 0 30 To 50 hp / 1,750 k BTU� ''��' - /.50.00 0 Over 50 hp I Over 7,750 BTU.�. �� ! 50.00 0 � � Boilers . . � � � Up to 3 hp � � ' � % �� $0.00 0 3 To 15 hp , ' � � ' / $27.15 1 ' - 15 to 30 hp � � $0.00 0 � 30 to 50 hp -,� $0.00 0 - , Over 50 hp - � Other Mechanical Fee � , , Investigation Fee . Plan Check Fee Reinspection Fee . TOTAL CALCULATED FEES COMMENTS I SPECIAL CONDITIONS $0.00 0 $0.00 50.00 $0.00 586.25 NOTICE: The work authorized by this permit shall comply wlth all applicable handicap access requiremenis undar Califomia statutes and related regulations. (Ord. No. 92-28, § t, 12-21-s2) EXPIRATION: This permit shall automatically expire and become voitl if work Is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlona and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (7/4) 7545628 2sewe la'oo) WORKERS'COMPENSAPON DECLARAnON: � I hereby eHirtn urWer penalry of perjury one of the tollowing tlederetlons: ❑ I have and wiil maintain e certiticate oi consent to sell-Insure br workere' compensation, es�0�odtletl tor by section 3700 0l the Lebor Cotle, tor the pertortnence ot the work br w�ich t�is pertnit is issued. ❑ I heve and will maintain workers' compen5etlon Insurance, as required by sectlon 3700 af the Lebor Code, tar the peAwmence of the work for whkh ihis permlt Is Issued. My woAcBr9' compensation Insurence carAer and pollcy numbar era: Cerder. Policy Number: (Thls sec(ion need not be completed il (be permlr ls velued et one huntlretl tlollers (5700) or less.) ❑ I certity Ihat in the peAortnance of ihe work br which lhis permit Is luue4 I s�all not employ any Oerson In eny manner so as to become subJect to Ihe workers' compensetlon lews of Califomla, end eprea that H I should become sub�ecl to the workers' campensetlon provisions oi Sectlon 3700 at the Lebor Code, I shell torthwith wmply with Ihese D�ovisions. Applicem SlgnaNre: Date: WARNIN�: FAILUPE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWfUL AND SHALL SUflIEGT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED THOUSAND OOLLARE (5/00,000). IN ADDITION TO THE C06T OF COMPENSFTION, DMMGES AS PFOVIDED FOR IN SECTION 3108OF THE Ll�BOR CODE, IMERESI. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I �ereDy ettirtn that I am Ilcensed under provlslons ot Chapter 9(commendng with Secllon 7000) ot Dlvlsion 3 of Ihe Buslness and Prafessions Cotle, antl my Ilcense Is in tull force end eflect. Lic. N Class b Gonirectofs Signeture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby attirtn t�at there is a consiruction lentling agency tor Ihe pertormance ot tne work tor which this pertnit is issued. (Sec. 3097, Civil Cotle). Lentlels Nama: Lenders AdCress: Signature: � Date: OWNER-BUILDER DECLAHATONS: I �ereby atflrtn Ihet under penelry of perjury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LnW tor Ine following reason (Sec. 7031.5. eusiness enC Professlon5 Catle: Any ciry or county which repuires e pertnit to conslmct, elter, impwve, demolish, or repelr eny siructure, prior to its is5uance, elso requires ihe applicent ior such pormit ro lile e signed statement ihat he or she is Ilcensetl pureuem to the proNsions ol ihe Coniractors Llcense Lew (C�apter 9(commendng with Seccion 7000) af DlNsion 3 ot the Business antl Professions Cade) or that tie or she Is e:empt iherelrom end the Desls tor the allegeE e:emptlan. Any violation oi Section 7031.5 by any applicant for e permit sub�ects the epplicent to e civil penalry of nol more then five huntlred dollers ($500).): ❑ I, es owner ol the properry, or my employees wlth wages as t�elr sole compensatlon, WILL DO 7ME WORK, antl the structure Is not intendeC or otfered lor sale (Sec. 7044, Business end Professions Cotle: The Contrectore License Law does noi aDP�/ �o an owner of properry who builds or improves thereon, end who does such work himsell or hersetl or through hls or her own employees, provitled that such improvemenis ere not intended or oflereC for sale. If, hov.•ever, t�e builtllnp or Improvement Is sold within one year ol completion, the owner-builder will heve Ihe burden of proNng that he or s�e ditl not Duiltl or improve for purpose ot sale.). ❑ I, es owner of ihe property, em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to conswct Ne prqea (Sec. 704a. Business end Prolessions CoAe: The mnirectars LJcense Lew does not eppty to en owner ol propeny who bullds or Imprwes thereon, end who contrects br such D�o�ed wit� a contractor(s) license pursuam Io tha Cantractors License Lews.). 0 I em ezempt under sec. Business and Professions Cade lor thLs reason: SlpnaNre: Date: Owner �D verllied by drivers license. ❑ Ves ❑ No Drivels ticense No. Expires: Vedllcation oi Ownership by (rype oi tlacumem, I.e. - property tas 6111 ar tleetl): DIVISION OF INOUSTRIAL SAFETY PERMITCERTIFICATON: ❑ I hereby ceriity that no excavetion ilve (5) or more feet in tlepth into whlch a person Is requlred to descend, will be mede in connection with work euthodzotl by thls pertniL and Ihat no building s�ructure, scaHoldinp, lalsework, or demolition or Gismantling ihereol, will be more Ihen thirry-six (38) feel high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Tnle 8, Celilamia Administretiva Code). ❑ As owner-bulltler, I will not employ enyone to tlo work whlch would require e pertnit trom the Divislon of Industnel Satery, es noted ebove, unless such person has e pertnit to do such work tmm the division. Signature: Date: Division ot Industnal Sefery Pertnit Number: CER7IFlCATE OF COMPLJANCE AND AU'THORVA710N OF ENTRV: I cenity under penalry of perjury thel I heve rea0 �his appliwtlon end state Ihet ihe inlormation given Is correct. I agree to compty with ell stete laws end clty ordinences releting to building construction, entl eu�hodze representailves of Ihe Clry of Coste Mesa to enter upon t�e ebove-described property for inspeclion purposes. I aproe not to occupy ar allaw occupency ol eny building authorized Dy this pertnit until final InsOectlon. Slgnewre 01 Legal Owner(s) AnNOr AuthoAzed Applicant WOE 1. INSPECiIONTYPE 7676 Fixetl SyStem Final Fire Preventlon 1266 200 201 202 203 Pool Spe Final Final Re-Root Flnel BIacWRetaining well Final Factory Fire Place Final Sign 204 Final Demolition . . . f�� COOEI INSPECTION7YPE 208 Final Mec�ankal 208 Flnal Plumbing 210 Final ElectAcal 212 Finel Fire Prevention 220 .Final Planning Apprwal. 222 Final Site 250 Final Bullding/Occupancy �g �� 0 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 1ob Address: 560 W 19TH ST Suite No B Vicinity: Parcel Nunmber: 42210320 �. Applicant HOOPER, DAVID-%' Address: 1314 PEBBLE SPRING LN /, , . . \ GLENDORA;CA � �. � � . � Owner.. JEFFREY A. FISCHER Address �17337 VENTURA-BLVD #205 ENCINO;,CA / Contractor. SIWI Address: 7314 PEBBLE SPRINGS CANE GLENDORA,CA ; Arch / Eng : Address: PLUMBING PERMIT Status: ISSUED Applied: 17/O6/2001 Issued: 17/062007 � . ISSUED BY: � , . . �_ . _ . . - , :. � � '�� „ � �� j � � :�_, � Phone:_ 626963-7643 �� _ �� - Zip: 91740 � - . � / �� ; -� �. . ., - _ � ,� � ; -�� `: -A _ _ � � �i � . � - ' _�' `_i � j A��'. :�' .� i . �� \ �, � , �� '� .A Phone: (878) 501-0145 `. A��.-� � �\ ��,A� � Zip[ �-�91316 � � ,`� j►-\ J �� yY � � � , - .. �� ' �� - Phone: 62&983-7843 � � � ' _ � � , `� Zip: 91741-2350 License: 513099 � \ �- "': -,, j - - . . - �; - - ; . - ��; - 1 ... .. "_ � _ '.._. ' <.. . ✓ � ' Phone: - � ' - . � - - , _ Zip:., _.� . � ' � - , . License: - � , � - %� � SCOPE OF PERMIT � REF: BOt-00929. TENANT IMPROVEMENT FOR ORY CLEANERS. "ELEGANT CLEANERS". PLUMBING TO. INCLUDE 1 FLOOR S�NK AND MISC. WATER PIFING. � � REVISED: 7128/02. ADD 1 WASH BASIN AND 1 WATER CLOSET FOR RESTROOM. SUPPLEMENTAL 'ISSUANCE�FEE. � �� " . , GAS LINE FOR.BOILER INCLUDED ON MECHNICAL PERMIT. -- �-' �--• =�- �"-' � . - � � . , - . - • ...� . � ISSUE FEE Backflow irtigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drein, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oiq Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 � $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 Qn 0 0.' , 0 0 0 .' 0 � 0 1 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY ' � _ AMT QTY . . . �� Laundry Tub I Washer • $0.00 -- 0 - �, Sump Pump, Landscape Irrigation $0.00 0 '� Swimming Poot,i P•Trap � 50.00 � 0- � .' Trap Prirner% "Pressure Regulator � � $0.00 �- •�0 � Urinal"' � �' � Brocess Piping (per 10 ft) $0.00 -�0 ' ; Vacuurri Brkr Bkflow(1-4) Receptors � . , . . . $0.00 ' 0 -� �/ 'Vacuum Brkr Bkflow(5+) Septic Tank $0.00 � ,0 � - --�" Wash Basin Sewer Cap for Demo - -$0.00 �-� 0�"� Wash Basin Set Sewer Connect 50.00 0 Waste and Vent System Sewer Private Line 50.00 0 Water Closet (Toilet) Shower $0.00 0 Water Heater I vent Sink, bar $0.00 0 Water Piping (Inst or Rep.) Sink, commercial $0.00 0 Water Re-pipe Sink, Floor 50.00 0 Water Service Sink, kitchen 50.00 0 Water SoRener Sink, servicelmop $0.00 0 OTHER Spa (private) $0.00 0 VIOLATION Spa (public) $0.00 0 PLAN CHECK REINSPECTION � _ � ' / ! AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $9.80 $0.00 $9.80 50.00 $0.00 $0.00 $7.50 $0.00 $0.00 $0.00 QN 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 NOTICE: The vrork authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related ��9�_}��9 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permlt shall automatically exp re an ecome vo i wo is no wmmenc vn in 180 days, or if work is suspended or abandoned for a period of 780 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicabie codes, end ell requlred Inspeetiona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545628 2�ests(arool WORKERS' COMPENSA710N DECLARATION: . 1 hereDy aHirm under peneliy of perjury one of Ihe tollawing tlecleretlons: � ❑ I hBve entl wlll maintein a certlllcate of consem to selhlnsure tor workers' wmpensatlon, es provitled tor by sectian 3700 oi iha Lebor CoOe, lor the peAortnence oi the work tor which ihis pertnit is issued. ❑ I havb entl will maintain xrorkers' campensatbn Insurenca, es requireA Dy sectlon 3700 of Ne Le6or Cotle, lor Ihe peAortnance of the work tor whlch this pertnli IS I55u9A. My workers' compensailon Insurance prrier and policy number are: Cartier. � Pdiry Number. (rhrs secuon neee mr ne canaerec u u�e Pe�u rs Ve��ee e� one nuna�ed daiers (S �oa) o� iess.� � I certify [�ai In t�e peAartnance ot Ihe work tor which ihis pertnit is issued, I shell not employ eny person in flny manner so es to become wD�ect ro t�e workers' compensetlon laws of Califomia, entl egree thet II I shoultl Decome sublect to the workers' wmpensetlon provisions ot Sectlon 3700 0l Ihe Lebor Code, I shell forihwlth compty wilh ihese provisions. ApDlicent Signature: Date: WRPNIN�: FAILUFE i0 SECURE WORKERS' CdAPENSAiION COVERAOE IS UNLAW FUL AND SW�IL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES MlD CML FlNES UP TO ONE HUNDHED THIXISAND DOILARE (5100,000�, IN ADDfTION TO THE COST OF COMPENSATION, DMIAGES AS PROVIDED FOH IN SEGTON 3lOfi OF THE LABOR COOE, INfEREST, M'D ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm t�ai I am licensed untler provisions of Chapter 9(commencing with Soction 7000) ot Division 3 of Ihe Business and Professions Code, antl my Iicense is In full force and eifecl. Lic. k CIa55 M ComrectaYs Signeture: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aMirtn that Ihere is a conswction lentling agency for Ihe peAormance of t�e work for which this permit is issuetl. (Sec. 3097, Civil Code). Lentler's Neme: LentleYs Address: Signature: � Date: OWNER-BUILDER DECLARATIONS: I �ereby aHirtn Ihat under penalty of perjury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW lor the tollowing reason (Sec. 7031.5, Business enG Protesslons Code: My dry or counry which requires a permit to construct, alter, improve, demolis�, or repair any strudure, prior to its issuance, also reQuires Iha epplicant for suc� permi� to tile e signed stetement that he or she is Ilcensetl pursuam to the pmvisions of Ihe ContraMors LJcense Lew (Chapter 9(commendng wit� Sectbn 7000) of Divislon 3 of the Business entl Professians Code) or Ihat he or she is exempt therefrwn end Ihe basis br the alleged exemptlon. My viWaGon of Section 7031.5 by eny ap0licant tor e pertni� suD�ects the epplicant to a civil penalry of not more than tive huntlretl tlollars (5500).): ❑ I, es owner oi the property, ar my employees wit� weges es ihelr sole com0ensetlon, WILL DO THE WORK, and Ihe structure is not Intendetl or oXeretl lor sela (Sec. 70M14, Business and Pmfessions COAe: The Contractors License Law tloes not appty to an owner ot Droperty who builtls or improves thereon, end who does such work himselt or herseli or ihrough his or her own employees, D�ovidetl I�et such Improvements ere noi IntenGetl or oNeretl tor sale. If, hor.ever, the builtllnp or Imprwement Is soltl within one year at completion, the owner-builder wlll �ave tha burtlen ot proNnp thet he or sha did not build or imD�ove for purpose ol sele.). ❑ I, es owner of the proDerty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to tons�ruct lhe projett (Set. 7044, Business end Prolessions Cotle: The contrectors Llcense Iaw does not apply ta en awner ot propeny who bullds or improves thereon, and who contracts for such pro�ect wit� e contractor(s) Ilconso pursuent to the CoNractors Licensa LawsJ. ❑ I em exempt un0er sec. Business entl Proteuions Cotle for ihis reason: Signeture: Date: Owner ID vedfled by tldvels license. ❑ Yes ❑ No Ddvers License Na. Expires: Vedflcatlon ol Ownership Dy (type at tlocument, I.e. - pmpeny tea blll ar tleetl): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certlly that no excavation five (5) or more laet In depth into which e person Is requireC to Gescen4 wlll be meGe in connectlon with work euthoAzed by thls pertnit, end thai no building siructure, sceMoldinp, felsework, or demolliion or tlismentlinp ihereoi, will be more �han Ihirry-slx (36) teet hlph. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Calllomia Atlministrative Code). ❑ As owneo-builder, I will not employ anyone to do work whlch would requiro e pertni� trom tha Division of Industnel Satety, es noted ebwe, unleu such person has e parmil to do such wark Irom the division. Signature: Date: Division ot Indusirial Selery Permit Number: CEHTIFlCATE OF COMPLIANCE AND AUfHOR¢A710N OF ENTAV: I cenity untler penalry ot perjury that I have reaa this aDP��on enA state that the information given is conecL I egree ro compy with all s;ate laws entl dry ordinances releting to huilCing consWction, entl authodze represeniatives of the Ciry of Coste Mesa ro enter upon the ehove-described property for inspection purposes. I egree not to occupy or ellow occupency ol eny builtling euthonzed by this permit until linal inspectlon. Signature Of Legal Owner(s) And/Or Authorized Appllcent IQQpf��, INSPELTIONTYVE 1618 Fixad System Final Fira Prevention 1268 200 201 202 203 204 Pool Spe Finel , Final RaRooi Finel8locWRetaining Well , Final Fectory Fire Place . Final Sign Final DemWiGon . . Qe�fi �$ COOE� INSPELTIONTYPE 206 Final Mechanicel 20B Final Plumbing 270 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency �ff. It�LH (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 �obAddress: 560 W 1gTH ST Suite: D Viciniry: ParcelNunmber: 422103�0 Applicant: PHOUNG, DAVID Address: 8877 WESTMINSTER AVE � GARDEN�GROVE;CA i ',. Owner� JEFFREY A. FISCHER Address 17337 VENTURA BLVD #205 i ENCINO, CA = ' - Comracror."� ,APPLE SIGN & GRAPHICS � " Address: � 8877 WESTMINSTER AVE I � � ` � , ' GARDEN GROVE, CA , Arch / Eng : Address: � i SIGN PERMIT Zoning: ISSUED BY: Phone: (774)894-1126 Zip: 92844 � Phone: (818)501-0145 Zip: 91316 Phone: (714)894-1126 Zip: 92844 � - License: 602081 Phone: Zip: License: Status: ISSUED Applied: 07/25/2001 Issued: 07/25/2007 A ,�� ` \ �_ � �� i � ' � � .'- SCOPE OF PERMIT � `� � - (\�, - INSTALL iW0 INTERNALLY ILLUMINATED CHANNEL LETTER�WALL SIGNS 18.5 SQ. FT. EACH FOR ,�- �/ ��\ I "EL CHINACO RESTAURANT'. � . , . = , [ � � � , � • � � % � � " � � �� 1 L� FEE SUMMARY� Plan Check: $72.31 � � ` � �� $D.00 , Permit` ', $111.25 SMIP Com:� . � $1.05 � � Other,' �� $0.00 _ , �� $0.00 Inspecti �: . $0:00 � _ _ � „ � _ _ ��,i! ;- Calc Valuation: i�;'$s.000.oc i��; , ; � �� ._ _ ". Claimed Valuation ,r �'/ ge;000.00 �/�/ � � , :�j�/ � `J� �� / ,// �. � �, �� , � $0.00�� _, � � � �' �j% � �,` �J �� </�$0 00 \ �� - � � G✓� �// �� j � %� �\�O. �� /� � �/ �,i Total: �` 5184:61 � � � �' � �i �.A�� , `�� . � . � � ; ��`�A C��.'� �`.' � � � �� -�` � NOTES: � % PLANNING & ZONING �,�� \�� ii�� , . i j % j' � �l, i /• � INOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia staWtes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) - �! EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned �� for a period of 780 days. I INSPEC710NS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapeetiona and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the axpiration. of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaae�ae Ierool WORKERS' COMPENSATION DECLARATION: • I hereby attirtn under penalry of perjury one oi the following dedarations: ❑ I heve entl wlll malntain a ceNflcate of consent to self-Insure tor workers' compensalion, as provlded tor by section 3700 ot the Le6or Cade, lor the pertortnence of ihe work for whlch this permlt Is I55ueA. 1 have and wlll meintein workers' campe�setlon insurance, as required by section 3700 of Ne Lebor Catle, for ihe perfwmanca ot ihe work tor which Ihis p0rtnit is IssueO. My workers' omp nsatlon Insurance Gertler enA policy number are: �7�y�� 7 �Certier. - � PolicyNumber: �f/'7V� �/I Z � � 1 (This secfi�i ne 0 nof be com leted i/ the B��f is valued ef one hundred dWlars ($100) a less.) � �—' ❑ I certity Ihet in Ihe DeAormence of the work for which this pertnit Is issued, I shall not employ eny person in eny'manner so es to become sub�ect to the workera' compensation laws ot Califampi� end e8rae thet it I should become sub�act to the workers' campensation provisions of Section 3700 of �he Lebor Code. I shell lorthwith compty with Ihese provisionsl \ %//JJ Applicant Signature: �� {^� �' � Dete: ��/ WARNING: FAILURE TO SECURE W NERS' COMPEN AT1IXJ COVERAGE IS UNLAWFUL AND 5lULL SUBIECT AN EMPLOVER TO CRIM PE TIES AND GVIL FlNES UP TOONE HUNDRED TTIOUSAN� DOLLARE (5100,000�, IN ADDITIIXJ TO T�E COST OF COMPENSATION, OAMAGES AS PROVIDED f-0R IN SECTION 3�O60F THE IABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm ihat I em fcensed untler provislons of Chapter 9(commencing with Sectlon 7000) of Division 3 ot the Business and Professions Code, end my license Is In full torce and eflecCLlc. p_�n –%) �� Cless A Coritrectors Signeture: .�� – Date: 7 9, � n 1 s i CONSTAUCTION LENDING AGENCY: ❑ I �ereby attirtn that there is e wnstructlon lentling agency for the pedormance ol tha work br which this permit is issued. (Sec. 3097, Civil Cotle). Lenderg Neme: Lender'S Adtlress: Signature: Date: OWNER-BUILDER DECLARA710N5: I hereby ettlrtn that untler penalry ai per�ury t�et I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor lhe following reason (Sec. 7031.5, Busin855 end Pratession5 Cotle: Any city or counry which requires a pe�it ro construct, alter, impmve, Aemolish, or repair any siructure, prior to its issuance, also requires the epplicsnt for such pertnit to lile a signetl statemem thet he or she is IlGensetl pursuant to Ihe provisions ol the Conirectors License Law (Chapter 9(commancing with Section 7000) ol DlNslon 3 of iha Business end Prafessions Code) or thet he ar she is exempt t�eretmm end t�e besis for the elleged e:emption. Any violation of Sectian 7031.5 Dy eny epplicant for a Oermit sub�ects the epplicant to e civil panelry ot not more than five huntlred tlollars ($500)J: ❑ I, es owner ol ihe property, ar my employees with wages as ihelr sole compensatlon, WILL 00 7ME WORK, end the slrucWre is not intendatl or oHeretl lor sale (Sec. 7044, Business end Prafessions Code: The Contractars License Law does not apply to en owner of property who builds or improves Ihereon, entl who does Such work himself or hersell or ihrough hIs or har own employees, pmvided ihat such improvemeNs are no� Intended or oflered lar sule. If, however, �he building or improvemenf is sold within one yea� ot.completion, ihe owner-builder will have the burden oi proving that he or she did not build or improve for purpose of sale.). �� /Ii_� ❑ I, as owner of the property, am EXCLUSIVEIV CONTRACTING WITH LICENSED CONTRACTORS to conslruct �he projecl (Sec. 7044, Business an0 Professions Cotle: TTe contractore Llcense'Lew does not appty to en owner ol pmperty who bullds or Improves thereon, entl who comrects br suc� project wtlh e Comracmr(s) license pursuent to the Contractors License Laws.). ❑ I am exempt unGer sec. �" ��`� Business and Professlons Code lor ihis reeson: SignaWre: �� -� Date: �v Owner ID verifietl by Anver'S IlcenSB. ❑ �es.. ❑ No Driver'S Llten50 No. Expires: Veritiwtlon ol Ownership by (rype ot document, i.e. - properry te�c till or Oeed): DIVISION OF INDUSTRIAL SAFETY VERMIT CERTFICATION: ❑ I hereby certify Ihat no eMcavation five (5) or more feet in tlepih into which e person Is required to descend, will be made in connection with work authorizetl by ihis permil, antl that no builtling siructure, s�ettolding, talsework, or tlemoli�ion or tlismentling thereot, will be more ihan ihirty-six (36) fee� �igh. (Chep. 32, Gry 2, Atl 2, Sec. 345, Title 8, Celitomia AdmlNsiretive CAde). ❑ As owner-builder, I will not employ anyone to do wark which would require e pertnit from the Division ol Industnel Satery, es natetl ebove, unless 5uch person has a permit to do such work from t�e division. Signature: Date: Division ot Industriel Sefaty Pertnit Number: CERIIFlCATE OF COMPLIANCE AND AUTHONIZATION.OF EMAY: I cetlily under penelry ot perjury fhet I have read Ihis applicetion and state thet the information given is correct. I egree Io comply wllh all stete lews end city ortlinances relating to building consimc�lon, end authonze representetives of ihe City o� Coste Mese �o enter upon Ihe ebove-descnbed property for inspeciion purposes. I egree not to occupy or allow occupancy ot any building authonzed by this permit until final inspec�ion. Si nature Of L al Owner(s) � � n �a��o�n�� AnNOr Authonzetl Applicant I�QQf�� INSFECTONTYPE QL[' �5 � 1616 Fixed System Final Fire Prevention 7268 200 201 202 203 204 Pool Spa Finel Final Re-Roof Final BIocWRetaining Wall Final Factory Fire Plece . Finel Sign Finel Demolition i00E I INSiEtTION TYPE 208 Finel Mechanical 20B Final Plumbing 210 Finel Electdcal 212 Finel Fire Prevantion 220 Final Planning Approvel 222 Final Site 250 Finel Building/Occupancy PeiE � �rm� s (714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 560 W 79TH ST 42210320 Applicant: RODERICK, RANDY Adtlress: owner: GARVIN DRIVE LP Address 16485 GARVIN DRIVE ENCINO, CA � . � Phone: 909-574-1400 Zip: Phone: Zip: 91436-3636 Contractor: NATIONAL CONSTRUCTION RENTALS Adtlress: 10403 GLENOAKS BL. iSSUE FEE Temp service test Res. alc package New Res (t-2 units) New Res (3+units) Pool / Spa Lighting Fizts Recepl Outlet5 Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Morors to 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole PACOIMA, CA 1 TEMP POWER POLE. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.50 $0.00 Quantity 0 0 0 0 0 0 0 0 ' 0 0 � 0. 0. 0 0 0 0 0 0 0 0 1 0 Phone: (800) 446-2018 Zip: 91331 � License: 687160 SCOPE OF PERMIT FEE SUMMARY Status: ISSUED Applied: 09/26/2000 Issued: 09/26/2000 ISSUED BV: � � Quantity , � . Temp Dist System / Lighting ' $0.00 0 - - " BuswAy/t00N� � � $0.00 0 " .� - ' �StandingSection $0.00 0 Misc Electrical Equipment $0.00 0 ' Transfo'rmers up to 1 kva/kw �$0.00 0'. . ...........-.....up to 10 kva/kw $0.00 0.. , � .. . .................up to 50 kva/kw $0.00 , 0� , � ' - . , ' ' ...:.............up to 100 kva/kw $0.00 - 0 � ._ � . • - ........_..:.....over 100 kva/kw $0.00 , � , 0 ' .• Low Voltage Equipment $0.00� ," 0 . � � Low Volt Wiring System /�CkC;-. $0.00." 0� ' j�� , �� Misc. Conduit - ' � -$0.00 . , 0 ` � Mlsc. Conductor , - $0.00 � � � 0 �. �' ' Circus ( gen or ride) ��" $0.00 �! 0- � . Circus (mech-ritle or lights) � _ $0.00 � � 0 �. ' Christmas Tree Stand , � .$0.00 0' Pireworks Stantl � - $0.00� � 0' = Other Electrical Fee , � $0.00 -; - j Investigation Fee' _ -- $0.00 � , �PlanCheckFee . �'$0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES 547.00 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitomia statutes and related regWations. (Ord. No. 92-28. § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned tor 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 inepeeqons and final approvel must be obtained. FaiWre to obtain inspections and final approval will result in the expiration of this permit. �, I FOR INSPECTIONS CALL: (714) 7545628 zaasae (arool WORKERS' COMPENSATON DECLARA710N: I hereby ettirm under penalry of perjury one of t�e lollowing deGarations: ❑ I heve end wlll maintain a certifiwte ot consent ta selt-Insure tor workers' compensation, as provided for by section 3700 ot the Lebor Code, tor Ihe pertortnence of �he work tor which ��is pertnit is issueA. ❑ I have end will meinlain workers compensetlon insumnce, as required by section 3700 ot the Labor Code, for Ne pertortnance of Ne work for which this pertnit is issued. My workers' compensation Insurance cerrier entl policy numbor are: Cartier: Policy Number: �f�on nesd not be completetl i/ the peimit is valuetl et one hundred dWlars ($100) or less.) c`eNiy Ihel in the pertartnance of the work lot which Ihis pertnit is issuetl, I shell noi employ eny person in any manner so as to become subjact to ihe workers' compensatlon laws W Calitomia, and egree that It I should become sub�ect Io the workers' compensation proNsions of Section 700 of Ihe Lebor Code, I shall fort�with comply wlth these provisions. �� / c.�i Applicant Signature: Dete: UU WARNING: FAILURE TO SECUHE WORKERS' CAMPENSATION ODVERAGE IS UNLAWFUL AND SHr1LL SUBJECT AN EMPLOVER TO CRIMINAL PE TIES AN CIVIL FlNES UP TOONE HUN�HED T/iWSAND DOLURE (5100,000�, IN ADDITION TO THE COST OF COMPENSATION, UAMAOES AS PROVIOED F-0R IN SECf1IXJ 37080F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTAACTORS DE R TION: I hereby aflirm thal I em Ily etl und pmNsio Chapter 9(co encing wilh Section 7000) of Divislon 3 of the Business and Pmtessions Code, and my license Is In full force antl eNecL Lic. N/ / Class p 1 CONSTRUCTION LENDING AGENCV: � I hereby eXirm that there is a construction lendinp agency for the pedortnance ot Ihe work tor which this pertnit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lendars Address: Signature: Date: ' OWNER-BUILDER DECLAHATIONS: 1 hereby eHim� thel under penely ot perjury Ihet I em E%EMPT PROM THE CONTRACTORS LICENSE LAW for Ihe follovring reawn (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires a pertnit to construd, alter. improve, demolish, or repair any structure, Drior to i�s issuance, also requires the epplicant tor such permit to file e signetl slatement that he or she Is IlcenseO pursuant to the provislons of ihe Contractors License Lew (Chflpter 9(commencing wit� Section 7000) of Division 3 01 the Business end Protessions Code) or that he or she is e:empt thereirom end Ihe basis lor the alleged ezemption. Any violation of Sectian 7031.5 by eny applicent tar e permfl subjects Ihe eppllcam to e civil penalry oi not more than five hundred dollars ($500)J: ❑ I, es owner at ihe property, or my employees with wages es their sole compensatlon, WILL DO TME WORK, entl Ihe structure is not Intended or oflered ior sele (Sec. 7044, Business and Professions Cotle: Tha Coniractors License Lew does not apply to an owner of properiy who builds or improves thereon, end who does such work �imself or hersalt or through his or �er own employeas, provided Ihet such Improvements are no� Intentletl or aHered tor sala. If, howaver, the building or improvement Is sold within one year of comD�etion, ihe owner-builder will have ihe burden of proving ihat he or sha did not build or improve for purpose of sele.). ❑ I, as owner ot the properry, am EXCWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business and Professions CoAe: The contrenors License Lew does not apDN �o an ownor of proparty w�o builds or improves thareon, and who wnirac45 for suc� pmject with a coniredor(s) license pursuent to ihe Contractors License Lews.). ❑ I am exempt under sec. Siqnature: Owner ID vedfletl by dnvers licensa. ❑ Yes ❑ No Business antl Pmlessions Code tor this reason: Verificetion of Ownership by (type of tlocument, I.e. - property tae blll or tleetl): DIVISION OF INDUSTRIAI SAFETY PERMIT CERTIFICATION: Dnvers License No. Date: ExpirBs: ❑ I hereby cenity that rro excavation five (5) or more feet in depth into which e person is required to OescenQ will be matle in connectlon wit� work authorizeC by thls permi�, end ihet no building sirucNre, scaflolding, falsework, or tlemWilion or tlismentling ihereof, will be more than thirty-su (36) tee� high. (Chap. 32, Gry 2. Art 2, Sec. 341, Ttle 8, Califomia AdministratNe Code). ❑ As owner•builtler, I vrill not employ anyone to Ao work which would require e pertnit tram Ihe Division ot Industrial Satety, es noted ebove, unless such pereon has e � permit to tlo such woB trom the division. Signature: Date: Division of Industrlal Satery Permit Number. CERTIFICATE OF COMPLIANCE AND Al7fHORQATON OF EMRY: I cenity untlei penalry of perjury Ihe� I heve read this application end slete Ihat the infortnetlon plven Is corre mply wi� antl� ' inances relating to Dullding consWction, end euthodze representatives oi the Ciry oi Coste Mesa to enter upon Ihe e va-descri fo speqion pu oses. I egree n t to xcupy or ellaw occupency ot any building euthorized by ihis permit until Nnel inspection. CO�E I. INSFECiqN ME 1676 Fixetl System Final Fire Preventlon 1266 200 201 202 203 Pool Spe Finel Final Re-Roof Finel BIocWRetaining Wall Finel Feclory Fire Place Final Sign 204 Final Demolition Applicant �g � � �.: � �.: �{iQgj INSPECTIONTYPE 206 Final Mechanical 208 Flnel Plumbing 210 Final Eleciricel 212 Finel Flre Prevention 220 Finel Planning Approval 222 FinelSite 250 Final BuiltlinyOccupflncy �ff. I�� s�7/ Job a.ddress: 560 W 19TH ST Suite: C Vicinity: Parcel Number: 42210320 Zoning: Applicant: WRIGHT, MARK Address: 1701WSEQUOIAAVE� '- ".- . � � � � , -� - � Phone: Q14)870-1010 , � � ORANGE,.CA' � - . Zip: 92868 Owner. GARVIN�DRIVE.CTD Address � . PARTNERSHIP�� -- - '. � � , � ENCINO, CA � �, - " Phone: (818) 501-0145 - '" 16485 GARVIN DR Zip: 91436-3636 Contractor. SIMRLEX GRINNELL LP � Address: 1701 W SEQUOIAAVE - � Phone: (774) 870-1010 � ORANGE, CA ' Zip: �.92868 ; � � �-.�License: 802591 � 803-00858 Plan CheCk: Permit: Other: �� _ $35.10 $54.00 $0.00 Total: $89.10 Status: ISSUED Applied: 06/16/2003 Issued: 07/11I2003 � ISSUED BY: �� ,. , ; � �. . . . . `� � � � � � , . -- `� . - _ FEE SUMMARY - -_ - - T ? - _ - . _ Calc Valuation: 8�,500.00 .. - Claimed Valuation; g�,eoo.00 .-�-.. � � � - --- - _ i' . ' _ • ✓' � `' �. � � � , � . 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 ihe work authorized under fhis permit to be considered legal, such work must comply with all applicable codes, and all required inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will� result in the expiration of this permit. . FOR INSPECTIONS CALL: (774) 7545626 taa�-as (�oo) WORKERS'COMPENSAnON DECLARATON: I hereby aHirtn undar penalty ot perjury one oi �he following declarations: ❑ I heve and will maintain a certiticate ot consem b selt-Insure tor workers' compensation, as provided tor by section 3700 of �he Labor Code, for the peAormance of Ihe wark tor which ihis Dertnit is issued. have and will maintain workers' compensetlon insurance, as requireO by section 3700 ot Ihe Labor Code, tor ihe performance of the work for which this pertnit is issuetl. My workers' compensalion Inst:or:.b :a:�sr antl policy numGer are: . Carder. � Poncy Number (This settion neetl not be comp/eted il fhe permit is ve/uetl a( one hundred dollars ($100) or Iess.J ❑ I certiFy ihat in the peAormance oi t�e work for which this permit is issuad, I shell not employ any person in any manner so as to become subject to tha workers' compenution laws oi Califomia, and agree that It I shoultl become sub�ect to Ihe workers' compensation provisions of Se tion 37 of ihe Labor Cotle, I shall forthwith comply with these�.(p�ra�vis�io' s. � /► �%� �APPliienti�ature:-y�-}—=� �'�-�Q'-" ^ Date: I� � I �O- � ) WARNINOt�FA1LURE TO SECURE WORKERS' WMPENSATION COVERA�E IS UNLAWFUL AND SHFLL SUBIECT AN EMPLOVER TO CRIMINAL PEI NALTIE$ AND CIVIL FlNES UP TOONE HUNDRED TFIOUSAND OOLLARE (E100,000�, IN ADDITION TO TME COST OF COMPENSATION, DAMAGES AS PROVIDED FO(i IN SECiION 3]O60F THE IABOfi COOE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of tha Business and Protessions Cotle, antl my license Is in full force and eflaclfClc.-N� Class N �Gontract�ure:}:�cu�4.t�Q.d� �../\ Date: � �� !%-� CONSTRUC710N LENDING AGENCV: ❑ I hereby attirm that there is a wnstmction lending agency tor ihe pedormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lendefs Address: Signawre: OWNER-BUILDER DECLARATIONS: Date: 1 hereby attirm that under penalry of perjury that I am EXEMM FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7037.5, Business entl Profession: Cotle: Any ciry or counry which requires a permit to construct, elter, Improve, Eemolish, or repalr any simcWre, pnor to its issuance, elso requlres the applicant tor such pertni to tile a signed statement Ihat he or she is licensed pursuent to ihe provisions oi ihe Conirac�ore License Law (Chapter 9(commencing with Section 7000) of Division 3 of thE Business and Protessions Code) or ihat he or she is exempt therofrom entl the Desis tor the allegatl exemption. Any violation of Section 7031.5 by eny epplicant for e pertni� subjecis ihe apD�iwn� to a civil penalry of not more than tive hundred dollers ($500).): ❑ I, as owner of Ihe proparry, or my employees with wages es their sole compensation, WILL DO THE WORK, and the structure is no� IntentleA or otfered for sale (Sac. 7044, Business and Professions Cotle: The Contraccore License Law does not apply to an owner of properry who builds or improves thereon, and who does such work himselt or herself or through his or her own employees, provided Ihat such improvemenls are not intended or oXered for sale. If, however, the bullding or improvement is soltl within ona year of completion, tha owner-builder will heve the burden ot proving that ha or she did not build or improve for purpose oi sale.). � ❑ I, as ownar of the property, am EXCLUSIVELY CONTRACTiNG WITH LICENSED CONTRACTORS to wnsiruct ihe project (Sec. 7044, Business and Protessions Cotle: The contrectors License Law does no� apply b en owner of propehy who build5 Or improves lhereon, and who contracis for such pro�ed with a ton�rettor(5) license pursuant to the Coniractors License Wws.). ❑ I em exempt under sec. Business and Professions Code for Ihis reason: Signature: Date: Owner ID venfied by drivefs license. ❑ Ves ❑ No Dnvers Licensa No. E:pires: Ventication af Ownership by (type of document, i.e. - praperty tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth Into which e person is requiretl to descend, will be metle in connection with work authorized by this permit, antl ihat no building siructure, scattolding, falsework, or demolition or dismantling thereof, will be more �han �hirry-six (36) tee� high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Celifomia Administrative Code). ❑ As ownerbuilder, I will not employ anyona to do work which would raquire e permi� from Ihe Division of Indus�rial Satety, es noted ebove, unless such person has e permit to do such work irom the division. SignaWre: Date: Division of Industrial Safety Permit Number: CEHTIFlCATE OP COMPLJANCE AND AUiHORVA710N OF EMAY: I certify under penalry of perjury [hat I have read ihis epplication antl state ihat the information given is correa. I egree to comply with all stele laws and cily ortlinances relating to building construction, antl authonze representatives of the Ciry ol Costa Mese to enter upon the above-descnbatl properry for inspection purposes. I agree not lo occupy or allow occupency of any builtling au�horized by ihis permit until final inspection. CODE t' INSPECIIONTYPE � 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roat 201 Final BIocWRetaining Wall 202 Final Faclory Fire Place 203 204 Final Sign Final Demoli�ion QdIE INf111A15 O�E� INSPECTIONTYPE ' 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency 7�g INi111�LS ► � (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 560 W 19TH ST 42210320 Applicant: VANOOSTENDORP, DAMON Address: P.O. BOX 3033 '" � ' NEWPORT BEACH, CA Ownec ,-GARVIN DRIVE'LP Address� - 16485 GARVIN DkIVE � Contractor Address: ENCINO,,CA� „ JETTY ELECTRIC P.O. BOX 3033 NEWPORT BEACH, CA Phone: (949)646-5062 � , � � Zip: 92659 , � � Phone: Zip: 914363636 �: •Phone: (949)646-5062 -' -. Zip: 92659 � . License: 677322 Status: ISSUED Applied: 11/092000 Issued: 11/09/2000 ISSUED BY: SCOPE OF PERMIT � REF 8000-0846, 186 LIGHTS, 10 OUTLETS, 6 SWITCHES, 4 SUBPANELS UP TO 200AMP., 1 SIGN.3CONDUITS,1"METER�UP,TO;"1000AMP. • � -� � "-� �- . . . -- , - �:. - � '` , t ._.. . .. .:_/.. . . ....... . . . ... . . , ISSUE FEE . - Temp serviCe lest � Re's. a/c package ' New Res (1-2 units). New Res (3+units) , Pool / Spa Lighting Fixts ,. Recept Outlets Switches Non Res Appl � � Res Appl � Service to 200a , , Service to 1000a ' . Service over 1000a � � Motors to 1hp Motors to 10hp � Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $19.80 �� $11.00 $6:60 $0.00 $0.00 , $0 00 $62.15 $o.00' $0.00 $0.00 $0.00 $0.00 � $0.00 - $0.00 - $122.00 $0.00 $24.60 $0.00 $0.00 � Quantity 0 0 0 18 10 .. . 6 _ _ -.Q '.-: :. 0 0 1�" �o�;�� _ 0 0 0 0 0 0 4 0 1 0 0 FEE SUMMARY � - � r. � ' � � Quantity - `-' ' - - - �! r Temp Dist System-% Lighting � _ $0.00 0 �� f� ,� - ) ' , � Busway/100ft„ $0.00 0 Qj-! , "' ��," Standing-Section � $0.00 0 i"� - .' - -/ � �r � Misc Electrical Equipment SQ00 0;/�' �'� _ , ' � ��' ! Transfortners up to 7 kva/kw $0.00 ,0/% ; , �-� �. � -._...__._._...up to 10 kva/kw $0.00 GO` ; �� % - � '' .''-, �, . ... - .., , . � . .., �,,' •. . :� ....::.......;up to 50 kva/kw $0.00 ;°/0 ., .� , ' r •��» � � ....._......'.:.-.up,to100kva/kw $0.00�,��0 �'-' j �; ,` Low Volta e Ver �100 kva/kw . $0 0%/ 0�,-'', :/% ...._ � . , ., � ... .....g Equipn�ent;_i_:'g.'.; - ..g0.00,.� 0 � � � �; ; � . LowVoltWiringSystemdCkf ��-$0:00 -�0 � � �/ Misc: Conduit � ,;:$54.60� i 3. �/j j � , Misa Conductor �� i $0,00' =✓0� �� ;� � Circus ( gen or ride) . � � % $0.00,-� 0 /, i . �. � Circus (meCh ride-or lights) ;,. �$0.00 j 0�� i� Christmas Tree Stand .$0.00 j0 j� FireworksStand�� ' ��.`�$0.00�"',0 Other Electd'cal Fee�� $0.00 %� -, J � � � � Investigation Fee � "�$0.00 , Plan Check Fee - - $0.00 - . Reinspection Fee � - " $0.00 TOTAL CALCULATED FEES E324.25 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatibally expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO 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 Inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. � FOR INSPECTIONS CALL: (714) 754-5626 244&6fi (f✓00) WORKERS' COMPENSATION DECLARATION: � I hereby eflirm under penalty ot perjury one ot ihe following declaratlons: � ❑ I have and will mainiain e certificate ot consent to selt-Insure for workers' compensation, es provided tor by section 3700 ot tha Labor Cotle, for the peAormence of the wark for which this permit is issued. � I have and will malntain workers' compensetlon insurance, as roquireA Dy sectlon 3700 ot Ihe Labor Code, tor ihe perfortnance oi the work for which this peimit is issued. \ My workers' compensation InsWance carner end policy number ere: �.c� ? Carner: i� 7�- 7E f"�/ i.0 Policy Number: � V /�/ �� (This section need not be complefed i! the permit is valued at one hunCred tlollars ($100) or less.) ❑ I ce�ity that in lhe padormance oi ihe work for which ihis pertnit is issued, I shell not employ =^�� ^.__,.re_.�= � jqg�y_ annar so as to become sublect to ihe workers' compensation laws of California, end e ree ihet H I should become sublect ro the wo'rkers' compe eti�prov'is'idns-e ction 3700 of llj�'�Laborf otle, I shall forthwith compl iWpaee-pmvis' 'a+c, � � /g / � nt Signature: .�� U� a a: � i WARNI TO SECURE WOFKERS' 001APENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTI 5 AND IVIL FlNES UP TOONE HUNDflEO $AND DOLLARE ($100,OW�, IN FDDfiION TO TME COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3�O60F THE LABOR CODE, IMEREST, AN� ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: provisions of Chapter 9(commencing with Section 7000) of Lic. # Date: and Protessions Code, and my license is in full CONSTRUCTION LENDING AGENCV: — ❑ I hereby aflirm that there is a conswction lending agency for the pertormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Atldress: Signature: OWNER-BUILDER DECLARATONS: Date: I hereby atfirtn thet untler panelty af perlury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any city or counry which requires a permit to construc6 alter, improve, demolish, or repair any structure, prior to its issuance, also requires [he applicant for such permit to file e slgneA statement ihat he or she is licensed pursuant to ihe provisions of the Coniractore License Lew (Chapter 9(commencing with Section 7000) of Division 3 ot ihe Business antl Professions Code) or ihat he or she is exempt therefrom and the �asis for Ihe elleged exemption. Any violation ot Section 7031.5 by any eppliwnt for e permit subjects the applicant to a civil penalty of not more than tive huntlred dollars ($500).): � ❑ I, as owner of the property, or my employees with wages as �heir sole compensation, WILL DO THE WORK, and Ihe sWCNre is not intentled or oflered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves Ihereon, and who does such work himself or herseN or ihrough his or her own employees, providetl ihat such improvements ara not intended or offered for sale. It, however, Ihe building or improvement is sold within one year of completion, ihe ownerbuilder will have the burtlen of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner ot ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business antl Professions Cotle: The con[racbrs License Law tloes not epply to an owner ol pmperty who bulltls or improves thereon, end who contracts for such project with a comractor(s) license pursuant b the CONracmrs License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID ventied by drivers liCense. ❑ Ve5 ❑ No Dnver's License No. VeriFicetion oi Ownership by (type of document, i.e. - proparty taz bill or deed): Expir85: DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no exwvation five (5) or more feet in tlepth into which a person is required lo descend, will be made in connection with work authorized by this permit, antl ihat no builUing siructure, scaHoltling, falsework, or demolition or dismantling ihereot, will be more Ihan Ihirty-six (36) feet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Title e, California Atlministrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division ot Indusirial Sefery, es noted above, unless such person has e permit to do such work trom the division. Signature: Date: Division of Indusinal Satety Pertnit Number. CERTIFICATE OP COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the infortnation given Is wrrect I agree to comply with all state laws entl city ordinances relating to building consimction, antl authorize representatives of ihe City of Cos�a Mesa to enter upon the above-described property for inspection purposes. I egree not to occupy or allow occupancy of eny building authorizetl by this permit until finel inspection. FODE t. INSPEGTIONTYPE � 7616 Fixed System Final Fire Prevention 1266. POoI Spa Final 200 Final Re-Root 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition OpTE �¢ COOE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elettnwl 272 Final Fira Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinNOccuoan� Q� � OI_ (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite No • Vicinity: ' � . Parcel Nunmber: 42270320 Applicant: O'KEEFE, JIM Address: 15007 OXNARD ST VAN NUYS, CA Owner: GARVIN DRIVE LP Address 16465 GARVIN DRIVE 4 ENCINO, CA PLUMBING PERMIT Phone: 818-781-9481 Zip: 91411 Phone: Zip: 91436-3636 Contractor: BLUEWATER PLUMBING & FIRE PROTECTION INC Address: 15007 OXNARD ST Arch / Eng : Address: VAN NUYS, CA Phone: 818-781-9481 Zip: 91417 License: 598461 Phone: 2ip: License: SCOPE OF PERMIT NEW 6850 SQ FT COMMERCIAL SHELL BLDG. 4 ROOF DRAINS, 3 SEWER CONNECTS, 1 WATER SERVICE, 3 HOSE BIBS. `ADD 4 GAS OUTLETS 8 4 WATER PIPINGS ON 1I78I01. REF: B00.00846 ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifler System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drein, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1�4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 50.00 so.00 50.00 50.00 50.00 539.20 50.00 $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 $0.00 an FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors 50.00 Septic Tank $0.00 Sewer Cap for Demo 50.00 Sewer Connect $73.95 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 Qn 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 7 012 6/20 0 0 Issued: 10R6/2000 ISSUED BY: Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater I vent Water Piping pnst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK • REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $39.20 $0.00 59.80 $0.00 $39.20 ao.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 4 0 1 0 C NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related ��" �� COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expue an ecome voi i wo is no commence wi in 180 days, or if work is suspended or abandoned lor a pedod ot 180 days. _ INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must compy with all applicable codes, and all requlred inspeetlona end final epprovel must be obtained. Failure to obtain inspections and finai approval will result in the expiration of lhls pertnit. FOR INSPECTIONS CALL: (714) 754-5626 � WORKERS'COMPENSATON DECLARAnON: � I hereby eHirtn under penalry oi perjury one oi Ihe IWlowing deGaretion9: ❑ I heve and will meinlain a certificate of consent to self-Insure for workers' crompensation, es 0«deE for by section 3700 at the Labor Code, for the peAortnence of the work Iw wnicli tnis pertnit is issued. r.n es requiretl by Section 3700 0l Ihe labOr Code, tor No pertormence ot Ne work tw whkh Nis pertnil is issued. ----_. . _• - Cartier. S✓�l. �Q, PdicyNumber. !✓G/SZo/Oo SDa (7hls secN nof be complefed ll the permlNs valued e( one hundred dollers (S100J or less.) ❑ I certl Ihe lhe pertortnence oi Ihe work tor which this permit is Issuetl, 1 shell nat employ any person In eny menner so es to became subJoct to the workere' comp lawa o1 Califamle, end epree Ihet It I s�ou10 become sub�ect to Ihe workers' campensetlon provlslons ol SecUon 3700 of Ne Lebor Cotla, I ehall lorthwith comply w th provisions. Appllcant SlgneNre: � Dete: � /Ii� 0 � WARMNO:FAILURETO EWORKERS'COM SAP COVEMOEISUNUWFULANOSHALLSU9IECTANEMPLOYERTOCfiIMINALPENPLTIESANDCMLFlNESUPTOONEHUNDRED THOUSAND DIX1ME 1 00. ), IN ADDITION TO TME COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 37080F TME UBOR OODE, INTEREST, AND ATTORNEV'S FEES. UCENSED CONTRACTORS DECLARATION: I �ereby aflirm that I em force and effect. LJa p_ Contractors Slgnature: CONSTRUCTION L ❑ IherebyeKrtn Lendefs Name: Signeture: _ ot Chapter 9(commenNng with Sectlon 7000) af DINSion 3 0l the Busineu fln0 Professions Code, and my Ilcense Is in full cie� a G— 3 6 �1. �1� Date: � /Q—a/ a conslrucGon lentling egency for the pertortnance of Iha work br which Ihis pertnit is issued. (Sec. 3097, Civil Catlej. lender's Atltlress: Date: OWNER-BUILDER DECLARATONS: I hereby aHirtn that untler penelry of perjury tha� 1 em EXEMP7 FROM THE CONTRACTORS LICENSE LAW lar t�e following reason (Sec. 7037.5, Business entl Prolesslons Code: Any City or Counry which requires e permit Io constmct, elter, Impmve, tlemolish, or repair any etruauro, pdor ta its issuance, elso requires the applicant tor such pertnit to file e slgneC stetement thet he or she is Ilcensed pursuent to ihe provisions ot Ihe Contrectors LJCenSe Lew (Chepter 9(commendng with Sectlon 7000) of DlNsion 3 ot the Business end Protassions Code) or that he or she is exempt t�eretrom and the basis for Ihe ellegetl exemptlan. Any vloletion o1 Section 7031.5 by eny eOD��aot far e permlt sub�ects the eppiicant to e cNil penalry oi no� more than ilve hunAretl Aollars (5500).): ❑ I, es ov.ner ot the property, or my employees wlth weges es their sole compensa�on, WILL DO 7ME WOiiK, end the structure Is not intended or otferatl tor aele (Sec. 7044, Business end Professions Cotle: 7he Conlrectors Llcense lew does not apply to en owner of property who builds or imprwes thereon, and who does such work himsell or hersetl ar ihrough his or her own employees, providad Nat such improvements are not Intendetl or oHeretl tor sele. If, however, the builtlinp or Improvement is sold wit�in one year o1 completion, the owner-builOer wlll heve t�o burtlen oi proving t�at �e or she tlitl rro� builA or Improve lor Durpose of cale.). 0 I, as owner ot tha property, em E%CWSIVELY CONTRACTING WIiH UCENSED CONTiiAC70RS to construct ihe prqect (Sec. 7044, Business antl Protesslons Coda: Tha contractors LJcense Lew Ooes not eDPly to an owner ot prope�y w�o builtls or improves thereon, entl who wntracts lor such projact with a wntrector(s) Ilcense pursuant Io ihe Conirectoro lJcense Lewe.). ❑ 1 em exempt untler sec. Busineu antl Pmlessions Code lor this reason: Signature: Dete: Owner ID verllied by tlrWers licensa. ❑ Ves ❑ No Drivers License No. Expires: VedllcaUon ol OwnersMp by (rype ot GocumenL i.e. - property taz bill or tleetl): DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: ❑ I hereby certlty ihet no excavatlon Ilve (5) or mare feet In depth Into which e pereon Is requlred to desCend, wlll be made In connec�ion wlth work eulhorizeC Dy Ihis permit, end t�et no buil0ing siructure, scaHoltling, lelsework, or demUition or tlismentling thereol, wlll be more then thlrty-slx (38) fael high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle B, Calilomia AtlminiStraNve Cotle). ❑ As owner-builder, I will not employ enyone to do work whlch wauld require e permit from the Divislon ol Industriel Selery, es nated above, unless such person hea e permit to tlo such work trom Ihe tlivision. Signature: Date: Division of Industnel Safery Pertnit Numbar: CERTiFlCATE OF COMPLIANCE AND AUiNORRATON OF ENfAY: I certity under penally of perjury Ihel I have raatl this epplication and stete Ihat ihe Inlortnetlon given Is cartecc I egree to wmpty wlih all state lews end ciry ordinnnces rolating to builtling constructlon, and euthodze represematives ol t�e Clry of Coste Mesa to enter upon the flbovo-descnbed praperty for inspection purposes. I egree noI Io occupy or ellow occupency ol eny builtling authorized by Ihis permil until linel Inspecllon. WUE I. 1618 Fucetl Syst mal Pire Preventlon 1268 Pool Spe Final 200 Final Re-Roaf 201 FInaI BIocWRetaining Well 202 203 Final Factory Fire Place Final Sign 200 Final Demolition Pdg 1�55 � �ig-0� Dei9 �yp� iNsveenon irve 206 Finfll Mec�anicel 20B Finel Plumbing 210 Final Elecincal 212 Final Fire Prevention 220 Final Planninp Approval 222 Finel Site 250 Final Builtling/Oaupancy PA� II{�E� �- �a-0i 7� (714) 754-5273 • Fax (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 . ,� Job Address: 560 W 19TH ST Suite No Vicinity: , , Partel Nunmber: 42210320 Applicant O'KEEFE, JIM Address: 15007 OXNARD ST VAN NUYS, CA . Owner: GARVIN DRIVE LP Address 76485 GARVIN DRIVE , ENCINO, CA PLUMBING PERMIT Phone: 818-781-9481 Zip: 91411 Phone: Zip: 91436-3636 Contractor: BLUEWATER PLUMBING & FIRE PROTECTION INC Address: 15007 OXNARD ST Arch / Eng : Address: VAN NUYS, CA Phone: 818-781-9487 Zip: 91411 License: 598461 Phone: Zip: License: Status: ISSUED Applied: 10/26I2000 Issued: 10/26/2000 ISSUED BV: SCOPE OF PERMIT � NEW 6850 SQ FT COMMERCIAL SHELL BLDG. - ' ', 4 ROOF DRAINS, 3 SEWER CONNECTS,.1 WATER SERVICE, 3 HOSE BIBS. <�. �, - "�� / REF:B00-00846 - � .. _ . � . ISSUE FEE Backflow irrigation Backflow Preventer � Bathtub Clarifier System Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Drein, Rainwater Drain, Roo( Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceprors (Grease, Oip Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 Qn � O 0 0 0 0 0 0 0 . 0 4 0 0 0 0 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer � $0.00 Landscape Irrigation $0.00 P-Trap ' $0.00 Pressure Regulator $0.00 Process Piping (per 10 fl) $0.00 Receptors 50.00 Seplic Tank � $0.00 Sewer Cap for Demo $0.00 Sewer Connect � $73.95 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 � � ��/� � � i ��. : , _ • QTY � '� /� � � � � i �AMT i. , � i 0 �-. Sump Pump�, � � � / $0.00 0 "',�i'Swirtiming Pool , % ,' $0.00 0 �' � , Trap Primer � $0.00 0 �, Urinal � � ' �. � $0.00 0 , Vaiuum BrkcBkBow(1-4) $0.00 - 0 VacuUm Brkr Bkflow(5+) $0.00 0 Wash Basin 50.00 0 .Wash Basin Set $0.00 3 " �� Waste and Vent System $0.00 0 Water Closet (Toileq $0.00 0 Water Heater / vent $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Water Re-pipe $0.00 0 Water Service 39.80 0 Water Sottener $0.00 0 OTHER $39.20 0 VIOLATION $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 TOTAL CALCULATED FEES: 5185.65 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 L NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void ii work is not commenced wilhin 180 days, or if work is suspended or abandoned tor 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 finel epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaas<c (s�oo) � • . _ . w ., _, `.�,�>3�. WORKERS' COMPENSATION DECLARATION: I hereby ettirm under penalry of perjury one oi Ihe IWlowing deGaretlons: ❑ I heve and will mainteln a certiflcate ol consent to selt-Insure tor workere' compensetlon, es proNded br Dy secUon 3700 of the Lebor Cade, fw the pertortnance of t�e work tor which thls partnit Is Issued. � 1 have and vrill mainteln workers' COmpensetion InsurenCs, as required by satlon 3700 of the Lebor Code, iw the pOAortnanCe ot the vrolk fw w�Id1 UI5 petmit 19155ued. My workers' Compen5allon Insurence cerAer end policy number ere: Cartler. Pdiry Number: (This SecGon need nat Oe complefetl i! Ne perml( is vaNetl e( one huntlred dW/ars (S I00) or leu.J ❑ I cetlity Ihat in the pertortnence of the work tor which Ihis pertnit is issuetl, I ahall not employ arry person In eny manner w es to becwne sub�ect to tha workera' compensetlon lews ol Celitomla, en0 apree Ihet il I shauld becoma sub�ect to t�e workers' compensatlon provislons ol Section 3700 oi Ne Lebor Cotle, I shall tort�with comply � these proNsions. Applicem Sipnature: Dete: ��-!2 �- � U WARNIN6: FAIWRE SE RE WORI(ERS' OOMPEfJ5AT10N EMDE IS UNUW FUL M10 SlULL SUBIECT Ml EMPLOYER TO CiUMIN�L PENALTES AND CML FlNES UP TO ONE HUNDRED T110USAN0 (5100, �. P1 A�D�T�ON TO THE WST OF COMPENSATION, DAM4GES AS PROVIDED FIXi IN SELTION 3)O60F THE IABOfl COOE, INiEREST, PND ATTORNEYS FEES. LICENSED CONT CTORS DECLARATION: I hereby aHirtn tha Ilcensed under provisions of Chapter 9(commendng wiU Section 7000) ot DlWsion 3 of Ihe Buslness and Professions Code, and my Ilcensa is in full torce ana eflea. u. a clau a ContractoYs Signawre. Date: 1 O- 3 6- O'� CONSTRUCTON L DING ENCV: ❑ I hereby aKrtn t t t is a consWction lentling agency for the pertormance of Ihe work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Addres5: Signflture: Date: OWNER-BUILDER DECLARATIONS: I hereby attirm t�at under penalry ot per�ury lhet I em EXEMPT FROM TME CONTNAC70R5 LICENSE LAW for the I011owing reason (Sec. 7031.5, Business entl Professions Cotle: My ciry or counry which requires a parmit to construct, elter, Improve, demalish, or repair eny strucWre, prior to its issuance, elso requiros Ihe appiicant for such permit b tile a signeG statement Ihat he or she is Ilcensed pursuent to the provisions of the Contractars Llcense Lew (Chepter 9(commendng with Sectlon 7000) of Divislon 3 of the Business entl Protessions Cotle) or that he or she is anempt therelrom antl the hasis tor the elleged e:empUon. My violation of Section 70.31.5 by any appllcant for e pertnit sub�ecis Ihe appliwnt lo a civil penalty of not more than five huntlreA tlollars (5500).): ❑ I, es owner of Ihe propery, or my employees with wages as their sole compenseUon, WILL DO THE WORK, entl the sWMura is nol Intentletl or oHeretl for sale (Sec. 7044, Business end Professions Code: The Contractors License Law tloes not apply to an ownor ot properry who Duilds or Improves thereon, antl who Coes such work hlmselt or hersell or ihrough his or her own employees, providetl �hai such improvements ere not Intended or oflered tor sale. If, however, Ihe builtling or Improvemen� is soltl within one year ot completion, t�e ownerbulltler will havo Ihe burden of Oroving ihat ha or she tlid not build or improve for purpose ot sale.). ❑ I, az owner oi the property am E%CLUSIVELY CONTRACTING WI7H LICENSED CON7RACTORS to construct Ihe project (Sec. 7044, Business end Protessions Code: The contraaors License Lew does not eppy to en owner ol property who bullds or Improves ihareon, and who contracls lor such pro�ect with e contrector(s) license pursuant to the Contractore Liconse Lews.). ❑ I em exempt untler sec. Business and Protessions Catle lar t�is reason: SignaWre: Date: Owner ID veritietl by tlrivefs licensa. ❑ Ves ❑ No Driver's License No. Expires: Vedflcetlon of Ownership Dy (type ot Aocumen�, i.e. - property tax blll or Ooetl): DIVISION OF INDUSTAIAL SAFETY PERMR CERTIFICATON: ❑ 1 hereDy certily Uet no ezwvation flve (5) or more leet in depth into which e person Is requlretl to Aescend, will be made in connection with work euthodzed by this I permit, antl that no building structure, scaflolding, falsework, or demolition or dismantlinp thereoi, will be more lhen t�irry-six (36) feel high. (Chap. 32, Gry 2, An 2, Sec. 341, Title 8, Celifomle Atlminlsiretive Cotle). ❑ As owner-builtler, I wlll not employ enyone lo tlo work which would require e permit trom t�e Division of IndusMal Sefery, es rroteE aDove, unless such person �as e pertnit ro do such work trom the divisian, Signature: Date: Divisian at Intlustrial Salety Permit Number: CERi1FlCATE OF COMPLUWCE AND AUfHORVJ1T10N OF ENTRY: I certity under penelty of perjury that I have reatl thls appliwtlon end state that the inlormetlon qiven Is cortect. 1 agree to compy wlth ell slete laws entl dry ordinences roleting to 6ulltling constructlon, and authorize representaWes of Ne Clry oi Coste Mesa to enter upon ihe ebovedexribed property far insDecNon purpases. I egree not to oa:upy or ellow occupenty ot eny builtling euthonzed by Ihis pemtit until Ilnal inspection. 1266 200 201 202 203 204 FIx ystem Final Fire Preventbn Pool Spa Final Final RaRoot Finel BIocWRetaiNng Well Final Factory Fire Place Final Sign Finel Demdition PAIF �e- s6-oa Date �$ �P,( INSPECiION TYFE 206 Finfll Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planninq Approval 222 Final Site 250 Final euiltlinyOccupanry PAiE Pi�ELS (774) 754•5273 • Fax (714) 754-4856 • www.ti.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: 560 W 19TH ST A POPLUAR CASH EXPRESS Parcel Number: 42210320 Applicant: Address: Owner GIL, HUGO P O BOX 676 VAN NUYS, CA JEFFREYA. FISCHER MECHANICAL PERMIT Address: 17337 VENTURA BLVD #205 ENCINO, CA Contractor: H A GIL CONST CO & DESIGN Address: P O BOX 676 � VAN NUYS, CA StaWs: Applied: Issued: Phone: 81&785-1842 Zip: 91408 Phone: (818)501-0145 Zip: 91316 Phone: 818-785-1842 Zip: 91408 License: 561186 ISSUED BV: SCOPE OF PERMIT 2500 SF INTERIOR STORE TI FOR "POPULAR CASH EXPRESS" IN STE A. 2 REPAIRIALT COOLING/HEAT; 1 GAS PIPING, 2 VENT FANSISINGLE DUCT, 12�AIR HANDLERS < 10000 CFM. . . _ . . . _ _ . . . . REF: B07-00450 � : . ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt CaolinglHeat Inst I Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box � , . Vent Fan / Single Duct � � Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater �uantity 523.50 $0.00 0 50.00 0 $27.40 2 50.00 0 $0.00 0 $0.00 0 $6.15 , 1 ��50.00 - 0 ' � 50.00„ 0 , � 50.00=;�0� � - j�$14.50 �2� � _ , 50:00� 0 � � 50.00 0 SOAO 0 so.ao 0 � $127:80 12 . $0.00 0 50.00 0 50.00 � 0 � FEE SUMMARY ISSUED 07/OSI2001 07I05/2001 Repair / Alt Absorbtion Unit , 80.00 Repair / All Refrigeration Unit � � $0.00 VentillatioqSystem �.,��,� -$0.00 Evaporative Cooler :� / $0.00 f, , '-., Commerciallncinerator �;. -' _ $0.00� , Domestic Incinerator � �$0.00 / Compiesso�s / Absorotion Svstems � ' Up to 3 hp / 100;k BTU _�. •, � � ' � $0.00 - �'3To15hp/SOOk�BTU';;`;�� ' $0.00 - - 15 To 30 hp / 1,000 k BTU � � ;.� $0.00` 30To50hp1,1,750k�BTU% ,i� �j-� ��$0.00 ' _Over 50 hp / Over.1;750-BTU � � , �i "� $0.00 Boilers � - . - � �' Upto3hp�" �`�. � ' $0.00 3T 15h -� �� '- - o p,. $0.00 15 to 30 hp� • � � ` � $0.00 �30 to 50 hp `,� � - � � � � $0.00 .. . Over 50 hp � ' � , %� $0.00 OtherMechanical�Fee ./ " . Investigation Fee " $0.00 " Flan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES 5199.35 COMMENTS I SPECIAL CONDITIONS Quantity 0 0 0 0' � 0 - 0 � 0 �0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void il work Is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order tor the xrork aulhorized under this permit to be consldered legal, such work must comply with all applicable codes, and all required Inspeetlons end finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2aa6+b (6roo) WOAKERS'COMPENSArON DECLARAnON: 1 hereDy aMirtn untler penalty of per�ury one ot the lollowing tleclarations: ❑ I heve entl wlll mainteln e ceniTiwte oi consem to selbinsure tor workers' compensetion, es provlded tor by section 3700 0l the LeDor Cotle, for the peAormance of the work lor which lhis pertnit Is issued. I heve erW will meintein workers' compensetlon insurance, as required by seMion 3700 0l Ne Lebor Codo, for the peAortnanca ot lhe work for which Ihis pertnit Ls Lssuetl. My workers' mp�e(ry�q �etlon Ins rence wmer entl policy number ere: Cerrier: � /� G � � _ _ Policy Number. (iNs seC 'tron�n d�nof 64 Eanplet�d 1! e permit /s va/ued et one h�ndred dollars (5700) or IessJ ❑ I ceNfy t�at ln the Dortormanca of Ne work tor which Ihis Oermit Is Issue4 I shall not employ eny penon In eny manner so as lo bocome sub�ect to the workers' compensetlon laws o1 Celifomia, entl egra et i I should become suD�ect to Ihe workers' compensatlon proNsions of Sect n 3700 af the Lebar Catle, I shell tort�wit� compty witt� Nese Provi Icrs. r� �, Appllcant Signeture: Date: S WARNINO: FNLURE TO SE W (Efi5 COMPENSA710N OOVERAGE IS UNtAWFUL M'D SHALL SUBJECT AN EMPLOVEfl TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE MUNDRED hI0U5NND DOLfAAE (51 .00OI. IN AODITICX� TO THE OOST OF �MPENS4TION. DHMGES 0.S PRON�ED FOR IN SECf10N 3]W OF hIE IJ�BOR CODE, IMEREST. AND ATfORNE1"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihet I em Ilcensed under provisions ot C�apier 9 lorce entl ettect. Lic. a Conlractofa Signeture: �(1�_ � Sectlon 7000) ot Division 3 0l Ihe Business and Proteuians Code, entl my license Is In lull Cless M Dete: 7 4`" P) CONS7RUCTION LENDING AGENCY: ❑ I hereby eflirtn that there is e constructlon lending egency for Ihe pertortnance ol the work for w�lch Ihis permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: LentleYs Atldress: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby eHirtn t�at under penelry oi pe�ury t�at I am E%EMPT FROM THE CONTRACTORS LICENSE LAW lor the following reeson (Sec. 7031.5, Business antl Professions Catle: Any ciry or counry whlch requires e pertnit to construc6 elter, Improva, demolish, or repeir eny StrucWre, pdar ro in Issuence, elw reQWres Ihe apPlicant for such pertnit to lile e siBned stetement that he ar she Is Iicensed pursuant ro ihe pmvisions of Ihe Contrecroro lJcense Lew (Chepter 9(commendng wlt� SecOan 7000) af DMsian 3 of the Business end Profeuions Code) or t�et he or she is e.empt therelrom entl the Casis far the elleged exemption. Any Noletlon ol Sectlon 7031.5 by eny appliCant tor e permil suD�ects Ihe eppllcant to a cidl penalry of not more then INe huntlred tlallars (5500)J: ❑ I, as owner of Iha proDeM1y, or my emplqrees with wages as Ihelr sole componsatlon, WILL DO TME WORK, entl t�e structure is not intentletl or otleretl lar sale (Sec. 7044, Business entl Professions Code: The Coniractors License Lew does not apply to en owner ol property who bulltls or Improves Iheroon, end who does such work himselt or hersetl or through his or her own employees, providetl ihet such improvements ere noI Inlended ar oMered lar sale. II, however, Ihe building or improvement is sold within one year of completion, the owner-builtler will have lhe burden of provinp Ihat he or she Oid not build or improve for purpose of sale.). ❑ I, as owner ol lhe property, am EXCLUSIVELY CONTRAC7ING WIT1 LICENSED CONTRACTORS to construct the projed (Sac. 7044, Business end Professions Code: The contrectors Llcense Law Aoes not appty �o an owner ol property who bullds ar Improves theraon, antl who wntrects lor such project with a comractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt untler sac. Business antl Pmfassions Cade lar ihis reeson: SignaNre: Dete: Owner ID venlietl Dy dnvefs license. ❑ Yes ❑ No Drlvels LJcense No. Vedticatlon ol Ownership by (type at documem, i.e. - propeM �ex bill or deed): ExD�res: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certity that no excavetion fNe (5) or more laet In depth Into which e person is requlred to tlescen4 wlll be matle in connection wlth work authorized by thb pertnil, and t�et no builtling sirudure, scattolding, falsewark, or demolitlon or Cismantling lhereol, wlll be more Ihen thirty-slz (38) leet hiph. (C�ap. 32, Grp 2, Ar12, Sec. 341, Title B, Calllomia Atlminisiretive Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit Irwn the Divlslon of Industrial Safety, as noted ebove, unless suc� person has e pertnit to tlo such work from the division. Signature: Date: Division ol IndusMel Safery Permit Number. CERTIFlCATE OF COMPLIANCE ANO AlJi110RIZA710N OF ENTAV: I cenlfy untler penalry ol per�ury that I have read this eOPliwtlon entl state that the informatlon given is correct. I egree to comply wilh all state laws end ciry ordlnances reletlng to building cnnstructlon, antl authodze represeNatives ot Ihe Clry of Costa Mese to encer upon the ebove-dexribetl property for Inspection purposes. I egree not to occupy or ellow occupancy of eny building eulhodzetl Dy Ihis permit until linel Inspec�lon. CODE t, ixsvernoxrVve 1616 Fixetl System Final Fire Prevention 7288 Pool Spa Final 200 Final Re-Rool 201 Flnel BIocWRetaining Well 202 Final Fectory Fire Place 203 Final Sign 204 Flnal Demolition p(�jF. 1�6$ �i,Qf�[ INSPECTIONTYPE 206 Flnel Mec�eniwl 208 Final Plumbing 210 Final Eloctdcal 212 Finel Fire Preventlon 220 Final Plenninp Approvel 222 Flnel Sile 250 FInelBuilding/Occupency 9_a�•(� �.�N l (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT � Job Address: 560 W 19TH ST Suite No A Vicinity: POPULAR CASH REXPRESS (UNIT A) Parcel Nunmber: 42210320 Applicant: GIL, HUGO Address: P O BOX 676 VAN NUYS, CA Owner: JEFFREY A. FISCHER Address 17337 VENTURA BLVD #205 ENCINO, CA Contrecror: H A GIL CONST CO & DESIGN Address: P 0 BOX 676 VAN NUYS, CA Arch / Eng : ' ' Address: Phone: 818-785-1642 Zip: 91408 Phone: (818) 501-0145 Zip: 91316 Phone: 818-785-1842 Zip: 91408 License: 561186 Phone: - Zip: License: ISSUED BY: Status: ISSUED Applied: 07/OSI2001 Issued: 07/OS/2001 SGVYt Vh PtKMII- "' � 2500 SF INTERIOR STORE TI FOR "POPULAR CASH EXPRESS" IN STE A. 2 FLOOR DRAINS; 2�� - . ' WASH BASINS, 2 WATER CIOSETS. • � � - - � REF:801-00450 ' , ... _ ..-�'.�' ' , ' ' _ � , �',.. ; i i' � ' � - FEE SUMMARY �:��.- ,• - '.. ;; =; , " AMT QTY� . -. ,. AMT ;QTY ,�/ �j�� - -�AMT QTY ISSUE FEE � � � $23.50-� � �� Laundry Tub7 Washer - $0.00 0 � `�'�iSump"Pump� - j � % $0.00 0 Backflow irrigation � � `50.00�',: 0 ��-Landscape Irrigation $0.00 0� . �� Swinimirig Pool �' � ,' $0.00 0 BackFlow Preventer 50.00' % �0 � �� P-Trap ' $0.00 `-0,= �Tr2p Prirner , , i $0.00 0 Bathtub 50.00 . 0 , Pressure Regulator 50.00 0 ��`, � Urinal�` $0.00 0 Clarifer System E0.00 � 0 Process Piping (per 10 ft) 50.00 �Q� � �` Vacuum Brkr Bkflow(1-4) $0.00 0 Conned (Ice,Sotla,etc) 50.00. 0 � � - � Receptors , $0.00 . . 0 . � \ � - Vacuum Brkr BkFlow(5+) $0.00 0 Dental Units $0.00 � 0 � , SepticTank $0.00 '0 �� , ;Wash Basin $19.60 2 i.,. Dishwasher $0.00 ��0 _ Sewer Cap for Demo '$0:00 --� 0 . ; Wash Basin Set $0.00 0 Drain, Floor 579.60 2 .Sewer Connect $0.00 - 0.� -�"-Waste antl Vent System 50.00 0 Drein, Rainwater $0.00 0 �Sewer Private Line , „$0.00 ��0 � Water Closet (Toilet) $19.60 2 Drain, Roof $0.00 0 Shower . �$0.00 0 Water Heater / vent $0.00 0 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 50.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service 50.00 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 � TOTAI CALCULATED FEES: E82.30 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Orcl. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatica�ly 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 �he work authorized under ihis permit to be considered legal, such work must comply with aIl applicable codes, and all required Inspections and (inel approval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 zsa6�a6 (aroo) WORKERS' COMPENSATION DECLARATION: I hereDy ettirtn under penalry ol per�ury one of ihe fdlowing tleclarations: ❑ I heva end wlll malntein e certificate ot consent ta selt-Insure for workers' compensstlon, es proviCetl tor by sedion 3700 of Ihe Lebor Code, tor Ihe pedormence ot Ihe wark lor whiCh Ui9 pormll is is5uetl. �I have arM wlll mQlntaln workers' compensation insurence, es requiretl by sectlon 3700 oi the Lehor CoOe, br Ihe peAamence ot Ne work tw which this permit is issuetl. T� My workera' f_ y.ompe�se�tlan Insurenc�� r�@ntl policy number ere: Cartier: C'�'�'�i �� PdICyNumber. /(�� (Th(5 secUon n n I c»mpleted Me permit /s ve/uod at ono huntlretl tlW/ers ($100) or less.) ❑ I certity thet in the pertormance ot t�e work lor w ich c�is perm' is IssueO, I shell not employ eny person in eny menner eo es to bemme sub)ect ro the workers' compensetlon lawa o1 Celifq Ia, end gree thet I shou �1 be ne suh�ect ta Ihe workers' compensation provislons ol Sectlon 3700 0l ihe Lebor CoOe, I shell lonhwlih compty wit� t�ese provl o F�6` l Appllcant Slgnature: Dete: � WARNINO: FAILURE TO SE F�, OPI COMPENSA 1CM C VERAOE IS UNUWFUL AND SW1L1 SU9IECT AN EMPLOYER TO CRIMIWLL PE TIES PN� GVII FINES UP TOONE HUNDRED T/IOUSANDDOLLAHE(51 ),INAD ONTOTNECQSTOFCAMPENSFTION,DAMAGESASPROVIDEDFORINSECilON310BOFTNEUBOFCODE,INTERE5T,ANDATTORNEI"SFEES. LICENSED CONTRACTORS DECLARATION: I hereby efllrm thal I am Ilcensetl untler provislons ot forca entl eHact. Uc. M Contrectofs SlgneNre: with Sectlon 7000) oi Division 3 al the Business and Professions Code, end my Iicense Is In tull Class N Date: �% � l CONS7RULTON LENDINGAGENCY: ❑ I here6y aXirtn ihat thare is a construction lentling agency for the peAormance of the work for w�ich this permit is issuetl. (Sec. 3097, Givil Cotla). LentleYs Name: .. _. . . —.— Lender's Address: _ Signature: Date: OWNER-BUILDER DECLAflATONS: 1 hereby aHirtn Ihet under penalry of perjury thef I em E%EhtPi FaOM 7NE con7RaCTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business enG Professions Cotle: My dy or counry whicli repuires e permit to construct, elter, Improve, demolish, or repair any structura, pdor to its issuence, elu raquires the epplicant br such pertnit to tile a signed slatement �hat he or she is Ilcensed pursuant to the proNslons af t�e Contracrors License Lew (C�apter 9(commendng wlt� Secllon 7000) af Divislon 3 of the Business flnd Professiwu Code) or that he or she is exempt therefrom end Ihe basis for the elleged exemptlon. Any violation oi Sectlon 7031.5 by eny applicant lor e pertnit wbjec[s ihe applicent to e dvil penelry of not more then Ilve huntlretl tlollars (5500).): ❑ I, az owner ol t�e D�W�rtY• o� my employees wlt� wages as their sole campensatirn, WILL DO TXE WORK, a�W lhe structure Is noI intendad or ottereO tor sele (Sec. 7044, 8uslness flnd Professions Code: Tha Contrectoro Ucense Law does not eppty ro an owner of property who bulltls or Impmves Iheraon, and who tloes such work himsetl or herself or t�rouph his w her own employees, pmvitletl Ihet such improvements are not intentletl or oNareO for sale. If, however, the �uiltling or improvamenl is sdd wlt�in one year of wmpletian, the owner-builder will �evo ihe burtlen ol provin9 Nat he or she tlitl not Dulld or improve tor purpose ot sale.). ❑ 1, as owner ol the property. em EACLUSIVELV CONTRACTING WITH LICENSED COMRACTORS to conswct the prqect (Sec. 7044, Busineu end Pmfeulons Gatle: TTe contrectors Llcense Lew does not epply to en owner of propeny w�o builds or Improves t�ereon, and who contracls br such project wl�h e contractor(s) Iicense Oursuant ro the CoNractors License Lews.). ❑ I em ezempt untler sec. Buslnoss and Professions Cotle for IhLs reason: Signeiure: Daie: Owner ID verilied by tlriver's Ilcense. ❑ Ves ❑ No Drive/s License No. Expires: Vedficetlon ol Ownership by (rype ot tlocument, i.e. � property taz blll ar tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ 1 hereby certlly thet no eacavation tiva (5) or mora feet in tlepth into which e perwn is required to descend, wlll be mede In connectlon with work euthorizetl by thls permit, and that no building structure, sraXolding, falsework, or tlemolltlon or tlismantling thereot, will be more ihan Ihirty-siz (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 3a1, Title B, Calitomla AtlministretNe Cotla). ❑ As owner-builder, I will not employ enyone to do work which would repuire e pertnil Irom the Division ol Indusiriel Sefery, es noted ebove, unleu such person hea e pertnit to Ca such wark irom Ihe d'rvision. Signature: Date: Divislon of Intlus�rial Salety Pertnit Number: CERi1FlCA7E OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I cenlfy undar penalry ol perjury t�at I �ave read INs eppliwtion and slate t�at l�e inlortnetlon given Is cortect I egree to wmpy vrith ell siate laws enG ciry ortlinances releling to �uiltling construction, and eut�onze represeNatWes of I�e Ciry of Casta Mese lo ontar upon Ihe ebove-deunbed property far inspection purposes. I egree not to occupy or ellow Occupancy oi eny builEing authorized by Ihis pertnit until tinal inspection. GOUE �. INSGECTIONIYPE 1678 Fl:ed System Final Fire Prevention 1266 Pool Spe Finel 200 Finel RaRoot 201 Final Block/Retaininq well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition BAiF I�L6 £QQEd INSPECTIONTYVE 206 Final Mechanicel 20B Final Plumbing 210 212 220 222 250 Final Electncal Final Flre Prevenlion Final Planning Approval Final Site Final Builtling/Occupenry QdIF. I[�9L8 9.a1.oi ni (714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Atldress: Suite Na Vicinity: Parcel Nunmber: Applicant: Address: Owner Address 560 W 19TH ST A POPULAR CASH EXPRESS (UNIT A) 42210320 GIL, HUGO P O BOX 676 VAN NUYS, CA JEFFREY A. FISCHER 17337 VENTURA BLVD #205 ENCINO, CA Contracroc H A GIL CONST CO & DESIGN Address: P O BOX 676 - VAN NUYS, CA Phone: 818-785-1842 Zip: 97408 Phone: (818) 501-0145 Zip: 91316 Phone: 818-785-1842 Zip: 91408 License: 561186 ISSUED BY: Status: ISSUED Applied: 07I05I2001 Issued: 07/OS/2001 SCOPE OF PERMIL " ' 2500 SF INTERIOR STORE TI FOR "POPULAR CASH EXPRESS" IN STE A: 36 LIGHT FIXTURES, 34 OUTLETS, 6 SWITCHES, 1 SUB PANEL GTO 200A, 2 SIGN CIRCUITS�, 3 LOW VOLTAGE EQUIPMENTS. � � � REF: B01-00450 . . . , ISSUE FEE Temp service test Res. alc packa9e New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches � � Non Res Appl � � Res Appl Service to 200a Service to 1000a Service over 7000a Molors to 1hp Molore to tOhp Motors to SOhp Motore l0 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole . Intermed Pole FEE SUMMARY' �- ' Quantity 523.50 50.00 50.00 50.00 0 sa.00 0 50.00 `. - 0 " , $33.68 � ��' 36 �.�'$32.95��35 c ,. � 36:60� �� ;8�- - ' _ � ,50.00� ��0��--`��" , �$0.00.� � 0�-' -,$0:00_ - -, 0� � � -'$0.00 � �i� 0. i �_ ` $0:00 . 0 , �, . ' $0.00=�� 0 . $0.00��.. ' Q„ . `: , $o.00 0 50.00 0 $0.00 0 50.00 0 530.50 1 $0.00 0 qa9.20 2 $0.00 0 $0.00 0 A - � Quantiry,�,� ' Temp Dist System 7 Lighting 50.00 - 0%� - �.- Busway /100 fl 50.00 ; 0 - .- Standing Section 50.00 �; � 0 �- - Misc Eleclrica6Equipment 50.00 -, � 0 . Transformers up to'1 kvalkw 50.00'�- 0. . , ................up to 10 kvalkw �. -." �,30.00' 0 ' � � � .................up to 50 kvalkw , "�50.00 � 0 ' � . .._._s:....._up to 100 kva/kw ;�/ $0;00 j ,_0 i� , �� ' �...:over 100 kva%k� $0.00 ��/ 0 , ; '� L'ovi Voltage Equipment�� $54;60: � �3i, -� Low Volt Wiring_System / Ckb �� $0.00-� � 0 Misc: Conduit � i$0.00 � � 0� MisaConductor:��'� �:�"$0.00%; 0 Circus ( gen or nde)�: � � �50.00, �' 0 Circus (mech ride �or lights) /ji 50.00 0 �. � Christmas Tree Stand - i-'� �-'50.00 0 Fireworks Stand , - � � . " $0.00 0 Other Electrical Fee 50.00 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee 80.00 TOTAL CALCULATED FEES E231.03 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 7241-92) EXPIRATION: 7his permit shall automatically expire antl become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPEC710NS: In order for ihe work authorized under ihis permit to be considered legal, sueh work must compty with all applicable codes, and all required Inspeetlona and tinal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 24t&681�) WORKERS' COMPENSA710N DEGLARATION: I nereby aKrm unCer penelry ot perjury one o1 Ihe tollowing Oecleretlons: ❑ I have entl will melnteln e tertlllcete of consent to sell-Insure lor workers' Compensetion, as provlded for hy section 3700 ot t�e Lebor Cotle, lor t�9 pertormenCe of Ihe �work fa whlch Ihi9 portnit is LSsued. I have eM vnll maintaln workeB' compensatbn Insurance, as requlretl Cy sectbn 3700 d tha Lebor Catle, tor the peAa�mance ol Ne work for whkh ttus permit is issuod. My worke cor/n�p—ensetion Ins^urIa^nce cartler end pdi�y number ere: �–+� Certier. ��T7� v�lV I 1 PolicyNumher. �� S�J " �� /rn�s secuon neee nar ne e�en u e pemu� rs �eiuec er a�e nundred dwie�s /Sioo) or iess.) ❑ 1 certity Ihet in Ne perlormence of the wark tor w�ich this pertnil Is Is�suetl, I shall no� employ eny person in any manner so es to bocome sub�oct to Ihe workers' comperuallon laws ot Calllomia, nd epree Ihet II I s�ay becom ub�ect to Ihe workers' campensatlon provi5ions o1 Section 3700 of the Lebor Cotle, i shell lorthwl�h comply vrith these ProNsio ��/�/ Appllcant SigneNre: _ Date: � WARNIN�: FNLURE TO SEWRE (EP � pENSATION DVERA E IS UNUWFlIL N1D SHALL SU91ECf rW EMPIOYER TO CRIMINAL PEItlALTIES AND CM� FlNES UP TO ONE HUNORE� T110U$M1D OOLLARE (5100. , IN ADDITI TO THE COST O PENSATION, DMMGES AS PROVIDED WR IN SECTON 3108 OF THE LABOR CODE, INfEREST, AND PTTORNEY'S FEES. LICENSED CONTRACTORS DECLAflATION: I hereby emrm that 1 em Iicensed under provisions of C�epter 9 fOfCO 0ntl efleC�. LIt. k ConlrectoYs Signature: _, CONSTRUCTON LENGING AGENCY: 7000) of Division 3 of tne B Cless a Date: Code, end my Ilcense is In full ❑ I hareCy eflirtn fhet there Is e wnsiructlon lending egency for the Dertormance of Ihe work for which this permil is issued. (Sac. 3097, Civil Cotle). Lendars Name: _. _ Lenders Address: Signature: Date: OWNER•BUILDER DECLARATONS: I hereby elfirtn t�a� unCer penelry ot perjury Ihal I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reeson (Sec. 7031.5, 8usiness end PrOte55ion5 Code: Any dry or county which requires e pertnit to construct, elter, impmve, demolis�, or repair any slrucNre, prior to its issuance, elso requires Ihe epplicent lor such permit m fle e signed stetement t�at he ar she Is Iicensetl pureuent to the provlsions of the Conireclors License Lew (C�apter 9(commendng wich Sectlan 7000) oi DlNslon 3 oi the Business an0 Protessions Code) or Ihet he or s�e Is exempt theretmm and the basls for the ellegeA axemptian. Any violation oi Sectlon 7031.5 by eny applicant tor e permit subjecLs the eppllcent to e civil penalry ol not mora then fve hundred dollare (5500).): ❑ I, as owner of Iha property, or my employees wlih wagos es thelr sde compensation, WILL DO THE WORK, and Ihe siructura Is not Intentletl or oHeretl lor sele (Sec. 7064, Business entl Professions Code: The Contracbrs Llcensa Lew does not epply to an owner of pmperry who builds or improves thereon, anA who tloes such work himselt or hersetl or Nrough his or her own employees, pmvided Ihat suc� impmvements are not intended or oHered tor sale. If, however, Ihe building or Improvement is sdd within one year ol completion, the owner-builder will have ihe Durtlon of proving Ihat �e ar she tlitl not Duild or Improvo lor purposa ot sel9.). ❑ I, es ownar of !he proDerry, em EICCLUSIVELV CONTRACTNG WRH LICENSED CON7RACTORS to consiruct ihe pro�ect (Sec. 7064, Business entl Professions Cotle: The contrectors lJcensa Lew tloes not epply to en owner oi propeny w�o builds or imprwes therean, entl who contraas for such prqect with e coniractor(s) Iicense Dursuant to t�e Contrattors License LewsJ. ❑ I flm exempt unOer 58L. Bu5in859 entl Prof85510l15 CAde tor IhiS r8e50n: Signature: Date: Owner ID veAfleE by Criver's Ilcense. ❑ Yes ❑ No Drivers Licensa No. ExDires: VeAfication of Ownership by (type ot tlocumen�, i,e. - property tex blll or dead): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby certify thet no excavation tive (5) or more leet in depth into which a person is required to descend, wlll be mede In connecUan with work euihoAzed by this permii, and that no bullCing sWcture, scaHolding, lalsework, or demolition or di5mantling Ihereot, will ba mwe thfln thirty-5ix (36) teet hip�. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia AdminlsireNve CaOe). ❑ As owner-Cuilder, I will nol employ enyone to tlo work which would require a permit irwn ihe DlNsion ol Industnel Safety, es noted above, unless such person has e pertnit lo tlo such work tmm the division. Signature: Date: Division ot Industrial Selery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUiHORVJ1710N OF EMAY: I certity under penalry ol perjury Ihai I heve reaC �his epplicetion antl state lhat the inlormation given Is cortect. I egrae ta compty wlth ell state lews end city oMlnences relating to building wnsWc�ion, en0 euthodze representetHes ot Ua Clry ot Costa Mesa to enter upon the ebove-deuribeE property for InspecUon purposes. I egree not to occupy or ellow occupancy of any building euthorized Dy t�ls permit unlil Iinei inspection. C9DE I. INSPECSRIN TYPE 7818 Fixetl System Flnal Fire Preventlon 1268 Pool Spe Final 200 Flnel RB-Roof 207 FInaI Block/Retaininp Well 202 Final Fectory Fire Placa 203 Flnal Sign 204 Finel Demoliiion � �/� ! Date / —�� Date QA¢, 7IIIQ1eL5 S.QQf,,,( INSPECTIONTYPE 206 Final Mecheniwl 208 Finel Plumbing 210 Final Electdcal 212 Final Flre Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency ueiE Ir�e4$ G�� (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite: B Vicinity: UNIT B- PAPA JOHN'S PI7�a Parcel Number: 42210320 Applicant: TAVAGLIONE, JAY Address: 3405 ARLINGTON AVE RIVERSIDE, CA owner: GARVIN DRIVE LP Address 16485 GARVIN DRIVE ENCINO, CA Zoning: Phone: (909) 684-8870 Zip: 92506 . ' � , Phone: Zip: 914363636 Contractor: TAVAGLIONE CONSTRUCTION & DEVELOPMENT INC Address: 3405 ARLINGTON AV RIVERSIDE, CA Zip: 92506 nrcn : JOE, ARERICO CALABRESE Address: 13104 GLEN COURT #7 ' CHINO HILLS, CA Zip: 91709 Phone: 909-684-8870 License: 278222 - ITECT Eng: � Address:� " � ' , , Phone: (909) 627-0011 License: Status: ISSUED Applied: 12/74/2000 Issued: 05/02/2001 ISSUED BY: Phone: License: � ` � � . � SCOPE OF�PERMIT'. �; `�;-• � ' 1500 SQ Ff INTERIOR RESTAUR4NT T.I. FOR "PAPA JOHN'S�PIZZA" (UNIT�B): '''`�_ ' � . . , NO SEATING PROPOSED --ALL TAKE-OUT. PUBLIC AREA APPROX. 220 SQ.FT. ��/ � � , � i� Plan Check: Permit: SMIP Res: SMIP Com: Other: ' Inspection: Total: $509.44 $783.75 $0.00 $14.70 $0.00 $0.00� . $1,307 89�' :� ;� � � � C.' � c � `�� O�, - . : %' �``,? .. SETBACKS ' � �� MAIN STRUCTURE Front ��;0- 0 �` \„ , � FEE�SUMMARY ; '_ __ '_ _ Calc Valuation: � $�o,000.00 �' , , . Claim Valuation.;'; ' g�o,000.00 � = " � �% � - ---- � t' �f'. . �. ,,, ,i,, , �� 'r" i -�y�. �� : - � Y � � ��. , _ : � � �'i �� %�� : ��/�; i/i Rear 0- 0 ACCESSORY Front 0-0 -. �Rear PARKING Ezistin : 0 Reauired: NOTES: � � 'LANNING & ZONING�;-'' , �\`�; �" % _ �- ��`. ' ,/, ,_ �� !;�;" ,;.�i.� Left 0; 0,' c� �\ Right; `r" 0. 0�; ,' , - � � � �� , �, Left 0- 0.;�- � Ri9ht ;��0- 0� /. /i. . /� . � ProPosed:-,"�0:%'J"�� -� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 244&46 (W00) WORKERS'COMPENSAnON DECLARAnON: I hereby aHirm under penalry 0� perjury one of the tollowing declarations: ❑ I hava and will main�ain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of Ihe Lebor Code, for the performance of the work tor which this permit is issuetl. �[�.. I have and will maintain Wo�kers' compensatlon insurance, as requireG by section 3700 of Iha Labor Code, tor ihe perfortnance of ihe work for which this pertnit is issued. My workers' crompensatlon Insurance carrier antl policy number are: - _ Cartier: Po�iCy iJumber. (This section neetl not be wmpleted il the permlt is velued at one hundretl dW/ars ($100) or less.) ❑ I certily that in the pertoR�ence ot the work for which ihis pertnit is Issued, I shall not employ any person in any manner so es to become subject to the workers' compensatio s of Celitomia, nd egree thet it I should become subjact to ihe workers' compensation provislons of Saction 3700 of the Labor Code, I shall forlhwith � complywith esa rovis�ons. � � � _� \ Applicant Signeture: Date: WARNING: FAILURE T EC R W qKERS' CO�dP SATION COVERAGE IS UNLAWFUL AND SNALL SU6IECT AN EMPLOVER TO CRIMINAL PENALTIES AND dVIL FlNES UP TOONE HUNORED 7110USM1D DOLLARE 1 1. ADDITION TO THE G1�5T OF COMPENSATION, DAMAGES AS PHOVIDED FOR IN SECTIIXJ 3%O60F iHE IABOR CODE, INTEREST, AN� ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby afflrm that I am licen5ed under provisi s ot Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business and Protessions Code, and my license is in full force an0 eNect Lic. H Class A ConirectoYs Signature: Dete: CONS7RUCTION LEN AGENCV: � ❑ I hereby aNirm that there is a constmction lending agency for Ihe peRormance of �he work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lentlels Neme: Lentler's Address: Signature: OWNER-BUILDER DECLARAnONS: I hereby ettirm ihat untlar per Code: Any ciry or caunry_whi< m ille e slgned statemenLihe Business end Professiori's Ci subjects the applican(to e civ �c ❑ I, as owner of the prope 7044, Business ana Prc himself or herself or thri soltl within one yearof� ❑ I, as awner of ihe prope Code: The conlraci0rs 1 license pursuant lo lhe ❑ I em exempt under sec. Signature: Date: ilry of perjury �het I em EXEMPT FROM THE CONTRACTORS LICENSE LAW far ihe following reason (Sec. 7031.5, Business entl Protessions i requires e permit to consiruct, alter, improve, demolish, or rapeir eny siructure, prior to its issuance, elso requires ihe epplicant for such pertnit he or she is licensed pursuent to ihe provlsions af the Contractors License Lew (Chapter 9(commendng with Section 7000) oi Division 3 of the le) or that ha or sha is exempt therefrom and Ihe bazis for the elleged exemption. Any violation of Section 7031.5 6y any epplicent for a pertnit penalty af nat more ihan five hundred dollers ($500).): yi �.� ,;or my employaes with wages es their sola compensation, WILL DO 7ME WORK, end the structure is not intended ar oHeretl for sale (Sec. sssions Code: Tha Contractors License Lew does not apply to an owner of properry who builds or improves Ihereon, and who does such work igh his oi.her'o`wn emplayaes, provided that such improvements ere not intendetl or otteretl for sale. H, however, the builtling or improvemen� is ompletion�the ow�er-builder will hava the burden of proving that he or she did not build or improve for Durpose ot sala.). y, em EXCLUSIVELY CONTRACTING WITH LICENSED CON7RAC70RS to consimct the project (SecJ044, Business end Professions censa L"ew tloe5 not epply to an owner ot proDetly who buAds or improvas theraon, end who coMreds tot such projecl with a coniractor(s) ontractors License Lews.). Business and Protessions Cotle for this reason: Ownar ID verifiad by dnvers license. ❑ Yes ❑ No Dnvefs License No. Verificetion of Ownerehip by (type ot documem, i.e. - properry tax bill or deed): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION: Date: Expires: ❑ I hereby certify Ihat no ex�avetion five (5) or more feet in depih into which a person is required to descend, will be made in connection with work au�ho�zed by this pertnii, and ihat no building slruIXure, scaftoltling, talsework, or demolition or dismantling thereof, will be more than Ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title e, Califamia ACministretive Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit from the Division of Industnal Satety, as notetl a6ove, unless such person has a permit to do such work ffom the division. Signature: Date: Division of Industrial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUiHORVA710N OF ENTTiY: I certify under penalry ol perjury that I have �eatl ihis application antl state ihat the informalion given is correct I agree to comply with ell state laws end ciry ordinances relating to builtling constmction, antl authonze representatives of the City oi Costa Mesa to enter upon the ebove-described property fo� inspection purposes. I agree not to occupy or ellow occupancy of any building authorized by this permit until tinal inspection. COOE tl INSPECTIONTYPE 1616 Fixed System Finel Fife Prevention 1266 Pool Spa Final 200 Finel Re-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Place �203 Final Sign 204 Final Demolition QRj� INTRIpLS � _� _OD@te , Date CODEt INSPECTIONTYPE 206 Final Mecharilcal 208 Final Plumbing 210 Final Electncal 212 Final Fira Prevention 220 Final Planning Approval 222 250 Final Site Final Building/Occupancy PAIE INTRIRLS (714) 754-5273 • Fae (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: 560 W 19TH ST A UNITq 4221Q320 ESTRADA,HENRY „ � ��i� , . __ � / ��`� � � owner: i �JEFF.I2EY'A.'FISCHER Address ', 17337 VENTURA BLVD #205- � ,; " ENCINO, CA%' , ' � ,,, Contracror. MARTINEZ ELECTRIC � Address: 625 S MAPLE AVE UNIT 8 MONTEBELLO,CA� ' �" " _- -_ �. ELECTRICAL PERMIT .Phone: 323-888-1935 ZiP: Phone: (818)501-014 Zip: 91316 Status: ISSUED Applied: 09/19/2001 Issued: 09/19/2001 ISSUED BY: � � `� \ ;� - � , � � � � �\ `� � � � � - � � �� .A _, � ,�� , ��, �� .. . � � �, / : � � �.:� �� • V_� i." 5 ` : .�ii: _ ��Phone: 323-888-1935 . i � Zip: 90640 � . . License: 432339 �� ; �. ,�Q' �� ' "04 - ; `; .` � � , I �,� � � , /� . � '� � : � _ _ - �- � �� ., � „ , � �.,� :�' , -� - � �� . SCOPE OF PERMIT , _ _. , __._. � ' � � / REF: SBOt-00098. TWO SIGN CIRCUITS�FOR TVJO.ILLUMINATED SIGN: �POPULAR CASH EXPRESS" � . . .. ..., . . . .. _ f-_�__.._..._ � . i � ISSUE FEE Temp service test : ,Res. a/c package New Res (i-2 units) New Res (3+unitsf . Pool / Spa � � - Lighting Fixts . Recept Outlets Switches ` � • � Non Res Appl , � Res Appl Service to 200a � Service to 1000a �' � Service over t 000a Motors to 1hp � Motors to 10hp Motors to SOhp Motors to 100hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole ' FEE SUMMARY � _. Quantity � ". _ ' _ _ � � . " � _. $23.50 .. � - . � Temp Disj Syslem /-Lighting �-� $0.00 Busway /100 ft."� $0.00 Standing Sectidn $0.00 � 0 Misc ElectricalEquipment � $0.00 0 Transformers up to�1 kva/kw � , $0.00 0 :ti.� �"':'.::::r:.,......up to 10 kva/kw ' � $0.00 0 ;;1' "- � ... ..up to 50 kva/kw ;�.,$0.00 0 � � - .. ::.u'p tor100 kva/kw �.$0.00 . 0 . .:...�- :.................over100.kva/kw._ � �- $0:00�� '^�='O,s�� -LowVOltageEquipment"��" �" �; .:, $0.00�� „ 0�- . • - Low Volt Wiring SystertS/ Ckt _ ' $0.00 �� . 0 � Misa Conduit , . , $0.00 ' '-b�, � Misc. Conductor $0.00 , '0. � _ . _ ' Circus ( gen or ride) � -" = � , - $0.00 - 0 Circus (mech ride or lights) ; �_�\ ,� $0.00 � � . -' 0 � . Christmas Tree Stand ' ' $0.00 � �,' 0 . - , , Fireworks Stand - . ��$0.00' ' � 0 � - Other Electrical Fee � , $0.00 0 $0.00 ' � -. 0 � �� Investigation Fee . , - $0.00 � � -Q . Plan Check Fee.. - . $0.00 0 � 'Reinspection Fee � $49.20 2 . . . $0.00 0 TOTAL CALCULATED FEES $0.00 0 COMMENTS I SPECIAL CONDITIONS Quantity � $0.00 0 .'' $0.00 0 �:;�� $0.00 0' " l )` i ; ,f �$0.00 0 � , , ' �$0.00 ,0; .' ( �, � � � , $0.00 �� 0/ -.�� j i ;` � $0.00�, , .0 �\ i �� I $0.00 jj % 0 i�dJ� . $0;00 ; 0'_ �-, -$0.00 0"� � � . 50.00 %'� �0 / � ` $0.00 ; ..0 � � �/' $0:00 �" �0 - = .$0;00 0 �. ' � �$0.00-' -0 , �$0:00 -�� 0.' -' $0.00 ' /0 $0.00 '" $0.00 $0.00 $0.00 572.70 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) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspaetiona end tinal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714)1545626 2446d8 (8�00) WORKERS' COMPENSATION DECLARATION: I hereby eHirtn untler penalry of perjury one oi iha tollow�ng declarations: ❑ I have and will maintein e certificete of consent to self-Insure for workers' compensatlon, es provided for by section 3700 of the Lebor Cotle, for the peAormance of the work for which ihis pertnit is issued. � I have antl will m� in workers' com�on insurance, as required Dy secUon 3700 of I�e Labor Code, tor ihe peAormence of the work for which this pertnit Is Issued. My workers' co VYatbu'n` I,�n/s�uranca r end Oolicy number ere: Carnec N� YY `��U Policy Number: (Thls ecHon need not be crompleted 1/ e permit is valued et one huntlred dollnrs ($100) or less.) I certify thet in the peAormence of the work tor whic this pertnit is issued, I shell not employ any pereon In eny manner so es to become subject to the warkers' compensation lews of Celliornle, end egree tha[ it s ould become su6�ect to the workers' compensation provisions of Sectlon 3700 of the Labor Cotle, I shell forthwlth comply with these provisio/ns—.�_, ^ 1' �/ O I Applicant SignaNre: �-C�'� Dete: �� t WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAOE IS UNLAWFIIL AND Shl4LL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND qVIL FlNES UP TOONE HUNDRED TIIOUSAN� OdlARE (5100.000�. IN ADDITION TO TNE CQST OF COMPENSATION, DAM0.GES AS PROVIDED f-0R IN SECiION 3]W OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONiAACTORS DECLARA710N: � I here6y aftirm that I am licensed under pro 'sions of ChapterIg ommencing with Section 7000) of Division 3 of the Business and Proteuions Code, and my license is In tull torca and etted. Lic. % �� ` Glass N Comrectors Signature: � - Date: � CONS7RUC710N LENDING AGENCY: ❑ I hereby aHirm that there is a consiruction lentling agency tor the peAormance of Ihe work tor which this permit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Address: Signeture: Dete: OWNER•BUILDER OECLARA710N5: I hareby eftirtn that untler penelry o1 parJury that I am E%EMPT FROM THE CONTRAGTORS LICENSE LAW for the followinB reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires a pertnit to constma, alter, improve, Gemolish, or repair any strucNre, pnor to its issuance, also requires the applicam tor such permit ro file a signed statement Ihat he or she Is Iicensed pursuant ro the prodsians o1 the Coniradors License Lew (Chepter 9(commencing with Section 7000) af DlWsion 3 of the Business and Professions Cotle) or t�at he or she is ezempt theretrom and tha basis for the allagad exemptian. Any violatlon ot Section 7031.5 by eny applicent for a pertN' subjecls ihe applicant to a civll penalry of not mora than fiva hundred dollere ($500).): f �1. ❑ I, as owner of ihe property,�ot my amployees wi�h wages es Iheir sole compensaiion, WILL DO THE WORK, antl the siructure is not intendeC or ofteretl tor sale (Sec. 7044, Busineu and Professlons Cotle: The Contradors License Law does not apply to an owner of properry who builds or improves ihereon, and who does such work himsaR or herseli or ihroug��hiS�or her own employees, provided that such impmvements are not inientletl or oHered for sele. If, hawever, the builtling or improvement Is sold within one year of completion`tlie owner-builder will have the burden of proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner ot iha pioperty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRAC70RS to consiruct ihe pmlect (Sec. 7044, Business and Professlons Code: The contractors License Lew daes not epply ta en awner af property who builds or improvas thareon, antl who conirects for such pmjed wlih a conirector(s) license pursuant to the Contractors License L'aws:). ❑ I em exempt under sec. !'i`n ' Business and Professions Cotle for this reason: SignaNre: � Y � Date: Owner ID venfied by driver's license. ❑ Yes j] No Onvels License No. Expires: Venfication ot Ownership by (type of document, i.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify ihet no excavetion five (5) or more faet in depth into which e person Is required to descend, will ba mede In wnnection vr�th work authonzed by Ihis pertnit, and that no builtling siructure, scaftolding, falsework, or demolition or dismantling thereoi, will be more then ihirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia AdministratNe Code). ❑ As owner-builder, I will not employ anyone to do work which would require e pertnit trom the Division of Industnal Sefey, as noted above, unless such person hes e permit ro do such work from the division. . Signature: Oate: Division of Indusirial Setety Permit Numbec CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalry ot perjury ihat I have read thi9 application and state t�at ihe infortnation given is correct I egrae to comply with ell state lews end ciry ordinences releting to building construction, end authonze representetives of Ihe Ciry of Costa Mesa to enler upon Ihe ebove-describetl properry for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by ihis permit until final inspection. n r KeaalOwner(sl , c And/Or Authorized Applicant eooe �. ixsvernoxrrve 7676 Fixed System Flnel Fire Prevention 1266 Pool Spa Final 200 Final Re-Roo1 201 Final BIocWRetaining Well 202 � Final Factory Fire Place 203 Finel Sign 204 Final Demolition PdIE IIQID9L5 � �� e Date CODEt INSPECTIONTYPE 206 Finel Mechanical 208 Final Plumbing 210 Finel Elecincal 212 Finel Fire Preventlon 220 Final Plenning Appro�al 222 Final Site 250 Final Bullding/Occupency P�IE It�LS (714) 754-5273 • Faz (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DqIVE, COSTA MESA, CA 92626 SIGN PERMIT Job Address: 560 W 19TH ST Suite: A Vicinity: Parcel Nunmber: 42210320 Zoning: Status: ISSUED Applied: 09/19/2001 Issued: 09/19/2001 ISSUED 8Y: Applicane ESTRADA, HENRY � � �. Address: . �<' - � j,.' ,�: _ Phone: 323-888-1935'� � ' `� � ' . i� %i .,_ �. �' �, c- i �., Zip: - � � . � � �.,� A i� , . � Owner. � JEFFREY-A: FISCHER � �; � �� \ . Address� 17337 VENTURA BLVD #205 � � � � • - �� . _. \ � � � - . Phone: (878) 501-0145 _ . ., i ' , � - ENCINO, CA= , �� Zip: 91316 � �� '�� V\ Contractor: MARTINEZ ELECTRIC �� Address: 825 S MAPLE AVE �� . ��. - ' UNIT B Phone: 323-88&1935 ^� � , � MONTEBELLO, CA _ Zip: 90640 . w'_��'yy O . License: 432339 - L_L' „1q , � . . Arch I Eng : . � . Address: " - � � �" Plan Check: Permit: SMIP Com: Other: Inspection: Total NOTES: Phone: Zip: License: �, . ; ,. � INSTALL(2)INTERNALLYICLUMINATED � - rcc aumiw $63.21 — _ _ _ ' _ _ � � $0.00 _ . . . $97.25 $0.84 $0.00 $0.00 $0.00 $0.00 . $0.00 . � $161.30 MIT _�. �� =R WAI:I: SIGN'35 SQ. FT. IN AREA � 4RY , � , , / , _ , � Calc Valuation: ��,,Sa,000.00 • i' Claimed Valuation: .; , sa,000.00 � ;;�' '_ , PLANNING & ZONING NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremanis under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This pertnit shall automatically ezpire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 '-aa�4s lflroOl WORKERS' COMPENSATION DECLARATON: I hereby ettirm under penalry of perjury one of ihe following tleclarations: ❑ I have end will maintain a certificale ot consent to setl-Insure br workers' compenution, es provided for by section 3700 of the Lebor Cotle, for the peAormance o1 the work for which ihi5 pertnit I5 iuuetl. ❑ 1 have and will meinWin My warkers' c pe cemer: � i, es required by sectim 3700 ot Ne Lebor Catle, far the peAortnance of Ne work for which Nis pertnit is issuetl. numbar ere: . Palicy Number. one or /ess.) �I certily t�at in ihe pedortnance ot the work for which � pertnit is issued, I shell not employ any person in eny manner so es ro become subject to the workera' compensation laws of Celitomie, en gree thet If I sl o d become sublect ta ihe workers' compensatlon provisions oi Section 370 ot the Lebor Cade, I ehell lanhwith comply with these provi;iar�a � 9 I� f O' � � � AppllcamSipneWra: � Dete: WARNIN�:FAILURETOSECUREWORKEFS'COtdPENSATIONCOVERAGEISUNLAWFULANDSHr1LLSUBJECTANEMPLOVERTOCflIMINALPENALTI ANDGVILFlNESUPTOIXJEHUNDRED TIKKI$AN� DOLLARE ($100,000), IN A�DITION TO THE CAST OF COMPENSATION, DAMFGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CADE. INTEPEST, ANO ATTORNEV'S FEES. LICENSED CONTHACTORS DECLARATION: I hereby eflirtn that I am licensed under pmvislons of Chapter 8(commencing with Section 7000) of Division 3 of Ihe Business and Protessioqs Code, end my license Is in full torce anA eHecL Lic. a Class p� � n . ConlrectoYs SlgnaNre: �� Date: ` I ' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is e conSWdlon lentling aBency for the pertortnance of the work lor w�ich Ihis pefmit is issued. (Sec. 3097, Civil Code). Lentle/s Neme: Lender's Atldress: Signetura: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn that untler penalty oi parJury lhet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW far the tollowing reason (Sec. 7031.5, Business entl Professlons Code: Any ciry or counry which requlres e pertnll to construct, alter, improve, demollsh, or repeir eny sirucNre, pdor to Its Issuance, elso reqWres t�e appllcant for such permit ro file e signed stetement that he or she Is Iicensed pursuent to the provlslons of the Conirectors License Lew (Chepter 9(wmmencing with Section 7000) of DlNslon 3 of ihe Business entl Professions Code) or thet he or she Is exempt therefrom end the besis for Ihe ellepe0 evemptlon. Any Nolation of Section 7031.5 by any e0011cant far e pertN' sublacts the epplicant to a civil penalty oF not more t�en ilva huntlretl tlollare ($500).): ❑ I, es owner of the property, or my employees with weges es thair sole compensetion, WILL DO 7HE WORK, antl ihe siructure Is not intended or oHeretl for sele (Sec. 7044, Business and Protesslons Code: Tlie Coniractors License Law dces noi epply to en owner of property who bullds or Improves ihereon, and who tloes such work himselt or hersetl or Ihrough hls or her own emDloyees, D�ovitleG thet such improvements ere not intentled or oflered tor sala. If, however, the builtling or Improvement Is sold within one year of crompletion, the owner-builder will �ave ihe burden of proving that he or s�e ditl not build or improve for purpase of sale.). /I iA� ❑ I, as owner of tha property; em�El(CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to conswct the pmject (Sec. 7044, Business entl Professions Cotle: The contractors Cicense Lew does not eppty to en owner oi pmPerty who builCs or Improves Ihereon, and who contracts for such project wlih e contredor(s) license pursuant to lhe Coniraiturs'LJcense Lews.). ❑ I am axempt under sec. v<<-�� %.. Business end Professions Code for Ihis reason: Signeture: �� %+' F� Date: Ownar ID verified 6y Arivers license. ❑ Ves��R O No Drivers License No. F�cpires: Vedficatian of Ownership by (rype ot document,,l.e. properry ten bill or deed): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: ❑ 1 hereby certify thet no e:cevetlon fNe (5) or more feet In depth inio which e person is required to descend, will be meCe in connectlon wlth work authodzetl by this permiL and ihat no building structure, sceMolding, falsework, or demolition or dismantling t�ereof, wlll Ee more then thirly-six (36) feet high. (Chap. 3.2, Gry 2, Atl 2, Sec. 341, Title 8, Califomia Adminisiretive Code). ❑ As ownervhuilder, I will not employ enyone to do work which would require e pertnit �rom the Division of Industnel Safety, es noted ebove, unless such persan hes e pertnit to do such work from ihe division. Signeture: Date: Dlvision ot Industnal Safery Permit Number. CERTIFlCATE OF COMPLIANCE AND AUTHOR¢ATiON OF EMAY: I certify unAer penalry ot perjury Ihet I heve reatl this application and state that the Informetion given is correct. I egree to comply wlih ell stete lews end clry ordinences relating to Duilding constructlon, end authodze representatives of the Ciry of Coste Mese to enter uDon the ebove-descnbed property for inspection purposes. I egree not to occupy or ellow occupancy of eny building euthonzed by this permit until tinel inspection. � Sign r 01 egalOwner(s) � � �ate And/Or Aut�orized Applicant Date COOE t. INSVECTIONTYPE 1616 1286 Fi:etl System Finel Fire Preventlon Pool Spa Final 200 Finel RaRaof 201 Final BIocWRetelning Well 202 Final Fedory Fire Place 203 Finel Sign 204 Final Demolitian � PAIE IximALS �QQ[( INSVECTIONTYPE 208 Finel Mechanical 20B Final Plumbing 210 Finel Electrical 212 Finel Fira Preventlon 220 Final Planning Approval 222 Flnel Sile 250 Finel Builtling/Occupancy PSIE II�leL9 (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite No B Vicinity: PAPA JOHN'S PIZZA (UNIT B) Parcel Number: 42210320 Appliwnt: TAVAGLIONE, JAY Address: 3405 ARLINGTON AV RIVERSIDE, CA owner: GARVIN DRIVE LP MECHANICAL PERMIT Phone: 909-684-8870 Zip: 92506 Address: 16485 GARVIN DRIVE Phone: ENqNO, CA Zip: 91436-3636 Contractor: TAVAGLIONE CONSTRUCTION & DEVELOPMENT INC Address: 3405 ARLINGTON AV RIVERSIDE, CA Phone: 909-684-8870 Zip: 92506 License: 278222 Status: Applied: Issued: ISSUED 05/02/2001 OSI02/2001 ISSUED BV: � SCOPE OF PERMIT WTERIOR TI FOR "PAPA JOHN'$ PIZZA" IN UNIT B. .-� . - 2 REPAIR/ALT COOLING/HEAT, 1 REFRIG SYS < 100 K BTU,�1 HOOD, W/MECH EXHAUST, 1 EVAPORATIVECOOCER. �- "- " " - ' '-'- - "� � REF: B00-02000 �� . - - ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair / Alt Cooling/Heat � Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box � ' Vent Fan / Single Duch. Appliance � Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater " �Quantity $23.50 $0.00 0 $0.00 0 $27.40 2 $0.00 0 $14.80 1 50.00 0 $0.00 0 = ' so.00 -o . ` $10.65 '7 -� $Q00 � �0 � , _ ,. , i $0.00 �_,0 ,_ . .' $0.00� 0 �-- �� . $0.00��0� � $0.00 ; 0 ,- $0.00 �-� 0 � - $0:00 �0'� ��$0.00 . -0 � $0:00 0 $0.00 0 FEE SUMMARY -�� - � Repair%AIt Absorbtion Unit 1 $0.00 Repair/AltRefrigeretionUnit -'� � $0.00 Ventillation System � -$0.00 EvaporativeCooler � :""i ,$10.65 � � " Commercial Incinerator ,� .,� ' .. $0.00� ' Domestic Incineretor "; � $0.00 Compressors / Absorption Systems %% ,. - _ � � Uplo3hp/100;kBTLL�..,-��,� � $0.00� , � 3 To 15 hp I 500 k�,BTU "'- �-"' ��' � $0.00 � 15 TO 30 hp / 1,000 k BTU j j �` $0.00' � �30 To"50 hp /,1,750 k BTU% /� � ��>�. %$0.00 � .Over 50 hp / Over,1;750 BTU ' ' � (i' � $0.00 � Boilers�� "� � � � �" i .� � Upto3hp ��,;.;,� .�./�� $0.00 � 3To15hp, - ,`, �,�� $0.00 75 to 30 hp' � '• �� ' $0.00 � 30 to 50 hp ' _ �j � $0.00 � ' �. � � � � �Over 50,hp � � i ,= $0.00 - OtherMechanicafFee - - InvestigatiomFee - $0.00 " ' � Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES E87.00 COMMENTS / SPECIAL CONDITIONS Quantity 0 � , , ' 0 , . 1 0 0 ,' 0 '0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicabla handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned tor 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 Inspectlons 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) 7545626 , J zaae�ae (erool WORKERS�COMPENSATONDECLARATION: I �ereby aK�+ under penelry of perjury one of the following tleclarations: ❑. I hav9 and wlll meintein e certificete of consent to selt-Insure for workers' compensetion, as pravided tor by section 3700 of ihe Lebor Code, for Ihe pertormence of ihe work tor which ihis pertnit is issued. �I havU and will maintain workers' compensation Insu2nce, es required by sectian 3700 of Ne Labor Code, for Ihe peAortnance oi the work for which this pertnit is Issued. My werkers' compensatlon Insurance carder and policy number ere: Certier. Policy Number: (Thls secfi0n need nol be complefed i! fhe permlt i5 veluBd ef one hundred dollars ($100) oi less.) � ❑ I certiiy Ihat In the peAormence of the work for which I�Is permit Is issuetl, I shall nat employ eny person In eny menner so es to become subject to the workers' compensation ws of Celifomia, en gree ihet if I should become sub�ect to the workers' compensation provisions of Sectlon 3700 of the Labor Code, I s�all forthwith comp�ywith es rovisions. ' �—� ^ O 1 Applicent 51gnaNre: � _ Deta: WFRNING:FaLURETO CU E C t(ERS'COMPEI TIONWVERAGEISUNLAWFULAND$MFILSUBJECTANEMPLOYERTOCRIMIWILPENALTIESANDGVILFlNESUPTOONEHUNDREO TFIOUS4ND Pa1-ARE 10D. �. I Dfi10N TO THE CQ^ai OF COMPENSATIIXJ, OAMA6ES AS PROVIDED FOFi IN SECTION 3]W OF TME UBOR CODE, INTEREST, AND ATTOHNEI^5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I em licensetl under provisiong oi Chapter 9(wmmencing with Section 7000) of Division 3 oi the Business end Pmlessions Code, an0 my license is In tull lorce entl ettect Lic. � CI855 M Contractaf8 Signature� � � Date: — � CONSTRUCTION LENDIH6�AGEflCY: ❑ I hereby aflirtn Ihat there is a construction lentling agency for the peRormance of Ihe work tor which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: LentleYs AtlOress: Signeture: OWNER-BUILDER DECLARATONS: Date: I hereby aHl� thet untler penelry ot perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reeson (SeC. 7037.5, 8u5iness end Profession5 Cade: Any ciry or couny which requires e permil to wnstruct, alter, Improve, damolish, or repair any siructure, prior to its issuance, also requires the eppliwnt for such permit to Ille e signed statement ihat he or she Is Iicensed pursuant to Ihe proWsions ol Ihe Cantrecbrs License Lew (Chapter 8(cammencing with Sectlon 7000) of DlWsion 3 of Ihe Business end Protessions Coda) or thel ha or she Is exempt therefrom end tho besis tor the elleged exemptlon. Any violation of Section 7031.5 by any epPlicent for e permit subjects the applicant to a clvil pe�alry of not more than (ve hundred dollars ($500)J: ❑ I, as o�+'ner of t�e propeny, or my employees with wages es their sole compensatlon, WILL DO T11E WORK, entl Ihe structure Is not intendetl or ofleretl for sale (Sec. 7p44, Business and Protassions Code: Tha Contractoro license taw tices not appty to an owner of property who builds or improves thereon, antl who does sucfi wofrt himself or hersell or ihrough his or her own employees, provi0etl Iha� such improvements are not intendetl or oHared for sale. II, however, Ihe builtling oi Improvement is sold Within one year ot wmpletion, t�e owner-builde� will heva the burden ot proving t�at he or she did not build or impro�e lor purpose of sale.). ❑ I, as awner of Ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTHACTORS to construa tha projea (Sec. 7044, Business antl Proteuions Cotle: The conirectors License Law tloes not epply to en owner ot Oroperty who bullds or Improves Ihereon, and who contracts for suc� project wit� a contrector(s) licensa pursuent to ihe Contractors License Lews.). ❑ I am 6xempt untler sec. Business end Professions CoAe for this �eason: _ Signature: Date: Owner ID vdrifietl by tlrivers ticansa. ❑ Ves ❑ No DrivaYs Licansa No. Expires: Vedfication ot Ownershlp by (typa of documenL i.e. - property ta< till or AeeG): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFILATION: ❑ I hereby certiry thet no excavation five (5) or more feet in depih Into which e person Is required to descen4 will be matle in connection with work euthorizetl by this permil, end that no building sirudure, scaHoltling, falsework, or tlemolition or dismantling thereoi, will be more than thlrtyslx (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Y�le 8, Celitomia AtlminiSlretiva Code). ❑ As owner-6uiltler, I will not employ enyone to do work which would require e pertnit trom tha Division ot Indusirial Safery, as notetl ebove, unless such person has e permit lo do such work Imm ihe tlivision. Signature: Date: Dlvision oi Industrial Sefety Permit Number: CER7IFlCATE OF COMPLIANCE AND AUfHORIZA710N OF ENTAY: I certify un0er penelry oi perjury that I heve reaa Mis epplication and state Ihat the infortnetion qiven is correct. I aglee to comply with ell state lews and ciry ordinances relating to building construction, and authorize representatives of ihe Ciry ol Costa Mesa to entar upon the ebove-descnDetl pmperty for inspection purpases. I egree not m occupy or allow occu0ency ol eny building authorizea by ihis permit until finel inspection. 1616 Fixed System Final Fire Preventlon 1266 Pool Spa Finel 200 Final Re-Roof 201 Fine� BIocWRelaining Well 202 Fina� Fectory Fire Place 203 204 Final Sign Fina� Demolition Q� UmTIAL3 �� ^Dajg \ (J Date CODE� INSPELTONTYPE Q� � 206 Final Mechanical — �— �( � 208 Final Plumbing 210 212 220 Final Electncal Final Fire Prevenfion Final Planning Approval 222 Final Site 250 Finel Bullding/Occupancy (714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite No B Vicinity: PAPA JOHN'S PIZZA (UNIT B) Parcel Nunmber: 42210320 Applicant: TAVAGLIONE, JAY Address: 3405 ARLINGTON AV RIVERSIDE, CA Owner: GARVIN DRIVE LP Address 16485 GARVIN DRIVE ENCINO, CA PLUMBING PERMIT Phone: 909-684-8870 . Zip: 92506 Phone: 2ip: 914363636 Contractor. TAVAGLIONE CONSTRUCTION & DEVELOPMENT INC Address: 3405 ARLINGTON AV RIVERSIDE, CA Arch / Eng : � Address: �, Phone: 909-684-8870 Zip: 92506 License: 278222 Phone: - ,2ip. - � License: _. . . ti " �i.'�'. ', i ISSUED BY: Status: ISSUED Applied: OS/02l2001 Issued: 05/02/2001 SCOPE OF PERMIT " _ ;- i - INTERIOR TI FOR "PAPA JOHN'S PIZZA" IN UNIT B. . � 1 GAS OUTLET (1-0), 1 LAUNDRY TUBIWASHER; 1 COMMERCIAL SWK, 3 FLOOR SINKS,� 1-� ' � � KITCHEN SINK, 1 SERVICEIMOP SINK; 2 WASH BASINS,-I-WATER HEATERNENT. REF: B00-02006 .' ;�, � ISSUE FEE \ Backflow irrigation �� Backflow Preventer � Bathtub Clarifier System Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 ouHets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) � �- '' . � FEE SUMMARY '� �" ��; ��'=' �.=� '-� "' . AMT QTY . - � � AMT QTY � j � /, � "� ,' AMT :$23 50 : � � A_�� Laundry Tub 1 Washer � .� $9.80 � �t � �� Sump"Purtip� � � � � $0.00 $0 00 j,.;0 �� Landscape Irrigation - , $0.00 _0 � ��'� Sv+imming Pool , � � $0.00 - $0.00 � 0 - - '- P-Trap � � $0.00 �--0 i �Trap�Pririier . '. i $0.00 $0.00 � � 0 � , Pressure Regulator $0.00 - 0 � �'. Urinal '� $0.00 $0.00 � 0' Process Piping (per 10 ft) $0.00 ,-0 ,� ��, Vacuum Brkr BkFlow(1-4) $0.00 $0.00 = . 0 ' � , Receptors � . � $0.00 ��, 0 � � - Vacuum Brki BkFlow(5+) $0.00 $0.00 '0 �- � SepticTank $0.00 - _ 0 i ; Wasli Basin $19.60 $0.00 �0. - �' - Sewer Cap for Demo � � $0.00 - � 0- . = . �/ =� Wash Basin Set $0.00 $0.00 0 . Sewer Connect � �- $0.00 - 0 �� - ",- ' � Waste and Vent System $0.00 50.00 0 � SewerPrivateLine � �,$0.00�"��0 "� WaterCloset(Toilet) $0.00 $0.00 0 Shower - �. " . -$0.00 0 WaterHeater/vent $12.30 $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 $0.00 0 Sink, commercial $g.80 1 Water Re-pipe $0.00 $0.00 0 Sink, Floor $29.40 3 Water Service $0.00 $6.15 1 Sink, kitchen $9.80 1 Water Softener $0.00 $0.00 0 Sink, service/mop $9.80 1 OTHER $0.00 $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 $0.00 0 REINSPECTION $0.00 50.00 0 TOTAL CALCULATED FEES: 5130.15 �lY 0 0 � 0 0 0 0 2 0 0 0 1 0 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and ralated regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned tor 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, an all required Inspeetions and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zane-ae (aool WORKERS' COMPENSATION DECLAHATION: I hereGy aHirtn under penalry of perjury one of the iollowing dedarations: �� ❑ I heve and will maintaln e certificete of consent to seN-Insure for warkers' compensatlon, es provided for by section 3700 ot the Le6or CoOe, tor Ihe peAortnence of 1he work tOr which this pertnit i5 issued. '@� I have end will maintain workers' compensation insurence, as requiretl Oy section 3700 of Iha Lebor CoUe, lor the pertormance af I�e work for which ihis pertnit is issue0. My workers' compensatlon Insurance carrler entl policy number are: Cerder. Policy Number. (lhis sectlon neetl nof be complefed i! Ne permif �s �elued at one hundreC dollars (5/00) or less.) ❑ I certity lha[ in the pertortnance of the work tor which this pertnit I5 I55ueQ I shall no� employ any person In eny manner so as to become subject to Ihe workere' compensation laws oi Celltomia, Rd egree Ihet if 1 shoultl Decome subjed to the workers' compensatlon provisions of Section 3)00 of Ihe Labor Cotle, I s�all tonhwlth compiywiN ePro Ions. � � ` ^� � Applicant Signature: Date: �� WARNINO: FAILURE TO �� UR RKERS' CpA �^�T��1 ODVEMGE IS UNUWFUL Ml� SHALL SU6IECT M! EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED THOUSANDDOLLFRE 1 ,000), ADDfTIONTOTHEW570FWMPENSATION.DhNAGESlSPROVIDEDWRINSECTION3)O60FTHELABORCODE,IMEREST,ANDATTORNE`fSFEES. IICENSED CONTRACT�RS �ECLARATION: I hereby aHirtn that I am Ilcensetl under prov� force entl eHect Lic�� of Chapter 9(commencing with Section 7000) of Division 3 ot ihe Business antl Pmfessions Code, antl my license Is In full Cless a Date: CONSTRUCTION LENbIFG AGENCY: ❑ I hereby affiim t�at there is a canstruction IB�ding agency for Ihe peAormance ot the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lentlefs Address: Signature: Date: OWNEfi-BUILDER DECLARATIONS: I he�eby aXirm Ihat untler penelry ol perJury Ihat I em E%EMPT FROM THE CONTRAC?ORS LICENSE LAW for ihe following reason (Sec. 7031.5, 8usine55 and P�otessl0ns Code: Any ciry or county which requires e pertnit to construct, elter, improve, demolish, or repair any structure, pnor to its iuuance, elso requlres the applicant far such permlt to lile e signed statement that he ar she Is IlcensBd pursuant to the DroNslons of the Contrectors lJcense Lew (Chepter 9(commendng wlih Saction 7000) of Divislon 3 01 the Business antl Protessions Code) ar thet he or she is exempt thereirom end the basis tor t�e allegetl exemptlon. Any violetion of Section 7031.5 by any epplicant tor e pertnit suD�ects the applicam lo a cMl Denalry of not more than fiva huntlreA dollers (5500).): ❑ I, as owner oi the property, or my employees with wages as iheir sole wmpensation, WILL DO THE WORK, and tha structure Is not intendad or otfered for sale (Sec. 7044, Business and Prolessions Code: The Coniractore License Lew tloes not aDPN to en owner of property who builds or improves thereon, anA who tloes such work himself or herselt or ihrough his or her own amployees, provided Ihet such improvemenis are not Intended or oHeretl for sale. If, however, the builtling or improvement is sold within one year of wmpletim, the ownar-builder will have the burden of proving that he or she did not build or impmve for purpose of sale.). ❑ I, es owner ot the pmperry, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTOHS to consiruct the project (SecJ044, Business and Professions CoOe: The contrectars License Lew does no� epply to en owner of propehy who 6uilds or Improves thereon, entl who contracis for such project wlth e contrector(s) license pursuent to the Contractors License Laws.). ❑ I am exempt under sec. Signature: Ownar ID verified by dnvers Ilcense. ❑ Yes ❑ No Busineu end Pmfessions Code tor Ihis reason: Verifiwtion ot Ownership by (rype o1 document, i e. - pmPerry t� bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CEAnFICATON: �rivers LicenSB No. Date: Espires: ❑ I �ereDy cenify t�at no excaveiion Ilve (5) o! more feel In depih Into which e person Is required to descend, will be mede in connection wilh work euthorizeC by this permit, antl that no building siructure, scattolding, falsework, or demolition or tlismantling thereol, will te more ihan ihirty-sia (36) leet high. (Chap. 3.2, Gry 2, An 2, Sec. 341, Title 8, Callfomia AtlminislreNve Code). � As owner-builder, I will not employ enyone to tlo work which woultl require a permit Imm the Division of IntlusMel Safery, es notetl ebove, unless such person has e permit to do such work from the division. Signature: Date: Division ot Industnal Safery Pertnit Numbar: CERTIFlCATE OF COMPUANCE AND AUTHOR17A7�ON OF EMRY: I certify under penalty of petjury Ihat I have read this epplication antl state Ihat the information given Is correct. I agree to comply with ell stete lews and �iry ordinances relating to bullding consiruction, entl authodze represantatives of ihe City of Costa Mesa to enter upon ihe ebove-tlescnbed property tor Inspection purposes. � egree not to occupy or ailow occupancy of eny building au�honzed by ihis permit un�il finel inspection. PSIE U�A4§ 1616 Fixad System Final Fire Prevention 1266 Pool SDa Finel 200 Finel Re-Root 201 FInaI Block/Reteining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition � c�.-� � Date CODE� INSPECTIONTYPE 206 Flnal Mechanical 208 Finel Plumbing 210 Finel Electncal 212 Flnal Flre Prevenfion 220 Final Planning Approval 222 FinalSite 250 Final BuiltlingiOccupancy '.1 :111. �� /' hI�J /� (714) 754•5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 560 W 19TH ST Status: ISSUED Suite No B Applied: 07/23/2001 Vicinity: UNIT B Issued: 07I23/2001 Parcel Nunmber: 42210320 Applicant: TAVAGLIONE, DON ISSUED BY: ' Address: 3405 ARLINGTON AVE - � � " �� . _ - ,_�r'� . _ _ , '",y ii �� ' _ � - � �.Phone: (909)684-8870 RIVERSIDE; OA��' � " f � - Zip: 92506 , � � � `\ �� ' \ / y �, � � i / � _. � : 'i . � ��, ,. -� - , � � �- , _ - � � �. j i , . � , ' �� -: `. � i � � - \ Owner: ; �JEFFREY A. FISCHER ' � � � � �� Address � -17337 VENTUF2A BI:VD #205 �� _ ; -�' � � �V� ` � " " Phone: (818)501-0145 � : � ' ' � , . ��\ . �',�-' -,' - ;.�� ,�✓' .� ENCINO, CA''� , ' . Zip: 91316 :' � � �" j -� = � � `� � .,� ' ; � . ,. � � i- . . � Contracror: � TAVAGLIONE CONSTRUCTION & DEVELOPMENT INC ��,�� Address: 3405 ARLINGTON AVE � ., . . - � . , ' � �� , , � � � . . : Phone: �- (909) 684-8870,. '" � � , " . , .. . . . . . . RIVERSIDE, CA ,-" " " � � Zip: 92506 . - . ; ' �� - � License: 278222 �� ./ �. � . A SCOPE OF PERMIT ELECTRICAL PERMIT TO INSTALL NEW 200 AMP SERVICE F.OR "PAPA JOHN'S PIZZA" (UNIT B). � ... . _ ' --�--'- �-- �.,. �_�., ` REF:B00-02000 - _ , - , ..,/,h,' - ' - - -- /' - - . ,ISSUE FEE $23.50 Temp service test $0.00 Res. a/c package� , $0.00 New Res�(7-2 units) $0.00 New Res•(3+units) . � $0 00 Pool / Spa , , � , ,�$0.00 Lighting Flxts ` , � �� $0.00 Recept Outlets '�, � ' �$0.00^. Switches ' � ; � �$0.00: Non Res Appl � � $0.00' Res Appl � � ''� $0.00 Service to 200a � � � , $30:50 Service to 1000a \ 50.00 , Service over t000a � � ' ,50.00 � Motors to 1 hp � � - $0.00 � Motors to 70hp A$0.00� Molors to SOhp 50.00 - Motors to 100hp $0.00 Motors over 100hp 50.00 Communication drops 50.00 Sub panel to 200a 50.00 Pole Light Pkg $0.00 Sign Circuits $0.00 Temp Pwr Pole $0.00 Intermed Pole 50.00 FEE SUMMARY - Quantity � : �� Quantity = " Temp DisfSystem / Lighting $0.00 0 � . � - � � � Busway /100 R . ; ' � $0.00 0 . � Standing Section ' $0.00 , Os ; � � 0 . ,�;�;MiscElectricalEquipment �$0.00 i3O/ ,�� >; � � 0 i;:��% T�ansformers upto 1 kva/kw $0.00 "!'0 '/, �� 0 •' �•,• ` ........ ._.::up-to:70 kva/kw $0.00' j i' 0 i� � i 0 . , ... ......,up to-50;kva/kw -_ $O.00i � 0 , �.. i �- - :;' .. � - . .._..,..,. . ., � ', °._ 0' �.. � � .......:_......uptoA00kva/kw`- $0.00 0' �," 0. : �� ..> :..........:_....over100kva/kw ;$0.00,� -�p i �, �„0 - � Low Voltage Equipment ' , $0.00 ; 0 � 0� - � � � Low Volt Wiring System / CkL- � $0.00 � � 0� /,�/ '1 . -MiscConduit - - ;�$D.00: �"0-. � . 0 � � Misc Conductor $0.00. ; 0 ' � � 0 � Circus ( gen or ride). . ` �� ; $0.00 .�;� 0, � �" 0 /; . Circus (mech�ride or lights) � �` $0,00".�- j0 ' 0 : ' � �Christmas Tree Stand � �� $O.W / 0 � 0 � ' Fireworks Stand ' - - $0.00 0 0 . ' �'� �Other Electrical Fee - . - $0.00 � 0 - -Investigation Fee - $0.00 0 Plan Check Fee SO.Ob • 0 Reinspection Fee 50.00 0 0 TOTAL CALCULATED FEES b54.00 0 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handirap access requirements under Califomia statutes and related regulations. (Orcl. No. 92-28, § 1, 12-21-92) EXPIRATION: This parmlt shall automatirally axpire end bacome void if work is not commenced within 1B0 days, or if work is suspended or abandoned tor a period of 180 days. �NSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspeetlona end final epprovel must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permlt. .% FOR INSPECTIONS CALL: (714) 754-5628 �j zae-as �aroo� WORKERS'COMPENSAnON DECLARAnON: I hereby eXirtn under penalry o1 per�ury one of Ne following declarations: ❑ I heve end will malntain e cenlficete ot consent to selt-Insure for workere' compensetlon, es praNded �or by sectian 3700 of tha LeDor Code, for the peAortnance af Iha �ork lor which lhis permlt Is Issuetl. have arM wlll meintain workers' compensetion insurance, es required by secUon 3700 of Ne Lebor Code, for the performance of the work for whkh NIs pertnit Is IssueO. My warkers' c etion Insuren errier entl olicy number ere: r�I /q Cerder. � �� Policy Number. I`� L�O 1� 7' OO (Tnls secNon need nof be crompleted Il fhe permit !s v ued ef one Aundred dollers ($100) or less.) ❑ I certity ihet in ihe peAortnence of Ue work for which Ihis permit is luuetl, I shell not employ eny person In eny manner so es to become eubl�� o the workera' compensation laws ot Cellfomla, entl egree that shoulE become sub�ect to the workers' compensetlon praWslons ot Sectlon 3700 af the Lebor Cade, I shell torthwith comply vrith ihese provisl q/ J (� ^� ApPllcent SlgneNre: �/� ° C Date: /— L_ � �� WARNINO: FAILURE TO SEWRE WORKER$' NSATION COVERAOE IS UNLAW R1L AN� SHAl1 SU8IECT AN EMPLOVER TO GRIMINAL PENALTIES AND GML FlNES UP TO ONE HUNDRED hKK1S4ND OOLLARE (5100,000), IN FDDRIIXJ TO THE C06T OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECf10N 37080F THE LABOR CODE, INTEREST, AND ATTORNEI"5 FEES. LICENSED CONTRACTORS DECLARATION: I heraby eNlrm thet I am licensed und r provislons ot Chepter 9(commencing with Section 7000) ot DlNsion 3 0l the Business and Professions Code, end my license Is In full force and efled. Lic. # �.1 �i `i'�7 _ Cless a CONredoreSignewre: �v r��, � --- �Date: �� CONSTAUCTION LENDING AGENCY: ❑ I hereby ettirtn t�et there Is e wnstructlon lending egency tor Ihe peAormance of Ihe work for which Ihis pertnit is issued. (Sec. 3097, Civil Code). LentleYs Neme: Signeture: _ OWNER-BUILDER DECLARATIONS: Lendals Addrass: Date: I hereby efllrtn �het untler penelry of per�ury Ihet I em EXEMPT FROM THE CONTRACTORS IICENSE LAW tor the following reeson (Sec. 7031.5, 8usiness end Professlons Cotle: Any clry or wunry which requires e pertnit to consWc�, elter, Improve, demolish, or repeir eny a�ructure, prior �o its luuance, also requires the applicant for such pertnit to iile e slgnetl stetement Ihat he or she Is Iicensetl pursuent to the proNsions of the Coniraqors IJcense Lew (Chepter 9(commendnp with SecUon 7000) 01 DIVISIon 3 01 the Business end Professions CoOe) or thet he or she is exempt theretrom end the Gesis for the elleged exemptlon. Any violatlon of Sectlon 7031.5 by any applicant for e DertM' sub�ects Ihe appllcant to e dvll penelry W not more than flve hundred tlollare ($500).): ❑ I, es ownar of iha properry, or my employees vnih weges es thelr sola compansetian, WILL DO THE WORK, entl Ihe strudure Is not Intended ar oHeretl for sale (Sec. 7044, Business end Professions CoOe: The Contractore License Lew does not apply to an owner ol property who builtls or improves Ihereon, and who does such work himselt or hersefl or ihmugh his or her own employees, provided that such improvements ere not IntentleA or oNeretl for sale. II, however, the builtling or improvemem is sold within one year of completion, ihe ownerbuildar will have �he burden ol proving ihat he or she ditl not builtl or impmve for purpose of saleJ. ❑ I, as owner of Ihe D�QOeM• am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to wnsWc� the project (Sec. 7044, Business and Professions Cotle: 7Ta contreaors Llcense Lew does not appy to an owner ol property who bullds or Improves thereon, entl who coniracis for such project wlth a conirector(s) Iicense pureuant to iha Conirectors License Lews.). ❑ I em exempt under sec. Business and Professions Code 1or this reason: SlgnaWre: Date: Owner ID verifietl by tlrivers Ilcense. ❑ Ves ❑ No Driver's License No. Expires: Vedflcetlon ot Ownership by (rype of tlocument, I.e. - property ten bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CER7IPICATION: ❑ I hereby certity that no excevetion five (5) or more teet in depth Into whlch n person Is required lo descentl, will be made In connectlon with work euthorized by Ihis permit, antl that no builtling strucWre, scalloltling, telsework, or Oemolitlon or tlismantling thereof, will be more lhan thirty-sia (38) teat hiph. (Chep. 32, Grp 2, Art 2, Sec. 341, 71t1e B, Califomia Atlminisiwtive Code). ❑ As owner-builtler, 1 will not employ enyone to do work whlch would require e pertnit from the DlWsion of Intlusinal Satety, es noted e6ove, unless such person hes e pertnit to do such work irom Ihe divislon. Signature: Date: Divislon of Industrial Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUfHOR¢A710N OF EMAV: I certily under penalry of perjury thet I heve read this epplicalion and slete that the intormation given is correct I agree to comply with ell stale laws and ciry ortlinences ralating ro builtling constructlon, end euthodze representetives ol the Ciry of Costa Mesa to enter upon the ebove-descnbed property for Inspection purposes. I agree not to occupy or allow occupancy of eny building authonzed by lhis permit until tinal inspection. COUE I. R15PECf10NTYPE ifi16 Fixed System Final Flre Prevention 1266 Pool Spe Finel 200 Flnel Re-Roo1 201 Final BIocWRetaining Wall 202 Final Factory Fira Plece 203 204 Final Sign Final Demolition %'? ?-Gl ' � Date . �$ �Qyf,� INSVEGTONTYPE 208 Final Mechaniwl 208 Flnel Plumbing 210 Final Eleciricel 212 220 Finel Fire Preventlon Flnal Plenning Approval 222 Final Site 250 Flnel BuildinryOccupenty GLg It�E45 7• 2��1 (774) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address 560 W 19TH ST B PAPA JOHN'S PIZZA (UNIT B) 42210320 TAVAGLIONE, JAY 3405 ARLINGTON AV RIVERSIDE, CA , GARVIN DRIVE LP 16485 GARVIN DRIVE ENCINO, CA Phone: 909-684-8870 , Zip: 92506 Phone: Zip: 914363636 Contraaor: TAVAGLIONE CONSTRUCTION 8� DEVELOPMENT INC Address: 3405 ARLINGTON AV . RIVERSIDE, CA Phone: 909-684-8870 Zip: 92506 License: 278222 ISSUED BY: Status: ISSUED Applied: OS/02/2001 Issued: 05IO2I2001 � � ' ` SCOPE OF PERMIT,'� � � � � INTERIOR TI FOR "PAPA JOHN'S PIZZA" IN UNIT B. � - � � ' ' � � � � � " � � 22 LIGHTING FIXTURES, 22 OUTLETS, 12 SWITCHES, 3 MOTORSJO i HP, 2 SIGN CIRCUITS. �- � � REF: B00-02000 � , �, � ' � � ,, ----- � -�- '- - -- - - � ��'_ ., ,. . '�; �� . ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) � New Res (3+units) Pool / Spa Lighting Fixts . Recept Outlets SwitGheS � � Non Res Appl � �� Res Appl � Service to 200a Service to 1000a Service over t000a Molore to 1 hp Motors to 10hp Motors to 50hp Motors l0 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Quantity 523.50 $0.00 $0.00 $0.00 0 $0.00 0 50.00 0 $23.46:. ; --� 22-�- �' . �523:46 ;`.• . 22 � . 'i $13.20��A��2 c- ./ $0;00, �'c0A,�_ ; $O.00�i �''0� ; ` �.:�� $0.00 % � � 0 �--_ � . $0.00 ; 0 , , 50.00 �� ',� 0 , .� � �51a.25, _, ' � 3 , S0.00�--�� 0 � $0.00�; ' 0-� � 50.00 � 0 "� , 50.00 0 50.00 0 $0.00 0 50.00 0 $49.20 2 50.00 0 50.00 0 FEESUMMARY,%' "" " � ,' . Quantity��/ Temp Di3t System'I Lighting 50.00 0��.� Busway H 00 ft--� 50.00 0% . _ Standing Section 50.00 �! 0 � _�� ., MiscElectricalEquipment 50.00 . ��0 , i '' ��, � i�✓ % ' ;' ; 'I i i'�, i Transforrtiers up�to 1 kvalkw $0.00 �i 0 �, i� ; . .......upto-t0�kva/kw _ 50.00%/ 0� _ � , ........ . , . � . . : _,� . . , , :.......:........up l0 50`kvalkw �-. �-.- �$0.00' 0 • � - , .........::....upto100kvalkw .�,.-50.00/,.0 ��. ; '%i ....over 100 kya�cw ��50.00��/ 0 i, � i Low Voltage,Equipment=% 50:00 `��0� � � Low VOILWiring:Systerti % Ckt ��50,00� � 0 /. '� Misc. Conduit - - . �-'S0.00 � �0 ' ,- Misa Conductor , � �� $0.00 - ,� 0 % Circus_ ( gen or rlde) '� � � � `$0.00.' - 0 Cirws (mech ride or lights) �50.00� � 0 Christmas Tree SWnd� /�� 50.00 0 Fireworks Stand ' � � i �$0.00 0 Other Electrical Fee�" - ' $0.00 Invesligation Fee 50.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES 5147.07 COMMENTS I SPECIAL CONDITIONS NOTICE: The work au�horized by this permit shall comply with all applicable handicap access requirements under California statutes and related regula�ions. (Orcl. No. 9248, § 1. 12•21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this �permit to be considered legal, such work must comply vrith all applicable codes, and all required inspectlona and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 2a4&d6 (BI00) WORKERS'COMPENSAnON DECLARAnON: t �ereby effirtn under penelry ot perJury one ol ihe following decleretlons: ❑ I �ave entl will malntain e certlticate af consent to sell�lnsure tor workers' compensation, es provlCetl lor by section 3700 of ihe LaDor Code, tor the peAormence ot the work for which thlg pertnit Is issued. � t hevB erM wlll meinleln workere' compensetbn insurflnce, es requiretl by sectlon 3700 oi Ihe LeDOr CatlB, for the pBAOrtnente o1 the wofk lOr which Nis pertnl� 15155ued. My warkers' compensatlon Insurence cerrler and policy number ere: Y Cerrier. Policy Number: (Thls sectlon neod nof Oe completed7! fhe perm/t is ve/ued ef one hundred dWlen ($f 00) a IessJ ❑ I certify ihet in t�e peAortnence of � e work for which ihis permit is Issued, 1 shell not employ eny person In eny manner so es to become suDject to t�e workers' compensetion lews ot Calllomle d agree that It I s�oultl become sublect to Ihe workero' compensetion proWslons ot Sectlon 3700 ot the Lebor Cotle, I shall fo�hwllh comply with se provlslons. �—� _ O 1 Applicant Slpneture. Date: WARNINL3: FPILURE T IORKERS' COMP ATION COVERAGE IS UMAWFUL AND SHN1 SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED TKKISANDDOILAR (51 ,000 ADDITIONTOTHECOSTOFCOMPENSATIqJ,DAMAGESASPROVIDEDFORINSECf10N3]OBOFTHEIABORCODE,IMEREST,ANDPTTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby altirtn that I censed under provlsl torca ena ettect. Lic a ConVacloYs SignaNre: of Chepter 9(commencing wlih Seciion 7000) at Division 3 0l the Business and Profeuions Code, end my license is in full Cless N Date: — — CONSTRUCTION LENBiNG AGENCY: ❑ I �ereby aKrm that Nere is a canstruction lending agency for the pertortnance ol �he work tor w�ich Ihis permit is issued. (Sec. 3097, Civil Cotle). Lenders Nama: Lendefs Adtlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereGy effirm that under peneliy of perJury Ihat I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Busineu end P�otessions CoCe: Any dry or counry which requires e permlt lo construct, elter, impmve, demolis�, or reDair any structure, prior to its issuance, elso reQuires Ihe epplicant br such permit to flle e signed stetemem Net he or she is Ilcensetl pursuent ta the provlsions ot Ne Contrectors lJcense Lew (Chapter 9(commendng wii� Section 7000) 01 DlvLslon 3 oi t�e Business and Professions Code) or thet �e or she Is exempl Iherefrom entl 1�e basls for the alleped axemption. Any violation o1 Section 7031.5 by any epplicent for e permit subjects Ihe epplicent to e cNil penalry of not mare than tive hundretl dollers ($500).j: ❑ I, es owner ot t�e Droperry, or my employees wlih weges es their sole compensallon, WILL DO 7HE WORK, antl the sWcture Is not intended or oflered tor sale (Sec. 70dd, Business entl Protessions Cotlo: The Contractors License Lew tloes not eppty to fln owner of pmperty who builtls or impmves theraon, end who does such work himselt or herselt or thraugh his or her own employee9, ProNdad t�at such Improvemenis ere not intentletl or oflered for sale. If, however, the builCing or improvement is solO within one yeer oi completlon, Ne ownar-builder will have tha burtlen ol proving t�at �e or ahe tlitl not Duiltl or improve for purpose of sale.). ❑ I, es owner of t�e properry, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consWct t�e pm�ect (Sec. 704a, Business entl Professions Cotle: The contrectors lJcense Lew daes not epply to en owner of property who �uilds or Impmves therean, end w�o coNrects lor suU projecl with e comractor(s) license pursuent to ihe Contreqars License Lews.). ❑ I em e:empl under sec. Business antl Protessions Cotle for this reason: SlgneWre: Date: Owner ID verlfie0 by Criver's license. ❑ Ves ❑ No Dnvels License No. Expires: Verllication ol Ownership Dy (type ol dacument, i.e. - property taz blll or tleetl): OIVISION OF INDUSTRIAL SAFETY PERMR CERTIFILATON: ❑ I here�y ceNy mat no excave0on Ove (5) or more leet in dept� imo wNch e person is required to descend, will be matle in connection with work authodzed by this permil, and thet no buildinp strudure, scaHolding, lalsework, or demoll�lon or dismantling Ihereoi, wlll be more than ihlrty-six (36) feet hlgh. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, CelHomla Atlministretive Cotle). ❑ As owner-builder, I wlll not employ enyone to tlo work w�ich woultl requiro e permii from ihe Division ot Industrial Safery, es noted above, unless such persan hes e permit to do suGi work trom t�e division. Signature: Dace: DlvLslon oi Industrial Satery Partnit Number: CERTIFlCATE OF COMPLIANCE AND AU7TIORIZATION OF ENTRY: I cenily under penalty ot perjury Ihat I hava read this appliwtion and state thet the informetlon given is cortecc I egree to compry wlt� ell stete laws enA city orClnances releting to building consiruction, and auMorize representative9 0l the Ciry ol Caste Mesa to enier upon the above-deudbed properry lor inspection purposas. l epree not to acupY or ellow ocwpenty ol any building authorize0 by ihis pertnil until (nel inspection. 7616 7268 200 nit 202 203 �� Fi:ed SySiem Final Fire Prevention Pod Spe Final Final Re-Rooi FInaI8lock/Fletaining Well Flnal Fettory Fire Place Final Sign Final Demolition PAIE It� �'-01 -UO � Date COpEI INSPECTIONT'PE 206 Final Mechankal 20B Flnel Plumbing 270 Final Electriwl 212 Finel Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupanq PAIE L�1,4 7� 23�DJ (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-�e�.�a�aUPRESSION PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite: B Vcinily: UNIT B• PAPA JQHN'S PP7A Parcel Number: 42210320 Applicant: RUGGIO, TIM Address: 2684 LACV S7 ' LOS ANGELES, CA owner. JEFFREY A. FISCHER Address 17337 VENTURA BLVD #205 ENCINO, CA Contrador. MASTER PROTECTION Address: 2684 LACY ST LOS ANGELES, CA Zoning: ISSUED BY: Phone: (213) 225-6666 Zip: 90031 Phone: (818) 501-0145 Zip: 91316 Phone: (213) 225-6666 Zip: 90031 License: 555875 SCOPE OF PERMIT INSTALL ANSUL SYSTEM FOR HOOD & DUCT FOR "PAPA JOHN'S PIZZ11" (UNIT B). REF:B00-02000 Plan Check: $54.11 Permit: $83.25 Other: $0.00 Total: $137.36 Status: ISSUED Applied: O6I12I2001 Issued: O6128/2001 FEE SUMMARY Calc Valuation: a2,a9e.00 Claimed Valuation: s2,ass.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•2B, § 1, 12•21-92) EXPIRA710N: This permit shall automatically expire and become void it work is not commenced wiihin 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permi� to be considered legal, such work must comply with all applicable codes, antl all requlred Inapectione and (inel approval �nust be obtained. Failure to obtain inspections and finai approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zanaealarool WORKERS'COMPENSATON DECLARAnON: I �ereby attirtn untler penalry of per�ury one ol the following tloclawtlons: � ❑ I heve end wlll meinteln e ceNflcate of consenl to sell-Insure for workera' compenaetlon, es proNded tor by sectlon 3700 0l the Lebor Gode, for the peAartnance of the work lor which Ihis pertnll Is Issued. ❑ I heve e� wN melntein wOrkers' oompenseUon insurenco, es requiretl by sectlm 3700 of the Lebor Code, for tha peAortnence ol Ne work lor which Ws pertnit Is Issuetl. My workers' compensetion Insurence certler entl pollcy number Bre: Cartier. Policy Number: (TAIs sectlon neetl nof be completed7! the permlfls veluetl ef one hundred dollars (4100) or IessJ ❑ I ceNfy ihet in ihe pedortnence of tha work br which thls pertnit is Lssuetl, I shall not employ eny persan In eny menner so es to bocome sub�ect to tne workora' compensetion lews ot GYIORII ,�e a 10 become sub�ect to the workers' compensetlon DroNslons ot Sectlan 3700 ot the Lebor Catle, I shall fort�with comply wIN Uese Provlsions. Applicent SlgnaNre: Date: WARNINO: FAILURE TO SEWRE W RS' OMP Sr1T1� CWERA6E IS UMAWRIL M1D SWLLL SUBIECT AN EMROVER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNOREO TVqUS4ND Dd1ARE (5100,000� IN AD TO7HE COST OF COMPENSATIOPL OAMAGES AS PROVIDED FOR IN SECTION 37080F TME UBOR COOE, IMEREST. AND ATfORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aitirtn Ihat I em 10rCB 9ntl eflecl. LIC. M_ Comractors SignaWre: CONSTAUCTON LENDING Chepter 9(commencing with Section 7000) of Dlvision 3 0l the Business and Pmtessions Code, and my license Is In full � CIa55 M d�� Date: ❑ I hereby eMirm ihat Ihere Is a constructlon lending apency for Ihe peAarmence ol Ihe work for which thls pertnit is iuuetl. (Sec. 3097, Civil Cotle). LenAe(9 Neme: Lentler'S Address: Signeture: Date: OWNER-BUILDER DECLARATONS: I hefBby 9lflrtfl Ule� undef Pen8lty 01 �IBf�ury [hat I em EXEMPT FROM TNE GONTRACTORS LICENSE LAW for lhe fdl0wing ree50n (Set. 7031.5, Bu51n855 8nd Profe551ons Cotle: My dry or Counry whlCh requires e permit to ConsiNct, elter, Improve, tlemdl5h, or repeir eny swcture, pdor to its issuance, also requirea tna epplicant for such permit to file e slgned stetement Ihet he or she Is Iicensetl Dureuant to Ihe prodsions oi the Contrectors License Lew (Chepter 9(commentlng with Sectlon 7000) ot Division 3 oi Ihe Business end Proteulons CadeJ or that he or she Is e:empt therelrom end tha basls for the elleged ezemptlon. My violation of Sectlon 7031.5 by eny appllcant for e permil suhjecis Ihe appl�cant to e dvll penalry o1 not more Ihan INe �undred dUlan (5500)J: ❑ I, es owner oi Iha property, or my amployees with wages es Iheir sole compensetlon, WILL DO THE WORK, enA t�e structura is not intentletl or ottere0 lor sale (Sec. 70d4, Business end Prolessions Code: The Contrectors License Lew does nat eppy to an owner ot properry who bulks or improves Ihereon, and w�o tloes suCh work himself w hersetl or throuph �Is or her own employeos, proviGed that such improvemenCq ere not Imended or oflered tor sele. tl, however, ihe building ar improvement is sold wlthin one year ol complatlon, the owner-bullAer will heve Ihe �urden of proving Ihet ha or she did not Duild or improvo lor purpase of sale.). ❑ I, es ownor of the propeM� em EXCLUSIVELY CON7RACTNG WITH LICENSED CONTRACTORS to canstruct the praject (Sec. 7044, Business and Professions Code: The contreaore License Lew does not aOPh �o en owner ol property who bullds or Improves Ihereon, end who cantracts tor such pro�ect wlih e wmrectar(s) Iicense pursuent ta the Contrectors Ucenso Lews.). ❑ I am exempt untler sec. Busineu and Professions Code br Ihis reason: Slpne�urB: Date: Owner ID verifietl by tlriveYs Ilcensa. ❑ Ves ❑ No Oriver's LJcense No. Expires: Vedflcetlon ot Ownership Dy (rype ot Oocument, I.e. - property taa blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certily that no excavatlon Ilve (5) or more teet In depth Into w�lch e person is reqNred to descend, wlll be mede In connection wlth work euthodzed by ihis permit, and tha� no building struMure, scafloltling, telsework, or tlemolition ar Cismantling t�ereol, will Ue more then thirry-six (3G) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, iitle 8, Celitomle Atlminl5trative Code). ❑ As owner-bullder, I will not employ enyone to tlo work whic� woulC reQuire e permit Irom I�e Divlslon ol Industnal Satety, es noted eDove, unless such person hes e permlt to do such work Irom t�e tllvislon. Signeture: Date: DIti51on of InduSMel Safe�y Permil Number: CERTIFlCA7E OF COMPLIANCE AND AllT}iORIZATION OF ENTHY: I cenily under penalty of porjury I�et I heve reetl Ihis applicelion and stete that �he informetion given is conacL I epre9 to comply with ell stete laws enA city ortllnances releting lo bullding consiruclion, entl eu�hodze representalives ol t�e qry of Coste Mesa to enter upon the ebove-deunbetl D�oPerty lor Inspection purposes. I egree not to acupy or ellovi occupanty ol eny building authorizetl by t�is pertnil until tinal inspeclion. COpE I. INSPECTIONTYPE Qdjf, �S 1616 Fixed S}5tem Final Fire Prevention 1286 200 201 202 203 Pod Spe Final Finel Re-Rooi FIne181ocWRetaining Well Final Feciory Fire Place Final Sign 20a Final Demolition COOEI INSPECTONTYPE 206 Final Mechanical 20B Final Plumbing 270 Final Electrical 212 Finel Fire PrevenGon 220 Final Planning Apprwal 222 Final Sile 250 Finfll Builtliny0aupancy enIF. li�$ � - a-o ia,o (714) 754-5273 • Fax (714) 754•4856 • www,ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT �ob Address: 560 W 19TH ST Suite: B � Vicinity: UNIT B Parcel Number: 42210320 npp�icant: HOOPER, DAVID Address: 1314 PEBBLE SPRING LN GLENDORA,CA � ' ; , ownec FISCHER,:JEFFREY A � Address ,17337 VENTURA BLVD #205� � , ENCINO, CA � Contractor. SIWI - ' � Address: 1314 PEBBLE�SPRINGS LANE GLENDORA,CA Zip: 91741-2350 Amh : Adtlress: Zip: Phone: License: Zoning: Phone: (626) 963-7643 . Zip: 91740 ' /. Phone: (818)501=D745, - Zip: 91316 - � Phone: �626-963-7643 License: 513099 ' Eng: Address: SCOPE OF PERMIT � 7200 SQ FT �NTERIOR STORE T.I. FOR "ELE�GANT CCEANERS"�(UNIT B)r FEE SUMMARY Plan Check: $117.81 Permit: $181.25 SMIP Res: $0.00 SMIP Com: $2.10 Other: $0.00 Inspection: . . $0.00 Status: ISSUED Applied: 06/19/2001 Issuetl: t v062001 ISSUED BY: ' ' , - - , Phone: - ' License: • ; Calc Valuation: Claim Valuation: ; ,, � Sotal: $301.16 � � " % ' , 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 Existin : 0 Required: 0 Pr000sed: 0 ' NOTES: COLLI KJ 11/06/2001 OCCUPANT LOAD NOT PROVIDED ON PLANS. � S t o,000.00 s�o,000.00 NOTICE: Tha work authonzed by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulatlons. (OM. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatiCally explre and become void if work is not commenced wlthin 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must compty with all applicable codes, and all requlred Inspeetlona and flnal epproval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaaa�as (e�ool WORKERS' COMPENSATION DECLARATION: I hereby eXirtn under penalry ot perjury one of t�e following OeGaretlans: ❑ I heve en0 will malniein e ceNlMate ot consent to sell-Insure for workers' compensetlon, as provided for by seciion 3700�ot Ne Lebor Code, br the pertortnance ot the �work lor w�kh Uis pertnl� I5 Issued. ve arW wlll In n xro rs' nsetlon Ins ra ce, es requlred Dy sectlon 3700 ot Ne Lebor Cade, tor Ue peAortnence ot Ne xrork tw whlch�tsEEE@@@ �is issuetl. CarrleMy workere' et rence der end ol number ere: � /� �� / PUi NumDer. � bB cortlp/etetl I/ Me pe/m/t Is veluotl et one ❑ 1 certity thet In Ihe pertortnance of the work tor which ihis pertnit is Issuetl, I shell not employ any person in any menner so es ta become sub�ea to the workere' compensetion lewa of C 1 omi end epr Ihet il I should become sub�ect to the workere' compensetlon provislons of Sacllon 3700 0l the LeDor Cotle, I s�ell forthwlth comply wlth Ihese Provi io s. / 1 � �� O� Applicent Signeture: Dete: � WMNW(i: FAILUiiE TO SEWRE ORKERS' COMFENSITIIXJ C VERAGE IS UNLAWRIL AND SI-01LL SU9IECT AN EMPLOVER TO CRIMINAL PENAL7IES AND CML FlNES UP TO ONE HUNDRED 7HOUSRIJDDOl1ARE(f100,000),INADORIONTOTHECDSTOF PENSATIIXJ,DAMFGESASPRW�DEDWRINSECTION3)OBOFTHEIABORCODE,INTEREST,ANDATTORNEI"SFEES. LICENSED CONTAACTORS DECLARA ON: i] I hereby aKrm that I em Ilcensed un r d��fRh�te 9( ommencing with Section 7000) of DlNsion 3 at the Business end Prolessions CoAe, end my Iicense is in tull force entl ettect. Llc. a LJ ( Class A Conirectofs SlgneNre: Date: / � CONSTRUCTION LENDING AGENCY: ❑ I hereby elTirtn ihat Nere is a construction lentling egency for the perfortnance of the work for which ihis permit is IssueO. (Sec. 3097, Civil Code). Lendefs Name: Lendefs Atldreu: Signature: _ Data: 1 here6y aHirtn Net�undei pBn0lly ot pe�ury Nat I em EXEMPT FROM TME CONTBACTORS LICENSE LAW far the followinp reason (Sec. 7031.5, Business end Pmfes5lons Cotle: Any clry or counry.which requires e permit to construct, elter, improva, demollsh, or repair any sirucWre, pnor ta its issuance, elso requlres tne ap011cant for aucn pertnit to tile e signed stetement thet he or she is Iicensetl pursuant to the proNsions of the Contrectors License Lew (Chapter 9(commendnp with SecUon 7000) ot Dlvision 3 of Ihe Business entl Professions Cbde)'or-Nat he or s�e Is esempt therefrom and the Desis for the elleged exemp0on. My vlWatlon of SecUon 7031.5 by flny epplicent far e pertr+: sub�ects Ihe eppllcant to e clvll penalry oi not more then Ilve hundred dollers ($500).): � J; 6:: ❑ I, as ownar o1 the property, or my employees with weges es ihelr sole compensatlon, WILL DO TME WORK, antl ihe siructura Is not Intended or otteratl for sele (Sec. 7064, Business and Professions Code: Tha Contrectors License Lew does not apply to an owner of D�operty who bullds or Improves therean, and who does suc� work �Imsetl or hersetl or Ihrough his or hecown employees, provided that such Imprwements ere not Intentled or otteretl tor sale. If, however, Ihe building or Improvement Is 9old wlihln one year ot mmpletion, the owner-builder will heve Ihe burden ol proNng ihet he or she did not build or imprwe lor purpose of sale.). � I, as owner of Ue property, am EXCLUSIVELY CONTRACTNG WI7H LICENSED CONTRACTORS to cansuuct the project (Sec. 704M1, Business flnO Professions Code: The contractors IJcense Lew does no� eDPly to en owner ot pmperry who builds or Imprwes theraon, and who coniracts for such projeIX wl�h e conirector(s) license pursuant to the Contractore LJcensa Lews.). ❑ 1 em e:empt unCer sec. Busineu antl Proleuians Code tor tNs reason: Signaturo: Date: Owner ID verlfied by OrNefs Ikensa. ❑ Yes ❑ No �rivers lJwnso No. Vedllcation ai OwnersMp by (type ot Cocument, I.e. - property tax bill or deed): 6cpires: DIVISION OF INDUS7RIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby certlly that no excevetlan ilve (5) or more leet in depih Into which e porson Is requlred to descend, will be metle in wnnectlon wlth work eulhodzed by t�ls permlt, end Ihat no building siructure, sceflolding, falsework, or demolition or dlsmantling I�ereo�, will be more than thirty-sic (36) feet high. (Chep. 32, Gry 2, Atl 2, Sec. 341, T1tle 8, Celitomia Atlministretive Cotle). � As owner-Dulltler, I wlll not employ enyone lo do work which would require a pertnit Irom the Dlvision ot Indusirial Seleh/, es noted ebove, unless such person hes e pertnit to do such work trom the division. Signature: Date: DiNsbn of industrial Salery Permit NumDer: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I ceriify under penelry ol Dorjury t�at I heve read thls epplicatlon entl state Ihet Ihe intortnetlon glven Is wrtect I egree to comply with ell stata laws enC clty ordinences releting to building construction, end authodze representetives ol the Ciry ol Coste Mesa to enter upon t�e ebove-descdbed properry for inspection puryoses. I egree not to accupy or allow occupancy ol eny building authorized by ihis parmit until tinel inspection. CODE �. INSPECTIONTYiE 1616 1286 FIxBA System Final Fire PrevenUon Pool Spe Flnal 200 Final Ra-Roat 201 Finel BIocWReteining Well 202 Final Fectory Fire Place 203 Final Sign 20a Final DemoliGon Qeg Ii�atS //'�� `�/Date U Date CODE� msvecrroNrrre 208 Final Mechanical 208 Flnal Plumbing 210 Final Electrical 212 Flnel Fire Prevention 220 Final Planning Approval 222 Final Sita 250 Final Building�Occupenry Peg It�ALfr � (714) 754-5273 • Fax (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA g2626 Job Address: Suite No Yciniry: Parcel Nunmber: 560 W 19TH ST B 42210320 ELECTRICAL PERMIT Applicant: HOOPER, DAVID Adaress: 1314 pEBBLE SPRING LN -. �' GLENDORA,CA '� , Owner: �JEFFREYA. FISCHER Address 77337 VENTUF2A BLVD #205 ENCINO; CA; �., �v Contractor. SIWI Address: 1314 PEBBLE SFRINGS LANE ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fixts Recept Outlet5 Switches Non Res Appl Res Appl Service ro 200a Service to 7000a Service over 7000a Motors to 1hp Molors to tOhp Morors to 50hp Motors to 700hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole GLENDORA, CA ; Phone: 626-963-7643 Zip: 91740 Phone: (818)501-0145 Zip: 91316 _-Phone: 626-963-7643 � Zip: 91741-2350 License: 513099 Status: ISSUED Applied: 11/O6/2001 Issued: 77I06/2007 ISSUED BY: � SCOFE OF PERMIT � REF: 801-00929. TENANT IMPROVEMENT FOR'DRY CLEANERS. "ELEGANT CLEANERS". ELECTRICAL TO INCLUDE 6 MOTORS TO 1 HP FOR DRY CLEANING�EQUIIPMENT.- � � � i � 523.50 so.00 so.ao 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 . $0.00 30.00 $0.00 so.00 so.00 $28.50 50.00 $0.00 $0.00 50.00 $o.00 $0.00 $0.00 $0.00 $0.00 $0.00 � � �-��FEE'SUMMARY � � � � �uantiry 0 0 0 0 0 . �.,� .. Temp Dis6System / Lighting Busway /100 ft Standing Seclion - Misc Electrical Equipment Transfortners up to 1 kva/kw ' � � � ............:..:up to 10 kva/kw .................up to 50 kva/kw .................up,lo 700 kva/kw - ' ..................over 100 kvalkw , low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit � Misa Conductor Circus ( gen or ride) Circus (mech dde or lights) Christmas Tree Stand Fireworks Stand - , Other Electrical Fee Investigation Fee Plan Checli Fee Reinspection Fee Quaniity ' 50.00 0 50.00 0 so.00 0 50.00 0 , , 50.00 '.0 $0.00 0 $0.00 == ,' 0 , 50.00 j � 0 . so.00 0 50.00 - ' 0 50.00 , 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 - " 0 so.00 50.00 50.00 50.00 TOTAL CALCULATED FEES 552.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authoNzed by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related I regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt shall automatically expire end become void if work is not commenced within 180 days, or if work is suspended or abandoned � tor a pedod ot 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 requlred Inapectiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiretion of this pertnit. fOR INSPECTIONS CALL: (714) 754-5626 zaaws It✓oo) WORKERS'COMPENSAnON DECLARAnON: I here6y ettirtn under penalry of perjury one of t�e ldlowing tladaretlons: ❑ I have fln0 wlll main�eln B cBfilficete ot consent to sell-Insuro lor workers' compenSBtion, es provided far by SBciian 3700 of Ihe LObor COAe, tor the peAortnence ol lhe lor which thL9 Dertnit is issued. I hev9 eM will orkeB' pB on nsurence, s qulretl Ey 9ettlOn 3700 ot Na Lebor Code, for Ne perfortnenCe of Ne wOrk for wtliCh Ulis (10 I is 15su0d. Myworkers'co tl n n cerrle policynu e� �OC/�v�� Certler: Pdiry Numhar. 0 �� (rnls secriar need nor ae compiereo ir rhe aenNr ts veNec er one nundred dw�ers (S�oa) or �ess.) ❑ I certlfy t�at In the peAormanca ot Ihe work tor which this pertnit Is issuetl, I shflll not employ eny peBon in eny manner ao es lo become sublec� to the workara' oompensatlon laws o1 Celitomi entl epree Ihet II I a�oultl bewme subject to the workers' compensetlon provlsions ol Sectlon 3700 of t�f Lebor Coae, I shell tort�wit� comply with Ihese Dr i ons. ,n.j, ' l�/ �� O I Appllcant SlgnaNre: �� ' ` � Date: � V WARNINCi: FFILURE TO SECURE WORKERS' COMPENSATIIXJ CO ERAOE IS UNLAWFUL AND SHALL SUBJECT Ml EMPLOVER TO CRIMINPL PENALTIES AND CML FlNES UP TO ONE HUNDRED T110USANOOOLLARE(5100,OW),INADDITIONTOTHECOSTOF PENSATION,DAMAGESASPROVIDEDF-0RINSECf10N3]OBOFTIELABORCODE,INTEREST,ANDATTORNEY'SFEES. LICENSED COHTRACTORS DECLAR I hereby eftirm that I em licensed unCer force en0 efFect. Llc. a Con[redoYs Slgnature: C!-�.� with Section 7000) ol Divislon 3 ot t�e Buslness end Prolessions de, e y Iic e is In full Class p _ Date: � CONSTAUCTION LENDING AGENCV: ❑ 1 hereby affirtn lhat there is e wnstruMion lending agency for ihe perfortnance of Ihe work tor which this pertnit is issued. (Sec. 3097. Civil Coda). Lendefs Name: Lendels Address: Signature: Date: OWNER•BUILDER DECLARATONS: I hereby aHirtn that under penelry ot per�ury thet I em EXEMPT FROM 7ME CONTRACTORS LICENSE LAw tor �he lollowing reeson (Sec. 7031.5, Business and Prafesslons Code: My Gry or counry which reQuires e Oermit lo consirucl, alter, improve, demolish, or repalr eny siructure, pdor to its issuance, elso requires the epplicant lor suc� pormit to flle a signeC statement ihet he or she is Ilcensad pureuant to ihe provisions at the Conirectors Llcense Lew (C�aD�er 9(commenGng with Sectlon 7000) af �INsian 3 ai the Buslness end Prolessions Catle) or thet he or ehe is exempt �herefram end the besis for t�e allepeO exemption. Any violetion oi Section 7031.5 by eny epplicent for e pertri' sub�ects Ihe epDlicent to e Gvil penalry of not mora then tive hundretl Collers ($500).): ❑ I, es owner o� the properry, or my employees wlth weges es thair sole compensetion, WILL DO TXE WORK, end the slrucWre Is not intendetl or oflereC far sele (Sec. 7044, Business and Professions Cotle: The Contrectors Llcense Law tloes not epply to an owner oi property who builds or improves theraon, end who does such work himself or hersetl or through hls�oaher.own employees, pravided thet such Improvements ere not Imended or ottered lar sele. II, however, the builtllnp or improvement Is soltl within one year ol completlon!Ihe �ner-builder will heve Ihe burden of proving that he or she ditl not build ar improve tor purposa ol seleJ. ❑ I, as owner of Ihe property, em EXCWSIVELY CON7RACTING WIT}1 LICENSED CONTAAC70RS to construd Ihe projed (Sec. 7044, Business entl Professions Code: Tiie contractors Llcense Lew tloes no(epply lo en owner ol property who bullds or Improves thereon, end who cantrecis tor such pra�ect with e contrector(s) licensa pursuant to the Contreclors License�Lews:). j:� ;�., ❑ I em asempl under sea �-� ��Business and Protesstons Code lor t�is reason: SlgnaNre: �� Date: Owner ID verified by drWers licensa. ❑ Ves ❑ No . Drivefs LJcense No. Vedflcatlan ol Ownershlp by (rype ot Aocument, i.e. - propeny tez blll or daed): DIVISION OF INDUS7RIAL SAFETY PERMR CER7IFICA710N: Expires: ❑ I hereby certiry that no excavetion five (5) or more feel In depth into which e person is requlred to deuenq wlll be made in wnnection with work eut�adzetl by this pertnit, entl ihat no bullding siruclure, scattolding, felsework, or demolition or tlismanlling thereol, wlll be mora ihan Ihirry-sl: (36) feet high. (C�ep. 3.2, Orp 2, Art 2, Sec. 341, Title 8, Celifomia Atlminisiretive Code). ❑ As ov.ner-builder, I will not employ enyone to do work which would require e pertnll Irom the DMslon ol Industrlel Setery, es noted ebove, unless such person has e pertnit to do such work trom the divislon. SlgnaNre: Date: D'Msion of Industrie� Safety Pertnit NumDer: CEHTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF EMRY: I cenify under penelry ot perjury thet I heve ree0 Ihis applicetion and state thet �he Iniormetlon given Is correct. I egree to comply wlth ell 9tate lews end City ordlnences releting ro bulltling constructlon, entl euthodze representalives of the Ciry ol Caste Mesa to emer upon Ihe ebove-described properry for inspection Durposes. I egree not to occupy or ellow occupancy of eny buildinp euthorizotl by t�is permil until finel inspection. COpE I, MSPECTIONT'PE Qdjf, Q�, 1676 Fixetl System Final Fire Prevenllon 1288 Pool Spa Final ��.� 201 202 203 Final Fe-Root Flnal BIocWRetaining Wall Final Factory Fire Place Final Sign 204 Final Demaiition �� (� (� � � Date COOE I INSPECTION ME 208 Finel Mechanical 20B Finel Plumbing 210 Final Electdcal 212 Flnal Flre PrevenUon 220 Final Planning Approval 222 Final Slte 250 FinalBuilding�Occupanty PAg ItI�ELS (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 560 W 19TH ST Suite No B Vicinity: Parcel Number: 42210320 npp�icane HOOPER, DAVID Address: 7314 PEBBLE�SPRING LN � , GLENDORA,CA�, - i , � owner JEFFREY A. FISCHER ,� Address: 17337 VEMTURA BLVD #205 - ENCINO,CA,� Contractor. SIWI. , Address: 1314 PEBBLE SPRINGS LANE GLENDORA,CA MECHANICAL PERMIT Phone: 626963-7643 Zip: 91740 � ' Phone: (878) 501-0145 Zip: 91376 Phone: 626-963-7643 Zip:, 97741-2350 License: 513099 Status: ISSUED Applied: 11/06/2001 Issued: 11/O6/2001 ISSUED BY: � , . �'\ �� . , �� _ .� � : �. �� b � _ , �. .�.�. _ .. - -. . . . � . SCOPE OF PERMIT REF: B01-00929. TENANT IMPROVEMENT FOR DRY CLEANERS. "ELEGANT CLEANERS". MECHANICAL TO INCLUDE: 1 GAS BIPING SYSTEM, 1�COMPRESSOR�UP TO 3HPI700 K BTU, 1 BOILER 3 TO 15"HP: � � _ , �, � ISSUE FEE Inst FAU <700 k BTU Inst FAU >100 k BTU Repair I Alt Cooling/Heat Inst / Rep. Recess Wall Htr Retrig Sys <100 k BTU Refrig Sys >700 k BTU Gas Piping Factory Fireplace , Hootl w/Mech�Ezhaust VAV Box �� : � Vent Fan / Single Duct Appliance , ' Fire Dampers � Smoke Dampers - Insl or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> t0000cfm Floor Furnace Floor or Suspend Heater Quantity 523.50 $0.00 0 30.00 0 50.00 0 $0.00 0 so.00 0 50.00 0 56.15 1 50.00 0 .50.00_.. 0 ,-'�- : $0.00 0 -$0.00 .. 0 ' $0.00� � �0 - ' so.ao 0 50.00 0 $0.00 0 $0.00 -0 $0.00 0 so.00 0 50.00 0- FEE SUMMARY ,. . Repair / Alt Absorbtion Unit ' Repair.l Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercia l Incine rator Domestic Incinerator . � Compressors I Absorption Systems „ ' Upto3,hp/100kBTU 3 To 15 hp'/ 500 k BTU %;� ;' �. " 15 To 30 hp7,1,000 kBTU -=� ,; , 30 To 50 hp / 7,750 k BTU , � " Over 50 hp / Over 1,750 BTU � - � Boilers - � , , Up to 3 hp 3To15hp 15to30hp 30 to 50 hp. Over 50 hp Other Mechanical Fee � Investigation Fee Plan Check Fee � . � " Reinspection Fee �Quantiry 50.00 0 50.00 0 � 50.00 0 50.00 0 50.00 0 50.00 0 $14.70 , 1 � $0.00 � 0 .�' $0.00 �0 $0.00 , 0 $0.00� 0 /'; , 50.00 0 527.15 7 $0.00 0 50.00 0 50.00 0 so.00 80.00 80.00 TOTAL CALCULATED FEES E71.50 COMMENTS 1 SPECIAL CONDITIONS NOTICE: Tha work authorized by this permit shall comply with all applicable handicap access raquirements untler Californla statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically ezpire and become vold if work is not commenced withln 780 days, or if work is suspended or abandoned tor a period ol 180 days. INSPECTIONS: In order for the work euthorized under this permit to be co�sidered legal, such work must comply with all epplicsbla codes, and eil required Inspeetlona end flnal epprovel must be obtained. Failure to obtain Inspections and final approval will result in the expiration of thls permit. FOR INSPECTIONS CALL: (714) 75y5826 zaae-ee laroo) WORKERS' COMPENSATON DECLAFiATION: I hereby effirm under penalry of perjury one of the following declarations: ❑ I heve end will maintein e Cenifiwte of consenf to seit-Insure for workers' compensetlon, es proNded lor Oy sectlon 3700 oi ihe Lebor Cade, for the pertormance o1 ihe work tor which Ihi9 permit 19 issued. 1 heve and wlll meintaln orkers' compai ' n insuranw, s required by section 3700 at t�e labor Cade, to� the pertortnence of NeQwork for whkh this p�qnill.s lssuetl. My workera' com tl n I carAe pdky ber are: I �j ,�t�/(� /� Cartier. PolltyNumber: ��__ L�j I �.J (Thls sectlan need nof be complefed!! (he perm/t!s velued ef one hundred dollars (5100) ar less.) ❑ I certity Ihet In Ihe peAormanc of the work lor which chis Dormit Is issued, I shflll not employ any person in eny manner so as to become subject to the workera' compensetian tewa IIPomI nd r t�at If I shoultl Decome sub)ect to the workers' compensetlon pmvisions of Section 3700 of the Lebor Ca0 , I shall toMwith comply with these pr Isl ns. I�//� % O � Applicant Signature: Date: ll� WMNINO:FAILVNETOSECUREWORKERS'COMFENSATIONC EMOESUNLAWFULMlDSHALLSU6IEGTANEMPIOVERTOCRIMIWILPENALTIESANDGVILFlNESUPTOONEHUNDRED Tl10USAND DOLLARE (5100,000�. IN ADDRION TO THE CQs^T OF PENSAT70N, OPANGES AS PimNDED f-0R IN SECTION 3IW OP THE IABOR OODE, INTEREST, AND ATTORNEYS FEES. LICENSED COMRACTORS DE I hereby effum thet 1 em licensed torce end efleci. Llc. q Conireclofs Signeture: _ (QOF�lmencing wilh Section 7000) 01 Division 3 of the Business � Class q It ILl n Daie: _ CONS7RUCTION LENDING AGENCY: ' ❑ I hereby aflirtn t�et ihere is a consiruction lentling egenry tor the pedortnance of the woAc fw whic� ihis pertnii is issued. (Sec. 3097, Civil Catla). Lender's Neme: Lenders Adtlress: SignaWre: Oate: Is In full OWNEH-BUILDER DECLARATIONS: I hereby eNirm thet untler penelry ol per�ury Nat I flm El(EMPT FROM THE CONTRACTORS LICENSE LAw tor the following reawn (Sec. 7037.5, Business entl Professions Cotle: My ciry or counry which requires a permil to consiruct, altor, improve, demolish, or repair any structure, prior to its issuance, elso requires the eDDlicant tor such pertnit to Ole e slgned stetemem t�at he or s�e Is Iicensed pursuent to the pmvisbns af the Contrectoro License Lew (Chepter 9(commenGng wlch Sectlon 7000) ai Division 3 of ine Business enO Protessions Cotle) or Ihet ha or sho is exempt ihereiram end the basis lor Iho alleged ezemption. Any Wolation oi Sectlon 7031.5 by eny eppllcant for e pertr+' sub�ects the flpp�icent to e clvil penfllry ot not more lhan fNe hundred Collare (8500).): ❑ I, es owner ot t�e prapeiry, or my empiqrees wlth weges as t�eir sole campenuilon, WILL DO TME WORK, end the structure is not Intended or ottered lor sale (Sec. 7044, Business end Professlons Cotle: The Contractors LJcense Law does not epply to an owner oi property who builds or improves thereon, and who daes such work himselt or hersetl ar Ihmugh his or her own emplqrees, pmvitletl Ihat suc� improvements ere not IntendeO or oHereC br sale. If, however, Ihe building or improvement is solC wl�hin one year ol completlon, t�e ownei-bulltler wlll heve Ihe burden of proving Ihat he or she tlid not builA or improve for purpose ot sale.). ❑ I, as avner oi the proparty, em EXCLUSIVELY CON7RACTING WI7H LIGENSED CONTHAC70RS to construct the project (Sec. 7044, Business end Professions Gotle: The contrectors lJcense Lew does not.eppy to an owner ol property who bulltls or improves thereon, ana who contracts tor such project with e contractor(s) license pursuenl to the Contractors License Caws.). ❑ I em exempt under sec. Business end Prolessions Code tor this reason: Signeture: Daie: Owner ID verilled by drivers Ilcense. ❑ Yes ❑ No DrNers Licanse No. Expires: VeAficetlon ol Ownership by (type of CocumenL i.e. - property ten bill or deedJ: DIVISION OF INDUSTRIAL SAFE7Y PERMR GERTIFICA710N: ❑ I hereby ceNy that no excavetlon Me (5) or more leet In tlepth into which a person is requlred to descend, will be metle in connection with work euthorized by �his permit, entl tha� no building structure, sceMoldinp, falsework, or tlemUltion or dismzntling Uereol, will be mora than thirty-sia (38) tee� high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Tlile 8, Celitomia Atlministrative Code). ❑ As ov.ner-builder, I will not employ enyone to do work w�lch would require e permit from ihe Division of Indusirial Sefery, es noteA ebove, unless such person hes a permit to do such work trom the division. Signature: Date: Dhrision o1 Industrial Sefery Portnit Number. CERfIFlCATE OF COMPLIANCE /WD AUiHORPA710N OF ENTRY: I certity under penalry of perjury that I hava read t�is epplicatlon enG slate ihat t�e intortnation given is canect. I egree to compty wlth ell stete laws entl dry orClnances releting to Eulhinp constNctlon, an0 aut�orize re0�esenWtNes of the Clry af Costa Mese to enter upon the ebovadescribed property far inspectlon purposes. I egree not to occupy or ellow occupanry of any building euthorizetl by this permit uNil linel Inspection. COOE 1. INSPELTION TYPE 1616 Fixed SyStem Final Flra Prevention 12fi8 Pad Spa Finel 200 Flnel Ro-Rool 201 Flnel BIOCWRe�elning Wall 202 Flnal Fectory Fire Place 20.3 Final Sign 204 Final Demolition I�-� °r OI Date QS¢, ��$ �QQ[a INSPECTIONttPE 206 Finel Mechanical 20B Finel Plumbing 210 Flnal Electrical 212 Final Flre PrevenUon 220 Finel Planning Approval 222 Finel Site 250 Final BuiltlinryOccupflnq QeiE R� (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 1ob nddress: 560 W 19TH ST Suite No B Vicinity: Parcel Nunmber: 42210320 npp�icant: HOOPER, DAVID "�=� Address: 1314 PEBBLE SPRING-LN GCENDORA,CA � Owner: �� JEFFREY A. FISCHER Address 17337 VENTURA BLVD #205 ENCINO,-CA Coniractor. SIWI Address: 7374 PEBBLE SPRINGS LANE Arch / Eng : Address: PLUMBING PERMIT Phone: 626-963-7643 � Zip: 97740 � , Phone: (818) 501-0145 2ip: 91316 ' - Phone: 626-963-7643 GLENDORA, CA Zip: 97741-2350 License: 513099 Status: ISSUED Applied: 71/06/2007 Issued: 11/06/2001 ISSUED BY: ' � � � Phone: � , - - � � " � . � Zip: , � � � . � , � , , License: � � j! - - � � � .� SCOPE OF PERMIT REF: B01-00929. TENANT IMPROVEMENT FOR DRY CLEANERS. "ELEGANT CLEANERS". PLUMBING TO INCLUDE 1 FLOOR SINK AND MISC. WATER PIPING. . ISSUE FEE Backflow irrigation � Backflow Preventer Bathiub Clarifier System Connect Qce,Soda,etc) Dental Uni[s Dishwa5her Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Ezpansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oiq Interceptors (Sand Auto ) AMT $23,50 $0.00 $0.00 $0.00 $0.00 $D.00 $0.00 $0.00 $9.80 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 Qn 0 � 0 0 0 0 0 0 1 0. 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY � - AMT�, '�QTY : - -= Laundry Tub I Washer .$0.00 0 Landscape Irrigation $0.00 0 - P-Trap ' � $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 � SepticTank 50.00 0 SewerCapforDemo 50.00 0 Sewer Connect 50.00 0 Sewer Private Line � $0.00 0 - Shower $0.00 0 - � Sink, bar $0.00 0 � Sink, commercial $0.00 0 Sink, Floor $0.00 0 Sink, kitchen $0.00 0 Sink, service/mop $0.00 0 Spa (private) $0.00 0 Spa (public) $0.00 0 �. %�� Sump Pump , , Swimmirig Pool Trap Primer, , � Urinal Vacuum Brkr BkFlow(1-4) Vawum Brkr BkFlow(5+) Wash Basin , � Wash Basin Set -Waste and Vent System Water Closet (ToileQ Water Heater / vent Waler Piping (Inst or Rep.) WaterRe-pipe Water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 50.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES: E43.70 QTY 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply wlth all applicable handicap access requirements under California statutes and related regulatlons. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or it work is suspended or abandoned lor a period of 180 days. INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with eil appllcable codes, and all required Inapeetlons and Iinel epproval must be obtained. Failure to oblain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545828 2a1&dBle�W) WORKERS'COMPENSAnON DECLARATON: � I hereby elfirm under penalry ot perjury one ot Ne tWOwinq deUaretions: . I �av entl wi0 malnisin e Certificete of consent ro setl-Insure tor warkers' compensetlon, es provlCetl tar by sectlon 3700 0l the Lebor Catle, tor Ihe peAartnence of the lar whlch this pertnit is issued. I have erW vrill ai tain wwkers' com ensatlrn insu ce, es required by seciion 3700 of Ne lebor Cotle, fw tha pertortnence ol the wwk fw whidi Nls pertnli Ls Iswed. M workers satio nsu c wrtier e�M� number era: G�ry '/� Cartier.Y C��Q ,�NYI � PolicyNumEer n�Z'S � V (This sectlon need not be completed i! Me pemdt is vaN one hundred dd�ers (S �a0) or less.) ❑ I cenify that in ihe partortnflnce of the wark for which tliis permil Is issuetl, I shall not employ eny person In airy manner so es to become suD�ect ta tha workers' compensatbn laws of Celifomi��@@@ nd egr e t at It I shoultl Eewme suD�ect ta the workers' wmpensatlon provLslons of Sectlon 3700 ot Ih LeDor Cotle, I ah I fonhwith comply wIN Nese Prw�M(�s. � � � I-_ 1_.- O ApPllcentSipneWre: 1 ��i oa�a: l// WARNINO: FAILURE TO SEIX1R ORKERS' COMPENSATION COVERA IS UNUW R1L AND SW1LL SU6IECT AN EMPLOVER TO CRIMINAL PENALTIES NlD CML FNES UP TOIXJE HUNDRED TIqU$IWD OOLIARE (51 W.000),IN FDDITIIXJ TO THE �670F NMPENSATION, DMNGES AS PROVIDED FOR IN SECf10N 31080F TXE UBOF COOE, IMEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby eHirm that I am licensed under torce antl etteci. Uc. # Gontractafs Signature: Section 7000) of DlNsion 3 of the Bu51n Pmfessi �-, e�Qr�/ Iicense is in full C7ass M � T Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby eMirm that Ihere is a Construction lending egency tor the pedormanCe ot the work for whic0 this permit is issued. (Sec. 3097, Civll Code). Lentlefs Name: LenCer's ACAress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHlrm that untler penalry ol perJury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ne following reason (Sec. 7031.5, Buslness entl Professions Code: Any ciry or counry w�ic� requires a pertnit to wnstruct, elter, improva, tlemolish, or repair eny atructure, D�w to Its Issuance, elso roqulrea Ihe appllwnt tor such pertnit ro file e signed stetement t�a� he or she Is Ilcense0 Dursuent to the provlsbns oi Ihe Contractors License Lew (Chepter 9(commenGng wlth Secllon 7000) W Dlvlslon 3 of ine Business en0 Pratessions Code) or ihet �e or she b ezempt t�erefrom and tha 6asis lor the ellege0 exemption. My Nalation a� Section 7031.5 by eny epplicant ior e pertr+' subjects tha epplicent to e cMl penelry of not more than Me hunOred Collars ($500) J: ❑ I, es owner ot the property, or my employaes with weges es their sole compensailon, WILL DO THE WORK, en0 Ue siructure Is no� Intended or oHered lor sele (Sec. 7044, Business and Professions Code: The Contradors License Lew does not apP�Y �a en owner ol properry who Eullds or Improves Uereon, end who does such work himsetl or herselt or through his or har own employees, pravided thet such Imprwements ere not Intended or atlered for sale. If, however, ihe bullding or Improvement Is sold within one year of completion, the owner-builder will have the burden of proving ihnt he or she tlid not 6uild or impmve lor purpose of sale.). ❑ I, es owner ot the propeM. am E%CLUSIVELY CONTRACTING WITH LICENSED CON7RACTORS to construct the pro�ect (Sec. 7044, Buslness and Prolessions Cotle: The cont2ctors License lew tloes not epply to en owner ol property w�a builtls or Improves thereon, en0 who contrects lor such project wlth e contrector(s) license pursuant to �ha Contrectors License Lews.). ❑ lem Slgnelure: BuSiness en0 Protesslons Code for Ihls reason: Dete: Owner ID vedfletl by drivefs Iicense: ��'O;)'es ❑ No Ddver's LJcensa No. Expires: Vedfication of Ownerehip �y (type of document, i.e. - properry tex blll or deed): DIVISION OF INUUSTRIAL SAFETY PERMR CER7IFICATION: ❑ I hereby cartity ihat no excevetlon five (5) or more leet in depth Into whlch e person Is requlretl to Oescend, wlll be mede In connection with work euthorized Dy this pertnit, end ihat no building structure, scailoltlinp, lalsework, or demolitlon or tllsmentling thereof, wlll Ge more Ihen ihirty�slx (36) teet high. (C�ep. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Califomia Adminisiretive Cotle). ❑ As ownervbuiltler, I will nat employ enyone to Co work which would requlre e pertnit from Ihe DlNslon ol InGustdel Setoty, as notetl above, unless such person hes e permil to do such work trom Ihe divislon. SignaNre: Date: Division ot Industrial Safery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORQA710N OF EMRY: 1 certify under penalry of perjury ihai I have reatl Ihi9 epplication and state thet ihe infartnatlon given is cortect. I egrae to compty vAth all state laws antl ciry ortlinances releting to building consiructlon, and authodze representaiives ol the Clry of Costa Mesa to enter upon the ebove-deuribetl property for inspection purposes. I agrea not to accupy ar ellow occupenty of eny builtling authorized by this pertnit until tinal irepection. cooe �. ixsvecnoxrne ' p�g �� 1616 Fixed System Final Fire Preventlon 1266 200 201 202 203 Pool Spe Final Final Re-Roof Flnal BIocWRetelning Well Final Fectory Fire Place Finel Sign 204 Final Demolllion COOE 1 INSPECiION TYVE 208 Finel Mec�anical 20B Finel PlumDinp 210 Final ElectricEl 212 Flnal Fire Preventlon 220 Flnal Planninp AOProvel 222 Final Site 250 Finel Bulltling/Occupancy QA1E II�64 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT JobAddress: 560 W 19TH ST Suite: A Vicinity: POPULAR CASH EXPRESS (STE A) Parcel Number: 42210320 npp�icant: GIL, HUGO Address: Owner: GARVIN DRIVE LP Address 16485 GARVIN DRIVE ENCINO, CA Contractor: H A GIL CONST CO 8 DESIGN Address: P O BOX 676 VAN NUYS, CA Zip: 91408 Arch : Address: Zoning: PhOne: 818-785-1842 Zip: Phone: Zip: 91436-3636 Phone: 818-785-1842 License: 567186' Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: 04/052007 Issued: 07/O5/2001 Phone: Zip: License: License: SCOPE OF PERMIT 2500 INTERIOR STORE TI FOR "POPULAR CASH EXPRESS" IN STE A. � � � REF:B00•00846(SHELL BLDG) . . � Plan Check: $181.51 Permit: $27925 SMIP Res: $0.00 SMIP Com: $3.57 Other: . $0.00 Inspection: $0.00 _ _ __ __ FEE SUMMARY; ;�� Total: $464.33,.. � � .� � "� ; i " �:A� � . SETBACKS ' - �' �' � , MAIN STRUCTURE Front�. 0- 0' �- , Rear 0- 0 ACCESSORY Front 0-�0;�� " � Rear PARKING Existin : 0�� ' R�equired: NOTES: Calc Valuation: sn;000.00 Claim Valuation: . - Sn,000.00 ,. .- , , , ; . � �,;, � � � / ; /: 'LANNING'& ZONING_�'%' �';\` %, l�/ , / ,� Lek 0-0 Right �� 0-0 -�, _ A `.�. "� /", ' 0- 0 ��Left ' 0- 0� ��'��t ��/ Right �; 0�0 �" �0 , • Pt� D , .'�_,.o " /: �� ' �, � ;;< _ - NOTICE: The work authorized by this permit shall comply with all apP��cable handicap access requirements under California statutes and relatetl regulations. (Ord. No. 9248, § 1, 7247-92) EXPIRATION: This permlt 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 tor the work aulhorized untler this permit to be considered legal, such work must comply with all applicable codes, end all requlred Inapeclions end final epprovel must be obtained. Fallure to obtain inspections and final approval will result in the explratlon of this permit. FOR INSPECTIONS CALL: (714) 7545626 � z��.e��, � WORKERS'COMPENSAnON DECLARAnON: ' . 1 hereby ettirm untler penelry ot perjury one of ihe tWlowing declaretions: ❑ I have end wlll mainteln e certlflceie ot tonsent to sell-Insure for workers' compen58Uon, es provided iw �y section 3700 of the Lebor Code, br lhe peAartnence of Ihe work for which Nis pertnit Is issuetl. -� I liave and wa maintein wwkers' wmpensatlon InSurance. es required by secUm 3700 ot Ihe labor ('.ode. tw Ihe pertormance of the work ta which this pertnit Is issued. My workers' m nsation Insurence carrler erW pdiry number ere: Gartier. S � � �N� Polic/ NumDer: ��8�� (Tbis sectim need nof be canplet ll Ihe perrNt is veluetl e! one hunOretl tldlars ($700) or less.) ❑ I ceNiy Ihat in Ihe peAortnance oi ihe work fof wMch thls pertnit is Issued, I shail not employ any person in eny menner so as to become subject ta Ihe workera' compensetlon lews of Cell�nd epree t t It I aho I bewme suD�ect to the workers' campensatlan provisions oi Section 3700 of Ihe LeDor Code. I shall fathwlth comply with thesa provi ' s. ` /n� Applicant Signemre: Date: �� ( , WARNINO: FAILURE TO SE ORK S' COMPENSATI COVERAQE IS UNUWFUL IND SNALL SU9IECT PN EMPLOYER TO CRIMI�ENALTIES AND CML FlNES UP TO ONE HUNDRED TYqUSM1D OOLLARE (S10D,OOOI• IN ADDRION TO THE W5T OF 001+iFENSr1TION, DAIMGES AS PRONDED FOR IN SECf10N 3)OB OF TNE UBOR CODE, IMEREST, ANO ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby aHirm thal I am Iicensed under provisions torce anE eNecc Lic. a Contractor's Signeture:� CONSTRUC710N LENDING (commencing vnih SecUon 7000) ot Division 3 of iha Business and Protessions Code, end my license is in full Clau a oa�a: 7 S b / _ _ ❑ I hore6y aXirtn that there Is e consiructlon lending egency for iha peAormance ol Ihe work br which this pertnil is issued. (Sec. 3097, Civil Code). Lendels Name: .—__ Lenders Adtlress: Signeture: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirtn thet untler penelry of per�ury that I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for tlie lollowing reesan (Sec. 7031.5, Business entl Professlons Cotla: Any ciry or county which requires e permit to conswct, elter, Impmve, demolish, or repair eny swcture, pdar ro Its issuenca, elso requires the eOD�icant for such permlt to tile e signed stetement Net he or ahe is IlcenSeA pursuent to Ihe provlsions of tlie Contrectors License Lew (Chepter 9(commenGng with Sectlon 7000) al DlNsion 3 01 the Businoss enA Professions Code) or ihet he ar she Ls exempl theretrom end the 6asis lor ihe elleged exemptlon. Any violatlan ol Sectlon 7031.5 by any epplicent for e permit suE�ects Ihe epplicant to e civll penelry of not more Ihan fNe hundred dollers (5500).): ❑ I, es owner of Ne properry, or my employees wilh wagos as their sole compensa6on, WILL DO THE WORK, entl the s�ructure Is not intended or oMeretl for sale (Sec. 7044, Busine55 and Professlons Cotle: The ContraMors Licensa Law does not eppty to an owner ot property who builds or Improves Ihereon, and who tloes such work himself or herselt or through hIs or her own employees, provitletl t�at such Improvements ere not intended or oMered lar sela. II, however, t�e bullCing or Improvement is sold within one year of completlon, ihe axner-builder will have iha burtlen ot proving Nat he or she did noi build or improva for purposa ot sale.). ❑ f, as owner of Ihe property, em E%CLUSIVELV CONTRACTNG WrtH LICENSED CONTRACTORS to wnstruct Ihe pro�ect (Sec. 7044, Business end Protes5ions Cotle: The contrectors Ucense Lew does not appty lo an owner oi properry who builds or Improves Ihereon, end wha contrects lor such pro�ect wlth e contractor(s) license pursuent to t�e Contrectore License Lews.). ❑ I em exempt under sec. Business entl Protessions Code for Ihis reason: Slgnature: Date: Owner ID veritied Oy tlriver's license. ❑ YB9 ❑ No Drivets License No. VeAfication ot Ownership by (type of document, i.e. - property tea blll or dee0): Expires: DIVISION OF INDUSTAIAL SAFETV PERMR CERTIFlCATION: ❑ I hereby certity thet no eacavation five (5) or more leet in depth into which e person is required to descend, will be made in connection with work euthorized by Ihis parmit, end thet no building siructura, acattolding, lalsework, or demalition or dismantling ihereot, wiil ba mora than thirty-six (36) leet higR (Chep. 32, Gry 2, Atl 2, Sec. 341, lltle B, Celilomle Administrative Cotle). ❑ As owner•Duiltler, I wlll not employ enyone to do work which would require e permit trom Ihe Division ot Industrial Selety, es notetl ebovo, unless such person has e permit to tlo such work trom the division. SlgnaNre: Date: Divislon oi InOustrial Sefery Pertnit Number: CERTFICATE OF COMPLIANCE AND AUTHORRATION OF ENTRY: I certity under penalty ol perjury Ihat I have reatl Ihis epplication and stata that the infortnation given is cortact. I agree to comply with ell state lews and ciry ordinances relating to builtling construction, and authorize representetives of ihe Ciry ol Costa Mesa to enter upon the above-descnbed D�operry for inspection purposes. I agree not to occupy or ellow occupancy of eny builtling authorizetl by ihis permit until final inspection. cooe ", wsvecnoxnve Q� INTRIAL; 7616 Pixed System Finel Fire Preventian 126fi 200 201 202 203 Pool Spe Final Final Re-Raol Finel BIocWRetelning Well Final Fedory Fire Placo Final Sign 204 Flnel Demolition CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbinq 210 Final Eleciricel 212 Finel Fire Prevention 220 Final Plenning Approval 222 Finel Site 250 Final Building/Occupency �E �� ia� �sa-sz�a • Fax ��ia� �sa-aass :ry CITY OF COSTA MESA � BI/ILDING DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 560 W 19TH ST Suile: viciniry: Parcel Nunmber: 42210320 npplicant: BOB MITCHELL Address: SIGN PERMIT Zoning: Phone: 310-523-9500 Zip: Owner. GARVIN DRIVE LP � Address;.:16485GARVIN-DRIVE . , � , ENCINO. CA ; _ . Coniiactor: AD ART/ELECTRONIC SIGN CC � Address:� 19603 FIGUEROA ST " , � CARSON, CA Arch / Eng : Address: � F= A \\ E . � . Phone: Zip: 914363636 Phone: 213 523-9500 Zip: 90745 � � License: 711214 Phone: Zip: License: NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 0 611 411 9 9 9 Issued: 06I14/1999 ISSUED BY: � _ , a ` ' �� , SCOPE OF PERMIT � � � INSTALL A 25' HIGH, 77 SQ.FT. FREE STANDING ILLUMINATED SIGN AT THE FRONT OF A SITE. , , . � . FUTURE TENANT SPACE LIMITED TO 36 SQ.Ff. "LUCY'S LAUNDRYMART'. ' � � FEE SUMMARY � , , Plan Check; $64.84 Calc Valuation: s5,000.00 $0.00 �; Permit; $99.75 Claimed Valuation: ss,000.00 �- 1 �SMIPCom; � $1.05 � ' %,'j Other, $0.00 , ,' $0.00 Inspection; $0.00 $0.00 � $0.00 ' , Total; $165.64 PLANNING & ZONING NOTES: so+� �� . c7" Q �� r `�\� j� t�5 t�°%`� t� 9 �p NOTICE: The work euthorized by this pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 1. 12-27-92) E7(PIRATION: This pertnit shall eutometically expire end become void it work is not commenced within 180 days, or if work is suspended or abandoned for e period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicabie codes, and all reQulred inapectlohe and finel approval must be obtained. Feilure to obtain inspections and final approvel will result in the expiretion of this permit. FOR INSPECTION$ CALL: (714) 754-5626 WORKERS'COMPENSAnON DECLARATON: � � � 1 hereby efllrm untler penelry of per�ury one ot the Idlowing tleclarations: � � ❑ I have and wlll malntein e certilicate oi consent to self-Insure tor workere' compensation, az provitleA tor by sedlon 3700 af the Lebor Code, for t�e peAortnence of ihe rk for which this pertnit Is issued. I have entl wlll maintain workers' compensetion Insurence, as requlretl by sectbn 3700 0l Ne Lebor Code, for Ihe perfortnance ot Ihe work tw which Ws permlt is Iswed. My workers' wmpe�n Insurence carrier and poli n er ere: � `� n /^ � c Carrler. '��f�'�� - Policy Number: �� D � _( SLC/ 3' (This section need nat be complefed i! the peimlf s velued ef ane huntlretl dollers ($f 00) or /essJ ❑ I certlly that in Ihe peAortnence ot Ihe work for whic� this permit is Issued, I shell noi employ any person in any menner so as to become suDject to Ihe workers' compensetian laws of Celifomia � e et ii I shou e subject to Ihe workers' compensatian provislons ol Sectlon 3700 of the Wbor Cotle, I shall� loRhwith comply wlih these provi�ia� /! _�/ / f� Appliwnt Signewre: ` Dete: CSL — G�-i" � WARNINO: FAILURE TO SECURE WORKERS' OOfdPEN$ATION COVEMOE IS UMAW FUL AND S/1ALL SU6IECT AN EMPLOYER TO CRIMINAL PENALTIES AN CML FlNES UP TO ONE HUNDRED THOUSAND DOILAHE (5100,W0� IN ADDRION TO THE OOST OF COMPENSATION, DAMA�ES 0.5 PilO��DED FOR W SECiION 37W OF TNE IABOR CDDE, INTEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm thet I am licensed unde� visions of torce entl aMect. Lic. a Contrectors SlgneWre: with Sectlan 7000) of Division 3 01 the E _ Class k Date: CONSTRUC710N LENDING AGENCV: ❑ 1 hereby ettirtn �hat Ihere is a canstruction lending egency far the peAortnance ot the work lor which Ihis pertnit is Issuetl. (Sec. 3097, Civil Cotle). Lentlefs Neme: lentleYs Adtlress: Signature: Date: OWNER•BUILDER DECLAHATIONS: my Ilcense Is In full I hereby eHirm ihat under penalry Ot per�ury that 1 em EXEMPT FROM THE CONTRACTORS LICENSE LnW tor Ihe tollowing reeson (Sec. 7031.5, Business anC Prolessions CodB: Any Ciry of counry which require5 e permit t0 conSWCI, alter, impmve, Aemoli5�, af repeif eny SlNdure, pnor Io it5 155uente, el5o requires the appiiwnt tor 5uch pertnil to flle a slgned statement that �e or she is Iicensetl pursuent to the provisions o1 t�e Contredors Llcense Lew (Chepter B(commanGng wIN Section 7000) oi Division 3 of �he Business and Protessions Cade) or �het ha or she Is exempt therefrom an0 Ihe besis lor Ihe eilegetl exemption. Any vlaletion of Sectlon 7031.5 by eny epplicent for e permlt sublects the epplicent to e civll penalty ot not more than flve huntlred Aollers (5500).): ❑ I, as owner ot the pmperty, or my employees wit� wages es thelr sole compansatlon, WILL DO THE WORK, end the strucWre Is not intentletl or offeretl tor sele (Sec. 7044, Business end Professions Code: The Conlrectora License Lew Coes no� eppty to an owner of property w�o bulltls or improves therean, antl who does such work himself ar herseli or Ihrough his or har own employees, provitled ihat such Improvemenis ere not Intentletl or oHered for sele. It, however, the building or improvement is sold wlthin one year ot completion, the owner-builtler will have Ihe burtlen of proving Ihel he or she did not 6ulld or Improva for purpose of sele.). ❑ I, es awner of the pmperry, em E%CLUSIVELY CONTRACTING WITH LICENSED COMRAC70RS to consWct Ihe prolect (Sec. 7044, Buslness and Pmlesslons Cade: The coNrectors License Lew tloes not epply to an owner of property who huilds or improves thereon, entl who wNwcts Por such project with e contractor(s) license pursuant to the Contredors llcense Lews.). ❑ I am evempi unAer sec. Business entl Proteuions Codo br this reason: Signature: Date: Owner ID verified by drivers licensa. ❑ Ves ❑ No Driver's LJcense No. Veriticetion of Ownership by (type oi tlocument, i.e. • property tax bill or deed): Ezplres: DIVISION OF INOUSTRIAL SAFETY VERMR CERTIFICATON: . ❑ I hereDy certiry t�et no excevation five (5) or more feet in depth into which e pereon is reqNred to descentl, will Ge meEe in connection with work euthodzed by this permit, and Ihat no building siruCture, 5catlolding, felsework, or demolitlon or di9mentllnp Ihereof, will be more then ihlrty-six (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, Celifomia Adminlstretiva Code). ❑ As owner-builtler, I will not employ enyone to Oo wark which would require e pertnit Irom the Division ol Industriel Safety, es noted ebove, unless such person has a permit to tlo such work from t�e tlivision. Sipnaturo: Dete; DlNslon of Indusirial Safety Pertnit Number: CERIIFlCATE OF COMPLIANCE AND AUTHOROATION OF ENTRV: I ceRify untler penelry of perjury that I hava read Ihis appliwtion and state that the infortnation given is correct. I agree to compty with all steta laws antl ciry orCinances rela�ing to bullding cansiruction, antl aut�odze representetives oi Ihe Ciry of Costa Mesa to emer upon the ebove-descdDetl property for inspection purposes. I egree not to occupy or ellow occupancy ol any building authorized by ihis pertnit until final inspectlon. SlgnaNre Of I Owner(s) Date � , �� -�`�� AnNOrAuthodzetlApplicant Date COOE �. INSVELTION TYGE 1618 Flxetl System Finel Fire PrevenUon 1266 Pool Spa Final 200 Final Re-Raoi 201 Final BIocWReteining Well i 202 203 204 2N8-68 Final Fectory Fire Place Finel Sign Flnel Demolition PAIE IIII�64 COOE� INSVECTIONTYPE 208 Final Mechanical 208 Flnel Plumbing 210 Final ElecUical 212 Final Fire Preventlon 220 Finel Plenning Approvel 222 Finel Site 250 Finel BullOing/Occupancy PAIE � PflQIECTPDDNESS: S6O W 19TH ST OWNEH'S NAME: UNION OIL COMPANY OF aonacss: CALIFORNIA BATTN PAOPERTY TAX P O BOX 7600 LOS ANGELES,CA 90051 AflCM/ENGINEEfl: NEG.NO.: RDONE55: IINIT: UNIT: venrninee: ENVIRONMENTAL MGMT & CONS ( 719 ) 779-2700 aooxess: 1300 LAKEVIEW AV ANAHEIM CA 92807 LICENSE� LONTHRCTOfl �ECIAPRTION: I h¢re�y a��irm I m lic setl untler D�ovisions af Chapter 9(commencing wi�� $eciion 7000� ol �ivisian 3 of Ihe Business antl Professions C , anA my ' en ' in lull lorce ana ellect. cirruc.:056290 STFTELIC.:6n:.745 �ass:r ? �Dale' �� `� � � Signa�ure' WOBREP$' COMPENSATION OECLFflFTION: ere�y aliirm �hal I have a cetlilicate of consent to setl�insure or a certificaie o� Workers' Camoenution,lnsurl ce.�ra c�nde� `opy tnereo� (section 3800. LaD. �1 / O 1/ 9 4 boucr xa.: STATE —y � Exv. onT COMPFNV: ❑ Cenilietl copy is nere0y Nmisnee. � CertifieG c rs IileO - e ciry Buildin Division. Oate: `� �3 � � �—� A icanl: ' E%EMPTION FflOM WOBNEflS' LOMPENSIITION D N: (itus satian nee0 nol be compleleG il Ihe permil R iw one hunCi � or 1e55�. I ceni�y I�ai in I�e Oedormance oi ��e work �or w�ich Ihis p¢rmit is issueU. I s�all not emDlay any person in any mann¢r so as Ia Uecome sublecl Io I�e Workers' Compensation Laws of Cahbmia. Date: SignaWre: NOTICE: II. a�ter making this tleclaraiion, you S�oNE Eecome suble�� o Ihe Wo�kers' Compensa�ion provisions oi ��e Labor Cotle. you mus� loh�wi�h comply wi�h such pmvisions or �his permil shall be deemetl revoked. CONSTNUCTION IENUING ACENLY: I her¢by alhrm Nat Ihere is a wnSlmciion IenAing agency �Or the peAormante of the work �or wnic� I�is permil is issued (Semion 3097. Civ. C�. LENUEfl: AODflESS: OWNEfl BUILOEB OECUflFTION: I hereby aHirm that I am exempl Imm �Ae Con�ra[tors' Slaie License Law tor the �allowing reason (Seciion 7Q3/.5 Business antl Pmlessional Cotle: Fny ciiy of counly whic� repuires a Dermit �o wnstmct, alter. impmve, Eemolis�. or repair any stmclure. prior Io ils issuance, also requires t�e applicant lor suc� permit Io �ile a sipne0 s�a�emen� tlut hPJS�e is licenutl Dursuam m I�e Omvivons oi Ihe Comrac�ors' Slale License Law �C�apter 9(commencinp with Semion 7000) ai Division 3 0� t�e Business an0 Pmlessions Coae) oi Ihat he/she i5 evempi Iheretmm ana ihe havs lor Ih¢ alleAea exemD��on. Fny WOlation oi Sec�ion 7031.5 Gy any applicant �or a Oermii wbjecis I�e ap0��ant �a a ciWl Denal�y o� not mOrt Ihan five �untlreE tlallars (E500�. I, as owner ol I�e pmDeny or my employees with wages as I�eir sole compensatian, will do ��e wark, an0 the ❑ slmcWre is nol inlenGetl or oifered for sale (Setlion 706d, Business anG Pm�essional CoCe: T�e Coniractors' Slaie License Law Oo¢5 noI apDM �o an owner al a pmDeRy wM EuilOs ar imOrweS i�ereon, anU w�o tl0e5 Suth work him5ell/Aersell ar �hrouAh his or �er own employees. D�oviAeO ��at suc� impmvemenis are not intenEeE or oifereU lor sale. tl, �awever the huil0ing or im0�ovement is saltl within one year of complelion. �he awner will have Ihe �urden ol pmving he/she tlid not bui10 or imDmve lor Ihe putpose ol 5dle�. � I. as owner of ��e OroDeny, am exclusivety cantracting witn licensed conlrac�ors ta cansimct the pmiect (Section 7044, Business ❑ antl Pmlessions CoOe: T�e ConVactors' State License Law does no� aDPly to an owner o� pmpe�y who builtls or Impmves I�ereon and who coniratls lor such pmle��s wit� a conirac�or�s�license pursuant �o I�e Coniractors' Slaie License Law). I am aware I�a� O�ooi al �Aeir Worker'S Compen5ation insurance shoula be providea Io me. � I am e�em0� untler Sectian: B. 8 P. C, for ihis reason: Oale: Owner. I do here0y ceriily t�al I am aware oi anA un4er5ian4 ihe re0uiremeni5 0� Calilomia Healih anA Sa�ery Cade Sec�ions 25505, 25533, and 2553a antl inat I or any lulWe buileing occupant wiluvnll not �circle one) neee to compty unlh saiA state cotles antl the reauiremenis far a permii lor consiruc�ion ar mo0ilicalion Iwm t�e Fir Oualiiy Managemeni DisVic�. fl¢siaemial conslmc�ion apD�ications are erempl �mm 111¢5¢ pfOvi5i0f15. Date: Apolicant: _ IhereUy ceiliiy��at I �avereatl�hii a0olica�ion an0 Slalel�ai or0inantM and slalelaw5 relalingio �uilding fqn5tmctian a pro0erly �orins�e[lion Durpo5e5. Da�e: ( � "3 �" 13 ignamre."� Driver's License or Sociai Securiiy a: is corBct. I agree �o comply w�� all ci�y an0 counly lidlivQS O�I145 GIylO Cf1�CfI1pOflil@ dbOVC-IIICIIGOOPA 16aPn6 Wnito—Buil�inq: Grean—CaCe Enforcemem: Canary—ApplicenC Pink—Revenue: GoltlenroU—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BP 065105 PERMIT NO: BP 065105 PLAN CHECK NO: N GOC�T: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU STR PURPOSE: DEM JOB DESCRIPTION ; DEMOLISH UNOCAL STATION SQ FT: CLAIM VALUE: 1,000.00 CALC—VALUE; 1,000.00 GROUP OCC: H-2 / COMMENTS: DEMO UNOCAL STATION �rx-***�x�x��r*-�***��**�-�+�*��-x-��*-x�******iE-��r�� *v�***��+r**-�*+t��t�t�-�t--��t**+t*�r�r��-��x�**-�t�t*��t�K�a� Z O N I N G R E Q U I R E M E N T 5 S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: PT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: ET IN PARKING REQ: PROV: PARCEL: 42210320 ZNE: REF NO: PLANNING NOTES> } iE fk 1f if if if iE ik 1E iE 1E iE iE iE iE iE iE �E 7E 3E if if !f !E iE iElE iE 1E if it 1f iE iE it it if iElE 1E aE iE iF ik iE ik iE it if if ik if 1E 3E iE iF iFlE if it iE !f ii iE �E iF if iF 1f fF iE iE 1f k 1E 1F �f jE iE — D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY , DATE: BUILDING APPROVED BY : DATE; Q APPLICATION ISSUED BY: � DATE: '�1�`�1� �r�r*�r�riri�*�t**�-**�-*�tr***�r�FTe'iF'�7F3F3FkiF��t*r... �rxiFr�'3'rir�F�r��t�r**x� **�*�*****3F'iF,.�FiFiF3F�r �F*x� if if if if �f if iE it it i4 if i4 if iE it ik if iE 1F if 1E iE jf iE ft 1E i! if iF if iE iE if it if iE iE if i! iE jE iE iE 1E if it if it iE iE iF if iF iE �f if if if !F # 1E if �f iE it if if if iE if �1E iE 1E if iE ic iFit iF LEGALIZATION;N £ E E S U M M A A Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 25,00 7.00 25R SMIP/NON—RES ISSUE FEE 20.00 .50 BUILDING—DIV—> PERMIT ISSUE PLAN—CAECK TOTALS----> 32.50 20.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED; BLDG PMT PLUMBING ELECTRIC MECHANIC z5.00 z%,00 TOTAL PAID DUE 52.50 52.50 .QO 5'...� OVER/SHORT: .00 FIRE SMIP/TOT GRADING PLAN—CHECK .50 iE 1F if if iF if iF af iE iE if 1f jf iF it i! if �! 1E 1f if iElf 1! i! iE if iE iE iE iE iE 1F 1! iE iElk jf if if iE?E iE �)F if iP if iF �E if 14 �,` 1E iE iE if iF if iE K iE ff iP if if iF if 1E iF iE 9E if jF iF K jE iflE 3E I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I F T I O N UNIT COST TOTAL COST PLU 1 SEWER CAP / DEMOLITION EACH 7.00 7.00 END OF FEES �. r , i � � ' � � / � / 02 QQ1`14b4-00151471 T GT �2.SC OATE: 11/30/93 TIflE= 09:43 CONSTRUCTION AND PLANN(NG APPROVALS Permit # -- bate .t. TemDorary Electrical Serv�ce or Pole � 2. Soil Pipe-Undrgmd. . 3. Electrical Conduit Utility-Undrgrnd. ' 4, Elettrical Condmt�Undrgrnd. 5. Steel Reintorcement � 6. Electricai UFER Grnd. � 7. Footings 8. Poundation � 9. Water Pipe-Undrgrnd. � - • 70. Structural Floor $ystem 17. Property Sewer Line & House Connection � 72. Sewer Cap • 13. Roof Orains � � 74. Rough Plumbing ,y.; 15. Rough Electrical-Condwt ; ' 16. Rough Electric Wiring � , . 17. Rough Wiring Sign ' i 18. Rough Electrical-T Bar Ceiling - 19. Rough Heacing & A�r Conditioning ' 20. Rough Factory Fireplace 27. Ducts,in Struiture 22. Ducts, Ventilatinq 23. Gas Pipe•Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling fStructural) & Monocoat 27. Frame and Flashing 28. Lathing & Sidi�g 29. Insulation 30. Drywall Nailing 37. Plaster Brown Coat 32. Electnwl ?ower MeterPinal 33. Final Electric 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 pomestic-Final 42. Sackflow Preventer 43. 8ackflow Irrigation 44. Landscape irripation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILOING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern Catifornia Gas Co 51. CERTIFICATE OF OCCUPANCY Date P00. , SPA Inspector ppPROVALS Permit 5'� Date 52. Pool & Equipment Locat�on 53. Steel Reinforcement 54. Fcrms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. AFPROVAL TO COVER-GUNtTE 58. Eiectrical Condurt�Undrgrntl. 59. Gas Pipe, O Undrgrnd., Test � 60. Backwash Lines, P-Trap, O Undrg�nd. � 61. AfPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Pl�mbing System - Final 65. Electrical�Fina� 66. Solar SYstem�Final 67. Fencinp & Access ApProval 68. APPROVED fOR PLASTERING 69. P6�L/SPASYSTE�USFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Under9round Hytlro 71. ProductPipinc��Gas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas � 0�I 74. Overhead Hydro 75. Dry Chemical 76. Dry Standoipe 77. FI;(ED SYSTEM FINAL ��" 76. FIF:E PREV. FINAL i'�4�• HEALTH OEPT. REQUIREMENT ,,,,., 79. FINAIINSPECTION _ _ 60. FOOD CERTIFiCATE ISSUED r Notes: r� � � A Inspector 0 u 1 Pioject Address J�-Q-d' , Applicant's Mailing Acldress Owner's Name � �� `�� "'t'� � � � P Address �c��o� ��• �4� �- Aich/Eng. T„15.�� 1(� � icense No. Address (meilin9) �' '�^' City License No. _�__ Sia3 LICENSED CONTRAGT9R DECLARATION I hereby affirm that I am licensetl untler provisions of Charter 9(commencing with sectlon 7000) o/ Divlsion 3 Of the Busine55 antl Professions Cotle, antl my licenze is in full for.5�� ntl eff¢cf. /] License Class � �']��,Uc N �-1�V Q � Date'0—,�� Signature_� i��-+ WORKERS' GOMPENSATION DECLARATION ' hereby aHirm that I have a cerllflcata oi consent to selt-insure or a certilicate '' Workeri' Compens5tion InSurance, o� a certl/ietl copy thereof (Sectlon .ao0. �.anj�SS�%DILO Policy Nob Company Certifietl copy is he/eby furnishetl. Certltl¢tl opy' f tl with the City Bu' i DI ifion. p ate � �� — APplitdnt �� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thizsectlon neetl not be completGtl it the perml[ is for On¢ huntl�etl ($100) or less). I certity that in the performance ot the work for whicn this permk is issuetl, I shall no[ omploy any Person In any manner so as to beGome subject to (h¢ Wotkers' Compensatlon Lav+S of Callfomia. Date Signature NOTICE: If, afte� maki�9 [hi5 tlecla�atlon, you Shoultl becom¢ Sublect to th¢ Worker5' Compensatlo� Provi5ion5 0l the ldbor Cotle, You mus[ forthwitb comply with such pfovisions Or thi5 Oermit shall be tleemetl revok¢tl. CONSTRUCTION LENDING AGENCV I hereby alflrm [hat Ibere is a construGtion lentling agency fo� tne pe�formance oi the work (or wniGh Ihis perml[ is i55uetl ($ection 309] Civ. C.) Lentler's Name LenOer's Atltlress OWNER BUILDER DECLARATION 1 hereDy a/(irm tnat 1 am exempt trom [he Contractor'S License �aw tor the followin9 rcason (Sect�on 7031.5 Business antl Professianal Cotle: Any city or munty whicn requires a permit to const�uct, al[e�, imp/ove, tlemolish or repair any strucWre, priOr lo �ts i55uanCe, d150 require5lhe apP�icant (or such pelml[ l0 file a zignetl statement that he/zhe Is IicenSetl pur5uant to the provisions ot the Contractor's LicenSe Law (Chao�er 9(commencin9 wlth Section ]000) ot Oivizion 3 of tM1e Bu5�ne55 antl Professions CotlC) or that he/she is exemp� Rierefrom antl thE ba4�5 for the all¢9etl exemption. Any viOlatiOn of SeC[ion /031.5 by any applicant ror a permit subjetts the applicant to a civil �enalty ol no[ more than five huntlretl tlollars (5500�. I, a5 owne� o� thC P�ope�ty or my employees wi[h wage5 as lheir Sol¢ tompensalion, will tlo the work, antl [he structure is �ot in[¢ntletl Or ofteretl for sale (Soc[ion �044. Business antl Protessional Cotle: Tha Cont�acto�'s LicenSe Law tloes not dPP�Y to an owner of a property who builtl5 or Improves thereon, ana who tloes such work hlmself/hersetl or through his or her own employee5, proviaetl IPa[ sucn ImOrovements are not intentletl o� offe�etl fo� Shce. If, howeveq tne builtling or improvement is soltl within one year ot com- pletion, tne owner wil� have the Durtlen o( proving he/she altl not builtl or im- prove for Ihe pu�pose Of sal¢). Q 1, as owner o( Ihe Property, am exclusively contracting with licensetl con- Vac[orsto consVu<t the project (SecNon ]044, Business and Professions Cotle: Tne Contractor's Lice�se Law tloes noe apply to an owner ot o�operty who builtls or Improves thireon, an0 who cont�aGts lot suth projeCtS witM1 a con- [ractor�5) IiCense purSUant�[o the Contractor'S LiGense Ldw�. I am aware Nat proot of their Wotker'S Compensallon insurance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. G lor tnis reason of Sign �iOY`�1VY�t��1 City of Costa Mesa ,E�ctric ❑Nomelecvic SIGN PERMIT � ■ � � � Description CanoPY Attraction Board Advertising Statuary Other Tract Sign (Security & Right of Entry Agreement Special Event (Request torm submitted) Change of Capy (amortization) Ground Wall Root Projecting Canstruction Convenienca Super Graphic ELECTRICAL FEES Fixtures Device Bozes OUtI2t5 $witch¢5 Sign Standing Sections IIssue Fee ' V81Udt10� $ � Planning Fee Building Permit Plan Check Electrical Plan Check 50% SMIP TOTAL FEE S $ $ S $ $ S � $3 Daie Owner I M1ereby certify thal I have reatl tnis application antl slate [hat th¢ above information is wrrect. � a9ree to comply with all ciry antl counry ortlinances DEVELOPMENT SERVICE$ QUIREMENTS: an0 state laws relating to builtling conSVuction antl Fe�eby authorize �epr¢- sentatives ot this city � o en�41�,�up �n the above-mentiOnetl Prop¢rty lo plannin A Ioved B inspection p�c� es. .�J�� -� V _ ,._ � /�,� 9 PP Y: Si9nature �i�{L�) C��'C�1�� Date u,� � YJ Building Approved By: Drivers' Litenu o 55 =/f — qppliqtian luuad By: CMF 006830, rev. 7/ea White-BuilEing; Green-Co�e Enforcement: Canary/�PG�icant; Pink-Revenue: Goltlenrotl-Assessor Programs ❑ Shopping Center/Integrated dev. ❑ By Owner/or ❑by City Date letrer sent �, Variance P/��5�� ❑ Planned Signing C.U.P. No I Ilumination ❑ Non-Illuminated � IntBrior Illumination � Exterior IIIuminatiOn INSPECTION APPROVALS Sign I Date Underground Conduit Foundations Rough Wiring I251 l0/pl/85 Office Usa Only (��J// (� Pr j��q rty A. P. No. __�j ' / / � r �`� Zonin / Sign Dist. Date Received Received h Sveet frontaga: Front: � � Ft. Right:� Ft. Lett: Ft. Rear Ft. Building set back from Wtimate Street: � �� Street: Street: Sign Loeation Front � Right Left ft. IIco4F Tl. Sign Description Si9n Dimensions Area Letter Haight �, � � x—� _...�� w. rc. = ad', /� 121 x = sq. ft. �0 (3) x = sq.ft. Items of Information: (7) 121 l3) Framing tal fo/r /Acpti�vityy Copy Verbage ��M e�U � "��Zz Final Electric �'%��A�� r Oate Data Date Plannin9 Sign Ground Sign: Overail Height `' Planter Area � q� � / Ground Clearance This activity Notes: Tatal Sq. Ft. of All Signage Total Site �:��., 24�ao - c�tr o� c�ssr��rs� . „ COSTA (�AESA BUILDING-SAFEfY DEPARTMEM' � � � � • � � , ... P.O. BOX 917 GOBTA M88A. �A��FORN�A . S E P 2 7 1965 � ��- For..Applicant�fo Fi1F:ln Complefely• ., . ,,3� LIC TIQ�J F, R PE yIT , . . TYPE OR PRINT � �iAi�� , - .. , • �: � ..,,. _. . . -ForO' ..�y. BUILDIN6 ••"� � 1 , �J, J_ . ..- � �. . .. ADDRE53 ' ". . ..V .� � .. `.- v .• • . • 116C[�PT NO. PHRMIT N .� .COSTP: MESA, �CALIFORNI:4 . . ; : � r , �, ; � ' �— , �j:�, . , � R6C 6 OY _ pA 6 A6C IV[ H� �y..�� . • . . .. Z � � �'��I OWNE �.�-�i W P=� CO�' - MAIL C�� r y(.�/{� BIIILDINO'.. � � \ Q � . � • ADDRESS �, -7i^1�� 45 /�"`�' _ �ADDRfiBH:� ..._•'� W � l'. _ yJ'. .. .. 1... . -'� ' EIRE � �� .�. CITY�r�M � SP�NG-� .� rT,o' 98-g73 ZONE .• ; .TYP . ' �- GROUP,` � APPROVED � `� ECT-_., "^ � -, . . . TEL � j BY . .: � 1 :•OATE � O" '�GINEER . �' -'NO. �I ; - . � \ - y u .,.�.' ,. , . .�. -c .:. __ , NING�-.:- .' ADURE58 OO �� N � Ul � � � (� � ' . ' ...�n � ., n. r i . . _- �: . ZO 6` - PLAN9 ..2� . �UILU XO� Y CONTRAC'f R�O CS . CO � J J y- . _ �w- ,_ _ . . : ..�. ... . - �.:. . . � . _ , . ✓ . p� , 1 .. . .,.� . . . LEOAL p 'y ADORESS O Q � I�. S jM Desea� n '� � S�� 1.�<C!S �� \ '^ �-�+C� � . .. � .. . ..._ .A:P.NO.y. �/, `• U � � CITY �L- N,OAI 1 G �- . � STATE /� T8L ^ A NOTE: NO EAVE OVERHAN6 BHALL BE LEBBTHAN ;. . � LIC.NO. 'i��+-•,NO..:iTi'3-�I`,.•�. .90'TOSIDE REARP. _ � �/ EAYEB •f n �� r SIZE � NO.OFBLDoe.X ALLOWED +� �'- � .(U:�BQUIREM T OFLOT A3• �� O I NOWONLAT V ' YARDSAPPROVED „' YARDS�APP,ROYED , USEOF �y� � _ .,r,MA1NBUILDIN6 . ACCESSORYBUILOING � _ EXISTINO BLD6.�LI,a/� 4 _ . _ � � _ _ ( FROM C/L HTREET) SETBACR LINE FROM • •' "` � ' - ' �` ' ' ' FRONT� - FT. "� � � `� OFT.� "' - � " CENTER OP BTREET REAR YARO � - - . _ . :'S._ '. i.� e , i L: � " . . SI�E YARD LEFT ' ' - ' RIG T . �' . ' R. SID6 FT.' , OFT..' ., '"' ' ' DESCRIPTION'OF WORK '� ' - �:eioe' r��C � _ ` .• ,fi:'- � . - .�..J.'.' �.. .�'_. _ . • REPAIR MOVINp10Nl_ ADDITIOSNi REAR' FT., " .' . -F7.f- . DISTANCE BET.. BET. MAIN B DEMOL MAIN BLDG9. 'ACCESS. BLDOB. BUILDI 6 �Z?�� NO.OP �'AR•# DATE SIZE FOOMB STORIH9 C. U. P. - � A�PR VED � �� EXTERIOR WALIr � ROOF 5��—C"L� APPROV[� ' � COVERING �r COVERIN6 Y DATE -� USE OF BUILDIfiG AND WORKTO BE PERFORMFD _�, p�/ HOLD FOR SPECI REQUIREMEN . S �D — —� ZO� S—Z� /�hlOf `' sc. Fr. ^ 1 HEREBY ACRNOWL¢OOE TXAT 1 NAVH N8A0 TXI6 Ap.P1i1GTION TN8 AMOUNT BHOWN UNDEfl VALOATION 19 FOq TH8 ' F ANO BTATE THAT TNE ABOV6 IB CORRECT A �jOREE COM• PUHP088 OP EBTABLIBXINO A PERMIT FE6 ONLY. � PLY WITH ALL C�TY OFOINANCEB AND BTATB WB P60 TINO 0 BOILDINO CONBTRUGT�ON. VALUATION N 1�1 �-h� g< PERMIT FEE �� S SIGNATURE m PERMITTE �/ � Q� a $ _ $ � � �' � AUTHORIZED AGENT . Q 4 LL TOTAL FEE U �J �� ,�.` ' _ -- - - _ _ ._ . --�----- .. �a�� a7c��..7��r�� _,� , � _; �:; s��: �QUz�s. . : _ _ . _ . .. � � � f '� ��er ,> 9��. . . . . . . , . . ., . . :_.. .. ... , . 1. Installat' � of cormnercial sidew lks aiid` coric'rete'"d'riv'eway `app'roaches �•- by the app'�cant',. at liis"e'?�P ense per the standard:;specifications_of•' the_ City o�' Costa�Pdesa; _L,�,} ._ � y., � _ 2. Tree plantiii"g"cbb3ga£ible wit'�i surrounding: aiea as :.indicatecl : on. plot , plan; - — - - - . . . .. . . . . , . -. .. :. _ � � � . .. _ ': �:: . . , , . 3• A:corner.masonry,planter•,;sha11 be.pr'ovided equi.valent'to,that located on the northeast ,corner� of West• 19t1i Street `and Anaheim `Avenue;� ' , 4. At least`20�, of the exterior; f'acing the front�.and two_sides'of.the ', building shall`be�of orn�ental masonry material with details_being.... �submitted to the`Director'of Planni.ng,prior'to�Buildin 'Permits ' � � �being .issued; `�' ... .,' '�"- � . � 5. Landscape planters shall be desigiied 'and ,placed� ;in"areas besi'd'e' the ` � main°structure, the details to be submitted to the IIirector'o£ P1an- . �ning prior.to issuance of..Building_Pexmits. , _ � 6. A 2"miiiimum wi.dth masonry landscape p,ianter shall be crnstructed �� lietween•,•driveways. oniNlapTe and Y7est 19th' Street; detailed plans being` submitted to' Dix�ector of �Planning. . . _ • :� � ' _ 7. The\placement`oi•all accessoiy st'ructures shall tie'approved by � -'.the Planning Departmer_t. c ' ' - � 8.;',p,6'�masonry waLl_&ha11 be constructed across the're"ax:property.. _ '�1ine by� the' owner,: at his e�cpense.. �` • 9...�Remove-existing driveways...:,. .... .. .....,:..�_;;:��.:. ,.... . , ..�,� :. _, 10. Tan.[s to b'e installed as ,per-.Uni�orm Fire code ig61: : �.. � 1�. Permit to.be obtained Yrom,Fire Department to install._tanks. �'_ 12. ,Piping plan to be submitted to Pire Department: -'= ,- -�-�- -- - � 13• Fire extinguishers•located'`as per Pamphlet No. 10 N.F.P,A. _; 14. Dedication of 8-1�2' on'Map1e Street for street;.widening:purposes. • 7.5 • A'ffiinimum of 12' shall be p�rovided between the base ofl the' �--- p�p -island��and .the _landscape planter: """` � ' '� - - ,. , ;. •. � • _-,'' � , _ , - . ... . , . . . . . . . . .. .. _ ' - � _ ci � . - k.. �,�_�.�, �i � . . ' .� � �: .I) � , .. ,. . � ..7 . . . ' _ _ _ _ .. . ._ . . ... . . ._ _ . . , ._ . . .; _ " i. � ' . , � ... ..'.. .. .. ' _ :-i. .�� , . � .. . . ..,•�y'� - ., • - . 4 .� . . . � _ .. ' -..' . �. � . . .. :�nl_.'�� f"... .-�� 1 . ' ". . , . - .. � . - . . . _.... __ . .�. . •' ' -.. � . , . _ ; ; . . . . . .. . _.... ._ . .. .... , � .. . . ' '.. ._ ` "_'...�.:* ,. _�. _ .-i . � , ,�, . . ' " ' "� " . .. , . ...._ . ._.__... .. r _'_,..__ ... .......... . � .. . . , _ . .. - '. , ' .. _'.�y ' " ._.' . ' . . ., - - ' .. ' . � a-�' . . ' ' . �� ' � . - � . . . `� `, ..� I . ,. . � . . .' "' , '"' ' ""_ " . , ,- , . . ,��. ,,,^�`. _. . � ;'`i':�';�,./i�_ � �.. . '."__ ' ._....._ '_' "".' ! . } (� . _ � . , ��,�, H-c V S � ` � . `'- �• . 2477 — — . � � � C1TY �r E;�;StA M�S� . . COSTA AAESA BURDING-SAFE7Y DEPARTMENT ' V.O. BOX 7?DD GOSTA MEBA� CALIFORNIA Y2620 . � . OCT 11 1965� For ApppcaM 'to F(11 In ComplHtly /V►LICATION FOR PE TYPE OR PRINT � A{%��III_�i\ a� / �/7c�� I�il�On ADOpHYB J U� �• 1� ! J� . _'—_ 11[CiII� NO. ►[I1NIT NO COSTA MEBA, CALIFORNIA � � � o r �Ta�(o u/ Gl�e?� 5, 65 �aR ' � ES �— S MAIL /� /� � / � r+"' , (/ ADDR'�O � Z AODR 1�� ✓ `�� • ( � FIR[ em � W�� C��/ • pL SONt TYP OROUP p „��„� � �alrs- �NoiHe �i%.�" � / er� � ONING AG�R6Qi _ ZO No.O/ u�co►X[w C- ltwtu eun.D�Ha , CO R �e ADOR D[icR�TOX • , ��'�d .i' .Z A. P. NO. I�S " �Z - 'X � � l � CITY � NOTe� NOlAVCOVHRNANOBHALLDBIdHBTMAN 8TAT8 TCL 80' TO 61DH a RHAfl . L LIC. NO. N EAVHB �" 61ZH �7/ wo.o►e�cw. ALLOWH� <U.B.C.RBGUIRHMHNT) OF LOT Now oN LOT (� „ YARDlAPPROVlD YARDBMPROVHD 1 � E7�jE57�'jNG BLOO. MAIN BUILDINO AGCQBSORY BUILDINO ` (PROM C/LffR[R) 88Tp�CK LIN6 �ROY � � . Q . I � � ♦ CeMTHp oP BTR6�T 11UR YM /,/ �� SIO Y R L6FT qlpifT R.� 16l ~ Ll . / DESCRIPTION OF WORK �. s�o _' ��S .GW ALTBRATION ADDITION R�p �' �' DIHTANG6 B6T. BET. MAIN G REPAIR MOVINO D8MOL1 X MAIN BLD6H. ACCESS. B1D08. BUILD�NO NO.O� V�•� DAT6 512E ROOMH 8TOR1 C. . APPROVHO H%TERIOR W�V -� O COVEHIN � O MrROV DATi I✓� . covertu+a � �� ` UYi O� �U ILDINY /V1D WOIIK M B� P[RRORMtD p, f0 �� i �� ByQ. Pf. � I H6R[pV �CRMOWLiDO[ iMAT.I XAVQ IWD TNI� .VRIGTON T11� AtlOYM �HOWp YN06R VALUATON IB POR TN[ � wND aT�i6 TMAT TN[ ABOY{ IB CORR[CT ANO AORfE TO COY. ►UnMGe[ 0► �ffMLIGNINO A P6RMIT P6� ONLY. PLY WIiH ALL CITY ORDIN11NCp A�10 OTAi[ I.AN't [OVIA'ANO eutto�NocoNsrn VALUA710N Q � }� PBRMIT R86 816NATUR! Or �� E PBRMI'R6 - t,j' L i AUTHORIZ6DA6Ql17 / /1 /m TOTAL P6fi �f� �.. � � 5095 ' COSTA MESA BUILDINCrSAFEf`f DEPARTMENT G.O. BOX�1200 � GOSTA MESA. CALIFOFNIA 92640 Fo� Appllcanf ro FIII In Completely TYPE OR PRINT euaoiNa ADDRE8D �' �� " COSTA MESA, CALIFORNIA � MAIL .. _ ' — ,� _ ' _ ' _� �, CITY OF �4S iA ME JAN 12 1966 APPIICATION FOR ZONING � xo. o� - uas or w�w \ n -9i' �urL suiw�x�rt� .��1L \�� ' / �r' ,e 3 �- J „� /'7 j ") d d- 3 / �„� - IALL BB Ll86 THAN U.B.C..REqUIRHMENT) 1 , YARDSAPPROVHD ` 1 • ACCE880RY BUILDING t-�- \ -� HOTQ:NOiAV60V[p � DO' TO HID� S RiAR F ewves �LOos. -b ALLOW[D � � YAROEMPROVBD — MAIN BUILDINO � L6TSACK LIN[ IROY � uas oP DESCRIPTION OP WORK :/.- _ -� / i' '1 HBqBBY IICKNOWL6D08 TMAT i MAV6 RCAD TMIB APPLIGTION AND 8TAT8 TXAT iM6 AlOV6 1� CORR[GT�AND AOR[[ M COM. PLY WiTX I1LL CITY OROI�jM CY AND /TAT� LAWY R[OYLATIHO 8 W LOINO CON9TRYCfIOp!/ e �urHORtzio wo�rtr ti VAR.Ij I DATE e PROV[D 6 r�./,,.- 6 c.,v.,�Q �X r 4;n � a C c� /) m e�.- 6 -� � �. �. � TH[ AMOUNT lMOWN UHOBIi VALUATION IB PDX TX6 j ■UPPO![ OP iBiAGLIBXINO A PHRM�T PH8 ONLY. is VALUATION _� � PERMIT FEB a��DO.— � � lo � TOTALFEE r I , � �. � " I 37 ' COSTA MESA BUILDINCrSAFETY DEPARTMEM' P.O. BOX 1200 COSTA MESA, CALIFORNIA Y272B For ApplkaM ro Fill In Corr�plehfy TYPE OR PRINT .._ , COSTA MESA, CALIFORNIA �/.�,�k.a _ � , � , ,. m. rro. or etow. �qOM DESCRIPflON OF WORK BUILDING s�ze BXTERIOR WALL 't NPAlGY ACItNOWL ANO BTAT6 TNAT T PLY WITX wLL CITY BUILOINO CON¢i110C � wuTHORtzm woerr[ � TO B[ .I X�Y6 P�AD tHl� AP'I.IWTOII i COqp6CT 11ND AOR66 M COM• i y1D �T�Ti UW� R[OYLIITINO OF C�S�A MESA MPLICATION FOR P �A�2�y��: a _ �ccRla Mo. ZONINO 1 S�—;�i d��" l�,�3 U d` i ovenHwNa sHw�� ee �ese ni�n YARDD MPXOVlD MAIN BUILDINO v�n. # YARCB MPROVHD ACG8880RY BUILDIN6 eer. rnwin e wccess.e� DATH ' '_"__ i Ti ' d` (� . � W 07 80. Rf. � TX[ IIYOYNT iXOWN �1ND6R VALUAiION 19 POR TX[ � NRPoGi O� tlTAl40HIN0 A P61iMIT �66 ONLY. � VALUATION � PHRMIT FEB ,� � o � ��'_ — w TOTAL PH6 a .^"' .: 29�44 FEB 17-6�00 349 0*****5.00 .. . " COSTA MESA BUILDING-SAFETV DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT ForApplicant to Fillin Completely RECEIV o ev DATE RECEIVED BUILDING ./ n a-iy-�9 ,�TE�u�� ADDRESS U 7 OWNER � I � A.P. NO. � MAIL BUILOING ADDRESS IO O L. • � ADDRESS � , Z . d U CITY ryp, TRACT HZ Z Q CANSTRUC710N .�� W A D O N LENDEF 2 p� J � BRANCH J �" Q _ OWNER m AODRESS J a OR ENGINE R .� NEL �(-Z /(a SE C N RJ-n V Q Q r (A• FIflE w� ADDRESS �(r 3�� G.... r V�O1.[ � ZONE aW APPROVED J O CONTRACTO L'�j e�' m Z I7�'h �� J � ADDFESS �� I�� • : • ■ ,I_ • u- / �� / ii �. _I�I W W ? / ZONE NO.OF USE OF NEW v �= CITV� �L��( �"� NO` J�p�'�� i P�'� � BUILDING ZH w� STATE 43Oq.y CITV YARDSAPPROVE� VARDSAPPROVED j O LIC. NO. LIC. NO. MAIN BUILDIN SIZE NO.OF BLDGS./ (FROM C/L STREEI OF LOT j, �, Q� NOW ON LOT {..i RpM T. USE OF '1 EXI5TING BIOG. S�.�y�-y I C-�:. s � FT F' S12E OF NO. OF � Z NEWBLDG. ROOMS STORIES L.SIDE F. U EXTERIOR WALL � ROOF _ COVERING COVERING REAR T. USE OF BUILDING AND WOflK TO BE PERFORMED DISTANCE BET. MAIN BLDGS. Q �.(�JSC I AI Q!✓M CT W C URP. $'� y s. y�Mt �^�� f�,.,. ./] - APPROVED � � a'.c. 1 9-J loroaC_ z 0 VI hereby acknowletlBe that I havo reatl thia epplication antl itnte � t�at the ebove InformeNon is correct entl aBrea to comply with � all laws ragulatinp builtlinp consttuc[Ion, anC I s�ell not employ F any parson in violatiOn of the wOrkmen's compensa[Ion laws ot y the State of Celifomie. zI hereby certity thet I am proparly licansetl nz a contractar unGer SQ. FT the Stato of Celifornia Businass entl Protessionf Cotla, Dlvisicn 3, TME AMOUNT S Chapter 9, end that such licenses era in tull forca anC effect, or I THE PURPOSE OF em eaempt from t�e provlsions of the Siate o( Californla Business VALVATION antl Profassione Cotle, Dlvicion 3, ap 9. Sie�ature � �.•' � /� � � ^ O v Petmittae �� 07 § �v O � Authorizatl ABent DATE APPROVED - m � 0 HOWN UNDER VALVATION IS FOR � ESTABLISHING A PERMIT FEE ONLV: Q � o� �, PERMIT FEE 5 � 7 �� m PLAN CHECK 5 E ��O o � LL TOTAI FEE 5 ,,s-,s�^�`on FFS°� uo.�o �:: �: t: COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 APP C I N FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only REc ve OATE RECEIVED DA7E ISSUED noo es"s560 W. 19th � -/ ' O PERMIT N OWNER U111O11 011 CO. A.P• NO. MAIL BUILDING O C�� ADDRESS P , O ADDRESS / TEL. L^^ L TRACT �// / LOT I BLOCK CITV I,�S An eles N�� VLGV CON5TRUCTION LENDER BRANCM OWNE Q G ADDRESS VALUE ARCHITECT TEL. $ OR ENGINEER UI110T1 Ol l CO . FIRE AODRE55 ZONE TYPE GFOVP APPROVED CONTRAGTOR �gwgO BV DATE ADDRES5 ZONE n NO.OF USE OF NEW A TEL. L/ _ p�p,ryg gUILDING �� CITV NO. V STATE CITV �ARDS APPROVED VARDS APPROVED LIC. NO. LIC. NO. MAIN BUIIDING ACCESSORV BUILDING SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT NT F. FT. USE OF E%ISTING B�DC• Separate permits are required for L SIDE F FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLOGS. ACC65. BLDGS. VAR.# DATE � C.U.P.y� APPROVED APPROVE J �� I �e�eby B�knowladpe t�at I �eve �aatl t�la applicailon enE �tete Mat the ebove Informetlon Is cortect antl apree to comply with ell lews reY�latlnp bulltlinp consbuction, entl I chell not amploy any porwn �� Iolallon of Ma workmen'� compenutlon lews of Me Stete 01 Californle. I haraby cartHy thet 1 em properly Iicanaetl as a contractor untlar 54. FT. Me Stnte 01 Celitornle Bu�inau entl Profasfions Cotla, Dlvl�lon 3, TME AMOUNT SMOWN UNDER VALUATION IS FOR Chepmr 9, entl thnt such Iieeneae ara In full force entl eHect, or I THE PURPO6E OF 6TABLISHING A PERMfT FEE ONLV: em axampt from the Orovlslonsof the5teie of Califo/nle Butinen VALUATION PERMIT FEE S . O�/J antl Profes��o�� Code, Division 3, Chapcer 9. �7j PLAN CHECK S Sipneture Pf Parmlrtae , � $ 2�O r- TAX 5 �� Auihorizad A7ant TOTAL PAID S (�, Q �; '� �r. i= , . `s ' � AP :-77PAIo001909+� �*�*10.50 uisa COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 P IC TION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only R c E V T RECEIV o BUILDING 1I� D E ISSUED AD�RESS �� CM I' PEF NO. OWNERX E !.l p"P' N�' MAIL BUILDING ADDRESS ADDRESS TEL. CITV NO. TRACT LOT BLOCK CONSTRUCiION w n D AL R P LENDER BRANCH OWNER � � ADORESS � �^ VALUS � O�J ARCHITECT TEL. SE c�� OR ENGINEER FIRE ADDRESS ZONE TVPE��ROUP��r APPROVED �! � �J CONTPACTOR • BY DATE a / ADDRESS TEL. ZONE NO.OF USE OF NEW CITY NO. �"3 . /Jf PLANS BUILDING STATE CITY VARDSAPPR ED VARDSAPPR D LIC. NO. L10. NO. MAIN BUILDI ACCESSORV ILDING SIZE NO.OF BLOGS. (FROM C/L STREET) ' OF l0T NOW ON LOT FRONT FT. FT. USE OF EXI5TING BIDG. FT Separate permits are required for L. SIDE FT. FT. electric, plumbing and heating work. � REAR FT FT. USE OF BUIIDING AND WORK TO 8E PERFORMED DISTANCE BET. BET. IN & MAIN BIDGS. ACC BLDGS. � VAF. # DATE C.V.P.�W APPROV APPROVED I heraby acknowletlge that I have reetl this appllcaiion antl staie chet the ebova information Is corre�t end a0�ae to comply with ell lews reguletlnB builtlin0 co^struction, end I shall noi employ any permn In vlolation of the workmen's eompensallon laws of the State of Calitornla. I hereby certlfy that I am O�operly licensetl as a contractor untler SQ. FT. tha Steta of California Business and Professions Cotle, DlviSiOn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF Chapter 9, and that cuch Iicenses are In full force nnd effect, or I THE PURPOSE OF ESTABLISHING A PERMIT F E O am exempi tram the provis(ons of the Stete of Celifornia Business VALUATION PERMIT FEE E anC Professions Cotle, Division 3, ChaPter 9. SiBnatura of .�� / � G Qb PLAN CHECK S Parmlttea��z .�-- —� 5 / V TAX E Authorized Agant / TOTAL PAID S �, � i� � � � � � COSTA MESA BUILDING-SAFETY DEPARTMENT P.Q, BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely —,.7U�s-e Ink Only BUIL•DING ��O M`/� I/ . )�_ A�DRESS OWNER u MAIL �/' ADDRESS [J QTV� CONSTRUCTION LENDEF BRANCH ADDRESS ARCHITECT CONTRACTOR CJ,�/. ADDRE55 /U{�� F. CITV � ^(� �� STATE /J f7�1 �% G� �] IIC.NO. �G./ �JJ �� i OF LOT �S� X I�O USE OF /`n"� EXIST7NG BLOG. 56/C ra TEL NO. BUILDING ADDRESS FIRE 24_ 5%05%78 FOR STRUCfURAL PERMIT DATE RECEIVED nnrc icc��„ �� NOL�7/d��b ZONE NO.OF USE OF NEW PLANS BUILDING CITV /(� VAFDSAPPROVED VARDSAPPROVED LIC. NO. OO(�JO MAIN BUILDING ACCESSORV BUILDII INO OF BLDGS. (FR/g fd Gl STHEET) NOW ON LOT � F6T(1M FT. FL Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED I he�eby Acknowladpa thei I have reetl thls appiication antl stata Met the ebove Inlormallon Is corract entl agrae to complY w�th etl lawa rl9ulating bulltlinp eonstruction, entl 1 zhall not employ eny perso� �� olatlon of Me workman's compensation lewe of Ma State of Celitornle. I hareby certify that I em properly licansetl as a contteetor �ntler Ma Stata of Callfornia Business antl Professions Cotle, Divlsion 3, Chepte� 9. anC that such Ileense! ere in full force antl affact, or I em exempt from Me provltions f the Stete ot Calitornia Businass entl Profea �ona o0e, Dlvisio Chapter`�/'/� . S}pneture of Permlttea A�thorized AOent APPROVED VALUAT�ON $l� 'ABLISHING A PERI PERMIT FEE E T'�� PLAN CHECK S TAX dy E TO L PAID E 23• 0 T�• _ �� . � N n m 'm m N � m m J� m m LL f U