HomeMy WebLinkAbout580 19TH ST - Building Permits"FBOJECT RDOPESS: S S O w 1 9 T� S T
� iwi�esxnme: pIERRE J BERTOLZNO
nooxess: 1014 ARHOR ST
� CMCA 92626
AflCH/ENGINEEB:
RDOPESS:
NEG.NO.:
UNIT:
UNIT:
PEflMITTEE: ALERT ELECTRICAL & SIGN ( 21 3) 225-8295
aooness: 3 � � 1 FLETCHER DR
L.A. CA 90065
LICENSEO CONTNACTON OECLABAt10N: I hereby aNirm ihat I am licensed untler pmvisions a� Chapter 9(commencing wiih Sec�ion
7000) o� Orv�sion 3 0l Ihe Busine5s antl Pmfessions Cotle. a license is in tult torce and effect. _
ciTv� : 50233 STATELIC.:zrjQl ssrt'-45
Date�. L S � — Signatu�¢: ,
WORKEflS'COMPfNSATIONDFCLANATION: Ihe�ebyaltirmthatihav at¢hdicaJeo(ton5emioself-inSureDraCetlifiCat¢olWofker5'
Compensa�ion Insurance. or a cerufied copy ihereoi (Section 3800, L. C). �
POLICY NO.: E%P. OATE:
_COMPANY: � � �
� Cehifietl copy is �ere�y lumishetl. ❑ CeM1itietl coDY is �iletl with lhe ciry Builtling OiviSion.
Oa�e: ' ADDlicant �
E%EMPTION FPOM WOBNEHS' COMPENSFTION �ECLAflFTION: (ThiS ion nee0 not be campl¢teA if,�he permii is fOr ane hundred (E700) or less�,
� I cerlily Ihai in In petlormance o� Ihe wo�k for which I�is permi 5 iss ed. I shall �no� em I person in any manne� So as �o b¢come
suble� Ihe orkers' Compensaiion laws ol Cali�omia. �
Date: � ` �Si9nat�re. � � ,
N0710E: IL a��er making IMs tleclara�ion, you shoultl become Subleci o ��e Wor rs Compensaiion provisions of Ne LaOor
Code. you must Ionhwiih compty with such D�oVisions or this permi� shall �e tl metl revoke0.
CONSTflUCTION LENOING PGENCY: I hereDy a��irm Ihat �here is a constmc�ian lending agency �or Ihe peAormance.ol �he work �or
which �his permii is issuea �Sectian 3097. Civ. C). .
LENDEfl:
nooness: � �
OWNEB BUIIOEB OECLIIFATION: I hereby ailirm Ihal l am exempl iwm �Ae Conirac�ors' S�a�e License Law tor the tollowinp reason
I(Sec�ian 7031.5 Business and Pmie55ional Code: Any cily o� couniy which r¢quires a permit b conslmct, alter, improve. demolish, or
repair any 5rtottwe. OnOr fo it5 i55uance. also requir¢5 t�e appFtant tor SUCh penn+t to �iie a sgne0 Slalemen� Ihai hP/she is licensetl
pursuanllo t�e pwvisions ol l�e Conlractors' $ta�e LiCense Law (C�apter 9(commencing with Seclion 7000) o( Division 3 of IAe Business
� antl Pmfessions Cotle) or ihai �e/5M1e is ex¢mD� ��erefmm an0 the basis for �he allegetl exemption Nny violaiion ol Sec�ion 7031.5 Cy
any applicanl �or a permil 5u�leci5 Ihe applican� b 3 civil Oenaliy of noi more lhan five hunAreU Aollars (E500�. .
I. as owner of ihe pmpeny or my employees wit� wages as their sote compensation.' vnll da the work, and ihe
❑ simclure is nol imenUetl or oileretl for sale (Section 70a4. Business an0 Professional Cotle: T�e Contracmrs' State License Law
tloes n0i apDly lo an Owner o� a Omperly wIW Uuilds or improves thereon, and who d0e5 Such wark himsel�/hersel� af ��mugh
his or her own employees. pmvi0etl ihat suth improvemenis are not intenAed ar onere� for sale. If, however the huiltlinA or
impmvemenl is soitl wi�hin on¢ year ol completioq the owner will have �he burtlen of pmving he/she di0 noi 6uilU or imprwe
' lor I�e Durpose ol sale). �
I, as owner of t�e pmDeny, am etclusively wnvactlng va,m IicenseJ coniractors to consiNct the pmject �Section 704d, 8usiness
❑ and Pmie55ion5 Cotle: The Coniractors' Siate License Law tloes not apDly to an ovmer of Oruperty who Guilas or impmves ihereon
antl who conUacls br such prolecls wil� a conirac�oqs�license pursuant to the Contraciors Sta�e License Law). I am aware
Ihat pmot ol i�eir Worket'S Compensa�ion irysurance shoultl �e pmvitletl lo me. .
� I am exempt untler Seciion: B. 8 P. C.
lor ihis reason: .
IOa�e: Owner
I do here�y cenify Ihal I am aware a� an0 untlerstand ihe requirements of California Health and Sa�ery Code Sec�ions 25505, 25533, antl
25534 an0lhat I or any Iuiure builM�9 accupant willlWill not (circle one) neee la comply wi�h saia sta�e cotles antl ihe requiremen�s �or a�
permii far consimction or mo0i��aiion imm Ihe Fir ualiiy Managemen� DisUicL Resitlemial cons[mction applications are exempt �mm
�hese pmvi5ian5.
Oale'. FpplicanC _
I hereby cerlitytha� I�ave reatl�lhls aDPllca�lon antl s�ete tha� �he
ordiwnces antl stat�'aws rela�ing lo bullding cons�mclWn antl her
properry �or InSN���On p^rpo5C5.
Dnve� s
t64� 06
Signalure'.
inlormation is correcL I agree lo comply wi�h all ci�y antl counry
�rire representaii�f �his ciry �o en�er upon �he abave�mentionee
p�sociaisecudiyx:
-Bulltling: Green—Code Enlorcemen�; Canary—Applicant;
Goltlenrotl—Assessor
CZTY OF COSTA MESA — SIGN PERMIT PERM NO: SHE'U59562
PERMIT NO; SBE 054562 FLAN CHECR NO: 04233-91 S � GOVT:.N.SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE; ELE STR SIG PURPOSE: OTH
JOH DESCRIPTION : ILLUMINATED ROOF MOUNTED SIGN SQ FT':
CLAIM VALUE: 1,200,00 CALC—VALUE; 1,200,00 GROUP OCC: B-2 /
COMMENTS: ILLt3MINATED ROOF MOUNTED SIGN
****�*�t**�**x �*�t� �**��*�***��t*** �t�t+t***+�**� x�t*�r*�t� x*+��-���**���**���*�r******+��***
S I G N I N F O R M A T I O N
DISTRICT': 1 TYPE: WALL ILLUMZNATION; INT CATEGORY; NEW
DIMENSIONS: 2FT OOIN 7{ 12FT OOIN AREA; 24.00Sl,�FT LETTER HT: S"
STREET FRONTAGE i; 225.00 S'I'REET 1: w 19TA ST
STREET FRONTAGE 2: 0.00 STREET 2:
PARCEL: 42214147 ZONE: C1 LOCATION > FRONT: X REAR;
BUSINESS NAME: LAS PALMERAS RESTAURANT > I.EFT: RIGHT:
O T H E R T O T A L S G R O:U N D S I G N
THIS ACT.IVITY . 24.00S FT OVERALL HEZGfiT: OET OIN '
THIS SITE 180,OOS�FT ., GRUUND CLEARANCE: OFT OIN
ITEMS OF INFO t 1 ,;�; PLANTER AAEA: O:�OOSQFT
ITEMS FOR ACTIjlITY• 1 BLDG SET BACi(: 20F'T-"�
COPY VERBIAGE : LA3 PAI,MERAS RESTAURANI - '
PLANNING NOTES: •,:t . � �
ik if fE �f iE it iE it IE iF iF iF IE jF iE k� if iF iE iE �F jE iE iE iE iE if aE iF iE 3E 1E if ii� 1F it if if !k iE �E if %iF if if if� if ir iFjf iE iE if iFif af iP iF iE 3F �F R jF iE �7E iF iF�7F 3F 3f 3E iF jE iE 3E 34 3f �lf
D E V E L O P M E N T S E;R V T C E S R E Q U I R E M E N;.T S
ZONING APPROVED BY
BUILDING APPROVED BY :.
APPLICATION ISSUED BY;
if iE 1F iF iF fE if if 1F 1f if iE iF aE iE 1! if if iFif IE jE'
LEGALZZATION:N , .
PERMIT
BLDG PMT
29.00
ISSUE FEE 18.85
i"--- 'i, '�-'
ra���i
PLUMBING ELEi
S U hyM A R Y
IC /MECHANIC
DATE:
DATE; �
DATE: lO/P�� I
STRUCTURAL SEGMENT;Y
SIGN SMIP/RES GRADING
24,00
SMIP/NON—RES
.50
BUITDING—DIV—> PERMIT ZSSUE P AN—CHECK TOTAL PA�lD DUE
TOTALS----> 68.50 15.00 18,85 102.35 102.35 .00
REVENUE DIVISION TOTAi�S--> C Li.ECTEb; 102.35 OVERJSHORT: 00
HLDG PMT PLUMHiNG ELECTRI MECHANIC SIGN SMIP/'POT GRADING PLAN—CHECK
29,00 30.0� 24,00 .50 18,85
3f 1F jE dF 1E 1E iE iE iE if iE df jE iE iFiE �lE aE aE jE #� iE1E 9F iE iE iE iE iE if iE iE 9f iE iE if iE 9F if if �If ik dE if�ic if 1F �1E 3F �f ik iF dE iFif �)f iE�� if �4 df dE34 #f �F �E if �lE �lE iE JF �IE iE �N-1E i6 iE * if�
I N D I V I D U A L F E E B R E A IC D O W N �
TYPE
ELE
QTY ° D E S G R Y P T I O N UNIT COST TOTAL COST
1 SIGN/ OUTLINE LIGFiT SYS ON 1 BR CYRC 15.00 1 5. 0 0
END OF FEES .
�3i �O1�GIII?—i6ir`Jii3 " � t-.;
DAT�' iG!1�t9; T7i5�: uc�:..
0
�`I��ONSTRUCTION AND PLANNING �
'�APPROVALS Permit # �,� ' � Date
1. Tempora�Y� Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. EI"ectrical Conduit Utility-Undrgrnd. . �
: 4. Elettrical Conduit-Undrgrnd.
'5.�Steel Reinforcement ^ �
•;,6. Electrical UFER Gmd. � -
� s� 7: • Footi ngs '.
.
�`�8� Foundation �- . � � � .
9. Water Pip¢-Undrgrnd. � , �
10. Structural Floor System � �
11. Property 5ewer L'ine•& House Connection .�
12. Sewer Cap � ' ,
13. Roof Dreins '> �
14. Rough Plumbing
15. Rough Elecirical•Conduit
16. Rough Electric Wiring
17. Rough Wiring $ign
18. Rough Electrical�T Bar. Ceiling
19. Rough Heating & Air Conditioning '
20: Rou9h Factory Fiteplace � ' -
i �
21..DuCt"s, in 5tructure. . - , - , . ' '`-
22. Ducts, Ventilating - � . . �
23. �Gas Pipe=itough & 7est ' .. _ .�, � �
24. Roof Framing � � � �
25. Roof Sheathing _ ' � .
26.�T�Bar Ceiling (StructuralF'& Monocoat
27. Frame and Flashing' t= " _ "• ,
29. Lathing & Siding - � - �
' 29. Insulatio'n = ' � - '
r
�30. DrywallNailing � - .� . _�.�' �
31. Plaster giown Coat�� • ' �� "
32.. Electrical Power Mete�-Final • . •
33.'Final Eleczric - , . Jz -� �
,34._'Final Heating_& Air,Conditioning .-
'�'35. �Final Gas Pipe-Test: � • �
,36. Hood oaCanopy . � ° �
• $7. Final Factory Fireplace
�38. Final Plumbing - . � �. �
�39. Water Service=Final ' . -
:40.,Gas Service�Final � . � r -,
41. Solar pomestic-Final � � • '
42. Backflow Preventer. • ;; ' �
43. Backflow Irrigation'� - �
:44. Landscape Irripatioh System . . .
45.:Sound Attenuation - •
r ._
.-46: Handicap Regulations = , .; . ` "
47. FINALS7RUCTURE&�BUILDING �
�s
:48:�FINALPLANNING �
�_49.;Electric Release to Edison
��50. Gas.Release to $outhem Califomia Gas Co
'51. CERTIFICATE OF.00CUPANCY
Date
POG ;PA
Inspector AppR V
O ALS Permit #
52. �Pool & Equipment Location
53. �Steel Reinforcement �
54. Forms
55. Electrical Bonding
56. Rough� Plumbing & Pressure Test
57. APPROVAL TO COVER�GUNITE
58. Electrical Conduit-Undrgrnd.
59. -Gas Pipe, O Undrgrnd., Test �
60. Backwash Lines, P-7rap, O Undrgrnd.
61. APPROVAL TO DECK
62._Backwash & Receptor-Final
63. Heater & Vent-Final ' '
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final � �
67: Fencing & Access ApProval
68. �APPROVED FOR PLASTERING
69. POOUSPA SYSTEMS FfNAL
' FIRE DEPT. REQUIREMENT �
c -'•. • �' � -
: APPROVALS PermiC# -
. 70. Underground Hydro � � -
"71..Roduct Pipinq 06as OOiI
72.�Underground Flush� " , .
'73. Undergrnd.StorageTank OGa,s d0il
- �74.�Overhead.Hydro ' - '
' 75�.-'�Dry Chemical � �
' 76. .Dry Standpipe j�`� R� � -
Y
•77. • FIXED SYSTEM FINAL � •
78. ,FIRE PFiEV. FINAL
. . HEALTH DEPT. REQUIREMENT
� � 79. F�INAL INSPECTION `� ,
0. �FOOD CERTIFICATE ISSUED � �
� ,
Notes
� �
h_ _ . , -.
i - �
. , - �
�
< - . �
�
o . _
i
,
�„ , .
. .� -
. . .n . . . . . _.
. ,.
. ,
. � � '! ' -
Date � Inspector
, I City of Costa Mesa �,: ' � � • �
bwelopment Services Department C E R T I F I C A T E O F O C C U P A N C Y No.
6uilding Safety Division
P. O. eox 1200
Costa Mesa, California
7he Building located at 580 West 19`Ph Str2et
has been inspected and found to comply with the provisions of all City of Cosia Mesa Ordinances appticable thereto
for a Grou
Use of Building
BZ Occupancy.
Legal Description 422-141-47
(See reverse side for Meres and Bounds)
Building Permit No G$1585 Electrical Permit No. G 51585 Plumbing Permit No. q S1S8S
Mechanical Permit No. G 51585 Number of apartments � and/or guest rooms
Fire Pre�ention Permit No. E 53738
ISSUED TO: .
Pierre &>rtolino
72SU tN. 1SlTtl St.
Costa Mesa, CA 92627
BuildingOfficial Tonv C'De Baca
�r• �/'
by �./: i , �. i" .� / .. '�--
� � Date September 26, 1991
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Build,ing Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. ,
CMF 3015•46 rev. 1/83 White -Owner, Cana�- � Numerical File; Pink - Bldg. Permit File '
Pfl0.1ECTR00flE55: SAO W �9TH ST
OWNEN'SNAME: �.yIFRRE BERiOI.INO
aooAEss: � 14 W 19 TH S I'
� CbSTA MESA
CA 9262'7
AHCNIENGINEEX:
� AOOflESS:
REG.NO.:
uNir. CITY OF CO5TA �ESA - HU:CLDING PERMST FERM NO; G OS]58`_
PER`,IT NO; G 051585 Pi.AN CHECA NQ: 00925-91 S GOVT: N Si3p ; N
CON TRUCTION TYPE:� PERMIT TYPE: ELE MEC PiU STR PJRPOS�: ALT
JOB DcSCRIPTION . INi. ALTERATIONS TO EXiSTING rZESTAi7RANT SQ FT: 1,000
UNIT:
PENMITTEE: ,�J� �_ppDENAS ( 213 ) 233-U306
noosess: SSU Lv 19TH ST
C.M, CA 92626
UCENSEU CONTNACTUB UECIANRTION: I hereby allirm that I am IicenseG unCer pmvisians ol Chapier 9(commencing with Section
7000) o� Oivision 3 ot Ihe Business and Pmlessions Cotle, and my license is in full lorce an0 effecl.
CITY LIC.: STATE LIC.: CLA55:
Oate: Signa�ure: -��-
WOfiNEBS'COMPENSFTIONUFCIABATION: I�ereEyaflirm��atlhaveacetlificateolconsemtoseli= oracertiliutealWorkers'
Comoensalion Insurance. o� a cenilietl copy I�ereol (Seclion 3800. Lab. C�.
yOLICY NO.: EXP. OATE:
� COMPANY:
I] Cerii�ietl coDY is �ereGy Wrnis�e�. ❑ Cehifietl copy i5 �iletl wilh I�e ciiy BuilAinA Di '' n. `'
'� I
Da1e: p001icanl: • �
E%EMPTION FBOM WONREBS' COMPENSF710N OECIAHRTION: �TAis section nee0 not be completea il ihe ce�mi� b lur ne hunOreO (31
I cenily Inat in Ihe pedormance of Ihe work br which Ihis permit is issueA. I shall not employ any pe6on in any manner so as
5u0iecl to the Wo�kers' Compensation LawS 0� California.
Oate: SiAnalure: �
NO710E: II, alter making I�is Oeclaration. yau stwultl bewme suhle�� �o I�e Workers' fAmp¢n5ation provi5ions ol tAe
COEe. you mu5i brt�vn�� comply wi�h sut� 0«sions or �NS Oefmii s�all E2 E¢emed revoketl.
CONSTBUCTION LENOING RGENCY: I �ereby aflirm Inal tnere is a cOnSimclion len�ing agency lar �he petlormant¢ ot II
w0ic� lhis permil is i=sueG (Seciion 3097, Civ. C�. ' /
LENUEX: � ``
nooness: �- �
for
OWNEB BWLOEB OECLABA710N: I herehy allirm ��at I am exempt tmm t�e Coniractors' State License Law im ihe followinA �eason
�Section 7037.5 Business and Pmfessional Coae�. Any city oi coun�y w�ich requires a permil to constmct, alter, imD�o�e, tlemolish, or
repair any slrucWre. Drior to its issuance, also repuires the aDDlicant for such permit to lile a siAneU slatement t�at h¢lshe is licenutl
pursuant to ihe O�ovisions of the Contractors' S�ate License Law �C�apter 9(commencing with Section 7000) ot Oivision 3 of the Busineu
ana Pmfessions Cotle) or that ne/she is exempt tnereimm an0 the basis for Ihe allepetl exemptian. /+ny violation ai Section 7031.5 by
any aOPlicantlor a Dermil suGjecls Ille aD0licantlo a Civil penalty ot nol more Ihan Irv¢ hunAreO Oallars (5500�.
I. as owner of Ihe proDeny or my emyloyees wiN waAes as Iheir sole compen5ation, will Uo I�e work, antl �ihe
� simclure is no� imenUetl o� o��ereA lor sale (Secimn 7044, Business anU Pmlessional CoCe: The Canlraclars' State License Law
Ooes nol apply to an owner ol a pro0eny w�o �uiids or impmves ihereon, anA w�o Ooes suc� work M1imsell/herself or thmugh
his or her own employees, orovidetl �na1 sucn impmvemenis aie not intendeA or offere0 tor sale. II, however the building or
impmvement is sald wiihin one year of complelion, Ihe owner will have Ihe bur0en o� pmving he/s�e ditl no� 6uiltl or impmve
lar Ihe purpose a� sale), ' '
❑ I, as owner of ��e proper�y, am excNsively contracting with licensea conlrac�ors to consimct ihe pmject (Section 7044, Business
antl Pmfessions Coae: The Comracmrs' Stare License Law does not aD01y Io an owner oi Dmpetly w�o bwltls or imOmves ihereon
ane wha coniracis br sucn Dwiecls witll a conimctorlsllicense pursuant to Ihe Contractors' Slate License Law�.l am aware
Iha� pmoi ol �heit Workef5 Compensati0n insurance 5h0ultl be O�a�itled lo me. '
� 1 am eaempt under Sectian: B. 8 P. C.
for this reason:
�ate: �- " '- Owne . ^�ri� �
I Do �ereby cetlity Iha� I am aware ol an0 un0erstantl Ihe requirements ol ahbmia Heal�h antl Safety CoUe Sections 2550.5, 25533. ana
25534 antl Iha� I or any Iuiure 6uil0ing occupan� willlwill no� (circle one) n etl to comply wiih said state code5 anA Ihe reQuiremen�s �or a
permil �ar conslmclion or motldicalion irom ��e Air Ouali�y Managemenl islricL Fesideniial conslNciian applications are exempt �mm
Inese provisions.
Date: Npplicant:
I hereUy cerWytha� I have reatl�his applicalion tl Slatei�at t�e aUoveinlormatian is corr¢ct. lagreelo comply wi�� all ciry and
orUinancesandslalelavrstelalinglo�uilUingco slmctionan0�ere0yaulhar¢ereD�esentativesollliiscity�oenteruponlAeaUove�me
pm0erry Ior inspeclion purposes. ^
G i�
Oaie: _1�/ ( � Signalure ��'�
ori�er's �icense or Saia� Security x: � �
ifiaLa6 W�i�e-Bmltling: Green-Caae Enlorcemenl: Canary-Aoalicant: Plnk-Ravenue: Goldenrotl-Assessor
*
N VALU:: ` 19,000.00 CALC-VALUE: 11,780,00 GROi7P OCC; B-'1 /
ENTS: REMUnEi EXISTING RESTAliRANT
IE �4 �lE �Y. ��'�JE �X ic if iE�If # �K �1f iE if iE �lE �1f �1E �1P �I(� if �lf �1F �M.-�ff dE-k #�)f �k i(� �iF �lE if �%-0F iC�dE df iE dF 3f �� 1f• iEif # # �7(� fE # if -0f� # ib �7h # if # �If �7EjE if iF �1E �7E dE 9F �JF �X �� dE �K
'L O N I N G R E Q IJ T R E M E N T S
S E T B A C K S _
\-
-------- MAiN BUILDING ---------- --------- ACCESSORY HliSLDTNC ----------
. FT IN REAR: FT IN FRNT: FT' IN REAR: FT SN
. r"' IN RGrT: FT IN LEFT: FT IN RGIi3: FT IN
PARKING REQ: PROV: PARC'EL: 42214147 ZNE: Ci ?EF NO: �_
PLANNZNG NC7TESi T ANT IMPROVEMENTS TO FNSTALL RITCHEN HOOD AND AN ?lIR-
> CON TiTONSNG SYSYEM ON THE ROOF,
N�dF iF-lE if �� iE #��lf -7E#�3E iF iF #� iE #' ie'. jj``. ic dE jE iE iF+F ic jE dE If Y�!E �tE'k �if�iE iE iF: uir ie �3E �iE�1f •)f df �i(•�tf �)f �Y )F�%i if iE �E iF d(� i: K�%{�k ii� iEi644 �Y iE iF 9E aE �7Et iE ��
n E V E I, O P y E N T S E. R V Z C E S; �- R E Q U T R E M E N, "i 5
`l,ONiNG AFPROVED &Y / (' �J � �- DATEc `-����
BiTILDING APPROVED HY : ' DATE;
APPLIC:4TION ISSUED BY; .' ���� /(..��-� DATE: �/(� �I �I
i;�IE�f-lE1f�1E1E+f�k*�1E�1Edfafif�E#�lE�1f��dEih. , ..:.:. . . .. . .. . . #�A#lF���RiFKiFX�xiE�lEif�If�1s�3E�l'-IE�E3FIF"�£� 3F'��Y:3F �
-IC� df iE �k iF �f iF df iFdFiE 1F-!f #f �lf� iE �f if if 3f �lF-1f 1E�7f �N� �k �'tf� if �i 1f dC� aF'3E iF if �Y���K. iF iF iF !i• M: �E ?c.k 3i >'.2i.?i a++<?e>': �: i� 7F •le �E+F Y'iF �k �lf �K �F?F�1F iF �K� a4 ��caF �Yi �if if �k 9f if �7f
I,EGALiZATIplV:N F E E�. S U M M A R Y ;;ti��,1:;fiGt(rtLS.G. �i�Qzi'?'.�NT�:.'�
AI�DG PMT PLUMHING ELPCTRIC MECHANI`C FIRE 5MIP/RES GRADING
FERMIT 135,U0 14.50 37.R0 29.00
25R 50$ 25$ :iMIP/NON-P.ES
PLAN 87,75 Z,47
ISSliE FEE 3,00 15.Q0 i5.00
HGILDZNC-DZV-> PERMIT ISSUE PLAN-CHECK iOTAL PAID DG�
TOTALS----> . 2i8.77 33.00 87.75 339.52 339.52 .00
REVENUE DIV77I.ON 'f<�TAL5--> COI.,LECTEI): 251.i? OVER/SHORT: UU
HLnG PMT PLUM(��.NG ELECT1iIC MECHAN:CC FIAE S'MTP/TOT GRADING PLAN-CFiECi�
135.00 17,50 52.SU 44.U0 2,4j '
-)( �k 3f if 9f ii� YF iE iE df IF 1E �If #��-If if �if. �if df �lf 9E lE �%� �IE iE 1E �If �%iE �%# # if �k ii �iE lt �1� �k if �K dE it dE iE if if i(� iE �Y.- �1� if lE �k� �)� k if T�%j(� 9E ii3!-�Y.-�Y. �Y. dF iE K� �lE �)E i(� k?E if 3k %iE
I N D I V I D U A L I� E E H R G A H�D O W N �
/
TYPE Q1Y D E S C k Z P T Z O N liNZT COST iOiAL COS't
5FC
ELE
ELE
ELE
ELE
ELE
MEC
MEC
MEC
PL[i
PI�U
RES-INT. ALTER TYPE V-N -AVER
F1'XTURES, LTGHTING 1 ST '10 EA,
RECEPT/OCiTi�ET 1 ST 20 EA,
RECEP:/UUTLEi ADDT'LTONA7 EA,
�MOTOR /POWR APPARATIiS 0. 0 - 1. , 0 }iP
5IGNI UuTLINE LIGHT SYS ON 1 BR CIRC
TNST FORC-A�R/GRAV FURN <= 100 IS BTU
REFRIGERAIION SYSTEM <= I00 R BTli/H
INST HOOD W/DUCiS FED BY MEC EXAA[ISi
WASA BASIN
GAS SERVICE
i1.78
.?5
.75
ds
3,00
i5.0U
9.00
o i aoe�a�s°� o-a
GATE: �;rn'�'9
1i,780.00
9.00
6.00
i,ao
6.00
=I.00
9,00
9.p0
�'�3T 6.Sa=•7,-
. ii:11 �.00
2,00
I `_
C�NSTRIY'.TION AND PLANNING P d' SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector '
1. 7emporary Electrical Service or Pole 52. Pool & Equipment Location .
2, $oil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. 5teel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electriwl UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7, Foo[ings 58. Electrical Conduit•Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test . �
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Foof Drains 64. Plumbing System � Final
14. Rough Plumbing � 65. Electrica�-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring 5ign 68. APPROVED FOR PLASTERING
18. pough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT�
20. Rough Fattory Fireplace APPROVALS Permit #
21, pucts, in Struc[ure 70. Underground Hydro
22. Ducts, Ventilating ' 71, Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough &' Test 72. Underground Flush
24. Roof Framing� 73. Undergmd.StorageTank OGas ❑Oil -
25. Roof Sheath�ng 74. Overhead Hydro
26. T-Bar Ceiling (S[ructuraq & Monocoat 75. Dry Chemical
27. frame and Flashing � 76. Dry Standpipe
2&. Lathing & Siding . • 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Air Conditi0ning � �Q� G�O �
35. Final Gas Pipe-Test �7,�q,� G� '
36. Hood or CanopY � (�'J
37. Final Factory Fireplace
38. Final Plumbing '�j�q� ��
3g. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer ' "
43. Backflow Irrigation '
44. l.andscape Irrigation System - .
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUI�OING ..`?� &c�/
48. FINAL PLANNING � •
49. Elearic Release to Edison �
50. Gas Release to Southern California Gas Co �- �
51. CERTIFICATE OF OCCUPANCY
No Date
PflOJECT QODNESS:
' aWNER'S NAME:
p�OflESS:
AflCHiENGINEEfl:
� AUONESS:
PEPMI7TEE:
aooxess:
NEG.NO.:
UNIT:
UNIT:
LICENSEO CONTHIILTOfl DECLANATION: I hereby affirm that I am IicenSeU wGer pmvisions of C�aO�er 9(commencing wil� Seciion
7000� ol �ivision 3 0l i�e Business antl Pmfessions Goae, ana my license is in lull force an0 efiect.
LITY IIC.: STRTE LIC.: CIASS:
Date: Signa�ure:
WOHREqS' COMPENSATION DECUIPATION: I h¢re�y a�hrm Ihal I �ave a cenifiCale oi ton5enf ro Sel4insure or a tertilicaie 0� WOrkers'
� Compensaiion Insurance. or a[erlilietl copy Ihereo� (Sec�idn 3800, Lab. C�.
�OLICY NO.: EXP. OATE:
LOMPqNY:
❑ Ceqifiee coDY is �ereby lumis�etl. ❑ Cenilipa copY is �iled wiih 1�¢ ciiy Building Oivision,
Oa1e: Ppplicanl:
EXEMPTIONFNOMWONNEXS'COMPENSAilONOECIAflATIDN: (ihissttlionneetlmilxrompleledillhepLvmilislaonelxnM�eC�51W)akss).
I cetlify ipat in �he pedarmante 0� the wark �or w�ic� Ihis DQ�mii is iSSu¢A. I shall not employ any Derson in any manner so ds la become
suble�� �o I�e Woikers' ComD¢nsa�ion Laws oi CalifOmia.
�ale: SigreNre:
NOT�CE: If. aller makinp Ihis declara�ion. you shoultl Oecome suhlecl 10 the Workers' Compensafian D�ovisions of lAe La�or
Code. you musl forihwi�� �ompry with suc� pmvisions or ��is permi� s�all 6e tleemetl revokCO.
CONSTPULTION LENDING FGENCY: I hereby aflirm ihat t�ere is a constmc�ion IenOing agency for tAe De�ormance of i�e work for
whic� Ih�s pwmil is IssueA (Sectlon 3W7, Clv. C).
LENUEP:
IIUGHESS:
OWNEP BUILOEfl OECLAPRiION: I hereby atlirm Ihal I am exempl imm Ihe Conlraclors' State license Law br tM1e lollowing reason
(5¢ction 7p31.5 Business an0 Profe55ional Coae: Any cily o� couniy w�ich requires a Dermi� lo con5�mci, alier, improve, demoliSM1, ar
repair apy Simtlure. p�i0r IO iii i55uante. also require5 t�e aOClicani �Or SUC� p¢rmil IO tile a SigneO s�atement IIIdi �PJsh¢ i5licen5ed
Dursuan�iolhe O�ovision5 Olihe Conlratiors' Slale LitenSe Law�ChaD�er9(commenting vn(h SeciiDn 70fI0�ot Oivi5i0n 3 at Ihe Business
an0 Pm�essian5 Cade� or ��ai he/S�e is eeempi Iherelmm ane I�e GasiS br �he ali¢Aed e*emplion. pny vi0lation ot $ecli0n 7031.5 Uy
any ap0licanl lor a p¢rmil SuUjet�S I�e appliCani�o a uvil penaliy Oi no� mOr2 I�an five �UnEretl Gollafs (5500).
I. as owner al tAe pm0eny or my employees wiih wages as t�eir sole compensaiion, will tla lhe work, antl Ihe
❑ stmcmre is not imentle0 or oileretl for sale (Section 70ad. Business antl Pmlessional Cotle: The Conlracrors' Slale license Law
tlaes not apply to an owner ol a pmperiy w�o builtls or improves �hereon, and who does Such work himsel�/herSElf or �hrough
his or her own employees, pmvitletl t�ai such improvemenis are n0t inlentled or olle�etl for sale. If, �owever ihe builtling or
impmvement is soltl wilhin one year oi coniplelion. Ihe owner will have ��e burtlen o�,provinA he/she tli0 no� Uuiltl or impmve
�a IIIE pulp05e D) 5318).
I. as owner ol Ihe pmDerly, am eKclusively contrac�ing wi�h licensed ConVactors m constmc� t�e Drolecl (Sec�ion 704d, Business
❑ antl Pmleuions Code: T�e Coniractors' State License Law Goes nol aDPW �o an owner ot properry wAo bwlEs or improves t�ereon
and who con�mcts lor such O�olects with a conlracloqs) license Dursuant to t�e Coniracbr5' State License Law�. I am aware
Ihal O�oa� ol I�eir Warker's Campensaiion insurance s�oula Ee pmvi4e0 to me.
� I am eKemD� untler Seclion: B. 8 P. C.
for I�fs reason:
Date: Owner.
i tlo hereby cenily inai I am aware al an0 un4erstan0 ihe reQuiremenis al Calilomia Healih antl Safery Code Sections 25505, 25533, antl
25534 an� Ihal I or any lulure builtling occupant will/will nol (cucle one) neetl to comply with Saitl state cotles antl t�e repuirtmenis lar a
permi� �Q� consVuction or motlilicalion imm t�e Air ualily Management Oisirict. FesiOential conshuciion ap0lications are exempl imm
ihese pfovisions.
Date: � AOViicanP.
I hereby cerlify thal I have reatl Ihis applicalian antl sta�e Ihal �he above inbrmalion is correcL I agree to comply with all ciry antl counry
or0inanq¢s antl slale laws relaling lo �uilding conslruclion and �ere�y aN�or¢e represenlalives ol this ciiy Io enler upon Ihe above�men�ione0
pmpetly for ins0ec�ion pur0ase5.
Da�e: SignaWre:
D�iver's License o� Sociat Security x:
164�-G6 Whi�e—Boiltling; Giean—Code EnlorcemenC Canary—Applicam: Pink—Bevenue; Goltlenro7—Assessar
PERMIT NO; G 051585 PLAN CHECK NO; 00925-91 S PAGE; 'l
it ie iF iF if i!� k!E k�f iF #� 1(� iF lf 3f ! 3F i(� iF �� k iF if if iE if i(� i�• 1F 32 fF�1F a!lE+�.� if iE 36 #� i�-iE iF 3f?F !!� ie ik i(� �1F 1E if ii�?F iF if ii� i: iF �36 IE dt 3E ii� ii� 3!� i'r k 14 if i?� if iE ii� 3t 3f IE 3!-
TYPE QTY D E S C R Y P T I O N UNIi COST TOTAL COST
PLii 1 GAS PIPiNG SYS OF 1 TO 4 OUTLETS "1.00
PI�U 1 GAS PIPING SYS 5t OU7'L-PER OUTi.cT 50
PLU 1 SiNHS, COMMe.RCIAi, OR ZNDUSTRIAi� 2.00
PT,U 1 SINKS, =LOOR '�,00
PLU 1 SINI(S, SSRVICE / MOP Z,00
PLU 1 WATER RE-PIPE �
MEC 1 VENTII.ATION FAN CONN TO SINGLE DJCT 9,50
END OF FEES
i
y
2
2
4
'l
2
4
00
40
O O
SQ
'�1�.%L��Pi._Z���� �1.�L��17.: ! i:
02� i1�034sifi-OG08431� 'E �''J '<SS. ';
DATE: Q4;08(91 TIliE: 11:5(
� CONSTRUF:TION AND PLANNING�
APPROVALS Permit #
1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electriwl Conduit Utili[y-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe-Undrgmd.
10. Structural Floor SVstem
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17, Rough Wiring Sign
18. Rough Electrical�T Bar Ceiling
79. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T�Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation �
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
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. Backflow Preventer
43. Backtlow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Q
No Date
Date
e
PwL & SPA
Inspector pppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical8onding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER�GUNITE
58. Electrical Conduit�Undrgrnd.
59. Ga: Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater& Vent�Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar SYstem-Final
67. Fencing & Access Approval
66. APPROVED FOR PLASTERING
69. POOUSPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd.StorageTank OGas ❑Oil
74. Overhead Hydro
75. Dry Chemital
76. Dry Standpipe
7�7. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
Date � lospectm
PNOJECT AOOXESS: S B O W 1 9 TH JCT
owxensr+nme: PIERRE BERTOLINO
aoonEss: 514 W 19TH ST
" COSTA MESA
CA 92627
AflCH/ENGINEER:
AODPESS:
flEG.NO.:
uNir: I CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F 05373
PERMIT NO; F 053738 PLAN CHECK NO: 01392-91 S GOVT: N SUPP: N
UNIT;
Paosess: E.0 FIRE PROTECTZON CO, (213)752-999�
• j�j1g9�0(`SHADUYyDALE AVE
LICENSEO CONfflRCiOp-�CCA�Fq�j�V I by aitirm mat I am �icensed uneerCpA"sio9ns of�9pi�er 9(commencing with Secti
7q10� ol Division 3 0l Ihe Business yn0 Pro�essions CoOe, antl my license is in lull lorce and eflecl.
LITY LIC.: STFTE LIC.: CU15S:
04 22 521052 —1
�atei _ Signawre: _ _ _
WOfl BS' CO ENSAT 0 ECIAqpTION: 1 AereDy affirm a have a if Ie ot c nt to seli-inmre or a cenificale ot Workers'
Compensation Insurance, ot a cenilietl copy ihereol (Section 38 . LaU. G.
POLICY NO.: /• E%P. OATE:
COMPANY:
� Cenified copY �s Aereby lumis�¢tl. ❑ CenifieA capy is filed with ihe ciry Builtling Oivisian.
Date:
Applitant:
EEEMPTION FROM WOPNEHS' COMPENSFTION UECLrIflATION: (1�is seoEon neeA no� �e campleietl if the per i�ys lar one hunOretl ($100� or less�.
I cetlily Ihal in Ihe pedormance o� Ih¢ woB �or which �his permit is'fsue4 I s�all no e ploy any per n i� any manner so a5 io become
su�lect he Workers' Com en5ali0n Laws o� Calibmia. /
�ate: SipnaWre:
OTICE: If. alter making ihis d@ctaration, you shoul ti ome suDiect orke '[ CDry ensati n provisions ol ihe La
COAe, yoU mus� fotlhwilh Comply wi�� Such pmvisions or Ihis permif II �e OeemeaTEvokeJ.
CONSTBUC710N LENDING pGENCY; I here0y aliirm that t�ere is a construclion lentling agency lor the peAarmance al ihe work lor
which this oermit is issued (Section 3097, Civ. C�.
IENDEN:
p00NE5S:
OWNEfl BUILOEN OECNPIITION: I here0y a�lirm IAat I am exempl lrom lhe Conlractors' State License Law �or Ihe lollowing reason
(Seclion 70J1.5 Business antl Pmlessional Cotle: Any ciry oi counly which requires a permit to conslmcl, aller, impmve. Aemolis�, or
repair any siNcture. prior ta its issuance. aI50 ROuires ine applicant for such oermit to file a signe0 statement that nUsne is IicenseA
pursuant to the O�ovisions ai t�e Con��acmrs' State License Law (Ctwpter 9 Rammentlng with Sectian 7000) at �ivision 3 al t0e Business
antl Prolessions Catle) or I�a� �e/5Ae is eKempllAerelrom anE �he Oasis lor �he all¢ged exemp�ion. Any violation ol Se[fion 7031.5 �y
any apDlican� br a permi� sublecl5 ��e appliCanl to a civil penalty ol na� mor¢ ihan �ive hunOretl tlo11ar5 (55110�.
I. as owner ol ine pmpeny ar my emyIoyees with wages as iheir sole comDensalion, will do the work, and ihe
❑ Slmtlure is nol inlen0etl ar 011¢red tor sal¢ (SeCtion 7044, BuSiness an0 Prolestional CoOe: T�e Comraciors' Slale License law
Uoes noi apoN �o an owner of a pmpeny wlw builOs or impmves tnerean, antl wno does such woM1 himseiBherself or ihmupn
�is or Oer own emDloyees, pmviGeA Iha� sucll improvemenis are not intenCetl or oflere0 for sale. If, however ihe huiltlinp or
improvement ¢ solE wii�m p�e year ol completion. t�e owner vrill have ihe GurEen of D�oving �e/s�e Gia nat Uuiltl orimprove
lor Ine Durpose of sale�.
1, as owner ol the pwpeny. dm exclusively contracting with licensetl contractors to constmct the D�ole�� (Seclion 70aa, Business
❑ an0 Prolessions CoOe: IM1¢ ('qnira[tOrs' Siale License Law Oces no� apPly to an own¢r 0� O�operty who �mias or impmves t�ereon
an0 w�o contracts lor such p�olects wi�� a contracloqs) license pursuanl to Ihe Coniractors' State License Law�. I am aware
�M1a� D��� ol lheir Worker'S COmpen5ali0n insurance SMula Ge DrOnOetl �o me.
� I am exempt unGe� Semion: B. 8 P. C.
lor Ihis ieason'.
Date: Owner
1 Co �ereUy cenily t�al I am avrare ol anU unCer5lan01he reQuirements ol Califamia Health and Safery CoOe Sections 2550.5, 25533. antl
2553<an0 inal I or any luture �uilOmg occupanl will/will not (circle one� neetl to comply wi�h saitl state coJes anA tAe repuiremenis br a
permil br conslmclion or mo0i�icalipn Imm Ihe Air Ouality Managemen� Oisirict. flesidential cons�mclion applicalions are exemp� irom
Ihe=.e pmvisions.
Oale'. ApplicanC
I here6y cetiily t�al I have iCaO IhiS applitali0n an0 Slaie Ihal lhe ab0 informa�ion is correcL I agree m comply vn�h all city anJ coun�y
ortlinancesantlstatelawsrelalinglobuiltlingcon9mdionandhereEy �orizerepresenia'vesail�iscity oen�eruponihea6ove�menlione4
prOpCtl r inspeClion pury05es.
��
oa�e. ` Signamre:
y�river's Li�ense o� Social Sewrily x: `.
�64v46 W��ite—Builtling'. Green�Coae EnlorcemenC Canery—ApPlicant; Pink—Revenue: Goltlenrod—Assessor
CONSTRUCTION TYPE: PERMIT TYPE; FIR PURPOSE: ALT
JOB DESCRIPTION : INT. ALTERATIONS TO EXISTING RESTAURANT SQ FT:
CLAIM VALUE: 1,050.00 CALC—VALUE; GROUP OCC; B-2 /
COMMENTS: CHEMICAL FIRE SUUPRESSION SYS RE•G51585
�t�**�*�*�x****r�r*****�r**�t�t�t**�**�******�e�**ir�r�t***�r*�***�r�*�****+�*�*+t�t�t**�r�r*�**�t
Z O N I N GS EftTEB�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING AEQ• PROV: PARCEL: 42214147 2NE: REF NO:
PLANNING N15TES>
)
iF iE if �E ItlE iE if iE 1F if iF k fE�F �t it af ik if If IF fF it 1E iF If iE k!k �F If iElf if 1f iF 1E if iF if if k iE ikiF �E If iE If �E iE af �f 1F �k!!iE iE IFlE �f iE iE fE �f iFlF %1f iF iF if if if it IF if 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
HUILDING APPROVED BY :
APPLICATION ISSUED BY;
�r******�e*****�****�r***
IF iF iF k if iF IE iE iF iF iF iF iFlElF 1f iE af �klF�F iE iF aF iF iF iF 3F aF IE ik k!f !t if if �f 1f ft iEiF
LEGALIZATION:N F E E S U M
BLDG PMT PLUMBING ELfiCTRSC
DATE;
DATE:
T
DATE:
����r�r��***��* *�r
M k�f iF �k if iF iF 3f ±f if iE iE iE �F IE aE �E �E IF �E �F M!F k iFif if if iF if iF iE
R Y STRUCTURAL SEGMENT:N
MECHANIC FIRE SMIP/RES GRADING
PERMIT 27.00
: �+ 652 SHIP/NON—RES
PLAN — � 17,55
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 27.00 0.00 "',�17.55 44,55 49.55 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 27.00 OVER/SHORT; 00
BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/TOT GRADING PLAN—CHECK
, 2%,0�
df 1E1t1f �f if �f 1f iFif jE 1E iE �)f if �E 1f �F dEiEiEjE if �E 1k1f 3EiE1f iE if �FiFif if it if fEif 1E if if if if 9F If iE�E if if if if if iE iE *if 1E iEjFiF iE iE iFiEjE iEiEiE �E 1E �E9E iElE IF ik if if
I N D I V I D U A—I. •` F E E B R E A K D O W N
TYPE QTY D.E S C R I P T I O N UNIT COST TOTAL COST
FIR 27 FIRE EQUIP FEE (FAOM`BLDG VAL TABLE) 1,00 27,00
END OF FEES
r�
K�y �,
� t_,
'� �,
�
�
O1 C��9�o'�-0'CL4�453 �•=a' — ,,;
p�1TE: ti4�0-�9f i ���.: r;�...'.
! � �
CONSTRUCTION AND PLANNING � P'00' �PA ' !
� APVROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector �
1. '�emporary Electrical Serviceor Pole 52. Pool & Equipment Location .
. ,�.
2. Soil Pipe•Undrgrnd. � ' 53. Steel Reinforcement
3ryl�t�ical Conddt`t�5lity-11Y1dPgmd. . 54. Porms ' .
pYq�IC,�"�t��cal Conduii�hdr9rnd. 55. Electrical Bonding �
�. St2el-Reinforceln� � 56. Rough Plumbing & Pressure Test
I� :M', '�
✓b�"''��setrical UFEF�"�ryc� iz' 57. APPROVAL TO COVER�GUNITE `T-
n ,., J.� • 01 V
r�;;%botings tCC o 58. Electrical Conduit-Undrgmd. �.
�'� Foundation -` �• 59. Gas Pipe, O Undr rnd., Test G
R:JI 9
�'.' Water Pipe-Undigr.pFi. ' 60. Backwash Lines, P�Trap, O Undrgrnd. �
10. Structurel Floos ystem � 61. APPROVAL TO DECK
11. Property Sewer }.ine& House�Connection 62. Backwash & Receptor-Final
72. Sewer Cap • `+ � 63. Heater & Vent-Final
�1 rc -
13. Roof Drains �
64. Plumbing SYstem - Final
14. flough Plumbinq = " 65. Electrical�Final
75. Rough Electric�h�Conduit � 66. Solar SYstem-Final
' 16. Rough E�ectric iring 67. Fencing & Access ApProval
17. Rough Wiring S�n 68. APPROVED FOR PLASTERING
18. Rough ElectricaisT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
4 l I I. l l ' TI--. �i-' Q. :F !� lY
20.�.ough Fg�torg Fir�place , a[.y .,t-; ;� J;� !r�, a: �diPPR4T�/AL$i;�,_;C,Perrv.it# -
� . � �.
214�iuGt'y, in�tr'q�.tu,�; '� 1 e-�F+ .TS M r-' `^ '7+� f • J � x- ;-�
�-. F '[�;�! .. . i-+S � :> C7 .�n � -,90. U�det�'¢un�Hyr�}o
22.`�Duci3. Jeptilgting.,* � �jY � '� S �;,M r v77. ProductP'rPing � Gas O:OiI
_ �-
23.2,as�PipetRoyqh &•Yest � �^ x "' J�` F`72. Under i1iLn� FI ^tc? '` �-s
�-. � a I n) S 't 1 CT !i w�a f-+ 9 v . � r �
24.�Roo'�FraminfyY'. ;�:� � %ri�� �..f.• �7 O � > � �3.a11ndergrn�StoraQe�ank 9Gas �OOiY
25. Roof�Sh�athing Y!' r OJ +: rr, ��q �, N* ��q C,�verhead WydroO�' �
�-.a < v i�k �. t..:x �.
C r- 'K ^ rq 7v ::
26.�'-Bar,Ceiling (Str(iclural) & 64n�ocoat x �� i7 �q:.> 75.cDry Chemical ` -�.p: p1 .. ��2�Q�
27.t.Frame and Fleshi��� a%� �. V w��� �� 76.FDry Stan �pe �T K J �� r�
a N;r: N[i7iJ 7' ::: ?+# .Y. ✓ �.: , �K i7 N
'F�,B. , Laihing � Sidyng�4m �: ��d"^ � # Z •• �: M 77.� FIXED S�'iS,3EMj�INALx �r
:Y19. Insulatio�r n r� H" "> '!n i v. 78'- IRE PREV. FIIVAL W� �. - �•ZS.i��
� "^ ^ pl'S :J *S cfi� U� 'ti 1
�0. Drywall�7ail�qg pW w , y..: �,..i HEALTH�,fj)EPT;;R.EQUIREMENT
�31. Plaster 8�ipwn Co6i��� �� � I j -^ 79.�FINAL INSPECTIOifJ ; t�' '�' ?T�
r'� n. r,�t -' i i�r�r :� �K rr t� tn
Lr t_ � I f-�F' :K � � %':k A. '� " ' F-
�32.�Electrical„Powpr N1'gIe �Final i ;� � ` .� x�;SO.�f00D C��7IFIEQTE ISSUED .�
V� '
3.'�inaYEl�'dirid GX � � C^ '� C�7 ( � � N * n�Not�s: �" ^' '" ' '.- ^+"�
�, �. r , . � t�. � , �i.��l•qi��n �_ D`��„�� IE�1 �l'
'�"�4. in H atin & R.i � �^ �`. � 1 : x' [� � M^ � ` =
.� !F �i �- g? ,.jnC��tio��S ;l :� � � �•/, , 0 �S.-t���n._��_�1? • �'2.k_
5.!$in27�Gas PiP�:•Testt m .t'� i;�,%t. .: !i �-� r_5 x h� �-;^,
.'\ I � '�' I F - ll'
' � � .. .� � .• ; � I �! � !�f' �, �^, • •�� �e t
�36.'�Ho or� noPY.�:n'_7 i(r•-� c xC7 � C i.�`k.'2. � ,v x ^t�'
.-, . . . .. � � .. ,.. .. . , .�. ..._ . . ::
'37.�inal;FaEtorv Fir�kce� � si� �: ?'t�� i i'�{*,+: i, c" * J .'
^r i c. t� .>' J x '�' N
�8..Fin3.Pl�bin '" •` �.. .. w x. N t �� 4 Q tr;,a -.
� 9�., N i ;e , 4�: �K S i�:� x m �-
,., .
� 9.c.\Nacm Seiyice-FinaJs i � x I I >. :� �+r•i� �' CC �
x c n
40.`�GasSer �ce-Final� �' � �f I ' `"G' ' X'`� `-�
[rf i �- t [n �Ct*'t�' S x� ln � � x �� oN � --
� �
L�olar pomestirFinal � ri .. .t. n � ! �� : �dv �-a *
I . , •-i, � :r .. .r -,
�42.�'9ackfloJ�Preventer�' `•" �'� r � � � 'y� v �=! � S
> v * I � b. . �:; >t' x ,.
5J .l �i r� ••`. - .
� 43. Backflow Irtigation* txS,S i � :.� * � �cacn� ixt � C � '-�
W Y Y' I1 / C
=44. Landsc I y � " g
c�, �(te �qatia� S sterr�x,�'�`.+, a :t nl C U G'+ t- t��', N N '.�^ v� '� c
x r �
�45.;�ound �teqyationF: .�cKF• n' �k z. E- x�r. :'1 N i- � a. i �, .t- y
'-, r r�.- x
��6.cHandicap'Reyulatio�s d � n�`� r;� �; � s Cv ;S >
�47.�1 AL STRU-.CTU E & BU{iDING � �. � I � � (e� :Y �= i+; j "� �y
n. r.� l ��-�` h+ t-� s
�48.,�,EIfV�,LPLANNIN(ir �t'+tr z. I '�:t.^J � '7 x G
�r I C��F• :r. ^) �! y,., a�. tn LYl �;, n
;99.r��-PEleciric Rele�se to Edison : r ; � '� x z u; '� �i' < �+
•'/f � .r, w r +
,;150._Gas�ielease to Southem Calijor�i� Gas Co a � / � S ^ "'`' �` r� �'
., I ( E� � : � � o • :.:tn :�
�1. CER•1'IFICATE OF.�OCCUPANCI` y'� ,� C �no � x c• o
No. Date
� (
:
�.I
i
'' c� k;
CiTY oF COSTn nnESA ,'C1ONS.{T�RUCTI�N PERMIT
ProlectAddress �R� W. � `- �+
Applicant's Mail�ddress / uf
. �
Owner's Name E � - Phone ��-�
Address 0 �'�-
.hreh/Eng. "cens No. 31
Address
Con[racmr'sName �Phone ��
Address (mailing) -7 %�� "� ^` `
City License No. ��7� /
LICENSED CONTRACTOR DECLARATION
I bereby aflirm lhat 1 am Ilcensetl Lntle� p�ovisions of Chart¢r 9(mmmencing
with Sec[lon ]000) of Dlvislon 3 of the Bu5ine55 dntl ProteSsions Cotl¢, antl
my Iicensa is in /u�.{orce antl effect� —t_ `�
Licen�� r acc lS 'ce e /
Da[e ' ' Signature
WORKERS' COMPENSATION DECLARATION
1 hereby aHirm tnat I have a cerUticate o( consent to seli-insure or a certificate
of Workers• Compensation Insurance, or a certitietl copy thereo( (Sectlon
3800, Lati. C. (1�- �
olicy No.q�-73-.5�'37�_3 Company aXAA� �f�'�
Cer[ifietl copY �5 hareby furni5h¢
Certif'etl op 75 filetl with the ci y B' tling y" o.
Date Applicant ' —
EXEMPTI N ROM WORKERS' COMPENSATION OECLARATION
(This section neetl no[ be completetl if [ne permit is for one huntlretl ($10 ) or
Iess).
I Cerlily [hal in lh¢ perfOrmance of tne work for which this permit Is issuetl I
shall not emplOy any pe�son in any manner So as to b¢cOmC Subject to t�¢
Workers' Compensation Laws ot California.
�a[e $i9nature
NOTICE: I�, after making this tleclaration, you shoultl become subject to lhe
Workers' Compensation Provisions of tlte Labor Cotle, you musl (orthwith
mmply with such provisions or this permit shail be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby atllrm that thare is a conztruction lentlin9 agency tor the performance
o( the work for which this permit is issuetl (Section 309� Civ. C.)
Lentler's Name
Len�er'S Fdtlress
OWNE0. BUILDER �ECLARATION
I hereby atflrm [haY 1 am axemp[ from the Contracto�'S License Law for [he
tollowing reason (Section 7031.5 Business antl Protessional Cotle: Any tlty or
counly which �equir¢s a petmit lo conitruct, alter, improve, Oemolish or repah
any structu�e, prior'tb:ils i55uance, also reqWres tM1e aOPlicant for such pe�mi[
t0 lile a Signetl statemenf Ihat he/she i5 licensetl pursudn[ to [be 0/ovi5ion5 of
the Contractor's Li<ense Law (Chapter 9(wmmencin9 with Section �000) of
Dlvision 3 of the Business antl Professions Cotle) or tbat ne/she-is exempt
ther¢(rom antl the basis tor the allegetl exemption. Any violation of,5ectlon
'031.5 by any applitant for a permit subjectz the appli<ant to a civil
�enalty of na[ more than five nuntlretl tlollar5 ($500).
U I, as owner of the property or my employees with wages-as their sole
comp¢nsatlon, will tlo tbe work, antl the structu�e is not infentletl o� o(fer¢tl
ior sale (Section 7044, Business antl.Professional Cotle: The'Contraclor's
LicenSe Ww tloes nOt apply to an owner ot a property wh0 builtls o� improve5
thereon, antl who tloes such work himself/herselt or throu9h his or her own
emO�oY.ees, provitletl that such improvements are not intenaetl or ofle�etl for
SaIB. If, nowever, the builtling o� imprOvement is Soltl within one yea� of com-
pieNon, ihe owner will M1ave the burtlen ot proving M1e/sM1c tlitl not builtl or im-
��ove for thC pu�po5¢ of sale). � ' ,
LI 1, as owner of the property, am exclusiv¢ty contracting with Ilcensetl con-
tractor5 to construtt Ihe project ($ection ]044, B�5ine55 dntl Profes5ion5 Cotle:
The Contra<tor's License Law tloes not apply to an owner of' property who
builtl5 or Improves inareon, and wtio <ontracts for 5uch projects wi[h a con-
[ractor(s) license pursuant [o the ConVacto�'s Licenze Law). I am awa�e that
proof o( their Wo�ke�'s Compen5ation insurance shoultl be provitletl to me
❑ 1 am axempt untler Section B. & P. C. for this reason
Date Owner _
I neieby certify �Ihat I have reatl thiz
Intormation is mrrect. I agr¢e to Comp
antl itate law� yrelating to builtling con
seniatives oL+[ Is�ty' tp�e er }+p9i
inspection pu�pDet // iY.
Siqnature Cll [I.IX C1/�
Drivers' License or 55 �' ��¢]-%
[at¢ tha[ the abOve
tl county ortlinances
•by authorize repre-
lone�l property_ lor
�i "C�
D'ute�
�
-_-
:ant <o fill in aIl spaces excev� tnose witnin neavy bortler lines ana sign a11 approorlata aeel
PE IT NO.' Tg�� CT� NO. LOT NO. ' UN`IT NO.
�o� %T a.� . '7�l/ll/-tC�fl -�
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R
❑ CONVERSION ❑ DEM OTHER
DESCRIPTIONOF WORK USFQ BLDC � ( � �
TVPEOFPERMIT LJGRADING LJFOUNDATION YSSTRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER t
PROJEC7 DESCRIPTION 5�. F oCCUaANCv '
CONSTRUCTIONTVPE�__ VALVATION^y�
20NE �GRADINGCU.YDS. ACRES_
Remarks: �% r � � ,Q7._ _ _ _ �/, �s�_Q _ r�.....
Sink
Preventer
Irrigation
Drinking Fountains �
Floor Drains
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap
Roof D ns
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Pool w/Spa
Water Closet�
Water Heater
w2221 �CfVICf
0
Rainspection Fee' � $15 � � Issue Fee � $ 3
Boiler
Duct-UnderGround
Duct - Strucwral
Duct - Ventilating
Exhaust System ❑ Multiple
FirepUFacL Blt. ICBO #
Heating System & Ducti
❑aioo,000eru oo,00q
Fee � $15
CMF OBfiS-46, rev. ]0/84 Whi[e - guiltling; Canary - Ap0liwr.t; Pink - Accounting; Goltlenrotl - Assessor
0
1015. —
A.P.#E �iZ—
S Main Building:
E
T Front
A Rear
C Right
K
S
71ng. Ret. �
Planning Notes:
Auromatic Washer -
Construction Pole Sub.
Cooking Unit
Dishwasher '
Dryers ❑Gas ❑Elec'
Fan
F.A.U.
Device Boxes
Outlecs
Switches
Garbage Disposal
Generetor - KW
3309 3/04/B7
Zone
Bui
Parking Req./Provided
.. • ELECTRICAL -
Trensformer ❑ 15�50 KW
❑ 50+KW
Meter ❑up to 100 amps
� Meter ❑over100amp
5-15 K W
Fee $15
Sub Panel
Motors�0- PO1Y.-8
Inc. S r �9�15�HP 016-15+
crowave
Pole Light
Range
Sign -
Standing Sections
Trash Compactor
luue Fee
1ANIGAL' PEES �
Hoodor T DEVELOPMENTSERVICESREQUIREMENTS:
VPeI ❑
Canopy Typell ❑ Zo�ing Approved By
' Building Appmved By
Refrigeration Syste Application Issued By �
,00 U ❑100,000
Repair/Alreration
laue Fee � $ 3
SUMMARV OF`FEES
BUIIDING PERMIT $ ----��� SMIP
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK �25% 3 ENERGV P.C.
ELEC7RICAL $ GRADWG
PLAN CHECK 50% y MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
�
73093 TL
O
N
I
N
G
R
E
Q
M
T
S
FEES .
$ 3
CONSTRUCTION AND PLANNING , POOL & SPA .
APPROVALS Permit# Date Inspector qppROVALS ' Permit# Date Inspector
1.. T.emporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ,
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel ReinforcemenY� 56. Rough Plumbing & Pressure Test
6. ElectricalUFERGrnd.' ' 57. APPROVALTOCOVER�GUNITE .
. 7. Footings - . � 58. Electrical Conduit-Undrgrnd.
8. Foundation ,� 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd: - 60: Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System; 61. APPROVAL TO DECK
i t. Property Sewer Line &�iouse Connection 62. Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final �
14. Rough Plumbing � . 65. Electrical-Final �
15. Rough Electrical-Conduit -° 66. Solar System-Final .
16. Rough Electric Wiring • ' 67. Fencing & Access Approval �
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERIIVG
18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
� i
20. Rough Factory Fireplace APPROVALS Permit #� - �
21. Ducts, in Structure . 70. Underground Hydro
22. Ducts, Ventilating � 71. Product Piping O�Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �''� �
24. Roof Framing , &? 73. Undergrnd. Storage Tank' O Gas ❑ Oil
25. Roof Sheathing � � . 74. Overhead Hydro �
26. 7-Bar Ceiling (StructuraQ & Monocoat 75. Dry Chemical � � .
27. Frame and Flashing � 76. Dry Standpipe ' .
28. Lathing & Siding � 77. FIXED SYSTEM FINAL' ,,
29. Insulation 78. FIRE PREV. FINAL �•
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT ' .
31. Plasfer Brown Coat 79. FINAL INSPECTION ' i;� T
32. Electrical Power Meter-Final � . 80. FOOD CERTIFICATE ISSUED �
33. Final Electric " Notes: - . � � . �
34. Final Heating & Air Conditioning - .. �
35. Final Gas�Pipe-Test . , ' ��
36. Hood or Canopy
37. Final Factory F�replace ' � �
38. Final Plumbing � _
39. Water Service-Final ' . �
' 40. Gas Service-Final � .
41. Solar pomestic-Final ' ' .
, 42. Backflow Preventer' � � ' � � '
43. Backflow Irrigation � .. � �
44. Landscape Irriqation SYstem � ,
45. Sound Attenuation � ; .
46. Handirap Regulgtions
47: FINALSTRUC7URE & BUILDING f8 �t '
48; Special Requirements Completed , -
49. Electric Release to Edison . ' . - -
50. Gas Release to Southern California Gas Co . �
57. CERTIFICATE OF OCCUPANCY . �
No. Date _. ' L; � `
.��-
; � ,CITY OF COSTA MESA
` � ' Building Safety Department
Applicdiion for permit for ihe fabricaTion and erection
of awnings, advertising signs or devices.
25462
�� /s �6
LOCATION "
B�ilding Site Address 580M ��. 19TH ST.
Name of Leasee T I NY T I M BUTCHER SHOP phone 546-948�
Contractor EXCELL-i�D ELECTR I C S I GNS State �icense No. 2`54'966
address 2312 S. Susarv ST C��y JANTA EiNA �CAL I F, phone �49-0334
A� '�itect or
aineer_
State License
DESCRIPTION
Description of awning, advertising sign, or device:
Awnings canvas � metal � Widih: ft. in. Length: ft. in.
Gro�nd Sign � Projection Sign � Roof Sign � Wall Sign � Metal Letter Sign �
Banner � Canvas Sign � Gas Tube Electric Sign (Sub-section 1.44, Ordinance 313) �
Combination Sign � Special Device (other) � Explain:
Two copies of plans and spxifications shall be submifted with application for permit for each sign. Plot on
plan sheets proposed location of sign and locations of all other signs at site. Minimum size sheets must be 18"
by 24" and non-erasable.
iVf within the 10-foot area of front property line, owner is to sign writTen agreement with the City.
; 'of Sign — Thickness � ft. � in. Height � r,. 6 in. Length 13tf. 6 in.
Weighf �`�� Ibs. Height above grade � 2ft. in. Projection � fr. � in.
The undersigned hereby agrees to fabricate and erect awning or advertising structure within the intent and
meaning and in strict accordance with the provisions of Ordinance 95, Ordinance 313 (Electrical Ordinance of
the City of Costa Mesa), and all amendments thereto.
ALL APPLICATIONS MUST BE FILLED OUT BY THE APPLICANT. ALL FOOTING, FRAMING AND ELECTRICAL IN-
SPECTIONS SHALL BE CALLED.
Signature of
Permitee EXCEL -AD ELEC 'R I C S I � JSThe amo�nt shown �nder Valuation is for the purpose oi
J/ � � establishing a permit fee only.
IA�ihorized Ag�
Recd. by
Form 214-1M-11-60-3.8 P
'\
VALUATION
s 600. 00
Permit Fee
Plan Check $
Total Fee $�
C�i'Y U� i;�S:� (v9E�A�
PhAR 21 1966
Date Issued �.��_� � Permit
Fire Zone Type
Approved by Da
� ( a— ZONING
Zone�Use of Bldgs.
A. P. No. s p ��— �/�,j
B�dg. $ite Ari�irncc � !) � � ' ( ( i
Legal Owner L/0�
Address � �""�'"�
Yards Approved. ' � d—��'�` �
Large Sign in excess of 8 s. ft. Setback fr cent line
of sireeT to front property line _ r�f� in. I
From property line to edge of sign �ft. in. �
Side Yard SeTbacks:
Left Side � ' ft. in.
Right Side
Building Line Sefback from
center line of street
Area of Sign
Height above Grade
Projection
Awning Size—Widfh
Length
Awning HeighT above Grade
Projection
Location and size r
approved.by
�N. in.
�ft. in.
��'� ft.� in.
ft. �in.
� ft. in.
ft. in.
ft. in.
ft. in.
ft. in.
�
� 45?6�
/ �_ COSTA MESA BUILDING-SAFETY OEPARTMENT
P.O. BOX 1Za0 COSTA MESA, CALIFORNIA 92626
For Applican[ to Fill in Completely — Use Ink Only
OWNER
MAIL
CITY
BRANCH
ADDFESS
ARCHITECT
CONTRACTOR
ADDRESS
CITv
STATE
LIC. NO.
SIZE
OF LOT
USE OF
TE�.
NO. -5.
TEL.
TEL.
NO.
qTV
UC. NO.
NO.OF BlDGS.
NOW ON �OT
Separa�e permits are required for
electric, plumbing and hea[ing work.
UILDING AND WORK TO BE PERFORMED
I hareby acknawledpe t�et I havo rantl t�la epplicetlon antl siato
that tho oEove I�formatlon is correct ontl npree to comply with
ell lewa re0uleii�B builtlinB conrtruction, antl I shall not emplay
eny person in v�alation of the workmon'a compensatian laws of
the Sta[e of Celt�ornia.
I hereby cariify thei l em proparly Ilcansetl as e controctor untlor
tha Stata of Cal�tornia Businacs ontl Professlons Cotle, Division 3,
Cheptar 9, entl ihat such licansas are in fult forca antl eftact, or I
om exompt from Ma provisions of ihe Siate of Calitornle Businen
end Proteasions Coda vision 3, Cha ar 9.
Signature of �
Permittae
Auffiorizetl AgaPi
:,:,�3 eir�i�� �5o�a t�
APPLICATION FOR STRUCTURAL PERMIT
ECEIVEDBV DATEFECEIVED nercicci�c..
ADDRESS
ED
VARDS APPF
MAIN DUII
iOM C/L STfi
BET
VAR. qY•
C.U.P.yW
THE AMO
THE PURP(
VALUATION
�
1 �
PERMIT N
VALUE �
S
� ' ZGROUP �
�% � . � �
F USE OF NEW
> BUILOING
ED YARDSAPPROVED
MAIN &
(L(O
n
m
m
N
JN UNDER VALUATION IS FOR m
'ABLISHING A PERMR �
PERMIT FEE S �� a
N
m
PLAN CHECK E "�
0
TAX E LL
i
u
TOTALPAID S 5�
i
AVPIICdr1L IO 1111 IO dll SpdClS G%CGp� LM1OS! W11M1i0 heavy Oortler lines anG sign all a00ropriate tlecl
CITV OF COSTA MESA ON$J�C]F�XJQJ� ID�RMIT PER�N ^ I�� TRACT NO. LOT NO.' UN1T NO.
. Projec�Address .��� / / � •d( �r(�[ ' ,
AppliCanYs Mailing Addf¢Ss ���2 C�'//11.+'m ' � TYPE OF CONSTRUCTION NEW ADD' �ALTERATION REPAIR
� � G��d �l . ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
' Owner's Name /�7L�� Phone DESCRIPTION OF WORK/USE OF BLDG.-'
Address ' , � ' '
Arch/Eng.� License No. TYPE OF PERMIT GRApING� FOVNDATION ❑ STRUCTURA�
Address I�' , ' /, ❑ TENANT �ELECTRICAL ❑ PWMBING ❑ MECHANICAL
Contractor's Nam�wa�fJ'�� t�a --Pho y' � OTtiER
PROJECT DESCRIPTION 5c?. FT. oCCUPANcv�
Addr¢Sslm �fngl�� ��r� n� �� CONSTRUCTIONTVPE � VP.LUATION$ '
CityLiCenSeNo. �� U � ZONE � GRADINGCU.YDS. ACRES_
LICENSED CONTRACTOR DECLARATION ' �
1 hereby aifi�m that I am licensetl untlet provi5iOh5 of Charter 9(�ommencing Remarks: �
with section 7000) oi Division 3 of the Business antl Profe551on5 Cotle, antl ' ' '
my license is in full t antl (ect. ���
License Class � c n5e N
Date � 5 9 t
WORKERS' COMPENSATION DECLARA ON Bai
lereby atfirm Ihat I have a certiticate ot consent to selt-Insure or a certilicate
Wo�kers` Compensation InSuran[e, or a rert�tjetl CoOY thereof (SeCtion gai
aoo, i.ao. c.).. '
Policy No. Company 63i
8 Certifi¢tl copy is hereby (umishetl. ,
Certifietl mpy is fileC with tM1e city Builtling Di�ision. Ba
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION C�`
(Thi55Ectian neetl not be Completetl it the pe�mit is fo� On¢ huntlretl ($300) or
less). � ' ��'
I cfrtlfy that in the performance of the wo�k �o� �+hich t �I5 permk I5 i55uetl 1
t
Sink
Preventer
Irrigation
shall not employ any person in any manner s a 4co subject to t�e Drinking Fountains
Workers' om ensati ws ot Calif
Date � Si9nature Floor Drains '
NOTICfi. If,after making.IhiS tlEclara ' n, y �oultl b¢come subject to the -
Wo�ke�s' Compensation provisions o the Labo� Cotle; you must forthwitn FIOOfSiflkS .
compty with such';provisions or this'permit shall be tleemetl �evoketl.
CONSTRUCTION LENDING'AGENCV GasSefviCe
I hereby aHitm that (here is a wnstrucfion lentlinq agenty toCthe pertormanc¢
of the wo�k for whicn this pe�mit is issuetl (SectlOn 3�97 Giv. CJ Int¢fc¢pt0/5
Lentler's Name
� �
�Lentler's AOtlress. -j - - - Kitchen Sink -�
OWNER BUILDER DECLARATION ' �
1 hereby aftirm thal I am exempt trOm the ConVacto�'S Llcense �Law to� the LevdtO�i¢5
following reason (Section ]03L5 Business antl Protessional Cotle: Any city or -
county whicb �equires a pe�mit to const�uct, alte/,'�mprove, tlemolish or repai� P-T�yp
any structure, prior3o its issuance„aiso requires <ne applicant forsuch permit
to tile a signetl statement that he/she_ Is,licensed pursuant�to the provisions of Roof Drains
_ �nalty of not more n
� LJ I, ar owner ot tt
� � campensation, will tl�
� for sale (Section' ]0�
License Law tloes not
thereon, antl wno tlo
employees, prOvitletl �
-sdl¢. It, howeve�, the
-�pletion, the owner wi
�rove for the purpose
.I, as.owner of the
:I
'S5 dOd PfOfE551005 �Ode) 01 !l13I OZ/Sf1¢"IS ¢%2RIpL
for ihe allegetl exemptiOn. Any violation of Section
[ for a permit subjects ttte applicant to a civil
five huntlretl tlollars (g5D0). � �
'�roperty or my� empioyees with wages as their sole
; work, antl [he structule i5 nOt IntentleG or otfer¢tl
Business antl Protessio�al Cotle: The Conttacto�'s
ity to an owne� of a proPerty who builtls or impmves
uch work.himselt/herself or through his or her own
such improvements�are not intentletl or otfere0 for
Itling or improvement is soltl within one yea� of com-
jve tne burtlen of p�oviN9 he/sh¢ tlitl nat builtl o� im-
ale). .
iperty, am exclusively coM�acting with licensetl con-
rtoject (Section 7044, Business antl Professions Cotle:
Law tloes not apply tP an owner of. property who
owias or improves mereon,-ana who-mntracts (or such projects with a con-
� tractor(s) Ilcenie pu�suant to the ContractoYs License Law). I am awa�e that
proof of their WorkeYs Compensatlon insuranc¢ shoultl be provitl¢tl to me.
, L� I am�exemp[ unGer Section B. & P. C. �or Ihis reason
Date � Owner" �
I her¢by tertify that �I have reatl [his appliwti0� antl.5tate that [he above
intormation is [orrecL'I agree to_comply with atl ��ty antl county ortlinances
antl state laws relating to builtling consVuction, antl�hereby authorize repre- �
cnnranvea nt mic cJrv .rn en�b, unnn rne annve-mentionetl orooertv tor
Reinspection ,Fee
Showers
Service Sink '
� Sewer Cap -
-Sewer Connection �
� Solar Collectors
' Solar Piping .
SolarTank �
Swimming Pool w/Spa
�Urinal t
i
�Water Closet ' �
Water Heater �
Water Service - - - �
� ;Auto-Wash ' �
i
� � Laundry Trays •
� ' i
�
$15 " ' �Issue Fee� '
Duc[ - Under Ground �
Duct-SVuctural , .
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Fire'pl/Fact BIL ICBO #
Heating System & Ducting ,
❑ai oo,000 sru �� oo,000 er
ISi9nature � v•`-'- —— Daie! -- O ol I .
� Drivers' License or 55 Reinspection Fee
CMF 0865-46, rev. SO/B6 White - Builtling; Canary - APPlicant; Pink - Accountin9; Goltlenrotl - ASSessor
$15
Hood�or Typel ❑ ' '
Canopy �Type II ❑ • �
Refrigeration System � '
❑0-100,000 BTU ❑ 100,000 8
SystemRepair/Alteration� '
Fire Dampers � �
Registers � ' �
laue Fee
0
�
1
A.P. #
S Main Building:
E
T Front
A Rear
C Right
g Left
Pln9. Ref. #
Planning Notes:
Automatic Washer'
Construction-Pole Sub. ._
Coaking-Unit- , �
Dishwasher.
Dryers ❑Gas ❑Electric
Fan �
E
Device Boxes �
Outlets • ' �
- - Switches -r - - - . --} �
Garbage Disposal
' Generator �65 KW �5-15 KW
� $ 3 �
Reinspection Fee
i FEES
_ DEVELOPMENTSERVICES
. Zaning Approvad By
'�Buildin9 APProved BY _
Application Issued BY_
$ 3
. l_ � . . _ . _ ' . _ ' - . . ,
� :`�`X�t� >. .
; 0382 '7%30/86 � �;e,3.40 >TL
_ _ . . zo�e�. r� - - .
'Accessary Building: , �
Parking
T�ansformer ❑ 15-50 KW.
� '� 50 + KW
Meter i �up to 100 amps
Merer, Doder 700 amps ' -_
Sub��Panel �� '
Motors 00-1.HP � 7'/, - 8 �
Inc.Solar Og-15 FiP �76-15+
Microwave (' � � ,
Pole Light . '
Range
Sign�j%ODAi N� '- '
Standin9 Sections �
Trash Compactor � ,
$15• , Issue Fee
.E�UIREMENTS:
1
0
a s
)ate '
� SUMMARV OF FEES ; , •
BUILDING PERMIT $ �SMIP ' $ -' �
PLAN CHECK $ ' .PERMI,T� �
� PLUMBING � • $ ' ' ISSUANCP " $
' � PLAN CHECK 25%. $ ' � 'ENERGV P.C. $ ,�
ELECTRICAL $ �� GRADING • $ -
PLAN�CHECK 50% $ MICFOFILM $ ��
MECHANICAL $ TOTAL F,EE $ �¢ � ✓
- PLAN CHECK 25% � $ � � ' ' '
CONSTRUCTION AND PLANNING
APPROVALS Permit #
1. �Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd. �
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
i6. RoughElectricWiring
17. Rough Wiring�Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe�Rough & Test '
24. Roof Framing
25: Roof Sheathing
26. T-Bar Ceiling (Structurel) & Monocoat
27. Frame and Flashing �
28. lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat �
32. Electrical Power Meter-Final
33. Final Electr,ic '
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. Backflow Preventer
43. Backflow Irrigation
44. L.andscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electrie Release to Edison
50.'Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
POO L & SPA ,
Date Inspector qppROVALS Permit#
�
52. Pool & Equipment Location
� 53. Steel Reinforcement .
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure TeSt
57. APPROVALTOCOVER�GUNITE
58. Electrical Conduit-Undrgrnd.
_ 59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
67. APPROVAL TO DECK
62. Backwash & Receptor-Final
- 63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. -Solar System-Final
67. Fencing & Access Approval
� 68. APPROVED FOR PCASTERING
- 69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
` $'L. I �L",�
Date + � I
70. Underground Hydro .
71. Product Piping O Gas ❑ Oil
72. Underground Flush '
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry� Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: �
n
�
Date ' Inspector
o�
.�
�
i
0
,
CITY OF COSTA MESA
o�`p"'f., BU/LDING DIVISION
F`�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
Ry,�, p
PERMIT NUMBER: BX11-00164
PERMIT TYPE B MISC STATUS: ISSUED
APN: 42214147 DATE ISSUED: 07/08/2011
Zoning: , ISSUED BY: RMD
JOB ADDRESS: 580 W 19TH ST CM
vicinity:
S�.FT: 1000
Suite/Unit
Primary Occ: Const Type :??
Valuation: E9,500.00
SCOPE OF WORK:
CONSTRUC710N OF A NEW NON-LOAD BEARING PARTITION WALL TO CREATE NEW OFFICE AREA WITH 2 LIGHT FIXTS
AND 9
OUTLETS FOR "Q C FINANCIAL SERVICES OF CALIFORNIA INC".
OWNER: OELKE, HERBERT G TR MC NAUGHTON, KENT AAddress:
CORONA D�L MAR, CA
City/State: 2600 E PACIFIC HIGHWAY
Phone:
APPLICANT; WOOD, BETfY NOLL
Ciry/State:
Phone: 909-542-4300
CON7RAC7pR: ALL PRO DESIGN WEST INC
Address: 13971 ANNANpALE LANE
Ciry/State: RANCHO CUCAMONGA, CA
Zip Code: 91739
ARCHITECT:
Phone
ENGINEER:
Phone
FEE SUMMARY
Building Plan Check;
Building PermiL
Electrical Permit:
SMIP Residendal
SMIP Commercial
Bldg Std Admin Fund
Address:
MCNAUGHTON, KENT SUITE 150 Unit
Zip Code: 92625-2117
Zip Code:
License No. 40Q400
Phone 909-899-7128
$45.31
$181.25
$35.60
$0.00
$1.99
$1.00
License No.
License No.
Cell:
Unit:
Unit:
TOTAL FEES $265.15 �
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays:
New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. Thanksaivina Dav and Christmas Dav
NOTICE: Ths work authorized by this pertnit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTION$: In order for the work authorized under this permil to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and final approval musl be obtained. Failure to obtain inspections and final approval vrill result in the expiretion ot this permit.
COpEt, INSPEC110NTYPE ORTE INP AL f�0UE1 �NSPEC110NTYPE D�� INi1TIAL
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Poo15pa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical �i g• ►• I I ��
201 Final BIaklRetalning Wall 212 Final Fire Prevention
202 Final Fa�(ory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Damolition Z50 Final Building/Occupanry
WORKERS' COMPENSATION DECLARATION:
I hereby affirm untler penalty of perjury one of the following declarations:
❑ I have anA will maintain a certificate of consent to self-Insure (or vrorkers'
compensation, as provided lor by seclion 3700 of the Labor Cotle, for the
peRormance ol the wnrk for which this permi[ is issued.
❑ I have antl will maintain workers' compensatbn insurance. as required by
section 3700 0l Ihe Labor Code. (w ihe peAortnance of Ihe work la which this
pertnil i5 issuetl. My woAcers' compensation Insurance carrier and policy
numDer are:
Carner:
(inis secfim need nd Da cwnderM s tM perni4 k valuN at me nurWred Ja'larslSi00) a/eu )
Policy Number:
��'P cerli(y Ihat in the peAortnance of the work for which �his permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree Ihat i! I should
become subject to the wvrkers' compensal"on provisions of Seclion 3700 0(
the Lab od . I s II forthwith c ly vrit thqse provisions. //
L —fiC� �/f,6o �_
lA liram'sS�pnaWre Daie-`_-
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST. AND
ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby alfrtn Ihat I am licensed under provisions o! Chapter 9(commencing
with Section 7000) of Division 3 of lhe Business and Pro(essions Code, and
my license is in full force and eflect.
Lic-t!—�tJ6 �}Q'72 g CJass.#.^�
�i.yi:, l�i-/.f. �l�.z/,9�.. . ��� -/�
TContrana's5ignaWre �_Oa�e
!' _
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a consimction lending agency for the
peAormance o! the �wrk for wfiich lltis permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lentler's Address:
Signa�ure Daie
OWNER-BUILDER DECLARATIONS:
I hereby aKrm lhat under penalty of perjury that I am El(EMPT FROM THE
CONTRACTORS LICENSE LAW lor ihe following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or counry which requires a permit to
consWct, aller, improve, demolish, or repair any stmcWre, prior to its
issuance, also requires the applicanl for such pertnit to fle a signed slatement
ihat he or she is licensed pursuant lo lhe provisions o( the Coniractors
License Law (Chapter 9(wmmencing with Section 7000) of Division 3 of the
Business antl Pm(essions Code� or lhat he or she is exempt therefrom antl
the basis for the allege0 exemption. Any violation of Section 7031.5 by any
applicant for a pertnit subjects the appliwnt to a civil penalty of not more than
five hundred tlollars ($500).):
❑ I, as owner of the propeny, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl Ihe sWCNre is not intendetl or
oftered for sale (Sec. 7044. Business and Professions Cotle: The Cont2ctors
License Law does not apply to an ovmer of property who huilds or improves
Ihereon, antl who does such vrork himself or herself or through his or her own
employees, proviaed thal such improvements are nol intended or oHered for
sale. Il, however, the builtling or improvemenl is sold within one year of
completion, lhe owner-builder will have the burden o! proving lhat he or she
tlitl not build or improve for purpose of sale.).
❑ I, as owner ol Ihe property, am E%CLUSIVELV CONTRACTING WITH
UCENSED CONTRAC70RS lo construct the projecl (Sec. 7044, Business and
Prolessions Code: 7he contractors License Law dces not apply to an owner of
propeny who builds or improves thereon, and who contractslor such project with
a contracla(s) license pursuaM to Ihe Cont2ctor5 Ucense Laws.).
❑ I am exempt untler sec.
Business antl Protessions Cotle for this reason:
GiMer ID verified by drivt� ., ncense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ovmership by (type of document, i.e. - propeny tax bill or tleea):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I �ereby cerlify thai no excavalion frve (5) or more (eet in dep�h into which a
person is requiretl ro descend, will be made in connection with awlc autMrized
by this permil, and that no building slructure, scat(d0ing, (alse�wrk, or tlemolilbn
or dismantling lhereol, will be more Ihan thirty-six (36) (eet high. (C�ap. 32, Gry
2, M 2, Sec. 341, Ttle 8, Califwnia AdminislraMe Code).
❑ As ovmer-builtler, I will not employ anyone to do vrork vfiich vrould
require a permil from lhe Division o( Industnal Satety, as noted above, unless
such person has a permit to do such work (rom the tlivision.
Applifanfs Sgna�u�e pale
Division ol Industnal Safe[y Permit Num6er.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
t. Will the applicant or presen[ or future Duiltling occupant need b file and
cenify a Business Plan for emergency response to releasa or threatened
release o( a hazartlous material? ❑ Ves ❑ No
(Section 25505 of Ihe Calilornia Health and Safely Code requires, with some
exceptions, that a Business Plan be fletl with the Costa Mesa Fire
Departmenl by every business which has at any one time during a reportetl
year a quantiry of hazardous materials equal to or greater than a weight ol
500 pountls, or a volume ol 55 gallons, or 200 cuhic leel of compressetl gas
at stantlartl IemperaWre and pressure).
2. Dces or will the appliwnt or present or (u�ure building occupant neetl to file
a registration form lor acWely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health antl Safety Code, wilh some
exceptions, requires regislralion with the Costa Mesa Fire Department by
each business which at any one �ime has on hanA a quantity of acutely
hazardous materials equal ro or greater than a vreight of 500 pounds, or a
vo�ume of 55 gallons, or 200 cubic feet of compressetl gas al slantlard
temperalure antl pressure).
3. Does or will Ihe applicant or present or (uture building occupant neetl ro
prepare an RMPP (Risk Management and Prevention Program tor acutely
hazartlous matenals�7 ❑ Yes ❑ No
(Section 25534 0l the Califomia Health and Safety Cotle provides Ihat the
Costa Mesa Fire Department may require Ihe preparalion, cenification antl
filing with the Fire Depahment of an RMPP by businesses which are required
to register acutely hazartlous malerials with the Fire Department.
4. If an RMPP is presently required, has Seclion 25534 0( Ihe California
Health and Safety Code been lully complietl vrith7 ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupaN require lor
the work which is Ihe subjecl of this application a permil !or such construclion
or modification from the South Coast Air Qualiry Management Districl or Irom
any other air pollWion control tlistricl or agency? ❑ Yes ❑ No
(Seclbn 65850.2 of the Califomia Govemment Code requires that the requestetl
information be fumished on applications (a nornresidential building permiis).
6. Will any part of the facility to be wnstructed under this permil be within
7000 feet from the outer boundanes ot a school? � Yes ❑ No
Qf yes', the facility musl meet Ihe requirement of Sections 25534 and 42303
of the Califomia Health and Safety Code�.
7. I( a permil from ihe South Coast Air Quality Management District or other
air polWtion control district or agency is requiretl for the work which is the
subjecl of this application, have all of ihe disclosures prescribed by Califomia
Health and Sa(ety Cotle Seclion 42303 been maAe? ❑ Yes ❑ No
8. QI yes', attach certificate ol compliance trom the appropriate air pollution
contml aHicer).
CERTIFICATE OF COMPLIANCE: I cenify that under penalty ol perjury the
information given above is correct. I agrea to comply with all state laws antl
cily ordinances regarding Hazardous Matenals an0 Emissions.
Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury that I have read lhis application and state Ihat
Ihe inlormation given is correcL I agree to comply with all state laws antl city
ordinances relating lo builtling construction, and authorize represenlatives ol
the Ciry of Cosla Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy o! any building
authorized by Ihis permi� until f nal inspection.
&gnawre oi Le9al ovmer�s) Da�e
S�praWre Date (/{y// ��� ��,�%hb. '�t �/
]OS].46 (YO]) �q��� nu�nonzee aoWiwm Lpa�