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Home My WebLink About727 19TH ST - Building PermitsPH0.IECT ROUNESS: % Z% W 1 9 TH S T owxex•sx�Me: RUSSELL A. PANGE nooxess: 1831 ORANGE AV COSTA MESA CA 92627 (714)642-6001 � AflCNIENGINFER: RDDRE38: NEU.NO.: UNIT: UNR: � PEflMITTEE: RUSSELL A. PANGE ( 714 ) 692-6001 �ooeess: 1831 ORANGE AV COSTA MESA CA 92627 LICENSEO CONTMCTOP OECIAMTION: I heraEy allirm t�at I am Iicense0 unEar provisions oi C�aDjer 9(commencinp with Sectian 7000� at Oivision 3 ot tAe Business anE Professions CoEe, an0 my license is in tull lorie anE eMect. cm uc.: sTnr� uc.: cuss: � } l?�te: _ Sipnatum: `�'�BNEBS' COMPENS�TION UELUM710N: I �ere�y attirm ihat I have a ceNlicate of cansent ro sel4insure or a ceNlicate ol Warkers' ��npensalion Insurance. or a certilietl copy th¢reat (Section 3800, LaO. C). LICY NO.: E%P. DATE: COMPRNY: ❑ CenilieU coOY �s nereby Iumis�eA. ❑ Certitied copy is tileE witA ihe ciry Bulldinq OiWslon. oate: appliwm: ueMmox rnoM woe¢exs• eoxv�xs�nax ocwiuTrox: �in�s sano� �eee �o� ee canoi� ii me perma is mr wu numrea �siam a iassl. I certiry Ihat in t�e petlormance ol t�e work tor wNch ih¢ permit is issued, I shall not emDloy any person in any manner to as to hecome sublect to the Workers' Compensation Lavrs af Califomia. � oate: 9qnature: NO710E: If, aiter maltin0 ihis declaration, you shoultl �ecome subject ta t�e WOBers' CamOensation pmvisions ot the LaEor � CaOe. 7rou mun IohlrvnN wmDN �t� wch Dravisions or IN5 permit slull Ce tlremetl rewked. CONSTBUCTION LENDING IIGENCY: I �ereby affirm�ihat t�ere is a wnstmction IentlinA a0enry for tlre Dertarmance ot t�e work lor whic� ihi5 permB is issue0 (�� 7. Civ. Cl. ' LENDER: ROOflE3S: OWNEN BUILDER OFCIAMTiON: I heaCy atfirm IAat 1 am exem0� «am Ihe Contactars' State Llunse Law for tM follwnnp reazon (Seclion 7031.5 Busineu antl Professional Coae: My ciry o/ wunry which repuims a permit ro constmct, alter, improve. demolis�, or repair any siructure. pnor to ils issuance, alm requires I�e apWicant lor such permR ta file a SipnM sfatement Ilat �dshe a Iicense0 pursuant ro tAe provisions of t�e Con[actors' State Licenu Law (ChaD�e� 9(wmmencinp wtt� Sectlon 7000) al Division 3 oi Ne Business and Profesvons Code) or Nal MJs�e is exem0� �eretrom and the Easis tor Ne atlepeE exempGon. My NOWtion al Sectian 7031.5 Uy �� applicant tor a Dermi[ wGjaR the aDDlicant to a cNil penalry ol not mom tAan /'rve hunOretl Eollars (55W). �I, az ovmer af Ne prapeny or my empIvyees xi[n xayes az thNr sole compensatlon, will Go tAe wark. anE I�e L� structure is not intenOeE or oifered lor sale (Section 7074, Business anE Protessianal CoEe: TAe Coniractors' State License Law Oas not appty to an awner ol a prapeM � �uilOs ar improves Ihereon. anE who Uces such xroM NmsNUtursell or t�roup� his ar Aer own employees, prwNed Vwt suc� �mpravemenis are not intendM m otlem0 for ule. If, hmvever t�e OuilEinO or impravement is SOIG within one year ol ComplBlian. I�e owner Will �ave Ihe Eurden ol Orovinp h2/5�8 EiC nat huiltl ar imDmva for t�e purpase oi sale). � N I, as owner ol t�e Droperty. am exUusNelv wntracunp vnth Ilcensetl cantractars to wnsWct Ue D�Mect (SecUon 7041, Business C.� anE Protessqns COEe: 7Ae Comractors' State Lice�e Wr Eocs not appy to an wmer ot pmperry wtp EWds or impmves Iherean an0 who contracts for such projecis cst� a contracror�s) license pursuant to the Contactors' State License law�. I am awam Uwt proof ai tAeir Worker's Compensxflan msuranu stauld Ee D�oH0e0 ro me. � I am exempt unaer Sectlon: B. 8 F. C. tortNs reasan: Date: �^ �� "�O Pxner. � I Uo �ereby ceeiry [hat I am aware ai an� untlerstanG t�a repuirtments ol Califor ' antl Satery CoOe Sections 25505. 25533, antl �2553a anA ttat I ar any future ouildinp occupant wilUwill tw1(artle one) neeE y wtth SaiE stata mOes an0 Ne reQuirements tar a permR lor construction or ma0ification Imm [�e Nr Uualiry ManaAement Oistrict. Hes' entlal consiruction aDDlirations are exempt Irom t�ese D�o�ons. � Date: ��'�� Appliwnt . I �ere�y certity tlat I �ave aaU tMs aDP��on anU state t�at ��e e" rmation is cartect. I a0�ae m comDN ��h an ciry anE counry '� wdinances an0 state laws relaUnp to Euildin0 consvuction aM trcre aNhoria represent ol Itus dry ro enter upon Ne aEove�mentloneE i prapeM/ �yar inspection puryous. � Date: X ' �3 � ( � Sipnatum: - ^ oriver's �iunse or Socia� Securiry x: `\ 1WtJ6 White—BuilEing:Oroen—CaOe Enlwcamant: Canary—Applkan�: Pink—Revenue:OdEen�oE—Asseaaor CITY OF COSTA MESA — SIGN PERMIT PERM NO: SB 048531 PERMIT NO: SB 048531 PLAN CHECK NO: 05254-90 S GOVT: N SUPP; N CONSTRUCTION TYPE: 5 PERMIT TYPE; STR SIG PURPOSE: OTH JOB DESCRIPTION ; NON—ILLUMINATED WALL SIGN SQ FT: CLAIM VALUE: 500,00 CALC—VALUE: 500.00 GROUP OCC: B-2 / COMMENTS: "COSTA BRAVA" RESTAURANT ��r��r**�*�r��x�***��*�**�r**�***�r�r*�*****�*�r�*�r**x*x�*�� x**��r*x��+r**+��r��r******� S I G N I N F O R M A T I O N DISTRICT; 1 TYPE: WALL ILLUMINATION: NON CATEGORY; NEW DIMENSIONS; 15FT OlIN X 2FT 08IN AREA: 29.00SQFT LETTER HT: 20 IN. STREET FAONTAGE 1: 200.00 STREET 1: W 19TH ST STREET FRONTAGE 2: 0.00 STREET 2; PARCEL: 42420202 ZONE: C1 LOCATION > FRONT; YES REAR: BUSINESS NAME: COSTA HAAVA > LEFT: RIGHT: O T H E A T O T A L 5 G R O O N D S I G N THIS ACTIVITY . 29.00SQFT OVERALL HEIGHT: OFT OIN THIS SITE ; 200.00SQFT GROUND CLEARANCE: OFT .OIN ITEMS OF INFO : 2 PLANTER AREA; O,OOSQFT ITEMS FOR ACTIVZTY: 5 BLDG SET HACR: 20FT '. COPY VERHIAGE : COSTA BRAVA (PLUS AN ANCHOR LOGO) �' -i PLANNING NOTES: iE if k iE iE ik iF ik 1k iE k i! if iF it iF ik i! if iF it �k ik it if ft i! iE if ik 9f if it ik iE iF 3t iF ik iE i! it ik iE iF ik iF if �f ik �E iE ik it if it iF 3E iE iE iE it iF iE 3k iE iF �E k iff� i� iE iE iE it it if iE ik D E V E L O P M E- LN T S E` R V I C E S R E Q U I R E M E N-T�� / ZONING APPROVED BY : �f fY- bkn_ DATE: �y/3/ HUILDING APPROVED BY ; DATE: �;I3 � APPLICATION ISSUED BY: DATE: IS �� ifikifltitifiliFitiFlFfF�kiE3fiEikiliFikikiF IF�EiF3E�EiEififitiF iF1t LEGALIZATZON;N F E E S� M A R Y STRUCTURAL��SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES�.j GRADING PERMIT 15.00 r.�a�z�� PLAN g,75 SMIP/NON�—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 44,50 0.00 9,75 54.25 54.25 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 54,25 OVER/SHOAT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK 15.00 29,00 .50 9,75 iE iF �! it iE * jk iE i! i! if iE iF 3t if 1E i! IF ih iF iF iF rt ik iE iF it ik ik 4 iE 1E iE iF 1E ik iE iF iE iE itlt ik iE ii ik ik iE iE M it it iF iE iE ik ik IE 3E iE ik if if 9f iF iF it IE iF iE itr 1E i! if iE iE M iE iE I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST NO FEES WERE SELECTED FOR THIS PERMIT 0; 00067334-0�067337 T ro1' 54,25 DATE: 03/13/90 iIliE: 13:51 CONSTiiUCT10N AND PLANPo��+� APPROVALS Permit # 1,. Temporary Elecirical Service or Pole 2. Soil Pipe-Undrgrnd. . 3. Electrical Conduit Utility-Undrgmd. 4.� Electrical Conduit�Clndrgrnd. 5. Steel Reinforcement � 6. Electrical UFER Grnd. 7..Footings . 8. Foundation . _ 9. Water Pipe�Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & House Connection j�j. SCWCf (�,2P . 13. Roof Drains � ' 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring 77. Rough Wiring Sign 78. Rough Electripl-T Bar Ceiling 19, Rough Heating & Air Conditioning 20. Rough Factoiy Fireplace�� • � 21. Ducts,in Structure � . 22. �Ducts, Ventilating � 23.'Gas Pipe�Rough & Test � � � 24. �Roof Framing . � 25. Roof Sheathing � ' . 26.�T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing ' 28. Lathing & Siding 29. Insulatio� ' � �. = 30. Drywall Nailing � � 31. Plaster Brown Coat .. 32. Electrical Power Meter-Final 33:�Final Electric � $4, Final Heati�g & Air Conditioning 35. Final Gas Pipe-Test' , 36. Hood or Canopy '37. Final FactorY Fireplace � � '38. �F�nal Plumbing ' �� .. 3g. Water Service�Final � � i 40. Gas Service-Final � � 41. Solar pomesticFinal 42. Bac flow Preventer" . 43. 9ackflow Irrigat�n � 44. Landscape Irrigation SVsiertr-�_._ " 45. Sound Attenuation ' " 46. Nandicap Regulations � ' 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING •- 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Date , !OOL & SPA Inspector pPpROVALS Permit # 52. Pool & Equipment Location � 53. Steel Reinforcement � 54. Forms ,. 55. Electrical Bonding • 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER�GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P�Trap, O Undrgrnd. 61. APPROVALTODECK 62. Backwash & Receptor�Final � . • 63. Heater & Vent-Final � ` 64. Plumbing System � Final ' 65. Electrical-Final j 66. Solar System-Final - 67. Fencing & Access ApProval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # ,70. Underground Hydro '' � 71: Product Piping O Gas ❑ Oil • 72. Underground Flush ' 73. Undergr�d, Storage Tank �O Gas � Oil � 74. Overhead Hydro � 75:- Dry Chemical 76. Dry Standpipe ' . � � , 77. FIXED SYSTEM FINAL' ' � �`�' •'->�7,8�FIRE PREV. FiNAL � Date � Inspector v �. �' r I i i- !• � � � HEALTH DEPT. REQUIREMENT � ' /� - �' 'r , { �i79,.,'FINALINSPECTION, ' 80 .FOOD CERTIFICATE ISSUED ' � � ��✓ Notes: � . � , .' � . ,•� % •`� ,�� . . . .. � • .- ,- 7r , .�;^ i , � r . ... . .:�,:e.�.y..�=.,�. ��>� Lop_ _ io �� . � ,. �r j� � , � �_ o„ � _ ��—� .. �� . � � � $� . �APPROVED � GTY OF COSTA MESA � PIANMNG DEPT. wuecr ro eioc. oenr. eco � `iY� DATE. 8�/3� Pf�?l i-0NS, DELETIO 'S, C; CORRI �£ �� BY i E PLAtv�.il;vG ,- �o.,� �� i � �-- P��rmit #S.g 4�� 7. THIS NUMBER MUST ACCOMPANY ALL INSPECTION REQUESTS� SHALL �a � *c City BY THESE NO CHA .�- BIVE� t,o�'rt'� FOA (NSPECTION CALL 754-5626 w � a�u s-t' PPROVED Costa Mesa Buildi�g Dept. ' DATE �_19% � MUST BE ON JQQ AT ALL TIFA�S M.4KE NJITHOUT PRIOR APPROVAI OF DEPT. � �T��RS i�R£ �`^AdE o�T'C� O F' W o02► • � , � t� THE ISSUANC OR GRANTING OF A PERlAIT OR AFPROVAL OF C PLANS ANU SPE IFICATIONS SHALL NOT GE CONSTRUED TO E3E A �� C1 � 5�„(�£� L PERM17 PCIR, O AN APPROVAL OF„ ANY VtOIATION OF ANY OF R THE PROVISIDN OF THIS CODE. NO PERMIT PRFSUMING TO GIVE � •-, �� (1� �� AUTFiC(11�V 70 �IOLATE OR CANCEL iHE PROVIS�ONS OF iHIS. 4%� CO�E SHALL BE ALID EXCEPT W 50 FAR AS THE Y/ORK OR USE VJ WHICHfTAUTN iIR'F,ISLAWFUL. THE ISSU SPECIFICATIOI FP.Ot.1 ?fiEREP SAID PLl.tJS BUiitAt:C OGE IN ViOLlQION � Tfic CITY. �E Of A PERAiIT DASED UPON PLANS 0.ND l^�� SHAIL NOT PREVFNT THE BUiLDING OFFIC�AL �� 3i REOUIRIIJG THE CORREGTION OF ERRORS IN �(�� U SPEGFICATIONS OR FROM PP.EVENTING ��C � w fIONS �EING ChRR�ED ON THEREUIJDER WHEN r� THIS CODE OR OF ANY OTHEF ORDINANCE OF AU 6 1 3 1��A ' AU8 � � 19�� City of Costa Mesa Development Services Department Building Safety Division P. O. Boz 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No. OO.SiC� The Building located at %2! E72st 19th StC6`8t has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group A3 Occupancy. Use of Building Restdu[dllt Legal D 429-202-02 (See reverse side for Metes and Bounds) euilding Permit No G 47899 Electrical Permit No. C+ 47899 Plumbing Permit No. G 47899 Mechanical Permit No. - C t17A99 Number of apartments and/or guest rooms ISSUEDTO: BuildingOfficial Tonv C' Da Baca Ru.3se11 A. Panas� � by �� 1.� . �f" ' � / y � `_ 1R31 Orana� Avehue, Unit E Costa F:2sa.CA 92626 Date Dacemher 7. 1990 This Certificate of Occ4pancy SHALL BE posted in a conspicuous place on the premises ami SHALL NOT BE removed except by the Building Official of the City of Costa Meu under Sec. 307 (e) U.B.C. CmF 1015-a6 rev. 1/aa White - Owner; Canarv - Numerical File; Pink - 61dg. Permic File PqOJECT ROUflES&: ��J 2�] W 19 TH S T uxir: ow•-^�gxnMe: RUSSELL A. PANGE PbDBESS: 1 H 3 S ORANGE AV #tE � _ ' COSTA MESA ` CA 92627 (714)642-6001. nxcxiexoixeex: RESTAURANT PLANNING SER, xen.xo.:NONE i �ooxess: 19 61 E, ED I NGER AV unrt: SANTA ANA CA 92705 PFnr�mEE: RUSSELL A. PANGE ( 714 ) 642-6001 - aonnesa: 1811 ORANGE AV E V COSTA MESA CA 92627 110EN5E0 CONTMCfOH DELUMTION: 1 �areEy aflirm t�at I am IicenSeE unEar praNsions oi CAapter 9(commencinp vnt� Section 7000) ol Oivisian 3 0l the Business ana Prolessions Cade, ana my Ikense I5 In full lorce and enect. CITY IIC.: STRTE 11L.: CIASS: '� �: Sipnature: iKEN3' COMPEN3�710N UELUMTION: I Aare6y alfirm I�at I have a cetlilicate af consent ro sel4insure or a certiliwte ot Workers' .npensation Insurance, nr a cenilieE wpy tAereof (Section 3800, LaE. C). IPOLICY NO.: F7(P. UA7E: COMPRNY: , CertitieU cnpy u �ereby �umi5l�eA. O CsNfud copy Ls IUetl »it� Ne dry BUU71n0 abisio�. . vate: �' Appliqnt: � ' �� ' omevnox rnoM vrowems• mxr[xs+mox o[uuunox: �ns suuun neeo � oe comqe�ee n me pemn a �or me n�neree �Siau� m kss�. 1 ceniry that in t�e peAoimance ot t�e work lar wNc� t�a permit is i��d; I slwll not emqoy any person N any manner sa as ta Cewme suhlect ta I�e Workers�Compenution Laws ol Califomia. i. - " � L: Oale: S�q�iuro: N0710E: tl, afler maAinA �� declarotlon, you stwulO Eecome subject to t�e Workers Compensatlon provlsio� ol tha LaEor CoOe, you must farthwii� camDN ��h suc� provisions ar I�is pe�mit shall he EeemeO revoke0. �� CONSfBUtTION LENOINO �GENCY: I AereEy aKrm Ihat t�ere I5 a construction IenEinp apency lar tAe�pertormance�of the work lor wNch t�is 7errtu�is iuued (Sectlon 3097. Civ. C1. .,i IFNOER: . .;i � eooxess: ' CITY OF COSTA MESA - BUILDING PEflMIT PERM NO: G 047899 PERMIT NO: G 047899 PLAN CHECK NO; 09597-90 L GOVT: N SUPP: N CONSTRUCTION TYPE: 5-N PERMIT TYPE: ELE MEC PLU STR PURPOSE: ALT SOH DESCRIPTION ; COMMERCIAL T.I. (RESTAURANT) SQ FT: 2,300 CLAIM VALUE: CALC-VALUE: 27,094.00 GROUP OCC: A-3 / COMMENTS: IQ�� fUG�.3��^ �� *��**�+rx�r*+�*�*�r** �r*�r� *�rx �r � *�x* *�**�r�r�r�r�r�r***��*x�r�*�*�«��t*�r��+r**+�******�iex Z O N I N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILDZNG ---------- --------- ACCESSORY HUILDING --------- FRNT; FT IN REAR: FT IN FRNT; FT IN REAR:' FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT:. FT IN - PARKING REQ: PROV: PARCEL; 42420202 ZNE: REF NO: PLANNING NOTES> > iP iE iE it 1t iE iE iE �f if iE iE if iE 1f if iE jf iE jEiE iE iE if iE it iF iE iE 1f ik iE if if if'it iE i! 1E it ik iE il-iF iE iE iE iE iE iE iE iE iE it 1E 1f it iE iE ik jk iF if iE �f iE 1E �E ik iE�fEiE �E iE ik 1E iF iF iF D E V E L O' P;_ M E N T S E,R V DI ^C rE S R E Q U I R E M E N T- S ZONING APPROVED BY %� ; TTU/�-- �y4. �1'eJ DATE; G��O BUILDING APPROVED BY,: /!� `" ��_ DATE: � O �_ APPLICATION ISSUED BY: � DATE: �O 3fi O iE1EiFiflEiEiE3E�E1fit�f�lEiEiEiElfiEi$iEiEfE �k E r i.i i t it �)fiEiflfiFiEiEiFif�1F iEiE �t*�***�it**��r*at****iejt******+r*�**�tit�atitatat*3t** i ��*at*jt�at*�+t****�**�at��**��**�*****it LEGALIZATION:N F E�E S U M A I�. Y,� � i;, STRUCTURAL•S,EGMENT:Y � �" OWNEp9UILOEPOEtUMTION: IherebyaXirmt�atlamexemptlmmt�eContactors'Slate�icensaLawlorihetollovnnOreason BLDG PMT PLUMBING ELECTRIC MECHANI�C")-�" FIRE SMIP/RES ��GRADING (Secuon 7031.5 Business ana Pra�essianal COEe: My rity af munty vAtich requira a permit to conswn, auer, ImD��'e. Oemofnn, or P ERM I T 2% 1. S � 4 0. 0 � 3 1 S � '� 1 1 J � � ; apair any SWCWre, prior ro its issuance. also repulrw Ue apD�t lor suc� perMt to tile a siOneE iWtement tlut he/stie is IkenseO - 2 S% S 0 Y ' ' 2 S R �''' • SM I P/ NON =R E S pursuam ro me D�ovisions oi tne Convacrors' Sute License Law (Cnaprer 9(commencin0 �+�� 10� Division 3 ot Ue Business p LAN 1 7(, 4 8 ��: "' �' �� 4, , � G i �tl Pmlessbns Catle) or ttwt hUsha is ezempt I�erelmm anE I�e p�is lar t�e allepeE exemD��on. My nolation ai Section 7031.5 by , � ., .• i� � ap0�� or a permit subjects t�e aOD�nt to a cNJ penatty al not rtwre IAan Ilve �unEreE Oollars (5500�. I S S U E F EE 3. 0 � 1 S. � � �.$ . � 0 . � BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK, �fOTAL'' PAID •�,,.�� DUE I, as owner of t�e D�opeM or my employaes wit� Wapes as Iheir mle comDensa6on, will Co the wark. an0 tAe r TOTALS----> 358.06 33,00 176.'48 '567.�4 567.54 .00 I ❑ stmcNa ¢ notinterWeO orofleredtorule�5ecnon 7040, B�ness anE PmfesslonalCoOe: TOe Contactors' State Licensa Law �, � , Oce5 n0� aDPly �a an ownlr 01 a Oroperty wlw OUJES Or impfoVes Iher20n, anE wtlo Uoes SUCh wOrk MmSelt/hersell of Ihmup� � 1 �� his or �er own emD�oyees, DroNOetl tha� such imD�oveme�ts are not intenEeO or olleretl far sale. If, twwever the 6uilEinO or REVENUE D I V I S ION TOTALS--> COLLECTED • 3 91�: 06� OVEF� /SHORT • �� improv¢mentismPowMmoneyearaiwmpletbn,Iheownerwill�avel�aburEenolprovin0�e�s�ediEnothuil0orimprove $LDG PMT PLUMBING ELECTRIC MECHANIC '� 'EIRE� SMIP/TOT GRADING liLAN-CHECK for Ihe purpo50 ot 5ale�. I, az oviner of ��e Oroperty, am exclusNeIy camracdnp vritA Ikense0 comractors to conslruct tAe pmiect (Section 70aa. Business '� = antl Protessbns Cotle: The CanVac[ors State Llunse Law tices not appry to an avmer of DropeM1f� who hml0.s or improves Ihereon and wlio conirac[s for such D�ojects vrit� a contractoqs) license pursuant �o lAe Cantractors' �tate License law),I am aware IAat proai ui their Woder'S Compensation insuranca SMNa pe Drovide0 ro ma. � I am exemD� un0er Section: B. 6 P. C. for lnis reazon: !y Uate: � � Z� � ( � Q�mer: � I Ua hereEy certity Ihat I am awam ol anE underslanA t�e requiremenls ol C' ' al nA Satery CoEa Sections 25505, 25533, an0 2553d antl ttwt I or any tuWre buil0inp owupant wilVvnll not (circle one) ca witA SaiC state coAes and Ihe repuiaments for a permii for constmction or maditica[ion trom tha N'�iry Manayement Distdct. Fles�dentul constmclion applicatlons ara exempt Imm ihese pmvisions. Oate: ApplicanC I hereby urtiry t�at I have reaE tAis apD�icalion anE stata t�al t�a aCove information is coracl. I a0ree to compy with all city antl counry or0inances and state Wvrs relatinp to huilEinp consWclion anE �ereUy aulhonze reDresentatives of is clly to enter upon t�a a�ove�mentloneC D�oOeM �or inspection purposes. � Daie: � 2 V' �' / �� S'AnaWre' �• oriver's License or. Sociai Secudry x: ' 16at�48 W�tla-BuilOing: Green-CaEe Enforcemen�; Canery--ppplicam; Pink-Rovenue; Caoltlenrotl-Asseaeor 271.50 43.00 46.50 �26.00 , ' '4.06 it fF 1f 1E �E if iE iE iP ik �f jf if iE iE it if !f iE 1klE iE 1ElE iE iE jE iE iE iE jE if 3E ik tF if i! ik it if ik if iE iE if iE if 3f iF i! iF 3E ii�il�,iE iF iE 1E if it dt if it jF iE if if if iE �E iE ik iF iF?E iE iE iF if I N D I V I D U A L F E E B � R E A;� K'� D O W N . 1 TYPE QTY D E S C R I P T I O N UI�IT COST TOTAL COST SFC ELE ELE ELE ELE MEC MEC PLU PLU PLU I�LO 2J00 RES-INT, ALTER TYPE V-N "y -F1VER:'� i7 11.78 10 FIXTURES, LIGHTING 1 ST 20 �'EA. � .7.5 J RECEPT/OUTLET 1 ST 2D ��'EA.' '' ,75 7 RECEPT/SWITCH 1 ST 20 �A,� " .75 � 5 NON-RES APPLIANCE NOT OVER 1�.0 HP.• J 3.00 1 INST HOOD W/DUCTS FED HY MEC EXHAUST,; 6,50 1 VENTILATION FAN CONN TO SINGLE ;DUCT - '�J'. 9, 50 2 SINK, bAR � ' 6 FLOOR DRAINS � '.� ,�r 2.00 4 SEWER, CONNECTZON TO bUILDING �EP.CH;� '' S,00 2 SINKS, FLOOR " � 2,00 �� ' � 'Of OOD63sb9-OODb3S?3 DHTE� Q6/261SC� TIhE: 27,09� � 3 15 6 4 4 20 . � -ro�' 14�10 50 25 00 50 00 00 00 00 391.06 � CO'NSTRUCTION AND PLAH.. .� �ROVAL� Permit #- 1.-Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. � 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. � 5. Steel Reinforcement 6. Elettrical UFER Grnd. 7. Footings 8. Foundation 9. Wa[er Pipe-Undrgrnd. 10. Structwal Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap � 13. Roof Drains � 14. Rough Plumbing ' 15. Rough Electrical-Conduit 16. Rough ElBctric Wiring � 17. Rough Wi�ing Sign 18. Rough Elactrical�T Bar Ceiling � 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe•Rough & Test 24. Roof Framing � r 25. Roof Sheathing • ' 26. T�Bar Ceiling (Str�uctural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding� 29. Insulation t % 30. Drywall Nailingi�'� 31. Plaster BroWn Cdat 32. Electrical Power Meter�Final 33. Final Electric 34. Final Heating &�Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbin9 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 S7RUCTURE & BUILDING 46. FINALPLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Date Date POOI ,PA Inspector APPROVALS Permit # 52. Pool & Equipment Location ;� (�IFl� 53. Steel Reinforcement ' � . 54. Forms . 55. Electrical Bonding 56. Rough Plumbing & Pressure Test , 57. APPROVAI TO COVER-GUNITE 58. Electrical Cqnduit�Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test � 60. Backwash Lines, P�Trap, O Undrgrnd. � 67. APPROVAL TO DECK 62. Backwash & Receptor•Final . ,' - � 63._Heater & Vent�Final ' 64. Plumbing System � Final ' , �� 65. Electrical-Final 66. lar SYstem-Final ' , ' 7. Fencing & Access Approval � � 68. APPROVED FOR PLASTERING . 69.' POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # �: �y . �,i�. / .�, • 1- : ' /' ' ,� . � � � • _. i ' ': i. ; . i'1 "�� r �•� i y, i. I �' i 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. fIXEDSYSTEMFINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION E0. FOOD CERTIFICATE ISSUED �� 91:� / '� �� r Date Inspector _-. c 0 �PflpIECT p00NES8: OWNEfl'8 N�ME: , , � AOOBE88: pflCH�NGINEEfl: 1 ROOHE88: rcxn�mE¢: �DDflE33: NEO.NO.: UNIT: IINR; � LILENSFD CONTMCfON OECIAMTION: I �ereDy affirm Itu� I am AcenseE im0er proNsbns oi CAapter 9(commandnp with Sectlon 7000) ol ONkion 3 0l t�e Busmess an0 Prolessions CaOe. an0 rtry Acerrse h in NO lorce anE ellect. Cltt IIC.: S7�iE 11C.: CUSB: �� Sipnatua: IKEpg• �OMVENLITION OECUMTION: I heaby attirm ilui l lave a artilipte al cansent lo utlifaura or a certificate o/ Warkers' .mpen�tian Insurznw, or a ceNfieO copy t�ereoi (Sectiw 3800, LaO. C). IPoLICY NO.: E%P. 0117E: COMP�NV: � CeNIieE copy is �ereDy hmiSAeE. ❑ CeNfieO copy u fileE vnth Ne dry BuilONp UNLUon. JdiE: AppliCant IXEMPfION FIIOM 1VORKEi13' COMPFMSI1110N OEGAMTION: (ftis sectim rcN not Oe mmpetW il tAe penm.'s ta one huntlreU (S10%w Im). I cerlly that in t�e pertormance of tha warF for wiuch Uk permil'a issue0, I 5Aa11 nof empby am/ per5on m arry manner w u ro become su0ject to tne Workers' Compnnation Laws ot Cafdomu. 02[0: $iqndtUR: NOTILE: II, aher malunq IM5 Oedaation, you sIroNO haome subject Io t�e Worken Compeiaatlon prwisiare oi t�e laCor CWe. you must IONmiN compy with suc� prwisions m tlis permil sAaA he 0eeme0 revoke0. LONSTq��ION lENU1N6 IIGENCY: I AereEy aifirm Ihat Nere is a ronstruciwn IeMinO a0ency iw t�e peRamu�ce o1 tlre work tor wnicn tnu permi� u tuuea (sauon an97. civ. c). IENDER: �ooxcss: OWNEq BUILOEB OECIANITION: 1 �ereUy affrm ttat I am eKempt from t�a Coninctors Siate Lkynse Law lor t�e followinp reason �Section 7031.5 Business anE Professional Cpde: My ciry oi cpunry wliic� repuirgs a Oerrtdt lo construcl, altar, improve, tlamolisA, or mpair any slrucNre, D�m ro its issuance, also repuirzs t�e applicant tor tuch permit to tile a sipnM sutemenl t�at �els�a is IicenseE oursuanuo Ine provislons ol Ihe Con[rocrors' Suta License Law (CMpter 9(commencln0 wit� Sectlon 7000) ot Oivision 3 0l t�a Business � Pmtesslons Cotle) or ��at Ae/ihe is exempt I�emirom an0 Ne Oas6 Por t�e alle0e0 eeempllon. My Wolation ol Section 7031.5 �y aDPlicant lor a permi� su0lacts IAe apDlicant ta a civil Denalry al not mom tlwn Ihe AunAreO Oollars (5500�. , I, as owner ol t0e proDeM oi my emyloyees with wa0es as thelr wle comDenutlan, wlll Uo t�e xrork, anA t�e I❑ stmctum fs not intenUeO or oHereL for sate (Sectron 7044, Business an0 Prolessianal CoOe: T�e Contactors' State License Law Eoee not appN �o an owner ol a pmpeM ��ws or imprwes tlmraan, anA wAo Ooa suc� work hlmseA/Mrsell or I�rouph Ais or Aer awn employees, prwiUW Itat wch improvemenis are not NtenCed w offareE lar ule. 11, liowaver tM OuIlOInO ar ImOi�ment is mIG w1INn ane year ol wmpletian, �I�e mmer will haw IM UurOen ol 0��0 hdslie UiO not huilE or ImD��e lor I�8 Durposa ol sale�. I. az owner al the properry, am exGusivery contracWp vnN GcenseO contractors to construc� IM project (Sectlon 704I, Business O aneplofessbmcme: ilmCavvaziaq'SiatelkemeLaweoernotanpytoanownerwp�operry w�oowa�«xr�ro�u� anE wAo condacts for sucn Droiata csN a wnVactor(s) Ikeine Dursuant m IM Contractan' Stata Llunse Law�. I am aware WI O�f ol Utlr WorNei s Compenci�ion insuaxe stquW Ee D�� a�. � I am exempt unEei Section: B. 8 P. C. lor Nu reason: Date: Owmer: I EO AlttEy ttrtity Nal I dm aware Ot anG unA¢rstanA Ne feyuiremenis 01 CalilOmW Heatl� antl Satlry COEO Sections 25505, 25533, antl 25534 an0 that I ar any fuNre EuAOinp oaupant vnlWnll not (arde one) neM ro compy wIU SaiE stata coEes anE Iha reyuiremenis for a permit for consimction or maEificatlon imm Ne N'r�iwllry Manapement DisVict. HesiEenlial wnstruction appliwiions are exempt tmm Ihesa proviUons. Date: Appliunt I hereCy �ertily ihat I have reaA tAis applicaUon and state that tAe aGove inlormation is carmct. I aprea to wmDN ��h all ciry anE counry araina�ces anA state Wwz reWtinp to 6uiINnO ��sVuction and Ire2W autlnrize aDresentativas ol t�b ciry to enter upan Me above�mentioneE proDerty IorinSDection purpases. Od�E: $Ipf13tUR: DrNer's Liunse or Social Securiry M: 1BO1�ae W�it�Bulbinp; Graen—COGe Enlorcament: Canery—Applkant: Pink—Rwenue: adtla�vo6—Aveaaor PERMIT NO: G 047899 PLAN CHECK NO; 04597-90 L PAGE: 2 ��r**�r�r�*�rr�e**�r�e�e�r*x*x�e�e*�e�r***�r**�r�r��*�****�r**�e�*�**�**x��***��r+��*x�r**x��**�e*�* TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST END OF FEES .n C�(VSTRUCTION AND PLA�, .G _ POOL .PA APPROVAL� Permit # Date Inspector p�PPROVALS Permit # Date Inspector 1. Temporary ElectricaV Service or Pole 52. Pooi & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Fieinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAI. TO DECK 11. Property Sewer Line & House Connection - 62. Backwash � Receptor�Final 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof prains 64. Plumbing System � Final 14. RougN Plumbing 65. Electrical-Final 75. RougH Electrical-Conduit 66. Solar SYstem-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval 77. RougN Wirinq 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 O Gas ❑ Oil 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergmd.StorageTank OGas OOiI 25. Roof 5heathing 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. Drywa�l Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ' 32. Electrical Power Meter�final 80. FOOD CERTIFICATE ISSUED 33. final Electric Notes: % �r� 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. 8ackflow lrrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINA4STRUCTURE&BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Pfl61ECT AOOpESS: '] z'] W 19 TH ST ,, OWNEB'S N1ME: RUSSEL PANGE ' noo�css: 3 HURNING TREE RD " ' NB CA 644-1444 RNCNIENGINEER: . . AODflE33: REO.NO.: uxn: CITY OF COSTA MESA - BUILDING PERMIT PERMIT NO: F 047692 PLAN CHECK NO: 04384-90 S CONSTRUCTION TYPE: PERMIT TYPE: FIR UNR: PERMtrt�E: pROFESSIONAL FIRE SERVICE ( 714 ) 923-8121 �ooxess: '780 E FRANCIS H ONTARIO CA 91761 LICENSED CONTMCTOP OECUMTION: I �ereDy allirm t�at I am IicenseE under D�ovisions of Chapter 9(cammendnp vAth Sectlon 7000) oi Divabn 3 oitAe Business antl Professions Code, anU rtry license ¢ in fulllorce arW ettect. cmuc.: 50779 sTnhuc.:580332 C ^vg: � ��' 4� ' Sipnature: �� 11(Efl3' LOMPEN311710N OECUMTION: I here alfirm Ilut I Aave a urtifiw o conseni lo sett-insure or a certifirate o1 Warkers' .ipenutian I9suJ apGq..a( ceniheE copy theroof�Section 3800. Lab. �. IPoLICY NO.: 1 1 7 J 4� 9 E%P. ORTE: � O I O 1 I 9 O wMr�xr: S TATE . � Certified coDY � �ara6y tumiSAeU. L�S CetlifieE coDY is file0 wil� I�e� in� oate: � % /� QO ApDlicant IXEMPfION FROM WOBI(EBS' COMPENERTION DECWLIITION: (TAis sec0on neeE not comp il e Oermfl is �or one hunEreE (5100) or less�. I certiry Ihat in the petlarmance ai t�e work for whic� Ihis Dermit is I55ueA, I shall na[ employ any person in any manner so as ro hecame su�ject ro tAe Warkers' Compenutlon Laws ol Calilomia. Date: SlOnature: NOTICE: It, atter makinA ��is Eeclaratlon, you S�oNU became SuDlect to the Workers' Compensation prodslons oi the La6o� CoUe, you must tortAvnt� comply wit� suc� proNsions or IAis permit shall he UeemeE ravokeA. CONSTHUCTION LENDIN6 pGENCY: I AereOy atfirm tAat there is a constmction IenAinO a0ency far tAe peAormance of t�e work lor w�icn ihis permit is Issuetl (Section 3097, Civ. C�. , LFNOEP: � '— RODNESB: i. OWNEB BUILDEB OELUMTIOX: 1 heahy aMrm ttu� I am exem0� ��m t�e Coniractors' Suro License Law far IOe fallowinp reason (Sectian 7031.5 Busineu anA Pmfessional CoOe: Fny ciry ol counry which requires a Dermit ta cons[mct, al[er, imDmve, Aemalish, ar f¢Ddif dny SINC�IIf¢, O�IUf (0 il$ ISSULltB, i150 fEQOif¢5 IAB aDD�IpII� 10! SUth DEfmit 10 til¢ d Slpn¢d SI2tEl11¢fl� �h2� hP15i18 6 IiC¢IISGd pursuant ro Il�e Drovisions ai Na Contrzctars SUte Licenu Law (Chapter 9(commentin0 �h Seclion 7000) of DNison 3 0l Ne Business ^�E Professions CaUe) or that Ae/she i5 exemD� Neatrom an0 tAe basis lar the allepeC exemptlon. My violauon of Sectlon 7031.5 Ey aDDlicanl for a Dermit subjacis IAa applicant lo a�clWl Oenalry oi not more ihan live huntlreU Oollars (f500�. �I, az owner ol the property ar my em layees wit� wape5 as iheir sole wmpensatlon, vnll Eo Ne work, antl Ue �1 siructure is not intentle0 or oflereC lor sale (�ction 7061. Business anA Protessional CaOe: Tne Contanors' State Limnse Law Uoes not apply to an avmer al a DroDem/ who EuilQs ar improvas tAereon, an0 who Ooes suc� xrork himsetlPoersell or throuOA h¢ ar her own employees, provi0ed tlut suc� Impmvemenls are not intenEeO or oXeretl tor sale. If, Mwever Ne DuilEinq or improvement is sol0 wit�in ane year ol mmplatlon. t�e owner will twve Ne burd¢n oi OroMnO �� b not buiW ar imprave for tAe purpose of ule�. 1, az owner ol I�e pmperry� am excluSNery contractinp with IicenSeE wntractors ro wnstmct Ihe prol�� (��on 704I, Business ❑ arq Professions Code: The CanUactors' $tate Lkensa Uw Ece5 nOt appty ta an owner of D�nY � bWQs w improves ticereon d11G Wlq fAlllfdCtS IOf Slltil OfO�ECIS \{I11 d C0f1IfdL10f(5) IIfR1158 PIIR113111 IO I11! �AII[2LIOf5� Sute License Law). i am av.art that D�� a� ��e�r Worker's Compans:Fion insuranca shoul0 be D��4eE to me. � I am exempt under Sectlon: B. 8 P. C. for Nis reason: PERM NO: F 047692 GOVT: N SUPP: N PURPOSE: ALT JOB DESCRIPTION : T.Z. RESTURAUNT SQ FT: CLAIM VALUE: 1,000.00 CALC—VALUE: GROUP OCC; B-2 / COMMENTS: SPRINK / HOOD REF PC#3799-90S T,I. ***�t*x***�e*�r�t�t*x��t**x��t�r�*it*�etx-�t*�*�***��ti�*�t�titit�*�***ir�t*�r*�t��tit�t*f�**x��t*x��*et�t�*�+t* Z O N I N G R E Q U I R E M E N T S S E T H A C K S ---------=-- MAIN HUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL; 00000000 ZNE; REF NO: PLANNING NOTES> � i! �t iE it it iE 1F i! if if it ik if i! iE �f if iE ik if it it if iF iF i! it iF it it �f iF if iF iF iE iE iE i! 1E if i! iE 1E if iF if iE it if it iF it it if if iE iE iE if iE ik if iE iE if iE if iE if it ik iE iE it if iE i! iE D E V E L O P M E N T 5 E R V I C E S R E Q U T A E M E N Ti5 ZONZNG APPROVED BY , HUILDING APPROVED HY : APPLICATION ISSOED HY� iF M if it iE iF itlF if if iF it iF jt ik if fk iE if jk jf if i! if �f iElklE 1f it if iF it ik if if !E if iE itlF iE iE iE iE iF LEGALIZATION;N PERMIT PLAN ISSUE FEE F E E ,K U M M A R Y BLDG PMT PLUMHING EL C MECHANIC DATE; o DAT�-��G6 � /d DATE: �� iElkiEifitiliEiki! itit 1E d! iE ft iE i!!E iF if i! iE iE �E 1f iE if iF it if * iF STROCTURAL SEGMENT:N FIRE SMIP/RES GRADING 25Fi5t 16.25 SMIP/NON-RES HUILDING-DIV-> PERMIT ZSSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 25.00 0.00 16,25 41.25 41.25 .00 REVENUE DZVISION TOTALS--> COLLECTED; 25.00 OVER/SHORT: .00 BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 2 5 , � � � iE iE iE i! 1EiE 1E iE if �E ik ik iEik iF K dE iE iF if iFjE ik it iE iE i! ik iE it iE i@ iE if jF �E itit 9F iE �E iE iE ii ik iE ik iF it it if iF iEit it iE iE iEjt i! iE iF 1E iE iE-1EiE iE iF iF iF1E it �k iFjE iF jE i! I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST Date: P"'nef� F I R I Eo �erehy certity tlwt I am awam oi an0 untlersWM t�e repuimmenis al Calitamu Heatt� anE Satery Code Sections 25505, 25533, anE 25534 an0 tAat I or any iNure bui101np occupant will/will nat (cirele one) nae0lo comDN �th sai0 state cotles anE [he requimmen6 tor a permit for constmction or moEiticatian irom Ihe Nr ualiry ManaOement �ISMct. Hesidentlal construction apDlications are exempt imm Nese Drovi4on5. ' Dale: Applicani: I hereEy certify tAat I have rea0 this aDPliwtlon an0 state t�at the a0ove informatlon is cortect. I apree ro campty wRh all ciry antl munry oNinances and state laxs relatln0 �a GuilEinp construnian anU �eretry aNh�o,Ax�a apresentatives al th's ctiry to enter upon tha abwe�mentioneE proDeM �orinspectian Durposes. " I/" f 1L I� . Date: � �� 9v Sipnature: ! � � Driver's ucense ar Sacial Securiry x: � 16a1�48 W�ita—BuilCinp; Graen—COEe Enbrcemant: Cenery—Ap011cent; Pink—Hevenue: GobanroE—Avaswr � � 25 FIRE EQUIP FEE (FROM HLDG VAL TABLE) 1,00 25,00 END OF FEES �f; ""� i i " " ., 'r: 1 ' `\I 01 OD062336—OO�b�336 T �+-f 25.04 DRTE� O6/li/90 TIt3f: OS:58 ' CQNSTRUCTION AND PLAN� � :001 '�pA '�APPROVALS Permit #' Date Inspector qppROVALS Permit # Date Inspector 1. �'�emporary 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. Steel Reintorcement , - 56. Rough Plum6ing & Pressure Test - 6. ElectricalUFER�Gmd. 57. APPROVALTOCOVER�GUNITE 7. Footings , .. 58. Electrical Conduit-Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrnd. . 60. Backwash Lines, P�Trap, O Undrgrnd. ' 10. Structural Floor System ' � - 67. APPROVAL TO DECK . 11. Property Sewer Line & HOuSe.Connection 62. Backwash & Receptor�Final • 12. Sewer Cap ' .� . 63. Heater & Vent•Final � 13. Roof Drains _ _ ' . .- 64. Plumbing System • Final � 14. Rough Plumbing 65. Electrical-F.inal 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 Electriral-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL � ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factocy Fireplace ' ' . . APPROVALS Permit # 21. Ducts, in Str.ucture ' � 70. Underground Hydro 22. Ducts, Ventilating � � � =71. Product Piping O Gas ❑ Oil 23. Gas Pipe•Rough & Test ' � 7Z, Underground Flush 24. Roof Framing . - . 73. � Undergrnd. Storage Tank O Gas � Oil 25. Roof Sheathing � ' 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat . � 75. Dry Chemical 27. Frame and Flashing � 76. Dry Standpipe � . � �28. Lathing & Siding ' - � �„` 77. FIXED�SYSTEM FINAL � � 29. Insulation � � 78. FIRE PREV. FINAL � 30. Drywall Nailing � . g �� HEALTH�DEPT. REQUIREMENT � 31. Plaster Brown Coat '!i� �� '79. FINAL INSPECTION ;32. Electrical Power Meter�Final SO..FOOD CERTIFICATE ISSUED 33. Final Electric : �.;,;''I Notes: 34. Final Heating & Air Conditioning � t� i' 35. Final Gas Pipe�Test • � �� :,�� ' ' 36. Hood or Canopy ' �- � 1 ' �� ri � _ . � r,y,.' 37. Final Factory Fireplace ��' � 38. �Final Plumbing � . �� 39. Water Service-Final � - . 40. Gas Service-Final ' - , 41. $olar pomesticFinal . � • 42. Backflow Preventer ' . � 43. Backflow Irrigation 44. Landscape Irripa[ion System � _ - 45. Sound Attenuation . .y 46. HandicapRegulations .� 47. PINAL STRUCTURE & 9UILDING � �''� 48. FINALPIANNING --• 49. Electric Release to Edison ,. �,- 50. Gas Release to Southern California Gas Co '� . � 51. CERTIFICATE OF OCCUPANCY No. Dace -_.J` Ciry ot Cos�a Mesa Development Services Oepartment Building Safety Division P. O. Box 1200 Costa Mesa, Califomia CERTIFICATE OF OCCUPANCY No. Q��. The Buildi�g located at 7�7 w lqfh S*rmt has 6een inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group n_� Occupancy. Use of Building f•rm�m�mial , Legal Description a�a—�m—m (Sea reverse sida for Metes and 8ounds) Building Permit No a79S9l1 Electrical Permit No. F.23Q49 Plumbing Permit No. P22562 M23739 ' Mechanical Permit No. ��5� Number of apartments - a�d/o guest oom/e�/� i ISSUEOTO: BuildingOfficial� ��d/�+��'/ /b/�� Id�ssel Pancre --� � - - 1831 Oranqe Avenue by (`�sta Nhsa. CA 92627 p�e (D 5/ � This Certificate of Occupancy SHALL BE posted in a conspicuous place on th premises am1 SHALL NOT BE removed axcept by the Building Official of the CitV of Costa Mesa under Sec. 307 (e) U.B.C. CraF 1015-ab rev. 1/83 Whit¢ - OwnBr; �anary - Numerical File; Pink � Bldg. Permit File C CITV O�`COSTA MESA CONI'yc,1TRU TI9.11y'�}�1 PERM'7�I!T� PipjeclAddreSs ��—�V• �� "` �•' `• � P.pplicant's Mailing Addr Owner'sName Dr ��1hOe� Phone Address -7 Arch/Eng. License No/�7�2� Addreu �2��i �]C��H� .�. i�. Contractor'sNam Phone G�;��g�� Address (mailingl%� 3g'! ►-� u�'J � �� Ciry License No:�7L �`L��; � ' � LICENSED CONTRACTOR DECLARATION i nereby aifirm that I am Iicensetl untler Orovislons of Chartar (com encinq Nwith section ]000) ot Olvislon 3 0! [he Buslness antl Profe s ons C e: antl my Iicense is i tul rte antl etfect. I LJcens CIaSs L ens Date •Si9nature WORKERS' COMPENSATION DECL O I hereby affirm [M1at I bave a certificat0 of consenl to Self-in5ure ot a'cert flcate of Worker5' Compensatlon Insuran<o, or a certlfletl copY th reoi ( tlon' 3800, Lab. C.) d � PolicY No. �Ilx. ZO 1�D�UComPany � eCertitiea covY �s hereby furnishetl. Certitietl copy i5 tiletl wi[h tna ci[y iltlin Dlvi lo . I � DateZ( 1..7 7G� APPIicaRf[ ` I � (Tnis section neetl not be completetl if the permit is for one huntlretl (5100) or iess). I certi/y tnat in the performance of the work for which thls oerm�t is issuetl, I snall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Si9nature "NOTICE: If, atler making this tleclaration, you shoultl become'subject to the Workers' ComOensation provizions of the Labor Cotle, you musc forthwith comply with such provisionz or this permit shall be aeemea revoketl. CONSTRUCTION LENDING AGENCV I hereby atflrm that there is a construction lentling a9ency for the performance o/ the work fOr which tNs permit is is5uetl (Sectlon 309] Civ. CJ �entler's Namo �enGer's Atltlress OWNER BUILDEN �ECLARATION I hereby aHirm that I am azempt irom the Contrac[or's Llcense Law for the following reason (5¢ction 7031.5 Business antl Professional Cotle: Any clty or � county which reqWres a permit to consbuct, aller, Improve, tlemolish or raoair any structure, prlor to its issuance, also requires the applicant (or such permil to file a si9netl Statement thdt he/she IS licenietl pu�suanl t0 the proviSiOns of the Contraclor's License Law (Chapter 9(tommencing with Section 7000) ot Division 3 of the Businass antl Pro(essions Cotle) or that ne/she is exempt , there�rom antl the basis for the alle9etl exemption. Any vlolation of Section. �.::903L5 by any applicant tor a permilisubjec[s the apP��<ant ro a civil ".:�enalty of not more [han five hunAreC tlollars (E500). -❑ I, as owne� of the prOpetry or my emplOyBes wlth w➢ges a5 thel� sole tomoensatlon, wi11 tlo the work, antl the s(ructure is not intentletl or ot(eretl for zale (Section ]044, Business antl Professional Cotle: The Contractor's Licenie Ldw tloes not apply to an owner of a property who builtls or improves thereon, antl wno tloes such work himsel�/herselt or throu9h his or har own employees, provitlea tnat such improvements are not intentletl or offerea for sale. It, however, the bulltlin9 or improvement I5 soltl wilhin one y¢dr ot com- pletlon, tha owner will nave the burtlen of orovin9 he/she tlltl not builtl or im- �rove for the purpose ot sale). � I, as owner of the property, am exclusively contracting with licensed ton- tractors to construct the proiect (Section 7044, Business antl Protessions Cotle: The Contractor's License Law tlOes not apply to an owner ot p�op¢rty who bulltls o/ Imp/oves thereon, antl wh0 mnt�acts tOr Such projecl5 with a Con- tractor(s} license Oursuant�to tne Contractor'S Litense Law). I am aware that proot of thelr Worker's Compenutlon Inzurance shoultl be provitletl to me. ❑ I am exemp[ untler Sectlon , B. & P. C!for this reason Da[e Owner I hereby certly that I hava rea ❑ s apDli on antl state that the above information ' correct. I a ree to IY with a I city antl county ortlinances and state la relating t iltling o stru antl heraby authorize repre- sentatives tnis city t u t a -mentlonetl Droperty for inspectlonp oses \ �- ��L 51 ture Da[e[.a[4^ qna Drivars' License or 55 � CMF 0065-46, �o�. � Iines anE sign all aDP�opriale tleelarations. �a.5�7� /l,ca� � �. TYPE OF CONSTRUCTION NEW ADD LTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH OT� P�- �� q,p,q� L DESCRIPTION OF WORK/USE OF BLDG....' S Main I � TVPEOFPEHMIT GRADIrvG OurvDATION TRUC7VRA� T. Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL A Reet ❑ �OTHER , C Ri9ht PRWECT DESCRIPTION 50. FT occUaANCv - � CONSTRUCTIONTVPE ��-� VALUATION$ S LCft ZONE�_ GRADINGGV.VDS. /�CRES- PIng.RCf� Remarks: Bar Sink kflow Preventer Back Irrigation Bathtubs Clarifiers Drinking Fountains Floor Drains F.loor Sinks Gas Service Interceptors / ftoof Drains Reinspection Fee UnderGround Structurel Duct- Ven i Exhaust System ❑ Mul� Firepl/Fact. Blt. IC80 # Heacing System & Du Oaioo,000e ioo, �` � � � � � " _I _ I ReinspeMion Fee Whlte - Builtlin9: Canary - Applicant; Pink - Accounting; GOltlenroC - AssasSor Showers Service Sink $¢wer Cap Sewer Connection Solar Collec[or • Solar Pi ' - ' S rTank Swimming Pool w/Spa Urinal _ er Closet Water ater Water Servi Auto-Wash Lsundry Trays $15 � laue Fee S15 Hood or Typel ❑ Canopy Type 11 ❑ Refrigeration System ❑aioo,000 ❑ioo,000 S m Repair/Alreration i pers Registers ' Iswe Fee eia� ii�ria6 �y,�/ I (� Planning Notes: aava.0 cv.. �. �........ ..�- .�.. FEES CJ�.Q • � ELECTRICAL A omaticWasher ' Trensformer ❑�15-50 � Const ction Pole Sub. ❑_50+ f Zone Cooking it Meter ❑up to5 .amps � Dishwasher Meter �ov �t00amps . Dryers ❑Gas ectric Sub P I �� Fan � tors�0.1 HP��1%x-8 F.A,U. ' InaSolar 09-15 HP.�16-75+ Fixtures Microwave • Device Boxes , Pale Light . . Switches � �Garbage Disp al� . �� Generat 0.5 KW �5-15 5 3 ' S 3 , � Reinspeaion Fee — DEVELOPMENTSER Zoning Approved By- Building Approved By APolifation 15sued BV_ REQUI Trash Co laue Fee .:., �,_ . . Sections� • actor � ' $ 3 I-r �u GJr _=:'. I ��'�: i 2 O N I N G R E Q M BUILDING PERMIT $ SlJJy1�/�V Q�FEs�fP $ 2�� G ZS 0Cl �PLAN CHECK - $ PERMIT .•�PLUMBING $ ISSUANCE $•� PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $� PLAN CHECK 50% $ MICROFILM $�� MECHANICAL ' $ TOTALFEE $Z� ' PLAN CHECK 25% § , s . � �bNSTRUCTION AND�PLANNING PROVALS Permit # ��t��,'f. Temporary Electrical Service or Pofe '2. Soil Pipe-Undrgmd. � 3. Electrical Conduit Utility-Undrgmd. � 4. Electrical ConduiUUndrgrnd. � � 5. Steel Reinforcement 6. Electrical UFER-Gend. � 7. Footings �,f�,{,e[ Q �� 6. Foundation � - - � 9. Water Pipe-Undrgrnd. \ 10. Structurel Floor System . 1�1: Property Sewer Line�& House Connection 12. Sewer•CaP ' . 13. Roof Drains " . �' 14. Rough Plumbing ' . � ' � 15. Rough Electrical-Conduit � 16. Rough Electric Wiring � 17. Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19.'Rough Heating & Air Conditioning 20. Rough Factory Fireplace ��21. Ducts,inStructure , � 22. Ducts, Ventilating 23. -Gas Pipe-Rough & Test 24. Roof Framing 25..Roof Sheathing a I, 26. T-Bar Ceiling (Structurap &�Monocoat . 27. Frame and Flashing � 28. Lathing & Siding ' ' 29. Insulation - 30. Drywall Nailing - 31. Plaster Brown Coat I1 32. Electrical Power Meter-Final I> 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ' � 36. Hood or Canopy , 37. Final Faaory 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 • 3 47. FINAL STRUCTURE & BUILDING s- 48. Special Requirements Completed F _� 49. Electric:Release to Edison, 50. Gas Release to Southern California Gas Co 51. CERTIFILA7E OF OCCUPAN�Y i, __ ate Date a Inspector DS v � i „ � POOL ?A APPROVALS Permit # 52. Pool & Equipment Location 53. Steei Reinforcement �, 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Elect"rical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap; O Undrgrnd. 61. APPROVALTO�DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 70. Underground Hydro 77. Product Piping 0 Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank 0 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: � , . s l.. e,,� c� U Date �Inspector � Applicant to /III In al1 soaces excevt tnoze witnin neavY �oreer lines ana slgn a11 aoo�oprlate aeclantions. RUCTION PERMIT cant'sMailin�g}[1dtlress' GV'�=i+ �. //(�/N�;7JY. wner's Nam�7e L/�TU/e� �5p Pho/ne� Address /��% �(% • �/ �� —L_�/ • Arch/Eng. License No. Address Contracror' N .li��, �Il1f 5/9ACS e lo ��49% Addresslm "i� ��% 3� S /J'IAiN ST '.S' �% �.,�� / ' City License No. �S� LICENSED CONTRACTOR DECLARATION 1 hereby affirm tnat 1 am Iicensetl untler provisions of Charler 9(commencin9 with section �000) of Division 3 of the Business antl Professions Cotle, antl my,license is in full jqrc�ntl etioct. � License Cla 5 ` Lic se No. Date �' ��'K� 5lqnature WORKERS' COMPENSqTION DECLAR TION ' 7e�eby affi�m [ha[ I hdve a certiliwte of mnseni [o selfdnsure o� a C¢rtlficate Workers' Compensa(ion 'Insurance, or a certif'etl copy inereo� (Sectlon s800, Lab. C. ' Policy No7��GA027�5"�oa`,�ompan �Certilied copy is hereby fumishea. � Certitietl copy�j letl with the'city il n Date /�' 30'O� APPllcant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be com0leletl if the permit is for one huntlrea (gl 0) or �e:si. I certity that in tne performance ot Ihe work for wM1ich tnls perm�t is suetl, I shall nol employ any person in any manner so as to be<ome subject to the Workers' Compensatlon �yws Of Cali(Ornia. Date ' Si9nature 'NOTICE: If, af[er maki�q this tleclaration,�you shoultl become subject [o the Workers' Compensatlon prov'sions of [he Labor Cotle, you must tortnwlth wmpry wilh zuch proY�s or this permit shall be tleemeG revoketl. CONSTRUCTION LENDING AGENCV • %' I hereCy a(firm inal there is a consiruction lentlin9 a9ency for the,performance of tne work for wn�ch this Permit is ISSU2C (Sactlon 3097 Civ. C.) I..ender's Name LBnAer'S AtlCreis OWNER BUILDER OECLARATION • I hereby af(irm tha[ I am exampt from the Cantracror'S Llcense Law for tbe followin9 reason (Section 7031.5 Business antl Professional Codei Any city or county whicn reqwres � permit to construct, alter, imProve, tlemalish or repair any stru<ture, priOr to its issudnce, also reqWr¢5 the appliWn[ f0� 4uch pe�mit � to file a Signetl statemqnt thdt he/she is IlcenSetl pu�suant to the�proviswns of �[he Contractor's License Law (Chapter�9 (commencinq wl[n Section 7000) of 'ivision 3 of the Business antl Protessions Cotle)"or that he/she is exempt erefrom antl tne basis for the allege0 exemplion. Any vio�ation ot Section - J31.5 by any applitant for a permit 5ubjects the applicant to a civil �enalty o� not moie than five huntlretl�tlollars (5500).' LJ I, �Ss owner of the property�or my employees with wa9e5 as their sole compansation, will Oo the work, antl the structure iz nol in[entletl or offeretl tor sale (Section 7044, Business antl Protezsional Cotle: The ConVactor's License Law tloes nOt 8pply [o an owner of'a property who builtls o� improvez Ihereon, antl wno tloes such work himself/herself or through M1is or her own employees, provitletl that such Improvements are not In[entletl or offeretl for Shce. It, however, lne bulldinq or improvement I5 soltl within one yoar of com- pletion, tne owner will�have the burtlen of provin9 he/she tliE mt builtl or im- ��ove for the pu�pose Ot sale). ' I,.as owner of the pro0erty, am ezclusively contractin9 with licensetl con- tractors to construct [he project (Section 1044, Business antl Professions Cotle: The Contractar's License Law doez no[ appry to an owner of property who builds or improves th¢reon, antl wno �ontracts for such proj¢ct5 with a con- [ractor(dl Ilcense pursVant to the Conbactor'S License Law). I am aware that proof o( lh¢ir Worker'S Compensation in5urance shoultl be p�ovitletl to mC. ❑ I am exempi untler 5¢�tion , , B. 6 P. C. (or this reason Date - 'Owncr _ I hereby cortify {�t . I have reatl Uils intotmatlon i5 Cq(�Qtt. I d9�¢¢ [O COmp Signature Drivers' Licen or SS CMF 0865-46, r¢v. 10/84 that !he above TYPE OF CONSTRUCTION L1 NEW LJ ADD /�iLTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. . , . TVPE OF PEFMIT GRADIN FOUNDATION STRVCTURAL , ' ❑ TENANT ❑ ELEGTRICAL PLVMBING O MECHANICAL � ❑ OTHER PROJECT DESCR�PTION Sp. FT.� �OCCUP V�— CONSTRUCTIONTVPE � ' VALUATIONS a� �� ZONE GRADINGCU.VDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Clarifiers , Dishwasher � Drinking Fountains Floor Drains � . Floor Sinks GasService ' Outlets3 Interceptors Kitchen Sink • - Lavatories P—Trep Roof Drains, � Reinspectian Fee ' � � $15 Duct - Under Ground Duc[ - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. IC80 # Heating System & Ducting� ❑ 0� 100,000 BTU � 100,000 Showers Service Sink - � Sewer Cap. . �Sewer Connection .SolarCollecrors ' Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash � Issue Fee Hood or Typel ❑ � Canopy• Typell ❑ Hefrigeration System ❑o�ioo,000eTu ❑ioo,oao ❑ System Repair/Alteration Fire Dampers Registers � , Reinspection Fae � � $16 � � ' luue Fee White - Bulltling; Canary - APPllcant; Pink - Accounting; Golqenrotl - Assessor r e $ 3 $ 3 A.P. # S Main Buildir E T Front ARear C Right K . . Ping. Ref. # Planning Notes: � Automatic Washer � ConscructionPoleSub. Cooking Unit ' Dishwasher Dryers ❑Gas ❑Electric " Fan • F.A.U. ' Fixtures Device Boxes � 8458 I/30/86 _ _ 2one Accessory Building: � I Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Met2r ❑up to 100 amps ' Meter ❑over100amps. Sub Panel � Motors DO-1 HP �1 h-�8 Inc.Solar �9-15 HP �15- � Microwave Pole Light owi�cnes - - Sign' � ' Garbage Dispossl ' � Standing Sections � GeneratoF �65 KW 05-75 KW • Trash Compactor FEES Z O N I N G R E Q M T $ Reinspection Fee . S75 Iwue Fee $ 3� DEVELOPMENT SERVICES REQUIREMENTS: ' r Zoning Approved By Date Building Appmved By - ' Date � �Q Appliption 15sued By- i Date � SUMMARY OF FEES � . BUILDING PERMIT $ , SMIP _ � , $ PLAN�CHECK � � . $ ' pERM1T . � - PLUMBING ' � $ �' ISSUANCE_' $' . � "PLAN CHECK' 25% $ ENERGV P.C.; $ � . ELECTRICAL. ' $ GRADING $ ' ' �. PLAN CHECK 50% $ MICROFILM § MECHANICAL 5 � TOTALFEE $ � - PLAN CHECK � 25% $ � J � CONSTRUCTION ANDPLANNING POOL&SPA APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgmd. ' 7�F'� ��_ 53. St=_el fieinforcerr�ent 3. Electriral Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation I 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structura� Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing Z-2.lS- (�1� 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL , 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 27. DuCts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test .72. Underground Flush • 24. Roof Framin � 9 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing �' � %: 76. Dry Standpipe 28. Lathing & Siding ,. 77. FIXED SYSTEM FI�NAL 29. Insulation - 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED , 33. Final Electric Notes: � u/� �"j� �/�� F�� 2Cl,'% ' �^ 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 ' - . i, 41. Solar pomestic-Final ' 42. Backflow Preventer ' , ' � � .43. Backflow Irrigation � . 44. Landscape Irrigation System " , 45. Sound Attenuation� ' 46. Handicap Regulations . � 47. F,INAL STRUCTURE & BUILDING . ' 48. Special Requirements Completed 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY N� Date .'... ,�, . _.. �.. � . . ,.. . r Applicant to fill in all spaces eaceD� those within heavy OorEer lines anC si9n all apProOriate tleclarations. CITY OA COSTA MESA � CONS/T�R� CTION PERMIT PEFf�QITaNO., ,_ _ TRACT NO. LOT NO. UNIT NO. ' Project Address �1' � �' �7 �" �T Applicant's Mailing Add ess Owner's Name r r�s.y � hone Address � 7 � � ' (.� S 1 Arch/Eng. License No. Address Contractor'sNam ,`En ��' '' Fq Q one�8� Address (mailing) ��"'� >��-�-�T r � A.� q� � City License No_ �SL �� / 3 IICENSED CONTRACTOR DECLARATION • I hereby aftirm that I am licensetl untle� provislon5 of Chdr[¢� 9(Commencing with section ]000) ot Divlsion 3 oi the Business antl Professions Cotle, antl my license is in uli fo e antl effect. ucense„c)a� �"�� _ucense rvo. 313 I S Date �1 519 t �� %%� �� WORKERS'C MPENSATIO D CLARATION I hereby atiirm that I have a certiticate o( mnsent to sel/-Insure or a certlflcale o� workers' Compensation Insurance, or a cercifietl copy thereof (Section 3800, Lab. CA) ' n Policy No.�L/- �0�� Companyr��L SYATES . J3-eertifietl copy i�filetlbwAPPhcac_tl. Builtlin9 Divislon � a L� �...../y1,�$��.` EXEMPTION ROM WORKERS' yvM ENSATION DECLARATION (Thisseclion neetl not be completetl it the permit is tor one huntlrea ($100) or less). I certify [hat in the pertOrmance of the work fo� which th15 p¢rm�t is Issuetl, I snall not employ any person in any manner so as fo become subject to the Workers' Compensation Lawi O( Califomia. . Da[e ' $i9na[ure `NOTICE: If, after makin9 this tleclaration, You shoultl become subject to the Worker5' Comp¢nsation provisions ot [he Labo� Cotle, YOu must torthwith comply with sucb p�ovi5iOn5 or this permit Shall be tleemetl �evoketl. ' CONSTRUCTION LENDING AGENCV I hereby affirm tnat tbere is a cdnsVuction lentling aqency for the per(ormance Of tne work tor which thls Oermit iz Izsuetl (Section 309] Civ. CJ lentler'z' Name Lantler's AtlEress _ OWNER BUILDER �ECIARATION I hereby affirm that I am exempt from the Gontractor's Llc¢n5e Law Por the followin9 reason (Section 7031.5 Business antl Grofesslonal Cotle: Any ci[y or county wbi<h �equires a pe�mit to const�uCt, alter, imp/ove, demolislt o� �epdir any structure, prior to Its issuance, also requires the apDlicant for such permit to file a slgnetl statemen[ tha[ he/she I5 Ilc¢nsetl pu�suant [o the O�ovi5iOn5 0( the Contrac[or's License Law (Chapter 9(commencing witn Section ]000) oT Division 3 ot the Business antl Profeisions Cotle) or [hat ne/she is exempt therefrom an0 the basis for the alle9etl exemption. Any violation of Section J031.5 by any applitant (or a permit subjec[s the applicant to a civll eendlty of not more than five huntlretl tlollars ($500). . LJ I, as owner oi the proverty,or my employees with wages as tneir sole ' compensatiOn, will tlo the wo�k, antl Ne StruGture is not intentletl o� Otf¢ietl (or sale (Seclion 7044, Busin¢5z antl Professional Cotle: The Contractor'S Litense Law tloe5 not appty to an owner of a pwperty who builtls o� Irt�p�ove5 thereon, antl who tloes such work himselt/herself or throu9h his or her own employee5, provitletl [hat such im0/ovements are not In[entletl or offcretl for sale. If, however, tne builtling or improvemant is soltl within one year of com- pletion, tha owner will M1ave [ne burtlen of proving he/she tlitl nOt builtl or irn- prove for the.Pwpose of sale). � ❑ I, as owner of Jhe pro0erty, am exclusively contracting with licensetl con- � tractor5 to con5truct the project (Sec[ion ]044, Bu5ine55 antl Pro(essions Cotle: The Contractor's license Ldw does mt apply fo an owner ot ,prOOerty who ' bulltls ot improves thereon, antl who con[racts tor suctt prolects with a con- tractor(sllicenze pursuant�to the Contractor's Licenze Law). 1 am aware that proof oF tnei� Worker's Compensation inzUrance shOultl be provitletl to me. ❑ I am exemp[ untler Section B. & P. C. for this reason Date Owner I hereby certi(y that 1 have reae ininrmatinn is correct I aaree [o ( Signature(� 6, Drivers' ylcense orS! CMF 0865-46, rev. 10/84 'tate thae the above tl county ortlinances eby autho/iie repre- ionetl prop¢rty fot Date___J,�.=�� TVPE OF CONSTRUCTION Ll NEW LJ ADD LI ALTERATION LJ REPAIR ❑ GONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPEOFPERMIT IJ GRADING LJ FOUNDATION IJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL . ❑ OTHER PROJECT DESCRIPTION Sa. F7. oCcuPANCY CONSTRVCTIONTYPE � VALUATION$ ZONE GRADINGCU.VDS. ACRES Remarks: v � ear Sink Backflow Preventer Backflow Irrigation Bathabs Clarifiers � Drinking Fountains ' Floor Drains Floor Sinks Gas Service Outlets Interceptors � Kitchen Sink Lavatories P-7rep Roof Drains Reinspection Fee � $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 eru O i oo.oao eT � I I peinspection Fee White - Builtling; Candry - APPllcant; Pink - AC<Ounting; Goltlenroa - ASSBSSor '$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-Wash Issue Fee Hoodor Typel ❑ Canopy, Typell ❑ iefrigeration System � N . � �0-100,000BTU ❑100,000 Sysrem Repair/Alteration Fire Dampers Registers � Issue Fee 0 FEES $ 3 $ 3 A.P. qp S Main Bi E T Front B Rear A C Ri9ht K Left S Ping. Ref. # Automatic Washer - - Construc[ion Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures. Device Boxes Outlets . Switches Garbage Disposal Generator 00.5 KW �5-15 5Q88 5/13/35 2one Accessory Parking'Req./Provided IICAL Transformer ❑ 15-50 KW ❑ SO+ KW Mecer ❑up ro 100 amps , Meter ❑over 100 amps . � Sub Panel Motors�0.7 HP�1h-8 Inc.Solar �9-15 HP �16-15+ Pole Li9ht Sign Standing Sections , Trash Compactor FEES :L Z O N I N G R E Q M T S t Reinspection Fee $75 luue Fee . '$ 3 DEVELOPMENT SERVICES REQUIREMENTS: 2aning APVroved BY Date Building Approved 6y _ Date Applifation Issued By- Date 5_� SUMMARV OF FEES BUILDING PERMIT $ SMIP $ � . PLAN CHECK � $ PERMIT 2 � PLUMBING � $ ' � ISSUANCE $ �cT"� PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ ' � MECHANICAL $ �DTOTALFEE $ • � PLAN CHECK 25% $ I� O Q/� � CONSTRUCTION AND PLqNNING POO� a 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-Uhdrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & 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 PLASTERING 18, Rough Elearical-T Bar Ceili�g 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conclitioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Produci 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. 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 � f� � 35. Final Gas Pipe-Test � 36. Hood or Canopy 37. Final Factory Fireplace , � 38. Final Plumbing 39. Water Service-Final � 40. GasService-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. Elearic Release to Edison ' - � 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPqNCY _ � No. Date � Aoo�ieant to fill in a11 spaces exeeDt tnose within heavy Oortler 11nes antl si9n all appropriate tleclarations. CirYOF-cOS'rAMESA' CONSTRUCTIONPERMIT .�roject Address __ 7 v2� / 9 f A �. ,Applicant'S Mailing/ �Address Owner i Name r1{ � ��b�i..� �phone Address Arch/Eng. License No. Address p�• Al Contractor's Name�s �"'�Q4�! �^' � • 'V �- Phone � �%��-� e o Addresslmailingl�.Z3.�yy��7—cr�p�STsc.1^�o IT7 City LicenieNo. .�/ /� LAawvA N�L¢ J LICENSED CONTRACTOR OECLARATION I hereby aitirm Ihat I am Iicansed under provisions of Charter 9(commendng with section 7000) ot Division 3 ot the Business antl Profeszions Cotle, antl � my Iitense is in full force antl e�fect. y Licenie Class Licanse o. 3�/ ;$� p Date��i �; 9C `'$i9nature WORKERS' COMPENSATION DECLARATION . hereby at(irm that I have a certificate ot consent to self-insure or a certititate Wo�kers' CompensatiOn Insurance, o� a certlfletl copy tne�eof (Se<tion �800, L'abl �LJ`�3Q3 �O (,� PolicY No1�S.,5�,� ComPanY o..S�aG. �wDaw.t��r Certifietl copY is �ereby furnishetl. � Certifie0 copy Is filed with the city Byi � DiviSion ate��./ l_�T— Apolicant � ' - •�—^ - ' �E%EMPTION�FROM WORKERS' COMP NSATION DECLARATION � (This section neetl not be completetl it the permlt is for ane huntlretl (5100) or less). I certify that In th¢ performanc¢ Of the wo�k (o� whictt thls pe�m�t Is Issuetl I shall nol emD�oy any person in any manner so as to become subject to t�e Workers' Compensation Laws of Calitornia. Da[e Si9naturo \`NOTICE: If, aRer makin9 this tleUaratlon, you shoula oecome subject to tne Wo�k¢r5' ComOensatlon prOviSiOns Of the Labor Cotle, you must (orthwilh- `compry with such provisions or. this ,permit. shall be deemetl revoketl. CONSTRUCTION LENDING'AGENCV' I h¢reby atfirm that lhere is a mn5truction Iantlinq agency tor tha pertormant0 Of the wOrk for 'wnich thi5 permit �Is ISSu¢tl (Sectlon 3097 Civ. G.) LenEer's Name _ Lentler's Atltlress � OWNER BUIL�EH �ECLARATION ' ' I nereby atfirm that I am exempt from the Contractor's License Law for the ' tollowing reason (Section 1031.5 BuSiness antl Protesslonal Coae: Any city or county which reqWres a permi[ to construct, alter, improve, tlemolish or repair any structure, prlor to its issuance, also requlres the applicant tor such permit to flle a signetl statement tnat he/she is licensetl pursuant to the provisions oi the ConVactor'vLicense Law (Chapter 9(commencin9 �+�tM1 Section �000) of ',rv�ivision 3 oi the Business antl Professions Cotle) or [hat he/s�e is exempt F,,,p,er¢from antl the basis tOr the allegetl ex¢mplion. Any violation�of Section '��J31.5 by any a001ican[ tor-a permit suGjects the applicant to�a civil enalty of mt more than tive huntlretl tloilars ($500).. � ❑ I, as oavner ot the property o� my employ¢es witn wa9es as thei� sole � compensatlon, will tlo the work, antl the structure is not intendetl or oiferetl for sale (Section �044, Business antl Professional Cotle: The Contractor's LicenSe l.aw tloes not apply [o an owner of a property wno builtls or improve5 thereon, antl who tloes 5ucn work him5elf/herseli or throu9h his or her own employecs, provitletl that such improvements are not intentletl or offeretl tor sale. If, however, Ihe builtling o� im0�ovement I5 so1G withln one year ot com- pietlon, the owner will nave tha Durtlen of proving he/she Eitl not bulltl or Im- prove forthe'purpose of sale). ❑ I, as owner o/ the property, am exclusively mntractin9 with IlcenseC ton- Iractorslo construct the projecl (Section 7044, Business antl Profes5ion5 Cotle: The Contractor's License Ldw does not apply to an ownor of property who builtls or Imoroves thereon, and who contracts for such orojects witn a Con- iractor(51 Ilcense pursuant�to tne Contractor's Licanse Lawj. I am aware tna[ proof o( thelr Worker'S Compensatlon insurance shoultl be o�ovmea [o me. ❑ I am oxempt untler Section B. & P. C. for tM1is reason Da[8 Owner 1 hereby certify that I have reatl this aOPlication antl state that the above informaUon is correcL I a9ree to comply with all city antl couniy ortlinances ana state laws relatin9 to builtling ronstructlon, antl nereby authorize re0re- sentatives o/ this city to en r upon tM1e above-mentionetl property tor insPectlan purpoy�s� � , � ' Signzture Ll Date 3-(S"'P TYPE OF CONSTRUCTION LI NEW LJ ADD- �. ALTERATION I�.REPAIR ❑�CONVERSION" ❑ DEMOLISH ❑ OTHER , DESCRIPTION OF WO(iK/USE OF BLDG. TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL� O TENANT �❑ ELECTRICAL � ❑ PLUMBING �ECHANICAL � ❑ OTHER PROJECT DESCRIPTION 5a. F7. �- oCCUaANCv CONSTRUGTIONTVPE VALUATION$ ' ZONE GRADING CU. VDS. , ACRES , Remarki: Bar Sink � Backflow Preventer � Backflow Irrigation ' Bath[ubs Clarifiers - . Dishwasher � ' Drinking Fountains � Floor Drains Floor Sinks � Gas Service Outlets Interceptors � Kitchen Sink Lavatories P-Trap . Roof Drains Reinspection�Fee ., , $15 Duct - Under Ground � Duct - Svuctural Duct - Ventilating - ' Exhaust System ❑ Multiple Firepl/Fact. Blt. IC80 �I`- %Heating System & Ducting Ssla-i oo,000 eTu O i oo,000 Drivers' licen�55 � ' � I I Reinipection Fea CMF 0865-46, rev. 30/84 White - Builtlin9: Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Assezsor Showers Service Sink Sewer Cap Sewer COnnection Solar Collectors � Solar Piping Solar Tank � Swimming Pool w/Spa Urinal Water Closet � Water Heater Wacer Service Auro-Wash �Laundry Trays° Issue Fee' FEES Hoodor Typel ❑ Canopy Typelf ❑ Refrigeration Sys[em ❑o-ioo,aoosru ❑�oo,000er ❑ System Repair/Alteration Fire Dampers i � Registers � 3T 5 - ' Isiue Fee A.P. �f`- S Main Building: ' E T Front 6 Rear A C Right SLeft Ping. Ref. # Planning Notes: Automatic Washer' Construction PoleSub. Cooking Unit Dishwasher' - � � Dryers ❑Gas ❑Elec Fan f.A.U. Fiztures Device Boxes Outlets Switches Garbage Disposal Generatoi �65 KW C Fee 0920 3�13186 4 Parking i�on� �� 2on� ELECTRICAL � ' Transformer ❑ 15-50 KW ❑ 50+KW Meter �up to 100 amps Meter ❑over 100 amps - Sub,Panel Motors O0.1 HP O 1�- B Inc.Solar 09-15 HP �16�15+ Microwave � Pole Light ' Sign ; Standing Sections 5 KW Trash Compactor $15 luue Fce FEES $ 3 Z O N 1 N G R E Q M T $ DEVELOPMENTSERVICESREQUIREMENTS: � ' Zoning Approved 8y Date i Building Approved By Date ��/y� APPiiration Issued.BY— �� Dat�%� u'� - SUMMARV OF FEES � � BUILDING PERMIT '� $ SMIP , $ • . PLAN CHECK $ PEFMIT � PLUMBING ' $ � � ISSUANCE $ � S O PLAN CHECK 25% $ ' ENERGY P.C. $ ' D ELECTRICAI $ GRADING $ � PLAN CHECK ,50% $ �T- MICROPILM $ � � y� ,��, MECHAN�CAL � $ ^Uv TOTALFEE ' $ ��_� $ 3 , PLAN CHECK 25% $ ' • ' GONSTRUCTION AND PLANNING POO SPA i 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. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structuraf 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 Sys[em � 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 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 77. Product Piping O Gas OOiI 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing � 76. Ory 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. Gas Service-Final 47. 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 Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADo�icant 10 fill in all soaces ezeeD� ihose witnin neavy borticr Iines ana sign all appropriate Gaclarations, PERjy]y7' NO. __,,. TRACT NO. LOT NO. UNIT NU. Applicant's Maili A dre Owfier's Name Phane Address Arch/Eng. License No. Address Contracror's Nam d �i1'1 Phone _ 'd Address (mailing) Ci2y License No. -�J+��—�[—�Q LICENSED CONTRACTOR DECLARATION I hereby allirm lhat I am Iicensetl untler provlsion5 of Charter 9(commencing with sectlon ]000) of Division 3 01 thu Buslnuss antl Professions Cotla, ana my Iicense Is in f�!o and eltect. ' �p D LIC¢f15¢ 55 IICUlISB O. � Date 519�ature _ � WORK RS' OMVENSATION DE LARATION h¢reDy af(irm lhat I hav¢ a certiticate oi consenl lo selt-insura or a certitiwte Workers' Compensation InSurdnCe, Or a certltietl'copy tnereot (Sectlon' .d00, Lab. C.) Policy No. Company Certifietl copy is hereby furnis�etl. Certifietl copy is fileE wlth the city Bulltlin9 Division. ' Da[e APPlicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - (Tnis section nee0 not be complatatl If the permit is tor one huntlretl (5300) or 1¢55). I te�Ufy that in Ihe perto�mance ai the wOrk 10/ whicn Ibis pe�m�t Is�55uetl, I shail no[ pl any p¢r5on in dny ma er�p as to become Su j¢Ct t a Work lon Laws ot Califar� /� Dale Si9naturo �l ..J 'NOTIC :. ite akin9 [his tleclarati n, you Shoultl b000m0 Sub� t 0 COmply w�[b sucb PIovILonS or [n15 pOfmll Snall 08 alem9a fevoHea. GONSTRVCTION LENDING AGENCV I hereby aliirm t�at there I5 a cons[rucllon lentling agancy lar lho performanco of the work tor whiGh Ihis parmit Is issuetl (SeCtiOn 3097 Civ. CJ Lentler's Name Lentler's Atldress OWNER BUIL�EN bECIARATION I beraby aftirm that 1 am exampt irom tho Contracror'S L�cense Law for lhe /ollowin9 �eason (Section 7031.5 Businoss antl Profesiional Cotle: Any <ity or ' county wNCM1 requires a Permit to construct, alter, improv9, tlomolish or repalr any strutture, plbr [OJlS ISSudnCe, also lequiros Ihe applicant fOr Sutll pofmil -to file a siqnetl Statement [ha[ ha/she is liconsetl pur5uan[ [o [he provlsions of -the Coniractor's License law (Chapler 9(commoncing witn Sactlon 7000) of ��vision 3 ot the Business antl Protassions Cotle) or tnat ba/she is exump[ erefrom antl tne basis lor the allegetl oxemptlon. Any violation of SecHon 31.5 by any apPlicanl tor a pe�mi[ SUbjects [ha applicant to d civil enalty of not more Ihan tive huntlretl tlollars (E500). � 1, a5 owner ot the property or my employees with wages as thelr sole mmpensation, wlll tlo the work, antl the Structuro is not In[entl¢tl or otfGr¢tl ' �. tor sale (Seclion 7044, Business antl Protessional Cotlei The Contractor's '� LicenSe Law tloe5 nOt apply-t0 an ownnr o( a proparty who bulltl5 or ImprovlT thereon, antl who does such w0/k himself/hCrseH o� N�ou9h hI5 O/ her Own employees, OrovitleE that such improvements aro not Intentletl or oHomtl tor ' sale. 11, �howeve�, lhe bulltling or imptovamant Is soltl wllhln On¢ yCd� ol COm- pletiOn, the own¢r will have lhe burtlen OI proving he/sho tlitl nOt bulltl o� Im- pfOvO �Or tlle pufpo58 ot Sale). ❑ 1, as owner of the property, am exclusively contracting wl(h Ilcensetl con- Iracl06t0 <OnsVuct lhC project (SeCtlon 7004, 6usinoii antl PIOfO55ion5 COda: � . The Contrattor's License t�w tloes not appty to an ownor oi property who Cuiltls or Improves thereon, antl who contracts for sucn proje<ts wltn a con- tractor(511icense O�rsuantlo tha ConVactor's Litnnsu Law). I am aware that prOol o( their WO�ker'S COmpenSatlon insu�anco shOultl bo provltletl t0 me. ❑.I am exempt unaer $ectlon , B. & P. C. for this reason Date Owner _ I h¢reby certity that I have rcatl this information Is wrrect. 1 agree to comp antl state la relating to bulltlip g con sentatives o thi city. to enteT upor insPection Ro� Signature Drivers' LI erise or 55 � TVPE OF CONSTRUCTION LI NEW IJ ADD IJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p *. DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPE OF PERM� GRADING FOUNOATION STRUCTURAL T Ffant ❑ TENANT ELECTRIGAL ❑ PLUMBING ❑ MECHANIGAL e Rear ❑ OTHER %� PROJECT DESCRIPTION Sq. F7. OCCUPANCv C Right K Left CONSTRUCTIONTYPE � VALUATION$ $ 20NE GRADING CU. VDS. ACRES P�ng. Ref. #' aemarks: �� • Planning Notes: Sink Preventer Irrigation Dishwa5her Drinking Fountains Floor Drains Floor Sinks � Gas Service Outlets Interceptors � Kitchen Sink ' Lavatories` . P—Trap Foof Drains � Reinspeetion Fee � $15 Boiler i Duct- UnderGround Duct - Structural Duct - Ventilating ' Exhaust System � Multiple ❑ Firepl/Fact.8lt. IC80 # Heating System & Ducting ❑0.7 00,000 BTU � 100,000 BT Reinspec[ion Fee I $15 F 0865-46, rev. 10/84 White - BuilCing; Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank � $wimming Pool w/Spe Urinel W�LCf C�0581 Water Heater Water Service Auto�Wash Leundry Trays . . Issue Fee Hood or Typel ❑ Canopy TypelL ❑ Refrigeration Sys[em �aioo,000eru �ioo,000 System Repair/Alteration ' Fire Dampers Registers - ' Issue Fee u ES $ 3 5 3 Auromatic W Construttian Cooking Unit Dishwasher Dryers ❑Ga Fan F.A.U. Fixtures Device Boxes Electric Garbage DiSposal ' Generator �0�5 KNl �5-15 0912 B/ly/06 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW :40G� 1�- FEES Merer Llup to 100 amps Meter-�pver-700amps' -- Sub Panel Motors �0-1 HP �A Yh = 8 Inc. Solar 09-15 HP �16-15+ Microwave Pole Light • Range � � Si9n � Standing Sections � Trash Compactor � Reinspection Fee �$15 � � laue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building ApD�oved By Aoolimtion luued By . SUMMARV OF FEES BUILDING PERMIT $ SMIP - PLAN CHECK ' $ PERMIT PLUMBING g ISSUANCE PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL $ � GRADING PLANCHECK 50% $ I%�7S MICROFILM MECHANICAL 5 TOTALFEE PLAN CHECK 25% $ � , , $ 3 $ Z O N I N G R E � M T S '��$ONSTRUCTION AND PLANNING '�APPROVALS Permit# r�' nmporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. ' 3� Electrical Conduit Utility-Undrgrnd. , 4. Electrical Conduit-Undrgrnd. � 5. Steel'Reinforcement � ' 6• Electrical UFER Grnd. ' 7. Footings ' , 8. FouRdation 9. Water Pipe-Undrgrnd. 10. Structurel Floor System � 11. Property Sewer Line & House Connection 12. Sewer Cap � _ 13. Roof Drains ' 14. Rough Plumbing � 15. Rough Electrical-Condui[ 16. Rough Electric Wiring ,. IA"S VJ 17� Rough Wiring Sign 78. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating . 23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat ' 32. Electrical Power Meter-Final 33. Final Electric 34. Final Hea[ing & 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 Southern Calitornia Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Date POO ;PA Inspector p�ppROVALS Permit# , ' 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE ' 58. Electrical Conduit-Undrgrnd. ' 59. �Gas Pipe, O Undrgmd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. � 61. APPROVALTODECK � 62. Backwash & Receptor-Final � 63. Heater & Vent-Final 64. Plumbing System - Final � . 65. Electrical-Final 66. Solar SYstem-Final e�o 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit# �; 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush � 73. Undergrnd.StorageTank �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: i, Date � I s � �� `� � ' (81 3 C057A MESA BUILDING•SAFETY DEPARTMENT P. O. BOX 9t7 COHiA MEBA. CALIFOMIIA For Applicanf fo Fill In Complefely TYPE OR PRINT BUILDING � ADDREBS 7 � T GOSTA MESA CALiFORNIA � STATE � LINB �t ��:G�i�� NOV 2 1962 FINA�!CE OEPT. CISY Of COSTA MESA APPLICATION FOR PERMIT BUILDING For Offiee Use Only ��T � ..�,.�......,. � .J RlCHIVED BY DATH NeGHIVED � T 1 B / II-Y-6Y II-Y-1 NO. - � BUIIDI � 7. /, / � 4 AODRESS G�� 7E�. COSTA MESA. CALIFORNIA �.17///9� � TEL: NO. NO. OF BIDGe. NOW ON LOT �.l /�' REAR YAR�I�i IRIGHT �XI D�SCRIPTION OF WORK OF I HGPlBY ACKN�WLEOOE TXAT 1 NAVE READ THIB MPLIGTION AND BTATE TMAT TH6 ABOVE 18 COPR6GT AND AGREE TO COM- PLY WITX ALL CITY ORDINMlCE6 AND 6TATE LAWB RE��(((111LLLyyy��TIN6 BUILDINO CON9TNUGTI�� Jf/ N I�� SIGNATURE OF i sw ow // ZONIN6 ZONE � I NO. OR q �I 1162 OP NEW /O � PUNB y BIIILDINO J !� LEDAL l � /l � � _ � r EVES (CBNiLR lINB 9TJ � REAR jl� FT. IN � APPROVED �� J�� DATE I, `�� L`�^ BY /V 4� \ \, / V � � TXE �MOUNT BHOWN UNOEP VALUATION IB POR TfiH �\ PURPOBH OF 88TABL18XIN6 A PeRMIT PEE ONLY. V VAWATION � �O �� PERMIT FEE $ �• $ / / � � PLAN CHECK $ ' � �/ DO C � TOTAL FEE �' LL / _ _ _ /, _ _. �J • ��f' ' �� : 4 4 7�3'7 - . COSi'A MESA BUILOIIVW-SAFETY DEPARTMENT v.o_soxi2nn r.nsrnMESA.CALIFORNIA92626 SE° 29-77Pa�o001517� ***+� uasn �8.�� APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill i� Completely — Use Ink Only RECEIVED BY DATE RECEIVED DA E ISSUED BUILDING � O -/�3-�, ADOFESS �� - OWNER � �'�� A.P. NO.�/��/ Z�' I 3 PERMIT NO. ' . 1T ADIDFlIE 5�Z 7 �' � 9 T� ADDRESS � W I `� S� v ena CITV CG jT�j,- � N04 C TRACT LOT �( BLOCK CONSTRUCTION W AD A P LENDEfi �' V � 'L� 2- BRANCH Q �,�,_,'�-' OWNER A O ADDRESS il VAL �� AFCHITECT �+ ' •� TEL. S 5 OR ENGINEER "L �� -.. FIRE /� ADDRESS ZONE T PE GROUP APPflOVED CONTRACTOR � BV DAT O � � ADDRESS TEL. ZONE NO.OF USE OF NEW UT ✓�h CITV � � �j, � �' NO. �- / P�� BUILDING If7j.CAfE STATE � ' CITY �'ARDSAPPROVED VAROSAPPFOVED L14 NO. LI0. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLDGS. (FROM C/Ly��tR�jTjTv �.,, '� OF lOT NOW ON LOT ROfYT // Ff. FT. USE OF EXISTING BLDG. Za t FT Separate permits are required for L. SI�E Z-0 FT. � FT. electric, plumbing and heating work. �.7 F4!�r i.v_ Fr. REAR USE OF B LDING AND WORK TO BE PERFORMED DI5TANCE BET. BET. MAIN & MAIN BLOGS. ACCESS. BLDGS. VAR.9W DATE C.U.P.qW n - - APPROVED APPROVED//Al// IO-7`7Z v�rrr I hereby acknowlatlBe thet 1 have reatl this eppllcation and siete that the above informetlon Is correct end aBree to comply with ell lawz reguleting bullding construction, end I s�ell not employ any perzon in violatlon of Na workmen's compensation lawz of Me Sceta ot Cellfornia. I hereby certify thet I am properly IlcanseC es e eonirector under S�. FT. t�e State of Californfa Businav antl Professions Cotla, �Ivision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, antl that such Iicenses ere In full torca antl effect, o� I TiE PUiiPOSE OF ESTABLISHING A PERMIT FEE ONLY: am azempt from the proviclons of tne Stata of Callfornia 8usinesa VALVATION PERMIT FEE y and Profeuions Code, Divislon 3, C�eptar 9. SiB�etare of '�//� PLAN CHECK 5 D Perminee / (/ O TAX Authorizetl ABant TOTAL PAID y 'a �� l��