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HomeMy WebLinkAbout140 19TH ST - Building Permits 9 CITY OF COSTA MESA - 4 BUILDING DIVISION °,t: . F I fdw:'.:i: ) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. 11011411+y PERMIT -w,.o,areo S4° SB05-00030 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 SIGN PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: A Applied: 03/17/2005 Vicinity: Issued:ueb03/17/2005- Parcel Nunmber: 42626318 Zoning:,_ ___ ISSUED BY: Iv�/KI✓ Applicant: ARTINGER, PAUL r'- ' - , Address: 7541 SANTA RITA'CIRCLE, i STANTON CAI- -�, ',r - Phone: 714-894-2011'/ /if r ,�, SUITE D7 " ' Zip:- 90680 - 'r \ Owner r CEFALIA JOE , r'� ' ' y , Address -,1649 BAYSIDE DR - Phone CORONA DEL MAR,CA Zip: 92625-1832 '' 77-j/ 'Contractor/V.', CONTINENTAL SIGNS INC 4. . `, Address: 7541jSANTA RITA CIRCLE SUITE'D i Phone+' (714)8942011 t•' l ..doa S - } STANTON,-CA- Zip" 90680 qtr; r'� 1. is s" h `�.. i r License: 664525 - . Address y . _ N - . r • I- - --- _ - Phone: Zip: A v� � License: _ _ - � - ' ._ '' i '- NJ' 'SCOPE`OF'PERMIT 16 SQ.FT.CHANNEL LETTER SIGN"ALTERATIONS+". - - .- - .- . - - - . —N„-.-FEE SUMMARY ft Plan Check: $45.01 _ � --Calc Valuation $2,00000 ' $0.00 , Permit: ' ' $69.25 t -. ,` Claimed Valuation: - ./$2,000:00_ -' • - SMIP Com i $0.50 -i;' i y Other $0.00 .�' /,/r` t ' ,x$0.00 ,iEk G/ - //,(//' Inspection: 'tel $0 00, !-. jr: <f ` -5;2' 5 t ''S4•;" < '2'' - ' '� _4 Total -,N., -$114.76'- r ,, . ,; , r \N ' ;. PLANNING &ZONING -, v,, ./ ///- ' NOTES: N-, 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) 1 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the rill for which this permit is issued. rI have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensationioinsurance carrier and policy number are: erM : co /T /atS / C iLyaralt.,7 q1 2 c (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr visions.�J l7 lic;pt(Signatu`Te:T ?pl —e— . &AO, �0 11101. — 7 — WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAG IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($l0g0C0),IN ADDITION TO THE COST OF COMPEN TION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm th licens�ed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.L' .A VC- f .2 S Mtn C! contracslSlgrjature:—,',�/./A?Kis`. CO'NST�torRUC ION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner 01 property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ l am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to tile and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? L]Yes No (Section 25533 of the Califomia Health and Safely Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have alt of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state taws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Siggature Of Legal Owner(s) Date � 3 —/7-0 S' Arm r Author Ized nt ggggs INSPECTION TYPE DATE 1ITRIAL5 COPEI INSPECTION TYPE PAIL INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy _ CITY OF•COSTA MESA 49 BUILDING DIVISION :i _..4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 J11, 10 oonnso PERMIT B01-00990 ed (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBaUILDING PERMIT n FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 140 E 19TH ST BUStatus: ISSUED Suite: Applied: 06/27/2001 Vicinity: BLOCKWALL&TRASH ENCLOSURE Issued: 06/27/2001 Parcel Number: 42626318 Zoning: Applicant: CEFALIA, JOEY ISSUED BY: Address: '818 W BALBOA BL Phone: (949)675-7130 NEWPORT BEACH,CA Zip: 92661 Owner: CEFALIA, JOE & STELLA Address 818 W BALBOA BL Phone: (949)675-7130 NEWPORT BEACH,CA Zip: 92661 Contractor OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT DECORATIVE BLOCK WALLS FOR TRASH ENCLOSURE AND PROPERTY LINE WALL 5'HIGH FOR A LENGTH OF 43 FEET AND 3'HIGH FOR A LENGTH OF 16'. WALL MATERIAL AND COLOR SUBJECT TO PLANNING APPROVAL. FEE SUMMARY Plan Check: $29.15 Calc Valuation: $1,180.00 Permit: $44.85 _ Claim Valuation: $o.00 SMIP Res: $0.00 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 Total: $74.00 PLANNING&ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 10-0 Rear 0-0 Left. 0-0 - Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all <7 required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. / FOR INSPECTIONS CALL: (714)754-5626 2446-46(8/00) `QECJ2ARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed it the permit Is valued et one hundred dollars($100)or less.) q❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(3103,P03),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc.a Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097.Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500).): ❑—I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. —7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of theyroperry,arty EXCLQSIV81: •CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Lice ns4 La d.,: • apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to'the Congest. -U•.: • Laws.). y ❑ I am exempt undr sec./ � % Business and Professions Code for this reason: (Signature: rw ' � Exp s/Q L( Verification ot Ownership by(type of document,i.e.-property tax bill or deed):—' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that n0 excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will bo more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration farm for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ___ _._.._ ....__ 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this epplication akermit for such construction or modification from the South Coast Air Quality Management District Or from any other air pollution control district or agency? LJ Yes 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have ail of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (II yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE Or OM'UANCE ANL{Ay ORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agr�to co sly wit• sl act'.,s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descd -•••pr. .M ft m • final inspection. I nature Of Ownner(3). . •— (%9!/ / /(Date-- - 7-1 And/Or Authorized Applicant Date COPE r INSPECTION TYPE PAH EMIIT1d6S coDEt IHSPEC110NTYPE PAh PTIIBSLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root �_ �—/F— 210 Final Electrical 201 Final Block/Retaining Wall -.//4/P Lc / 212 Final Fire Prevention 202 Final Factory Fire Place _T - / ll 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy g CITY OF COSTA MESA 4,4W-- BUILDING DIVISION >:i r,r " . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ;• rk2 • PERMIT E01-01066 fi (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No Applied: 12/20/2001 Vicinity: Issued: 12/20/2001 Parcel Nunmber: 42626318 Applicant: CEFALIA, JOE & STELLA ISSUED BY: (A•-I... Address: 1649 BAYSIDE DR ,- '.-,i-'-'�' --- /"-/ -- `Phone: 949-675-7130 -_� �.� 4� . CORONA DELMAR,-CA A Zip:' 92625 1 / /r"�� Owner,/, CEFALIA;JOE & STELLA " -- - - 1-1-7-,..---7, ,,,A' 'N/ ,-,\, \ 'y Address /1649 BAYSIDE DR --- / 77 / Phone: ,�. / •/ CORONA DEL MAR,CA Zip: 92625 . A 7 / ,„ 'v , Contractor. OWNER-BUILDER i"!a �0 • Al Address: ,"� - - �.ifrR '/Phone; - �\ _ - _ , Zip: ,*� License: 0 - �!i� �•�� . ,'N / , . // -_ _.. SCOPE OF PERMIT A �, r , REF B01-01979:ELEC. FOR TWO PARKING LIGHT.'POLES. // \\* ,, FEE SUMMARY 2, - TQuantity -_ _ 2 _ /7/ _ Quantity ,/ ' 'ISSUE FEE , $23.50 - - / Temp Dist System/Lighting - $0.00 0 Temp service test $0.00 Busway/100 ft, $0.00 0 Res.a/c package $0.00 , Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Rea(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 , . - up to 10 kva/kw $0.00 o ,0 - Lighting Fixts . $0.00 0 '' • - up to 50 kva/kw $0.00, - 0 Recept Outlets $0.00 0 -• up to-100 kva/kw $0.00;,' ' 0 Switches, 450.00 0 over,100kva/kw/ ,$0.00>/ 0 Non Res Appl, , $0.00: - _ 0. - Low Voltage Equipment ' - $0.00 0' l Res Appl `. ,,4 //.$0.00N 0 , ' -Low Volt Wiring System/Ckt , 440:00,' " 0 Service to 200a ,/,,,, $0.00 -;0 _Mist,Conduit $0 00 0 �, ' i Service to 1000a'.' ' $0.00 /0`,, - - - , Misc.Conductor -7."'"/"7. $0.00:lc / Service over 1000a - ,$0.00 7-0....7, _ Circus(gen or ride)-- - $0.00 0 -„7 Motors to 1hp \,, -7 , ' $0.00," ' A " - Circus(meth ride or lights)','.. '$0.00. /0 / Motors to 10hp _$0.00 0 Christmas Tree Stand, ` ',/50.00 -Y' V Motors to 50hp ' -$0.00"- ''i -,0 . ' , -Fireworks Stand ' x$0.00,'//0 Motors to 100hp x$0.00 , • 0 , Other Electrical Fee , ."$0.00-" Motors over 100hp $0.00 0 ' - • " Communication drops $0.00 . �� 0' ' / . ''• Investigation Fee - - ''K-� $0.00 Sub panel to 200a $0.00 --0_ - - . Plan Check:Fee ---"" - $0.00 • Pole Light Pkg $67.00 2 - - ' '" ' Reinspection Fee- $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $90.50 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(5/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars(.5100)or less.)- El I certify that in the performance of the work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Uc.N Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:My city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within ohayear.of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of theproperty,:am.EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions ,.p \Code:The contractors License-Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors'License Laws.). --148 ❑ I�:,:exe ,n under sec. / Business and Professions Code for this reason: Sir yLS)=' �. - _ _ '- - . _ r _ _ I Dat: /2 — 2 — • :r ID.�ied by driver' tense. ;•'es 0 No P - ►�:1•0. _ - xpl :.: Verification of Ownership by(type of docume t,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-bullder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greeter than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed_gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas et standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 11 an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South ('dost Air Duality Management DIstria or other air pollution control district or agency is required for the work whist-17i'the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No __ —.—._......_...r__.._ __.__.._..._....._. .._._ —_. B (II'yes",attachcartilicate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc'1'd property for insy p'.n pu •• =5 I agre: "n to occupy or allow occupancy of any building authorized by this permit until final inspection. ‘Oradir - /2E— - / " ignatur: :: • : s) And/Or Authorized Applicant Date ;ODE A INSPECMIN TYPE PATE al CODF! INSPECTION TYPE PATE ISLE 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. - 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy -" r CITY OF COSTA MESA a BUILDING DIVISION - > :r g.stapriT; , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4, PERMIT E02-00181 .orw (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No A • Applied: 03/07/2002 Vicinity: Issued: 03/07/2002 Parcel Nunmber: 42626318 Q�� Applicant: ARTINGER, PAUL _- - - - - ISSUED •BY: �� /_fir Address: 7541 SANTA RITA CIRCLE'#D i/ _ -- - - j�.- - -Phone: (7,14)894-2011 - - - - /. /i -4 A‘ --i / ' A STANTON.CA71,- , �' Zip: 90680 • (, / r --„,„ �� / /� ` ' - J / 'N Owner:�EALIA JOE cw.'( Address/' 040 BAYSIDE DR, , 2� g Y \ ;" \ i\"/ Phone: \� t74 . � ; , CORONA DEL MAR,CA Zip: 92625-1832 v� A iii' / - 4- C• ontractor: ;/CONTINENTAL SIGNS INC - � Address ,7541vSANTA-RITA.CIRCLE#D - • l \ �i „-Phone: (714)894-2011 ,---N., STANTON CA /--" - Zip: 90680 - ��- - License: 664525 ' ' _ . SCOPE OF PERMIT , i/ .ELECTRICAL TO INCLUDE:,1'CIRCUS(GEN OR RIDE)FOR"CLEANERScSIGN' _ SUMMARY' i Quantity_ _-,L;FEE 1:`•/11:`• ` /ti Quantity ' , __' ISSUE FEE : $23.50 ••-•• - - -_ ---- Temp Dist System/Lighting-- $0.00 0 / , - , Temp service'test`;4 $0.00 • Busway/100 ft,2 $0.00 0 (5 Res.a/c package' '�', $0.00 J Standing Section $0.00 0 I' \ New Res(1-2 units). ' $0.00 0 Misc Electrical'Equipment New Res(34-units); :, $0.00 0 Transformers up t61 kva/kw $0.00 >0- • , Pool/Spav ' - / A, . $0.00 0 •. -v up to 10 kva/kw $0.00 2,0(/ ' ' Lighting Fixts - $0.00 0 - up to 50 kva/kw '$0.00 -' ` 0 Recept Outlets v$0.00 . 0 -up to-100 kva/kw $0.00/,' 0 Switches',\/ c \$0 00 0 - _ - oyer�100 kva/kw, $0 00�� 0\ _ / Non Res Apply-. `` $0.00 - " �_'0'- - ' :Low Voltage Equipment' .- -$0.00 0 v" / / Res Appl -3 �27$0.00\--,,,;.\\,,,,, 0, 6 ' „21, =Low Volt Wiring System/Ckt...-2.:$0.00/2 0 ' '/ Service to 200av�, /,' $0.00 - �0 ' ' Misc:Conduit - $0,00 4/�0 /�1 Service to 1000a-N ./ $0.00-, \--.---.6:\\-„, - Misc.Conductor - .d $000 /0 , A • Service over 1000a 7 , ..$0.00 ' .I-0 =- = _ _ Circus(gen or ride) '- ' /$23.50- 1 -. ./ Motors to lhp � �, $0.00�',^� ,0 Circus(mech ride or lights)' \ ,$0.00 -// 0 Motors to 10hp $0.00 , ' 0 Christmas Tree Stand. - --$0.00 .-11' 0-' Motors to 50hp - $0.00 2i •-0", . , _ Fireworks Stand- $0.00 - '/0 Motors to 100hp $0.00 . 0 , - - - _ Other Electrical Fee / $0.00: Motors over 100hp $0:00- _0 _ Communication drops $0.00 ,_ --0i ' ' -S- ` 'Investigation Fee -"i, -:-----$0.00�- $0.00 Sub panel to 200a $0.00 -----0 - _ Plan Check Fee _ $0.00 Pole Light Pkg $0.00 0 ` _ ' Reins_pection Fee i $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $47.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 24413-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insure carrier and policy number are: c rrien S -7— Polic`y.NJ`mtier: /(- 16 6 4.2.8' rs section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. p d • viq rgppucan(Slgriature':. '/ Rti"�—C. • ate: ' / 0 ARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under gtovisions of Chapter 9(commencing with Section 7000)of Division 3 of the-Business and Promo assions Code,and my license is in full force andaffect uc.pr t li -2 '� S Tractor's Signature: a / !1 rDetf1 3 —7 - a CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that-under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county.which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that'he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions,Code).or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty.ef' re than five hundred dollars($500).): ❑ I,as owner of the property,or my,emnotmoplo e s with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Codeglie Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completionfltherowner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IU Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with ell state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signet re Of Legal Owner(s) Date QicuO e�,�h 7 ' O And/OhAulh etl A !cant. �D�te. elvL---__ - . ;ODE I, INSPECTION TYPE INTmAU ;ODE I INSPECTION TYPE PAIS Its 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site • 204 Final Demolition . . 250 Final Building/Occupancy CITY OF COSTA MESA aBUILDING DIVISION Y:� a;,r., .' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0. % I PERMIT Po `1�se b,,, P02-00137 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No A Applied: 03/11/2002 Issued: 03/11/2002 Vicinity: /�y'/ Parcel Nunmber: 42626318 _ ISSUED BY:,, 1.J/`-� - , , Applicant: TERRY, MICHAEL'; Address: 104 VIA LIDO SOUD / - Phone: 949-675-4535 ' NEWPORT BEACH,CA : - Zip: 92663 - / i �� A_ Owner CEFALIA;JOE -1* J , I, Address 1649 BAYSIDE DR' .�)� ,1" (� j �, Phone: ���: ::� 111 "' ' • CORONA DEL MAR,CA Zip: ;92625-1832 Contractor 'LINNAUS, ROBERT . ,j, ' - Address: 15560 ROCKFIELD BL \,-, - - ' - _. , - / -SUITE C216 - - Phone: 949460-0997 - -_, 7- l IRVINE,CAS Zip: 92618 7 �! � License: C18713 / Arch / Eng : LINNAUS, ROBERT _ ' Address: 15560 ROCKFIELD BL SUITE C216 Phone: 949-460-0997 ` IRVINE,CA '' Zip:, 92618 - • License:-C16713 - • SCOPE OF PERMIT • ' PLUMBING TO INCLUDE: FLOOR SINK ONLY , REF.601-01593 - FEE SUMMARY AMT- • Q1Y- .. AMT OTYr.S.-. AMT QTY ISSUE FEE ' $23.50 - Laundry Tub/Washer $0.00 0 Sump Pump -$0.00 0 Backflow irrigation' ' $0.00 . 'o, Landscape Irrigation $0.00 0 .Swimming Pool $0.00 0 Backflow Preveritei $0.00.' 0 _.�P-Trap $0.00 ' 0 "Trap Prinier, ' $0.00 0 Bathtub $0.00 0. Pressure Regulator $0.00 0 - - Urinal - $0.00 0 Clarifier System \$0.00, 0 Process Piping(per 10 ft) $0.00 0 VacuumBrkrBkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 ' 0: Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units '$0.00 , 0- , - Septic Tank $0.00 0 - Wash Basin? $0.00 0 Dishwasher $0.00 ' 0 Sewer Cap for Demo $0.00 0' Wash Basin Set $0.00 0 Drain, Floor $0.00-. 0 Sewer Connect - $0.00 0 " , "Waste-and Vent System $0.00 0 Drain, Rainwater $0.00 0 _ ".Sewer Private Line.' . . $0.00' 0 --, c - Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 - - Shower - . $0.00 . 0 ' Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 - Sink,bar" -- -- , ' '$0.00` 0 ' Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial --' - $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $9.80 1 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $33.30 COMMENTS I SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244&46(eoe) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm undei penalty of perjury one of the following declarations: • ❑ 'I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for wNch this permit is Issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these•rovi (. Ppplrcant STgnafuie_ -, te: 3!! 02., WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI/ PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THAI ISAND DOLLARE($100.000).N ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Uc.M Class k Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to acivi/l'pemaity of not more than five hundred dollars($500).): u / ❑ I,as owner of the property',�or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code::The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her owrYemployees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is e.."old within one year.of completion;the Owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). El am exem r sec. im'" Business and Professions Corte for this reason: L O eth b i ue I YJAta:,3�(!!O Z v�neislD veiltie 1 by drive s license. Yes 0 No rivers flee rise No»�'�' xpf'riLa;L.II 30 OZ, Verification of Ownership by(type of doe en,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this pemtit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and SafetyCale). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes*,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. c_c_i_rek Signature Of Legal Owner(s) Date Vl!/d2 __ -Aix/Or Authorized Applicant - WOE t 11120114.811E1 ERIE IZCIALS pot INSPECTION TYPE PATE ISLE 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 . Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION >•4- •,,,,, ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4j t '-"7" . PERMIT w�, S802-00028 etbiftwario . a (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ' SIGN PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: A Applied: 03/07/2002 Vicinity: Issued: 03/07/2002 Parcel Nunmber: 42626318 Zoning: q p-y/� ISSUED BY: �9eOr _ fes. - Applicant: ARTINGER, PAUL j,cs'7 /. - _� __s-. ,_ Address: 7541 SANTA RITA.9 7 i/' 7 '� SUITE% �,1, �� �� Phone: 714-894-2011 � - _ STANTON,CA N - " , ' Zip: 90680 / ,-- �,�,, Owner. /CEFALIA;JOE i; [\ cc � Address /j'1649 BAYSIDE DR / „5-,- = . - v -`: <A/ �� \ \ �� Phone: 7/ - N CORONA DELLMAR;CA� Zip: 92625-1832 � • /=ti A, Contractor: CONTINENTAL SIGNS INC ,. v ' 1j '. Address: ' 7541 SANTA RITA CIRCLE#D r t'SS\; �, r Phone: (714)894-2071 STANTON,CA Zip.:-90680 -�` - License: 664525 Arch/Eng: '� � , - i-, • � . . \ Address. - ”' - Phone: " /7;�\ Zip: _ , License: / / / "i''''( / /i ) ,SCOPE OFP_ERMIT• " 'y--' \<. INSTALL A 30 SQ.FT.-/WALL SIGN FORA CLEANERS:— " '" � . . `�. }\.... ; FEE SUMMARY . ; Plan Check: $45.01 — _ '-�I Calc Valuation ; '32000.00_ $0.00 -. _ Permit: ' $69.25 ,�4/ Claimed Valuation. , - 32,000.00 / . ,SMIP Com: ‘ $0.50 % _ Other , $0.00 % Inspection: - $0.00 AA V" °j x$0.00 ° t; .; $0 //1 .: 1 /, Tota .. C$100476, 72/2/7// A / v'-\ \>' , - - PLANNING &ZONING A , ;/ / NOTES: , ` 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. i INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLAR WORKERS'COMSN N DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - • - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. �n1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. �My workers'co ensatlon Insurance carrier and po1licy Th number are: nv.(42(002.25- .(rr c/ I olicy ` Number:pt O(®©ZO �IAIs'section need not be completed if the penmif is valued et one hundred dollars($100)or less.) ❑ 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith AAyypp'�'pp��1{comply with these proyjsions. s ighitiireP' . t 3• 7 Nl/4iNING:SFAILURE TO SECURE WORKERS'WMPENSATION COVERAGE IS UNLA LAND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVILOFINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professioee-Bode,and my license Is In full Detractors SIgnatuiei. F�-chi , �'� -�� ate:ru- I 0 Z CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county whichirequires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business end Professions Codef:or,ihat he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil.penalty of not more then five hundred dollars($500).): �-i aiiz ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The,Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or hero`wri emp)oyees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). va ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which ere required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? al Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health end Safety Code Section 42303 been made? 0 Yes 0 No 8. (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. C SS' natureOwner(s) 3 7 tndr0rAuthoriz plicantDate—Li .r, CODE I INSPECTION TYPE PATE a INTITIAL$ PODE4 INSPECTION TYPE Q6I INFIX 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition . 250 Final Building/Occupancy • CITY OF COSTA MESA 49 BUILDING DIVISION >N,,,,,air ...4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 rill • PERMIT E02-00241 st (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No C Applied: 03/26/2002 Vicinity: Issued: 03/26/2002 Parcel Nunmber: 42626318 Applicant: TOM PHAM ISSUED BY: Address: - . - Phone: 714-901-4599 - Zip: \ - N j Owner% CEFALIA,`JOE - , . Ir1• Address 1649 BAYSIDE DR - Ill Phone: YY 0 CORONA DEL MAR,CA Zip: 92625-1832 3 ,� o0. Contractor ,/STAR SIGNS • - - Address: 14392 HOOVER STREET - ` - `--Phone: 714-799-3130; WESTMINSTER,"CA ' Zip: 92683 - i .��- - License: 734413 - - ` SCOPE OF PERMIT . . ,.. v, ' ELECTRICAL FOR ILLUMINATED WALL SIGN,RE:S802-00037. - ,- - N; FEE SUMMARY ` f., - N ,Quantity - - Quantity ' r ISSUE FEE $23.50 ••I - ` "Temp Dist System/-Lighting - $0.00 0 c - Temp service test $0.00 Busway/100 ft ' $0.00 0 ' - Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 ' New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 , 0- - ' Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets , $0.00 0 , • up to 100 kva/kw $0.00 . 0 , Switches $0.00 _ 0 , ' over 100 kva/kw.-, $0.00 0 - Non Res Appl $0.001 I-- 0 Low Voltage Equipment -$0.00 0 Res Appl / -,-$0.00 _ O 0 Low Volt Wiring System/Ckt $0.00, v 0 Service to 200a ' $0.00 ` 0 Misc.Conduit Service to 1000a $0.00 • - - 0 ., - Misc.Conductor $0.00 ' 0 Service over 1000a ;, • ,-$0.00 -0- - Circus(gen or ride) - ' $0.00: 0 Motors to 1hp - $0.00: ,0 Circus(mech ride or lights),A,..v" "$0.00 " . 0 1/ Motors to 10hp $0.00. 0 Christmas Tree Stand $0.00 0 ' Motors to 50hp $0.00 0 - Fireworks Stand • '$0.90'- /0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00. ' Motors over 100hp $0.00 ' 0 ' Communication drops $0.00 0- • " Investigation Fee " - - $0.00 Sub panel to 200a 50.00 -- 0 - - Plan Check Fee- • $0.00 Pole Light Pkg $0.00 0 "ReinspectionFee $0.00 Sign Circuits $24.60 1 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $48.10 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS 1 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, 12-21-92) 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 180 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 Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(eros) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars(S f00)or less.) ge I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'co nation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: i . a _ Date: '2../ 74, // O L �`/ WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HURDRED THOUSAND DOILARE(SI C0,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section )of Division 3 of the Business and Professions Code,and my license is In fuil— force and effect.Lic.B f 27 144y 1 / Class Contractor's Signature: S'1,o2 Si CT)i � Date: 3 l te. (cut . CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county,whlchTrequires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement.thet he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Cale)of thathe or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil pehalty of riot more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employee's with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:,ThQ Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or herownemployees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion:tire owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will he applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 0 Yes No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this,a�ppplication aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 —Will any pan of the facility to be constructed under this permit be within 18N feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (11 yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penally of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: _ CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:1 certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SI•nature Of Legal Owner(s) /74 /0;ate SI An Or Authorized Applicant Date CODEC INSPECTION TYPE 2AIE _ IL�.IL45 CODE! INSPECTION TYPE• RALE IN1IItALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy p5f6 " CITY OF COSTA MESA 4 ►'D BUILDING DIVISION '- �rr. ..�. ( .fi DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT 5802-00037 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • SIGN PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: C Applied: 03/26/2002 Vicinity: Issued: 03/26/2002 Parcel Nunmber: 42626318 Zoning: ISSUED BY: Srr Applicant: TOM PHAM Address: Phone: 714-9014599. ,/ Zip: ' -SN, Owner: CEFALIA, JOE Address. ,1649 BAYSIDE DR/.- Phone: - CORONA DEL MAR;CA Zip: 92625-1832 Contractor: STAR SIGNS t>r �e a Address: 14392 HOOVER STREET _� ' Phone: 714-799-3130 /St. ^ WESTMINSTER,CA -• Zip: :92683 r $ - d- - \ License: 734413. 9A � ' Arch/Eng: 'Address: • _ - /_ Phone: Zip: License: / / SCOPE OF PERMIT - ERECT A 28 SF ILLUMINATED WALL SIGN FOR"NAILS&SPA". • • . \ FEE SUMMARY Plan Check: $35.10 Calc Valuation: $1,450.00 $0.00 _ Permit: $54.00 Claimed Valuation: $1,450.00 SMIP Com: $0.50 • Other: $0.00 $0.00 • Inspection: $0.00 , x$0.00 /x$0.00' •Total:. $89.60_. PLANNING &ZONING ' NOTES: , 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(&%) • a WORKERS'COMPENSATION DECLARATION: . I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and wit maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars(5100)or less.) El I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signatures,y ?��� / Date: 3r' Z1- /0'2 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDR6� THOUSAND COUARE($100,00D),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)-of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lk.a '7 7 k N)S ! Class x / Contractor's Signature: c'fivt_ C1 c V 7 Date: U''2 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter(4(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her,own employees,provided that such improvements are not intended or offered for sale.if,however,the building or improvement is sold within one year of completion,the Owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). 0 I,as owner of the property,am se EXCLUS not:appf ,toi ACTING WITH LICENSED CONTRACTORS to and the project(Sec.7044,Business and Professions Code:The to License Law does not epplI)�to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Lawk./. ❑ I am exempt under sec. `' Business and Professions Code for this reason: Signature: F. � Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to lila and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes U No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility.must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Igate 3 /14, eZ Anr Authorized Applicant Date CODE 6 INSPECTION TYPEgaff. Rf htAl& cow INSPECTION TYPE gall II1�L$ 1616 Fixed System Final Fire Prevention 208 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign • 222 Final Site 204 Final Demolition _ .250 Final Building/Occupancy • lit CITY OF COSTA MESA BUILDING DIVISION IDEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT E02-00742 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No D Applied: 08/06/2002 Vicinity: Issued: 08/06/2002 Parcel Nunmber: 42626318 Applicant: HO,THUY - - ISSUED BY: Zi[7. ____ Address: 15151 MORAN ST , i'�` - - _ Phone: 714-890.0932 ,.�. WESTMINSTER CA-'" - Zip: 92633 . j - Owner/ CEFALIA,`JOE c - - . vim Address 1649 BAYSIDE DR - - - , / - 19 I. . Phone:CORONA-DEL MAR CA Zip: 92625-1832 a 0 ' r Contractor: T-SIGNS - Address: 15151 MORAN ST- - -- '• -„Phone:e: 714-890-0932 WESTMINSTER.CA.' - - Zip: 92633 - ' - - - License: 735992 _ - . - SCOPE OF PERMIT // ELECTRICAL TO INCLUDE:2 SWITCHES:-1 SIGN CIRCUIT,AND 2 TRANSFORMERS UP TO 10, - ' KVA/KW."BALI FURNITURE AND HANDICRAFTS"REF.:SB02-00100 - '.i.'/ , \� FEE SUMMARY Quantity - _ ii" , - � , _ Quantity ISSUE FEE , $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft- , $0.00 0 Res.a/c package $0.00 Standing Section • '$0.00 0' New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0i.,Transformers up to 1 kva/kw $0.00 0 ' Pool/Spa $0.00 0 - - ' ' - up to 10 kva/kw $24.60 - 2 ' , Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 , 0 , Recept Outlets ,$0.00 0 _ up to 100 kva/kw: $0.00'' 0. - Switches ' ' -$2.20- i , 2- over 100k4a/kw '- '$0.00/ 0' ' Non Res Appl $0.00 0 Low Voltage Equipment ',$0.00 : - 0 Res Appl - $0.00 =- ,,0 - Low Volt Wiring System/Ckt ,,$0.00 „0 / Service to 200a ` $0.00 ''N "- 0" , Misc.Conduit Service to 100044 $0.00 �0 - Misc.Conductor - - :$0.00- '" 0- - / Service over 1000a $0.00 - , 0 - Circus(gen or ride)' -"10.00. ,-0 / Motors to 1hp N ' $0.00 ' 0 Circus(mech ride or lights) ` ' $0.00 - - 0 Motors to 10hp $0.00 0- ,. Christmas Tree Stand -$0.00 - /0 Motors to 50hp ' $0.00 0 N Fireworks Stand . $0.00 0 Motors to 100hp $0.00- - 0 -Other Electrical Fee : $0.00 Motors over 100hp $0.00 ' , - -0-- Communication drops $0.00 - O ""c-, -- _ - Investigation Fee.-_l", $0.00 Sub panel to 200a $0.00 0 - ' - - ,Plan Check Fee - $0.00 Pole Light Pkg $0.00 0 .. Reinspection Fee $0.00 Sign Circuits $24.60 1 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $74.90 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be Obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O -I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. 72‘.- I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insuran carrier and policy number are: Camera S7 TF CT/NDcPollcy.Nun'ber: ,IS3ti11�3 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers compensation laws of California,an agree that 11 ould become subject to the workers'compensation provisions of Section 3700 of the r Code,I shall forthwith comply with these provisi Applicant:Slgnemre: fin Daa.---- D U WARNING:FAILURE TO SECURE ORK ENSA COVERAGE IS UNLAWFUL MD SHALL SUBJECT M EMPLOYER TO CRIMINAL PENACDI2g AH CML FINES UP TO ONE HUNDRED THOUSAND DOLLMtE(5100,000),IN ADD I I 0 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under• ovi i••s•f hapter 9(commencing with Section 7000)of Division 3 of the Businessad Professions Code,and Professions Code,and mylicense Is in full 'torea.anteffef LI - 'Clasp Co ct ignatutsc [ 11.. CDate:'? o CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a constniction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the appticanfto arct it penalty of not more than five hundred dollars($500).): h ❑ I,as owner of the property,:oryiy employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044;-Business and ProlesslonsCode:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through hiCor her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,.the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions • Code:The contractors LlcensiaLaw,does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Ttle 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Ves0—N o (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............._..____ __ _ _____._._... . 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or willo the applicant present or future building-o-deo-P-at other for the work which isi the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes P No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of Ina facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _._ which is the 7 a permit from the South Coast s Quality cn ed Management DistrictHor other epollution cion 4l district3 agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by CaliforniaCeltoHealth and Safety Code Section 42303 been made? 0 Yes 0 No �..___..._..... 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application end state that the Information given Is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature O1 Leal ner(s) Dyke OP cAo&Oi-Au iodzad.APPlkent�' &Da e COOS 6 INSPECTION TYPE DATE INITIALS CODE INSPECTION TYPE PATE IIKONI& 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .. 200 Final Re-Roof 210 Final Electrical 201 Final BIocWRetalnIng Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy "004, CITY OF COSTA MESA 4BUILDINGPERMIT DIVISION e ,„,, 411 i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER S802-00100 411140oRmso 6% (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 SIGN PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: Applied: 08/06/2002 Vicinity: Issued: 08/06/2002 Parcel Nunmber: 42626318 Zoning: ISSUED BY: Lam/ C �} � Applicant: HO, THUY . 7 Address: 15151 MORAN ST-,/'' � - Phone: 714-890-0932 / - ' WESTMINSTER,CA - Zip: 92633 , Owner:j CEFALIA;,JOE - Address, 1649 BAYSIDE DR _ - ! / Phone: CORONA DEL MAR,CA Zip: 92625-1832 3 Contractor T SIGNS / ”, Address: , 15151,MORAN ST Phone: 714-890-0932 40° , , _ WESTMINSTER.CA -.. Zip,` 92633".•:,c License: *735992 Arch/Ehg: — . Address: - . / - Phone: - _ ' Zip: i License: - , 7 , / / !' ' 7 7' ` SCOPE OF PERMIT - ;\-' , 2'4'HIGH X 9'WIDE ILLUMINATEDCHANNEL-LETTERS ONrFRONT STORE ELEVATION • - , v FEE SUMMARY ,/',y,, . , Plan Check: $54.11 - - / Calc Valuation: ,/ $2,200.00 $0.00 , - Permit: $83.25 • " ` Claimed Valuation: $2,200.00 ' SMIP Corn: $0.50 ' Other: $0.00 ' '$0.00 I , - Inspection: .$0.00 '$0.00 j • . $0.00: - Total: 4137.86 -7* . � - - PLANNING &ZONING NOTES: , - • I 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections andfinalapproval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: -- ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'corn r1(ation In nce wrier and policy number are: ,)c 3E-kg ' 7 1 Carrier: �r� -UN Iv Po`cy.Number. -(This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ . I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and gree that if 155hould become subject to the workers'compensation provisions of Section 3700 he Labor Code,I shall forthwith comply with these provision . 1 , 6 O ApplicanhSignature: lIV Dale1 9 WARNING:FAILURE TO SECURE W ENS COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINu�x{�.r�,p(—� TIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDI O THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: iil.hereby affirm.that I am licensed u••er• • o• of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prole '•ns Code,and my license Is in full rr once andLic.p _ Class* > _ Conf s'SIgnature: I MIPINts Date: I_ • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county-which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement,that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and ProfesslaniCode)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a',clvil penalty of not more than five hundred dollars($500).): v: r- ❑ I,as owner of the property, or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or he%own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion;Die owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). CII,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractois'License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,l.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). e Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SignatureLeg;l r(s) Da Analtiurized'Applicant CODE t INSPECTION TYPE PATE INIffl6U CODE I INSPECTION TYPE PAIS MCA 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing .. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention _ 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Slte 204 Final Demolition 250 Final Building/Occupancy • f CITY OF COSTA MESA , 4 9 BUILDING DIVISION >:t r,,— rA " DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER lo I rral i, . PERMIT ra , carso gyp; B01-00493 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: Applied: 04/12/2001 • Vicinity: Issued: 04/12/2001 Parcel Number: 42626318 Zoning: Applicant: CEFALIA, JOE & STELLA ISSUED BY: G -t Address: 10055 SLATER AVE ' " Phone: 949-675-7130 FOUNTAIN VALLEY, CA Zip: 92708-0040 Owner: CEFALIA, JOE & STELLA Address /10055 SLATER AVE . - - / Phone: 949-675-7130 • �� / FOUNTAIN VALLEY,CA Zip: 92708-0040 Contractor: 'Addressit, Phoney � ' • . License: ' . - .Arch - - Eng: Address: Address: '1\ ' , \ , Phone: Phone: ', ' Zip: - License: License: - / / /, , , ._r - -, SCOPE OF PERMIT - DEMOLISH,EXIST FRONT HOUSE/AND ATACHED GARAGE. - - - • - - .- _ ; I� T. '.1 1 --_ i -- /i � �'‘_ikV FEE SUMMARY r = j i Flan Check $0.00 Calc Valuation: J5'; c $3000:30 iPermit: `,'• $83.25Claim Valuation: /it I $3,000'00 SMIP Res , .,'x$0.00 iv/1 if. ----."` Pt' SMIP Corn: v$0.00 // 14 c / /1•11 \ Other $0.00 i . -// Inspection: . $0.00 , i ii / ' -A./(// Total- $83:25 , // //,''� vi��A U/, ' /-. ,-. ' 2-� 75`,/7) AJ/ \�� N / 7-.22> --'- '" PLANNING &ZONING \\„ v/� ' SETBACKS \\--v -y- �., MAIN STRUCTURE Front 0 - / Rear' -0-0 Left 0-0. . Right '0;0�/�/ ACCESSORY Front 0-0 Rear.- 0-0 Left 0-0 / Right2 ":0-0" PARKING Existing: 0 Required: -0 Proposed: 0 , NOTES: 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: r+ I hereby affirm under penalty of perjury one of the following declarations: • - " ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as'provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued et one hundred dollars.($100)or less.) ❑ 1 certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions J • Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exceMpt u der c. Business and Professions Code for this reason: -Signature: , Expires: /7^/1/-0 S Verification of Ownership by(type of document,i.e.-property tax bill or deed):-'"� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire • Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described roperty for inspecti n purpo s.I roe to occupy or allow occupancy of any building authorized by this permit until final inspection. -_/_z-D / ature Of Leg wner(s) ��Date And/Or Authorized Applicant Date CODE# INSPECTIONTYPE , PATE' INTBIALS CODE# INSPECTION TYPE DATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall • _ 212 Final Fire Prevention 202 - Final Factory Fire Place _ 220 Final Planning Approval • 203 Final Sign 'J�'�/��1/� 222 Final Site 204 Final Demolition 3/9//).$ 1�!' v 250 Final Building/Occupancy r i . CITY OF COSTA MESA 4 e '° BUILDING DIVISION >•q-�,,,,�.,l DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t is . PERMIT B01-00494 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: Applied: 04/12/2001 ' Vicinity: 1-3 Issued: 04/12/2001 Parcel Number: 42626318 Zoning: �j� Applicant: CEFALIA, JOE & STELLA ISSUED BY: Y � Address: 10055 SLATER AVE _ Phone: 949-675-7130 FOUNTAIN VALLEY, CA Zip: 92708-0040 - Owner: CEFALIA, JOE & STELLA Address /1.0055 SLATER AVE - / ' Phone: 949-675-7130 ,FOUNTAIN VALLEY,CA . Zip: 92708-0040 N " �. Contractor: , 'Address:' _ A Phone: - ��, Zip:' . " . 'License: _ . • " \V '' 7 • - \‘ ` \ Arch ': -- - - Eng: ','N' ' Address: , Address: . ,'1 ' Phone: Phone: . ' \ �. Zip: License: License: • -SCOPE OF PERMIT DEMOLISH EXIST BACK 3 UNITS: - - - - - - i' , . FEE SUMMARY Plan Check: $0.00 _ __ Calc Valuation: • • $5,000'00 . ' 'Permit:' $111.25 - Claim Valuation: se,000.0o' ' ".. SMIP Re§: $0.00 SMIP Coma ' $0.00 %i i "i Other: t $0.00 • 2/ I c ---,-/ /,1 Inspection.` / v-$0:00 ` ' J Total: $111.257 ; /i'� VAAN ,)/ vV v/ V -2 ' PLANNING &ZONING � %/ ' / jU • S' v ✓C2 ------N-- 2 ; ,SETBACKS ✓ ; MAIN STRUCTURE Font •0- 0 Rear 0-0 - _ Left 0-0 -- Right" 0`02 /7/ ACCESSORY \,:'` ,- ront' _ 0-A ' . Rear- 0-0Left 0-,0 ,• , Right`,'--0-0';�' ' PARKING Existing: 0\ ' Required: 0_ Proposed: 0, NOTES: 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - • • I hereby affirm under penally of perjury one of the following declarations: - ❑ I have end will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1X,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 371:60F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Llc.a Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is ?5,V-:"--Ns N�s sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ?QUI as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions G Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exe t ung r se Business and Professions Code for this reason: �y Signature: /.! „_.Date: 9 /L . Ownerl er ed by rs license. "Yes 0 No Driver's License No. Expires: yidina4_Verification of Ownership by$ pe.of,Hocument,i.e.-property tax bill or DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,An 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder. I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city o.inances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe roperty for ins tion.urpo -s.I a�fte not to occupy or allow occupancy of any building authorized by this permit until final inspection. • y —01 Sign ure()Legal rOwner(s) _ .Date And/Or Authorized Applicant Date CODE 6 1N5PECTIONTYPE pat INTITIAL$ ;ODE# INSPECTIONTYPF PATE JNTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign ]�' 222 Final Site 204 • Final Demolition 4/4/0 I2 ,4.4' 250, Final Building/Occupancy Mac CITY OF COSTA MESA a a a BUILDING DIVISION >:j •,„,, .� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t �^i� PERMIT 801-01979 44"friSORMS°‘54. (714)754-5273 • Fax(714)754-4856. • www.ci.costa-mesa.ca.O�LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 140 E 19TH ST U Status: ISSUED Suite: Applied: 12/20/2001 Vicinity: Issued: 12/20/2001 Parcel Number: 42626318 Zoning: Applicant: CEFALIA, JOE & STELLA _ . - - — _ __ _ ISSUED BY: V Address: 1649 BAYSIDE DR __ ---" --�/'--"� ,c -_ -- ,-�_ /- ' Y--- --,Phone: CORONA DEL'MAR CA ' - . Zip: 92625 / �_\<��� / `��` `\ Owner: CEFALIA'-JOE &STELLA ' - •- '/ ''-.--;'', Address /1649 BAYSIDE DR\ - _ / - �V> -A /. 7//N \ •', \, - _- .:- Phone "� � N.y/ NA� / /CORONA DEL MAR CA` - Zip: 92625 i / ;/ \ / i •ACV '/ v'; Contractor: �O,WNER,BUI DER ' � '�� ,\..* �V�;'•\ .Address:- , N./2/ / 77/ /; / �," %,%,% Phone: ' C \ Zip: ' License:> 0 - Arch.: i - ...;%.i - Eng: _ `, - , ,� Address: - �� -_ - Address , , - Phone: � .,_. _ - _ / / V/>- -\ vZip: / License: - ... � `License: SCOPE OF PERMIT INSTALL TWO LIGHT POLES.TO A MAX HEIGHT OF 27'6"_ _ .,.--7. _% I_ • , ^. FEE SUMMARY -- . .Plan Check: ` $45.01 .r- '-',. -. , , ' -- Calc Valuation: ._ $2,000.00 Permit: $69.25 — � i• -- Claim Valuation / - $2000.00 ' SMIP Res: $0.00 'SMIP Com: - $0.50 • Other:. $0.00 Inspection: $0.00 , v "Total: ,$114 76 * // PLANNING &ZONING / i / SETBACKS-7\ ''' /7 N / -, /47 / %i j ; MAIN STRUCTURE Front '0- Ni --Rear/-0-0 Left - 0-0 Right - . 0-0 i/ i ' ‘ ' v / '% ACCESSORY 'Font N.,,0:0 /," _ //, Rear___0:0 - -Left 0-0 Right :.0-0,,,,i; , / PARKING Exishnq.�.0 Required. 0 Proposed: 0 / ., NOTES: - - . 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(Mg) DE WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Cade,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.4 Class M Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)of that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions ode:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). E I :•• : : pt under sec. �/�� Business and Professions Code for this reason: a. gnatur:' ,2. _.rfalf./,7� ..... 11... sate: 72"-- ____ •wner s erified by di iris limns:.� es ❑No raver License No. ' . . �. :, — or Verification of Own.'ship by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes UPI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Cast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describ t property for inspecC� �- A �'- to occupy or allow occupancy of any building authorized by this pe ' • ' :I ins•ection. � / s!a�• 2 e � 0A � .,r.i w W ner(s) Date And/Or Authorized Applicant Date CODE I INSPECT10NTYPF DATE =Aka CODE! JNSPECTIONTYPE all MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site /i 204 Final Demolition 250 Final Building/Occupancy air ..7_, CITY OF COSTA MESA 4 "41) 41 BUILDING DIVISION > ••4 o.‘,7113 A' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 his t � PERMIT '�' „�. Crbo -OCS (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSWICAELWel,92626 GRADING PERMIT Job Address: 140 E 19TH ST Status: ISSUED • Suite: Applied: 08/04/2000 Vicinity: Issued: 03/26/2001 Parcel Nunmber: 42626318 Zoning: -__ ISSUED BY: Applicant: CEFALIA, JOEB"STELL"P;= --2, ") - Address: 10055 SLATERAVE , - -� -< - . '( - V L, Phone: 949-675-7130 / I - FOUNTAIN,VALLEY CA-\ 1 \ . Zip:..' 92708-0040- J�J �G/( C\ v -� Owner: /CEFALIA, JOE & STELLA - �`S�� �� ��_ Address, 10055 SLATER AVE iT.- ' N ; ' /1 y��N // C // Phone: 949-675-7130 ' `, -.N., C /) V\, /i 7/ FOUNTAIN VALLEY,CA Zip: 92708-0040 \'/ / \;\\ ,%i/ (/ /�� V ��:'� _/,/ '1/ �� /�� 9. ` A /� ;Address: �� _ ;� �� / �i ,•Phone[ i. ^ ��`b, i l Zip /7i 2 � - ,.License: - ��.�� ��( L Eng CATHERINE CON-NEW - • \,, , i rl Address: 7-7/ // 2 �.- ' Phone: V '' ut 0 / _,Zip:lj f! ' — - - - License:-.C34495 - - - -1 \\ � / I 0, v..x n ''7 SCOPE OF PERMIT - •.-1, ' C H ' ,\CUBIC YARDS ,,�l 7I ��GRADING FORA NEW 3600 SF COMMERCIAL BLDG. . :- - , L- ; i I I l 1 t �! % ' J iO I REF:PA-00-07(VARIANCE) �,. -.5�y - � /�' nl� -� 1 up , _ l� � - rte:: MATURE TREES ON FULLERTON SIDE OF PROPERTY TO BE PRESERVED DURING SITE GRADING PER // I�� I LETTER FROM CEFALIA DATED 3/08/01. 7 // " m / . .• _ ., 500 Ai" l _ ��� ��� ,.• �� \� �� FEE SUMMARY /�/ Plan Check:2 \ $33.00 .;!;" Calc Valuation: Coo SA\ n \$0.00 ",;";-" ,,,,..„- \ i ' /i'y Permit: �� $107 00 d• i cn .s. co, � oo Other: /$0.00 ,; DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensat I n carrier and n e: Cartier. : Policy Number, don need not be ampler if the permit Is vs ed et a hundred dollars($700)or less.) I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of alifomla,and agree that If I should•:come bject o the workers'compensation provisions of S Ion 3700 of the Labor Code,I shall forthwith comply with these prov ions. /� Applicant Signature: - •l-e w 4'. z Date: /l J 1 WARMNO:FAILURE T RE WORKERS' TION i ERAGE IS UNIAW AND SWILL SU0JECT AN EMPLOYER TO CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOI(SAND DO.ARE( .000),IN ADD O THE COST• COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Llc.N Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fNe hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exam t under sec. NBusi ss and Professions Code for this reason: Signature - —cc-611 ( /�G► z Date: '--Z1 -0! Owner I• led by drivers ' ense. 0 No Drivers License No. Expires: Verification of Ownership (type of docu t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..._..._...an _�_ _._ _ 4 If en RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If-yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penally of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AL/THORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prop y for inspection pu s.I agr no oc . or ow occupancy of any building authorized by this permit until final inspection. Signatur f Legal Owne 01 Date And/Or Authorized Applicant Date LODE/ INSPECTION TYPE PATE' IRIDAL@ LODE( INSPECTION TYPE QAIF NmALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall • 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval p 203 Final Sign 222 Final Site r 2, 204 Final Demolition 250 Final Building/Occupancy U • 9 CITY OF COSTA MESA • - 4 . BUILDING DIVISION o q, ... F I :� � I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT %Poems*se M02-00118 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No A Applied: 03/15/2002 Issued: 03/18/2002 Vicinity: UNIT A(THE CORNER CLEANERS) Parcel Number: 42626318 - - ISSUED BY: Applicant: ,TERRY MICHAEL-,,2/,2 .' -- • / - - Address: . , " - - Phone:'949-466-0900 i / ," .,ii / -. A / - ' Zip: Owner CEFALIA, JOE ' . _ Address: ' 1649 BAYSIDE.DR - AA / i 7,/ /./% - Phone: - , , CORONA DEL MAR,CA Zip 92625-1832 ' Contractor: OWNER-BUILDER ,. • Address: .Phone: _ , - Zip: - - License: • SCOPE OF PERMIT , - 1674 SF INTERIOR TI FOR A DRY CLEANERS,"THE CORNER CLEANERS"IN STE A. 1 HOOD - • W/MECH EXHAUSTFORBOILER. , REF: B01-01593 _ - _ , ' - _ - , . REVISED 3/19/02 ADD ONE BOILER-9.5 HP AND SUPPLEMENTACISSUANCE FEE. • • A. - FEE SUMMARY - ' Quantity - qi Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat • $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall HV $0.00 0 .. ' Commercial Incinerator .- ' $0.00 0 Refrig Sys<100 k BTU $0.00 0 - _ Domestic Incinerator $0.00 0 , Refrig Sys>100 k BTU\ `N' ' $0.00 0 _ Compressors/Absorption Systems ' Gas Piping,� \ ->/$0.00=•-0 - ` Up to 3 hp/100 k BTU - '-/ $0.00' ,0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 ,- 0 Hood w/Mech Exhaust . /' $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 -0 30 To 50 hp/1,750 k BTU ' $0.00 0 Vent Fan/Single Duct , $0.00 - 0 Over 50 hp/Over 1,750 BTU • ; $0.00 0 Appliance ; $0.00 - 0 - Boilers - - - - Fire Dampers .$0.00 0 Up to 3 hp ' ' , ' $0.00 0 Smoke Dampers $0.00, 7.0 _ ' _ 3 To 15 hp • - . •- $27.15 1 Inst or Relocate Appl Vent - '$0.00 0 N _ - 15 to 30 hp , " $0.00 0 Air Handlers< 10000dm $0,00. 0 30 to 50 hp . $0.00 0 Air Handlers> 10000cfm '$0.00 0 - Over 50 hp " �„ $0.00 0 Floor Furnace $0.00- 0--% - Other MechanicafFee Floor or Suspend Heater $0.00 0 - ; - --- --Investigation-Fee- $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $68.55 COMMENTS/SPECIAL CONDITIONS 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. 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448.46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is i"'aged. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOt1ARE(S103,003),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lk.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec, 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. _ qui._d, _ _._ Yes —_._.. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? la Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomla Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct,I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signate el Ow er And/Or Authorized I t Date gnu 1, INSPEC1iON TYPE PATE MAO 0131 IN5PE052N TYPE n /1 RAM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1'cX'/—cOL 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention _ 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition .- . 250 Final Building/Occupancy CITY OF COSTA MESA 49 BUILDING DIVISION F 'n ..�1.1 l DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J• PERMIT M02-00118 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No A Applied: 03/15/2002 Issued: 03/18/2002 Vicinity: UNIT A(THE CORNER CLEANERS) Parcel Number: 42626318 " " ISSUED BY: >Sit Applicant: TERRY MICHAEL <:--' . " Address: i O - " / % Phone:'949-466-0900 � / , / - Zip: / - Owner: CEFALIA, JOE - _ - • i, - Address:' 1649 BAYSIDE-DR - ' Phone: N' - ' CORONA DELMAR,CA Zip: 92625-1832 / Contractor: ?OWNER-BUILDER - . ' Address: "z, �_� • - . Phone: ',. - / _tip: . , • License:0 . �� - SCOPE OF PERMIT N , 1674 SF INTERIOR TI FOR A DRY CLEANERS,"THE CORNER CLEANERS"IN STE A. 1 HOOD ' W/MECH EXHAUST FOR BOILER. REF:B01-01593 . , ,_ ' . _ - . . - FEE SUMMARY,. Quantity - 'Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit , $0.00 0- ' Inst FAU<100 k BTU $0.00 0 Repair,/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventlllatiori System $0.00- 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 , Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 , Refrig Sys,>100 k BTU • $0.00 0 - - -Compressors/Absorption Systems Gas Piping ., $0.00 0 Up to 3 hp/,_100 k BTU $0.00 0 Factory Fireplace - _ , $0.00 0 . . 3 To 15 hp/500 k BTU ', , $0.00 0 Hood w/Meth"Exhaust, " $10.65-:_I --- . . , 15 To 30 hp/1;000'k'BTU- - - , - ' $0,00 i0 VAV Box ' $0.00 0 30 To 50 hp/1,750 k BTU / N $0.00 - 0 Vent Fan/Single Duct . '' x$0.00-' _0 " Over 50 hp/Over 1,750 BTU ' - - $0.00 0 Appliance $0.00 --0 Boilers - - Fire Dampers " " N " - $0.00 -0 - " -Up to 3 hp - $0.00 0 Smoke Dampers ' $0.00 0 3 To 15 hp . - $0.00 0 Inst or Relocate Appl Vent N - $0.00 0 - . - 15 to 30 hp - - $0.00 0 Air Handlers< 10000cfm' $0.00. 0 30 to 50 hp, - - /' $0.00 0 Air Handlers> 10000cfm - ' '$0.00 .0 - - Over 50 hp- , $0.00 0 i Floor Furnace $0.00 0` Other Mechanical Fee ' - Floor or Suspend Heater .$0.00 0- . . , Investigation Fee - . - $0.00 Plan Check Fee- � -- $0.00 "_ Reinspection Fee " $0.00 TOTAL CALCULATED FEES $34.15 COMMENTS/SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora 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, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244644(600) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: • ' ❑ ' I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Carrier: • Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(SI00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.N Class 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division.3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursu.• to the Contractors License Laws.). ❑ I a . exempt c. Business and Professions Code for this reason: Signatur-. ♦.-_. Asa Date: 3 f l8/Do. Owner ID verified b driver's lice .:. ❑Yes 0 No Drivers License No. __ �� Expires: /1/So/op Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one lime during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does h or wo the oast Air or Quality M present or Management building occupant at requireother for the work ontc)is the subject age of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any err pollution control district or agency? �Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and SafetyCode). a per _ ..._ _.._._ ..._ agency ____r.._ ._ __. 7 application,If a permit from the-South Coast Air Quality ed Management DistrictHor n Safety air po Code S control district03 or is required for the work which is the subjed of this have all of the disclosures prescnbed by California Health and Section 42303 been made? ❑Yes 0 No B (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. 1 agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application end state that the Information given is correct. I agree to comply with at state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. -�'Ignature Of Legal Owner(s) ' --3/ / Date And/Or ,uthorized Applicant Date CODE t, ly$PECnON TYPE ..0 IMALS gODEE INSPECT10NTYPE PATE NIIDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 200 Final Plumbin 200 Final Re-Root 210 Final Ele Tal lACSIr � � L 201 Final Block/Retaining Wall 212 Fina re Prevention 202 Final Factory Fire Place - 220 ' al Planning Appr al 203 Final Sign 222 Final Site y 204 Final Demolition 2 0 Final Building/Occupancy • CITY OF COSTA MESA 4 BUILDING DIVISION : .4 ,,,,,, 1 8 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER 4. g a I PERMIT litbkore.arspe# P02-00153 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us - 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No A Applied: 03/15/2002 Issued: 03/18/2002 Vicinity: UNIT A(THE CORNER CLEANERS) Parcel Nunmber: 42626318 - ; ISSUED BY: Applicant: TERRY MICHAEL' - /� Address: iii-i-/ - i / �j v l Phone:, 949-466-• • . //; \ ' _ _ �•/ v _ ' Owner' /CEFALIA, JOE Address 1649 BA/SIDE-DR' / , /2 -/ ."- \',\:. 11 ' . / //' , /% Phone: > - ' CORONA"DEL MAR,CA Zip:" 92625-1832 7' Contractor %OWNE• R-BUILDERS Address: - , '`.. - , . , , - Phone:_ = 7 V '- I . i •, - Zip. License: 0 7 - Arch / Eng: . _ _ -0 -' - .. Address: Phone: .. ._Zip:-S ,. - , � ' License:-- /�:: - - �: SCOPE OF PERMIT ' 1674 SF INTERIOR TI FOR A DRY CLEANERS,'THE CORNER CLEANERS"IN STE A.2 GAS ," - OUTLETS(1-4), 10 PROCESS PIPING(PERIOF.T), 1 VACUUM BRKR BKFLOW(1-4), 1 WATER , ` PIPING(INST OR REP), 1 WATER SOFTENER.REF-B01-01593 AND P02-00137 ' FEE SUMMARY AMT '`�OTY, -AMT OTY - /AMT QTY ISSUE FEE .,--�� 423:50/, Laundry Tub/Washer $9.80 1 ,, Sump Pump � / $0.00 0 Backflow irrigation" N, ,$0.00 /, A�-^:-'O Landscape Irrigation ' $0.00 0 " 'Swimming Pool / i / $0.00 0 Backflow Preventer vA $0.00 /---0::,_ , - T.' -.P-Trap, $0.00 -:0 " Trap Primer' - $0.00 0 Bathtub \' , $0.00, 0 - Pressure Regulator. $0.00 .0Urinal $0.00 0 Clarifier System $0.00 ' ' 0 ' , Process Piping(per 10 ft) $98.00 10 _ Vacuum Brkr Bkflow(1-4) $12.30 1 Connect(Ice,Soda,etc) $0.00- 0 , ' - Receptors $0.00 ..0 . .Vacuum Brkr.Bkflow(5+) $0.00 0 Dental Units $0:00 ' - 0, , Septic Tank ' '' ' $0.00 ,0 , Wash Basin $0.00 0 Dishwasher $0.00 ` 0 Sewer Cap for Demo' $0.00 0 ' Wash Basin Set $0.00 0 Drain, Floor $0.00 0- - - Sewer Connect , , $0.00 0 . - Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 :, 0,- Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower - ' $0.00 0- Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $9.80 1 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $12.30 2 Sink,kitchen $0.00 0 Water Softener $9.80 1 i Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $175.50 6.,. .•C•4Y3/3rrCIm&t.Mt . •ONa 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,§ 1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244846(WOO) IC' DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' • ❑ Ihave and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. • ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number. (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) - - ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force end effect.Lie.a Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is zi sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). Of I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I a exam at r sec. Business and Professions Cede for this reason: Signature�M. Expires: ()/3%2 Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Cade been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akereit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection, Si. re Of ego Owners) -311/�Z An.Or Authorized Appli nt Date CODE INSPECTION TYPE PATE 2E0:081.a can E INSPECTION TYPE DATE =AL$ • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. -p/7 —E[pN 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 . Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ - 250 Final Building/Occupancy CITY OF COSTA MESA , - o BUILDING DIVISION - err. �... Y • „,,,.,, ,,,, DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER 4. � . • PERMIT _f �; B00-01424 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT ,.r,. ;t- Job Address: 140 E 19TH ST Status: ISSUED Suite: Applied: 09/12/2000 Vicinity: Issued: 03/26/2001 Parcel Number: 42626318 Zoning: Applicant: CEFALIA, JOE & STELLA- ,, >A—T ISSUED BY: Address: 10055 SLATER AVE .-- - " - -. - - - -- ,/j��' L. Phone:- 949-675 7130'. FOUNTAIN VALLEY:CA--; i ' I Zip: 92708 C040 ' � - - Owner: CEF�AL'IA; DECLARATIONS WORKERS'COMPENSATION DECLARATION: . I hereby affirm under penalty of perjury one of the following declarations: ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain rs'compensation insurance, s required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensa In u n caner and F mber are: Cartier: j Policy Number: (This ction need not be complete if the permit is va ed at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws o California,and agree that if I should beco subjec o the workers'compensation provisions of Se tion 3700 of the Labor Code,I shall forthwith comply with these p S inions. /' ApplicantG Signature:T . WORKE PENS I ERAI Date:R � 2�IE b I WARNING:FAILURE T% RE WORKEI PENSATI ERAOE IS UN FUL AND SHALL SUBJECTR AN EMPLOYER TO CRIMINAL ENALTI, I D FINES UP TO ONE HUNDRED THOUSAND DOLLAR 000),IN ADDI TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Tic.a Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exemtf).inder sec. / / / Business and Professions Code for this reason: Signature: /iCC.C_c i Oracriere ! Date: C'S/7.(e0/ Owner ID ve fi by drive -/cense. (4 Yes 0 Drivers License No, xpires: Verification of Ownership•y(typo of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ap ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes INo (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed Under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of Compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with at state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY: I certify under penalty of perjury that I have read this application end state that the information given is correct.I agree to comply with all state taws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe-property for Inspect • rposes.I egr• t noupy o)allow occupancy of any building authorized by thjs permituntil fi0al inspection. 31`�J ' Sit•: ure If Legal/er(s) or Date And/Or Authorized Applicant Date CODE A INSPECTION TYPE PAI€" INIID965 CODE INSPECTION TYPE PAIL IMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 . Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site /�� /7 204 Final Demolition • - 250 Final Building/Occupancy Ft.5 ' .�' / - r a -* CITY OF COSTA MESA -- 4 BUILDING DIVISION >•4---a..1,.,, � $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t. t ..�... i®II 4• r'' • PERMIT !"� 601-01593 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 140 E 19TH ST Status: ISSUED Suite: A Applied: 10/08/2001 Vicinity: STE A(THE CORNER CLEANERS) Issued: 03/18/2002 Parcel Number: 42626318 Zoning: Applicant: LINNAUS, ROBERT - ISSUED BY: / /(%IG — Address: 15560 ROCKFIELD BL - - - - - - , - _ SUUITE C216 ,' " - Phone: 949-460-0997. IRVINE,CA-' ii_- Zip: 92618 ' - /. Owner: CEFALIA, JOE & STELLA , Address 10055 SLATER AVE ' ,/_ ' /' Phone: 949-675-7130- - - ' FOUNTAIN VALLEY,CA Zip: 92708-0040 Contractor: OWNER-BUILDER I Address:. - /:, /' . , / Phone: ' Zip: License: 0, Arch : LINNAUS, ROBERT " i-.." ,. Eng: ‘N Address: 15560 ROCKFIELD BL - - Address:; - SUITE C216 -- Phone: 949-460-0997 - Phone: - ' IRVINE,CA/ ' Zip: 92618 'License: C18713 License: SCOPE OF PERMIT. . 1674 SQ.FT TENANT IMPROVEMENT FOR A DRY CLEANING BUSINESS:APPLICANT IS TAKING TWO UNITS IN A FOUR , UNIT RETAIL SHELL BUILDING.PER APPLICANT THE FRONT UNIT IS UNIT A. -. FEE SUMMARY ' Plan Check: $172.41 - - Calc Valuation: $16,000.00 Permit: $265.25 �' Claim Valuation: $16,000.00 SMIP Res: $0.00 SMIP Corn: $3.36 Other: $0.00 'Inspection:-' '$0.00 ,:i: 7 ' / / ' . Total: ' , $441:02 v (:.,•-- .:- PLANNING&ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 / ACCESSORY Front,- 0-0 Rear. ,0-0 • Left 0-0 : Right 0-,0 PARKING Existing: 0. Required: 0 , Proposed: 0 NOTES: - . - " 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 yyy'''''' 244846(&W) 4 7 \ DECLARATIONS i7 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ ' I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. o I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: •• Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N Class M Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). • Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursu t Contractors License Laws.). ❑ I amxe1W m, 3/pt ndE Businss and Professions Code for this reason: Signature:L" - l.>aYJ �L Date: (e/0z Owner ID verified b drivers li ' ❑Yes 0 No Driver's License No. Expires: 11/36/02— Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Wit the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). or __. __...l.._...__ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. a If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? lCD Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .__theac___.._.._ ._ 6 Will anyhP .._..._._ _...._._ part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • ( l / Si attire Of Legal Owner(s) -3/j g/gate�.],�^ AndlOr Authorized Applicant Date CODE P INSPECTION TYPE QLIE 9RRIAL5 CODEI INSPECTION TYPE MTh MALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site A 204 Final Demolition .250 Final Building/Occupancy CITY OF COSTA MESA 4 ► @ BUILDING DIVISION o �' 4 g DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER FI i 4 PERMIT E01-00226 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No Applied: 03/26/2001 Vicinity: Issued: 03/26/2001 Parcel Nunmber: 42626318 Applicant: CEFALIA, JOE & STELLA, , „ „ _ ISSUED BY: Address: 10055 SLATER AVE. <2! -- 1 �j -- \< Phone: 949-675-7130' \` FOUNTAIN VALLEY CA \ Zip:'- 92708-0040 /1 ,-\-._,„,'".� Owner: ;CEFALIA, JOE 8 STELLA . / /j// - '-'-t,.'-\ o � w\ Address,`710055 SLATER-AVE � -�� /v�� V /� / ;, \� / N. N // ��� Phone: 949-675-7130 \ .- 0 FOUNTAIN V LLEY,CA Zip: 92708-0040 .C, �7 / 1 ////,_20./ 'c_v' / ,' / - ,' �, /� °�� ��V' / kContracto>>'OWNER BUILDER ` /ryC / Addrses ` //,% /;\ • .\ \ ti\�Oi \\ _ , ;/; _/ A ;Phone. ', .--- ` V 1 1j 1 �/ 0 , /� < - Zip: '- �" ''N • % 6 , ` am- ,� 7 f �� License: 000000 I li: / . /. .. - - - - - i- � �� � �1 � ,,1't--i j ,r,i, II-,',./ SCOPEOF'PERMIT ,' IT)r-1(' \) i ‘C. : _-- ; H.\1 . • I (TEMP POWER POLE NEW COMMERCIALJBUILDING:REF:B00-01424: \ I y„ . __J ��I. - I \;� \ , i r \ I il,\ , \It C V ' 2 c' FEE SUMMARY / 7 �_� SI I Quantity _ /� Quantity (i ��! \I'SUE.FEE-\ AV I $23.50 Temp Dist Syste /Lighting $0.00 0 JLi_ (4 Temp service test v\ $0.00 Busway 1100 ft!/ $0.00 0 0/ '/ Res.`s/c package\�' , $0.00 / Standing Section,• `$0.00 0/ ,��./1 New•Res'(1-2-units), \\,,� $0.00 l 0 Misc Electrical-Equipment $0.00 5 , New Re's(3+units)- \\i $0.00 0 T ransformers up to 1 kva/kw $0.00 /0/ / Pool/SpaV\ A-� \‘v`�$0 00 ) 0 - , q:- up to 10 kva/kw $0.00 i<0 Lighting F,ixtsV \ \\$0.00 0 • - up to 50 kva/kw $0.00.70 / Recept Outlets v-1 \$0.00 0 2 • ° up to-100 kva/kw , $0 000 C/ i Switches \\J <�\ $0.00 ,x_0,54 �. , 2 ( v '"over 100 kva/kw 1 -$0-.00/ 0 /. 91 Sij /;$0.00 VA 0 ' • ✓ &J` - LOW Voltage Equipment> c'.>$0.00 0 0 A / $0,Ian t Wring System/Ckt, $000(/�����0, 0,,- $0. . nduit" ° t $0.00 C//0/ la ($0. nduetor� $0.00 0 000a �- $0. 0 //^/ -gen.oi=ride) \/CS0:00� 0r,Motors to 1hp � $0.00' \ 0 - _ __ Circus:(me`ch-ride or lights) $0.00 �0/ Motors to 10hp x$0.00 J/01��^ _ Christmas Tree Stand �C$0.00 65 0 Motors to 50hp $0:00-,..„,,,,,,,,b, \ / ^Tal1t p r- Fireworks Stand?\\,, $0.00/0 Motors to 100hp $0:00\0 UUU ___ Li J Otherl Electrical Fee 7$0.00 Motors over 100hp $0.00 Q_�_ �-/i;A\t[-A) U ••--��� Communication drops $0.00 0"<T) z -- _ Investigation.Fe �7Ky- $0.00 • Sub panel to 200a $0.00 0-- o%'c;-P.lah:Check.Fee $0.00 Pole Light Pkg $0.00 0 _'----Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $23.50 1 TOTAL CALCULATED FEES $47.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expirationof this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6'00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: . , . I hereby affirm under penalty of perjury one of the following declarations: ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ 1 have and will maintaiggqqqq workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My wricers'comae n B carrier a !icy number are: Carrier. Policy Number: ze Is don need not be completed ll the permit Is efu d at one hundred dollars($100)or less.) I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws o Califomia,and agree it if I should ubjeco the workers'compensation provisions of Se ion 3700 of the Labor Code,I shall forthwith comply with these pr si••s. C c,^ 3 2,60/ 7/ Applicant Signature: / ,!`-/f((/rr""' Date: rrfGA/LL/ WARNING:FAILURE TO •• RE WORKER '•• •ENSATVERAGE IS U AND SHALL SUBJECT AN EMPLOYER TO GRIM! PENAL11 S AND CML FINES UP TO ONE HUNDRED U THOUSAND DOIRE(SIC0,000),IN ADDIT• TO THE COST COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Pr fesslons Code,and my license is in full farce effect.Lic.4 Class 4 ""(af� ra Si : Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 3/Z-- / Signature: Date: 3/G Co/ t) / Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,TWO 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire (Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 II en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 NO --- 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes D No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws end city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Masa to enter upon the above-de ribed property for In p tion p I a of to py or allow occupancy of any building authorized by is permit until final inspection. "`i L/y g,6)/ Dol Signature O gal Owners D to And/Or Authorized Applicant Date SORE I INSPECTIONTYPE RATE' EMU ODE( INSPECTION TYPE RALE Di)IDALE 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof _ 210 Final Electrical 1/7/0/ rs.• if 201 201 Final Block/Retaining Wall _ 212 Final Fire Prevention - 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy �' S CITY OF COSTA MESA - . � BUILDING DIVISION f I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER tb• PERMIT E02-00009 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No Applied: 01/02/2002 Vicinity: MONUMENT SIGN Issued: 01/02/2002 Parcel Nunmber: 42626318 Applicant: ARTINGER, PAUL ISSUED BY: Address: 7541 SANTA RITA CIRCLE#D - ''' - .- Phone: (714)894-2011 STANTON - ;CA.," Zip,. 90680 . N �. , . /,' Owner:/ CEFALIA,JOE & STELLA- - - �- Address ,-,1649 BAYSIDE DR', ' - - - ' % A Phone: - » ,, / ' ,i CORONA DEL MAR/,CA Zip: 92625 /i� "i • .Contractor:_ CONTINENTAL SIGNS INC -- , - - - ,, \-' - ,, , c.' v v. , " Address: /7541-SANTA RITA-CIRCLE#D - ; ,.. --:Phone: (714)894-2011 - ' - STANTON,CA Zip: -90680 . _ - . ' ,, License: 664525 " - - - N SCOPE OF-PERMIT , ., -. ,, .'ELECTRICAL PERMIT FORNEW ILLUMINATED MONUMENTSIGN FOR"CEFALIA CENTER". INSTALL 1 SIGN CIRCUIT. i REF: 51302-00001 N, �FEE SUMMARY Quantity Quantity ISSUE FEE . $23.50 Temp Dist System/Lighting $0.00 0 - , Temp service test $0.00 Busway/100 ft ' $0.00 `0 Res;a/c package, $0.00 •- . "-: Standing Section $0.00 ` 0 New Res.(1-2 units)" " .$0.00 0 ; - ‘;" •Misc Electrical Equipment New Res,(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00:, 0 , Pool/Spa, .,,, x,$0.00 0 ., - up to 10.kva/kw .- _- $0.00, 01 Lighting Fixts $0.00 "I--- ''''o- up to 50 kva/kw $0:00 0 - / Recept Outlets, ' , ,'- $0.00/-.- 0 - ,- up to 100 kva/kw . . $0.00 • ,` 0 Switches ' ' $0.00'- - 0 ' over 100 kva/kw " '$0.00' ^0 / Non Res Appl ', , . - $0.00. - . 0' , Low yoltage Equipment /$0-00 -', 0 . - Res Appl ,.;\ - ,-$0.00 '01 ' Loy/Volt Wiring System-/Ckt % $0.00- ; 0 -',/ Service to 200a $0.00 % -- ,0 _ Misc.Conduit ' $0.00' %0 / Service to 1000a - - $0.00. '4, 1; 0 ' - Misc.Conductor ,, "$0.00 0� Service over 1000a '$0.00 '/ , 0' i - ,Circus(gen or ride)' ' - -10.00--",„, 0 Motors to 1hp 4$0.00_.` `' 0` .. Circus(mech ride or lights) , -$0.00, 0 Motors to 10hp $0.007-' 0 ,. ,'Christmas Tree Stand .c, $0.00 0 Motors to 50hp $0.00 '\ -- 0' -- - ' '--Fireworks Stand "1! ,- $0.00 0 Motors to 100hp $0.00 \"0,,_'" - - - - .OtherElectrical Fee , - $0.00 Motors over 100hp $0.00 Communication drops $0.00 0 -Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $24.60 1 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $48.10 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754.5626 2446-46(WOO) G DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations:: ❑-. I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. , 1 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: - CC��Ieer.'t^. ,S r n e • Icy Number=:.- Y I On (Riis-section need not be completed if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as'to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these r�eR'visions�.7 A�plicent Signature: rPL--! pt• — '� — t� WARNING:FAILURE TO SECURE WORKERS COMPENSATION ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM ER TO CRIMINAL PENALTIES AND CIVIL FiNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE r'nfT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm t licensedy -Ca under provisions of Chapter 9(commencing with Section 7000)of Division 3 of tiro Buusine o.siSlgnaj and Professions Code,and my license is in full force end effect a " CI s5`"sp Contra .?-- -.-� �<r / -„'[ - O 7_-_ CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑. I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or herown employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). . PP presentbuilding occupant _ .._...._..........._...___...._._ N 2 Does or will thea applicant or or future need to file a form for acutelyhazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penally of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SI nature Of Legal Owner(s) Date At-t•-e- I - A - ate_ rA orizedpplicant ii=--f' CODE I INSPECTION TYPE PATE IIS CODE! INSPECTION TYPE PATE INTIUAL6 1616 Fixed System Final Fire Prevention 206 FinalMechanical 1266 Pool Spa Final 208 Final Plumbing .. 200 Final Re-Roof 210 Final Electrical rt-Q' rt7 201 Final Block/Retaining Wall 212 Final Fire Prevention (/ 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - - - - .250 FinaLBuilding/Occupancy CITY OF COSTA MESA 4 � BUILDING DIVISION c`t .�, DEVELOPMENT SERVICES DEPARTMENT- PERMIT NUMBER • 4 PERMIT M01_flfldlfl (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No Applied: 08/21/2001 Issued: 08/21/2001 Vicinity: Parcel Number: 42626318 _ _ ISSUED BY: 4-k��j .- ' Applicant: REAMS, DANNY' -.D7 ' - • i ; , �. , Address: /,, / 1 - , Phone: 562-430-5755 - Zip. ,. _ • - Owner: . CEFALIA, JOE &S_TELLA- Address: '10055 SLATER AVE ',o -, Phone: 949-675-7130 FOUNTAIN c/ALLEY,CA Zip: 92708-0040 _ Contractor REAMS HEATING AND NC _ Address: 615 SILVER SHOALS AVE - 'Phone: 562-430-5755 ,. ., 7 SEAL BEACH,CA- , `>-- - ' Zip: _ 90740 License:162995 - '/ SCOPE OF PERMIT ' / REF: B00-01424.ADD 4 PACKAGE UNITS AND DUCT WORK FOR NEW RETAIL SHELL BUILDING. . . '- FEE SUMMARY ' ' - ' ' . • QuantityQuantity, ISSUE FEE $23.50 Repair/All Absorbtion Unit - $0.00 0 Inst FAU<100 k BTU $0.00- 0 ' . . i:', Repair/AIt,Refrigeration Unit $0.00 0' Inst FAU>100 k BTU $0.00 , -0-- ' '- " Ventillation System • $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler ' . $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU . $59.20 4 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU , $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 , . 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box ' $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct , . - ` $29.00_ 4 ,. Over 50 hp/Over 1,750.BTU 7 $0.00 0 Appliance . $0.00 0 Boilers . Fire Dampers / '/ $0.00 . 0 - Up to 3 hp $58.80 4 Smoke Dampers . . " , $0.00' - 0 3 To 15 hp , $0.00 0 Inst or Relocate Appl Vent ' '$0.00 - 0 15 to 30 hp . - $0.00 0 Air Handlers< 10000cfm - . $0.00 0 _ 30 to 50 hp $0.00 0 Air Handlers> 10000cfm •$0.00 0 . Over 50 hp - - $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee / $0.00 Reinspection Fee - ' $0.00 „- 7 TOTAL CALCULATED FEES $170.50 COMMENTS/SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(&00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 5ernI have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this perm' is issued. ave and will maintain orkels'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. y workers'.. rpensati•n In-1 r9nce carder and policy number are: er. �' Policy Number: (This section need not be.. . ,.if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the perform: .e of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif. ia,and agree that if I should become subject to the workers'compensation provisions of Section 37 f the r Code,I shall forthwith comply with these Provisions I O 1 Applicant Signature: - Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Lic.It Class N I r� I Q 'Contractors Signature: -• Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pern:P subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, _or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greeter than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health end Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermtt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the Califomia Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (II"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. L4 S' nature Of Legal Owners) — /0-, / dilate And/Or Authorized Applicant Date ;ODE I INSPECRON TYPE QAIE 119:01AL5 ;ODE( INSPECTION TYPE PAH 1616 Fixed System Final Fire Prevention 206 Final Mechanical y'S�ii"G 1266 Pool Spa Final 208 Final Plumbing 3e 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 411 'F CITY OF COSTA MESA - 4. A. BUILDING DIVISION j:�,,;' �� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0, roll ' / PERMIT I'`1sLe p,,,,,i l" P01-00206 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No Applied: 04/12/2001 Issued: 04/12/2001 Vicinity: �jyr, ISSUED BY: �' - Parcel Nunmber: 42626318 Applicant: CEFALIA, JOE &STELLA Address: 10055 SLATER AVE , , ' Phone: 949-675-7130 FOUNTAIN VALLEY,CA Zip: 92708-0040 - A - N ' . Oviner: CEFALIA, JOE& STELLA ;�„ . Address 10055 SLATER AVE . • Phone: 949-675-7130 FOUNTAIN VALLEY,CA Zip: 92708-0040 A , \ - V� Contractor: ' , - Address: - - '`' Phone: Zip: License: - V1 Arch / Eng: t --- - - ' . - I Address: r - V '� . Phone: - i � ; -- - - - -Zip: .' � r " - License: ' (�• SCOPE OF PERMIT 7:7NI' / / \�,�; ` % SERWER CAP. ;i /' C, � i�i 'FEE SUMMARY: %/ 7. �0� \ ; AMT <,;QTY , -, AMT QTY. - - ,,L / 'AMT QTY ISSUE FEE', �A ' $23.50 -, ., ' Laundry Tub/Washer $0.00 0 - Sump Pump N .;,�'$0.00 0 Backflow irrigation'. ,$0 00 0 ' Landscape Irrigation $0.00 0 _:Swimming Pool Ari $0.00 0 Backflow Preventer7A </$0 00� 0 ,��A` P-Trap - - , " $0.00 0 , .� Trap Primne(� i ' $0.00 0 Bathtub �A $0'.007', 0 -..f-s.","„-"Pressure Regulator $0.00 0 - �/ Urinal; 'c / $0.00 0 Clarifier System v A$0.00 �-0 Process Piping(per 10 ft)' $0.00 0 i -Vacuum Brkr Bkflow(1-4) $0.00 0 �, Connect(Ice,Soda,etc)N. �$0.00VA0 _ Receptors - $0.00 0 .Vacuum BrkrBkflovi(5+) $0.00 0 Dental Units $0.00 0 ': ' Septic Tank - $0.00 0 ' ` 7-Wash Basin'% / $0.00 0 Dishwasher $0.00 0' - '1/ , Sewer Cap for Demo„ $9.80 ',1 , Wash Basin-Set $0.00 0 Drain, Floor $0.00-;- .0'- . �' ' 'Sewer Connect - $0.00 0 ' Waste and Vent System $0.00 0 Drain, Rainwater $0.00 /,0' , Sewer Private Line ‘$0.00. - 0 " ' --,,Water-Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 "- Shower "$0.00 0 . Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 - Sink,bar $0.00 - 0 - Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial - _ "$0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $33.30 COMMENTS/SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. • ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued, My workers'compensation Insurance carrier and policy number are: Carrier. Policy Number: (This section need not be completed it the permit Is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDr11DN TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lk.It Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,atter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion.the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). A--1-as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contrac ors License Laws.). ❑ I am exe t u er Business and Professions Code for this reason: 97-72 —01 Si nature:. DDate::n� Owner I ied by er's license. r Yes; 0 No Drivers License No. '© DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,lalsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisapplication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc..ed property for o s•ection rps.I.LT=: no so occupy or allow occupancy of any building authorized by this permit until final inspection. • ei Signaturedr'9al Owner, Date And/Or Authorized Applicant Date pnnp E, INSPECTION TYPE DM' INTRIAL$ CODE! INSPECTION TYPE PAS tlrtrifiaS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 4/19/b! BA V 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 . Final Building/Occupancy _ CITY OF COSTA MESA _ 4BUILDING DIVISION >. N,,, r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t ' •• PERMIT J+rtPosmso,p P01-00254 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No Applied: 05/02/2001 Issued: 05/02/2001 Vicinity: RESTROOMS Parcel Nunmber: 42626318 ISSUED BY: Applicant: CEFALIA, JOE Address: 818 W BALBOA BL Phone: (949)675-7130 NEWPORT BEACH,CA Zip: 92661 Owner: CEFALIA, JOE & STELLA Address 818 W BALBOA BL Phone: (949)675-7130 NEWPORT BEACH,CA Zip: 92661 • Contractor: OWNER-BUILDER Address: Phone: Zip: , License: 0 Arch / Eng: " - - - - , • Address: - Phone: . - - ---Zip: '. - � ' , License- SCOPE OF PERMIT • ' PLUMBING PERMIT FOR NEW 4-UNIT COMMERCIAL BUILDING. INSTALL 2 ROOF DRAINS,14 GAS OUTLETS, 1 SEWER CONNECTION,4 WASH BASINS,4 WATER CLOSETS,4 WATER HEATERS,&4 - WATER SERVICES. , •, REF:B00-01424 ,, _ .�- _ v• , , , ' • - - - v FEE SUMMARY, _ -- �\ `-AMT,%„OTYl��A\ - AMT _ Q - .' AMT OTY ISSUE FEE $23.50' = - --Laundry Tub/Washer $0.00"' 0'1; K Sump Pump . . $0.00 0 Backflow irrigation ' '$0.00A, 0 Landscape Irrigation $0.00- - 0 Swirnming,Pool $0.00 0 Backflow Preventer $0.00.N 0 -- '/ " P-Trap $0.00 0 T� '. \ Trap Primer $0.00 0 Bathtub $0.00. ,0 . Pressure Regulator , - $0.00. 0 ' ' Urinal $0.00 0 Clarifier System $0.00- - -0--,.. - " Process Piping(per 10 ft) $0.00, ,0 --Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 -0 - Receptors , - $0.00- -0 _ --,97-- Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 ._ - ` Septic Tank . $0.00 0,-,--„:,' . Wash Basin $39.20 4 Dishwasher $0.00 0 - -Sewer Cap for Demo - . $0.00- '''0 - - Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect - $24.65 - 1 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $39.20 4 Drain,Roof $19.60 2 Shower $0.00 0 Water Heater/vent $49.20 4 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $39.20 4 Gas(1-4 outlets) $6.15 1 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $240.70 IISTICE. The work aulhurirod by this permit shall ouin I with all a hln handik.a auCsss lequiienients under Califumia stajutes anti tutored regulations.(Ord.No.92-28,§1, 12-21-92) COMNIEyNTS/SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permlt� 1 FOR INSPECTIONS CALL: (714)754-5626 (// 2446-46(6/03) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit/s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL ARE(510D000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). . I;as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions (K—I; JCode:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exe at under Business and Professions Code for this reason: Signature, j D_ala: —2 ' J ��� Owner rifled by d' er's limns 0 Yes 0 No Driver's License No. � /Eaplres:-///br Verification of Owne ship by(type of document,i.e.-property tax bill or deed): L -' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully compiled with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 6 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des ribed property for in a tion purpose ogre t to occupy or allow occupancy of any building authorized by this permit until final inspection. � '� Signature Of al Owner(s) Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE QDIF. low CODE( INSPECTION TYPE PATE ItialA[()L!$�,�/�/�'A�✓., 1616 FixedlSystem Final Fire Prevention 206 Final Mechanicalmbi41,1 : 1266 Pool Spa Final 208 Final Plumbing .3/�i/0,Z 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA tea) BUILDING DIVISION .bl DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • PERMIT4. rail ; S602-00001 6 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 SIGN PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: Applied: 01/02/2002 Vicinity: Issued: 01/02/2002 Parcel Nunmber: 42626318 Zoning: ISSUED BY: Applicant: ARTINGER, PAUL , Address: 7541 SANTA RITA •!i' - ; SUITE D - Phone: (714)894-2011 j - STANTON,CA . ' ' ' , Zip: 90680 /: Owner: / CEFALIA,JOE & STELLA � Address 1649 BAYSIDE DR'- - . Phone: , , _ /; / ' CORONA DEL MAR;CA Zip: 92625 ' "�,, ',N Contractor:; CONTINENTAL SIGNS INC N - Address: ' 7541 SANTA RITA CIRCLE#D , ' ' ' v\, Phone:. (714)894-2011 , STANTON,CA Zip: 90680 '-_ - Lidense: 664525 Arch/Eng: ' - A; - Address: .. - , - Phone: Zip: . License: 7 " ' ' ' / ' . 'SCOPE OF PERMIT ' 53 SO.Ff.,7'HIGH DOUBLE FACED,ILLUMINATED MONUMENT SIGN FOR"CEFALIA CENTER". ' . , 'FEE SUMMARY '% y Plan Check: $72.31 = ' Calc Valuation: 35,000.00 : $0.00 , j Permit: $111.25 , Claimed Valuation: ' $5,000.00 SMIP Corn: $1.05 Other: $0.00 $0.00 Inspection: . $0.00 , -. $0.00 .- ,$0.00 ' " A Total: $184.61. N - PLANNING &ZONING NOTES: , - 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 244646(6W) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. - 0---11;ave end will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation durance carrier and policy number are: 4 (Carer: X I T L� l PolNumber-_ - ' /6/g0«-eG. LtTMs-section need not be completed If the permit Is valued at one hundred dollars(5100)or less.) o I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that III should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these ovisions. A_ppliccaant-Signature:these Ef.n �-`r�C!J� — 0 WARNING:FAILURE TO SECURE WORKERS'COMPENSATIO COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOUARE(5100,cCC),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that Icensed under•revisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prof ions Code,and my license is In full force and effect. /Gless.0-2 a If CorRtectofs'Slgnature:7*-f A1/2 r � trate: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Tltie B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ .._.c_....._._ ._ _ --__..._.— _ 3 Does or will the-applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomla Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a,aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). ... ___.___...._...___...... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If''res',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). Co- _....._.__...._ ._ __. _ _...._ 7 If a permit than the South isclst res QualitycedManagementCalifomia la eal or dhSr airpollution ooncontrol district03 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Cellfomla Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si n f Legal Owner(s) Date And/Or(Authod Appiic?rt CODE iAPETTI0N TYPE PATE INTITU65 QDDEf INSPECTION TYPE QATF• IKOE65 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place . 220 Final Planning Approval ' 203 Final Sign Wit /1WVw 222 Final Site 204 .Final Demolition ��/ 0 250 Final Building/Occupancy �cCITY OF COSTA MESA BUILDING DIVISION 041/0 .-Ha!::, ,,. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT 4ktetan *# JstzD3-ICOI&5 p1 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTRFv1EA?CA 92626 SIGN PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: D Applied: 10/20/2003 Vicinity: Issued: Parcel Nunmber: 42626318 Zoning: ISSUED BY: Applicant: BOIES, ED , Address: Phone: 562-498-6655 i Zip: 7 Owner: CEFALIA, JOE Address 1649 BAYSIDEDR Phone: CORONA DEL MAR,CA Zip: 92625-1832 Contractor: FLYNN SIGNS AND GRAPHICS INC Address: 3315 E ANAHEIM ST Phone: 562-498-6655 LONG BEACH,CA Zip: 90804 License: 816708 Arch/Eng : Address: . Phone: Zip: License: SCOPE OF PERMIT INSTALL 20 S.F.CHANNEL LETTER,ILLUMINATED SIGN FOR"COMPUTERS"SUITE D FEE SUMMARY Plan Check: $54.11 . — - - - Calc Valuation: $3,000.00 $0.00 Permit: $83.25 Claimed Valuation: $3,000.00 SMIP Corn: $0.63 Other: $0.00 $0.00 Inspection: $0.00 $0.00 Total: $137.99., PLANNING &ZONING NOTES: 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned • for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: '-- • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the _..„_work for which this permit is issued. (D '1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. wa s';co nnsaationnAsurances.ris and policy number are: ,`/ �y} Carrier: C-%!/(,/K�.'-o//l/ /L1NlG Policy umber. �`7 /�Lv�/ tl secflen need not be completefJ if the permit is valued et one hundred dollars($100)or less.) O I certify that in the perform'nc= i! • •7 hich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cal,yllr a•• :: :.1 at If I •ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi_.. cantttgnature: // Date/O•._U 3 WARNING:FAILURE.TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED USAND OOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby:afflrif that I am li -qs=d u 'slo s o hapter 9 • mencing with Section 7000)of Division 3 of4he.Busine an Pssions Code,and my license is In full force entlieHeclLicsx=O: i / �� C ss�x ContrBctgr' Signature: LAOS' e:--'t0— C,uraeanir 3 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Cade): Lender's Name: (Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit t0 file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply t0 an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes'',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If`yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. • Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe,pro.- - •r inspe •'imposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. gnat a Of gal Owner(s) Date • � ' /4-7-10'70 21i And/Oi`AuthorizedAppllcant - t,4.e CODE I INSPECTION TYPE �— PATE MAI& ODE INSPECTION TYPE Prig 7 L4 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site a 204 Final Demolition 250 Final Building/Occupancy /1-13-03 M CITY OF COSTA MESA t BUILDING DIVISION o,j- .► f I o_r�rI DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER " PERMIT E03-00981 F (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No D Applied: 10/20/2003 Vicinity: Issued: 10/20/2003 Parcel Nunmber: 42626318 Applicant: BOIES, ED ISSUED BY: Address: 3315 E ANAHEIM ST Phone: 562-498-6655 LONG BEACH;CA Zip: 90804 Owner: CEFALIA, JOE • Address 1649 BAYSIDE DR Phone: CORONA DEL MAR,CA Zip: 92625-1832 Contractor: FLYNN SIGNS AND GRAPHICS INC Address: 3315 E ANAHEIM ST Phone: 562-498-6655 LONG BEACH,CA Zip: 90804 License: 816708 SCOPE OF PERMIT INSTALL 20 S.F.CHANNEL LETTER,ILLUMINATED SIGN FOR"COMPUTERS"SUITE D.REF.: $603-00105 ELECTRICAL TO INCLUDE: 1 SIGN CIRCUIT. • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 ' 0 - up to 100 kva/kw $0.00 0 Switches ' $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc:Conductor $0.00 0 Service over 10003 $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 - Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-48(8/00) DECLARATIONS a A WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ I h ve'and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the de for which this permit is issued. •• 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ▪ M work r wi,,{a,1ol_pot,cv n r-are: �/,� �` /�' 'tamer er:y ('�(/�¢� r /✓fH2 Pollcy Number:3/f a /M �/ ( (TIis section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of�'if for whi • :s permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califori_rlpd • :•r: r ould Papule subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply withthese,provish.- _ _ II ApplicantSignature: (-Date:- -� 3 -WARNING FNLURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(6100000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE TABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lico •.: v' - •'.ter. mends with Section 7000)of Division 3 of the Buslnes,l P o saSons Code,and my license Is in full tome end effect.LIETN"---S / iP o��_ �' Class•lr— C- LContractor's Signature: r -� _ Date: -4Q 17 9 " /% 'S CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption,Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe civil penally of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation live(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _� _ _ • _........_.... _ _.��.__...._ . .- .._._ _.. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code boon fully complied with? 0 Yes ❑Na 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a2ermit for ucti such constron or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safely Code Section 42303 been made? 0 Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: _ CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described:rep....v. or inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .•atu :Of :gal Owner(s) nn Date _And/OrAuthorized Applicant I Date ---Th CODE I INSPECTION TYPE DAM MAI CODE! INSPECTION TYPE Pell• g4ITI AU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 1 200 Final Re-Roof 210 Final Electrical i -/5-03 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy •—`._. CITY OF COSTA MESA _ 4 BUILDING DIVISION >:t / DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER F r ,.,,, .-�i PERMIT J Kw • t B02-00297 Sbobronarso' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite: C Applied: 03/01/2002 Vicinity: Issued: 03/01/2002 Parcel Number: 42626318 Zoning: Applicant: JOE CEFALIA . " ISSUED BY: Address: - �i�_. - _ !i"-' - ^Phone: 949-675-7130 .---<, ' Zip: / /: i,�_ Owner CEFALIA;JOE ,� m� - / Address 1649 BAYSIDE DR ; _ .- i N ` /7), A ,, \ Phone: - .� N/ N ,, ,. CORONA ADELMAR CA' Zip: 92625-1832 \ � // - K ; Contractor. N, /ice'- ,\ ,. �'Address: N iG '�/, Phone:' Zip: ,/,',�� - License:' • - Arch : PETE,VOLBEDA "= , Eng: 7 Address: 127 W B ST. / '\- -'-- Address: - , , , " , '11 Phone. 909)391-5888 - '.: " -, ; Phone: - - ONTARIO CA:,_�C . - I.' �\ , _ - Zip: 91762 License: C13077 N> / `License: - SCOPE OF PERMIT . 805SF NAIL SALON TI,CREATE OFFICE AND INSTALL SINK IN,IT; '/, A - �•'\ -• ' FEE SUMMARY r•' • Plan Check: $35.10 ' Calc Valuation: $1,500.00 Permit: $54.00 --- - - - - -- % ''- Claim Valuation: 7. 81,500.00 SMIP Res: $0.00 / ,SMIP Corn: - $0.50 _ Other $0.00 Inspection: ‘c$0.00 V , , .' ':\Total: - $89:60 PLANNING &ZONING '/ i SETBACKS / \ ' "�_ : MAIN STRUCTURE_Front /,0;0 Rear -.0-0 _Left 0-0 _ Right -,0-0 ' / N , / =0 ACCESSORY Front' , 0 ,'_, -Rear 0-0 Left 0-0 Right " 0-0 =- , PARKING Existing:.. -0 - Required: 0 Proposed: 0 - - NOTES: "Ni, 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, 12-21.92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648 WOO) DECLARATIONS -3 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. - , ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed ii the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: • WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.090),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a _ Class N Contractor's Signature: Date: • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fwe hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CON R' TING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contract (cense Law•oes not app,/ • ner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuan/ the ontractor- 'cense La. '. ❑ I am exempt nder s+c. 1 'i/ Business and Professions Code for this reals:- Signature: -cater Date: .7MITE Expires: J Verification of• ership by(type of docum',I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greeter than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? Q yes Q No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Yes DI No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND Av. •' R TON OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct "gree •comply w' all st: - d city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abov:-describ .g.•pe /inspe• • •u ses.- agree not to occupy or allow occupenyy-of any building authorized by his erry1 until final inspection. "-f I Si-' ure Of Le Owner(s) Date And/Or Authorized Applicant Date CODE I INSPECTIONTYPF PAIL INTIMLS PODS! INSPECTION TYPE Galt ILL • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place . 220 Final Planning Approval 203 Final Signm 222 Final Site n 204 Final Demolition _ 250 Final Building/Occupancy CITY OF COSTA MESA 4'1^-� ^•� BUILDING DIVISION j? r-,,,• "i, DEVELOPMENT SERVICES DEPARTMENT PERMIT N BER F. 'PIC- i I ian PERMIT 1 itbiboanon`44* 01-00631 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, OSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No C Applied: 10/29/2001 Issued: 11/21/2001 Vicinity: UNIT C ISSUED BY: / M Parcel Nunmber: 42626318 VVV ��` Applicant: CEFALIA, JOE' - 'Z. . Address: 818 W BALBOA"BL' ' - Phone: 949-675-7130 NEWPORT BEACH;CA , / Zip: 92661 -- Owner: ' CEFALIA, JOE & STELLA . / , Address 1649 BAYSIDE-DR - - ', ,. Phone: , CORONA DEL MAR,CA Zip: 92625 . i Contractor: OWNER-BUILDER - Address: - - Phone: Zip: License: 0 - Arch / Eng: PETE VOLBEDA r - / r. Address: 127 W B ST. , . • . Phone: 909)391-5888 ONTARIO CA., - Zip: 91762 ‘ ;% , License: C13077 / - SCOPE OF PERMIT INTERIOR PLUMBING WORK FOR A NEW NAIL SALON IN UNIT C OF A RETAIL STRIP MALL.4 FLOOR DRAINS,2 WASH BASINS. REF:B00-01424 - ' - ' FEE SUMMARY _ AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation . ' $0.00 / 0 . Landscape Irrigation $0.00 0 : Swimming Pool , $0.00 0 Backflow Preventer $0.00 0 .P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub .$0.00 / 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 . )0 Process Piping(per 10 ft) $0.00 0 i Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 / Vacuum Brkt Bkflow(5+) $0.00 0 Dental Units $0.00 ': 0 Septic Tank $0.00 0 Wash Basin $19.60 2 Dishwasher $0.00 / , 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $39.20 4, - Sewer Connect , , $0.00 0 , Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 -i - - Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower . $0.00 ' 0 - Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $47.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $129.30 (.UMMEN IS/SPECIAL CONDITIONS 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers compensation Insurance carrier and policy number are: Cartier: Policy Number: (This sect/on need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100000),IN ADDr1ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic,N Class 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Cale:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pearl-. subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is old within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ■ am e I pl under sea / / - Business and Professions Code for this reason: gnetur: tT ararAIanr �� s: .-- r Lta N •,ne ' rila bydri :eslicensf a Yes No rap nse No. dr --- � --0 Verification Owner ip by(type of:ocu •nt,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes_❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous matetlals)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? la Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part Ofthe facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of lhls application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE MID AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given Is correct. I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des ed property for ins.: '•n pu :,•-e i :gr:A•t to•f cupy or allow occupancy of any building authorized by thi I inspection. • •• e5) ' / ig cure •; II ner(s) Date And/Or Authorized Applicant Date COOED, INSPECTION TYPE PAIS EMU NSF INSPECTION TYPE PATE IIOIIISLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical �,( /� 1266 Pool Spa Final 208 Final Plumbing u,1 5-0 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA 4� 9 BUILDING DIVISION 1 0 rill> 1•,,,. ',• DEVELOPMENT SERVICES DEPARTMENT RMIT NUMBER f t 4. Iia r. PERMIT VE02-00205 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 E 19TH ST Status: ISSUED Suite No A Applied: 03/15/2002 Vicinity: UNIT A(THE CORNER CLEANERS) Issued: 03/18/2002 Parcel Nunmber: 42626318 Applicant: TERRY MICHAEL ISSUED BY: Address: - - - --,' Phone: 949-466-0900 Zip: Owner/ CEFALIA;JOE ; :•,- Address /1649 BAYSIDE DR _ - ,- , Phone: , CORONA DEL MAR,CA Zip: 92625-1832 ' - / . 'Contractor: OWNER-BUILDER • `7 Address - •;- Zip: - . �. - - License: 0 _ v . ,„ • SCOPE OF PERMIT 1674 SF INTERIOR TI FORA DRY CLEANERS,"THE CORNER CLEANERS"IN STE A.5 . NONRESIDENTIAL APPL,4 MOTORS TO 1 HP,4-MOTORS TO 10 HP.REF: B01-01593 - • I - __ •- FEE SUMMARY Quantity - - /7 •, - Quantity / - ISSUE FEE $23.50 Temp Dist System/Lighting . $0.00 0 ' Temp service test $0.00 - Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section '$0.00 0" New Res(1-2 units) $0.00 0 Misc Electrical Equipment •$0.00 0 ' New Res(3+units) $0.00 0 . Transformers up to 1 kva/kw $0.00 " 0- Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 0 • Lighting Fixts . .$0.00 0 - - up to 50 kva/kw $0.00 0 , Recept Outlets • $0.00 _ 0 up to 100 kva/kw $0.00 ', - 0 " - Switches , $0.00- 0 • over 100 kva/kw $0.00 0 7 Non Res Appl - . , •,$23.75' • 5 Low Voltage Equipment $0.00 ' 0 ', Res Appl $0.00 . 0 Low Volt Wiring System/Ckt -$0.00 . - 0 Service to 200a $0.00- . - 0 Misc.Conduit $0.00 . 0 Service to 1000a . , , $0.00 0 - - Misc.Conductor $0.00 0 Service over 1000a $0.00, 0 Circus(gen or ride) $0.00 / 0 Motors to 1hp - '$19.00 " 4 Circus(mech ride or lights) $0.00 , 0- Motors to 10hp '-. $49.20 , --4 / - / - Christmas Tree Stand , •- $0.00 " 70 Motors to 50hp -$0.00. , _ 0 Fireworks Stand $0.00- ' 0 Motors to 100hp $0100 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 • 0 Communication drops $0.00 "-0- _ - - Investigation Fee $0.00 I Sub panel to 200a $0.00 0 -Plan Check Fee - $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $115.45 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS_ 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, 12-21-92) EXPIRATION: This permit Shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections end final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 . 244648(8'00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will main(r/In workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued. My workers comps sation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1C0,030),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is �sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursu: the Contractors License Laws.). ❑ la e e pt 1 c. Business and Professions Code for this reason: Signatur:' f L L ._� , a /Date: 9//105 Z Owner ID verified b drivers li : se. 0 Yes 0 No Drivers License No. _ !/QExpires: (j / Verification of Own: ship by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management end Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Cale provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purpocns.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • Sigirol:Ortega!Owner(s) ://Diat An..•r Authorized Applicant Date LODE I, INSPECTION TYPE DALE EMU CODS! INSPECTS/NMI IMF gIIIEL4 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .. n n L 200 Final Re-Roof 210 Final Electrical Vil7i IYz''-HJ.I_l� 1 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval - 203 Final Sign 222 Final Site 204 Final Demolition . 250 Final Building/OccUpancy CITY OF COSTA MESA 4 , BUILDING DIVISION - j: � DEVELOPMENT SERVICES DEPARTMENT PER NUMBER t. 1 �'* 1 I' PERMIT 01-00940 (714)754527c3+• Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 140 E 19TH ST Status: ISSUED Suite No Applied: 11/05/2001 Vicinity: NEW COMMERCIAL SHELL BUILDING Issued: 11/05/2001 Parcel Nunmber: 42626318 '" Applicant: STEADMAN, RANDY ISSUED BY: Address: 4322 LAKEVIEW AVE - - - - '�- - Phone: (714)970-5002 YORBA LINDA--,,CA.' - ' Zip: 92886 Owner:,'CEFALIA,'JOE & STELLA- Address r 1649 BAYSIDE DR - - - �.� Phone: - CORONA/DEL MAR,CA Zip: 92625 - , ' Contractor: Y L ELECTRIC INC Address: 4322 LAKEVIEW AVE " , . '„ _Phone: (714)970-5002 - YORBA LINDA,CA ' ' ' Zip: 92886 , . License: 724621 . SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW COMMERCIAL BUILDING. INSTALL'60 LIGHT FIXTURES, 55 RECEPTACLE OUTLETS, 16 SWITCHES,-1 SERVICE TO 1000 AMP,4 MOTORS TO 50 HP,4 SUB PANELS, 3 LIGHT POLES,&4 SIGN CIRCUITS. , REF:B00-01424 . ' =' FEE SUMMARY • "Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 ' Busway/100 ft $0.00 0, Res.a/c package $0.00 Standing Section $0.00 • 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 , " 0 Pool/Spa ' ' $0.00 0- . up to 10 kva/kw $0.00 0 Lighting Fixts , $51.20�,' , 60 up to 50 kva/kw $0.00, 0 Recept Outlets $47.55' . 55 . up to 100 kva/kw $0.00 0. Switches $17.60. 16"N over 100 kva/kw $0.00 • 0 ' Non Res Appl $0.00 0 . Low Voltage Equipment $0.00 0 Res Appl \ $0.00 0 Low Volt Wiring System/Ckt $0.00 0 ' Service to 200a $0.00 0 Misc.Conduit ' $0.00 0 Service to 1000a ., $62.15 1 , . ' Misc.Conductor $0.00 0 Service over 1000a $0.00' 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 - 0 Circus(mech ride or lights) $0.00 0 Motors to 1Ohp $0.00 - 0 ' Christmas Tree Stand , -' $0.00 0 Motors to 50hp $98.40 -4 Fireworks Stand ' $0.00 0 Motors to 100hp $0.00 0 - Other Electrical Fee $0.00 Motors over 100hp $0.00 0 . Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $122.00 4 Plan Check Fee $0.00 Pole Light Pkg $100.50 3 Reinspection Fee $0.00 Sign Circuits $98.40 4 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $621.30 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS - 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: • - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) that In the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cal mia,end agree that if I sho d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro Applicant Signature: Date:, hi Q ( -WARNING:FAILURE TO C R WORKE PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FiNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADD TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that.l.am licensed under provisions 1 Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prof ions Code,and my license is in full force and's Lice �DIa�� Contractor's Signature: Date:— t CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction ending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a peri+' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? UYes j2J No (Section 65850.2 of the Califomia Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 11 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i ....:L: ,..,• •''S7!0 : - 4. /Gate r An•rOr AuthorizedApplicant . (-- tel_ C00E I INSPECTION TYPE PhIL INTrtLALS CODE I INSPECTION TYPE PAIE- Ifs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 20 Final PlumbingA* ,. /1 L 200 Final Re-Roof 210 Final Electrical ���jy 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ..• Pia CT ADDRESS: 140 E 19TH ST UNIT: 3 & 4 CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 070695 ( OWNER'S NAME: LEE, SHERMAN SHYH HUANG I . ADDRmS: TR PERMIT NO: B 070695 PLAN CHECK NO: N GOVT; N SUPP : N l , 9316 EL CAMINO AVE FOUNTAIN VALLEY,CA 92708 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: REP 963-4392 ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : REPAIR AS REQUIRED PER HOUSING CODES SQ FT: 4, 000 ADDRESS: UNIT: CLAIM VALUE; 5, 000 , 00 CALL-VALUE: 4, 000 . 00 GROUP OCC: R-1 / PERMITTEE: CHARLIE CHAO CHEN ( 714 ) 963-4392 • ADDRESS: 9316 EL CAMINO AV COMMENTS : SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY, 1991 UBC F.V. CA 92708 **********************+t+t*x*+t********+tkr*+E************* ****************kE******+ESE LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQU IR EMEN TS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: EXP: Date'. Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: hereby affirm that have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT I N • LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN Compensation Insurance. or a certified copy thereof(Section 3800, Lab. C). POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV; PARCEL; 42626318 ZNE: REF NO: , r] Certified copy is hereby furnished ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > ******************************************************************************* ate: Applicant DEVELOPMENT SERVICES R E U I R E M E N T S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). Q I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become ect to the Workers'Compensation_Laws of California. !! // oo ZONING APPROVED BY DATE: L. (-" // ' Signature: C � BUILDING APPROVED BY NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. /J�,T//J� ,� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; ( �E iF�f DATE: U I 1 (� which this permit is issued(Section 3097, Civ.C). ***'xx'******MN'****'****'*****************1F* *********************.N.*. .F {F4E"'11FFFF if iE of1F LENDER: ********************************************************************** ******** ADDRESS: LEGALIZATION;N - F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC, MECHANIC FIRE SMIP/RES GRADING (Section 7031 5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 63 . 00 - . . 50 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed % pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN - SMIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE --- • I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK ' - TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 63 . 50 0 , 00 0 . 00 _ 63 . 50 6 3 , 5 0 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• '�� 63 . 50 OVER/SHORT improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve 0 0 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC - FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 ; r , 50 ❑ and Professions Code: The projects state LicenseLaw does /TOT ot GRA to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should he provided to me. I N D I V I D U A' L' F E E BREAKDOWN N I am exempt under Section:BP7044 B.&P.C. for this reason: OWNER-BUILDER TYPETY DESCRIPTION .S C R I P T I O N S2 UNIT COST TOTAL COST Dal / - t i -1'1- Owner: - C-- ---4./(.. SFR 4000 ALTER BY VALUE RESIDENTIAL NOZONE 1 , 00 4 , 000 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END' OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from , --- these provisions. Date. Applicant: EXPIRED,)RED . I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county y, �(��/�//�,, '/A' ,C//�p,,�,,, r , ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned DATE Ati r'�! a,� /711""- r property for inspection purposes. Il ,V11 C' e /_ / / — I —✓� 4? Q�J:Q1/11 5°.5 TIME:$06 T[E7 63.50 Signature: DATE' 01/11/95 1.5:51 Driver's License or Social Security k 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor --,,-.7111111111111 r. ' --COP*STRUCTION AND PLANNING POOL 'A V' •APPROVALS Permit*,'# Date Inspector APPROVALS Permit# Date Inspector 1. jTemporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.: 53. Steel Reinforcement ,t 3.°E(eci&al Conduiil-hility-Undrgrnd. 54. Forms 4. Elecirlcal Conduit Undrgrnd. 55. Electrical Bonding • ";;5. Steel Reinforcement 56. Rough Plumbing & Pressure Test _..6. ElectricalUFER:Grnd. 57. APPROVAL TO COVE R-GUN13E ;- ``-7. Poolings 'i; 58. Electrical Conduit-Undrgrnd. ,l ;8. Foundation - 59. Gas Pipe, 0 Undrgma., Test '-9. Water Pipe-Undrb':nd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 14. Structural Floor System 61. APPROVAL TO DECK 1.1. PropertySewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewgr Cap 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing .. 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electri&Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT I 20..nRough Factory Fireplace • u;t*1 < " -' '" ' �APPROVA -'~Per. t# - rl 21;.',Ducis,irr Struct e; i r -1 t • 70. t?nderyroUnd H/dro - -- 22. Ducts, Ventilating ' i 1r • . ` , '' t * :'71. ProduciP3ping !`;'Gas C.jOil Ji 23::.Gas-pipe;Rough &test , �i :: . -i72. Underground Fiush,-:• * - ? c' . a - ____i24: Roof Ftemin9 3 ^n', i ,: i _ .73,,Undergq.SioraneTark Gasn Oil I ri, ; T- ' 25. Rood Seathin9 '`, v ••s ^.: 74:,Omerhead Hydro ; 26:-T-Bar Ceiling (St- aural) &:Mo rocoat t 75_D,ry Chemical F I 27. Frame apd Elashf g u. r 1 li r r _.14 xi . d 76. Dry Standpipe t=• &._ l 28. Lathing^& Siding- r 1 5 ., •' • " ` 77.'' FIXED StSTEc FINAL! •. rn:_. 1 y .74i i t "29. Insulation r ri I ,, •, 78..FIRE PREY. FIN' Ai_ ,'30. Drywall*NaiVFhg � r ' •� HEALTH'DEPF. R'EQUIR,EMENT' 1 . ; u.1-_, -'31. Plaster Brown Cot, r• , ton' : i I I. i .•79. 'FINAL INSPECFIUl;N , -fI '32erElectricatPd®er MeteL.Finall c m I I 1N s '080.'FOOD CERTIFICATE ISSUED 33._Fin EI ctric, ,- `t+ t n . Qf- lta# .- ,�� .e. -i n i I I 1" Notes: •3-1,� !"7 _z.L i•s �^PI�Ge'G4TF�Y1 .u34.'Final Heating;& Air.Conditioning k I a t % �i , „ I t. . ,yak - <5; ,�� P� k� of ter: 35.1Final Ga;Pipe-Test" ' ,., iI . _fr./ 7- 121:, } "7 i f i--:to-11 60/ ,.b.,.c ei •:36. Hood or Canopy . _, I * 1 I• �•4 4 ". 14 „ ly'U 37.;Fin'4I Factory Firep)aEe e, S:r Ya .,� I I ' L - 9 - `-o- ' k„,./j, �, - ii -38. Final Plumbin - i i i 1 . 13: rc c G 1 39. Water Service:Final* I I' ° n u; - I a ,40. Gas Service-Final-1. . •;t ..,I:•„• : r' Ii j I - � . • r, .l - 41. Solar Ddrnestic-Final-- `,j " , ' I ' _' -, 42. Backflow Preventer, � ; I I 1. s n• .C. -+ . ._ * ,. rat ' , - - 43. Backflow Irrigation° • .t a `''ice`1 la ;44. Landscape Irrigation Systeme rii- ho ti * p; r-1 r+ r; , lr1 pi - a ;ii ny w 'T R". (lir .• `45:Sound Attenuation' = h1 PI° ' ' `' ` ` H; ' ` .. ..a. . . ... 'i46. .Handicap Regulations Lr: ---i•- •••-• * 47.-:FINAL STRUCTURE & BUILDING I (. " "1 "i: ; _ i 48. -FINAL PLANNING i '-• .. C11 I j• n i - _ :49."Electric Release to'Edison i 1 i, ' '• ;50._.Gas Release to Southern California Gas Co ': : -1 _ :51. CERTIFICATE OF-OCCUPANCY. • , * • No. Date PROJECT ADDRESS: UNIT: OWNER'S NAME: 140 E 19TH ST 4 CITY OF COSTA MESA — BUILDING PERMIT PFRM Mn. R 070F9F „�AneGL9s: TREE, SHERMAN SITYH HUANG PERMIT NO: B 070696 PLAN CHECK NO: N GOVT: N SUPP : N 9316 EL CAMINO AVE FOUNTAIN VALLEY,CA 92708 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: DEM AecN/EADDRESS: 963-4392 REG.NO.: UNIT: JOB DESCRIPTION ; DEMOLTION TO AN ILLEGAL ADDITION # 4 SQ FT: PERMInEE: CLAIM VALUE: 300 . 00 CALC-VALUE: 1, 000 , 00 GROUP OCC : R-1 / ADDRESS: CHARLIE CHAO CHEN ( 714 ) 963-4392 • 9316 EL CAMINO AV COMMENTS : SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY, 1991 UBC pp c) cyn *************************************************it****************4*a**ln*4 ****** LICENSED060)ofiis3 the DECLARs and hereby affirm de rant am licensed under lfrorce n o t. er 9(commencing with Section 70001 of Division 3 of Business and Professions Code.and my license is in full force and euect. ZONING REQUIREMENTS CITY LIC.: STATE LIC.: CLASS: EXP• SETBACKS Date: Signature: MAIN BUILDING ACCESSORY EAILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' Compensation Insurance.or a certified copy mereol(Section 3800.Lab.C). FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN POLICYNO.: EXP.DATE: LEFT: FT IN RGHT: • FT IN LEFT; FT IN RGHT; FT IN COMPANY: PARKING REQ• PROV: PARCEL: 42626318 ZNE: REF NO: '3 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> Date: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES R E,Q U I R E M E N TS I cenily that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compen ation Laws of California. /+ nth. �— / / '7' Signature: r ��• �� ZONING APPROVED BY DATE: OTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. DATE: CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work tor which this permit is issued(Section 3097,Civ.C). APPLICATION ISSUED BY: �:A(�k 4F DATE: c# # �Ie yF� ************************************* * *** ********************** * *** LDESS: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or BLDG PMT PLUMBING ELECTRIC. MECHANIC FIRE SMIP/RES GRADING repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 25 . 00 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). . 50 • ISSUE FEE • I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS——--> 25 . 50 0 , 0 0 0 . 00 2 5 , 5 0 25 . 50 , 0 0 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED : 25 . 50 OVER/SHORT• . 00 for thepurposeolsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 25 .00 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and whocontractsfor such withCompensation insurance should be provided io theme.Contractors'State License Law).I am aware ******************************************************************************* and proof of racir foorsuch projects tihn insurance should be prursuan to me. ii I am exempt under Section: B.8 P.C. INDIVIDUAL F E E BREAKDOWN for this reason: BP7044 OWVER—BUILDER p C G� TYPE QTY DESCRIPTION UNIT COST TOTAL COST /—/ / – 1 Owner: C-/G--� - ereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and NO F EES WERE SELECTED FOR THIS PERMIT 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from �I i e :..,. , -.. y these provisions. EXPIRED ''+iii^ „ :„.,r in 7 - 1 '1O,'au ` PAT Date: Applicant, 01/11/95 TIME: 15:52 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county R ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned DATE/20444". ,A_ - %JJ C--------t--X-% pr y for inspection purposes. s,. ate: /--// Signature: - , Driver's License or Social Security p: ••-• Canary-Applicant;Pink-Revenue:Goldenrod-Assessor ' ,CONSTRUCTION AND PLANNING P00t ;PA , q?PROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector , I • 1/Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement r 3. Electrical Conduit Utility-Undrgrnd. 54. Forms '4. Electrical Condutt-Undrgrnd. 55. Electrical Bonding pi 11.4-.. -thin '5;;Steel.,RLtlnforcerrieri# 56. Rough Plumbing& Pressure Test ;' . •61;Electrical LIFER=Gird. 57. APPROVAL TO COVER-GUNITE .. 7. Footirigs -'-t 58. Electrical Conduit-Undrgrnd. -8..,Foundationi' 59. Gas Pipe, 0 Undrgrnd., Test 9: Wa;erpipe-Undrened. 60. Backwash Lines, P-Trap, 0 Undrgrnd. . 10.iStructural Floor System {f 61. APPROVAL TO DECK 11.'Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewei;Cap r,. 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing. - ,• 65. Electrical-Final 15. Rough Electrical:Conduit - 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT _ 20. Rough FactorytFireeplace ,r = � r APPROVALSTs:,Permit # ' - 21. D'ucts,.in Structure s- . •• •• •-i.. : : Cl .4+ 70. Undergronn-d HydFo .. . �, y . e 22. Ducts;Ve?rtilatjngrt I ,� i _, . y�' 7a. Product F�,rpiji6 0das 0(',,il ;;' 23. bas Pipe-Rough& Test • n'i1. PI � • .; 72. Underground Flush(I..; - - ; 1 24. Roof Framing s I D �; mit _ 73. 'Ci'ndergrnd:Storage'!'ank 0 Gas 0 Oil Fes_ a 11 of -1,$ ' - -, s 1 25. Roof Sheathing _• > n-, ' 74. verhead Hydro j-,s . i 26. T-BarCeil;ng (Structural) & Mong'coat _.� '? .,11,t r 75, rv;Chemical 27. Frame and-Flashin§: , t',,.,-1, r ., y, , 76. Dry Standpipe ;= ui - 28. Lathing &;Siding r..-;! ] •_j a t ., 1• 1 it 77, r4IXED SYSTEMdINAL , _, , 29. Insulation. _, .. 1 I• • 78. LIRE PREV. FINAtn ., - is { 30. Drywall Nailing r ; h '' HEALTH DEPT. REQUIREMENT :• 31. Plaster Brown Coat' ° • „ 1 I: 39. FINAL INSPECTION 32. Electrical Power Meter-Final ' , ' it : 80. FOOD CERTIFICATE ISS9IED 33. Final-Eleciric j ';; ,1 y x ^• • Ix , Notes: ,I *-i r, 1 :±? _ 34. Final:Heating&Air;Conditioningt • 1 1*. • Z: 7 ,-„ ,n i:, , ': i . 't ,�' 'M.- % I35. Final•Gas Pipe-fest_, ; 61,u •, I I` ` `r CIti,_ -; ' I' 36. Hood or Canopy • ' ' I F; X. ($ 37. Final-Factoiy Fireplace I Es', t• I li 38. Final Plumbing I I; _ "' '' , 39. Water-Service-Final'. _' ' I '' ° �. ' I it` .. -' '..; , 1 �- • 40. Gas Service-Final 11 - my _ i N 1 l+ •:y _ 41. Solar Domesti-Fina'I` - - l; '�. ,:: •23 42, Backflow Preventer•,4 ' ll • N • : '+ '' . _. -:i n:t^.r Y F• 43. Backflow Irrigation': tit4 '= .,, t•�• _ • o; 44. Landscape Irrigation System .•+ n_ u: • 11 7 -17 • is : ) •' 45. Sound Attenuation' F ' 'r 46. Handicap Regulations - ' - - • -•0 • 47. FINAL STRUCTURE& BUILDING 1 I r • -I 'i _ F, 48. FINAL PLANNING t ; r- - • . I ' IY PI z 49. Electric Release to Edison 1 - I ' s n 50. Gas Release to Southern California Gas Co • , ' 51. CERTIFICATE OF OCCUPANCY - - - No. Date ' ';25DRESSOF91.1ILOClG 140 E 19TH ST WIT: CITY OF COSTA MESA — BUILDING PERMIT OMNERSNAMEwmm* LEE, SHERMAN SHYH HUANG PERM NO: B 071664 1 ADDRESS: TR 9316 EL CAMINO AVE PERMIT NO: B 071664 PLAN CHECK NO: N GOVT: N SUPP : N • FOUNTAIN VALLEY, CA 92708549-5818 y APDL.MAILING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH • ARCHITECT OR ENGINEER: UC.No.: JOB DESCRIPTION : T/OFF REROOF W/BUILTUP 6 COMP SHINGLES SQ FT: 3, 138 ARM OR ENG.'S ADDRESS: MT: CLAIM VALUE: 3, 138 . 00 CALC—VALUE: 3, 138 . 00 GROUP OCC : R-1 / CONIRACTORSNAN@ GOLDENWEST ROOFING ( 714 ) 827-5371 CONTRACTOR'S MAIMS 6626 SEQUOIA DR COMMENTS: REROOF 600SF FLAT W/BUILTUP, 1900SF SLOPED W/COMP, SMOKE DET REQR ADDRESS: BUENA PARK CA uLNo.: 432088 ******************************************+F****+E+~*******+ +E�t�rat+E>t+Er*r+cr********** 90620 WIT: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby aft ion under penaly of perjury that I am licensed under provisions of Chapter a SETBACKS (commenting with Section 7000)of Division 3 of the Business and Professions Code.and my license is in full tome and effect. cmLlc.No.:036783 uc.cuss: C-39 MAO.: 43 088 XP: 00/00 MAIN BUILDING ACCESSORY BUILDING Dm.: '�i/fig/SS Contractor �� FANT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN /' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby dram under penalty of perjury that I an.exempt from the Contractors License Law for the fallowing mason(Section 7l131.5 Busmen and Prolesa«n Code:Arrycity or county»rich meninx;a Permit to construct.altar,Mixon. PARKING REQ: PROV; PARCEL: 42626318 ZNE; REF NO: demolish,or relief any stmclure_prior to b issuance.also requires the applicant for such pend to Ne a sipNd statement tun he or she • h licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Sedan 7003)el DNuion 3 d the PLANNING NOTES> liminess and Professions Code)ix the he«she is exempt therefrom and IM basis f«the alleged exemption.Ar violation of Sedan >. 7031.5 by any applicant for epernd subjects the applicant to a civil penalty of net more than five hundred dollars(S.5001). **tE**thtEth*dEthih**titE1E***ih*th***thih**tfdf***th*********tutu*tEtEihtptEth***iEtfthtf*tf*********tEtf***thif o I,as owner of the properly or my employees wkh wages as their sole compensation,Will do the work.end the structure is not intended DEVELOPMENT V E. L O P M E N T S E R V I C E S A E Q U I R E M E N hT S or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en owner of proper Q who builds or improves thereon.endsuch who does work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however.the building or improvement S sold within one year d completion,the ZONING APPROVED BY owner-builder will have the burden of proving he or she did not build or improve for the purpose d sale). • DATE: ❑ I,as owner of the properly,em exclusively cortradkp with licensed contractors to construct the project(Section 7044,Business end LJ Professions Coda:The Contractors license Law does rd appy to en owner of property wlc bolds«improves thereon end who BUILDING APPROVED BY : !/ DATE: contracts for such propos with a dwrad«(s)licensed pursuant to the Contractors License Law). Elmxm «this Reeampt«dse : B.SP.C., resaon: APPLICATION ISSUED BY; "* DATE; 771-474/11--- E** ome: Gm"' LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby candy that I em aware of end understand the requirements of California Health and Safety Code Sections 25505.25533,end 25534,and Met I or any future Wilding occupant will/evil not(circle one)need to comply wih said state codes and the requirements ler a permit for oomtruclinn or modification from the A4susTi y Mananagenwm District.Residential construction appicmions are exempt from them BLDG PMT PLUMBING ELECTRIC „ MECHANIC FIRE SMZP/RES GRADING provisions. PERMIT 63 . 00 . 50 Date: Applicant: - SMIP/NON RES WORKER'S COMPENSATION DECLARATION:I hereby arum under penalty of perjury one of the following darmbns: PLAN ISSUE FEE ❑ IhaveandwamaiMeinacertificateofcoesarttosetimureforwarkers'mWensation,asprovidedl«bySection3700ofthLabor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Coda,for the performance ol to work for*Rich this permit is blued. O I have end xis maintain workers'compensationiatrrenoe.m required by Seao,3700 d the Labor Code,for the performance of the TOTALS— > 63 . 50 0 . 00 0 , 00 63 . 50 63 , 50 . 00 work for whkh this perm is issued.My workers'compensation insurance wrier end policy number are: Carrier: REVENUE DIVISION TOTALS--> COLLECTED; 63 , 50 OVER/SHORT: . 00 / Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need not be completed t the peon4 is for one hundred dollars($1001 or lees.) 63 . 00 , . 50 ❑ I cent that in the pedom ecce of the work for which this permlt Is Sued,I shell not employ enY person In enY manner ea es to • become subject to the workers'compensation laws of California,end agree that i I should subject to the workers' {(.tf*ti**tE*********thih*dh*th*th*th***dE***dE*tEth****tf*****tf*iftftftE*ififtft{t{t(�tf-tEtEtf-tFtf*tf-{htf.tftf.tEtEiftFif-tfiy compensation provisions of Section 3700 of the Labor Code.I shall l«thwil ropky wih Dale:9;.,2946- Applicant:Vi'/./ / if/!/� a INDIVIDUAL .: F :E E B R E A K D O W N Warning:Failure m a scan wortuiaorm«usUon coveragels wfewM and awl subject anwroloyer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil lines rpt to one hundred thousand dollars($130.300A in eddNan to the cost of conpesatbn,damages as provided car In ssctm37asprmmCock the Labor anrd•vm oNaf«s SFR 3138 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 3, 138 , 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that therm is a corwnudicn lending agency for the END OF FEES performance of the work for which this permit S issued(Section 3097,CN.C). LENDERS NAME: LENDERS ADDRESS: I certify that I have read this application and stale that the above information is coned.I agree to comply with all city and county ordinances end state laws Sallie to building construction and hereby authorize representatives of this dry to enter upon the above-mentioned property for inspection purposes.MARSHALL DAVIS 01 00178 05 00178905 TOT 63.5E ( DATE: 03/29/95 TIME: 13:56 Dm /(1`/9_-- ✓ rre J Appk®rnC«nm« /' 5151<5.WP) • White-Building&Safety;Green-Fb:Canary-Appicem:Pink-Revenue:Goldenrod-Assessor rI - CONSTRUCTION AND PLANNING - POO. SPA r Date Inspector Date Inspector APPROVALS Permit# • APPROVALS Permit # 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -•3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Etectricat Conduit-Uridrgrnd. 55. Electrical Bonding 5. Steel Reinforcement-' 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER•GUNITE _ . .-7Footings .. 58. Electrical Conduit-Undrgrnd. ' ' ?8•L.FpUndation - , 59. Gas Pipe, 0 Undrgrnd., Test , '•9..Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O,Undrgrnd. 10. Structural Floor System61. APPROVAL TO DECK , '11. Property Sewer Line & House Connection - I. i P 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final ' ' 14. Rough Plumbing, :, ( . 65. Electrical-Final t 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric,1.9iririg - 67. Fencing & Access Approval • - , 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical:T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL • 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT i. 20-Rough Factory Fireplace " • ' APPROVALS_ •- Permit # 21. Ducts, inStrutture • '- •• _ - _ 70.•_Under9'round Hydro 22. Ducts,Ventilating, • 71. Product'Piping 0Gas C1011 23. Gas Pipe-Rough & i ,. 11 I. 72. Underground Flu4h' 24. Roof Framing" ri; ; - : 7.3. Undergrhd.Storage Yank 0 Gas 0Oil 25. Roof Sheathing .3113:9- (4-4,Z-_. 74. 'Overhead Hydro 26. T-Bai;Ceiling (Structural) &Monocoat - 75. Dry Chemical 27. Frame and Flashing- „ _0 • 76. Dry Standpipe 28. Lathing &Siding-' e '' ' -, •'I .. "I' 77, FIXEDSYSTEM'FINAL 29. Insulation I' 78. FIRE PREV. FINAL ' ' 30. Drywall Nailing ' , • , - HEALTH DEPT.REQUIREMENT 31. Plaster Brown.Coai - I I ,. . 79. FINAL INSPECTION 32. Electrical Power Meter-Ftnal ` '. L ' 80: FOOD CERTIFICATE ISSUED 33. Fina6Electric:. _ .- - `. Notes: 34. Final Heating& Air Conditioning's I ' I. q - I lir-3-13-r- el -' S 35. Final Gas Pipe:Test . `• .. /4. 4 !t lam`' t if ,. „Arne / - - 36. Hood or Canopy - • - ' '• : - 64-61 37. Final Factory Fireplace • t • • 38. Final'Plumbing n; t •1, I '• ' 39. Water Service-Fina. ; . 40. Gas Service-Final - . • •• ' 41. Solar Domestic-Final • '. ' 42. Backflov3.Preventeg -- 43. Backflow Irrigation, ' " ' 44. Landscape Irrigation-System " ' _ 45. Sound Attenuation _ ,• , I - 46. Handicap-Regulations _ • - 47. FINAL STRUCTURE & BUILDING „),q5U/-/_c. /i 48. FINAL PLANNING _ - r 1 `�l� ' 49. Electric Release to Edison ' • 50. Gas Release to Southern California Gas Co " 51. CERT I F ICATE OF OCCUPANCY y ' No Date ADDRESS OFSMLOINO: 140 E 19TH ST Wet: 3 & 4 CITY OF COSTA MESA - BUILDING PERMIT GYNERSNAMEIFfl *N: LEE, SHERMAN SITYH HUANG PERM NO: IP 071963 ADDRESS: TR - 9316 EL CAMINO AVE PERMIT NO: IP 071963 PLAN CHECK NO: N GOVT: N SUPP: Y FOUNTAIN VALLEY,CA 92708963-4392 APPL.AWL ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: OTH PLU PURPOSE: REP ARCHITECT ORENGINEER: US.NO.: JOB DESCRIPTION : REPAIR AS REQUIRED PER UPC SQ FT: ARCM OR Un'S ADDRESS: WIT: CLAIM VALUE: CALL-VALUE : GROUP OCC : R-1 / CONTRACTORS NAME CONTRACTOR'S MNLINO COMMENTS : REINSPECTION FEE FOR PERMIT #P70698 ADDRESS US NO.: ******************************************************************************* Wes: ZONING REQUIREMENTS UCENSED CONTRACTORS DECLARATION:I hereby dr Nader penely of palmy IM 1 am licensed under provisions of Chapter a SETBACKS (commencing rah Section 7000)of Dial,,0 of the Business and Professions Code.end my Scenes is in hug force and effect. Cm UC.NO.: UC.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING Date: Contractor: FRNT; FT IN REAR: FT IN FRNT: FT IN REAR : FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby drum under penaky of per)ury lhet I em exempt from the Comredon License Law la the reason PARKING REQ• PROV: PARCEL : 42626318 ZNE; REF NO; 'emdes ah.or rapany structure_prior to b issuance,also requires the applicant for such peemil t0 fib a signed statement that he or she licensed pursuant to the provisions of the Contractors License Law[chapter 9(oamnarvina with Section 7003)of Div'sion 0 d the PLANNING NOTES> justness and Professions Code]or thee he or she is exempt therefrom and the Mss for the eloped exemption.Am'violation d Sedbn > 7001.5 by any applicant for a pants subjects the app4era toe the penaly drat more then(wit hundred dollars 155001). ******************************************************************************* o I.as owner of the property or my employees with wages as thei sole compensation.cal do the sok and the ebcdure a not intended oroffered for sole(Section 7044,Business and PmteaaaaCods:The Corurrtprs License Lew do.sari applyto en Owners properly DEVELOPMENT SERVICES REQUIREMENTS who bolds or improves thereon,and who does such wk himself or herself orthrough he or her own employees,provided that such improvements are rot Wended or offered for sae.V.however,the building a inpro a mend is sold within one year d completion.the ownerbuider will have the bunion of proving he or she did not build or improve for the purpose of rob). ZONING APPROVED BY DATE: ❑ I,as owner of'he properly.am exMive&ooarsdig with Scented contractors to cantered the project(Sedan 7044,Business and Professions Code:The Contractors Lcsoe Law does roe apply to en owns of property who Wide or improves thereon end who BUILDING APPROVED BY DATE : Waimea ler such projects with a moradr(s)licensed pursuant to the Cotredre License Law). : / / Q] Iamexemprunder Sedion:Bp7Q44 B.AP.C..tomare®pn:QQWNER-BUILDER APPLICATION ISSUED BY: 5 DATE: r/1 gf Date: Si // 9 /1-r Owner: l� P • �.4. C...- .----. ******************** l****** + ***************u********************** 4********* I do hereby certify thatin Iaaware d and understand the requirements of Cdfrna Health and SNR'Code Saab's 25505,25505,25500.and LEGALIZATION ; N F E E SUMMARY STRUCTURAL SEGMENT:N •25534,permrdtlutlorry MursbuldggomthpentwM/wD nel(drelsre)trosdtopemp/a wlheaideWesodesend eexesobernsoeler - BLDG PMT PLUMBING ELECTRIC - MECHANIC FIRE SMIP/RES GRADING epermi ler construction an f oredmionbomtMM�t of(drnwe))neer to comply)music ndecodeon wrhexemrfrom merttsthese P PERMIT 30 . 00 Date: _ Applicant: 25* SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby album under penalty Of Perjury one of the following dedretbns: PLAN • ElI have and will maintain a cenlbconsentate ofconsentlr to sensure for wkan'compensation,as provided for byof th by Section 3700e Labor ISSUE FEE Code.frthe perfmnsro the BUILDING-DIV, > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ IhaveadMImainteioworkers•compenmaminsrra.,eareairedbySdbn37Oodu,.LabrCode,brtheperfrmancedtM TOTALS- --> 30 . 00 0 . 00 0 . 00 30 .00 30 . 00 00 work for which this pane is issued.My workers'compensation Insurance carrier and poky number are: I Canter: REVENUE DIVISION TOTALS--> COLLECTED : 30 . 00 OVER/SHORT: . 00 t Poky NumberBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not be complelso t the perm!a for one hundred dcdan Mellor mu) 30 , 00 ❑ 1 eerily that in the performance of the work ler with this permit Is hard.I dug not employ any perm In any manner so a to become subject to the workers' Mee of California,end agree those provisions. sob]ed to the woM1m' **************************************************************************compensatiocompensationn provisions of Section 37C0 of the Labor Code.I shell fort h�aa� pll'a'Oh Date: 417,7? /"-T Applicant: / w . = �� INDIVIDUAL F E E BREAKDOWN Warning:Failure tosecure workyrs_'Lronwrwdon coverage la unlawful.and shell subject ansmploesr tocrinlrS/Penns Lod TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST doll Ones rp to on.hundred thousand dollars(5104000A In ad/den to the cost of compensation.densities aa presided tor In Section 3706 of the Labor Cods.Interest and attorney's lees I .CONSTRUCTION LENDING AGENCY:I hereby affirm under pen"'of Patten nue there a M e oondnion lending agency lethe r PLU 1 PLUMBING RE-INSPECEIDN FEE 30 . 00 30 . 00 performance of the work for which this Name a issued(Section 0097.CM.C). END 'OF FEES • LENDER'S NAME LENDER'S ADDRESS: I certify that I have read this applicationrd ewe that the above information is tined.I agree to comply with all coy and county ordinances and state laws relating to building eahsauuion rd hereby authorize representatives el this city to enter upon the above-mentioned property to inspection purposes. Cfy� � -0 y- 7 A � a 5 I C- .N, 0i 00180221-00180221 TOT 30.00 / �_p Name DATE: 04/19/95 TIME: 11:45 /'� L//'v _ !Z 4.-K.—.---- Date V// t/,f /� • Signature d pewmer/AoentApplcendcantradr - (5151-46.WP) WMe-BuihGg 5 Safely;Green-9e:Crary-AppFia:Pink-Rereru:Oabruod-Assessor • . - CONSTRUCTION AND PLANNING POO SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding • 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER.GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing . 73. Undergrnd.Storage Tank ❑Gas ❑Oil 25. Roof Sheathing • 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing • 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric • Notes: 4 ( J 34. Final Heating& Air Conditioning /28. i , 9� rn �a9Ya�T+V 1+0� „new,. 35. Final Gas Pipe-Test te ;Le 36. Hood or Canopy S--(4-L21C ``(( 37. Final Factory Fireplace 38. Final Plumbing C-16.9( - 39. Water'Service-Final . 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date ( j,. PROJECT ADDRESS; , UNIT: OWNER'S NAME: 140 E 19TH ST . • 3 & 4 CITY OF COSTA MESA — BUILDING PERMIT PERM NO• P 07069R ADDRESS: LEE, SHERMAN •S•HYH !PANG TR PERMIT NO: P 070698 PLAN CHECK NO: N GOVT: N SUPP ; N 9316 EL CAMINO AVE FOUNTAIN VALLEY,CA 92708 CONSTRUCTION TYPE: PERMIT TYPE; PLU PURPOSE: REP ARCH/ENGINEER: 9 63-439 2 flEG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REPAIR AS REQUIRED PER UPC SQ FT; PERMITTEE; CLAIM VALUE: CALC—VALUE: GROUP OCC: R-1 / ADDRESS: CHARLIE CHAO CHEN ( 714 ) 963-4392 pp 9316 EL CAMINO AV rY-nn �qQ '77nqF� COMMENTS: REF: B-70695 " MISSING 2 LAUNDRY STANDPIPES LICENSEDCONTRACTK OEVLARATION: I hereby affirm than amlicensed undtf ofDYan?ofL9afiler 9(commencing with Section **********************************************' ******M'***************'********** 7000)of Division 3 of the Business and Professions Code,and my license is in full farce and effect. ZONING REQUIREMENTS CITY LIC.: STATE UC.: CUSS: SETBACKS EXP: Date: Signature: MAIN BUILDING WORKERS'COMPENSATION DECLARATION: I hereby allirm that I have a certificate of consent to self-insure or a certificate of Workers' IN : FT IN ACCESSORYFRNT: FT INBUILDING Compensation Insurance.ora certified copy thereof(Section 3800,Lab.C). t LEFT; FT IN AGHT:FT IN LEFT: FT IN RGHT; FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42626318 ZNE: REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy filed with the city Building Division. PLANNING NOTES> > I Date: Applicant: *545******4*455**********445****4*5**44****5***4*55544*****5554***4454454444454 EXEMPTION FROM WORKERS'CDMPEBSA*ON DECLARATION: (This section need not be completed if the permit 6 for one hundred MOO)or less). DEVELOPMENT S E R V I C E S " R E Q U I R E M E N T S I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. o o /� , a. j— T I ` 4—r Signature: r/G— �/C' cCLc -�-- ZONING APPROVED BY DATE: OTICE:If.alter making this decfaratioo.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. : DATE: CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Section 3097.Civ.C). APPLICATION ISSUED BY: DATE: 4 © � —t—,5 ************************************4 *******************?44154. *******************4415 * LDRESS: ADDRESS: ************************************************************************ ** *4* LEGALIZATION: N F E E S U M M .A' R Y STRUCTURAL SEGMENT: N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or BLDG PMT PLUMBING ELECTRIC MECHANIC: FIRE SMIP/RES GRADING repair any structure.prior to its issuance,also requires the applicant for such permit to Ile a signed statement that he/she s licensed PERMIT 82 ,00 pursuant tome provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5%' . and Professions Code)or mat he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN SMIP/NON—RES any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the ISSUE FEE 7— 20 ,• ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law BUILDING—DIC > PERMIT ISSSS UE PLAN—CHECK TOTAL PAID DUE does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through TOTALS————> 82 . 00 20 , 00 . 0 . 00 — ' 102 . 00 102 . 00 . 00 his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 102 , 00 OVER/SHORT : , 00 for the purpose of sale). I.as owner of the property,ane.UuSively contracting with licensed contractors to construct the project{Section 7044,Business BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ❑ and Professions Code; The Contractors'State License Law does not apply to an owner of property who builds or improves thereon 102 . 00 and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. ****4***************************455**444********4***4444555******.*.44.x.*.**.***4455 1 am exempt under Section:HP709 BP7044 B.O P.C. I N D I V I D U A L F E E H' R E A K D O W N minis reason: W_NER—BUILDER TYPE QTY D E S C R I P T I O N • UNIT COST TOTAL COST at �- / / �� Owner: �� , 1 o hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and PLU 1 BATHTUB 7 . 00 7 .00 25534 and that I or any future building occupant wiluwill not(circle one)need to comply with said state codes and the requirements for a PLU 2 LAUNDRY TUB OR WASHER • permit for construction or modification from the Air uxliiy Management District.Residential construction applications are exempt from PLU 2 SHOWER 7 . 00 14 , 00 7 , 00 14 , 00 these provisions. PLU 3 SINK, KITCHEN7 , 00 21 . 00 Date: Applicant: PLU 2 WATER CLOSET (TOILET) , 7. 00 14 . 00 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county PLU 1 WATER HEATER AND/OR VENT 7 . 00 7 , 00 ordinances and state caws relating to building construction aro hereby authorize representatives of the dry to enter upon me above-mentioned PLU 1 GAS PIPING SYS OF ' 1 TO 4 OUTLETS 5 . 00 5 , 00 property for inspection purposes. END OF FEES Dat : (-t 1 -A4 Signature: /(; -----______r01 001;'4:07-0174807 TOT 102.00 river's License or Social Security v: ` • 541-E1 :1, 1..;15 TINE: 15:51 ` 164146 White-Building;Green-Code Enforcement;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor ICONSTRUCTION AND PLANNING POOL . 'A t APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ,. 53. Steel Reinforcement 321Eletrrca'i Conduit i Iity-Undrgrnd. 54. Forms : • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 15: Steel Riinforcemetit 56. Rough Plumbing & Pressure Test , . .6/:Electrical UFER/G'rnd. 57. APPROVAL TO COVER-GUNITE .17..Footings -'y 58. Electrical Conduit-Undrgrnd. - ;8JFou• ndation 59. Gas Pipe, 0 Undrgrnd.,Test 97:Wet Pipe•UndrgrrlcJ. 60. Backwash Lines, P-Trap, 0 Undrgrnd. ,. , 10.: Structural Floor System 61. APPROVAL TO DECK 11.,Property Sewer Line & House Connection 62. Backwash & Receptor•Final 12. Sewer Cap a 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing: 65. Electrical-Final 15. Rough Electrical,Conduit 66. Solar System-Final 16. Rough Electric Wring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical') Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -, .._ , • -1 - - .1' _ 20. Rough Fa&ZoniiFir`p1ace 'i-'• _ D t" APPROVAL'S-';DPernili # ' 21. Ducts,in Structure`,. - I � - - t^ • • 70. UndergroUndil ydio r. 22. Ducts:,Vethilating`" '- •.1 - !dal 's'.r . ,-I .';. 7A. Product ��p�hg 0�as. OQiI 23. Gas Pipe-Rough& Teat 1 / :l '.• 72. Underground Flush - 24. Roof Framing•1 'Ti • . - 4) 6' 7.3. Undergrnd.Storage,t nk QGas 0 Oil ' 25. Roof Sheathing ..' " •_ ,: • - 74. Overhead Hydro . 26. T•Bar•Ceiling (Structural) & MonbSbat r-t ';; 75. Dry Chemical _ , ,: , 27. Frame and.Flashing, , to-,y • .• ). „ 76. Dry Standpipe. > C I. 1 -t • 28. Lathing& Siding : -I 5,:; • ."•. "I •'l ' 77, 'iIXED SYSTEM FINAL ; ';' 29. Insulation' 4 � I i - 78. FIRE PREY. FINAL ?.� 30. Drywall NailingS I f. : • HEALTH DEPT. REQUIREMENT r '••. 31. Plaster Brown Coat , , , I I. - 79. FINAL INSPECTION; t=- 32. Electrical Power Meter-Final I • ' I la 80. FOOD CERTIFICATE ISSyED 33. F.i'nal l`leotiic ` o : .' I , ' I' r NtesS ;, '; Oj2S:3� J • 34. Final Heating&Air ConditioningCe I I" ^''•: ' '' • 35. Final Gas Pipe-Tesr.' ; . ' • I: /' -1'Ll id C1 36. Hood or Canopy - I I . 1 .v.2.4_ 37. Final Factory FirePlabe ' • .`"tom r-„/ jr yt(27<Z>' _rJ- 1 38. Final Plumbing t Y t t' I I: ;J'.'(, ``7<, . , /7 7.;s , f S 26 UPN7 ai 39. Water Service-Final• : s 1• iii .; i,� 40. Gas Service-Final _ : 1` S _/g 5c-,', ) 41. Solar Domestic-Final - -. - 2 42. Backflow Preventer r I . • u' • .. - • 43. Backflow Irrigation _ • , ,,,. , - 44. Landscape:Irrigation System .• .,-. - •, • .. :t• - ' - ''" : _ - • - - - •. K. 1• 45. Sound Attenuation , ; TI - ' , r,;; 4: • c• - ; 46. Handicap Regulations -, r'--'?' 47. FINAL: STRUCTURE& BUI1:DING . . 1., '' '1, 48. FINAL PLANNING • ' i I ' • 'I , 49. Electric Release to Edison 50. Gas Release to Southern California-Gas Co - - 51. CERTIFICATE OF OCCUPANCY - - - No. Date I PROJECT ADDRESS; , UNIT: OWNER'S NAME: 140 E 19TH ST - 3 & 4 CITY OF COSTA MESA — BUILDING PERMIT PFPM Nn• M 070A97 ADDRESS: LEE, SHERMAN , &HYH •?3UANG TR PERMIT NO: M 070697 PLAN CHECK NO: N GOVT; N SUPP : N 9316 EL CAMINO AVE FOUNTAIN VALLEY,CA 92708 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: REP ARCH/ENGINEER: 963-4392 REG.NO.: ADDRESS: - UNIT: JOB DESCRIPTION : REPAIR AS REQUIRED PER UPN, & UHC & UBC SQ FT: PERMITTEE: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-1 / ADDRESS: CHARLIE CHAO CHEN ( 714 ) 963-4392 p 9316 EL CAMINO AV oo�y /Tpp COMMENTS : REF: B-70695 DIi ``,, rY-nn enfo7CQdPer9(commencing with Section ***********************************************************************4******* LICENSED000)ofCONTR3 of EECLARs and hereby affirm that 1 am peened untlLYprerce 70001 of Division 3 of the Business and Professions Code,and my license is in full force and effect. Z ON ING R EQU IR EMENTS CITY LIC.: Date: STATE LIC.: Signature: CLASS: S E T B A C K S EXP : WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self.insure or a certificate of Workers' ACCESSORY BUILDING Compensation Insurance.or a certified copy Inereof(Section 38110.Lab.C). FRNT FT MAIN BUILDING IN REAR: FT IN FRNT: FT IN REAR: FT IN POLICY NO.: EXP.DATE: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN COMPANY: PARKING REQ: PROV: PARCEL: 42626318 ZNE: REF NO: ❑ Certified copy is hereby furnished. ❑ Certified copy is Med with the city Building Division. PLANNING NOTES> Date, Applicant: > *******************************ifififlFlEififififiF****ifiF******#ifififiFiflt*******#t#****{fifiE*** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(51 W)or less). D E V E L O P M ENT T S E R V I C E S R E U I R E M E N T S I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become Q subject to the Workers'Compensation Laws of California. /— I /— • -Y Signature: L,...,,, .,_._,Z,. Com/ ZONING APPROVED BY DATE; NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED B Y Code.you must forthwith comply with such provisions or this permit shall be deemed revolted. DATE CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for • which this permit is issued(Section 3097.Civ.C). APPLICATION ISSUED BY: +�it iF DATE: c UNDER: ************************************* ************************** ** ADDRESS: ******************************************************************************* LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or BLDG PMT PLUMBING ELECTRIC MECHANIC . . FIRE SMIP/RES GRADING repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 18 ,00 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5 SMIP/NON—RES 5011) and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($ . • ISSUE FEE 15 . 00 I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through TOTALS————> 18 , 00 15 . 00 0 . 00 33z00 33 , 00 . 00 his or her own employees.provided that such improvements are not intended or offered for sale.II,however the building or improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTAL S--> COLLECTED: ' 33 . 00 OVER/SHORT: . 00 for the purpose of safe). L as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon 33 , 00 - and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. ******************************************************************************* I� �7 1 B.8 P.C. INDIVIDUAL F E E B_ R E A K D O W N X roram thisexempt reasonunder Section:B 157044 7099 e. . / — / OWe R—BUILDER OwnerC�/'( C// TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST . .� do hereby cenify that l am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 2 REPAIR/ALT HEATING ' UNIT/SYS W/CNTLS 9 , 00 18 , 00 25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Ouafily Management District.Residential construction applications are exempt from these provisions. • Date: _ Applicant: , I- I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned ' properly for inspection purposes. 1 / - / / Pr C�� -tee O nArEetoisos aol�4so4 Toa 31,00 J ale Signature: 9i TIt1E: 1`5:50 + river's License or Social Security et: 1641.46 Mae—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL ,PA APPROVALS Permit# Date Inspector APPROVALS Permit# - - Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. , 53. Steel Reinforcement . 3'',Electnca) ConduI 5,Jtifity-Undrgrnd. 54. Forms A. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '54;Steel Bti.inforcernerii 56. Rough Plumbing & Pressure Test -6r.Etecttical UFER.Grnd. 57. APPROVAL TO COVER-GUNid, 7.-.Footings - 58. Electrical Conduit-Undrgrnd. E:1•Fou'rfd'ation Lr `. 59. Gas Pipe, 0 Undrgrnd., Test r 9i•Wat rpipe-Undrgrnd. 60. Backwash Lines,P-Trap,0 Undrgrnd. 101:Structural Floor System 61. APPROVAL TO DECK 11..Property Sewer Line & House Connection . 62. Backwash & Receptor-Final . . . 12. SewerCap 63. Heater & Vent-Final ' 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing. ; 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric NTring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electricall Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough FaCtory;Fireplace ,�;r "} c ' 4.APPROY _. ALS'• , P_'Prmjf 4 ' 21. Ducts„in Strutsture . .. . .. . + _ - - , 70. Underground Hydro 22. putts?VeT'tiiating t' I t•- 2: K 71. Product Pgipg 0(;as QaTTl 23. Gas Pipe-Bpugh'& Test -.. s n ::. c c }.0 - 7-2. Underground Flush, -. • . J 24. Roof-Framing • :': - r•`-• •-• ri • 1 73, tpdergrnd.Storacq'fank Q'Gas 0.Oil 25. Roof Shea{hing y ., - f. .,I, , 74. Overhead Hydro _ 4. 26. T-Ban'Ceiling (Structural) & Monocoat v 71, C' r;-f t 75. pry Chemi931 44 27. Frame and:Flashing;; ) � ,: • ,.L. a• . • 76. Dry Standpipe t •M - 28. Lathing&rSiding t: is ' •' •-a 77. 'FIXED SYSTEM FIf' AL ' 29. Insulation. _ • • I i. 78. EJRE PREV. FINAL' - 30. Drywall Nailing i HEd$LTH DEPT. REQUIREMENT 31. Plaster Brown Coat , ,•,,• i fa • 79. FINAL 114ECTION, s. • 32. Etectrical_Powe'd Meter-Final ' • :u I 4.. '80. P43100 CERTIFICATE ISSUED . • 33. Final Elect?ic 1 . i• . Notes:`3iS-% t• _ /axes 7441, . 34. Final.Heating&IAir Conditioning- 7. ` s-�6,.�N at Y-- •-t.. _r , 35. Final Gas, e-Test ' y ' • ' 36. Hood or Canopy • - r t'' -; . --, L' /L / .. t 1, 4_4 LINO 37. Pillaged-dry Fireplace" ; ., - I I . ./'_/4 -'JCT • [. )147-1;./.-454-.,..4. Z. _ 38. Final Plumbing I I` :�-r �.. .• 75T.'•� Nr•-�` 39. Water ServiPe-Final u I 1, . �� -5:1C L'.,yZR7[dy"� la) _ 40. Gas Service-Final •- . i n ! i :11)---14 pS 41. Solar Domestic-Final; `- ' - ' :' 42. Backflow Preventer . - L. • x. . - • . 43. Backflow Irrigation . 44. Landscape,lrrigation System . .ii - - - n' -!' !, . -' 45. Sdund Attenuation _ °', 46. Handicap Regulations .. . 47. FINAL,STRUCTURE & BUILDING - I I �: . 48. FINAL PLANNING • • ; ' I` :1 s • t 7. 49. Etectric Release to Edison i 1 50. Gas Release to Southern California Gas Co r I• -• _ • - - 51. CERTIFICATE OF OCCUPANCY - < t - No. Date P