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700 19TH ST - Building Permits
' AOPlicant to till i0 all CITY OP•COSTA.MESA PEa�nir NS CON$TRUCTI(11V PERMIT � �� � vwner y Addrezs ' Arch/Eng. Address ' Contractar 0 IPL.a withln haavy Gortler lines anG.s(9n all appropriate tleclarations. . _ r ' TRACT NO. LOT NO. � BILDG. NO. �� -- '- •- 1 � � TVPE OP CONSTRUCTION : ' � . . �� � . + �S � �d NEW- ❑ ADD '�' O ALTERATION - � � �, - � - A'� 2(j ❑ REPAIR ❑ CONVERSION. ODEMOLISH � .. _ O OTHER � OESCRIPTION OF'-WORK P"P' � - ' _ _ ' _ ' ' -:�-' . ZONE '3 TVPE OF PERMIT . - �" � '' , � . ' ' SErBnCK C 5" D�GRADING O-FOUNDATION ❑STRUGTVRAL-- SIDE-YARD - � '�Q,TENANT' ECECTRICQL ❑P.LVMBING.OMECHANICA 5DE- A I M1ereby affirm that I am IlcenseC untlerprovlslons'of Charter 9(com- ��' RIGHT fnan<Inq wit� setdon 7000) of ,Division 3 oi the Buslness antl ��OTHER � Protessions Cotle, a tl my Ilu�se is in' full torce antl'eliect. , pROJECT.DESCRIPTION �REAR�'HRD(7 Litanse ass - anse No � - - - ' " -'-"'- '- - " VKG. SPACE RE Date � � Z 519nature .` 4� �. - -' . . . _ . . _ �.. WORKERS' COMPENSATION DECLARATION � OCCVPqNCY_CONSTRUCTION TYVE � � STREET WIDTH � 7519 -'9/10/82 ' 8.0� 7t, ZONINGREGULATIONS�r - ' � � PLN7Gp. gRUEF. p3° VROPE�RTYNLINE '•. � P/L) _ - _ � PROV.IDEO ��r � - �PARKFEES - . I hereby atTirm tnat I have a'certl/lcate of consent"to sel�-Insure or a VALUATION ZONE � '�ZONING APPROVED BV - Cartifiwte of Workeri' Gompensatlon Insurance, or a certi/ietl copy - - - , _, thereo} (Section 3800, Lab. C.). - - GRADING CV. VDS. �� � ACRES - - SPECIAL CONDITIONS: Poficy No. Cort�Pany ' - Q Certltietl CopY �5 hereby (urnizhatl. pEMARKS: �• - ' ' Q Certifletl copy I5 flleU wlth Me dty'8ulltling Diviston. ' , ��%EMPTION FROM WORKERS' COMPENSATION DECLARATION iThis section need not be tompletetl if the permi[ is for o�e huntl*etl �� � . . S5100 or less1. �� � cert�fy that ln the performance of the work lor wnlch this permit is ISsuetl, I shall not emPloy any p¢r5on in tnY �nner so as to become PL•UMBING � - PLAN CHECK subject t0 the Workers Compensation L,aws of Ulifornia. ' Dale � � � Signature ' ' • � BATHTU85 - � SHOWERS -� _ - NOTICE: If aftar making thls tleclaration, you shoultl become subject TOILETS URINALS, _ (o the Workers' Compensation provisions of the Labor Cotle, you must � � forthwitn comply wlth such provisions or this permit s�all be tleemetl LAVATORIES �DOUBLE,LAVS -: revokltl. CONSTRUCTION IENDING AGENCV ' ' - - KIT.SINKS - . , DISHWASHERS -- 'I hereby atfirm that t�ere Ii a constructlon lentlin9 agency for the Der- SERVICE SINKS .. �.SVMPS � formance of the work fo� which this permit Is ISSuetl (Sectlon 3097 G�. CJ. , _ . _ . __ . . FLOOR SINKS - :•FLOOR DRAINS��' �.entler'S Name Le�tler4 Adtl1¢55 '�" �' '� '� �' l^'3� � � � � � �DRINKING FOVNTAIN$ � -- � � OWNER�BU�LOEH�DECLA0.ATION ���:r � �'� ' "� � � INTERCEPTORS�' �' CLARIFIERS'" ' I hereby affirm tM1a[ I am exempt from_the Con[rac[or's License Law to� In¢ following �eason (5ec[IO� 7031.5 Bu51�e55 drltl AO(¢SS�OnS CoA¢: SWIMMING POOL PTRAP qny tlty or cou�ty which requires "a permit to consvuct, al[er,' improve, tlemollsh or repair any structure, Drior to its Bsuante, also re� yyq7ER SERV ICE ALTERATION - quirei the apDlicant for such permit to tlle a signetl stateme�t that pe . iCM1ceise09Pursuant [o_tne,proviflonz oi the Contractor's Lit¢nse L3w . GAS SERVICE - OVTLETS ' ELECTRICAL � ' '..PLANGHECK "GENERATOR �' ��py KW�110KW ' - ' TRANS�ORMER' � .. � - APPLIANCE - 10-50�KW_SO+KW� �-� � MOTORS�- •0-1 HP_1-10 HP' `' , _ � (INC. SOLAR) . 30-50 HP_50 + HP - FIXTURES OUTLETS SWITCHES' - - - GAS TUBE SIGNS - - - PO�E LIGHTS � - � �- - ( ap er (commenang wrth SCttion 7000) of Dlvision 3 of the - - - B�siness antl Prdessions Cotle) or that he is exempt•therefr,om antl the ..yyqTER•HEATERS -� BTV �OUTPUT'� ` � � yazis for the allegetl ezemption. A�Y violdtion of�5ection 7031.5 by � aPY�appIlCdOt (or.a permit;subjetts the apPllWnt to a tivil penalty SEWERCONNECTIONS -- � — -�- 01 not mOre [han +iw huntlretl tlollars (§500). ' [] 1, as owner of tno proporty, ov my emPloyee!-with wagos as [helr - SOLAR TANK -- - COLLECTORS �--- . stlla compensatlon, will do the work, and Ihe structure is not Intentletl o� ofterea for sale. (Section 7044, Businez5 antl Pro�essions Cotle:-The � SOLAR PIPING SVS. �--' � - -� - Contra<to�'s l_icense l.aw tloas oot apply to ao owner ot a propetfy who� builtls or Improves thereon, antl-who tloes such work�himsel! or ISSUE FEE ' � �� �" - -- - � th�ougb his.own employees, provitletl that such improvements are not intentletl or oHered /orsale. If, however, tne builtling or imProvement MECHANICAL PLAN CHECK I5 soltl within one year of completion, the owner will have lhe burtlen of �rov{nq he tlttl not bulltlror {mprove for the Purposa ot saVO). HEATINGSVSTEM 0400,000'BTU � � ❑ 1, as owner of the property, am exclusively contracting with qND DUCTING - licensetl contractors [o construct the projact (Sec[ion 7044, Business 100,000+;BTU' antl Rofessions Cotle: The Contractor's License Law tloes n0t apply to an owner o( property �who builGs or improves [hereon, and who con- REFRIGERATION U-I�O,�OU BTU trAtts (rom such projects with a tontrattor(s) Iicesnetl pursuant to SVST.EM the Coutractor'i License Law). � 300,000 + BTU � . � I am exempt�under $ection �8.�& P. C. for [hls BO�LERS BTV � reaw� Da�e Owner SVSTEM REPAIR, ALTERATION I Pereby certifythat I have reatl t�is�pppfation and st�te tha[ t�e above EXHAVST SYSTEM MVLTIPLE SlgnaturE 1D te • '�� Dr�vers' Lit se or 55 � - �SSV E FEE CMF 0865-46 Whlte-Builtling; �ynary-Applicanh Pink-Accounting; Goltlenrotl-Asz¢ssor PANELS - MA�N . SERVICE'�MP-�'P�j� C APPLICATIONA7PROVEDB �� DATE- � SUMMARV OF FEES. . � - BUILDING. . - . - ' . ._ - . . VERMIT E � SMIP �- $ PLAN CHECK $ PERM�T . .. - ISSUANCE $" PIUMBING S GRADING S '-PLAN CHECK S� - � ELECTRICAL = 6 _ ' S PLAN CHECK g - _MICROFILM § ' � TOTAL FEE $ � ' MECHANICAL E - PLAN CHECK" E LE55 AD- VANCEPC $ � � FINAL FEE $ ' � � - ' AVPllwnt to fill In al��tl!��;YaxceO� �nosa within haavy EorEar Iines ana sign au aoorooriate eeclarotions. � � � - . .� _ ' . " ' ' ' _' � CITK OF COSTA MESA' �� �' � . p MIT NO TR T NO. .LOT NO. BLD .' I ' , �� � �. �.�_CONSTRUCTION PERMIT , . � �P lo%t3�" '�2. Q.38 � �, . , . - � . . . . � . �'�°I �����.,; . , ,:<.r , , ^'Applicerit's Mailing Address � �� � '� ' "� '��'� �'Q'�"� t � �PE OF CONSTRUCTION NEVJ ADD ALTERATION � ' REPAIR � - � � . ' , , �� _ . . _ ' � ( � FiojectAdd�eu �7�i� �/I- %�+" � ' Ct�c'T%J %7%/.1'�i ' ❑:�CONVERSION ❑ DEM LI ❑ OTHER.� : � ' ' ' � . . � � , , . � '_ ' . . 7 _ . ( � ` ��Owner's NamB ���r �AM�'� 'f� � � B�G � ohone CY3- ��3Y ' D CRIPTION OF WORK , . . � � G Ul '' C/ � � ,' Z I G E UL T NS" Addre55{ SG'r �%. y~�. �r �!N'r ' 7ypEOFPERMIT � '•GRADING � FOUNDATIO STRUGTURAL . 'A.P:9W - � � �� �� ' \ . ' . . . • , . , , ' � Aroh/Eng. '�" • " A%ZN��� GC LiCenS0N0. ' ' ❑:TENANT O,ELECTRICAL iPLUMBING �MECHANICAL i • PLNG.REF., O �BUILDING � � ' / Y � S�3Y ✓ n' L Nc,oa�it9' i1�'.��T— � ��'�OTHER • AddrE55' � � �� ' ' ,-._ TO BUILDING � '/- ' -- i � H : � o ' ' E V� I E P��� VARD (TO P/L ' Contractor's Nem� ���� <-` L""�T2n�1'o?� `r.�d,one �+s3-.. C2O ; ppp,�ECT DESCRIPTION SQ.' FT. OCCU➢ANCV �' CONSTRUCTIONTVPE 1' /U ' VALUATION$ �p %Z�% LEFTSIDEVARD � �C RIGHT�SIDEYARD �- � ��' ' Addrealmeiling) ,y�L 'N /3�7%�1✓/q S� . O,�'.VrYC r�4 . 3.� lS y � � - - J? 2'L o([6'L " � ZONE ' , � GRADINGCV.YDS. ACRES PKG.SPACE REQ. PROV DED -; r, ��(: �icense No. � � - CICENSED CONTRACTOF DECLARATION � ' � ' � � ' �' � - ' • Remarks: �� S ��SD ,'l/ /9 8'Z� STREET WIDTH � ( " 'PARK FEE $ _ 1 hereDy alfirm l�al I am Ilcensetl untler Orovislonz ot Chartei.9 (commenNng . _ � � , : �. � . witb Sectlon 7000) 01 Olvlzian 3 of tha BuSiness en0 Prof8551on5 C6Oe, an0 rLyL/ ML- 81�5"7 P�8�6 %l. iii � . . SPECIAL CONDITIONS: , I ' � ' � my Ilcenu�ls In /u11 fo e anC'etfecl. � ' <�,`t U�� � ' - PLUMBING I � 1 HOLD. FOR SPkCIAL RE@UIRLRIENTS � ' � � LJcense qess I< e i �' MDate � " ��' � s Siqriahre � � 1 W00.KER5' COMPENSATION DH N ON . � '� 1 f Bef Sink Sawef Cap � ; ; i ELECTRICAL • I.hereDy alflrm that I have a certH wtebtconsent to sdlf�nsur8 oi a certiticate � � geckflow-PrEventer-- � -� 'SBYueLConn2ction • ��. Automatic Washer � 'Meter _�over 10a emps , ' ' of Workers' Compensallon Iniurance, o'r- a ceitltletl' copY thereoi (Sectlon . , Construction Pole Sub Paneb ' � `J+ 3800, Lab. �C..1.'� y��p�>�� - ; , � " � Beckflow Irrigation ' $olar Collectors -'j ,� j `L � � . � � ' ' � Po�Ji�y No. LLy�JY_L.d_.�I— Company'.LbIQ'%=ANIJ G4�AL'I`�' . ' � � ' ' � . i,. Cooking Unit ' ' ' '�d Sub Po10 � � ' , ' �� y lkl Certliletl copy Is her�by furnlzhetl. ' t � � �1 � .• � �• Bathtubs � Soler,Piping � , �, :2 p . . . � � �. .� � , ,i , � V' LJ Certliletl copy I5/11e0 with the clty BuI1tlIn9:Dlvislon. • j ,/ Dishvcasher ' ;MotofS �0-1 HP � 1Yz$ .�� � Date � � • noVlicant - � ' -' • Clarifiers 1 So1ar Tank _ i; I � ` � • � .•+ � �. . , . , �_ , : E7(EMPTION FROM WORKERS' COMVENSATION DECLARATION ' ' DiShW25hE� f• � SWimmin PoOI�W/Spa �/�� DryerS ❑Gas" OElectric'.`' �.jncSolalO9 15 HP �j6-15+ � '� � (Thlisactlon neea not ba completea 11 the,permltli /or�ona huntlratl (5300) or � . . , : -_. . 9 � .T7' "" 1 - , � i � lass). � � ; '. . .... i . • + 'i i I .."M� Fan I ' .'I � �Microwave �'°' `f: � : I certiry�that 9n the parlormanceAf tho work }or which'Ihls permq is I55ueC �I,' �� Drinking Fountains � � � Urinal �j , (� ; , , � 2 � � .` � . , : : . , ' shall-not employ any porson in an� manneriso��as to become sublect.to the � -` � - � � � � . �� � F.A.U. % � � °� -� �Pole'�Li hi � `� � ' ' Workers'�Compensatlon Lawsof-Calfoinia., �,I ' f � r f FluorDrainsi j � WaterClo52t .-^� �;..' L i r* ' �; � ✓•� � � 9 � '� i� � j � . Date ' � SlBnature .. . � • , • . , • � : ' - ' , • , .�. NOTICE:'Ih,altar'makirig�[�Is�CeclaraHon,youshouldbecomesuD�ecYto�tha' Flao�Sinks•'---�- �--i--� �^WaterHeate�.� �r�-i-.-9-'- �O �- .Fixlures� ^ � �_� y �Rang2�,_ _ �. �_ 1_`,. _ .'_J- i Workers'i Com0en5alion provisioni,of the LaDor Cotle,.you.must. forthwith � - . � . _ , ' i , . com ly �wiN' such pfOVI510�5,-�Af „LIIIS. efTli Ishall be �tl80matl' revokotl. �' ��WOtCf�SCrvice ,� -� ' i i Device BoxBs _� - , ' Si n� .` r � ; � ; P _c , . . , i � + Gas SerSice� I +Outleis � . �. , , 9 � , i , � , CONSTRUCTION�LENDING AGENCV , : F � •I . , ' ' ' � , -�� � �' �• i ; 1 hereby aftirm that there Is.alconstructlomlentlin a en<y for tbe erformanca � '� � "' • � :� Outlets"1 � ,Standin �, � 9 9 $ }� Interceptors, { : � G � -I gSections �� t + ' � ot the ,work for, w�l this� permlt is �I55ueE � (Sectlon ,90 7� dv. C.) , _ � ' � �, , � , l.antlar's' Name' ���r � � ' � ' � - : Kitchen Sink' °� r' ;^ y � ; ( ' Switches, � •� p ctor ! �� � � � � i •- /t; � 1 : r „ 1 ' .. . � . _. i . t. • . I ITrash.Com a � � ! 'r' � LenCer•s, ACCres " � ' � - { � � - m �.p : Gar6a e,Dis o5al � � � ' '' ' � � OWNER�BUILDER DE LARATION ' . ; . i : � . 1 !� y � , ' � ' �'atOfiCi.� 1 ,t. „� � . . . I ' I .. i '. I t _ ' � � . 9 P . .. ' � : � . ^ • 1 �' I nerebyfaftirm that I am exempt;f�om the',Contractor'S�Llcensa �aw tor the' � p_T a .� _ "� C '� J� , , r � Gerieratdr„�OrS KW 0545 KW • 4 1+ ' � 1 � � � � followin9 reason'(Sectlon 7031.5 Buslnass antl Protesslonal'Cotlo: Any clty or , . , P� � , , ; � � i , •'p- t ,. •' ' � � ' ' �wunty wnich'requires a Oermit to construct, aljer improve; tlemolish�or'rapalr ; - . ., � .. ' _ � , � � _ p, � , Transformer'Q 7�5-50 KW . , �j � �, �'; � ' � any struclure; prbr to Its issuanca,�also reqWres t�e apD�icant for su<h permit , RoOf�D�ains r . � � � ' ' � to (ile a siqnetl slatemenl lhat ha/she I5 Iicensetl pursuant lo the�provl51En5 of ' � `' � Q � - � � . . . . : � � . . � -. '. + O5U+ KW . E , Rein ction Fee ! {T�visloo r3 bfrthe Business anUhPPo/esslons Cotle)�o9 that hee/6he•Is�exempt ` Shbw9ri � ,. , � Reinspection,Fae � I".`y6.. ' '�� }' � � S75 � F�,yPreirom'anC the basis for the allegetl eaempplon. Any.vblatlodo7 Sectlon , ; _, - � � Y � � � � ^ � ; - � �, Meter �u to 100�am s ' ! � � ' i '°3D31.5 Ey �any.appllcant'for-a permit sub�ects the�apP��cant to a <Ivll , - �' ' ' - P P A � �'IssueFee� � �$ 3 1 � enalty of nobmore chan flve hunOretl Collars (5500). -' �'� ,!';.. i / SeiviGe Sink � w ' j H � �� �� Iitua Fee'�� I ; �$ 3 � Zoning ApproVBd By �`• - � ' Date � j'���I °as,owner ot.tha property or my employees�,with wa9es�as thelr solo ' , _ , . . . � `>f � • L� , �/ ZS. ' compenzatlon` wlll!tlo tha work, antl the structure Is not intentletl or otieratl , ,�� j �'�� � - MECHANICAL ; ; � ��{ �� � i � � 1 � . 'for ule,�Sac�Ion 7044, Business�antllvro�esslonal Cotle:'Tne'Contractor's . ApplicationApO�o�BY� , , 1Date �� � License Law tloes not apply toan owner oi a property;who bulltls or Improves �' �' � ��, Aefrigeretion System ; ,� ' '� �•� ,. .!� � . Boiler, I ' � _� „ i' I r. A lintion Inued�8 •i • , .�. . 1 �/�ZS��� thereon,iantl who'Goes such work himself/herseif or throu9h his or her own � 1 i PP � Y• . . Date empioyeas, provitletl that such�improvements are not intentletl or oHeratl /or • ' ��0-100,OOOBTU ❑100,OOOBTU� � � ; saie. If, howevBq Ihe bUIlGing o� Imp�ovement IS 901tl withln One y8aY0f Com- � I, Duct - UnderGround ' � � � �. � ,�� �,'. . ` �: SUMMAHV OF FEES �, � � ' O�etlon, tha ownar�wlll have the bu�tlen Of proving he/she tlitl not bulltl o� Im- � . � . i' V • � f ��.+q ���� � , rom for tne vurpose o( saie). �, �-, ; J � Duct - Strucmral -! � System Repeir%Alteration ' � � ' j0 l 1 � '� i, as owner ot the � � ' ' ' . � � � , BUILD�NG PERMIT .$ � , SMIP � � $ ��� Droperty, am exclusively contractin9'with.11censetl con- , • � � � lractorsto.constru<ttha'Oroject.(5acqon7044„BuslnossanG,ProtassionsCatle:.'._�•DuCt_Ventilating___��__,�„_. ._,_, .,_�„ __,�,� PLAN'CEC $.y�� �� `PERMIT ' � The Conlractor's Cicanse Law does not apply to an owner of property wno � ' � , • � H� K'f i ; .� dSSUANCE � , ' � ' bulltls or Improves thereon, antl who <ontracts for such pro7ect5 with a con• j. ' Exhaust System ❑ Multiple O' � '' �" � � � y, �PLUMBING, ��,,. $� � $ � i tractor 5 Ilcense uisuant to the Conlractor's License Law . . • � � ` ' ' �' � f ( ) P I' , I � � ' ; �. :PIrAN C,HECK �! $ '.'�Z8.7S �t'GRADING � I, $ � � � ' � I'am exempt untler Sectlon 8. & P. C. �or thid reason 1 Firepl/Fact.8lt. ICBO;W � �� � j� I • I - � � �� ' � ' ' ' � �� � ,ELECTRICAL; � $ ' � . $ �� : Date ' ° � Owner� � ' - ' �� ' ' � HeatingSystem&Ducting , � � . ' � ' � �� MICROFILM � ''i hereby �certiry-thati�nave-reaC�this-appllcatlon-antl state thnhttie�above - ` �a100,0008TU 0100,0008T1 � - -- - ,- � • - � q PL.AN CHECK� . $ � ', $ � � , � Intormatlon ii corre<t. I agree to comply wlth all ci[y antl county ortlinances �. � r � r4 � ' • � •� , TOTALFEE $ ',antl state,lawi relating.to builtling constructlon,'antl heretiy authorize repre• i - � � �� �MECHANICAL " •$, •�l . , �' �. . � sentatives o/f is•cliy 'to anter•,upon he a ve-man �e� property tor ; � HoodoF Typel ❑� , � � ReinspectionPae ' L$15. � �i �'.' �' LESS ' � � � . . Inspacuon our 1��� C• �4ncr�L,.cr�v � � : Cano ' T e II ❑: � f i � J� i -. �PLAN CHECK� .:$, �f�. �. 519nature ! t ' Oato /•'2a7=�3 j , � � r. � , •� � � , �: ' ' � . ' �•� �, ADVANCEDPC �"$ �� � Regis[ers � , ��e Fee ' � •S 3 ' 1 - . . � i ' �� � � � Drivers' IJ a or:55 � � � j FINAL FEE � i$! . . . . � . . � � _ . - _._ '_ _' ' .__ ..' . �. ._. .. . ... . __ . .. ''_ _ ' ._ . "' '_' . . .- . . . CMF 086546 rav. 12/82 , White - Bulltling; Canary - Appliwnp Pink +Accounting; Goltlenrotl - Assessor ' _ . ' - . / � � � - - �� ,., '� :. ' ,. _ �.. �r ., - , '.% �ONSTRUCTION AND.PLAN PLG' � � P � ' �=' : � "' : �O. SPA . - _ � •; � � , - ' -�D3te - !Inspector �' " � �� - ��Date ' Inspector ` :, _�APPROVALS . Permit #�� ;.APPROVALS �' Permit � � � ,. 3 r - - � - - � � °��� T- 1�. Temporary Elactrical Service o'rjPole • � >;. . �� � ;^ �' ` � '52:'- Pool & Equipment l:owtion � � ' �. � � - � � � •- � � t, . - :.� L . , y : ' , �' Y? Soil Pipe-Undrgrnd? • ry o; � i,. ���d'� _ '- 537 Steel Reinforcement '" ' . `., - 3. Electrical Conduit 17tilitv-Undrgrnd�., ' ;�. - `. �� � _ -, ` G - � -54 ^ Forms �� - � � � � � _ - , .� ' 1O 4: Electrical Conduit-Undrgrnd _ _,I , " %. � `c - ' : 55. Electri�ral�Bondin � � � � rn i , t� cc:� �-.- 9'�. . '�:' . ` - r r',. . 5. Steel �Reinforcementi � ,S�'. � ' �. 'Z,1%��3� ;�.8 ' - : i56.- Rougti Plumbirtg & Pressure Tes[� � - , , � " 6: El�ecrticahUFER Grnd.� '_ � i �.' �- ; o� � 57=.' APPROVAL TO'COVER-GUNITE{ ' _ �� � �; _ 7. Footings ' � � i . . '- f i y : .-f � .�. ` � - . - . 7_ .; � � •$8:.Electrical-ConiJuit-Undromd. - < 8. Foundation • " � � ' - I i �'� ',�7, g�3 r �; ' � 59. Gas Pipe,`O.Undrgrnd., Test'- c . � _. � - ' 9. Witer Pipe ;Uudrgrnd. ' � ;� „ � - 5'�� � �gp. Backwash Lines, P-Trap, 0 Undrgrnd.. � - '; � 10. Stiuctural Floor SYstem �� ; ?-(j,s-'6j �� %�f 61. APP.ROVAL TQDECK ~ - �'' ' -'. r, 11. Property Sewer Line & �House�Conne'c[ion - 'ii = � . �, Backwash & Receptor-Final `� �:, ' 12. Sewer Cap � ' '� � � r;; � � o ,' �= _ • 63. Heater &iVent-Final _ �. , - ' , 13. Roof�Drains � � � , ; "'= ; � �r . ;'g4. Plumbing�SYstem.-.Final . ' ' � Q 14. �Rough:Plumbing' . ' � `_3 � , jJ '�65. Electrical-Finab • '"` - v - • r - •- /:4 �� �:�15C Rough Eiectrical-ConduiY��r'I..:�I "'n- -I,,.II,-( j �.! I. yb6:r�Solar SY,stem-Final�` - --" �-- �- - �. .-� . - "'.' -- �� �, -16.',Rough_Electric:Wirings Y � = ' `[�" � = � " F= �-, � .- "67� Fencinq &'Access Appro`val t�- - � - - -'- '"" � �'�`...- r.n. _ � ,� t' i� � 9 . 1�7. �Rough Wuirig'.Sign•' ;� � � �i� �i , ' ' � : : � ' � gg,' APPROVED FOR P.LASTERING� � a:I 1 i ����_ - Rough_Elec_tric'a1-T'Bai Ceilirig '�i t, �� � � �"- ; I 69.� POOUSPA SYSTEMS FINAL - �` , 19 ` Rough�Heating &.Air�Condrtioning f� ' � JS�3 � . fj' � � .FIRE DEPT.:REQUIREMENT_, � � - . i : . _ � � _ �. � , . . ' . ! , � _ _ �0"Rough Factory Fireplace , � � ��� �� � � ; � ! � APPROVALS' � Permit # • I` � � - �21, iDucts; in Stiucture� '• � �:' l7 r'�,� �; ; ' j � j i � 70: Underground Hydro �� '' � � � = � � � � � �22. Ducts;, Ventila'ting ; -• ' .•� "` �� � j ' j ` ,�1 Produc[ Piping � Gas ❑ Oil � ' ; �23.:Gas�RiPe;Rough & �st .x '• `Ic� n�. i� � _'�-� i---i-� I -�- ;-j � �- -- ,. . . . _ , , _ � - ,_ -_ � ,_�� _„ � , I ( _ •�72•I Undergrounii Flush� � - i -24: �Roof �F.raming ' ' " �z ;;.,,, i _ . ` ' ; ' _� � .� ;. 73.� Undergrnd. Storage Tank O Gas ,� Oil � � � ' 25.'Roof-S�eatliing � �� ' j �.-i � � r � , -�j '$3 �� � 74.; Overhead Hydro �' -; ' ' � . n '- 2B ,T-Ba� Ce'rling (Structural�i 8(�Monocoat' � � � '- � . . �� 05J Dry Chemical � • � ' - � �,; 27; �Frame a�d ,Flashing! � � �' .� � � ' ; y_ ' _S3 � t3'yt/� � ;76. Dry Standpipe • . . .•� , t � r. . � � . 1�•� � • 28.'Lathing'&'Siding ��. •?i d,' r_ � �77. FIXEDSYSTEMFINAL :. 29: sinsulatiori? '' F � ,� �� , .�q�3 ;�i"? � �78: FIRE PREV. FINA�L ` � � • =30. �Drywall Nailin �j � � ' g �Notesi _9_ - �� e ..:31.'Plaster �Brown Co�F� . i ; r � �� _g3 .. . � . � . �` . �` _ .. � - ., - . - . -; ° - �� , . 32. Electrical.Power Mefe�,-Fina( �� . �i ; 1�;� ��. � , �C:'.:•^'!,' �!�G'/ �,��� . . " � � � 33.;Final Electric .. . � �� �� l, il. �; I �,.`;,;;',.�:'>. "� 34. Final Heating &�Air Conditioning,,. . ' � , � � ' � � 35. Final Gas Pipe-Te3t ' � � - 'y � T � _ - - :�� 7l8 s'f W . 36. Hood or �CanoPY.�` � r � -,' S> ti � r � � I t � . ; � ; � - ' � = . , . _ 37. Final Fac[or.y�Fireplace- � ' �� �' , . = t ! I � ` ; '3,�, Nofe � �� � ,- '�- 38. Final Plumbing . � � • � ;.. _. � �"/� S%J, � . (� ' � . . ' � . . .., �_; ` � 39. Water Service-Final � � - 1 � � � � � ' - - i r 1 i- �'� � 1: i 40. Gas Service-Final � � , � � ' ��'� � �S, yJ, ��� ! " _ i . � � i � , j ' . . '{.,?� � 41. Solar pomestic-Final � 1:,, ! - I- -?�--�_�-- _ r 42. Backflow�Rreventer ¢I E � • f�";1.,�- i--'-- - - -�- '- - � � .�i . `•�: �;�, . . - � �:._�- ' - �'` ' c� =;. i, .: .� , � . � r . 43. Backflow'Irrigafion ; � ! ���, ; _ � _ i . �„ � f�, � - � 44. Landscape Irrigation�System � � '�•�'•-� ' -� � �, ' � : � � - - � ,- ` "' � c ; . ,, - � � . . �- . , - � . 45. Sound rAttenuation � � � � ,� , { +; � � ` I : � • � � � i � . . , ' i 'i . �.ni � _ � ` ; ,� I,o + • v` � - . . 1 : I i i ', . . _ � � 7 46. Handicap; Regulation's � j:. � I � �_' � � - 47.�FINALSTRUCTU{iE&BUILDING� ;. � . � ' ' � " ' r � if /� f3 � � ; i 48. Special Requirements Completed . � � �� , .`',0 ' . ' . � �,�. . `„ i i � � 49. Elec[ric Release;io Edison� � j ' � _ Y..�-.. � i._� _ _ _ _.1 . -- ' � � �'� . _, � i � 50. Gas Release to Southefn California Gas Co � � f ; � '; ' �. ' . - i � 51. CERTIFICATE�OF OGCUPANCY 9 � ' _ _ __�.. .1 � ' :_ � _ ' ".� ".� � . � '- �";.'• , . � ,, ,. -, �- - r ---�- � . •,�•.l � �- ,. � , � f'� j No ' - � Date -- - � -- - - - - - -- - I� Ciry�of Costa Meu Development Services Department Building Safety Division P. O. Box 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No. QQQ�OO The Building located at �nn wFem 1Q'iw CTi7F'FT has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group �2 Occupancy. Use of Building IntC'Y'].Ut Altt..'TdY�0I1S — t'IEd].Cdl Offl.� ��j��jT+� Legal Description 11:r-346-22 � (See reverse side far Metes and Bounds) N3�8257 P-6866, P-7650 Building Permit No SP-6138 Electrical Permit No. E-6961 Plumbing Permit No. �"6138 Mechanical Permit No. �—A�S� Number of apartments —�— and/or guest rooms —�' ISSUED To: Building Off.icial�� ����iGlC_. Dr. J�nes Stirlxl by /�C: ���/� �— �oo w. i9m str�t ��s��. costa r�sa. cA /S�,l /9 f'j3 Date This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises end SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. cr.nF 1o15-a6 rev. i/83 White � Owner; Canary - Numerical File; Pink - Bldg. Permit File ' AGP���nt lo flll In all spaees exeapt those wlthin heavy EorEer Ilnas and sign all approoriata Eaelarallons. � CITY OF COSTA MESA. � ; � . � _ ? . . _ PERMIT NO. i ' . TRACT NO. LOT NO., , BLD .� . ' - ' , , . , , . ' . CONSTRUCTION PERMIF� •: . , � ,� G � . , . , � „ '� . . , � - - AppliCent'EMeilin AddfE55 � �Z4� -TVPEOFCO�ISTRUCTION fJEW ADD ' ALTERAT.ION REPAIR �� . . ,5�63 3/OP/83- •- �4���. �� PfOjlCt Addfess �Q� �.L �Y4�G� S T . , ' , ❑ CONVERSION ❑ DEMOLISH ❑ OTHER . . . ' � � � '� I � � . � � OVInEf's N/e�me '�2.� �� �/R"p �— !%'�b ohone��G3 ��O � �DESCRIPTION OF WORK . . . - . ' I E U� � T NS . AddfP35 /� `ti ��g �- S7-' OCTA' f'%7�FLS A� 7ypE OF PERMIT � GRAOING ' FOVNDATION STRUCTURAL ' A. P: � ' t ' � 20NE ; '- - Afch/Eng. ���'��` ' ' ' LiCEn58 No. � , '� TENANT� ELECTRICAL ❑�PLUMBINO ❑ MECHANIC,AL' �. � ' ' . . � ,BUILDING� - .PLNG. REF. � � � � � � � � Addf255� �L-,�� `' 22N� �Q(/ ' GG' ' .,O��OTHER - � . � � ' . . TO PEILDVNLINE � ' REAR VARD (T0 P/L) . ; ` /:%2.K��. �/�-G� � ' v � 6 � PROJECT DESCRIP710N. 54. FT. � oCCUPANCv ��%%'e�C . _ Contracror'a Name. ho�n/e , , ' � � . �9� 9z ^ • � IEFTSIDE VARD S � ' RIGHTSIDE VARD � • � ' � G�%.�Z L¢- G.�it-ti/\ /-s// G�-' CONSTRUCT�IONTVPE �' � VALUATION$� pKG.SPACE;REQ. � PqOVIDED AddfBSs (meiling) 1 � I ZON� ' - GRADING CU. VOS. 'ACRES '� Licensa No. 2 �l'{-'�f �7 � . - . : � , . � . . . "' LICENSED CONTRACTOR DECLARATION I � � � • � Ramarkt: � �'3 • �� . STREET WIDTH , iPARK FEE $ ' •T � ," I�hereDy alfirm that 1 am Ilcensatl unOer provislons of Charter 9(cominancing . _. - SVECIAL CONDITIONS: with-5e<tlon 7000) of �Ivislon 3 of the Buslness anC Protesslons Cotle, anA , - � � � � ' � � � � �- - 1: my Iicanse Is in /ull torce anC-effect. • � ` � ' � ; ucenie slass � � License No. �� %'�� 7 � ; ' - PLUMBING � , � . . � . . � � . . ., ' � s . oateQ-�7L2oi� � i �� _ o . . � � � . � ' , , . � , . . : WORKERS' OMPENSATION DECLARAT ON � ' '%� � � . Bef Sink , SEwCf Cap I r � I ELECTRICAL � : � .L�ereOy'affirm that Lnava a certificate.of coniflnt.to solNnsure or.a.certifirate_ � gackflow PrCVCnter--r -- -� �-' SBwEr COnnEction: � T-�-�--- -- � AutomatiqWasher � _ _'Meter over 10� amps t �� ot Workers• Compensatlon,t� surance„ or a certlileC; copY tharaof (Sectlon � � - ' ' � � • 3B0o, l.bD. CJ `�' �-"-' d.('Z��� ; . � ; geckflow Irrigation ' Solsr Collectors � � ' Conitruction Pole � �� Sub Panel' / , : j PoIICY No.�� `p (� . ComPanY �S� �� c.� , . . . � ' ': - t � Cooking Unit . Sub Pole I � � ! � 8 CerUfleE�copY IS he�9by fu�nizhetl. � � ' � � � Bathtubs ! � � Solar Piping ' � ' ' . � - . I : i CorUBetl copy I filetl with tha ci[y Builtling Dlvislon. � � � � � � - - Dishwdsher . � •MotOrs 0-1 HP�ih$ • � Data • AOPlicant � � � ' ' • ' Clarifiers � Solar Tank , �i ' EXEMPTI N,FROMWORKERS'COMPENSATIONDECLARATION ' Di5hNA5heI ' ' ' I SWimmingPOOIW�Sp2� ' � -Dryefs OGeS;OElectnc '�� IlnaShcari�9-15HP �16-15+� � , ' (Tbis sectlon neetl nat be Com018tetl it the Dermlt Is 1or one huntlreA ($300)`ar , � � - - -' � ' . �� Fen' 1 �j,�� � R,' � �Microwave ' �� � � � � � � � lecertify ¢hat in the Darformence of the work for'which this perm�t Is Issuetl, �� Drinking Founteins � I � U�inal : � � • � j � � shall: not employ any person In any manner so�as to become subjectto the - . • i � . F.A.LL 7 � Pole Light . ,' � - � , Workers' ComDenutlon•Laws of Califarnla.' � � , ; � I FI6or Diains� � � Wacer Closec� . � I 4� � ' � � � �. Dale � � � Si9nature � � ' ' ' � � � q Fixtures � � ' � � '"-NOTICE:�If,-a/termaking�tMstleclaration,-you shouldbecome-subjact-to4he-�- --^� F��o��Sinks �-- ' -- - - �Water Heater� �- - � a�-- -� "/� - --�� +.. _.L_. __ �Aange_ _ � _ _ _ �y .� ; WorkerY� Com�ensaUon rovisions of the Labor Cotle,.you. must,forthwith . . . . � , � . _ ' '1 ' � ' , ' comO�Y �'�'��h. such DrOvl5lonsjor'this�'permlt �shall be :tleemetl. reVokatl� � � � GasServicej • Outiecs+ � � : 'lNateiService'� . ; � : ; , �eviceeoxes:,. � $jypi `� � . ' CONSTRUCTION�LENDING AGENCV • ' � ' 'I . . � ' � � ' � � ' � - i , �q� Outlets„ � �StandingSections � � , �I I hereby affirm that there Is a,construttlomlenAing agencyAor the parformance, � i� � Interc¢pta�s � �'��i - i�� -r �;) 1 �_ � " r- ' � { ; � � of the work for which. this: permit �Is �luuetl .(Sectlan •3097 Cir. Q): ' - . _ . . � ' . � Lenaer's Nama - ' �- ' ' � ' � - � '' i _ Kitchen Sink� " . , � , - . . 3 � Switches ' � 1 Trash Compacfor � � Q tantler's 'AACreu � ' ^ . - 1 " : ' ' � � - . , I � � Lavaiories� �� :- � { . , • � Gertiage.Disposal � i � ��. . I � i � OWNER BUILDER DECLARATION � '- . " I � +' � % - ' ' � � � ' i herebv afiirm th5t I am exemot�Trom the Contractor's LI<euse Law for the - �• - �� -• �' GenE/ato� �0-5 KW OS-15 KW � . I:J I; aslowner of tbe(prope[ty oi -ompensdtlon' wlll�tlo ihe work, an lor sale:(Sec4lon 7044, Business; � License Law tloes oot apply to-an o thereon„antl ,who,0oes'suc� work employ ees, provitletl thac such�impi ule. If, howaver, t�e bulltling or IR pletlon, lhe awneriwlll have dhe bu �rove tor tha purposo of salaj. � LJ I, as owner of the property, am [fdCf Of5 SO COOSSfUtf lh2,D�OJeCt, ($E� The Conlracmr's �Icense Law doe builtls or Improves thereon, antl wi t�dtto�(S� II[ense pU�Suant t0 the Ca ❑ l,am enempt untlar Sectlon= ; � . Date � Ownerl_ nsa or rev. I - Builtl n9; Canary tesslonal Cotle: Any Uty or , P-Trep . . � _ � i improve� tlemolish'orrepair - � � � ,,. . . - - . - e applicanbfor such parmit . �' RoOf D�ainS� � � !j T _ -� usuant to tha'DCa��sions oi . ' � ` � . � � ln9 with Section 7000) of � ' " . � _ p. ; ' ' ' � �- Reinspectibn'Fae ' � $15 'or that he/she' is' exampt '= � Showers ,� �' _��� 1 n� � i. Anv violatlon:of SecHon ". _ „ � , . _ . ' . . tna-aPDllwnl to a civii � ' ' . . .. �). I ' ' n i � � Service Sink ! � ''I � , 1 _' { ; laue Fee =. � � $ 3 s wlth wages�as theti sole ` � MECHANICAL � " Iz not IntanCeC or ofieretl , .� ' � i j �. I il Cotle:�The•Contractor's � � , � , rty'who builtls or iinproves � ' B���e� � 4i �' �� `• ' Retrigeretion System j � i ' or [hrou9h hls or her own � � � � � ' ' � ` 1 � - ' ' 1 iot Intentlatl or oifered tor � Duct=UnderGiaund i � � ��-.100,OOOBTU ❑100,OOOBTU' �Itl withln ona year.ot com- � � i � he/She Aitl not builtl or Im- • � � � � • � � _� f • � t ; Duct-Structural : � System Repair/Alteration !'�� itracting�wlth Ilttnsetl con- ' � , i • Iness antl Professlons Cotla: � . Duct -, Ventilating 1 �.. � an owne� of Droperty who , ' . - � - �' � • , � . r su<n prolects with a con- Exhaust System ❑ Multipie �� � - � � ise Law). � . . . • � - e. & P. C. for this reaion � � Firepl/Fact. Blt. �C80 # ' � � � � � � ' � � I � � � . 1 � � Heating.System & Ducting � i , ; � { � 1 F � � i aria�state�that tne acove�— —}- 04100,OOO�BTU �d00,0008 � --• -- � - , � citY antl couniY ortlinances 5 • � I . � ~ �!� � .' �....� �-�� � � ntl hareby autharize reD�e- Hood ar T { � �e•mentione0 property Tor ' � YPe� �' , � � ReinspectionFee� � -$15� � � i ' 1 Cano T� e I I ❑� � 4 ( i . I i ' oate Z y3 i I 1 1 ' ' � . . . � �'� — � I j Registers � � � � ' ��+e Fee �•$ 3 -A�PIlcant:Pink-�Accountin9�Goltlenro0-Assessor ' -- "�' -""_� "- - -�� -" �. � "' i Trensformer. 015-50 KW � ' ' � , , •�5U+KW� � � , ;ReinspectionFee ' $15'. Meter� �up (0 100 amps � � ;Issue Fee' i ' �'$ 3 � . , in9 APPro�ied�BY ' � Date . I .- ' - , I . ' + � ' i rlimtion Approred By - � � ate � . .. . • Q i ilication Issued�By _ < �' ' nate �� �8� j � : SUMMARV OP FEES , . � � ' �BUILDING PERMIT $ � � SMIP � , $ 1. ` ,PLAN CHECK� � $ � � PERMIT � � � ' PLUMBING $� � . ' I�UANCE' { $ ; i i �PLAN CHECK, i $, � i GRADING ; �$ I ` ' �ELECTRICAL' $. �d� i �PLANCHECK� � $ o�%.�o� ! MICROFILM ' $; � � � - ; . ' ; TOTAI'FEE� � $ � � MECHANICAL • $ ; LESS 1 ( � � , � IPLAN CHECK' ! $ � j ; � � � i � , � � . ; � A�VANCED PC j$ iT ; '� n' � ' � ! , j ' FINAL FEE. � $ � � � � _ . --- -- - �";�CONSTRUCTION;AND;PLANNING ° � �.' 4' •.• `: � �, . . ., J�. �0�, iPA;- _ ,- -_ n, -, . :APPROVALS - Per'mif#� -�� ',`Date .i�spector �'�APPROVALS': Permit#-' � Date � Inspector . , i � . :> r- ' . . - '- � �'' �1� Temporary, Electrical Service or`Pole` ' a� �. : '� " � R � ^ " � � ' � - ,y i., �. I � i F _ ,_ _ ; I� ;52i�Pool &-Eguipmenf Locatiom� : r,� • d � � - . .- . . � �, " � - 2: Soil Pipe-Undrgrnd.' � � ;.�: �� i �; '✓ ��; - ��53� Steel Reinforcement _ , � � � ''' � � :, - - -- .� 1� 3: E�ectiical Conduit UtilitwUndrgrnd:�' _ � -' ` - �`�; ',54. Porms' - . � _ - - ' .� �� � 4'. Elect�ical Conduit-Undrgmd� ' �_' Z • � %_ , -�' � � 55: Elec[rical�Boniling - - �� � _ _ = � � • I �' 5. Steel�Reinforcement �' � 'V ` ' '- ^ �': ` °'` `2,• ;56,. RougFi Plumbing & P�essure Test ' i i i. �,�,_", - . . 6: 'Elect�ical•UFER Grnd.� � ' L ! ' - � � � ?' `, o= , 57, APPROVAL'TO�COVER-GUNITE � , `•� ; ' � 7. Footings � . I ' , n m �'° � � � ��58: Electrical.Conduit-Undrar�d. � '�� ' , , �� B. Foundatiori _ � �� l''' �' � � _ �59. Gas �Pipe,;O� Untlrgrnd., Test' � . - ..' - t � � '= 9. W@tei Pipe-Undrgrnd. ' � _ -�-� *_ !'gp, �BackwasFi Lines, P-Trap, O Undrgrnd.=' � ' 10. Stiuctural Fldor System .� � 5 '� -, ; t% � ' , 61. QPPROVAL TO DECK ' �"" • � , �` ' , �. 11. Property Sewer Line &,House Connec[ion; a � � ' ,a? � ° . 62. �Backwash"& Receptor-FinaG � � � . - � I I. , b � . � i m b - �! i '' I � - c 12. Sewer Cap � ' � I � :; � � � '- ^ •'63. Heater & Vent-Final, • ' _ = % I I � � c� ! �I - - - r'.e. 13. Roof Drains - � • �� '! ' � • � '64. Plumbing:System : Final � �- � ' ` i' 14. Rough,Plumbing' � ��� -� � � � �'65. Electrical=Fina6-"� - . ' � - '` 15: �Rou h"Electricai-Conduit--� -r--T;-� - - �-- - - -• - - �, g, 9 ,, ,� � �-�.- �"- - ' 66': SolanSYstem=Final" ' � ; � -- r � _I ��,46.•,�Rough-Electric Wiring. ' '� yfF' ' ' _^- ' � - � � ' - - - - -. �i � .i • m• �. � �' 1 : f� i 'l�� � ` I � �67 ' Fencing &'Access APP'roval � ; � - � - _ Ns17.'�RougKWiring`Sign�� ' • j i0: I ' �: j _ f': ' 6$.i APPROVED FOR PLASTERING � _ � - - - 6 0, �i'c I���: _ '�� 18..Rough Electrical:T`.Bai Ceiling f � � � � i ! ' ' ; : : _ � 69.� POOUSPA SYSTEMS.FINAL � - � � � , , I p N 7g, Rough'Heating &!Air Conditioning �' �' °� � � � � i'FIRE DEPT.'REQUIREMENT � ^ � ` 20. Rough� Facto'ry Fireplace � �� � � � � , � � ; � AppROVALSf i Permit # � � � - � ' m �'. �.'i t, � I i , � ' 21. Ducfs,-in Strueture�� ' I ;'( �� ;i i � � � ' � 70� Underground Hydro � � - , � ; ��,�22. Ducts, Yentilating � . .' :� , �� � � ' � ' ' � � , � � � �) � � 71.; Produa Piping O Gas ❑ Oil _ i � ; 23. Gas Pipe-Rough & Test .� � , { ' � ; � � � �72. Underground Flush � � � • ~ A ��'-24.�RoofFraming: � �- � 4�_�-,.,I-;�.,�-:.-,'- ,. p3.�Undergrnd.StorageTankOGas._OOiI � . , � � 25. Roof Sheathin .' � ' , � � �� ` ;' 9 ' . jn �� � � i.. 1; � - � �`' I � �74. Overhead HVdro j - � , i ; 26. �T-Ba} Ceilin'g "1StructuralL & Mono,coaY � �, i '; i , ,; � � ,75 � Dry Chemical ' � � : � " ' � ' .. ,_27..Frame antl Flashing, •- ` � � �� ) ; _ � , , � � 76. Dry Standpipe , - • - , � `_ R 28. L'ath'ing & Sidingi �„ I� i !' �' i �; � � 177.' F�IXED SYSTEM FINAL , . � � � - o �� � �29,�Insulation-�� ' " � � i Q � ' ! � 78. FIREPREV.FINAL � � i _ _ � `- - 30. Drywall Nailirig " � � t� . � � � � , 'Notes � ' i • � � � a � � _31. Plaster Brown Coat; � � � � �� '. -� � � � - -�f- • - -- _ - - - �-� ��qL , OwC, - �XC�=� ��32. Electrical�Power MeterFinal � �� � � � � i � � � �, � • �" ,� " J C j i , .' � 33. Final Electric ' ' � � • � • a ` E - 34. Final Heating &�A`r Conditioning • � � � �;' I' Lf LL� C�-, ' '.-� _� : . �_ - . , -. . � 35. Finai Gas Pipe-Test� � � �� - �, _ � - i � ; �r� � ` �� - 36. Hood or CarioPY._;� �' r � � �� . S ' : �p i , � � i . �� N � � ` � .- . u ~ � ' i G. . .. � . . C ' ` � P� 37. Final Factor�y Pir'epla'ce� � i ! � ,� I % � �- � �- � , � �� � . � � � � C.; 38. Pinal Plumbing j � r � � ^� , , , ;� I ' _ �' �, �. ' - , , � .. -, ` . � 39. Water�SeFvice-Final . • � '; ; � ,�; � � ' � � . • � � � �I � 40. Gas Service-Final � �� ' ' + � I �, � , i " � ' a i � � I i 41. Solar pomestio-Final j ', ; ,_ __I _ ' � _ i ' ' ' , � - ' � ' . � , 42. Backfl�ow Preventer ,. � � i � •.,� _ ' , i ' ! j i I ' '' � � . � � ' . . - ' ' - -� i- t M1 ' �' ' n i , ' � � - ' 43. Backflow Irr,iga4ion ' � i j �ti � , � ��� � . � o � : j'- _ _ � : � � . I , . - , 44. Landscspe Irrigation �SYstem � � : �. . � ; �c � _ ; a ; � � � - , , i � - - ' - 45. Sound:�Attenuation ; , .� ' . � � ' . � � � ` � i � - i � � 46. Handicap Regulations i ! .� i � - ' ��- _ j i ( � , ' ;, " � ' � � ' i tA, 47.� FINAL STRUCI UREi& BUI�LDING�� i o , i I � � _ � ; � � � � , ; � ' . " i 48. Special Requirements Completed � � � � � = � � I � � � � ; � ' � ' �V� � , . 49. Electric Release.to�Edison' I i i_ ; _ � � � _. . '� � � � � � (- i -f- -}.�i_y_'. i n i � � r( i 50. Gas Release to Southem California Gas Co ,� � � ; I - ' .. , "' � � . � 51. CERT:IFICATE'OF OCCUPANCY � ,_ ' � _ _ ! ; �_ ,_' '__ , _, . ' - � � , , ' `No. � � i Date f � - -- I` � - - � '- --_ �- - - ' . . .4._ �� .i}..�1"�_h __ _1 I ' � , � AOY��v�� to /ill In all spacef eteapt those wlt�in �eavy Cortlar Ilnes anC slyn all aoorooriata Caelanlions. , CITY OF COSTA MESA' ' pERM1T NO. - • TRACT NO. . LOT NO. � BL .- • �; � � ; �ONSTRUCTION PERMIT_ ' .. � � : - �{'E''.. �2 : �. "- i % ' . ., .. . . � "t .:_ � •3�:i'I 8/:',t/!'?' ' f�eC:.' � Yl. AppliGnYi Meiling AddflR � � 7 � ' ' 2V�E OF CONSTRUCTION � ' _ � NEW ADO, ALTERATION REPAI R � , , ' ' • � � , � , ' � _ _ ' . � ' Aoject Address I � ' D O' � ' ❑ CONVERSION �❑ DEMOLISH ❑ OTHER � ' ; , � � ' • Owner'tName J � � �^ �1�� • .Phone���� �f� � DESCRIPTION•OFWORK� _ . 1 - . '�p0'�,-/.� � �, = �' � . ` _ '• ' . , , AddfOss . � TVPEOFPERMIT�/ �' ORADING' ' FOUNDATION STRUCTURAL � A.P:�M ' � ZONE � � : ' - � Alth/Ene � . � ' L'ICenEBNO.� � ' `; i ❑TENANT I.CIELECTRICAL ❑VLUMBIN(i� MECHANICAL � PLNG.REF.M� ' � BUILDING • - � - A�ddraaa ' : ' � � O,'OTHER . � . � � - � I �• . ' . �� TO BUILDING. ' � . 1 1 ' - � -- Contractor.'f Nam '� -� � hone � i PAWECT DESCRIPTION� 5�: FL1 � •- OCCUPANCV , �. AEAR VARD�lTO P/U ^ � � CONSTRUCTIONTVPF ' � VALUATIONS - - IEFTSIDEVARD , � � RIGHTSIDEVARD � '� � � Atldresslmeiling) ��h��\. ` �3...�.-.Aa•..-�.�� �'� C7?1�Z , . : . . , . . ' _ - � • ' � � � ZON$ � ' � ' � GRADING CU. VDS. ACRG� PKG. SVACE REQ. � � ' ' PRpV1DED ' � - � Licenae No. �$% ��--�-- i � i � � . � - - � LICENSHD CONTRAGTOR DECLANATION . Rema�kt: ' ' � � � .. STREET WIDTM �_ PARK FEE S '� � I heraEy aftlrm t�dt .I.ain Iltense0 unOe� D�adslons o1 C�arter�9 (CommenrJng , _ ' with sactlon 7000) of �Ivlslan 3 of the Buslness an0 ProfeulOns CGGe, an0 � , ��, � � � � . SVECIAL CONDITIONS: ' � mY Ilchnse Is In full to ntl e}fect. ' . . . _ . IJcense b ss' ' � cense No. %'�% ��Z � , • PIUMBING � • . • • . f � � . Date' � � ' SIg aTu e � ^�� � - , - WORKERS' C MPENSATION DECLARATION ' . BaiSink � SBwer CBp• � � I ELECTRICAL I hareCy�affirm lhat I have a Eertitiw[e of consenbto saH�nsure or a certiflcate ' ' I ' 1 A.utOmatio Washe� � �Mete� �Ov2r 10b amps � .-01 workers' Cbmpensatlon Iniurante, or a certlfletl�copy nereof j$ectlon , " B�kfiowPrOVenter-- - SBNBPCAnnBttion' - �-- -- . -�-- -- - - - ' 3800, Ub. C:) n + � � � gg�kflow Irripation � - $plar Collectors ' , Co�struction Pole � ' � Sub PaneL T ; PoII � No.TL�i'�Z I� JS'�� � ComOanY � ' . _ . . , " " � . Cartltiea coDY is nereby turniztiea. : � , BMhtubz 1 Solar Piping • . • . ' Coaking Unit , Sub Pola : , � ; Cer I coD �sflle0 wlth theclty Build12ulDlWcio¢. . � , � DiSh�Ydih2f . • .MoWR �04 HP �1X$ ' ' , � �ate_���_ ADP�i�nt �L. �E _ 4� L��r�_c f' � Claritiers � � j . , Solar Tank , . � � � � ; 1 -�EXEMVfION; ROM WORKERS'_COMPENSATION DECLARA� • DiShwaShe! ' ' . � � SWiTTing POOI WISpe , ; ; Dryers ❑Ges � OElectfiC� ' � ? � ; ' I ss)?��tlon naetl not be tomD�eteO if ihe permit Iz forlone huntlratl (5300) or ; . _ , , ��Inc:Solar:O9 ;75�HP "076=15+' ' � 1 cartify�that in the Deriormin<e ot the work tor which Mis permk iz IssuaG I i � Drinking Founteins � � Urinal i � , � I , � � Fan , � i , � ,Microwave , � � { I , shall:nol amploy any person In any manner so�as to become suDject.to [he � � � . � . � �� � � F.A.U. � . ,POIe�.Li ht � ' � Workers'jComOe����o���ws oi Califomla.� � � � � I i 7 1 Floor D�eins; j : i � Water Closet, ; i i Q' � � � 9, � : � � Date • ' • �Ignature ' ' � � . � , � Fixtures ; 1 1 ' Ran ' . NOT.ICE: If, alter maklrlp tNs OBclaraUon, you.should' becoma subjact.to.the. ! ' Floor Sinks . _ � _ _ Water_Heater . .} - - - _ _ _ _ .,.L.._ _ �_ _.� 1.. _ � � ' Workers'! Compensalion provislons of .tha Labor� COCa, you must fOr[hwith i � � " ' �� � � . , � w , , Device Boxes • � � ' ' . � I comply �With� such �prOvislons��or'thl5,•Dermit Thali be �tleametl' reVokeE., 1 1 G895erviCB ' ;Outlets t"'I �,� �1Net¢fServlCe , � ,1, '� . 5�9�' 1 � 1 � CONSTRUCTION LENDING' AGENCV'� � ! ' � I heroby aHirm that lhere Is aiconstruction lentliny a9oncy /or the� performance; �.� ! �nterceptOrS � r' � - -. �� � j' }' � OuUets i ' • �Stending $ection5 � 1 ' of tba 'work for whlCh_ [hli; permlt' Is lluuetl'(SeCtion' 3097� Clv. CJ ^ � � . . . � . � � 1 � _ �� �� ^ i • q Switches Trash Com ector � Lentlm's'� Name' - _ _ , { Ki�chBn�Sink i' _ _ � i P � � LanGer's, ACCreis �= : - � , . � � , - � - �' � ;� � � . Gerba e Di o5al , . ' � � i ' OWNER BUILDER DECLARATION �-• L' : - vetOfies �' Pn -� � � T � . v' 9 SP � i I . � � I haiaDy.at/irm'that I am'exampt irom tha'Contiactor's License Caw tor tne , p_Tra � �� � � � '- � � v� Generetor �0-5 KW �545 KW � ', , ' � followinq reaaon� (Sectlon 7031.5 �BuSinezs anG Protasslonal Cotle: Any city or P� ` 1 � r �counry wNch roqulroz a permiFto construcq alter ImDrova, EamaliSh o�'mpalr ! . � � , , . . ,� , . , � , Tran5lo�mB� ❑75�50 KW � � � ' "eny strucWro, prlor to Its Issuan<e, alio mqulres t�e�aD011cant for sucn permit' � Roof�Drains' '� - � - '' � � �' .+ � � : i to file a signetl statement that �e/s�e Is IlcensaE pursuant to tne provislons of ' � � � , - • �.e Contractor's�Liconse l.aw�(Chapter 9(commencinq with SecUon 7000j ot �� ' ' 1 r ' �' J ', ' � - - � r�� �' 5U+ KW � � � ��Reinzpection Fee , '�R4Aslon �3. ot tno eusiness dnd Protassians Coae) or tnat he/sne Is axemDt Showers . (• � e I,.. � Reinspection�Fw ' , , . � "ire/rom,tntl the, basls tor the alle9atl exemptlon. Any vlolatlon.oPSoctlon '� . ' � �'. �- '., - , : ,`; Meter ❑up to 100amps j . IauO FeB. ' � S 3 ":'$31.5 by '.any aDPlicent fon a , permit • subjects -t�e �appliwnt lo a Uvll ' . • _ . _ � enalty a/ not more tnan 11va huntlretl tlollars (5500)'. � ' " • Serv�ce Smk � � � _ � •� laue Fee � , S 3 � � � � 1 _ . Zoning APProJed BY ' Date I�� 1,'as;owner oY the �property. or:my ertiployeas wltn wa9es es t�eir sola i MECHANICAL• ' �- �' � � �� � � compansatlon wIILCo the work, antl the-structurols not IntenCetl or offeretl � '• �; � ' _ , i� Appliration AOP�oved By atB + for salo Secflon 7044, Buslnezs'anEVProfe55ional Cotla: The Contractor'S � , Litense law tloes not apply to,an Owner o/ a proparty.who bulltls or Improves BoilBf ' '� 1 �"� R¢ffig2fBlian SySteT , 1� - : 4�, Appliration Issued B ' � ' � 1 -��F� i , theroon,'antl'who Coes� such'. work �Imself/heriel! or throu9h hii or pe� own - �' - � • 1 �_ i� !� V � at9 Iemplayeos, provitletl tnat such.improvements ara not IntonGatl or otferetl for ❑p-100,0008TU ❑100,OOOBTU. � � Sale. I/, howoVer, tha bulltling or Improvement Is 6oltl wl��In ono y0ar of com- 'I Duct - Under Ground � � '� .� - r, � i I t ' o�etlon, t�a owner wlu �ave tne burtlen a/ provin9 ha/she tl10 not builE or Im- . ., ' ' ' ' � � ' � � SUMMAR V OF FEES ' '�r,owfor,tho�purPoseo/sale). �' -, � . Duct-Structurel . ' SysiemRepeirlAlteration • • + • �gUILDINGPERMIT $ � ' .' SMIP ' $, � � LJ I, ds owner of t�e proparty, am ex<lusively contractinq wit� Iicensetl con ' ' ' � � t/dGtO�sto construtt th0•project (Sectlon 7064, Business antl Prolesslons Cotla: Duct_ Ventilating � , � ' � � �;j ,PLAN CHECK, ! $� '� PERMIT " � � � '' The' ContraCtor'z IJteMa Ldw tloes not aoD�Y to'an owner of'oroparty wno -� "- , �� � I$$UANCE ; E ' builtls or ImD�oves tnereon, antl who contracti tor such projecti with a con- , ExhBuSt SyStem Multiple � � • ' ' PLUMBING � $ traclor(5) Ilcensa pursuant to the COMrattor's Linnse Law). � . , ' � 1 am.examD� unEor Section . B. 6 P. C. for t�is reason � Firepl/FetL BIt. IC80 � � 1 � ; ; 'P�.N CHECK� $ � GRADING •$� ' � ' ' - ELECTRICAL, $� � � • $ } ' Date " ' - � Owner' � � '` HeetingSystem&Ducting � � ' " •' „ f�� ' � • MICROFILM : S � � � I..�ereb�.cartlfy that.l_nam reaC.thls applieatitin anE state lhat [be.above. f.�❑6100,OOOBTU �100,0006 _. .. t. ., ____ e . PL�N CHECK 'i $� �— . � . f Informa lon IS Corrett. I a9ree to complY �'/�th all clty antl tounty orClnantes � � y-/y.'] ' TOTAL FEE $. � antl".staie laws relatin9 Ja butltling construction, ana heretiy authoriza repra- � Hood or � MECHANICAL $ �_ � .j , sentativei o/'thls+Uty�to enter upon tha above-mentlona0 Property for / � , Typal ❑ J � Reinfp9ctiOn,Fae � ' �` � �ESS � � . , Inspaction ourpos ' � : ��o � T a II ❑' . ,PLAN CHECK $ 1 �D.;� . 519netur! �%- ' I i Dat�,d-.�83 I ; � . . , . -. . � . � . � ADVANCED.PC � , � • � • ' Regirters � � � ' laua Fee � . S 3 � ' ! � �, , � Orivers' Llcensa or.55 $ �, � � j � � FINAL"FEE �� � CMFO865-46rev.12/82 �Whi[e'BuilEin9:banary-AppliwntiPink-Accountln9:GOltlenrotl�=Assassor "-" ' �- `- - "�'-""-' ' "-' —"" "�'- --'"" --" ' - "` - . ^. _ _ . . _. .' _ _.. ._ �_ . _ .. _ 2 �� CONSTRUCTION AND PLA NING 4 =? r � -�.. ': e; �.a � � -c � POq SPA . � _ ' _f. � . i � � � `�c`Date;�'�OSPCCiOf �r � ' �,:; , . _ ;. ', . o' - _ �;APPROVACSm Permit#, ; -�„`y - � �=�APPROVALS `Permrt# . Date` � •Inspecmr� . t • 1 p - _ , . . 3 �1�' ITemDorary Electrical $erviie�or,Pole � �.- ' �� F.t ?� `; ; � ' 52��Pool &rEquipment Location' � � - - '�it2.ISoi��Pipe-Undrgrnd' �`- Is=�c 1 ' `- '"' - ���_' I� � � .. ` ' : - . _ . �. , , ,- � ; •r. < - �53: Steel "Reinforcement , I � t3. �Electiical Coniiuit UtilitJ;Undrgrnd. � ��t i � `{ � .:54i Forms�;- � "E,�� - ; � - � `'_• Y � � '� t4. Electrical Conduit-Undrgrnd � _ �I . n : °c � � c55 Elec[rical Bonding - - ' - ' � � � �� ' Q r.r i � t'o w ir . . �5. �Steel�Reinforcertient � �? � `� ' � - � ' ;-. ` ' t 56. Rough.`Plumbing"& Pressure Test _ - - ` � �s• iElectrical UFERjGrnd: : " _ � � � • - ' �57; APPROVALTO:COVER-GUNITE 7. jPooti°95 i I i i 1: o I^ =. y _' �' �'58` Electrica� Conduit-Undrar'od. '_ � � ' . - 8. �Foundation �' ( � ' , � ° � ' ' • _ �' '�59. `Gas Pi,pe; ��Undrgrnd., Test; � ' � . � � ' - 9. �Wetei Pipe�Undrgrnd. ' r 5 .. '' - t, � _ � � °Ep. _gackwash�L'ines; P-Trap, ❑ Undrgmd. - _ 10. �Structu�al Floor System � ; � , ! ' ?� ' , �,61. APPROVAL TO DECK ' 11. �Properfy Sewer Line &� House�Connection. � � , . : :�, �BackwasFi�&� Reaeptor-Final � � 12. �Sewer Ca � . . � . ' � - - ' ' - . . � P � - - `63. .Heater &:Vent-Final ' - 13. Roof Drains ; � ' . - ' , �: ,: � � g4. '.pjumbing SYstem -�Final .�, -'- ' - , ' , � 14. �fiough Plumbing� � • � � � - ' ` '6,5. Electrical-Final � - • ' ' c ' ;=15'.�Rough'Electrical-Conduit-��i '-}- r r- -..� - - �-�*- _ . . . .. - - �- - � -- � w �_ i� � I+ � � 66: Solar.Sysfem-Final �- f. �r - . . � � � . . .; �R16:�Rough,Elec[ricWiring. .: } ` � ; ! ,, f� - q� "."„ ,�{c � + �67. Fencing & Access�Approval� � _ � � - - --.- � : �`1 :;RougkWirin'Si ni' `� i �"' ! ' ' '- ' ' i gg; APPROVED'FORPLASTERING � � � 7i�.. 9 9_ .�' I.�� �- � ��I ' f � '18.YRoughsElectripl=T�Bai Ceiling •! �i ` I -, � ._ ; � - � ' ' � � 69: POOUSPA;SYSTEMS FINAL . � � 19.tlRough•Heating & AirConditioning � ; . � •, � I ! ; � , ;FIRE DEPT. RE�UIREMENT . � z0.!Boug�Factor� Fireplace � � � �; i � I� i APPROVALS � Permit�W � i °�u�- . . , , . , , _ , 21�Ducts,;in�Struc[ure' ' � �� r � � - � �� �70� Underground Hydro �, . � ' � � ;22.�DuGis,Nen`ilating�, - . � �� U � � � � � '71, Produc[Piping�OGas ❑Oil _ , �� �23.yGas��Pipe-Rough & Test � ' � �� �, �� � ? � � +; �7y; Underground Flush � i T ��24.rRoof Framingi , � � I ��� �� � i -, ; n � ; ��„� ., - �73. Undergrnd.�Storage.Tank OGas- ❑Oil � � 25.��Roof Sheathing � � � � r' ; � . � � ` � � r � _. � . �' ;74: O'verhead HYdro ' .. _ . � I i �1 � �-26.�T�Bar Ceiling'IStructural)i& Monocoat � � � t , - I � � ;75. Dry Chemical ; - ' ' ' - � 27., Frame and Flashing - ' � �, � � � � ' ' ! � 4. �76:, Dry $tandpipe, - '' � ? ; 28.,; Latfiing & Siding � � � � �� ; I � � � '! � �77� FIXED SYSTEM F.INAL � �. � at on. ' ' � � I � �� i � , � 7g. FIRE PREV. FINAL � � i � � � � (_29_.Insul i i • „ � , !� � I � � � "�30.�-Drywali Nailing � ; � � , " � � � � ' Noter _`..��' ' � ' f, r• , � � � , : ', ,� - � - � r � - . -r -; 31.� Plaster�Brown Coat . � i j � � '132.'�Electriral� Power MeterFinal ( ;, � ' � � � � �., i� � � �.. :, � ' �' � � � 33. Final Electric ' ' � � • Y ' � �/�� � . � � , •' .., � ' ; I ; . ' ' � � 34. Final Hear�..� R Air Gonditionin� Vr..�. /��3 ��� � . • + - �� 35. Final Gas Pipe-Test � � '. , ` I n `' " - � . � z ., - _ _ - � _ - _ - _ � • 36. Hood.orifanoPY=`� r � � ;1 r ' �, � . � ; �� -. . _ � � - I . .. �.� . . _ . . r, �. i n 1 4 37. Final �factor�y F,ireplace` � _ oi i�: I - ` i - � � � - � � , � (' . . . . . 38. Final �Plumbing� � � � � � �1 :� � ° I � 7 � � � i � � � � �; _ _ " P ' � ° ' � '' . . �, 39. WaterlService-Final � . � ' ; � � 1 � � � - tt i I - t 40. Gas Service iFinal � � � � � � � � � i; i , i i , . . , . 41. Solar �DomeiticFidal i � • �- - � -I_- � �--I --�-, i - � _ � _ � , `,�. ;t.yr . r k< 42. Backflow Preventer r�l j ' �,. �_ -r , � _ � . i ' ! � _ . . . . ' '"• .. 43. Backflow Irtigation � I � � � � ' 3' " - � � _ I ; , i ' ' . �.i i�:�-,.: �. , � . . -� i i � � . 44. Land;cape Irngation;System! - � � , ; � : �. :. � � � . w . 45. Sound ;Attenuation;� I �. � : i II � ,� ; � � - � � i � " ' � � ' ti' � i � ' � '� � 46. Handicap Regulationsl � r � � � �`_• � � � � � � i � ' � ' � ' , � r � ;; T 47. FINALSTRUCTURE�&BUILDING� ,� ; I �� � � , � � I � I;� � � 48. Special.Requirements Completed � ' ,�� �, � � � f I i � i i -' ," � � , 49. Elec[[ic Release tolEdison � i i� , ) 'J ' ! _ _ _' _ � : -�- -- ' u i i � i � --* � r , r - I 50. Gas Release�to Southein CaliforniaGesCo � � j � � ; . � �: ' .� I I " • ' �� • '.' t� �� .� � � � � 51. CERTIFICATEOF OCCUPANCY K '_ �_rt i. _ � . _,__' . ';. _T j, r ' _ __."_ , j �', No �� ' � Date ' � �� ' , � , � i� � 1 . � i � . . �„-r--�-•.�..4�_--,�.,._ �.._.y_ � L 1 _ � - - � J" OF COSTA MESA STRUCTION PERM�IT: AVP�lunt to flll ln all aD+tea azupt t�ote wit�in �eary CorUer Iines anC ai9� +�� �o�rooriata Eeclarallons. _• PERMIT NO. TRAC��NO. LOT NO.- BL . . T7/ oi i c y ApplicBnYs Meiling Address -. - ' Project Addrms 7(�l% 1 JFTT /9�T �'.1—�F� Owner's Name �� .�nFS �,P6! ohon��'� ,�9 Addrezs -S,�CM F ArchlEng. R�Ss� � Licente No. Address '� � 3 4 /�/f4 L/l%� SU?� ZSh �� Contmctor's Nem��'�r�N��d'p%� ��� �hona37/-'S'S�dD Addresa Imeiling✓» � 9 �L�ff/.JOUA �iii, (S� Licenae No. �, � % 7��� - � LICENSED CONTRACTON DECLARATION • ' � I hereby at/i�m [hat I am 11<enSOE untlOr provislonf ot Charter 9(commenUng � with sactlon 7000) o} Dlvlslon 3 0/ tha Buslnass an0 Prafesslons Cotla, antl my Ilcansa Is in /ull forte antl eflect. / �/ � L1can58 1 z�� llcans 10/ T' Date � Signature . WORKERS' COMPENSATION DECLARATIO / 1 haraGy d/firm t�dt 1 �dve.a certiflcata oi con5 t lo uli nSufa or-d CBrtifiwt0 of Warkeri' Compensatlon Insurance, or a certlfieC copy t�ereaf (Sactlon 3800, Lab. C.)' '/ � - Poilcy No. � ��!-�TO.3 ComPanY�O� .m�,Pv P�,Qt.. eCertl/leC copy li hareDy fumis�eG. � : �, � Ce f tl copy is fileC wlth the CI[y ng Dlvislon. Oate'� APPIiwn� ' .. EXEMPTION;FROM WORKERS' COMPENSATION DECLARATION (ThlisaCtlon neBG mt be Completetl IT tha permit IS fOcone huntl�etl (E300),or, � iess). . ' . i � . � 1 certiry that in the performance of lhe work Tor which this Derm�t ISlssuetl I. shall• not employ,any persan I� any manner so as to Eecome zub7act to tha" Workars' Compenutlon Laws of Callfomia. ' . Dale - SIB�ature � NOTICE: I/, aftermaking tnis Gatlaratlon, you SnoulC Decome subject to the Workers' Componsallon provlslons.of Ihe LaDor COUo, you must fortnwitn. ' com0ly wit�� such OroWSions�mr [hfs �permit •s�all be tleematl revokaG. ' CONSTRUCTION LENDING AGENCV ' ' ' 1 hareby aHirm t�at [hero Iz a construcliondentling agen<y tor the' parformance of the work for, whiCh this p8rmit Is,iisuotl (SeCliOn 3097 Clv. C.) �enGar's Name - _ _ � - �entler'S Atltlress � — OWNER BUILOER DECLARATION � � ' I harabv affirm [hat I am exempt irbm lhe Contrattor'S Licanse Law Tor ttie to y1.5 oy any appnwn[ ror a. permrt suo�ecis [ne appucan[ [a a uvu � �fialty of not moro t�an tive huntlreA tlollars (5500). . 1, as•owner o1'the.0�operty or my employees with wa9es as their zole comDensation wlll tlo the work; ana�.tM1e structure�is not intentletl orofteretl fof Shce (SGC�IOn 7044, Busineu antl � PrOfB55IOnal Cotla: � Tha GontlaGtO!'S LJconse Law tloes not aOPly to an owner of a property who bulltls or Improves tharaon, antl who tloes such work himzelt/hersel/ ar through hIs or har own , emD�oy ees, provlGeU tnat such�improvaments are not IntentleE or offeree for sale. If, however, the bullding or ImOrovement Is soltl wlt�in one year ot cam- plation, lhe owner will hava the burtlen of proving he/she tlitl not builtl or Im- � �lOv! fOf the pufpaie Of ShcB). � � '• � I. Ss ownar o( lha OroOerry, am exUuzlvely contracting�with Ilcenietl con- ' Date TYPE OF CONSTRUCTION' ,�C.I NEW ADD LJ ALTERATION LJ REPAI R - , ❑ CONVERSION ❑ DEMOLIS OTH� DESCRIPTION OF WORK � �^�"�'� - TVPEOFPERMIT GRADINGp� FOUNDATION � STRUCTURAL � A.P.M�� ❑ TENANT ❑ ELECTRIGAL .q�VLUMBING ❑ MELHANICAL PLNG.REF.qW ' " � ❑ 9TNER ' 1 ' TO BUILDING� PRQIECT DESCRIPTION S�.FT. � � � OCCUPANCV P ��N CONSTRUCTION�TVPF VALUATION$ � �LEFTSIDEYARD . ZON� GRADINOCU.VDS. ACRES � PKG.SPACEREQ. Ramark�: � � 3 �- STREET WIDTH ' SPECIAL CONDITIONS: ruct Iho'project (Saction 7044, Busineis antl Rofesilons Cotle: ' - 5 License Law does not apPly to an Ownor of O�oDerty who ves t�ereon, antl who contracts for such projects with a con- � O�rsuant lo [�e Cantractor's Licenso Law): unEer Sectlon 8. 6 P. G. for MI5 reazan Ownar � �-t�abbhava reatl•this aDolicatlon antl'State thaYt�e'above' �' ' Ber Sink � Beckftow Preven[er ' " , Beckflow Irrigation � Bathtubs Clerifiers Dishwasher � � � Drinkin9 Fountains � Floor Drains � � Floor Sinks � � �� GasService "Outlets Interceptors ' Kitchen Sink� . 1.8v8tOfies � P-Trao, � � . � RoofDrains. • Shawers . Service Sink - �. t ' Boiler � • Duct - Under Ground . IDuct • StrutNral 0 Sewer Cap Sewer Connection � Soler Collectors Solar Piping � Sotar Tank : : ' Swimming Pool w/Spa Urinal ' Water Goset � Weter Heater � - � � Water Service '. -� Exheust System ❑ Multiple ❑ FirepllFect.Blt.IC80sIE ' Heeting System & Oucting ❑ ai oo,000 eTu O i oo,000 en sentatives o1 - Is tlty to entar' upon t aDove-mentlonea Prop� � � Cano �� TVPe 1 ❑ � � inspectlon o rpo s. � � � , � Slgnalur � Data � � Re..iste�S , � Drivers' Llcense or 55 9jt ' 9 CMF 0865-46 rev. 12/82 Wnite - Bulltling; Canary - Applirznl: P�nk - Accounting; Goltlenrotl - Assessor N , R - Reinspection Fea ,r' •�� - Isue Fee'�� ' , l..�E 3�. IANICAL , . � � . Refrigeretion System ❑a�oo,000eTu Oioo,000eru ' � ' 1 � � ( i ; . _ i " ' ' i _ i . � Y �� • � Reinspec[ian; Fee � � � S75 � ; Izwe Fea , � � � S 3 Automatit Wazher � Conrtruction Pole Cooking Unit i Uryers uGas� Fan' � F.A.U. ' Fixtures ' Device Boxes 76Ud 4/21 /d:, I uvu.. t�G 20NE BUILDING ' � ccZcnrr rii er REAR VARD (TO P/L), RIGHTSIDE VARD PROVIDED PARK FEE . Meter LJwer_t00amps.. � �Sub Penel � Su6 Pote ' . Motors DOd HP ❑if.$ � � Inc.Solar �9-iSHP �16-15+ Microwave � ' •Pole Light �� , ..yo . _ " _ �_ Sign • � Standing Sections . ' � Trash Comoacmr � ' Garbage Dispoul Generatar �0�5 KW �5- Transformer �75-50KW ❑5U+KW Meter Oup to 100 amps Zoning Approved By ApPlifation Approved BY _ Appli�ation laued By � 0 SUMMARY OF FEES �� � � � 'BUILOING PERMIT $ SMIP � ! $ � P�AN CHECK � $ � - PERMIT � PIUMBING $ _�� ISSUANCE ' $ � � � PLAN CHECK $ �� GRADING • S � i. i ELECTRICAL � $, . ' ' � $ � MICROFILM $ � � 'PLAN CHECK $ ' � MECHANICAL � $ ' TOTAL FEE; $ ' �PLAN CHECK � $, ' , qDVANCED PC �Q' 0O 1 � � • � _ . �. . � FINAL FEE' �� , ., � - - - - - - --� _ _ -- ' eoo� n � a`CONSTRUCTION AND PLANNI ._G : �, - ':.�� � �' �;�-. . � '� - � � '- `-� " - . A;_ ' ' - •� . �Date . � ;Inspecfor � � ' f Date � �Inspecmr ^. �APPROVALS , Permit #= ' � i ; � �� _ _ . �,APPROVALS ' Permit # . _ . �` �t` ;femporery Electrical Servi�e or Pole� � j� • � - � .52", Pool & Equipment Location . . . ' � ii 2: Soil Pipe-Undrgrnd' � �� � �, j . ' � � �53�.� Steel Reinforcement � � � � � .� � � o?/�J � ,. .' 3: Elect�ica� Conduit Utilitv-Undrgrnd �� � ti_ , `: . 54.� Forms � _ . � - � - - - ' , �' �' 4c Electrical Conduit-Undrgrnd: ' ° � � .� ' � �55.� Electriral BonBing • - - � �� 4 . - 5: Steel'Reinforcement � � ? � � `� - , � 56. RougFi P.lumbing & Pressure Test � . �� ' 6� �Electrical UFER Grnd.'. -°�' ��, `,�" �� � : 57: APPROVAL TO COVER-GUNITE 1 i' 7. Footings � � � � -: � - ' I i' � � -- `'58: Electrical Conduit-Undrarnr{_ .. •. ' 8. Foundation � � �, , , � _ _ � � �� � - � 59. Gas Pipe, �_Undrgrnii ; Test' . . 9. Water Pipe-Undrgrrid. '' . . � - ,- . ',gp. Backwash Lines, P-Trap, O Undrgrnd. � i ' � 10. Struc'tural Floor System '• � �'� 61. APPROVAL'TO DECK 11. Property Sewer Line & House Connection� �t = . � 62. Backwash & Receptor-Final ' , 12. Sewer CaP . � � - , ; . , - _ . ' . � , . _ � � 63. Heater & Vent•Final 13. Roof Drains ' � ' � " � � . , �_ � � � ; gq. Plumbing System�; Final � : � . - � „ 14. Rough Plumbing � ' � � .. � � �' ,� lj � 65. ElectricaPFinal � � � ' ' •'�� 1 � .; 15.=Rough Electrical-Conduit-1 -�- - . - ' _t- �" ' " ,' - ,;.66.i Solar SYstem-Final � � � i� � ' � � - �� �i 6. Rou h Elec[ric Wirin - -� - � . - � - ' �- ` ,- r�• 9 9 � � � � � , ���', . _ '�67..� Fe`ncing & Access Approval ,-" � . _ "17. fiough Wiring,Sign•_ ' - �� � � '' I � .' �' � � ' 68.'APPROVED FOR PLASTERING � � - ' _ i�= - - � = i' - � �" 18. Rough Electrical-T Bar�Ceiling; � � . 1`- � 69.' POO.L/SPA SYSTEMS FINAL � � � � ' ` �i 19. Rougti�Heating & Air 6onditioning � . � ( � , j � ! FIRE DEPT. REQUIREMENT � �- ' . . 20. Rough Factory Fireplace� ! � ' i � i , ' , { , ' APpROVALS Permit # '' � '. ' ,� � i ;; � 21.'Ducts, in St�ucture�� �, � �� �� �' � � � � 70. Undeiground Hydro ' � : ,� ���22. �Ducts, Ventilating � ': � �: �; � f � � ' � � 7�.! product Piping O Gas ❑ Oil � ;23. Gas Pipe-Rough & Test ., � � ;Iry � i I ' '- } �2.� Underground Flush � ' ' j • .� . .. � � �. '�24. Roof Framing � � i ii� � �- � '� � �� 73. � Undergrnd. Storage Tank � Gas ❑ Oil , � � , y�5. Roof Sheathing � i - � � � ,'� � � - I ' ° ' � 74.! Overhead Hydro � • ' , � ' i '-26. T-Bar Ceiling (Structuraljl & Monocoat� .' �� � I ,: � '. , 75.' Dry Chemical - . ' - i � = .� �27. Frame and Fla3hing . � �� �� � _ l � . : , � 76.� Dr;y Stanilpipe . . � 28. Lathing &, Siding .� � t ' � i l � 'i , _ � 77. FIXED SYSTEM FINAL . ' , ` 29. ;Insulation � ' ? ' : � � �� . �' � � , , 78., FIRE.PREV. FINAL ' '-30. �Diywall Npilin`g � � ' • � ' ; � � 'Notes:: � � � / L' ��d 31. Plaster Brown Coat � i� � � � ', I ' =7 , � . � '� � ; , . . , ' -� i.�32. Electrical Power Mefer-Final . � � ''�yyf t� B[L � 1 , .. ° 33. Final Electric ' � �� � , � ; �.,� , ' . 34. Final Hea[ing & Air' Conditioriing ^ , � ' � , ' y � ; � - - .. � F . P I � 1 ) � I T � � _ - . I ' ' � 1 . . . , , � � � 35. Final Gas Pipe-Test, � C' ; � � � , ` � � _ � � � i �' 36. Hood or CanoPY�, i � - � � - � ' . i . . - . . - .' , � - �� �. - r ' � - c i ; 37. Final Fac[ory Fireplace �� � '_ . - � � � . � - . , � • � _ 38. Final Plumbing ; - � � r � � -' � , ' � � , � � � " . 39. Water Service-Final � '. �� �. . ' ' ' � . i i ' 40. Gas Service-Final � � i; � �, '� � , � i � 41. Solar pomesticFinal � ' � � ! ' I ' , , � �� � � ' r - -- _ ' '-- . _ . .�. ._ _ 42. Backflow,Preventer� _ j ' ,., ; ' � , ' „'� .� . � - +-- � ' 43. Backflow'Irrigation, - � � I .' �" " � -- � � � �. i �- ' � 44. Landscape Irrigation�System � � . � �- � " � ` � � "� , � - � �� 45. Soundh%attenuation _ �'� �. ' . ��, i � � , ; . r j � � ' . � . , � � � .�^ . � - ' .� :' � � : . '. , , , � i . ' : r 46. Handicap Regulationi, r ' i � I : • � , , � - r� - : � i u � 47. FINAL STRUCTURE & BUILDING , � � � � - � � � ! ' � ' 48. Speciab Requireriments Completedl �i ; � I - � . i � ; � i � � � ' • � , . -� . � �. 49. ElectricReleasetoEdison' , ' , ' , _ _� � � _ . � � � � � � F � - �- - - -• - . - "- "� _," _ , !' 50. Gas Release to Southern California Gas Cn � • � � I 1 � l'� 51. CERTIFICATE OF�OCCUpANCY � �_�y_ .' �_ ' �_ _ �_ . ;_' , , ' r ' ( 1 i .,1 .i ' i No ' Date �' i � � , CITX 6F COSTA MESAT � CONSTRUCTION.PERMIT , noouwnt to nu in au �wces axeeoe eno' �r poraer nnes ana siyn all aoo�oo•�rte aaclaotions. � PE IT NO. _y. LOT NO., • L . . � . . , , S� �.' - � , ApplicanYf Mailing Addreu TYPE OF CONSTRUCTION - NEW ADD ALTERATION REPAI R . . , ' PfOjeCt Addlest � ❑ CONVERSION ❑ DEMOLISH ❑ OTNER . . � . _ Owna's Name h g DESGRiaTiON OF WORK � . Atldf05s . � TVPE OF PERMIT GRADING �UNDATION STRUCTURAL A. P. qW Arch/En8• . LiCenSBNO. ❑TENANT ❑ELECTRICAL PLUMBING ❑,MECHANICAL PLNG.REF.vIt� Address' � � � O�OTHER � � - ' � TOBVILDING Contractor's Nam,G ' ' hone PROJECT DESCRIPTION 5�. FT. ' OCCUPANGY P PE INE Add�esslmeilin0�3-7� ��"r'���-�� ���" CONSTFUCTIONTVPF VALUATION$ ' LEFTSIDEVARD � "' ZON� � GRADINGCU.VOS. 'ACRFS ' PKG.SPACEREQ: licenae No. � . - LICENSED CONTRACTOR DECLARATION � Ramarkt: _ � � 3 � , ��STREET WIDTH � I:he�eCy%affirm that I am Ilcensetl untler pro��slons of Charter,9 (commencinq wltb Sactlon 7000) 07 Dlvlsion 3 of the BVzlneu antl Professlons CoOe, an0 . . � � • ; , ' • , ' SPECIAL CONDITIC rtiydlcensa Is In full btce anG eftect. � ���� ��- _ � u� � �a�iass Date 5�9nature WORKEHS'-�SATIONDE RATION� � ' . ' • BerSink I herooy aHirm�that 1 have a CerNTi te ot <onunt'to.self-Insure or a certlflWte � BBckflow PreVenter -- 01 Workers' Compensation Insurante,•oI a CBfUfleO'COOY thereof (Settion . 3800, Lzb. C.) � � � � � � ' I Backflow Irrigetion aoucy No. C��' A�3� LiO�I Companv �GartITleG�copy Is �ereby f�C. � � �iN ' , � Bethtl Certi le0 cbDY �sd iletl with t�e city Itli�9 Divislon. Date �e��/T_o �' AVPliwnt • .I Clarifi EXEMPTION'FROM WORKERS' CO ENSATION DECLARATION i Dish (This sectian neaG not De tomD�eteO I e permit is }or one �undretl (5300) or i iece�rtlfy ,that In the pertorman<e of tne worN foi whlcn tnis perm�t Is IssueC I � Drink shall�not' employ any person In any manner so as to bacome subject.to t�a � . Workers'�Compansatlon Laws of Californla., i � . � � � FI00� Date � ' �I9nature � � � NOTICES If, attar makin9 this tleUSration, you sboulC. bacome suEject to the ' =� FI00� Workars' ComDenSation Drovisions of the labar Cotla, yau. must forthwith � tomD�Y �'��h� suc� provisloni or this jpelmit ,shall be •OeemeO revoketl.� . G85SI CONSTRUGTION IENDING AGENCV'� � � I �ereby afflrm that there is a construction le�tling a9ency for t�a pertormance Int2rc oi tha work foK.which this; parmit .Is ,�sduatl (Sactlon 30BZ' Civ. CJ �` � LenCer•s� Name- � ' � ' Kitch� LenCer•s AtlGreis � � • ' � . . . . • • ' � { _ . .. OWNER BUILDER OECLARATION � ' ' ' � �-8v2t1 �^�•�^v aifirm th5t I am'exempt trom ine Con[ractoi's Ucenze Law for the Date washer ing Founcains � i Drains . Cinkc ._ � aevuer'wnnac��on - . Solar Collectors Solar Piping � Sotar Tenk � � Swimming Pool w/Sp � Urinal . iq reason (Sectlon 7031:5 Bus{ness ahd ProteSslonal Cotle: Any city, or � P-T�flP - • wnic� requlres a permibto tonstructr alter improve' tlemolish or repalr - icture; prlor to Its Issuance, also reqU�res t�e applicant for su<h permit ROOf D�ains � signetl statement that he/s�e Is Iicensetl pursuant to the orovislons of ,� ' tractor's License Law;(ChaOte� 9(coR�mencing with 5eciion 7000) of � � � � '3 -of tha ,Busineis and� ProT855Ion5 CoOe)'or Ihat he/She. is exempt + �� ShoWefs ' - ' � �m antl the basis tor t�e allegeC exeTPtlon: Any violatlon of SacNon i "' _ ' Dy.any applicant ior.a�permit'sUbjects tha•applicant to a' ciNl � � ' . of not more than tive hunOreO OOIIarS (E500). � o� i 52rvit2 Sink � , '�•owner ot [he•property or my emP�oyeai with wages'ai thelr sole � . , sation' witl tlo the work, an0 the•structure is not in[enCetl or ofteretl �� ��, �'- � �. (Secfion 7044, Business antllProfessional Gotle::The Contractor's � .� � , � ldw Ooes mt aOPly to�an own¢� ot a G�oper[y who builtlz o� Imp�ove5 � BOil2f: � ' f � � ' (antl,who tloes�su<h work himselt/perseif or lhrough his or her own - �' eas, provitletl that tuch'improvamants are�not Intantletl or offeretl for � �oweveq the builtlin9 or imorovement is sad wimin one yearot com- ; Duct %Unde� Ground ( � tha owner,wlll have t�e burAen of proving he/she tlitl not buIIC or Im- �' rr the puroose of,sale). • � DucT-Structurel ownei of tha property, am extlu5lvCIY contracting:with IlcanSeO con- � to canstruttlne.project.($ectlon ZOa4. Business antl. Professlons Cotle: _ Duct - Ventilating_ ' i, __ __ ntractor's Litensa Law does not aDG�Y to an owner of property who , . �� rt improves thereon, antl who contrBcts for such projec[s wlt� a<on- ' Exhaurt Syst¢m ❑ Multipie ❑ s) Iitense Durivant to the Contractor'S Litense Lawj: . • - ezemp[ un0er Sectlon � , B. 6 P. C. for this reason � Fi�Cpl/FaCt. Blt. ICBO •# � Owner � ' ' ' � Heating'System & Ducting y certity �Ma[ I have reaC this appliwtlon anA ztate that the above = ❑P700,000 BTU'�100,OOOB7 llon {5 correcL 1 agree ta camply wlt� all city antl county ortlinances - . ta laws relating to builUln9 co95trud�on, anG �ereby authoriza reDre- . Hood o� T 0 I �� � as of hi� Uty'to entar pGn the above-mantlonetl pro ert tor ��� TYPB II ❑ 1 on au oi. • ! ' re Date � ' Lt e or'S5 # Registers I i5-46 rav. 12/B2 White - Bulltling; Ge�ary - Appliwnt; Pink - Accounting; Goltlanrotl - Assaisor Water Closet� ' ' Water�Heater, - Water Service � . � . � ' � : � � Reinspection:Fee � � � i � �sue Fee �- � 0 �� A �._i��� �UUN 2 1 1983.� ccronCv C�L er • REAR VARD (TO P/U . RIGHT SIDE YARD PROVIDED f PAflK FEE�§ ` L' � � ' ELECTRICAL � i � _ AutomaticWasher � ' 'Meter ❑rner100amps• _ _ . � Construction Pole: i ' Sub�Penel, . IOOBTU �100,000,6TU epair/Alteiation , I Reinspection Fee Issue Fee ' $15 S3 515 $ 3 Cooking Unit •o�� Sub Pole , � : Dishurdsher . Moton O0.1 HP ❑iK-8 - . Dryers ❑Gas ❑Electric` Inc.Solar �9d5HP 016-15+� Fan ' Microwave � � i � F.A.U. . . . Pole�Light � � , Fixtures � � Range. . Device Boxes - ' Sign, � � Outlets . StandingSectionz � . , � � � � Trash Compactor Garbage Dispoul � i , • � � � Generator� �0-5 KW �5-15 KW " ' � � Transformer 015-50KW ' � . � • . ❑5U+KW. . �Rainspac[ionFee � S75' � Meter ❑uo to f 00 emas � 1 ��_.._' �__' � � � � 4 v � Zoning Approrad BY ' Data . � � Appli�ation Approved By i ata -�sY-rY-"-�-'— APPlication Issued BY � � � �ate , � , � I SUMMARV OP FEES , , i , i BUILDING PERMIT $' � SMIP � $ ' . '�PLAN CHECK� $� - PERMIT � � ' �PLUMBING , . $. � . ��UANCE , � S � GRADING � } $ � � PLAN CHECK $ /� . ELECTRICAL ' $� 1 � $ � . PLAN CHECK � $ MICROFILM � $ . � MECHANICAL � $ � TOTAL�FEE' $ � ' LESS � � � : � - 'PLAN CHECK . $' � ADVANCED PC i $ � � ' ' , ; ' , FINAL FEE ' $ I� `\ . ' .�_ ,�_-. . ___ _ ` . . _ _ _ _ _ 'E?�?CONSTRUCTIONANDiPI NG� •; j: ��'�:t : x ' ; - � 7� .POOL A -- - ' :.� ., . ��,�� �-' tr � c z r �,:;� -�Date r, e.lnspector -�. - - Date � Inspecto� �. �AP,pROVALS m Permif;#� - ., -APPRObALSy" �Per'mrt# ` - � U1 1\. - G a. � J> n t `_7 C_ l' Y[ '> C .. ' ' . u � �l� � e�nporary,Electrical Service n"r�Pole= :� :�: ' ' � � � ; o � _ "� ' ',52� Pool &�Equipment Lo`cation _ � - � �� �t - n'.- n. i., � z_ _ - - F .2 �SQiI�PiPe-Und�gr�d:� �+ , F �o � �I. °- _ •, ° v �^ . `` � �53� Steel Reinforcement � � _. � ; - � � .n � � ;:. � ,3,��Elec�rical Con�uit Utiliiv Undrgrnd � �s� � • � � � z� >>� ',54� Forms ; o , ' °- ; � � �� ; ' , `' 4: Electrica�l'Condurt UBd{�,qrnd� - �. cr i g �' ' " � �' ' ' , �55 Electrical.Bonding `� - ' " '�R�i J 1 'i I�qn' ♦O� _ Qn r` i ' - r. 2_ % ' ' 1 � � � tL � Y . � _ . . � ... . . . . - 52 Steel ReinfDrcement� � � r -, �� ; p; , _ _- ;, � „' - 56., Rough Pluinbing & Pressure,Test _ " � - z � � �• i 6� ��Iec�iCaI�UFER Gr'hd:�. � � �% �:'i,a,��� � "9� � ?: ' ` `_57` APP,ROVRL.TO COVER-GUNITE. � � r; � � � i',; ..� : � . , , . _ _ 7. F otirigs �' � - I � a , ' ; � � '. :' : ; ..58.�.Electrical 6onduii-0ndro.�d, ' ' �- r . ,�9,�� r '+ •� �a:v � rti. , s� ,i 8. Foundition � � ` � � �' � � � "I � � ' F� �59. Gas Pipe,_O; Undrgrnd", Test' - j � - �' � - -� -.� - tOr' .< . l; 9� Weter'Pipe+tUndrg�md..�t I ?��,-:;�,� : � ��f �c � � �`60. Backwash.Lines,�P-Trap,'O U�drgrnd. - � - � , '��'� � � - 10. S[ructural-Fla`or Syste.�h � �5 � ' : � � , � � �� �.61. APPROVAL TO�DECK - _ ° = .� 11. Pr"bpert� Sewe� Line &,House�ConnOctiont �'s7 ;' �? S - 62. Backwasfi & Receptor-Final' � - . � � I-:I I I .I d.- �'n , I ; > �L.i -Cf 1 ' ' 12. 9e4vei Cap., � �, ., i i ^ � ,� -: ; �. .- � . -. , . : . � , � , f � : _ � •, '� . `� � �� �� 63. Heater &;Vent-Final.. _ . _ _ 13. Rnof�Drain� , g�r�i � __ '��'I � �' o F, ,64. PlumbingSYstem.:.F,inal"`:,�- _ - �.: � � 14. Rough Plumbing � ��� �i � �a I"� � � � � � -� �` 65. Electrical=Final > �:. � �'., ' . . . E o - v .' - . - . .�._. . � :: - -15�Rough E��'ct7ical=Contluit ' � -'66.� Solar Syatem-Final' "" " '� " r s �s k �r,���-r -r-=�� � r -� . " +-�16. 'Rou h-Ele@tric;Wicin , t �� '-"F' ;"r" T, ' ) '' - �:. �67.� Fencing &•Accesi Approval� - - � �� - . - '; '- 'a �a d ml 9 � ^+�_i J -� 9• �� � _ � (i i� o � . � �0� ��i I �: � = . -c �i ;17. (Roilgh�Wi�ing"Signf S m' •`•' �+ I� { + . � c I . ` - f � j , + ° �, , 168.i APPROVED FOR PLQSTERING i � � � i - - :; � 18. fRough��Electrical:T_Bar Ceiling � �� � •' : � � '. � �' ; . . � � . �. , I! , �. � I+ I i,{•- I I �� I.� �69 � POOL/SPA SYSTEMS F,INA� � . i - � � 19. �Rough�l-leating & Pjir Conditioniny �I � ' ° � ` � � � �FIRE DEPT,�REQUIREMENT^' � � � ' � _i I , h>>.�� i._� I,_. �� i�� . 1Els� �� �:, �,? , I. ; � 20. �Rough.:Factory FirBp�ace� � � { � � � � i APPHOVALS+ � Permit # � � � � ' ��� ; cl� � r _� m � 1 r � .( (r II � ! I . I i � -c i i � - � ! 'il ° � - vt �1 ' - i i � � � � � . . . � � • , . . � � 21. �6ucts,an Stru'eture?� �'� � a ;! �.� � � ' � ; � i � �70. Undeiground Hydro , , �'y . . � o :� - , „ s 1 i � . J . _ � . ^DuG'fs. �Venyilatin9 � t q j'� !� �I i I � � � �' � 171.� Product Piping OGas OOiI � . . : 1 � ;G`as�Pipe-Rough & Test n' ,'� '�,�,� �f __� �_ _� L . I _ � . t ' �72•J UndeFground Flush� ' ' i � � � � I �''�c i iri - i � .. .: i. .�. � �1 24. Roof Fiaming� ; i � • { � . n, � � � r� ( o 'v � � � ; 73.� Undergrnd. Storage Tank�O Gas�_O,OiI � , , � - a �1. i in � i t.�� i n�bv �����_ ';h' _, - .1 i � ; 25. �Roof Sheattiing � � f � I : �) �Iij'� �� f � � ��' P � : � � � ' � � ` � � J4.� OverBead Hydro j � _ . , , � --A .. m i i- � � i. i I, n � P-26. 7T-6ai Ceiling (Structu�all, & Monocoat� I; i � �;., �• ��, I _� ���75I Dry Chemical , . " �- � � a^ i • � - i i � � i � i :�.� i _� , �- � � � � . 27. Frameand Fla�hing� - ! ����� �, �'�, �'; ( � � � �.3 � I '�76.� Dr,Y Standpipe . • � - ' . '; u 28. Nlj.attiing & Sidfng� �^ ! I; � �� �f ! � 1 � !.: � ; � 77.� F�IXED SYSTEM FINAL - - �� �'' 29_�;Insulatiori ° � ! Q � n �' � �� �) � � � � � � i78� FIRE PREV. F�INA�L . . � � � : }=30. �Drywall Nailirtg i i � � � .i '� � ( 1 + � � I. � � �Notes:� � 1 , . � ' � � i � . ' !Y`31. �Plaster Brown Coat � � � � �� 'I--� -� �- -�--- � - � -� - -� i 1 -, � �, - , r - � -- �� - �- - -, - I � � t i� i ( � i 1 i i � n e T ,� �: i � e i � � � i � r � n � 32. ��lectrical Power Meter,-Final ' 1 ( � I � � � .� � �. � i � ; ,; r , , , � , �� �L-�- - L � _t . _ � _ 1 � � 33.�Final Electric. � .� ! ( � �' �' � i• � � � � J_,� � � � � ' -...l,ec.--« �+b- r-4 .�- � 34. Final Heating &�Air Conditioning � I . � .! ! r _�_ I I - � '-��- �' ��: .I , . .. `~� � - i (l,. r ::c r t + 35. Final Gas Pi'pe�Test� � I .� i :n ; �•I ; _ .' �`_ I `, { ' m ; �. i.,` -i � i �_ � ': : �' i : _ . . - . .- � � - - " � "c c � I . � • � _ • r) '� { r e . Q y . �� c t � � ± j d - •� 36. Hood or �Cariopy�� '. ,- I c � z i nI �j 1 F � � I ^. I �` � � � � - t r ' z � . . � � ` I ' : ; : . - u�t << m i:.i a li 1? I:. � I 1 � � ; . 37. Final �actory�F��epl$ce� I i ! n� !� � � � o t ` � ' � ; I I ( " i ' � ,�i.. � ' _ 1, . .� ,� , . „ . � 38. Final lumbin � ^ ' c u � V � � � I � � ' � . - - . ' ' � 9 � � �s ��� 7�/,i'�Ylt=� t i �i•�'� �r 39. WaterSe�vice-F+nal' � � ' �t � 1 ! � j p � � ! � I I 1 �• , , 40. Gas Se}vice-Final I � � � � � 7� y�� i � �'" . � � � , ;� t i i� � � � � i � 41. $olarD mesticFinal I � � I b L � � _S_ -.1. �_ --- -� .�1 .' � , � M:�.I 1 I I � r '�� _ _� � �' �" '.. _ . 42. 9ackffo"W",P.r vente❑) 4 � j , , , Awl� n� 1_I_� � f � h-�i�--��- � --� �-I-'- -� 1--'v- - - - - . . � 5 i�� " I ,i ' 43. Backflow Ifr{gation r 1 �°;'_ � ' � � c! iu�r, i-�v � I � �� i�:T; � 'i � 44. Landsc3Ge I�ri9etiorrSyrtem i I ¢<��: � m i � I , � : � > � t � � �! .� � I . ( . . . . . �� -, t r,45. Soundl AAttenu�tior� Q l'^ I¢ i A I Q� i �` I � 1 � I � �:( V! i i I-� "� - _ `` �� -' � :`46. Handi�aP.Re ulBtionS � � I qq ' : `- � � � � � � ' " � � � � : �� �- � 7 � F i - r . i� �. i �.. �g.��i i �m� II ���� � � iT� � ' �� � � �E: - r 'r� , 47. PfNA� $TRUCTURE & BUILDyNG �`� i i j-� � V � ' I i � � i � ���- , ', ` 48. S eci � Re uiremerits Com leted y ' � � � � I I ' , 'r ' " . ., . .> ,. �, . �: P,ah .q. i � iPt i L� � � I���`� I � � i � ,J � , � .,_49. Elec[r��c Release�to �Edi�on� � f �� � � �� :�1__��_�_ F - �_�....t.. �_r _ _ � ' ' � . ' ' ' •. S�t• i 1 1 L � I I 1 t t � i � I ' ' � i . i � 1 � . � .. - 50. Gas Release to Southe�n Califomia Gas Co � ' ._ . u u�.� � i I i 1 � � ( i I 1� � ..l• ..... . . � . � 51. CERTIFIEATE�O 'OCCUPANCY �� � � t i� I '' i �`�_ �--�'- ;_.t _ .�.__. ,� _ , , f�fo i� II � � I Date I I ; � I i i � -! , � ; ��� . ��� � �,I � . r5r_'c'-�":.::�:�,., .i.y�_:.,_'r-=_�_� ...,��•,_ 1.. _�-.._ __y._i - ,� City of Costa Mesa Development Services Department Building Sate[y Division P. O. eox 1200 Cos�a Mesa, Califomia CERTIFICATE OF OCCUPANCY No. The Building located at 700 WEST I9'PH S'I42RA,T, I1NTT (` has been inspec[ed and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B2 Occupancy. . , , Use of Building DEN1'AL OFFICE Legal Description 422-261-21 ISee reuerse side for Metes and Bounds) Building Permit No 8 56210 Electrical Permit No. E 562R7 Plumbing Permit No p 56302 Mechanical Permit No. tSSUED T0: ,Tam?a Rhirhl �f9t 700 P7. 19th ST. (:nar, M?aa, rn 07F.�7 Number of apartments and/or guest rooms Building Official �ny C'De Baca by [9arch 23,. 1992 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CraF 3015-a6 rev. 1/83 White - Owner, Canary - Numerital File; Pink - Bldg. Permit File Pfl0.1ELTRDONES$: %OO j"1 ZyTH S�� �NR' C OWNEN;$N�F: STiRBL JAMES TR nooeess: 505 W '19TH ST COSTA MESA,CA 92627 (714)645-9334 necN�excixeex: R,J, DRAFT/DESIGN xec.xo.:NONE nooaess: 9 0 4 2 P I OIvEER uNir: HUNTINGTON BEACH CA 92646 PEAMinEE:RICHARD FLORES (714)968-6095 ADONESS: 9O9Z PIONEER DR Hi7NTZNGTON HEACH CA 92646 110ENSEO LONTMCTON OECl4flRTI0N: I �ere�y aflirm lhai I am Ikensea untler pmvisiorts ol Clupier 9(commencinB ��� Seciion 70W� ol Oiviaon 3 0l ine Business and ProfeSsions COOe. aM my Ikense is in lull force aM elleCl. c�nuc.:0554G68 sTnreuc.:562107 cuS`:B r� Oate: Z � �— 4�/ Signature: —. � WOflNEflS' COMPENSRTION UECIAflATION: I hereUy allirm I�al I �ave a cenilicate ol tonsent lo selbinsure or a cetliliWte ol Workers' CAmcensation Insurance. or a cetlilietl copy inereol (S¢ction 98W, Lab. CI. POLICV NO.: E%P. ORTE: Cenilie0 mpY �s here0y fumishe�. ❑ CenilieE copy is IileG wtlh ihe city BuilEinq Divisian. E%EMVf10N FHObt YNflKEflS' fAMPEN5ATI0N OECLAIiAT10N: (ihis secUon nee0 rot Ee comyetN i� Ne pvml k �or one hutlre0 (5100� or less�. I cenity tnai in tne oedormance of ine work for wnich tha pemrit is asu a. I s/pall not emdN' airy per n in atry manner m as Io bewme suEjttt to tlre Warkeri Compensation Laws of Calitomu--y2��" '�' oa�e: 2� � 1� C/� SignaWr¢: NOTICE: If, alier makinp tAis aeclaration, you shoNE Uecome 5u01ect to the Workers' ComOensation Orwisions of �he La6or Cotle. you must IonAwiltl comDly with such orovision5 or tNs permit shall be Aeemed revoketl. CONSTHUCTION LENOING �GfNCY: I hertUy afiirm I�ai Ihere is a mnslmtlion lending aOenCy lOr I�c DeNa�mante o� �he woB tOr wnicn Ihis oermn is issueE �Section 3W7, Civ. LL � �xoee: �ooxess: � OWNEB 9UIlDEN OECulU7lON: I here6y affirm Ihdt I am exempl Irom Ihe Coniractor5' State LuenSC Law lor Ne lonovrinq reasan (Section 7071.5 Business anE Pmfessional Cotle: My ciry ol counry whic� repuires a permil to canstruct, atter, imprwe, tlertrolisn, or rt0air any stmcNre. p�io� la its issuance. also rtpuires the aDW�nt lor such permit ro lile a 5ipneA stattmem tlut Aelshe is ticensed pursuam m t�e Omvisions ol iAe Coniractors' Slate license Law (C�aD�er 9(commencing with Seciron 7000) of Diuision 3 ot t�e Business an0 Pmfe59on5 COtl¢) ar Ihai �e/s�e is ¢xempt theretmm antl llie Oa95 for lhe alleqetl exemD��on. My vioWtiOn of SeCtion 7031.5 �y any apDliWnt lor a permit sublects Ihe aDPlicant ta a civil oenalty ol not more than tive hunOreA Eollars �5500�. I. as owner ol t�e proDeny or my empbyees vnih xapw as iheir sole compensatlon, wiA ao the work, antl t�e ❑ simcture is not inten0e0 or oilereG for sate (Secuon 70a4, Business antl Pmlessional COEe: TAe Coniractors' State License Law Aces not apply to an awner ol a D�oDeny wno builJs ot impmves lhereon, antl w�o Eces suc� wod himselt/herseif or tllmu0h �is ar �e� own employees, proviGeC Ihat suc� imprwemenis are nol infentle0 or ofle20 lar ule. II. howCver ihe builEinp or ,im0�ovemenl ¢ 5010 vnt�in one year ol fAmplelion. I�e awner vnll �ave ihe OurGen al pmvinp �e/She OiE noi builE or improve for ine DutpOSe al sale�. I. as owner ol tne Dropeny. am exclusNeIy conVattlnp wit� IitenseG conlratmrs Io con5Vuc1 IM D�Wa� (���n 70lC. Business ❑ anE Prolessians CoGa: T1�e Coniractors' State Licmu Law Uces irot apply to an wmer ol properry who EW6s ar improves thereon an0 wiw canlratts �or SUGM1 pmjeCls wiN a canVatlat�5) licenu puf5uani �0 l�e COntratlOrS' State LKe�Se Law). I am awara ihat orool ol ineir Worker's Compensation insuonce shoWA �e pmdtletl to me. � I am eeem0� un0er Seclion: B. 8 P. C. br Ihis reason: Dale: Ownec i ao nereby cem�y �hat I am aware ol antl untlerstanE ihe repuirtments af Calilomia Healtn an0 Safety CoGe Sections 25505, 25533, an0 2553d antl Uui l Or any IUWre buiiaing occupani wiNwiA nol (drUe one� neeC Io compty vni� SaiU slate codes and lhe reQuiremenis lor a permit for construciion or mo0ilication Imm ihe pir Ouality ManaAement GsiricL RevOemial constmctim aOM���S art exempt Imm ineu o�ovisions. Dale: ADO�a��: I nereEy certily �Iw� I luve reaa �nis aoo�ica�ion ane sta�e Rut �ne aGme inlormation is carrect. I apree to mmoN ��� all city an0 wunry ordmancesanGstatelawsrelatinO�oGuilaingcautmclionaM�ereGyawMr¢ere reuntativesaliNsc enteruponNeaOove-mentianeE pmperiy loi inspeclion pm0ose5. /��'//� Oate:�—{=� SignaWre: y//u/� �.d/ ori�ers ��cense ai Saiai Secudiy x: 160t<6 W�ite—B�ibing; Green—CoEe Enforcemenl: Canary—Applicant; Pink—Revenue: GdtlanroE—Assassor CITY OF COSTA MESA — BUILDING PERMZT PLRM NU; � 5bt1 PERMIT NO; B 056210 PLAN CHECH NO: 00191-92 L c,U '1': N S Y: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOS�: ALT JOB DESCRIFTION ; COMMERCIAL T,I. (DENTAL OFFICES) SQ FT: 1 1,660 CLAIM VALUE: CALC—VALUE: 8,93U,80 GROiJP OCC: B-21 / *�*�****i�*x**B*R�**��*��*�*��Di�Di�**k+�**���*�*��**��xHO*D FOR������A���QL�l�EMIENTS 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; T'T IN REAR; FT IN FRNT; FT IN REAR: r�T IN LEFT: FT IN RC T� FT IN LEFT; FT IN RGHT; FT IN � ��Il'9l'u.Bi�?JU '- PARKING RE • � P UV: � PARCEL: 92226121 2NE; C1 REF NO: PLANNING N�1'ES> INTERIOR ALTERATION FOR CONVERSION OF VACANT RETAIL SPACE TO > A DENTAL OFFICE. P— TO ALLOW INSPECT. OF RESTRIPING OF,LOT. kK�iEifiE-1E3FaFifiE)EiEiEiF�lEii=iF,iFitjfiEitiE?EkIF jHFR�K�k3F*aFiE3f3i�iEiFk�EleiFlEiEiEiEikjE3f�aEiE1F3t�ifiEiF�Ele�lF�l't3e3F#aEihif-iFiF3E�3i3FieiilE3f�k� D E V E L�Q P N E N�T S E R V I C c S R E Q U I R E M E N,T S ZONING APPROVED BY :�4'�� DA1'E; _ (f I7�2 HUILDZNG APFROVED;'BY ; v� DATE: 3/1/ � 2 APPLICATION ISSU6D� BY; ��' �� DAT'E: I.'L 2 IF iE 1f if if ik iF #E fE iF ik N� #�iE iF if� iF iE iF iE !F iF .t n� � if C�'i����i -- � '£iF'R"iF'iFie`k''�FiFiF k if Y� af 1F iE IF lk iP��,r �,��k���itit 3f I4 *�t*x�***�t*�*�t*+�*�*���*x*x�����***x•��*�**x�k* *�-�*u+�►*��*�x���c�x�*�x��xrtx�a��*���x�* LEGALIZATION;N� �' F E E S U M�M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRICr NyECHANIC FIRE SNIP/RES GRADING PERMIT 108,00 � PLAN 70.20 � ' � SN,IPiN88—RES ISSUE FEE BI3ILDING—DIV—> PERMIT ISSiiE PL'AN—CH��K TOTAL PAID DOE TOTALS----> 109.88 0.00 . 70.20 180.08 180.08 ,OU REVENUE DIVISION TOTALS--> COLLECTEDi 109.88 OVER/SHORT: .00 BLDG FNT PLUNBING ELECTRIC MECHATYT,C FIRE SMIP/TOT GRADING PLAh—CHECK 108.00 !--, • �. 1.88 iE it iE if if iF jf !f if IE iE 1F 1E iF 1E 3'r iF 3e iF 3E iF if iF iF iE } 1E i4 iF i(� i't If # i4 i(� iE iF iF )f iF94 }f�if if iE 1f it 3E iE i� 1F ii� IE !E ii i'r ih # IE iE iF k If iE iE iE iF iE if iF iF iF iF Ihie k ie #-lE I N D I V Z D U A'L F E� B R E A K D O W N TYPE QTY D E S C R I P T I O N� �''1 UNIT COST TOTAL COST SFC 830 OFF—INT, ALTER TYPE V—.IV� "•"—AVER 10.12 8,399.60 SFC $30 EQU—ALT COMM. AIR�CbND /f�� —AVER ,64 531,20 E1�D OF FEES . 1 � � ; f. t <� ,� .. .r.'.-h�� .I ' . .. � �i�.. U1.'1���` �_.� � ' C07JSTRUCTION AND PLANNING � - P���iA APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1, Temporary Electrical Service o.r Pole 52. Pool & Equipment Location . � - -2. SoilPipe�Undrgrnd. _ 53.'SteelReinforcement ;3. Electrical Conduit Utility�Undrgrnd. � 54. Porms 4. Electrical Conduit-Undrgrnd. � 55. Elettrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Eiectrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footinqs 58. Electrical Conduit-Undrgrnd. 8. Foundation ' S9. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. •� , 60. Backwash Li�es, P-Trap, O Undrgmd. 70. Structural Floor System , � 67. APPROVAL TO DECK 11. Property Sewer Line & House Conne�ion 62. Backwash & Receptor-Fina� ' 12. Sewei Cap � 63. Heater & Vent-Final 13. floof Drains .�. 64. Plumbing System • Final � '14. Rough Plumbing � 65. Electrical-Final � 15. Ro�gh Electrical-Conduit , 66. Solar System�Final 16. Rough Etectric Wiring 67. Fencing & Access Approval 77. Rough Wiring Si9n 68. APPROVED FOR PLASTERING 18. Rough Eleurical�7 Bar Ceiling 69. POOL/SPA SYSTEMS FtNAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Dutts, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe•Rough & Tesi 72. Undcrground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Ceiiing (Structural) & Monocqat 3/y�9 f�% 75. Dry Chemical !i �lf 27. Frame and Flashing �� 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - �8. FIRE PflEV. FINAL 30. Drywall Nailing Z zY HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ���' 79. FINAL iNSPECTION l 32. Electrical Power Meter�Final � 80. FOOD CERTIFICATE ISSUED 33. Fina� Electric rvoces:HOLD FOR SPECIAL REQUIREMENTS 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � �/��_�� 0 � 36. Hood o� Canopy Z^� �-� � �-1% % - 37. Finat Factory Fireplace - 38. Final Pfumbing 39. Water Service�Final 40. Gas Service•Final 41. Solar pomestic•Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation SYstem 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDIN� ��� - aB.�.�CiQ�� 3 49. Electric Release to`Edison 50. Gas Release to Southem Califomia Gas Co 51. CERTIFICATEOFOCCUPANCY No. Date c) � PflOJECTR00flE55: . 7OO W 19TH Jrl �N�T. �, OWNEN'}NRME: STI7ZBI� JAMES TR • aooxess: S O S W � 9 TH S T • COSTA MESA,CA 92627 nncx�excixees: � �� 4 ) 645-9334 pEG.NO.: - �oowEss: R J DRAFT/DESZGN NO�mT 9042 PIONEER PEqMinEE: HUNTINGTON BEACH CA 92646 noosess: RICHARD FLORES (714)968-6095 9042 PZONEER DR HUNTINGTON HEACH. CA..92646 LICENSEU CONTflRCTOB �ECIAHRTION: I M1ereEy alhrm ��at I am IicenSeC un0er proNsions ol Chapier 9(commencinA wi�h Section 7000� al �rvision 3 ot I�e Business antl Pmleuions CoOe. anG my license i5 in lull lorce anE e�fed. ciTv uc.: 0 5 4 6 8 QsTaTe uc.:� 1 � � cu : p�ise��� Date: � � �� ` l �/ i9naNre: _ (�, / WOFNENS'COMPENSRTIONOFCIAMTION: I�erebyatlirmt�atl�aveacenilicat �consennosel4insureoracertilicalealWorkerl' Comoensation Insurance, or a cenJiea copy lhereoll��� �, lao. C�. POLICY NO.: E%P. ORTE: COMPANY: � CertilieA wpy is herzhy fumiSheG. ❑ CeN1ieE mpy is liletl wit� ttre tiry BuilOinq Div6bn. �ale: ApOfiWni: E%EMPiION fflOM WOXKEPS' CONPENS/�TION UE TION: (mo sation need rol be canWeteG ii tAe pgr 1 certi�y Ihai in I�e Detlormance ol Ihe xrork br [� 1115 pemtii is i55ue0 I Shdll Ol empby anyQQHH��jjo SuUlect IO llle Workers' Compensatmn Laws Califomu_ =ej���"��G�� . Date: � �L Signalure: �.6�C�% N�TItE: If, alter maWnq ihis OecWratio . yau shoNG Ge ame su01�� �o the WOM Camp s: Coee, you musi lonnvnin comply with sucn pronsrons or iNs permit sAall Ue tleemea revokea. CONSiHUtTION LENOING RGENCY: I �ereUy affirm that t�ert a a canstmction IenJinq aqency for whic� t�is Dermit is issuetl (Section 3097. Civ. C�. LENDEfl: FOONESS: orn wmae �s�a� a less�. >r�ner so as lo became o� �h¢ La�or � e ol the work �or OWNEfl BUIL�Efl DECLABRTION: I �ere0y aflirm �hai I am exempi Irom 1�¢ COntfatiors' State License Law lar Ihe lollowinp reasan �(Section 7031.5 Buvness anC Pmlessional COCe: My nty ol counry which reduira a Dermit lo wreWct, alt¢r, imprwe, tlertroli54 or �e0air any 9mcture. prior lo ils issuance. als0 repuires I�e a001iWnt lor suc� Dermlt ta lile a SipneE statemeni ihai �Us�e is licensetl pursuanl b rtre Drovivons ol ttre Convactws' Siate �icmu Law (CliaOttr 9(commenpnp vni� Seciion 7W0) o� OiNsion 3 0l I�e BuSinesS an0 Prolessions Code� or that �e/sne is ecemp� t�ereimm an0 t�e Gavs lor tAe allepe0 e�empiion. My dolation ol 5¢ction 7031.5 by any aDDlicanl fa a permit su01�� Ne appliwm m a civil pNulry ol mt more ihan Irve IlunEreA OODars (5500). I, as avmer ot t�e prOperty or my emWayees wit� wdyes az Iheir SOIe tompe�5d�ion, wiA do the waA, anE t�a ❑ simclure i5 nol inlenEea ar of�ere0lar sale (Sectiw 704C. Bus�nus anJ Professional CoOe: 7ne Coniractors' Slate License Law Ooes n0i aOWY �0 an ownBr o� a propetly x1p MriMS or imprOVCSIAefeon, aiM vRq Oce5 5ut� wod �ims¢IIl�BrSell Or �hroup� nis or ner awn employees. O�oviAeA Inat sucn impmvements are nol intenOeG or oflered for sale. II, however ihe builAinp ar im0�%'Cmem is sol0 vnt�in one ywr af camplelion. I�e owner will luve lhe burOen ol provin0 Aalshe Ui0 not build or imprwe lor ihe purpose al Sale�. I. as owner of t�e DmOetly, am exclusively conlractinp vnth Iicense0 contracmrs m canslmct I�e pmlect �Section 7044. Businass I❑ and Pmlessions CoGe: The Cantractors' State Licertu Law Eces ml appy to an ovmer al D�PenY � Dui105 or im0�wes Ihereon antl wha [onlracl5 br SUCA Dmle��s wi�h a cOnlratl0r�5� IitenS¢ Our5uanl l0 Ihe ConlratiDrs' Sia�e L¢ense Law�. I am aWare I�al O�ool o1lAeir Worker's Compen5ation insurance s�ou10 Oe pmnAeU �o me. � I am e�emD� un0er Sectian: B. 8 P. C. tor Ihis reason: oz�e: rnmer. I tlo �ereby cenily Nal I am aware ol anG un0ersiantl ttle reQuirtmenLS ol Lalifomia Mealth ana Safery CoEe Sections 25505. 25533, and 2557C an0 tlWl I or any tulure Wdding acupant wiMvill rwt (tirde onQ neEU to fAmply witil5ab s�dte COtles anE Ihe teQuiremenis lor a permii lai construclion or mo0i�ication Imm �he Air Oualiiy Manapement DiSlrici. NeSiCentul conSlrutiion apDlications are exem0� ��om inese pmvi9ons. Date: I M1er¢Oy tltldy IIWI 1 havt rea0 ilti5 ap ortlinantes an0 5ta10 Wv5 �elating lo Uui O�openy lorinspec�ion purposes. oaie: 2�—� % state 1Aa1 IM aUOVE infotmali0n 6 tOrreci. 1 aqree to compty willl atl Dnver s laense or Social Secunty p. �; - ifi4t�46 W�'ite—Builtlino: Green—Code En�orcemenC Canary—Aoolicanl; Pink—Revenue: Goltlanmtl—Assassor CITY OF COSTA MESA — BliILDING PERMTT PERM NO: P 05630. PERMZT NO: P 056302 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU FJRPOSE: ALT JOB DESCRIPTION : COMMERCIAL T.I. (DENTAL OFFICES) SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / COMMENTS:�RE;ttH56710 CONNECT PLUMBING FIXTiJRES +���***Y�*�**�*��***�*k�*****�:***x �*�r*x rr**x�-*x•��*��**�c *+t*�*u��*�******�*� x��kx•+�� u v 7. 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 BOILDING ---------- --------- ACCESSORY BUILDZNG --------- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT; FT ZN RGAT; FT IN PARRING REQ • PROV; PARCEL: 42226121 ZNE: REF NO: PLANNING N6TES> � R if iF iF iF iF iE1FlF �!E /F i! # iE ii � iF 3i� 1i" ie k ik !F iF if dF 3F iE iF ii if j'r iF if 1E iF 1E if fF fh�3F iF # ii iE 1f�=f�it ir iE if jc if 3. if i� * iFi!� iE ii� iE 3F �3E 3e iE Y� iE ie iE 3't � ic iE !E ii iF iE ii 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 N, E N T S 20NING APPROVED BY f- DATE; BUILDING APPROVED BY : � DAT'E: APPLICATION ISSUED BY: �� DAiE: Z��� 16iEX�141f1FiEifif#d(�iFii�lFi(�lEifX�iFiM1ifiFiF;r'3F'iiFiF'iFiFiF'iFiFieiF�iF7F�r�.�if 7fiz'iFiF�iFiFi'Fi�iF'irYiFie3F1EiEK�IElE-lEifiEiF x'�>.x if�lf it fE if aF iE iE %7F i2 iE if if� iElE lf��lE � ie �}(� �1F if ii� IF fF ff !e 14 if iE 3E if iF id i'r ih iF if 3F #F ii• iE )f ie if IE iE �e iE if �E iF �f 34 if iE iF iElf if � il� i(� iF iE if iE iE �F iF?!� iF �lt-if� iF rt R iF i41i� LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMHING ELECTRIC N,ECHANIC FIRE SMIP/RES GRADING PERMIT 4.00 25Y SNZP/NON—RES PLAN ISSUE FEE 3.00 BUILDING—DIV—> FERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 4.00 3.00 0.00 7.00 '1.00 ,00 REVENUE DZVISION TOTALS--> COLLECTED: 7.00 OVER/SHORT; ,00 HLDG PMT PLUN.BING ELECTRIC MECHANIC FIRE SN,IP/TOT GRADING PLAN—CY.ECK %.00 if iF iE if * i4 3f 1F 3f �14 iE iE iEiE if �if iF iF jf K IElRlk iF IF iE?f iF iF 1f #f %� %1f iF iF i't 1(� �1F if iF i'r If M ih iF iE Ji� )f iE ii� iF iF if 1Fii� if �)f�iF i(� if if� �E iF 1F iE 1f� af 3F 1F �1F if If ?f iF iF 1E if X- 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 U N UNIT COST TOTAL COST PLU 1 WASH HASZN 7.,00 2.00 PLU 1 WATER CLOSET (TOILET) 2.00 2,OU END OF FEES ��i ����� I� 'J.,ir,- "' " "�7=� �='='- "� - '�' : r:��. ` ' CQ�USTRUCTION AND PLANNING � -. POOI.'A APPROVAIS Permit# Date Inspector qppROVALS Permit# Date Inspector � 1. �Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. . 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. E�ectrica� Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reintorcement - 56. Rough Plumbing & Pressure Test 6� Electrical UFEF Grnd. 57. APPflOVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test ,', 9. Water Pipe•Und�grnd. �� � 60. Backwash Lines, P�Trap, O Undrgrnd. � 10. Svuctural Floor System .'!� 61. APPROVAL TO DECK . 11. Property Sewer Line & HouseConnection 62. Backwash & Receptor-Final � 12. Sewer Cep � 63. Heeter & Vent-Final 13. floof Drains '� , 64. Plumbing System - Finai 14. fioughPlumbing ��t �' � �jJ(, �(,�� 65. Electrical�Final 15. Rough Electrice(Condu�t , 66. Soiar Sys[em-Final i6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPpOVED FOR PLASTERING 18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Condittoning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilat�ng 71. Product Piping O Gas ❑ Oil 23. Gas Pipe�kougN & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Srorage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (5tructural) & Monocoat 75. Dry Chemical 27. Frome and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PfiEV. 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 35. Final Gas Pipe-Test ' . � 36. Hood or Canopy � _. 37. Final Factory Fireplace - 38. Final Plumbing 3 q�qZ G�� 39. Water Service-Finai 40. Gas Service-Final 41. Solar pomesticFinal 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING _ , 48. FINALPLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY No. Date � . PN0.IECT�IUORESS: %OO W 19TH ST ��T� C OWNEfl'SaYRME: �TIRBL 3AMES TR aoowess: 505 W f 9TH ST .' COSTA MESA,CA 92627 (714)645-9334 AflCH/ENGINEEN: RqJ, DRAFT/DESIGN ncc.r+o.: NONE A�ORESS: 7Q4Z PZONEER uxir: H[JNTSNGTON BEACH CA 92696 PEflMITTEE: �]IM TAYLOR ELECTRIC ( 805 ) 522-1613 aooxess: 1811 EDGEWOOD DRIVE C SIMI VALLEY CA 93063 LICENSED CONiMC7oB DECUMT10N: I Mreey aliirm ttut I am li[enSW unEer provision5 0l ChaOter 9(commenGnq with Setlion 7000� of Oivision 3 ot Ihe Busine55 anG Prolel5ion5 CaAe. an0 my IicenSe is in lull latte an0 eHecl. cirruc.:055480 sr�Teuc.:392936 cuss: Cl0 �,��,��-�r� � —__. so�aw . _ _ � wOBHENS' COMPENSR7ION OECUNATION: I Aereoy af(irm niliute ol consent ta sell-insua or a cenifiwte ol Workers' Compensalion I�su� r�ci i?�wie� rlovv inereai ISectian 3eo0. �an. �'� / fl,� 19 2 roucv No.: STATE FUND EIIP. DRTE: COMPaNY: ❑ CertilieA copY is hereby �umisM1eQ � CenilieA capy is ftled wit� t�e dry Buildinq Uivision. -�x--'Z ' � bi `) Z ncPr� � ��� .. . - ��, . EXEMPTION FflOM WOflKENS' COMPENSATION �ECIAMTiON: (iN5 mI E! CanD��� �� ��e Demm �s �of 0�e hUndreE (5100) or Ie 5). 1 ceriify ihal in the DeAo�mance ot the wofit irn wt�iCh ih'S Oelmif R�sSue6. I 5hall �roi ¢mpfoy atry p¢rson in My R1an�fe( 5o as to hecoine su�lecl la Ine Worker5' CAmDensdtion LawS of Cafilamia. ' Date: Siqnature: NO710E: If. atler making I�is aeclara�ion. you ShoNE Oecome 5u01�� �o t�e R'orkers' Campenution provisions ai t�e Labav'.: fqGe, you must Ion�wiN comdY �N sucA provisions or ih5 perrmi s�Wl be CeertreO rewkeG. "•� '� CONSTPUCTION LENDING �GENCY: I hereGy affirm ttut tlrere 5 a crostructron IaMinp agency tor the certormance al tAe work 10! wAi�A I�is Dermit is iSsueG ($eclion 3097, Gv. C�. � ' f, I lENOEB: ' ' nooaess: . . OWNEB BUILOEB UECLABR710N: I here�y allirm ilui I am exempt Imm tne Contractors Staie LicenSe Law lor tha tollowinA �eason (Seciion 7031.5 Business anG Professional Cotle: Hny ciry at munty wkcn rtyuias a pe�mit to consbuc�. alier. improve, Oemohsh. or repair any simCture, o��or Io its issuance. also ropuirts tne aooliwnl lor sucn Dermit to lila a slOneE stalemenl inai Oe/s�e Is licensetl pursuam to ine O�ovisbns ol ine Coniractors' State lkeirse Law (Clupter 9(mmrtrenang xitn Section 7000) ol Division 3 0l tAe Busineu �� anG Pro�essions Catle� or IIWI he/s�e is eRmpl I�eRlrom anE t�e bavs lor ihe allepe0 ex¢mption. My vialation ol Staion 7031.5 by � any appliwnt br a permit wbl��s t�e aD0��n1 to a ciNl Denalry ol noi more tlwn live hunCrEtl Oollars (SSW�. I, as owner al t�e D�a7erty or my em loyees vdm waoes as tAeir wle com0e�satian, vnll da Ihe woM, ana I�e ❑ s�mcWre is rq� imenEea or olleree lo� sale 1�tnn 70a4, Business anE ProluUonal Cotle: The Contractors' S�ate Lice�se Law Coes irot appty to an owne� oi a 6�aDeny wtu MdWs w improves thwean, anU xtw does such wurk NmSW/l�erse�� nr lluouqA his or her own employees. O�ovitle0 Inal suc� impmvemenis are nat intendea or a11eB0 �01 sale. If, however tAe euiltlmp o� imOmvement is solE vnihin one year ol com0le�ion, i�e ovmer will Iwve t�e EurEen of pmvin0 M/s�e EiE nol UuiIE or improve , la tlre pu+pose ol sale). I. as awner ol I�e proDeny, am e.Uus�very contracGnO �� �KenceE wmractors la conslmct t�e pmject (Seclian 70C4, Busines5 ❑ ane Professions CoCe�, the Cont�actas' Stata lkense Law dces �wt appty to an wmw of p�operty wla Ou��Us or imDroves lheraon anA w�o contracis for sucA Drolecis wit� a mmractoqs) license Wr{uanl ta ihe Comnctors' State License Law). I am aware �hal Orool ol ineir Ww4er's Compcnsatron inw�anu sMuW Ue prWtled to me. � I am erempl untler Seclion: B. 8 P. C. lor t�is reason: Oate: Oe*ier. I tlo nereoy cenily inat i am aware oi ana unders�ana tne reQuiremems ot Calitomia Heal�h antl Salety CoOe Sections 25505, 2558�, an0 2553a an0 inai I ar any imure builAing occupant wiMviA not InrGe one) need ta compy wii� ui0 state aUes an0 ihe requremenis lar a permil lo� conslNction or motliliUtion Imm i�e Air Oualiry Managemenl Uslnct. R¢5i�ential consiruCtion applications are exem0� �mm �neu provisions. Date: apWicanr. I hereGy cenify t�at I �ave read Illis aOV���ation and state iha� t�e aOWe intormatian R torBct. I a0ree to fAmpy vnih all ciry and counry o�ainances atW sta\e laws relati� ta 9uil0inp cdtst[utti0n anC M.cetry autMn[e Bp�eSGltatire5 W tM16 CQy to mtet UpM lhe a�Ove�mGUiOnetl O�OOehy IOf IpSpEtlbfl pOfpO5C5. m�2 ` ) Y-�f Z_ s;g,� ��iver's ucense or Sodai Secudip x: 16dt�06 W�ile—BuiMing; Green—CaOe Enlorcement; Canary—Ap0���2nt: Pink—Revenue; Goltlanroa—Assessor _ '� CITY O'F C05TA MESA - BUILDING PERMIT rtxr, Nv: e: U7bL9 PERMIT NO: E 056247 FLAN CHECK NO: N �� i; rv JVLY; 1� CONSTRUCTION TYPE: 5-N FERMIT TYP�: ELE PURPOSE: ALT JOH DESCRIPTION ; COMMERCIAL T.I. (DENTAL OFFICES) SQ FT: CLAIM VALUE: 3,500,00 CALC-VALUE: GROUP OCC: B-2 / *���****ir****B*R*�*�*�******4*D�D�t*�**�*a�H*x*��******��*****x������*�*****+����x 2 O N I N GS ERT�H�A�CIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT IP3 REAR: FT IN FRNT; FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RGFIT: FT IN PARKING RE • PROV: PARCEL; 42226121 7.NE: REF NO: PLANNIiJG N THS> > *�;��***��*******��*x��*�*****���***�*�**�*+�**�*��*����**�*�***�*�*�*�*��*****�* 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�N E N T S ZONING APPROVED BY "�'" DATc: J BUILDING APPROVED BY ; w Y DATE: APPLICATION iSSJED BY: ..' DATE: � % ��� � *i��t�t�x��t*x�*�*i�*�t***��ti�f��itiF iF�FiF�£ 'i�iF�iFi�'�ti�F'iF�r���'3F'�x�r*�rit#*i�*�K�rii'�'£'k�3F�T�*� iFiFifjFiFikiFiEiF�IFji#FiFif�iFlFikif�kiFlt�iEiFiFiFiklFiEiE9FiF�lE��Eif�lf� 'atiFiFikiei4iF1FiF3F1FiFiFikiFikiF3elFiFieit3FiPiF�ieaEitiFRifY�iF3iitji�iFiFie�F LEGALZZATION;N F�E E° S U M M A R Y STRUCTJRAL SEGMENT;N BLDG PMT PLUMBING,�ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT PLAN ISSUE FEE 6250t 15.00 SMIP/NON-RES BUILDING-DIV-> PERMIT I55UE PLAN-CHECK TOTAL PAID DUE TOTALS----> 62.05 15,00 0.00 77,05 77.05 .00 REVENUE DIVISION TpTALS--> COLLECTED: '77,05 OVER/SHORT: .00 BLDG PMT PLUMHING ELECTRZC MECHANIC FIRE SMIP/TOT GRADING PLAN-Ci-IcCK 77,05 !E iF iE iF iE iF iflf jF if 3h if iF jF iE 3i iF K� # it i6 if� iF if iF �F ie 3F iF ie aF ah 3E jP iF �)f ?F±i� if iF iF 3e iF 3h ie it��� iF ih iF 1F K� 3d iF IF ii� #� if ib iF IF iCie iF iF ie K� a! ic ii� iEiE iF iF iF if iF ie If I N D I V I D li,A L F E E B R E A R D O W N TYPE QTY D E S C R I P�T I O N UNIT COST TOTAL COST ELE 9 FIXTURE5 L3GHTTNG 1 ST 20 EA. .75 6.75 ELE 10 RECEPT10i7TLET 1 ST 20 EA, .75 1,50 ELE 14 RECEPT/OUTLET ADDITIONAL EA, .45 6.30 ELE 6 RECEPTISWITCH 1 ST 20 EA. 75 4,50 ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18,50 18.50 ELE 1 SUB-PANEL 11.Q0 11.00 ELE 1 MOTOR/PO�TR APPARATOS 1.1 - 10.0 HP 7,50 1.50 END OF FEES .� .r�a r_(�'�.n, -� - ' � n•'rC• -� i-- - •. _.. �..!'_i:_ ,. � . � CQNSTRUCTION AND PLANNING ' P�Q� 'PA ? • ARPROVALS Permit #-T- bate I.nspector p�ppROVALS Permit # Date -Inspector � . ��. Temporary Electrical Service ol Poie ' - 52. Pool & Equipment Location , 2. Soi� Pipe-Undrgrnd. ' _" - 53.� Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrital UFER Grnd. 57. APPROVAL 70 COVER�GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation � • 59. Gas Pipe, O�Undrgrnd., Test 9. Water Pipe-Undrgrnd. , 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structural Floor System - • 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptpr�Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � 64. Piumbing System � Fina1 , i 14. Rough Plumbing E''. Electrical�Final . 15. Rough Electrical-Conduit � p �_ 66. Solar System�Final _ � / �IZ 16. Rou h Elettric Wirin �- � 9 9 /�2 � 67. Fencing & Access Approval � 17. Fough Wiring Sign 68. APPROVED FOR P�ASTERING 18. Rough Electrical-T Bar Cei�ing L� t�� „� 69. POOL/SPA SYSTEMS FINAL 19. Rough Neating & Air Conditioning FIRE DEPT. REQUIREMENT •2�. Rough Factory Fireplace APPROVA�S Permit # . 21. Ducts, in Structure 70. Underground Hydro '• 22. Ducts, Ventilating 71. Product Pipin� O Gas � Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation '� 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plasier Brown Coat % . FINAL INSPECTION 32. Electrical Power Meter�Final �Q'L 00 CERTIFICATE ISSUED 33. Final Electric J � � . f� 34. Final Heating & Air Conditioning � 35. final Gas Pipe-Test 36. Hood or Canopy 37. Final FactorY Fireplace 38. Finai Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer ' � 43. Backffow lrrigacion 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. FINALPLANNING 49. Electric Release to Edison ,, 50. Gas Release to Southern California Gas Co �� 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa �. Building Division - � � APPLICATION FOR STATE OF CALIFORNIA TITLE 24 ACCESSIBILITY EXEMPTION Documentation of Unreasonable Hardship t�s�' S5279 Project Address 7� %y �-�Ty �f Plan Review �h�• Owner �T��� 5r�i�� (�/��plicant ( 1 � � Telephone Telep�ona � I hereby request an exemption from Title 24 accessibility standards pertaining to reasonable availability to, or usage by, the physically handicapped. . . . . ,. . . H. � � �'� � � D The following information is provided to assist in determination af reasonable hardship: . f��� AF ��a^TA fdfigq 1 The ro osed facili is a /�7�JGlG�li GL�i/r/!O 'f %e 'L''T/,}:� ai neir,��Mr� „� • P P tY I7SG�Dffit � 2. The cost of all contemplated construction is: $ . 3. The cost of the access feature is: $ � . 4. . The access feature increases the cost of construMion by N�' % 5. The financial impact of the feature on the feasibiliry of the project is: The following persons provided information shown in the above section: i _� � � %� �il//��� /l i I �i��/� //i�wi �i . � �� / . /., . FI RM ADDRE55 � OCT 181982 � ��abN�w��,lww�4��a� SIGNATURE . 1 E �!- � If approved, the determination of unreasonable hardship and this documentation do not allow an exemption from any other ' access requirement. � - ' • �Th exemption re uested by this form applies to the following item of the project, which is shown on pages '�Y � Z �of the plans: ❑ Equivalent facilitation will be provided as specified in Section ❑ Provision for equivaient facilitation is not required as per Section Submitted by: '�. CMF 0969-46 _ , � . Title 24, C.A.C. , Title 24, C.A.C. �b�5/8Z Date � ������� . �°� P�''�''"� � ���,� n� �D•��,b,g� P � �� � Bissell Architects 3434 Via Lido, Suite 250, Newport Beach, California 92663 (714) 675-9901 November I, 1982 City of Costa Mesa Building Division P. 0. Box 1200 Costa Mesa, California 52626 Reference: Dr. James Stirbl - Medical Building 700 West 19th Street Cos[a Mesa, California 92627 Gentlemen: We have reviewed the plans and other pertinent data prepared for the above project by Architect Charles Huntley Rivkin, and wish to incorporate that information as part of the plans we will be submittirig for review. Sincerely, �`�1�� Glen Gellatly Project Architect GG:Ib cc: James Stirbl, M.D. NOv � 2 REC� BISSe�� Architects October 18, 1982 3434 Via Lido, Suite 250, Newport Beach, California 92663 (714) 675-9901 PAr. Victor Newton Assistant Director of Development Services City of Costa Mesa Building Division RE: PLAN CHECK #55279 (700 W. 19th St.) Dear Mr. Newton: RECEIVED CITY OF COSTA t;�ESA FLAfdi;IN�; nn� A� OC� I81982 p� ���yl�/Ulul11�1�I'�".�1� Per your instructions, we kindly submit plans, application and this letter for your review. We are requesting accessibility�exemption from new handicap requirements because of unusual circumstances, and also due to the rather tight constraints of the proposed medical clinic. The circumsta nces that preceded our involvement are as follows: During the plan�:check processing and after construction bidding on the Charles Rifkin proposed plans, we were asked by Dr. James and Lola Stirbl to redesign the exteriors of their proposed building with instructions to alter the floor plan and site plan as little as possible. This has been achieved and we are now completing our plans along with HVAC Plans, Title 24 energy calculation's and electrical engineering (items not provided in the Rifkin plans). We feel that the new exterior elevations more than otfset the apparent dilemma of new regulations and calendar date delays making this project a more viable addition to the existing built environment of West 19th Street. Thanking you for your consideration.in advance, I remain Sincerely, CLi��C�ii�'v C� Glen Gellatly GG/tb cc: Dr. James Stirbl o'� �`:�'�;'E::��. � T� � - � � x�;r �r� �a.. � . _�-:� � --�-�� ��r �.�h1..L7f9� �_�.. ,~'ti!f va.� -3.1`� r� �iL .L 9l�SJ p�i6� � ��.� � J'�i1✓ \1�.L1.1�..-i�... � -T� .- r_� . ,. R.G"HITECTURE � PLANNING � INTER.20�.:. October 7, 1982 Dr. James Stirbl, M.D. 700 West 19th Street Costa Mesa, CA Subject: Plan check status of proposed Medical Clinic '�o be built at 7Q0 West 19th Street, Costa Mesa; City of CosLa htesa Plan Check Number 5527 All plan check corrections have been incorporated on the drawings, according to the scope of worY, included in our contract dated February l6, 1982. The following items remain to be completed, which are the responsibility of the owner to complete. Refer to item A, Scope of Architect's Services of the agreeme�t, Under the �uilding Division, City of Costa Mesa: Item q4, Submit energy calculations and indicate energy compliance state�nt �,n plan, signed by licensed designer, Item p5, Provide soil report, and indicate on plan the soil bearing capacity. Item N6, Submit rr�echanical and compleCe plumbing (isametric) plan for the pr�oposed project. - Under the Planninq_Division, City of Costa tlesa: Item N5, Detailed landscaping and irrigation plan shall be submitted and apprc��ed prior to issuance of building permits. Sirice you only have a temporary permit to use a trailer for your medical clinic, ? should like to remind you that the above required plan check items must be completed by licensed professionals or licensed cantractors prior to the issuance of your.building permit. Both the above mentioned ,�rork and plan checking could take considerable time so that you should allow for this time in planning your con5truction schedule. � I will sign the plans after the above work is approved by the City of Costa Mesa, and when I am paid my past due billings, according to our contract. Ver -truly yours,� �%:r�-� �-��� Charles H. Riv,�Tin, -A[l1 ' CH F'/ i f cc: Marilyn 47olfrarn, Director - Re-development Agency Douglas C13r•k, Uirector - Development Services Vic Newto��, �uild'ing Ot�'icial Ben Chernick, General Contractor ,n - - y, � 'tc � . :, � � ., .. . . ,: v w� i 'i,. a� '� '�S. G� �i; t' ��; .�r, - _ C��: i :a :j: :r � � � � � October 13, 1982 RECEIVED CIfY OR CO3iA M�Sq PLAtVg�ip,�r. ,irnr. �, ocr 1 s �s82 � ���w�uN��s���t8 Mr. George Bissell Bissell Associates 3434 Via Lido Suite 250 ' Newport Beach, California 92663 RE: A medical clinic for Dr. James Stirbl, M.D. Dear George: T`ne enclosed copies of. my plst due Uilling to Dr. Stirbl, dated September 15, 1982 and a letter pertaining to the Plan Check status of the job are self-explanatory. I shall be glad to sign off as architect of record, upon receiving the remainder due, according to my contract with Dr. Stirbl. Good luck in your dealings with the Stirbls. Cordially, C� Charles H. Rivkin, AIA CHR /cy cc: Klaus Staschil, City of Costa Mesa Department of 13uilding & Snfety i33 DOVER DRIVE SUITF_ 24. NFWP(�RT REACH. CA 92663 (7141 646•778� � ����I�.L3�� H�J�TT�.� Y R.I�6T'���1lT c��C� ��.�:�I�'�CT � ASS�CI�T�S �.RCHITECTURE � PLANNING • INTERIORS September 15, 1982 T0: Dr. James Stirbl 505 West 19th Street Costa Mesa, CA 92627 SUBJECT: A 2000 square foot Medical Office euilding to be located on the north-west corner of 19th Street and Pomona Avenue, Costa Mesa. INVOICE FOR ARCHITECTURAL SERVICES Upon receiving a building permit or according to item D of the agreement should the work be suspended, the amount shail be paid to date of suspension of the work at the rate of $40.00 per hour, or upon the stated fee basis to that point of time, whichever is greater. All work required under our contract has been done in order to obtain a building permit. Therefore Section C, Fees and Payment Schedule, Payment 5 isnow due ...............................................................$1,000.00 The original contract was for a 2000 square foot medical office building, with any future addition to be dotted in on the site plan, Nowever, at your request and signed approved preliminary drawing, ir4y office expanded the working drawings to include 4,386 square feet of enclosed building area. This more than doubled the size of the building that was provided for in our agreement. At this time, I am not proposing that rt�y fee be proportionally doubled. However, in order to cover at least in part the additional work and time expended, an additional $1,000.00 is being added to my fee. I will consider this payment in full, providing payment is received within one rronth of this billing. Total ar�hitectural fees now due and payable ..............................$2,000.00 Thank you Your attention is also directed to Section B, Services and Ex enses Not Included, Item 5. Blueprints and other reprcduction costs s a j-66e — paid for directly by the owner. �� � 33 DOVER DRIVE, SUITE 24, NEWPORT BEACH, CA 92663 (714) 646•7788 �.. BISSeII Architects Apri I 12, 1983 3434 Via Lido, Suite 250, Newport Beach, lifor ia 92663 (714) 675-9901 O � U j� � ��� � 6" � R. L: Sa,r•o,_M�-�Q� �I cl����c -- �7ad `'`,_'' i 9�� P.e rv�.�'f" � Bert Morgan Department of Building and Safety C�ty oF �.,_... ...�__. Box 1200 Costa Mesa, California 92626 Reference: Sano Medical Clinic Building Dear Bert: Please be informed that [here are no areas where plywood shear walls require plywood both sides. If there are any questions, please do not hesita[e to call me. Sincerely� ����/ ` � Glen Gellatly GG:Ib cc: Don Torrey, Prime Contractors C��C��O�An1LS C�N 0� �� � ��� ��I�D:P?G tT:�:..._�d APt� � 5 �§�5�3 a�w7 �''�, .. ]:; ll i2 3 � ���l�Sa� �fl���d � l � 4 : Applleant to /ill in all spaees a:eeD< <�esa wlt�in �aavy GorGar Ilnaa ana sign all a0��ooriata Ueelantions. ' � � GTV OF COSTA MESA; • •' � ' .. , _ � PE IT NO� � TRACT NO. . . .LOT NO. " B � ' ' � . � • ^ .... -� ' . ' CONSTRUCTION PERMIT ' . ' • ' " (o ao%O . - � . � . . , • . .. . , . ' . '�� I }. �J� : < - , �. , ADPfcant'z Mailing Address � 'r// � TYFE OF CONSTRUCTION � NEw ADD � ALTERATION � 'REPAIR � - 1 . _ - ' ; � �� � ' . •�' . � PfOjeCt AddreSS � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � __ : . , , �• . . ���/ DESCRIPTION OF WORK '- ' � � p� ' Owner s Name : � . . : Phone �fC��/; . . _ . , � ' 1 G U - 'O Addreu ' ���-L/� ' • � - -TVPEOFPERMIT ' ' �GRAOING - FOUNDATION STRUCTURAL, �"� A.P.eW ' ' ' � �IONE . � ' � � Arch/Eng. �S t�l�" � � Licenu No. ❑ 7ENANT ❑' ELEC7RICAL PLUMBINO ❑ MECHANICAL ' ' PLNG. REF.9W ' ' � ' BUILDING ' { ' �. Addreu , v � S . '�� � �,�OTHER, . . - TO BVILDING' . t . • . Contrector's Nam T hone PROJECT DESCRIPTION. SQ. F7. - -' .oCCUaANCv P PE V � E ' REAfl YARD (TO P/L) .'CONSTRUCTION TVPF �VALUATION 5 :�EFTSIDE VAqD RIGHT SIDE VARD '' � . Address (mailing) • _ . . ' . � ' ZON€ GRAOINGCV.VDS. 'ACRES PKG.SPACE.RE�. , . � PROVIDED � ' iicenu No: � - � ' LICENSEO CONTRACTOR DE LARATION � � Remarks: Fi / . -. STREET WIDTH ' PARK FEE-S _ ', I'�heieby atfirm that�l' am Iicenietl unCer provisions o/ C�arter 9(<omm8ntinq , _ ' wl'tti•saction 7000� of Dlvlsian 3 af [he Business entl %Ofe55ions COUe, antl ' ' �` ' � SFEdAL CONDITIONS: � ' � my Iicense is (h full force antl efhct. . ' ' � _ _ Llcense G ss � nze ' � � ' � PLUMBING - � � ' � � �� � � ' ' � ' • � - Data ' .Si9nature ` ' . � �"ORKERS' COMPENSATION DECLA' ATION , � � Bef Sink � � Sewer C2p � � - '` ! L , - ELECTRICAL ! I ' ,:�`-q'.reDy,;aiflrm thal I.have a tertl}Icate uf tonsent to_sal(-0nsurepr a.Certlflwte_ -. � BGCkfIOw PreVentBl � � - - --SewCf CqnnCctiOn"'- ' - - � � '� � %�urome[it Wa�hef � � � ' : _ _ Meter ❑Over 100 amp5 _ Workers' Campansation InsurSnce,�or a cerHfietl,copy thareof (Sectlon , � - . ' ' �5`00; LSb. C ) ./ • r� � �p !. Backflow Irrigation . Solar Collectors � • Conztruction Pole �Sub Panel � • ; � , POIicY No. ��.?�'s6'Z'�T�omPanY ar% Cl.�/�4�L���i��. "' ' - � . . �Certltietl copy is nereby turnisbee. � i � j � � � Ba[htubs , ' . Soler Pipin9 , � . � � CookinglU`mP` , �� �Sub Pole � . � � � Certlfie0 copy is tllea with the Nty Builtlin9 DIvlSion. � �ishu�a5he i ,Moto�s �0-1 HP ❑ 1'h$ { oate Appliwnt . Clarifiers . � SotarTank , _ . EXEMVTION�FROIN Y/ORKERS' COMPENSATIOfJ DECLARATION � � , � . � - Dr ef ' Ga5 �❑ ¢otrit - - • ' Dishwasher t Swimming Pool w1Spa . Y �, n Solar �945 HP ��1645+ (Thissection neatl not be <om0�etetl if the parmlt Is !or one huntlre0 �5300) or � _ �, - i i '�le ei�tlry �that in the performance of the work for,wNch thl3 permil Isdszue0 I . �rinking Fou;ntains � Urinal � � � ��, _ FaO ( /�� owa � � � , ' shdll�n0[ amplay any pefson In dny mdnn6f SO as [O bGCOTe subjeC� to t�le : � . � � [[ � , workers"Campanutlon,laws of Californla.' � f ' • FloorOroins� 7 . ? F����� : Pole L;g��t I� � � � � Date ' � Sl9nattiro � • � • . � Wet2fqO5et� . 1 � , . . I . . . ! . � ' .�. � ._�' _ _WaterHea[er` .; L_ :,..'... . _. _ .�_. _L � _ .�.A n9'� _l._.� .,-NOT•ICE:If,.after making this�tleclaratlon, you�ihoultl bacame-sub�ect�to�the- FloorSinks-�, --- -- F _ . , _ ' Workers'; Compensatlon provlslons o/ the Labor Cotle,.you must /ortllwltb - ' Comply wlth- Suth prOvlilons or thls'.�Dermit shall bB aeamed� rovokotl._ � :�- Gas Service � ' Outlets �_ Water Service '-' - -� ��10e � ' E ' ! . � CONSTNUCTION�LENDING AGENCV- '�� �� i ' �' • � - ' - . : � , � ' I neretiy aiNm that t�ere is a conslruction Ian0ing agenty for lha; erformanc0. � Interc¢ptOrs , ' - .._ . Ou[lets � '�� �C � Stan g SectiOns � � � of the work lor whlch: this� Dermit 'is •Is5ue0' (Soction •,30�7' Civ. C ; - . . . ' ' ' Lender's� Name• ' � ' Kitchen�Sink� �: ' • ' . Switches ' � � ' . rash Compactor • � � � i LnnAe�r's; AOOress i . : ` . � ' : °- � ' . ; . . . -_ � - . ' ' ' . , � � � OWNER�BUILDERDEGLARATION' � ' ` - • - LaVatafies - t - � � � . . , _ �� � Gef68g2Di5posel , , , j 6 , 1 �ereby,atilrm tha[ I am exempt from tfie�Contractor's Llcense Law tor tho - - ^ � � _ _, . Ganeretor, 00�5 KVJ 05�15KW . � � : followln9 reason-(Sactlon 7031.5 Businanantl Pmlesslonal Cotla: Any Nty o� I � P-Tr9p� - 1•� :. � I '.COunty wnlcn'requiro5 d permi[ t0 <Ons[�uct, altB�, 11Oprove, Eem011sh O/ �BOdi� ' �� �.. - - . 1 T�80510fm2� Q 15-50 KW ' t i � any strutlura; prbr to Its'issuance, atso requlres the appllwnP/or such �armlL RoOf.D�ains � �� . �__ . , . ' ta file a Slqnetl statemanl thal he/She IS IIC¢nSBtl pursuant to lhe�provli on5 0}' ' ' ' � ' � 05U+ KW � '� � � the Contractor'i Ucenze Law.(Cbapter 9 (cammencing with SeCtlon 7000) ot - .: ' � �+ ' : ' ' • - ' � � , �Reinfpection Fae ' $15 � ��,,•,asion 3 at. tne Buslnass-anC�Profeulons, Coae) or that no sho'.Is,onorifpt � Showers - -� � 1 Reinspection'Fee • ,E75 � �efrom �anG tne; basis for tho allegetl exem0��on. My vlola�lon� of Sactlon ' ' . ' - , - • MetEr ❑up [0 100'ampi t Issue Fe0 � $ 3 1:5 by, any aDP�����' �or'.a' permlf Sub7B<ts'Ihe �ap0���q� to a Clvil �` � " � � � ' � � alty 0� �ot more than /ive hunGrea Aollars (5500�: � .' -. , ; �' � � Service Sink . ~ � � • �ysue Fee � �$ 3 ZoninB APP�oved By ' � , ; 'Date � � , I; as �oaner of� tha property or my employees with wages,as thelr sole , � , , � . , i , � � � � � . mmpensatlon wIIL•ao the work, antl tne structure Iz not Intanaea or of(eretl �� I ' �,, MECHANICAL' , � ' � � �or ule (SecElon 7044; Business: antl; Vrotesslonal Cotle:. Tha ContractCr's � � ^ � .AOP��mtion Approvad By . Date � � Licanse Law Ooes not apply ro'an owner of a properb'who ouilAs or Im�roves � • - � � 'Refrigoration System ' � ' � ' �. � �ia = 8•7 � thereon,'antl wno tloe5.iuch,wurk hlm5elf/harSeH or throu9 h his or her own i BOilef I r 1 `� � % . qppli�tion Issued By � . � ' �Date -7 emplorees, provitletl that such Improvements are�not Intontla0 or offoreO for � ❑0.100,OOOBTU �100,OOOBTU � Duct = Under Ground• ' • � � � sale. I howaveq tha bulltlinq or Improvement Is ioltl wlthin ona'year�of com- 1 . • � J ' • ' �' �, ' SUMMARV OF FEES � � � - pleLOn, tne owna� wlll OdvO thB G�rEen O/ ptoving �e/S�o CIO n0[ buIIE O/ I�n- . � � � . {' ., �roveforthepurposeotsale). � , t � ', � Duct-Strut[ural ' SystemRepair/Alteretion ' � BUIL'DINGPERMIT $ � � SMIP ' . $ � 1, as owne� o/ the property, am axclusivery contracUng wlth�Ilcenso0 con- � , . � � � � r �' ' tractorsto construct the D�oject (Section 7044, Business,anC Rofassions Cotle: , Dutt - Ven[ilatipg_ � __�_ � _ � IPLAN CHECK� � $I � . pERMIT ' • � '.�The Contractor•s Ucense Law doas nol adply to an owner o( prop¢rty W�o � � � � IS$UANCE � !$• ' � bW105 oi�lmprovez [hereon, anE wha.contracts for sucn projects with a con- ' ExhauStSystem ❑ MWtiple O. ` ' ' � � , ' .PLUMBING ' ' $' �� � • . � � tractor(s) Ilcense pursuant to tne Contractor's License Law): � - ' , � � PLAN CHECK � $'' .�.�. ^ ; GRADING � $ � ❑ I.am exempt untlar Sectlon . B. S P. C. /or this ruason , . Fi�epVFaCt. Blt. ICBO iY• � � • . { �, � � � �� , , - � i - � • ' . : . � ; Heatin S stem & Ductin , ' ; � � • ELECTRICAL, i. $; � ; � ,� �� ' $ � � ',Date �' � Owner 9 Y 9 i , . p. t � ( 4 � ' 1 hereby certify �thaL i nare� reaA this aovlicatlam antl �state that tha aEoro-• - ❑0.100,OOO�BTU•0100;OOOBF� -- -- -- • � 'PLAN CHECK� , $�.. � : ��MICROFILM � E � _ � informatlon is correct. I aqree to comply wilh a�l tlty antl countY ortlinances -� . . . � f �. . � � I � ' j� TOTAL�FEE ;� $� � � antlistate lawi rolating to DuilGi onstructlon, anG heroby authoriza repre- � . ��MECHANICAL $ �. � , . untativev ot this ;Nty � to above-mentlonetl Oroperty tor ' � Hood or Type I ❑ � � ` Reinspection FeB � s$15 � ' � i � � � . { IESS ' � ' � . InspecUon pury o�es. � . Ceno .T e II ❑� � � � i . �PLAN CHECK� �� - I ' S19nature�%� � oat ��3 : � ; � . . . . : , : , � ; , • , ADVANCED;PC $ ! � orivers' ucensa or 55 ����� ' Registers � � � �a;,e F� a s ! , � !, a t j � ; • � R � � � FINAL FEE ; � $ (� CMF�0865-46rev.12/B2 White-BUIICing;Canary-Appliwnt;Plnk-Accountln9:GOICenroG-Assessor � � .. � - �� - � - � � ' ,� � � � _ � •.� ' '` _ CONSTRUCTION AND PLAN� �N.G�n^ �� ��� P'�` � . _APPROVALS Permit #_�.(�.� Date ` Inspector �ppROVALS Permit � ��1. Temporary Ele�ctrical Service or Pole � 52. Pool & Equipment Lowtion � � _ - 2. Soil'Pipe-Undrgrnd. .- �� 53. Steel Reinforcement � 3. !Ele��ipl Conduit•Utilitv-Undrgrnd. - 54. Forms � ' .� ' �� �4. Elect�ical Conduit�Undra�nd. � 55 Electrical Bondin � � � �5. Steel,Reinforcement j , 6: ;Electrical UFER Grnd. ' , � 7. Footingi . 8. Foundation ' Y. • 9. Water Pipe-Undrgrnci. ' � l 10. Struc[ural Floor System . 11. Property Sewer Line & House Connection . 12.9ewer•Cap : A . 13.,Roof,Drains • ! 14. ,RougkPlumbing ` 15.,Rough-Electrical-Conduit� 16. �Rough Elearic Wiring - 17° ,Rough'Wiring Sign - 18: RougFi,Elecirical-T'Bar Ceiling � 19. Rough� Heating & Air Conditioning � 20. Rough.Factory Fireplace � 21..Ducts, in Structure :�r' 22. Ducts, Ventilating � � 23. Gas Pipe-Rough & Test . ' 24. Roof Framing 25.'Roof Sheathing " ` ' 26.,T•BarCeiling�Structural)�&`Monocoat 27..Frameand Flashing 26. Lathing & Siding 29. lnsulation . 30. •Drywall Nailing . , . 31. Plaster Brown Coat �� 32. Electrical�Power Meter-Final ' 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Fac[ory Fireplace - 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final , � ' 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation $ystem 45. Sound �Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison � - 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY No. ' _ Date . g 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical �pnduit-Undrar��l. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd.- 61. APPROVAL TO DECK " 62. Backwash & Receptor-Final 63. Heater & Vent•Final � 64. Plumbing System - Final' ' � 65. Electrical-Final 66. Solar` ystem•Final � 67. Fencing & Access ADProval ' � 68. APPROVED FOR PLASTERING 69. POOVSPASYSTEMSFINAL , FIRE DEPT. REQUIREMENT APPROVALS Permif # 70. Underground Hydro 71. ProductPipingOGas ❑Oil ''r . 72.' Underground Flush 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 74. Overhead Hydro � . 75. Dry Chemical - 76. Dry Standpipe 77. FIXED SYSTEM FINAI. 76. FIRE PREV. FINAL Notes: � � � � Jd/� r. �'.. /��� .�__ �.•� .._./ _ i @ � f Data � Inspector, � ' . , t' , n o� .GiYJ/ �: �rai a� _ T y�'/ no T IB� �_ � � �' m AADlieant lo fill in all SOaces wltnin CITY OF COSTA MESA P RMIT NO. CONSTRUCTION PERMIT � S U1 fZ Dortler tines ana si9n all apvrov��ale aeclarations. 'TRACT NO. LOT NO. BLDG. NO. - Prolect Address 7O� � VPE OF CONSTRUCTION '���yv� Owne� Phon -,j ❑ NEW O ADD ❑ ALTERATIONP e Addfess0 �(� �� - � � ❑�REPAIR��CONVERSIONODEMOUSH�- ArchlEng. - � � � License Na: � ❑bTHER � Addre55 • _ /�' DESCRIPTION OF WORK �, Contract i - _ ho � TY_�F PERMIT � � • Addreu '—' �� Jh B�RADING 'O FOUNDAT'�IO/N ❑STRUCTURAL" LIGENSED CONTRACTOR� DECI_qRATION �'i�O 3O TENANT ❑ ELECT�RICAL�IPLUMBING ❑MECHM I he�eby a(ti�m th;.t I am IiCensetl untle� p�ovislons Of Charte� 9(com- �•� - � '\ � mentin9 with settion 7000) of Divislon 3 of the Business antl ❑OTHER� - — Profezsioni Cotle, a y Iicense is in 1 (pr e n eitect. pROJECT� �D S�/CR(I�P-T�ION Li�se Clasz � + ��� Sp. FT. J_Gr.� ' y a +j�n'_ ' ' �7''�� �.J � . . . WORKERS'COMGENSATIONDECLARATION� \ OCCVPANCV_CONSTfiUCTIONTVPE� �I hereby�affirm tnat 1 have a certiticate of consedt�te.bal4insure or a VALUHTION �� - ZONE ' V cerHfiwte of Worker5J'..�Compensa�ion surance, or a cerH(letl copy - thereot (5¢�(jpp 3 � •Compan�- �� GRADING CU.'YDS. A RE 9- �Po 'Cy NC "'�� j Certifie0 copyAs hereby fumishstl. - . REMARKS: - - ❑ Certifietl <opy is filetl with the city Builtling Divi5lon. EXEMVTION FROM WORKERS' COMPENSATION DECLARATION � ' (This setlion neetl.not be complet¢tl if the permit Is.far one hunCreQ . ' - .- �_ r , �(5300) or less). ' I certify that in the per(ormance of the work for which lhis permi[ is , _ Issuetl, I shall.not employ any person in any manner so as,to become PIUMBING LAN K 'SUGject to.the Workers' Compensation l.aws ot California.. ,Date� � � Si9nature � BqTHTU85 � �SHOW 5 NOTICE: It after making <his tleclaration, you snoultl become subject TOILETS I 5' :to the Workers' Compensation proylsions of tne Labor Cotle, you must � _ 'forthwith mmply with such provl5ions or tnis permit shall ba tleemetl LAVA RIES O lE'LA revoketl. . _ 'CONSTRUCTION LENUING AGENCV � KIT INK HWA RS • ' I hereby affirm that there is a tonStructlon lentling agency for the per- 5 RV CE� S SUM � formance of the work �or. which tnls permit is issuetl (SecUon 309] Civ. C_). . , � ' ' . ' . FLOO SINKS� F DRP.INS � Lentler's Name '� - ' ' � - � Lentl¢Cs Atltl�ess � � ' ' � " �DRINK NG FOUNT INS � OWNER'BUILDER�DECLARATION ' � � ' �� � INTERCEPTOR$ CLARIFIER$ I her¢by afTirm thaYl am exempbf�bm tM1e Gontractor'S License Law for tne tollowing�reason•�Sectlom7031.5 Budiness'antl ProfeSsions Cotle: SWIMMING POOL PTRAP "' '' Any city or munty whiGh requ{res a permit to consLuct, alt¢q 6uslne55 an0 YIOfC55�0lIS Coae) Or that he'I5 exempt thErefrom antl Ihe basis for the alleqetl exemption. qny violation of $ection 7031.5 by any app�icant'far a permit subjeCts [he applitant to a Uvil�penalty ot not more t�an five huntlretl tlollars ($500). ❑ I, az owner of Ihe property, or my employees with wages as Iheir sole <ompensation, will tlo the work, antl Ihe strutture is not intentletl or offeretl for sale. (Section ]044, Businesz antl Rofessions Cotle: Tne Contractor'S Li<ense Law.tloes,not apply to an owner of a property who builtls or improves thereon, dntl who Goes such work himself or through his own employees, proviqetl tnat sucn Improvemen[s are not intentletl or otferetl for sale. If, however, the builtling or improvement is soltl within one year ot completion, the owner will have the burtlen of proving h¢ tlItl not builtl or improve (or lhe putpose of ule). ❑ I,-as owner o( lhe�property, am exclusivety coNraclin9 wilh licensetl contractors to cons[ruct the project (SecUon 7044, Business antl R'ofessions Cotle: The �Contractor's Licensa Law tloes not appry to an owner of prOperty wh0 builtls o� ITproves th¢rCOn, antl who Con- l�acl5 Irom suth projetts with; a mntrac[o�(5) Ilce5ne0 purzUant to the Contractor'S Liceuse Law). ❑ I ari� exempt untler Section' - g. �. P, C. (or this reason Date Owner i(ythat 1 have reatl this application an0 sta[e Iba[ [he is COrreGt. I agree to �pmply with all Clty dntl t �tl state laws relating to construction, antl he�¢by aut es' �f lhis <i[y to e�er uoon the above men. WATERSERVICE � �ALTERAT�O � GASSERVICE OUTLETS WATER HEATERS - -'BTU OUTPUT . - � SEWER CONNECTIONS ' SOLARTANK COLLECTORS SO�AR PIPING SVS. ISSUE FEE MECHANICAL PLAN CHECK � HEATING SVSTEM 0-300,000 BTU - � AND DVCTING � 100,000 + gTU REFRIGERATION 0-300,000 BTU SVSTEM �� 100,000+8TU , BOILERS BTV SVSTEM REPAIR,ALTERATION . . EXHAUSTSVSTEM MULTIPLE ' Orivers' LicenSe or 55 ��'�� �% ' ' ' '��UE FEE ' - - ' � CMF 0865-46 White-Builtlinq; C��ary-Applicant; Pink-Actountin9; Goltlenrotl-Assezsor A.P. 84do J/3�/62 - I1,0:1 TL PLNG. REF. �p ' • , L5EpFT �A � R�IGHTAR � . ' - . REAR VARO (TO P/L} - " - " PKG.SPACE REQ. ' PROVIDED' STREETWIDTH � � - PA{3K'FEES , AL CONDITIONS: , . ., � , _ ' I ; '" . . . . . • . ' I 'ELECTRICAL�- � a�AN CriECK - � �SCO. FT. �� GENERATOR � 0-1 KW_ 1-10 KW �� TRANSFORMER � ' APPLIANCE 30-50KW_50+KW ,MOTORS ` 0-1 HP_1-10 HP � � 'QNG SOLAR)� 10-50 HP 50 + HP ;FIXTURES, 'OUTLETS SWITCHES � GAS TUBE SIC.NS . . . . ' � POLE LIGHTS " ' ' _'�..: "�� PANELS ' MAIN � SUB �� � SERVICE ' ' " ' qMP" � 'ISSVEFEE APPLICATION APPROVED BV ' DATE � L • � SUMMARV OF FEES� , . BUILDING ' - ' ' ' - - PERMIT � § • 'SMIP .: :. E__ PLHN CHECK 5 �ERMIT ' PLVMBING E -� �SSUANCE- f PLANCHECK' E " � -GRADING E�- ELECTRICAL S� ' � s � ,PLAN CHECK § � �'7�CROFILM S MECHANICAL S�� - . T,OTAC FEE E 'PLAN CHECK $ � LE55 AD- ' � , � VANCEPC S___ . � FINqL FEE E_L��O , Applicant ta fill (n all soaees within M1eavy boraer lines antl sign ali approO��Bte.Oeclaratians. � GTV OF COSTA MESA ' PERMIT IVO. -TRACT-NO.' LOT NO. , BCDG: NO. � � '� � - - ' CONSTRUCTION PERMIT � �' JO#.10067 6280 3/24/83 40.00 .TL ProlectAddress % [�j. t . St.._ � TVPE OF CONSTRUCTION' - � '� ' �• OWn¢� S PhO�p�=- - �d)�W'�O-A4D L� AETERATION " � _ � �-Addrea98Z N. BdtdVl3�St. OTdI] G �-�REPAIR�❑CONVERSION ❑DEn�0u5r�- _ ZONING-REGULATIONS - � � �"ArchlEng. � ' License No.' ❑ OTHEit A P � � - � Addr¢55 '- ' "' . . DESCRIPTION OF WORK 1 .. , ZONE ; PLNG REF.�� \ 'Contractor Kinrie Air:-Conditio�R7nn TYPEOEPERMI7 �� � � �Q �y� � ' B D B I I G Address` SETBACK T. OP V INE � 441 S 'Ariaheim' B1 . Anaheim � ❑ �aAo�Nc . ❑ FOUNDATION ❑'STRUCTURAL' L��TYARD � ' � • ' � L'ICENSED CONTRAGTOR DECLARATION � -- ❑'TENANT �O ELECTRICAL ❑PLUMBING.g}�9ECHANICA 5IOE VA � " - " ' 1 hlre0y atfl�m thut I am IlcenS¢tl Untle� proyi51on5 Of Cha�te� 9(COm- ��'� � � RIGHT 'mencing' wlth-- section 7000) of DlWsion�^3 of -the-Business antl ��� 07HER �-- --�^ - " - " qEAR VARD (TO P/y Rofessions Code antl my Ilcense is In tull (orc a 1p(ett.� pRO�ECT.OESCRIPTION . _�� License Class �-20 ' ense No.��'���" -, y PKG.SPACE RE�. PROVIDED , • - osee��"5IR �' Si9nztur - SQ: FTn �, . . , �. ' _ ' ' _ �' . . _ . _ r _ ' OCCVPAIVCV_CONSTRUCTION TVPE_ y STREET WIDTH PARK FEE-E� WORKERS' COMPENSATIO CLARFTION - - - - � - ZONING APPROVED BV .DATE " - I htreby a�firm that 1 have a eriificate of Consent to self-insure or,a � VALUASIOIVSli 11� � ZONE � certifl�te ot' Workers' Compeniat(on Insurance,-or a ttrtf�ietl copy -- - -- -- '' - SPECIAL CONDITIONS: � - � [hereot (Section 800 b. C �,GRADINGCU. VDS., � ACRES " ^�u�rrvo.- C9�99'1f149�,-�omaanv _ 'TNA . --'_' __._._ _ __ _ _ _. . - . _ _ . ._.. . . .. . _. . . . ,... : �'+� � � �' ' � � '. CarU(ietl copy Iz�hereby furnishatl.� - _. . . - REMARKS: � - - -- - - - --- - - �CertiOetl copy is filetl with t�e�clty Bulltling Divislon. i . - � EXEMPTION FROM WORKERS' GOMPENSATIONbECLARATION ' �', ' � ' � - ' - - �'-" ' - ' - --�� � - ' (This sec[ion_neetl-not be completetl il.the.permit is for one.huntlretl _ _ ' __ ' _.•�. _ . _ . _ � ._.. _ _ . . . '1O�"' =_- ' . . .._� (E300) or Iessl. � . , . ••�- ....� 'i'' " ._I_certity that.in.She.pertormance of the work for_which this,permil is - � issuetl, I shall not employ any porson In any manner so as to become � PLUMBINGu�, �� � 1". PLAN CHECK � ELECTRICAL �- �PLAN CFIECK - - -� sublecLto�the.Workers.Compensation.Laws,oF,Calitomia. _ . . .. .. _ . _ � Ddte � $I9ndtura BATHTUB$ SHOWERS � NOTICE: If after�makinq tNs tleclaration, you shoultl betome subjecl � TOILETS� �r' � j URINALS ��-- GENERATOR 0-1 KW_ 1-10 KVJ - � to the Workers' Compensatlon provlsions of the �abor Cotle, you must �-� ��-� TRANSFpRMER � •- ��• ! torthwith compry�with such provisions or this permit shall be tleemetl LAVATORIES DOUBLE LAVS - �- � APPLIANCE 30-50'KW_SO+KW'- ' - -'� revOketl. - .. _ • . -r' - _ - .. CONSTRUCTION LENDING AGENGV KIT. SINKS � DISHWASHERS � - �-MOTORS" ' 0-1 HP_1-10-HP'-� �- "'7 -� � I hereby affirm tbat there is a construttlon I¢ntlin9 a9ency for the per- SERVICESINKS' ;�� �� SUMPS - � -"-' ONC. SOLAR) -10-50 HP-_50 + HP � -+ (ormdnce of the work tor which�tnls permit is issuetl.($ection 309]� � � ��" '' � Civ. CJ. ' - -' -- � FLOOR SINKS� � FLOOR DRAINS � � FIXTURES " OUTLETS ' -SWITCHES' - � - � - t_entlEt's Nam¢ - Lentler's Atltlress DRINKING FOUNTAINS� �� ' - GASTUBESIGNS - " -'" - '- ' OWNER BUILOER'DECCARATION'-" -`"- " ' ' " ' � INTERCE'vTORS � CLARIFIERS 'POLE LIGHTS - "' --�' - - - � "' � � ' � I n¢rebY aftlrm that I am exemp[ from the Connactor's License Law for r� tne ioilowing'reason�(Sectlon ]031'S 6uslness'antl Professlon5 CoGe: SWIMMING�POOL �� �P�TRAc�' " PpLES METERED ��SUB Ally Cily OY COUOty whiCh l2q111fB5 d p2�({�It t0 COOSIfUCI, allel� improve, tlemolish'or'repair'anystrutture, pr�or'to Its Issuance, also re- yyqTER SERVICE � ALTERATION - � PANE�S- ' MAINT --5CI6-., '� � ""'� qWrez [he apFlicant tor sucb permit to lile a signetl 5ta[emen[ tnat he � � �^ is Iicensetl purSuaRt tb"lhe prOvislons ot-[he"�onvactor•s Llcens¢ Law GASSERVICE OVTlETS -SERVICE � " -' ''AMP-n - (Cnapter 9(commencing witn Settlon 7000) of Oivision 3 of [ha __ _ __ _ Busine55 antl wwessmns Coae� or that"ne I5'ezempt tberefrom antl the- yyqTER HEATERS B7U OUTPUT; �� ,. y - ha5I5 fo� the alleged exempUon. Any violdtibn Of SeGtion 7031.5 by - ' appliranCfor`a'permit'suD�ects the app�icant to a civil penalry SEWERCONNECTIONS ��" � - '� � " " - '- ' 1"� - � " �ot more than five huntlretl tlollars (5500). ' .� I, a5 owner of thG property, or my employees wilh waq¢5 as iheir � SOLAR TANK -- �COLLECTORS � "" "" -' " ' """' " sole.compensation,.will.tlo. [�e.work, antl. [he,structure i5 no[ Intentletl ot offeretl fOr Sale. (Se<tion ]044, BuSin¢55 antl R'o(essions Cotle: The SOLAR PIPING SYS. 1� � �SSVE FEE - �� � Contractor•s License Law. tloes not apply-So.an owner.of_a property. --- -- - -- -qppLICATION APPROVED BV '" -' DATE3.=� wtlo builtls or improve5 Ihereon, antl who tloes such work himseH O� ISSUE FEE �I .[hrou9h-his own:employees,.provltletl_[hat su�h improvement5 a�e not - Intentletl or otferetl for 5ale. If, however, the builtling or improvemenl -MECHANICAL PLAN CHECK is.soltl within.one year o( completion, Ihe oWner_will have.lhe_burtlen SUMMARY.OF FEES.��. _ ' of proving he tlitl not builtl or improve for the purpo5e af sale). 'BUI�DING - "' ' -' `- ''- -- HEATING SVSTEM 0-500,000 BTU PERMIT E SMIP. ' .'$ �'I,'as owner of the property, am exclusively conVacting �wi[h -AND`DUCTING �� ' - "-- - - " "- ' � - � �'--- ♦ ' litensetl contractors to construci the projec[ ($¢�t�on 7044, Business IOO,OOO+BTU 'S � PLANCHECK E '�7ERMIT � antl Professlons'Cotle:-The-Contractor's Ciceqse�Lawtloes�notapplyto - -�--- - - - - ISSUANCE�� E�' an owner ot property who builtls or improves thereon, antl wno con- REPRIGERATION 0-300,000 BTU PLUMBING - tracts-from�suctr projectrwitn� a�contractor(s)-Ifcesnetl pursuant to� -SVSTEM' ' - ' ' - - -- -�- - � — - S - � � GRADiNG-S tne Contractor's License Law�. 300,000 + BTU PLAN CHECK. a• •�•„ ;..: ❑ I am exempf untler Section� �� g, & P. C. br thiS BOILERS BTV ' ' s ELECTRIGqL E � rea5on - - • "'� - - '" ' _MICROFILM E' ' A SVSTEM REPAIR, ALTERATION � PCANCHECK E � -� -� . - �DdtG - OwnGr - � - - � - - MECHANICAL TOTAC FEE E .Lherebyterti(ythat I have reatl.this appliwtiory antl state [hat the above EXHAUST SVSTEM MULTIPIE �_._, �LE55'AD-" � ' InformatlOn is wrrecL 1 agree lo COTpIy Wit� all city antl County � - PLANCNECK � VANCEPC §_ -. ' o�tll0ance5 antl ztate laws relating to construct�on, antl hereby autnorize_ 2 vents eonneeted t0 ., ��7 �_ ,, ' representat' s Of thi5 c' y to enter upoq -the above men[ionetl ~ -� �� � \.ProOertY_ o inSPettb r Oses. " " -. ... . ._ _ _ _ _ _. . " ' ' __ _' " ' ' _' Signature `ISSUE FEE- 3 Qp ' �CMF 0865-46 White-Builtling; Canary-Applicant; Pink-Accounting; Goltlenrotl-Assessor CONSTRUCTION AND PLANNING /� � POOL & SPA � - � APPROVALS � Permit# � U/� Date In�pectot pppROVALS Permit� � ' Date � Inspector 1. TempOrary Electrical Service or Pole . � 43. Pool & Eq`� -.?ent Lc .e''acion - . 2. Soil ipe-Undrgrn 44. Steel Reinforcement � 3. Electri�l Conduit Utility-Undrgrn 45. Forms ' 4. Electrical Conduit-Undrgrn 46. Electrical Bonding . tee ein orce 47. Rough Piumbin & Pressure Test � 6. Electri�yl UFER Grn 48. APPROVALTO COVER-GUNI7E 7. ootings - 49. Electrical Conduit-Undr rn � 8. Foundation - 50. Gas Pipe, ❑ Undr rn, Test 9. Water pipe-Undrgrn 51. Backwash �ines P-Tre ❑ n r rn 10. StructuralFloorSystem • 52. APPROVALTODECK ' 'i ' 17. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final 12. Street $ewer Connection ' 54. Heater & Vent-Final • 13. Rough Plumbing • 14. Rough Electric-Conduit - •56. Electrical-Final 15. Rough Electric-Wiring - �- 57. Solar System-Final 16. Rough Heating & Air Conditioning � •- encing & Access Approval . 17. Ducts in Structure � - � APPROVED FOR PLASTERING 18. Ducts, Ventilating - 19. Gas Pipe-Rough &Test 60. POOUSPA SYSTEMS FINAL 20. Roof Framirig r. - " 21. Roof $heathin - � ' . ' � . 22. Frame and Flasbin NOTES: e� `, � 23. Insulation ' ' o `� v 24. Lathing & Siding - � ' � - ' � 25. Drywall Nailing � ' ' � - � 26. Plaster Brown Coat ' � 27. Electrical Power Meter-Final � 28. Final Electric ' 29. Final Heating & Air Conditioning 93 30. Final Gas Pipe-Test � � 31. Final Plumbing � ' 32. Water Service�Final • � 33. - Gas Service-Final_. �� - ' 34. Solar bomestic-Final ' 35. Landsra e S rinklin S stem. � ;�36.� � Sound Attenuation 37. Handi�yp Regulations 38. FINAL STRUCTURE & BUILDWG ' � 39. Special Requirements Compfeted � ' ' - • � � ' � 40. Electric Release to Edi�gn_=_ 41. Gas Release-to Southem Califot ia Gas Co. � 42. CERTIFICATE OF OCCUPANCY . _ _ � No. Date ` � ApD��v�� t0 fill in all spacas a:cept those wit�in �eavy OorGar Iines anU sign all approoriata Geclantions. ' ' CITV OF COSTA MESA � ' � . ._ P MIT NO. ��... � ; . TRACT NO. � - LOT NO.. . ! BL . -' � ' ' •� , . '' • ' ' �_ � � ...� � + � CONSTRUCTION PERMIT , � - ' • � � �o �" ' '. -. � r , .. 41 4�. �/i�/ .:,' , -' . ' { „� ' i q � � ' � � ' � - � � , TYPE OF CONSTRUCTI ON' ' NEW ' ADD ALTERATI ON " �REP91 R � � - � � , � ' - r , � � , ' � ' ' � . ' ; , � _ pplicent s Mailing Addrea . ' - , , , � �' ' ' ❑ CONVERSION .Q DEMOLISkI ❑ OTHER•� - � - � � - � - � ' - � ' ' r �. � Prolect Address: . _ � ' : . . . . - • ' - . .. . ' ' ��/,{� ppp DESCRIPTION OF WORK � Owner s Name ' � � �� `-S � � ` � hane �r�.i" . _. . _: � . , . . . ; . ! ' ' . I _ I G EGU . ' - 1 � Address. � �1��'�� � - TVPEOPPERMIT � 'GRADINGl � FOUNDATION '� STRVCTURAL � ' A.P.1W' ' .. � ZONE � - ' - � I.i ' . � Arch/Eng. �-�Ss ��' � License No.� � � ❑iTENANT � EIECTRICAL ,��PLUMBIN6 ❑��MECHANICAL � .PLNG. REF.91E- ' � , - • � d. i •BUILDING � , � � ' 'i � i Addreu '� 3 S ' "� . _O��OTHER ' r : � � I - • : � =, i 1 1 � � TO'BUILDING�.' �. . i . , i � Controctor,'s Nam � � � � hone "3' O ' PRQIECT DESCRIPTION � 50: FT.• ' �. � '- �OCCUPANCY � � P V �NE - � REAR VARD (TO P/U" � Addresslma'lingl���%�79' ��� vUt,rt.'rIF. ' CONSTRUCTIONTVPF � � ; , VALUATIONS� � � LEFTSIDEVARD , . " RIGHT�S�DEVARD tn • �' � � • I - � ZON$ • � GRADINGCV.VDS: ' IACRE� PKG.SPACEaREQ. � � PROVIDED � ' License No. � � � ' - � ' � ; I . , i i _. - ; LICENSED CONTRACTOR DECLARATION { � � .� � Remi�ks: � � � � � � � , � STREET WIDTH � ' � PARK FEE�$ - ! I hBreby;a(tirm thdt 1 dT Ilcensatl untler provislons of Charter 9 (commencing ' . ' , , , � � � � � � � � � wlth sectlon 7000) ot Dlvislon 3 01 t�e Bu5ina55 antl Profesilons COtle, snA � i � � ~ � � � � . � � � f ' SPECIAL CONDITIONS: � � - - ; i "• my Ilcense,i5 in fulldorn anO effect. . ' r%' ' ' . , . � , _ I � � t7cense Class' ' - � � LJce � o . • � � ' PLUMBING : y ( ' , . � � � � � , . . ' t , � : i Datery�' Q' Q� Signatura � � ,., i Bar,Siok � i � SevuerCap' • ' � i ELECTRICAL ' � • ' � : �ORKERS' COMPENSATION DECLARATION' � �- . � � � - - - � -� � • . , � ' ' • �ratiy aftirm.that I have.a.�ertlfirate.of.consenLto self. nsure oi a certNiwte_.. � BeCkflaw�Preventer � i � -- � Sewer Connettion�•- �� -q - , _.. �.._ _ Automatit Washer , _�,,,�y._ _,.� tMetCr pover 10� amps {_ '_ _a I �� ��Workers' Compensatlon Insurance„or a certifletllcopy Ihereof (Sectlon � � - - __ - - � - ' : 00, Lab. C:� t � � ! � rhr j � ,i, i Backflow Irrigation , Soler Collectors � � ! � � Condtruction Pole � ' � � �Sub PaneP � � � � � ' Po�ICY No. /Oi� 'i� 2 ; ComPanY � � 1 : . : ' ' _' _ _ i . 9 ; • . 'Sub Pole ' 1 , . . : n z— � Cookin Unit y�.� Certlfietl�copy Is nereby furnlshetl. � Bethtubs ( ' � � � Solar Piping ; . � . - I . I i 1 � JiY Ce HI coqy, I� IIeA wlth tha clty B DI on. � • . � . . � , � i Dishwasher . { �:Motors �0-1 HP '� 1 X-8 �� ' 1 �- -�j5� : • � Clarifiers SolarTank , � � { ' �' . ' Date AOPliwnt � � � __ '_"_ : . • . ^EXEMPTIONIFROMWORKENS'COMPENSATIONDCLARA ON � � - ' -Dryer5�OG5�pEie�triC-�' �� IncSoler.�9-15HPO16-05+' � �(ThissaCtion neetl not be <ompletetl If the permlt IS Tor one huntl 0( 00); or ? � DishWasher � : . SWimming POOI W/Spe i y . � � f less). 1 7 1 t i f ' • . , ' � . , r - � � . 1 Fan p � �Iliclowave . ' � , t � I cerUfy,that in the pe�fo�mance ot the work for�whic� this perm�t Is Issuetl 1, ' O�inking FOuntein�s � � . Urin01 � , � . � � .PC "� -0 . � I shalHnot emploY any parwn In any manner m�as to becoma subject.to t�le : . . . , _ . . , p,q,�J, � r� r' ��012 L-ight � � � � Workars"Compensatlon Lawzof Californla.� I � � t � FloorDreins; � . WatarCloset i � i �I / i1 a � Date � � � ci9nature � � � ' ' • � . . . . - . � � i � -NOTICE: If,�aftarmaking thirtleclaralion; you shoultlrbecame•subject to�tha -� � - � Floor-Sinks � -- - - �- -� — � - Water Heater � --'-- -� --' . _ _ . Fixtur �! . �9e p� . ! � .. ... D i .. . 7! , R. _ �_, ' . . ; � Workers'� ComDenSation provislons,o/ the Laboc Cotle, yau must forthwith � . . � . . - . y� . DCvic2�dnp5� � �� •g,Q�� � G� n ^� V � ' � ' comply wit�: such provl5ions�or „thls 'permit ;5hall� be �.tleemeG �evbkeA.j � ' i Gai Service• . Outlets 1 . ,. �Water Service � � . �, � ���� CONSTRUCTION I.ENDING AGENCV � ' ' � ' { ' ' , - _ - " : ; / � � • , I hareby xfflrm that there Is a'con5tructlomlantlin9 agency for thelperformance � Interc¢pt0�5 ' a^ -� a� �. ! Outle[5 ' nd� $¢ct�Ons � � • r of the work tor` which-this�, parmit' is �issuatl �.(Sectlon 30BT Civ C-) - � � , ` � Lenaer'sl NameF � - � Kitclien-Sink ,. � -? � ; t � �� r , Switches i � � J �� � res pac{or � 1 ? ' Lentler'S1 AAErass :. � _ : r n' _ ,^ , . , ' , ' � .` � . � _ � � Lava4ories-� ` `� . �' � ; i 1 Gartiage Dispo3el � 1 \ � ! . . � . � OWNER�BUILDER DECLARATION `.-, , . ' >' I '� . � �- , _ , ' � � . � I _ . � Y t � ' , • 1 hereby�aftlrm that I am exempt'trom the Con[raclor'S;License Law Torihe � ,� �. �; � ._. 1 4 Generatar; 00�5 KW 05-15KW � ' ' foltowing reason' (Section 7031:5 Business antl Professlonal Cotle: Any tlty or � � ? �TrSp� ' . , m ' ( -- �� , )� ( ;, � . ' • • � . county which requires a parmlLto construct, alter im�rova, tlemolizh or�repalr t � .+ - ��y � Transformer Q�5-50 KW . • ' r � ��any structure; prlor to i[s iuuance, also requiras fl�e aDP���anPior suc� permit_ n Roaf!Drams � � � � c� L,+ % .` i} ��., , Q • ' 1 � - f to file a signetl i[atemenYthat he/she I5 Ilcenzetl pursuant to the'prbvislons of � '�._ ' ' ' � , . -' ❑5U+ KW � ( - � e Contractor's.Llcense taw (C�apter 9 (commencing;with Sectlon 7000) ot - .. ... ' 1- 1 :�• i � � � ' ' : ' � �RainSpaction Fe6 ' $7g�� � '���ISIon;3�of.the�BuSinessantl'Bro7ession5Cotl8).or..that�he/ShO�is�exempt � ShOWEfS . �Tr , �. . i ReinSpBction�Fe9i $15 ' ' _ ' ' f eirom•antl [he; basis fot tha allegetl exemptlon. Any_violatlon"of Sectlon � ' ' " ' - ' ' " 'Meter ❑up to 100'ampi °laue Fee' � �• � ' S 3. ! �:�71:5 by.any 'applicant Tor •.a .permlCsubJ ects the apPlicant to a' civil ' ' � I ` � l - � ; � . naity oi not mom than five nuntlree eollars (S5oo). : . ; � � i : � �!��ce Smk , ^ : : � `= _. laue Feb ,r � � a 3 Zo���B MP�owd BY Date � � ; „ IJ 1, •as �owner ot tha �property 'or my employees wit� wages�az their iole _, �. � � � ( � . , � � � mmpensation wlll tlo the work', anC.the structure� is not intentlatl or otferatl -� '; . - MECHANICAL � , qppliption Approved By ' �ate • ' � . for sale • Sac�lon 7044; BuSinass' antl; VrotesslonaL Cotle:. T�e• ContractOr's , .- /� � Licensa Law Coes not appry tO�an oWner Of a property who bulltls or improves Bollef, i � ' Ref�igeretion SyStBm . . � �' �1 p t � -' � �_ � � . . � APPlimtion Isiued By �`�7 ' � 'Date Y �$TO '� ' thereon,'antl who'tloes, such� work hirriself/herself or Ihrough his or her own � � i . . . . , I employ aes, proWUetl tbat such ImDrovaments are�not IntentleG or oHeratl for � ��. � ❑0.100,OOOBTU ❑100,0008TU� - ' sale. If, however, the bulltlinp or Improvement Is soltl wlthin one;yearlot com- � ( Duct - Under Ground� � � � � . , : � � i � ' ' SUMMARY OF FEES � � !, ! i � pbtion, the owner will have the burtlen of proving he/she tlitl not builtl or Im- ,. � . i ' � � t i i� � � . �ravefortnepurposeo(saie)�. � � , �:' � � ; ' Duct Structurel i: : � SystemRepair/Alteiation � . ,BUILDINGPERMIT $.: ' 1 SMIP 1' �� ' $ f' LJ 1, as ownei ot tha property, am exctusively tontrattln9.with;licensetl cbn � � ' � � tractorsto construct thelDro�ect.tSectlon 7044, Buslness anC protesslons.Cotle: ..' _: Dutt _ Ventilating.,.__�, y �_ ,�__+-_.�1 -,, j_� , . • PLAN CHECK+ � S � � i PERMIT � ,. �. 1 The Cmtractor's Llcenia Law does nOt apply to an owner of O�operry w�o i � . � 1 ' / - ISSUANCE � :$'� j ; bullOs or Improves.[hereon, antl who contra<ts (or such pro7ects wlth a com ; ExhauSt System ❑ MWtiple � i ' � � . � • PLUMBING � $..11�" � •� . � . i � tractor(s) Ilcensa pursuant to the Contractor's Llcense Law): 1 +' + ' - ' ' - � ' � � ^ � GRADING �` $ ` �� r�� i ( � ��; :PLAN CHECK' . E �, O�I am exempt unGer Sectlori B, & R C. for this reason FiiCpl/FeCt. BIt. ICBO �k � f� � + � , . � � , � �' � ! •• � i 1 i ' - f 1 y. . � j . . i �ELECTRICAL. { $ � ' , g �, :. Date � ! 1 � Owner ' �' � :� ; t ' �� Hestin9,SYstem & Ductin9 � ; t� i � , f . ' � ' � 1 � 1 hereb y�-certify-tbaDf�have-reaC,thls�apDlicatlon-and-state ttiat ttie above-�• � c �6100,OOO�BTU 0100,000 - • ,PLAN CHECK� � $ ' � MICROFILM $ � Informatlon Is�correct. I agrea to comply with a11 ciry antl tounty ortlinances . � ' ' ! ' �� � j' �i � � � � � f� TOTAL FEE ,$ i ' ' antl state taws relating.to bulltlin s .uctlo �antl hereby authorize repra- j - , • . ,� - �MECHANICAL � $,. � . Hood or T e I ❑�� ' 1 � • l � • �� ; 'sentaHves ot.mis'Nt to a up e ove-mantionetl oroperty for YP � �. Rei ctionFee. $16 ' � i • ?� � LE55 � 1. ^� PLAN CHECK� $� � 1 Inspectlon o r s. : � � -] . '� Cano T e II ❑ � '. i . � . . . j ADVAf�CED PC �� $ � �� `.519nature ' I Date 1 ' ' � � � � � � ' ' { � � +. ! � �_- Drivers' License or'S5 � �� � Registeis . Issua Fee � $ 3 � � � . � � � }� ! I FINAL FEE' �� $ �� ! . _.._ '_ _ _' _ . - - �_ . _.____ - ' _ ' __ ._ . ..._ . . "'_. _ . ' . _'' _--'____ _ _ .__ :. _. ___' _ _ _ _ " . __ .. . . . T '._. ' .... . . . . . . CMF 0865-06 rov. 12/82 White - Builtling; Canary - Appliwnt; Gink - Accountlng; Goltlenrotl - A55eisor ' ' ' � - -- ' - - - - - "-'- �- --"' ' - -' .\ , . .. . .. �; - �_ - c� �CON§TRUCTION AND PLAN NING� ' ' �� - �. n, • � � � ' �OZ PA : -?., , ' � - . � , '� ;' ' = ' ` . ��A����-.�'1f -Date - ..'Inspector � . . .. `. . ` ., � Date ' lospecwr : � : APPROVALS .,, Permit #�`O�(¢�.� _ _ , _, � . APPROVALS' Permit �1`- , � �1; Te�mporary Elect �ica�l Service or �Pole � C� = : � � . : �; ; ' ' _ ` � ' 52� Pool &�EquiDment Location ; � � " _ - ,. � � , �� �� ` " • , = ,. : , � ,r- � o: ' -•' :- , � - � ^� 2� �Soil Pipe-Undrgrnd.`� �- S � � ; , ' - � , �;,�� ^:' . 53.� S[eel Reinfarcement _ , _ � "„ - 3! Eiectrical Conduit Ufilitv-Undrgrnd. � �.�' j � z `� � ' - � 54, Forms � � , - �_ � � � �� 4-Electricail Condui4-Undrgrnd � ; , - � � - � �- � •55: Electrical Bonding -' - � j � � 5: Steel�Reinforcement ; ' ^ _ J � -'�' - 56. Rough Plumbing-& Pressure Test ' _ 1 � � 8: ElectricAl UFER iGrnd.� � '' ' • - - 57 , APPROVAL TO_COVER�GUNITE � _ _ , ' 7. Footin s � ! � � �• �- � r•�- � - ._� � � �. . { : � i 9, ; i , � ,,�, � ;., � � � _ : �58. Electrical Conduit-Undrarr+d. � ; i . 8. Foundation � � , '� � � � � " •I.' � � �59. Gas�Pipe,'�O'-Undrgrnd.,Test�� ' , � ; �, ' r � 9. Water Pfpe�Undrg'rnd. : ' � ' - %, j ; , ^_ . `fi0. 8ackwash Lines, P-Trap, ��Undrgi�d.: � � ' 10. St�uctural Floor System _�, `� � , 7;; 61. APPROVAL TO DECK , -. 1 t. Property Sewer Cin"e &iHous �Connect,ion� ! �� �j=�' ; � � 62. Backwash �& �ReceptorFinal�� � � � . ' � ' �' 12. Sewei Cap � � ; i � � o � , � ,�� �,� "63. Heater &: Vent-Final . - • " - � � I •'+ t- 13. Roof,Drains u��y. icj,.Xd-M`F3 ' ' `� ° 64. FlumbingSystem-Final-' � i � 14. �Rough Pluriibing� � � � 9� � ' . � "65. Electrical•Final' • � - - ` ` - � ' ' � � 15.`,Rou h-'Electrical-Conduit '�� - --"'--' � � ----' - "' -- - . -- ' -- - 9 T .. � I� I � � ; ' i - � ' �,66. �Solar Systein-Final� � ' - � - _ _ �_ .. . � .�16. �Rough �ElecLric,Wiring ^ ; ; � ,' � « ;`, ., f:� f:l = �- "_ 67'�Fencing & Access Approval - �. . - �- l7. ,Rough�Wiring'Sign;: . . � !� . I ; 4 •_ � �.- � � . � r . - gg. APPROVED FOR PLASTERING � '� ! ' ' I - 1r8:,�Rough:ElecK�ri�`cal�:T�Bar Cei,ling� �'� �� � : i-, ; � ' " f ��: � _ � ;69r POOUSPA SYSTEMS FINAL +' r � - � �� � � �� i ., 19: Rough Heating &�Air,Conditioning �. � � i � . � I �FIRE DEPT.'REQUIREMENT � - , � . ' - r ' , ; . .. i' � , 20. �fiough Factory Fireplace, � ; �; • i � i + APPROVAL& Permit # � R � :� � 21.'Ducts;'in Structure; �" � ���? i� '' i � i � � � �7p � Underground Hydro , ' � • � ' - `22. �Duc[s, Ven\ilating r ` � � `� �i '� J i � � ' � � 77 j Produc[ Piping O Gas ❑ Oil � '. � -. ,23. Gas�Pipe-Roug,h & Test c. � ,� � �� � �_ � ; � � � �i2. Underground Flush . , 1 . � -24. ��Roof Framing � - ' � `� ��;; � i � ' �� � � ! . _� � -� I - �: ;73 � Undei rn orage Ten O Gas ❑ Oil � � � �� �'. 25^;lRoof Sheathing � � �� � � � � I�;i . � i ' - � i -` + " �74: Overhead Hydro � � , • � ' 26. ;T-6ar Ceiling'�Structural�i & Monocoat' � � � � �: � ? � 75. Dry Chemical i � � ' - , . � �� i �.27. ,Frame and Flashingi l � ! �� � i ' � `r I I , � 76: D'ry Standpipe - , - � � � ' ; ,� �- ' 28. �LatBing & Siding! n ,' ' � � , , � � ' � '77. FIXED $YSTEM FINAL. � � i y � 29, losulation �� _� � ,� �` � ' i i� � � � i � 1 , '78: FIRE PREV. FINAL . � • � , -30.iDrywall Nailing � y .i i i I ,I� �� � � � j � j �Notes:, ' � . � - ' � � � � _ .. . - -- -- - - ` �31. Plasfer Brown Coat � i I � � � � � � � � "32.�Electrical Power Meter'-F�inal ' � ; ! ; 1 � � � � . � : ' - . , 33.�Final Elearic ' � l � _;� i`--� � � ,v.� ( �, ' ' � , � � � �� 34. Final Heating &'Aii Conditioning i� I � 1 , � f I � ( � i�' - nr. I_ 1 35. Final Gas Pipe=Test '' !' . � 5 I ,; � i � I = � - � , ' � � . , - ' 36. Hood or�CarioPY_�� R': � � _ ' �� � � ! � ` � . � , , . ' . ' - -, •_ '. - r 'i , , - � � .� . _' n� - �. � _ , , - . 37. Final Factor;y Fire'place � � oi �i � � �r 1= M � i ; : � i , � , ' w � � •� (� � � " ` � ', , I , , . 38.� Final Plumbing � I � '�� „ i - - � ;' , ' ' . ' - ' s f ' 39. WaterService-Final � �� � "I ' � ! i � . � . ' . . . • � � � 40. Gas Servic ; , : ! � �' � i I � , - ! ' ; ' .� �' ' - e-Finai : � • , u i: i i i � ' 41. Solar pomesticFin'al � ' � ,� , � _' _ _ . ..,�_ , _. _ J T _ , _ � -. . _ � � i i � 42. Backflow P�eventer, � i � � i �I � �- --� +- --- -� '- �-- � � � : � i �� , a� � � � �; �` _ _ i , � . . i - 43. Backflow Ifrigation � � � ' � �.` , .; g � { � n ; F • '` � : 44. Landscape lirigation System �, ' � t � - � � ; � ' � � � :g � � � � � ' - 45. Sound FAt � - ,� " - I r � , , o ' ' : , ' "� . _ , . tenuation ; � - �. _i �i � 46. Handicap Regulatiori4 I � ; � j � , � � � ;; ! , r I � � ' � ' '� � _i I - . ,� � . . .. .. , , � 47. FINALSTRUCTURE'&BUILDING' �` � � �r � � i � i � " �i 48. Special Requireinents Completed ' • � � . � � � � ` �� � � - - �� � � � I i 49. Electric Release�to�Edison� � � � � ' - �-t-�-• i t "" _' '"� ' � � � � -�}�-- �` i ' u � � � � � � i i t . . . .'� � . 50. Gas Release to Southern California Gas Cn � � i • ' � � �- � . ; • i � i � i 51. CERTIFICATE'OF OGCUPANCY ,� ;_ _ _, _' _ _, � . ' ' - �- , � . �- ' . ' No � , Date � . � t -'1 ' � : , rr 4�� ` r. , � ' �., r �F ,' � '7f 35 COSTA��!�1ESA BUILDING DEPARTMENT � P.O.80X 31� A COSTA MESA. CALIFORNIA ��E FOR APPLICANT TO FILL IN IOWNER LEG�L DESCRIPTION A.P. NO. SIZE , , OF LOT DSTA MESA. CALIFORNIA C � n [, O Il .�„ � c TEL. NO. LIC. NO. C�I�TY �LIpC�. qr+� TEL �/ 00 No.� now SETBACK LINE FPOM � Ci / �ONI �N ` /, S� CENTER OF S1pEET SD � REAR VARO (O / � SIDE YARD RIGHT S f LEFT �O ,[ — —_�'— DESCRIPTION OF WORK INEV' J\ AITERATION AODITION 51=E DING �J , I' � NO.OF � / �c r ROOMS C� STORIES 1 ' E%TERIOR WqLL/''� ROOF /j 1 ICOVERING �J/G G COVERING JC�i7 L I ��- • �-�� s�� . ��� REct�v�o �-ac�-SS' APPL CATiIIOf�F`�OR PERMIT � B�UrI�L•�D IIN;G _,FjOR OFFICE USE ONLY 70 O k/ / 9"�'� S COSTA MESA. CALIFORNIA' 0 i Q/)I�� � OATE � CORRECTIONS DEPT. Sr3 x 2Y a � . 1 NEFE9Y w�NNOWLE�GE THqT I MAVF RE�O TNIS APPLICaT10N AND L� $T�TE TN�T TNE ABOVE IS COHRECT AND �GXEE TO COMPLV WITN �LL (S�/ Z S�y CITY OXOINANCE$ AND STqTE L�WS REGVL4TING BUILOING CONSTRVC� T���� VALUATION SIGNATURE OF � C � PERMiT FEE S �� � PERMITTE� �K . y I $ /)� ^ �� � PLAN CH£GH S �� � � /�'y���� � % L AUTHORIZ�O AGENT N'� �G. � TOTAL FEE $�'� \ I � �' '�636 �OST,4 MESA BUILDING DEPARTMENT P. O. BOX 31] COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN BUILDING '�%O �. ) /� � AODRE55 � K/ . COSTA MESA. CALIFORNIA OWNER AftCMITECT OP 'GINE ADi.reE55 /� TEL. NO. LIC. NO. LEG�L LOT.•f DESCnivnOrv N�D"�7" �� BLOCK TRAC A.P.1�0. w- f /V � � � �.� i SIZE ^� �/ NO.OF BLOGS. �OF LOT � /' O�% Now orv �or USE OF E%ISTING BLDG. �,( �$ SETB�CH LINE FNOM CENTER OF STNEET fEEAF VARO RIGHT LEFT Z �EP 16-St'Yp �tsn '3c:4� � i�C�� =C��;����0 Pb��v� �� ��5'V. APPLI:CATIQ,N�F,QR PERMIT BUILDING FOR OFFICE USE ONLY NECEIPT NO. 7p MI O � � % � 9E I[O BV �ps XEC I �q 155UE BUILDING / / � A %( ADDRE55 7OO /�� � � � r7— COSTA MESA. CALIFORNIA FIRE � 20NE ZONE NO.OF TVPE/ GROI L CORRECTIONS C� DESCRIPTION OF WORK 0 � � NE' ALTERATION ADOITION REPAIR MOVING DEMOLISH „��'� � BUILDING NO.OF `, SIZE ROOMS STORIES � EXTERIOR WALL ROOF � / COVERING COVERING / - USE OF NEW y' � BUILDING ^ /—'� � '� i % p V � .� �/"� . �. j !� 0 � . `� 1 MEREBV 4CNNOWLEDGE TN1T 1 MAVE READ THIS APPLICFTION ANO `� ST1TE TMRT THE �BOVE IS CORflECT RNO AGREE TO COMPLY WITH RLL CITY OR�INRNCES AND ST/�TE LAWS NEGULwTING BUILDING CONSTRUC- riorv. VALUATI ON / SIGNATURE OF -�/j / PERM�T FEE S PERMITTEE "� ��"��� �� � J. / `—� PLAN CHECK $ $ f�� V��! AUTHORIZED AGENT — ( TOTAL FEE ✓I ��i : r (� � '��{� [0������ �A Applications Must Be Filled Oul By Applic�t ���� L rv "' � �o�'�. Department of Buildings Application No._ �� �'-� �PPLICATION FOA THE ERECTION OF SIGNS To the Building OEficial oE th� City oE Cosia Mesa, Calii.: Applica ion is hereb made tor the erection [] alteration ❑ removal �❑ of an advertising structure in ac d sation herein set forth. (Check sauare what is to be done). � ( e Ink or Indelible Pencil) C i E--R�L� � EA�'3 SOCATION -- �s°�p"h'"y -�oo �/ 9�' 9 - � Building Address Ftr2'riohi G Lot �T� o Block � Tract�.� A. P. No.� � S 3�� -S / Zan '� ner's Namely�M�s �•�-% O�vner's Address d5 ���, �'2i=u�,=__�\ Contractor's Name��4 ��� State License No. � 4-� 6� 2 O . ` Contractor's AddressLS --`�� �.�o"�"� Phone �=� � ��1�74 City License No.� _ � __ DESCRIPTION�OF SIGN � � , ($ketch showing location of proposed sign on back side of this sheet. Plans and other data must also be filed.) • i ,, � �, � �i Size of Sign—Width 4� Z it. Height—��n_—[t. Height above Grade �� � ft. Thickness � 2 in. Weight I 500 Ibs. (Including Electrical TransEormers, etc.) � State location oE other signs on building ^ The undersigned hereby agrees to construct the advertising structure in.strict accordance with tHe provisions of Ordinance 95, Section 39, o( the Electrical Ordinance of Costa Mesa, and all amend- ments thereto. � CITY OF COSTA MESA PLANNING DEPT. SUBJECl TO BLDG. DEPT. REG. 1,0�� DATELZ� BY PL.�N T_CFj�/yff �c/�} by VALUATION 1 r"" ' � $ 2 000 � ate7 e�'Gd_. /{ $ / FEE /5'�� � z�. FORM 214 IM 1�57 OUT BY THE APPLICANT. INSPECTION MUST BE CAT i Fn gn Here ��l/LGGLQa<c C � ��'/SQ.li�P/% By )EPARTMENT USE ONLY Plans Checked • �gF�}�6 � ! b , %� � �' Da e I ed Plan Examiner �� (o�er) 0 FOR SELF-SUPPORTING SIGNS Size and Location Section 7 of Ordinance No. 95 r` . � • � ' � ' , _ - - ,- Width of Lot C/L , SiAn Area "1 _ - �d% Deviation hom C/L of la , � C/L oF Lot _ � . � — :� . . Curb � � STREET OR� HIGHWAY t ; i _ \ . ---�' '. .' , �..-- - - � � _ �,._. , , �,r �, ,V � „� r� ; ���,�i�, ���•y _ FILL IN ALL DII�NSIONS - SHOW ALi: S UCTURAL-MENIBERS �� . � ...,...,� . T ,4�� 5 1 G N � 7 "(�,QTa� }.:L r' �. / _ �� � `• j7' ,�' � � � `��1J � � ' v � .� � � • _�. � , . _� .\ '� � :'� , � • Sec 6 of Ordinance No. 95 ', . � ' ' � .. ... . . _� .. _ � � .. . . �_ _ , I o • k c c r. F IProperty Line . , �_ _ " , i R �— _ COSTA MESA BUILDING-SAFETY DEPARTMENT • P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 For Applicant ro FID in Completely — Use lnk Only BUILDING ��QO . / r� ADDRESS W T�ENANT�R J n� e (� Q� FDDRE 5 /�� -` 7 TA' � ♦ CITV �Q�a /�/P,S'a NOL TZ"S CONSTRUCTION . _ FS 5 W 6� a h y S F O w ("' a c �' i' a x w o. 0 � 6. Z W x 3 BRANCH ARCHITECT . TEL. OR ENGINEER NO. ADDflESS CONTRACTOR ��� ���N7y�aCTn�^� ADDFESS �Q, �(7/C� /�5(j I�LQ j �TEI. CITV �UMT7/�/Ci70/� Li�Ci�rlNO. ��/-6 LIC.N0.��3�5 �` 2 ( LICVNO. SIZE NO.OF BLDGS. OF LOT � NOW ON LOT USE OF EXISTING BLOG. Separate permi[s are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED : �-- � - �' 6eo6 iizeiei io.so r;.! � _� ._ _ APPLICAT[O�FOR S"fRUCTURAL PERMIT RECE ED PERMIT ' - ' I �,,i�% u� ��9�aQ . 1 A.P.NO. //S — �y� BUILDING �%nD �% ADDRE55 ��(/ UNIT OR SPACE NO. TR.NO. lOT iz - NEW ADD ALTERIREPAIR OWNER U5� ROVED APPROVEDSETBACKS PLANNING ACTION I hareby acknowlatlBe that I hava reaA this application antl state that the above informetion is cor�ect and apree to comply with all lews regulating builCing construction, antl I shall not amploy any Oerson in violatlon of the workman's compensation lews of Me Siata of Californie. I hereby certify that I am properly Ilcense0 as a contractor under the Steta of Californle eusiness and Professions Cotle, Divisian 3, THE AMO Chapter 9, entl that such licenses are in full torce and etfect, or I THE PVRP( am exempt from the provisions ot the Stete of Calitornia Business VALUATION and Professions Code, DivAision 3, Chapter 9. Signatura of /�j �//p Q� p Permlttee /�;�%C./v� 5 1DU� or [/I Auihorizetl AOant Date � DATE BLK. � � MOVING DEMOLISH m � a' m N � JN UNDER VALUATION IS FOR m /18LISHING A PERMIT FEE ONLV: e PERMIT FEE E q � PLAN CHECK E o TAX 5 1S U TOTALPAI� E /%J �i