HomeMy WebLinkAbout767 19TH ST - Building Permits_,
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LENDER'S NMIE
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CITY GF CGSTA MESA - S L'iiN PERMII'
PERMIT NG: SB G8�32b PLAN CHECK NG: 04413-97 S ' GuVT: N:ii'li+P: N
CGNSIRUC2IUN "TYPE: PERMIT TYP�.: STR SIG PURF(iSfi: GTH
JOB DESCRIPTIGN : 1 MGNUMENT 6 1 WALL NGNILLUMINATEL 52GN5 SSj FT:
CLAIM VALUE: 4,392.G0 CALC-VALUE: 4,392.OG GROUP OCC: i3 i
COMMENTS: "CLINICA LATING AMERICANA" WALL ti MUNUMENT SIGNS
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S I G N I N F O R M A'! I V N
DISTRICT: 1 TYPE: MONUMENT/ WALL ILLUMINATION: NGN CATEGU22Y: NtW
LIMENSIUNS; 18FT OOIN X 4FT OOIN AREA: 121.SOSQF7 LET'IER HT: 18 CNCH
sTREET FRUNTAGE 1; 58.00 S'IRE�T 1: W,191H
STREET FRUN'PAGE 2; 0,00 STRE:E'f 2;
PARCEL: 42420105 Z�NE: C1 LUCATIGN > rRGNT; X REAh:
BUSINESS NAME: CLINICA LATING AMERICANA > LEFi; RIGH'i:
U T H E R T G T A L S G R i� U N u s I G N
I'HIS ACTIVITY , 121,S�S�FT UVERALL ii�.IGHT; 7tr 4TN
THIS SI7E 75.GOSUFT GROUNL CLEAItANCE; OF'i bIN
I'IfiMS GF INFU z 6 PLAN?ER AREA: 1�10."vuSUFT
ITEMS FUR AI:TIVITY: b BLLG S£T BACK: 2"vFI
COPY" VERBIAGE : CLINICA LAZTNU AMERZCANA
HANA ACU-THERAPY
PLANNING NGT�S: 1 MONUMENT SIGN 1 WALL SIGN. 5'PREET AGL
3e %iF iF 3f iF 3F 3F 3F 3F i4 # iF ir ie if ii #�F iF ie iF iE ie w iP iF 9i iF iF iF w ii ie iF ie've'se i'r ie aF'vF if ie if if ie iF ie ir ie iE iF ii ii ie ii # ir se ii ii ii iF if 'se iE w if 9f ie iE x i� x x� x x
L E V E L U P M E N T S E R V I �c:-+E 5 R E Q U T R E M E N'i s
ZGNING APPRuVEL BY V� LA'IE: Io 20�
BUILLINi, APFRGVEL BY
AFPLICAI'ION ISSUEU B
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Y
nLLG PMT PLUMBING
PERMIT 95.75
SIGN
LHTE:
UATE: iJ � i 1
'vFiFiiiiiiie'sf�eiF iex�w ir xfexiFii
SIRUCTURAL S�:GMENT;Y"
SMIFiNt,S GRHLING
� � sM IF i NUN-itES
PLAN o4.84 � ,yz
ISSUE FEE '
HUILUING-LIV-> FERMI7 ISSUE PLANICHECK 'I'UTAL PAIu LUE
TGTALS----> 1G"v.b7 0.00 �- b9.89 1ti5.51 lb�.�l ."v"v
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kEVENUE LIVISZGN 70TAL5--� CGLL'EC'IEL: 1b5.51 UVER/SHGRT: ."v�
BLLG FMI' PLUMBING ELECTRIC MECHANIC S1GN SMTF/iGT GRALING FLAN-CHECK
99.75 _ : .92 G9.84
I_
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I N D I V I D U A L' F, ' E E H R E A K D G W N
TYFE QiY D E S C R I P T I U N•�. DNIT COST LOTAi CUSI
NU FEES WERE SELEC'I�:L rGR THIS YEi2MIT
I
�
EXPIRED�`��
DATE���L�
I (% '`
18-28-1997/83:48 DM/f165.51
�cor�:e�-eeiaisa
PERMIT:985326
ti
CONSTRUCTION AND PLANNING P0, . SPA
APPROVALS Permit# Date � Inspector APPROVAIS Permit# Date Inspector
1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location
2, $oil Pipe�Undrgrnd. - 53. Steel Reinfprcement �
3,�E(ectrical Cpnduit Uti�ity-Undrgrnd. 54. Forms
�' i4. E�ecirical Coriduit�Undrgrnd. ' 55. Electricat Bonding
z 5.�Steel Reinjo�cemenF, � 56. Rough Plumbing & Pressure Test
'� 6�� Electrical'UE�ER�GrT'n�. � 57. APPROVAI. TO COVER�GUNITE -
p •:7.,- �ooti ngs
� �� � � ' j'l p� 58. Electrical CondUit-Undrgrnd.
:6.'�Foundation � � � u 59. Gas Pipe, � Und�gmd., Test
'F 9. Wacer Pipe-Undrgmd. :� 60. Backwash Lines, �P �T�ap, O Undrgrnd.
�± � 0. Structural Floor Svstem - � 67. APPROVAL TO�DECK
11. P�operty Sewe�, Line & 4ouse Eonnection 62. Backwash & Recepior-Final
�Z• Sn`°e` CaP �� -. 63. Heater & Vent-Final
13. Roof Drains r_ 64. Plumbi�g System • Final
14. Rough Plumbin.g- � � � 65. Electrica6Final -
15. Rough Electrical•6onduit �� 66. Solir��ystem�Fina�
16. Rou9h Electric WPring� � - 67. Fencing & Accex ApProval
17. Rough Wi�ing Sign � .- 68. APPROVED FORYLASTERING
z.
18. Rough Electricat�T Bar Ceilin9 � 69. POOUSPA SYSTEMS FINAL -
79. Rough Heating & Air Conditfoning - FIRE DEPT. REQUIREMENT
- ,� .,,�,-. _ - �� " t: - r - .
20. Roug� Faetory�Fir�p�ace L„� Y'^ x�L -." - c. _ A�P VA�LS.r P,e�nii,t�g� '' ` "
~ ^ ;�r� ~ % �•. � -7-r- .
Zj. �UCtS,.in $TfUCTuf2q Y X E;qi*1� S�� , V�ti _ .� 70. S1rttleKgroond HQdW�� .' �.
•..
22. Dycts?Ve$`tilat}ng� �'��'�.r.�..^'.� �r' - ' 71. P�qd�ctPipin9Q6as QOi) i
23. Gas Pipe�f3'ougli & Test �� •3��' .�.> � � �. • - � t ' 7,2. d7ntlergroUnA Flnsfi ' �-+' +.
24. Rqof `Frahting ' 7 � - � _� £ ^ � � � � = � `1�3. ,�1r�dejgP{�d. S[oray0 Tank;G�G�s C�10i1
^ '� F a. y✓ J-� •• �
25. Roof�:Sheafhin9 ,5 i� 'r ^ �1�*t = . ..' � � '7 74. Overha3d:k�lydto � �
� _ t
26. FBar•Ceiling �Struct5ralf •& fV�onoc,oai � "' � _ �? ?5. i�r� Chnmical ' _ �� ,
27. Frame anciFlazhing ; Z � ' � �� � _ ` � ° � �' _
_ S•�� = R' l&. Dry Standpipe �� �, �..
28. Ldihing �idiPg ^' i Q S � ? r_ ' ' _ _ � � '_ ••� 77, Ff,XEO.�SYSTEM FIRIAL '� F .,,,, - �
S! 1.+:= : ` : - T;R • '
29. Insulatiorij �. .�.t v:, • �-•u: : �� v � S �' I 78. FIRE PREV. FINAL ' 'T. � = •
30. Drywall Pfailin"g' ^� i -' ''� : -"' `= � ' . I (4 �� HEAITI-GREPT. FFEQUfREMENT `, ''
�31. Plaster Brown Eoati �' 1'. � - ��' ��r 7�. FINFtL�NSPECTIpN x . �
_ i% Y _ . .
: 32. E'tectriwl PowO'r Met���FinaP � r -' 80. PUOD�SERTIFICATE IS�QED �_ ��^ �
s�. -.r T~�.KT) � r . -, •�/
�33. Final;�leuric . � � .� S . � ; Notes: ///�/Q$ � :�a `�G`K+�'"'` �v,
, . . - .�� ` . �
c 34. Finah}leating & Air Gonditioning _. a: � ? t � i � 5 2 ' � '"
, . , 1 � R%8�'�!�^" ��s - Gati%. //�
� � 'l � ' . � � ! J
� 35. �na('Gas i e°festt r�r •. Sm. �7`' ' � "�=
,i. � P .j � �r, - .�, � i i �t: - r a �_ _
� 36. Hoodwr CgnoPY �• _ v _ t � It - ,Y 'i n � - -
�
�37. F;nal�actqry FireP`aCeq . � '' f I- r i _
�38. Final�Plumbing = i� - � T -, - - - -`. � � �f = -
�� -
= 39. Water^Ser��ce-Finalz �' '-'� J J ' � '' � � '` ' - - c -
n ��76 ����= , 1 -�: - .q.r r � t �ai ��_
=40. Gas Serviqe-Final � � .�•;, .. .. � . ' - - k at , � �� � �, t� , �. _
, 1 r � 1 i C �
-41. $olar pomestie=final f �; � - � ��r� � =y r �� � ti v y 1�� � r ' -
42. B�cktlow�Preventer: � : '' ' ' ' 1 - � t. ? �_ . i - '-
Y. � ^-� a C
-43. BOckflow Irrigation ' ; �i ~ ^ = R . ; •y � •� ' .
4
4p. Landscape� Irri,qation System7 ' U • •• � � • ` '7 '- � �; __ -' � � � ,, '��
45. Sdund Attenu2tion '• T _ `t�r ^ u `. � '� j ° � - :j: �`� _:°' "�
,r- ` ��
48. }�dndicap7iegufationi - .. .. .. •�n:,. � r � i :; : S . �-� � - � �,
.r -
47. F.�NAt STRUCTURE & BUI�DING � ' •' " ,
� . � � ,
48. F�NAL PLANNING ` .. . � � . I �k �. -
� � c
49. Electr�ic Release to Edison - • * '' s� '• ' -
� ; �i : . �
50., Gas tielease to Southem California Gas Co .. � .- _� •� �
5i. CERTIPICATE OF OCCUPANCY t w: *= '� •
No, Date
, .... ..-. , . . . . . , � � .:`; , � . .��..J �.. _.r... .... .ro�.+..w . .� ^ �r . � .
�� ��it�� o �o�ta 7Y� e�a
r �
■ . 2'
. Developinent Services, Division of Building and Safety
CERTIFICATE OF OCCUPANCY
V ���.�� �
This cerrificate is issued pursuant to the°requirements of�the�Uniform Building Code, Section 308
adopted by the City of Costa Mesa cerafies`that:at the hme of-its fssuance the building structure herein
,�„ � . _ � ,�. .
below described was inspected andrapprovedifoi:occu'pancy;as.follows:�
Building Address 767 W. 19thG;
�i
�,� �,
Use L,finn sq ft T��I�'�� i
�: v �'
1 `''.
Group B Type�of Con
�t/ n
Owner of Building' nr: ri�i i tA:;i
;� �, � = ;r;
� � �v}
Address 7�7 W �Qth CY-YPPr�`
: ` ���j
suu.��rrc oFeic�.=itonp ��It
ACTING BUILDING OFFICItiL��
� % �
REQUIRED TO BE
- �.- � \
1,: ✓� � _ � r i ;�� �%,�
__—� -- � � � rr„ �� . �.
�;)'���.,1 c_ :
V–N Fire�Zone'���.�" '
o� •rc_ r._,^4"�02 'i2.'r. � . ,
� /n: - �':; , t,
��-- 1�, � �
Permit No. B81919
Use Zone C1
. . � , u ,((� Y
n;y _�: �. "-^Dafe ��``nr�/PT t , ta9
4= w-'�" x: ``t%'' � \�.`) 2'/,
� _ _..,���A �U��.
�' �
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:i ="�
['ED'IN-A CONSPICOUS PLACE
;:;
woxess aF euinua 7 6 7 W] 9 T H $'� •. u�T: .Jl�Q'
am�aswaeir�cDEt CILLIAN�I lb�— /
. ; wo�ss: 767 W "19TH ST
OSTA MESA, CA 92627 (714)541-5258
�vv�. wnmo �om�ss
�xexrrenonaux¢mSTEVE .BRENNAN ucw_ 307397
/JICN.Ofl FHO.'9 WUNE53: Z 1 6 S Z AB ED UL ur�r:
MISSION VIEJO CA 92691
cor+m�crarswu¢ STEVE BRENNAN CONSTR ( 714 ) 859-0703
�a„p„�,�,,,,,� 216 5 2 AB ED UL
��MISSION VZEJO CA ��; 307397
92691 �M;
LICENSED COMN�GTONS DECLAR�TION: I herab/ ellim uider pmWy d pm�W IM 1 am Icamad urder pwi�bne d/C�Mpx 9
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OWNEN BUILDEN DECWI�TON: I Iweby dNm wMer pero�y d pr'Fvy �� I em ammp hom �M Cmlredon lioeroe Lew lor IM
Idbwiq rmwn (u`eubn )W t S Bwi�w md Rvtaviorn Code: MY Uy a oowiy whidi �oWiAe e permn to oorroWct. Ner. impwa.
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>031.5 b/ eiry apWkeN ta e permd aApna the appfrwn lo a rni penetly d n4 man ihmi fva MiMM EOGen �SSW�.
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Otle: �VO�:
WOPKER'9 COYVENS�TON OKWIAItON: 1 Mr�by elfmm u�dr pruby d perpvy ar d tM Idbwinp detlereliw:
� I luw ad MI meinian s cMiliWa d mwnt lo wprmun b rMeri ov�p�mnion. n prd'k�d la by 9a4ion 9100 d tM labor
Code. la tM pMartwc� d tM wwk tor which tlu� pamu u mu�d.
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MdklawtiiNNbpemYbowA.Mywv ST�TE FIiND "d°��'«��. EXPTRES
r �mn., - 07/O1/97
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9�ctlon ])O6 al N� LWor Ca6. InlruL erM �ttumn+� fw.
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LENOEfl'S AODNE99:
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1pfunpetlq"0"'D°'°'STEVE BRENNAN
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(515tJ6.WP)
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CITY OF COSTA MESA.— BUILDING PERMIT \
_ -_ _ PERM NO; B U81917
PERMIT NO: H 081919 pLAN CHECK NO: 00489-97 A GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION : 1500 SQ FT OFFICE T.I, SQ FT:= 1,500
CLAIM VALU£: 13,000.00 CALC—VALUE: 18,900.00 GROUP OCC: H /
COMMENTS: "DR CILLIANI" OFFICE T.I.
**�t*�***�r�*x***�t*�****�x�x��t�t***x�**x*�t�t**�rx�t*�t�t�r+tw****���+��t*�t**�tx��t**��r�rx��t*r�+t�r�*�t*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARRING REQ• 24 PROV: 30 PARCEL: 42420105 ZNE: C1 REF NO:
PLANNING NdTES> INTERIOR ALTERATIONS FOR NEW DOCTORS OFFICES(TOTAL MED.=3340
> SF+9qOSF OFFICE).
16lf IE fE 7f� 161E 1E IE 1f IF IE iE if iF iE 1E 1E 1ElElF 1E IE 1h IE K iF iF 1I' 1f iE 1(� if IF iF IF k iE 1! IE 1f If 7f iF if IF if if if 1E 1f 1E fF iE if iF 1E IE iE If IE iE iE iE if IE 1F IE fE iE iF if if if iE 1f IE iE i(�
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S
ZONZNG APPROVED BY �L�Vv�[te/+t l'�l��a ( t DATE: �Z
BUILDING APPROVED BY : SC'�� DATE: 3(s�97
APPLICATIOtV ISSUED BY: DATE: 3. �
iFlEifif1E1f1f1E181fiEiEiFlfiFlEkiElflflfik 7k1k7E1F1FMiflkiEif 1FiE
LEGALIZATION:N F E E S U M R Y STRUCTUAAL SEGMENT:Y
� J� ✓ / �
HLDG PMT PLUMHING ELECTRIC��MECHANIC ":'-FIRE SMIP/RES GRADING
PERMIT 274.75 , . .
PLAN 44 .65 �., . ' -_; : � % i - SMIP3N97-RES
ISSUE FEE /.. /, ' ' r �� !;
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK .� '�TOTAL� PAID DUE
TOTALS----> 278.72 0.00 � ,;44.65 ' ,f �J23':37•-, 323.37 ,00
. IJ i ..� � - i
REVENUE DIVISION TOTALS--> COLLECTED: ' 2,78.72 -OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC �FIAE SMIP/TOT GRADING PLAN-CHECK
2�4 . �S , ,."�. -) �, �- - 3. y�
/
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I N D I V I D U A L, F: E E' �B r�R/E A K.. D O W N
TYPE QTY D E S C R I P T I O N l � . ��- �fJNIT COST. TOTAL COS'f
• '� � �i ..� .' � t:'y. ,� ' � .
SFC 1500 OFF-INT. ALTER TYPE V=Ni -AVER �' %l�f:.88 ' ,'.� 1��7 20.00
SFC 1500 EQU-ALT COMM. AIR COND.� •;AVER ' �• .'I2 a1�Q80.00
•iEND OF FEES � � � � ��)
I.
� � ''• , � MaR 0 51997 �.,
The wo►k authorized by this permit shall ' �� ' ''
�DN wiM ell applicable handicap '., �- CI'fY; UE COSU1 NIES�
access requtrements under CelNomia �� �
statutes end related repulations. , � � }- ,
(ord. No. az-�a, § 1, ?2-zt-s2) . , ..
� �CONSTRUCTION AND PLANNING . . P�4 SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
�� �': Temporary Electrical Service or Po�e 52. Pool & Equipment Location .�
y, Soil Pipe•Undrgrnd 53. Steel Reinforcemeoc
�
�3. ElectricalCorxluit-Utility•Undrgrnd.- 54. Forms
' 4. Electrical �ondpiP-Undrgrnd. . 55. Electricai Bonding - .
5, yteel Reinforce�nen��, 56. Rough Plumbing & Pressure Teti ,-
'� B. Electrica� t7FE�.i'Grr?d. � 57. APPROVAL TO COVER•GUNITE T
7. Footings"= " ' � 58. E�ectrical Conduit•Undrgrnd. ��
8. Foundation 1 59. Gas Pipe, O Uerdvgmd„ Test
-...�� r .
9. Water Pipe-Undrgrnd.�, 60. Backwash Lineb; P-Trap, O Undrgrnd. '
10. Structural FloorSysrem 61. APPROVAL TO DECK '
17, pr'operty SewEr line.& House Connettion 62. Backwash & Receptor•Finai
12. 5ewer Cap � � ' 63. Heater & Vent•Final
13. Roof Drains __ � 64. Plumbing System - Final
14, fiough Plumtiing 65. Electrical-Final
15. Rough Electrical�-Conduit T 66. Solar System-Final I -
76. Rough EjectricWiring . 67. Fencing & Access ApP�oval
_ 17, pough Wirinq 5�gn � 68. APPROVED F'�R'PLASTER WG
T$, pough Electrical�T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL
79, pou�h Heating & A�r Conditioning .r -^ cy FIRE DEPT._REQUIREMENT .
20.-:PoughF,acto�yF�eplace __ �K ;;; = = r.'� _ APPROVAL�� Permit# " ��
I 21.�-E)uets, i�StruCtufei �• �• - !'* _ 70. Underground F�ydro Y
22.-0ucis. Venti ting A "� " ^ _ `:} ' .
(,'d, .�s, ,� �- e; ;-.> ; 77. Produe(-Piping�C�Gas OOiI F"' o n^� O
23. Gas�Pipa-Ro�h & Test _ - � � � � ,` �_ � � 7p, Undergrou�d Flush ' - '_'_ > o; � 2, �
I 24. Roo-f Fr8'ming __ "- T l '
x' � � '..:. ' 73. Undergrnd. Sto`rAyeTan�C O Gas Obil �� o�a `
_ c
25. floof� Shs-dthing " - •= , x � � - - �., e 7y -0verhead Hydia � � �
_ c � t; � v
26.:T-B�r Ceilin9 45tru�turaq &fAortflcoai =� � � ' - 76� Dry:Chwnical � � - " - - � a = � �'
27,�reme and Flashiog. _-�c . x_^� c,� 76. Dry Stai�itpipQ�T v c�i ��i, •
28. Latfiing� Siain�' � c: --� x : : � • r z, . . . s ' ✓ - -: -, � �� � .
� r � 77.. FIXED:.S�'STE�)�(F�FINA.L,.. _ c �: �.
29. Insuiation �� G* ` �� ' 78. FIRE PREV. FIIB'AL � - �" �� : � `'
s
� 30. Drywa1l,.Nailing �K � " w F � "- �� � -HEAL'�H DEf�xT�REQUIReMENT « :;� c
37. Plaster 8rowp Coat� = .� i= „� • .I � - 79. FINALftNSPECi�ION .. - - ''_ � �
32.:Electric5l,Po�Ner hle�erF.inal �' _ ' ", � �" $¢ FOOD CERTIFICATE rSSUED �_.`
. , , Y i � � /
- 33.=final E�ectric ���. � c �: •- � ' � �� �l Notes: 3//-S`�J,��/,� � o� ��7
34. Fin3f Heatin�'& Air�Coriditionrag= "' •� _ � �� ,�:� ��„� �G�� i`�%/%�
.- L. T " . I
35.�Final GaS.Pipe•Tes[, ..� f ..� . , ,�/ ^� � W, � m
` y�C_Cois,s...s�
36 _HOod Or Canopy *= � r- s c x^ i' r � '
< i� a:`- x _ + r: _' I L(r_ �„ r
� � � � /
37.'FinalFactory FireRlace� � �-; = _ - � ' - , ���p7 LlU 5..�/� i��2�:�/
' 38._Fina{� Plumb'mg M �_ _ - K '. _. . ' ,z � 3 �f y7 �Or � X � � �
- x ¢ x / � �i�TiC_Y.G� ` �<� �I% /
39. Water Service-Final,, � . � . e Y � /x �� � / � ' , -�
v��.- .
40.�Gas Service-F�nal . = �-. " ; '*' "' , Z iG� /'� ,/ � / /
. `-' , � • �Y/97 -.�-c�-=Ca�sw(��/' w�.�r ��r.�
4L'Solarpomesue-Final � _ . - � ?;' /J � �.'� �` y
- _ /��� K »t/_���,..��"✓���
42. �ackflow Preventer� ^ • ' � " � ^
+ - tT'
43. Backflow Irr�gation�. �,-"" �� • � } � � r - � • "
t- .r . ��
••44. Landscape Itripatiop Systerr+_ "" � r - t "" � '- '-" ' `- s: c, " � �` '' _ ' _
.�' - r� - a' �r - - - r-
=45:$ound Atte(�uatiorL' -... � � `. -� F r = . • -�C �Z
46. Hand'+caPRegulations �T_ " , �' T = ; � -- y - �
_47.=�FIN#�L STRt7CTURE & BUItDiNG ^ ��f/ �-!, ' '- _ � ' ' ''
l - n "' rvm
:�
48._fINAL PLANNING i^%- '= �' � '� �' -' ` �' _ �"
. � - �. -
A9.�EtecPtic Release to Edison G F •� • � � -R
50: �as Release to Southern Califorrria Gas Cv .f � � . '- " - �" _ _
51. CERTIFICATEOF!OCCUPANCY - ` ' •� • - ' " -
No Date
�
�
�
AooxEssaeu�m+u: 767 W 19TH ST
uamexsxwe�ciwan+:DR CILLIA�3I ^
^ .m�ss:7'67 W' 19TH ST
• COSTA MESA, CA 92627
�vx. Wmwo �oo�ss:
1PCNRECI OR FIIm1ffA:
ar+rn�crarsx.�STEVE HRENNAN CONSTR
cor+m�,cmxs�21652 ABEDUL
uooxEs4MTSSION VIEJO CA
92691
L1CQl4ED CONfN�CTORS OECL�fl�iION: I M'eby elfim uMr prWy d pa'jury
(cammawsq wGh Section )OW) W Divcion 3 W tln Bu�nee erd Vmfx�oru
CT' 11C. NO.: G� 11Q CIA39: B 11C. NO.: %
Dete: � '� � — / � Coweda:
OWNER BUILDEN OECLAfl1TON: I lwoby el�um �vWx prulY d Mrjvy Ihel l wa
Idbrnp rasam ISetlian lWt.5 Buiwn end Pralwaiau Code: MyW a mun�Y
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convecb 1« wN qqede wnh a mMredorp) licenasd punuw �o tM Comrsaon Lkan� law�.
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WOPKEP'S COYPENSATON DECLAR�TON: I MreEy elfmn wtla prully d parjury ww d the fa0ow'vq detlwiom:
� IAmeMWmei�vviecML'rabdm�mNloeaOtiwmbrwvkan'canVMWon.nYwidadfaMSWan3A0W�Mlabar
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wuk la WJN N'v P�e ia mueE. MY wvlse' bn imuronee urtier ud VdKY mlmEv en:
c�« ST�TE FUND EXPIRES
r� N�,n,, — 0 7/ O 1/ 9 7
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mmpe�Wbn pa'viom d Satlion 9100 W �M leEu Code, I 1 � c nD r w� pwiepv.
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psAwmanro d tM xak br Mutli thu pami u ewW (�� �. Cw. CI.
LENOER'S NMIE
LENDEN'9 �DOflE59:
I ceiby t1W I hm mtlOro eppliutian md nme Ntl IM abw� Wwmelian u canw. I eyN to mniply w4h e0 my rd mumy advurcw
and eme lew� nW ip to bnNiq eonmwim vd Mreb/ euM'¢� rapwnimM1m d IM dry b rqs upan �M aEwsmeMiwrod popem/
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(5151J6.WP) Whna-BuiNvq 8 Sa1W: areamFb: Cuwy-Appiranl: Pink-Rewnw:0okenrod-Aew�wr
CITY OF COSTA MESA — HUILDING PEkMI'C
PERMIT NO: B 081505 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR
PERM NO; B UU1S0'i
GOVT: N SUPP: N
PURPOSE: UEM
JOB DESCRIPTION : DEMO IN PREP FOR T.I./ PL CK 469-97A SQ FT:
CLAIM VALUE: 500.00 CALC—VALUE: 1,000.00 GROUP OCC: H /
COMMENTS: "DR CILLIANI" OFFICE /
*x�at�t**�*at*atet*at***�*�t*itetx�itat*it*itat*atat�t**�rat*+eat*�t-*itit***it**atat�***jt**at�e�*at�t*�t*********
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: F1' IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: F1' IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ: PAOV: PARCF.L; 42420105 ZNE; REF NO:
PLANNING NOTES>
i
'lE �E fE ik 1E �E IE 1E �E �F fF if iE iE iE iE iE 1E �E 7t iE Ik iE iE iE iE 3f iF 1E aF 1E iE'lE 1E IE if iE 1F fF 1E 1E iE 1k 1E fE iE fElElf iF 1FlE Ih 1f� iE IE 1E iElElElElE fE iE �E ik 1f �k iE iE fE iE fE'IE ik iE IE iE fE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N'T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE: � y�� / 7
ik �k if iE iElk if 1E iE iF 1E if iklE 1E 1E 1f 1E 1k 1ElklE 1E 1E 1E 1E IE 1E iE iE if �E��{FIE IE
LEGALIZATION:N F E E S U M M A R Y STRUCTORAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 34,75
SSUE FEE
UILDING—DIV—> PERMIT ISSUE PLAN—CHECK
OTALS----> 35.25 0,00 0.00
EVENOE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLOMBING ELECTRIC MECHANIC
34.75
SMIP/NON—RES
.50
TOTAL PAID DUE
35.25 35.25 .00
35.25 OVER/SHORT: ,00
FIRE SMIP/TOT GRADING PLAN—CHECK
.50
iE iFlE iF 1E 1f 1f 1E Ik 1f if i! IElE 1k 1E iE iF ik 1! 1t ik iF 1k iFlE if if ik 1k iE fF 1f ik iE k!f 1E 1f 1! ik ik 1E 1f !k it 1k �E 1Elf k fF 1E 1f 1f IF fk 1E 1E 1F Ik 1E iE fE 1E IF 1E 1E 1k ik ik iE iE iE 1E if IE 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
BQ-86-1997/83:47 DM/f35.25
RCPT1:01-8001728
PERMIT:981505
� GONSTRUCTION AND PLANNING � P00 SPA -
APPROVALS �Permit # Date Inspector� APPROVALS Permit # Date Inspector
. 5. Temporary_Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement �
'3. Electrical Conduit Utitity�Undrgrnd. 54. Forms �,
4. Electrical Conduif�Undrgrnd. . 55. E�ettrical Bonding •
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
' 6. Electrical UfER Grnd. � 57. APPROVAL TO COVEfi�GUNITE. .
7. Footings �� 58. Electrical ConduirUndrgmd. F
., 8. Foundation 59. Gas Pipe, O Undrgmd., Test � '
9. lNatet Pipe-Undrgrnd. ' � 60. Backwash Lines, P•Trap, [a Updrg�nd.
10. Structural Floor Svstem � 61. APPROVAL TO DECK �� �
71. PropertY Sewer Line & House Connection ' 62. Backwash & Receptor-Final �
72. Sewer Cap - � 63. Heater & Vent•Pinal -'
13. Roof Drains ' 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough ElectricabConduit 66. Solar System-Final
16. ftough Electric Wiring � � 67. Fencing & Access ApProval �
17. Rough Wiring Sign � - 68. APPROVED FOR PLASTER NG
�
� 18. Rough Electricai�T Bar Geiling 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
22. Ducts, Ventilating .,• ., � 71, Product'Piping OGas ❑Oil
23. Gas Pipe-Rough & Test , � ' 72. Underground Elush-
24. Roof Framing - ' 73. Undergrnd.StorageTank �Gas ❑Oii
25. Roof Sheathing � • _ 74.-Overhead Hyd�o ,
26. T-Bar Ceiling (Structurall & Monocoat . . 75... Dry Chemical � -
27. Frame and Flashing . � � - 76. Dry Staodpipe'- '
28. Lathing & Sidinq , -i - � 7�. FIXED SYSTEM fINAL� -
29. insulation � ' 7S. FIRE PREV. FINAL �
30. Drywall Nailing . . -- HEALTH DEPT. REQUIREMENT
37. Plas.er Brown Coai •' 79. FINALlNSPECTION ` -
32. Electrical Power Meter-Final 80. FOOD CEiiTIFICATE ISSUED
33. Final Eiectric ' 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 pomestiaFinal � �
42. Backflow Preventer � '
43. Backflow Irrigation -
44. Landscape Irrigation Sysiem- ' . . - - - .
45. �Sound Attenuation . . � � �, � : � .
46. Handicaa Regulations / _ �� � -
47. FINAL STRUCTURE & BUILDING /�//�y I
[ (6 / �� ` -
48. FINAL PLANNING ��
49. Electric Reiease to Edison � � �
50. Gas Release to Soutfiern Califomia Gas Co _ ,
51. CERTtFICATEOF'OCCUPANCY � '° - -�'
No. Date
-i,.�bnFSsaewioma ']67 W 19TH ST °�° -��
�- pW�RSW}YEIFRlW/k R CILLIANI � ' �0/�'(�
��Eu �67' W 19TH ST
O5TA MESA, CA 92627 (714)541-5258
.no�. Y�nua �woa[ss
r�
uwwrr�on�+anvn: STEVE BRENNAN
uuxanoas�uox�ss:21652 ABEDUL
MISSION VIEJO
�crarsru�:STEVE BAENNAN CONSTR
cwm�croxs��amo 21652 AHEDUL
�oo�sxMISSION VIEJO
92691
11CagED COMflACTON9 OECUAATION: I Mreby eflim wMer pnNy d q
(od�me�q wilh Saclian ]OOOId Oirobn 3 Mthe B�o'viev end P�
p�(Y LIC. NO.: („ (� 1�1G CLASS: B UC. NO 1
�`w ,.. � r
Da�e: � — J '� Coraxfa: I
pWNEP BUILUEN DECLAN�TION: I Iweby dfirm utlx pene�y G per'�.vy Ihd
�•� 307397
uxr:
CA 92691
(714)859-0703
CA ucra_ 307397
uxr:
pd my yomx�'n�in I(pp� d heqa� 9
j%$� EXP ; G��
v
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e ymmnd punuent to �M pwioma al Ihe GoNraCa� lioeroe lnw �Cheqm f
Bum�e uk Aoleeaiom Codel v �het M n eM M womq IArehan eM tM d
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a a'.�a ro. a. cs.ao� rou. e�,�... �e wa..�, coe.: me cav�
.n,o ww « mo�. mamn..�e.no me..w�.,a+� mn.,e «nmae� �
impwemanm era na imenEed n ollered ia eeb. M. Aows.er.IM Cuild'i�q o
om �M Cpqestlm lioeius lew la Ne
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lo fJs e uyeE petmwu UW he p�M
wnn s.a�an �ooq a u+oon a a n.
p.e eKempon. ,4n �idmu� a 9eacn
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w�TAo tl�exo�k.etk
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� I. n oMrw d iM YWmY. am ud�'M' mmrorinY wiN GwmaE camMon m mmtruG tlr pcla (9wion mM: &s'am� md
Prafanion� CoCe: TM CauMon Li.anro Ler Eoa na'mdY b en onv d P�^V^�Y who bdlb a 6npe+u iha�on mM Mu
wMmcb la arh p4�+ weh e mm�acMq 6�wiwG P�uutl to IM Canrem+L4wn�e Lewl,
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Dde: � Owns:
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I M��`/ cenM Hut 1 em awve d md wdrsivk iM �Wu�w d Cellmie MeeM mM Se1MY Cada Setlbm Y5505.25533. vtl
25SM11. enE IMI I a enY Mun Mukvq oauWen� will / wA rw� (arc4 ane) need io camPN wIh veid me�e mtlm enE �Ae nWiremaN� br
.oen!q�mm�.inKtid,«madSre�ionrmn�ne�.�wS�iv "vw�Maniirl.n.dCeniNmmivaionaw��we...Kampemnm«.
p��.
DWa: �00«
WONKEN'9 CONPEN9ATION DECL�R�TION: I Iweby elfirm uMer penMy d pw�W or� d tM IdbvArp Mtiveuro:
� Ihc+eeMwdmeia�ecaMr�ModsrviowtlswmbrwY+kes'oom�+Yion.nVa�laMS�mon9'lOOd�Mlebor
Gods. la tlr pNamm�ca tl Ae wM la w1irA Nu pemW u inued.
'_ Ci I M1m aM xil meinian woM1ms' aomro��un invrtenro. m nWued M Swion 7/W d Ne lebor COM. br iM V��^^�� d iM
��•� wak la whici� Nb O�G e u�ueE. MY warMen' oomP�+vbn imurenu fertix en! W�Y wmbx ers:
c�« STATE FUND EXPIRES
v�. ra,me., — 0 7/ O 1/ 9 7
(�pb saakn naee m M mnpMd / w a�l 'e Mr an �wrwee dNwn �Sirol a Iro.1 .
� 1 mn�y Net (n Ns pMmmrce d iM waF M Mikh tAe permn b Inuad. I Md nol �mpby urv parsn N em/ mwr �o n lo
e�m�ro wW.e to tM xvks�' mmGn�� �+ a C�IluNe. en �yr t tl ouk Exair aibjW to IM waM�'
co�mpanmion pw'vomC ya -e�aaion a100 d �M lebor COEe. o�vit o ou piwbiom.
DAe: \,'-� " / / �YW'am:
w�mmv: auW. ro.«�n. wonr...'rnnw�+tlorr cw«+w . unre+�nn..�,a rn.�eiK�.� Mw�oy. ro ax.�w c�mo.na
qyt� Nrs �q a ar MiMrM tMuuM CWIw (S1u4�A b bfitlon ro tM cwl ol mnpru�UoR demqpr o prorMW ror In
9Ftlm �)OB o/ IM l�0or Code. IN1ru4 ���m�l'� �
ca+srnucnoN �ErwNu �oerxr: i ns�.ev mnm, �a., vn.ro a�,y iw m.� :. oawNao� �c au�v ro� me
pAormenm d tM xmk fa xhidi R� pem�i h ewed (�� �l. CH. CI.
IENDEA'8 NMIE
LENDEP'S MONES4:
� CM�F/ I�Id � hFB 1lGQ �Iq W�ILG�1q1 YM� YN! ��1lI I�MlbOVO YdM11BilOfl i CORtl1. � pIM 10 WI��/ W1�1 GD M/BlIQ OJ1W% M�IIWICO�
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�°'�°"�"°�"°�`"''� RENNAN
J
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Dme:� ^� �
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CITY OF COSTA MESA - BUILDING PERMIT p£RM NO: E 081920
PERMIT NO: E 081920 PLAN CHECK NO: N GOVT: N SUPP: N
�CONSTRUCTION TYPE; V-N PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCRIPTION ; 1500 SQ FT OFFICE TI(ELECTRZCAL PERMIT) SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: B /
COMMENTS: "DR CILLIANI" OFFICE T,I. / RE; 881919
*�rx��rx �**r��r�r*x�*�**�r�r*+r*x�********x�x�x �r�r**�e*�*x�*x **��*�r�r*�r�r�rx��r�*���r�r�rr��***��r�r**
Z O N I N G R E Q U I R E M E N T S
S E T B A C 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: 42420105 2NE: REF NO;
PLANNIPIG 13<5'PES>
i
iE Ik 1t M 1k 1h if if iF 1F fE 1f k k 1E if 1k iE �f' 1E 1(� Ik iE fE 1F iE 1f ik if if i41F 1E ik iF IE if iF if 1E I(� iE if iE 7E ik iE 1E iE 1E 1k if iE fF 1F 1E 1f IE fE fE 1F 1EiE iE Ik M IE 1E 1k 7E iF fh k IE ik k Ik iE IF
D E V E L O P M E N T S-E:R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY %• DATE:
BUILDING APPROVED BY : - DATE:
APpLICATION ISSUED BY: DATE; ����
iflflfifiFlFiFif1E1f1i1f1E7E1E1k1f1Fifi[�M1E iEi('1FKiFIfifIFlEih liif
LEGALIZATION:N F E�E� S U II M R Y STRUCTURAL SEGMENT:N
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 12.00
SOY SMIP/NON-RES
PLAN
ISSUE FEE 22.00
HUILDING-DIV-> PERMIT ISSUE PLAN-CAECK TOTAL PAID DUE
TOTALS----> 12.00 22,00 . 0.00 34.00 34.00 .00
REVENUE DZVISION TOTALS--> COLLECTED: 34.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GIZADING PLAN-CHECK
34.00
I iE if iE If IE M!f k fE iE IR 1f if fE 1E if 1E 1f fk 1f 1f 1E IE IE M iE If M fF IE 1( if 1f if if 1f 1F 1E 1f If 1E 1f 1f M iF 1f 1E 1k IE 1f M fF 1f 1f 1E 1E 7E IE 1f 1F fF 1F 1E if 1F iE K if 1E IE 1E if iE 1F 1F fh iF 1E if
I N D I V I D U A L F E E B R E A K D O W N
TYPE __.QTY D E S C R I P T I O N
ELE 8 RECEPT/OUTLET 1 ST 20
ELE 4 RECEPT/SWITCH 1 ST 20
END OF FEES
The work euthorized by this perm(t shgll '
�omP�Y w�fh all eppltcable hendipap
eccess requlremenffi under CelNomta
effitutes and releted reguletions. �
(Ord. No. 92-28, § 1, 12-21-92)
(5151-�B.WP) Whaa-Buidiq6Sale�Y:Oew�Fb:CenuY-AVG�eM:Rnk�ww:OdEenmA-MAnar � i
UNIT COST TOTAL COST
EA. 1.00 8,00
EA. ].,0 4.00
p �, �'�'
MAR Q,5 T�37 �
ClTr ;�, �� ;;/I ,�IESA
� CONSTRUCTION ANOPLANNING P��' 'PA
-4� ' Date Inspecior Date Inspectbr
I 'APRROVALS Permit # . APPROVALS Permit #
1. Temporary Elec[rical Service or Pole 52. Pool & Equipment Location .
2. Soil Pipe�Undrgrnd. 53. Steel Fieinforcement ��
.-•� Electriwl-Ceixlvirlltiliry-Undrgmd. 54. Forms �
�� '� Electrica�Co}1dw��tl�rgrnd. 55. Electrical Bonding ' _ -
->� 5.� Stcel Reinfa�Eerqrery� 56. Rough Plumbing & Pressure Test --
-.'6:, Electrica'£9�FEQ:�in2i. � 57. APPROVAL TO COVER�GUN�TE _
�7. Footings'y��;����: ` 58. Electrical CondiiiFUndrgrnd. '
�, $. Foundation y �- 59. Gas Pipe, � Und�rnd., Test '
r:
9. Waier Pipe�Unda�'rnd.;;, . � � 6p. Backwash Li�es.; P�Trap, � Undrgrnd.
70- Stfvctural Fioo'r�System 61. APPROVAt TO F7ECK
� �. Property Sewer Une_& House•Connection
� 62. Backwash & Receptor-Finai
12. Sewer Cap ' . 63. Heater & Veni�Final .
13. Roof Orains �,,,, � 64. Plumbing SYstem - Final
14. Aough Plumtu`ng. �- 65. Electrical�Final
15. Rough Etectrical�Conduit ' 66. Solar System-Fjnal
96. Rough Electric?Niriry'q � -��a( 9 67. Fencing & Access�Approval
. 17. Rough Wiring Sign , ` ' 68. APPROVED FE-1R'PLASTERING
, 18. Rough Electric@YT Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Aik Conditioning T` v c^ FIRE��PT,,jiEQU1REMENT rn
20.�3oughFa,ho�(�FtcE�lace �._ �Q: � 5;, Pc�. APPB'OV4R�'y.'�,�.C., Peimit#" ^
21.Oucts,in.StrffPtu�'E'r •• •• =+�. '+' S �� ���'" 70.;Unde�reund Fjydro '�
r.� �'�-. x
22.Ducts.Venticin �� -� � T ¢,r. � m.� .�
. l� 4i;,; ':., :.. C ,. 77. Produc,t;Piping CGas OOiI F, �
,�-,
23. Gas�R�pe�-Flo�h & Test _ , r C J r 7p. Undergreund Fu"sh � - o E � n
e � �- -
^ � 1. � F^ � ...-. Y � O � 4 S 1 --1 v Q�' � �' -
24.`Roof-Fr3min9 ;�x ��� �, �; ,,,q. , 73. Undergriid.Stcxa�eTankOGas CfOil .c � � �:.;
25. Rooi-.Sh�thing ^ x ,i ��. r x �^' � ^ x� 7A'. Overhead HVdr�o„ M[ p��
r�- - �� =a -a'.
26�;T-Bar�Ceiling (StruF[�ral� &�RAtS'np�oat k - � `- n'' �. Dry Chamical ,_.= , ' - .� r. �,
.
y7. Frame and Flashir3g':: =� c r.- ;w r�� 76. Dry StatRipipe�� * y �T'-: � o � m`
� 28. Latliing� Siding -� ,.. �� = s x* � . ..� 7L FIXED;$�STEM'•FINAYI.� ^ ^ _ � ' � � v
�
29. Insulation q� " <_'u� �� .. � '= 7$. PIRE PREV. FIRIRL " - " - � " � c n
� .. .... �w . _ -. .-. , � _ � .. _ _ ,
' 30. Drywa11,4Jailing 'i �: � .;`. F, � i ��� � NHEALFA OEPT'REI1UIqEMENT � s� �
�. 31. Plaster 8row�rCoatx � rT * � � µ� 79. FINAL�tVSPECEtON x � �
`. 32._Elecvica�Po�r NfE{;er�F_inal � �" � ` ,� 6�3'. FOOD CERTIFICATE �SSUEQ
: 33. _Fina`l� Electric- � i -� e: 1 Q/ � �� �,_ �' - otes: � ,�_ ; � � ��:/yS ffj,p � r%
i_-�- `
' 34.=inaCHeatin§;& AitCorfditioningS - r � i � � . - �✓ i-a' r --
35.�� r rr - i. � ; � �. � .�
in�l Gas Piqe,•Tesj , ,J, .: �.� �., 1 � ,.�r : � Jxe '7-� r� � r'�
36. f,Hootl or`CanoPY _„ � �-.... c a: � �' p � i. o , •-
rt ... -. T, `. ..1 .r F ?I "_ " rt- ; [*'
37. F.inal.FaCory Fir�(ace;- �� ` v n� � i -;e � _ * - �
� 38. Find�P�t7mbing -? T'� � � � � x _ � � �
Water Se�ice•Final `. �'' , ' "M `
39. � .; ,r , . � ' ' a � T,-
; 40. Gas Service-Finai r• ^� a'- �_ '�Ti i I �•� F 4 e` ; y
� 41. Solar polnestioFiny`i = .., " �; `" ' � - � �
<. � ..�
42.BackflovrPreventer*- a 4 ;� �z' >F � C
_ � r, n r
- r - K� � ., r y :�.
43. Backflow IrrFcjationa --' �; �- :, r � � � ���. �
44. landscaAe I�igacion Svseem�.�. : r. c* = 7 _ ». r' o ^ct � ^ - - � /� �' -
_ - rv �. r- � tj :A " 4' '�. tT' /
•'45.�Sound Atter�ivationr -- - � ;i.'.� ` � 7 ;�` '�� z ' r�, -
r -
_'46.•MandicaP flequlations _ - . . .- � o^ �_ L.. c r ' .
�K l^' Tt , �•
s¢7.=fIN�1� $TRFICTUR"e & BUILDING ` r �-'r� n' S� C� ; r !� '
49.'FINAL PLANNINCr� -. • r"• �°! � r'
_49. ��ecTric Release to Edison • �' 'T " Y
r 'M. :i t
_ i . _ _
.50._Sasf?elease to Southem CalifprniaGasCn x� � �' �- �' _ ' ' - - �,r �
�- � : � _
'51. CERTIFICATEOP-OCCUPANCY n ._ ',= ^ ` - �
No Oate
AOOHESSOFBNI➢WG:_ 7Fj% W _19"I'[{.•ST� , uM: �
mvriercsrw�eivaawn:pR CILLIAidI ' - � �� � � � �
' �nw+�ss 767 W 19TH ST ����
�.
05T MESA,''CA 92627 (714)541-5258
wa�. �,uiwc �nonEu
�xcxrtEclon�+m+�x:STEVE. HRENNAN�_ _ _.__ _.,_ _ uc.no.: 307397 ..
AXCH.ONFNG.'S/iWflE55:�16SZ ABEDUL ��:
MISSION VIEJO CA 92691
caxm�crarswu�:STEVE BRENNAN CONSTR ( 714 ) 859-0703
ca+macroas wuuac 216 5 2 AB ED U L .
�oo�ss:MISSION VIEJO CA ucxo.: 307397
92691 uNr:
IJCENSE� COMflACTONS DECL�NATION: I Mroby eRrm uMx perWy d paijury tlW I em Iicer�eeE undm povidona d Cheptx 9
(ednmemeq r.ilh SeeUan ]000) d Oivisun 3 d Me &ninea eM Pmfeadms Code, aM my Loeeue u in h0 faee aM ,�.�
cmuc\�eo: (�q��uacuss:B uc.No: 07 9 _EXP; �
'cs�
Dem: / Conheam.
OWNEfl BUIIDEP DECIAFATION: I hereby e(firm unear peneYy of perryry thet I em eicempl trom �M Comradon licensa lew la the
Idbxiq remm (�� ]0�1.5 &niiasa vd Pndeaebn%Code: MY c1y a coun�Y �� �Wime e pertnit to mnWd. ellx. imprwa.
Eamdeh. a repei any eWcture: pnor b de eaueMe, abo requirae tha eppliant la wch parmil to fib e sq�wd Memem tlW he ar eM
is licensed Wnuenl to Ihe qonaone d IM Coniraclws Licenee Lew �Cheqx e(oomme�iq wilh Sed'qn )000) d Dveion 3 af iM ,
Busrcv erd Prdmsiona COEej «�hm he or eha u xemq tlwrel�an aiM IM ba�ia far ihe dleped uemption. My violeton d Setlion
)031.5 by enY eGP��I /a e permX wbjeee Ihe eppliceM lo a avd peneAy d ip1 maa Ihen (n•e �unA2E Edlen �i500�.
� 1.avowrerdihapropeM�mY�V�W�a�hwepesmlhe'eedacpnpafuetion.wJldoihevro'Ic.enEiMMrudureumtin�mdeE
� aaflereEbreebl��]Osa.BuaineeeeMPrdesabroCOAe:TMConlreclonlicenselewdoearolapplytoenownerdpropeM
who Wida or inYae+�hereon, enE wlw dma ewJi xak IimmM a ha�ae� a Nraqh he a her own emObi�, po+�dad Ihet auch �
impwemenp ere nol inteMeA a dlxad lor sab. tl, howewr. tM buidi�q a inprwemam e saltl wilhin anY� d camWaiun. �he
� owner-buiNer will heve ihe buNen ot provirp he ar she did nM buik a im0� ��� WT�e d eele�. �
❑ �. e. u.n« a ine wow�r. � e.di�wlv ��reana �.un �i�,.w w�v.nn. ro conmue u» wq� tseaon mu. &�.ire.. ena �,
�
Pmteasiane Cade: TAe Coniredae Lienx Lew Aoea ria epply w en owner W p�apeny wlw Wilds a impwr �hnean ud x1n r�
conlrecta lor euM Drojeqe wnh e conlrador(e) IkanseE W�uan� to ihe ContreMn Limriea lew�. �
� I em axamq uMer Seclim: B. d P.C.. M Ne ieawn: �� •
�; i
. De�e: � �^^r�
� I do M1neb/ cenM thel I am ewme d end uMreteM Ne rtVuiremenb d Gdiomu HeeEh eM Se1MY Cotle Satliam 25505. 255J3. aM
y553.1, enE tliet I w e�ry Mun buiWirq mvpeM will / wil nd (arcb aro) neeA b mmply M� eeid qete mdr eM t!n reQuimneMa M
eparmillarconalructionwmodifim�ionhan�MAi ue-6il.iiiy —arepamam0ie�rie.RaeidemialoonA�uclbnnppicetioneeneRemptlromMeee
yoWaone.
Dem: AOW�
WOFlKEP'3 COYPENSITON OEC WiATION: 1 hereby eifirtn unEer penetty d pajury aw d tha IODoxirp detlerelioro:
� I Mve aM wil mainlan e cenifr�e d cansant io veXinwre M wuken' canpemelian. m pro+ided for by Saeian �]00 al iM leba
Cotle, f« �he pMama�e d tha wwk lor wMch �hie pe�mit is ieaued.
- T7 I hew ard xd meinten xvMsa' mmpemmnn imuruun. m nQu'ved by Safian �100 dthe lab« Cade. br tM pe�lormerce d iM
1� ,.�i«.n�nm�.a�naA.�a.Mr�STATE FUND ���"Um�ue: EXPIRES
c�.:
Pdiry Number. — 0 7� � 1� 9 7
�nis secrmn �.ed rwr o-s mmWe�ed r rne v�x a ro. �e nunered ea�e�s Isiaol w rmv.l
� 1 mrl%y thel in iha peelormeze d iM w«k lor r.Ach Ihie pertnil ia iasued. I ehdl roi emplry eny penm in ury menew w n lo
become wbjail to iha wWsa' canpenxtian �awe d CeNanie. � epree��tt ehw�N beroma w�jea �o IM MaFen'
penwlion pwieiau d Seqbn �]00 d iM LeM Cada. I ahel 11{c�pl� y�t Noea qwiabm.
v ri
o�,: ��� — 9 Z ���: i i/
c
Wem/np: FeNun ro aecun woilrn�'rompNuetlon roverep� l� unWwNl, aIW IWI wbJ�c! en �mployx ro crlMnsl psneltlos and
clvll flMa up ro wre �urWred fMu�+rW EWlen (5100,OOOA In edtlltlon ro M� cwt ol rompawtloR tlemepa u praWtlsA ror In
Sxtlan 9]OS ol N� Lebor Cotls, Intaut, entl attomry'� hu.
CONSTfiUCT10N LENDING AOENCY: I hemby elfiim uMer panely d perjury ihel lhere w a cvna��uaion bMinp epmry br Hro
pan«mvKe a in. woh �or wnim inu ro�t'n es,ee (smiw, ao9], cir. cI.
LENDEN'S NAME:
LENUEN'S ADOHESS:
�o, ��a�w�
�
aiim end ame �nm me mw. m�omimion o wma. �.o� m comWr wiln m� tltr.�e wmn advnence.
oonyvueion erd hereby auiharae repreeentetivae d Ihe tlry ro en�m upon tM ebo.e.meMioneE pmpeny
✓E HRENNAN
o�<:� ^�
WIJta-Buikiq 8 Sefery; GieerFFb: Cewry-Appirant; Pink-Rerenue: Oddeneo�Maemr
-.---- .__ _..CITY O�
PERMIT NO: M 081921
�
COSTA MESA -�_BUILDING PERMTT.
PLAN CHECK NO:
W
PERM NO; M U£51921
GOVT: N SUPP: T1
CONSTRUCTION TYPE; V-N PERMIT TYPE; MEC PURPOSE: OTH
SOH DESCRIPTION : 1500 SQ FT OFFICE TI(MECHANICAL PERMIT) SQ FT:
CLAIM C�ALUE: CALC-VALUE: GROUP OCC: H /
COMMENTS: "DR CILLIANI" OFFICE T,I. / RE: B81919
*�*�*it***�**�r�t*x�t*�t*�r*itx*�t**��t*�t*+�*�t�r�r***�t�t��t�t�t�t*�t**********�r**�tx�t�t�t�t*�**�t**+t�r*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
-------- -- MAIN BUILDING ---------- --------- ACCESSORY B LDING ---------
FRN'f: FT IN REAR: FT IN FRNT: FT IN RE ; FT IN
LEFT:,. FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REp • PROV: PARCEL: 92420105 ZNE: REF NO:�,
PLANNING NC)TES>
�, %
�1E iF ik iE 1E'lf iE IE 1E fE 1E 1E �k 1E 1E IF ik 1E 1E 1f 1E if� 1F 1f 1f 1E k 1(� 1F 1! iE if iE iklE iF �k �E if iE Ik iE 1E 1E 1! 1E 1E �E iE 1E fE iE 1f 1E 1E iE 1E fE iElf 1E if 1f �f 14 �E!(� iE iE 1E k iE 9f if fE if fE Ih iF
D E V E L O P M E N T S E R'V I C E S R E Q U I R E M E N T S �
ZONING APPROVED BY �,= DATE: �-
BUILDING APPROVED BY : � DATE:
APPLICATION ISSUED HY: ��=5 DATE: I
1F1liFiElEiFiflfiEif1E1E1E7EifjEi@If�iEifiE1E lfifiEiEiEiEiEfEiF�Q F'if���
LEGALIZATION:N F E E �S U M M A R STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTR-IC',MECHANIC FIRE SMIP/RES GRADING
PERMIT r,'j 26.00
'� �
� ;,,258 SMIP/NON-RES
PLAN ' • t/�
ISSUE FEE �� � 22,00
BUILDING-DIV-> PERMIT ISSUE PLAN=CHECIC TOTAL PAID DUE
TOTALS----> 26.00 22.00 �� 0.0\0� 48.00 48.00 .00
: V �
REVENUE DIVISION TOTALS--> COLLECTED:!j •� 48,00 OVER/SHORT; 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
��Q:a'.;��
�/ . �/ .
iE 1k iE fE IE Iflk if 1f iF 1f �f If 1f 1f !E iE Ik iE 1E 1E 1E if fE 1E �E 1E IE 1E 1E IE �E 1E 1F �N i! 1F f6�IF �E fE 1E1E iE iE f! fE 1E fE i! 1E 1E iE iE 1E 1k iElE 1f 1E iE'lElE iElF �f �F i! fE �E iE 1E iE iE iE iE k 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 f�, ONIT COST TOTAL COST
MEC 4 VENTILATION FAN COENDTOFSF�ESE DUCT 6.50 p
� � . _� � .� �� ��
, ; - .,. . . MAR 6 51997
The work authprized by this permit shall �, . . r�;�
�+ary wta, �i , ..; _., , � R
aPPlicable handicap
��'eQ��►aments under Ce�Nomla ''' 6� �
sOatutes end relatetl r�gulaUons.
(oro. No, e2-as, � 1, ya.ar-s2> .
c�TY oF ces+� f�; ;,��s
9
CONSTRUCTION ANDPLANNING PQO SPA
�� APPRQVAIS Permit# �ete Inspector pPPROVALS Permit# Date Insp _
1. Temporary E�ectrical Service or Pole 52. Poo� & Equipment Location -
2, Sqil Pipe-Undrgrnd. 53. Steel Reinforcement �
,�. El±ctr�cal�Condui{-Uiility�Undrgmd. . 54. Forms _ '
� 4, Electrical:Coridni �U�,Ylrgrnd. ^ _ 55. Electrical Bonding � �
�•-5. S{eel Reinforce�nent: ' 58. Rough Pfumbing & Prxssure Test -
�6. El4ctricaj:.h7FER.Gt�,d. - �• 57. APPROVALTOCOVER�GUNITE �
z-
�� 7: Footin s� " ��-'"��. ' . -
. g _,- 58. Electrical Conduia�Undre�rnd. _
� 8. Foundation - - 59. Gas Pipe, O U�rgrnd., Test
_�
9. Water Pipe-Undrgrnd.-' 60. Backwash Lines, P'-Trap, � Undrgmd.
► -
• 10. Sti•uctural FloorSVsiem � 61. APPROVAL TO OECK i
_�
11. PropertY Sewer Line& House Connection �, 62. Backwash & Receptor-Final
12. Sewer Cap i� ; 63. Heater & Vent�Fina(
13. Rbof Drains _ 64. Plumbing SYstem - Final �
14, Rough Piumbing� .- � 65. E�ectrical-Final
15. Rough Electrical�Coi�duit - 66. Solar SVstem-F' al
. �F�
76. Rough Electric�WiriHg � � 67. Fencing & Access-ApProval �
17. Rough Wirin9 Sign ,� 68. APPROVED F�R'P4ASTERING
18. Rough Electrica[.T Bar Gei4ing � ' 69. POOLlSPA SYSTEMS FiNAL �
79. Rough Heating & Air Conditioning � �z .L'j �J _ FIRE DEPT,.REQUIREMENT �. �
�- t
20.U,Rough Factory Firep�ace `_`� � � ; y {; „ - AppROVAI$,�, Peimit #' "
21.-Ducts, ir�Str�cture � - _ + = - -'� 70.`Unde�g�ouqd F;�ydro
-, c -s� ` o =r^.
22.,Ducts, Ventiletin§"'� ^�. �. ,� - 'z` `,` 77, ProducfPiping'CT'Gas �'i0il � E � �
23. �Gas�Pipe-RoqAh & Test T = � t" _ _ ^�a .- 72, Undergfound Ftush � - � { � � '� c
24,=RooE� Fr,a`min§ i, w " "- ., �,' 7.3. Undergrnd. StOya�e Tank � Gas �'OiI '� � � �'
_ ,..
25. Roof•Sheathing .� r r . y � � _ _ ��W ! 74. Overhead Hydrb = G � � �:
26.=�-B�: CeiVing (Stry',tYuraq &�Mqnocoat ` �, • ` ; 7g. Dry Chemical,_-: ; � n �s a'� �
27.-Frame and Flaship9� _.ea �: �^ ir-� . � '"-'� _ 'y
_ 76. Dry StaatlP�Pe='� y ? 4
C
28. Latfiing� Siding- Q�. _,- �-. � i ..� 7.7 FIXEQ�YSTE�FINP;L� - � .T'� Cr � �
29. Insulation _ 5 .. .. •• � {_..'� Z8. F�RE PREV. FINAL * = �' � � � �
30. Drywa�I�Nailing �� _ : �. � , �` _ �.HEALY.N DE�'REQUIREMENT t �
31. Ptaster 8rown Coatx �. 7 � 4��� - 79. FfNAL3iVSPEC�fON �
32.[;,Electrical,Power Me'te�-Ftina� :' ; � g T` 8(3: FOOD CERTI�ICATE I$SUED .
33.-FinaLElectrio � t . tt � � , ;e t3oter. �_ � � - - �
- ,: _ - � _ � - ��.� -- i2-?��'
� 34.'Fin3t Heatin§.& Air�Coriditioniag= ~ � ��C�'" _, '%I�a��`-' ��
- _ . .r. c:c % . �•�t��f��f'' =H , i - ._ _�
p i
35.rFinalGasPipe-Test: .� .. � � .�..- 3- 4�h�=��__�,���s^_
36. �,Hood o�CanoPY � - _ � - � � . `1 ( � _
- ",- : - - � /Z1G�r �''_,
� 37.�PinaLFa�ory Fireplace - .: �_ � # ' x ` ,: . �- J� ���� '
p�=-%,�N�U�.`��c_ _/�
� 38. Final�Plymbing � [ �: � ; .. i iw. ��6=� F.'�f"�;j4f�C1-C�S �
3g. Water Se7vice-Final,, � � , � x . � _ � ,. n
40. Gas Szrvice-Final - � a. -. - � n� ; c, -�r _ .ti ..
T ��
� 41. Solar DaMesticFinal = _ ' : �� _ - �; _ -
42.�ackflow�Preventer� � ��: '� � `1� ' = -
� -r ~
43. Backfiow Irr�atior%; � �� � � ,-_ � � ' - �•
�i4. �andscape ItriAation SYstem_ = � ' i -. _ � � . � : �� '� '' � �-' `
�r c_ ^.'r <- �- ..�"'�'/
45._$ound Attenuatio ' 1� `- " . . - - ;, ` _ -� r' . `� � - -
�1s i ` s F c
�. . . . ' _ " '. _
46. •Handicap•Regulatio�s -. � T, z ^ ;� - � �d `"''
�
47.�IPFALSTRUCTU(�E&BUIL'DING ' � r}� �"` •�.
� . � �� .
48.�INAL PLANNING -• � •" • 'x � ^' _ ; �' P.�
49.`Eie�i'.ic Releese to Edison • � . �` � - � " � �
.
_50._Gas Release to Southern California Gas Cv �� � ' �z t- �• ' � C � ^- - •
r - k -
-51. CERTIFICATEOFOCCUPANCY * � � " � '�= ` ' � �
No. ___. __._ Date __
'�pp�a��' I6% W 19TH� ST� ��
w�r+�asw�EiF�^+:DR CILLIANI� ` �
' ' �p� 76� W 19TH ST
:OSTA MESA,�CA 92627 (714)541-5258
�vtt, Yuiwo �oox�
uNr: .�
/D!-f0
uwxnecronemi�nn:STEVE BRENNAN ��= 307397
�xcx. ox u+a.•s �oo�ss: 216 5 2 AH ED UL ��+T�
armucrarsru� STEVE BRENNAN CONSTR CA 926�14 ) 859-0703
coNm�croxs�uu�o.,21652 ABEDUL
' ,�ssMISSION VIEJO CA ucxo: 307397
92691 , wrt:
11CplSED COMflAGTORS UECWiATION: I hareby eflim uMa perelly d pxjivy Ne� I em Icaned uder prwisbra d Cheqr 8
(mmma�tlro w'vh Senion ]000) al 0ivieion 9 d the Bumnm and P�douoeu Co e� entl m Greve e m �iA lau end NI .
cm uc. No.: (�O?)� uc. cuss: g uc. No.: �7 9 E}tP : IrGiQj
om.: c�e�
OWNEN BUILDEX DECLAPRTION: 1 he1eEy ��m untler pee�y d perjury �hel I etei 1 Imm the Comreaon Lieama Lew la ihe
Idbxiq reewn (Seqian )0.'f1.5 Bu+iw» ud PMmabna COAe: �nY uY a muntY �� �9� e peemil to eambuel. eller. improw.
demd'oh, u repai e�ry awciwa. prirc �o ae uewiwe, ebo repuirn tM epplimM la euch prmE m fib a syrod ewamenl qu� he n sM
ia li�y� punueM io iM Drwiume d Ne COMredm Licenae Lew ICheqx B(�mercinp wilh 3edion ]000) W Oirisbn J al Ihe
Bwinaae enE RWe'saiom Cadel a thet he > ahe u usmq therNmn eM iM baau la IM dbped ssempion. My videtbn d Satlion
�oa�.s W.m aop� �« e wm+ w4.as ms wd�m �o e wa w�+ain d oa mo�. �na rw. m,�e mo.�, �ssoop.
❑ I.mowriara�haPWa�YamYamWvA�winweqamlMiedammw��.vntldolhawoA.eMlMavununena'vaudetl
a dlereE br We (SeGion ]DM. Butinenvd PMeswonaCade: TM1aConitappc Lbms lew doe+�pl eDOM loan ovrtixd papMy
wM Wida a inna++IMrean. W Mn dom uM v.ak timeetl a henN a Ilvwph hn n M ovm emWul�. p�1eE ihm arA
' p'v.mmemi me na :aswe a Wwae �« ws. n. nowe.s. uie antlua «:nwo.am«n e eda wahu� ans rev a cqnd.�cn m.
ownx-0uiNx �xri hew �M WNm W 0�'��q he a eM did na build a impm*!or �M puryne d seb�. `
❑ 1. n ox�w d �he D�Y. em uduv.dY camrenn0 vAh ficenaed contMan ro cam�ud Ne VM�C (Sadun 1a1. &w'v�w� md
Pmlmiom Cade: TM Cam�etlm lirores Lew Ems M wdY to en oMnar d �
Popeny Mw buJic a'v�pnvr thaeon vd Ma
conlrecis /or �idi pqwYs wiih e mMredoKe) licemed punueM lo Ihe Comreaas Limme Lew). . f. /
��
CITY OF COSTA MESA — BUILDING PERMI"f
PERM NO: P 081922
PERMIT NO: P 081922 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : 1500 SQ FT OFFICE TI (PLUMBING PERMIT) SQ FT:
CLAIM VALUE:
CALC—VALUE:
GROUP OCC: B /
COMMENTS; "DR CILLIANI" OFFICE T.I. / RE: H81919
f[�********�r�t*i�*r**ft�rit*x�**�titftit�r***i�*it************ir**it*itftftit�t�t�trx�ir�r�t+tft*�t�t+tit+r�r�t�r*�r+�*
2 O N I N GS ERTEH�AUCIKRSE M E N T S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT ZN 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: 42420105 ZNE: REF NO:
PLANNING NdTES>
i
iE iF iE it M it it iE iF iE if 1t iFit it if 1t it it 1t i61E i! iF it iF i! iF if 1k iE iE 1E it 1E k 1F iE 1! iE fE iE iF fE 1k iE,iF k iF if iE ik 1E iF fE IE fE iE IE 1t i4 fE it iF iE iF it ik iE iE it it it if iE iF itit it
D E V E L O P M E N T S E R V I C E S=! R E Q U I R E M E N T S
ZONING APPROVED BY '" DATE:
HUILDING APPROVED BY : " DATE:
❑ IunexemquMxSsetion: B.8'PA.,brthurodon�. ,c' �� �•��� APPLICATION ISSUED
.� iFIFIfiFKiklElkikiFikilfElElFiEikiflF
De1e: ' Owriar
i eo n.�wy wnay mm i�..�.e d.oe �,�e.�,�a u�e �aw�,mm a c.i�o�,:. �+.�dn .�a smwr ca�. sec�. uws, asv�..�e L EGAL I Z AT I ON : N
TAS�. W Nd I n enY Mwa dnkl^Y m�pe^i will / wil ml lwcb ar) �weE b m^C�Y xth �eiE Me codw end tM nV��erb br
.o.,�ni«�„iNa�,«�e�bn�m.�.��ae��ua�a.w.b«nw�mNa�ron��..�....mw��w.. BLDG PMT
p«�+«» P ERM I T
om: noNbw:
wonKen•s corco+s�nor� oecux�noH: i n.,eey �, wd. w�.ny a�.y o�. d m. muo.�y e.�d�.:
q 1 hm W rril meimen awndirala d mmeM b setlswn M waeken' mipsueton, o paiAed /a by Semon 3]0p d IM leEor
Code, fa iM pMormenu d tM xark la wldch ihie pe'mA o weued.
_I] �nn.w��,mnne'nwa�w+•mmv����w,enc..mma�.aMs.eiana>oodms�en«coa..ro.m.w�ameno.dm.
7C wwk la whi� Nie permit b ievueE. MY ��n' cwnpmeelian imure�s rairix enE pdiy number ue:
c�e�: �TATE FUND EXPIRES
Pdiy Numbr. �%� Q 1��] %
r*n�..n;e,�,.w�wrw�d.�.e,n.o.�.Aro.o�nw�meaaa�.,.rs,00�dba..� .
QI mn'N � h� V^�a^^^^� d �M vork lor v.Tich ih'v pwmu b hwed 1 Nuly mpby vy prson m am/ menrw p n lo
Mmnr abjea �o �M xvM��' mmp�nWb� Iewa d Cefdamis, na ql � I ouM becw�r mmjed lo Ilr worken'
oompenaetian prowiom d Sauion 9100 d �M lebor Code. I aly mh�� wi se qmivma.
�+ v
Dtle: �a� � �J ^ � �GW'�� i
Weml�p: FeNun b ucun wK�n'rorrywwtlon carwadi I i� , mtl • 1• Ncf en Nrployr ro cNm��ulpm�ltlp erM
cMl nna w ro one n,nOrorl thouuntl CWI+n (Si0qao0), M etltlltlon ro tlh cwr ol rompsiueWn asmspu u povNHO ror In
s.�nw, ans or m. �.ne, eoa., rne.i..e .�e.rco.�.y. r«..
CONSTflUCl10N LENDINO AOENCY: I Mroby elFrtn uMer periaAy d perjury ihm tMrt ie e oonst�udion MMi�p qpnry br Me
pOrlormenm d �he wM br whiM Ihe paimN n'vaeE (Sepon 309], CN. C).
LENDEN'S NMIE
I LENOEP'S ADORES4:
1 qn'dy IIW 1 heva roeE Mu eppl'r.ation end pma thel lhs ebma'udamelion e cmW.l eprae to canply weh e0 ay eM munry advwcea
anE attla bwe'Ntl�q m buiWq cormbv<m eM hereby eWw¢e mpseematiw d Ihb uryb emx upan iM ebova�meNionad poprry
�w��'°�°��STEVE DRENNAN
PnM Nem�
D�,� - S- `� �
.C�— u Ymmre d Owir/�pxNAw����reaa
(5151.y.WP) Whne-Buildiq 8 Selary: GreemFk: Cwuy-�ppkant: Fnk-qewnue: (3okenroE-Naaaor
F E E S U
PLUMBING ELECTRI�C'
94.25 .
M M A �`K Y
f '
Ft ECiiAN I C
. y
DATE: �
1f�FIFiEiFfE1F1f�IF iflh
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
252 yA. �,, (,-. ` , SMIP/NON—RES
PLAN � �
ISSUE FEE 22.00 =- -� .- ' r `
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK � TOTAL PAID DOE
�TOTALS----> 94.25 22.00 �� 0.00�,✓'��% 116.25 116,25 ,00
REVENUE DIVISION TOTALS--> COLLECTED: � 116.25 OVER/SHORT: .00
BLDG PMT PL116I25 ELECTRIC M�,`CHANIC �, FIRE'•SMIP/TOT GRADING PLAN—CHECK
� � ,�, �'
*it�t*+�*�*it***��***�r��+�itiE�r*�r�*rt***�+��t'*x�*�tx itie*.�r*+t*it��**********�tit*x�it*at*�titit�titiErt�*�*
I N D I V I D U A L�' F E E ;'B R E A K D O W N
�� `
ITYPE . QTY D E S C R I P T I�O N; �� ," � UNIT COST TOTAL COST
PLU 5 WASH BASIN � �� '' �j� �i _ p, )5 4 5
PLU 2 WATER CLOSET (TOILET)✓ %; • 8.75 ��1
PLU 1 WATER HEATER AND/ORt• VENT'• '�, �:' 17., p�:�3 ],
�PLU 1 SEWER, CONNECTION TO HUILDINGi '',EACH 22, (� 2,
_..._..., END OF FEES,\ , \ r �g97
The wOrk euihodzetl by this p�rmit shell �`� ; � ��+ . MAR 0 5
I comPy with ell eppltcable handieap �' ���'� MESA
� �: ' � COSTA
aoceae requlrementa under Celtfomla -=� i: T''�. ; C17Y. OF
sffitutos end releted reguletlons. '. . j_,,
I (ord. No, s2-2a, § �, 12-21-92) � ,
f
COA�STRUCTION AND PLANNIfdG PQOL _ SPA �
� APPROVALS Permit # . Oate l�specto+ qPPROVALS . Permit # Date tnspector
�.
t. Temporary Electrical Service or Po1e 52. Pool & Equipment Location ' -
.
2, Soil Pipe�Undrgrntl%gLAB �3-b-9� gN 53. Steel Reintarcement
t
w3 F.tectricat-CoridO+t�UtilityUndrgrnd. 54. Forms -
�F� Electrica�o7idyjl,'-kliidrgr`nd.�� , 55. Electrical Bonding �
.-....... �,
-5., St�el Reinfiorcemet�t� � 56. Rough Ptumbing & Pressure Yest - '
�•'f,r�. Etectricai:.�2F£f�Qind. , 57. APPROVAL TO COVER�GUNITE "
_ i r _
� _ "O �;'_. -. � ' �
'7; Footingsn�.- � �-�, ' - . 58. Electrical CondLie,Uadrgrnd. -
� 8. Foundation �� =� � 59. Gas Pipe, CI Undr�grnd., Test ' �
9. Water Pipe-Undcgrnd. �� . . 60. Backwash Lines; R�-Trap, C� Undrqrnd.
70. SvLctural Ploo,ri$ystem . � - � 61. APPROVA� TO BECK .
.e
11. Prqperty Sewer Line_& y_:-.��=�Connectioo .? `6'0l� g(� 62. Backwash & ReceptorFinal �
J
12. Sewer Cap � � ti , 63. Heater & Vent�Final -
13. ROOf Drains :_ � � 64. Plumbing SYsxem - Finat
14. Rough Plumlung� - :Z _ 65. Electrical-Final ' �
15. Rough Electrical�Conduic � - 66. Solar SYstem-F�al �
16. Rough EfectriclNiring 67. Fencing�& Acccas Approval � �
17, Rough Wiring Sign � � . 68. APPROVED F�R'PLASTERING
18, Rough E�ect.icai�T Bar Ceiling 69. POOUSPA SYSTEMS FINAI
19. Rough Heatin� & Air Conditioning FIRE DEPT REQUIRENIENT
�] - U r 'X .' .'Hr- �. _'= e-
20.�ough Facto�y Firk�lace `,=; X,�; ,r �; ;-� �,* � APPROVAiy"�;_ Permit # Y �' � - - '
27.Aucts,irr_StrSMu2� � ^ •• * � � �Y _ 70.FUnde�gre�d f�dro '�
22.,Ducts,Ventil�ing '� n= `� �'�' "'^,�, r
.: r- � �-y�. G 77. Produei�io�ng�Gas b0�1 z U� Q
_ .. ,. - �
23. "Gas Ripe�fiouph & Tcst m� x^ CC k; ��x r 72. Undergr`eund Fiu'sh ^� 3; i� •
a -
24.�Roo�Fr�ming' N � "� � ^ ,� °. „y� = 73� Undergtnd.St ��e7ank �Gas OOiI Y � ._ � � v��
25. Roof-Shg�thing f.� C �•� � b� rti+� 7ai., Overhead Hyd.b i: ._ �� � rl�
Y Y u'-i J ^1 i, '^' Y- � y.�. _� :- " � 1 '
26.'T-Ba`r Ceilin9 (Str�s�urall & tcdj��coat � � � * 7g. Dry Chemical _.=_ r ' ,�� Q- � J� h����
� r t: :: �. �. � - ,_ _ . - = � � �'� -
2J.'Fremeaodflashiitg> =�� {�• • �� 76. DryStatTdpipe.-.�^ > -� T i-a � �m��
28. Lat�ng Siding= ': c'. '_�.^ r *� •"` r� p^ ? D�� ��,
�i � ` ,x •.� •.� w 7L FIXED,�i'ST€NF�F�tNP;L,.,, - ,Q� -- Y
K� 1
29, Insulation p�� �� •• � i � �� 78cFIRE-PREV. FINY�L ` � - : °' v ��'
30. DryH�all jyailing � x._, * �, �-(� * �.'4i � LH�AL'f� DEP7.'"REQUIR�Nf�,ElttT -' v E
31. Plaster8rowtrCo�=�,�, .. -r r: � 1 �,K,. 7�. FINAL�tNSPECi40N � �� - �
32."_ElectricaTPoiver IMe�aF`�inal ,*�, �'� � � }' � 8� FOOD CERTI��CC,TE CSS�UEp �=�
' r �- 'K � T F ,m, - . C ' ^/
33.�„Pinal�Eleetri�. .�� ,r.t �;: ;r: I ',�..� f�Totes:3-b��j`t-�i�'��� P�P�nr����-oK Q'f
34.;Fin17:HeatinJ'& Air�Contlitionii�tj= •'� �' H � �' Z �� �
:
r- � .� t:� t*� x^ ' 1 �:�-f�
35.�FinaTGas Pipe}Te�s.3,'; � .: g ,..., � � - :
r ' ����' _:P���z��_� �
36. Hoad orxanoP4 ':.^• c". a -. � � � �x. !�'21 �
c � - ,; �i T ..' .,: y . 'r _ .
� �i "J%�.����
ti � .�. < r [r , G! ' + /''� �
37.'finS`�Fa�ory Fire'p�ce � , E;;- �. n � Z3 - , A�� " �L �( e/l
_ _ �! 1 /� p�' � �+ �2�. "L`._�;'z'
38. Fina?�P�Orfibing -'r _ _.; 1�27���!{i�C{:-._ , -j �.L �% ` ��_ _ C� _
39. Wate� Se vice�Final* �' �' -x' , '� � //, .y~' S- -
� r t .�. - ��7 . % Dif���7
40. Gas Servjce-Final x�*: a'r' � < x x � i' h _. '�' � " �
r r:. t- '+' t i R<'
41. Solar OomesticFin�1 = n " �; " � � -jz, �=. � - _
42.'Backfiow-Preveniera v r. ✓ i � y �F, a, _ _
r - - m =n ^ �
A K � � L' �. _
43. Batkfiow Irri�ation„ `'`" x� ,,, c � y ' �
A4. landscape Irr•igation SYsiem_" " K ?7 '7 = � r � =1% y "' = ' � '' _ -. - �. �L ' ;
.ti - er �l.r �- -.0 �
�45.,�,Sound iA.tterfuation�" _ „ � x $' � .,� T x r 7 ��D � �' * -
�•
_36.�Nandicap.RegulatioAs �� � �r c� � _ -. S - i.;,'i � �^ q
r r ✓ - r,
g7,�INi4LSTROCTURE&BUfLDING ` i , � 1' � �' _ v� ^' �
. x. t�: '�
48.�INE1L PLANNING;: ,-- � �"�_` T w '' ti''', e`:,
i - r'
4g, =Eleciric Release to �di:on � �" . = � ,� ; - �, _ �� , "�'
� � : ,r.
50. -Gas;Release ro Soutiiern CalifoFnia Gas Co a� � * � - - ' • . �+ -�� � � �t'
. -
c, rGaTicirnrc,nc ncci ianNcv _ �- � ' _ - - • -
Oate
I�
I �
AOOPESSOFBNLOINO: %6% W 19TH ST
ONNERStuYEIFqIOMk ��5, JERRY
�opEu 1903 YACHT ENCHANTRESS
I NEWPORT HEACH, CA 9,2660
MPL. Y�ItIIJG ADDNESR ^ /�
�NCHRELT OP FNtlNEEN: �C/ �� % � ^
MCX.OP EN0.'S AOONE53:
u�+T: 1 0 9
uc. No.:
uxr:
co�m�aoaSw� HAN' S BUILDING 6 PLUMBING ( 213 ) 388-6713
carn�ctorrs�uiwo 610 S SHUTTO PL
�no�ss:L.A. CA ucr+o.: 518009
90006 �M 109
110EN5ED CONTPACTOPS DECUPA7�ON: I Mreby dlim urdar peneYy d perjury Ihtl I em licenwd uiMer prwieim� d Ghaqr Y
(aommuidnY wnh Seclion )000) d D'nieqn � d the Buurrv uM Pmtwuma CoEe. vd mY Icaus u in hA lau xM Mlad.
cmuc.No.: uc.cuss: C-36 uc.r+o.: 518$Q9 EXP:
om.: a�l — n 3 �$.� c��.�.,«: �,�v a��=',r% ��;l..rn
OW NEfl BUILDER �ECLAPATION: I heApy atfi�m under pendy d �ury Ihet I am aump liwn iM Camretlae I.ioense law lor Me
Iopow+q �aew� (Sed'pn )OJI.S Bu�iia+a end RdmiOnf COM: MV NY a opudY wfiidi nVwti s W�mY to crostruq. etlr.'vnV�.
nd'eh, v repei any eMutun, pior b Gs ewaroa, e6o rWu'uae tM epplimrtl la wrh pamiil to fib e WnaE MtsmeN Ntl M a�M
oenw wrniw m �ne a�+�^• a ms cameeaas Liosma law Icheq« a(awmn«�tiw .un saaon �000) d oi.:iwi a d �ro
s�re uk Nd»�iom CoMI a ihtl As a eM u uemq �herdmm uN tM beYs la IM dbpM ex+rtWion. MY v'dtlion W SWion
)031.5 W enY ��^� la e pa�mn wbjyy �he applcenl to a avJ penelly ol ml mwa IMn Ms huMrad dd4n �SSWI).
� I.00xnerdtMpoperlYamyamplqaeswYhwapesmtMieobaom�ian.wJldolMwork.aMlMso-uctunu�wliNeMed
w oilered br eele (Seclion 101�, Busiiwp eiM PMeeaonv Cods: The Coniretlon Liunss 4wdoee ml eppty lo en o�nerd O�PeM
w!ro WIEs a inprwas t�oreon. entl xta does such xwk Nm WI a MnN a thraph �e a Mr ovm ompb/ees. qwidsd iM wch
improwmanle ere not inleMed n oHsred lor eeb. H, however, iM Euiki�p w'vnpovemanl ia �dd wilhin me yw d mmpls�bn, tM
owner-0uilder will heva iM buNen M pwinp he or eM did nd bwk or impon la iM Wrpna d�ebl.
� 1. u owwr d the O�W�Y. ^�^ ud�way oonlredip xith lianead conhxiaa ro corubud iM pWW (Satlion ]011. Bushwe end
PMwima Coda: ihe Caweeaa llerea law doss m� eouN ro an ox�s d P�M1' Mc W81s r NW�'d tlww� eM Ww
conirecu Itt wdi proptls xNh a odtlraGa(e) IcemeE pmuw to the CONratla� Lioane lew�.
� I em azanp uMer SMion: B. 8 P.C.. br Nn �eeson:
Dete: ��
I do haroby ceMiy �M1tl I em ewera ol erq uMeniand tM rtpuimmams d Celyomu Heellh eM SNery Coda Serfbns 25505. 25StJ, eM
y55�1. yy Ihu I or enY �� �ikirp o�i will / wil ral (dreb aw) need to canply wih qid ml� mEm uM �ha �puinmmb lar
epermlllacamVuctionamodifiwionhqniMAi u�eMpameMDiNrid.ReddentWmiMnidbneppiratiamenuemqlromtMu
wa;.�.
WOflKEH'S COYPENS�TON DECI.�qATON: I Mrab) eMmi uMr paiMy W par�wy ar d iha blbr.irp Eedartlioro:
� IAevaaMvAme'vtlenecanfratqdmustlloutlreuiv�laYvka+'w�WsiWb�.wpwidedtabySMim3l00dtMleEa
COEe, �a �M pMamarca W Ne r�wk la wlich tAu pemiil o bswd.
� I hevs end xJ mtlmen wo'ken• aomV�ion i�mueros. m nawed M Saa'vi na0 dYr LaEn COM. br Ns w�trm� a tM
work tu wliid� Mie paimil is iuueG. MY workera' compenmtbn imurence rertis uM pdiry numMr ue:
Cemer:
PdkyNumber.
mia .saion ne.d rwr n canvbae r rh. c«mY e rar w,s nvnmsd dor�.�a Isiwl a hm./
� 1 cenh' � M� P^�o^^°^�° d IM wark ia which ihw pemiu u nwetl. I aMC nol empby erry paaan n ury menrw w n lo
pecm�s wbptl b �M xaM1xY tdnpenWion Iewa d Cd'danu. ud eyea tlW L I�hJoW��d b°e�w a�bjeq �o tM wvksn'
canDemtlun 0�'�siom d Sad'an 3J00 d Ihe lebor COM. I Mell�� '"nhi�> ✓�/! ���
one: v i �� �j �� .i_ �cdc.m:
w.mLW: F�9un ro wcun ro�kw�• cy�penutlon cww�W b u wM, urtlWll au0/sl m MnPloys'ro crlM�wl Wn�Mln uM
c/H/ llnu W �+ �� hundrMlMus�M SnlYn (S10Q000J, M /tlon b N� rost oI rompwwtbn, Wmsp�� I/ provlCetl bi I�
9�ctlan 91P6 0l fhs L�lor CoeM, lirtxu� yy ettom�y'� /w.
CON9TFUCTION LENDINO ROENCY; I heraEy ��m urMer pendy d perjurv �� �Mn u a oontlrud'wn bMi�p eperiry fa iM
paApmeMe d tM �wAc lu which iAe p�i u ewad (�� �]. CN. CI.
LENOEH'9 NANE:
LENOEfl'S �ODNE33:
I cenily ihet I hae,eed Nu xpWirmian bd neb iM1et Na eEwa'udmnetim o canetl. I apess �o comply xdh aA ruyanE camly ad'vanro�
eM etme bwa mimeq lo buikrtq cmm�rJion ud heraW aNhorae iapaseMetivm d Ihe tlly M mlx upon IM eCow�menloneE pmDeM
1« im a' �pupw'er (/t / / / / � Ol.�'n 6/N
1 0/ !(+ �
PnN Neme �
om,: � ,— oj — ./
` Sipn uro d OwnadRpenUAppFranVComreaa
(S15t�E.WP) WAnrBuiMip85e1ny:Greer�Fb:Ceiwy-Appf�ani:FnF-Rewnw:(bNenmFMmaa
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: P 073066 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU
JOB DESCRIPTION : INSTALL A GAS LINE
PERM NO: P 073066
GOVT: N SUPP: N
SQ FT:
PURPOSE: OTH
CLAIM VALUE; CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: NO OTHER WORK AUTHORIZ£D HY THIS PERMIT
**�t�t****at�t�*�at*at*itit�*****it****it�t**ititati��t*it�t*itf��r***x��-*+r�tit�et*x�***�t**�-�t**at****x�*ac**
Z O N I N G R E Q U Z R E M E N T S •
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BOILDING ---------
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: 42420105 ZNE: REF NO:
PLANNZNG NOTES>
i
3E �lt iE 1k 1f 3E 3E 1E 1E 1k �E 3E iE IE 1E if iF iE 1E iE i(' 3E iE iF iE i8 iF ff 1F if 1F if 1ElE iE iE if �If iE iE 1E iE'lE �IE aE iE')E �k 1E 1E 1F �IE 1F if iE ih iE 3E 1F 3f if 1h if if ii if if 1F �E 1@ iE iE if iE 1F 1F aE if {F
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
20NING APPROVED HY DATE:
BUZLDING APPROVED BY : _ DATE:
APPLICATION ISSUED BY
jE iE aE aE iE 1f 3E ik �f iE iE iE iE 1k 1F 1k 1f iE if iE IE
LEGALIZATION:N
HLDG PMT PLUMBING
PERMIT 525�
PLAN
F E E S U M M A R Y
r` ` f• _
ELECTRIC MECHANIC
�, � n
FIRE
DATE: �
iEiE1Ei(�If�1E1E�lE �'iF1f1E
STRUCTURAL SEGMENT:N
SMIP/RES GRADING
SMIP/NON—RES
ISSUE FEE 20.00
HUILDING—DI�'—> PERMIT ISSUE PLAN=CHECK � TOTAL PAID DUE
TOTALS----> 5.00 20.00 0.00 25.00 25.00 .00
REVENUE DIVISION TOTALS--> COLLECTED:e 25.00 OVER/SHORT: .00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIR'E SMIP/TOT GRADING PLAN—CHECK
25.00 •
. �
fE fE �E 1f 1E 1E 3f iE fE iE 1F �f ff 1E 1f iElE 1E 1E iE iE k if 3E iE 1E if �E k iE 1E iE iE iE fE iE iE fE 1E 1E iE 1E iE 1f iE 1E iE IE jE 1E 1E 1E 1E iE �E 1F iElE iE iE iE �f 1F �E 1E iE iE IE 1E iElE iE iE iE �E 1f !k iP iF
I N D I V I D U A L� %F E E B�R E A K D O W N
TYPE QTY D E S C R I P T I O.,N .� UNIT COST TOTAL COST
PLU 1 GAS PIPING SYS OF' 1 TO 4 OUTLETS 5,00 5.00
END OF FEES' �
- , l
i � .
V '
" . .F
� ' I
' ' ' �y 1'i -'�.1_•"1 - .-.1".j111p �`�T c. r1n
�� _ �s' _iG_� ',. ' '-..,,.. _1".�1��
, ; 1
� .
�
CONSTRUCTION AND PLANNING
APPR4VALS Permit #
1. 7emporary Electrical Service or Pole
2, Soil Pipe�Undrgrnd.
3. Electrical Conduit Utility•Undrgrnd.
4. �lectriwl Conduii•Undrgrnd. _
5. Steel Reinforcement
�6. Electrical UFER Grnd.
7. Footings
8. Goundation
9. W.�ter Pipe-Undrgrnd. �
10. S{ructural Floor, System �
7 t. Ftoperty Sewer Line & House Conhection
12. 5ewer Cap V '!
73. ftoof Orains '
14. Rou9h Plumbing �
15, fiough Electrical•Conduit •
16. Rough Electric Wirin9 '
17, Rough Wiring Sign
78. Rough EleciriCal-T Bar Ceiling
79. Rough Heating & Air Conditioning
�
20. Rough Eactoty Fireplace - �
21. Ducts, in Structure
22. Oucts, Ventilating
23. Gas Pipe•Rough & Test •
24. Roof�Framing
25. Roof Sheathing
26. T•Bar Ceiling (Structural) & Monocoat
Z7, Frame and Flashing
28. 4athing & Siding • �
29. Insulation
30. Dryevail Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Finai Electric
34. F�nal 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-Fi�al
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irriqation
44. t,andscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Re�ease to Edison
50. Gas Release to Southern California Gas Cc
51. CERTIFICATE OF OCCUPANCY
Date
POC �PA
Date Inspector APPROVAIS Permit #
52. Pool & Eq�ipment Location ,
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Piumbing & Pressure Test
57. APPROVAL TO COVER•GUNITE
58. Electrical Conduit-Undrgr�d.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P�Trap, � Undrgrnd.
61. APPROVAL TO DECK .
62. Backwash & Receptor•finai
63. Heater & Vent-Final
64. Plumb�ng System - Finai ' .
65. Electrical-Final
66. Solar System-Finai
67. Fencing & Access Approval
68. RPPftOVEO FOR PtASTERING
69. POOL/SPASYSTEMSFINAL
, FIRE DEPT, REQUIREMENT
APPROVALS Permit #
70. Underground Hydro '
71. ProductPipingOGas ❑Oil
72. Underground Flush ,
73. Undergmd. Storage Tank O Gas ❑ Oil
74. Overhead HYdro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL.
78. FIRE PAEV. FINAL
HEALTH DEPT. REQUIREMENT
� 79. FINAL INSPECTION
� , 80. FOOD CERTIF.ICATE ISSUED
Nates:?_�-9S iYa ��s_��
` Y% `'CJ G Z/
I�iL..�.L'�Yi.i�
Date �Vnspector
!/
Aovlicant to fill in ali spaees exeept those witnin heavy Dortler lines ana sign a11 approo��ate tleclarations.
CI Y OF COSTA MES CONSTRQUC ION PERMIT / MIT T T LOT NO. UNIT NO�. . .
Project Address � W '�— `� � � � L �a/� ` �� � �� � � �O� .. .
Applicant'S Mailing Addless �QO3 ���IIIiLr��i.S TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
T_�/.�� ���� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # ►� O 2ona
Owner's Name I�SQ � K��F Pho��.�+sFVV D IPTION Oj Vy��E Op'pLaC�i. . OIGG( G� �.
Aildress �iK L-/ iCLM S Main Buildin9: e s y 'ng:
Arch/Eng. ��""•' Q�C'• LicenseNo.G�SIZS TVPEOFPERMIT GRADING ❑FOUNDATION STRVGTURAL T Front �� 0
Address � 7+ ���' �� ��yTENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear "'- 5 N
LJ�OTHER A �
Contractor's Nam Phone Z C Right n, N
Address (mailing) ' PROJECT DESCRIPTION So. FT. oCCUa NCv � K Left �' G
CONSTRVCTIONTVPE �✓� VALUATION$�� S C �
City Litense NO. ZpNE � GF3ADING CU. VDS. � AC0.E5 ` R
LICENSED CONTHACTOR �E LA ATION Ping. ftef. # Parking ./PfOvidCd E
I hereDy atfirm that I am licens tl un er r i ions of Charte� 9(commencing rtemarks: Planning Notes: n
with 5ection 7000) ot Dlvision 3 of tn us ness antl Professions Gotle, antl � M
my license is In tull force antl ef , C. S D T
� LiCense Class �cense No. _ S�
oate Signature • PLUMBING FEES
WORKERS' COMPENSATION DEC RA ION � ' 8af Sink Showers
�I hereby attirm that I have a certific te of mnsent to self-insure or a certi(icate ELECTRICAL FEES
oi workers' Compensation Insura ce, or a certitietl copy thereot (Section gackflow Preventer Service Sink
3800, Lae. c.) �, Automatic Washer Transformer ❑ 15-50 KW
PolicyNo. Company Backflowlrrigation SewerCap - ConstructionPoleSub. ❑50+KW �
eCertifietl copy is �ereby furnishetl.
Certifietl copy is filetl with the city Builtlin9 Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
pate APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers $012� COII¢ct0f5 Di5hwa5h¢� MBl¢� ❑OVC� l00 amps
(Thissection neetl not be completetl it the pe�mit is for one huntlretl ($300) or Di5hwd5hC�
Iess). Solar Piping Dryers ❑Gas ❑Electric Sub Panel � • -
1 ce�tlty that in the pe�to�mance of the w fo� which thi5 pe�m�t is iSSuetl, 1 �
shall not employ any person in any r so as to me s ject to the Drinking Fountains Solar Tank , 1 Fan
Worker/_ en ' 1_aws of Calit � Mo[ors �0-1 HP �1Ni-8
Oate �O Si9nature Floor Drains Swimming Pool�w/Spa F.A.U.
NOTICE: If, after makin9 this tleclara on, yo hould beco subject to the � Inc. Sola� �9-15 HP �16-15+
Workerz' Compensation provisions of the Labor Cotle, you must forthwith FI00lSinkS Ufinal '
comply with such provizions or this Oermit shall be tleemetl revoketl. Fixtures Miciowave
CONSTRUCTION LENDING AGENCV Ga55ervicC OUtlets WatefCloset DeviceBoxes PoleLiht
I nereby aTiirm that there is a construction lentling a9enty for the performance 9 �
of Ihe work tor w ic is permit is •issuetl (Sectlon 3097 Civ. CJ InterceptOrs . Water Heater OutlCts
Lentler's Name �5�� Range '
Lentler's Adtlress KitChen $ink ' - Wa[er $erviCe .
O'NNER BUIIDER DECLHRATION�� ' � _ Switches Sign �
I her¢by affirm that I am ¢xempt trom th¢ COM�actor'S License Law tor the LdvatO�i25
tollowing reason (Section 7031.5 Business antl Protezsional Cotle: Any city or Garbage Disposal ' Standing Sections
munty which �equire5 a pe�mit to const�uct, alter, Improve, tlemolish o� �epair P—Tfdp
any Structure, priOr to Its issuance, also requires tM1e applicant tOt such permit Generator �0-5 KW 05�75 KW T�35h COTpdctO� ,
to til¢ a signetl statemen['that ne/she is licensetl pursuant to the p�ovi5ions Of Roof Drains
Ihe Contractor'S License I..aw (Chapter 9(commencing with Section ]000) of
7Vvision 3 ot the Business antl Professions Cotle) or that he/she is exempt
there(wm antl the basis for the allegetl exemption. Any violation of Sectlon , , •'
]C31.5 by any applicant for a petmit Subjects the aOP���dnt to a civil -
�enalty ot not more Ihan tive buntlretl tlollars (g500). 3 '
I, as owner of the property or my em0loyees with wages as their sole Reinspection Fea $75 Issue Fee $ � - �
tompensation, will tlo the wo�k, antl the st�ucture is not intentletl o� ofte�etl �
for sale (Section 7044, Business antl Professional Cotle: The Contractor's � MECHANICAL Reinspection Fee $15 luue Fee - $ 3
FEES '
License Law tloes mt apply to dn owner of a pwperty who builtls or improves ,
thereon, antl who does such work himselt/herself or through his or ner own DEVELOPMENT SERVICF,�REQUIREMENTS: • � ' `,�
employees, provitletl that such improvemen[s ar¢ not intentletl or oHeretl tor gOilCf HOOd O/ TypE'I ❑ � Q�� �
sale. H, however, the builtlin9 r,r improvement is soltl wiNin one year ot com- CanOpy Typ¢ I I ❑ Zoning ApprOV¢d By �� DatB �T �+
pletion, the owner will have the burtlen of proving he/she tlitl no[ builtl or im- Duct- Under Ground @uilding Appr�ved By Date � V
�/Ova for the purpose ot sale).
I, as owner of tne prooerty, am exclusivety mntraccing with licensetl con- Duc[ -Structural Refrigeration Syste Appliption Is�ued By I� 'Date a.(�
t�actOrs to consiruct the O�oject (Section ]044, Business and Profe55ions Cotle: �
The Contractor'S License Lvw does mt apply to an owner of property who Duct - Ventilatiog ❑0-700,000 BTU ❑100,000 BTU � SU RY OF FEES
builtls o� improves the�eon, antl who contracts for suc� 0/ojects with a con- '
iractor(s1 license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ s� SMIP $ �`��
proof of their Worker's Compensatio surance shoultl be providetl to me. PLAN CHECK $ 32.�2 pERMIT
❑ I am exempt untler Section B. & C. ior his reason FirepVFact. BIL ICBO # '� PLUMBING $ ISSUANCE $
� — p Heating System & Ducting �� PLAN CHECK 25°6 $ ' ENERGV P.C. $
i hereby certity t � have reaa this appiic on and stat at the a0ove ❑0.100,OOOBTU 0100;OOOBT ELECTRICAL $ GRADING $
intormation is cL I agree to comply with all city antl mu ty ortlinances .
antl state laws I ing to buil ' 9 construction, antl hereby authorize repre- $ � MICROFILM
sentaUves of city to n po the above-mentionetl property for PLAN CHECK 50% $
inspection p � MECHANICAL $ ��•�Z
Signature � � Date��"�'S TOTALFEE $
Drivers"Li �se or � Reinspection Fee $15 Issua Fee $ 3 PLAN CHECK '25% $
CMF OBfi5-46, rev. 4/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor - -
CONSTRUCTION AND PLANNING ��_ PO(QL & SPA
APPROVALS Permit# - Date Insp�tor AppROVALS Permit# Date Inspector '
+ 1. Temporary Electrical Service or Pole � 52. Pool &�Equipment Location �� /
� 2. Soil�Pipe�Undrgmd, � �;�, 53. Steel Reinforcement sy Jl�'
� F � � .
3. Elec[ricol-Conc7uit�Utility�Undrgmd. �(' 54. �orms . � , ���i
.
,�4�Elecincal ConduiiSUndrgrnd. , 55. `E�ectrical Bonding � ��^ n
5. SWeevf�ein{orc�merit . 56. Rough Plumbing & Pressure Test ���
6� Ele i ical UF�fj;cGrnd. 57. APPROVAL TO COVER-GUNITE /'�� ���iJ
Vf LI .. 1.` - �il .�/.� ���}
77�.Foot�ngs �,; �'�, ��� � 58. Electrical Conduit-Undrgmd. (���1� "�l �
$.: 4ptlndation� � i{� � . � j�� 59. Gas Pipe, O Undrgmd., Test fY ��
9r Water Pipe-Ur�d�grnd. (/t� 60. Backwash Lines, P-Trap, � Undrgrnd. �-i� ��
� �u �.
10:'Sia ctural Fldor System d y 61. APPROVAL TO DECK �i� Q6
11. P� ��ty Sewer Line & House Connection l� j 62. Backwash & Receptor=Final � i�j';
�
12. Se"we�Cap_ �- G� 63. Heater & Vent-Final v,�r k�
H o �'
1 �ROof�Drai�s :.: - � 64. Plumbing System - Final �; . �'
r_
14d Rough PlumlS;ng � 65. Electrical-Final • bv
15. Rough Electrical=Conduit 66. Solar System-Final � .
16. Rough Electric Wiring . " 67. Fencing & Access Approval
17. Rougli 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 Strucfyre � 70. Underground Hydro
22. Ducts, Ventilating ;, ' � . 71. Product Piping OGas ❑Oil
23. Gas Pipe-RougFi,'&�7est � 72. Underground Flush
� 2_4. Roof Framing ,,� - � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathin j�~� •
9"«� 74. Overhead Hydro
26. T-Ba�;Leiling (Structural) & Monocoat ' 75. Dry Chemical �
�.
27�. � Fram� and Flashing ..• � vv 76. Dry Standpipe
28. Lathing & Siding ' ' 77. FIXED SYSTEM FINAL
29. Insule`tion �, 78. FIRE PREV. FINAL �
i' HEALTH DEPT. REQUIREMENT
30. Drywall Nailing; �-,)
31. Plaste'r Brown Coatt�i 79. FINAL INSPECTION �
32. Electriral 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 i . �
38. Final Plumbing � . . ' �
39. Water Service-Final ' � ' � �
40. Gas Service-Final • �
41. Solar• Domestic-Final � , ,
42. Backflow Preventer �. � � ,
43. Backflow �rrigation , '` . � � ' � •
•�
44. Landscape Irrigation System � ' � '
45. Sound Attenuation � � � �
46. Handicap Regulations � ' � a
47. FINAL STRUCTURE & BUILDING ' , - � ���
O
48. Special Requirements Completed '
49. Electric Release to Edison.� � �
50. Gas Release to Southern Califomia Gas Co , , ' � ' � �
51. CERTIFICATE OF OCCUPANCY . � �� " �
No. Date ' �
2�O rj v"� ��� �-'•/ln � �J �//�o0�i�a�t to flll in all spaem except t�osa wilhin neavy eorticr Ilnes antl sign all aoProo/�ate evclantions.
Ci7voF..COSTaMESA CONSTRUCTIOIVPERMI� �
�Project Address - - -
npprca�rsmaulnyadd�ess 10�t22 Trask Ave.
Charles Chile Rest. Pho„Q 548-2294
Owner i Name
Atldreu 767 W. 19th
Ar�h/Eng. � License No.
Atldiesz
Convactor'sNam A-ames Plumbin2 vhone 530-2440
Atldresslmailing) 70422 Trask Ave. Carden Grove
City License No. 6664 -
LI�ENSED CONTRACTOR DECLARATION
1 hereby affirm [bat I am license� untle � lons of Charter 9(commencing
w�th section 7000) o( Divislon 3 he Busin ss antl Cotle, antl
my license is in tull forca antl�ti n. 030�
Licenzo Cless �' � � LiGens d'
Dete Q—!n�RL Signatu
'"�ORKERS' COMPENSATION �LAR N
+reby aHirm that I navc a certifiwte o nsent to se�f-i�sura or a cmtincato
Wo�keri' Compensation Insu�anca, a ca�tl/I0tl copy Ihe�eof (Sectlon
�aoo, uoW��g4076419 Fremont
I�cy No. Company
Ce�lifietl Copy I5 he�¢by furnizhetl.
Ce�t� i¢ op 5 filetl with the cit Buildin Isio
oace �-�b-g� noa���a�r�-ames� �iumiiing-Heating
EXEMPTION FROM WORKERS' COMPENSATION DEC!_ARATION
(Thissection neetl not bo completetl if the Oermit is for one huntlrotl ($100) or
lets).
I cerlHy Ihal In the Pe�formance o� th0 wo�k tOt wnith tMs pe�m�t Is ISSuetl 1
snall nol amo�oY any purson in any manner so as to betome subject to t�e
�Morkars' Componsatlon I,.aws of Callfornia.
Dala Signature
NOTICE: 11, atter making this tletlaration, you ihoultl become subject to tho
H'orkers' Compensation provisions of the L2Dor Code, you mus[ forNwith
comD�Y �+'�t� such provizions or this oermit shall De Ceemetl revoketl.
CONSTRUCTION LENOING AGENCY
� hereby dffi�m that tttere is a wnsl�uction lentling a9ency fo� th¢ PerbrmancE
oF the work for whlch this permlt i5 ISSuetl (Section 309] Civ. C.)
LanEer's Name
Lentler's ACtlresz _
OWNER BUILDEH DECI.ARATIOfi�
I hereby alfirm that 1 am oxempt irOm the Gonlraclor'S Llcenze Law for the
�ollowin9 reason (Sactlon 7031.5 Business antl Protesslonal Cotle: Any city or
County whlCh rGqWreS d perTit lo construct, dlte�, ITP�oVG, Oemolls� Or �o0air
� a.... er.ueeura ndrn to It< issuanee. also reouires the appllcant lor sutn oormlt
ieretrom antl the Easis lor the allegea exemption. AnY�vlolation o( Seccion
/031.5 by any appliWOt tor a p¢�mit 5ubjeCtS th< dppliCanl to a Civll
eenalty of no[ more t�an five huntlred tlollars (E500J.
LI 1, ai owner ot [ne property or my employees wiln wages as their sole
tom0ensatiOn, will tlo tM1e wo�k, antl Ihe structu�e is not intentletl Or otteretl
�or ule �SCction ]044, Business an� Professional CoOe: Tbe Con[ractor's '
LlcenSe Law tloes nol dpply to an own¢� of a property who builtl5 or im0/ovez
t�e�eOn, dntl who tlOCS SUCh work hiTself/hersell o� Ihrough his o� he� own
Cmploye<s, prOvltletl [ha[ zuch ImprOvaments ar0 nol Intentletl or ofler<tl tor
Sale. If, nowover, tne DUIItlin9 cr improvament Is soltl wllhin one year of com-
pletion, tIW owne� wlll havC llte b Wtlon Of P�Oving he/ShC Oitl not builtl or im-
��Ova torthe pu�po5a ol5ale).
I, as owner of tM1a property, am axclusiveiy contracting wltn Ilcensetl con-
tractors to constru<t tna D�oject (Sectlon 7044, Businoss anO Protasslons Cotla:
7ha Convacror's Llcense l.nw dOei nol ap01y t0 an owner of property wbo
builds or irt�Oroves [he�¢on, antl who contratts for zuch projacts wl(h a co0-
tra<tor(i1 I1cen5¢ pur5uant�to Ihe COntractor'S LitBnse Lawj. I dm aware that
proot o1 t�eir Worker•s ComOensat�on insu�ance shOultl be provitletl [o me.
❑ 1 am Gxempt untler $ection B. @ P. C. �or this reason
bate
reatl tnis ap ica(q n antl state that tne above
to ccmnlv�[Dfall Ntv antl counta�ortllnances
TVPE OFCONSTRUCTION I.J NEW U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF PERMIT LJ GRADING LJ FOUNDATION LI STRUCTURAL
❑ TENANT ❑ ELECTRICAL PL MBINC�_ ME ANICAL
❑ �OTHER �epYHCe Wd E.I Ci�'eater
PROJECT DESCRIPTION 5q. F7. oCCUaArvCv_
CONSTRUGTION TVPE VALUATION $
ZONE GRADINGCV.Y�S. ACRES_
Remarkf:
Sink
Preventer
Irrigation
iking Fountains
x Dreins
�r Sinks
Service Outlets
Kitchen S�nk
Lavatories
P—Trap
Roof Drains
Reinspection Fee
$15
Boiler
Duct-UnderGround
Ducl - St�uctural
Duct � Ventilating
Ezhaust System ❑ Multiple
Firepl/Fact Blt ICBO #
Heating System & Ducting
❑P700,000 BTU 0100.000
>i9na[u �
Reinspection Fee $15
Dr'vers' 'c nse ar 5
CMF 0865-46, rev. 4/84 White - BuilUing: Canary - ApPliwnt; Pink - Accounling; Goltlenrotl - Assessor
Shawers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
$olar PiPing
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet.
Water Heater
Water Service
��
Isue Fee $ 3
iANICAL FEES
Hood or Type 1 ❑
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000eTu ❑ioo,000eru
System Repair/Alteration
laue Fee I $ 3
A.P. �
S Main Building:
E
T Front
A Rear
C Right
K Left
S
Ping. Ref. #
Planning Noies:
Auromatic Washer
Consvuction Pole Sub.
Cooking Unit
Dishwasher
�ryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures .
Device Boxes
Outlets
Switches
Garbage Disposal
Generetor d0.5
8777 9/24/g4
ZonB
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter �aver 100 amps
KW U5-75 KW
Sub Panei
Motors00.1 HP �7Yh-6
Inc.Solar �9-15 HP �16-15+
Microvrave
Pole �ight
Ranga
Sign
Standing Sections
Trash Compactor
�.0� Tt,
FEES
2
O
N
I
N
G
R
E
Q
M
T
$.
- � Reinspection Fee � �$15 � � luue Fea � S 3'
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approvetl By Date
Building Approved By Dat�
ApA��u�tion Issu9d By Dat 2
SUMMARV OF FEES
BUIL�ING PERMIT g SMIP $
PLAN CHECK $ PERMIT
PLUMBING ` $ 5_00 ISSUANCE $
PLAN CHECK ' 25% $ ENERGV P.C. $
ELECTRICAL - 5 GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ �nn
PLAN CHECK 25% $
�CONSTRUCTION AND PLANNING PO� ,� SPA
�APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
�1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
i
_2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement �
-3. Electrical Conduit Utility-Undrgmd. 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
t
7. Footings . _ 58. Electrical Conduit-Undrgrnd. ..
� 8. Foundation 59. Gas Pipe, O Undr9rnd., Test �
9. Water Pi e�Undr rnd. �
P 9 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
72. 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 � 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 Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Fiush
24. Roof Framing . 73. Undergrnd�ageTank �Gas ❑Oil
-r�
25. Roof Sheathing ' 74. Overhead Hydro
,
26. T-Bar Ceiling'�Structurap & Monocoat 75. Ory Chemical � .
27. Frame and Flashing � 76. Dry Standpipe � . •
28. Lathing & Siding 77. FIXED SYSTEM F�NAL
29. Insulation � 76. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL IN$PECTION .
32. Electriral Power Meter-Final , 80. FOOD CE�FIFICATE ISSUED
33. Final Electric Notes: 9/2��� (��,� ��. (��
34. FinAI Heating & Ai� Conditioning �/Z��S _���- 4q/j�cJ �(�Q
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace � '
�
38. inal Plumbi �
39. ater Service-Final P �
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 Califomia Gas C4 �
51. CERTIFICATE OF OCCUPANCY
No. Date
AYV�icant to fill In all spaees axCapt those within heavy CorEer Ilnas anG sign all apGroprlate Eeclaratlons.
, GTY OF COSTA MESA � -
CONSTRUCTION PERMIT �V
�. Project Address � � ` �
I ApplicanYs Mailing Addrew �v v 'L G' �t •
li Owner's Name ���`"�`� Phane .
I Addreu
Arch/Eng. License No.
Addreu '/
�i Concractor's Nam � L��T��G Phone ��z'��bY
Iiaddresslmai�ingl /599 d�v7Z�c2 - 9 � i
City LicPnse No. � �
LICENSED CONTRACTOR DECLARATION
�� I�haYeby affirm [hat I am licenutl untler provisioni of Charter 9(commencing
' with s¢clion 7000) of DIVI510n 3 0( the BuSinesS antl PrOtesslon5 Cotle, an0
my Iicense Is in full torce antl eHect. �`O� ��
License lazs '- Ic nso No. �
oate ��- sig tu e o �B/L'V+
'�ORKERS' COMPENSATION �ECLARATION
�Q�eby a(Brm Ihal I hdv¢ a cerliflCate ot COnsent t0 5aH•In5ur8 or a cortlfiw[e
• Workers' Componsation Insurance, or a certifietl cppy thereof (Settlon
3BOp; �b. CJ �
Polity No. � ' Company
8 Certitietl copy is hereby.furnishea. ' i ' .
Certi(ieC capy is filetl with the city Builtling Division.
Dat@ APplicdnt �
EX�MPTION FROM WORKERS' COMPENSATION DECLARATION
(This u<tion neetl not be completetl if the permit I5 (or one huntlretl (3100) or '
less) . '
I ceYtity that in the pe�forrnaqca Of tbe wOrk / r vhiCb ilfls pe�mh lt lssuatl 1
shall not employ any permn In any mann 5�!o�8ecome subject to t{�e
Workers�o��n�ti6n Laws of Califor a V�
DatO d y Si9natura L6'
NO710E: It, after mdking lhi5 CeclaratlOn, you shoultl het0 �e Subject to th0
Workers' Compensatlon provisions of the LaOor COGe, you must torthwith
comply with such provisions or thiz permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aTfirm tha[ thare is a construction lentlin9 agency for the Oertormanca
of ihe work for whith this Dermit Is issuetl (Section 3097 Civ. C.j
LenGer's Name
Leotler's Atltlress �
OWfJER BUIL�ER DECLARqTION � '
I hQreby afBrm thal I am exampt trom lhe Cdntractor's Ucenm Law for tha '
tollowinq reason (Sactlon 7031.5 Businass anU Profesilonal Cotle: Any cily or
county wbich requlros a permlt io construct, alter, improve, Eemolish or repair
any structura, prlor lo ils issuan<o, also requirns tha applicanc tor zuch permit
to f�le a signetl slatement lha[ ha/she is IlcenSetl pursuant [o Ihe OrovlSions of
�: '�e Contractor's Ucense law (Chapter 9(tommencing witn Sectlon �000) ot
'`}',�,�.vision 3 ot tha Business antl Professlons Cotle) or that he/she is exempt
,';,'erefrom ana the basis for the alleged exemptlon. Any vlolation of Saction
�+�°�.'031.5 Oy any applicant tor a permit. subjects the appticant to a. <ivil
lLenaity oi nol more lnan (tve huntlred tlollars (E500). '
�� I, as owner of Ihe property or my employeas wilh wages as their sole
CArqpenSatlon, wlll tlo tbe work, antl the structura iz nOt Intentletl or ofiarep
tor �le (Settion 7044, Buziness anU 7rofessional Cotle: The Contractor'S
Licenu Law tloei not apPIY to an owner of a property who builtls or improves
t�ehaOn, antl who Eo¢S SUGh wo�k nlmselt/�¢rSElf o� tll�ough his o� hOr own
embloy ees, provltletl tM1at such improvamen[s are not intentletl or offeretl tor
sa�a, I/, howaveq the builtling or improvement Is 5old wlthin one year of com-
pletion, [ha ownor wlll have tha burtlen ot proving he/cha tlld no[ bulltl or Im-
�roye forthe purposo of sale).
I, as ownor of tne proDerty, am exclusively contractin9 `�+��h Ilcensetl con-
tra¢�o�s to construct the pro�ect (Sec[lon 7044, Business antl Ro/essions Cotle:
Thp� Contractor'z Llcanse law doei not apply [o an owner of property who
Dulltls or imOroves tnareon, antl who contractz for such Drojects with a con-
traq�or(s) license pursuant to'tne Contractor's License law).
❑ I am exempt unCer Section B. & P. C. for this reazon
Da�o
I hereby cerUfy that
Inlprmation Is corroct.
anq state laws relaUm
sentatives of lbls c
insbection Durpos
Signature
Dry�rs' LicenSe or S
CMR pg65-46 rev. 7/83
Owner
that thn aGove
� .. �.
TVPE OFCONSTRUC7ION NEW ADD ALTEqATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER �
DESCRIPTIONOFWORK �
TYPE OF PERMIT�{ LJ GRADING IJ FOUNDATION LJ STRUCTURAL
❑ TENANT yO� ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT UESCRIPTION 5�. FT. oCCUvnNCv`
CONSTRUCTION TVPE VALUATION $
ZONE GRADING CU. VOS. ACRES_�_
Remarks:
Bar Sink
Preventer.
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service • Outlets
Intercep�ars
Kitchen Sink
Roof Drains
Reinspaetion Fee
$25
Duct- Under Ground
Duct-Structural �
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. 612. ICBO #
Heating System & Duc[ing ,
00-100,000 BTU � 7 00,000 BTI
� �� - I I Reinspection Fee
White - Builtling; CanarY - APPlirant; Pink - Accountln9; Goltlenrotl - Asseisor
A
$25
Showers
Service Sink
Sewer Cep
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Warer Closet
Water Heater �
Warer Service _
n
Isue Fee $ 3
A.P. # , .
S Main Building: �
E
T Front
6 Rear
A
C Right
gLeft
Ping. Ref. qW
Parking Req./Provided
Use of Building: .
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Eleci
Fen
F.A.U.
Fixtures
Device Boxes
OuNetS
SwitChes
Garbage Disposal
Generetor 065 KW C
5�15
- 2715 �/19/84
Zone
ssory Builtli
Park.Fees $
ELECTRICAL �
Transformer � 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps '
Meter �over100amps
Sub Panel
Motors � 0� i HP � 1 h- 8_
Inc.Solar �9-15 HP �16�15+
� Microwave �
Pole Light .
Range
Standing Sections
Trash Compacmr
IANICAL ' FEES Reinspeetion Fee $y5 laue Fee
PUBLIC SERVICES REUUIREMENTS:
Hood ar Typel ❑ �
CanoPY TVPe II ❑ ZoninB Approved By
' Application Approved By
Refrigeration System
❑0.100,OOOBTU ❑100,OOOBTU
System Repair/Alteration
Izwe Fee � $ 3
4.20 7L
$ 3
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK 5 YERMIT
PLUMBING S ISSUANCE $
PLAN CHECK $ i ENERGY P.C. ,$
ELECTRICAL $ _�P�l GRADING $
PLANCHECK • $ ,/,L�J MICROFILM $
MECHANICAL � S TOTALFEE $ �' ��
PLAN CHECK § . '
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��� CONSTRUCTION AND PLANNING POC SPA .
APPROVALS Permit# E���� Date Inspector qppROVALS Permit# � Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . � - 53. Steel Reinforcement
3. �E�ectrical Conduit Utility-Undrgrnd. ' 54. Forms -
4.'�Elec[rical Conduit-Undrgrnd. ��� C 55. Electrical Bonding .
� 5. •S[eel Reinforcement 56. Rough Plumbing & Pressure Test
6. .Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. �Footings • 58. Electriral Conduit-Undrgrnd.
S.�Foundation . 59. Gas Pipe. � Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System • . 61. APPROVAL TO DECK - '
11.' �roperty 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 � ag � `➢ � 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 Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil �
23. Gas Pipe-Rough & Test 72. Underground Flush
24. RoofFraming . 73. Undergrnd.StorageTankOGas ❑Oil
25. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical
27.. F�ame and Flashing 76. Dry Standpipe .
28. l.aihing & Sidinq . • 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 � . 3�S �1 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-Finai
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 Catifornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
AOV��cant to fill in all spaces except those wit�in �eavy borEer Iines antl sign all apP�opriata Geclantions.
CITY OF COSTA MESA. �
,CONSTRUCTION PERMIT .
- ProjectAddress 7� z w 14� •�� �Bf7�P n-l�fA
Applicant'sMailingAddreu �4�3 y'�CKTE�C�/4A-f/'M�
Owner's Name nn�✓d�d M�'��0�-+� Phone
Addressl4D3YALKY'Cti'C4..�;�.IKC-r '�P�r/eiT Scli
Arch/Eng. � �"�'r� License No.
Address
Contractor'sName �W�d'� � Phone���
Address (mailing) S�� e n C ����/�
City Licnnse No. -
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am Iicensetl untllr provislons of Charter 9(commen<in9
with section 7000) of DlviSion 3 ot [he Busineu antl Profe55ions Code, antl
my Iicense is IS f�ll�,orce antl e(fect.
LICef15¢ CId55N �d� License No.
Date Si9nature
'vORKEFS' COMPENSATION DECLARATION �
�ereby aHirm tha[ 1 have a cer[ificate oT consent to selLinsure or a cerHficace
. Workers' Compensatlon Insurance, or a certifietl topY Ihereof (Settlon
3800, Lab. C.) .
Policy No. Cbmpany
BCertliietl copy is hereby (urNshetl. '
Cer[ifietl copy is (iletl with the city guiltling Division.
Date APPlicant ----
EXEMPTION FROM WORKERS' COMPENSATION DECIARATION
(This section neetl not be comple[etl I� the p mit is for one huntlretl (E700) or
less).
1 certity that in lha performance of tne for which this perm�t is lssuetl, I
shall not employ any perzon in any rn r so ecome ubject to the
Workers' Co(np 9$ati ws of Calitq i�
Data r�( —�S�9nature
NOTICE: If,'after makinq this tleclarat you houl bec e subjett to the
Workers' Compensalion provi5ion5 of he Labor Cotle, yo mus[ torthwith
'� comply with such provl5ions or th�s permlt shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV "
I h¢reby atflrm thal thlr¢ Is z con5trucqon lentling a9ency for the performance
ot the work tor� y�hich- this perm�t is issuetl (SecHon 3097 Civ. CJ
l.entler's Name J'_:�h
l.enCer'z Atltlress
OWNER BUILDER DECIARATION '
I hereby affirm that I am exempt from jhe Ctintractor's License Law for tha
a
erefrom antl tbe basis for tne anegetl exemp[ion. Any vioiat�on oi Sacnon
031:5 Dy any appllcant for a perM{t subjectr -the appllcaM to a civll
en y of not more tnan five hunGretl tlollars ($500).
I, as owner of the property or rryy employees with wages as Ihair sole
compensatlon will tlo Ihe work, antl the structure Is not intentlea or offeretl
for sale (Sec�lon 7046, Business anq Professional Cotle: The Contractor'S
�icense law tloes not apply to an own¢r of a property wno'builtls or Improves
thereon, antl who tloes such work hirnself/hersel! or tnrough his or her own
employees, provitletl that such•improvements are not intentletl or oTtoretl'tor
5aie. If, �owever, lhe builCln9 or improvemen[ is soltl within one year o! com-
pletion, lhe ownar will have tha burden of provinq he/she Eitl not builtl or im-
�rova Portha purposa otsale).
I, as owner of the property, am aXtluslvely contracting with Iicensetl con-
tractorsto construct the project (SectiOn ]044, Buziness antl Profassions Cotle:
The Contractor•s Litense law does not apply to an owner of property who
builtlz or Improves thereon, antl who co cts tor such projects with a con-
tractor(s) Iicense pursuant to the Contr o 5 License law).
❑ I am axempt untler Secflon Cj� & P. C. for this reason
I hereby certity lha I bave reatl this appFica�on antlKf�[e that the aCove
information is corr I a9ree to comply witn all city anCcounty ortlinances
antl state laws r¢I I 9.to builtlmg onstru tlon, antl hereby authorize reDre-
sentdtives Of th t0 t On e dbove-m¢ntion¢0 property for '
inspection purp / �,�
S�9nature + Date
CMF
rise or 55 � �/�-� ,
rev. 7/83 White - Bulltlin9;
,�$ - /� J � '"`-,-bx�sA /�pl- �a / !
TYPEOFCONSTRUCTION- ' rvew ADD ALTERATION REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER q,p, �6
DESCRIPTION OF WORK QDO O�"Q v��C � '�%3' t'�li
S Main
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T FrOnt
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Reer
❑ OTHER
PRpJECT DESCRIPTION SQ. FT.�—OCCUPA �_� � K Right
CONSTRUCTIONTVPE ,�� VALUATION$ �O r g LCft'
20NE GRADING CU. VOS. � ACRES Ping. Fef.
Remarks: � C� Parking R�
Use of Bui
. PLUMBING FEES Planning �
Bar Sink . Showers
Backflow Preventer Service Sink
Backflow Irrigation Sewer Cap �
Bathtubs Sewer Connection
Clarifiers Solar Collecmrsr
DishoYasher � Solar Piping
Drinking Fountains Solar Tank
Floor Drains Swimming Pool w/Spa
Floor Sinks
Gas Service
Interceptars.
Kitchen Sink
Lavatories �
Drains
Reinspaction Fee
Outlets
$25�
eoiier
Duct - Under Ground
Duct-Structural �
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Oucting
❑ ai oo,000 aTu O i oo,000 ar
Reinspection Fee � $25
APP�icant; Pink - Atcounting; GoldBnrotl - A55¢Ssor
Water Closet
Water Heater
Water Service
Issue Fee
Hood or Typel ❑
Canopy Typelh ❑
Refrigeration System
❑aioo,000eru ❑�oo,000
System Repair/Alteration
laue Fee
Automatic Washer
Cooking Unit
Dishwa5her
Dryers ❑Ga
Fan
F.A.U.
Fixture5
Device eozes
Outlets
lectric
2538 �/17/H4
B
Park.Fees $
ELECTRICAL - " ,
Transformer ❑ 15-50.KW
❑ 50+ICW
Meter ❑up to 100 amps '
Meter ❑over 100 amps �
Sub Panei - '
.Morors �0.1 HP 01'h - 8
InaSolar �9-15 HP �1E75+
� Microwave -
Pole Light
Range �
Garbage Disposal Standing Sections
Generator �65 KW �5-15 KW Trash Compactor
$ 3
Reinspection Fee S25 �uue Fee,
FEES
PUBLIC SERVICES REQUIpEMENTS:
. Zoni�g Approved By ���/
Appliwtion ApProved By
Appliqtion laued Bv
$ 3
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK
ELECTRICAL �
PLAN CHECK
MECHANICAL
� PLAN CHECK
17.00 TL
$ 3
SUMMARV OF FEES D'�
$ D � SMIP $
$ �� PERMIT
$ ISSUANCE $
$ ENERGY P.C. $ �
$ GRADING $
$ MICROPILM $
$ TOTAL FEE $ / • �D
$ •
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CONSTRUCTION AND PLA ING
. APPROVALS Permit# �� �. Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Elecirical Service or Pole 52. Pool & Equipment Location
� 2. Soil Pipe-Undrgrnd. � , 53. Steel Reinforcement "
3. '�lectrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit-Undrgrnd. � .� 55. Electrical Bonding � '
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. 'Electrical UFER Grnii. 57. APPROVAL TO COVER-GUNITE � '
7. Footings . � - 58. Electrical Conduit-Undrgrnd. � ' ' �
8. Foundation : �� 59. Gas Pipe, O Undrgrnd., Test ` �
9. Wafer 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
' 18. Rough Electric Wiring � 67. Fencing & Access Approval �
17.� Rough Wiring Sign� � 68. APPROVED FOR PLASTERING
'98. Rough Electrica6T 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. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Frarrie and Flashing ,� .� b e� 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. Gas Service-Final
47. Solar pomestic-Final - ,
42. Backflow Preventer • - �'
43. Backflow Irrigation . �
44. .Landscape Irriqation System ,
45. Sound Attenuation � . -
46. Handicap Regulations ' ,
47. FINALSTRUCTURE&BUILDING ��'j � CC �
48. Special Requirements Completed ,
49. Electric'Release to Edison � • . . . . '
50. Gas Release to Southern California Gas Co � . •
51. CERTIFICATE OF OCCUPANCY �/ � �
No. � Date � �� (=.°-� �- ,i(��Q'Y .
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COSTA MESA QUILDIN'
P.O. BOX 1200 COSTA ,
FETY DEPARTMENT
,CALIFORNIA 92626
For Applicant to Fill in Completely — Use ►nk Only
BUILDING n� ^ 'I. �/yfj✓��'
ADDRESS L / �V '�
OWNER OR �d� O �v�y !
TENANT ��6�C i
ADDRE 5 % ! �7 qi l� � "J
CITY �-6�� �rrA NOL'�
CONSTRUC710N
BRANCH
ADDRESS
AFCHITECT
CONTRACTOF
ADDRESS
TEI.
CITV NO.
STATE CITV
LIC. NO. I.IC. NO.
OF LOT SS X Zp NO.OF BLDGS.
f � NOW ON 1.0T
USE OF ��r���AL
EXISiING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING 4ND WORK TO BE PERFOFMED
7�fA1"f� P,V eLo
I hereby oeknowled8e thot I heva reatl thl� appllcation end stete
Mat tha ebova inforination is corract entl aBree io comply wlth
ell lews rogulatinB building concvuctlon, entl I ahall not amploy
eny peraon in violation of tha workmen's compensation laws of
Me State of Celifornia.
I hareby certify that I am proparly Iican�ed as a contractor untlar
tha Stete of Celiforni siness entl Profaulons Cotla, �ivision 3,
Chopiar 9, entl ihai ue licenaes are In full forca antl effact, or I
em exampt }rom e p vislOn4 Of the S[ota o} CelifOrnia BusinBsf
antl Proteasions C e ivis 3, C epter 9.
Sipneture of
Permlttee
or �^��,C
Authorizetl ABant Daro �
2226 ,
' �"TS'fltd�'�U�2�`�L PERMIT �_T
A.P. No. ii� — o y�— � �
ADDRE55 77��7G %(�//`(� �
UNIT OR
SPACE NO.
!/�' �/FJ'li I LOT /JO� < OI
NEW ADD ALTER REPAIRIMC
OWNER TrRR y �"1i�}"�'1%
USE �
N'GNGGOr'�.�E VALUE
C —/
20NE /
APPROVED \
APPROVEDSETBACKS
PLANNINCa ACTION
APPROVED
DATE
!1
DEMOLI
�"� Zon —�
To BGveK w'`�L�'
DATE
APPROVED
"_� O —���79
THE AMOUNTSHOWN UNDER VALUAT
THE PURPpSE OF ESTABLISHING A PERMIT
VALUATION PERMIT FEE S �
Li�Sf PLAN CHECK E
5 Q�VV
� TAX E
V
TOTALPAID b
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- COSTA MESA BUILDING-SAFETV DEPARTMENT
•. P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
.'
For Applicant to Fill in Completely Use Ink Only
BUILDING — (`T
ADDRESS / ✓
OWNER _ . � �{y
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CITV
CONSiRUCTION
BRANCH
ADDRES
ADDRESS
CONTRACTOF
ADORESS
CITV
STATE
LIC. NO.
SIZE
OF LOT
USE OF
TEL.
NO.
TEL.
TEL.
NO.
CITV
IIC. NO.
NO.OF BIOGS.
NOW ON LOT
Separate permi[s are required (or
electric, plumbing and heating work.
I hereby ecknowledBe Mat I hava reatl this applicaHon antl stete
that Ma ebova Intormation is correei end eprno to comply wlth
all laws rapuletlnp buildinp conrt�uetlon, and I shell not amploy
any permn In vloletion of Ma workman'e compensallon laws of
the State of Cellfornia.
I �ereby certify thai l em properly Ileensetl as e connaetar untler
tha Stata ot Celifornia Busineu and Protessions Code, Division 3,
Chapter 9, antl thet sueh Ileenses ere In full force and eftxt, or 1
am exempt trom tha provlsions of the Stata of Callfornia Business
enG Professions Code, Divislon 3, Chaptar 9.
Sipnatura of
P¢rmlttea
Authorizatl Apent
�,
,:.
6063 6%:I1+/78 277.00 —T !
5063 671'4/78_ '27T�QOLI(T�
I� F�6�'R�P�!T � I A '".,�a
� DATE RECEIVED �/
OATE ISSUED
A.P. NO.
BVIIDING -
ADORESS
TRACT
VALUE
FIHE
20NE NO.OF USE OF NEW ^\
PLAf.LS BUILDING
YARDSAPPROVED VAFDSAPPROVED �
DISTANCE BET
MAIN BLOGS.
VAR. /+
C.V.P.qW
APPROVED
VALUATION
$ if /
J ��
BET. MAIN &
PERMIT FEE E
PLAN CHECK E
TAX E
TOTALPAID S
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� • COSTA MESA BUILDING•SAFETY DEPARTMENT
.. P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BVILDING
ADDRESS T N S
I OWNE G �
MAIL �% � � ! —f 5%
ADDRESS
ST /=SR TEL. �!j-
CITV NO.
CONSTRUCTION — (p 0/
LENOEq �1 V 1L
BRANCN
ADDflESS
ARCHITECT y � �• TEL. _ _
,_
—� 3253 6%LI�%7B�.w•��};��$�n TL+
. ,_;- ._ _ .. ._ . .
RE
FIR
R
FOR STRUCI'URAL PERMIT
DATE RECENED nerc iccucr
�
' AiVqOVED
CONTRACTOR -� � Vp�j� BY DATE
AD D R ESS
TEL. ZON NO.OF USE OF NEW
CITY NO.
PLAN$ BUILDING
rHi STATE CITV �'ARDSAPPROVED VAROSP.p
� LIC. NO. ll0. NO. MAIN BUILDING ACCESSORI
{i) SIZE S NOW ON LOT (FROM C/L STREET) /
�. OF LOT d f.fi FT.
a USE OF . � � /
� E%ISTING BLDG.
vJ _
� Se�+arate perrttits are required for L SIDE FT
electric, plumbing and heating work. ` !�
WREAF FT.
�.., US BUILDING ND WORK TO BE PERFOFMED DISTANCE BEf. BEf. MAIN &
Q MAIN BLDGS. ACCE�. BLOC
� VAR.qW DATE
a �Z i5S1c1Niti.. �F{�1 C.V.P.qW APPqOVED
� APPR
} �
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BLOCK
ED
� i �eraby acknowletlpe that I have raetl ihis epplieetian entl state �
(� that tha ebave Intormatian Is correct antl ep�ee to comply with R MENi': m
� all lows requlating bulidinp coneauctlon, and I shall not empioy n � I
Z nny perwn In violation ot Ma workman's compensallon laws of m
Tthe S<ete of Californie. � m\
3 1 he�oby certify that I am properly Iicansatl as a contractor under SQ. FT. �;+
��
the Stnte of Californla Business entl Profesalons Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m�
Chapter 9, entl that such Iicenses era In full toree and effect, or I THE PURP06E OF ESTABL6HING A PERMR FEE ONLV:
am exempt from Me provislons o Stem of California Buslness a
VALUATION CRMIT FEE E
mtl Pro essions Code, vi C et 9. ��Gsrj � u+
p�p �S m
SI ature f PLAN CHECK E � Q ^� �
0
LL
P rmittee $ TAX S �
U
Authorized ABan TOTAL PAID E a