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(714) 754-5273 • Fex (714) 754-4858 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
EIECTRICAL PERMIT
Job Adtlress:
Suite No
Vicinity:
Parcel Nunmber:
845 W 19TH ST
42419107
.4pp�icant: PRAUM, STEVE
Address: 1049 MELROSE � �
�
' �/ ''- ' Phone: (714)231-7501 � ,
i',/�;�,.- - . i
PLACENTIA, CA� �� � . Zip: 92887 ,
� / , . ,
, / , . .
Owner: , BOECKMAN, CAROLYN SUE TR
� ,,._
Address'iiPAUL TRAUTVJEIN�,TRUST� '
� �, REDDING,CA '- � Phone:
�
� 536 AURORA BC Zip: 96001-0100
, �. " � ,' i=,
Contractor: ORANGE ELECTRICAL CONTRACTORS
Atldress: 1049 MELROSE � .
PLACENTIA, CA
. � - AhOne: (714j980.2300
' Zip: 92887
- License: 747129
Status: ISSUED
Applied: O6/OS/2003
Issued: O6/O6l2003
ISSUED BY:
. SCOPE OF PERMIT
CONVERT EXISTING OVERHEAD ELECTRICAL SERVICE TO UNDERGROUND FEED.
duantiry
ISSUE FEE $0.00 �
Temp service test $0.00
� Res. a/c package $0.00 �
New Res (1-2 units). `, , $0.00 ,
New�Res (3*unifs) � $0.00
Pool I Spa- '-� � � �� �, $0.00
Lightlng Fixts . �$0.00
Recept Outlets . -� 30.00
Switches . � ' �.$0.00 ,
Non Res Appl � � , -� 50:00� �
Res Appl ,-'� , -, $0.00 � �� ;
Service to 2QOa $183.00 �
Service to 1QOOa �� �.� � 50.00
Serviceover1000a`,� $0.00
MOlOrS t01hp V �- � $0.00�� '
Motors to 10hp \ $0.00- ` � .
Motors to SOhp � $0.00
Mo�ors ro,00np ao.00
Motors over t00hp $0.00. �
Communiption drops 50.00 � -
Sub panel to 200a E0.00
Pole Light Pkg $0.00
Sign Circuits SO.pp
0
0
0
0
0
0
0
0
�8
0
0
0.
0,'.
0
0.
0
0 ;
�' ,
0
0
FEE SUMMARY ,
� Temp Dist System / Lighting
Busway,/100 k
Standing Sectlon �
Misc ElecMcabEquipment
. Transtormers up to 1 kva/kw
` . ,� � .:: �:. �........up to 10 kva/kw
.. .
: , �. . � .................up to 50 kva/kw
.................up to 100 kvalkw
. ....i .............over 100 kva/kw �.
Low Voltage Equipmenl �
� -Low Volt Wiring System / Ckt
� Misc. Conduit �,
Misc. Conductor .
_ Circus ( gen or ride)
Circus (mech ride"or lights)
Christmas Tree Stand , '.
� Fireworks Stand ,
' Other Electrical Fee � .
Quantity
$0.00 0
50.00 0.
ao.00 o'
$18.20 1
$0.00 . 0
$0.00 0
$0.00; ; 0
$0.00 �-� 0 .
$0.00, 0
ao,00 o
$0.00 � 0
ao.00 0
ao.00 0
E0.00 0
$0.00 : 0 �
50.00 0'
$0.00 � 0
ao:oo
��
Inves68ation Fee " 50.00
� Plan Check Fee � �� 50.00
_ReinspectionFee 50.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92•28, § 1, 1241-92)
EXPIRATION: This permit shali automatically expire and become void if work is not commenced within 1 BO days, or If work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all eppUcable codes, and all
requlred Inspeetlona end flnel approval must be obtained. Fallure to obtain Inspections and final approval will result in the expiration ol this pertnit.
FOR INSVECTIONS CALL: (714) 7545628
zaae-ae �arao�
WORKERS' COMPENSAnON DECLAFiATON: �
I hereDy eflirtn unAer penalry of per�ury one of iha following declarations:
❑ 1 �ave end wlll maintein a certlflcete of consent ta salt-Insure for warkers' compensetlon, es providetl tor by section 3700 af Ihe Lebor Cotle, for Ihe pertormence of the
�work for w�ich IhiS pertnll is IssueO.
I heva end will maintein woAcera' compensetlon Insurence, as required by section 3700 of the Lebor Code, for Ihe peAormance oi Ihe work lor whkh Nis permlt Is Issued.
My worke campensetlon Insurence carder end poliry number ere:
Certier. � A�� � �% 7 PWIry Number. �I �L9 �e
(fils secUrn need not be completed tl fhe pe�m/t ls ve/ue0 ef one hundred dWlers (5100) o� IessJ
❑ 1 certity that in the peAo ce ol Ihe work for wNch t�is pertnit U Issued, I shall not employ eny person In eny manner so es to becwne subfect to the workere'
campensetlon laws ol Gal la, e�d egrea t�at N I ahoulA become subject lo Ne workers' compensatlon proNsions of Sectlon 3700 oi Ihe Lebor Cotle, I shell fanhwlth
cwnPN wiih these provLsio . II 1/
Applicam Slgneture: A Y Date: �q-�;
�.I
WARNINO: FNLURE TO SECURE WORKERS' COMPENSATION COVEMOE IS UtQAWFUL ANO SHAl1 SUBJECT M! EMPLOYER TO CRIMINqL PENALTIES ANDGVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLAFE (Et00,OW). IN AODITKKJ TO THE COST OF COMPENSATION, OAMFGES A$ PROVIDED f-0R IN SECTION 31O80F TiE IABOR CODE, INfEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I �ereDy aNirtn that I am Iicensed under provisionsq Cr�p r 9(commendng with SecUon 7000) of Division 3 oi Ue Buslness and Professions CoOe, flnd my Iicense is in full
io�� a�a ee�. uo. x '141� Z9 V Y�1 ae� a
Contractors5lgnature: i Date: f,-9-0
CONSTiiUCT10N LENDING AGENCV:
❑ I hereby aKrm thet there Is e construction lending egancy tor lhe peAortnance ol the work for whlch Ihis permit is Issued. (Sec. 3097, Civil Code).
Lentlels Neme: Lenders Address:
Sipnelure: Date:
OWNER-BUILDER DECLARATIONS:
I herehy eMirtn that under penalry af per�ury that I em EAEMPT FROM THE COHTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Prolessions
Code: My ciry or munry which requires e pertnil to construct, elter, improve, tlemdis�, or reDelr eny siructure, pnor lo Its Issuance, elso requires Ihe applicent far such pertnit
to flle e signed statement Ihat he or sha is Iicansetl pursuent to the proNsiore oi tha Conirectors lJcense Lew (Chapter 8(commendnp w0h Section 7000) 01 Dlvlslon 3 0l Ne
Business end Professions Code) or Ihet he or she is exempt iherelrom end Iha basis far the elleged exemption. Any Nolation of Sectlon 7037.5 by eny eppllcant for e pertnit
subJects the epplicant to e civll penelty ol not more than five hundretl tlollars ($500).):
❑ I, es owner of the property, or my emplayees with wages es thair sole compensetion, WILL DO THE WOFK, end t�e structure is not intendetl or oHaretl for sale (Sec.
7044, Business and ProleSslons Cade: The Conirectors License Lew does not apply to an owner of property who builds or Improves Ihereon, and who does such work
himsetl or hereetl or through �is or her own employees, provided Ihet such improvements ere no� intended or oflered for sele. It, however, Ihe building or improvement is
sold vrit�in one year ot completion, the ownerbuilder will heve.t�e burden ot proving tha� he or she ditl nm build or improve br purpose of selaJ. �
� I, as owner of the property, em EICCLUSIVELV CONTRACTING WITH LICENSED CONTRACTOHS to consiruct the prqect (Sec. 7044, Business end Pmtessions
Cotle: The cantractors License Lew does not eppty lo en owner ol property w�o bullds or Improves thereon, end who conlrects lar such pro�ed wit� e conirector(s)
Iicense pursuant to the Contrectors License Wws.).
❑ 1 em exempt under sec.
Slgnature:
Owner ID vedfied by drNefs Iicense. ❑ Ves ❑ No
Business and Professions Code lor Ihis reason:
Vedllcation of Ownership by (rype ot tlocument, I.e. - property �a�c olll or aeetl):
Drivefs lJcense Na.
Date:
E�ires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
❑ I �ereby ceNty ihat no excevatlon flve (5) or more teet In depth Imo which a person Is requlreC to Oescend, wlll be mede In tonnectlon vrith work authodzed by this
pertnit, antl that no builtlinp structure, scattoldinp, telsework, or demdition a dismentling thereof, wlll be more then thirty�six (38) feet high. (Chap. 3.2, Orp 2, Art 2, Sec.
341, Title 8, Calllomia Administretive Cade).
❑ As ov.ner-builder, I will na� employ enyone to do work which would require e permit Irom Ihe DMsian oi Industrial Selery, es noted ebove, unless such persan hes e
permit to tlo such work Irom Ihe division.
Signature: Date:
Division of Indusirial Sefery Permlt Number:
CERTIFlCATE OF COMPIJIWCE AND AllT}IORIZATION OF ENTHY: I cenity under penalry of perjury Ihal I have reetl this epplication antl state Ihet the Iniormatlon given is
correa. I egree to ompty with ell atete lews end ciry ortllnances reletlng to Ouiltling constructlon, end euthodze representetives of t�e Ciry ot Costa Mesa ro enter upan the
ebove-d85crlbed pr erry f r Inspectlon purposes. I egree no� to occupy or ellow occupency ot eny building euthonzed by this permit until final Inspectlon.
SI eture OI Legal Owner(s) Date
6-�-��
MNOr Authorized Applicant Date
eooe r. ixsvernoxme � PAiE It�kS
1678 Fixed System Pinal Fire Preventlon
1266
200
201
Pad Spe Final
Finel RaRoot
Finel BlocklRetaining Well
COOEI INSPECTIONTYPE
20G Final Mechaniwl
208 Final Plumbing
210 'Final Electricel
212 Final Flre Preventlan
202 Final FeMory Fire Place 220 Final Plenning Approval
203 Final Sign 222 Final Site
20a Fi�l Demdition � 250 Flnel Builtling�Occupern.y
�
��
1t�Li
(71a) 754-5273 • Fax (77a) 754-a856 • www.ci.costa-mesa.ca.us
MECHANICAL PERMIT
Job Address: 845 W 19TH ST
Suite No
Vicinity:
Parcel Number: 42419107
Appliwnt: LOHMANN,JOHN
Address: 18732 FAIRWOOD LN
SANTA ANA
Owner: TRAUTWEIN, PAUL TR
Address: , °hL & M PROPERTY MGNT
NEWPORT BEACH,CA
1617 WESTCLIFF DR #112
Contractor: TRI CITIES REFRIGERATION
Address: 18732 FAIRWOOD LN
ISSUED BY:
Phone: 714-771-1988
Zip: 92705
Phone:
Zip: 92660
' � � Phone: 714-771'-1988
SANTA ANA . Zip: 92705
License: 530299
Arch I Eng :
Address:
Phone:
. Zip:
. - - License: � - � �
SCOPE OF PERMIT -
INSTALL 1 EVAP. COOLER, REF B00-01253.
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >700 k BTU
Repair / Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust �
VAV Box
Vent Fan / Single Dud '
Appliance � '
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < t0000cfrn
AirHandlers> t0000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
$o.00
$0.00
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Repair I All Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System ;
. . �. Evaporetive Cooler �
� Commercial Incinerator "�
Dortiestic Incinerator �-
Compressors / Absorption Svstems' .
Upto3hpl100kBTU-- . �
3 To 15 hp I 500 k BTU
15To30hp/1,OOOkBTU� - �
30 To 50 hp / 7,750 k BTU � .��"
� Over 50 hp / Over 7;75o BTU " ���
Boilers � ;�.� , .�<: .
Up to 3 hp
3Toi5hp ," -
15to30hp , ,
30 to 50 hp , . �
Over 50 hp , "
Other Mechanical Fee � -
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 09I262000
Issued: 0926R000
�uanqty
E0.00 0
$0.00 0
$0.00 ' 0
$10.65 1
E0.00 0
E0.00 . 0
50.00 0
50.00 0
$0.00 0
� , : $0.00 0
�� ;50.00 0
/
30.00 0
so.ao 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
50.00
E3a.15
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatirally expire and become void if work is not commenced within 180 days, or il work is suspended or abandoned
br a period of 180 days. -
INSPECTIONS: In order for the work autharized untler this permit to be considered legal, such work must comply with all applicable codas, and al�
requlred Inapections end final approvel must be obtained. Failure to oblain inspections and tinal approval will result in �he expiration o1 �his permit.
FOR INSPECTIONS CALL: (714) 7545626
2ae&a8 (8/00l
WORKERS' COMPENSATON DECLAAA110N: �
I here�y aXirtn under penalry ot perjury ona o� Ne fdbwirg dedarations: "
❑ I heve end will mafntain e certiflcate o1 consent ro sell-Insure tor workers' compenseUon, as provided br by section 3700 oi the Lebor CoOe, for Ne pertarmance ot Ne
work tor which this permit is iuuetl.
❑ I hava end will maUitein wwkers' compensation insurence. as requiretl by secUon 3700 of Ihe LaGor Code. for Ne peAortnance oi the work fa whkh this pertNt is issued.
My workers' compensatlon Insurance wrr�er entl pollq number are:
Cartler:
(Thls s1
Policy Number.
orless.J
I.cetlily that in the Dertortnance of Ihe M'ork far which this pertnit is issueq I shell not employ any person in any menner so es to hecome su6�ect to Ihe workers'
compensetion laws oi Iltomia, enC egree Ihat It I s�oultl become subject to the workers' compensatlon provlslons ol Section 3700 ot Ihe Le6or Code, 1 shall larthwlih
comply with these p slon / � Gj �7
am Simiemre:� �--� /1 � ; " Date:_ �/ — d G — ��
IN6:FNLURE RE WORKER C ENSAP CZCOVFJUOE IS UNLAW R1L M!D SWLLL SUBIECT Ml EMPLOYER TO CRIMINAL PENr1LTIE5 AfJD CML FlNES UP TOONE MUNDRED
iAND DOLLA � OO.ODO). IN ADDITIp1 O THE CO^.aT OF COMPENSATION. DAAIAGE$ p4 PROVIOED FOR IN SECTION 3]OB OF THE UBIXi CODE, INTERE$T. AND ATfORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
by afllrtn t�a� �am lice der pro sl o hepter 9(commencing with Section 7000) ot DiWsion 3 oldhe Business end Professions Catle, end my Iicense Is In full
e�a exec�. u�. a �ciass a�G— � 8.N / e,
ac�s:Slgnatur� �Oete: �=�li — C70
♦�
iTAUCTION LE NG AGENCY: ' � � ---�
I hereby alfirm ihat t�ere is e consiruction lending agency br Ue pedortnance ot t�e work for whic� this permit is iuued. (Sec. 3097, Civil CoOe).
Lontlef9 Neme:
Slgnature: _
OWNER•BUILDER DECLARATIONS:
Lentlefs Atldress:
Date:
I hereby eNirm that under penelry oi perjury �het I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professlons
Code: Any ciry or counry which requires e permil to construct, alter, improve, demolish, or repair any strucWre, D�ior to its issuance, elso raquires the eppliwN fw such pertnit
ro fila e slgnetl sWtement ihet he or she is IlcenseO pursuam ro Ihe proWsions of Ihe Contrectoro lJcense Lew (Chapter B(commenUng wlih Sectlon 7000) oi DNLsion 3 of Ne
Business and Pmfessions Gode) or Nat �e or she is exempt Iherefrwn and Ne basis for the ellegeO axemption. Any Nolatlon ot Section 7037.5 by eny applicant for a pertnN
subJecis the applicant to e dvil penalty at no� more than frve huntlred ddlare (S500j.j:
❑ I, es owner ol t�e property, or my emp�oyees wIU wages es their sole compensatlon, WILL UO THE WORK, antl the structure is noi intended or oflered br sela (Sec.
7044, Business and Professlons CoOe: The ContreMors License law dces not appy to en owner ot properry who builds or imprrnes ihereon, antl who does such work
himselt or herself or ihrough his or her own employees, provitled that such imprwemenis are not Intendetl or oHered far sale. If, however, Ihe bullEing or improvement is
soltl within one year o1 wmpletion, Ihe �'�erbuilder will have t�e burtlen of pmving thai he or she did not builtl or impmva tor puryose ol sale.�.
❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING WRH LICENSED CONTRACTOHS lo consiruct the prolect (Sec. 7044, Business an0 Profeuions
CoCe: 71ie conirectors Ucanse Law tloes not appy to an owner oi property who Dullds or Improves thereon, end who contrects lor such projed with a contractor(s)
license pursuant to t�e CoMractors LiGense Lews.).
❑ I em exempt under sec.
Slgnature:
Owner ID verifietl hy drivefs license. ❑ Yes ❑ No
Business antl Professions Code for this reeson:
Vedllcetion ot Ownership by (rype at tlocuma�t, i.e. - propeny teu bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMR CER7IFICATION:
Orivefs Licensa No.
Date:
Expires:
❑ I hereby certify Ihet no excavatlon five (5) or more feet In depth inta which a person Is requlred to descen4 will be mede In conneqion wit� work euthorized by Ihis
pertnit, end thel no building sWCNre, swNoltling, lalsework, or demoli�ion or tlismentling thereot, will 6e more Ihan ihlrty-six (38) feet high. (C�flp. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Celifomia Administrative Cade).
� As owner-Duilder, I will not employ enywie to tlo work which woultl require e pertnit from the Division of Inaustnel Sefery, es noted ebove, unless auch person hes e
pertnit lo do such work from the division.
Signature: Date:
Division oi Indusinal Safary Pertnit Numher.
CERTIFlCATE OF COMPLIANCE AND AUiNOR¢A710N OF ENfAY: I certify under Denalry of perjury that I hevo read �his a0������on and state thet the informalion given is
correct. I agree to comply wlth ell stete laws end dry oNinences relating to building constructlon, antl authorize representetives of the Ciry ot Coste Mese ro enter upon the
ebove-describad property for inspection purposes. I egree not to occupy or allow occupency ol eny building euthoAzed by Ihis permit until linal inspectian.
PdIF It�Li
181fi Fixetl SyStem Final Fire Prevention
1288 Pool Spa Finel
200 Finel Re-Root
201 Flnel BIocWRetalning Well
202 Final Fettory Fire Place
20.3 Final Sign
204 Final Demolition
� — .� G oai00
° - — oeie— _
y00E� INSPECiqNME
208 Finel Mechanlcal
208 Final Plumbing
210 Final Electdcal
212 Final Flre Preventlon
220 Final Plenning Approvel
222 Finel Site
250 Final Bullding/Occupan�y
f �.
(7�a) 754-5273 • Faz (7�a) 75a-a856 • www.ci.costa-mesa.ca.us // hHIM UF1rvt, I.VJ ih mWh, �.n nmm
PLUMBING PERMIT
Job Address: 845 W 19TH ST
Suite No
Vicinity:
Parcel Nunmber: 42419107
Applicant: ROBERT OWEN
Address: 2218 LAUREL PL
NEWPORT BEACH, CA
Owner: . TRAUTWEIN, PAUL 7R
Address %L & M PROPERTY MGNT
NEWPORT BEACN,CA
. 7617 WESTCLIFF DR #112
Contrector: ROBERT OWEN BUILDING CO
Address: 2218 LAUREL PL
Arch / Eng :
Address:
NEWPORT BEACH, CA
Phone: (949)631-3820
Zip: 92663
Phone:
Zip: . 92660
Phone: (949)6373820
Zip: 92663
License: 471754
Phone:
Zip:
License:
SCOPE OF PERMIT
WATER PIPING, REF B00-07253 AND P00-00045.
ISSUE FEE
Backtlow irrigation
BackOow preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drein, Floor �
Drain, Rainwater
Drain, Rqof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Ov@r 4 outlets)
Gas Replpe
Gas Service
Interceptors (Grease, Oip
Interceptors (Sand Auto )
AMT
$7.25
50.00
$0.00
$0.00
S0.00
50.00
50.00
$0.00
$0.00
50.00
$0.00
$0.00
50.00
50.00
so.00
$0.00
$0.00
$0.00
50.00
$0.00
�TY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
AMT QTY
Laund'ry Tub I Washer $0.00 ,: 0
Landscapelrrigation $0.00 �0 -
P-Trap $0.00 0 - -�
Pressure Regulator $0.00 0
Process Piping (per10 ft) $0.00 0
��� Receptors $0.00 0
� Septic Tank 50.00 ' . 0 ' '
Sewer Cap for Demo _$0.00 0 �
SewerConnect $0.00 0 ,
Sewer Private Line , - : $0.00 0 �
Shower � � �$0.00 . 0 �
. Sink, bar $0.00 0 � �
Sink, wmmercial � $0.00 0 .-
Sink, Floor $0.00 0 "
Sink, kitchen $0.00 0
Sink, service/mop $0.00 0
Spa (private) $0.00 0
Spa (public) $0.00 0
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 09I07I2000
15sued: 09I07/2000
ISSUED BY: �
SumpPump
Swimming Pool .
Trap Primer '
Urinal '
� Vacuum Brkr Bkflow(1-0).�
� Vacuum Brkr Bkfiow(5+)
- Wash Basin '
� Wash Basin Set
Waste and Vent System
Water Closet (foilet)
Water Heater / vent
�Water Piping (Inst or Rep.)
- Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
50.00
ao.00
50.00
$0.00
50.00
50.00
$0.00
80.00
$0.00
80.00
$0.00
$9.80
$0.00
ao.00
80.00
$0.00
$0.00
$0.00
50.00
TOTAL CALCULATED FEES: 517.05
QTY
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
NOTICE; The work authorized,by this permit shall comply with all applicable hantlicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 9248, § 1, 1241-92)
EXPIRA710N: This permN shall automatically expire and become void if work is not commenced wilhin 1B0 days, or if work is suspended or abandoned
tor a period of 780 days.
INSPECTIONS: In order for the work authorized under this parmit to be considered legal, such work must comply wilh all applicable codes, and all
required inspeotions end final approvel must De obtained. Failure to obtain inspections and (inal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2448d8 (B�pp)
WORKERS' COMPENSATON DECIARATION: '
I hereby ettirtn untler penalry oi per�ury one of Ue fWlowing tledaretions:
❑ I �eve end wlll melntain e certificata of consent to sell-Insura tor woBers' compensation, es pmvidetl tor by section 3700 of the Le6or Code, br the peAormence of the
�work ior which this DB�it Is I�ued.
Ihave
CaMer.
(Tlils s�
ensatlon inwrance. es required by sectipn 3700 01 the Lebor Code, lor Ue peAortnenca of tl�e work for which NLs pgrmlt Is iswetl.
cartier and policy numbar ere:
� Policy Number.
... . . . . . . _ ._
one
o�less.J
❑ I cenify Ihat in Ne peAorman f If �e wor�-}pli.ihich Ihis pertnit is IssueA, l shell not employ an rson In eny menner so es to �ecome subJect to the workers'
compe ewSaFG II� �� tl e rSe Ule It I shaulA betWne sub�ect to t�e workere' roH5lons oi Settio 700 he Labor Code, I shell Iorthwlih
y with these proY nj���
Ilcant Slgnature: � —� �%�� C
ARNIN(3: FAILU SE� RE �ERS' WA�PFNSATIOM COVEMGE IS UNLAWFUL AND SMRLL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CM� FlNES UP TO ONE HUNDRED
(E100.OW� IN MWTIOM TO THE WST OF CqMENSATIpN, OAMr1GE5 A$ PROVIDED FOR IN SECTION 3]O6 pF THE UBOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED
C�apter 9(commencing with Sectian 7000) of�he Business en ro�sions Cade, end my Iicense is in fuli
i�i1095 N _1
/
L��
CONSifiUCT10N LENDING AGENCY:
❑ I here0y ettlrm Ihet Ihere is e wnsWctlon lending egency for the pertortnance of Ihe work for w�ich t�ls permit is is9ued. (Sec. 3097, Civil Catle).
Lendefs Neme: Lenders Addreu:
Sgnature:
OWNEH-BUILDER DECLARATIONS:
9ate:
I hereby attlrtn Ihet under penelcy ot perjury ihet I em El(EMPT FROM THE CONTRACTOFiS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Professlons
Cotle: My dry or counry which requires a pertnit to canstruct, elter, Improve, tlemdlsh, or repeir eny siructure, prior to Its issuence, elw requires the applicant ta such permil
to tile e signed statement that hB a� she Is Iicensed pursuant to Ne pmNsions of the Contractors License Lew (Chepier 9(wmmenGng wIU SecUan 7000) of DMsirn 3 of Ihe
Business and Pmtessions Code) ar that he or sha is esempt Uereirom and the basis lor Ue allegad exemptlon. Any vlolatlon of Sectlon 7031.5 by eny epplicent for a permit
subjects the eppllcant to e dvll penalry of not more than five hunOretl dollars (5500) J:
❑ I, as owner of Iha properry, or rtry employees vriN wages as their sde compensation, WILL DO THE WOHK, entl Ne structure is not Intended or oHered ta sele (Sec.
7044, Business and Professiwis Cotle: The Contrectors License Lew does not apPN �o an owner ot properry who builds or improves Ihereon, anA who does suc� work
himself or herselt or through his or her axn employaes, proviCed Ihat such imprwemenis ara not intentled or ottered for sale. It, however, the building or Imprwement is
sold within one year of completion, the owner-builtler will have Ihe burden oi proving that he or sha ditl not build or improve tor purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTAACTING WITH LICENSED CONTRACTORS to construct t�e project (Sec. 7044, Business an0 Professions
Cotle: TTe coniractors LJcense Law daes not appy to an ownar of property who bulids or Improves Nereon, end who coniracts br such project with a mntraaor(s)
license pureuent to the Coniractors Licensa Laws.).
❑ I em exempt under sec. Business antl Professions Catle lor ihis reeson:
Sign9�ur0: Date:
Owner ID verified by drivefs license. ❑ Ves ❑ No Driver's License No.
Verification of Owners�ip by (typB ot Cocument, i.e. - property tac bill or tleed):
DIVISION OF INDUS7RIAL SAF�' 7ERMR CERTIFlCATON:
E�cpires:
� I hereby certily thet no excA�atlon five (5) or more leet in tlepth Into which e person Is requlred lo descen4 will be mede In connection with work aulhoAzed by U�S
permit, and thel no builtling siructure, sceHolding, lalsework, or demolition or dismantlinp iheraof, will be more �hen �hirry-six (38) feet high. (Chep. 32, Grp 2, Ah 2, Sec.
341, Title B, Califomla Atlministrative Code).
❑ As owner-bullOer, I will not employ enyone to do work w�ich woultl require e pertnil lrom the Division o� Industrial Setey, es noted ebove, unless such perso� has e
pertnit to do such work trom the Civision.
Signetura: Dete:
Divislon ol Intluslrial Safery Permi� NumDer:
1 CERTIFlCATE OF CAMVUANCE �1D AUTNORVJITON OF EMRV: I cerUly under penelry oi perjury �hat I heve read Ihis epplication end state that Ihe informatlon given Is I
corted. I agree to compty wit� e0 stete isws anC clry otdlna+xes relatl� to building mnshuction, and authorize represanteGves ot lhe Ciry ot Coste Mesa tu ente� upun Ne
ebove-tlescribed praperry tor�speciicp purposes. I egree not to aaupy w allaw occupency of any building euthonzed by Ihis permil until final inspection.
COOE t. INSiECTWNTYPE
1616 Flxed System Final Fire P�eventlan
1268 Pool Spa Flnal
200 Final RaRool
201 FIneI BIocWRetelninp Wall
202 Final Fectory Fire Place
203 Finel Slgn
20d Finel DemWition
�$ f�QyE,( INSPECTIONTYPE
208 Finel Mechanical
20B Flnel Plumbing
210 Final Electrlcel
212 Final Flre Prevention
220 Final Planning Approval
222 Finel Sita
250 Final Bullding/Oxupency
� i
' _�!'7.,
i.iiii!IS
�
O M
t� �
0
J
••�� a,•'
p�a� �sa-svs • Fex (��a).�sa-aess
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPAATMEIST
PERMIT
PLUMSING PERMI7
,lob nddress: 845 W 19TH ST
Suite No A
Vicinity: UNITA
Parcel Nunmber: 424�9'107
Applicant: MAESE, JIM
Address: 454 COSTA MESA ST
COSTA MESA, CA .
\ . .
� '
owner:. TRAUTWEIN, PAUC 7R' �
Address ' %l & M PROPERTY NiGN7
' ' - NEWPORT BEACH,CA ,
, 1617 WESTCLIFF DR #112
Contracror. BAYSHORE PLUMBING
Address: 454 COSTA MESA ST
� COSTA MESA, CA - ��','
Arch / Eng :
Address:
Phone: (774)723-0806
Zip: 92627
Phone:
Zip: 92660
:: �
/
; � Phone:, (714)723-0806
Zip: 92627
License: 584702
Phone:
Zip:
_ �"License:. .
PERMIT NUMBER
P00-00045
77 FAIR DRIVE, COSTA MESA, CA 92626
��
ISSUED BY:
Status: ISSUED
Applied: 01/24/2000
Issued: 01/24/2000
SCOPE QF PERMIT %
� PLUMBING PERMIT FOR T.I. FOR -FAMOUS DONUTS- (UNIT A). INSTALL 6 GAS OUTLETS, 3
COMMERCIAL SINKS, 5 FLOOR SINKS, 1 WASH BASIN, & 1 WATER CLOSET.
REF:699-01253 � '
ISSUE FEE
Backflow irrigation
Backflow Preventer .
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Orain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (7-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceplors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
50:00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$6.15
$2.20
$0.00
50.00
$0.00
$0.00
0
QTY
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation ' $0.00
P-Trap � $0.00
Pressure Regulator $0.00
Process Piping (per 70 ft) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar - $0.00
Sink, commercial $2g.4p�
Sink, Floor $49.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
3
5
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
SumpPump
Swimming Paol
Trap Primer .
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum BrkrBkFlow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
07HER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
so.-oo
$0.�a
$0.00
$0.00
50.00
$0.00
$9.80
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
TOTAL CALCULATED FEES: §129.85
�
Qn
0
�
0
0
0
0
1
0
0
1
0
0
0
0
0
NOTICE: The work authorized by Ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within t80 days, or it wodc is suspended or abandoned
(or a period of 780 days.
� INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
I fequlred inapectlona end tinel approval must be obtained. FaiWre to obtain inspections and final approvaf wiA result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSA710N DECLARATON:
I hereby aflirm untler penelry of parjury one ot t�e following tleclarations: �-
❑ I heve end will maintein a cartllkata of consent to selhlnsura for workers' compensation, as providetl tor by section 3700 ot the Labor Code, tor Ihe pertormance of the
work for which this permit is issued.
❑ 1 have end will maintein workers' compensation insurenca, as requiretl by section 3700 of the Labor Code, for Ihe pedortnance of Ihe work for which this permit is issued.
My workers' compensation Insurance cerrier and poticy number ere:
Cerrier: Policy Number:
(This section neetl not be completed i/ Me pe�mit is velued ef one hundred dollers ($100) or less.)
r.-'�'�i
��`I,cenify that in the perfortnance of the work for which t�is permit is iuuetl, I shall not employ eny person in eny manner so as to become sub�ect to the workers'
compensation laws of Californie�and egree ihat it I should become subject to the workers' compensetion provisions oi Section 3700 of the Lebor Cotle, I shall forthwith
comply wiih these provisio
a. r '
�Applicant Signature: f�� � ' Date: � � ' � � �)
WARNING PAILURE TO SECUR ORKERS' CAMPENSATION CAVEFAGE IS UNIAWFUL AND SMALL $UBIECT AN EMPLOYER TO CRIMINAL PENALTIE$ AND CIVIL FINES UP TOONE HUN�RED
THOUSAND DOLLARE (E100.00C , IN ADDITION TO THE WST OF COMPENSATION, DFMAGES AS PROVIDED FOR IN SEGTIIXJ 3706 OF THE LABOR COOE, IDREREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn that I am licensetl under provisions oi Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, and my license is in full
force antl eNect. Lic k Class # �-�(.
Coniractors SignaNre: � " Date: /—Z4 - 2000
CONSTRUC710N LENDING AGENCV:
❑ I hereby attirm ihat there is a cons�ruction lending agency for Iha peAormance ol ihe work lor which Ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Neme: Lendefs Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I he�eby aHirm ihat under penalry oi perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7037.5, Business and Professions
Cotle: Any ciry or counry which requires a partnit to consiruct, alter, improve, demolish, or repair eny strucWre, prior to i�s Issuance, also requires the applicant for such pertnit
to fila e signetl statemen� that he or she is licensed pursuant to Ihe provisions of the CoNractors License Law (Chapter 9(commencing with Section 7000) ot Division 3 ot the
Business entl Professions Code) or that he or she is exempt Iherelrom end ihe basis for Ihe elleged ezemption. Any violaiion of Section 7031.5 by any applicant for a permit
sub�ects Ihe applicant to e civil penalry of not more than five huntlretl dollars ($500).):
❑ I, as owner of the property, or my employees with wages as thair sole compensation, WILL DO T1E WORK, antl Ihe siructure is not intended or oflaretl lor sale (Sec.
7044, Business and Prolessions Code: 7he Contracmrs License Law tloes not appty to an owner of property who builds or improves thereon, and who does such work
himselt or herself or through his or har own employaes, provided Ihai such improvemenis ere not intended or offeretl for sale. If, however, the building or improvement is
soltl wi�hin one year ot completion, ihe owner-builder will heve the burden of proving ihat he or she did not build or improve tor purpose ot sale.).
❑ I, as owner of ihe property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construc� the project (Sec. 7044, Business antl Professions
Coda: The contractors License Law dces not epply to en owner ot property who Duiltls or improves ihereon, antl who contracis for such project with a coNrador(s)
license pursuant to tha Contractors License Lews.).
� I am azempt under sec. Business antl Pmfessions Cotle for this reason:
Signature: Date:
Owner ID verifed by tlnvefs license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of tlocument, i.e. - propeny taz bill or deed):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certify that no excavetion five (5) or more teel In de0�h Into which a person Is requiretl b tlescentl, will be made in connaction with work authonzed by Ihis
pertnit, antl that no builtling s�rudure, scaHolding, talsework, or demolition or dismantling thereof, will be more then Ihirry-six (36) teet hiqh. (C�ap. 32, Grp 2, An 2, Sec.
341, Ttle B, Calitomia Adminisirative Code).
❑ As owner-builder, I will not employ anyone �o tlo work which would require a permit from ihe Division of Indusirial Sefery, as noted above, unless such person has a
permit ta do such work from t�e tlivision.
Signature: Date:
Division ot Induslrial Safety Permit Numbar:
CERTIFICATE OF COMPLIANCE AND AU7}10RIZATION OF ENTRV: I certily under peneliy of perjury that I have reatl ihis application and state that ihe information given is
correct. I agree to comply with all stata laws antl ciry ordinances relating to building construction, and authorize re0�esentatives of ihe Ciry ot Casta Mesa to enter upon the
above-descnbetl property lor inspection purposes. I egree not to occupy or allow occupency ol any building authonzetl by this permit until final inspection.
�����fuyt,9) LR�q�Owner(s) � — L y oat �OU
/ � ✓(ilJ:.u�
AnNOr Authonzed Applicant Date
COOE t. INSGECTIONTYVE A�TE INTRIALS
7616 Fized System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201 ' Final BIocWRetaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
2aa6as
CODE� INSPECTIONTYPE
206 Final Mechenical
208 Final Plumbing
210 Final Electdcal
212 Final Fire Prevemion
220 Final Planning Approval
222 Final Site
250 Final Buildinq/Oaupancy
jl� NTITIRL
� S J,I
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626
PLUMBING PERMIT
1ob Address: 845 W 19TH ST
Suite No A
Vicinity:
Parcel Nunmber: 42419107
Applicant BANGERT,.BILL� '
Address: PO BOX 17 �,
, � � � Bhone: 714-83&0937
.TUSTIN, CA � . � Zip: 92781
.� . _ �
Owner. BOECKMAN; CAROLYN SUE TR
Address PAULTRAUTWEINTRUST
REDDING, CA Phone:
536 AURORA Pl Zip: 96001-0100
Contractor. MBTJ BANGERT INC -
Address: BO BOX 12 , �
TUSTIN, CA � .
,'ti" - . i
Arch / Eng : _ . .
Address:
ISSUE FEE
Backflow irtigation
Backflow Preventer�
Bathtub
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roo(
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Phane: 714-83&0937
Zip: 92781
License: 752497
, . .
Phane:
Zip:
License:
Status: ISSUED
Applied: 02/04/2003
Issued: 02I04I2003
ISSUED BY:
SCOPE OF PERMIT
PLUMBING TO INCLUDE: 1 PRIVATE SEWER CONNECTION.'FAMOUS DONUTS AND SUBS' UNIT A
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landswpe Irtigation 50.00
P-T2p $0.00
� Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
. Septic Tank $0.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $24.65
Shower � $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
QTY
0 �
0
0
0
0
0
0
0
0
t
0 . .
0
0
0
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr BkFlow(1-4)
Vacuum Brkr BkFlow(5+)
Wash Basin -
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or RepJ
Water Re-pipe
Water Service
AMT
$0.00
50.00
$0.00
$0.00
so.00
$0.00
$0.00
30.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
on
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, entl all
requiretl Inspectlona end final approval must be obtained. Failure to obtain inspections end final epproval will result in Ihe expiration of this permit.
FOR INSPECTIONS CALL: (774) 7545626
244&d8 (8�00)
WORKERS'COMPENSAnON DECLARAnON:
1 hereby attirtn under penalry of per�ury one of Iha tWlowing dedaratians:
❑ I heve end will maintein e cenificate of consent ta self-Insure lar workers' compensetion, es provitled for ty secilon 3700 0l the Lehor Code, tor Ne peAormence of the
�work for which Ihis pertnii I5 issued.
� 1 �ave antl will melnWin workere' mmpensation inwrence. as required by se�yipn 3700 of Ihe Labor Code, for Ne perfortnance of Ihe work iw which this p6rtnit Is IsweO.
�—M�y __workers' pensatlon Insurence carder ntl policy number ere:
-Ce�rier: = �T �_E � V�j Policy Numtier.�
=/s secNon neetl not Ee completed!/ the permif !s ve/ued e( one hunOred dollars ($100) or less.). � ' .
❑ I ceniy t�at in t�e peAormance of the work tor wNch I�Is permit Is issued, I s�all not employ any person In eny manner so es to 6ecome subJect to the warkers'
compensetlon laws af Celitamie, antl agree Ihat il I ahould becortie suD�ect to Ihe workers' compensetlon pmWsions oi Sectlon 700 o t�e Lebor Cotle, 1 shall torthwiN
compty with these pr%�visions. �
Applicenl 5igneture: !_I � /( .� oa,a: , a y j O�
`WARNINC3.`FAILURE TO 5 R W PENSATI 0 E DE IS UNUW Fl1L M1D SHALL SUBIECT rW EMPLOYE(i YO CRIMINAL PE TIES M!D CML FlNES UP TO ONE HUNDRED
TIOUSAND DOl1ARE (5100,000�, IN ADDRpN TO THE WST OF COMPENS4TION, pMUGE3 il5 PRWIDED FOR IN SECiION 7/OB OF TNE IABOF CODE, IMEREST, AND ATTORNEY'S FEE$,'
LICENSED CONTAACTORS DECLARATION:
Chepter 8(commenGnp wilh Sectlon 7000) ol Divislon
enect. uc.
Code, and my Iicense Is In full
CONSTRUCTION LENDING AGENCY: "
❑ I hereby alfirm t�al l�ere Is a construction lending egen�y tor the peAortnance ol Ihe work for which this permit I9 issued. (Sec. 3097, Clvil Cotle).
Lentler's Name: _ _. _ . Lendefs Address:
Slgnature:
OWNER-BUILDER DECLARATONS:
Date:
I hereby aflirtn thet under penaly of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reawn (Sec. 7031.5, Business anO Professions
Code: Any ciry or counry which requires e pertnit to construct, elter, improve, demolis�, or repair eny structure, prior lo its issuance, elso raquires t�e ap0licant tor such pertnit
to fle a sipned stetement Ihat he ar she is licensed pursuant to Ihe proNsions ot Ne Contreciors llcense Lew (Chapter 9(cammencing with SecUon 7000) ot Division 3 of Ne
Business and Pratesslons Cade) ar that he or she Is exempt therefrom and the besis for ihe elleged exemptlon. Any violation of Section 7037.5 by flny epplicent for e pertnit
suhjects the epplicant m a civll penalry ot nat more than five huntlretl dollars ($500).):
❑ I, es owner oi �he property, or my employees wlih weges es Ihelr sole compensatlon, WILL DO THE WORK, end t�e structure I9 noi Intentletl or aHered tor sale (Sec.
7044, Business entl Prolessions Catle: The Contractors License Law does not apply to an owner of property who builtls or improves thereon, and who tloes such work
himself or herseN or Ihrough his or her own employees, providad that such improvemenis are not intendetl or oNered for sale. II, however, the building or improvement is
solA within one year of wmpletion, the owner-builder will have ihe burden of proving that he or she did not builtl or improve tor purpose ol salaJ. �
❑ I, es owner ot the property, am EXCLUSIVELY LONTRAC7ING WI7H LICENSED CONTRAC70R5 to conswct the project (Sec. 7044, Business and Profassions
COCe: 7Te contreciore IJcense Law tloes nm appy lo an owner of property who bullCs or imprwes thereon, antl who coniracts lor such prolea with e wntrector(s)
license Dursuant ro the Contracrors License Laws.).
❑ 1 em exempt under sec. eusiness end Professions Cade tor this reason:
Signetura: Da�e:
Owner ID venfied by drivers Ilcense. ❑ Yes ❑ No Drivars License No. Expires:
Verlflcatlon of Ownership �y (type of tlocument, I.e. - property tex �ill ar tleea):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excavetion Me (5) or more leet In depth Into which e person Is requiretl to Aescentl, will be mede in connectlon with work authoAzed Dy this
pertniL and Ihat no huilding strudure, scafldtling, lalsework, or demditlon or dismantling thereof, will be mora t�en thirty-six (38) feei hig�. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calllomia Administretive Code).
❑ As owner-builder, I will not employ enyone to do work whiCh would requlre a pertnit tram the Dlvision oi Industnel Satety, es notetl ebove, unless such peraon hes e
permit to tlo such work Irom Ihe division.
Sipnature: Date:
Divislon ot Industrial Satery Permit Number:
ICERTIFlCA7E OF COMPIJANCE AND AUTHORQA710N OF ENTRV: 1 cenify untler penalry of perjury thel I have reed ihis flpplication antl state Nat �he inlormalion gNen is I
correcL I egree to compy wilh all siate laws end Gry orElnances relating to Guiltling construction, entl euthorize representatives of the Ciry ol Cwte Mesa ro enter upon the
ebovo-descnbed properry for inspection Duryoses. I egree not to occupy or allow occupancy ot any building authorizetl by ihis permit until linal inspection.
cooe �, iNsveenoNnve
1816 FixeA System Final Fire Preventlon
1286 Pool Spa Final
200 Final Re-Rool
207 Final BIocWRetelninp Well
202 Final Fectary Fire Plece
203
204
Pinel Sign -
Finel Demolitlon
QAIE 4II�64
COOE� INSPECTIONTYPE
206 Finel Mechanicel
20B Final Plumbing
210 Finel Elot�dtal
212 Flnel Fire Preventlon
220 Finel Planning Approval
222 Finel Site
250 Finel Builtling/Occupancy
" 'i
CIT = COSTA MESA, BUILDING SAFET. .,NISION
POST IN CONSPICUOUS PLACE ON 1
NOTICE a
Schedule inspection one workday in advance. To schedule inspections, call (714) 754•5626.
1) Permit number, 2) Job address, 3) Inspection item number, 4) Day and date you need the
BuildingAddress: ��`�-' j
Building Permit 1F:
MRchanical Permit #:
Type:
piyn Check No.
u[W ADD ALTER
Item k
4
6
8
11
12
14
16
18
20
22
24
26
30
33
Electrical Pertnil #:
; Plumbing Permit #.
Group:
Issue Date:
L
Uxner.
Contractor:
Job Description �
C`��Q�QJ�.- �.\''�� �
PERMITS EXPIRE 180 DAYS (6 MONTHS) FROM ISSUE OR LAST INSPECTION
STRUCTURAL
Footings
Slab
Strudural floor
Pre-Inspect Roof
Roof Sheathing
T-Bar Ceiling-Structural
Shear Panel
Frame 8 Flashing
Lathing B Siding
Insula(ion
Drywall Nailing
Plaster Brown Coat
Pre-Grout
Disabled Access
ELECTRICAL
36 Ufer Ground
38 Elec Conduit - Underground
44 Rough Elec - Wiring
46 Rough Elec. Conduit
48 Elec T-Bar Ceiling
50 Elec Power Final
51 Temp Power Final
PLUMBING 8 MECHANICAL
52 Soif Pipe - Undergroand
54 Waler Pipe - Underground
55 Underground Gas
62 Rough Plumbing
64 Rough Mechanical
66 Rough - Faclory Fireplace
68 Sewer Syslem
72 Gas Pipe - Rough Tesl
90 Gas Pipe Test - Final
92 Water Service • Final
NOTES: SEE REVERSE
a559-as Vev.osns�
Date � Inspector
flem p POOL & SPA
94 Pool & Equipment Location
96 Steel Reinforcement
100 Electrical Bonding
102 Rough Plumb & Pressure Test
104 Approval to Gover • Gunite
106 Elec Gonduit - Underground
108 Gas PipelUnderground Test
110 Backwash Lines, P-Trap,
Underground
112 Approvalto Deck
116 Pool Plumbing System - Final
118 Pool Electrical - Final
122 Fencing/Access/Alarms Approval
124 Approval (or Plaslering
126 Pool/Spa Systems - Final
1610 Overhd Hydro/Overhd Rough
1612 Dry Chemical
1614 Dry Sfandpipe
1616 Final • Fixed System
Call (714) 754-5626 for the following:
2�0 Final Re-Roof
201 Final Blor,k/Retaining Wall
203 Final Sign
204 Final Demolition
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
Call (714) 327-7400 for the following:
212 Final Fire Prevention
Call (714) 754-5335 for the following:
214 Final Transportation Svs.
Call (714) 754-5671 for the following:
216 Final Engineering Approval
Call (714) 754-5307 for the following:
218 Final CMSD Approval
Call (714) 754•5245 for the following:
220 Final Planning Approval
Call (714) 754•5626 for the following:
222 Final Si(e
250 Final Buildinq/Occupancv
Date
Date
Intpectw
Inspector
i �
Date Inspector
Date Inspector
Date Inspector
Date Inspector
Date Inspector
Date � Inspector
��r•srx�
(714) 754-5273 • Fa�c (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicank
Address:
845 W 19TH ST
A
A
42419107
GEORGE,THOMAS
701 N EUCLID ST
LA HABRA, CA
Owner: TRAUTWEIN, PAUL TR
Address %L & M PROPERTY MGNT
NEWPORT BEACH,CA
1617 WESTCLIFF DR #112
Contracror. PMG INC.
Address: 701 N EUCLID ST
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool I Spa
Lighting Fixts
Recept Outle[5
Switches
Nan Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to tOhp
Motors ro SOhp
Motors to 100hp
Morors over t00hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
LA HABRA, CA
ELECTRICAL PERMIT
Phone: 562-905•3576
Zip: 90631
PhOne:
Zip: 92660
Phone: 562-9053576
Zip: 90631
License: 461365
Status: I SS U E D
Applied: O6/14/2000
Issued: O6/14I2000
ISSUED BY: r� `
SCOPE OF PERMIT
REF 899-01253 FOR UNIT A, FAMOUS DONUTS.
18 LIGHTS, 18 OUTLETS, B SWITCHES,IBATHROOM FAN, 1 REF. COMPRESSOR UP TO 10HP, 2
PANELS UP TO 200 AMPS,
$23.50
50.00
$0.00
$0.00
50.00
$0.00
519.80
$19.80
$8.80
$0.00
$0.00
30.00
$0.00
30.00
$4.75
$12.30
50.00
so.00
$0.00
$0.00
567.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
18
18
8
0
0
0
0
0
1
1
0
0
0
0
2
0
0
0
0
FEE SUMMARY
Temp Dist System I Lighting
Buswayl100ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................ovar 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misa Conductor
Circus ( gen or ride)
Ciras (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
50.00 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 0
b0.00 0
$0.00 0
50.00 0
$0.00
50.00
50.00
$0.00
TOTAL CALCULATED FEES 5149.95
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void il woAc is not commenced vnthin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell
required Inapeetlona end final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permi�./
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMPENSATION DECLARATION:
I hereby aHlrm under penelry ot perjury one ot Ihe lallowing tledarations:
❑ I heve and will meintaln e certfllcate oi consem to sell-Insure far workers' compensetion, es provided lor by sectlon 3700 of the LeDor Code, for t�e pertormance ol the
work lor which this pertnit Is IssueO. .
I �ave end will maintain workers' compensaGon insurance, es requiretl by sectlon 3700 0l Ne Lebor Code, for the pedortnance of the work for which Ihis permit is issued.
y workera' cnmpensation Insurence carder end policy number are:
cemert� Policy Number:
(This section neeC nof be completed if fhe perm/t fs valuetl et one huntlred dollars (5100) or /ess.)
❑ 1 cenify thet In the pertortnflnce ot tha work tor which this pertnit is issued, I shall not employ any person In eny manner so es to become subject to t�e workere'
compe Celif la, and agrae that If I shoul becoma subject to the workere' compensation pmvisions ot SectiGn 3700 of the labor Code, I shell forthwith
rrnn io s � �e� / / ///
Ap icent SlgneWre� � //—p/i � /`-- ` Dete: (D /! y/� O
: AILURE TO SECURE WORNER5 COMPENSATION fiAGE I UNLAW FUL FND SW1Ll SUBJECf AN EMPLDYF�TO CRI IN/�, PENA ES AND CML FlNES UP TO IXJE HUNDRED
TMOUSAND OOLLARE (5100,000), IN ADDffION TO THE COST OF WMPENSATION, DAMAOES FS PROVIDED FOR IN SECTION 37060 THE IABOR CODE, IMEREST, AND ATTORNEY'S FEES.
DECLARATION:
$IgnatUre:
ol Chapier 9(commencing wllh Seciion 7000) of Divislon
CI059 M
DBIe:
Code, antl my Ilcense is in full
CON9THUCTON LENDING AGENCV:
❑ I hereby eNirtn Nat there is e canstruction Iending egency tor the peAortnance ol the work lor which Ihis permlt is issued. (Sec. 3097, Civil CaAe).
Lentler's Neme: Lendels Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby eNirm that under penalry of per�ury thei I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing raason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires a permit to consWcl, alter, improve, tlemolish, or repair any structure, pnor to IIs Issuance, also requires ihe appliwnt for such permit
to file a signetl statement ihat he or she is licensed pursuant to the provislons o1 the Contrectore License Law (C�epter 9(commencing with Section 7000) of Division 3 ot ihe
Business entl Professions Code) or thai he or s�e Is exempt theretram antl the basis for the elleged exempiion. Any violetion oi Section 7031.5 by any epplicant tor e pertnit
sub�ects Ihe applicant to a civil penalry of not more then five hundred dollars ($500).):
❑ I, es owner of the properry, ar my employees wIN wages as iheir sole compensation, WILL DO THE WORK, antl ihe sWcmre is not Inlended or attered tor sele (Sec.
7044, eusiness and Professions Cada: The Contractors License Law Ooes nat apply to an owner ol proparty who builtls or improves thereon, and who tloes such work
himself or herselt or Ihmugh his or her own employees, provided that such Imprwements are not intended or otterad tor sale. It, however, the building or imprrnement is
solC within one year oi compleLon, Ihe ownerbuilder will have the burtlen of proving that he or she did no� build or improve for puryose of sale.).
❑ 1, as owner of the pmperty, em E%CLUSIVELV LONTRAC7ING WRH LICENSED CON7RACTORS to construct Ihe pmject (Sec. 7044, Business anA Prolessians
Code: The coniractors Licensa Lew does not appy to an owner of pmperty who builtls or improves Ihereon, enA who contracts tor such project wilh a contractor(s)
license pursuant to ihe Contrectors License Lews.). �
❑ I am exempt under sec. Business and Prolessions Code for t�is reason:
Signeture: Data: _ _ _ �
Owner ID verifietl 6y tlrivefs license. ❑ Ves ❑ No Drivers License No. Erylres:
Verification af Ownership Dy (type ot document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON:
❑ I hereby certity Ihat no excavation tNe (5) or more feet in depih Into which a Derson Is required to descen4 wlll 6e metle In conneciion with work euthodzetl by Nis
pertniL end thal no Ouilding strudure, scaHoltling, falsework, or Gemditlon or dismantling thereot, will be more Ihen ihlrry-six (36) teet �ig�. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calitomia AdminlslretNe Code).
❑ As owner-builder, I will not employ enyone to do work which wauld requlre a pertnli Irom ihe Division ol Indusirlal Sefety, as notetl flbova, uNess such person has a
permit to do such work irom the tlivision.
Slgnature; Deta:
Divlslon of Industnel Safery Pormit Number:
CERTIFlCATE OF COMPLI/WCE AND AI7T}fORVA710N OF ENfAV: I certity under penalry oi perjury that I heve reetl thls epplication antl stata that the informatlon given is
correcL I egree to wmpy with ell state laws entl ciry ordinances relating to 6uilding wnstruction, antl aul�orize re0resenletives of ihe Ciry of Costa Mesa to enter upon the
ebove-tlescnDetl praparry far inspectlon purposes. I egree not to acupy or allow occupanty of any building eulhonzed by Ihis pertnit until linal inspection.
COUE II. INSPECTIONTYPE
1616
1266
Fizod System Final Fire Preventlon
Pool Spa Final
200 Final Re-Roof
201 Final BIaWRetaining Well
202 Final Fectory Fire Place
203 Final Sign
264 Final Demolition
26a8-Is
��$ 4QQ� INSPECTIONTYPE
208 Finnl Mechenicel
20B Finnl Plumbing
210 Finel Electncal
212 Finel Fire Prevention
220
222
250
Final Planning Approvel
Final Site
Final Builtling/Occupancy
INi1f1�L5
i�� � � �
. v�Vc�l
(�ta) �5a-5273 • Fex (7�4) 75a-4856 • www.ci.costa-mesa.ca.us 77 hAIM UFIIVC� GVJIA MCJX� liN tlW<O
BUILDING PERMIT
Job Address: 845 W 19TH ST
Suite: D
Vicinity: SUITE D (BOTANACA HANNA)
Parcel Number: 42419107
Applicant: MUNCE, WILLIAM
Address: 1810 NEWPORT BL
SUITE C
COSTA MESA, CA
Zoning:
Phone: 949-6463679
Zip: 92627
Owner: BOECKMAN, CAROLYN SUE TR
Address PAUL TRAUN/EIN TRUST
REDDING, CA Phone: . _ .
536 AURORA FL Zip: 96001-0100
C on va cto r: O W N E R-B U I L D E R
Address: � . �
Zip:
Arch :
Atldress:
Phone:
Phone:
License: 000000
Eng:
Address:
ISSUED BY:
SWtus: ISSUED
Applied: 03117/2003
Issued: 03/18/2003
Phone:
Zip: � �License: LicenSe:
SCOPE OF PERMIT-
REPAIR TO FIRE DAMAGED UNIT. WORK TO INCLUDE: ROOF SHEATHING AND FRAMING, DRYWALL, WINDOWS.
Plan Check: $25.19
Permit: $38.75
SMIP Res: $0.00
SMIP Com: $0.50
Other: $0.00
Inspection: $0.00
Total: $64.44
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
Rear 0. 0
Rear 0- 0
FEE SUMMARY
Calc Valuation: S�,000.00
Claim Valuation: Si,000.00
PLANNING & ZONING
Lefl 0- 0 Right
Left 0- 0 Right
PARKING Existinq: 0 Re uired: 0 Propased: 0
NO7ES: KUBOT_BJ 03N812003 OK TO ISSUE BLDG PERMIT PER KJC;
0- 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (OM. No. 92-28, § 1, 1241•92)
EXPIRATION: This permit shall automatically expire antl become voitl II work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considerad legal, such work must comply with all applicable codes, end ail
requlred Inepectiona end flnal approval musl be obtained. Failure to obtaln Inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5628
zsaa�e �a�m�
WORKERS'COMPENSAnON DECLAHATON: �
I hereby etfrm untler penaly ot perjury one of the Idlowing tleda2tions:
� I have entl wlll maintain e certNicate ot wnsent to self-Insure for workers' compensatlon, as provided tor by section 3700 oi the Labor Code, tor Ne pertortnence o1 Ihe
work fOr w�iCh Ihi9 pertnit is issued.
� I heve entl will melnlaln woAcers' cwnpensalion in5uranC6, as requiretl by sectlon 3700 of ihe Labor Code, lor the pertormence of the wark for whlch this pertnit I5 Issued
My workers' compensation Insurance carner and policy number are:
Carrier: Policy Number:
(Thls sectlon need nat Ee comD�eted Ir fhe permi�ls veluetl et one hundretl dollars (5100) or less.)
❑ I ceNiy Ihet in Ihe pedormance of the work tor which I�is permit is IssueC, I shall not employ eny Derson In any manner so es to bewme sub�ect to the workers'
compensatlon lews ot Califomie, antl egree that il I shoultl become suD�ect to the workers' crompensetion provislons of Sectlon 3700 of Ihe Lebor Code, I shall toMwith
wmply with Ihese prOvisions.
Applicenl Signature: Date:
WARNINO; FAILURE TO SECURE WORKERS' OOMPENSAT70N COVERApE IS UNLAW FUL AND SHALlSU&IECf rW EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED
TIId1S4ND DOILARE (5100,000), W ADDITION TO THE CQST OF COMPEN$ATON, DAA4IGES AS Pf10VIDED FOFi IN SECiION 3708OF THE UBOR COOE, INiEREST, M1D ATTORNEY'$ FEES.
LICENSED CONTRACTORS DECIARATION:
I �ereby eHirtn that I am licensetl untlar OroWsions of Chapter 9(commencing with Sectlon 7000) of Divislon 3 oi the Buslness and Prolessions Code, antl my license Is In tull
lorce entl ettect. Lit. p Class q
Contrecbfs Slgnature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eMirm that there is e constructlon lentling egency for Ihe peAormence of Ihe work for which this permit is Issued. (Sec. 3097, Civil Cotle).
Lentlels Name: Lenders Atldress:
Signature: Date:
OWNER-BUILDER DECLARAT10N5:
I here6y ettirtn thet under penelry of perjury thet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW lar the following reeson (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or wunty which reQuires e permit to construct, elter, improve, demolish, or repair any strucWre, pnor to Its issuance, also requires the epplicant tor such pertnit
to tile e slpne0 statement thet he or she is IicenseA pursuant to the D�oNslons of Ihe Gontrectore License Lew (Chepter B(commencinp with Sectlon 7000) of DlWsion 3 at 1he
Business entl Professions Code) or thet he or she is e:empt thereiran and Ihe basis lor the elleged exemption. Any Wolatlon ot Sactlon 7031.5 by any epplicant for a pertnN
sublecis the epplicent ta e civil panelry at not more than five hundred dollers (5500).):
❑ I, es owner ot t�e proDerry, or my empiqrees wit� wages es their sde compensation, WILL DO THE WORK, entl t�e slructure is not Intentletl or ottered tor sala (Sec.
70a4, Business enC Professlons Cotle: The ConUactors Llcense Law does not appty to an owner of property who builCs or improves thereon, and who does such work
himsetl or hersell or Ihrough his ar her own employees, provided thet such improvements ere not intendetl or ottered lar sale. It, however, the building or improvement is
_ /soltl wit�in one year ot completion, ihe owner-builder will have ihe burden ol prmdng ihat he or she did not build or improva for Durpose ol sale.). '
� 1, as owner ol the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the projact (Sec. 7064, Business and Professions
Code: The coniracrors Llcensa Lew does not appty to an owner ot pmperry who builtls ar impmves thereoq entl who comrects tor such pro�ect with a contractoqs)
license pursuant to the Contractws License Laws.).
❑ I em exempt yntler 5. Business end Professions Code for Ihis reason:
Signature: i../�1i'� Date: 3'�b' �3
Owner ID verlfied by drivers licensa. �es ❑ No Drivers Llcense No. Exp���; �- oS
Verllicatlon of Ownership by (rype ol tlaumenL i.e. � property tex bill or tleetl):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certlly t�at no excavetion five (5) or more teet In dept� Into whlch e person Is requlred to descend, will be mede In connectlon wlth work euthonzeC by ihls
permll, antl ihat no building siructure, scettolding, lalsework, or tlemolitlon or tlismantling ihereof, will be more than Ihirty-si: (38) teel high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Tille 8, Celltomia Atlministrative Code). ,
❑ As ownerbulltler, I wlll not employ enyone to do work which woultl requlre a parmit irom the Division of Indusidel Sefely, es noted ebava, unleu such person hes a
permit to do such work trom the tlivision.
SlgnaNre: Date:
DiWsion ol Industrial Satety Pertnit Number:
CER7IFlCATE OF COMPLIANCE AND AUTHORIIATON OF ENfRY: I cenity untler penalry ot perjury t�et I heve read this epplicatlon enC state thet ihe iniormation given is
correcL I egree to comply wlth all state laws end ciry ordinances releting to Dulltling construdlon, entl authodze representatives ot Ihe Ciry ol Coste Mesa to enter upon the
ebava-descnbed pmperty lor inspection purposes. I agree no� lo occupy or ellow occupency ot eny building authorized by Ihis permit until tinel inspedian.
( �� gqeture Oi Legal Owner(s) Date
.( 3�[3'-�
AnNOr Aut�ed Applicant Date
COOE I. �Nsveenoxrrve
1618 Ficetl System Final Fire Prevention
1288 Pool Spe Final .
200 Flnel Re-Root
201 Flnel BIOCWReIalning Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Finel Demolition
PAg 1t�ELS
tooe� wsvecnoxnae '
206 Final Mechanicel
208 Final Plumbing
210 Final Electrical
212 Finel Fire Preven�on
220
222
250
Final Planning Approvel
Finel Slte
Final Buildinp/Occupenry
�
It�
�
(71 a) �54-52�3 • Fau (�14) 75a-4856 • www.ci.costa-mesa.ca.us �� rniR oHive, GU51 A MtSA, liA yZ62ti
Job Address: 845 W 19TH ST
Suite No D
Viciniry: SUITE D (80TANACA HANNA)
Parcel Nunmber: 42419107
Applicant: MUNCE, WILLIAM
Address: 1810 NEWPORT BL -
SUITE C
COSTq MESA, CA
ELECTRICAL PERMIT
ISSUED BY:
Phone: 949-646-3679
Zip: 92627
Owner: � �BOECKMAN, CAROLYN SUE TR
Address � PAUL TRAUTWEIN TRUST
REDDING, CA " ' Phone:
536 AURORA PL Zip: 96001-0100
Contractor ONINER-BUILDER
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units) �
Pool / Spa . -
Li9hting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to 50hp
Motors to t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
- Phone:
Zip: '
License: 000000
Status: ISSUED
Applied: 03/17/2003
Issued: 03/18/2003
, , ,SCOPE OFPERMIT
REPAIR TO FIRE DAMAGED UNIT. WORK TO�INCLUDE:� ROOF SHEATHING AND FRAMING, DRYWALL,
WINDOWS. ELECTRICAI. TO INCLUDE: 2 LIGHTS, 2 SWITCFiES AND 2 RECEPTACLES.
$23.50
50.00
$0.00
$0.00
$0.00
$0.00
$220
$2.20
$2.20
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
2
2
2
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misa Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electncal Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.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
$0.00
$0.00
$0.00
NOTICE: The work authorizeq by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § t, 12-21-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspended or ebandoned
for a period of 180 days.
INSPECTIONS: �n order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapeetions and final epproval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this pertnit.
FOR INSPECTIONS CALL: (71q) 75q-5626
zaae�ae(eiool
WORKERS'COMPENSAnONDECLARAnON: '
I hereby aHirm under penalry of perjury one of Ihe following declarations:
❑ I have enA will malntain e certlticate of consent to self-Insure lor workers' cnmpensetion, as D�ovided tor by section 3700 ot the Lebor Code, lor Ihe peAormance ot the
work for which ihis pertnit is issued.
❑ I have and will maintain workers' compensatlon Insurance, es required by sectlon 3700 of the Lebor Catle, for the peAortnance oi tha work tor which this pertnit is Issued,
My workers' compensatlon Insurence cerrier enA policy number ere:
Cartier. Policy Number.
(This sectfon need not be cnmp/eted i7 the peimit is valued at one hundretl dW/ars (5100) or less.)
❑ I cerlity Ihet in the pertormence oi the work for which Ihis permil Is ISsueQ I shall not employ eny persan In eny menner so as to become subject to the workers'
compensatlon laws oi Celifomie, end epree thet if I should become sub�ect to Ue workers' compensation provislons of Saction 3700 of the Lebor Cotle, I shall forthwith
comply with Ihese provisions.
Appllcent Signature: Dete:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATIpJ COVEMGE IS UNIAW FUL M1D SHALL SUBIECT AN EMPIOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE MUNDRED
THOUSAND DOLLARE ($100.000�, IN ADDITION TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED F-0R IN SECTION 3]OB OF THE LABOR CODE, IMEREST, AND ATTOFNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn that 1 em licensed untler proNsions of Chapier 9(commencing wit� Section 7000) oi DiNsion 3 0l the Business end Professions Code, antl my license is in full
brce and eflect. Lic. N Cless N
Comrectols Signeture: Date:
CONSTRUCTION LENDING AGENCV:
❑ I �ereby eNirm that ihere is e consimctlon lending aqency for ihe peAormence of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lendera Neme: Lendefs Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirm that under penalry of perjury that I em EXEMPT FROM TT1E CONTRACTORS LICENSE LAW lor ihe tollowing reason (Sec. 7031.5, Business antl Pmfessions
Code: Any city or counry which reQuires a permit to construct, alter, Improve, demalish, or repair eny strucWre, pnor m Its issuance, elso requires the epplicant for such pertnit
to tile e signetl statement thet ha or she is Iicensed pursuent ta the proNsions oi Iha Coniradors LJcense Lew (Chepter 9(commenGng with SecUon 7000) of Divislon 3 ot ihe
Buslness flnd Professions Code) or thet he or she is exempt therefrom end the besis tor the allegetl exemption. Any violation of Section 7031.5 �y eny flpplicant for a pertnit
subjects the epplicaN to e civil penalry of not more than five hundred dollars ($500)J:
❑ I, as owner of the property. or my employees wlth weges es their sole compensation, WILL DO 7HE WORK, end the structure Is not intentletl or offered for sale (Sec.
7044, 8usiness and Professions Coda: The Coniractors License Law does not apply Io an owner oi property who builtls or imD�oves thereon, entl who does such work
himseN or herself or through his or her own employaes, provided Ihet such Improvements ere not Intended or otteretl for sele. If, however, the bullding or improvement is
— /sold within one year of completion, the awner-builder will have the burden ot pmving �hat he or she did not build or Improve for purpose of saleJ. '
p� I, es owner of the properry, em EXCLUSIVELV CON7RACTING WITH LICENSED CONTRACTORS to consiruct Ihe prolect (Sac. 7044, Business and Professions
Cotle: The contractors Llcense Law tloes not epply to en owner oi property who hullds or Impmves thereon, end who coniracts for such pro�ect with e contractor(s)
license pursuant to iha Contractors License Lews.).
❑ I em exempt uqder s�c. Business and Professions Code for Ihis reeson:
Slgnature:
Owner ID verified by tlnver's Iicense. �Ves ❑ No
Venlicatlon of Ownership by (rype ol document, i.e. - property tav blll or deed):
Date: 7 � [8 �� 3
Dnvers Licensa Na / Expiras: �– �!—
DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION:
❑ I hereby cartify that no excavetion five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this
permi�, and iha� no building s�mctura, scafloltling, falsework, or demoll�ion or tlismantling Ihereof, wlll be more ihen thirty-six (36) teet hlgh. (Chep. 3.2, Gry 2, Atl 2, Sec.
341, Titla 8, Califomia Atlminlstretive Code). ,
� As ownerbuilder, I will not employ anyone to do work which would require e permit from ihe Division of Indusirial Setety, as noted above, unless such pereon hes e
pertnit to tlo such wark from Ihe tlivision.
Signeture: Date:
Division ot Industnal Satery Permit Numbar:
CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF EMRY: I cehity under penalry of Derjury that I have read ihis application and state thet the infortnation given Is
correct. I agree to comply with all slate laws end ciry ordinences relatlng to 6uilding consiruction, and suthodza represen�atives of Ihe City ot Coste Mesa lo enier upon Ihe
eDove-described properry tor inspection purposes. I agree not to occupy or allow occupancy of eny building au�horized by this pertnit until finel ins0actlon.
�1 Sig a re Of egal Owner(s�_ Date
.lf � �(� /O}
AnrllOr Authorized plicant Date
CQOE �. INSPECTIONTYFE
1618 Fixed System Final Fire Prevention
1266 Pool Spa Flnal-
200 Final Re-Rool
201 Finel Block/Retaining Wall
202 Final Factary Fire Place
203
204
Final Sign
Final Demolltion
�eg iiQQ�
CO�E I INSYECTION TYPE �
206 Final Mechenical
208 Flnal Plumbing „
210 Finel Elec�ncal
212 Finel Fire Prevention
220 Final Planning Approval .
222 Final Site .
250 Final Building/Occupancy
(714) 754-5273 • Ka�c (714) 754•4856 • www.ci.cosla-mesa.ca.us 77 FAIF DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 845 W 19TH ST
Suite:
Vicinity:
Parcel Number: 42419107
Applicant: HANSEN, DUKE
Address: N6646636
2oning:
Phone:
Zip:
Owner: BOECKMAN, CAROLYN SUE TR
Address PAUL TRAt1TVJEIN TRUST
REDDING, CA Phone:
536 AURORA PL 2ip: 96001-0100�
Contractor. ROSS & BARROWS INC.
Address: 260 E ALTON AVE
SANTA ANA, CA
Zip: 92707
Arch :
Address:
Phone:�(714)557-7440
License: 327802
Eng:
Address:
ISSUED BY:
Slalus: ISSUED
Applied: 04/29/2003
Issued: 04129/2003
. Phone: - ' . � Phone:
Zip: Licensa: License:
SCOPE OF PERMIT,
REMOVE OLD B.U.R. AND INSTALL A NEW 4 PLY BUILT UP-ROOF FOR COMMERCIAL�BLDG. 5,000 S.F.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: Ss,2as.00
Permit: $181.25
SMIP Res: $0.00
SMIP Com: $1.94
Oth@r: $0.00
Inspection: $0.00
Total: $183.19
SETBACKS
MAIN STRUCTURE Front 0- 0� Rear � 0- 0
ACCESSORY Front 0. 0 Rear 0- 0
PARKING Ezistin : 0 Required: 0
NOTES:
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Claim Valuation: �s,zas.00
Right 0- 0
Right 0- 0
NOTICE: The work aulhorized by ihis permit shall compty with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § t, 72-2t-92)
EXPIRATION: This permit shall eutomatically expire and become void if work Is not commenced withln 1 BO days, or If work is suspended or abandoned
for a period of 180 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, end ell
required inspeetlone and final approvel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
wn-en �acu�
WORKERS'COMPENSANON DECLARAnON: �
I hereDy attirm under penalty of perjury one of the tdlowing declaretions: � ��
❑ I have entl wlll maintein e cenillcate at consent to self-Insure for workers' compensation, es proNded far by saction 3700 of Ihe Lehor Code, for the perfarma�ca of the
.J work far w�ich th�s pertnll is Issued.
}(1/ I have antl wlll ma�ntain workers' compenseUon insurance, es reqWreO by sectlon 3700 ot tha Letwr Code, for tha perfortnance ol the work tor which Nis partnit is lsweC.
( My wo s' compen tlon Insu�r Wce ca er and pollcy number ere: %� p�
ce�rier: ����'��i I'[� �.� Policy Number: ✓��Op �-5 ' L✓D j
(Ihls aecN�be complet l! (he permif !s valued et one hunCred dollers ($ f00J or Iess.)
❑ I ce�ity Ihet in ihe peAormanc 1 the work for which this permil is issued, I s�all not employ any person In eny manner go as lo become sub�ect lo Ihe workeB'
compensation IaWs of Celll la anA aprae Ihet il I shouW Eecome sub�ect to the workers' compen5ation provlsions ot Sectlon 3700 0l the Lebor Cotle, I shali toMwlth
compty with thesa p�ovis �1
nppncam Sipnewre: ����� Date: � y! � �3
WARNINO: FAILURE TO SECURE WORI(ER$' C�OMPENSATION pWEMOE IS UMAWFU� AND SIU11 SUBIECT AN EMPLOYER TO CRIMINAL PENA�TE$ rW D CMl FlNES UP TO ONE HUNDRED
TNOUSAND DOLIARE (5100.000). IN ADDITION TO THE COST OF C0IAPENSpTIpN, DAAIFOES AS PROVIDED F-0R IN SECTION 3�08OF THE LABOR CODE.IMEREST, AND ATTORNEI^5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm thel I em
lorce and eMect. Llc. k �
ContreMors Slgnature:
of Chapter 8(commencinp wilh Sectlon 7000) of Dlvlslon 3 af the Business antl Prole5y5i�ns Cotle, end my Iicense is In full
C1839 M G � /
oaie: y=� _ Z,
CONSTRUCTION LENDING AGENCV:
0 I hereby ettirtn tha� there Is a construction lentling egency for ihe peAortnance of t�e work for whicli ihis permit Is issued. (Sec. 3097, Civil Cotle).
Lendefs Neme: Lendels Address:
Signetura: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirm t�at under penalry of per�ury thet 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe follawing reason (Sec. 7031.5, Business flntl Professions
Cotle: Any ciry or counry whlch requires e permit to consiruct, alter, imprwe, tlemolish, or repair eny siructure, prior to its issuance, elso reQuires the ap0licant for Such pertnit
to lile a stgaed stateme�� that he a� she is Ilcansed pu�suant to the proNsians ot the Conlrectors Ucense Lew (Chapter 9(commencing wit� Seaion 7000j ot Diviston 3 of the
Business entl Professitl�s Code) or that he or she is exempt theretrwn and t�e basls for tha elleged exempHon. Any violation oi Sectian 7037.5 by eny aOP���nt for a permfl
sublecis the applicant to e chnl penalry of not more Ihan frve huntlretl ddlers (5500).):
❑ I, es owner ot t�e P�operty, or my employees wllh wages as their sole compensatlon, WILL DO THE WORK, and the sirucWra Is not intendetl or ottered tor sale (Sec.
7044, Business and Professlons Code: The Contraclors License Lew tloes not apply to an owner ot property who builas or improves Iheraon, flntl who does such work
himselt or herself or �hrough his or her own employees, provided that such Improvements are not intentled or oHeretl for sale. II, �owever, the building or improvement is
sold within one year o1 completion, Ihe owner-builtler will have tha burden of proving that he or sha did not build or improve �or purpose of sale.). �
❑ I, es owner ot the p�operry, em EXCWSIVELY CONTRACTING WIiH UCENSED COMRACTORS to consfruct the projed (Sec. 7044, Business and Pmtessians
Coda: The coniraCtors Llcense Lew tloes not apply to en awner ol property who builas or Improves ihereon, and who contracis for suc� proJect wit� a contractor(s)
license pursuant to the Contractors Licanse Wws.).
� I am exemp� unde� sec. Business enA Professions Code tor this reason:
SignaWre: Date:
Owner ID verified by drrvers license. ❑ Yes ❑ No Dr'rvers License No.
VedOcatlon of Ownership by (rype o1 documem, i.e. - property tex biil or dead): _
DIVISION OF INDUSTqIAI SAFETY PERMR CEfi71FICATION:
Expires:
❑ I hereby cenity Ihe� no exceveiion flve (5) or more fee� in tlepth into whlch e person is requireO �o descend, will De made in connectlon with work euthorized by Ihis
pertnit, end Ihat no building sWc�ure, scaHdding, falsework, or demoliiion or Eismemling Ihereof, will be more than thirty-six (36) feet high. (C�ap. 3.2, Grp 2, An 2, Sec.
341, Title 8, Califamla AdministretNa Cotle).
❑ As owner�builder, I wlll not employ anyone to do work which woultl require e pertnil Irom Ihe Divislon ol IndusMel Sefety, es notod ebove, unless such pereon hes e
pertnit to do such work trom lhe division.
Signeture: Date:
Divlslon of InCusirial Selery Permit Number.
CERTIFICATE OF COMPW�NCE AND AIlTHORIZATON OF ENiHY: I certify under penelty of perjury thet I have read ihis application and state �het the information given Is
correct. I agree to comply wlth ell state laws entl ciry orGinences rela�ing Io building con5wctlon, end euthonze representatives of Ihe Clty of Costa Mese to enter upon Ihe
ebove-described property �or inspettion purposes. I egree noi Io occupy or ellow occupancy of eny building euthonzed by Ihis pertnil until final inspection.
igneture 01 Legal Owner(s) Date
/ ���lc� �/-29 v3
—� An Authonzed ApO����� Date
LOOE �, INSPFLTIONTYPE
i818 Fixad System Final Fire Preven0on
1288 Pool Spe Finel
200 Finel Re-Roof
201 Flnel BIocWRetalninp Well
202 Final Factory Fi�e Place
203 Final Sign
204 Finel Demolitlo�
CdiE It�Lfl
�7� �
LOOEI INSPEGTIONTYPE �
206 Finel Mechenlcal
20B Flnul Plumbing
210 Final Electricel
212 Finel Flre Preventlan
220 Final Planning Approval
222 Final Site
250 Final BuilGing/Occupancy
Q�ff. II�EL9
(7ta) 754-5273 • Fax (7ia) 75a-asss • www.ci.costa-mesa.c��'LDING PERMIT �� tAIF1 UHIVt, GVJIA MtSA, GA tlZti20
Job nddress: 845 W 19TH ST
Suite: D
Vicinity: SUITE D
Aarcel Number: 42419107
Zoning:
Applicant: MUNCE, BILL - L8 M PROPERTY MGMT
Address: 7810 NEWPORT BL
SUITE C . - Phone: 949-646-3679
COSTA MESA, CA � Zip:
Owner. BOECKMAN, CAROLYN SUE TR
Address PAUL TRAUTWEIN TRUST
� REDDING, CA Phone: �
- 536 AURORA PL � " Zip: 96001-0100 -�
ConVactor. '
Address:
Zip:
Arch :
Address:
Phone:
License:
Eng:
� � � � Address:
ISSUED BY:
Slatus: ISSUED
Applied: 03/O6/2003
Issued: 03/06i2003
� Phone: � � Phone:
Zip: , � , . License: License:
SCOPE OF PERMIT
OEMOLITION pERM1T FOR FIRE DAMAGE TO UNIT. ��' . �" '
FEE SUMMARY
Plan Check: $0.00
Permit: $69.25
SMIP Res: $0.00
SMIP Com: $0.50
Other: $0.00
Inspection: $0.00
Total: $69.75
SETBACK$
MAINSTRUCTURE Front 0-0
ACCESSORY �. Front 0- 0
PARKING ExtsGnq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: �0
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation: S2,000.00
Claim Valuation: Sz,000.00
Right 0- 0
Right 0- 0
NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 9248. § 1, 12-21-92)
EXPIRATION: Thi� permit shall automaticalty expire and become vold if work Is not commenced withln 180 days, or if work Is suspended or abandoned
tor a period of 180 tlays.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all appllcable codes, and all
required Inapeetlons and finel approval mus� be obtained. Fallure to obtain inspections and final approval will result in the explration of ihis permit.
' FOR INSPECTIONS CALL: (714) 7545828
2C4648 (9N0)
WORKERS' COMPENSATION DECLARATION: • � �
I hereby eXirtn under penalry ot peryury one ot Ihe fallowing dedarations: �
❑ I heva entl will maintain e certiticate ol cansent to sel4lnsure tor workers' mmpensatlon, es provitletl for by section 3700 of Ihe Lebor Cotle, for the pertortnance of Ihe
wark for which Ihis pertni� is issuetl.
❑ I have end vAll maintain workars' compensatlon Insurance, es reqWred by section 3700 of Ihe Lebor Cade, tor I�e pertortnance ot the woAc fw whkh this pertnit is issuetl.
My warkers' compen ,t�Io/p InSurenCe er enC pollcy number ere: �
Certier. \ J�(L.� Q Policy Numher.
his sectlan need not be camp7etetl if Me mut ls velued et me huiMred doNers �S 100) w.leu.) ,
I cenity t�at in the peAortnence o1 Ihe work for which Ihis permil is issueq I s�all nm employ eny person in eny menner so es to become subject to the workers'
compensatlon lews of Celifomle, entl egree thet If I shoultl Decome sub�ect to the workers' campensetlon pravisions o1 Se� 3700 0l the Lebor COGe, I shall foMwlN
comply with these provisJ ons. n %�\�,� � /� /�,�
Applicent Sipneture: �v,L .�-�C�C.-� v�l t A+. � Da1e: `�!'' lY )
WFRNINO: FM�URE TO SEWiiE WORKEPS' COMPENSFTON COV �E IS UNLAWRIL AND SNALL SIIBIECT AN EMPLOVER TO CRIMINAL PENALTE AND CML FlNES UP TOONE HUNDRED
hKKISAND OOLLARE (5100,000). IN ADIXTION TO THE C46T OF COMPENSATIpN, DAAUGES AS PROVIDED FOR IN SELTION 31080F TME LABOR ODDE. WTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLAHATON:
I hereby eflirtn that I am Ilcensed untler provlsions af Chapier 9(commencing wi1� Section 7000) ol OMslon 3 ot the Business end Prolessians Code, entl my Iicense is in full
lorca end etlect. Llc. a Class a
Conlreciofs Signature: Dete:
CONSTRUCTION LENDING AGENLY:
❑ I hereby eHirtn t�et ihere is e constructlon lending agency br Ihe pudormence ot Iha work lar which this pormit is issued. (Sec. 3097, Civil Cotle).
Lender9 Neme: Lender's Atltlress:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirtn that under penelry ol per�ury Ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for t�e lollowing reason (Sac. 7031.5, BuSiness entl Profassions
Code: Any ciry or wunry which requires e permit to canstruct, elter, improve, tlemdish, or repair eny structure, pdor to Its issuance, also requires Ihe eppliwnt for such pertnit
ro lile e signed stetement ihet �e or s�e Is IkenseC pursuant to the provisbns oi ihe COMractors License Lew (Chepter 9(commendng with Sectlon 7000) of Dhnsirn 3 of the
Business end Prolessions CoOe) or thai he or she is ezempt Ihereirom and ihe Oasis for ihe elleged exemptlon. Any violation of Section 7031.5 by eny appliwnt for e pertnit
subjects the epD�icant to a civil penalty oi not more than five hunaretl Aollars (5500).):
❑ I, as owner ot the proparty, or my employees with wages as thelr sole compensation, WILL DO THE WORK, end ihe siructure Is noI intended or offared for sale (Sec.
7044, Business and Professions Code: Tha Contractors License Lew does not apply lo an owner oi property who builds or improves ihereon, and who does such work
himsell or herselt or t�rough his or �er own employaes, providetl thet such Improvements ere not Intended or oflerad for sale. If, however, Ihe huiltling or impmvement is
sold within ona year oi wmpletion, the owner-builder will have the burden of proving ihat he or she did nol build or improve for purpose ol sale.). '
❑ I, as owner of the pmpetly, em E%CLUSIVELY CONTRACTNG WITH LICENSED CONTFiACTORS to construct tha project (Sec. 7044, Business end Professions
Catle: The coniraciors Lkense Lew tloes not eppty to an owner of properry who �uilds or improves Ihereon, end who contracts for such prolect with e contredor(s)
license pursuant to the Contractors License taws.). �
❑ I em exempt under
SigneNrB: ��
Owner ID veritied by drivers license.
Busineu antl
❑ vas ❑ No omers
Veriflcation oi Ownership by (rype o� Aocument, i.e. - properry tax bill or tleetl):
�JL�1!!G
DIVISION OF INDUSTRIAL SAFETV PERMI7 CERTIFICA710N:
❑ I hereby ceNfy ihat no excevetion tive (5) or more feet in depih Into whic� e person is requlreO to tlescend, wlll be made In cannection wit� work euthorized by Ihis
permll, and Ihat no building siructure, scaHoltling, falsework, or demolltion or disman�ling Ihereof, wlll be more ihan thirty-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celilomia AtlminislretNe Cotle). ,
❑ As owner-builtler, I wlll noI employ enyone to tlo woAc which would require a permit Irom the Divislon ol Industriel Sefery, as noted ebove, unless such person has e
permit to do such work trom the tlivlslan.
Signatura: Date:
DlNsion oi Industrial Safery Permli Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOpIZA710N OF ENTRV: I certity under penalry of perjury thet I heve read this applicatlon and state t�et ihe Iniormation gNen Is
correct. I egree to mply with ell stete lews antl ciry ardinances reletinp to Euilding const tion, end euthodze representatives of t�e Ciry af Costa Mesa b enter upon the
above-desc 6ed pr peM � r ins ection purposes. I agree not to occupy or ow accupency ny building euthorized by this p rtJiil unt fjnal inspection.
z� ���-,v._.- i� -��C� ��
SlnnaM1VY IIMBIiTVf1NlISi J T— �8�0
And/Or Aut�orized ApDlicant
COpE �, IHSPEC110NTYPE Q�
1818 Fixod System Flnal Fire Preven�ion
1268 Pool Spe Final
200 Finel Re-Roof
201 Final BIa1JRetelning Well �
202 Final Faclory Fire Place
203 Final Sign
20d Final DemolitlGn ' ��
�
�
CODEI INSPECTIONTYPE �
206 Flnel Mechanical
20B Flnal Plumbing
210 Finel Electricel
212 Flnal Fire Prevemian
220 Finel Planning Apprwel
222 Flnel Site
250 Flnal Bulltling/Occupanq
PAg It�
(714)754-5273 • FvcI714)754-4856
Job Address: 845 W 19TH ST
Suile No
Vicinity:
Parcel Nunmber:
Appliwnt: DAVID CROWELL
Address:
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Owner: VISTA ASSOCIATES.
Address 7706 80TH ST, �, �
PLAYA DEL REY, CA
ELECTRICAL PERMIT
Phone: 714-4443592
2ip:
Phone: 949-6463679
Zip: 90293
Contractor. CROWELL, DAVID ELECTRIC '
Address: 2975 RED HILL AV ��- �
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 7000a
Service over 7000a
Motors to 1 hp
Motors l0 10hp
Motors to SOhp
Molars to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
COSTA MESA CA - �
� �� Phone: 714-044-3592
' Zip: 92626
License: 482184
SCOPE OF PERMIT
FIREWORKS STAND ON BLOCKBUSTERS SITE FOR YOUTH,SERVICES.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
50.00
$0.00
so.00
$0.00
S0.0a
$0.00
$0.00
$0.00
$0.00
Quantity
,�,,FEESUMMARY� ,
- � Temp Dist System / Lighting
Busway I700 k �
Standing Section
Misc Electrical Equipment
Trans(ormers up to 1 kva/kw
................up to 10 kva/kw
� .................up to 50 kva/kw
.................up l0 100 kvalkw
..................over 100 kvalkw
low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
dnvestigation Fee
Plan Check Fee
Reinspection Fee
PERMIT NUMBER
E99-01246
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 12/23/1999
Issued: 72/23/7999
ISSUED BY: - ��
Quantity
80.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
50.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
$11.00 7
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES §34.50
COMMENTS / SPECIAL CONDITIONS
J
NOTICE: Tha work authorized by this permit shall compty with ali applirable handicap access requirements under Calitomia statutes and related I
regulations. (Ord. No. 92-28, § i, 12-21-92) ,
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned �,
for a period of 7 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all �
required Inepeetions end final approvel must be obtained. Failure to obtain inspections and final epproval will result in the expiration of this permit. I
FOR INSPECTIONS CALL: (714) 7545626 �.
WORKERS'COMPENSAnON DECLARATON:
I hereby aHirtn untler penalry of pehury one ol ihe tollowing tleclaretions:
❑ I heve end will mainiain a cehilicate ot consent to seN-Insure tor workers' compensation, es providetl lor by sectlon 3700 ot the Lebor Cotle, tor Ihe peAormance of Ihe
work for which this permit Is 135uad.
❑ I have and will maintein workers' compensation insurence, as reduired by section 3700 oi the Lebor Cotle, tor the peAortnance ot I�e work for which ihis permit is Issuetl.
My warkers' wmpensetlon Insurence cerdar and policy number ere: ,
Cerdor. �1P_�"� d / Policy Number;
❑ I cenity t�at in Ihe pertormence of the work for which this pertnit is Issued, I shall not employ any person In any manner so as to becoma subject to Ihe workere'
compenSeUon laws ol Califomia, entl egree thet ii I shoultl become sub�ecl to Ihe w9rkers' compensation proNsions ot Section 3700 0l t�e Labor Code, I shall forthwith
compty with these Wslons. � �f1 /1' � �
� AppliceniSigneWre: �D (.vc�.�r�C Dete: /L — %.3 � qR
WARNINO: FAILURE TO SECURE WORKERS' WMPENSATIIXJ �VERAGE IS UNLAW FIIL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNORED
THOUSAND DOI.WiE (5100.0OO�.IN ADDfTION TO THE COST OF COMPENSATIIXJ, DAANGES 0.5 PFOVIDED FOR IN SECTION 3]W OF iHE LABOR CODE. IN�ERESi, AND ATTORNE`f5 FEES.
�
-'I
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I am licensed unde�rp rovisions oi Chapter 9(commenGng with Section 7000) of Divislon 3 of ihe Business and Professions Cotle, and my license is in tull
force entl eHect. Lic. # �ig Z LPS �i � Class N_ C— ��
ConlractorsSignature: �.-� � Date: /Z'Z —
CONSTRUCTION LENDING AGENCV:
❑ I hereDy eNirtn that t�ere is a canstruction lending agency tor Ihe peAortnance of ihe work tor which this permtl Is issued. (Sec. 3097, Civil Cotle).
Lendefs Neme: Lendefs Address:
Siqneture: Date:
OWNER•BUILOER DECLARATIONS:
I hereby aflirtn that untler penalry of per�ury thet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business antl Professions
Code: My city or counry which requires a permit ro consiruct, alter, improve, demWish, or repair eny sWcture, prior to its issuence, elw requires the eODlicaN for such pertnit
b flle a signed statemem ihat ha or she Is Ilcensetl pursuani Io the provisions of ihe Contractors License Law (Chepter 9(commendng with Sectlon 7000) ot Dldsion 3 of the
Business and Protessions Code) or Ihat he or she is e:empt iherelrom anA t�e basis for Ihe alleged ezempilon. Any violation ot Sactbn 7031.5 by any epPlicant for e pertnit
su6Jecis the epplicant to a civil penalry of not more than tive huntlretl dWlars (5500)J:
❑ I, es owner of the property, or my employees with wages es t�eir sola compensation, WILL DO THE WORK, and the structure is not imendad or oNeretl for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not eppty to an owner of properry who builds or improves thereon, and who dces such work
himself or harself or ihrwgh his or her own employees, provided ihat such imprwements are not intendad or oflered for sale. It, however, the building or improvement is
soltl wit�in one year ot mmpletion, t�e owner-builtler will heve the burden of proving ihat he or she alU not build or improve for Ourpose of sale.).
❑ I, as owner of the property, em EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to conslmct the pmjec� (Sec. 7044, Business and Pmfessions
Coda: The coniractore License Lew does not apply to an owner of pmpeM �'ho builds or improves thereon, antl who conirects lor such prqect wi�h a contractoqs)
licensa pursuant to ihe Contractors License Lews.).
❑ I am ezempt under sec.
Signature:
Ownor ID venfietl by tlrivefs license. ❑ Yes ❑ No
BuSMeu end Protessions Cade for this reason:
Vedfication of Ownership by (rype ai tlocumenl, i.e. - propeny tex 6ill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N:
DnvelsLiCenSe No.
Date:
Ezpires:
❑ I hereby certify thai no e:cavetion tive (5) or more leet in depih into whfch e person is requireA lo descend, will be made in connectlon with wark euthorizetl by Ihis
permlt, anA ihat no bullding siructure, scaHolding, felsework, or tlemolitlon or tlismamling Ihereof, wlll be more �hen tAlrty-si: (36) toet NgR (Chap. 3.2, Gry 2, Art 2, Sec.
341, Ttle B, Calilomia Administretive Code). �
❑ As owner-builder, I will not employ enyone to do work which would require a permit imm ihe Division of IndusMal Safery, as noted ebove, unless such person has e
permit to do such work trom the division.
SignaWre: Date:
Division of Industrial Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUlT10RIZATON OF ENTRV: I certily untler penalty of per�ury that I have reaC this epplication end state that ihe information given is I
wrrecl. I agree to comply with all stete lews end city ordinances relaNng to building cronsWction, end authodza rapresentetives ot the Ciry ol Costa Masa !o enler upon the
ebove-descnbetl property for InsDectlon purposes. I agrae not �o ocCupy or ellow occupancy of eny building euthorized by this permil until Ilnal inspection.
Of Legel
CODE �. INSPECTON TYPE
1616 FixeC System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
207 Final BIaWRetaining Well
202 Final Fecrory Fire Place
203 Final Sign
204 Finel Demolitian
2aBJ8
Date
(� - Z 3-4q
Date
OATE �$ S,QQE� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final ElecMcal
2tt Finel Fire Prevention
220 Final Planning Approval
222 FIneI5lte
250 Final BuiltlincyOccupanty
JIII'
/ �
� i i
(7l4) 754-5273 • Fax (774) 754-4856
Job Address: 845 W 19TH ST
Suite: %�
Vicinity: UNITS A,BBC
Parcel Number: 42419107
_ CITY OF COSTA MESA
BI/ILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Appliwnt: ROBERT OWEN
Address:
BUILDING PERMIT
Owner: TRAUTWEIN, PAUL TR
Address %L 8 M PROPERTY MGNT
NEWPORT BEACH,CA
1617 WESTCLIFF DR #112
Contracror ' ROBERT OWEN BUILDING C
Address: . 430 RNERSIDE�AV
NEWPORT BEACH CA
Zip: 92663 �
Arch :
Adtlress:
Zip'.
Zoning:
Phone: � 949-631-3820
Zip:
Phone:
� Zip: 92660 �
O
Phone: 714 631-3820
License: 471754
' - Phone: � - "
License:
- Eng:
/ " Address:
SCOPE OF PERMIT
� - COMBINE UNITS A, B& C.
REMODEL STORE TO WA7ER SALES, DONUTS AND BURGER STORE "FAMOUS DONUTS AND SUBS".
SEATING IN ORIGINAL DONUT SHOP PORTION WILL REMAIN UNCHANGED FROM THE EXISTING;
� � � ` � ,. FEESUMMARY '
PERMIT NUMBER
B99-01253
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Plan Check: $385.94 - - , , Calc Valuation:
Permit $593.75 ci��.,,v�i���r�,,,,
SMIP Res:
SMIP Com:
Other:
inspection:
Total:
$0.00
$9.45
$0.00
$0.00
$989.14
SETBACKS
MAINSTRUCTUFE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0. 0
Rear 0. 0
Requi�ed: 0
�
PLANNING & ZONING
Lefl 0- 0
Lek 0:0
Pr000sed: 0
Right 0- 0
Right 0. 0
Status: ISSUED
Applied: 8I70/1999
Issued: 1112411999
Phone:
License'.
$45,000.00
S45,o00.00
� `1 �
A.� , �v
/�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Celifornia statutes and related
regulalions. (Ord. No. 92-28. § 1, 12-21-92)
EXPIRATION: This pefmit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
tor a penod o� 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all
i requlred Inepec0one 6nd final approval must be obtained. Failure ro obtain inspeaions and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
��
WORKERS'COMPENSAnON DECLARAnON: � �
I heroby aHirtn untler penalry of perjury one ot t�e lollowing tleclaretions:
❑ I have end will maintain a cenificete of consent b selbinsure tor workers' compensation, as pmvitletl tor by sectlon 3700 0l Ihe Lebor Cotla, for the pertortnance of the
work lor which this permit Is issued.
❑ I have antl wiil meintain workers' compensation insurance, es requiretl by sectlon 3700 of the Lebor Code, br the peAormance of Ihe work lor which Ihis pertni� is issuetl.
My workers' compensation Insurance carner and policy number ere: /� ^7 (� �7 4
Cerner: �~'-�ii ICi�if�' -{—J!U(� ( PolicyNumEer. � 7_5 C� � 7 / � � /
(Thls section need not Oe cnmplefeO I! fhe Oermif is valued et one hundred dollars (S I00J or /ess.)
❑ I ceNty Uat In Ue pertortnence at the work tor which Ihis permit is issuetl, I shall not employ eny person in eny manner so es ro become sub�ect to the warkers'
wmpensation laws of California, and gree ihat if I should become subject to the workers' compensetion provislons of Section 3700 ot the Lebor Catle, I shall lorthwith
comply with �hese provision �/�1 /^/
Applicant SigneWre: �� . (� JC� / Date: l//�i �/7 Y. �
WARNINO: FNLURE TO SECURE WORKER$' NMPENSATIIXJ COVEMpE IS UNLAW FUL AND SHP11 SUBIECT AN EMPIOVER TO CRIMINAL ENALTI S AND dVIL FlNES UP TO ONE HUNORED
THOUSAND DOLLAHE ($100,000), IN ADDRIIXJ TO TME COST OF COMPENSATION, DMMGES AS PROVIDED FOq IN SECTION 3]080F TME IABOR CA�E, I�`REREST, AN� AT70RNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aXlrm ihat I em
torca end eflecL Lic. a
, � ContrectoYs Slgnature:
�
of Chapter 9(commencing wlih Seciion 7000) ot Division 3 0l the Buslness entl
� Glass A
� � Dete: !i
CONSTRUCTION LENDING AGENCV:
❑ I �ere0y ettirtn that t�ere is a consiruction lending egency for the DeAormence oi t�e work for w�ich this pertnit is issued. (Sec. 3097, Civll Code).
Lender's Neme: Lentlers Address:
Signeture: Dete:
OWNER-BUILDER DECLARATIONS:
is in full
I hereby eflirm that under penalry ol perjury t�at I am EXEMP7 FROM THE CONTfiACTOqS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Proleuions
Code: Any ciry or counry which requires a permit to wnsiruct, atler, impmve, demolish, or repeir eny strucwre, prior Io its Issuance, also requires the applicaN tor such permit
lo lile e slgne0 statement t�at �e or she is licensed pursuant to t�e provisions of ihe CoNractors License Law (C�apter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or Ihai he or sha is exempi therefrom and ihe basis for iha ellepetl exemption. Any Nolation of Sectim 7037.5 by eny epplicant tor e Dermit
sub�ecis Ihe applicant to e civil penalry of nat more than tive hundretl Aollars (5500)J:
❑ I, as owner ot t�e property, or my employees with weges as their sole crompensatlon, WILL DO THE WORK, antl the sWcture is not intendetl or oHered for sale (Sac.
7044, Business and Professions Cotle: Tha Contrectors License Law does not apply to an owner oi property who builtls or improves Ihereon, antl who tloes such work
himseif or hersell or ihrough his or her own employees, provitled that such improvemems ere not imended or oNered for sele. If, however, the huilding or improvement is
sold within one year of completion, the owner-builder will have the �urtlen of proving ihat he or she ditl not builtl or improve for purpose of sale.).
❑ I, as owner ot Ihe propeny, em EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to constmct the pmject (Sec. 704a, Business end Professions
Coda: The coniractors License Law does not appty m en owner oi pmperry who builds or impmves ihereon, end who contrects for such projecl with a contraaor(s)
license pursuant to the Contrectors License Laws.).
❑ 1 am exempt under sec. Busineu antl Professions Code for ihis reason:
Signeture: Data:
Owner ID verified by driver's licansa. ❑ Ves ❑ No Driver's License No. Expires:
Verification of Ownership by (�ype of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
❑ I hereby ceNty ihet no e:cavetlon fiva (5) or more teet In tlepth Into which e person is requiretl ta tlescenq wlll be mede in connectian wlth work authorized by this
permit, entl thet no builtling structure, scaHalding, lalsework. or tlemolitlon or tlismentling Ihereot, will be more than t�irry-six (36) feet high. (C�flp. 32, Gry 2, Art 2, Sec.
341, Tula B, Celifomia Administretive Code).
❑ As owner-builder, I will not employ enyone to do work which would requira a pertnit fmm Ihe Division of Industdal Salery, es notetl ebove, unless such person has a
permit to do such work irom t�e tlivision.
Signeture: Date:
Division ol Indusinal Safety Permit Num6er:
CERTIFICA7E OF LOMPLIANCE AND AIfiHORIZATION OF ENTRY: I certiy under penelry of perjury that I have reatl ihis epplication and state Ihat t�e Information given is
correct. I agree to comply wlih all state lews and ciry ortlinances relating to buildinq construction, and authonze representaiives of the Ciry of Costa Mesa to enter upon the
ebove�0escribed property lor inspection purposes. I egree not to occupy or allow occupancy o� eny bulltling authorized by ihis permit untll final Inspection.
a re 1 al neQs) ta
�
� �Aut�orized Applicam / /// Daty�—�
COOE I. INSPECTIONTYPE
1816 Fixed System Final Fire Prevention
1266 Pool Spe Finel
200 Final Re-Roof
201 Final Block/Reteining Wall
202 Final Factory Fire Plece
203 Final Sign
204 Final Demolition
24a6-a6
29IF
INfI71AL5 �QQf,� INSPECTIONTYPE
208 Finel Mechanicel
208 Final Plumbinq
210 Final Electrical
212 Final Fire Preventlon
220
222
250
Final Planning Approval
Final Site
Final Building/Occupancy
Q� INTRIa�s
q-L9-aa �
PflQIEtT ADDNESS: 8 t] S j•1 1 9'j'fj S'i'
OWNEP'SNAME: VZSTA CI�ETER
FOOHESS: �CANE
AflCM/ENGINEEN:
p00HES5:
flEG.NO.:
uxir: �
UNIT:
PENMITfEE:'1HEIS G LAISY (7i4)821-0663
aooness: 2517 CERRI'iOS
LONG BEACH CA 90806
LICENSEU LONTPALTON DECIABATION: I �ereUy aflirm �Aai I am license� unaer provisian5 ot CtwO�er 9 �cOmm¢nting wi�� Sec�ion
7000� ol Division 3 oi t�e 8usine55 antl Pmfessions Code. anA my license is in full lorce and eilecl.
ciTr uc.: 054 667 STpTE LIC.: �"'(� 66 � a � CLASS: (.'� 4 — ^_
oaie: I�— L— 9 I / s��namre: �Q^r'-'a /' � r-
wOBKEHS' COMPENSFTION oECIABATION: I hereby affirm that I have a ceniliwte oi consent to selNnsure or a cenilicate of Workers'
Comp¢nsation Insuran[e, o� a cenilietl copY �hereo� (Section 3800, La�. �.
Poucv xo.: fl 0016 214 exr. oarc: 6/ i 2/ 9 2
camraNr: TRANSAMERtCA
�� CertilieE copy is hereby fumis�etl. [� CenilieA coDY is filetl vnt� the c,}'^.�`Builtling DiNSion.
� { ^ � Q Applicam: � �"� / a �
E%EMPTION FflOM WOflNEPS' fAMPEN5ATI0N UECIAflATION: (i�is Seciion neeU nol0e mmple�eU i� Ne pelm� is lor one hmGreE (Sl lp) or less�.
I ceriify Ihai in ��e pedormance ol the work for whic� this permi[ is i55ue0, I shall nol employ any Oerson in any manner sa as to 6ecome
SuOj¢CI IO �Ile WOrk¢IS Gompen5dti0n LdvS 0� Cdlilafnid.
Oate: Signa�ure:
NOTICE: Ii, after malting this tleclara�ion. you 5hoW4 hecome Sublect Io ihe Warkers' COmpenSation provisions oi ��e Labor
Co�e. you must lanhwitn compty with sucn provisions or this permit snall be eeemea revoketl.
CONSTflUCTION LENOING AGENCY: I here6y aliirm t�a� ��ere is a constmclion lentling agenry �or �Ae Oe�ormance af ��e work lor
whic� Ihis permi� is issuea (Section 3097. Civ. C�.
LENOEB:
AOUNESS:
OWNEP BWIDEN �ECIAHRTION: I �ereby atfirm ihat I am exempt irom the Contractars' State L'uense Law for t�e followinq reawn
�Seciion 7031.5 Business an0 Pmlessianal Cotle: Any cily o� counly w�ic� r¢Quires a permit Io cons�rucl, alter, impmve, dem�li5h, or
repair any 51mt�Ure. prior Io ils issuante, also repuire5 ��e applicant tar suth permi� to lile a 5igneG Slalemeni Iliai he/Sh¢ is litensetl
pursuant to t�e pmvisions o� Ihe Comramors' Stale License Law (Chapter 9(commencing wilh Seclion 7000) of Oivision 3 ot Ibe Business
antl Pmtessions Code) or Ihal he/she is exempt therelmm and the hasis �o� I�e alleAed exempiian. Any viola�ion ot Sedion 7031.5 by
nny applicant br a permit suble��s ��e applicani lo a civil penalry of not more t�an five �undre0 Uotlars (5500).
4 I, as owner of the prooerty ar my employees with wages as ineir sole compensation, win tlo the work, and �ne
stmciure ¢ nol imenUetl or ofleretl for sale (Section 7044. Business antl Pmtessional Cotle: TAe CanVactors' State License Law.
does noi apply to an ownef of a pmperty who Uuit05 or improve5 ihereon, an0 who Does suCh work tlimself/hefsell or �hmug�
' �is or her own employees, provitletl t�at such imD�ovemenis are noi intentle0 or oiferetl lor sale. �i, Aowever ihe builtlinq or
�impmvement is soltl wilAin one year of compleiion. IAe owner will have ihe hurtlen of Droving �e/she CiJ noi bui10 or improve
lor Ihe purpose ot sale).
I. as owner of I�e propeny. am exclusively conVacting with IicenseA contractors lo conslmci �he pmjecl (Sec�ion 7044, Business
antl Pmfessions Co�e: 1he Comracmrs' State License law does not apDty to an owner ol pmDerty who Omltls or improves ��ereon
antl who contracis far such pmiecis wit� a conUacbr�s) license pursuant to Ihe Conlractors' State L¢ense Law�. I am aware
Ihai proof ot l�eir Workei 5 Compensation insurance shoultl be pmvi0e0 �o me.
� I am exempl untler Seciion'. B. 8 P. C.
lor I�is reason:
Oate'. Owner
I Ao hereby cenily Ihai I am aware ol an0 understan0 i�e repuirements o� Calilomia Heal�h anA Safe�y COUe Se[lions 25505, 25533, anA
25534 antl Ihat I or any IUWre �uilding occupant willlwill na� (circle one) need to comply wilh saitl slate cotles and the requir¢men�s br a
permil for consbunion or motltlication Imm Ne Air �ualiry Managemeni OislncL FesiOemial conslmction applications ar¢ eKempt Imm
Ih¢se pmvisions.
�aie'. plicanL /
I he�eby ceriify��a� I haveread this applical n an0 sta�e��a� I�e a�ave informalion is correcL I agree �a comply wit� all city antl c un�y
orOmancesantlslatelaasrelal�ngiobuiltling onsimtlionandnerebyaulhor¢ereD�esenlativesoflhiscilyloenteru0anlheahove-me�onee
pf4pCriy la! Inspeclian purp05¢S � A . /� (� /1 /� /�
�ale:_I1'�`�' l_I 99na1ure: � ��i�-��,—
Oriver'S �icense ar Social Sewrity k:
164L46 Whue—Bmltling�, Green—Cotle EnlorcemenL Canary—ApplicanP. Plnk—Revenue: Goltlenme—Assessor
C1TY OF COSTA MESA — 3UILDING PERMIT
FERNII NO: B 059955 PLAN CFiECK NO: N
COhSTRUCTION TYPE: PERNIT TYPE: STR
JOB DESCRIPTION : REPAZR FIRE DAMAGE AS REQUIRED
CLAIM VALUE; 12,OU0.00 CALC—VALL'E: 12,000,00
PERM NO: 3 05995`_
GOVT: N SUPY: IS
PJRPOSE: REP
SQ FT: 12,000
GROUP OCC: B-2 /
COMMEN"CS : ]C
**��*�+��x�*�*��x����***x�r***��x ��**+�*�*+��*��*��*+�*�rx*�*****+�x*����e***� u*��:*x���*�
' 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 BUZLDTNG ----------� --------- ACCESSORY BiJII.D`1NG ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: F? IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO;
PiANNING N('3TES>
�
1E ie iE ii 3E it i4 i'r 1F iF �f 1F iE �IF jf if iF ii� # If iE �7F iF aF �f if � iE k iF aF 3f iF �f 3e �1F If� iF iF if IE 3F iE IE iF �l4 �7f If 3e * ii 3'r 7F �lE 1FiF iF ii �le iF iF iF 3i��if r. iE it #� iF iF+f 1c iF i� iE if !S aE
D E V E L O P M r. N T S$; R V I C E 5 R E Q U I R E M E AT T S
ZONING APPROVED BY DATE;
BUILDZNG APPROVED BY ; DATE:
APPLICATZON ISSUED BY: DATL•
ll fo,�,�,�
if3cifitiiFiFlFif361F�1i1fifiF�lhlfifiEiERifi(� . . . �7i�iEiFli�iEi'riF�k�iFiF x iFirfFf(�
iE 3F if �k iE �l'r 3i if �1h 3E if IE iE i(� K 1E IF iF iE iF iE 3f if iE 1E#:� iF ii• 3f lE iF 3k if it%iE �K� iE iE af iE af• if iF if 3F iF iE iF Y.� 3i �E iF?t�iE iE if ic if iF iF �E 3F iF iF iF IF ik lE 3c 3F lt if IE iF iili� if if
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
s
BLDG PMT PLUMHING ELECTRIC MECAAAIIC FIRE SMIP/RES `y�, GRADING
PERNIT 135.00 ,. ,Y:
PLAN
ISSUE FEE
BUILDSNG—DIV—>
TOTALS---->
PERMIT ISSUE PLAN—CHECK TOTAL
1J7.52 O.UO 0.00 137.52
REVENUE DSVISION TOTALS--> COLLECTED; 137,52 OVER/$'�
BLDG PMT PLUMHING ELECTRIC MECHANIC FTRE SMIP/TOT �,{
135,00 I 2,$�'
ih �F �lF i( 74 3(� iE 3(� i(� �1(� i4 if i(� i(� if IE k iF if iF iF 34 iE�if 3F iF 1E i(� if !f If i(� if !E iE jE it� iF iF k� 7F iF ic ie ih ih ii� if 1f� iE if 3E %� 3f if iE iE iF #iF 3E�
I N D I V I D li A L F E E B R E A R D O T�T" N
TYPE QTY D E S C R I P T I O N liNIT COST
SFC 12000 FIRE DAMAGE/VAL COMMERCSAL NO`l,ONE 1,00
END UF FEES
C� �
C
f,
�' � �' N `
TO AL COST
� 1�� 0 � Q, � �
� r v.+ ^
� � ��
1
� lrv�mm�lcfo IncnAf110L1S �; JI:iQ_iL•`r'] ��']17Q.' j: nT -
:f1T�: �,?/JO�'�'� T�:t�B 7'-i'}y -.. ._
�t��LS'� ,I�3 ql
� � l �r�
CONSTRUCTION ANDPLANNING POOL�4
APPROVALS Permit # Uate Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service'3r Pole . 52. Pool & Equipment Locati0n �
2. Soil Pipe-Undrgrnd. �' ,. 53. Steel Reinforcement '
3. Electrical Conduit Uti�ity-UrfQrgrnd. Z 54. Forms -
4. Electrical Conduit-Undrgrnd. 55. Electrica� Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVEfl�GUNITE
7. Footings . 58. Eiectrical ConduibUndrgrnd.
8. Fo.undation �.", 59. Gas Pipe, O Undrgr�d., Tes[ ��-'E
�
9. Water Pipe•Undrgrnd. 7 60. Backwash Lines, P�Trap, O Undrgrnd. �/.'
10. Structural Floor System • 5 '; 61. APPROVAL TO DECK
11. Property Sewer Line & HoUsoConnection � 62. Backwash & Receptor�Finai ;'�r
12. Sewer Cap '� 63. Heater & Vent�Final �`
13. Roof Drains � ;,� 64. Plumbing System - Final ��
14. Rough Plumbing C.'j• . 65. Electrical-Final =?�
�
75. Rough Electrical�Conduit ` 66. $olar System-Final `�
.J
- 16. Rough Electric Wiring 67. fencing & Access ApProval
' J�y. Reuqh Wiring Sign 68. APPROVED FOR PLRSTERING
18. Rough Electrical�T Bar Ceiling 69. POO�/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rou9h Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. DuMs, Ven[ilating 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. Frame and Flashing , 76. Dry Standpipe
28. Laihing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 76. 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 `'M °� �` Q�. Notes: � � ��
\\ \ -
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-TesT • �
36. Hood or Canopy �q
I
37. Final Factory Fireplacc ' . _ _ _�
38. Final Plumbing
39. Water Service�Final , �
40. Gas Service-Final , . !
41. Solar pomesticFinal � � ��.�,
42. Backflow Preventei � � , �
43. Backflow Irrigation I� )
�44. Landscape Irrigation System � � , ,Q �/ ; _ �
45. Sound Attenuation 7 �
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING
48. FINAL PI_ANNING � '
49. Electric Release to Edison
50. Gas Release to Southern Califurnia Gas Co ! '
51. CERTIFICATE OF OCCUPANCY' •
No. Date
PROJECT ADOPESS: 8 4 S W 1 9 TH ST
owxen s xnme: VERA R. HUGHES
aooeess: 701 CLIFF DR
CAW9�2663BEACH
ppCH/ENGINEEB:
RUOflFSS:
flEG.NO.:
uxir: A6H
UNIT:
PEPMITTEE: NEONIC :'�i� ( 714 ) 499-2573
nooness: 31502 MAN VISTON
SO LAGUNA BEACH CA 92697
LILENSEU LONTPACTOfl OECIANRTION: I �e�eEy atlirm 11iai 1 am tic¢n5e0 unCe� provi5ioht of Chap�er 9(cammencinq wit� Seciion
7000� al Orvis�on � of I�e Business an0 Prolessions COtle. antl my license is in INI force ana eflect.
cirruc.:044023 srnteuc.:523289 S5 C45
oate: _L�-�{' S C�_'j�— 5�gnamre: — - . . - -
WONNEBS' COMPEN ATIUN OECtAPATION: I �ereEy atP� . �hat i, � a certiliwte nunt ta sell-insure or a ceniliwte of Workers'
Compensaiion Insurance, ar a cenifiea copy inereol (�iron 38W. LaD. CI.
eoucrNo.: 1058377-92 EXP.DRTE: OS�OSI93
COMPRNY: STATE FUND
❑ Cenitied cooY �s nere0y lumisnetl. � CenifieU copy a fileA mtn tAe tiry BWaing Uvision.
Oate�. +I_���L aooi�cam: �
E%EMP110N FflOM WOfl Efl5' fAMPENSRTION OEClAl1ATIfIN: (Tlus 5eclim mxU m� Ge mm0 e d Ue permi is tor ane huMreA �5100) or less�,
�� I cerlity that in Ine pedormance ol ine wark lor whicn inis oermit is issueE, I shall not employ any person in any manner so as to become
' subjeci ro I�e Workers' Compenutbn laws ot Catifornia.
�a�e: Signa�ure:
NOTICE: I1. aller making I�is Oe[Iaraiian, you ShoWa Uecome SUUIe�� to Ihe Workers' ComOensation pmvisions of I�e LaOor
CoOe. you must tonllwiN comply wil� suc� pmvisions or tNs permit s�all Ge Oeemetl revok¢E.
CONSTBUCTION LENOING FGENCY: I nereoy allirm inat Ihere is a consiNction IenOing agency for the pedormance ol ihe wod lor
whictl I�is permil is isSueU (Setlion 3097, Civ. C�. �
�exoEn:
nooness:
OwNEP BUILDEB OECUNAtION: I nereGy allirm tlw1 I am exempl Imm tAe Contractors' State License Law lor ine lollowinq reason
(Section 70J7.5 Business an0 Pmlessional Cade: Any cily ol counly wliich Rpuirts a permit to cansimct, alter, imprwe, demolis�, or
reDair any s�mctu�e. D��or to its iswance. al5o repuires the aDDtiunt br such Dermit to lile a siAneO siaiemem tAat �e/s�e is licensetl
pursuam io 1he pmvisions ol I�e Conlraclors' Slale License Law �C�apler 9(commencing vnlh Section 7000) al 0ivision 3 al IAe Business
anU Pm�essions Coae) oi ��at �e/sne is ezempt ��erelmm an0 ��e OasiS for �he alleqe0 eeemD�ion. My violatian ol Section 70.11.5 Uy
any applicanl bt a permit SUDjecis I�e apDlicanilo a civil penalty of nol more tlWn five AunAred Oollars (5500).
I, as owner ol �tle propeny or my employees with wapes as �Aeir sde compenutian, witl Ao tlle xrork, and tAe
❑ simctum is no� intenEetl or ollere0lor ula (SeCtqn 7Dad. Buvness arid Pmlessional Code: T�e Coniractors' State License Law
tlaes nol apv�Y �o an owner ol a pmpCny wlp ouilUs or im0«s inerepl. ana wA0 tloes suU w0A him5ell/nerseif or ItlmuOh
�i5 or her Own emplOyE¢5. VroviAeO Ilut Sutll imD�ov¢men6 are nol inlBn4e0 0l all¢re0 lor Sall. II, �aweve� I�e buildin0 of
improvemenl 6 Sa10 witlnn ana year ol COmpletion. I�e Owner vnll hdve t�e DurGen ol D��A �U5t1e Eid nol bui10 Or improve
lor Ihe �urpose a� Sale).
i, as owner ol ine propeny, am exclusiveIy conVaciinp wit� IiceineG coniraclors to construct Ihe prolect (S¢ction 70E4, Business
❑ ana %ole5Si0n5 CoOe: The CmittactoR' $late LaG6e lfix GOPs not apply to an wmer ot prop¢rty wM �uuQS w imprOv¢i tllereon
I anG wno com�acis lor suc� D�olecis vnt� a contractaqs) lic¢nsa Ourwant to t�e Comractors' State Licenu Law). I am aware
Ihat prool ol I�ti� Warker'S Compensaiqn i�Kurante 5tnN0 Ge praviaetl IO m0.
� 1 am exemD� undei 5¢clion: B. d P. C.
for inis reason:
I �– I
Da�e: �^ef�
i ao nereoy cenily Rut I am aware ol aiM unaerslana ine repNremenis ol Ca0lomia Mealih an0 Safery CoOe Sectians 25505, 25533, and
2553� and ihal I or any luture builamg acupanl wilUwill not �cirUe one) nee0lo comDN wilh SaiO slale codes ana ihe re0uirements lor a
permil br conSVuciion Or moaiticatqn �wm I�B Air ualny Manaqemeni Oi5lnct. flesiEeniial conslmciion applitaiion5 are exemp� Irom
Ihese pmvisions.
Oate: AOGlitanl:
I M1cieby cetldy I�al I have ieaA tAis applicalion ana slate �Aai IAe a0ove in�orma�ion is cortecl. I agree Io comply with all cily antl coun�y.
ortlinances aM 51a1e Ww3 reldtinq to UmMing LOn5Vut1i0n aM �ereGy aNhOriZe reD��enlalivM ol tNs qty to enier upon Ihe a60ve-meNioneA
pmOerly for Inspe lion pur ises. �
�ale: "��-- Signature:_„ �
oriver's License or Socia� Security p:
t6a1-a6 Whae—BuJOing: Greon—Cotlo En�o¢emenC Canary—Applican�; Pink—Revenue; Goltlenmd—Assessor
CITY OF COSTA MESA — SIGN PERMIT PERM NO; SBE 059996
PERMIT NO: SBE 059996 PLAN CHECK NO: 04998-92 S GOVT; N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE; ELE STR SIG PURPOSE: OTH
JOB DESCRIPTION : ONE NEW ILLUMINATED CAN SIGN SQ FT:
CLAIM VALUE: 600.00 CALC—VALUE: 600.00 GROUP OCC: B-2 /
COMMENTS; THE "FAMOUS SUBS AND DONUTS" SHOP
�r�rr�r�r�r�x�e��e�e*+����r�r�r�r�e�*�rx���xx��r�r�r��*�:�r�r��r*�e�*��e*�+e�r�r�r�r*�r�r�e�r�e�r*��r�r**�r�r�*��rx*�r�r�r�r
S I G N I N F O R M A T I O N
DISTRICT: 1 TYPE; WALL MTD CABINET ILLUMINATION: INT CATEGORY; NEW
DIMENSIONS• 2FT OOIN X 8FT OOIN AREA: 16,OOSQFT LETTER HT; 17
STREET FRONTAGE 1; 972,50 STREET 1; 4i 19TH ST .
STREET FRONTAGE 2; 150,00 STREET 2: PLACENTIA AV •
PARCEL; 42419111 ZONE: C1 LOCATION > FRONT; X REAR:
BUSINESS NAME; FAMOUS SUBS AND DONUTS > 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 16,OOS FT OVERALL HEIGHT: OFT OIN
THIS SITE . 100,00S�FT , GROUND CLEARANCE; OFT,- OIN
ITEMS OF INFO ; 4 ." PLANTER AREA; O�,OOSQFT
ITEMS FOR ACTIVITY: 9 '" BLDG SET BACR: 20FT•�•=-
COPY VERBIAGE ; FAMOUS SUBS AND DONUTS
PLANNING NOTES; ''��
M k 1tlF if if itlflF k if 1f iflf M!! if iE if 1F iE if iE iElE ik iE iE it iE iF iF iF iF.iF iflE iF iF if iF M ik M K!t iE M if if ikik k i! IF if IE �F1f if �E iF iF if ik if iE �f 1F iE �E �f iE 1F iF if If iE if
D E V E L O P M E N T S E�R V I C E S R E Q U I R E M E. N,�.T- S
ZONING APPROVED HY �L'C..rr DATE: /-% / �
HUILDING APPROVED HY ; DATEz�.ii//s/9�
APPLICATION ISSUED HY: DATE•
**+t**�e*�r*�**�r**�t*�rr*�t* ■�e�er***�rit*��������*
LEGALIZATION;N F E E S U H M R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUHBING ELECTAIC MECHANIC SIGN SMIP/RES GRADING
PERMIT 17,00 15 00 16.00
�O! SNIP/NON—RES
ISSUE FEE 11.05 15.00 .SO
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 48.50 15.00 11.05 74.55 74.55 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 74.55 OVER/SHORT; 00
BLDG PMT PLUMHING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
17.00 30,00 16.00 .50 11.05
Ik 1FitlFk ik 1E k iklk 1F iFikit k ikiFl6�f i! k k 1E iF IE 1Flf �f iFik if if 1f 1F 1f 1f if ik iEif iFlflE �f iF if 1Eik1k kiEiE it Ik 1FikiE iE iFiF �FikiE fEik1E iE1E ik iEiEiFik iF1f M ikiF1E
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
ELE 1 SIGN/ OUTLINE LIGHT SYS ON 1 BA CIRC 15.00 15.00
� END OF FEES
%
�71 11�.t:. ' _. - ' � .
� ' �
CONSTRUCTION AND PLANNING POOL �A
APPROVALS Permit # Date I�speetor pppROVALS Permit # Date Inspector
- 1. Temporary Electrical ServF�'cevr-Pole, L � 52. Pool & Equipment Location "'
r
2,�.�SoilPipe•Und��nd. o�...: vF J� 53.SteelReinforcement �
K�.�Elec�riw� Conc(aii�lhility-Undtymd,;,� ;� 54. Forms � �'��
��
t 4.C&_festrical CondvitN4drgrnd. �,^ 55. Electrical Bonding �}
i 5'i'$ieeFReinforce��i� ��"� 56. Rough Plumbing & Pressure Test- � ��
LL' ��ERctrical UFEB Grnd. .� 57. APPROVAI TO COVER�GUNITE y
�`�-��otinqs i� � � 58. Electrical Conduit•Undrgr�d. a'
f- �. Foundation Gx LL�� ; 59. Gas Pipe, O Undrgrnd., Test � �
9. Water Pipe-Undrgrnd. � r� 60. Backwash Lines, P�Trap, O Undrgrnd. �✓�
10. Struttural Floor System -. '� 61. APPROVAL TO DECK i��
11. Property Sewer LinS& H�4 ��nrrection 11 62. Backwash & Receptor�Final
� ! �,
12. Sewer Cap y '� ` y ���"' 63. Heater & Vent•Final �'�
13. Roof Drains � y � 64. Plumbing System � Final ��
14. Rou h Plumbi ��
9 � 65. Electrical�Final ')
15. Rough Electricst-Conduit 66. Solar System�Final
16. ROugh Electricy iring 67. fencing & Access Approval
� 7. Reugh Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electric`�'dl,-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19: Rough Heaiing & Air Co�ditioning FIRE DEPT. REQUfREMENT
�'� 7 c ct r-� c F G ,.
20'7?o��ph F.2ctoZY R��lace��-+(-^�t� x. =FG +� G PRR��LS'h P�,iiY� " y
Z S Ao ¢ 5_ :JSJC�'..`.:�! ..:7?7C S :C ' N•-. � �'
21.-Due25, ieStryttur�g;; zSC�'.Ga1SQ.u•. �:U V � a S O,�l�lndergrOend Hyr1cU`� S y
22•\Qu`s, Vent�Tetiriq; � c` �Y r••v =�' O.T[� �� _71 .`�?� uct Piping [y�5� G"t� x
23..CCia{�''p� Ro h 8i�fesc 's�za �r-,_ 7,m �c ,T ,..ax �� � ,�„ r
� !;4 vvOVS r- � Cn ? 72^�Wnderground Flu'sF� i -{;.- x
�_ _
24;^RobiFEamirig ='� =-`�f :T'��CJ : #: O 73. �n{3erg�d.Storaye,Tank�,a5 CiOil `
TT � ^�CQ,1'.' T; }.� Y.
25��RoF S 'athin9 : x } ��'y .• ~ ~ , �` n' `� -� v �- ,.. r
� .�� T.ar;r,-. > . »: J �74; � verhe�.WYckn C.
26.vT•Ber Ceiling (Str4ciuraN'BrManoCbSt c' � *�� 75MBry Ch 'Cal ' X�
.. .. - ....-. :�r.
27��rame and Flash�� Qo ��C "'""£ � � 76y�ry S[an�ipe Z, � �x �'
28.�Lathing�kSM�ng x y,Sa�'.�� � aa^ �f •7,^fIXE�YSTEMF lA"7� "v ,.,
C Dt+ ?_XI.�C y�_i '- ,r,;s7 K �' . '+� -
l29. Insulati� , ��,: ;,,,_ ... �-�` ;V � 8. IRE EV. FINAL i R; .� , i-
„ . .
�,30. Drywall NailA+9 w,� ^� cc �Nc :n :ic r1 � , �t x +�HEALTH-0EPT. REQU4REMEPoT -
r31.Plaster&o�aCa�t`�'�yE `, �, ,¢ .�'�. ,'i4J9.}:1[yAL�fVSPECTI��D13 x`; x" r''�
C32.•Electric27 Po�ver�bleierF�aal -7C =E G = U ' •� 0. �?QbD Q£RTIFICATE ISSl76FJ Y✓ '-'
¢- •r ss �-- c'S � .m m T -Z K �
33.`�iny E� tric Z^ � �
.f. � i =� S S� .� � 4 Cl"� - `=iT. 'a ` i--T.
E34f�Fir1Y� H�pting& AiuC9nditioning�; j t� _�• �� ;{� •,_i �S il2 x S N�
- ni x +
.V : . •'• ,f; ,. Q S o: x ', C]cac OC:�- -S x -� ;CC
•,Z35� in-21 Ge�t Pipc-T?y?k ' z7 �K �• x � �.� :�-d x � -n
� �
i 36: opd ogCanoPYO.: y . ' *� :' � 'i� � s_ <, r`.c ' � r ' s:�
„ � m
�37`;Fin'�1 Fa�tory Fire�aSeN ��G � ;. r �` E � y `�;
�38:'FiRal Pltimbing � C=�-;a?iF:- � �X � +� ' S -2 x 2 �
�_ . �.-�
� 39PWaier Service-FinaR' -T_^' �' w x ` ,'� �Se x cc f
in a. �c ��c--✓.>t x?;` .�. � i: x � F� n .
S40.iGai`�ervice- nal ,:._ ... , " ' . ..
xJ Q:L' v'Q 4.:• :c m � r ^: vti
L '
:'41'.'Solarpomef€SoFinal^�-^.� ^ �'"y ;�`•v = =� Qv - a f
-•� p x�^�...��4 . i�h7 '! ,� Nti .;� S x.<
+ ac v
42''Bac�flow Preventer� .� �;t� .��' ` k K �� 7�_ . �K J �
},., ._
43. Backflow Irr ation'` ''•n�' tJ �c, M a: o tcE-c !: � n�
-� « s:- v�..� xc �car z� x ca � �' •
;44. Landscape fkiyation Syste�n z;i;�` ••� x:�; �, C�� t� N:v �^ �< n ..
�45�-Sound Atte,QVatioR 't J �����+'� K � � -* n "" '" 7�' �' ` "
`� � x <t::. v :.�nx F s � �Z • F.. x
T•
G46: �HandicaP R'ulations ��',' . .. �"r�� p c' .� i� cK S•,`.•ri S x
47,1FIf�17AL STFtC1CTURE &BsJILDING �� - A / % � `= iv sc 7 #
v i ` -
r48` FINAL PLA`NNING �� �raN x N ,r f�+'tTl !i7 Q
^497'El�ctric Releese to'Edisan �r � � � � � ' R - �
w [n M ic
a50,SGarRelease to Souihem California Gas Co j'� = F. `". o�r,J ., •
,:
-051. CE$TIFICATEOfsYOCCUPANCY x \ r.y i„ ^•.o z�� .< P- c
No. Qate
�
i
/
�
Pfl0.1ECT AOOflE55: �,/ [� 4-� W 19 TH S T
OWNEfl'SNAME: F�iMOUJ SUH�i F• UO�U�1S
aooeess: gANE
c� y �-� vC�Y
AHCHIENGINEEH:
RDOflESS:
flEG.NO.:
uxiT: �
UNIT:
�{
PEpMinEE: SUNNY CONS'TRUCfION (719)572-9923
aooness �q04 MUSCATEL AV
ROSEMEAD CA 91770
LICENSED CONTHACiOfl OECLAflFTION: I hereby affirm ��a� I am IicenseA un0er pmvisions ol Chapter 9(commencing wilh Sec�ion
7000) of Division 3 0l ��e Business and Pm�essions CoOe, antl my license is in full brce an� elfect.
cirr uc.: / /� srarE uc.: 5 2 6 9 8 6 cuss: �
Daie: / / — {'L'—�� . SignaWre: — J�/ ����
WOflKEPS' COMPENSPTION OECIANATION: I here�y a��irm Ihai I have a tertiii e ot cor�5eni IO Se16in5ure Or a teM1i�itate a� WoM¢rs'
Compen5alion Insurance. or a cenified coDY ��ereol �Section 3800. LaO. C)
eoucrno.: 1264055-92 EXP.URTE: QB�OS�93
cameaNr: STATE
❑ Cerlilietl copy is hereby Wmis�etl. � Certilied copy is liletl with �he ciry BuilOing Division. /' -
[� r� /�
Daie: //r' � r / C_ ADOlicant: % �� �
EXEMPTION fBOM WOHNEBS' COMPENSPTION DECLAflATION: �ihis 5eciion nettl � be complei[d ii Ne perml is lor one hunOred (5100) or less�.
I ce�ily I�at in Ihe De�ormance o� ihe work for w�ich ��is permi� is. issuetl. I shall noi employ any person in any manner so as ro become
SUGlecl lo Ihe Warkers' Compensalion Laws of Cahfomia. ,
� Oale: SignaWre:
NOTICE: If, alier making ihis declaration, you snoul0 Decome suhiett to ihe Workers' Compensation pmvisions of the Labor
CoOe. you musl Iotlhwiih comply with su[� pmvisions or �his permi� shall be AeemeO revoke0.
CONSTBUCTION LENOING RGENCY: I here�y allirm �hat �here is a Canslrut�ion lenaing agency �or Ihe De�ormanCe ob�he work tor
whicn Ihis permil is i<5ue0 (Section 3097. Civ. C).
LENOEfl:
ROOflE55:
OWNEfl BUILDEfl OECLABRTION: I Aereby affirm Ihai I am exempi imm ��e ConVactors' S�ate License Law for �he following rea5on
(Section 7031.5 Bu5ine55 and Vm�eSsional COAe: Any ci�y ol county which requires a permit �o consimc6 alter, impmve, tlemolis�, or
reoair any slmcture. prior lo ils issuance. also requires the applicant far sucn permit to file a signea statement ihat he/she is licensetl
pursuanl lo Ihe pmvisions ol Ihe ConVaclors' Slate License Law (Chap�er 9(commencing wilh Sec�ion 7000) of �ivision 3 0� t�e Business
antl Protessions Cotle) or ihat he/she is exempt t�erelmm and tAe basis 1or ihe allegetl exemption. �Any violation of Section 7031.5 by
any applicanl br a permi� subjec�s �he applicant to a civil penally oi no� more lhan �ive hundred dollars ($500).
I, as owner o� IAe O�opeRy or my employees wi�h wages as Iheir sole compensation, will do the work, antl �he
❑ stmcmre is not intentletl or olleretl for sale (Sec�ion 7604. Business and Pwfessional Cotle: iAe Coniracmrs' State License Law
Ooes noi ap01y �o an Owner Of a proDe�y w�o OuiltlS or imD�OveSlAereon, and who tloe5 SUth work him5ell/hersetl or Ihmugh
�is Or �er own employees, pmvi0e0 �hat suc� impmvemenls are n0i in�enAeO Or offered fOr Sale. If, how¢ver ihe builtling or
impmvemen� is sold wiihin one year of completion. Ihe owner will have IAe bur0en of proving �ehhe ditl not builtl or impmve
lor ine pur0ose al salel.
I. as owner ol the pmperty. am ¢xclusively coniracting wi�h licensetl conirac�ors ro can5imct the Dmlecl (Section 7044. Business
❑ antl Pmfessions Code', IDe Contractors' S�ate License Law tices no� appty �o an owner ot pmperty who builtls or impmves thereon
antl who contracls lor such pmjecis wit� a contracioqs) license pursuan� to �he ConVactors' State License Law).1 am aware
t�al pmoi oi �Aeir Worker'S Compen5aiion insurance shoul0 be pmvitled �o me.
i� I am exempi untler Seciion: 9. 8 P. C.
lor ihis reason:
Oale: Owner
I Do �ereby renity I�at I am aware of antl underslan0 �he requiremenis of Califomia,Health and Sa�ery Code Sections 25505, 25533, and
25534 ane ��at I or any fulure builtling occupanl will/will no� (circle one) neetl ta comply wi�h saitl state cotles and �he requiremenis �or a
permil lor consimc�ian or motlilica�ion iwm �he Fu Qualiry Management �istricL Fesidential constmc�ion applicaiions are exemp� twm
Nese provisions.
�ate: NpDlicanl:
I hereby cetli�y Ihai I have reatl Ihis applicaiion antl staie thal ihe above intorma�ion is correcL I agree to comply wit� all ciry antl counry
ortlinances antl stalelawsrela�ing�o bwlDing conslmclion antl here�y au�horizerepresentatives of�his ciryio en�erupon�he ahove-mentionetl
pmpeny br inspec�ion purposes.
Oale'. _r� �,� n� SignaWre'. � � �
/
Oriver s License or Social Securiry p: � �
i6aba6 Wbile-Bulltlinq: Green-Cotle EniorcemenL Canary-Applicanl: Pink-Fevenue; Goltlenmtl-Assessor
CITY OF' COSTA MSSA — HUILDiNG Pe�kM7'1' P�kM NO: B OS9839
LERMIT NO; B 059839 PLAN CHECK NO; 03751-92 I: GOC�T; N SCJPA: N
CONSTRUCTION TYPE; P�RMIT TYPE; STR , PURPUSE; A�T
JOB DESCRIPTZON ; RELOCAI'E WALL TO ENLARG� CUSlOMER AREA SQ FT; 970
CLAIAS VALtJE: S, 000. 00 CALC—V;4i,UE; 12, 241 ; 40 GROOP OCC; B-2 /
COMMENTS; 9705F' r;XIS'PING SUBS 6 DONUTS T.I,
*?�*x��*#x•�x�*���t**��+r�r**#�r�r�*tt x#*x#*x�#f�*x�r*#��t�*x�tx#��x��t x* x��t�r�r#�� ##���*�*���*� x•k
2 O N I N G R E Q U I R E M E N T S '
S E'f B A C K S
------------ MATN BDILDING ---------- --------- ACCESSORY BOILDTNG ---------
rRNT: FT iN REAR; FT IN FRNT; FT IN REAR; cT IN
LEFT; FT IN RGHT; FT IN LEi�T; FT IN RGHf; FT IN
PARKING REQ• PRUV; PARCEL; 42419107 ZNE: C1 REF NO•
PLANNSNG Nr�TES> INTERIOR ALTERATION FOR AN EXISTING SANDWICH SHOP TO ADD
> DONUT AREA.• .,.,.�
iE # 1E 3E iE ih # iE #9E # iF�K� # l£ 1F #!E if ## iF iE # if iE iy?{ if iF iE iE iE it # Ya� %# iE f! ## 1E 1E iE iF iE iE # if it 3f # 3f % X##!F iF ## i't ### iE,�-R�3(•# iF lE ji� iFli iFlf-i4
D E V E L O P M E Ni; S E R V I C t� S R E Q D I R E M E N i-'S
/�+;
20NING APPHOVED i3Y �:i ��C DATE: l� L
BCiILDING APPROVED HY ; DATE; f•`'•�
APPLICATION IS5UEU BY• li�` T�S � �� DATE: '%(� �o �"1L—
iEiFii")Fif'Ifi%il'iFiE1�I"lI'il'if'1l'3FiEiF3f"Jf�#iG#]tt-Fi�3rTtYI�"IFfF�fFTt]tiFftXfF 'ir]FiFR�ft]tivfFiERX' 'ItY�iFiElfSf3Fi%1%3fi4iE3EAfeltlt#irhh'X.-r3Fit
-lF * if 3F iE # iF if iE �E iE iE iE if if iE �7f� �1(-iF jt if -%iE iFlf 1f if iE iF 3E if �lF !f if 3E #!f� �lE?E iF �IE if 3E if !E iElF �E if-iE IFlE if iE iE jE #-If �1(� 3f � jE 3f jf �1(� % rt iE iFlE * ik iP fF # 3E if # lf
LEGALI7.ATiON:N F E E 5 U M,M A�jt Y STROCTURAL SEGN.ENT:Y
BLDG PMT PLUMBING ELECTti�IC-� MErCiiA;vIC FIRE SMIF/RES GRADING
PERM=T 144,00 , . ':,j SMIP/NON—RES
PLAN 93.60 � 2,57
ISSUE FEE "�,
BUSLDING—DIV—> PERMIT ISSUE PLAN=C ECR � TOTAY, PAID DUE
TOTALS----> 146,5�1 0,00 r�9�.60 240,17 240,17 ,00
.. . g
REVENUE llIVISION TOTALS--> COi,I,EQTED•�` g"�146,57 OVER/SHORT; 00
HLDG PMT' PZ�UM$ING ELECTRIC M�CH;ANl-C,1: F,11iE SN,IP/1'O'T GRADING PLAN—CHECK
199.00 ,. . , 2.57
1! iEiF iE iF K� i4 !F!f ih 1f # if iE # if iE )t iE if ihlE if �IE %� iF )f %# iF 1F 1ElElf.iFiE if3k # i(1E if jf iF i( # 1(� 3f # dE iF if iE # if tk fE iE 3F 1E �E iE IF-%i(� 16 iF fP iE # X� iF fi # iE iE# iE iE
I N i� I V I D C7 A.•i '� r tE � �3 R E A K D O W N
TYPE QTY D E S C R I P T I O N,- ; [INIT COS'I' TOTAL C6ST
'i
SFC 970 RE5—INT. AL'fER TYPE V—N �� '=AVER 12,62 12,241,40
END, OF FEE� '
. ' r
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CONSTRUCTION AND PLANNING POOI 'A
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 •
•�. 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. APPROVAL TO COVER�GUNITE
7. Footings � . 58. Eiectrical Conduit-Undr9rnd.
8. Foundation �� 59. Gas Pipe, O Undrgrnd., Test ��
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P�Trap, � Undrgrnd. ".
10. Structural Floor System . 61. APPROVAL TO DECK
11. Property 5ewer Line & HouseConnection ' 62. Backwash & Receptor�Flnal �
12. Sewer Cap � 63. Heater & Verit�Final ,'�
13. Roof Drains .� 64. Plumbing System � Final
14. Rough Plumbing . � 65. Electrical-Final , '
15. Rough Electrical-Conduit,' 66. Sotar SYstem�Final
16. Rough Electric Wiring � �� . 67. Fencing & Access Approval
.17. Rough Wiring Sign 68. .APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in 9tructure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Fough & Test � 7Z, Underground Flush �
24. Roof Framing ' 73. Undergrnd.StorageTank OGas 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 i � 78. FIRE PREV. FINAL
30. Drywall Nailing (Z/�� � �. HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat i � 79. FINAL INSPECTION
32. Electrical Power Meter�Final ' � ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric � � '
, I � Notes: [ � �. �,LpsuG �;.p �,✓ o�,�L _��,ty,5 �
34. Final Heatin & Air Conditionin { � 6`y
9 9 1 �Fc �s:� 9'.�l°X�b� fXtd�idw s�£wr� /
35. Final Gas Pipe-Test � i �YIiC'lfi7( � _��1 ----
36. Hood or Canopy "� / /� a�'
� � J�,/�j�s.. �"�/Fm /Uo E�I� fh✓ �J-�B
37. Final Factory fireplace � � ��
38. Final Plumbing � ! .! �,2'i�'J'`Z. ;(/C�7/C� �j,��
39. Water Service-Final � i (
40. Gas Service-Final �
41. Solar pomesticFinal � � .
42. Backflow Preventer � � i
43. Backflow Irrigatioa
44. Landscape Irripation System
45. Sound Attenuation ��
46. Handicap Regulations
47. FINAL S7RUCTURE & BUILDING I
i . �
48. FINAL P4ANNING � � ,
49. Elearic Release to Edison � i
i
50. Gas Release to Southern California Gas Co � ,
51. CERTIFICATE OF OCCUPANCY
No. Date
\I
t.
� �i
l`�
PBOJECT AOOBESS: C�'i 5 W. • I 9 TH ST
� OWNEN'SNRME: �AMQ1iS' JrUBJr b ��VtII�J
� AODNE55: 5�y_�
i �•
ANCHIENGINEEH:
FDOXESS:
flEG.NO.:
uxir: A
IINIT:
PEflMITTEE: GUNNy CONST'RUCI7.ON ( 714 ) 572-9923
aooeess: Zqpq MUS"CATEL AV
HOSEMEAD CA 917%0
LICENSEO CONTBRLTON UECIAflATION: I here0y ailirm thai l am licensed under pmvisions o� CAaO�e� 91cOmmencing wii� Sec�ion
7000) ol Div�sion 3 0l the Business anA Pmlessions Cotle. and my Iicense is in full force anC effecl
ciTr uc.: / � sTnre uc.: S 2 6 g g 6 cuss: a //
Date'. ��� Lf=iF—•i.� Signamre' — // C C��_
WONNEPS' COMPENSRTION UECLppp710N: I hereby aifirm t at I have a certifi e oi wnsent ro seli-insure or a cenificate of Workers'
Compensation Insurance. or a ceqified copy ihereol (Section 38W. Lab. C�.
POLICVNO.: Lif14��J��92 E%P.OATE: OH�OSI93 ,
camrnxr: STATB
❑ Ceni�ietl copy is hereby turnishetl. � CeM1i�ietl capy is liletl �he ciry BuilAing Division /
j/ ! /"� L
�ale: !('�-i�-�2 ' ApplicanC � d�—�� �/� r~
E%EMPTION FBOM WONNEBS' fAMPEN5ATI0N OECUMTION: Rhis SecGon neetl not be%omplet¢O i1 �he permitis for one AunOreO �5100) or kss�.
1 certily thaf in Ihe AerlormaMe o! fhe work tor which �M5 pe�mit is issued. I shal o� empl0y any person many manner so as Io become
5u01e�� �o Ihe Workers' ComDensa�ion Laws ol Calibmia. '.� �
�ate: _ Signa�ure: ��
NO C: IL after making IAis tleclamiion. you s�oultl become suUlecl m ihe Worke s' Compensation D�ovisions oi the Labor
Code. You mu5i totlhwith mmpty wilh Such O�ovisions or Ihis permit 5hall be a¢emed revoketl. , f.
CONSTflUCTION LENOING RGENCY: .I hereby afiirm ihat Ihere i5 a consimctian lentling agency for t�e;pedormance oi t�e work for
w�ic� Ihis permit is issued (Sec�iOn 3W7. Civ. C�.
LENOEH:
aooness:
ci�rY or• caa;a ua�� -�„1����t�ti. ,��.u.�r pExr, AIO: P 059,842
PERMII' NU; P OS3642 . PLAN CHECK NO: N GOVT'; N 5(.PP, N
CONST'i2UCTION TYPE; PfiRMIT T'YPE; PLU PURPUSE:.ALT
JOB UESCR'IPTION ; R�LOCaT� WALL TO c,N;,ARGF. CUSTOM.�R AkEA SQ FT;
CLAIM VALUE: CALC—VALUE; GROUP OCC: H-2 /
COM,tiIENTS: 970Sr EXIST SUBS & DONUTS TI, #B59839
f�#�**�rt#*�-zx#�#**�i��-�t�-�t�*�ic��rft���*��*x*x�*��-**#�tx*+��#ft*r����#tt�*##f��i��2x�x�*��*i�*�;r�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 5
------------ MAIN HUZLDING ---------- --------- ACCESSO}2Y BUILDING — — —=----
FRNT: FT IN REAR; eT IN FRNT; FT IN REAR; F'T �..i
LEF?: FT IN RGHT; rT IN LEFT; FT IN RGHT: r'i 'CN
PAkKING kEp• PROV; PARCEL; 4?.919107 7.NE: HEF NO;
E�LANNING Nf3T'E5� •
?
# iE 3t if� %� # iE %� ik if %� 1h iE it N!E k# iE if iF iE iE fF iF if aF 3t iE iF % it� 3t # iE �x� it iF iF�(• % fF if �t #��}(:3f�it� k#�� # if �7ki4 %� �k IF if #if if.iF fh ff # if 3( iF it f'r �% ## M� iF A� (t?e
D E: V E L O P M E N T S E R V I C E S �' R E c� U I R E M E N T S
ZONING APPROVED BY �+' DATE:
BUILDING APPROVEb BY ; � DATE:
APPLICATION ISSDED BY- �`". DATE• 1� ���
1f'.Eiiif'iE9I'iEiF1EiF'lElfif#iFil-1Fif#lfiFiElt'9t�X�R')t%*!t%%'%-R'u'X%'X"Rit fe1F'Tk*%�ft%ftftftie*%�iFlPikiF#iF1EIFiE1EiI' tr-�. #. !t#iF
iE 1f 1C if 1F if ii- IF # iFlE if iF ik iF 9f if M,ii� fF iE iEiflf 1(� # iF )f # 1E 7f iF iE if!(• i! iF # ii� if if #### if 1! 3F X� # 1Flf if ### K- ### iF 7F iE 3k iF 3f� ## 1E iF iE # iC� fF Si #!f 1t :
LEGALIZATION;N F E E S U M M A R Y ST'RUCTURAL SEGMENT;N
OWNeBBW�oEBDECu�xA710x: �herebya��irmmatlamexempt�mmtheContrac�ors'S�a�eLicenselaw�or�heto��owingreason HI.iDG P��11' PLUMHING ELECT�ZC M$C$7iNIC FIRE � SMIP/RES C,+Fi1i�IN(�i
(Section 7031.5 9usine55 an0 Pm�esSional Cotle: Nny ciry oi counry which requires a permi� to constmct, aller, impmve. Aemolish, or pERMI T • ' 3 5 0 0 ' '�
' reWrt any StmcNre. O�ior to ils igsuance. also repuires ihe applican� for suc� permi� lo lile a signetl 5tatemeni �ha� he/she is licensetl Z 5$ _ /�
Ipursuamm�hepmvisionso�l�eConVacmrs'S�aleLicenseLaw�Chapler9�commencingwi��Seclion7000�o10ivision3ot�heBusiness pLAN . � � SMIP/NON—RES .
an0 Pmlessions Cotle) or �hal he/she is exempllherelmm and the basis �or the allegea exemplion. Any viotation ot Seciian 7031.5 by �' ,
' any applicant for a permit subleqs the applicant to a civil penalty ol not more Ihan five huntlretl tlollars (5500�. 1'SSUE FEE 20 , �� •
l as awner ol ine pmpeny or my em ioyees with wapes as meir soie compensation, will do me work, antl�tne BUILDING—DIV—> P$Ii�iIT Z5SUE 's�J:�A�—CHECH TOTAL PAID D(JE
❑ simcmre is no� imenden or oire�eo �or sa�e (section �oaa, eusiness and Pmiessiona� coae: rne Contracmrs' Sta�e �icense �aw 1 OT'AL S----> 3 S, 0 0 2 d, � 0 �• 0, 0 0 5 5�, 00 S 5. U 0 , 0 �
tloes not apply to an owner o� a pmperly who builds or impmves ��ereon, and who does such work himsel�/herself or thmugA ��') '
his or her own employ¢e;, pmvitled �ha� suc� impmvemenis are not intentle0 or aflered �or sale. I�, howeve� the Duilding o� REVt.NUE D I V I S ION TOTAI,S--> COLLEGTED • S �. 00 OVER /5HOR'f • 00
improvemenl is sold wit�in one year ol compleiion. �he owner will �ave �he burtlen ot pmWng he/she Eitl no� bui10 or improve
ro�meo��noseoisaie�. BLDG PMT PLUMHING ELECIRIC NfECHANIC FIRE SMIP/TOT GRADTNG�PLAN—CHECK
55,00 '-+ ��
I, as awner ol Itle property, am exclusively conVacting wilh licensed contracmrs to consimc� �he pmle�� (Sec�ion 704a, Business X; (',
❑ antl Proiessions Co�e�. The Conirac�ors' S�ate License Law tloes not apply ro an owner oi pmperty who builtls or impmves ihereon
andwhoconVactslorsu�hprojecl5wit�aconVattor�ylicen5epursuan��otheCon(ractors'S�a�eLicenselaw�.lamaware #3f1E�iEiF##iFiElElEit�h�7ciFif9f#I(�lFiFfE3ElhiE#3EifiFl4�Ef6lF�1F9F#SFiE�7fdE�lF'Fif�iF�f3EiF#i(�iF3ElFi(•iF#�i(�K1ElE#it�#�3FihlE�lf-it-?F3E3(-3flf�3(�Ifk�iEl6M�iF
iha� D�oa� ot their Worker's Campensation insurance shou�e be pwvieed ro me. 2 N D I V ��(J �. � F$$ B Fl $ A K D � W N
� I am exempi under Sec�ion: B. 8 P. C. �
mrmrsreason: �'YPE QTY D E S C R I P T Z'�� �N UNIT COST TOTAL COST
Oale: Ownec
I tlo hereby certity Ihat I am aware ol antl untlerslantl Ne requiremems o� Calitornia Heal�� antl Sa�ery Code Sections 25505, 25533, antl
25534 and Ihat I or any luture builtling occupant willlwill no� (circle one) neetl �o tomply with SaiA state cotles an0 ihe �equirements lor a
permil �ar consimclion or moUifiCa�ion imm Ihe Air Ouality Managemen� Oistrict. pesi0ential constmc�ion applica�ion5 are exempt Irom
�hese O�ovisions.
�ate: pDPlicani:
I nereby ceitAy tha� I have reaU �his apPliwlion and slate �hat �he above intormation is correcl. I agree to compty wi�� all ci�y and county
orainances and slate laws relaling �a puiltling cons�mc�ion antl hereby aWhariie repr¢senialives of this ciry to enier uDon Ihe above-men�ionea
propetly �or mspec�ion purposes. � ' � �
I"`
Oale:_/��—��—� � Signalure: ��� `
orivei'sLicenseo�socialSecuriryxr .
�64t-46 Whpe—Builtling�, Greo�—Gode Eniorcemenl', Canary—Appllcanq Pink—Revenue;-Goltlenrod—Assessor .
�.: / �
PLU 1 SINR, BAR �`' 7,00 7,00
PLU 2 SINK KTTCHfiN ;. 7,U0 9.4.00
PLU 1 SINK�, FLOOR • 7,U0 ', 00
PLU 1 STNKS, SERVICE / MOP 7.00 . 7.00
�ND C�F F'fiES
��
•'%
'> +, ' � � .. \
^ GJNSTRUCTION AND PLANNING . POOL �„PA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
`I. Temporary�Electrical Service.or Pole � 1• 52. Pool & Equipment Location ,
�. Soil Pipe-Undrgmd. -�• - �' 53. Steel Reinforcement ,;'
� 3. Electrical Conduit Utility-Undrgrnd. • � � 54. Forms -
�
.4. Electrical Conduit�Undrgrnd. L �� 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 Svstem . 61. APPROVAL TO DECK . �'
11. Property Sewer �ine & House'Connection � 62, Backwash & Receptor�Final
12. Sewer Cap ./ 63. Heater & Vent-Final
r
13. Roof Drains ,' 64. Plumbing System - Final �
14. Rough Plumbing '" �%Zc�, �� 65. Electrical-Final -
l
15. Rough Electrical-Conduit 66. Solar SYstem-Final
76. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. 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, Underground Flush '
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oii �
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 � i i 77: FIXED SYSTEM FINAL
29. Insulation � � � 78. FIRE PREV. FiNAL
30. Drywall Nailing � � � HEALTH DEPT. REQUIREMENT
31. Plaste� Brown Coat I � I 79. FINAL INSPECTION �
� �
32. Electrical Power Meter-Final � � , 80. FOOD CERTIFICATE ISSUED
33. Final Eleciric � i i Notes: �` j�YL (�,p�aj ��� (�+'/J
34. Final Heating & F,ir Conditio�iog � � � �� � (.(p� �p� ..- (�ci�
i
35. Final Gas Pipe-Test � � '
36. Hood or Canopy � � F
37. Final Factory Fireplace . f � ' � _
38. Final P�umbing . � �3 L(��
39. Water Service-Final � j j�`
40. Gas Service-Final , �
I
41. Solar pomesticFinal �
42. 8ackflow Preventer
43. Backflow Irrigation
44. Landscape Irripation SYstem
' 45. Sound Attenuation
46. Handicap.Regulations -
47. FINALSTRUCTURE&BUILDING �
48. FINALPLANNING �
49. Electiic flelease to Edison � � _
50. Gas Release to Southern California Gas Co �
51. CER7IFICATE OF OCCUPANCY
No. Date
I
PflOJECTAU0flE55: 8,[�S W 1lTH ST
OWNEN'S NIfME: F�OUS' SUBS &. DONUTS
nooxess: SAME �" "
APCH/ENGINEEF:
AOOXESS:
NEG.NU.:
uxiT: A
uxiT:
PEHMITTEE: SUNNY CONSTRUCTION ( 714 ) 572-9923
RODfiESS: 2404 MUSCATEL AV
ROSEMEAD CA 91770
LICENSEo CON7PRCtOP OEC�IHATION: I �ereUy aliirm Ihal I am I¢enseU untler Dmvisions of ChaD�e� 9lcommencing wit� Section
7000) ol �rvisinn 3 of the Bu5ine55 antl Pmlessions CoOe. an� my license is in lull force an0 effecl.
aTv uc.: aTpTE uc.:526986 cuss: g
Date: _�_! _ �� Siqnature:
� WOflNEflS' COMPENSATION tlECIANRT10N: I �ere0y ailirm t�al I have a ce�ilita�¢ nI consen� to 5¢IbinsUre af a t¢M1iliwie ol Workers'
COmpenSalion Insurance. or a ttrtiliea cooY ��e�eal ISection 3800, LaG. CI.
I POULVN0.:1264�55-92 EXP.ORTE: OSIOS�93
�� camrnxr: STATE
❑ Cenifie0 copy is here�y lumis�etl. � Cenifie0 coOY �s filetl wi�� t�e city Building Uivision.
Date: Applicam:
E%EMPTION FNOM WOPKEPS'C�MPENSAt10N OECIAB�710N: (ihissecUon nee0 notUecompletetlifthe p2rmitis brone �unEr¢4�5100�or1¢55�.
I cenily ihal in ihe oe�ormance of ihe work for wnicn Ihis oermit is issuetl. I sfull nal employ any person in any man so as to become
suGiCtl i0 iM1e Workeri Compensaiion Laws ol Cahlomia. �
Date: _ '� � � Signature: rr ��
NOTICE: II, ter making ��i5 declaralion. you shoula become sublec� lo the Workers� Compen5aiion provisions oi Ihe La6o�
Coae. you must Ionnwith comoly wilh sucn Dmvisions or this permit shall be OeemeU revakee.
CONSTXUCTION LENOING R�ENCY: I �er¢Uy aliirm ihal there is a cOnstrU[tion lentling ag¢nty lof Ihe pedarmen[e o� Ihe wOrk �or
whic� ��is permii is i=suea (Settion 3W7. Civ. C�.
lENOEfl:
AOOflES$:
OWNEP BWLDEH OECLAPATION: I hereby allirm Ihat I am exempl lrom Ihe Coniractors' State License Law for tAe followinp reason
�Seclion 703L5 9usiness antl Pmlessional Cotle'. Any ciry o� coumy which reQuires a permi� to consiruc�, alter, impmve, Oemolish, or
ieDair any 9mclure. prior lo ds issuance. also iepuires ine apD���ant for such permit to file a signed slatement ihat nelshe is licensetl
pursuani lo Ihe provision5011pe Cumratmrs' S�a�¢ LiC¢nSe Law (Chapi¢r 9(cOmmencinq vnth $ettion 7000) ot 0ivivon 3 0l lhe BuSiness
a`k Pmlesvons Cade� or�nai he/s�e ¢ exempit�eretmm antl t�e 6asi5 �oriAe atlege0 exemDtim. Any violation oi Section 7031.5 Oy
any aOP�itant Por a permit sublKis t�e ap0�icant to a uvil Denal[y of noi moro t�an five AunOreA Oallars (5500�.
I. as owner ol Ihe Ompeny or my emyloyees wit� wages as t�eir sole compensation, will Go i�e wark, antl t�e
❑ s�mclure is noi in1en060 ar ollered lor sale (Seclion 7044, Business antl Pmteuional Code: Th¢ COnlractor5' S�ate License Law
tloes not apply to an owner ol a pmDetly who 6uilOs or improves t�ereon, antl who tloes suc� work �imsell/Aerself or tArough
his or �er own emploVees, pmviUeO thal such impmvemen�s xre noi iniended or o��eretl lor sale. II, however Ihe buildinA or
improvement is soltl within one year oi comDle�ion. ihe owner will have �he burden of pmving he/she tli4not builtl or imDmve
�or Ihe purpose o� sale�.
1, as awner o� ��e pmparty, am exclusiv¢Iy conVacting wi�h lic¢n5ea conVatlors to cons�mc� Ihe pmlec� (SeCtion 7044, Business
�i ❑ and Pmieuions Code' The Contratlors' S�a�e License Law Coes nol appty Io an owner o7 pmpeny who bmlds or imprrnes �Aereon
an0 w�o caniracts br such pwlects wi�h a coniractor�s�lic¢nst Vursuanllo Ihe Coniractars' Sla�e LicenSe Law),I am aware
Ibal O�oof o� I�ert Wo�ker'S Compensalion insurance should be provi0etl �o me.
� i am exem0� untler St��ion: B. 8 P. C.
lor Inis reasore �
Daie: Owner.
I ao nereoy ceniiy Inat I am a�are af anU untlerstana ihe requiremenis o� Caliiomia Healih an0 Safery Coae $¢ctions 25505. 25533. an0
255� ana Ihat I or any IWure Duilding occupdnl wilVwill not (circle one) neetl lo tamply with SaiC stale cotles anU ihe requiremenis lor a
permn br cons�mction ar mod�licalion imm �he Air Ouality Managemenl DisUici. flesitlential cons�mction apDlicaiians are exempl trom
mese pmvisions.
�ale: Npplicant:
I he�eoy cetldy ihal I nave rea0 ihis aDo�icalion anA slale inat ihe ahove inlormalion is fArrect. I agree to comply with all city ana counry
arAinancesantlstatelav2relatingm�uiltlingtonsimclionanG�ereOyamtwraempresenW�ivesaiituscily�oemerupo nea�ove�meniwnetl
pmoeny lor inspecibn Ourpo4es. `1
1 �_d� Si n `
�Date. _ _� 9 amre: � �
ori�a's �icense o� soaai secu�ity r:
i6nba6 W�ne—Builtlmg�, G�een—CoEe Enfo¢emenC Canary—Appl¢anl: Pink—Revenue; Goldenro0—Assessor
CITY OF COSTA MESA — BUILDING PERMI7' , PERM NO; E 060122
PERMIT NO: E 060122 PLAN CHECK NO; N GOVT: N SUPP: N
CONSTRUCTION TYPE; PERMIT TYPE: ELE PURPOSE: ALT
JOB DESCRIPTION ; RELOCATE WALL TO ENLARGE CUSTOMER AREA SQ FT:
CLAIM VALUE: 1,100.00 CALC—VALUE; GROUP OCC: H-2 /
COMMENTS; SERVICE DPGRADE FOR SUHS & DONUTS T,I. REF:B59839
*�t**�r+e*+��r�r�+r�t�*�r�rx�*�*�t+�x��rx**+r�t�r*�r��r*+t�rx**�+t*x**+r�t�r�r�r�t*�t*�r�+t**��r**�r�t�t��t�r****�t��t+t
Z O N I N GS ERTEB�AUCIKRSE M E N T 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; 42419107 ZNE: REF NO;
PLANNING N(51'ES>
i
��t�r�r�**,r�t�t*��*******+��r*�rx�x�*�t**�r�r*�t:;r�r**�t�r�r�r*+t�r�e*�t�r�r�*�r�t�r*��t�t****�r*��r�r�r*****�*�r�r,e
D E V E L O P M E N T S�E,R V I C E 5 R "U I R E M E N T S
ZONING APPROVED BY / DATE;
BUILDING APPROVED HY ; ' DATE;
e
APPLICATION ISSUED BY: `" DATE: / d�
iEiklEiE�kklkiF�tif�fiP3FiEifiEfElEiElFikik iFiFiElf�iEiFiE1EiF 3EiE
ifkifififkif�F�F1Eif�fiEiEikfFiFiElEiFiFifiElElEiEiEiFiF iFitlkiEif iFifiklFiEiEitriEitiEiFiFiFiElFiFikiFlflEifiEffiFifiF�k1litiF�EifiFiEiEkifiFlFiEifiEit
LEGALI2ATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;.N
PERMIT BLDG PMT PLUMBING ELE18R5C� MECHANIC FIRE SMIP/RES GRADING
�Oi SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 18.50 15,00 0,00 33,50 33.50 ,00
REVENUE DIVISION TOTALS—=> COLLECTED; 33,50 OVER/SHORT; 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
33,50
if 1f if k fk 1f if iF iE iE 1ElE if itlf i!!E i! iE fF 1E fElE iE iE iF if 1E iF i!!f 1f 1E iE iE�F if iE 1f ft iE iE if if !! if iF it iE itlk 1Fif iFiE if 1F 1! iE iE iF iE iF iE if iF �E iE 1E 1E if iE iE 16iE 1f lE 1F iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18,50 18.50
END OF FEES
J
CONSTRUCTION AND PLANNING POOI ;PA ;
AQPROVALS Permit # Date Inspector APPROVAIS Permit # Date Inspector
7, Temporary Electrical Service or Pole . 52. Pool & Equipment Location .
2,. $oil Pipe-Undrgrnd,� ' '�' ` 53. Steel Reinforcement �-
+ }3'.,•Electriwl ConduiI-.lJtiliry�Undrgrnd; � 54. Forms
.� Q. Electrica� CondiriYU�drgrnd. 55. Electrical Bonding
.4: - � .
��b. $teel Reinforcam'ent� � ,� 56. flough Plumbing & Pressure Test -
•���&. ElectricalUFE�R�Grnd. �� 57. APPROVALTOCOVER�GUNITE
r '
, "k,�Footings ' S8. Electrica� Conduit-Undrgrnd. �-
�, i��$�, Foundation - 59. Gas Pipe, � Undrgrnd., Test �
i:
' �_�
9. Water Pipe�Uniirgind. 60. Backwash Lines, P�Trap, O Undrgrnd.
th. 5tructural Floor System ' 61. APPROVAL 70 DECK
I 11. ?roperty Sewer Line & HouseConnection 62. Backwash & Receptor�Pinaf
s•
12. 5ewer Cap i ry � i 63. Heater & Vent�Final .
13. poof Drains � 64. Plumbing System • Final �•
i 14. Rough Plumbin'g '' � 65. ElectricabFinal � ��
15. Flough Electrical-Conduit � 66. Solar System-final
i' .
16. Fough ElectricNViring � 67. Fencing & Access ApProval .
i 7. 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
� ' ' t.^ J'- ¢+: .0 F T�
I 20.�ough F_acto�y F=yeplace � z r `- �` C � r'?' '� �ppRt`]VA}5:=='OperFnit # �` �' -'
� } F 1 5 .�' -4 �L x S r-� 'J' � �c - t ) c T -rl
� :- c r -. .- � . x .,
21 LDucts, i��Stwccueex i•• •• �-j � F-� x 770. Unde grdRnd Hptlro � ��
� � 22. Duets, Venii�atiri r < <u� �t � E�` :=7}, producL,�� n Ci s ,OII
- � � � -� �J;: � C` �c �� � :J x w ,t�f 9 � �.
ti.. . ' � . S. Y: r . .Y. �.: . �n, t ' # ...n
I 23.. a; Pipg`_Rou"qh $�test � t; a y: .q 7� p* M.72. Underground Flus� ;: r--
24CiAooi Fr.amirn3 tT' � i E-.- �•'TI n C' G'z .. �•# >73 �Undergrnd. Storag�e�..7ank'� Gas ❑ 011
25. RoOf Sh�athing �� x' � "`' j ;� �;� '7q;�p�erhead�Hyd%� x
I 26�c7�8er Ceiling (StnuMurell &9lAonocoat - � -'rr '� 75ti.Dry Chem:cal tt' r
27^ reme a d Flashin -` � ^ t rc x - � i., x�c . z
cf .� _ � . �:c .:; 'r �tx � 7G Dry Stani�pjpe :.-q � >
� 28�� 4athing & Siding�x' .: -¢.i *� s ••n x 77�� FIXED �YSTE[JI �INACr �_ r n
f� _ . r• } 'K �i :.: ?: '� ` Y: lj
'�29. Insulaton ". ,,; � .. R �;;: 78�FIREPREV.FI�RnL M>
�30. DrywalL+NaitTg '* x r T* � HEALTH;DEPT-. REQUIRE'NIENT
�31. Plaster �own CdAt,`, > � :� r ��� :` � �79�FINAL I(VSgECTI.�N. � " �' �
:-32cElectrica} Po�cverMetet-Final� � +� i. �� '� r�80.�F00D CERTIFIC/CT_E ISSUED �'�
_ ._ . .. �v � - . �_ .�
5.33�'Kin'a,l Eja�tric ='.+��: t • Z fY1��fT• . -.< < �No�?Si �y -��, � �_ r� �� r�
S. .. Y .� : _. '• -
,;34,^�ir�a Heryting:& F.ii;ConditioniDg; � ^ 1-- a .c �•v •S f" : � •-- � :J
35,�Firfal Gas Pipe-T�t^ .j• ` ,�,= ^ n`^-. , .T•.� "r- :J
,� � a s. ,.;,c � r
� Z ._ . � 1 �� . . ..
.=36. Ho'od or;,Canopy - . r - ._ < �• ��.' \ i x r ir� .a ' �- r
- �� r� �..-r:
,'37 -Pina`I Factory Fireplace_ ' �-�' �. r � " t - �� x ^ ^ r,
_ ; . < t � ...
38. Final Plumbing - - �f� ; . .. _ � 1 = :k ` S -� ; � ��
.Z39. Water Service-Final' ' - � ' + � """• `«
> � �; , '- t .. �„' < F
�40. Gas Serv�ce-Final�.� ' , S x��., a�.� --r � -
s41. Solar DdmesticF�rtel "• • `� � � W C � `" �
c ;�, ` >� =v n - r x .
-'42.'Backflow Preven{e4 " . ` Y ;� _ � . _ '
43. Backflow Irrigation � � •� .� '; t � ' � :- " :' �, -.
_ . -� .� x � - �- ^ .,. v
r44. 4andscapelirigationSysterirm;� �. �,�� J -+ .0 �L;J :�� ��
�45:'Sound Attenuation - .� - , ' >. .� " -;". _ : �- �` � • -
ti
. C' i 1 K r T n i: M - Q '
y c r .. . .. ., i � .�. : _ '
._`46: Nandicen Regulatiqns " � -; .. � ,,�,� - .
J47,�pINAL STRUCTU��RE & BUTLDING � � / ; - •= � `
.
r.- �- � � : a � •
148::FINAL PLANNING � •< � �' r. � r S �
c49=Eleetric fielease to*Edison � '> ' � :s � n S �
; 50�Gas�Release to Sou2hem Califomia Gas Co .` � � � ' V _ � ��
t r � . 1•r
'51. CEflTIFICATE OF,OCCUPANCV t % i- < ; . , �p •- . _
No. Date
I�I
�
PP0.IECTPDUflE55: ��45 iJ 19TH ST
OWNEN'S NRME; FAMOUS SDBS S DONUTS
nooecss; SAME
ABCN/ENGINEEH:
RDOflESS:
RFG.NO.:
UNIT:
uxir:
PEPMI7TEE: PACFIC WEST FIRE (310)545-5055
aoosess: Zpz�5'�` '2{'n3Rj�7D ST�{7 9
LICFNSEU LONTBRLTOB UECIAPFiIDN:' ffiereoyBaMm tFai 7 am �xense0 unaCAvisio � rC�ap r 9(cammencing wit� Section
7000) of �ivision 3 of 1�e Business antl Pmlessions CoOe, anG my license �s in tull force anE ¢ifeci.
ciTruc.:047297 sTnrEuc.:551586 �uss:C—l6
Oa�e: /t — 3• �T i Signxmre: _�C��tw � _
WOpNEPS'COMPENSAilONOELIAMTION: I�ere0y�11irmt0atltwveacertifiyteol aulfinsureoramrlilicateofWorkers'
Compensation InsWance. or a cendiea fApy Inereol (Settion 3800, Lab. CI.
P041CY NO.: E%P. ORTE:
LOMPANY:
❑ ceNliea covv �s nereoy lumisnee. ❑ Ceniliea copy is fileA vritn tne city eui�einp Drvision.
Da1¢: AOp�icani:
E%E/AVTION FNOM WOHNEPS' COMPENSATION OECIAIUTION: (tlio secuon need mt he wmpeicd il �h¢ p¢rma 5 ta one hunGred (5100) oi less�.
I tepi�y Ilwl in the pedarmanc¢ 0� IOe wor4 Por whiC� ttut �t+mii is i55ueG, I 5hall n0� ¢mW% am/ per On in any manner sa as ta hecome
subject lo ��e Workers' LomDe��wn Laws o� CaG�omu.
Oate: �Z jU `l'L Siqnature:!
NO710E: II. alter mawnq t�is Eeclaratiw, you s�oulC become whl�< <o t�e Workers' Compensation pmvisions of the LaDor
Coee. yrou must lontmitn comply with such prov'rsions w tlrs permit slutl �e Ceemed revokeC.
CONSTBUCTION LENUING RGENCY: I hereGy allirm tlut t�ere is a consiruclion IenOinq aqency for the Dedormance oi the work for
w�ic� Ihis permit is issu¢d (5¢cti0n 3097. Civ. C).
LENOEH:
aooness:
OWNEB BUILOEB OEUABRTION: I �ere6y afiirm ihat I am exempt tmm t�e Contonors' Stare Liceiae law lar Ihe fUlowinp reason
�Section 7031.5 Business an0 Pmtessional COAe: Any city ol county which repuires a Dermi� to construct, aller, im0�ove, tlemolish, or
repair any s�mc�ure. D�ioi toi�s issuance. also repuires ��e aODlipant lor suc� perml� �o lile a siA�eO sla�ement ihal �elshe is Iicense0
pursuam to ��e Dmvisions ol the Conlracmrs' Stale License Law �C�aD�er 9(commencinB with Section 7000) ot Oivision 3 0l I�e Business
antl Pml¢Ssi0n5 fAde) or IAa� he/She is eeempi IAerelrOm an0lh2 Oasis lar I�e allepe0 ex¢m0��on. Any WOlalion ol Se[IiOn 7Q'{1.5 by
any aD�licant for a Dermit su61eci5 Ihe appliWnl lo a civil De�alty of not mora Itlan liva hun4reA tlollars (5500�.
q I. as owner ol tile D�openy or my empIoyMS �tA wages as t�eir 5ole compensalion. wiA Uo I�a work, an0 I�e
suuclure is not intenGeC w oflereE lor sale (SeCuw 70a4. Busness a�W Proteaional Cotle: T�e ConVaclori State Littnu Law
does nol apply Io an Ovmer ol a propErty wip OuiIES ar imprw¢5 I�ermn, anE wlro Go¢5 sucA woM1 �imull/Irersel� or tllroup�
nis or ner own emd%'ees. pmvi0e0 ttul Sutn improvements art nat intenaM or ofler¢E lor 5ile. I( Mwever Ine Euildinp or
impmvement is solC wlt�in one year ot tpmpleliW, IOe owner wi0 �ave t�e GurOen ol prOvinO �Us�e Gitl not Cui10 or impmve
lor t�e Durpose ol Saie�.
I, as awner ol �he pmpeny, am exclusively comraclinp witA IicenseE comractors m consimct ihe pmject (Section 7044, Business
I❑ anU Pmlessions CoCe: TAe Cantractors' Staie License Law Gces roi apply to an ovmer of procerry � �mlEs or imD��s Iherean
. an0 who Conlfacis lor SUCh pmjetls vnlh a Con�ratlol(S�fit¢n5e Oursuanllo I�e COn(ratlOrs' Seare License law�. 1 am aware
lhal Praol o� I�eit WOrkei 5 Compeiaati0n insurin[! s�ou1E G¢ DravitleE IO mE.
� 1 am exempt un0e� Sec�ion: B. 8 P. C.
br Illis rea5on:
Dile'. Ovmer.
I no nereby cenily inal I am aware of and unaerstan0lne reduiremenis ol Calitornia Heatln ane Satery Cotle Sections 25505, 25533, antl
�553d an0 ��at I or any tulure Ouiltlmg occupant vnll/vnll no1(cirde ane) neeJ lo comply wilA 5ai0 state coAes anU Ihe repuirem¢nls for a
PNrmil �ar cons�mc�ion or motlilica�ion Irom ine Ait Ouatily Manapemeni D4�fici. fleSiGeniul cOnstNciion aDO��cations are exempi �rom
�n¢se omvisions.
Date: Rppticam:
I her¢Uy cetli�y lhal I have read I�iS ap0�����on anG Slale Ilul ItIE a0ove in�Ormaiion is tar�Sii. I agree m wmply vn10 all ci�y ana counry
ordinatKesanCslatelaw5relatingto0uil4ingWrttrutlqnaMlRreb/aNMriteRpr¢SmWNKSoftA tirytoMlteruponl�eahOve-mentiane0
PropeAy lor inspedion purpoSeS, �
Daie'. �� •' � 9 � SignaWre: T_
Orivefs License or SoCial SeNrily x:
t6nL<6 Whi�e-6uilEino: Green—COCe Entorcemenf. Gnarv—AuoNcanf, Pink—Revenue: CaoldenruU—Auesmr
'�_
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F 060501
PERMIT NO: F 060501 PLAN CHECK NO: 09557-92 L GO�'T: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: rIR PURPOSE: OTH
JOB DESCRIPTION : FIRE SUPPRESSION FOR COMMERCIAL HOOD SQ FT:
CLAIM VALUE: 900.00 CALC—VALOE: GROUP OCC; B-2 /
COMMENTS: 970SF EXISTING /"FAMOUS SUBS 6 DONUTS"
1E iF i! 3E if iE ik iE N� iF ik 9E if� it iF iE iE 1E iF if� iE if k iE iF iF�/F 1E jF af �1E iE 7E ib iF 3F IF jF if i(� aF iE iF iF 3E �t af dF �k iF Y.� iF iE aE jf iE if iF �Fi(� if ik iE i!� iF if iEit fE iF if ib k if iE 1f iE 1! jF
Z O N S N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN Bi7ZLDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT ZN LEFT: FT IN RGAT: FT IN
PARKING RE • PROV: PARCEL; 42414107 ZNE: REF NO:
PLANNING N TES>
>
ih iE if'Ik if'lI' 3F iF iE 1E if iF if iE iF 3F Y if iE'1f iF If i! 1f iE If'If iP i!'7!-il� iF if iE 1E'Ii"If'IF'IF i!'II' iI' iEik �I' iF ikiF 1f lE if jF"3I'iF if -7h if� iFiE if Y.' if ic iE Y� 3F iF lf iE IF if M.� ik iI� iE 3F af 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 I+4 E N T S
7.ONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
(T t`�
APPLICATION ISSUED HY: 'N�- �'t'V` DATE; (2 6 �
ifiEitihiE�lFltiE!litiklklE�iFiEiFiE!4�1tiFiE . . t . . �iFif+4�ifiFif�fif�3 e iE#
*�r�t'*'��t�xii�rit*ie*i�'x,•ir�x�ie***�t*�r*ir'ieie�tafiaafir�iiir�r�r***iEie�'it'*�t*�r�r*ir*�rieif��r�-�'iF�"��ie**x3[3!xi%*��tiE�'
LEGALIZATIOAl:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT ���St SMIP/NON—RES
PLAN 14.95
ISSUE FEE
BUILDING—DIV—> FEAMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 23.00 0.00 14.95 37.95 37.95 ,00
REVENUE DIVISION�TOTALS--> COLLECTED; 23,00 OVER/SHORT: 00
BLllG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECI(
' 23,00
iE 1E if dt i4 IF iFiE iF 1E dE iE aflE if iE iE if iE-1E iF iE 1F �1F fE 1E iE �% � if iF iE iF �1F iFiF if �iFdF �%iF �lE if iE lE iE �lE1Ei(� if iEik �� iE'1f �lf if iE iEiF if 1E iE �lE iF'1(�iE �M iF i(� if �� iE if if-IF iE if 1f
Z 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 A T P T T O N UNIT COST TOTAL CUST
FIR 23 FIRE EQUIP FEE (FROM BLllG VAI. TABLE) 1.00 23,00
E1Jn UF FEES
t.
n, -��; .� , _ . . --
;:t: • - .-
CONSTRUCTION ANDPLANNING P��� PA I
APPROVALS Permit:# Date Inspector qppROVALS Permit # Date Inspector
1, Temporery Etectrical Service or Pole 52. Pool & Equipment Location
2. Soii Pipe•Undrgrnd. 53. Steel Reinforcement
'.;3. Electrica� Conduit Utility-Undrgrnd. 54. Forms
� 4. Electrical Conduit•Undrgrnd. � 55. Electrical 8onding -
5. Steel Reintorcement 56. Rough Plumbing & Pressure Test
� 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7, Footings 56. Electrical Conduit•Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe•Undrqrnd. 60. Sackwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
77. Property Sewer Line & House Connection 62. Backwash & Receptor-Final -�
12. Sewer Cap 63. Hea[er & Vent-Final
13. Root Drains 64. Plumbing System • final
54. Rough Plumbing .' 65. Electrical�Final
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. Rough Electrical�T Bar Ceiling 69. POOL/SP,A SYSTEMS FINAL
ig. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
Zi. DuCts, i� Structure 70. Undergro�nd Hydro
22. Dutts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe•Rough & Test 72, Underground Flush
24, Roof Framing 73. Undergrnd.StorageTank OGas OOiI
25. Foof Sheathin9 74. Overhead Hydro
26. T�Bar Ceiling (Structurall & Monocoat 75. Dry Chemical }� 17�pp �,3}aZ W�
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL ''(!�'�'3 (.�,�-
30. Drywall Nailing HEALTH DEPT. RE�UIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter�Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Ai� 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 Irripation 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. CEFTIFICATE OF OCCUPANCY
No. Date
� aect+DOPESS:
� t,owr�Esaame: }rA�0US�5U�Sx&SUO�ViSTS
'+ AOOPESS: S��
pRGMIEt�GiNFFP:
AUOflESS:
REG.NO.:
UNii: A
UNiT:
PEflMITfE4: SUNNY CQNSTRuCTION (7i4)572-9923
AOOflE3$: 74O�i MGfiCATEL AV "
ROSEMEAD CA 91770
UCENSED CONiRAG108 qEttAFlA7tON: i bereby athrm that 1 am li¢enSea under pr�visio� o� G�ap�u 9 Icomm¢n6ng with Seciion
1000i a� avi9on 3 0� �ne Bu;iness aM Pt6t@SSions Code. antl my Iicense ig in tu0 IorcE antl ettect.
CITY 414; /�` /" �51/R�TE. L�C,: S z 6 9$ fj V� 1"'�
Oate: �—Ll. =-�C'---.L--�="S�gnamie: �. �,% r"'- �
WOflNEflS' COMPENSATION DELLANRTION: i �erehy 3ffirm thai i have a certihca o� Corisent to sEll-iosme or a eertitrcate al Wark¢rs'
Compensailon mgurancB. or a cenitie0 copy mereol (Sectian 3900, lab. C�.
noucvNo.:1264055-92 ENP,OATE: DB�OS�93
C9MPANY: $ 1 ATE
`� CeRili¢q wpy is hereby Iprnishetl. Cl] CenitieE capy i8 filed with the city 8uiidirg pivi;ian.
' Jdle: _.l�"'.-��i.+� RRPIiCant: � %Ir�r �
E%EMPTtON FAqM WOPNEB$' COMPENSAiION OELtAMiION: fTMa sccfion �eC rro16e wmpieteU i1 ihe permi( is Ia one huM]ted (SiWy a kss1.
� cen��y ma� in me aeormenn ni �he wo�r, for wnkn th�s permi� �s �ssuee. i shau noi enroby any parson io aoy manner so as co become
3ubjec� ro Ilie yJor4e�S' Compensaiion Lawg o� GDlitornu.
Oaie: SSgnalure:
� wonee u, atter �,aairiq iMs eec�ara�ion. yo� shw,w aecome sueiec� ro ma wor�ers' Gompensalion provisions ot tM Labor
. Uod2. yroU must forchwith compty witn sbch pr9msi9ns 9� this Oe��� s�a�l 6E deBm¢d ICMke7.
CONSTftULT10N LEN6ING AGENCY: I qere6y a((irm that there i5 a canstruttion lending aqency far the p¢AotmarwE of ttµ work for
��. whlcn tM1q perrmt is asun,tl ISection 3697, Civ. C).
LENDER:
� 0.00pE53:
�WNEB BWLOEF OELLA0.RTION: i here0y aHirm (Oat i am ez8mp� imm It�e Coniractors' State Lkehse Law tor tM1e lollowing redsnn
(Sec[an 70315 9usness and 7rotesswnai CoOe: Any city of countY which rtpuires a permit to sanstruct, alrer. improvt. 4em01ish, ar
rep3�� anp strUGture. 6rior fo i15 �swance, aiso te0u�25 Ibe aDO���nt lar such Dercnil lo hle a:ignpA sielement that AP15tiE is lic¢nsed
p�rsuant to ine provisions oi ine Conuactms' State LMen;e 4aw (C�apt¢r 9(commeiwing with Spctan 7000) oi Oiv'�aion 3 0� l�e Busi�ess
antl Pro�essiong COtlp) or tt1a1 helShE is exempt Itiereirom antl InQ basiS fm (he alie9¢d ex¢mpiiofi. pny violatipn o� Sectian 7p37.5 Oy
any apD�kan� �or a 6ermit 3ubjeets (ne applitani 10 a C��� PeOa�ty ai nat mare Ihan lire Au�tlretl tl011d�s (5500�
I. as awr�ti bt tne prbperty o� my employees wittl wages as their sWe compensatiun, wip tlo tne work, and tne
d sUucWre is not intended or ofigred fot sale �Sectbn 70e4, Bus�ness antl Praiessional Code�. The C6npactois' State Lkehse Law
tlaes �rot avWY �o an owr�er ol a pr9perty w�q WNds or imp�qve& thereon. and wM tloCs su¢n wmk �imsCnlherseif or tNoug�
bi5 Or her Own emploqEeS, D�a�d� Ihb� 5uch imprwemenl3 ar¢ `rol Mten4e0 0( 6fleY¢tl ior 521e. 11. howeV¢I l�@ OUiWiOg bt
�imorovEment i5 so10 wiMin one year o� comDlefion. IhN owoer will have the burden o( D�4vinB he/ghC did oot Ouilp o� improve
ior me ouroose at saiei.
i. ds owne� o< <he 4�mperty am exclusioety coatracliog with licensetl eGniractoa ro canstract thg projeci (Sestion 70aq 9us�ness
❑ an0 Pro�essim; COOe: The Contracrors' Stbte license Lax tices not apply Io an ovmer of OroOe,�wtro bu�M8 or improves ther¢�
an� w�o cOnttacts ior SucA projesls vrith e mnt�actOq$ lice�se pursuant ro ttie Contraceors ta�e Uceme Law). I am aware
tOdt Dn}pi Oi N¢it Wo�kei 5 C6mpep53116� in5UR�CP, St10U�0 � pf0YlA00 IO I�1¢.
� � am exemD� untlei Sectio�: B. 8 P. C, .
(o� tfds fgason;
da�e: Owner:
I qo hCreby ceili(y 1ha41 am aware ot entl understand Ine req�iremBat9 ot Califomia Nea�tA and Safety COUe SeCtbns 25505. 2553:, and
25534 an� ihdt 1 or any IUNB builUing acupant vHlAwin �ioi {circle Oney �¢¢d tq comply witn saitl StaU, GOdE; aM (h¢ r¢OaiBment& Ior a
pEemit �6r oonstruction or maAilicabon imm i�e Air ahty M2nagement p5trict ReSidenual cron,tmctkn�ap�catbns are Bxempt trbm
(h¢Sk p�Wl5�on5.
bare: AVP��ant:
I�Ere6y ceNly UHt�fiave�¢a0ifus applaatqn 2nd state �I�atrtie aboveinfofmdtioniS Carr2LL IagteEto comply w)Ih tliciry arM county
orUi��rwes antl s�ate lao�g rclating tq buii�in9 consimniqn and nere0y aulfwrize representatives ai t�is ci7 io ¢nle� �D� the atlove�menlioned
pmperty lor inspecUon purpose5. ��
Oate: �j���,..Z--'SiqnatU�e: �� �"' �
Orivei s license or Social S¢curity n: �.� �
IgaL46 Wnuq—gudtl�ng: Green—Cqae En(orCemenC Canary—Applicanf. PinM—Rav¢we: G6�dervad—pssas56r
CZTY OF COSTA M�SA � BU2LDING PER�ii1' t�ERM NO: E 459$41
P.&RMTT NG; E 059$4i PLAN CHkCI{ N�; N �Oti'T; tJ SUPP; N
CONSxRtJCTTON T'YP�: P�RMIT TYPE: K'L� Pt3ftPUSg; A:,�t'
JOB Dk.SCRSPTTON ; RBLOCATE WALL TQ ENLARG� CU51'OMER AREA SQ F'I';
CLASM VALUB: CALC��,'ALUE; GROUP �CC: B-2 /
*��*�rt*���*��#x+��**#*���+as*�����#����r��4*���*8�**t�#��u�c�r��t���t,rxxxx•i�x x s�x�n�x�+��t�+��
2 O N I N G5 ER�'E$�AUC.txR�E M� N T S
_�__---_____ MAiN EU,ILDING —___-----_' -------..— ACCtS50RY $UiLDSNG --�______
FRNT; fiT iN REAr�: FT IN �RNT; F't' IN R$Ac�; Ft TN
LEFT: F'T 1N RGHT; FT IN Y.E�T: Fi' ZN HGHT; �'T IN
PARKING REQ• PROV: PARCEi,; 92419107 ZNE; kEfi NO:
PLAt3NSNG N�ST�S>
}
iF # it� #�1E # ik if it x� iF#�1t ## ic 3t j( f(�iF 3t iF it # ik#dt-iE it# �t 3t ,�E�i: �if x� 34 ib # it # iF fE# fF ## M� iF 3F if # i4 K# k��)f sE ## iF K� K� tE i[ ## 3Fi6iF-1F ##�l iF %3t• if
D$ V E L O P M E N i S E R V 1 C E S R c; Q U T R E;: E N i S
ZONING APE�RQVED BY ;i. DAxE;
$UILDING APPf20VEb BY ; `'''� DATE;
APPLTCATTON ISSUED EY; .�+-. .}-�-y�- AAT�:� l� �o ��-
#if#ihlf�'1F#�FiEiE3tfEiEjlit#1FiflEif##—;F`Ti�i�'Pc%'s'F"�7F1eX'i�'#=RiFit'FivRfF"#Tr%ititie�TtlfiEiP##1hiEiEiE3L� 1tftYtRrtSr x �!f
iE fE �E if iE iE iE iFlP if # iE 1E # iP �E 1P �lF �f iF �f iF iF i6 iE I[� K� 167F K� IF if iE ibVF iE 9F'4 tF iG �7F iE if 14 )E!F # iE if i(^ K iF #�IP-X�:E ak #####?k �lL� 3E iE i6 iF ii # 9F iE iF it 9(� #%# #
LEGALIZATT4N;N F 6 E S U M M A R Y STRUCTOitA1. SEGMENT:N
p£AMTT B�'DG PMT PLTJM$ING EL�Zq'R�I�C MECHANIC FIRk. SN.SP/A$S GRAf3ZNG
�p� SMiP/I30N-RES
PLAN
ISSUE FEE Z5,00
Bil3LDiNG-IIIV-> P&RMIT I$SUE PLAN-CHECK T4TAL PAID DUE
TOT'RLS----> 29.00 iS.00 d,00 39,d0 39.00 ,00
REU6NUE DIVISIqN TOTALS--� CQLiECTED: 39,00 QV�R/SHORT: 00
BLDG PMT PLUMBiNG ELECTRIC MECHANTC FIR� 5MIP/Tpi GHADING PLAN-CHECK
39.40
# 3F i6 i( iF it ## 1f it 9E iE # iC� i(-if k�k if j(� if iEiF iF# ik 1F ifif ## 34 # iE# it i4 iEi(� �1F# iF # if �klF if� it i6lF ###!6 iFlf ## 9E #!F # IE 1G i(� i6 k 1f � 3C� 3F ib 3E fF 3F ####
T N D I V I T3 U A L F E E � it E A K D O W N
TYP& QTY D E S C R I P T I O N UNTT COST TbTAL C45T
EL£ 12 ftECEPT/OUTLET 1 ST 20 EA. 7S 9,pp
ELE i SIGN/ OUTLTNE LIGHT 5YS ON 1$ft CIRC 15,00 25,00
fiNb OF FEES
,, ' \('�CONSTRUC710N AND PLANNING POOI�PA
�F.+�PPPOVAIS Permit # Date inspecior qppROVALS Permrt # Date inspecmr
�,�
1. Temporary Elecirica� Serviceor PoVe 52. -Poot & Equipment location �
< Soii Pipe-Undrgmd. C 53. Steel Reinforceme�t
•�3. Electricaf Conduit Utility-Undrgrnd. � 54. Farms
1
' 4. ElectriCa� Conduit-Undrgmd.' S5. Electrical BOnding "
'` 5, eel Reinforcement 56. Rough Plumbing & PresSure 7est �
6. EI_ ctrical UFE Grrid. 51. APPRpVAL TO COVER�GUNITE
7. Footings 58. Eiectritai Conduii-Undrgrnd.
8. Foundation 59. Gas Pipe, (� Undrgmd.. 7est ,'
9. Water Pipe-Undrgmd. 60. Backwash Lines, P�Trap, O Undrgrnd. '
70. Strucmra� Fioor Svstem . ' 67. APPROVAL 70 DECK '
11. Propertv Sewer t,ine & House Connection &2. Backwash & Receptor-Finai
12. 5ewer Cap 63. Heater & Vent-Final
13. Roaf Drains �, . 6A, Plumbing System � Final •
14. Rough Plumbing 65. Electricai�Final
15. Rough Elect�ical-Conduit '. + 66. Solar System�Final •
16. Rough Elettric Wiring 67. Fencing & Access Approval i
17, Rough Wiring Sign � 68. APPROVEp FOR PLA3TERING
18. Rough Electrlcai-T 8ar Ceifing 69. POOtJSPA SYS7EMS F�NAL .
19. Rough Heating & Air Conditioning FIRE pEP7, REQUIREMENT
20. ROugh FactorY Firepiace ' APPROVAIS Permit #
21. Oucts, in Structure - 70. U�derground Nydro
22, Oucis, Ventilating 77. Product Piping � Gas C70i1
23. Ga: Pipe•Rough & Test 72. Underground flush �
2A. Root Freming 73. Undergrnd. Storage Tank O Ga5 Q Oii
25. Roof SfieaChing 74. Overhead HYdra
26. T-Bar Ceiting (Siructurai} & Monocoat 75, Dry Chemical
27, Frame and Flashing 78, Ory 5tandpipe
28, Lathing & Siding ' { 77. FIXED SYSTEM FINAL
29. Insulation � � � 78, PIRE PREV. FINAL
30. DrywaU Nailing I ( � HEAL7H DEP7, REQUIREMENT
31, Piaster 9rown Coat � 79. FINAL INSPECTIQN
32. Eiectrical Power MeterFinal t f � 80. POQD CERTIFICA7E ISSUED
33. Final Electric , � ,1�. .�7' � � Notes:
3-0. Final Heati�g & Air Conditi0ning j
35. Finai G2s Pipe•Test ( �
36. Hood pr CanopY � � �
37. final PaciorY Fireplace � �
38. FinB� Plumbing i � i
39. Water Service•Final �
40. Gas Service�Final � �
41. Sola� OpmestirFinal �
42. Backflow Preve�ter ' ,
43. 6ackflow Irrigation
A4. Landscapa irripation SYstem
45. Sound Attenu8tion
46. Hdndicap Regulatio�s
47. FINAL S7RUCTUR� & 8U�101NG � - �
AS. PINAIPI.ANNWG � �' `
49. Elearic Release to Edison ' �
5p 1 Gas Release to Southern CaGfarnia Gas Co � �
51. CERTIFICATE pF QGCUPANCY
No. Oate
PflOJECTAUUHE$$: 8t1S W 19TH ST - uxiT: A6B CITY OF COSTA MESA — SIGN PERMIT �"PERM NO: SB 059995.
OWNEfl'SNpME: VERA R. HUGHES '
ADDflE55:']OS CLIFF DR . PERMIT NO: SB 059995 PLAN CHECK NO: 04497-92 S GOVT: N SUPP; N
NEWPORT BEACH
' CA 92663 CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE; OTH
AflCNIENGINEEfl:
ROOflE55:
NEG.NO.:
UNIT:
PEflMITiEE: NEONIC MAN ( 714 ) 499-2573
aooeess: 31502 MAN VISTON
SO LAGUNA HEACH CA 92697
UCENSEO LONiBAC70B UELL11NpTI0N: I nereUy affirm ihal I am licensed untler prodsions af Cnao�er 9(commencing witn Section
7000) ol DiviSion 3 0l Ihe Business antl Pmle55�ons Caae, an0 my lic¢nse is in Nll�orce and ellec�.
cinuc.:0�40� 3TpTELIC.:SZ3ZB9 cus C4
Date: � � � � Signature: _ — — _ — .
WOBIIEBS' CO PENSRTION OECLABATION: 1 �ereUy a��irm IOai I �ave a ce i�icate al consen o II-inmre or a cenilicate oi Wo�kers'
ComOensation 1 5}�� tdip pY Ihere0l (SetliOn 3800, LaE. 1
POLICY NO.: � V�� ���—� � E%P. DRTE: S/ O S I9 3
comrnxv: STATE FUND
-'] Cenilie0 copy is �ereby tumisheU. L� Cenifie� caOY �s fileG wi��y BuilGing Divis�on.
Date: � I I ` ' �_ ApplicanC �� �
E%EMPTIONFflOMWOBNEHS'COMPENSRTIONUELUflAT10N: (T�iSsmionn not�ecomDleleUiltA permitisioronehuMre4�5700�orlew�.
I cerlity I�a� in itle Detlormanc¢ of Ihe work lor w�ich �his permit is issued, 1 shall noi employ any person in any manner so as �o hecome
5ubjetl lo ��e Warker5' Com0en5aiion LawS ol Califomia.
Date: Signaiure:
NOTILE: II. alter makinp iAis Oeclaraiion. yau s�ould hecome suGl�� �o tAe Workers' ComDensation Omvisions of the Labor
Coae. you must lonhwilh comply with such provisions or ihis permit shall �e tleemea revoked.
' CONSTBOCTION LENOING FGENCY: I �ereDy affirm ��at tAere is a consiruction IenOing aAency tor t0e Dedormance of the work for
w�ich ��is Dermit is i53ue0 �Seclion J097. Civ. C�.
LENDEfl:
aooness:
OWNEH BIlILOER OECIAHRiION: I Aereby aBirm IAat I am ex¢mpi Imm t�e Comracmrs' State License law for Ihe foliowing reason
(Seclion 7031.5 Business anA Pro�essional Cotle: Any city of coun�y whic� reQuires a permit�o consimct, al�eL improve, demolish, or
repair any stmcWre.'Orior to i�s issuance, also reQuires���e applicanl lor suc� permit Io lile a signetl s�a�emen� �ha� �e/she is licensed
pursuani Io Ihe pmvisions ol l�e Coniractors' Slate License Law (Chapter 9lcommencinq wit� Section 7W0) ol Division 3 of Ne Business
ane Pm�essions CoOe) or I�ai he/she is eKempt I�erelrom and tlte 6asis �or Ihe allege0 exemp�ion. Any vioia�ion ol Section 7031.5 Uy
any applicant lor a oermil su6iects ihe applicant to a civil penalty of not more tAan live hunCretl dollaR ($500).
I. as owner at Ihe Dmpeny or my employees wil� wapes as Ineir sole compensation, will tlo the woB, and the
❑ simclureis nolinlenUed orol�erea�orsale�5ecuon 70ad, Business anE PmlessianalCotle: T�e Con�ractors' Slate License Law
Ooes no� aDPty �o an owner al a pmpeny w�o builds or imD�a�eS ��er¢an, antl w�0 AoeS SUth work �im5el�/hersetl of �hrouBh
his or her own employees, pwvidetl �hai such improvemenls are no� intentlea or afleretl lar saie. I�, however �he builtling or
impmvemen� is 5old wilhin one year o� Complelion, Ihe owner will have Ihe burtlen oi D�oving h¢/She did noi Uuild or improve
loi Ihe purpo5e ol salel.
I, as owner oi the Dmpeny, am exclusively conirac�ing wil� lirensetl comraclors �o consimc� Ihe D�olect (Sec�ion 7044, Business
❑ and Professi0ns COAe: ihe Contractors' State License Law tices not ap01y to an owner ol pmpeny who bmltls or impmve5 thereon
�� ana w�o coniratls lor such proletls wii� a coniractOr�S) license pursuant Io I�e ConVacbrs' Slaie L¢ense Law�. I am aware
Ihat pmol of Iheir Worker'S Compensaiion insuranre 5houlU be providetl to me.
� 1 am exempt unEer Seciion: 8. 8 P. C.
tor Ihis reason:
Oale: Ownec
I Oo �ereby cenify tAal I am awdre af antl untlerstantl Ihe repuiremenis oi Calilamia Health anA Safety CAtle Sections 25505, 25533, ana
2553A an01ha1 I ot any �uNre 6uiltling O[cupant wilVwill na� (tircl¢ one) neetl lo campty wit� SaiE 5tai¢ ta�es an0 �he requiremen�s �ar a
permil lor con5lmciion or modifica�ion iwm Ihe Air Ouabiy Management �islnct. Fesidenlial cons�mtlion applicalions are exempt �mm
IhQSE p1091510115.
Dale: Ap0licanl:
Ihet¢by cerldyl�ai I �ave reaa IOiS a0olitaliun an0 Sialelhal I�e aDOv¢ iniormaiionis corr¢ci. I agreeio camply vnt� alltity anE counry
or0inances and state laws reia�ing �a bwlCing consimdion antl �ereby aN�orize represenlaiives ol lhis city to enter u0on ��e a�ove-mentione0
pmperiy lo� ins clion f�Y�ses.
�a�e:—�.�-���i'� SignaWre:—J—_V /�
oriver'sLicenseorsonaiSecuriry�:
I6nba6 wnne—Boilaing: Green—Cade Enlo¢emam: Cenary—nppliwnC Pmk—Ravanue; Goltlenrotl—nwessor
JOB DESCRIPTION : CHANGE OF COPY / EXISTING SIGN CABINET SQ FT;
CLAIM VALUE: 200,00 CALC—VALUE: 200,00 GROUP OCC; B-2 /
COMMENTS: THE "FAMOUS SUBS 6 DONUTS" SHOP.
*:�e�**r�e�r�rx�r�r�**r****�**�r+r�r�r*r�r��r*���x�**�r�r***�r�e��r*�r*�r**�r�e�r**�*�r*�e******�r�r�r�r�r��*
S I G N I N F O R M A T I O N
DISTRICT; 2 TYPE: CHANGE OF COPY ILLUMINATION: INT CATEGORY: CHA
DIMENSIONS: 2FT-OOIN X 8FT OOIN AREA; 16.00SQFT LETTER HT: 12
STREET FRONTAGE 1; 472,50 STREET 1: A, 19TH ST
STREET FRONTAGE 2: 150.00 STREET 2: PLACENTIA AV
PARCEL; 42419111 ZONE: C1 LOCATION > FRONT; X REAR:
HUSINESS NAME; FAMOUS SUBS AND DONUTS > 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 : 16.00SQFT OVERALL HEIGHT: OFT OIN
THIS SITE : 100,00SQFT GROUND CLEARANCE; OFT OIN
ITEMS OF INFO : 1 PLANTER AREA: O.sUOSQFT
ITEMS FOR ACTIVITY; 1 BLDG SET BACK; 20FT '
COPY VERBIAGE ; FAMOUS SUBS AND DONUTS ;;
PLANNING NOTES:
!ki! M M if iF if if iFlt 1E 1t 1flf it 1F If M!f!t ik it if 1k if iF iE i! if iF k�k iF itlf �F if if if �f it if if iFif �t iF iF �F if if if if fflf 3flF IF k if i! If iF k if iF �t ik iE 1F IElf 1f If if iflt �F k
D E V E L O P M E N T S E R V I C E S R E Q D I R E M E N�:T. S
ZONING APPROVED BY S� � DATE: ��N !S'
BUILDING APPROVED BY : DATE: g' ?�
APPLICATION ISSUED BY• DATE; ��/������
il�Fk�fifitkifiFiFit�EiElkfklFltrlfltlkiEk 1flfiflfiFifititikif ifiF
LEGALIZATION:N F E E S U M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADING
PERMIT 15,00 10,00
PLAN 9,'75 SMIP/NON�—RES
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 25,50 0,00 9.75 35.25 35,25 ,00
AEVENUE DIVISION TOTALS--> COLLECTED; 35,25 OVER/SHORT• 00
BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
15.00 10,00 ,50 9,75
3E iE iF iF K �f 1k ii It 1F �f'M I%1f k ff if M if if It iF M!f It �t if k ik ik �E if iE 3fl1'!F!E ik 1f 1F iE iF3f if iflE'1f"if iE�E if �h If if iE iFlE 1t if iF if �f i{' IE ik 1f'1Flh IF if if 1f iF ik 1f IF 1E 1E iF
I N D I V I D U A L F E E B R E A R 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
U3 ('Q!.. . . - - , .. .
D::iFr : .. .. . . ,'" �
CONSTRUCTION AND PLANNING P00 iPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector �
�1. Temporary Electrical Servr�ror Polyfz . 52. Pool & Equipment Location --
� 2. Soil Pipe-Undrg�,rnd. o S" ��.; � 53. Steel Reinforcement .y�
'tl r ") G
1. .
��.�c�ricalCon���)tility�(7n51�'grn�dr`.� `�� 54. Forms
v 4.CE�urical ConOulI�+�drgrnd. + i p `7 55. Electricai Bonding � i
3 5.r$`teet; Reinforce�u� ��.,r 56. Rough Plumbing & Pressure Test r�
=i�: Etectrical UFEB�'irnd. u 57. APPROVAL TO COVER�GUNITE �
y
�t �.'�;otings l,'� z 58. Electrical Conduit-Undrgrnd, i
�L�B. foundation p,� �' � � 59. Gas Pipe, O Undrgrnd., Test �
9. Wa[er Pipe-Undrgrnd. � j 60. Backwash Lines, P�Trap, O Undrgrnd. !/�
10. Structural Floor System /r1 j �1--� 61. APPROVAL TO DECK � �
11. Property Sewer Li �& H�b�et�:onimction ,;: 62. Backwash & ReceptorFinal �,��
12. Sewer Cap i, f � . 63. Heater & Vent-Final i �`�
Y �
13. Roof Drains '� - �'�.f.,T y�� v 64. Plumbing SYstem - Final �
14. Rough Plumbijfg L' �� � � 65. Electrical-Final
15. Rough Electrica!-Conduit � � 66. Solar System-Final
16. Rough Electrie"�W�ring 67. Fencing & Access ApP�oval
c�
117. Rough Wiring�jgn 68.-APPROVED FOR PLASTERING
�18. Rough Electriest-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
' . .� -.. - . . . . Qx - tT tT�- :+F ,: ?�
20caFo h E3ctoLy F�.usplaee�-+F�¢a �' E^O V M O P8f3Q1EALS� P�eNiDQk T
x s = n: s cc v H T• c �: T r, +.-i �.
,-� � ,nmrt;n.-i :vc y < .= xQ a T * ,
21 u�s,ir��-,Stwct� _�5{s��;mSO :�N � S �70.;k1r�qerground�ijeqk�y-; ,s :
22. DuL2s, Vintqsti�� C1�, •�tiFflt-�Gn'Cs7 � K . 77�Xrrf uct Piping ��a! Q� �'
�m i n- x
23�Gas i R�' h&'�r est "S ^•^�« y.� 'zs x tr ,�-+ � i CC x
• � P� °� �t NCp�nS > r�+ � S?� t*7 C ��O�JS��erground F��� l .a[':1-. x
� . n v .
24:uHoafFEaming Sx -�-�2, h[�^<it� ' a�7 O 73. K1c�ergF'nd.StoragATank`t+^'Gas �Oil
rr- � n, - !1 �-•n n vr ' x . �� �t
25. Ro�,f SF�athing _ * '�` �C�" •' "" :`" k m 'n . 74�;'�J�rhe'�d.Ji dr �� �;`-o "
lTN T`�i`'� ,'� • e G � Y�
26._�T-g�qr Ceiling i5tweturafj;�&tv]onocp�t s� m� 75?l0ry CFrE'mical . `: ?� �
- � r.
27°�'Frame d Flas � `�� O�� .• . ..••� " ^. .-. � `'
a, �� �� ;to SD � xs �6.���YStanBpiPe� •n� O� x.S i
28.�Lathing Siding � SSa'- �� r `�'-�� x� •77:•>FIXE€7'SYSTEM•FPWAC�.'S � v (5,
�29. Insulat�n �Y �,`'y'�`."n�..,� N * m 78. �IRE �iEV. FINAL i rq a� -r
J30. DrywalUVaiting N* N:n c0 Z7cc [z� x ,; .� :/`"x rW- HEALTN;DEPT.��EQU6REMEPIT;*1
��1. r,
`�31. Plaster &ov�r� C�a� �C�' G�y,^s F fi /; i 79.� �IyNALrNSPECTt��� ;� � z
`�32�Electrica Po¢ver eter i�l -, i..% G s N ��' O�fcCkflD�ERTIFICATE ISSllED *
.33yFi I Electr Fx .-+ n� � r m ot :m �ti a ^� �'
,� � i ti* i i S �S ^ O x tl -7 _[r, x'"_ C �:U
_34nFiri�,IHflatinq&F,kC�nditionirig,2 a x � S t�x a S�7
v35 r,Firia'1 Ga� Pi�e-T.g�S� '' '� S n� o� ^ ic � C� ,�Co� :�'. � x.T c'�
36�Ho'- oLCanoPY' �" v v ic J: m *��} C
i 9� C1 i q f E (l!.
��37�Firid�IF�etor F�re I�e �""'�y xt� <.�' �i x :r
y ��r< <ccc'+tn R `,« s * G
(` ` 'x _ Ai9.1m x; �,- -
,S38;FinaJ P[umbing x y-y�-r�hrr7r,-� > �{c S �c x r
�T39�VJal@r S43vice�Finat: :� r•� ^ 7 T � ti x [^ .., sc �: � f�
m v �n ti-�c�-�:: .�m` c-� x z .. y �� o :-,
� 540.'GaS�er�ice�Final "'x`iS` -�- `F -✓ '� `-" • . .-
Z 1 4. ti �t t(:'i • �Q'i �GiJ K i�7 JRJ ✓.'.1i '
:-+41v6olarD`omeSlic�FirtalVr-= •y �-"Ft �C� i �tu r-+ �e �s-
.- 'r'�: m % � n,... �7,V J' s: x 7
42�'Backfl� Preventey S ya: h ~ 7� xr Y'" k ��. j� ... C�a �
43. Backtlow Ircigatiorc� ��!n:L^ � (� - �¢ =� K c �^ '� k C �
� s: � i.a T' �n z x x.li i x Cl
x '<-N6 c-. ;¢T, c x� ti�> >:.s L?
�44. LandscaPe I�riaation Systg�. ;,1 •• • •• x .q p ,_,x - n; ;V �C? � v
� `" c� F : xc' � �� �'� a[4 ;� _
�45:�Sound Attenu8tion ¢~ >".aCJr-
.r x .� e nY -. .T �w �C F
;?46;;Handicag Reyulatiqns �`,-, �`;�`�r�,; �. ; � • k G � S • ON • X.
� �.. _ �� -v . - - ':
�47.^,FINNLSTRt1CTURE�rBUILDING� � s•- N S% :t
m � � +� `_ t n ,r � / t i P:
''48`jFIM1IAL PLANNIN�i •• �r �.v � V • /' � � i T C�7 ' �• V
049� Elec�ric Release to�fdiion _ �� • �� � � .� S ! x -
./, � : <rr.
v50�Ga JRelease to Soujhern California Gas Co �: ��! 11 �'� S `" ."�y `
{�; � C c �*• �
;�51. CE�TIFICATE 0, OCCUPANCY r; `� > ;� =c �c=: � ,-
No. Date
., ..
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-
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
A
For Applicant to FID in Completely — Use Ink Only
RE(
BUILDING �j,/ � (��-
ADDFESS p '7 ' `� /
OWNER /j"Z(/ [yi� (/ P"F
MAIL ^ � �L�I N� ADII
ADDRESSc�� D P / '1 �
TEL. �3-�
CITV �.�� ��OCl NO. % �i / (7
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BiiANCH
ADDRES'
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ADDRESS
ADDRESS �
CITV
STATE
LIC. NO. �,
SIZE
OF LOT
TE
TEL. (�J
NO. �f.�
CITV
LIC. NO.
NO.OF BLDGS.
NOW ON LOT
Separate permits are required for
elec[ric, plumbing and heating work.
OF BUILOING AND WORK TO BE PERFOR�
xT�2io2 �-n,
G�AN C� E �'7�TiLY
I hereby acknowledBa that I have Yeatl Shis appllcetion end stete
t�ec the above Information Is corrB�t and aprea to compiy with
ell laws reguletinp builtlinp connruction, antl I shall not employ
any perwn in vloletlon ot tha workman's eompensatlon lews of
the Stete of Celifornla.
I hareby certify thei 1 am proparly Ilcensetl as a contractor undor
t�e Sute of Callfornie Businew antl Professions Code, Dlvialon 3,
Chapier 9, antl that such Iicensas are In full forca end effect, or I._
em exempt from Me pravislonz of the State of Celifornis Businew'
nnd Professlons Cotle, Divislon 3, Ch/agte��9.
sienature o� n 1. /� ii �
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� �,��f�7��e��a00 ?95~ *,:��23()0
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FOR STRUCi'URAL PERMIT
DATERECEIVED �DTFiecimn
�`
^ ���'�.�� PERMITNO.
K
PROVE � / �
DATE ��A /
r
f� NO.OF USE OF NEW
PLANS Z BUILDING
VARDSAPPROVED VARDSAPPqOVED
MAIN BUIIDING ACCESSOFV BUILOII
DI5TANCE BET
MAIN BLDGS.
VAR. qW
TNEAMOUNTS
THE PURPOSE OF
VALUATION
BEf. MAIN
ACCESri. B�
DATE
APPROVED
PERMIT FEE E
TAX E
TOTALPAID 5
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COSTA MESA BUILDING•SAFETY DEPARTMENT �
P.0• BOX 1200 COSTA MESA, CALIFORNIA 92626
APPUCATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only qECEI DATE RECEIVED l�f �$ F�
BUILDING �.,��_ �/ ��� O� %/ E/ J
oWNEq
MAIL
CITV
BRANCh
ADDRESS
ADDRE55
CONTFACTOR
ADDRESS
CITV
STATE
IIC. NO.
SI2E
OF l0Y
USE OF
TEL.
TEL.
NO.
CITV
LIC. NO.
Separate perrttits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WOflK TO BE PE�,FORMED
1 �ereby acknowletlpa that I hava raetl ihts application antl nate
t�et the above Information is correct and ep�ee to eomply wiih
all lewz repuleting bulltllnB conrtruetion, and I ahall not emplay
any per6o� �� ��olation of the workman's compensatlon lawz of
me stata ot celitornie.
I he�eby cartify ihat 1 am proParly licenwtl aa e eontractor untler
che Staie of Celifornia eusineu enA Profasslons CoEe, Dlvlsion 3,
Cheptar 9, end that such licensas are in tull forca antl effact, or I
am exer�P< from Me provfslons of the Stete of Celitornia 8usinecs
and Professions C da, Division 3, Ch tar .
Signeture of
Permittee
Authorizatl AB t
ESS
ED
VALUE
TE
N� / IPLAN$ I BUILDING E�
/�
VARDSAPPROVED VARD$Af
DISTANCE BET.
MAIN BLDCS.
VAR. #`
C.V.P.#'
APPqOVED
DATE
&
THE AMOUNTSHOWN UNDER VALUA
THE PURPOSE OF 6TA8 P D A PERMI
VALUATION PE E S
y{_� PLAN CHECK §
v
$� ✓ TAX $
TOTALPAID E
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COSTA MESA BUILDINGSAFETV DEPARTME—
P.O.BOX1200 COS7AMESA,CALIFORNIA92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant ro Fill in Completely — Use Ink Only
._ . _ RECEIVFDBV DATE6ECEWiO ..�r�������..
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OWNER L��S
MAIL �
ADDRESS
CITY ^
CONSTRUCTION
LENDER
BfiANCH
ADDRESS
AFCHITECT
TEL.
NO.
TEL.
ADDRESS
TEL.
CITV ?/'j NO.G('/
F—
STATE CITY
LIC. NO. LIC. NO.
S I2 E � NO. OF BLDGS.
OF LOT NOW ON LOT
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and hea[ing work.
USE OF BUIIDING AND WORK TO BE PERFORMED
��
ZONEn
��I �
VARDS
BET. .
V AR. qW
C.U.P.qW
APPROVED
OF USE OF N i
NS BUILDIN
VED VARDS APPRO'
NG ACCESSORV BUI
BET. MAIN &
ACCESS. Bl6
OATE
I hereby ecknowletlpa thet 1 hava raetl this applicatlon and smte
(hot the above informatlon is eorract entl aprea to comply with
all lews raguletinp builtllnB constructlon, antl I shall not amploy
ony perwn in violatlon of the workman's compensetion lows ot
the State of Calitornia.
I hereby canify that I em proparly Iicensed es e<ontrector untler SQ. FT.
tha Stete of Califarnia Businesa antl Professions Cotle, Div(sion 3, THE AMOUNT SHOWN UNDER VALUA
Chepter 9, antl that such Iicensas ere in full force entl effect, or I THE PURPOSE OF ESTABLSHING A PERMI
em exampt from tha provislons of the Stete of Callfornia Buainass VALUATION PERMIT FEE y
antl Protessions Code, Dlvision 3/, C/heptar 9.
SIB�amreof ✓//. � ��J P�-/�NCHECK E
Parmittea ���L�:�� 5 ('V
v ��� TAX S
Auffiorize�ea�t/ TOTALPAID $
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�— 0548 10/03/80 8.50 Tl�
� �," COSTA MESA BU�LDINGSAFETV DEPARTMENT APPLICATION FORS`CRUCTtlRpL PERMIT -'� -"
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r.v.o�n �cw sw�nrvwn,�.nurvnrv�na
RECEI ED PERMIT
For Applicant to Fill in Completely — Use Ink Only
ADDRESS .7� C/�r^ .W � Y'ST A P ND �� Q
BUILDING �/t /
TENANTOii Yt � �� ADDRE55 T_�
i.t' i N I /'/ �
MAILING Y �/ S j SPACE NO.
AODRE55 1s
TR.NO. LOT BLK.
TEL.
c�rv �'O ST/� �r �S%� ZE
NEW ADD LTER REPAIR MOVING OEMOLISH
CpNSTRUCTION
LENDER
BRANCM '
OWNER C1.I.�'
ADDRESS VA UE
ARCHITECT TEL. USE ��,
OR ENGINEER
ADDRESS 20NE TYPE GROUP
+.!'�- Auj APPqO %1I�_ / �_
CONTFACTOR /✓J L' i✓(� 5 /f' � U/�� BV ��COPO4TE D' Q
nooaess s7 /_7 �v�S�//n�c�-Td�� —
TEL. �
CITV S',9N%/�/fiv� . NO. LJ//yL�
STATE CITV APPRO EDSETBACKS
�IC. NO. ';� J y�L'� LIC. NO. '
SI2E NO.OFBLOGS (FR0 C/LSTREET)
OF LOT NOW ON LOT FT.
USE OF
EXISTING BLOG.
Separate permits are required for � si FT.
electric, plumbing and heating work.
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED PI.ANNING ACTION
� �L$ % /r�CO
p DATE
/PG� C/�/��7 I'/�C( .SYS//�/�'t. APPROV
APPROVED
1 horaby acknowlatlBe thet I hnvo reatl this appllcation entl rta2e
Mat tha ebova information is tot�ee[ antl op�ea t0 eomply with
ell laws repuleting building conrtructlon, entl I shall not employ
eny perwn in violatlon of Me warkman'� compensation laws of
Ma Stete of Colifornia.
I hereby <ertify Mat I am properly Iicansatl as a coniractor unEar SQ. FT.
tha State of Californie Business antl Protasslone Coda, Divlsion 3, THE AMOUNT SHOWN UNDEfl VALUATION IS FOR
Chapter 9, entl thei zuch licensas are in full forca antl affeet, or I THE PURP06E OF ESTABLISHING A FERMIT FEE ONLV:
am ezempt from tha provialona of the Stete of CelNornia Business VALUATION
antl Professionf Code, Division 3, Chapter 9. PERMIT FEE E 8, ��
$Ipnoture of �i ��L �1 _ .r � PLAN CHECK E
Permiitee il—�+�---�[.��- / S � � ��� � p�r
XI 1.J TAX E VV
AuthorizatlAgant Date ��%� � �n `JJ TOTALPAID E �^
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