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Home My WebLink About628 19TH ST - Building Permits. . ;., . ; „ .-�. , . .. . , , 1,^;, _ � . .. � r�.. . . • `�+.�NS..�C.:.:y,�;ti•�Sl�%�;.d:v..`1;i Mir� ;,t;.r4'�;�"�-i:r -""'.+,Cr ,... , , . � CIr �1 OF COSTA ME A �.� Development Services, Division of Building and Safety CERTIFICATE'OF .00CUPANCY ��<' _ � � . �.. This certificate is issued pursuant to the requirements of the Uniform Building Code, Section 308 adopted by the City of Costa Mesa certifies that at the Hme of its issuance the bu ilding structu re herein below described H�as inspected and approved foroccupanty as follows: � BuildingAddress 628 4i, 19th St. ` ` BIdg.Pe�mitNumber g04-00821 Use Office ` _ Group B Type of Construction' N=N %. ' i�� " Use "Lone Ownerof$uilding Costa Mesa Sanitary .DiatrictTenant City of Costa Mesa Address 628 w. 19th -St.:, Costa Mesa., CA 9266 . B., BUILDINGOFFICIAL-K�l3riIlQ,NgUj�@ri,C.B.O. PeCe T nace, om ination nspec o 'Date 03/29/OS REQUIRED TO BE POSTED IN A CONSPICOUS PLACE . . _ _,- ..� ..... . . � ._._.�.-_ :�c„�.,.... � CIr-�Y OF COSTA M� SA c Development Services, Division of Building nnd Safet� CERTIFICATE�,QF�OCCUPANCY This certificate is issued pursuant to the of Costa Mesa certifies that at the time ol approved for occupancy as follows;�� Bailding'Address 6 z a W.� 19'ti Use Of�fice ��: Group Owner of Building Ch Address 3518 Lake Acting BUILDING OFFICIF �\, � -� er1D,r. Santa Ana, f it/Morqan .y." � ti� , �'�<.. �� n.�k � � ° ��:XB��I�: C.B.�. �r.,. REQUIRED TO BE � SecHon 308 adopted by the City >w described was inspected and Number 804-00821 Use Zone l ,, � }918�pector, Pete Tenace A CONSPICOUS PLACE _ _ _ w . , __ _._. .._„�,. _ ...... __T_y..._.__ ., _ --. � .;- CI�C C3F CCJSTA� M� SA � Development Services, Divisibn of Building and Sc�feh� ' CERTIFICAT_E�QF�(UCCUPANCY !�==,,__,` i ;' , � ��_� �,, ��.�-r/',a�—�,�( Fi! �� i j'7—�..` This certificate is issued pursuant to the requi"rements of the Uniform Build�ng Code, Section 308 adapted by the City ofCostaMesacertifiesthatatkheti �ofj `s�nc�e.b"u'ildingstidcture��e\belowdescribedwasinspectedand appravedforoccupencyasfollows:,�/� � i, � .� � ��'�, �� .L� . .. C/� �: � .� �� BuildingAddress 628 W 19'thiSt. , r" �� 804-00$21 �,� � � 81dg PeimitNumber I, ,�'_,.� �:.y✓..,�;.�, � � 1 r\, ��?�\ti� Use D�fice/Aeadquart,ar.s�;; Costa�Me�ea-3ani�t,ation�YAistibr�iet . ; �`` ',� f �> � - ----r� V; �u l 1�,� Group Type ofConstruction•-^-Qi �m W -r�rc Fire�one �� i !P� Use 2one „� � '�^---^^-� , .�_ry_ , i(;�, �=,; �u� �\,' t i-�.t.1 1�. !'1 _..�,,.., H i Y,,,� �(`j +4' Qwnerof$uitding Cheon �¢"xw.onq L$m:__T-ru�s:t^=�— .��Tenant i�$ -aE Costa rfesa '�;�C� �-_ � ��, o�i:5a�nitary DisCricf Address ___351$ Lake Cen£er_ Dr_; ,_ _Santa Ana, CA ; p4� '' �°\ \ ,-7r�, ,. 1 � �Zr a BUILDING OFFICIAi.-R1C�c'�A.� $TOWri,�C $.� p�t � � � � � � �; � _ .-- � � �� c��il '�� '•> .-��:-�i n� urz��r�,ro $� rosT�b rN� A �2—/�-a ❑mhination Znspec 4 rr.Ac� _� � ' CI ; 1 OF CO"5 i A M: �A c Development Services, Division of Building and Safet� � CERTIFICATE�.O- F OCCUPANCY This certificate is issued pursuant to the of Costa Mesa certifies that at the Hme ol approved for occupancy as follows,� BuildingAddress 628 W. Use i - Group OwnerofBuilding Cheon Address 3518 Lake f COri -- i , Sec6on 308 adopted by the City >w described was inspected and Number B04-00821 �'�!.�� ,r,, ,�. �� = Use Zone i";t t=_i , , Costa Mesa t San :tar District �te'i\�Dr. ;l Saaha An ��CA �9 7:� 4'�i r,% y� ��/ � . .,_ I ��J�� . � a t� ^ �\� � . � � � BY< x-.-' BUILDINGOFFICIAL-R1CIC�f��.BrOWri; C B O. pete�Te "ace;�Combination Znspector ' tl � � � � � �\\\�%i�' ' � �:Date�. j ��-� '.if�' lr ';' �,r1J� o0 � �� . �.i:. , -� —,? , % ED TO BE POSTED IN A CONSPICOUS PLACE City of Costa Mesa Development Services Department Building Safety Division P. O. Box 1200 Costa Mesa, California The Building located CERTIFICATE OF OCCUPANCY A�$ W. 19th Street No. QCO�� t' I , has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group_ Use of Building. Legal Descriptio �"2 Occupancy. Office 422-19'1-22 (See reverse side for Metes and Bounds) Building Permit No �9600�B9700 Electrical Perm�it No�600�E9790 Plumbing Permit No. P-9694 Mechanical Permit No. 1'1'"10�65 Number of apartments � and/or guest rooms � ISSUED T0: BuildingOfficial ,YV� �.Ki ��ilil�lG Y. T. I.ee --�/ �/ �e - by �'i C_ l�/ii.ii�Ch �. 720 W. 19th Sts�t. Costa Mesa� CA Date ��if7/1� �/ �Y 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 Meu under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White � Owner; Canary - Numerical File; Pink � Bldg. Permit File City of Costa Mesa Building Safety Department P. O. Box 317 Costo Meso, Colifornio � CERTIFICATE OF OCCUPANCY N� 2583 C 7he Building lowted at �� Z�ih 8k1�ttC!'' —_ has been inspected and found to comply with the provisions of all City of Costa Meso Ordinances cpplicable thereto for a Group _�i� Occ�pancy. Use of Building Q41'�tl��iliid:2!$ � Legal Description � �5'�� i5ee revorse side for Mete� and eound�) Building Permit No.�cc�i�i Electrical Permif No. Q��_ plumbing Permit No. g�� Floor Load Signs have been installed as Room Capacity Signs have been instaled as required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartmeni house, hotel, or lodging house shall be �sed or occ�pied until the owner or operafor has been iss�ed a valid certificote 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 b�ilding or portion thereof 2) The number of apartments or guest rooms 3) Ownership � If Group H Occupancy, �umber of apartments andfor guest rooms as req�ired �nder Sec. 17050.1 (d), California Administrpfive Code, Title 8, Chapter 9, Article 8. Number of apartments and/or guest rooms ISSUED TO: L'.i�' " `�!3; B�ilding Official � . 1 .,.c • , � This Cerfificate of Occupancy SHALL 6E posfed 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. 306 (e) U.B.C. F,�,,, Hva�aM_lla�s_s P � . . , � � • CITY UF COS1'A MESA ' BUILDING D/YISION >t � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us : �. � FOR INSPECTIONS CALL: (714) 754-5626 lq��m,•p PERMIT NUMBER: P08-00010 PERMIT TYPE PLUM APN: 42214222 STATUS: DATE ISSUED: - ISSUED BY ISSUED 01I1012008 BJK JOB ADDRESS: 628 W 19TH ST CM � Suite/Unit: Vicinity: COSTA MESA SANITARY DISTRICT . - - - .. �. � , SCOPE OF WORK: REPLACEMENT OF TFiE EXISTING SEWER LINE ONSITE AT THE "COSTA MESA SANITARY DISTRICT" OFFICE. NO OTHER WORK AUTHORIZED: WITH THIS PERMIT. �.. ". OWNER: COSTA MESA SANITARY DISTRICT PHONE: . ' - . APPLICANT: BJORNSON, DEBBIE ,� ' .� PHONE: 949•645-8400 , ; � � � � ,. CONTRACTOR: OWNER-BUILDER � Address: . � ' � � � City/State: ' ZipCode: ARCHITECT: .. �� ENGINEER: - • -� . Address: 628 W 79TH ST �� City/State2ip: � COSTA MESA,,CA. � - - - ' Address: � • .628 W 19TH ST �,: - . City/State/zZip: "��COSTA MESA, CA ' _ � License No. 000000 _ � - PHONE: _ . CELL: License No. � � . _ , . PHONE: License No.� , � ,. PHONE: � PLUMBING PERMIT FEE SUMMARY � �PLAN CHECK FEE: � $0.00 ' PERMIT FEE: $48.15 TOTAL FEES: . $48.15 .. �!f);ii�� , , °��^rr:ic�•. '}(ii."Y Ly NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requirements under Califomia stalutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work musl comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to oblain inspections and final approval will result in the expiration of this permit. COOEP. INSPEGPONTYPE ORIE �NiffUlS CODE� INSGECTIONTYPE OAiE ��=:�VITI71RL5 1fi16 Fixetl System Final Fire Prevention 208 Final Mechaniwl 1266 Pool Spa Final . 208 Final Plumbing 200 Final Re-Roof 210 Final Electncal � 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site � ��'� 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION� '� I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for vrorkers' compensation, as provided for by section 3700 of Ihe Labor Code, for the pedormance of the work for vfiich this permit is issued. ❑ I have antl will maintain workers' compensation insurance, as required by section 3700 of lhe Labor Code, for Ihe perfortnance of Ihe vrork for which lhis pertnit is issued. My workers' compensation Insurance carrier and policy number are: Carrier. (This seGbn need rwl be wmpleletl A t�e permrt is value0 al one �undretl Cdlars (E10pf wless ) Policy Number: � I certify lhat in the peAormance of ihe work lor which this permil is issuetl, I shall not employ any person in any manner so as to become subject to the workers' compensation laws o/ Califomia, and agree that if 1 should become subject to Ihe workers' compensation provisions of Sec[ion 3700 0( the Labo �ode, I shall f hwilh comply with these provisions. r �� ;,��_ / /�-a9 AO�IiwnP SlgnaWre� Oa�e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNL4WFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full (orce and e%ect. Lic. # Class # Conlractor's SignaWre Oale CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm ihat there is a construclion lending agency for ihe peAormanca of the work fa which Ihis pertnil is issued. (Sec. 3097, Civil Cotle�. Lender's Name: Lentler's Address: OWNER-BUILDER DECLARATIONS: I here6y affirm that untler penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any city or county which requires a permit to consWct, alter, impmve, demolish, or repair any s[mcture, pnor lo its issuance, also requires the applicant for such permit to fle a signed statemenc that he or she is licensed pursuam lo the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicanl to a civil penally of not more than five hundred tlollars ($500).�: ❑ I, as ovmer of the propeny, or my employees with vrages as their sole compensation, WILL DO THE WORK, and the structure is not in[entled or ofteretl for sale (Sec. 7044, Business and Professions Cotle: The Contrac[ors License Law does not apply to an owner of property who builds or improves thereon, and who does such vrork himsel( or herself or lhrough his or her own employees. providetl lhat such improvemenls are no[ inlended or oftered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builtler will have the burden of proving that he or she tlitl not build or improve for purpose of sale.�. � f� I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH �iIC�JSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contracrors License Law dces not apply to an owner of Signalure oaie propeey who builds or impmves thereon, an0 who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I a cont2ctp�s) license pursuant to the Contractors License Lavrs.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is wrrect I agree to comply with all state laws and city ordinances relating to building construction, antl authorize representatives ol Business and Pro(essions Code for this reason: lhe Ciry ol Costa Mesa to enler upon the above-0escribed property (or inspectian purposes. I agree not to occupy or allow occupancy of any builtling aulhorized by this permit until final inspeclion. �jy /��"�� Signalure of Leqal er(s) 'Da/��'��///e//J/�� %� Signalu Da�e r /✓�� j�� //`� �/8 ao5].a613ro�1 ir��iir s • � � Antl/orAut�onzea ppliw Dale � �--- :• �I —.^.r�19r ID verifed by � Expires: �� Verification of Ownership by (type of tlocument, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetli(y lhal no excavation frve (5) or more (eet in depth in(o wfiich a person is required to descend, will be made in connection with work authorizetl by this permit, and that no building swcture, scaHWding, falsework, a demolition or dismantling thereof, will be more than thiny-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Title 8. Califomia Administrative Code�. ❑ As owner-builder, I will not employ anyone lo tlo work which vrould require a permit from the Division of Industrial Safety, as notetl above, unless such person has a permit to do such v.ork from ihe tlivision. Appliran�'s Signature Division of Industrial Safety Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will ihe applicant or presenl or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safely Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a repoAed year a quanlity of hazardous materials equal lo or greater than a weight o( 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at sWndard temperaWre and pressure). 2. Does or will the applicant or present or fWure building occupant need to fle a registralion form for acutely hazartlous materials? ❑ Yes ❑ No (Section 25533 of the California Heallh and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazartlous materials equal to or greater t�an a weight of 500 pountls, or a voluma of 55 gallons, or 200 cubic feet of compressed gas at standartl temperature antl pressure). 3. Does or vnll the applicant or present or future builtling occupant need lo prepare an RMPP (Risk Management and Prevention Program for acutely hazardous ma[enals)? ❑ Yes ❑ No (Section 25534 of the Calitornia Health and Sa(ety Code provides that the Costa Mesa Fire Department may require the preparation, certification and Ning with the Fire DepaAmenl of an RMPP by businesses which are required to register acutely hazardous materials vrilh the Fire �epartment. 4. If an RMPP is presently required, �as Section 25534 of the California Health antl Safery Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the appliwnt or present or future building occupant require for ihe wnrk which is ihe subject of Ihis application a permil for such construction or modifcation from Ihe South Coast Air Qualiry Management Districl or from any other air pollution control tlisMct or agency? ❑ Yes ❑ No (Seclbn 658502 of the Califomia Govemment Code requires tha[ the requested information ba fumishetl on applications for non-residential building pertnits�. 6. Will any part of the faciliry to be constructed under this permit be within 1000 (eet (rom lhe oulef bOundaries of a SchOol? ❑ Ye5 ❑ No (It "yes", the facility must meet the requirement of Seclions 25534 and 42303 of lhe Califomia Health and Safety Cotle). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is requiretl for the vrork which is the subject of this application, have all of Ihe disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No B. (If yes". attach certificate of compliance from the appropnate air pollution control officer). � CERTIFICATE OF COMPLIANCE: I certify that untler penalty of perjury the information given above is correcL I agree to comply with all state laws and city ordinances regarding Hazardous Malerials and Emissions. (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa•mesa�DING PERMIT �� FAIR DRIVE, COSTA MESA, GA 92626 .lob Address: 628 W 19TH ST Suite: Vicinity: ROOF Primary Occ: B Eat<50/ OKce/ Bar<50 Parcel Number: 42214222 Appliwnt: RAINS, RANDY Address: 260 E ALTON AVE SANTA ANA, CA Type of Construction: Zoning: Owner: COSTA MESA SANITARY DISTRICT Address 628 W 79TH ST ' COSTA MESA, CA Contractor: ROSS AND BARROWS INC. Address: 260 E ALTON AVE SANTA ANA, CA Zip: 92707 Arch : Address: Phone: Phone: 714-557-7440 Zip: 92707 Phone: 2ip: 92627 Phone: 714-557-7440 License: 327802 Eng: Address: Status: ISSUED Applied: 04282006 Issued: 04/282006 I./�� / . • /r Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL" 1 LAYER OF 15# FELT, 30 YEAR COMPOSIT�ON SHINGLES AND REPAIR/REPLACE SHEETING AS NEEDEp, 27 SQUARES FOR "COS'iA MESA SANITARY DISTRICT' FEE SUMMARY Plan Check: $0.00 Permit: $153.25 SMIp Res: $0.00 SMIP Com: $1.64 Other: $0.00 Inspection: $0.00 Total: $154.89 • PLANNING & ZONING SETBACKS MAINS7RUCTURE Front 0-0 ACCESSORY . Front 0- 0 . , PARKING � , exfstina;" o - - Rear 0.0 ' Lek 0•0 Rear 0-0 , Left 0-0 Reauired: 0 Pr000sed: 0 Calc Valuation: S�,eoo.00 Claim Valuation: S�,eoo.00 Right 0-0 Right 0-0 INO710E: 7he work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related � regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire antl become void if work Is not commenced within 180 days, or it work is suspended or abandoned for a pedod of 180 days. � INSPECTIONS: In order for the work euthoAzed under thls permlt to be considered legal, such work must comply wlih ell applicable codes, and all requlred Ingp�Nona end tinal epprovel must be obtatned. Failure to obtain inspectlons and finai approval wlll result in the expirat(on of th(s pertnit. FOR INSPECTIONS CALL: (714) 754-5826 eaao-so �aw� WORKERS'COMPENSAnONDECLARATON: , �f - 1 hereby effirm under penaly of perjury one ol Ihe following tlecleretions: '. . ❑ t heve dnd will mainlain e certifiwte of consent ro self-Insure for workers' compensetfon, as provitletl for by sectlon 3700 of the Lebar Code, for the peAortnence of the �w�ork to,� which ihis permii is iuuetl. �' tS i rlave entl will maintain workers' compensa�on insurance, as required by seclion 3700 af Ne Lebor Cotle, tor the pertortnance of Ihe wark for wNdi Vtis pertnit is Lssuetl. a�fM wotke[s' compLensaGon In rance carti antl policy number are: ��T{ �`� � oliCyNumber. yG0 —I � �S�S—O � '(fh�s secNon neetl not be completed i! f�e peimif /s vslued et one hundred tlollers ($100) or /ess.) �— ❑ I cenify t�et in the pertortnance of the work tor wNch fhis permit is issued, I shell not employ eny person in eny mannar so es to become subject to the workers' compensetlon laws of ia, antl egree that il I ahould bewme suDject lo the workers' compensatlon provislons ot Sectlon 3700 at t�e Lebor Cotle, I s�all lorthwith comply with t�ese vi "l�J� Applf� IgneNre: .._ 7/ � q�</�-.z K� `�% � JAMRMN : FAI4UFE TO SECU ' COMPENSATION COVEMGE IS UNLAWPUL AND SHALL SUBJECT AN EMPI Y�EflTO'CRIMINAL PENALTIES M1D GVIL FlNES UP TOONE MUNORED T10USAN0 DOLLARE (E100,000), M ADDRION TO THE C0.5T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTION 3)OB OF THE LABOR CpOE. INfEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATON: ons ol Chapter 9(commencinp with Section 7000) ol Division 3 o e.BuWnecs.anA Prafessions Catle, and my Iicense is In full �L Cless a �� Date: �l ^ z �t — � � CONSTRUC710N LENDING AGENCV: '— ❑ I hereby aHirm t�el lhere is e consiructlon lendinp egency lor the pertormance of ihe work lor which this pormit is issuod. (Sec. 3097, Civil Code). Lentler's Nema: Lentler's Atltlress: Sipneture: OWNER-BUILDER DECLARATIONS: Date: I hereby eHirtn Ihet untler penalry of perjury thet I flm EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW br the tollowing reflson (Sea 7031.5, Busl�ess flnd Pratesslons Code: Any Ury ar county which requires a pertnit to consiruct, a�ter, improve, Oemolish, or repeir eny siructure, p�or to its issuenca, elso �equires the applicant for such permit to file e signed stetement that he ar s�e Is Iicensed pursuant to Ihe provisions oi the Contractars lJcense Law (Ghepter B(commencing with Section 7000) of Dlvision 3 ot Ihe Busineu antl Professions Code) or thal ha or she is exempt theretrom antl tha basb lor the allegetl exemption. Any violation oi Section 7031.5 by any epplicent lor e pertnit subjects t�e epPlicant to a civil penalry ot not more than five hundred tldlars ($S00).j: ❑ I, as owner ol the property, or my employees wlih wages as iheir sde compensetlon, WILL DO 7HE WORK, enC Iha structure Is not intendetl or otteretl for sala (Sec, 7044, Business antl Professions Cotle: The Contractors �cense Law tloes not apply to en owner ot Dmperty who builds or improves thereon, and w�o does such work himsell Or herself or Ihraugh his or her awn employees, provided that such improvemenls are noi intended or ottered tor sale. II, however, ihe buildinq or improvement is sold witMin one year of completio�, the owner-builder will �ave the burden ol proving ihal he or she did not 6uiltl or improve lor purpose ot saie.). � ❑ I, as owner of the property. am EJ(CLUSIVELV CON7RACTiNG WITH LICENSED CONTRACTORS to construct Ihe pmject (Sec. 7044, Business antl Pmtesslons Code: Tpe comractors License Law tloes not apply lo an owner of propeny who butltls or lmpmves ihereon, antl who contracts lor such projea with e contrector(s) license pursuant to tha Contractors Licanse Laws.). ❑ I em e:empt untlar sec. Business and Professions Coda for this reason: Signawra: Dete: Owner ID venfietl Dy dnvers licensa. ❑ Ves ❑ No Drivefs License No. Expires: Veritication of Ownership by (rype ol tlocument, i.e. - praperty tax bill or deetl): OIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICA7tON: ❑ I hereby cenify t�et no excevetion five (5) or more feet in depth into which e pereon Is requiretl to tlescend, will Oe metla in connectlon with work authodzetl by this permit, antl Ihat no builtling strucNre, scsNoltling, lalsawork, or Aemolition or dismentling thereoi, will Ge more than I�irry-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TIIB B, Califomia Adminis�re�ive Cotle). ❑ As owne��builtler, I will not employ anyone lo tlo work which wauld requlre e permil Irom ihe Division ol Intlustrial Seley, es noted ebove, unleu such person has e permlt Io do such work irom ihe division. Signeture: Dela: Divislon of Industrial Sefery Permit Number: CEiiTIFlCATE OF COMPLIANCE AND AUiHORQATON OF EMAY: I certily under penalry ol perjury Ihai I have read this application end stata that (he infortnation given is correct. I egrea to wmpy wi�h ell stale �aws end dry ordinances relating ta 6uilding construction, and authodze representatives of Iha Giry ol Coste Meu to enter upon Ne ebove-described prope�y.to�.ip�pection purposes. 1 egree not to occupy or ellow accupanty of eny building eulhorizetl by l�is permit until finel inspection. COpE I, ius�mriONTVPE 1616 Flxetl System Final Fire Prevemion 1266 Pool SPe Final 200 Final qe-Rool 201 Flnel6��k/Retaininq Well 202 Final Fectory Fire Place 203 Final5ign 20< Finel demolitlan P�IE 1[�dLS S� � 7 ^l_ tl.�� ' Date � "yq7 COOE 1 INSPECTION TYPE QS¢. I�LS 206 Final Mechenical 20B Final Plumbing 270 Final Elecirlcal 212 Flnel Flre Prevanlion 220 Final Planning Approval , 222 Final Site 250 Final BuildincyOccupency (714) 754-5273 • Fex (714) 754-4856 • www.r�.casta-mese.cBqi�LDING PERMIT 77 PAIR DRIVE, COSTA MESA, CA 92626 Job Address: 628 W 19TH ST Suite: Viciniry: Primary Occ: Parcel Number: 42214222 App�icam: GIL LUKOSKY Address: 475 NEWPORT BLVD Type of Construdion: Zoning: NEWPORT BEACH, CA . owner: COSTA MESA SANITARY DISTRICT Address 628 W 19TH ST COSTA MESA, CA � � Contractor: ACCENT FLAG AND SIGN SERVICE Address: PO BOX 1114 � � - LOS ALAMITOS, CA � Zip: 90720 � Arch : Address: Zip: Phone: License: Phone: - 949-646-5166 Zip: 92663- - Phone: Zip: 92627 Phone: 714-527-0988 License: 542360 Eng: Atldress: � , SCOPE OF PERMIT INSTALL 30' FLAG POIE FOR "SANITARY DISTRICT' LOCATED IN FRONT OF PROPERTY FEE SUMMARY Status: ISSUED Applied: 1026/2005 Issued: 10R6/2005 /i� / �''/ � � : _ �� Phone: License: Plan Check: $63.21 Calc Valuation: Ss,aoo.00 Permit $97.25 Claim Valuation: S3,aoo.00 SMIP Res: $0.00 . � SMiP Com: $0.71 Other: $0.00 Inspection: $0.00 Total: $161.17 PLANNING 8 ZONING SETBACKS MAIN STRUC7URE Front 0. 0 Rear 4 0 LeR 0• 0 Right 0- 0 ACCESSORY Front 0. 0 Rear 0. 0 Lefl 0- 0 � Right 0. 0 PARKING Existina: 0 Reauired: 0 Pro ose : 0�� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Californla statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) " • ' ' ' EXPIRATION: This pertnit ahall automatically exp�re and become void II work is not commenced wlthin 780 days, o� if work is suspertded ar abarWoned for e period of 180 days. � INSPECTIONS: In order tor the work eutFwdzed under this permit to be considered legal, such work must eompty with all epplicable codes, and all requlred Inspeetlona and flnel epproval must be obtained. Failure to oblain Inspeclions and final approval will result in tha ezpiration ot this permit. FOR INSPECTIONS CALL: (714) 7545828 ,..P.o �aw� WORKERS'COMPENSAnON DECLARAnON: ' ' ' , ' ' I hereby eHirm untler penalty oi perjury one o1 the tdlowing dedarations: ❑ I have anC will maintain e cenilicate of consent m sel4lnsure br workere' compensatlon, as proddetl br by seciion 3700 of Ihe Le6or Cotle, tor Ihe petlormance oi Ihe work for whiCh Ihis pertnit Is IsSuetl. �ITeve etM will maintaln workers' compensetion inw2nce, es required by section 3700 of Ne Lebor Cotla, for the peAortnance oi the wark fw whkh Mis permit is Lswetl. My workers' campensation Insuren^ce carrier entl poli�y number ere: Cerne-:�—� <�hC (-VN�% PWicy.Number.i l�/% �a� . (,Thls sectlon need not be complefed i! Me peim/t is valuetl et one hundred dWlaro ($ f00) ar less.) . �_ ❑ I certity Ihat In the per compensatlon laws of compy with Ihese pro ol the work tor whic� this partnit Is issued, I shall nm employ eny peroon In eny manner so es to become sub�ect to the workers' i, and rea t�at It I shoultl become sub�aci Io the workers' compensellon pmWslons of Sectlon 3700 of ihe Labor Cotla, 1 shall lotlhwtlh __ � De�ey /o�i.(ol✓� � • AAPENSATI CpVERAGE IS UNLAW FUL AND SIULL SUBJECT AN EMPCOYER TO CRIMINAL PENALTIES M1D CML FlNES UP TO ONE HUNDREO lON TO THE OF COMPENSATIp{ DAANGES AS FROVIDED WR IN SECTION 3108 OF THE UBOR OOOE, INTEREST, ANO ATTIXiNEYS FEES. LICENSED CONTRACTORS DECLARATON: pmvisions oi Chepter 8(commencing with Section 7000) ot CONSTRUCTION LENDING AGENCV: ott�e'Buslness end Prolessions Code, entl my Ilcense is in full Cia�a __C6///� u2 ❑ I hereby eHirtn t�at there is e construction lentling agenc,y tor Ne pedortnanca of Ne work lor wNch I�Is permit is issuetl. (Sec. 3097, Civll CoUe). Lendefs Name: LerWefs Adtlress: SlgnaWre: OWNER-BUILOER DECLARATIONS: Date: I hereby eHirm Ihet untler penalry ol perJury Ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Buslness end Professlons Cotla: Any city ar wunry which reQWres e permit to consiruct, alter, Imprave, demolish, or repair any structure, pdor to its issuance, also requires ihe epplicant for such pertnit to flle e signed statemem that he or s�e Ls Ilcensed pursuant to t�e Drovlsbns oi the ContreMors License Lew (Chapter 9(wmmencing wllh Section 7000) oi Divislon 3 of Ne Busineu end Professions Code) or Ihat he or she is exempt thereirom and the basis for the allege0 e:emptlon. Any violation of Sectlon 7031.5 by eny appliwnt for e permil sub�ects the epplicant to a civil penalty of not more ihan five hundred tlollars ($500).J: ❑ I, es owner of ihe property, or my employees with wages es Neir sola compensetion, WILL DO THE WORK, antl the slrucWre Ls no1 InterMetl or oMered for sele (Sec. 70E4, Business and Pratessions Cotle: The Coni2ctors License Lew tloes not appty to en owner ol properry who builtls or Improves Ihereon, and who does such work himself or hersetl or Ihrough his w her own employees, proviCetl that such Imprwements are not Intended or aHeretl br sale. It, however, the building w impmvement is soltl within one year W completion, ihe owner-6uilder will have �he burtlen of proving ihat he or she tlitl not build or improve tor purpose af sale.). ' ❑ I, as owner of Ne O�Werty, am E%CLUSIVELV CONTRACTNG WIT1 LICENSED CON7RACTORS to consiruct the project (Sec. 7044, Business antl Professions Cade: The comractors License Law does not appty io an owner ol property who builds or Improves thereon, end who contracts far such pm�ect with e contredor(s) license pursuant to the Comrectors License Laws.). ❑ I am exempt under sec. Business enC Professions Cade lor Ihis reason: Slgneture: Data: Owner ID verifietl Dy drivefs Iicense. ❑ Ves ❑ No Drivers License No. Expires: Verlticetlon ol Ownership by (rype af tlocument, I.e. - properry tax blll or deed): DIVISION OF INDUS7RIAL SAFETY PERMfT CERTIFlCATON: ❑ I hereby certity that no excavation INe (5) or rtrore feet in Oepth into which e person is requlred to descend, wlll De mada in connectlon wilh work euthorized by Ihis pertnit, antl Ihat no building swMure, scaHdding, falsework, or tlemolllion or dismantling Ihereof, wlll be more Ihan thirry-six (38) feet high. (Chep. 32, Grp 2, An 2, Sec. 341, 71t1e B, Califomla Atlminlslrative Code). ❑ As ownar-builder, I will not employ enyrone to do work which would require e permit Irom the Dlvision al Industriul Sefety, es noted ebove, unleu auch person hes e permit to do such work lrom Ihe division. Signature: Dete: Dlvision ol Industnal Satery Permit Number. CERTIFICA7E OF COMPIIANCE AND AIJTTIOR¢A710N OF ENiHY: I cenily under penelry ol perjury that I heve reatl t�is epplication and stete Ihat tha intortnation gNen is correct. I agree Io comply wlih all stete lews end ciry ortlinances releting to bullding construction, end Buthorize representetives ot Ihe Ciry at Coste Mesa ta enter upon the ebove-descnbed properry lor Inspectlan purposes. I egree not to occupy or allow occupency ol eny building euthorizetl by this permit until linel inspection. [JI ifi16 Fixed System Final Fire Prevomlon 1266 Pool Spa Finel 200 Final Re-Root 201 Final Blak/Re�aining well 202 Finel Fectory Fire Place 203 Finel Sign 204 Finfll Demolltlon � CO�E� INSPECfI0N7YPE 208 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Finel Fire Prevention 220 Finel Planning Approval 222 Final Site 250 FlnalBulltling/Occupflnty � � �� (714) 754•5273 • Fex (�ia� �sa-a85s • www.ci.costa-mesa.ca.us 77 hAIH UMIVt, p051 A MtSA, GA 9Z626 BUILDING PERMIT Job Address: 628 W 19TH ST Suite: Vicinity: PARKING LOT Parcel Number: 42214222 Zoning: Applicant: DEBBIE BJORNSON Address: 628 W 19TH ST � Phone: 714337-3535 COSTA MESA, CA -, � Zip: 92626 � Owner. COSTA MESA SANITARY DISTRICT Status: ISSUED Applied: 10/06I2004 Issued: 10/06I2004 1�, . ,.� ' �- Address 628 W 19TH ST � ' � � - " - , . . � � . . Phone: - � , , _ �� ' , � COSTA�MESA, CA . : - Zip: 92627 � � , - , � j Convactor. O W N ER-B U I LDER , Address: � � � � � ' � - - � . �� . � Phone: � � � � Zip: , - license:` 000000 , Arch : - Eng: � . AddreSs: . . ., . Address: � " - Phone: - . ' Phone: , �, Zip: . � License: , � .License: SCOPE OF PERMIT COIJSTRUCT APPROXIMATELY 81 S.F. TRASH.ENCIOSURE PER CITY'S STANDARDS FOR"SANITARY DISTRICT" � . .. . , , , � . 1 - �._ , ' i- � FEE SUMMARY Plan Check: $45.01 - Calc Valuation: S2,000.00 Permit: $69.25 � ' � : ' � , - ' , _ � Claim Valuation: � � �52,000.00 SMIP Res: $0.00 � - _ , � . SMIp Com: $0.50 Other. $0.00 �" , � �_ � Inspection:�, $0.00 � � � � � - \\ Av� � �Total: S1'14-78 `�'•�' - _ %� rY � V j" �� , �. , � � , . � PLANNING & ZONING �- � ' � � , SETBACKS� �ii ' ,' � � '�. . � MAIN $TRUCTURE Front -0. �0 - _ Rear - 0- 0 Left . 0- 0 � „Right' �0- 0 ,, , ; � �� , . , � _ - , . , i,; ACCESSORY � Front � 0• 0 � Rear—� 0- 0 - _Lefl �0- 0 � Righ�t — 0- 0� - ' PARKING Existinp:' ,0 ��- Re uired: ' 0 , Pr000sed: 0 , � _, . , NOTES: . , � . . NOTICE: The work author(zed by this permfl shall comply with all applicable handicap access raquirements under Calitomia slatutes and related regulallons. (Ord. No. 92•28, § 1, 12-21-92) EXPIRATION: This permlt shall automaticalty expire antl become vold if work Is not commenced withln 180 days, or if work Is suspended or ebandoned for a perlod of 180 days. INSPECTIONS: In order for ihe work authorizetl under this permit to be considered legal, such work must comply with ell apDlicable codes, and eil requlred Inapeetlona end tinal epprovel must be Obteined. Faiture to obtatn inspecNons and flnat approval witl resuit in Ihe expfration of this partnit. � FOR INSPECTIONS CALL: (714) 7645828 aro-+o law� WORKERS'COMPENSAnON DECLARAnON: � _ _ � I hereby aHirm under penalry of perjury one of Ne following deUarations: �� ❑ I have entl wlll malntain e cenificate of consent to self-Insure for workers' compensetion, es proNded for by section 3700 0l Iha Lebor Cotle, tor the pertormenw of��,hB work for w�ich Ihis permit is issuetl. . Y ❑ I have end will maintaln workers' Compen5etlon insurence, as requireG by sectlon 3700 0l the Lebor Cade, for the pertortnance af t�e work lor which this pertnit is issued. My workers' cOmpensaUon Insurence carrier antl policy number are: CBrrier: P011cy Number: (This section neetl not be comp�eted I! the pertrtir is velued et one hunered oollers (5100) o� less.) I certity �hat in Ihe pertolmance oi �he wark tor wMcn this pertnit is issueQ I shell not employ eny person in eny menner so as to become suDject m t�e workere' compensetlon laws ot CaIlfOmia, antl egree thet II I ahould �ecome 5ub�ecl tO lhe workere' Compensation provislons of Section 3700 ot Ne Labor Cade, I shell torthwit� comply with these pravi �s. Q aniSipneWre: � .CJ�B'L1':JO� l--Dater- /�� IN(3:�FAILURE TO SE RE WORKERS' COM ENSATION GUVEMGE IS UMAW FUL M1D SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FlNES UP TO ONE MUNDREO iAND DOLLARE (5100,000), IN ADDIiION TO THE ODST OF COf.1PFJ!$A7�pry, DMIAGES PS PROVIDED FOH IN SECTION 3'!OB OF THE IABOR CODE, INfEREST, M1D ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm Ihet I am IlcenBed under prodslons ot Chepter B(commencinp wit� SecNon 7000) of Didslon 3 ot Ihe Business entl Prolessions Code, anA my Iicense is In full force and eHact. Llc. M Class q Contractor's Signature: Dete: CONSTRUC710N LENDING AGENCY: ❑ I hereby aHlrtn that there �s a wnstruction lentling apency br Na peAormance ot iha work for which t�is permil Is issuetl. (Sec. 3097, Civil Cotlej. Lentlefs Name: Lendefs AdAress: Slgnature: Date: OWNER-BUILDER OECLARAT10N5: I here6y aflirtn Ihat untler pena�ry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW far Ihe following reason (Sec. 7031.5, Business entl Protessions Code: Any ciry or caunry which requires a pertnit to construct, elter, improve, demolis�, or repair any-slrucWre, pnor to Its Issuance, also requlres the appliCam tor suc� permit to file a signetl statement that he ar she Is Iicensetl pureuam to t�e proNslons oi ihe Comrectors License Law (Chapter 9(commencing with Section 7000)^o1.D'Msbn 3 of Ihe Business entl Prolessions Coda) or t�et ha or she is exempt therefrom end Ihe �esis for the ellegea e:emption. Any vloletion o1.Sec�ion:7031:5�byany apP�icent tor a Oertnil subjecis ih; �eppl`cant to e civil penalry of not more ihan flve huntlretl tlollars ($500).): ��i�� ❑ I, as owner.ofthe�properry, or_my employaes with wages es their sole wmpensation, WILL DO-THE' WORK, entl ihe sWcture Is not Intentletl or ofleretl br sale (Sec. 7044, Busineu anC�Professbn's CotlerThe.Conirectors license Lew does nol,apply lo�an owner of properry who builtls or improves t�ereon, end who does such work himselt or herself or ihrough his or her own employtres,.provitlatl thaLsuch'impmvements ere noi iniended or ottered for sale. If, however, the builtling or Impmvement is sold wiihin one year of completion, ihe owner-builtler will�the buitle=ol proving that he or she Ai0 not build or improve lor purpose of sale.). � �0� I, as owner of the properry, em E%CLUSIVELY COMRAC7INC WI7H LICENSED.CONTRACTORS to construct the pmject (Sec. 7044, Business entl Professions _—� Gode: The conirectors Llaeose Lew does.cwtepply to en owner oi pmperty who builds ochnproves thereon, antl who wmraqs tor such projeq wlih e conVactor(s) license pursuant to the Gontractors,licehse Lews.). --�:,� ❑ I am axempt under sec. �� Business end Professions Coda tor this reason� Slpnature: - �� i Date: - � ^�� Owner ID venli j�dirvers liGense. ❑ Yes ❑ No l�Drlvefs License No. �� E�ires: Veritication af.Ownersltip by (rype ol tlocument, i.e. � property tax hill or deed):-- f �-. DIVISION OF INDUS7RIAL SAFETV PERMI7 CERTFICATION: ❑ I hereby certity that no ex�evetlon five (5) or more laet in depth into whlch e person is required to descend, wlll be made In connectlon wlth work authorized by this pertnit, and Ihat no builtli�g strucNre, sceMdtling, talsewark, or demollilon or dismantling t�ereot, will be more �hen thirty-si: (38) feet high. (Chap. 3.2, Grp 2, An 2, Sec. 34t, Title 8, Celitomia AdministretNe Cade). ❑ As owner-bulltler, I will not employ enyone to da wark whic� would require e permit Irom the Division at Industnel Selery, es noietl ebove, unless such person has a pertnit to do such work from Ihe tlivision. Signature: Date: DiWsion oi Indusidal Setery PeR�it Number. ICERTIFlCATE OF COMPLIANCE AND AUTHORQATON OF EMRV: I cenity under penalry of perjury ihat I heve �eed this epplicetion entl stete that the intortnation given Is I correct. I egree to comply with ell state laws end ciry ordinences relating to building constructlon, entl euthonze representetives of the City ot Costa Mese to enter upon the ebove-described propetly for inspection puryases. I egree no� to occupy or allow occupency of eny builtling authodzed by ihis pertnit until final inspection. [d•7'1��Hk9]iqi¢riil7� 1616 Fixetl System Final Fi(e Preventl0n 1286 Paol Spe Finel , 200 Final Re-Roof 201 Final BIOCWReteining Well 202 Final Factory Fire PIaGe 203 Finel Sign 204 � Final Domolltion QAff. Itf�ELfl /O'(�'U7 — ( oece COOEA INSPECTIONTYVE j1�. I�Le9 208 Final Mechenical 208 Final Plumbing 210 Finel Electrical � , 212 � Finel Flre Pleventlon � � 220 ' Finel Planning Approval � ' 222 Flnal Site ' • 250 ' Final Bullding/Occupenry (714) 754-5273 • Felt (714) 754•4856 • www.Cl.Coste•mese.Ce.U3 77 FAIR DRIVE, GOSTA MESA, GA 92626 MECHANICAL PERMIT Job Address: 628 W 19TH ST Suite No Vicinity: COSTA MESA SANITARY DISTRICT Parcel Number: 42214222 Applicant: HEIM, JOHN Address: � - �- ` Phone: 714-632-6717 Zip: Owner. i COSTA MESA SANITARY-DISTRICT Addresst -628 W 19TH ST -� �- � Contractor: Address: COSTA MESA, CA" Phone: Zip: 92627 Status: ISSUED Applied: 09/15I2004 Issued: 09/28/2004 ISSUED BY: CIRKS CONSTRUCTION INC DBA K D C CONSTRUCTION 1442 E LINCOLN UNIT 334 ORANGE,CA � "'� Phone: (714) 632-6717 �.. Zip:, 92865 � . � Lloense:763589 SCOPE OF PERMIT REF: 804-00821-TENANT IMPROVEMENT FOR COSTA MESA SANITARY DISTRICT HEADQUARTERS. SCOPE OF WORK TO INCLUDE: OFFICES AND DISABLED ACCESS UPGRADES. . ' , � , � ' . �. " � ., . � MECHANICAL PERMIT IS FOR (2) 5 TON �UNIT REPLACEMENTS (2 IN$T'FAU < 100K BTU 8 2 - �, � , COMPRESSORS 3-15 HP/SOOK BTU), KITCHEN RANGE HOOD (MISC. APPLIANCE) 8 3 EXHAUST - . FANS/SINGLE DUCT. � ' , � . , , ,. . � _ --- .._ ;� , . � FEE SUMMARY Quantity � � � �uantiry ISSUEFEE � $23.50 Rep IrlAltAbsorbtionUnit �� 50.00 -�0 Inst FAU <100 k BTU $29.60 2 Repair I Alt Refrigeratlon Unit 50.00 0 � Inst FAU >100 k BTU . 30.00 0 Ventillation System - 50.00 � 0 . Repair /�PJt Cooling/Heal � , � $0.00 0 �— � .. -� Evaporative Cooler � � � $0.00-� 0 Inst / Rep. Recess Wall Htr � � � $0.00 0 'T ^'"`� -'' � Commercial Incinerator ' `.; / $0.00 0 � � Refri S s<100 k BTU �- , � t" � � g y, �, $0.00 0 Domeslic Incinerator ,;� : � $0.00 � 0 � Re(rig Sys >100 k BTU � ;� $0.00 0 . - " � " Compressors'% Absorotion Svstems- � � ' Gas Piping `� -; $0.00 0 � -� Up to 3 hp 1100 k BTU ' �$0.00 �� 0 Factory Fireplace �,� ' . �= $0:00 0 ' . . , � - 3 To 15 hp / 500 k BTU � � � . $54.30= 2 Hood w/Mech ExMaust . . � ,- 570.65 _�1 � � � � 15 To 30 hp / 1,000 k-BTU� � - $0.00 0 VAV Box , ; � . � . �- 50.00 � 0 � � 30 To 50 hp I 1,750 k BTU ' , � , % - 30:00 0 Vent Fan / Single Duct - � - 527_75 3� � - . � - , Over 50 hp / Over 1,750 BTU '; ;-� / � �- 50.00 0 Appliance � � ' $0.00 � 0 � - Boilers � ' � � � - . � Fire Dampers � �$0.00 0 � Up"to 3 hp _, - - $0.00 0 Smoke Dampers � �� - $0.00 ' 0 , - , � 3 To 15 hp , � �� - 50.00 0 Inst or Relocate Appl Vent . 50.00 -0 . 15 l0 30 hp _ �, " � 30.00 0 Air Handlers < 10000cfm ' 50;00_ � 0 �� 30 to 50 hp � $0.00 0 Air Handlers > t0000ctm $0.00� �0 =- - � ' - Over�50 hp _ - -. � � $0.00 0 Floor Fumace $0.00 � 0 �- � Other Mechanical Fee�� NOTICE: The work authorized by this permit shall comply with all applicable handlcap access requirements under Californla statutes and releted regulations. (Ord: No.�92-28, § 1, 72-21-92) EXPIpATION: This permit shall eutomaticalty expire anC become void if work Is not commenced within 180 days, or II work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the vrork authorized undar this pertnit to be considered legel, such work must comply with all epplicable codes, and all requlred Inspeetlona end flnel epproval must be obtained. Fallure lo obtain inspections end final epproval will resutt In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 � 2M&48 (fl�00) WORKERS'COMPENSAnONDECUwAnON: , � , � _ I hereby aXirm under penalty oF perjury one of Ihe Idlowing dedarations: ❑ I heve entl will maintain a ceNlica�e ot consem to selt-Insure for warkers' compensatlon, as provided for Gy sec�lon 3700 ot Ihe Lebor COCe, for Ne pertortnence ot U�e wark br whi[h ihi5 pertnit i5155ued. 'R� Fhave end will mainWin workers' cDmpensatlon insurence, as repuired by secUon 3700 oi Ne Letwr Code, for Ihe perfortnance of ihe work for which this pertnit is issuetl. r My workers' co p satlon I%°�rance carrier end pdicy number are: l/' �/ Cerrier: �p lii�P PoIlcyNumber. `C��(�G�� —U � (Th/s secNon need not 6e complefed ll the miit 15 veluetl af one hundretl tlaller9 ($100) oi less. J � ❑ I cetlity Ihel in Ihe peAortnanca of the wy c tor which Ihis pertnit is issued, I shell not employ eny person In any menner so ns to became subject m the workers' compensetlon laws of Calllomia, end epre t t If I shoultl become sub�ect to the workers' compensation provislons ol Sectlon 3700 of the Lebor Cotle, I shall forihwith comply wlih ihese pro 'sions. /� l`,' ApplicamSlpneWre:% Dete: n %-Z�`�/ WARNINO: FNLURE TO SEW E ORKERS' �.iPEf15AT10N COVERAGE IS UNLAW FUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNE$ UP TO ONE MUN�RED TlqUSPNDDOUARE�5100. . NADDITIONTO�lIEOOSiOF�N,PEN$4TIpN,DMM6E5ASPRWIDEDFOFINSECilON�7080FTHELABORCODE,IMEREST,ANDATTORNEV$FEES. LICENSED CONTRACTORS DECLAfiAnON: I herehy aNirm Ihet I am licensed unGer O�ovlsions of C�aO�er 9(commencing wilh Section 7000) of Division 3 of the torce end eflect Lic. x!� %Cv3S�`t .. qes: Conirector'SSlgneture:� L. �— G �C"1-- Date: antl Professions Coda, entl my license is in full CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn Ihat there is e cons�Nction lending agency for iha pedormance ol ihe work for which this permi� is Issuetl. (Sec. 3097, Civil Cotla). LenGefs Name: Lendels Atltlress: SignaNre: Dete: OWNER-BUILDER DECLARAT10N5: I hereDy eNirtn thet under penelry of perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Buslness entl Professions Code: Any city or counry wNch requires e permit to construct, alter, improve, demolish, or repair eny structure, pnor to Its issuance, also requires the ep0��ant la� such parmit to file e signetl statemeN Ihat he or she Is Iicensed pursuant to Ihe pmvisions ol t�e Contractors License Lew (C�apter 9(cammenpng with Sectlon 7000) ot DMslon 3 ot the Business antl Protessions Code) or t�et he or she is ezempt therefrom entl the besls tor Ihe elleged exemptlon. Any violatlon oi SecHon 7031.5 by eny eppllcaN for e Dertnit sublecis �he applicant to e civil penalry oi not mora then five hundred dollars ($500).): ❑ I, es owner of Ihe property, or my Umployees with wages as thelr sWe compensatlon, WILL DO THE WORK, and tha structure Is not intended ar ottere0lor sele (Sec. 7044, Business and Professions Code: The Contraciors License Law does nol apply to en owner ot property who bullds or improves theraon, antl who tloes such work himsell or hersetl or �hrough his ar her own employees, providetl t�at such imprwemenis are not Intended or oHeretl lor sele. If, however, t�e building or improvement is sold wiihin one year of completion, the owner-buildar will have ihe burden of proving Ihat he or she did no� build or improve for purpose of sflle.). ' O �, es owner of the properry, am EXCWSIVELV CON7RAC71NG WITH LICENSED CONTRACTORS to construct the project (Sec. 70a4, Business end Pmfessions Code: The rnmractors License Lew does not epply to an owner ot pmperty who bullds or improves thereon, and who coniracts for such project wlih a contraaor(s) license pursuam to ihe CoNractor3 ��ense Laws.). ❑ I em exempt under sec. Business antl Protessions Code for this reason: Signeture: Date: Owner ID varified by drivefs license. ❑ Yes ❑ No Drivers Litense No. Vedlicatlan of Ownership by (rype of document, I.e. - properry tex bill ar tleetl): DIVISION OF INDUSTRIAL SAFETV PEAMIT CERTIFICATION: ❑ I herehy certiry that no excavatbn P�e (5) or more teet in de Expires: ❑ As owner-Duiltler, I will not employ enyone to tlo work which would requlre e permit from Ihe Division of Intlusiriel Setety, es notetl ebove, unless such person hes e permil Io do suc� work Irom t�e tliV�Sion. Signeture: Date: Divislon ot Industrial Safery Permit Numtler: CERTIFICATE OF COMPLIANCE AND A�ORIZATION OF ENTRY: I cenify under penelty of peryury that I heve read this epplication and slate that the information given Is correct. I egree to compy wlth ell siate laws end ciry oMinances relating to builtling construction, antl euthodze representatives ol Ihe Ciry of Caste Mesa to eNer upon the ebova-descnbed D�operty tor Inspection purposes. I agree not to occupy or ellow occupancy of eny building authorized by ihis Dermit until finel inspectlon. COpE I, INSYELTIONTYPE QAjE II�ALS i676 Fi:ed System Final Fire Prevenllon 1288 200 Pool Spa Final Finel Re-Roof 201 Finel BIocWRetaining Well 202 Finel Fectory Fire Place 203 Final Slgn 204 Final Demolition //'Date �^ 7e°' 6�.1 ' Date n � LODE� INSPECTONTYPE �AjF�/ _ 206 Flnal Mechenical � �� i� �` 20B Final Plumbing 210 Final Eleciricel 212 Finel Fire Prevention 220 Final Planning Approval � 222 Finel Slte 250 Finel Bullding�Occupenq � (714) 754-527� • Fex (714) 754•4856 • VnVW.Ci.Cos�e-mB5a.C8.u5 77 FAIH UHIVt, GUJ I A MtS'A, GA 9'Lti2ti Job Adtlress: Suite No Vicinity: Parcel Nunmber: ELECTRICAL PERMIT 628 W 19TH ST COSTA MESA SANITARY DISTRICT 42214222 Appiicanc DAVID CROWELL - � -, , - Address: 2915 RED HILL AV .- �' � i - D-103 ��!� � - , - Phane: 714-444-3592 .� COSTA MESA;.CA � - Zip: 92626 . , i Owner.' , COSTA MESA SANITARY DISTRICT� � Address�, �628 W 19TH ST',''.. �. � " ," � - � . � Phone: - COSTA MESA, CA Zip: 92627 Status: ISSUED Applied: 07/13I2004 Issued: 07/20/2004 .. � :A � . .� �;_- � � �:. .�_ � /j .... � : � Contracror. DAVID CROWELL ELECTRIC INC Atldress: 2915 RED HILL AV �` _ � D-103 �� Pbone: 714-444-3592 - ' . COSTA MESA, CA _. Zip: 92628 � . , , � � � �i � - . , _ � License: 800789 - � , SCOPE OF PERMIT , - • , � TENANT IMPROVEMENT FOR COSTA MESA SANITARY•DI$TRICT HEADQUARTERS. SCOPE OF WORK TO INCLUDE: OFFICES AND DISABLED ACCESS UPGRADES. � 13 LIGHT FIXTUf2ES (3 NEW AND 10 RELOCATIONS), 59 OUTLETS (RAISING EXISTING), 6 . SWITCHES � . � REF:804-00821 ` , _ " � - _ - - -. -- ` - i : ' . ISSUE FEE ` $23.50 Temp service test \ � $0.00 Res. a%c package `� �$0.00 New Res�(1-2 units) � , • �$0.00 New Res (3+units) � $0.00 Pool I Spa �� , - 50.00 Lighting Fizts , %!�$14.30 Recept Outlets �� - �� $50.47 Switches ��: � $8.60 � NonResAppl �`� �, � $0.00 �. Res Appl � � �� $0.00 � Service to 200a �,' $0.00 Service to 1000a $0.00 Service over 1000a $0.00 Motorstothp $0.00--. Motors to 10hp $0.00 Motors to 50hp $0.00 Motors to 100hp $0.00 Motors over 100hp $0.00 FEE SUMMARY. �uantity �� . _ - - Quantity � � - -. ,Temp Dist System / Lighting �$0.00 i�0 .' - � . ��?��,' Busway/100ft $0.00 .;,,0' � � � ,, �,��c�� . Standing Section $0.00-�,!. 0 � � � 0 t?-._�' , � Misc Electrical�Eguipment $0.00 /�% 0 � � _ 0 �� , Transformers up to t;kvalkw =_. - $0:00 � 0 ; � � 0 �" . : ....:...........up to 10 kvalkw ��0.00 . 0 � � � 13 . ' .... ::..........up to 50 kva/kw .. 30.00;�, 0 ; �� , .59 ' � .................uP to�100 kvalkw. - ' $0.00 ;✓: 0 / � _, g , ., ._ ' � .. ....... .......over 100 kva/kw � _ $0.00 ` :- p , " , 0 -_ C,�� _ LowVoltageEquipment � �,'$0:00':' 0; � �0 - Low Volt Wiring System / Ckt " $0,00 � ,/� 0�� ' � 0 - ' Misa Conduit � `, ' � $0.00'i " 0 , 0 .� � � Misc. Conductor �� $0.00 ", �- � 0 0. Circus ( gen or ride) � 50.00 � 0 � 0 _ . Circus (mech dde or lights) � � ! $0.00 0 _ 0_ � - , Christrnas Tree Stand ' '� ' $0.00 0 0 --, " - _ � � . Fireworks Stand � $0.00 0 0 -- � _ Other Electrical Fee $0.00 0 A NOTICE: The work authorized by Ihis permit shall comply with all applicable handicap access requirements under California sta�utes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire end become void if work is not commenced within 180 days, or if work is suspended or abarWoned for a period of 180 days. �, � . INSPECTIONS: 'In'order tor the work aulhorized under this permit to be considered legal, such work must comply with all applica�otles, and ell requlred Inspec[lone and�ftnal epproval must be obtained. Failure to obta'rn inspections and final approval will result in the e�iration of lhis permit. / FOR INSPECTIONS CALL: (714) 7545626 �/ saaaae�aroo� 0 WOqKEqS'COMPENSATIONDECLARATON: I �ereby eXirtn untler penalty of perjury ona of the following daGarations: ❑ I heve flntl will meintein e certiflwte of cansent to setl-InsUre br workers' compensetion, as praNdatl tor by sectlon 3)00 ot Ihe Lebor Code, for the peAormence of the work for w�lch this pertnit is luued. -�.. I have and wlll mainlaln workers' compensatlon Insurence, as requlred by secllon 3700 of the Labor Coda, for the pedortnence of ihe work for which this permit Is Issuetl, �--My w�orke��,j _Com�.p.ensatloi Insuranca cerder entl policy number ere: +1 Ce�� [IIAC�i�IMf� POIicyNumbe� �L�—�� (!N8 secHon neetl nof be completed i! the permif Is velued af one hundred tlollers ($100) or less.) ❑ I ceNty Iha� In Ihe pertormance ot Ihe work for which this pertnit is issued, I shall not employ any person In eny manner so as to become suD�ect to Ihe workere' compensetlon Iaws�Celtlomia,�nd egree thet I�uld become sub�ect to the workers' compensetion pmvisions oi Sectlon 3700 of iha Lebor Cotle, I shell foRhwith a�W '��C/f,� rData,'.,'%� ��v� � TO SECUFE WOqKERS' COMPENSATION COVEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CNIMINAL PENALTIES AND GVIL FINES UP TO dJE HUNDRE� F($100.000), IN ADDIT1qJ TO THE COST OF COMPENSATION, DAMAOES AS PROVIDED FOii IN SECTON 3]W OF THE LABOR COOE, IMEREST, ANO ATTpqNEY'S FEES. LICENSED CONTpACTORS DECLARATION: oi Sectlan 7000) ot Cada, and my license is in full CONSTRUCTION LENDING AGENCY: ❑ I hereDy attirtn Ihet there is e construction lending egency for the peAortnence of the work for which Ihis pertnil is issued. (Sec. 3097, Civil Code). Lentlefs Name: LendeYs Address: S�B�eture: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn thet untler penalry ot perjury thet I em E%EMPT FROM THE CON7RACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business end Professions Code: My ciry or county which requires a pertnit to wnstruct, 911er, Improve, demolish, or repair any siructure, pdw to its issuance, also requires the applicant tor such permit to file a signed slatement thet he or she is Iicensed pursuent to ihe provisions oi the ContraMors License Lew (C�epter 9(commencing with Section 7000) of D'Msion 3 of ihe Business and Prolessions Code) or t�at he or she Is exempt therefrom end the hesis for the allegeC exemption. Any Woletion of Section 7031.5 by eny applicant for a pertnit suD�ecls ihe epplicant to a clvil penally of not more Ihen five hundretl tlollers ($500).): ❑ I, es owner oi Ihe property, or my amployees with wages es thelr sole compensatlon, WILL �O THE WORK, end Ihe siructura Is not Intentletl or oNeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Lew does not apply to an owner of property who builds or improves Ihereon, entl who does suc� work himself or herself or through his or her avn employaes, provided that such improvements ere not intended or aRered torsale. If, however, the bailding or improvemeni Is soltl within one year of completion, the owner-builder will have ihe burden ol proving that �e or she did not build or Improve for puryose oi sale.). � ❑ �, as owner of the Droperry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTFiACTORS to wnstruct Ihe pwject (Sec. 7p44, Business and Pmfeuions Code: Tha conireaors License Law does not epply lo en owner oi propeny who bullds ar impraves lhereon, entl who crontrects tor such pro�ed with a cantractor(s) � license pursuent ta Ihe Contractors License Lews.). ❑ I am exempt untler sec. 8usineu and Pro(essivns Code for inis reason: Signeture: Date: Owner ID verified by driveYs license. ❑ Ves ❑ No Dnvers Licensa No. Vedtication of Ownership by (type ot document, i.e. - properry �ax hill or deetl): DIVISION OF INOUS7RIAL SAFETY PERMR CERTFICATON: Expires: ❑ I hereby cert0y that no exwvetion tive (5) or more teet In tlepth into whiCh e pereon Is required to descend, will be mede in conneclion with work authorized by this permit, and that no builtling siructure, scaflolding, falsework, or demolition or dismantling thereof, will be more than thiM1y-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ti11e 8, Calitomia Administrative Cotle). ❑ As owner-6uilder, I wlll not employ anyone to tla wark which would require a pertnit from the Division of Industnel Safery, es noted ebove, unless such pereon hes e permit to do such work from the division. Signature: Date: Division of Industriel Safery Permit Number. CEpTFICAlE OF COMPLIANCE AND AUTFiOHVATON OF ENTRY: I certlfy under penaity of perjury that I heve read Ihis application antl state ihat Ihe infortnatlon given Is carect. 1 agree to canply with ell state laws and city adinances relating to bullding conshucUon, and authodze representatives of [he Clry oi Costa Mesa to e�ter upon the ebOve-descnDed properry br inspection purywes. I egree not to occupy or allow occu0ancy ot eny building authonzed by Ihis permit until tinel inspection. COOE� INSPECTIONiVPE ✓ 1616 Fi:ed System Final Fira Preventlon 7266 Pool Spa Ffnei 20p Final Re-Roof 201 FInaI8locWRetelning Well 202 Final Factory Fire Placa 203 Final Sign . 208 Final Demolilion Qaj[ IMRIpLg FODE� INSPECTIONTYPE 206 Final Mechenicel 208 Final Plumbirig 210 Finel Electdcal 212 Final Flre Prevenllon 220 Final Planning Approval 222 Finel Slte 250 Final Building/Occupancy BCSE ! �� 1t�9Lfl (714) 754•5273 • Fax (714) 754•4858 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 628 W 19TH ST Suite No Vicinity: COSTA MESA SANITARY DISTRICT Parcel Nunmber: 42214222 Applicant CIRKS, KEN Address: - - - % �� - Phone: 714-632-6717 �\ 2ip: . i � Owner. �� COSTA MESA SANITARY DISTRICT Address �828 W 19TH ST �. - � � Phone: COSTA MESA, CA Zip: 92627 Status: ISSUED Applied: 07/13/2004 Issued: 07/28/2004 ISSUED BY: i _•,= ` , � �/ � . , _ � ��. •� � , ' , � �� Contractor. CIRKS CONSTRUCTION INC DBA K D C CONSTRUCTION � Address: 1442 E LINWLN � . - UNIT 334 ' "� Phone: (714) 632-6717 � ORANGE, CA � . � Zip: 92865 ; � � �. License: 763589 � � Arch / Eng : � - . - ` - . , , } , Address: . _ . i .. .. - . . ,. . ' . . � _ . . _ . . .. _'� !' . . . . � - _ .. Phone: - . � " . Zip; , _. ' . . �- - _� � �. �'License:,. _. �_ i�,,',. .. ' . , % SCOPE OP PERMIT � " � � , � . TENANT IMPROVEMENT FOR COSTA MESA SANITARY-DISTRICT HEADQUARTERS. SCOPE OF WORK TO INCLUDE: OFFICES AND DISABLED ACCESS UPGRADES. REF: B04-00821 ' y , , , PLUMBING TO INCLUDE: 1 FLOOR DRAIN, 1 GAS (i�l OUTLETS), 1 GAS SERVICE, 1 SHOWER, 1� ,, '�� , ` �' KITCHEN SINK, 1 TRAP PRIMER, 3 WASH BASINS, 3 WATER CLOSETS, AND t WATER HEATER. �� - j � � . , � � v.!s.,� . . �' � , , �� , 9/74/04: SU PLEMENTAL PERMIT TO ADD 2 DRINKING FOUNTAINS & t�URINAL �, ii'� � .�/ . . - . . � _ : �,�i . . . ` , � �/„- . `�. - - � ' , . - �- � �,,, . FEE SUMMARY , - ' �: � � � "AMT ;; QTY - � � � � � ' . � AMT �TY . " � ; i � , " � AMT QTY ISSUE PEE �� `-_ $23 50 ' / „ �, -L`aundry,Tub / Washer " $0.00 - � 0 �� ,Sump, Burrip � , ' � � �$0.00 0 Backflow irrigalion - $0.00. � 0 � � Lantlscape Irtigation $0.00 0 � � � � Swimming Pool � � E0.00 0 Backflow Preventer � � $0.00 0 - � . P-Trap � $0.00 0 . Trap Primer " � $9.80 1 Bathtub ��$0.00 , 0 � � Rressure Regulator $0.00 0 � Urinal - $9.80 1 Clanfier System $0.00 �- � 0., � Process Piping (per 10 ft) $0.00 - 0 Vacuum Brkr BkOow(1-4) $0.00 0 Connect Qce,Soda,etc) $0.00 � - 0, � - � Receptors - - $0.00 � 0 �- � � Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 �0�_ � = - Septic Tank—' � A� � . ' - $0.00 � 0 . � � , � �' Wash Basin $29.40 3 Dishwasher $0.00 0 � �Sewer Cap for Demo $0.00 " 0 � %� Wash Basin Set $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRA710N: This,permit shall automatically expire and become vold if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be consldered iegal, such work must comply wi�h all applicable codes, end all requlrad Inepectiona end flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 754-5626 / 2ae�4618�uo) , / WORKERS'COMPENSAnON DECLARAnON: � � ` � _ I hereby effirm under penalry ot perjury one ot the lollowing declaretlons: ❑ I heve end will maimain a certlfics�e ot wnsem to selbinsure tor workers' compensation, es provided tor by section 3700 0l the Labor Code, for the peAormance of the work for whlch this permil Is Issued. - � I have end will melntain workers' Wmpensation insurance, es required by secYlon 3700 oi ihe Lebor Code, for the peAortnance of ��e work for which this permit is Issued. My work rs' compensation Insurence carner antl policy number ere: _ .��n�� —��- Carrier: �� .�n 0 Policy Number: (This section e nof be co lefed il the permit is valued et one huntlred dollers ($100) or less.) . . ❑ I cenify that in the pertortnence oi ihe work for w�ich ihis pertnit Is issued, I shall not employ eny person in eny manner so es to become subject to ihe workers' wmpensation laws ot Celit le, a�0 agree t t il I should become sub�ect to the workers' compensetion provisions oi Section 3700 oi the LeUor Cotle, I shall forthwith comply with these provision . �`/�—�� ✓ p Applicant SignaNre: Date: WARNING: FAILURE TO SECURE W ERS' COMFENSATION CAVERA�E IS UNLAWFUL AND SFULL SUBJECT AN EMPLOYEH TO CRIMINFL PENALTIES PND CIVIL FlNES UP TOONE HUNDRED T/IOUSMlDOOl1ANE(5M100,000),W TIONTOTHECqSTOFCOMPENSATION,DNAAGESASPROVIDEDFORINSECTION310BOFTHEIABORCODE,INTERE5T,ANDATTORNEI"SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aXirtn that I am force and eNect Lia a Contrector's Signature: of Chepter 9(commencing with Section 7000) of Division 3 of the Busin ss end Professions Cade, antl my license is in full Classq . �ZC� � C �� Date: �_/J o�( CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that there is e cons�Nction lending egency for Ihe pertormance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lendels Name: Lendafs Adtlress: Sipneture: OWNER•BUILDER DECLARATIONS: Date: I hereby affirtn that under penelry of perjury that I em E7(EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Buslneu end Profeulons Code: Any ciry or counry whic� requires e pertnit to construct, alter, improve, tlemolish, or repair eny strucNre, pnor to its issuance, also requires the ap0��ant tor such permit ro lile e signetl statement Ihel he or she Is Iicensed pursuant to the provisions of ihe Contractors lJcense Ww (Chepter B(cammencing with Section 7000j of Division 3 ot the Business and Professions Code) or Ihat he or she is exempt theretrom end the basis for the ellegetl exemption. Any violation of Section 7031.5 by eny eOPlicant tor a pertnit sub�ecis the applicant to a civll panelry a� not more ihan live huntlretl dollers ($500).): ❑ I, es owner of the properry, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and the siructure Is not intentled or oflered tor sale (Sec. 7044, Business antl Professlons Code: The Contrectors License Lew does not apply to an owner of pmperry who builds or improves lhereon, and who does such work himsetl or herself or through his o! her own employees, provided thet such improvemems ere not intentletl or oflered lar sale. H, however, the building or impravament is sold within one year oi completion, the owner-builtler will heve the burden of proving thet he or she tlid not build or improve for purpose of sale.). ' ❑ I, es owner of the property, em EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to canstruct Ihe proJact (Sec. 7044, Business entl Professions Cotle: The contrac�ors License Lew tloes not appty to en owner of propeny who bulltls or Impmves thereon, and who coniracis for such pro�ect with e coniractor(s) license pursuant to the Contractor& �cense Lews.). ❑ I em exempt under sec. Signeture: Owner ID veritietl by ddvets license. ❑ �es ❑ No Businass antl Professions Code for this reason: Verllicetion ol Ownership by (rype of doGument, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PEAMIT CERTIFICATION: Dnvefs License No. Date: Expires: ❑ I hereby certity thet no exwvatloo ��a (5) or more teet in tlep(h into which a person is required to descand, wtll be mada In connection with work authodxed by this permit, and �hat no builCing siructUre, scaHolding, lalsework, or tlemolition or tlismentling ihereot, will be more ihan I�irry-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title 8, Califomia Adminisireti�e Cotle). ❑ As owner-builder, I will not employ anyone lo do work w�ich would require a permit from the Division of Indusirial Satery, as noted above, unless such person hes e permit to do such work Irom the dihsion. SignaWre: Date: Division of Industnel Satety Pertni� Number: CERTIFlCATE OF COMPLIANCE AND A�F10RQ/1TION OF ENTRV: I certify under penalry oi perjury that I have read this application and state that the infortnatlon given is correcL I agree to comply with ell slate laws end ciry ordinences releting to builtling consWctlon, and authodze representetives oi the Ciry of Coste Mese to enter upon Ihe above-described property tor inspection purposes. I agree not to occupy or allow occupency of any building authonzed by this permit until final inspection. CODE t. 7616 1266 200 201 202 203 Legal Owner(s) Fixed System Final Fire Prevention Poal Spa Final Finel Re-Root Finel Block/Retaininp Well Final Factory Fire Place Final Sign Q� 20a Final Demolition � � _ .uu_ CODE� INSGECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elacincal 212 Final Fire Preventlon 220 Final Plenning Approval 222 Final Site � 250 �FinalBuilding/Occupanty Date '�'j-!U -�G� Oate �. I 10'_ ' -v� i % (714) 754-5273 • Fex (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT 1ob Address: 628 W 19TH ST Suite No Vicinity: COSTA MESA SANITARY DISTRICT Parcel Nunmber: 42214222 Applicant CIRKS, KEN' �" �, Address: � � . - � � ' '" � ' Phone: 714-632-6Z17 . � ' . , .' . . ' Zip. -. �'' i; � . . � - � : . Owner:� � COSTA MESA SQNITARY DISTRICT Address 628 W 19TH ST -� ` Phona: � , i COSTA MESA, CA Zip: � 92627 . Status: ISSUED Applied: 07/13/2004 Issued: 07/28/200 ISSUED BY: Contractor. CIRKS CONSTRUCTION INGDBA K D C CONSTRUCTION Address: ' ]442 E LINCOLN �� ' � � - � , . . � _ _ .� � . � - UNIT 334 ; � Phone: (714)632-6717 - - � ' � ORANGE, CA � - - Zip: 92865 , " ' � Arch / Eng : Address: License: 763589 � � � . - � . , Phone: — - - - __'�. Zip: � � Gcense: � . � SCOPE OF PERMIT - � � ��. � " �'� TENANT IMPROVEMENT FOR COSTA MESA SANITARY DISTRICT HEADQUARTERS. SCOPEOF WORK TO � � INCLUDE: OFFICES AND DISABLED ACCESS l'1PGRADES. REF: 804-00821 �� . � � � _ PLUMBING TO INCLUDE: 1 FLOOR'DRAIN, t GAS (1-0 OUTLET3), 1 GAS 5ERVICE, 1 SHOWER, 1 �. •� -.� KITCHEN-SWK, 1 TRAP PRIMER,-3 WASH BASINS, 3 WATER CL'OSETS, AND 1 WATER HEATER. - . . , � . ,. - .. . . . _. , .. . _ ,v; . , � : � � ;AMT ISSUE FEE \ � � �; $23.50 Backflowirrigation � .�$0.00 BackflowPreventer ��$0.00 Bathtub $0.00 Clarifier System 50.00 Connect pce,Soda,etc) $0.00 � DenWl UniLs $0.00 Dishwasher $0.00 D2in, Floor $9.80 Drain, Rainwater $0.00 � �FEE SUMMARY � % ��„� �. ; orv �_ ' nMr Qrr= �" � <'�% •, � � , � .. i � �' � Laundry Tub./ Waslier- ° $0 00 = A- � � Sum Purri � � ' � i 0 - ` , Landsoape �Imgatlon` �� l $0.00 �" -0 � =- 3wi ming Pool � 0- ,�� -.P-Trap ' � $0.00 0�� ',ATrap"Primer%�� 0 � � Pressu�e Regulator „ . $0.00 - 0 �. ��Urinal�; �i� D '� Process Piping (per 10 ft) $0.00 ,0 -, ,Vacuurn Brkr Bkflow(1�) A . �Receptors $0.00 -0- �, .Vacuum Brkr Bkflow(5+) 0� � .SepticTank"� � $0.00 0 `�� WashBasin 0 �- �.. SewecCap for Demo - � - $0.00 .- 0 � �.� � � Wash Basin Set 1 Sewer Connecf `' -�"' �-- '$0.00 -� 0 Waste antl Vent System 0 Sewer Private l.ine -- 50.00 0 Water Closet (Toileq AMT $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $29.40 $0.00 $0.00 $29.40 �TY 0 0 t 0 0 0 3 0 � 0 3 M0710E: The work authorized by this permit shaff comply with all appficable handicap access raquirements under Califomia statutes and related regulations. (Ord. Nb. 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 suspendetl or abandoned for a period of 180 days. � INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inapectlons and finel approvel must be obtained. Failure to obtain inspections and final approval will result in the ezpiration ot this pe�mit._ FOR INSP@CTIONS CALL: (714) 7545626 /'T�� zaac�ae (doo� WORKERS'COMPENSAnONDECLARAnON: ' � �• ' - � � ' • I hereby effirtn under penalry of perjury one of Ihe following declaretfons: ' � , ❑ I hava end will meinteln e cenlficete of consen� to sell-Insure for workars' compensetlon, es provitled for by sectian 3700 of the Lebor Code, for the peAormance of the ,_�_ work for which this permit Is issuetl. ❑ I certify ih0t in the peAo compensetion Iaws oi G comply with these.p�_ovi can�t SClgnaNre: _� WA� f�J(��:FAILUH2"TO'SECGRE iHOlY1Sr D OOIIARE ($100.0001� rkers' campensetlan insurence, a5 required by sgqlon 3700 of the Labor Code, lor the peAortnance of Ne woM lor whkh this pertrut is Issued. � Inwra�ce cartlar end polky number ere: �� , `�^ _ O� ' Pof�yNumber.- (JClZ/ 'eted i! the pe�iNs velued et one hundred tlollers ($100J or IessJ ance o1 the ork for which thls permit is Issued, I shall not employ any person In eny manner ao es to become subject to the workers' fomie, rea that ii I shoultl Dacrome subJect to Me warkers' compensatlon provisions of Sectlon 3700 01 the Lebor Code, I shall forthwith ns. > oa�a-� � -7�'-c�-- ORKERS' COMPENSATION COVERAGE IS UNLAW FUL AN� SHALL SUBJECT AN EM .1p1'ER TO CRIMI W1L PENALTIES AN� CIVIL FlNES UP TO IXJE HUNDRED ADDITION TO THE COST OF COMPENSATION, DPM4GES AS PROVIDED FOR IN SECTION 31060F THE UBOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED COMRACTORS DECLARATON: at Chapter 9(cammencing with Section 7000) af Division 3 and my Iicense is in full CONS7RUCTION LENDING AGENCY: ❑ I �ereby eHi� thet there is a constructlon lending agency for ihe periormance of ihe work lor which this pertnit is issued. (Sec. 3097, Clvll Cotla). Lendats Name: Lentlafs Addrass'. Signature: OWNER-BUILDEA DECLARATIONS: Da�e: I hereby eftirm tM1at under penelry ot perjury that I am E%EMPT FROM TME CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business entl Profeulons Cotle: Any city or county which requires a permR to construct, alter, improve, tlemolish, or repeir eny struaure, pnor to Its Issuence, also raqulres the epplicent for such permil to file e signed s�etement ihet he or she Is Iicensed pursuant to the pmNslons of tha Contractore lJcense Lew (Chapter 9(commencln8'�'Ith Secpon 7000) of DlWslon 3 ot Ihe Busineu end Professions Code) or ihat he or she is exempt Iherefrom anC t�e besis for the elleged exemption. Any violation o1 Seclion 7031.5 by any applicant for a pertnit subjects the eppl�wnt to a civil penelty of not more then tive hundred dollers ($500).): ❑ I, as ownel of the proDerty, or my employees with wages es t�eir sole compensation, WILL DO THE WORK, and the sirucNre 15 not intentletl or oHeretl for sale (Sec. 7044, Business antl Professions Code: The Contractors License Lew does not apply lo an owner of properry who builds or improves thereon, and who does such work himself or nerself or ihrough his or her own employees, provlded ihet such Improvemenis ere not Intended or otteretl for sele. If, however, ihe bulltling or Improvement Is sold within one year ol comple�ion, tha owner-builder will heve iha burden of proving that he or she ditl not 6uild or improve for purpose oi sale.). � ❑ I, as owner ot the property, am EXCLUS��ELV CONTRAC7ING WITH LICENSED COMRACTORS to construct the project (SBc. 7044, Business and Professions Cade: TTe �oniractors Llcense Lew tloes not appty to en owner ot pmperry who bullds or Impmves ihereon, end who contrects far such pro�ect wlth e contractar(s) license pursuant to the Coniractors License Lews.). ❑ I em ezempt under sec. SignaNre: Owner ID veritie4 by drivefs license. ❑ Yes ❑ No Business end Professions Code lor this reeson: Verification of OW�ership by (rype of dxument, i.e. - properry tex bill or Aeetl): Drivers License No. Date: Explres: DIVISION OF INPUSTRIAL SAFETY PERMIT CERTIFICA710N: ❑ I hereby cehify thet no excavetion five (5) or more feet in depth into which e person is requlrad to tlescend, will be made in connectlon wlth work euthorized by this permiL and ihat no builtling structure, scattolding, }alsework, or demolition or dismantling thereoi, will be more then thirty-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Tltle B, Celitomia AtlmiNSirativ0 Code). ❑ As owner-builder, I will nol employ enyone to do work which would requlre e permit from ihe Division of Indusirial Salety, as notetl ebove, unless such persan hes e pertnit to d0 such work trom the tlivision. Signature: Dete: Division of Indusinal Sefery Pertnit Number: CERTIFlCATE Oi COMPLIANCE AND AUT110A�710N OF ENTRY: I certify under penalry of perjury that I heve read this appliwtion end state Ihat the inlormation given is correct I agree t0 �omply with ell stete lews end ciry ordinences relating to Culltling consWction, and euthodze representatives of the Ciry of Costa Mese to enter upon the ebove-descnbed p�operty tor inspaction purpo5es. I agree not to acuDY or allow occupancy of eny building authorized by this permit until final inspec�ion. S3GE_L WSPiSIl4nne� QdjF �$ COpE� INSVECTIONTYPE 1616 Fized System Final Fire Prevention 208 Final Mechanical 1266 Pool Sp9 Finel 208 Final Plu ng ♦ 200 Finel RB�Roof E 'wl 201 Final8lock/Retaining Wall 2 Preventi 202 Final Fadory Fire Plac � 220 Fin Planning pr al 203 Finel Sign � 222 Final Slte 20a Final Demd�Uon 250 Final9uiWi�glOccupancy �. � m. (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us P FAIR DflIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 628 W 19TH ST Suite: Vicinity: COSTA MESA SANITATION Parcel Number: 42214222 Applicant: JOHN HEIM Address: Owner: Address Contraclor. Address: Zoning: Phone: 714-632-6717 Zip: LAM, CHEONG KWONG TR UNIT C SANTA ANA, CA � . " Phone: � � 3518 LAKE CENTER DR Zip: 92704 . � j CIRKS CONSTRUCTION INC DBA K D C CONSTRUCTION 1442 E LWCOLN UNIT 334 - " Phone: (714) 632-6717 ORANGE,CA ISSUED BY: Status: ISSUED Applied: 04/29I2004 Issued: 06/29/2004 �� Zip: 92865 License: 763589 " � - Arch : ROBERT THORNTON ARCHITECTS, INC Eng: • Address: 250 NEWPORT CENTER DR �� Address: SUITE M100 �, Phone: 949-640-9876 � Phone: NEWPORT BEACH, CA - � Zip: 92660 License: C24188 , License: SCOPE OF PERMIT TENANT IMPROVEMENT FOR'COSTA MESA SANITATION DISTRICT�HEADQUARTERS". SCOPE OF WORK TO INCLUOE: OFFICES AND DISABLED ACCESS UPGRADES. ' � Plan Check: Permit: SMIP Res: SMIP Com: Other.' Inspection: \ Total: $208.81 $321.25 $0.00 $4.20 $0.00 $0,00 $534.26 � SETBACKS��' � MAINSTRUCTURE'Front "0. -�:-�. ACCESSORY FronC . 0. PARKING Exis6nq: FEE SUMMARY - - ' , ,' �. 0 �Rear_ 0 Rear 0, - - Re uired: Calc Valuation: Claim Valuation: PLANNING& ZONING � - � i . 0- 0••' • . tefl- 0- 0� =.� � Right, �% 0. 0�� . 0.0 , Left . 0-0 �� Right� 0-0�� i 0� � Proposed: , 0 � ' � $20,000.00 S2o,000.00 NOTICE: Tfie woik�authodzed by this permit shall compty with all applicable handicap access requiremeMs under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall aulomatically expire and become vold if work Is not commenced withln 180 days, or if work is suspended or abandoned lor a period of 180 days. INSPECTIONS: In order lor �he work euthorized under this permlt to be considered legal, such work must comply with all applicable Codes, end ell requlred Inspectlona and Iinel approvet must be obtained. Fallure to obtain inspections and final approval wilt result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 ra•r�.:�t�xnt WORKERS' COMPENSATION DECLARATION: � � � I hereby eNirm untler penalry ol perjury ane ot tne lollowing declaratlons: ❑ I heve entl will malnieln e cenificate of consent lo self-Insure lar workers' compensatlon, as provltled lar by sacilon 3700 0l the Lebor Code, tor the pertormence of the work for which this permit Is issued. � I have and will meintein wwkers' compensaLon Insurance, es requiretl by section 3700 of the Lebor Code, lor ihe perfortnance ot �he work for which Nis permi� Is issueC. My work co satio Insurance wrrier end policy number are: // /J / �' Cartier. �� (J� Policy Number; _(CD i�—`d �A�/ � �� (!h/s secNon need not be oompleted U fhe permif !s valuetl et one hundred dW/ers ($100) or /ess.) ❑ I canity thet in the peAormance ot ihe work for which Ihls pertnit Lq Issue4 I shall not employ eny person In eny menner so es to become subject to t�e workers' compensation laws o elllomia, entl agree that If 1 should become sub�acl to the workers' campensetion proNslons ot Sectlon 3700 of the Lebor Code, I shall torthwith Comply wl�h IheSe pro lan %� Applicant Slpnature: � Dete: l.� � "� WARNINO:FAILURETOSEW WORKERS'COMPENSnT10NCOVEMGEISUNLAWRILAND5W1L15UB1ECTrWEMPLOVERTOCRIMINALPENALTESANOCMLFlNESUPTOONEHUNORED THOUSNND DOLURE (5100.0OO�.IN AODRqN TO TNE CQST OF COMPENSATION, OAMAGES AS PROVIDED FIXi M SECiION 3708OF THE IABOR CODE, ItJrERESi, AND FTTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aMirm Ihet I em Iicensed under pravisions ol Chapter 9(commencing with Section 7000) ol Divislon 3 ot the Busl9ess entl Profeuions Code, entl��^y Ilcense is In full torce antl eHecl. Lla N CIa9s a 9 ��v . �.' �n lf1� ContrectofsSigneture: .�. �/1 Dete: / 7n �YIG, � CONSTRUCTION LENDING AGENCY: ❑ I hereDy eilirtn t�et there Is a construction Iending egenCy for the peAortnence oi Ihe work tor whiCh this perml� Is issued. (Sec. 3097, Civil Code). Lentlers Name: Lenders Address: Slgnature: OWNER-BUILDER DECLARATIONS: Date: I hereby eHirm thet under penaliy ot perjury thal I am EXEMPT FROM TME CONTRACTORS LICENSE LAW tor t�e tollowing reason (Sec. 7031.5, 8usiness entl Professlons Code: Any ciry or wunry which requires a pertnit to construd, alter, imprwe, demolish, or repair any structure, prior to its issuance, elso requires the applicant for suth petmil to tile e signed stetemem thet he or she is licensetl pursuant ro t�e proNsions ot Ne Contrectors llcense Law (Chepter 8(cammencinq with Sectian 7000) of Division 3 oi ihe Business end Pmfessions Code) or that he or she is e:empt theretrom entl Ihe besis for Ihe elleged e:emptlon. Any Wolatlon of Sectlon 7037.5 by any epplicant for e pertnit subjects the epplicen� to a civil penelry af not more ihan flve hundred tlollers (5500).): ❑ I, es owner ol ihe properry, or my employees with weges es thelr sole compensatlon, WILL DO THE WORK, and Ihe siructure Is not intendetl or oHeretl for sale (Sec. 7044, Business and Professions Code: The Conirac�ors License Lew Aoes not appty to an owner ot property who builds or improves t�ereon, and who tloes such wark himself or hersetl or through his or her own employees, provided Ihat such impravemenis are not Intended or aflered tor sale. If, however, ihe building or improvement Is sold within one yeer ot completion, the ownerbuilder will have the burden of proving that �e or sha did not build or improve for purpose ot sale.). � � I, es owner ot the pmperty, am EXCLUSIVELV CONTRACTING WI7H LICENSED CON7RACTORS to construct the prolect (SecJ044, Business and Pmfessions Code: The conirectors Llcense Lew does not apply ta an owner ol propeny who builds or Improves ihereon, end who contracts for such pmject with e contracior(s) license Dursuant to t�e Contractors License Laws.). ❑ I em exempt under sec. Business and Pmlessions Code for this reeson: Signatura: Date: Owner ID verifietl by tlrivers license. ❑ Yes � No Orivefs License No. Expires: Veriflcatlon ol Ownership by (rype ot document, i.e. - properry tax bill or deetl): DIVISION OF INDUSTAIAL SAFEiY PERMR CEHTIFICATION: ❑ I hereby certity thet no excavation frve (5) or more tee� in depth into which a person is requiretl to Oescentl, wlll ba mede in connecilon with work euthonzed by this pertnit, end that no building structure, scaflddinp, tel5ework, or demolition or dismantling thereoi, will be more t�en thitly-six (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Tille 8, Calitomla Adminisiretive Cotle). ❑ As owneo-Dulltler, I wlll not employ enyone Io tlo work which woultl requlre e permit irom Ihe DINSIon of Industdel Setery, es noted ebove, unless such person hes a permit to do such wark tram ihe division. Slgneture: Date: Division ot Industdal Satery Permit Number: CERTIFlCATE OF COMPLIANCE AND Al7IHOR¢AT10N OF ENTRV: I cenity under penalry of perjury thel I have reatl this epplication and state that tha informetlon given is correct. I egree to comply with all state laws and ciry ortlinances relating to bulltlinp construction, and euthorize representatNes of Ihe Ciry ol Costa Mesa to enter upon tha above-described property lor inspection purposes. I agree not to occupy or ellow acupancy of any building euthonzed by �his permit unGl finel inspection. eooe �. iNsvecnor+nre� t8i8 FIxeA System Final Fire Prevention 1268 Pool Spa Final 200 Finel Re-Roof �01 Finel BIocWRetaiNng Well 202 Finel Fectory Fire Place 203 Finel Sign 204 Finel Demolition PAIE 1i�43 COOE I INSFECTION TYPE 206 Finel Mechenical 200 Final Plumbing 210 Final Electrical 212 Finel Flre Prevention 220 Finel Planning Approval 222 Finel Site 250 Finel Building/Occupancy ua�e 2�.i - U t�1 Date �.17��Ciiiil.l!1 � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92628 ELECTRICAL PERMIT Job Atldress: Suite No Vicinity: Parcel Nunmber: 628 W 19TH ST 42214222 Applicant PRAUM, STEVE Address: 1049 MELROSE - " .- ; - � �- - �Phone: (714)231-7501 PLACENTIA CA�� -� . , Zip: 92887 . j � � . i - , ' /, `�� % ,�� - � - . - Owner:�, 'LAM, CHEONG KWONG TR � � � Address � -UNIT C � � . � - � / �; � �SANTAANA,�CA-, -� Phone: j�, 35181AFCE CENTER DR Zip: 92704 � � / / � � Convacwr. ORANGE ELECTRICAL CONTRACTORS Address: 1049 MELROSE , ° - _ � ' PLACENTIA, CA ' � Status: ISSUED Applied: 0&05I2003 Issued: O6/O6/2003 � , � �� , � � � �� = � �� . � �. �� , -� � � � ;-Phone: (714)980-2300 Zip: "92887 . . License: 747129 SCOPE OF PERMIT � CONVERT EXISTING OVERHEAD ELECTRICAL SERVICE TO�UNDERCaROUND FEED. �� . . � . . . . _ . _. . . . �. �uantity - ISSUE FEE 50.00 � Temp service4est $0.00 Res. a/c package � . 30.00 New Res (1-2 unils) $0.00 0 New Res (3vunits) ' $0.00 0 Pool / Spa- � � � � � � $0.00 0 LightingFixCs � ��, $0.00 0 Recept Outlets � �,50.00 0 Switches •� � . ' 30.00 0 �. � - Non Res Appl., ;, 30;00�: `� 0 -� ResAPP� \ �,�� "-�$0.00 � 0 Service to 200a. � "-� $30.50 _ �7 Service to 1000a �� - �- $0.00- 0 � Service over 1000a �-�. $0.00 ' �0 � Motors to 1 hp � - � $0.00 i ,' � � 0 � Motors to 10hp �. $0.00�.,�-.- �� 0 � ` - Motors to 50hp �, � $0.00 � 0 �. Molors to 100hp �$0.00 � � 0 . Motors over t00hp $0.00, , 0 - Communicatlon drops 50.00 � _ 0 � -- Sub panel to 200a $0.00 � 0 _�; � Pole Light Pkg $0.00 0 Sign CircuitS 50.00 0 FEE SUMMARY �uantiry Tamp Dist System I Lighting � 30.00 0 Busway /100 R $0.00 0 . Standing Section '� �0.00 0 ' . Misc Electncal Equipment $18.20 1 �- Transformers up l0 1 kva/kw $0.00 0- i- - � � .:... :.:.......up to 10 kva/kw �50.00 � 0 ,. : . .' � ..........:....:.uP to 50 kvalkw $0.00. � 0 ` . .................up to 100 kvaBw $0.00 . � 0 ..................over 100 kva/kw.'. . . $0.00 . 0 : � � � , Low Volfage Equipment $0:00 0 � � ��- Low Volt Winng System / Ckt '$0.00 � 0 Misa Conduit � $0.00 � 0 Misc. Conductor � $0.00 0 , Cirgus ( gen or ride) -,y0.00 - 0 Circus (mech ride or lights) �. , , � $0.00' - � 0 , " Chrislmas Tree SWnd' - , �$0.00 � 0' � �r FireworksStand $0.00 �� 0 ' Other Electrical Fee $0.00- � ' � Investigation Fee -, , � <- ' 30.00 . - - Plan Check Fee � � .% � $0.00 _ _ Reinspection Fee � a0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremants under Calitornia statutes and related regulations. �Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This peimlt shall automaticalty ezpire and become void II work Is not commenced within 180 days, or If work Is suSpended or abandoned for a penod of 180 days. - INSPECTIONS: In order for the vrork authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell required Inapeetiona end final epprovel must be obtainetl. Failure to obtain inspections and final approval will result in the expiration ol this permit. FOR INSPECTIONS CALL: (714) 754-5628 zaaere�amo7 � e , . - . . .. . ,� , _ - _ _ -2> - ;�'--:2 .' WORKERS' COMPENSATION DECLARATION: I hereby ettirtn under penalry of perjury one of ihe tollowing decleretions: ❑ I have end will meinteln e certllicate ot consent to selt-Insure tor workers' compensetlon, es provided tor by sectlon 3700 oi iha Lebor Code, lor t�e peAormenca ot t�e �/ work for which t�ls parmlt Is issuetl. p I have end will meintain workers' compensatlon Inwrance, as reQuired by secUm 3700 of I�e lsbor Code, for Ihe peAortnance oi the work for whkh Nis pertnit Is iswetl. My workersQ' wmpensetlon Insmanca carder end policy numDer are: p� Certier. J i A 1"5� F J�..1 � Policy Number. Z 2! ? (lills sBtNo/1 need rrot be caflpleted I7 fhe pemtif ls veNed et me h�nCretl dd/ars (5100) w IB55J ❑ I cerlity t�et in t�e D ormance ol tha work tor which thls permit is issuatl, l shall not employ eny person In eny manne� so as to bewme suD�ect to Ihe workers' compensetion laws Celito , gnE agree I�et tl I ahould become sub�ect ta the workers' compensatlon provisions of Section 3700 0l t�e LeDor Cotle, I shall fanhwlth comply with these pr s s. �V S q ADPlicent Sipnalure: /\ Date: _ �'� ` WARNINO: FAILUFE TO SECURE WORKERS' COMPENSATION COVERADE IS UNUWFUL M1D SHML SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE MUNDRED T/IOUSAND OOLLARE (5100.000�. IN ADDRION TO TNE WST OF COMPENSATION, DAANGES AS PROVIDED FOR IN SECTION 3]08 OF THE UBOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECIAHAT10N: I hereby eNlrtn Ihat 1 am IlcenseC unAer pr si 1 C�ap�e�9(commendng with Section 7000) ol Olvislon 3 ot the Business and Prolessions Code, enC my Ikense Lq In full rorce end enect. �c. a � �I "1 I 2`� „ Y\ c�ess a � v ContrectorsSignawre: Dete: ' "� CONS7RUC710N LENDING AGENCV: � ❑ I hereby eflirm thet there is e construction lending egency for the peAormance ol Ihe work br w�ich this permit is issued. (Sec. 3097, Civil CaGej. Lentlers Neme: Lenders Atldress: Slgnature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn Ihet untler penalry of perjury Ihat I flm E%EMVT FROM THE CONTRACTORS LICENSE LAW lor iha tollaving reason (Sec. 7031.5, Business end Prolession9 Coda: Any city or counry w�ic� repuires a permit to construct, alter, improve, tlemdish, or repalr eny structure, prlor lo its issuance, elso requlres the epplicant tor such pertnit to lile e signed statement Ihet he or she Is Ilcensed Oursuant to the provlsions of the Conirectora LJcense Law (Chapter 8(commencing wi�h Sectlon 7000) of Divlslon 3 of the Business end Professions Cotle) or that �e or she is e:empt t�eretrwn antl t�e besls for the elleged exemption. Any violatlon oi Sectlon 7031.5 by any eppllcaN tor e permit sublecis Ihe applicant to e civil penelry of not more than Ma hundred dollars ($500).): ❑ I, es owner of the property, or my emplqrees with weges es their mle compensation, WILL DO THE WORK, end Ihe swciure is not intendetl or otteratl for sale (Sec. 7044, Business and Profeuions Code: iTe Contractors LJcense Law does noi apply to an owner of property who builds or improves thereon, and who does such work himself or herselt or thmugh his or her own employees, providad that such Impmvemenls ere not intended or oHereC for sale. If, however, the DuilCing or Improvement Is soltl within one year ai campletlon, Ne ownerbuilder vrill have ihe burden ol proving t�at he or she did not bulld or impmve Por pufpose of sele.). ' ❑ I, as owner ot the praperry, am EXCLUSIVELV CONTHACTING WITFf LICENSED CONTRACTORS ro consiruct Ihe project (Sec. 7044, Buslneu enC Pmfessims Cotle: The mmractors License Lew does not appty to an owner of pmperry who builds or improves thereon, entl who contracts tor such pro�ect wlth e contractor(s) license pursuant lo Ihe Contractors license Laws.). ❑ I em exempt untler sec. Signeture: Owner ID verified by drivers license. ❑ Yes ❑ No Business end Pmtessions Code for this reason: Verllication of Ownership by (type ol tlocument, i.e. - praperty lex bill ar deed): DIVISION OF INDUS7RIAL SAFETY PERMR CERTIFICATION: Drivefs LJcense No. Date: Espires: ❑ I hereby certify that no exceveilon tNe (5) or more teet in depth into which a person is requlred to OescenQ wlll be mada In connection with work euthonzed by Ihis pertnil, and that no builtling siructure, scetfolding, telsewark, ar demolitlon or dlsmflntling thereot, will be more Ihan Ihirty-six (38) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title 8, Calllomla Atlministretive Cade). ❑ As owner-builder, I wlll not employ enyone to tlo work which would requlra e permlt irom Ihe Divislon oi Intlustrlel Sefety, es noled ebove, unless such person hes e pertnll lo tlo such work Irom the division. Signeture: Date: Division of Intlustrial Safery Pertnit Number: CEHTIFlCATE OF COMPLIANCE AND AUTMORVATION OF EMRV: I certify untler penalty of perjury �ha� I heve reeC this applicetion an0 state Ihat Ihe infortnatlon given is wrrecL I egree to comply with ell stete lews end clry ortllnances relating to Guiltling construdlon, and amhodza representetives ot tne Ciry ol Caste Mesa to enter upon Ihe ebove•des� Ry br inspac�ian purposes. I egree nol to occupy or allow occupancy of eny building euthodzed by this permit umil finel inspection. 9 neWreOlLegelOwner(s) Date �-q-o� AnNOr AuthoAzed Applicent Dele .� � ' I!. �19� 1616 Fi:ed System Flnal Fire Preventlon 1268 Pool Spe Final 200 201 202 203 204 Finel Re-Rool Final BIocWRetalning Well Final Fectory Fire Place Final Sign Final Demdltlon p�¢ g�$ j�Qyf�,( INSPECTIONTVVE 206 Final Mechanical � 208 Final Plumbing 210 Final Electrlcal 212 Flnel Flre Provontlon 220 Finel Planning Approval 222 Finel Slla 250 Finel BuilAing/Occupancy � .- L/1 � It�Lfl � F ' AOP��ant to fill in all sDaces eiceo� thosa withtn heavy bortler lines ane sign all approoriate tleelarations. � ' CITY OF-COSTA MESA' � � - P IT NO. � TRACT NO. LOT NO. BLD . . CONSTRUCTION PERMIT �- 47Q(� r � � Project Addresr Applicant's Mailin`g Addreu . Owner's Name aVt^� Phone Address �� 1� �Arch/Eng. ,� � u'"'� ��- License No. C( f� + Address '\ _ Contractor's Nam ' � 0 � �hsne ��? � � Address�lmailing) ��"a '/ - \City License No. �/ � 7'I . LICENSED CONTRACTOR DECLARATION � b hereby afiirm [hat t am Iicensatl untler prOviSions of Charter 9(commencing with 5ection 70� ot Divlslon 3 0( the Business antl Pro(esslons Cotle, a tl � my Ilcense is In f f ce antl ef(ect. � Licens lass � lo �No. � Date � Si9nature � � ORKERS' COMPENSATION D CLARATION nereby attirm that I have a certlficate of cnnsent to selt-insure or a certificate ' 1 Workers' Compensatfon Insurance, or, g� c¢rtitietl copy thereot (Sectlon 800, lab..C.) ' r t po' rvo.36G%3�g'3 comPa�y�G�%RI-i� �1 dc Certitietl cooY Is hereby turnishetl. . CerI�}'fie copy etl with the c' trtl�n D n. � Date_pC��— APPlicant . -EXEMPTION FROf��WORKERS' C MPENSATION DECI ATION - - (Thissectlon neetl not be cOmpletetl if the.permi[ is tar one h nGrBtl ($100) or . less). � � �� . ' . I certify that in the pertormartce;of the work tor�which this perm�t is issuetl I shall not employ any person in�any manner so as to become subject to t�e Workers' Com0en5ation Laws ot Califorrtia. Date Si9nature � NOTICE: If,'after making this Ceclaration, you shoultl become sub�ect to the � WOrkers' COmpensation provisibnsbf'the'�Dor Cotle, y0u Tust forthwl[h' comply witn such provtslons or this permit shall be tleemetl rovoketl. CONSTRUCTION LENDING AGENCV - _ I nereby afflrm thal [here is a constructlon I�ntling aqnncy �or the performance of tho work tor which'• thiz Oermit is � issuetl, (SecHon� 3097 Civ. CJ ' I.ander's Nama. _ . LenGer'S Atltlress� - OWNER BUILDER DECIARATION � ' I her¢by afflrm that I am ezempt from the' Contractor'z l.icense Ww for th¢ � following rea5on (Sectlon 7031.5 Business entl.Profeszional Cotle: Any ciry or COunty whiGh �eq W�es d Oe�mit to const�uCt, alter, ImO�ove, d¢m011Sh o� repai� anY Structufe, pllo! to Its I55uance, d150 fequiles tha applican[ fof such parTit [iere(rom antl the basis for the alle9etl expmption. Any violafion of Section F131.5 Dy, any applicant tor a permlt 8ubje<es the appncant to a civil �enalty ol�not more tnan five huntlretl tlolla�s ($500). � 1, as own¢r oi lha properly or my er�Dloyees with wages as IhGir sole 2ompen5dtion, will tlo Itte wo�k, antl the�slruttU�e i5 not intentletl o� offered for sale (Se<Uon ]044, Busine55 antl Profe55iOnal Cotl¢: Th¢ ConVacto�'S Ucense Law tloes not apply to an owner of a proDerty who�builtls or Improves th¢reOn, antl who'tlOes Suth wOrk himself/her5¢If O/ thrOu9h hi5 Or h¢� own ¢mploy ees, prOvltletl thd[ such Imp�oveme�ts a�e not in[entletl o� ot�e�etl for sale. I1, however, the builtling or improvement I5 soltl wilhin ona year of <om- pletion, tne owner wlll have the burtlen of provin9 he/she tlitl not bulltl or im- r ose ot sale . . � rove for the u P ) P � I, as owner of the property, am excluziyely contracting with IicenSetl con- tractors to construct the project (Section 70qq, Busines5 antl Profeszions COCe: The Contractor's License Law.does noI appty to an owne� ot.p�operty who builtls or Improves tnereon, antl who contYacts for such projects with a con- tractm(s) license pursuant to the Contrattor's License l�w): ❑ I am exempt untler Section B. & P. Q�or this reason Date� � Owner" I. hereby ttrtity that I have reatl tnis applicatlon antl riate that [he above i��,.rmafinn ic cn..nct: I aaree to comolv wltn all rJtv antl.countv ortlinances TYPE'OF CONSTRUCTION NEW ADD ALTERATION' � REPAIR ❑ CONVERSION ❑ DEMOLISH O OTFiER DESCRIPTION OF WORK � - ) TVPE OF PERMIT ❑ GRADING ❑ FOUNDATION �TRI ❑ TENANT �❑ ELECTRICAL ❑ PLVMBI�� ME[CHA� ❑ •OTHER 'L.ti+-/� PROJECT DESCRIPTION SQ. FT.� � CT. -�--oCCVar CONSTRUCTIONTVPE VALUATION $. ZONE GRA�INGCU.YDS. AC qemarks: . , - Bar Sink Backflow Preventer Backflow Irrigation Baihtubs Clarifiers � � Dishwasher � Drinking Fountains , ' Floor Drains. • Floor Sinks � Gas Service Outlets Interceptors� � ' Ki[chen Sink � � Lavamries - . P-Trap Roof'Dreins� - Reinspaetion-Fee � $25 Duct- Under Ground Duct - Structural Duct - Ventilating � Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO �h � Heating System & Ducting ' ❑0�100,000 BTU 0100,OOOBTI ��sPa�t �e� / � Atcounting;Goltlenrotl-Assessor $25 Showers _ Service Sink �' Sewer Cap Sewer Connection Solar Collecrors Solar Piping ' Solar Tank . Swimming Pool w/Spa Urinal j Water Closet Water Heater � WaterService � Issue Fee N Hoad or Typel ❑ CanoPY TYPe II ❑ ' Refrigeration System . ❑0-100,OOOBTU ❑100,000 System Repair/Alteretion Issue Fee RAL FEES $ 3 FEES A.P. # � S Main Buildi E T Front B Rear. A C Right � K Left $ Ping. Ref. Parking Req./Pr� Use of Building: Planning Notes: � Automatic Washer Cooking Unit ' Dishwasher Dryers ❑Gas ❑E6 Fan F.A.U. • Fixtures Device Boxes Outlets Switches Garbage Dispoul � Generator �65 KW � �I Reinspection Fee � PUBLIC SERVICES F Zoning APProved BY_ Appliwtion Approved A liption laued B PP V .�'�1: � �/�.��' . Zone Park.Fees $ ELECTRICAL �`� �Transformer � 15-50 KW � 50+KW Meter Dup to t00amps— ,Meter ❑over100amps;; Sub Panel . , 'MotorsO0.1 HP O1X'`8 Inc.Solar 09-15 HP �16-75+ ' Microwave � Pole'Light � Range Sign Standing Settions � KW Trash Compactor $25 �' �ssue Fee n ."40,�' T. ii FEES $'3 O N I N G R E Q U R E M E � � SU R F FEES � � BUILDINGPERMIT $ � O SMIP. $ O.S�J �� P�P,N CHECK , $ � Z PERMIT � � , ` PLUMBING ; $ ' ISSUANCE $ PLAN CHECK � $ ENERGV P.C. $ y ELECTRICAL $ GRADING $ PLAN CHECK $ MICROFILM $ , MECHANICAL $ TOTALFEE $ � , PLAN CHECK � $ ?'CONSTRUCTION ANDPLANNING�� ' - - PO pq ' �APPROVALS Peimit# � .Date f: Inspector - AppROVALS Permit# Date Inspector i ��1. Temporary Electrical�Serviceor Pole � . �'1 - 52. Pool & Equipment Location � . : ,.. �- ��2. Soil Pipe-Undrgrnd. � ' .i �A � . 53. Steel Reinforcement _ � ' 3.. Electrical Conduit�Utility-Undrgrnd.r.• !,f'� � 54.�F.orms . � �'� �4. �Electrical Conduit=Undrgrnd. � ' 55. Electrical Bonding " � -, ' �_ ',5: Steel Reinforcement -', �" 6.. Rough Plumbing & Pressure Test : ' 6. Electrical UFER Grnd. � �?, �� 57. APPROVAL TO COVER-GUNITE �• 3' 7. Footings ' ,�,ti �� . �� Z �� : . 58. EI ctrical Conduit-Undrgrnd. � �^ 8. Foundation - ��"��' • , 59.,Gas Pipe, O Undrgrnd ; Test � �.�, 9. �Water Pipe-Undrgmd. • � i.., .� 60. Backwash Cines, P-Trap, O Undrgrnd. ' 10`Structural Floor System �" y �-� 61. APPROVAL TO DECK � � �� .. 11. Property Sewer Line & House Connectiori �._ ,'" '� 62. Backwash & ReceptorFinal �. � 12, Sewer Cap ^ "" � ' � �`� � . 63. Heater & Vent-Final � + �� 'r 13. Roof Drains �� ` � 64. Plumbing System - Final � - -,,. 14. Rough Plumtiing��, '� � . -. "- 65. Electrical-Final - . 1 ' 15. Rough Electrical�Bonduit�" � - '- - � 66. Solar System-Final ' 16. Rough Electric-Wiring , ' � �� . ` 67: Fencing & Access Approval ' 17. Rough Wi'ring Sign ' � �, 68. APPROVED FOR PLASTERING �18.' Rough Electrical-T Bar Ceiling , � , - 69. POOUSPA SYSTEMS FINAL � -19. Rough Heating & Air Conditioning . , FIRE DEPT. REQUIREMENT i 20. Rough Factory Fireplace ' � ; APPROVALS Permit # 21. Ducts, in Structure . � � � 70. Underground Hydro r 22.,Ducts, Ventilating . � � � ' ' 71. Product Piping 0 Gas ❑ Oil � 23.'Gas Pipe-Rough &.Test: , . � , 72. Underground Flush :'� � , � n 24. Roof Freming � , � � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing `� , � _ 74. Overhead Hydro ' 26. T-Bar �eiling��Structurel) & Monocoat � . - 75. Dry'Chemical �.. 27. Frame•and Flashing , � 76. Dry:Standpipe . 28. Lathing � Siding _ � , ' � � � . 77. FIXED SYSTEM FINAL 29.'Insulation �` . , � ' 78. FIRE PREV. FINAL 30. Drywall'Nailingi_, "• , ' � HEALTH DEPT. REQUIREMENT , 31. �Plaster Brown'Coat. � � 79. FINAL INSPECTION 32. Electrical Pow�i Meter-Final i 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric'� ; � Notes: ' 34. Final�Heating & Air Conditioning; � • - �c c . Svia 5 35. Final Gas Pipe-Test ' ` . � - - 36. Hdod or Canopy ' • � � � . . I - - ' . 37. Final�Factoiy.Firep�ace , ' ; ' , " - 38. Final Plumbing;,,; � , ' . � � 39. Water Service-Final� � • ' � , . � . .. i 40. Gas Service-Final ��, �� ' 41. Sol9r pomes`tic-Final � _ _ _ . . • � • � 42. BackflowPreventer ' ' , � . -4"�� 43. Backflow Irrigation� � ' ' � ' � �_ � � - � � . � �, j '�., 44. ,Landscape Irrigation System , � . 45. Sound.Attenuation , ' , � - , � ' . �� i � - - i 46. Handicap Regulations , � - � , � � • 47. FINALSTRUCTURE&BUILDING = � / ' 48. Special Requirements�Coinpleted � - � ' . � ' � ' ' 49. Electric Release to Edison � � - - ' ' • � , - - , � i � 50. Gas Release to Southern California Gas Co , � ' � �� 51. CERTIFICATE OF OCCUPANCY- - � _ _ . _ _ . '^ } . . � f; No - - - �-� Date � . . - � � ' ' � .' � ., � . �� ,rR � �� .� ;� •., -� �. �^ �.. � � T 'r: � •a� Y ; EC p T10 tetl Untl�* pi rlUi Its��t tho� f'n� i' � .�ApDlleent,to 1111 In�ell �paas sxnpt;l�ow witNn �mvy OorCar h r i �� t r.�� TflACE N; c.t '�,L� w �_r� . :��;� . �YRo 1- s C a/� na' • No. �d �'� , �{ ;. . ,.� , .+' ' li�;u�.ol:s H�� ,,J�! � Eo�. t , S:• F�i _l• a ona untl�W ( 300 0�' e L � lhi pai �t I� luiw Ir'� 1 Aa��me- uel t co�thei, ,. t e _� tln9; G �CO�oD�I�t�EatlafatlonL � � � � -: , � ' , r : . — y,� , -. - . �1 �r . . S I,W W �W. . L7 4' i RJ � I✓ tD �.'��O ti (4it� W,4i f�D I it}, 1/ "i Q� iD � 0 � Iry3 �ii P}11Ftrt. . `' . . . ... } � �'.'`° �: i .5 %tiP•�'�`.0 1�� ai �.� �S.L:�.c �-2 � `" �� : ��i: C` S � a 1 m ^� • I i� I� J.� l: m:a., nnei�Buiwina � u-. . a:I n:l.� i=. naeeisd.�Fe imi�o,.: , m. 1. �+ {= o I fWEa �i s� I L*.1..� .�c � ti �:'1� g7ffG -« � t .:I: m - n .. .A . . . . - .. . . . _ . . bE � RIP�ION S � ' � .- `OCCIIPA{V� " .f .C. RWh? "A` T�: ` , ��,,..�`.i rr �. m�j. M m 1: � c,� bd,,, • { ' 0 a 1(�1 Ti0�1'TY E • N. ~'� ' �l�lU TIO.N S .I I � � � S �I - ' v� � . `. � �� l 4 �."C Q i [C: .�, �m •Y2'. }. E r '� n Oi�ADINO CU. V�'!S� �'� �•IqC- � .�,^ Pin& Ref. f�.i�j;. � �t' ' 1'.. �' I Perk felf S} ,� A' \.' N �C` C G � .l. � . y� .1 1 . . . . • : u — - /;� '��i °Q.' • ' .� � �� =u ' : Pdrliinp�qaV./Provided' r ; �:I' / r ; � .Sr.. t�. � � cr'•. �. � ��A °' ,� u = � �E 36fi: S • i2 .v3 Waof Bulldlnp ,... t � �� F�t� .\ � �� /1 �' it c�`m '.n �5 E � , i.: -;Tu,•. c," ', I' PL B NO. 'p.'.., •' I ' 'FECS ' WennlnB��t .:.'r i� .(' i;,f • � t ' � �I`�T. . %,r,. .> �.4j � �,c � y M nk� 'Shbw :3..:t': .4.. � ��h' -.! �'r.. :�: -a- '.n:» �l: •:il,jrf � �y ��.6,�. i�'+ _ �� N , >; < i...' T rreventer , � . salvicro s�nli . -j. .. _ 1 �. � I .. ' � G �. Y .�; y '� � �i. � io Irttgetion ' j . ; I $efver Qap :', ' . _ �' - : -„ . - _�� y � ELECTAICAL '. :'. ,. �� ; - . FE68 � � .i °� + ` . �.I � -:� I . Sawar nnectio � „ . ! '. utbmetlE We�her � •: � �. .� f7nrufoniier � 76i60.KWV i : : : . . � • . : 1 , , . � � , r� �� '. .,.. �. � i ,.1 . � .'So�er'Cbl�ecmn�. 1 . F �..- :, � � .: i � r � . , .,.. - .Conitr�c[`bn'Pole S�k :- �.° .�.,. t . .60+�KW :'Y. ., .1_._ - .L�' .h. aihBr, a: "SdtarWP�+�O .e�- � ck.tbqklnp' -�r: � ,1�'�_��!'_�pkit00e� In Fo- ntaf� e➢� � �.' ��. �:So�ar Tjnk� � , .. � � . � , � Diihwmh , a , . � .~� ,�s � I;` Mitdr �bvar 100 emPe s .�i :•. :. - D eiro �:" . .�� e�>: ....,. . Sr�iimminp_... � w/SPa ,-'. � _ � .- + ��' .D�V,kt . Gei , ,� leevk �• . .� Sub�Peire�t.. .' �' Sink� �- � `::.�, �Ur 1. '. �k ,. � .� Fan � r �. .: Woton o� r�v d�x-��a � . � �,.' � mka �,;`cOJnan v� � ,innm aomc f:' �' ,;: .. j � �o � F AIU �,,. �" � �Ine.�oki O9� 6 H� 0161 I edcori �.=:.'�. %,'.; � : ,i vwacer'ilac .-. .. .,. .-: � . �' � _ F�xturet . Mi66wa � �j., a �� ir.; vz..c� ��c: c� '�lVetaiServlci'�"'� `� — y r' p n� Dev,ee8 ze� ,�". ,4_. �Pole�LipliE, :s+ 'rv �. �N' /'P Pr�°��-��"'��..a�i�� ,3+.a��m ��' "��m m��t....�-Q'i��.� �.� Outab-'k','s ��r��. 1, �R°^�e. y i� .f W. °� � �.L7�.�. . � /1 �° c a �-:8 , i� 'rt. .- � � 5 � �r7 � '� Switche�'", � . 'r.a� � . ct ' s N . � h^; ; 'j,. I S�Y^. � �D' s�? r �, -:� �� { �8�. J-`� I.-iv, �.>�) m� �.:,.�:l.- ce. wo�r6omi� -..�%�I: '_l` I'= � hsceddlog,seit�oro r} ��.��VN-�'��I..Q��n+'t� �.� � �c,' ��.. I•� .I.��-j.5'1'F"`:�f'�i':A Geneiatoi�05K1!J.�3151�W_ Tra�iCo'. .or .� �l sp�a�on�oa� �� 'G. �' m� � �1�' ,��- .�':C7._) 5 S,iB . ,. �. .•_ � : .:i� �' ,_ •1 : �t ,.: y � _ . z�. a k � � � MECHANICAI -. . � m ei�pe{ion`R�s{ �� B �I �Fw � ` ..};., . ' ' ,8t3. .. � .0 r.. •.� 1- a FBE9 . . �� 2 '` �d w � -TYPe � ❑ � cz ,.� PUBLIC'SERVIC�8 R �UIRE EHT9, .. �a - _ f t ..� �,_ ' . ^o : � .ti �� ; .�m = � ;. Ny �. ,m: . m ..�Zoiii �� nd BY � � Y�.: _ i il - I ' � . • 4lrroPY � T.1%Pe 11 ❑ _ ��Q . ' p _ �I �q l"" l .. . . �lnne7 und c � .� ueejton nnw,oliaa � �+' . , � _ . , ` f . s ,� i . � • 4ruc�utal . R,s.�,�fripare�bn �Y�e I �¢ � � IlaUon I fBy � ��. � r ��. . .' �.. : � , r • entl ating -.�• L'-'16�100.000 �TU P100 � T�U '� j . r.',' S V Ok FE�S � �. ', i: � ',B,UILC�INGIPER IT. ',S- � ' � ' �MIP� S � M p .Sy em � � � ulti a Y m epei /Alt ti n . . � � r L .. � . d/ ectr8lt.ICBO r � P�ANCHEGK S `PERMIT I � , �Pfl.U�M�IN � .,s, ..I, '.�. ISS4 ANCE �'• s� 4,.• � SVatom & Duciing . �u''- �,�, PLAN CHE�K t ��. ''$ ' NERGV iP C." $ " IOb. BTU.�1t10. ,•... ,�, rr'.ELECtfRICAL- "!''� $� '-�` HAbIN6: _ '.s. -.. " - r -: P N CHECK �.:r 's • . � ICi�OFILIM' �S - ;~ .' ` 1�ECHALNICAC S OT�L FEE S `' �' �Ior�Fie ., gj5 . I��F's • �' �1 . � 6 3 - PLAN GHECK E � � � � ' � I � i � � . , . i .i . . . . - . � � � e.Jnwiso.__�_�_..L_..L.J-1--...i._..'._ ..t_.f.__1 ___ ...1 _1.. t._ +. : : i I • � � : � ' _' e _".�'"_' ' _ ' ' ' " " "'. .._ _ . . � � _ . . .. . . ... . ��+�CQNSTRUCTION ANDPLANNING � - � � PA '�• APpROVALS . Permit # � Date �� lnspector � qpPROVALS � Permit # Date Inspector � "- ;�1. Temporary Electrical Serviceor Pole `. �� 1� 8 52.'Pool & Equipment Location � . '2. Soi! Pipe�Undrgrnd. - .- '� . ` 53. Steel Reinforcement � ' 3. �lectrical Conduit UtilityUndrgrnd,; �. ' 54.� F.orms � . - . - ��4. Electrical Conduit-Undrgrnd. _ . � ' � 55. Electrical Bonding ' � , � � : 5: Steel Reinforcement � '� .- . 56. � Rough Plumbing & Pressure Test • � , ' 6• Electrical UFER �md. � .%,.3 ; J( 2� 57. APPROVAL TO COVER-GUNITE •� 7. Footings �� ._�i � .3�' S8. Electrical Conduit-Undrgrnd. � 8. Foundation - �� 59.;Gas Pipe, 0 Undrgrnd., Test - 9. Water Pipe•Undrgrnd. � � , � � 60. Backwash Lines, P-Trap, O Undrgrnd. ' 10` Scructural Floor S�stem . • 61. APPROVAL TO DECK '� � �11. Property Sewer Line & House Connectiori �� -'- - 62. Backwash & Receptor-Final � • 12. Sewer Cap � • . ' � , . 63. Heater & Vent•Final - . . 13. Roof Drains " . • � 64. Plumbing System - Final �. __r 14. Rough Plumbing•� ' ' � -. - 65. Electrical-Final - . - � ' 15. Rough Electrical-Conduit ` . -- . 66. Solar System-Final - ' i 6. Rough Electric Wiring � ; , 67: Fencing & Acceis Approval " 17. Rough Wiiing 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. F?ough Factory Fireplace - APPROVALS Permit # � 21. 4uM5, in Structure � 70. Underground Hydro �� 22.:pucts, Ventilating � , � � 71, product Piping O Gas ❑ Oil 23. Gas Pipe•Rough &.Test . � . . 72. Underground Flush . , 24. Roof Framing • • 73. Undergrnd.StorageTank OGas ❑Oil . 25. Roof Sheathing � � s �. �Z (� 74. Overhead Hydro 26. 7-Bar �iling (Structural) & Monocoat � 75. Dry Chemical 27, Frame'and Flashing � D S �, 76. Dry Standpipe . ZB•, Lathing & Siding • �.�' � )�� 77. FIXED SYSTEM FINAL 29, insulation - D S _ S J8. FIRE PREV. FINAL 30. prywall�Nailing ' HEALTH DEPT. REQUIREMENT ' � 31. Plaster�$rown'Coat . , � 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric , � Notes: -�rAMtN L� 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test '_ � _� , � ��/� � 36. Hdod or Canopy ' �G� � J ,_ 6 37. Final Factor.y.Fireplace � . _ �, - ' ' � S y � 38. Final Plumbing � � � t 39. Water Service-Final � � ' ` , , , A �� . � /g 40. Gas Service-Finat ,', , U, /�Q �Q , 41. $olAr pomestic-Finel' � � . _ � • � . 42. 6ackflow Preven4er � � • , 43. Backflow Irriqation� � � � � . � . � - •, . '�� 44. Landscape Irrigation System � � , 45. $ound Attenuation ' . � � � � � � '�46. Handicap Regulations . - � : ' '47. FINAL STRUCTURE & BUILDING p S. �8. 48. Special Requirements Completed �/s C 49. Electric Release to Edison � � � � � � � � 50. Gas Release to Southern Califomia Gas Co ' � '� 57. CERTIFICATE OF OCCUPANCY r No Date - � � Aoolicant to fil� in au sDaens axce�..-anosa within��7�.�-�_ .. _.._l �..�...� .��al. OF COSTA MESA NSTRUCTION PERMIT � Project Address ApplicanYsMailin9,A/ddress ?��'�• �QrN S`r• �AS'lA d.IG�� Owner'sName �I' rT' (�� --ohone�� Address �-,7� � • k Q T� �' \' Arch/Eng. ��f'f'RK G-fi LicenuNo. GIOiiG� ,`� Address rL 1H f'C _ \ '� V Contracror's Nam � � one L � . Address (mailingl � � , I � Ciry LicPnse No. LICENSED CONTRACTOR DECLARATION \ I.hCr¢by aHirm lhat t am Iicensetl unAer pravi5iOn5 0/ Chdrter 9(COmm¢ncing with section ]0 0) of Oivision 3 of tne Business antl Professions Cotle, antl ,}.f my Ilcense is in II ( rce antl eftect � �. � p� - 9 License Class Li se No. � � Date Signature ORKERS' COMPENSATION DECLARATION' � hereby affirm that I bave a certi(iwte of cOnSent t0 selftinsUre or a certifi�ate �f Workers' Compensa[ion Insurance, or a certCifietl <opy thareot (Sectlon 3800, Lab.4�, � G 7J y S�3 ComPanY �J� �^I Q j ll � PoliCy No. % U. Certitietl copy is hereby furnis�ed. ^/ if tlFopy is ileG with the city Byity ing Divis" Date� l�.(� APPliwnt (( l. ] �(� 5�� C�. Cn�� EXEMP ION FR M WORKERS' COMPENSATION DECLARATION �� (Thi55ectiOn neetl nof be cOmpletetl if the p¢�mit i5 (or on¢ huntlrBtl (E300) ot less). I certify tnat in the p¢rformance of the work /Or whlGh this p<rmR I5I55ued, I shall not employ any permn in any manner so as to become sub�ect to the Workers' Compensation Laws ot Californla. i Date �i9nature ' NOTICE: If, after making this tletlaratlon, you shoultl become subjecf to [ba • Work¢rs' Compensation provisions at lhe� labor Cotle, you must forthwltM1 compry wit� such provisions or this pormil shali be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I nereby afflrm lhat tt� re is a com[ructlon lentling agency tor the pertormanco of Ihe work for �q�iUa xhis ,qermit is Issuetl (SecHon 3097 Clv. C.) . Lantle�'s Nama ' / U V I� '�`- LenOer's Atltlrezs OWNER BUILDER DECLARATION � - I hareby aHirm that 1 am exemPt irom [ne Contractor'i LJtense Law for [ho I011owin9 reason- (Section 7031.5 8usinei5 antl Profossional CoOe: Any city or • - county whlc� requira5 a Dermlt to construc[, alter, Improva, tlemolish or repalr .any struclure; prior [o its issuance, also requires [he applicant for su<h permit to lile a•signetl ztatement thal he/she is IlcenSBtl pursuant to the provlslons o/ he Con[ractor's License Law (ChaOter 9(commencing witb Sactlon 7000) of iviSiOn 3 O/ tha Busine55 antl Pro(esslons COtle) Or thal ne/ihe Is exempt heretrom antl the basis for t�e allegatl axemp[lon. Any vlolation of Section 7031.5 by any applicant for a parmit zub)etts lhe'applicant ro a civil �enalty of not more than five huntlretl tlollars (E500). 1, as owner of tha Oroperty or my amployees with wages ai thelr solo componsation, w111 tlo the work, antl the structure Is not IntentleC or oHcrea /0� saln ($eclion 7044, Bu51ne55 antl Profassional Cotlu: Tho Coniractor'S Licanse l.aw tloes not app1Y to an owner ot a property who bulltls or improves Ihmeon, antl who tlo<5 SUch work him5¢If/ha�self or thrOugh hi5 Or h0/ own , employ Ces, provitletl tttat Suth Improvements dra nOt Intendetl o� ofteretl tor Sa10. If, however, the Ouiltling at Improvemen[ IS soltl wlthin Ona yedr Of COm- pletlon, the owner will nave the burtlen of proving he/she tlitl not bulltl or im- �rove for the purpose ot sale). I, a5 owner o( the OrOp¢rty, am ezclu5ively ConlracUn9 wllh IlcenS@tl con- traCtolS to conSbuGt the project (Se<tion 7044, BUSIne55 an0 Prot855IOns CoAa: The Contra<tor's License Law does not aOP�Y to dn own¢� ot property who builtls o� ImprOves tha�eon, antl who COnt�acts b� Suth project5 with a COn- tractor(5)Iicense pursuant to the Contractor•s Litense Law). . ❑ 1 am exempt untler SeCtion , 8. A P. C, tor th15 reason Date Owner� , i hereby cerlify that I nave reaa lhis appllcation antl state that the above InPormation is conect. I agree to compty� wlth all city antl counly ortlinances Signature Drivers' Lic nse or 55 � MF 0865-46 rev, ]/83- W�ite - BW Itlin9: �nary' APPliwnt; 0 � c -. � vv � �.; , TYPE OFCONSTRUCTION rvi ❑ CONVERSION ❑ DEMOlISh DESCRIPTION OF WORK N� e ADD Ll ALTEi2ATION IJ REPAIR TVPE OF PERMIT LJ GRADING U FOUrvonT10N U STaUCTVRA� ❑ TENANT ❑ ELECTRICAL ❑ PIVMBING ❑ MECHANICAL ❑, �OTH E R DECG PROJECTDESCRIPTION �S�T._ O• OZ OCCUPANCY__ CONSTRUCTIONTYPE�•N - VALUATION$ /S2 ZONE ' � GRADING CU. VDS. ' ACRES_ Remarks: �/",C./. yp _��iQ_Z . Sink Preventer Irrigatlon Clarifiers Oishwasher Drinking Foun�ains Floor Drains. � Floor Sinks ; � Gas Service Ouclets Interceptors � . Kitchen Sink ' � Lavatories i oot Drains Fee 525 Duct• UnderGround Duct - Structurnl Duct - Ventilating Exheust System � Multiple ❑ Firepl/Fect. Blt. IC80 ak Heating System & Ducting ❑0700,000 BTU O100,0006Ti - ' I , I Reinspection Pee Actounting; Goltlenrotl - A55essor 0 $25 Showers Service Sink - Sewer Cap ' Sewer Connection Solar Collectors Sotar Piping Solar Tank Swimming Pool w�Spa Urinal • Water Closet Water Heater ' Water Service IssUe Fee Hood ar Typel ❑ ' Canapy Typell ❑ Refrigeration System � ❑aioo,000eTu Oiao,000si System Repair/Alteration Issue Fee � FEES S 3 A.P. iW " I'i��'� S Main Building: TFront pZ� � iyy�H„ � e Rear � 3 � A C Right . � � S�eft S' � Ping. Ref. dk � � �3 _6 Parking Req./Provided � /J ' UseofBuilding: ��Y; Planning Notes: n n . _0 �.. - zode" L...... �c,�an, Accessory Building: - Z O N • I N G . R ' E Park.Fees $ � � , U I � B R L'- • E � .u-t,eL'. . N �"" E !no .� 1117 �...n. �:.. .. �fr/n / N ELECTRICAL P.utomatic Washer Transfarmer ❑ 15;50 KW Construction Pole Sub. � 50 + KW Cooking Unit -1 ' - Meter �up�to 100amps Dishwasher � Meter ❑over 100 amps Dryers ❑Gas ❑Electric Fan• F,A.U. Fix[ure5 � ' � Device Boxes � Outlets Swimhes Garbage Disposal Generator 00-5 KW �575 KW � Reinspection Fee - PUBLIC SERVICES R Zoning Approvad By_ Application Approved � FEES .- i �— — Sub Panel Motors O0.1 HP O1 i4 - 8 InaSolar �9�15 HP �16-15+ Microwave Pale Light Renge Standing Sections Trash Compattor 5251 �uue Fee S APPliwtion Issuad Bv �� 2� I � Date U/,[S/b'�� SUMMARV OF FEES � �D,%O BUILDING PERMIT $ _f IS.,SQ SMIP $ ' PLAN CHECK � $ PERMIT ' PLUMBING $ ISSUANCE 3 PLAN CHECK � $ ��-- ENERGY P.C. $ ELECTRICAL $ _JL�u V . GRADING 5 PLAN CHECK $ • D4 � � MICROFILM § / - MECHANICAL $� TOTAL FEE 5 Sg`' � PLAN CHECK $ ' � _ .� CONS7RUCTION AND PLANNING • PO SPA APPROVALS Permit# Date Inspector p�ppROVALS Permit�r` Date Inspector - t. Temporary Electrical Service or Pole � 52, Pool & Equipment �ocation 2. Soil Pipe•Undrgmd. _- �, � 53. Steel Reinforcement �, 3. Elec[rical Conduit Utility-Undrgrnd. , ' 54.• Forms . . 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel fleinforcement .� ' S6. Rough Plum6ing & Pressure Test � . ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings � ' 58. Electrical Conduit-Undrgrnd. B. Foundation • • 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, � Undrgrnd. � 10. Structural Floor,System ' �t 61. APPROVAL TO DECK � 11. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap �'' � • 63. Heater & Vent-Final 13. Roof Drains � _ � ' 64. Plumbing System - Final � 14. Rough Plumbing . . � 65. Electrical•Final 15. Rough Electrical-Conduit 66. Solar System-Final •1.6. Rough Electric Wiring 67. Fencing & Access Approval !�7'7. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling , 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air CondPtioriing FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace �� APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro .. �. . 22. Ducts, Yentilating',',� �� '., 71. Product Piping O Gas ❑ Oil 23, Gas-PiFe-Rough;&'Test i �� 72, Underground Flush 24. Roof F'raming � ' .��r= 73. Undergrnd.StorageTank f7Gas ❑Oil 2J: Roof Sheathing . 74, Overhead Hydro 26. T-Bar Geiling (Structura�) & Monocoat 75. Dry Chemical 27. Frame and Flashing ,- 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat • �� 79. FINAL INSPECTION 32. Electrital Power Nleter-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 Factor�y Fireplace 38. Final Plumbing 39. Water Service-Final .� 40. Gas Service-Final 41. Solar pomesticFinal _ �� 42. BackfloW Preventer �' 43. BackfloW Irrigation • � � 44. ,Landscspe Irrigation System - 45. Sound Attenuation 46. Handic2p Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requiremen[s Completed 49. Electric Release to Edison - � 50. Gas Release to Southern California Gas Co � . 51. CERTIFICATE OF OCCUPANCY `/ 4 G v� _.,o�Z�.,,,,i(a * G7�Q,d.e No. GL03� Date $7 � r 1 --•---- AOP�icant ta flll in all spaees except those within heavy Coreer Iines an0 sign all aoo�opriate Oeclarations:"�� , ' CIl'Y-OF COSTA�MESA '. - RMIT NO. TRACT NO.� lOT NO. -BLD . . . _ _ . . 4]y�. . . . , :�� t CONSTRUCTION PERMIT � �, - J � � : � ' _ � . , 1/ - ProjeCt Addf255 � TYPE OF CON TRUCTION- NEW ADD ALTERATION. REPAIR -^^ • •� "- �''� � �V , Applitant's M2ilingAddrEss. � � �� %P �❑ CONVERSION -❑ DEMOLISH ❑ OTHER , - q;p,'�6 ' _ � ,Zppe - OWnef'S Nam2 PhOn2 OESCRIPTION�OF WORK S Maln Building: � ACCe550ry Building: 2 � Addiess TVPE OF PERMIT GRaDING FOUNDATION' STRUCTURAI T Front � � N \ ArCh/Eng. Litense No.� ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL • - B Rear ' - ' - � r -' a N � AddrESS � � ;� �OTHER _ D i' ��7a � PROJECT DESCRIPTION SQ. FT. ' OCCVPANCV C Right . - G Contractor'sName � � P+w K p , . � � L � /Y\ ' CONSTRUCTION TVPE VALUATION § g �ef[ . E � Address Ir^ n/ � ( � . 7 -- 20NE GRADING GU. VDS. ACRES ping. Ref. # . � . Perk.FC25 $� Q City LicPn N U LICENSED CONTRACTOR OECLARATION '. Rema�ks: ' � i Parking Req./Provided � � -' � I her¢by aftirm that I am Ilconsetl Under proviSiOns of �Chartei 9(comm2nGin9 . . , R � with section 7000) of Divis(on 3 ot the Businest antl Professions Cotle, antl o w.�,2 oik �.v�y Use of Building: � . E my Ilcense is in full fprca an� r,(fect. // - � • � � Licens las C_ (.J � �, yc s - �� PLUMBING � FEES P�anning Notes: M Date� � 5�9 L _ �/`� . . . . � E RKERS' COMPENSATION DECLARA �A , ' . Bar $ink ShOW¢f5 � N eteby dffirm Ihat 1 havC a Certiticate Of <6nFent to self-insure or a terUticate � gackilow Preventer ' Service Sink . ' " T Worker5' CompensatlOn InSurance, oc a certlfle cop tnereo (Sectlon S 00, Lab. r,, �U Backflow,liiigation Sewer Cap � ELECTRICAL FEES ' PolicY No. �`�'�!�� ComPany �� . - ' � Cert� etl covv �s nerebv.�urnisnetl. � , , Bathtubs ' � Sewer Connection Automatic Washer 'Transformer ❑ 15=50 KW , rt I cl i�s witn the dty Bul g D on ' Clarifiers �' Solar Collectors � Construction PoleSub. � � 50�+ KW Date �� ,Applitant � EXEMPTION FROM WORKERS' COMPENSATIOry' CLARATION Dishwasher - � � - - � - - - - .- -. (This section neetl not be completetl If the permit i one huntlretl (E100) or - Solar Pipin9 Cooking Uni[ . �Meter ❑up to 100 amps - Iesi) , n 1 ' ' Drinkin .F.ountains � ' - ' � ' I certify that in Iho �pe�fo�mdnce ot tbe wo�k tOt�whlch this pe�m�t i5I55uetl i , 9 � Solar Tank � , , Dishiwasher .� � Meter ❑Ov¢� 100 3rt1p5 , shall not employ any person in any manner so�as to become subject to t�e -. � � � � ' , . Workers' Compansation laws oi Caurornla.� i .' ' Floor Dreins , Swimming Pool w)Spa'� . Dryers ❑Gas ❑Electric 'Sub Panel . . Date � Si9nature ' � - , • • , - � NOTICE: If, after makin tM1is tleclaratlon, you shoultl become dub'ecl to the � FIOo1 Sinks ' Ufinal ' � Fan � . 9 , : Mota�s o o-, HP o, �= s � Workers' Compensatlon-provisions of the Labor Cotle, you must forthwitb - comply with' such provisions or tnis permlt � shall be tleemetl revoketl. Gas S2rvice � Outlets Water CIoSEt � � ' ' r�F.A.U. � Ina Sola� �9�15 HP �16-15+ CONSTRUCTION LENDING,�AGENCV. ' •"' ' ' " " I hereby affl�m that Ih¢re Is a const�uGtlOn lentling agenty tOr the pe�fo�manc¢ '. InLCfC¢pt0�5 �Water Heater, �- �5 Fixtures ;Microwave � of tbo wark for which � this permit is issuetl (SecNon. 309] Ciy. ,C.) • , , � i.entlers rvame , �- - � Kitchen Sink - � Wa[er Serv'ice `' Device Boxes � ' Pole Light �entler's Atlaress; ' � � � - � � - ' Lavatories . � � OWNER BUILDER DECLARATION .. : � ' ' ' ' ' � '. Outlets ' Range ' /,� u I hereby atfirm that 1 am exampt trom the Contra<tor's Licanse Law for the . p_Tr0 � ' following reason (Section 7031',5 Busina5s antl Professional Cotle: Any city or � _ P � • ' � Switches Sign ' � p.f county which reqWres a permit to construct, alter, improve, tlemolisM1 or repalr � - . - .any structure, prlor to its"issuance, also requires the applicant for such permit �FOOf D�ains '� ' � , � Garbage Disp0521 � Standing Sections I to tile a slgne� statement tha[ he/Sh¢ I5 Iicensetl pu�suant f0 [hE provisions O/ ' . _ . e Contractor'S License Law (Chapter 9(commencing with SecUon 7000) of '. '� � _ - - vision 3 of tne Business antl Protessions Cotle) or Ihat he/she is exempt _ . - � . � Generator �0.5 KW �5-15 KW TraSh Compatror . refrom antl t�e basis for the allegatl exemp[ion. Any violation ot 5ection � ' , �, . 31.5 Dy any. applicant (or a periTlt subfects tne aOP��cant t0 a civil ReinSpecti0� Fee $25 - laue Fee` ' § 3 - � nalty of:not more [han five nuntlroa tlollars (y500). - . I, as� owner ot the property or my amployees with wages as their sole MECHANICAL Heinspection Fee $25 Inue Fee $ 3 wmpanzation, will tlo the work, antl the-structure is not Intentled or offeretl - FEE$ tor ule (Section 7044, Business antl Professional Cotle: The Contractor4 , . PUBLIGSERVICESREQUIREMENTS: � License l.aw tloes not apply to an owner ot a property.who builtls or Improves goiler ' Hood or Type 1 ❑ - thereOn, antl who tloe5 Suclt wo�k him5¢If/he�sel/ or tn�ou9h his o� h<r awn � � 20�ing App�Ov¢d By � DetB employ ees, provitletl that such improvaments are not intentletl or offeretl tor � - ��opy � Type I I ❑ . . , , , Duct = Under Ground ' sale. If, however, tne bulltlin9 or Improvement Is soltl within one year ot com- . � Application Approved By � Date pletiOn, Ihe owner will nava the burtlen of O�oving h¢/sh¢ tlltl nOt builtl o� im- rove for lhe vurpose oi sale�. Duct - Struc[ural Refrigeration System , Appliotion Issued By � �✓1 � Dat 3 � 1, as owner of the property, am eztlusively contractVn9 with licensetl con- ❑6100,000 BTU ❑ 100,000 BTU tractors lo construct the project (Section 7044, Business anE Protessions Cotle: Duct - Ventilating . SUMMARV OF FEES , The Con[ractor•s License Law does not apply to an owner of property who ' builtls or improvas tnereon, antl who contracts for su<h orojects with a con- Exhaust SyStem ❑ Multiple ❑ System Repair/Alteration ' . BUILDING PERMIT $ SMIP, �$ � tracmr(s) license pursuant to the Contractor's Llconse Law�. PLAN CHECK $ PERMIT ' . ❑ i am exempt untler Section B. & P. C. tor tnis reason Firepl/Fact. Blt. ICBO # PLUMBING $ ISSUANCE $ �ate Owner. Heating System & Ducting •, pLqN CHECK . $ ' ENERGV P.C. $ i.hereby certify that I hava reatl thls appiication antl state that t�e above ❑6700,OOOBTU �100,0006T . .� ELECTRICAL $� GRADING $ information is correc[. I a9rae to complY w�th all city antl county orCinances • antl-stale laws relating to Euiltlin9 mnst n, antl hereDy authorize revre- , ' PIAN CHECK $ �� MICROFILM $ sentativez of t�i5 cit to e te he abova-mentiDo�nt Q�property � � , , • . inspectlonouro . �/ � MECHANICAL . - $ TOTALFEE $ � Siqnature � , . orivers' License or 55 � Reinspection Fee $y5 luue Fea • $ 3 PLAN CHECK •$ CMF 0865-46 fev. 7/83 W�Ite - Builtling: Canary - Appliwnt: Pink - Attounting; Goltlenrotl - Assesmr . . . _ ' . _ . '' � . °GONSTRUCTION AND PLANNING P PA ' �•� APPROVALS � Permit# ' Date Inspector p�ppROVALS Permit�'-r Date Inspector : 1!Temporary Electrical Service or Pole� 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - . ,., 53. �Steel Reinforcement 3. Electrical Conduit Utility-Undrg�nd: S�y� �� 54. Forms 4�. Electrical Conduit-Undrgrnd. , .` � �!e 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., 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 12. Sewer Cap , _ 63. Heater & Vent-Final � 13. Roof Drains 64. Plumbing System - Final 14. Rough plumbing � � 65. Electrical-Final 15. Rough Electrical-Conduit � 66. Solar System-Final 16. Rough Electric Wiring /�3 G 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical-T Bar Ceiling yo e� 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 V 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing , � 73. Undergrnd. Storage Tank C] Gas ❑ Oil 25. Roof Sheathing , 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &�Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding � 77. FIXED SYSTEM FINAL 29. Insulatfon 78. FIRE PREV. FINAL 30. Drywall Nailing �� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat • 79. FINAL INSPECTION 32. Electrical Power Meter-Final � ' 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - f� 35. Final Gas Pipe-Test 36. Hood or Canopy ' � 37. Final Factory Fireplace 38. Final Plumbing 39. Wa[er $ervice-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 48. Special Requirements Completed , � 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY � No. Date / ' ' AGplicant to flll In all sDacei ezeeD< <hosa wllNn heavy DorCer Ilnas anC sign all aOV�opNata Gaclarallons. ' ' CITV OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLD . . 1 NSTRUCTION PERMI7 � CO ' Pmject Address • Applicant's Mailing tA�ddreu Owner's Name 7-• � e-- Phone � Address Arch/Eng. License No. Address Contracto,'<tiw,.,oSJel�l2i8 /l• .S Pi+ti�,,,,,, ii3� Addresslmailingla��' 's• ��'"�.% ��— Ciry License No. , LICENSED CONTRACTOR DECLqRAT10N I here�y allirm that I am Iicenze0 untler provlslons of Charter 9(commencin9 with section 7000) ot Divislon 3 of the Business antl Professions Cotle, antl mY Ilcenze is in fuy�i6rcE�rW.eifect, . �y,� �Ai/ Date� $i9nature� OR ERS'COMPENSATION D Lq nere0y aHi�m [hdt I have a certitiyte f Workers' CompenSation Inzuraqce, 3800, Ldb. C.) PoliCy No. G ertifietl Copy I5 he�eby fu�ni5h0tl. arti(ietl <opy B tiletl wit� the city I Date A�P�icant� EXEMPTION FROM WORKERS' COM �(Tsissection naetl not be completetl i It ertlty Ihat in th¢ performanCe Of t i snall not emp loy gnyp erson in any r WOrkersYCO�htlenffitl�n lawi of Cdli/ conunt [o salf-insure or a certificate ' a� certLif�pY_. copY tnereot (Section pany f-�-F-/-.�,1'l�l0� JEin9 Division. INSATION DECLARATION oerviit istor one hunCrebIS1001 or NOTICE: H, after diakln9 this tlecldrati6n, yoWsnouiH b e iubj8ct to the Worker5' Compenlation pwvisions of [ne Labor Cotle, u mu5y tortnwitn i comply with SUC� proviilOns o� ph(5 pOrTlt s�afl e tleemetl revokeE. . CONSTRUCTION LEN�ING AGENCV ' � I hereby afBrm that there is a conslruction IenCing agency lor Ihe per/ormance , of Ihe wOrk fOr wnich lhli Pe�Til is ITSuetl ($eCHOn 3097 CIv. �CJ , Lentler's Namn �ntlar's Atltlress � OWNER BUILDER UECLARATION � ' .1 hereby affirm.tnat I am ex¢TPt irom l�e Cont�actOr'S LI<lnse Ldw to� the �'[ounty whlth requires a permil to to ��enY struCture, prlor to Its issuance, a ro f��e a signatl statement that �e/snt na Con[ractor's Litensa Law �Chap�e IvISiOn 3 of iho 6usinozs antl Prol erofrom antl the basis for the allef 031.5 by any applicant for a' pe � onnalry of not more than (Ive huntl�ei n I, as owner o/ the property qr compensation, will tlo tha work, antl fo� salo (Saclion 7044, Business ar �Iconse Law tloes not appty [o an'q�y theraon, antl w�o tloes such work h �� em0loyoes, provitletl that suth �mpra sale. I/ howev¢r, the builtling or Ir�F pletlon, tho ownor wlll nave the byrc �fOVa fof the pufpOse o� sa18�. I, xs owner of tha property, arq e tractorslo conSVuct the project (Sect The Contractor's Llcense Law do¢s builtls or Imorovas tnereon, antl whi tr or(s) Iicense pursuant to the Con am exempt untler Se<tion� pate Owner � nereby cerHfy [h t I ve re tl Informapon is <orrett. �I gree to Soi dntl State lawi r¢Idtl o buii ng SBf�Idl�VBS O} IIIIS [O inspectlOn pu�posa ` 5igna[ure Drivers' License or 55 � CMF 0865-46 rev. 7/83 White - Qu alter suo�acts-tna appucanc w a avu lars (E500). ' amployoos with wagas as their sole structuro is nol IntanOeC or ot(eretl ro(esslonal Cotle: Tha Contractor's A a properry wlto bUlltls or Improve5 If/her5811 ar through his or h0r own ;nts aru not intentlatl or otferetl for ment Is soltl within one year o! com- f proving ho/sha tlitl nol builtl or im- slvely contractin9 with Ilcenzetl <on- '044, Business antl Professions Cotle: apPly t0 d0 owner of property wh0 �it[a Cts / suGh pro�ects wl[h a con- pT'S LI 58 �awJ. � dfP. C. jp�his rea50n TVPE OF CO� TRUCTION EW ADD ALTERATION REPA1 R � ❑ CONVERSION ❑ DE OLISH ❑ OTHER q,p,.* , DESCRIPTION OF WORK S Main Building: TVPEOFPERMIT GRADING FOUNDATI.O�N/ STRUCTVRAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING JQMECHANICAL 6 Reef ' ❑ �OTHER / A' - PROJECT DESCRIPTION 5�. FT. oCCUPANCv C Right . K CONSTRUCTIONTYPE VALUATIONS S Left ZONE GRADINGCU.VDS. ACRES ping.RCf.�`- pemarks: � Parking Req.IProvided ' Use af Building: � PLUMBING FEES Planning Notes: Sink Preventer Dishwasher h Floor Drains Floor Sinks Gas Service Inrerceptors Kitclien Sink , Lavarories P—Trap Roof Drains ' � . . Fea n $25 nouer � Duct - Under Graund Duct - Svucturel Duct - Ventilating Exheust System ❑ Multiple ❑ Firepl/Fact.Blt.ICBO# , Heating System & Ducting SI0.100,000 BTU �100,OOOBT' �-� I I Reinspection Fee I $25 Canary - AOP��t: Pi^k - Accounting; Goltlenrotl - As5e55or ShOw¢rs Service Sink Sewer Cap Sewer Connection Solar Collectors SOlar Piping. � - -" Solar Tank . Swimming Pool w/Spa Urinal Weter Clout . Wa[er Hea[er Water Service • laue Fee Hood ar Typel � ' Canopy Typell ❑ Refrigeratian System 04100,OOOBTU ❑100,000 System Repair/Alteration Issue Fee 0 2440 I/16/84 I2one Acceuory Buiiding: $ ELECTRICAL ' , , Automatic Washer ' Transformer ❑ 75-50 KW Construction PoleSub. ❑ 50+ KW Cooking Unit � � Meter �up to t00amps Dishwasher � Merer ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan ' Morors�0.1HP�1X-8 F.A,U. � InaSolar �9-15 HP 016-15+ F iztures� ' Microwave Device Bozes � Pole Light Outlets " Range ' ' Standing Sections KW �5-15 KW Trash Compactor ' $ 3 " / � � � Reinspeition Fee $T5 �ssue Fee FEES PUBLIC SERVICES RE�UIREMENTS: , � Zoning APProved By Appliption�Approved By � ncoMatfon issuea ev c, G{/ r $ 3 �' 13.OU iL $ 3 . SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT � PLUMBING $ ISSUANCE $ PLAN CHECK $ ENERGV P.C. $ ELECTRICAL § GRADING $ PLANCHECK $ � MICFOFILM $ f MECHANICAL $� TOTAL FEE $ 3 L� �PLAN CHECK $ � • O � O N I N G R E Q U I R E I� CONSTRUCTION ANDPLANNING ' ' ��WO PA � ' � - APPROVALS Permit # Date Inspector AppROVALS Permit # � Date Inspector 1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ,� . 53.� Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd, 54. Forms 4. Electr,ical Conduit-Undrgrnd. �� 55. Electrical Bonding '� 5�. Steel Reinforcement � � 56. Rough Plumbing & Pressure Test :� i 6' Electrical UFER Grnd. . 57. APPROVAL TO COVER�GUNITE � 7. Footings .- , - 58. Electrical Conduit-Undrgrnd. � � S' Foundation •� , ��' t� 59. Gas Pipe, O Undrgrnd., Test . �; • 9., Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, O Undrgrnd. � 10,-Structural�FloorSystem �-• , 67. APPROVALTODECK , 11. Property Sewer Line & House Connection . •' " 62. Backwash & Receptor�Final , � 12� Sewer Cap " i +� ' ,�- � . 63. Heater & Vent•Final � ' , 13. Roof Drains _ % 64. Plumbing System - Final � � 14. Rough Plumbing � 65. Electrical-Final 75. Rough Electrical-Conduit 66. Solar SYstem-Final 16. Rough Electric Wiring 67. Fencing & Access Approvat 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heeting &�Air Conditioning ,� � � FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure i� � 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 O Gas ❑ Oil 25. Roof Sheathing . 74, pverhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry'Standpipe 28. Lathing & Sidin9 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coa[ 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE �SSUED 33. Final Electric Notes: eZ `� � 34. Final Heating & Air Conditioning � �� y 6 8M l% OHL liOAYE � 35. Final Gas Pipe-Test � ' ;r � 36. Hood or Canopy �Y � �-- y 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final ' 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation � �44. Landscape Irrigation System . 45. Sound Attenuation 46. Handicap Regulations , � 47. FINALSTRUCTURE&BUILDING ' . . 48. Special Requirements Completed , 49. Efectric Release to Edison 50. Gas Release to Southern California Gas Co . ' 51. CERTIFICATE OF OCCUPANCY No. Date AOP��cant lo (ill in all sDacos except tnosa wit�in neavy Eortler Iines ana si9n ali aDPropriate Eeelantions. ' CIi�Y�OP COSTA MESA �. , , � P MIT NO. " TRACT NO. LOT NO. BLD . . - - CONSTRUCTION PERMIT - - � � 9' , � = 447 I I/:: /, i, �, T ProjeCt AddreSs � TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR � � Applicant's Mailing Addrezs � � ' ( � CONVERSION ❑ DEMOLISH ❑�OTHER A.P.51t • � 'Zone -DESCRIPTIONOFWORK �/�,�/6eC �L/LG�� 5 Owner's Name � �� r Phone _ 5 Main Building: � Accessory Building: ' - ' Z Addreu �L� �1 � �/iU C. ey7ii �_(fl.�C%ID4. .Y'SI_ . . E� � O -/ TVPEOFPERM�T GRAOING FOUNDATION STRVCTURAL T Frant _ N Arch/Eng. �d-' / � � �/l%�i /LiC¢n52 Na.�� ❑ TENANT ❑ ELECTRICAL �PLUMBING ❑ MECHANICAL B Reaf - ' � Address �� 2 w �g !-LJ �np L.—�/,��j.Ny.�.��./c[� - ❑ qTHER C Right - . G Contracror's Name��—�D1l.�,"� 6 �hone� PROJECT DESCRIPTION 50. F7. OCCUaANCv K . R ' 6 �. � CONSTRUCTIONTYPE VALUATIONS g left � � E Add�es5lmailing) ZONE GRADINGCU.YDS. ACRES Ciry License No. �O�o ��— q Ping. Ref. # , Park. Fees $� '.• - '� n LICENSED CONTRACTOH OECLARATION Remarks: �. , . P3rking Feq./Provided � u I �ereby� affirm t�at I am licensetl untler provislons of Charter 9(commencing � with ie<tion 7000) of Division 3 of tha Businnss anU Pro(essions COCe, antl Use of Building: ' ' - R my Iicense iz In /ull force antl etfect. - . E License la s Licen No. � • PLUMBING FEES Planning Notes: . • . M Date Y' S19NaWre � , , � E ORKE0.5',COMPENSATIONDECLARATION ' BerSink Showers. `-' N iereby,affirm that I have a terUficate of consent to selLinsure or a certlficate • gackflow Preventer Service Sink � � - ' ' T Worker5' ComOensatlon Insurance, or a certltietl cOpy'thereOt (Saction' ' - - - S eoo, i.ab. C. / / Backflow Irrigation Sewer Cap b. ` ELECTRICAL � FEES Po11cY No. ��/�ComoanY .� Yfi. /P. L�l�¢'O�f% • . ❑ Certifietl copy is hefeby f ufnlstletl. ' �, �•' BdthtUbS S2w¢! COOOECtlO� ' � , -� � Automatic Washei,,., Trensformer ❑ 15-50 KW �CerUfietl�p py ts fjl�jP..)+�ith t�e ciry Buil�tli9� DIvISio� /l �,/ ❑ 5p + KW Date %� /_—_ ��'��n� } APP��wnt ��/'.Q--�-��' -�+� � Clarifiers � Solar Collectors . Construction Pole Sub, EXEMPTION FROM�WORKERS' COMPENSATION OECLARATION- - Dishwa3her �' Soler Pi in - (This section neetl not be campleleC if tbe permit Is for one hunGretl (E100) or,� - P 9' � Cooking Uni[ � ' 'Met¢r'�up to 1008mp5 '' less): • i ' . , .. . . _ , � . I ce�lity that In�lhe p Drinkin Fountains . pelfolfnance ot the wolk fOI whlth thii efm�t IS ISsuetl',I' 9 $018t Tdflk Di5hwd5h¢f � � MEtff �Ov¢f 1�0 dTpS shall� not employ any per50� in any manner so as'to become sub�nct [o t�e' � ' Workers• Compensatlon Laws of California. - a Floor Drains Swimming Pool w/Spa � /� Dryers ❑Gas ❑Electric Sub Panel Dale ' S�9nature - ' ' �� '/ � • NOTICE: If, atter making tNs tloclaratlon, you ihoultl become subject ta t�e Floor Sinks � Urina) s.�. Fan Wo�ke�s' Gompansatlon p�oviSlons of the Labot COtlO, y0u TuSt (orthwith ' . _ MotorsO0�1 HPO1K-8 comply w)th SUCh p�ovi5{o�s, o� thl5 Oe�mlt s�all be tleeTetl revoketl. Gas Service -Outlets � �. Water Closet • 8� � CONSTRUCTION LENOING�AGENCV� ' ' F.A.U. In0.SOldr 9-15HP�761$+ I her¢by dHlrm that th¢r¢ I52 cOnstruCtiOn lantling ag8ncy tof the peffolmance InICIC¢ptOfS - W8t¢f HCdt¢f � � FI%tuf¢5 � O/ the wOrk lor whicn ��5 Oermit 'is. Is5U0tl (SecHon 309] Civ. CJ , MiCrOwav¢ Lentler's Namn �� %v � Kitchen Sink -� • Water Service ' - �'�- Device Boxes � ' Pole Light L.entler's Atltlross� � - . - OWNER BUILDER OECIARATION - LavOtOri¢s . ' Outl¢ts � Range I haroby aHlrm thdt 1 am exempt from t�¢ COntrdCtOr'S LlcenSe tdw tor the p_Tre lollowing reason (Snction 7031:5 Business antl Pro/assional Code: Any dty ar P ' � - Switches � Sign county wnich roq Wres a p0/mIt l0 ConStrutl, aller, ImO�ova, tleTolish Or repol� . . any slructure, prior lo its issuance, also reqWres the apP��ant tor such permlt Roof DrainS � ' . �to fil¢ a Signod Statement thtt he/she I5 Ilcensetl pu�SudOt t0 thB provl51ons of Garhage Disposal Standing Settions e Contractor's License ls�' (Chapter 9(commoncing witn Sectlon 7000) ot " � � - ' - . ision 3 ot tho Businezs antl ProfeSsionS Cotle) or that ne/sne Is azempt - - Generator 00.5 KW �5-15 KW Traih COmpactOr ra(rom Sntl the basis for.tha allegetl exomptlon. Any violat�on of Soction 31'S by any appliwnt (or a permil subjects the applicanl to a Gvil ' � ' ' enalty o( nol more than (ive huntlretl tlollars (5500). Reinspection Fee $25 Issue Fee S 3 . ' I, as ownor of the praPerry or my employees witn wa9as as lheir sole - MECHANICA� Rainspedion Fea $25 �ssue Fee � $ 3 compensation, will tlo the work, an0 the structura Is not intentletl or o/teroa FEES for sale (Saction 7044, Bustnoss antl vratessional Cotle: Tho Contractor's , PUBLICSERVICESREQUIREMENTS: ' � �icenze law tloos no[ appty to an owner of a property who builtls or improves Boiler ' �� Hood Or Type I ❑ thereon, antl who tlo¢5 SUGh wOrk hlmself/narsalf or through ni5 or har own � � � 2oning ApprOVBd 8y � DetO � employees, piovitletl thal such ImOrovamen[z aro not �Inlentletl or of/eretl tor Canopy Type 11 ❑ Duct - Under Ground Application Approved By Date sale. It, howowr, tno Dulltli�9 a� improvement is sOltl wllhin ona yoar oi com- � '. � plation, tne owner will nave the burtlan o( Droving �e/51te Gltl not Ouiltl or Im- - . �rove tor tha purpose ot sale). Ouct - Structural Refrigeration System Appliption Issued By ��/ Data/{ y�� I, as owner ot Ihe propirty, am exclusivety contracting with Iicensotl con- � - ❑61�,�00 BTU ❑100,� BTU traciors to conztruct the prolect ISaction 7044, Buslness antl Profesziont Cotle: Duct - Ventila[ing SUMMARV OF FEES � The �Contractor's License l2w' d085 nOt appty t0 an owne� af ProOerty who bullds or improves tnereon. antl who coneracts for such projects with a con- Exhaust System ❑ Multiple ❑ System Repair/Altera[ion BUILDING PERMIT $ SMIP $ � tractor(s) licenso pursuant to tho Contractor's License t.aw). P V1N CNECK $ PERMIT ' � I am exempt untler Section B. & v. G�or this reazon Firepl/Fact. Blt. ICBO # �3� ISSUANCE $ • � . PLUMBING 5 Date � Owner Heating Sys�em & Duc[ing PLAN CHECK $•�� ENERGY P.C. $ I hereby certify that 1 have reatl Ihis applicatlon antl state that the above ❑o-100,000 BTU �t00,0008T ' GRADING $ InformaUon Is <orratt. 1 agree to comply with all tlty antl tountY ortlinances - � ELECTRICAL $ . antl state laws relatlng to Puiltling constructlon, antl hereby authorize repre- - MICROFILM $ sentativez ot this city [o enter upon the abovaynentionetl Property for PV:NCHECK $ 'inspectlonpur o s. / // � MECHANICAL $ ��p� /� � Signature ( Date //�Z�A.� ' TOTAL FEE $ ZZ �=_ Orivers' License or 55 $ Reinspection Fee $Z5 Issue Fee $ 3 PLAN CHECK $ CMF 0865-46 rev. 7/83 ' White - Builtlin9: Canary - qpplicant; Pink - Accounting; Goltlenrotl - Assessor �- ' � - . � �CONSTRUCTION AND PLANNING . PO PA '� - � ' APPROVALS � Permit #� -- Date� � Inspector qppROVALS � Permit # Date � Inspector � 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Undrgmd. ' ' - � � �� j� � 53. Sreel Reinforcement � � 3.• Electrical Conduit'Utility-Undrgrnd.' � � ' 54. Forms 4. Electrical Conduit�Undrgrnd. - �� 55. Electrical Bonding ' 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test � ' 6. Electrical UFER Grnd. , 57. APPROVAL TO COVER�GUNITE • ' 7. Footings , � . _ - 58. Electrical Conduit-Undrgrnd. 8. Foundation ,� ' . 59.. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd., • ��, Fy � � 60. Backwash Lines, P-Trap, O Undrgrnd. 10.Structural.FloorSystem � 61.APPROVALTODECK 11. Property Sewer Line & House Connection ��p� � 62. Backwash & Receptor-Final 12. Sewer Cap .' 63. Heater & Vent-Final �- 13. Roof Drains . 64. Plumbing System - Final • . 14. Rough Plumbing . /9 �L 65. Electrical-Final � 15. Rough Electrical-Conduit � � 66. Solar System-Final 16, Rough Electric Wiring � ', � 67,. Fencing &%access Approval 17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � ' 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace , APPROVALS Permit # 21. Ducts, in Structure � 70. Underground Hydro � 22. Duct4, Ventilating. . � 71, Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test ' .. �� 72. Underground Flush 24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. �Dry Chemical 27. Frame and Flashing ' � ' 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing ' � HEALTH DEPT. FiEQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECTION � 32. Electriral Power Meter-Final • 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning � � 35. Final Gas Pipe-Test c..t 7j�� L�� • � 36. Hood or Canopy - � � 37. Final Factory Fireplace ' 38. Final Plumbing � � 3 �j� �',O ' 39. Water Service-Final . 40. Gas Service-Final af �� 7.�� (,Fjj • 41. Solar pomesticFinal � _ _ . 42. Backflow Preventer . � 43. Backflow Irrigation , - ' 44. �Landscape Irrigation System � _ 45. Sound Attenuation � ' 46. Handicap Regulations . ' A7. FINALSTRUCTURE&BUILDING . ' 46. Special Requirements Completed � , , � • 49. Electric Release to Edison � - -� � 50. Gas Release to Southern California Gai Co 51. CERTIFICATE OF OCCUPANCY � � . . . No. Date ', , . . �; 233?9 , �OSTA MESA 9U�'.roING-SAFETY DEPARTMENT � P.O. BOX 81] �, COBTA MlBA. CALIFORNIA For Applicnnf to Fill In Complefely TYPE OR PRINT BUILDIN6� /��i � /.Ei � AODRE56 i� COSTA MESA, CALIFORNIA t. � AR�'+ITECT FEE RECEiV� DEC 15 1964 fINANCE DEPT. ��Y� Q� COSTA MESA L C ION FOR PERMIT BUILDING For Ofilce Use Only, w L W /T'Ti: �--- - � . ZOI'�6_// PLAN!`� OUILDNO�J��%'. �/ C G �� DE➢<RIRION�� Q�(��" � �� A. P. NO. //'s•.r 3 Z 2�/� NOTE: NO EAVE OVERHAN6 SHALL BE LESS THAN �, �" OP BLDaO. 6ETBACK LINE PROM CENTER OF BTRE6T ��' REAR YA@D SIDHYARDI LEFT '�"" I'R16NT _� • DESCRIPTION OF WORK WALL TO BE YARD9 APPROV ED VAR. # YARDSAPPROVED ACCESSORY BUILOIN6 bATE � 1 HEREBY ACKMOWLEDOE TX�T 1 HAVH READ TXIB APPLICATION THE AMOUNT eHOWN ONOEH VALUATION 18 FOR TH! � ANO 9TATE THAT TX6 ABOV6 IB CORRECT AND Ap fi TO COM- PURPOSE OP EBTABLI9MIN0 A PERMIT FEE ONLY. Q pLY WITH ALL CIiY OR I NG81 ND HTATL LA �OULATIN4 eUlLnirvo coNsirsucf VALUATION �i �.- N SIGNATURE OF ' PERMITFEE $ ' � m PERMITTE � , $ I � 1/�` PLAN CHECK $ O AUTHORIZEDA6ENT � � V �') �-LL . _ � 2�3�� FEE RECEIVED .. : � CbSTA MESA BUILDING-SAFETY DEPARTMENT �AN 8 �9� � � P.O. B01� �1] �aBT. MgeA. �A��FOR��A �� FINANCE OEPT. CIiY OF COSTA MESq For Appllcon� fo Fill In Complefely APPLICATION FOR PERMR TYPE OR pRiNT � BUILDING For Office Use Only BUILDING � � � � • ..1.`...J' :..C(. .:; I fl)_L . . ADORES9 ' ' PHCEIPTNO. PEflMITNO COSTA MESA. CALIFORNIA_�� p; , : �� , . _ _ , � 3.�1 �,s x�cervc ��-ow% ^� ci o t is f � 9O. T:� . _ - �..�d ' � {/ ' `i � : �� i OWNHR G •.�: .n. � _ ,�.' ...rl'.. �1 �"'%\ , ' �� . � ..� i . '+ �`� . . . �BUI -� INOJ . �.n. ..` ///,_-'/ �i. MAIL / G /'�� (1 .1�' �aZ7"j,�. �^-(�� '_y ADDRESS. �� _ !/1/ ADDRE68 4 p !� "V ` lS 1"" � . . , " . . _-:. "'. ' .,. . ' . ,,�/ .�� u.• • •�.�. ., b>'L�rr. AJ'�i '•.9 IZONEH ul�H :l 1:i'f1P8 • 'OUP TEL. cin c�/Gt3r e r�2.;•� n v� No: ��./730 -.._�,.,� .. ,� . .. APPROVHD '��'� � tO:J`L � AP^'+ITEGT ,TEL•:, � -' it�� IBY _DATE C 31NEfiR _ �L NO. � � - �.. _ _ ,. ..,... ... ..... n.:: , :i � . � i: �.. :1.� ::r�3:: ',�'. ZONING : . � c :�'. . wooaess "• � ZOry.6 _ NO.OPJ,.J.� ;UB[OP:NEW � l' PLAN6 � BYILDINO CONTRACTOR �� ' L6o�L / O '1 � ADDRHDD � DeaCRiRlo c_ d�- CITY A.P.NO. I S �� 6TATE �T2L'. 90T TO S�IO6 8 REARRHLNO BHALL BE LESS THAN \ n V1 LIG. NO. N . // 1 EAVES O SIZE 4//�' Y � No.oieLD46. ALLOWEO <U.B.C.REGUIREMENTI OF LOT / V�� NOW oN Loi � USEOF /'` � �'ARDSAPPROVED YARDSAPPROVED EXISfiNGBLDq, � L 'j' t `� MAINBUILDIN6 ACCESSORYBUILDING (FROM C/ SfR6ET) \ 88T�ACK UN6IROM FRONT FT. � FT• C 1 cENTert oF eTRerr REAR YARD � HIDeYARDI L@fT RIGHT � � R.81DE 7PT.. � �. pESCRIPTION OF WORK �. s� e er. %� �. � i I ALTiRATION DITIOI REPAIR M Vlry DBMOLIB SIZIEDIN6 � / NO.OR L �ROOMB STOR EXTERIOR WALL R� ROOP COVERING UOD GOVERIN6 U56 C�F BUILDiryp AfiD WORK TO BH PHRFORMHD 1 HEHBBY ACKNOWLBOOe'TXAT 1 X�VB qBAD THI6 AND BTATE THAT TX8 ABOVC 19 CORqHCT ANU I�f PLY WITH ALL q'ry pRDI� XCiB ANq BTATB L�WIE BUIlO1N0 CONBTpUCf10 L� PERMITT6 E OF / Q` AUTHOR126D I,pQNT DI8TANCE BBT. BET. MAIN Q MAIN BLD 8. ACCE55. BLD68. VAR.a% �� OATE J��,N/ � C.U.P. APPR VED � 1 APPROV6D � HOLD F R SPEC REQUIREMENTS �- Q i2e N 8C. RT. � THE �MOUNT BHOWN UNOBP VALUATION IB RON TH6 S PURPOS6 OI [GTABLIBMINO A. PEPMIT FHE ONLY. 0 VALU TION ��l � m I �/) PERMITFEE $ ✓ � //� V m s ' e �� DD'� ��a TOTALFEE "t . . - � , . . . ,. . . . • � .o `J . ' , ` . '7�{' i{g G!,' C �Sltir � r ;r� : ;.'; ::,: . . . . . : • 'r�.:i�; `i:J) �U . .. : . - ... .,;. �, �-. .. , . . . . . .. . . . . . . . 1 r .,. ! . -' . .. , � . ' _ "_ �• . '. - Speclal.Requirementai . _ _<_�1. ' Dedication to.the City of .Costa Mesa of �all�land :_ •� 30.00 feet Yrbm c�l.of 'existing Meyer Place. ' ,�2. ' Installation of, co�ercial sideWalks� with concrete --- - driveiray approaches, along Meyer P]ace.in,Yront of • �. Parcels A,'B and C and,along�West�l9th Street'in front : - ' ,oP-Parcel A, by-the o�mer at his expense; per standard;- .., `'�,;; � epeciPications oY the City of Costa.Mesa. .,,�.,; 3;:� Tree planting. compatible vith the exea under, the direction �of '� 'i `. the` Street' Dept. '; � �. _� ' '. , -� .. — . � . : .. . �,. :. ." ,' . .. , ., , . _ _ . �.... •. .:_. , . . . . . . . .._ . .. �..y .. ._ .._ . ...�."' ""' .. ' �. ... ._ . ., � . . 'l. •�. .' . . . . . . .. . � . . . . . . • , q'.. .. . _ .. ... . ._ _'.. __ . - .. � . .,. _ . ._ _.. . _'_'.-.-._:.. � ar. • �_ � � . , �_ � ' "",.. .. . _ . _ �.,. . .� ' _"' '''_� ''_' .'__��_ .. . . ,. . .. . ... . � '` .: . �_�� ... '1. � ;� , +�. ' : � '. . .c ...-... ._i,! _., . � . . ' ' .. .... I_j(�..5. �_i;n< �yi. . lt.j'� • , ' . " - �' = . .a . . . _�... ;._ . . ' _ __' . . . . � . ' �� .� . . . � . - i . ... ._ . . . , _. • . •C.'. �1� �i . . ' - . .� • . . •( •Y . , . . . J. . � � . 1 .......�.. � .. . .. '' " � 23448 a•. . � '�OSTA MESA BUILbING-SAFEfY DEPARTMENT � P. O. BO][ D1] COHTA M68A. CALIFORNIA For Applicant fo Fill In Comple}ely TYPE OR PRINT BUILDINB j � (: ' C ADORESS 6 6 — COSTA MESA, CALIFORNIA ■ MAI '+ITECT � TEL, NO. OP BLO00. USE OF EXISTING BLO6. 9HTBACK LINH FROM DESCRIPTION OF WORK ROOF BUILDINO AODRE89 PIRH FEE RECEIVED JAN 21 1965 fINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMR' BUILDING For Office Use Only 0 A. P. NO. I � ) � NOTE: NOEAVEOVERF 90" TO SIDE B REAR P. EAVE9 ALLOWED YARD9 MPROVED MAIN BUILDIN6 (FROM C/LSfREET) I , VAR.� S l C�A '[.0 lA9 A L L . � C. / n t I HEREOV ACRNOWL6D0H TH�T I XAVB pBAO TXIB App��GT�ON ANp BTATE THAT TH8 ABOV6 IH CORRECT /�NO AOpSfi TO COM. PLY WITN ALL CITY OHDINANCBB AND iTAT[ LAW9 iOULATINO BUILOINO CON6TqUCT SIGNATURE OF PERMITTE AUTHORIZfiO A66NT T-% GUILOINO � �`' \ � � , � � SHALL BE LE 8 THAN \ V . (I1.B,C.R80UIREMENT) /� YAR�SAPPROVED � � ACCESSORYBUILDING \ Y� eEr.i ACCE DATp � 1I —1r� 7 � 6G. FT. � TNe �MOUNT eHOWN UNDBP VALUATION IB POp TX8 � PUflPOBH OP 88TABL�6HINQ • PERMIT PEE ONLY. Q VALUATION � m PBRMIT FEH $ � � i $ �.�v - s TOTAL PEE 3 ' � " � 297F3 COSTAMESABUILDING-SAFETYDEPARTMENT FE820-69�qsa00 540 �*��**S.QO P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEI D DATE REC IVED DAT ISSU D/ (y ADDRESS ✓.� W¢a� `qT� �� /�b/ �ew s�� OWNER p A.P. NO. MAIL BUILDING Z ADDRESS � ADDRESS a U CITV p•j0� NOL G��=�/'� TRAC H Z Z Q CqNSTRUCTION �"/ �+ O N LENDER am J — BRANCH ' . OWNER m J ADDRE55 J m ARCHITECT TEI. SE a OR ENGINEER N V N FIRE wa ZONE T 2 ADDRESS a W ' �' APPROVED J O CONTRACTOF 6�1y��Gd� C Bv J� ADORESS ZvO� G�,..y��y.o�dve � w W ZON NO.OF � ¢� T E L. P�� Z� c�rv'�c,...^, or� •.Juan� No. L`12-2i1 ' W � STATE CITV �'APDS APPROVED j O IIC. NO. LIC. NO. MAIN BUILDING SIZE NO.OF BLDCaS. (FROM GL STREET) � OF LOT NOW ON LOT ONT FT. USE OF EXISTING BLDG. � SIZE OF NO. OF � Z NEWBLDG. ROOMS STORIES L SIDE FT. a EXTERIOR WALL FOOF COVERING COVERING REAR FL � USE OF BUILDING AND WORK TO BE P RFORMEO DISTANCE BET. a O MAIN BLDGS. Q T . (� � p � VAR. qW O G+ O��`� O r O YJ V. �\tl( 1 h C.U.P. 9W r . APPROVED N Z O VI horoby acknowletlpe thet I have read thfs nOPlicetion antl siate � thnt the ebova intormation is carract entl apreo to comply with � ell lews reBulatinp builtlin0 �onattuc2ion, ond I shell not employ F„ nny pe�son in violatlOn ot ihe workmon's compensatian laws Of N the Stato ot Calitomla. ZI heroby certify that I am proPerly Iicansetl as e conirettor untler SQ. FT. the Steto of Celifornia Business entl Professions Cotla, Oivisicn 3, THE AMOUNT SHO Chapter 9, entl thet such licensez ara In full forea antl effect, or I THE GVRPOSE OF 6 em axempt from [ha Orovlsions of the Ste[e o( Cel(lornie B�siness VALUATION antl Professions Cotle, Divisi n � Signat�ra ot �� Permittee � 5 Authorizetl Ap¢nt VALVE � DATE �� USE OF NE � BUILDING / VAROS APPROVED ACCESSORV BUILDING � BET. MAIN & ACCESS. BIDi DATE . TOTAL m � 0 VqLVAT10N IS FOR � A PERMIT FEE ONLV: Q — m = 4 � � ] �_ m K5 E S l/ LL /". •'♦ �V�V� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely AODRESS �u�"'O �' `� �J� OWNER �U�v� �-L' �ia�G MAIL _ _ ,. !l P. �y TEL. CITY �_w�j,pT w+n�V� NO. �a`IZ"�-�I� CONSTRUCTION � , l I.FNf]FR '�� Cll "" W �`1T BRANCH �y�v jJcv,'�ti Ha�`oav` �\ucV nooRess � �.\l...r�'c�•� Gn�:{er v� � a ARCHITECT � � TEL. j�3 OR ENGINEER � e�': r��, "+Ca`�IO NO. Ci4 li'i4.�: CT nooAess 3�0`l0 �J;�s�..,c��1nc� L}� p�.a�we�- .., e.- �.] CONTRACTOR �FhN �<tci.rc.q 1, (�J ADDRESS ZVC� GC.M�m.�cWt��•l'.'l�� ,` y (�y TE L. CITY `vCw�e.'�\ \.]o-.iai.� No. C:�-Iz.i`I�', STATE � CITV L1C. NO. UC. NO. OFLOT ��' X CIO+ INOWONLO� I USE OF � E%ISTING BLDG. O�� `� e`^^ o� G.c SI2E OF (y �y,j,`%� } � NO. OF NEW BLOG. � s�� IS ROOMS STOflIES EXTERIOR WALLQIyMtMrw ROOF GoW'j�.< � iil� COVERING�; 7f,�,. COVERING�l�ipTsc:,�.�:•L��T USE OF BVILDING AND WOPK TO BE PERFORMED Q.—�Lo w.nli � Gc� (.�ic qt.� I haraby acknowlatlBa Mat I Nave reatl Nis epplicetion antl s[ata that No ebove informaiion is correct antl apree to eomply wiN ell laws repulating builtling co�strueHon, entl 1 shall not employ eny person (n violation oi tha �+orkmnn's compansation laws of the State of Celifornla. I �ereby cart(fy Nat I am proparly Iicensetl as a contrecror untler the State of California Businos5 entl Profawions Cotle, Divisicn 3, Chapter 9, antl that suc� IicanSes ere in full forca antl effect, or I am exempt Irom the provisions of the Stata ot California Business antl Protesiions ode, Divicion : Chepte�9. \ $Ipf18IVfB O} �,1 Permfttee ��'•--��+ Authorizatl Agant � FEB 28-69�a—iOOQ 749# ¢***39.00 CMSA TION FOR BUILDING PERMIT BUIIDING ADDRESS ROVED JE NO.OF I PLANS YARDS APPqOVE MAIN BUILDING �n GROUP `" vr DATE \ i.7 USE OF NEW (.AZ AYH � BUILDING n VARDS APPROVED ACCESSORY BUILDING � )19Z� Ciar DISTANCE BET. .� BEf. MAIN & MAIN BLOGS. ACCFSS. BLDGS. VAR.� / OATE C.U.P.# �-�-Vi$ APPROVED ��L- APPROVEC� wL�"' '"__ �7 _�'1 � THE AMOUNT SHOWN UNDEF VALUATI THE PUFiPOSE OF ESTABLISHING A PERMIT VALUATION PERMIT FEE 5 � S�^ I _'� PLAN C �� %� / TOTAL m e 0 I IS FOR ^ = ONLV: � ¢ � N � _ m E � LL . . . . . 29790 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 , For Applicant to Fill in Completely Q p Et � ADIDRESS � O � ` `� OWNER �p�y� \ GG�f-C" MAIL (� j� ADDRESS �"��' �1 G C'M LH pCCQ.1r �+ `'�VI` . Z . �. a U CITV �.z;� e c\�..a�y..-_ti NOL �'�yZ-i FZ Z Q CANSTRUC710N� .-- ( ��•�.rt- ON LENDER ��U ��+.� � Jm BRANCH l�\lil'.. �itt�� G-c�fJCi• `U,�+� mJ ADDRESS {��-�I•.�\0i1 Ca�`C AflCHITECT [� ' TEL. �i J N OR ENGINEER "" C`� � �'� � V N.�� u� wQ ADDRESS 3��L% k%�1S�.V�V 1J�Jot�Pl 4"w OVNeY'�J��\A� J O CONTRACTOR �Sb�;� �cc. r�' m [� J� ADDRESS LGC� Gb vvt Nn pCOtv. �`� W W z= TEL. � CITV �G t� .z� NO. ��'1 2•i' � STATE CITV y� LIC. NO. LIC. NO. 7 � SIZE � � NO.OF BLDGS. / OFlOT �� C INOWONLOT / F SIZE OF NO. OF Z NEWBLDG. ROOMS STOF aEMEflIOR WALL ROOF COVEFING COVERING USE OF BUILDING AND WORK TO BE PERFORMED W a Q�o-,,. aC �'_l� o c�� . W a�.\� G�n H tn �,Ov�r� S.c1� o o��c e �:.'�" Z O VI hereby acknowletlge that I have reatl this application antl state � ffiat the above intormation is correct antl a8�ee to comply with . � all laws regulating building consttuction, and I shall not employ � any person in violation of the workman's compensation laws of y the State of Calitornia. � � zI hereby certify that I am properly licensetl as a contractor untler SQ. FT. o the State of Calitornia Business antl Protessions Code, Divisicn 3, THE AMOUNT SHOWN UNDEF VA�VATION IS FOR � Chapter 9, antl that such licenses are in tull forca antl eftect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: am exempt from the provisions of th€`�e of Calitornia Business VALUATION ¢ antl Protession Code, Divislon 3, Chapter 9.\ ro j PERMIT FEE $ c' ] Signature of {r��} � m Permittee - $ /./T// PLAN CNECK $ — E � \j'V V e Auchorizetl Agent � �/� LL TOTAL FEE ri v fE9 28-6,�00 75Q �**�***5.00 APPLICATION FOR BUILDING PERMIT EIVED BV DATE RECEIVED nerc icc�r� BUIIDING ADDRESS OWNER 4 � FIRE �� ZONE z APPROVED � ZONE NO.OF USE OF NEW �� ' U '� �, PLANS Z BUILDING . . YARDSAPPROVED VAflDSAPPflOVED MAIN BUILDING ACCESSORV BUILDIN (FROMC/LSTREET) i� � ' �./ �� M/ 7 & VAR.# �,-(p(i-(�YJ DATE C.U.P.# APPROVED �2-�J APPROVED�L.Y.. '"_' '7�77- `� . Z . aU H Z ZQ ON am J � < 2 � J Q U� Za W � aw WZ J Q m Z J Q W W O= Z � W � 70 F" z Q U 1 i Q � H N Z � F U � � F N Z ' ' 29228 . COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fi!l in Completely eui�oiN� /-� P/. ) i n'� r-l'F� o.T OWNER MAIL TE L. CITV BRANCH ADDRESS ARCMITECT ADDRESS CONTRACTOR��'fm�F �� fL ADDfiESS /Gj�� L�J��i/O/f A/�� TEL. ./ CIT�//%7JlL'J/M� NO.ld37- STATE �33 �� CITV LIC. NO. LIC. NO. SI2E i NO. OF BLOGS. OF LOT NOW ON LOT VSE OF EXISTING BLDG. SIZE OF NO. OF NEW BLDG. ROOMS STORIE: EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING ANO WORK TO BE PERFORMED O I hereby acknowledBa [het I have reatl this eppllcatlon antl rtete thet the ebove intormation is correct antl aBrea to camply with oll laws raguleting builtli�p consvucNon, ontl I shall not employ eny person in violation of t�e workmen's compensation laws of Ne Steta ot California. I �araby cerHfy that 1 erh Properly licanmtl na e contractor untlar the Siate ot Californie BNsiness entl Profauions CoGa, Divisicn 3, Chepter 9, antl that such �kenws ara in f�li forco antl affect, or I am exempt irom the p�o��sions ol [he $teta of Callfotnle B�finess untl Professions Cotla, Div�slon 3, Chapter 9. SIB�atore of ///.�_ , ) �/Jf hL ��, ) Permlttea �/l lOd/ //' �1/�oq�Z�n.—i / Authorizatl Apent/ rato F1AR 13-69�MSr00 299� **�*34.5� APPLICATION FOR BUILDING PERMIT RECEKIyE Y DrA�T^F��V� D�E �9�U // 1 "� BUIL ADO OWNER FIRE 20NE APPROVED )N NO.OF �' PLANS � VARDS APPflOVED MAIN BUILOING FOM GL 5 EET) DISTANCE MAIN BLO VAR.,$ C.U.P.3W DATE �T VARDS APPROVED BET. MAIN & � �� ) � e S0. FT. o THE AMOUNTSHOWN UNDER VA�VATION IS FOR � THE GVRPOSE OF ESfABLISHING A PERMIT FEE ONLV: ¢ VALUATION � PERMIT FEE S . O O j /�/!/ �(/ m 5 (J `' PI,AN CHECK $ ///. � E o` S LL TOTAL FEE S ��J � ,-; . �, 36236 � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Appliran[ to Fill in Comple/[ely BUIIDING ��i /� l9 f `� � ADDRESS D L � / � OWNER �'—S /TS„} �C/C?/��5� � n L� MAIL /� J / � S7` Z ADDFESSrp �. a U CITV TEI. '[�'z'��%9 � Z o� �%%SQ No.d .f Z Q CONSTRUCTION O � LENDER d m • � BRANCH m. J ADDRESS J m AflCHITECT TEI. Q OR ENGINEER U y Q W � ADDRESS aw J O CONTRACTO °° z gax.-r ./ Ln�o W p� ADDRESS .�L ((/p� � w TEL. Z � CITV .t NO. (�' �-5 W � STATE CITV - N¢ LIC. NO. LIC. NO. � � SIZE NO.OF BIDGS. OF LOT NOW ON LOT ,^ USE OF � EXISTING BLDG. L � H SIZEOF O �O_ ZQ NEW BLDG. T STORIES � EXTERIOR WAIL ROOF COVERING COVERING ' = USE OF BUILDING AND WORK TO BE PERFOFMED a a Q � H N Z O VI hereby acknowl¢dBe t�et I hava reatl this application antl stete � thet the above information is correct antl agree to comply wlth � all laws regulating builtlinp consttuction, entl I shall not employ r any person in violation af the workman's compensatlon laws of (q Me Stata of Californta. ? 1 �areby cenify that I am properly Iicensetl as a contractor under the State of California Busineu entl Profeuions Cotla, Divisicn 3, Chepier 9, antl that such lieensas ere in full forca anE eifec; or I am ezempt from the provlslons of tha State of Californla Businau and Protessions Code, Division 3, Chapi¢r 9. Sipnatura of � n , /� n // Permittee _ .i/-�-QCu•aY �/� %�['b��-✓� Authorized Apent � � Pp�4 Q'"" t:i2'.r:Y� �� :,:s, ,-73��.�.OD s.� = a ..oa AP IC TION FOR BUILDING PERMIT �I.V C ATE REC VED DATE ISS p� V '� �/ PERMI ULJU No. v�3�-- DI G IRESS � � TRAC�/Q,/1JS LOT 6 BLOCK r � 1ER '� S /✓G �infJ �C.i�O �/�si�/ ua . FIRE ZONE APPROV ZON�NO.OF � plp,N� YAROS APPROVE MAIN BUILDINC BET. VAR. iW C.U.P.a MOLD THE THE USE OF NEW v�j BUILDING p^� VARDS APPROV ACCESSORV BUIL 3�S BET. MAIN & TOTAL S7ATE m TAX o VALUAT ON IS FOR ' A PERMR FEE ONLV: m� Q / n - $ 7 m K S E S C✓.Z� a . �� 37085 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING p )p C ADDFESS p W / / > � f OWNER � --S %J'J_] 6/C Id , �-+ 2 . a cWj rZ z� am J � J' Q m. J Q U � Za w¢ aw w2 J 0 m Z J � w W 0 = Z �— w � N ¢ � 0 � Z Q U Q � F N Z O F- U � � r N Z CITY BRANCH , ADDRESS ARCHITECT CONTRACTOR [�[J�S�' �G ADDRESS'$G�C.J �/� �, „^ ` � CITV S• Fj/ ///�%t�/[�. STATE LIC. NO. S12E OF LOT USE OF EXISTING 9LDG. SIZE OF NO. OF NEW BLDG. ROOMS E%TERIOR WALL ROOF COVERING COVERI USE OF BUILDING AND WORK TO BE Cd r (...�c. Q �n /] U /, NO. No`. �1�/:3 CITV LIC. NO. NO.OF BLDGS. NOW ON LOT RE IV [ � A.P. NO. BUILDING ADDRESS TRt � OW� FIRE �Wr,-1-73PAto00 004# *��*48.50 c�isa �'f'ION FOR BUIIDING PERMIT \ y %T�R! .C� S rJT E� %. Ei z rl � 20NE�,. NO.OF �f PLANS VARDS APPflOVED DISTANCE BET MAIN BLDGS. VAR. aY+ � � T DATE BLOCK E OF NEW �,'Lr�l•v' LDING�X/S%%/�1 VAFDSAPPROVED BEf. MAIN & ACCESS. BLD DATE � i hereby acknowledBe t�at I have reatl this epplicetion antl stete ✓ Ihet the above intormation is corract antl apr¢e t0 cOmply with all lews regulating builtling constru<tion, antl I shell not ¢mploy eny person in violetion of the workmen's compensatian laws ot the State ot Calitomle. LD FOR m I heraby cartify [het I em proparly �icansatl as a controeror under SQ. Fi�pEC�t RE O tha State of Califomla Bvstness entl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALVATION'7 - OR Chep[er 9, and that s�c� lieenses are in full fOrce entl etfoct, ar I THE PURPOSE OF ESTABLISHING A PERMR FEE ON�V: Q am exempt from tho provisions of Ne Stnts of Ce111omta Busineu VALUATION �� and Professione Codo, Division 3, Chap er 9. /7U PERMR FEE .�� m N :J� � SIB^atura ot �� m Permittae �� $ �DOD P�P.N CHECK $ '�— E �y w/i `o Aathorizetl Agont �� LL TOTAL FEE $ AVPlicant to fill in all CITY OF COSTA MESA PEHMIT NC CONSTRUCTION PERMIT Fj— S< within �eavy bo�Ge� lines anC zign all appropriate tleclarations. _ TRACT NO. LOT NO.- �BLOG. NO. Projett Address bZs - - TwfYPE OF CONSTRUCTION OWne�j C Q • Nry PhonE � r'� �p, NEW ❑ ADD ❑ ALTERATION Addrew Z\ � S , � �7yr ❑ REPAIR ❑ CONVERSION ❑DEMOLISH Atth�Eng. �' Q^,� �w� License NO. C I OOO z, � OTHER AddfC55 � DESCRIPTION OF WORK Contractor :CV122Y E��Neo'Y• � Phon _ TVPEOFPERMI �,,( Addreu •�� Q Q/�'_ UQ• 1(,S ❑GRADING �NDATION 1�,5T0.0 LICENSEO CONTRACTOR OECLARATION ' ' ❑ TENANT,�CTRICAL'P�LCIMBING � . 1 hereby affirm lhat I am 11<ensetl untler provizlons ot Charter 9(com- � mencing with section 7000�' of �Ivision 3 0( the Business antl ❑ OTHER Pro(esslons Cotla, and m li<ense is in tull �rce an t�ect. •PRO�ECTD �C +PTION � -- p�� License Cla s �cen o. Z" "� 'y Date i �� Z- Si9nature � SQ. FT. - � � - � WORKERS' COMVENSATION DECLARATION � OCCUPANCY � STRUCTION TVPE _ �� I hereby affirm that I have a cer,[i(Icate of consent [o If-Insure or a' VALUATION ZONE terlHicate o( Workers' Compen5ation Insur nco, or a certlBetl copy � thereOt (Sectip[t I380p, lab• C�� L' GRADING CU. VD . ACRES _ � :Y No. � l�I L; Z� Fxny Q 6V� I V15. . . . .ertifietl copy is �ereby furnishetl. REMARKS: �. Certitietl copy is filetl wllh t�e city Builtlinq Division. EXEMPTION FROM WORKERS' COMVENSATION DECLARATION � ZS 'j � (This section neetl not be mmpletetl if [he-permlt is for-ona huntlretl IE100) or lessl. � . .. . . . .. " . ....- -I certify that in the pertorman<e of the work fonwhith this permit is Issuea, 1 shall not emPloy any.oerson in any manner so as to bewme PLUMBING - ' � PLAN CHECK subjett to the Workers Compensation Laws of Calitornia.- •� �•. Date Slgnature - 6ATHTV85 SHOWERS NOTICE: If after'making this tleclaration, you shoultl becomo subject ' TOILETS. .• VRINALS to th¢ Workers' Compen5ation provislons of the Labor COtl¢, you mu5t torthw{th comply with such provisions or this permit 5hall be tleemetl LAVATORIES DOUBLE LAVS �revoke�. • -� - ' -' - - . ' CONSTRUCTION LENOING AGENCV � K�T. SINKS DISHWASHERS 1 h¢r¢by affirm Iha[ [her¢ is a con5[ruCUOn lentling agency for [he per- SERVICE $INK$- �Sl9M formance of the work for whicn this per it is issuetl (Sectlon 3097 �n Civ. CJ. ;�w`,J �� FLOOR SINKS O R D �INS `� y Lentler's. Name Lentler's Atldres� RY�S O 'ut �.b �teS[A ORINKING FOVNTAI 5 '� � F; � OWNER BUILDER DECLARATION � � � � INTERCEPTORS �IF��RS l _I h¢reby affirm that I am exempt from the Contractor's�License Law for the following reason (Section 7031.5 Business ane Profez5ionz Cotlei' SWIMMING POOL - P TRAP Any city or county, whith requires a'permit lo construct, alter, improve, tlemolish or repair-any structure, prior to its issuance, also re- yyqTER SERVICE ALTERA N qWreSSh¢,applicant for such Dermit to file a signetl statement that he is Ilcensetl pursuant to the provisions o! the Contractor'S License Law GAS SERV ICE O� 5 (Chapter 9(commen<ing with Section 7000) o( Division 3 of the BuSiness antl Professions Cotle) or that he is exemp[ therefrom antl the' yyqTER HEATERS 6TU "s tor lbe'dlle9etl exemp[ion. Any violation of $ection 7031.5 by appliwnt for a permit suojects the applicant to a tivil Oe�alty' SEWER COIVNECTIONS .wLmore than five nuntlretl.tlollarj (E500). Ll I, as owner ot tM1e property, or my employees witn wagoz as their �SOLAR TANK COLLECTORS sole mmpen5ation, will tlo the wo�k, antl the SbuCture is not Intentletl Or Off¢retl for sale. (Secllon ]044, Busine55 antl Protessions Cotle: Th¢ $OLAR PIPING SVS. � � - Con[tacto�'s License Law tloes nol apply to an owne� of a prop¢�ty who builtls or improves thereon, antl who tlo¢s sucn work himself or ISSUE FEE throuah his own emolovees. D�oviOetl lhat-such ImDrovem¢nl5 are noI ._ _. ._ . .. �tl O/ ofter¢tl for sale. It, howev¢r, the bWltling or within one year oi�completion, the owner will ha roing he tlitl not bulltl ar improve for the pur� as�owner ot Ihe property, am ezclusively con a ron[ractorz to construct the oroiect f5ectlon ] dn Owner ot p�operiy wno ouiios or improves inereon, ana wno con- t�aGts from such pro�eG[5 with a COn[ta[tor(5) IIC¢Sn¢tl pursudnt to the Contractor's License Law). ❑ I am exempt untler�Section V � .B. & P. C. for this reaSon Date - - '" ' "Owner � � - � - I h¢rGby c¢r[ity that I have rBatl [his dppliwtion antl State.that the a0ov¢ information is correcL I agree to tomply with all city antl county orGinances anA ztate lawi.relatlng to cOn ruction, dntl hereby authoriie r¢pre5enfativCS of 5 city to n�pon ihe above mentionetl prooerty for insp c bn pur o s. p klgnature ��✓� �-� Date1Z�(6'p2' MECHANICAL PLAN CHECK HEATINGSVSTEM 0-100,000BTU_ AND DVCTING ' 300,000 t BTV _ REFRIGERATION 0-300,000 BTU_ SVSTEM 100,000+gTU_ BOILERS " BTU' SVSTEM REPAIR,ALTERATION ,EXHAUST SVSTEM � � ._ MULTIPLE Drivers' Lip �__ _ _ ' - ISSUE FEE' " CMF 08fi5�46 White-Builtling; Gnary-Applicant; Pink-Accounting; Goltlenrotl-Assessor ,. .. 1827 12/16/82 ZONING REGULATIONS A.P. � ZONE D SETBAi RAL S�OE Y 7i�IGHT�n� / � � REAR VARD (TO P/L) PKG. SPACE REQ. STREET WIDTH � ZONING APPROVE�� f, SPECIAL CONDITIO 5: �a� spEc Ac ELECTRICAL ' PLNG.REF. � zQ.�u�k PARK FEE E 'LAN CHECK � � _ GENERATOR p.l ItW_1-30 KW _ TRANSFORMER APPLIANCE 30-50 KW_- 50-+ KW _ MOTORS � 0-1 HP_I-10 HP-'_ UNC.SOLAR) '30-SOHP SO+�HP_ �FI%'TURES � OUTI_ETS SWITCHES ' " GAS TUBE SIC�NS' - ' - �I�G_� � METERED �SUB qNELS -C'"-'-.MA'IN,.,- .'SUB'. ' ERVICE " ' " " AMP ' ISSUE FEE - ,�� . 369e3:i TL � SUMMARY OF FEES � . BUILDING / • ' ' /+�.� _ PERMIT ,y�$�E): . snnie � , . �a�_J_.�,I,S- PLAN CHECK E PERMIT , ' ' ISSUANCE� S�� PLVMBING 5 " GRADING� � E PLANCHECK -$ -� � , � ' ELECTRICAL $' � � ', � � 'a 'PLANCFiECK g MICROFILM.$' MECNANICAL-E ' TOTAL FEE.S'� � PLAN'CHECK` $ ' 'LESSAD- � ' __ VANCEPC $ :. .,.. ,. .. � .3� 3� . GINAL FEE E � ` CONSTRUCTION AND PLANNING - POOL & SPA,'� t.:"�. _•, Date Inspector �' " �--' Date r- Inspector ; APVROVALS Permit# APPROVALS Permit# ' � -'-- --._ . .--- - _ "' 1. Temporary Electrical Service or Pole "" '� 43. Pool & Equipment Location . Soil ipe-Undrgrn � � • 44. Steel Reinforcement- -- � �• � � • � - - �-� - - �� • � . . _.. . _ . 3. ..Electrical Conduit Utility-Undrgrn _�,, • _ _, 45. �Forms. ' . . _. . . _. . . . .. 4; . El�ctricdl�onduit-Undrgm '� � 46. Electrical Bondin �• - •_ - tee em orce - •- � � � 47. Rough Plumbin & Pressure-Test � 6. ElectricalUFERGrn � . " 48.'�APPROVALTOCOVER•GUNITE - �-� - - 7. ootings ' �� - ' � ' 49.�"Electrical Conduit-Undr rn � � ' - 8. Foundation .._. � ' � 50. Gas Pipe, .❑ Undr m, Test � � . 9: ->INatflr Pipe-Undrgin'T ' 51. Backwash Lines P-Tre � 0 rrdr�rn"• � �� :'�' 10. -: Structural Floor SYstem _ � ` ^" 52.: � APPROVAL TO DECK - ' ' ""' " " '� - - - � - -.j.1.c;•Prope�ty Sewer Line,& Hous��Connection � _53:, : �ckwash & Rece tor-Final �'- �� - � .12. Street Sewer.Connection � � - � � 54. Heater &�Vent-Final � � � � � � � � 13. Rough Plumbin9:,.. I : . .. . . - -- -- - - _ • ,.- '- , . . ,.- 14. Rough Electric-Conduit - -, � - --�56. � Electrical-Final � 15. Rough Efectric-Wiring '-' - -' - -- - ,•�, � �'.. :: .' r:,• ... �� _: 57.�"Solar SYsterti-Final . . . ... . . . .- . . - 16:= Rough� Heatin &-Air Conditioning�. - - - � _ encing & Access Approval . � 17. .Ducts in Structure_ � �� APPROVED FOR PLASTERING � � ' _78. Ducis, Ventilating � ' _ _ - � 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL � 20. Roof'Framing � - ' � �� - 21. Roof Sheathiri' ' ' ' ' � � ' �. , � . , . � 22. Frame and_Flashin '- NOTES: ' ` • • � � - 23.� Insulation` � ' � � � " ' "' " '' - ' ' � - - : .. . " - . -. -. . ----- ...--- 24. Lathing.& Siding. . �' ' ' - -- - • - --'• .,. .. _ _. _ .. : _. . ... .25. Drywall Nailing � �� ' - � " � � 26. Plaster Brown Coat ' � • � - 27. Electrical Power Meter-Fina� _� � " • ' � ' � � � �� 28.- - Final Electric � ' � � 29. Final Heating & Air.Conditioning '�- - � � ' ' ' - 30. Final Gas Pipe-Test. � � � ' - � � � 31. Final Plumbing � ' � -� ' " � � �32. Water Serv"ice-Final � ' • � ' :'3 : Gas Service=Final � � " ' � � 34 Solar pomestic•Final • � � � � . :.36,.�Landsca eS rinklin"�S stem�_• � 36. Sound Attenuation � � - 37. Handicap Regulations - - � 38. PINAL STRUCTURE & BUILDING � ' 39. Special Requirements Completed � � � - � - -� ' ' 40. Electric Release to Edison � � � � - ' - - � � ' 41. Gas Release to Southern Califomia Gas Co. � - " ' ' 42. CERTIFICATE OF OCCUPANCY _ . . . . . . ' ` ',�t '' No Date � -