HomeMy WebLinkAbout678 19TH ST - Building PermitsPERMIT TYPE
Sub Type:
�-
CITY OP COSTA MESA �
BIIILDING DIYISION -
77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754�856 • vnvw.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
B COMBO
COM ALT
JOB ADDRESS: 678 W 19TH ST CM"
PERMIT NUMBER: BC09-00497
STATUS: ISSUED
DATE ISSUED: 0112, 812010
ISSUED BY: 1��(T�-+
���.i ��J
Suite/Unit:
APN: 42224219 , � Zoning: ' ' .. .
Vicinity: Primary Occ: �
ConstType: . SQ.FT;,: 0 � , Valua4ion: $30,000.00
SCOPE OF WORK: CO-LOCATION FOR "CLEARWIRE". INSTALLATION OF AN UNMANNED CELLULAR FACILITY LOCATED AT
AN (E) SPRINT CELL SITE. WORK�TO.CONSIST OF THE INSTALLATION OF NEW EQUIPMENT CABINET LOCATED INSIDE A
MECHANICAL ROOM, (3) 4' PANEL ANTENNAS, (3) 2' PARABOLIC ANTENNAS, 1 GPS ANTENNAS W ITH A 200 SVC.
OWNER: BETHEL TOWERS OF COSTA Address: MESA - � - UniL• IRVINE, CA
Phone:
City/State/Zip: 17951 COWAN . , � „
APPLICANT: TRAN, PHAN . Address:
Phone: 760-224-3135 City/State/zZip: - - �
CONTRAC70R: X3 MANAGEMENT SERVICES UJC �, � - License No. 933263 --
Phone: 760-224-4305 Address: 2780 LA MIRADA DRIVEUnit: �
Cell: � City/State: VISTA, CA
ARCHITECT:
ENGINEER: CHRIS S LEE
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: � -
Building Fees:
Electrical Fees: �
Mechanical Fees: �
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
"Refer to fee receipts for all fees pald tor projacl
License No.
License No.C61054
$287.46 � ,
$442.25
$54.00
$0.00
$0.00
$0.00
$6.30
$2.00
$792.01
Unit .
' STE A
ZipCode 92081
PHONE:
PHONE:714-389-9229
)
�NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes antl related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this pertnit to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE t. INSPEC710N TYPE
1616 Fixed System Final Fire Prevention
1266
200
nit
202
203
204
Pool Spa Final
Final Re-Roof
Final Block/ReUining Wall
Final Factory Fire Place
Final Sign
Final Demolition
DRTE
IN�$ �Qp�F� INSPECTIONTYPE
206 Final Mechanital
208 Final Plumbing
210 FinalEleCinWl
212 Final Fire Prevention
220 FinalPlanningApproval
222 Final Site
250 FinalBuilding/Occupancy
P� iNTf11RL5
S�i
•11�J
WORKERS'COMPENSATION DECLARATION:
I hereby aKrm untler penalry of perjury one of the (ollowing declara[ions: •
❑ 1 have and will maintain a certificate of consenl lo sel4lnsure for workers'
compensation, as providetl (or by section 3700 of the Labor Code, (or the
eAormance o! the work for which this permit is issued.
e and will maintain vrorkers' wmpensation insurance, as required by
ec ' n 3700 of the Labor Code, for the peAormance of the work for which Ihis
pertnit is issue My workers' compensation Insurance carrier and policy
number are: r
Carriec T �✓G/
(IDis seabn nee7tl not 6e mmpleted tl ihe permrt is v—alu7etl at obne n^undietl tldlars (5100) a IessJ
Policy NumDer: / ZW �%�� �/� O /
❑ I certify that in the perfortnance of lhe wnrk for which this permi[ is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia. and agree that if I should
become subject to the vrorkers' compensation provisions of Section 3700 of
the Labpr Code. I shall forthwith comply wi[h these prov ions.
� � 2 ��
��� o e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNORED THOUSAND DOLLARS
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATfORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm thal I am licensed under provisions ot Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pr fessions Code, antl
my license is'n full force antl eflect.
� �i���
Lia Class #
Z8�
� t2<t2s.5ianaWre ' F Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a constmctbn lentling agency for the
peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code�.
Lentlei s Name:
Lentler's Adtlress:
SiB�aWre
OWNER-BUILDER DECLARATIONS:
I hereDy affirm that under penalty of perjury ihat I am EXEMPT FROM THE
CONTRACTORS UCENSE LAW (or the following reason (Sec. 7037.5,
Business and Professions Code: Any city or county which requires a permit to
consWct, alter, improve, demolish, or repair any stmcWre, prior to its
issuance, also requires the applicant for such pertnit lo file a signed statemenf
that he or she is licensed pursuant to the provisions ot ihe Contrac[ors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pmfessions Cotle) 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 pertnit subjects Ihe applicant to a civil penalry of not more than
five hundred dollars ($500).):
❑ I, as ovmer of Ihe property, or my employees vrith wages as their sole
compensation, WILL DO THE WORK, antl the struclure is nol intended or
oftered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himsel( or herself or [hrough his or her own
employees, provided that such improvements are not intended or oftered for
sale. If, however, the building or improvemen[ is sold within one year of
completion, the ownervbuilder vrill have the burtlen of proving that he or she
did not build or improve for purpose of sale.).
� I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to consWct ihe projecl (Sec. 7044, Business and
Pmfessbns Cotle: The contractors License Law dces not apply to an owner of
property who builds or improves thereon, and who cont2cls for such project with
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am ezempl under sec.
Business and Professions Code for this reason:
Slgnalure � Dale
305]-66(9/ ]�
Owner ID venfed by tlriver s license. ❑ Yes ❑ No
Driver's License No. Expires:
Venfication of Ownership by (type of document, i.e. - property [ax bill or tleed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excavation frve (5) or more fee[ in depth into wfiich a
person is required to descend, vnll 6e made in connection with work authorizetl
by this permit, and that no building structure, scaffdtling, (alsewurk, or demolition
or dismantling thereof, vnll be more than [hirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, California Adminisl2tive Code).
❑ As owner-builder, I will no[ employ anyone to do work which would
require a permit (rom the Division of Intlustrial Safety, as noted above, unless
such person has a permit lo tlo such work from the division.
Applican(s SignaWre
Division of Induslrial Safely Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or presenl or future building occupant neetl to file and
certi(y a Business Plan for emergency response to release or threalenetl
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the California Health antl Safety Cotle requires. with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department hy every business which has at any one time tluring a reported
year a quantity ot hazardous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperalure and pressure).
2. Does or will the applicant or present or future building occupant need to file
a regislration fortn for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0� the Calilomia Health and Satety Code, with some
exceptions, requires registralion with the Costa Mesa Fire Department by
each business which at any One lime has on hand a quantily of acutely
hazardous materials equal to or greater than a weight ot 500 pountls, or a
volume ot 55 gallons, or 200 cubic feet of compressed gas at slandard
temperalure and pressure).
3. Does or will the applicant or presenl or (uWre building occupant need lo
prepare an RMPP (Risk Management antl Prevention Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Healih antl Safety Cotle provitles that [he
Costa Mesa Fire Department may require the preparalion, certifiwtion antl
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazartlous materials with the Fire DepaAmenl.
4. If an RMPP is presently required, has Sec[ion 25534 of the Cali(omia
Health and Safety Code been (ully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or fu[ure building occupant require for
the vrork which is the subject of this application a permit (or such constmction
or modifcation from Ihe South Coast Air Quality Management Dislrict or (rom
any other air p011ution control district or agency? ❑ Yes ❑ No
(Section 658502 0! the Califomia Govemment Code requires that the requested
infortnation be fumished on applications for non-residential builtling permits).
6. Will any part o! the faciliry to be consWcted under this permit be within
1000 feet from lhe outer boundanes of a school? ❑ Yes ❑ No
Qf yes", the facility must meet lhe requirement of Seclions 25534 and 42303
of [he Califomia Health antl Safety Cotle).
7. If a permil from ihe South Coasl Air Quality Management District or olher
air pollution control disUict or agency is required for the work which is the
subject o( this application, have all of the disclosures prescribetl by Califomia
Health and Safe[y Code Section 42303 been made? ❑ Yes ❑ No •
8. Q! yes", attach certificate of wmpliance fmm the appropnate air pollutior�
control oKcer). �
CERTIFICATE OF COMPLIANCE: I certify lhat under penalty of perjury the
information given above is correcL I agree to comply with all state laws and
city ortlinances regarding Hazardous Matenals and Emissions.
SignaNre Oate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry ol perjury that I have read this application and state that
the information given is correcL I agree to comply with all state laws and ciry
ordinances relating to building consWction, antl authorize representatives of
the City of Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
_ WreorLegalOwner(s) Oa�e
� A��-----� � � i�
CITY OF COSTA MESA
.
BUILD/NG D/YISION
+ � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w�mv.ci.costa-mesa.ca.us
:
"•���, FOR INSPECTIONS CALL: (714) 754•5626
PERMIT NUMBER: E07-00742
PERMIT TYPE ELEC STATUS: ISSUED
DATE ISSUED: 08114/2007
. -' ��'' -: ISSUED BY: SOK
JOB ADDRESS: 666 W 19TH.ST CM f. Suite/Unit:`. -'
Vicinity: ROOF � � . . �� � - , ._-_ . . �' . .
SCOPE OF WORK: REPLACE N/ATER HEATER/BOILER FOR'BETHEL TOWERS OF'COSTA MESA" _LOQATED ON ROOFTOP. ELEC
INCLUDES: 2 MOTORS TO 1 HP AND 1 MISC. CONDUIT. . �,
, . -� � "i� ' ..
OWNER: BETHELTOWERSOFCOSTA� `. �-: Address: MESA Unit:IRVINE CA".� _
PHONE: � -_-, City/State/Zip:,,,� 17951 COWAN; �, i :��.�
APPLICANT: DAN WILDERMAN ��� �(� - ' Address: � 666 W 19TH ST - Unit.LL �
PHONE: 949-642-9941 ' .,, , . � � Ciry/State/zZip: COSTA MESA,�CA - �
CONTRACTOR: OWNER-BUILDER _ . ' . � License No. 000000 �
Address: Unit: PHONE: - - . -
City/State: ZipCode, - CELL: -
' -!
i�. ' . ' � _ ., .�� n�)` f3..i
- _ .. Y:
ELECTRICAL PERMIT FEES �, ,
Electrical Plan Check Fee`. . ` ` $0.00 ' -._ `. ,�
Electrical Permit Fee: $51.20
Reinspection Fee $0.00 � . _ ,
TOTAL FEES $51.20
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulalions. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply with all applirable codes, and all
required inspections and Flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiraGon of this permit.
oc oea• INSPECTIONTYPE on� ixnnn�s oea INSPEL110NTYPE on� IN1171AL5
1678 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing �1
200 Final Re-Roof 210 Final ElectriWl `1 � �
201 Final BIocWRetaining Wall 212 Pinal Fire Prevention P
202 Final Factory Fire Place 220 Final Planning Appraval
203 Final Sign 222 Final Siie
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSA710N DECLARATION: � �� �
I hereby aKrm under penalty q( perjury one of the (ollowing declarations: ,
❑ I have and will main[ain a certificate of consen[ to self-Insure for vrorkers'
compensation, as provitletl for by section 3700 of the Labor Code, for the
peAormance of the vrork for which this permit is issued. ��
� I have and will mainlain a�orkers' compensation insurance, as�required tiy
section 3700 of the Labor Code, for the peAortnance of the work for which this
permit is issued. My vrorkers' compensation Insurance carner and policy
number are:
Cartier.
(TNs sedm nttN noi �e mnpleley d the pertna a vaNed at one nuMrM OOYars (St00) wless )
Policy ber:
� I-ertify tha[ in the pertormance of [he work for wfiich this permil is
uetl, I shall not employ any person in any manner so as to become subject
to Ihe vrorkers' compensation laws o! Califomia, and agree that if I should
become subject to ihe workers' compensation provisions of Seclion 3700 of
ih o od r I all forthwith comply wilh these provisio s.
�� O
p i�fs S�gnatura�' � � - Dai -
> �:�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO 7HE 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 ot Chapter 9(commencing
with Section 7000) of Division 3 of the Business antl Protessions Code, antl
my license is in full (orce and eBect.
Lic. # Class #
Gonvac�or's Sgnat�re Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a construction lentling agency for the
pertormance of the work (a wfiich this pertnit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
SignaWre Date
OW NER-BUILDER DECLARqTIONS:
I hereby aKrm that untler penalty of perjury Ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5,
Business and Pro(essions Cotle: Any city or county which requires a permit to
conslruct, alter, improve, demolish, or repair any stmcWre, pnor lo its
issuance, also requires ihe applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Protessions Cotle) or that he or she is exempt therefrom and
the basis for lhe alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve hundretl dollars ($500).):
❑ I, as owner of the prop@rty, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oHered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner ot property who builds or improves
thereon, and who does such wprk himself or hersel( or through his or her own
employees, providetl that such improvements are not intended or oftered for
sale. If, however, the building or improvement is soltl within one year of
wmpletloq the ownervbuilder will have the burden ot proving that he or she
did n uiltl or improve for purpose of sale.�. � .
� I,;as ovmer�of ihe prop�rty, am EXCLUSIVECY CONTRACTING WITH�
ENSED CONTRACTORS to construct the project (Sec. 7644, Business and
Professions Code: The coNractors License Law dces not spply to an ovmer of
pmperty who builds or improves Ihereon, and who contracts for such project with
a confractor(s) license pursuaqt ro lhe Contraclors License Laws.).
Ovmer ID verifetl by dnvei .�se. Yes ❑ No 1
� v rs icens w�o. � Expirestac: � / ��
ion o'�4nershi Dy (type of document, i.e. - proper y taz��iill y deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:'
❑ I hereby certify that no excavation frve (5) or more feet in depth inlo wfiich a
person is required lo descentl, will be made in connection with work authorizetl
by this pertnit, antl that no building sWclure, scaFfdding, falsework, a tlemolition
or dismantling thereof, will be more than lhirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 347, Title 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do vrork which woultl
require a permit from Ihe Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicanfs SignaNre Da�e
Division ol InduStrial Safety Pertnit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need tp file and
certify a Business Plan for emergency response to release or threatenetl
release o( a hazardous material? ❑ Ves ❑ No
(Section 25505 Of lhe California Heallh and Safety Code requires, vnlh some
exceptions, lhal a Business Plan be filetl with lhe Costa Mesa Fire
�epartment by every business which has at any one time tlonng a reportetl
year a quantity of hazardous matenals equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic (eet of compressed gas
at standard tempereture and pressure).
2. DOes or will the applicant or present Or future builtling occupant need to file
a registration form for acutely hazartlous materials7 ❑ Yes ❑ No
(Section 25533 of the Califomia Health anC Safety Code. with some
exceptions, requires registration vrith the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of aculely
hazartlous materials equal to or greater ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperawre and pressure).
3. Does or will the applicant or present or tuWre building occupant need lo
prepare an RMPP (Risk Management and Prevention P.rogram for aculely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 0! the California Health and Safety Cotle provitles thaf the
Costa Mesa Fire Department may require the preparation, certi(cation and
(ling wilh the Fire Department of an RMPP by businesses which are requiretl
to regisler acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Calilomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or presenl or future builtling occupanl require tor
the work which is the subject of this application a permit for such construction
or motlifcation (rom the Sou[h Coast Alr �ualily Management District or from
any other air polWtion control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemmem Code requires that Ihe requasted
information be fumished on applications for rron-residential building permits).
6. Will any part of the faciliry to be constmcted under this permit be within
1000 (eet from Ihe outer boundanes of a school? ❑ Yes ❑ No
pf yes", the facility must meet Ihe requiremenl of Sections 25534 antl 42303
ot the Cali(ornia Health antl Safety Code).
7. If a permit from the South Coast Air duality Management Distnct or other
air pollution control district or agency is requiretl for the work which is ihe
subject of this application, have all of the disclosures prescribed by Cali(ornia
Health and Safety Cotle Section 42303 been made7 ❑ Yes ❑ No
B. pf yes", attach certifcate of wmpliance fmm the appropnate air polNtion
control oKcer�. " �
CERTIFICATE OF �COMPLIANCE: I certify that under penafly of perjury the
infortnalion given above is correct. I agree to compty with all state laws and
city ordinances regarding Hazardous Matenals and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state that
❑ I am exempt under sea � the informalion given is correcL 1 agree to comply with all state laws and ciry
ordinances relating lo building consWction, antl authonze representatives of
Business and Professions Code for this reason: - the City of Costa Mesa to enter upon the above-described property (or
inspection purposes. I agree not to occupy or allow occupancy of any buil0ing
authonzetl by this pertnit until final inspection.
_ � $ig � 011 gal Owner s) D
�� 5'g 1-7'„ p !
305]-46( 0]) - '
MdIaANM1onzeQA$pl�k' ���, Data
�
�
CITY OF COSTA MESA
BUILD/NG DIVISION
�
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754•5273 • Fax (714) 754-4856 • www.ci.wsta•mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER M07-00460
PERMIT TYPE MECH STATUS: ISSUED
DATE ISSUED: 08I1412007
• - 'ISSUED BY: SOK
JOB ADDRESS: 666 W 19TH S'f CM . ;� Suite/Unit: .=_
Vicinity: � ' . � � � � " -. � - �
SQ. FT: 0 " . . .. . -.. - -
\ - - '
SCOPE OF WORK: REPLACE WATER HEATER/BOILER FOR "BETHEL TOWERS OF'+COSTA MESA" LOCATED ON ROOFTOP.
2 UNITS AT 750K BTU FOR�EACH. , � ._4 ��
. . �� . . , . .� +: - . , .
OWNER: BETHEL TOWERS�OF COSTA , � - Addressi`� `� MESA Unit:IRVINE; CA ��
PHONE: �' " � , Ciry/State/Zip: 1�7951 COWAN'•-� � _
APPLICANT: DAN WILDERMAN • , �� �" Address: 666 W 19TH ST -Unit: -- �'
PHONE: 949-642-9941 ., , , � CirylState/zZip: COSTA MESA,-GA ' �
, . . ;. _.. .�
. . ,: � q � : ..... � . _ ... ;,�-. ._ _ ., ,. , , �, . :�
CONTRACTOR: OWNER-BUILDER � - - - License No. 000000 �
Address: Unit:" ' � � PHONE� � � � � � �� -- � �� - � - � -��
City/State: �
ZipCode:_ . . .
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: � �, $98.00 , ..,.,,� � ,
PLAN CHECK FEE: - � $0.00 � � � - �
INVESTIGATION FEE: . � � ��� $0.00 ` ' .. .- .
REINSPECTION FEE: � . � . $0.00 - .� ,
TOTAL FEES: $98.00 .
CELL:
i
;
,:;: �:,.
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California slatutes 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 authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and Fnal approval must be obtained. Failure to obtain inspections and fnal approval will result in fhe expiration of this permit.
LODE/. INSPECTIONTTE ORjF IN7171AL5 OE INSPECTIONTYYE [J �l DR IN R .
1816 Fixed System Final Fire Prevention 206 Final Mechanical O o<< 0__-�
1266 Pool Spa Final 208 Final Plumbing �
200 Final Re-Roof 210 Final Electnwl
201 FinalBtock/Retaining Wall 212 Final Fire Prevention
202 Final Fadory Fire Place 220 Final Planning Approval
203 Final Sign 222 FinalSite
204 Final Demolition 250 Final Building�OccuOancy
�
WORKERS' COMPENSATION DECLARATION: � '� .
I hereby aKrm under penatly of perjury one of the (ollovnng declarations: _�.
[] I have and will maintain a certi(ca[e of conseN lo self-Insure for vroikers'
compensation, as provided for by section 3700 of [he Labor Code, for the
peAortnance of the work for which this permit is issued. '
[] I have and will maintain workers' compensation insurance, as required by
sectbn 3700 of the Labor Coae, (or the pedortnance of ihe �+ork fw which this
pertnit is issued. My workers' compensation Insurance carcier and policy
�Umber are:
Carrier:
(This sedm neM no16e cbmpete0 d(he ce�1 is vaNetl ar one nuiMmd cbtlars (S I00) n less )
Po�lic�y Number:
�I�Aify that in the peAormance of the work for which this permit is
shall not employ any person in any manner so as to become subject
lb Ihe workers' compensation laws of California, and agree ihat if 1 shoultl
become subject to the workers' compensation provisions of Seclion 3700 of
lhe or otle, I shall forthwilh comply with these pGrovisi ns.
D � �
IApP� n�l'SYSi�lur�.` �i
Ssa
WARNING: FAILURE TO SECURE WORKERS' COM ATION COVERP.GE
�S UNLAWFUL AND SHALL SU&lEC7 AN EMPLOYER 70 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 COOE, INTEREST, AND
ATTORNEY'S FEES.
I,ICENSED CONTRACTORS DECLARATION:
I hereby affrm ihat I am licensetl untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effecl.
Lic. # Class #
ConVaclar s $ignalure Oate
CONSTRUCTION LENDING AGENCY:
� 1 hereby a((um that there is a constructbn lentlinq agency for the
performance of the v.ark for wtiich this permit is issued. (Sec. 3097, Civil Code).
len0er's Name:
lender's Address:
SgnaWre Dyte
OWNER-BUILDER DECLARATIONS:
I hereby affvm that under penalty of perjury that I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5.
Business antl Pro(essions Cotle: Any dry or county which requires a permit ro
construct, alter, improve, demolish, or repair any strucNre, prior to its
issuance, also requires ihe applicant for such permit to file a signed statemenl
lhat he or she is licensetl pursuant ro the provisions of Ihe Contractors
license Law (Chapter 9(commencing with Section 7000) of Division 3 of the
9usiness antl Professions Code) or that he or she is exempt therefrom and
the basis for the allegetl exemption. Any violation ot Section 7031.5 by any
appliwnt for a permit subjects the applicant to a civil penalty ot not more than
fve hundred dollars ($500�.�:
d I, as owner of [he property, or my employees with waqes as their sole
Compensation, WILL DO THE WORK, antl the structure is not intentletl or
6((ered for sale (Sec. 7044, Business and Pmfessions Code: The Contractors
L.icense Law does not apply to an owner of property who builds or improves
�hereon, and who Aces such work himselt or herself or Ihrough his or her own
employees, provided tha[ such improvemeNs are not intendetl or oflered for
sale. If, however, the building or improvement is sold within one year of
Completion, Ihe owner-builder will have the burden of proving Ihat he or she
tlid not builtl or improve for purpose of sale.�.
� a�owner of the property. am EXCLUSIVELY CONTRACTING WITH
C�SED CONTRACTORS lo construct ihe project (Sec. 7044, Business and
Pro(essions Code: The contractas License Law tices not apply to an amer ot
property who builds or improves thereon, and who contracts for such pmject with
a contractor(s) license pursuant ro the Cont2ctors License Laws.).
❑ I am exempt under sec. �
6usiness antl Protessions Code for this reason:
��
��i /� /. � ��
�"✓��'//.v.�� Iir._(�—��p��
�. � � 1'�'' 1',.-'�5:4/' /�
�' i
,, OvmerdD verifed by drive. .nse. ❑ Yes ❑ No
Diiver'S Licen� � EzPiies: d'.O�
en icahon of Ownership by pype of document, i.e. - property�la b or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ' �
❑ I hereby certAy that no excavalion (rve (5) or more feet in deplh into which a
person is requiretl to descend, vrill be made in connectbn wilh vrork authonzed
by this pertnit, and that no building strucNre, scaf(dding, lalsexork, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high, (Chap. 3.2, Grp
2, M 2, Sec. 341, Title 8, Califomia Administ2live Code).
❑ As ovmer-builtler, I will not employ anyone to do work which woultl
require a pertnit from the Division ot Industrial Safety, as noted above, unless
such person has a permit to do such vrork from the tlivision.
Appicanfs SignaWre Dale
Division of Industnal Sa(ety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
t. Will the applican[ or present or future building occupant need to file and
certify a Business Plan for emergency response lo release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of 1he Califomia Health and Safery CoOe requires, with some
ezceptions, that a Business Plan be filed with Ihe Costa Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantity of hazardous materials equal to or greafer than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or wili the applicant or present or future building occupant need to fle
a registration form lor acutety hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of the Calitomia Health and Safery Code, with some
exceptions, requires registration wit� lhe Costa Mesa Fire Department by
each business v+hich at any one time has on hand a quantity of acutely
hazartlous materials equal to or grearer than a weighl of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre and Dressure).
3. Does or will the applicant or present or future building occupant need ro
prepare an RMPP (Risk Management and Prevention Progrem for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 ot the Califomia Health and Safely Code provitles that the
Costa Mesa Fire Department may require the preparation, certifwtion and
(iling with the Fire Department of an RMPP by businesses which are required
to register acutely hazartlous materials vrith the Fire Department.
4. If an RMPP is presently requireQ has SeClion 25534 of Ihe Califomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does o� will the applicant or present or fulure Duilding occupant require for
ihe work which is the subject of this application a pertnit for such wnsWction
or modification from the South Coasl Air �uality Management Distric� or from
any other air polWtion control districl or agency? ❑ Yes ❑ No
(Section 658502 of the California Govemment Cotle requires that the requested
infortnation be (umished on appliwtions for nornresitlential building permits�.
6. Will any part of the facility to be conshucted under this permit be wilhin
1000 (eet from the outer bountlaries of a school7 ❑ Ves ❑ No
Qf "yes", the facility must meel the requiremen[ of Sections 25534 antl 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Qualily Management Distnct or other
air polWtion control distnct or agency is requiretl for the work which is Ihe
subject ot this application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made7 ❑ Yes ❑ No
�8. Qf yes", anach certi(cate of compliance from the appropnate air pollution
control offcer). ' �
CERTIFICATE OF COMPLIANCE: 1 certify �lhat unCer penalry of perjury the
information given above is correct. I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions. �
SgnaWre � Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty ot perjury that I have read this applicalion antl state that
ihe inlortnation given is correct I agree to comply with all state laws and cily
ordinances relating to building consWction, antl authonze representatives of
the City of Costa Mesa to enler upon lhe above-described property (or
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzed by this permit until fnal inspection.
Sig a e Le I Owner(s) Da�
� ,-. � g .�
A tl or A'uthonieE;Applicanl � Da P
J... ._ , ,'�—�
. �
CITY OF COSTA MESA
BUILDING D/VISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. s
°•��, FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER P07-00499
PERMIT TYPE PLUM STATUS: ISSUED
DATE ISSUED: 08/14I2007
• ISSUED BY: SOK
° .'. �
JOB ADDRESS: 666 W 19TH ST CM � —.- �'. Suite/Unit: .;
Vicinity: ROOF , �- ,
SCOPE OF WORK: REPLACE�WATER HEATER/BOILER FOR "BETHEL TOWERS OF COSTA MESA" LOCATED ON ROOFTOP.
2 WATER HEATERS AND 1 WATER PIPING. �� �
. ,!' . r ... . r.
' �t. . - .. .: - . . . . . _
OWNER: BETHELTOWERSOFCOSTA � . �--- =.=Address'� ' �� MESA IRVINE CA _��'�� �
PHONE: -_ � ,.. � , � ' City/State/Zip: 17951,COWAN." -_ -: ; .
APPLICANT: DAN WIL�ERMAN ^ �- ' ` � . Address: 666 W 19TH ST ! ;:' � "� � �'�
PHONE: 949-642-9941 ," . , �� City/State/zZip: COSTA MESA, CA ,�
.
�.
.�. ; i , � .. ' . .. .. . ... ... . . _., .. , . . .., .. . . .
CONTRACTOR: OWNER-BUILDER � � � , LicenseNo. 000000� . '�
Address: � . � � PHONE: - �
City/State: . . , ZipCode: . < . ' - , .. .. CELL: _
_ . i' .
PLUMBING PERMIT FEE'SUMMARY - .�
PLAN CHECK FEE: 50.00 ,
PERMIT FEE: $57.90
.,
,. � , � ' .. -.,
TOTAL FEES: $57.90 :, . �
. :
:�• .�;..
... . ' 4-. . �
I..: .�
.ni'� � . .f•t.. x. . ' � - �..
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES'180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply with all apDlicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration ot this permit.
GOpEp. INSPECTIONTYPE �F, INT7UL5 CODEt INSPECTIONTYPE � [� INnn�us
1818 Fizetl System Final Fire Prevention 206 Final Mechanical s a� �
1268 PoolSpa Final 208 Final Plumbing
200 Final Re-Roo( 210 Final Electncal
201 Final Blak/Retaining Wall 212 Final Fire Preveniion
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Sita
204 Final Demolition 250 Final Building/OccuOancy
�� .
WORKERS' COMPENSATION DECLARATION: �� �` �
I hereby affrm under penalry of perjury one of Ihe following declarations: •
❑ I have and will main[ain a ceAificate of consent to selbinsure for workers'
compensation, as provitled for by section 3700 0( the Labor Code, (or ihe
perfortnance of the wVrk for which this pertnit is issued.
❑ I have antl will main[ain workers' compensation insurance, as required by
seclion 3700 of lhe Labor Code, (w the performance of ihe uork fa vfiich this
pertnil is issuetl. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(T�is secfion need irol be mmple(etl Rlne permR is value0 al one hurMied da9ars (S100J a less )
Pol/icy Numher:
� I certi(y lhat in the peRormance o! the vrork for which this permit is
issuetl, I shall not employ any person in any manner so as to become subjecl
to the workers' compensation laws of California, and agree that if I shoultl
become �ect to the workers' compensation provisions of Section 3700 0l
the or Co le, h II forthwith comply with these provisio�
a �
ApWicaqf's Signa Wre Da
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL ANp SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRqCTORS DECLARATION:
I hereby aKrm lhat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0! the Business antl Professions Code, and
my license is in full force and effect.
Lic. # Class #
ConVatlbr's Signalure Date
CONSTRUCTION L�NDING AGENCY:
❑ I hereby aKrtn that Ihere is a construction lending agency for the
peAormance of the v.prk fa wfiich this pertnit is issued. (Sea 3097. Civil Code).
Lender's Name:
Lender's Address:
Sig�u�ure Oale
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or county which requires a permit lo
consWct, alter, improve, tlemolish, or repair any sWCNre, pnor to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing wilh Section 7000) of Division 3 of the
Business antl Professions Code) or Ihat he or she is ezempt therefrom ane
the basis tor the alleged exemplion. Any violation of Section 7031.5 by any
applicant for a permit subjects ihe applicant to a civil penalry of not more Ihan
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees wiih vrages as their sole
compensation, WILL. DO 7HE WORK, antl Ihe structure is not intended or
ofleretl for sale (Sec, 7044, Business and Professions Code: The Contractors
License Law does not apply lo an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her ovm
employees, provided that such improvements are not intended or offereA for
sale. If, however, the building or improvement is sold vnthin one year of
completion, Ihe owner-builder will have the burden of proving that he or�she
did not builtl or improve tor purpose of sale.). _ .
�as owner of lhe �property, am EXCLUSIVELY CONiRACTING� WITH
LICENSED CONTRqCTORS to consWct the pmject (Sec. 7044, Business and
Professions Code: The contractors License Law dces not appty to an owner of
property who builtls or improves ihereon, and who wnt2cts for such project vnth
a contractor(s) license pursuant to �he Contractas License LawsJ.
❑ I am exempt under sec.
Business antl Pro(essions Code lor lhis reason:
D l b
5 gnatore oate
3051-46�3I0])
� Owner ID veri(ed by tlrive� . .:nse. ,
Expires: =2,,1��d"
Verificalion of Ownership by (type of tlocument, i.e. - property taz bill or deed):
DIVISION OF INDUSTRIAI SAFETV PERMIT CERTIFICATION: �'
❑ I hereby ceA'rfy that no excavation frve (5) or more feet in depih inro vfiich a
person is required to descentl, will be made in connection with work authorized
by this pertnit, and that no building structure. scaffdding, falsework, or demolition
or dismantling thereof, will be more than thidy-six (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 341, Title 8, Califomia Administ2We Code).
❑ As owner-builder, I will not employ anyone to tlo vrork which would
require a permit irom the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work (mm ihe division.
Appl�canfsSignaWre Date '
Division ot Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant neetl to fle and
certify a Business Plan for emergency response to release or threatened
release of a hazartlous material? ❑ Yes ❑ No
(Seclion 25505 oF t�e California Health and Safety Code requires, with some
ezceptions, that a Business Plan be fled with the Cosla Mesa Fire
Department by every 6usiness which has at any one lime tluring a reported
year a quantity of hazardous malenals equal to or greater than a weight ot
500 pountls, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at standard temperature antl pressure).
2. Does or will the applicant or present or tuture building occupant need to file
a regisiration fortn for aculely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of the Califomia Health and Safety Code, with some
ezceptions, requires registralion with lhe Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
�azardous matenals equal to or greater than a weighl of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard
tempereture and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazartlous materials)? ❑ Ves ❑ No
(Section 25534 of the California Health and Safety Code provitles that the
Costa Mesa Fire Department may require the preparation, certifcation and
Ning with the Fire Department of an RMPP by businesses which are required
lo register acutely hazardous materials wi[h the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the Califomia
Health antl Safe[y Code been fully complietl with? ❑ Yes ❑ No
5. Does or will the applicant or preseN or Wture building occupaN require �or
the wvrk wfiich is the subjecl o( this application a permit for such wnsWction
or modifcation from the South Coast Air �uality Managemenl Dislnct or from
any other air pollution control disirict or agency? ❑ Yes ❑ No
(Sect'ron 658502 of the Califomia Govemment Code requires that Ihe requested
infortnation be (umishetl on applications fa noo-resideNial building pertnits).
6. Will any part of the facility to be conslructed under this permit be within
1000 fee[ from the outer bounAaries o( a school? ❑ Ves ❑ No
Qf'yes", the facility must meet the requirement ot Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a pertnit from the South Coast Air �uality Management Districl or other
air pollution conirol district or agency is required tor the work which is �he
subject of this application, have all of lhe disclosures prescnbed by Califomia
Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certificate of compliance trom the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury Ihe
information given above is correct I agree do comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signawre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this applicalion and slate that
the information given is correcL I agree to compty with all state laws and city
ortlinances relating to building construction, antl authorize represeNatives of
the City of Costa Mesa lo enter upon the above-describetl property for
inspection purposes. I agree not lo occupy or allow occupancy of any Duilding
aulhorizetl by this permi[ until fnal inspection.
�ign ureolLegalOvmer(s) �ale
.�.�.�e�, .���� � �
or AulhonxeG AOpht�anl Dat
8
dob Address: 666 W 19TH ST
Suite:
Viciniry:
Primary Occ: R-1 Hotels/Apts/Res >10 Occ Type of Construclion:
Parcel Number: 42224219 Zoning:
Appiicant: DAN ARMSTRONG
Address: 541 E JEFFERSON
ORANGE,CA
Owner: BETHEL TOWERS OF COSFA
Address MESA
IRVINE, CA � � �
17951 COWAN
Phone: 714-315-7353 ISSUED BY:
Zip: 92866
Phone:
Zip: 9261 a
Contractor: "DAN ARMSTRONG CONSTRUCTION SERVICES
Atldress: 541 E JEFFERSON " ",
OR4NGE, CA �
Zip: 92866
Arch :
Address:
Phone:
Status: ISSUED
Applied: OS/08/2007
Issued: OS/0812007
Phone: 714-315-7353
license: 690042
• Eng:
• Address:
Zip: License: � �
• SCOPE OF PERMIT
FIRE REPAIR FOR UNIT 608 AND CORRIDOR AT "BETHEL TOWERS".
�. ,.
Phone:
License:
FEE SUMMARY
Plan Check: $0.00 ' `Calc Valuation: s2e,a�s.00
PermiL 5411.95 Cleim Valuation: 5zs,000.00
SMIP Res: $0.00 .
SMIP Com: 55.64 ,
Other: , $0.00 � _ . . : �;= ' ,':
Inspection: $0.00 � :. _
Total: $417.59 -
� , , � PLANNING & ZONING ' � � � �
SETBACKS � ���� � � ' �':.' ; , ,
MAINSTRUCTURE Front\.0-0 Rear."0-�0� Left ��,0-0�� Right 0-0�� , �.
ACC SSORY Front �0- 0�� .' - �' Rear 0- 0� ' Lefl 0- 0'�-�� Right - �0- 0 �
; �,
PAfiKING � Ezistina:' 0� ��Required: 0 Pr000sed: 0 '
�. � - ,
� . -A , ,
�� � - � � "�
,\
.,� - , . _�' "v .
. ` . �-i ,'� �
NOTICE: The work authorized by ihis permit shall compty wNh a�l applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or il work is suspended or abandoned
for e peripd of 180 days.
INSPECTIONS: In order for the work euthorized under this permit to be considered legal, sueh work must comply with all applieable eodes, and all_
required inepectiona and Iinal approval must be obtained. Fallura to obtain inspections and final approval will result in the expiretlon of ie!permit. _
FOR INSpECTIONS CALL: (714) 7545626
eaao-aa �aw)
WORKERS'COMPENSAnON DECLAiiAhON:
I hereby eMirm under penalry o1 perjury one oi Ihe following dedarations:
❑ I heve end will malntein a certllicate oi consent to selt-Insure tor workere' compensetlon, es provided for by section 3700 0l the Lebor Cotle, for the pertortnance of Ihe
work for which this pertnit Is Issuetl.
❑ I �ave entl wlll mairriam workers' wmp�nsa(lon Insurence, as requlred by sectlon 3700 oi ihe Lebor CoEe, tor �he peAortnance of Ure work tor whlcli this pertnit Is Issued.
My warkera' compensatlon Insurence cerrier entl policy number are:
Certler.
(i/1/9 Sf
0! IBss.)
Policy NumDer:
lyg[WytFat in the Dertormance of the Workje whlch Nis peimit is iuueA, I shall not employ eny person in any menner so as to become sub�ect to t�e workers'
com ensetlon laws of Ce mia, end �9Jr 4 et If I should�Btome sub�ect to Ihe workers' mmpensation provlslons ol Sectlon 3700 at t�e Lebor Cotle, I shell tort�wlth
comply with these Orovl �f [/� /��
xiM�8lgrleture:--��_- / 7 I'✓1[.i�/ � �� Deta:-�. . � /5 � ��
IJJ(i:.FAILURE.TOSECURE� WORKERS' OOMPFJI$pTIpN CpVERAGE IS VN WR1L AND SW1LL SUBIECT rW �� CAIMINAL PENALTIES AND CML FlNES UP TO ONE MUNDRED
iAND DOLURE (St W.00O�.IN ADDfTION T07HE WST OF COMPENSATION, OMUGES AS PRJVIOED FOR IN SECTION 31080F TME IABOR COOE, INiEREST, AND FTTpRNE1^g FEES.
LICENSED CONTRACTORS DECLARATION:
(cammenGng with Sectlon 7000) of Dlvislon 3
Code, and my Ilcense is In full
CONS7RUC710N LENDING AGENCY:
❑ I hereby etfirm that there is e consWqion lendinp egency tor Ihe peAormanca ol ihe work lor which Ihis pertnit Is IssueE. (Sec. 3097, Civil Cadej.
Lendefs Neme: LenCers Atldress:
Sipneture:
OWNER-BUILDER DECLARATIONS:
Date:
I �ereGy ettirtn thet under penalry oi per�ury lhet I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business enC Professlons
Code: Any ciry or counry whic� requlres e pgrmit to construct, alter, Improve, demolish, or repair any structure, pdar to its issuence, elso requires the epplicant lor such pertnit
ro flle e sipned atetemem that he or she Is IlcenyeO pursuam ro the proWslons ot t�e Contreaors License Lew (C�epter 9(commendng wlih Secllon 7000) of Dlvlslon 3 01 Ne
Business entl Protessions Code) or that he or she Is e:empt Iherefrwn and the basls for Ihe elleged e:emption. Any Wolatian of Sectlon 7031.5 by eny applicant for e partnit
sub)ects the eppllcam to e civil penalty oi not mare then frve hundreE dWlars {$500).J:
❑ I, es owner ol the properry, or my employees wit� wages as their sole compensetion, WILL DO THE WORK, enO the strudure Is not intendetl or ofteretl for sele (Sec.
7044, Business and Profeulons Code; The Contreclore License Law Coes not apDN �o en owner of properry w�o Gullds or ImO�oves theraon, antl who does such work
himsetl or �erself or through his or her pwn employees, provided thet such improvements are not Intendetl or oHereO for sale. It, however, the building or Improvement is
sold within one year oi completion, the owner-builder wili have the burtlen of proving that he or she ditl not build or improve br purpose of sale.). '
❑ I, as owner ot ihe propeM. am EXCLUSIVELY CONTRAC7ING WI7M UGENSED CONTRACTORS to wnstmct the pmjact (Sec. 704a, Business end Professions
Code: The wntredors License Lew does not apply to an owner ol property who bullds or Improves ihereon, end who contrects for such pmject wlih e contrecior(sj
license Dursuani to the Coniractors License Lews.).
❑ I em exempt under sec. Business end Professions Code lor this reason:
Signature: Dale:
Owner ID vertlied by drivers Ilcense. ❑ Yes ❑ No Drivefs License No.
Vedllcation of Ownership by (rype of documgnt, I.e. - properry tau bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION:
Expires:
❑ I hereDy certity Ihat no excavation fNe (5) or more leet in tlepth into which e person is required to descentl, will be metle In wnnection with work authorizeE by this
permlt, end that no buildl� structure, gceHdding, lalsework, or demditlon or tlismantllnp Uereot, will be more then Ihirty-six (38) teet high. (Chep. 3.2, Orp 2, Art 2, Sec.
341, Tltle B, Califomia AGministretNe Cptle).
❑ As owner-bullder, I will not employ enyone to do work which would require e pertnit trom the Division of Intlustnel Salery, es notetl above, unless such person hes e
permit to tlo SucA wak fran !he tlivi5ipn.
Slgneture: Date:
Dlvision Of Intlustdal Safety Permit Number.
CERTIFlCATE OF COMPLIMICE AND AUTNORQATON OF EMRY: 1 certlly under penelty of perjury thet I heve reed Ihis epplicelion entl state Iha� lhe infortnatlon gNen is I
cortect I egree to compty with all stete laws entl dry wdlnances relatinp to bullding construction, antl euthodze representetives ot Ihe Ciry ot Coste Mesa to enter upon the
ebove-0escrlbed property for Inspection purppses. I agree not lo oaupy or ellow occupancy of eny buildinp euthorized by t�ls pertnit until flnel inspection.
CODE /. INSPECTIONTYPE Q�¢, I[i�ELS
7616 Fixetl System Final Fire Preventloq
7268
200
Pool Spe Final
Final Re-Roat
201 Flnel BIocWRetalning Well
202 Flnal Fedory Fire Place
203 Finel Sign
204 Flnel Demdilion
COUE� INSPECTIONTYPE
206 Final Mec�enlcal
208 Flnel Plumbing
210 Flnel Elecidcel
212 Finel Fire Preventlon
220 Finel Plenninp Approvel
222 Finel Site
250 Finel Building/Occupency
PA� IIlI��L4
(714) 754-527� • Fax (714) 754-4856 • www.ci.costa-mesa�C��TRICAL PERMIT �� FAIR DRIVE, GOSTA MESA, GA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
ApplicanC
Address:
666 W 19TH ST
42224219
DAN ARMSTRONG
541 E JEFFERSON
ORANGE,CA
Phone: 714-315-7353
Zp 92866
Owner: BETHEL TOWERS OF COSTA
Atldress MESA
IRVINE, CA ' - . Phone:
17951 COWAN Zip: 92614
contractor: DAN ARMSTRONG CONSTRUCTION SERVICES
Atldress: 541 E JEFFERSON
ORANGE,CA
FIRE REPAIR FOR UNIT 608 AT
Phone: 714-315-7353
Zip: ' 92866
Litense:690042 _
Staws: ISSUED
Applied: OSI08/2007
Issued: OS108/2007
1
ISSUED BY:
ELECTRICAL INCLUDES: 4 LIGHT FIXTURES, 8 OUTLETS AND 6 SWITCHES THROUGHOUT UNIT.
FEE SUMMARY
- �uantity , '� ' � ��� , Quaniity
ISSUE FEE 523.50 � . Temp Dist System / Lighting 50.00 0
Temp service test , 50.00 . Busway /100 ft �,.,� $0.00 0 ,
Res. alc package 50.00 Standing Seclion �-� 50.00 0. " , .
New Res (1�-2 units) 50.00 � 0' , MisqElecirical Equipment 50.00 0 �
New Res�(3+units) � 50.00 �- 0 - --� _ -" , - � � Transformers up to ] kva/kw 50.00 0 . �
Pool / Spa $0.00 ' - 0 � _ "• .................up to 10 kva/kw . 50.00 0 �
Lighting Pixts , 54.q0 4 ................:up to 50 kvalkw � 50.00 0 .;
Recept Outlets 58.80 , 8 .................up to 700 kva/kw 50.00 0: � �
Swilches 56.60 6 ..................over 100 kvalkw � 50.00 0, _ � .
Non Res Appl .` $0.00 0 Low Voltage Equipment 50.00 0 �
Res Appl -' g0.00 0 ,. � Low Volt Wiring System / Ckt 90.00 ,;-0' - -
Service to 200a � � - 50.00 0 � � �Misa Conduit 50.00 � � 0 � ",
Service to t000a �' � 50.00 0 Misc. Conductor 50.00 � 0 �
Serviceovert000a � 50.00 0 - . � � Circus(genor�ride) 50.00� � 0 ,�� ,�
Motors to thp , � � SO.OQ � „ 0 � � ' , Circus (mech ride�or lighls) . - 50.00 0 � ,
Motors to 10M1p � 50.00 . 0 Christmas Tree Stantl � E0.00 0�-
Motors ro SOhp � , 50.00 . - � �. 0 Fireworks Stand 50.00 � � . 0 ' "
Motors to 100hp , - � �$0.00 - - 0. � " Other Electrical Fee 50.00 � � ' , �
Motorsover7pOhp ' - i$QQO� 0 � � - � � � � - �
Communication dmps ;� �, -` 50.00 � ; �0 . _ � . Investigation Fee -� . - 50.00, , .
Sub panel to 200a '� '� -50:00 0 �� Plan Check Fee ' ' . 50.00 � �
Pole Light Pkg -50.00, � - .0 ; - Reinspection Fee� . '. ! 50.00 .
�_
Sign Circuits \�50.00 " 0 %, - � -
TempPwrP01e 50.00�� �0 � ', . TOTALCALCULATEDFEES 543.30;'�
Intermed Pole 50.00� �� 0 � . . . "
' COMMENTS / SPECIALCONDITIONS
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, 72-21-92)
EXPIRATION: This permit shall automatically explre and become void if work is not commenced within 180 days, or if work is suspentled or abandoned�
tor a period of 180 days. '
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must compty with all epplicable c'o',d�..r and ell I
requlred Inepectlone end nnal approvel must be obtained. Failure to obtain inspections and finat approval will result in the expiration of t�s�permiL �
FOR INSPECTIONS CALL: (714) 754-5628 -
zaae-+e laroo)
WORKERS' COMPENSATION UECLARATION:
I hereby eMirm under penelry ot perjury one ol the following tleclaratlons: .
❑ I have antl will maintein g�M1ificete oi consent to self-Insure lor workere' compensetion, es pmvitletl tor by sectlon 3700 ot the Lebor Code, far t�e Oertormence ol the
work br which this pertnit Is Issuetl.
� I heve flntl wlil meintain workers' compensellon Insurence, es requiretl by aectlon 3700 of Ne Lebor Code, for the peAortnence ot Ne work tor which ttiLq permit Is IssueA.
My workero' compensatibn Insurance carrler end pollcy number ere:
Carrier. Policy Number:
(�Th/�s secNon need nof be oompletetl il Ne perml( Is velued et one hundred tldlars (Sf00) or IessJ
Yd' I ceNly Ihat in the peAortnence of Ihe work br whic� thls pertNt is issue4 I aheU not emplq any person in any manner so as to becorna subJect to t�e workere'
compensatlan laws o lilom7a, entl a8 s thet tf I alioyM become suEJect to ttre worlcers' compensetlon pmNslom af Sectlon 3700 0l the tebar Cade, i shali forthwlih
comON with these o'• ons. /1
AppliwntSlgnaNre: � D�+—�-�- oa�e: S =�—!�7
WARNIN(i: FNLURE TO SEWRE Wpql(ERS' CpMPENSATION ODVERAOE IS UwFl1L M1D SFUl1 SUBIECr rW EMPLOVEq TO CRIMINAL PENALTIES PND GML FlNES UP TO ONE MUNDRED
TFIOUSAND DOLLAPE (5100,000). W ADDITION TO THE COST OF COMPENS4TION, DMMGES AS PROVIDED FIXi IN SECTION �pg OF THE LABOR CqDE, IMEREST, AND ATTpFWEy'S FEES.
LICENSED CONTAACTORS bECLARATION:
I hereby eltirm Ihat I em
torce entl elfed. tJc. a_
Contrectofs SlgnaNre:
9(commencing with Section 7000) of Division 3 of ihe Busines/s� nC P�a�essions Code, and my Ilcense Is in lull
Cless M /J �
� Date:_ �S=.P-O%
CONSTRUCTON LENDING qGENCY:
� I hereby elfirtn ihat there is a ronstructlon IendlnB eBenry for the peAortnence ol the work for whirJ� thls permit Is lssued. (Sec. 3097, Civil Code).
Lendera Name: Lendefs Atldress:
Slpnature: Date:
OWNER•BUILDER DECLARATIONS:
I herehy ettirtn NaI under penglry of per�ury t�at I em E7(EMPT FROM THE CONTAACTORS LICENSE LAW lor t�e iWlowinp reason (Sec. 7031.5, Business entl Protesslons
Code: Any ciry or counry whfch requlres a permit to Construct, atler, Imprwe, tlemolisn, or repair eny sWdure, D�or to Its Issuance, alw requires the applicant lor such permit
to file e slgnetl atetement Ihat he or she is Iicensetl pursuent ta the proNsions ol the Contrectors License Lew (Chepier 9(commendng wit� Section 7000) of Divislon 3 al the
Business entl Professions CotleJ or ihat he or she is exempl t�eretrom enC t�e basls tor the elleged exemption. Any Nolatlon of Section 7031.5 by eny eppllcant for e pertnil
subl�is ihe appllcant lo e civll penalry ot not more than tive �untlretl tlWlers (E500J.j:
❑ I, es owner ol the property, or my employees wlih wepes es ihelr sole compensation, WILL DO THE WORK, and the siructura Is not intentletl or oMeretl lor sale (Sec.
7044, Business flnd Pmtp,�ions Code: The Contradors Llcense Law does not appry lo an owner ol properry wha builds or impmves thereon, and who does such work
hlmselt or hereelt or IhroUgh his or her own employees, providetl t�at such improvements ere not intended or oHered tor sale. H, however, ihe Duiltlinp or improvement is
sdd within ana year of cOmpletion, ihe owner-bullder wlll �ave the burden of pmving that he or she dld not build or improve tor purpose of sale J. '
❑ 1, es owrrer ot the property, em EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS m conatruct the projec! (Sec. 7044, Business end Profess7one
Cotle: The conirectors Llranse Lew does not apply to en owner ol propeny who builtls or Improves thereon, end who conlrects lor such pro�ect with e conirector(s)
license pursuant to t�e Contrectors License Lews.�.
❑ I am exempt under sec. Business enA Professions Cade lor this reeson:
Signature: Date:
Owner ID verllied Dy tlrivers IiCensa. ❑ Ves ❑ No Drivets License No.
Ver111cation ol Ownership by (type of AocumenL I.e. - properry tax blll or deed):
DIVISION OF INDUSTRIAL SqFETY pERMR CERTIFICATON:
Eaplres:
❑ I heraby certity that no ezcavatlon Iive (5) or more leet in depth into which a person is required to descend, wlll �e matle In connection with work euthoAzeE by t�ls
pertnit, entl Ihat no huilding sWdure, sceHalding, lalsework, or tlemollHon or dismentling thereof, wlll De more t�an �hirry-six (38) feet hiph. (C�aD• 32, Grp 2, Art 2, Sec.
341, Title 8, Celllomla Atlminislrative Code).
❑ As owner-bullder, I wlll not employ enyone to do work which would raqulre e permit irom Ihe Divislon ot IndusMel Sefery, as noted ebove, unleu such person �es e
pertnit to Oo such work from Ihe division.
Signature: Date:
Divlsion af Industrial Safery Pertnit Number:
CER7IFlCATE OF COMPLUWCE AND AUTHORRATION OF EMRY: I ceriity under penelty of perjury Ihe� I �eve read Ihis eppllcation end stete Nat Ihe Iniortnellon glven Is
correct. I epree to compy with ell slete lews end city ortllnances releting to building construction, end euthodze representatives ot the Clry of Costa Mesa to eNer upon the
ebove-descdDed properry tor Inspaction puryoses. I egree not m occupy or ellow occupancy ol eny Duilding authodzed by this permit unlil fnal insDectlon.
8' eture OI Le Owner(s) �ate
t�J a--S c� P— O%
And/OrAulhodzed Appli nl Date
COOE /, INSPECTIONTYPE
7616 Fi:ed System Final Fire Preventlon
12fi8 Pool Spe Final
200 Flnal Re-Rooi
201 Flnal Block/Retelnlnp Well
202 Final FeMory Fire Place
203 FIneI5lgn
204 Flnal Demdltlon
QAIE Ql�IELi
COOE� �NsvernoNnre
206 Final MechaniCal
208
210
212
220
222
250
Flnal Plumbing
Finel Electrical
Flnel Fire Preventlon
Finel Plenning Approval
Finel Slte
Flnel Building/Occupency
Pdffi ItIIQ1eLi
�:
. �.,.
���a) �sa-52�s • Fex (714) 754-4856 • www.ci.costa•mesa.ca.us 77 hAIH UHNt, GUSIA MtSA, GA'J2626
PLUMBING PERMIT
.lob Address: 666 W 19TH ST
Suite No
Vicini�y:
ParcelNunmber: 42224219
App�icant: DAN ARMSTRONG
Address: 541 E JEFFERSON � , � � - "
� � � Phone: � 774-315-7353'
ORANGE, CA � � � Zip: 92866
Owner: BETHEL TOWERS OF.COSTA
Address MESA , " � - �
IRVWE,CA , .. Phone:
17951 COWAN Zip: 92614
Contractor: DAN ARMSTRONG CONSTRUCTION SERVICES
Address: 541 E JEFFERSON
ORANGE,CA
Phone: 714-315-7353
Zip: 92866 �
License: -690042 �
SCOPE OF PERMIT
FIRE REPAIR FOR UNIT 608 AT "BETHEL TOWERS". REF.: 807-00619
ISSUED BY:
Status: ISSUED
Applied: 05/08/2007
Issued: 05/08I2007
PLUMBING INCLUDES: 7 P-TRAP AND 1 KITCHEN SINK. � .
' - FEE SUMMARY . . • • '
AMT gTY � AMT ,aTY AMT gTY
ISSUE FEE � 523.50 laundry Tub / Washer 50.00 �0 Sump Pump � 50.00 0
BackOow irrigation 50.00 0 �� Landscape Irrigation 50.00 0 Swimming Pool 50.00 - 0
BackOow Preventer - 50.00 0 - P-Trep .'. � _ 59.80, 1�� - 7rap Primer 50.00 0
Bathtub 50.00 0 , Pressure Regulatoc 50.00 � 0 , Urinal 50.00 0
Clarifier System : 50.00 0 Process Pipin9 (per i0 fp 30.00 ' 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect Qce,Soda,etc) 50.00 0 Receptors - 50.00 � 0 Vacuum Brkr Bkflow(5+) 50.00 0
DentalUnits 50.00 0 SepiicTank , 50.00 �0 WashBasin , $0.00 0
Dishwasher ' ' � 50.00 0 Sewer Cap for Demo -' 50.00 "-0 Wash Basin Set ' SO.W, 0
Drain, Floor �,- . •. 50.00 0 Sewer Connect � 50.00 0 Waste and,Vent Sysrem - 50.00 0
Drain, Rainwater � �'S0.00 0 Sewer Private Cine' � 50.00 0 Water Closel (Toilep �" 50.00 0
Drain,Roof � 50.00 0 Shower; �,'- ��- � 50:00 0 WaterHealer/vent � � 50.00 0
Drinking Fountain 50,00 0 Sink; bar �- 50.00� ��� 0 Water,Fiping Qnst or Rep.) � 50.00 0
Expansion Tank - 50.00� � �0� � _�-. ,t, Sink, commercial 50.00 ;: 0 • � _ � --Water Re-pipe' - $0.00 0
Gas Earthquake Valve 50.00 ` .0 �, � Sink, Floor � � 50.00 � 0�' � � Water Service i0.00 0
Gas(1-4outlet's),� ,�50.00 0�.�� - Sink,kilchen - . 59.80 , 1 -WaterSoftener . - 50.00 0
Gas (Over 4 outlets) , -��50.00� 0.� �� . Sink, service/mop 50.00 0 . � OTHER. � � 50.00
Gas Repipe 50.00� `0 � ' Spa (pr(va(e) , 30.00 0_ VIOLATION ' 30.00
Gas Service ', 50.00 � 0 � Spa (public) . 50.00 0 �. PLAN CHECK $0.00
Interceptors(Grease,0il)-` 50.00� � 0 - _ " ��"REINSPECTION $0.00 0
Interceptors (Santl Auto j� �50.00, � � 0�� � ' r � ' � - � ' - �� ! � �
� - "_ " � , � � , , . � , TOTAL CACCULATED FEES: 543.10
COMMENTS I SPECIAL CONDITIONS , ' '
NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requiremenis under Calitomia statutes and related
regulations. (Ord. No, g2-28, § 1, 12-21-g2)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or
for a period of 180 days.
INSPECTIONS: In qrder for the work authorized under this permit to be considered legal, such vrork must comply with all applicable co�
required Inepeetlons and finel approvel must be obtainad. Failure to obtain inspections and final approval will result in ihe expiration of thiS
FOR INSPECTIONS CALL: (714) 7545826
zaows �sroo�
WORKERS'COMPENSAnON DECLARATON:
I hereby ettirtn under penelry o1 per�ury one ot tne Iollowing dedaretlons:
❑ I have entl will maintein e ceNlicate ot consent to sell-Insure for wi
work tor w�ich Ihis pertnit ls issuesf.� �
❑ 1 heve and x
My workers'
Cerrier.
in ihe pertortnanca of ihe work
m laws of Celifq(�i le, enA egree
ninsurance.
end pollcy n
one hundred
es proviCed br by secilon 3700 oi Iha Lebor Cade, tw Ne pertortnance of ihe
by section�700 of Vre Lebor
or less.)
fa which this
Is issued, I shall not employ any pereon In any manner so es to becoma sub�ect lo the workers'
ne sub�ect Io tha workers' compensetlon proWsions of Secllon 3700 of the Lebor Cotle, I ehall torthwlih
��ent.Slpneture:-���i'!i"r.faLi-ti--4 Data: � i�—'�� ?
WARNIN(3: FNLUFE TO SECURE WORKERS' C�OMPENSATION COVEMOE I MAWFUL AND SFUl1 SUBIECf AN OYER TO CRIMINqL PFNALTIES AND CML FlNES UP TOONE HUNDRED
TIId15AND DOIURE (5100,000� IN ADdTIIXJ TO THE CQST OF NAIPENSFTIIXJ.OAMAGES /S PRWIOED FOR IN SECfIIXJ 3NB OF THE IABOR dJDE.INfEREST, AND ATTORNEY'$ FEES.
LICENSED COHTRACTORS DECLARATION:
9(commencing with Sectlon 7000) 01
enect. uc. a
Code, antl my license Is in lull
CONSTRUC710N LENDING AGENCY:
❑ I hereby aHirtn that there is e constructlon lentling egency tor the peAormenca of the work for w�lch Ihis pertnil is issued. (Sec. 3097, Civil Code).
Lenders Neme:
Signature: _
Lendefs Address:
Date:
OWNER-BUILDER DECLARATONS:
1 hereby eflirtn that under penelry ot per�ury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor Ihe tollaxing reeson (Sec. 7031.5, 8usineu enC Professions
Code: Any dty or county which requires e permil to consWc�, elter, Impmve, damolish, or repeir eny structure, pdor to its Issuance, elso reqWres the appllCant lor such pertnit
b tile e signed atetement Nat he or she is Ilcensed pursuent ta t�e provlsions ol the Contrectors IJcense Lew (C�apter 8(commenclnp wlth Sectlon 7000) oi DlWslon 3 of Ihe
Business enA Professions Cade) or thet he or she Is exempt theretrom antl t�e besls for the elleped axemptlon. Any Nolation of Sectlon 7037.5 by any eppllcant for e permlt
subJects t�e epplicant to a clvll penelry ot not more than flve hundred dollers (5500).):
❑ I, es owner ot fha property, or my employees with wages es thelr sole compensation, WILL DO TXE WORK, end the sWcture is not Intentled or oHeretl for sale (Sec.
7044, Business and Professions Code: The Contractors lJcense Lew does not appty to an owner of properry who builds or improves thereon, enC who does such work
himself or hersetl or through hls or �er own employees, provided that such improvements are not IntentleE or oHeretl for sale. If, however, the building or improvement is
sdd wit�in ona year of completion, the owner-builtler will �ave the burden ot provinp tha� he or she ditl not 6uild or imprwe tar purposa af sale.). '
❑ I, es owner of the property em EXCLUSIVELV CONTRACTING WI7H LICENSED CONiAACTORS to consiruct Ne project (Sac. 7044, Business enC Professlons
CoGe: The contrac�ore LJcensa Lew tloes not apply to en owner ol property who Dullds or Improves thereon, antl who contracts lor euch pro�ect with e contrector(s)
Ilcense pursuenl to the Contrectors License Lews.).
❑ I am exempt unUer sec. Business end Professians Cade (or this reason: �
SlgneWre: Date:
Owner ID venfied by tlriver's Ilcensa. 0 Ves [J No Drivefs License No.
Verificetlon oi Ownership by (rype ot tlocument, I.e. - properry ten bill or daed):
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMI7 CERTIFICATION:
❑ I hereby certity thet no axcavetlon Ove (5) or more leet in tleptn into which e person Is reqWred to descend, wlll be matle in connectlon with work auihodzed by thls
permit, end that no buildinp swcture, sceNolding, leLsework, or tlemolitian or tlismantlirg thereol, wlll be mora Ihan thlrtyslx (38) feet MpR (Chap, 3.2, firy 2, Art 2, Sec.
341, Tltle B, Celifomla Atlministrellve Code).
❑ As owner-bullder, I wlll not employ enyone to do work which woultl require e partnit Irom Ihe Dlvislon of Industrial Sefery, es noted ebove, unless such paraon has e
pertnll to do such work IrOm Ihe division.
Sipnature: Date:
Divislon o1 �ndusirial Salery Pertnit Number:
I CERTIFlCATE OF CQMPIJANCE AND AIJfFiORIZAiION OF ENTTiV: I certity under penalry ot perjury that I �ave reatl this application end stale that the informeUon given is I
Icorrect. I egree to comply with ell stete laws entl ciry ortlinences reletlng �o bu(IAfng cronstrucffon, end authodze representettves of Ihe City ot Costa Mese to enter upon the
ebove-described property tor Inspection purposes. I egree not ta occupy ar ellow occupency of eny builtling euthorized by this permit unlil linel inspection.
CODE t. INSPECTONTYpE
1676 Fixed System Final Fire Prevenilon
1268 Pool Spe Finel
200 Finel Re-Robi
201 Flnal BlocWpetalnlnp Well
202 Final Fectory Fire Plece
203 FinelSign
?p6 Finel Demolitipn
�g �j f�Qyj,( INSPECfIONTYPE
206
208
210
212
220
222
Final Mechanical
Finel Plumbing
Finel Elecirical
Finel Fire Prevemlon
Finel Planning Approval
Final Site
250 Final BuiWing/Occupancy
�
� —�' ' �
Job nddress: 666 W 19TH ST
Suite:
Vicinity: UNIT 608
Primary Occ:
Parcel Number: 42224219
npp�iwnt: DAN ARMSTRONG
Address: 541 E JEFFERSON
Type of Constmction:
Zoning:
Phone: 714-315-7353
ORANGE, CA Zip: 92866
Owner: BETHEL TOWERS OF COSTA
Address MESA � .
IRVINE, CA � Phone: .
17951 COWAN � Zip: 92614
Contractor. DAN ARMSTRONG CONSTRUCTION SERVICES
Address: 541 E JEFFERSON �
ORANGE,CA
Zip: 92866
Arch :
Address:
Zip:
Phone:
License: � �
Phone: 714-315-7353
License: 690042
Eng:
Address:
Status: ISSUED
Applied: OSI07/2007
Issued: OSI07/2007
��� � �
�' •
. � �
Phone:
License:
SCOPE OF PERMIT
DEMOLISH DAMAGE CAUSED BY FIRE AT "BETHEL TOWERS" IN UNIT 608. �
FEE SUMMARY
Plan Check: 50.00 ,' Calc Valuation:
Permit: $125.25 " - - Claim Valuation:
SMIP Res: $0.55
SMIP Com: 50.00
Other:. 50.00 _
Inspection: 50.00 , ` � .' .
Total: $125.80 � �
PLANNING 8 ZONING
SETBACKS �
MAIN STRUCTURE Front�, 0• 0 Rear _� 0= 0�, Le(t '-0• 0; ��. Right 0, 0�;
' � ' . i��,� i
. . ;'.
ACCESSORY Front -0- 0?' " ' Rear 0- 0 - Left 0• 0" . �� Right -- 0- 0 �
PARKING Existina: . 0 , _ Reauired: 0 Pr000sed: 0
' � ."�
'V � � , � . . _ �
. �',
- . .
� \ S � , / .
� ` � / , - � � � ' � � �.
�
` /
ss,asi.io
55,708.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 9248, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced wlthin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapeetions and final epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
Yan&e8(bno)
WORKEHS'COMPENSAnON DECLARAnON: ��
1 herehy efllrtn uMer penalty of perJury one of the fallowing dedaretlons:
❑ 1 have BnO wI0 malntain a certificate of consent lo self-Insure tor vrorkers' compenseilon, es provldad tor by sectlon 3700 of the LeDor Cade, fw Ne peAortnance o11he
work tw which this permlt is issuetl.
❑ I have end wlll melntein wwkers' compensetlon Inwrence, av requireU by sectlan 3700 W the Lebor Cotle, for Ne pertortnence W Ne work lor whkh Ws pertnit lv Iswed.
My workers' compensation Insurence cartier end policy numDer ere:
Certler:
ale
Policy Number:
o�165s.)
•�7-4Ce ty Na� In t�e peRormence ot the work fo� whic� this permit ls Issued, I a�all not employ eny person in eny menner so es to b6come subject to the workerg'
nsetlon laws ol C Ilomle, end egrae t it I s�oultl come sub�ed to Iha workars' campenseilon provlslons of Sectlon 3700 0l Ihe Lebor Cotle, I shall forthwlt�
y�wiM.lhese pro s' n9.
pllcant S re:_.'� Hn-Q S ta�—�_ �%—�i �
WARNIN(3: FAILUHE TO SE R$' �pMPENSATIqJ COVEMOE IS NUWFUL M1D SMALL SUBIECT AN �Ei1�iOCRiAUNAL PEWILTES ANO qVl� FlNES UP TO ONE HUNDRED
THIXISAND OOLLr1RE (E100.000), IN ADDfTION TO TNE COST OF COMPENSATON, DAM4GES PS PRWIOE� FOR IN SECTION 3]080F THE LABOR CO�E, INTEREST, AND ATTORNEY'S FEES.
UCENSEDCONTRACTORSDECLAHATON:
9(commendng with Secllon 7000) of Division
end ettect. LJc. M,
ectofs Signelure:
Gess k
Date: _
end my license is In full
CONSTRUCTION LENOINC AGENCY:
❑ I hereby efllrtn lhat th�re Is e consiruction lending egenty tor the pertormence ol Ue work for wNch ihis pertnit is issued. (Sec. 3097, CIWI Cotle).
Lendera Name: Lentlefs Address:
Sipnelure: Date:
OWNER-BUILDER DECLApATIONS:
I hereby eXirm that under penalry ol per�ury Ihal I em E%EMPT FROM 7ME CONTRACTOHS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Professions
Code: Any Gry or wunry whic� reqWres e permit to construcl, elter, impmve, demolish, or repalr eny structure, pdor to its issuance, elso repuires the eppliwnt for such pertnll
to tlle e signed stetement thet he or she Is Ilcensed Dursuant to the provLalans at the Cantractors Llcense Law (Chapter 9(wmmencing wit� Section 7000) oi Dlvislon 3 01 the
Business entl Protesslons Cotle) or Ihet he or she Is evempt �heretrom end the basis for t�e elleped exemptlon. Any vloletlon of Sectlon 7031.5 ty eny applicant tor a permlt
sub�ects Ihe eDPlicent to e dvil penelry of not more then five hundred dollers (5500).):
❑ I, es owner o� the properry, or my employees with wapes as t�eir sde campensetlon, WILL DO THE WORK, entl t�e structure Is not Intendetl or oHered tor sale (Sec.
7044, Business and P�olessions Code: The Contrflctore Llcense Law does not flppy lo en owner of property who builds or impmves thereon, and who does such work
hlmself or hersefl or Urough his or her own employees, providetl Ihat such improvements ere not intended or oNered tor sela. If, however, Ue builtling or improvement is
sold within one yoer ot �pmplation, Ne owner-builder will heve t�e burtlen of proving �hat he or she did not builO or Improve for purpose of sale.). '
❑ I, es owner of the properry. em E7(CIUSIVELY CONTRACTING WRH LICENSED CONTiiACTORS to construd the praJed (Sec. 7044, Business end Professions
CoOe: The contredws License Lew does not appty to en owner ol property w�o bullds or improves thereon, entl who coniwcts for such Oro�ecl wit� e contractor(s)
license pureuent to Ihq Contrectors License Lews.).
❑ I em eaempt under seC. Business entl Professions Cade lor this reason:
Signature: Date:
Owner ID verllied Dy tlrivars license. ❑ Ves ❑ No DrNels LJcense No.
Verificetlon ot Ownership Dy (type at dxument, i.e. � property te< bill or tleatl):
DIVISION OF INDUSTFIIAL SAFETY FERMIT CERTIFICATION:
Exvires:
❑ I hereby cerlity thet no excavetlon tive (5) or more teet in Aepth into which e person Is requireC lo descend, will be mada In connectlon wlth work euthoAzetl by thls
pertnft, end Ihal no bWidfng structure, scaHolding, felsework, or tlemWillon or dismantftnp Iheraof, wlll 6e mora Ihen IMtly-six (3B) ieet �fg�. (ChaD� 3.2, Grp 2, Arl Z, Sec.
341, Title 8, Celilomla Administrative Code).
❑ As owner-bullCer, I will not employ enyane to do work which woulG require a pertnit Irom (he Division of Induslnal Sefery, as noted ebove, unless such person hes e
permli ta do such work irom Ihe division.
Slgnature: Date:
Division of Industrial Setery Pertnit Number.
CERTIFlCATE OF COMPW WCE AND AUTHORIIATION OF ENTRV: 1 cenily under penalry of perjury that I have read this epplicetlon ena state that the intortnatlon piven is I
correct. I egrea to compty With all stete laws end ciry ordinances relatlnp to bulldlnp constructlan, anC authorize representetives ol the Ciry ol CAsta Mesa to enter upon the
ebove-dexdDed property for Inspection purposes. I egree not lo occupy or ellow occupancy of eny building euthonzad by ihis permil until linal inspectlon.
COOE t. �NsvecnoxTrve
1616 Fi:ed System Final Fire Prevention
1266 Pool Spe Final
200 Finel R8-Root
201 Final Block/Reteining Well
202 Finel Factory Fire Place
203 FlnelSipn
204 Final Dem Itlon
QAg RfI�ELS
� (/"' �
cooe� ixsaEcnoNTrve
206 Final Mechanical
208 Final Plumbing
210 Final Electdcal
212 Flnal Flre Prevenilon
220 Final Planning Apprwel
222 F7nelSlte
2W FinalBuilding�0aupency
pq0.1ECT ROONESS: ( 6( W 19 TA 5 T
OWNEq'S.NAME: �t,THEL TOW2Rs' OF COSTA
- 'auoeess: MESA
2525 N�.WFORT BLW
COSTA MESA,CA 92627
ppCHIENGINFEfl:
ROOHE55:
REG.NO.:
UNIT:
UNtT:
PENMITTEE: GRAHANi HROTHERS ( 714 ) 546-1653
auuness: 2452 CENTURY
COSTA MESA CA 92626
�ILENSEO CONTBRCTOfl OECUflRTION: I bereby allirm t�al I am Iicense0 unUer Dmvisions ol C�apier 9(commencing vnN Seciion
7000) ol Division 3 ot �he Business and Pmlessions CoOe, anU my license i5 in lull lorce antl el�ec�.
mrruc.: ) 9 3 sTareuc.:7.4860 s C�/—'20
ate: Siqnaiure: ��� P_ .
WOBI(EBS' C MPE RTION OEClAM710N: I A¢reGy atlirm t�at I �ave a certificate ol rnnsem to selbinsure or a ceniliwte a/ WaM1ers'
Lompensalion+�n�s e. qr d�j � eAcp py er¢o� (Sec�ion 3800. LaG
pOLICV ND.: •`�1 b 1"�"!! E%P. ORTE: H IO 1 I42
cornrnNr: LZBERTY MU,yT�iJAL
� CenifieA c py rs h eEy hrnisnetl. L'] Certilie0 coDY i ileE with city�tli�0iviv'op.
/
/� n //
date: � _(�— APPlicani: T,/L� � (.v /K ^-�� __
�. E%EMPTIUNF OMWO EBS'LOMPENSIITIONOECtABA710N: �TMssectionneedno�becamDleted'dt�epermitis�orone�untlred�3100)arless).
�I I certily �nal in Ne Dedormance al Ihe work tor which Ihis permit is issueA. I shall noi employ any person in any manner W as to become
I Subletl to Ihe Workers Compensali0n Laws 0� Calibmia.
� tla�e: SipnaNre:
NO710E: II, altet making this Declaratlan, yau slwultl heGome Wh{eCt to ttle Wurkers' Compe�satian pmvisioas ot Ne La6or
Cotle. you must lorthwiih comply wiM suc� pmvisions or Mis permi� shall he deemetl revoketl.
CONSTBUCTION LENOING RGENLY: I hereGy allirm Iha� ��ere is a constmnion lentling agency lor Ihe Gedormance oi Ihe work lor
Which this permilis iuuetl ($e[�ion 3097. CiV. C�.
LENOEfl:
nooness:
pWNEB BWLDEfl DECLABFTION: I hereby alliim ihat I am exempl imm tAe Caniractors' State License Law far ��e lollowing reason
($ection 7031.5 Business antl Prolessional Code: Any ciry ol counly which fequirts a permit �o consWci, alier, imprwe, tlemolish, or
repair any s�mciure, prior lo iis i55uance. also �eQuires the aOPlicanl for suc� permil �o �ile a 5igneG s�aiement Itut AaJshe is licensetl
pursuant lo I�e pmvi5ion5 ot Ihe Conirat�ors' Slale Litense LaW (C�aD�er 9(Commentinp vmh SeClion 7p10) ol DiviSiOn 3 al ��e BuSineSS
yn0 Professions COJe� or ihat Oe/s�e is eKempl iherefmm and tlle Gasis for the alleged exemption. Fny violation of Seclian 7031.5 by
any applicanl lo� a permit subjecis ihe applicant Io a civil penally of not more than live hunOreA Gollars (5500).
I, as awner ol Ihe property or my em loyees wilh wapes as iheir sole comDensation, Will tlo ihe worM. an0 ihe
p suucwre ¢ nat mtenaea ar o��erea �or saie (�ection 7Wd, Buaness antl Pmfessianal CoOe: The Coniractors' State license Law
aoes no� appty ta an owner of a O�oDe�y who builAs or impmves thereon, anE w�o Does such wafk himsell/�ers¢I1 or t�rouAh
�is ar her own employees, pmvi0etl Ihal such impmvemenis are not imenaeE or oMereU br sale, Ii, however t�e builAinB or
impmvemen� is soltl wi�in one year ol comDletion, IM1e owner will have IAe 6urtlen ol O�oving he/She Aid noi �uilG ar improve
lor Ine purpose ol sale).
l as owne� a( the o�ooenY. am eeclusively contrac�ing with lic¢nsed contractors to conslmct ihe D�olect (Seclian 7044, Business
� antl Pro�euims CoOe: T�e Canlraciors' Siate Lkenu Law dces no� appry lo an ownef oi proDe�1y who builGs or improves Nereon
an0 wh0 contracts �or suc� D�ole��s vnl� a contraclof(s�license pursuanl �o Ihe Con[racfOrs' State Litense Law�.l am aware
Iha� O�ool of Iheir Worker'S Compensation insurance ShoulE be provitletl lo me.
p I am erempt untler Sectiore B. & P. C.
Inr tnis reason:
Oate: Owner
I do hereby cenily Ihai I am awa�e ol ana underslanE ��e requiremenls o� Caflomia Healih antl Salely Catle Sections 255Q5, 25533, and
p553a and thal I or any �Nure GuilGing accupanl wilVvnll no� (circle one) neeU lo compty vn�h Said siate cotles antl ��e repuirements br a
pe�mit la consVUc�wn us mDtldRatiOn imm tRe Air �uality Manaqement OisUiCL ReSbential CanuruCtion app��Calioas are exempt f[om
Inese provi5ion5.
pa�e: Applicant:
I hereby certify Ihal I �ave reaC ihis appiitation and state that tAe above informalion is WrrecL I agree to comO�Y ��� atl city and counly
nfdlOdOLES drtlS�dICIlW$fQ�d11p010�0��104 COOS1NCi1011d1Idt1E1C�y d111h01QCf�fCSC111d11Vp$ pi��05 qTjIDC111E1 W00 �hEd�OVC-I1IEIIIIM6'd
�t)at¢. �� Sipna�ur¢: /
pd�ers �i ense SaGal SeCudlY M: �
t6at-a6 W�ne—Builaing; G�aen—Cotle Enlorcement; Canery—AODIi<an�; Pink—Revenue; GolOanroO—Nsseswr
CITY OF COSTA MESA — BUIi,Dl'NG PERMIT PERM NO: M 05619`_
PERMI'T NO: M 056195 PLAN CIiECK NO: N GOVT; N SUPP: N
CON5TRUCTION TYFE: PERMIT TYPE: MEC PURPOSE: OTH
JOB DESCRIPTION ; INSTALL SMOKE FILTRATiON UNIT SQ P1:
CLAIM VALUE: 1,800,00 CALC—VAL[JE; GROUP OCC: B-2 /
COMMENTS; NO T,Z, WORK
*�1E IE iE dF df iF 3(-�Yif iF i(� �k if iE 1F �)c �lE iF�1E iE iE iE�IE 3E 3F iF �ff �lf iE �� df �iF�IE �)f 9E dF1E if iE if �N-�)f iE �3E �iE iE �lE�k �f if �Fif� iF iE-1F �N iE if iE df jE #�if dEif �IF 9E if� iE iE-?E�lEdf if iF 1E iE #
Z O N I N G R E Q U I R E M E N T 5
ssTeacxs
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT � TN REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL; 422�4219 'LNE; REF NO;
PLANNING NtSTES>
i
j'r �1Eit k 1E iE iF } i(� iF IE iF 1E iE iE 7F iE if iE iF IE it iE it iF 1f iE iE iE iF iE iE iE iF iF if k�iE ie 3F 3F dF iE i!� ii-3b it iF 3E ie ik iflf # if if ib%if jr #h iF iE �E K� i� if if 3E dh iE 3e ii- 3F ih 3t- iE ie iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY i DATE;
HtIILDING APPROVED BY ;_ M- ��� � DATE; ��_�
APPLICATION ISSUED BY: DATE: lr 9�_
iEiEiE9FiEiFiF4Eil9FifiFiFiE3FkiF9ElEiFiEiF �it �fr . iFif•iEfE�*�tlFR�M � /6��ifdf
�1EififiFltiFlEjfiEihiFii�ifiF�liiEiEi'riEiFiEifiliflEiE?haFififiFie-IFiFlFiEiEiFie `IFiEifificiEihiEieifiEif��lEiEihifi'tiFifiEifiE�F�IEiEiEiFi(�}iF3i�*ifi4iFi�iF
LEGALIZATION;N F E E S U M A R Y STRUCTURAL SEGMENT;T3
BLDG PMT L�LUMBING ELECTRZC MECHANiC cIRE SM1P/RE5 GRADING
PERMIT 6.50
25Y SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DliE
TOTALS----> 6.50 15.00 U.00 21,50 21.54 .00
REVENUE D7VISION TOTALS--> COLLECTED: 21,50 OVER/SHORT: 00
BLDG PMT PLUNBING ELECTRSC MECHANIC FIRt SMIP/TOT GRADING FLAN—CHECK
i1,JO
iE iE iE �N� 1f �1F iE iE if 1E i! iE iE 1E if- IF fF if -1f 1F iFi(� ik iF if iE if iE 1L� iE iE if 1E iF iE ie it' iF iF iE ii� ie ic iFlE iE ii !e if iF ihlf 3E i@ i61F 16 if �E if i6 fF if iF if iF ih 3e iF ii� i'r iE � ir i`.� ie jhlF iF
I N D I V I D U A L F E E b R E A K D O W N
TYPE QTY D E S C R Z P T I O N UNIT COST TQiAL COST
MEC 1 VENTILAT30N SYS NOT UNDER PERMIT,EA, 6,50 6.50
END OF FEES
�. i ��GOYCi ���.inZ•�«' "fj'' . _
T'�lT: L'.?�i!!J' 'TI�C: /' _
/
� �
CONSTRUCTION ANDPLANNING: �� _ P��� `PA '
� Date Inspeetor Date Inspector
A�PPROVALS Permit � % - _ AFPROVALS Permit # .
, ,
t., Temporary Electrical Service o��'ole • 52. �Pool & Equipment Location '
2. Soit Pipe-Undrgmd. .� , 53.'Steel Reinforcement � -
3. Electri�l Conduit Utility-Und(grnd. - - 54. forms
4. Electrical Conduit�Undrgrnd. � �' � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electri�al UFER Guid. 57. APPROVAL TO COVER�GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Fo�ndation � ' 59. Gas Pipe, � Lndrgrnd., Test �
9. Water Pipe-Undrgrnd. � I 60. -Backwash Lines, P�Trap, O Undrgrnd.
10. Struct�ral Floor System ' - 61. APPROVAL TO �ECK
it. Property Sewer line & House:Connection 1 62. Backwash & Receptor-Final
12. Sewer �yp 63. Heater & Vent-Final
13. Root Drains - � 64. Plumbing System � Final
14. Rough plumbing � 65. Electrical-Final
15. Rough Electrical-Condult 66. Solar System-Final
16. Rough E�ettric Wiring 67. Fencing & Access Approva!
77. Raugh Wiring Sign . 68. PJPPROVEO FOR PIASTERING
18. Rough Electriwl�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. ftough Factory Fireptace �� APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas OOiI
23. Gas Pipe-Rough & Test 72. Undarground Flush
24. Roof Kraming 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme 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. Electrical Power Meter-Final -�� 80. FOOD CERTIFICATE ISSUED
33. Final Eleciric � � '. Notes:
34. Final Heating & Air Conditioning uL•l�('ZL�
( • • \
35. Final Gas Pipe-Test ' �� �,
36. Hood o� Canopy
� � i
37. Final Factory Fireplace '
38. Final Piumbing
39. 44�ater Service�Final
40. Gas Service�Final
41. Solar pomesticFinal
42. Backflow Preventer , ,
43. Backflow Irrigation
44. Landscape Irripation System
45. Sound A[[enuation
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING -
48. FINqL PLANNING / � �" ' �
i
49. Electric Release to Edison ���''.✓
50. Gas Release to Southern California Gas Co � �
`
5T. CER7IFICATE OF OCCUPANCY
No. Date
PPOJECTAUONE55: 666 W 19TH ST
6""F�ax"tME'BETHEL TOWERS OF COSTA
aooecss: MESA
2525 NEWPORT BLVD
COSTA MESA,CA 92627
pNCH/ENGINEEfl:JAMES RUSSELL
noosess: 4411 NIANTZC PL
uxir:
NEG.NO.:
3 21�iQ
PEflMITiEE:YORBA LINDA CA 92688
AOOflE55:H R. NELSON CORP. (714)582-1598
M2'/G2G12T(�CNORDER�7O LN �,q
/LICENSEO CONTHRCNA�ECOIID1ffUN: IXere ETtir�m tha� � am �kenseE unCA � I�onZ of Chapter 9(commencinp wit� Senion
7qq� at �i ' ion ol �� usineu ana Pmfessions CoOe. an0 my licen in I' force 0 elle I.
CITY UC.: �� STRTE 11C.'1 S S 4
Date: ;i $i9naWre: _ '
WOBNEN COMPENSATION UEQABRTION: I �ereUy a��itm Uui I tWve a t onsenl l0 5¢II�inSure or a cerlilitale o� Worker5'
Comoensa�ion insurance. or a cendieU cooY ��ereai (Section 3800. Lao. CI.
raucvNo.:1137418-93 E%P.DRTE: S�C�4
�mrnxr: S TATE
Cenifie0 copy is �ereDy fumis�eG. � Certili i ci ilEin '� ian.
Dale:'�0��� AppliwnC
E%EMPIION FflOM WONKEIIS' COMPENSATION OECIAflATION: (itK secipn neeE noi be can0�� it Vre perml4 fa one AundaO (5100) ar less�.
I cetlily Ihat in ��e Oertormance oi Ihe woB lor wNc� lNs perrttit is iSsueA. I shall not empl0y any person in any manne� so as �o be[ome
suble�� �o I�e Workers' Compensation Laws ol Galitornia.
Oa�e' SignaWre:
NOTICE:iI, aiter maWng ihis tleclaratian, you shoNC Gecome suDlect to l�e Workers' Compensation O�oviswns of ihe La6or
Code. yoU musl larihvnlh comply vrith Such pwvisi0n5 or INS De�mi� shall bE G¢¢meE revokeA.
CONSTflI1LTI0N LENOING RGENCY: I her¢Gy atlirm that I�ere 5 a[on5ttuciion IenOing apeMy br Ihe pedofmance ol �he work lor
which Ihis Derm�tis issue0 �Section 3097. Civ. C�.
LENOEfl:
aooxess:
OWNEP BUILDEP OECIAflATION: I here�y aflirm IAai I am eKemp� Irom Ihe Coniractors' Slaie License Law �or Ihe lollowing reason
(Section 7031,5 Business and Pmiessional CaOe: Any ciry ol counry whic� repuires a permi� m cansimc6 atter, impmve, demolish, or
iepair any simcture. o�ior to ils issuance, also requi2s Itle aoDlitant tor sucn Oermii to lile a sipnetl statement Ihat APJslle is Iicensetl
pursuanllo Ihe provisions ol ihe Coniractors' State Lkense Law (GIaO�er 9lwmmeMinq vnih $ettion 7qp) of Divi9on 3 0l ine Busine5s
and Pwle5von5 CoOe) or Itui he/s�e is exemp� IAerelmm an0 ��e OasiS lor Ihe allepeA ¢xemD��on. Any WOIaIiOn ol Set�ion 7031.5 Uy
any applicant for a permil suUiec�s Ne ao0��nt lo a civil penalry ol not more thdn live huntlre0 Eollars (3500).
I. as owner ol I�e property Or rtry em oyees vnN wapes as Iheir sole compensa�ion, vnll Aa Ihe wark, anA �he
� svucmrt is not intenEeU or auere0 for sale (�tiw 70a4, Business anE Pmlessional Coae: The Contranori State License Law
COw not aOD�Y �o an owner of a O�apetly wlp GuilAs or imD�w'es thereon, anE wno does such work �imselVherseli or t�muBh
�i5 Or Aer own ¢mployees. pmvide0 Ihat SUCh imprOvemenis ar¢ n0i ini¢nGeG or OIIe�eA lOr Sale. II, however 1�0 UuilamA Or
improvem¢nt is soltl vnihin One year al comple�ion, t�! mmer vnll �ave t�¢ GurOen ol pmWnp �Uslie Ei0 n0i �uilG ar impmve
lor the purpOse al Shce�.
I. az owner ol ��e pmpeny, am e.UusiveN contracunq vnin ilcense0 wmraciors �a constmct t�e o�oject (Sectian 70a<, Business
❑ anE Pm�essions CaEe: T�e Comracmrs State Litense Law tices na appry to an ovmer ot propefryvAro Oml0.s or improves I�ermn
( � Ih fAnl a t '$Ial �itense Law) I am aware
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; GRA 062562 /
PERMIT NO; GRA 062562 PLAN CHECK NO: 00963-93 L GOVT; N SUPP; N
CONSTRUCTION TYPE; PERMIT TYPE; GRA PURPOSE: OTH
JOB DESCRIPTION : GRADING PERMIT (PARICING LOT UPGRADE) SQ FT;
CLAIM VALUE; CALC—VALUE; GAOUP OCC; R-1 /
COMMENTS; REPAVING RESTRIPING 6 CONC. FLAT WORK (ON SITE) RE: 962-93L.
�e�r�r*��r�r��e�*�er�r�r�rr��x��rr*���r+r�e*�+r�r*�r+r�r�r�r�r+��r�r�rx*�r+r�r�e*x�e�r*+r+�*�r**�e�r*�**�r�r**+r�r*�r+r��r
2 O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
PARRING REQ• PROV; PARCEL; 42224219 ZNE; REF NO:
PLANNING NfSTES>
� —"
1!!E fE iF if ik if it if iElE if if if if 1F iF if iF iF iFiE if if k i! iE IE if if iF iliF iF ikik ik ik 1E 1E iEiF1E fE if 1E iFiF 1E 1Elf if iF �E 1E 1E iF k 1F iE i! if if 1f if ik iF iE iF if fE k IF IE iE iE ik iE iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N-T"S
ZONING APPROVED HY C"� G—� DATE;
BUILDING APPROVED BY ; V�/� DATE: �
APPLICATION ISSUED BY: DATE•� 6�
if�fifiFiEifikikifffifMkiF141kiElEklfiflE f���3f1EilklbifiElfiE1F iFif
*+r�t*�r�t*�r�r*x�e***�r�r�*�r�tr+r�t�t+t**rr+t****��r***i t*+t**�r�r�r*���r**�r*�t�t�t�r�r**��t**�r'�*******�*�
LEGALIZATION:N F E E S M M A R Y STRUCTIIRAL' SEGMENT;N
BLDG PMT PLUMBING ELECTRI MECHANIC FIRE SMIP/RES GRADING
PERMIT � " 135,00
SMIP/NON—RES
ISSUE FEE 33.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 135.00 3.00 30.00 168.00 168.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 138.00 OVER/SHORT: 00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
138.00
anOw�ocamrac�slorsuc�Drqtttsvnt�acomractorlslrteme0ursuama e rcors e *,****�,*,K,*�,*,**,***,***,*�,**,*,*„�,x,***,****,*,***,*,***,*,*„�******,**,�*,�*_�*********************
Itu� proo� al I�eir WOrker'S Comperisatbn insuraixe 51pu10 OB yovWed to me.
� I am ecempl un0er $ection: B. 8 P. C. I N D I V I D U A L F E E B R E A K D O W N
io�mis�easore TYPE QTY D E 5 C A I P T I O N UNIT COST TOTAL COST
Ua�e: Mnier.
I tlo �ere�y cerlity I�al l am aware ol anE unaerSlanA I�e repuirzm¢nis ol Calilamia Heali� anG Sal¢ry COGe S¢ctians 25505, 25533, an0 NO FEES WER E S EL ECTED F�R TH IS P ERM IT �
P553< an41na1 I or airy IUWre building acupant wiNwiA noi (arcle One) neeU to comply vn1A uiE siate cOEes antl Ihe repuirements for a
oermil for consimc�i0n or moaititalion Iram ihe Nr Ouabty Management Oistnct. HeLGential mnSVuttiOn aDVliqtions are e�emD� ��om
Ihese O�oviSions.
Date: ApplicanC
'I �ereby cerUfy ��at I �ave rea01hi5 ap0�aation an0 slate Ihal Ihe a0o nt 's wrreci. I agree Io wmpty wi�� a0 [iiy anG counry
ordinante5 an0 slaie Wws rela�ing lo �udUing crostruciion arM �ere utln' rese aiives f tfis uty to emer upon t�e aUove�mentione0
pro0e�ly la���r ///inspeciion OurpOses /
oate: (o �� � �� Sign t
�river'S License or Social Searity •,-
16ai�C6 Whne—Bviltlmg; Green—CODe Enfo¢emen�: Canary—AOWicant: Pink—Revenue; GOIEanrotl—Asseswr
O1 00140791-00140791 T O T 138.u0
DATE: Q6/1!/9's TI41E: 1`:36
�
� CONSTRUCTION AND PLANNING --�
APPROVALS Permit #`r Date
��7. Temporary Electrical Servic� oT Pole
2. , Spil PiPe-Undcgrnd., ' - r.
_ 3, �F.tectrical Conduit llldity�Unorgrnd: .��
'4. Electricaf Conduit-Ur+drgmd:i,' _ •t �
�5. St�?e: Revdoreemant
6c Etpcfncat UPER G:ad.
- 7. footings �� � r � .
8: Fp,und,7tioh - � '`
��
8 Watcr Pipe-Undrgmd. � - � �
�, --r
10: Structural Floor System ; � ' .
17. P�oper;y Sewtr LinC.&, HousefAnnectidA'
12. Sewcr Cap �. • ' �
. �.
13. Roof Drains . " T-
14. Rough Plumbing "
75 Rough HtectricatCondui2 ' �
i
76. Rough Eectric Wiring
i l. flaugh 4Viring Sign
18. Rough E�ectricaFT Bar Ceiling
79. Rough Heating & Air Conditioning
�
, r ...
PC 9 SPA - -
inspectot qppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bond�ng
56. tiough Plumbing & Preisure Test
57. APPROV�I TO COVER GUNITE
58. Electrical Conduit�Undrgmd.
59. Gas Plpe, C] Undrgrnd., Test
, 60. Backwash Lines, P�Trap, �7 Undrgmd.
�-
61. APPROVAL TO DECK
62. Backwash & Recepcor�Fina�
63. Heater & Vent-Final
64. Plumbing System � F�nal
65, Electrical�Final
66. Solar System-Finai
67. Fencing & Acceu ApProval
68. APPROVED fOR PLASTERING
69. POOLISPA SYSTEPJ�S FINAL
S ._ FIR€ DEPT. fjEQUIREMENT
-r u -'s �PPROVAl:S � � .Pernjit # � �
; � �70. Undergrbund-Hydro v
- � :I1. ProductPipin9[7Gas COiI
" ' 72. Undergrourid Flu�h
.,. 73. Undergmd�Storage'S"ank O Gas � Oi;
- '• 74. Overhead HVdro - _ '
� + 75.;�ry Chem�cal . ,.' �
� 76. Dry Stand�p? � �
� 77. FIXED SY57EM FINAL �
- 78. FI�RE PREV. FIf�AL � _�
, _, , HEALTH.DEPT�REQUIREA1E�T
r � i z
20. 1?o�h F'accory Fi ev�ace .`` t y t ;-
21,'Ducts, irt 5trveture ' " " ' � ' - '
�: �
22. puqis. bentitaiins},: - . '' (' . : ,
23. Gae Pipz�Rough @� T�est � ' c '
�. r T
24.' Roof Frdming. : .' � . ; � ,
25. Roof Sheathing ' ' - % �� � �
26. r•Ba�r,Cc;hng �Struc�urall & 6lQrocoat ` ' "
• , i
27.�framea«tJ Flashing�: � �, -, -
28. Lathing 75 Siding�. '. ' .J'� `. _ ' •
' -_ - �. ..' . 1
79. InSuiatwn - * � -
- r
"30. Drywail AlaJing _ ,; �.
c�t. Plaster gco,vn Coni � : -. -
-:b - � ' �-i,_t'
� 32. .Etectncyl Po�+Tr Mete��P�nal � ' -'
,`ii3.`Finaf EleCtrit� �' K .I . �
� .� a,: �-��� � - -
i�34.•Final Heating& G,ir�oPditionirsg' :� � .
35..Final Gae Pipe.Test : +-; � : . -
�Ci6..Hood or Canoav _': ' .;. y � .
, .
37.�Final-.PaFtory Fireplece . .
38.�infl1 PluNbing .. •� ' . -
39. "L`latet Service-Final . �c " ; �
d0. Gas SerwEe�F�nal � ' • �
Y
'41. Solar DvmesiicRdaf ' r
r -
�42. BackflowPreventec � � -
43. Backflow Irricjatiop . '' ' ' .
A4. Landsc2 e Irriqa[io� SYstem= �- . -r .-
� f-.
'45.�Sound Attenuation. . ' .. � '.; �
ri16. Har.dicap Regulations - ,
A7.�FINALSTRUCTURE&BUILOING /��/q
A8. FWALPLANNWG � �
49. Electric Release to Edison
50. Gas Release to Souchem California Gas Ca -
91. CERT�FICATE OP OCCUPANCY x
No. Date
�I � 79. FINAL INSPECTI(NV '�
f''� 80. �OOD CERTIFI�ATE ISSUED
Notes: '
-� I -�;--�--r-
. '_ _ _ - -
= 1-�� - =.
r
r �
i
_I �_`_ . . _
�
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i ..
�I_2 '
� . ' _
i t •
� �
_�
Date Inspector
%
. I
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ADDFESS Oi BUILqNO: 6 Fj 6 W 19 TH S T
OYMEA4WWEIFpAWlL BE'�'HEL TOWERS
' �ooxEss: 666 W 19ST
COSTA MESA
�A 92627
�vv�. wma'o �nowest
MCNRECT ON FNtlNffN:
AXCX.Ofl ElNi.'S ADDNE55:
(719)642-4061
uc. no:
�� ROOF
UNT:
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: M 071603 PLAN CHECK NO: N
CONSTRUCTION TYPE;
JOB DESCRIPTION ,
PERMZT TYPE: MEC
lAC SYSTEM 61EXHAUST FAN
PERM NO; M 07160
GOVT: N SUPP: N
SQ FT;
PURPOSE: NEW
CLAIM VAL[IE: 6,000.00 CALC—VALUE: GROUP OCC; /
c«rtn�crarsrwie GRAHAM BRO HEATING AND AI ( 714 ) 546-1653
CONfii�CTORSYNIAq 2952 CENTURY PL COMMENTS: VENTILATION 6 PROCESS COOLING
aoox�ss: COSTA MESA CA uc.xo.: 248609 +E****+�****+E*�**+t***r-�+t*+�*****+��+r*+r�rx-**+r+t�r+e�r+r***�r�r*ar�*�rx��r**�rr+r*+rr*�-*�rir�t+e*+tr******
92626 urn: Z O N I N G R E Q U I R E M E N T S
LICENSEU COHfNACTONS OECLIPATION: I Mraby ellim uMer paiuly d pxjury thtl I un liceneed wMx poNeian al Chaplx 9 5 E T H A C K S
(mmmentl'q Milh Sxiion ]000) d Orvision 9 d Ne Buai�wee vW PMeasiana Codp, aM my licenve ie in lull lan erd aNarl.
cmuc.No.: 059 3 uc.cuss: C 20 uc.No.: Zq8604 E/�X`P; 06/95 ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
o,�,: 3 cam,w«:C�X?�,I�G�-n�Re� /TL. FRNT; FT IN REAR• FT IN FRNTe FT IN REAR: FT IN
. LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
OWNEP BUILDEN DECL/�NAT�QN: I here�y effirm uMer penaly d perjury tMl I em exemp Imm tM Conveupa Lbenee lew Ia ihe
�dw� �ea� (s«l� �a+i s e�a�s �d vrdaviooa coes: n�y c�v a�my �� ��i� a�rmn io ootiwn. enar. +mvow, pARK I NG RE/� • PROV : PARC EL ; 4 2 2 2 4 219 Z N E; R E F NO :
damdah. or repei eny evuciur0: qKK lo ils bwwim, ebo repuina IM epplimnt lor such psimG Io fib a eipmd altlenwnt UW M a eM M•
m r�„n p,,,�,dn „ in, wom�oo� a ma co�,ireao�. uo�.. �w �cnap.. s(o�m.M:�y ..nn s,aoo �000� w oH.� a a �n. P LANN I NG NOTE 5>
Buairom ard Prdmioru Cadel a �het Ir v ahe u exemq iherahan eM iM bmw tar IM dbOb uamNion. My vidmion d Seaion
> ='
)031.5 W eM' eodiceN lor e W�mil wd� �M WWicent to e tivil W�Y d na moro ihen fwe hurM�ed Edbn j3fADd. 1E 1f if if �E 1E if 1F iE i! 1E �lE it if ik ik 1E i! ik iE iE iE iE if iE if if M 1E iE if iE 1E ik iE if iF dt if it iE iE iE if iE iE 1E iE ik iF %if iF iFlf if if if if if 1(�!E 11 if iF iF iF 1f iF 1F iF iF if 1F iE iF 1F iE iF
� I.dowroroftMpapenyormY�ObY��^'�hwepeaulMiedaoxnpenwian.wJldo�Mxwk.arMMealvXune�wlinterkaE 'i
aaReredfarxle�Saclbn�aa,BwireaendProfuebnaGods:ThsConheaaelioenesLewEwendeppymanownerWpropaly D E V E L O P M E N T S E R' V I C E S R E Q U I R E M E N T S
who Euida w inprowe ihe�eon. anE wM10 daee euch xwk Mmaell a heneC ar Ihraqh he or her own empbyeee, qarideE ihet euch i_
imqovemama era mt imerded a oflaed fa eele. N, however, iM buitliiq ar'unprovemen� Is eok v�hin one yeer ol campblon. ihe Z ON I NG AP P ROV ED B it ��
o..��.w�� �;n ne� ine c�be� w a,ama na a�.ne em �a n�aa a �mv� t« me w�m�a a.�a). DAT E:
� I. m mmer d tM propeny. em sxdimiwly contrmip xilh IimneeE wnVecton to wnetrutl the Dblan (Saqion ]OU. Bueiiwee enE
PMeaeiana Code: TM Caitredae Liceree Ler doee ml MVM lo an o�mer M prapeny who Witls a impovm thorson aM who B U I LD I NG AP P RO V ED B Y ; 11 D AT E;
eonveeb M wdi peopar w� e mmrador�s) IiromW punuem �o tM GmVaaae Lieense lewl.
❑ ����q��ee�senare e.er.t..ro�m����: APPLICATION ISSUED BY: _ iCy'tiC' Gaa�v! DATE• 3�'L ��
Dete: OxTer: iE if iF 1! ft if il� if 1f iFlF it iF 1f If if %1f if
I da hareby cMily Ihel I em aws d ud wdeislenE IM ispuirem«ua al Cd'Aamie Meellh uk Salery Cotle Sediom x5505, u5a3, end L EGAL I Z AT I ON ; N
f5530. vM thet I a eiry tNure buikin0 �+Va^� �II / wil mt (dreb one) neeE lo campty wIh eeiE elele mdea enE iM repuimmpM M
epermiliwmnawctian«modi(�b�haniheA'v ue�6TlrepememDiMrid.ResiEeMWoonm�uaoneppiratiwuaraezamptimmlhma HLDG PMT PLUMBING ELECTRIC MECHANIC
o�o��s��^=. P ERM I T
, 20.00
�a- 25R SMIP/NON—RES
PLAN ,
ISSUE FEE i, 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 20,00 15.00 0,00 35.00 35.00 ,00
REC�ENUE DIVISION TOTALS--> COLLEC.TED: 35.00 OVER/SI-IORT; 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CI-IECK
35,00
iE iE jf if M if if ik iE it if if it if �1f M M 1t K if iE if if fE aF iE if it if if if if it if if if it it if ff if iF it if if iE 1t if if iE if iE if if it if iF 1E iF jf if if i! if if 3f �f iF iF it i! if if it 1E if iF 1f i!
I N D I V I D U A L';F E E B R E A K D O W N
TYPE QTY D E S C R I P T Z O N�, UNIT COST TOTAL COST
MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4,50 4,50
MEC i INST/REL AIA HANDL UNIT 0-10000 CFM 6.50 6.50
MEC i INST/REL BOIL/COMPR 0.0 — 3,0 HP 9.00 9,00
END OF FEES
\
/ �
F E E �S U MvM A R Y
WONKER'S COMPENS�TON DECI�RATION: I Mraby elfirm wMer parelry d peijivy me d Ns tdlowinp Eatluazuro:
� I wilmeimene��'�edmmam�oaatlrneuntorworken'campemelbn.uprovidedlmby3acVm9100d�MLeEa
la tM pMormanaa d Ne xak /a wlich Ihu pemin w uawd.
1 hew ud xil meiMen w��n' �pensetion irmnuae. n nquired Ey Smbn 5100 d tM lebor Coda. br IM pe�brmvwe d iM
wak la whiW Ihia Mrmil o baued. MY worMee' eomPenaubn imureewe rere�ar ud Vdie/ numbm are:
c�.r. L.7HERTY MUTLIAL. EXPIAES
PolcyNumber: W('11Fi1O�O%iF�Oi4 QQ��l�9rj
(Thia xe tivn neeE na be comPbteE 1 tM G�A u br am hunereC dollers (3100/ «bm.)
� I eenry Ne� in �he pMOM�enea d tM wark br v.Tkh �hb pe�mX la bweE, I WII � empby erry penon in eery manner eo m to
e«ome a�d� m ma won�,: coma��, �ew. d cvnomr. e�d ee�. ind n i.no�u �o aqaa io �ne wo�xa.•
com sation D ' d,� ior 3)00 ol�MleborCods.l�ehelllon�" �' comdi wiNthow Gmvieions.
om.: ���%R � acqK.�u: -�i-sl n rY ��J7', .�
W�minp: F�Nun ro sec�n N/kw+'rompeiuetlon coverep� la unNwNl, enC aIWI ulf�et ur rnyloyer to eNMNI p�Wtlr eM
dv/l flnu up ro ans �'ntlid ���+� �Mn (SfOQPPDA M M11tlon b IM cwf ol ronpmsetbr5 Wmvyu u poHtlW br In
S�ctlon 9]P6 ot ths LaborCoa. /nMuf. aM attomry'� Iwi.
CONSTNIICTION LENDIIM PdENCY: I heraby alfi�m uMer peneMy M perjury tl�et tMre ie e wnatrudian bMinp apeMy br Me
�IBf�Of111BfICB O��NB WO1�(�O! NillU`1�h6�181111� 19 691184 ($BC1011 '.109�/.riM.Ci.
� LENDEH'S NAME:
LENDEWS AOPAE55:
I cenity Ihm I heve reed Nia epp��� eM a�e�e thel �he above iMametion ia cmee. I epras to comply wil� ell Uy eM ooumy adire�ee
eM sWe kvn raletep b buiMiq ��u� end Mnby eWvrzs repremn�Nivea d �he nmy to emx upon the abwe-memioned popery
la inypaaion purpoma..
"i��ti� 7 Y��r = - —
Pnnt Name
F/LO_ � Q� oe�e: 3��
� Si9��u�eotOwnetlRpenVApO����VConVecior
�5t51dfi.WP) Whns�uildiqdSefery;�rearFfvle;Cuwy-Appira�nt:Pink-(ievenw;(3dEenroE-Asaeseor
FZAE
**�r�r����* **
STRUCTURAL SEGMENT:N
SMIP/AES GRADING
�t 09I7°632-0��?Zh32 Ta] T 35.OG
D'nit: 43/33:`95 ;iilE: 14.:ci
GDNSTRUCTtON ANDPLANNING NOO. .SPA '
}��APPROVALS Permit # Date Inspector qppROVAIS Permit # Date Inspec2or
i
�� 9. Temporary Electrical Service or Po)e 52. Pool & Equipment Location � _ -
2. $oil Pipe�Undrgrnd. � -- 53. Steel Reinforcement . � � '
.. 3. ,�lectrical Conduit UtilitY-Undrgrnd. 54. Forms �� '
=�4. EleMrical Conduif-Undrgmd. ��� 55. EleCtrical Bonding �
5. $teel Reinforcement, 56. Rough Plumbing & Pressure Test ,
�6: `�lectrical UFEft�G'rntl. 57. APPROVAL TO COVER�GUNITE .
'i7. Footings ,. . ' 58. Electrical Condliit=Undrgmd.
8. Foundation - - 59. Gas Pipe, � Undrgmd., Test
9. Water Pipe-Undryrnd. , • 60. Backwash Linez,P�Trap, � U� drgrnd.
10. Structural Fioor Sys:em - . $t. RPPROVAL TO'DECK ,_ �
i}. Prq,Cer2y Sewer-S.ine.& House`�onpection 62. 8ackwash & Receptor-Flna1
�
12. Sewer Cap ' �: I &3. Heater & Vent-Fi�al
13. RoAf Drains _ � 64. Plumbing System � Final � -
14. Rough Plumbing� :� . 65. Electrical-Final .
15. Rough Electrirai-Condu�t - 66. Solar SYstem-Fi�ai
76. Rough ElecIric Wiring 6J. Fenci�g & Access Approval _
17. Rough Wiring Sign :L; . 68. APPROVED F(�,R.PLASTER WG � �
18. {iough Electricai-T Bar Ceiling� 69. POOUSPA SYSTEM1AS EINAL �
79. Rough Heating & Air Conditionin9 FIRE DEPT. REQUIREMENT
20. flough Pactory Ficepiace � r " ' , ; APPROVALS� -� Permit # � � �
21. �Ducts, in Structurei •• •• � _ - '" - 70. Ondergiound Hydro
22. Oucts, Ventilating; ' � �� �� ' '" ' �
F,. ;� 71. Product;Pipinc� 0�6as u0ii
23. Gas 1Pipe�Rough & Test yl � -, , C} •- 72, Underground Flush +
24. �Roof�Framing" ' ' ' "n, • •�� �__�: !- 73: UndergrnB.Sto�;sqeTank,��Gas ❑Oil
25. Roo4. Sheathing . 1? v��-. '�' r �-^ c` 7G, Overhead Hydro `
26. T�Bar'Ceiling tS2ructural} & Monocoat ., � - 7 75. Dry Chemical ' �_ '' ��
27. .Frame a�d Flashing'. •=�x�,. � r� 7fi. Dry Standpipe�-� .� � � .
28. Lathing & Sid;ng , ' � ; ,�;� -'; -� "� "� " 77. FIXED SY.�TEM=fINAL , '
-C _ . .. _ .. _�� 1 .�� i � .
29. Insulatiqn . _. .• z � ' � 78. PIRE PREV. FINA� - � -
" 30. Drywall roailino � ° ��i ' . HEALTH DEPT. REQUIREMENT
a � _
, 31. Plaster Brown-Coat , �;-+ r , 79: PINAL (NSPECTION .
32.'-Electricai Power Mettr-Final � `�- I . "�� 80`.; FOOD CERTIFIGATE IS$UED
;T
� 33. Fina(1Electric, � - � x � i �� Notes: � ; ;- . . _ . .
� � �
34. Final'Heating_& Air Conditionirig� ,-� ^�_1„'x. - '; /� l ,s��--- � • �_. j��!
�r �: -Y :i� r --).• - ii ' ti�-�'- �/:��#--/'-
35. Final~Gas Pipe Test ., ,_;;"� .: ; � 1 . 4, - .�..: "� _ ' . ;
36. Hootl��or CanoPY * _ :'-'7 �. i � --�' = � � � . �
mr:. _� - i '*i
^ x rl ^ '., t' . -r. i, I ' ,- .
- 37. F„inal.FactorY FirePlace :.. .. �. ; �'�. .. _, - _ .
' 38. FinalPlumbing " � �. � � I . - . . . . � .
� 39. WateT Service�Fina4 ' - �. ' ' " ' � ' � -
40. Gas Service-Finai . -� - : � j � : �
� M1 r.
' 41. Solar pomesticFinat -. - . - ' � ir t� -� =� • .. -
42. Backflow Praventer , �� �� i 5 •.
. �� ,: �-�
43. 88ckflow irrigation' � `� ', � , '. �.
- } J. . �
44. Landscape tr�igatiorvSYstem�:. . ^t - :? < e� ,L - . - .
" �r
45. SOund Attenuation' � ;` , � ` '� � � � , _ - �
�, . !r r _
46. Handicap Regulations - � � : _ - •
47. P1NAL STRUCTURE & BUILDING ' " I � , �� - - _ ,
,y r -
48. FINAL PLANNING � � � , � ' � !
� �
49. �Electric Release to Edison ' � ''� , � '
50. 6as Retease to Souther� Califomia�Gas Co � - '• �� - �"' � _ . � � • �
'�.
51. CERTIFICATE OF OCCUPANCY r. � - .
No. Date
I ' J
iOflE� 666 W 19TH ST UNIT:
' �E'BETHEL TOWERS OF COSTA
noosess: MESA
' 2525 NEWPORT BLVD
� COSTA MESA,CA 92627
AflCNIENCINEEfl: � 7 1 4� flEG.NO.:
aoosess:ROBERT C. COULSON S.E. 17�T:
7801 ORANGETHORP� AVE
PEPMITTEE:BUENA PARK CA 90621
ADOflESS:H, R, NELSON CORP. t714)582-1598
M277G2G12T(�C�OR(7D7ER�7O LN q�
�ILENSED CONTNpt7T1ATFLOHAi@N' I �iere�yEailir�m that I am Iicense0 un A'9 �Chapter 9(commencinq wilh Section
7�1 ai Oiviyon 3 t�e,9usineu aM Prolessions Code. an0 my license I lull �a e ifeci.
�ITY LIt.: �8� STRTE LIC.:2 S S 4 3 $
Oa�e: Signamre: — . . _
WOflNEflS' COMVENSRT �N OECLAMTION: I hereCy a�lirm lha� I lwve a te " te en� to selbinsure or a certiliWie ol Workers'
Gompensa�ion Insmance, o� a cenitien copy tne�eot i�tion 3800. �a�. C�.
voucrxo.:1137418-93 EXP.DRTE:� 94
comvnxr: S TATE
7 CeNfietl copy is hereby Wmishe0. � Cenilie rs. n P il ' g U' on.
pate: �[f'���� Applicant; :
E%EMPfIUNFNOMWOPKEHS'WMPENSRTIONOFCIAfl�T10H:'(ih¢stttiM pleteOillhepum15�aWrehuNre0�510�a1es5).
I ceriily ihai in ihe peAormance of ihe wark tor whiU Ih4 perrtut rs iuuetl, I shall noi employ any person in any manner w as lo become
gu�jecl lo Ihe Workers' Compensation Lavrs al Calilom�2�; '
D��e: Signature:
NO710E: II. aner mdkinq this aeclaraGai. you sAOula Cecome subject to ihe WOM1eIs' CompenSation provisions ol Ilie Labor
COEe. you must fonliwii� cOmoly mt� sIK� provi5i005 arUYS plrmii slull OC deemeA rtvokeJ.
GUNSTflUCT10N LENDING �GENCY: I hereoy atfirm•ln$i tnere i5 a tanSVUtiion lending apenCy �or ��e peAOrillance a� I�e wOfk lor
�vhic� Ihis permit is issuetl (Section 3097, Civ. C�. � � ��
LEN�Efl:
ROOXE55:
QWNEB BUILDEP �ECIAXATION: I �ereby allirm Ihal I am eKempl Imm I�e ConiratlOrs' S�ate License Law lor the I011owinA reason
(Section 7031.5 Business and Pmiessional CaOe: pny ciry ol coumy wliic� repuires a permii to co�ntmct. atter, imprwe, Eemolis�, ar
reDair any sirUcture. prio� lo ils iuuanre. also repuires ine appliqnt for wcn Oermit to file a sipned stalemenl t�at ne/she is licensetl
pursuant m �ne Omvisions af ine Camractors' Siate License Law (C�aO�er 9 gommencinp wit� Section 7000) ol Division 3 0l t�e Business
�nd P�o1¢SSions Code) W Ihal R¢!Sh¢ is exempf tRertl�Om a�W the Da5�5 lar RIe all¢qPA erem0���. �Y ����� o� $eUion 7Q31.5 Cy
any aoGlicant far a permit subieps ihe applicanl lo a civil penally of not mare Ihan live Auneretl dollars (55W).
I, as owner ol �ne V�openy or my empIoy¢es wii� wa0� az t�eir sole compensalion, vnll Ao ihe wark, an0 i�e
Q simcmre is not imenaea or oaerea mr u�e �Secimn 70a4, Busmess aM Pmlessronal CoOe: Tne Comractors' Stare License law
Aocs nal ap01y Io an owner ol a propeny wtq OW�Js or impmvCS I�ereon. an0 who Ooes such work himSelf/hersell or I��ouph
Ais or �er own em0�0yee5. pmvi0¢tl t�al suc� imOmvemenl5 are not inlenOtO ot ollered tor Sa10. II, �owever I�B OuilOinp or
� impmvemenl is 5o1a within ane ycar of mmpletbn. I�e Owner will tWve Ihe burden of O�ovinp �e/She Uid nat Oui10 or im0�ove
i for Ihe Ourpose of ule�.
I. as owner of i�e pro7eny, am e.dusively coniractinp with licensed contractors to consimct Ihe D�ole�� (Seclion 704a, Business
❑ ana Pmiessions Codet Ttie Convacteri State License Law uces no� appry w ao amier al O�oOer1y �0 6uilds or impmves lhereon
anU who contra[�5 �o� suc� D�o�etls wtl� a wntractoqs) IicenSe purswnl lo Ihe Canlnciors' $Ia�e Lice�Se Law�, I am aware
Ihal pfoai 01 I�eir WOrker'S COmp¢n5alian in5urantt 5tqutl De proviOM IO m!.
Q I am eeempi un0er Seciion: B. 8 P. C.
lor Inis reasan:
Oate: Owner.
I eo nereoy cenify inai I am aware ol and uMerstana ine �equiremenls al Calilornu HeatN an0 Salery CaGe Sectians 25505. 25573, anA
$559E ane I�al I ar any Iuiu2 Ouilaing acupan� wilVwill noi �cirde one� neetl lo comph "^ttl said s�a�e co0es antl I�e requiremenis for a
petmit fm constmClion ot moddicatwn trom tqe Ait OuaUty Managem¢nl �iSttiC6 ReSiUerttial coaSVUtlion aDDIiCaUoni are eeempl Imm
�MSe Omvisioni.
O��e: ApD�icam:
�hete�y [ertily Iha� I hav¢ r¢atll�is aDD�iCalion and Slale Ihal Ihe a�a��u+a � nis Corr¢C1. I agree�o ComDly wilh all [ily antl tounty
�prEinancesanASlaleWwsrelalingtoEudGirpmirsVuctionanE�ereR Ito' e5 nUiives IfNSutyio¢nt¢rupanlheabOve�mention¢O
pmp¢tly lor in eclion purposes.
pa1e: �� Sign �
pr'rver's License or Saial Securiiy ro:
i6<i�n6 Whne—Builtling; Green—CaCe EniorcemenC Canary—Applicant: Pmk—Revenua: GolEanroO—Asseswr
. CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; B 062564 PLAN CHECK NO; 03322-92 L
CONSTRUCTZON TYPE: 5—N PERMIT TYPE; STR
JOB DESCRIPTION ; ADD MAINTENANCE AREA TO EXISTINGBLDG
CLAIM VALUE;
PERM NO: H 062564
GOVT; N SUPP; N
PURPOSE: NEW
SQ FT; 1,155
40,000,00 CALC—VALDE; 77,849,88 GROUP OCC: B-2 /
COMMENTS; 1155#SF OF ONE STORY MASONRY ADDITION,
kMififkiE�flEkltikikif�f�FkfEiFifkifkififiklk�filiFik�fkiFifikiFlkifififikiFif�fiFiFlfiFifitif�kiflfkiFft�t�Fk�FkiFitklkkiFklfkkkltfkifk3Fi!
2 O N I N GS ERTEBaA�CIxRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; 194 FT IN REAR; 85 FT IN FRNT: FT IN REAR; FT IN
LEFT; 185 FT IN RGHT; 175 FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• 130 PROV; 138 PARCEL; 42229219 ZNE; R4 REF NO;
PLANNING NOTES> 1 150 SQ. FT•, ADDITION TO BETHEL TOWERS TO ADD STORAGE AREA
> O{� FIRS'I' FLOOR. —
*�t�r�ex*�e�t*�t�r**�t�r��t+r�r*�*it�r�r�rrt�t�r***�r�r�r�+r��rx�r�rr�r*x��*x�r�r�r*�r��t�t�r�r�r�r�r�tx��e�r*�t*�r�r*�t�r*x��r**
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T�5
ZONING APPROVED BY DATE: 0 6 I 0�3
BUILDING APPROVED BY : DATE; �
APPLZCATION ISSOED HY: DATE;.�'
1E M�F iF iE iF iE it iF iF IFif if iElE iE if M iF if �E 1F iE if� 1F iE ik �E iF iF 3! iE�Tf7FiFit k
ifitiFMififikkifik�fM�EkiflfiFifkkiFk�tklfiflEkikffMiflFifi! 1kM1EMlkikikiklk�EifiEifiklliFikifll�!lfiFkifNlEil1E1f1f1f1ElE1flFiFklEiEifififlk
LEGALIZATION;N F E E .S U M�M;A R�Y . STRUCTURAL SEGMENT:Y
•/ ii�'i
BLDG PMT PLUMBZNG EL CTRIC MECHANIC'' FIRE '-SMIP/RES GRADING
PERMIT 540,50 . ' "•
�'r� ' ' " - SMIP/NON—RES
PLAN 351.33 a • i - � f ',' � - .-- �5.21
BUILDINGEDIV—> PERMZT ISSUE PLAN—CHECK 'TOTAL �•PAiD DUE
TOTALS----> 555.71 0.00 '�351,33 , 907(04 ,'� 907.04 .00
REVENUE DIVISION TOTALS--> COLLECTED•l• S55'.71 OVER/SHORT; 00
HLDG PMT PLUMBING ELECTRIC MECHANI� �' FIRE�',SMIP/TOT_• GRADING PLAN—CHECK
540.50 �. 15.21
i. � . . ' / � � �.
1t if if if if if i! 1f if if if if if iE if if iE i! M if jf iF i! iE 1f ik ik if i! if iF �t �t if iE if k�f if ft iE it iF 1E 1k!! 1F M�iF 1f if il� �E ik �E k Ik af k 1f ik iEiE ik if if 1E iF iF iFlklE if if iE if if 1f �f
I N D I V I D U A L F E E B R E Pi R' D O W N
�/ ' I �� . j
TYPE QTY II E S C R I P T I O N C' •; _� UNIT COST TOTAL COST
SFC 1155 ELD—TYPE V—N •~'�� �.=AVER 62,70 72,418,50
„�ND OF FEES ,
L J:
y,�
��I '
'' f �
. � .
�f . .
O1 40140789-00140790 7�� T g5.5.71
QqTE: 06/11i93 TItAE: 15:36
�Q{ySTRUCTiON AND PLAR+NING
pPsROVALS Permit;;
��7. "emporary Electncal Service er Po�e . ,
?. �d,PiPe�Undrgrnd. _ ! . .
3. -FlecUl�l.Cort�uit Uxl�ity�Un rgmd. .
a. Ei¢cL�cal Condwt-Undrgmd. �
i
5. Steel Ro:r�iorwment • �
6� Elactcicyl UFEft�Gmd
7 Foocmgs , �'.
8. Fou�dacron -
� 4'.'atCr P�P�•Undrgrnd. . .
10: StructuraF Fiuor Systerp 4� `� -'.
. �•{--t..
1 T. ProP'�rty $�e:+0r Line $� HOucg (;pnn6.:tioc
j 12. Sewer CaP . ... .
� ,
, 73. Root Dra�ns ' ` . �
14_ Ruu9�n Plumhmg �
i 15 Rou�n tlectriwt�Condwt
Date
A
� 1G. Rou�h Elec[ric1.'Viring �
�-
i 7. Rough tVving Sign
18. Rou9h Etectrical�T Bar Ceil�ng
19. Rotrgh Ne�ating & Air Corditionrnq
20. Tto�c�h F�ecor+l" Fi(eqlace ' z_� -
21. Ducts, in5!ructu.c ` .... �_ q .
i
22. Q7uqYa. V,entilaiinc�` � . LL : ' . .
----r -^ . _ .
23, Gas`P;p_�Ho:u;h & T�st ' _ � ��
24.�'Aod�'Frdming. . ; � � . ,''
25. Rcu¢SFe.:th�r.g '.� :
1 26.�T•Bu1' Cciling �SVtic�`urall & MqnV[oaS
�?7 f.'zine�,qj F'l.^n;rqr r -��� -
- � -
� '_28. L2tMng & 5ding - . - . . t ' �.
_:.T
29. Insuiat�o� � • �
���--- sssr3D. �•v'.a!I ��'iil,n4 '.-=r-----=-"• '��
�7�Piaster tirown-CoaeY ,- �4 -- _ --
32-Ete�.,.�.�Po1.:�'��e%%f�nc' -
�,i3. ¢In�k Hr.CinC'• _ . � S •-
�i
`$4. C�.na1 H-34�nqF_� Air�o�ii�t�o-.i?:,; � 'r,- "` ,�
35. ^�inel Gas Pipc•Test r�� _ x'
36. �100fi Qi Z,'nnDPY '� a a �^
_ � � � � � [!. L �L
37.'Rinai FcEtory Firpplace � �
38. -Pina4 P�ombirtg � � ' -
39. `C^/ater Stuvice _Final A .r ' x ,�
40. Gas Sen�ce�Fi�al ` � �
�+4_ - (��� r K
41.'Solar Oqmest�k-Final_ ' ` � - �� `'
42. Backflow Prevznter� � �
4�. Backtlow Irriqation ' ,`. � � � .
A4. Landscc3lnigationSYstcm - `�• z' `
45. $ound qttenuation'. " . "
'16. Han~ dica gulations _ -
47. FINhL STRUCTUFEE & BUILDING ��/
!
4B FINAL PLANhING • -
4g. Electnc Release to F.tlison
50. Gas Reicsse ro Southem Catifornia Gas Co
51. CER'lIFICATE OF OCCUPANCY �
Ro._ _ -_ - Dare _ _
Insp¢ctor
POO SPA �
APPROVALS Permit; Date Inspecmr �
52. Pool & Equipment Location , �
53. Steol Rcinforcement i
54. Forms �
---'�
55. Electricdl6ond�ng ;; • I
�
56. Ruuyh Plumbing & Pressure Test
i
57. APPROVAL TO COVF.R�GUN�TE • '
-1
58. Electrical Cor.du:t�Undrgrnd. _,__'_{
59. Gas V�pe, � Undrgmd., Test 'r •- �
�-�
G0. Backwash Linus, P-Trap, i:, Untlrg•nd.
G7. APPROVAL TD DECK
G2. Back�vash & RecegrorFin�l � �
63. Heater & Vent-Final � '-��
i
G4. Plumhing System � Finai ��-I
65. Eloctrical-Finai i
66. Sotar SVstem�Final �
67. Fencing & Access Appruval .
68. APPROVED fOR PLASTERiNG
69. POOL/SPASYSTEMSFINAL
, FIR�,DEPT. REQUIR�MEN7 � I � �
'�PPROVAI.S, : Permrt ir ., , I I
i0. Underground Hydro ' � I I
77. Product Pipin9 C7 Gas ❑ Oil I I
'92. Underground FIUCN• ' r �
.'!3. �lndergrnd, StorageTank L Gas ❑ O�I � ? �
I _�
74.`bverhead Hydro'
� - � 1
75.�Dry Chemicui � - . � �
;-�--� --�-- -----
76. Dry Standpipe ` ��
77. FIXEO SYS7EM -r"!A� � �
. . �----
78.`fIRE PREV. FINAt � � i
----1----j i
' HCALTH UFPT, dEQUIREq'EP!T -_ -
'79. FINqLIf�SPLCTION-�_�� � �
`f30. FOOD CERTIFICATE IS�UFD� � � - 1
,,-D�--=� - --' I
�NoteS:C,q//� �/ �.AK• 'IL�J�/, .(Jo/ I
��..��y 9- !'r-93 �.4..�� ---1.
-r�- �,��. �=�-----' I
�^ - � i
_���/ �' ,O�-� -�
///)� ,.. ,_ ;-� '.1.�;- j_i/ ra�T �
`��V _ ' �` � / �1 "-_ _ ' I
ro�G � � ✓Uv _/ 3ir/� / s '� ' I
��
`
�
PflOJECTRO�NESS: 666 W 19TH ST
owx:�snnrne: BETHEL TOWERS OF
_.�" aooxess: M ESA
2525 NEWPOAT BLVD
COSTA MESA,CA
ABLNIENGINEEP:
ADOflESS:
UNIT:
COSTA
92627
PEC.NO.:
UNIT:
rcxmirreF: H. R. NELSON CORP ( 719 ) 582-1598
aooness: z�TGzG127(�C�ORD7E�O�7 LN
LICENSEO CONTflPCT011-6EC[dBRiIOFf: � I �e%6y e1Grm�tnat I am Iicense0 uneer p aAinvo�u o�19up�r 9(commencing with Seclion
7000) ol DiNvon 3 0� I�e Buvness aM Pmlessians CoOe. anE my license is in lull �oae anA eflecL �
ciTr uc.: 0 2 0 6_ p 8��;"���¢ uc" 2 S 5 4 3 3 cuss: H�I /�_
Da�e� _�O=C_— Signamre: ����5
WOBKEHS' LOMPENSRTION DECLANRTION: I nereUy alfirm ihat I nave a ceniliwte of wnsent to self-insua or a certiliute of Workers'
ComOensalion Insutance, or a ttnilie0 wpy l�ereo� �SeCibn 3800. LaO. C).
roucrNo.: 1137418-93 E%P.ORTF: OGIOS�94
cantrnxr: STATE
❑ Ceniliee copy is nereEy IumoAM. � Ceni;ied copy ¢ lile • ih t ry ilding 'vision.
.. `6 — � �� ppplirsnt
E%fMP�ION FPOM WOflNEflS' COMPENSATION OECWIIATION: (flri5 sttmn neW not 0e cwnpkteA i111ie perml is Iw me RmtlreO (5100) Or k55�.
I cehity Ilut in the pedarmance 01 t�¢ vrork Iw w�ic� ihis perrtoi is issuetl. I shall noi emDloy any person in any manner so a5 ta become
su01ec1 Io Ihe Worker5' Compen5diion Laws al Calibmia.
Oa1e: Signamre:
NOTICE: II. alter maMing t�is Geclara�ian. you slioulE become subjen m t�e Workers' ComDe��ion O�OviSions 0� Ihe La�or
CoOe. y0u mu5i tori�with COm01y with Suth pmvui0n5 ar INS p¢rmiLS�all �e OeemeG revokeA.
CONSTflUC710N LENDINC AGENCY: I �ere0y affirm ��at t�ere is a conSiNction lentling agency lor t�e pedarmance of l�e work lor
wAich IAis permil is i5sue0 (Seciion 3097. Civ. C�.
LEN�Efl:
PDONESS:
OwNEH BWL�EB DECuflRTION: I nere�y affirm Inat I am e�empt Imm ine ContraCtors' Slate license law tor t�e following reason
(Section 7031.5 Business antl Pmtessional CaAe: pny ciry oi caunly whic� repuires a permit m constmct, ai�er, impmve, demolish, or
reDair any slmclure, o�ior to ils issuance. also repuires Ihe appliunl for such vermit to lile a si0ne0 slaiemenl thal he/she is licensetl
pu6uanllot�e provisions ofl�e Coniraclors'Slate licenu Law�ClWpter9�fAmmenung vnt� Section 700f1�ol�ivision 3 oliho Business
anU Pio�essions Code) or Ihat ne/s�e is eMempi IMrefmm and ine Oasis for t�e allege0 exempiion. Any violation of Section 7031,5 by
any applicanifor a permit suUiecis t�e ap0���ant �o a civil penatty ol not more tllan live hun4re0 Collars (5500�.
I. as awner ot ihe D�openy or my emCloyees wiln wa9es as ineir sole compensalion, will Oo tlle work, antl Ihe
❑ stmnure is nol inteneea or ofle�ea lor sale (Seclion 70aa. Business an0 Protessional CoUe: The Contracrors' S�ate License Law
Ooes no� apON �o an ormer of a pmperty wno �uiWs or imprwes ihereon. anG who Eoes sucll work �imsel0�erself ar IhmupA
his or ner own employees, O�ovitle0 itWt suctl imo��'emenis are not intenCeG or otferea tor 5ale. If, however ine buildin0 or
impwvement is 5010 wi1Nn One year o� compl¢lioq t�e awner vnll have Ihe burEen ol provinp �e/sAe Oitl not Gui1G or impmve
for Ine purpose ot salel.
I, az owner oi me pmpeny, am e�clusiveN conVacOnq vnt� Iicense0 wntractors m constmct ihe pwjeci (Seclian 7044, Business
LJ ana Pmfessions CaOe: T�e Conlraclors' State License Uw Oces noi appty to an oxner ol Omperry wla Cmlds ar imprwes ihereon
anG w�o coniracts lor sucn D�qnis wiin a contraqoqs) lice�rse purswni m lhe Cantraztar5' S�ate License Lawl. I am awaa
ihat 0��� oi ineir Woder's Camp¢n5ali0n insurance S�IoulO Ce o«4� �o me.
� I am ezemD� unGer Sectbn: B. 8 P. C.
for tNs ieason:
�aie: Owner.
I Uo �ere�y ceNIY ��� I am aware al anE underslan0 t�e reQuiremen6 of Calilornid Health anC $atety Catle Seciions 2550.5. 25593, an�
2553E an0 ��ai I o� any IWure EuilOing octupant wilVwill noi (cirUe one� neeG Io compN w+�� sxiG Siate cades anJ I�e reduiremenis �or a
permit br consvuction or rtw0ilication Imm t�e Au hry Managemem Dist�ai. Pes�aentul mnswc�ion aOD�ications aa e.empt Imm
I�ese Omvisions.
Oale: ApW�cant:
I �er¢Uy c¢rlily Ihal I luve reaa ��is a001rcation anG slale Ihai t�e a� �'!rf �et n is corr¢ct. I agree t0 cOmply wilh all ci�y anU counry
or0inances antl slate laws reWting io 6uilEing consimclion and nere� aut ¢e r � re ntativ ol i�¢ ciry ta enler upon the above�men�ioned
property for inspeclmn pur0oses
Oaie: `d � �_ �� Signatu '
Driver's License or Social Security x:
t6at�46 W�ne—Builaing; Green—COJe Enbrcemen�: Canary—ApPlicanl Pink—Fevanue; GOICenrW—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 064294 PLAN CHECK NO: 03705-93 S
CONSTRUCTION TYPE: PERMIT TYPE: STR
JOB DESCRIPTION : CONSTUCT SSLF CITY STD BLK WALL
CLAIM VALUE:
PERM NO: B 064294
GOVT: N SUPP: N
PURPOSE: NEW
SQ FT: 58
1,500,00 CALC—VALUE; 3,117,50 GROUP OCC: B-2 /
COMMENTS: CONSTRUCT 6FT HIGH HLK, WALL ( 4FT BLOCK OVER 2FT RETAINER)
7!7lMk1ffklkMif�ffkikl!lf�fiEkififfkfkfEifilifMMMMkfhlfMlfklfkikitililMititltkitififkifitllfllf!!fflf�flE%1f7k1fMftfflflFifMiFM1FMil1E1flF
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ: PROV; PARCEL: 42224219 ZNE; R3 REF NO:
PLANNING NOTES> CONSTRUCT 55' LONG, 6' HIGH RETAINING WALL ALONG THE WESTERL
> WESTERLY PROPERTY LINE OF BETHEL TOWER.
�x�**�t****�tx*�r*�r�r*�r�r********+r�r�eir�r*i��r*�rrr****�t******+tr�+�fr**+r*�***x**+�*�r�c******�**
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N_T: S
ZONING APPROVED BY V-'C DATE:'. Z% �
HUILDING APPROVED HY ; �D Hla DATE: �i�� I�
APPLICATION ISSUED BY• DATE; �.�
itlFltk%iliEiE7kitlflElflf3Eif�fiEiF%illt ifiFMiF�EMifiEitif iF
if �f if if if if 1f if i! iE 1f 1f if 1! if * ik �E 1E 1! �E 1f iE iE �! 1f M k if 7t 1f 7F M 1F if i! iE 1t if 1f 1f 1h 1f 7f 7i iF fk it iE 1! if if iE iE iE k if fE fF 1tlf M 1f iE 1F �F iF 1F if �k iF ff %%if iE fk iE 4
LEGALI2ATION:N F E E ,S :U, M'.MiA R•Y � STRUCTURAL SEGMENT:Y
r �.
BLDG PMT PLUMBING ELECTR-I,C-;• M�ECHANIC ,, FIRE SMZP/RES GRADING
PERMIT 63.00 �� j v% i• +., , n 50
PLAN 40.95 ;�'�, n � ' ��'f / SMIP/NON—RES
ISSUE FEE ,r ' �� w ' ' ��
BUILDING—DIV—> PERMIT ISSUE PLAN=CHECK %'j;�'TOTAL PAID DUE
TOTALS----> 63. 50 0.00 I;� � 4'Oi.95 ;``� 104'? 45 104.45 .00
� �� � � r 4
REVENUE DIVISION TOTALS--> COLLEGTED: ��l~���,63.50. OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC �;FIRE� SMIP/TOT GRADING PLAN—CHECK
6 3. 0 0 %: •.� � •'. . S O
!
1t if it 1f M it it 1E it 1k ff it if if ik M!k k 1E it iE iE if 1! if k k k iE iE iE 1E it if M 1F M.it 1t ikW k�iF if if!! iE M if �E iE iE M if %it if 1f if 1F iE it if r r iF iE 1t M 1F if M if iF if iE iE �f �f
I N D I V I D U A Is" F•,.ECE ;�B R� E A K D O W N
TYPE QTY D E S C R I P T I r0 N: ' ' /�
,y �-,�� :/yUNIT COST TOTAL COST
SFR 58 RES—CONCRETE BLOCH„WALL �� / FT."'. 20.00 1,160,00
SFR 58 RES—RET WALLS <= 3�FT W/rSURCHG/ FT,�/ 30.00 1,740.00
END • OP' F.EES ;
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�Ji �J�t48203-OC143204 T��T o,3.5�J
DATE� 10/Q4/?3 TIHE: 11:�]1
,CONSTRUCTION AND PLANNING ' - POOL Y 4 '�
.' • OSte Inspector ' Date Inspector
,�'APPROVALS Permit#._._. APPROVALS �'erm"1c��•
�� 1. Temporary Eleccrical Servi or Pote , � 52. Pool & EquipmenYLocation ,�
2. Soil Pipe-Undrgrnd.. •" � 53. Steel Reinforcement �
3. Eiechical Conduit Utitity-Und�gmd. 54. Forms �.
. .
^. 4: Electrical Conduit-Undrgrnd,�' 55. Eiectrical Bonding
5., Steei Fieinforcemenc ' 56. Roagh Plumbing & Pressure Test
6, Electliwl UFER Grnd. 57. APPROVAL TO COVER�GUNITE -
��7r Footings ' 58. Electrical Cqnduit�Undrgmd.
$. Founddtion , 59. Gas Pipe, � Undrgrnd., Test ti,•�
9, Water Pipe•Undrgrnd. �' r�' 60. Backwash Lines, P-7rap, O Undrgrnd.
� '
I 10: Structural Floor System ''� ��� 61. APPROVAL TO DECK �
� 11. Propertv Sewer Lina & House Connection � . 62. Backwash & ReceptorFinal
.
� 12. Sewer CaP � �: , 63. Heater & Vent•Final '
13. Roof Orains � � � 64. Plumbing System - Final
14. iiough Plumbing -�.= 65. Electrical•Final �
15. Rouqh ElectricaGCondua �� " 66. Solar System�Finai •
16. flough Electric Wirinq ' 67. Fencing & Access ApProval
� 77. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical•T Bar Ceilirg 69. POOL/SPA SYSTEhAS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.'Rough Factory Firepiace � . � - " ' APpROVACS • Permit # ' �'
.� . .
21. Ducts, in Structura. - � , . . - -i � 70. Underground Hydro '
22. Ducts, Ventilating . " )i. Product�Piping OGas ❑Oil
23. �Gas Pipe•Rough & 7est ' , . � 72. Underqround�Flush '
24. Noo�'Framing � � •• � �73, undergrnd: Storage Tank � Gas ❑ Oif �
25. ftoof Sh¢athing y�- 74, S}y�rhead Hydro '
26. T•Bar Ceilin9 IStructuraU & Monotoat � 75. Dry Chemical '
27. Frame and Flashing , 76. Dry Standpipe �`
28. Lathing & Siding . ,� � 77.' FIXED Sl'STEM FINAL
29. Insulation , � •• ,. ' t . � 7g,�.FIRE PREV. FINAL - -
.30. Drywall Naihng � ' HEALTH DEPT. REQUIREMENT
37. Plaster Brown-Coat 79, FINAL INSPECTION
-�-
�32. ElectriCal Power MeterFinal -' . �' .� 60. F00� CERTIFICATE ISSUED
. .. /�/.7 .�..� �� �
33. Final.Electric� `+' �- Notes:/� _��� (��p��_, �Ca. � S�/C�
�4. Final Neeting & A�� Conditioning . � . •�- �0/ � �'� �[P �� �O -/P.�q3
35. Final Gas Pipe _Test . z �� / �I �
Ytr71t�,� 'CM� 2Y O-G., i�!_�/
36. Hood or Canopy � � / ' G�tjl
Pc..a/J�s'�-'�e �L�-/_v=Za-P_3�7
37. Finai Factory FirePlace' . - � , � �0��:�(6 (�},�d� �fi� L��
38. FinalP�umbing ' �Oh�l��, �
39. Water SeFvice-Rinaf - ' � ��
, .. .,(/O! �eaG'�'' !_p Grov1�- //-s�q 3
tt0. G'as Service-Final -
. %!a G!w;�_!!�7-Y_J_ _ .
41. Solar pomesfic•Pinal • , , ' _
42. BackflCw Preventer _ � ' '� ,
43. Backtlow Irrigation . �� � � ' .
44. LandscapC Irripation System � ,-c,�_ _ . ' � �
'45. Sound Attenuation • - ' -
46. Handicap.Regulations � � � _ 1 �
47. FINAI STRUCTURE & BUItDING I_Z��� �•` .-
48. FINALPLANNING ��� �_.,
49. ElectriC Release to Edison .�.�
=!-
50. Gas Release to Southern California Gas Co _� y -- �
51. CEA 1FICATE Of OCCUPAIVCY -
fVo. Date
C�I
'c--
�onnrsso�em�ov+c: 666 W 19TH ST �N* ROOF
oxrhxsx.�eiv�u�an+: BETHEL TOWERS
moxess: 666 W 19ST
COSTA MESA
:A 92627 (714)642-4061
1VPL.Y/JlRlO �DDIIE55:
uicxrtecr on �¢n:
uc no:
dliCll OP FNG'8 AOORE55: UNT:
cowm�crarsru� GRAHAM BRO HEATING AND AI ( 714 ) 546-1653
CtlRNACiMrSY111RlG 2952 CENTURY PL
.no� COSTA MESA CA ucxo.: 248609
92626 urr:
LICENSEO COMH1CTOfl4 DECLAPATION: I heroby eflFm uMm panelly d perjury Ihel 1 em IiceneaE under prwiaiam M Ghaqm 9
(mmme�ip wnh Sxtian ]ODO) d Oniaion 3 d the Burinen end Pmtnnoru Cods. ud my 4oeme u in tuA 1au eM atlsa.
cmuc.No.:005963 uc.cuss: C 20 uc.No.: zq8604 EXP; 06/95
� /1,�. ^ '
ome: c� conumn:�Y�i�l'Y� �%��S �C�—
OW NEN BUILDEN D CL�HATION: I hereby elfirm uMer penely d perNrv �� � em e�amq �rom �M Comreqws L'aeius lew la Me
Idbwep raoon (`�� 103�.5 Buarop eM PMuaionv Cade: AnY cYY a muniY �� nV�� e permil to mmWcl. Mm. impow.
�imd'oh, or ropei em/ svunure. prior b is ea�enca, ebo nqu'um IM epplirarit fa euch pemN to fib a eqmE �Wemeru UW M a eM
4�^� wnuent lo Iha vrwuiane d iha Comrman lirome lew IClaNn 9lmmmenen0 wCh Saaion ]000) d Oiv'sian J d �M
�uvma eM AWw'vru Codal a tIw he a ehe u ezamq Ihsehom and iM Mm ta tlr aMY� u«Mion. ,4rv vdmion al Saeion
nK11.5 b/ any eppliwit �a e permp wbpGa IM eppli�anl �O a tivi pe�alry d nd mors �Mn Ma huM2d EaOu� �5500�.
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a MereE tar veb (Sanian'lOM. Buvreae ard Pmlaaeiana CaEs: The CaMretlaa liceroa lew Eom not MV�Y loan owrordYWMV
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�� I. m ornw d IM V WMY. em ssdieiwl�/ canlratlYq xVh 4ensed contraclas lo mutrW ths PeM� (SWun ]OM. &svws enJ
Pmfeaian CaEe: TM Contreqws licanee law Cam no� eroN �o en ox+wr d D�G�Y who EWds a I�n'ee Iherean anE r.fio
canl�ecb la e�rh yqetle wil� e mYMa�e) IceneaE punueM la IM ConVetlas liaenea Lawl.
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oma: ow�«: _ _ _ _ _
i eo nawr �«wy mm i.m..a.e w ena �.ae+w�d ub Ac�«m d c.r�� rwen e�e smnv coe. s.u:.�
a553a, eM the� I«enY Mun WitlinY �� rrin / wil m1(�'vcb one) neeE ro candY win �d awe coda� md
woxKen�s corv�non o[tux�noH: i n«� mr� wb« o.�my a p.�.y a» a m. imo.� eea..mo�:
� IheveeMxdmem�ewacMilkelsAmmentioeatl�mwebrwMen'campe�umbn.nVa'�IvMSetlion�)OOd�Mleba
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eMwilmmivenxoM1r�'mmM�vn'vwvar�.n�apwiW WSmion]�dNslebarCoM.brlMW�a^�edtM
'.,�n��«.n:mm�oa,me�,.a.Mv�'���i���1�P�°��wv: EXPIRES
c.�:
P,�,M,m� 08/O1/95
(Tlus sMian med rw� be ttmFMIM I iM M'mt e Id om hwMiea Edkn Is1P0l w ba.1
� I onN �� iM1e perlm�urcs d�M wak br whch t�is pmnG u weuetl. I dutl m� ampb/ vry pmn in eiry men�wr o m to
beconn wM� �o iM wYmY mmprumion lawe d Ceftlomie. end eBrea tlW Y I�hwk bwme nmjW m tM w�lw�'
mmpem1tl^bn P�+/p/��+ M Saaion J100 d Ihs lebor Code. I du0lanhwe com/DN� �� p��.
Dete: �_l�l-3 /"1 � MG�"rsn: F C l YiT
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dHl I/nu �q ro aro nvMrW fhouuM tldlw fJ�Pq WOA N�Ifbn ro M� awt ol rompsiu�tbM1 Cem�y�� n povltlM ror In
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panamerce d tl,..«x tu. wnidi inb wm� u ewsa (s.ao� ao9�. cH. cl.
LENDEP'S NAYE
LQlDER'S1DDflE%:
I ee�M �hn I Mre reW Nw WW�� aM Yeb Ilut Ns ebwa'uJametion o emw. I epew lo eanVN �nA e0 M' eM mumYordi'unor
aM atete Mwe ielnM b b�dd�q emWuman vd Iweby eWwce iW�+��atiws d IM'ily b eNs uD� Na ebv.smsYcewC paperly
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�
CITY OF COSTA MESA - HUII:DING PERMIT .
� PERM NO: E 071609
PERMIT NO: E 071609 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE; PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCAIPTION ; lAC SYSTEM 61EXHAUST FAN ' SQ FT;
CLAIM VALUE; CALC-VALUE; � GROUP OCC: /
COMMENTS; VENTILATION 6 PROCESS COOLING / RE: M71603
******r********+�***r*****�r*ir********sr****s+r********r+r********+rs�cs***********i�*
Z O N Z N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ • PROV: PARCEL: 42224219 ZNE: REF NO:
PLANNING N(3T'ES>
i
1Eifafjf if1fM jf ifififM if M 1f if i! M 1f M if M if 1f ifM M M if iF if if it iP1Fif 1fltif if if 1f * K iflfif iFifif 1f 1F1f M if 1f 1E iPiE iFjf if if if fFff iFif iE if 1f �k fE iFifif ifif iE
D E V E L O P M E N T S E-R V I C E S R E Q U I R E M E N T S
ZONING APPAOVED BY % DATE:
HUILDING APPROVED HY :
APPLICATION ISSUED BY:
LEGALI2ATZON;N F E
HLDG PMT PLUMBING EI
PERMIT
S U M M?? R Y
RIC MECHANIC
.50
SOx
PLAN
ISSUE FEE 15.00
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECI(
TOTALS----> 50,50 15,00 0,00
REVENUE DZVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTAIC MECHANZC
25,50
DATE;
DATE; 2 S_
�riFii*it*ie**rr*�r ri � +t*
STRUCTURAL SEGMENT:N
FIRE SMIP/AES GRADING
SMIP/NON-RES
TOTAL PAID DUE
25.50 25.50 .00
25,50 OVER/SFIORT; 00
FIRE SMIP/TOT GRADING PLAN-CHECK
if 4kifk if 1f 1f 1f if ff !f k if if if if M M k 1! iF !f if if 1h if M iflf M if if iflf 7f ifM ih M 1f if M 1f M ifif lfff 1f M M1f 1lff M Y if !f 1f 1k k M M 1f ff 1f 1F iF ff iF tf ififif Y iE7f iF
Z N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T Z O N UNIT COST TOTAL COST
ELE 1 MOTOA/POWR APPARATUS 0,0 - 1.0 HP 3,00 3.00
ELE 1 MOTOR/POWR APPARATUS 1,1 - 30.0 HP 7.50 7.50
END OF FEES
a1 D017a6;2-ooi78632 Tr3 T 25.�0
�nTE: O.lIZJ�?J TIPIE: 14:g7
i
POO. . SPA --�
CONSTRUCTION ANDPLANNING � I
APRROVALS Permit 3t�_ Date Inspector qppROVAIS Permii # Date Inspector I
, i. Tempo�ary Etectrical Service or P9ie 52. Pool & Equipment location ; . ,
. '
2. Soil Pipe-Undrgrnd. - . 53. Steel Reinforcement I ,
-�3: Eiectrical CondaibUvGtv-Undrgrnd. 54. Forms � .. �
�'4,�Etectrical CondujbUhdrgrnd. 55. Electrical Bonding ' �
`�5. Steel Reinfo�cemeny- 56. Rough Piumbing & Pressure Test - �
•- 6:"Electrical UFER•GrnB. 57. APPROVAL TO GOVER-GUNITE ,
'.7. Footings .,.�3_ 58. ElectricaE Cond.U�i; Undrgmd.
8. Poundation �: a• ._. 59. Gas Pipe, O Und�grnd., Test
�-... .,
9. lVater Pipe-Undi2�md.'�; - 60. Backwash Line;,�P�Trap, O tlndrgmd.
. . �
70. Structurai FloorJSystem ' 61. APPROVA� TO DECK �
7 t, Pr'operty Sewer.-Line_& House�Connection 62. Backwash & Receptor-Final ,
�2. Seri'e� CaP . � :, � 63. Heater & Vent�Fina! '
13. Rqof Drains �. 64. Plumbing System - Finai •
14. Rough Plumbing . 65. Electrical�Final ��
15. Rough ElectricabCo�nduit �� 66. Solar System-Fipai ' �
76. Rouqh Electric 1Niring "' 67. Fencing & AccCss•ApProval - I
� 7�. Rough Wiring Sign - 68. APPROVED FOR'PLASTERWG )
18. r�ough Electrica'I�T Bar Ceiling 69. POOLISPA SYSTE^AS FINAL
19. Rough Heatinq & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory FZ�place 'j �; '"�` � ';: . : APPROVALS�. Permit # ' '!�
21..Ducta, inStructuc�' ' •� •• �-.' - � � � - 70. Undetgrou`rid HYdro '
- , � -,
22..DuctS, Ventilaiingi � � ��;� � ,J F;,' � 71, product��ipinc���Gas ❑Oil
23. �Gas Pipe-�F{ough &�7est ; r<' . f�') a 72. Under�round Flush �
24.'Roof Praming �"' `'� " �� � = �; ,_�� ; 73. Undergmd.Storat�eTank OGas ❑Oil'
1
25. Roof Sheathing �< r� ' � - • 7q. Overhead HYdro
26.-T-Ba�' CelGng IStructurail & Monocoat ; y � � �''' 75. Dry Chem�cal -� � ' - =;-
27. _Frame and Flashin ;.` � `-� ' � - � ' '+�
> 9, �;:�:; _ n., 76. DryStandpipe� ..
�+ 28. Lathin & Sidin ' '-' "�•�'�' �' ' � � ' �
9 9 . , y,�;.� ,_, � " ..� . � ..i� 77. FIXED SYST�M'FINA� .
29. Insulation ' � �� �� .• � � � ( " ;� 78. FIRE PREV. FINAL
' 30. Drywali Na�ling •_ �� �� � i I- ' -'HEALTH DEPT'REQUIREMENT
37. Piaster B�own Coat < ^ � ;:-r,� . I � '} �, 79. FINAL INSPECT:10� � ��� =���- �
32.tilectriraY,�'Power Me�er=Fina1 � '�� � �• +," ? 8_. FOOD CERTIF�C7-�TE ISSIIED ''� �
33. �Final�Electric�1 r,y i �/ 'IV� . "� -' _ - -
34. �Final-Heating'& Air Conc}itioning5: .. • -' � � � 1� �t ., � � : �::' r ._. � _
-� : � � � � - : t •
� I35.'Final Gas Pipe�Tesf.; ,�,`n .. `. � ':; � ' - ._ ��� ,- � .. ,.
36. �Hood�or CanoPY =' - - � � '' ' '�; _ ,';,- - _ ._, ,�
� - ,�.. . I 1 - ,❑ *•
' 37.'Finaj�factoryFireplace'_ �_ �, r � � ��, 1 J- ��
. 38. Pina!'Plumbing • . � * I � �r -, '� ., �
39. 4VateF�Service�Fina,f _ • �i � � � �� � ' ' ' "
, i
� �
40. Gas Service-Final . . - o ,., � � _ - � �
• 41. Solar pomesticFinal "- �i " ` '-'' i � '` . , . .
�+
42. Backflow Preventer - `� � � � � � � � -
i
,
43. Backf�ow Irrig2tion 1 '-� .F _,. , '. , '� - .' .
,; .i _. ,t ... -, � ' -
AC. Landscape irripation System � r �-� . : _ � �
�
�45. Sound Attenuation' i0� - " ', ' " 1 � ` ' 4
. - . .. . Tt .. - . . - �
J
-46. �Ha�dicap.Regulations - ; F � i c ., � . �
�
47.PINA.�STRUCTURf&BUILDING , r � � - -�
� "
48. FINALPLANNING� � � � � i' .' � -
' 1 -
•49. 'ElectYic ftelease to Edison • ' � � .'. '" '� ,. . �
!
50. Gas Release to Southern Califomia Gas Co � � � • ' ••
� 1# Y'
51. CERSIFICATE OF OCCUPANCY � - T --
No. Date
�
PflpJECT RODflESS: 6 6 6 W 19 TH S T
OWNEH'S NFME: BETHEL TOWERS OF COSTA
aooncss: MESA
2525 NEWPORT BLVD
COSTA MESA,CA 92627
AflCH/ENGINEEP:
RDUNESS:
PEflMITTEE: 'I'HE BAKER CONS't T' �-ON CO
ADDNFSS: I ZO Z HUNT'Eft
SANTA ANA CA 9
LIqENSED CONTqFCTOfl DECtApqTION: I �ereby a irm �hal I am licensetl unaer pmvlsion
7pp) ni U�sian 3 of t�e Business and Pmfessions e. anU my license is in full force an
ciTruc.:047439 sT�TEuc.:55496� cuss: �n
�a�e: � � �ure: —
N10PR ' COMPENSp710N �ECIABATION: I here0y afiirm I have a
CAmpenSation Insurance. or a ceniliea coDY ��ereof (5ec0 JBIp, laE.
roucv No.: WC 711519 4 3 2 4 xP. onTE:
COMPRNV: CNA
�` Cetlilie0 cOpy i5 �er¢�y NrniSheU. m C¢rtili¢0 co � IileA wi��
Wte'�_� ��.r{ ✓ Mpliwni:
E%EMPTION FflOM WOBNEBS' COMPENSRiION UECIAflATION: (TAis secti n
I tetlity I�a� in I�¢ p¢dormantE 0� Ih¢ work �o� whiC� Ihis permi� is is etl.
sublecl lo �he WorkeR' CAmDensa�ion Laws ol Calilomia.
Oy�e: Signamre:
' NOTICE: If. afler maki�ry t�is Geclaratron, you 5trou10 subet
CoGe. y0u mu5i fori�wilh COmDN ��� Suth prOwsion5 or I s Der
CONSTBUCTION LENUING PGENCY: I hereDy alfirm ��a� there is a con
I whicn ihis permit is i=sueA (Section 3097, Civ. C�.
LENOEfl:
AOOFESS:
UNIT:
REG.NO.:
UNIT:
( 71`
2705
s oi ChaD�er 9
J eltect.
��ica�e ofcansen��o
7/O1/93,
)835-9572
�mmencing vnin Section
a tetlitiCale o� Workers'
� permit is lor ane hunOrcO (St00) a iess).
person in any manner so as to hecame
fVlorkMs' Compertsa2'ran provi5ions a7 tlk La�or
Ue deeme0 revokeE.
�n lendinq agency for the Oedormance af t�e wod �or
OWNEB BUILDEN OECLAXRTION: I �erehy allirm ihat I am exempt imm the Contractors' State License law for Ihe followinp reason
($et�ion 7031.5 Busine5s an0 Pmlessional Coae: Any Ciiy ot tOUnry whith r¢puires a permit �o tonslmc�, al�¢r, impmVe. Cem01i5h, Or
�epair any simciWe. prior �o ils i55uance. a15o requi2s ihe applitant lor sucn vermit to lile a 5igne0 statemenllnat he/she is IicenSEA
pbrsuam to Ihe pmvisions af Ihe Contractors' Siate License Law (Chapter 9lcommencing wit� Section 7000) oi Oivision 3 of lhe Business
ane Pmlessions CAtle) o� that helshe is exempt iheR�mm antl tAe Oa5i5 for ine allegeA exemption. My vioWtian of Section 7031.5 by
any aODlicant lor a permit suDlects Ihe apD���nt to a civil p¢nalry af nol more tlWn five hunGad OWlars �5500).
� I, as owner of Ihe pmOenY o� my employees with wages as Iheir sole compensation, will ao ihe work, and the
strucmre is rrot inteiMed a oHe�eC la sale (Seclwn 7Md, Business arM Protessional CoCa: The Gontractors' State Lkense Law
Eces not aDPN �a an oxmer al a proDerty wlw EuilOs ar imDmves i�ereon, antl wAo Ooes such wad �imself/herself or thmug�
his ar her own emDloyees. pmviUetl ihat suc� im0�ovemems are not inlentletl ar otlere0 br sale. II, Aowever tAe buil0ing or
imD�ovementis solA vn�hin one year ol wmpletion.ihe owner vnll �ave tAe Durtlen o1 DmNng �e/she ai0 nol buila orim0�a�e
lor ine pur0ose of salel.
!. as owner o� the Wope�Y• am e+clusively conirac�inq wi�h licensed conVacmrs Io cOnsVum the proj¢ct (Sec�wn 704d, Business
❑ anE Pmlessians Catle: The Contrzctors' State License Law Does not apDly to an owner ol pmpeM � bmlUs or imprOves �hereon
antl w�o Conlratis lor Suth D�oIe��S wiih a COnIraClor�S) lirenu Dur5uanl lO l�e COnVa[lori State License Lawl. I am aware
Ihat O�ool oi tAeir Worker's Compensation insurance should be D�a�iae0 to me.
� I am exempt untler SeCiion: B. 6 P. C.
!or �Ms reason:
Date: P«ner.
I tlo �ereby [ertity ��ai I am aware o� and und¢rslanU ihe reQuiremen�s al C
2553a and Iha� I or any IWure Ouilding occupanl wilVwill no� (cirtle one n
permil far consimction or modrf¢afian fmm the Ad Wafif en1 0
�he5e Owvi5ion5.
I nere6y cetlily �hat I have reatl Inis aDP�i tion and state
brdmanc¢santl5taielawsrelatingtobuilain ns�mctian��
�mperiy IOi in5petlion purposes.
bate/ gnaiure:
(
� orrver's ticense or sx+a� Security x:
iF�ab46 Whne—BuilEing; Green—COEe Eniorcemei
ana Safery Coee Sections 25505, 25533, and
h sai0 state wtles anC ihe reQuiremenis tor a
AI�COIISINCt10� dp0���dt1005 d!E y%pfl101 IlORI
aA�ee�o comD�Y �+ilh all ciiy an0 couniy
is ciry to enter upon Ihe above�mentione0
Pink—Revenua: oltlenroE—Pssessor
CITY OF COSTA MESA — BUILDING PERMIT PEkM NO; F 059970
PERMIT NO; F 059470 PLAN CHECK NO: 03970-92 L GOVT; N SUPP; N
CONSTRUCTION TYPE: PERMII' TYPE: FIR PUAPOSE; OTH
JOB DESCRIPTION : BACICFLOW RETROFIT SQ FT;
CLAZM VALUE; 2,000.00 CALC—VALUE; GROUP OCC; B-2 /
COMMENT5: *
�r�r�*x�r**�*****���**�r�r****�r�*���r+�***�x��x�#x�x�*�r�r�*�r*�x��r*x#��x�#�-x�*��r*�*+��r��zx x****
Z O N I N G R E Q U I R E M E N T S
sETancxs
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT' IN FRNT; FT IN REAR; F'P IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ • PROV; PAACEL; 42224219 2NE: REF NO;
PLANNING NOTES>
i
�,�����,�*�*�**,�,�**�x**����*+�*�,�*��*��«�������r��***�***�,��*��*��**���*x****�**��«��
D E V E L O P M E N T S E R V Z C E S ft E Q U I R E M E N T S
ZONING APPROVED BY DATE;
BUIiDING APPROVED BY ; DATE:
APPLICATION ISSUED BY• � �— DATE• �
1EaEfkiFiEiEkikiEil�it�iEiFitiFi(•iEiFil�lEi4ik�F7F7FiFiCiFiFiF'�F3F�rTtiF�3FiF3�7F+'F�riFiF� ��F3FiFiF�E3F��flFif3FitiEiEiEilikiEikii�iE tr r�r i rir#i4
if 3F �lF iE �lF �)F iF iF iF 7E iE if if i(� �k iE �! �lE iE # iE if if iF iE 1E iF iP if it iE i! �E iE �lE �F iE ik if iE iE iE?E if iE iF %!E if if if -k� * iElE �lE if ik iF ik iE iF iFiF 1E iE ik iE iE il�',c iE itlE �lf iF iE 1E iE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 45,00
6S8 SMIP/NON—RES
PLAN 29.25
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 45,00 0,00 29.25 74,25 74,25 .00
REVENUE DIVISION 1'OTALS--> COLLECTED: 45.00 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR
45_00
i! iF9(�ik �lE if dt il-�]E if if *iF 1E �IE if if iE iF-IE �lE �1E ih �Ik iE 1EiE ib �k ih iE-%� 3E iF iF 16 k iE�lE-� 3E #�It �IE iFiE �1E iF �lf iE �1(-iE�IF-lE �JF �lE �E �1F �ihiE �lE -IEiF iE # K� 9E �K�9E iFiF If iE iF�1f # i6 iF i6
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNZT COST TOTA1� COST
FIR 45 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1,00 ' 45,00
, . END OF FEES
�r
/ /
t� '�'!' d
�
,��� � d/ 1 i'.� 4'� _ ' ' ' _ '
'�� ; S . � __ . . ; �
. ,
CONSfRUCT10N AND PLANNING .• POOI._ SPA
APPROVALS Permit�# �� �'� , Date � Inspector p.ppROVALS Permit # Date Inspector
1. -Temporary Eteccriwl Service or Pote 52. Poo1 & Equipment Location
2. Soil Pipe-Undrgrnd, „ . .- . 53. :Steel Reinforcemen[ '
3. Efectriwl Conduit Utitity-Undrgrnd. , 54. Forms
4. Electrical ConduiFUndr9rnd. � 55. Electrital Bonding 1
5. Steel Reinforcement E: 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. , 60. Backwash Lines, P�Trap, � Undrgmd. �'•.
10. Structural FIooF 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 ' ,t � . 64. Plumbing System - Final
14. Rough Plumbing . 65. Electrical-Final -
15. Rough Electrical-Conduii 66. Solar System-Final
16. Rough Elearic Wiring 67. Fencing & Access Approval
17. Rou9h Wiring Sign 68. APPflOVED FOR PLASTER�NG
78. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Condiiloning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating _ 71. Product Pipidg OGas ❑Oil
23. Gas,Pipe•Rough & Test . � � 72. Underground Flush � �/�� � .,�L-f
2A. Roof Praming - �� 73. Undergrnd. Storage Tank � Gas ❑ Oii T�rJ\
25. Roof Sheathing 74. Overhead Hyd�o
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - �
27. Frame and Flashing 76. Dry Standpipe
��8. Lathing & Sidin9' • � � 77. FIXED SYSTEM FINAL ��
29. Insulation ' _ � 78. FIRE PREV. FINAL �//7 y'�
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
i i .
31. F�aster Brown Coat � I � 79. FINAL INSPECTION
32. Electrical Power Meter-Final � I � � 80. FO00 CERTIf ICATE ISSUED
33. Final Eiectric i � I Notes: �
3A. Final Heating & Air Conditioning ' i � .
35. Final Gas Pipe-Test � .� j
36. Hood or Canopy � �
37. Final Factory Fireplace �
� �
38. final Plumbing � I
39. Water Service-Final ' I I
40. Gas Service-Final � �
i
41. Solar pomestic-Final I
�
42. Backflow Preventer � � � -
43. Backflow �rrigation
44. Landscape Irripation System
45. Sound Attenuation
48. Handicap Regulatio�s .
47. FINAL STRUCTURE & BUILDING � "
I I
4$. FINAL PLANNING ( , ,
49�. EleMric Release to Edison � I �
50. Gas Release to Southern California Gas Co � �
51. CERTIFtCATE OF OCCUPANCY �
No. Date
I �—
PflOJECT RDOflESS: 666 W 19TH ST
ownensNnme:BETHEL TOWERS OF COSTA
PDOflE55: yESA
2525 NEWPORT BLVD
COSTA MESA{, CA 92627
NflCHIEN61NEEfl: �� S 9� 6 4 z— 9 7 4 S pFG.NO.:
�ooeess:
UNIT:
UNIT:
PEPMITTEE: VANCE 6 ASSpCIA'f6S ( 71 4) 646-3211
AO�PE55: 837p WEF5gT 17TH �,
❑LENSE� CONTBPCTOP'6E2uMnoM�iTiere auirm ma� i am i¢emea unaeCi po�ns�o � 07 �fiapter 9lcommencing wnh 5ection
74pp� ol orvision � of ine Business antl Pmlessions CoGe. an0 my license is in full force etlecl.
c�rr ��� � 01 � srnre uc.� 6 8 9 3 3 cuss:
bate: �Gi � signature: �- — -
WOBREflS'COMPENSRTIQNDECUIBRTION: I�e2bya�li�mlha�IhdveaRN reoiconsenttosen-insu�eoraceniliwteotworkers'
Compensation Insurance. or a cendietl cooY �hereol (S¢cuon 3800. Lao. C).
roucrNo.:AS1161030253042 E%P.ORTE:O%IO� I9j
comraxr;LIBERTY MUrT_jIAL \\\ /�
❑ Cenilietl copy is nereoy fumisnea. �E� Gertilie0 opy � �ea vn �e aty B�ij �
\� Daie: ��� �� AppliWnt' �
ESEMPfIONFpOMWOPREq$'fAMPEN54T10N0ECUMTION: (TNsstt�ronne[dnolEE�mpl¢ICdil�hepRmiS�oronehundred($100)orl¢Ss�.
I cetlily ihal in Ine pedotmantt ol ine wOrk tw whicA iNs penrvt ¢ i5su¢a. I shall no1 employ any persOn in any manner 5o as to Oecome
su01e�� �o �he Workers' ComOensaiion �aws of Ca4lomia.
�ate: Sqnamre:
NOTICE: If, aller making ihis declaration, yau shoula Decome suUject to the Workers' fAmpensation Omvisions af the la�or
CaCe, you must IOM1AwiI� COm01y wil� Such Orovi5i0n5 or IN5 permil s�all be tleempE revokea.
CONSTBUCTION LENOINC PGENCY: I nereGy afiirm Inal inere is a consiruction lenaing agenry tor Ihe DeAormance ai tne work lor
w�ich I�iS permi� is issu¢0 �Stt�ion 3097. Gv. C�.
LENOEfl:
ADUflE55:
OWNEfl BNLOEN UECIRBRTION: I heRW aflirm t11a1 I am exempt imm I�e COnVactorS' State L'¢eilse law lor t�e follovring r¢a5on
(Sec�ion 70.3t.5 Busineu anE Professional COEe: Any pty ol cpumy whicn r¢puires a permit m construct, alter, im0�ove, Uemolish, or
repair any slmciure. prior lo its issuance. also reQuires t�e aDDliwni lor such De�mil lo Iiie a 5igneG 5�aiemenl I�ai �e/sbe is licensetl
pursuant lo IAe pmvisions ol the Comractori Siate License Law (Chapter 9(commencinp vnt� Seclion 7000) ol Oivision 3 ol I�e Business
an0 Proi¢Ssions Catle) or Itul MJshO ¢ e�em0� lherelrOm anG I�e Oasis br I�e aIICqCE exempiion. Any vi01aii0n ol $ettion 70.31.5 Ey
any a00�itani br a petmil SuEjetls IAe applicani l0 a tivil p¢ndliy ol n0i mOre ltun live hunGr¢A tlallaR �5500).
I. as owner ol me pmDeny or rtry emWoyees witn wapes az iheir sole compenuiion. vnll Co t�e work, an0 Ine
❑ stmcWre is not intendetl or allerea for sale (Secuon 70aa, Busineu and Pmlessional Coae: 7he Conlrac�ors' Siaie License Law
tloes not a001y lo an owner ol a pmpetly wM Guiltls or impmveSlhEaon, an0 who Ooes such work M1imsell/Aersell or IhrouAh
�is ar �er own employ¢es. prwi0¢O tiul suc� imD�wemenis are nol fntenLM w oflered for yafe. If, however fhe 6uilCinO o�
impmvement is So10 vntnin one year of completbn. Ihe owner vtil luve t�e Gurden ol pmNnq �¢/51ie Aitl not Euild or impmve
lOrl�e pUrpoSe 01 Sale�.
I, as owner ol t�e propeny. am eKcluvvely �onirac�ing wii� Iicense0 conirac�ors lo con5lmci Ih2 O�oletl (Seclion 704<, Business
❑ an0 Profe55ions CoOe: ihe COntracfars' SfafB LitenSe Law Ooes irot appty ro m Owner al prOpeRy wha bmMs Or improves thelean
an0 w�o canlracis for sucll pwiecis M+1� a tAnUactor(s) licenu Dursuant to the Coniraciors' State L¢enS¢ Law�. I am aware
Itul prooi ai 1�¢ir Worker'S ComDensx�ian inwrance 51wNG Oa proviEcO m me.
� I am e+empt unticr Setlion: B. 8 P. C.
lor this reasan:
Da�e: Pmer.
I Do ne�eUy cenily tnai I am aware ol anG unCerstan0lne repuir¢ments al Cdlifornia Health antl Salely CAae SectiOns 25505. 25537. anU
2553e mE tnat 1 or any tulure OuiMing xcupant niWwiN rat (drne one� neeE m crompry wit� sab state COUes arM t�e repuirertrents lar a
peimil Im consimction p� modiliwtipn Irom I�e Air uahry Mawgement Distnct. RevGeqiial cons�mc�ion applicalions are exem0� ��om
these omvisions.
Oa�e: ADO�kant:
I h¢re�y tCrii�y �Aai I �aVe read �Ais applitalion antl Slale ItWI Ihe aGav¢ intofma�ion is COrretL I a0r¢ comply witA an ciry an0 coumy
orainancesand slatelawSreWlingio OuilOing consim ' M �ere�y au� oraerep�esematNeSp is cii o eru0��he a�ove�men�ioned
propetly brinsp,(e�ction O�urpous. `
Da�e: �'�1�' `�\� Signature:
. �river's Lirense o� Social Searily x,-
164ba6 WIu1e—Buil�ing; Green—COGe Enbrc¢mem: Canary—Appkam: Pink—Revenue: GoMenroE—nssaswr
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B Ob1439
PERMIT NO: B 061439 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE; ALT
JOH DESCRIPTION : APPLY NEW CLASS 'A' BUILT—UP ROOFING SQ F'P: 35,000
CLAIM VALUE: 35,000,00 CALC—VALUE: 35,000.00 GROUP OCC; R-1 /
COMMENTS: SMOKE DETECTORS RE�DIRED PER 'THE 1991 EDITION OF TNE UHC.
�*�*x�r�r****�rx��r�***xx�r**x�*** �xx**x�+��t�tx�x-rr�t�r**�e*x�#x�x�*��r�r�t*x�**�*x*�x�*xx�t�r��**�
Z O N I N GS ERT�B�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUSLDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ� PROII; PARCEL; 422242I9 ZNE; kEF NO:
PLANNING Nt5TE5>
i
�r**x��*x��+�**x*�*f��x ***�+�**�**�rx***�*##*��x****�**�x�r***�rt*��x�r. x x x x x x�*�x�r*#±��c xx x*
D E V E L O P M E N T S E R V I C E S R$ Q U Z R E M E N T S
ZONZNG APPROVED BY DATE;
BU3LDTNG APPROVED BY ; DATE;
APPLICATION ISSUED BY: . DATE• 3/ �
3titM'1FiE1F)fiE1EiliFififlEitiEifiElfll�iFlf IF - f} e F tf y�.,� I Rhif t iE1EiE#if1EiF1f'lfiffE .tftRRft �tYifif
kiEiEK�iFifik3Fi61F�itikkiEiflEiFiEilkif�tifiFiFiEit%1EiEiFiFiFiEitiEiEikw't T, I(fflfiFiE3ErtiEiEiEiFifitiFiEiEiFK�ik%�IEihlFiki(-iEN�ikib
I�EGALI'lATION;N F E E S U �+�* STRUCTURAL SEGNENT:Y
�.� :
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 317,00 3,50
IPLAN SMIP/NON—RES
ISSUE E'EE '
BUILDZNG—DIV—> PERMZT ISSUE PLAN—CHECR TOTAL PAID ,�_ DU£
TOTALS----> 320.50 0,00 0,00 320.50 320,50 — ,00
kEVENUE DIVZSION TOTALS--> COLLECTED• 320,50 OVER/3HORT• — 00
HLDG PMT PLUMBING ELECTRIC MECiiANIt FTRE SMIP/TOT GRADtNG;19i.AN—CHECK
317.00 3,50
iF ff if if Iklk If it?k iF if 1! 1Elt iE iE fk 1k ik iE 1f �l(-if !f 1klE 1F iE 1! if 1k iF'lf lElF k iF'1F ltit 1! ik fk iF iF ik if iF iFlklF iF iE iP %� if #!F!(� 1f if 1E%iF M• 1E IFif i(� i(� Ik it ik if if�lf�lf it df
I N D I V I D U A L F E E B R E: A K D O W N
TYPE QTY D E 5 C R I P T I O N UNIT COST TOTAL COST
SFR 35000 REROOF BY VALUE REEND�OFIFEESN07.ONE
f
EXPIRED
Incomplete inspections
t�i� _ _____ S�S ���
1.00 � 35,000.00
CONSTRUCTION ANO PLANNING
APPROVALS Permit 1`r
�. Temoorary Electrical Service or Pole
2. SoiV Pipe-Undrgrnd. '
3. Electrical Conduit Utdity-Undrgrnd.
4. Electrical Conduit•Undrgrnd.
5• Steel Reinforcement
6. Elecvical UFER Grnd
7. Footings
8. Foundation .
9. Water Pipe-Undrgrnd.
10. Structural Floor Sysiem � 1
11, Property Sewer Line & House Connection
12, Sewer Cap � 1 `
13, Roof Drains '
14, Rough Plumbing
75. Rough Electrical-Conduit
16. Rough Electric Wiring
17, Rough Wiring Sign
1 g, Rough Elearical-T Bar Ceil�ng
79, Rough Heating & Air Conditioning
20. Rough Factory Fireplace
27, Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Tesc
24. Roaf Framing
25. Roof Sheathing
26. T•Bar Ce�lin9 ISt�ucturall & Monocoat
27, Frame and Fiashing
28. Lathing & Siding
29. Insufatwn
30. Drywall Naihng
37. Plaster Bro�vn Coat
32. Electrical ?ower NleterFinal
33. F�nal Electric
34. Final Heating & A�r Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. final Factory Firepiace
$$, Final Plumbing
3y. LVater $ervice-Final
40. Gas Service�Final
41, Solar pomes2ic-Final
42. Batkflow Preventer
43. Backflow Irrigation
44. Landscape IrriGation System
45. Sound Attenuation
46. 1landicap Regulations
47, FINAL STRUCTURE & BUILDING
48. FINALP�ANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
5t. GER7IPICATE OF OCCUPANCY
No. Date
Date
0
POOL & SPA
Inspector �yppROVALS Permit �
52. Pool & Equipment Locacion
53. Steel Reinforcement
54. Forms
55. Electrical8onding
56. Rough P�umbing & Pressure Test
57. APPROVAL 70 COVEfl�GUNITE
56. Elactrical Condurt�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Linns, P�Trap, C7 Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor�Final
63. Heater & Venl•Final
64. Piumbing SYswm - Fi�al
65. Eiectrical•Final
66. Solar System-final
67. Fencing & Access ApP�oval
66. APPROVED FOR PLASTERING
69. POOUSPASYSTE�UtSFlNAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hytlro
71. Product Piping C]Gas ❑Oil
72. Underground Fl�sh
73. Unde�gmd. Storage Tank � Gas � Oit
74. Ocerhead Hydro
75. Dry Chemical
76. Dry Siandpipe
� 77. FIXED SYSTEM FINAL
� 78. FIRE PREV. FINAL
• HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
't 80. FOOD CERTIFICATE ISSUED
i
: ' + Notes:
��
i��
r
. ' I ,
�{1$pQCtiOi'is
Date � Inspector
0
m
-!
V
/' I
/
�
�
,�oonessaeaiuw 666 W 19TH ST
OWNER8IUYEIfIPlOWk BETHEL TOWERS OF COSTA
/iD°"E� MESA
2525 NEWPORT BLVD
=OSTA MESA,CA 92627(�14)
�cv�. �uuno �onx�sx �
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UNT:
ca�"�ct°Rs""'� SEACOAST ENTERPRISES ( 714 ) 642-3890
�����""�0 2488 NEWPORT BL
"0°�' COSTA MESA CA �N0' 360631
92627 u"T
' IJCENSED CONiNACfOq4 OECLAF11710N: I hsWy � �udr pxW y d ppuy tlm I an 4wC uMr po.vm� W Cheqs 9
(aomm�nc^G wu� SecYon ]000) tl ONuon 9 d Ns Budroo mW PmlrYvu COM. md mY Gcame e m lu0 bm aM �%aC.
emue.'no/..: 40[3�026 U0'0�g' C-1 uc.No.: 606 �l,/� EXP; 06/95
Daia: Yr l9— ! � CavMn: �/
OW NER BIIILDER DEttARATION: I Mnby d1Um unEar pmely d 'ury �hN I em eremq fmm lAe CaNrmon lican�e lew la IM
lollowiq reewn (5aabn l0.'11.5 Busnee� xd Ralauion+ Code: • n munry whirA iepuirae e pmne to mmW�Y. ellm. Improvs.
, Eemd'eh. a repai ury strucwre: prior b b euwm. aleo re�we� tM epplimV la ach pa�m! W fib e dpned Mmenl thel he a eM
';, �;�en..e w�w �o me nwvim. a ms com�.a«. �;�ee �e. lcneq« s(camm«m,a wun seaon rowl a o�eo� a d �ro
Bu�inan md Prdeaioro Codal «�Iw Ir a dn e ssemq �Iwehvm and ihe bmis 1> tM alspsd uemq'vi. MY vbletion d Swion
�m�.s M errv �cN�m i«. o.� ��n• �oo�+b �o. � o«�rN a na mon uw� rw. inmeree mom. �swop.
� I.mowrrdiMpW�YamY�wihr+YoeaUricYmmpssm'vi.rAdotlrwakmMiMMx.9m'snd"vaadeE
«MxeEW veb (Se�ion 10u. BuvroaaM PN»sw CoOe: The Cauraam limena Lew don na ewNmmownera papMy
who buida a mVw*! �haaan. mM Mn Aom arl+ak IimwE a henN a Ww� lie a Mr wm wnqopw. pwidod �!w aM
impo.wnwa me nd waded aWxd la uM. tl. Mwever. Na Moti�q a inpow^an u wtl wGNn arYw d aomG�ion. IM
cwrcrL�nYar w� Mw iM bnbn d pw'vq M a�he 6E nU buid a hnpw In Ne pvpws d ede).
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Prdmdan Cotle: The COMradon L'canx Lew doee nol eGD�Y b an ow�wr d PWMY w1w WiIM a imV�'r iha�aan eM who
wnirecro M aM pd�e xM � mr+redMq ficanasd o�� to tM Cau'ertm Liava Lervl.
� I am ssemq uMa Seelion: B. 8 P.C.. be Uw iaeson:
Oale: A`'"^r
i m n«.w «nev uw i�..... a.oe �,b.+w,e me nw:.m.w a c.udx. iwm� .oa smw wa. sww�. zsm, zssa�. �a
w� i «.�r . . .
i� ub..
Deu: �Vo�u��
WOPRER'S COMYEN9AilON DECW1Al10N: I Iwaby tlfrm �Nx paWry d prMvy ur d IM W Wrkp Mdwmom:
❑ �n.v.wwme'v+,n.�.nufw.amm.+�o..nLm..w..vrk..•canc«i.mian...a�r«we.aionalroa�n.�.mr
coe.. �a m. wmm�.nc. a n..lan �v.d:�n mu o� e 4.wa.
❑ inm,.�a�;��m.�..we��w��m.�.a....�+m�n.eeys.eu�arooam.i.e«cros.m�m.w�N�wm.
work lu Mhitli Mi+ 0+�� b iaueE. M' walwJ oomro�+dian imurenc� urrir W D�Y numbw ero:
c�.�: nn�rrnuF EXPZRES
POGcyNumOr. SA54—Q19S_�na�n O1/10/96
(mia eaction mM nd Ds cm�pMlM I tlr o�I u M ms hiadnA emua R�aol n 4mJ
� I canN Net n tM OMamencs tl ilr rak la r.TirA Nu D� u u�uM. I tlu0 b�mOM �^Y Ga� n M' menner c n to
pecoms aEjeC lo iM vMmY mnprrnion Isw d ' eM p�r tM � 1 wiEjw �o �M v.wka�'
�D�+� o.wean a s.aw� aroo a u» i.e« i.nla � mmV�
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w.m��ro: auun ro wcun.ort.n' mmp.ru�don rov.nw M1 uJ.rw. ra.�wi mlK�.n.mv�ww ro cmNw n�u uw
elvll Ilnu W ro arw MndnO Moua�n0 AWI�n (JiQ40WA ti��n b IM ewt ol ronprwUoM1 4m�pu u provMM br In
9�ctlon J108 0l M� UEor Cod1, Infwrt �n0 �flom�ya ha.
CON9THUCTION LENdNO 1OENCY: I hnaby dMn uMx perieQy d perjuy Ihe11Mn u a cvnA�udion kndi�q eparwy br IM
peno�a,u a m. w�x m..nd� me o«�*i u ew�ae (saaon aos�. c�. cl.
LENDEP'9 NMIE
LENDEP'S MONE39:
I eoniN �het I M�a euE Nu eGV�^ W mte �IW Ms ebvn "vdm�Wian u eonotl.l pyse to eamdY xrt� eY �YY en0 wuniY adirorcse
W ewe lewe nletiw b bwMno m'mewian W ts�by einlv¢a �eq�wnetiw d Ne rdybWw w� �M ebma�rtenion�E popeery
(515t-�6.WP)
ome: � h "7 �
WAna-Build'rp d Sefay: arserFle: Canv��pppFani: Fnk-fievenue: Goldenm�Mwav
CITY OF COSTA MESA — BUILDIPJG PERMIT
PERM NO: F 07179
PEAMZT NO; F 071799 PLAN CHECK NO: 00823-95 L GOVT: N SUPP; N
CONSTRUCTION TYPE; 5—N PERMIT TYPE: FIR PURPOSE: NEY]
JOB DESCRIPTZON : INSTALL FIAE ALARM SYSTEM SQ FT:
CLAIM VALUE: SO,OOO.QO CALC—VALUE; GROUP OCC: B-2 /
COMMENTS: INSTALL FIRE ALARM SYSTEM
*-ur*�itrit*it+F+ri[�+r�r**rac*�axrjcac�**a��t+�* x�+Fr+t*��c��c**rr�r�c�t*�r+*�tir-*�r*�aaFrac-w�arrr�r+r�tac-�r*r�a�**as.r-�.
Z O N I N G R E Q U I R E M E N T S
S E T B A C Y. S
------------ MAIN BUILDIP]G ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT ' IN REAA: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 42224219 ZNE: REF NO:
PLANNING NOTES>
i
iM1 iF iE if if it'V M if if if if 1f if if-iM i! 1f Y if if if')f if if if iE if iE iF If if iR iE iF iF if 1f'If if iE iE i%aF iR iF iF 1f if if Y- K�Y i:1F iF iF if 1f if if if iF iF 1L JF iG if aF it iF i� 1f tf iR if if if if
D E V E L O P M E N T S E A V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY . DATE:
HUILDZNG APPROVED BY : DATE:
APPLICATION ISSUED BY: �� DATE: ��F�����
itif�fifiFiflfiFaf{fiMiflFlfififMY�lFifiFlfiF�F�F��17��iF iT)TiF�F�3ZRi$���i��Mi���IfiF�RMlf�ifll�iFiRic iiAc
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/RES GRADING
PERMIT
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 415.00 0.00 269.75
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
415,00
65� SMZP/NON—AES
269,75
TOTAL PAID DUE
684.75 684,75 .00
415.00 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN—CHECK
415.00
it ik �Ik ik if 1F'M� il-iF �k ih iF iF iF 1f iE 1! if iR iF ik if iR �f ii if ik iR if � 1F i�-il� �k i! M� ik M' iE if i('if it �lf i� ih iF i!� if ik if iF if 1f iF'M' il� i!� 1! i!� iF iF i� iE ii it ih ik iF if i�' if i� if i1 Y if iF i!
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C A I P T I O N UNIT COST TOTAL COST
FIR 915 FIRE EQUIP FEE (FROM HLDG VAL TABLE) 1.00 915.00
END OF FEES
i
�i R01)?444-00179444 T C:� 4i5,QQ
DATE: OS/O6/95 TFtIE: 10:"s4
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
i �
1. Temporary Electricat $ervice or PoIB 52. Pool & Equipment Locatiqn
2, Soil Pipe•Undrgrnd. 53. Steei Reinforcement
3. Electrical Conduit UtilitY�Undrgrnd. 54. Forms '
4. Electrical Cond�it•Und�g�nd. 55. Electrical Bonding
5. Steel fleinforcement 56. Rough Plumbing & Pressure Test
6� Electrical UFER Grnd. 57. APPROVAL TO COVEfl�GUNITE
`7. Footings 58. Electrical Conduit-Undrgrnd.
8, foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe•Undrgrnd. - 60. Backwash Lines,iP�Trap, O Undrgrnd.
10. Structurol Floor SYstem 67. APPROVAI. TO DECK �
11. Property Sewer Line & House Conneciion 62. Backwash & Receptor•Final
12. Sewer Cap � . 63. Heater & Vent•Fi�al
13. Roof Oraint 64. Piumbing SYstem - Final
14. Rough Plumbing . 65. Electrical•Final
15. Rough Electricai-Conduit 66. Sofar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approvai
17. Rough Wiring Sign 68. APPROVED FOji�PLASTERING
18. Rough Electrical-7 Bar Ceiling � 69. POOLlSPA SYSTEP�iS FINAL
19. Rough Heating & Air Conditioning PIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � - APPROVALS , Permit # �
21. DuCti, in StruCture � � - _� 70. Underground Hydro
22. Ducts, Ventilating � ' 71. Product Piping � Gas C� 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) & MonocPat 75. Dry Chemical
27. Frame and Flashing, . • 76. Dry Standpipe -
28. lathing & Siding - - 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PflEV. FINAI / ��
30. Dryrovall Nailinj ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter•Final ' , S0. FOOD CERTIFICATE ISSUED ,
33. Finai'Electric -� •� Notes: - _
34. Finai Heating & Air Conditioning . • -
35. Pinal Gas Pipe:Test `
36. Hood or Ca�opy - �
37. Final Factory Fireplace - ' � � � -
38. Final Plumbing -
39. Water Service-Final ' . � '
40. Gas Service-Finai ' - '
47. Solar pomesiic•Final ' -
42. 8ackflow Preven[er
43. Backflow Irrigation . �
44. Landscape Irripation System � �
,
45. Sound Attenuation , , , . .
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING �
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
y
_j
�aeclAauEss.. 666 W 19TH ST uNiT:
OWNEN'SNAME: BETF'IE� TOWERS OF COSTA
nooeess: MESA
2525 NEWPORT BLVD
COSTA MESA,CA 92627
(714)
ANCHIENGINEEfl: ROB ERT C. COULSON, S. E, pEc.xo.: i �� n
aoon¢ss: �g01 ORANGETHORPE AVE uNn:
PEflMITTEE: BUENA PARK CA 90621
nooncss: BRISCOE ELECTRIC (714)549-9570
2546 FAIRVZEW
SANTA ANA CA 92704
LICENSEO LONTNACTOfl OECIANATION: I here0y allirm I�a� I am licensetl untler prOvisions o� C�apier 9lcommoncinp with Seclion
7000� ol Oivision 3 0� I�e BuU�e55 and Prolessions Coae. antl my liconse is in Iuil lome ana eflecl.
ciTruc.:077198 sTaTeuc.:38393. c�ass: _-�0
Uate:_���3 SignaWre:-�
WOPNEBS'LOMPENSR7IONOELUppiION: InereGyatfirmlhailnaveacenili teoltonsenitoul6in5ureoramniliWteolWorker5'
ComDenution insurance. or a cendiQO cooy ��eieot (Section 3800. LaE. C1.
roucvNo.: WC68000527-07 E%P.DATE: lOIOl I9�I
� COMPANY: CC 2 E
�❑ cen�rea coov �s nerzey mr�anea. � Certilietl copy is filetl witn ihe ciry Building Division.
�ale: � -��9�--_ AGDlicanC-�� l .
E%FIAPTION FBOM WOPIIERS' COMPENSp7�ON �ECIAIiATION: (ihis setlion �eeC iw� C€ com0lpeG i� Ine perml ¢ lor one IiunAreO (5100� or less�.
I cenily Ihat in the oeAormance ol the work lor whicn tnis permit is issuetl. I s�all not employ any oerson in any manner so as ta �ecome
5u0jeci to t�e Worker5' CamDensatipn Laws al Caldomia. �
Date: SignaNre:
NOTILE: II, alier maMinA IMs Ee�laralion, you s�oultl become suGjeci lo I�e Workers' Campensaiion pwvisions o� Ihe La�or
Cotle, yrou must lonliwith fAmpty with such pmvisions or ihis oermit snall Ue eeemeA revakea.
CONSiNUCT10N LENOING RGENCY: I �ereUy aliirm that roere is a consiruction IenOing aqenry for ihe pedarmance of t�e work for
w0ic� Ihis permil is i55ulE �Sec�ion jp97, Civ. C�.
LENUEN: "
RODflE55:
OWNEB BWLUEH OECIAXRTION: I hereEy allirm that I am exem0� �mm t�e Comractors' State License Law lor ihe lollowing reason
ISeciion 7031.5 Business anU Pro1e551onal CoUe: Nny city oi county whic� rtpuirR a permil to wnstmct, alteL improve, tlemalisn, or
reoaii any slNCWre, D�io� lo its i55uance. alm requires ihe aoPlicant lar sucn permit to file a sipne0 statement Ihat nUsne is Iicense0
pursuant to t�e D�ovisions ot t�e Can��acmrs' Siale License Law �C�aO�er 9(commencing vnin Sectian 7400) ol Diuision J ol Ine Busines5
anC PmIe55ion5 COde) ar tlul �PJsng is e*empl I�¢relrom anC I�e Dasis br I�e allegetl eeemo�ion. My violation ol Settion 7031.5 Uy
any apo��nt lot a permii weiecis ihe apo���:�� �o a civil oenalry of not rtwR tlldn liv¢ nunarM Odlars 1�1.
I. as owner al Ine O�oDeny or my em loyees with wa0es as iheir SOIe wmpensation, vNl ao the wark, and Ihe
❑ s�mclure is noi imenaeJ or olferea for sale I�ction 7044, Business antl Pmlessional CoEe: The Contracrors' State License Law
does not app1Y �o an Owner af a pmpeny w�o builds or impmves thereon, an0 who Jaes suc� work himselflhersell or ihmug�
�is ar her own em0loy¢e5. bmvitle0 I�al Suth impmvemenis are nol in�¢nCetl Or oflereE for sale. I�, however IAe huiltling or
impmvement i5 sa�a wt�in One year ol tompletion, I�e owner will have i�e bur0en ai prwinq hPJShe Ui0 not �uild or improve
�, for ine ourpose of salel.
I. as awner ol t�e pmpeny, am eRclusively contracting wit� licensea contracmrs m consiruct ��e pmiect (Sectian 7044, Business
❑ ana Pm�¢ssions LoOe: i�e �qmractor5' Slate license �aw does not aODN �o an wmer ol pmpeM � ��IGs or improves ihereon
antl wno comracts lar wch pmiec�s wi�n a contracmqs) license purzuam to ine Contractors' State License Law). I am aware
I�ai 0��� ol Ihei� Worker'S Compensalion insurance snoultl be pmvidetl la me.
� I am exemp� under Seciion: 8. 8 P. C.
br i�is reason:
Oa�e: Owner.
i Uo ne�eey cenily inai I am aware ai ane unaers�ana tne reauiremems ot Calitomia Healin an0 Satety CoOe Sections 25505. 25593, ane
2553A ana Itul I or any tuture ouiWinq oCaDanl wilUwill not (circle one) need to comD�Y ��� sdid stale fAees ana tne reauirements for a
permit lor canstmclion or rtpailica�ion Imm Ihe Air Oualily Management OiSVicL R¢5itlenGal construc�ion appliWiions are e�emp� Irom
Wese pmvisions.
Dale: Applicanl:
I �eie0y [¢tlify �IWI I lave reaG INs a001icalion antl staie I�al I�e a0ove informa�ion 4 Corre[I. I a0�ee Io tomDN ��h all ciiy anA county
OtdiNntes ana Slate IawS r¢IdGng t0 DWbinq fAnSlrutiion antl �eteby aN�Orrz¢ rep�¢5¢nla�ivC5011145 Gty l0 enier upOtl IM1¢ a00ve-men�ioneU
prap¢rtY lorin5�ttlion purpoS¢s. /�, / ♦
Oale: �� � � Signamre: / //
Oriver'S Lirense or Saial $¢cuniy q:
t64L<6 Wnne-Bwking: Green--�e Enbrcement; Canary-ApPlkan�: Pink-q�enue: GdCenroE-Nssessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 06532�
PERMIT NO: E 065329 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: 5-N PERMIT TYPE: ELE PURPOSE: NEW
JOB DESCRIPTION ; ADD MAINTENANCE AREA TO EXISTINGBLDG. SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 /
COMMENTS: 1155#SF OF ONE STORY MASONRY ADDITION, RE:NB62564
r**�r*�*r**x*xx+r+rxit*#ir+t�rxiri�*xirir*�r�r+tx�**�r******�r***�r***s****�r�t***#****�r****�=*,r+r***
Z O N I N G R E Q U Z R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 42229219 ZNE: REF NO:
PLANNING NdTES>
> _.
**�*,�**�,�,�,�,�*�,�,�***,��,�,��,���**���.*��,�******�*,�**�**,�,�,�#*,�****;���****,��**,��#*���*
D E V E L O P M E N T S&� V I C E S R E Q U I R E M E N T S
/�
ZONING APPROC�ED BY � DATE:
HUILDING APPROVED BY : DATE: j
APPLICATION ISSUED BY; �-�- DATE: ��-lI� �
�t**�e*�t�t**�r*�r�e�rx******* x�.�R**�******�r�F�Fi��x�**
1EitiFiFitititiFiFiFitifiEiEifili(�iFM3fMititiEitifiE�lFifiEitiE iEiEil�iFikifiFiklfiEiE�fi(�iFififiFiF+EifiFifiF%aEif�RifiFlEMif�FiE�)FiFjFif�iFiFii�#ifi(�if#
LEGALIZATION:N F E$ S U M M A R Y STRUCTURAL SEGMENT:N
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 93.25
SOR SMZF/NON-RES
PLAN
ISSUE FEE 15.00
HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DOE
TOTALS----> 43.25 15.00 0.00 58.25 58.25 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 58.25 OVER/SAORT: .00
HLDG PMT PLUMHING ELECTRIC MECHANIC FZRE SMZP/TOT GRADING PLAN-CHECR
58.25
1k jf i! �f fE 3E 3f i! if if 1F if iE iE if if if 1E iF 1E iE ik 1t iE iP iF if itlf �t ic 3f if 1F iE iE fE 1f iF fE iE 1E fE jF iF iE i! iF if iF iF IE iE iF 1E if 3f iE 1E iE iF?F iF %iE 3f N� if iF 1f iF 1ElF if -N� i�if iE iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 12 FIXTURES, LIGHTING 1 ST 20 EA, .75 9.00
ELE 15 RECEPT/OUTLET 1 ST 20 EA, .75 11.25
ELE 8 RECEPT/SWITCH 1 ST 20 EA. .75 6,00
ELE 1 SUB-PANEL 11.00 12.00
ELE 2 MOTOR/POWR APPARATUS 0.0 - 1.0 HP 3.00 6.00
END OF FEES
�1 Q01523i4-0015y314 T� T 58.2�
DATE� 12/14/93 TihiE: 14:49
I CONSTRUCTION AND PLANNING ;
APPROVALS Permit �'•r`
�1. Temporary ElecVical Service or Pole
� 2. Sod Pipe-Undrgrnd.
3. Electrical Conduit Utility�Undrgmd.
4. Electrical ConduibUndrgrnd. ,
5. Steel Reiniorc2ment I
G. Eleetnw' I.FER Grnd ����
7. Fooungs I''�
� 8. Foundation
� 9. Water Pipe�Undrgrnd.
i
� 10. Svucturoi Fioor System
1 i. PraRer:y Se..r! Lirr & House Connectioo
�� �p
i 13. Raof Drms
14. Fough �lumbing
� 15 Roagh E;earica!-Condwt
� iG Ao;,gn EiectricV7iring
t-- t,ILG.�LS
( 77. Fough ;1'i-�r.g Sign
18. Ro�gh Electriw�-T Bar Ceihng
79. Rough Hecting & Air Condi[wning
20. Rough Factory Fireulace
21. D�tts, in Struoturc
22. Duets, Venti'aLrtn
23. Gas P�pe�Rough & 7est
24. Roof Framing
25. Roo1 Sheathing
26. T�B�r CeJmg (Structurall & Monocoat
27. Frame and Flashing
28. ;aihir.g & Sitlin�
29. Insulat�on
30. D�y�•.au �\a�hng
31. Plaster Bro�vn Coat
32. Elcct�ica� Po�+er N'.Cte� Finai
33. Fi�;,i Eteunc
34. Final He�t�ng & A�• Conditioning
35. Final Gas Pipe�Test
36. Nood or Canopy
37. Final Factory Fireplace
38. Finai Piumbing
39. 4Yater Service�Final
40. Gas Serwce�F�nal
41. Solar pomesurFinai
42. Backflovi Preventer
43. Backflow Irrigation
44. Lar.dsw0e Irrigation SYstem
45. Sound Attenuation
46. Handiwp Regulations
47. FINAL STRUCTURE & BUILDING
48. fINALPIANNING
A9. Etectric Retease to Edison
50. Gas Release to Southem Catifomia Gas
Date
`
POO L _ aPA
Date Inspector AppqOVALS Permit �
� 52. Poo: & Equipment Locat:un
53. Stcol Reinforcement
54. Forms
55. Electrical Bond�ng
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit•Urdrprntl.
59. Gas Pipe, � Undrgmd., Test
60. Backwash Lines, P�Trap, � Undrgrrd.
61. APPROVALTODECK
62. Back�:�ash & fleceptorF�ral
63. Huatcr & Vent•Final
64. Plumbing Systam � F�nul
G5. Eloctrical�Final �
66. Solar System-Final
- jrqy �� 67. Fencing & Accese Aopr�val
68. APPROVED FOR PLASTERING
69. P06LlSPR SYSTEP,iS f I�AL
FIRE DEPT. REQUIREfV�EIVi
APPROVALS Permrt #
70. Underground Hydro
71. Product Piping C; G,is �, � Ori
72. Underground Flush
73. Undergmd. Srorage Tank � Ga, :� O�I �
74. Overhead Nydro
75. Dry Chemical
76. Dry Standpipe
77. F�XED SrSTEA9 F�r!A�
76. FIRE PREV. FI�AL
HEALTH DEPT. REQUIREA:itP!T
79. FINALINSPECTION_____�
n 80. FOOD CERTIFiCnrE iSSUED _L
( ?�� /X � I Notes: - - -
Oate Ilnspector
�
bbb W 171n J1
PflOJECTRU0HES5: HETHEL TOWERS OF COSTA
�� OWNEH'S NAME: MESA
I aooeess: 2525 NEWPORT BLVD
' COSTA MESA,CA 92627
UNIT:
IAN WADDELL C41219
AflLH1ENGINEEfl: SSS3Z WILD CHERRY CI NEG.NO.:
ADDHESS: H B CA 9 2 6 4 7 UNIT:
BRIGGS ELECTRIC (719)863-9901
PEflMITTEE: 1666z MILLIREN AV NONE
nooeess: IRVINE CA 92714
LICENSED LONTNpCTOP DELIABATION: 1 �ere�y allirm ��a� I am IicenSeA untler pmvisions oi C�apler 9(commencing wilh Sec�ion
70001 al oi��g g��usiness and Pmte�9s���Og �0 my license is in f�11 �prqe�d eftect.
LITY LICq.: STpTE UC.: (/y �y��/. CUISS� — �
Oate: f � /� —�� Signa�me:J! �_ .
WOflNEBS' Cp�qP,F�$q�Ip�l p T1p& I hereby allirm I�a� I have a e li cqn�¢ �0 5 insure or a certi�ica�e ol Workers'
POLILY N0. n IMlurMdl W N�ER i o3Aereol (Sec1iE%PBORTEab. �1� �� �/ y�
COMPANY: X
� Certi�ietl caDY is hereby turniSheE. ❑ CertilieG ca/DY i.s,,fi�led wiN I�e cily 9uilding Oivision.
Daie: / '�� � • � �' ' AOOIiwn1: % � ! /.vei/.— i r^'��
E%EMPTION FBOM WOBNEBS' fAMPEN511T10N OECLAMTION:� QMs seclion neeC no� be compleleE if tlie permit is lor one hunUreC (3f00) or leu�.
' I ceriily t�at in Ihe Dedormance ai tAe work IOr w�ic0 Uis permi� is issue415�a11 nol emDloy any person in any manner so a510 become
sublecl lo Ihe Workers' Compensa6o�law5 ol Calilomia
�ate: Signature:
NOTICE: II. atler making ihis Ueclxtalion, you ihould EeCame suGle�� �o Ihe Workers' Compen5aiion O�a�sions o� IAe LaUor
CoOe. you must torl�wit� comply,avii� such pmvi5io�5 or �his permit shall be tleemeG revake0.
CONSTflUCTION LENDING AGENCY:. I Aereby affirm lhal IM1ere is a con5�mciion lending aAency tor I�e Dehormance ol ltle wod �or
w�icn Inis permii is issuetl (Sec�iod3097, Civ. C�. �'i
� . ,,
�NOEw: rn,
aoosess:
I' / I
OWNEB BOILOEfl OECLABRTION: I �ereby a��irm ihai I am exempi �mm I�e Conttactors' S�ale License Law far �he lollowing reasan
(Section 7031.5 Business antl Pro�essional Cotle: Any ciry oi counry which repuires a permii lo cons�mc�, alter, impmve. demolis�, or
repair any s�mciure. O�ior lo ils issuance. alsa repuires Ihe aDPlican� lor such permil Io Iiie a 5igneG statemenl Iha� �e/s�e i5licensetl
pursuam io t�e pmv¢ions ol t�e Comraclars' State License law (Chapier 9(commencing wilh Section 7000) ol Oivision 3 0l the Business
antl Prolessfons fAae) ar that he/she is exemo� �herefmm anA ine basis lar Ihe allege0 e�emption. Pny vialalion al Section 703t.5 Oy
any aDDlicanllor a Oermil SUGjeciS Ihe applicani to a civil penalty of nol more �han liv¢ AunEaO Dollars (5500).
I, as owner ol ��e properiy or my employees with wages as Iheir sole compensa�ion, will tlo �he wmk, and Ihe
❑ s�mcture is nol in�entled or olfereU lor sale (Section 7044, Business and Pmtessional Code: The Con�ractors' Slaie License Law
aoes noi apply Ia an owner o� a O��DQ�Y who Guilas ar impwves �hereon. and who Oo¢5 sucb wafk himsetl/her5¢II or Illmugh
hi5 or her own empl0yee5, prmide0 I�a� SUc� impmvemenis are noi iniendetl or atlere0 �or sale. II, �owever t�! GuilUinA Of
' imorovement is solA vnihin one year oi compietion, tne owner vnll have tne UurAen ol pmving he/sne 4i0 nol Ouile ar impmve
lorine Duroose of sale�.
I, as owner ol Ihe propetly. am eaclusively conUacling wi�h IicenseA conVactors to constmc� lhe pmle�� (,Section 7044, Business
❑ and Pm�essions Cotle: The Conlracmrs' State License Law tloes noi aDPly to an own¢rol proDeny wlw �mlds or impmves Ihereon
antl w�o conVacis for sucA Dmjecls with a caniraclor�s) license pursuant �o Ihe Caniractors' State Licens¢ Law�. I am aware
I�al 0��� ol ��ei� Worker'S Compensa�ion insurance shoul0 De p�ontled Io me.
� I am exempt unaer Section: B. 8 P. C.
lor Ihis reason:
Daie�. O�vner.
I Ga �ereUy cenily t�at I am aware o� an0 untlerslana Ine repuiremems o� Calitomia Healt� an0 Sa�ery Cotle Sec�ions 25505. 25533, anJ
2553d an0lnat I or any IUNre �uilding occupam will/wiil not (circle one) nee0 �o camply wiN Saitl state cOGes and the requiremen�s br a
peimi� Im conslmction or modi�icalion �rom Ihe Frt Ouahty Managemeni �istric�. flesidential constmction applicaiions are eaempl fmm
Ihese Owmsions.
Oale: Ap0licanl:
I here�y certily Nal I �ave reatl �his aDP�ication an0 51aie t�at ��e above informa�ian is correcl. I agree lo compry wi�h ail cily and county
ortlmances antl stalelawsrelating�o �uiltling consimc�ion ana hereby aulhorizerepresenta�ives olihis ciry ro enleru0onihe above�men�ionea
pmDen Ioiinspeciion Vurposes.
Oate: —/� '
,�
�river's License o� Social Secwity a:
1641�a6 White—Bmltling; Green—Cotle Enlorcemen�; Canary—Applicanl; Plnk—Revenue; GOldenmE—Fssessor
CITY OF COSTA MESA — HUILDING PERMIT
PERMIT,NO: BE 063901 PLAN CHECK NO: 03438-93 S
CONSTRUCTION TYPE; PERMIT TYPE: ELE STR PURPOSE; OTH
JOB DESCRIPTION : REPLACE EXISTING 5 LIGHT POLES SQ FT; 9,999
CLAIM VALUE: 4,999.00 CALC—VALUE; 4,999,00 GROUP OCC: B-2 /
COMMENTS; REPLACE S-20FT HIGH LIGHT POLES
iE iE iE3E if 4 if iE if 1E M%iE it iE k if iF if �f ikif if if ik iE iE if if if iE ik �1f if if if 3f if if if iF iE ik iE if dE iF iE iEiElf iE ik iE if iF it 1F iF iE if iF iE iE �E iE iF 3E 3f iE dE iF �E iE 1E 1E if� * iE
Z O N 2 N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ • PROV: PARCEL; 42224219 ZNE: R3 REF NO;
PLANNING Nt51'ES> 5— 20' HIGH LIGHT STANDARDS TO BE INSTALLED WITHIN THE
> PFtING LOT OF HETHEL TOWERS. WILL NOT BLOCK RE�UIRED PKING.
if�Eif�fiFifi6iFiEififillEiFiFikifiFlFiEikififiElfiEififkififiEfFlfifiFkiEiF1ElEikiEfElflfiElEiklElEiE1FlEifiE1E�lifiliE iFifiFiEiFlFiEiEiFiF�Fif1F1FlEiEif
D E V E L O P M E N T S E: =R' V I C E S R E Q U I R E M E N T� S
ZONING APPROVED BY '•+ WCSk— DATE:I�
BUILDING APPROVED BY : ''� DATE;''1
APPLICATZON ISSUED BY: `� S� DATE: �I!��:�0 ��j3
iEiElEiEiEiE3EififiEifif�E�f1EiF1E3EiF1F3EiE3FiF7FiFiFiF�fifif3FifiF�fiF7FifiFiF7F�FiFiFiF #"iFiFiFiF'iF3F3FiFlFifiEiEiEifiEiEiEiF���FiFiE
1E 1! iE iE �E i! �f if lEiF iE iE if ik iE if 1F iF 1ElE �E iE iE it iE iE iE �E iF iE iFdE 1f ik.3f iE iE �FiE iE 1E 1t 1E iF 1Fif 1f iE it iF�f if it ik 1f �F iE 1E ik iE iE iF iE iElElEiF�t if if if fk 1f ik ff iE iE i! iE
LEGALIZATION:N F E�E�� S U M M A R Y STRUCTURA� SEGMENT:Y
r�
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP%RES GRADING
PERMIT 72.00 25.75 " `�
503 SMIP/NON—RES
PLAN 46.80 1.05
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAIll DUE
TOTALS----> 98.80 15.00 46.80 160.60 7.60,60 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 160.60 OVE;R/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECX
72.00 40.75 1.05 46.80
iF 3F iF 9f df iF iE if iF fE i! 9E k� iFif 3E iE iE if 9Flk iE iF ik iE iE iF if 9E �Ik it k if itr ik if 1t 3E �t i! iF iE iFif iE if if 1F it 1EdE 1F if iE it9E if �E ik iF iF�7F iE 7f if��M-iE iE iElt if ik iP iF ik it if if 9E
I N D I V I D U A L F E E H R E A K D O W N
TYPE
ELE
ELE
QTY
4999
5
2
D E S C R I P T I O N
STRUCTURW BY VALUE PER $1.00
POLE/PLATFORM MOUNT LIGHT FIXT. EA.
MISC CONDUIT NOT LISTED RE PERMIT
END OF FEE
UNIT COST TOTAL COST
1.00 4,999,00
11.00 27.00
O1 Q014567�—OQ146579 T 4 T IbO.bD
��A7E: Oy/10/93 TIPIE: 14�3Z
\
�
0
�.,
� CONSTRUCTION AND PIANNING
APPROVAIS Permi4 r�"`r Date
1. Temporary Electrical Service.or Pole .- �
2. Soil Pipe-Undrgrnd. -
3. Electrica! Ccaduit UtiirtY•Undrgrnd. �
4. Electrical ConduirUndr9rn� g'�Jtl
✓j
5. Steel Remforcement
6. Elettrica�l UFER Grnd a T
7. Footings � �"y, 1
-{ `�
8. PoundaUon "
9. Water Pipe�UnCrgrrtd. •• -
10. Structural Floor System -
11 . Property Sewe. Line & Houie Connection
12. Sewer Cap � .
73. Roof �rain5 -�
14. Rough Pium6ing �
15. Rough Electrical�Condwt �'�
16. Rou�h Electric Wiring
17. Rough Wiring Siyn
18. Rough Electric3l-T Bar Ceilinq
19. �Rouoh Neating & A�r Condiuonmg
20. RougF� Pactory Firepiace ' � ' '
2f. Ducce, in Strucwre �
22. DuctS, Ventilajing � �
23. Gas Pipe-Rough � Test , � �
24. Roof Framing
25. Roof Sheathing �
26. T•Qar Ceiling (Structural) & Monocoat
27. Frame and Fla;hiP9 . � ,
28. Laihing & Siding • , ��
29. Insulation . �� _ _�
30. Dryivali Nail�ng ' :
�
31. Plaster Brown Coat , . �
32. Electricai Power Me:erF�nal �
33. Final E1ec�ric ' i '/a�
(I
34. Final Meating & Air Condi".ioning /
35. Finai Gas Pipe�Tes1-. ' .' . ", .
36. Hood or Canopy � � .
37. Fina� Faaory Pireplace ' ;' �
�
38. Final Pf�mbing �
39. LYater� Service-Final
4Q. Gas Serv�ce-Fina'
4t. Salar pomestic-Final
42. Backflow Preverttei �
43. Backflow Irrigati4n -
44. �andscape, irrigation SVstem � . � �
45. Sound Attenuation
46. Nandicap Regulations ..
47. FtNAL STRUCTURE & Bll�LDING f' �, I
48. HNAIPLANNWG
/ ��
49. Etectric Re�ease to Edison �
50. Gas Release to Southern California Gas Cu �
Date
Inspector
POO� SPA
APPROVALS Permit,$ Date Inspeycor.
52. Pool & Epuipment LocaUon '.
53. Steel Reinforcement ,
54. Forms
55. Electrical6o�din9 � �
56. Rough Plumbing & Pressure Test
57. APPROVAI TO COVER�GU�!tTE
58. ElecVmal Conduit�Undrgrnd.
59. Gas P�pe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, � Undrg�nd � r
61. APPROVAL TO DECK '
62. BaeRw;,sh & Receptcr-Finat
63. Hea[er & Vent-Final � �
64. Plumbin9 System � fi�al �
�
G5. EleCtricaLFinal � �
i
66. Solar System-Final •+ '
i
67. Fencin� & Acaess Approval �
68. APPROVED FOR PLASTERI'JG �
69. POOL/SPASYSTEA15FINAL '
FIRE DEPT. REQUIREMENT �
i
APF�OVALS Permtt ;r -, .
70. Under9round Hytlro '
�
71. Product Pipin9 �I Gas C Oil �
72. Underground Flush � !
i3. Undergrnd. Stor�ye Tank u Gas �: Od �
74. Overhead Hydro '
-�- . -; ---i
75.'Dry Chemical i
� - -1
76. Dry Standpipe ;
- ---+
77. FIXED$YSTEF.iFINAL
78. FIRE PREV. FWAL �
-- -i
HEAITH DEPT. REQUIRF.rl1E��T ��
�9. FIiVAL INSPECTIQN � �
80. FOOD CERTIFICATE iS5l1ED '�
Notes: - ------ -- �
I
, , --------- �
, �
n
craooness: 666 W 19TH ST
OWNEN'SNFME:BETHEL TOWERS OF COSTA
aooeEss: MESA
2525 NEWPORT BLVD
COSTA MESA,CA 92627
pNCNIENGINEEN:
aoosEss:
!91!
UNIT:
FEG.N0.:3 Z 1 dlT`.
�iiia
PEHMITTEE:YORHA LINDP. CA 92668
aooness:H R NELSON CORP. (714)582-1598
2'121�1 CORDERO LN
MISSION VIEJO CA 92691
ENSEU CONTHACTOP DECIANaTION; I �ert0y alli�m put I am license7 unGer pmvis�ons of ChaO�er 9(commencing wit� Section
0001 0l Oivisi J i ine siness ana Protessions Coae, an0 my ti n i5L s�N: rce anE elfec�.
CITV IIC.:O � SiRTE UC.:Z S S�I
Date: Signaiure:, _
WOHNEPS' C PENSRTION OECIAflATION: I �ere�y ailirm tlwi I �av e oi consent Io SelGinsure or a cenificate oi Workers'
Compensation insurance. or a ceNlieO copy �hereoi (�clion 3800. LaD. CI.
eoucvNo.:113'I418-93 E%P.O�TE: �94
�OMPANY:STATE �
Cetlilied copy is here0y fumi5�e0. n( Ceriilietl ' e il i� g yASion.
1 � /,
�a�e: f CJ �C-/ �3 MD�icanl
E%EMPTION fNOM WOflNENS' COMPEN511TION OELLAMTION: (m¢ seclqn t be canpkteC ii me pemt B la me nuMretl �57001 or lessl.
I cetlity I�ai In the pedormancB oi ��e work lor whic� INS permii i5 issu¢E. � Shall not employ arry Derson in any mann¢r Sa as ta 6¢tOme
suejectlo tne Workers' fAmoensation Laws of Calibmia.
�ate; Signature:
NOTICE: II. al�er making inis eeclaration. you shaula Decome suoiect ta ihe Workers' CAmoerrsation O�ovisions of tAe Labor
COCe. you mus� torlhvnU COmO�Y ��� 5ut� pmvision5 or Ilis permii ywtl 6e Oeemed r¢vokeC.
CONSTBOLTION LENOING AGENCY: I �erzGy aifirm l�ai there 4 a construt�ion lenaing agency lor t�e peAormance ol Ihe work �or
which inis Dermi�is issuee �Section 3097. Civ. C).
LENOEN:
ROOflESS: .
OWNEB BUILOEP DEClA8RTI0N: I �ereUy al6rm tAat I am erempt Imm 1Ire Contracmri State L'¢e(¢e Law for t�e followinq reamn
(Se@ion 70.71.5 Business an0 Pmlessional COOe: My Gry of counly wN[h repuires a permit to conslruct, aller, improve, Aemolish, or
re0air any simtlure. prior to its issuance, also repuires Ihe applipnl fo� sucn Oermit to lile a sipne0 slatement Itlal he/she is Iicense0
pursuam io tne piovivons ol t�e Comractors' State licenu Law (Gupter 9(commenunq vnt� Sectbn 7000) ol Oivision 3 of the Business
ana prolessions Coee) or Inat ne/sne is eeempt Inerefrom anJ Ine easis for �ne allege0 e�emption. Any violalion ol Section 703t.5 by
any applicanl for a permil 5u0jec15 Ihe applicanl �o a civil penalry ot nol mo2 t�an live �undre0 tlollarS (5500).
I❑ I, as awner of Ihe prope�y or my employees wil� waAes as Ineir sole compensalion, wili tlo Ihe work, and Iho
stmcture is not imentled or oller¢E for ule (Section 70aa: Business anE Pmlessional Cotle: T�e Contraciars' Slate License Law
Eoes nol apply lo an owner ol a prODe«Y w� �uilds ot impmves �hereon, and w�o does such work himsel�/herselt or ��roug�
his or her own employees. D�oriOeE i�a� wch impmvemems are not imen0e0 or ollereA lo� ule. 11. hawever the Uuiltlinp or
im0�ovemem is m�d witNn one year o� wmpletian, t�e owner will have t�e hurJen QI pmvinq �Us�e ditl not build or im0�a�e
�or ine owpote o� utel.
I, as owner ot the pmperty. am exclusNery w�vactinq vri�� IicenseE canuaciors ta consiruct ��e O�olea (Seaion 7U44, Business
❑ an0 Professians COGe: T�e Contrxtod Sute License law Eces �at appy ro an owner of properry wno buiias a improves mereon
an0 wno conlratis lor sutn prq¢pts wiln a cMiractorls) liceate pursuant to ihe Cantractors' $late License Law�. I am aware
Ihdl O�ool 0� i�¢if Wofk¢r 5 �Al11ptO5d�i0n inSufdOt¢ SI10u10 UE pfpNGM ID m¢.
� I am exempl untler Section: B. 8 P. C.
lor I�is r¢ason:
�at�; Ownec
� tlo hereby cenily iha� I am aware o� an0 untlerstantl ihe repuiremena al Califarnu Neaitn antl Salery Cotle Sections 25505, 25533, antl
255�E an0 Inat I or any lulwe �uil0ing acupant wi1IM'111 np� �uNe ane) need lo mmpry xith SdiC state co0es anU t�e repuiremenis lor a
Ob�nit lar construdion or modi(ution trom tlm Nr WaYry Marugemen! Ditlrici. HevCentul tonsVuciion appliwiions are exempl Irom
ineSc O�ovisions.
Date: M�Rcam:
�hPreOy tetlity��a� Iliave reae 1�i5 aDDlitaiion and Slate IIWi I�e o fi ni5 correci. I agree�o tomply wiih allGty and touniy
�4inanresantlslateWwsrela�inglobuilpingconsVunionaM�e yam re emaliv ��hi5cityloenleruponi�eabove-m¢n�ioned
proper�y �or inspeciion 0urposes
Dat¢; � � • � � �� SignaW�e.
� Oriy¢r's License ar Socui Secuniy e:
164un6 Wnite—Buibiig: Green—CoOe Enlwcemenl; Canary—Applicanl: PinF—Fevgnue; GOMe�uoO—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 062563
PERMZT NO: B 062563 PLAN CHECIC NO; 00962-93 L GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; OTH
JOB DESCRIPTION ; REPAVE, RESTRIPE 6 T-24 UPGRADE PARH.LOT SQ FT; 3,000
CLAIM VALUE: 3,000.00 CALC—VALUE: 3,000,00 GROUP OCC; R-1 /
COMMENTS: INCLUDES CONCRETE CURB S FLAT WORR (ON SITE ONLY:)
r�e*��***wx�t��e�r�r�r���e**�r**�r�r*�e**�t�r**�r**�t�e��t�t*+t�t�e�e �r�t*��t*r****��t+t�r�t���r�r*�r�r*�e*�t�**+t*
Z O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUZLDING ---------
FRNT: 14 FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT; 4 FT IN RGHT: 5 FT IN LEFT; FT IN RGNT: FT IN
PARKING REQ• 180 PROV; 183 PARCEL; 42229219 ZNE; R3 REF NO; PA-93-10
PLANNING NZST'ES> ADD 45 NEW PARKING SPACES AT BETHEL TOWERS, SUBMITTED BEFORE
> END OF APL PERIOD WITH HOLD HARMLESS LTR,
*�r*�r�r**�t**�e�r�r�t�e��e*�r*r�t�t�t*�r�*�rx*�r�t****�r�r�tr�r�r*�r�r�t�t*�r*�t*�t�t�r�t�t*�r*�r�t*�t�r********��e*�t�r
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.'T S
ZONING APPROVED BY G`l F� —T�' DATE; 06 /C� 3
BUILDING APPROVED BY ; V C� DATE; �'�
APPLZCATION ISSUED HY• ,, �J� DATE•,`
1FififiFlfiFlfifMififlfiFiflfifikMlfiFlkif 'ff��if1F1f1fifififlFiFiFiF'•: '1Fif
i1�lFifiFififlEiflfiFifiliFifiEifiFlklfiFikikiFifiFiklfiFililiF�lfiflflfiFlkifiFlf f�lFiklflfikiEitlflkififiFlfiFiFifiFlfiflfiflFiF1llEiFiEilililiFiFiF3fif1lili!
LEGALIZATION;N F E E S M M A R Y STRUCTURA�I, SEGMENT;Y
BLDG PMT PLUMBING ELECTRI MECHANIC FIRE SMIP/RES GRADZNG
PERMIT 54.00
ISSUE FEE 35.10
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 54,50 0,00 35,10
REVENUE DIVISION TOTALS--> COLLECTED;
BLDG PMT PLUMBING ELECTRZC MECHANIC
54.00
50
SMIP/NON—RES
TOTAL PAID DUE
89.60 89,60 ,00
54.50 OVER/SHORT; 00
FIRE SMIP/TOT GRADING PLAN—CHECK
.SO
ifMififlFifff�fMfkitifMlflFkiFMiliFM�FklfkiFiFMiflF�f1llkiFikMitiFlflFlFM1f1E1EfFklfkkikkltfFifiFiFklkkkiFlF�f1l1E1fikifiEikififfF1E1E1EiFik
I N D I V I D U A L F E E H R E A K D O W N
TYPE (aTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3000 ALTER BY VALUE RESIDENTIAL N020NE 1,00 3,000.00
I END OF FEES
O1 00140787-0014�788 T�7 T 54.50
DpTE� OS/I1/93 TI11E: 15:35
CONSTRUCTION AN� PLANNING
� APPROVAIS Permit �`r
i, Temporary ElectricalSerY�ceP�Pole
2. Soil Pipe•Un�rgmd. :r. ; • , �
. 3. Elec!rital COrRluit�UtiOt'y•Undrgrnd. �
' 4. E�ectrital Condu�t�Uodr rn �
e d•,' •�
i ;l
� 5. Steat Remf�•ce.-ent �
�. Eteehical ITFER Gmd
7. Footings ,
6, F'oundauoh -
:
9, Water Pipe•Undrprnd. � �
7U: Structural Floor Sysiem ; i '+�
11`. Prap¢rtY Se�bCr Line.&!Hoir��Cannettior��;
12. Sewer GaP ' ) ,,
73. Roof Orains � - %, '/.
14. Rough Plumbinq
15. Rough Eiectricai-Condu�t
76. Rough E!¢ctrict^liring :
77. Rough Winng Sign
18. Rougb Electric3l-T Bar Ceilmg
19. RouqR Heaung & Air Cor.diLoring
Date � Inspector
rQ� �PQ
APPROVALS Permit #-,�,
52. Pool & Equipment Locat�oa
53. Steel Reinforcement
54. Forms
55. Electrieal Bonding
56. Rough Plum6ing & Pressu�e Test
67. APPROVAL TO COVER-GUNI?E
58. Electncal CondumUndrgmtl.
59. Ga5 Pipa, O Ur.digrnd., TeSt
60. Backwash Lincs, P-Trap, C] Undr9rnd
67. APPROVAL TO DECK
62. Back�vash @� Reeeptr,r�Fina�
63. Heater & VenbFinal
64. Plumbing Systom � F�nal
65. Electrica6Final
66. Solar System�Final
67. Fencing & Access Approval
68. APPROVED FOR PLAS7EHING
69. POOL/SPASYSTEh4SFtNAL
_FIR� DE�pT, f�y.QUIREMENT
i � ��
Date inspect�r I
�
i1.
20. 'Rou�h �ctoN �gptace '_ " � .� .,_,� ,� ,APPR(�VALS� " Pertyit ,k�;._ �
.- . . f �-t+=-c- - �
21. Duc2s, in Structurx-� •• ��'�- � • z 70. Udderground.Hy�ro �.
c t �
22. DuCA. Vdntit�tin9 � i- '.. t_ ,= ��' t71. Produc[��@inc� GG�fs C�Od --
� ���� � � � - - -
23. Gat Pipe-Rotlqh & Test + � : ^�-72, Underground Fl�ti� � ' �
' ' - • ^ - . - a_�r-� �� _ .
24. fioof Framing �'; � � '� - .��. � - ' 73.'LndergrnB.Smra��: Tan!c t�7, Gas .:Ql � �-
25. Rooi Shrathing = + _ . � �74 �-Overhead Hytlro ^ -- - -�-� --I -- -
26. `T•B� Ceding IStrU�turall & Mprtocodt ' ;` a a 75. ,D�y Cbem�al : j �; ` '
27. Frame eRd F.Is�shing� - . -. *� 76. Dry Stand@�f�e �-Y��� � -� '�
_ , -'L- -- - �
28. Lathing$S�d�ng-,_ _ �' . ••"'" 77�.FIXEDSY,S?[�Y�.1NAL.'.�- - t
29. Insulation • � • � � � + � ' u 78.'FIRE PREV. FIR,A]_ � - ^ I '
-- +
�30.DrywallNailmg �' . ,� j " - HEALTHDEPTiR'E�UIREVENT
� , { � �----�r----------
�,�i. Piaster 8iu�•.Qt CO�fi � : �r -� : I <�,.7g, FINAL INSP£CTICfJ z �
.•�--_`: - - ' -LC-.' ' __.�1_ •___ _
32: �IectricatPo�mer itAeter Pinal �'�, �'�- , _�� n 'B0. `FOOD CERTIFI�:A1 E IS$UED. ;� _
i _ - �
.33. Final Electr�o - Notcs: _
_ - - '•�- - - - -- --- +
34.� Final Heating-& A1r�Cond�.t`o�iaJ� `� " � � �
" _�� --x t � ---- '
35y Finel Gas Pip'��TestK `
36. Hood or Canopy � � _ � � V �r _
� . .• .
37..finaLFBctory Fireplace� ' � �- � �
38: FinB"f Plvi bYng . . -' ° " �
' 39 �LVate7 Seivice �Finai� . �` ` "
. . c
4D. Gas Service•Final- • S*� ; i w*
- �
41. Solar Damesuc-Final , � �� _�
. . -e-- . �
42. Backflow Preventer - - -
43. Backflow �rrgation' � � K ,
�44. landscaPe Irrigacian Sys[em: � ' '
45. Sound Attepuation - . ' �
46.�Nandicap Regulationt -�
47. FINALSTRUCTURE & BUILDING -' I�J
/
48. EINAL PLANNING d
,_
49. Electric Kelease to Edison -
50.. Gas Release to Souther� California Gas Co
51. CERTIFICATE OP�OCCUPANCY '�
Oate
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City of Costa Mesa
Building Safety Department
P. O. Box 317
Co�ta Ma�a, Californio
CERTIFICATE OF OCCUPANCY N� 2531 C
The Building located at ��'� l�.�i s`.,R.'8'r+
has been inspected and fo�nd to comply with ihe provisions of all Cify of Gosta Mesa Ordinances applicable thereto
for a Group S Occupancy.
Use of Building +^� e���L�ilf S�xiIA�RR
Legal Description �'����b 8 2§ �
. (Sea rever�e �ida for Metes and Bound�)
Building Permif No. ��3�� Electrical Permif No. ��i�h ' plumbing Permit No. h, ,��
Floor Load Signs have been installed as Room Capacify 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 apartment house, hotel, or lodging house shall be used or occ�pied
until the owner or operator has been issued a valid certificate of occ�pancy by the enforcement agency.
(b) A new certificate of occupanry shall be obtained whenever there is a change in:
1) Occ�pancy classification of a building or portion thereof .
2) The number of apartmenis or guest rooms �� .,
3) Ownership .
If Group H Occupancy, number of apariments and/or guest rooms as required under Sec. 17050.1, (d), California
Administrative Code, TiTle 8, Chapter 9, Article 8. � '
Number of aparimenis— and/or guest rooms
ISSUED TO: Building Official
� � � Cr� '� bY /�
� . !1 .. .�.n .y ..i
This Certificafe of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of the City of Costa Mesa under Set. 306 (e) U.B.C. Fonn soar—it�[—tt-es.-s-s r
City of Costa Mesa
Building Safety Deparfinenf
P. O. Box 317
Costo Metd, California
CERTIPICATE OF OCCUPANCY N� 2532 C
The Building located at ��[1iL�,�$ ��
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group �� Occupancy.
Use of Building
legal Description u�� � �
' (Sae ravarse side for Mefas ond Bounds)
Building Permit No. �� Electrical Permit No. � Plumbing Permit No. �,'_
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 apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has baen issued a valid certificaTe of occupancy by the enforcement agency.
{b) A new certificate of occupancy shall be obiained whenever there is a change in: "
1j Occupancy classificaTion of a building or portion ihereof
2) The number of apartmenis or guest rooms�
3) Ownership
If Group H Occupancy, number of apariments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrativ� Code, Title S, Chapter 9, Article 8.
Number of
ISSUED TO:
�:!JT.;IA � e rifr:::: HT Lr.;' c1
and/or guest
•
�L/-='�� .
v-
�. - :G.rY.rnui/a>� �:I . }•t
This Certificafe of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT 8E removed
except by the Building Official of fhe City of Costa Mesa under Sec. 306 (e) U.B.C. Fom� svaa-iM-it-es-.ss r
'� � 34 T
�. , ����''�'67�M5���`'Zs=� ��'�3r7�1.�_
•t .� :; -6 ,JSA��E6fi'�"*�3�731.25
"'; COSTA AAESA BUILDINCrSAFETY DEPARTMEPR � �ia � ` � 1 .�,il • �7::
P.O. BOX 720! C09TA MESA� CALIFORNIA 92l20 [ � _
.� 1'ii :':C' _ _ .: ' � .I./� _ FG}�%��� '" 1 ♦ L i " r:: + y � .i�� i ...
For AppllmM ro Flll /n CompleNly ", ir ArPLICATION FOK PERMIT �;
f:::- _TYPEjOR-PRINT':i '�� e' �•. ia,T -'� �•i �t I.�' - cBU14DIN6 i Cl�.i1G .�
�m�a�na .. For OHIci U:i On�Y. -, t
ADDRHDY G� �sr /9-µ Er ..
'l�l IJf.1i.AiCiII{NO:r.7'� _�[�M�TN.�
COSTA�MESA. CALIFORNIA y., � � , �„ ,.y;.•. ,. -. i� .
'.1` . , nic v.r .� ."e.tsfe ccivpo ! Jli MTt� UQD�
r ;Tn . ._ �3 O�� �O
OWN6R S�/aEL TTuE25 aF Cosri� MEsq� '
euaoina . - � :�•,�, � c -: .
wooa 2�0'1 �:�C�oColL4Do'iT�'����SU/TE' :2U5 � ADOR Q. , a�. .,��»�� � n..,: ..�
'rlly '19J11: )Y. " :T[C3 Jq �]l: 1ZONQ • '•.�'i !�!� ,ryP � .i : U OROUP^�',
eirr P aoEua. eac��r � NO.�_.-_.._ r •.i:lJ .... i•� .c.c��o,z.:
' . ',�novec
�ncMrrecr-:jQ�S ='F'"Ea'2S'au "rTi�-T76-3G5%�� er� � r - ��.: DAT6.�n +�
� HNOINH6R �
;,,. . ;:,' -s .; ;.r , ., � i.�..ZONINfi: �;. <-� io
�rteaa !7!/(.(�EStMOA�'t � ..�:/�/M... - �wx�� : /�.. .No:o►,� c u,co.n�rv � • •`•'
G , Qyr/�' !uw. � au�wino,'
CONTRA ' .� • �', ' .�'�'�.. -. .. -� , , .. . � _ �
�...� "�-.�l'", :.� ; P.:.`.' :�9'.un_ �JL :L60ALiry"✓. Y��f� 7. /�Y1: 1i_CI^B
ADDR L� j� p ��cn�mox 4"'T ���T
� i�-'�11 `JJc� : 1- 11� l,.. :l'.nllu�.l_ (�
CITY ' •�S''• j(��..i��/:s "ibr . y?For�:; .A.B.NO:. ;I��:.J��1a•�n�<�r�:��/L./^fj
_r�+ � � / �a/31 - :. �L�:u �N0T8:NO:GVQOVERNAN6BHACCEBl:Q88THAN C\
STATB �� �� THL. , // � EO• TO SIDB A REAR .,L ���
LIC.NO. i ' :rtin�1N . I :T� 17Yt" �F' .._,i � � �� • .�y ):�.!�C 71i0� l�C � iC
SIZE ',�+�741�Ir•lV'.�g���0�� GINo.'O/elDw;?'�',1 A{ypWeDlTy j=�::]: �fU:B.CSRE�UIREMHNTI \v
OFLOT J yZ _J _NOWONLOT` �� •YAROOMPROVED��r�` �_[��YAXDBAPPROVBD ^
U660R � ,MAINBUILDINO, , ACCHDBOPYBUILDIN6 V
EXI6TINOBLD6. .r., .. _. .-.�._ '
(RROMGLYTR[LTl - -- ' . .. �
86TSACKIJN61R011� CI�I '.Ji,.��i vJJD. fJ' A�.L r .• . ) �)I.':i ?' ^.:� • � �
ceNT[R o� 8TR[�'f �� J R6AP YM I�`� TR �NT'' �O J� "PT.'
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^ � . J 'S' . i3'O'F�i .iJ 'i0 .'OL'J�'_.7!'�
�' ii:�1�J� �i9' ' �>C.(.0,�:::J !11.i1D !�'':. .�..PT. - i�
G1D YAR L!R �RI01TT' - . . �. . ,..
DESCRIPTION OF WORK 481D � -ir:;i �]oi..; :.� nu ��
___ ..7i .. .. �.1:i2 q.i7:lIJ!r I-�_'. .1:1
. YO IX� ALT6RATION ' ACDITION.dJ:"-�•`. •RBAN,I�%..�.IT...'._+.,.,..fr . •,:PT.,,. �'
.9'.L� ....� f.O . 1J 'DIHfANC6B6T. ip ��p.tBET.MAINQ r
FILFAIR �- MOVINO� •.' . �� '�6MOLI X� _ _MAIN BLD06: ACGE89: BLDOB."
r. . . _ _ " ,. 'VAR.# �.Cf.�':37: `..�_ DAT6�.17 �-. :JLt .- r
BUILDINO C^ � �� NO OR, t. �-e Q �
81Z8 ✓�-'i�l/�" ROOMBn���l�8TpR1 ��"�� C: -� i+�r'�'J ,APPROVID - -
� .. � . �e.. vC,i.0 " • . � `�" p'tOT•f J" ",,. . . . _" _ IJ'J9:I 1 /I /
. .,
Ce0 ERINO ALL�O'UG.� .COVHRINO7n M�ROV[D.'••' d/" -..
GoNG..�-� . ........ .. ��'i.. .DAT[..�_!i_:G
UDiO�lUILDIpOANDWORKTOB[PQRFONM�D E UIRENIENI'� W
SEN%OfL`7L%yYZCN "APA.�iNEil7 'J � •HULD�BORISPECIA �j.Q_.. ,:u,� m
� -ri ..V� .r^.. �
lr, ::: y. �� . �'7 ln v�_::) :�. _ .� t kw , SEE .REVERSE��SID ,. .t , .. ,*„ 1 '
�::,kc:Jao �'�•.ii�:s:'r.��Lc .-.....:��_�� .r; 1 _ �y'J •,��:i r ':n.. :i.7':�oq�
-BO..PT. _ �
1 Xmt�Y 11CNNOWL[DOi'TMAT.1 HAV[ RNC 1M1/�A!►IJGTON�'� �TXI AM�UM� �MOWry�UNO�R7VwLUAT10N IG �IOR TXt � �
AND 6TAT6 TNAT TN[ AGOVi JO CORR[CT ANO AOp6[ YO COY. ►UP'Os[ 01, fRAGYOXINO A� P6RMIT�P66 01{LY.,,
YLx WITX ALL e1TY 00.DIHANCY AjID RAT[ M Ri0YL11TN0 y�UATION ' j��
euamNocoxernu h. GO
PBFMIT F86
8I6NATURlOP .L.. �` G� L s��� 293-,�
PBRMITTB o
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` 'iTH01112[DAO[M ( '7��
TOTA1 PEE /
:i
� � J� .. ,lT �1 �f • � p� . ' , _ � - . . �Y� �
SPECIAL REQUIREMENTS: , ^'�'� � '' _ :.
. .:."
� ' � • � ... . .�.ao�.0 �.� .� , . -.., i_ " �: '/ -
1. Shall meet all the requirements,of the State Fire Marshall Code,
Tit1e T9.`= ' ' � - � '
2. Shall meet_al�l.applicable requirements of the City of Costa Mesa _
Uniform Fire Code. " -, .
•'" 3.:Shall�provide:adequate fire hydrant-coverage as,per the Yequiie-
ments of_the-City_of_Costa_Mesa. ` • •- � '
4. D'edication of' 10;.'00 feet;on West 19th Street for.parking bay and
� _ ._ . �- -- --- - - -_ ��1 :.•„ : . _ _ .�.
-- -sidewalk.-- - - - " : a'�c - - -- -- ---- • ------ . _ _.-- -
__S...Installation.of_ornamental_stteet lights,served�undetground.on. •
' West,,l9th Street, by the applicanf, at their expense,, under t}ie .
"- "'direction of the Stieet ;Lighting -Superintendent -an3=the•-uumber =�'--" .
. _ of.ornamental. street_.lights :required is also under:;the.direction '',�
' of the Street Lighting Superintendecit.- -- �`-~ �' `
�'-'6". InstaTTatiori of conciete "sidewalks_adj'a'cent^�to all�frontage_���.__ - _ _
F_ ._per standaid.specifications of_the City of'Costa Mesa, by,• '_ '
•
applicant, at their expense,�in.accorda`nce wi'th'City Engineer',and' -"'
� ,-- ' Traffic Engineer' e -requirements:.. _ .�__ _ _ __ _ _ . ___ -_ _ ' ._ - _'__ .
,__7..Applicant to_construct_,_at_their expense, per standards of the
sCity of Costa Mesa under.:the directfori of the City Engineer; a ''-_
20 foot paved aIley in the rear adjacent to all fiontage they._,
'� _._rare developing_east from their project line:,to Pomona•Avepue.•;`
i - and that-said portion of the alley-as outlined above; sha1l-be- -
, _} - � "dedi'cated'to the City; of, G,osta,Mesa. _ _ , . � , � '
8. Ingress and egress to Pomona Avenue.,and Meyer Place under the
direc[ion of �fhe�Tiaffic^Engineer.—�� `'-=�'' " -- --- �
f ,---9.-Tree.�planting_compatible_with.the sur-rounding area as-indicated.
� on the plot plan. — - --- - - - -
''-10'.- ATl ufilities skall be anderground.--- -- -
� 11._The:entire_Fountain and Pond and landscaping,in the as center of .
the main:entrance shall be completed on thie phase. �
12. The extent of-laudscaping.on the'remainder of•the 316:70' of�the '
,',.site shall be under,�the direction�of the Directoi of Planning:�
13. �If the second applica[ion for the proposed second siinilar building
-is not-made within-two•yeara from the_date of.the option"`to '
. r•.purckiase the adjacent land, that the, applicant acquire -the ,right� of��
• � way for tfie circulai-driveway: -" ' `- -.. ._ '- = - " `. - -- -- "
14. Letter to be;fiTed�by applicant with the City of_Costa.Mesa that _
upon demand b the Cit should it be necessary additional on-site
- AIl,tfl�r��veW��d��tiB�i�°���edto be complied with.prior to final :'.- "'
-..occupancy being released:' . � ; .
'; . - ` ,- . . - ' ;
. . . ' ,� `
.
.. �
f' GOSTA MESA BUILDINCrSAFFfY DEPARTMEPR
P.O. BOX 11M COSTA ME$A� CALIFORNIA Y2L2!
For AppBeaM fo F(11 In Compl�Nly
TYPE OR PRINT
wnoa�s° G 66 (,JEsr /Qth ST/lEt T
COSTA MESA. CALIFORNIA
2G!
n�
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R �er�E, ef(ee
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33%,4/� 385 I no.oreWa
ueur nu . m
DESCRIPTION OP WORK
iO 4o z
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N�
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1 X[RIRY �CRNOWL[DO� TMAT�1 NAV[ p�/�O TY(I� M!
AND BTAT6 TNAT TM[ 11lOV�.IB COpR[CY AND AOR[i
PLY WITN �LL CITY OROINANC�t A�1D RAT[ IAWr 11[i
euaoixo �owsrnurn .
BIONATUR�O� � _�^. � C.�6,
PBRMI7TH
AUTH0111Z[D AOtMT ' � �
PRIO
APR -7•67cn'sa�0 429:> :: : �` 173.
rata
f�ES•=6'G7c��sa00` 267�`=>'_r?*-�_�.?�
NPLICATION FOR PERMR
6UILDING
For ONin U» Only
R[C[II� NO. �Siltl�T NO.�
3
ZONING �� ,
�
�. P. �o. i i s-�� a-- a�+�-s�
wara� Ho ewva oveeHweto et+wu ea �ssaTHrw
80• TO HIDB ! REAR P. L �\
ALL WED fU.B.C.REQUIReMRN'f) \ AJ
YARCfMPROVlD YARDBMPROVHD \
MAIN BUILGINO ACC6880RY BUILDINO ��
( PROM C/L iiR[Cj) I
„T 7 ��,�9 .�. �
v
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R. ID
�eic 30 � , rr ��
--- � � _ �
VM.�j I DATe
�Y Zi/'O� � � � DAT[ i'Io—IO
H D FOR SPECIA REQUIREMENT� , a
w
See main building for conditions. �
ea. rr. s
rxc wroupr �xowrt unomt vwwwrww �e raa nic
N11Nel OI i/TAGYDNINO A �6RYIT /4 ONLY.
VAWATION �
� PERMITFEB II',J �� m
' �Qj OO�I .�7 �� '
TOTRL PEH � 7
:
� . 2744 I
♦' COSTA MESA BUILDING-SAFETY DEPARTMENT
V.O. BOX 1200 � COSTA ME6A. CALIFORNIA 92626
For ApplicaM to F711 In Compleroly
TYPE OR PRINT
eui�oiNa 1'11
ADDRPSC
COSTA ME3A, CALIFORNIA
NO. 01 �LDW.
r aere�cRuncrnor
DESCRIPTION OF WORK
WALL
1 HEPCBY IICKNOWL6DOQ TXII
AND BTAT6 TNAT TM6 AGOVB
PLY WITM ALL CITT ORDIIUN�
BUILDINOCON6TRIlGf1 N.
SIGNATURE OP
PERMITT6
wurHortizco woarrr
NO.O�
R�OOM�B
I WOOF
rx�c
\.�� AUG 15-67� j«OO 867 �'-:�`: �� ��.�0
APPLICATION FOR PERMR
BUILDIN�i .
fOr Offlce Ute Only
R[C[I'T NO. I /�
Y - �
ruw
AP.NO. Il �
HOT6: NOBAVHOV[RH,
80' TO e1D6 a RBAR P. I
6AVE8
ALLOWiD
YAR08 MPROVHD
MAIN BUILDINO
vwn.#
0
�f��� jfLL4�C
! !
SMALL BE L688 TXAN
(U.B.C.R60UIR6MENT1
YARDSAPPNOVBD
ACCEGSORY BUIL�IN6
DAT6
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TH8 AMOIIM BMOWN UNOBfl VALUAT�ON 18 PON TH6 j
�URP088 OP 69TABLIBHINO A PEflMIT PBB ONLY. �a
VALUATION ^�+ q—� �
� PERMIT FEH S IV' U(/� p
��/�- °
J �/ �
Tor��Fee �:l-
� `COSTA MESA BUIIDINGSAFETY DEPARTMENT
p, O. BOX 72M COSTA M63A� CALIFORNIA 92E20
��
For Appllmn� ro FIII 1n Completdy
TYPE OR PR�IN��T
ADDRH,OH Y� l!/ {� W // —
GOSTA ME6A, CALIFORNIA
L(%��
�S 1•
�-aYn L'a'a � /1'/A�
30 �s a. (.�-` .
�'�r�.¢�.
rwor
DESCR1P710N OR WORK
ar� 23�00,1308• ****3150
A►PLICATION FOR PERAAfT
BUILDINO
for Offlcs Ur� Onfy
11[c[I'T Ho. p
0
A. P. NO. //J � N
NOTE: NOEAVEOV80.
80• TO B�DH Q RHAR F
lAVEB
ALLOWBD
YARGB MPROVlD
NAIN BUILDIN6
v�n. tt
uss or xtw
euuo�Na
8XALL B¢ 1688 TMAN �
�
(U. B. G. RBQUIRBMHM) �
YARDS APPROVHD
ACC6 RY BUILDINO �
DATH
^ / ' �+ ' IG (j (�-4 V '
�/ !/ � 4l 1��� .
80.iT.
1 N[R6GY ACRNOWLtDO[ TNAT.1 XAV6 Rf11D T1�1/ A►ILIGTOX TXt AMOYNT �MOWN UND6R
I�ND BTATC TNAT Tli 11GOV�,10 CORfl[C1' AND p[� YC COY. IUPPOt[ OP ifiAOYONINO
PLY WI}H A�L CITY OIID Ap0 �TATi II�OYGTNO yALUATION
emtcino �onerqu
810NATURlOr P6RM
PBRMITYH /
AUTN011�3[OAOtNi s ✓ O�
TOTR
�,
! p�
W
�
�
�
IG IOR TI[ �
PfiG ONLY. �
a >- �
fo• 5� w
� �� - � 28536 �r -s. '" ��� ��* � a6.00
•' COSTA MESA BUILDING-SAFEiI' DEPARTMENT �E�7� ��V %�E''���� T
P.O. BOX 1200 � COSTA MEBA. CALIFOflNIA 926Z0
ior Appllccnf to Flll /n Complatoly APPIICATION FOR PERMR
TYPE OR PRINT BUILDINO
eui�ciNa ��� �/ � % fo► OHIm Use Only
AODREH9 �,„_
n�cairr Ho.
COSTA MESA. CALIFORNIA �� J
11[C[IY[D�Y �d1T[R6C[IV[D DATCJ88U6D
�' U9EOP
7G 3�.s1
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e
No`.�-�7- G� sk>
DESCRIPTION OF WORK
BUILOINO
81ZE
EXTlRIOH WALL
1 HlR6HY ACKNOWL6D0{ TNAT 1
AND 8TAT8 TXAT i116 AGOV
PLY WITX I�LL CITY OROI Cd
BUILOINO CONDiROR10 . .
� AUTHORIZiD AO�NT
TX19 MPLIGTON
ID AORlB M COW
V[D //� � 2 _`.�
c- DATE_
ZONING
NO.O� UY[OIN[W �
_/ �uru Q e �oi o�
,-
TON ` �
o. //�- �- ,1 t/ J- o�s �
HOGV60V[RHAN68HALLOHL688THAN �"
YARDH MPROV HG
MAIN BUILDINO
vwn.#
�
U.B.C.REQUIRQMENTI �
YARD9APPROVHD
ACCHD80RY BUILDINO
PT. I 1 '
�.
owre
er / DAT6
a
w
�
�
eo. Rr. �
TH6 AMOUM OMOWN UNDBP VALUIITON 18 IOR TX6 j
■UPPoG6 OP SHTABYBXINO A P[qMIT �BB ONLY. 3
VALUATION �
PERMIT FEE • p
� �
W'
0, D� `— � , o
TOTAL PEE `�
. 286��
. .+ C�OSTA MESA BUILDING-SAFETY DEPARTMEM
P.O. BOX 1T00 COSTA MESA� CAL�iOflN1A 92620
Por /lppllmM to Ftll ►n Complehly
TYPE OR PRINT
�VILDINa i� �
ADDRBYS C
COSTA MESA, CALIFORNIA
_.._.__'R. n��.v� , .�.1 E/n'
61 MAIL
w BBTBACK LIN6
DESCRIPTION OP WORK
�
REAAIR
BVILDIN�
% �/�'/`.
1 N6RSeY ACkN01YL�DOi iNAT.I
ANO BTAT[ TNAT TM[ AlOVi le
� AUTXORIZHO AP4iY
cor-
RAX21.-�iJD1.t23 o****k3.00
ArPIICATION FOR PERMR
BUILDINfi
For Off(n Us� Only
/
� DAT6 � �2�' �� .
ZONING
NO.01 VOIOIH[W
lLAN� � OUILDINO
L60AL
YARDOAPPROVED
MAIN BUILDINO
VAR. #
� �
— y�C(.� 1 S' �
sH�u ee �eas TH�w _
tu. e. e. aecuireeMarrt� \
YARDSAPPROVHD ��%O
ACC6DHORV BUILOIN6
1
�. � �
� d .
OAT6
D � � a
w
ea. rr. �
n�� �wouert �xowH uxoea vewenon ie von rNe �
�YRPoG[ OI �RApL19NIN0 A P6RMIT !6Q OHLY. �
VALUATION �
PBRMITR86 ��nG �p
$ ��� e W
.� o
TOTAL PB6 0/ . GO
Z .
aU
Z
Z a
ON
am
J7
J V7
Q�.i
f
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J 0
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: �14n2
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. eOX 1200 COSTA MESA. CALIFORNIA 92626
FEQ 19-70�hwO0 576$ �***ZC.S�
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEI EO BY DATE RECEIVED DATE ISSUED
ADIDRESS � W S� _ _ �� / _�/��
� E K %�.S
' _ .� PE � I T^i•!.!/
OWNER �/vlj; A.P.NO. //
MAIL / �� ) �`
(-'� � ADIDR'E S 6 � W I`I
ADDRESS (f �{! • U +T - -
CITY �U(J � NO�j TFiACT (LB L T A BLOCK
CANSTRVCTION W ADD A P
LENDER
BRANCH "' �
OWN E R ,(.�.c.p- . "'�
ADDRESS ' VALUE pv
APCNITECT TEL S $
Ofl ENGINEER N .
FIqE �
ADDRESS ZONE ' TVP GROUP
APPROVED 2—/�
CONTRACTOR �� 6, � N �U BY �ATE {
ADORESSa Q� /�- / ,-� /p
TEL.Q��y " ZONE NO.OF USE OF NE ,N
CITV 6 3rC �l NO.(7a7Q��T� C� PLAKS C) BUILDING
�IC. NO. /13 Q LICYNO. vMA NSBUILOING ACCE SOPV BUILDING
SIZE NO.OF BLDCaS. (FROM C/LSTREET)
OF LOT NOW ON LOT ROfYT FT FT.
USE OF
EXISTING BLDG. FT FT.
SIZE OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE F. FT.
EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING ANO WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
� MAIN BLDGS. ACCESS, BLDGS.
C < /Q �.y, VAR.aF` DATE
/` �/� � G /CJ C.U.P.� APPROVED
,� O 6� APPROVED �) D
/
I hereby acknowletlqe that I have reatl this application antl stete '
that tha above intormation is correct antl agree to comply wlth
all laws regulating building construction, and I shell not amploy
any person in vlolation of She wo�kman's compensation laws of
the Stata ot Californla.
I hereby certify thet I am properly licensed as a conbactor untler SQ. FT.
ihe Stata ot California eusiness and Protessions Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNDER VAIUATION IS FOR
Chepter 9, antl that such licenses ere in full forca entl etfact, or I THE FURPOSE OF ESiABLISHING A PERMIT FEE ON�V:
am exempt fr�vi5i�5tate elifornie Business VALVATION �"Q
ana Professio C , D visl Ch ter 9 O O PERMIT FEE $
Signatur o QU ^
Pelml T 5/� PLAN CHECK $ ��
Authorized ABent �
TOTAL FEE $ ��
�
.' - �2 2
, COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. 80X 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING _ � _ .��
ADDRESS
,I �/n
OWNEF � ��L. '�G/` �/
MAIL ' � _ � /��
Z ADDRESS • r + -
W W TEL. �/�
d U CITV G(i J Ir NO. �/
Z Q CANSTFUCTION �" �/' n7
O� LENDER L�--_ • " �/
am
J 7 BRANCH - `
J �
a � ADDRESS �
tt`
ARCHITECT :��� TEL.
- N OR ENGINEER N
U Q
w K ADDRESS ���
aw /
J O CONTRACTOR (�� l!/ E%y-`
mZ
J � A�DFESS
W w
� TEL.
Z � CITV NO.
W � STATE CITV
N 2 LIC. NO. LIC. NO.
� � SIZE I NO.OF BLOGS.
OF LOT NOW ON LOT
a�ov —a-7�00 o9s ���***5.00
APPLICATION FOR BUILDING PERMIT
RECEIVED BV DATE R EIVED DATE ISSUED
�o— � o �r, v. � o
BUILDING
ADDRESS
TRF
FIRE
u
—�//// rl —
(JE NO.OF
PLANS
VAFDS APPROVED
MAIN BUILDING
, /9 �'
pG ^
OT /7 BLOCK
^,
VALUE
$ \\
�
GROUP \
� DATE � a y.�
V
�� \
USE OF NE��z_ CA/22C.
ACCESSOflY BUILDING �
Qe-e-�i C�/ � '
0
EXISTING9LDG. L (q , S rF �T
H SIZE OF NO. OF
Z' NEWBLpG. ROOMS STOFIES L.SIOE OFT. FT. --
U EXTEflIOR WALL ROOf
COVERING COVERING REAR D FT. FT.
J VSE BUI�DING AND WORK TO BE PERFORME DISTANCE BET. BET. MAIN &
�c � 676S�G MAIN BLOGS. ACCF�. BLDGS.
�� . VAR.� DATE
O r 0.U.P.# APPROVED
NAPPR � /_. �Q
� ff LD FO � r-
F �
U1 hereby acknowledge that I have reatl this application antl state f4 �.Q. �t ��� ^'
thai the above information is correct antl a8ree to comply with d �� f
� all laws regulating building construction, antl I shell not employ �+U-� � +�� � - �
F any person in violatlon ot the workman's compensation laws of
y the Siate ot California. �,�/ �
z I hereb certif that I am Sd. FT. / Li�• Y✓ o
V y prope�ly licensetl as a contracto� untle�
the Stete of California Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses ere in full force antl effect, or I THE PURPOSE OF ESTABL6HING A PERMIT FEE ONLV: m
am exemp< from the provisions of the Sta�e ot Calitornia Business �
and Professions Cotle, Division 3, Chapter 9. VALUATION f � �
//,�� � �� ,�f _ / —? , PERMIT FEE $ �S �
SiBnature of � �/J� ���2'�'I � �_ m
Permittee ��/"/L (7 � 1� �y,(�,Q�� $ J/0�\ p�,qN CHECK $ E
i a
Authorizetl Agent � � j�— LL
TOTAL FEE 5
', ` � �28 � 3 rnir,
COSTA MESA BUILDINGSAFETY DEPARTMENT ��R �'-r'���ttaSnOO 363# **� �34.50
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
ForApplicanttoFillinCompletely qECEIVE BV DATERECEIVED DATEISLSUED
AODRESS � - yrh /�� � /� / �—/[✓�Q—�/
OWNEF OI�'G J A.P. NO �J ��� PE�'l 1 i
MAIL BUILDI G /�� �/�
ADDRESS G�G _ w_ � y rS �+DDRESS �p
d U CITV COT�� GS.a NOL6YZ-�� TRACT LOT � BLOCK
2 Q CON5TRUCiION A
O N LENDER �/� `%
a m T�
J � BRANCH
J � OWNER i
Q'"�� ADDRESS
� � VALUE
ARCHITECT TEL S 5
— `� OR ENGINEER N
V � FIRE
Q
w Q ADDfiESS ZONE • TVPE GROUP
d w APPROVED A
J O CONTRACTOR �� � f BY DATE � � �
m Z �7 /
J ¢ ADDRESS �%/�G✓ /�fy���e'� {,pq.rT `
W W ZONE NO.OF USE OF NEW
�= TEL. C�� p4q� BUILDING �
Z� CITV LOa 9 co[ � NO. �2%'328E
W� STATE CITY '/ YARDSAPPROVED VAROSAPPROVED
j O ��c. No. 2f3? 9 p LIC. NO. ��U � MAIN BUILDING ACCESSORV BUILDING
SI2E NO.OF BLDGS. (FROM C/L STREET) �
OF l0T NOW ON l0T R M' F. F.
USE OF
EXISTING BLDG. rS. S F FT.
f' SI2E OF NO.OF
Z NEWBLOG. ROOMS STORIES L.SIDE F. .
U EMEflIOR WALL ROOF �
COVERING COVERING REAR FT. FT.
J USE OF BVILDING AND WORK TO BE PERFORMED DIST BET. BET. MAIN &
MAI BLDCS. ACCESS.BLDGS.
�VT— �Y � VAR.qW DATE
O J�'(, C A/ C.U.P.qW , APPROVED
~ APPROVE 2
(A � . J ^ �
Z
O
UI horeby acknowlatlBa thet 1 hava read this applieation entl stete
� that tha above iniOrmation is correct a�e eeraa to comply with
� ull laws .aBuleHnB builtling consvuction, antl I shall not employ
� nny parson in violation o� the workmen's compensation lews of
y Me State of Calilor��e. w
e
Z I hereb certif xhat I am SQ. FT. o
V Y p�operly licansetl es a contract0� untle�
[he S[n[e of Celifor�ia Business entl Professions Code, DlvislGn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chaptar 9, antl lhei such licensos ore In t�ll forca and aifxt, or I THE PVRP�E OF ESTABlSHING A PERMR FEE pNLY: �
om axempt from Ihe provision a$tatn of ColitOrnia BuSinesa Q
ondProfessionsCotle,Divisi 3, apter9. VALVATION � �) N
�/�y PERMIT FEE $ �� L`-C/ ]
SIB�oture of J{�/ � � � m
Pormittee �`� $ � r0 ��— p�qN CHECK $ I� S O E
`o
Authorizetl ABant � �O LL
TOTAL FEE 5