HomeMy WebLinkAbout801 19TH ST - Building Permits\
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reaecT�ooxess: 801 W 19TH ST
owxee•sx�Mc: RALLY' S HP.MHURG�AS
eooeess: 8525 GIBBS UR, ST302
S.D. , �
619 —576 •2060
�NCNIENDINEEH:
�ooxess:
PEflMITTEE: CAL SELECT BUILDERS
�ooeess: 9300 LA PALMA
ANAHEIM
110ENSEO LONiMCTON OEClAN1T10N: 1 �are0y amrm ttut I am liceme
7000) ol OivBion 3 0l IAe Businw uM Pralessions CaOe. aM my Ga
cmuc.:�51236 ���uc:590765
oate: _� ��� ��ura:
WOHKEPS'COMPEM311TIONOEClAM710N: IhereEyafl t vea�
Compen5ation�lnwrana or a cerliGBO Capy Itw.reo� (�� �� LaE..C'
rrru)—Yoi✓�., �1 i
MJLICY NO.: EXP. WTE:
�caMr�xr� FREMONT INDEM
uxrt:
aeo.No.:
uNrt:
(714)996-3470
CA 92807
iovo
with Sectlon
or a urUfkate oi WOMcrs'
i fRNfietl COpy I5 �IeteEy IunIWeE. � CefltliEE tOpy 6 illE th dry B'I � p Division. �
Date: �IQ � J O ` ApDliant:
IXEMPfION FHOM WOBI�RS' WAIPENSATION OECUIIATION: (iFa ' nxE nd tl tM pnrtit a Id me huntlrN (f100) w lus�.
. I certiTy tlut in Ue pertwmafze ol tM work lar x1ric0 Nis permit o asue0. I s�atl no mD�' NY De� ��Y ��r so as ro Oecome
� sublect lo t�e Workers' ComDensatlon �aws ol Calitamu.
Oala: SlpnaWm:
NOTICE: Ii, alter maldn0 this EecWrztbn, you SMNE Cemme suUject ro t�e Workers' Compenution D«�� ol the LaDor
COEe. yau must IonM.ilh mmpy rriN wcn Drovi5lms or Itis pcmdt stull Ee aeemeE revoke0.
fANBTPOCTION lFNOIMG �GENCY: I herzCy aMirm Itwt Uere Ls a mnsUucthn IenGInO apency lor Ne peAormance ot Ihe vroh tar
wliic� Ihis permR a issueE (Section 3097, Civ. C�.
IEXDEH:
pDOflE3&:
OWNEH BUILDEN �ELIAMTION: I �ere�y allirm tAat I am exempt trom t�e GonUactars State License Law for the tollowin0 reamn
(Section 7031.5 Business anE Profeaional CoOe: Arry ciry oi counry whk� repWres a pertni� to corxiruct. al�er, Improva, Oamolis�, or
repair arry swcture, D�or to Its iswarice, aLto repuUes tM apptican� lor such pemtit to fJa a d0�� state�nt tlw� �dsha Lt IlunSeU
pursuant to tAe prodsions ol IM Comracmrs' State �Ittnse Law (Chapter 9(commencinp vnt� Sectlon 7000) oi ONislon 3 0l tAe Businass
anE Professlam Cotle) or tlwt ANSAe h exempt ��erelmm an0 t�e Oass Por t�e aAepeE exemD�wn. My vbWtion ol SacGw 7031.5 Ey
any apDliwnt lor a DerMt su�lect5 the aDW�nl to a cMl penalry ol imt mom than Iive hunEmO OOIWrs (5500�.
I, a5 owner at Ine DroDeM or my empIq'e!5 wit� Wa�u az clkir SOIe tampensatbn, will Eo Ina wOrk, and t�e
❑ simctura is nat Inten0e0 or otteretl lor sale (Saction 7041, Bus ness anE Protesslonal COAe: T�e Contrectars' Slate License Law
Eces nat apDM ro an owner of a O�opeM � �uiWs or ImD«s �Aerean, m0 wlro Eoes suc� woM �imsell/hersell or IArouOh
his or �er awn am0loyees, OroNEeA I�at sucA ImprWemenls aro nol IntenAetl ar oflemd lor cale. 11. howover the EuilGinp or
Imprwamem is wIE xiIDin ona year ol com0letbn, t�e mmer witl luve the Eurdm al provinp �e/stia Ei0 not Euild ar impmve
� lor Ihe Durpose al ule�.
I, as awner ol IAe DroDerty, am ezclusivery contracWO ��� licensed wntacmrs to wnstmct Ihe Drolec� (Sectlon 70a1. Buslness
❑ anA Prafeuions CoOe: The Contractors' Stata licenu Law Eoes not appry to an owner ol proporty wlw GUA0.s or Improves t�ereon
anE w�o coniracte lar wc� D�ojects c�tA a canVactor�s) Ilunse pursuant to the CanVactors' State License Law). I am aware
IAat p�ool of Ihelr Warker'S CamDenatlon insurance sMNE Ea D��ded lo me.
� 1 am eMempt unUer Section: B. 8 P. C.
lor Ihis aason:
Data: Mnier.
I Oo here�y certiry IAat I am awam ol anA unaerstantl Ne requirements al Callomia Mealtn anE Safery CaGe Sectlons 25505, 25533, and
25534 an0 that I or any future Wnldin0 �+DN� �II rqt (drtle one) neeE to compty vritA sai0 sWte w0a anE Ihe reyuimments lor a
permit tor consimctbn ar motlilicatiw Irom Ne N'r 6uahry Manapement Distdct. NeSiEentlal wnsirucGon aD011cation5 am eMemD� «om
ineu omNsions.
Uate: AppGca�C
i hereby ceniry that i nave reaC tnis appliwtlon anE state �Aat tAe aoove in matlon is cort e/ I a0�e ro co witn all ciry an0 counry
ortlinancesanOstatelaw5relatln0����p���A'au' reprtsenta INbUry.to t uponN �Uwrrt�tpne0
properry �or' pectlon putposes. J
Oah: ^' � Spnatu2:
oriver's tkense ar Soda� Securiry ;v:
166148 W�it�BuilEinp; Greerv—CaEe Enlorcsment; Canery—WWicant; Pink—Ravenuo: GolEanroC—Feeeseor
CITY OF COSTA MESA — SICN PERAIIT
PERMIT NO: SBE 049099 YLAN CHECK NO: 05:181-90 S
CONSTRUCTZON TYPE: PERMIT TYPE: ELE STR SZG
JOH DESCRIPTION : 50SF LUMINATED WALL SIGN
PERM NO: SHE 04°044
GOVT: N SLTP?: N
SQ FT:
PURPOSE: UTH
CLAIM VALUE: 1,000.00 CALC—VALU£: 1,000.00 GROUP OCC; B-2 /
COMMENTS: REFER TO P.C.#3368-90L
���**�r**x*#x�#���r*#;�*�r�*�#���a��r�*a���##��#*�xx�-**�**+r�r�*rr*�r*�*��*���#x*#*�#*�#�r��#
S I G N I N F O R M A T I O N
DISTRICT: 2 TYPE: 2 WALL ILLOMINATION: INT CATEGORY; NEh
DIMENSIONS: 3FT OOIN X 2FT OSIN AREA: 15.00SQFT LETTER HT; 2Q
STREET FRONTAGE 1: 127.00 STREET 1: PLACENTIA AV
STREET FRONTAGE 2: 145.50 STREET 2: 2 19TH ST
PARCEL: 42419112 ZONE: C1 LOCATION > FRONT: X REAF.:
BUSINE5S NAME: RALLY'S HAMHURGERS > LEFT: RIGHT:
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY . 15.00SQFT OVERALL HEZGHT: OFT OIN
THIS SITE ; 15.00SQFT GROUND CLEARANCE: OFT OIN
ITEMS OF ZNFO : 5 PLANTER AREA; O.00SQFT
ITEMS FOR ACTIVITY: 5 BLDG SET BACH: 30FT
COPY VERBIAGE : RALLY'S HAMBURGERS WITH LOGO
PLANNING NOTES: AREA S ITEMS OF INFO F/ THIS FRON'�. ONLY
ik jF #�)E # iE iE 3E iE 3F �7t-ih �N-�lE aF ## iF �JF i! �kiF 3f iF �IE 9F 9f i4 i(-iE it af �M iF it ## ik iF iE iF #�ih iE �(-iF iF It 7E ###� �%iF it iF 3k �lE ### iE iE ## #�E #%# ###%� # it �1t -k lE
D E V E L O P M E N T 5 E R V Z C E S R E Q U Z R E M E N T S
ZONING APPROVED BY w�� DATE;
_. .. - ..=(_Q '`la
HUILDING APPROVED BY : DATE: �
APPLICATION ISSUED BY: a1'� DATE: q��8'�
%dE �)E 3E it �lE � if� jE �7f 3f- iF 3E iE it it dk-0F ## iF•k iF if ## 3EiE jF ##�iki���7F�F�-,jt ik
LEGALIZATZON;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMHING ELECTRIC MECHANIC SIGN SMIP/RE5 ��G�ft'�1DING
PERMIT 25.00 15,00 15.00 •�-
PLAN 16.75 �SOII SMIP/NOCN�RE3f'
• J� � 4
ISSUE FEE 15,00
DUILDING—DZV—> PERMIT ISSUE PLAN—CHECR TOTAL PAIU ', . DUE
TOTALS----> 55.50 15,00 16.25 86,75 86.75 • ,} ,00
REVENUE DIVISION TOTALS--> COLLECTED: 86.75 OVER/SHORT: �" 00
BLDG PMT PLUMHING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PL�1-.CHECR
25.00 30.00 - 15.00 ,50 16.25
iF �iF iF i(� if ii �lk iF d4 iF i4 iE ik iE dF iE iF iE iM1 dEik if �F iF-)E �4 iE if if ik iE �1F �3t iF �IE it �1E iF iE it 9E jk 1F iE-7F�lFi1� it iE 3k dF 9k iF if �lE iFiE iE if # dt �Jk # if-%iE 3k iE iE �k # dF k if -� 3E # iE iF
I N D I V I D U A L F E E H R E A K D O W N -
TYPE QTY D E S C R I P T I O•N UNIT C06T TOTAL COS'f
ELE 1� SIGN/ OUTLZNE LIGHT'SYS��N 1 BR CIRC 15,00 15.00
�; EtdD O: FEES
EXPIRED
Incomptete Inspections O1 OOOc424C�-iGi�ci��� _
. .
DATE: Q;�15/40 r:�,z: ._ .
lydt6 � --- $Ig
. + %
CONSTRUCTION AND PIANNING �� PO . SPA
APPROVALS Permit# Date Inspector APpROVALS Permit# Date Inspector
n,r
i. Temporary Electrical Service�or Pole r 52. Pool & Equipment Location
2. Soil Pipe�Undrgmd. . -,a 53. Steel Reinforcement j
3. Electrical Conduit Utility-Undrgrnd. 54. Forms %
4. Electrical Conduit-Undrgrnd. '' 55. Electrical Bonding
5. Steel Reinforcement 56. Rouqh Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings _ -� 58. Elec[�ical Conduit�Undrgrnd. �/
g, Foundation ', �+�n: 59. Gas Pipe, O Undrqrnd., Test �'��
:� s -
9. Water Pipe�Undrgrnd. j'J ' 60. Backwash Lines, P�Trap, O Undrgmd. �.'
10. S(ructural Ploor SVstem . �:� 61. APPROVAL TO DECK i
11, Property Sewer Line & Houte Connection' � � 62. Backwash & Receptor-Final
12. Se�wer Cap � 63. Heater & Vent-Final
i
13. Roof Drains ' ' 64. Plumbing System � Final � f�i;
14. Rough Plumbing � •� 65. Electrical-Final '�'
15. Rough Electrical-Conduit ,j 66. Solar System-Final : x
� 16. Rough Elearic Wiring � � 67. Fencing & Access ApProval �.
17. Rough Wiring Si9n 68. APPROVED FOR PLASTERING ,
18. Rough Electriwl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Struaure 70. Underground Hydro
22, Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �
27. Frame and Flashing 76. Dry Standpipe - .
28. Lathing & Siding 77. FIXED SYSTEM FINAL
� - I
29. Insulation 78. FIRE PREV. FINAL ' �,
30. Drywall Nailing HEALTH DEPT. REQUIREMENT F` `
31. Plaster Brown Cqat 79. FINAL INSPEC710N ', � -"
- �
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED a
33. Final Eleciric Notes: ?->?�- J Ca` �/' �� ��� �"
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test "'
36. Hood or Canopy I
37. Final Factory Firepiace I
38. Final Plumbing
39. Water Service-Pinal I�
40. Gas Service-Final
47. Solar pomestic•Final I
42. 9ackflow Preventer
43. 8ackflow Irrigation
44. Landscape Irrigation SYstem ' I
45. Sound Attenuation �'� �
46. Handicap Regulations � � I
47. fINALSTRUCTURE&BUILDING If1COfT1 lete.lnspections
48. FINAL PLANNING � �
49. Electric Release to Edison �I
50. Gas Release to Southern Calitornia Gas Co
51. CERTIFICATE OF OCCUPANCY .,i
No. Date I
PNOJECTROOflE55: 8OS W 19TH JrT
OWNEfl'S NpME: L 6 M VENTURES
aooeess: SUITE 1060
1901 AVE OF THE STARS `" —
LOS ANGELES,CA 90067
FflCHIENGINEEP:
aooxess:
flEG.NO.:
UNIT:
uxiT:
, PENMITTEE: SOUTH BAY NEON ( 619 ) 691-8686
aooness: 171 MACE ST A-1
CHULA VISTA CA_.91911
UCENSEO LONTNACTOfl OEClABRTION: I �ere�y allirm ��a� I am licensetl under pronsions o� C�apter 9(cammencing wii� $ec�ion
7000� ol Division 3 al ��e Business an0 Pmtessions Catle. antl my litense is in �ull force an0 eflecl.
ciTr uc.: 054126q STATE LIC.: 4 S 201 cuss: �(` ��+��
�a�e: � ��,Z—.{_� SignaWre: _ �1'�`ti./� —
WONKEflS' COMPENSATION OECIABATION: I �ertDy altirm lhal I have a tetliiita�e ol ConSeni eli� re or a ceM1iticale o� Work¢r5'
fqm0en5dtion Insutance, or a cerlilie0 copY ��ereol (Seclion 38110. LaU. C�.
eoucrNo.: 728994-91 E%P.OFTE: OZIOSI92
comraxv: STATE FUND
-I Cerliiied copY is �ere0y Iurnis�¢tl. C}� Cehi�i¢tl Copy i51i1e0 wi�h �Ae city Building oivjsiyn��
ozte: �—/ 2 — �,/ p.. �� r ��iy""—TC.//
E%EMPTION FflOM WOPHEflS' COMPENSATION OELLAPRTION: (ihis SeqiOn ne¢C nol be comDle�eA i� I permi� is lor one hunOreU (5700) or less�.
I certity Ihal in I�e petlormance o� Ihe work for w�ich t�is permii is issuetl, 15�a11 na� employ any per5an in any manner so as Io �ecome
sublec� to ��e Workers' Compensation Laws o� Lalifomia.
Daie: Signalure:
NOTILE: II, alier making ihis Oeclaralion. yau s�oultl become subjec� Io Ihe Workers' ComOensa�ion pmvisions ol lhe Labar
Coae. y0u mu5i Iotlhwilh tom0ly wiih Sut� O�oviSiOns or Ihis permi� Shall be Ueemetl revOketl.
CONSTflUCTION 1EN01NG RGENCV: I here0y aflirm Ihal I�ere i5 a tOnSlmction 1¢nEing agenCy fOr ihe pedormanCe ai lhe wOrk for
w�ic� Inis permi� is issued (Sec�ion 3097. Gv_ C�.
anoness: FOAMERLY "RALLY' S"
HAMHURGERS.
OWNEB BUILOEB OECUBpTION: I �em0y attirm tAa� I am exempt Imm t�e Cantractors' State License Law for t�e following reawn
�Section 7037.5 Business antl Pmleuianal COAe: My city of coumy whic� repuires a permit to consiruct, aiter. im0��e. aemolis�, or
repair any simcmre. prior to its iuuance, also reQuires Ihe a001icant for such Dermit to lile a signeU statement ihat Ae/sAe is licensetl
pursuam m Ine pwvisions ol the Conirac�ors' Slaie License Law (C�apter 9(commencin0 wi�� Seclion 7000) oi Oivision 3 0� �he Business
antl Pm�essions Code) or thal he/she is exempt t�erelrom ane Ihe hasis lor Ihe allegetl exemption. Nny viola�ion ol Sec�ion 7031.5 by
any appli[anl lor a permi� suhlecls Ihe aOVlicani to a civil penalry o� no� more �han live Auntlre0 tlollars (5500).
I. as owner ol ine pmoeny or my employees witn wa0es as Ineir 5ole campensation, x�ll Ao Ine wark, an0 Ine
❑ simcmre is not intenOeA or olleretl lar sale (Sec�ion 7044, Busineu antl Pwfessional CoOe: T�e Cantracmrs' State Licenu Law
tloe5 not apD�Y �o an owner ol a Dmpeny w�o OuilOs or impmves IAereon, and who does suc� wo�c �imseti/Aerself or ihrouA�
his or her own em0�oyees, Dmvitletl t�at sucA imDrovemems are not intentletl or ollereA for sale. Ii, however the buil0ing or
improvemeni is sold within one year o� comple�ion, �he owner will have lhe burtlen of pmvinA he/she tlitl no� builtl or impmve
, lor I�e purpose of sale).
I.as awnerolt�e pro0eny, am e�clusively conirac�ing wit�licensed coniractors m consimctlhe pmject�5ection 70Ed, Business
❑ ana Pmfeuions Code: 7he Contracmrs' Siaie License Law dces noi apDN �o an ovmer ol pm0erty who builEs or impmves ihereon
antl who conVacts lor such pmiecis with a coNraclorls) license pursuant lo ihe Coniraclors' State Litense law). I am aware
Nat 0��� ol I�eir Worker'S Compensa�ion in5urance shaultl Ge O���deJ Io me.
� I am exempi un0er Sec�ion: B. 8 P. C.
lor Ihis reason:
Da1e: Ownec
I Oo hereEy [eNly ihal I am aware 0� and untlerS�anG IOe repuirem¢nis oi Calilornia H¢alth antl $afery Code Se[tions 255f15, 25533, and
2553< and �nat I or any tuwre Ouiltlmp occupant wiiNm�ll n �(circle onq neeG ta compty with SaiA siate cotles an0 ine reQuirements lor a
permit for conslmdion or moAilicalion imm the Air Oualily Management Dislricl. Residential conslmtlion ap0lications are exempl imm
��ese pmvisions.
Date: FpPlicani:
� nereoy cenily tlut � nave reae ihis ao0���a�ion ane sta�e itut ine above inlormation is wrrect. I agree m compty vnth all city ar�tl wunry
ordinances an0 slalelawsrelatingto Umlaing consimction ana �ereby aut�oriierepresentalives oft�is ciryto enterupontlre aLove-mentione0
pmperi/y lor mspeciion Durposes. .��/ /
Date:l=��%�— SignaWre: ��"'� ��
orive�'s Ucense oi sa+ai sec��nY .: �
�6ai�46 W�iie—Builtling; Green—Gode Enlorcamom: Canary—Applican�; Pink—Revenue: Goltlanrod—Assessor
PERMIT NO: SB 053895
CITY OF COSTA MESA — SIGN PERMIT
PLAN CHECK NO: 03529-91 L
CONSTRUCTION TYPE: PERMIT TYPE;. STR SIG
JOB DESCRIPTION : CHANGE SIGN FACE
CLAIM VALUE: 700.00 CALC—VALUE: 700,00
PERM NO; SB 05384
GOVT: N SUPP; N
PURPOSE: OTH
SQ FT:
GROUP OCC: B-2 /
COMMENTS: "ALBERTO'S MEXICAN FOOD"
*+t********�r+t*�***+�****x�***�-�t�t�r***+�+�*�t�t*�e*�e*�***�e*�*�t�e*�x�+t****�r*a�x **x�+�*******x*
S I G N I N F O R M A T I O N
DISTRICT; 1 TYPE: GROUND ILLUMINATION: INT CATEGORY• CHA
DIMENSIONS: 6FT 02IN X 8FT 0?.IN AREA: SO.00SQFT LETTER HT: 12"
STREET FAONTAGE 1; 145,50 STREET 1: G7 19TH ST
STREET FRONTAGE 2: 127,00 STREET 2: PLACENTIA AV
PARCEL; 42419112 ZONE: C1 LOCATION > FRONT; X REAR;
BUSINESS NAME: ALHERTO'S MEXICAN FOOD > LEFT; RIGHT;
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY SO.00SQFT OVERALL HEIGHT: 7FT 2IN
THIS SITE c SO.00SgFT GROUND CLEARANCE: OFT OIN
ITEMS OF INFO : 5 PLANTER AREA; 100,00SQFT
ITEMS FOR ACTIVITY: 5 BLDG SET BACK; 20FT
COPY VERBIAGE : ALBERTO'S MEXICAN FOOD
OPEN 24 HOURS
PLANNING NOTES:
IF �E it k 1E 3k if k!E IF iFlF if iF ik 3E if �Fif !f iF �1F 3E 1f ik k 3f 1F �f 3f �f �E iE �f 1flE 1E if iE 1t iF if iF iF 3F iF if ik 3f if fF iE k iF �Eff IE aFif iE iE il� ik �E �F iF iE 9k iE it �E �E 3E fE If iF if if iE
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; 9/� �
BUILDING APPROVED BY : DATE: 9/-2 9
APPLICATION ISSUED BY• DATE• ��
aFiEik�lhifiFiF1E�E�Fi!lE1flt�EiEiF�lFk�fiElE iEaFifiFlEiEifiEiEk iEfF
LEGALI2ATION;N F E E S U M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP�/RfiS GRADING
PERMIT 19.00 10,00 " �
SMIP/.NON—RES
PLAN 12.35 -,50 "
ISSUE FEE '
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL `�PAILIs DUE
TOTALS----> 29.50 0,00 12.35 41.85 41,85� ,00
REVENUE DIVISION TOTALS--> COLLECTED: 41.85 OVER/SHORT.;�, 00
BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRAD:ING PLAN—CHECK
19.00 50.00 ,50 12.35
i
i! iE 3E if ik �k iE iE if ik iF iF If iF iE 3E IFif k if 1F �F ib iE if iF iF if iF 1k If if iE k k k iE iE if 3f IE k iF if iF It if 1EiF itif 3F IE �f iF if �F if k if if itr if iF iE 1F iE iE 1E ik IE iE iE if ik if if iF 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
�� E �r��i �Ii f,
N E SEIiEC_• ED
�ncomplete Inspections
,: �;
:'�$ - "n
uate _ ( ---
s�8
UNIT COST TOTAL COST
FOR THZS PERMZT �
ai aco9�cn9-;,co�;ci� -: r_� -
QFT�� �9/iZ'91 T;Fi's: 13'i;� �
��;� CONSTRUCTION AND PLANNING
�� APPROVALS Permit # Date
,.
1. Temporary Electrical Service or Pole .
i- C'
2. Soil Pipe-Undrgrnd. ���• x v '
.,,
.i3.`E�'cttical Conduit Utility-Undrgrnd�.-'� f
>•9:%ElectricalCondui Uadrgrnd.� ..�:;
�,��,'.:Stg�l f:einforcer�pept� ' _
��.: . - •,�- .
r,.5.r_Electrical UFEFt �irnd. •
',7-; Foolings �;o.` '_� ,'
9. Water Pipe-Undrgrnd. �i: !'/+
,�
10. Stwctural Floor Svstem � � `�
i
11. ProFrErty Sewer Line'& HoUze Gonnection �
,., r�
12. S?wer CaP `y - %
� -_l� y , ",
13. Roof Drains ��� ,�
14. Rough Plumbir}g, ' i-� � ��
15. Rough Electrica'I.Conduit .j'
�c
16. Rough Electric�Wiring
17. Rough Wirinq S�n
18. Rough Electricb�T Bar Ceiling
.
79. Rough Heating & Air Conditioning
POO :PA
Inspector qppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
� s54. Forms
. �c
� ;:55. Etectrical Bonding
�� r56. Rough Plumbing & Pressure Test
c ;i�7. APPROVAL TO COVER�GUNITE
58. Eiectrical Conduit-Undrgrnd.
� 59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
' 62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System � Final
65. Electrical-Final
66. Solar SYstem-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOI/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
,..i S �, _ - � :n. . .�, �
Date Inspector
t
i'
�.
�-�-
, i
�: .
•1
. �
�,i
i/ �
.�
.. �/.�
20.�rfioughFactoryFiieplace��-�: '��r:..: : :-C � -! G .APPROV_ALS ��' Pei�riif`� �� =-
�., !•> ; : i S u' �' ltr ti � r r. J. '�x � �- z' 3: N� :>
-ru �-� .�r �Y � ." �i
21.�DuctS,ir�Stryctui8� �;g.;�,i,�,SC i�i�� �:x 5 70.�-Lindergrouad Hydro��: .� �� r I
22.�Dudt3, uentilatin9.' `'� "' ��' �� �'r�' =��k ✓ 77.'°Pio � ct Piping O'G;�s' ��Oil' .. �I
_ �. . ...Yrv+ •�: r. 'mr� �.., t'i 9' ..� � �z. r
23. Gas'PiPe'�Rough &'Test =�''%`'. :r " ''' ° T - ' � -� " _ i
- n;:'- �•.S � � . � S72•"Ur�derground Fluslr,; . .
24.�Rool.Framing� Sr -� s '- *r'f�`C �= 7 �� =73. Undergr�id.Storage=Tank qGas' OOiI �'
^ n�7.•Y r� u r �-a '1 t. i.S �
25.•TRoo�,SH�athing . � ,�;- " 7 ; �' ' '��� �74.;�Overhea� Hydro � �;� �`� r �'
26.-T-Bar Ceiling (Struciurall & MonocoaP � - �=751� :Dry Chp,�nical V • • '-'
i. . .- .....: . ...l. ._ .- ,_ . - . .,
27.�rame and FlashiRB� � � ._,�; �� �� � 'a � .�- ' j76. D Stand �i e �' �` '' :-��' �r `, r. _
z_fY P�P :c::,- -•W �.
28. Lathing�$ S[dings,: ��;z- ; �n. 'r' ;� y •• •77, ••FIXED'SYSTEM FfNAL��^ 'F _ �
29. Insulati� "K� _..•-l-"1PJ •�.:� �'�' v.:t ( ' i � ^� �
M `: . p,J . . _c _ > � / ,78air�IRE PHEV. FINAL i ;�7 .. .- �r t'•�� e>
30. Drywall:Nailiag ^.. :.'o .. � x � ,,f �; %'� LHEALTH DEPT VREQUIREMENT !�; _'
'31. Plaster �rowP,Coat; " E` ,'�-,:, ��Ci � �j_ �79; F�I.NFrL'INSPECTId� u; � C T •;„ �
, ..
`32.-Electrical�Power Meter Final :S , ^ z:: ��' 80,��� OOD OERTIFICATE ISSUED � x� �
i33.�final Eleyctric ` ,r; S_
,34.-Final: Heating:& Air'C fditionin�
'35.;Final Gas Pipe-Test�� ��
l'y
,36.�Hood or Canopy - .
'�7."FinaY�Factory Firepla�e '�;
ry;
. . Y �r �
;38.�Fin�l:Plumbing g, �; .•r�:�
:39.'WaY2r Service-Final��- �-
n ... ^ ..i.�
;40.`,Gas�Service-F_fiial r ��� ' ��
.� ->
.� 3!x7 - rir, tn S -s' a .
7 � NOLe1�. .. - _ , �
C :e � �. ��� u 'S .. i S ' 7
�� ni
- r ~ �. . I ,7j � ^ -� i,S .< r 'l
>.. � i,'.. kl. � .�: _._� � ... ,
a '/ 4 ' �
� A� f %. .i
, ,4 . � 'r `.`i
x� tn ; ' �ir �' � .r� . r��
-�. , � , �' �L • O
.�� I
'�' � Jm .1 ,_ Y.'L
^:
��i � �3 .t ! �(� r . - eL�l^ Y C. �
{:.'n . + �:. I �' >' -. c� �
�S :i!1 x l�� I 'r _N � i '.�
'41.•Solar pomestYcFinal ' ' - - -�' < � . �}" - ' T N
p ♦ -C fT � Y v J- '' T C '%.
/. 1 S L i'T.�• ' �" M .. '
42. Backflow Preventer., • '_'r n r� x� � 4+' CJ • �� ' e� '
43. Backflow Irrigation� _�.-N;- �G� Sz.� � y :�: � �' � �^�.-.� � ,_ ,� .
:. `: v "*c.j: < s. .� - ��1 � s �.
;J44. Landscape ILigatio� SYstem t;_C . . ., q �•t •� , - : � :x 0.r �»D � R E D G �' .
- - . ` - > r :. -' 'F 5' -- ' �. E., ' ^ ; �" "� ^��,�.,�5 �
>45.C5ound Attenuatiori'� „ ,� �,� ;G �. -._,.nm018L8�,�, Fiy/� ,y
n� r� r-:� 7: �..
� . � � �r'- S: L�:i„' �
:i6.'.Handicap,Requlations . .. .... .,, -�,�
;� _
�47.�F INAL STRWCTU RE &�&UI LDING
l i �. ?�i! Q
IAL PLAroNING„ � " y. -,-`�
:tric Release to Edison •r
-flelease to SoufF'iern California Gas Cv
4TIFICATE OF,OCCUPANCY
� Date
�,
y :j
t
0
N
PflOJECT ROOHESS: $ O 1 W 1 9 TH $T
OWNEN'S NFME: j� S M VENTURES �
nooeess: $UITE 1060
1901 AVE OF THE STARS
7�425816pgS,CA 90067
APCNIENGINEEP: . HEG.NO.:
RUDHESS:
UNIT:
UNIT:
PEflMITTEE: �AL SELECT BUILDEAS ( 714 ) 996-3470
aooness: q300 LA PALMA
ANAHEIM CA 92807
IICENSE� CONTflACTOp OECIABATION: I �ereDy aflirm Ihal I am license� under Omvisions ol Chap�er 9(commencing with S¢clion
7000� oi Orvision 3 0l ihe Business antl Pmlessions Catle, an0 my bt e is in full force an0 eifect.
c�rvuc.:051236 STATELIC.:S9O%6 CIASSjJL��� /
�r� ��.�� `.��_ ., i .
Dale: � �=..➢--P� Signaiure: /YI! (;i1W�---•�—�
� WOPNEBS' COMPENSpTION OECLAPATION: I here�y af .. n t� t I AaveVertAicate o nsem �o selbinsure or a cenilicate oi Workers'
, Compensaiion�'�j cp, or G,, i e Ihej=�°%�ISection 3800. Lae. )
POLICYND.:^r�V—�tl����—V` E%P.OpTE: OIOZIII
comvaHr: FREMONT INDEM
❑ Cetliliea coDY �s qere0y fumishea. SLG Cetli�ietl ca is lilr . v 1� the cir uilGin �' ion.
�Date:/ 2 ^.�. �( � FGVliwn �
E%EMFTION iPOM WOPkEHS' COMPENSATION OECIAflAT10 : Q�i55eclion neetl na1 be complete0 i� the permi� i51or one hunOreU �E1001 or 1e55�.
I renily ihat in @e oetlormance o1 ihe work lor which Ihis permit is issuea. I shall not employ any p¢rson in any manner so as to become
suble�� �o Ihe Workers' CamOensation Laws OI CalilOmia.
Da�e�. Signamre:
NOTICE:I1. alier ryiaking M5 detlarali0n. y0U ShOuld beCame SUGlett b t�¢ Wofkers' CAmpensation 0�o'/�SianS o� the LaOor
CoOe, you mu51 IOnhwilh comply wiID su[b prDvisions or tlus permil s�all 6e deemeE revokeC.
CONSTPUC7IUN LENDING PGENCY: 1 hereby affirm tAat ihe�e is a cons�mction lending agency lor �he pedormance ol tbe work for
wnich Inis oe�mit is isEued �Sectian 3097. Civ. CI.
LEN�Efl:
AOOflE55:
OWNEB BWLUEB oEL�pqp710N: I hereby afiirm �hat I am exemD� ��om tAe Coniracmri Slate License Law for �he following reason
(SeCiion 7031.5 Bu5ine5s antl Pmlessianal CaAe: My Ciry al couniy wNth r¢quues a permil IO wnsimct, alleL imprwe, demoli5h, or
repair any simcture. prior ioits fuuance, also reQuires the apDlicant lor sucn permit to file a signeU statement tlut ne/she is licensetl
pursuam ta ��e pmvisiuns ol Ihe Contracmrs' Sia�e License Law (ChaD�er 9(commencing wi1M1 Seclion 7000) ol Division 3 0� Ihe Business
and Pmlessons Code) or t�ai �e/she is exempl Iherelmm antl ��e 6asi5 tor �he allege0 e�emp�ion. Any violation a� Sec�ion 703L5 by
any appiicant for a permil sublects I�e appiicant lo a civil penalty ol not more ihan live �unOreO tlollaR (5500�.
� I. as owner of the pmoeny or my employees wilh wapes as lheir sole comp¢nsation, will tlo Ille work, an0 ihe
❑ stmcmre is na� intendeA o� olterea lar sale (Sectwn 7044. Business an0 Pmtessional Cotle: The Contractors' State License Law
tloes not aD��Y to an owner af a pmpeny who builds ar impwves tAereon, anE wlw Ooes such xrork �imsell/Aersell ar t�mugh
� �is o� hEr owq employees, pwvitletl Ihai such improvemen�s are noi inlentletl or offeretl br sale. Ii, however �he builtling or
imD�ovemem is saltl wrthin one year ol com0�etwn, Ihe awner vnll have the Ouraen ol pmving he/she Oitl not �uil0 or impmve
lor I�e pur0ose o� sate�.
p I.as ownerofihe propehy,am exclusively conirac[ing wi��licensetl con�racmrs�o consimc���e pmlec��5ec�ion 7044, Business
,� and Pmleuions CoOe: T�e Coniracmrs' Sta�e License Law tloes not apO�Y �o an owner oi pmDerty who builtls or impmves �hereon
- ana w�o conlracts lor sucA Omjects with a coniracmr(s) license Dursuam ro t�e Contracmrs' State License Law). I am aware
I�al pwa� ol �peir Worker's Gompensabon insurance should �e pmvi0etl lo me. �
� I am e.empt un0er Sectian: B. 8 P. C.
I IOf IhiS r¢d50q: .
�ate: Pwner.
I tla hereby cenify Ihal I am aware o� antl untlerstand �he r¢quiremen�s ol Calilomia Healih and Sale�y Code Sections 25505, 25533, anA
25534 anA Uat lor any Iuiure bUiltling otw0anlwill/will not(Cirtle One) n¢¢tl�o Comply wilh 5ai0 Slale code5 antl�her¢quir¢men�5for a
permi� far conslmclion or modificalion fmm Ihe Pir Ouah�y Managemeni DisVict. flesitlential consimc�ion applicaiions are exempt tmm
inese O�ovisions.
Date: ppplicam:
I hereby cetli�y IM1aI I have reatl �nis aOPlicalian antl slale Ihal� aboveinlo� ation�r .. I agree to ply wil� a0 ciiy antl county
or0inancesandstalelaw5relatinglo�uiltlingconsimclionanah rebyaWho' e prese es Ithisciry e ruponll a0ove�men�ion¢d
properiy lar ins0eclion purposes,
Date: _��_��._ Signaiure _ _
onver's �icense or Sociat Secunry a: /
16a1-a6 W�ite—Builtling; Green—Co�e Enbrcement; Canary—ApP�¢anl; Pink—Ravenuo; Goleenr —Assessor
CITY OF COSTA MESA — SIGN PERMIT R .
PERMIT NO: SHE 050156 PLAN CHECK NO: 06967-90 S G 1: ,
CONSTRUCTION TYPE: PERMIT TYPE: ELE STR SIG PURPOSE; OTH
JOB DESCRIPTION : ILLUMINATED WALL SIGN SQ FT:
CLAIM VALUE; 500.00 CALC—VALUE: 500.00 GROUP OCC; B-2 /
COMMENTS: *
�r*****�r***�r�r*�rx�r�***�r*�e********�+�**�**�e�e*�r�r*�r�r*�r�r�r�*********�e**�**�r*******�r*�r**
S I G N I.N F O R M A T I O N
DISTRICT• 1 TYPE: WALL ILLUMINATION; INT CATEGORY; NEW
DIMENSIONS: lOFT OOIN X 2FT OOIN • AREA: 20,OOSQFT LETTER HT: 17 IN
STREET FRONTAGE 1: 128.00 STREET 1: LT 19TH ST
STREET FRONTAGE 2: 0,00 STREET 2;
PARCEL: 42419112 ZONE; C1 LOCATION > FRONT; X REAR:
BUSINESS NAME: RALLYS HAMBURGERS > LEFT: RIGHT:
O T H E R T O T A L S G A O U N D S I G N
THIS ACTIVITY 20.00S()FT OVERALL HEIGHT; OFT OIN
THIS SITE c 100.00SS3FT GROUND CLEARANCE; OFT OIN
ITEMS OF INFO : 2 PLANTER AREA; O.00SQFT
ITEMS FOR ACTIVITY: 7 � HLDG SET BACK; 20FT
COPY VERHIAGE : RALLYS HAMBURGERS
PLANNING NOTES; DELETE SIGN B AND AllD SIGN L
IF * if �E �F jf iF �F iE 3f if If 3F �f if if k IE iF af iF �E if if ik iE li �E IE IflF �f iE if 1F iF if iF if iE if If iE �f IE iE If M iE iE iF iE iFif if 3F if IE iE if fE iF if iF it aF if 1E k K iE if it iF If �E If if 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
20NING APPROVED HY � �Q-- DATE: ���
HUILDTNG APPAOVED HY : � C. � DATE: _,LZ�_''_
APPLICATION ISSUED BY; � C—C- DATE:
�e�■,e*�r�r***�t�t*****�t�t�t��t ���*�t*�*�e**� ! �e% �t*
LEGALIZATION:N . F S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN ,�SMIP/RES GRADING
PERMIT 15,00 15.00 ' 20,00„, •
SOt SMIP/NON—RES
PLAN 9. 75 r'.'.v , 50
ISSUE FEE 15.00 ''
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 50.50 15.00 9.75 . 75.25 75.,.25 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 75.25 OVER/SHORT: 00
HLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
15.00 30q00 20:00 .50 9.75
t.
�**'�ii'**ieii �it*ir*'iei%ii'ii'irx**ie*+�ii i�'if �ei�4Eie �r* K'*ii �*+�*ia*�ri%ieair�t*�c �ii'ie �+�if*if �rie* �* �ii'� � �*�'iE***if *iei%
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY j ll E S C R I P T I O N� UNIT CUST TOTAL COST
ELE y'. 1 SIGN/E�[f'!'�.RIFFE�LIGHT SYS ON 1 BR CIRC 15,00 15.00
�L. Incomplete Inspections END OF FEES
D2tE r — — $� ... � . •
■
�
oi oan�sao�-eoo�s4�i �ez�z -s.2=.
DATc': Y2/03/90 TICI�: 15:`6
CONSTRUCTION AND PLANNING POO�
APPROVAIS Permit # Date Inspector qppROVALS Permit # Date Inspector
. �
1. Temporary Electrical Service oi Pole��,. . 52. Pool & Equipment Location ,'
2. SoilPi e-Undrgrnd. �� �'b7 .
P � ,,.,�s 53. Steel Reinfarcement -
3."Elec�}ical Conduit,U[ility-Undrgrnda`�',' i' 54. Forms �,
^4'.�£IeaiicalConduifUndrgrnd. - 55. Electrical8onding �.'
r .w -
� 5� Stee� Reinforce9�eni' �,,� 56. Rough Plumbing & Pressure Test �
-�.�6�.CEIecYrical UFER Grnd. ��' ��: 57. APPROVAL TO COVER�GUNITE �-
rn n
�` Z.. Fooungs ;� ,- �:� . � � 58. Electrical Conduit-Undrgrnd. • • �•�,
�� 8. Fountlation y�� ��.,,;,_ '� 59. Gas Pipe, O Undrgrnd., Test ..
� - -
9. Water Pipe-Undt'grnd. ,� ,� ' 60. Backwash Lines, P-Trap, O Undrgrnd. �'
10. Stiuctural Floor�System �!'" _ , r 67. APPROVAL TO DECK ,,�
1 t. Property Sewer Lin �& House Connection� �� 62. Backwash & Receptor-Final .
12. Sewei Cap �
. 63. Heater & Vent-Final • J
�,
13. Roof Drains � � , r� 64. Plumbing System - Final ,� t
14. Rough Plum6iAg � � 1 �;± 65. Electrical-Fina4 �
75. Rough Electrical-Conduit " . '_ 66. Solar SYstem-Final i�
16. Rough ElectricNliring . ,� 67. Fencing & Access Approval �
i�.
77. Rough Wiring 5.Lgn ' 68. APPROVED FOR PLASTERING '
18. Rough Electri '-c�1�T Bar Ceiling - 69. POOL/SPA SYSTEMS FiNAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
_ - - � - t �C� 'T �:: x .- ;^
20: Rough Facto��y Fiieplace c- -�t�^ 'ct" -F.;, � "ApPROVALS �• Perriiii•# `� ''` -
> ':J : ° :?.C.�'7::1:..0 �ti i:�7<<1G :-t _ �" . '.i: ..[ i' - > ' T
, � . . LS.�t:�'i i- P.�'�...[. • -� � 'i ) �'. _�. l�
21.'DuCCs,imStruCtu�s: ;�.,�-rn�;n,�L ;Vpl �'� 5 �0: UndergroundHydro'��
22. Ducts,Ventlating-u � +� � �a:,-' �0:�':� °'n ^ 5 .� �
c c r� ?7 -m,-i.z i.� o .t -���:-.�,�°duct Piping q.Gis: ❑Oil�
23 ;Gat PiPe-Rou h &�Test J '4'U'a. "'�' "`s'• �. ' r,x (_ .- � p�_ M '
_ 9 �._.�,;.a � 7�-. r � y =72 ,Underground Flustr i
24.�TAoof Framing ti �_` 1 2. _� uT :� �� � l -73 .Unifergrnd. Storage;Tank O?Gas � Oil `
}...r�7•r .. -. �::r, r C'i y Sv� � � Y ti.L <
25.`Roor,f Sfi�athing - -�,;,-..,�,� j .. � �; j7q:tiOverhea5l•Hydro � . �-
�
26. T�Bar Ceiling (Structurall��&•Monocoat [N� . ,� v � � ��755!,Dry Ch��al, • � ' _ :'� °'
2T.;FrameandFlashing` d�...:i�=. .•..`'Z ,�:'` �6._.:-. � r' �:'- =� '�s .
�-, Y r�Y StandpiPe� r-� ,� . .
.� .r - tn.,-� v�• - �
28. Lathing�Siding � �S� •- �<s�r '�'�. •�7�•FIXEDSYSTEMFINAL�� +�v - -
....T ,,. ••� n � , �
"�29. Insulation `1 � �- '��"'.�^� �'�' � Y �� .YB...FIRE PEjEV. FINAL � ��e! J � � '
Y l� .. 7:�: ;1: .� � � � � %.
'� r _.. 00`'J:JO� : s �':� .. � i
T30. Drywall�-Nailir�g -ti HEALTH-DEPT.R�EQUIREMENT � :�
' / I. n"..
�`31. Plaster Biown CoaYx �� r y � � � �:; � � � �� �-� 9.�F�INAL'INSPECTION`j , ', `' ' �" �
S. �:
�-32:_ Electrical Povner MeierFinal �,�: ; � , � ; _ • 0.: � -
_ �:I �80;%, OO.D CERTIF�CATE ISSUED t _
- - y • :� �: �'� N ' �r ?7 5 � �•' ' t-i; �r7 cr � J' :!' ~ - �
�y33.�Final Electri� S � ,�-, � Note'�t; ��,y _ - ,,. - _
.�, :
��34rFinal Heatingti& AiqConditioningi . y: i.,:�' �� �;hr .� �-i, .5 �^� = S 7%'4 �
� . i. n• •� -"" - -
�35 �,'•�Final Gas Pipe-TesY�` :r � -� '-.+ 1 �:.L ' }� '��" - � �' ,T' NC
� ,n ��., I I� �� a.� a -
�36.�Hood or Cano ' �� `� . . • : . � � � �� 'J �-- . .. � • `" .,
. PY w � i' . . • i � la S. ?: .t� .i � > '
�z+� n
'•�37.=Final FaciorY FireplaFey ���`J - .'n ; � �� � ^ ;" -
�rr ;G
538.�Fina( Plumbing •. _� ::.i r��r;•.',,- i= r.- � I�� i µ � i-c �_ r,
�:39.: Water Service-Fina�e :,:?: � ' l �" �� ' ' ��-}`� �, ' • �vSc r ~ ^
in -r rt, u;[.. ;C"'] � �� •_.
� , ,,
s40."Gas-Service-Final ' �-'"''-" " `^ ^ " "" � �
s. • •_C,u O•S •t:.i .n t ,�:� ^i .. }i; �
.Y
� !
; 4L_Solar pomestic•Final .� - :�--[+= • . '-
� � '� .�•r�- � c � � � k: a:_, �=� � x
42}�Backflow Preventer; . �'• - ::' C�` :� � I � r .^v :i r ' �
i ^ - 'ii' i'. � � � � .fi
43. Backflow Irrigatiom� �•�: � rCJ;�sr�y r � E`X P I R E D�'" ^`' �
:s r.-, wac .;� .'
:44. �andscape liripatio� SYitem - �r� �; T v - `� neomp ete �S� 10�5 �} r -
<'95 �Sound Atterivation� ,-i �. :�,:. - : %�; � "' .� � � � � .l ..� �. .
� :r� , r. l}dtE- ' �Y...a.�
:46tHandicePRegulations ���r; s:`"""' `� .. .:'" � y ;: ...
�,.�: � « r �; S -'�' S
47 �PINQL STR.UCTURE &�BUILDING ��� •� � -? �,� �� ��� �o �
a. � i -
;-48PFINALPLANNING_ ' ":' •` • •� r :':. `: V '
�, � i -in_ . C� :�'. � ) /� . ,:i C
-49.�=Elect'ric Release to Edison �' ' p� r '�: _, !� % < f: 6c � � • _
�I i�x i,- ,_r •-�
// �' ' r S � o.:. a, �..� � r�
�50.tGas.Release to Souihern California Gas Co . �� �, , , . � . �>;�, . ,r
_51. CERTIFICATE OF;OCCUPANCY , ; �. ;; -•j . _ . : �
No. Date
Pfl0.1ECf ADDflES3: H O L JI 1 9 TFI ..ri T
OWNER'SN�ME: RALLY'S HAMBURGERS
�ooeess: �i:, ', •i2bPF� L�hr or.j(1_
S.iS.
619-576�2060
RflClVENCINEEH:
�ooxEss:
uxn:
x�o.xo.:
UNI7:
PEqMimE.�4300ELACPALMALDERS (714)996-3470
nooeEss: ANAHEIhi CA 92807
LICENSED CONTMCTOH DECIAMTION: I �ereCy allirm tlwt I am Ilcensea unEer D�ovisions ot CAapier B(commencinp wlt� Section
7000) ol Oivision 3 al ih¢ Business anC Profettions COGe, a E my Ilc is in NII torce and eNeq.
cirr uc.: 0 51 Z 3�Gy� sT�re uc.: 5� 9 0 7 6`_ u�: Y
Date: ���=LQ C Si7namre: en i� l�.�'-��a.� - �
WOHKENS' COMPENSAtION DECIAMTION: I �ereDy a irm tlut I luve a artif¢a[e ot consent W uJbinsure or a uNlirate ol Workers'
Compensation.lnsuranu a� � sertiGeU eopy ttrereol (Section 3800, la�. q.
rmicywo:r'r"� "' "" "• ocv oerc: iJ/O1/90
•.wPµ�. FREMONT INDEM '
znifiepd wUY ¢ hel�bf Iumahe0. �/ CertilieE cWY ���etl �xith I �dN &n1 p ONtion.
o-a�e: /��-��.- C/� ` nppticant: i�.�i ..lost L�a/���� /
�v�rox �xon� woxKCHs' mur[xs►nox o[uuuTmx: (ma sxum �a ee mnW � oemn e ror one numrea ISioo� a 1.
I certiiy tlut in tAe peAorr���a a� Ne work lor wAkh IAis pemtil is �sweE• I sha0 not empby arry persan in any manner so az to 6ecome
�� suCject to tAe Workers' WmOensatian Laws af Califamia.
Date: S�pnatua:
NOTICE: tl, afler maFJn7 Nis EeUaratbn, yau sIroNO Eecoma subl� ro t�e Warkers Compensatbn D��ons oi tAe labor
CoEe, yau must ronhwitn compy vri�� suc� pmvisions or tNs Dermit shail Ca OeemeO mvokeU.
CONffiPUCTION LENUIN� ��ENCY: I hereEy aifirm tAat them is a cansiructian lentlinp apency tor the peAormance of IDa woM1 lor
wAicA this permit is iuuea (���n 3097, Civ. C).
lENOEP:
nuoxEss:
OWNEB BUIIDER OECUN�TION: I �ereEy affirm WI 1 am ezempt tram ttre ConVaclws' State Lkeiue Law lor tM fdlowinp roason
(Seclbn 7031.5 Business:�d VrofessbrW Cona: My dry o� counry wtoch re7utres a permlt ro w2sirucl, atter, Imprwe, demolish, o�
mpair any SWclure, D�o<<a its issuance, also repwru Iha epD��� �o� wU pemtit to �la a siO�eE atatement ttat �e/s�e I511cen5eA
pursuant ro Ne D�� a� ��a Caniactors Stata Lkease Law ICtuDter 91�mmmanp wi[n Seabn 7000) ol D'Msion 3 0l tne Business
anE Professbm COEe) w wt I�e/sl�e b eKempt IMntrom �nE tlre Uam Iw the �OepeO aempibn. My vioutlon ol $ectlon 7037.5 �y
anY appfrcant lar a vermit suElats Ne �pplican� to a dvil penalty ol not more Wn Ibe �unEreE tlallazs (`�1.
I. u owner al Na O�O�M or rtry e wR� wapes u UKir sde compemation, wiA tla IM xork. anE IM
❑ swcture is wt interWeO or ollere0lor sale�707d, Businar an0 Professio�ul Cotle: 7M fqnVaqors' Staro License Law
Anes not aDDh �a an ovmer ol a Oroperty wAo �uMs or ImOrwes t�eaon, aM wAo Eoes suc� vrork Almsell/�erselt or IMoup�
tus or �er oxn emVbY«�, P�wkeE Owi sucl� �mD��menis are irot inteMM or ottereE �or sale. Ii, Ipwever IM OuilEinp or
imD��'ement IS SOIE wlWn une year ot compleUon. Uie owoer will luve Na Curden ol OroNnO �� a� not OWItl or ImD�%'e
' br me ouroose a�. uiel.
I, az awner ol I�a D�oDerry am uGushery contractlnp with IkenuO wntncton to construct tAe pmject (Sectlon 7044, Business
❑ antl Professiarrs CNde: The Contractars' State Lkeme Lxw Eoes not zDON to an wmer ol proper1ywlro EuilOs w ImO�s Iherean
an0 who contrzcls�or sucA projects wlt� a conVattw(5)liume Dursuant ro Ihe Cantactors' State License lawj.l am aware
Ihat D�oof oi Nei� K'orker's CompensaUon Insurance S�ouIE Ce D�eO to ma. .
� I am exemD� under Sectlon: B. E P. C.
for this reasan: '
Oate: Ovmer.
I Oo nereby ceniy ttut I am awam oi anE unAerslmE tAe repuiamenis ol Califomu Mealtn an0 Salary CaOe Sections 25505, 25533, anE
25531 an0 inat t ar any IUfure ONIOinp occupant wiNw10 not (cvde one) neeU ro mmpy wit� saiE sute w0es arM ��e reQuiremenis lor a
permit lor construclion N�nEifiratian Inm the Atr�ua �ry MuwOement Disirict. HesEent¢I constnwtlon apD���:��wis are exempt tram
Iheu Druvisiont.
��e: ��,:
I nereEy certiry �lut I Iww rea0 tNs ap0lintion aM suta ttat Ne aEwe
artlNarrces an0 state laws �eW�Pq ro OUACmp� aM trerA
propeM for incpectun W�Dous.
Date: � ��^'�� Sipnawra:
Dnver's Licenu or Social secunry x:
to comDA'�^Fatl cib anC
18413fi W�ita--BuilEi�g: Grlen—CaEe Entortement; Cenery—qpplicant: P�avenue; GolOanroC—Aaseuor
CITY OF' COSTA f4ESA - SIGN PEAMIT PHRM NO: SHE 049043
FERIIIT NO: SHE �49043 PLAPI CHECK �10: 05780-9U 5 GOVT: N SUPP: N
�'�7I1"dTFtUF''TIC1P� 'I'Y�'�'E ?�kF12T T`YP$; �I,E �TEi cTB p'C7ar:�•c�: �TH
JC+P L�ES�RIPTint� ;�-7,y5F LpMIyATEP WALL �IGN5 SQ FT:
CLAIM VALUE: 500.00 CALC-VALUE: SOO.UO GROUP OCC: H-2 !
COMMENTS :' � P C- k 33(on- 2� L
*a*�+��r*��**�, �e+r�*��r**x+��r*#��c**�r�rx�***�*******�**+����**tr�##�r+r�x#**+����****���**�
S I G N I N F O R M A T I O N
DISTRICT: 2 TYPE; WALL, CONVENIENCE & MENU ILLUMINATION; INT CATEGORY: NEW
DIMENSIONS: 8FT 02ZN X 6FT 02IN AREA: SO.00SQFT LETTEit HT: 20
STREET FRONTAGE 1: 127.00 STREET 1: PLACENTIA AVENUE
STREET FAONTAGE 2: 145.50 STREET 2: W,19TH ST
PARCEL; 42419112 ZONE: C1 LOCATZON > FRONT; REAR;
HUSINESS NAME: RALLY'S HAMBURGERS > LEFT; X ' RIGHT:
O T 2i E R T O T A L S G R O U N D S I G N
THI5 ACTIVITY : SO.00SQFT OVERALL HEIGHT: OFT OIN
THIS SITE ; 100.00SQFT GROUND CLEARANCE: ' OFT OiN
ITEMS OF INFO : 2 PLANTER AREA: O.00SQFT.
ITEMS FOR ACTIVITY: 5 HLDG SET BACK: 30FT
COPY VERHIAGE : RALLY'S HAMBURGERS AND LOGO PLUS MISCELLANEOUS'CONVENIENCE
SIGNS AND A MENU bOARD
PLANNING NOTES: WALL SIGN AND TOTALS F/ PLACENTIA FRONT.
iE iE i(� iF i(-if iF iE i6 iE iF iE it iE iF 3F jF jE iF 3E if -k iE it �JE iF if iF iE iE iE it i! it �)E fE it iF # i! #�E iE * iE iE iE �)F iE iE iE if �)E 3F ## dE �IF �IE iE iE iE tE �lE jF iE i! # iE ## iE iE iE iE �t ii 3E ik
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 W� � DATE: �Lg=�_
BUILDING APPROVED HY : DATE:
APPLICATION ISSUED BY: �G� vATE: 1"'��`1 ��#�
*�tc�x�*it�ieie#�rititat#at�-�r*ie***it it�s*�r*�**at* �i��
LEGALIZATION:N F E E 5 U M M A R Y STRUCTURAI'v SEGhiENT:Y
BLDG PMT PLUMBING ELECTRZC MECHANIC SIGN SMIP/RE5�>� GRADING
PERMIT 15,00 30.00 50.00 �': .•
SOa SMIP/NON-AES
ISSUE FEE 9�75 15.00 ��(f
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL FAZD '� DIIE
TOTALS----> 95,50 15.00 9.75 120,25 120.2:5 .00
REVENUE UIVISION TOTALS^-> COLLECTED; 120.25 OVEA/SHORfi: 00
bLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING�$LAN-CHECK
15.Q0 45.00 50,00 ,50 � 9.75
'Y # if iF'1F iE 1E'k i4 it iF ik iF iE iF'h iF iF it iF IF #'k if it iFlt iF ik iF iE 9F it ik 1t 1F ak±F iE iFlF 111F iF iF iE 1E ik tF iF±E 1t iF 1k k 3k iF 1F 3t jF it it il� 1E iF it 3t 3F1�1F 1F?t iE # iE iF 1f )k �1-
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N I� UNIT COST TOTAL C05T
ELE 2 �IGN/ OUTLZNE LIGHT SYS Q$I 1 HR CIRC 15,00 __ 30.00
' E X P I R E D END oF 1�EEs ,z a�ae�s.��-ntos9;�4 -, � ,_
� l?ATE: C�4/13J5C, Tif:F: : .. �
Incomplete Inspections
I
_lYdiE _...� —� $I$ �.a�
�
CONSTRUCTION AND PLANNING - � PO SPA
�APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
n .
1. Temporery Electrical $ervice or Pole � 52. Pool & Equipmen[ Location
2. Soil Pipe•Undrgrnd. �;= � 53. Steel Reinforcement • �
3. Electrical Conduit Utility�Urid�grnd. 54. Forms i
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ;
6• Electrical UFER Grnd. _ 57. APPROVAL TO COVER�GUNITE �
7. Footinqs � . � 58. Electrical Conduit�Undrgrnd. �
8. Foundation �',•` � 59. Gas Pipe, O Undrgrnd., Test ;/
9� Water Pipe-Undrgrnd. ' � � 60. Backwash Lines, P�Trap, � Undrqrnd. �
lO.lStructural Floor Svstem : !�• 61. APPROVAL TO DECK ' ��' I
11., Property Sewer Line & House Connection 62. Backwash & Receptor�Final . i
12. �Sewer Cap � � . 63. Heater & Vent-Final . . � I
13. Roof Drains �� . � 64. Plumbing System � Final �� ��
. v
14. Fough Plumbing " , 65. Electrical-Final ��+� I
15. Rough Electrical•Conduit ^ 66. Solar SYstem-Final � " �; 'I
16. Rough Electric Wiring , 67. Fencing & Access ApP�oval � ,
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING '�
,1
18. Rough Electrical�T Bar_Ceiling 69. POOUSPA SYSTEMS FINAL I,
79. Rough Neating & Air Conditioning FIRE DEPT. REQUIREMENT ��
20. Rough Factory Fireplace APPROVALS Permit # I
21, Ducts, in Structure I
70. Underground Hydro
22, Dutts, Ventilating 71. Protluct Piping � Gas ❑ Oil I
23, Gas Pipe-Rough & Test 7Z. Underground Flush i
24, Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Aoof Sheathin9 74. Overhead Hytlro
26, T�Bar Ceiling (Svucturai) $ Monocoat 75. Dry Chemical I,
27. Frame and Flashing 76. Dry Standpipe �r
28. Lathing & Siding 77. FIXED SYS7EM 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: _ 6-Q/ CQ �g� CO/1.7�a�df
34. Final Heating & Air Conditioning
35, Final Gas Pipe�Test .
36. Hood or Canopy
37. Final Factory Fireplace
3$. Final Plumbing
39. Water Service-Final
40. Gas Service�Final �
41. Solar pomestic�Final
42, Backflow Preventer
43. Backfl0w Irrigation
44. Landscape Irrigation SYstem �
4$. Sound Attenuation
46. Handicap Regulations � �
47. FINAI. STRUCTURE & BUILDING a e _ ig
48. FINAL PLANNING � . .�;.
49. Electric Release to Edison w �
50. Gas Release to Souther� California Gas Co
51. CER7IFICATE OF OCCUPANCY
No. Date
�
t
.p
PflOJECT AUUFESS: $ O I W 1 9 TH ST uxit:
OWNEfl'S NAME: L 6 M VENTURES �
� AOORESS: SUITE 1�60 r
1901 AVE OF THE STARS
L05 ANGELES,CA 90067
ANCMIENGINEEP:
AOONE55:
NEG.NO.:
UNIT:
' PENMITTEE: SOUTH BAY NEON ( 619 ) 691-8686
aooxess: 171 MACE ST A-1
CHULA VISTA CA 91911
LICENSED CONTBACTOF DECIAFpTION: I hereby aihrm ��a� I am IicenseA untler provisions ol ChaD�e� 91�ommencing with Section
7000� ol Divsion 3 0l ihe Business ana Pmfessions Cotle. an0 my license is in lull lo¢e antl el�ec�.
ciTv uc.: 0� 5 2 2 6 5� 417 O 1 cus�E�
�ate'. r.: SigoaWre: _ wr=-
�_�_,a—_
WOflNERS' COMPENSATION ECLANATION: I �ereAy allirm IAaI I have a cerlilica�e of conseil��o -insure or a cehilicaie o� Workers'
Campensa�ion insmance. or a cenified copy ihereol ISec�ion 3800. LaO. CI. '
roucvNo.: 728994-91 E%P.OATE: OZIOLI92
comraxr: STATE FUND
� Cenilied coDY �s �ereby fumishetl. � Ce�ilietl copy is fileU wit�e ciry Bui�tling Ulvisjpc.
.z'. _( '� � �� AOPlicant: _ �
E%EMPTIUNFBOMWOflI(Efl5'COMPENSNTIONOECIAflPTION: (ihi55ec�ionneeUnol�ecampleleAilthe0ermit�ntlre0($1ql�orless�.
I ce�ily Nat in Ne pehormance ot IM1e work �ar which t�i1 permii is issuetl, I shall n0i employ any person in any manner so as to becom2
suDl¢CI �0 Ihe WOrk¢r5 COmpep5dli0n �dw5 Ot C2��AOfnid.
Daie: Signature:
NOTICE: Ii. al�er making this declaration, you shoul0 6ecome sublect to ihe Workers' Compensation pwvisions oi ihe La6or
Code, you musl fotlhwilh com0ly with suc� provisions or ihis permit shall be tleemed revoketl.
CONSTBUCTION LENUING RGENCY: I here0y allirm Ihai t�ere is a constmction IenOing aAenty Por �he peAormance 01 the work for
w�it� I�is permit i5 iSsueG (Sxiion 3097. Civ. C�.
iexoen: FORMERLY "RALLY' S"
aoosess: HAMBURGERS
OWNEB BUILUEB PECIABRTION: I 11ere0y alfrm I�ai I am ¢x¢m0� ��am I�e CanlraCiurS' Slate Llcense Law lor tne Ianovnng reasan
(Seclion 7031.5 Busine5s antl Pm�essronal Coae: Any city ol couniy whkh reduires a permil lo consVucC aller, impmve, Oemolis�, or
reDair any S�mtlwE. P��or lo ils i55uance. a150 re0uire5 ��e ap0litan� lOr SUCh permil to file a Siqned Slaiemenl Ihai he/She i5litensetl
pursuant io �he pm+isions of t�e Comracm�s' S�ate License Law �Chapter 9 �commencing with Section 7000) of Division 3 0l tAe Business
antl Prolessions Cotle� or ��at he/she is e�empt tAerelrom antl t�e basis for Ihe allegeA exemD��on. Any violation ol Seclion 7031.5 Oy
any aOPlican� �or a Ve�mit subjec�s Ne applicanl to a[iNl�penalty ot not more ��Jn live huntlre0 tlollars (E500�.
I.. as owner of Ihe O�oOeny ar my employees wil� wages as iheir sole compensation, wlil Oo ihe work, and ihe
Q slmcNre is not in�enCetl or o�leretl �or sale (Senian 76a4, Business an0 Pm�essional CoAe: The Coniracmrs' State License Law
Ooes noi apO�Y lo an owner ol a pwp¢ny who builOs or impmves iherean. and who Aaes such work �imse��/hersell or ihmupll
his or her own emoloyees, provitlee ihat suCh impmvemenls are not inten�ed ar ofhretl lor Sale. If, however ihe 6uilAinA or
impwvement is 5010 wrt�in one year ol comple�ion, ��e owner vnil have Ihe hurAen ol proving he/she 4i0 nai builU or imDmve
�or ihe pUr�oso ol Sale). -
I, as owner of Ihe D�operty. am eeclusively coniraclinp wilh Iicense0 coniractors to consiNtt lhe prolect (Settion 7044, Business
❑ ana Pmfessions Coae: The Cantracrors' State Lkenu Law Aces not apPy to an ovmer ol pmpeM �o bwlAs ar impmves ihemon
an0 w0o cOniratls �or su[� D�oiecls vnl� 3 conlracloq5) lirense pur5uani to �he Conlraciors Staie License Law�. I am aware
��al pma� ol �Aeir Worker'S Compensa�ion insuran[e S�Ould Ge proviEetl �o me.
� I am exempt un0er Senion; B. 8 P, C.
for �his reasonl
�aie: - --- M/ner.
I ao nereoy cenifY I�al I am aware ot ana untlerstana Ine reQuiremenis oi Calilomia Hea�th an0 Safety COAe Sections 25505, 25533, an0
25534 and I�a� I or any lu�ure building occupan� will/will no� (circle one) neeA to compty wilh said slale cotles anA ��e reQuiremen(s �or a
permii for constmc�ion or moAilicalion Irom Ne Air �uality ManaAemen� Dislrict. qesidential constmction aD0lications are eaempt Imm
ihese pmvisians.
Oale: ADPlicani:
1 �¢reEy cenify Ihai I �ave reatl �his application antl Slaie Iha� 1�¢ abave in�ormaiion is correcl. I agree Io comOty vnt� all ci�y an0 coun�y
or0inances ane sialt �aws relaiing Io �uil0ing consimc�ion an0 hereby authorixe representatives oi ��i� fo en�er upan the a�ove-menli0netl
pmp¢ity lor inspeGion purposes.
Oale: _� L� "'� (r�_ SignaWre: _ , �"�
oriver's �icense or Socu� Securiiy x: _
i64bu6 Wm�e—Awltlmg�, Green—Cotle Enlorcement: Canary—Applicam; Pink—Favenue; GOltlenroJ—Assessor
CITY OF COSTA MESA — SIGN PERMIT PERM NO; SB 053844
PERMIT NO: SB 053899 PLAN CHECK NO; 03523-91 L GOVT; N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE; OTH
JOH DESCRIPTION ; CFIANGE SIGN FACE SQ FT;
CLAIM VALUE; 700.00 CALC—VALUE: 700,00 GROUP OCC: B-2 /
COMMENTS: "ALBERTO'S MEXICAN FOOD"
*****�**��r�*****�*+�*��**x x ***�***+�+��****+�**+�*�*�*****�e**�r��r�r�+��*�**�****�*�*+��x�
S I G N I N F O R M A T I O N
DISTRICT: 1 TYPE: WALL ILLIIMINATION: INT CATEGORY: CHA
DIMENSIONS; 6FT 02IN X SFT 02IN AREA; SO.00SQFT LETTEA HT: 12"
STREET FRONTAGE 1; 145.50 STREET 1: W 19TH ST
STREET FRUNTAGE 2; 127.00 STREET 2; PLACENTIA AV
PARCEL: 424197.12 ZONE- C1 LOCATION > FRONT; REAR:
BUSINESS NAME: ALBERTO'S MEXICAN FOUD > LEFT: X RIGHT:
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY , SO.00SQFT OVERALL HEIGHT: OFT OIP1
THIS SITE : SO.00SS�FT GROUND CLEARANCE: OFT OIN
ITEMS OF INFO ; 5 PLANTER AREA: O.00SQFT
ITEMS FOR ACTIVITY• 5 BLDG SET BACR: 20FT
COPY VERBIAGE : ALHERTO'S MEXICAN FOOD
OPEN 24 HOURS
PLANNING NOTES:
iF at fE i! if iF iF 1F If �f if it 3F if iF if if it iE k iE if ik k k IF iE if Ik If iE iF iE iE if 1F �E iF if if it �E ff if it IF 3E M IE fEif IE �lE iF k if �Fif it fE i! iE iE if 1k iFiF iE IE if fElF 3F if ik IE 3f iF iE
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 ISSt3ED BY; DAT.E; ��'a�/9,
iFifiFifafiFaElEiElfiEiFif3EiEiFlEiFiFiFiFi! iF1tIfMlfiFlEiFjFiE �'£iF3f
LEGALIZATION;N F E U 1 M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC SIGN •�SMIP/RES GRADING
PERMIT 19,00 10�00;
PLAN 12, 35 :; �tiJ:SMIP/NON�—RES
ISSUE FEE
BUILDING—DIV—> 'PERMIT ISSUE PLAN—CAECK TOTAL "� PAID DUE
TOTALS----> 29,50 0.00 12.35 41.85"'. 1., 91.85 ,00
REVENUE DIVISION TOTAliS--> COLLECTED: 41.85 OVER/SHORT• 00
BLDG PMT PLUMHING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
19.00 50,00 ,50•-+ 12,35
�F iF if if iE iF iE 1E iF if iE k 3f ik 3f �k iF if k 1E iE 3f �F i! �F if iE 3F If k iF if if �E IF If iF �E IF iE iE iF iF �E iElE �f if if 1f It iE M iE If if iF k �E,iF,IF 3E if IF iEiE iE iE iF if iE iF 1E iE if iE iE 1E If
I N D I V Z D U A L F E B R E A K D O W N
TYPE QTY � D E S C R I P T I O N � UNIT COST TOTAL COST
InNco�mpfefe�ns o�ELECTED FOR THIS PERMIT
� ' . i � /
vate ,,.. -- Sig �..__ �
�
4
ei vaUTJ�I`J�IIIV]7l'OJ -��.z- ,�.;,.-;
DATE: 09/12�91 7it1E: 1�: �r �
'� CONSTRUCTION AND PLANNING P��� �A
' APPROVALS Permit�# Oate Inspector qppROVALS Permit # Date Inspector -
��
i. Temporary Electrical Serv"re'e� Pole � '� 52. Pool & Equipment Location �
,a r � , .
2. Soil Pipe-Undrgrnd. -: �� �.=i, � 53. Steel Reinforcement .
, 3.; El����ical Condnij Uiility-C�ndrgmd:; �'' /'r r Y$4. Forms y'j
u �r•- �-� �- i�� i,� :s��
--.};iElecvical Conduii-Ucidrgrnd. y,_ �r _55. Electrical Bonding
'35„`�S%el•Reinforcemenr �^56. Rough Plumbing & Pressure Test '
n��a'Vltr� v>
rEfec(rical UFER'G�;tid. • : n�7. APPROVAL TO COVER�GUNITE �
�:7�: Footinqs �_:� _ �',t � - 58. Electrical Conduit�Undrgrnd. � �v
:`:g� Fo4F'�fdation � �� �l` � � r� 59. Gas Pipe, O Undrgmd., Test �-
9. Water Pipe�Undrgrnd. �i j,� 60. Backwash Lines, P-Trap, O Undrgmd. ���1
10. St��ctural Floor SYstem . �; .`_�j, ; 67. APPROVAL TO DECK ��
11. PioRerty Sewer l.inr& Hqoi�'Conn_ection 62. Backwash & ReceptorFinal '�
i j
72. SeeJ1v CaP / . 1 �
�, , �� ! �. � - 63. Heater & Vent-Final � ;
13. Roof Drains :� ,� !i , �� ' L' 64. Plumbing Sysrem - Final � /.� ,� �
14.' Rough Plumbiri§ � '/ � �� 65. Electrical-Final �;' j
15. Rough Electric��Conduit 66. Solar System�Final �
16 Rough ElectriclViring 67. Fencing & Access Approval
77. Rough Wiring Sig�i 68. APPROVED FOR PLASTERING
78. Rough Electricai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �� - � FIRE DEPT.�REQUIREMENT
20.nRouyh fr,�ctor.y Kj�eplace• �,r �":�; � ,`, '-;-�..p �= �y (i qppROVALS �t Permit # L
.r n .� - .. r - � �
21.'Ducjs, in_Structuie':. -,n.~� �.. '3 S'' " 70.:1� `� ' "� •' -
:�. r.s.r r r 5..:1:, ;Lti .- . S � nd�rground HYdr4 . � ..
22. Du4ts, Ventilating.= :' � � •�ti � ^!rjn g x. � 7� �=;pro�uct Piping ��GSs ❑'Oit -
23.,GasPiPe;Ro48h&'Test ..Sr,za ��;-'c;iti �•, C'" .�72.�l�nder r �"^� _ �
- „�^:: S F� �� n 9 ound Flush x
�: ��, - :. � .� a � `. ~ .� a4 r i_ � � � v - � .0 -
24.�Poo�( Framing� .�-. : `~ z. �[- :-'.^ ^'� x p . 73. llndergmd. StorageTank.O.Gas ❑ Oil
M^
25. RoofSHeathing - `�t��?r� " ^� ' ,�, �'� '°_'• �7q?,pve?hearJ Hydro ' "
.,r -U�
26�;T•Bar Ceiling IStuicturaW.�&.N�onoCoat � `. �+75.;.�Dry Chemical �� � � w. . � _ �
27.cFrameand Flashin ���' GcT:� ' •� ' � '•76._Dry Standpipe� r `'' ' �: Y ' ' `�
., -�;' x:.- `� :��- - ��:z� s
28.�Lathing.$iSiding� �, :��....- rt�tr� +�`., .. ..77�FIXE0.SYSTEMFINAL1.�: y ;�--, �
� 29. Insulati p c '`j: ".'..:...'��-.^�•;r . ^� a: �:� ,;h. -7B.r�IRE PREV. FINAL • � . ^ ', :,
¢ 'r: .C:•.. v j�' ..i1 n s'� l' ti i
y � o •r r�v� • .,.-:. �. . � r .w v_ � -. '.•:et
30. Drywall;Nailing 1;. ;- ^-o ;syCJc� �. �"' v � •' 7�. .-.HEALTH DEPT. REQUIREMENT.%�jt;^, �-
_ : .I_
�'�31. Plaster Brown Cort_%i� . _ �'�; ;4'�j a • . ;79. FINAL•INSPECTION� �r - � �y" u
�-32.=Electrical Power Nle'ter=Final :S ' ' • .; ��; , (%F�OOD CERTIFICAi�E ISSUED ti � t�.';
�33: �Final Electrid - � ' �S " - �lote`s. �`� ' ~x� " �
- � x .a ��s1 -
. , _, . ... .r s t� . •t m.: 1 . ' �.,i::
,34. fin� Hea[ingt& F,ic;Conditioning � - � r -: -y, , � �
.'35_�Final Gas Pipe•Test� T - '`- - � : �'� '` . . � '*� �' .
� -.-�
v r. � . �n
36.� Hoo`cJ or CanoPY �� � �� �; %" 'Zi:�.. > :�w � ��� c
_ 1�
:�
��37.�FinalFactoryFirepKaCe �ersr x.{� ' � r?�� �r
.. . x ' ,.r.P : t � D. I �tr �l �-i :U•- � i..,.
�38.�FinaLPlumbing ..s ;n�,r.'�t'-: , �� ,C • +��s
�.
'_39. Watar Service-Finab : - � v .� ;i•'. : . : I �s � ^ n. jo t ix, 1-
�c 1 U
�40: �Gas�Service-Final � " ����V .. L� � i.yr `�� �� - '��' i rY
� -
� 41 r$ola� DomesticFinei � . �" , : ;P; x = ; �� �y- - - .. : �� .
- � r- � ' .r r �a
42: Backflow Preventer' `. �- c � � r., r . x� ;� i > ; . "c- e >.
• - - 0 1 � it '
43. Backflow Irrigationr � *+ - �'T � T e � ,� " ' C .
K 1�• "T.^I Y_ IC /
Y r.�-,` . , tF i 'i L .
��,44. Landscape Irrigation SYsterp ,T ,� • ; • • vt ' - .� .���---- �-=�
. . -_ ` _ - . . -.:. _ .
.45.r�ound Atrenuatiorr. ��� � ':�- - �"�. �' ��� �
r _r c.. � ♦
,46 Handicap_Regulations "` '.'�. ;, � �r " `� . ,1 ; ' '; . � .
.; . �i', ti .� �
�47.�INALSTRWCTURE BcBUILDING � ' `,• y, .�,� �. ,:� � �'. �� �
;i , ,,. , �
`48.?FIN'AL PLANNING' • _ `� �o ..x N.i;i �,�,I �!'�' `', `: '�: r -
�49.;Ele�ric Release to Ed�sbi� �i � j`+ �- `.r �� i • .
�,50_�Gas.Release to Sout�em California Gas Co " ��� �M %.� �; �' , �I;' ': ,',
`51. CERTIFICATE OF�OCCUPANCY j, :�. - �„� , i
No. Date
�\i
City o( Costa Mesa
Oevelopmem Services Department
Building Sa(ety Division
P. O. eox 1200
Costa Mesa, Califomia
CERTIFICATE OF OCCUPANCY No.0033�9
The Building located at 801 W2st 19th StCC'et
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group B2 Occupancy. '
Use of Building R@8t8uCarlt
Legal Description 424-191-12
(See reuerse side for Metez and Bounds)
Building Permit NoS48600rB43048 Electrical Permit No �BOZIrE49iS6 plumbing Permit No. P�791
N�echanical Perm't No. M 492�% Number of apartments
rire �revon�ion t tao. F 9316
ISSUED TO:
Rdlly�9 H]IIIbUL'9@C3
8525 Gibbs Driv�
San Diego� CA 92126
Building Official
and/or guest rooms
C'De;•&3Cd
� �
bY / 1 � .� � --/�� �.
Date �ember 14� 1990
This Certificate of Occupancy SHALL BE ported in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. �
CMF 1o15-a6 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File
PNOIFCT RODNESS: $ O S W 1 9 TH S T uxrt:
' owxen�sx�Me:RALLY'S HAMHURGERS
nooeess: g525 GZBBS DR, SAN DIEGO
, CA 92126
`� 619-576-2060 �
IIPLIUENGINEER: SCHUSS, CLARK 6 ASSOC �c.xo.:C118d0
�� nooeess: 9474 KEARNEY VILLA RD uxrt:
S.D. CA 92126
PENMITTEE: CAL SELECT BUILDERS ( 714 ) 996-3470
^�o��: q 300 LA PALMA
ANAHEIM CA 92807
LICENSEo CONTMCTOH OEClAM710N: I here0y aKrm that I am IkenseA untler provisions ol Chapter 9(commendnq wilh Section
7000) ol ONision 3 at ihe Busineu anE Protessions CaOe. anU my Ikense a in full force aM eflect.
CRY 11C�' � STR7E LIC.: %C �SS' � /
Date: _t) � / �3 6 �Q� o�o�� �.f!—��Fa�—��—
flNE�fi LOM7EN311TION UELUMTION: I �ereEy aflirm IAai I have a certificate ot conunl to uB-insure or a cerGfica[e ot Workers'
npenution Insuance, or a cetlitieU cop ther¢at (5¢ction 3800, Lah. C).
ucrxo.:WP89-48755�-OS �cr.n�Te: 10/01/90
ornvnxv: FREMONT INDEM
CertifieE coDY �s here6y tumisAeE. � CaNtlieE coD O wilh the dry q Divis/io/n.�%
Date: ���` —�O /� MVIi�3 ����'i��L= _ /
EllEMVfION FHOM WOHKENS' COMPENSITON OECIAM710N: (Ihis uclion neeC not he mmDleteO if ihe pemui is fa one hunOreO �f100) or less�.
I ceniry [hat in Ihe pedormance oi t�e wod tor w�ich Ihis Dermit is issue0, I shall not em0loy any person in any manner w as to Eecome
suEiect ta tna Warkers' Campensation Laws af Califomla. �
Oa�e: Sipnalur0:
NOTICE: II, alter makln0 t�is Eeclaratlon,�you s�ould hecame su0lact to the Workers' Campensafion pmNsians ol I�e LaEor
CaUe, you must fotlhwllh compty with suc� pmvislons or ihis permtl shall Ue UeemaO revokeA.
CONSTBUC�ION LENUINO �GENCV: I �erohy atlirm tAat t�era isa cons[rucGon lending aAency tar tha pedormanra al ihe xrork lor
which tAis Oarmit 15 issuetl (Sec�lon 3097, Civ. C). ,,,
- lFNOER: ' ' •
aooeess:
OWNER BUILDFB OECIAMTION: I hereUy aflirm Ihal I am exempt trom tAe Coniractors' State Lic¢nse Law lar t�e I011owin0 reason
(Seciion 7031.5 Business anA Pmlessional CoOe: My ciry ol counry whic� reQuires a permit to canstruct, al[er, ImD��'e, �emolish. or
repair any slmcWre, pnor to its issuance, also mpuires the apD�icant lor SucA permit to fle a sipned statemem ihat �e/s�e is Ilcense0
pursuant to Ne pmvisions ol the Cantractors' State Liunsa Law (C�aO�er 9(commencinp with Sectwn 7000) af �ivision 3 oi Ne Business
an0 Prolesions Cade) or tnat MJs�e ¢ exemp� ttceretrom anU Ihe Oasis for t�e allepe0 exemplion. My Nolation oi Sectlon 7031.5 �y
�aDP�icam lor a Dermit suGlects I�e applicant to a clNl penalry at not more than five hunUreE Collars (5500).
I, as owner of tM propeM a� �7' employees witn wapes ss tAeir sale compensation, will tlo t�a work. anE the
I stmcture is not intenCeO or ottemtl lor sale (Sectlon 767d, Business an0 Pmleaional Code: T�e Contactars State Liconse Law
dces not apDN ro an owner of a Omperry x1a OWES ar ImD��s IAereon. anE wAo Ooa such vrork himuli/trerself or ituaup�
�is or her own em0�es. proNdeO Itwt suc� improvements are wt intendeA ar afferetl tor sale. It, however t�e bWOinp or
impmvemenl is wl0 witNn one year ol comDletlon, IAe owner vrill �ave Iha OurCen ai Dmdng MJsha AiA not bui10 or imDmve
iw Ure Durpose ol salel.
I, as owner oi the D�operry� am exclusively convactlnp with IicenSeC contractors ro wnstruct the prol� �on 7094, Business
❑ arq Profe55Ms CaOe: The Contnctors' Sfaro Lice�e law Eces ml appry ro an mmer at propeM �� or imprwes Ihereon
anA wlio contracis lor such prol�� ��� a can(rattoqs) license Dursuant ta the Conirnctars' State L¢ense Law). 1 am awam
Nat praof ol Ueir Worker's Compenu0on insurance s�aultl Ce pmNEeE to me.
� I am exempt unEer Section: B. 6 P. C.
1or Iltis reasan:
Date: Owner:
I Uo trereDy certity tAat 1 am axare ol anO uMersunA IAe requirements ol Calilomia Heatth anU Safery Cotle Sedior¢ 25505, 25533. anU
25534 anE that I or any future builainp occupant vnNwiil not (cirGe one) nee0 ro wmply with saitl state co0es anE �he requiremenis tor a
permit lor conswction or rtroEiliation Imm tM Nr uahry Manapement OLstrict. NesiOentlal wnstruction applicaUons are exemD� �rom
Nese O�ovisions.
Date: ApDlicanC
I here0y certity that 1 �ave reaE Ihis aOD�ication an0 sqta Ilw� I� abova information a ect. I apree to comDN �h all cRy anE counry
orUinances antl sWte Wws rNatlnp to 6uilEinO �^� Cion anE �e by aulMnz/e epr es oi t�a cily ro ey�yupon the a0ovo-mentbneq
pmpe tor InsDeCion Ourposes. // //� //// �
Da . �./`� — S' ipnat�f� �A - Lr �,��
oriver's �icense ar Saia� Secunry M:
t6al-ae Whita—BuilEinB; Green—Cade Enlorcamant: Canery—lWplicent; Pink—Ravanue: GOIEanroO—aaseawi
PERMIT NO: B
CITY OF COSTA MESA - HUILDING PERMIT PERM NO: B 048600
048600 PLAN CHECK NO: 03368-90 L GOVT: N SUPP: N
CONSTRUCTION TYPE; V-N PERMIT TYPE: STR , PURPOSE; NEW
JOH DESCRIPTION : 719SF RESTAURANT,NEW CONSTRUCTION SQ FT; 1,422
CLAIM VALUE: 40,000.00 CALC-VALUE: 44,153.10 GROUP OCC: B-2 /
COMMENTS: RALLEY'S HAMBURGERS �
*�rx*�r+��r+r�r�r�r�r«*�r�r+r*x**�**�r�r*�r�r��r**+r�*x**�**+r�*�t*��r�r+r�x�r�r+rx�x�r�*x�*�*x�***+r****�r�rx*
Z O N I N GS ERTEB�AUCIKASE M B N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDZNG ---------
FRNT; 94 FT IN REAR; 40 FT ZN FRNT; FT IN REAR: FT IN
LEFT: 68 FT IN RGHT: 84 FT / IN LEFT; FT IN RGHT: FT IN
PARKING REQ• 6 PROV: 8 PARCEL; 42419112 ZNE: C1 REF NO: PA-89-111
PLANNING Nd'fES> 711 SF DOUBLE DRIVE-THRU, FAST FOOD RESTAURANT WITH OUTSIDE
> SEATING FOR-,12 OR LESS PERSONS.
�t*�tu��tir*iri��r�t�***�t.**�r.��t�r'�t�r�t'�t*'i��t*�t**+r*+ri�i��r+�*+t�t*+r*+t�t*�tx�x�*+t****i�*i��t�t�tx-�t*�x-*+�****�t�t�t�tf�
D E V E;,Iy O'P�:M.:E��N AT%�� S E R V I C E S R E Q U I R E M E N T S' q
ZONING APPROVED; BY �' � ��J / n'�^' � i�� �.I� DATE: U� �.'���'� la
HUILDING APPROVED HY{:•_ -' .:' DATE; �' ' ;,
,
APPLICATION ISSUED BY; t--�� "'� '�., � �- DATE: � I'�O" ��
ifiFifitikikif�ritiFikiFifit�ritiEirikiliFiE3F��FiF�F3FiF3FTF3FiF7f3FiF3F3f7f3f3F 3F 3FiF3F'iF;F'iFiF�FiE3F3FiF�fi(�iFiEiFia�E1Ei(�1t
it if iE iE * if ik if it IF it af ik it iE �F iF M if �F 1F if iF k ik M iE iF,1F 3E it 1E jE iF iF iklk iElE iE if iE 3f iE iE %iF iF iE iE iE iE M 1F if if fk it 1F iE if iF iE IE iE 1E if iE iF �E 3E �F iF iE it if iF 1F 1E
LEGALI2ATION:N F E E S U M M A R Y STRUCTURAL SHGMENT:Y
HLDG PMT PLUMBING ELECTRIC' MECHANIC FIRE SMIP/RES GRADING
PERMIT 382,00
� SMIP/NON-RES
PLAN 248.30 6.62
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 388.62 0,00 248.30 636.92 636.92 .00
REVENUE DIVISION TOTALS--> COLLECTED; 388,62 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FZRE SMIP/TOT GRADING PLAN-CHECK
382.00 -� 6.62
if ik iE if it ik i! ik 1f ik ik it 1E iE if if 3t ik df iE ik iFlF k if i! iF iE it 3t iE k if iF i! it ik i! iE iE if 1f i! if ik ik ik iF ik �F k if 1E it iF iE if iE ff if i! ik it iF i! iE iE �E iElE it iE it ik if �F iE iE iE
I N D I V I D U A L F E E H 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
SFC 711 RES-TYPE V-N '. -AVER 58,90 41,877.90
SFC' 711 EQU-COMMERCIAL AIR COND -AVER 3,20 2,275,20
END OF FEES
U1 �aD677k3-QQ3577;4 T c.7T d8�.a�
OATE= OS/i6/90 TIi1E: i6:38
G016STRU�TION AND PLAN . L& SPA
Date Inspector Date Inspector
APPROVALS Permit # � � APPROVALS Permit # ,
1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location ,
2. Soil Pipe�Undrgrnd. �, " 53. Stee! Reinforcement -
3. Electrical Conduit Utility-UncJrgrnd. 54. Forms �
.
4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding
5. Steel Reinforcement . � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVAL TO�COVER�GUNITE
7. Footings . � 58. Electrical Conduit-Undrgmd. '
$. Foundation . ��. .,�, s� 59. Gas Pipe, � Undrgrnd., Test '
9. Water Pipe-Undrgmd. �� 60. Backwash Lines, P�Trap, O Undrgrnd. �
10. Structural Floor System �� . � 61. APPROVAL TO DECK � �
11. Property Sewer �ine & House Connection �'� 62. Backwash & Receptor-Final ��,
72. 8ewer Cap ' ' ��+ 63. Heater & Vent-Final " r
,�
13. Roof Drains � "
64. Plumbing System - Final . =1
14. Rough Plumbing � 65. Electrical�Final
55. Rough Electripl�Conduit� � 66. Solar System-Final �
16. Pough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
7$, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL •
79. Rough Heating & Air Conditioning _ FIRE DEPT. REnUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. pucts, in Structure ' :70. Underground Hydro
22. Ducts, Ventilating - "71. Product Piping � Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing ' . 73. 'Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing �g 74. Overhead Hydro '
26. 7-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
Z7. Frame and Flashing B(� � 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation � Q�' 78. FIRE PREV. FINAL
30. D�YWaII Nailing � �' HEALTH-DEPT. REQUIREMENT
31. Plaster Brown Coat ' 79. FINAL INSPECTION
32, Electrical Power Meter�Final • 80. FOOD CERTIFICATE ISSUED
33. Finai Elecvic � , _ Notes: � � '
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test 1�4�
36. Hood or Canopy � " �
37. Final Factory Fireplace -
38. ��nal Plumbing
39. Water Service�Final � �
40. Gas Service-Final . �
41. 5olar pomestic�Final � � -
42, 6ackflow Preventer �
43. Backflow Irrigation
44. Landscape Iiripation System
45. Sound Attenuation - '
46. Handicap Regulations - ,
47, FINALSTRUCTURE&BUILDING `� � O �
48- ECi e-'� _
49. Electric Release to Edison . -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
reaecr�oonesa: 801 ,W 19TH ST
awxee•s ruME: 8 S 2 SY G I B B SMD RRG S T 3 0 2
nooness:
S.D.
619-576-2060
�HCHIENGINEEN:
ROOflFSS:
uxR:
REO.NO.:
UNR:
PFflMITTEE: CAL SELECT BUILDERS ( 714 ) 996-3470
�ooxess: 4300 I,A PALMA
ANAHEIM CA 92807
�CENSEO CONTMCTOB OFClAN1TI0N: I hereby attirm Ihai I am Ikensetl unAer prohsions of ChaDter 9(comrtrenun0 ��h SecGon
70�) of Olvision 3 ot Ne Business antl Professions CaEe, anE rtry lice e k in full rte antl enen.
cmucy/ ��51236 sT�reuc.:590765 u�;� .
Oate: _/=����SlOnature:
WOBNENS' COMPENSATION DEClAMT10 : I herehy allirm th t I have a ce ifiwte of consent ro selbinsure or a certiliwte o1 Warkers'
rpmpensation wrdnm ar � rt�eC eo thereol (Seciion 3800, La�. C�.
�irul--��cii.�.��--�i iJ/�S190
ooucr xo.: exr. oAh:
�ornrnxr: FREMONT INDEM
Ce�ilieA coPY �s Aer¢Ey tumisAetl. � CeniOed coDY �s �letl ' e ciry B� inq Division.
oa�e: nunnwnr'~
IXF1:Pf10N FqOM WOHIIEIIS' COMPFN&11 OECWUTIO .. � sectim rot be m if tta permft is �w me Aundrea (S7 w less).
I fxnity ttut in IM1e peAorrtunce ot tne xrork lar wNcn ihis pemut is IswM, I stull not emp�Oy any Oerson in arry manner m az to Decame
SJhIeC� �0 tAB WOfk¢!5 COmpCO5dti00 L2W5 0� C21i�Omid.
De�e: SlpnaNre` �
NOTICF: It, aher makinp this Eeclaation(yau shoWU becoma suElec[ to t�a Workers ComDensation pmvisions of the LaEor
COEe, you must IortnwiN comdY ��� such Drwisions or ihLs permil 51WI Oe OeemeO rewkea.
gpNSTRUtT10N IFXDINO �CFNCY: I �ereDy aKrm that��ere is a constmclion IenUinA apenty for t�e petlormance of I�e vrork �or
wNc� tAis permil is issue0 (�tion 3W7,Civ. C). �_
IFNDEfl: �
aooxess:
OWNEB BUILOEN �ELWUITION: I �ere�y amrm Ihat I am wcempt fmm IAa Contactors Stata Lkense Law for Iha Iolloxin0 reason
(Section 7031.5 Business an0 Vrofessional Catle: My Ury ol county whic� requires a pe�i� to wnstmct, alter, ImD�'e, Oemolish, ar
mPair any ttmcture, O�or lo Bs issuance, also requires I�e aDDlicant lor SucA permit to file a sipneE s�atement Itwt Ae/s�e is IlcenseC
pprsuanl to IAe DroNsians oi Ihe Coniractors' State License Law (ChaD�er 9(commencinp witA Sectlon 7000) af Division 3 0l the Business
add Pmlessions Code) m t�at Oe/she is eeempt t�erafmm anU Ihe Oasis lor t�e alle0e0 exemptian. Any violation ol Section 7031.5 by
any e7Dliwnt /o� a Dermit sublects the aOW���t ro a cNll penatty ol not mom Ihan iNe hunEreE OWlars (f500�.
I, as awner ol Ne properry a my employees wit� wapes as Ndr sde compen5alion. will Oo Ne work, azM I�e
simcture is not intentle0 ar otlereE for ule (Seciion 70C4. Business anE Professianal CoOe: T�e Contactors' State License Law
� Cces nat apD�Y �o an owner ol a pmperry w�o bui105 or improves thereon, and who does sucA woB �imsell/Aerseli or [�muph
his or hE� own em0�oyee5, provi0e0 that such improvements are not intanEed o� attem0 lor sale. I/, however tha builtlinp ar
impmvement I5 solE within one year ol wmpletlon, the ovmer will have t�e burden of pradnp �e/s�e tlIE nat DUJd or Imprma
lor tAe purpose oi ule).
p I, az avmer ol l�e 0���. am excluSiveN con[actinq wit� liceraed contractors to wnstrud tM pmject (Section 70bi, Businass
and Protessions Cotle: T e Contractors' State License Law tices not appty ro an ovmer of Oroper1y who 6mIE5 ar imprmes Nereon
anA wAo caniracts for such prolec(s vnih a contractor(s) license Oursuant to tAe Cont2ctors' State Licanse Law�. I am awara
that Orooi ai iheir Worker's Compensatlon insurence s�oula Ge praviOeA ta me. -
p I am eKempt un0er Section: B, b P. C.
lor IA¢ reason:
08�e: Ownec
I do hereDy cetliry t�at I am awara al an0 un0erstanE the repuiramenis al Califomia HealtM1 anA Satety COAe Sac[ions 25505, 25533, ana
py53C anA that I or any fu[ure EW�Uinp occupant xilYxill not (cirde onel need to comvN �U �4 state codes anE t�e repuirements tor a
pgrmrt tor mnstruction or modifiwtion imm t�e Nr Qualiry ManaOement Distnct. NevOentlal constmction applicatlons are exempl imm
tticse prmisions.
Da�e: ADP�itant:
I bereby Cerfily IIIaI 1 have r¢aE INS applipti0n an0 SWIe I�ai lhe a6ove inlar
oreinances ana sW�e Wvrs reWlinO �o �uilUinp irucGon an0 neaby autho' r r
propeM far ' pectian purposes.
Otte: � ` SiOnature'
Driver's License or Social Sacunry x:
r.ei.au wnl�w_BuiMifw�. GrearCode Enlweemenl: Ca�arv—AoOUfA�t:
I apree ta�up�DN �h all ciry an0 wunry
Ihis cRv tdwier uo0n W a0wtmentlonW
GWEenrotl—Aweamr
CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 049048
PERMIT NO: B 049048 PLAN CHECK NO: 05785-90 S GOVT: N SUPP: Nt
CONSTROCTION TYPE; PERMIT TYPE: STR PURPOSE: NEW
JOH DESCRIPTION : TRA5H ENCLOSURE SQ FT: "' T�0
CLAIM VALUE: 2,000.00 CALC-VALUE: 2,000.00 GROUP OCC: H-2 /
COMM£NTS: AEFER TO P.C.#3368-90L
�*��***x�r� ��r#�r*#*�*��#�**�**����r*#x+�**�*#���r*���***+��rx***�r+r*a��r*,��*�****a�*�r���c*�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUZLDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: 95 FT IN REAR: 40 FT IN
LEFT: FT IN RGHT: FT IN LEFT: 40 FT IN RGHT: 16 FT IN
PARKING REQ; PROV: PARCEL: 42419112 ZNE; C1 REF NO:
PLANNING NOT£S> TRASH ENCLOSURE TO BE CONSTRUCTED FOR THE PREVIOUSLY
> APPROVED RALLY'S HAMHURGERS - PER CITY STANDARDS
��r*�x *��*�r*�*�r***�r*x����+�**�r�r�r�*� �r*�r**x��*x��rx�***��r�e�r*�r�r�******�r*�+�rt�*�r�r��r******{�
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 GUC� IL DATE: c7:- ( g-sj�
bUILDING APPROVED BY ;
DATE:
APPLICATION ISSUED BY; DATE: +IO'—`�
it �t �E+
it 1F iF iF it it dF 3E 3E iF jt iF iF 3F 3F it iF if iF iE iF 3t iF if 3F 3F df 3F iF iF iF iE ik iF if iE iF if iF iE iF iF iE 1E �E iE iE if aF 1E jE iE ik iE iE # if� iP iE af it iE jE iF aF iE it iE if 3E 9E 3E iE jf
LEGALIZATION;N F E E S U M M A R Y , STRUCTURAL SEGMENT:Y
BLDG PMT PLUMHING $LECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 45.00 50
PLAN 29,2g SMZP/NON-RES
ISSUE FEE �
BUILDING-DIV-> FERMIT ISSUE PLAS3-CHECK TOTAL PAID DUE
TOTALS----> 45.50 0.00 29.25 74.75 74.75 .00
REVENUE DIVISION'TOTAL5--> COLLECTED: 74.75 OVER/SHORT; 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRAllING PLAN-CHECK
45.00 .50 29.25
# jf-jE iF if �)h jE �lk 1E 1E 1E iE iE if iE iE ik ik iE jE �1! if �IF if iE iF iF �lE jE iE if iF �!(� if !F iE �lE ik if �)t iE iE iE if iE dE �)f it iF iE iE iE ib it ik * iE 3E iE if iE 3E-IE iF �4 3E-)F iE iE 3f dF �lf if iF 1E iF 1E if� 3E
I N D'Z V 2 D U A L F E E H R E A K D 0 W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 100 RES—TRASH ENCLOSURE / FT. 20.00 2,000.00
END OF FEES
O10001�984�-Otl0o4847 ��"d'
!'ATE: 04/18f9D 7If1E: 1Z:54
CONSTRUCTION ANDPLANNING P SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service pr Pole . . 52. Pool & Equipment Location � j
2. SoilPipe�Undrgrnd. ", �� 53. $teel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement '6�,..(,� W i 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings �p.�8-=i (p�/ 58. Electrical Conduit-Undrgrnd. .
8. Foundation '�L?- 59. Gas Pipe, O Undrgrnd., Test t�.•r''
9. Water Pipe�Undrgrnd. , %. '. 60. 8ackwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor SYstem �j � ,� 61. APPROVAL TO DECK ' y,�
11. Property Sewer Line & House Connection _� - 62. Backwash & Receptor�Final .i
12. Sewer Cap ._ -�?� 63. Heater & Vent-Final �.
13. Roof Drains � � 64. Plumbin9 System-- Final '
14. Rough Plumbing �; -� 65. Electrical-Final , �
15. Rough Electrical�Conduit '�� 66. Solar System•Final ';
16. Rough Electric Wiring � . 67. Fencing & Access ApProval �
77. flough Wiring Sign � 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOLlSPA SYSTEMS F�NAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. DuCts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nai�ing NEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECT�ON
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. Fina� Factory Fireplace
38. Final Plumbing '
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING Il � �
46. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY '
No. Date
� �.
Pfl61ECT �DORESS: S O 1 � W 19 TH S T
owxenaeerne: RALLY' S AAMHURGERS
�0°�� 8525 GIBHS DR, SAN DZEGO
CA 92126
UNIT:
619-576-2060
.RflCNIENGINEEfl: SCHUSS, CLARK 6 A$$�C pEc.xo.:C11830
ADOHES&: 94']Q xEARNEY VILLA RD uxrt:
S,D. CA 92126
PENMITTEE: CAL SELECT BUILDERS ( 714 ) 996-3970
�ooness: q 300 LA PALMA
ANAHEIM CA 92807
IILEN5E0 fANTMCfON OECtAMtIDN: I �eroUy allirm that I am IicenseC unEer D�ons of Gwp[er 9(commendnp witn Section
7000) ol Oivision 3 at ihe Busineu an0 Proleuions CaOe. ana my ikeiae a in lull lorce and elfec[.
cirr uc.: 51q2 3 6 /sr�nre uc.:5 9 0 7 6���
Data: —��! � �-(� SlpnaNro:
WOBNEBS' COMPENSNTION OECIAMTION: I herehy aKrm I�ai I have a cetlliicate ot cons¢nt to setbinsure or a cahlficate ol Workers'
Compensatian Insuranre, or a ceni/ied capy Iherzol (SecGon 3800, LaO. C).
�oucrxo.:WP89-487553-01 exr.onre: 10/01/90
nrnvaxr: FREMONT INDEM
J Ceni�iea copy is nereoy �umisnee. � Certi/ie0 copy is fil wit��ry9wl inp ONisian.
Oate: , � � �� �O Appliwnt:
IXEMPIION FHOM WONKFNB' COMPENSATION UEClAHI1T10N: (�liss secUm neeE not Oe completaE il tAe paml ¢ ta ace �unOred (f100) or kx�.
I CertiTy that in lhe p¢AOrmance of Ihe work tof whiC� ��is permfl i5 i55u80, I shall noi lmDlOy any person in any manner 50 az lo Oecortre
suCject ro IAe Wo�kers' CortWensalion Laws ol Catilomia.
U210: $IOIIdNlO:
NOTICE: tl, alter maltinp this UeGa2ilon, you stioultl become sublect to t�e Workers' Compensation prmdsions of tAe LaUor
CaUe, you must tarlOwitA campty with suc� pmNsions or tNs permit stwll Ge EeemeU revokeA.
CONSTROCTION 1EN01N0 RCENCY: I heraby affirm I�at there is a constmction lentlinp apency for ihe Dehormanca ol the wark for
wAICA �Ais Dermit i5 issue0 (Sec�ion 3097, Clv. C).
IFNUER:
pUOflESS:
OWNEP BURDER OECIAMTION: 1 �ereCy atlirm Ilwl I am exempt irom ihe Contrzctors' State License Law for the followinp reason
(Sectlm 7031.5 Business and Professimal CoOe: My dry ol caunry xTicL reQulres a permi� ro conswp. alter, Improve, tlemolish, or
repair a�ry slrucNre. prior ro tts issuar�ce, also requiru Ne apqicant lar such permn to file a si0�� statement Itui �Nsha is Iicense0
pursuant to the provisions o11Ae Contrectors' Stare License Law (C�apiar 9(commencinA ��� ���ion 7000) of DNision 3 of Ihe Business
anE Professions Code) or that MJs�e I5 eMempt Ihere/rom and the hasis lor t�e alleped evemptPon. My violation ol Section 7031.5 by
any aDP��� �or a pemut subl� t�e aDO�Unt ta a civil penalry oi not more Itwn Mo �unEre� Eollars (SSW).
I, as owner oi I�e proOaM or my emyloyees with wapes as Iheir sole compensation, will do IAe work, antl the
❑ stmctureis notintenCeO orollerediorule�5ection 704A. Business and PmlessionalCaae: The Coniractors' State License Law
Eces not aDGry ro an owner ai a property wlw OuilOs ar impmves t�emon, antl wlio does such �wM himselt/�arselt or t�mu0h
� his or �er own emptoyees, DroviOed Nat suc� imDrovemenis ara no� intentled ar ofleretl for sale. Ii, Aowever ihe bullElnp or
ImDrovement is soltl mthin one year oi comD���ion, t�e owner will �ave tha buNan oi Dmvinp he/she EIE not Cui10 or Impmve
br �he Ourpase oi ssle).
I, as owner ot ihe prape�1y am exdusively wnlractinp with Iicense0 wntractors ta constmct Ihe prolect (Sectlon 701d, Business
❑ anE Professims COEe: Tlre ConVaclors State Lkense Law Ooa not appty to an mmer at property wta hwlEs or improves Uereon
md wtro contracCS for sucA projeds wtth a coniradar�s) license Dursuant lo tAe Contractari State Licensa �aw�. I am axare
tAat 0��� of ��eir Worker's Campensation insurance s�ould Ge pravi0e0 to me.
� I am exempt unEtt Section: B. 8 P. C.
�or Na reason:
Date: Owner.
1 do �ereby certity t�al I am aware oi anU unEarstanE the requirements of Calilomia H¢alih antl Safery CaUe Sections 25505, 25533, antl
T5534 an0 tlut I or any fuNre huiltlin0 acuDant wiNwill not (circle one) neeA ro wmDly with sai0 stata coCes anU ihe reQuiremen�s for a
permit lor consWction ar maCifiwtlon Imm t�e N'rTManagement D'¢Irict. HeSiGentul canstruction apD�iwtions am exempt Imm
these DroWsions.
Date: ApDlicanL .
I �ere�y cerliTy t�at I have reaOlhis aDDliration anC state
orOinances an0 state Wvrs relatln0 �o EWOinq can5trucGon �
G�aDeM �orinspection Durposes.
Date: ���7�D SiOnamm:
Driver's License or Social Secunry x:
I apree ta compty witn all ciry anE counry
ids cM ro errceuiea Ne aEave�mm6oireE
1Bat�aB W�ita—Builtli�g; Green—CoEe Enlorcament; Cenary—Appliceni; Plnk—Ravanue; C�abenroC—Aveawr
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: GRA 048621 PLAN CH£CK NO: 05348-90 S
CONSTRUCTION TYPE; V-N PERMIT TYPE: GRA
JOb DESCRIPTION : 7195F RESTAURANT,NEW CONSTRUCTION
CLAIM VALUE:
3,000.00 CALC-VALUE;
PERM NO: GRA 048621
GOVT: N SUPP; N
PURPOSE: NEW
SQ FT:
GROUP OCC; B-2 /
COMMBNTS: RALLEY'S HAMHURGERS •
***��r*�r�****�*�***�r*�t��r*+t+��**r*��*��r*�+tit*+�+t+t�it�****�r�it+r***+t**�rx��x�**�*�r�r�r**�r*�it*
Z O N Z N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAA: FT ZN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING RE(� • PAOV; PARCEL: 42419112 ZNE; REF NO;
PLANNING NCS'I'ES>
>
it iF it iF k ik it k it 3f ft d! iF �t dt iE ik dt iF it if �t it ik iE 3l� iF * if !f if iF 1F k it iE iE iF iE 1E iE iE iE iF iE if iE iF if it if iF 3f 3E if iF it ik iF 3f iE iF it iE ik iE iE Ik iE iE ik iE �F 1E 3E it df iE iE
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 HY DATE:
HUILDING APPROVED BY ; S�- R� � DATE: O��
APPLICATZON ISSUED BYe�'�� S�J" DATE: O�%% /�%
ikfE�kifikiEkiliEiEikiEdkiEiFikiEiF*i41l�t3f �F7F�1FiFi�iFi� �F3F3fiF3F3F�F��TiF�iFiFiF�i4iEiEiEiEiFklEjtiE��i�ikif
iF �1(� �t fk 1E iE ik �E 1E iE iF it iE 3t it 1f 3f 1F it 1F iE if i! 1F iE 1E iE iE fk if 1f �ElE iE ii if !k jE iE it dF 1F M iF ik �F fE 9k iE iE �1E if iE i! if iFlk 3k 1t iE �E 1E iE 3f if iF if 1F iE 9F iE if �k if iE if Ik if if
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
� n,.
BLDG PMT PLOMBING ELECTR2C^..MECHANIC FIRE SMIP/RES GRADING
PERMIT � +. 22.50
PLAN ^ � ��' SMIP/NON-RES 15.00
ISSUE FEE y -' � "
BUILDING-DIV-> PERMIT ISSUE PLAN�CHECK TOTAL PAID 3DUE
TOTALS----> 22.50 3.00 , j.-,�l•S".00 40.50 40, SO , 00
� i
REVENUE DIVISION TOTALS--> COL'LECTED: 40.50 OVER/SHORT: .00
BLDG PMT PI�UMHING ELECTRIC MEGHANIC FZRE SMIP/TOT GRADING PLAN-CHECR
„ 25.50 15.00
x-**�r�r***��r*ir*��***�*�rx-���***+tjr�t**�t�t*�t�t*+t*�t�r�r�rx�ie*�r*�x-�tx-**�t**�r�t�t�***�r-�t�r�at*�r�atx*�tet*
I N D I V I D U A L cF���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 .
, �� �
�, / ':��'
O1 QCDfi7325-OOD�7E2b Te7'T ;p,5p
DATE: �E/17/9Q 7Ft{E: 15:�3
CONSTRUCTION AND PLANNING P�,... & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
_r_ r
1. Temporary Electrical Service'or Pole � - . 52. Pool & Equipment Location .
2. Soil Pipe�Undrgrnd. `� 53. $teel Reinforcement , J,
3. Electrical Conduit Utility�Und�grnd. � 54. Forms �`-'
4. Electrical Conduit-Undrgrnd. � ' . 55. Electrical Bonding
5. Steel Reinforcement 56. (iough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings � 58. Electrical ConduirUndrgrnd. -
8. Foundation ;%° '�.,� 59. Gas Pipe, O Undrgrnd., Test �� �i
� r : �
9. Water Pipe�Undrgrnd. � / i. 60. Backwash Lines, P�Trep, O Undrgrnd. ,���
10. Structural Floor System j' � 61. APPROVAL TO DECK f� '
11. Property Sewer Line & House�Connectiori � � 62. Backwash & Receptor-Final '
' .:
12. Sewer Cap �r, � 63. Heater & Vent-Final ���
13. Roof prains `
,t 64. Plumbing System � Final �
14. Rough Plumbing � - � 65. Electrical-Finai -
15. Rough Electrical-Conduit 66. $olar System-Final 1
16. Rough Electric Wiring � . 67. Fencing & Access APProval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. RougN Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning .FIRE DEPT. REnUtREMENT
20. Rough Factory Fireplace APPqOVALS Permit #
21. Ducts, in Structure �� 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas PiPe-Rough &,Test � 72, Underground Flush �
24. Roof Framing - � 73. Undergrnd. Storage Tank O Gas'O Oil
25. Roof Sheathing 74. Overhead Hydro -
26. T-Bar Ceiling (Structuroq & Monocoat . 75. Dry Chemical
27. Freme and Flashing " 76. Dry Standpipe
28. Lathing & Siding � � 77, FIXED SYSTEM FINAL .
29. Insulation � „ ��': 78. FIRE PREV. FINAL �
30. Drywall Nailing ':���. HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat , 79. FINAL INSPECTION .
32. Electrical Power MeterFinal � 80. FOOD CERTIFIC TE ISSUED -
33. Final Electric . • Notes: '� a7 � ��.'�� /�,O
34. Final Heating & Air Conditioning ' � '�!(� �b/ Ci '
35. Final Gas Pipe-Test ',�
36. Hood or Canopy � � ' � � � ` ' �
�
37. Finat Factory Fireplace " _
38. Final Plumbing � , ,
39. Water Se�vice�Final
40. Gas Service-Final
41. Solar Oomestic�Final �
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation System -
45. Sound Attenuation
46. HandiCap Regulations
��
47. FINAL STRUCTURE & BUILDING (�
48. FINA4PLANNING /�'!
49. Electric Release to Edison �`
. u�
50. Gas Re�ease to Southern California Gas Co �) ��
51. CERTIFICATE OF OCCUPANCY
No. Da[e
rxaecr �ooeesa: 8 O 1• W 19 T H S T
' owxeg•sxune: RALLY' S HAM9URGERS
�ooxess:8525 GIBBS DR, SAN DIEGO
CA 92126
uxrt:
619-576-2060
RRClIIENGINEEN: SCHUSS, CLARK G ASSOC NEO.NO.:C11$3O
�ooness: 9474 REARNEY VILLA RD uMrt:
S.D. CA 92126
PEpMmEE:AFFORDAHLE PLUMBING (714)548-9206
aoosess: 330 E 15TH
CM CA 92627
110ENSED COMTMCTOP DELUMTION: I �erehy aNirm that I am IicenseU untler OroNsions oi CAapter 9(commencin0 ��� Sectian
7000) oi Division 3 0l tAe Bu4ness an0 Protesslons CaAe. anA my Ilcense is In fu0 torce anA eflacl. �
cm uc.: 017.3 n2 42 srnre uc.:3 7 2 7''v��y� C— 3�M�1
Date: _���. V�— Sipnature: � ��
WOHKEHS'COMPENSATIONOECIAMTION: IhereOp affirmtA I ave cehilicateolwnsen[Iosel6insurearacertificateaiWorkers'
Compensation Insu���e. ur a ceNlieO copy t�emol (Section LaO. C�. -
'O�ILY NO.: EXP. ORTE:
� OMPRNY:
., Certifie0 copy is �ereby fumis0etl. ❑ CeNfied tapy is til¢E vnt� IM dry Building Division.
Date: ' � ApplicanC
[xu�rrrox rxorn xroxMrxs' me�e�xs�Trox oewuunox: m� secmn neee � ee comqeue n me �rmn's ia are numrea nioo� a kssl.
I ceniry that in the Ve�wmana ol the waA for wNc� tM1isPy�s osue0, I s II not employ any person in arry manner w az to Eecoma
su6iect ro t�e Workars'�ComDensation Laws of Cali/ornia.� / �,
--r''
" CITY OF COSTA MESA — HUILDING PERMIT PERM NO; P 048791
PERMIT NO; P 098791 PLAN CHECK NO; N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE; PLU PURPOSE: NEW-
JOB DESCRIPTION : 719SF RESTAUAANT,NEW CONSTRUCTION SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: REF B98600
�***�*�******�r*�r��r**�r*xxx����**��*�r*�r�*+r+r*****���***�**+r*�**�**���******��*�*�*
Z O N I N G R E Q U I R E M E N T S
s E T a A c x 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
PARKING AEQ: PROV: PARCEL; 42419112 ZNE: REF NO:
PLANNING NOTES>
>
iE 3f 1t dF ik iF 1E iF if iF jF jE iE 9E 1! iE ik iE 1E if jE dE iE if jt iE ik i! iE if ib 1E 3E 3E ik iE iE k iE iF if ik iE iElE iE IF if dE 3E if 1f if if iF iE iE �f iE dF. jE iE iE iE if iE 3ElE 3t iE iE it 9f !E jE fE iE iE iE
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:
I Daie: �. •—) V Slpnaiufe: 3�� r W�-/�^���- � — . .
NOTICE: If, aM1er makinp Nis tleclaratlon, you shoultl hec e suol t ro ne Warkers' Compenutbn o�ovisions oi ihe Labar BUILD ING APPROVED BY .�. DATE :
Cutle, you mu5i lart��� wmply wiN wc� provisions or �ds pem�stwll 6e Oeemed avokeE. — i
' CONSTHULTION 1FN01N0 �GENLY: I here�y atlirm Nat them is a cansiruction IenUinp a0ency lor �he peAarmance ol I�a work for AP P L I CAT I ON I S S U ED H Y: " —�
wluc� Nis Dermit is issuM (Sectlon 3097. Civ. CI. it ik iE it i! ik i! it iF it i(� it �E if if iE if iE �E iF dE itiF'iF
lFNOER: ' iEiEiEibitiFitikitifiEifiFjEif3kiEiElFiFifdFi(�iliE�EiFif�E�E±EjEkjkiE
nooeess: LEGALIZATZON:N F E E
OWNEB BIIILOEB OELUMTION: I hereby atfirm Ihat I am eMemD� �rom the Cantractors' State License Law for me tollowinp reason BLDG PMT P LUMB I NG EL EC
(SecUon 7031.5 B�siness anE Professional COEe: My ciry oi counry whlcA repuires a Dermit ro consVuct, alter, imDmve, demolish, or p ERM I T 4 3, � 0
repair any sVucture, D�or to its issuance, also requims ihe apDlicant lor such Dermit ta tile a si0nea statement Ihat he/she I5 Iiunse0 2 5�
pursuant to Ne D�o�Lslons oi tM Contrzclors State License Law (Ctupier 9(commendnp wiN Sectfon 70W) of Divisqn 3 at t�e Business P LAN
anA Prafessions COae) or Ilwt he/she is ewempt Iheretrom antl the basis for Ihe allepetl exemption. My nolation of Section 7031.5 �y
any aDD��� �or a Demtit subecls the aOD��Unt ro a civil penatty af mt more Ihan INe huMreA Oollars (550�. I S S U E FEE 3. 0 0
I, as owner of IM Draperry or my emplay,ees with wapes as t�eir sale compensatlon, will Eo tAa xro�k, an0 tAe
❑ simcture i4 not intenAeO or atlered lor ule (Secbon 7061; Busmess anU Pmfessional CaEe: T�e Cantracrors' SUte License Law
, dces not aPDN.�o an owner oi a DroDerty who builtls or imD�aves tAerean, anA who dces such woM �imselfinerself or t�mupA
his ar her own emDloyees. Drovitletl that such improvements are not intenGeE or onereE far sale. tl, �owever ihe builtlln0 or
Improveme�� �5 wld within one year of camDletlan, the owner will have the Eurden of pmvinp hUs�e tliE not Oui10 or Improve
lor Ue Durpase al sale�.
� I, as ownel of Ne DropeM. � exUuSiveN anVac6nq wit� IicensM contnctars to constnxA the prqeC (Sectlon 70a1, Business
❑ � p����ms Cotle: The Cartraclors' State Ucerise Ww Uces mt apqy ro an avmer ol D�7�nY who bmlQs or imD�ww ticereon
anE w0o W�traqs lor wch prolects wit� a cantractoqs) license Dursuant Io t�e CO�tnctors' �tate L¢ense Law�. I am aware
tha� proof ol ��eu Worker's Compensatlon insurar¢e slroul0 Oe D�aeO ta me.
� I�am exemV� un0er Section: B. 8 V. C. '
fo� t�is redwn:
Date: Ownec
I Eo here6y certity that I am awam of an0 unOersWnC ina requiremenis ol Calitomia HealtA anE Sahry CoOa Sectiore 25505, 25533, an0
2553C antl tlut I or anY fNure OuilOinq occupant vnll/will not (tirUe one) neeE to wmpty with saiC state co0es anE Ne repWremenis lor a
permn for cansiruq� or mo0ifiwtian tram me Nr 0'ua�iry ManaOement Oistrict. HeSiEential anstruction appliwtions are eKempt trom
Ihese proNsions.
Oaro: ApDlicant:
I �ereGy certily tha� � �ave rea0 this apPlicatian anA staro Itut t�e ahove informatian is correct. I apma to wmpry wit� all ciry ana counq
orUinances an0 stata laws relaiinp ro builUinp conswqion anG hereyY�� nza representaqvw ol Ihis ciry to enter upon t�e above�mentiorre0
pmDeM for inSPeGllan DurP�es. � ^ e
$i^'2�RD s� /��� ri-.
Date: Onatum: �^'�A � rl ���
om�er's �iunse or Soriai Sttvmy M:
t8ai8 W�ita--dulkirp; Green—COEe Enlorcement; Canary—Applicant; Pink—Revenua: GoWenroE—Assasaor
DATE: ��Z��
' x, ����*��t�*�*��r*���+�*
rt 7E iE 1E iE iE iE iE iF i! * if 1Flf IE iE iE if it iE iE fE iE if 1F 1k �E iE 1ElE dElt iE �F iE 3E if 1E
SFJ M M A R Y STRUCTURAL SEGMENT:N
iC MECHANIC FIAE SMZP/RES GRADING
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 43.00 3.00 0.00
REVENUE DIVZSION TOTALS--> COLLECTED:
HLDG PMT PLUMBING ELECTRIC MECHANIC
46.00
SMIP/NON—RES
TOTAL PAID DUE
46.00 46.00 .00
46.00 OVER/SHORT: .OU
FIRE SMIP/TOT GRADING PLAN—CHECK
ik * jk iF it it it �f �! iF iE ik it i! it i! ik iE iE iE iE iE if if if iE iE f! jF iE k if �E �)f iF iE iE �f jE jf !E 1E it ik iE if it i! iflE iE jE iE ik iE 3t iE iE fk �k �E if iF iF �E jf jE iE iE jE iE ik ik if �E iE 3E if ik
I N D I V I D U A L F E E B R E A K D O W N
TYF�E QTY D E 5 C R I P T I O N , UNIT COST TOTAL COST
PLU
PLU
PLU
PLU
PLU
PLU
PLU
PLU
FLU '
PLU
PLU
2
2
1
i
1
1
1
4
1
9
1
WASH BASIN
WATER CLOSET (TOILET)
WATER HEATER AND/OR VENT
WATER 5ERVICE
GAS PIPING SYS OF 1 TO 4 OUTLETS
GAS SERVICE
BACKFLOW IRRIGATION
FLOOR DRAINS
SEWER, CONNECTION TO bUILDING EACH
SIt3KS, FLOOR
SINK�, SERVICE / MOP
2.00 4,00
2.00 2,00
2.00 2.00
2.00 2.00
2,00 8,00
5,00 5.00
2.00 8.00
2.00 2,00
oi c�o6as�s-000ass�a ��-s ;s.un
DRTE: E�3/28.'90 T3ii�: 15:03
. CONSTRUCTION AND PLANNING � PV�� & SPA
�APPROVALS Permit# Date Inspector qppROVAIS Permit# Date Inspector
1. Temporary Electrical Service,or Pole - 52. Pool & Equipment Location "�
2. $oil Pipe-Undrgmd. �� . ��' (�� 53. Steel Reinforcement 't'
3. Electrical Conduit Utility-Undigrnd. 54. Forms -
4. Electrical Conduit-Undrgrnd: . .. 55. Electrical Bonding
5. Steel Reinforcement � . 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. ' 57. APPROVAL TO COVER�GUNITE
7. Footings � � 58. Electrical Conduit-Undrgrnd.
8. Foundation ,- �' -' ' 59. Gas Pipe, O Undrgrnd., Test '-
9. Water Pipe�Undrgrnd. �-- _ 60. Backwash Lines, P-Trap, O Undrgrnd. --
10. Structural Floor System " -� � 61. APPROVAL TO DECK ,
11. Property Sewer Line & House�Connection ' " 62. Backwash & ReceptorFinal :
72. Sewer Cap � �- � ' ' 63. Heater & Vent-Final ' �
13. Roof Drains � �' -� 64. Plumbing SYstem � Final �
.i '
14. Rough Plumbing '� Gf �•(� 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solar System-Final •
16. Rough Electric Wiring , � 67. Fencing & Access Approval ' �t
17. Rough Wiring Sign 68. -APPROVED FOR PLASTERING .
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL '
. . . . .. .. . . . _ _ . . .
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Undeiground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Shea[hing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. freme and Flashing 76. Dry Standpipe �
28. Lathing & Siding . 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing �' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ; 79. PINAL INSPECTION
32. Electrical Power Meter�Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric � � Notes:
34. Final Heating & Air Conditioning L� �
35. Final Gas Pipe•Test / Qp '�,
36. Hood or Canopy ',,;' .
37. Final Factory Fireplace '.
38. Final Plum6ing �Q',�qQ [,r�
39. Water Service�Final 103 40 4�
40. Gas Service-Final � �
41. Solar pomesticFinal �
42. Backflow Preventer
43. Backflow Irrigation �0 � (,�P
44. Landscape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING •
48. FINAL PLANNING �
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PflQIECT �ODNE83:
' OWNE:r'S NAME:
, ROOHEE9:
AflCH/ENGINFEfl:
1D�RE33:
PEflMITTEE:
ROOflE33:
NEU.XO.:
UNIT:
UNR:
IlLENSED fANTMCTOR OECIAM710N: I �ereCy attirm ItW� � am licensed under Drovisions al Claphr 9(commencinB �fA Seclion
7000) al ONision 3 0l t�a Busine55�aiM Prolessions COEe, ME my liunse is m full force anE ¢flecl.
CITY I1L.: ST�TE 11C.: LUBS: '
Oate: SiOnaWre: �
'�I WOBKEHS' COMPEXSATION DELUMTION: I here0y allirtn ttut I luve a ceNficate ol wnsem ro utlinsua or a uNficate a1 Warkers'
fAmpensa[ion In5u2nt8, of a teNliEtl CaDY IhereOf (Setiion 3gpp, �ap. C�. '
�l1CY NO.: E7IP. D�TE: "
AMP�NY: •
..] CenifieA coOY �s nereCy tumis�eE. ❑ CenitieC covY is fileE whh IAe ciry BuilEiny Uivisron.
Daie: MD����:
IXEMFfION FROM VIOHKFAS' COMPENSITIOX OECIANITION: (�ryis sn.tion neW noi Ga wmpktN ii Ihe penrct is fa ane AunOreA (5700) a Iqs�.
I ceNty Itwt in tAe pertarmance al Ihe work lor whic� t�is De�mit is issue0. I stull not emDby any person in any manner so as to bemme
su0led to tAe Workers' Compensatbn Laws ot Calilomia.
Uate: Sipnatua:
NOTICE: II, atler makinq IAis Eeelaraiion, you s�oultl hecame su0lect to t�e Workers' CamDensatlon O�ovisions oi [he Lahor
CoCe, you must lorthwith wmpty rrith suc� pmvisians Or INs permit shall Ee UeemeO revnkeE.
CONSTHUCTION LENOINO RGENCY: I here0y atlirm ihat th¢�e is a constmcllon IenElnp aqency lor the peAarmance of Ihe wod for
which IDis permitis IssueA (SecBon 3097. Civ. q.
- lFNOER:
ROOflE33:
OWHEH BUIlOEN UEClAMT10N: I hareby attirm ihat I am axempt Irom Ihe Coniractors' Slate License Law for Ihe followinp resson
(Section 7031.5 Business and Proiessional CoOe: My ciry ol �ounry whic� reQuirzs a permit to construct, alhr, imDmve, Oemolish, or
reDair any s[meture, prior ta tts issuance, aiso reduires t�e app�ican� lor such permit ro file a sipne0 s[atement [hat ha/she is licensetl
pursuam to tAe prmdsions ol Ihe Contractors' State Liunse Law (Chapter 9(commencinp wiih Section 7000) ol Oivisian 3 of ihe Business
anU Profassions CoEe) or Ihat �e/she is exempt tAerefrom antl ihe ba5i5lor tAe alleqeU exemD��on. Any violation of Saciion 7031.5 by
any apDlicant far a Dermlt suhjects ihe aDPliwnt to a Udl penalry af not mom than five huntlrM Uollars (5500�.
I; az ownar ol the pmOenY ar my� employees wi�h wapes az thelr sole comDensatian, will Uo fAe work, anE �he
`� simdure is not intenEeU ar oflereU lar ule (Sectlon 7pb7, Busineu anE Professional CoOa: The Cantractors' State license Law
Ooes nat aDGry to an owner oi a pmperry who CullAs or imDroves Ihereon, and wAo da¢5 such woA himuli/herself or ��rouph
� his ar her wm employees, provi4eU I�at SucA ImD�Memen(s am not intentleE or ollered for sale. Ii, �owever Iha buildinq or
ImD�ovement is so10 witAln one year of completlon, tpe owner will Aave the burUen ol Dmvinp he/5Ae Aitl not builU or improve
. lor tM Durpose al sale). ,
u
� 1 am exempt un0er Sectlon:
IOr tlli5 2250�1:
8. 6 P. C.
pursuant to t�o
proW0e0 lo me.
constmct
ner ol ora
am aware
Date: Ovmer:
I Eo �erlhy urtiry IAat I am avnre ol anA uiMerstantl Ihe reQ4irlmenLs oi Glifamia Healt� antl Safery COGe Sectpns 25505, 25533, antl
25534 anA I�aI I Or any fuNrO EuilEfnp occUpant wIIVvAII not (CifCle OnB) ne80 ro COmpty wiih uiA SIaIe caUes an0 t�e reQuimmenls lOr a
permn for camWction or maEiliwlion Irom the Nr Uualiry Manapement Oisinct. ResiOential wnsiruction apDliwtions are exempt trom
these Omvision5.
Date: Applicant:
I hereEy certiry that I have aaOlNs appGwtion antl state tlut ��e ahave Nlormatlon is mrtat. I apree ro compy vnm a0 dry anE couny
or0inances anC state lavrs alaunp to OwlAinp canslrucuon anE hea0y auttrorhe reD�esantaliues of this dry ro enter upon Ihe aCavo-mentioireE
DropeM forinsPe� Purposes.
Date: SipnaNm:
Oriver's license or Socul Secu�iry N:
16nJ8 W�i�e—BUIIGifp; Green—COEe Entorcemam; Gnery—Applicenl; Pink—Ravenue; GdAanrotl—Asaeuw
. � i.
PEAMIT NO: P 048791 PLAN CHECK NO; 05518-90 N PAGE; 2
�r**x�***x�**�******�rx��+r�*xx��x�*+t���x�r***�***�x�*+r*��+�*+�***�r�***+r�r*�**�r+r***��r*�r*+r*�
TYPE QTY D E S C R I P T 2 O N UNIT COST TOTAL COST_
PLU 1 INTERCEPTORS FOR GREASE, OIL SOLIDS 2,00 2.00
END OF FEE�
s• .
:�
i'
'�
#Dl1F'LYCt�TE 6`c�C�YF•a�
�t DQ�58�7&-uQ06°`iR �'C!T 45.OQ
L�AT�: OS/?8(93 TItiE: ?��OE
�
CONSTRUCTION AND PLANNING ' P��L & SPA
i, APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector'
1: Temporary Electrital Service or Pole 52. Pool & Equipment Location
2, Soil Pipe•Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
. 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. ElectricaVUFERGmd. 57. APPROVALTOCOVER-GUNITE
7. Footings 58. Electrical Conduit-Undrqrnd.
8. Foundation - 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Urtdrgrod. _ � 60. Backwash Cines, P-Trap, ��Undrgrnd. -
10. Structural Floor System � 61. APPROVAL TO DECK
71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ' 63. Heater & Vent-Final
13. Roof Dreins - 64. Plumbing SYstem � Final
14. Rough Plumbing s� �y0� � 65. ElectricabFinal
15. Rough Electrical�Conduit � 66. Solar System-Final
16. Rough Electric Wiring ' . 67. Fencing & Access ApProval
77. Rough Wiring Sign - � - 68. APPROVED FOR PLASTERING
18. RoughElettrical-TBarCeiling 69.�POOUSPASYSTEMSFINAL -
� 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas d Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. ROof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Struciurall & Monocoat 75. Dry Chemical
1'7. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. DtYwall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:�%/I�KA KJpB7iL �✓FM7 tl1C� L�iO
34. Final Heating & Air Conditioning
35. Finai Gas Pipe-Test
36. Hood or Canopy
37. Final factory�Fireplace
38. Final Plumbing
39. WAter Service-Final .
40. Gas Service-Final
41. Solar pomestic•Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDiNG
48. FINALPLANNING
49. Eleccric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�—
PR0.IECfA00HESS: $OI � W 19TH ST uxrt:
ownen•s x�Me: RALLY' S FiAMBURGERS
aooxess: g525 GIBBS DR, SAN DIEGO •
CA 92126 , •
619-576-2060
RRCHIENCINEEB: SCHUSS, . CLARK b ji$$�C NEO.NO.:CLiB3O
nooness: 9q'7q KEARNEY VILLA RD �NR�
S,D. CA 92126
PENMIREE: A 6�M AIR CONDITIONING ( 714 ) 996-0332
�ooeess: q300 LA PALMA
ANAHEIM CA 92807
LILENSED COMMCfON OECUMTION: I �ereEy affirm WI I am Iicen5e0 unOer D�ons of Gwp[er 9(commendnp xiN Sectlon
7000) ot Division 3 0l tAe Business an0 Prolessions CoOe, an0 my Ikense is in lutl lorra aM ettect.
cm uc.,: l51�5n 2 2 6 �5slnn uc.:19 7 3 41 �f�� C— 0 D �
Date: _���.L-- SlOnature: O� �^� "�'"" �
'- :�.IIKEBS' COMPENSpTION UECIAMTION: I �areby affirm t�at I have a cahilicate ai canun� to selbinsure or a cetlllicate oi WOMers'
'ColnDensation Insuranca, or a certifieU copy tAereol (Section 3800, La�. C�.
roucr xo.: Exr. o�re:
COMPiU1Y:
❑ CeNfeE copy is �ereDy tumiSheE. � CenitieE capy is fle0 wIN t�e dry BuiIENp ONidan.
Dam: Applicam:
E)fEMPfION FROM V10RIfFAS' COMPENLITION UEClAlU710N: (ilus se�tion need no� 6e wmpleted'A Na permit is br one Auntlred (570� a lar).
I certiTy ihat in the peAormance at tne work lor wAich Inis cermit is iuue0, I s�all not employ any person in any manner w as to hecame
su0ject to tha Workers' Campenution Lavrs ol Califomia.�i�/
� Dala: �0^ �u�D SipnaNa: �{ v
NOTICE: If, atler makin0 ihis Oeclaatlon, you s�oulE hecome suUlect to the WOMers Campansation D�ovlsions oi tAe Lahar
COAe, you must IorlhwitA comply wlt� such proNsions or t�is Oermit shall �e tleeme0 revokeC. •
CONSiBUCTION 1FN01NG AGENCY: I hereEy aKrm that IDere is a consiructlon Ientlin0 a0ency for the pedormance ol Ihe work far
i which �his permit is iuuetl �Section 3097, Clv. C).
IENDEfl: �
11DOflF83: �
OWXER BUIIDER OECWUiION: 1 �ereUy aflirm that I am eaempt fmm t�e Cantrzclors Sute Lice�tte Law for Ne iWlovrin0 R�n
(Section 7031.5 Business anE Professional COEe: My cm/ oi counry whic� repuires a permit to rnnstrucl, atter. ImO�'e, dertwliSA. or
mpair afry strupure, D�or to its issuance, also repuias the apD���ant lor such permR to file a 5i0�e0 statement I�a� �U6Ae is Iicense0
� pursuani to t�e D�a�sions of the Contracrors' State License Law (C�epter 9(commencinp with Section 7000) of DlviSian 3 ot the Business
� an0 Professions Cotle) or ihat �e/sha I5 exemD� Iherefmm an0 ihe basis for t�e alleOeU exemption. Any violation ol Sectlon 7031.5 �y
ayy a0711cant for a Dermit suhlecis [he aD011cant lo a civil penalry ol not moro than five hunUreO dollars (5500�.
I, az owner ol the property or my employees wiM wapes as tAeir sale compensatlon, will Uo t�a work. antl Ue
❑ structure is not intenEeO or otlered tor sale (Sec6m 7094. Business an0 Pmfessional CaEe: TAe Comactors' SWta Limnu Law
Oces not appy lo an owner al a properry who Uuiltls or imDrwes Ihereon. anE wlro tlaa suc� xroA Nmull/liersetl or I�rouAh
his or her own empbyees, DrwiOeE t�at such improvements am not intenEeE or oflereC for sale. Ii, Irowever t�e huilEing or
I improvement is soW within ona year ol comDletlon, Ihe owner vritl Iwva I�e OurEen ol provinp �e/she AiE not builE or ImOrove
�or tne Durpou of sale).
I, as owner ol Ine propeM. am exclusively canvactinp vrit� IlcenseA comractors to construct Ine prol�� (�ctlon 70aa, Business
❑ anE Professions COOe: The Caniraclors' State License Law dces not apply to an mmer of Droperty wtw Eutlds or imprwes Nereon
an0 who conlacts for such O�ol�s ��th a conVactar(s) license Oursuant to the Cantractors' State �unsa Law�. I am aware
that proof of their Warker'S Compens:tlon msuance shoulE Ge D��'�DeE to me.
� I am exemD� unAer Secdon: B. 8 P. C.
lor Inis reawn:
Oate: Ownec
1 Eo �ereUy ceNty tAat I am aware ot an0 untlersWnC the 2Quirements ol Calilomia Heatt� antl Safery COAe Sedions 25505. 25533, an0
2553C an0 that I or am/ IUWa buil0inp occupant vnll/will not (prUe ana) nee0 ro comON �� ��4 state caUes anE Na repuiaments for a
permil for wnstructlon or mo0ttiwtion trom tne Air Oualiry ManaOement Uistrict. flesi0ential m�5trucuon appliwtlons aro aempt Iram
mese n�waianc. �
e
Date: ApDliwnC
I hereby certiy tAat I hava rea0 ��is applicatian anC state that the a6ave inlormation is carract. I aproe to comply wilh all ciry antl caunry
or0inances anA stata laws alating to Uuil�inp constmction anU �ereby aut�odza representatives ol Nis ciry ro enter upon Ihe a�ova�mentioned
DmOeM �or inspeclion pu�ryos�e/s. � '�/�/
-Date: �0� � G(� . $ipnature'(�{�"v �
Driver's uunu or Sada� Security x:
1&i1�C8 W�ita—BuIlEinp; Gr9en—CaGa Enlortemenf, Canary—App��cartl; Pi^k—Rewrme; GaWenroO—Maovw j
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: M 049280 PLAN CHECK NO; N
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC
PERM NO: M 099280
GOVT: N SUPP: N
PURPOSE: OTA
JOB DESCRIPTION : MECHANICAL FOA NEW RESTAURANT ' SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: RALLEY'S HAMHURGERS/B-48600
*�****�*���e�*x�e��r�rxx�r*�e****��e��r�r+r�r�r*+r�r�+r*rx***�r��**w�r*�r****����*+r**+r*rrx **�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 BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN,RGHT; FT IN LEFT: FT IN RGAT: FT IN
PARKING REQ• PROV: PARCEL; 42419112 ZNE: REF NO:
PLANNING N�3TES>
> •
iF ik k iE ik i! if M if iF ik iF fF fE if ik k k ik iF iF if k if ik if i! k k 1E iF iF ik iE iE iF ik iF if if ik IF iF if if if iF iF k i! 1E ik±f if ik k ik ik ik ik iE if iF iF iE i! iE M it iF 1E i! �1k i! iE iF if dt ib
- 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 BY � DATE; �
HUILDING APPROVED HY : DATE: 7�
APPLICATION ISSUED HY: DATE: �`6 Z' u
'kitdfitifikkit�klkikfkifiklF�ri�ikilMikifiF 3F3F�iFlfiFfFiFiF1k±E1t3kik ifiF
�it**it�r�r�xit****ir�r�*�+r*��at�r**��r�r**�*�r**it�a ��r���r�it�r�*�r�r�r*rir**��r***�r+r�r*��rit**��t****it
LEGALIZATION;N F E E� S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GAADING
PERMIT 31.00
25Y SMIP/NON—RES
PLAN , .
ISSUE FEE � 15.00 ,
BUILDING—DIV-> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 31.00 I5.00 0.00 46.00 46.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 46.00 OVEA/SHORT: .00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
46.00
if !F ik ik itlf !f iFlf !k if ik iF fFlk iFlF M ik 3E if if !k if it ik if !f!! k 1t 1F k!f !f �! f! iE iF M �F if 1F %1f if iE 3k ff iF �E iF %�k if iE it it %iF 1f iE iF iF �k if !k iF N iF iF �F iE iF iFlE iE M M
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
MEC 1 INST FOAC—AIR/GRAV FURN <= 100 K BTU 9,00 9.00
MEC 2 INST HOOD W/DUCTS FED BY MEC EXHAUST 6.50 13.00
MEC 2 VENTILATION FAN CONN TO SINGLE DUCT 4.50 9.00
END OF FEES
0
Q1 D0071ai1—QD07101] '�r_a'p'
DATE: la/02/9� 'il'I�E: b5:32
46.OG,
i ' I
CONSTRUCTION AND PLANNI � POvL & SPA
APPROVALS Permit #• Date Inspectnr APpROVALS Permit # Date Inspector
�
1. 7emporary Electrical Service or Pole 52. Pool & Equipment Location �
nr
�2...,�,So,il Pipe-Und Fnd_r `�' ' �
,, fg„ c� 53. Steel Feinforcement
• 3.-�IectricaFGonduit=UiilitY-Und?grnd. 54. Forms '
�7^r �^
,'.4�.�Electrical�Condurf U�drgrnd. 55. Electrical Bonding
S.tSteel Reinforcement }� 56. Rough Plumbing & Pressure Test o
..-'� -enr �-
'�6c�'ElectncakUFER;Grnd. j� � 57. APPROVALTOCOVER�GUNITE ��
� �,'. :c � � ....
�,Z•.CfootingsCi+ ,�� µ. , 58. Electrical Conduit-Undrgmd. ��" ti
�� � e
".B:�Foundation� � � 59.GasPipe,OUndrgrnd.,Test ""
_9i�ater Pipe-(lndrgmd. 60. Backwash Lines, P-Trap, O Undrgmd. -
,;
r
lO.rStructura141oo�System - 61. APPROVAL TO DECK : ,�
11.�Property Sewef'Line;& House;Connection 62. Backwash & Receptor�Final
1 �
12. Sewer Cap =� �y o- 63. Heater & Vent-Final
1
13. Roof Drains: ., �, ' 64. Plumbing System - Final
14. Rough Pl,umbi�g ' .. 65. Electrical-Final � ..
15. Rough Electrica6Conduit � � 66. Solar System-Final
16. Rough Electric�Wiring 67. Fencing & Access ApProval ,
1�. Rough Wiring S�gn - 68. APPROVED FOR PLASTEflING
18. Rough Electrical:-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating &,Ayr Conditio ing � /p� ,,.FIREDfiP�'. REQUIREMENT. r
'-� < , � � < . � � c� ?' �� .�( �-l^' '-(�i,� � -7 5_ L. _
20.pRou h Facton, Fire lace `�'�; =' � v " `� *' T � y,-j` ^� T' * � -
§ Y � P : S; :.,G .� S �• �^i� x :L�PPRO,VAL'S;�-,FPermit #
c. ...c Y T ^.�._a. .-f �
?�.��UCiS, If1•�t/UCLUf2 r 1 . •• F.$ :: � ✓ ^* X � �-�f �'..i`i X
.�, �z i �-; �: {� F, �j�; M �0. Undergrou{�d�Hydro ,;
22.•Oucis.Ventilatin'�` � "" �� � `.' �,� -�
-- 87:� � fJ �: O 4 C� i-.�:'r <71. Product�Piping �Gis Oi0i1 ,
�.n
23. Gas;Pipe_,Rough & Aest ���, �-� �� G`t �� * �72. Undergrouyhc�,Flu;h� x j,
r- �.. �. rr, � i H r .. `.. t. � � y� � , . r. � -
24.'Roof� Framing �; i; �: � 'C H:.r a� 73."Undergrnd. StoragE7ank O Gas ❑ Oil
ti n _ �.
25. RooNSheathing ;�%* H `� ' �; �� `=' m ^* � 7qrp�erhead Hydro�� ;;
�A v lTl T >
26.yT�BaCCeiling (Str�uciural) &KMonocoat �; p � p� �: 75�Dry Chemical c^7 �~ l SSt=]
- .� .- � �
27.=Frais�eandFlashin'x �t^,x �cc' � �+Xy � � -� �* , �i^ �
�9s ..mn !r. m ,,.��; ,e 76. Dry Standpip'e ,.l.�-, .K C
`28. Lat`hin & Sidin " � ": -'�W �' �• ` . ..x ; '-"' ....� . p"<;
c., 9;..,, 9 �:� l7rs;F O a � � �+ : 77.yFIXED SNSTEM�F,INALy �.
�29. Insulation �'Y� v s " x �. � � 't" 78.eFIRE PREV. FINA"�1 � � `"' '-'"�
r, �-. n r c n * S �+.� z: x'
�� :j �' 'Y �r x H ' r • ' - c: s y
��30. Drywall:Nailing �s,� � i x r I � � k g HEALTH?DEPT.:-REQUIREMENT
,"31. Plaster Brown'Coatx � � R"' � � � ' � �`79. FINAL INSPECTIbIV � ~�'1��
� T Y L � I �: .K . I �J 'y 'i ✓ •'J �i i
Y n� ' - �; �- �.� � 1' 1 X. ~ '+, :-�
�32.:Electrical-Power Meter`-FiPal ; x � i � y 80.�FOOD CERTIFIZ`ATE ISSU�D � �,x;'�
`33.�Final:Electric'� "�Y r' ' '� '•` � "'� .NoCes " `'�`' { ' � �''�"
r- ..f .� Y +: T ! �'x .1: �t iT`.f` i: R'T��5S
r, ' -„p i c � n /s: i q: a: : .� [ �'.a a r„ a v
��34.:Finel� Heating�& Air�Ca�ditioning- �,., . � erp� (�I(,� �: * ,: H t �.,C;'�
,^
�35.!Final Gas:Pipe-Testr ��� � � �-+ � ' �'=�* � .=o C�Hc r ~ c>+ t'
v � i �c x -t �.:'lo * C+± N
,- ^ _ " s: � � IT"7 �t % Cl � ' ' Y: � 2 C � J s � -� i.
�36.yHooii or,�CanoAv �; � . �r,; �; �, � � -" .� �; � �� . �'r�,r.5
`37.�Final�Factory Fireplace x � E-F � � � , , � k ""� ' " � � -'{"
x rt1 Ix n Q.-� "'J ;n �; G t*; i�i
:�38. FinaLPlufnbing � R' � � I �c i n " •� • � �. �y l.
�T7 ! i. �C rticV o •n * T.T-.rJ
"�9. Water Service�Final � F , y. ��: ! I �' � :� .-- - �u T ~ ��j-��
yc ~ � a: k -. n. r; i-1 -. (ti c.�
�40. G8s Service-Final t' �'' �r"'O� S � �' � �"' u'� .�:� � -�-
� x (".'.. i-� x � I � vc E. . a r s r.,
r47. Solar OomestiaFinal `' ;r, x`� � i �+ a: [^ '�o o� =�? o
i. ^ -V X' �-� N� S
x N w } � -p,: v� G -: r. r v t-, �
,42.�Backflow Pre enterx `�. ��y� ��i „ w t'iC E^
�, , �._> . .. ., ... ...,_ _
43. Backflow Irngation=. :� * .� ?" * �� �� * ^ � ' ' '
.. ;� : � r o �-�
� r, u�T.CJ S f:r •; �; -K.%'... ,-] �J 1::J .� t.v�
;94.,.Landscape Irrigation System��w �,t r �,:t ,�# , = F 4, ;,a: �� r c-
. (., � _ r- -� � � - � r � - - .� j
�45. ;Sound Attenuationx • •• � • �� , , '+7 t�^,i' .� !-. c' tr' •S • �
rn ..i > ^ / .-i^. �•F. M
46. H2ndicap'Regulations -' � �. *�'%� � 5 vo �
Ar:� Q t. J
�47.'FINAL STRUCTURE & BUI`L'DING > F. ! . � « � � � "' �-
�
, n� � T- _
48.�FINALPLANNING# "` . �'' � ��� �'''' r � ; ��
:� t� : ! t D� S � t�
�49. `Elecftic Release to Eilison , , � ' � •� � =� t •i � r �+
! � ;✓_� :�
- i� .
�50. �G2s:Release to Soutliern California;Gas Co _ ' X " �" `" � ' ,
r �,r. •. .'<- = c, n t o o a
`51. CERTIFICATE OF OCCUPANCY ' "' " '
No. Date
Pfl0.1ECTAU0NE3S: AALLY.'S HAMHURGERS uxir:
OWNEH'SN�ME: SSiS GIBHS DR, SAN DIEGO
�oopess: CA 92126
619-576-2060
SCHUSS, CLARR & ASSOC C11830
RNCH/ENGINEEH: Cjq'74 KEARNEY VZLLA RD pE6.N0.:
�onxess: S, D. CA 9 212 6 uxn:
CIRCUIT ENTERPRISES INC, (714)996-9351
PENMInEE: ']1Z S RICHFZELD RD
�oo�u: pLACENTIA CA 92670
LICFNSEO fANTN�CTON UEClAN1T10N: I �ere6y aKrm WI I am GceriSM unOer D�om ol Clapter 9(commencin0 �t� Section
�000� m o�Cy��'3 S'2"�usiness a� Rol°�RS �Si ' S�a mY Gaina a in �o io��edm on�.
CITY LIC.p: 4� STRTE UC.: CIAS3: N '' /'I,,,J
�Oate: _O'.Z.I-( �� SipnaWre: _ _ _ _ _ te�"`�^�'� I
�IJCYNO�ii��IAN� EClAly1T�N; J 6eret0y a�t ���a,Ee�ifi�� i cqige i to ulFinsura or a certiflwte ol Warkers'
EBrid dl pS' TPfao 1 l¢ 1 / J
❑ cen�r�ea war �s �prymme�nea. ❑ cenmree wcr i� rum �+m we cnv �m
�ate: O��O�//IV MVticant: � �U.u+C�'i1^�
IXEMFfION FlIOM VABKFAS' COMPFNSITION OEfAAMTION: (Ih6 sectim mi De compete0 il Ne pe�rti� ¢ ta me huqrW (510� or kss).
I certity that In Ihe performanca at [�e work lor wltich Nis pemtit ¢'swetl. I shall not empby any person in anY manner m u ro hecome
subject to tAe �'orkers' Compensatbn Laws o/ Califomia. '
Date: Spnature:
NOTItE: tl. aller rtwlonq tlris OeWation, you shouM become wEjecl ta Ne Wofkers' Compensaoon VroNsions of the LaEar
CoOe. you mu5i fortlrvnt� compy wiN wc� provisions or tlu pemtit siWl Oe dremW revoked.
CONSTHULTION IENUING 11GENLY: I tcereEy affirm tlut IAere o a wutruction IenEinp apene/ fw Ne perlormarke ol t�e xrork lor
which Inis perMt is issue0 (Sectian 3097. CN. C).
lFNOEH:
anoxess:
OWNEP BUIIDER OELUMTIOX: I IreBCy atfum WI I am exempt hom Ne Contranors State License Law lor IM Idlowinp reason
(Seqian 70J1.5 Busine55 aM Prof�slon� CaOe: My dry o1 cqmry wNcll requires a permil ta mtttnM, alter. imprwa. EemWiSh, or
a0v� any stru«ure, D� a�� ��. � repuires Ne apD��< <� sucl� perMt to Ida a 510�re0 SWtement Ihat �e/sM b GcenSaC
pursuant to the D�a�isions ol the Conlracto�s' State Licensa Law (C�aD�er 9(commencinp witA Sectlon 7000) of Olvislon 3 0� ��a Business
an0 Pmlessions CaOe) or ihat �e/sAe is aMampt Iherelmm an0 t�e �asis for t�e alle0� eRamD��on. Any violaiion ol Section 7031.5 Ey
any apD��cant lor a Dermil su0jects t�a app6ant ro a riW�penalry of �rot more ttan INe hunOreO dollars (5500).
I, u owner of Ne Droperry or my em7loyxs wiN wapes u iheir Sole tomp¢n5atlon, will Eo IAe woA, anE the
�� strvcturo is not imenEeO or aifered lar s�le (Section 70a�, BuSness anE Professional Cade: TM Contnctors' Sute Liansa Law
ap� ipt aDdY to an owner ot a DropeM � ��s a Imp�oves ltcereon. aM wlp Eou such rrork Nmsattlhersell or UroupA
nLt or ner ovm empbyees. D��� �� ��^�D�^K^u are not mtmEM w ottereE iw ule. If. Mwever iha oui�alnp w
Improvement is sol0 wiWn one year al comDleUon. Ua owner wiA luve t�e �urEen al provinp ANSM GiG not Eui10 or improva
ior I�e Vurpose N ulaJ.
I, as awner at t�e Dmpetly. am excluUvelv conlracOnO ��� IlcenseO contracrors to constmct tha pmject ISactlon 7044, Business
❑ an0 PrO�essions CaAe: The Cantractors' SGte License Law EOes not apDN �o an ownar ol properry wAo Du110s or improves tAereon
an0 wlw contracts for wc� Orol�s w1IA a contractor�s) IkEme Dursuant to tM Contnctors' Stata Lkenu Law). I am awam
IAa� D�i ol Neu Workcr's Compe�utron insurarce s�wWO be Wwi0e0 to me.
� I im lxemD� �r Section: B. 8 P. C.
lor tlu5 rtason:
oatr. ��
I Ua �ereCy ceAiry tAat I am awam al anE un0erstan0 tAe requimmen�s oi Caflomia HwItA an0 Sa�ery CaOe Sactions 25505, 25533, an0
25531 anOlAat � or any tutum DUIMinp xwpant will/Mtl �pt (prde ane) neetl ro compty Mth sald state coEes and Iha reQuiremenis lar a
perMt lor conA���n or mo0iliatlon trom Ne�ry Manapement Disirkt. HeSWential constmctlon apptications are axemOt irom
theu orovisiws.
Oate: MPGcant:
I �ereEy ceNry ��� I Aave reaa Ws apDlkation anU state Wt tM aEova infarmation'a carrect. I aprea to compy wRn all ciry an0 counry
orAinancps aM sUta Wxs relaMp to EwlOinp mnstrucfion aM IereN/ aufMr¢e represenGtives ol Ittis cny �o enter upon IAe abovo-mentlone0
proDeM �o�ryinspectian purpposes. —���I I ''
Daie: 0 � ! � �/(�W�"3 � �
0lNtf'S LiCCf190 w �� ���MY N:
teltd8 NTite—&+iM'vp: Green—CoEa Eniwcemant: Cenery—MW�t: Pink—Ravenue: Gotlenio0—Aveaaor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 048811
PERMIT NO; E 048?11 `� PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-N PERMIT TYPE; ELE PURPOSE: NEW
JOH DESCRIPTION : 719SF RESTAURANT,NEW CONSTRUCTION SQ FT:
CLAIM VALUE: CALC-VALUE; GROUP OCC; B-2 /
COMMENTS: RALLEY' S HAMBURGERS Q,E�'; a��(�L'�
*�**�r**+r*�r**�+��*��+�**�r�r�*+�*�*�*�rx,��r*�x� x*x+r�**�ex�***�r+r*�r*�r�r**��*+��+��x***�*x**�*
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�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; 42419112 ZNE: REF NO:
PLANNING NOTES>
>
if ik iP iF iE 3E ik 3E iF if if it iP jE 3E it it iE iE �E iE iE If iE iE 9E 9E iF i! k it it iE.it 3E !t iE it if iE iE iE �t iE iE iF jt iE iE iE i(� iE iE 3k ik 3! iE 1E iE 3E 3F iE iE it iE iF it iE iE if 3E iE�iE iE 3k iE ib �1F 3E
U E V£ 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 DATE;
BUILDZNG APPROVED HY � -- DATE:
APPLICATION ZSSUED B`c; " DATE: U��(}/�
ititiEiFitililifikifiEifie�itifiEiFjf'kkiEiEiFi.3t�cz F�3FhFii , .�F it�cx- ..- x�t�'�iEiEiFiFiF�E�IFif�Fit� tFitikie
iFMiEiEif3fdf3F3klkiflFll�EiElfifif3klfififitiEikiFiFlFiEfFiFdfiE�ltlkik , ,c.« :iFihikitifitfElEiFiEiEififill6iEiEiFififiFifiEiEiFiEiEdFlEif9fMiEifiF3F
LEGALIZATZON:N F E E S U.�] M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT g(,p�
5 $ SMIP/NON-RES
PLAN
ISSUE FEE 15.00
HUILDING-DIV-> PERMIT ISS�E PLAN-CHECK TOTAL PAID DUE
TOTALS----> 86,00 15.00 0.00 101.00 101.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 101.00 OVER/SHORT: 00
HLDG PMT PLUMHING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN-CHECK
ioi.00
1t k�! it if ik i! 3f iE ik if ft iF �f it iflk if if !f iFlf iF if iE iE iE k �f if i! it itlk it it iF iE iE it dk iE iE iE it iF if ff ff �k if it if it iE iF iE 1E �k 1k k it ik if ik iF �f it it iE fE iE iE 1f ik iF i! iE it
I N D I V I D U A L F E E H R E A K D O W N
TYPE
ELE
ELE
ELE
ELE
ELE
ELE
ELE
ELE
QTY
20
10
20
5
15
1
4
1
D E S C R I P T I O N
FIXTURES, LIGHTING 1 ST 20 EA,
FIXTURES, LIGHTING ADDITIONAL EA.
RECEPT/OUTLET 1 ST 20 EA.
R£CEPT/OUTLET ADDITIONAL EA.
RECEPT/SWITCH 1 ST 20 EA.
SERVICES BELOW 600 V& BELOW 201 AMP
MOTOR/POWR APPARATUS 0.0 - 1.0 HP
MOTOR/POWR APPARATUS 1.1 - 10.0 HP
END OF FEES
UNIT COST
,75
.45
.75
.%S
18.50
3.00
7,50
TOTAL COST
15.00
4.50
15.00
2.25
11.25
18,50
12.00
7.50
L! 0005861b-+J0068676 TCtT ;OS.D�
DkTE: GE/29/40 TICE% 16:3f
1 { '
� CONSTRUCTION AND PLANNIN P OL & SPA
APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment �ocation �.
2. Soil Pipe�Undrgrnd. j' 53. Steet Reinforcement .
. �.
3. Electrical Conduit UtilityUndrgrnd. * 54. Forms .�
. 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test - �
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System , 61. APPROVAL TO DECK �
1 t. Property Sewer Line & House Connection ' 62. Backwash & Receptor�Final �
12. Sewer Cap � 63. Heater & Vent•Final '
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical�Final
15. Rough Electrical-Conduit � 66. Solar SYstem•Final
16. Rouqh EI@�tric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrital-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 � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
.
27. �Frame antl Flashing 76. Dry Standpipe
2� 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 Bi�Air Conditioning ��
1,
35. Final Gas Pipe�T�st
36. Hood or Canopy� '�
� ;
37. Final Factory Fireplace � ,;j
38. Final Plumbing " � �
39. Water Service-Final �
40. Gas Service-Final � �
41. Solar pomestic-Final
42. Backflow preventer
43. 8ackftow trrigation _
44. Landscape Irripation Syttem
45. Sound Attenuation
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING ' "�
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date
�
��
I �I
PNOJECT 400XES5: 8 O 1� W 1 9 TH JrT UNIT:
OWNEN'S NAME: �AI�LY'�S AAMBURGERS
� RDDFESS: BSZS GIBBS DA, SAN DIEGO
CA 92126
ANCHIENGINEEH: 6 1 9— S�I6 — Z O 6 O NEG.NO.:
�ROOflESS: "SCHUSS CLARR 6 ASSOC C1 ��30
94�4 iCEARNEY VILLA RD
PEXMITTEE: $'D. CA 92126
aooness: CIRCUIT ENTERPRISES INC. ( 714 ) 996-9351
712 S RTCHFIELD RD
PLACENTIA CA 92670
IICENSED CONTBRCTOB oECIAHRTION: I hereby allirm ttwt I am licensetl untler pmvisions ol C�apter 9(commencing with Seclion
7000) 0� OiviSion 3 0l I�e Bu5ine55 anG PmIe53ion5 Cotle, and my license i5 in IuA larce a BIIeCi
ciTvuc.: 04 LZZ/�, �S)TPTELIC.:5355��� cuss: C—
Da�e: �—L-� S9na�ur���
WOBflEBS' LOMPENSRTION OEClAfIAiION: I here0y alfirm t14t I have a ceniticare of consent to selbinsure or a cenifiwte af workers'
ComDensalion Insutance, o� a cerUfietl coov ��eteol (Section 380p. LaD. C).
vouarNo.: 59C0020212756 EkP.URTE: OSIOS�9�.
camrnNv: AETNA
� Cenifie0 copY is hereDy fumis�eA. ❑ Cenifie0 mpy is fileE with ihe a�y Buildi Di aio .
Oate:,.�(% �V- '� `�lV qpplican y
E%EMp710N FBDM WOPItEflS' COMPENSRTION DECIAflRTION: Rks SMbn neetl not Ge compkte0 i� tAe pxmil is �a one hunOreO �311p) or less�,
1 cetli�y �ha� in Ihe pertormance ol lhe work lar whiCh IhiS p¢rmii is iuueQ. I Shatl not employ any Oers�n in any manner 5o as to heCOme
subiect to ine warkers' Comoensation Laws al Calilomia.
Daie: Signamm:
NOTICE: II. after making Ihis CeGaratian, yau SAoultl bewme wOject ro tAe Workers Compensatlon pmvi5ions ol t�e Labar
Cotle. yau mustlon�vnt� comoly wilh sutli provisions or iNs permil s�all be Oeemed revoke0.
CITY OF COSTA MESA — HUILDING PERMIT PERM NO: E 09975
PERMIT NO: E 099756 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: QTH
JOB AESCRIPTION : 719SF RESTAURANT,NEW CONSTAUCTION SQ FT:
CLAIM VALUE; CALC—VALUE; GROUP OCC: B-2 /
COMMENTS: RALLEY'S HAMBURGERS �
*�*****x�***�x****�*�r*r******��**�t*�*��t�r*�r�*�t�r*�r�r�r�txx x�x�w�r�x �t*+��r�r+t�r�r�r+�**+��r�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 BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT; FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV; PAACEL: 42419112 ZNE: REF NO:
PLANNING Nt3TES>
� .
1t �f �f ik iF i! if iE If iF iF iFiE iE if k iE ik if jf iF iE if iE 1E �E iF k if iE k 1k IE if iE k 1E 1liE iF iF if iE it IF li if 1f 1Flf jk If fk If iE iE iE ik 3Eif iE k ff aF if if iE if if iE * iF iE iF if k iF Ik if
D E V E L O P M E N T S E A V I C E S R E Q O I R E M E N T S
Z�QIA�PrI�RAOVED BY • DATE:
BUILDING APPROVED BY : DATE:
I CONSTNUC710N LENOING AGENCY: I Aere�y a�lirm I�ai IAere i5 a tonS�NCiion le�tlinp apenty lal Ihe pedormante o� Ihe work tar APPL I CAT I ON ISSUED B Y: DATE : I�
4i�icA Ihis permit is i55ueU (Setlion 3097, �iv. C�. {p {(.{E*{(.{p.* {(.�(.*{E {(. �{p{(.y.%{f{(�* {f* **.�.�.***.�.*.* �„µ
i LENOEfl: �FikMiiikiFlEafifitiEiFlEiflEiflfkiElfiFiFifiFlfifififlEiEkiFiEiElFiFiEiFMi iFifiFlEiEiEiflFiEkitifkM�IkIfIfIFiFIFifIfiF1M1*4iEifiEifiEiEkiE�EiflF�1F�^__'
nooeess: LEGALIZATION:N F E E M M A A Y STRUCTURAL SEGMEHT;N
OWNEB BUILOEB OECIAPpTION: I �ere0y allirm I�ai I am e.empt Imm t�e Contactars' Siate License Lzw for tAe lollowinq reason H LDG PMT PLUMB ING ELEC IC MECHANIC FIRE SMZP /RES GRAD ING
(Section 70.77.5 Business aM Pmlessional �upe: Any dty ot wunly whic� r¢quires a permii m consiruct, alter, impmve, demolish, or P ERM I T 00
re0air any sVutlure. O�ior to ils issuance. also ro0uires Ine aOV�icant �or such p¢rmil Io lile a sipneJ s�aiement I�at helshe is licensetl
purspTnt �a �he pmvisions ot ihe Comracwes' Staie License Law �COaO�e� 91�ommencing vril� Section 7000) oi Oivision 9 oi ihe Business - ' �= SM I P/NON—RES
and P�otessions CaOe� or i�ai �e/s�e is erempl therelmm mtl ihe Oasis far I�e alteqea exemplion. Nny violation ol Section 7031.5 by PLAN �
any d00�icanl lor a De�mit su�jects ��e appliwnt to a cml p¢nalty ol nol more than live hunaretl Eollars (5500�. ISSUE FEE 4, S�
� as ovmer al ��e O�oDerty or my em ioyees witn wapes as their sole compemation, will tlo IAe work, antl I�e BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DOE
� simctureisnoiintenCedarolferetllorsalel�ctmn70da,Buvne55anAPmte55ionalCoAe: TheConiractars'State�icense�aw TOTA.I.S----> 15.00 4,5� �.,9{L__�- 19.5� 19,50 ,0�
tloes not appry lo an owner oi a pmOerlY w� �uiles or imD�aves Ihereon, an0 who Eoes suc� work Aimsetf/herself or thmu0h
his or �er awn employees. proviaeA t�ai suc� impfOvemCnlS are WI inlenOEtl ar O�Itred lor 521E. II, Mwever th! Euil01n0 or
Iar�i�ee0ue0o e�sa¢)��n ane year ol mmpletim. Ilu ovmer wlll luv¢ tne hur0en ol D�ovinq �e/sne Eitl not 6uiIE or im0�ove REVENUBLDGVPMTOPLUMB NG ELECTR I COMECHANnIC
� i. as owner ai tne v�ocenK, am eKuusiveN contratling vnt� IicenseE rontraciors to consirup I�e O�oled (Section 70a4, Business 19 . 5 0
and Prol¢Ssi005 COde' T e COntratt0/5 $tafe LK¢n5e Law �OES rt0t apply to anOw�Mr o� IN w�0 MMI�s or imprOv¢s Iherew�
19.50 OVER/SHORT; Op
FIAE SMIP/TOT GRADING PLAN—CHECK
anOwhocantratlslorsucnProjecisvntnacantracto�(511¢msePursuamtOlMCanttattOrS'$�a�eLicenS¢Law�.lamaware iFififlFlfiFiklElEiFIf�lFlfiflFlfl(�if1EiE1ElfiFffiEiElflflFik3kIF1EiE1FlFft{EIF{fiE{ki4�1(�{(�{(�{F{(.*1E{t{p{E{p{p{{{Ek{t{E{p{E{�.{E{E{E{F{E{�.{p{F{E*{E.�.�{t{f{f
Inat pmol ol Ihei� Workefs Comoenution insurance snoula oe O�oviae0 to me. I N D I V Z D U A L F E E H R E A K D O W N �
� I am eMempt onEe� Setlion: B. 8 P. C.
m�tnrs�easa�: TYPE QTY D E S C R I P T I O N� UNIT COST TOTAL COST
oa�e: �e� ELE 1 TEMP WORKWITH EA. 15.00
I tlo hereby cetlily ihai 1 am aware ol antl unGersian0 Ne repuiremems ol Calilomia Heallh anG Sale�y CoGe Sections 25505, 25533, antl ' END OF FEES 1 5. � Q
255�a ane t�al I or any IUWre DuilOing acupani wilVwill nQi (circle one) neetl lo wmpry wittl sai0 stata cotles and t�e repuiamenis lor a
permii lor consimctiw m moadication tram �Oe Art �ualiiy ManaOemem GsMct. HesiOentul consiruction apD����ans are exemD� �rom ,.
t�ese proNsions. '
Date: A00�.'ant
I her¢by cetlily Itut 1 Aave reae i�is aDDlication antl siate itui Ine aDove infotmatian is carrecl. I apree to campN `/��A ail cify an0 county
orUiryancesanOslalelawsrelatingtoEubiqg�pnsWtlionaMhereEyautMriterepreseniaf o7tA aryt enteruponiheahove-memioneE
pmperiy lo� ms�¢cilon Ourpose5.
�b� 9� ,
Da1N. SignaWre: —Mo
o���ers �icense or Socim sea�ity a:
16a1�n6 Wbiie—Bwitling; Green—Catle Enlorcemom: Canarv—AOPlican�; Pink—Revenuo: GolOenmtl—Assessor
..._�
Nov s �sso � :
C1TY �F COSTA MESA
! � i
CONSTRUCTION AND PLANNING = PO�L & SPA � �
APPROVALS Permit # Date Inspeetor qppROVALS Permit # Date Inspector
• 1. Temporery Elec[rical Service or Pole r 52. Pool & Equipment Location "
2. $oil Pipe-Undrgrnd. - 53. Steel Reinforcement -
.
3.�Electrical.C�nauit Utility-Undrgrnd-`' 54. Forms '
� 4: ElearicaliConduit-Undrgmd. .. ' 55. Electrical Bonding '
'-�5i Sreel Reinforcement . `� 56. Rough P�umbing & Pressure Test ��
6.;�Electrical�•UFER.Grnd. .. T. 57. APPROVALTOCOVER�GUNITE ��
�-7r�Footinys ��: �i �� i 56. Electrical Conduit�Undrgrnd. �
;'a; Foundation � r � 59. Gas Pipe, O Undrgrnd.. Test ; �
i
9. Water Pipe=4Jndigmd. � � 60. Backwash Lines, P�Trap, � Undrgrnd.
10..Structural �Ioor�SYstem =�. 61. APPROVAL TO DECK ��
11. Property'SeCver:Line�& Hous`Connection ' 62. Backwash & Receptor-Final
12. Sewer Cap .' C. _ 63. Heater & Vent-Final
13. Roof Orains - rt � 64. Plumbing System � Final
14. Rough Plumbing' r - 65. Electrical-Final '
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring �� 67. Fencing & Access ApProval
17. Rough Wiring $ign 68. APPROVED FOR PLASTERING
18. Rough Electrical'-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -
� - - - - - - 7 ". C,v-.cJp. iy' ,
20.vRough Fbctor.y FGeplace . S�� tC`' x �? .; r�• APPROVAL'S%�.�..Permit #' �
� �i 'v Cr• �.•4r s ' r .. !� G' � f . n t�
21.`Duc�ts, in-Sv,uctu e� . .�.. "�< F$ = ,;; , ���'����' �r . , .
-�7�. U�ndergro�nd�HYdro .
22.�DuctS, Ventilatin9�r -� ,'r � :> • r7�. Product'Piping O"Gas 04i1
23.`GasPiperRou9h&7est �� ; � . - " "' ' � ' -
,T,� r •� . � '..72. Underground FIusF-, - .
24. �Roof Framing - � - . � : _ � � • + �73.�'Undergrntl: Storage Tank � Gas ❑ Oil -
25. Roof Sheathing ,.; ' `� ``- � ' ,, „ �'74,`Overhead Hydro� T , _ -
.� . �
26..T�Bar Ceiiing lStructural) &dvlonocoat � � .a ' 75:'Dry Chemical � �- - � .
27 =Frame a d Flashing' � y.0 y� .R 76. Ory Standpipe -:�i 'S " �� t •
' 28. � Lathing-& Siding^ = . � �_�+;�, * r �: • 77.z FIXED SYSTEM-FINAL' �� �
�`29. Insulation 1' `� y ' �' � 'i ` I � 78.�fIRE PREV. FINQL ' ,x �z � �
�:30. Drywall Nailing --_� � �� � � � i. t � HEALTH,DEPT� RE�UIREIVIENT
r31. Plaster B�'own Ct�t. ,� ' n,�.. ; I,I? ;� z7g��FINAL INS�PECTION� ' ' �'
�
"32.•Electrical Power MeierFinal� " ' � ,� �80.:FOOD CERTIPI,CQTE IS6UED
, 33. Fina� Electric_ �' �. ' � "' � �` � '�Nofes: =s� � ' � �
a•
�. . �� f t � _..: -? C !',/t' � ' ' � � �ry: i
�,34.. Final Heating & Air,Conditioni�g� , i �' 't: ,� .' �.•- r ` '
35 ��Final Gai Pipe•Test• _ + � i r` ��' o;' ��S •�' :.
- I �, y. ��. - �,.
u36. Hood onCanoPY . �7`L i�. . ,a ' C. t �� ' p: �V . � •
_37 �FinAI Factory Fireplace ' �;�' 'i "-' ' . ' ' ``'
, r_ I �c r n�
. .. a ` . .... _ , v �
'38. Final Plumbing � i � � � � � �. r - � s �
f39. Water Service-Final•. � � �+ �a I,� b+� .. •-:a x ti
S � ' i�
=40. GasService-Final r ,T�,.�,. � �,. I Y '� ��, �,,. � .
��91. Solar pomestiaFinal � ' � •� � _ ' � � -y • � - F
i i ��> ,• o *:
42. `Backflow Preventer ' `�- ,; �� � � �` "' ,A ' ,
., � : . _ - _ . .
43. Backflow Irrigation �*:•`� �- '+ u�= * � `'
�: � i i n
. . �. N � �>
ry.44. Landscape Irrigation Systemy:,._= x ,. i ; - , ;, ,�; � i; �: ' �j _
S'45 ;'Sound A[tenuation � - �' + 5: r; [ : . - l' a� i:� ; + -
. �� ��.. - r .
�,46. Handicap.Reg'ulations - �_ , `' � '�; ; _ ' � '� ,
� C
�47. _FINAL STRlIC7URE & BUhLDING � �"�., � � 5 � "
.y
48.; FINAL PLANNING ''�"� _ ' ' ' � ' .
„ -y . �.
-49?Electric Release to Edison . - s � ' •
„
�'50. Gas.fielease to Souihem California GasCo ', I I �r + = � - . ���' . � `
t' =' -
.51. CERTIFICATEOE�OCCUPANCY ; ; � . �, i.� ; -. � j, �
No Date
.PR0.1ECT11DDflE33: BOI.W 19TH ST uxn:
owxee�s nnre: RALLY' S HAMHURGERS
RDDflE58: BSZS GIBBS DR, SAN DIEGO
� CA 92126
619-576-2060
RNGI/ENGINEER: SCHUSS CLARK 6 Fi$$�C qE0.N0.: C 1 i B 3O
RDDRESS: 9474 �CEARNEY VILLA RD uxrt: .
S.D. CA 92126
rEx�nmee: PROFESSIONAL FIRE SERVICE (714)923-8121
�DOHESS: %8O E FRANCIS H
ONTARTO CA 91761
LICENSEU CONTMLiOB DECWUTION: I �ereEy amrm ttu� I am OcenseE unAer DroWsions of Clwpter 9(commencin9 �� ��lon
7W0) ot Divltion 3 al tne Business uN Prolessions CaEe, an0 rtry I¢ense 6 in hdl iwce aM etlect.
ciTv uc.: 0�i0 7� �T�h uc.:5 8 0 3 3 2 '_— c�ss� C—� `
D-"' _(� $ipnaNre:
�IIS' COMPFM311TION OECLAM7 N: I trereGy allirm tlut I Aave a c �iwte al Knt to ul6insure ar a certi/iwte of WOAers'
�,ansatian I�sYr� � i c�rliliatl capy thereol (Stt[ion 3800, LaO. C)O / O S/ 9 1
,'3r no.: STATE exr. o�re: i
COMPANY:
❑ cerurea am u nereey mmisnm. f� CeN/ieE copY � tilM wiN Ne dry BWOinq On' ian.
Oate: '�� ( V �MDlicam: !///�'— `�� (
IXEMPItON FlIOM WOBI�RS' COIAPFNE1TIpN DELIAM110N: (itis section ne noi Ee mmpletW il IM penm's la me �unOreE (5700) a ka).
I certiry that in tne pertormaixe ol t�e work lar wtecli Ihis permh a issueE, i stWl mt empby arry ce� �n any manner so as ro become
su0ject to ihe Workers' Compensatiap Laws at Califomia.
Oata: Siqnature:
NOTICE: If, after maMinA ���5 Eedaation. you shoul0 Oecoma SuUI� �o t�e Workers' ComDensation OroNsions ol t�e Labor
CoOe. you must IorltrvnN wmDH wiU wch Drovisions or tlns permit SWII ha OeemeU revokeE.
CONS7RUCTtON LENOINU IIOENCY: I AerzOy allirm ita� Uere I5 a mnslrucibn IenEing apenry for ttu Derlormance of t�e xrork lor
whitA llus permii is iswe0 (�Oon 3pg7. Civ: C1.
lFNOER:
�ooness:
OWNER BUIIDER OECIAMTION: I hereCy allirm ttwt I am exempt Irom Ue Contrzctors' State Licensa law far t�e lallawinp reason
(Section 7031.5 Business anE Roleulunal CoEe: My chy al aunry wAic� repuires a Dermit to cromirud. alter. ImDrova, Eemolish, or
repair any structure. D�or to IB Issua��, also repuires Ne app�cant lor suc� permit lo file a siO�eE statement ihat hUSM ¢ Iicense0
pursuantlo Ne provisions aithe Contraclors'Stata Ucense Law�C�npter9(commencinp with Section 7000)olUivislan 3 ol��e Business
an0 Pmfeuion5 Co�e) or I�at helsAa � exem0� ��erefrom anE Ne Cu'a lor I�e vlepe0 exemptlon. My vblatlon of Section 7031.5 Ey
any apDlicant lor a Oermit su0jecb tly appll�ant ro a civil penalry al irol mam Itun INe AunCreO eollars (55001.
I, as mmer of IM D�operty or rtry emqoy wiU wa0a az NeU sda compensatlon. wlll Uo I�e wnrk, antl tne
structum is rrot IntenOed or otleraO lor sale (Sa.L�7061, Buslneu aM Pmtessbnal CoEe: TM Conimctors' State License Law
aoo ret apoN to an wmer ol � pmperry wM EWldc or Imprwu �tureon. ard wtp Eoes sucn work nimseNAersNI or tnrouan
�is or her own emDlayees. DrovWeO WI wch impravements ara rmt IntenEeO or oMereA Im sale. II, however I�e Euildinp ar
impmvement is 5dE wittun one year ol ampletbn, ttre wnxr w70 lave Ne WrCen ot 0��0 �� � �ol UWO or imprwe
lor Ue Durpose at 5t1e1.
I, az owner ol Ihe OmpeM. am p¢lusively mntraN�p wit� Iicense0 wntnctors ro constmct the Droject (Sactlon 7061, Business
❑ anA Prafessbns CoEe: The fAmractors' Stata llcensa Law Eoes not aVp�y lo an ormer ol Droperty wM DuilCs or imprwes Iherean
and w�o cantracts for sucn prqects wltn a cantactaqs) license Oursuant to IM Contradors' �tate Licensa Lawl. I am aware
Ihat praal ol t�eir Wo�kar'S ComDensatlon Insurdnce s�oNE �e pmdOeE to mB.
� I am exemD� uMer Section: B. E P. C.
la� tnis reason:
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: F 049316 PLAN CHECK NO: 05651-90 S
CONSTRUCTION TYPE: V—N PERMIT TYPE: FIA
SOH DESCRIPTION ; 7195F RESTAURANT,NEW CONSTRUCTION
CLAIM VALUE: 1,000.00 CALC—VALUE:
PERM NO: F 049316
GOVT: N SUPP: N
PUAPOSE: OTH
SQ FT:
GROUP OCC: B-2 /
COMMENTS: RE: B48600 PAIMARY BLDG, PERMIT.
iliFikkifitkiFitilikifft�kkitiFifikkikifikititkMikififlllfiFikikitikikkkiliFifififkilikklFkifMifififififlkkklkikiFlfikifikiliFiF�E�FiEiF1FlEitiF
Z O N I N,G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAA: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKZNG REQ• PROV; PARCEL; 42419112 ZNE: REF NO:
PLANNING NiSTES>
>
!k if i! ik 1f if iF ik iF iF ik it if if if if it if iE jF iF it ft 1t ik iF if if ik ik if iF if k k if if i! if i! iE ik iF if iE it iF 1k it iF i! i! k 1k iE iE i! iE ik k i! iE ik 1E if iE iE iE iF if jf iF iE 1F if iF IElF 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 HY ;
DATE:
APPLICATION ISSUED BY: DATE:
*�r*ft*itir�t�rr�r*�e�t�r*x�r�r*** ft*****�r�t�t*�i���F**
if it if ik 1k if if !f �! 1E iE M M iE if M IElf it iE iF iF iE it IF IE k ik It iE if M iF iEltlk ik iF iF ik ik M ik iE iE M iF %ik N M iF �k it IF iE iE iF M 1F iF iF iF iF iF iF iE iF iE iE iF if iF iE iF iE K if iF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 25.00
65t SMIP/NON—RES
PLAN 16.25
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 25,00 0.00 16.25 41,25 41,25 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 25.00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTAIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
25.�0
iE i! iF it ik iFiF it it �lF M if 1F i! if ik 7f ik 1FiE * iF it it ik 7F ik iF ik if iEiF i! 1FiFiF iFiF iF 1t ikik it ik iE iF i! iF ihiE i! iF iF ik iE ihit jFlFik it ik it it it iF ik iFiF it iF iFiF iFlF iF k iF if
I N D I V I D U A L F E E H A E A K D O W N
TYPE
Da�e: Oxner: I FIR
I Uo �ere0y certiry tlut I am aware oi an0 unEerstanE ihe reyuiremeros oi Catllomia Healt� antl Safery CoEe Sectians 25505, 25533. an�
2553< an0 ttut I or arry tuture OWtluip ocwpant wiIIMT irot (drde ane) � to canpy wiU sai0 sute wOa aM Ue repuirertcen(s lor a
permit lor coreWpbn or moCificatlon Irom t�e N'�uatiry Marupement DisVict. Hesitleniial con5irucGon applications are eKempt Irom
t�ase Orovaions.
Oate: npDucanl:
I here0y certity tAat I Aaw reatl t�is applicatian and state ttut t�e a0ove inlormation is conect. I aprea to comDly wlth all ciry anA counry
or0inances arM state laws reWtinp to babinp trucibn anG IertEy auttnrhe representatVves ol�{tie dry lo mter upon �M aEove� 6metl
property lor inspeclion purposes. �///�/
02I8: O r� ��� SqNlu2: ,-"�i��/// //��� _
Driver's �iunse or Sada� Seeunry x:
1811�dB Whi�e—Buibiiq; Green--.OoGe Entarcament; Canary—ApWi'snt: FI^k—Revenue; GokenroE—Fssesaor �
QTY
25
D E S C R I P T I O N
FIRE EQUIP FEE (FROM BLDG VAL TABLE)
END OF FEES
�i
i
I
♦
:�
UNIT COST TOTAL COST
1.00 25.00
02 04071iEb—D�70711D5 �'��f' !S.C[
DATE: ;Oi�4l90 TIItE: il�`Q
CONSTRUCTION AND PLANNIN 7L & SPA
APPROVALS Permit # � Date Inspector p�ppROVALS _ Permit # Date Inspector
1. Temporary Electrical Service or Pole;! � 52. Pool & Equipmeat location� '
n �. , .
-2.; Soil Pip2-Undrgrnd� V ��r . 53. Steel Reinforcement
=�3.`EleMiiCa,l'Gond�m't`Utiliry�Undrgrnd:,� 54. Forms
?`-'rt.�_. -r.•-'.� c
".Y4.�Electjca)�Conduii Undrgrnd. 55. Electrical Bonding
,.SMSteel Reinit,orcement %< 56. � Rough Plumbing & Pre:sure Test �
�46�Electric9lrUFERyGmd. p 57. APPROVALTOCOVER�GUNITE � "'
y,7=Footings:+ ��l �.. 58. Electrical Conduit�Undrgrnd. r�
�"rB.�FoundBtion "�� ��
� 59. Gas Pipe, O Undrgrnd., Test
�9;: Water PiPe; Undrgrnd. . 60. Backwash �ines, P�Trap, Q Undrgmd. �
r�
lO:iStruct�r'a,I.Flo� System '' � 61. APPROVAL�TO DECK
11;'�Propertv�5ewer, Line & Hbuse Connection , 62. Backwash & Receptor�Final
12. Sewer GaP =�� 4• - ,' v 63. Heater & Vent�Final
ti �
13. Roof DrainsJ� ��
_ 64. Plumbing System - Final
74. Roughnlumbng 65. Electrical�Final -
15. Rough`Electrir�..al-Conduit 66. $olar System�Final
76. Rouqh Electric:Wiring : � 67. Fencing & Access Approval
17. Rough Wiring'Sign � 68. APPROVED FOR PLASTERING �
18. Rough Electricel�T Bar Ceiling � � 69. POOL/SPA SYSTEMS FINAL �
19+�Rough`Neating & Air Conditionag r„�, �. n �,r , „FI�i�DEFT. REQUIREMENT
c� � :: .�w �..�-: `v . .. ... -.. t; �r �-(S�� b7 '� % �-'.
20� Rough�F_.actory F_.veplace � s,: S�, �: S .=x x �;APPROVAtS-+'r-�Pessnit #-
. �- ...� �.r
21,DUGts,inStiuctiiiA; . .... �i:s x S � �,+, r, • •'�-,. � >
.� �.� r,_.� �x n ti n� ::70. il�nderg�o7jn� Hpt1ro �.
22�-Ducts,��%eniHatingr , �'�; q: � rt; F.x s•^ 71, product7Piping O'Gas �Oil �
� 23r'Gas;Pipe�Ro?�gh�&+Test ' �yH na *� �' O* �' 7y Undergro 2d FlusH ;` E"
.., K !?7 a: x 5 x�.) N,�
.�, � i � r ..t.. �. _. � K F -• .�u� �. �u
24.- Roof F.raming .. a� .± s > -� r r . 73� Undergrnd. Stocage;Tank*O Gas ❑ Oil
25. fioof SFeathing �� r N `"• *,y � y '� ;� 7q;� Overhead Hydra�.,.,, y:
�
y • :]>t rF�H i. CJ [�7XA � •=•• A;•� �". -,
26:,T-82r Ceiling IScFuptural) &'Monocoat x p >. n� k 7y� Dry Chemical F.j :�, i p,.!Fqp (,V�
27',Framea�d Flashin�q �'='� a�!" " x" ^` 76. DryStandpipe f"'' " y �
, ., ,., r, ,,. � >. •: . . �c � , : r ; a
_- , .-� ' _, �' vl '7 rL W 7: x i .. .. .. x „ p' F-' c'� '7 _ �
;28. Lathing;&Sidiny�r r;x;, p 'r � i �* 777FIXEDSY.STEM(�INAL�� '�.^.� 10•1Fq) �.9
29. Insulat�0� .� ;;:� � ^ " �,� � � � � 78� FIRE PREV. FIN'�R. L �'' " G;
`7 'T � r • I �� N v-•; � r-, -.
� 30. Drywall;Nalmg:, � t., � ��; F. � � �� S rHEAITH�DEPT�. REQUIF}EMENT
%31. Plaster•8rown Coat '� ' "�" '' � � � �'"79 FINAL INSPECTf(�N +� "�
r i y� c.. " i: � �x � . O .r
[' '7 " �' : 1 M "'J 'C a. ' 1 P; -F. , '�, :J
a�32.;Electric3lPower:MetersFinal � � � �� K SO:,FOODCERTIFICATEISSI�ED.� ;�
' 33�: Final Electdic �� � � + � � � � "� '0 � � Noies: `y "�"� ` �= � ��"
m .r rr �:; r-� ~ � r 1 I �t: r: r.� rf r.: [� a i S
L. .'�-: ;l X 1 }K X :� :i i'� y' �
��34�:Fi�alHeatin &Ai�'Condrti0nin�g �
� l-, I' . �7 t: � � p< �' J ra H'� r.
I �r
35:�Final Gas Pipe-TesF' r: ^ ?�'--' ' ; '" I �:ro c7'^_ * � 'J'"
�. M � 1 :x T ' C' �
p 36. Hood o� CanoPY!%. r•y c �. ��. ! i ca r = nca .� .?• .
� x' J�l rn e �+ x D7 .'T7-J �' ;- >i�,
'�37�••Final F"ectory Fireplacez f�c- -� c � i �: �. ' .� X '':}
:� c n; h�: .c � r, n.,-�
7 m "t f' CJ ' `-� +. 1 1� q' i" � .i H'J x!,: r
-:38,�Fina.l Plumbing �. M _ �, � , y x :- H � . �
..�39:,Waier Service-Final: g , � :� c. � ` S: �:.� .-. ��::o > u +
+� y: � r c,.s ;: r'1 r.:
�,�40.' Gas Serwce-Final '� r n� F� i�`' � ��; `� F`; �� ,*�� v
. w
`'41`Solar pomestioFinel jq � � �- , . +�
� �~
42. Back5low Preventet: ^' �: . � ;" * x,.� . ''`" '� p ,
! x•J Or!t-f # �� Y x r0-Jfl iT:C' .
. ._.� � � . _ _- . . .
43. Backflow Irr,igation: >+ ? '�: * * � � •� ��r �` •
y . r� ; �
•• •. r.• ITi i;l �"'n k^7 " G C7 4: 7' ^ fU N "" f� u :.: C
'?44.� LandscaPe i�rigation SYstem:``� � ��. r,�, ,� L z ,1 �c ;; S �„
^t � l' '
�'45=�Sound�Attenuation -y •��• : �� . ,., tT;�� x �•� p� eL • 6•'7 �
C ..)' v l I 1-1'A ._-1
'•46:'Handicap Regulations " O ' " '; � ` 4 � `��
�: s- . . 'S � " ,r. . f. :T} �7
,,47:'FINAL STRUCTURE & BUI'LDING .;: � � � �r � � � � - F
.�
48i-�FINAL PLANNING f.F�+ �• r; � ;s. M a :*7 * f'
,r �: 2::� � r, v a <
��49..'.Electric Release to��Edison � � � � � ._ �,� w � ''�
I � �» �. � -
-50:�Ga's Release to Southem Calitbr'nia Gas Co x � ` `."_ 'J • "'- . `� .
.� � x x o -> c � . ..
51. CERTIFICATEOFOCCUPANCY " '" "' ^ '
No. Date
PeOJECT A0UflE55: -� 01 `W l 9•j•H rD•I• UNIT:
OWNEfl'SNAME:��LLY'S HAhiRURGERS
noneess:8525 GZHBS DR, s'AN DIEGO
CA 92126
619-576-2060
FRCHIENGINEEB: SCHUSJ � CLARX E ASSOC pEG.NO.: C S�� 3U
aooxess: 9,��y gEARNEY VZLLA RD T' ,
PEflMITTEE: �'D' , CA 92126
aooRess: DANSCAPES ( 714 ) 746-0730
621 ANDREASON F
ESCONDIDO CA 92029
LICENSEU CONTNACiOH OECLAPATION: I hereby allirm ��at I am Iicen5e0 un�er pmvisions ol CAapter 9(commencing with Seclion
7000) ol Div�sion 3 0l Ihe Business antl Pmlession5 Cotle. and my license is in lull force antl el�etl.
aTvuc.:516 56 �Tq"TE,,"c538384� cus��
Oa�e: ��' 4 � SignaNre:_ !� ' ��`^�
WONKEBS' COMPENSPTION DECtAPRTION: I her¢Ey aflirm ��ai have a cenilicaie ol consem to selbinsure or a cenilicale ol workers'
Compensalion Insmance. or a cenilied copy Ihereol (Seclion 3800, LaD. C)
POLICYN0.:12O�I9�J�I'9O E%P.OATE: OA�OSI9i
comrnxv:STATE FUND
❑ Cenilietl copy is hereby fumis�ed. � Cerli�ietl copy is liled wiih t�e ciry Builtlin �ivision. �
Oate: /G �i O APOlicanL �i✓M.� �1�^"".'�
�!
EXEMPTION FP M WOFI(EflS' COMPENSp710N DECLAPp710N: (T�is section nee0 not be completeU il Ihe permil is lor one huntlBtl (E700) or less�.
I certily t�ai in I�e pedormance of Ihe wark lor which this permit is issued. I shall noi employ any Oerson in any manner so as to become
sublect lo Ihe Workers' ComOensaiion �aws af Cali�Omia.
Dale: SignaWre'.
NOTICE: If, afler making Ihis Aeclara�ion. you 5hou10 become suble�� �o �he Workers' Compensa�ion O�ovisions ol ��e LaEor
Code. you musl �onhwitn comply wi�h suc� O�ovisians or �his permit shall 6e tleemeE r¢vokeA.
CONSTPUCTION 1EN01NG RGENCY: I hereby allirm ihat Ihere is a consimclion lending apency lor I�e pedormance ol Ne work lor
which ihis permil is issuetl (Sec�ion 3W7. Civ. C�. �
LENOEfl:
ADOPESS:
OwNEN BUILOEB oECUBFTION: 1 nereby affirm inat 1 am eKempt imm tne Contracmrs' State License law for 1ne lallowing reason
(Section 7031.5 Business an0 Pm�essional Cotle: Any city ol coMty which requires a permil to consimct, aller, improve, demolish, or
re0air any slmcture. prior �o i�s issuance, also repuires the'apPlicani lor SucA permit Io lile a signetl slatemenl Ihai helshe is licensetl
pur5uan110 ��e pmvisions of lhe Contra[lors' S�ate License Law (Chapter 9(commencing with $ectian 7001p ot Division 3 0� Ihe Bu5ine55
and Pmfessions Catle) or thal he/she is exempt therelmm anU �he bavs for the alleAeA e�em0�ion. My violation ol Section 703t.5 Dy
any apP�icantlor a Dermit sublecis ihe appllcanito a civil Denalty of not more ihan five Aun4re0 tlollars (5500).
I. az owner oi tne omoeny or my employees wit� wages as IAeir sole compensation, vnll Eo l�e woA, an0 ��e
❑ stmcwre is not imendetl or otterea lor sale 15eciion 7044, Busines5 antl Pmtessional Code: The Contracmrs' Slaie License Law
Ooes noi appty lo an owner o� a pmDe�Y �'/ha �uilJs or impmves thereon, antl who tlaes such work hims¢II/h¢rsell or II1muAh
his Or her own empi0yee5, O�OvitleA �hal Su[h impmvemenls are noi inlen0etl of Oil¢re0 for Sale. II, how¢v¢r Ih¢ huilAinA of
impmvemeni is soltl vnNin one year oi completion. Ihe owner vnll have I�e Ourden o� pmvinp he/s�e Citl nol GuilE or improve
�or Ihe purpose a� sale�.
I.as ownerof�he O�openy.am e�clusivelycontracting withlicenseA coniractors m consimclt�e prolecl�Sec�ion 7044, Business
❑ an0 Pmtessims Catle: The Conlraciors' State License Law tices noi aOPN �a an owner of pmpeny wAo bwl0.s or improves ther¢on
an0 who wmracis lor suc� pmjecis wit� a contractoqs� ficense pursuam to ��e Contractors' Sia�e License Law�.l am aware
Iha� pmol ai t�eir Warker's Compensation insurance s�ould �e piavNeO to me.
� I am eKempl under Seclion: B. 8 P. C.
for ihis reason: '
Daie: �+ner.
I 00 �ereby CeNfy Ihai I am aware o� an0 undetSlanG Ihe requiremen�s ol Cali�omia Heai�h an0 Salery COGB Setiions 25505, 25533. anU
2553C antl ihal I or any iNure builaing occupanl wiWwill nol Icircle one) neeA to comply wilh saiA state coees ane the requirements lor a
permi� far constmc�ian or mo0i�ication tmm t�e Air Ouality Managemenl Disirici. Fesitlen�ial cons�mclion apDlicalions are evempi Imm
mese o�ovis�ons.
Da�e: AD�licane
I hereby [ettdy�hatl have readl�is applitaiion an� Slale thallhe abOveinbrma�ionis tarreti. lagr¢e Io CamplY wi�� allciry anG tauniy
ordinantes and staie laws reWting io building conslmction ana �ereDy autlbrRe reDresentatives ol IAis ciiy Io en@r uDon I�e aUOv¢�mention¢d
property �or InSpet�ion Durpo5e5.
oate: /D �i D s�9�am�e: — �Y =-- —
�n�er's ucense or 5ociai Securiiy q:
t6at�a6 �"1�ne—Bmlainq�. G�een—Co�e Enlo¢emenC Canary—AOPlicant: Pink—Revenue: GOIE¢nroE—Hssessor
� �
i . � � �
CITY OF COSTA MESA — BUILDING PERMIT PEHM NO: P 099597
C'ERMIT NO: P 099597 PLAN CHECK NO: . N GOVT: N SUPP: N
CONSTP.UCTIC�N TYPE: V—N PETtMIT TYPE: PLU FURPOSE: OTH
JOB DESCRIPTIGN : BACKPLOW IRRIGATION FOR,NEW RESTAURANT 5Q FT:
CLAIM VALUE: CALC—VALUE: GAOUP OCC; B-2 /
COMMENTS: B-48600
*.r****�t�e�t�t�+r*�*�r**�e�t*�r***�*�*+�***�r*��r*��t��������t�r*��**�r�r***x��r*x�x�**�tx-�x�»�i:**+��:�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
------------ MAZN BUILDING ---------- --------- ACCESSORY HUILDiNG ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEBT: FT IN RGHT: FT '� IN LEFT: FT IN AGHT; - FT IN
PARKING REQ: PROV: PARCEL: 42419112 ZNE: REF Nu:
PLANNING NOTES>
� .
iEif�Elfjf�f�fififiFifikifiFlk�EkiEif3FifiElfffiE�1ElflEik�fiEiEiFififaFifiFifiFif. if�1F%�itiElfiFiflF#ifiE�fif�kKdEiEif1E�'��k7fifk�Eif�EiEifiE�klEiE
D E V E L O P M E N T S E R V I E S_ R E Q U I'R E M E N T S
ZONING APPROVED BY ' DA'fE:
bUILDING APPROVED BY : " DATE:
APPLICATION ISSUED BY: DATE: Gd Z. �
dfilifkkif�ElkiE*itlfiEiElFiflfiEiliEiFiF , aflfifafif�fif�fiElE� � �F
iE 3f if if �E iE iE it iE M iE i! 3k if if if if iE af jE iE iE i! iE if 3E if 1f aF 3f if if �lf if if if if iF aE iE �E ff fE fE % if 9f � iE if iE if i� iF if 1F df if i4 �f �f if if 3f if 3F lf k��% if if �f iF if iF iF jE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAI, SEGMEVT:N
HLDG PMT PLUMRING ELECTRIC MECHANIC F:CRE SMiP/RE.^, GRAL�ING
FERMIT 2.00
25% SMIP/NON—RES
PLAN
ISSUE FEE 3.00
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAZD DUE
TOTALS----> 2.00 3.00 0.00 5.00 5.00 .00
REVENUE DIVISZON TOTALS--> COLLECTED: 5.00 OVER/SHORT: .00
BLDG PMT PLUMBING EiECTRIC MECHANIC FIRE SMiP/TOT GRADING PLAN—CHECK
5.00
ik iE 3E M if iE iE if i4 �F if 1f if �If iE it iE dE iE if i6 �f i4 i4 3F iF i4 �4 iE af jf iE if 3f jE ik % if if ii iE iE 1E �E iE iE k iE iE if iF iF ik iE rt iF if iE iE if if if iF if �E 7E If K�� iE if if iE if �f 3E 3f 3i �e
I N D I V I D U A i. 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 'COTAL COST
PLU 1 BACI(FLOW IRRIGATION 2.00 2.00
END OF FEES
ry,
O1 D�07?738—Q�072735 '� C�a
6ATE: 10/:4/SO TI19E: i?:24
: I
�
� %� r
CONSTRUCTION AND PLANNING - POOL & SPA �
APPROVALS Permit #- Date Inspector APPROVALS Permit # Date Inspector
. r
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
n
2. S.oil Pipe-Undrgrnd. , �� • ' 53. Steel Reinforcement �
� 3. Electrical Conduit Utility-Undrgrnd. I 54. Forms '
' 4. Electrical, Conduit-Undrgrnd.i • 55. Electrical Bondin9
i ' 5. S[eel Reinfoicement. '� 56. Rough Plumbing & Pressure Test -
6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE
9 , �� �� . 58. Electrical Conduit�Undrgrnd.
'�Z' Footin s .
8, Foundation � 59. Gas Pipe, O Undrgrnd., Test '
.,
9,� Water Pipe-Undrgrnd. � ` 60. Backwash lines, P�Trap, O Undrgrnd.
II�- 10, Struttural Floor SYstem - : 61. APPROVAL TO DECK
11, Property Sewer Line & Flouse Connection � � 62. Backwash & Receptor�Ginal �_
12. Sewer Cap . "_ ' 63. Heater & Ve�rFinal �
Y 73. Roof Drains � , 64. Plumbing Sys[em • Final �
14. Rough Plumbing, 65. Electrical�Final ,
15. Rough Electrical-Conduit 66. Solar SVstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign - 68. APPROVED FOR PLASTERING
18. Rough Electriral�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEP7. REQUIREMENT
� „ �, .
20. RoughFactoryFireplace .;;z; , � ' ;� , ' APPROYALS'' 'Permit# .
,
25. Ducts, in Strutture� � . �• • ��• r • � ^ i '�70. Underground'Hydro �
22. Ducts, Ventilating �' ' �{ � , �� j' j1, Product Piping OGas ❑Oil
23. Gas Pipe�Roug�h & Test � � � � . - � : 7y. Underground Flush � �
24. Roof Framing' "' ' � �;,73. Undergrnd, Storage.Tank O Gas ❑ Oil
y
25. Roof,Sheathing r , . � � 7q. Overhead Hydro'� �
26. T-Bar Ceiling (Structuraq & Monocoat �'� ' ` • 75., Dry Chemical . : � � '
p7, 'Frame and Flashing ,. • _ � � � � �:• �� ; 76. Dry Standpipe � � i ` .
28. Lathing & Siding � � . �;f �'� ' . + ' ' �",� �� 77. ,FIXED SYSTEM�FIN%>l� , ,
29. Insulation � �� .. j� � �, � 78'�FIRE PREV. FINA�L '�.
30. Drywall Nailing ' � � ' _ 'HEALTH�DEPT. REQUIREMEN7
;
31. Plaster Br'own Coat ��-,�.� j ,; �, 79. FINAL INSPECTION �
32. Electrical Power Meter-Final "' H� 80. �F000 CERTIFICATE ISSUED "
33. Final Electric , . . �� � � r � Notes: � . � � , �
34. Pinai He2ting�-& Ait Conditioning � + � � � `i .� • - � � f _ '
35. FinaPGasPipe;Test` � ' � � � 1 "� � � �
. �i , � r i t1: � c�
36. Hood or CanoPY ' � � � -A Y �. , .. . , •
37.��Final�FactoryFireplate ' '� � ' ��� � :.-,�� �
�� ; .
/ 38. Final•Plumbing . ��� ����j (�}QO�`' � _ ,
- 39. WaterService�Final� . ' � , ' , �
40. Gas Service-Final , ' I ra ; -. , .
.,
47.SolarpomesticFinal' ' i[i , ' � .
� �
42. Backflow Preventer. '�
�c '' , ., ,
43. Backflow Irrigation� ''�� ••' � j�Qp L�p .� ,
,44. LandscaDe Irripation System � � . � � � . � � '
.
45. �Sound Attenuation. � ' • ` - , � ' : ' •. ' . �
46. Handicap Regulations � . � � . . .
47, FiNAL STFUCTURE & BUILDING � � 71
�
� 48. PINAL PLANNING j . � �� ' '
49, E4ectsic Retease to Edison � ' . �� � ' � '
i .r �
50. Gas Release to Southem California Gas Co i• ` � �
�- � 51. CERTIFICATE OF OCCUPANCY � ~: r . � �� . • �
No Date
�
rna¢cr �ooness: S O 1 W 19 TH ST
OWNEWSNIIME: ORANGE COUNTY SXI CLUH
�ooaess: SAME AS AHOVE
714/895-1937
�qLIUENGIXEER:
�ooxess:
nEc.xo.:
uxrt: p
uxrt:
PE"�"rtr�E: NAULT ENTERPRISE ( 213 ) 863-7363
AOOHEBE: SZLSH FIRESTONE HL D
NORWALK CA 90650
IICENSED CONTMCiOR OFCIAMTION: I �ereGy aKrm WI I am fice�J unGer D��s ol C�apier 9(commencinp wii� Sectron
7000) ol Uivisian 3 0l t�e Business aM Professions Cotla, aM my 6cense is in NA torce aM ettect.
ciTruc.:047 63 $T"T����462113�A��0C-30
oate:�����7 Si9namra: �4..t't'
WOq LO N TION OECUN1ilON: I IrereEy afl�tlul I Mw a ceNfrare oi wnsenl ta setlansure or a certiliwle oi Workers'
Compen5ation InwrazWe. Or a ceNfxE co% NereO� (Sectim 3800. LaO. C�.
roucr xo.: �. ��:
LOMPIINY:
� CeNfieO CODY ��re�Y tumaAeE. ❑ CertifieE copy ¢ file0 xiih Ue tiry BdIAin9 �on.
Daie: MD�t:
IXEtAP1tON FHOM VlOBI�NS' COILPFNSITION OEClAH11T10N: (fFa x'on rcN nat he m�kteE if IAe D� b for mie MeqrtE (f70� a lessl.
I Clrtily IINI i tne pe ornunu of Ne work for which Uus permii a� uW.1 snau not e an N anY ma�r w az to Oecome
SUEI� o t W CAmpCn53li0n LdwS ol CdGtartu2.
�ate: �� Slp�uture:
T tE: If, her malany Na Gedaration, you wbl� �o Uce Workers' Compenution prov'¢ians of tlre Labor
CoOe. you must foNmif� compy vriN wc� Dr '' or ftns perrtut siWl Oe deemeE revoke0.
fANSTRUt710N lFNOIXC M.ENCY: I trereEy atfirtn WI Nue a a msiruction IenEinq apency tar Na perlormance af Iha woh lor
whic� t�a permitis LssueU (�tlon �097. Civ. CI.
IENDER:
�OOflE88:
OWNEP BUILOER OECIAMTION: I AeaUy amrtn Wt I am aem0� �ram Ihe Cpnrattors' State Liceme Law tw Itre Idlowinp reason
(Sactlon 7631.5 Business aM PratessiwW CaOe: Am/ dry ol munry wtuch repuires a pemti� to caxirucl. alter. ImDrme, Eemolis�, or
repair any slmcNm, D�or to It5 55wnu, aLso repuves Ne apDGrant for sucA permit ro file a 5i0�� statement ihat �e/s0a Ls IiunseE
pursuam m tAe O�ovisions ol IM Contnctors' S�ate License Law (CMpter 9(commenanp wM Seclion 7000) ol UhAsion 3 af the Business
anE Professions Catle) ar ttwt AUSAe is ezemD� NM�m anE tlu Uasis tor t�e a�epeG eaemD��. �Y �ution ol Section 7031.5 Dy
any aDP���nl lar a Dermit suEjuts 11re applkant ro a dvll penalry ol rot mae Wn fm �undreE Edlars (f500).
I, az owner of t�e D�oDerty or rtry em loyees vnN wapes az t�eir sole com0ensation, wfll do tAe vroA, an0 IAe
❑ structura is no� IntenUatl or aHered br sale (�n 7064, Busnw an0 Protusimal COCe: T�e Cantrzctors' Sbte License Lew
Gas nat appN to an axner of a DropeM � ��� w impmres Nereon. aM �Mio Eoes 5uc0 wark Nmsetl/hersell or t�rau0h
Ns or her own em0loyen. OraW0e0 WI suc� imDravements are not intenOeO ar otlere0 tor sale. II, Mwever ��e Ouildinq ar
imD�ovement is wIE witMn one year ol comD�etiw, tlre mmer xill Aave tAe buNen oi provinp hNs�e Uitl not �uilA or ImD�ove
br tne ourpou o� u�e1.
I, as owner ol tAe D�operry am �clusivery contracWp wiN IicenseC contractors ta wnsiruc� Ne Droject lSectlon 704d, Business
❑ an0 Professions CaUe: Tha Comractors' State Lice�ua taw Uces ra� apON �o an mmer oi D�7eM � Dullds or Impioves the2on
an0 wtw conirac6 lor sw� projects wIN a wmrapor�s) lia�e Dursuant to Ne Contactors' State Liunse Law1. I am aware
Nat Draof ol IAeir Warker's Campensation uGwnnce sMuN Da D�� to me.
� I am exempt unOer Secibn: B. 8 P. C.
lar Ihis aasan:
Date: Owner:
I Do heaby certity tAat I am awam ol aiM uMerstan0 t�e reqWrements oi Califomu Heatt� and Salery CaEe Sectlore 25505, 25533, antl
25534 and �hat 1 or any tuture Eu11Uin0 �upant vnlUwill not (tirde one) neeE to compy wit� sai0 state coda and Ihe rapuirements br a
permit tor wnstruction or moOitiption Imm Ne N'r�Marapement 0¢idct flesiEentlal constmction apDliwtions are eKempt Iram
Nese provisians, �
Date: Applicam:
I �ereEy cetlity IAat I have read Nis apDliwtion an0 state Uwt t�e�Dove inlormation is conecL I apree to comply wit� all ciry an0 counry
or0inances anU sta laxs re tinq m UuilUinp cronstrucuon ana ne �6y ai horae represematives ol t�is ciry ta enrer upon the aDova-mentioned
DmpeM �or in5 dion . A
�ate: { SiO�tur �w�
orive s L� ense ar cial Secunry x:
1691J8 WMte—BuilEi�p; GreerCoOe Enlorcemant; Canary—Applicant: Gink—Ravenue; GolOenroE—Avesmr
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; E 047991 PLAN CHECH NO: N
CONSTRUCTION TYPE: PERMIT TYPE; ELE
JOB DESCRIPTION ; ELECTRIC FOR FIAEWORKS STAND
CLAIM VALUE: CALC—VALUE:
PERM NO: E 047941
GOVT: N SUPP;
PURPOSE:
SQ FT:
GROUP OCC: /
N
C�TIM.1
COMMENTS:
***�*�x�r��r�****�r�r�r**�exx�exxxxx���*�rir�k�**�r�r+r��r**�e��x�*�*+r�r*+r�rx�rx�*x��**:�*�*�*�r*�r�r
2 O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT ZN REAR; FT IN FRNT: FT IN REAR: FT ZN
LEFT: FT IN RGHT: FT ZN LEFT: FT IN RGHT: FT IN
PARKZNG REQ: PROV: PARCEL; 42419112 ZNE: REF NO:
PLANNING NOTES>
> ,•„ -•
�*x**��c��*���**�+r�**�****x�**��***;x�*�*�r***�*��r*****���**��e*+r��r+�*±����r�r��r***�*��*
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 HY '� DATE:
bUILDING APPROVED HY : �' DATE:
APPLICATION ISSUED BY; •? DATE: _�6��%�
jEiEiFiEiEifiEiEjEiEiEiEiE3E3fdFififjkiEifit . � ikiEiEiEit**iEiEiE�iF �f%
iE if fE iElE jf if iE iF if 7E iF iE �E �E %iE iE jF iE iF 1Fli ff �E iE iP iE iE it if if iE iE if if iE if i4 iE if ik iE iE iE i4 iE 1E if k ik �f iE iE iE iF it ik iE iE iE iE aF iF iE if if iE if jE iF iF if iE af ik if iE ik
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 7.50
SOt SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECH TOTAL PAID DUE
TOTALS----> 7.50 15.00 0.00 22.50 22,50 .00
RE�'ENUE DIVISION TOTALS--> COLLECTED: 22,50 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
?Z.rJ�
it 3t iE ik it i! it if it it if if 1f iF iE iE it k ik iF i! ik if if if if iE if i! if k if iF iE if if iE if if if ik it iE 1E iE if it iE if iE i! it iE if iE k if iE iE iE 1E iE if ik k iF iE iF if if iE iE if iF 3E iE iE if 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
ELE 1
D E S C R I P T I O N
FIREWORKS STANDS
END OF FEES
UNIT COST TOTAL COST
EA. 7.50 7.50
O1 00064i43—ODOo4143 T�3 T _2.SQ /
DATE: 06/23/90 TittE; U9:18 (/
1 CONSTRUCTION AND PLANNING - POC .SPA .
� � - Date -Inspeetor Date Inspector
� APPROVALS Permit #-- . APPROVALS Permit # ��
� 1. TemPorary Electrical Service or Pole � 52. Pool & Equipment Location .•
1 2. SoilPipe-Undrgrnd. -" �� 53. SteelReinforcement
3. EleCtrical Conduit Utiliry�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
7. Footings 58. ElectriCal Conduit-Undrgrnd. �
8. Foundation ' 59. Gas Pipe, O Undrgrnd., Test -
.
9. Water Pipe-Undrgrntl. - 60. Backwash Lines, P�Trap, O Undr�rnd.
10. Structural Ploor System � �' 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection „ 62. Backwash & Receptor•Final
12. Sewer Cap � 63. Heater & Vent�Final
13. Roof Drains 64. Plumbing System � Final
14. Rou9h Plumbing 65. Electrical�Fina1
15. Rou9h Electrical�Conduit 66. Solar SYstem-Final
16. Rough Elearic Wiring . 67. Fencing & Access Approval
1J. Rough Wiring Sign _ 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Struaure 70, Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �Ga: ❑�il
25. Roof Sheathing 74. Overhead Hydro {
26. T-Bar Ceiling (Structural) & Monoroat • 75. Dry Chemical . �
27. Freme and Flathing � 76. Dry Standpipe '
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINA�
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �"l� 79. FINAL INSPECTION
_. r -
32. Electrical Power Meter�Final , 80. FOOD CERTIFICATE ISSUED
33. Final Electric Qig� 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-Finat
40. Gas Service-Final .
41. Solar pomesticFi�al
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING �
48. FINALPLANNING '
.
49. Electric Release to Edison �` .
50. Gas Release to Southern California Gas Co /�'
51. CEfiTIFICATE OF OCCUPANCY
No. Date
�
Applicant to fill In all sDaces except ttlose wlthin �eavy Oortler Ilnas antl sign all appropriata Ceelarations.
CiTVOF COSTq��� COJV�TRUCTION PERMIT
Project Address
9'
Applicant's Mailing Address �z�� " '" � Q�S%
Owner's Name �L yu.Aq � Phone '
Adtlreu
Arch/Eng. L'rcense No.
Address ppp��,��D���777;/'
Contractor's Nam � t Phonecs��5c
Addresslmailing) � � �f S ��r-
City LicenSe No, t� �q � 3
LIC�NSED CON7RACTOR �ECLARATION
I hereby aflirm that 1 am Iiconsetl untler provision5 ot Charter 9(tommoncing
with sec[lon 7000) ot Dlvlslpn 3 ot tne BuSinesS antl Professlons Cotle, antl
my I{cense is in II to e antl eltect. /,
Licens Class � en o.
Date ' — Si9nature
WORKERS' COMPENSATION DECLAR TIO
I hereby afiirm that I hava a certiticat< consent to seH-inw�e or a cer[ificate
oi Workers' Compensation Insurance, or a certifietl copy thereot (Section
380Q, �.zb. CJ
Policy No. Company
8 CertHietl Copy i5 herCby IUmished.
Cer[iiletl copy is tiletl wilh ihe city Bu11tlMg Dlvisl0n.
Date Applicant
EXEMPTION FROM WORKfRS' GOMPENSATION OECLARATION
(Thiisec[ion neetl�no[ bo completetl it tho permit is tor Ono huntlr¢tl IS300J or
Icss).
I cer�ryy �pat in Ihe portormdnce ot [na Work for whith thi5 p m�t i5I55uatl I
sball not amploy any person In any ma ner s as boc subjoc[ to t�te
Workers' Co �a Laws of Califo .
Date — Si9nature
NOT�CE: 11, atter mak ng this tleclaration, y shoul0 become suD{ect to the
Workers' Compensatlon provisloni of che bor COGe, you must forthwlth
comp�y �yi{h such p�ovlsion5 Or IniS pOrmit 5M1a11 be tleemetl rovOk04.
CONSTRUCTION LENDING AGENCV
1 bereby alllrm tha[ there Is a construction Ientling a9ency for the Oerformance
oi the work for which this permlt iz Issuea ($ectlon 3097 Civ. C.)
Lenqer'z Name
Lender's Atlaress
OWNER BUILDER DECLAqAT10N
I hereEy al(irm lhat I am exemPt from the Contractor'S License Law for the
tollqwing reason ($ection 7031.5 Businesz antl Protessional Cotle: qny clty or
Oiviyfon 3 oT tM1e 8uslness antl ProtesSioni Cotle) or that he she fs exempt
tnerp(rom antl t�e basis far lhe allegetl exemptlon. Any vlola ion of Sectlon
7031.5 by any appllcanl (or a permit sub�ects fhe appllcanl to a tivll
��dlty of not more than five huntlretl tlollars (5500),
LJ I az ownar of the property or my employees witn wagaz as thelr sola
compnnsapon, wlll Co lho wo�k, anC [he it�utture IS not IntentleC or offere0
lor sale (Seclion ]044, BuSinezs antl ProPossional Cotlo: Tne �ontractor'S
Lfcenie Law tloes not apply to an owner o1 a property who bulltls or improves
thereon, antl wno tloes sucll work hlmseH/herselt or Inrough hls or her own
emp�oy ees, provitletl that suth ImDrovements are not Intentletl or ofteretl for
sale. �t, hOwaver, (he bulltling Or ImprovamGnl IS soltl wlthin On0 year o1 COm-
pletion, the owner will have tne burtlan ot praving he/sho eltl not bulltl or Im-
prave for the purpose of sala),
❑ �, as owner of the property, am excluslvely contracting wilh Iicensetl con•
tra<tors to construct Ihe pro�act (Se<tion 7044, Business antl Pro7essions Cotle:
The Conlractor'S License Ldw does not appty to an ownor o! property who
builtls or Imoroves [hereon. antl who contracts ior 5ucn oroletts wlth a r.on-
tractor(s1 bcense.oursuant m me Con[ractor's License I,.aw). I am aware thac
oroof o( thelr Worker's Compensation Insurance shoultl be provitletl to me.
❑� am exempt untler Section B. 6 P. C. tor tnis reason
Da[e Owner
I hereby certity that I nave reatl this applicatlon antl state that the above
information is mrrecL 1 a9ree to comply with all city antl county ortlinances
antl state laws rel [ing to uiltling construction, antl hereby authorize repre-
sentdtives of th' 1 o e t/ u the above-mentionetl Oroperty for
InSDYGtIon purp e ���
Si9nature Da[e
Drivars' Litensa or 55 '
0864-46, rev. 5/88 Wnite - Builtlin9: Canary - Applicant; Pink - Accounting; GOltlenroE - Aisesior
.�.. .. �� ........ .._' _'. .__. .,,... �.... A.P.SW
S Main Building:
TVPE OF CONSTflUCTION NEW ADD A�T RATION R PAIR E
❑ CONVERSION ❑ DEMOLISH C�THER T Fronl
DESCRIPTION OF WORK/USE OF BLDG. A Rear
TYPE OF PERMIT GRADING FOUNDATION STRUCTVRAL � C Right
❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g� Left
❑ �OTHER Ping. Fef. dh
PROJECT DESCRIPTION SQ. FT. OCCUPANCv Planning Notes:
CON STRUCTION TVPE VALUATION 5•
ZONE GRADING CV. VDS. AGRES
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
DiShwasher
Drinking Fountains
Floor Drains
Flooi Sinks
GasService OuUets
Interceptors
Kihhen Sink
Lavatories
Roof Drains
Reinspaction Fee I $15
Boiler
Duct - Under Ground
Du[t - Strucmral
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl/Fact. Blt. iC80 �k
Heating System & Ducting
❑ai oo,000 sTu O i oo,000 sri
Reinspection Fee � $15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urina!
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tra'ys
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
RefrigeraGon System
I]0�100,OOOBTU ❑700,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
�
�
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher ,
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fiztures
Device Boxes
Outlets
SwitCh¢5
Garbage Oisposal
Generator O0.5 KW 05-15
2one
Building:
Parking Req.IProvided
ELECTRICAL
Trenstormer ❑ 1S50KW
❑ 50 + KW
Meter ❑up to 100 amps
Meter �over 100 amps
Sub Panel
Motors �Pl HP � 1 A- 8
Inc Solar �9-15 MP 076�15�
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
Reinspeaion Fee $15 luue Fee
$ 3 DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
FEES Building Approved By
5 3
N
1
N
G
R
E
Q
M
T
$.
FEES
SUMMARV OF FEES ii
BUILDING PERMIT $ SMIP $ .
PLAN CHECK S PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ � ENERG�' P.C. $
ELECTRICAL $ o'�d`�� GRADING $
PLAN CHECK 50% $ MICROFILM $ J2
MECHANICAL $ TOTALFEE $ �` •
PLAN CHECK 25% $
0' OIII�3b149-i:GC3b149 ��"7 �2e�L
J6TE� +Jo!331d9 TiFI:: 17:37
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole � .52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � �. � 53. Steel Reinforcement _�
(,3. Electrical Conduit Utility-Undrgrnd: �� 54. Forms '�
� - .
4. Electrical Conduit-Uriilrgrnd. 55. Electrical Bonding
5. Steel Reinforcement _ 56. Rough Plumbing & Pressure Test s nA
'8. Electrical UFER'G�nd � �� 57. APPROVAL TO COVER-GUNITE
7. Footings �• '•. r' � j- 58. Electrical Conduit-Undrgrnd. � �� �
8. Foundation �, ,/_ �' 59. Gas Pipe, O Undrgrnd., Test �
i�
9. Water Pipe-Undrgrnd. �') ��' 60. Backwash Lines, P-Trap, O Undrgrnd. '
i
10. Structural Floor SYsiem '� 61. APPROVAL TO DECK
11. Property Sewer'Lin`e.& House Connection � 62. Backwash & Receptor-Final
1
12. Sewer Cap }.. � ���. 63. Heater & Vent-Final .
r
13. Roof Drains �. 64. Plumbing System - Final •
14. RoughPlumbing�'� 65. Electrical-Final ��
15. Rough Electrical-Conduit 66. Solar System-Final
-16. Rough Electric Wiring 67. Fencing & Access Approval
�17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
i
��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 � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25: Roof Sheathing 74. Overhead Hydro .
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. La4hing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. 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
41. Solar pomestic-Final .
/�
42. Backflow Preventer
43. Backflow Irrigation � ' '
44. Landscape Irrigation System ' •
45. Sound At[enuation -
46. Handicap Regulations -• '
47. FINALSTRUCTURE&BUI�DING � �
48. Special Requirements Completed � ,
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co . ,
51. CERTIFICATE OF OCCUPANCY ' . i
•
No. Date ,_� _y_
, , f
OF COSTA
roject Address _
App�icant's Mailin�
Owner's Nam(�e�y �
Address Js
CONSTR
Applicant to fill in all spaces except tpose within heavy Gortler lines ana si9n all appropriate tleclantians.
ON PERMIT rt����� � ���. ..� �. , ,• ���� ����;
-�-t r P P i- B 3 I�l 1 Por^ l--
P �S�y�yL��,�(yy��[� �S LL�a TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
eN w� e�"�' �"l.7Q� S'll 2 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
_Phone �� DESCRIPTIONOFWORK/USEOFBLDG. �Pt+�atih.�
II1 ., r�_ (� A- Q 7 1� i , '
Arch/Eng. g� � � ` t�'�"�n� �icense No. C sg5 7
Address 3'-'� Q � � 5� �1 o-CA 1�.3
Contractor'sName�_.t�ay.4Pr �oM Phone _4�
Addresslmailingl -�1S3f r QM S�' i �
City Licenu No. "— 7� 4�
LICENSED CONTRAGTOR DECLARATION
I hereby attirm that I am licensetl untl¢r provisions of Chdrte� 9(commencin9
with section ]000� ot Divizion 3 of the Business and Professlons Cotle, an
my license is in I force antl efiact. ,/
Ucenze Glass i ens o. y
Date �'�L' 'g Siqnature � '
WORKERS' COMPENSATION DECIARATION
iereby affirm tnat 1 have a certificale ol consen[ to selbinsure or a certi(icate
Wo�ke�5' Compensation Insu�ance, or a ce�titi¢tl <Opy thereof (SecHon
3800, Lab. C.) - �
Po�icv No. Eoe575631 `�- comPanv L/v7°f �o�
� Ce�tIitietl copy 15 hi@etlbwithrth¢hcit�y inq D i51�. y/�///7
Od[e�( � Z G `�� APPIiGant � � �v �
EXEMPTION PROM WORKERS' COMPENSATION DECLARATION
(This 5ettion neetl nol be ComPle[etl it the permit is for One huntlretl (E300j or
iess).
1 certity thal in [be pp�formance of lhB work fo� whi[h this pe�m�t i5 i55uetl, I
snall not employ any person in any manner so as to become subject to the
Workers' Campen5atlon LawS of California.
Date � Signature
NOTIGE: If, after making this tleclaration, you shoultl become subject to the
Workers' CompenSatlOn provisions ot the I�bor Cotle, you must forthwitn
complY with suc� provisions or tttis permit SAall be tleemetl revoketl.
CONSTRUCTION LHNDING AGENCV .
I hereby affirm that th¢re is a construction IenGin9 agnncy for the pertormance
of the work for whicn this permit is issuetl (5ection 3097 Civ. CJ
Lentler's Name
Lentler's Atltlress -
OWNER BUILDEN OECLARATION
I hereby aftirm tha[ 1 am exempt frOm the Cont�actor's LlcenSe Law tor tbe
followin9 reason (Sec{ion �031.5 Bu5ine55 antl Professional Cotle: Any city or
County which r¢quires a Pe�rtiit to con5t�ucq alt¢r, Improve, Cemolish o� re0al�
any s[ructure, prior to its issuance, also requires tne applicant tor such permit
i to file a Si9netl Statert�ent that h¢/Site is Iicensetl pursuant IO the provi5ions o(
�he Con[ractor'S LicenSe Law (Chapter 9(commencing wi[h Seclion 7000) 01
�vision 3 ot lhe BUSiness antl Profe551on5 Cotl¢) or tha[ he/she is exempt
erefrom antl the besis for the alle9etl exemp[ion. qny violation of Section
.031.5 by any applicant for d permil subjects (hG appli<ant lo d clvil
Qendlty of not mor¢ than five huntl�etl tlolla�s (E500).
L.J 1, a5 owner ot the propertY or my employees wlth wages a5 [M1eir Sole
compensation, will tlq tne work, antl tne structure is not intentletl or otieretl
for sale (Section 70qq, Bu5ine55 antl Professional Cotle: The�Contractor'S
License law tloes not apO�Y �o an owner ot a property wno builtls or improves
thereon, antl wlto tlqes Such work hlmself/herself o� through hls or her own
employees, provitletl ���t such improvements are not intentle� or offeretl tor
sale. It, howeve�, th¢ bullEin9 O� imprOvement is sOltl withln on¢ Year Ot com-
O�etion, the owner wp� have the buraen of proving ne/sne tlitl not builtl or im-
p�Ovt for the purpose pf sale).
❑ 1, as owner oi tn@ properry, am exclusively contratting with licensetl Wn-
tractors to construct the project (Section 7044, Business antl Professlons Cotle:
The ConVat[or's LiGense Law tloes �not apply to an owner of proPerty who
builtls or improves try¢reon, antl who Contracts Por such projects with a con-
Iractor(s1 ncense pursuant to the Contrac[or's �icense Law). 1 am aware that
proof of their Worker's Compensation Insurance shoultl be provitletl to me.
❑ I am exempl untler $ection B. & P. C. tor fhi5 reason
TVPE OF PERMIT U GRADING LrJ FOVNDATION LJ STRVCTURAL
❑ TENANT� ❑ ELECTRICAL; ❑ PLVMBING ❑ MECHANICAL
� ❑ OTHER . /�
�ROJECT DESCRIPTION $Q. FT. � � ��� oCCVPAN��Cv�p
CONSTRVCTIONTVPE V� N VALUATIONS�
20NE �-( GRADING CU. VDS. ACRES: •n
Remarks: QC#
^ Cl7Y /
Bar Sink
Backflow Preventer
- Backflow Irrigation
O/-� M/C.2o j'/[M
�rinking Fountains
Floor Drains ' "
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories �
P-Trap
Roof Orains
Reinspaction Fee $15
Boiler
Duct-UnderGround
Ouct - Svuctural
Duct � Ventilating
Ezhaust System ❑ Multiple
Firepl/Fact.8lt. ICBO #
Date owner - Heating System & Ducting
� I hereby certiry ehat I have reatl this avP�ication antl ztate tnat me above '❑4700,000 BTU �100,000
Intormation is correc[. I agree to comply with all city antl county ortlinances
antl state Iaws rolating to builtling constructlon, and hereby authorize reore-
sentatives ol this Ury [o enter upon [he aDove-mentioned property tor .
Inspectlan pur s 5
Si9nature ��� � wJ � Q Daie 3 / O Q
Drivars' Li SS ' Reinspection Fee
CMF 0865-46, rev. 30/84 White - BWltling; Canary - Appllcan4 Pink - Accounting; Goltlenrotl - Asse55or
$15
ShoWers
Servite Sink
Sewer Cap .
Sewer Connection
$013! COIICCLOIi
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service�
Auto-Wash �
Issue
Hoody�r� Typel ❑
Canopy Type 11 ❑
Refrigeration System
❑0-t00,0006TU ❑100,OOOBTU
System Repair/Alteration
F ire Dampers
Registers
Iuue Fee
$ 3
$ 3
A.P. # p�� -
S Main Buildin9:
E
T Front �
aRear
C Ri9ht �
g Left �
Ping. Ref. # - A
Planning Notes
Automatic Washer
Cans[ruction Pole Su6.
Cooking Unit
Dishwasher
Dryers ❑ Elec
Fan � � �
Boxes
Switches � -
Gar6age Dispoul
Generator �0-5 KW
Fee
DEVELOPMENTSER
Zoning Approved By _
Building Approved By
4020 I/27/g6
Zone
Accessory Building:
Req./Provided
ELECTRICAL
- Transformer �� 15-50 KW
� ❑50+KW
Meter LJup to 100amps
Meter ❑over100amps
Sub Panel
MotorsOO-1 HP�01%-8
IncSolar �9-15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
5-�15 KW Trash Compactor
$15 Issue Fee
629,41- 7L
FEES
$ 3
2
O
N
I
N
G
R
E
Q
M
T
S
SUMMAR�OF FEES ' 80 �
BUILDING PERMIT $ �33" � SMIP $ �.__
PLAN CHECK $ �� � PERMIT- �
PLUMBING $ ' ��UANCE $ . _
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING S
PLAN CHECK � 50% $ MICROFILM $ �/- � '
MECHANICAL � $ TOTAL FEE $ �
PLAN CHECK ZS% $ � • ,
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # � Date Inspector
1.�Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
. 7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor SYstem 67. APPROVAL TO DECK
11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing 65: ElectricabFinal ,
15. Rough Electrical-Conduit �� ' � 66. Solar System-Final
16. Rough Electric Wiring ' 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
�18. Rough Electrical-T Bar Ceiling ,� � 69. POOL/SPA SYSTEMS F�INP,L� �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT- �
20. Rough Factory Fireplace . APPROVALS Permit #' _
21. Ducts, in Structure 70. Undergraund Hydro .
22. Ducts, Ventilating ' - 71. Product Piping O Gas �:Oil� , -
23. Gas Pipe,Rough & Test 72. Underground Flush � �� -
24. Roof Framing 73. Undergrnd.StorageTank�Gas OOiI
,
25. Roof Sheathing � �� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat ,� 75. Dry Chemical ' '
27. Frame and Flashing • � 76. Dry Standpipe �
28. Lathing & Siding 77. FIXED SYSTEM FINAL. � �_�
29. Insulation 78. FIRE PREV. FINAL �
30. Drywall Nailing ' • ' HEALTH DEPT•: REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric �� • Notes:
34. Final HeSting & Air Conditioning ---
': '_ -
35: Final Gas Pipe-Test � -� � � � ' � - � .. . �
36. Hood or Canopy • .
37. Final Far,tory Fireplace . -
38. Final Plumbing • -
39. Water Service-Final �' . � .
40. Gas Service-Final � .
41. Solar pomesticFinal . , � - - ` .
' 42. Backflow Preventer � -
�
43. Backflow Irrigation '' � , �
44. Landscape Irrigation System � � • ,
� 45. Sound Attenuation �
46. Handicap Regulations ' �
47. FINAL STRUCTURE & BUILDING ' � '�
48T Special Requirements Completed ' ' � �"
49. Electric Release to Edison ' �'
50. Gas Release to Southern California Gas Co . , ,
51. CERTIFICATE OF OCCUPANCY
No. Date �
Pq0.1ECT �OOPESB: 8 O 1 W 1 9 TH ST
� OWNEH'SN�MF: LOU HliNGA'fE
FDOPES&: 8 O 1 W 1 9 TH ST
COSTA Me.SA
CA 9262'1
(213)863-7363
I �PCxIFNGINEEN:
�ODflESS:
1
_ uxrt:
Nf6.ND.:
UXR:
PEHMIREE: NAULT ENTERPRISES, INC, ( 213 ) 863-7363
�ooxess: 12158 � IRESTONE BL D
NORWALY, CA 90650
�CENSED CONTMCtOH OECIAMT10N: I Aereby aMrm [Aat I am IlunSeO unEer DroNsions of CAapter (wm cinp wit� Sectian
7pJ0) 01 Division 3 of tAa Business an0 Prole55ions CoOe, and InY cense i lutllorco anE eflect.
cirruc.: U47963 $T�TEuc.:46i113 � C-1 .
�ate: _�z �-9 l Sipnatum:
WONIlEHS' COMPEN311TION OELUMTION: I hereDy allirm �hai I a ceNficala ol m t to utlJrnura a aNliate af WaM1srs'
ComPensation Inmrance. or a artllieC copY ����� (����o� �• ��� CI.
Pol1tY NO.: F](P. 011TE:
;4MPpNY:
� CenifeO ropy a nereby fumisli¢E. ❑ CeNfieO mpy ic fileE wiU Ne ciry Buil0in0 OiviUon.
Oate: App��:
IXEMPfIUN FIIOM WONIIENS' COMPENSITION DEfAAMTON: (Ri5 5ec6on rieeU iroI Ee
I ceniry ttut in ihe perlarnance ot ine work for x1ucA tlds pemtit 5155ue0 I^ �ro
sublep to tAe Workers' Compensation Laws oi Ca9tamia. ,
Date: � � � " 9 � SqmWre/�
NOTICE: II, atler maMnp this Eeclarztion, you sAWI Gecome SuDject ta IM V
Catle. YW mu5l IortMAI� cnmDN vriN sucl� Dtwltiarts a lttis Ottrtdl stwll Oa
CON�RUCTION 1EN01NG 1GENCY: I �ea6y alfirm ttut Nere is a mmtruction
wAich Ihis permfl is isweE (�ion 3097. qv. C�.
IFN�Efl:
nooxess:
ii Ue
Comperrsation D��s�ons ol I�e La�or
! remked.
apenry �or ihe pertormaMe of the work lor
OWNEB BUIIDEB OELlAN1TI0N: I �ere0y atfirm Itut I am exempt tmm t�e Contractars' State License Law far Iha lotlowinp �eason
(5e���on 7091.5 BuAnett an0 Pratusknal Coae: Nry dtY at cowty wlticli repWres a permit m coistruct, alter, imo�e, Eemolah, or
re0ai� �Y structme. D�r to Its issuance, aho repures t�e aDD�an� tar sucA perrtdt lo lile a sipne0 statemenf Itwt �USM is IicenseE
pur6uant to IAa D�avisions ol Ine Coniractms' State License Law (Chapter 9(commencmp xitn Section 7000) ol Division 3 0l IAe Businass
an0 Prolessions Cade) or t�at hNshe is exampl l�eretmm anE tAe �asis tor t�e a�iepeA ekamD�ion. Airy Wolation ol Sectlon 7031.5 �y
eny aDPlicant 16r a Dermit suEjects IAe applkant to a civil penalry ol mt more Ihan �he �unEreE OWWrs (I500).
l as owner ot �ne o�opeM or my e�pIwem wim wapes az ma sae mmpnaatlon, vAu ao the wa�k, ana me
❑ siructure B�wt NteMW ar ollerW tor sale (Seclbn 70aa, 8u5Ness a� Protedonal CoEe: T�e Contractan' State Limnse Law
Cces not apDry ta an avme� ol a DmpeM � �u06s or improves Nereon, anA x1a Ooes such work �im5ell/�erult or I�muph
nis o� Ire� own empfoyees, provided tlut suc� �mprovame�ts aze not inte�nE o� oHertO �or sak. 11, Iwwever tha huilWnq ur
improvement is soltl wilAin one year ot camDletion, the axner wiil �ave the CurOen ol provin0 �e�s�e Uid noi Duiltl or ImDmva
lor Ihe purpose ol Sale�.
I. as wmer oi the D�M1y am exdusve cmVapinp wiN IiameO conlradma lo cqisWct Ue DrqM (Sectbn 70N. Bus�au
❑ 2M Pf0iC55�M4 �AdE: Th! �OfIViL10R �IiSOlkfJ6! LdW E00511012VV�Y W N OMMf 01 pfOpllrty WIG bW45 Of IRIDf0Yt5 fl�tfl011
ynE wlq rAnVacls lar wcti pmjecLs wiN a canUactor(51 �� 7ursuant to Ue ConVaclori State Ucense Law�. I am aware
IIWt pr0ot 0� ��eir Warkef's CompEreatlon Insu2nce slroulE Ee provlOeE to ma.
� 1 am exempt undu Seclbn: B. E P. C.
fOr IN5 reaWn:
Dd10: ��:
I tlo hereDy ceniy lhat I am aware o� anE unAersWntl t�a requiremG��s ol Calilomia HealtA anU Satery CoOa Sectlons 25505, 25533. anE
� 2553a anA that I or any future huilEinO awD�� �+���I not (drde one) neeE to romDN �N saW state coCes antl Ne aQulremen[5 for a
penNt iw consWClbn or mo0ilkaUon tmm ihe AIr�Mwptmmt Okiricl. fleiOmtial canSvucUm apdiwtions are aempt irom
IheSe Dravisions.
Date: pOM����
I nere0y ceniTy tAai I Aave rea7 tAis aOD��tian ana state tAat tAe we inio atlon is co . I apre
orUi��s anA sUte Wws rela�inp to EuilOinp malnitllan arq e epiesenuf I tpis�
prapeM br in5peclbn puryous. —/
� —710 '_ c�'/ � j
OatR: pnaNmr
orivei s �kense or Sociai Securiry x: �.
18a1A8 NTile—BuiWinp: Green—Cotle Enlorcamenl: Canery—Applicant: Pink—Fovan�e; G
and
C�TY OF COSTA MESA — BUILDING PERMI'f PERM NO; E�U52529
PERMIT NO: E 052529 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRIICTION TYPE: 5—N PERNIT TYPE; ELE PURPOSE: Oii;
JOB DESCRIPTION : FIREWORRS STAND SQ FT:
CLAIM VALUE: CALC—VALliE; GROUP OCC; B-2 /
COMMENTS: FIREWO�KS STAND FOR THE "OR CO SKI CI,UB"
�F iF �f if if if 'T� �k if ,�F iF;F �E # if if iF iF if iF if iE iF 1E aE i: iF iM1 1f 3E r if 3t� #� if ir�)F if 3f if N-iF 7F aF if �1f 1f lE ��:� Y iE 3F )F if iE 3f lr af aF :F ii� jF lf iF ac iF 3i'+F 3i� iF iE if ie # 3F #� aF if,F
Z O N I N G R c Q U I R E M E N: S
S E T B A C K S
------------ MAIN 3UILDING ---------- --------- ACCESSORY BDILDING ---------
FRNT; FT IN REAR: eT IN FRNT: FT IN REAR; FT IN
LErT; FT IN RGHT: FT IN LEFT: PT iN RGHT: FT IN
PARKING RE ; PROV; PARCEL: 42419112 ZNt: RHF NO:
PLANNING N�iES>
> •
iE iF 3f ii ie i63i� 3F 9e iE #�N� i4 iE i� # i(- iF if iF i2 ii� � if i'r * 3E iE �f iF iF ieae if if le � iF-% if R�1F if iE iF ie iElr if� k iE i'r i'r if 3f if iF ii�iF i* ii�ii� 3'r ii �f K� iE a: ie iF ih x 3F iF if 1'r if K• 3E
D E V � L U 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 3Y DATE:
BUILDING APPROVED BY : DAiE;
APPLICATION ISSUzD BY: � DATE; C�c�26�9�
iE1Elf�->if�16�f?fK�j'taEifiel:?kiF#��7F3f#}y.T'�,c +' .�n xfr i.r fF i�:i-ii-F.1fRIfaf3FR3e}'.#'�K�TlTii'ri—Ti'i7£iEiF
�(�iF�Mi:Y�iMiF#'�ififlElEh'�aEihlElfiF#ii�aF�i4�F?fif3F�kif1F?Eii�iFif•�1F#3FiE �3i�lF i,i�iFl4lflfkf(�aFii��k�ieif3fii�i'r�R�!'#7f�R�FR�'tlfiflF3r+kiEiE3�'�j'r��af�
Lc.GALIZATION:N F e. E. S U M M A R Y STRTJCTURAL SEGMENT:N
rERMIT BLDG PN,T PLUN.BING ELEC�RS�C MECHANIC FIRE SNIP/RES GRADING
l SOg SM.IP/NON—RES
PLAN
ISSUE F'EE 15.00
HUILDING—DIV—> PERN.IT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 7,50 15.00 0.00 7.2.50 22.50 .00
REVENUE DIVISION TOiALS--> COLlECTED: 22.50 OV'cR/SHORT: ,00
HLDG PMT PLUMBIh'G ELECTRIC MECiiANTC fiIRE SN,IP/TUT GRADING PLAN—CHECi(
�2.5�
iF � Y� 1F iE if�i(•if i'riFj4�K�i(�iE 3i��f IF If ii if if N�i4 if�ih if� 1F ii��/F 1F aF�FdF K•af ii N�#iE N�af x�if i't #F�f #f��f �'�ii iF iEi6 iF fF lf %�iF IF iF 7���F i'r fF )F +f� �F 3% 1{ lf �t 3c i'�D� ie L;.IF ii�
I N D I V I D U A L F E E B R E A FC D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 7 FIREWORItS STANDS EA. 7.50 7.50
' Et3D OF FEES
Jd �.�,Li"IIiL—NL ����i`L� ii � ��
LHTk� �D;i6i�'1 ',1:':: J�''ll
CONSTRUCTION AND PLANNING PG & SPA
. APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
i. Temporary Electrical Service or PoIB 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgmd: _ . 55. Electrical Bonding -
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAI TO COVER�GUNITE
7. Footings ,�, 58. Electrical Conduit-Undrgrnd. .
8. Foundation _ 59. Gas Pipe, O Undrgrnd., Test �,
9. Water Pipe-Undrgmd. - 60. Backwash Lines, P�Trap, O Undrgrnd. ��,�
.
10. Structural Floor System �-"� 61. APPROVALTO DECK
. i
11. Property Sewer Line & House Connection • 62. Backwash & Receptor�Final -
�
12. Sewer Cap - • /_ J 63. Heater & Vent-Final
13. Roof Drains �', �' .\� 64. Plumbing System - Final � �
14. RoughPlumbing i' ( ,��� 65. Electrical�Final �^
15. Rough E�ectrical•Condui, '�' 66. Solar SYstem-Final �
16. Rough Electric Wiring 67. Fencing & Access ApProval
77. flough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Efecirital•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heatin9 & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. DuCts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceilin9 (Structural) � Monocaat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL '
30. Drywall Nailing ' HEALTH DEPT. RE�UIREMENT
31. Plaster Brown Coat •• 79. FINAL INSPECTION
32. Electrical Power Meter-Final - . FOOD CERTIFICATE ISSUED �
l
33. Final Electric �Z% �l s:
34. Final Heating & Air Conditioning '
35. Final Gas Pipe�Test � •,
36. Hood or Canopy
37. Final Factory Fireplace '
38. Final Plumbing � .
39. Water Service�Final
40. Gas Service�Final
41. Solar pomesticFinal
42. Backflow Preventer
43. 8ackflow Irrigation
44. Landscape Irriaation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINALPLANNING �
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Cn �
51. CEFTIFICATE OF OCCUPANCY
No. Date
�`
�
AoO���ant to Iill in all spaees excaD� those within neavy bortler Ilnas ana sign all aovrooriate aeclarations.
CiTv oF COSrn MESA ' CONSTRUCTIO PER IT �
.
Project Address � �
Applicant's Mailing Address
Owner's Name ^ Phone
Address
Arch/Eng. License No. � ��'
Address
��` �
Convaclor's Nem � !o��ne — '
Address (m� ����� /32 ��QU1 •�/t �w. C �Y:Al110��
CitY License No. 3 S �� �
LICENSED CONTRACTOR DECLARATION
1 herCby altlrm Ihat I am licensetl untler provl5ion5 ot Chdrt¢� 9(commencing
witn sacUon 7000) of Oivisbn 3 ot the Buslness antl Professions Cotla, antl
my Ilcenze is in lull torca an e/tect. �// �b
LlcanSe CI IGen No.
Date —_y/ � `Signature �u��� ��
'ORKERS' COMPENSATION DEGLARATION�
ereby ailirm tnat I nave a certilicate of consant to self-I�sure or a certiflcate
� workers' Compensation I/ny urance, or a certHiea cooY tn eof (SacOon
3800. Lnb. ���� �/ C�/Rir/6 N� T/l�
Policy No. � / ./.Q— Company
BCertifietl cop �ereby fumisnetl.
cer tie tiied wun tne rity s'y� ow� �o
Da[e � ��� Applicant
EXEMPTION FROM WORKERS' COMPENSA ON DECLARATION
(ThisseGtlon neetl nol be mmpleteG If the perm ii for one �untlretl (5300) Or
less).
I certify that In the pertormance ot the work tor which thls perm�t is issuetl 1
sball nOt employ any person in any Tanne� so as to betOm¢ subjett to t{�e
Workcrs' Compensatlon Laws o/ CaIlPornla.
Oate 99nature
NOTICE: If, a/[er making this tleclaration, you 5houltl become sub7ec[ to the
Workers' Comoensation proWzions of the Labor Coan, you musl forthwith
comply witn Suth prOvisions or thi5 POrmit inall be tle<meC revokatl.
CONSTRVCTION LENDING AGENCV
I nereby aliirm ihat (heie is a constructlon lantlln9 a9enty for the performance
oi Iho work fOr wnicn Ihii pCrrnit Is Issuetl (Soclion 3097 Giv. C.)
Lentler's Name
l.anUer'z AtlAress
OWNER BUILDER DECLARATION
I heroby alflrm that I am ezempt from tha Conlractor's License Law for tho
following reason (Settlon 7031.5 Business antl Professlonal COUe: Any city or
county whlch requirez a permit [o constru<l, alter, improve, tlemolisn or rapalr
any sVuctu�e, prio� lo'its issuance, alSo reqWieSlhe applican[ to� such p¢rmit
[o fi�e a signetl statement tM1at he/she Is Iicensetl pursuan[ to the provisions ol
'�e ConVactor's License Law (Cnapter 9(commonUng wi[h Sec[ion 7000) o(
vl5lon 3 Of lhe Buziness antl Plofe55iOns Cotl6) Of [hal he/She is exempt
�e�ol�om anC Ih¢.basis for Ihe all¢9etl exemptlon. AnY viOldtion of 5¢CtiOn
)031.5 Dy any appliEant for a permit subjects the applicant to a civll
�enalty oi not mote [han five huntlretl tlollars (§500).
LJ I, as owner of the property or my employees witn wagez as their sole
coTpenSdtiOn, will Oo the wofk, antl [Ile stluGtufe I5 not in[¢nCetl or Oftetetl
tOr sal¢ (SetliOn 7044, Bu5ine55 antl Pr0lBssional COtle: Th¢ Conttacror'S
License Law tloes not appry [o an owner ot a property who bulitls ar impmves
thereon, antl who tloes sucn work himseli/herseH or through nis or her own
em0�oyees, provitletl t�at such improvem¢nts a�e pOt Intentletl or otfe�atl tOr
� sele. If, however, t�e buiitlin9 or improvament iz soltl wlthin one year of com-
pllUon, the ownt/ wlll have th¢ burden Of proving h¢/She tlItl not bullA o� �T-
ptOve fo� th¢ pu�po5¢ ot sale).
❑ I, as owner of the property, am ezclusiwlv contractlng witn Ilcensetl con-
trattors id consvuct tne o�oiect (5¢C[iO0 7044, BU51�055 dOtl A07¢SSi005 COtle:
Th0 Con[ractor'S LicenSe Law does not apply [O an owner of prOPe�ty who
builtls or Improvus thereon, antl who conlracts tor such projetts wlth a con-
. tractor(s) ucense pursuant to tho Contrac[or's L�tonse Law). I am aware that
' prooi Of lhel� Worker'S Compensdtlon Insuranco shoultl be provitle0 t0 me.
�❑ I am axempt unUer Section 8. & P. C. for lhii reason
Date
certiy
m is a
ISignature �
Drivnrs' Licanze or 5
Owner
ve r¢atl th15 applicatlOn antl state tnat the abova
ree to comply with all <Ity antl county ortlinances
builtlin9 constructlon, antl hereby au[�orize repre-
enter .uoan Ine above�mentione�f oroDertY tor
TYPE OF CDNSTRUCTION IJ NEW LJ ADD LJ ALTERATION LJ RE�AIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, �
DESCRIPTION OF WORK/USE OF BLDG.
� S Main Buildin9:
TVPEOFPERMIT GRADING FOUN�ATION STRVGTURAL T FrOnt
/❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
❑ OTHER ' C Righ[
PROJECT DESCRIPTION Sq. FT. oCCUPAry/� V K
CONSTRUCTIONTVPE VALUATION$1/,� $ Lefl
ZONE GRADWG CU.vDS. � ACRES Ping. Ref. �
Ramarks: .� --- -- -- � Planning Notes:
Sink
Preventer
Irrigation
Dishwasher -.
Drinking Fountains
Floor Drains �
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavarories
P—Trep
Roof Drains
Reinspection Fee � $15
Boiler
Duct- Under Ground
Duct - Svuttural
Duct - Veniilating
Exhaust System ❑ Multiple ❑
Firepl/FacL BIL ICBO #
Heating System & DuCting
❑aioo,000 eru Oioo.000er�
Reinspection Fee � S15
CMF 0865-46. �e�. 30/84 Whit¢ - Buil�ing; Canary • Applicant; Pink - AccoOntlng; GOItl¢nrotl - ASs¢SSOr
Service Sink '
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Warer Heater
Water Service
Auro-Wash
Laundry Trays
laue Fee
Hood or Typel ❑
COnopy Typell ❑
Refrigeration System
❑aioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dampers .
Registers
laue Fae
FEES
Automatic Wesher
Construction Pale Suh.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Electric
Fan
F.A,U.
Fixwres
Device Baxes
Outlets �1
Switches
Garbage Disposal'
4269 3/19/B7
Zone
Accessory
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
❑5�15 KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors�0.1 HP �1Yh-8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Si9n
Standing Sections
Trash Compacmr
23.00 �'!
FEES
2
O
N
I
N
G
R
E
�
M
T
S
S 3
Reinspection Fee $15 Issua Fea 5 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Buildin8 APProved By Date
Appliwtion luued By Date
SUMMARV OF FEES
BUILDINGPERMIT $ 17.50 SMIP $ O�SD
PLAN CHECK • $ PERMIT
PLUMBING $ S.JG ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL § GRADING 5
PLANCHECK 50% $ MICROFILM S
MECHANICAL S TOTALFEE $ 23.L�6
S 3 PLAN CHECK Z5% g
CONSTRUCTION ANDPLANNING FOOI&SPA
APPROVALS Permit # Date InsPector p�ppROVALS Permit # Date Inspector
1.�Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � � �
5. Steel Reinforcement 56. Fough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings _ 58. Electrical Conduit-Undrgmd. "
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
12. Sewer Cap ��� 63. Heater & Vent-Final `
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit . 66. Solar System-Final ,
i6. Rough Electric Wiring ' 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling J 69. POOUSPA�SYSTEMS FINAL
79. 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 � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing � . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing ' � 76. Dry Standpipe
28. Lathing & Siding ' 77. FIXED SYSTEM FINAL
29. Insulation , 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioniny
35. Final Gas Pipe-Test
36. Hood or Canopy '
;
37. Final Factory Fireplace • � � �
38. Final Plumbing . ' � �
39. Water Service-Final • '
40. Gas Service-Final
� 41. Solar pomesticFinal :
42. Backflow Preventer . _ , .
•43. Backflow Irrigation . _ � .
44. Landscape Irrigation System . , ,
�45. Sound Attenuation - I
46. Handicap Regulations � �
47. F�NAL STRUCTURE & BUILDING . �/y� ��� '
48. Special Requirements Completed �
49. Electric Release to Edison '�
50. Gas Release to Southern California Gas Co - �� �
51. CERTIFICATE OF OCCUPANCY
No. Date
PflOJECT POOHESS: 8O1 W 19TH $T
OWNEP'S NAME: L S M VENTURES
ROOHESS: SUITE 1060
1901 AVE OF THE STARS
LOS ANGELES,CA 90067
AHCH/ENGINEEP:
AODNESS:
NEG.NO.:
UNIT:
UNIT:
PEXMITTEE: SOUTH BAY NEON ( 619 ) 691-8686
aooxess: 171 MACE ST • A-1
CHULA VISTA CA 91911
LICENSEU CONTBACTOR DECNBRTION: I �ereUy allirm t�at I am IicertsM u�er Orovidons ol C�apter 9(commencing with Section
7000) o� Division 3 0l I�e Busineu ana Pmleuions Catle, an0 my liCense ¢ in �ull torce and efiecl.
c�Tvuc.: 059126 STFTELIC.:ql'� cuss: C-45
Date�.���� Signatur����— _ — — _
wOP flS' CO PENSpiI CLAflATION; I nereey atlirm inat I llave a tenificate of cansent to�llbi re or a ceniticate of warkers'
Compensation Insurance. or a cenilied cooY �hereol (Section 3800, Lab. CI.
PoucvNo.: 728994-91 E%P.ORTE: OZ�OSI9Z
' comraxr: STATE FUND
� Cenifie� capy is �ere�y fumis�e0. � Ceni�lieA capy is fi_le�0 wit� l�e ciry BuilOing Divisio
w�e: 9.�./ 7 9/ Aoorwm: ���'-c • _
E%EMPTION f110M,— �'- WOXNE S' �MPENSRTION OECLAXATION: (Ttis sectpn nreE mt 6e completeC il U p> ., is for one huMrM (5700) a less�.
I certity Ihal in ihe oertormance al ine wark lor whith thi5 permit is iSwed. I shdll nol employ any per5on in any manner 5o as to Uecame
SUbjec� Io I�e Workers Compen5aiian Laws ot Calibmia.
�ate: Si9wiure: '
NOTICE: II, alier makinq I�iS tl¢tlaraiion, y0u S�ouIE EeCOme SUGje[I to I�e Wafkers' Compensation pmvisians ol the LaUor
COEe. y0u musl fartlrmin comdY `�+�� suth prwiSiMs or tlti5 permii Shall Oe JeemeE rewkCd.
LONSTBUCTION 1EN01NG �GENCY: I �ere0y atlirm rtai there ¢ a wrrstructqn IenGing agenc/ for t�e peAormance oi t�e work lor
whicn inis vermit is i=suetl (Sepion 3097. Gv. CI.
LENDEfl:
aoonEss:
�� i
OWNEB BWLUEN DELtAM710N: I �ere�y allirm Ihat I am exempi imm i�e Coniraciors' Siate License law lor t�e I011awinA �eason
(Sec�ion 7031.5 Business ana Rofesvonal CoOe: Any pry ai coumy whic� repuires a permit to mnsimct, alter, imprwe, aemolis4 or
reoair any slrutWre. Drior to its is5uance. al5o reduire5 the applicani lar sut� permil ta lile a signeU slatemeni ihal �¢/s�e is licenud
Dursuant io tne O�ovisions ol ine Coniratlars' State Licens¢ Law (Ctuo�er 9lcammencinp vriln Section 7000) oi Oivision 3 of Ihe Business
an0 PmIe55ion5 Coae� of I�al �els�e i5 ¢x¢mpi IAerelmm and 1�¢ Oasis br I�e all¢peG enemD��on. Any violation o� $lCliOn 7031.5 Oy
any aDPlicant lor a Oermit suClats t�e apDliwnt to � ciW penalry of �ro� more tAan five OunOreO Oollars �5500�.
I, as owner ot Ine pwperty or my emyloyees vrith wa(�CS as ineir Sole compensation, will Eo ine work, ana Ina
❑ simcmre is noi intenaea or olleretl lar sale (secuan 70aa, Buwiess an0 Prolessbnal CoOe: The Contractors' State License Law
Ooes not aOD�Y to an ownei ol a D�operiy wilo Ouilas or improves Nereon, anE who Jaes sucll work himself/hersell or �hmugh
his or ber own empl0yees. Orovi0e0 �hat suc� impmvemenis are noi intenGeO or ollerea for sale. If, �owever ihe builtlinA or
' impmvement is Soltl wilAin one year ol campl¢Iion, Ihe own¢r will have �he burGen o� O�ovinp he/ihe Aitl no� Uuiltl or impmve
I torlbe Durpose of sale�.
I, as owner of I�e properly, am evClusively tonirac�inp wilh IicenSeE conlracior5lo con5lNc� �he pmjecl (Sec�ion 7044, Business
❑ antl Protessions Coae: The ConVatlOrs' Siate License Law Ooes nol apON �o an ovmer o� pmDerty who �uiltls of improVeSlhelean
ana who wntratls lor sucA D�olects wil� a wmracmqs) licenu Dursuant to ihe Contraciors' State License Law�. I am aware
IM1aI pmol ol Iheir Work¢r's ComDensation insurance 5houlA �e O�oviOeU lo me.
� I am exempl untler Section: B. 8 P. C.
tor Nis reason:
Date: O+vner.
I Uo hereby cenity inal I am awaie ol ana understanA Ihe tepuirements of Cdlilomu Hedtih and Safety Cotle Sections 25505, 25533, ane
25534 an0 t�at i or any imure huilUing acupant vnNwiil not (cirUe one) �eeU �o campty vn�h saiG state codes and �he reQuiremenis lor a
permit lor conslmction Or moCilication Imm I�e An Oua4ty Manapemeni OiSlrici. Hesiden�ial con5�mciion applicali0n5 are ¢Kempt �mm
I�e<e D�avisi0n5.
�ate: APVliwnt:
I �ereby certily thal I lure reatl thi5 appliWtion anU stale ihdt I�e aDOve inlarrtuGon ¢ fArrecL I agree ta comply wit� all ci�y anU counly
oidinances antl slate laws relating Io �uil0ing constmciion an0 trereW aNlarize reDreSenlaiive5 of INs dry Io enter upon Ihe aDovemeniionea
OmOehy lorinspeclbn Ourpo5e5.
�aie:_����'�� Signatur� �
o�ivei's Licenu o� Saia1 Security r: (;
t64t�46 W�ne—BuilOing; Green—Coae Enbrcement: Canary—Appliwnt; Pink—Revenue: GolEenrod—Asseswr
CITY OF COSTA MESA — SIGN PEAMIT PERM NO; SB 053829
PERMIT NO: SB 053829 PLAN CHECK NO; 03504-91 L GOVT: N SUPP: N
CONSTRUCTION TYPE; PERMIT TYPE; STR SIG PURPOSE: OTH
JOB DESCRIPTION : CHANGE FACES ON TWO (2) SIGNS SQ FT:
CLAIM VALUE; 2,000,00 CALC—VALUE; 2,000,00 GROUP OCC: B-2 /
COMMENTS; "ALBERTO'S MEXICAN FOOD"/FROM "RALLY'S",
�t*+t�t*�t**�t*��r�r�r*�t�r�r*�r�*�*�t+t�t*�t��r*�**�t�t+t�t�t���r�r**+t*�r�r�r�r�r�t�t*+�***�r*�*�r�t+r+��r****�r*+t+t*�t
S I G N Z N F O R M A T I O N
DISTRICT; 1 TYPE: WALL ILLUMINATION: INT CATEGORY; CHA
DIMENSIONS; 6FT 02IN X 8FT 02IN AREA: SO,OOSOFT LETTER HT; 12
STREET FRONTAGE 1; 145,50 STREET 1; W 19TH ST
STREET FRONTAGE 2; 127.00 STREET 2; PLACENTIA AV
PARCEL: 42919112 20NE: C1 LOCATION > FRONT: REAR:
BUSINESS NAME: ALBERTO'S MERICAN FOOD > LEFT: X RIGHT: '
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY . SO,OOS FT OVERALL HEIGHT: OFT OIN
THIS SITE SO.00S�FT GROUND CLEARANCE; OFT OIN
ITEMS OF INFO � S PLANTER AREA; O.00SQFT
ITEMS FOR ACTIVITY; 5 HLDG SET BACK; 20FT
COPY VERBIAGE : ALBERTO'S MEXICAN FOOD
OPEN 24 HOURS
PLANNING NOTES: -
�*�r�t***+e*�t+t�+t*�t*�r*�t*���***�r*��t�t�t�trt�r*���t���t''' �r* ,; *+r****�r**+t*�r�****x��rrt�r*
D E V E L O P M E N T S E�I V .o-.. I R E M E N T S
ZONING APPROVED BY ,
BUILDING APPROVED bY :
APPLICATION ZSSUED BY:�
, k1FklfkitiFiEitkifiFllkkififilltitlFk
LEGALIZATION;N /
BLDG PMT PLUMBING
PERMIT 45.00
PLAN 29,25
ISSUE FEE
M
� DATE: ��,/f/
�]` DATE: ,��
� DATE� �
�r�t�r**it+r �t�
STRUCTORAL SEGMENT;Y
SIGN SMIP/RES GRADING
10,00
SMIP/NON�—RES
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 55.50 0,00 29,25 84,75 69,75 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 84,75 OVER/SHORT: 00
HLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
95.00 50.00 .SO 29,25
k it k if If iE k �E ih if if if iF IE k if iF if if iE if k it iE iF k iE iF if iE iE if i! iE if k ik if fE ik iE ik if k iF �f �f iF if if if k iF if 1E if iF �E �f k iE k iE if if iE iF iE ik IF if 1E k M k if If if iF
I N D I V I D U A L F E E B R E A K D O W N
TYPE (JTY D E S C R I P T I O N UNIT COST TOTAL COST
NO FEES WERE SELECTED FOR THIS PERMZT
01 QOG4f94:Z-�_.^�?iS4i � _�T c.,;:•
.ATc: ��'I<"!"? T`_F:E' uG:;S
CONSTRUCTION AND PLANNING � POl . SPA
Date Inspector � Date Inspector
APPR�OVALS Permit # - , � APPROVALS Permit #
,i
1. Temporary Electrical ServiCE or.Pole �: 52. Pool & Equipment Location �1.
-s ,
2. Soil Pipe-Undrgrnd. .�-�+' �, �� T V 53. Steel Reinforcement ��'
3,, Elecjiical Conduit U2ility-UnBigmd?� '� � 54. Forms �-
`"4.:EIecVical Condy.it=Updrgrnd.� � 55. Electrical Bonding
'�b` Sfeel�Reinforcem'eht - 56. Rough Plumbing & Pressure Test ��
��I: a:1:: ��.
,L 6:��Electrica� UFE�6rnd. -` 57. APPROVAL TO COVER�GUNITE '1
�c
"'7. Footings �-•� �� 58. Electrical Cqnduit�Undrgrnd. c.
j 8. Fduridation S ' �� 59. Gas Pipe, O Undrgrnd., Test �� �
9. Waler Pipe•Undrgrnd. �j '�a 60. Backwash Lines, P�Trap, O Undrgmd. �!
10. Siructural Floor Svstem ��a " � 61. APPROVAL TO DECK � Y
,:.,.
F' i
11. Property Sewer Line & Hops�IConr(ection i: 62. Backwash & Recepror•Final
, �.: 1•
12. SewH Cap '� - � � �� 63. Heater & Vent•Final � �
-, �
i�
13. Roof Drains V� �� - 64. Plumbing System - Final /� �; ''
14. Rough Plumbing -' ,•},� '� �?,,� 65. Electrical-Final ����
15. Rough Electric`dL-Conduit ,% 66. Solar System-Final r�
16. Rough Electric'Wving 67. Fencing & Access Approval
17. Rough Wiring Sig'r,i 68. APPROVED FOR PLASTERING
18. Rough ElectricaL-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditionin9 FIRE DEPT. REnUIREMENT
20. �Rou b Factor F,�ce lace. � � V �� � • - L � � �L � ��
g y p APP.AOVALS �- Permit.�
�7,. � - - �. ���.r - _ .
;, r ,; - .
21. ,Duc'ts, in Struceur'.e:. - r •�" � t, ` 70.�O�d�'er round H �� r ° �
0.`:.^ T'e. l� 1 7n: _ \ 9 YCI[O �� �
22.-Ducti, �(entiiating : ;�� � ' - � �"•�- : < �• �� �7�-:product Piping O'Gas' ❑O)t ^
c ` �,^:^•L'z- r11 R J - 1+ �:, - ..
23.'�Gas Pipe�Rough &'Test " � � � _ , t s. 72;-"l�nc�erground Flusl,i , - _
24.^Roo� Framing -, . y ;� ^ ^ ^ .. ; % -r/3 JUndergmd. StoragB:Tank OGas 40i1
r �• �
25. Roof Sfi,athing z;^ ;,�-, , ' ' - `• ��74: �Qve`rhead Hydro � �- F
26. �T-Bar Ceiting (Str'uctural�;'� Monocoaf �75c �Dry Chemical �• s ^
27. Frameand Flashin � , '-� • "' - ' -
~t : 9a ����� ..��� :� �., 7 �76.i4ry StandpiPe' u ; � L � . �:
28.` Wthing & S�¢ing?,� :,�� • � � � �. vt - , a' •- .•77.� fIXED�SYSTEM FINAC=� = � i
'29. Insulation �= '•' �` - - f,r� ~�,� �-" � " �' ��qB�IRE R�,tEV. FINAL „� �,.
� 30. Orywall-Nailing S�� � .�o �u��o"% V J � � !; �%rf;/' � ,+HEALTH DEPT. REQUIREMENT ��
"31. Platter Brown CoaF k ^ '' ' � "� � `��' ..' � � %79aj.�If��4L�INSPECTIpNJ y '
' ni .. ,r � -n,, . _ n ... . . �r
� 32.-Electrical Power p7le.terFir�l ,- �, ; p; `•j 80:;,'F'AOD CERTIFICATE ISSUED . x
, 33. Final Electric = + -- ;.�° � ;n I Notesi�` "' , _ j�; ' .
� �r. . �
.• .. . . , u , ;,p i . _ .r;
�34.� Final He�tings& F:irnConditioning j J � � ., r _ . ,> -�
� 35.�.'Final Gas Pipe-TeTi' � � S C +. � ' � 1> , . . ^�+ ? �
9 R' � fi
.36. -Hood o�,CanoPY_ r � �f, `i v h.-. . l. 5 A �q.,� .� } � pt �i.
R; r I; � (lc f .M _
37._�Final Factory Fire"pta�e ;,'�.� r � ' { �„�'��� r _ 't_'
; . . -
,38.: Final PI'umbing _ ,. .S�y-.l� ��- ��. � °J i ' S�`��' .� - } „
'.r `.
_39.�VJater Service�Fi�al. • � -'>. � 'v � :' �{ � , r.;ti� r �r �L
n c� - - �.� .:u•ir - .f�l... I "T.r��- q � _
'_'40. ,GarService-Elnal `,� - � ;; . .• r' 4:. .,, ( ' ,.=i- ` "_ �,� , �,' , .
- .�t
, 41: Sola� DomesticFinal ` �� � _ - � �. : ^ � � i �� � , �"! - - r
^� r ��r,t. ) % ti �]•- - j' "t 'J.
42. BackflowPreventer; `� P'� ��`�=�"�' •:_:�r� o . � _ , r.
. .,,: ,���; �o- . 4, .�_ �,
43. Backftow Irr'�gationt � � y G. � �4 ,' - % -•� - � ' -
�11. 'i• i" '� 4 l� i..
,�44. Landsca e Itri ati ' S \ie'm- � • �j. ' - - v . � � . �+•
P 9 � Ys . �i..... a 7*' �r �Y 'J 7 �-
'45 ��Sound Atte4uatiorr •2 ✓,�1C c �� r�' � � ' � '���; •
.� ..� . � ��� � .� - -
�46. HandicaP.Regulations ';". "`..''" �' " .. ..� � . ' . -
� ,r . � �, 7i'
47. FIPfQL STRUCTUF�E &�BUILDING � � +� i'� .,� � �;f�. . .�i � . . ;
..i i� �. . s . '
`A8.,"FINAL PLANNINC�i; • �"��:,; y .J ��; ' ;rl� ,e ,�, :�'. 4 ^ -
�.
�49.: Electric Release to Edison ���� ; �� ; � ���r. i u � i '
50. Gas�Release to Sou[,hem California Gas Co � �� �� p I_'. , .�.��.�� �
51. CERTIFICATE OF'OCCUPANCY ; � , �� '.? � .
No. Date
ADP���ant to flll In all soaees except those wlthln heavy bortler Ilnez anC sign all approv��ate tleelarations.
I PERMIT NO. TRACT NO. LOT NO. UNIT NO. A P
CI7Y oF COSTA MESA CONSTRUCTION PERM T
Project AddreSs �B� � !9 T'� .�%
ApplicaAt's Nlailing Addreu ��� � � �/����/1GIEJW'Ti/ �• �
Owner's Napme,, �Q{_�� � O�� C� • Phone
Address !�h_`� 484j' �N'9k'/�`'M �a. 9a�s
Arch/Eng. License No.
Address /
Convactor'sNam NE N pho��p7'ad1L-!}3S2
Address (mailingl�0/ �! (�w2Mp,1)�.lE77�craL �iCAJA �Y2/�
Ciry License No. �l Z� � �
LICENSED GONTRACTOR DECLARATION
I hereby af/irm t�at I am licensetl untler provisions of Charler 9(commencing
witn Seclion ]000) oi Divislon 3 of tho Buslness antl Professions Cotla, antl
my Iicense is in tull forc � tl ef(e<t.
License CI ss —Licens �O
Date / /� � Si9ndtu/G
A IRKERS' COMPENSATION D CLARATIO I
�ere0y aifi�m that 1 have a cerlitiwta oi con nt to self-insurE,a a certificate
uf Workers' Compensation Insurance, or a cer0fietl copy tnereof.(Settlon
3800, Lab. C.)
� vou�r rvo �5-7i� 7� 9-8� comaa�v T� �
� �Certitietl copy is hereby furnishetl.
CerUf tl-co y is IIeO wilh the tlty iltlin ivisi p.
�Date�� APPlicant
EXEiG»Pi'ION ROM WORKERS' MPENSATI� DECLARAT
(This section neetl not be completetl It the Oermit iz for one nuntlr E100) or
IC55).
I c¢rtity Ihat in Ih2 Perto�manc0 Of tne wo�k for whi<h this pe�m�t Is iSSu¢tl I
shall no[ employ any person in any manner so as to become subject to t�e
Workers' Compenzatlon Laws o( California.
Date Si9nature
NOTICE: H, atter making this tleclaration, you shoultl become subject to the
Workers' Compensation provisions o( Ihe Labor Cotle, you must forthwith
comply with such provisions or [his permit shall be tleemetl revoketl.
` CONSTRUCTION LENOING AGENCV
I horeby atilrm tnai there is a construction lenain9 agency for the performance
of the work for which tnis permit is Issuetl (Section 3097 Civ. C.)
Lentler's Name
�enCer's Atlaress .
OWNER BUILDER DECLA0.ATION
I hereby atiirm lhat I am exempt from the Contractor'z license Law for lhe
tollowing reason (Section ]031.5 Business antl Protes5ional Cotle: AnY Nty or
county which requires a Permit lo construct, alter, improve, Gemolish or repair
any struciur¢, prlor to its issuance, also requires tne applicant for such permit
� file a si9netl statement thd[ he/she is Iicensetl pursudnt to tb¢ prONSIonS of
� Contrac[or's License Law (Chapter 9(commencin9 with Sec[ion 700D) of
iision 3 of the Businesz antl Professions Cotle) or that he/she ls exempt �
� .,�erefrom antl the basis for [he allegetl ezemption. Any violatlon of Sactlon
7031.5 by any applicant for a permit zubjects tne apP��canl to a Gvil
� enalty of not more than five huntlretl tlollars (E500).
� I, as owner of Ihe p�o0erty or my employees with wages as thelr sole
compensation, will tlo tne work, antl the structure is not intentletl or offeretl
for sale (Section 7044, Buziness antl Professional Cotle: The Contractor'S
+.�c¢nse law tloes not apply to an owner of a property wno builtlz or improves
[hereOn, antl who tloes such wo�k hlTselt/he�seli or [hrough hf5 ot her own
} employ¢e5, ptovitletl that Such imprOvem¢nts ar¢ not inte0tletl o� o((Bretl for
sale. If, however, the builtling or improvement is soltl within one year of com-
� pletlon, the owner will have the burtlen of proving he/she tlitl not builtl or im-
�1rove lor the purpose ot sale).
I, LI I, a5 Owner Ot tbe prope�ty, am exclu5ively cOnVactin9 N'�th Ilcen50tl cOn-
Iracto6 to con5tfuct tM1e D�oj¢C[ ($CCNOn ]064, Busine55 antl PrOtesslont Cotle:
'The Contractor's LicenSe Law dOes nOt apply to an owner of prOperty who
' builEs or imoroves tnereon. antl who mn[racls tor such oroiacts with a con-
tractor(tl Lcense pursuanc to me ConVactor•s License Law). I am aware tbat
prOot of tneir Worker's Companwtion Insurance shoultl be provitletl to me.
❑ I am exempt unaer Section B. & P. C. for this reason
Date
Drivers' Llcensa or 55 $
Owner _
have reatl th
upon
n antl stata that the above
city antl tounty ortlinances
antl her¢by authoriia repre-
ve-mentinnen or�oertv for
E3 6 $
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPA1 R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
�E CR��IPTION O W0��4C+• �
��WJ f�� � �� f" i�1�.r�
TYPEOFPERMIT GRA�ING FOUNDATION STRUCTVRAL
❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
'PROJ�CT DESCRIPTION 5�. FT. OCCUPANCV
CONSTRVCTION TVPE VALUATION $
ZONE GRADING CV. VDS. ACRES
Remarki:
Sink
Preventer
Irrigation
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust5ystem ❑ Multiple❑
Firepl/Fact. Blt. ICBO �k
Heating System & Ducting
❑0.100,0008TU �100,OOOBTI
Reinspection Fee � $15
�
0865-46, rev. 5/88 Wnite - Builtlin9: Canary - APPlicant; Pink - Accounting; GOICenrotl - Assessor
Showers
Servite Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
..�
5 Main Buildi
E
T F�ont
B Rear
A
C Right
K
g Left
Ping. Ref. #
Plannina Notes:
FEES Automatic Washer
Construction Pole S�
Coaking Unit
Dishwasher
Dryers ❑Gas ❑EI
Fan
F,A,U.
Fixtures
Device Boxes
,Z Outlet5 �
Switches
Garbage Dispoul
Generator OP5 KW
Fee
zo�a
Accessory Building:
Parking Req./Provided
ELECTRICAI
Transformer ❑ 75�50KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
ic Sub Panel
Motors �41 HP � 1'f, - 8
Inc. Soiar �9-75 HP 016-15+
Microwave
Pole Light
Range
Stending Sections
5 KW Trash Compactor
$15 Issue Fee
$ 3 DEVELOPMENTSERVICESRE�UIREMENTS:
2oning Approved By
FEES Building APP/ovad By
Appliistion Issued By
OF
- BUILDING PERMIT $ SMIP $
Iefrigeration5ystem PLANCHECK $ PERMIT -
�OO,OOOBTU ❑100,OOOBTU PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENEqGV P.C. $
iystem Repair/Alteration GRADING $
ELECTRICAL $ 2'%r1S��
FireDampers PLANCHECK 50% $ MICROFILM $
Registers MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
Issue Fee � $ 3
O 1 Q00? 18U5-00021805 T� T
UATE: 12/12/88 TIFSE: 09:40
N
I
N
G
R
E
Q
M
T
S.
FEES
32.rS
. . . ,` '{ \.. _� .. � . . . .
CONSTRUCTION AND PLANNING . P� & SPA ;
APPROVALS Permit# DateL� Inspector qppROVALS Permit# Date Inspector
+ -
1. TJmpo�ary Electrical Service or Pole� �_ �� 52. Pool & Equipment Location ,•1
��
2. �oil Pipe=Undrgrnd. .. � 53. Steel Reinforcement i•
3.�lectri'cal�Conduit:Utility-Undrgrnd. ✓ e' 54. Forms
< < n
4�Electrical Conduii-Undrgrnd. �� i 55. Electrical Bonding ,�
� :_
�`��+Steel.Reinforcement, � r� 56. Rough Plumbing & Pressure Test �
.,i,. _.n n
v`•
6•�Electr,icalUFER.Grnii. ' ,� 57. APPROVALTOCOVER-GUNITE
. n i: .
7�,Footings• '� � �� �-�i 58. Electrical Conduit-Undrgrnd. '
8ti Foundation �� l' ��� ,F � 59. Gas Pipe, O Undrgmd., Test � a'
' A IJI
9.�Water Pipe-Undrgrnd.. � ;, • 60. Backwash Lines, P-Trap, � Undrgrnd.
10! Structural Floor System /• � �' .� 61. APPROVAL TO DECK �
11. Prriperty'Sewer Line & House Connection ��, ,� 62. Backwash & ReceptorFinal
.�
12. Sewer Cap � S Q-�'. '� �: ;.;
63. Heater & Vent-Final
13. Rodf D�ains ✓�, �; ,v � (/ 64. Plumbing System - Final -
14. Rough Plumbing �= � 65. Electrical-Final .
75. Rough Electrica�-Conduit 66. Solar System-Final
16:, Rough Electric Wiring 67. Fencing & Access Approval
�i �
17.� Rough N%iring Sign 68. APPROVED FOR PLASTERING
I�J
i8...Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
. �.
19: Rough Heating,& Air Conditioning FIRE DEPT. REQUIREMENT
2Q.•Rough Facto�y Fireplace APPROVALS Permit#
21: Ducts, in�.Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe:Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
:.
25. Roof Sheathing 74. Overhead Hydro �
26. T-Bar),Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme�and Flashing 76. Dry Standpipe
28. Lathing"&�Siding 77. FIXED SYSTEM FINAL
.,
29. Insula iori 78. FIRE PREV. FINAL
V'' � HEALTH DEPT. REQUIREMENT
30. Drywa�l Nailing
31. Plastei),Brown Coat 79. FINAL INSPECTION
32. Electrical'Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
/-/? l/eo�U�S
34. Final Heating & Air Conditioning � ,� ' `
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final .
40. Gas Service-Final
41. Solar pomestic-Final � ; '
42. Backflow Preventer -i , � •
43. Backflow Irrigation • •
44. �Landscape Irrigation System . �
45. Sound Attenuation • �
�
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING �� �
48. Special Requirements Completed ,
49. Electric Release to Edison "" •
�
50. Ga; Release to Southern California Gas Co " '
51. CERTIFICATE OF OCCUPANCY "� , - . ",
No. Date �, ' � .
• os esa u�c�n►g �epartment rJ6S
�� 771 EAST 20th STREET ��
_ �:; .. .
i�, COSTA MESA, CALIFORNIA
�� FOR APPLICANT TO FILL IN
Bufiding � � /J �
Addreu ' � � — 7 '
Costa Mesa, California
Nearest p� '1
Cross SL %� � E/� fi� �t I
+dre5s
Address
M etea
�.
Rooms
� Roof
Addition �
Demolish
I hereby acknowledgB that I have read this Application
and sta[e that the above is correct and agree to comply
with all City Ordinances and State I.aws regulating
building construction. 1
Signatureof � /
Permittee \,
�
Authorized Agt.
$aluat�y / � plan Check $ /
/
Y� Total �
Fee $ � G
wu �na r,-w �r n-na
APPLlUATlUN 1�'Ul{� YL�'KMl't'
BUILD,LNG 7
FOIL OFFICE USE ONLY
I_ Riceipt No. I Perm(t No.
_ Z rj a� � .S s��
:eived by Date Rec'd. Date Issued
� y � �-s-�
Address
Cross St.
Zon� _ /
k'Cl"I_�v-
Costa Mesa, Cali
CORRECTIONS
APPROVALS
Foundadon Loeation I Inspeetor
Forms, Materlals,
Under-Pinning
Frame: Fire Stops,
Ext.
:r. Int.
Bond Beam
FINAL
Date
/
• , -, .. . _ . . ,� .,
� �•
. , ;:� ..
.. :b �
- -n-
. °, . �_ �.: _.,
. . �. ,
Show loeatlon and distancce�irem'���
i
� property Iina and�tietween buitdings
,�)J'i1i�� t'.il'�"
C.-
0
'• 'osta Me"sa Building Department r�s APPLICATION FOdt PERMIT
, /:', 111 EAST 20th STREET �- B U I L D�� N G '
. � COSTA MESA, CALIFORNIA �
iOPM 204 G-X 2M 8-54
. . - � � ? ' - � - � '�'. �
. � > �-.
� - , , . - .. ��„ .
. � . .. ,- _ w '
,I
�. , " 1 ' ,
r :
- i7
C
.�. ' ' "_ '_ .' _' _ , - -_ ...
.: n ' _ .
. �-- . :[I: . '� . .
'.� ' , r-.. ......
�_ .
�� . _
-. P�jLOT PLAN - - - ; = . � - -; .. . : . . . _. ---
� 3how loqatid��arid�distarices�iro r��� ' -�. . . 'r'� . � �, :
QI � �_�.;�„ t ql � i
� property Iine and between bulldinga ' • , . . . -'.i .; ' ' {
, ��.
' . . . __ . . . . ._ � � . . � - _�.,. . il
. ` __. ..?,,. . . . . . . ,� , - . ... ._
. ' �
, �
, i
rc' ,.. v
' . i
r� .. ..
- �r ._
, Costa Mesa Building Department
• '- ' 111 EAST 20th STREET
�' . ,' COSTA ME&A� CALIFORNIA �.y
FOR APPLICANT TO FILL IN
Bullding /� �
Addrese 'y
Costa Mesa, California
Owner .[��� � (�/[,� L
Mail
Address ��S ,��/,�
, P Tel.
City No.
Arohitect or Lic.
Engineer No.
Idress
c�c�
Contractor � �,qNS r � No.
Address
De er ptlon I No. sQg �� Block
(Attach Metes and Bounda) � � �:
����' �� I No. of BI
Size of Lot Now on I
Use of C No. of
Existing Bldg. J, �. I Familles
Setback Line from i Rear V�
Center of Street /�iX . Sida Ye
�Movino 1 I Demolish
e
:erior Walt
APPLICATION FOR PERMIT 's'�
4�46 BUILD�tNG �
� FOR OFF`ICE USE ONLY I
� � Recelpt No. � Permit No.
Costa Mesa, California
CORRECTIONS
•v oF cosTn r.:Es�a
PLA�r+iFdG U.'"-.PT.
BA
APPROVALS
Building � rounaauon wcacwn
Forms, Materials,
j Under-Plnning
� `p Frame: Fire Stops,
Bracing, Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to rnmply Lath. Inl.
with all City Ordinances and State I.aws regulating
building constructton. Lath. Ext.
8ignatureof
Permittee �- Plaster, Int
Authorized Agt. plaster, EM.
Valuallon Permit Fee $ �p — Masonry Reinforoed
m' Plan Check $ '� gond Beam
$ D Total
Fee $ � � FINAL
� FORM 204 S-BP ZM 8-55 !
0
Y
C N
J - �
_a -� ... ...: �' �
` a ,
. a. ... _- - — -� � -�- `-� a` � :,
' '�_ .
Street -
� I
_ " _ r��Y r�V
- Show location and distances from
u
� property Iine and between bulldinga �
u
A--_ - __ _ • . � _
" _ ... �_. � �� . _ __i._{.�.
. i ��I: .
.� �'... -
c_S • ' �
c�
3E'!
o .
ro .
ro
t3 .
t .
_ ,�� .t� ,. .. .
.. _ � . �. 1 . ' . `�.• ' �..� ,
. . - . � � , . ._ .��
_ - -- '� -J= "-`—^�- �.�`-- .�..
. . . . . LT—� �.�,L� .r. � � . . . .
` _ � I• } '
- _ _ .. . \. �f ,� '. - . . .
_ . ' ' ". "" _ "_ _ ; ,'
�BJ ,5��' ��}.'.\�:.�u J !_s���Ji\ ''. _ .
�• _• `.. .. . � .. i� � , `.J � 1 r— _'_ \;`, ``
-' . '�
. � . . .. i v ._ . ' . .
. � . ! . . . ' ' ' .
Lfu.,.. .._'L. ��— � .. � . �
a. .. .
.�•�� _ l;l.'; ' - . � � - ' " "' '
� ']�. �:. . �' . . .' '
`� . ___
i „ .�`��.. . .
'r _.. ,. � , ' '
t- >` . �_ . �1 . -
. . . -- - �.t �.. • . - . . .
; , i , . � _ '
:� , . . ,
_.. , .�� %_ .... . .
_ , . ..
`` - ,' _ . -
� -
— �� _ .:.iti.�4 � . . �
'� •
_ - �— �
J t. � 4'� �����f All?Applications Must Be Filled Out By Applic�
a��"�' �s�� �`"Department of Buildings A�
: -�. �,,..�.�,�� ��. .
�1 �'� �� �APPLICATION FOR THE ERECTION OF SIGN$
To the Building Official of the City of Costa Mesa, Calif.:
6465
No.—
Application is hereby made for the erection ❑ alteration ❑ removal!❑ of an�advertising-structure
in accorda tj�n �� in set forth. (Check sauare what is to be done).
����`�' � (Use Ink or Indelible Pencil) . , - �. �
C�IDE-•R�-�L�R EAR -�-�C TION- � - - -���,/ — - -
Building Addreas /
- G f $locl�_�__�aCt�[�' . . No. ��� — O 3 c — / � Zone�
Uwner's
Contractor's
Contractor's
:[�Ifi
II
�
Owner's Address� � -��-n-+,'-,� a%�"'P ,�
State License No. ' ' �
Phone��,'� � ��° City License
• DESCRIPTION OF SIGN � � ' .
i
(Sketch showing location of proposed sign on back side of this sheet. Plans and'other data �
be filed.) �� i ,
Size of` Sign—WidilL(.--ft. Heigh��t. Height above Grade�
i
Thicknes �� ~'n. W gh� a lbs. (Including Electrical Transformers, etc.)
State location
- �ts thereto. � 0
APPLICATTn�?��T^ ^^
r
OR UP� ���N��A'le�l���
v�� Q
CITY Oi=1C! �5TA M, �
PLah�i��;iG_ cY: ._
SUBJEC7 Tp BLDG. �F�'�• RE�
� ��� ..
� , • � �
BY �- .� T �
�J� ' $ 2 , d� c, �
Date ec FEE
2 % 5 $'�
FORM 2I4 1M 1�57
,; , . : _ � '
to.construct the advertising structure in strict acco'rdance with p�t'e
ion 39~ o�f�the Electrical Ordinance of Costa Mesa,�and•alI^ameitH-
P {r .• � '�' '
, i �.�eca�a 3»a0'c►� �eo I79G�j `, �
OUT BY THE APPLICANT. INSPECTION MUST BE CALLED
� (
i
p �J���� ,
ign Here ��-L�✓i /'`'y''.."—�1*
_. . ;. � �
� `$y�. .• �. C/'+
DEPARTMENT USE ONLY �
� ans G'hecked, ¢� �; A' � peyrmi 1_ o�l
� � �
rirn � 2 z 7�� 6' "•�6. :.
�Date I ued
Plan Examiner '4-/ Z -7��
(over)
� . �.._ __ , �,�: . 1
� , . , _ - �,� ��� ���c;u�'L. ��`_�`� ; 3
X • FILi. IN ALL DIIv�iQSIONS
�„ .-,...,.._.,.�,
� �5 SHOW AI:L'..STRUCTURAL MEMBERS
�. . •- � - - - - - �- . . � � -- 1 �n ��l
�
u
�� :, . .: � T
FOR SELF=SUPPORTING SIGNS. 5 1 L- N.
Size and Location '� �;� di ��rq? f
Section 7 of Ordinance No. 95'-' '�' ' �.; —.I�
�i_.. !� ;?- �t'z��J�
,: .. � , .
-- -� - �=- - ; `' �., . � . .
a , . �' 1 � � � � � ` , Sec. 6 of Ordinance No. 95 � �
n � . � ,
' . . .. . � . . � . ' . � �' � . .
'\ ..
' E �4l�idth of' , � _ . t � .
', :\ _. C/L '' . . ' . .
. � i {tE
. _ ' ! . . „x�.0 . � ew..�
,�� 1� SiAn Area - wurr,..e.r... aw
��: tl ij �
t +1 :� �, - . _ _ _ . ; . . t ` ! �r,.r' � y '
i4
", E ' � � �� i �m c�o�o� — � , , �+ ' _ .
v!— � . , � �/L oE Lot ' i . ' � �/ � � . ,� �1
. . ; y, y � ,, v
/� �f1[IL OF I � (3AC1( L/Nt� n
. .. ._ � - �_ , _ . r
' d - --
� �4 .. '�
_,_ . � • , , I .. • ` �
Property .�/ ,
— ♦ ` � '' �' = ' `, _ J � _ - _ ' Llne _ .
v ,� ,� .
,
- !/ �' /��nt- ot �� ;
/O Y/U H '�SCRry. _ ` S � .
I ' � . - . ��� —_�-' � ,
. STREET HIGHWAY ' ' �'� -^. . - . �-�. \ � .� , ,
. j �; '. � ,',l'_ 3 � � ' ' '`
, ,, , _ ;
,; -.
- ', �
_ . . � _ __ _ . . _ - ' ' 4t.i
; .�
� �. 1.��ai0
,� .
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPL/CANT TO f/[L /N COMPLETfLY
TYPE OR PRINT
BUILDING f) � ' I
ADDRE55 L� A
COSTA MESA. CALIFORNIA
OWNER Sl,� f I a I I i�d ,
■! ITECT A/. / / LIC.
L
LEGwL ILOT I
OESCRIPTION NO. 1
'd - .'
A.P. NO.
SIZE � �
OF LOT � �i
E%ST�ING BLDG. �� ��1�
SETBACK LINE PHOM
r�� �EC�����
� ��-�7-5�
APPLICATIONNF�OR EPERMIT
�BUI�LFDING4 MESR
fOR OFF/CE USE ONLY
I HECHIPT NO. I PEIiMIT NO.
APPROVED
BY
DESCRIPTION OF WORK
ftEAR
N. I II ALTERATION I II ADDITION I
REPAIR I II MOVING I II DEMOLISH I
BUILDING NO.OF
SIZE ROOMS STORIES
EXTEftIOR WALL IROOF
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORME�
•M t'/", �, I� .O F.� � �t �. I
1 HEREBY ACKNOWIfiDGE THAT I XAVE N6AO THI9 APPLIGI�TIOrv
ANO STAT6 THAT TNE ABOVE 19 CORHECT AND ROREE TO COM-
PLY WITN M1LL CITY ORDIN�NCES /ND STATE LAWB REOIILATING
BOILUING CON6TRUCTION.
SIGNATURE OF��/� �� � ,� �
PERMITTEE 1. a-� �=
AUTHORIZED AGENT
! owTE RECEIVED DA fi 189UED
�a ;�7-3 D a�:
(v/ �.,/./9���7`•
COSTA MESA, CALIFORNIA
ZONING
NO.OP U8E OF NEW
PLANS BUILO�NO
/ DATE
EVES
ALLOWED
THE AMOUNT BNOWN UNOER VALUATION 19 FOR THE
PUPPOBE OF EBT�BLIBNING A PERMIT FEE ONLY.
VALUATION /
/ v� O � PERMIT FEE S p.7 �
/
$ PLAN CHECK $
TOTAL FEE 5 JO� f
V
' `� �,. 28922
' COSTA MESA BUILDING-SAFETY DEPARiMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA BZ6Y6
For Appllmn} ro Fill In Completoly
TYPE OR PRINT
COSTA MESA. CALIFORNIA
i�r LG �� G CO
� //4!_ iC�.IQO�.�,ti
� 6 F
• �'• �uX Tu.ii Ho 0 3 :
�/ E• �✓s .sl fj�. �
uc No. ��j� qL N6L.cnBG-O3 L�
OFLOT/��•�O� k /SD. � n°o'w°Qe ai�' /
USE OF /�
EXISTINOBLDO.J�'�v�CC -S��P�
G6T�ACR 41X[ �ROY �
DESCRIPTION OF WORK
WALL
1 X8R6lY ACKNOWL6p06 iMAT 1 NAVC RfAD THt/ APPLIGTION
AND BTATB THAT TN{ AGOV[ IY CORR6R�AND AORBt M COM.
PLY WITN ALL CITY OR NCY ANO LAWY qWY TINO
BIlILO1H0 CON6iRU
a�e�:.A�Re � !�'�l/✓T'" - .
AVTHORIZiD AQtNT
SEP 12-68cn;p00 342�' ,:;�"�1:.51.
�
APPLICATION FOR PERMIT �
BUILDING ^
for Offlm Use Only
11[curt no. �nMAtfo.- �
NO.O� YY[
_ � ru�n� L, eu�i
� , ) ,.� .
. O �
'6-oz�_ i� b ,�,.«1 . �
YARDtAPPROV60 YAROBAPPROVfiD \
MAINBUILDINO ACCEiBORYBUILDIN6 a
fFROMGLYi'R6R1 CANO �
PRONT �Z- PT. '
R.DIDL rrl �. ° . is �-�-$ ���
�. o�o �U.�. .r.
W.(i' tl
�
RGR 4�7� S�. �. a
-J
DIYTANC[![T: BBT. MAIN Q y�
MAIN BLD f.+ ACCFBD.BLD09.
VM.S� DATB t ,
e. u. v. - 6 APPROVHD �/`` V
APPROV �
OY � oAT6 '� —Ei �'
a �
� O
� �
O
/3G6 eo.Rr. � _
TN6 I�NOUHT 6XOWM I�NOHH VALY�TON �9 FOR TX8 j
�YRPol6 OP iBTAGLI8XIN0 A P6RMIT P88 ONL�. �.a
yALUATION �
� PERMITPEH ��� p
__� 0
i �Z'o �e . �i W
// / DD TOTAL FEH / I✓ D
. r� . • -�- , . .1. , . . : ..� - ' - � ' .. '
, ' . � . . � •;� v�tl O. . � r:I `�� . :- ! � 1 '1 . ,
� N � e � �1 y. . � > ' � , � '` �
e � V � 1. I . .
� � 1G � �) ±. � 1�i -i yl � ��'l� �� �. � � _ . :
�' . � � � t* -� � I� ���'.� ! 2 S n�: L.I � � � J Oi ' .� .'� � � J . •. .
� � ' � �� 1 �� t � . . . � .
�'% ' . . i
. � � ' '1 rl �� if� � . • �1 ' � 1 � '.i
� ��' � ; i l � i �?��� �� i i : � � ��i� �' ' � . � � i � �,: � . •.
� � ,. �� � 1 I.�I � i I"`_� � � � I. ,
y � . 1 � ! l I ,) �•� : i �� �� I • l� �I� ; `�, '-' , j �
! �—,`'j-- I -.'�"i � -�_� L� � _�._E_�� �t' � :1�' � :� ---�- � }� � ' .
' 1. so p ter /gh be ' 1,a11 etrre e ea 1.y ur is ds d
i!j si e� -, the�p�iva 'sl d e' o a 'u ed i a este y direction o � ,\
y o d th ]. er �
�,�2. No po table sto age structures shall be consLructed.
3• All signs sha11 be constructed by permit. �
4. All vending mechines and merchandise shaL1 be contained inside.of the building. I ,
i 5. No rtaLis, posts� accessory structures, rental trailers, stora;e or other devices
� shall be placed in the open lo� 2rea -= and that it be kept clear to provide I'
i traf£ic circulation through the shoppino center parkin� lot.
, 6. A1]. trash containers, d�psters and empty drums sha11 be contained in a �
; screened area.
7. Sidewalks shall be constructed of Portland Cement Concrete per City of Coeta I' .
b�sa standard plans.
8. Concrete driveti�ay approaches sha.11 be constructed of Por�lznd Ca-nent Concrete �
from the curb to the property line, per City o£ Costa b12sa standard plans. '�,
i 9. biust meet all specifications of the Uni£orm Fire Cale. r
I�.0. Provide extin�uishers as required by the Fire Aepartment. ��` �
� a.l.. P.L1 flammable liauid stora.ge to be inspected, approved, and permit issued under I ;
� the Uniforei Fire Cale. f
72. Copy of blueprint as built to be submitted for Fire D2partment records. �,
.�3. Advance cost to install nerr ornasnental steel street light (�118.50) and i;. `.
iadvance energy charge (�52•50) at south property line on P12centia. Total i ,
amount required: .$171.00.
7.�. Tree planting, in parkway, comp2tible tirith surrounding area under the direction ��
of the Street Superintendent. One 15 gatl.on tree to be planted in planter
� ' (due to 4' walkway). on W., lyth Street. I�'� {'' f
—�T � ' I I � � T��^ � �'� . . 1 .��— - ��J i�F J
i �'': . 1 � �-- �
1 1 f .t
' . �`'� i � .I i r i � b: Z�'iO_i ' �i _ � ' � - '. � � i ..I / � �� f�.
. . ..tl�}� ^ � � ' �I � r'I �I� ( t _ � j 1 � ! � I .
� , _ . ' . . '. . . .: - ' ' ,. . . ' " ' . _' _ _. _ v _ _ "" _" . . .. < ...- � xrIN._ ^a' r-.�^ •
• •�' . S �� � , � '. �
.'. �q I 22
•COSTA MESA BUILDINGSAFEfI' DEPARTMEPR
P.O. BOX 720! C08TA ME9A� CALIFORNIA 9Y62!
For App11mM fo FJO In ComplsNly
TYPE OR PRINT
IUILDINO �
,o R� Ro f LL��"
GOSTA MESA, CALIFORNIA
Fd HI2N
L
!� Cf �•L�N
NT• � •
"h1 S
- C_. �1.
7 +�
xo. or e�oo�.
NOW oN tOT
/ e �1 r- i
DESCRIPTION OF WORK
WALL
�1 N611[GY ACKNOWL[DOi TIAT.1 MAVR
AND OTAT[ TMAT iN� AGOV[,l0 pl
PLY W�TM ALL Y A �
eYILO�MG _ _ CT10 .
� AUTNORIZ[D AO[NT
�
AP►4G�ION
R6i M COY.
SEP 17-68PA1D00 466 �****+�6.00
CpSA .
IJPLICATION FOR PERMR
BUILDING
For Offic� Uu On1y
ZONIN(;
/ „o. o. u.s o, n �
.�. v .�����o y�
YARDiAPPROVlD
MAIN BUILDINO
v�n.#
� ^��
1ALL Dfi Ll9H TXAN
U.B.C.HEQUIRlMQNT
YARDBAPPROVHD
AGGBYHORY BUILDINO
DATH
-� • m
m
�. �. �
TI[ AYOYM /M�WN UHON VALUATON 10 IOq TXH �
MJpIWeI O! iITAG1.�DXINO A �6pY1T I6{ ONLY.
VAWATION � p
/�D� � PlRMfT R66 �
0(J, r_ w
TOTAi. PQS l ^—
/
': � �: / 29284
-COSTA MESA BUILDING-SAFETY DEPARTMEM
V.O. BOX 1100 COBTq MEBA. CALIFORNIA i26i0
Fo► Appl7caM fo F(11 In Compleroly
TYPE OR PRINT
BUILDINO O / �+,
ADDRE89 (
COSTA ME3q, CALIFORNIA
:HITECT
%
■ 8fAT8
l,i
US8 OP
EXIBTIN6 BLOO.
Y6TGACK Llttl 1110Y
DESCRIPflON OF WORK
1 N6qlBY ACRNOWL6O06
AND BTATH TryAT T16 ACi
PLY WITX ALL CITY OROI!
BYILOINO GONDTRYCTION.
816NATURB OP
P6RMITTH
wunroRiz¢n wo«rr
1100P
�
7
MAVI 116AD TXIO I�PPLIGT�OM
CORR6GT AND AOR6[ TO COY.
AND AAT{ 4Wo P[OY4T1N0
OCT 24-68�M;QO01216 cJ,*¢�*1?_.00
APPIICATION FOR PERMR
BUILDINfi
for Offlce Use Only
ZONING
r�o. or u.a o.
�una d euaou
�
-� VJ/ ���
MANO SHALL EH LH88 THAN
YARDD APPROVQD
MAIN BUILDINO
vwn. tt
u..e. e. eeou�neMerari - �-
YAROB MPROV HD
ACC8Y80RV BUILDIN6
RT. �
� ��
B6T, MAIN Q
wceeas.au
DATH
� ( � a
O7
�
�
BC. Rr. '�
TN[ AMOUIR lMOWM UND61i VAI,UATION 1! IOH TN6 �
�URroG[ OP �lTAELIBMINO �1 PBqMIT �8H ONLY.
VALUATION �
^� � PHRMIT PEH �i p
'�� o
��, � W
J TOTAL PE8 /�• �
�- .
y Y 3I6OI APR-8-70�q;FOO 450 0**�+�j0.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
APPL�CATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
REC£ � D E R�EIj(�D DA��T/Fj�If$/S}l ED �
ADIDPES$ �I �♦ I �� �- � � /� F�/ �/ �
OWNER ��!'«�- 17.L l.D- A.P. NO. / 'D ✓ -�S P��S// %JO/
MAIL � �/ BUILDING
ADDRE55 PO • �Fd4C� /1DDflESS �O/
dU CITV NO�. S�S)� Z� TFIAC�T�y.+�I
Z
CONSiRULTION W A A R
O N LENDER �
am
J 1 BRANCH ' —
OWNER
`� ADDRE55 � �
J m ARCMITECT � TEL. _ SE
Q OR ENGINEER N
U �
Q FIRE
W � ADDflE55 � ZONE TV
d W
W Z �a \ (�_, � . � . APPROVED
J O CONTRACTOF V ���w.p,r 8V
�J � ADDRE55 B % � •,� tr rd'�, / S� �F'\-' •
w w TEL./ �/ ZONE NO.OF/�
Z� CITV ���� NO. (p Y�'JS�iJ G� �/ P�� at-
N—0 STATE p, Z CITV `� � (] VARDSAPPROVED
¢ LIC. NO. 7`� y� LI0. NO. ptl�) MAIN BUILDING
7O - (FROMC/LSTREET)
512E i NO.OF BLDGS.
OF LOT � Sr% �{. �S� NOW ON LOT � FRONT FT.
USE OF �,/��E C.L..I �
EXISTING BLDG. V VV ��-`�'lC{/\ FT.
F SIZE OF �}� NO. OF
Z NEW BLDG. ROOMS STORIES L SIDE FT.
a EXTERIOR WALI ROOF
COVERING COVERING REAR FT.
USE OF BUILOING AND WORK TO BE PEFFORMED DISTANC BET.
4 MAIN BIDGS.
O 1 �� <' ' � 6MNL. I L /W C URP. #
F 6ds_��n� � APPROVED
y 'I�Dr�
o G
VI hereby acknowledpe thet I heva reetl this epplication end ste[e
� ihat the above intormation Is co�rect end eBree to comply with
� all laws rB9�leting building consttuttion, end 1 shell not emptoy
F„ any parson in violation oi tha workman's compensetion laws ot
y the State of Celifom(a.
zI hereby certity Nat I am pro0erly licensetl as a contractor under SQ. FT.
the State of Calitornia Buztness entl Professions Cotle, Dlvisicn 3, THE AMOVNT SHOW
Chapter 9, entl that such licanses ara in tull torca and effact, or I THE PUFPOSE OF EST<
em ezempt (rom Me ovision ( the Stata ot Cal(fornle Business VALVATION
antl Protessions C tl, ivision hepter 9.
i
SiB^ature Of
Permlttae 5/�, � F
Authorized ABent
l
VALVE
�d
USE OF NEN�rG�MG
BVILDING
VARDS APPROVED
BET. MAIN &
�
0
UNDER VALUATION IS FOR ^
LISHING A PERMIT FEE ONLV: �
¢
.�
RMIT FEE $/ � �
]
m
4N CHECK 5 �— E
�y o
LL
TAl FEE S O�
- -- -- ,� �
_ . . �+�77.8
COSTA MESA BUILDING•SAFETY DEPARTMENT
� P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUI LDI NG ��
ADDRESS / � /
OWNER ! �! (�
MAIL
ADDRESS �
TEL.
CITV G /�`. NO.
� CAN5TRUCTION ,
LENDER
BRANCH
ADDFESS
ARCHITECT TEL. �
R
A.P. NO
BUILDING
�AODRES��S
A1/i/�
OWNER
'-----------�--=-�:.�-
�",°oo„ss� �;:F�ao.�o
�r,T zs-�s�>,s:
FOR STRUCTURAL PERMIT
DATE RECENED nnre ieci�en
BLOCK
�
FIfiE �\
AODRESS 20NE TVPE GROUP
APPROVED P�/.� �
CONTRACTOR ' BV 6 DATE p J�
ADDRESS O �� ZO / NO.OF ' USE OF NEW I
TEl p�q�/ BUILDING �
ciTv /ZfJ-N 6L No. �1 D CC
� STATE CITV �ARDSAPPROVED VAROSA PR VED
�IC. NO. �� LIC. NO. �� MAIN BUILDING ACCESSORV ILDING
� S12E . NO.OF BLDGS. (FROM GL STREET)
L OF LOT � NOW ON LOT FROM FT. F
a USE OF I
i,�„i EXISTING BLDG. 51
y
F� Separate permits are required for �. si T. T. '
q electric, plumbing and heating work. RE F. Fr. �
ti VSE OF B LDING AND WORK TO BE PERFORMED
DI5TANCE BET. BET. MAI -
Q� � MAIN BLDGS. ACCESS. BlIX'aS.
i..i VAR. � DATE -
a, � '� C.U.P.# APPROVED
� ' . APPROVED
r — —
�
x
w
0 I hereby acknowledge thet I have reatl this application and staie � �
p�. thai the above informetlon is correci entl a8�ee to comply wlih ,�
a all laws regulating bulltlin8 consttueNon, antl I shall not employ ..
,� eny �parson in violation of ffie workmen's compensetian laws o� �
� t�e Stete of Celifornia.
3 1 hereby ceRify ihet I am properly Ilcensed as a eontractor unde�
SQ. FT. � rv
tha Stata of Callfornia Business anG Profassions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chaptar 9, end that such Iicenses are in full force antl effact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE NLV: �
am enempi from tha pr sions of the Stete of California Business VALUATION a
antl ProfessionsCode„ ivi lon 3 Fihepter 9. PERMIT FEE $ m
� PLAN CHECK $ U o
Signature of � $ LY7�a �� LL
Permlttee 1�+� �
1��.�� TAX 5 � U
Authorizetl Ageni TOTAL PAI D S G„/(j
� �.
' ���s2
��"COSfiA MESA BUILDING-SAFETY DEPARTMENT � 926�6 E7%.i 3/�78 40. PO
P.O. 80X 1200 COS74 MESA_ CALIFORNIA 92626 _` � . " "' "' - ' " '
APPLICATION FOR STRUCTURAL PERMIT
For Appiicant to Fill in Completely — Use ►nk Only RECEI V ED BV DATE RECEIVED DATE ISSUE
BUILDING - � /_ ) � � �..�3., �
ADDRESS ��/
PERMIT NO.
OWNER S /� �,G I L, CO A.P.NO.
MAIL BUILDING %1 �__
ADDRESS ADDRESS (/
TEL. TRACT LOT D BLOCK
CITVGU.S �� � NO.
CONSiRUCTION N W ADD ALTEfl P M
LENDER
BRANCH �)
OWNER S7iELL 6 ��^ � G
ADDRESS �rn �J E
ARCHITECT TEL. US '�rIF LC $
OR ENGINEER N ,
FIRE
ADDRESS ^ ZONE � TYP / GROUP
CONTRACTOR
"�/ � YN� / E/� I� r GGNS / ByPROVED DATE '
ADORESS �S,�O/ 4i CoMMoN iJ�aL
pTY Y V E�I � TEL. ZON� PLAOF BUILDING EW
9 f� k'� No. 82trt,3�
STATE � � LICVNO, � vMAION BUPLDOING ACCE SORV 8U IDING
LIC. NO. CJ O
SIZE NO.OF BLDGS. (FROM C/L STREET)
OF LOT NOW ON LOT RONT FT. � FT.
USE OF �-/'-
EXISfING BLDG. �E j// L� .�T� / Q FT. FT.
Separate permits are required for . �. sio Fr.
electric, plumtiing and heating work. REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
^ MAIN BLDGS. ACCESS. BLD(3S.
� �/ ���/� �'Y SD L /V � I NF C URP„$ APPROVED
APPR V
� G._.
1
j I heraby aeknowledge that I have reatl this application end stete
that the abova Informetto� is cotrect entl apree to comply with
ell laws repulaiing buildtng construetion, antl 1 shall not amploy
eny perwn in vlolation of ma workman's compenution laws of
� Me SteSe of Celifornla.
� I he�eby certify that I am proparly licensetl es a conttactor under SQ. FT.
the State of Callfornia Bus�ness antl Professions Cotla, Div(sion 3, TNE AMOUNT SHOWN UNDER V4�UATION IS FOR
Chapter 9, entl thet such licenses ere in tull force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE NLV:
em exempt from Me proviSions of the Stete of California Business VALUATION PERMIT FEE
antl Professions Cotla,-ONision 3, Cha�p�iar) 9. -$
Signature of ///� -f/�/j��/�_ /�/� � PLAN CHECK $ �, �Q
Permlttee / �' '�`%�( /�� $27 `/
� TAX E
AuihorizedAgent TOTqLPAlO $ d , (�
��
PNQIECf AOOXESB: B O S W 1 9 TH ST
owxex•s N�Me: RALLY' S FIA.MBURGERS
nooxess: 8525 GIBBS DR, ST302
S.D.
' 619-576-2060
IINR:
' 1HCNIENCINEEB: . flE0.N0.:
�UOflESS: . UNIT:
PERMITiEE: CAL SELECT HDiLDEAS ( 714 ) 996-347U
�ooxEss: 4300 LA PALMA
ANAHEIM CA 92807
LICENSED CONTMCTOB OECIAM71aN: I �ereby aKrm [�at I am Ilcensetl und9 m' ions ot C�apter 9(commencinp with S¢ction
7000) of DiNsion 3 ott�e Business anE Professians CaOe, an0 m icense is ull to e an ttect.
an uc.: 0 512 3 6y �sTnTe uc.:/5 9 0 7 6 5 �$. B /
�ate�. �-�(Y—{-Cl—/ siAnature:
WORKENS'COMPFNSpTIONDECUMTIO�: IherebyaHirm Ihaveacerti te con t elf-insureoracertificateafWorkers'
ComDensation Insurance ar a certiliN crop t�ereoi (Section 3800, LaU..G).
�IICYNO.;Vrr�l--�u��.�.i—vi E%P.URiE: LJ/O1I9O
�Mrnnr: FREMONT INDEM
.J Certified coDY � �ereGy fumishe0. � rtifie0 copy is fil 0 wit� 1 iry B i ng Oivision.
� Date: P �� �� pPDlicanC
E%EMPTION FBOM WONNEfl3' COMPENSITION DELIARATION: Qhis seclion ea not �e tt the Dermit is for one hunEreE (510� or less�.
I cetliy �hat in the peAormance of Ihe work for which this permit is issuea, I shall not ploy any Oe�son in any manner so as to hecome
suble�� �o Ihe Workers' Compensatian Laws of Califamia.
� Date: SiAnamre:
N0710E: It, atter malting tAis Eeclaratbn, yau shoWA hecama su6lect ta t�e Workers' Campenution pmvisions af ma Labor
CoOe, you must torihvnth comDN wit� suc� proNsions ar t�is De�mit shall Ce OeemeJ revok¢d.
fAN8TB11CTI0N IENDING IIGENCY: I �ere0y affirm Nat Ihere is a canstrudion IenainA agency lor IAe pertarmance at Ihe work for
w�ich Nis De�it is iuueE (Section 3097, G¢ C).
�xoex:
nooeess:
� OWNEB BUILDER OECUMTION: I hereby aifirm that I am exampt from Iha Contractors' Stata Licanse Law far ihe fallowinp reason
'(Section 7031.5 Business anA ProlesSlonal Catle: Any,ciry oi county w�ich requires a permit ro constmc[, al[er, imOrove, Oemalish, or
repair any s[rucWa, priar to its Issuanca, also requires ihe apPlicant for such permit to file a siqned statement [ha[ �e/s�e is IicenseU
pursuant to ihe Omvisions oi ihe Canlractars' State license Law (ChaD�er 9(commencinq vnth Section 7000) of DiNsion 3 oi tAe Business
anE Prolessions CaAe) or that he/she is exampt therefrom and the �azis tor the alleBed exemption. My viola[ion of Sectlon 7031.5 by
�� any aODficant tor a Dermit sublects t�e aDDlicant to a ciWl penalry ol not more than frve �wdred Eallars (5500).
I, as owner af I�e D�oDeM or my emVloyees wit� wapes u iheir sole wmDensation, will do t�e wark, an0 t�e
—I strucNre is not intentle0 or aBereE tar sale (Secnon 70M, Business anE Pra/essional Code: T�e Coniracrors' Stah License Law
Oaes not apON to an ovmer ol a pmDeM w�o builds or improves Ihereon, and who Ooes SucA �vork himselt/herselt or [hroup�
` �is or her own employees, pmvldeE that such imprwements are not inten0ea or otferetl for sale. It, however ihe builEinO or
imOrovement is soltl witAin ane year oi comDletian, �he owner vnll �ave Ihe bur0en ot proWnO ha/she Oitl not Oui10 or improve
for tAe purpose af ule�.
I, as owner oi ihe proDerty, am exclusively contrac[in0 with Ilcensed contracrors to constmct the Drolec[ (Saction 7044, Business
❑ an0 Protessions CoOe: The Conirectors' SW[e License Law Uces w� apDly to an owner ol property wtw bmlds or impmves ihereon
and wtro contrac[s br such Omlects wiN a coniractor(5)license Dursuant ro the Coniractors' State License Law�. I am aware
tha[ Drooi oi their Worker's ComDensation insurance s�oNE De pmvitled to me.
� I am exempt un0er Sectian: B. 8 P. C.
for Nis reason:
Oate: uwner.
I Ao hereby certity lhat I am awara at anE untlerstand the repuiremenls oi Califamia Heatth ana Safety Cotle Sections 25505, 25533, and
25530 anE t�at I or any future Ouil0in0 occupant wiil/will not (circle one) nee0 to comply with saiU state coAes an0 t�e requiremenis for a
permit for constmction or moAi/icatian irom ihe Air Qualiry ManaBement Oisiric[. Nesitlential constmction aD01iw[ions are exempt trom
these provisions. .
Oate: MplicanC —
I �ereEy certiy Vwt I have reaE Nis application.an0 slate [�at the al
orainances an0 sute uws reW6np to EuilEinp rpnstruNon and Ice26y
D�aDaM �a� �ns ec[ion purpases. /
♦
Date: � �� � SiAnaWre:�
oriver's License or Social Securiry x:
1861�48 Whita—BuilAing; Oreen—COEe Enlorcement; Cenery—Applican�;
to wri7y�y/xM all cily anE
GolCenraE—Aaaessor
CITY OF COSTA MESA - SIGN PERMIT
PERMIT NO: SBE 0'99045 PLAN CHECK NO: 05733-90 S
CONSTRUCTION TYPE: PERMIT TYPE: ELE STR SIG'
PERM NO: SHE 099045
GOVT: N SUPP: N
� PURPOSE: OTH
JOFi DESCRIPTION ; SOSF LUMINATEU MONUMENT SIGN SQ' FT:.
CLAIM VALUE: 1,500.00 CALC-VALUE: 1,500,00 GROUP OCC:' H-2 /'
COMMENTS: REFER TO P.C.�3368-90L �
*****���*�#�r#�# x�**�u-* x�***-x��*���-*�x-*�#�+c���***+t��#x-�t��t*�-�*�t#*�x�***�:�**+�-��x�•�r####*-x-�*�t*
S I G N Z N F O R M A T I O N �
DISTRICT: 2 TYPE: GROUND ILLUMINATION: IIVT CATEGORY; NEW
DIMENSTONS: 3FT 0'lIN X 6FT 021N AREA: SO.00SQFT LETT�R AT: 20
STREET FRONTAGE 1: 127.00 ' STREET 1: PLACENTIA AVENUE
STREET FRONTAGE 2: 145.50 STREET 2; W 19TH STREET
PARCEL: 42419112 ZONE: C1 LOCATION > FRONT; X REAR:
HUSINE55 NAME: RALLY'S HAMHURGERS > LEFT: RIGHT;
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY . SO,OOSQFT OVERALL HEIGAT: 7FT 2IN
�THIS SZTE : 100.00SQFT GROUND CLEARANCE: OFT OIN
ITEMS OF INFO : 3 �� PLANTER AREA: 200,OOSQFT
ITEMS FOR ACTIVITY: 5 %R BLDG SET BACK; 30FT,
COPY VERBIAGE : RALLY'S HAMBURGERS�,,�,,WITH LOGO � , �
PLANNING NOTES: TOTALS ON THIS •PERM3T FOR PLACENTIA ONLY �
*�e **-�*�-�tx�*�x-***�t-**�r�t�-x��� *�t**��-�ar**�x-****-x�***��*-x�*****��r�-*�r*��x��r*�r***�-�arx-**arat#*�t��-*�t-�*
D E V E L O P M E N T S Er� V I C E S R E Q U I R E M E N'T S
ZONING APPROUED BY ��� C,v�{L T DATE: �-18 ^��
HUILDING APPROVED HY : � • _ DATE: .
APPLICATION ISSU�D HY
iE �E iE 3E jEiE IF 3F �E iE�� iF 3E iE �E 3E 3E i( 3E iE 1E
LEGALIZATION:N
PERMIT
BLDG PMT
35.00
PLAN 22.75
ISSUE FEE
S U M M A R Y
PLUMHING EL$CTRIC MECHANIC
15.00
S�$
15.�0
iF iF �1F iF iE �]F�E #-3E 3F iE �7E �� iEif dt �� fF �3E-%� �3e �%�1E iE 3E
' STRUCTURAL SEGMENT:Y
. :/
SIGN SMIP/RES GRADING
50.00.' –
SMIP/NpN–RES
.50" '
i
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DL7E
�roTALs----> 100.50 15.00 22.75 138.25 �13s,25� � ' .00
REVENUE DIVISION TOTALS--> COLLECTED: 138.25 OVER/SHORT: � 00
BLDG PMT PLUMBZNG ELECTRIC MECHANIC SIGN SMZP/TOT GRADIN� PLAN-CHECK
35.00 30.00 50.00 .50 ' , 22,75
�
�1E 3f jF iE iE �7E iE i4 iE iE iE iE �lf ik iF #�iF-)E iE±F df #�lE 3t �%if iE �lf �� aE iE iE iF iE iF aF 3F jt?E jF jE if-ik dt iE i6 dt i(� 1E-� iE�7E-%�1F jE-%�lE �)k �%aE iF iE jf �7F 3E-k dEjE ik �H--1F-%�1F jE iE jFiE �1E jf-
I N D I V I D U A L F E E B R E A R D 0 W N � � �
TYPE QTY U E S C R I P T I O N UNIT C,OST .• TOTAL COST
ELE 1. SIGN/ OUTLINE LIGHT SYS ON 1 BR GIRC 15.00 15.OU
END OF FEES "
' 01.0006983S-G�lOh9�,��i� 'fe�T 7.3&,2.;
DAi'c: �9/13i°4 7IME� 12.51 /
� ��
1
CQNSTRUCTION AND PIANNING ' � •.` $ SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
- r
1. Temporary Electrical Service or Pole �;/' - 52. Pool & Equipment Location ��
2. Soil Pipe-Undrgrnd. :r �, /� 53, Steel Reinforcement �"
t?"
3. Electrical Conduit Utility�Undigrnd. �l . 54. Porms ^.'
d. Electrical Conduit�Undrgrnd. r1 55. Electrical Bonding
5. Steel Reinforcement 56, Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. " 57. APPROVAI T0 COVER-GUNITE
7. Footings , 58. Electrical Conduit-Undrgrnd.
g. Foundation ,•� - ,�� 59. Gas Bipe> O Undrgmd., Test ��
9. Water Pipe-Undrgmd. �� �- �� _ 60. Backwash Lines, P•Trap, � Undrgmd. �"�
10� Structural Floor System-' ,��.� �!: 67. APPROVAL TO DECK ' '%
11. Property Sewer Line & House Connection� "`• . �
�._r ; � 62. Backwash & Receptor�Final� . , �;�
12. Sewer Cap .�' % '� 63. Heater & Vent-Final • �
i �
13. RooS Drains �,� � 64. Plumbing SYstem � Flnal � ��
i
14. Rough Plumbing % �'- .. •1 . 65. Electrical-Final - . I %
15. Rough Electrical-Conduit �'' . 66._Solar SYstem-Final " �
t
16. Rough Electric Wiring �, • 67. Fencing & Access Approval � '��
ll. Rough Wiring Sign , �; � � � 68. APPROVED F,OR PLASTERING �
18. Rough Elettrical-T Bac Ceiling: � 69. POOL/SPA SYSl'EMS FINAL
ly. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace APPROVALS Permlt #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas � Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing ' 73. Undergrnd. Smrage Tank O Gas ❑ Oil
25. Roof Sheathing 7q. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27, Frame and Flashing 76. Dry Standpipe
28, Lathing & Siding 77. FIXED SYSTEM FINAL
29, Insulation 78. FIRE PREV. FINAL
30, Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32, Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33, Final Electric SZ Notes: �
34. Final Heating & Air Conditioning -
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
3g. Water Service�Final
40. Gas Service-Final �
41. Solar pomestic-Final
42. Backflow Preventer � � � ��
�
43. Backflow Irrigation � ^
� �
44. Landscape Irriqation System
45. Sound Attenuation
� ..%
46. Handicap Regulations ,5 ly'pf�� ��Q/��E�p �� _�
47. PINALSTRUCTURE&BUILDING I ` 3�D�i vbp g�� U rc5 \�/� '
48. FINAL PLANNING
49. Elearic Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date