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Home My WebLink About586 19TH ST - Building Permits(714) 75a-5273 • Fex (71a) 754-4856 • www.ci.costa-mese.ca.us n rv.in unrve, wa i M m�an, �n amco ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: 586 W 19TH ST NEW CHANNEL LETTER WALL SIGN 42214147 Appliwnt: NGUYEN, PHUONG Address: 8109 BOLSA AVE �; ; . MIDWAY CITY, CA--- � ; ,, � : � i i' � � i Owner: j OELKE, HERBERT G TR � , Address " .%BERTOLINO, PIERRE�J� - COSTA MESA, CA. 1014 ARBOR ST ' Contractor: BUT7'ERFLY SIGNS Address: 8109 BOLSA AVE � MIDWAY CITY, CA�� .Phone: (714) 894-0076 Zip: 92655 Phone: Zip: 92627 � :Phone: (714)894-0076 Zip: 92655 License: 637709 Stams: I SS U E D Applied: 11I74/2001 Issued: 11/14/2001 ISSUED BY: ' SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW ILLUMINATED CHANNEL LETTER WALL SIGN FOR "88 LIQUOR". � INSTALL 1 SIGN CIRCUIT. � � - • - . - - - � � � - � . , � ISSUE FEE Temp service test Res. a/c package New Res (9�-2 unils) � New Res (3+units) _ Pool / Spa - Lighting Fixts' ' � Recept Outleta Switches � � Non Res Appl �� - Res Appl Service to 200a � Service to 7000a Service over 1000a Motors to 7hp Motors to 70hp Molors l0 50hp Motors l0 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole REF:SB01-00124� �uantity 523.50 50.00 $0.00 $0.00 50.00 $0.00 $0.00 � - $0.00- �,�� $0.00 � 50.00 . $0.00 . 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 524.60 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 FEE SOMMARY ; Quantity Temp Dist System / Lighting 50.00 0 Busway I700 R 50.00 0 Standing Section $0.00 0 Misc Electrical Equipment $0.00 " ' 0 Trensformers 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 I Ckt -$0.00� � 0 Misa Conduit $0.00 -0 Misa Conductor . ' "$0.00 ' 0 Cirws ( gen or nde) ' $0.00 � . 0 Circus (mech ride or lights) .$0.00 0 Christmas Tree Stand $0.00 0 Firework5 Stand ' - $0.00 0 Other Electrical,Fee � $0.00 Investigation Fee $0.00 Plan Check Fee b0.00 Reinspection Fee 50.00 TOTAL CALCULATED FEES 548.10 COMMENTS / SPECIAL CONDITIONS i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis untler Calltomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: Thls permit shali automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a pedod of 7 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applirable codes, and ell requlred Inspactione end Ilnel epproval must be obtained. Failure to obtain inspectlons and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 2aa&ae (0�W) WORKERS'COMPENSAnON OECLARAnON: I hereby eRrm untler penalry of perjury one ot t�e following dedaratirns: ❑ I heve end will malniain a cenificate of consent ta selt-Insure for warkers' oompensetion, es Drovlded tor by sectian 3700 of the Lebor Code, tor the peAortnance o1 the work for which Ihis permit is issuetl. {�I•heve entl will maintain worlcers' compensatlon insurence. as required by secUon 3700 al Ihe Lahor Code. for the pertortnance ot Ne work far wNUi Ws pertNt Is Luued. �-- My workera' �m7�pe,nj�tion insuren certix entl poliq number ere: �Certier = � "1 it,lV �n.A PollcyNumhen ' n� I �B � ^ O I (Thls sectlon neetl not be complefed l/ fhe perml( s velued et one huntlretl tlol/ers ($100J or Iess.) ❑ I certity Ihel in the peAormance of Ihe work for which thls pertnit is issueq I ahell not employ eny person In any menner ao es to become sub�ect lo the workers' compensetlon laws oi '! ie, entl egrea t�et It I s�ould become sub�ect lo t�e workers' compensetio_n provlsions of Sectlon 3700 of Ihe Le�ar Code, I ahall Iorlhwilh rcomDlywiththese r visl hs. � � ' Applkant Slpnewre: ^ - � Dete: � � /� � /� WARNINO:FAIWRETOSECURE �RKERS'ODMPEI ATIO C GEISUNLAWFULANDSWLLLSU&IEQMIEMPLOVERTOCRIMINALPE TIESMID LFlNESUPTOONEHUNDREO TIIIX1SiWD Op1ARE (5100,000), IN �DDR10N TO THE O NSAT70N, DAAWGES 0.S PRJVIDE� FOR IN SECfION 3/08 OF THE IABOR CODE, INTEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirtn the(I a�ensed under rovisions of Chgpter 9(commencing with SeCtlon 7000) oi Dlvision 3 of the B7siness and Profeuions Code, enC my license is In tull torce entl ettect. Ua A � Class p ` u , z Contrect`, o YfsSlgnature:�-' Date:� I E CONSTRUCTION LENDING AGENCV: ❑ I hereby eHirtn t�at t�ere is a conslrucUon lendinp egency for Ihe peAortnence ot t�e work lor which this permit Is Issued. (Sec. 3097, Civil Code). Lenders Neme: Signeture: _ Lentler's AOdress: Date: OWNER-BUILDER DECLARA710NS: I hereby eHirm that under penalry of per�ury thal I flm EXEMPT fROM THE CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e pertnit to construd, alter, imprwe, tlemdish, or repelr eny structure, prior to ifs iuuancs, elw requires Ihe appiiwnt for such pertnit to tile e signetl stetement ihet he or she is Iicensetl pursuant to ihe provisions of Ihe Contrectors License Lew (C�apter 9(commendng with Seclion 7000) oi DMsion 3 of Ne Business end Pmfessioni:Cade)�.or t�at he or she Ls exempt therefrom flnd the besis far the el�egeC exemptlon. Any violatian of Secllon 7031.5 by eny appllcant for e perm�' subJects the epplicant to a civil penalry of not more than Me hundretl tlollars (5500)J: ❑ I, as owner of the proparry pr�nry employees wlth wages es Neir sWe compensalion, WILL DO THE WORK, and the structure Is not Intentletl or oftered tor sale (Sec. 7044, Business and Professirns Code:.The Cantrectors License Lew does not appty to an owner ot properry who builtls or improves ihereon, antl who does such work himself or herself or through his or her own employees, provided that such improvemenis are not intended or oHereO tor sale. II, however, ihe building or improvement is sold within one year ot completion, lhe owner-builder will have the burden ot proving t�at he or she did not builtl or impmve for purpose of sale.). ❑ I, es owner of the properry, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the prqect (Sec. 7044, Business and Proteulons Catle: The conirectors License Lew does not epply �o an owner oi property who bullds or Improves Ihereon, antl who conirects lor such projecM wl�h e comractor(s) license pursuant to the Contractors License Laws.j. ❑ I am exempt under sec. Business end Protessions Code tor this reeson: Slgnature: Date: Owner ID veritied by drivers license. ❑ Yes ❑ No Orivers License No. Ezpires: Verllicetion ot Ownership by (type ol tlocument, i.e. - praperty tac bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFlCATION: ❑ I hereby ceNty Nat no excavation Iive (5) or more leet In depth into which e pereon Is requiretl to tlescentl, wlll be made in connectlon wIN work euthorizetl by thls pertnit, antl ihat no building siructure, scaHOlding, falsework, or demolitlon or dlsmantling Ihereoi, wlll be more than Ihlrty-six (36) feet high. (C�ap. 3.2, Gry 2, Art 2, SeC. 341, Title 8, Celitomia AtlminlstratNe Cade). � As rnvner-Dulltler, I will not employ enyone to do work which would require e pertnit trom the DiWslon af Indusirial Safery, es notetl ebove, unless such pereon hes e permit lo do such work tram the dMslon. Siqnature: Date: Dldslon oi Industrial Selery Permit Number. ICERTIFlCATE OF CAMPLIANCE AND AUTHOROA710N OF EMAY: I cenity untler penelly of perjury thal I have read this application entl sWte that Ihe infortnatlon given is I wrtect. I egree to compty wl�h all stete laws end dry ortlinances relating to Dulltlinp constructlon, entl aulhorize representetives ol the Ciry ot Coste Mese to enter upon Ihe ebove-descdbed property for inspection pwpwes. I agree not to occupy or allow acupflnty ot eny building euthonzed by this permit until finel inspecdon. Of Legal CO�E I, INSPECTIONTYVE te18 Fixod System Finel Fire Preventlon 1288 Pod Spe Finel 200 Flnal Re-Roof 201 Flnal Block/Retflining Well 202 Flnal Fectory Fire Place 203 Final Sign 204 Final Demdltian ' �g � COOE 1 INSPELTION TYPE 206 Finel Mechenicel 208 Finel Plumbinp 210 Final Electricel 212 Finel Flre Preventlon 220 Final Planning Approvel 222 Final Site 250 Finel Building/Occupancy PAg I[f�L@ (�ia) �sa-s2�s • Fax (�ia) �sasass • www.ei.coste-mesa.ca.us 77 FAIH UHIVt, GUS IA MtSA, cn azozc Job Address: $86 W 19TH $T Suite: Vicinity: Parcel Nunmber: 42214147 Applicant NGUYEN, PHUONG ", ,� - Atldress: 8109 BOLSA AVE" i/'- ;� �� i � MIDWAYiCITY, CA � - i" � ` Owner: /OELKE, HERBERT G-TR Address � °hBERTOLINO, PIERRE J. � COSTA MESA, CA . � , � 1014 ARBOR ST � � Contracror: BUTTERFLY SIGNS Address: 8109 BOLSA AVE SIGN PERMIT Zoning: Phone: p14)894-0076 % Zip: 92655 � � Phone: Zip: 92627 Status: ISSUED Applied: 11I74I2001 Issued: 11I742001 ISSUED BY: ' " , Phone: (774) 894-0076 ,*1/ y� , MIDWAY CITY, CA , Zip: 92655 � . �y �' ' � License: � 637709 .�C� , Amh / Eng : � - - . _ ��'" , , Address: � _ � � , ' , Phone: � - . � � Zip: � License: � , �' � ' - � � SCOPE OF PERMIT ..' � � . REPLACE AN FJCISITNG 28 S� FT BUILDING SIGN WITH A NEW, 17 SQ Ff CHANNEL LETTER � BUILDING SIGN FOR "88 LIQUOR". Plan Check: Permit: SMIP Com: Other. Inspection: � ��: Total: NOTES: $31.14 $�.00 $47.90 $0.50 $0.00 $0.00 $0.00 $0.00 � � _ $0.00 - � � , $79.54 � � � � FEE SUMMARY . �� - , PLANNING & ZONING Calc Valuation: Claimed Valuation: - si $7,250.00 St,zso.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomla statutes and ralated regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall eutomatically 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 tor the work authorizetl under this permit to be considered legal, such work must comply with all epplicable codes, and all required inspectiona and tinal approvel must ba obtained. FaiNre to obtain inspections and final approval will result in the expiratlon of this pertnit. FOR INSPECTIONS CALL: (714) 7545828 416d8 (fl/00) WORKERS'COMPENSAnON DECLAtiAPON: i hereby eHirm untler penelry ot per�ury one of iha tWlowing dedaretions: ❑ I heve entl wlll maintflin e cenifcate of consent ro setl-Insure for workers' compensatlon, es providetl far Ey section 3700 oi the Lebor Code, tor �he pedortnence of the ��x�rk for whiCh �his pertnit Is issued. �I have entl will maintain wwkers' compensaibn insurexe, as required by secUon 3700 of Ne Labor CoAe, lw the pertwmance ot the work tor wh�h this pertNt is IsweA, �� orkers' com ensatlon I rence rrler end palicy numbar are: —7 Certier. 5��. �� Pol(cy Numher. _ � n� � /��— � � (Thfs secNar need nat be oompleted!! (he pemtil ls velued et one hurMretl tlW/ars ($100) a leu.) �'-'— ❑ I cenity that in the peAortnence of the work lor which this permil Is iuued, I shall not employ any person In any manner so es to bewme subJect to ihe workers' compensetlon laws of Celtlomle, en ree Ihat tl I should become sub�ed to [he workers' campensetlon provislons ot Sectlon 3700 of lhe Lebor CaCe, I ahell tort�with crompty with these prov si . I� / I� /,^ � AppAcent SlgneWre: Date: �— V WARNINO: FAILURE TO SECURE WORI RS' CaA1PEN5ATip OVEMO IS !UW FUL M!D SHML SUBIECT AN EMPLOYEp TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE NUNdiED TqUSMIDDOU.ARER��).�NMOfT10NTOTHECQST WAIPEN9AT i,DAMAGESASFfiOVIDEDFORINSECfION3]OBOFTHEUBORCODE,WTEREST,MlDATTORNE'/'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm ihet I.em Ilcensetl under rovlslc force end eMact. IJc. A� ' ConCrectoYs � SlgneNre: i � 9(commencinp with Section 7000) of Dlvision 3 ol.the Business entl Prolessions Code, entl my Ilcense Is in lull � Cless s� � �� ,Date:ti �I \ ('i � CONSTRUCTON LENDING AGENCY: ❑ I hereby aMrtn that thare is e conslrucUon lentlinp apen�y tor Ne peAortnence of Ihe work for wNch Ihls pertnit is issued. (Sec. 3W7, CMI Cotle). Lenders Name: Lendefs Address: Slgnature: Data: OWNER•BUILDER DECLARATION3: I hereby eHlrtn thet under penalty ot per�ury thei 1 em E%EMPT FROM TME CONTRACTORS LICENSE LAW tor the lollowing reeson (Sec. 7031.5, Business entl Prolessions Code: Any ciry ar counry which requires a pertnit to wnstrucL alter, imD�ove, damolish, ar repair any siructure, prior to its issuenca, elso requires t�e appliwnt for such pertnit la flle e signed statemem that he or she is Ilcensetl Dursuant to Ne provlsions at the Cantrectors LJcense Lew (Chapter 9(commencing wit� Seclion 7000) of DMsion 3 of Ne Business end Professlons Code) or t�et �e or she Is exempt t�erefmm end Ihe besis for t�e allepetl exemption. Any violetion ot Section 7031.5 by eny applicant for e pertN' sub�ects the epvlicant to e ciNl penalry ot not more than frve nunaretl tldtars (5500).): � 1, es owner ol t�e pmperty, or my employees with wages es thelr sole compensation, WILL DO TNE WORK, anC the sW cture Is not InterMed or otteretl for sale (Sec. 7044, Business and Professlons Code: The Contrectors License Lew tloes not appty to en owner of properry who bullds or improves thereon, antl w�o tloes such work �Imselt or hersetl oclhrough his or her own employees, proNded thet such imprwements ere not intended ar oftered for ule. If, however, the building ar improvement is sold within one yeai:ol iompletion, the ownerbuiltler will hava t�e burden of proving tha� he or she did not build or imprwe for purpose at uleJ. �vi �_ ❑ I, es owner ot the propetly;,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTFiACTORS to construd the prqect (SecJ044, Business and Professions Code: 7he contredors License Lew does not appy to en owner oi property who builtls or improves thereon, end who wntracls tor such project with a cantractor(s) licensa pursuant ro the Contractoi3 License LawsJ. ❑ I em e:empt under sea �� J� � Business antl Professions Code foi this reeson: Slgnature: �t�n �. Date: Owner ID venfied by drivefs Ilcense. 0, Yes �� 0 No Dnver's License No. Eapires: ,� Vedlication of Ownershlp by (type of tlocumenL i.e. - proPerty tex bili or deed): DIVISION OF INDUSTAIAL SAFE7Y PERMR CERTIFICATION: ❑ I hereby certlty Ihat no excavetlon Me (5) or more feet In depih Into which e person is requlretl to Cescend, wlll be mede In conneqlon with work aut�orized by thls pertnit, end t�at no building siructure, scattoltling, falsework, or demolition or dismantling t�ereol, wlll De more then thirty-six (36) feel high. (Chap. 3.2. Grp 2, Art 2, Sec. 341, 7lle 8, Californla Administretive Cotla). ❑ As owner-builder, I will not employ enyone to tlo work whic� would require e pertnit Irom Ihe Divislon of Intlustnel Sefery, es notetl ebove, unless such peraon has e permlt to do such work irom the division. Slpnature: Date: DlWsion of industrial Sefery Pertnil Number: HAZARDOUS MATERIALS AND EMISSIONS CEHTFICATON: 1 WIII Ihe epplicant or present or tuture bulltling occupant neatl to lile enE cenity a eusiness Plen lor emergency response to releese or IhreeteneO release of e hezartlous materlal4 ❑ Yes ❑ No (Sectlon 25505 of �he Celilomis Health end Safery Cotle reQuires, with some exceptbns, that a Business Plan be filad with Ihn Coste Mesa Fire Depertment by every business which hes el any one time tluring e reportetl yeer a quantiry ol �azardous materials epuel to or greeter than e weight o1500 pountls, or e vdume o1 55 gallons, or 200 CubiC feet of compreuetl ges at stendaN temperature end pressure). ................................................................................................................................................................................_................................................................................................................... ............_...... ...._.............._............._ 2 Does or will Ihe appllcant or present or future building accupenl need to file e registretlon form for ecutely hezerdous materials7 ❑ Yes ❑ No (Sectlan 25533 ot Ihe Celtlornla Healih and Selery Code, with some exceptlons, requlres regisiretlon with Ihe Coste Mesa Flre Dopertment by each business which et eny one time �as on �and e quentiry at awtaty hazerOous meterials equel to or preater Ihan e welpht of 500 pounds, or e vdume ai 55 gellons, or 200 cubic leat of compressetl gas et sfendard temperaNre end pressure). .._.........._—.....'—._....'_�.._"_'_""'._.. .._ ......_..__._ ..........................._..._......._..._.._"""_ 3 Does or wlll t�e apD��ent or prasenl or tuture builAing occupent need to prepare an RMPP (Rlsk Menepement end Prevention Program lor acutety hazartlous metertals)7 iection 25534 of the Calitomia Heallh epertment ot an RMPP Dy businesses ............_._...._._' en RMPP is presently required, has S .........�........___" oes or will t�e epplicant or present or Nat ot tha Celitomie Heelih end Safery GOEe Deen —_" _..__............__....... 8 occupent require lor Ihe work which is the e t or from eny other elr pollWon control dlsldcl mayi e Fire with7 certitiwUon antl filing with the Fire (Sectlon 658502 of I�e Calitomia Govamment Code repuires Ihet the requested Informa�lon be tumishetl on epplications for non�resltlenUal _ ............................................._..._..............."_�—__........_._._.......'_"......................._..............._._................................................_................. ..._..._.._._.... WIII eny Dert oi the faciliry to be constructed under thig permit be within 1000 feet trom the outer baunaaries af a school? ❑ Ves ❑ 1 (II yes', the faciliry must meet the requirement of Seciions 25534 and 42303 ot ihe Califomia HeeIN and Safery Code). _'........."_____'. ._..__ ................................._..._.�___............_.�...... It e pertnit from the South Coast Air �ualiry Management Disirict or other air polWtion control tlistrid or egency is required tor the woi aODlicaLon, have ell ot the disdosures prescnbetl Ey Califomla Health end Safery Cotle Section 42303 been made7 ❑ Yes ❑ No or (II'j�es', ettach cartiticate ot com0�iance irom the apDroGMate air pollution control otttcer). CERTIFICA7E OF COMPLIANCE: I ceriify that under penalry ol perjury t�e informatlon gNen eDove Is correq. I agrea to compry with ell state laws antl dry ortlinances regartling Harardous Materials entl Emissions. Slgnature: Date: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF EHTRY: I certity under penalry ol perjury that I �ave read this eDPliceUon end stete �hat the Intortnellon gNen Is correct I agree m comply with ell atate laws enC city ordinances relating ta building consWctlon, anC authotlze representallves of the Clry of Costa Mesa Io eNer upon the ebova•tlescnbed praperty Iw inspeclion purposes. � epree not ta occuOY or ellow occupancy ol eny builOing eu�horized by this permit until finel inspection. COOE /. 1816 1288 200 201 202 203 204 IMSPECiIONTYYE Fixed System Final Fire Prevenlion Pool Spa Final Final Re-Roat FIneI8lock/Reteining Well Final Factary Fire Place Flnal Sign Finel Demolitlan QdIF. II�LS I I l iu �c� 1 � oT�_ COOE I INSPEC710N TYPE 208 Flnal Mechanical 20B Finel PIum6ing 210 Plnel EIocMCal 212 Finel Fire Prevention 220 222 250 Finel Planning ApDroval Finel Site Flnel Bulltling/Occupency s.� • r CIT,v OF COS7A M CONSTF�� TION.PERMIT ` � Lt, /7m Si/1EE% : r�ject Addtess ! (�' Applicant's Mai' Add e s �- yp� liJES%R//AOK L i Owner's Name ��p�.�� o�r�� y9 Pno�a -97 Address �1JG Arch/Eng. License No. Address Contractor's Nama �'V � �TZ Pnone Address (mailingl � City License No. LICENSED GONTRACTOR DECLARATION 1 hereby affirm that I am licensetl untler provisions of Charter 9(commencin5 witb section 7000) of DiviSion 3 0`jp ' Bu iness antl Professions Cotle, antl my Ilcense is in full force antl ef(ect �' � � l ' �icense ciass •l Icense No.� Dale Si9nature � WORKERS'COMPENSATION OECIARATION ' ' nereby affirm that I have a certl8cate of consent t0 self-insure or a certitica[e f Workers' Compensation Insurance; or a cerUtietl topy thereof (Sectlon 3800, l.ab. CJ , "' - " ' Policy No. Company eCerti(ietl copy is hereby fumishetl. .� , � , Certifietl copy is tilea with the cfty Builtling Division. Dale Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissec[ion neetl ml be completetl if the permit Is.tor one huntlre (5300) oi less). /j I ce�tify [hat In lhe perfotmance ot the v{D� tor whi his 0� is ISsuetl; I shall not employ any pe�son in dny �p�ylpr so as eco e ject to th� Workers' ComPen;atlon, LawS ot Caqfpr�yJry(//AAn . . �% Aop��cant to fill in all ipaces except ihose within �eavY Dortler Ilnas antl sign all appropriala Eeclarations. 'NOTIC�: If, �it �nB�cing ehis tleclarat , you sho�lYQ beL�orrme sub)ect to the Worke�s' Comp nsalion provi5ions o th¢ Laboi Cotle, you musl forthwi[h comply with Such p�ovisions or thiz Oe�mit shall be tleemetl �evokeU. CONSTRVCTION LENDING-AGENCV ' - I hereby�afflrm that tnere is a,constructlon lentlin9 agency for the pertormance ' of [he work for which [his permit is issuetl (Section 309] Civ. C.) L.entler's Name . Lender'S AAtlress �% , . - . OWNER BUILDER UECLARATION I hereby affirm that I am ezem0� from lba Contractor's License Law fonthe . tpllowing-reason (Sectlon 7031.5 Business 5ntl PrOfessional Cotle: Any city or county wnich requirez a permil to construct, alter, improve, aemolish or repalr any ztructure, prior to IK.issuance, also requires the applicant for such permit �to file a si9nutl Statement that he/she is Ilcensetl pu�suant to Ihe provisions of the Contraclor'S License Law (ChaOter 9(commencing with Section 7000) ot 'Jivision 3 ot the' Business antl P�ofe55iOn5 Cotle) or that he/zha is exempt ierefrom antl Ihe ba5i5 for Ihe alle9etl exemOtion. Any vlolation ot SectiOn 31.5 by any appl{can[ fo� a petmll SubjeGts tne applicant to a civll nalty of not mo(e than tive nuntlretl Collars (5500). .I, as owner of the property'oi my employees wi[h wages as lheir So10 Ort1p¢n5a[io�� will tlo Lhc work, antl tM1e 5[�Ilc[UIB IS not IntenOetl or otteretl for sale (Se<tion �044, Business antl Profezsional Cotle: Tne Contractor's �� License law tloes not apPly to dn owner Of a property who builtls or imprOves ' thereon, antl wno tloes such work himselt/herseH or through his or her own employees, provitletl that such improvements are not intentletl o� offeretl tor Sale. It, howeve�. the builtling o/ ImO�ovoment IS soltl witnin one year at com- pletion, the owner will have the burtlen ot praving he/she aitl not bulltl or im- p�ove torthe purpose ol5ale). ' ❑ 1, as owner ot the property, am eKclusively cont�acting with Iicensetl con- t�aclo/s to cons[tuct the projecl (Sectlon ]044, Bu5ine55 antl Professlons Cotle: The ContractoYs license Law tloes not apply to an owner of propMty who builtls or imDwves thereon, antl who contracts tor such projects wlth a con- tractor(s) license pursuant [o the Contrac[or's License Law). I am aware [hat proof o� [heir Worker'S Coinpen5ation Insurance shoultl be provitleU to me., ❑ I am exempt untler Section _ B.,& P. �. foy�[hls reason ' Dace �� Owner I hereby certity t at I have reai information is cgf,rect. I agree tQ Signature !/./w' Drivers' License or 55 � _ E I(QZ-`da ' r f �-r� -.... __. TVPE OF CONSTRUCTION NEW P.DD ALTERATION REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTIONOF ORK/USEOF BLDG. �� ra- 'P,ci�-�i�%X I�UI1Ci�S'+Cf�� TVPE OF PERMIT�/ G ADING FOUNDATION STRUCTURAL ❑ TENANT YJ ELECTRICAL �PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION S�.FT. iIJ�T OCCUPANCV�_ CONSTRUCTIONTVGE ' VALUATION$ 2'�i'r�C%� 20NE ' GRADINGCU.VDS. ACRES Remarkz: Preventer Irrigation Drinking Fountains ' Floor Drains' � � Floor Sinks Gas Service Outlets � Interceptors Kitchen Sink _ Lavatories , - , Roof Drains Reinspection Fee Boiler .� � Duct- Under Ground Duct - Structural Duc[-Ventilating ' Exhaust SVsrem ❑ Multiple ❑ Firepl/Fact. BIL ICBO # Heating System & Ducting ❑6100,000 BTU 0100,000 BT Reinspection Fee � $15 CMF'0865-46, r¢v. 10/84 White - Builtling: Canary - Ap011cant; Pink - Accounting; Goltlenrotl - Assassor PLUMBING $hOW¢IS Servire Sink Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal ' Water Closet Water Heater Water Service _ Auto-Wash � e Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System � ❑0.100,000 BTU ❑100,000 BT System Repair/Alteration Fire Dampers Registers i laue Fee FEES e $ 3 � " $ 3 A.P. # S Main Buildi E T Front B Rear A C A�9ht K Left S Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. . Cooking Unit Dishwasher � Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Baxes , Outlets Switches . Garbage Disposal Generetor �0-5 KW � Reinspection Fee - DEVELOPMENT SERVIC Zoning Approved By_ Building Approved By APPlitation laued By— Accessory Building: 1 ELECTRICAL - Transformer '0 15-50 KW O 50 + IC W Meter ❑up m 100 amps � Meter ❑over100amps Sub Panel � . Motors �0.1 HP 1%�- 8 3�i� Inc. Solar.09-75 HP 016-15+ �Pole Light , Range Sign ; Standing Sections 15 KW Trash Compactor $15 � . ��Issue Fee� BUILDING PERMIT , $ I (04, SD PLAN CHECK $ �p. �2 PLUMBING $ ��.FL PLAN CHECK 25% $ �•�� ELECTRICAI $ ��D'OD PLANCHECK 50% $ ��5(i MECHANICAL $ PLAN CHECK 25% $ . � FEES $ 3 FEES � SMIP $ � , PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ MICFOFILM $ TOTALFEE $ �.�n -CONSTRWCTION AND PLANNING,- � � � � , ' . POI. .t SPA - . •' �' Date Inspector � Date �Inspector APPROVALS - Permii # � APPROVALS Permit # � 1 r Temporary EleGtrical Service or Pole � . 52. Pool�& Equipment Location � . � 2.�-Soil Pipe-Undrgrnd. . .53. Steel Reinforcement •� :�.� Electrical Conduit Utility-Undrgmd. � 54. Forms .. � f_.4) Electrical Conduit-Undrgmd. � � 55. Electric&I Bonding � .: 5�. Steel Reinforcement � ' �56. Rough Plumbing & Pressure Test � ' �`�6• Electrical UFER Grnd. _ .57. APPROVAL TO COVER-GUNITE . � � 7..Footings , 58. Electrical Conduif-Undrgrnd. . _ ' 8C Foundation _ � . 59. Gas Pipe, O Undrgrnd., Test ; - '.9. Wate� Pipe-Und�grnd. � � � � 60. Backwash Lines, P-Trap, O Undrgrnd. � � 10. Structural Floor System .� ' 61. APPROVAL TO DECK . 11. Property Sewer Line & House Connectiqn . 62. Backwash & Receptor-Final . � i . 12. Sewe� Cap � . 63. Heater &-Vent-Final � 13. Roof Drains � � � 64.. Plumbing System - Final, � 14.'Rough Plumbing � . �� 65. Electrical�Final. 15. Rough Electrical-Conduit - �; 66. Solar SVstem-Final� �" ' ' � ' � •i . _ 16. � Rough Electric Wiring �� 67. Fencing & Access Approval 17� Rough Wiring Sign ' � ' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . 20. Rough Factory Fireplace . APPROVALS. Permit# 21., Ducts�, in Structure " ' � 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil ,; 23: Gas Pipe-Rough & Test _' :�,. ;. 72. Underground Flush . � 24! Roof Framing . � 73. Undergrnd. Storage Tank � Gas ❑ Oil 25.' Roof Sheathing 74. Overhead Hydro .26'T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical ' : 27! Frame and� Flashing . ,. 76. Dry Standpipe � 28r. Lathing & Siding � . • 77. FIXED SYSTEM FINAL - � �r 29:� Insulation � • 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coet . � 79. FINAL INSPECTION - 32.�Electrical Power Meter-Final . '80. FOOD CERTIFIC TE ISSUED . 33. Final Electric . � �,p� • ��, Notes: � 34. Final Heating•&.Air Conditioning . - 35. Final Gas Piqe-Test, - ' � � 36. Hoodor Canopy , - - " ' , 37. Final Factory Fireplace ' � - � 38. Final Plumbing ' �� ' r/ � � � 39. Wate�rService-Fi�al 40. Gas'Service-Final � . ' ' ' � ' 41. Solar-Domestic-Final ' , - . ' ' . ' 42. Backflow Preventer, ' - , • � �" � � 43. Backflow Irrigation ~ , •1 44. -Landscape Irrigation System ."-` . � 45. Sound Attenuation � , . . , �. � � - • 46. Handicap flegulations � � • � • 47.FINALSTRUC7URE&BUILDING �1i ?iL � _ , � 48. Special Requirements Completed � - 49. Electric Release to Edison ' -� � ' �k 50. Gas Release to Southern California Gas Co � � � � ' ' � � . ' -" 51. CERTIFICATE'OFOCCUPANC� Y /� /` �`C : • �, __ . � . No. �� Date $ D�z 7 � ' , � . � .� ��_ �� AOP��ant ta fill in al1 spacez exeept those within neavY eoraer lines ana sign all apo/ovriate aeclaratlons. CiTY pF COSTA MESA /CONSTRU T�N PERMIT � rojpct AddresS b W � Applicant'sMaili/ Ad r� �� Owner's N^a�m�e� l�,,��.�p �VPhone Address J�� L✓c71 o%L.O'i�/C 1� . Arch/Eng. Licenu No. Address Contractor's Name �� Phpne� Addrew (mailing) � g � �• � �S�/� City License No. _ �y Z- LIC�NSED CONTRACTOR DECLARATION I het¢by affirm [hat I am Iicensetl untle� p�ovi5ions of Chdrte� 9(mmmencing with section 7000) o( Dlvlsion 3 ot the Business antl Protessions Cotle, and my Iicense is In tull iqcCeinp�tiect. UC2f�5C 55 �� /yj �L No. oate�L.� Signaturn �� WORKERS'COMPENSATION DECLARATION � nereGy afflrm that i nave a certificate o1 consent to selt-indure or a cerNfica[e � ' Workers' Gompensation Insurance, or a certifietl copy thereof (Section d00, �b. C:) �QM �7 � � Policy No. ��L�'�}� ComPanY ��M�� C¢rtifietl coPy is �er y furnishetl. � �CerC9 4 op is ' with Ihe cit tliilq n ate � Applican[ r"� EXEMPTION FROM WORKERS' CO ENSATION DECLARATION (Thi: s¢��ion neetl not be complete0 if the permit is for one huntlretl (E100) or Icss), I[er{�{y (hat In the perto�mance o( the wo�k for which thl5 perm�t is Issuetl, I Shall not employ any pe�50n i0 any mann¢r So as to beGome subject [o the Workers' Compensation I.aws of California. Date Si9nature 'NOT�CE: H, afte� making Ihis tletla�ation, yoU shoultl become Subject to th¢ Workers' ComOenution proNzlonz of the Labor COUe, you must fOrthwith ' comply witn such provi5lons or this p¢rmit SM1all b¢ tleemetl revoketl. CONSTRVCTION'LENDING AGENCV ' 1 hereby affirm that there is a mnstructlon lentling agency for the performance of the work for which this permit is issuetl (Sectlon 3097 Civ. G.) Lentler's Name LanUeYs Atltlress � OWNER BUIIOER OECLARATION I hereby atfbm lhat I am exempt trom the ConVactor'S Lic¢nse law fo� the following reason (Sectian �031.5 Business antl Pro�essional Cotle: Any city or County which requires a p¢/mitto con5truc[, dltEr, improve, Eemolisb o� �e0air any structurq prior to its issuance, also iequires the applicant tor such permit to tile a Si9netl zlatemen[ that be/She I5 IicCnsetl�pursuant to tha prOvisions o� the Contraclor'S License law (Chapter 9(commencing witb 5ection ]000) of Div�sion 3 0( th¢ Bu5ina55 antl Prote55ion5 Cotle) or [hat he/She i5 exempt •.refrom ana the basis tor the allegetl exemption. AnY Wolation o� Settion 31.5 by any applicant for a permit subjects the ap0��ant to a civil nalty oi not more than five nuntlre0 tlollars (§500). ❑ I, as owner ot the property or�my employees witn wa9es as tneir sole tort�0¢nsation, will tlo tho work, antl [he structure Is not intentletl or otferetl for sale (Section ]044, Business antl Protezsional Code: The Contra<tor's Lic¢n5e ldw tloes nol applY to.an owner of a properly wna builtls or Improves theteon, an0 who Eoes such work himself/herselt or lhrough his or �er own em6loyees, providea tnat such improvemenfs are noi intentletl or ot�eretl tor Sale, �t, however, the builtling ar improveme0t i5 soltl wlthin one year Of Com- � plelion, [be own¢� will have tbe bur0en of proving h¢/she Uitl no[ bulitl or im- p�oye for the pu�pose ot Sale). � ❑ I, as owner of the p�operty, am excluslvely contracting with licensetl con- traCtors to construct the project (Section 7044, Business antl Protessions Cotle: Th@ Contrac(or': License Law does not aOP�Y to an owner of property who bui�ds or imoroves thereon, antl who contracts for such Drojects wltn a con- traCtor(s� license pursuan't�[o the ConVactor's Licertse Law). 1 am aware that Prpof o their Worker'S Compensation in5urance shoultl be p�ovidetl t0 me. ❑ I am exempt untler Section B. & P. C. for tnis reason Date ' Owner _ I hereby certity tnat I nave reatl lhis Inip�matlon Is mrrect. I agree to comp ana ztate la re�ating i sentatives o i s/ty inspectlon r o 5. Signature Dri�ers' License or 55 � TYPE OFCONSTRUC710N LJ IYEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER' Ap # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICA� B Rear ' • C� �OTHER %� PRWECT DESCRIPTION SO. Fr. - oCCUPArvCV C Right K Left CONSTRUCTION TYPE VALVATION $ $ 20NE GRADING CU. VDS. ACRES ping. Ref. � Remarks: C I� Zg� PlanningNotes: � Bar Sink 8ackflow Preventer 8ackflow Irrigation rinkin9 Founteins loor Drains loor Sinks as Service Outlets Kitchen Sink Lavatories P-Trap • Roof Drains Reinspection Fee � $15, Boiler Duct - Under Ground Duct - Structurel Duct - Ventilating Exhaust SYstem ❑ Multiple ❑ Firepl/Fact elt. ICBO # Heating System & Ducting ❑ o-� oo.000 eTu O i oo.000 er Reinspection Fee � $15 CMF 0865-46, rev. 10/84 White - Builtling: Canary - AP011cant; Pink - Accounting: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection .50�3f COII2Ck0l5 Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Isue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System �0-700,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES 'Automa[ic Washer Construction Pole S Cooking Unit Oishwasher Dryers ❑Gas ❑E Fan F.A.U. Fixtures Device Boxes Outlets Swit�hes Garhage Disposal Generator 065 KN 3177 If/29/84 . 2one Accessory Building: ELECTRICAL � - Trensformer ❑ 15-50 KW ub. ❑ 50+KW Meter ❑up to 100amps Meter ¢r 100 amps � lectric Sub Panel c/Le:�Ccc� �ar�b�ll a i �"Y.C$ Inc.Solar 09�15 HP �i6- Microwave Pole Liahc � ! Standing Sections � 5�15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee FEES �DEVELOPMENTSERVICESRE�UIREM_- E' -,�NTS: Zoning Approved By 8uilding Approved By $ 3 SUMMAiiV OF FEES . BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE P�,4N CHECK 25% $ ENERG� P.C. ELECTRICAL $ �ZLi-� � ; GRADING PLAN CHECK 50% $ D./'7 M�CROFIIM MECHANICAL $ TOTALFEE PLAN CHECK 25% $ _. ___ _ . 29a25 Tt, FEES $ � Z O N I N G R E Q M T $ � •"�CONSTRUCTION ANDPLANNING - � � . POC SPA . APPROVALS - Permit# Date � Inspector AppROVALS Permit# Date Inspector ,,1. Temporary�Electrical Service or Pole 52. Pool & Equipment Location . �, . 2, -Soil Pipe-Undrgrnd. - , � 53. Steel Reinforcement . , ..3. Electrical Conduit Utility-Undrgmd. " �54. Forms�• . . ' 4. Electrical ConduiPUndrgrnd. • 55. Electrical Bo�ding ' . 5: Steel Reinforcement , -.� 56. Rough Plumbing & Pressure Test ��' -6• Electrical UFER Grnd. , - 57. APPROVAL TO COVER-GUNITE . �r7. Footings � • � ' S8. Electrical Conduif-Undrgrnd.- -. . _ ' � 8' Foundation' � ' - � 59. Gas Pipe, � Undrgrnd., Test ' � _9. Water Pipe-Undrgrnd. . �� . 60. Backwash Lines, P�Trap, O Undrgmd. 10.�Structural Floor Sysiem ' 61. APPROVALTO DECK - _ 11. Property Sewer Line & House Connectiqn � 62. Backwash & Receptor-Final . 12. Sewer Cap � . � 63. Heater& Vent-Final � 13. Root Drains � � � 64. Plumbing System - Final . � 14. Rough Plumbing � . . 65. Electrical-Final � 75. Rough �Electrical-Conduit 66. Solar System-Final �_ - � � � 16. Rough Electric Wiring � - ' 67.'Fencing & Access Approval .- � �17. Rough Wiring Sign • � - 68. APPROVED FOR PLASTERING 18.� Rough Electrical-T Bar Ceiling „ �. 69. POOUSPA SYSTEMS FINAL , � 19. �Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT . 20. Rough Factory Fireplace APPROVALS. Permit #• 21.,,Ducts, in Structure ' � 70. Underground Hydro , 22.��Ducts, Ventilating 71. Product Piping OGas ❑Oil , 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Freming 73. Undergrnd. Storage Tank � Gas ❑ Oil. 25..Roof Sheathing • 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing & Siding , � 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. fINAL INSPECTION 32. Elect�iral Power Meter-Final . 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final,Heating & Air�Conditioning ' . 35. Final Gas Pipe-Test ' . . , 36. Hood or Canopy , ' � � � 37. Final Factory Fireplace • � _ 38. Final Plumbing � . , 39. Water Service-Final � � . 40. Gas Service-Final 41. Solar pomestic-Final . � 42. Backflow Preventer , '" � ' � 43. Back4low Irrigation ° : 44. .Landscape Irrigation SYstem ' � . , 45. Sound Attenuation � � , �� ' ' 46. Handicap Regulations . _ � � ' � ' ^ 47. FINALSTRUCTURE & BUfLDING . 48. Special Requirements Compteted : � ' � � 49. Electric Release to Edison ' � , . � ' � � - - � 50l' Gas Release to Souther� California Gas Co ' �y � , � ' . � ' ' ' � 51�. CER7IFICATEAF OCCUPANCY . _ . . ' . -, , - , No. " � Date � � .' . . � City of Costa Mesa Development Services Department Building Safety Division P. O. Box 1200 Costa Mesa, California CEHTIFICATE OF OCCUPANCY No. OGI.Jv� The Building locateq at 586 4iFSP 19'i4f SPSF�IT has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group k3-2 Occupancy. Use of Building LI.�i1nR SIl7RF. Legal Description 422-141-19 (See raverse side for Metes and Bounds) duilding Permit No� .�'F'-1F7R0 Electrical Permit No.uuF'tA9R0,Fltidg�,'umbing Permit No. n��_1F91�o Mechanical Permit No. r�16028 Number of apartments and/or guest rooms ISSUED T0: P� J. � BuildingOfficial �/� /"1 � I �!/lit,i- by �/, e `�r �„�,,,r... ss6 w., i9Tx sr., aos� r�, cA. �� ,9 �,19�1 This Certifieate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Meu under Sec. 307 (e) U.B.C. CMF 1015-a6 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File T Avv��ant to fill in all spaces except those within heavY boraer lines antl sign all apProoriate aeelarations. �7T�'OFcoSTA MEsa CONSTRU�TION PERMIT �p/ Project Address � a b �• � � � �S Applicant's Mailning Address g � � w�� Owner'sName 1'W-�"�c�5 �--1 TQ�/�PI�b�e Address 'r1if� �li. � lTi. S}' �S'TW �PSA�e14 Arch/Eng. �. License No.' Address � ��"� /.� / Contractor'sNamct�a.tl[,1 x��-7 Pho� � � Y Address Ima"I� gl Lr�%J.,Z 5�• AL �t'qi is1 Ktl S�..5 . Ciry t,icense No. :�J.J� _�o�� - -1�'-�3�+� � LICENSEO CONTRACTO(t OECLARATION � I hereby affirm that I am licensetl untlergf.� � on5 of Charter 9(mmmencin9 with ��{on 7000) of Division 3 of t 6 ine ntl Protessions Cotle, antl my license is in i II forc antl eftect. Licenke lass - License lo:�� DateT �� Si9nature WORKEFS' MPENSATION DECLA � , - nereby affirm that I have a certificate of consent fo selt-� e or a certiticate ' bVbrkers' Compensation InSurance, or a certifietl wpy tttereof (Section ,800, �,ab. C.) � � � � Poucy No.�o¢ iy aa We comPa�y j Rwc� TnSLrnnce C�1t. �Cartifietl copy is hereby furnishetl. ' Certifietl copy is filetl with the city By�Itling Division. oa[e - aoa�icant �k-m✓�'�Pj'C�O� 'CCb(b+ai EXEMPTI N FROM WORKERS• COMPENSATION DECLARATI (This section neetl not be completetl if the permit is for one huntlretl ($100) or less). I cert�fy�that in the perto�mance o( the work fot which.this pe�mit is i55ueQ I' shall' not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califomia.. • ' Date - Signature NOTICE: It, atter making this tlpcla�atiOn, you ShOultl becoRte subjecl to fhe Workers' Compen55tion provisions ot the Labor Cotle, you must forthwith- comply with, such p�ovlsions or this permlt shall be tleemetl vevok¢tl. ' CON$TRUCTION LENDING AGENCV ' " I hereby a(firm that there is a con5t�uction lentling a9ency fo� the perfo�mapc¢ of the work .tor which this permit is issuetl (Section 3097 Civ. �C.) Lentler's Name Lentle�'s AOtlress OWNER BUILDER DECLARATION�� ' I hereby atfirm that I am exempt from the COn[ractor's LicenSe Law for tne following reason ($ection 7031.5 Bu5lness antl Professional Cotle: Any city or munty which reqUires a permit to Construct, alter, improve, tl¢molish or repdir -any Structure, prior to its issuance, also reqWres the aoPlicant tor such permit to tilw a sianetl statemen[ that he/she is IicenSetl Dulsuant t0 the Pfovision5 of 'kfrom antl th¢ basis (Ov the allegetl exemption. Any v101atlon oi SeCAon q.5 by any applican[ for a permlt subjects the appliCant to a Civil a��y of not more than five huntlretl tlollars (g500). � � i,.as�owner of thE P�oper[y or my employees with wd9e5 as thei� Sole , �ben5ation, will tlo the wo�k, antl the St�uCtu�e is not intentletl or offe�etl sale (Saction �044, Business antl Professional Cotle: Tha Contractor's � ense Law Aoes not applY to an owner of a property who builtls or improves r@on, antl who tloez such work h7mselt/hersel/ or through his or her own oloyees, provitletl that Such Imp/ovements ar¢ not intentle0 0� ofteretl tor ��. If, howeveq the builtling cr improvement is soltl within one year of com- :ion, the owner will M1ave the burtlen of proving he/she tlitl not builtl or im- �e for the purpoze of sale). - �, as own¢r of (he p�ope�ty, am exclusively contracting with licensetl COn- :torsto construct lhe project (Sectlon �044, Business antl Professions Gotle: . ' Contractor's Lirense l2w does nOt apply to an owner of Oroperty wh0 �tls or improves thereon, antl wno�conbacts for such projects with a con- :tor(s license pursuant to fhe Contractor's Licanse Law). I am aware that Ot o� tneir Worker's Compensation insurance shoultl b¢ provitletl to me. I am ezempt untle� $ection B. & P, C. for tM1is �eason Date Owner Drivers' Licens�'oP'S5 � CMF 0865-46, tev. thi ana nereoy dutnonz¢ repre- ve-mentionetl-pr,operty /or TYPE OFCONSTRUCTION LINEW U ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMpLISH ❑ OTHER A,p. # DESCRIPTION OF WORK/USE OF BLDG. S Main Buildin� E TVPE OF PERMIT '❑ GRADING 'FOUNDATIQN ❑ STRUCTURAL T Ffont ' Q TENANT Q ELECTRICAL ❑ PLUMBING 1�'MECHANICAL - " B Rear ❑ �OTHER � ' � ' p' PROJECT DESCRIPTION 5�. FT. - OCCUPANCV � C Right _ K Left CONSTRUCTION TVPE VALUATION $ $ ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: � ' Planning No[es: . � Sink � <flow Preventer - cflow Irrigation Jrinking Fountains � � • Floor Drains ' Roor Sinks - � �35$2(VIC2 �'Ql1t1CL5 � Interceptors � � � Kitchen Sink � - Lava[ories . P-Trap • Roof Drains � Reinspection Fee � . ' $15 6oiler Duct - Under Ground � Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple FirepVFact. Blt. ICBO # Heating System & Ducting ❑ ai ao,000 sTu O � oo,000 — �T-� I I Reinspection Fee Applicapp; Pink -Accounting; Goltlenrotl - ASsessoY� $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w Urinal- Water Heater ' ' Water Service . Issue Fee. . ' i 'g 3 , iANICAL FEES Hood or Typel ❑ � Canopy Typell ❑ � � � Refrigeration System �4100,000 BTU ❑100,000 BTU !_�- C$ System Repair/Alteration - Issue Fee � $ 3 Automatic Washer ' Construction Pol¢ Sub. ' Caoking Unit • Dishwasher Dryers ❑Gas ❑Electric Fan. F.A.U. Fixtures Devic¢ Boxes Outlets Switches Garbage Disposal 1355 II/01/84 ' �6,� � 7.OG ;TL 2one Z I Parking Req./Provided i ELECTRICAL ' Transformer ❑ 15�50 KW- , ❑ 50+KW Generaioi �0-5 KW �5-15 KW Meter ❑up to 100 amps , Meter ❑over100amps Sub Panel i Motors �0-1 HP �i %- 8 lnaSola� �9-15 HP 016-15+ nn:.....,........ .. _ Pole Light Range . Si9n Sianding Sections , Trash Compactor , � Reinspection Fee I. $75 ' ' Issue Fee DE V E LOPMENT SER VICES R EQUI R EMENTS: Zoning Approved By � Building Approved 8y Application laued ey � 'fi� FEES $ 3 � SUMMARV OF FEES ' BUILDING PERMIT $ SMIP $ PLAN CHECK $ � PERMIT � PIUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ �� TOTALFEE $ �•�� PLAN CHECK 25% $ I N G R E Q M T S. " CONSTRUCTION AND PLANNING � � � � • POO; iPA ; ,APPROVA`LS Permit# Date .Inspector qPPROVALS ��Permii# � Date Inspector �1. Tempora'ry Electrical Service or Pole; . 52. Pool & EquiPment_Location � - � � ' 2. Soil Pipe-Undrgrnd. ' , - . ' - 53. Steel Reinforcement � 3. Electrical Conduit Utijity-Undrgmd. � .54. Forms � � �. 4. Electrical Conduit-Undrgrnd. y� � _ 55. Electricel Bonding � - ' ' 5. Steel Reinforcement ' • � 56. Rough Plumbing & Pressure Test 6. Electrical UFER G'rnd. . � , 57. APPROVAL TO COVER-GUNITE . 7., Footings � - � � ' 58. Electrical ConduirUndrgrnd.. � , �8. Foundation , . - : _ , 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � - � '60. Backwash Lines, P-Trap, 0 Undrgrnd. . 10. Structural Floor System � � • . 61. APPROVAL TO DECK 11. Property Sewer•Line & House Connection � , �62. Backwash & Receptor-Final 12. Sewer Cap �� _ � . 63. Heater & Vent-Final � � 13. ,Roof Dreins � , - 64. Plumbing System - Final 14.'Rough Plumbing � � � • , 65. Electrical-Final � , � 15:�RoughElectrical-Conduit . - - 66. SolarSystem-Final. - - - - � 16. Rough Electric Wiring � :� � , � - 67. Fencing & Access Approval ' - - 17. Rough Wiring�Sign� � . � 68. APPROVED FOR PLASTERING � 18. Rou h Electrical-T Bar Ceilin �� 9 . 9 . 69. POOL/SPASYSTEMSFINAL 19. R'ough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT � 20.' Rough Factory Fireplace • - , APPROVALS Permit # 21. Ducts, in Structure � I � 70. Uniierground Hydro " �22. Ducts, Ventllating , ! 71. Product Piping OGas ❑Oil � - 23. Gas Pipe-Rough & Test : ,��. � � �72. Underground Flush � 24. iRoof Framing '� � 73. Undergrnd. Storage Tank O Gas ❑ Oil��: • 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceilirig (Structural) & Monocoat ' � 75. Dry'Chemical . . 27. Frame and Flashing � 76. Dry Standpipe , 28. Lathing & Siding : i 77. FIXED SYSTEM FINAL � 29. Insulation � 78. FIRE PREV. FINAL 30. Orywall Nailing � .HEALTH DEPT. REQUIREMENT � 37. Plaster Brown Coat � � � ' �79.� FINAL INSPECTION . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � � Notes: �. � 34. Final Heating & Air Conditioning ��y �'�� 35. Firial Gas;Pipe-Test � ' � ' I 36. Hood or Canopy . ' - ' . 37. Final Factory FiFeplace - � - 38. Final Plumbing � . � , ' � � 39. Water Service-Final � ' ' � 40. Gas Service-Final , ' � �, � . ' . 41. Solar pomestio-Final . ., ' , � ' `-"� � . . _. , 42. Backflow Preventer . � � � � 43. Backflow_Irrigation . „ . . - - . . ' . � � ' ' " ' 44. ,Landscape Irrigation SYstem , � � - ' I � � � -- 45. Sound Attenuation � � � � i 46. Handicap Regulations � - � . ' � � � . ' I 47. FINALSTRUCTURE&BUILDING ' ' � � 48. Special Requirements Completed � � "� i , � 49. Electric Release to Edison ' - - - - . � . . � 50. Gas Release to Southern California Gas Co � �' � � . ' 51. CERTIFICATE OF OCCUPANCY No. Date , � � ♦ � AOplieant to till in all spaees except ihose within heavy Doraer lines antl sign all aDD/ovriate tlaclarations. GTY� F COSTa MEsn CONST1R,UCTIOI#PErRsM—IT . ProjecnAddress �� W � �� - 'Applican�s Address �Qalner's Name w Phone Addreu �A � Arch/Eng. � � License No. IAdd'ess CJntractor's Name � Phone Address (mailing) Ciry License No. LICENSED CONTRACTOR DECLARATION ' I hereby aHirm that I am licensetl untler provisions of Charter 9(commencin9 wi[h section 7000) of Divislon 3 of the Business antl Grofessions Code, antl my license is in full force antl efiect. License Class LicenSe No. Date Signature WORKERS' COMPENSATION DECLARATION � hereby affirm that I nave a certificate of mnsent to salLinzure or a certlficate ` Wo�kers' Compensation InSurance, o� a certlfietl copY thereot ($ection 300, �ab. C.) ' Policy No. Company 8 Certifietl copy is hereby fumishetl. Certlfietl copy is tiletl with the city Builtlin9 Dlvislon. Da[e Appli[ant E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be tomple[etl if tne per i5 for on¢ huntlretl 5100) or less). I certify that in the periormance of the wo or whi<p t p mi ' issuetl, I snall not plo n�a{son In any mdu 5 [6� c 5 ect2o the H worker m sa❑ law5 of Calita(ni Dat � $ignature� NOTICE: H, aflet making this tleclaration, you shoultl becom¢ subjec[ [o [he Wo�ker5' Compensalion provisions of the Labor COtle, y0u must to�thwith comply with such orovisions or this permlt shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby affirm that there i5 a rons[ruction lending agency for the pe�to�mance of tne work for which thls permit is ISSU2� (Section 309� Civ. C.) L¢ntler's Name Lentler's Atltlress '� OWNER BUIL�EH OECLARATION I hereby affirm that I am exampt from the Contractor's License Law for the following reason (Section 7031.5 Business antl Professlonal Cotle: Any city or Coun[y which requires a Oermit to construct, alter, improve, tlemolish or repalr any sVuc[ure, prior to it5 issuance, also reqWres the applicant for SUGh pe�mit to tile a signetl stalement that he/She is licensetl putsuant to the provision5 of the ConVactor'S LiCense Law (Cbapter 9(mmmencing with Section ]000) of Division 3-of the Bu5ine55 antl.Protessions Cotle) or lha[ he/she i5 ezempl :�;._' �3ef obY anYhaPPI cantrtorea 11Peemitxsub)ects theYaPPI c[ant �o Sd�civil d`iMp �y of no[ more lhan tive huntlred tlollars (5500). . I, as owner of the proverty or my empioyees with wag¢s as iM1elr sole � compensation, will tlo the work, antl the sVucture is not Intentletl or offeretl for zale (Sectlon ]044, .Businesz ana Professional Cotle: The Con[ractor's License Law tloes not appry [o an owner ot a pmperty who builtls or lmproves lhereon, antl who aoes such work himselt/herself or through �is or her own employ¢es, OrOvitletl lhal Su[h improvements ate nOt Intentletl or Ottnretl for sale. 11, however, Ihe builtling o� Improvement is soltl withln one yea� of COm- pletion, lhe owner will have the buraen ot proving he/she tlitl not bulltl or Im- prove tor the purpose ot sale). ❑ I, a5 own¢v oi Ihe p�operty, am exclusivety mnt�aCting with IlcenS¢tl Con- IfdCI0I5I0 COOSIIUCL lh8 p�OjCCL (SCCi1011 �044� BUSIfI¢55 dOtl P(O�MSI005 COCO: The Contractor's License Law tloes not apply to an owner of property who builtls or improves tnereon, antl who contradts for such projects wlth a con- t�actor(s) license pursuant to the Cont�actor'S license Law). I am aware [hat proo/ of their Worker'S Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section T�—�:.� & P. C. tornhis reason Date �� _�� I hereby certity [hat I in(ormation ect. I antl state ws rel ing t zentatives oi tnis city inspe<tion ur es. Signature Drivers� �icense ar 55 � Owner � ve reatl this tion antl all clty a i, antl hE bOv¢�T¢I � 3�0� w t+Ciir��;utt,�'or� I TVPE OF CONSTRUCTION NEW . ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ,---f��J w� �� ` L� TVPE OF PERMIT GRADING' LJ FOUNDATION LJ STRVGTURAL ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCV_ CONSTRUCTION TVPE VALUATION $ ZONE GRADINGCU.VDS. ACRES— Remarks: � Bar Sink Backflow Preventer Backflow Irrigation Bathtubs " Clarifiers Dishwasher Drinking Fountains Floor Drains� Floor Sinks � GasSerJice�;� Outlets Interczptors,l� KitcRen Sirik` Lavatories; !, o_r.:;.: . . I PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collecrors - Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash ' FEES Reinspection Fee I $15 I I Isue Fae � $ 3 Boiler Duct - Under Ground Duct - Structural Duci - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blc ICBO # Heating System & Ducting ❑0-100,000 BTU 0100,000 BT Reinspeaion Fee � $15 CMF 0865-46, rev. 1o/gq White - Bulltling; Canary - ApPlicant: Pink - Accountin9: Gol�enrotl - AssesSor Hood or Typel O Canopy Typell ❑ Refrigeration System. ❑o-,00,000sru o,00,000eru System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 A.P. # Gf' O� S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # ' Planning Notes: 47E!;� S /,-! =. / : 7 Building: ELECTRICAL ' � Automatic Washer Transformer 15-50 KW Construction PoleSu6. ' � 50+KW Cooking Unit Oishwasher ' Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device eoxes ' Outlets Switches • � Garbage Disposal Generator �0-5 KW �5-15 KW � Reinspectian Fee � $15 DEVELOPMENT SERVICES REQI 2oning Approved By Building Approved By Application Issued By � Meter �up to 100amps �� Meter ❑over 100amps ^— Sub Panel Motors �61 HP �i %- 8 . Inc.Solar 09-15 HP �16-15+ Microwave .Pole Light \ � � Range $ign Standing Sections Trash Compactor . Issue Fea FEES $ 3 SUMMARV OF FEES � ' BUILDING PERMIT $ ' SMIP $ PLAN CHECK $ .PERMIT PLUMBING $ ISSUANCE ' $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ � GRADING $ PLANCHECK 50% $ S•'�F17 MICROFILM � $ MECHANICAL $ TOTAL FEE $ �� • ZV PLAN CHECK 25% $ - � /I \ CONSTRUCTION AND PLANNING POOL & SPA. i'� ,- APPROVALS Permit# Date Inspector qPPROVALS Permit# �� ' � Date Inspector 1. Temporary Electrical Serviceor Pole � 52. Pool & Equipment Location' " �� , , , 2. Soil Pipe-Undrgrnd. • 53. Steel fjein4orcement ' � • 3. Electrical Conduit Utility-Undrgrnd. • ' 54. Forms . � • 4. Electrical Conduit-Undrgrnd'. 55. Electrical Bonding �� j • , - 5. Steel Reinforcement � 56. Rough Plumbing�& Piessure'Test� ' 6. Electrical UFER Grnd. " 57. APPROVAL TO COVER-GUNITEs ' 7. Footings � - 58. Electrical Conduit-Undrgrnd. '� 8. FoundatiOn � • 59. Gas Pipe, � Undrgmd., Test • �-' 9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, � Undrgrnd. �-� ' 70. Structural Floor System 61. APPROVAL TO DECK I � � 71. Property Sewer Line & House Connection 62. Backwash & Receptor-Fi�al. � �� ' 12. Sewer CaP 63. Heater & Vent-Final ' • 13. Roof Drains 64. Plumbing System - Final ' 7 14. Rough Plumbing 65. Electrical-Final � 15. Rough Electrical-Conduit 66. Solar System-Final f 16. Rough Electric Wiring 67. Fencing & Access Approval� � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T�Bar Ceiling 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning , FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducis, Ventilating - 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro . .- 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 76. Dry Standpipe - 28. Lathing & Siding , 77. FIXED SY.STEM FINAL 29. Insulation 78. FIRE PREV. FINA� "� 30. Drywall Nailing� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION • 32. Electrical Power Meter-Final FOOD CERTIFICATE ISSUED , 33. Final Electric otes: ' 34. Finai Heating & Air Condltioning � 35. Final Gas Pipe-Test ' ' ' 36., Hood or Canopy 37. Final Factory Fireplace . �38rFinal Plumbing . . •� 39. Water Service-Final � � i 40. Gas Service-Final ' 41. SolarpomesticFinal� _ � - '42. Backflow Preventer ," 1, _.. 43: 8ackflow Irrigation . � '.44. Landscape Irrigation System � � 45.. Sound Attenuation .'� 46. Handicap Regulations . , . 47�.FINALSTRUCTURE&BUILDING �` . ` : ..� - � 48. SpeciaLRequirements Completed . � • - 49. �Electric Release to Edison , , �50. Gas Release to Southern Califomia Gas Co . � 51. CERTIFICATE OF OCCUPANCY � - i� - � No. Date � ' �