HomeMy WebLinkAbout814 19TH ST - Building Permitsy f
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�� IZ' � OF COSTA ME� '� � c
Developnient Services, Division of Building arid Safet�
�_. ,
,
CERTIFICATE OF OCCUPANCY
This tertificate is issued pursuant to the requirements of the 2007 California Building Code, Section 110 adopted by
the City of Costa Mesa certifies that at the time of its issuance the building structure herein beloH� described was
inspected and approved foroccupancy as follows:
Building Address 8� 4 W. 19th Street Bldg. Permit Number BC10-00021
Use Res"taurant
A
Group B Type of Construction V—B
Owner of BuildingMiHhael D FdulkneY
Address 814 W• �9th Street, Costa Mesa
sui�D�Nc oFF�c�nL-Khanh Q. Nguyen, C.B.O.
_
Fire Zone
_ Tenant Big
CA 92E2p.
Use Zone
Belly Deli
Date � 2'20-10
REQUIRED TO BE POSTED IN A CONSP[CUOUS PLACE
�
�
CITY OF COSTA MESA
4C. �p MF q B�IILD/NG DIVISION �
;�{@ 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Faz p14) 754-4856 • www. . os es ._. _D
� FORINSPECTIONS CALL:(714)754-5626 -
°"°°°"°'� PERMIT NUMBER: BC10-00021
PERMIT TYPE: B COMBO
Sub Type: COM_ALT
�oe a�oRESS: 874 W 19TH ST CM
APN: 42230175 Zoning: �, ,
Vicinity: BIG BELLY DELI
Const Type: V-B SQ. FT: 1101
STATUS: ISSUED
DATE ISSUED: 09120/2010
ISSUED BY: RMD
Suite/Unit:
Primary Occ:
Valuation: $75,000.00
SCOPE OF WORK: 1,101 SF INTERIOR TI FOR "BIG BELLY DELI" RESTAURANT. WORK TO INCLUDE NEW NON-LOAD
BEARING WALLS TO CREATE 2 NEW RESTROOMS, KITCHEN AREA, NEW COUNTER AREAS AND SEATING WITH
ALTER/REPAIR RETURN AIR VENTING, MECH GAS PIPING, 1 MECH HOOD, 2 VENT FANS, t SMOKE DAMPER, 1 FIRE
DAMPER, 11 LIGHT FIXTS, 20
OUTLETS, 10 SWITHCES, 1 SUB PANELT0200A, 1 COFFE/ICE CONNECT, 3 FLOOR DRAINS, 1 DRINKING FOUNTAIN, FAS
OUTLETS (1-4), GAS SERVICE, 2 P-TRAP, INTERIOR SEWER CONNECT , 1 COMM SINK, 3 FLOOR SINKS, 1 KITCHEN SINK, 1
SINK SVC MOP, 2 WASH. BASIN.�2 WASTE AND VENT. 2 WATER C�OSET. 1 WATER HEATER. -- . ,
OWNER: FAULKNER, MICHAEL D
Phone:
APPLICANT: JOHN CHRISTENSEN
Phone: 949-933-9858
CONTRACTOR:
Phone:
Cell:
ARCHITECT: JOHN MARVICK
ENGIN�ER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
, Address: 814 W 19TH ST
Ciry/Siate/Zip: COS7A MESA, CA
Address: �. � � ��
City/State/zZip:
Address: Unit:
ciry/state:
License No.C22267
License No.
$532.19
$818.75
$99.10
$83.00
$235.45
$0.00
$15.75
$3.00
$1,787.24
License No.
� � . . ' Unit:
Unit: .
2ipCode
PHONE:714-549-7554
PHONE:
"Refer to fee recei ts for all fees aitl Tor ro ecl
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays- 9:00 am thru 6:00 pm. Prohibited all hOu�S - SUndays and the following Federal holidays:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremen4s under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be oblained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
LOOE1. INSPECTIONTYPE DRTE INTI➢ALS COOEp INSPECTIONTYPE � OpTE � INTITIALS (%
1616 Fixed System Final Fire Prevention 2�6 Final Mechanical x' 12 -22-ID �N G.(i'��
1266 Pool Spa Final 208 Final Plum6ing � �a '� a-/O �/ ��i('��
200 Final Re-Roof 210 Final Electrical X ia - a a-�v �_ (2�
201 Final Biock/Retaining Wall 212 Final Fire Prevention
202 Final Faclory Fire Place 220 Final Planning Approval
203 Final Sign 222 FinalSite
204 Final Demolilion 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby af(rm under penalry o( perjury one of Ihe (ollowing tleclarations:
❑ I have and will.maintain a certifiwte o! consent to self-Insure for workers'
compensalion! as.prov�etl�for�by•section 3700 of the Labor Code, (or the
pertormanc�of the �rk (`� ichti� permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 0( the Labor Code, for the perfortnance of the vrork for which this
pertnit is issued. My workers' compensation Insurance cartier and policy
number are:
Carrier.
(ina sedqn neetl �rol0e oompetetl nlne permR is valuetl at one nuneretl tl�0ars (5f00) w less)
Policy Number:
❑ I certify thal in the peAormance of the work for which this permit is
issuetl, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, antl agree that if I should
become subject to the workers' compensation pmvisions o( Section 3700 0/
the Labor Cotle, I shall forthwith comply with these provisions.
Appliwm's SignaWre
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm thal I am licensed under pmvisions of Chapter 9(commencing
with Section 7000) of Division 3 0( the Business and Pmfessions Code, antl
my license is in full force and effect.
Lic. # Class #
Comroctor's Signalure
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a construction lending agency for the
pertortnance o! the �nork fa wfiich this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penally of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for �he following reason (Sec. 7031.5,
Business antl Professions Code: Any city or county which requires a permit to
cOnsWct, alter, improve, demolish, or repair any sWCNre, prior to i[s
issuance, also requires lhe applicant for such permit lo fle a signed statement
that �e or she is Iicense0 pursuant to t�e provisions of the Contractors
Litense law (Chapler 9(commencing with Section 7000) of Division 3 of the
Business antl Pro(essions Cotle) or that he or she is exempt Iherefrom and
the basis for lhe alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecis the applicant ro a civil penally ot nol more ihan
five huntlred dollars ($500�.):
❑ I, as owner ol the pmperty, or my employees with wages as their sole
compensalion, WILL DO THE WORK, and the stmcNre is no[ in[ended or
oBeretl for sale (Sec. 7044, Business antl Professions Code: The Contractors
License Law does not apply [o an owner of property who builds or improves
thereon, antl who does such vrork himself or herself or through his or her own
employees, pmvided that such improvements are aot intended or oHered for
sale. If, however, the building or improvement is sold within one year of
completion, ihe owner-builtler will have the burden of proving that he or she
ditl not builtl or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to consiruc[ the project (Sec. 7644, Business and
Professbns Cotle: The contractors License Law dcesnot apply to an owner of
property who builds or improves [hereon, and who contracts for such project with
a contractor(s) license pursuant to the CoN2ctws License Laws.).
❑ I am exempt under sec.
Business and Professions Cotle for this reason:
Slgnalure
305]<6 (3/0])
Ovmer ID venfed by tlriver's license. � Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (rype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certily that no excavation frve (5) or mwe feet in depth into which a
person is requiretl to descend, will be made in tonneclbn wilh v.ork authorized
by this permit, antl that no builtling strucWre, scaHdding, falsework, v demolition
or dismaniling thereo(, vnll be more than Ihirty-six (36) feet high (Chap. 32, Gry
2, Ari 2, Sec. 341, Ttle 8, Calitornia Adminisirative Code�.
❑ As ovmer-builtler, I vrill not employ anyone lo do work which would
require a permit trom the Division of InOustnal Safery, as notetl above, unless
such person has a pertnit to do such work (rom the tlivision.
Avp����'s Signalure �ate
Division of Intlustrial Safety Permi[ Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicanl or present or (uture 6uilding occupant neetl to file and
certify a Business Plan for emergency response lo release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safery Code requires, vrith some
exceplions. that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity ol hazardous materials equal to or greater than a weiqhl of
500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stantlard temperature and pressure).
2. Does or win the applicant or present or future building occupant need lo file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
excep�ions, require5 registralion wi�h the Costa Mesa Fire Department by
each business which al any one time has on hand a quaniity of acutely
hazardous malerials equal to or greater than a weight ot 500 pountls, or a
volume o( 55 gallons, or 200 cubic feet of compressetl gas at standard
temperature and pressure).
3. Does or will the applicant or presenl or fuWre building occupant need [o
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous malerials)? ❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health antl Safely Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
fling with the Fire Department of an RMPP by businesses which are requiretl
to register acutety hazartlous materials with the Fire Department.
4. If an RMPP is presently requiretl, has Seclion 25534 of the California
Health antl Safety Code been fully complied with? ❑ Yes ❑ No
5. Ooes or will the applicant or present or fuNre building occupant require for
the vrork which is the subject o( this application a permit tor such constmction
or modi(cation from the South Coast Air �uality Management District or fmm
any other air pollution control dislrict or agency7 ❑ Yes ❑ No
(Section 658502 of the Calitomia Govemment Code requires Ihat ihe requestea
infortnation be fumishetl on applications for non-residential builtling pertnits).
6. Will any part o! the facilily to be constructed under this permit be wi�hin
1000 leet from the outer boundaries ol a school? ❑ Yes ❑ No
(I( "yes", the facility must meet the requiremenl of Sections 25534 and 42303
of the Califomia Healt� antl Safery Code).
7. If a permit (rom Ihe South Coasl Air duality Management Distric[ or olher
air pollution control district or agency is required !or the work which is the
subject of this application, have all ol the disclosures prescnbed by Califomia
Health antl Safety Cotle Section 42303 been made? ❑ Yes ❑ No
8. Q( yes", attach cenificate of compliance from the appropriate air pollution
conlml oKcer�.
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalry ol perjury ihe
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty oF perjury lhat I have reatl this application and state that
the infortnation given is covecL I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enler upon I�e above-tlescnbetl properly for
inspeclion purposes. I agree not to occupy or allow occupancy of any building
authorized by Ihis permit until fnal in5pec[ion.
Signa�ore o! LeBal Ovmu�s� Date
AndlorAut�onzed Apphcanl Date
. . ;
�
\ CITY OF COSTA MESA
� ""' BUILDING DIVISION
. q.� - '
F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
��� FOR INSPECTIONS CALL: (714) 754-5626
fi PERMIT NUMBER: BC10-00021
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: COM_ALT DATE ISSUED: 0912012010
ISSUED BY: RMD
�os ao�Ress: 814 W 19TH ST CM
APN: 42230115 Zoning: , ,
Vicinity: BIG BELLY DELI
Const Type: V-B SQ. FT: 1101
Suite/Unit:
Primary Occ:
Valuation: $75,000.00
SCOPE OF WORK: 1,101 SF INTERIOR TI FOR "BIG BELLY DELI" RESTAURANT. WORK TO INCLUDE NEW NON-LOAD
BEARING WALLS TO CREATE 2 NEW RESTROOMS, KITCHEN AREA, NEW COUNTER AREAS AND SEATING WITH
ALTER/REPAIR RETURN AIR VENTING, MECH GAS PIPING, 1 MECH HOOD, 2 VENT FANS, 1 SMOKE DAMPER, t FIRE
DAMPER, 11 LIGHT FIXTS, 20 � �-
OUTLETS, 10 SWITHCES, 1 SUB PANEL TO 200A, 1 COFFE/ICE CONNECT, 3 FLOOR DRAINS, 1 DRINKING FOUNTAIN, FAS
OUTLETS (1-4), GAS SER,VICE, 2 P-TRAP, INTERIOR SEWER CONNECT , 1 COMM SINK, 3 FLOOR SINKS, 1 KITCHEN SINK, 1
SINK SVC MOP, 2 WASH BASIN, 2 WASTE AND VENT, 2 WATER CLOSET, 1 WATER HEATER.
OWNER: FAULKNER, MICHAEL D Address: 814 W 19TH ST � � Uriita ; s)-��{j'7';
Phone: City/State/Zip: COSTA MESA, CA -" - �
APPLICANT: JOHN CHRISTENSEN Address: Unit: :
Phone: 949-933-9858 - City/State/zZip: ,
CONTRACTOR:
Phone:
Cell:
ARCHITECT: JOHN MARVICK
ENGINEER:
60MBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address:� Unit:
CitylState:
Lfcense-No.C22267
License No.
$532.19
$618.75
$99.10
$83.00
$235.45
$0.00
$15.75
$3.00
$1,787.24
Monday thru Fritlay - 7:00 am thru 7:00 pm. Saturdays- 8:00 am thru 6:00 pm. F
New Years Dav. Memorial Dav. Indeoendence Dav. Labor
License No.
ZipCode
PHONE:714-549-7554
PHONE:
IOPY�Oi,D
. � � . , . yNITH
� � R. i i�:ltic
� OiJ� ;7�tiiJ, !=A5
. ..�'iCk'iEilSINK, i
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2010 - PER CMMC Sec. 73-279
all haurs - Sundays and the following Federel holidays:
ksaivina Dav and Christmas Dav
NOTICE: The work authorized by this permit shall comply wilh all applicable handicap access requiremenls under California statutes and related
regulations. (Ord. No. 92-28. § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. ����7585
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of lhis permit.
' �:.t LC!=,i�
�COpE /, INSPEC7IONTYPE DAT ixnnei COUEt INSPEL710NTYPE D�TE._� INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechaniwl �• �-�:��� � ,
1266 Pool Spa Final 208 Final Plumbing � � 2. �� s• ��_���
` �
200 Final Re-Roof 210 Final Elec�nral i��� �
�.
201
202
203
204
Final BIocWRetaining Wall
Final Factory Fire Place
Final Sign
Final Demolition
+. .
272
220
222
250
Final Fire Prevention
Final Planning Approvai
Final Site
Final Building/Occupancy
''' 1:_'��"
/a-aa -�. �, p� �oz'�
1
� ' '
WORKERS' COMPENSATION DECLARATION:
I here6y affirm under penalty of perjury one o( Ihe tollowing declarations:
❑ 1 have and will maintain a certi(cate of consenl lo sel6lnsure for vrorkers'
compensation, as provided for by section 3700 of the Labor Code, for ihe
pertormance o( [he work for which this permit is issued.
❑ I have and will mainlain workers' compensation insurance, as requiretl by
section 3700 of the Labor Code, for the perfortnance of the work for which this
permit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Carrier:
(This secfion need �rot De wmple(etl i{the pe.mrt is valuetl a( one nundred Collars (8100) or less )
Policy Number:
❑ I certify that in the performance o( the vrork for which this permit is
issued, I shall not employ any person in any manner so as to become subject
[o lhe workers' compensation laws of California, and agree that if I shoultl
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall torthwith comply wi[h [hese provisions.
ApPlicanfs Signalure Oate
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATI�ORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eRec[.
Lic. # Class #
Gontra<tor's SignaWre Daie
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn thal there is a constmction lending agency for the
peAortnance of the work fa wfiich this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby affrm that untler penalty of perjury that I am EXEMPT FROM THE
CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
constmct, alter, improve, demolish, or repair any strucWre, prior to its
issuance, also requires the applicant for such permil to fle a signed statement
[hat he or she is licensed pursuan[ to the provisions o( Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pm(essions Code) or that he or she is exempt therefmm an0
the basis for the alleged exemp[ion. Any viola[ion of Section 703L5 by any
applican[ for a permit subjects the applican[ to a civil penalty of no[ more [han
fve huntlred dollars ($500).):
❑ I, as owner of Ihe property, or my employees with vrdges as [heir sole
compensation, WILL DO THE WORK, and the structure is not intentled or
offered for sale (Sec. 7044. Business antl Professions Code: The Contractors
License Law does not apply [o an owner of property who builds or improves
[hereon, and who does such vrork himself or herself or [hrough his or her own
employees, provided thal such improvements are not intended or oRered for
sale. If, however, the builtling or improvement is sold within one year of
co letion, the owner-builder will have the burden of proving that he or she
tli ot build or improve for purpose of sale.).
I, as ovmer o! the property, am EXCLUSIVELY CONTRACTING WITH
� LICENSED CONTRACTORS to conslluct the project (Sec. 7044, Business and
Professbns Code:.The contractors License Law dces not appty to an owner ot
property who builds or impmves thereon, and who contracts for such project with
a contractor(s) license pursuan[ [othe Contracrors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for ihis reason:
� � � /d
� % 93iqnalure �1 �� �—Oydie�
305�-46(3/0]) �4
Owner ID verifietl by drive' nse. ❑ Yes ❑ No •
Driver's License No. C:xpires;
Verifcalion of Ownership by (type of document, i.e. - property tax bill or deetl):
D�VISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certAy that no excavation fve (5) or more leet in depth into which a
person is required lo descend, will be made in connectbn vrith work au[honzed
by ihis pertni�, and that no building stiuclure, scaffdding, falsework, or demolition
or dismantling [hereot, will be more than Ihirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administrative Code�.
❑ As owner-builder, I will not employ anyone to tlo work which would
require a permit from ihe Division of Industrial Safety, as no[ed above, unless
such person has a permit to do such work from the division.
ApphcanCs SlgnaWre
Division of Industrial Sa(ety Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to fle and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 0( the Cali(omia Health antl Safety Code requires, with some
exceptions, ihat a Business Plan be filed with the Costa Mesa Fire
Depanment by every business which has at any one lime tluring a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stantlard temperature and pressure).
2. Does or will the applicant or present or future building occupanl need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Sec[ion 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department Dy
each business which at any one time has on hand a quanlity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet oF compressed gas at standard
temperature and pressure�.
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management and Prevenlion Program for awtely
hazartlous materials)? ❑ Ves ❑ No
(Sec[ion 25534 of [he California Health and Safety Code provides thal the
Costa Mesa Fire Department may require the preparation, certiTca[ion and
filing with Ihe Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 ot the Califomia
Health and Safety Code been fully complietl wi[h? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the vrork which is the subject of this application a permit for such construclion
or modifcation from �he South Coast Air Qualily Managemen� Dis[rict or fmm
any other air polWtion control district or agency4 ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires [hat the requested
in(ortnation be fumished on applications (or noo-resitlential building pertnits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
Qf "yes", the facility must meet ihe requiremen[ of Sections 25534 and 42303
of the Calitornia Health and Safety Code).
7. If a permit from the South Coasl Air �uality Management DisMct or other
air pollution control distric[ or agency is required for the work which is the
subjecl of ihis application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certifica[e of compliance from the appropnate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazartlous Materials and Emissions.
SlgnaWre Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correcL I agree ro comply with all state laws and city
ordinances relating to buildinq constmction, and au�honze repre5entatives of
the City of Costa Mesa to enter upon the above-described property tor
inspection purposes. I agree not to occupy or allow occupancy of any building
au[horized by this permit until fnal inspection.
� of Le r(s Da
e0/<�
A�tlTrAWM1onzeDAppl¢dnl ,Dale - .
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us ' 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 814 W 19TH ST Status: ISSUED
Suite No Applied: 06/OS/2003
Vicinity: Issued: O6/O6/2003
Parcel Nunmber:
42230115
App�icant: PRAUM, STEVE _ -
Address: 1049MELROSE ,'-' :"�
�.��-%=:���� � � Phone: (714)231-7501
PIACENTiA, CA ;�. � Zip: 92887 . i
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Owner:�, 'F,AUCKNER; MICHAEL D
� � � �� ,
Address%,�874 W 19TH ST i �
�
� � i/,�� " Phone:
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i� COSTA MESA, CA Zip: 92627
,�'" �'�;-°;
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Contractor: � ORANGE ELECTRICAL CONTRACTORS
Address: , J049 MELROSE � � �
�� � _ - - "Phone: p14)980-2300
� �
. ,PLACENTIA,�CA " � Zip: 92887
. � �� � � ; ` - License: 747129
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, , -, - . ; SCOPE OP PERMIT ,
CONVERT EXISTING OVERHEAD ELECTRICAL SERVICE TO�UNDERGROUND FEED.
� � - , � FEE SUMMARY � � �
� . Quantiry -- • , .
- 'ISSUE FEE � $0.00 ' ' " � - �
� Temp,service test , $0.00
�.Res. a/c package'� ; $0.00 ,
New Res (1-2 units)�, �� �o, $0.00 � 0
New Res (3+units); � 1`'���; $0.00 0
Pool/�Spa�. � '� , ��' � $0.00 � 0
Lightlng Fixts � - '. �� 50.00 0
ReceptOutlels ���$0.00 0
Switches � � _� `�$0.00 . _, 0„ �'�
Non Res Appl�,,� ' $0.00�� ,' 0 -
ResAppl � -, ;, ��- $0.00`,� 0
Service to 200a _ " �" $30.50 � � � � 1
Service to 1000a ��, - �- $0.00 � „0 - ,
Service over 1000a �-, �. -� $0.00 , �0 -
Motors to 1hp � :��, $0.00,"; � � . 0
Motors to tOhp $0.00�, � i-� 0� ,
Motors to 50hp �� �$0.00, - , 0 -
Motors to 100hp �� $0.00 �- \ 0 �
Motars over 100hp $0.00- � 0
Communication drops $0.00 � - 0
Sub panel to 200a $0.00 ` 0 ,�
Pole Light Pkg $0.00 0
Sign Circuits $0.00 0
Temp Dist System / Lighting
Busway,/100 ft,
Standing Section .
Misc Electriql Equipment
_ Transformers up to 1 kva/kw
.•'. '', '' .:�. ::.:.......up to 70 kva/kw
.� vi' � %� - ` ..........:......up to 50 kva/kw
- � ' � � .................up to.100 kva/kw
..................over 100 kvalkw.
� Low Voltage Equipment
-� Low Volt Wiring System / Ckl
Misa Conduit
Misc. Conductor -
� - Circus ( gen or ride)
- Circus-(mech ride or lights) �
.. Christmas Tree Stantl
Fireworks Stand
' Other Eleclrical Pee
. Investigation Fee � "
_ -: Plan Check Fee � - �
- _ Reinspection Fee
Quantity
$0.00 0 ;
$0.00 0 i �
$0.00 0
$78.20 1
$0.00 0"
$0.00 0
$0.00 � � ", 0
$0.00;' 0. �
$0.00 � 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0 ,
$0.00 0
$0.00 ; 0�
$0.00 0
$0.00 "
ao.00
$0.00
$0.00
NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inepections and final approval must be obtained. Failure to obtaln inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626 ,
WORKERS'COMPENSAnON DECLARAnON: �
I hereby ettirm under penalty of perjury one of the following declarations:
❑ I have end will maintain a cerllficate ot cpnsent to selt-Insure tor workers' compensatian, es providetl for by section 3700 ot Ihe Lebor Code, lor the peAormance ot the
J work for which Ihis permil i5 i55u8C.
L+J I heve end will maintain workers' compen��ion Insurance, es requiretl by sectlon 3700 of tha Lebor Code, tor Ihe perfortnance of ihe work for which this permit is issued.
My worke ' compensetlan Insu�ce carrler erW pollcy number ere: q
Cartier: ��1 J..� PolicyNumber % Zq �O 7
(Tbis section need nat be crompletetl i! the permiNs ve/uetl et one hundred dollais ($100J oNess.)
❑ I certify that in the pedortnan .e of ihe wbrk for which this pertnit is issued, I shall not employ any person in any manner so as to became subject ro the workers'
compensatlon lews of Celifo�la, an egree Ihat if I should become sub�act ro the workers' compensation provisions oi Section 3700 of Ihe Lflbor Code, I shall fonhwith
wmply with ihese Drovisions
ApplicantSignature: Date: � �"O�
WARNING: FAILURE TO SEQIRE WORNERS' COMPENSATIpJ COVERAGE IS UNIAWFUL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENnLTIES AND GNIL FlNES UP TO ONE MUNDRED
THOUSPND OOLIARE (E100,000), IN ADDITIIXJ TO TNE COST OF COMPENSATION, DAM4GE5 PS P(iOVIDED FOR IN SECTION 31060F TME IABOR CODE, INrEREST, AND ATTORNEYS FEES.
' LICENSED CONTRACTOHS DECLARATION:
�� I hereby aMirtn that 1 em licensed under proWsions oI�hapte 9�n mmencing with Section 7000) of Division 3 of the Business antl Professions Cotle, and my license Is In full
rorce and enect. ua a "l 41 l'7.�� V �\ Class s I C�
ComractolsSignature: Da[e: �—����—
' CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is e construction lentling agency lor the peAormance ot the work for which Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lander's Neme: Lender's Aadress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eNirm lhet untler penalry of perjury Ihai l em EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe tollawing reeson (Sec. 7031.5, Buslne59 entl ProfeSsions
Code: Any city or county whic� requlres e permit Io consWct, elter, improve, demolish, or repair any strucWre, prior to its issuance, elso requires the epplicant tor such permil
b tile a signed stetement the� he or she Is Ilc�nsetl pursuant to ihe provisions oi the Contraqore License Lew (Chapter 9(commencing with Sectlon 7000) of DlNslon 3 of the
Business end Pmfessions Cotle) or �het he or she is exem0� �herefrom an0 t�e besis tor the ellepetl exempiion. Any violetion oi Section 7031.5 by eny applicent tor e permit
subjecis the epplicent to e clvll penelry of not more Ihan flve hunCretl tlollers ($500).):
❑ I, as owner ol ihe properry, or my employees wlth weges es ihelr sole compensation, WILL DO THE WORK, and the structure Is not Intentletl or ofteretl for sele (Sec.
7044, Business and Professions Code: 71ie Comrec�ors License Lew does not apply to an owner of properry who builds or improves t�ereon, and who tloes such work
himself or herself or through his or her own employees, provide0 t�et such improvements ere not imendetl or oflered lor sele. II, however, Ihe bulltling or Improvement Is
sold within one year ol completlon, the owner-Gullder wiil heve�ihe burden ol proving that he or she did not build or improve tor purpose of sala.). '
❑ I, as ownar ol the properry, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Busineu end Profeulons
Code: Tha contractore License Lew tloes not apply to en owner oi propeny who builtls or Improves theraon, and who contracis tor suc� project with e contrector(s)
license pursuent to ihe Coniractors License Lews.).
❑ I am exempt untler sec. Business end Professions Code for this reason:
Signature: Date:
Owner ID veritied by dnvefs licensa. 0 Yes ❑ No DriveYs License No. Expires:
Verilication o� Ownership by (rype of tlocument, i.e. - property tex bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERM17 CERTFICATON:
❑ I hereby certity thet no exwvatlan five (5) or more feet In depih into which e person is requlred to descend, will be made in connection with work euthonzetl Dy this
pertnii, and Ihat no building sirucNre, sCaHoltling, talsework, or demWiiion or dismantling thereof, will be more than �hirry-si: (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
347, Title 8, Celilomla AOminlstralive Cotle).
❑ As owner-Oulltler, I will not employ enypne to do work which woultl requlre a permii trom tha Division ol Industnel Satery, es notetl ebove, unless such parson has e
permit ro tlo such work trom Ihe division,
SignaNra: Dete:
Division of Industnal Satery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTTIORQATON OF ENTRY: I certify under penalry ot perjury that I have read Ihis epplication anC state thet the information given is
cortect I egree tp1wmpl with all stete laws entl Gry ordinances relaling to bullding conslruction, antl authorize representetives of the Ciry of Costa Mese to enter upon the
ebove-0escribed opeA) f r inspection purposes. I agree not to occupy ar allow occupancy ot eny builtling authorized Dy this pertnit until tinal inspection.
' neture Of Legel Owner(s) � �^v O� Date
y
AnNOr Aut�orized Applicanl Date
COOE L INSPECTIONTYVE
1616 Flxed System Final Fire Preventlon
1266 Paol Spe Final
2p0 Finel RaRoof
201 Final BIxWReteining Well
202 Finel Fectory Fire Place
203 Final Sign
204 Final Demoli�ion
�g �^� f�QQ[� INSPECTIONTYVE
206 Final Mechanical
� 208 Final Plumbing
210 Final Eledncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
� 250 Final BuilGing/Occupancy
QAIE
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F�IPJ�CT RDOflE55: 81 4 W 19 TH S'�
OWNEP'SNRME: FAULKNER MICHA€L D
aooaess: 814 W 19�TH ST
CdSTA MESA,CA 92627
AHCNIENCINEEH:
�ODHESS:
HEG.NO.:
UNIT:
UNIT:
renmine¢: THUNDER ROOFItdG ( 714 ) 646-4122
aooness: 854 W. 19TH STREET
COSZA MESA CA 92627
LICENSED CONTRACTOB OECLAflpTION: I �ereby affirm �ha� I am IicenSeU untlef D�ovisions o� Chapter 9 �commencing witn $ec�ion
7000� ol �ivision 3 Of Ihe Busm¢55 and PmIC55i0n5 Cotle, an0 my liCense is in lull tOrte antl eilecl.
CITY LIC.: S S%.3 S sTa.e uc.: 6 3 S 14 cy�ss: C� 9
a�e: Signaiure: � �(\� . _ _ —
WOXKEBS' GOM ENSRTION OECa�T10N: I �eieGy ani �nal I nave a certifiwte of consent to sell-ins a i certilicata oI WOMers'
Compensalion Insurance. or a ce�ilie0 coOY ��ereol (Seci 3800. Lab. C�.
PoLICY NO.: EIIP. ORTE:
COMPANV:
1 � Cetli�ietl copY is hereby turtlis�ed. ❑ Cenilietl copy is IileU wiih I�e city Builaing Divisian.
oate: Applicant
EXEMPTION FflOM WOflNEflS' COMPENSRTIQN DECUMTION: (IDis sec�ion nee0 not �e complete0 if ihe permil is lor one hunAreA �f10U) or less�.
I cenily ihat in Ine peAormance ol Ihe wark lor whicn Ihis permii is iss�t emp�oy any perso� manner so as ta Uecame
su61ec1 t t�e Worker5' CAmpenSation Laws af Calilomia. YI /
/AI n ��.
�pt¢; SipnaWre: ���1l�v�
NOTICE: I. afler making ihi5 Oeclaralion, you s�oultl come suejec� to tne warkers' ComDenu�ion prov ' I I�e Labor
CoOe. you mu5i totlhwrth c�mply wii� 5uth prOvisio or Ihis Oermit S�all be tleemed revokeC.
LONSTNUCTION IENUING RGENCY: I hereby allirm lha� there is a constmction lentling agency lor ��e edor nce o� Ihe xrork lOr
w�ic� ��is permil is iuuetl (SecUon 3097. Civ. C�.
LFNOEB:
pODNESS:
OWNEB BUILOEB UECIABRTIUN: I here�y affirm Ihat I am exemp� irom Ihe Contractors' State License Law for t�e following reason
(Section 7031.5 Business ana Pro�e55i0nal COtl¢: Hny ciry o� counry which r¢qUires a permit �o con5irud, al�er, im0�ove, Oemolis�, o�
re0air any simclure, pdor lo its issuance, also requires ehe aD�licant for such permit to file a siAnea statemenl t�at he/she is licensetl
pursuan� to �he provisions ol the Lonlraclors' S1aie license Law �C�apter 9(commencing with Section 7000) of Division 3 0l �Ae Business
ana Pmleisi0n5 Cotle) or Ihai hel5�e i5 exempi Iherefmm an0 Ihe Ua5i51or Ihe allege0 exemOtion. My violati0n of Setlion 7031.5 by
� any aD����canl 5or a Dermit sublecis ihe applkanl lo a t'r�nf Denally ot not mort tiWn tire huntl(eE OWlars �SSW).
I, as owner of ihe proDertY e� mY emVloyees with waAes as IM1eir mte compensation, will Ea the vrork, antl l�e
❑ stmcmre is not inten0e0 0� a��e�eA �or sale (Secuon 7044, Busineu anA Pmtessional Caee: i Ae Contracmrs' State license Law
Gces not appry to an owner ol a pmpeny wlw OvilOs or impmves there0�. and who does suc� vmrk �imself/herself or IhrouAh
his or ner own employees, OroviEee tAat such impmvemems are not mtentlea or aiferea lor sale. II, however ihe builUing or
improvement is soltl with�n one year 01 tompletion. Ihe owner will have Ihe burEen ol provinp �e/s�e tlitl noi builJ or impmve
lor Ihe purpose ot sale�. -
I, as owner of ihe propetlY. am e�clusively coniracting with licensetl conlractors to constNct Ille Dmlect (Section 7044, Business
❑ anU Pmfessions Cotle'. The Conlractors' State License Law Ooes not aDPty to an owner oi pmpeny who builtls ar improves thereon
and who conVacts for such pmletis with a contractor(s) license pursuam m the ConVactars' Sta�e license Law). I am aware
Iha� proo� of �heir Worke� 5 Compen5aiion insurance ShoNJ Oe providetl lo me.
� I am exempl untler Section: B. d P. C.
lar Ihis r¢ason:
Date: Owner.
i Ao �ere�y cenily ihat I am aware ol anU unAerstan0 t�e requiremenis of Califomia Health and Salery COGe Sections 25505, 25533, an0
25534 antl I�a� I or any luture bui�tling occupanl willlwill not (circle one) neetl �o comply with said Slaie cotl¢5 an0 ��e �equiremen[5 �or a
permil lor conslmciion or motli�i[.alion Irom the Fir Ouality Managemen� �is�rict. Aesidenlial consiruction aDDlicaiions are exemp� /mm
Ihese pmvisians.
Oale: AOVlicanC
I here�y cerlilyl�ai Ihave read IbiS apD�itaiion antl Sla�e �ha�ihe abOv¢ inlormaiioni5 Correti. I aqre¢Io compty vri�h all cily an0 tounry
orCinances an0 slate laws relaiing lo EuilQinq CMSVutiion ana llert�y aNM�e reprESEntatives o� tN5 ary �o en�er upOn IAe alpve-menfion¢C
pmoeny 1 insDeclion ourpases, � � ��,�S��Q/ (�
1
R$ie: ot. SignaWre: S1'i1" �'.�l i�,Pl \
od�ers �kense or sociai Securi�y x:
164La8 Whi�e—Builtling: Grei�—CoOo Enlorcemene, Canary—Applicanl: Pink—Revenue; Goltlenrotl—Assessor
CITY OF COSTA M6SA — BUILDING PERMIT �x ; �
PERMIT NO;;B. 058872 PLAN CHECK NO: N t� •
, _. -
CONSTRUCTION TYP ; PERMIT TYPE; STR PURPOSE; ALT
JOB DESCRIPTION ; T/OFF RESHT, REROOF W/BUILT UP SQ FT; 2,100
CLAIM VALUE: 2,100,00 CALC—VALUE; 2,100.00 GROUP OCC: B-2 /
COMMENTS; "FAULKNEH LAWN MOWER SHOP"
+t�r*�x*�t**�r*�*�x�t�t�r*�** �*-x �*��a��c ***� *� *******x *�***x�e�**�c�ex**+e�tx�***t�*�** �+e�*+t***
Z O N T N GS ERT�H�AUCS�RSE M E N'f 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 RGHT; FT IN
PARKING REQ PROV; PARCEL; 42230115 ZNE: REF NO;
PLANNING NC7�'ES>
��� � �
1F 1! iElf !E iE 1E iE iE 1E 1k k!E 1E iklE ih if �%iE iE 1E if 1E it iE iE iE iElk iE 1E iE iE iF iE 3E IF 1ElE �E ff 1E iE iF iE i! if it iE if �E iE if iE it 1t iE ik ff 3! iF �EiEif i! iE i! �if ik 1E i! 3F if if iE iE if
D E V EwL O P M E N T S E R V I C E S R E Q U I R E M E NCT S
ZONING APPROVE�D BY DATE: `��.
BUILDING APPROVED BY ; DATE: �1
APPLICATION ISSUED BY; • DATE; �
1FiiiEffiFlEiFiFlEiElEiElfiE�F'1FlFIE1EiE1ElE � �E�liEiFlf3fiE1E1FiF iEiE
itffiFitlEiElElElE�ElfifiElfifiFlEiElFltiFlEiEiElfiElkiEitftlEiflkiflfiFitiEifiliEfk lEiElFiElEiEiElEiFiEiFiFkfkiEiflEif�fiklEiEiEil'SEiE3EiEifiF�IEaEiEif
LEGALIZATION;N F E E S U M A R Y STRUCTURAL`SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 54.00
PLAN SMIP/NON�—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 54.50 0.00 0.00 59.50 54,50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 59.50 OVER/SHORT; 00
BLD54P00 pLUMBING ELECTRIC MECHANIC FIRE SMIP/TO�T GRADING PLAN—CHECK
1E iE iF i6 iE iE i61F if if iF if iF �t 1E if �E iE iEiE iE iE iE iE �F if ih 3E jf fE iE �F iF iE iE iF iF �ElF iF �E �t iFiF if iF iF�E 3FiF ik iF iF iF�161t 1k iE 1E if iE iE IF iF ik aF iP ik it iF iE iF if iE if if iE 3F k
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
SFC 2100 REROOF BY VALUE COMMERCIAL NOZONE I.00 Z,100,00
END OF FjEES
�
�
�; ��ria::�: -1.;�-;,,� --_: , ,
,iL u";��t/;� .iL .:�z
CONSTRUCTION ANDPLANNING ' POOL ?A I
�� APPROVALS Permit# Date inspector APPROVALS Permit# Date Inspector
i
1. Temporary Electrical Service or PoYe - 52. Pool & Equipment Location
2. Soil Pipe-Undrgmd. �• `' ' 53. Steel Reintorcement .
3. Electrical Conduit UtilitV-Undfgrnd. ° 54. Forms
4. ElectriCal Conduit�Undrgrnd. 55. Electrical Bonding
� 5. Steel Reinforcemertt � 56. Rough Piumhing & Pressure Test
6. Electrical UfER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. E�ectrical Conduit-Undrgmd.
8. Foundation ,� "�" 59. Gas Pipe, � Undrgrnd., Test --•
9. Water Pipe�Undrgmd. � - - 60. Backwash Lines, P�Trap, O Undrgmd. •
10. Structural Floor System �� . � 61. APPROVAL TO DECK
11. Property Sewer Line & House-"Connection - 62. Backwash & Receptor-Fina�
12. Sewer Cap , 63. Heater & Vent•Final -
73. Roof �rains ��t 64. Plumbing System - Final
14. Rough Plumbing .. .� 65. Electrical-Final
15. Rough Electrica7-Conduii •.� ! '
,� 66. Solar System-Final .,
76. Rough Electric Wiri�g . 67. Fencing & Access ApP*ovat �� '
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT
20.' Rough FactoTy rirepVace ' " - APPAOVAIS, Permit #
21. Ducis, �n Structure. . . � _ . � � 70. Underground Hydro
22. Ducts, Ventilating �� ` , 71. Product.Piping OGas ❑Oil
23.'GaS Pipe�Rough &'�est - � - 72. Underground Flush � Y
24::Roof Framing - ••;r i 1 M_73. Undergrnd. Srorage Tdnk O Gas ❑ Oii
?�5' RQoJ Shgathing ' " S:. �� � � '�' ' 74. Overhead Hydro '
26. .T�Bar Ceiling iStructural) & Monocoat 75. Dry Chemical -
i.
27. Frame and Flashing 76. Dry Standpipe ' �
28;MI�athing & Siding • • 77. FIXED SYSTEM FINAL
29. Insulatibn .� : .�, � 78. FIRE PflEV. FINAI.
30. Drywall Nailing �' ' HEALTH DEPT. REQUIREMENT
31. Plaster Brosvn Coat � -%�I. 79. FINAL INSPECTION -
� +- - _
32. Electrical Power Meter�Final (', ' 80. FOOD CERTIFICATE ISSUED
�
33. Pinal Electric � � �;�� � Notes: "
'34. Final Heating & Air Conditioning„ .~. I� �.. , -
35. Fi�al Gas Pipe-Te:t . , : �
36. Hood or,Canopy I ; ;� ~ � .
37. �Final Factory Pireplace ' I �� � .� .•
38. Final Plumbing • � �
1
39. Water 5ervice�Fina1 �
40. Gas Serv�ce-Final � � .
41. Solar pomesticFinal � � � �
42. Backfld�' Preventer � ! �
43. Backflow irrigation� � ,
44. Landseape Irrigation System _ _ . . -
45. Sound Attenuation
46. ,HandiUP Regulations � �
47. FINAL STRUCTURE & BUPLDING ����NZ �W�'_ �
I
48. FINALPLANNING � - �-�
49. Electric Release to Edison � �� ��
50. Gas Release to Southern California Gas Co � �.� '
51. CERTIFICATE OF OCCUPANCY i
No. Date
r�
:� �� .. :05 ��J a�_.j���� 6��L���"� �
� u�
�OSTA MESA BUILDING DEPARTMENT
`. °. B°X "' .FINANCE DEPT. �� �
COSTA MESA. GALIFORNIA
r,�Tv n� r,psTa raEsa
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING � BUILDING
A�DRE55
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
, PECEIPT NO. P/EPMIT NO
OW N E .// ((%��
MAIL AE EIV'O BY OiTE }ECEI O<TE ISSU
nnnaccc.�_'i/� �%..i.. �.. fi%.�.. �� � 2 //n tis% � L�o �
ARCHITECT
OR ENGINEER
ADDRE55'�
LEGPL
DESCflIPT10��
A.P. NO. /
USE OF
E%ISTING BLOG.
$ETBACN LINE Ff10M
CENTEN OF STREET
NEW
EXTERIOR W,
COVERING
USE OF NEW
BUILOING
a��E �.a �1 � , TNO.
LIC.
NO.
�7��.� 1 b 9 Y �
� � CITV LIC.
!i�ir�%jri,snr� No. h�
� . n�. No:�.�
BLOCK TRAC
— So _ o
� � \�� NO.OF BLOGB.
J �IOW ON LOT
�♦
�p i [
i_Y. REAR YARD L
DESCRIPTION OF WORK
AITERATION x ADDITION
MOVING DEMOLISN
� NO.OF
' / ROOMS STORIES
��r ROOF �GY S/'1
—JtIALL� COVERING
Q�di'e.7//� S�. ,-„
FIRE
20NE�
20NE�
� �i y w r� t=
COSTA MESA. CALIFORNIA
��i�I C1%'�"' f� {a DATE /�//
Y�
CORRECTIONS
:�h � v..I
CiTY 0:= �. STA *d.r'..�iA
�T,i , . . �.—n—
SUCJ�Ci :O I D�. UEPT. RECv.
STATE TH�T TME �90VE IS CORFECT AND RGREE TO COMPLY WITX �LL
CITV OR�INRNCES �ND ST4TE L�WS FEGULITING BU�LOING CONSTFUC�
iioH. VALUATION
�
SIGNATURE O
PERMITTEE � �
S�Z�� \
AUTHORIZED AGENT
PERMIT FEE $ d �
PLAN CHECK 5 y`�
TOTAL FEE S /.L"''
9"'
�- V���
C�STA tviESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPUCANT TO F/LL /N COMPLETfLY
TYPE OR PRINT
BUILDING l
ADpRESS � � Z < !-
OSTA MESA, CALIFORNIA
OWNER �S�C��,
MAIL � . . '- . .. _ _ _
r.
DESCRIPTION I NOT I BLOCK I TRA
A.P. NO. � J �! a./—
SIZE ,/ �NO.OF B�.DGS.
OF LOT �_� �/j ��S NOW ON LOT
USE OF
EXISTING BLDG. /�
SETBACK LINE FROM
ceHtea op srne['r REAR YARD
/ 4 ! /�
SIDE YARD LEFT — RIGHT �rj
DESCRIPTION OF WORK
REPAIR I IIMOVING I II
BUILDING. �`//��ROOMS
s��E . i-� % 3, /
EXTERIOR WALf� ( ROOF {
COVERING 7/{�CCO COVERING /
US OF,BUILD N AND WORK TO BE PER
i� _ 1 ll �L :% [7 .
�
�I HEREBY AGItNOWLBOGE THAT I HAVE READ TH`5 APPLICATION
AND STATE THNT TH6 ABOVE IS CORREGT ANO AGpEE TO COM�
PLY WITN ALL CITY OPDINANCES RND STATE LAWS REGULM1TING
BUILUINGCONSTFUCT�ON^�.,� ��,.
' AUTHORIZED AGENT
�
� � ������`''�l
� 1",� /. �. . I
� ��ao f� ����,
FI;!:�,�,��;E DEPI.
���� I� :�n�Ti d�I.�'�.
APPLICATION FOR PERMIT
BUILDING
FOR OfF/CE USE ONCY
I REGEIV� NO. I PEflMIT NO.
/DZ/�
BUILDING •
A�DRE55
COSTA MESA. CALIFORNIA
FIRE 7—
ZONF TVPF I . (]ROIIP • �
APPROVED
�ONING
NO. OF I USE OP NEW
PLANB � BUILOING
(CENTER LINE STJ
(o aiOp"�'y ��S
TME AMOUNT BHOWN UNDER VqLUATION 19 FOH THE
PURPOBE OF ESTABLIBHING A PERMIT Ffi6 ONLY,
VAlUAT10N ) �
PERMIT FEE S �p�i —
$ '3/ �J O J PLAN CHECK S �p �
TOTAL FEE S � O
�'7 5 (3
���'G'j' �° f�a-7f�
5e 5�
'LOSTA MESA BUI LDIN(i-SAht t Y UtYAFi I MtN I �' 1� '
_� ��� P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
P A ON FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
E E ED V DATE RECEIVED D E SU
ADDRESS �� "�'U �� JT � � �
'%� �/ ,L� PEp M1T Q�
OWNER (/D�(ii�p // O/��S A.P. NO. � (•., "
MAI l BUILDIN �
ADDRESS ADDRESS (
CITV`OS'%y¢ �I�SR� Na��6YS-5175 TFACT -/COT� BLO
COKSTRUCTION W '�` P
LENDER
BRANCH
OWNER L ���
ADDRESS d VALUE ��
ARCMITECT TEL. Nr•/TLr g
OR ENGINE R
i1RE F /1
ADDRESS ZONE T E GROUP L�
CONTRACTOR ��e � U L� < Bv A�VED OATE �����
ADDRESS
TEL. ZON NO.OF USE OF NEW
CITV ' NO.
PLAtS BUILDING
� STATE CITV `�AFDSAVPROVED VAROSAPPROVED
i LIC. NO. - UC. NO. MAIN BUILDING ACCESSORV BUILDING
{,yI
SIZE NO.OF BLDGS (FROM C/L ST� T)
6. OF LOT NOW ON LOT
a USE OF
,.�. E%ISTINGBLDG OF��C'L S�OW'R�O�
T� T
�
F SeFarate permits are required for L SIDE � cr.
� electric, plumbing and heating work. REAR FT. FT.
[..i USE OF BUILDING AND WOqK TO BE PERFORMED DISTANCE BET. BET. N&
Q MAIN BLOGS. ACCEa. BLOGS.
, GF'Ficc Se eaa��.a6 �P�f-H"�ov VAR3W onre
a C.U.P.�. AWROVED
� � '1 I � p APPR D
� �
`7 I
a
m
0 I haraby aeknowletlBe thei I have �eatl thls application entl stnte
y� that the above (nformatlon is eorreet and agree to comply wIM
�+ all lews reBulatinB building construction, entl I shell not employ
Wany penon In violatlon of tha workman's compensation laws of
,� Me State of California.
3 1 hereb ca�tlf that I am SQ. FT.
y y properly Ilcensed as a cont�actor untler
Me Stete of Calitornle Bueiness antl Professions Cotle, Division 3, THE AMOUNTSHOWN UNDER VALUATION IS FOR
Chapte� 9, entl that zuch Ilcanses ere in full force antl effact, or I THE PURPOSE OF ESTABL6HING A PERMIT FEE ONLV:
am exempt from Me provlsions o7 the State of Celifornia Buslness VALVATION PERMIT FEE E
end Professlons C e, Division 3, Chapter 9 /n/ ��
SIBnBtu10 0} �,���'�j?,/��]//„ j�' _^ � P�N CHECK S
ParmiKee � l�� ������ � $� TAX S �%
AuthorizeEApent TOTALPAID S �