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Home My WebLink About698 19TH ST - Building Permits� CITY OF COSTA MF �A , Development Services, Division of Building and Safety CERTIFIGATE OF; OCCUPANCY This certificate is issued pursuant to the requirements of the Uniform Building Code, Section 308 adopted by the City of Costa Mesa cerfifies that at the Hme of its issuance the building sfructure herein below desaibed was inspected and approved for occupancy as follows: . � ��_Y� �'t* �G -i BuildingAddress 698 W. 19th's'Street - � B1dg.PermitNumber B06-01773 Use Smok.e loung¢/�Retaiil ,'ar��' � � -"�(�46.0 sf) �.` ��?,. Group B TypeofConstruction' �-N"'�' '�'�itgEoh50 OwnerofBuildingNichol'as P�,--DiP3'e�t�so � � '�� Tenant 1800 Penninsula.'Place, Costa M'esa, CA Address + �- �� C1 Use Zone SU�LT.ANA HOOKAH LOUNGE 92627' '` ��`a, _..,� hs � � �: , ;,,''By _ BUILDINGOEFICIAL-Khanh�Q NgUj�ell;_C B �, . , 02/O1/07 Date , . -,ir..,: - ., - ' :'..._.. '� ,-;"- �.. .., ._._ . .,:, � . REQUIRED TO BE POSTED IN A CONSPICOUS PLACE u �, (714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 .lob nddress: 698 W 19TH ST Suite: Vicinity: Primary Occ: B Eat<50/ Offce/ Bar<50 Parcel Number: 422242�0 Applicant: JAMMAL, ANTOINE Address: 2684 HARBOR BLVD COSTA MESA, CA Owner: DI PIETRO, NICOLAS'P Address 7800 PENINSULA PL - COSTA MESA, CA C o ntra cro r. O W N E R-B U I L D E R Address: - � � Zip: Arch : Address: Zip: Type of Construdion: V-N Zoning: f G Phone: _ '�,,., License: Phone: 714=390.7874 Zip: 92626 Phone: , Zip: - 92627 Phone: License: 000000 ISSUED BY: Eng: ACP ENGINEERING Address: 39808 NOTTING HILL MURRIETA, CA 92563 Status: ISSUED Applied: 10/19/2006 Issued: 1 0/1 92 0 06 Phone: 858-610-5733 License: SCOPE OF PERMIT 960SF INTERIOR T.I. FOR "SULTANA HOOKAH LOUNGE". WORK TO INCLUDE: CONSTRUCTION OF NON-LOAD BEARING WALLS FOR 1 NEW _ UNISEX HANDICAP ACCESSIBLE RESTROOM AND 2 STORAGE AREAS,.EL, MECH AND PL WORK. ,� - FEESUMMARY - ` Pian Check: $72.31 Calc Valuation: ga,eoo.00 Permit: $111.25 ' Claim Valuation: ga,5oo.00 SMIP Res: � $0.00 - � � �_- - � SMIPCom: . . $0.95 �_ _____ _ — __ �_.-_ _ ._ �, Other: $0.00 ' � � Inspection: $0.00 ; �� Total: �. � 5184.51 � - _ ,',,�� PLANNING & ZONING SETBACKS �,;� � , _ /� MAINSTRUCTURE Front. 0-0 �� ReaF 0-0 ' - Lefl _ 0-0 ',� Right�:�„0 0� , �� , � , i �� c. - . - _. - " ` /, ACCESSORY'-'��, Front 0;0 �� Rear, 0-0-_ � Left� 0-0 - . �-Rigtit� 0=0 ;��. - � - . ' ' � , li � � / . PARKING Existin :- 0 Reauired:- 0� Pr000sed: 0'. -' ' ' , , � , " - � � i, � _ ' '.. �,. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(ornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) ' /�� EXPIRATION: This permit shall aUtomatically expire and become void if work is not commenced within 1 BO days,�or it work is suspended or abandoned for a period of 180 days. � � � INSPECTIONS: In order for the Work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754562fi 2aa6-ae la�ool WORKERS' COMPENSATION DECLARATION: . . I hereby aHirm under penalry of perjury one of the following declaretions: � �� . -. .� . � I have and will maintain a certificete of wnsent to selFlnsure for workeis' compensetion, as provided tor by section 3700 of ihe Lebor Code, for the�.pedortnence bf ihe work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, es required by section 3700 oF Ihe Labor Code, for the peAortnance of �he work for which Ihis permi� is IssueO. My workers' compensation Insurance carrier and policy number ere: � � Cartier: (Tiiis section need nof be .�r^,` - ��1"I'ceitity.that in ihe p� � mpensation laws compty with thesa � nt;S�A e re� � ,..r•, �. _. WARNING: FAILURE T SEC T/iOUSANO DOLLARE (b1 .1 Ihe IN ADDITION TO THE erone oile55.) Policy Number: �hich ihis permit is issueQ I shall not employ any person in any manner so as lo bewme subject to the workers' It I s�oultl bec � e subjec� ro Ihe workers' compensation provisions ot Section 3700 oi the Labor Code, I shell forthwith D'aie:_ 4 �� - � I- �O � NJ COVERAGE IS UNLAWFULlWD SHALL SUBJECT AN EMttOYER TO CRIMINAL PENALTIES AND CIVIL FINES lIP TOONE HUNDRED OF COMPENSATION, DMMGES AS PROVIDED WR IN SECTION 310fi OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Sedion 7000) ot Division 3 of ihe Business and Professions Code, end my license is in full . torce and eNact. Lic. e Class q Contractors Signature: Date: CONSTRUC710N LENDMG AGENCV: ❑ I hereby aHirm that thera is a constmction lending agency for the pedormance of the work for which this permil is issued. (Sec. 3097, Civil Cotle). Lender's Neme: Lender's Address: Signature: Date: OWNEH-BUILDER DECLARATIONS: I hereby aRirm �hat untler peneliy ot perjury thet I em E%EMPT FROM THE CONTiiACTORS LICENSE LAW for iha tollowing reeson (Sec. 7031.5, Buslness entl Professlons Code: Any ciry or counry which requires a permit to constmct, elter, improve, demolish, or repair eny stmcWre, prior to its issuance, also requires the applicant tor such permit to tile a signed statement that he or she is licensed pursuent to Ihe provisions ot iha Contrectors License Law (Chapter 9(commencing wlth Sectlon 7000) of Division 3 of ihe Busineu antl Professions Code) or that he or she is eaempt therefrom and the basis tor the alleged e:emption. Any violetion of Section 7031.5 by eny epplicant for e permit subjecis ihe applicant to a civil penalty of not more ihan five hundred dollers ($500).): ❑ I, as owner of ihe property, or my employees wiih weges es iheir sole compensation, WILL DO T1iE WORK, end the structure Is not intended or oftered tor sale (Sec. 7044, Business and Protessions CoCe: The Contractors License Law tices not apply to an owner ot property who builds or improves thereon, and who does such work himsalt or herself or ihmugh his or her own employees, provided that such Impmvemenis are not intended or oNeretl tor sale. tl, however, Ihe builtling or imOrovement is sold within one yeer of completion, ihe owner-builder will have ihe burden of proving Ihat he or she did not build or improve for purpose of sele.). ❑ I, as owner of the property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business end Professions Code: The con�ractore License Law tloes not epply to an owner of pmpeny w�o builtls or improves thereon, antl who wniracls for such project with e contractor(s) license pursuant to the Contractors License Laws.). ❑ I am ezempt under sec. Busineu end Professions Code for ihis reason: Signature: Date: Owner ID venfied by drivefs license. ❑ Ves ❑ No Driver's License Na. Expires: Venfiwtion of Ownership by (rype of tlocument, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more feet in tlepth Into which a person is required to descend, will be made in cannection with work authorized Dy this pertnit, antl that no building siructura, scaHoltling, falsework, or tlemolition or tlismantling Ihereof, will be more than ihitly-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Ttle 8, Galibmia Administrative Code). ❑ As ownar-builder, I will not employ enyone to tlo work w�ich would require a permit irom the Division oi Indusiriel Satety, es noted ebove, unless such person hes a permit to do such work from the division. Signature: Date: Division of Indusinal Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AU7HORIZATON OF EHTRV: I cetlity under penalry of perjury ihat I have read ihis application end state that the information given is correct I agree to comply with ell stete laws entl ciry ortlinances relating to builtling construction, antl authonze representalives of iha Ciry of Costa Mesa to enter upon the above-tlescribed property for inspection purposes. I egry�not to occupy or allow occupancy of any buildinq authorized by this permit until finel inspec�ion. LO�E �. INSVECTIONTVPE 1616 Fixed Sys(em Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 201 Final BIocWRetaining Well 202 Final Factory Fira Place 203 20a Final Sign Final Damolition � COpE II INSPEC110N TY7E 206' ' Final Mechanical 208 Final Plumbinq 210 � Final Electrical � 212 Final Fire Prevenlion 220 222 250 Final Planning Approval Final Site Ln 0 lA�l� ..'.�J ,_.. � •R. , . JobAddress: 698 W 19TH ST Status: ISSUED Suite No Applied: 11/21/2006 Vicinity: SULTANA HOOKAH LOUNGE Issued: 11/212006 Parcel Nunmber: app�icant: JAMMAL, TONY Address: �'"�;i� ` �i �/ ' Owner. DI PIETRO; NICOLAS P � Address 1800 PENINSULA PL� � � ..i �� COSTA MESA, CA � � � " ,' .�' ;, ��-�� . _' i, Contractor. �OWNER;BUILDER � ; ii�: � � � Address:' - /�. / : ��' � /%/ i � � /�i. � �' � - Phorie:� 714390-7874- _ . , �, � .. . .. -. _ _ ./� ' ZjP- . ' Phone: ` Zip: 92627 Phone: Zip: � License:000000 , ^\ .. L ISSUED BY: � �, .. � ; \��`°\.� i� - , \ \ � _ , � � � , . � SCOPE OFPERMIT �" �- 960SF INTERIOR T.I. FOR "SULTANA HOOKAH LOUNGE". WORK TO INCWDEI CONSTRUCTION OF . ,, NON-l:OAD BEARING WALLS FOR 7 NEW UNISEX HANDICAP ACCESSIBLE RESTROOM AND 2 STORAGE \\ ` AREAS, ELEC, MECH AND PLUMBING WORK � ' ' i REF: BOB-01773� ' �� , � , �\ � � - 9LIGHTFIXTURES.S�OUTIETS;.3SWITCHES -� - -.- . - . . , � i, i - - o ' ,G ' , i' `�. FEE SUMMARY ISSUE FEE Temp service test , �Res. a/c packa9e New Res�(1-2 units) New Res (3+units) Pool I Spa Lighting Fixts � ' Recept Outlets � Switches - ., � Non Res Appl �, �uantity . ' S23.50 . - ' � � $0.00 _ _ � $0.00 .. _ . . _ _ $0.00 0 50.00 0 $0.00 0 89.90 9 55.50 5 _ 53.30 3 , ��.� � $0.00 0 .� ;';`? �� < Res Appl�`, � ^ , ��$0.00 0 r; •S'� -' ; �� - Serviceto200a� ,� ��$0.00, ,�--:-.0.�^;' .,. Service to t000a � - $0.00��: 0 � - Service over 7000a� �'/�50.00� � `:� 0 �__ " � - Motors to thp - 50.00 �' ,� 0 ' MotorstotOhp ` ��_ `" ,50:00�� 0 `� -' � �" - Momrsto50hp A��%50.00�i - �0�-�"'��-: Molors to 100hp 50.00�. ,,� 0_ - - Motorsovert00hp � � � 000 � 0 ' Communication drops Sub panel to 200a Pole Light Pkg Sign Circuils Temp Pw� Pole Intermed Pole $. i 50:00 � „`0 �, _-�i _ . $0.00.` 0,�; -� $0.00 � `� . p - , � Quantity �, Temp Dist System / Cighting 50.00 0 -"� Busway1100ft , . ` 50.00 0 � Standing,Seotion - 50.00 0 ,� Misc Electrical Equipment 50.00 0 6 � Trensforviers up to 1 kva/kw � 50.00 07 �� ..............:up�to 10 kva/kw � 50.00 0 . � .................upto50�kva/kw � 50.00 ;.0 .� � ..............:..up to 100 kvalkw ' 50.00 � 0' � :.......:.........over 100 kvalkw 50.00 � � 0 . Low Voltage Equipment 50.00-� ��, � 0 � � Low Volt WiringSystem I Ckt 50.00'� 0 . Misc. Conduit �� .� - - 50.00 0- � Misa Conduclor � � - . - '30.00 0 � � Circus ( gen or dde) -'-" 50.00 0 Ciras (mech ride or lights) .' . 50.00 ,� 0 Christmas Tree Stand � . 50:00 .. �0,- �, Fireworks Stand -%�i " -��50.00 i A�� Other Electrical Fee � � -- 50.00 � ; „ , , Investigation Fee � , � 50.00�',- Plan Check Fee 521c10' � Reinspection Fee � " � 50.00 50.00 � -0 -- - 50.00 ��0-�_ '<� , , - � - T07AL CALCULATED FEES E63.30 S0.00 0 -� -- �-•=_. '��- _ COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92•28. § 1, 72-21-92) EXPIRA710N: This permit shall automatically ezpire and become void if work is not commenced within 100 days, or ii work is suspended or abandoned for a period o1 180 days. INSPECTIONS: In order tor the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetione and (inal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (7/4) 7545626 24664816100) WORKEflS'COMPENSAnON DECLARAnON: I �ereby attirtn under penalry ol perjury one ol the following doclaratlons: ❑ 1 heve 9�tl will maimeln a certificate of consent to solbin5ure lor workers' compensation, es provitled br by seciion 3700 ot the Lebor Cotle, for the peAormance ol tho work tor which this pertnit Is Issuetl. ❑ I heve 8�d will maintein workers' compensatlon insurenco, es roquired by soclion 3700 0l ihe Le6or Co�e. lor Ihe perfortnance ol lho work for w�ich this permit Is IssueO. My workers' compensatlon Insurence carrier entl pollcy number ere: Certier. Poliry Number: (ihis section �esd not be completed 1! fbe Oermif is ve/uetl af o�e huntlretl tlollars (Sf 00) or /ess.) ❑ I ceNfy ihat in the peAartnance of Ihe work lor w�ich this permit Is Issueq I shall not employ any person in eny manner so as lo beComa subiect to ihe workers' �pepsation laws of Callbrnla, end egree thet II I shoultl become su0�ect to the workers' compensetlon proNsions oi Secqon 3700 0l the Lebor Code, I shall lonhwith cpmpy with ihesa provision9. Applicant Sig�eture: �ate: WARMN(': FAILURE TO $EWRE WORI(ERS' COMPEfJSAiION COVEPAGE I$ UNIAW FUL M1D SMALL SUBJECT AN EMPLOVER TO CRIMINAL PENNLTIES M'D GVIL FlNES UP TO IXJE HUNDRED TIIIXISAND �RE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, DAAaGES 0.5 PROVIOED FOF IN SECTION 3']Ofi OF THE LABOR CODE, INTEREST, AND AiTORNEV'S FEES. LICENSED CONTAACTORS DECLARATION: I here6y aHirm �hat I em licensed under provislons of Chap�er 9(commencing with Secfion 7000) of Division 3 of the Businau and Professions Cotle, and my license is in full force and ettd�i. Lic. k Class a Contractofs 5�g�aWre: Date: CONSTRUC'nON LENDING AGENCY: ❑ I hereby aHirtn thet there is a con5iruction lentlinq agency lor Ihe peAortnance of ihe work tor which this pertnit is issuetl. (Sec. 3097. Civil Code). lentlers Name: Lentler's Adtlress: Signature: Date: OWNER-BUILDER DECLARATIOl15: I hereby aKrtn thet under penelry of perjury Ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for Ihe following reason (Sac. 7031.5, Business and Professions Code: Any dry or county w�ich requires a permit to construct, aller, improve, tlemolish, or repair eny structure, p�or to its issuance, also requires tha applicant tor such permil ro fle e signed statement that �e or she is Iicensed pursuent to Ihe provisions oi the Contractors License Lew (Ghapiar 9(commendng with Sectlon 7000) ot Divislon 3 ot Ihe Business and Pmfessions Cade) or that he or she is exempt Ihoretrom end tha besis for t�e ellepetl e:emptlon. My viWetion ol Section 7031.5 �y any apPlicent for e permit subjecis Ne a7P��< <o e civil penelry ol not mare Ihen five huntlretl tlollers (3500).): ❑ I, es owaer of the properry, or my employaes wlih weges es �helr sole compensetion, WILL DO THE WORK, and ihe swcture Is not intendetl or oHeratl tor 5ale (Sec. 7p44, qusiness antl Professlons Code: The Contractors License Lew does not epply lo en owner ol property who builds ar improves Ihereon, and who tloes suc� work himsell or herself or thraugh his or her awn employees, provided Ihe1 such improvemenis ere not Intendetl or oflered tor sele. II, however, iha builtling or improvement is ,_,/ 5,q�d wit�� one year ol completion, the owner-builder will heve Ihe burden ol proving ihat he or she tlitl not build or imprwe for purpose ol sale.). �.{y I, es owner of tho pro0ehy, em E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to Consiruct �he pr0lecl (Soc. 7044. Business antl Protessions \ Cotle: Yhe contrectors Llcense �ew does not apply to an owner ol property who builtls or Impmves thareon, antl who rnntrects br such project with e con�rector(s) �• license u�U l.l¢1Le ContraRidrs License Laws.� Owner ID�en�iedby drivors Venfication at Ownership by Business ana Prolessions Cade lor ihis raason: i.9. - property lez bill or deed): DIVISION OG INOUSTRIAL SAFETV PERMR CERTFICATION: No. ❑ I hereby certity �het no axcavetion five (5) or more feet in depih inio which a person is required to Cescend, will be matle in connectlon with work authorizetl by Ihis permit, antl tha� no building slrucNre, scaHolding, felsework, or tlemolition or dismantling Ihereol, will De mora than Ihirty-six (36) laet high. (Chap. 32, Grp 2. An 2, Sec. 341, 71tle 8, Celitomia Administretive Cotle). ❑ As ownerbulltler, I wlll not employ anyone to tlo work which would require e pe�mil imm lhe Dlvision ol Industrial Selery. es notetl above, unless such person has a permit to do such work from �he division. SignaWre: Oate: Division oi Industnal Safery Pertnit Number: CEHTIFlCATE OF COMPUANCE ANO AUTHORIIA710N OF ENTTiV: I cenity under penalry of perjury Ihet I have read this epplication and state �hat tha informetion given is correct I agree to wmply wit� ell stete lews antl ciry ordinences relating to huiltling constructlon, end euthodze representatives ot the Gity ol Casta Mesa to enter upon the ebove-descnbetl property lor inspectio� purposes. I egrea not to xcupy or allow occupanty ot eny Duilding authorized by Ihis permit until final inspection. COQE �. INSPECD4NTIPE 1616 Fixed System Final Fire Preventian 1266 Pool Spe Final 200 Final Re-Roof 201 Finel BIocWRetaining Well 202 Final Factory Fire Plece 203 20a Final Sign Final Demoiitlon veie U�ASS �j INSPELTONTYPE 206 Final Mechaniwl 20B Final Plumbing 210 Final Elecinwl 212 220 222 250 Final Fire Prevention Final Planning Approval Final Site Final BuildincyOccupancy ' 1 1111. �i • .-.�� (714) 754-5273 • Fau (714) 754-4856 • www.cl.costa-mesa��TRICAL PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: 698 W 19TH ST' SUL7ANA HOOKAH LOUNGE Parcel Nunmber: 4222422� Applicant: JAMMAL, TONY Address: � .� � �/„ ,v � Owner. DI PIETRO; NICOLAS-P Address 1800 PENINSULA PL � � , �� . :.i, i , � � � COSTA MESA, CA , � " ,�,' �i/�� ` i,�0.� .�., Conuador: �OWNER-BUILDER Address: � � ' /�� Phone: 714-390.7874 '' Zip Phone: .- Zip: 92627 Phone:' Zip: License:000000 ! ISSUED BY: Status: ISSUED Applied: 11212006 Issued: 7121Y2006 � � � - SCOPE OP PERMIT ' � .��960SF INTERIOR T:I. FOR "SULTANA HOOKAH LOUNGE". WORK TO INCLUDE: CONSTRUCTION OF . �� NON-LOAD BEARING WALLS FOR 1 NEW UNISEX HANDICAP ACCESSIBLE RESTROOM AND 2 STORAGE "� - AREAS,-ELEC, MECH AND PLUMBING WORK. _ � . V� _ , ' REF: BO6-07773�'� �> ' ! ^ , � � - �� 3 LIGHT FIXTURES, 5 OUTLETS, 3 SWITCHES . � . . �.. / /' .. FEE SUMMARY � � ' � Quantity , - � �ISSUE FEE $23.50 , , �-� ; _ � Temp Dist System / Lighting . ' ;Temp service test $0.00 -. . -- ' � ' Busway /100 ft � ` � � :Res: a/c package� 50.00 :,- -- „ _ _ ."�� Slanding Section . . New Res (1=2 units) � $0.00 0 Misc Electrical Equipment New Res (3+units) , $0.00 0 Trans(ormers up to 1 kva/kw Pool / Spa '� $O.OD �' 0 ...............:up to 10 kva/kw Lighting Fixts '� $3.30 3 ........:........up to 50 kva/kw Recept Outlets• , � � � �� 55.50 5 . y _ :.� _.,...,;..........up to 100 kva�kw Switches�`\ ' � _' � $3.30 3 � �-�`�" ......:...........over 100 kva/kw Non Res Appl '� ��, .$0.00 �, 0 � r'.� s� �--� Low Voltage Equipment Res Appl., �'� ' 50.00 0 � � Low Volt Wiring System / Ckt Service to 200a. �$0.00, � r.-•_, 0'' =� Misa Conduit '. . • Service to 1000a� �$0.00` � 0 � � Misa Conductor Service over �t000a_ i,:"$0.00�� 0 " � � Circus ( gen or ride) Motors to thp � - � '. �� , $0.00 �' � 0� �_ ' � . - � Cirws (mech ride or lighls) = -;. Motors to tOhp \�� `� 50.00� � 0�,� �\ �' o. ChrisMas Tree Stand. � � Motors to SOhp � �� %50.00 �- 0� � = .. _ _ , _ Fireworks Stand � _ Motors to 100hp � �� - � 50;00- � ' ; � , 0 � - _ Other� Eledrical Fee , Mators over 100hp `� � ��50.00, . 0 , � � Communication drops � � �$0.00 �� 0 �. ` , � .Invesligation Fee Sub panel to 200a �-$O.OD' -- �� 0�� Plan Check Fee , Pole Light Pkg S0.0p � �� 0 �' 'Reinspection Fee SignCircuits $OAO� � ��0` � � �� Temp Pwr Pole 30.00 �--' 0.._ ` � - TOTAL CALCULATED FEES Intermed Pole $0.00 0 - �, - . ' - Quantity $0.00 0 - $0.00 0 $0.00 0 $0.00 0 $0.00 0� 50.00 0 50.00 0 $0.00 0 ' $0.00 ' 0 -$0.00'� , 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 � $0.00� '-0 � 50.00 - � 0 .'�. � ' $0.00 0 , so.ao $0.00 51Z80 $0.00 553.40 c NOTICE: The work authorized by this permit shall comply with ell applicable handicap access requirements under Ca�ifomia statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) , EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or II work is suspended or abandonetl for a period of 180 days. � � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell required Inepeatlona end finel apprpval must be obtained. Failure to obtain inspections and tinal approval will result in tha expiration of this pertnit. FOR INSPECTIONS CALL: (714) 754-5628 �,�-�y zaa+s (eroo) WORKERS'COMPENSAnON DEGLARATON: I hereby etllrm under penelry of per�ury one of the fWlowinp deGaretlons: , . ❑ I heve end wlll meintein e ce�in�ate of consent to selbinsure for workers' compensetlon, es provlCetl fw by sectlon 3700 of t�e Lebor Code, for the peAortnance of Ihe work lor which Ihis permit Is issuetl. • ' ❑ I heve arM wi0 meintain workers' compensetlon insurarke, as requiretl Dy secibn 3700 of tfre labor CaAe. fw Me pertartnance o1 the work tw whkh tltis permit is Lssu90. My warkers' compensation In3urence caMer end policy number are: Cerrier: Policy Number: (ThIs sectlon need nof be oomp/eted ll fhe permlt Is valued et one hundred dollers ($ f00) or IessJ � I ce�ly that in the perto ance oi Iha work tor which thls pertnit is Issue4 I shall not employ eny person in any manner so as lo become subject to the workers' compensetion laws o m�a end egree Ihet il I shoul become sub�ect to Ihe workers' compensation provisions of Sactlon 3700 of the Labor Cade, I shell torthwlth comply with t�ese _ ; � . _ ' � � � O G qp`pl�_nYSlp�elure:. CDet� WARNIN(3: FAILURE TO SECURE WORI(ERS� COMP � WVEM�E IS UNLAW R1L AND S/ULL SU9IEGT AN EMPIOPER TO CRIMI PENA�TIES PND CML FlNES UP TO ONE HUNDRED 7F7IX1SM1D DOLIARE (5100.000� IN FDO�TION TO THE COST OF COMPENSATION, DMNQES AS PROVIDED FO{i IN SECf10N 31080F TNE IABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED COMRACTORS DECL�ATON: �, I hereby eNlrm thet I em licensed under provlsbns ot Chepter 9(commencing with Sectlon 7000) of Divlsion 3 of Ihe Buslness antl Professlons CaAe, enC my Ikense is In full i lorce end eMect. Lic. x Class x CoNrectors SigneWre: Date: CONS7RUC710N LENDING AGENCY: ❑ I hereDy eifirm lhat there is e C�strucUon Ientlin8 egency for the pedortnance ol the work for which ihis Dertnit is issuad. (Sec. 3097, Civil Code). Lenders Neme: Landefs AdOress: Slgnature: Date: OWNER-BUILDER DECLAHATIONS: I hereby eXirtn t�et untler penalry ol per�ury Ihet 1 em EXEMP7 FROM THE CON7RACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Business entl Professions COEe: Any ciry ar counry which reqN�es a pertnit lo construct, elter, improva, demolish, or repeir any sirucWre, pdor to its Issuence, elso requlres lhe epplkznt for sueh pertnit to file e slpnetl etetement t�at he or s�e b Ilcensed pursuent to t�e proNslons of Ihe Contraccors Llcense Lew (Chepter 9(commencinp with Secilon 7000) of DMsion 3 of the Business end Prafeulons Code) or Ihet he or sha is azempt therelrom end the hasis for Iho ellegod exemption. Any Noletlon a� Section 7031.5 by eny appllcant lor a pertnit ,gu_bjec�s �he epplican� �o e civil penel�y ol not more Ihan Ilve hundred dollars ($500).): �tf3 I es owner of t�e pmperry, or my employees wlth wages es thelr sole compensatlon, WILL DO TME WORK, end the structure is not Intended ar otfereC for sele (Sec. 7044, Business end Professlons Code: The Contractors License Lew tloes nol apply to an owner ol property who builds or Improves thereon, antl who tloes such work �Imself or herselt or thmugh his or her own employees, provitled ihet such Improvemams ere not Intentletl or oMered lor sele. Il, however, Ihe bulldinp or improvemeM Is soltl within one yeer oi compleiion, the ownar-builder will heve t�e burGon of provinp thet ha or sha did not 6uiIE or Improvo for purpose af sale.). ❑ I, es owner ot Ihe praperty, ard EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to canslruct Ihe pr0�ed (Sec. 7044, Bu5ine55 end ProlesslOns Code: The conirectors Licens� �-ew tloes noi aOPh �o an owner ol property who bulltls or Improves Ihereon, and w�a con�rects �or such project wit� a conirector(s) Ilcense pursuant to the Contre��ors License Laws.). ❑ lam Owner ID veriliad by drivels Vediicatlon oi Ownership by ❑ Ves ❑ No Business anA Professions Code br Ihis reason: _ be�:—L t!/2i/ob diive`rs"ucenseNo.'+ Fxptres: I-I-o�- dacumem, i.e. - pmperty taz b11i or deed): DIVISION OF INDUSTRIAL SAFET�' PERMR CERTIFICATION: ❑ I hereby certlly ihat no ezwva�lon five (5) or more feet In tlepth into which e person Is requiretl to tlescend, wlll be made In conneclion with work euthorizetl Dy this pertni�, end Ihet no building siNdure, scaHolding, lelsework, or tlemolliion or dismentling ihereof, will be more than thirry-six (38) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Ttle e, Celifomle AtlminlStralive Code). ❑ As owner-OuilAer, I will not employ enyane to do work which would require e pertnit trom ihe Division at Industnel Sefery, es notetl above, unless such person hea e permlt to da such work tran the dlvision. Signature: Date: Didsion of InAustdel Sefary Permit Number. CERTIFlCA7E OF COMPLUWCE AND AIJfHORQATION OF EMRY: I cenity untler penalry oi perjury Ihat I have read this epplication antl state that ihe Infortnatlon given is wrrect. 1 egree to comply with all st2�e lews entl Ury ortlinences relating to bullding conslruMlon, end authodze representatives of t�e CNy of Costa Mesa to enter upon the ebove-descdbed property tor inspactiw� purposes. I egree not to occupy or allow occupancy of eny building euthodzed by Ihis pertnil until finel inspeclion. WOE �. INSPECTION TYFE 7818 Fixed SyStem Final Fire Pre�ention 1288 Pool Spe Flnel 200 Finel RaRoo1 201 FIne181ocWRe�eining Well 202 Flnal Fecrory Fire Place 203 Finel Sign 20d Finel Demolition � PAiE � II�LS �� DE� RlSPECTIONTYPE 206 Flnal Mechanicel 208 Finel Plumbing i 210 Fina 212 Flnal Flre rev on 220 Final Planninp Approval � 222 Final Site ' 250 �FinalBullding/Occupancy' Date �g �4� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 698 W 19TH ST Suite No Ycinity: SULTANA HOOKAH LOUNGE Parcel Number: 42224220 Applicant: JAMMAL, ANTOINE Address: 2384 HARBOR BL COSTA MESA, CA Owner: DI PIETRO, NICOLAS P Address: 1800 PENINSULA PL COSTA MESA, CA Contractor: OW N ER-BU I LDER Address: MECHANICAL PERMIT Phone: 714-390.8774 Zip: 92626 Phone: Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: Status: Applied: Issued: ISSUED 10/20I2006 1020/2006 SCOPE OF PERMIT 960SF INTERIOR T.I. FOR "SULTANA HOOKAH LOUNGE". WORK TO INCLUDE: CONSTRUCTION OF NON-LOAD BEARING WALLS FOR 1 NEW UNISEX HANDICAP ACCESSIBLE RESTROOM AND 2 STORAGE AREAS, ELEC, MECH AND PLUMBING WORK. REF: BO6-01773 " �� 2 VENT FANS W/MECH EXHAUST ISSUE FEE Inst FAU <100 k BTU - Inst FAU >100 k BTU Repair/Alt CoolingMeal Insl / Rep. Recess Wall Fitr Refrig Sys <100 k BTU � Refrig Sys >100 k BN � Gas Piping . FaIXory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Dud Appliance � � Fire Dampers , ��. Smoke Dampers �� Inst or Relocate Appl Vent Air Handlers < 10000cfm� . AirHandlers> t0000cfm Floor Fumace Floor or Suspend Heater � �� uantity $23.50 $0.00- 0 $0.00 0 $0.00 0 $0.00 0 80.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 - _o � �:574.50� 2�.; . $0.00 0 , so.00: ;b , � $0.00�' 0-�"; � $0.00 . 0 $0.00 , 0 $0.00 0 � 50.00 0 50.00 0 , PEE SUMMARY Repair / Alt Absorbtion Unit Repair / All Re(rigeralion Unit Ventillation System Evaporetive Cooler Comme rcial I ncinerator Domestic Incineretor Comoressors /Absorotion Svstems Upto3hp/100kBTU 3 To 15 hp / 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU ' Over 50 hp / Over 1,750 BTU j; � Boilers � �- - Up to 3 hp _ - . 3To15hp - „ - 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee . . Plan Check Fee �- � Reinspection Fee Quantity 50.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 50.00 50.00 ; � $0.00 $0.00 i � �-$0.00 � 'so.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 TOTAL CALCULATED FEES E38.00 COMMENTS / SPECIAL CONDITIONS � � � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requlrements under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1Bp days, or if work is suspended or abandoned for a period of 180 days. '� INSPECTIONS: In order for iha work authorized under this permit to be considered legal, such work must comply with all epplicable eotles, end ell requlred Inapeetlons and (Inal approval must be obtained. Failure to obtain inspeclions and final epproval wili result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 21d8d816D0) WORKERS' COMPENSATION DECLARATION: . . � I �ereDy eNlrm under penalty 0� Per�ury one oi ihe following decleretlons: � ' , ' , ❑ I heve and will mfllntaln e certilicale at consenl Io aell�lnsure for workera' compensetlon, es provitletl lor by section 3700 of Ihe Labor Cotle, for Ihe peAormence of Ihe work lor whlch ihlq pertni� �s IssueA. , ❑ I have eM wlll maintaln Workers' compenseUon insurence, es require0 6y section 3700 of Ne Le6or Cotle, far Ne pertarmence ot Vre wwk tor w�ich ihis pertnit Is Issued. My workers' wmpensetian Insurence carrler and policy number are: � Cerrier: � Pdicy Number. (This ctian need naf be cromp�eted ll fhe permit is velued et one hundred dollars (5100) or less.) cenify thet in Ihe peAaR�ence of Ihe work tor whlch Ihis pormit Is Issuotl, I shell not employ eny persan in eny menner so as to bocomo subject to the workere' compensation lews of IFornle r e Ihet if I shoul0 become sub�ocl to Ihe workers' compenSallon Drovisions ol Sectlon 3700 0l ihe Lflbor CoOe, I shell toM1hwllh compty vrit� Ihese p n�s�/s�,,� i1 ! �—Sl�netu[e: - - -uJ-"^'� MNN OX _ te' / � — �-0 -- l`�i G. : FAILURE TO SEW RE W��ER$' COM SATIIXJ ODVERAGE IS UNLAWFUI. rWD SHALL SU91EGf Ml EMPLO O CRIMINAL PENALTIES AND CML FlNES UP TO IXJE HUNDRED TYKKISAND Od1ARE (E100,000), IN ADDITION TO THE COST OF COMPENSATION, DMtAGES AS PROVIDED FOR W SECTIIXJ 37a80F iNE LABOR CODE, IMERE51, M1D ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby elTirtn I�at I em Iicensed untler proNslons of CheO�er 8(wmmenUng wit� Sectlon 7000) ol DiWsion 3 01 Ne Business and Protessions Code, end my Ilcense Is in full torce entl ettect. Lic. p Class M Contrectafs Signature: Date: CONSTRUCTION LENDING AGENCV: ' ❑ I hereby ettirm that there �s a conSlruction lending egency for ihe Dedormance oi t�e work for which this permtl is issuetl. (Sec. 3097, Civil Gode). Lendefs Name: LenOers Address: Signatura: Date: OWNER-BUILDER DECLARATONS: I hefeby affitm Ihat untler penalry of perjury �het I em EXEMP7 FPOM TtE CONTRAC70RS UCENSE LAW br the lollovnng reason (Sec. 7031.5, Bu5Ine53 0nd Professians Code: nny dry or counry whicn �aquires e pertnit to cnnstruct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires tha epplicant for such pertnit to file e signe0 slatement ihat he or she is Ilcensed pureuant to t�e provislons of Ihe Contractors lJcense Law (Chepier 8(commencing wiN Section 7000) ol Divlsion 3 of Ne Businass and Prolessions Code) or ihat he or she Is exempt therefrom and �he basis for Ihe alleged exemption. Any violetion of Sectlon 7031.5 by any epplicant tor a permil �uD' ls ihe appliwnt to a cMl penalry of not more then five hunAred Aollars ($500).): I, es owner of Ihe propeAy, or my employees with weges as iheir sole compensation, WILL DO THE WORK, anE the structure Is na1 IntentleC or otteretl for sale (Sac. 7044, Business and Prolessions Cotle: The Conlrectors License Law does not epply to an owner oi properry w�o bullds or improves thereon, antl who tloes such work himselt or herself ar thmugh his or her own employees, pmvided Ihel such Improvements ere no� Intended or oXered far sale. If, however, the bulltling or Improvement Is I wid within one yeer ol completlon, the owner-buil�er wlll �ave the burtlon ot pmWn9 Ihet he or sha ditl not builtl or improve for purpOse ol sale.). �. i I, as owner ot t�e D�oPeM� em E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to conswtl t�e projeU (Sec. 7044, Business en0 Pmfessions " Cotle: TTe wmrectors Lkense Law Ooes noi apply to an ownar of propeny who Duiltls o� imprwes thaieon, entl who coM�acts im snch project wNh a contwctor(s) license oursuenLlo the Contractors llpBnse Lews.). ❑ I am exem usiness an0 Professions Code lor this reason: P Signalnra�--� � 071�-a Owner ID verifletl by tldvers Iioense. es ❑ No 1jvel�s�License'No. � Veriticatlon ot Owners�lp by (tyPe ai documeni, i.e. - property ten blll or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICA710N: Ei�plrei ._./�- � I hereby certity ihet no excavetlon five (5) or more leet In depth into which e person Is raqulred lo tlescenQ will be mede in connectlon wlih work eulhodzed by tNs pertnit, entl that no builtling sirucWre, scaHoltling, lalsework, or demolition or tlismantlinp theraof, will be more t�en thirry-six (38) leet high. (Chap. 32. Grp 2, Atl 2, Sec. 341, Ttle B, Calltomia Adminisirative Cade). ❑ As ov+ner�builder, I will not employ enyane to do work which would require e permit Irom ihe Division al Intlustnel Safery, es notad ebove, unless such person has e permit to tlo such work from tha division. Signature: Date: Division oi Intlustriel Satery Pe�il Number: CERTIFlLA7E OF CAMPLIANCE AND AIJTTfOROATON OF ENTFiY: I certity untler penalry of perjury that I have reatl this epplication end state that the inlormation given is cortect. I egree to comply with ell stete laws and ciry orCinances relating to �uiltling construction, and euthwize represenWtives ol Ihe Ciry of Costa Mese to enter upon Ihe ebove-Oescnbetl properry tor Inspection purposes. I egree not to occupy or ellow occupancy ol eny builtling authorized by this pertnit unUl tinel inspeclion. COUE �. 1616 1266 200 201 202 203 Fixetl System Final Fife Prevention Pool Spa Final Finel Ra-Root Final Block/Retaining Well Final Pactory Fire PIaGe . Finel Sign 204 _ Finel PdIE II�EL�a S.Qf�.! INSPECfWNTYPE � ' 206 � Final Mec�anical 20B Finel PlumDing 210 Final ElectriCal 212 220 Final Fira Preventian Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��MBING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 �ob nddress: 698 W 19TH ST Status: ISSUED Suite No Applied: 10/202006 Issued: 10/20I2006 Vicinity: SULTANA HOOKAH LOUNGE Parcel Nunmber: 42224220 Applicant: Adtlress: Owner: JAMMAL, ANTOINE 2384 NARBOR BL COSTA MESA, CA DI PIETRO, NICOLAS P Address 1800 PENINSULA PL COSTA MESA, CA Contrador: OW N ER-BUI LDER Address: Phone: 714390-7874 Zip: 92626 Phone: Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: � � SCOPE OF PERMIT � � 960SF INTERIOR T.I. FOR "SULTANA HOOKAH LOUNGE". WORK TO INCLUDE: CONSTRUCTION OF NON-LOAD BEARING WALLS FOR 1 NEW UNISEX HANDICAP ACCESSIBLE RESTROOM AND 2 STORAGE AREAS, ELEC, MECH AND�PLUMBING WORK. REF: BO6-01773 � � - - . �' . 2 VENT FANS WIMECH EXHAUST 1 WASH BASIN, 1 WATER CLOSET., ISSUE FEE Backflow irrigation Backflow Preventer . Bathtub� ' - , Clarifier System Connect (Ice,Soda,etc) . Dental Units � Dishwasher Drain, Floor� � Drain, Rainwater ' Drain, Roof '� � Drinking Fountain�' Expansion Tank , Gas Earthquake Valve � Gas (t-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oiq Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00'- $0.00 $0.00 $0.00 ` $0.00 $0.00 $0.00' $0.00 so.00 so.ao FEE SUMMARY , � AMT Laundry Tub I Washer -50.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 fl) �� $0.00 .0 Receptors $0.00 , 0 SepticTank $0.00 ��, 0 ,�� . - � •. Sewer Cap for Demo . $0.00 -;0 � - �-SewerConnect- , �$0.00 �0,',"�:. -�Sewer Private Line ° $0.00 ". 0 � � �; _> Shower � - $0.00 �0� � -�_Sink,bar " � $0.00 0 ,. . Sink, commercial . - $0.00 � 0� . � Sink,�Floor "$0.00 0 �. Sink,kitchen $0.00 � 0 • Sink, servicelmop - � $0.00 . 0 � � � Spa (pnvate) � $0.00 0 � . Spa (public) , $0.00 0 0 l:f1MMFIJTC / CDC!`IAI an 0 0 0 0 0 0 0 0' . 0 0 0 . 0 "'" 0 ' 0 , 0- 0 0 0 SumpPump Swimming Pool � Trep Primer, � , . Urinal Vacuum Brkr�Bkflow(t-4) Vacuum Brkr Bkflow(5+) Wash Basin Nlasti Basin Set� , -Waste and Vent System 'WaterCloset.(Toilet)�� ` � W ater Heater / vent . . -Water Piping�(Inst or Rep.) Water Re-pipe= ' " ' Water Service � Water Softener OTHER" , VIOLATION -FLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 50.00 $0.00 30.00 TOTAL CALCULATED FEES: 543.10 arv 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 NOTICE: The work authorized by this pertnit shall comply with all applicabie handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work Is suspended or abandoned for a pariod of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inepeetlons and finel approvel must be obtained. Failure �o obtain inspections and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 xae�as (aroo) WORKERS'COMPENSAnON DECLARAnON: � ' , I hereby aXirm untler penalry of perjury ona of the following decleratlons: �' . � . ❑, J heve entl will meintain e cenificate of consent to self-Insure tor workers' compensetion, es provlded tor by section 3700 ot the Lflbor Cotle, for the pertortnance af the work for wMCh Ihis permii is luuetl. ❑ I have and will maintain workers' compensaUon Insurance, es repuired by section 3700 of the Lebor Catle, for ihe peAortnence of the work for which Uils permit is luuetl. My workers' wmpensation Insurence carner antl policy number ara: Ca�ner: � Policy Number: (1Tl�l5 secHon need not be complefed i! fhe Oerm/f Is valuetl et one hundred dollers ($100) or less.) �yJj, I certity that in the peAormance of the work for which I�is Dertnit is issued, I shall not employ any person in eny mannar so es to Decome sublect to the workers' compensetion laws o lifomi d ree thet If I sho Id become suDject to Ihe workers' compensetion provislons ot Sectlon 3700 oi iha Lebor Code, I shell forthwith comptywiththes m io ` -7�.-� /� AQpliyen_(,Slgna�re: - r'Da19: �I� �' ��. WARNINO:FAILURETO CUREWORKERS' PENSATIpJCOVEM0EI5UNLAWFUlAN�SHALLSUBJECTANEMPIOYERTOCRIMINALPENALTIESANDGVILFINESUPTOONEHUNDRED TNOUSANDDOLLARE�S100,OW�,INADDITIONT ECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECf10N31080FTHELABORCODE,IMEFEST,FNDATTORNEI"SFEES. LICENSED CONTRACTORS DECLARATON: I hereby aHirtn that I em licensed under provisions ot Chapter 9(wmmencing with Section 7000) o� Division 3 of the Business and Professions Cotle, flntl my license Is In full . i forte antl ettecL Lic. # Cless tt , ! ContractoYs Signawre: Dete: CONSTRUCTON LENDING AGENCY: ❑ I hereby ettirm that ihere is a construction lending aBency for t�e pertortnance of the work for which Ihls pertnit is Issuetl. (Sec. 3097, Civil Cotle). Lentler's Name: Lendefs Adtlress: Signeture: Dete: OWNER-BUILDER DECLAi7A710NS: I hBfBby etfifm lh0t undBf penalty Oi pBr�ury Ihei I 0m EXEMPT FROM 7NE CONTRACTORS LICENSE LAW tof the lollowing ree5on (Set. 7031.5, Bu51nBu Bnd PfOfBuiOnS Code: Any city or counry which requires e permit to conslruct, elter, improve, demolish, or repair eny slrucWra, pnor to its issuance, also requires Ihe epPlicent tor such permil lo file e signed sWtement that he or she is Ilcensetl pursuent to ihe pravislons of ihe Contractors Licensa Lew (Chapter 9(commencing with Section 7000) of Divislon 3 ot the Business entl Professions Code) or that ha or she is axempt therefrom end ihe basis lor the elleged exemption. Any violation of Section 7031.5 hy eny applican� for e permit su ecls ihe epplicant to a civil penalry of not more ihen five hundred dollars ($500).): � I, as owner of Ihe property, or my employees wit� wages es their sole compensation, WILL DO THE WORK, and the structure Is not intendetl or oflered lor sale (SeC. 7044, Busineu antl Professions Code: The Contrectore License Law does not apply to an owner of properry who 6uilds or improves ihereon, end who does such work himsetl or hereelt or ihrough his or her awn employees, provitletl Ihat such improvements are not Intentletl or oXeretl Por sale. If, however, iha building or improvement is � soltl wit�in ona year ol completion, the owner-buildar will heve Ihe burden of proving that he or sha did not build or improve tor purpose of sale.). „� I, es owner ot the properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to conslruct ihe prolec� (Sec. 7044, Business end Protessions l� Code: ThB tonlractors LicenSe Lew tloe5 no� epply to en owner of Oroperty who buI105 or Improve5lhereon, end who cONratiS tor suth proled wit� e con�rac�or(5) license pursuant to ihe Contractors,License LewsJ. ❑ I am exe ua Business and Professions Coda tor Ihis reason: i paun . � Owner ID vedtiad by dnver5licen5e. Yes ❑ No Om7ar'�;No. ' Verification of Ownership by (type of document, I.e. - pmperty tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certlty ihat no excavetlon tive (5) or more feet in depth Into which a pereon Is requireC to descend, wlll be matle in connection with work euthodzed by ihls permit, end that no builtling siructure, scaflolding, Ialsewolk, or demolition or dismamling thereot, will he more than t�irty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Calibmia Administrative Code). ❑ As awnervbuilder, I will not employ enyone to tlo work which would require a permit trom the Division ot Industrial Safety, as noted ebova, unless such person hae e permit to do such work trom the divislon. Signature: Date: Division ot Industnal Salery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUIHORIZATON OF EN7AY: I certify under penalry of perjury ihat I have read this epplication and stete that ihe infortnation given Is correct. 1 agree �o comply wl�h all state laws end ciry ordinances relating to building construction, and euthonze representatives ot the City of Coste Mesa to enter upon ihe ebove-described proPerty tor inspection purposes. I agree not to occupy or allow occupancy ol eny buil0ing authorized by this permit until Finel inspection. COOE I, INSPECTIONTYPE 1616 Fixed Syslem Final Fire Prevention 1266 200 201 202 203 204 Owner(s) Pool Spa Final Final Re-Roof � Final BIocWRetaining Well _ Final Factory Fire Place , � _ Final Sign _ Finel Domolition I L CODE� INSPECTIONTYVE 206 'FinalMechanical 208 Final Plumbing 210 Final Elecirical 272 Finel Fire Prevention 220, Final Planning Approval 222 Finel Slte , 250 Finel BuildingiOccupency 'J � .�'� 5499 � COS?y4 M�SA BUILDING DEPARTMENT ' P. O. BOX 31] COSTA MESA. CALIFORNIA FOR APPLICANT O FILL IN Bl11LDING � ' / /` /� _ � A/DDRE55 �� ( I _ _ COSTA MESA. CALIFORNIA OWNER L/IJ�C/Y(�.�L (LA MAII /.�� ,./ /p. ^( �. ADDRESS{O (.(// 7 IARCHITECT OR ENGINEER lE�^� LOT OESCRIPTION NO. A.P. NO. SIZE OF LOT USE OF E%ISTING BLDG. SETBACK IINE FROM CENTEF OF STREET IIC. NO. � QTY LIC. NO. TEL. NO. O � BLOCK TRACT , / � O.OF BLOGS. n NOW ON LOT �r e � REAR YAFD �7 SIDE YARD RIGHT /�. LEFT �� DESCRIPTION OF WORK NEW ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING�Z �. d NO.OF SIZE ROOMS STORIES EXTERIOR WALL � y ROOF cnvcwiur. �/2w�d1 COVERING �`��_V��-.,.�-�-' `��-�..� F E RECEIVED '� r�, /I ��7' �Q INANCE EPT. AF�LI�AGQ�IV�R PERMIT BUILDING FOR OFFICE USE ONLY RECEIPT NO. pEHMR NO. s y� RECEIVE� BY �RTE RECENED DFTE ISSUEO � BUILDING ADORE55 COSTA MESA. CALIFORNIA FIRE ZONE APPROVED BV [iY CORRECTIONS r_tz'�' c,- � ,9 `� L � ; Ta r:+esn i\lf ~. 6lGG. D�PT. REG. V � ' `� _ ' I HEREBY nCKNOWIEOGE THwi 1 NPVE RE TMIS RPPLICATION PNO � STI�TE TMI�T THE ABOVE IS CONRECT RN� AGflEE TO COMPLV WITM iLL CITY ONOINANCE $T.�TE LAW$ REGVLATING 9VILOING CONSTRUC� T�o�� VALUATION SIGNATURE O ��L,�, f�ti(AC PERMiT FEE $ PERMITTEE ,,,nnn /� Q' PLAN CMECK $ $ AUTHORIZED AGENT � TOTAL FEE 5 GROVF � � � � . ..✓ ,• . Jl % - All Applications Must Be Filled Out By Appliccml Department of Buildings Application N�o'ri64� APPLICATION FOR THE ERECTION OF SIGNS To the Building OEEicial of the City of Costa Mesa, Calif.: Application is hereby made for the erection� alteration ❑ removal Q of an,advertising structure in accordance with :nformation herein set forth. (Check sauare what is to be done). ��( S�Tg a C K s (Use Ink or Indelible Pencil) , • C L S I D E- -R L R E A R L°�AT'°N tg �-- -�� Building Addre _ Lot Bloc � Tract�� A. P. No. J� S� � 3 d '��Zone �- _ Owner's� Name u�an► a coT-r Owner's Contractor's Name_��[' i 1-� � G N� e �J � i 1—� State License No. I � v1 �► � � Contractor's Address � � Z CB M M C- RC 1 p 1 phone ,� �� .Cit�y License No._` , DESCRIPTION OF SIGN , � (Sketch showing location oE proposed sign on back side oE this sheet. Plans and other data must als� be tiled.) ��, , �j Size of Sign—vWidth�ft. Height b_ft. Height above Grade tS � {t,� Thickness o' '� in. Weight—�2�J�lbs. (In•c'luding Electrical Transtormers, etc.) t � State ]ocation o( other signs on building' N � IV C \'� The undersigned hereby agrees �to construct the advertising structure in strict accordance with the provisions of Ordinance 95, Section 39, ot the Electrical Ordinance of Costa Mesa, and all amer' menls thereto. , ALL APPLICATIO[VS MUST BE FILLED OUT BY THE APPLICANT. INSPECTION MUST BE CA�.t.Fn FO��N.I\.LVLI Y;�D �_ �.�9 � _.fi/c+� c� �. S. /_'-. �� . � $i n Here � FINANCE DEPT. aY - CITY OF COSTA MESA FOR DEPARTMENT USE ONLY Recvd. by � Date Recvd. �a 3-S FORM 214 IM 1�5] VALUATION � Plans FEE Z — Examiner (over) Permit No. �� Date Issued , �_a3� � FOR SELF-SUPPORTING SIGNS Size �d Location Section 7 oI Ordinance No. 95 �`- - /' 1 � ' . - - - ' - �. : v � \ _ '+«� E - � '�.� � Width �of Lot , ; t � � �n �---ti c�L ��irjN' � mudihuuuuwu n .n j. � ��C%,�. . Sign Area from G/L of lot C/Li f Lot I — � � , � -, - � I � � ' '\ I �\1 � � _� STREET OR HIGHWAY � . ` � • - (. , ' , . . ,__ __^,�. ,r 1 r � � � a i�� ' � _ ' FtLL IN ALL DINIE[VStONS � , � I� SHOW AI.I. STRUCTUAAL MEMBEAS . T � � 5 1� G N � � ' .� -�.t . . . ' .' : � - ' �. ` . . : � �� ;' � . < _. , i c �� _ ` . ,; � Sec. 6 of Ordinance No. 95 ' �: � �� , .i! � l' . � �.� _ J ' ' U � . , , ., _ � , � � �+s�x..ar---7 + ruurrt . - txn� rron�n 4�! .�-, . „ C��c �LAN� ' � APP�ON�D � C1TY 0 � ��.ST.n A5L•SA � PL �:tilt�r f�EPI'. � u �cUBJECf 7C 6lUG. DEPT. RC•G. n � . .t . I Pr p��y. �i. •' � DATE� � — �� e� .-,�-�. _ � � ` I � �. - - ---- ---- -- �'---' .' --'� ,