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Home My WebLink About707 19TH ST - Building Permitst CITY OF COSTA MESA � � BUILDING DIVISION � ; _ � DEVELOPMENT SERVICES DEPARTMENT �• - � P�RMIT PE I UMBER � �� SB98-00131 Y (714) 754-5273 • Fax (714) 754-4856 . 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: �� Ni 19TH $T Suite: Vicinity: Parcel Nunmber: 42420203 App�icant: BALLARD, DESMOND Address: „ ; % � ..i'_ � _ Owner: JAMESL'AND"ASSOC LTD Address STATER�BROS MARKETS - COLTON;CA� �� - � - jPOBOX150�. / ��_ ' � �� i�%; � / Contractoc � AWARD-SIGN CO:' �,�,. Address: 1701 8 BOYD!; ; i-;� �� %./. !" % �=% i S.A., CA ; ;� �� !i% Arch / Eng : � . Address: 7 � � . ' ;� - e � Plan Check: `�. Perm�t: SMIP Com: ' Other: � �,. Inspection: SIGN PERMIT Zoning; '.� PFione:"�714258-1560 - Zip: n " Phone:� - �.. � "- Zip: 92324 � Phone j 714-258-1560 Zip:.� 92705 License:Y 642321 � : j .` : . ' , ('Phone:'_ . Zip: License: Status: ISSUED Applied: 09/17/1998 Issued: 09/17/1998 � � � SCOPE OF PERMIT INSTALL NEW CHANNEL�LETTER BLDG SIGN FACING W 19TH ST; CHANGE COPY ON 1 EX. F.S. SIGN B 1 EX. BLDG SIGN. 7SAME �SIZE'L� f �' " � � -5� �cr-( � F;nq L" , FEE SUMMARY ,� � � , . $97.34 � .,_,;�.,.,r-��-:: : "r„ .�/�.�-�,��CalcValuation: ' � $0.00 - - --- - �= � , $149.75 — � ' ' �� Claimed Valuation: , � $1.89 _ $0.00 ` NOTES: �, � $0.00 � ' $0.00 . $0:00 ' - � $0.00: . �� .. �,�•, � $248.98., � � ; � � � , � �, `��`PLANNWG & ZONING �' , ss,000.00 �. $9,000.00 � � i EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectiona and flnel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot ihis permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSA710N OECLARATION: _ I hereby affirtn unAer penalry of perjury one of ihe tollowing declarations: ❑ I heve end will meintain e ceeiTcate o1 consem to seN-Insure br workers' compensetion, as provitleA tor Dy secUon 3700 of the Labor Code, tor the peAormence of the work tor which this permit is issued. . � �I heve entl will meintein workers' compensation Insurence, es requiretl by seclion 3700 of the Labor Code, for ihe pertortnance ot the work for which t�is pertnit is issued. My workers' compensation Insurance cartier entl policy number are: Carner: Policy Number: (This section need no( be camp/eted il fhe permit is velued et one hundred dollars ($100) or less.) � ❑ I certiy thet in t�e pertorma ot ihe work tor whlch this parmit is issued, 1 shall not employ eny person in eny mennar so as to become subJect to the workere' co nsetio ws of � a, and egree Ihet I�f 3hou� be,come subj�to the workars' compensetlon provislons oi Sectlon 3700 of the Lebor Cotle, I shell tonhwith � SEC9RE WORKERS' COMPENSATION iRWEMG�Y3f1NLAVPFII�AND SFiALL SU& (E100.000), IN ADORION TO THE CQST OF ODMPENSATION, DAMAGES AS PROVIDED DECIARATION: ;ed under provisions of Chapter 9(comm�cing with Section 7000) ot DiWslon 3 7orce entl ettect. conveaors sl� Date: L1L PENALiILS AND GVIL FlNES UP TO ONE HUNDRE� LABOR CODE, INfEREST, AND ATTORNEI^S FEES. end Professions Code, entl my license is In full CONSTRUC710N LENDING AGENCY: ❑ I hereby affirtn that �here is a consiruction lentling agency for tha peAortnance oi the work for w�ich ihis pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signatwe: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirtn Ihet untler penelry of perjury Ihat I em EXEMPT FROM THE CONTFiACTORS LICENSE LAW tor the following reason (Sec. 7031.5, 8usiness and Professions Code: My ciry or counry which requires a permit to construct elter, Impmve, demolish, or repair eny structura, pdor to its iuuance, also requires the apD�IcaN tor such pertnit to tile e signed stetemem thet he ar she is licensed pureuem ro the provisions of �he Conirectors License Lew (Chepter 9(wmmencing with Section 7000) of Divlslon 3 oi the Business and Professions Code) or that ha or she is exemp� Iherefrom antl ihe basis tor the alleged eaemption. My violation ot Section 7031.5 by any applicant for a permit subjecLs the applicant to a civil penalry of not more Nan five hunAretl Aollars �$500).): � � ❑ I, es owner of ihe property, or my employees with weges as Iheir sole compensation, WILI DO THE WORK, and the structure is not intended or oMared for sale (Sec. 7044, Business end Professions Cotle: lTe Conirectors LJcense Lew does not appty to en owner of properry who builds or improves thereon, flntl who does such wark himself or herseli or Ihrough his or her own employees, provitletl t�at such improvements are not Intended or oMered for sale. If, however, ihe bullding or Improvement is sold wit�in one year oi completion, ihe owner-builder wlll have ihe burden oi proving that he or she tlitl not build or improve tor purpose oi sale.). ❑ I, es owner ot ihe properry, am EXCLUSIVELY CONTRACTING Wf7H LICENSED CON7RACTORS to construct iha projeci (Set. 7044, Business end Professions Coda: The comredors License Law does not apply to en owner of property who Guiltls or improves t�ereon, end who contreqs for such project with e contrector(s) Ilcense pursuent to the COMracrors License Lews.). � ❑ I am exempt under sec. Business and Professions Cotle for Ihis reason: SigneNre: Date: Owner ID veritied by drivefs license. ❑ Ves ❑ Na Dnver's License No. Expires: Vedfication oi Ownership by (rype of tlocument, i.e. - pmperry tex blll or deed): DIVISION OF IN�USTRIAL SAFETV PEHMR CERTIFICATION: ❑ I hereby certily thet no excavation five (5) ar mare feet in depth into which a person is requireA to tlescend, wlll be made in conneMlon wich work eutharizetl by thls pertnit, end that no building siructure, scattolding, telsewark, ar tlemolition ar tlismamling thereof, wlll be more than Ihirry-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttla B, Califomia Administretive Cade). ❑ As owner-buildar, I will not employ anyone to do work which would require e pertnit trom Ihe Division ot Industnal Sefery, es noted above, unless such person hes a pertnit to tlo such work fmm the division. Signature: Date: Division of Intlusirlal Sefery Pertnit Number: CERTIFlCATE OF COMPLI�WCE AND AUTHORVJITION OF EN7AV: I certify untler penelry of perjury ihat I have read �his epplication and stete Ihat tne Inlormation given is conect. I egree to compy with all stete laws and ciry ordinences releting to building conswctlon, and euthorize representatives ot the Ciry of Coste Mesa to enter upon the ebove-descdbetl properry for inspection purposes. I egree not to occupy or allow occupancy ot eny builtling auNodzed by Ihis permit until final inspection. LQ�E I. INSPECTIONTYPE 1816 1266 Fixed System Finel Fire Preven�ion Pool Spe Fnal 200 Final Re-Roo1 201 Finel BIocWRetaining Wall 202 Finel Factory Fire Plece 203 Finel Slgn 206 Fnel Demolitlon rr`:�:i �g �� /o-ZG-q� � LGPE( INSPELTIONTYPE 206 Finel Mechanicel 20B Final Plumbinp 270 Final Electdcel 212 Fnal Fire PrevenGon 220 Flnel Planning Approval 222 FInaI5lte 250 Fnal Bullding/OauDancy f7{i�L•iinr.�S1 '7; � � SUII.DiNG BAFETY DBPAS'1'mENT Nq 1532 � � '.P. O: Aaz Na ri7 I Caeta �tesa, Calitaeda � Dat.. �D _ � � ._ f, � i . � QTY OF COSTA s[F8A ' I � CERTIFICATE OF OCCUPANCY i � •. � HaYdm6 PeemiL No/t% 2 71 Electrlctl Perm�t Na P4tmbing Permit No- �� i v.� a aanat� /� �— T �_ � [,c_-� !/i� �.�: � l TLb 6dldiug Ix.fed u�>;� y� �el - l f��' -� �� LeL�I Des�� (8es ieverse aMe [or E[etes �nd Bo�mde) hae been impected aad taund W comply wlth the Pmvlsiona d aII Qty ot Coefa Mea� Ordia• ancee aPP�ce61e Yhereto for a GeouP �� 1- OceuPency TO: � . 1 l�— -��:1 eis�` rn� p��i �� CC: ❑ OrlQioal—Owner ❑]s! copy—Gas Co O�d eop9—Ed�eao Co. 3M copy—P91e lio�m f0! B-H P U[ 1-l0 . e.. . .a.. CITY OF COSTA MESA �4YpMF,p �. BUILDING DIVISION it� ^tgp" 77 FAIR DRNE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax (714) 754-4856 • vnvw.ci.cosla-mesa.ca.us �. ` p FOR INSPECTIONS CALL: (714) 754-5626 '`a�^"' PERMIT NUMBER: BC11-00373 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: 07I2812011 ISSUED BY: RMD JOB ADDRESS APN: 42420203 Vicinity: ConstType: V-B TOT W 19TH ST CM SQ. FT: Zoning: , , 18288 Suite/Unit: Primary Occ: Valuation: $100,000.00 SCOPE OF WORK: 18,288 SF EXTERIOR AND INTERIOR TI FOR "SMART AND FINAL". WORK TO INCLUDE EXTERIOR REpAINTING, ENLARGEMENT AND REP�.4CEMENT OF ENTRANCE DOORS, REMODEL OF (2) EXISTING RESTROOMS, CHANGE OUT OF EXISTING REFRIGERATION CASES AND NEW REFRIGERATION ROOF TOP EQUIPMENT. 2 FLY FAN, 18 LIGHT FIXTS, 41 OUTLETS, 5 SWITCHES, 2 NON RES APPL <1 HP, 400A SVC, 3 MOTORS TO 1 HP, 6 MOTORS TO 10 HP, 2 MOTORS TO 50 HP, 2 SUB PANELS TO 225A, 2 FLOOR DRAINS, 1 GAS REPIPE, 2 COMM SINK, 12 FLOOR SINK, 1 SVC MOP SINK, 2 WATER CLOSET, 1 WATER HEAER, 1 WATER REPIPE, 3 WASH BASIN, 2 HOSE BIBB. OS/23/11 PLANS REVISED TO REPLACE EXIST CANOPY AND A NEW PRODUCE DEPT. 15 LIGHTS 7 OUTLETSD 3 SWITCHES 12 FLOOR DRAINS 1 BAR SINK 1 FLR SINK 2 KITCHEN SINKS OWNER: DELCONREALTYASSOCIATES Phone: APPLICANT: KIRKLEY, CHRIS Phone: 909-792-4625 �ONTRACTOR: KIRK�EY CORPORATION Phone: 909-792-4625 Cell: Atldress: °hSTATER BROS MARKETS City/State/Zip: 21700 BARTON ROAD Atldress: City/State/zZip: License No. 408026 Address: 1222 INDIANA CTUnit: CitylState: REDLANDS, CA ARCHITECT: COURTNEY AND LE ARCHITECTS License No.C16365 ENGINEER: ANF AND ASSOCIATES CONSULTING STRUCTURAL ENGR PHONE:626-448-8182 � COMBINATION PERMiT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanica! Fees: Plumbing Fees: SMIP Resideniial: SMIP Commercial: Bldg Std Admin Fund TDTAL FEES: "Refer to fee receio[s for all tuus oaiA for nrninct $161.49 $993.75 $376.13 $38.00 $444.90 $0.00 $21.00 $4.00 $0.00 Unit: COLTON, CA Unit: : STE 102 ZipCotle 92375 PHONE:626-275-6800 License No.C27612 `j'hf; ��rn�it r,�,�j� c�� C;fJ -��Lr�( — N�.,� w J � r-<-cu^'G � ��Ci1 �f'�U L'r�l/ HOUR5 FOR GONSTRUC710N ACTIVITY: EFFECTIVE 3N812010 • PER CMMC Sec. 13•279 Montlay thru Frieay- 7:00 am thru 7:00 pm. SaturAays-9:00 am thru 6:00 pm. Prohibited all hoUfS - SUndays and the folloWing Federal holiday5: regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work auihonzed under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspeclions and fnal approval will result in the expiration of this permil. COpEI. INSPELPONTYVE OATE INTITIALS GOOEC INSPEGTIONTYPE �ATE /INi1PAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical , �31� f� �I"' 1266 POoI Spa Final 208 Final Plumbing �• �7 �' �/ �� 200 Final Re-Roof 210 Final Electncal Im .�i �• 1 � �_ 2�1 Final Block/Retaining Wall N12 Fina� Faclory Fire Place 203 Final Sign 204 Final Demolition 272 Final Fire Preven�ion 220 F'mal Planning Approval 222 Final Si�e 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalry ot perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self�lnsure for vrorkers' compensation, as provided (or by section 3700 of ihe Labor Code, for ihe peAortnance of the work tor which this permit is issuetl. ' ❑ I have and will maintain vrorkers' compensation insurance, as required by section 3700 of lhe Labor Code, for the peAormance of the w�rk for which this permit is issued. My vrorkers' compensation Insurance carrier and policy number are� � 't�'�=�zu�s '��.x. C�. Carrfer. (Tfus sednn neetl ipl �e mmdefe0 Atne ce� �s �ahretl ar me nurMietl �dars (5100) wless ) P licy_Number �(� �_ � I ( � ( ❑ I certify lhat in the peAormance of ihe work for which ihis permit is issued, I shall noI employ any person in any manner so as [o become subject to the workers' compensation laws of California, and agree Ihat i! I should hecome subject to the vrorkers' wmpensation provisions of Section 3700 of the bor�ode, I shall ( with comply with these provisi ns. � �� App iWnl's SignaWre �i � WARNING: FAILURE TO SECU E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWES TO ONE HUNDRED THOUSAND DOLLARS (5100,000�, IN ADDITION TO TH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3 O6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) oF Division 3 of ihe Business and Professions Code, and my license.is in tutl force and effect. (7 Lic. � � � Ydss # 1� � � �'Cenlmclor's SignaWre fJalp,\ \Y �' CONSTRUCTION LENDING AGE CY: ❑ I hereby aKrtn [hal there i a constructbn lending agency for Ihe perfortnance of Ihe �ork fa which this permit is issued. (Sec. 3097, Civil Cotle). Lender s Name: Lender's Adtlress: OWNER-BUILDER DECLARATIONS: I hereby aKrtn that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, impmve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for such permit to file a signed statement thal he or she is licensed pursuan� to the D�o�isions of the Confractors License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of the Business and Professions Cotle) or lhal he or she is exempt cherefrom and the basis for the alleged exemption. Any violalion of Section 7031.5 by any applicaN for a permit subjects lhe applicanF to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees wilh wages as Iheir sole compensation, WILL DO THE WORK, and ihe structure is not intended or offered for sale (Sec. 7044, Business antl Pro(essions Code: The Contractors License Law does not apply to an ovmer of property who builds or improves thereon, and who does such work himsel( or hersel( or through his or her own employees, provided that such improvements are not imendetl or olfered for sale. If, however, the buildinq or improvement is sold within one year of completion, the ovmer-builder will have the burden of proving that he or she did not build or improve tor purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTiNG WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The contractors License Law tloes not apply to an owner of propedy who builds or improves Ihereon, and who wntracts fw such project with a contractw(s) license pursuant to the Conlractors License Lavs.). ❑ I am exempt under sec. Business and Professions Code (or this reason: ignawre 305]-a6�310�) Owner ID verified by drivei � ncense. � Ves ❑ No Driver's License No. Ezpires: Venfication of Ownership by �type of Gxument, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby ceAify Ihat no eacavation frve (5) or more feet in depth into wfiich a person is required to descend, will be matle in conneclion with vrork authodzed by Ihis permit, antl Ihat no building struciure, scaFfdtling, falsewnrk, or tlemolition or dismantling thereof, vnll be more than ihirty-si� (36) feet high. (Chap. 32, Grp 2. Art 2, Sec. 341, Ttle 8, Califomia Atlminist2tive Code�. ❑ As ownervbuilder, I will not employ anyone to do vrork which vrould require a permit (rom Ihe Division of Intlustrial Sa(ety, as notetl above, unless such person has a permit to do such vrork trom the tlivision. Appliwnl'S SignaWre Dale Division of Industrial Safety Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or future building occupan[ need to fle and certify a Business Plan for emergency response to release or mreatened release of a hazardous ma[erial? ❑ Yes ❑ No (Section 25505 0! the California Health and Safety Code requires, with some exceptions, Ihat a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazartlous matenals equal to or greater than a weight of 500 pounds, or a volume o( 55 gallons, or 200 cubic teel of compressetl gas al standard temperature and pressure). 2. Does or will the applicant or present or future 6uilding occupan[ need Io fle a regisiration (orm for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of Ihe Califomia Health ana Sa(ety Cotle, with some ezcep[ions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hantl a quantity of acutely hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at standartl IemperaWre and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutey hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Sa(ety Code provitles that the Costa Mesa Pire Depatlment may require Ihe preparation, certification and fling wilh the Fire Department of an RMPP by businesses which are required to register acu�ely hazardous materials with the Fire Depariment. 4. If an RMPP is presently requireQ has Section 25534 of the California Health antl Safety Code been fully complied vrith? ❑ Yes ❑ No 5. Does or vrill Ihe applicant or present or fuWre 6uiltling occupan� require for lhe vrork which is the subject of this aOPlication a pertnit for such construction or modifcation from the South Coasl Air Quality Management District or from any o�her air pollu�ion cONml tlistriCt or agency? ❑ Ves ❑ No (Section 658502 0( Ihe Califomia Govemment Code requires that the requested information be lumished on applications for rwo-residential builtlinq permits). 6. Will any part o( the facility to be consWcted under this permit be within 1000 teet (rom the outer boundaries of a school? ❑ Yes ❑ No pf "yes", the facility must meet the requirement of Sec[ions 25534 an0 42303 of the Cali(omia Health and Safety Code�. 7. If a permit from the South Coast Air Quality Management District or other air pollution control tlistnc[ or agency is required for the vrork which is Ihe subject of this application, have all of the discbsures prescribed by Calitomia Health antl Safery Code Section 42303 been made? ❑ Ves ❑ No 8. Qf yes", attach cenifcate of compliance from t�e appropriate air pollution control oKcer�. CERTIFICATE OF COMPLIANCE: I certify that under penalty of peryury the information qiven above is correcl. I aqree to comply with all state laws and cily ordinances regarding Hazardous Materials and Emissions. SlgnaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalry of perjury that I have read this application and state that the intormation given is correct I agree to comply with all state laws and ciry ordinances relating lo building construction, and authorize represen�alive5 of the Ciry of Costa Mesa to enter upon the above-descnbed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �naWreofLegal eqs) le � � I /(pNp.Aullronietl AOWicdnt le r�� CITY OF C�OSTA MESA LO�pMFS,p sunn�N� �►ws►oN it�g 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wviw.ci.costa-mesa.ca.us �R�a�o fi FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: SB11-00075 PERMIT TYPE B_SIGN JOB ADDRESS: 707,t1N�1.9TH�ST CM Vicinity: SQ. FT: 0 STATUS: ISSUED DATE ISSUED: 08I11/2011 ISSUED BY: RMD Suite/Unit: Valuation: $16,000.00 SCOPE OF WORK: INSTALLATION OF (2) ILLUMINATED CHANNEL LETTER BUILDING SIGNS, (1) ILLUMINATED CABINET BUILDING SIGN AND (1) FREESTANDING SIGN FACE CHANGEOUT FOR "SMART AND FINAL" WITH 3 SIGN CIRCUTS. � OWNER: PHONE: APPLICANT: PHONE: DELCON REALTY ASSOCIATES HENIGSMAN, gILL 562-595-7725 CONTRACTOR: T N T EL�CTRIC SIGN INC Address: 3080 E 297H STUniC PHONE: 600-655-6366 Ciry/State: LONG BEqCH, CA ZipCode: 90806 ARCHITECT: ENGINEER: SIGN PERMIT FEE SUMMARY PLAN CHECK FEE: HOURLY PC FEE: PERMIT FEE: ELECTRICAL FEE: SMIP FEE: OTHER: INSPECTION: BLDG STD ADMIN FUND TOTAL FEE: $172.41 $0.00 $265.25 597.30 $3.36 50.00 $0.00 $1.00 $539.32 Address: STATER BROS MARKETS Unit:COLTON, CA Ciry/State/Zip: 2f700 BARTON ROAD Address: Unit: City/State/zZip: License No. License No. License No. 803133 CE�I.: 562-595-7725 PHONE: PHONE: NOTICE: The work authorized by lhis permit shall comply wilh all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. FaiNre to obtain inspections and final approval will result in the expiration of this permit. C0� �E t INSPEC110NTYPE 1616 Fixed System Final Fire Prevention 12fi6 Pool Spa Final 200 Final Re-Roof 207 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Finai Sign 204 Final Demolition UATE IN701RL5 COOE/ INSPECTIONTYPE 206 Final Mechanical 208 Final PlumDing 210 Final Electncal 272 FinalFire Prevention 220 Final Planning Approval 222 Finat Site 250 Final Building/Occupancy OnTE INTI11RL5 5 e-",.,ca-..' ��4% WORKERS' COMPENSATION DECLARATION: . , I hereby aflirm under penalty of perjury one of Ihe following declarations: ❑ I have and will maintain a certifcale of consent to sel(-Insure for vrorkers' compensation, as provided for by section 3700 of the Labor Code, for the pertormance of �he work for which this permit is issued. ❑ I have antl will maintain workers' compensation insurance. as required by section 3700 of the Labor Code, for the pedormance of the vroB fw which this permit is issued. My workers' compensation Insurance carrier and policy numberar�j:' Cartier:. (�l f� `SA�i,i �,SCk�A^r! �/nei� (TNs section nee�mmpleted Aibe peimrt is valued at one nuntlred tlollars (St00) or less ) Pol� i yNumber: � � C ❑ I certify that in the peAormance of the work (or which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws o( Califomia, and agree that if I should bewme subject to the workers' compensation provisions of Section 3700 of th Labor Code, I iall forthvrith comply with these pro(�isions./ K�// ( �/ pl�aW'd�Sgnaiure , te� WARNIN : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUT AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and e%ecl. �,u__�o 3 /3? ��5�# c-vr ��- d'�U�l/ (. i;ontraClor's5ignaWre rD .nte CONST CTION LENDING AGENCY: ❑ I hereby aKrtn that there is a constructbn lentling agency for the peAortnance ot the v.ork fa wfiich this permit is issued. (Sec. 3097. Civil Code). Lender's Name: Lender's Address: Signalure OWNER-BUILUER DECLARATIONS: I hereby aKrm lhat under penalry of perjury that 1 am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Cotle: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any strucWre, prior to its issuance, also requires the applicant for such permit to file a signetl statement Iha� he or she is licensed pursuant to the provisions ol ihe Contractors License Law (Chapter 9(commencing with Section 7000) o! Division 3 of the Business and Professions Code) or that he or she is exempt theretrom and the basis for the alleqetl exemption. Any violation ot Section 7031.5 by any applicant tor a permit subjects �he appliwN to a civil penalty of nol more Ihan fve hundred dollars (5500).): ❑ 1. as ovmer o( lhe property, or my employees with wages as their sole compensation, WILI DO THE WORK, antl the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an ovmer of propeAy who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or oKered for sale. If, however, the building or improvemeN is sold within one year of completion, the owner-builder will have the burden of pmving that he or she did not build or improve for purpose o( sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS to construct the projecl (Sec. 7044. Business and Professbns Code: The contractors License Law dces not apply to an ovmer of property who builds or improves Ihereon, and who cont2cts !or such pmject with a contractw�s) license pursuant lo the Contrectors License Laws.). ❑ I am exempt under sec. Business and Professions Code (or ihis reason: � S�gnature 3�5]-46(3/0]) � '4rOwner ID verified by drivei e iicense. ❑ Yes ❑ No Driver's License No. Expires: Verifcation of Ownership by (type o( document, i.e. - properly tax bill or deed): DIVISION OF IIJDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certdy Ihat no exwvalion frve (5) or more feet in depth into wfiich a person is required to descend, will be made in connection vnth work authonzed by Ihis pertnil, and that no building structure, scaffdtling, falsework, p demolition or dismanlling thereo/, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2. Sec. 341, Ttle B, Califomia Administ2tive Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit from the Division of Industrial Safery, as noted above, unless such person has a permit to do such vrork (rom the tlivision. A�d�� s Signa Wre Division of Intlustrial Safery Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file antl certify a Business Plan for emergency response to release or threatened release oi a hazardous material? ❑ Ves ❑ No (Section 25505 of lhe Califomia Health and Safety COtle require5, wilh 5ome exceplions, Iha[ a Business Plan be filed with Ihe Costa Mesa Fire Department by every business which has at any one time during a reponed year a quantity of hazardous materials equal to or greater than a weight of 500 pountls, or a volume ot 55 gallons, or 200 cubic feet of wmpressetl gas at standard temperature and pressure). 2. Does or win me applicant or present or future building occupant need to fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safery Code, with some ezceptions, requires regislration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantiry of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of wmpressed gas at standard remperaWre and pressure). 3. Does or will Ihe appliwnt or presenl or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes � No (Section 25534 of the Califomia Health and Safety Cotle provides that lhe Cosla Mesa Fire Department may require [he preparation, certifcation and fling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous matenals with the Fire Department. 4. If an RMPP is presently requireQ has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future builtling occupant require !or the work which is ihe subject of Ihis application a permit for such wnstruction or modification fmm the South Coast Air Quality Managemenl Dislrict or fmm any other air pollu�ion conirol di5trict or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Code requires �hat the requested informalion be (umished on applicalions fa nornresidential building pertnits). 6. Will any part of the (aciliry to be consWcted under this permit be within 1000 feet fmm the outer boundaries of a school? ❑ Yes ❑ No Qf'yes", the facility must meel Ihe requirement of Sections 25534 and 42303 of the Califomia Health antl Safety Cotle). 7. If a permit from the South Coas� Air Qualiry Management DisMct or other air pollution control district or agency is required for the work v+hich is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certifcate of compliance from the appropriate air polWtion contml officer). - CERTIFICATE OF. COMPLIANCE: I certify that under penalty of perjury the intormation given above is correct. I agree to wmply with all state laws and city ordinances regarding Hazardous Matenals and Emissions. SignaWre Da1e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I ceAify under penalry of perjury Ihat I have reatl this application and state mat the information given is correct. I agree to comply wilh all slate laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property (or inspection purposes. I agree not to occupy or allow occupancy ot any builaing authonzetl by this permit until final inspection. /� SignaWreo LegxlOwnerp) Dale / /l.�ir ��" . ��ii �(i A rAulllp(IiCtlrlPpl¢dnl �_ (71b) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 707 W 19TH ST Suile: Vicinity: SMART AND FINAL Parcel Number: 42420203 Applicant: JOHNSON, CHARLES Address: Zoning: - Phone: 760-951-0574 Zip: owner: DELCON REALTY ASSOCIATES Address , %STATER BROS MARKETS " - COLTON, CA� :- � - . , Phone: 21700 BARTON-ROAD � . 2ip: Contractor. JOHNSON CONSTRUCTION � Address: 15354"BONANZA RD - , STE B ; Phone:-� 760-951-057 � . - VICTORVILLE, CA � Zip: 92392 � License: . 789646 Arch : Address: Status: ISSUED Applied: 02/25/2002 Issued: 04/11/2002 ISSUED BY: � Eng: Address: i . � Phone: . Phone: � Zip: � , License: License: , -. . SCOPE OF PERMIT - INTERIOR REMODEL TO NEW ISLAND COOLER/FREEZER, NEW 10 DOOR REACH-IN FREEZER AND NEW 16 DOOR DAIRY/DELI COOLER. NEW ROOF TOP UNIT. ' Plan Check: $418.76 Permit: $644.25 SMIP Res: $5.00 SMIP Com: $10.50 Other: $0.00 Inspection: $0.00 Total: $1,078.51 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0=0 ' PARKING Existin : '0 , NOTES: . FEE SUMMARY PLANNING & ZONING Rear 0- 0 � Lek 0- 0 � Rear 0- 0 Left 0- 0 Reauired: 0 � � Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0. 0 Right � 0- 0 ' 350,000.00 $so,000.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, g 1, 12-21-92) EXCIRATION: This permfl shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requtred InapecUona and tinal approval must be obtained. Failure to obtain Inspections and final approvat will resufc in the expiretbn ot this permit. FOR INSPECTIONS CALL: (714) 7545626 _ � WORKERS' COMPENSATION DECLARA710N: . � ' I hereby ettirm under penalry of perjury one oi lhe following tlacleretlons: . ❑ I have antl will maintein e cetlificete ot consent Io sel4lnsure lor workers' compensatlon, es provitled lor 6y seIXion 3700 ot the Lebor Code, for the pedortnance ot �he work tor which this pertnit Is issuetl. . � ��} I have entl will maintain workers' compensetion insurance, as required by section 3700 of tha Labor Cotle, for the pertortnance of Ihe work for which Ihis partnil is Issued. V My wo`rkere' compensetlon Insurence carder and policy number are: ^ n Carrier. �•T/4�; f//.l�li Pdicy,� N� u b:��i ��Ob��— �� f(This sectiori need not be complefed Il fhe permit is velued ef one huntlred tlollars ($f 00) or IessJ i ❑ I certtly that in Ihe pertortn r e work for which t�is permit is issued, I shell noI employ any person in eny manner so as to become subject to the workers' compensetlon laws oi C�1 ,I� nd egrea that tl I shoultl becoma subject to the workers' wmpensatlon pmvlslons of Sectlon 3700 oi Ihe Labor Coda, I shell forihwith comply wilh the5e pr w APD�eant'S19neture:— Date: /— �.s2 �n20G6�-- L... WARNIIJG: FAIL'UFE TO SE WORKERS' COMPENSATIIXJ COVEMGE IS UNLAWFUL AN� SMALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES M1D CML FlNES UP TO IXJE NUNDREO T/N%1SAND DOLLARE (5100.000�, IN nDDRION TO THE C0.ST OF COMPENSATIIXJ, OAMNGES AS PROVIDED FOR IN SECiION 3]O60F THE LABOfl CODE, IN�EREST, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm ihat I am licens d un r rovl ons of Ghepter 9(commencing with Section 7000) ol Division 3 ot the Buslness�d Prolessions Cotle, end my Ilcensa is In full forca enC eHect Lit'p �� rClas� CONSTRUC710N LENDING AGENCV: � ❑ I hereby aRirtn ihat there is e construction lending agency tor the pedormance of the work tor which this permit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Atlaress: Slpneture: Dete: I hereby eflirtn that under penelry qt perjury Ihet I am EXEMP7 FROM THE CONTAACTORS LICENSE LAW tor the followinq reeson (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which,requires•e pertnit to construct, elter, improve, tlemolis�, or repair eny swcNre, prior ta its issuance, elso requires the epplicent tor such pertnit to lile e signed stetement that he ocshe�is Ilcansed pursuam ro t�e provisions of the Contrectars License Lew (Chepter 9(cammencing with Section 7000) of Dlvision 3 of ihe Business entl Profeuions Code) or thet he oyshe is eaempt theretmm and t�e basis for t�e elleged e:emption. Any vlolatlon oi Section 7031.5 �y any applicent for a permit sub�ecls the eppliwnt to e civll penalry of �not�more than five hundred dollers ($500).): ❑ I, es owner ot ihe property, or my employees with wages es Ihelr sole compensatlon, WILL DO THE WORK, en0 Ihe siructura Is not inten0etl or oHeretl for sale (Sec. 7044, Business and Professions Code: The Contraciors License Lew tices not apply to en owner of property who builds or Improves thereon, antl who does such work himseH or herself or t�rough �is or her own employees, provlOed ihet such improvemenls era not intendeC or oflered for sale. If, however, the building or improvement is soltl wit�in ona year ot completion, the owner-6uiltler wlll have the burden ot Oroving thel ha or sha ditl not build or improve lor purpose of ule.). ❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTAACTORS to construct Ihe project (Sec. 7044, Business end Professions Coda: The conirecrors License Lew does not epply to an owner ol property who bulltls or Improves thereon, entl wha cantracts tor such project with e contracbr(s) licensa pursuant to the Goniractors License Laws.). ❑ I am e:empt under sac. Business and Professions Cotle for ihis reason: Signeture: Date: Ownar ID vanfied by drivers license. ❑ Ves ❑ No Drivefs License Na. Verification af Ownership by (rype of dacument, i.e. - properry ta: bill ar deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Eapires: ❑ I hereby certify �het no ezcavatlon flve (5) or more teet in depth Into which a person Is required to descend, wlll be metle In connection with work euthoAzetl by this permit, and that no building structure, scettolding. talsework, or demolition or dismantling thereof, will be more Ihen ihirry-six (36) teet high. (Chap. 3.2, Gry 2, Art 2, Sac. 341, Ttle B, Califomia Administretive Code). ❑ As owner-builtler, 1 will not employ enyone to do work which would require e pertnit trom the Division oi Intlustrial Satery, es noted above, unless such person has a pertnit to do such work irom the tlivision. Signeture: Date: Divlsion of Industriel Safety Permit Number: ICERTIFICATE OF COMPIJANCE AND AUTMORIZATION OF ENTRV: I certify under penelry of perjury thet I have reeC ihis epplication end state thet tha Intortnation given is I correcL I egree to comply wi�h all stete lews entl city ordinances releting to building construction, end authodze representa�ives of the Cily of Coste Mesa to enter upon the ebove-descnbed property tor in��iGypuryoses. I agree not to acupy or allow acupency of any building authorized by Ihis parmit until tinal inspection. COOE t. INSVECTONT'GE 1616 Fixetl Sysiem Final Fire Preventlon 1266 Pool Spe Final 200 Flnal Re-Roaf 201 Final Black/Retaining Well 202 Final Factory Fire Place 203 Finel Slgn 204 Final Demolilion P�jF IHfffIALS �OpE� INSPEC710NTVPE 206 Final Mechanical 20B Finel Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site ' 250 Final Building�0aupancy P�IE 1t�kL5 (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.Ca.us 77 FAIR DFIVE, GOSTA MESA, GA 92626 PLUMBING PERMIT Job Address: 707 W 19TH ST Suite No Vicinity: SMARTANDFINAL Parcel Nunmber: 42420203 Applicant JOHNSON, CHARLES, Address: 15354 BONANZA RD - � . STE�B . - � - � Phone: 760-951-0574 � '- VICTORVILLE, CA - � Zip: 92392 , „', � � � �; �- - . � , � Owner: DELCON�REALTYASSOCIATES i Address %STATER�BROS MARKETS , i,: � � COLTON; CA " Phone: � 21700 BARTON ROAD Zip:, Contractor. JOHNSON CONSTRUCTION - . Address: 15354 BONANZA RD - � � . � � , STE B . - Phone: 760-951-0574 VICTORVILLE, CA, . Zip: 92392 - License: 789646 Arch / Eng : Address: Status: ISSUED Applied: 07/OZ2002 Issued: 07/02/2002 ISSUED BY: Phone: . , - � Zip: , , . � . � � License: . � - SCOPE OF PERMIT • INTERIOR STORE TI FOR'SMART AND FINAL.' 2 FLOOR SINKS. REF: 802-00260 ISSUE FEE BackFlow irrigation Backhow Preventer Bathlub � Clarifier System Connect pce,Soda,etc) . Dental Units Dishwasher Drein, Floor Drain, Rainwater Drain, Roof Drinking FounWin Expansion Tank Gas Earthquake Valve Gas (1-4 ouUeLs) Gas (Over 4 oWeLs) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) ' AMT�� ( $23.50 ` $0.00 � $0.00 � $0.00 � $0.00 i $0.00 � $0.00 i $0.00 - i $0.00 ; � � $0.00 i so.00 � � $0.00 i $0.00 i $0.00 i $0.00 I $0.00 i $0.00 i $0.00 i $0.00 I $0.00 I Laundry Tub / Washer Landscape Irrigation P-T2p �� Pressure Regulator Process Piping (per 10 ft) Receptors Septic Tank " SewerCapforDemo Sewer Connecl � Sewer Private Line Shower � Sink, bar Sink, Commercial Sink, Floor Sink, kitchen Sink, service/mop Spa (private) Spa (public) AMT QTY $0.00 0 - � Sump Pump � $0.00 0 Swimming Pool , $0.00 0 Trap Primer, $0.00 0 Urinal � � $0.00 0 Vawum Brkr Bkflow(t-4) $0.00 0 Vacuum Brkr BkFlow(5+) $0.00 0 Wash Basin $0.00� 0 . Wash-Basin.Set $0.00 0 Waste and Vent System $0.00 -0 Water Closet (Toilet) 50.00 0 water Heater / vent $0.00 0 Water Pipin9 (Inst or Rep.) 50.00 0 Water Re-pipe $9.80 1 Water Service $0.00 0 Water Softener $0.00 0 OTHER $0.00 0 VIOLATION $0.00 0 PLAN CHECK REINSPECTION COMMENTS / SPECIAL CONDITIONS AMT $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 533.30 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements undar California statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 . / zsas�aa �s�oo� WORKERS'COMPENSAnON DECLARAnON: � ' I hereby aKrm under penalry ot perjury one ot ihe following declarations: � . ❑ I have and will maintein a certifiwte of consent to sell-Insure for workers' compensation, as provitled far by section 3700 ot the Labor Gode, for the peAormance of the ��work for w�ich this Dermi� Is issued. . �[a�l have arW vrill maintain workers' oompansation insurence, as requiretl by sectlon 3700 of Ihe LeGor CoOe, for iha perfortnance oi the work for whic� ihis pertnit is IssueO. `�y workers',compensatlon Insurance cartier end policy number are: /'L Cartier. -STi9%/Z `(J/�Q - Polity Numhec �tl T r�� — �� (Thls secfion need not be completed il fhe permlf Is valued et one hundred dollars ($100) or less.) ❑ I certify ihat in the peAorma Se work for which this pertnit is issued, I shall not amploy any Derson In eny mannar so es to hecome subiect to the warkers' compensetlon lews of Cely nd agree that if I should become subJect lo the warkers' compensatlon provislons of Sectlan 3700 oi ihe Lebor Code, I shell fort�with cromply with Ihesa prov' ( A �plicent'SignaNre:7 .D�te /— OsZ — d'.pOa- WMMNG!FAILURETOSEWR ORKERS'ODMPENSATONCOVERAGEISUMAWFULANDSWILLSUBJECTANEMPLOYERTOCRIMINALPENALTESANDCMLFlNESUPTOONEHUNOqED THOUSPND OOUARE (5100,000�, IN ADDRION TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVIDED FOH IN SECTION 3)O60F THE LABOR CODE. IPREREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn ihat I em licensed force and eflact. Lic.� with Sectlon 7000) of Dlvision 3 oi ihe 8usiness� d Prolessions Code, and my license Is in iull CInCa'M. CONS7RUCTON LENDING AGENCV: � ❑ I hereby eHirtn that Ihere is a construction lending egency for ihe peAormance of iha work for which this permit is issued. (Sec. 3097, Civil Code). Lentlefs Nama: Slgneture: _ Lendefs Atldress: Date: ,OWNER•BUILDER DECLARATONS: I hereby eflirm Ihe� untler penelry of per�ury �hel I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Buslness end Protessions Cade: Any ciry or counry which requires a permit �o consirud, alter, improve, Aemolish, or repair any siructure, prior to ils Issuance, elso requires the appliwnt br such pertnit to lile e signed statement Ihat he or she is IlcenseA pureuant to the provisions ol the Contractors Ucense Law (Chepier 9(commendng with Section 7000) oi DlNslon 3 of Ihe Business and Pmfessions Code) or ihat he or she is e:empt Meretrom and t�e besis tor the allaged exemptlon. Any viWatlon of Section 7031.5 by any applicam br e pertnit sublects Ihe applicant to e civil,panalry of not more then Ilve huntlretl dollars ($500).): ❑ I, as owner ot t�e property,'of my'B 7044, Business antl Professions�G himself or herself or,through his or, sold within ona yaar of�completion, �� ❑ I, es owner of the praperty; em EXI COGe: TTie contreccors License LeN license pursuant ro Ihe Comractors ❑ I am exempt under sec. Signature: Owner ID venfietl by tlrivers license. s with weges es iheir sala compensatlon, WILL DO THE WORK, and the structure Is not Intentletl or oNeretl lor sale (Sec. ConUactars License Law does not apply to an awner af properry who 6uiltls or Improves thereon, end who daes such work employees, provided that such improvements are not in�enCetl or oHeretl for sale. It, however, Iha building or improvement is v-builder wiil have the 6urden of proving that he or she ditl not builtl or improve for purpose of sele J. ICY CONTRAC7ING WI7H LICENSED CONTRACTOHS to consiruct the prolect (SecJ04d, Business and Pmfesslons it apply to`an owner of pmperry who builds or improves thareon, antl who comracts lor such pmjecl with e contractor(s) Business and Prolessions Code tor this reason: _� : ❑ Ve5 ❑ No OAverS LiCenSe No. VedOcation of Ownership by (type ot tlocumem, i.e. - property tex bill or daed): Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICA710N: ❑ I hareby certify Iha� no excevation tive (5) or more feet in Oepth inio whic� e person is required to descend, will be matle in wnnectlon wi�h work authorized by ihis pertnit, anC that no building siructure, scattolding, lalsework, or demolition or dismantling thereot, will be more than thirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle 8, CeliPornia Adminisirative Cotle). ❑ As owner-6uilder, I will not employ anyone to do work which would require a Oermit from the Division of Industrial Satery, as notetl ebove, unless such person hes a permi� to do such work From ihe division. SigneNra: Date: DiNsion of Indusirial Sefery Pertnit Number: CERTiFlCATE OF COMPLIANCE AND AUTHOFiIZATION OF ENTAV: I cenity under penalry ot peryury that I have reatl ihis apPlication enG state that the intortnetlon given is correct. I agree to comply with ell state laws end city ordinances relating to builtling construction, entl authorize representatives ot Ihe Ciry of Casta Mesa to enter upon the eDove-descnbed property igr inspection purposes. I agree not to acupy or ellow occupancy of any building euthorized by Ihis pertnit until finel inspection. COOF t. IHSVELTIONiYPE t6i6 Fixed System Final Fire Prevention 1286 Pool Spa Finel 200 Final Re-Roof 201 Final BIaWRetaining Well 202 203 Final Factory Flre Place Final Sign 204 FinalOemolition � � �Q,Qf�ji INSPECTIONTYPE 206 Finel Mechaniwl 20B Finel Plumbing 210 Finel Elactncal 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 � Final Building�Occupancy Q� � (714) 754-5273 • Fax (714) 754d856 • www.ci.coSta-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: 707 W 79TH ST SMART AND FINAL Parcel Nunmber: 42420203 ApplicanC JOHNSON, CHARLES Address: 15354 BONANZA RD " STE B - � Phone: 760-951-0574 VICTORVILLE,.,CA - Zip: 92392 �", � " � -j. � owner. � DELCON REALTY ASSOCIATES �- - „ . Address . -%9TATER BROS MARKETS . , . COCTON, CA i'� � � " Phone: � ., .' � 27700.BAR70N ROAD Zip: � � % Contractor. JOHNSON CONSTRUCTION ' Address: �15354 BONANZA RD ' �' ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+uni4s) Pool ! Spa Lighting FixLs Recept Outlets Switches Non Res Appl � Res Appl Service to 200a . Service to 1000a , Service over 1000a Motors to 1 hp Motors to tOhp Motors to SOhp Motors to t00hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign CircuiLs Temp Pwr Pole Inlermed Pole Status: ISSUED Applied: 07/02/2002 Issued: 07/02/2002 ISSUED BY: STE B - "Phone: 760-951-0574 VICTORVILLE, CA . - Zip: 92392 - - � � License: 789646 - SCOPE OF PERMIT - - INTERIOR STORE TI FOR "SMART AND FINAL.' 3 RECEPT OUTLETS, 3 MOTORS TO 10 HP. REF; B02-00260 � -� - � $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quaotity 0 0 0 0 �: . 3 0 0 0 0 0 0 0 �� _3 0 0 0 0 . 0 0 0 0 0 FEE SUMMARY Temp Dlst System / Lighting Busway /100 ft Slanding Section . Misc Electrical Equipment Transformers up to 1 kva/kw ...............:up l0 10 kva/kw .................up to 50 kva/kw .................up to 100 kvalkw � ..................over 100 kva/kw Low Voltage Equipmenl Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand � Other Electrical Fee Investigation Fee Plan Check Fee ReinspecUon Fee Quantity $0.00 0 ' $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $o.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 P $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $63.70 COMMENTS I SPECIAL CONDITIONS NOTICE: The work a�thorized by this permit shall comply with all applicable handicap access requirements undar California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days, INSPECTIONS: In ordgr for lhe work authorized under this permit to ba considered legal, such work must comply with all applicable codes, and all requiretl Inspectlons and final epproval must be obtained. Failure to obtain inspeclions and final approval will resul� in �he expiration of this parmit. FOA INSPEC710NS CALL: (714) 754-5626 , � � � 2aa6e6 (8�00) . WORKERS' COMPENSATION DECLARATON: - - I here6y eHirm under penalty of perjury one ot the following tlecleretions: ❑ I heve and wlll mainteln e certiticate ot consent to seli-Insure tor workers' compensation, es provided for by sectlon 3700 ot the Lebor Code, lar the pertortnence of ihe ,r.� ork for which Ihis permit is issued. . �' I have and will maintaln workere' compensetion Insurance, as required by section 3700 of Iha Lebor Cotle, for Ne perfortnance ot Ihe work for which this pertnit is Issuetl. My workers' compensation Insurance ceMer an0 oolicv numher ere: ane -`POIIcy,Numben �b '!� ga�a( � - O � or less.) ❑ I cenify that in the pertormance ol t r which this pertnit is issued, I shell not employ any pereon in eny manner so es to become subject Io Ihe workars' compensetlon lews oi Califomie �het ii I should become subJect to the workers' compensetlon provislons ot Sectlon 3700 of Ihe Labor Catle, I shell forthwith comply with Ihese provisions. iApplka�CSignature:-� � Dete: � �-0.�'.��oZ- �-�- WARNINO: FNLURE TO SECURE WOR RS' COMPENSATION COVERAGE IS UNLAWFUL M1D SHALL SUBIECT AN EMPLOYEP TO CFIMINAL PENALTIES AND GNL FlNES UP TOONE MUNDRED T/iOUSANO OOLLARE (5100.000),IN ADDI710N TO THE CQST OF COMPENSATION, DPMAGES A$ PROVIDED FOFi IN SECfION 31080F THE I.ABOR ODOE, IPREREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: 1 �ereby atFirm Ihat I am Ilce^�e�dJ{^i er ppr vislon ter 9(wmmencing with Section 7000) oF Division 3 of the Business�P tl Prolessions Cade, antl my license is in full force anG eHect Lic_ p� %X7(e ��n � . _ Class � .6 CONS7RUC710N LENDING AGENCY: � ❑ I hereby attirm that Ihere is a consiruction lending agency for ihe pedormance ot the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Neme: __ _... Lendefs Address: SlgnaNra: OWNER•BUILDER DECLARATIONS: Date: I hereby eflirm ihet untler penelry of perjury t�at I em E%EMPT FROM THE CONTRACTORS LICENSE LAW far tha tollowing reason (Sec. 7037.5, Business antl Professions Cotle: Any ciry or counry which reQuires a pertnil to construct, elter, Improve, demolish, or repeir eny siructure, pnor to its issuance, also requires the apD�icant tor such pertnit to Ille e signed statement thel he or she Is Ilcensetl pursuent to the pmvlsions of Ihe Contradore License Law (Chepter 9(commencing wlth Sectlon 7000) of DlWsion 3 ot Ihe Business end Profeulons Cotle)�or,ihat he ar she is exempt therelrom end ihe basis for the ellegatl exemption. Any violation of Section 7031.5 by eny aDPlicant ior a pertnit subjects ihe epplicant to e civil �penelty of not more than five huntlretl tlollers ($500).): ❑ I, es owner ol the property, or my employees with wages es their sole compensetlon, WILL DO THE WOFiK, antl the structure is not intentletl or ottered tor sele (Sec. 7044, Business and P.rofessions CoOe: The Contractore License Lew does not apD�Y �o an owner of property who builtls or improves thereon, antl who does such work himseli or herseN a thiough his or her bwn employees, providetl t�at suc� improvements are not intandetl or ottered for sale. II, howevar, the building o� impmvement Is soltl within one year ol wmpletioq the owne� builtler will �ave Ihe hurden of proving t�at he or she did not 6uild or improve tor purpose of sale.j. ❑ I, as owner of the property, em E%CLUSIVELY CONTRAGTING WITH LICENSED CONTRACTORS lo construct t�e projact (Sec. 7044, Business antl Professions Cotle: Tha camrectors License Lew tloes,nbt appry ro en owner of property who bullds or Improves thereon, end who contrects lar such project with a contrector(s) license pureuent to ihe Contrectors License Laws.). ❑ I em exempt untler sec. Signature: Owner ID verifiad by drivers license. ❑ Yes ❑ No Business and Pmfessions Cotle tor this reason: Vedfication of Ownership by (typa of tlocument, i.e. - pmperry tex bill or deed): DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: Orivels LicenSe No. Date: Expires: ❑ I here6y ceriify that no excavatlon tive (5) or more feel In tlep�h Into which e person Is required to descand, will be made in connection with work eu�horizetl by this pertnit, and Ihet no building structure, scaHolding, falsework, or Cemolition or tlismantling t�ereol, will be more Ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Titla B, Calilamia Administretive Cada). ❑ As owner-builtler, I will not employ anyone to tlo work whic� woultl requira a pertnit irom the Division of Industnel Safety, es notetl above, unless such person hes e permi� to do such wark from Ihe division. Signeture: Date: Division of Industnel Safery Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENfAV: I certity under penelty of parjury ihat I have reatl this epplication and state thet the Information given is wrrect I egree to comply with all stete laws entl ciry ordinances relating to building consWction, antl euthonze representatives oi the Ciry of Casta Mesa to enter upon the eDove-descnbed Droperty for inyp�yion purposes. I egree not to occupy or allow occupancy of eny building authorizetl by this pertnit until tinal inspection. CODE �. INSPECTIONTYVE 21F 1[i�19L5 1676 Fixetl System Final Fire Prevention 1286 200 201 Pool Spa Final Final Re-Rool Flnal BIocWReteining Wall 202 Final Factory Fire Place 203 Final Sign 264 Final Demolition � GOOE 1 INSVECTION TYPE 206 Final Mec�anical 208 Final Plumbing 210 Pinel Electrical 212 Finel Fire Prevention 220 Finel Planninq Approval 222 Final Site 250 Finel Building/Occupancy �:17�I�riiliF.l4i r (714) 754-5273 • Ferz (714) 754•4856 Job Address: Suite: Vicinify: 707 W 19TH ST WHOLE ROOF Parcel Nunmber: 42420203 Applicant Address: Owner: Address CITY OF COSTA MESA BUILDIN6 DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Zoning: PERMIT NUMBER I 899-01162 77 FAIR pRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07/27/1999 Issued: 07/27/1999 WRIGHT, ROSS iSsueo ev: 430 W 168TH ST .-�. . - : . . � : CA ;.�J,�`-"� _.�. ,Phone: 310-327-2263"- - . � , GARDENA ,; �/.'`% , � � " � " Zip: 90248 � - � � _ .i��- - . . � - i'� '� - i.�';�. _ i„ JAMESL'AND, ASSOC LTD, . / � � ' i , i; i i .� , , _ � . ,-�� STATER�BROS MARKETS i - � - - � ' ' -. ' ` COLTON. OA �V � � -�4 � : Phone� ' '� �� • � __ � �� : P�O BOX�150 '/ � ' 2ip� 92324 ti .;� ' �- � � `-��• �\ ,�•.�//-^�:'� :�' � . ;i �\� �•� MUTUAL-ROOFING COMPANY �`�; ��/` �� , asowiseirisr `��<; �� '� . �„� : i.- % ;� Phone:• 310327-2263 �� • � � I �' GARDENA.CA �� , - � ��,� , %`�� Zip:� 902A8� License�; 4A2500 , , , � � , f ,� . ,;%� . . . - . � - \ ,:,Arch : �:� �' � � � � r . ,�' .� ,, Eng: • � ,. . � ; �;Address: : ,;.'�i�.' '�. ./ A l � �; . . . _ Address:, .. .. . " , �� 1 ' i � -Phone: - - � ,-'� , Phone: � i �� _ ��.. _ .- " � - ,�,�.�,. , . , ��' ^-; ;� Zip f .�- � ,.,� �nse: Zip: � -License: �� . � � . .. � � � .. ;� � � / � � � �' . � �� SCOPE OF PERMIT � � . ,�� ,._...,. / REROOF EXISTING COMMERCIAL BUILDING "SMART &�FINAL",(170 SQ): TEAR OFF EXISTING BUILT-UP ROOF, EXISTING SHEATHING TO REMAIN: INSTALL NEW BUILT-UP ROOF (BASE, 2-PLY, 8 CAP). , �. � � � Plan Check_ ��'�� $0.00 �� ` Permit:'� . - $29975 � �' SMIP Res:` � � ^ � $0.00 �� SMIP Com: ,^;'�, $4.30 � �'�� Other:, .�$299.75 �Inspectiori: �� ; ;$0.00 � � �� . � ��Total: �, . $603.80 �� : ��.�� '�, � , �� . SETBACKS� � � � � � � ; � MAIN STRUCTURE Front 0-`0 , , ACCESSORY Front,� 0.0 �- PARKING Existin : ' 0'' NOTES: �� FEE SUMMARY �,', , .,�,,,�- � ' _ -- , � �_ � `_ �� , � Calc Valuation: __ .— : ,/ �� Claim Valuation: , - .� , -� � , '- PLANNING & ZONING y � Rear ,_ Oj�O�- �" � -� Left �- �0- 0 Rear 0- 0 Re uired: 0 Left 0. 0 � Pr000sed: 0' Right Right 0 ' ' a $2Q480_00. $20,480.00 ,� � �,� t ,, , NOTICE: The work authorized by this permit shall comply with all epplicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12•21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for e period of 180 days. , INSPECTIONS: In order for the work authodzed under this permit to be considered legal, such work must compfy with aH applicabie codes, and aif required Inapectlona end tlnel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: _ I hereby eRirm untlar penalry ol perjury one oi Ihe following declaretlons: ❑ I heve antl will malntain e ceritllcate of consent to self-Insure Por workers' compensation, as provltletl for by section 3700 oi t�e Labor Code, for ihe pertormence of the work for which this permit Is issued. ❑ I heve antl will malntein workers' compensation insurance, as reqWretl by section 3700 ot the Labor Cade, for the petlormence o� the work for whlch this permit is Issued. My workb�s' wmpensatian Insurence cerrier end policy numDe� ere: Cerrier. Policy Number: (This sectlon need not be camp/eted il tbe perm/t!s velue0 at one hundretl tlollers ($100) or less.) ❑ I certify Ihat in the pertormance of Iha work for which Ihis pertnit Is Issued, I shall not employ any persan in any manner so as to becrome subject to the workers' compenseiion laws ot Celitomia, end egree �hat if I should become subject to the workers' compensetlon proNsions of Seclion 3700 of Ihe Le6or Code, I shall torthwith comply with these provisions. Applicant Signature: Date: WARNING: FAIWAE TO SECURE WORKFAS' COMPENSAT70N Q�VEPAGE IS UNUWFUL AND SHP11 SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED F-0R IN SECTION 3)O60F THE LABOR CODE, IMEREST, AN� ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm lhat I am IicenseG under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professlons Cotle, and my licensa is In tull torce antl ettecc �c. # Cless N Conirectofs SlgnaNre: Da�e: CONSTRUCTION LENDING AGENCV: ❑ I hereby a�� Ihet there is a consiructlon lentling agency tor tne peAortnance oi Ihe work tor w�ich Ihis pertnit Is issued. (Sec. 3097, Civil COCe). Lender's Name: Lendefs Address: Signature: Date: OWNER-BUILOER DECLARATIONS: I hereby affirtn that under penalry of perJury thet 1 em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the Following reeson (Sec. 7031.5, Business end Professions Coda: Any ciry or counry which requires e permit to construct, alter, Improve, tlemolish, or repair any strucWre, pnor to its issuance, also reqWres the applicaN for such permil to file a slgned 5tetement �het he or she is licensetl pursuent lo the provisions ot the Contractors IJcense Lew (Chapier 9(commencing with Secllon 7000) of Division 3 of the Business end P�atessions CoOe) or Ihel he or she is exempl Iherefrom entl iha Desis tor the allegetl exemptian. Any violation of Secllon 7031.5 by eny epplicant for e permit sub�ects tne apD�icant to a civil penalry ot not more than five hundred tlollars (3500).): ❑ I, as owner o� Ihe property, or my employees with wages as Iheir sole compensetion, WILI DO THE WORK, end the structure Is not Intended or offered for sale (Sec. 7044, Bus��ess and Professions Cotle: The Coniractors LicenSe Lew tloes not appty ta an owner of prapeRy who builds or improves thereon, end who tloes such work himself or herself or through his or her own emplayees, provitled that such improvemenis are not Intended or oNered for sale. If, however, the building or improvament is soltl within one year of completlon, Ihe owner-builder will have Ihe hurden of proving thet he or she did not bui10 or improve for purpose of sale.). ❑ I, as own�r of t�e property, em E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct the project (Sac. 7044, Business end Professions Cotle: Th9 contrectors License Lew does not appty to en owner ot property who builtls or ImD�a�es Ihereon, end who contrecis for such prqect with a contractoQs) license pursuaN ro the Contrectors License Laws.). ❑ I am exempt under sac. Signature: Owner ID venfietl by dnvers license. ❑ Yes ❑ No Buslness end Professions Code tor ��is reason: Venfication of Ownership by (rype ot tlocument, i.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Drivers License No. Date: Expires: ❑ I hereby certity Ihat no ezcevatlan tive (5) or more feat in tlepth into which a person Is requiretl Io tlescend, will be matle in connec�lon with work authorizetl Dy ihis permit, end that no building stmcture, scaHOlCing, falsework, ar tlemolltlon or dismantling thereot will be more than thirty-six (36) feet high. (C�ap. 3.2, Grp 2, Art 2, Sac. 347, TiUe 8, Califomie Atlministrative Code). ❑ As owner-builder, I wlll not employ anyone �o tlo work which would require e permit from the Division of Industnal Safety, as noted above, unless such person has a permit to da such work trom the tlivision. Signawre: Oate: Division of Indus��al Satery Permit NumDe�: CERTIFICATE OF COMPLIANCE AND AUTliORIZA710N OF ENTRV: I certity under penalty of per�ury that I have read ihis eppllcetion end stete ihat ihe information given is correct. 1 agrea to comply with all state laws entl ciry ordinances relating to buil0ing construction, end authonza representetives of the Ciry ol Costa Mesa to enter upon the above-descnbed properry for Inspectlon purposes. I egree not to occupy ar ellow occupancy oi any bulltling euthorized by this parmit untll final Inspection. Signeture Ot Legal Owner(s) AnNOr Authonzed Applicant GOOE t. �j�Q�PE PAIE I[�IEL: 1616 Fixetl System Final Fire Preventlon 1266 Pool Spe Final 200 Final RtrRoof 201 FInaI Block�Relaining Well 202 Finel Fec�ory Fire Place 203 Final Sign 204 Final D6molilion 2448�a6 CODE� IN57ECTIONTYPE 20fi Finel MachaniCel 208 Final Plumbing 210 Final Electncal 212 Finel Flre Prevention 220 Finel Plenning Approval 722 Final Site 250 Final Building/Occupancy Q� � • v �''�,�E ►-. ; ,. '::.�:: � �! (714) 754-5273 • Fax (714) CITY OF COSTA MESA � BUILDING DIVISION� DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Job Address: 707 W 19TH ST Suite No Viciniry: Parcel Nunmber: 42420203 PERMIT NUMBER � 77 FAIR DRNE, COSTA MESA, CA 92626 ISSUED BY: status: ISSUED Applied: 08131/1999 Issued: OB/31/7999 Applicant: KANCHAN, GUILLERMO _ -- - - �:,r.i.: �.� ;- -. Address: 2501 W. JEFFERSON BLVOX �,✓%- ;:�. - - - . --_ -,_, i� i�� _/� �Phone: ,714323735-2860- � � ;. LA. CA - //� , i"� . �, Zip: 80078 � � � r ��' � i i ,- \ / � � \ �7�� ./"'� � � 5i � � �j� � / � �i �-� �. �ii%� �_ � � _.,. _ __ . l� i � �� i � ,' A Owner: JAMESLAND ASSOC LTD ` = Address jSTATER 9ROS MARK 5', -4 �'�-'S' �� x `'� �`�' --\`��a\ � % � �� J ��,\ ��COLTON;�CA �� Phone. �� / / /� �� i�� P o eox;iso//'/ z�p: szsza �\�1��, i�� i�"� \\i%jj/ �`��`�� ' \��. / v� � ///%i `��'�� i. A�', Contract�:; KAN'S.ELECTRICAL SERVICES � � , �/��Address.�1 2501;W�JEFFERSONBLVD ry � �? � � �� ,%, Phone'--714-323�735-2860 � ' - �- ,• � � .� � �. ,.,, ... . .. � . �� , ' ��\ ��LA.CA .- "� � Zip:- 90018�1 ; •'�� `� . . �. � 'i� % _ . ,. � � n . -license: 488569 - � � � - ` ! � _ -� ,1-� ' _J i��f' /� ' � /�,�ri, r _- '- " `_ �� ,/�•� .^'`,'. � - , . -�.� � � , , iC- _ - - -- ;�i \:-._ ,..1 . � ' ' ' �' " /�� SCOPE OF PERMIT � � � ��. ' �� 3 SWITCHES 3�MOTORS UP TO SOHP, 1 200 AMP PANEL, 20 LIGHTS, SMART AND FINAL. REF ' -�, i J �, � " _ _ -'_�_ �_ � _ -" _ , � � / c� �, ..__, ;;'>l r`; ; i � � � . �� .. c.-„ .._ . . . � �- � ' i FEE SUMMARY ' " . � � � \ M Quantity�,.� �n, Quantit ' � --�- , , . � �. '� � ISSUE FEE 1`' $23.50 � � _ - � =��`� _T Temp Dist Syst��-Lighting � $0.00 0 � j:'''; � ' � - �lTertip service test , : $0.00 � - -> ;�Busway /t00 fl � -'- - �' $0.00 0 � ' � � - ' �� Res. a/c package � .. $0.00 � Standing Section $0.00 0 %, • % , � ; � , � � _ New�Res�(1-2 units) � 50.00 � � 0 Misc Electrical�Equipment �$0.00 0�'�% �" �'L % Ne`yv�Res(3+units)� ' � 50.00 � � 0 Transforinersup"tolkva/kw-� �$0.00 0%�� '�� ,v t PooU.Spa ��, '�,� 50.00 0 � � . . ..............�.upto10kva/kw J�$0.00 �p;�` ,.',,,, � �� ,. Lighting�FiMs . - , , $22.00 � 20 " .. ....up to 50 kva/kw � � $0.00 �� 0� � � Recept Outlets � - . �� $0.00 " 0 � � �A ; ., - � � ^ up to 100 kva/kw $0.00�;� � 0 � � ' . Switches �_�� . ��- $2.20 , 2 `.;'' ' , .... . (. "�over 100 kva/kw ,,�. $0.00 j-;i p � Non RerAppl, `�$0.00 0 � . �' � " ' , Low Voltage Equipment � ,� $0.00�, 0 ` - � Res Appl •.'� �\ , SO 00- - � 0; k �7'�""; " � � -� Low Volt Wiring System I,Ckt , -= $0.00� 0 ' -� ' Service to 200a� �"� 50.00�� - =:�0�� ,� , �"t : � �� .Misc. Conduit , ...� �� ; � $0.00/„ 0 i� / , Service to 7000a ' / � �$0.00-`� - `0 ' , ' -Mlsc°Conductor � - "'$0.00`"% 0 ,', Service over t000a • � ' �i .$0.00 �0 �.,,' �, ; � � Circus ( gen or ride) i ' � $0.00 � ' 0 �- % Motors to 7hp �` � �' ,$0.00� -0� _�\ � _� r '; Circus (mecH ride`oclights) , : $0.00� , 0 i � ,' Motors to 10hp � `� ��'' $0 00 �, �� 0 �� '� ^ � �- Christmas Tree Stand � '��'; $0.00 � .0 �. ' Motors to 50hp � .�1 ., $73.80�� / �3� � � � - _ - F.ireworks Stand � ,-$0.00 � 0�� Motors to 100hp � = � $0.00 - � � � 0_ ; Other Electrical Fee , � $0.00 � � d/ Motors over 100hp ' � $0.00, � � 0 � ' ' - � Communication drops �$0.00. �= - 0 = � � - Investigation Fee � � ' �$0.00 Sub panel to 200a $30.50 -. ' 1 � . . �� Plan Check Fee , � � � $0.00 Pole Light Pkg $0.00 � 0 - � ; - . ReinSpecti0n Fee - ' $0.00 Sign Circuits $0.00 0 - " '' :i- r i �. � ! y � - Temp Pwr Pole $0.00 0 �'- TOTAL CALCULATED FEES E152.00 . Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period o� 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wi�h all applicable codes, and all requlred inspeetlona and flnal epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSATON DECLARAnON: I hereby aHirm untler penalty of perlury one ot ihe following declarations: ❑ I have and will maintain e certlficete of consent to self-Insure lar workers' compensation, es pmvided tor by section 3700 of the Lebar Cotle, for Ihe peAormance of ihe work for which this permit is issued. I have end will maintaln workere' wmpensa6on insurance, es reqWreO by section 3700 ot the Lebor Cotle, for the pedormanca of the work for which Ihis permit Is issued. My �w�orkerys' �co�mpemny�etionp1nsuran rtier antl policy number ere: Certier:./�✓q{¢I� v�fGc.. �' Policy Number. /G �^-� � II J�1 S O o d . (This sectfon need not be co p/eted 7! the permit is va/ued et one huntlred dollers ($100) or less.) ❑ I cenify that in the pertortnance of the work for which this pertnit is issued, I shall�not employ eny person in any manner so es to become sub�ect to ihe workers' compensation laws of Calilomia, and egree ihat if I should become subjeq to the workers' compensation provisi s of Sectlon 3700 o� Ihe Labor CoAe, I shall forthwith compl ' ese provisions. �� , ,y/ � - icant Si : Date: WA NINO: FAILURE TO SECUPE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFIIL ANO SHALL SUBJECT AN EMPLOVER O CRIMINAL ENALTIES AND QVIL FINES UP TOONE HUNDRED TMOUSAND OOLLARE ($100,000), IN ADDITION TO THE COST OF CqMPENSATIIXJ, DAMAGES AS PROVI�EO FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. DECLARATON: of Chapter 9(commencing with Section 7000) of n 3 of the Busi ss and rofessions Cotle, and my license is in full % Class # �^ / 6 comractors CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn Ihat there is e consiruc�ion lentling agency lor Ihe pertormance of t�e�work fo� which this permit is issued. (Sec. 3097, Civil Code). Lender's Neme: Lender's Address: � Signature: OWNER-BUILDER DECLARATONS: Date: I hereby eHirm ihat under penalry oi perjury Ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW fo� ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e permit to construct, elter, Improve, demolish, or repelr eny siructure, pnor to iis issuance, elso requires the applicant for such permit to lila a signed statement thet he or she is licensed pursuant to the provisions of the Contractors Licensa Lew (Chapter 9(commencing with Section 7000) oi Division 3 of the Business antl Professions Cotle) or thet he or she is exempt therelrom antl t�e basis for ihe elleged eaemption. Any vlolation ot Section 7031.5 by any epplicant for e partnit sub�ects ihe epplicant ro e civll panelty of not more than five huntlretl Eollers ($500).): ❑ I, as owner ot the properry, or my employees with weges es thelr sole compenselion, WILL DO THE WORK, and Ihe strucWre is not Intentletl or ottered for sala (Sec. 7044, Business and Professions Cotle: 7he Contractors License Law tloes not apply to an owner of property who builds or improves ihereon, and who does such work himself ar herself or through his or her own employees, provided ihat such improvements are not Intentletl or oHeretl for sale. If, however, ihe building or improvement is sold within one year of completion, the owner-builtler wlll have Ihe burden of proving that he or she ditl not huild or improve lor purpase of sale.). ❑ 1, es owner af Ihe properry, am EXCLUSNELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe pro�ect (Sec. 7044, Business antl Professions Cotle: The contractors License Law tloes not apply to an owner of pmperry who 6uiltls or improves Ihereon, antl who conirects for such project with e contractor(s) license pursuant to the Contractors License LewsJ. ❑ I am exempt untler sec. Business and Protessions CoGe tor this reason: Signeture: Date: Ownar ID venfied by dnver's licensa. ❑ Yes ❑ No Dnvefs License No. Expires: Verifica�ion of Ownership by (type ot document, i.e. - property tez blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehify that no excaveilon tive (5) or more teet In depih into which a parson Is requirad to descend, will 6e made in conneciion wiih work authorized by Ihis permit, and Ihat no building structura, scaHolding, falsework, or tlemolition or dismaniling thereot, will be more Ihan �hirty-six (36) feet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title 8, C0litomle AtlministfeliVe Cotle). ❑ As ownar-builder, I will not employ anyone to do work which would require a pertnit trom the Division of Industnal Satety, es noted ebove, unless such person has a permit to do such work irom Iha division. Signeture: Date: Division of Industrial Safety Permit Number: CERTIFlCATE OF CO�PLIANCE AND AUTHORVJ1T10N OF EN7AV: I certity under penalty of per�ury that I have read this epplication entl state that the information given is correct. I agree toiomply II state laws and ciry ordlnences relating to huilding consiruction, and authorize representatives of ihe Ciry ot Costa Mesa to enter upon the ebove-desr,ribed pr � inspection puryoses. I egree not to occupy or ellow occupancy of eny building authorized by this permit until final inspection. 1676 1266 200 201 202 203 INSPECTIONTYPE � Fixetl System Finel Fire Prevention Pool Spa Final Final Re-Roof Final Block/Retalnlnq Well Final Factory Fire Place Final Sign 204 Final Demolition 2416-46 15-3� -y �NiffIALS CQQE� �NSPELTONTYVE 206 Final Mechanical 208 210 212 220 Final Plumbing Final Electncal Flnal Fira Prevention Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy QR� INTIfIRLS �i:l s � y��' i �.:�::� ; ; �, (714) 754-5273 • Fan (714) 754-4856 CIN OF COSTA M�SA ` BI/ILDING DIVISION1 DEVELOPMENT SERVICES DEPARTMENT PERMIT PLUMBING PERMIT Job Address: Suite No Vicinity: 707 W 19TH ST Parcel Nunmber: 42420203 PERMIT NUMBER � P99-00510 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 08131/1999 Issued: OB131/1999 npplicant: OTTO,THOMAS -�"i �.%' : � �� " �' � > �� :�__ Address: 272 CAMINO ARROYO%%'� -� � - � ' �= �" � '.�i = -'1�, , '�Phone: 714-974-0580 � � �- � ANAHEIM HICLS �_ �-1 � . Zip: 92807 .i�, � / , - �� , �. � � _ _ , / !, , -'\ �, ,- , � Owner -�,'JAMESLAND ASSOC LTD: ` � � '��' V '': ' �� Address� STATER BROS�MARKETS'� �� ' r ' � ' \� �/�� COLTON.CA";�1�� Phone: �� . < ��V��A i ,-� . ii <. - , . . i' •V1�� /,,/� �'P O BOX 150�� Zip: 92324 . V A�,� , ' �, / �� r \ / �/�/ �`\,, / \ :\ :� � �; , � � ; ,,.� , ,. �/ � �i - .. ' ��.,A �,; �/ / �/ j . i%i. � � . .;� _ , . � j ,Contractoc - NEVNVO PLUMBING CONTRACTORS � � �.�� , , �_ ;,��;; �,. , i �\ � , f � Address � 272 CAMINO ARROYO � : : • ' �_ • , ; � � .. �, �. `� `, � ' ,� !� ��iPhone: 714-974-0580 .. � . �. � ��, � -- � . � � � ` �ArchlEng�:� �� Address:� : �, , � � , ANAHEIM HILLS'' ,� \ / � � \ " ^'' .2ip: 92807 � �; ' i � - -� -�� License 66796fi - - I G� �.� ' ' . �� . j � - � � - Phone:� � ' � ,� ,;.� - �'� . . . ", `: , . .,. lzip:. � " � - License: � � " . -�''! ��"''SCOPEOF.�I •. � �. „ � � 3 FLOOR SINKS, SMART AND FINAI. - _� � ti, _ ' � �C �� i : �y,� � �,A �. , __ �'" • . ' -. ' ,�� , � \ \ � � � � \ . � � � :. �- � FEE SUMMARY. _,: _ ,�, _ �\ ` � `, , � .' � AMT QTY , . ._ '- AMT � �QTY � " . , ISSUEFEE� � � � �� $23.50 . Laundry Tub I Washer $0.00 0 �Sump Pump � - � Backflow.irrigation,.� ,�$0.00 0 °" Landscape)rrigation - , $0.00 0 SwimmingPool - ,� Backflow Preventer $0.00 0 P-Trap,� . �� 50.00 0 . Trep Primer Bathtub , � � - $0.00�,� 0 Pressure Regulator $0.00 0 � � Urinal � Clarifier System � . 50.00� �� ,-0 .- Process Biping (per 10 R) - $0.00 � 0� � . � ' Vacuum Brkr Bkflow(1-4) � Connect (Ice,Soda,etc) 30.00 . �0 . . ", � Receptors , � $0.00 0 . , - Vacuum Brkr Bkflow(5t). Dental Units V '� � � $0.00 - 0 �� ; , , Septic Tank �� ` � � $0.00 0 ;.iWash Basin , , Dishwasher �� . -,$0.00'' 0' - , _,,��,Sewer,Cap for Demo ' $0:00 �. 0` - - � �� Wash�Basin Sat Drain, Floor � � $0.00 � ;0 - Sewer Connectr �-' � 50.00 _ 0 -- -, � � Waste and Vent System �\ : ��_ Drain, Rainwater � . 50.00� � 0 " � - Sewer Private Line � . 80.00 �0 �"- . �. Water Closet (Toilet) Drain, Root V�- �$0.00� �� 0� � , - Shower - $0.00 0 , � �Water Heater/vent Dnnking Fountain �,$0.00 0- . Sink, bar $0.00 0 ,�.WatecPiping (Inst or Rep.) Ezpansion Tank $0.00 �' 0 � _ ' � �Sink, commercial � � $0.00 0 � � Water Re-pipe Gas Earthquake Valve $0.00-,- � 0�� `� Sink, Floor $29.40 � 3�' �'Water Service Gas (1-4 outlets) $0.00 0 �� Sink, kitchen � , . . $0.00 0 , " ' Water Softener Gas (Over 4 outlets) $0.00 0� ' Sink, service/mop $0.00 0;�=' � OTHER Gas Repipe SO.00 o Spa (private) .-�- ,- -50.00� � 0-" VIOLA710N Gas Service 50.00 0 Spa (pubiic) $0.00 0 PLAN CHECK Interceptors (Grease, Oil) $0.00 0 REINSPECTION Interceptors (Sand Auto ) $0.00 0 COMMENTS / SPECIAL CONDITIONS +' ( �I; � , %, AMT i QTY $0.00� 0 $0.00 0 $0.00 0 $0.00 0 E0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 So.00 0 80.00 0 $0.00 0 80.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 0 TOTAL CALCULATED FEES: $52.90 INOTICE: The work authorizad by this permit shall comply with all applicable handicap access requiremenis under Califomia staWtes and related � regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall auromatically expire and become void if work is not commenced wi�hin 1 BO days, or if work is suspended or abandoned �'�,. for a period of 180 days. I INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such vrork must comply with all applicabla codes, and all i required Inapeetione and flnal epproval must be obtained. Feilure to obtain inspections and tinal approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 J WORKERS'COMPENSAnON DECLARAnON: � I hereby eHlrtn under penalry oi per�ury one at the lollowing declaretians: ❑ I have antl will maintain a ceNTicate of consent to self-Insure for workers' comperwation, es providetl for by section 3700 01 the Lebor Code, far t�e DeAormanca of Ihe work tor whlch this pertnil Is Issuetl. ❑ I have arW wi0 mainUln workers' compensetion Insurence, as requirad by secllon 3700 01 I�e Letwr Code, tar the peAormance ol iha vrork for which this pertnll Is issued. My workera' wmpensetlon Insurence cardar end policy number ere: Carder. PWicy Number. (fhls secf/on need not be comp/erea I! fne permit is veWed et one nunared dW�ers (St00) or �ess.) �I cenity Ihet in t�e pertorma I the wark br which this pertnit is issued, I shell not employ eny person in any menner so es to Decome subject to the workere' compensetion laws oi Cal' e e r thet If I shauld become su6�ect to the workere' compensetlon rovisions of Se tlon 700 of the lsbor Code, I shell Ionhwlih comply with Ihese pro ' o� �� J cent eture: ( Date: WARNINO' URETOSECUREWOfiKERS'COMPENSATIONCOVERAGEISUNLAWtULANDSHRLLSUBIECTANEMPL CHIMINALPENALTIESANDCMLFlNESUPTOONEHUN�RED D OOLIARE (5100,000), IN ADDfTIQV TO iHE 00.5T OF COMPENSATION, �AMAGES AS PHOVIOED FOR IN SECiION 31W OF TME LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTAACTOFiS DECLARA710N: I hereb � 1 am licensed un provisic ce end c . c. Caniractors Sionature� ot Chapter 9(commendng with Sectlon 7000) ot Div6tien9v4t�a Business and Prof�ulons Code, and my license is In Full 6Urf$�llG7fON LENDING AGENCY: ❑ I hereby ettirtn Ihat there is a constructlon landing egency for the peAortnance of the work for w�lch �his permlt Is issued. (Sec. 3097, Clvll CoAe). Lendefs Name: Lendefs Atldress: Signeture: _ OWNER•BUILOER DECLARATIONS: Dete: I hereDy attirtn thet under penalry ol per�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Protessions Code: Any dry or counry which raquires e pertnit to con5truct, alter, imprwe, tlemolish, or repelr eny siructure, pnor to its luvance, also requires the applican� for such permit to file e signetl stetement that he or she is licensed pursuant to Ne provisions of Ihe Contractors Licensa Lew (Chapter 9(wmmenGng with Section 7000) of Divislon 3 of the Business and Professions Cotle) or that �e ar she Is exempt iherafrom and the basis for Ihe elleped exemption. Any Ndalion of Section 7031.5 by any appliwnl for e pertnit sub�ect9 the eppliCant to a civil penalry ot not more than Ilve hundred dollars (5500).): ❑ I, as owner oi tha pmperry, or my employees with weges es Iheir sola campensetion, WILL DO T11E WORK, entl the swcWre is not intended or oHered lor sale (Sec. 7044, Business and Pmtessions Code: The Comractors License Ww does not epply to an owner of property who builds or imprwes thereon, antl w�o tloes such work himself or �erselt or thmugh his or her own amployees, providetl that such Improvemenis ere not intended or oHered for sale. It, however, the builtling or improvemem is soltl wit�in one year of completioq tha owner-builtle� will have the burden ol pmving thet ha or she ditl not builtl or improve for purpose of sale.). ❑ I, es owner o1 the Oroperty, am E%CLUSIVELY CON7RAC71NG WfTH LICENSED CONTRACTORS to construct the pra�ect (Sec. 7044, Business entl Professions Code: The conirec�ors License Lew tloes not eppty to an owner of property who builds ar improves thereon, end who contrects lor such project with e contrector(s) license pursuant to the Coniractore License Lews.). ❑ I em e:empt untler sec. Business and Professlons Cotle lor this reason: Signature: Date: Owner ID verifiea �y tlrivers license. ❑ Ves ❑ No DAvels LJcense No. E�cpires: Vedflcation ot Ownarship by (rype ol document, i.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETV VERMR CERTIFICATION: ❑ I hereby cenlly thai no exwveUon fiva (5) or more feet in tlepth Into which a person Is requiretl to descentl, will be matle In wnnecllon wiN work authodzetl by lhis permit, end Ihat no building slructure, scaflolding, lalsework, or damolition or dlsmentling thereoi, will 6e mare Ihen Ihirty-si: (38) le9t high. (Chap. 3.2, Grp 2, An 2, Sec. 341, Title 8, Celifomia Adminlslrative Code). ❑ As owner�builtler, I will not employ enyone to do work which would require a pertnit Irom the Division of Induslrial Safery, es noted ebove, unless such person hes e permit to tlo such work from ihe division. Sipnawre: Date: DiviSion ot Intlusirial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIlT}IORIZATION OF EMRY: I ceniy untlar penelry of per�ury that I have reed this eppllcation and state that the Inlormatlon given Is correct. I egree b compty vrith all state laws end city ortlinances relating to builtling constructlon, antl amhoriza representetives ot Ihe Ciry ot Coste Mese to enter upon Ihe ebove-descdbed pmperty tor inspection purposes. I agrea no� �o occupy or allow occupency ot any building authodzed by this pertnii untll Ilnal Inspection. CODE L INSVECTIONTYVE �— 1616 Finetl System Final Fira PreventlOn 7266 Pool Spa Final 200 Final Re-Rool 201 Final Block/Retaining Wall 202 Finel Fectory Flre Plece '• 203 Finel Sipn 204• Final DemoNlan � - "� " xba&a8 P6IE IHimAis COOE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Finel Electricel 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site - 250' Finel Building/Occupancy PA� I[RIIId1S • v Ri 1 (714) 754-5273 • Fax (714) 7541856 Job Address: Suite: Vicinity: 707 W 19TH ST ROOF Parcel Number: 42420203 Q CITY OF COSTA MESA BUILDING DIVISION l DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Zoning: PERMIT NUMBER 699-01379 77 FAIR DRIVE, COSTA MESA, CA 92626 App�iwne BLAIRE, TERRY ISSUED BY: Address: 1241 DISTRIBUTION WAY _ _.- — __.__ , CA _- ��;%,Phone:r.p60j599-0123�� VISTA � �� -, � �Zip: - 92083 � -� ' � < �� Owner: Address N � �+�,< <' Z ,\ 24. CA_ ' r�'Arch : //.' ;. / / � i ii i i Address: � � /,!�� /i' -� r' i ;, � , � �;, 1 ZiP� � / � // 4' � / )( StaWs: �SSUED Applied: 08I30/1999 Issued: OB/3011999 = -i ' � � � A'_ c� � � � �� i �� D ASSOC LTD � � � � ,'�� \\ ?.MARKETS� � 1 ` ; �, _, ': � � � { / .��i . .A/� 1 �-� ------ �✓� // �A�. �� ' / � � �Phone: _; -- �--_ '�-� :� / � � /�` � � �� \ \ l/�-��- `=Zip�-92324�^��\ �� \J\ �\ /�/� ��' ^ ��\ �J i \ \ LER,CONSTRUCTION �� j �,- ,. UTION WAY �� \ � � Phone: (760) 599-0723 � �� license:;� 522934 , : �' Fy_.\ /�`_' / �0� -5 � ' � �Phone �� _ � _ r - , - License. { \� "-f './ ` / � �� ;� � CONSTRUCT TNO 48 SQ. v 1 -• �� ; P,lan Check:, $45.01 ,� Permit ,�� $69.25 � �SMIP Res , $0.00 ' SMIP Com� � � $0.50 � '��, � Other. �� $0.00 �nspechon \ � . $0.00 ��1�� (� �� V ��:, ��\ Tota j $114.76 ACCESSORY PARKING ;' Eng � �ndaress: ' \ ,,� �� ,�/ � : _ SCOPE OF PERMIT V " � : EQUIPMEN2 FLATFORMS�FOR "SMART 8 FINAL". � � ti.,,. ,� „ i v . . � `' `� "- FEE SUMMARY - � �� ,i Calc Valuation: �. 1 � ' � " ' Claim Valuation: "' —� , . , ��„�. � i � �� r�.�, ; . !- _. . _ . - . _ i � " / � . "' � � az,000.00 — s2,o0o.00 ; _ �" _. , � � � . .. . — 4; i i � , � �� . r.� - , . , /; `. . � � � ;= ��:,� _ ,a ��_ ' . , � , ; .,..� , . ,. i �. . � J - � - `,-" ;E Front 0.�0 � �,�Rear 0.0'- :A �i' �`, ` Front � 0= 0 . Rear _ 0• 0� \`<`_ /�" '_. i, Eiistinq:.' �. 0 ��- Required: . � p- V'-= � " ' � � NOTES: LANNING & ZONING,.. _ �,i,;�, � � ' , �. • , `� �� ii� "�C'�j ;' � Left 0- 0_ RigM <0. 0 <� � . A,,� �i `�'-=Cek �0-0. � Right,�0-0- �� - �:' %`�'�� , Pr000sed: 0 r � - � � ' . . ;��' _A\.. '/ ""�� -:.; ;"s;�_.. .✓� . _ .i i ., NO710E: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automa�iCally expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 deys. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with ell applicable codes, and all required Inapeetlone end flnal epproval must be obtained. Failure to obtain Inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 JI WORKERS' COMPENSATION DECLARA710N: I hereby eHirtn under penelry ot perjury one ot t�e lollowing decleretlons; ❑ I heve end will maintain e certificete of consent to setl-Insure for workers' wmpensation, es provitled for by sectlon 3700 ot Ihe Labor Cotle, for the peAormance of the work for which Ihis pertnit is IssueC. ❑ I have arW will mainieln workers' compensa6on inwrance, as requlred Dy section 3700 01 Ihe Lebor Cotle, for Ne peRormanca of Ne work tor whkh this pertnit Is issued. My work ' compensallon Insu nca carder flntl policy number ere: �7 (� CarAer. �Dl�� xi , PdicyNumber. AIILJC3/ / �7�Z— (lhls sec(ion need not be completetl !! Ne permlf is va/ued ef one hundred dollers ($100) or leu.) ❑ I certify that in ihe paAortnence f Ihe work tor which this permit is issuetl, I shall not employ eny person in any manner so es to become sub�ect lo the workers' compensation lews of Celifor i, ntl agree ihat if I should become subject to the workers' compensetion provisions of Section 3700 of the Lebor Code, I shall forihwlth comply with these pmvis� � (� [�' Applicant SigneWre: .� Dete: CJ'�D'7 i WARNINO: FAILURE TO SECURE WORKE COMPENSATION COVERAQE IS UNLAWFUL AND SMALI SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES M1D GVIL FINES UP TO dJE HUN�RED T/qUSANDDqURE(5100,000),INFDDIT� PITOTHECOSTOFOOlAPENSATION,DMUGESASPROVIDEDFORINSECfION3]O60FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARA710N: I hereby aflirtn Ihai I am Ilcensetl untleryrovi§Ic lorca antl ettect. Lia x�_ ContreclofsSlgnemre: _ ot Cheptar 9(commencing with Section 7000) of Didsbn 3 ot the Business en P�ofes i n. Code, antl my Iicense is In full � class a � _ �fn. Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn Ihet there Is e consiruction lending egency for the DeAormflnce of �he work for which this permit is issued. (Sec. 3097, Clvil Code). Lendefs Neme: Lendefs Adtlress: SigneWre: OWNER-BUILDER DECLARATIONS: Date: I hereby eflirtn ihat under penalry of per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a pertnit to consWct elter, impmva, demolish, or repeir eny slrucWre, pnor to Its issuenca, also requires the epplicant lor such pertni� b 81e e signed stetement I�aI he or she Is Ilcensetl pursuent to Ihe pmvlslons ot Ihe Contrectors LJcense Lew (Chapier 9(commenGng wilh Section 7000) of DINSion 3 ot the Buslness antl Prolessions Code) or t�et he or she is ezempt t�eretrom end ihe basls for Ihe ellegetl ezemptlon. Any Noletlon at Sectlon 7031.5 by eny epplicent tor e permlt subJects Ihe applicant to e civll penelry of not more than five huntlretl tlollars (5500).): ❑ I, es ownar of the propeny, or my employees with wages es ihelr sole compensetion, WILL DO THE WORK, and the structure is not intended or oNaretl lor sale (Sec. 7044, eusiness and Professions Cotle: The Contractore License Lew Ooes not apply to en owner of property who bulltls or improves thereon, antl who does such work himself or herself or through his or her own employees, provided that such improvements are not Intentled or offeretl for sale. If, however, the building ar improvement is sold within one year of completion, the owner-builder will heve Ihe burtlen of proving thet he or she did not build or improve for purpose of sale.). ❑ I, es owner of tha propeny, flm EXCWSIVELV CONTRACTING Wf7H LICENSED CON7RACTORS ta canstruct the pro�ect (Sec. 70a4, Business antl Professions Cotle: TTe contrectars License Lew does not appy to en owner ot pmperty who bulids or ImOroves thereon, antl who conirects tor such project with a crontrectoqs) license pursuam to the Contrectors License LewsJ. ❑ I am exempt untler sec. Business end Professions Coda for t�is reason: Signature: Date: Owner ID veritied by drivefs license. ❑ Ves ❑ No Dnvar's License No. Expires: Vedfica�ion ol Ownershlp by (type ol daument, i.e. - property lex bill or deed): OIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: ❑ I hereby cenify ihat no exwveiion five (5) or more teet in depih inro which a person is required to descend, will ba mede in connection with work fluihodzetl by ihis permil, and Ihat no bullding structure, scafFUtling, falsework, or tlemWi6on or tlismantling t�ereol, will be more than t�irty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Califomie Administrative Code). � As awner�bullder, I wlll not employ anyone ta da work whlch would requlre e permlt Irom t�e Division ot Induslrial Safery, es noted ebove, unless such person �es e permit to Co such work Irom the division. Signeture: Date: Division of Indusirial Safery Permit Number: ICERTIFICATE OF COMPLIANCE AND AIJT}IORIZATON OF ENTRV: I cenity untler peneliy of per�ury that I have read Ihis epplice�ion entl stete that the infartnation given is I correcl. I egree to comply wlih ell stete laws and ciry ordinances relating to building constructlon, entl euthonze representetives at Ihe City of Caste Mese to entar upon the ebove-tlescribed property lor Inspection purpases. I agree not �o accupy or allow occupency at eny building authonzetl �y this permit untll Ilnel Inspectlon. CODE �, wsveenoxttve 1816 Fixed System Finel Fira Prevention 1266 Pool Spe Finel 200 Final Re-Rool 201 Final BIocWRetelning Wall 202 Final Factory Fira Plece 203 Final Sign 204 Final Demolition zuare PAIE I�p� cooe� iNsrecnoxnve 206 Final Mechanical 208 Finel Plumbing 210 Finel Electdcal 272 Flnal Fire Preventlon 220 Finel Planning Approval 222 Final Slte 250 Finel Building/Occupancy I � v Q� I[�45 V� (714)754-5273 • Fax(714)754-4856 Job Address: 707 W 19TH ST Suite No VlciNty: Parcel Number: 42420203 CITY OF COSTA MESA BYILDING DIVISION � DEVELOPMENT SERVICES DEPARTMENT PERMIT MECHANICAL PERMIT PERMIT NUMBER � M99-00415 77 FAIR DRIVE, COSTA MESA, CA 92626 SWtus: ISSUED Applied: 09/0311999 Issued: 09I03/1999 ISSUED BY: Appllcant: GIBBS, KENNETH �. _��_�, �1 -.-�: =i _� v � Address: 13910 CERRITOS CORPORATEDR " �� =' \� '-- � � -,� `�\ Owner: � �i� "Address:� 13910 CI /�,�Y < �' � /�/rl/ � �/ �� CERRITI � � � � � � � ��i% � �� Aroh I Eng �� .-t, j �� LAddress '/,' � � I �; f �� , � , , �/ y+� � - ,t �\ / �� > f,= ; �, � __ �, ,-, `,_� �G, i tPhone: 582•927-8863 � � ��-� �� 1 � �Zip: 90703-2458�� / �� C�� '�_ � �; �, t � ��, t�i��_� ,SSOC.LTD`-�-= -�- '_ _ =�L'%;� ( � �`j v\\ \RK TE 3�,�i"-=_<.�ca��C � i �%:✓ Phone: _� \��\�� /� i\ � �'� ; Zip: 92324 � �� 'ERATION CORP ��' ., � l, \� � ' ?RRITOS CORPORATE DR �' �� Phonei 562-921-8863 . _ -._�� )S. CA . . . . �: i 90�03-2458 � � i � ��V �., � � � A �y �License: _.637175!` ,: � ; � � > � {OS" <..�` V�- � i � \ �\\ \ � I s� \�� ,-_`v- � _ � __^ ,� �� /\ . r U��i�" �,�.��, / J i.�� `_i � Phone� � ��--J � l W ` _. 1� �� Zip: �'��. � .r License;. .� � . - _ .: -_ �� ' � . , , \, � ,� �� ? (�,, `SCOPE '� �,F, 2 COMPRESSOR UP�TOZ.5 HF..REF�B99-01 � r�� a�nun , \� , ��n'w , s �-`�zti�'�:� -, ,•. � �^ ' � QuanUty �, � - - ISSUE FEE, 1 � � 823.50 ' Ingt FAU <100.k BTU�V��, $0.00 __ 0 Inst FAU >100 k BTU ��'�� 50.00 0 Repair/Alt Cooling/Heat�� $0.00 0 � .. Inst�! Rep. Recess:Wall Htr� , $0.00 0 _ • � � ` + �" 4RY��T ^ � �� i � i , r T i- _ - _ . , i : ._ - QuanUty� Repair/ AIt�Absorbtion Unit '!: 30.00 � 0 �� Repair / Alt Refrigeration Unit �% �� $0.00 0�� . �! : Ventillatlon-System � �%;?, � 30.00 ' 0 i Evaporative�Cooler � lj � CS0.00, 0' � � Commercial Incinerator � , i-�� `50.00' 0` ; Refrig Sys <100 k BTU ��A 50.00- 0 � ' �-�-'�.,Domestic Incinerator � � !ij-'� '�50.00 ; 0 � Re6ig Sys->100 k BTU ,��A EO 00 0 �-;: ' = Compressors I Absomtion Svstems� j� �� .� � Gas Piping�� VA $0 00 0 �� '', � Up to 3-hp / 100 k BTU �� '!�"� �" $0 00 0� Factory Fireplace •"�� ,$0 00 - 0 _� r -�- � �� 3 To 15:hp I 500 k BTU - i�� -'-� � 30 00 ; 0 Hood w/Mecfi.Exhaust �=-$0 00 � 0'�' �". ' 15 To 30 hp / 1 000 k BTU �� -. $0.00 � 0 VAVBox �� $000� 0�"�, � . �' ';30To50hp/1750kBTU� � �j�� ,50.00 0 Ve�n�t Fan I Single Duct � �� SO 00 �0-� � ,� , � ? - - -Over 50 hp�/ Ovar 1;750 BTU /j �, �/i � ,50.00 0 FirelDa pers ��,\ `�� 5000 0'..�=\, _�� ``. .\Upt 3'hp'-.' � \�� / j, i�' 50.00 0 Smoke Dampers \A'\, �,30.00 , 0 . _ 3_To 15 hp `� � ,� � � � $81.45 3 Inst or Relowte Appl Vent- �� -� �,� $0.00 : �0 ��` � � 15 to 30 hp -. ��. U' � ; �" � $0.00 0 Air Handlers < 70000cfm \- \50.00'� 0� � ' �� ' �� ; , - 30 to.50 hp�-` �� ;� � � �" � 50.00 0 Air Handlers > 10000cfm �� 50.00 0 �-� ,� '-' � -- - Over 50 h � "i -= �� p=. �_ . / E0.00 0 Floor Fumace �$0.00 -- 0 � V - �V�, � -0ther Mechaniwl Fee �"r �% Floor or Suspend Heater $0.00,, 0- �- � � � � � � � InvestigatiomFee'�' �- 50.00 � � '<:- - Plan Check Fee--' 50.00 - - � =' � "r'` � � Reinspection Fee 50.00 TOTAL CALCULATED FEES 5104.95 COMMENTS / SPECIAL CONDITIONS NOTICE: The work euthorized by this permit shall comply with ell applicable handicap access requirements under Califomia statutas and related regulations. (Ord. No. 92-28, § 1, 1241•92) EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or il work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all appliceble codes, and ell requlred Inapeetlona and flnel epprovel must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of this parmit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSATON DECLARAnON: - I hereby affirtn under penelry ot per�ury one of t�e I011owing tleda2tions: ❑ I heve entl wlll melntain e certlficete ai consent to selt-Insure tor workers' compensetion, es provided for by section 3700 ot the Lebor Cotle, for the pertormanca ot the ��' work for which this Dermit is issued. [I \I have and will malntaln workers' compenseLon Insurence, as required by secllon 3700 ot Ihe Lebor Code, tor Ihe peAortnence o� t�e work tor which ihis pertnit is issued. My workers' compensation Insurance caMer end policy number are: Cerder: (Thls se or �ess.) Policy Number: ❑ I certify thet In Ue pertormance e work wh is permit Is issued, I shall not employ eny person in any manner so as to Decome subJect to t�e warkers' �com nsation lews of Calito ', and at { Id.become sub ect to Ihe workers' co ensation rovisions oi Sectlon 0 t the labor Cade, I shall forihwith �a�5�a . � �� 9�� pplicent Signatur � Dete: FAILURE TO SEIXIRE WORKERS' COMPENSATION CpVERAGE IS UNLAW FUL M!D SHALL SUBJEGf AN EM CPIMI UL ENA�TIES AND CIVIL FlNES UP TO ONE HUNDRED TFKKISAND DOLL4RE (5100,000), IN AODITION TO THE COST OF COMPENSATION, OMUGES 0.5 PROVI�ED FO{i IN SECfION 3108OF TME LABOR ODOE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACT 9S.DECLAR I here�y at I em Ilcen d under for d eNect. Lic. M Conir ctoYs 51 CONSTRUCTION LENDING AGENCY: Sectlon 7000 of Divlslon 3 of ness entl Pro�@ssions Cotle, antl m Ilcense is In full Y _ assa �'SX _ 9-3— ❑ I hereby eNirm t�et Uere Is e constructlon Ientling epenry tor the peAormance of Ne work for which this permit Is Issuetl. (Sec. 3097, Civil Code). Lendefs Neme: Lendefs Address: Signeture: _ OWNER•BUILDER DECLARATONS: Dete: I �ereDy ettirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Buslneu entl Professions Code: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repalr any siructure, pdor to its Issuance, elso requires the epplicant for such permit to file a signed sfetement t�at he or she is licensed pursuant to the provisions of the Coniractors lJcense Lew (Chapter 9(commencing with Sectlon 7000) ol Division 3 of ihe Business antl Professions CoOe) or that he or she is exempt t�erefrom end tha basis for Ihe alleped exempNon. Any violatlon of Section 7031.5 by any epplicant tor a pertnit sub�ects the applicant to a civil penaly of not mare than frve hundretl Oollars (5500).): ❑ I, es owner ol the properry, or my employees with wages as iheir sole compensation, WILL DO 7HE WORK, entl the siruciure is not intenCetl or atteretl tor sale (Sec. 7044, Business entl Protessions Code: The Coniractors License Lew does not epply ta an owner of property who builds or improves thereon, end who daes such work himsetl or herselt or thmugh his or her own employees, providetl that such Improvemems ere not intendetl or oHeretl for sale. If, however, tha builtling or improvement is sold within one yaer of completion, the owner-builder will have i�e burtlen ol proving Ihet he or she did not 6uild or improve tor purpose of sale.). ❑ I, es awner of t�e property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Buslness and Professions Gode: The conirectors License Law does not eppty to an owner oi property who builds or ImOroves ihereon, and who contracis for such projact with a contractor(s) license pursuant to Ihe Contractars License Lews.). ❑ I am exempt under sec. Signature: Owner ID veritietl 6y tlrivefs license. ❑ Yes ❑ No Business entl Professions Cotle br ihis reeson: Verification of Ownership by (type af tlaument, I.e. - properry tax bill or deeA): Driver5 LitenSe No. Date: Expires: DIVISION OF INDUS7RIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby cenity that no excavatron fNe (5) or more feet In tlept� into which e person Is requlred to descenq will be metle Im m�nectlon with work authorizetl by this permit, antl ihat no Duiltling sirucNre, scaflolEing, lalsework, or demoliNon or tlismantling Ihereof, wlll be more then thirry-slx (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Cellfomia Atlminisiralive Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which wou10 require a permlt irom ihe Dlvision ol Industriel Salery, es noteO ebove, unless such person has e permit to tlo such work trom t�e tlivision. Slgneture: Date: I Divlslon of Industdal Sefery Permit Number. ICEHTIFlCA7E OF COMPLIANCE AND AUTHORVATION OF ENfAV: I certify under penalry ot parJury �hat I have read this eppllcalion and stete that the intormation given is I correct. I agree to compty with all state laws end ciry ordlnances relating to bullding constructlon, end euthodze representetives ot Ihe Ciry ot Cosla Mesa to enter upon t�e above-tlescnbed pmpetly for Inspectian purposes. I agree not ta occupy or allow occupancy a� eny bulltling authorized by this permit un01 tinal Inspectlon. ceie �s 181 B Fixetl System Flnel Fire Preveniion 1266 Pool Spe Final 200 Final Re-Roof 201 Finel8locWRetelning Wall 202 Finel Fedory Fire Place 203 Finel Sign 204 Final Demolition Y4o&a8 COOE I INSPELTON TYVE 208 Final Mechenical 20B 210 212 220 Finel Plumbing Finel Electrical Finel Fire Prevention Final Plenning Approvel 222 Flnel Site 250 Flnal Building/Oaupancy Date �.i .w�i. rr �I, CIN OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PER MBER `"`"'� E98-00987 (714) 754-5273 • Fau (774) 754-4856 � 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 707 W 19TH ST Suite No Vicinity: Parcel Nunmber: 42420203 Applicant: Address: Owner: Address BALLARD,DESMOND status: ISSUED Applied: 09/17/1998 Issued: 09/17/7998 - .�,'� � ' FFione: -' 258-1660 �� ,...'• _ . 7�'� % ' Zip:- � � � � ;��,�' � , . /� i � - _ . �r': ' �� s , `�j, �� - �;� JAMESL�AND ASSOC.LTD �� - �� -�� ' ,� �\ �A iTATER�BROS MARKETS'� =' k - �' �� '� '� l � V ��`j ii f n � ' - - " - �.; l �. A�� i � \ OLTON,CA ��. _ �Phone �\„ �,.� ;-. � � �_\ � � �\ -, i�i�/P0�80X760-, j/ Zip: 92324 =�_,��•/��.�� :�� i .//��;% �:�`�� ;�`" i �`,� !n;y�l �'\ /,ji;:% � �1�� ,\,, Con;trector.'i .AWARD-SIGN CO. �, "� ' � � i � � � ,� �� ,, . ;Address `� r'1707 S�80YD ' ��' ' �� `,` n � � . ' � �-�i � /i�.� 'i� - _ , Phone:y 714-258-1560 , -'-, ��`, � � i � ��S.A:CA.,- . ::�Zip.�92705� •� ' � . �, ..� � � � _ '. / �.. "'� � 1� �.+�License: .64232� . ..�_ ` � � � = ? , . -' - ' '� " � � f .1 . "� _ - . y . J �� - . . �. � �. ,! ' - /. : � . . - - � . � . `� � � . � � . - .>: � .. ' . � � � � � � SCOPE OF PERMIT ' . ` ` ILLUMINATED WALL SIGN "SMART & FINAL" REF 5898-131. " V � j r. / � ,i__ �,ri � �_ y . ISSUE FEE Temp service test Ftes. a/c package New Res (1-2 units)a New Res�(3+units) Pool / Sp'a, . . Lighting Fiits "��. � Recept Outlets , - Switches � �� . _ Non Res AppL ��, Res Appl � .- ,,, Service to 200a ��. �� Service to t000a Service over 1000a `.. Motors to 1 hp , Motors to tOhp Motors to 50hp Motors to 100hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole � � � ,t . � , .... �. . , - �� - � FEE SUMMARY � � ��. � � �� 'Quantity . . .' Quantity r $22.00 • � " "' `�? � - ,-_ Temp�Dist System'% Lighting. � $0.00 0 • $0.00 � - _ • - . -.=6usway /100:ft• rE- �-'" � -, $0.00 0 : . $0.00 ' - ` ' � -� -� Standing�Section � � � $0.00 0%� �,� � ' $0.00 � 0 Misc Elechical Equipment $0.00 0`�.. , ; ^ $0.00 .� 0 Transfoimers�uptolkva/kw � $0.00 0:�� . � ,•�,. $0.00 0 ._._.....:...-.upto�]O.kva/kw $0.00 `0�" � . '. �� . $0.00 0 .................up to 50 kva/kw , $0.00 ,' .p' ' . , . - .� $OAO , 0 - .....r...........up to 100 kva/kw $0.00: "- 0 . . . �. j �� $0.00 0 :...:..-�.......over100kva/kw '$0.00�;,,' 0 . '.$0:00 0 ;�� , Cow Voltage Equipment $0.00 % 0 � � ' - $0.00 j,� 0 � �� ,'- � ,Low Volt Wiring System / Ckt „$0.00� 0' ,, - � � ��$O.00;j,� ^0� � - ��`;.., �'Misc�ConduiY^ ' -'�$0.00 0 i "$0.00'� `�� 0 .';. . � , Misc,Conductor.� - $0.00 ; 0 : �� $0.00 � 0. � , ; ; - � -'Circus ( gen or ride) - � � � $0.00 � � . 0 �, �i � _ $0.00, 0 -_ � � � � \' •Circus (mech Flde or lights)- � $0.00 � � 0 � �� $0.00 � 0� � � , �.-,ChristmasTieeStand . , ��$0.00" =.O�i � . $0.00� - '' , 0 . � . Fireworks Stand $0.00 - � • 0 � - � � $0;00 � � .' 0'-� � ' -; Other Electrical_Fee � , � � $0.00� � � �`$0.00�. , p � .. . $0.00_ - _ 0 ' �� , � � � Investigalion Fee , - � - � . �$OAO � $0.00 � 0- ' � �, Plan Check Fee - �$0.00 $0.00 � 0 _ , � � _ __._ Reinspection Fee � -" $0.00 $22.00 1 - - . . _ _ , , - " . $0.00 0 � � TOTAL CALCULATED FEES $44.00 $0.00 0 COMMENTS / SPECIAL CONDITIONS EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a penod of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapeetlons and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. fOH INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby aifirm under penalry oi perjury one of the following tleclarations: ❑ I heve end will maintein a cenificate ot consant to selt-Insure tor workers' compansetion, as provitled for by section 3700 oi the Lebor Cotle, for ihe perfarmance at the work tor which Ihis pertnit is issued. �I have end will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Cotle, for ihe performance of ihe work for which Nis pertnit is issuetl. My workers' compensation Insurence carrier entl policy num6er are: Cartier: � Policy Number: (This sectian need not 6e comp/eted i/ the permit /s velued et one hundred dallars ($100) ar less.) ❑ I certiy that in Ihe pertormance oi Ihe work for which Ihis permit is iuue4 I shall not employ any parson in any mennar so as to become subject to the workers'� Sempenu' laws o mie, antl agree ihet i houl co su� workers' compe proviswns oi Sectl �n 3700 oi ihe Labor Cotle, I shell fonhwith �M rov ns. o %� � � �/n ry Applicant Signature: `/( i Data: ! D YJi9dIdG-FAlttl TO URE WORKERS' COMPENSATION COVERAGE IS UNtAWFUL AND SHALL SUBJE AN EMPLOYER CFIMINAL ENAL IES AND CIVIL FINES UP TO ONE HUNDFED THWSANDOOLLARE�$100,OW),INADDITIONTOTHECOSTOFCAMPENSATIIXJ,�AMAGESASPROVIDEDFO WOFTHELABORCODE,IMEREST,ANDATTORNEV'SFEES. LICENSED a(ihet I am lic�qsed� nder provisions of Chapter 9 BCL LIC. # SignaNre: with�on 7000) of Division 3 of�9,g`iness end Professions Code, and my licanse is in full Date: CONS7RypT10N LENDING AGENCY: �� Q I hareby affirtn �hat ihere is a constructlon lending egency for ihe perfortnance of ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lendefs Nama: Lendefs Address: � Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby aNirm ihat under penalry of perjury ihat 1 am EXEMPT FROM TiE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions Code: Any ciry or county which requires a pertnit to construc4 alter, Improve, demolish, or repair any strudure, pnor to its issuance, also requires the applicant for such pertnit ro tile a signetl statement Ihat he or she is licensed pursuant to t�e provisions ot ihe Contrectore License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of ihe Business and Professions Cotle)br thet he or she is exempt iheretrom end the basis for the alleged exemptlon. Any violation of Saction 7031.5 by eny applicant for e pertnit subjeds ihe apPlicant to a civil panelry of nat more then five huntlretl tlollers �$500).): ❑ I, es owner oi the property �or my employees with weges as their sole compensation, WILL DO TME WORK, and the striicture is not intended or ofleretl for sele (Sec. 704d, Business and Protessions Cotle: The Contractors License Lew does not apply to en owner of properry who builtls or improves ihereon, end who does such work himself or �erseli or Ihrough his or her own amployees, providetl �het such improvements are not intended or oHeretl for sale. If, however, ihe bulltlinq or improvement is sold within one year of completion, ihe owner-builder will have the burtlen of proving Ihat he or she tli0 not build or improve for purpose of sale.). ❑� I, es owner ot Ihe propetly, am EXCLUSIVELY CON7RAC71NG WITFi LICENSED CON7RACTORS to consimct ihe project (Sec. 7044, Business antl Professions Code: The coniractors Licanse Law does not epply Io an owner of property who builtls or improves Ihereon, and who conirecis for such projec� with e conirector(s) license pursuant �o the Contrac�ors License Laws.). ❑ I am exempt under sec. Signature: Ownar ID venfied by drivefs license. ❑ Ves Verification of Ownership by (rype of dwument, i.e. Business and Professions Code tor ihis reason: ❑ No Dnvefs License No. property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Date: Expires: ❑ I hereby ceNiy thet no eacavation five (5) or more teet in depth INo which a parson is required to descend, will be mede in connection with work authodzed by this permit, and ihat no building shucture, scattolding, talsework, or tlemolition or tlismantling Ihereof, will be more t�an thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Title 8, Celifomia AdmlNstretive Cada). ❑ As owner-huiltler, I will not employ enyone to tlo work which would require a permit from ihe Division of Intlustnal Safery, es noted above, unless such person hes e pertnit to da such work from ihe division. SignaNre: Date: Division of Indusirial Safety Parmit Number: CEHTIFlCATE OF COMPLIANCE AND AUfFiORIZATON OF ENfHY: I cenity under penalry of perjury that I have read this epplication and stete that the informetion given is wnect. I egree to comply with all slate laws and ciry ordinflnces relating to building construction, end authonze representetives of the City of Coste Mesa to enter upon �he ebove-described property for inspection purposes. I agree not to occupy or allow occupency oi any building euthonzed by this permit until final inspeclion. .� . � m., N�9 1616 1268 200 Fixed System Final Fire Prevention Pool Spa Final Finel Re-Roof 201 Finel BIocWRetaining Well 202 Finel Fectory Fire Place 203 Final Sign 204 Finel Demolilion za5ee DA� U�AL4 caoe� ixsvecnoxme 206 Finel Mechanical 208 Finel Plumbing 210 Finel Electncal 212 Final Fire Preventlon 220 Finel Planning Approvel 222 Finel Site 250 Final Building/Occupency �17.�ii ! � i r,unr.q �_ ��Applicant to fill in all sDacas within heavy Daraer lines ana si9n all apo�opriate aeclarations. GTY OF COSTA MESA PERMI N TRACT NO. LOT NO. p BLDG'. NO.' - � - , CONSTRUCTION PERMIT � D (�` � 0292 6/29/82 g,pp :7� ,.,,. . __ . Proiect Address Q Oj � Q g�{O. TVPE OF CONSTRUCTION , � � � � � - � � „ � � � Ownef ��E�i � P�h/one � 3 Q' ❑ NEW � ADD ' � ALTERATION (A�/.� ' � � - ' '�� - � Addr¢ss ' 3 a- a�c.dn 1C('- •�'I��6 - � REPAIR ❑�CONVERSION C)E LISH �'L� ' � ZONING REGUTATIONS 'Arch/Eng. �, - - ' '� LicenseNo. - � - �OTHER � DESCRIPTION OF RK p"P' � " ' • � 'Addf255 �' ' - !' - ' " ' - - ' • " 20NE 'PING. REF. � " - ' ' contractor Phone S d7/3 �— - - - - - TpgU p t. . . RAM1J l�//. y9 TVPEOFPERMIT 5eT ac r. I irvG• '�Addf255 'a'�a i N' �( � CSd � . � GRADING,' O-FOCINDATION ❑ STRUCTURA�� ^ � yARp _ P0.0PE�TV LINE �, LICENSED-CONTRACTOR DECLARATION � �� -❑TENANT �ELECTRICAL OPLVMBING�OMECHANICA 9�p g-yq . . � _ _ . I hereby affirm tn;,t I am Iicensetl Untler ision5 Of Chafter 9. (Com- �. � �'; � RIGHT mencing with'sectlom 7000) o( Divp on of the� Business� antl -��OTHER- -- -- . Protesslons Cotle, jantl my Ilcense AS full force antl e fect. - � • ' '� REAR YAR� (TO P/L) � � �_ �-" - � U. �- / - _ _ 7 _ PROJECLDESCRIPTION Lirensa las �� ice e IVo. t � ,� t� ' � ' -� � � : ' � PKG: SPACE REQ. PRO V IDED�. ' ' ' Date Signature 5�. FT.. '� " . _ _ . . . _ _ , _ WORK RS COMPENSATION C ION -_ � OCCUPANCV�CONSTRUCTION TVPE � STREET WIDTH� � PARK F,EE 5" . ZONING APPROVE� BV'- ' � DATE �I hereCy affirm that I have a ce cate f consen[ to seH-insure or a�_VACVATION ZONE � � "certiflcate ot Workers' CompenSation InSurance, �Or-a certl(IeG copy . _ � - . _ _... . � . �thereof (Se<tlon 3800, Lab. C.). . � GRADING CV: YDS. ACRES ,SPECINL CONDITIONS: � - PoIICY No: � � ' ComPanY " - ' -- - ' ' ' ' - "- " " ❑�Certifieticopyis�hereby.turnisnetl.. __ _ _. - _ �. REMARKS:'. . . �� _ _ _. __,._ _ _ . , . . ❑ Certlfletl topy iz filetl witn t�e city Builtling Division. � � � � - .- - - ' � . EXEMPTION FROM WORKERS' COM7ENSATION DECLARATION - ' ' - ' • � •' '-• � ' - - - - - (This section.0¢etl no[.D¢ cOrtlplet¢tl It th is fo� on¢ huntlr¢tl _ ' ',I �, ,. SE3001 or lessl. - f . , . ""''" 1' _ " . - - ..." _ ' ' ' . cert(}y that In the p¢rtormanCe ot th¢ or whith lhiS permft IS . . ' issuetl, I s all n t employ any person i - nne so as to become PLUMBING •� ',� PLAN CHECK " - '� ELECTRICAL -`' PLAN CHECK - - ' Subject he�'d el5' CompensdtlOn O/ II nid. f _, __ _ _ Date � Signatura � BATHTVBS ��SHOWERS , _ � NOTIC : If tter making this tleUara ' u shoultl betome subjeci �. TOILETSp� � ,� V RINALS-' ' " ' -�GENERATOR �- p:l KW_ 1-30 KW � - ' - � ' to the Workers' Compensation provi ' s ot he La�or Cotle, you must �-- � ' TRANSFORMER � . forthwith comply"with such provi5ion5 or this permit 5hall be tleemetl LAVATORIES DOVBLE'CAVS'--' - '"- -.APPCIANCE - 10-50 KW_50 t KW - - - revoketl. � _ . � CONSTRUCTION LENDING AGENCV �KIT:SINKS " "'- �ISHWASHERS - '.MOTORS \ '^ Od'HP_1-30 HP ' � - I hereb affirm Ihat [herG is a Constrvttlon I¢ntlin a enG for [h¢ Gr- - - ' -- ' IN0. SOLAR) _. ' � tormance ot [hG work tor whicb this permit is I5iue0 (Sec[ion 3097 SERVICESINK$ $UMPS " '� '( � 30-50 HP_�SO+HP- - -- - _.I Civ:C.). - " " " ' "-" -^" ' . ' FLO�ORSINKS ' FLOORDRAINS- ' - - 'FI%TVRES'- OUTLETS "-SWITCHES- ' -'-' .Lentler'z Name 'Lentler's Atltlress � � ORINKING FOUNTAINS - `�' " ' -" ' ' ' •�GAS TUBE SIGNS - - � - •� - - - �� - OWNERBUILDERDECLARATION ' -- ' '" �NTERCEPTORS CLARIFIERS � � POLELIGHTS' ' - ' - -- - - - - + I hereby af(irm that I am exempt trom.the ConVactor's LicenSe L.aw for tne tollowing reason (SecHon�7031.5-8usiness and•Professions Cotler -SWIMMING COOI-` PTRAP' ' ' ' - � -- ' Any city or county which requires a permit to construct, alter, ' �POLES METERED�� SUB� -� improve, tlemollsh orrepair any structure, prior to9trissuance, also re- yyqTER SERVICE - ACTERATION " ' PArvEL'S'" '-' ' MAIN -' SU8' � - - quire5 the ap:litani to� Such Oermit to fila a Signetl Statement tha[ h¢ ._. � I5 Ittensetl pursuant to the provlsions'of [he Contractor's Cicense law GA59ERVICE � � � OUTLETS ' - SERVICE • ' - - - - -•- ---- qMP -- -- - (Chdpt¢r 9(commenting wi[h SeCtion 7000) ot Division 3 of the Business antl'Professionr Cotle) or that �ne Is exempt tharefrom antl the yyqTER HEATERS ` - BTU OVTPUT' ' - ' -�^- - - - - - -- ` �-- ^ - •I basiz for the allegetl exemption. Any violation of Section 7031.5 by any applicant'for a. permit subjectrtne applicant ro a clvil-penalty SEWER CONNECTIONS . - '- " ' '- " ' - - - - - - - - of mt more lhan five huntlretl tlollars (§500). � - ❑ 1, a5 owner of the property, or my employ¢e5 with wage3 es [heir' SOLAR-TANK' COLLECTORS""" � � ' ' _ � ' ' ' _"_ ' "_ sole compen5atlon,_wlll tlo_Ihe work„antl the s[ructure,is not Intentletl � �^ ' or ofieretl for sale. (Section 7044, Business antl Professions Cotle: The � SOLAR PIPING SVS. � --~`� - - �SSVE FEE' '� - -� - -- - Cont�acto�'S ucense Law tloes not apPly to an owne� of a prop¢r[y - 'who builtlz or Improves thereon, antl who tloes zuch work himselt or ISSUE FEE •� - -- ' �"' - ' APPGCATION'APPROVED BV - -- --, DATE ^- - Ihrou9h .his own ¢mployees, provitletl tbat sucb ITprOvements are not intentletl or offeretl for sale. If, however, tne builtling or improvement- MECHANICAL �LAN CHECK -��- � Is soltl within one year o/ mmpletion, the owner will have the burtlen I $UMMARV OF FEES , ' , of proving he tlitl not builtl or imurove tor the pur0ose of-zale). HEATING SVSTEM 0-100,000 BTU - BUICDINO- -�- -- -- �- - - , � �� I, as-�owner�of-t�e�pro0erty, am exclusively-con[racting wi[� �. PERMIT . E �' SMIP; 5 licensetl contractors to cons(ruct the project (Sec[lon �044, Buziness AND DUCTING 300,000 + BTU � �� antl Professions Cotle: The Contractor's License Law tloes not apply to � � PLAN CHECK_ S PERMIT � an owner of property who builtls or improves [hereon, and who con- REFRIGERATION 0-100,000 BTU , PLUMBING - - ISSUANCE S tracir from� such pro�ects with a contra<tor(sy Iicesnetl-pursuant to � SVSTEM - --- � . S_ .. ,GRADING E' � the Conlractor's License Law). 300,000 + BTU � PLAfV�CHECK S . ',� � \ ❑ I am exemp["untler Section - B: S P. C.-for this BOILERS BTV f ELEGTRICAL �y �- ' ' a' _ � reawn- ' PLANCHECK E MICROFILM S �-+ � " SVSTEM REPAIR,ALTERATION \V Date n ' TOTAL FEE S �` I herebycertitythat I h e r [his appliwtion antl siate tna[ the above EXHAUST SVSTEM MVLTIPLE � MECHANICAI .E' `information is correct -1 ee [o mmply wiih all city anG county PLAN CHECK� y� LE55 AD- ortlinances antl sfate la ei ting [ mn5[ruction, antl hereby authoriza ' VANCE PC S= representatives of t cit ' lo nter upbn Ih! abOJe e one0- � ' ' ' � a property for inspe i es. ` , Signature Date � V . • _ FINAL FEE S� Driver ' License o 5 ! � � ' ISSUE FEE - - . . _ CMF 0865-46 i[e-Builtling; Gnary-Applifant; Pink-Accounting; Goltlenrotl-Assessor CONSTRUCTION AND PLANNINCG ' POOL & SPA .. ,� . APPROVALS Permit# Lyd�OO Date Inspector qppROVALS �� Permit#' � n� � Date � Inspector i. Temporary Electrical Service or Pole � - 43. Pool & Equipment Location •� - '' - - Soi ipN-Un rgrn 44. Steel Reinforcern0nt- � - � - -. 3._.Electrical Conduit Utility-Undrgrn 45. Forms -- - � - - 4._ Electrical Conduit-Undrgrn - . .46. '.Electrical Bonding - -- - - . tee am orce � 47. RougR Plumbin �& Pressure Test � � � - .6. Electricai UFER Grn 48: APPROVALTO COVER-GUNITE -' 7, ooting6 ' Y 49. Electrical Conduit-Undr rn ' • 8._ Eoundation . � 50: . Gas P.ipe,, ❑ Undr m, Tes -�' - � 9. Water-Fipe-Undrgrn _ 51. Backwash Lines P-Tra ❑ nd� rn ' �'- ' ��- - 10. . Structural Floor SYstem. 52. APPROVAL TO DECK" ' ' , 11.. Fropert Sewer Line.&.House Connection: �._ _.53. Backwash &.Rece torvFinal - � �� - 12. Street Sewer Connection `' �' � � � �� 54. Heater & Vent-Final � ,. 13. Rough Plumbing ' " ' -' � ' 14. Rough ElectricConduit - � - �56: Electrical•Pinal � • " � � � 15. Rough Electric-Wiring- � � - - - 57. Solar System-Final . � � ` ' i 6. Rough Heating & Air Conditioning � ' - - � - - - - encing & Access Approval �� 17: Ducts in Structure � - - - APPROVED FOR PLASTERING . ' ' - � * 16. Ducts, Ventilating - � - � _ _ ' � � 19. Gas Pipe-Rough &Test '' 60. POOUSPA SYSTEMS FINAL " , '� 20. Roof Framing ' � -- - � � ' 21. Roof SheatFiin � - -: � � � � � � � � 22. Frameand Flashin NOTES: ' 23. Insulation- - � � � � ' � --24. Lathing & Siding - � --- - -- - �- - - - � • � 25. Drywall Nailing - � � ' � - � � - ' 26: � Plaster grown Coat � � ' � � 27. Electrical Power Meter-Final _ - "" � '' ` , � 26. Final Electric - - - - - - - -� - � � � � � 29: Final'Heating & Air Conditioning� - � - - - � � � � 30.. Fihal Gas Pipe-Test - ' • 31. -Final�Plumbing , " ' � " ' ' �32. Water Service-Final � -- - ' � ' � � � � - ' � ' 33. Gas Service-Final � - ' � ' ' 34. Solar pomestic-Final � � � � - � � � - • ' ' � ' 35. landsca e S rinklin S stem ' � � � 36. Sound Attenuation � . 37. Handicap Regulations � ` � � �� ' 38. FINALSTRUCTURE&BUILDING • - - � 39. Special Requirements Comp�eted � � � �� ' � � 40. Electric Release to Edison ' � -� ' 41. Gas Release to Southern California Gas Co. � 42. CERTIFICATE OF OCCUPANCY - _ . - ' ' � No � Date i 7�y- 5a �� - � CITY OF COSTA MESA COt� (�TRU� Project Address �Q? � /� Applicunt's Mailing Address a��'� �✓� Owner'sName �✓�!� ��'Ph�� Address� �37p'� ��/�'L� � Arch/Eng. '�� , L Address � '- Convac�or's Nam � N� SCt�� Address (mailing) ��' 2 y � C _ City License No. —�.Z.rj LICENSED CONTRACTOR DECLARATI I he�ebg a(firm [hat I am li<ensetl untlet o c with sectlon J000) o( Olvision 3 of t B nE my Iicense is in full (�cce� q.eHect. License Q 55' �� Da[e � Si9nature )RKE 5' COMPENSATION D A ION .ereby atfirm ve a certi of onsen of Workers' CompensaL e; or a cee 3800, Lab. L.)�y�1� � � ��2 ` PolitY No. G ��t � PanY' BCertlfietl copY �s h¢reDy lurnis N No. _�%�`�'' AOP��ant to fill in all spaces except t�osa wltnln neavy borEer Ilnns anC sl9n all appro0riate Ceclaralions. � T rPERMIT NO TRACT NO. LOT NO. UNIT NO. ., ..-,G,,, e of Charler 9 (tommencing antl Profeszions Cotlo, antl :nse No. �p �/ � I% 'e or a certifiWte tnereof (Soction C¢r[ifle0 copy IS lil¢tl wit e city Bulltling Division. Date Pplicant EXEMPTION FROM WORKERS' COMPENSATION ARATION (This section neetl not be completatl if the plrmit is � o e ��nCretl (5300) or . less) , I certity�tbat in lh¢ p¢iformance ot the wo�k tor hic this pe�m�t fz Issuetl I shall not e pioy any person in any manner so s ecoma subjett to t�e Workers' (on Laws of Califomia. Oate Si9nature 'NOTICE� It. a t makinq [h(5 tlec�a�alion: o tl'b¢Come subject to the � or FG I hereby atfirm th ere f cons r ctlon g�agenc [ne rwrmanca ' of the work fo ' is 5 c Civ. C.) Lentler's Namo —� � � � � - � Lentle�'S AOd�e55 `�'�- ^' ,�—�- �� _ � •� 7— OWNER BUIL�EN DECLARAT10fJ � I he�eby atflrm that I am ezempt /�om th¢ COnt�actor'S LIC¢nse Law tor [hu follow�n9 reason (Sectlon �031.5 Business antl Profes5ional Cotlo: Any citY or county whlch requires a permit to <onztruct, alter, improve, tlemolizh or repair any structure, pnor to its issuance, atso requires [ne aoP��ant tor such parmit 'o �ile a siqnetl Statement thdt 11C/Sb8 15 IICCOSIitl pUfSUdlII f0 IIIB pfOVI5I005 OI e Contractor's.License Law (Chapter 9(commen<ing witb Sectlon 7000) of 'rision 3 ot t�e Business antl Professions CoOe) or that ho/she Is exampt terCtrom ana lhe bails for thC allegetl ex¢mpllon. Any vlolaUon oi $ccllon , ]031.5 by anY applicant (or a permlt Subjects tM1e apPlicanl lo d civll �e�dlty ot not more lhan liv¢ huntlretl tloliars (5500). 1, as owner of the property or my employecs with waget as their sola compeniatiOn, will tl0 Ine work, antl lhe structure is nat in[enEetl or oHeretl lor ule (Section 7044, Business an0 Prolessional Cotle: The Contraclor's LicenSe Law tloe5 nOt applY �o an owner Oi a property wh0 builtls oniTprove5 lperaon, antl wbo tloe5 Such wO�k himsell/berselt or throug� h15 Or hOr own employees, provitletl that such Improvoments aro not Intanaea or otleretl for sale. It, however, tne buil0ing or improvement is saltl witnin ono year ot com- pletion, tne owner will have the burtlen ot pwvin9 he/sne dla not Eulltl or Im- ' prov! to� Ihe purpOse o1 Sal¢). . � � ❑ 1, ds owne� oi Ihe p�operty, am exClu5lv¢ly Cont�actin9 wlth IICCnintl con- tractors to conztruct the pro�ect (Section ]044, Business antl Profezsions Cotle: '� The Contractor'S LicenSe Law does not apply to an owner oi property who builtls or iinproves cnereon, antl who contracts for such projectz witn a wn- tractor(51 licen5e punuant�to ttle ConVactor's License Caw�. i am awara lhat proof o( thei� Worker'S Co sation insurante shoultl ba provitlBtl to ma. ❑ I am ezempt untle� $ec n B. & P. C. lor thli rea5on TYPEOFCONSTRUCTION LJNEW U ADD LJ ALTERATION IJ REPAIR � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p,ny . . DESCRIPTION OF WORK/USE OF BLDG. � � S Main Buildir TVPE OF PERMITof GRADING FOUNDATION STRUCTVRAL T Front ❑ TENANT JeELECTRICAI ❑ PLVMBING ❑ MECHANICAL 8 Rear ❑ �OTHER � ' A PROJECT DESCRIPTION 5�. F7. � oCCUaArvCv C Right �CONSTRUCTIONTVPE - VALUATION$ g Left . � ZONE � G IN CU YDS. AC0.E5 p�ng. RCf. # Remaiks: I O.n.. .a1/1 � �/i . 1• /if� 1! /I/U1D7 . Planning NO[25: Bar Sink Backflow Preventer ' Backtlow Irrigation Bathtubs � - - Clarifiers � Dishwasher �rinking Fountains Floor Dreins Flbor Sinks ' . Gas.Service Outlets Interceptors, Kitchen Sink . ' - Lavatories P-Trap Roof Drains Reinspection Fee � $15 eoiier �uct - Under Ground Duct - Struclural Duct � Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fatt. BI�. ICBO � � Date O - � Heating System & Ducting I here0y certify [hat I have eatl'thi5 application ana slale that lhe abovo ❑a100,�� BTU �10�,�00$T information is correcc. gr to omply with'all <ity antl county ortlinances antl state lawz relatin iltli constructlon, antl hereby authorize epre- sentatives of this cit upon the above-mentlonetl oper �r - inspection puroosas. , ' Oate � Signature - Orivers' License or � Reinspection Fee CMF 0865-46, rev. ]0/84 White - Bulltling; Ganary - Appliwnt: Pink - Accounting; GolOenrotl - Assessor $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wesh laua Fee Automatic Washer ing Unit ' 6414 � r- , _ � Accessory Building: � Parking Req./Provided i i, � � ELECTRICAL� ' ' Dryers LJGas LJEIe ' Fan • .F.A.U. _. . . Fixtures Device Boxes . Outlet5 Switches Garbage Dispowl ' Generator D0�5 KW I Hood or Typel ❑ Canopy Typell ❑ � Retrigeration System 00.100,OOOBTU ❑100,000 System Repair/Alterotion. Fire Dampers Registers � Iwue Fee 5 3 5 3 � Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Mecer ❑over700amps Sub Panel Motors �41 HP O 1'r4 - 8 InaSolar 09-75 HP �76-15+ Microwave Pole Light Range Sign ' Standing Sections Trash Compactor . � Reinspectian Fee �$15 � I luue Fee DEVELOPMENT SERVICES RE�UIREMENTS: ZoninB Approved By Building APProved BY � Application Issued By �` � 13;00 TL .:_T�.S�' TL FEES 0 5 3 � SUMMARV OF FEES ' BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT - PLUMBING $ - ISSUANCE $ ' PLAN CHECK 25% S � ENERGY P.C. 5 ELECTRICAL $ � GRADING S ' - PLANCHECK 50% $ MICROFILM 5 ' MECHANICAL � $ TOTALFEE S �.�• PLAN CHECK • 25% $ � 2 O N I N G R E Q M T S � CONSTRUCTION AND PIANNING POOL & SPA �: " � Date Inspector Date ?Inspe�or APPROVALS Permit # APPROVALS Permit # - _ 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � c� 3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms t: 4. Electrical Conduit-Undrgmd. � 55. Electrical Bonding � � ll 5. S[eel Reinforcement 56. Rough Piumbing & Pressure Test ,• 6. Electrical UFER Grnd. 57. APPROVAL TO COVEFi-GUNITE 7. Footings 58. Elearical Conduit-Undrgrnd. � " . c� 8. Foundation .� 59. Gas Pipe, O Undrgrnd., Test . 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Properiy Sewer Line & House Connection 62. Backwash & Receptor-Final , 12. Sewer�Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final . 14. Rough Plumbing 65. E�ectrical-Final 15. Rough Electrical-Conduit � 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign , 68. APPROVED FOR PLASTERING _ 18. Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. FEQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil� 23. Gas Pipe-Rough & Test 72. Underground Flush � - 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing . 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. Plaster Brown Coat 79. FINAL INSPECTION � • • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �j � Notes: �� 34. Final Heating & Air Conditioning � � 35. Final Gas Pipe-Test . 36. Hood or Canopy ' � 37. Final Factory Fireplace . • ' 38. Final Plumbing � 39. Water Service-Final • ' 40. Gas Service-Final ' • • ' , 41. Solar pomestic-Final � � � ' 42. Backflow Preventer • 43. Backflow Irrigation � ' • � 44. Landscape Irrigation System • ' 45. Sound Attenuation - • . 46. Handicap Regulations � . :� ; 47. FINAL STRUCTURE & BUILDING � 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY " No. � Date - _ � ,- AOO��tanl t0 Iiil in all ipaees ezceD� lhose within neavy noraer Iines ane sign all aDo�avriate tleclantions. aTY OF COSTA MESA CONSTRI�C�TION PERMIT . Prolect Address ?V � �'L�• �� Applicant'sMailir��q)Address - - 3 L �t. �' ' Owner's Name C��f �C� ��='r��`"Z� Phone �� Address �' � 7U �— ��"t-�' e<a✓c LA.r. ✓.�' l(.1,�✓+ Arch/Eng. License No. Address � Contractor'sNam �'�aN Pho e � Z� Address (mailing) � z7� City License No. Z � IICENSED CONTRACTOR DECLARATIO ' I hereby aHirm th5t 1 am licensetl untler pr isl s of Chart¢r 9(cnmmentlng with sectlon 7000) of Division 3 of the usi antl Vrofessions Cotle, antl my license is in full try�.�¢ a� e cl. � O Llcense Clayz �•� ense No Date 519nature ' : WORKE 5' C MVENSATION DEC I( ' I nereby atfirm that I have a certi(ica � con: ot Work s• Com salion Insuran , o a 380�b. Poli o - co va � eC 1letl py 5 her y f rnish tl. Certi/ietl c is filetl wit [he c uiltlin Oate � oo��ant E%EMPTION FROM WORKERS' COMPENS/ (This section neetl not be compietetl.il the peri 1255) I c¢rtity tn t m he p �fo�manGe o1 the wo�k Shall not e I per5on in any mann¢r Workers tim laws af Cali(omia. . Da[e Si9nature E�q z� y : TVPE OFCONSTRUCTION NEW ADO ALTERATION REPAIR ��❑ CONVERSION ❑ DEMOLISH OTHER A p # � � DESCRIPTION OF WORK/USE OF BLDG. � S Main Buildi E TVPEOFPERMIT GRADING FOUNDATION STRUCTVRAL T FrOnt ❑ TENANT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL 6 Rear , ❑ �OTHER � � A PROJECT DESCRIPTION $Q. FT. OCCVPANCY ' C Right K Left CONSTRUCTIONTVPE ' VALUATION$ $ ZONE ' GRADI G CU. VDS. ACRE p�ng. Ref. # Remarkf: -, A. _ _ � A .�. i. _ ... i✓ _ . � :I � /] .�� Planninq Notes: or a certiflwte Bar Sink e of (Sec i n gackflow Preventer � Backflowlrrigation ' Bathtubs oi 'NOTICE: f, f er makin9 tnis tleUaratlon, y ulkl become subject to the Workers' Compensation provizions oi (ne r Cdtle, you must fortnwilh com0ly .wi[� such prov�zions o� thi5 p t zhall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 hereby attirm lhat there is a con5trutUon lentling agency for the performance of the work tor whicn this permi[ is issuetl (Settion 3097 Civ. CJ Lentler's Name Lentlet'S Atltlress _ , � � OWNER BUILDER OECLARATION ' I hereby aifirm that I am exempt trOm [he COM�acto�'s LlcenSe Law. (or the following reason (Seclion 7031.5 Buslness antl Pro(essionat Coae: Any city or county wnich requires a permiYto coMtruct, alter, improve, tlemollsh or rapair any structure, prlor to its issuance(also reqWres the applicant for such permit f0 file a Si9netl Statement thal he/ih¢ is licensetl pursuant to the prOvisions of tne Contractor'z License Law (Chapter 9(commencing wltn Sec[lon 7000) of � Division 3 0( Ihe'Busin¢ss antl Professions Cotle)�o� that he/Shn is exempt theretrom antl the basis for'the allegetl exemption. Any violation of Sectlon �7031.5 by any applicant tOr a, permit SUbjects lhe appllcant to a tivll ��enalty of not more than five huntlretl tlollars (y500). I, as owner oi tne property or my'employees with wages as lheir Sole comoensation, will tlo the work, antl the structure Is not Intentletl or offerea for zale (Section ]044, BuSiness antl Professional Cotle: The Contractor'S License Law tlOes not apply l0 an own¢r ot a prop¢rty who bu71tl5 or improves thereon, antl wno does such work himself/h¢rselt or througn his or her own employees, provi0etl tha[ sucn improvements are nol intentletl or ot(eretl for sale. If, noweva�, the bulltlin9 0� improvement iz Soltl withln one yea� of com- pletion, the owner will have the burCen of proving he/she tlitl not builtl or im- prova for the purpose of salo). � ' ❑ 1, as awner Of tbe praperty, am exUusively ConVaCting with Ilcensetl con- Vactors [o construct the O�ojeGt (Section 7044, Business antl PrOfesslonz Cotle: '� The Contractor's License Law tloes not aoPty to an owner ot property who Duiltls or improve5 [he�eon, antl who conVac[s to� such p�Oj¢tts wltM1 a con- t�actor(5) license pursuan[ t Contrac[o�'s License Law). I am aware that proot of their Worke�'S G p sation Insurance zhoultl be provltl¢d [o me. ❑ I'am exempt untler Sect on B. & P. C. tor inis reason t - � Date - � I hereby certily that I 1 informatibn iz correct. I �antl stata'laws relating SINLdIIVCS O( IFI�S CISY InsOection purposes. �Signature � � �rivers' license or 5 CMF 0865-46, rev. 10/84 Wnite -'Building; anary above nance5 Jrinking Fountains 'rloor Drains Floor Sinks � 3as Service Outlets Incerceptars Kitchen Sink - Lavatories . P—Trep, - ' fioof Drains � Reinspection Fee .$15 Boiler Dun - Under Ground Duct � Sttuctural � Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. BIL IC80 •# Heating System & Ducting ❑P700,000 BTU 0100,000 BTi Reinspection Fee � $15 ; Pink - Accounting: Goltlenrotl - Assessor $hOW¢f5 Servite Sink � ._ Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal . Water Closet - Water Heater Water Service � Auto-Wash ' laue Fee Hood or Type I ❑ Canopy Typell ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers i Issue Fee EES � - - Automatic Washer � � Construc[ion Pole $ub. f% . Cooking Unit � `� Dishwasher Dryers ❑Gas ❑Electric aa $ 3 Fan F.A.U. Fixtures . - Device Boxes Outlets Switches Garbage Dispoul Generemr �0.5 KW 4314 6/06/85 ' Zone AcceSsory Building: ELECTRICAL 15 KW Transformer O- 75=50 KW' O50+KW Meter ❑up to 100 amps Meter �over 100 amps Sub Panel Motors�0.7 HP�1'r5-8 Inc.Solar �9-15 HP �16-15+ Microwave '. - Pole Light Sign ; Standing Sections Trash Compac[or ' Rainspec[ion Fee �$15 � � luue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning APProved By � - Building Appraved By Application luued By � 8.0� TL 2 O N I _ N G R E � � M T S FEES � $ 3 SUMMARV OF FEES � , � ' � BUILDING PERMIT $ � SMIP $ PLAN CHECK $ PERMIT ' � PLUMBING, $ �SSUANCE ' $ PLAN CHECK 25% �$ ENERGV P.C. $ ELECTRICAL $ �-Of� GRADING $ PLAN CHECK 50% � $ MICROFILM $ MECHANICAL . $ TOTAL PEE � $ ��'OC� PLAN CHECK 25% $ , , i i 1 CONSTRUCTION AND PLANNING .� POOL & SPA '. .: APPROVALS - Permit # � Date . Inspector qppROVALS Permit # - Date Inspector � 1. Temporary Electrical Service or Fole . _. 52. Pool. & Equipment Locatiort . ' ,� '. 2. -Soil Pipe-Undrgrnd. �53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. . ' � 54. Forms .� � 14. Electrical Conduit-Undrgrnd. �� .' 55. Electrical Bonding - .• 5. Steel Reinforcement� . - � 56. Rough Plumbing & Pressure Test • _ �- 6� Electrical UFER Grnd. � � 57. APPROVAL TO COVER-GUNITE . :i7.�Footings ' • ' ' � . .. 58. Electrical Conduif=Undrgrnd. • . 8: Foundation ,�' 59. Gas Pipe, O Undrgrnd., Test ' - � - ,9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trap, O Undrgrnd. - ;: . �10. Structural Floor System 67. APPROVAL TO DECK 71. Property Sewer Line & House Connection �, 62. Backwash & Receptor-Final 12. Sewer Cap � , " - �' - � �� 63. Heater & Vent-Final � . � 13. Roof Drains . ' , � 64. Plumbing System - Final - , 14. Rough Plumbing - � 65. Electrical-Final 15. Rough Electrical-Conduit �-�� 66. Solar SYstem-Pinal . � - 16. Rough Electric Wiring � ', 67. Fencing & Access Approval � � " 17. Rough Wiring Sign � � � 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ce,iting 69. POOL/SPA SYSTEMS FINAL - i 19. Rough HeatiQg & Air Conditioning . FIRE DEPT. REQUIREMENT ' .� � 20. Rough Facfory Fireplace „ � APPROVALS Permit # - 21. DuctS, in Structure - � 70. Underground Hydro . 22. Ducts, Ventilating � , 71. Product Piping O Gas ❑ Oil �23. Gas Pipe-Rough & Test •� � ' 72. Underground Flush 24. Roof Framing �' - . . . , 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing ' �. � 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. Plaster Brown Coat �� 79. FINAL INSPECTION . . 32. Electfical Power Meter-Final,:, 80. FOOD CERTIFICATE ISSUED 33. Final Electric � �' � e " Notes: � � 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test � 36. Hood or Canopy , , � . , 37. final Factory Fireplace , � . � . 38. Final Plumbing 39. Water Service-Final ' � 40. Gas Service-Final . � � . � � � 47. Solar pomestic-Final 42. Backflow Preventer , ' � 43. Backflow Irrigation � 44�. Landscape Irrigation SYstem � � 45. Sound Attenuation � 46. Handicap Regulations ' - , � , - . 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed �� ' � 49. Electric Release to Edison , - -, � - i � - � � � , . 50. Gas Release to Southem California Gas Co i � i • ' . � 51. CERTIFICATEOF�OCCUPANCY __ ._ � , ,_ _' . ' ' No. Date * � , � . ' , , . Ci7v OF COST�MESA_-� TION PERMIT Projetl Address �� APP��an�'s Mailirg Atldress h Owner'gNamepc �rGn�C �h^��`� Pho-�ne�Vpl Address Z�t+—� � �G, �`�+T v �"� l. i' Arch/Eryg, License No. , Address ConVactor's N mP 51��i Ph Jl� Address Ima �"�� Z- g� �p qV� G Fu�iO . M.�• CityLicenseNo. 7� 1�(� LICENSED CONTRACTOR DECLARATION 1 hCreby aHi�m �hat I am Ocensetl untler orovisions of Charter 9(ca with seclion 7000) oi Divislon 3 of thc uslnais antl Profossions my Iicense i5 in full �or antl � . ��' Licanx Class _LICenSe Date�.�_'_�� S�9�a[ure WORKpRS'COMPENSATION DECLA TIO �—wOP��anfto flll In all spaees egee0< <hose within heavy Co�Oer lines anO sign all appropriate Geclarations. Cotle, antl � hereDy aftirm that I have a certifitdte cOn to 5llf-inswe Or a ce�Uflcate �( Workers' Componiation Insuran r rtliteC copy tnareof (Section �3800, �ab. 0.) _?olicy No. Company eCertifietl copy is horeby turnishetl. Cert��ietl copy Is iiletl with the city Builtlin9 Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (Tnis 5lction neetl not be completetl it the permit 15 for one huntlretl (Sl 0) or less). I c¢rli/y [hat in Ihe perlormante of Ihe work 1 Which tn15 p¢rT�t i5 ueQ, I shall nOt emo�oy any porson in any manner as to become s � ct to the WorkeqS� CaVPen5a5J� Laws of Califomia. �� i complY with suGh p�ovlsiOns or tnls p t s�d(Vb0 tlaaTetl /evoked. CONSTRUCTION LENDING AGENCV �� I nereby aHirm that t�ere I5 a construtUo e tlin9 agency tor [ne Oarformance oi the work for which this permit Bsuetl (Se<tion 309� Civ. CJ L,Cnaer's Nama Lontlerz AtlCress OWNER BUILDER DECLARATION I he�e4y affirm Lhat 1 am exempt trom Ihe Conttatto�'s lic¢nse Ldw for the tollowing reason (Section 7031.5 8usines5 antl Professional Cotle: Any city or county whlch �eqW�es a pe�mit lo ConsVUG[, alier, ImOrove, demolisb or re0air any siructure, prior to its issuance, also reqWres tne applicant fOr sucn Permit to tile a si9netl statamon[ tnal he/zne is licensed �ursuant to tha provisions of thC COntraclor's License Law (Chapter 9(COmmenCin9 with Section 7000) of � Oivision 3 ot the Business antl Proteizions Cotla) or that ho/ihe is exemp[ borelrpm antl the basi5 tor Ih¢ allegetl exOTptlon. Fny v101alion ot SeCtion /031.3 by any applicant for a permit zubjects the applicant to a tivll '� enally ol not more tnan five huntlretl tlo�lars (E500). �, a5 owner of lho pro0er[y Or my oTploy¢85 with wage5 ds their sole compensa[{on, will tlo Ihe work, antl tne itructuro is not IntentleC or otferetl lot Sale (58ctiOn 7049, Bu51ne55 antl Pro(ESTIOnaI COtla: Th0 Contfactor'4 License I�w tloes not appry to an owner of a properry who bulltls or improves thereon, antl who Eoes such work himself/nerselt or throu9h his or her own emplOyeez, Orovltlotl that SUCh Improvemen[5 dre not lntentletl o� ottereC tor ule. It, however, lhe bulltling or improvement is soltl wlthin ona year of com- plClloq tne Owner will have Ihe b4rCen Of Provinq �e/sh¢ tlitl nOt bWltl or im- prove tor the purpose oi sale). ❑�, 8s owner o1 IM1e proOertY, am excluzively contractinq wltA Ilcensetl com� tractors to consvuct tne pro�ect (Section �044. Buzinezs antl Protessbns Coda: The Contractor'S Li<ense ldw tloes no[ appty [o an owner of property who builtls or improves thereon. antl wno conVacts for such orolects with a con- tractor(sl Lcense pursuam to [ne Convattor's Li�ense Ldw). I am aware Ihat proo/ o� their Worker's Compensdtion Inzurance shoultl bo provltletl to me. ❑ I am exempt untler Seclion B. & P. C. �or this reason Date 1 ha I ag to � to Inspec(ton purpases. Signature Drivers' License or 0865-46, rev. 5/ 8 Owner antl ��,.L�'•�lS l�/ / ......,..'_' _'...'. .,�.�...... A.P.iW S Main Buildi TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' 7 Fron[ � DESCRIPTION OF WOFK/USE OF BLDG. � A Rear TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL � C Right ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $- Le(t ❑ �OTHER Ping. Ret. dh PROJECT DESCRIPTION SQ. FT. OCCUPANCV Planning Notes: CONSTRVCTION TYPE VALUATION S ZONE GRADING LU. VDS. ACRES Rema�ks: Sink <flow Preventer cflow Irrigation Drinking Fountains Floor Dreins Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspaction Fee � $15 Boiler Duct- Under Ground Duct � Struciural Duct - Ventilating ExhaustSystem ❑ MWtiple Firepl/Fact Blt. iCBO # Heating System & Ducting ❑0�100,000 BTU 0100,000 Reinspection Fee � 515 Builtlinq; Canary - APPlicanh Plnk - Accountinq; Goltlenrotl - Assessor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wath Laundry Trays laue Foe Hood or Typel ❑ Cenopy Typell ❑ Refrigeration System ❑0-100,OOOBTU ❑700,000 System Repair/AlteratiOn F ire Dampers Registers Isue Fee FEES $ 3 Zone Par ELECTRICAL Automa[ic Washer Transformer ,� 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter Qup to 100amps Dishwasher Meter ❑over100amps Dryers ❑Ges ❑Electric Su6 Panel ' Fan Motors �61 HP �1'rS-8 F�A�� InaSolar �9-75 HP �16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Garbage Disposal Generator []0.5 KW �575 KW Standing Sections Trash Compacmr � Reinspection Fee I g15 ' I Issue Fee DE VE LOPMENT SEH VICES q EUUI q EMENTS: 2oning Approved By Building APProvad By FEES C� SUMMARVOFFEES BUILDING PERMIT $ � SMIP $ PLAN CHECK $ PERMIT PLUMBING y �SSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTAICAL $ � GfiADING $ PLAN CHECK 50% $ MICROFI�M S MECHANICAL $ TOTALFEE $ �sv PLAN CHECK 25% g � ` l $ 3 �-.Ai'0o�;� D0035859 tn� OATE: �bT�fi89 TI(�E: 09�a4 N 1 N G R E U M T S. 22.jG CONSTRUCTION AND PLANNING POO. _ SPA APPROVALS Permit # _- Date Inspector qppROVALS Permit # Date Inspector �^ fi�, i. Tempora�y Electrical Service or Pole L� 52. Pool & Equipment Location �'�� 2. Soil Pipe-Undrgrnd. � � � 53. Steel Reinforcement - 3�_Electiica� Conduit Utility-Undrgr,nd� L 54. Forms �-_ i� �� 4!Elec4;�ical Conduit-Undrgrnd. �� 55. Electrical Bonding Y.- 5!`yS[eel�Reinforcemeni �• r 56. Rough Plumbing & Pressure Test . � 6. Electrical UFER Gmd�' �� 57. APPROVAL TO COVER-GUNITE ' . r ! � ' .%" •7.'Footjngs, ,�� _ i�� 58..-ElectricalConduit-Undrgmd. --.��, 8 Foundation �� '� ; , � ,�l; �59. Gas Pipe, O Undrgmd., Test �_ 9. Water Pipe-Undr'grnd. � ./f� 60. Backwash Lines, P-Trap, O Undrgrnd. / �. lOF $Iructural Floor System � ��r� 67. APPROVAL TO DECK ^ 11. P{oper{y Sewer ^ine & House Cbnnection ' 62. Backwash & Receptor-Final 12JSe.w�Cap '-:-?� � . ' T. 63. Heater & Vent-Final 13.'Roof-Drains '�''- r� � -- ,, � ,.-� ✓� 64. Plumbing System - Final 14:,R�ugh Plumbing', .s� � � 65. Electrical-Final 15:�RoUgh.Electrica!'-Conduit 66. Solar SYstem-Final � i 6. Rough Electric Wiring 67. Fencing & Access Approval (1;2. Rough Wiring Sign 68. APPROVED FOR PLASTERING qg�. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL �19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �20. Rough Factory Fireplace APPROVALS Permit # 7. 21. Ducts,in Structure 70. Under9round Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical _ 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final . FOOD CERTIFICATE ISSUED . 33. Final Electric �j Notes: 34. Final Heating & Air Conditioning �., 35. Final Gas Pipe-Test � 36. Hood or Canopy •- - �!� 37. Final Factory Fireplace �� 38. Final Plumbing � . (' � 39. Water Service-Final ' � �y 40. Gas Service-Final � , (\ 41. Solar pomestioFinal -' � � 42. Backflow Preventer �• �i�l � i 43. Backflow Irrigation � �V 44. Landscape Irrigation System v 45. Sound Attenuacion 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING �� 48. Special Requirements Completed 49. Electric Release to Edison f} �l 50. Gas Release to Southern California Gas Co ��G � ,� 51. CERTIFICATE OF OCCUPANCY -�- `" /1� � � N0. Date �^ �"' ��4L . !4�O�Iwnt to fill In all spaees ezeept thow wit�in haary borAer Ilnes anU slgn all aOD�qDrBte Ceclantions. _ . � CITY OF COSTA MESA ' � ' ' � � . PERMIT NO. • . . � TRACT NO. • LOT, NO. B . . . • - � � - � - , . . ' CONSTRUCTION PERM T ' :. � , � �' i ' ' a ' : • . � � � 9676' � " " q p;7 ' YL , i,� � . AppliCenYs Meiling AddI8S5 � TVPE OF CONSTRUCTION � , �lEw � aoo. ��7e TION RE7AIR � � , ` .- . � • ; ,� . �� . ' '� - ' �,(% 'i' Q, . - O.CONVERSION -.❑ DEMOLISH O OT ER � ' - ' - � � � � ' � � �� ' ProlectAddress � . . , 4 O . � � . . - . � t•� :�, OWnBfSNeme (ed'� �� '� DESCRIPTIONOFWORK �_ i �S P e .�� - � i . . . . .' . I E ULATI S .. Address. �e � (,(hyj � 2 'L} - ' � . : - � _ . . . . , , TVPEOFPERMIT GRADING POUNDATION STRUCTURAL A.P.SM' ZONE AfthlEng:, ' . ' LiCenSB NO. , ❑ TENANT � ELECTRICAL O PLUMBING' ❑�MECHANICAL ; - pLNG. REF. q� � _ - .BUILDING - � - - - AddrE54' � - O.�OTHER •- i - TO BUILDING- � . - .pEAR VARD (TOP/U � � QAIVG/S ./ ��J �q PRWECT DESCRIPTION SO. FT. � •OCCUPANCV PE v i e - Contmcmr's Nam � - � hone . —�— . � ' , - Addressli^ �� pZ�s � CONSTRVCTIONTVPF ' ' �VALUATIONS� �Sd• � � •LEFTSIDE VARD RIGHTSIDE VARD - �- ._ � '76•90(� � , � 20N� - • GRADINGCU.VDS. ACR,ES PKG.SPACEREQ. PROVIDED , Licenae No. d � .` LICENSED CONTRAGTOR DECLARATION � � � ' ' ' ' ' ' ' Remarks: STREET WIDTH PARK FEE'$ � 1-�Breby aHirm thet I am IlCensetl untler provl on f Chafter 9(tommencing ... , ' ' • , -- wlth sectlan 7000) a1 Dlvislon 3 of tha Bu na tl Profe55lon5 CoOe, antl . ' �.' � . � • � ' ' � SPECIAL CONDITIONS: � _� my Ilcensdis In tun forc' anz�a effect. •3'B 773iJ . . . - . PLUMBING � �� ' � �' � � LJtensa Class LI 5� No. ' � Date Slgnaturo � . Bar Sink �� p . ' � JRKERS' COMPENSATION DECLAR , ' - - _ _ . � , ELECTRICAL .ereby ainrm tnat I nave a isrtiriwte ot nsan to seM-insure oi a certHiwte - � g�kf�ow Preventer' " Sewer Connection' - � Aurometic Washer . __ Meter over l Ob emps .__ - � 01 Workari' Compenution Insurance, or a certlfleO�coDY t�ereof (Sectlon ' � ' ' . . 3Bo0, Lab. c.) ( , � 8ackflaw Irrigaiion � Solar Coliectors ' ' � Construction Pole ,Sub Panel . Policy No. ' • - Company � �� Cooking Unit � Sub Pole . � 8 Certifletltopy is hareby furnisfiatl. , � , , '. Bethtubs Solar Piping � I WrtHletl copy Is flled with tne.city BuIl0lnq Divislan. � Dishvuesher �Motors DO-1 HP ❑ 1 R$ Clerifiers SularTank � � ' Date �� ApPlicant • . - .� - � - - - EXEMPTION FROM WORKERS' COMPENSATION CL t3AT10N ; DiShMldsh2f l � SWimmin9 Po01 w/Spe � , t �ryers ❑G85 ❑EleCtfiC '� � InC.Solaf �945 HP �1645+ ; ' . �Thissectlon naetl not be complete0 If the permlt Is or ne untlratl (5300) or � � lesz).. � � . � a � � . �� . � � � Pan � . . � � Micrawave , . t � NdITICEthat9n the Gerformince of the workTo� h t s perm�t ISlisuetl I ` 9 . ' � � ' � � I cartNY' � .. ; . F . . Orinkin Fountmns Urinal : Fixtures : Pole Light ; � � � � � em lo any person In any manner so to b'ome uD)ectto tRa - Workars'�o p om Laws af eaufornia. � Floor Drainz, t Water qoset� . � � Date ignature ' � - - � . ' ' 1 ' O 1 ,af e. maklnq thlTtleclaration, ro becoma suble<t-to tne•" - Floor Sinks , - y- -- ` - -' - Water H22ter ' - , '- � .;Range . _ . _ _ .� _1 . _, �._ , . � Workers'; ComDensation provlsions.aT the la Cotle, you mustfort�with . . . - • . � � tom ly �wltlt. such rovislons-or thi5• ermt'Shall be�GeemeQ revokBG:� � ' . _ .; .; DeviceBoxes - ' $j � ; �, � p D o Gas Service� '�Outlets � Water Ser'vice • � 9 ' CONSTRUCTION:LENDING AGENCV ' 1 � �'� ' i - ' ' � ' � i i . � . . �� , OuUets ,StanilingSections � � � � 1 hareby afflrm that tltere IS a;<on5tructiomlantlin9 aqency for the'.p erfo/manCe . ' �p(efCBptols � � ' � � ' . � + � n � ' ' ', of t�e work for whlch.: t�ir permit Is f Iisuetl ;(Saction 3097 Civ. CJ, � ',� , . . Switches � � ' � i ' � Lenaer's Nama? � � - - - ^ "" � ' ' Kifchen Snk . � . - i . : � i Trash Compactor � , , � "lanOer's. Atltlross '- ' - - � � ' - � � �� . - � c. . . � GarbageDispoial ; ' • - ' i : , OWNER BUILDER OECLAftAT10N " � ' • �etOriES � � ' 1 nereby�aTfirm�that I am"exempt trom the�Cantractor's Ucense L.aw for the � -. _. , �. i, _ `, . , Genererod DO-5 KW 0545 KW � • VL ', following reason"(Sect1od7031.5 Business an0 Professlonal Cotla: Any diy or � � P-T�ap� ': • rs' - � '� � • � � - Icounty which requires a Germlt to construct, alter improve; tlemolish or"rapalr � T�anSfo�me� �75-50 KW ' ' ' � .�any struclure, prlor to Its Issuance,.also raqulrez t�e applicant tor such Oermil � Raof Dreins � - •! ` � �� . � ' ' 'o file a ilgned itatament'tha[ he/she is 11<enSeE pursuant ta tha�Drovisions o1_ � - . . 1_. ' ❑5U+ KW 'Reintpettion Fea §75� � Contractor'S License Law (GhaD�er 9 (commencin9 witb.5ection 7000) of - - � - �' ' ' ` i - . t ' � Aslon,3 of the BuSiness antl. Protesslons Cotle), or that he/she Is exempt ShowC�s ' . Reinspec[ion FBe . $15 , . areirom'an0 the. basis Tor t�e alle9etl axemption: Any vlolation' ot SecHon `� ' � �, � , � " Meter ❑up to 100�ampi �laue Fae � � S 3 � 7031.5 by any apD��cant tor a, permit- suD�ects the • applican[ to a- civil • 3 �-- - , ��enalty of not more than tiva hunGreO Eollars (S50%_. . „� � ; _' ServiCe Sink �' � i. ; Issue Fee ' $ 7_pning Approved By ' � � Dat9 LJ I, as4owner ot' [he proDerty ormy employoes.with wa9e5'as t�elr sole . MECHANICAL compensatlon' will'tla the work, an0 the.structure Is no[ in[entleC or oitaretl ''� : t � C - Appli'ation Approved By ' atB � for sala (Sec{lon 7044, Buslness�antl:Profasslonal,GOtla: The Gonbd<tOr'S ' - , . : ' � i . ' LJcense Law does not aOP�Y to an owner oi a properiy wtio builCs or Improves Boiler' � � ' Refrigeration System , . � � - tharaon, antl who ,tloes such work himself/herself or thraug� hts or her own • _ Applintion IauOd By � - ata em0�oyeas, provitleE tnat such Improvaments ara.not Intentletl or offereC for � Duct= Under,Ground 7 �0-100;OOOBTU ❑100,OOOBTU ' sale. If, �owevar, the Dulltling or improvement I5 sottl within one year of com• ' , � • SUMM V OF FEES . • ' pleUon, lhe owner-wlll have t�e burEen of proving ha/ihe tlltl not builtl or Im- � � - . . ' . , rovefortnepurposeo�sale). . ; , . � ' ' Duct-Structural i� � SystemRepair'/Alteiation ;BUILDINGPERMIT $ �� SMIP � ' $ � 1 � � I, as owner ot the property, am exclusively contractin9 wlth�licensea con- � � � � � ' � � ' � � � . � ' tra<iorsto construct the Oroject (Section 7044,.Business antl.Professions COEe: -. Duct-.Ventilating . ._ .. __.� _ _ - _ , . PLAN CHECK� $ PERMIT �� Tha Coniractor'S License Law does not appry [o an owner of pwperty who � ' , . � - , ' � ' I$$UANCE f $� � •Eulltls or Improves thereon, antl who�<ontracts for such proja<ts with a con- ' Exhaurt'System ❑ Multiple �� ' 'PLUMBING $ , , � traclor(s) Ilcense pursuant to the CoMractor's License Law). '- ' , � ' � GRADING � $ �' PLAN CHECK $ � ❑ I am axempt untlar Sectlon . B. & P. C. for this reason . ;� Fi�2pl/Fatt. Blt. ICBO # t ' , � : ' ' '�— � • a i / • ' �� Heatin S stem & Ductin • ( � � i. �ELECTRICAL $ � � ' Date ' ' ' Ow er'• ' . •• ' � 8 Y 9 I i � i � � � � 1 MICROFILM � $ � I-�ereb � Certlfy that 1'hav re ,th appllwtlon antl�ztate�that ttie�aDove-� �• OP100,000'BTU-0100,OOOBT - - r- �- PLP�NCHECK $ .IMorma�lon Is mrrett. I a9 co ty with all dty.antl county or nances , - - � - - � + ' ' f� ' MECHANICAL . $, . � j TOTAL,FEE. � $ � �� ' antl-state laws relating toi tllnq uction,�,antl hereby authorl re ra- � HoOd oi Type I ❑� �� ' � � ' ' ' 1 • santatives of �this'city to t r the above•mentione0 pyo �tY (�D , t��o T e II ❑' ' Reinspection Fee� . 515 ip�qN CHECK, i $ - • , '� LESS f j' � . ' InSDettlon DurpoSei. � � � b Q,� '� � -' � . , , ADVANCED PC $ �J' ' i Siqnature � ' Date . , R isters ' i � j �� Issue FaB -' �. � $ 3 , � � ! . t �� ' � !. I i . /1 . � Drivers' License or,55 � 1 � i � �. � � PINAL FEEj $_b.�— CMF 0865-46 rev. 12/B2 White - Bulltling; Canary - APP��wnp Pink - Accounting; Goltlenrotl - Assassor . . ' . . . . ' ' - - � ;_CONSTR:UCTION.AND"PCq �. NING� � �� :�_'ii ''�:'�.�" - ''�^=':� :,,�-=�C SPA ' ..� - - � : _ � n y :n � ic J - =xpo- i `_APPROVALS ', PermiY#-`-'� a ' S�Dete 'Inspector .; ;APPROVALS� Permit# .' � Date Inspeetor� � � L v�a YC I� _ ' ' ' '- �7: Tempora ,ry,�Electrical Service orPole � "' �. . 'o '`�' 1 ,�52� Pool &�Equipmenf Location � � -� 7 , -- � �: e � _ � �� n - _ _ _ _ _ ': `i SoilPipeSUnd�grnd.' = F�� ' �Z=. �." ^r�.i ',53°8teelReinforcement� . �' - r ;� - � �1 ' C - 3: Electrical Conduit�Utilitv-Undrgrnd. - � =' i � 54 � Forms':;-' = ;=u ,� . _. _ � � � � °4.ElectricalConduit-Undrgmd °" '_�' - -^ ``` •55,Electrica68onding-� �,;' � - rt i i �.��d�� E�.3 �. - 5' Steel Reinforcement� � i � •� - - � '; ; � ' ` �" g` := ` : 56.. RougK Rlumbing.& Pre"ssure Te'st ' � 6• Electrical UFER Grrid.� i `� ' � `' � > �� ° 57"' APPROVAL TO'COVER:GUNITE. � _�' ," ' _ i � ,. 7: Footin95 •� � ' , I � x . - . - "� : � ; ' 58: �Electrical:. . � . ' . CondUINUnOfornd.- 8. Foundation: � � � � ' � �� " � __ -59. Gas �Pipe; O Undigrnd., Test = � ' - � � ' - 9. Water Pi e-Undr ind. � " - -� _ , P 9 � � - _ �,60. Backwasli L•ines,�P-Trap, � Undrgmd. . 70. Structural.Floor System �' o , � � ' ^ ^' 1 ",61. APPROVALT'O.DECK � _ ; �, : 11. Property Sewer Line & Hous �Connection - � �, ' _ ` ' i62. BackwasFi &;`Receptor-Final ' . ' . . . • 12. $ewer Cap � ' � _ � ' � � � ^� '�'63. Hea4er &_Ve�t-Final �. -- _ � , 13. Roof �Drains ' � � ; _ . ' �� ;ig4. Plumbing;Sysfem�- Final � ' - �� . '> � I• 14._ Rough,Plumbing I . . ' � � � r - � �'65. Electrical=Final� '-� � � • • ' ' � - � 0 Y . 15.-Rough'Electrical-Conduit"i -' ' � "' - -'� - - - T'r-�""66. �So`,Ia�,Sysfein=Final - - � ' ' ' " ""- -'-" - � � �. � , � , . ''16. Rough ElectricWiring• ' - �'s � '' �� -_ -; � '� 67 ��Fencin &�AccessApproval,�= � -� '- "-" 0 7�n .r. �, - 1.: 4 ;f" I , �'' ,9, . . . - _ ,17.,RougMWiring Sign': � � :: i ' �� ; o , , I ._ i .° l � i ; ; �68 � APPRO.V,ED FOR PLASTERING ' , - ;t ` - .} 18. Rough�Ele'cfrical,T 8a� Ceil�in9� �� i_ I � �'�'!°� �, g9 I P00 �/SPA SYSTEMS FINAL �� ''.- � + X - �� 19. Rough.Heating & Air Conditioning � � � P � �� i i ., � � � i ,FIRE DEiT, REQUIREMENT-' � _ � 1 ' .�� 20. :Rough�.Factory Fireplace, i . , � ! � � � . � APPROVA�LS� ' Permit;# _ '' �.- ' � � 21. Ducts,in Stiucturev " I � �i i I ! I ( � I ' � ' � � ' ' ' ' � t � i � � JO.� Underground Hydro . , _ � � _ - . : . " �` 22. Ducts, Ventilating " � r � � `� � ; , � ' ; I ( � q1.� Product Pipiing O Gas OOiI ' , . � � � I j I, 23. Gas�Pipe-Rough & Test j , � ! ,;. I,� --�--� � j � � � 72.� Und g ounii Flush' -- ��`� . � - - - .- -� , --� - m - � . . ._ � � , � . � . ' ' �' 24. Roof Framing� � � � �'�'.: , � ,� ; - � -. : � �' $' . �73.: Urideigmtl. Storage Tank�O G_as ❑ Oil i � ' r7 - - 4�' , �� -i..l�. i a a 25. 'Roof.Sheathing � � ( ��=' j� �.F I.- j F('�^ � 74.1 OJerFiead Hydro `; i= i � � �' 26. tT-Ba� Ceiling (Structural�, & Monocoat-- � - F' ` � �l ! i „� : 75., D'ry Chemical � - � - _ � _ r. ' � ��27. Prame and Fla'shing, � � �j �� = � ' � ( ', � , ; 76.� Dr�y Standpipe � - � - � - ' . � ° . .- _ � i � :. .. •�. - .: . , , � 28. �Lathing & Siding � �, :, '� � i � � � � I I c; . I 77.� FIXED SYSTEM%FINAL _ � � � �� 29: �Insulation ; ' � ,`� -'� � � ' �� j � � � � � � I 178 � FIRE PREU�. FINAL 1 � � ; ? � •-30. Drywall Nailing -� �' � I !� ,+ � � � ! � � �Noter.� I � � , � ' ' . . � , � � � � r--. �� 31. Plaster Brown Coat � _ 1 � . � --� -� - � -� -'--� -�� }-- � r-- . i -� - --- �.- -. .. _ -- - � --r - � i , `� � �� ' ' � i � . I i j j . ! i � . � � - . . . . "� . -' 32. `ElectnCal Power Meter-Final � � � , I � � � � • ' . � t ; " 33. �Final Electric � I � � ` �� ' + % /� � �� I�. 1�_ � � � � ' � ' t 34 Final Heating &�Air Conditioning �'i' ` I , j � I � � � I I � i �� ` _ F ' ,',. � ;' :.. � •. . �,_ .i.��i� :r.i,�•• i - . �- � . � - 35. Final Gas'Pipe-Test' r- � �; � T i . �' �� I c; �.= . I � ; � i � : � '� - . . - . . � . 36. Hood or CanbPY" `.' a �'� � i� � � i ` � . . . i � • i • � - i' . 4 _ .. ' -• - : > >� ni :� i`,i~ . . 37. Final Factory Fireplace , -� i . _ ' ` ; " � � . . � , ,;, 1-1'°}` i;� � I I � I I<<,'I' � "- ., ., 38. Final Pldnibing � � -� ' ' ' ! ' � � ' ; . ' � - . . � 1 I � �• !' I�a � � �. � i � �� : 39. Water $ervice-Final' ' I � ii , � ; f I � I ' ` ; = ' ' � , ' . •, 40. GasService-Final ! i � � � �� , , I ! � � � I;; ; �. , , , 41. Solar D'o"mestio-Final � � ' � � � I _ � ' � � � �" J� t - ' ' � . - � I � � � f- - - -1- ---I -�- -,-4--�--� - � 42. Backflow�Preventer� i � i � ��; � � -�--! . ��-- =- ! .�- , . �_ I � -� - - � � � . • , n. : _ ' ��;. � � - ' � . . 43. Backflow Iriigation F � � i I ,'; � i' �`_ �'i =�_ I'� I s,� L; � i :I � i � '. ,'r . �o 44. Landscape Ircigation�SVstem i . "n'�.. � , -� I � ; � ;: � f j � �, `; i � � � , I , � '- - r. � . � , , r•- > 45. Sound'� �Atteriva2iori ; �._ � ? � i y , ' I `' � �; I � I ; '' � : � + I � �n . � � .' - - . _ `: a � 46. Handicap�Reguletions i �`_ � i a�- � i ' i� j � � �=1 '� i j y! �.1- ��' -`i �_� 'c', c. 47.�FINALSTRUCTURE&BUILD�NG� '2 � �(�-^��i� � i� j i I� �,�.' !i ` � 48. Special Requirements Completed� � � ` � � �'� � � ' � , � � � . . � � .. ,, � � � I � I! f,(r.� I 1 I� 1 I i 49. Electric Felease�io Edison� � 1 n ...�-.� _ ; -;+�. �-��-'i � - - � ' ' '�, 50. Gas Re�lease to Southern California Gas Co � ! f � ( I ; i I � � � � i ._ � - • � � �� ' � . ! 51. CERTIFICA7EOF�OCCUPAi C` r � ' � � � � '-� -' � � , ' No �' � ' Date ,�. f --�-j - --f -r-� - �I--------T_' . 1 , �:._ r-�} ,_ � - CITY,�F COSTA Project Address _ Applicant's Maili i Owner's Na[m�e� �� Addreu �OGL' � Address � � �, (� ContreCtar's ame— L(Y Address (mailing) -� /rJ Ciry License No. LS LICENSED CONTRACTOR DECIAR I I M1ereby atfi�m tha� I am licensetl und r p viSiOn with section 7000) of Division 3 0l e sines! my IMcenze is In tull c� �n/Ztlett. License Gla s - �� LI[ ��te �� Signature C� 'ORKER ' MPENSATION DE R TION � �ereDy aftirm t�at I have a certill of consenl ..i Workers' ComDensation Insurance, or a certi 3800, Lab. C. �`�� V Policy No. �� Company �{�l Certifietl copy is hereby furnishetl. ❑ Certi}ietl sopy 6 filetl with the city Buittlin P , Oate �+�'/r %��'C qpplicant No. of and IT Selltinsure or a AVD�I<ant to fill in all spacei ezeeD� 1�ose wlt�in �eavY �orEer Ilnas anE sl9n all apOropriale Eeclarations. (Thiss@ction noetl�not De cOmpletatl tl Ihe it is i one nunarea (5100) or less). I certify Lhat in ihe performance of Ihe�wor br ch this permR is issuetl, I SM1all �ot emplOy any per50n in dny man,p r 5 � to b<COTe subject to Ihe Workers' Compensation l.aws ol Cali(9orrya. � Date Signature � � NOTICE: H, alter makin9 Ihis tletld�atlon, you snOultl b«OTe sub78tt [O the Workers' Compensalion provisloni oi•the Labor Cotle, you muit for[hwith comply ��vith' such Orovlsions or this pormlt shall ba tleemetl revoketl. � CON57RUCTION LENDING AGENCV 1 nereby altirm that tbere is a constructlon IenOln9 agancy tor the performance of thg work toc which this Oermlt Is issuatl (Sectlon 3097 Gv. CJ Lpntler's Name - Lender•s Atltlres5 � OWNBR BVILDER UECLARATION � ' I hereby affirm lhat I am ezempt lrom thn Contractor's Ucensn law for the tollowin9 reason (Sec[lon 7031.5 Business antl Professional Cotlo: Any city or muntv nim rmuires a oermit to construct. alter, imorove, tlemolish or repalr to Ille a signetl itatement [na[ no/sna �s ucensao pwsuam n v�vvnrv�o v� tne COnlractor's L(tenu Law (Chapler 9(commoncing with Se<tlon ]000) of Divisipn 3 o� the Bu3iness antl PrOfessions CoEO) a� that ne/Sha IS exem0� tnerelrom antl t�e baiis for t�e allegetl exemptlon. Any violatlon of Sectton 7031.5 by any applicant for a Permil subjocts tho aoV��<anl to a civil �enalty ot not more t0an Bve huntlratl tlollars (5500). I, as. ownor of the property or my..employeos wllh wa9oi as their sole comPCnsation, will tlo the work, antl the strutturo is not InlentloA or otferetl lor sale (Sectlon 7044, Business antl Prafesslonal Cotle: Tne Contractor's Liceny¢ �w tlocs not aOPly to an owner o1 a property who bulltls or improves there0n, antl wno doe5 Such wo�k �Imitlf/ner501/ o� througM1 his o� he� own emplayees, Provltlntl that suU improvements ara not Intentletl or offeretl tor Tale. If, howevC�, th¢ Oulltling or ImprOvem¢nt IS SOId wlthin ona Vod� of com- pletlop, tne owner wpl nave tho bur0en oi provin9 ne/sne ala not bulltl or im- p�ro,vqtor the purposo of sale). ' ' WJ I, as owner ol Ihe property, am exclusivery contractln9 wlth Ilcensetl con- [ractors [o construtt lha O�olecl (Sectlon ]044. Businesi antl Protessions Cotle: The Contractor•s License Law does no[ applY �o dn awner o1 property who builtlg or improves thereon. antl who conVacts tor such oroiects with a con- Vactor(sl hcensa purs to �na Contracmr's License Law�. i am dware lha[ proof o( their Work S mp¢nsalion insurance ShOultl be proviCatl t0 me. ❑ I am exempt untl Se ian B. 3 P. C. for lhis reason Date Owner I•her@by.c8rtify I have roa Intormation is m ct. I aaree to Si9natuie � � Drivers' Li e 55 0865-46, rev. 5/88 TVPE OF CONSTRUCTION LJ NE ❑ CONVERSION ❑ DEMOLISH � DESCFIPTIOly�F WORK/USE OF J ADD LJ ALTERATION L1"REPAIR OTHER TVPE OF PERMIT IJ GRADING U FOUNDATION LJ STRUCTURHL ❑ TENANT � ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ��O �OTHER ' � PROJECT DESCRIPTION 5a. FT. OCCUCArvCv_ CONSTRUCTIONTVPE ' VALUATION$ � ZQNE�_�, GRADING,CU/YDS. ACRESJ / r� • �• / qemarks: Tn_._ 'L./(1� /A .�Cii /1 J.VI. �il� Preventer Irrigation rinking Fountains loor Drains � loor Sinks � as Service - Outlets Kitchen Sink Levatories P—Trap Roof Drains Reinspection Fee Boiler Duct- Under Ground Duct - Struc[urel $15 Ezhaust SyStem ❑ Multiple ❑ Firepl/FacL81t.IC80# . Heating System & Ducting ❑ ai oo,oao eTu o i oo,000 sT� 3` T— I I�ReinspectionFee White - Builtling; Ganary - Applicant; Pink • Accounting; Goltlenrotl - Assessor $15 Showers Service Sink Sewer Cap Sewer Connection SoWr CollectOrs Solar Piping Sotar Tank Swimming Pool w/Spa Urinal Water Closet ' Water Heater Water Service ' laue Fea Hood or Typel � Canopy Type 11 ❑ Refrigeretion System ❑aioo,000sru ❑ioo,000 System Repair/Alteration Fire Dampers Pegisters lesue Fae q.P. 9W S Main Bu E 7 F�ont B Reor A ' C Right g Left Ping, Ref. � FEES Fluromatic Washer Construction Pole Sub. Cooking Unit Dishwasher _ Dryers ❑Gas ❑Electric S 3 53 Fan • F�A.U. - Fixtures Device Boxes" Outlets . Switche5 Garbege Disposal � Genere2or 00.5 KW f0B DEVELOPMENT SER ZoninB APProvad BY _ Buildine APP�ovad By Zone ry Building: • . 2 O • N I N , G R AeQ.lProvided E � M 7 S. ELECTRICAL - Transformer ❑ 15�50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Oover 100amps Sub Panel Motors O0.1 HP � 7 X�- 8 Inc.Solar �9-75 HP"016-75+ Microwave Pole Light . Range , I I Standing Sectiont 5-15 KW TrasMComoacmr $75 � � Istue Fee FEES $ +� SUMMARV OF FEES � � BUILDING PERMIT• $ . SMIP ' $ PLAN CHECK $ PERMIT - PLUMBING $ ISSUANCE $, PLAN'CHECK 25% $ �� ENERGV P.C. $ ELECTRICAI $ de(.�U GRADtNG $ • PLAN CHECK 50% $ MICROFILM $ '� � �J� MECHANICAL $ TOTALFEE $,$�'! PLAN CHECK 25% $ � � ' nLa000�nza-onao�os;. Tco-�- . . a2_so CONSTRUCTION AND PLANNING ; PO.,� & SPA -i_ �� APPROVALS Permit # Date `+ Inspector AppROVALS Permit # \ Date Inspector r 1. Temporary,"�lectrical Service or Pol o,- ' 52. Pool & Equipment Location �. . _ � '� •2. Soil Pip�-Uniirgrnd. • ' ' . � 53. Steel Reinforcement _ _ ' i 3:'°Elect�ical�Gon(iuix Utility-Undfgi'nd�. � '' 54. Forms • - :4.,EPect�ical Cbn�luit-Undrgrnd. -_ � 55. Electrical Bonding _ � �, .. �5. Steel;Reinforcement � 56. Rough Plumbing & Pressure Test „, '6. EPeettical UFF�R Grnd.' .�; 57. APPROVALTOCOVER-GUNITE �> : � .; 7.' Footing{ �< << `i � � _ ,. . � ' `�� • 58. Electrical Conduit-Undrgrnd.. - � . S.�,FOundation �'�.�. �� ' •- ,:. � 59. Gas Pipe, O Undrgrnd., Test � ; 9. Water Pipe-UnNrgrnd. _ � " 60. Backwash Lines, P�Trap, O Undrgrnd. � 10. Svuctural Flobr System • ��'� i 61. APPROVAL TO�DECK. _ �11. Property Se�wer Line & House Cbn� nBction 62. Backwash & Receptor-Final 12. Sewer Cap�i : �. � y- � • , 63. Heater & Vent-Final " � � 13. Roof Drains '��- i: �, , ' 64. Plumbing System - Final � 14. Rough Plumbing . � , � 65. Electrical•Final ' - - �'�15. Rough Electrical-Conduit - 66. Solar System-Final .' 1�6. Rough Electric Wiring 67. Fencing & Access Approval . 17. Rough Wiring Si9� 68. APPROVED FOR PLASTERING �- •78� Rough Electrical-T Bar Ceiling •) 69. POOL/SPA SYSTEMS FINAL 19.' RoughrHeating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough'Factory Fireplace' � APPROVALS Permit # 21. Ducts, in Structure �� 70. Underground Hydro 22. Ducts, Ventilating . 71. Product Piping OGas ❑Oil , 23. Gas Pipe,Rough & Test , 72. Underground Flush 24. Roof Fiaming : 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sh athing . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &,Monocoat 75. Dry Chemical 27. Frame and Flashing - " , 76. Dry Standpipe " 28. Lathing & Siding • r' 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � ' 33. Final Electric 4 Notes: , 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace � 38. Flnal Plumbing .. 39. Water Service-Final - � _ 40. Gas Service-Fina� ' � , 41. Solar pomestic-Final 42. Backflow Preventer �• e 5 i' �� t 43. Backflow Irrigation � �' ' ..� �� 44. Landscape Irripation System �' '1,�� 45. Sound Attenuation �1 .�� 46. Handicap Regulations . , :s< ,.� 47. FINALS7RUCTURE&BUILDWG � �� !v i d8. Soecial Requirements Completed ';;; �� 49. Electric Release to Edison .;>+, t� ' � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY ' -' a No. Date �'J ,� CiTY oF,cOSTp.(Q��7jy .A CO STRUCTIO PER tT'�� Croject Address �-I � Applicant's Maili g Address Owner's ampe Phone Address �(y� %�5� Arch/Eng, License No. Address /�`�� Contractor's Nam � Phone ��.) 7� Addreu (mA�l'nnl j�/ ` C 'm��LC Ciry License No. _�T �� LICENSED CONTRFCTDR DECLARATION 1 hereby atfi�m Ihat 1 am lic¢nsetl untle� provision5 of Charter 9(<ommencing wilb section ]000) ol Dlvislon 3 of [Oe Buzlness antl Professions Coqe, antl my 17cense is in IW orc antl eHect. \License Cla d ic se No.�� Date � Signature _ ° 'ORK�RS' COMPENSATION DE LARATION nereby atfirm tbat 1 have a certlfitate Ot consen[ to selt-Insure or a certlflcate �of Workers' Compen5ation Insurante, or a certitietl copy thereot (Section 3800, L,ab � �(J `'(� Policy No.�.JLG!�� j�Company /`�•"•��`�� Certifietl capY is hereby furnisbatl. i❑letl with the Uty uiltlin9 D i �ate AppliGant � EXEMP ION FROM WORKERS' CO PENSATIO DECLARATION (Thissection need not �u completatl it tha perml[ I5 �or one huntlretl (5300) or less). I certlty Nat In the periormance ot the work for which this perm�t is issuetl, I shall mt em0�oy any O<rson In any manne� so as fo pecome subject to the Workers� Compensation �aws ot California. Oate Signature NOTICP: If, af[er making this tleclaration, you shoultl become subject to [he Wo�kerS' Compen5atlon provl5ions. of thG 12bo� Cotle, you mu5t torthwith comply with suc� OrOvisions or' Ihis De�mit Shall be tleemetl �evoketl. CONSTRVCTION LENDING AGENCV I hereby atfirm that there is a consiructlon lentling agency for the pertormance of the work for which lhis Permlt is issueA (5¢ction 309� Civ. CJ lender'k Name Lentler'S Atltl�e55 OWNER BUILDEH DECLARATION ' I hereby affirm that I am exempt irom�the Contractor's License Law tor the (ollowi�q reason (Sectlon ]031.5 Buslness antl Professional Cotle: Any city or county whith requires d p¢rmit to conit�uct, alteq improve, tlemOlish or repair dOy SLIUCLU(E� pf10f IO �LS �SSULOC2� d150 lEQIl�fCS [IlE dppllCdOi }OI StlCh pQfTll to fi�e a signatl statement that he/she is Iicensetl pursuant to the provisions of tM1e CoqtractoPs License law (Chapter,9 (commencirtg w7th Se<tion ]000) ot ' Division 3 of the Businesz antl Pmtessions Cotle) or that he/she is exempc therefram antl the basis tor the allegetl exemp[ion. Any violation ot 5ec[lon ]031.5 by any applican[ tor a permit subjectz the applicant to a civil �enalty of not mora Ihan five huntlretl tlollars (5500). I, a5 owne/ of Ine prOp¢rly or nly employees wittt wages as th¢ir sole tomp<qsation, will Do th¢ work, antl the zt�ucture is not intentletl or otferetl for wle (Section 7064, Business antl Pro(eszlonal Cotle: The Con[ractor's LicenS@ Law aoes not appiy to an owner ot a property who builtls or improves thereoq, antl wi�o tloe5 such wo�k himzel//herSeH or through his o� her own employees, prOvitletl lhat SUCh imprOvements are not Intentletl o� offeretl tor sale. If, how¢ver, the bulltling or ImprOvement Is soltl within one year of com- pletlon, the owne� will have the burtl¢n of proving h¢/sne tlitl not builtl or Im- p�ove for tM1e purpose ot sale). ❑ I, as owner of the property, am exclusively contracting with licensetl con- tractorsto consVuct Ihe project ISectiOn 7044, Bu5ine55 antl Professions Cotle: The Contractor'S License Law does not apply to an owner of propetty who builtls or improves thereon, antl who contracts tor such projects with a con- tractor�s1 ucense pursuant to t�e Contracror'S Licenze Law). I am aware [nat proof of thel� Workor's Compensation in5urance� sM1Oultl be provitletl to me. ❑ I arp exempt untler $ection B. & P. C. for this reason Date Owner _ I here4y certity that I nave reatl thls a intormation is mrrect. 1 a9ree to tomply antl Sldte Idws relating to b tling wnsti senta[ives ot thiz clty er upan inspect�on pos�s. Si9na[Ure Driverg• LICenSe Or 55 � n antl state that the above city antl countY orqinances antl hereby autho�ize rep�e- ve-Tentionetl P�9Pe�ty�fo� �o��ant to fill in ali spaces exceD� ��aze within neavy bortler lines and si9n a11 avPrao/�ate tleclarations. PE�T �. �� TRACT NO. LOT NO. UNIT NU. TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p�p � DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi TVPEOFPERMIT GRAOING FourvoATloN STRVCTVRAL T Front ❑ TENANT ELECTRICAL ❑ PLVMBING ❑ MECHANICAL B Reer ❑ OTHER %� PROJECT DESCRIPTION 5�. F7. oCCUaArvcV C Right K CONSTRUCTIONTVPE ' VALUATIONS g Lef[ ZONE'� GRADING CU. VDS. ACRES Ping. Ref. # Remarks: Planning Notes: Sink Preventer frrigation Bathtubs rinking Founiains loor Orains loor Sinks � as Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Dutt-UnderGround Duct � Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact Blt, ICBO # Heating System & Ducting ❑ 0-100,000 BTU � 100,000 BTI Reinspection Fee � $15 CMF 0865•46, rev. 30/84 White - Builtling; Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor NG Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar 7ank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration F ire Dampers Registers Issue Fee FEES $ 3 FEES $ 3 Automatic Washer Construction Pole Sub. Cookin9 Unit ' Dishwasher Dryers ❑Gas ❑Elec[r Fan F.A.U. Fixtures Device eoxes Ouclets Switches Garbage Disposal Generator �65 KW �! � � 7,� Zone � � 'I ing; � Parking Req./Provitled ELECTRICA� ' Transformer ❑ 15-50 KW ❑'50+KW Meter LJup ro 100amps Me[er ❑over 100 amps Sub Panel Motors �41 HP �1 h� 8 Inc.Solar �9�15 HP �16-15+ Microwave Pole Light Range 5 KW Trash Cor Fee �$75 � � Iwua FEES Z O N 1 N G R E Q M T S DEVELOPMEN7SERVICESREQUIREMENTS: � • Zoning APVroved BY Date " 8uilding Approved By Dat _/ � Application Issuad By Datfl__ �a�to �/o y SUMMARV OF FEES . BUIIDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ � PLAN CHECK 25% 5 ENERGV P.C. $ ELECTRICAL $ o-Z� GRADING $ PLANCHECK 50% $ � MICROFI�M $ --��/�/ MECHANICAL $ TOTAL FEE $ �'�— PLAN CHECK 25% $ CONSTRUCTION AND;PLANNINGt.i POOL & SPA APPROVALS Permii# _ Date Inspector qppROVALS Permit# Date Inspector i • - 1 fTemporary Electrical•Service or Pole 52. Pool & Equipment Location n, 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 1 55. Electrical Bonding 5. Steel Reinforcement � ' 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation �(�., � 59. Gas Pipe, O Undrgrnd., Test .� 9. WatgrjPipe-Undrgrnd�'� i- 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System ��,'� 61. APPROVALTO DECK 11. Pro ert Sewer Line & House Connection __ P Y r i 62. Backwash & Receptor-Final 12. Sewer Cap '}F',�� 63. Heater & Vent-Final 13. Roof Drains . '�, �� 64. Plumbing System - Final 14. Rough Plumbing ', �t �: 65. Electrical-Final 15. Rough Electrical-Conduit �' •�.` � 66. Solar System-Final 16. Rough Electric Wiring p` 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Struaure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Freme and Flashing 76. Dry Standpipe � : 28. Lathing & Siding 77. FIXED SYSTEM FINAL f 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT �� 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED %� 33. Final Electric Noter. ( �� 34. Final Heating & Air Conditioning . � �i• 35. Final Gas Pipe-Test 36. Hood or Canopy n 37�? Final Factory Fireplace �. r.%f 38: Final Plumbing !y W -�• I'a 35. Water Service-Final ' y� 1,;,� " `� 40. Gas Service-Final � r ' -"� � � � v�. �i. 41. Solar pomesticFinal � ?� � J �� ;, ' - ��: � :�A2. Backflow Preventer =' C�� G_ ;�; � �. � � "1.�,3. Backflow Irrigation S- "�` "' )� . � 1 . _� t- 4a � ,� , ;�44. Landscape Irrigation System :�• ; U•t� " ' ��.� . � ., ,�. • .� f, - �„� ' '45. Sound Attenuation ' L ' � 46.- Fiandicap Regulations � �' i�! ;; • ' nif l {l 4`/. FINALSTRUCTURE & BUILDING � �- �-'�r''� % ; _ �! .-.. � 48. Special Requirements Completed ' :-��/ ' = t,__ • , _ � 49; Electric Releaseto Edison �; '• � -�" • �� ^ • _t� .r. ... 50. Gas Release to Southern California Gas Co •�" '� � ` �af K 51. CERTIFICATE OF OCCUPANCY � , No. Date t- ._. � ' � ' ' r' CITY OF COSTA MES CONSTI Project Address �J i(/ � App�r.ant's Maikl' d�ess � Owner's N' �e `�d��Gy%�� Address cF�2� Q � � � Arch/Eng. �� Address '1 ConVacmr's Nam n� � � Address (mailing) 2 City License No. �26 9� LICENSED CONTRACTOR OECLARAT 1 hereby affirm that I arn licensetl untler with section 7000) of ��ision 3 of t❑q my license iz in fyjl,forSe�tl effect. � T No. AOp��cant to (ill in all spaees eacept t�ose within heavy bortler Iines ana sign ail apvroprlate eeciarations. ot Charter 9 (Commencing antl PrOf¢SSI ns Cotle, an0 �nse No, �� Oate..�.� ZQ�.;!� Signature �/� 'NORK�RS' C6MPENSATION cX€crdR ion � � �ereby altirm that I have a cer iilc 6of onsent to self-Insure or a certificate r Workers' Compensation Ins r ce, or a certi�ietl copy lhereot (Section 3800, Lab. C.) Policy No. Company BCertifi¢tl Copy is hereDY /umishetl. ' Certifietl capy i5 (iletl w�th,the dty Builtlirlg Date APplitant - � E%EMPTION FROM WORKERS' COMPENSA' (Thi55eGlion nCetl not be completl0 if N2 perm Iess). I cer[ifv lhat in tht oerf0�mance Of Ih¢ wOrk one nunaretl (5100) or � this perm�t is issuetl, I become subject to the Date o Signatura NOTIC :If,a er m kinq thiStletidra ion u oultl become subject to [he Worker5' CO PenSa[ion P/ovisions O La Or Cotle, you must tortnwim tomply with sucn p�oVisions o� thi permit shall be deemetl revok¢tl. CONSTRUCTION LEND�NG AGENCV I hereby aiflrm that there�s a mnstruction lentling agency for the performance ot the work for which thi5 permit is issuetl (SectlOn 3097 Civ. CJ Lenaer's Name l.entler's Atltlress . OWNER BUILDER DECLARATION 1 hereby aftirm that 1 am exemot from the Contractor's L��ense �aw for the following reason (SectioP �031.5 Business antl Professional Cotle: Any tity or counTy whlcn requires a permit to construct, alter, improve, tlemolish or repalr any structure, prior to its Issuance, also requires the applicant tor such permit to tile a signetl statement that he/she Is licensetl pursuant to the provisionz oi the Con[ractor's License ��+ (Chap[er 9(commencing witn Section �000) ot Division 3 of [he Busine55 antl P�0lesswn5 Cotle) or thal he/she is ezempt - th¢r¢/rOm antl the baiis fOr [he allegetl exemptiOn. Any vloldtion ot Section ]031.5 by any applicant tor a permit subjects the apPlicant to' d<Ivil penalty o1 not more than �ive huntlretl tlollars ($500). LJ 1, as owner ot the property or my employees with wages as their sole com0ensation, will Oo tBe work, antl the structure is no[ intentletl or offeretl tor ule �Seclion��044, Business antl Professional Cotle: The Contractor's License Law Ooes not apPly to an owner oi a property wno builtls or improves lhereOn, antl who tloes such work himself/�erself o� tn�ough his o� her own ¢mployae5, prOvitletl tha< Such improyements are not int¢Odetl or of(ere0 !o� sale. It, howaver, the bu�ltling or improvement is soltl withln one year ot com- pletion, [M1a owner will Pave the burtlen ot proving he/zh tlitl nol builtl or im- �/Ove for [he pu�posebf saie). I, as owner of the property, am exclusively con c In9 with Iicensetl con- Vactorsto construct the P�ojec[ (Sectlon ]044, B- n antl Professions Cotle: The Con(rac[or's Cicense Law does not apply a wner of property who builtls or improves therion, antl who coniract for ch projects with a con- tractor(s1 I¢ense purzuan� to the Coneractor' Lic � Law�. I am aware that p�oof of Iheit Wotker'S Compen5alio ins r n 5 oultl b0 provitletl [o me. L7 1 am exempt unO�4r Section .& P. C. tor this reason' Date � sentatives Of this inspection purpa s.� Siqnalure Drivers' Llcenz ar CMF 0865-46, rev. 10/84 the 8ulltling; Canary �i above a TVPE OF CONSTHUCTION LJ NEW LJ ADD LTERATIO I ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT GRA�ING FOUNDATION STRU TUI ❑ TENANT�ELECTRICAL ❑ PLUMBING ❑ MECHAN AL ❑ OTHER ' PRO.IECT DESCRlPT10N 50. FT. oCCUaFNCv CON STRUCTION TVPE VALUATION $ _ ZONE GRADING CU. YDS. �_r_ �RES_ �/��' / Remarks �%. � ..a !ff' .CJx�. !d� ai Sink -� � ' � ackflow Preventer eckflow Iirigation athtubs larifiers • IShWdShC! rinking�Fountains loor Drains . Gas Service � . Outlets Inteiceptors � Kitchen Sink Lavatories P—Trap Roof D�ains , Reinspettion Fee. Boiler Duct - Under Ground PLUMBING • � _ � Showers ` Service Sink Sewer Cap Sewer Connection . Solar Collectors- � - Solar Piping . � Solar Tank • -� ' Swimming Pool�w/Sp: Urinal - Warer Closet Water Heater ' . WaterService . Auto-Wash Laundry Trays $15 ' Issue Fee ' MECHANICAL ,� Hood or Typel ❑ Canopy Typell ❑ Duct -'Ventilating Exhaust System ❑ Multiple Firepl/Fact.81[. ICBO # � Heating System & Ducting ❑ 0.100,000 BTU � 100,000 Reinspection Fee � ' $15 nt; Pink - Account ng; Galtlenrotl - A55¢sso� Refrigeration System ❑0�700,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers � Issue Fee $, 3 FEES $ 3 A.P. # S Main Buildi E T Front 6 Rear A C Right ' K Left $ Ping. Ref. dp Planning Notes: Automatic Washer Construction Pale Su6. CuOking Uait Dishwasher Dryers �Gas ❑Eleci Fan F.A.U. Fixtures Device Boxes Outlets Swfrches Ga�bage Disposa� Generator �0-5 KW C Fee 8230 5/2D/07 ' � Zone Parking Req./Provided ELECTRICAL - Transformer- � 15�50 KW ❑ 50+KW Meter ❑up to 100 amps � . Meter �over 100 amps 15 KW � $15 Sub Panel , Motors 00�1 HP �1'h-8 InaSolar �9-15 HP'�16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor luue Fea DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By Building Approved By � 13on i� FEES $ 3 SUMMAHY OF FEES �, ' . BUILDING PERMIT $ SMIP $ PLAN CHECK $ ' � PERMIT - � PWMBING S �SSUANCE $ P�,4N CHECK 25% S +�—�— ENERGY P.C. $ ELECTRIGAL $ �� GRADING $ - PLAN CHECK 50% �$ MICROF.ILM $ - MECHANICAL $ � � � TOTAL FEE ,$ �� PLAN�CHECK 25% $ � Z O N I N G R E � M T $ CONSTRUCTION AND PLANNING � ' POOL & SPA • APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipmen[ Location . 2. Soil Pipe�Undrgrnd.� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test , 6. Electrical UFER Gmd. 57. APPROVALTO COVER-GUNITE. 7. Footings 58. Electrical Conduit-Undrgrnd. . 8. Foundation ' 59. Gas�Pipe, O Undrgmd., Test 9. Water Pipe-Undrgmd. .- 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK � � 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final' 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � ' 64. Plumbing System - Final 14. Rou9h Plumbing 65. Electrical-Final - 15. Rough Electrical-Conduit � � , 66. Solar System-Final 76. Rough Electric Wiring 67. Fencing & Access Approval �� 17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � � 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . 20. Rough Factory Fireplace APPROVALS Permit # " _ 21. DuCts, in Structure 70. Underground Hydro _ � � �' 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush �� % � .� 24. Roof Framing � 73. Undergrnd. Storage Tank �,Gas ❑ Oil 25. Foof Sheathing ' 74. Overhead Hydro ... 26. T-Bar Ceiling (StructuraQ & Monocoat 75. .Dry Chemical '�� t � • 27. Frame and Flashing � 76. Dry Standpipe �� 28. Lathing & Siding . . 77. FIXED SYSTEM FINAL, ,�' 29. Insulation • 78. FIRE PREV. FINAL �:�i' � 30. Drywall Nailing � HEALTH DEPT:�REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ,` 32. Electrical Power Meter-Final • � 80. FOOD CERTIFICATE ISSU�ED � 33. Final Electric fi^ W. �c, ,7_ _�� Notes: 5 1�1- �- if -g , 34. Final Heating & Air Conditioning . �4,.a-�.-�i_" - _ 35. Final Gas Pipe-Test � ' � - 36. Hood or Canopy . : '� 37. Final Factory Fireplace , . ' � 38:.Final Plumbing � � � � � � ' 39: Water Service-Final , � � � - 40. Gas Service-Final � - �� y . :41. Solar pomestic-Final. � ' � i • n �42. Backflow PFevenzer '� -- � � � - . �; '% i'�- - ,� :43. Backflow I�rigation � ' � � - �� . ' �' , / . •44. Landscape Irrigation SYstem .�' - ' , ! !45. Sound Attenuation ' � � ' ' ' , . 46.•HandicapRegulations . � , . ' y, 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 , � .._ ' � _✓_�r A CITY OF COSTA MESA,e,COI� STRUCT ON PERMIT Project Address � � 7 V-' } �� S� C, �� 4SL Applicant's Maijjn�g 7qddre{s ��fi��{� r� • 1'�� Q270 Owner's Na ey�'`� �-" �n"'�\ �1`� Pnhone16 3d �a Address �L4 1�1'�� j` 1"� �' P�"C l. �"tOSG . Arch/Eng. i.k �� ic�en/� No.�� Address +St24r At��,,�,.,, �z 1'. 'v�v'yQIA �. �i2 Q Contracto�'sName_ Qf� k �I I�J_ _ Phone7��Iq63�+�! Addresslmailing) � 1`�S rc�� eL icLQt%i� �iya2��& b� 6 `j0 � City License No. LICENSED CONTRqCTOR DECLARATION I hereby affirm tnat I am Ilcensetl untle� p� islo 01 Charter 9(mmmencing wlth section ]000) of Division 3 of th ine i antl Protessions Cotle, antl my Iicense Is In tulytorcepntl effect. / � 4'Z71O . License lass L� (J 'T se No. �� _, Date Si9nature VORKERS' COMPQNSATION DEC � ON , . hereby afllrm that � have a certificate consent to se141nsure or a certiticate of Workerz' ComDensation Insuranc or a certitietl coPY thereof (Section 3800, lab. C.) Policy No. � Company Certifletl copy Is hereby fumishetl. Certifletl copy IS filetl with tne city Builtling Dlvislon. Oate Applicant ' . . EXEMPTION FROM WORKERS' COMPENSAT �ECLARATION (This saction neetl nbt be completetl if the per Is r onC huntl�etl ($100) 8r less). I c¢rHfy,that in th¢ pertormanGe Ot the work tOr tich this permR is i55uetl, I sha11 not employ/aqy p¢rson in any mannel so / ecome subject to the Workers' p rls �p �ws o( Calitornla. Date �� .� Signature NOTICE: If, after making this tleclaratio , ou shoultl become subJect to the Workess' Compensa({on provisions of th Labor CoGe, you must forthwith comply wi[h such p�ovlsions or tnis perml[ snall b¢ •tleemetl �evoketl, CONSTRUCTION LENDING AGENCY ' I hereby at(irm lhat there is a construction lentling a9ency for tha pertormance of the work fOr which this Oermil is Issuetl (Section 309] Civ. C.) Lentler's Name Lentler's AEtlress � � OWNER BUIIDER DECLARIITIOfJ � 1 hereby afflrm that I am exempt from the Contrac[or•5 License Law for the followin9 reason (Section �031-.5 Business antl Professional Cotle: HnY city or countY which requj�es a pe�mlt to cons[�uGl, alter, improve, tlemolish or repdi� any sVucture, prlm (o its issuance, also reqWres the applican[ for such permit to fil< a signa� slalement that he/she iz licensetl pu�suant to Ihe provision5 Ot thG Contractor's LlCense Law (Chapter 9(commencln9 wl[n Section 7000) of DiviSion 3 Of the gu5ine55 antl Pro(e551on5 COtle) or tllat he/she�is exempt therofrom antl the basis for tne allegeG exemp[ion. Any violation of Section ]031.5 by any applicant tor a permit subjects the applicant to a civil ee�dlty ot ml mo�� lhan five huntlretl tlollars (E500j. LJ I, as owner ot ihe property or my employees with wages as their sola compensation, will tlo the work, antl the structure iz not intentleC or ofteretl for sale (Section 7044, Business antl Professional Cotle: The Con[racror'S LlcenSe'Ldw tloes not apply to an owner oi a property who builtls or imoroves thereon, antl wno aoes such work �himselt/herself or throu9n his or her own employees, provitletl [haf such'imProvements are nOt intentletl o� offeretl fo� Sale. It, howev¢r, the builtling c� imprOvement I5 soltl wlthin one year of com- pletion, tne owner wlll have the burtlen ot proving he/she tlIG not builtl or im- �rove tor the purpose ot sale). I, as owne� of the property, am exCluSively Con[�acting witn licensea con- tractors to conSt�uCt [he p�oject (SectiOn 7044, Bu51ne55 antl Professions Cotle: Th¢ Contractor'S License Law tloes not aPPIY Io dn ownet of p�operty who builtls o� improve5 the�eon, antl who cont�acts 1or suCh project5 with a con- tractor(sl license pu�suant�to the ConVactOr'S Icens¢ Law). 1 am aware that proot O� Ihel� Worker's Compen5ation ms ce Shou10 be prOviAetl to Te ❑ I am exemo� untler Section B. & P. C. tor this reason Date wner I hereby C¢rtlfy [ha I' e reatl lOfOlTdtl00 i5 COIIp „1 d I¢C LO ( antl state laws rela ng to tlin< sentatives ot this enter in5p¢Ction pu�PoS S Si9nature Drivers' License or 55 � the i 5tate that t�e above antl coun(v ortlinances nt to fill in all spaces except those within neary boraer linas ana sign all aDD�opriate tleetarations. TVPE OF CONSTRUCTION LI NEW U ADD U ALTERATION LJ I ❑ CONVERSION ❑ DEMOLISH�-OTHER �� DESCRIPTION OF WORK/USE OF BLDG. _ TVPE OF PERMIT LJ C.RADING L ❑ TENANT '�ELECTRIGAL _C ❑ OTHER PROJECT DESCRIPTION 5t�� FT.— C O N 5T RUCTI ON TYPE 20NE__T GRADI Remarks: Sink Preventer Irrigation Clarifiers � Dishwasher � Drinking Fountains � Floor Dreins � • Floor Sinks GasService � 'Outlets InterceptOrs Roof Drains Reinspection.Fee $15 Boiler Duct - Under Ground Duct - Struc[ural ' Duct - Ventilating Exhaust SyStem ❑ Multiple Firepl/Fact.6lt. ICBO # Heating System & Ducting ❑ o-i oo,000 eTu O i oo,000 Reinspection Fee . � $75 CMF 0865-46, rev. 4/84 White - BuilCing; Canary - Applicanq Pink - AccounUng; Goltlenrotl - Assessor IFOUNDATION LJSTRVGTURAL PLUMBING ❑'MECHANICAL OCCUPANCV_ _ VALUATION $ ' VDS. �RES— Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Ur'rna7 Water Closet ' Water Hearer Water Service ' Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑o-ioo,000sru ❑iao,000 System Repair/Alteration Issue Fee FEES A.P. � S Main Buildin9: E T Front ARear C Right S Left � Ping. Ref. # Planning Notes: 317 5/31/et� a nn Zone Accessory Building: Z O - N I N G . • - R Parking Req./Provided E � M T S. ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction PoleSub. ❑ 50+KW Cooking Unit � Meter ❑up ro 100 amps Dishwa5her Meter ❑over100amps Dryers ❑Gas ❑Elec[ric Sub Panel ' Fan ' Motors�0-1 HP�1X-�8 F.A.U. Inc.Solar �9-75 HP �16- Fixtures � - � Microwave- - Device Boxes Pole Light � Outlets . Range Switches $ign Garbage Dispoul ' Standing Settions Generator 00.5 KW 05�15 KW Trash Compactor $ 3 _ Reinspection Fee $15 luue Fea FEES DEVELOPMENT SERVICES REDUIREMENTS: Zoning Approved By Building Approved By Aooliwtion Issued Bv $ 3 e FEES $ 3 - SUMMARV OF fEES BUILDING PERMI7 $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ Q)-CO GRADING $ PLAN CHECK 50% $ �MICROFILM $ MECHANICAL $ TOTAL FEE $ �1 PLAN CHECK 25% $ . . CONSTRUCTION AND PLANNING _ POOL & SPA � �,APPROVALS Permit# Date Inspector qppROVALS Permit# ' Date Inspector 1. Temporary Electrical Service or Pole • , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms -� ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . , 5. S[eel Reinforcement � 56. Rough Plumbing & Pressure Test � 6: Electrical UFER Grnd. � � � 57. APPROVAL TO COVER-GUNITE � 7. Footings , . � - 58. Electrical Conduit-Undrgrnd. ' 8. Found'ation ' 59. Gas Pipe, O Undrgmd., Test � 9. Water Pipe-Undrgrnd. _-� 60. Backwash Lines, P-Trap, O Und�grnd. 10. Structurel Floor System 61. APPROVAL TO DECK 71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap � 63. Heater & Vent-Final � 13. Roof Drains 64. Plumbing System - Final _ 14. Rough Plumbing 65. Electrical-Final - 15. Rough Electrical-Conduit �66. Solar System-Final ' 16. Rough Electric Wiring � . ' ' 67. Fencing & Access Approval �� . 17. Rough Wiring Sign � 68. APPROVED FOR P�ASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL . 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � � ' APPROVALS ' Permit # 21. Ducts, in Structure � 70. Underground Hydro ?2. Ducts, Ventilating , 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. �Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing • ' . 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. Plaster Brown Coat . 79. FINAL INSPECTION 32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ys � Notes: , 34. Final Heating & Air Conditioning � . 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing � , 39. Water Service-Final � 40. Gas Service-Final � 41. Solar pomestic-Final . 42. Backflow Preventer � 43. Backflow Irrigation . � 44. ,Landscape Irrigation System 45. Sound Attenuation _ . 46. Handicap Regulations " � 47. FINALSTRUCTURE&BUILDING � � 48. Special Requirements Completed •- 49. Electric Release'to Edison � � � 50. Gas Release to Southem Califomia Gas Co � . � 51. CERTIFICATE OF OCCUPANCY ' No. ' Date � - , City of Costa Mesa Development Services Deparqnent Building Safety Division P.O.Box 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY � N�. 902b�6 The Building located at %(�% WpQ}' 19th StC2et has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto tor a Group R1 Occupancy. Use of Building C[�[v Stote Legal Description R?4r202-03 (See reverse side for Metes and Boundsl Building Permit No B 36853 Electrical Permi[ No. F. 37425 Plumbing Permit No. P�7633 Mechanical Permit No. M��5�� Number of apartments and/or guest rooms ISSUED TO: Smart e Final P.O. Box 2377 r,og Anaeles. CA 90051 Building Official Willia[a T. Horrard by =f / i� � � / � - - � Date April 24� 1989 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 Ciry of Costa Mesa under Sec. 307 (e) 11.B.C. CMF lols-46 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bidg. Permil File I . CITY OF COSTA Project Address — Ovjrxr's Address CONSTRUCTION PERMI )"7 1. 1 1 d r'.� No. AoO�«ant to tili in all soaces axcept those witnin neavy earaer lines ane sign all apv�ovrlate tleclarations. PERMITNO. �,R�Ci�O�.'n LO,� .T�O�y, UNITNO. TJ �o $s.3 Y c�l Wi.wr.,- -- __ A.P. #/ , J TVPE OF CONSTRUCTION NEW ADD .4LTERAT ON EPAIR S Main E � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER tS T Frpn � DESC I TION OF WORK SE OF BLDG. ^ �� A Rear ,Q • • EOFPERMIT GRA ING FOUNDATION , STRUCTURAL �i K Righ Address �'✓ n' N Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION 1 hereby altirm �hat I arry liconsetl untl0/ P�ovi51on5 of Chalt¢� 9(commencing with section ]000) of Givislon 3 0� the BuSiness antl Profasslons Cotle, antl my licenze Is in full force antl eftect. License Class LicenSe No. Date S�gnature WORKERS' COMPENSqT10N DECLARATION hereby alflrm that I hare a cerlificate of consent to selt-inzure or a certi(icate . t Workers' Compen5ation Insurance, or a certitietl copy thereoi (Sectlon 5800, Lab. C.) � Policy No. Company eCertifi¢E copY �S h¢�eby fU�n15h¢tl. Certitietl copy is (Iletl vij(h the city Builtlinq Division. Da[e Applicant EXEMPTION FROM WqRKERS' COMPENSATION DECLARATION (This section neetl not be completetl If the permit is tor one huntlretl ($100) or less). I certity tnat in the performancG Of the wOrk fOr which IS perm�t is i55uetl I snall n0[ emplOy any P@�Son in any manne� so as Con e j< [o [�e Workers'Fo ¢ n�ws of Calit m Dale �1%%Si9natu�e NOTICE: I a ter making [his tleclaratlon u shoultl Oecoma subject to the Workers' Compensalion provisioni of th� bor CoOe, you mus[ forthwlth comply wilh such pro��sions or this Oermit sM1all be tleemetl revoketl. CONSTRUCTION LENbING AGENCV 1 nereby atiirm ihat therQ is a conztructlon lentling a9ency for Ihe performan<e �of [he work far whiCh this permlt is issuetl (Settion 3097 Civ. C.) Lentler's Name Lender's Atltlre55 OWNER BUILDER OECLARATION � � I herebv af(irm lhat I atn exempt from the Contractor's.License Law for the -to tile a signetl statemeqt that ne/sne I5 ucensea pursuam m me prvvumm o� +he ContractOr's License �yw (ChaOter 9(commencin9 with SeCtion 7000) ot vision 3 of the Busi�ess antl Professions Cotle) or that ne/she is exemp[ !relrom and the basig for the allegetl exemption. Any violatlon o( Section �31.5 by any applicdnt tor a parmit Subjects the appliCant to a civil nalty ot not more Ihary {7y¢ huntlretl OOIlarS (E500).. � 1, as owner ot lhe proDer[y. or my employees wi[h wa9es as their sole compensation, will tlo the work, and the structure is not intentletl or�otteretl �or sale (Se<tion 7044, gusiness antl Profezslonal Cotle: The Contractor'S LicenSe law tloes not apply to an owner of a prope�ty who bu11tl5 0� improves ther¢On, dntl wha tloes SutM1 wo/k hlTself/herseli o� through his o� h¢/ own employees, provitletl thdl such improvements are not intentlea or offeretl tor sale. il, nowever, tne bUiltlin9 0� iTP�ov¢ment i5 SOItl wlthin one yea� o( com- pletion, the owne� will hav¢ [he Du�tl¢n ot proving he/S�e tlitl nOt builtl ot im- r ve �ortne purpose ot 5ale). I, as owner of the proverty, am exclusiveiy contractln9 wlth Iicensea con- racto/s t0 const�uct the project ($e<tion ]044, Busin¢ss antl Ptote5510ns Cotle: The ConVactor's License Law does n0[ apply t0 an owne� of�pm0e�ty who Cuiltls or improves Ihereon. antl who contracts for Such orOi¢Cts with a con- tractor(s1 I�cenze pursudnt ro ene ConVactor�s License I..aw). I am aware tha� prooi o( their Worker'S Compensation Insurance shoultl be provitletl to me. ❑ I am exempt un er 5¢ctbn B. 6 P. C. for this reason 'i Date Owner Signature Drivars'� — :ertity that I have reatl tn ppli<atlon antl state ' n I5 corr¢cL I agree [o c ty wrth dll Clty antl cou aw5 relatin9 to builtliny{ onStruCtion, antl hereDy a ol this city (p enj¢fypon tpa aj�ove-mentionetl TENANT C� ELECTRICAL �OTHER � �5�� (A PRQIE�GT6�CHIPTION 54. FT. oCCUP CONSTRUCTION TVPE�� VALUATION $ �— ZONE GRADINGCU.VOS. A( Remarkt: Bar Sink Backflow Preventer 6ackflow Irrigation Clarifiers Dishwdsher Drinking Fountains Floor Drains Floor Sinks Gas Serviee Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspec[ion Fee � $15 Bailer �utt - Under GrounA Duct - Structural Ouct - Ventilating ' Exhaust System ❑ Multiple ❑ F irep l/ Fact. Bl t. i C80 dk Heating System & Ducting ❑6100,000 BTU � 100,000 BT >c ! T'—, I I ReinspectionFee White - Bulltlin9; Canary - Applicant; Pink - Accountin9: Goltlenrotl - Assessor a $15 Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fea �� Ping. Ref. # �� Planning Notes: Hood or Typel � CanOpy Typell ❑ Refrigeration SyStem ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole COoking Unit Dishwasher Ory¢r5 �Gas ❑ Fan F.A.U. Fixtures Device BoxeS Outl¢ts _ Gaibage Disposal � Generator Oa5 KW �5-15 KW 1 . .� � _.��Reinspection Fee � $15 DEVELOPMENT SERVICES HEQU. $ 3 ' ZoninB APP�bved BY R � FEES _'.� 8uilding ppprovad 8y �IL' l: , ' BUILDING PERMIT $ p ; PLAN CHECK $ �PWMBING $ 'PLAN CHECK 25°6 $ , tELECTRICAL $ •PLAN CHECK 50% $ ' �, MECHANICAL $ �� PLAN CHECK 25% $ , • � , $ 3 � Zone tICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter �up to 100 amps Mecer ❑over 100 amps ' Sub Panel Motors 00.1 HP � 1'6 - 6 � Inc.Solar �9-75 HP,�i6-15+ Microwave Pole Light .'- ' Range ' . Sign Standing Sections Trash Compactor Issue Fee N I N G R E O M T S. FEES $ 3 ca�� SMIP $ •7S PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM $ ''')�-(^!y� TOTALFEE $ �J CONSTRUCTION ANDPLANNING APP�i�'VALS Permit # Date I 1._ Te�porary� Electrical Service or Pole 2. Soil Pipe-Ohtlrgmd. 3.: Electrical Cbnduit Utility-Undrgrnd. 4.`'ElecfracalConduit-Undrgrnd. � ti. 'Elect�ic�I�UFLR Grnd. � 7. Footings : �. 9.,.Wate�� 10^Str�uctural Flq`or System i�tt Property.Sewer Line & House Connection 12: �Sewen Cap � 14. Rough Plumbing 15.�Rough Electrical-Conduit l6a Rough Electric•Wiring ' 17. Rough Wjring Sign i 18. Rough•Etectrical-T Bar Ceiling.i �� 19. Rough Fieating & Air Conditi�ning 20. Rough Factory�Fireplace t � 27. Ducts,-in,Structure � �. v r 22. Ducts, Ventilafing , �' :i 23. Gas PipejRough`& Test �+'' r, 24. Roof Framing'":; �,� ' 25. Roof;Sheathing'; � � _ , � L 26. T-BarhGeiling (St�uctural) &��vjonocoat 27. Frame arid Flashing � �' i 28. Lathirig.& Siding �� 29. Insula ion '� !-. � , 30. Dry aIl:Nailing',; '� '-''��t � �� i � 31. Plaster Brown,Coat .i, t'� 32. Elect�ical PoweF Meter-Final . 33. Final�El�etric'� .,, 34. Final Heating & Air Condi[ioning 35. Final Gas Pipe-Test •-36. Hood or Canbpy � �,e �37. Final FactorY Fireplace 38. Final Plumbing � , �39. Water Service-Fina�j � .40. Gas�Service-Final •'• �� 41. $olar pomestic-Final: '� � 42. Backflow•Preventer '� � .y�� • 43. Backflqw Irn aiinn � �t� - �''_ 44. .L.y.ndscape� lrrigation �System 45. So.and �� [enuation,-�� . 46. Handicap�Regulations �� 47. FINPL:STRUCTt�RE&;BUILDING 48. Spec;al Require�nents Completed i 49. Electcic,ReleasetoEdison .50. GasrReleasetoSoutherr�CaliforniaGasCo 51. CERTIFICA7EOFOCCUPANCY � No. Date j YVI JYH nspector' qppROVALS Permit# ' Date Inspecior 52. Pool & Equipment Location ��,. 53. Steel Reinforcement � ' ' 54. Forms " . � . 55. Electrical Bonding �' 56. Rough Plumbing & Pressure Test 'y. . i 57. APPROVAL TO COVEfi-GUNITE - i, i- ., 58. Electrical Conduit-Undrgrnd. �' • � � 59. Gas Pipe, O Undrgrnd., Test - �� - ,�. � 60. Backwash Lines, P-Trap, � Undrgrnd. � � „ � 61. APPROVAL TO DECK � ' 62. Backwash & Receptor-Final ' i "/; 63. Heater & Vent-Final " - ' 64. PlumbingSys[em�-.F'rnal • ' ' 65. Electrical-Final • 66. Solar SYstem-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINA� FIRE DEPT. REQUIREMENT APPROVALS Permit# 70. Underground Hydro 71. Product Piping � Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical ' 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � , 80. FOOD CERTIFICATE ISSUED Notes: �- ' � � � � � ,n. � n _L 1� A � _�_ -�1_Ir.. T- �7 � � � �,��,-��yr• ��1 ,., � .. i �� , / �' ' 7 � '� � � �:'1 � � • �.. , �. wi J 1; J � � ! •- �� •� � ., ^ ; I ��.i,�'.. ' �'� • F� � AoO��ant to fill in all soaces exceo� lnose within neavy borAer Iines antl sign all apvrovriate tleclarations. PERMIT PERMIT NO. _ � TRACT NO. LOT NO. UNIT NO. CITV OF COSTA MESA �C�O♦NSTRUCT ON . Projea Address �07 W • , ��" � _ Applicant'S Mailin Address �� SSU �AL� MA� ST Owner's Name ��T � F�r0.�-- phone Address �i700 Yjo`iLE (.�Vr`r Cnt L�Y�.ELES Arch/Eng. License No. Address Contrector's Nam�ro�.c ^ CnT��P �`�Uc�— Phone 530-ofiSi Address (mailin9) ( � ��p SP.C� �1R1 ' ) . Cily License No. �� /�%� LICENSED CONTRACTOR DECLARATION I her¢by attirm lhal I am licensetl untler provi5iOn5 0/ Chdrt¢/ 9(comm¢ntlng � with SeCtion 7000) o/ Divlsion 3 Of Ihe Buslness antl Profeszions Cotla, antl mY1lc�soi�nlW1 rce�tlefiect. � n � ��/ License C-aS �� Oate., � 5'9 t e � WORKERS' COMPENSATION DECLARATION 'ereby alfirm Ihat I have a certiticale ot con5ent to self-insure or a certl(icate � Workers' Compensation Insurance, or a certilietl copy thereof (Sectlon ..d00, �ab. C.) ' P,�ollf Y No. ��r� 3�G�,�ComP nY �� IyCertifietl copy is hereby furnishetl. � \ ri Certiti ca y is tiletl wLLh the city ' tl' Da[e Applitant \ EXEMP ION FR M WORKERS' COMPENSATION DECLARAT N , (Tnis section neetl not be comple[etl if tne permit is for one huntlretl ($300) or iess) I certify that in the performanca of the work tor which thls perm�t is issuetl I shall nol employ any person in any manner so' as to become subject to t{�e Workers' Compensation Laws ot California. I Date � Signature NOTICE: If, after making this tleclaratlon, you shoultl become subject to the ' Workers' Compensation provisions ot tne Labor Cotle, you must (orthwith comply with such p�OviSlons o� thi5 permit thall b0 tleemetl rOVOk¢tl. CONSTRUCTION LENDING AGENCV 1 hereby atfirm that there is a construction lentlin9 a9ency for [�e pertorman<e Of lhe work for whiGh Ihis permil i5 iStuGtl (Sectlon 309] Civ. CJ L.entler'z Name �f Lentler's Atltlress OWNER BUILOER DECLARATION I hereby aHirm ihat I am exempt hom the Gontractor's License Law for the /ollowing reason (Sectlon 7031.5 Business antl Professional Cotle: Any Nty or counly which requires a permi[ to con5[�uct, alt¢/, Improve, tleTolish or �epal� any st�uclure, priOr to il5 issuanGe, dlso �equir¢5 tne appliGant fo� such pe�mlt 'to tile a signetl statement Ihat h¢/she IS lit¢nsetl pur5udnt to the prOvlsion5 ot "�e Coniractor's License law (CnaO�er 9(mmmen<ing wltb Section 7000) ot •ision 3 ot the Business antl Pro(essions Cotle) or that ne/she is exempt relrom antl the basis tor the allegetl exemption. Any vialation of 5¢ttion ..31.5 by any applicant for a permit subjects Ne applicant to a clvil �enalty of not more Ihan (ive buntlretl tlollars (5500). LJ I, as owner of the proporty or my employees with wa9es as their sole compensation, will Ao lhe work, antl the structure is not intentlea or offeretl tor sale (Section 7044, Business antl 7rof¢ssional Cotle: The Contractor's License Law tloes not apply to an owner of a property who bulltls or improves thereon, antl who aoe5 such work himself/herself or [hrough his or her own employees, provitletl that such Improvements are not Intentletl or otteretl for sale. If, however, the bulltling or improvement is soltl within one year of com- pletioq the owner will have tne burCen of proving he/sne tlIC not builtl or im- prove for the purpose oi zale). ❑ I, as owner of ti�e property, am excluslvely contracting with Ilcensetl con- tractorsto construct tne project (Section 7044, Business antl Professions Cotle: - The Contractor's License Law does not apply to an owner of property who builtls or Improves thereon. antl who contracls tor such oroiects with a con- lId<t0l�5� I�C¢n5¢ pUISUdn[ [O [fl¢ COnVdCt01'S Li<805C I..dW�. I dT dwdl0 Ihdt prooi o their Worker's Compensation insurance shoultl be providetl to me. ❑ I am exempt untler Section B. d P. C. tar this reason Dale Owner I herebvi certifY [hat I have reai all Signature / \Oo^�",u' Drivars' License or 55 $ _ that tne above TVPE OF CONSTHUCTION LJ NEW LJ ADD U, ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTIO OF yWOARK/USE OF BLDG...,�� TVPE OF PERMI� LJ �AOING LJ FOUN, DATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION S�.F7. OCCUPANCV C O N ST RUCTION TYPE V A LUATI ON $ 20NE GRADINGCU.YDS. ACRES Remarks: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Roof Drains Reinspection Fee � $15 Duct- Under Giound Duct - Structural Duct - Ventilating Exhaust SyStem � Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0�7 00,000 BTU O 100,000 BTi Reinspection Fee I S15 0865-46, rev. 5/80 White - Builtling; Canary - Applicant; Pink - At<ounting; Goltlenrotl - Asseizor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash - ` laue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration Syste��m///,,, ❑0.100,000 BTU�100,000 BTU System Repair/Alteration Fire Dampers Registers I�sue Fee A.P. •/k S Main Buildi E T Front B Rear A C Right g Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers OGas ❑Elec Fan F,A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0.5 KW C Zone ELECTRICAL Transformer � 15-50KW OSO+KW � Meter ❑up to 100 amps Mecer ❑over 100 amps Sub Panel Motors�0.1 HP �1h-8 Int.Solar �9-75 HP �16-15+ Microwave Pole Li9ht Standing Sections 5-15 KW Trash Compactor Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: / 2oning APProved By FEES � Building Approved By � Aooliption laued Bv •_._ 1 SUMMARYOF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ �' ' 0 PLAN CHECK 25% S N I N G R E U M T S. FEES $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ '� (,j /y'] TOTALFEE $ _�_ 0100027497-60027497 TC1T 24,t�0 DATE: O.i102/S9 TIM�: 14�55 - 1, Ct ` .. . �,;'� \\`` � ' .. . . . . \ CONSTRUCTION AND PLANNING ' / �� ' SPA APPROVALS Permit # Date� Inspector qppROVALS Permit # Date Inspector ,� 1. Temporary Electricgl Service or Po`�e %� 52. Pool & Equipment Location Q. Soil Pipe-Undrgrnd. ..;, -"�� 53. Steel Reinforcement 3�Electriical Condu.it Utility-Undrgrnd. �� 54. Forms . ' .� 4!Electrical Conduit-Untlrgrnd. ::j `. 55. Electrical Bonding _•� � Steel,Reinforcement ,'�• � : 56. Rough Plumbing & Pressure Test �., 6. ElecfriCel UFER�Gmd� ,�� '�' 57. APPROVALTO COVER-GUNITE -.� 7;,Footings , �� 58. Electrical Conduit-Undrgrnd. � � � l. 8' Foundation . �� `�� 59. Gas Pipe, O Undrgrnd., Test _, � : �� Water Pipe-Undrgrnd. ,,• � 60. Backwash Lines, P-Trap, O Undrgrnd. � i 10. Structural Floor System j; -••�� . 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection ._` !�.. 62. Backwash & Receptor-Final � r , 12. Sewer Cap. I, r+r t � 63. Heaier & Vent-Final � 13. Roof Drains � �� '� �� 64. Plumbing System - Final � ;., �.. 14. Rough Plumbin�� . 65. Electrical-Final � 15. Rough Electrical-Conduit 66. Solar System-Final 76. Rough Electric Wiring 67. Fencing & Access Approval 1�•. Rough Wiring Sign 68. APPROVED FOR PLASTERING � 18. Rough Electriral-T Bar Ceiling 69: POOL/SPA SYSTEMS FINAL �� 9. Rough �FI_eating & Air Conditioning . FIRE DEPT. REQUIREMENT 20._RoughFactoryFireplace �-Y APPROVALS Permit# J 21. Ducts,'tr%Structure i 70. Underground kydro 22. Ducts,Ventilating ..�� 71. ProductPipingOGas ❑Oil � 23. Gas Pipe�Rough & Test �� 72. Underground Flush . 24. Roof Fr�ming "�'� 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing w 74. Overhead Hydro i 26. T-Bar Ceiling (Strucwraq & Monocoat 75. Dry Chemical '� 27. Frame and Flashing 76. Dry Standpipe. 28. Lathing & Siding 77. FIXED SYSTEM FINAL '� 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED _ .�; 33. Final Electric Notes: �_ _ � �' 34. Final Heating & Air Conditioning / 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ' 39. Water Service�Final 40. GasService-Final '�1 ,� 47. SolarQomestic-Final j, . 42. Backfl0w Preventer � � 43. Backflow Irrigation � � . '" f 44. .Landscape Irrigation SYstem /': 45. Sound Attenuation �• y �% 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING �� 48. Special Requirements Completed 49. Electric Release to Edison �� i. 50. Gas Release to Southern California Gas Co l! - 51. CERTIFICATE OF OCCUPANCY �:� �.� No Date �!'� � ADGlicant lo fill in all spaces azce0< <hose wit�(n heavy eoraer Iines antl sign au aoDrovr(ala Ueelantions. RMIT NO. N N UNIT NO. A P# CITY OF COSTA MESA CONSTRUCTION PEFiNIIT � — (��' 9�{- ^... LUi_4 - 2n� - fia � Project�qddress APPIit2nt's A9ailirg Address �O� `s� Owner's Name ��Y�� ¢ �'��'L pfi�n �% �73f Addreu �1 -Si �✓G� E'�iu� rJ C4�,/i�jOS ArchlEng.�`+�0�lr0Yt/ f� Licenu No. � �Z�Tc` Address �� ) G Contractor's Nam hone Address (mailing) Ciry LiCenu No. LICEN$ED CONTRACTOR DECIARATION I hereby affi�m t�at I am Iicenietl untle� provl51on50f Cnarter 9(Commencin9 wllh sett(on ]000) o! Dlvit(on 3 of tho Buzinoss antl Profesitons �otla, antl mv Iicense is in /ull force antl etiect. License Class Licenia No. Datc Signature WORK�RS' COMPENSATION DECLARATION heleEy atfilm lhal I have a c¢rtificate o1 cOn58nt lo salt-in5ufe of d celtl(itdto ; Wotkers' CompenSatiOn InsuranGe, or a certiti¢U copy lhoreof (Sectlon .f800, I.ab. C.) Polity No. Company eCertiriea copy is nereby turnisnee. . Cerq�{etl m0Y �s tiletl with the city Builtlin9 Division. Date Applicant E%EMPTIpN FROM WORKERS' COMPENSATION DECLARATION (Thi55ectlon neetl not be tompletetl ii [ho permlt is for one huntlratl (5100) or less). I Certify (hat in th¢ perlo�mance o� the wo�k tOr wplch tn15 pBrtll�t Is ISSu¢tl, I Shall nOt employ any pe�50n In any Tanner TO as ." o bj� t to the Worker=� o p on Lnws o( Cali a! �r Data - _Si9nature NOTICp: f, ter making thiz tleclarat on ou shoultl bacome SuD�ect to tne WorkerE' Compensation provisions e Labor Cotle, you must forthwith comply viith suc� Orovislans or is pormit shall be aeemea revoketl. CONSTpVCTION LENOING AGENCY I hereby afiirm that them Is a conztructlon lentlin9 a9ency lor tne Derformanco ;of the wprk !or which lNt permil it issuetl (Sectlon 3097 Civ. CJ I,tntler's Name Lentler's Atltlrezs OWNER BUILDER DECLA0.ATION ' I hereby aHirm Lhat I am exempl from [no ConVactor'S Llcenso Law !or the followi�q reason (Soction 7031.5 Business antl Profe55ional Cotle: Any citY or County which �equire5 a pe�mit to cOnSt�uCt, alte�, imp/ove, tlemo115n o� r¢pal� any strutture, prior [o its issuance, also raqulres the apo��ant lor such permit [o lile a si9netl statement that he/she is Iicensetl pursuant to lhe provisioni ot +ne Contractor•s License Law (Chapter 9(commencinq with Sectlon 7000) of 'vision 3 01 tlle Bu5Ine5S antl PlofesSiOns CO�e) ol that 118/Tha Is exelllpt :relrom an0 the basis tor the allegetl exemptlon. Any vlolalion o( Section J31.5 by any apPlicant for a permit SUDjectS the applicant to a civil �enalty ot not more [Aan five hunCretl Oollars (5500). ' I, ds owne� of [M1e property or my 9mploy¢¢5 with wage5 ds thEl� so12 compensation, will tlo tha work, antl tho structure is not intentletl or ofterea for sale (Section �044, Business antl Professional Cotla: The Contractor'S Licensp Law tloes nol apD�Y �o an owner ot a propeYty who bWlOs or Improves tper¢On, antl wh0 tlo<5 sutb work hlmSeH/hotselt or tnrough hIs O/ her own emplOVaes, Orovitletl that Such imProvOmen[5 aIe OOI Int8ntl8tl or o(/Gretl fo! sale. It, �owemr, the bulltlin9 Or ImproveTent IS soltl withln ane y¢dr of coT- plCtloq, tba Owner will hav! Ihe burtle0 01 PrOving h¢/she tlitl nOt bu71A or Im- pr e lor the purposa of sale). I. ds ownar ot [he p�oPerty, am axcWSivOty contracting with IICOnSetl COn- ra lorsto cons[ruct the project ISettion 7044, Business ane Profaisions Cotle: Tno Contractor•s Licansa Law does not aPPly lo an owner ol proporty who builas or improves l�ereon. antl who contracts lor such orolects with a con- Ibactor(51 license Ounuan[ to me Con[ractor's LlCnnse Law). I am aware tnat prool o( their WO/k9r's COmPensallon Insu/anGo should be prOvltleG to Te. ❑ I am ezempt untlar 5ection �I� P. C. tor this reason Dale Owner have reai 3 C-� 4.5 Z 7YPE OF CONSTRUCTION NEW AD� ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHE$ SCRIPTION OF WORKlUSE OF BLOG. �N��A-��,fQ��IJ'''C��'L��/// ��' � � L� �• i O //' _/e �'�' TVPEOFPERMIT GRAOING FOUNDATION STRUCTURAL ❑ TENANT j7�jTELEwC RICAL 4 PLU/�MBING ❑ MEC�HIA'N^ICAL ❑ UTHER I S.�,I�rT ( OIL �E/_� � PRQIECT DESCRIP ION St��. F�Tj. oCCUPANCv_� CONSTRUCTIONTVPE y VALUATION$ ��r%:7CJ�'�— ZONE GRADINGCV.�'D5. ACRES Remarks: `��'�r1�t. iln P.��f' 1�%QS��MeM.A Bar Sink Bxk£bw Preventer Backflow Irrigation Drinking Fountains Floor Drains • Floor Sinks . GesService Outlets Kitchen Sink Levatories Roof Drains Reinspection Fee Boiler Duct - Under Ground Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank S �mming Pool w/Spe Urinel Water Closet Water Heater Water Service Auto-Wash Leundry Tra'ys $15 I�sue Fee MECHANICAL Hood ar Typel ❑ Ca9epy Type 11 ❑ Duct - Ventilating L Exhaust System ❑ Multiple Firepl/FacL Blt. iCBO # Heating System & Ducting ❑P700,000 BTU 0100,000 �_� I sonlatl�es ot thii tlty lo en pon tpa apove-menuonea proper y or InSpeCtiOn Pu�p�C5-� j ,G� Date � f Signature //Ysy.✓ � Drivars' Licen 5� {�/ %� Reinspeetion Fe9 0865-46, rev. 5/98 White - Builtling; Canary - Applicant; Pink - Accountin9; Goltlenrotl - Assessor $15 Refrfgeration System ❑aioo,000sru ❑ioo,000aT System Repair/Alteretion Fire Dampers Registerz lssue Fee S Main I E T Front B Rear A C Right Ping. Ref. # Planninp Notes: FEES Automatic Washer Construction PoleSub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Davice Boxes Outlets SWitche5 Garbage Dispoul Generatar 00.5 KW Fee Parking Req./Provided "' ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps � Sub Panel Motors � 0� i HP � 7 X• 8 ! . oiar 0945 HP 0l6�15+ Microwave Pale Light � Renge ''+`� � • Standing Sections 5 KW Trash Compactor $15 Issue Fee $ 3 DEVELOPMENTSERVICESRE REMENTS: 2oning APPravad By FEES Building Approved By APPlication Isued BY $ 3 SUMMARVOF BUILDING PERMIT $ ZT• �D PLAN CHECK $ PLUMBING $ PLAN CHECK 25% S ELECTRICA� $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ N I N G H E Q M T 5. FEES $ 3 vr�� SMIP $ • .S_ � PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Z�•s� . ,. _... ,. ... .. - CQ(USTRUCTION AND PLANNING POl . SPA / Date Inspector • � Date Inspector APPROVALS Permit # APPROVALS Permit # i 1. Temporary.Electrical Service or Pole '•' 52. Pool & Equipment Location ,�, . . '1. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement •� ' � � 3.,Elecir;ical Conduit Utility•Undrgrnd. �' 54. Forms • n �` .i 4. �Electrical ConduiY=Undrgrnd. 55. Electrical Bonding i .; - 5..Steel Reinforcement 56. Rough Plumbing & Pressure Test �, 6. Elect'rical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ' �� 7. �Footings�.; �;� � ; ' 58. Electrical Conduit-Undrgrnd. �,� �� ' 8. Foundation '� 59. Gas Pipe, O Undrgrnd., Test % �� `.; ..i � • 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. '�-� i � 10. Striuc[ural Floor System '; �� 61. APPROVAL TO DECK , ' .t 11: Property Sewer Line & House Connection i 62. Backwash & Receptor-Final � �Z.Sey�'QICaP•' �.� 63.Heater&Vent-Final � , r 13. Rqof D�ains ' 64. Plumbing System - Final � .. 14. .Rough Plumbing 65. Electrical-Final 15. Rough Eiectrical-Conduit 66. Solar System-Final �16. Rough Electric Wiring �J � 67. Fencing & Access Approval 17�. Rough 411iring Sign �i � 68. APPROVED FOR PLASTERING .� 18! Rough Electrical-T 8ar Ceiling �;Ct1 69. POOUSPA SYSTEMS FINAL l�l 4 .- 19: Rough Weating & Air Conditioning��4 FIRE DEPT. REQUIREMENT � 20� Rough �actoryF.ireplace �•--; G i APPROVALS Permit # 21� Ducts, in:StruCture 7� r� � � �. 70. Underground Hydro 22. Ducts, VQntilating I �_ � �) 71, Product Piping �Gas ❑Oil � i 23. Gas Pipe;Rough�& Telt -}-j 9� , J2. Underground Flush � � 24: Roof F�ming '1 -• �1, 73. Undergrnd. Storage Tank 0 Gas ❑ Oil . �25: Roof Sheathing'\ '�� i 74. Overhead Hydro 26. T-Bar'Ceiling (St�uctural) $�Monocoat 75. Dry Chemical ... 27.�fVame'arid FlasHing "�, y-�'�� 76. Dry Standpipe 28. Lathirig•&'SidiT� ^�� 77. FIXED SYSTEM FINAL � .r-/�. �, � i � 29. Insulat�on � � �,� 78. FIRE PREV. FINAL '�' ��= r HEALTH DEPT. REQUIREMENT 30. Dryw I.Nailing-' �„ ✓` 31. Plas[e}.Brown Coat � _'� � 79. FINAL INSPECTION .- 32. Electncal Power Me{erFinal;'�� 80. FOOD CERTIFICATE ISSUED 33. F nal Electric - f� j' Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy � 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final : , �� 41. Solar pomesticFinal, . , j � , � ,4�. Backflow Preventer' � ' ��'�,i� ,� � .r 43. U�aeliflow �Irrigation 44.��L•endscape Irrigation System � " - v. 45. Sound �Ajtenuation ' ' �� 46.••hlandicarp Regulations � ;,` ' 47' F'INAL`STRUCTURE &�BUILDING � L ' 48.�'Special;Requirements Completed 49' Elec�ric Release to Edison �; 1,1 ,i `50. LGas•flelease to Southern California Gas Co �� 51. CERTIFICATE OF OCCUPANCY - f No. Date i , : , � 1 ADGllcant l0 fill in all spaces except lhose wi�hin �aavy CorCer Iinas antl fign all aoG�ovriate tlaclantions. CITV OF COSTA MESA CONSTRUCTIOpN PERMIT PrM..�� Addresz �% �L9�'Sf'� �L n' S� 1�� rApplicant'sMailinoAddress �_l 5� f?'�- G.� /��+G �--� �� Owner's Name . L�l � �- _?hone Address s Arch/Eng. License No. Address Contractor's NamG� -z�� y � ,,� hon Addrest (ma�l'ng) !t—/] s� L�-�* F��—�= �� City License No. �.�r�� LICENSED CONTRACTQR DECLARATION I hereby aftirm tba[ I am IicenSetl untllr provi5ioni ot Chdrtar 9(commencing with seclion 7000) ot Dl��slon 3 oi the Business antl Profeszlons Cotle, antl my license is in lull i<e G effect. License Class � License No 22 Date � Slgnature WORKERS'COMPENSA710N DECLARATION �I nereby aitirm Ihat I have a certlticate of consent to sel(-insure or a certificate of Workers' Compensatiqn Insurance, or a certifietl copy thereol (Setlion 3800, Lab. CJ',i ,,/ �','A PolicY No.1/ X1� � � Z(7,romPanlF 1� ��-0�� Certiti¢tl copy'i5 h¢reby furni5h¢tl. Cer ti p is letl with the city i mg i i ��j{ Date �� APPlicant � -��" � � � EXEMPTION FROM WOpKERS' COM ENSATION DECLARATION (Thismction neetl not be tompletetl if the permit is for one hunCretl ($100) or iezs). I certiiy that In.tne perlormance of the work for wnich this perm�t is issuetl I snall not employ any person in any manner so as to become subject to t{�e Workers' Compensatlon l.aws ot Cali(omia. Date S�9�ature NOTICE: 11, alter making (his tleclaration, you shoultl become sub�ect lo lhe Workcrs' ComDa�sal�on provislons ot Ihe Labor Cotle, you must forlhwith comply with sucn provlzlons or this permit shall be aeemetl revokea. CONSTRUCTION LENpING AGENCV I hereby altirm that lhara is a con5trutlion lentling a9ency tor the performance of tha work for which tnis permit is issuetl (Section 309� Civ. C.) Lentler's Name Le�ticr's Atltlrass OWNER BVILDER DECLARATION I hereby alflrm lhat I am exempt trom the ContractorY Liceaso Law tor the following reason (Soctio� ]031.5 Buiiness antl Pro(essional Cotlo: AnY cltY or county whiGh requires a p¢rmil lo COns[ruG[, alter, improve, tlOmoliih Or repdir any ztruclure, prlor to ct: issuanca, also requires the appHwnt tor such permit �n tiie a sianotl tlatement tbat he/ihe I5 Ilcenutl pursuant to [he provislons of DlviSion 3 0l the Buslntlss antl PfofeSAOns COae) o! [nat ne/sna is exemp� tlmrefrom anE lhe basis for the allegeU exemption. Any violatlon of Section 7031.5 by any aOP��a�� for a permit suDjects the applicanl to a civll �enalty o1 nof more than five nuntlrotl tlollars (E500�. 1, as ownor of [ho properly or my employees wilh wa9es as their sole compensatlon, will tlo lhe work, antl the structure is not Intentle0 or otferotl br sale (Sectlon 7044, Business antl Protezsional CODe: The Contractor'S Lltense Ldw tloCs nol apply to an own8r Of a prOpe/ty wh0 Oulltli Of ImplOv05 thoreon, antl wlto tlo05 SUGh wO�k himselt/It¢rself or Ibrpugb his or her own employCes, provltlOtl Iha� such Imp�Ovement5 are nOt intentlatl O� o118retl �or sale. It. however, tne Culltlin9 a� ImO�a�ement is soltl withln one year of com- plecion,'tM1a owncr wlll 11ava the burtlen oi Provin9 he/she tliC nat builtl or Im- prove lor the purpose o1 salo). ❑ I, as owner ot lhe Droperty, am exclusively contracting wlth Iicensetl con- tractors to construct the project (Section 7044, Business anC Protesslonz CoOe: The Contractor's Licensp Law does not aPPly to an owner of property who builtls or imoroves thereon. anE who contracts for zucn oroiects witn a r.on- tractor(sl Iicens0 pu�suaqp to �ne Conuactor•5 Licenu Law). I am aware that proof o( lheir Warker'S CompensaHon insUtant¢ ihoultl be provitl<4 [o m!. ❑ I am exempt untler Soclion B. 6 P. C. for this reaton Date Signature ' �"� Oriverz' L ense or 55 0865-46,rev. 5/88 Owner ive reatl thii appliwtion antl state that the abova nae to comply with all tlty antl county orGinances builtling ConStrucUOn, antl hereby authorize repra- �[er upon the above-mentionetl OroPerty f Oai�� , _.. ... ,. _. . - -- .,... ...,. / A.P. (O S Main 8uildi TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T FrOnt DESCRIPTION OF WORK/USE OF BLDG. A Rear TVPF OF PERMIT GRADING FOUNDATION STRUCTURAL C Right ❑ TENANT ❑ EIECTRICAL � PLVMBING ❑ MECHANICAL . S' Left � � �oTHEa Ping. Ref, qW PHOJECT DESCRIPTION SQ. FT. OCCVPANCY Planning Notes: CONSTRUCTION TYPE VALUATION $ ZONE C�RADING CU. VDS. ACRES Ramarks: _ _ L` � Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinb Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Droins Reinspection Fee � $75 Dutt - Under Ground Duct - Structural Duct - Ventilating Exhaust Sys[em ❑ Multiple Firepl/Fac[. Blt. �CBO # Hea[ing SVsrem & Ducting ❑0.100,000 BTU 0100,000 �` I I Reinspaction Fee Whlte - Buileing; Canary - Applicant; Pink - Atcountin9; Goltlenrotl - Assessor $15 Showers Service Sink Sewer (:ap Sewer Connection $018f C.OIICCLOlS Solar Piping Solar Tank Swimming Pool wl5pa Urinal water Claset � Water Heater Water Service Auto-Wath l laua Fea Hood or Typel ❑ Cenopy Type �I ❑ Refrigeration System ❑aioo,000eTu Oioo,000 System Repair/Altera[ion Fire Dampers Registers Issue Fee FEES Automatic Washer, Construction PoleSub. O Cooking Unit Dishwasher %, Dryers �Gas ��Elec� Fan �� F.A.U. � Fixtures �L� Device Boxes ✓„� 1 r wT Outl¢ts $ 3 2one Acceuory Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Me[er ❑up to 100 amps Meter ❑over100amps. Sub Panel - MOtors �Pt HP �1 X-$ Inc. Soiar �9-15 HP �16�15+ Microwave Pole Light Range Dispaul Stending Sections i� �0-5 KW �5-15 KW 7ratb Compacror Fee 1$15 I I luue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning qpproyed By Building Approved By .- SUMMARV OF , BUILDING PEfiM1T $ ' PLAN CHECK $ � /. . " PWMBING $ PLAN CHECK 25% $ ' EIECTRICAL $ ' iPLAN CHECK 50% $ .. �MECHANICAL $ � PLAN CHECK 25% $ $ 3' / FEES $ 3 SMIP $ PEHMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ a'S•D� oi o0D27285-000a7285 Tra'y DATE: 02/28/89 TI17E: f5:38 n cS. O N I N G R E Q M T $. r " CONSTRUCTION AND PLANNING ~ �< . PO6.. & SPA - � r � � 1:lPPROVALS Permit# �-� Dat�� Inspector qpPROVALS Permit# Date Inspector ''� 7. Temporary Electrical Service or Pole � � 52. Pool & Equipment Location • /' - ., � 2. Soil Pipe-Undrgrnd. j �, 53. Steel Reinforcement - �; ' ',t.V ^ .._ ,,'y � / �. . 3�Electnca! Condwt Util�ry-Undrgrnd� �" � 54. Forms �� o. ,. ,. .� 4�,E�ectYcal Cond�it-Und�rnd. ;'J ��.. 55. Electrical Bonding ��. 5. Steel3Reinforcement,� � � � � , �v�� ,F ��, , 56. Rough Plumbing & Pressure Test �� 6��Ele`tiical UFERiGmd�J C i� 57. APPROVAL TO COVER-GUNITE �� J �N� otings � � �� 58. Electrical Conduit-Undrgrnd. �X `�� 0 8. Fouridation � � �r• � �[q . .�'ijfl • G C _7 59. Gas Pipe, O Undrgrnd., Test �i �/ �!' u tiPipe-Und��d. � �� 60. Backwash Lines, P-Trap, O Undrgrnd. "1i �10! Structural Floor�Sysiem � >� 61. APPROVAL TO DECK n . �- 11�� P�opeity Sewer Li��& House Co�nni ction �;� �� . 62. Backwash & Receptor-F.inal � .� 12. •S'ewer Cap �� f ,y„ �' 63. Heater & Vent-Final • 13. Roof Drains �� - �.., 0(�1 64. Plumbing System - Final � �� 14. Rough Plumbing��j -� � Ct 65. Electrical-Final � � 15. Rough Electrical:Co`nduit � ^; w 66. Solar System-Final i6. Rough Elec[ric'Wiring � �� 67. Fencing & Access Approval _ �� '`17. Rough Wiring Sign 68. APPROVED FOR PLASTERING . � . �18. Rough Electrical-7 Bar Cei�ing ��69. POOL/SPA SYSTEMS FINAL 1� Rough Heating & Air Conditi �ning � ' 3� FIRE DEPT. REQUIREMENT .1 .- -�Ki Rough Factory Fireplace`� � -?APPROVALS Permit# �21! Duc[s, in Structure � ,�' '.70. Underground Hydro 22. Ducts, Ventilating • /a �� 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Ro�qh & Test �� _ .� y. � �7_Z\,Underground Flush 24. Roof Framing �� ', 73. Undergrnd. Storage Tank 0 Gas ❑ Oil ' - 25. Roof Sheathing �-' �� .-. � � � - . � 74; Overhead. Hydro • - - . 26: T-Bar Ceiling (Structural) & Monocoat , 75. Dry Chemical 27.'PremeandFlashing � /J.61 DryStandpipe ... m � 28._ Lathing & Siding 7,7/.' FIXED SYSTEM FINAL " '� 29. Insulation 78. FIRE PREV. FINAL �� 30. Drywall Nailing /f HEALTH DEPT. REQUIREMENT.,= .- - 31. Plaster Brown Coat ' 79. FINAL INSPECTION � 32. E�ectrical Power MeterFinal � �( _.� FOOD CERTIFICATE ISSUED � 33. Final E�ectric �' V �� Nates: � �9 � 4, � 34. Final�Heating & Air Conditioning r 35. Final Gas Pipe-Test i � � 36. Hood or Cenopy ' T - � C � � 37. Final Factory Fireplace 3S. Final Plumbing ' �� 39. Water Ser.vice-Final - . 40. Gas Service-Pinal . - 47. Solar pomestic-Final ' 42. Backflow Preventer C ; � �� 43. Backf�ow Irrigation �_; 44. Landscape�lrrigation System �'�� 45. Sound 'P�ttenuation �� 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requiremen[s Completed 49. Electric Release to Edison ; 1 ,,, 50. Gas Release to Southern California Gas Co � �V ♦: 51. CERTIFICATEOFOCCUPANCY �;T �� y� i No. Date L_ � Y(�Yy � ` ) (JG %(% ApDlicant to flll in all spaces extept thosa wlt�in �eavy Gortler Iines anE si9n all appropriatv Geclarations. CITV OF COSTA MESA CONSTRUC�T�ION PERMIT PERMIT NO. �� TRACT NO. LOT NO. UNIT NO. A P,�y Ione Proje�?.Adtlreis � � S Main Building: Accessory Building: Applicant'S Mailin Addr25S � / TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E Z ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Ffonl Q Owner:sName �Phone��57f'/% DESCRIPTIONOFWORK/USEOFBLDG. A Rear N ,. Address ' � G�� TVPE OF PERMIT GRADINC. FOUNDATION STRVCTURAL C Righ[ N Arch/Eng Licenu No. K G AddIe55 ' 1 I,/-,,'� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g� Left R Contractor's Name�/qc.� /u�- phple��y�3 ��O7HER ping. Ret. qW Parking Req./Provided E Address (mailing) � .14�/d a�.�BA.�P�i+'.S�P%�.�5 PROJECT DESCRIPTION Sq. FT. OCCUaANCv Planning Notes: M � 4 Z C��G7p CONSTRUCTION TYPE VALUATION $ T Cily Litense No. � 20NE GRADING CU. VOS. ACRES- g LICENSED CONTRACTOH DECLARATION I hereby alfirm [hat I am lic¢n56tl untler provislans o( Charter 9(<ommancing Remarks: � s with seclion 7000) of Divislon 3 al the Business anU Professioni Cotle, antl my Iicense is in f I lorce ana eftect. - ELECTRICAL FEES Licenu lass _ �%� License �`/;^_� . Date Signature PLUMBING FEES Autometic Washer Transtormer ❑ 75-50 KW � WORKERS' COMPENSATION DE ARATIO ConStruCtiOn POleSUb. � 50+ KW ,�„��rereby aftirm thal I have a cerHt ate ai coni t to selftinsure or a certlticate Bar Sink ShOwe�s - {>Workers' Compensation Insurance, or a certifietl copY thareof (Section gackflOw Preventer Service Sink Cooking Unit Meter ❑up to 100 amps 'S00, Lab. C.) .I/n �Policy No.ldlG�'��n✓.�-i� CamoanyM�I'�^wQ�sU�� . Backflowlrrigation SewerCap Dishwasher Meter ❑over100amps certitietl mpy is hereby rurNshed. Oryers ❑Gas ❑Electric l Certitietl cop is filea with the city Buil 9 Oivi /n��./J /{� ' " 68thtub5 SewC� Connection Sub PanEl Da[e�� APP�� =�({�I'�'�""s - " Fen EXEMPTION FROM WORKERS' CO NSA ON DECIARATION Clelifiel5 $olar CAllectOfi MOtOr5�U1 HP ❑7'h_ 8 Z� pV (Thissection neetl no[ be completetl i he Derm t is for one �untlretl (5100) or F.A.U. 16 415 HP �16-15+ � Icss). , Dishwasher Solar Piping 5 I certify that In lhe pe�formanCe of the wo�k fOr whlch this pe�mR Is Issuetl I - FI%tuf25 shall not employ any person in any manner so as to Eecome subjecl to t�e Drinking Fountains $Olar Tank 0 � Miaowave � Workers' Compen5ation Laws of Calltomia. Device Boxes Date 5iqnatura Floor Drains Swimming Pool w/Spa Pole Light NOTICE: It, afte� making thi5 tlecla�a[Ion, you ShOUItl Decome subjeGl t0 [h0 /� �UtICtS Range Workers' Compensatlon provislons ot lhe Labor Code, you must forthwith FIOo� Sinks U�inal <omply witn suCh provislons or lhi5 OCrmit shall be tleemetl rovoketl. swiicnes 3 CONSTRUCTION LEf�O1NG AGENCV Ga55erviCC OUtI0t5 We[e�Closet Sign � I hereby aHirm that there is a conitructlon lentling agency for lhe per/ormance Garbe e Dis Oul of thn wo�k 10r whlch this permit I5 Issuetl (SeCtion 3097 Civ. C.) IOt¢�C¢ptOfS Wacer Hea[er 9 P SteOdiOy $CCtiOnS Lpntler's Name 1 Lentler'S Atltlress Kitchen Sink Water Service � Generetor �65 KW �5-15 KW Trash Compacror OWNER BUILDER DECLARATION I horeby at/l�m ihat I am ¢xBmpt IrOm the CoOtractor's LICenTO Law IOr Ihe LevetOri¢S AUtO-WeSh 1 I011owing reason (Sectlon 7031.5 Businass antl Profasslonal Cotla: Any city or counly whlcb fGqWfes d ptrTlt to <OnilNtt, dltet, ImprOvO, tlemoliih Ot fepalr P-TfBp �.BUndfy T18y5 any structure, prlor to i[s issuance, also requlres the applicant (or such permit Jto file a signotl statement that he/sne I5 Ilcenzetl pursuant to lha provisioni of Roof D�ains � the Contractor'z Litense Law (Cnapter 9([ommencln9 with Settion 7000) of -'•�ision 3 of the Business antl Protessions Cotle) or [hat ne/she is exampl qeinspeetion Fea $15 Issue Fee �pirom antl the basis for the allagetl exemption. Any vlolation of 5acllon ,1.5 by any applicant tor a permit subjectz the a00��<ant to a clvil �nalty of not mora tnan five huntlretl tlollars (E500�. $ 3 DEVELOPMENT SERVICES REQUIREMENTS: 1, as ownor o( the proporty or my omployee5 wilh wagei as lholr sol9 ReinSpBc[ion Fae $15 ISSue Fea compen5ation, will tlo lha work, anC the struc[ure iz not Intentletl or otferetl Zoning APProvetl By Data Ior sale (Seclion 7044, Business antl Profaszional Cotla: Tho Contra<lor's MECHANICAL FEES ' Building Approved Bv LlcenSn Law tloes not apPly to an ownar of a property wtf0 builtls or Imp�ovei �Det� lncreon, antl who tloes such wO�k M1imseli/ho�self or tnrOug� hls or he� own AppllCetiOn ISSUBd By �et omployee5, Pfovltl¢G that SUCh imprOvem¢nts ar0 nOt Inlentletl Or Ot7eletl fOf BOII¢f HOOd Of TypQ I ❑ I� salo. If, however, tne builtlin9 or improvomenl is soltl wlthln ono year of com- Canopy Type 11 ❑ - SUMMARV OF FEES plelion, tha Owne� will hdve tna bu�tlen al prOving h</She Eitl nOt bulltl a� IT- DUC[ - UfIdC� G�OU�d �rove tor the purpose of sale). BUILDING PERMIT $ SMIP $ LJ I, as owner of tne property, am eaclusivaly tontractin9 wlth Ilconsetl con- Duct -Structural Refrigeration System pLAN CHECK $ PERMIT lfactoR to COnitluct IhG ploject ($CCNOn 7044, Bu5Ine55 antl Prot@SSIo05 COOe: The ConVactor'S License Law does not apply to an owner of property who Duct- Ven[ilating �0.100,OOOBTU ❑100,OOOBTU PLUMBING $ �SSUANCE $ builtls or Improves lhereon. antl wno conlracls �or such orolecls witn a r.on- ENERGV P.C. $ II tractor�z� license pursuan� co ene ConVacmrs LI<ense Law). I am aware that Exhaust Sys[em ❑ Multiple ❑ SyStem RepaidAlteretion � P�N CHECK 25% $� proof o thnlr Worker's Compenwtlon insurance shoultl be provltlatl to me. ELECTFICAL $ GRADING $ ❑ i am exempt untler Section B. & P. C. ror this reason Firepl/Fact Blt. iCBO # Fire Dampers MICROFILM $ Heatin S stem & Ductin Re isters PLAN CHECK 50% $ � Date Owner 9 � 9 9 MECHANICAL $ 1- he�eby ce�tlfy that I havB �eatl lhis ao��ation antl itdta tnat the abova ❑41��,00� BTU �10�,40�8 TOTA� FEE $ information is correct. I agree to comply wilh all city antl county ortlinances PLAN CHECK 25% $ antl state laws relating to builtling constructlon, anC hereby authorize reD�e- sentdtives o1 thl5 ily to [ef upOn Ile dbOve-mGntionetl plopGrly fol Inspection purpo • Signature Datez-� Drlvers' L nse or � Reins ction Fee $15 Isue Fee $ 3 � o� oao2so62-o¢D26062 TGT ss.ar. 0865-46, rev. 5/BB White - Builtlin9: Canary - APPIi<ant; Pink - Accountln9; Golaenrotl - Asse55or DATE� 02/D9/89 t7nE• il'Q% \ ' 1 ' • . . . .. . . 1 . . . . �),� � ' � � f CONSTRUCTION AND PLANNING :� POC SPA Date Inspector Date Inspector ,?�PROVALS Permit # ' � APPROVALS Peimit # 1, Temporary:Electrical Service or Pole '' 52. Pool & Equipment Location ' I 2. Soil Pipe-Undrgrnd. ,.. �' 53. Steel Reinforcement 3. Electr cal Conc�uiu Utility�Undrgrnd. . 54. Forms w�,:� 4. Electricaf Conduit-Und�grnd. . 55. Electrical Bonding ; 5. Steel Reinforcemeni.., 56. Rough Plumbing & Pressure Test � �" 6. Electrical UFER G�nd. I-' 57. APPROVAL TO COVER-GUNITE `' i 7. Footings' ' � . ' ' i • � 58. Electrical Conduit-Undrgrnd. . ' . ; 8. Foundation _ ' �� . . �' 59. Gas Pipe, O Undrgrnd., Test 9. Watei Pipe-Undrgind. I . 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System =� "' 61. APPROVAL TO DECK 11. Property Sewer Line'& House Connection i 62. Backwash & Receptor-Final 12. Sewer Cap ;: ,;_ �' � '_ 63. Heater & Vent-Final 13. Roof Drains ' ,, 64. Plumbing System - Final � � 14. Rough Plumbing '` , 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Fina� 16: Rough Electric Wiring l� 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18 . Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19! Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �_ 20: Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Struc[ure 70. Underground Hydro 22. Ducts, Ventilating ,1 71. Product Piping 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. Freme and Fiashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 0. FOOD CE IFICATE ISSUED 33. Final Electric 9 Notes• �fi )�, � 34. Final Heating & Air Conditioning ' �� T ` 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Firepiace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer .- " � � ' � 43. Backflow Irrigation - � � 44. Landscape Irrigation System �� i 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. CERTI FICATE OF OCCUPANCY =_, � �{ ' � ' • �� + �. j �) ; �i . .. No. Date - ' -. '�.i ` 1 , I� / ' 1� -/�� C�STA MESA BUILDING•SAFETY DEPARTMENT � P. O. BOX 977 C08TA MfiBA. CALIPORNIA For Applicanf fo Fill In Compleiely TYPE OR PRINT .� BUILDING / � ��'� ADDRE68 COSTA MESA. CALIFORNIA AODRESS �O•�O IS� cirv �oLToN GAU nw�ru �rw l.i �.1��A2.ot�)u • TEL. !QK Ntl 9 LIC. NO. �" NO. '�� SIZE � � NO. OP BI OF LOT �UO X Z�D Now on'. USE OF EX16i1NG BLDG. 6ETBACI( LINH PwON cenreR oP sTPear REAR YAR[ SIOE YARD ILEFT IRIGHT DESCRIPTION OF WORK � , , . . � NO. OF � USE OF BU FE�E RECEIVED � NPR 5 �.1 \ FINANCE DEPt. � CITY OF CO�SA APPLICATION FOR P BUILDING For Offiee Use Only qece�wr Ho. fertyl r+o. /`/ �-1 �, Y�I �� -�� ( �2T�� u� F ��b 7 ..�v . �y-� �} , COSTA MESA. CALIFORNIA - BY ✓�\�7 � DATE Y�G(- C9� � ZONING ZON6� I I PtAN9 �I BUILDINNlY�_ . ^ \ iri.u, � � �eaw� 1 ' //_� DEBCPIPTION �^y • � (�J D / � rcerma uxe e' FRONT ?I _ _'__ / _ /n (/'7_ - O e \_ • 1 HERBBV ACNNOWL8D6E THAT I HAVE R8A0 TXI6 MPLJWTION THE AMOUNT 6HOWN UNDER VALUATION 18 FOR THE AND BTATB THAT THE ABOVE �B GOPREGT AND AOPE6 TO GOM• pUPPOBB OR EBTABLIBHING A PERMIT FEE ONLY. PLY WITH ALL CITY OPDINANCHB AND BTATE LAW6 RlOULATINQ euttn�Ha coHSTxu oH. VALUATION J � � SIGNATURE OF ,� _,i2�� PERMIT FEE $/D /J o-N PERMI7TE $ ,,, �D p�qN CHECK $ ��• � / AUTHORIZED AGEN7 / ✓� � 0 TOTAL FEE (O O: SO O . � � � _ �� 2a� CUSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MFBA. CAL�FORNIA Fo� Applieanf to Fill In Completely YYPE OR PRINT BUILDING ADDRESS � , COSTA MESA. CALIFORNIA 1 MAIL � 6TATE TEL. 68TBACK LINE FPOM CENTER OF 9TRE6T SIDE YARD ILEFT II DESCRIPTION OF EXTERIOR WALL ROOF COVERING COVEI U6E OF BIIILOING AND WORK TO I FEE RECEIlIEU 196t 6 Z 9f1� FINANCE DEPT. CITY OF COSTA MESA AUG'29196 � � APPLICATION FOR PE�MIT BUILDING For Office Use Only NEC6IPT NO. _P{BMII.NO._ TEL./' n'�� BUILDIIbI{ I-� `� 1Gf� {. NO. ADDRES$ / O / � � � f �1 `� TEL. . ^^ _ C STA MESA. CALIFORNIA iNO. /�'1 FIRE �G L�L ____ �__""_ �Y ND. OF BlDGB. ZONING NO. OF �� I UeE OP N PUNB BUIL�IN� LEOAL YARDS APPROVE� IC8NT8P LIN6 BT.1 APPROVED �� 'O`-1.1= GY EVES I XHReBY ACKNOWL8p08 THAT 1 HAVB HBAD TMIB APPLIWTION THB AMOUNT BHOWN UNDBP V�LUATION 19 POR TMe ANO BTATE THAT TH6 I�BOVH IB CORPCR AND AOPHB TO COM- pUpp088 OP eBTABLI8HIN0 A vBqMIT P88 ONIY. PLY WITH ALL CITY O�INANCE AND 8T/�T¢ W9 6Y111...��TNO 9UILDINO CONBTRULTION. . T� �O ( VALUATI N / � SIGNATURE OF � PERMIT PHE $ �� PERMITTE Q..0 J $� �J iC..A PLAN CHECK $ � � AUTHORIZED AGENT '` (J V � /L"r TOTAL F6H �-� � � BUILUING S9FETY DEPAR.TMENT N� 1532 � F. O..Roz Nd. 31T Cesta Mesa, Californla �� Date �d — � � — ,(z� CPPY OF COSTA MESA CERTIFICATE OP OCCUPANCY Building Permit No� � 7 I t Electrical Permit No Plumbing Permit No � . .. . � use of The bvilding iceated at— _� �'7� �i,1(„ . �� .[� �? /�_� � B I.egal Description (See reverse side (or Metes and Bouuds) has been inspected and found to comply with the provisioas of all City of Costa Mesa Ordin- ances applicable thereto for a Group �� —�-- Occupancy. I SUED TO: 3 C9� Bullding Official - � ��il%�r � � ,%s.Pif i.�,�, � /. (O�r of Buil ) B)�%� /C-i►'z. CC: ❑ Original-0wuer ❑ 7at copy—Gas Co. ❑ 2nd copy—Edisoa Co. ❑ 3rd copy—File Form 208 SB P 1M i-80