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Home My WebLink About600 19TH ST - Building Permits(714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 600 W 19TH ST Suile No Vicinity: Parcel Nunmber: 42214220 Applican�: Address: Owner: Atldress Contrector. Address: MARK EILAND BALL ROAD LLC 600,W19THST �� , -COSTA MESA; CA. ;, � � � � BEST SIGN PRODUCTS INC 2127 S SUSAN ST STE 1 SANTA ANA, CA Phone: 714-546-9710 Zip Phone: 2ip: 92627 Phone: 714-546-9710 Zip: 92704 License: 530800 SCOPE OF PERMIT -� ELECTRICAL FORILLUMINATED WALL SIGN FOR "CASH PLAS", RE:SBO6-00012 FEE SUMMARY ISSUED BY: Status: ISSUED Applied: 02/762006 Issued: 02/162006 � Quantiry ' Quantiry � ISSUE FEE � 323.5D � � . '�' Temp Dist System / Lighting $0.00 0 Temp service test 50.00 � Busway /100 ft � $0.00 0 Res. a/c package 30.00 Standing Section 50.00 0 New Res (1•2 units) 50.00 � 0 Misc Elecirical Equipment $0.00 0 New Res (3+units) 30.00 0,, Trans(ormers up to 1 kva/kw $0.00 0 � Pool I Spa SO.OD 0.� � � ................up to 10 kva/kw $0.00 0 Lighling Fixts ' 50.00 � 0 .................up to 50 kva/kw $0.00 0� � Recept Outlets 50.00 0 ..................up to 100 kva/kw $0.00 0 Switches � 50.00 0 ............:.....over 100 kva/kw $0.00 0 Non Res Appl . 50.00 0 Low Voltage Equipment $0.00 0 Res Appl , 50.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduil $0.00 0 Service to 1000a � 50.00 0 ' �Misa Conductor $0.00 0 Service over 1000a 50.00 0 � Circus ( gen or ride) 50.00 0 Motors to 1 hp � � 50.00 0 � Circus (mech ride or lights) $0.00 0 Motors to 10hp � ��50.00 0 � Christmas Tree Stand 50.00� 0 Motors to 50hp-_ , �'50.00 ;' - ' -'`0 - , � Fireworks Stand . � 30.00 0 Motors to t00hp � /�, 50.00 j ' 0 - , " Other Electdcal Fee 50.00 Motorsover100hp .,!' -50.00��? 0 - Communication drops �.30.00 � 0. Imestigation Fee $0.00 Sub panel ro 200a ,,. 50.00 � 0- - � Plan Check Fee $0.00 Pole Light Pkg , .$0.00 .�� 0 ' � Reinspeclion Fee 50.00 Sign Circuits �� . 324.60' � . 1 � Temp Pwr Pole � �- 50.00 � � 0� TOTAL CAICULATED FEES 548.10 Intermed Pole . 50.00. - 0 � � � � COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Orcl. No. 9248, § 7, 72•27•g2) EXPIRATION: This permit shali automaticalty expire and become void il work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply wlth all epplicable codes, and all requlred Inapectiona and final epprovel must be obtained. Failure to obtain Inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 75M5626 . c.+o-+o lawl � WORKERS' COMPENSATION DECLpHAiION: I hereby effirtn under panaNy ot perjury one N Me toi�owing Oadaretions: ❑ 1 have entl wlll maintain e certificate af consent to sell�lnsure tor workers' compensatlon, es provitled lor hy sectian 3700 of Ne Labor COCe, tor Ne peAortnance of the work for whlch Ihis pertnit is issued. ❑ I heve enA wlll malntain workers� cwnpensatlon insurence, as required by sectlon 3700 0l Ihe Lebor Cotle, for ihe partormance of the work for which Ihis pertnit ls issued. My worke campe�gatlon Ins anca cartier end pdicy number are: (�� Gartiec ��C� �� Policy NumOer. (Thls sect/on ne nof be canpleted i! (he peimiNs va/uod ef one huntlred dallers (5100) or Iess.J ❑ I certify Ihet in the pedormance ol lhe wo which Ihls permit is issued, I shell not employ,eny perso� �� any manner so es to �ecome suDject to the workers' compensetlon laws of Cali� ree t Id become suD�ect to ihe workpre' wmpensetlon provislons of Sectlon 3700 ot Ihe Lebor Catle, I shall forthwlth comply with these pmvi s. / Applicant Signeture: `� oe�e: �— —1 C.� — Q� WARNINO: FAILURE TO SECUflE WORKER$' COMPENSATIIXJ COVEMGE IS UNUWFUL AtJO SMALL SUBJEGf AN EM7LOYER TO CRIMINAL PENA�TES AND dVIL FlNES UP TO ONE HUNDRED TFKKISAND D0.URE (5100,000), IN ADDRION TO THE OOST OF COMPENSATION, DAMAGES 0.5 PROVIDED WR IN SECTIIXJ 3]OB OF TME LABOR CODE, IMEREST, AND ATTORNEI"S FEES. L�CENSED CONTRACTOflS DECLARATION: I hereby eMirm ihat I am Iicensed under provisic torce end ettect. uc. a g�C) `�J17 GomractoYs SlgneWre: ��.� of Chapter 9(commencing with Sectio 000) ol Division 3 0l �he Business � Cless a � � Date: � and my Ilcense is In tull '. GONSTRUCTION LENDING AGENCV: I[� I �ereby aNirm Ihat t�ara is a consWction lending egoncy Por Ne peAormance ot the work tor whict� thls p¢rmit Is issuetl. (Sec. 3�97, Civil Cotle). Lendels Neme: Lentler's Adtlress: Slgneture: Dete: OWNER-BUILDER DECLARATONS: I hereby eMirtn tha� untler penelry at perjury that I em EJ(EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7037.5, Buslness an0 Professions C�o: Any ciry or counry w�ich requires a permit to construct, elter, improve, tlemUish, or reDeir eny sWcture, pdor to its issuanca, elso requires Ne epplicent for suc� pertnit to ��le a slgned statement that �e or she Is licensetl pursuam w the provisions oi Ne Comrectors LJcense Lew (Chepter 9(commencing with Section 7000) of Dlvision 3 ot ihe Busineu end Prafessions Gatle) or thai he or she Is ezempt Iheretrom entl Ihe basis for the elleqed exemption. Any violetlon of Secllon 7031.5 by any epplicant for e permit sUbjecls Ihe epplicani to e cidf penairy at not mora than fiva �untlred dollers ($500j.j: ❑ I, as owner oi Ihe property, or my employaes wlth wages es their sole compensation, W ILL DO THE WORK, enA Ihe siructure Is not intentled or oflered tor ule (Sec. 7044, BuSiness end Profeuions Cade: The Contrectors License Lew does not apply to en owner ot pro0erry who bu�lds ar impm�es thereon, entl who does such work himsetl or herselt or t�mugh his or her own employees, providetl t�at such improvements are not Imended or oflered br sale. If, however, tha builtling or impmvement is sold within one year of completioq the owner-Duilder will have the Gurden of proving that he or she ditl �ot builtl or improve for purposa of seleJ. ' ❑ I, as ownBr of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTHACTORS to constmct the project (Sec. 7044. Business and Professions Code: The contractors ��cense law does not eppty to en owner of propeny who builds or improves ihereon, antl who contracts for such projact with e comracbr(s) licensa pursuant to the Contracrors License LawsJ. ❑ I em exempt untler sec. Signeture�. O�'�er ID vedlied by dnvefs license. ❑ Ves ❑ No Business and Protessions Cotle tor this reason: Ve��ica�ion ol Ownership by (type ol dwument, i.e. - proDerty tax bill or deetl): Drivels License No. Date: Expires: DI�ISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: d I hereby certify Ihat no excava�ion five (5) or more �eet in depth into which a person is require0 to desce�d, wlll 6e matle in connec�ion with worN euthodzetl by Ihis pertnit, entl t�at no builtling s[rutture, scaHoltling, lalsework, or demolition or tlismentling t�ereol, will be more ihan t�irty-six (36) tee� high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, iltle 8, Calitomia Atlminisirative Cotle). ❑ As owner�huilder, I will not employ anyone to do work wNU would require a pertnit Irom ihe Division oi IndusMel Sefery, as noted ebove, u��ess such person has a pertnit to do such work Gom Ihe division. Slgnature: Date: Dl��sion of Indu9trial Safery Pertnit Number. CE�FlCATE OF COMPLIANCE AND AUfHORVA710N OF EMAY: I certity untler penalry of perjury thai I have read Ihis flpplication end state Ihet the informatlon given is correct. I egree to comply wi�h ell state laws flntl dty ordinances rela�ing to Guiltling construction, end eu�honze representatives of I�e Ciry of Coste Mese lo enler upon the ebd�e-descri6ed property tor inspection purposes. I agree nof to occupy w aNcw occupancy ot eny bnilding euttrorized by this permit unW finfll lnspectia�. i u t Legal O er(s) / Date � 2-f(,� ,'rll„ � onze _ _.. Date �, INSPECTIONTYPE 1616 Fi:ed System Final Fire Pravention 1266 20tl 201 202 203 204 Pool Spe Finel Finel Pe-Rooi Flnel Block/Retaining Well Finel Fectory Fire Place Final Sign , Finel De��illon �jf, f(j�S� �QyE( INSPECTIONTYPE 206 Flnal Mechanlcal 20B Final Plumbing 210 Finel Electdcal � 212 Finel Fire Prevenlion 220 Finel Planninp Approval 222 Final Site 250 Final BUilding/Occupancy PAg lI�LS 9� � � i�v (714) 754•5273 • Fax (714) 754-4856 •��ci.coste•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 SIGN PERMIT Job Address: 600 W 19TH ST Suite: Vicinity: Parcel Nunmber: 42214220 npp�icant: MARK EILAND Address: , . ,-� �. owner: BALL ROAp LLC Address 600 W 19TH ST � ' COSTA MESA, CA' " , � . - Contracmr: BEST SIGN PRODUCTS INC Address: 2121 S SUSAN ST, ' STE 1 ".�,i : � ' SANTA�ANA, CA � Arch I.Eng : Zoning: Phone: 714-546-9710 Zip: Phone: Zip: 92627 Phone: 714-546-9710 Zip: 92704 License: 530800 Addressl � „ ., • , , ; � � . � P-hone: . ZIP � � � ' ' License: SCOPE OF PERMIT , ONE 19 S�.FT. ILLUMINATED WALL SIGN FOR "CASH PLUS" FOR UNIT F. FEE SUMMARY Plan Check: ' Permit: SMIP Com: Other: Inspection: � Total $25.19 $0.04 $38.75 ' $0.50 $0.00 $0.00 $0.00 $0.00 $0.00 $64.4i � : �� ' �� , . , PLANNING 8 ZONING '' �-_ ; _ � _ �'� , i , Status: ISSUED Applied: 02/162006 Issued: 0?J162006 �ISSUED BY: Calc Valuation. seso.00 Claimed Valuation: seso.00 NOTICE: The work authorized by this permlt shall comply with all applicable handicap access requi�ements under Calitornia statUtes and related regulations. (Ord. No. 92•28, § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work euthorized under this permit to be considered legel, such work must comply with all epplicable codes, end all required Inapectlons and finel approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 ...a�.a �aw� � WOHKERS'COMPENSATON DECLAFiA�ON: _ . I hereby eMrtn untler penelty of parjury one of Ne fWlowing tleclarations: ❑ I have end will mflintein a certificate o� consent ta setl•Insure for workers' compensation, es provitled for by section 3700 of the Labor Code, tor the peAormance oi the wark lor which this pertnii is issued. ❑ I heve erM will m � orkers' canpensetbn Insurerte, es uiretl by secllon 3700 af Ne LeDor Cade, tor Ihe pertarmance ol Ne work tor which thLq permit is issued My worker ' ompensetian n ce er en numD are: /� Certier. �-� � Policy Number. �� O— I (lhis s need nof be comp/eted i! tl e permit is ve/ued et one �undred dW/ers ($ J w Ieu.) ❑ I certily thet in Ihe pedortnance of Ne work for which Ihis permit is iuue4 I shall not employ eny person in eny menner so as to become sublect to the workers' compensetlon laws of Celifomia, and agree that It I shoultl become sub�ect fo the workels'�compensatlon provisions ot Section 3700 0l the Labor Code, I shall torthwith comply with these provision / �y ApD�icant Sfgnature: � . � Date: �_` � ' L�p �l WARNING: FAILURE E WORKERS' OO�dFENSATION CWERAGE IS UNLAWFUL FND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENN_TIES AND CIVIL FlNES UP TOONE HUN�RED TTfOUSNND DOLLARE (5100,OW), IN A�DRION Ttl THE WST OF COMPENSATIIXJ, DAMAGES AS PROVIOED FOR IN SECTIIXJ 37080F THE UBOR CODE, IMEREST, AND ATTORNENS FEES. LICENSED CONTRACTORS UECLAHATION: I hereby aHirm that 1 am lorce entl eNect. Lic. a_ Conirectofs Signeture: Chapter 9(commencing with Section 7000) ol Dhnsion 3 0l the Business / / Cless p ! and my license Is in full CONSTRUCTION �ENDING AGENCY: ❑ I hereby attirm that Ihere is a construclion lentling agency Por the peAortnance of t�e work tor which this Oertnit is issuetl. (Sec. 3097, Civil Cotle). Lenders Neme: Signelure: _ OWNER-BUILDER DECLARATONS: Lendefs Adtlr855: Date: I hereby eHirtn thet untler penelry of perjury lhat I em E%EMP7 FROM THE CONTRACTORS LICENSE LAW lar the following reason (Sec. 7031.5, Business entl Prolessions Code: Any ciry or counry which requires e pe��l to construct, aller, improve, Oemolish, or repair any structure, prior to its iuuence, elso requlres the eppllCaN tor such pertnit to tile a slgnetl stetement thet he or she Is Il�ensed pursueN to the pmdsions ol the Camrecrors LJcense Lew (Chepter 9(commendng wit� Sectlan 7000) ol Dlvlsion 3 oi the Business and Prolessions Cotle) or that he or she is exempt therefrom and ihe besls tor Ihe ellegeA exemptlon. Any vidation ol Section 7031.5 by eny ep0�lcant tor a pertnit subjects the epP��em m e civil penalry af no� more �han five hundred tlollars ($500)J: ❑ V, es ownar ot ihe D�operry, or rtry employees with weges es ihei� sole wmpensalion, WILL DO THE W OAK, end che sW cNre Is not inlendetl or oMered for sale (Sec. 7044, Busineu end Professions Cotle: The Contractors License Lew tloes not appN to an owner of properry who builtls or improves thereon, and who tloes such work himselt or hersell or Ihrough his or her own employees, provitled Ihat suc� improvements ere not Intended or ottered for ule. H, however, the huilding or improvement is solG wi�hin one year af completion, the owner-builder will heve the burden of proving thet he or she did not build or imprwe for purpose oi sale.). � ❑ I, es owner ot the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTBACTORS to canstruct t�e project (Sec. 7044, Business antl Professions Code: The comrac�ors Licensa Lew tloes not appy to an owner ot property who builds or impmves thereon, and who contracts tor such proJect wlih a contreaor(s) license pursuant to the Contrectors Ucense Lews.). ❑ I am exempt undar sec. Business and Protessions Code tor Ihls reason: Signature: Oete: Owner ID vorilied by dnver's license. ❑ Yes ❑ No Orivar's Licanse No. Evpires: Veritication of Ownership by (type of document, I,e. - propeny taz blll or tleetl): DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICA710N: ❑ 1 hereby certily �hat no exwvation tiva (5) or more teet in depih into which a person is required to descend, wlll be made in connecUon wi�h work euthorizetl Dy ihis permit, and that no building siructure, swHWding, talsework, or demolition or Uismantling thereot, will he more than thirry-siz (36j teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Celifornia Administrative Code). ❑ As owner-huiltler, I will not employ anyone to do work which woulA require a permit trom t�e Division of Indusirial Safety, as notee ebove, unless such person has a pertnit to do such work trwn ihe tlivision. Signature: Data: Divislon ot Industrial Selety Pertnit Numbec CEHTIFlCATE OF COMGIJANCE AND AIffNOR¢A710N OF EMRY: I certity under penalry ol per�ury �he� I heve rOaA INs appliwtion an0 stete Ihat t�e intortnetlon given is Cortect. I egree to compy wit� all state laws entl dry ordinances relating to Ouiltling construction, and euthodze representatives ot Ne Ciry ot Costa MeSa to enter upon the ebove-Uescribetl properry for inspection purpOses. I agree nat to occupy or ellow occu0ancy of eny building euthorized by this permit until fnal inspection. COOE I, INSVEC710NTYVE 1616 Fixed System Finel Fire Preventlon 1266 Paol Spe Final 200 Flnal RaRooi 201 Final BIocWPeteining Well 202 203 � Finel Factory Fire Place Final Sign Final Demolition �n —; _ I lo Y�(o / Date CO�E 1 INSPECTION TYPE 208 Finel MeChanical 208 Finel Plumbing 210 �Finel Elecidcal 212 Finel Fire Prevantion 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupency PAIC It�LS ��ia� �sa-sz�s • Fex (714) 754-4856 • www.c�.cos�a-mesa.ca.�slGN PERMIT Job nddress: 600 W 19TH ST Suite: Vicinity: Parcel Nunmber: 42214220 App�icant: PHUONHG NGUYEN Address: Zoning: Phone: 714-894-0076 _ Zip: - - . - .. , . ��,�: ?- , . . . � Owner: BALL ROAD LLC - Address 600 W 19TH ST ' � ' %�'" - �' � � � ' �� Phone: COSTA MESA, CA - � _„ Zip: _ � 92627 -� ., . , . . . ( ..y :._ . . . . Contractor. BUTTERFLY,;SIGNS;. ." = ` Address: � 8109 BOLSA AV � " . . �- MIDWAY,�CA � � Arch / Eng : � � � � Address: Phone: 714-894-0076 Zip: 92655 License: 803767 �, ; Phone: '�` Zip:.-_ � � License: 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 09/01/2005 Issued: 09/0112005 ISSUED BY: � � � � - � SGVYt Vh F'tKMI I � � - , ILLUMINATE CHANNEL 2175 SQ.FT. CHANNEL LETTERS SIGN FOR "CALIFORNIA FOOD.STORE" IN � � UNIT A. ` . . . ,_,,-z. � , . v� , g_ _ _ .FEE SUMMARY _ _ .. m _�: s� , �� Plan Check: $54.11 , fb. � Calc ValuaUon . ' . '$a;000.00 , . � . $0.00��.>_ : - . _ � - m. '' Permit: $83.25 `^-� ClaimedValuation .:- . $s,00000 ' . .. f SMIP Com ; $0,63 ;� . - -: . , . �� , � _..: �•,. _ ,.. . . , Other: $0.00 a, ...... $O.Otl -- . F Inspection: , $0.00 • • �@�.0� - " ., 3 .. . ' . . � ' . W0.0� i: � ' . . �. E.. � Total: $137 995,�; � �c�,,, ,, � , ' �� . . ,Y . �� d. , . . .^��: � � PLANNING & ZONING ;. b , i.. � �- � � , _ � � �r.. � < a ".& -.� , ��, , , � t . �� .i��( W.... � �:�� • � al`� "'� ' � ,`"r ' ..,, _, n'�.. ' �. �rc�> . � � v e. "' . Y `T"iF�,�� .. - � ` a.�...«,.,._.....�".i _.., NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Celifoinia statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) c�, foXalperTod ot�180'day6rmit shall automatically expire end become void if work Is not commenced within 180 days, or if�work is suspended or abandoned INSPECTIONS: In order for the work �uthorized under this permit to be considered legal, such work must comply with ell applicable codes, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit. FOR MSPECTIONS CALI: (714) 7545626 � �"+ 260&4fi (flb0) WORKE� M ENSATION DECLARATION: �{°— . }l I hereby aNirm untler penelty of per�ury one ot the following declaretions: � ❑ I have end will mainteln e �enificate ol consent to sell-Insura for workers' compensetion, es provldeA for by section 3700 0l the Labor Cotle, for iha peAarmance of the ork far w�lCh ihi9 permit �s �ssuetl. ave and wlll maintain wo�kers' compensetlon Insurance, as required by sectlon 3700 of ihe Labor Code, for the perto�mence of Ihe work for whiU ihis pertnit is issued. M worke!rs�'1�p m{pe�,nsatlon InTsmance rtier end poliry number ere: e� J"TT 1KJ Ts� Poli Number. I l� e� I 7 i3 3— O� (Thls 5,ectlon need nat be comp�efed Il the pe�mit Is velued ef one huntlred dollers ($f 00) or less.) ❑ I certity that in ihe pertormence of the work for whlch Ihis permit is Issued, 1 shell not employ any person in eny manner so as lo become su6�ect to the workers' compensetion laws ol Celltomia, anG egrae ihet'rf I should become suD�ect to Ihe workere' mmpensetion provisions of Saction 3700 01 the LeDor Code, I shall fonhwith �o wi�h �hesa P� 9 / ( % � pliCant nature: � (�],/�,,�-b �� Dete: W NIN�: FAILURE TO SEC �E RKERS' COMP AT10N�OV�AAGE IS UNLAWFUL AND SHALL SU9IECT AN E O CFIMINp1 PEN TES ANDOCIVIL FlNES UP TO ONE HUNDREO TMOUSANDDOLLARE($100,000),INADDITIONTOTHE TOFCAMbENSATIIXJ,DAMAOESASPROVIDEDFIXiINSEGTION3]WOFTHEIABORCAOE,INTEFEST,MlOATTORNEV'SFEES. TRACTORS DECLARATON: at I am licensed under provis ons of Chapter 9(commencing with Section 7000) of Lic. k �� H 7 COGe, and my Iicense is in iull CONSTAUCTON LENDING AGENCY: ❑ I hereby ettirtn tha� Ihere i5 a construction lending agency for ihe peAortnance of ihe work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Neme: Lender's Address: S{gnature: Date: OWNER-BUILDER DECLARAYIONS: I hereby aHlrm Ihet under penalry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW far the tollowing reason (Sec. 7031.5, Business entl Professions Code: Any city or county which �equires a permit to construct, elter, Improve, demolish, or repalr any structure, prlor to its Issuance, elso requires Ihe epplicant for suCh permit to Ole a signetl statement Ihet he or she Is Iicensetl pursuent to ihe pmvisians ot the Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Dlvision 3 oi the Business entl Professions Cotle) a< <hat he or sha is ezempt thereirom and the basls for the ellapetl exemption. Any violetion of Saction 7031.5 by any epplicant far a pertnil subjects the epplicent to a civil penalry of not more Ihan fve hunOretl Gollars ($500).): ❑ I, es owner of the property, or my employees with wages as their sole compensatlon, WILL DO THE WOqK, and the structure is not intended or otteretl for sele (Sec. 7044, Business and Pmfessions Code: The Coniractors License Law does not apply to an owner of properry who builtls or Improves the�eon, end who does such work hlmself or harself o� through his or her own employees, provided that such Improvements ere not Intendetl or otfered for sale. N, howaver, the building or Impravement Is sold within one year ol completian, the owner-Duilder wlll have the burtlen of proving thet he or she did not 6uild or improve lor purpose of sale.). � ❑ I, as owner ot Ihe D�Werry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTpACTORS to construct the proJect (Sec. 7044, Business and Professions Cade: The contractors LICB�se Law does not epply to an owner ol propeny who �uiltls or improves Ihareon, and who contracts tor such pro�ect with e conirector(s) license pursuant to the CoNrectws License Laws.). ❑ I am axempt under sec. Business end Protessions Code tor this reeson: Siqnature: Dete: Owner ID veriTietl by drivels license. O �es ❑ No Orivers License No. E�ires: Venfcation ot Ownership �y (type oi document, i.e. - property tex bill ar deetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby certify that no exW�alion five (5) or more fee� In depth into whlch e person is requlred lo descend, wlll be mede In connectlon wl�h work au�horized by �his permit, and that no building struclure, scattolding, falsework, or demolitlon or dismantling thereof, will ba more ihan ihirty-siz (36) feet high. (Chap. 32, Grp 2, AA 2, Sec. 341, Tltle 8, Celitomia Adm��strative Cotle). ❑ As owner-buildar, I wlll no� employ enyone to tlo work which would reQulre e permit from the Olvislon of Intlustnel Sately, es noted ebove, unless suc� person hes e permit to do such work from the divislon. Signature: Date: Division ot Intlusinal Satety Permit Number: CERTIFICATE OF COMPLIANCE AND AUfliORIZATON OF ENTRY: I certity under penalry of perjury thet I heve reed ihis application end state that the Informatlon given Is wrtect 1 agrea to comply with all stete lews and ciry ordinances relating to builtling consWctlon, entl euthodze representelives of the Clty of Casta Mesa ro enter upon the ebove-described property for inspection purposes. I agree not to occupy or allow occupancy ol any building euthonzed by Ihis pertnit until final inspeqion. COUEI, INSPECTIONTYPE 1616 Fixed System Final Fire Prevemion 1266 Pool SOa Final 200 Finel Re-Root 201 Finel BIocWRetaining Well 202 Final Fectory Fire Place 203 Flnal Sign 204 Final Demolition CODE1 INSPECTONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Finei aianning npproval 222 Final Site 250 Finel Bullding/Occupency P�IE Itff�@ (714) 754-5273 • Fe�c (714) 754-4858 • www.c�.costa-mesa.c��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, Gn 9262s Job Address: 600 W 19TH $T suite: F Vicinity: Primary Occ: B Eat<50/ORce/ Bar<50 Parcel Number: 42214220 App�icant: CARLOS PADILLA Address Owner: BALL ROAD LLC Address 600 W 1gTH ST COSTq MESA, CA Contractor. VAULT CONSTRUCTION Address: P.O.BOX 488 � - " YUCAIpA, CA Zip: 92399 . Arch : Address: Zip: 839SF;'CASH AND PLUS" STORE TI. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $117.81 $181.25 $Q.00 $z.os $o.00 $0.00 $301.12 Phone: License: Type o( Construction: V-N Zoning: Phone: 909-797-7121 Zip: Phone: Zip: 92627 Phone: 909-797-7121 , License: 755571 Eng: Address: SCOPE OF PERMIT SETBACKS MAINSTRUCTURE Front 0-0 Rear 0.0 ACCESSORY Fronl 0- 0 Rear 0. 0 PARKING existina: o Required: a FEE SUMMARY PLANNING 8 ZONING Status: ISSUED Applied: 12I152005 i55�ed: ivisnoos ISSUED BY: �� Caic Valuation: Claim Valuation: Left 0- 0 - Right Left 0- 0 � ' � Ri9ht Pronosed: 0 . � - . 0- 0 0- 0 _ Phone: License: 59,800.00 $9,800.00 � NOTICE: The work authorizeq by thls pertnit shall comply wlth all flpplicable harWicap access requirements under Califomia statutes and related ragulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shall automaticalty expire end becoma vold if work Is not commenced wlthin 180 days, or il work Is suspended or abandoned lor e period of 180 days. INSPECTIONS: In order tor the work authorized under thls permlt to be considered legal, euch work muat comply with ell appliceble code9, end all requlred Inapeetlone end flnel epproval must be obtalnetl. Fallure to obtain Inspectiona and final epproval will result in the ezplretion ot this pertnit. FOR INSPECTIONS CAIL: (711) 7545828 sea-ae �aroo� WORKERS'COMPENSAnON DECLAflAnON: ' ' ' I �ereby eRirm untler penalry oi perjury one of the tollowing declarations: '� � .. ❑ I heve end wlll melntain e cenificate ol consent ro setl-Insure lor workers' compensation, as provitled br by sectlon 3700 of the LeDor Code, lor t�e pertarmanca ot Ihe work far w�ich ihis pertnii is issuad. . - �}' I have entl will maintain workers' cwnpensation Insurarxe, as requireC by sectlon 3700 of the Lebor Code, for ihe peAormanca of Ne xrork fw whkh Ws pertnit is issued; /� My workeC� �satl�Inw�JN� nd policy number are: �, 7C' Certier. //`� (J Policy Number: � 7 7/ Z.� I � (TM1Is secnwr nee nof be canplefe tl Ne pemtitls velued e( one hwMred dollers (S7 ) or /ess.) . . . ._ . � ❑ I cenily that In t�e pertarmance ot t�e work lor whiU Uis pertnit L5 issued, I shell not employ eny persan In any menner so as to become sub�ed to the workers' cpnpensellon lews of Cell , enC e thel il 1 should,become suD�ect to Ihe workers' co pen5ati0n provlslons ot Sectian 3700 0l Ihe Lebor Cotle, I shall torthwlt� comply wlih these prov' s.� / Applicent SlpnaNre: �� oe�a: % �— %.1 —O� (i WARNINO: FAILUHE TO SECURE WORKERS' COMPENSATIdJ COVERAGE IS UNLAWFUL AND SHALL SUBJECf AN EMPLOYER TO CPIMINAL PENALTIES PND CIVIL FlNES UP TOONE HUNDRED T/K)USAND DOLURE (5100,000), IN ADDITION TO TNE C0.ST OF COAIVENSATION, DAAIAGES /S PROVIDED FOR IN SEGTON 37080F THE IABOq CODE, INTEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eXirm that I em Ilcensed under provlslons ol Porce ana enea. uc. a � S Contrectafs Signeture:� with Sectlo ) of Dlvision 3 oi Ihe Buslness end Professions Code, entl my Iicense is In full � Class p � ' / Dete: % �— —%�--OC— CONS7RUCTION LENDING AGENCY: ❑ I hereby aflirtn t�al Ihere Is e construction lending egency lor the pertormence oi the work tor which this permit is issue0. (Sec. 3097, Clvil Code). . Lentlels Name: Londer's Atltlreu: Signature: Dete: OWNER•BUILDER DECLARATIONS: I �ereDy eHirtn thet under penalry ot perfury ihat I em EICEMPT FROM THE CONTRACTOHS LICENSE LAW for the following reeson (Sec. 7031.5, Business anA Professlons Cotle: Any ciry or counry which requires e permit to �vnsWct, alter, improve, demolish, or repalr eny strucWre, pdor to Its issuance, elw requires the epplicant for such permit to file e signetl statement that he or she Is Iicensed pursuent to the proWsions ol ihe Conirectors LJcense Lew (Chepter B(cammendng with SecUan 7000) of Division 3 of the Business end Professions Cotle) or that he or she is eaempt therelrom antl t�e besis for Ihe ellegetl exempllon. Any Nolation of Sec6on 7031.5 Dy eny appllcant for e pertnit sub�ecis tha epplicem ta a civil penelty of not more than Me huntlreG tlollars ($500).): ❑ I, as owner of the properry, or my employees with wages as thelr sole compensatlon, WILL DO TME WORK, end the siructure Is not intendetl or oflered lor sale (Sec. 7044, Business antl Professions Code: The Coniractors License Lew Coes not eppty lo an owner ot properry who builds or imprwes Ihereon, anA who does such work hlmsetl ar hersetl ar Ihrough his or her own employaes, pmvidetl Ihat such Improvemenis are not intended or otteratl for sele. If, however, the building or impmvement is sold within one year oi completion, t�e owner-builder will have the Durtlen ol proving that he or she did not 6uiltl or improve tor purpose of sale.). ' ❑ I, as owner of the pmPerty, em E%CLUSIVELY CONTHACTNG WITH LICENSED CONTRACTORS to construct t�e pmjed (Sec. 7044, BuSiness antl Pmfessions Catle: The contreqors llcense Lew does not appty to an owner ot property who 6uilds or Improves thereon, and who comracts lor such pro�ect with a contrector(s) license pursuant to t�e Contractors Ucense LawsJ. ❑ I em axempt under sec. Signature: Owner ID venTietl by tlriver's license. ❑ Yes � No Business end Protessions Code tor this reeson: Verlticatlon ol Ownership �y (type af tlocument, i.e. - properry tex bill or tleetl): DIVISION OF INOUSTRIAL SAFETY PERMR CERTIFICATION: Drivefs License No. Date: Expires: ❑ I hereby certify t�at no excavation five (5) or more teet in tlept� Into which a person Is requlred to tlescenQ wlll be mede in connection wlth work euthorizeO by this permit, entl that no builtling siructure, sceHolding, talsework, or tlemolitlon or tllsmantling thereoi, will be mora then Ihirty-six (3B) leet �Iph. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Tltle 8, Calltomia AdmInlSlretive Cotle). ❑ As ownerbuilder, I wlll rat employ enyone ro do work whic� would require e pertnit tmm the Dlvision ot InOustrial Satery, es notetl ebove, unless such person has e permit to do sucn work trom the tllvision. Signature: Date: DlNglon ol Intlustrial Selety Pertnit Number: CERTIFlCA'�E F MPLIANCE AND AUTHORQATION OF EMRY: I cenily under penalry of perf ury Ihet I have reaC �his applicetlon end state that the Infortnatlon given Is correcy%gree to pty wltt�.eN�atate laws end dry ordinances�rel ting to buildinp construcUon, end authodze representatives ol the City ol Coste Mesa to enter upon the ebov9-d 6EnbeA pr erty for Ins ction pu _rposes. I egree`n� py or ellow ocapancy ot eny building euthonzed by Ihis pertnit unGl final InspecNon. � /y aNre �pelOwrier(s) / Date � � � t — 0 � AndO uNorizeA Applicant Deta CODE I, INSPECTONTYYE 1616 Fized System Finel Fire Prevention 1268 Pool Spa Finel 200 Finel Re-Roof 201 Flnel BIocWRetaining Well 202 Finel Fectory Fire Place 203 Final Slgn 204 Final Demolltlon . . QAIE Ni�l� � . COOE I INSPECTION TYPE 208 Finel MBUlenical 208 , Final Plumbing � 210 Flnal Electdcal 212 Finel Flre Prevenllon 220 Final Planning Approval 222 Flnel Slle 250 Finel Builtling/Occupanry (714) 754-5273 • F8X (714) 754-4856 • wWw.Ci.COSfe•mBSe.Ce.US 77 FAiH �RNE, GOS IA MtSA, GA 9Z6"16 ELECTRICAL PERMIT ,lobAddress: 600 W 79TH ST Suite No Vicinity: CASH PLUS Parcel Nunmber: 42214220 Applicant: CARLOS , Address: P O BOX 486 YUCAIPA, CA Owner: BALL ROAD LLC Address 600 W 19TH ST COSTA MESA, CA Contractor. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fizls Recept Outlets Svritches Non Res Appl Res Appl Service to 200a Service to t000a Service over 7000a Molors l0 1hp Motors l0 10hp Motors lo SOhp Motors to 100hp Motors over 700hp Communication drops Sub panel to 200a Pole LigM Pkg Sign Circuits Temp Pwr Pole Intermed Pole VAULT CONSTRUCTION INC P O BOX 488 YUCAIPA, CA Phone: 909-797-7121 Zip 92399 Phone: Zip: 92627 Phone: 909-797-7121 Zip: 92399 License: 755571 SCOPE OF PERMIT tN7ERIOR 839 SF STORE TI FOR "CASH $ PLUS." REF: BOS-02304 10 OUTLETS, 2 SWITCHES $23.50 $0.00 50.00 $0.00 $0.00 50.00 so.00 511.00 52.20 $0.00 50.00 $0.00 $0.00 so.00 50.00 50.00 50.00 $0.00 so.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 10 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighling Busway/100ft Standing Seclion Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up l0 50 kva/kw .................up l0 100 kva/kw ..................over 100 kvalkw Low Voltage Equipment Low Volt Wiring Syslem / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Olher Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee ISSUED BY: Staws: ISSUED Applied: 01/10/2006 Issued: O1I702006 Quantiry 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 so.00 0 50.00 0 50-00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 so.00 0 50.00 0 50.00 0 $0.00 0 $0.00 so.00 50.00 50.00 TOTAL CALCULATED FEES 536.70 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Californla statutes and related regulations. (Ord. No. g2-28, § 1, 12-21•92) EXPIRATION: This permit shall automatically explre end become void if work is not commenced within 180 days, or if work is suspended or abandoned lor a period ot 180 days, INSPECTIONS: In order for the work authorized untler this permit to be consideretl legal, such work must comply with all applicable codes, end all required Inspeetiona end final epproval must be obtained. Failure to obtain Inspeclions and final approval vnll result in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 , 24a&48 (fl�00) WORKERS'COMPENSATION DECLARATON: . I hereDy aflirtn unde! penalry of perjury one of the following tleclaratlons: , ❑� I have end will melnteln e cortllicate of consent to sell-Insure for workers' compensatlon, as proNdetl for by section 3700 0l the Lebor Code, tor ihe peAormence ot Ihe wark lofwhich lhis pertnit Is ISsueG. '�'� %I hevB entl will meintain workers' compensatlon Insurflnce, as requiretl by section 3700 0l Ihe Lebor Coda, for the perlwmence of the work lor whlch Ihis pertnit is issued. /"My wo FAyrs�r��setlor�Jrtsorap�cartier and poliq num�er are: �` r Carrier. �—lir u9 rc�+�7 Po��cyNumoer�� ! 27 / (77i�Cffon need na� be compleletl !! fhe pemut is valued af one huntlred dol/ars ($100J or IessJ ��_ ❑ I ceNly t�at in the peAor f Ihe work For which t II is issued, I s�all not employ any person in any manner so es to �ecome subject lo �ne workers' compensation laws oi elifomi end e hat il I oul ecome subject to the workers' compensation provisions of Section 3700 ot the bor CoAe, I shall fonhwith _ wmply wit) ese p v lons. , /— //, ' U� ApDli� Ipnature: O te: V WARNINO: FAIWRE TO SECURE WORKFAS' COMPENSATION COVEMGE IS UNLAWFUL AND SHALL SUBIECT AN EMpI.OVE�R TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED TMOUSMID DOLLARE (5100,000�, IN AODfiIIXJ TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3108OF THE 1A80R CODE, IMEREST, AND AYTORNE`fS FEES. LICENSED CONTRPCTORS DECLARATON: I hereby eMirm �hat I 8m licen�s /under sion ot Chapter 8(commencing vrith Section 7000) oi Divlsion 3 ot Ihe Business ep�Profeysions Coda, entl my IMsnse Is in lull fOfce end BfleCl. Lic R. !—�� Cfe59'R /J � Gontrectors�Sipnswre: pa�e: ' O—O � 1 1 CONSTRUCTON LENDING AGENCY: ❑ I hereby attirtn that thera is a construction lending egency for the pedortnance of the work for which this permit is issued. (Sec. 3097, Civil Cotla). , Lenders Name: Lendels Adtlress: Signature: OWNER•BUILDER OECLARATONS: Date: I �ereDy effirtn thei untler penelry of Der�ury Ihat I am EXEMPT FROM TIE CONTRACTORS LICENSE LAW tor Ihe following reeson (Sec. 7031.5, Business flnd Professlons Cotle: Any ciry or cou�ry which requires e pertnit to consiruct, alter, Imprave, demolis�, or reDalr eny structure, prior to Its luuance, elso requires the applicant lor such pertnit to lile e signetl stetert�ent thet he or she is Iicensetl pursuent to the provisians oi 1he Contrectors Llcense Lew (Chapter 9(commenGng wlih Sectlon 7000) ot Divislan 3 oi ihe Business entl Prolessions Code) or ihat he or she is exempl Iherefrom and Ne basis lor the elleged exemption. Any Noletlon of Sactlon 7031.5 by eny applicant for e permit subjects the epplicent lo e civil penolty ol not more �hen five hundred dollers ($500).): � I, es ownar ol ttre D�operty, or my employees with weges as Ihalr sole compenutlon, WIL� DO THE WORK, antl the strudure Is not intentletl or oMereC lor sale (Sec. 7044, Business antl Protessions Coda: The Contractors License Lew does not appty to en owner of property who builtls or improves thereon, and w�o tloes such work himselt or herself or through his or her awn employees, provitled thet such imprwements ere not intendetl or oHered tor ula. If, havever, Ihe building or impmvement is sold wiNin one year ot completion, the owner-builder will heve the burden ot proving that he or she tlid not Duild or improve lor purpose of sale.). � ❑ I, as owner of Ihe property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to rqnstruct the pro�ect (Sec. 7044, Business end Professions Catle: The conttaclors License Lew does not appty to en owner ol property who builds or improves ihe�eon, and who mntrects tor such projed wlih e conirector(s) license pursuant to the Contraaors License LewsJ. ❑ I em exempt un0er sea _ Slgnature: Owner ID veritiad by d��ers Ilcense. Vedlicetion ot Ownership by (type ol Business entl Protessians CaOe tor lhis reason: ves ❑ No i.e. - property lax bill or deed): Onvefs LicenSo No. Dete: Ezpires; OIVISION OF INDUSYR�AL SAFETV PERMR CERTIFICA710N: ❑ I hereby certity tdat no excavation tiva (5) or more teet In tlepth into which a person Is requiratl to tlescend, will be ma0e In conneciion with work euthodzeA by this permit, and that no builtling slructurB, scaHOlGing, lalsework, or tlemolition or tlismantling thereof, will be more Ihan Wrty-su (36) feet high. (Chep. 32, Gry 2, Atl 2, Sec. 341, TiUe 8, Cali�ornia Administrative Code). ❑ As owner-Duiltler, I will not employ enyone to tlo work which would require e pertnil Irom the Oivislon ot Industnal Selery, as noted above, unless such person has a permit to tlo sucp work irom Ihe division. Signeture: Date: Division of Intlusinal Satery Permit Number: ICERTIFlCATE OF COMPIIANCE AND AUTHORIZATION OF ENTBY: I certily under penel�y ol perjury that I have read Ihis epplicalion antl state ihet t�e Inlortnation given is I wrrect. I egree to comply witn ell state lews antl ciry ortlinances relating to huilding wnswction, end euthodze representatives ol t�e Ciry ot Costa Mesa to enter upon Ihe ebove-described property lor inspection purposes. I egree not to occupy or allow occupancy of eny building authonzed by this permit until final inspectlon. .. . . ' L• ..�. 1618 Fized SyStem Final Fira Prevention 1266 Pool Spa Final 200 Finel flaRoof 201 Flnel BIxWRe�aining Well 202 Final Faaory F��e Place 203 Final Sign 204 Finel �emolili0� PAIE 1�RL5 /_/O —o6ate 400E� INSPECTIONTYPE 206 Finel Mechenical 20B Final Plumbinp 210 Final Electrica{ 212 Finel Fire Preventbn 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupenry P6g 1t�i a2 � (714) 754-5273 • FBX (714) 754-4856 • wMhv.Cl.coSte-fn058.Ce.u4 77 FAIR �RIVE, GOS IA MtSA, GA 8'L6Lti MECHANICAL PERMIT Job nddress: 600 W 19TH ST Suite No Vicinily: CASH PLUS Parcel Number: 42214220 npplicant: PADILLA, CARLOS Address: P 0 BOX 488 YUCAIPA, CA Owner: BAIL ROAD LLC Address: 600 W 19TH ST COSTA MESA, CA . Contractor. VAULT CONSTRUCTION INC Address: P O BOX 488 YUCAIPA, CA ISSUED BY: Phone: 909-797-7121 Zip: 92399 Phone: 2ip: 92627 Phone: 909-797-7121 Zip: 92399 License: 755571 SCOPE OF PERMIT INTERIOR 839 SF STORE TI FOR "CASH $ PLUS." REF: BOS-02304 1 REPAIR/ALTCOOLINGMEAT ISSUE FEE Inst FAU <700 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heal Insl / Rep. Recess Wall Htr Retrig Sys <700 k BTU Refrig Sys >700 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Sing�e Duct Appliance Fire Dampers Smoke Dampers Insl or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Fumace Floor or Suspend Heater 523.50 50.00 $0.00 $13.70 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 50.00 50.00 50.00 Quantiry FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation Syslem Evaporative Cooler C ommercia l I n cine rato r Domestic Incinerator Compressors / Absorption Svstems Uplo3hp/100kBTU 3 To 15 hp / 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechaniwl Fee Investigation Fee Plan Check Fee Reinspection Fee TOTALCALCULATEDPEES COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: 01/102006 Issued: 01/10/2006 Quanlity 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 SO.oO 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 50.00 50.00 537.20 NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related regula�ions. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or ii work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the vrork euthorized under this permil to be consldereC legal, such work must comply with all applicabla codes, and ali required Inspeetlona end flnal epproval must be obtained. Faiiure to obtain inspections antl final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 2A46-68(8/00) WORKERS'G�MPENSAnON DECLARATON: -�� I hereby affirtn under penalry ot perjury one ot the following tledara0ons: � � ❑ I �ave antl will maintain e ceniticate ot consent to self-Insure for workers' compansation, as provided for by section 3700 af the Lahor Code, b� lhe peAormance ot �he /wark tor which this pertnit Is issued. and will Insurance, as rgquired by sectlon 3700 of the Labor Code, for tho pertortnance ot the work far which Nis pertnit is issuetl. ? policy number ere: � � � � n � / . pdky.Num�er: !/ velued at one hundretl tld/ers (5100) or less.) � ❑ 1 certly t�at in the perfo ce of tha work tor w�ich this pertnit is issuod, I shall not employ eny person in any manner so as to became subject to Ihe workers' �p¢�getlon laws alil ia, e0 ree tliat If I � Id become 5ub�ecl to t�e workers' compensation provislons ot Sactlon 3700 ot the Labor Cotle, I shall forthwith comply Wit� thes isi s. � �WP��IS�� `� Da`eJ � ""/O,^' O � WARNINO: FAILU:7E TO SECURE WOPo(ERS' C061PEN TION COVERAGE IS UNUWFUL rWD SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDREO THOUSAND DOLLARE �5f 00,000), IN ADDITION TO TME WST OF WMPENSATION, �AAMGES AS PROVIOED FOR IN SECTION 3]OB OF THE LABOR COOE, IMEPEST, AND ATfORNEY$ FEES. LICENSED CtlNTRACTORS DECLARATION: I hereby affirm lhal I em licensed untler Orovis.yi ns of Chapter 9(commencing wilh Section 7000) ol Divlslon 3 of �he Business an r-fesylons Code, end my license Is In tull lorce end eHec�. L.io.�l i S/ Cle�e q / Contrectors� Signet, e' Dete1 /—/ O— O I �- CONSTRUCTIDN LENDING AGENCY: ❑ 1 hereby 0nirm that chere is a consUuctton lentli� apenry tor �he peArnmance oi the worn tor which t�is permil is is5ue8. (Sec. 3097, Civil Code). Lenders Neme: Lentler's Adtlress: Signature: Date: OWNER•BUILDER DECLARA710NS: I hereby efllrtn Ihet untler penelry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW br ihe tollovnng reason (Sec. 7031.5, Buslneu and Professions Cotle: Any Gry or wunry which requlres e permlt to construct, elter, improve, demdish, or repair any swcture, pnor to its issuance, alw requires IhB applicant tor such pertnil lo lile a signetl statemem that he or she Is Iicensed pursuant ro Ihe pmvisions ol ihe Contrectors Llcense Lew (Chepter 9(commendng wich Secqon 7000) ot D'Msim 3 of the Business and P�ofessions Cotle� or that he or sha is exempt Iharetrom and the Dasis far the elleged eaemption, My violaUon ot Section 7�31.5 by any applicaat tw a permit sublec�s the app��wnt to a civil penalry af not more than frve hundred tldlars (5500)J: ❑ I, es ownU� ol Ihe D�aPery, or my employees wi�h wages as t�eir sole compensation, WILL DO 7HE WORK, antl Ihe structure Is not intentled or oHerad lor sale (Sec. 7044, BuSiness antl Professions Cada: Ttie Contractors License Law does not appty to en owner ot property who builds or improves therean, antl who does such work himsell or hersetl or ihmugh his or her own employees, provided that such improvements are not Intended or oflered tor sale. If, howaver, the building or impmvement is sold within one year ol completion, Ihe owner-builder will have the burden ot provinq ihat ha or she did not Ouiltl or improve for purpase oi sale.). ' ❑ I, es own9r of the property, em E%CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the pmjed (Sec. 7044, Business and Professions Cotle: Th� contractors License Lew tloes not apply to an owner ol propeny who builds or impmves ihereon, and who coniracts for such project with a coniracbr(s) license pUrsuant to the Contractors License Laws.). ❑ I am exempt under sec. SignaWre: Owner ID veniied by drivefs license. Ves ❑ No Business entl Pmfessions Code for Ihis reason: Verification ot Ownership by (rype ol tlocumenl, i.e. - property taz 6ill or deed): Dnvers License No. Date: Expires: DIVISION OF INDUSTRIAL SAFE7Y PERMR CER7IFICATION: ❑ I hereby cenity that no excavatlon tive (5) or more feet in depth into whic� e person is required to descend, will be matle in connection with work eulhodzed hy this permit, end that no building sWcture, scaflolding, lalsework, or Cemolition or dismantling thereof, will be more ihan ihirry-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title d, Californla Adminlstretive Code). ❑ As owner�builder, 1 will not employ enyone to tlo work which waultl reduira e permil from the Division of Industriel Sefery, es noted ehove, unless such person has e permit ro da such work trom Ihe division. SignaWre: Date: Division of InGus�rial Satery Permit Number: CERT1FlCAiE OF COMPLIANCE AND AllfMORQATION OF EMRY: I cenlfy under penalry ot perjury ihat I �eve reatl ihis application and state that Ihe inlortnation given is correct. I agree lo comply with ell stete laws and ciry ortlinences relating to builGing wnsWction, en0 eut�odze representatives of the Ciry of Costa Mesa to enter upon the ebove-descdbetl p�operty for inspection purposes. I agrea not to accupy or ellow occupanq at eny builtling au�honzed by this pertnit uNil tinal inspectlon. cooe �, mseesn4n.vz� 1616 Fixetl System Finel Fire Preventlon 1266 Pool Spa Final 200 Finel Re-Rool 201 Final BIocWRetaining Well 202 Final Fa�ory Fire Place ' 203 Finel Sig� 200 Final Demolition ��l / � /Q � fnl� Q�1g �$ �QyE� INSPECTIONTYPE 206 Flnel Mechanical 208 Flnel Plumbing 210 Flnal Electncal 212 Final Fire Prevention 220 Finel Planning Approval , 222 Final Slte 250 Finel Building�Occupancy 2 �z (714) 754-5273 • Fax (714) 754�4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 600 W 19TH ST Suite No D Vicinity: UNIT D (SUBWAY) Parcel Nunmber: 42214220 Applicant: PARK, BRIAN Address: Phone: 714-225-1337 CELL Zip: Owner: ROBERTSON, GENE H TR Address 536 SEAwARD Phone: CORONA DEL MAR, CA Contractor: YOUNG PARK CONSTRUCTION Address: 5357 BARRETT CI Arch / Eng : Address: ISSUE FEE Backflow irrigation Backhow Preventer Balhtub Clarifier System Conned (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor BUENA PARK,CA Zip: 92625 Phone: 714-523-5256 Zip: 90621 License: 405940 Phone: Zip: License: Status: ISSUED Applied: 04I01/2o04 Issued: O6/18I2004 ISSUED BY://// / �' J�� V SCOPE OF PERMIT INTERIOR 1290 SF TI FOR'SUBWAY" IN UNIT D. WORK TO DEMOLITION/ADDITION OF NONBEARING WALI, ELECTRICAL, MECHANICAL AND PLUMBING WORK. NO ADDED PLUMBING FIXTURES; ONLY CHANGE-OUT OF EXISTING. 2 FLOOR DR41NS, 1 KITCHEN SINK, 1 SERVICE/MOP SINK, 1 URINAL, 1 WASH BASIN, 1 WATER CLOSET, 1 WATER HEATER/VENT REF: 804A0640 AMT 523.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 FEE SUMMARY QTl' AMT Laundry Tub / Washer $0.00 0 Landscape Irtigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 k) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo ,. $0.00 2 Sewer Connect $0.00 on 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(td) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Sel Waste and Vent System NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California regulations. (Ord. No. 92-28, § 1, 7241-92) EXPIRATION: This permit shall automatically expire end become voitl II work is not commenced within 180 days, or if work Is s� for a period of 1 BO days. / INSPECTIONS: In order tor the work authonzed under this permit to be considerad legal, such work must comply with al�e� requlred Inepectione entl finel epproval must be obtained. Failure lo oblaln inspections and final approval will result in t� xpirat / FOR INSPECTIONS CALL: (714) 7545626 / ! zaawe �eroo� , / AMT $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $9.80 $0.00 $0.00 on 0 0 0 1 0 0 1 0 0 and related orabantloned �le codes, and all of ihis permit. WORKERS'COMPENSAnON DECLARAnON: I hereby aMirm under penelty ol perjury one of the following tleclerations: ❑ I have end will melntain a certilicate ol consent to selt-Insure for workers' compensatlon, es pravided tor by sectlon 3700 of �he Lebor Code, for Ihe pertortnence ol the � �ork tor w�ich this pertnil is issued. �' I have entl will malntain workera' compensation insurence, es requiretl 6y secllon 3700 ot the Lebor Cotla, for the peAortnence of tha work tor which Ihis pertnit is Issued. My workers' cppipensation Insurence cerrier and policy number ere: ❑ I cetlify thet in the per compensetion laws oi compty with these pru FULURE TO SECURE � -��.nwmm�: _/ l/ 73.1 S— �3 — 6 �, U ffre perm/t !s va/uad ef one hundred dollars ($100) or less.) of Ne ork tor wNch Nis pe IssueE, I shall nat employ any person in any menner so as to become subject to the workers' i, en� ree that il I shoula me uD�ect to lhe workers' compensetlon provlsians ol Section 3700 of the Labor Code, I shall forthwlN _ Det� !o . % � • �i � 0 M1D SHML SUBIECT rW EMPLOYER TO CNIMINAL PENA�TIE$ AND CML FW ES UP TOONE HUNDiiED ES AS PROVIDED FOR IN SECfION 3'lOBOF THE IABOR CODE, INTEHEST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I �ereby eHirtn thet I em Iicensed un r pravisions oi C�apter 9(commencing with Section 7000) ol D'Mslon 3 ot the Business end Professions Code, anA my license Is In tull brce end�e�6G:kl� i �/7/l.vr.2% �i � �—Cless i� . t'l5 CONSTRUCTION LI ❑ I hereby aflirtn Lentler's Neme: _ Slgnature: _ is e construction I�fi�ifig egenCy for the perfortnance of Ihe work tor which Ihis pormlt Is is5uetl. (Sec. 3097, Civil Cade). �� Lendar'S Address: Dete: OWNER-BUILDER DECLARATIONS: I hereby eHirm Ihet under penalry oi perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any clry or counry whic� requlres a permit to construcL alter, improve, tlemolish, or repeir eny strucWre, pnor to Its issuance, also requires the applicaN tor such pertnit to file e signetl stetement that he or she Is Iicensed pursuan� to lhe provisions of the Contredors LJcense Lew (Chepter 9(commencing wit� Section 7000) of DMsion 3 ot Ihe Busineu end Profeulons Code) or t�et �e or s�e Is exempt t�eretrom antl Ihe besis tor the elleged exemption. Any Wolatlon of Section 7037.5 by eny epplicant far e pertnit sub�ects the epplicant to e ciWl penalry of not more than frve huntlred ddlars (5500).): ❑ I, es owner ot the property, or my employees with wages as their sole compensa�on, WILL DO THE WORK, antl t�e structure Is nat intended or oHeretl tor sale (Sec. 7044, Businew end Protessions Code: The Cont2ctors License Law does not apply to an owner of property who builCs or improves thereon, and who does such work himself or herself or through his or her own employees, provided thet such imprwamenis ere not Intendetl or oNeretl for sale. It, however, Ihe builtling or Improvemeni is sold within one year of wmpletion, ihe owner-builtler will have the burden of proving thal he or she ditl no� builtl or improve for purpose of sale.). � � I, es owner of the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ta construct ihe project (Sec. 7044, Business entl Professions Code: The contractors License Lew tloes not appty to an owner of property who bulltls or Impmves thereon, end wha contracis tor such project with a coNracior(s) license pursuant to the ContraIXors License Lews.�. ❑ I em e:empt under sec. Business antl Protessions CoAe br this reason: Signature: Dale: Owner ID verNied by drivers license. ❑ Yes � No Drivefs License No. VerillcaHon of Ownership by (ty{�a of tlocument, i.e. - properry tac bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Expires: ❑ I hereby certily Ihet no excavatlon Ilve (5) or more leet in depih into which e person is requlred to Cescen4 wlll be mede in connection with work euthorized by this permit, entl t�et no building slmcWre, scatfolding, falsework, or tlemolition or tlismaNling thereol, will be more t�en thirty-six (38) feet high. (Chap. 3.2, Gry 2, An 2, Sec. 341, Ttle 8, Celllornla AdmlNsiretive CoCe). ❑ As owner-builtler, 1 will not employ enyone to do work which would reQuire e permil lrom Ihe Dlvlslon ol IntlusMal Sefery, es nated ebave, unless such person has e permit to do Such work Irom Ihe divislon. Slgneture: Dete: Olvision oi Industrial Selety Permii Number: CERTIFlCATE OF COMPLIIWCE AND AUTTfORIZATON OF EHTRY: I certily under penalry ol Dorjury thet I have reeG Ihis application end state iha� the infortnatlon given is correcl. I egree to comply wit� ell stete lews antl ciry ordlnances releting to builtling construction, end euthodze representetives ot Ihe Ciry ol Costa Mese to enter upon Ihe above-tlescribed property tor inspection purposes. I egree not to acupy or ellow occupency al eny builtling authodzed by this permit until final inspection. COOE �. INSFECTIONiYPE 1618 Fixetl System Final Fire Prevention 1268 Pool Spe Finel 200 Finel Re-Roo1 201 Final Block/Retalnlnp Well 202 Flnal Fectory Fire Place 203 Finel Sign 204 Final Demalltlon QdjE �$ SODEI INSPEGTIONTYPE 208 Finel Mechanical 20B Finel Plumbing 210 Final Elecirlcal 2�2 Finel Fire Preveniion 220 Final Plenning Approval 222 Final Site 250 Final Building/Occupency Date ..1.� / �. �ci PAIE It�E65 Job Address: Suite No Vicinity: MECHANICAL PERMIT 600 W 19TH ST D UNIT D (SUBWAY) Parcel Number: 42214220 nppiicant: PARK, BRIAN Address: Owner: Address: Contrador. Phone: 714-2251337 CELL Zip: ROBERTSON, GENE H TR 536 SEAWARD Phone: CORONA DEL MAR, CA Zip: 92625 YOUNG PARK CONSTRUCTION Address: 5357 BARRETT CI BUENA PARK,CA Phone: 714-523-5256 Zip: 90621 License:405940 Status: ISSUED • Applied: 04/01/2004 Issued: O6I18I2004 ISSUED B .: �O%� � �%'� ��, SCOPE OF PERMIT INTERIOR 1290 SF TI FOR "SUBWAY" IN UNIT D. WORK TO DEMOLITION/ADDITION OF NONBEARING WALL, ELECTRICAL, MECHANICAL AND PLUMBING WORK. . � NO ADDED PLUMBING FIXTURES; ONLY CHANGE-OUT OF EXISTING. 2 REFIRG SYS < 100K BTU, 1 VENT FANISINGLE DUCT REF: B04-00640 ISSUE FEE Insl FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst I Rep. Recess Wall Htr Re(rig Sys <100 k BTU Refrig Sys »00 k BTU Gas Piping Factory Fireplace Hood w/Mech E�chaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater 323.50 $0.00 $0.00 50.00 so.00 $29.60 $0.00 50.00 50.00 $0.00 $0.00 $7.25 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry FEE SUMMARY Repair I Alt Absorbtion Unft Repair / Alt Refngeretion Unit Ventillation System Evaporative Cooler Commercial Incinerator Domestic Incinerelar Compressors / Absarption Syslems Up to 3 hp I 100 k BTU 3 To 15 hp I 500 k BTU 15 To 30 hp I 1,000 k BTU 30 To 50 hp / 1,750 k BTU � Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calik regulations. (Ord. No. 92•28, § t, 1241•92) EXPIRATION: T�is permit shall automatically expire and become void if work is not commenced wi�hin 180 days, or if work is tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all required Inapectiona and final approvel must be ob�ained. Failure to obtain inspections and final approval will result in the e� FOR INSPECTIONS CALL: (714) 7545626 znasre �eroo� Quantity $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 and related orabandoned �le codes, and a�l of ihis permi�. WORKERS' COMPENSATION DECLARATION: I hereby ettirtn untler penalry af perjury one of iha fallowing tleGarations: ❑ I heve end will mainteln e ceNlicate o� �onseni to sell-Insure for workers' compensetlon, es pmvltleA tor by sectlon 3700 ot the Lebor Coda, fw Ne pertortnance oi the rk for which this pertnit Is IssueA. I have and wiil maintain wo'Icers' campensetion insurance, aa requireE by sectim 370p of ihe labor Code, lor Ue peAortneiue ot ihe work fw whkh Nls pemut Is issued. My workers' w tlon Insuran cemer a d polcy number ere: �: � 36 3- o� Emno�� , � �v �" Pa r�,oe,: 1 % �s_ (m!s secHon needTi6t be comp�eteo ll the peimtr veNeO ef one hundretl dollars ($/00) or /ess.) � WFRNINO; FFILURE T THdISAND DOl1ARE LICENSED CONTRACTORS DE I heretry'aflirm IF—iai18R1'pcensed lorce and�a �_� CONSTRUCTON LENtl1NG AG t/ ❑ I hereby aHirm that there is Lentlefs Neme: Signeture: f ihe work tor which Ihis il is issued, I shall not employ any person in eny manner so es to becoma subject lo t�e workers' enA a8ree Ihe1 If I sl�l�tl��e sub�ect to the worken' compensation provlslans of Sectlon 3700 of Ihe Labor Code, I s�all lonhwl�h ��/� � � • /��/ 13A� MOE IS UNUWFUL M!D SNALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES ANO CML FlNES UP TO ONE HVNDRED OOST OF ODMPENSATION. UAMAGES 0.5 PRO��DED FOR IN SECTION 3'!OB OF THE UBOR COOE, INfEPE$T, AND ATfORNEYS FEES. pro�slons ol with Sectlon 7000) ot Divvlsl�on'3'of 1he�8u ess antl Professlons Code, enA my Ilcense Is in tull �Class a � oare: y.�,r y 5 D lending epency far the peAartnance oi I�e work tor which ihis pertnit is Issued. (Sec. 3097, CiWI Cotlej. Lentlefs Atltlress: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn that under penalty ot perjury lhat I am E7(EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Pratessions Cotle: Any ciry or county which requires e pa�i� to wnstruct, elter, imprwe, demolish, or repeir eny siructure, prlor lo its issuance, elso requlres.the epplicant for such permit to file e signetl statement that he or she is li�ensetl pursuent to tha proNsions of the Conlractors LJcensa Lew (Chepter 8(commendng with Secllon 7000) ot Dlvision 3 af Ihe Business end Professbns Code) w thet he e� she is eaempt therafrom and the Dflsis fw tha ellegetl exemption. Any Woletion af SecUon 7031.5 by eny eppliwnt for a pertnit sub�ects t�e ep0�want to e civtl Denairy ot no� more than frve huadred dollars (E500).): ❑ I, es owner W Ihe pmperry, or my employees with weges as their sde compensetlon, WILL DO THE WOHK, antl t�e struaure is no� Imendetl or ottered tor sale (Sec. 7044, Business and Prolessions Cotle: The ConiraMws License Law tloes not appty to an owner of property who builds or imprrnes Ihereon, antl who tices such work himselt or herseli or thraugh his or �er own emplayaes, proWdetl that such improvements ere not intended or oNered lor sale. If, however, the building or improvement is sold within one year of campletion, Ihe �nerbuilder will have the burden ol proving that he or she did not 6uild or improve tor puryose ol sale.j. � ❑ I, as owner of ihe pmperry, em EXCWSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business end Professions Code: 7he conirectors Llcense Lew does not epply to an owner of propeny who bulltls or Improves thereon, end who comrects for such pro�ect with a contractor(s) license pursuant to the Contractors License LawsJ. ❑ I am azempt untler sec. Busineu and Prolessions Coda for this reeson: Signature: Data: Ownar ID venfietl by tlrivers Ilcense. d Yes ❑ No Drivefs License No. Vetlflcetion ai Ownarship �y (type of tlocum�nt, i.e. - properry tes bill or Geetlj: OIVISION OF INOUSTRIAL SAFETY PERMR CERTIFICATION: ExpireS: ❑ I hereby certily Ihet no excavetlon live (5) or mora teet in depih into which e person Is requiretl to tlescend, will be metle In cannection wlth work euthorized by this pertnit, end tha� no builtling stmdure, S�allolding, telsework, or demo�ition or Oismentling thereoi, will be more then thirty-siz (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomla AdministretNa Gode). ❑ As owner-Duilder, I will not employ enywie to do work whkh wauld require e permlt trom the Division af Intlusirial Selery, es noted aDove, unless such person hes e pertnil to do such work trom Ihe division. Sipneture: Dale: Dlvision ol InOustrial Sefery Permit Number: CERTIFlCATE OF COMPIJANCE AND AUiHOR¢A710N OF EHIAY: I certily under penelry ol perjury thet I heve read t�is epplication enC siate Ihet the inlormation gNen is correct. 1 egree to compry with all stete laws en0 dry ortlinences relating to building construction, entl authoriza representetives of the Ciry oi Coste Mesa to enter upon the ebove�described property lor Inspection purpeses. I aprea not to occupy or allow occupancy of eny builtling aulhonze0 by ihis permit until tinel inspecilon. COpE I. INSVECiIONTYYE Qdg 1616 Fi:etl System Finel FIre Prevenllon 1268 Pool Spe Finel 200 Finel Re-Roof 201 Flnel BIocWRetnining well 202 Flnal Factory Fire Place 203 Finel Sign 204 Final Demditlon Date d_/�. oy ` ats—� �� a MSPECTIONTYPE 208 Final Mechenlcal i � 208 Finel Plumbing 210 Finel Electrical 212 220 222 250 Finel Fire Prevantlon Finel Planning Approval Final Site Final Bulltling/Oaupenq aoonEssawnmu 6�0 W ly'1'H S"1' OWNER8NAI1EIfRAWN: ROHERTSON, GENE H TR �uoxrsx 536 SEAWARD CQRONA DEL MAR,CA 92625 714) 760-8364 .v�..�•noaesx MCXRECT OR fW WFEA: c«rte�crara ru�: CONIN�CTOR9YYIRlO �oo�ss uNr: uc xo. UMT: UG NOc uNr: 11CFNSEO CONTNACTOq3 DECL�FRTON: I Mmby dfim urder peruly W peejuy tM� I em IimsaE wWer pwi�iaro N Cheqx Y i�,,,mw .nn c«�� 000� a awo� a a me e� .�a a�eo:�. coa.. roe mr co.v. m m nm mR..d atw. cm uc. wo.: uc. ctwss: uc. No.: E X P: Dma: � Cap�wm. OWNEq BUILDEP DECLAflATION: I �mab/ eRum ivWr prWy d perjry INt 1 am avmq Imn iM fqmMm Lban�s Lew In IM fWbMviY rwm (SeGcn ]W 1.5 &niaf� eM PMemo�u CaCs: AnyW a mvuY Mfi'vlt iF�� s O��i lo mq4uN. e11N. imMOM. md'qh. a ropei vry euunu�e. p'v m ea'ew�v, eho �pwo tM epp6mm tar qch panim �o fYe e o�nM aelrneN dW M a�hs Keruee w� �o �ne a�� a me wurem+ Lic�» �... f�a. e lm+un.�a wn seao� noo) d oi.e'v� a d u. �a end Prdwioro Codel a thel M o eM u ezemp tlwetrom uM �he Cem 1> tM eAePd uemqion. Mrv videiion d Sod'on )m�.5 M eny epWiw+ta e aemd aiMe+ Na �c�+'� �o e dN v��'i d nu maa ihm R.v hudesd eo4n �S.mp. ❑ I.mwmsrdiMV�Wa�YamYa^MWM+x'fAweWatMidemm0��. TEotMwF.mdNseNclun4nU'vnendad a dlueE br seb (Saction 10u. Bue'vra end Pmleseom Code: Ths Cantmfas licema lew Aom M eoG�Yloen ov.nerd p�opa�ry who Wdda a inMq's+rheram. vd wtro dom suM xM 1"vnseE a henM a Wu� hu a Mr own emybr*e+. Pwldoy fiet wch unP�mow ero nU'vaefdeE a dleetl ta ub. tl. lwxa. tM bisbin0 a inpwanra u wN wdhm arYw d m�Isbn. IM ywiyrbiiNv wi0 Mre Ns dvden d porinp M a dr tid rG Mdd a'vnpova la Ne prtpu� d qb). ❑ I m ornr d tM V��Y. em uAmwlY mwetl^0 wN foenwA mY�etlan b mmvuC Yr pcW (Sauion ]OM. &r"ur� end Admsau Code: The COMrapon li.wm ler Aow m eppy m en mwiar d PaP�Y Mc buit6 a'vnpw'm �Mraon eM wM convecu fa aN VbR�+ wiN a ave�Ms) fcenseE P�+� to ths m Licwae ' i,,,, ,m„ � �„e, ,n;o,,: H P 7 0 4 4 B. 8 P.G.. lar Nu n eis — ' Owm`° a G 1 i c«wv �w i.m..b.. a.m u�e«,w�d u,e na�«m a e.uarce �eeen.�d seM coa. sw�m. asos. zssb. ene . end Mn I a anY Mive biNnO �a wT / wil rw� (ucb one) meE b wnW/ Mh �od mts mCe� aM iM npvensqs la eoandlnmmvuctio�amoEirslianhvmUr�i�tv erwonwa0inrie.Meda�tlalmutMionact�ubmenxaMlmmtlrw WORKEfl'8 COYVENS�TON OECLAfi1TON: 1 hrWy elfrm vNr pwrtly d pwjry uw d tlM bbwinp Aeduet'vs: ❑ IMwmdMlmmuanecatC4malawsn�ouCaim�bwMen'm�pnmu�.mpwkdtab�9auimal00tltMlebar Catls, ta �M palamenc� d tlr uak la Mirli Nu pame u mueE. ❑ � n....na w meimen.aweiY mnv�c� umrteme... �.m�.d M swbn a�oo a u» �.e« coa.. m. in. w��. a m. wpk fa which iAi� psrmn b ivusd. MY w�� P�� imurvics mnix eM pofwy number vs: c.�:� w�y r�e. , INt pcfion isd nd M cmµJMM l tlw P�� u b aw MnAd dNu. R1001 n MwJ ❑ I wnM Ne� m Me GM«nu�w a iM wM lor M�ich �An P�u u e�wd. I du0 m� anWW ^^Y Da� n enY mennr w m to becmM wblea io �hs MoherJ eomoema�ion lew a Cefdmde. enE e0� Vut tl I�MUM beeaiw w4w m �h� xaNa�• como«i.wim povi.qn. a s.ebn smo a in. leeo. coee. �.n.o �wn.nm m�oN wun mo.. po�iao,n. ome: aw�iran: Wunbp: FW� ro wcun woAr�' canOvu�Can cmvrpr b uW�M eW Ntll Ne/aK �n uT� ro cMIrWVMuftl�W NvN nnu'q ro m. nuMrW Moua�d AMhn fsf W POOA M�llbn ro tM roat ol ronp�ru�tb� Lanps u prvvlJM ror In 9�etlm �106 0l fM IiOor Cod. Infwt aM �thnsY�� . CON$TAUCTION LENDINO AOENCY: I hereby ell�m unEer penMy d pwjury thm tMn b e mnn�upion I�ndirq penry M IM DMamenoe d iM wwk la wluAi Ih's paml u eaed (�� . Cw. CI. LENpFA'S NAME LENOEN'S MDNE9S: I�^'�W thet I Mw reW Nu e00«+�A^ W qab IIW tla eEaw "vqamdion u canM.l eWM �o aomdY �Vh e0 mY W�Y wd'vwm xM eta�e kw� MNYq b btikvq conWutlian ddlwabV eulharts �spa�enlev+M d tM d1Y to eNM uDa+IM eEws-mW unlE pW+hY �o`m°°°°'°"°`�`°°°°°'..�ENE ROHERTSON _ (5�51�16.WP) s • � . Selety Green-Fb: CwmAppFaa: Rnk-Re.anue: (idEwvoC-Nmaar CTTY OF COSTA MESA — BUILDING PERMZT PERM NO: E 079242 PERMIT NO: E 079242 PLAN CHECK NO: N GOVT: tV SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION : ZNSTALL MONUMENT SIGN 6 EXTEND EXZTING SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: H / COMMENTS: "SIGN DEPOTE, DONUT CALIFORNIA STOP " REF:SB-79241 !f !f aE aE IE �E aF iE jE �E iE 1E iF 1E �F �F iE iE If iE iE iE iF �E 1E ff 9E iE 1E iE iE iE 1E aF iF if iE �E 1E �E iE iE iE �E iF fE iE �E if 94 iE 1E 1ElE iE 3E iE * k IE iE fElElElE iE iF iE iE 161F 1E fE 1f 1E 1k jE if IE Z O N I N G R E Q U Z R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUZLDING --------- 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 REQ: PROV: PARCEL: 42214220 ZNE: REF NO: PLANNING NOTES> > ik 3E if iE iE iE �E �E af 1f iF iE IE'� �E iF if iE iE iF 3E 1F aE 9E iE iE iF iE if iF IE 1E �)E jf if'If 3f iE iE if 1E aE iE iE aE'IE iE 1E iE iE 1F jf 1E if iE 1f iE * 1f iE if if if 3F fE iE iE iE jE iE iE i(-iF iE 1E 1E if i61E D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: / APPLICATION ISSUED BY: ��-C-- DATE: Z3 (/7 �f3f�flf'fM1ifiE1F�FIfff�if�iFiFlEfEfEiE3EfflEiE iElkiflf�lFlFiFiffflf�if *iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 22,00 508 SMIP/NON—RES PLAN ISSUE FEE 22.00 HUZLDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 22.00 22,00 0.00 44.00 44.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 94.00 OVER/SHORT: .00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 44.00 1F i6lf IE iE fE if if if iF 1f 1F aE 3E 1E iF 16 iE 1E 1E iF ik iE iE ik if if iE iE 1E 1E fF iF if iF iE iE If 1F iE fE !E 1E ib iE iF iE aE if k iE �f iE iE �f 161f 1E IE 1f iF iE 1E ik if 1E iE iF iF af 9E iE iF IF iE �f 3E iFlE I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 SIGN/ OUTLINE LIGHT SYS ON 1 BR CIRC 22.00 22.00 END OF FEES �x��R�Dtons In omplefe tnsp �� 3�3I q l S,� �. . .�--- CONSTRUCTION AND PLANNING � ' P00 �PA APPRc)VALS Permit # Date Inspedor : APPROVALS Permit # Date Inspector r 1. Tertlpo�ary Electrical Service o[ Pole 52. Pool & Equipment Location � , � 2. $oil Pipe•Undrgrnd. 53. Steel Reinforcement � 3. Electricai Conduit Utility-Undrgrnd. , 54. Forms 4. Electrital Conduit•Undrgrnd. 55. Electrical Bonding �' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Eloctrical Conduit-Undrgrnd. � 8. Foundation 59. Gas Pipe, Q Undrgrnd., Test 9. Water Pipe�Undrgrnd. 60. Backwash �ines, P•Trap, O Undrgmd. 10. Structural Ffoor SYstem � 61. APPROVAL TO DECK 1 i. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap '" 63. Heater & Vent-Final 73. Roof D�ains 64. Plumbing SYstem � Final 14. Rough P�umbing ' 65. Eiectrical•Final 15. Rouah Electriwl-Conduit 66. Soiar System•Final 16. Rough Electric Wiring 67. Fencing & Access ApProval � 77. Rough Wiring Si9n 68. APPROVED FOR PLASTERING • 78. Rough Eiectrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINA4 79. Rou9h Heating & Aii Ccnditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. OuciS, Ventiiating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rou9h & Test 72. Unde��round Fl�sh 24. Roof Framing 73. Undergrnd.St6rageTank OGas OOiI 25. Roof Sheathing 74. Overhead Hvdro 26. T�Bar Ceiling (Structurall & Monocoat 75. Dry Chemical 27. Frame 8nd Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. �nsulation 78. FIRE PREV. FINA� 30. Drywal� Nailinq 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 35. Final Gas Pipe•Test . 36. Hood or Canopy . 37. Finai FBctory Fireplace 38. Final Piumbing 39. Water Service•Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. LandscaPe Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 46. FINALP�ANNING . 49. Electric Release to Edison 50. Gas Release to Southern California Ga: Co 51. CERTIFICATEOFOCCUPANCY No Date eoonessaeu�ar+a 660 W 19TFI ST �hR9NWEIFpqWN ROHERTSON, GENE H TR �ow�ss 5 J 6 SEAWARD � CORONA DEL MAR,CA 92625 714) 760-8364 uR. muw/o �ooxEsx �xcxrtecr oe �++nx�n: CONf11ACTON'S W11�: CONfPACTOR8 WIIPlG moxFss urar: uc. w.: uxr: ue No.: urr: LICOISED COMNNCTORS DECLApAT10N: I hreEy elfrm ivdx Dene�Y d pryvy Mq I em Ifewnetl uds pro�'n'vu d Ghepr 9 (comma��q wuh SecYion ]OD0) d �Nieun 9 d Ns Buaviea and Pralss'va COJe. end mY li.ves u m 1u0 b�m ad aflarJ. cm uc. No.: uc. cuss: uc. No.: o.b: co�+mmor OWNEfl BUILDER DECLRNRTION: I Mreby elfirm uMer peiWy d parlNN �� I em exemq tmn tM ConVetlaa Lkanae lew ta tM :'�ybv.'n0 �enfon (SeUbn )031.5 &piiefs vd Rdeseiona Code: Any ciY a aoun�Y whith nVwree a Pe�^A lo ew4Wtl. Ma.'vnVv.e. �.�,,,";md'nh, or repe'r any ei�ucturo, pmr io ne ueuarce, ebo raQuiree i�e applicent Iw auc� permil lo fila e aiB� eletemenl Mtl he a�M ' yoneW Wnuen� lo Iha povulms d Ns Contrmore Li�wnae i.., �cn.q« e(mmm.�d�y �.en s.aoo �oaol d o:.�+m � d�ro �uamse eM Prdevione Code� ar Ily� M a ehe ia exomq iherMvn eM the Weie la IM dbpeE ezemqian. My violelion oi Sadion 10J1.5 by a�ry eppliunl /a e pnmJ ei�bjx.ls Ihe epplcen� Io a wJ penelry d ml mds Ihen IMa huMreE Edlen �SSOOp. � I.mmmerWiMO�Wa�YamYamMWa*wYhweOmm�MidemmVeromion.wiAtlolhoxwk.eMtMsOuctunim�imeMW a o11wW lar aW lSxaan ]Ou. Buairu uW Pmtxdau Code: The Catlretlon ik+rus Law does na eGNvw en'wnrrd V�wab who Euids a inP�*= �Aaean. ad Ma doee eurh v.ak h'vneMt a Mne� a Map�lm a her am ampb�ew• povidad �MI aN imqwanwa ere nd intxdeE a dlend la eeb. tl. lawewr. iM buitliip or inqorornW'w wN xithm ane yser d oomplelbn.IM wnw-0uidx wa heve tM buiden d V�+��q he « ohs did mi ddtl «'vnpw+la tM W Wee d ah�. ❑ i. e+o� a me v�r. �,.a�.�+.�r ��•ro �wn u�..a wwaa«. m�m,m,a me wa�+cseno� ra.. a,.nw..m v�d..:o„+coae: rna caaread. �n.,.. �., eo« m wdv m� o.�« a o�wnv �no n�ae. «�ww.. m.�.00 .od wn cmtrecls Ia wtl� o�lea^ rmh e wmre�fale) feaneaA punueM to ihe Com n lioems Br�. D i.m.�a�me,s«��:H 7044 e.ar.c.ro,nm�,: ete: " Ownar: —_ ereby cenily ihet I em ewere d eM wEentend tM rtduiremenle ot Celiwnie HWII aM Satery Coda Seaiau 25505, 2531�, end 255�1. eM tlW I a eiry Mure EUJEirp �wpent will / wil m� (a2b me) neeE to oomply wi� wd attla mdw rd tM ipu'vamaro lur ape�millwmnet�ionarmod?iWiw�ry�tMAr u-BT�.%nepemeni0inria.Rsekenlialmnn�wioneppiulianuaaxemqlmmNw Oms: AVW�: woaKen•s cowao+s�non occun�noN: i n«.ny �� c«�ny a�wr ,�e w me rom.;� e.d.�mo�.: � IhwaeMxilme"vJaFacanSovedm�wn�owCcw�abMvken'mmqnWhn.oPa'�bWSWim3100dNsleEw Coda. lv �M pMamerca af tha wpk la w1Jch I�b pamu u inueA. � i nw..na .a meuxe:,.�d.• oomo.��, �wrence. e Am,ow W s.e:n a�oo a m. �em coe.. am. w�� a m. wpk lu whirF Mu parmil ie b�ued. MY ��' �^0^^�a" imuremw cerrier ud poliry number era: c�..: Pdiry Numher. (Thie iscfion neeC iw( 6s romdefeE / tM pemi! ie Iw are huMrcA Jdbre �SI00� w Iw.) � � M110Y � 111 I�M OBf�ClI�MEO O� ��1! WOI�I �OI W�1C�I IhM ie�� O 10&1M�. �� 1101 lTpO/ BIIY Vd�� M YM/ IIINM! F tl 10 become e�bpn lo �ha xo�lwrs' comperrelion laxs d Glilanie. enE p�es Ntl J I NwM Eecoms aE�w to tM worlmn' �omv��, wwuoro a senion alao a ine leb« coa. � dw� �oim.en oomyy wini uw pwitian. Otle: Appl'ran: Wbnl�p: FWun ro wcuro woilr�n'ronpwu�tlon rov�rp� l� unMrM, uM �Mll �W/ct m�nplqr ro crhNiml prultlr mtl tlHl Iliiw �p ro aro h�ntlml Mouu�q Ao/l�n lSfOqG00A b�Rbn ro M� cwt o/ conpr�uWR deinP� u prvrMM M In s.caon �roe or m.laeo, coa.. �ror..t .�e.rcormr', n... CON9TIi11GT10N L6IDING AOENGY: I Iw�eby ellrm iuMer pene�H a P«juY �� tM u e mrmiuuien WiCLp pen�.y Ior tle pMormeme W IM xak br wt�ieh ��e Wemi u eaeE (Sadion 30B]. C'v. C). LENDEP'4 N�yE LENUEfl'S RODNE$g; I ce�ily iAet 1 haw mad i�c apd�ip� yy data i�et Ihe ebwe iMormuion is cmw. I epna b canpF/ rrith all my erd couMy ordine�ar �nd �iNe lewe reWinp b buildvq co�qruabn end Mreby eWwr¢e repreeen�etivw d �hie cXyto anler upon ihe abow�memionW qopeM �°`"°°°"'°"0"'P°'°' ENE ROBERTSON ome: � � <' � �� sq��. d pxmr/�panVAppManU�onlred« (5151-16.WP) M/h4s-Buf�7iq 8 SdMy: �rrn-Fb: Gaury-Appfeaitl: Rnk-qs.�nue: Oddsuod-Naena PERMIT NO: SB 079241 CONSTRUCTION TYPE: JOH DESCRIPTION CLAIM VALUE: C�TY OF COSTA�:'A — SIGN PEAMIT PLAN CH�CK NO: 03510-96 L PERMIT TYPE: STR SIG INSTALL MONUMENT SIGN & EXTEND EXITING PERM NO: SB 079241 GOVT: N SUPP: N SQ FT: PURPOSE: OTH 800.00 CALC—VALUE: 800,00 GROUP OCC: D / COMMENTS: "SIGN DEPOTE, DONUT CALIFORNIA STOP " iE 3F 3f 1E 1E 3E jE if iE �ElE IE if iE iE iE fE 1E �)E 3E �E iF �E �F iF 1E 1E 9f iE iE �f iE if if jE aE if iF iE K iE iE aE IE 3E 3E 9E fE if 1E if iE �E 3E iE iE iE IE IE iE 3E iE iE iE 1E iE 1ElF 3E 1E iF df �f if iF iE iE IE iF S I G N I N F O R M A T I O N DISTRICT; 1 TYPE: FREESTANDING; WALL ZLLUMINATION: INT CATEGORY: NEW DIMENSIONS: 8FT OOIN X 4FT OOIN AREA: 56.00SQFT LETTER HT: 18 INCH STREET FRONTAGE 1: 127.00 STREET 1: ANAHEIM STREET FRONTAGE 2: 133.00 STREET 2: 19TH ST PARCEL: 42214220 ZONE: C1 LOCATION > FRONT: X REAR: BUSINESS NAME: ANAHEIM & 19TH CENTER > LEFT: RIGHT: O T H E R T O T A L S G R 0 U N D S I G N THIS ACTZVITY . 56.00SQFT OVERALL HEIGHT: SFT OIN THIS SITE . 198.00SQFT GROUND CLEARANCE: 1FT OIN ITEMS OF INFO 1 PLANTER AREA: 64.00SQFT ITEMS FOR ACTIVITY: 1 BLDG SET BACK: 20FT COPY VERBIAGE : CALIFORNIA STOP MULTITENANT SIGN PLANNING NOTES: �*+�****��***+�+�****�**rt**�*�**�*��x��*��**��***�*�rt�***+��****�**�****�+�+�*��*��+�� 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 APFROVED BY (r—'L DATE: BUILDING APPROVED BY : DATE: � G APPLICATION ISSUED BY: DATE: *�**x***+�*��t***��**** *****��c-*�*��F*x LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y HLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADING PERMIT 29.25 PLAN 19.01 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 29.75 0.00 19.01 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 29.25 SMIP/NON—RES .SO TOTAL PAID DUE 48.76 aa.�6 .00 48.76 OVER/SHORT: .00 SIGN SMIP/TOT GRADING AI�AN—CHECK .50 19.01 iE fE iE �F if 1E if iF jE iE iE �E If iE jf �E 1E 1E aE 1E af if i!!E if !E iE iE aE jE �f dE 3E fE �E �1f �E iE if !E �E iF �E iEiElF fE iE 1E af �E iF aE 3E IE iE if 1ElE iE iE 3F if 3E 1E iE iF iE iE fE 9E �E jE jf jE 3E if IE 1F I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N ¢� UNIT COST TOTAL COST NO FEES WERE SELE�'�+F MIT pA'� ri J Q , 3, EONSIBUCTION AND PLANNING - !�pppOVALS Permit # - : 1. Temporaty Electriwf Service or Pofe 2. Soil Pipe•Undrgmd. , 3. EleCtrica� Conduit Utility•Undrgrnd. 4. Eleotrical Conduit-Undrgmd. 5. Steel Reinforcement 6. EleCtrical UFER Grnd. 7. Footings 8. Foundation 9. Water Pipe�Undrgrnd. 10. Structural Floor Svstem 11. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 14. Rou9h Plumbing 75. Rough Electrical�Conduit 16. Rough Electric Wiring 77. Rough Wiring Sign 78. Rou9h Electrical-T Bar Ceilin9 79. Aoug6 Heating & Air Conditioning 20. Rough Fac:ory Fireplace 27. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Tesc 24. Roof Framing 25. Roof Sheathing 26. T�Bar Ceiling {Structuratl & Monocoat 27. Frame and Plashing 28. Latning & Siding 29. Insulation 30. Drywall Nailing 37. Plaster Brown Coac 32. Electriral Power Mecer-Final 33. Fina� E(ect:ic 34. Final Heating & Air Conditioning �-Fine�tias Pipe-Test 36. Hood or Canopy 37. Fina� Factory Fireplace 38. Final Plumbing 39. Water Service�Final 40. Gas Service-Final 41. Sola� Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINA� STRUCTURE & BUILDING 48. FINALPLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co Oate � PO( SPA Date Inspector ? AppROVALS 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. Gas Pipe, � Undrg�nd., Test � 60. Backwash �ines, P-Trap, � Undrgrnd. 61. APPROVAL TO DECK � ' 62. Backwash & Receptor•Final � ' 63. Heater & Vent-Final 64. Plumbing System � Final 65. Electrical-Final . 66. Solar System�F(nal � 67. Fencing & Access ApProval 68, APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAI FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Nydro 71. Product Pipinq O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank Q 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 Noces: �� Date �Inspector PHOJECTADOflESS: EjOO 1"1 19TH J�T OWNEN'SNRME:ROBERTSON, GENE H TR nooeess: 5 3 6 SEAWARD � CURONA DEL MAR,CA 92625 I � APCH/ENGINEEB: � AODflE55: flEG.NO.: UNIT: UNIT: PEflMITTEE:SOHN HENHY ROOF'ING ( 714 ) 548-6213 AUGHE55: j'J�O, HOX ib%2 COSTA MESA CA 92628 UCENSED CONTHACTOfl OECIAPATION: 1 here0y aflirm Iha� I am licensea unaer Dmvisions ol Chapler 9(cammencing wit� Seciion 7000� ol Division J of Ihe Business ana Pmtessions Cotle, an0 my license is in lulllorce and ellect. cirruc.:0348 7 sraTeuc.y15232 �ss: � Dat � SipnaWre: _ WOPK ' COMPENSA710N �ELLABA710N: 1 here - Ihal l �ave a ceniliWle of tansent �insure or a ce�ilicale of WoherS' Compen5ation Insurance, or a cenilie0 caDY �nereol ection 3800, 1a0. C1. POLICY NO.: E%P. OATE: COMPANY: '� cen�i�ea covr �s nereoy mm�sneo. ❑ cena�ea coor �s eiea w�m me c�ry s�aamo omsro�. Oate: ApplicanL E%EMPTIONFBOMWOflKEflS'COMPENSATIONOECIAHATION: Qhi55et�ionneeAn0lUetOmpl¢feOil�hepermili5loronehuMr¢a�Slip)orless�. I cerii�y Ihal in I�e pedOrmante ol Ihe work IOr whith t�is p¢rmi� is i55ueA. I all /nol Jem�plo/y�y y Oenon in any manner so as to become Subjetl IO �he Workers' , mpensati0n Laws 0� Calilomia.// �n��sY�a[ �i��=Gil-s.K+fJ oai s�9� CE: II, after making inis aeclaration, you ultl wme sueiett to ihe workers' COmpe ian o�a�s�ons al ine labor e. you must fonhwit� compty wit� sucn ' ns or ihis permit Shall be GeemeE revoke0. CONSiflUCTION LENDING AGENCY: I nereey aflirm Inat inere is a tonsimction IenEing agenty lor tAe pedormance ol Ine work for wnicn ihis oeimit is i=suea ISection 3W7. Civ. CI. LENOEN: ADOflE55: CZTY OF COSTA MESA — BUILDING PEkMIT PEAM NO; B 061668 PERMIT NO: H 061668 PLAN CHECK NO; N GOVT: N SUPP: N CONSTRUCTIO�� TYPE: PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : REPLACE CONC. TZiE WIT'H CLAY 'S' TILE SQ FT; 4,850 CLAIM VALUE: 4,850.00 CALC—VALUE; 9,850.00 GkOUP OCC: 8-2 / COMMENTS: REROOF ON THE 'MAf]SARD' ONLY. **rt***±�**�r�***#***x�****#******x�r***��*��**�+��r*��****�� *x�#x x*x �*�r*�c��x x-�*#****�r Z O N I N GS ERTEB�AUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- 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 RE • PROV: PARCEL: 42214220 ZNE; REF NO: PLANNIIvG N TES> > _ A it*�tx�it�-*****atx�iE3r�x��Fi�-***�**it**at*ir****et*�kit*�rat*itx�iEx-*it�t�x�*itarie*3tx�ie�*��x�**at3t#aF�t-�'it�*at �i[�itic�* D E V E�L_ O P M E N T S E R V I C E S R E Q U Z R E M E N'Y' S .� ZONING APPROVED'BY DATE; '�, BUILDING APPRQVED BY : DATE;; � � •.. APPLiCATION ZSSUED BY; . DATE: � '�� if'�iElriflfiFifiE'1EiEaEiEiE�fiFii'1fe("lE'lEiEiFiF3't3F�F�A'YEI�!'�F!'�'%- 'IF. ..�Fi'F�FiFiFia �3F3F1t h ', 1—FiF7EiEif'1Fik'1Fi%itaE')f Ir/I %'x #ik �t�tx��r**+��t*******x�****�r*****#x*�r��r#±�***�t�r�t*�t��*xx -k+t+�*�**�xx**#�r*�r#�e#�kx�*#x*#�r LEGALIZATION:N F E E S D M M A R Y STRUCTbR'AL;,SEGMENT:Y OWNEflBUIl0EB0EClAflPTION: Ihe�ebyallirm�hatlamexem0��wmt�eContractor5'S�ateLicenseLaw�orihe�ollowingreason BLDG PMT PLUMBZNG ELECTRIC MECAANIC FIRE SMIP/k�$ GRADING (Seclion 7031.5 Business and Pm�essional Cotle: Any ciiy al counry whic� repuires a permii Io con5imcl. aller. impmve, eemolis�. or p ERM I T % 2, � 0 �' repair any Slmtlure. prior Ioi15 i55uante. a150 repuires I�e applitanl �or Suc� p¢rmil Ia tile a SigneG Slaiemenl IAai he/She i5 litensetl Dursuan� to �he pmhsions ol ihe Coniraclors' Slate license Law (CIwD�er 9(wmmencinp wi10 Seciion 7000) ol Oivision 3 0l �he Business SM I P/ N015—RES anC Prole59on5 Cade) or Ihal �e/Slie is exem0� �here�mm an� I�e OaSiS tOr IAe allegetl ¢aemption. Any violalion ot SetiiOn 703L5 by P LAN 1, Q Z any aOD�i[ant far a permil suble��s Ihe applicanl lo a cidl penalry ol no� more I�an live �unErtG Oollars (f500�. I SSUE FEE i, as owner o� ine vmveny ar my emyioyees witn waAes as ineir soie compensation, win oo tne wone, ane me BUILDING—DIV—> PERMIT ISS(J$ PLAN—CHECR T�TAL PAID DUE ❑ slmcWre is noi intenEeG or oflerttl far ule (Seclion 704d. Busineu antl Pmiessional COUe: TAe Contraclors' Sute License Law T�TAL S----> 7 3. � 2 0. � � �. 0 U �] 3. � 2 % 3. Q 2 . Q Q � Ooes nol app1Y �o an owner ol a pmDerly w�o builGs or impmveSlAerean, antl who doe5 5uc11 wofk himSelVhersell or ��rouq� � his or her own employees, pmvidetl Nal such improvemenls are nol intentle0 ar ofiereG lor sale. il �owever ��e builtling or improvement is soltl within one year ol com0letion. Ihe owner will have Ihe hurden ol provinA �e�ihe Oitl nol �ui10 or impmve R EVENUE D 1 V 1 S I ON TOTALS--> COLLECTED • 7 3. 0 2 OVER / SHORT • � � � ro�ineo��voseoisaieJ. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR I, as owner ot the pmDer�y, am eeclusively conVaming with licensea comracmrs Io conslmc� �he pmlect (Seclion 704a, Business 7 2. � � 1, 0 2 ❑ antl Pmfessions Coae: T�e Contractors' Sia�e LiCense Law does no� apply Io an ownero� pmpetly who buil�s onmprove5lhefean anawhownVacisforSuchDrole��SwilAaconiractor�5�licen5e0ursuanitolheConlraclor5'Sla�elicenSeLaw�.lamawa�e *,*.*„�,K„�*.*,*,.x,i(,.x„x.�(.�(„k,i(,7(„N,ififiE#*iE.x„x,if,.�(„x.i(,.K,7f„x.�(#�(,.K,.K.,�,if,if,�(,*i(��f,lf,�(,#,K,*�(,�(,�(,�(,�7(_K,{(,{(,�(„�,x�,X,iE*#�lE*k�(�*�(�K��f,�E�(,#�Eif I�ai prool oi �heir Waker'S Compen5aiion insurance ShoNtl be pmviEetl �o me. � I am e�empi untler Seciion: B. 8 P. C. I N D I V I D U A L F E E B R E A K D O W N mnnisreaso�: TYPE QTY D E S C R Z P T I O N UNIT COST TOTAL COST oaie: °""ef' SFC 9850 ALTER $Y VALUE COMMERCZAL N020NE 1.00 4�850,00 I eo �ere�y cenity I�at I am aware ol antl untlers�and ��e requiremenis ol Calilamia,Health anU $alery Cotle $eciions 25505, 25533, antl 2553a and �ha� � ar any �uwre bui�mng occupam wi�vwin no� Icirde onel neeU �o como�y wim saiA vaie coUes and me reQuiremems lor a END OF' FEES permii inr r.onslmc�ion or mo0ilica�ian Imm Ihe Air Ouah�y Management Dislricl. Resitlential consimction aDDlicaiions are exemp� irom Ihesc provisians. �ate: ApPlicanl: _ I here�y cerii�ythat I have reatl�his aDolicalion and slateihall�e a orainances and state laws relaling lo building conslmclian ana here�y pmDe��Y �oi inspeciion p r0oses. � 0 e� - Signaiure �riv s License or Socia� Security a: � is I agree Io comply with all ci�y and county �is ciiy IO ¢nler upon I�e above�menlione0 164La6 Wnile—Builtlinq: Green—Cotle Eniorcement; Canary—AppllcanC Pink—Revenue: Goltlenmtl—Assessor O1 00136938-0013693Y "1"C17" 73.0? DA7Et OS/08/93 7ItIE� 13t14 CONSTR�CTION AN� PLANNING APPROVAtS Permit � �. Temporary Electrica� Service qr Pole 2. Sod Pipe-Undrgrnd. 3. Electricai Conduit Utihty•Undrgrod. A. Electrical Conduit�Undrgrnd. 5. Steel Reinforcement 6. Electrica� UFER Grnd 7. Footings 8. Foundation 9. Water Pipe�Undrgrnd. 10. Structural Floor System ' �}, Property Sewer Line & HouteConnection 12, Sewer Cap 13, Roof Drdins 14. Rough Plum6ing 75. Rough Eiectrical-Conduit 76. RoughEiectricWiring 17, Rough Wiring Sign 18. Rough EVectricat•T Bar Ceiting 19, Rough Heating & A�r Conditioning 20. Rough Factory Fireplace 27. Dutts, in Structure 22, Ducts, Ventilating 23. Gas Pipe�Rough & Test J 24. Roof Framing 25. Roof Skeathing 26. T•Bar Ceiling (Structuraq & Monocoat 27, Frame a�d Flashing 28. lathing & Siding 29. Insulation 3Q. Dryvuail Nailing 37, Plaster Brown Coat 32. Electrical?owerMeterFinai 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe�Test 36. Hood or Canopy � 37. Finai Factory Firepiace 38. final Plumbing 39. �VateT Service�Finat 40. Gas Service-Final 41, Solar pomestic-Final 42. Backflow Preventer 43. Backfiow Irrigation 44. Landscape irripation System q5. �und Attenuation 46. Handicap Aeg�tations 47. FINAL STRUCTURE & BUILpING 48. FINAL PLANNING 4g, Electric Release to Edison 50. Gas Retease to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY lo_ -_ _ _ Date Date " � PQ:,� :� SPA Inspector AppROVAIS Permit � _ 52. Pool & Equipment Location 53. Steel Reinforcement 54. Porms � 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER•GUNITE 58. Eloctricai ConduiGUndrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P�Trap, O Undrgrnd. 67. APPROVAL TO DECK 62. Backwash & fleceptor•Final 63. Haater & VenPFinal 64. Plumbing SYstem � F�nal 65. Electrical�Final 66. Solar System-Fin:,l 67. Fencing & Access ApP�oval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL � FIRE DEPT. REQUIREMENT APPROVALS Permit,$ � E 70. Underground Hydro 71. Product Piping � Gas ❑ Oil 72. Undergraund Flush � 73. Undergmd. Stora9e Tank 0 Gas ❑ Oil 74. Overhead NYdro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � 80. FOOD CERTIFICATE ISS�ED Notes: Date � Inspector � � PHOJECTFDOHESS: [jOO W 19TH ST OWNEN'S NFME: ROBERTSON JEAN ' aooRess: P O BOX 1� 6 CORONA DEL MAR,CA 92625 PNCHIENGINEEfl: AO�PE55: HEG.NO.: uNir: UNIT: 1 PENMIiTEE: JEAN ROBERTSON ( 714 ) 650-5102 � noosess: 600 W 19TH ST COSTA MESA CA 92627 LICENSEO CONTflALTOP OECLAPATION: I �et¢by allirm Ihal I am licensetl uneer proviSions of C�api¢r 9(camm¢nCing wiih Set�iOn 7000) ol Div��sion 3 of �ne Business and Pmfessions Code, an0 my license is in lull �orce ana eilect. CITY LIC.: STATE LIC.: ClA$5: a�e� Siqnawre: .IOBREHS' COMPENSATION OECLANp7lON: I hereby aHirm that I have a cenilicate ol consent m sell�insure or a cenilicate ol Workers' Compensaiion Insurance. ar a cenifiea copy ihereof (Seciion 3800, La�. C). POLICY NO.: EXP. UATE: COMPRNY: ❑ Cerlifietl coDY is hereby lumished. ❑ Cetlilied copy is liletl with ��e city Builtling Division. Dale: Applicant E%EMPfION FflOM WOflREflS' COMPENSpTION OECLPBATION: (ThiS 5¢Ction neeA n0i �e tample�eU i� Ihe permil is fof one �unOretl (5100) or Iess�. I certity Ihat in the pedormance a� the work lor whic� Ihis permi� is i5sued. I shall no� employ any per50n in any manner so as to Eecome su6leci Io the WorkerY Compensa�ion Laws ol Caiifomia. Date: � � Signalure: NOTICE: II, after making �his declaration, yau shoultl become 5u�lec� �o �Ae WOBers' Compensalion pmvisions ol the LaEor Code. you musi larthwilh comply wiih such provisions or this permii shall Ee tleemeG revoked. CONSTflUCTION LENOING RGENCY: I hereGy aifirm Ihal ��ere i5 a mns�mttian IenUing aAenty �Or Ihe pedOfmante af t�e wOrk lor whicA I�fs permil is issue0 (Setlion 3W7, Civ. C�. . LENDEN: � AOOflESS: - OWNEP BWLOEB oEClA11ATI0N: I �ere6y aifirm tAat I am exempl tmm t�e Coniractars' Stale License law for the followinA �eason (Section 70.31.5 Business and Pwiessianal CoJe: Any ciry ol county wAich repuires a permit to constmct, alter, imprave, Oemolish, or re0air any simclure. prior to its issuance, atw repuires the apDN�ant for such permit to lile a signe0 statertcem Itut he/s�e is IicenseA pur5uani lo ihe provisions al lhe ConVactors' Stale License Law (C�apter 9(commencing wilh Section 7000) ot Division 3 al ��e Business antl Pmtessions CoOe) or iha� he/she is exempt iherelmm and ��e basis lor Ihe alleged exempiion. Bny violation ol Seciion 7031.5 6y any applicanl for a Oe�mit su6jects ihe applicant to a civil penalty ol not more than five hundretl Uollars (&500�. I. as owner of tAe propeny or my emplayees with wages as t�eir sale comDensatian, will Co t�e work, and ihe ❑ simcmre is not intenaetl or oflerea for sale ISecuon 70a4. Business antl Pmiessional CoOe: TAe Coniraclors' Stat¢ License Law Ooes not apply to an owner of a pmperty wh0 builtls or imWoves Ihereon, antl wno tloes such work himselt/hersell or througn �� his or her own emDloyees. pmvi4e0 Ihat suc� impwvemeniS are not inlentle0 or o�fered IOr Sale. II, �awever I�e builtling or' impmvem¢m is soltl vnihin ane year oi comD�elion. ihe owner vnll Aave the 6uraen o� pmving �dshe Aitl no� Oui10 ar improve lor Ne purpose o� sale�. I. as owner of ihe pmDerty. am e�clusively coniracting vnt� licensea comracmrs m consimct t�e prolect (Section 70aa, Business � ana Pmfessions CoOe: The Contractors' State License Law tices not appty to an owner of pmce�y �o bm105 or imprwes ihereon and w�o coniracts lor such O�ojecis vnih a conlractor(s�license purSuanlio i�e Comraclors' S�al¢ LiCense Law),I am awdre Iha� pmot ol lheir Workei 5 Compensation in5urante S�oultl Oe provitlea Io me. � I am eremD� untler Section: B. 8 P. C. � �or ihis reason: / oate: ��' �--g^ /_! Qwnec 1 do nereby cenify �nat 1 am aware ol ana understan0 Ihe reQuiremems of Caf mia Healtn antl Satery e Sections 25505, 5533, antl 25534 antl �hat I or any fuWre �uilding acuDant wilVwill noi (circle an¢) n¢e n[ pty vnlA sai0 s�a�¢ Ces anE �he requir¢menis for a Oermil br cnns�mction ar modAicalion Imm Ihe Fir Ouahry Managemen� Oistnc . flevdential con9mction applitalions are exempt �mm I�ese prohslons. Dale: ADplitanl: I �ere�y <enily Ihal I have rea0 Ihis ap06taiion antl Slaie Ihai t�e a0ove inlormalion 15 torreq. I agr¢e �o comD�Y'M�h all tiiy and toUnty orAinances and Sla�e laws relaling lo buil0ing constmclion antl hereGV aulhor¢e represenia�ives ai this city lo enler upon I�e a�ove�mentione0 pmperiy for inspeclion purposes. �^ � , / / // / ., / ..� oate: �"� 2�� Signalurt: �L l�J•'�. iliGlj�� Iouver s ��cense a� soc�ai secumy n: � I6nt�<6 Whpe—Builtlinq: Green—Gode EntarcemenC Canary—Applkanl Pmk—Revenue: GOIEenrotl—Assessor CITY OF COSTA MESA — HUILDING PERAIIT PERM NO: A 05120 PERMZT NO: P 051202 PLAN CHECK NO; N GOVT; N SUFP; N CONSTRUCTZON TYPE: FERMIT TYPE: PLU PURPOSE; OTH JOB DESCRIPTION ; ADD 2 SHAMPOO BOWLS/Cii��WATER HTR SQ FT; . CLAIM VALUE: CALC—VALUE: GROUP OCC; H-2 / CUMMENTS; NO "B" PERMIT TO REFERENCE, �*��r** �*�t�r*a�*�t***x�t**�t****�r**��a�x+��e*x�r*�t***��*�t*�e***�r***�t* ��e*x�e�*��t*ic-** ��c�**x�*� Z O N I N GS ERjEBQAU�IKRSE M E N T S ------------- MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT TN REAR: FT IN FRNT: FT IN REAR; FT IN LEET: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT' IN PARKING RE • PROV: PARCEL: 42214220 ZNE: REF NO: PLANNING N `['ES> i **��r*�t�r*�**r.��r*�*�er��t**�r�r��r*�r********�r+t�r�r+r�r*xx��r***�*�r*+�*x��r**+r**�r�r***�**+�x*�+t� 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 HY • DATE: BUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY: DATE: �,,r�� iflFif1F1E1ElElEiEiF1ElF1FiEifIflElEif-iEiPk .�FifKlFifIFaE)fik1E / iFik iEiE�fiEitifiF*�EiflflEiE�EifIElEiElElfiEiFiffEiFiflEil3EiEiEiF1E�EiFiE�FkiPifiFilaEif 1EiEififMiFifiFiEiEifiEl4iF±fi4lFfEiFif*ifiFltiflEiE�lF�tif#iFl!�iF LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N PERMIT BLDG PMT PLUM6IN�G� ELECTRIC MECHANIC FIRE SMIP/RES GRADING 25t SMIP/NON—RES PLAN . ISSUE FEE 3,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 6.00 3,00 0,00 9.00 9.00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 9.00 OVER/SHORT: 00 BLDG PMT FLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK y . Q 0 If iE If iF if �1F 1F if if 3E If iE iF i! k IE fE IE If if IE 1F IF iF iE k k iP iF k if if iF iE iE iF M 1E iE �! iE iE iF 1F ik iF IpiF k if Y.� If ik K� fE lE iE If ii iF if if iF af fF * if 3E if iP iE �R iF iF iE i4 iF 4�f I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER HEATER AND/OR VENT 2,00 2.00 PLU 2 SINKS, COMMERCIAL OR ZNDUSTRIAL 2.00 9.00 END OF FEES DL �JIIDSih01—�JD8E601 '.��•� DiliE: 02/2$%91 TI�iE: i7:b� �CONSTRUC�AND PLAN�.��JG POOL & SPA APPROVALS Permit�# Date Inspector qppROVALS Permit # Date Inspector � 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. E�ectrical C.onduit Utility�Undrgrnd. 54. Forms � ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �. _ �S.�Steel Reinfarcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER-Gmd. 57. APPROVAL TO COVER-GUNITE 7. Footin9s �� 58. Electrical Conduit-Undrgrnd. � 8. Foundation '� 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structurol Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final '' � 13. Roof Drains ' 64. -Plumbing System - Final 14. Rough Plumbing � 65. Electrical-Final �'` 15. Rough Electriwl�Conduit 66. Solar SYstem�Final ' 16. Rough EleCtric Wiring 67. Fencing & Access ApProval � � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING _ 18. Rough EleMrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.yRough Factory Fireplace � _ � - ; A APPROVALS� ;Permit # _ , _, 21.' Ducts, irt Siruciure' � � � - 70. Undergroand_ Hydro • 22. Ducts,Ventilating � - � . � �:` � 7�, product;Piping�Gas ❑Oil 23.'Gas Pipe`Rough & Test . �, ��' 72, Underground Flush� � 24. Roof Framing • �� ' � 73:FUndergrnd: Smrage�Tank O Gas ❑ Oil - 25. Roof Sheathing , • � '` � .74.'Overhead Hydro 26. T-Bar Ceiling (Structuralf & Monocoat � � 75. �Dry Chemical - � ' 4 27. Frame and Flashing '� ` 76: Dry Standpipe '� N l, ' 28. Lathing�& Siding� �� . • ^ 77.. FIXED SYSTEM FINAL� � ' 29. Insulation - ' " � - � 78.s�FIRE PREV. FINAL � • �� 30. Drywall�Nailing - � i,'�� • ' ��HEALTHDEPT.REQUIREMENT 31. Plaster Brown Coa't ,� ' ' 9, � 79. FINAL`INSPECTION - 32. Electrical Power Meter�Final, � -f � ,� . � .80. -FOOD CERTIFIC9TE ISSUED . , 33. Final Electric � ''� �}_,' `Nofes: " j�;; � ,.- 34.: Final Heating & Air Conditioning - . � � y„• . , • _ 35. Final GaS.Pipe-Test _ ' • .. ' ' • _ . �" 36. Hood,or�CanopY � r � �'.s: i � - 37.�Final Fectory Fireplace ' � - � �: " ' � : `�� 38. Final PI'umbing . � � . $ (/ ��• [�� -. �� . . 39. Water,Service�Final �' i "' -� ' � �. 40. Gas Service-Final � , .. r -� , , � _ -41. Solar pomesticFinal : ' • � , � 42. Backflow Preventer: , � � 43. Backflow Irrigation ?.'. . ' ' ' : 44. Landscape Irrigation System�;, T � �- i � ��-� 45. Sound Attenuation ' + '�: _ .46. Handicap Regulations - � � � , _ 47. FINAL S7RUCTURE & BUILDING ; �, � 48. FINAL PLANNING . ' � �� ` �� ,• � . -� ,49. �Electric Release to Edison � '� .. � %: 50. Gas Release to Southem California Gas Co I � f�� - � _ 51. CERTIFICATE OF OCCUPANCY � ' No. Date City of Coste Mese Buildin8 Sefety Depertment P.O. Box 1200 . Costa Mesa, Celifornie �.� .n p� . . �-Bt'+ ' o ..C..r:..l:q • .!4',1..-li..d! CERTIFICATE OF OCCUPANCY �j_ 3�f�;'7 The Building located at '-'1!1 ''aei- 1Qth Ctraat fui+p !1 ."., R has been inspected and found to comply with the provisions af all City of Costa Mesa Ordinances applicable thereto for a Group ''-^ Qccupancy. , U5e Of Bullding Mr.-n�rri>1 � Legal Description '� � .��_t�9_�n (See reverse eide for Metes and Bound�) Building Permit No �^'��' Electrical Permit No, ��" '�' Plumbing Permit No. �' Number of apartments -�- and/or guest rooms -��- ISSUEDTO: BuildingOfficial -' �— � % ..,.�_ _....f' �—__.r--__ . O � yY - .1iiG'=.i/� c�... Li ,�. /Gl-ti �' ..._ -� ' � .� �^�' Victor f,. �le�:�ton-Jirector 'iuilci,�r �,r' Date SFniPr�har 1ti. 19Ft� This Certificate of Occupancy SHALL BE posted in e conspicuous place on the premisea end SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form BU 34 Rer. 11/70 G�ty of�.Costa Mesa Building SafeTy Deparfinent P. O. Box 317 Coslo Mesa, California � CE�RTIFICATE OF OCCUPANCY NO 2213 C The Bvilding located at �� 1� � has been inspecfed and found.to comply with the provisions of all City of Cosfa Mesa Ordinances applicable thereto for a Group �� Q"a Occupancy. Use of Building � � �'i� � � ' Legal Description �.7��1 63 � . (See revane side for Meros and Bo�ndi) . Building Permif No. �� Electrical Permit No.� Plumbing Permit No. �'�— Floor load Sig�i h'ave bee� installed as Room Capacity Sig�s have 6ee� instaled as required �nder Sec. 2308 �U. B. C. . required under Sec. 3301 (1) U. B. C. 77050� CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificaTe of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained' whenever ihere is a change in: 1)� Occupancy classification of a building or portion fhereof 2) The number of apartments or guest rooms 3) Ownership . . , , If Group H Occupancy, number of apartments and/or gvest rooms as required under Sec. 77050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. � ISSUED TO: N�mber of apartments and/or guest � �;Iio; �'� c'�Y�:a�'�' Building Official by /.�G e�i��v�.+--✓ : .. - ..��. 'J This CerTificafe of Occupancy. SHALL BE posted in a conspicuous place on fhe premises and SHALL NOT BE removed excepf 6y fhe Building Official of the Cify of Cosfa Mesa under Sec. 306 (e) U.B.C. � Fo� auaa—iM—ii-s3—ss r ', � � , , 232?_4 M �COS7A Jr1E5A BUILDINGSAFETY DEPARiMENT '. ,P.O. BOX 917 COSTA M68A. CALIPORNIA 'For Appltcant to Fill In Completely TYPE OR.PRINT BUILDING / Ty � ADDRE9 � - COSTA MESA, CALIFORNIA FEE RECEIVED �- �4a'�c�� d��i. . ?LICAT�ON �OR �Ekh111��E� BUILDINC4 '0/ D�IC@ {�SB �II�y I RHC81pT NO. �ERI.�I�N(1� . J e[ w�acn�ikCT � - " TEL. BY DA7H � � ORENGINEER �IC f-I/�}l�/S NO. G%t�� ZONING AD' ffiI EY�ib- Q�� T- �H'�' ione � no.ov us¢oprvew ' Cl PLAHB 2 BYILDINO Sta• $[ld CONTRAG7'OR/��JH/J/ An/ .� L.(J 138 � C Tt/ � oescn�rr�on Por. Lot 26� F.I'.Canopy ADDRHS % G1P.t=�- '�: - r�� ' ��3 ' �' � r cirv ` GA - � r, . � .: .. , . . w: r. t+o. �-. i15 -322-62 ;and 63 J- NOTE: NOEAVEOVERHAN68HAL BELESSTHAN LIC.TNO. /19 Q "•, �NO.�' L'V� tii � �(. 90' TO SIDE a REAR P. L _��F� . EAVES ��N SI2E �� "J� � , . I'No.oFBLDoe.'jl ALLOWED�� fU.B.C:RE�UIREMENT> OF LOT ' ' NOW oN LOT USEOF �� ' ' � � � . ... � • YAR�9APPROVED •�� ; YARDSAPPROVED EXISTING�BC�O^^"�-'-�'�•' ' - _ MAINB(JILDINO ACCESSORYBUILDIN6 fFROM C/L REE/',�J1�/y�� p BETBACKLINEFROM."- -� --��.-- �. -" FRONT ��FT.✓�"�1 �"�O' �� I /�� CENTEROp_6TREHT ' , REAR�YAR� �jL� ��p /�y�//,��_ SIDE YAkD � LHPT � R16HT � ` , . R. SIDB ��PT. �:�". � f (j • FT. " _' , `- DESCRIP710N'OF WORK'• � � •: �.ai�e'�'�vr:'.,—' . ��` Fr.` ' NEW �'ALTERATION AODITION REAR �� FT, �_ ��"' Ff.'. • � � , - �� ' 'DISTANCEBET. , -' •'BET.�MAINQ' ,��.',�//�, MAIN BLDGS, ACCESS. BLDG3. "" REF M VIN6 . DEMOLISH �B=IEDIN6.;S�� Z'.•. ROOM9 `-� STORI88 " . 'CAU.P. C-J�V '� APPROVE�1�2-64 ` L EXTERIOR VJALL � ` n .': ' :I' ROOF ' t ' ' APPROV . . I / I7 C COVERING .. �T COVERIN6 MlT- er _ owre _ USE OF �U)LDINp Af�ID WORK 70 BH PERFORMED _ �OLD FQR, SPECIA RE UIi\C.trY �� C "C /l.�"iJ�iO �'` " See revers side for conditi s .. ,r.-. . •,: - � ,. , , , „ . . . . . . " sa �. ^ 1 HEP6BY ACKNOWLE006 TXATII X�V6 pBAO�TH18 APPLIGTION TH6 �MOONT eHOWN UNDEH VALU�TION IB FOR TNB E- AND BT�TE.'jX�T.THB ABOV6�I8,CORRBCT AND AOpE8�T0-COM� � PUHPO6E.Op 69TABLI8XIN0 A PeqMIT. FE� ONLY. p PLY WITM,AL{. OROINANC86I�NO 8 T8 LAWe R60ULATINO � ypLUAT1ON � Q`� q BUILO�Np STR ION, ' �,p p HIGN URE � J PERMIT FEE $ �� PER ITTE � �. . [,�OOO � � ,, m s. L H � o AUT�RIZE/NT .S� � TOTALFEE� $ . _ , __, � ._ . .�..._.,� ____�_____.:___ _.--_. ....._ _ - � „ . �... .. ..,� Conditions c "� r— '. - ' . .. .. _ �;. . ,' � .-. .. , _; . -,.:� � : . .. '.: ;, .. . ,� ,._..:>::._,.:: ..'::-. ... . ;,. ��,E.�. . . . _ _, . . -- -; .. . _ . .. 1. Inst'allation-of commercial.sidewalks and concrete.driveway._....�.� approaches; ;by;,the_applica"nt_.and�or owner,.'at' his experise; `as per , standard.specificatzons�oY the'City of Costa Mesa. � _.. , - 2. Tree.planting compatible_ with the� surrounding area_as indicated , on the`plot plan. .- , _.. . . , . .._ ,•:. - 3: � Co`rner Iand"scap�e�'pl"anter under the„direction:of: the:�Director bf._ ' r� .-�.•.,. �.: +':, _�,.Planning:.,', -- .� : -.. c^,� .:�.___ � - • . . .: . �; !.(� , ��: � .: � ' ' , ' . _..,.... _ «.. _. � �-- ' 4. •Installation of' a'6' block wa1T: by-�the'appTicant and�or`owtler;"=' � • at:his,expense;- along.ttm;<north property li:ne,_ as.per speciYications. , _ of the Cit ' " ' y :of Costa. Mesa._, : _ _ ... ;_. . __ .. : � 5. A d'rawing indicating piping layout',to be"submitted'to the Fire;- � . Department:< -�- � : . ._.. . , � . ti. . . _�:o, , . ; , 6.. Planter areas shall'be�'designed to.be located along the exteriqr . . wall-of�tkie m'airi`'structure, the design wi'tI��materials £o_�be used shall be under.-the Planning:-Depar£ment. . ,' _:�, . ; ._7. A minimum-size,l0.' x 10' cement block�trash area shall�be'cons'tr'ucted . - - � w9irm'ksr?aras[4vR�y �ris � cmxxc�kiz�vrxu¢� �ha}�anitxicQxYvixeeffidarx�ric� . .` � — "r---� ....._ _... . � .. . � � ' in an area.where visibility from the street-;wil1 be at�a m'inimum.� � 8. F�terior sides of ystiizcture sha1T be conetiucted of at `least- , . 25�:brick..or'.other:acceptable.material un3er_the directhori�o£;the ' Planning �Department. _ : �. . , -. . ..' " ; . , : - 8-A = iri'accordarice'with the"elevations �as presentecl�by�the-; , = applicant andisigned.by-the.Director of Planning.� " � ' • . � .o,: �;._>....;�..::i. ...,:.��;:J�.. '... . I., -. — , r-.• �n? , _• . .r . � � . .... . ... , � . . -*t�- . ' ... . . I � . . . . . . . . . _ . .. . . � .Yt. '.f'. s ' .e.. � .b..., _ _�._...�... �-._� , ��•�•S� . . ' .. 7. �. � - ' , . . , . . J..... .�. - � . .. '. , . .�i. . ., �......1,..::�;k,.. L...� � . jr :..._\ ,,, _ . .. ._. - - .. . ... __�;.....__.._ - . Y . ..... . . . . . .. . .... .` :.. ' •. . ' \ . . � .t'w � -:' ' - , . _ t ' � l �� .. ' SF `` .. . , ' � '�1 •` ',�\ . . - ' t� G• . . .1 . . y�., , �: . � . .. . . .,�'.t�itx '`.�t _ . . . - - -. . - •, . . - -. - - � �.. . . . _ . .._.. _,..:...��_:.:<.....:_.._._.....:_...... ... _._ � ,.;;.�..: i �i��. +�i: cnz�d ��?a �. �.l(��CE; ��al' � ��;a �• � 3..�' ' � ,� . . ty 's ;'�� '1' �� _. __� - . ;`.�_ f3l; �: t..S�,'- � � : � 23�2� �EE RECEiII� �, , COSTA.MESA BUILDING-SAFET`( DEPARTMENT �JA� 1 9 �9�7 � '.,P.O.BO%317 C08TAMBHA,CALIPORNIA FINANCE OEPI. �� For Applican► �o Fill In Completely liP�LYC�7C��RI1��A11T Q TYPE OR PRINT BUILDING � For Office Use Only euaoiNo � A�DRE59 — R6CHIPTNO. ERMITNO. COSTA MESA, CALIFORNIA � 3 � .� H[C81V pY pA p8C ED ATb 169 EO OWNER � .S {^` ,O • � � MAIL ' � BUILOINO 'y �.i ADDRESS ADDRESB � FIRE `�� TEL.' ZONE TYPE OROUP CITV NO. j�/ ARCHITECT /f / ABYPROVHD �Q � pTE // / ORENGINE6RL�I � (�A✓ �II i'NO. !v'� - /� ��)�J NING � AC 33 � .0 W' S. • P- S✓ / t / O 2oni_ no. oP uae oR NHW . `• t / F� PLAN9 7� lUILDIryO CONTRACTOR d w� /� O (/� � ADOR8II8 O aS I `P LeOAL �O �/ ��% D6iCR1'TION� CITY � S�/4-�/ i' il (, IO-I / ' A. P. NO. I �!O �� O� NOTfi: NO EAVE OVfiRHANG SHALL BE LESS THAN � STATE �/ NEL. a^ y/�/�� ` 90" TO SIDE R REAR P. L. LIC. NO. I � "f ^1 / EAVES SIZE I No.oPeLDas. ALLOWED (U.B.C.RE4UIREMENT) OF LOT NOw oN tAT YARDBAPPROVED YARDSAPPROVE� USE OF � MAIN BUILDINO ACCESSORY BUILDING EXISTINGBLOG. � I ��/L� . (FROMC/L9 � BETDACK LIM@ PROM FRQNT . FT. CENTER OP 6TRH8T REAR YARD . SIDEYARD) LEFT � R�a�{7� � � R.61OE �. DESCRIPTION OF WORK �. aioe �. �. ' !/ REW � MOV� 6TION — OEMOL 8H RHAR FT. FI'• DISTANCB BET. ' BET. MAIN R MAIN BLDG8. ACCE55. BLDGB. BUILDINO � NO.OP VAR.�' DATE _ SIZE ROOMS 8T R168 C.U.P.3R APPR VED EXTERIOR WALL I ROOR APPROViD � COVERING COVERIN6 Br � USHOFBUILQIN$ANDWOR TO EP6RFORMfiD . a nl �i�ll� �.ws r�w � . . sa. Fr. � . I HEREBY ACI(NOWLEO06 TNAT 1 XAVB PlAD TH19 APPLICATION TH8 AMOUNT BHOWN UNOER VALl1ATION IS POP TH6 �', AN� BTATE TXAT TH8 ABOVH IB CORHECT ANO AOREH TO COM. PURPO6E OR HSTABLIBHIN6 A pERMIT FEE ONLY. 0 PLY W�TH ALL C�TY OHD�NANGHB ANO BTAT[ LA R60ULAi�NO . � BUILDINO ONBTRU 1 N. . VALUATION �� ., � i�+ N PERMITFEE $� SIGNATUREO �� m PERMITTE s 120� � � , ��'; AUTHORI2fiDAGfiNT . . ' . �� ` ' TOTALFEE $ /� . -� . . '- 23502 COSTA,MESA BUILDING-SAFEfY DEPARTMENT '.,P.O.BO%91f COBTAIA6BMCALIFORNIA � For Appllcanl fo Fill In Complefely TYPE OR PRINT AOb EIS9 D� �V . , S� . COSTA MESA, CALIFORNIA • 1 pp OWNER (JL ( � L COF ( • MAIL ADbR6S8/ Icirr 1�01 T7NGE26' CR1... rTio ARGHITECT TEL. KE Cj �-ONST L � � � ►�1, E`M S7" i BHTpACK LIN6 FI10M CBNTexoPaTRBaT RHAR B�bBYARDI LEM1T � I R16HT DESCRIPTION OF WORK WALL �� lLDING AND W< %�% % — � �'�'l�S� : •�� rdL � _ . _ FEE REGEIUEU f�NANCE$OEP�1. � 9teaic�'n�Qs��RM4€�nR BUIIDIN(i For Office Usa Only ev FIRE TH ZONING ZON[ NO.OF I U860FN1 (^ � I PLANB �/' BUILOINO YAR�B MPROVED MAIN BUILDING o�srwNce eer. MAIN BLOGB. VAR. # , - \ � � -6� �-63 �_., ; SHALL BE LES9 THAN � (U.B.C.REpU1REMENTI � YAROS MPROVpD (� ACCESSORV BUILOINO ` FT. �_y� — V DATE � H8RE9C' �CKNOWLBD� THAT� XAVe Rq1D THIB APPLICATION TXe �MOUNT BHOWN UNOEH VALUAT�ON 18 POP TNe ANU BTATB THAT TX8 ABOy6 IY CORPBCi.�NO AOREe TO COM• PURPoBf O� HGTABLIBXINO A PEHMIT P88 ONLY. PLY WITH ALL CITY ORUINANCU AND 9TAT[ LAWO q[OUI.�TING VALUATION BUILDINO CONeTRU N. ^ ^ a ' � / / � ` PERMIT FEE SIGNATUREOP W^'p^�VJ ,/ PERMITTE .� r Q O� � 5 � AUTHORIZ6D A6HNT' ��GL�j• LL . TnT� `F E $ ��/`�' ' ' . ' COSTA MESA BUILDING-SAFETY DEPARTMENT � P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 , For Applicant to Fill in Completely — se Ink Only BUILDING � " ADDRESS OWNEROR %l ' TENANT C.f � MAILING ADDRES BRANCH ADDRES: TEL. � A� F STAT6� � CITV � LIC. N�/ LIQ NO. g,� SIZE . NO.OF BLDGS. L OF LOT NOW ON LOT a us �i � EXI ICL` � FSeparate permits are required for q electric, plumbing and heating work: �.�., USE BU I ND W ��ED Q Q e O ', � % r .� a w � I hereby ecknowledge that 1 have reatl this application antl state � that tha above information is correct antl agrea to comply wlth �. all laws regulating building consttuction, antl I shall not employ Z any person in violation of the workman's compensation lews of ,w=, the Staie of Californie. 3" I hereby certify that I am properly licensetl as a contracior under tha Stata of Callfornla Business and P�ofesstons Cotle, Division 3, Chaptar 9, and that such licensas ere in full force antl affect, or I f h t the State of Celifornia Busine 7094 11/20(7� 5.50 TL APPLICATION FOR STRUCTURAL PERMIT RECEI PERMIT 1�i0 4 9 2 0 0 1V A.P. NO. ��— � \ �^-�-4/ BUILDING � /� �. ' � ('�' ADDRE55 V(f J UNIT OR SPACE NO. NEW ADD ALTEI OWNER USE +` ZONE v I T' APPROVED ev APPROVED SETBACKS PLANNING ACTION am exempt rom t e provisionso VALUATION antl Protessions Co , Divi , Chapier 9. Signatura of � �QO, _ PermltSee $ or Autborizetl Apent Date REPAIR MOVIN( �/ L ,VALUE � E GROUP DATE N r OATE APPROVED nnTC II EMOLISH ^� " \ _ � � n i m N 7 JN UNDER VALUATION IS FOR m 'ABLISHING A PERMIT FEE ONLV: � PERMIT FEE $ q n PLAN CHECK 5 � m 0 LL TAX S �� f U TOTALPAID S � .r%� �COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626 For AppGcan� to Fill in Completely — Use Ink Only BUILDING /.OG �%% I � ADDFESS 1.< ' OWNEROR �y„ �yU �Y�� TENANT � Urj �/ / / ��F MAILING /�� n /��h �I ADDRESS �i� TEL. CITV NO.. CONSTRUCTION `� LENDER BRANCM AODRESS ARCHITECT S �U �K J �- TEL. ORENGINEER `Ch1�Y NO. y� w y{. ADDRESS LFi �/ (� � % � t�Y�,Yj APPLICATION A.P. NO. � `�L� BUILDING /� ' / ADDRESS (Q UNIT OR SPACE NO. T`�ai'v,n�w 5°�0+� la`F ?� NEW _ ADD ALTER REPAIR MOVII USE ED • � ADDRESS� ��U�S-rG' �I CITY NOLSY G'V/V� F STATE CITV A7PROV TBAC LIC. NO. LIC. NO. C {� SIZE NO.OF BLDGS (FROM C/ STREET C. OF LOT I��. S )( / �( 0' NOW ON LOT ONT �T. a USE OF � E%4STtM1lG BLOG. (�j �_ � �L, r F Separate permits are required for �. sio �/ FT.� o electric, plumbing and heating work. REAR Fr. � US F BUIL ING AND WORK BE PERFORMED PLANNING ACTION a o . � 7 APPR E } � a � �a I hereby ecknow�edBe that I hava raetl thls epplication and smta that the ebova i�formetlon Is co�re<t end agrae to comply with �. ell laws repulatinp builtlinp contttuction, ond I shall not employ Z any person in violation of the workman'c compensatlon lews of � the Stete of Californle. 3 I haroby carNfy thai l em proparly Ilcensatl ez e contreeior untlar SQ. FT, the Stam of Californle Busines� antl Profeaslons Cotla, DIvlslon 3, THE AMOUNT SI Chapter 9, entl that sueh Iicansas ere in tull forca entl efixt, or I THE PURP06E OF am exampt from the prorislons of the of Celifornia Businesf VALUATION and Professi ns Cotla, Divisl 3, Cha er 9. SIB�atura DQO, ' Paimlttee 5 Q Or I ' `/� �7 Authoriz�tl Agent Date C/ PERMIT 8a50 TL �� VALUE S DATE APPROVEO .,_�� C— DEMOLI � n i w m 7 VN UNDER VALUATION IS FOR (0 'ABLISHING A PEFMIT F E ONLv: � 7ERMIT FEE E dQ m PLAN CHECK S � iO 0 LL rnx s , S'a f U TOTALPAID 5 � � F � a Q � � x F C F C � � � � a � � a z � S 3 '�COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOK 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only ADDRESS 1.(OQ W I�� C�rI, T�ENANT�R W V�a`� "� I• ��'iON'Qr W ADDRES ��y� �Gtl�.{(.� �� TEL. CITY vs'��,L ('�7..(S CV NO.��ii0'4��fI CONSTRUCTION /Fi' BRANCH ADDRESS --' ARCNITECT \@Yh TKZ'�<�lM. TEL. OR ENGINEER J 7 No. ADDRESSU�Y Ir I�� 1�"Y✓W C.n CONTRACTOR ,/.��d V'C�-Q /� US � � ADDRE55 I��I R�%/��' �I �( •-�.� TEL. CITV I.C/S� ( / / YSC'.� NO. �G'{ STATE CITV LIC. NO. LIC. NO. SIZE /��IQ � /�O NOWONLO S / OF LOT USE OF EXISTING BLDG. �d N �Q Separate permits are required for electric, plumbing and heating work. U5� pJ� ��PeuGS�l 4(i�-' l tOMBE PEFiFOfiMED /V [� LO /771%7�iVt/d � ��- z� _/" x Us' D " I hereby ecknowledpa thet I heve reetl this nppllcetion and state thet tho above Information Is correct entl apree to comply wlth ell �ewa re0ulatlnp buildin0 eonsttuction, and I ehell not employ eny perwn in violetion of the workman's compensetion laws of the Staie of Californle. I heraby cartNy that I em properly licensatl es a contrector untlor the Siete of Celifotnla Businea entl Profeuions Cotle, Dlvitlon 3, Chapter 9, antl Mat such licensas ere In tull force entl effeec, ar I em examOt from the provisions of the Steta of CalHornia Buslnen and Profassion Cotla, Dlvision 3, Chapter i� sie�a��.e or Permittee o, �� -yy-�� AuthoAzed Agent te 7` �I/29/79 209oI9 TL APPLICATION FOR STRUCTURAL PERMIT A.P. NO. C � C� I '� � �V BUILDING �� l� , ADORE55 UNIT OR SPACE NO. TR.NO. NEW ADD ALTER REPAIR MOVI OWNER Q� VALU USE (J • 20NE TYPE GRO APPROVED BV DATE APP D SET8ACK5 I (F C/LSTR€ET) ONT FT. R. SIDE � FT.O G/ �.5�1�r I (�/� 7FT• �— � / � � /� U �REAR �/ IFT�./ / PLANNINGZCCTION� m � F40LD FOR SPECIAL RH9UlREMtNI � m �SQ. FT. � THE AMOUNT SHOWN UNDER VALUATION IS FOR m� THE GURP06E OF ES'fABLISHING A GERMIT FEE ONLV: � a O VALUATION PERMIT FEE E N n PLAN CNECK S O fO M � LL \�� 5//� 3q� TAX s 8,o r � TOTALPAID 5 _ � �. �-COSTA MESA BUILDING•SAFETY DEPARTMENT APPLICATION OF R STRUCTURAL PERMIT r._ P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 , r REC BV PERMIT �� For Applicant to Fill in Completely — Use Ink Onl Y - BUIIDING /..,.� �_ 1 I � A.P.NO. ' • ' ''� -- V" ADDRESS �OEI«/ I�(/ BUILDING /_��. � ' OWNER OR ADDRE55 Ip(�CJ TENANT UNIT OR MAILING / �� ' SPACE NO. ADDRE55 TR.NO. LOT BLK. TE L.t�- CITV NO. p NEW ADD ALTER REPAIR MOVING DEMOlISH CONSTRUCTION LENDEfl I / V BRANCH OWNER A�DRESS VALUE ARCHITECT TEL. USE ��, �� $ OR EN INEER /` ^ � Z ADDRESS 20NE C� PE N GFOUP APPROVED n CONTRACTOR BV DATE � Q � ADORESS TEL. CITV NO. STATE CITV P.PPROVEDSETBACKS LIC. NO. LIC. NO. SIZE NO.OF BLOGS. (FROM C/L STREET) OF LOT NOW ON LOT OM FT. USE OF EXISTING BLDG. FT. Separate permits are required for L SIOE FT. electric, plumbing and heating work. REAR FT. USE OF BUILDING AND WOFK TO BE PERFORMED PLANNING ACTION � y � �.�/_/ � DATE (�Kj�(i GAi� APPROVED APPROVED I harebY acknowletlga that I have �eatl this application antl slate that ihe ebove InformeNon is correct and epree to comply with ali lawa ragulating builtling conrtrucNon, antl 1 shall not employ any parson In violetlon of Me workman's compensation laws of the Smte of Californle. � I hareby certity thai l em proparly Ilcensetl as a eonirector untler SQ. FT. the Siate of Calitornie Business entl Profacsions Coda, Division 3, THE AMOUNTSHOWN UNDER VAIUATION IS FOR Chapter 9, antl that aue� licenses are in full foree antl effect, or I THE PURPOSE OF ESTABL6NING A PERMIT FEE ONLV: am exampt from tha provisions of the Stata of California Businass VALUATION PERMIT FEE E o .S and Profession Cotla, Div(sion 3 hepter 9. �' PLAN CHECK § Signatura of / ///��/// ! Permlttee $ � TAX S � or �1 Authorizetl Apent D�te 0 ` TOTAL PAI� E O SO ': °COSTA MESA BUILDING-SAFETY DEPARTMENT .' • P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant [o Fill in Completely — Use Ink Only AOIDRESS 1��04 W / G �� OWNER Oij a �r�, � d v e. �c,� TENANT ADDRE 5 U� Slji �`�'<<"� /rv�� TEL. CITV r,(UIINri��N �� NO.�+�,��/ LENDER V, 1 BRANCH ` ADDRESS ADDRESS TEL. R �Lt� %4-e hvs K �,/ -� A.P. NO. � BVIL�ING ADDRE55 UNIT OR SPACE NO. NEW OwNER U5E � APPROVED TTON FOR STRUCTURAL PERMIT y P1960 6iN°�ao5Q28� �� 7_ iU�- � n ., �TER REPAIR MOVING DEMOLI "��."fi � � V UE � �{y S TYPE GROUP V '♦ DATE � Z �� TL b \ ADDRESS �(f I S I'a /-� �' �'�'��0 � arv KTiu 7'ON ('�� No.`�d'v��7 � � STATE Q- 1 CITV AFFROVED SETBACKS LIC. NO. /J,(`(�G � UC. NO. � SIZE NO.OF BLIX'iS (FROM Gl STREET) 0. OF LOT NOW ON LOT ONT F � a USE OF � EXISTING BI�, y FSeparate permits are required for L SIDE r � electric, plumbing and heating work. REAR �,W„ USE OF BUILDING AND WORK TO BE PEFFORMED PLpNNI G ACTION a Q � ( DATE i APPROVED APPRO r — .� � w � I hareby ecknowietlBa that I hava raetl ih(a eppllcatton end ctete � y�, that the ebova Informetlon Is correct end aprae to comply with �. ell lews reBulating builtllnB conrtruction, and I�hall not employ i 'z ony perwn �� olation ot Ne workmen'a compensetlon lawt of ° � Me Staro o} Ca�ifomia. m 3 1 hereby eenify that I am properly Iiceneetl es e concrector untler S�. FT. j Ma Smte oi California Business end Professlons Coda, Dlvlsion 3, THE AMOUNT SMOWN UNDEF VAIVATION IS FOR m Chepier 9, entl t�et sueh Iicensas ere In full forea entl affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: � nm examD� from Ma provlsiona ot the Steie ot Celitornle Bu�ineaf V ALUATION PERMIT FEE S O � q entl Profess�ons Cotle, Dlvialon 3, Chepter 9. � '^ n �7 PLAN CHECK S p Sipnemro ot / �y �y Permittee '1 5 �_ TAX S D� V or Authorizetl Agent Date � TOTAL PAI D E O� � F � � a a y y S F G W F Q G 1 i' .� a � a 0 � 4 Z W S 3 For Applicant to Fill in ` , � DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT IFORNIA 92626 RECEIVED PER _ Q522 . .3b �'31' - u� �� o�y �;' ,; - . ADIORESS � O � I��/�iF'� A.P. NO. S OWNEROR 1.'Y� d��w ADDRE55 TENANT W • UNIT OR ADORE 5 �[/�� dC J(�` �'Y��p SPACENO. `�� ( �/` TR.NO. CITV N�IU (ro l.G `T �-�l N0�.7SyP �I» CAN5TRUCTION LENDER -�� BRANCH ADDRESS ADDFESS ADDRESS C 91aJ�^ / TEL (� CITY µµ��,(�G�QM LK NO.�y' 1 STATE CITY LIC. NO. LIC. NO. SI2E NO.OF BLDGS. OF LOT �CCQ � � 3 3 NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work: USE OF BUILDING AND WORK TO BE PERFORMED �r . � .I NEw ADD ALTER REPAIR MOVINC OWNER VALUE �SE SeAarK��N. cv.crl $ APPROVEDSETBACKS (FROMC/LSTREET) / PLANNING ACTION APPROVED r- DATE APPROVED LISH I hareby acknowletl8a that I have �eetl this application antl stata � Mat che ebove Intormation is corract and aBree to comply wich all laws reBulaiinB builtling const�uction, and I shell not employ i eny permn In vlolation of the workman's compensation laws of d tha Staie of California. �� m I hereby cercify ihat I am proparly �icenud as a cantractor under SQ. FT j the State oi Callfornle Business end Profasslons Cotle, Division 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR m Cheptar 9, end Mat such licenses era in full forca antl affact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: � am axamDt trom the provlsions ot the Steie of California Businau VAlUAT10N PERMIT FEE 5 q entl Profeseions Cotle, Divislon Chapter . � '^ n /"! PLAN CHECK $ ^ Si netura Of � L �� Pe mlttee S 7 7QQ. �� TAX E �, F or V AuthoAzed ABent Dat �� , �� TOTAL PAI� 5 Q Q� •, COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use [nk Only BUILDING /wOO � � � � ADDRESS � OWNEROR . N� I%�I. IT TENANT Vl��1' P..�4) ADDRE 5 �� rQ � (-.. �-ycjQ CITY (�j,(u� � �Ny `U� � t.� NOL d��'I/ MfJCTO111T1f1l�1 � APPLICATION FOR STRUCTURAL PERMIT A.P.NO. 'j��i—��7iZ�<ZO AD�RE55 L'OO W I "J ' UNIT OR SPACE NO. H.rvo. LOT NEW ADD ALTER BRANCH OWNER ADDRESS ARCHITECT TEL. VSE SI APPROVED CONTRACTOR D BV ADDRESS TEL. CITY NO. rF. STATE CITV APPROVED SETBACKS � LIC. NO. LIC. NO. {,y SIZE NO.OF BLDGS (FROM C/L STREET) 4 OF LOT NOW ON LOT OM FT. a USE OF � E%I5TING BLDG. y FSeparate permits are required for L. SIDE FT. � electric, plumbing and heating work. REAR Fr. 1 �.W. USE OF BUILDING AND WORK TO BE PERFORMED PLqNNING ACTION Q 0 ' '� Q _ / � Q C / APPROVED �., 7 ..l a w a� I he�eby eeknowlatlge that � have raatl t�la epplicatlon entl stete that the ebove information is correct entl aprea to comply wlth a ell laws raBulatlnB buildinB construction, and I shell not employ Z eny perwn In violatlon of ihe workman's compenseNon lews of � the State of California. 1 3 I hereby eertify thet 1 am properly Iicensetl as a controctor under � � the Stata of California Business antl Professions Cotle, Division 3, THE AMOUI Chapter 9, and thet such licences are In full force entl effect, or I THE PUflP06 em ezempt from Ma provisions of the Stata of Celifornia Businest VALUATION antl Protesslons Code, Division 3, C/h)� p�er 9. SlOnaiura of!' �i �� /'� �. / � OO Permittea V�� `! Y!/ ( (/LG/�t/ S I of ��.Y!_ � f'� AuthoAzed ABen< Date � a � „ �1� DEMO � ''VALUE E rIYGROUP (j— �— DATE �i—i.G—S DATE Mf� I,0 Tla � m 'm T 2/d�'— � ] SH WN UNDER VALUATION IS FOR N �F ESTABL4SHING A PEFMIT FEE ONLV: � PERMIT FEE E � • N m PLAN CHECK y � GO °1 0 LL TAX E Cj• �'� U TOTAL PAID E n . / (] � • COSTA MESA BUILDING-SAFETY DEPARTMENT � P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant [o Fill in Completely — Use Ink Only BUILDING %N f E ADDRESS OWNER OR TENANT /UQ. Y(� �J� ZA-- MAI LI NG n ADDRESS ��D �� K��/,$�f • /� ,�n TEL. , CITV C•.Qi'fA�/Y/�Q�i G�s• Na.�yr-yG �2 CONSTRUCTION LENDEF - BRANCH ) ADDRESS CONTRACTOR ADORESS CITY F STATE � LIC. NO. {i,� SIZE G OF LOT a USE OF � EX15fING BLDG. y TEL. NO. CITV LIC. NO. NO.OF BLDGS NOW ON LOT FSeparate permi[s are required for 0 electric, plumbing and heating work�. E,�„ USE OF BUILDING AND WOFK TO BE PERFORMED a c .., �'�,.�,.J. . � � � � APPUCATION FOR STRUCTURAL PERMIT ' 3ECEIVE V PERMIT ATO 5 0 5 9 8 ,�� A.P. NO.I�%�%1�'��J� � '�I �� __ BUILDING ��Q ADDFE55 UNIT OR SPACE NO. TR.NO. LOT NEW ADD ALTEI OWNER � u V5E T',�- A ZONE T' APPROVED BY � APPROVED SETBACKS (FROM GL STREETJ� PLANNING ACTI "C�� ' REPAIRIMOVI .GC i �� vA E • SS� DATE DATE _ 2 �, 0 I hereby aeknowletlBe tha[ I �eve reatl this applicetion and stnte � � that the abova Informetlon is corract and eprea to comply with a oll laws regulating buildlnp concvuction, antl I ihell not employ m Z any permn in violation of Me workman't compensation laws of w the Stete of California. ^ �� m 3 1 �areby canify that I am properly licenxd as e conttactor untlar S�. FT. O"l � J tha State of Californie Business entl Protassions Code, Dlvlsion 3, THE AMOUNT $HOWN UNDER VALUATION IS FOR m Chapter 9, antl that such licenses ere In full force enC effact, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: � am ezemOt irom the provisions ot tha State of Celifornia Businass n' —_ a andProfessionsC e, ivislon3,Cha ter9. VALVATION PERMITFEE S �t � m PLAN CHECK b /) �f , � o Sipnatura of c v. �� " LL Permittea g 7 v TAX E �. S� U Or AuthorizadABeni Date TOTALPAID E �3. ';v : COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING �� q � ADDRESS �OO W �T�Y R W.-�..'(�1 !//// �//��'"`�" MAILING � �� ADDRE55 �Q 7 � S�Q � „r �., � TEL.�UL CITY�UNT�r.TeN�.iac NO.�YS� � BRANCH ADDRESS CONTRACTOR TEL. APPLICATION FOR�SiRUCTURA�L PERMIT 25,0f1 Tl. REC�EIVE/p IBr PERMIT � �/� /�l.! A.P.NO. � L .�� ADORE55 ljQ W I u UNIT OR SPACE NO. �-� TR.NO. LOT BLK. NEW ADD I.TER REPAIR MOVING OEMOL�SH OWNER W v VALUE USE � , �! 5 � 20NE VPE GROVP '�2' APPROVED /� DATE 7 --(J �V 8Y TEL. CITV NO. F' STATE CITV APPROVED SETBACKS i UC. NO. UC. NO. a �y SI2E NO,OFBLDGS. (FROMC/LSTREET) 0. OF LOT NOW ON LOT OM FT. a USE OF � EXISTNG BLOG. .�-i F Separate permits are required for L SID Fr. Q electric, plumbing and heating work. REAR Fr. � USE OF BUILDING AND WORK TO BE PERFORMED PI.ANNING ACTION F G Q - E G � APPROVED � C Yi QI �areby acknowladpe that I heva reatl tniz eppllcetion antl state y� that the ebova Information is corract antl aprea to comply wlth O� ell laws reB�latln0 builtlln0 �onrtrucNon, and I ahall not amploy � any parmn in vlolation ot tha workman's compensailon laws of � ihe Stata of Califarnla. 3 � nerebv cartity tnac � em properly Iicensetl as a contractor unCar SQ. FT. tha Stata of Celifarnia Business antl Professions Cotla, Div(sion 3, THE AMOUNT SH01 Chapter 9, entl that such licenses are in fuil force entl effect, or 1 THE PURPOSE OF ES am exempt irom Me proviSionsof theStote of Californla Business VALUATION anC Profesaions Cotle, Division 3, Chaptar ^9. SIO�atura of � � / � A . � / . . „�� $ /�� Q Parm�`ttae _ ��ti(YCA � - 4 �w ` Authorizatl A6ant Date _ � �� APPROVED PERMIT FEE E PLAN CHECK b �ux : TOTALPAID � n i v m � IS FOR m ONLY: � vy � � m - s� � S-D � . � � �I r... �, ,. . , � � ". CITY OF COSTA MESA BUILDING D/VIS/ON 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • v+ww.ci.costa-mesa.ca.us . FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BX07-00318 PERMIT TYPE B MISC STATUS: ISSUED APN: 42214220 DATEISSUED: 12121/2007 Zoning: , ISSUED BY: BJK JOB ADDRESS: 600 A W 19TH ST CM Suite/Unit: A Vicinity: RIDGE BEAM -� �Primary Occ: Const Type :?? SQ. FT: 0 �- Valuation: E6,000.00 ' SCOPE OF WORK: REPLACEMENT OF-THE�RIDGE BEAM OF AN EXISTING RETAIL STORE, "CALIFORNIA FOOD STOP" IN UNIT A. NO OTH�R � � �% � � � � WORK AUTHORIZEp WITH 7NIS PERMIT.�'�,:'�' � � � OWNER:� 19TH AND ANAHEIM LLC ;' -' , Address:: 600 W 19TH ST � Unit City/State: COSTA MESA, CA . �� Zip Code: 92627 � � _ Phone: . . .. - � APPLICANT: PECK�NPAUGH, DAVID City/State: HUNTINGTONBEACH,,CA , ,,., Phone: 714-375-5777 CONTRACTOR: OW NER-BUILDER Address: City/State: Zip Code: - • � ARCHITECT: Phone , ENGINEER: , Phone Building Plan Check: Building Permi�: Electrical Permit: SMIP Residential SMIP Commercial $O.00TOTAL FEES Address: 16101 GOLDENWEST ST � Unit: Zip Code: 92647 . . Unit -- '. ,_ . .Phone FEE SUMMARY $81.41 $12525 $0.00 $0.00 $0.00 ; - $206.66 8 „� a License No. 000000 , Cell: License No. � ,� , . ' License No. � • ^ '•OOU STOF" �i NOTICE: 7he work authorized by lhis pertnit sfialt comply with all applicable handicap access requirements under Califomia statutes and related regulalions. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: PERMI7 EXPIRES �80 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the vrork authorized under this permit lo be considered legal, such work must comply with all applicable codes,,and �all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE/, INSPECiIONTYPE DATE INiI AL CO�E� INSPECTIONTYPE L N �L 1818 Fixed SyStem Final Fire Prevention 206 Final Methanical 1286 Pool Spa Final 208 Final PlumDing 200 Final Re-Root 270 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire PreveMion 202 Final Factory Fire Flaca 220 Final Planning Approval 203 Final Sign 222 Final Si�e a 204 Final Demolition ' 250 Final Building/Occupancy� � � `� " lJ �� WORKERS' COMPENSATION DECLARATION: � I hereby aKrm under penalty of perjury one of the following declarations: � I have and vrill maintain a certificate of wnsent to self-Insure for wvrkers' compensation, as provided for by section 3700 of the Labor Code, for the peAormance of the work for which lhis permit is issued. � I have and will maintain wwkers' wmpensation insurance, as required by secl'an 3700 of the LaDor Code, for ihe pertortnance o( the work fa which this permit is issued. My workers' compensation Insurance carrier antl policy number are: Cartier. (71us sacfim me0 ndOe cnn�yefe0 d�ne pemrd u vaWed of ma nuntlretl tl�9ars (f �00) nbss ) Policy Number: �I certify that in the peAortnance of lhe vrork for which lhis pertnit is sued, I shall not employ any person in any manner so as to become subject to lhe workars' compensation laws of Calitomia, and agree Ihat il I should beco subject lo the workers' compensation provisions of Section 3700 of the ah r Code, I ha forth 't comply with lhese provisions. / y �7� I /d"l Aod��' �aWrc Da1e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINP.L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S ($100,000), IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensetl untler provisions of Chapter 9(wmmencing with Section 7000) of Division 3 of Ihe Business and Professions Code, antl my license is in full brce antl effect. Lic. # Class # Cantrector's Sigrialure CONSTRUCTION LENDING AGENCY: ❑ 1 he2by af(mm ttiat there is a constructbn lending agency fa the peAormance of tlie wwk fa wfiich tNs pertnit is issued. (Sac. 3097, Civil Code). Lenders Name: Lentler s Adtlress: oate OW NER•BUILDER DECLARATIONS: I hereby affrtn ihal untler penal[y of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the follovnng reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permil to consWct, alter, improve, Cemolish, or repair any sWCWre. prior to its issuance, also requires the applicaN for such permit Io file a signed statement that he or she is licensed pursuanl to lhe provisions of the Contractors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of ihe Business and Professions Cotle) or that he or she is exempt therefrom and t�e basis for the alleged ezemption. Any violation of Section 7037.5 by any appliwnt for a permit subjec[s the applicant to a civil penalty of not more lhan five hundred tlollars ($500).): ❑ I, as owner of lhe property, or my employees vrith wages as Neir sole compensation, WILL DO THE WORK, and lhe structure is not intended or oHered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apply to an owner of property who builds or improves t�ereon, and who does such work himself or hersel( or through his or her ovm employees, provided lhat such improvements are not intended or oHered for sale. If, however, the building or improvement is sold within one year of complelion, Ihe ovmer-builder will have [he burden of pmving thal he or she tlid not builtl or improve for purpose of sale.). I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH ENSED CONTRACTORS to construct the projecl (Sec. 7044, Business antl Professbns Code: The contractors License Law dces not apply to an ovmer of property wfio builas or improves thereon, and who contracts for such prqect with a cmlractor(s� license pursuant to the Cont2ctors License Laws.�. ❑ I am exempt untler sec. Business and Professions Cotle lor this reason: �.- I� �� na re oa e 305]�46(�/O]) . - '-, +; �, Owner ID verifietl by Cri/ Expires: � 09 Venfication ot Ownership by (rype of document, i.e. - property Wx bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certAy Ihat no excavation Me (5) a more teet m depth into wfiich a person is requiretl to descentl, will be matle in connection wilh wurk authorized by this permit, and ihat no huilding struclure, scaHdding, (alse�wrk, a demolition or dismantling Ihereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, M 2, SBC. 341, Tlle B, Cafi(Ortlia AEmfniSlraWO Catle). ❑ As owner-builder, I will not employ anyone lo do work which would require a permil from the Division of Industrial Safery, as noted above, unless suc� person has a permit to do such work from lhe division. AOPllcant's SignaWre Dale Division of Industrial Safety Permil Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to fle and certify a Business Plan for emergency response ro release or threatenetl release of a hazardous material? ❑ Yes ❑ No �Section 25505 0! Ihe Calilomia Health and Safery CoGe requires, with some exceptions, that a Business Plan be filed with lhe CosU Mesa Fire Department by every business which has at any one time during a reported year a quantity ol hazardous materials equal ro or greater lhan a weight of 500 pounds, or a volume of 55 9allons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or (uWre building otGupant need b file a registration form for acutely hazar0ous materials? ❑ Yes ❑ No (Section 25533 of Ihe Califomia Health and Salely Code, with some exceptions, require5 regislration with Ihe Costa Mesa Fire Depariment by each business which at any one time has on hantl a quantily o! acutely hazardous materials equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cuDic teel of compressed gas at stantlard temperature antl pressure). 3. Does or will Ihe applicant or present or fuNre builtling occupant need to prepare an RMPP (Risk Management antl Prevention Proqram (or acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 0l the Calitomia HeaIN and Safery Code provides that the Costa Mesa Fire Department may require the preparatlon, certifiwtion and filing with the Fire Department of an RMPP by businesses which are requiretl ro register acutely hazartlous materials with the Fire Department. 4. If an RMPP is presently required, has Sectlon 25534 of the Calilomia Heallh and Safely Cotle been fully complietl vrithl ❑ Yes ❑ No 5. Does or will Ihe applicant or present or future building occupant raquire for the work whic� is the subjecl o( this application a pertnit !or suc� conslruction or modifcation Imm the Soulh Coast Air Qualiry Management District or Irom any olher air pollution coNrol dislrict or agency9 ❑ Yes ❑ No (Seclqn 65850.2 0l lhe Califomia Govemmem Coda requires lhat the requested information be fumishetl on applicaCans for rarrresiOenUal building pertnits�. 6. Will any part of the facility lo De wnslructed under Ihis permit be wilhin 1000 feet Irom the outer boundanes of a school? ❑ Ves ❑ No (If'yes'. the facility musl meet Ihe requirement of Sections 25534 and 42309 of the Calilornia Health and Safery Code). 7. If a permit from the South Coast Air �uality Management District or other air pollution conlrol dislrict or agency is required for the vmrk which is the subject of this application, have all of the disclosures prescribed by California Health antl Safery Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", attach certificate of compliance from the appropriate air pollution control offcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty ol perjury Ihe information given above is correcL I agree to wmply vrith all slate laws and city ordinances regartling Hazartlous Materials antl Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the in(ortnation given is cortecL I agree to comply wilh all state laws antl ciry ordinances relating to builtling consWction, antl authorize representatives ot the City of Costa Mesa to enter upon the abovedescribetl property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by Ihis permit until final inspection. Signat . 1 pal O� r) te ii� , ��-� AnOlorAuth z ApWiwnt Dale (714) 754•5273 • Fex (714) 754-4856 • www.Cl.Gosta-mesat��TRICAL PERMIT n FAIR DRIVE, GOSTA MESA, GA 92626 Job Address: 600 W 19TH ST Suite No A Vicinily: A Parcel Nunmber: 42214220 ApplicanC Address: Owner: Address Contrador. Address: ISSUE FEE Temp service lest Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts . Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over t000a Motors to 1 hp � ; Motors to 10hp' Motors to SOhp , Molors l0 100hp Motors over t00hp Communicalion drops Sub panel to 200a Pole Light Pkg $1911 CIfCUI($ Temp Pwr Pole Inlermed Pole PHUONG NGUYEN 8109 BOLSA AV MIDWAY, CA BALL ROAD LLC 600 W 19TH ST COSTA MESA, CA .. BUTTERFLY SIGNS 8109 BOLSA AV MIDWAY. CA Phone: 714-894•0076 Zip 92655 Phone: ., . � Zip .' 92627 ' Phone: 714-894-0076 Zip: ; 92655 License: 803767 . SCOPE OF PERMIT ' REF SBOS-00109 FOR CALIFORNIA FOOD STORE. ELEC: SIGN �. 523.50 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 50.00 $0.00 so.00 30.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 , $0.00 $0.00 $0.00 . $0.00 $24.60 $0.00 $0.00 Quantity - 0 0 0 _ ,0�-..... ... 0 0 0 0 0 0 0 0 - �,.�.:.: '-�.; 0 � 0 0 � .. . 0 _ p.. �. p _, , . �.0 '.... . FEE SUMMARY Status: ISSUED Applied: 09I012005 Issued: 09/012005 ISSUED BY: � L ;Temp Dist'System / Lighting .?Busway/100ft . Standing Seclion �- �� - Misc Electrical Equipment _ Transformers up to 1 kva/kw , .. . ..........up to 10 kva/kw, . .:. ... ..........up to 50 kva/kW .. .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System I Ckt Misc. Conduit Misa Conductor `Circus ( gen or ride) �Circus (mecFi rideAr lights) �'Christmas Tree Stand "� ,;-��<� �� Fireworks Stand �� " � Other Electrical Fee . � �-�investigationFee`�-^�'�� .. . . - -.Plan Check Fee' �°_.-. - ' ' �, �. -..-�Reinspection Fee , , ., rY i '� E � -�-TOTAL-CALCULATEDiFEES . .' ,' . ,.�r_, i_ � Quantity 50.00 0 ' $0.00 0 ' $0.00 0 $0.00 0 so.00 0 $0.00 0 , $0.00 0 $0.00 0 50.00 0 $0.00 0 so.00 0 $0.00 0 $0.00' .' 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $O.OP , $0.00 ' $0.00 �$0.00 -, �� $48.70,,�� NOTICE: The work authorized by this permit shall compty with a�l applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 7241-92) ,� � EXPIRATION: This permit shall automatically expire and become vold It work Is not commenced withln 780 days, or it work Is suspended or abandaned for e period ot 180�days. • INSPECTIONS: In order for the work authorized under this permit to be consldered legel, such work must comply; �h all epplicable codes, and ell required Inspectiona end finel approval must be obtained. Failure to obtain Inspectlons end final approval will result�ln the expiratlon of Ihis permit. FOR INSPECTIONS CALL: (714) 7545828 r/ xaaa<e�dno) WORKERS'COMPENSAnON DECLARAnON: I hereby aHirtn under penalry of perJury one of fhe fdlowing dedaratlons: ❑ I eve end will maintein a cenllicete of consent to self-Insure far workers' compensetion, az provltletl tor by seqion 3700 oi �he Lehor CoOe, fOr Iha peAortnance of the ork tor which tttis pertnit is 155ued. end wiA mainWn workers' canpensatbn inwre�e, es requlretl Gy sectbn 3700 ot Ne Labor Catle, lor the peRortnanca ol the xrork fa whkh Nis pertnit is issiretl. My orke�q' cqm�tlon Insjure��nce cer�ier end policy number ere: ^ -�7p rti • ,<�T �yy !� P iry r. I� O� �/(7 �� is secNon need not completed / e pe if !s velued et one huntlretl dW/ars ($100) or less.) ❑ I cenlly that in the pertarmenca of the work lor which Ihis permil b issue4 I shall nat employ eny persan In any menner so es lo become sub�ect to ihe workers' satlon lews of Celifomia, enG eprgqqq thet II I should become sub�ecl to ihe workars' compensetlon provlslons ot Section 3700 ot the Lebor Cotle, l shall forNwith ompty Ith these p�oy�'�oriyi ��M^ J �bete: -1 / � �n � IlcantSi ture: ��•1/liun� � "-. " W 0: FAILURE TO SEWRE WORKERS' COM TI VERAGE IS UNUW FUL AND SlNLL SUBIECT Ml CRIMINAL PENALTI AND CNIL FlNE9 UP TO ONE HUNDRED THOUSAND DOLLAHE (f100,OW). IN FDORION TO TNE CQSi OF COMPENSATION, DAANIOES AS PROVIDED FOR IN SECTIpJ 3]OB OF THE LABOR CODE, INTEREST, AND ATTORNEI^S FEES. DECLARATON: iat I em uc. a _ of Chapter 9(mmmendng wlth Seclion 7000) ol DiNslon 3 of the B p q� � oece: _ Cotle, flnd my Ilcense Is in full CONSTRUCTION LENOING AGENCY: ❑ I hereby afllrm ihat there is e Con9truCtion lending egency tor t�e peAormance of Ihe work tor whic� ihls perml� Is IssueC. (Sec. 3097, Civll Code). Lentlefs Name: Slgnature: _ Lentlels AtlEress: Date: OWNER-BUILDER DECLAFiAT10N5: I hereby etllrtn thet under penalry ot per�ury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the follawing reason (Sec. 7031.5, Business end Professions Code: Any Gty ar wunry which requlres e pertnit to consiruct, elter, Improve, demolish, or repair any structure, pdor to Its issuance, elso requires the ap0�icant tor such pertnit to file e signed steremem that he or she Is Iicensed pursuant ro the proNslons of the Coniredors Llcense Lew (Chapter 9(commencting wlih Sectlon 7000) of DMsion 3 of the Buslneu entl Prafessions Cada) or Ihet he or she Is exempt therefrom and the basls for t�e allegetl exemptlon. Any Nolatlon oi SeIXion 7031.5 by eny applicant for a permit sub�ects the epplicant to e civil penelry ol not more ihan five hundrad dollars ($500).j: ❑ I, es owner of the property, or my employees with wages as their sde wmpensatlon, WILL DO TME WORK, and the structure Is not intendetl or oXered for sale (Sec. 7044, Business antl Professlons Code: The Contractors License Lew Coes not epply to en owner of property who bullds or improves thereon, antl who does such work hlmself or herself or ihrough his or her own employees, providetl that such Improvements are no� Intended or oflered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder vrill have ihe burden al proving that he or she tlitl not build or improve for purpose ot sale.). • ❑ I, es owner of the property, em EXCLUSIVELY CONTAACTING WITH LICENSED CON7RACTORS ta construct the project (Sac. 7044, Business end Professions Cotle: The contractors llcense Lew Goes not eppy to an owner ot properry who builds or improves thereon, end who contracts for such pro�ect wlih e wntreaor(s) license pursuant to ihe ConUactors LJcense Laws.). ❑ I am exempt untler sec. Business and Pmfessians Catle lor �his reason: Signature: Date: Owner ID veritied by drivers Iicense. ❑ Yes ❑ No Orivefs License No. Vedficatlon o1 Ownership by (rype o1 dacument, i.e. - pmperry tex bili or daetl); DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: E�Ires: ❑ I hereby certity thet no excevatlon five (5) or more feet in depth into which e person is requlred to tlescend, wlll be made In connectlon with work eutharizad by thls pertnl6 end that no bullding sWdure, scattdding, lalsework, or demoll0on or dlsmantling thereof, wlll be more than ihiAy-sla (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Celitornle Atlminlslrelive Cotle). ❑ As owner-builder, I will not employ enyone to do work which would require e pertnit Iram the DlWsion ot IntlustAal Setery, es natetl ebove, unless such person hes e pertnit to do such work irom Ne division. SlgnaNre: Date: DlNslon of Industnal Satety Pertnil Number: CER7IFlCATE OF COMPLIANCE AND AllTTIORVA710N OF ENfAY: I ceniy under penalry ot perjury that I have reed this epplicatlon en0 state that ihe Infortnatlon given is wrrect. I egree lo comply with ell stete laws end dty ortlinances relating to bulltlinp construciion, end euthorize representatives oi �he Ciry af Cos�a Mesa to enler upon Ihe ebova-tlescribed propeny lar Inspection Dwposes. I egree not to occupy or ellow acupency ot any 6uilding euthorized by Ihis Dermit unlil finel inspection. Signeture COpE I. INSPECTIONTYGE Qd¢, 1818 Fixetl System Final Fire Preveniion 1268 200 201 202 203 204 Pool Spa Finel Finel Ra-Root Final BIacWFietaining Wall Final Fectory Fire Place Final Sign Final Demolition � S,QQ�j INSPECTIONTYPE 208 Finel Mec�enicel 208 Final Plumbing 210 Final Elecirlcel 212 220 222 250 Flnel Flre Prevention Finel Planning Approval Flnel Site Final BuIlding/Occupenry QLg It�LB LB PXOJECT AOOflESS: 6 O O W 1 9 TH JCT UNIT: B OWNEN'SNAME:GENE ROHERTSON nooAess: P O BOX 156 CORONA DEL MAR CA 92625 (714)75D-8364 RflLH/ENGINEEfl: PAIR �F PENCZLS flEG.NO.:C� aooeess:11681 CHESTER AV uNiT: GARDEN GROVE CA 92640 aenrninee: GENE ROHERTSON ( 714 ) 760-8 �i64 aooaess: P, O. BOX 156 CORONA DEL MAR CA 92625 LICENSEU CONTflPCTOP DECIABBTION: I here�y a�lirm Ihal I am IicenseA untler promsions o� C�apier 9(commencing wiih Section 7000� ol Orvision 3 0l Ihe Business and Prolessions CoOe. and my license is in full brce and ellecl. CITY LIC.: STRTE LIC.: CLASS: Oate: Signa�ure: WOB8ER5' COMPENSR710N DEClANR710N: I �ereDy allirm I�a� I �ave a cenificate ot consent to selbinsure or a cenilicate of Workers' Compensaiion Insurance, or a cetlifietl capV Ihereol �Section 3800, Lab. CI. POLICY NO.: E%P. DRiE: LOMPANV: 7 C¢riifiea capY is �ere�y �urnishe0. ❑ Certilie0 copy i5 �ileE wii� IOe ciry Building Division. Oate: ApDlicant: E%EMPTION FBOM WOflI(EBS' COMPENSATION OECUflATION: Qhis section ap0 nol be completeU il Ihe permil is fa one hu�reU �3100� or less�. I ce�ify t�ai in Ihe Dedormance ol the wark lor which I�is permii is is d all not em 1JE� /a�nnJyyY/yyyee//��m in any manner so as �o become sub ecl �o�/7e Wo/rMe,rs' Coqm e ation Laws ol Calibmia. �`E�.. Daie: / ��.j `/ � Signa�ure:� NOTICE: If, a�ter making Ihis declara�ion, you s�oula become subleci �o � e Workers' Compen5aiion pmvisians o� Ihe Lahor COAe. you musl Iori�with comD�Y �� such prov4ion5 ar ��is permi� shall be Geemetl revokeA. CONSTflUCTION LENUINC AGENCY: i hereby a�hrm t�al Ihere is a con5imc�ion IenOing agency �or Ihe pedormance ol Ihe work for whicn Inis Oe�mit is issue0 (Section 3097. Civ. C�. LENUEH: nooness: OWNER BUILOEB OECIAflAiION: I �ereby allirm Ihal I am exempl imm Ihe CanVaciors' S�ale License Law br Ihe following reason '(Seclion 7031.5 Business antl Pmlessional Cade: Any city al counly wnich reQuires a permit to constmct. aller. impmve, demolish, or ' repair , ny Slmclure. prior lo its issuance, alsa requires Ihe apP�icanl �or such Dermit to �ile a signetl Slatement I�al he/s�e is IicenSeA pursuam Io t�e Dmvisions ol ihe Conirac[orY Slale License law �Chapter 9(commencing wilh Seclion 70110) oi Oivision 3 0l ��e Business antl Prolessions Code) or ihal he/she is exempt Iherefrom antl I�e �asis lor the aileged exemption. Any violation of Seclion 7031.5 by any aDP�icant lor a De�mil subjects the applicanl to a civil Oenalry of no� more Ihan �ive hundred Aollars �1500). I. as owner ol Ihe propeny or my employees wilh waAes as iheir sole compensation, will tlo Ihe work, an0 �he ❑ simaure is not intenCetl or afiere0lor sale (Secuon 70a4, Business and Pwiessianal Code: The Cantractors' State License Law tloes noi aDDly lo an owner oi a pmperiy who �uilds or impwves Ihereon, and who tloes suc� work him5e0/AerSei� or fhmuA� his or her own employees. providea �hai such impmvemenls are not in�entletl or o�fereG for Sale. IL Mwever Ihe buil�ing or impmvemeni is 5010 vn�hln one year oi compleiion, I�e owner vnll have the burtlen ot pwving �e/s�e GiE noi buila or impmve for ine ourpOse ol sale�. v, I, as owne� ol Ihe pmperiy, am exclusively conlrnc�ing with licensea convaclors ta cansVuct Ihe Orolec� (Sec�ion 7094, Business CJ antl Pmtessions CaUe: The Comractors' Slate lkense Law Coes noi apply m an owner ol D�operty wta builUs or imD�a�es inereon an0 who conirac�s for such pmlec�s wi�� a conVactoqs)lic¢nse pursuant�a �he Conlraciors' Siale License Law�. I am aware Ihal O�ool ol t�eir Worker'S ComDensation insurance 5�oulU Oe pwvitletl to me. � I am edemo� unaer Section: B. 8 P. C. � lor Uis reason' 7 _� _93 , Oate: Owner I Oo hereoV �enily �hat I am aware ol an0 un0erslantl the repuiremems oi Calilornia Health an0 Safety Cotle Sections 25505. 25533. antl 25534 an0 I�at I or any luture building occupanl will/will not (circle one) n¢etl �o compty w�th SaiE state coaes antl Ihe requir¢menis tor a permit lor conslmction or modifica�ion fmm �he Nir Ouality ManaAemeni Dislrici. FeSitleniial conslmc�ion ap0licaiion5 are exemp� imm I�CSE O�Oh5i0�5. Oate: AO��ieam: I �ere0y ceriity I�ai I �ave reaa 1�¢ apP�itali0n an0 5taie Ihat I�e above inlormaiion i5 mrretL I apree Io camply vnl� all tiry anU Coun�y orOmancesanOs�alelawsrela�inqto�uileingcons�mclionanO�ereWaulh e presentalive i �y eemeruDonlheabove-mentionetl pmperly br inspeclion ourDG7ases Da�e: / — � � _ / � SignaNre: � , � - Orivefs License ar Social Securi�y a: 1641�a6 Wlute—Builaing: Green—Code Enlorcemam; Canary—Apphcanf. Pmk—Revenu¢ Goltlonrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT t ; .� PERMIT NO; B 062999 PLAN CHECK NO; 01457-93 L —Z,�pI�57PIT-Fi CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; ALT JOB DESCRIPTION : EXPAND CONVENIENCE STORE 294SF SQ FT; 294 CLAIM VALUE; 3,000.00 CALC—VALUE; 2,181,48 GROUP OCC; H-2 / COMMENTS: EXPAND EXISTING CONVENIENCE STORE +��r�t�t�r�r� �*****�*��**x�**�****�r�**��*�x******�**�**�r*�rx�r******��-x*�*�**�t**+�x x�** Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCES�ORY BUILDING --------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN ,LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN IPARKING REQ • PROV; PARCEL; 42214220 ZNE: C1 REF NO: IPLANNING NOTES> INTERIOR ALTERATIONS TO EXPAND UNIT "H" BY 294 SQ, FT, BY > REMOVING A DEMISING WALL, �e*�*��e��r��r� �r�t***� �t**x�r�t**�r�r*�r�r�x*�e��t*x�t x�r�r� �*�r�r �*�r�rx **x* �t�tx x �e*� �r*�r�r�r�r*�r**+�� r��r D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY ; �� DATE; /3� � BUILDING APPROVED BY ; DATE; 7/3I� APPLICATION ISSUED BY;� DATE; /3 3 ifltlfitiEillfifiFlEiflfiEif7tiFlfiFikftlfif fEiFifiFikiFlFifiFiF F �f 1Eif iEif7tlEiFiE1ElEiEiflEifiEiEiF�fifiEfElElkifiFkiEiFlflfiEiFiflkifitiEiE�FiElFlflEiE-lE!( ftrltiEil�iEM�ikik�Eifif�FiEiElEiEiflfiEfF1E1F�E7l�f)E�EiFifIf3E3FifiE LEGALIZATION:N F E E S U,y M A R Y STRUCTURAL SEGMENT;Y BLDG PMT PLUMBING ELECTRIC N,ECHANIC FIRE SMIP/RES GRADING PERMIT 54,00 SMIP/NON—RES PLAN 35.10 ,50 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID 'DUE TOTALS----> 54.50 0,00 35,10 89,60 89,60 ,00 REVENUE DIVISION.TOTALS--> COLLECT6D; 54,50 OVER/SHORT; ,00 BLD54P00 PLUMBING ELECTRIC MECHANTC FIRE SMIP/TO�T GRADING PLAN—CHECK i! if !! k if i! ik ik if it 1E i! if iFlf iFlf if if if k 1t i! if it if it it it if if it ff it k ik ik it if f! k ikik �f !F if iF k 1t k fF 1(�!k!f !f ik 1f if 3f k if 1f 1F iFlE Ik if iklE 1f fF 1E iFlE if iE )F If?f I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 294 STO—INT, ALTER TYPE V—N —AVER 7.42 2,181,48 END OF FEES EXPIRED DATE �0 � 01 00142694—OD14259` T OT 54.gp QATE: 07/13/43 Tf�iE: 10:20 COIVSTRUCTIOf�:•AND PLANNING APPROVALS Pe�mit;r`� � 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd, 3. Electrical Conduit Utility�Undrgrnd. 4. Elecirical Conduit�Untlrgrrtd. . 5. Steei Reinforcement 6. Electrical UfER Grnd. 7. Foo2ings 8. Poundauon 9. Water Pipe�Undrgrnd, 10. Str�ctural Fioor System it. Property Sewer Line & House Connection 72. Sewer Gap - 13. Roof Drains 14. Rough ?lumbing 15. Rough Eleccrical-Conduit 16. Rough Electric Wiring 17. Rouyh 47iring Siyn 18. Rough Electrica3-T 8ar Cei��ng � t9. Rough Heating & Air Condrtioning 20. Rough Factory Fireplace ; ' 21. Ducts,in Structure 22. Ducts, Vent?Iating � 23. Gas Pipe�Rough & 7est � 24. Roof Framing 25. Root Sheathing � 26. T•Bar Ceding (Structurall & Monocoat 27. Frame and Flashing 28. l.athing & Sidirg , 29. Insulation 30. flry�vall Nailin9 31 . Ptaster Bro�vn CoaF � 32. Electrical Powe[ Neter�Pinal 33. Final Nectric � 3A. Final HeaUng & Air Conditioning 35. Finai Gas Pipe�Test � 36. Hood or Canopy 37. Final Factory Fireptace 38. Final Piumbing 38. `Nater Service-Final 40. Gas Serv�ce-Final 41. Solar pomestic-�inai S2. Backflowv Preventer � 43. Backflow Irrigation 44. Landscape lrriqation System 45. Sound Attenuation 46. Handlcap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAI?LANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cc Rate Date � I�spectqr � I ,( ; 0 0 POOL.. SPA � APPqOVAIS Permit �_:._,„ 52. Pool & Equipmenl Locationy - 53. Stce! Reinforcemeni _ 54. Forms 55. Electricai Bonding �� 56. Rough Plumbing & Pressure Tzst �� 57. APPROVAI TO COVER�GUNITE 58. Electricat Condaii�Undrgrnq. �� 59. Gas Pipe, t7 Undrgrnd„ Test � 60. Backwush Lines, P�7rap, � Undrgmd. � 61. APPROVALTODECK I I62. Backyvash & ReceptorFinaf � 63. Hea2er & Vent-Fi�ai^^-�i 64. Plumbing System � Finni I 65. Electrica6F�nal ', 66. Solar System-Final '��. 6�. Fencing & Accees Apnroval '��. 68. APPROVED FOR PLASTERING '��.. fi9. P06L/SPA SYSTEMS FINAL '�, FlftE DEPT. RECIUIREMENT --~' APPROVALS Permit � �� 70. Underground Hydre 77. Product?ipinyG'Ga, �Oii 72. Underground Flus�� 73. Undergrnd. Storagc Tank C Gas � Oil 74. Overhead Hvdro `^ 75. Dry Chemical 75. Dry Standpipe 77. FIXED SYSTEnA FINAC '�� 78. FIRE PREV. FINAL HEALTH OEPT. REQUIREME 79. FINAL INSPECTION � BQ. FOOD CERTIFiCA7E ISSUED Notes: 1 r Date �-I tnspect¢r � „ ,., , �_�_... _ , a ,. ._, . � ____ ......._..---._ ...------- Job Adtlress: 600 W 19TH S7 Suite:yir � Viciniry: ' Parcel Nunmber: 42214220 Applicant: COONE, MICHAEU3D SIGNS Adtlress: 23034 LAKE FOREST. STE C LAGUNA HILLS, CA Owner: ROBERTSON, GENE H TR Aqdress 536 SEAWARD CORONA DEL MAR, CA Contracror. CUSTOM TECH DESIGN Address: 15201 WESTSTATE ST Arch / Eng : Address: Plan Check: P�rmit: SMIP Com: Other: Inspection: Total: NOTES: WESTMINSTER,CA SIGN PERMIT Zoning: Phone: 949 770-9252 Zip: 92653 Phone: Zip: 92625 Phone: (714) 891�-7796 � Zip: 92683 �.. Licerise: 561816 Phone: Zip: License: SCOPE OF PERMIT 18 SQ.FT. CHANNEL LETTER SIGN (SUBWAY). $45.01 $0.00 $6925 $0.50 $0.00 $0.00 $0.00 $0.00 $0.00 $114.76 Status: ISSUED Applied: 03122/2004 Issued: 0312?J2004 ISSUED BY: ,�.�pZRE� ��DA FEE SUMMARY - - ' Calc Valuation: s2,000.00 PLANNING & ZONING Claimed Valuation: 52,000.00 NOTICE: The work authorized by this permit shail comply with all applicable handicap access requiremenis under Calitomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire end become void N work Is not commenced withln 180 days, or if work Is suspended or abandoned I for a period ol 180 days. INSPECTIONS: In order for the work euthorized under this permlt to be considered legal, such work must comply with all applicable codes, end all requlred Inapeetlone end finel approval must be obtalned. Failure to obleln Inspections and final approval will result in the expiratlon of this pertnit. FOR INSPECTIONS CALL: Q14) 7545828 ��I zaae-ae �e�oo� WORKERS' COh1PENSATION DECLAHATON: ' I hereDy eNirm under penelty; f perjury one ot the following deUarations: . �•� ❑ I heve and wlll malntaln e`eb:ificate oi consent to seN-Insure for workers' compensatlon, es provided for by sedlon 3700 0l ihe Labor Code, for the peAortnance of Ihe work for which Nis pertni� i5 i55uetl. ❑1 1 heve and will mainlain vrorkers' compen5atlon Insurence, as required by sectim 3700 ot Ue Lelwr Code, fw Ne pertortnance at the work for whkh thLs pertnit is lssued. � My workers' compensatbn Insuwnce wrder and poliry numCer ere: Polity Num�er: or/ess.) �, I tlify ihat in the peAormance of the wark tor which t�is permit is Issued, I shall not employ eny person in any menner ao es to become subJect to the workers' mpensation lews of Celllomla, and egrea that It I shoulA become sub�ect to the workers' wmpensetlon provislons of Sectlon 3700 of the Lebor Code, I shall torthwlth � comply wilh Ihese O�aNslons. n /j / �pllcant SlgneNre: ��iG�n. l/ (.�..�: D CDat . 3' 2�— � y WARNINO: FAILURE TO SEWRE WORKER$' COMPENSATION COVEMGE IS UMAWFUL AND SHFLL SUBJECT M! EMPLOYER TO CRIMINAL PENALTIES PNO CML FlNES UP TOONE HUNDRED TKKISAND DOLL4RE (5100,000), IN ADDRIIXJ TO THE ODST OF OOMPENSATION, DAMFGES AS PRONDED FOH IN SECTION 3IO60F THE UBOR COOE, INTEREST, AND ATTORNEV u FEES. LICENSED CONTRACTORS DECLARATION: I hereby effirtn Ihat I am licensed under provislons ol C�apter 9(commendnp with SeIXlon 7000) ot DlWsion 3 o1•the Business antl Professions Code, entl my Ilcense is in tull lorc� antl eflect. Llc. a � L I 8/G �Ctacs s C—Y1 Oontrectofs Slgnawre: ✓YH , r......0 Daie: 3— 2 �—oY CONSTRUCTION LENDING AGENCY: ❑ I �ereby aNlrtn Ihat t�ere Is a consiruciion Iendlnp epency for ihe peAormence of Ihe work tor whiCh ihis pertnit is luuad. (Sec. 3097, Civll Code). Lentlefs Neme: Lenders ACtlress: Signatura: OWNER-BUILDEH DECLARATIONS: Date: I hereby ettirm that untler penelry of perjury Ihat I flm EXEMPT FiiOM THE CONTRACTORS LICENSE LAW tor Ihe following reeson (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry which requires a permit to consiruct, elter, impmve, tlemolis�, or repair any sirucNre, prior to Ils issuance, also requires lhe epplicant for suc� pertnil to file e signea stetement t�et he or she is Iicensed pursuent ta the provisions of the Contrecbrs Ucense Lew (Chepter 9(commencing with Seqlon 7000) of DNision 3 of the Business and Professions Cade) or that �e or s�e Is exempt therefrom and the basis for the ellegetl ezemptlon. Any violetion of Section 7031.5 hy eny eppllwnt for e pertnit subjects the applicant to e civil penalry at not more t�an tNe �undretl tlollers ($500).): ❑ I, as owner of the properry, or my employeas with wages es Iheir sola compensetion, WILL DO TME WORK, antl the structure Is not Intended or otlered tor sale (Sec. 7044, Business enA Professions Code: The Contractors License Law does not appty to en owner of properry who bullCs or improves Ihereon, and who Coes such work �imselt or hersell or t�roug� his or her own employees, provided ihat suc� imprwements are not Intended or oHered lar sele. tl, however, the building or improvement is sold within one year of completion, tha owner-builder will have the burden of proving that ha or sha did not build or improve for purposa ot ule.). � ❑ I, as owner ol Ihe property, am EXCLUSNELY CON7RACTING WI7H UCENSED CONTRACTORS to canswct the project (Sec. 7044, Busineu end Professions Code: The contwaors License Law does not eppty ro an owner ol property who builtls or Improves Ihereon, and who comrecis tor such pmject wit� a wntrectoqs) license pursuant m the Contractors License Lews.). ❑ I am exampt under sec. Business end Professions Code for this reeson: Signature: Date: Owner ID venfietl Dy dAvers Ilcense. ❑ Yes ❑ No Drivefs License No. Vedficatian oi Ownersnip by (rype oi tlacumem, i.e. - properry tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: E�cplres: ❑ I hereby certity ihat no excavation flve (5) or more feet in depih Into which e person Is required to descend, will be matle In connection with work authorized by this permit, end ihet no building strucNra, scaHoldinq, telsework, or demolilion or dismantling thereol, will be more than thirry-siz (36) feei hiph. (Chap. 32, Gry 2, Ar12, Sec. 341, Ttle B, Celllomia Administretive Cotle). ❑ As owner-builtler, I wlll not employ enyone to tlo work which would repuire e pertnil Irom the Divislon of Industriel Selery, es notetl eDove, unless such person has e pertnit to do such work from Iha d'Msion. Signature: Dele: DiWsion ot Industnal Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUiHORVA710N OF ENfAV: I certtty under penalry of perjury t�et I have read thls epplication end state that Ne IntormaUon given Is corred. 1 agree to compry with ell state laws enO dty ortlinences relating to builAing construction, and euthorize represenlaUves of the Giry oi Cosle Mese to enter upon Ne ebove-descnbed properry tor Inspeclion purposes. I egree not to ocapy w ellow xwpency ol eny building euthodzed by this pertnit unGl Nnel Inspection. � �rn� �SlgnaN Ot gelOwner(s) Dete i�(/��,:�// � .?i'b2—OY v AnNO�Authodzed Applicent Dete COOE �. INSPECTION ME 1616 Fised System Finel Fire Prevenpon 128fi Pool Spe Finel 200 Final RaRaot 201 Flnel Block/Reteining Well 202 Final Fedory Flre Place 203 Flnal Sipn 204 Flnal Demolltion Q� Q� CO�E! INSPECiIONTYPE _ 208 Flnel Mechanicel 20B Finel Plumbing 210 Flnel Elecidcel 212 Finel Fire Prevention 220 Flnel Planning Approvel 222 Final Site 250 Flnal Building/Occupancy � It� (714) 754-5273 • Feu (714) 7543856 • www.ci.costa-mesa.ca.us i i rnin unrvc, wa i h mwh, i.h azoco Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address ELECTRICAL PERMIT 600 W 19TH ST � ,/ 42214220 COONE, MICHAEU3D SIGNS 23034 LAKE FOREST, STE C _� IAGUNA HILLS, CA 92653 ROBERTSON, GENE H TR 536 SEAWARD CORONA DEL MAR, CA Contractor. CUSTOM TECH DESIGN Address: �5201 WESTSTATE ST ' ISSUE FEE • Temp service test � Res. a/c package � New Res (1-2 units) New Res (3+unils) Pool I Spa Lighling Fixts Recept OuUels Switches Non Res Appl � Res Appl Service to 200a � Service to 1000a Service over 1000a Motors to thp Motors to 10hp Motors to SOhp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a WESTMINSTER, CA Phone: 949 770-9252 Zip: Phone: Zip: 92625 Phone: {714)891-7796 Zip: 92683 License: 561816 - SCOPE OF PERMIT REF: SB04-00041; 18 SQ.FT. CHANNEL LETTER SIGN(SUBWAY) ELECT. FOR ILLUMINATED CHANNEL LETTER SIGN. $23.50 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Status: ISSUED Applied: 03122/2004 Issued: 03I22/2004 ISSUED BY: � �� , ;l �� ' / Temp Dist System / Lighting Busway /100 ft Standing Section . . - Misc ElecUical Equipment Transfortners up to 1 kva/kw ................up to 10 kva/kw ......:..........up to 50 kva/kw ' ...:.............up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Voll Wiring System / Ckl . Misc. Conduit . Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Eleclrical Fee Investigation Fee Plan Check Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 ao.00 0 ao.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by ihis permlt shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (OM. No. 9248, § 1, 12-21-92) EXPIRATION: Thls permit shall eutomatically expire end become void if work Is not commenced withln 780 days, or If work Is suspended or abandoned for a period ot 1 BO days. INSPECTIONS: In order for the work authorized under thls permlt to be considered legal, such work must comply with all appllcable Codes, end ell requlred Inapection8 end finel epprovel must be obtained. Failure to obtaln Inspectlons end final epproval wlll result in the explretion ol this parmit. FOR INSPECTIONS CALL: (714) 7545626 2a4&4B (8�00) WORKERS'COMPENSAnON DECLARATON: I hereby aflirtn under penalry of perjury one of the tollowing dedaretions: ❑ I have entl will meintain e cenificate of consent ta selt-Insure tor warkero' compensation, es proNtled for by saction 3700 of the Labor Code, for t�e peAortnance of Ihe LL work for whiCh this pertnit Is issued. �y �.t have antl will malnWin workers' compensatlon insurence, as requiretl by seclbn 3700 of tha Labor Code, for the pertortnance of the work for wh�h thls pertnit is issuetl. �/ My workers' compensation Insurance carder and poliry numDer are: 5�'�� Nsu�v POIIcyNumber. !s cNon need no( be canpleted i1 the permlf !s velued et one hundred tlallers (5100) or less,) . 1 ertity that in the peAortnance af Ne work br which this pertnit is issued, I shall not employ eny person in eny manner so as to becnme sub�ect ro t�e workers' pensatlon laws ot Celllomla, and epree thet It I should bernme sub�ect lo lhe workers' compensatlon pmvlsions oi Section 3700 ot [he leDor Code, I shall forlhwlN compty with Ihese provisions. /� /� ApplicemSignature: �i'�'LiG(�c.. 0 C....ov� Deta: 3�Z.2—OS' WARNING: FAILURE TO SECURE WORKERS' COMPENSATION WVEAAOE IS UNLAW FUL AND SHFl1 SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND pVIL FlNES UP TO ONE HUNDRED TFqUSAND DOLLARE (E100,000�, IN ADDfiION TO THE CQSi OF COMPENSATION, DAMACaES AS PROVIDED FOR IN SECTION 3]OB OF THE UBOR CODE, INfERE$T, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm Ihet I em Ilcensetl untler provisions of Chepter e(commenGnp wilh Sectlon 7000) ol Divisian 3 of the Business end Professions Cade, end my Ilcense Ls In tull lorce entl ettecL Lic. a SG I �G Cless a C—'�/S ContractoYsSignemre: _�'YYI. Date: 3-2�—nv CONSTRUCTION LENDING AGENCY: ❑ I hareby eMirtn Ihel lhere is a canstruction lentling egency tor Ihe peAormanca ol ihe wark lor which I�is permit Is issued, (Sec. 3097, Civil Cotle). Lendefs Neme: Lendor's Atlaress: Signeture: Date: OWNER-BUILDER DECLARATONS: I hereby eHirtn ihat untler penelry ot perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe fallowing reason (Sec. 7031.5, Business and ProteSSions Code: Any ciry or wunty whicA requires a pertnit to construct, alter, improve, demolish, or repair eny sWcture, prior to its iuuance, elso requires thb eppliwnt tor such pertnit to tile e signetl statement t�et he or she is licensed pursuam to the provlsions af the Comrecrors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 ot the Business end Professions Code) or that �e or s�e Is exempt theretrom entl Ne basis for the ellegetl exemptlon. Any violetlon of Section 7031.5 by eny flpplicam for e pertnit sub�ects t�e ap0licant to e cidl penalry ot not more than five hundred dollers ($500).): ❑ I, as ownar of the property, or my employees wlth weges es thelr sole compenutlon, WILL DO TNE WORK, and the strucWre is not Intentled or otlered for sale (Sec. 7044, Busineu antl Professions Cotle: The Contraciors License Lew tloes not apply to en owner of property who builtls or Improves thereon, and who tloas such work himselt or herseN or through his or her awn employees, Orovided Ihet such imprwemenis are not Iniended or oflered tor sale. If, however, Ihe builAing or imprwement Is sold within one year o1 completion, the owneabuiltler xNl have the burden of proving ihat ha or she tlid not build or improve for purpose of sele.). • ❑ I, as owner of tha property, am E%GLUSIVELY CONTRACTING WRH LICENSED CONTRACT08S to construct the project (Sec. 7044, Business antl Professions Cotle: The contractors Llcense Law does nm appty to an owner oi property who builds or Improves ihereon, and who contracts for such project with a contractor(sj license pursuent lo the Coniractors License Lews.). ❑ I am exempt untler sec. Slgnature: Owner ID venfiad by driver's license. ❑ Yes ❑ No Business entl Professions Code br this reeson: Vedficetion ot Ownershlp Dy (ty{le ot document, I.e. - praperty teu bill or tleed): OIVISION OF INDUSTRIAL SAFETY PEHMR CERTIFICATION: Drivers License No. Dete: Eapires: ❑ I hereby certify that no e:cavation five (5) or more teet in depth into w�lch e person is requlred to descend, will be metle In connection with work euthorized by this permit, an0 ihat no Duilding siructure, scettoldinp, telsework, or Aemolltlon or dismantling thereof, will be more Ihen ihirty-slx (38) feet high. (C�ep. 32, Grp 2, Art 2, Sec. 341, Tille 8, Celltomla Admini5iretive Code). ❑ As owneo-builder, I will noI employ enyone to do work which wauld requlra e pertnit trom t�e DlWsion oi Intlustdal Setery, es noted ebove, unless suc� person �as e pertnit to do such work trom the divi5ion. Siqnature: Date: DiNsion of Intlusidal Safery Permit NumDer. CERTIFlCATE OF COMPLIANCE AND AUfHORQATON OF EMAV: I cenily under penelty oi Derjury that I have reatl this epplication end state t�at the Iniormation given is wrrect. I egree to comply with ell stete laws end dty ordinances relatlng to bullEl� constructbn, end euthodze representetives at Ihe Ciry ol Cosle Mesa to enter upon Ne ebove-deunbed propeny tor inspection purposes. I agree not to occupy or ellow ocapancy of any builtling authorized by Nls permit unlil finel inspection. Sign re LepalOwner(s) "YYI�t t�,� , �,.� O 3- z 2-O A r Autnodzed Appllcant COOE I, INSPECTIONTVVE 1616 Fixed System Finel Flre Preventlon 1288 Pool Spe Flnal 200 Finel Re-Roof 201 Finel BIocWRetalning Well 202 Final Factory Fire Place 203 Finel Slgn 204 Finel Demolition pdg �4g CODE� ixsvecnoxrrre 208 Finel Mechanicel 200 Finel PlumDinp 210 Final Electncal 212 Flnel Fire Preventlon 220 Final Plenning Approval 222 Finel Siie 250 Final Building/Occupency QAffi V�ELfl t (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ee.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT � Job Address: 600 W 19TH ST Suite: D Vicinity: UNIT D (SUBWAY) Parcel Number: 42214220 Applicant: PARK, BRIAN Address: Owner: BALL ROAD LLC Address , 600 W 19TH ST Zoning: Phone: 714-225-1337 CELI Zip: Phone: � COSTA MESA, CA Zip: 92627 Conuactor: YOUNG PARK CONSTRUCTION Address: 5357 BARRETT CI BUENA PARK,CA Zip: 90621 Arch : Address: Phone: 774-523-5256 License: 405940 Eng: Address: Phone: ISSUED BY: SWtus: ISSUED Applied: 03/31f2004 Issued: O6IO2/2004 Phone: Zip: License: License: SCOPE OF PERMIT INTERIOR 1290 SF TI FOR "SUBWAY' IN UNIT D. WORK TO DEMOLITIONIADDITION Of NONBEARING WALL, ELECTRICAL, MECHANICAL AND PLUMBING WORK. NO ADDED PLUMBING FIX7URES; ONLY CHANGE-OUT OF EXISTING. Plan Check: $536.74 Permit: $825.75 SMIP Res: $0.00 SMIP Com: $15.90 Other: $0.00 Inspection: $0.00 Total: $1,378.39 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Fronl 0. 0 PARKING Existino: o Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 s�s,�oo.00 S�s,ioo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and relatetl regulations. (Ortl. No. 92-28, § 1, 12•27-92) E%pIRATION: This permit shall automatically expire antl become void if work is not commenced within 180 days, or il work is suspendetl or abandonetl for a period of 780 days. � � INSpECT10N5: In order for the work euthorized under this permit to be consi0ered legal, such work must comply with all applicable codes, and all requlred Inspeetlona end Iinabapproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOq INSPECTIONS CALL: (714) 754-5626 . a-.o �awi � , WORKERS'COMPENSATON DECLAFiAnON: I hereby aXirm under penalry of perjury one ot tne following tleUaratlons: ❑ I hava antl will maintein e cenificata o1 cansent to selt-Insure lor workars' compensation, es providad for by sadion 3700 0l Ihe lebor Code, lor ihe pertortnance ot Ihe work tor which Ihis permit LS issuetl. ❑ I have end will maintaln workers' mmpensatlon inwrance, es requireA Dy sectim 3700 of the Labor Code, tor the parfortnance of Ue work tor whkh Nis pertnit is iswed, My workers' compensation Insurance carder entl policy numDer ere: Cartier. Policy Number: (Tbls section neetl not 66 �pleted 1! the permlf fs velued et ane huntlretl tlallers (5100) or less.) � I certity that in the pertartnance of Ne work lor which ihls permit is issued, I shell not employ eny person In eny manner ao as to 6ecome subleci �o Ihe workers' campensetlon laws of Callfamia, and gree Ihat I s�oultl Detome sub�ec� Io the warkers' compensetion proNslons of Set�Ion 3700 of �he Labor Catle, I shall tort�with complywiththe5/0 s. APDlicent SlgnaWre: (� � ¢ � � � � . QC Date: WARNINO: FAILURE TO SEGUHE WOPo(ERS' CO EA6 ! COVEAAGE IS UNUWFUL M!D SMRLL S1191ECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVI� FlNES UP TOONE HUNDRED THOUSAND DOIURE (E100,OOOI.IN ADDRION TO THE CQST OF COMPENSI1ilON, DAALIGES A$ PROVIDED WR IN SECfION 3108 OF THE UBOR COOE. INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTOAS DECLARATION: I hereby ettirtn thet I em Ii�ensetl under provlslons oi Chepter 9(commenGnp wil� Sectbn 7000) oi DlNslon 3 of ihe Bi Iorce end eHect. llc. a° ` 4� b Class a Contractofs Signeture: Date: _ CONSTRUCTION LENDING AGENCV: Professlons Cotle, enA my license Is In tull ❑ I hereby ettirtn thet lhere is a wnstruction lentling epenty for the peAormance of fhe work tor whiCh Ihis permit is issuetl. (Sec. 3097, Civil Coda). Lentler's Neme: Lendefs ACtlress: SlgnaNre: OWNER-BUILDER DEC4N7AT10NS: Defe: I hereDy eflirtn that under penalty af perjury t�at I em EI(EMPT FROM THE CONTRACTORS LICENSE LAW lor ihe follrnving reason (Sec. 7031.5, Business end Prolessions Cotle: Any ciry or counry which requires e permit to construct, elter, improve, AemWish, or repair eny strucWre, pnor to its issuance, elso requires Ihe flpplicant tor such pertnit to flle e signed statemem thet he or she Is Iicensed pursuent to ihe proNsions of the Conhactors lJcense Lew (Chepter 9(commencing with SecHon 7000) 01 Division 3 ot the Business and ProfessionS �de) or that he or sha is exempt t�erelrom end Ihe 6asis for the elleged ezemption. Any violatlon of Section 7031.5 by eny epplicant for e permit sub�ects lhe applicant to e ��vll penalty ot not more than tive huntlretl tlollars ($500) J: ❑ 1, as owner oi Ihe ploperry, or my employaes with wages as their sWe compensation, WILL DO THE WORK, and Ihe structure is not intended or oMered lor sale (Sec. 70a4, Business and Professions Code: The Contraaors �cense Law Coes not appty to an owner ot property who builds or improves thereon, antl who does such work himselt or herself or ihrough his or her own employaes, provided that such impmvemenis are not intended or aHereC for sale. If, however, ihe building or imprwement Is sold within one year oi completion, the owner-builtler will have the 6urden of proving Ihat he or s�e did not build or improve tor purpose oi ule.). ❑ I, as awner ot Ihe p�oDeRy, em E%CWSIVELV CONTRACTING WITH LICENSED COMRACTORS to construct the project (Sec. 7044. Business and Pmfessions Code: The contractors IJcense Law tloes not apply to an owner of propeny who bullds or Improves thereon, and who contracts for such project with a coniractoqs) license pursuant to Ihe Coniraciors License Lews.). ❑ I em exempt unGer Sec. Business antl Professions Cade for this reeson: Signawre: Deta: Owner ID veritied by tlrivers liten5e. �V85 ❑ No Drivefs LicenSB No. Expire9: Verification of Ownership by (rype of document, i.e. - property tax 0111 or deetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby certlly ihal no excavation five (5) or more feet In depih into which e person Is required to tlescend, will be metle In connectlon with work euthorized by ihis permil, antl thet no building swcture, sceNoltling, lalsawork, or demoliNon or tllsmantlinp Ihereol, wlll be more then ihlrtysiz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Titla 8, Celifam�a Aaministrative Cotle). � As owner-6uiltler, I will not employ enyone to do work which woultl require e pertnit Irom �he DlNslon ot Industriel Setety, es noted ebove, unless suc� person hes a pertnit to do such w0� ��om Ihe Aivision. Signature: Date: Division ot Intlustnal Satory Permil Number: CERi1FlCATE OF COMPL�ICE AND AUTHORVA710N OF EMAY: I certity under penalry ol Dorjury that I have read this epplicalion end state that the intormatlon given is correct. I egree to compy �'Ith ell stete lews end ciry orCinances relatinp ta building construction, an0 autnonze representetives of the Ciry of Costa Mesa Io enter upon the above-0escribed properry for inspection pur{ases. I egree not to occupy w allow ocwpancy ol eny building auihorized by this permil until final inspection. COpE �, INSiECTIONTYPE �/ 1618 Fixed System Finel Fire Prevention 128fi Pool Spe Finel 200 Flnel Ra-Rooi 201 Finel BIocWReteining Wall 202 Finel Fectory Fire Place 203 Finel Sign 204 Final Demolition PlIF It�Lfl CODE I INSPEC710N TYPE 208 Finel Mechanical 200 Final Plumbing 210 Finel Electdcal 212 Finel Fire Preventlon 220 Finel Planning Approval 222 Finel Site 250 Final Building/Occupenq QAff Iti�EL$ (714) 754-52i3 • Fex (714) 7%-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: ELECTRICAL PERMIT 600 W 19TH ST D UNIT D (SUBWAY) 42214220 PARK, BRIAN Phone: 714-2251337 CELL Zip: ROBERTSON, GENE H TR Address 536 SEAWARD Phone: CORONA DEL MAR, CA Contracror. YOUNG PARK CONSTRUCTION Address: 5357 BARRETT CI ISSUE FEE Temp service test Res. a/C package New Res (1•2 units) New Res (3+units) Pool I Spa Lighting Fixts Recept Ouqets Switches Non Res Appl . Res Appl Service to 200a Service lo t000a Service over 1000a Molors to 1hp Motors to 10hp Motors to SOhp Molors to 100hp Motors over t00hp BUENA PARK,CA Zip: 92625 Phone: 714-523-5256 Zip: 90621 License: 405940 ISSUED BY: SCOPE OF PERMIT INTERIOR 1290 SF TI FOR "SUBWAY' IN UNIT D. WORK TO DEMOLITION/ADDITION OF NONBEARING WALL, ELECTRICAL, MECHANICAL AND PLUMBING WORK. NO ADDED PLUMBING FIXTURES; ONLY CHANGE-OUT OF EXISTING. 1B OUTLETS, 8 SWITCHES, 1 SUB PANEL TO 200A REF:804-00640 523.50 $0.00 $0.00 $0.00 50.00 50.00 $0.00 S19.80 58.80 $0.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 Quantiry 0 0 0 0 18 8 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist Syslem / Lighting Busway/700ft Standing Section Misc Electrica! Equipment T2nsformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw low Voltage Equipmenl Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand . - Fireworks Sfand Other Electrical Fee Stams: ISSUED Applied: 04/Ot/2004 Issued: O6I17I2004 Quantity so.oa o $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access raquirements under California statutes and related regulations. (Ord. No. 92-28, § 1. 12-21-92) E%PIRATION: This permit shall automatically expire entl become void II work Is not commenced within 1 BO days, or if work Is suspended or abandoned for a penod of 1 BO days. INSPECTIONS: In order lor the work euthorized under this permit ta be consitlered legal, such work must comply with all appliceble codes, and all required Intpeetions end final epproval must be oblained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 24a648 (6/00) WONKERS'COMPENSA�ONDECLAFiATON: I hereby aNirtn under penalry ol perjury rne ot the following dedaraGons: ❑ I heve enA will meinlain e certilicate of canseni to sell-Insure for workers' compensatlon, as provitled for by sedlon 3700 ot the Labor Code, for the pertortnance ot ihe y�ork for whlU this pertni� 15 f55uetl. �j�l have and wlll malnid�n workers' oompensation Insurence, es requiretl Dy sectlon 3700 of the Labor Code, for the pertortnance of the work tor which this partnit Is issuetl. --�My wor�c¢rs' Compensatlon InsurenCe cerrier end policy number ere: ❑ I certify t�0t In t�e p wmpensetbn laws PoncyNumoer., /4136.S3—U�/ orless.) � ¢nence of t�e wodc br whic� lhls pertnit t5 issued, I shall no1 employ eny parson in am/ manner eo es to become SUDject lo Ihe workeB' allfomia, entl e that It I s�wld become sub�ect to Ihe workers' campensetion pmWsions of Sectlon 3700 of Iha LeDor Code, I shall torthwith 6t0�9. oeie: 6-l-Dy d�.-K 6•/- us WOFKERS' COMPEN54TION COVEMGE IS UNLAWFUL AND SW1LL SU&IECT AN EMPLOVE TR O CRIMINAL PENALTIES AND GVIL FlNES UV TOONE HUNDRED IN M�rt10N TO TNE COST OF COMPENSATION, DAMAGES AS PROVIDED FIXi IN SELTION �OB OF THE UBOR CODE, INiEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLApA710N: I hereby.aHirm�thal.l.am Iicensetl untler provlsions ot Chepler 9(commencinp wilh Section 7000) ol Dlvislon 3 of tha.Business end Profeulons Cotle, enA my Ilcensa Is in full CONSTRUCTION LENDWG AGENCY: ❑ I hereby eHirm Ihat Ihere is e construction lending epency for lhe pertormance of Ihe work for whlch ihis permit Is issuetl. (Sec. 3097, Civil Cotle). lontlefs Name: Lendefs ACGress: Signature: OWNER•BUILDER DECLAAATONS: Date: I �ereby attirtn thet under penalry ot perjury Nat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the tollowing reason (Sec. 7031,5, Business end Professions Cotle: Any ciry or county which requires e permit to consiruct, alte�, improve, demolish, or repair eny structure, pnor to its issuance, elso reqNres the epplicant for such pertnit to file e slgnetl statement that he or she is Iicensed pursuent to the proWsions of the Contractors License Lew (Chepter 9(crommendng with SecUon 7000) of DMsion 3 0l the Business end Prolesslons Cade) or thet he or she is axempt therefrom entl tha besis for �he elleged exemptlon. Any violetion at Sectlon 7031.5 by any appllcant tor a permit subleqs the epplicent to e cMl penelry o1 not more than live hundretl tlollars ($500)J: ❑ I, as owner of Ihe proParty. or my employaes wilh weges as lheir sde compensation, WILL DO 7HE WORK, and the strucWre is not Intentled or oMeretl lor sele (Sec. 7044, Business antl Protessions Code: The Contractors License Law does not appty ro en owner ot property who 6uilds ar improves thareon, and w�o tloeg such waflc himselt or herself or ihrough his or her ov.•n employees, provided that such improvemenis are not intentled or oHered for sele. It, however, ihe huilding ar improvement is soltl within one year of complation, the owner-builder will have the burden ol proving ihat ha or she tlid not build or improve tor puryose of sale.). � ❑ I, as owner of the propany em E%CLUSIVELV CONTFiACT1NG WIiH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: Tha comrectors License Law tloes not apply to an awner of propeny w�o builds or Improves thereon, antl who contrects for such project wlih a contractor(s) license pursuent to the Contractors License Laws.). ❑ I am exempt unCer 56�� Signature: Owner ID venlied by drivers license. � Yes ❑ No Business entl Professions Code lor this reason: Verification at Ownershl0 by (ryPe ot tlocument, i.e. - praperty tex blll or deed): DIVISION OF INDUS7RIA4 SAFETY PERMIT CERTIFICA710N: Drivers Licensa No. Date: Fxpires: ❑ I hereDy certity that no e:cavetian five (5) or more feet In depih into which e Derson Is requlred to tlescend, will be mede in connection with work eut�orized by t�is permit, and that no Du��tling slrucWre, scaHolding, ielsework, or tlemo110on or tlismantling thereot, wlll De more then ihirty-six (38) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Calitomie Adminisiretive Cada). ❑ As owner-bullder, I v/i�l not employ enyone to do work which would reQuire e permit from Ihe Division of Industnal Sefery, es notetl ebove, unleu such person hes e permit to tlo such work from the tlivision. SlpnaWre: Date: Dlvision ol InGustriai Sefery Parmit Number: CEHTIFlCATE OF COMPLIANCE ANU AIfIHOR¢ATON OF EMAY: I cenity untler penalry oi perjury Ihat I have read this epplication and state that the inlomiation given is correct. I agree to compty with ell st te'laws end ciry ordinences relating to bullding constructlon, antl authoAze representatives of the Clty ot Costa Mese lo enter upon t�e above-describe�.prnperty to� inspec on purp es. agree not to xcupy or ellow occupancy of eny Oullding authorized by Ihis permit until final inspection. �� / _ Signeture egalOwner(s) � , Date �7•1�]�CFi9i9iGSii19+ ie76 Fixetl System Finel Fire Preventlon 1268 Pool Spa Finel 200 Finel Re-Roof 201 FIneI8locWRetaininB Well 202 Final FeCtOry Flre Place 203 204 Finel Slgn Finel DemdiUon pAg 1t�LS eooe� ixsvecnoxrvae 208 Finel Mec�enical 208 Finel Plumbing 210 Finel Eleclncal 2i2 Finel Fire Preventlon 220 Finel Planning Appwvel 222 Finel Slte 250 Final Building/Occupancy QAg II�L6 —/�� Il�lr ��l��I, (714) 754•5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 600 W 19TH ST Suite: D Vicinity: KITCHEN AT GOLDEN STAR DONUTS AND CHINES Parcel Number: 42214220 Applicant: PHAM, THUC Address: 6291 CERRITOS AV LONG BEACH, CA Owner: ROBERTSON, GENE H TR Address 536 SEAWARD Zoning: Phone: 562�23-1525 Zip: 90805 " Phone: CORONA DEL MAR, CA Zip: 92625 Contractor: VINA INVESTMENT AND CONSTRUCTION COMPANY Address: 6291 CERRITOS AV LONG BEACH, CA Zip: 90805 Arch : Address: Phone: 562�23-1525 License: 435419 Eng: Address: ISSUED BY: Status: ISSUED Applied: 07/18/2002 Issued: 09/10/2002 Phone: Phone: Zip: License: License: SCOPE OF PERMIT NEW 4'-6" HOOD ADJACENT TO EXISTING HOOD AND NEW FOOD WARMER (STEAM TABLE) 3' X 9"GOLDEN STAR DONUTS AND CHINESE FOOD" IN STE D. � ' Plan Check: $63.21 Permit: $97.25 SMIP Res: $0.00 SMIP Com: $0.84 Other: $0.00 Inspection: $0.00 Total: $161.30 FEE SUMMARY PLANNING & ZONING Calc Valuation: Sa,000.00 Claim Valuation: Sa,000.00 SETBACKS MAIN STRUCTURE Front 0- 0 Rear 0- 0 Left 0- 0 Right 0- 0 ACCESSORY Front 0- 0 Rear 0- 0 Left 0- 0 Right 0- 0 PARKING Existinq: 0 Reauired: 0 Pr000sed: o NOTES: KUBOT BJ 09/10/2002 OK TO ISSUE ELEC PERMIT FOR SWITCH FOR BLOWER PER KJC; NO ELEC PLANS SUBMITTED. � NOTICE: The work authorized by this permit shall comply with all applicahle handicap access requiraments under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell requlred Inspeetiona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of thls pertnit. FOR INSPECTIONS CALL: (714) 7545626 2sa6se Iaroo) , � WORKERS'COMPENSAnONDECLARAnON: ' � I hereby a%irm untler penalry of per�ury one of Ihe lollowing declaratlons: ❑ I h and wlll malntain a cenificete ot consent to self-Insure for workers' compensetion, es provitleA for by sactlon 3700 ot Ihe Labar Cotle, for Ihe pertormence of ihe ark tor which this pertnit is issuetl. I heva end will maintain workere' compensation Insurance, as requiretl by sectlon 3700 oi the LaDor Cotla, for Na perfortnance ol Ne work for whlc� this pertNl is issuetl. M worke nsatlon �nsurence carrier enC li number ere: Certier: y ��L �/(i %� � � Pdicy Number. �� %� / (ihls secfion need not be comp ete i/ Me'peimitls veluetl at one hundred dW/ers ($100) oNessJ � ❑ I cenify t�at in the pertormance ol the work tor w�ich t�is pertnit is IssueA, I s�ell not emplay eny person In eny manner so as to become sublecl lo Ihe workere' compensetion laws oi CeliFomle, end agree ihet ii I should become sub�ect ro Ihe workers' compensetlon provislons oi Sectim 3700 ot the LeDor Code, I shall forthwith comply with these provisions /� Applicant Signeture: �� CtirL� Dele: "/ — � � • h � WARNINO:FAILURETOSECUiiEWORKERS' PENSATIONCAVERAGEISUNUWFULANDSMALLSU&IECTANEMPLOVERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDRED T}iIX1SAND DOLIARE (5100,000), IN ADDRION TO THE C0.ST OF COMPENSATION, DAANGES il5 PROVIDED FOR IN SELTION �OB OF THE UBOR COOE, INTEREST, AND ATfORNEY'S FEES. LICENSED CONTfiACTORS DECLARATION: I hereby eHirm ihat I an force entl eHect. Llc. p Conirectors SignaWre: oi Chapter 9(commencing with Seclion 7000) ot Divislan 3 ot t�e Business and Professions Cade, and my license is in full Glass M � De1e: �_ /U _ �� CONSTRUCTION LENDING AGENCV: ❑ I hereby eHirtn thet there is a wnsiruction lending egency for the peAormence of Ihe wark for which ihis permit Is Issued. (Sec. 3097, Civil Code). Lentler's Name: Lenders Address: Sipnature: ' Date: OWNER-BUILDER DECLARATONS: I hereby aMirtn Ihat under penelry af per�ury Ihat I em El(EMP7 FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which requires e pertnit to wnswct, elter, imprwe, tlemdish, or repair any sW cture, pnor to its issuance, also requlres the epplicant tor such pertnit to Ille e signed statement that he or she Is Ilcensed pursuent to tha provisions ol ihe Cantrectars license Lew (Chepter 9(cammenGng with Sectlon 7000) of DlWsion 3 ot ihe Business end Professions Cotle) or that �e or she Is exempt theretrom end the basls for the alleged e:emption. Any violation of Section 7037.5 Dy flny epplicant for a permit sub�ects ihe epD�icant to e civll penalry of not more than five hundred dollers ($500).): ❑ I, as owner of Ihe properry, or my employees wiih wages es �helr sole compensation, WILL DO THE WORK, and t�e structure Is not intentleO or otterad tor sale (Sec. 7044, Business and Professlons Cotle: The Contractors License Lew does nol apply to en owner of property who bullds or improves �hereon, end who does such work himself or herself or through his or her own employees, provided that such improvements ere not intentled or oHered lor sale. If, however, tha building or Improvement is sold wit�in one yeer oi completion, ihe owner-builder will have ihe hurden oi proving that he or she did nat build or improve tor puryose ot sale.). ❑ I, es owner of Ihe properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construd tha proJed (Sac. 7044, Business end Professions Cotle: The coniractors License Lew does not epply to an owner of pmpeny w�o bullas or Improves Ihereon, end who contracts tor such pro�ect wlih a contredoqs) license pursuant to �he Contrectora llcense Laws.). ❑ I em exempt under sec. Business antl Profeuions Cotla tor this reesan: Signature: Date: Owner ID verilied by drivers Iicensa. ❑ Ves ❑ Na Drivets License No. Expires: Vedtication ol Ownership by (lype at dwument, i.e. - pmpery ta�c bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: ❑ I hereby certity that no ezcavetlon five (5) or more feet in depth Into which a parson Is required to descend, wlll be metle In connectlon with work euthodzed Dy this permit, entl that no builCing siructure, scettolding, felsework, or demolitlon or dismantling Ihereof, wiil be more ihan t�irty-sla (36) teet high. (Chep, 32, Grp 2, Art 2, Sec. 341, Title e, Celifomla Atlministretive CoOe). ❑ As owner-Dulltler, I will not employ enyone Io do work which would requlre e pertnit iram the Divislon ol Intlusiriel Safery, es noted ebove, unless such person has e permit to do such work trom Ihe division. Signature: Date: Division ot Industrial Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE ANO AUTHORVJITION OF EMRY: I certify under penalry ot perjury that 1 have reatl t�is applicetion end state ihet ihe Infortnation given is correct. I egree ro comply wlth ell state lews end ciry oMinances relaling to Dulltling construction, entl euthodze representatives oi the Ciry ol Costa Mese to enter upon Ihe above-described property for inspection purposes. I agree no1 ro occupy or ellow occupancy ot any building euthorized by this permit until flnel inspectlon. Signeture Of Legal Owner(s) Date ��.�a % o.� G - �Q'- i72i end�rn numnri d Annli�ant ._ Date CO�E1, INSPECTIONTVPE 1876 FixeO System Final Fire Preventlon 1268 Paol Spe Final 200 Finel Re-Roo1 207 FIneI Block/Retelning Well 202 Final Factory Fire Place 203 FinalSign 204 Final Demolition polE It�lS COUE I INSPECTION TYPE 206 Final Mechanical 208 Finel Plumbing 270 Finel Electrical 212 Flnal Flre Preventlan 220 Finel Planning Approval 222 Finel Site 250 Finel Building�Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, GA 92626 Job Address: Suite No Vicinity: MECHANICAL PERMIT 600 W 19TH ST D STE D KITCHEN (GOLDEN STAR DONUTS 8 CHIN Parcel Number: 42214220 Appliwnt: PHAM, THUC Address: 6291 CERRITOS AV LONG BEACH, CA Owner: ROBERTSON, GENE H TR Address: 536 SEAWARD Contrador: Address: Phone: 562-423-1525 Zip: 90805 Phone: CORONA DEL MAR, CA Zip: 92625 VINA INVESTMENT AND CONSTRUCTION COMPANY 6291 CERRITOS AV LONG BEACH, CA Phone: 562-423-1525 Zip: 90805 License: 435419 ISSUED BY: Status: ISSUED Applied: 07/18/2002 Issued: 09/10/2002 SCOPE OF PERMIT MECH PERMIT TO EXTEND HOOD 4' AND ADD FOOD WARMER (STEAM TABLE) 3' X 9"GOLDEN STAR DONUTS AND CHINESE FOOD' IN UNIT D. 1 HOOD W/MECH EXHAUST, 1 GAS PIPING.. REF.: 602-01099 ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall HV Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Insl or Relocate Appl Vent Air Handlers < 10000c(m Air Handlers > 10000ctm Floor Fumace Floor or Suspend Heater $23.50 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $6.15 50.00 $10.65 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 Quantity FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial I nci nerator Domestic Incinerator Compressors / Absorption Svstems Upto3hpl100kBTU 3To75hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp . .. 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee � Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 ao.00 o 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 E0.00 0 50.00 0 50.00 0 ao.00 0 So.00 50.00 $0.00 $40.30 NOTICE: The work authorized by this pertnit shali compty with all applicable handicap access requirements under Califomla statutes and related regutations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automaticalty expire and become void if work is not commenced within 1 BO days, or if work is suspended or ebandoned for a period of 180 days. INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all applicable codes, end all requlred Inspectlona and Ilnal approval must be obtained. Faiiure to obtain Inspections and final approval will result in the ezpiretion of this pertnit. ,, FOR INSPECTIONS CALL: (714) 754-5626 � / � 2sae�ae (aaol ', � WORKERS'COMPENSAnON DECLARAnON: � �� I here0y affrm under penalty oi perjury one oi the following declaretions: ❑ I �ave entl will malnlain a certiflcete ot consem m self-Insure for warkers' compensetlon, es provitletl br Oy sedlon 3700 ot Ihe Lebor Cotle, for the peAormance ot the work for whlch this permit is issuetl. �jl��a`ve and wrll maintain workers' compensatbn insurence, as requlretl by Section 3700 of Ne Lebor Code, tor t�e perfortnance oi the work fw whiU Ihis pertnit is iswed. My worke%�a' o�° nsation Insu� nce carder end policy number ere: Certier: 5�61 � L f-✓N // Policy Number. 2 /. (7hls sec0on need not be 4 IeteO i! the permif !s veNed e� one hwMretl ddlers (5100) or Iess.J / 5C� � ❑ I cenity Ihat in the peAormenca ol the work for which this permlt Is issued, I shell not employ eny peraon in any menner so es to bewme subject to the workers' wmpensation laws ot Calllomie, flnd epree thet II I shoultl Decome sub�ect to Ne workers' compensatlon provislons ot Sectlon 3�00 of the LeDor Code, I shall torthwlth comply with these provisions. / ApvllcaniSipnaNre: �'—`�� Date: Gr. %U • U9 WARNIN�: FAILURE TO SECURE WORKERS' TION WVEMOE IS UNLAWFl1L AND SHML SUBJECi AN EMPLOYER TO CRIMINAI PENALTIES M1D GVIL FlNES UP TO ONE HUNDRED T/KKISAND DOLURE (5100,000�, IN AD�RION TO THE CQ^a70F COMPENSATION, OAMAGES AS PRONDED FOR IN SECTION 37080F THE IABOR CODE, INfEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm Ihet I em Ilcensed under provisi< force enC ettect. Llc. a Contrectofs Signeture: C�aO�er B(commendng with Sedlon 7000) of DlNsion 3 of the Business end Prafeubns Code, entl my Ilcense Is In tull � CIes9 p �J. -�— Dete: �I-_! d . U, CONSTRUCTION LENDING AGENCY: ❑ � hereby eHlrtn thal Ihere b e consWctlon lentling agenry tor Ihe peAortnance of tha work lar which Ihis permit is Issued. (Sec. 3097, Civll Code). Lenders Nema: Lendefs AdEress: Slpnatura: Date: OWNER-BUILDEH DECLARATIONS: I hereby ettirm that under penelry o1 per�ury Ihet I em EXEMPT FROM THE CONTFiACTOHS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Buslness end Prolessions Cotle: Any Gty or county whiU requlres e permlt lo construct, alter, Improve, tlemWish, or repalr any sirucNre, pdor to its issuance, elso requires the appliwnt for such pertnit to iile e signed stetement thet he or she Is Ilcensed pursuam to the proNsions ol ihe Coniractors Llranse Lew (Chapter 9(commendng with Sectlon 7000J of Division 3 of Ne Business antl Protessians Code) or that he or she is axempl Iherefrom end Ne besis for the allegetl e:emptlon. Any violation of Sectlon 7031.5 by eny applkant tor e pertnit suhjects Ihe appllcant to e clvil penalry of not more ihan frve hundred tlollars ($500).): ❑ I, es owner of Ne properry, or my employees with weges as t�eir sole compensatlon, WILL DO THE WORK, antl Ihe siructure Is not intendetl or oHered for sale (Sec. 7044, Business antl Professions Code: Tha Contractors License Lew tloes not flppty to en owner ot property who builds or Improves thereon, end who does such work hlmself or herself or through his or her own employaes, provitletl Nat such Imprwemenis era not IntenOetl or oNered lor sale. N, however, the builtling or improvement lv sold within one year ot completion, the owner-builtler will have t�e burtlen of proving ihat ha or she did not Guild or improve lor purpose oi sale.). ❑ I, es owner of the property, am E%CLUSIVELY CONTAACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business end Professions Cotle: The wntractors License Lew Oaes not appty to an owner ol property who bullds or Improves t�ereoq en0 who contraMs for such pro�ect wlih a contractor(s) Ilcense pursuani to the Contrectors Llcense Laws.). ❑ I em eaemD� under sec. Business entl Professions Cotle tor thls reason: Signature: Date: Owner ID verifietl by dnvefs license. ❑ Yes ❑ No Drivets License No. E:pires: Ver111cation ol Ownership by (rype of document, i.e. - praperty les 6III ar tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: ❑ I hareby cenify that no excevetlon Ilve (5) or mare Ieei In depth Into which a person is requlretl to Cescend, wiil be made in connectlon wlth work euthorized by tNs permit, enA that no Dulltlirig siructure, scaflolding,lalsawork, or demdltlon or tlismantling t�ereol, wlll De more then thirty-six (38) feet high. (Chap. 3.2. Grp 2, An 2, Sec. 341, Tltle 8, Celitomia Atlminlstrative Cotle). ❑ As owner-builtler, I wlll not employ anyone to tlo work which wovltl requlre a permit Irom the Didslon ol Industriel Sefery, es noted ebove, unleu such person hes e permit to do such work trom the dhdsion. Sipneture: Date: Dlvision of Industrial Safery Pertnit Number: CERTIFICATE OF COMPUANCE AND AUTHORIZA710N OF ENTRV: I certity under penalty of perjury that I heva reed Ihis epDlicallon and stete thet the Information given Is correcL I egree 10 comply wlth ell stete lews entl ciry ordinances reletinp to bulidinp constructlon, and authodze representatives of the Cily ol Coste Mesa to enter upon t�e eDove-Oescnbed property for Inspection purposes. I agree no� to oaupy or ellow occupancy oi eny building euthonzed by this pertnit until final inspeMion. Signat re Of Legal Owner(s) Date �iG,� �—, cZ -1 a • �)g - MNOr Autliwl d Appl - t Date CODE �, INSPECTIONTYPE 7818 Flxetl Syslem Final Fire Prevention 1268 Pool Spe Final 200 Flnal Re-Roaf 201 Finel Black/Retaining Well 202 Final Fectory Fire Plece 203 Finel Sign 204 Final Demolition QAIF. II�LS COpE� INSPECfIONTYPE Qe¢. ��$ 208 Finel Mechenical 208 210 212 220 222 250 Finel Plumbing Flnal Electricel Flnel Flre Preventlon Flnel Plenning Approval Final Slte Finel Bullding/Occupency (714) 754-5273 • Fex (714) 75q-4856 • www.cl.CASW-mes2.Ce.us 77 FAIR DFIVE, GOSTA MESA, GA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address ELECTRICAL PERMIT 600 W 19TH ST D KITCNEN AT GOLDEN STAR DONUTS 8 CHINESE 42214220 PHAM,THUC 6291 CERRITOS AV LONG BEACH, CA ROBERTSON, GENE H TR 536 SEAWARD CORONA DEL MAR, CA Phone: 562-423-1525 Zip: 90805 Phone: Zip: 92625 Convactor: VINA INVESTMENT AND CONSTRUCTION COMPANY Address: 6291 CERRITOS AV ISSUE FEE Temp service test Res. alc package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept OutleLs Svntches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motars to 1hp Motors to tOhp Motors to 50hp Motors to t00hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole LONG BEACH, CA Phone: 562-423-1525 Zip: 90805 License: 435419 ISSWED BY: Status: ISSUED Applied: 07/18/2002 Issued: 09/10/2002 SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW 4'-6' HOOD ADJACENT TO EXISTING HOOD AND NEW FOOD WARMER (STEAM TABLE) 3' X 9"GOLDEN STAR DONUTS AND CHINESE FOOD" IN STE D. 1 SWITCH REF.: 802-01099 � $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.10 $0.00 E0.00 so.00 50.00 $0.00 ao.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 �uantity FEE SUMMARY Temp Dist System / Lighling Busway /100 ft Standing Section Misc Elecirical Equipment Transfortners up to 1 kva/kw ................up to 10 kva/kw .................up l0 50 kva/kw .................uP to 100 kva/kw ..................over 100 kva/kw Low Voltage Eduipment Low Volt Wiring Syslem / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Sfand � Otner Electncal Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $O.DO 0 $0.00 0 $0.00 §0.00 $0.00 $0.00 TOTAL CALCULATED FEES E24.60 COMMENTS / SPECIAL CONDITIONS NOTICE: The work aulhorizetl by this permit shall comply with all applicable handicap access requirements under Calilornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: ThIs permit shall automatically axpire and become vold if work Is not commenced wlthin 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be eonsiCered legal, such work must comply with all applicable codes, and all requlred Inapeetlona and fina) approvel must be obtained. Failure to obtain InsOeations and linat aOProval wiil result in the expiral(on of ihis permit. FOR INSPECTIONS CALL: (714) 754-5628 , zaa�s �e�ao� WORKERS'COMPENSAnON DECLARATON: �� I hereby eMirm under penalry of perjury one o1 the IWlowinp tledarations: ❑ I heva end wlll rteainteln e ceniiicate of consent to self-Insure tor workers' compensetlon, es proNdetl br by saction 3700 of the Lebor CoOe, fa tha peAortnflnce of the /^�ork for which ihis pertnit is issued. �f I hava antl will mainteln workers' campensation insurance, es requlretl by section 3700 of the Lebor Cade, tor I�e perfortnance of the work far wNch ihis pertnit Is luued. My worke coqlpensflUod Insurance carder and policy number are: Cartler. ��li i-�/,J�.0 � PoliryNumber: �,Z,rLI/N'�a (Tnls sectlon need nor be eted il rhe permlt /s velued et one hunored ddlers ($100) or less.) T'� o- ❑ I certly t�at In t�e DeAormance of the work lor which this permit is Issued, I shell not employ eny person In eny menner so es to become sub�oct lo iha woAcers' compensetlon laws oi Califomia, entl epree Ihet It I shoultl bemme sub�ect to the workers' compensatlon provisions of Section 3700 of t�e Lebor Code, I shell tort�with compty with these provislon . ApPliwnt Signeture: �� -�_ Data: �- �v � C� � W�WJINO: FNLURE TO SEWFE WORKERS' OOA�ENSA� MOE IS UNLhWFUL AND $HML SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNE$ UP TOONE HUNDRED TKKISAND DOLURE R��1. IN ADqT10N TO THE COSf OF COfdPEN$AT10N, OMMGES AS PROVIDED WP IN SECTION 3108OF THE IABOR OODE, IMEREST, M!D ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby atllrtn t�a� I em torce entl eHect. Lic. M_ Conirector's SlgneNre: CONSTRUCTION LENOING AGENCY: Chepter B(commencing wlth Sectlon 7000) oi Dlvision 3 of ihe Business eq� Prolesslons Catle, enA my license is in full Class N �/ � Cs"6 oece: �— �6, �� ,- ❑ I hereby eHirtn that there is e consiructlon lending egency tor the peAortnance ot the wark for which ihls permit Is Issued. (Sec. 3087, CINI CoUe). Lendef9 Neme: Lentlefs Atltlress: Signature: OWNER-BUILDER DECLARATIONS: Daie: I hereby eMirtn Ihet under penalry ot perjury that I em EJCEMPT FROM THE CONTAACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Professions Code: Any ciry or county which requires e permlt to construct, alter, Improve, tlemdis�, or repalr eny atructure, prior to Its Issuance, elso requlres the apD�� ar such pertnit to tile a slgnetl statement that he or she is Iicensetl pursuan� to ihe provisions of ihe Contrectors Llcense Lew (C�apter 9(commendng wlth Sectlan 7000) of Divlslon 3 of iha Business end Prolessions Cotle) or thet �e or s�e Is exempt therefrom end the basls for the elleged exemption. Any violatlon of Sectlon 7031.5 by any epplicent for e pertnil subjecis Iha epplicent to e civil penalry of not more than flve �untlretl tlWlers ($500).): ❑ I, as owner ot t�e property, or my employees wl�h wages fls Ihelr sole compensatlon, WILL DO THE WOflK, entl Ihe structura Is not intended or oNeretl for sele (Sec. 7044, Busineu entl Professions Cotle: The Contractors License Law does not apply to en owner ot property who builds or Improvas Ihereon, antl who tloes such work himselt or hersell or through his or her own employees, provided that such improvemenis are not Intentled or ottered for sale. If, hawever, Ihe bulltling or improvement Is sold within ona year of completion, the owner-builder will have ihe burden oi proving that �e or s�e tlitl not Duild or improve lar purpose of sale.). � I, es ownar ol the pmperty, am EXCLUSIVELV CONTRACTING WITH LICENSEO COMRACTORS to consWct Ihe project (Sec. 7044, Business and Pmfessions Cotle: The comrectors License Lew does not eppty to an awner ol properry wha builtls or Improves t�ereon, end who contracis tor such proJen with a conirector(s) license pursuant to the Contrectors License Lews.). ❑ I em e:empt unCer sec. Business and Professions Code lor �his reason: Slgnelure: Date: Owner ID verl�ietl by drivefs Ilcense. ❑ Yes ❑ No Drivefs License No. Venflcation o1 Ownership by (ty{�e oi dacument, i.e. - propem/ te�c bilt or tleetl): DIVISION OF INDUSTRIAL SAFETY PEflM1T CERTFICATION: Explres: ❑ I hereby certify that no excavatlon five (5) or more feet In depth lnto w�ic� e pereon is required to descend, will be made In connection wlth work euthoAzeA by this permlt, antl that no bulltling siructure, scaHOltlinp, lalsework, or tlemolition or tllsmantling I�ereol, will be more than Ihirry-si: (38) feet hiph. (Chap. 32, Grp 2, Art 2, Sec. 341, T1Ile 8, Celifomia Atlministretive CoAe). ❑ As owner-bullder, I wlll nol emplay enyone to tlo work whlch would requlre e permll from ihe Dlvislon ot Industrial Setety, es notetl ebove, unless such person hes e permit to do such work tmm the divislon. Signeture: Date: DlWsion of Intlustria� Setery Permit Number. CERTIFlCATE OF COMPLIANCE AND AIJfMORQATION OF EMRV: i ceNfy untler penalry of perjury thet I have read this epplicetion entl state Ihat ihe iniortnation given is I correct. I egree ro comply wii� all stete lews end dry ordinarrces relatlng ro building conslruclion, end authodze representetive5 ot I�e Clry af Costa Mesa ro enter upon the ebove-tlescdDetl properly for inspecUon purposes. I egree not to acupy or ellaw occupan�y ot eny building euthodzed by this pertnit until linal Inspeclion. COOE �. INSPECTIONTYPE QAIE QiT�19 1818 Flxed Sys�em Final Fire Prevenllon 1266 200 201 202 203 204 Pool Spa Finel Final Re-Roof Finel BIocWRetaining Well Final Fattory Fire Place Final Slgn Finel Demdltion LODE 1 INSPECTION TYfE 206 Finel Mechanical 208 Finel Plumbing 210 Finel Electrical 212 Flnal Fire Prevantlon 220 Finel Plennin8 ApProvel 222 Final Site 250 Flnal Building/Occupency �%• (D• OZ�c Date �ff. II� � �I �PNOJEf RDUflE55: 6 O O W 1 9 TH $T UNIT: C�D owN�fl'S NRME: GENE ROHERTSON aooness:p O BOX 156 CORONA DEI. MAR CA 92625 (714)760-8364 ppCN/ENGINEEfl:PAIR OF PENCILS xec.xo.:NONE FUOflE55: S I E) S I CHESTER AV uxiT: GARDEN GROVE CA 92640 PENMITTEE: GENE ROBERTSON ( 714 ) 760-8364 aooness: p, p, BOX 15 6 CORONA DEL MAR CA 92625 LICFNSEU CONTHRLTOB OECNBR710N: i nereEy allirm ttut I am 6a�eA un0e� prwaions of Ctwpte� 9(commentin0 vnth Section 7000� ot Drvision 3 0� t�e Business ana Prolessions CoOe. an0 my license is in IWI lorce anG ellect. CITY LIC.: STRTF LIC.: CUSS: Oa�e: SipnEture: WORNEHS' COMPENSRTION DECUIBRTION: I �ert0y af�itm Ilut I have a Certilicat¢ 01 canSenl �a 5¢II-insure Or a certificate al Workers' Compen5alion Insutance. or a cenili¢tl copy I�ereol �SeCtion 38011. LaE. q. POLICY NO.: EXP. DATE: COMPRNY: ❑ Ceniliea coDY �s nere0y lumisnea. ❑ Cenilie0 copy is IOeO vni� I�e dty BuilOing Divisian. Jaie: App�Kanl: E%EMPTION FNOM WOflKEflS' COMPENSITION OEpAMT10N: (ilu5 iMiOn nxO rol0e comp �O iI Ne pelmil5 ta Wre hmGreG �510%w less�. I cenily ihat in Ine oedormance ol ine work for wNcn inis permit is 6 . I shau not e � y son m any manner so as to became su01�� la I�e Workeri CamOensation Laws ot Calilomu. Date: _ � � Spnaturt� NOiICE: II. after ma ng ihis aeGaration, you Slwu a �ec e suCjeci ihe WOMers' ComDensation pmvisions of the Labor fAee. you must fonhwith comoN v^�n sucn ptoNSbns ar tks ce�� slu�� Ee aeemeA re'rok¢E. CONSTflULTION LEN�ING AGENCY: I �er¢�y ailirm lha� I�¢re i5 a can5�m[Iion IenOinq ap¢ncy �or IAe DeAormanCe ol Ihe work lof whice Ihis Oe�mit is issued (Sec�ion 3097, Civ. C�. LENDEfl: aoosess: OWNEB BUILOEB �ECIAMTION: I hereEy aflirm t�ai 1 am eMemo� ��om t�e Contractors' State L'uertse Law tor t�e lollowinp reasan �Seclion 7031.5 Business and Pro�essional CoOe: Any ciiy al coun�y w�ich r¢puiRs a permii lo conslNtt, alter, improve, Oemolish, or re0air any 9mclure, prio� to i6 iisuance. als0 reQuires Ihe appliWnt lor suc� Dermit to lile a siqn¢d statement ttut �e/s�e is IicenseE pursuam lo the pmvisians al Ihe Comracmrs' Siale License Law (ChaD�e� 91�ammentin0 w��h Sec�ion 7000) ot Division 3 0l i�e Business antl Pmlessions CaOe) or tlui �e/she is eRempi tAerelrom an0 ��e Oasis lor tAe allegeU exemption. My violalion ol Seclion 7031.5 Gy any app6cani lor a permil 5ubleci5 Ihe appliCanito a ciNl penally ol noi more I�an live hunCred E011ars �5500�. I. as owner ol I�e D�operiy or my !mployees vri�� wapes a5 IAeir sole campensali0n, will Ao �he work, ana Ihe ❑ s�mcWre is not intenGeA or ollereU lor Sale �5¢ctian 70a4, Busness anA Pmleuional Cotle: The Comractors' Stale License Law Ooes not apDly lo an owner ol a pmpeny w�o Guilds o� imDmves t�ereon, anE w�o Ooes such work himsell/�ersell or tAmuph his or her own emD�oYees. pmviGeO I�a� suc� impmvemenls are not intend¢tl or alle�etl lar sale. II, however the Uuiltlinp or impmvemenl is salU wit�m one year ol completion, Ille owne� will have ihe buraen ol Drovinp �e/s�e GiE not builA or improve lor ine purpose ol salel. I, as owner ol Ihe pro0eriy, am excWsively cOnVaclinq wi�h IiCOn50E con�rac�ors lo con5lmti Iha pmjncl (SeC1100 7044, tl�5in¢55 � ano Proless�ons Lotle: TAe Cantractors' Slate Lkense Law Oaes nol aOVN �o an ormer af pmDetly w�o Duilas or improves Iherean and who comracis for suc� Omjecis wilA a conlratlOqs� license pursuan� lo ��e Camracmrs' Slate License Law�. I am aware iha� owol o� i�eir Worker'S Compenu�ion insurance stroula he Dmvi0e0 lo me. � I am evempt untler Section: B. 8 P. C. lor Ihis reason: �ate: 7i'-'��—y� Q+me' . I 00 her¢by [erli�y I�ai 1 am awar¢ ot an0 unEer5lanE Iile re0uiremeni5 0l Calitamia M¢aIN an0 afety COGe Sec�rons 25505. 25533, antl 25534 antl I�at I or any luture Cuiltling acupdnt wilVwill nol (citUe one) �eeC to compty with SaiA slate cotles ana ��e reQuiremenls lor a permil loi conslruclion or mOEilica�ion Itom i�e Air0ua0iy MandpemBnl Ustric�. NeSitlenlialtOn5lm[Iion aDPlitd�ions afe ¢eempi Irom ihese pwvi5ion5. Daie: 0.pD��nt: I hereGy certilythal I �ave reaa��iS apOhca�ion ana statelhalihe aDoveinlo�mation is wrreci. lagree lo [ompty vnlh allciry an0 counry o�Ginances an0 state laws reWiing Ia UuiWmq consiruclion anG nereby auiln � p enutives al t' to mt upon the a0ove�mentione0 properly IorinSpeciion Durposes. Oate: Signature: y � — oriver's License ar Socu� Secu�iiy a: �6ai.a6 W�i�e—BmlCmg; G�een—CoUe Enlorcemem: Canary—Applicanl: Pink—Revenue: Goldenro0—Assessor CITY OF COSTA MESA — HUILDING PERMIT PERM NO; B Ob PERMIT NO: H 062998 PLAN CHECK NO; 01458-93 L GOVT; N SUPP; CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; ALT JOB DE5CRIPTION : 1386SF DONUT SHOP T.I, S� FT; 1,386 CLAIM VALUE: 19,000.00 CALC—VALUE; 10,284,17 GROUP OCC: B-2 / COMMENTS; THE "SUNRISE DONUTS" k if k if ik fF if if k if 1! k if if if !E if iklt iE iF iE i! i! ik if if if if iE iFlt 1t it k�)t M iF ik if iF k iE 7f !F!k if if i! iE it if it if iE ik if 3Elf iE ft if ik iflE iF if if iF i! i! 1E iF iE k fF iE iF if Z O N I N G R E Q U Z R E M E N T S S E T B A C K S ------------ MAZN BOILDING ---------- --------- ACCESSORY BUILDZNG -------- 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 RE�• PROV; PARCEL; 42214220 ZNE; CI REF NO; PLANNING N TES> INT ALT TO CONVERT EX THRIFT SHOP TO DONUT SHOP, MAX SEATING > 12, SEE LETTER IN FILE F/ OPERATING/DELIVERY HOURS. - ��r�*�x�r�r�r�r�r**�e�*�***��x �r�r*�r�r*�r*�*�e��r�*�r��x��*��r��**r�**�rx �r�r�r*��***,�***�r��rx±��r� D E V E L O P M E N T 5 E R V I C E S R E Q U I R E M E N`'�' S 20NING APPROVED BY :�—P DATE: w /—�� BUILDING APPROVED BY ; DATE: ' ~(-� � � J �� APPLICATION ISSUED BY; DATE; �' %�� 1FifikiEikiEifikiliflE7EiFiEitffitifiEiFkiE , � kkifiFil�ifiEiEiEiE 3Ei! kiEiFiEikffiEififkifkiFifififiEiEiffffEififiEiFkifitiFllitifkik!!i!iliFif IEifififlf itfli44lfkiEilitififififiklliElE!liEiF�ifiEil�iEifiEiFiliPlhlEiF LEGALIZATION;N F E E S U�M M J�. R Y STRUCT,II�F1�' SEGME;NT;Y BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/R'ES GRADING PERNIT 126.00 . , � SMIP/NON—RES PLAN 81 . 90 . „ j -,. 2, 16 ISSUE REE � •'; HUZLDING—DIV—> PERMIT ISSUE PLAN—CHECK � TOTAL PAID DUE TOTALS----> 128,16 0.00 8L:90 ": ��210.06 ?.10,06 .00 REVENUE DIVISION TOTALS--> COLLECTED; '�il•`2B;16 OVER/SHORT; ,00 BLDZ6P00 PLUMBING EL�ECTRIC MECHANIC �FT'�R'E SMIPZT06 GRADING PLAN—CHECK .� i:'. it it if �E k �k iE iE k k iF iE ik ik k iE if it ik iE k fF k k it iE k it iF iF ft k If �k If jk �t k iF it if f! iP ��1E 1E iE ib k i4 iE fk if if iE iF If if !E k iF 1! if i! iE if iFlE iF ik iE !E iE if fk iE iE %if I N D I V I D U A L F E.E �,B R E A K D O W N TYPE QTY D E S C R I P T I O,'N �: .�M UNIT COST TOTAI, COST SFC 1386 STO—INT. ALTER TYPE V—N ' i—AVER 7.42 10,284,12 END OF FEES'- l ) / _ /. f i �` ' O1 00142692—OD142693 T C�T 12a.16 DATE: 07l13/93 TT14E: !0:?0 / � CONSTRUCTION AND PIANNING APPROVALS Permit � Date Inspecior 7. TemporcrY Electncal Service or POIe � %. So�! Pio��Und�yrr.d. I 3. Eicctricai Conduit Utdrty•Undrgtr.rl. 1'-- - -- � 4. E�ectncal Cocdurt-Undrgrnd. � 5. S:z�: 9e��ia��en: fln,�t,:c..�. Li Ei� Gr.d. r. f•oot�ngs �- -- � R. Foundation 9. t".'atc: P�Pe�Undrq�nd. 10. SV:.cturai Flaor Systen i t. Propefty Sewur Line & Ho�sE CAnnection i 12. $ewer Cap t-- 13. Floot G��nc � 14. Raugh Plumbinq F15 Rough Electrical•Conduit , l6. Rough ElectrfclViring � 17. Fou�� :71r,cg S�.gn 18. Roug9 Eieetrical-T Bar Cz�lmg 79. RougN Heating & Air Conditwning 20 flu..qh �attnry fncpl3Ce . 21. D�cta, i� S:r,:ct,.ra 22. D4cts, VenlJahnq 23. GG; ?iP��Hough & Test � 2�� Roo! fram �g � 25. Hoo� 5:*. att„nq �--- --- ---- ��. 'i-Bar Cr.�l�ng (Stru�tural) & �rinnocoat 21. F,ameancl fla,hm� ------- � r 77. L'.th r.n tL 5 d �.� � Z�. 6ru.yLCn 30. Drywa�l Naihng I 31_P';.stcr ��o_.��i Ceat - ' _� 3? t . ;�:c.� Po:�.er .": cte•�F�� -- 33 � FI.,,,� F�^ctnc 34. Final Vieating � A�r Contlitionin� 35. Final Gas Pip:�Test . 36. Hoad D� Ca�aPY � 37. F�nai Factory F�replace 38. Final Plumbing 3°.`.Vatcr Ssrvico-finat r-' 40. Gas Sert�ce-Finai I41. Solar pomestic-Pinal 42. Backflow Preventer 43. Bad�tlo�� Iri;gation ' 44. LandsWpe Irnqation Systcm 45. Sound Attonuation 48. Handitap Regulations 47. FIf:Ai STRUCTURE & BUILDING /� 48. FiNA4PLANNING � 49. Elecnic Release to Edison 50. Gas Relcase to Southem California Gas Cc,� Date � e � 1 ; u 0 POOL lA APPROVALS Permit,-�r 5T. Pool & Equipment Location I 53. Steel Reinforccrtient I -�-_� 54. .'-orms 55. Elec[rical Bondmg 5G. Ro�.^,h Plur�b�n� �4 Presaurr Te=.t � i4 57. AP'ROVAL TO GO\'EH�GU?.'TE �� 58. Electrical ConduibUndrg�ntl. 59. Gas PipE, O Undrqmd., Test ' G0. 8ac!a�: ��sh 1 inus, P�Trap, :� '.;.,.:::5•�d. � Gi. APPROVAL TO DECK , 62. Backwash L Heceptor-F�nal i 63. Heater & VenFFinal �� G1. Piumhing Systcm P�nal 65. Elcctrical�Finai __ 66. Sa�ar System�Final . 87. Fenci�g & Access Anoro�at 68. APPROVED FOR PLASTEf;IP;G 69. POOUSPASYSTE61SFINAL FIRE DEPT. REQUlREN1ENT APPROVALS Permlt;`� 70. Underground H�dra 71. Prod�ctPipin9CJGas �i0il 72. Under�rou�d Flush Date � Inspecmr -�� --� t �73. Undergmd. St�ran_ T.:n:� _� Ga: 0' � �� -�--- ---�-----' 7<. OIe r ct Oh tl Hyaro � � -- I- ------ - ---+- - - - i5. UrY Lncmical I -- -- -, 76. DryStandpipe --------- - � � � 77. FIXEG SYSTE',1 �i":Al �----- ---- - � � --�-- -� - -� 78.�-V. FIf2AL � �_i _ ._ -L-_-_ _ ' � tIEALTH DEPT, fiEQUIREi�IE?�T I - - - � � 77. FINAI INSPFCTIpN -��- �- --- -' � -��- -- ; -'i-------- - - ' -- - � 41 FOOD CENiIFICATE 155L=� r- �- /�� -1_ . - -. . ' I Notes: -�. R/,� - - t----i � � I °J3--1� or _�i%A.o� � vv� - - - � � � 1-.-1-_� '--�-"-� -�-�---- -^-/ /__ -'� t--��wiw„`-/--'--r�G(,yV--�-�-i-� ��-, �! _. i4!�. �.,�c.►ti _�C�.�.r.4�� ( '! Ciry of Costa Meu Development Services Department Building Safety Divizion P. O. Box 1200 Costa Meu, Califomia CERTIFICATE OF OCCUPANCY No. The Building located at 600 W. 19TH STREET UNITS C/D has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2 Occupancy. Use of euilding DONUT SH�B Legal Description 422-14-220 (See reuerse side for Metes and Bounds) Building Permit No B62998 Electrical Permit No. E63028 Mechanical Permit No. M63264 Number of apartments Fire Prevention ito.F633388 ISSUED TO: The "Sunrise Donuts" u�u w. i in �creac Costa Mesa, CA 92625 bing Permit No?'63280 and/or guest rooms BuildingOfficialn Tony C'De BAca i� � , by � ��'':��1�/ � �:li��/�hj�� pate Hovember 29, 1993 This Certificate of Occupancy SHALI BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 le) U.B.C. CMF 1o15-a6 rev. 1/83 White -Owner, Canary - Numerical File; Pink � Bldg. Permit File FN0.IECT ADOHESS: Ej O O W 19 TH S T� UWNER'S NRME: GENE ROBERTSON ADOAESS: P O BQX 156 CORONA DEL MAR uNiT: C /D CA 92625 AflCHIENGINEEfl: � 714 � 76O—B 364 AEG.NO.: aoeness: pAIR OF PENCILS N01�Nir: 11681 CHE5TER AV GARDEN GROVE CA 92640 PEflMITTEE; PAUL' S PLUMBING ( 714 ) 893—�517 aoosess; 9101 SINCLAIR AV WESTMTNSTER CA 92683 LICENSED CONTRACTOB OECLABATION: I her¢Oy allirm �hat 1 am li�¢nsetl untler provisions of CnaD�er 9([ammencing wit� Seciion 7000� ol Dirsion I e Business ana Pmlessions Coae, anE rtry license is in lulllorce an0 ettect. eirv ueV.� ��/�sTn,e uc.:6 0 615 3 cuiss:(r�_-36 oa�e: _9=—==�-3�— sienamre: ��%jj ^ '�Vj�(�{ /� WOBNEflS'COMPENSATIONDECIARATION: IlrefeOyaNifmfIWNIWJea�¢2iL ttotd ico�¢nttO5elf�inSyrCofaCe2diCdlealWarkRS' fAmpensauon Insurance. ai a cerliliea coDY ��ereol �Seclion 3800. LaE. C1. PoLICY NO.: EXP. ORTE: COMPANY: ❑ Ceniliee coOY is nereey lumisn¢a. ❑ Cenitie0 coDY �s IileA with ihe cily 8uilainA Oivision. Oate: �1Vv��cant: F%EMPTION FROM WOHNEPS' fAMPENSAiION OEClAl1AT10N: Rhis secuon neeG irot be wmpletM il IM perml a la ane �unErtO (5100� or less�. I canity inat in ine oedormance of ihe woM far whicn iNs perrtpt is 6suee. I sAdll nol emvloy am/ person b atry manner So as to oecome Suhjeti lD the Workers' Compensa�ion LawS al CalitOmu. n Da1e; �� Signalum: � ` r � NOTICE: 11, alter makinp Ihi tleclaralion, you shaWtl GefAme su ject to ih Worker5' fAmpensation D��ons of Ihe Labor CoGe. y0u mus� lorl�with tomDly wit� Sut� DmW5inn5 or IIpS OErmii shall 6C Oeemed avOkeG. CONSTPUCiION LENOING RGENCY: I hereCy allirm Inal lnere is a conslruction IenOing apency lor Ine Oetlarmance ol ihe work for wnicn tnis oermii is issue0 ISemion 3097. Civ. CI. LENOEfl: ROOflESS: OWNEP BUILOEfl OECIABRTION: I here�y aflum IIWI I am eeem0� �mm tne Contra�tors' Slaie LifRnSe Law for I�e lollovring reason (Seclion 7037.5 Business and Pmfessional COae: Any city al wunty which requires a permit ta construct, atter, impmve, Oemolish, or repair any s�mcture. prior Io iis issuance. also repuir¢5 t�e apD�icant �or suc� permii lo lite a 5igne0 s�atemeni I�ai h¢/she is licensed pursuam lo Ihe O�ovisions ol t�e Cantracrors' State Lip¢nse Law (CtuD�er B(commencing witn Section 7000) a� Division 3 0l �he Business antl Profesvons Cotle) or Inal he/sne is exempt iherefrom antl ine oas5 lor Ihe alleAed exemption Any violation of Section 7031.5 by any appliwnifor a permit 5u0ject5 the applicani lo a dvil penalry ai no� more I�an live Aun�re0 Oollars (5500�. pI, as owner al ihe pm0erlY or rtry employces wit� wag¢5 as Iheir Sple camcen5ati0n, wi0 Oo tAe work, and Ihe structwe a nulinlen0ea orollere0�orsale�5eciion 70ad. Buvness anE PmlessiOnalCoAe; T�e Can�rattors'Sia�e license Law aoes not appry lo an owner of a WODeny wlq ouiltls ar imprOves inereon. anE who Oces wCh vAA NmtdlRMrulf or ihmu90 Ns or ner o"m employces. O�oviaetl i�al suc� improvemenis are not inlentl¢4 or oflere0 br 5ale. II, �WRver Ihe Oviiding ar improv¢men� i5 saltl wit�in one year ol compl¢Iion, I�e owner wiil have I�e burGen ol pmdnp �pl5�e CiG n01 Dui10 or imprOve lor ine DutUOSe al saiel. I. as owner ol the pmper�y. am e�clusively con�raclinA wii� Iicensed con�rac�ors lo conslmcuhe D�olecl (Seclion 704a, Business ❑ arM Pmfasims Code: 7he Contractms' State L'aense Law Uo¢s rrot aOP�Y �o an owner oi propetty wtro Cmlas m improves I�ereon anU wno comracls mr sucn pmiec�s witn a oonvactoqs) liceme vursuant ta me Comraaors' State License Law�. I am aware �M1di pmo� ot ineit Worker's Comp¢nsdtion insurance s�oul� Oe O�ovided to me. q 1 am e.empt unaer Sectian: B. 8 P. C. to� mis reason: Oa�e: �ner. � Oo nere�y cenify ��al l am aware ol an0 underslanA t�e re0uirements ot Cahbmia H¢al�� and Sa�e�y Code Sec�ions 25505, 25533, antl 2S53d ana Nat I or any lulure �uilding accupan� wilVwill nol ([ircle one) neetl to camply wilh 5ai0 state co0e5 anG Ihe reQuiremenis lor a �ermil �ar consimc�ion o� moailicailon �mm I�e Air uatny ManaAement Oistnct. BesiGential constmction apDliwiions are e�emp� imm ��eu Omvisions. Odie: �1ppliCani: � hereDy ttr�ity Ilwl I �ave matl Ihii aDO�� an0 Slat¢ Itul Ihe aCOVe intOtmaiion iS torrec�. I aqreE to compty wil� a0 cily an0 wunry o�pmantts an0 stat¢ laws ieWiinq lo huilUing COnslmpion anG �erePy aNlrorrze �epresenialives ol ItdS dry �o enie� upon I�e aUMe�mention¢� V�OpGpy IOf inSpPCiiOn pufp02¢5. / „� Daie: n ~ � — u � Signat�re: � ` � ` �"� ` ! Driver's Lkense or Social Seariiy a: � � �64t<6 White—BuilCmg: Green—Coee EntorcemenL Canary—Applicanl; Pink—Revenue: GdEenroC—AuaSsor CITY OF COSTA MESA — HUILDING PERMIT PERN. NO; P 063280 PERMIT NO; P 063280 PLAN CHECK NO: IV GOVT; N SUPP; Y CONSTRUCTION TYPE; PERMIT TYPE; PLU PURPOSE: O'fH JOB DESCRIPTION : 1386SF DONUT SHOP T,I, SQ FT; CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / CONuyENTS: THE "SUNRISE DONUTS" / RE; B62998 6 P63070 IE if ik iE iF iF 1f k�lt it il� if iE iE if iE i(� # iE iE iF iE iEiE iE iElt 3E k if iE 1E iE i! fF # iElf if # iElF 3Flh lt �lf 4� 1k % N 1E ih iF # iE iF # iE iE k�!F iF i(� 1Fi(� iFiF lE iF iF fE fF 1E if fE df #�1E �1f Z O N S N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILAING ---------- --------- ACCESSORY BOILDING --------- FRNT: FT IN REAR; FT IN F'R1JT; FT IN REAR; FT ZN LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN PARKING RE�• PAOV; PARCEL: 42214220 ZNE; REF NO: PLANNING N 7'ES> > �F . iF iE 1t if iE it iF 1E itltlt iE iF iE �)t if 1E 1! if �IE if iE ik �E if iE �)t # iE if iF!!!f!k 7E i! if ik if if iti(� �k if� it # iF�t 1E iF k fE 1f if �Eik #�lE it if� if iF if if �1F ## if # 3E # iE if �E #!k jE IE?f 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 'LONING APPRO�/ED BY r' DATE; BUZLAZNG APPROVED BY : ,i DATE; *��,Lr**�**�**�*��D*H**��k-3`t�F��.. 's��',� nr� �sE�3F�xnu�rD**#z*k � *ar MkiFltiElErtkk7FitifiF%�kkkffifiEitkfFiEiFiEiEiFiffkillF�IkiFikititlfif#%�fl�ikikif� ifiEiFlkiElfakiEiE#iEiFkiflFiE#if#iFi[�iEiF##9Ff41EiFifM�if LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMHING ELECTRIC NECHANIC FIRE SMIP/RES GRADING PERMIT 21.00 _ 25� SMIP/NON—RcS PLAN ISSUE FEE 10,00 BUILDING—DIV—> PERMIT ISSOE PLAN—CHECK TOTAL PAID DOE TOTALS----> 21.00 10,00 0,00 31,Q0 31,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 31,00 OVER/SHORT; 00 BLDG PMT PLUMBING ELEC'fRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR 31.00 1E iE if it if iElE if it �)t!E k iE k rt if if !! it iE 1f fE k it 1F if iE i! �lk it 71� if iE * tf i! iE if iF it fE k �f -N-iE if ik if Ih if if k tE i4 it # it k iF # k 1flf ik it ik iF# # 9f� iE ##?f ik i4 if ��!E I N D I V I U U A L F E E H R E A K D O W N TYPE QTY D E S C R I P T I O N ONIT COST TOTAL COST PLU 1 SINKS, COMMERCIAL OR INDUSTRIAL 7,00 7,00 PLU 2 SINKS, FLOOR 7,00 14.00 END OF FEES O1 00243970—DD243970 T C�T 32.Q0 DATE� OE/02/93 TIME� 08:32 CONSTRUCTION AND PLANNING APPROVALS Permit � �. Temparary Electncal SeryZP or PT- oie 2. So�i Pipe-Undrgrnd. _ 3. Eiectricai Conduit Utihty,Chdr-� g� rnd. - �J 4. Electrical Conduit-Undrgrrxl. 5. Steci Reinforcement 6. E�ect�icai UFER Grnd. 7. Fooungs 8. Fourdation 9. VJater P�pe�Undrgrnd. • 10. Structural Floor SYstem 77. Property Sevier Line & Hd�se Co�nection 72. Se.ver Cap 13. Ro�' Cla,rs - 14. Raug'� P�umbinp 15. Rouph E�ettneal•Contlua 16. Rough Eiectric Wiring 17. Rough Wiring Sign � 1 B Rough Electrical-T Bar Ceiling 19. Rough Heating & Au Condition�ng 20. Rough Fattory Fireplace 21. Du:ts, in Str�ctur,; 22. Dca�, Vcnr�atinq 23. Ga, Pipa�Rou3h & Test 24. Roof Framinc� 25 Rco! Shcathin3 26. T�Bar Ce�hng IS[nmwrali Fv hionocoat 27. Fiamcar.d Flashing 73. Lath•^9 & Siding 79. Insulatior, 30. Drywal� iJailing 31. Plasmr B�o�vn Coat 32. E�ectrical Pov:er M11eter F�rai 33. Findl ['ecVi[ 34. F�.^.I Heat��ng & A�r Cocd�.t�or.r.y 35. P;nal Gas P�p��Test 36. Hoorl o� Canopy 37. F,nsl Fsctory Fvep',ace 38. Fi^,�I Plum6ing 39. C.'ater Service-Final 40. Gas Serv�ce-Final � 41. Saia� DomesticFinvl 42. Backflow Prevent¢r 43. Backflow Irrigation 44. Lar.dscape irtiqation $Ystem 45. Sound Attenuation 46. Hardiwp Regulations 47, FiRAL STRUCTURE & OUILDING 48. F;NALPLANNING 49. Eiectric Release to Edison 50. Gat Release to Southem California Gas Cc 51. CERTIFICATE OF OCCUPANCY lo. Date Date POO L & SPA lospecYoi qppROV�LS Permit;x 52. Pool & Equipment Locai'cn 53. Steci Reinforcemeat 54. FormS 55. Electrical Bondmg 56. Raugh Plum6ing & P�essure Test � 57. APPROVAL ?0 COVER-GUNiTE 58. Electrical Condu�r Undrarna. ` 59. Gas P�pr., O Ur.urn•��d , Tcst � 60. GaC4v:ash L�ne=,P�Trap,'� Unu�grnd. � s 61. APPROVAL �OCECK 62. B.cM::ash & fleez.:te'�FLee' 63. He�ter & VenbFir.;' u0. ?lumhinq System � F�,^.,:I _ G5. Electrical�F�rtal 66. $olar SySl:m-Fin:.i 67. Fencing & Access Avpro��.,l 68. APPROVED FOR PL,qSTERiNG 69. POOUSFAS'YS'E��ASFINAL FIRE DEPT. RE�UiRE��7ENT APPROVALS Pcrmrt=:r 70. U'�derpro�'�d Hyvo 71. Prod�ct P,piny G.is "� �Jii 72. Underq'o::nd F�,:s�, 73. Undergtnd.Storz•��c-ark ='Ga� �0�,' 7+. O�rrhead H��c�^ � Date Impectur , 75. D�v Chemiw� 76. Dry Stand,^_�pt __ 77. FIXED SYSTe"• FILAL 78. FIRE PREV. FIK�lL HEALTH DEPT. REQUIREN1EiVT � 7�. FIiVAL INSPECTICL � 80. FOOD CERTIFiCA`E iSSUED � - -- -- ---- --- 1 Notes: --- -- - -- I ----� 1 -- ---- ---� PFOJECT AU�RESS: ( O O � 19 TH S T u"�': C/D �WNEN'$ NqME: C>ENE RdBERTSON ADOHESS: rj 0 B�x 1 J6 COkONA DEL hiAR CA 92625 ANCH/ENGINEEfl: i 7 S 4 � 7 6 O— 8 3 6 4 �. flEG.NO.: aoosess: pAIR OF PENCIL� tJO1�NIT: 11681 CHESTER AV PEflMITTEE:GARDEN GROVE CA 9264U nooeess: REACH AIR COMPANY ( 719 ) 636-6256 11751 CARD'iNAL CIRCLE GAkDEN GROVE CA R2643 . LICENSEO LONTflACTOfl OECLABATION: I hereby affirm Ihat I am I¢ensed un0er Dmvisions of Chapter 9(commencing with Section 7000) o� DiYsion 3 0� Ne Business ana Professions Cotle. ana my license is in lull �orce and eBect. . CITY LIC.: STRTE LIC.:4 S i O 9 H cuss: C 2 0 Date: Signature: WOBKEBS' C�MPENSATION DECLAFFTION: I hereby af�irm Ihat I have a certiticaie o� consent �o sell�insure or a cetli�icate of Workers' Compensalion Insurance. or a cer�ified copY �hereo� (Section 3800. �ab. C�. . POLICY NO.: E%P. DATE: COMPRNY: r] Cenified copy is hereby tumishetl. ❑ Cehitietl copy is tile0 wi�h ihe cily Builtling �iNsion. v/f �ate'. ApplicanC .< � E%EMPTION FROM WOPKENS' COMPENSATION UECUflRTION: �This Seciion ne 0 no� be comDle�eA il �he permi� iS tor hUn4fe0 (5100) or Ie55�. I cetlify �ha� in Ihe petlormance of Ne work for whic� t�is permil is issuetl, shall n 1 employ 2ny person in an nner sa as �o become sublecl Io ihe orkers' ompensa�ion Laws ol Califomia. L� .oate: signamre: NOTICE II, after aking �his tleclara�ion, you should becom¢ sublec Ihe WoBers' COmpen5a�i0n�OmviSions o� �he Labor - Cotle. you must ioMwR� comply wiM suc� pmvisions or I�is permi� s�all Oe deemetl revokee CONSTBUCTION LENOING RGENCY: I here0y a�firm �hat mg agency for Ihe pedormance ol �he work lar w�ich this pe�mit is issuetl (Seciion 3097. Civ. C�. '� � �ENDEfl: 1 � AtlOHESS: � OWNEfl BUILDEH OECtABRTION: I hereby a��irm Iha� I am exempi Imm [he ConlrattorS' $�ale License Law br ��e following reason (Sec�ion 703�.5 Business anU Pmfessional Cotle: Fny city ol county whic� requires a permit b cons�mc�, ai�e�, impmve, tlemolish, or repair any SUucWre, prior �o iIs issuance, alsa requires the aOPlicani for such permit to file a signed Slaiemen� that helshe is licensed pursuam m Ihe provisians o� �he Comratlors' Sla�e License Law (Cbap�er 9(commencing with Section 7040) af �ivision 3 oi Ihe Business and PmIe55iPn5 CoOe) or ��ai ne/she is exemp� �here�mm aritl Iha basis lor Ihe alleged exemptmn. Any viola�ion oi Sec�ian 7031.5 by any aOPlican� �or a permit subjec�s Ihe applicanllo a civil penalry ol not more �han �ive hundretl tlollars ($500). ❑ I. a5 owner oi �Ae pmOerlY o� my employees with wages as ��eir sole comDensation, will tlo Ihe work, an0 Ihe stmc�ureis no�intentletl orolieretlforsale�Sec�ion 70dA, Business antl Profe55ionalCoae: T�e Conirac�ors' Slaie License Law tloes noi apply lo an owner of 2 pmperiy wha huilds or impwves thereon, and who does suc� work himseli/hersel� or thwugA his o� �er own employees, provided ihal such impmvem¢nls are no� in�ended or otteretl for sale. If, however �he building or improvemen� is SoIU wiNin one year o� completioq the owner will have �he burtlen 0� provinp he/she tlid noi build or improve tor IPe pu�DDS¢ Of Saf¢�. I, as owner ol ihe pmperty, am exclusively coniracting with licensetl contractors to consimct ihe pmlect (Sectian 70q4, Business ❑ and Pm�essions Code: T�e Coniractors' S�a�e License Law does not appry to an owner of Dmpeny who builtls or impmves Ihereon and who comracts lar such O�ole��s wilA a contractor(s)license pursuan� lo the Contracmrs' S1ate License Law�. I am aware ihat Pmo� oi iheir Worker'S Compensation insurance shauld be pmvitletl to me. � I am exempi under Sec�ion: B. 8 P. C. tor �Pis reaso - . .pate. Ownec I do hereby cenily tl at I am aware ol antl un0erslan4 �he requiremenis o� Califomia Heal�h and Sa�ery Cotle 5' , 3, an0 2553<ana IM1aI I or any fuWre huilding occupant will/will not (circle one) need to comply with ' es antl Ihe requirement5 �or a permit lor cOn9mc�ion or moJdicaiion �mm ihe Air Oualiiy Management 'sV ia conslmc�ion ap0�ication5 are exempi irom IlleSe pravi5ian5. �aie'. ApplicanP I hereby cer0�y Iha� I have reatl Ihis appliwlion ana s�ate �ha� Ihe above mtorma�ion is correcL I agree �o com ly wi�h all cily antl coun�y ar4inancesa0451alelawsrelatinglobuildingconSlmctionan4herebyaWhodze�presen�ative5of�hi5ciryioe r pon��eabove-mentinneC pmpetly lor in eclion pur oses. r Da�e'. U ( SignaWre: ��h � Driver�s License or Sociai Security a� i64t-a6 WPite—Building; Green—CoOe Enlorcement: Canary—/pplicant; Pmk—Fevenue: GolCenroE—Assessor -�. CITY OF COSTA MESA - HUILDING PERMIT PEkM NO; M 063264 PERMIT NO; M 06326A PLAN CHECK NO; N GOt7T; Jd SUPP; iu CONSTRUCTION 'CYPE: PERMIT TYPE: MEC PURPOSE: OTH JOB DESCRIPTION : INSTALI� COMMERCIAL HQOD 6 EVAP C_OOI�Ek SQ FT; CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 / COMMENTS• THE "SUNRiSE DONUTS" REF•B62998 ��t***��r***�r*�*�t�r�*�t�r*x��**��****�*x �t*�+c�r*******�*�r*�*x**�*+txx�•�e��i�t*x*�**�x�* 2 O N I N G R E Q U I R H M E N!' S sETaAcxs ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FftNT: FT IN kBAR; FT IN fiRNT: FT IN REAR; FT IN LEFT; FT IN kGHT: FT IN LEFT; PT IN RGHT; FT IN PARKING REQ • PROV: PARCEL; 42214220 2NE; REF NO; PLANNING NfSTES> � %�/ iE iE iE 1E 1E iE �K- if iF �fE if iF iE iE 1f 1E lFif �1F iE if iE iE �(� iE �E iF iF�1F !F iE �%!E �F if� iE iE iC-� �k !ElE.3f� iE #!F iE iE ildE � if N� 1! if lE iE iE if iE %3F iF %� i(�i[• �E 3F lE ik %� 1E 3F?i�iE # if� !E?f D E V E L O P M E N T S E R V I'C� E 5 R E Q U I R E M E N T S ZONING APPkOVED BY ••�/ DATE; � BUILDING APPkOVED BY : � DATE; APPLICATION ISSUED HY: �- .. DATE; 7r�� 3liFitikitiEi6lErtiEiEiE�(-iEiEiEit1E-IEiEltit t irf. �..�t . . . . i� r�, . . , z � it ��lEfki6iEiEiEiEitiE�lE ir +r �i�fFX�� iE iF if lE if !F �IF 3E 3E iE )f �3Elt iE i(� %� 3F iE N� jE 1! ik iF ih ih!(� iE ff if iE iF iF 3P iF iF'iP iFiF iFit ��!(/�x,. .'�N-i! �)t �(� ialf iF iE �X� �lE it i@ iF fE 1f 3F 3f -1P ik iE ih 3E %�iF i(� �1E IFiF iE iE X� # iF iF LEGALIZATION;N F E E 5 U�M'�M A R Y STRUCZ'URAL 5EGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 13,00 PLAN � i� zS$ SMIP/NON-RES ISSUE FEE BOILDING-DIV-> PERMIT I5SUE P� N=�CHECK 15.00 TOTAL PAID DUE TOTALS----> 13,00 1S,OU � 0,00 28,00 2R,00 ,00 kEVENUE DIVISION TOTALS--> COLLECT$D; 2$,00 OVER/SHORT; 00 BLDG P,yT PLUMBING ELECTRIC ME�iiANIC FIRE SMIP/TOT GRADZNG PLAN-CHECK ', - 2$,. 0 0 r" �ir 3E iE if if %iE ih 3F iF %iF IFiE-k 3i� N� ik fFlh if iP�% fE !E K� �It� iE i(�!f lE 3F?4� lE �)Ft%��1E iE if 7E �1L� 1F N- iF If i(• it 9(� ih lE 3E ih�Jt 1E �lh i@ N�'lE ik fF?f� ik iE iE 74 iE 3E lf #!E if-iE !F IE 1F iE if il� iF iF I N D I V I D U A]� �r F E E B H E A K D O W N TYPE QTY D E S C R I P T I.O-N / ✓ MEC 1 INST HOOD W/DOCT5 FED BY MEC EXHAUST' MEC 1 INS'P/ftEL NON-POR1'ABIIE EVAP COOLER ['END OF FEES r_ �. u � � / UNIT COST TUTAL CO5T 6.50 6,50 6,50 6,50 O1 Q�143917-D(1]43�17 T CaY lo,�p l OpTE: 07/30/93 TT�iE� 11:50 Y � � CONS7RUCTION AND PLANNING APPROVALS Permit # 1. Temporary Electricat Serv�ce os Pote 2. Soil Pipe�Undrgrnd. 3. Electricai Conduit Utility-Undrg�nd. 4. Electricai Conduit�Undrgrnd. 5. Steet iieinforcement 6. £lectrical UFER Grnd. 7. Footings 8. Foundation . 9. Water P+pe-Undrgrnd. 10. Struct�rai Fioor System i i. ProperiY Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 14. Rough �I�mbing 75. Rough Eiectrica6Condu�t 16. Rough Electric Wiring 17. Rough 4Viring Sign 18. Rouc�h Electricai�T Bar Ceiling 19. Rou9h Heaxing & Air ;7onditioning 20. Rough Factory Fireplace 21. Ducts,ln Structure 22. Oucts, Ventilating 23. Gas ?iae�Rough & Test 24. Roof Framing 25. Roo* 5heathing 26. T�6ar Celiing (Strur.tural; � Monocoat 27. Frame and Flashing - 28. ( athing & Siding 29. insulatlon 30. Drywall Nailing 37. Piaster Bro�vn Cqat � 32. Elecirital Power Meter'rinal 33. Finai Electric 34. Fina; Meating & Air Conditioning 35. Finai Gas Pipe-Tesi _ _ 36. Hood a� Canopy 37. Finat �actory Firepiace 38. Fina! Piumbin9 39. 4Vater Service�Final 40. Gas Setv�ce-Final 41. Solar pompsticFinai 42. Backfiow Preventer 43. Backflow Irrigation 44. LandscaPe irrigation System 45. Sound Attenuation 46. Hardicap Regulation, 47. FINAL STRUCTURE & BUILDING 48. FINAI. PLANNING 49. Electric Release to fdison 50. Gas Release to Southern California Gas Cc 51. CERTiFICATE OF OCCUPANCY Date Dace � P00� opA t Inspector �pROVALS Permit � Date ' _ 52, Pooi & Eq�ipment tocatian ,�, S �-L._ 53. Steel Reinforcement .`�--' 54. Forms _ �� 55. Electrical8onding __ 56. Rough Ptumbing & Prassure Test - 57. APPRQVAL TO COVER�GUNITE 58. Electrical Conduit�Undrgrncl. � 59. Gas Pipe, O Undrgrnd., Test ( 60. Backwash Lines, P�TraP, �� Undrgrnd. �� t G7. APPROVAL TO DECK ��-- � 62. Back.raash & RcceptorFinai ' � _� � � 63. Heater & VenbFina� � � �- 64. Pturttbing SYstem � Finat �"% i � ��C�Y65. Electrical�Final � � / 1 , , 66. Solar System-Final - ' ' � 67. Fenein� & Access Approvai � ! E 68. APPROVED FOR PIASTERING 1! 69. POdtlSPASYSTEPi�SFINAL r FiRE DEPT. REQUIREMENT I APPROVALS Pc.rmit �` 70. Underground Hydro 71. Product Piping :� Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas � Qii 74. Ovefiead Hydro 75. Dry Chemica� 76. Dry Standpipe . . 77. FIXED SYSTED.fi r�INAI. . 78. FIRE PREV. FINAL � � '� ; HEALTH.DEPT�. R�QUIREN7ENT � ` � 79, FINAL IP�SPECTION� �' � 80. FOOD CERTIFfCr�TE iSSUED ��/ i Notes: fi�.IP7 f��/�/"_. �_ �. �� '. , -- ;-_ Inspector .> �i . _-% � i �� r' PHOJECT AOUNESS: 6 Q 0 OWNEH'S NAME: GENE FDONESS: P � B uxrt: C /D CORGNA DEL MAR CA 92625 (714)760-8364 pNCNIENGINEEfl: PAI R OF P ENC ILS flEG.NO.:NONE I nooeess:11681 CHESTER AV uxir: GARAEN GROVE CA 92640 PEHMITTEE:P�j FUGAT£ ELECTRIC ( 714 ) 964-0465 aooRess:10022 VALLEY FORGE DR HUNTINGT'ON BEACH CA 92646 IICENSEo CONTHACTOB oECIABATION: I hereby afiirm Ihat I am licensetl under omvisions o1 Chao�er 9(commencing witn Seclion 7000) o� Orvision 3 0� Ihe Business antl Pmfessions Code, antl my license is in full force and efR LITY LIC.: STRTE LIC.:S 4 O% Z�J c�10 Da�e: 7r�y—r3 Signamre:��_ — WOqKEBS' COMPENSpTION �ECIAHATION: I hereby a�hrm tha� I have a ertihcat consent to selbinsure or a ceni�ica�e o� Workers' Comp¢nsa�ion Insurance. or a cenified copy Ihereof (Sec�ion 3800, La�. C). POLICY NO.: E%P. DATE: COMPRNY: ❑ Ceriifietl copy is �ereby lumishea. ❑ Certitiea copY is �ile0 wi�� the ciiy Builtling Division. Oaie: NpplicanC EXEMPiION FPOM WOflREBS' COMPENSpTION OECLl�PRTION: �Thi55ection nee0 not b¢ comple�e0 i� t�e permi� is lor One hundreA (5100) ar less�. I certity Ihal in Ihe pertormance oi �he work �or w�ith ��is permi� is i55ue0. I 5hall n employ any� any mannef 5o as l0 6eCome su�lect to �he Workers' Compensation Laws o� Cali�omi�� Oa1e: — � ^ SignatureG NUTICE: I( afier making his declaralion, you shoWd become suble to Ih orkers' Compensation D�ovisions ot �he labor Code. you mus� lorihwith comply wilh such pwvisions or I�is permii s�a be EeemeO reuoketl. • CONSTBOCiION LENUING AGENCY: I here�y a�firm Iha� Ihere is a consimction lentling agency Por the periormance a� the work lor whir,h this permn is issued (Semion 3097. Civ. C). % LENOEB: j ' aooxess: OWNEN BUILOEP oECUPA710N: I here0y aflirm that I am e�empt Imm ihe Contractor5' State License Law for the fallowing reason (Seq�ian 7031.5 Business antl Pmfessional Code'. Nny ci�y of coun�y which requires a permit lo constmc�. al�er, impmve, demolis�, or -r¢p�ir-anys�mC�ure.-.priocl0.i�5:issuanCe.-al5o repuire5.the.applicanl-fOr SUch�permii �o Iile a�SiAnetl 5ta�emenL��a� he/she.is�liCenSeU -- pursuant �o Ihe pmvisions al the Coniraqors' S�ate License Law (Chapler 9(commencing wiN Section 7000) o� Division 3 0� the Business antl Pmfessions Cotle) or Ihal he/she is exempl therefrom antl I�e Oasis �or the alleged exemption. Fny viola�ion ot Sec�ion 7031.5 by any applicant �or a Dermit su�lect5 I�e apPlicanllo a civil penalty ol not more than live Auntlred tlollars (5500). I, as owner oi ihe pmpeny or my employees with wages as inefr wle compensation, will tlo ine work, an0 ihe ❑ slmcWre is nal intenaetl or oifereC lor sale (Section 7044. Business an0 Pmfessianal Cotle: The ConVacmrs' S�aie License Law aoes nol apply �o an owner of a pmperiy who builtls or impmves lhe�eon, ana who tloes such wo�k himself/�erself or ��rough �is Or Aer own empl0yees, pmvidetl �hal Suth impmvemen�s are nOt in�entled of o�feretl �or sale. II, however I�e huilding or improvemeni is so10 within one y¢ar ot completion. the owner will have Ihe �urtlen o� proving helshe ditl not builtl or imDrove Nr the purpase ol nle). � I, as owner o� Ihe pmpeny, am exclusiv¢ly contracting wit� licensed conlractors m constmct the pmlecl �Sec�ion 7044, Business antl Pmlessions Cotle: The Coniraclors' State License Law tloes no� apply to an owner oi properry wAo huilds or impmves �hereon antl w�o conirac�s �ar such prOjec�s with a contracmr(s) license pursuan� lo ihe ConVacbrs' State license Law�. I am aware Ihal pmoi ol Iheir Warker'S Compensalion insurance ShoWd be pmvide0 b me. � I am exemD� untler Sec[ion: B. 8 P, C. for Ihis reason�. �at¢�, Owner I Op here�y cenity Ihal I am aware ol and unders�an0lhe requiremenis o� Cali�arnia Heali� antl Sa�ery Ca4e Sections 25505, 25533, and 25534 analhal lor anyfuiure builtling occupaniwill/will noi�circle one) nee0 to camply wiih 5ai0 siate Godes dn0 lhe requiremenis�o( a permit tor can5tmcfi0n or modification from Ihe Al��ty Mdnagement DiSfdcL Re9tlential con5tmt0on appAcalions are exempt from these o�ovisions. Da�¢: qpplican[ I hereby ceriily Ihal I have read this application and state I�atihe ahove in�ormationis corretL I agree to comply wilh allci�y antl county or�inances ana s�ate laws relating �o Owitlmg consimction antl �ereby aut�orke represematives ol ihis city to enter uDon the a0ove-mentionetl ��Operty loi inspect�n DurO^ses. �/ �_�� Oa�¢: ? " _/_p� Signaiure 6� � I or��er s Cmense or Socia� sacunty a: }( 1Gai.e6 White—Bbilding; Green—Code EnformmenC Canary—ApO��anC Pink—Fevenue; GoMenrotl—Assessor CITY OF COSTA MESA - BUILDING PERMIT Y�: M NU; � b[u PERMIT NO: E 063028 PL'AN CHECK NO; N t,t� 1; tv SUYY: N CONSTRUCTION TYPE; PEkMIT TYPE; ELE PUkPOSE; OTH JOB DESCRIPTION ; 1386SF DONUT SHOP T.I, SQ FT: CLAIM VALUE: CALC-VALUE; GROUP OCC; B-2 / COMMENTS; THE "SUNRISE DONUTS" / kE; B62998 *�r*�r�� *��r**�r�r**�r*��x**�r*x �c *u�*�ex�****�*x+�**�� x-x#x �r��x��r��x*�-**s�*�*�r� *�x��**�* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCfiSSORY BOILDING --------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN LBFT: FT IN RGHT; FT IN LEb'7': FT IN RGHT`; FT' IN PARKING REQ • PROV; PARCEL: 42214220 ZNE: REF NO; PLANNING NCST'ES> i # fE �)E iF k if 1F �f !E iFiE 1E ik iE iE i6 �IE #F iE iElE fk �f iF iE 1E iElk 1E iE 1F �E �E �1FiE iflf iE iE k if iFiE iE iFik ik i6fE fF iE iF iF if iE dE #iE If !FlEif if !F fE �flE 7E iF ff !F ik 1P jE �E K� iE iF 3E D E V E L O P M E N T S E k V I C E S R E Q U I ft E M E N T S 20NING APPROVED BY . BUILDING APPROVED BY : APPLICATION ISSUED BY; L/ c� *��r*�r*�r***x*�***�*��r ' . 1k 1F if iF iF �E iE iE iE iE 3F iE it iE iE iF 1t iE iE iE ik ik �E If �F if� 3F �( 3f iE 1f �E if if iP �E 3f if �lF iE iE'1k it �3E LEGALI'LATION;N F E E S U M M BLDG PMT PLUMBING EL$CTRIC MECHANIC FIRE 5MIP/RES GRADING PERMIT 31.50 -`—_ -- -,. .; -_- - "-- - ..-.._� -- --503--..,-._.. ,_._—_. ,_ _ Si9IP'lNON-RE3- PLAN ISSUE FEE 15,00 BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 31.50 15,00 0,00 46,50 46,50 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 46,50 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTkIC MECHANIC FIRE SMIP/TOT GRADING PI,AN-CHECK 46.50 DATE; DATE; �G� DATE- �� 3f7E?F (F'�F�f'�R"3FiF-IEiEiEititfE3tiF*��1F x� iFit iE 1t 3E?f iF )(-�lk if iF�f if iF if ff if %iE iE lE #!E iF iF �1F # iE # iF iF fF if 1f R Y STRUCTURAL SEGMENT;N it iFik�)f 9F 1E 1E iE iE iF iE it 1E 1f i! iF iE iE 1E iE k7E7! it 1Fi! �k iE iF 1F if it iE 1E 1F iE iF ik 1f iF iF iE ik iE i!� 9t iFltlE 1t )E iF iF i(� iE fE iFiFlF if ib iF if iFlE �lE iE if �F k!f if iF �%iF if iF if if I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 19 RECEPT/OUTLET 1 S2 20 EA. 75 10,50 ELE 7 MOTOR/POWR APPARATUS 0,0 - 1,0 HP 3,00 21,00 END OF FEES 01 00142817-Q014?3I7 T f� T 46.5� DATE: 07/14/93 TI11E: t0:15 0 � C�NSTRUCTION ANO PIANNING i APPAOVALS Permit # 7, TemporarK Electrical Service or Pole 2. Soil Pipe-Undrgrnd. � � I3. Etectrical Conduit UtilitY•Urtdrgrnd. I 4. Eiectrical Condwt-Undrgmd. 5. $xeel.Reinforcement 6. �Iectrical�UFER Grnd II 7. Footings 8, Foundation - j � '. 9. Water Pipe-Undrgrnd. - 'I 10. 5vuctural Floor Sysiem � . i t. Praperty Sewer Line & Ncitise CoQnecYton 12. 5ewer Cap . 13. Roof �r3ins . 14. Rough Plumbing ' 15. Rough Electriq6Contluit� 76. RoughElectricWiring ' 17. F?ough Wiring Sign � 18. Rough Electrica6T Bar Ceiling` 78. Fough Heating & A�r Conditioning 20. Raugh Factory Fireplace � _ 21. Ducts,in Structure 22, Oucts, Ven2ilating 23. G�s Pipe�Rough & Test 24. Roof Framin9 � ' � � 25. RooE Sheathing 26. Y�Bar Ceiling {Structural) & Monocoat II 27. F:ameandFiashing 28. 4athin9 & Sid;ng 29. insulation I 3U. Orywall Nailing 37. P'aster 8ro4vr, Cflat 32 Electrical Power Keter�Pinal 33. K�nel E�ectric 34. Final Heating & Av Ctlnditioning 35. F�nal Gas Pipe�Tesi 36. Naod or CancPY 37, Final Pactory fireplace 38. Final Plumbing � 39. tiVatev Service-F'snat 40. Gas Service�Final ` 41. Solar pomesttc�Final 42. Backflow Preventer 43. Backflow Irrigation 44. (.andscape lrrigation System 45. Sound Artenuation 46. Hardicap Regulations 47. PINAL STRUCTURE & BUILDWG 4$. FiNALP�ANNING 49. Electric Release to Edison 50. Gas Release to Southem Caiifornia Gas Cc 51. CERTtFICATE OF OCCUPANCY No. Oate Date ( Inspector �.i POOL _ aPA APPROVAl5 Permit # 52. Pool & Equipmeni Locat�on 53. Steel fieinforcement 54. Forms 55. Electrical Bonding 56. Rough Piumhing & Pressure Test 57. APPROVAL TO COVER GUNITE 58. Electrical Conduit�Undrgmd. 59. Gas Pipe, f� Undryrnd., Test 60. Backwash Lines, P-Trap, O Und:ornd. 61. APPROVAL TO DECK 62. Batkr.ash & Receptor Pinal 63. Heater & Vent-Finai 64. Plumting Syscem - Fnal 65, Electrical�Final 66. Solac System-Finai 67. Feocin� & Accr,ss A��proval 68. APPRQVED FOR PLASTERING 69. POOUSPASYSTENiSFINAL � FfRE DEPT. REQUIREINENT APPROVRLS Permit #` 70. Undergr0und Hydro 71. Prodi+ct Pip,incf C; Gas ❑ OiI 72. Underground Fiush 73. Undere: nd. Srorage Tank O Gas : O�i 74. Overhead Hydro 75. Dry Chemical 76. Dry STandpipe 77. FIXEp SYSTEA4 FINAI. 78. FIRE PREV. FINAL HEAITH DEPT. REQUtREMENT 79. FINALINSPEC710i\� I �90 FOOD CERTIFICATE ISSUED � Date �Inspector � � PN0.IECT AODFESS: ( O O W 1 9 TH ST owNens xnn+e: GENE ROBERTSON nooeess: P O BOX 1 S 6 COi20NA AEL MAR CA 92625 RBCMIENGINEEfl: � 7 1 9� 7 6 0—$ 3 6 9 noosess:PAIR OF PENCILS 11661 CHESTEFt AV uNiT: C /D NEG.NO.: � NOT��iiT; PEflMITTEE:GARDEN GROVE CA 92640 nooxess:UNITED FIRE & SAFETY C0. (909)279-8208 12305 DOHERTY ST RTVFACT p q(� �ICENSEO CONTNAL70PUELCAflAT10N:�lliere�y a�rrm mat i am iicensetl unaeCr y�pPovisoos oT Chapter 9 �commenclnA ��h Seaion )000� ol Uvison 3 0� I�e Bus�ness ana Pmie59ms Cotle. an y-f nse ¢ in lull forte anG elfeci. ciTr �� O� `^ STRTE LIC.6 ,z 1 O 9 '�-5s S 6 Oate: / Signalure: _ � `^ WOHNEB LOMP SRTIONOECIAPATION: IfrereOya�f Ihatlliaveaterii�i[att0�Wn5en�IoSelt-in5ure0racertiliWi101Workers' 1:ompensation imwance. o� a cendiM coDy ��+e�eot �Section 3800. Lab. q. pOLICY NO.: EXP. ORTE: COMPRNY: ❑ Cerii�ied LapY �5 �eRby WrnisAed. ❑ Cenifietl capy is IOeE wlt� the ciry BUBEing Oivision, Ihle: APViicant: E%EMPTION FflOM WOflKEflS' COMPENSIITION OEQAIiATtON: (19se �m�WletM it Ne perm� z iw me hwqrM (5100) a less�. I Cerlity IIWI in e Oedorman[e o� I�¢ work Ior whith Iltis De�il is ixw I nol ¢mploy any p¢6an in any m3nner so as to �ecame Subjecl_W I� or O�ation Laws o� CaGtomia. � � Y pate:U � Siqnature: NO ICE: II. al r making Itus CecWratqn, you shoNE mme suUject to t�e Wo�kers' Compensation provisions of lhe �abor CACe. you must lonhmin como�Y `^'�� suth prW6ioh5 or Iks permil sfull ee deeme0 revake�. G�NSTRUC710N LENOING RGENCY: I hereDy allirm tnat there is a wnstmction lentling agency lor the perlormance ol t�e work for �ahich ihis Oermii is issuea �Section 3097, Civ. C�. lFNOEfl: FUOflESS: 0�'1NEN BOILOEB OECIAMTION: I �ereby allirm ihai I am evempt imm ��e Contractari State License Law lor Ihe follovnng reason �$¢clion 7037.5 8usineu an0 Pmteisanal COGe: My tity ai wunty w1uN r¢puir¢5 a Vermit to consirutt, alter, improve, Aemalish, or repair any simcWre. prior lo Ys issuance, alio reQuires ine avVlicant lor sucn oermil lo file a sipne0 statement ihat Ae/sne is licensea .pursuani Io 1�¢ Omvisions ot I�e Comracmrs' Slate License Law (COaO�er B(oommencinp vn�� Seclion 7000) ot 0ivision 3 0l Ihe Business aiM P�oles5ions Cod¢) m lhal helsh¢ is exempt t�e�etrom azW Ne Oass br l�e alkqeQ e�emplion. My vioWlia� ul Settion 7631.5 �y a�Y aDO��nt lor a plrrtoi 5u0jeCi5 t�e app�Na�t to a tiJ�� pefully ot noi more ihin live �unEreC dollars (5500�. I, as owner ol IAe pmpeny ar my employees wit� wdpes as t�eit sole camDe�sation, wiA Ao ihe wod, antl IAe Q stmcwre is not intendee or offere0 �ar sale (Secuo� 70aa. Bus�ness antl Pmlessianal COEe: The Conlractars' Stab License Law aoes nol appry Io an owner of a propeny wtp ouiles ar improve5 ihereon. anE wlp 00¢5 w[h woA himsell/herself or ihmuph his or �er awn empl0yee5, O�OviQEA Itul wcli impmvemen(5 are n0i ini¢n0¢4 or oliere0 lor sale. I�, �owevcr l�e Uuiltlinp or imorovemenl is so10 �I�in ane year of compl¢ti0n, I�e Pxnel �till luve I�e OurOen ol proving Ilds�e Cid noi bui10 or imDmve lar ihe Ourpose al sale�. I, as owner ol I�e pm0eny. am eKt�usively contraG�inp willl IicenSeO conlratlof5 io tOnSlmt� Ihe pmleC� (SeClion 7044, Business Q anU Pro�eivoni Cn�e: i�E CAnlr2G[WS' SlatE Lictt6¢ Law CUeS nol apply l0 ao Ovm¢r 01 properrywho UutldS Or improve5lAer¢on anG wtw conlratls lo� wc� OrqetlS xim a coniranoqs) licenu pursuani ta i�e Coniraclws' Sia�e License Wwl. I am axare �hai pwol ot 1�¢i� Woiker'S Cam0en5aGon inwrance S�oula 0¢ prpri0etl lo me. p I am ¢�empt un0er SecGon: B. 8 P. C. �0� I�iS �¢dWn: [laiel Qxnec I ao nereDy cenity ihat I am aware ol ana unOerstana iAe repuirements ol Californu Healih ana Salely Coae Sections 25505, 2553.7, ane 2553< antl Itul I or any IUWrO CuilNng otnlpdni wiWwill nol (urUe one� neeG �o comDN ��h Said Sial¢ cotl¢5 an� the rOQuiromen�5 lar a pe�mitbtconst�uction a moatiication 4omtne Ait OuahtY ManagementUstntt. ReSiQentialtAauruCtion applications are exemOtlmm ��ese OroviSions. Oa�e: A70��ani: I h¢ieby cenily I�al I �ave r¢ad I�6 applita�i0n and 51aie I�ai ve ini mation is mrrect. I aA�e¢ to compty wii� all city ana coun�y prainancesan0 Ialelawsrelalingto�Wttlingconstmction ere�yamho' esentativesoitMscirytoenlerupont�ea0ove�mentionea pmpetl�i i Peclion Oo� ' pate: O� SignaWre: n��ers u�e�s� o� so��a� se��nv +: �� 5aLa6 Whne—Bmltli�g; Green—CoEe Enbrcement Canary—ApW��L Pink—Revenue; Gd4enroE—Assesmr CITY OF COSTA MESA - BUILDING PERMIT �PERM NO: F 063388 PERMIT NO; F 063388 PLAN CHECR NO; 02705-93 L GOVT; N SUPP; N CONSTRUCTION TYPE: PERMIT TYPE; FIR PURPOSE; OTH JOB DESCRIPTION : INSTALL FIRE SUPPRESSION FOR HOOD SQ FT: CLAIM VALUE: 600,00 CALC-VALOE; GkOUP OCC: B-2 / COMMENTS; THE "SUNRISE DONUTS" / RE: B62998 �r**�r+�**�r+��x*�r�r*�r�r��t�r*x�*+r��+��x�r�r�r�r��r�+�*�r�r*xx#*� x•��r�tx��r+t�t��r�rar+�****x��r�r�r�r�ex�*��t�r** Z O N I N G R E Q U I R E M E N T S sErsAcxs ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT; FT I13 RGFIT: FT IN LEFT: FT ZN RGHT; FT IN PARKING REO• PROV; PARCEL; 92214220 2NE; REF NO; PLANNING N(STES> i �lf iE if it iE iE if iE if i! k it iE iE iE it iF iE 3E if rt if iF rt ik iE 3f iP iE tf IE iE fF iF 3E if iE iE iE iFiF iF!! iF it iE it k� ik �f !f iFiE iFiE ft #iE if # k iF iE iF 1E i(� 1E iF i4 it iE fk±E if iFfF iE i(� ff D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY ; DATE; APPLICATZON ISSUED BY: ��L S�.- DATE:� � -3 ifiFiflfiEiPiEiEif�E�klEiE�lEiflfiEif#E1fiElfiF�if3FiFiF7F'iF�iFt—F3fif3F�-�tiF 'iF3F�3FiF iFitft3F3F�iFiEiEiFiEififiElFikfEft . x rir iklE !f 3f if �F �E iE iF if if 1E k 1E if 3t iF it iF iE if if Ik i! i! if if if iF t! k# iE iFlf fF iE iF iE �)t ik iF iE iE if iEiElk it iF ff if iE iE iF iF iE If if # iE 1F iF iE # it i!� fF iC-ih iE i6 fF if iF K� ## iE iE iE LEGALI2AiION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FTRE SMIP/RES GRADING PERMZT 1765R SMIP/NON-RES PLAN 11.05 ISSUE FEE BUILDING-DIV-> PERI�IP ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 17.00 0,00 11.05 ?.8,05 28,q5 .00 REVEhUBLDGt,PMT�PLifMH NG ELECTRIC�MECHANll2C FIRE��SMIP�TOT/SGRADING PLAN-CHECR i 1%,�� iE iE 1E iF If� iE �lf if ib )t iE iE if if 1f IE aF aF 3E � 1E jF iE �IF �lf iE i(-�lf iE ik if� iE-1k If iE iF i(� iF iF iE �1F iE iE �)f -k !t N�lE iF iF iE i(- JF if 1F iE �Y iE iE if iF if if if iE �� # if 1( #�� af jf iE IE iF-Y,� iE # I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST 'IOTAL COST FIR 17 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 17.00 END OF FEES J O1 Q014<391-00144391 T U T i7.00 DATE: �7l66l93 if14E: 13:11 • . � . � j . COUSTRUCTIOR AN� PLANNING i qPPROVALS Permii � c� �, �� 1. Temporary E�ectncal Servi �r Pole � � 2. SO'� Pio'�Undrgmd, � �� .i E.:c 'r��ni Crndu-�,t Ut Viry•I�+.�,yrqrr.rl. �-- -- ;�--4- E�ectricc: Condu.YUnd+grnd. � �. $l:�' %if��+GC3T.en( �-- I 6. {',i �Inc:! U� �9 G:rtd. �- -- -- - � 7 f-:obr.�< {--- -- 8. Fo�ndation I �^ 9. C.dCt• P�Re-Und�grr.d. � � �---- -- 'i 10. SI'LGSWd�'loorSystem'�j 77. p�-a�r..ty S:`I in:� & Hu,.'�eCGnnrcIio� , 12. Sti��..r C�P � 31 Root Dre.ns �r14-F,o�rn G;,,mb.ny - 15 F:.:gh E'� c�riCa��Cond::�t �-- --- r-- -- i 16. Ra�.�hEleC��c`.7irirg � 17. Rough �;J�rmg S�gn 18. Rocgh Electricai" Bar Ce�hng 19. Rouph Ncating & Alr Cor,dit�oninc� %O. '�L_�yl'. h�ILG�V Fir��n:yce 21. Duct:, in Structur IZ2. D�cts, Vent�iatmg 23. G�, 7ip. l',ough fS� Test 74. flooi Fr�ming 25. Ro_f Shcdthina � Ii6. i �9ar C»�i��a IStructurail & ;elo�ocoat I Z7. �rame.r.:: �'.ecn�r.q - � 28. Lath�n_c� S�d�ng , 29. In:W;.t�.an 30. D'Y":a'I P.'.rr,�B 3t. P��::cr 6:.:�.n ,^,..�r. � 32 E'rcb�ca� Po��.ar 64et�rr�F�ci�-- - 33. F�nc; Elnctrc 34. F;na' H:atm? G A�� Co'd�To�:cg � �35. Final Gas p�p_�Test �6. H��c or Canapy 37. F�rai Factory Fuepidce 3&. Fin.l F.umb:ng 39. tVater Service-Fina� ' �0. Ga. Sere�c�-rmal r41. Solar pomestie-Final � t- ti2. °ackilo��.� P.ev2nter n3. 8ackflow I:riyat�on ' 44. landseepe� trngation System 45. Sound A[t�,nuation A6. I-landiwp Rcgulations � Al. FI�'AL Si AUCTURE & BUILDING 48. FINALPLANNING 49. Eiectric Release to Edison 50. Gas Releasc to Southem California Gas Co � �No• Date Date r �/ POO L m SPA Insprctor APPROVAIS Permic � i 52. Pool & Equipment LocaY,on i 53. Stecl qeinfprcement ____ __ 5C. Form _ _ _ 55. Electrica� Bond�ng 56. Ra�yh Plun�b�ng U"iessu;e Tes: 57. AFPROVnLTOCO\'FR�GU�:iTi 58. Electrical Cocdu�t�Urdrgrnd. 0 �_e 0 � Da[e �Inspettor � 59. Ga� Pipe, l� UntlrPmd., Test I -i- � G0. B�e�wash l.ines, P�Trap, �. Unci�o�ro. � i - -- - 61. APPROVAL TO DECIC '� �_�� _ }62. Batkevdsn S� Rec�p!nr�F�na� � G3. Heatcr & Veni-Fin� 6�. Plumbing Systom - F�nul � 65. Eluctrical�Final ` ' i 66. So1ar System�Final _ �- 67. Fenci�g & Access AnP�uval -;- 68. APPROVED FOR PLASTERING 69. POOLlSPASYS7EhM1SPINA� FIRE DEPT. REQUIREMENT i A?PROVAl5 Permrt,F -... i � n u 7�. Undergraund Hydro i I � -� ' 71. Product Pi�:nq rJ Ga�. � O�I I-� � -�-- --� 72. Urdcrgrau�id Flus� � � - i 73. Undcrgmd, Storagc 7ank C G��s_ Od �T, _ `_� --� 74. OccrC^ad Hydro I I _____ ___�__. ___�_�.- 75. Dry Chemicel -� V-- e�..3o� i.'(l -- _�er�,. 7fi. Drv Star.dniP: -- �- � -- ---- - - �--- -- - --a �7. FIXED SYSTE�^ �"'^:AL �,3p.0� � (,v� � - G� '- � -! 76. FIf3E PREV_F!1'AL __ __ $ 3D-rs,l�, � HFALTH OEPT. REOU!REf.�E'�:T � 7�. FI��'AL!NS!`CC'li:'�; -- -------- --------- , i � B0. FOOD CEHTIF IL'/.*E �SSU� � ! t - - - -- - -. - - -- � -- - --� - - -- � -- --- Lote;: -- --- -J - -- - ---t -�--- �--'-- -- - i --- - -1 - -- ----- ------- � I ,�-------------`__� (714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us � . �..�., ..� ,� •" ...-.., ^ ...--.., -.. -__-- Job Address: 600 W 19TH ST Suite No D Vicinity:. GOLDEN STAR DONUTS (STE D) Parcel Nunmber: 42214220 Applicant: STARK, CHRIS Address: 7229 VARNA AVE NORTH HOLIYWOOD, CA Owner:� ROBERTSON, C7ENE H TR Address 536 SEAWARD � CORONA DEL MAR, CA Contracror. ALAP ASSOCIATES GP Address: 7229 VARNA AVE Arch / Eng : Address: ' K NORTH HOLLYWOOD, CA REPLACE 1 WATER HEATER. PLUMBING PERMIT Phone: (818)407-1247 Zip: 91605 Phone: Zip' 92625 Phone: (818)407-1247 Zip: 91605 License: 771905 , Phone: _"_ ._ Zip: � . . Cicense: SCOPE OF PERMIT ISSUED BY: StatuS: ISSUED Applied: 09/15/2000 Issued: 09175/2000 � � FEE SUMMARY '� � �� - AMT - gTY . - '„ � ' AMT QTY�: : _ .: � / . .. �AMT �TY ISSUE FEE, � � $23.50 .` -" - ' � Laundry Tub I Washer $0.00 0 - � � � Sump Pump - � ,$0.00 0 Backflow irrigation� $0.00 � 0 � Landscape Irrigation $0.00 0 �Swimminj Pool "�, $0.00 0 Backflow Preventei `. ; "$0.00 0 � � P-Trap , $0.00 0 - - Trap Primer� ' , � � $0.00 0 Bathtub � � � ` $0.00 �; , 0 - --�Pressure Regulator $0.00 0 ; � � � Urinal � . "" ,- � $0.00 0 Clarifer System � � . $0.00',' - 0 � - Process Piping (per 10 ft) $0.00 � 0 - " � Vacuum Brkr Bkflow(1-4) $0.00 0 Connect pce,Soda,etc). ' , $0.00 , 0' � � � . Receptors � $0.00 0 � � Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 � Wash Basin $0.00 0 Dishwasher �$0.00� 0 � SewerCapforDemo, .$0.00 0 WashBasinSet $0.00 0 Drain, Floor $0.00' -0 � . Sewer Connect �$0.00 0 , Waste and Vent System $0.00 0 Drein, Rainwater $0.00 0- � Sewer Private Line $0.00 0' '- Water Closet (Toilet) $0.00 0 Drein, Roof $0.00 0 " Shower � �� $0.00 0 - Water Heater / vent $12.30 1 Drinking Fountain $0.00 0 Sink, tiar $0.00 0 Water Piping pnst or RepJ $0.00 0 Expansion Tank $0.00 0 Sink, commeroial - "$0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (7-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Sokener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER 50.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access raquirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned for a period of 780 days. . , INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inepeetions and final epproval must be obtained. Failure to obtain inspections and final app�oval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244&4618/00) . . WORKERS' COMPENSATION DECIARATION: I hereby aHirtn under penalty ot Oeryury one ot Ihe tollowing declerations: ❑ I h antl will maintain a certitiGate ol consent to self-Insure orkers' compensetion, as provided tor by sectlon 3700 of Iha Labor Code, for the peAormanca of Ihe rk for which Ihis permil 15' Vetl. I heve an ' I alntain wo ' compensatlon insure , es req red by sedlon 3700 of Ne Lebor Cade, for Ne peAormance ot the work f wNch this pe�mit is issued. My wo rs pensatlo s fence carder end pof numb are: / Carrier: Pdicy Number: D�/` DOZ�-s � (This sect(on need not be comp/efed ll fhe ermir Is lue et nundred dollers ($100J or less.) ❑ I cenify t�at in Ihe pertortnance 0� t work t whic s pertnil is iuued, I shall not employ eny person in any manner so es ta become subject to ihe workers' compensetion lews oi C' if I ould 6ecome sub�ect to Ihe workers' compensation provislans o1 Sectlon 3700 oi the Lebar Code, I shall fotlhwith comply with these pro sio G� � Applicent Signeture: Date: / — �� WARNINO: FAILUFE TO SECURE W ' COMPENSATION PA E IS UNLAWFUL AN� SWLLL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES NJD CML FlNES UP TO ONE HUN�REO THOUSANDDOILNRE(E100.00O�,INADDITIa'1TOTHECO^uT0 CAMPE SATION,DAMAGESASPqOVIDEDFORINSECilON3]O60FTHElABORCODE,IMERESi,ANDA170RNEY'SFEES. LICENSED CONTRAC70RS DECLARAn N: I hereby aHirtn that I am licensed unde� p' o h� r g(commencing with ection 7000) of Division 3 ot t�e Business antl Profes �' ns Code, and my license Is in full force antl ettect Lic. a "�� Class a C' –.2 (.> Contraaofs Signature: Dete: � �� n CONSTRUCTION LENDING AGENC : ❑ I hereby attirtn Ihat there is a consiruction lending egency for ihe peAormance of the work for which ihis pertnil is issuetl. (Sec. 3097, Civil Cotle). LentleYs Name: Lenders Atltlress: Signeture: Date: OWNER-BUILDER DECLARATONS: I hereby atfirtn that untler penalry of pe�ury thet I am EXEMPT FROM THE CONTFiACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business anC Professions Cotle: Any ciry or counry which repuires e permit �o consirucL sNer, improve, tlemWish, or rapair any sVuctura, prior to its issuance, also requires Me applicant for such pertnit to file a signed statement Ihat he or she is Ilcensetl pursuant to Ihe pmNslons of the Contrectors License Lew (Chapter e(commencing wit� Section 7000) of Division 3 of ihe Business and Pratesslans Cotle) or Ihet he or she Is exempt therefrom antl the basis lor Ihe allegeU e:emption. Any violation of Seclian 7031.5 by eny epplicent far e permit suGjecis the applicant to a civil penalry of not more than Me hunGred dollars (SSW).): � I, as owner o� the properry, or my employees with weges es �heir sole compensation, WILL DO THE WORK, antl Ihe strucWre is not inlended ar oReretl for sele (Sec. 7044, Business end Professions Code: The Contraqors License Law does not apPh to en owner of Droperty who builds or improves the�eon, end who does such work hlmself or herself or through his Or her own employees, provided ihat such improvements are not intentled or affered tor sale. If, howeve�, ihe building or improvement is sold within one year oi comple�ion, lha owner-builder will have ihe burden oi proWng thet he or she ditl not build or improve for purpose ot sale.). ❑ I, es owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTOHS lo consiruct the project (Sec. 7044. Business end Professions Cotle: The contractors License Law does not epply lo an owner ol property who bullds or improves theraon, and who contracts for such pmject with e contraaar(s) license pursuant to the Coniractors Licensa Lews.). ❑ I em exempt under sec. Business end Professions Code tor this reason: Signa�ure: Date: Owner ID verifietl by tlriver'Slicen58. ❑ Yes ❑ No DnvefS LJcense No. Expire9: Verificetion oi Ownership by (type of document, i.e. - pmperry tex bill or tleed): I DIVISION OF INDUSTRIAL SAFETY GERMIT CERTIFICATION: ❑ I hereby cariity that no excavation five (5) rn mora teet in Cepih iMo which a parson is requiretl to descend, will be matle in conneclion with work euthorized by this permit, and thet no building sWdure, sceHolding, felsework, or tlemolition or dismantling ihereof, will be more �hen ihirty-slx (36) teet high. (Chap. 3.2, Grp 2, Atl 2, Sec. 341, Ttle 8, Gelifomie Adminisirative Code). ❑ As owner-builder, I will no� employ anyone to do work w�ich would require e pertnit trom the Division at Intlustrial Sefery, es noted ebwe, unless such person has a pertnit ta do such work from Ihe division. Signatwe: Date: Division of Industrial Sefery Permit Number. GOOEI, INSPELTONTYFE 1616 Fizetl System Flnal Fire Prevention 1266 Pool Spa Finel 200 Final Re-Root 207 Final BIocWReteining Well 202 Final Facfory Fire Place 203 Finel Sign 204 Final DemWition I9.Iq lllllll�i �vv[ • 206 Finel Mechanical 20B Final Plumbing 210 Final Electricel 212 Flnal Fire Prevention 220 Final Planning Approval 222 Final Sita 250 Final Building/Occupancy �i nuwoa¢ I_ � PHOJECT ADOBE55: E OO w 1 9�H JrT UNIT: C/D OWNEfl'S NAME: GhNE ROBERTSON ' aooxess: P O BOX 156 CORONA DEL MAR CA 92625 (714)760-8364 APCN/ENGINEEN: PAl R UF' P ENC I LS xec.no.:NONE aoosess:11681 CHE5TER AV uxit: GARDEN GROVE CA 92640 PENMITiEE: PAUL' S PLUMBING ( 714 ) 893-7517 aooncss: 9101 SINCLAIR AV WESTMINSTER CA 92663 LICENSEO LONTBACTOfl DECIABATION: I �ereUy aifirm Ilul I am Iiten5e0 unGer pmvi4on5 al Clupter 9(commenting wli� Seclion 7a00� ol Uivision 3 0l t�e Business and Pml¢ssiore CoOe. anG my licenu a in tull lorce an0 ellect. c�Tvuc.: sTnreuc.606153 cuss:C-36� Dale: �� 3 SipndWre: �—�� -- WOfl1IEXS' COMPENSR ION OECIABRTION: I he2by allirm Itul I tw e a ceri iwte al tonsenl lo Selbin5ure or a CeM1iliwte ai Workers' Compensalion Insurance. or a cenih¢G cow ��ereUl (Sttlion 7800. LaO. tl. POLICY NO.: E%P. ORTE: COMPFNY: ❑ Cenifiea copy is �ere0y tumis�etl. ❑ Certilied wpy B IileG v.il� tlre dry BWCing Divitiw. Oate: Md�� E%EMPIION FHOM WOflNENS' COMPENSRTION DECIAfIRPON: (II� seelun nee0 rol be eom�kteq if tlk p�ril k fa me hanOreG (5100) or less�. I cehity ltwi in t�e Oedormance a� lne xrork lo� whiU� IN5 Oermii is iuue0. I SAall not employ arry Derson in any manner so as lo Uecame su�lect lo I�e WorkerY Comoensation Laws of Calitomia. � Da1e: _(`f�// /� SiOnaium: NOTICE. II, alier aking Ihis Oeclaration. you s�oula be�ubl�� a e WarkerS' Compensafion pmvisions oi I�e La�or 1 CoOe. you mus� IoriMvil� comply wit� 5uc� D�ohsions Or lds Dermt stull Ee EeemeA revokee. CONSTflUCTION LENOING PGENCY: 1 nereey allirm thai �ne�e is a constNction lenainp agenC/ for the peAormance ol ine v/ork lor which t�is permii is i55ueJ �Se[tion 3097. Civ. C�. LENOEfl: ADONE55: OWNEB BWLOEB OECUIIATION: I nerz0y affirm tlwt I am eaempt Irom t�e Canuaclors' Siate License Law lar ��e fotlowing reason (Seclion 7031.5 Business antl Pmlessional fqAe: Any cily 0� fAunly w�it� repuir¢5 a permil lo con5lNc4 alter, impmve, tlemolish, or repair any Slmcture, prior to ils issuance, also reQuires l�e ap0��ant lor such Dermit ta lile a SiA�e4 Sla�ement Ihat �e/sne is licensed pursuant io tne o�ovisions ol ine Contractors' S�ate License Law ICtuo�er 9lcommencinp vnih Section 7000) ol Division 3 0l tne Business ana Prolessions Co0e) ar ihal ne/sne is e*¢mpt Inerelmm antl the oasis lor ine atlepea eKemplion. Any violation ol Sedion 7031.5 by any a001icant lor a Oe�mit suble��s I�e applicanllo a civil p¢nally al noi moie 1�an Irve nuntlreA dollars (5500�. I. as owner o� t�e D�opetly or rtry emyloyees wilb waAes as Neir sole compensation, will Ao Ihe work, antl Ihe ❑ slmcmre is not iNenOeU or ollere0 �or sale �Section 70aa, Busineu and Pmlessional Code: The Coniramors' State License Law aoes noi ap01y lo an owner ol a pwperiy w0o OuilOs ar impmve5 I�ereon, anG w00 d0e5 SUCh work him5¢II/�ers¢II Or I�wugh nis or her own employees. D�ovitle0 Inat sucn imD/ovemenls art not inlentlea or olleretl for sale. II, however Ihe builtlinp or impmuemenl is SOIE witM1in one year oi [ompleiion, ihe owner will �ave Ihe Guraen ol O�Ovinq �elshe ditl nol UuilA Or impmue Im ihe purpose ol sale�. I, as owner oi the Dmoeny. am e�clusively [onlraciinp with IicenSed contra[�ors to con5imcl lhe D�olecl (Seclion 7044, Business ❑ an� PmIe55i0n5 CoAe: TA¢ ConVaclars' Siate Liceme Law Ooes noi aOPly �o an mmer ot Oroperty wfw �wlAs ai impmves Iherean antl wno conlratls lor sucn o�olects wi�n a conUacior�sllkense oursuant ta the Caniraclor5' Stale Laense Lawl.l am aware I�at pmol ot I�eii Worker's Compensaiion insurante stwulE �e O�a�0e0 lo me. � I am exempl untler Seclion: B. 8 P. C. lor t�is reason: oate: ' O.mer. I eo hereey cetlily inal I am aware of an0 unCerstana Ine repuiremM6 al Califomia Healtn ana Satery CoOe Sections 25505, 25533, an0 2553E ana Inat I or any IWure builGing acupant wilVvnll n01(iuUe ane) neeG lo campty wi1� ui0 sWte coGeS anA Ihe requiremen�s br a Oermit Im convmc��on or mo0i6cation �mm t0e Ai� uahty Manaqemem Oislrict. ResiEentul wnslmction appliwtions are ezem0� ��om ��ese Dmvisions. � Dale: ApPlitdnl: 1 nereoy ceNly inal l nave read in5 aov�ication ana state ilWl ine a0we inlormatian is carrect. I apree 10 [omON �^�n all ciry ane caunry oremanre5antl51ateWwSrelalinglOGUJNngmt51NOi0natW�er¢Oyaullnr¢eteyes¢nlative5olllti5q�y�o eruponiheabove�mentionetl pmpeiiy Iar inspect�o^n pur oses. Dale: � " SignaWre: �' �river's �icense or Soua� Secunty .: � i6at-a6 White—BuiWiig; Green—CoOe Enlorc¢menl: Canary—Applicenl: Pmk—Revenue: Gobanrop—Assessor CITY OF COSTA MESA — BIIILDING PERMIT PERMIT NO; P 063070 PLAN CHECK NO; CONSTRUCTION TYPE; PERMZT TYPE: PLU JOB DESCRZP'I'ION : 1386SF DONUT SHOP T.I. CLAIM VAL(lE; CALC—VALUE: Y Yt:K NV: Vb�V/V (a V�1�; SUY ; N PURPOSE: OTH SQ FT; GROUP OCC; B-2 / COMMENTS: THE "SUNRISE DONUTS" / RE: 862998 ��**��****�r***�r��**�****��rx*�r�e��r*�*��r*��*x****�***�**�r� �rxx*xx�*�**+r�r�**�#�** Z O N I N G R E Q U I R E M E N T S S E T 8 A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT ZN REAR; FT IN FRNT; FT IN REAR; FT Itv LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARXING AEQ• PROV: PARCEL: 42214220 'LNE; REF NO; PLANNING NdTES> > iE iE it iE iE if k iE iF 1! if jF iF ik iF iE iF ib if if iE iE 1t i! ik if it if iE if % k iE iE iE iE if 1E i(�i! K-if �k iE iE 3h i�iE !f it il iE it if it iE 1tlE it iE iE 3f iE i4 iE �E iE if it * iE1E fE iE iE ik ie if �1F D E V E L O P M E N T S E R V. ;I.. C E S-;'• R E� U Z R E M E N T S ZONING APPROVED BY %' DATE; ✓ ,� " BUILDING APPROVED BY APPLZCATION ISSUED BY• ie�r*rt*ieit�rit+�ie**ir�+c ��x*it fE iE iE iE fE if k iF ik iE iE iE if if 7E it iE 1f if if N� iE k if if if if iF ik if if �f if it k if i! if LEGALIZATION;N F E E S � DATE; ' � DATE; �% �o 1tSF3F3FiE�FTit�,�Tf�it�F�fF�t7FiFiFiZ��F7EitkfEik3EiElkiFN� �ft fr iF±E �� k �f if jf if 1tiE jE lE dF ik it k k M� k iF if k if if ik ik ik 3F fP iF �%it �E IF iE ik iF iE iFlf iE if U M M A R Y ST'kUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 27,00 25t SMIP/NON—RES PLAN �y - / — ISSUE FEE 20,00 BUILDING—DIV—> PERMIT ISSUE P}.P:N—CHECF( TOTAL PAID DUE TOTALS----> 27.00 20,00 0.00 47,00 47.00 ,00 REVENIIE DIVISION TOTALS--> COLLYg:CTED: 47 00 OVEA/SHORT; 00 BLDG PMT PLUMBING ELECTRZC MECHANIC FIftE SMIP/TOT GRADING PLAN—CHECK 97,00 Ji % K iF # iF aF 3F i?� iE iF iE if ?F?F iF i� iF iF if 1F iL #� iF iF iF iF i%iF # iF iE iE iE i! i(' If �lE 3E �IE if iE iF 14 IPl4 IE ik �F i(�it i(� iF 1E iE if 1E iklF lE i4 iF 1E iE� if if if fE 3F if iF 3F )E!E 3tlP iE 16 iE I N D I V I D U A'Ii;' F E E H R E A K D O W N %' TYPE QTY D E S C R I P T Z O N IJNIT COST TOTAL COST PLU 1 SINK, KITCHEN '; 7,00 � 7,00 PLII 1 WASH BASIN '' � 7.00 7,00 PLU 1 WATER HEATER AND/OR%VENT 7,00 7.00 PLU 1 GAS PIPING SYS OF ��1 TO 4 OUTLETS 5.00 5,00 PLU 1 GAS PIPING SYS S+ �OUTL—PER OUTLET 1.00 1.00 � END OF FEES .� "a`' Oi 00�4301�—Q0143Q10 Ti] T d7.Q0 DATE: U7l16,'93 TIpE: i1:33 ..L - GONSTRUCTION AND PI.ANNING APPROVAIS Permi<-r 1. Temporary Electrical Service o� Pole 2. Soil Pipe�Undrgmd. ' 3. Eiectrical G�r.durt Ub!i!y�U��drgmd. � 4. Electricai Condurt�Jntlrymtl. 5. Steel Reinforcament . 6. Electrice� UFER G�r.d � i __ � 7. Puoti�qs . � --- ; 8. Fou^dat�on ' 9. 1Nater P�pe�Und�9�rd. 70. Structural Floor System . it. Properry Se�eer Linu & House ConneCion 12. Sewer Cap f 13. Roof Ora�ns 14. Rough Plumb�:�g 75. Rough Flaccr�ca�-Condu�r 16. Rough ElectricbViring 17. Rocgh l'l:nng 5�gn 18. Rough El,etrical�T Bxr Ce.;�rg 19. R�u3h Htat�ng & A.r Co�j"! oni�g � 20. Rou9h Factory Firao�ace 21. DuMs, in Sructura 22. Dgas, Vent�l.iting 23. Gos Pipe Roagh & T�.t 24. Raof Framl^g 25. Roaf Sheati��,�� 26. T�Bar Ce:tin915t��ctu�311 &'d�o��coat 77, Frame and Flashing-- - J 28. L'dthing & S�d�ng 29. Insulahon 30. Dryc.ail Na�linq 37, P�aster 8�oc.� Goat � 32. Eleetr:calPa�.�`Pi_�.,-°----- 33. F,r.;' E'.ecr c 34. Fin�l Heat�r�., & A_Cord�t'orl�; - 35. Final Ges Pipe�Tc=t , 36. Hood or CanopV 37. F�nui Factory F�rep,ac2 38. Finai Plumb:ng 39. Water Service-�inai 40. Gas Service�Final 41. $olar pomesnrFinai 42. Backfiow Prevencer . 43. B�ckflow Inigation 44. Lands4pe Irnqation Syst�n� 45. Sound Attcnuation 46. Handiwp Rcgu�aTons 47. FINAL STRUCTURE F, 6�ILDING 48. FINALPLANNING 49. Electric Release to Edison 50. Gas Release to Southern Califo�nia Gas C4 51.-CERTtFICATE OP OCCUPA�CY No. Datc Date a POOL .PA laspector APPROVALS Permit � 52. Pool & Equipment Locat�on 53. S!eel Reinforcement V 54. Farqi; I 55. Electrical8onding 56. Rough Plumbing & Pmssurc Test � �� 57. APPFlOVAL TO COVEN GU�:i � E � �'__- ---- : _ I 58. Elcctncai Cundu�? �ndr_cd. ; � I _ � 5�J. G�.� P�pe. � Und:g•^d . hci � c I Date Inspector I i � i __ i i --r I - -�- � I --�.- - 60. B�rkr shL�nu�,P.7rap r.:l.�d•,,•,a. ' I - -- __"__'� �__1___"' 61. APPROVAL TO DECK �_ � 62. Batk�vash & RrcuVro� Fina�� ! ' 63. Huater & VenbFinal ��-_-- � --- - - - -7 G4. Plumbing System � F�oal � G5, Electrical-Final � 6G. So�ar System�Fina! - --- �, 67. Frncing & Acccss Aoproval 68. APPROVED FOR PLASTEfli�VG 69. ?OOUSPASYSTEti7SPINAL � � _ I - -._ FfRE DE?T, REQUIREh7EiVT i . ' I APpROV/:LS Permit �= � -�- -- i "- � 70. Underc,ra�nd Hyd� � � � � 71. Predcct P'pinq fl G�s '�' Od I _'�-- - � -�- - --r �%2. Undargrounii I 1u5�• � _ ___,._._ ___�__�_____ I%3. Undergmd. Stor ;c T�r,:; ;� Gas .' O.I � � -- - --- -1� -�---- - � 74, Uverhead Hydro � � - ----+--- -i- - -- • 7C:. Dry ChumiCal ' ------ --�---- _ . 76. Dry Stan.ipipe __ _ _ 77. FIXED SYSTEM FINAL - -�-- _I 7E. FIRE PREV. FINAL _� �_ 1 ; i HEALTH DEPT. REQUIREfLiEN i � �79. PINAL I� .,----- - - ---- --- ---r- -- - `1 �"[ CT i C'J � -I-- - 90. FC`OD CE FTI( ICl� E �E$U�D ' - t-- ot°„� :,z-��_ ��' �� - . � ---- -- ----- - - - - - - . Ci�y ot Costa Mesa Development Services Depariment � BuildingSafeCyDivision P. O. Box 1200 Costa Mesa, Califomia CERTIFICATE OF OCCUPANCY No. gQ2�f�� The Building located at FinO CIIaah 1�IFh Shc[�ah. iinif � has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group '9 Occupancy. � Use of Building Mini Markah Legal pescription d��—ld�—�(1 (See reverse side for Metes and Bountls) Building Permit No. R 3�795 Electrical Permit No. R�'�4(1? Plumbing Permit No. P 7�7Q7 Mechanical Permit No. � 3�� Number of apartments and/or guest rooms ISSUED T0: .Taan Rnhortann 536 Saward Road r.,,-�� .a�t Mar. C`8 Building Official William T. Ho�arcl 7 / by � i-„� :' -- Date anri 7 1 A. 1 QRca This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. cMF 1015�a6 rev. 1/83 White � Owner, Cana••� - Numerical File; Pink - Bldg. Permi[ File i AOC��ant to tlll in all s0aees except those within heavy Dortler Ilnes antl sign all ciTi'��F COSTn MESA , CONSTRUCTION PERMIT ; Pr j�L add��: GDJ � 19'�'k Sle /a � ApplicanYsMailingAddress� !s�3( S�a�.JarA Qr�i. ('Di'h Owner'sName S�aN y �� •'—' Phone Address �G 5«.�....A 2.d C. �..�r. c.��l Mar Arch/Eng. License No. Address — Convacror's Nam Phone Address (m�'i��g) � Ciry License No. LICENSED CONTRACTOR DECLARATION I he�eby alfi�m tbat I am lic¢nsetl untle� provislons ot Chart¢r 9(commendn9 with section ]000) of Oivision 3 0( the Business antl Prof¢ssions Cotle, antl my license is in full force antl eitect. , License Clazs LicenSe No. Date Si9nature •NORKERS'COMPENSATION DECLARATION �ereby af(irm that I have a certifitate of consent to selbinsure or a certiflCate Wotkers' Compensation Insurance, or a cartifietl copy thereof (Section 3800, LaO. C.) Policy No. Company 8 Cer[ifietl copY �s M1ereby fu�ni5h¢tl. Certifietl coOY is (iletl with the city Builtlin9 Divislon. Date APPlicant EXEMPTION Fi30M WORKERS• COMPENSATION DECLARATION (Thissection neetl not be completetl if the permil is tor one huntlretl ($100) or less). I certity [hat in [he pe�to�mance Ot the wo�k fo� whiGh fhis pe�mR is Issuetl, I shall not emPloy any pgrson in any �nner So a^` e 5 79ct to the Wolk¢�5'' COTD0f151HO�yldWS ot Califo ia. / Wo�kers' Compen5ation provisions of Labo� Cotle, you must forthwith comply with suc� O�ovi5iOn5 or � permit Shall De tleemetl revOketl. CONSTRUCTION•LENDING A CV I hereby aifirm that lnere iz a mnstruction lentlin9 agency for the performance Of the work for which Ihis permit is Is5ue0 (Section 3097 Clv. CJ Lentler'S Name �en0er4 Atltlress - OWNER BUILDER,OECLARATION � 1 hereby aHirm ehat I am ezempl from the Contractor's License Law for the following reason (Section 7031.5 Business antl Professional Cotle: Any city or county which require5 a pe�mit [o construct, alte�, impvove, tlemolish or re0air any structure, prior to.its issuance, alm requires the applicant (or such permit to tile a signetl statement Ihat he/She Is Iicensetl pu�5uant to the proviSiOns of •he Cont�acto�'s Li<ertse Law, (Gnapte� 9(commencin9 with Section ]000J o( `vision 3 of the Business antl P�ote55ion5 Cotle) or that he/she is exempt erefrom antl the basis tor.the allegetl exemption. Any vlolation of Section _ 031.5 oy any applicant for a permit subjects tne apP��an[ to a civll ty ot not more than five huntlretl tlollars (§500�. e I, as owner ot [he property o� my�ewipLa+pB'�v+ith wages as their Sole compen5ation, will tlo the work, antl the structure Is not intentleG or otferetl for sale (Set[ion 7044, Business antl Professional Cotle: The Contractor'S License Law does not apply to an owner ot a proper[y who builOs or improves Ihe�eon, antl who tloes sucb work himself/he�selt or thrOugh M1I5 0� h¢r own employees, provitletl Ihat such improvementz are nOt IntenOetl or aftetetl for sale. 11, noweve�, [he'Duiltlin9 0� improvemen[ Is soltl within one ycar o( com- pletion, the owne� wlll have the burtlen of proving he/she tlitl mt builtl Or im- �1rova for tne pur0o5e of sale). � U I, as own¢r of th¢ pro0erty, am exclusively contracting with liGensetl COn- tractors to mnstruct [ne projett (Section 7044, Business antl Pro1e55ion5 COGe: The Contraclor's License Law aoes not apply to an owner oi property who buil�s or improves ihereon, antl who conVaCIS for such projettz with a con- [ractor(51 I�cense pursuant t0 tM1e ConVa<tor'S License Law�. I am awa�e that proof of their Wo�ker'S Compen5ation inm�ance shoultl be provitletl t0 me. ❑ I am exemv� untler �ection r rpnthis reason I hereby adrti intormation is antl state laws 52fILd�IV25 O� inspection ou)r Signature L �OriveR�' Licens 1F 0865-46, re•/: owner nave rea the above ortlinan�es TYPE OF CONSTRUCTION LJ'NEW LJ AOD 13? ALTE tlATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER, DESCRIPTIONOFWORK/USEOF.BLDG. ��^vp"� J^��— �D��ate Oeclarations. > N/19ta REPAIR TVP�PERMIT LI GRA�ING LJ FOUM7ATION LJ STRVCTVRAL TENANT ❑ ELECTRICAL ❑ PIUMBING ❑ MECHANICAL ❑ OTHER PRQIECT DESCRIPTION 54. FT OCCUPANCv CONSTRUCTIONTVPE VALUATION$ �L6 �DD✓ ZONE GRADINGCV.YDS. AC13E5 Remarks: P C T�Q. I3 5 �7,��(� 1� G#� lo I-� c- PLUMBING FEES 3ar Sink 3ackflow Preventer 3ackflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Flaor Sinks •i GasService '�Outlets Interceptors , i Kitchen Sink Lavatories -" P—Trap Roof Drains " • - ReinspeRion Fee §75 Boiler Duct- Under Ground � Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepUFact. Bic ICBO # tleating System & Ducting ❑6100,000 BTU 0700,OOOBT Hainspection Fee - Building; Canary - Applicant; Pink - A<counting; GOltlenrotl - Assa55or $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash Laundrv Trevs Issue Fae Hood or Type I ❑ Canopy Typell ❑ Refrigera[ion System ❑o-ioo,000aru ❑iao,000 System Repair/Alteration Fire Dampe�s Registers laue Fee $ 3 $ 3 A.P. �I'+ S Main B E T Front 8 Rear A C Right K Ping. Ref. # Planning Notes: 7640 3/28/BB � / Zone � Accessory euilding: ` , Parking Req./Provided Automatic Washer ConstructiOn Pole Sub. Cooking Unit Dishwasher Fan F.A.U. Fixtures Device Boxes OuUets Switches Garbage Disposal Generator 00�5 KW ELECTRICAI Transformer ❑ 15�50 KW ❑ SO+KW Meter ❑up to 100 amps Meter ❑over 100 amps $uh Panel Motors�61 HP�1Yh-8 Ina Solar �9-75 HP 016�15+ Microwave Pole Light Range S[anding Sections 5-15 KW Trash Compactor 210000 TL FEES Z O N I N G R E � M T S I Rainspeetion Fae I$15 ' I Issue Fee I $ 3 I DEVELOPMENTSERVICESq/��Q/��JI/q�]EM TS:(.� � /J3G� 2oning APProved BY—�Lu ��' ` Date `J Building Approved By T� Date� �_ ]� Appliotion laued By Date� � `^' SUMMARV OF FEES BUILDING PERMIT $ ZQ�. � SMIP $ 3. o� PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL S TOTAL FEE $ �� • V� PLAN CHECK 25% $ , POOL & SPA � '' CONSTRUCTION AND PL'IYNNING . • • APPROVALS Permit#�' Date Inspector qppROVALS Permit# � Date Inspector 1. Temporary Electrical Serv� e or Pole 52. Pool & Equipment Location � i� 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement • � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ;[; .� 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � � 5. Steel Reinforcement 56. Rough Plumbing & Pressure.T,est � 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE � 7. Footings � 58. Electrical Conduit-Undrgrnd.`- f 8. Foundation - 59. Gas Pipe, � Undrgrnd., Testr { � 9. Water Pipe-Undrgrnd. '•' 60. Backwash Lines, P-Trap, O Undrgrnd. !'! 10. Structural Floor System `: 61. APPROVAL TO DECK �%. � 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final � 72. Sewer Cap 63. Heater & VenrFinal � / 13. Roof Drains 64. Plumbing System - Final � ;� 14. Rough Plumbing 65. Electrical-Final ' 15. Rough Electrical-Conduit _ 66. Solar System-Final ' 16. Pough Electric Wiring . 67: Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL �- 19. Rough Heating & Air Conditioning . . � FIRE DEPT. REQUIREMENT .� '� 20. Rough Factory Fireplace APPROVALS Permit # _ � 21. Ducts, in Structure 70. Underground'Hydro• 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � � .e 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil '' 25. Roof Sheathing 74. Overhead Hydro _ � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . • ' 27. Frame and Flashing ��p, r 76. Dry Standpipe , - • - � 28. Lathing & Siding 77. FIXED SYSTEM FINA�L '' "; 29. Insulation ' 78. FIRE PREV. FINAL ' • 30. Drywall Nailing _ a y� HEALTH DEPT: REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION : ' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE I�SSUED 33. Final Electric � Notes: � - 34. Final Heating & Air Conditioning < 35. Final Gas Pipe-Test ' ' 36. Hood or Canopy � � 37. Final Fac[ory Fireplace � . 38. Final Plumbing ! ' � '- - 39. Water Service-Final � . 40. Gas Service�Final • 41. Solar pomestic-Final � ' ' 42. Backflow Preventer � . 43. Backflow Irrigation � � . � � ,� � 44. Landscape Irrigation SYstem �_ - '. ' 45. Sound Attenuation . �-' � 46. Handicap Regulations � � ( � . 47. FINALSTRUCTURE&BUILDING � �C � • � 48. Special Requirements Completed , 49. Electric Release to Edison � �� 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY +, � No. Date .. A__„___. ._ .�..:_ "�. "____" _'"___...._"_ ..:..:_ �__.... �_"'_" .�__" _�� ,'."__.:...e we..�,...:..... �t7v oF COSTa MESA CONSTRU �ION, PERMI,T,� / ProjeRAddress 6�6 �' � �� +- � 0 Applicant's Mailing Address 95 � a%� O// L. Owner's Name Phone Addreu Arch/Eng. License No. Address Contractor's Na e Pho e yZ ��a Addresslmailingl ��i—'�«�� e�� Ciry License No. LICENSEO CONTFA R DECL RATION I hereby altirm that I am licentetl untler provisions of Cnarler 9(commencing wi[h section 1000) of DlviSion 3 0l tha BuSinesS antl Pro(e55ion5 Cotle, ane my Iicense is in tull tor<e ana ettect. ��6. � Q� License Class � � License N�o oare �`- 7 fr 4' P 95 l '• - CQ= �„'�"��rT— WORKERS' COMPENSATION DECIARATION O I hereDy aifirm that I have a certi(icate ot consent lo sali-insure or a certlficate o( Workers' Compensation Insurance, or a cerUfietl copy thereo( (Section 3800, Lab. C.) PoliGy No. Company Certilietl copy Is heraby furnishetl. Certi/i¢a cOPY IS filetl with [h¢ city Builtling DiviSion. Date APplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be completetl if tha permit is for one huntlretl (S100) or less). 1 certi(y that in lhe perfOrmance ot the work f0/ wltich this Oe�m�t is i55uetl, I shall not employ any porson In any manne(�So as to b�ecom bject to the Workers' Compen tlon Laws of California.' �^`YG. Da[e � ^ 2�SI9naturC NOTICE: If, atter ma i g[his tleclarailon, you shoultl become subject t he Workers' ComOensation proWslons of th¢ Labor Cotle, you mu5t tort with wmply with such provisions or this permit shall be tleemetl� revoketl. GONSTRUCTION LENDING AGENCV ' I hereGy affirm that there Is a ConStvuction lentling a9ency for [he performance of the work for which this permit is issuetl (Sectio�309i Civ. C.) Lentler's. Name ' �entler's Adtlress' OWNER BUILDEH �ECLARATION I hereby affirm tha[ I am exampt from Ne Contractor'S Llcense.Law tor [M1e following reason (Section ]031.5 Buslnass antl Professional Cotle_ Any clty or 7031.5 by any dpPlicant tOr' a p¢rml[ subject5 Ihe applicanl [o a clvu penal[y of nol more than ilve buntlretl tlollars (5500). ❑ 1, as owner oi tne property or my employees with wa9es as their sole compensation, will tlo the work, antl tha s(ructure is not intentletl or offerea for sale (Section 7044, Buslness antl Professional CoUe: The Contractor's Litense Law tloes not apply to an owner ot a property who builtls or improves thereon, antl wno tloes such work himielf/nerselt or Ihrou9h hls or her own employees, prOvitletl that Such impfOvomen[5 dre not Intentl<� Or offeletl (or sdle. Ii, howeve�, the builtlin9 0� Improv¢m<nt Is soltl within one yea� ot cOm- pletioq the owner wlll have the burtlen of proving he/she tlitl not builtl or Im- prove forthe puroese of sale). ❑ I, as owner ot the prooerty, am extlusively contracting wltn Iicensea con- tractors to construct the project (Section 7044, Business antl Profeszions Cotle: The Contractor's �License Law tloes not apply to an owner ot property who builtls or improves thereon, antl who contracts (or such projects with a con- tractor(51 lic¢ns¢ pu�suant to Ihe Contra<tor's License L.aw). I am aware that prOot Of theit Worker'S COmpensation Insurance shoultl be P�ovitletl to me. ❑ I am exempt untle� Section � B. & P. C. for thi5 reaSon Date Owner f hereby certliy that I have reatl Ihis applicatlon ana state that the above information is correct. I a9ree to comply with all city antl county ortllnances antl state laws relating to bulltlin9 �oSstrucNon, antl hereby authorize repre- Sentativ¢z o1 thi ty to ente� yqon[ha dboye-mentio0etl property for inzpection purpo es n / (/ _ // Signatme /w.��lh/�Y�p�> Date�,`�3"'�ff Drivers' License or 55 � �' ' �'a 7 9 �, ,...�. ..�. _� . ..�. �,., , , �. TYPE OFCONSTRUCTION NEW FiOO ALTERATION REPAIR ❑ GONVERSION ❑ DEMOLISH ❑ OTHER q,p, # DESCRIPTION OF WORK/USE OF BIDG. S Main Buildi E TVPEOFPERMIT GRADING FOVrvDATION STRVCTURAL T Front ❑ TENANT ❑ ELECTRICAL �PLVMBING ❑ MECHANICAL A Reaf ❑ OTHER PROJECT DESCRIPTION Sq. FT. OCCUanrvCV C Right K Left CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CV.YDS. ACRES P�ng. Ref. # Remarks: �� J 9(� Plannin9 Notes: Bar Sink Backflow Preventer Backflow Irrigation Bachtu6s Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P-Trap Roof Orains Reinspection Fee $15 Duct- Under Ground Duct - Structurel Duct - Ventilating Ezhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0�100,000 BTU O t 00,000 8Ti Reinspection fee � $15 CMF 0865-46, rev. 30/04 Wltlte - Bulltling; Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Asseszor $hOWerS Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swiinming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash Laundry Trays Issue Fee Hoad or Typel ❑ Canopy Type I I ❑ Refrigeration Sys[em Oaioo,000aTu �ioo,000eru System Repair/Alteration Fire Dampers Registers Issue Fee FEES � Automatic Washer Construction Pole S� Cooking Unit Dishwasher Dryers ❑Gas ❑EI Fan ' F.A.U. Fixtures Device Boxes ' OUtleSS Switches Gar6age Disposal Generator �0.5 KW l 7642 3/28/8f1 Zone Accessory Building: Perking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 700amps Sub Panel Motors D O-1 HP � 1 h- 8 Inc. Solar �9�15 HP �16-15+ Microwave Pole Light � -f: Range , Sign Standing Sections � 15 KW Trash Compat[or $ 3 I �— Reinspaction Fee $15 luue Fee FEES DEVELOPMENTSERVICES RE�UIREMENTS: 2oning Approved By Building Appraved By APoliption Isued By $ 3 SUMMARY OF FEES BUILDING PERMIT S SMIP PLAN CHECK $ � PERMIT PLUMBING § ISSUANCE PLAN CHECK 25% $ 3• 5 ENERGV P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% $ 5 20 e 50 T i. FEES $ 3 Z O N I N G R E � M T $ CONSTRUCTION AND PLANNING . POOL & SPA �APPROVALS Permit# Date Inspector pppROVALS Permit# Date Inspector 1�-�Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. � 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electricai Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO�COVER-GUNITE 7. Footin,gs�, � 58. Electrical Conduit-Undrgrnd. 8. Foundation � ;• 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe:Undrgmd. - 60. Backwash Lines, P-Trap, O Undrgrnd. .10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 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. APFROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling �., �;;�..� � 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ,'r` 20. Rough Factory�Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts,Ventilating 71. ProductPipingOGas ❑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 , ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL � i 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: � l�� 34. Final Heating & Air Conditioning � � �/i 35. Final Gas Pipe-Test " ' � 36. Hood or Canopy , 37. Final' Factory Fireplace � 38. Final Plumbing � 0� i/, � . 39. Water Service-Final - - 40. Gas Service-Final � 41. Solar pomestic-Final . / . ; 42. Backflow Preventer . 43. Backflow Irrigation , ' � , 44. Landscape Irrigation System . � � . ' 45. Sound Attenuation � ": 46. Handirap Regulations . ' �' - �.h�. 47. FINALSTRUCTURE&BUILDING � � ' ' 48. Special Requirements Completed � � � 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co . . 51. CERTIFICATEOFOCCUPANCY `j N0. Date • •' f � .. . . . .r� � � Applicant ta flll In all sDaces except inose wltnin neavy eoraer 1(nps antl sign all approprlate tlectaretlons. cI7Y �F COSTA Esa C�QNSTRUCTI�N PERMIT r�nicoc aaa,e�s �OD lJesa� / y— Si�c. /� •P.Pplicani's Mailing Addrets �A`�C- Owner's Name -��a w 12e�+�'S» Phone >6'�'Jv73 Address �� Sec..�ord ?el. C,orouc. a..� anqr Arch/Eng. License No. Address Contractor's Nam hone Adcfress (mailingl City License No. LICENSED CONTRACTOR DECLARqTIO1V I h@�eby atfirm that i am IlcenSetl untler proviSlOns of Charter 9(commencing wl(h sectlon ]000) of Dlvislon 3 oi the Business antl Profeisions Cotle, antl my IlCense is in full torce antl effect. License Class Licensa No. Dale $I9naturG yW*,ORKERS' COMPENSATION DECLARATION j'„„�@reby attirm tbat I hdve a certifiCdt¢ ot tOnsenl to TOIf-InSur< Or a celtifltate �, WOrkefs' COmpenSdtiOn Insurance, of a ceftlflGtl cOpy ttlereof ($ectiOn ��'.�800, Lab. c.) Pollcy No. Comoany BCertifietl coDY �5 hereby (urnishetl. Certifietl copy is (iletl with the city Builtling Dlvislon. Oa[e � Appllcant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnis SeCtiOn neetl not be cOmpletetl if tne pGrmlt Is !or One nUntlratl (5300) or less). I c(�tity thal in th¢ pertormance ot tpe wOrk to� whiGh [his pe�m�t is issUetl I shall n0[ emp Oy IlnY P�rion in any mann¢f so d5 I 5 ject (O t�le Workers' o n t' Laws o/ Califomia. Da�e Si9na[ure � � N071eE: If, a er makin9 this aeclaraC , you shoultl become subject to the Wo�ker5' Comp¢nution provlslon5 Ihe labor CotlG, you mu5t /orthwith Corytply with such prOvi5lon5 or hi5 pe�mit Shall be tlGeTetl revOkeO. CONSTRVCTION LENDING AGENCV 1 heroby alfirm that thero is a construction lentling a9ency tor the oerlormance ol (he work for w�ich thls OerTit is ISSuatl (Se<tlon 309] Civ. C.) LnnEer's Name �entler•s Atlaress OWNER BUIIOEN UECLANATION I herGby diflrtb that I am exOmO� �rOm the Contrdctor'S License Law for tne followlog reasOn (Section 7031.5 Busineisantl Prp/ei5ional Cotle: Any Uty or <Ounty wnith �equi�es a pe�mil lo con5t�ucl, dlte�, Imp�ove, tlemoli5h Ot r¢pal� any strucWre, vrior to its Issuance, also requires tho apolicant for sucn pormlt to fiie a siqneq statement that he/she it lic�nsatl pursuant to the proviilons of Ihe Contractor4 License Law (Chapter 9(commeocing wl[h $ection 7000) ol 11��sion 3 of [he Business antl Profeisions Cotle) or that he/ine is axompt 1CrOtrom an� tlt0 ba515 lo! th0 allegetl exemPlion. Any v101ation Ot $BCtion i031.5 by any applicant lor a permil zubja<ts tha appllcant to a civll ✓�e alty ol nol more than flvo nuntlred tlollars (E500). I, as own¢� of the praporty . , .. . an owner of a oroperry who builtlz or improves �ork pIm581t/herSCH or Nrough his o� h0� own imorovements are noc intentlea or otterea lor sxle. If, noweveq tne bulltling or Improvomenc is soia w�mm one year oi com- plellon, Ine oWner will have Ihe burden of Proving ne/she tlltl not builG or im- �rove for lhe purpose of sale). I, az owner of the proverty, am excluslvery con[ractln9 wit� Iicensetl wn- tr8<toR to consV uct lna project (Section ]044, Businasi and Professionz Cotle: The ConVactor•s License Law dOes.not appty to dn owner ot proPerty who bViltls or improves tnereon, anC who contracts tor such projects wlth a con- t�actor(s) iicense pursuant to tne Contractor's License L.aw). I am awaro that P�oof o( tM1eir WO�ker'S Compensaqon insurance should be ProvitleE to ma. ❑ I am exempt untler Section 8. L P. C. for this reason �.m�-iii �i s �.r.vza TVPE OF CONSTRUCTION U NEW LJ ADD L"J ALTERATION LJ REPFIR ❑ CONVERSION ❑ DEMOLISH ❑ OTH R DESCRIPTION OF WORK/USE OF BLDG. ��uvQ�' � TVPE OF PERMIT LJ GRADING LJ FOUNDATIOt�/fJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING bJ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SR.FT. OCCUVArvCv— CONSTRUCTION TVPE VALUATION $ 20NE GRA�INGCJJ.V�S. ACRES_ Remarks: Bar Sink eackflow Preventer Backflow Irrigation Bathtu6s Clarifiers Drinkin9 Fountains Floor Dreins Floor Sinks GasService Outlets Interceprors Kitchen Sink lavatories P _Trep Roof Drains Reinspectian Fea $15 Duct - Under Ground Duct � Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepUFact Blt. ICBO # Heating System & �ucting ❑6100,000 BTU 0100,000 BTi f �'�� -�"—�� I I Reinspection Fee I $15 � orivers' Lice r 55 9F — CMF 0865-46, v, 30/04 Wnite - Builtling: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal wBICI CIOSCi Water Heater Water Service Auto-Wash Launtlry Trays laue Fee � $ 3 A.P. # S Main Buildi E T Front B Fear A C Right K Lef[ S Ping. Ref. # Planning Notes: Automatic Washer Construction,Pale Sub. Cooking Unit Dishvuasher Dryers ❑Gas ❑Elec' Fan F.A.U. Fixtures Device Boxes Outlats Switch¢i Garbage Disposal Generatar �65 KW C Zone Accessory guilding: Parking Req./Providetl ELECTRICAL Transformer � 75-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors�0.1 HP�1:5-8 Inc.Solar �9-15 HP �1E15� Microwave Pole Light Range I I Standing Sections 5 KW I I Trash Compactor Reinspection Fee � 515 Issue Fee IANICAL FEES Hoodor T DEVELOPMENTSERVICESREQUIREMENTS: ype I ❑ Cenopy Type II 0 Zoning Approved By Building Approvad By _�� RdeIfrigeration System p0.100,0008TU ❑100,000 System Repair/Alteration Fire Dampers Fegisters ��a Faa �s � s�fr Z O N I N G R E Q M T S FEES $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PIUMBING $ �SSUANCE S PLAN CHECK 25% S ENERGY P.C. S EIECTRICAL $ GRADING 5 P�AN CHECK 50% S ��--��jj��-- MICROfILM 5� MECHANICAL $--.�5� TOTALFEE S 3 7.5 PLAN CHECK ZS% $ � CONSTRUCTION AND�PLANNING POOL & SPA APPROVALS PermiY# Date Inspector qppROVALS Permit# Date °Inspector 1. Yemporary ElectricaCService or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement q 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' . 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test : 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � 7. Footings 58. Electrical Conduit-Undrgrnd. � �8. "Foundation 59. Gas Pipe, O Undrgrnd., 7est '9i ,Water Pipe-Undrgmd`. - � 60. Backwash Lines, P-Trap, � Undrgrnd. �i 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connaction 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains . 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electricai-Co�duit 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign� 68. APPROVED FOR PLASTERING � .18. Rough Electrical- Bar Ceiling 69. POOL(SPA SYSTEMS FINAL .�. 19. Rough Heacing $'Air Conditioning PIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # !2�{. Ducts, in Structure 70. Underground Hydro • Y.. 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil, � 23. Gas Pipe-Rough & Test 72. Underground Flush "� , 24. Roof Framing 73. Undergrnd.Stora9eTank OGae ❑Oil • � 25. Roof Sheathing 74. Overhead Hydro �� 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �' 27. Frame and Flashing �5,., 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 �;j ' �/ 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED {'� „. 33. Final Electric Notes: � ' 34. Final Heating & Air Conditioning ' _'`- 35. Final Gas Pipe-Test 36! Hood or Canopy _' � 37. Final Factory Fireplace � - 1 38. Final Plumbing � ' � r 39. Water Se�vice-Final � ,� � , 40. Gas Se{vice-Final � G � � ; 47. Solar pomestic-Final � � r • � 42. Backflpw Preventer � t - � 43...Backfldw Irrigation ' /� i � � � • � 44. Landscape Irrigation System � -� � � � ' ' �� 5. Sound Attenuation ' �` �, • 46. Handicap Regulations � 4�.,FINAL• STRUCTURE & BUILDING� � " , � 48� SpeciaS Requirements Completed • - ' � 49. Electric Release to Edison • � ,7 50. Gas Release to Southern California Gas Co �� i� 51. CERTIFICATE OF OCCUPANCY i / y�. No. Date • . '� -- Aoplicanl to fill in all spaces except those wit�in �eavy bortler lines ana sign all approorlate tleclarations. CI7V oF COSTA ME A CONSTRUCTION1PERM ^ Proje�tAddress �� 1 J��4'f' �9 �'! � Appl icant's Mai ling Address Owner'sName �G� � Phone Addreu 5� G fiea�.lr�c� �.�. C�"vi+w �c� �ar Arch/En9. License No. Address Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm [hat I am licensetl untler provisions of Charter 9(commenUng wi[h sectlon 7000) of Divislon 3 of the Business antl Professions Cotle, antl my Iicense is In full for<e antl effect. License Clazs License No. Date Si9nature WORKERS' COMPENSATION DECLARATION I nereby affirm tnat I have a cer[iticate of consent to sel!-insure or a certificate of Workers' Compensation Insurance, or a certitietl coOY �hereof (Sectlon �3800, Lab. CJ Policy No. Company Certifietl copy i5 hereby fumishetl. CertlBetl coDY Is filetl with the diy Builtlin9 Division. Dale APPlicant E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thi55ecllon neetl not be complet¢tl if ttte permit is tar one huntlretl (E100) or less). I certify tbat In Ih¢ Pe�fo�mance of the wo�k fo� wM1icb this perm�t i5 issuetl I shall not empioy a y pe�5on in any manner so az to me suoiect to the WO�kets' Co en ws of Califomla. �ate Signature NOTIC :�, aft r makin9 tnis tle<larati ou snoWd become zubject to the Workers' ComDensalion provi5ians o Labor Cotle, you must forthwilh comply with such provizions o� s permit Shall be tleemeA revoketl. CONSTRUCTION LEN�ING AG CY I hereby atfirm inal lhere is a conSVuctiOn lentlin9 agency (or the per(Ormance of the work Por which thi5 p¢rmil is Issued (Section 3097 Clv. C.) Lentle�'s Nam¢ �Lentler's Atldress OWNER BUILDER UECIARATION I hereby affi�m thal I am ¢xempt lrom the Contracto�'s LlcenS¢ Law for the followin9 reason (Section 7031.5 Business antl Professional Cotle: Any city or countY whith requir<5 a Oe�mit to construct, alter, improve, tlemoli5h o� �epair any sVUG[ure, priOr to Il5 isSuance, also �equires Ihe applicant tor suctt perml[ rn �iin a cianetl sta[ement [ha[ he/She Is licPnsetl pursuant to [he provisions o/ M¢�ef�om antl the basls tor the allegetl exemplion. Any vloiauon o� aocuon 7031.5 by any applicant for a Pe�mit subje[ts the applicant fo a civil 0e�� Ity of no[ more [han (ive huntlred tlollarz ($500). J!1 I, as owner of the property.�--=i � "�^"�' ""6 eanpe�netierr will tlo tne work, antl the structuie is not intentled or otferetl for sale (Section 7044, Business antl Professional Cotle: The Conlractor's License law tloes not apOb �O an owner of a prope�ty who builds or imp�ove5 th¢reon, antl who tloes SUGh work himielf/herselt or through b15 or her own employces, prOvitletl thal such ImOrovement5 are not in[entleG or ofteretl fo� sale. If, however, the builtlin9 or improvement is soltl within one year of com- pletion, the owner will have the burtlen of proving he/she tlitl not bulitl or Im- prove tor the purpose oi sale). � 1, as owner of tne p�operty, am ezclusively contractin9 with licensetl con- tlattofs t0 con5truct tht project ISection 7044, 0u5ine55 antl ProteS5lon5 COtlN The Contractor's License Law does not applY to an owner of property who builtls or imvroves thereon, antl who contracts for such projects with a con- tractor(sl license pursuant to the Contractor's Litense Law). I am aware tnat prOot of th¢ir Worker's Compensation insurance shoultl be provitletl to me. ❑ I am ezempt untler Section B. & P. C. lor this reason oate I hereby cer[i' intormation Is dlld SLdLC IdWi sentativas ot � insoe�tfon pur[ Owner have rea � m ana state that the above i city antl countY ortlinances antl hereby authorize repre- we-men[ionetl propeJ�y for TYPE OF CONSTRUCTION LI NEW LJ ADD IJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISM ❑ OTHE q,p, �6 DESCRIP71 OF WORK/USE OF IDG. �o�� "d"� n.-'_ � .�'1s�orn-� �a /YI�wJ � /11ar L� S MainBuilding: TVP O�MIT� GRADING LJ FOVNDATION STRUCTURAL T Front ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAI. A Rear ❑ OTHER C q�ght PRQIECT DESCRIPTION 5t3. FT. oCCUPANCY K CONSTRUCTION TVPE VALUATION $:`�'S7 g Left ZONE GR ING GU.YDS. ACRES Ping. Ref. # Remarks: � �� Q� ��%q � Planning NOtes: Bar Sink Backflow Preventer Backflow Irri9ation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Dreins Floor Sinks Gas Service Outlecs Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee . $15 Boiler Duct - Under Ground Duct - Svuctural Duct - Ventilating Ezhaust System ❑ Multiple Firepl/FacL Blt. ICBO # Heating System & Ducting ❑0�100,000 BTU 0100,000 I'�v�"•�� - _ Reins ction Fee $15 o' LI o 55� � '� � � y CMF 0865-46, rev. 10/04 Whi[e - Builtlinq; Canary - Applicdnt; Plnk - ACGounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap ' Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal WdSEf CI052L Water Heater Water Service Auto-Wash Issue Fee Hoad or Typel � Canopy Typell ❑ Refrigeration SVstem ❑a�ao,000eru ❑ioo,000sr System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 $ 3 Automatic Washer Construction Pole$ub. Cooking Unit Dishwasher Dryers �Gas OElectric Fan F.A.U. Fixwres OuUets Garbage Disposal Generator DO-5 KW 0119 �/':�i� Zone Parking Req./Provided ELECTRICAL . Transformer ❑ 15-50KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps / Sub Panel Motors 00.7 HP � 1'h � 8 Inc. Solar 09-15 HP �16-15+ � Microwave Pole Light� - flange 5KW Standing Sections Trash Compactor I Reinspection Fee �$15 I I laue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By 8uilding Approved By 2 - O N I N G R E Q M T $ FEES SUMMARV OF FEES , , BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT - PLUMBING 5 ISSUANCE 3 PLAN CHECK 25% 3 ENERGY P.C. $ ELECTRICAL $ _� GRADING 5 PLANCHECK 50% $ - MICROFILM $ �p�J�� MECHANICAL $ TOTALFEE $ � PLAN CHECK 25% $ � '-' �' �' " POOL&SPA �CONSTRUCTION AND PLANNING • �• • '�• �APPROVALS Permit# Date Inspector Date Inspector , . �i, '�APPROVALS Permit# c , 1 , . . 1.� � 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 Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Foqtings �`' � _ 58. Electrical Conduit-Undrgrnd. �.• i 8. Founclation 59. Gas Pipe, O Undrgrnd., Test :. iY,. 9. Water�Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 1 63. Heater & Vent-Final 13. Roof Dreins 6 64. Plumbing System - Final 14. Rough Plumbing � 65. Electrical-Final t5. Rough Electrical-Co�duit ; 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 Ceilii�g 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 Chemiral " � 27. Frame and Flashing 76. Dry Standpipe i�,,..- + 28. Lathing & Siding 77. F�IXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL � • 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � �� r, `_ 31. Plaster Brown Coat 79. FINAL INSPECTION ' �<< �.� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED " �+� �.. 33. Final Electric =lb-� Notes: S �6i f �.' � 34. Final Heating & Air Conditioning �- J�� O 35. Final Gas Pipe-Test 36. Hood or Canopy ' • 37. Final Factory Fireplace � �� 38. Final Plumbing � ��`'� �_ `� 1 '� 39. Water Sefvice-Final + . , 40. GasService-Final . {� . . �.41. Solar pomestic-Final ; • ' 42. Backflbw Preventer � �J� � � " � 43. Backflow Irrigation � " ,' ,� „� � 44!',Landscape Irrigation System � � " ' �.' n45. Sound Attenuation , . ' 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING � � , ' ' � ' 48' Special�Requirements Completed � ' � f 49. Electric Release to Edison # ' � 5�. Gas Release to Southern California Gas Co �� , 51. CERTiFICATE OF OCCUPANC� � � No. Date �