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Home My WebLink About420 19TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4B56 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, GOS7A MESA, GA 92626 BUILDING PERMIT Job Address: 420 W 19TH ST Suite: Vicinity: ELECTRICAL ROOM Parcel Number: 41920505 Applicant: JOHN YAR,4LIAN Address: PO BOX 55787 SHERMAN OAKS, CA Own�r: CHURCH, FIRST UNITED Address METHODIST OF COS7A MESA COSTA MESA, CA 420 W 19TH ST Conuactor: J Y BUILDERS I M S Address: PO BOX 55787 SHERMAN OAKS, CA Zip: 91413 Arch : Address: Zoning: Phone: 818-482-9228 Zip: 91413 Status: ISSUED Applied: 12/13/2004 Issued: 12/13/2004 ISSUED BY: Phone: L�YZ�D z�P: szsz� _� . � Phone: 818-893-4556 License: 703019 Eng: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REPAIR FIR� DAMAGED ELECTRICAL ROOM FOR "UNITED METHODIST CHURCH" Plan Check: Permit: SMIP Res: SMIP Com: Oth�r: Inspection: Total: $117.81 $181.25 $0.00 $2.10 $0.00 $0.00 $301.16 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Fronl 0-0 PARKING ExisUnq: o NOTES: FEE SUMMARY PLANNING & ZONING Rear 0- 0 Left 0• 0 - Rear 0- 0 Left 0- 0 � Required: 0 Proposed: 0 . Calc Valuation: Claim Valuation: Right 0- 0 Right � 0- 0 ' sio,00a.00 Sia,000.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handlcap access requiremenis under Califomia statutes and retated regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This permlt shall automatically expire and become vold it work is not commenced within 180 days, or ii work Is suspendad or abandoned tor a perlod ot 780 days. INSPECTIONS: In order for lhe work euthorized under this permit to be consldered legal, such work must comply with all applicable codes, end all requlred inspectlona end flnal epproval must be oblained. Fallure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545628 ?ae�ae (arool WORKERS'COMPENSAnON DECLARAnON: 1 hereby eMirm untler penalry of perjury one of the tollowing declaraUons: .—. / ❑ I have and will melnieln e ceNficate of consent to selt-Insure for workers' compensetlon, es provided for by section 3700 0l the Lebor Code, lar the pedormence o1 Ihe work iar which this pertnit is issuetl. ,[],_�4�h ve and will maintein workers' compensation Insurence, es requiretl by sectlon 3700 0l Ne I.abor Cotle, for ihe pertortnance ot Ihe work tor whiU Nls pertNt Is Issuetl My workers' compen er. cHon nee0 not be owl I cerUfy ihat in the peAo� compensatlon laws of C ��h.WB59_p�� Appliwn� Signa� WiLpNINO: FAILURE TO SECURE TVKKISAND DOLLARE (5100.000), �nce carrier antl pollcy number are: � Policy Number: the permitls veNed e� one hundred dW/a�s ($700) or /eu.) �"'-- LICENSED CONTRACTORS DECLARATION: anea. uc. a is Issued, I s�all not employ eny person In any menner so es to become sub�ect to Ihe workere' ne sub�ect to the workers' compensetion proNslons ot Sectlon 3700 oi Ne Lebor CoEe, 1 shall forthwith � Dat�Z' / � `(� y COVERAGE IS UNLAWFUL AND SHAIL 6UBJECf AN EM�OVEiS�TO CRIM� TIES ANO Q L FlNES UP TOONE HUNDRED ' COMPENSATION, DMl4GES AS PROVIDED f-0R IN SECTION 3706 OF THE UBOR COOE, IMEFEST, AND ATTORNEYS FEES. of Chapter 9(commencing with Sectlon 7000) of Professions CaAe, end my Iicense is in tull GONSTRUCTON LENDING AGENCV: ❑ I hereby attirm that ihere is a construction lending agency br Ihe pertormance of ihe work lor whlch Ihis permit is issuetl. (Soc. 3097, Civil Code). Lenders Neme: Signature: _ LendeYs Atltlress: Date: OWNER•BUILDER DECLARATIONS: I hereby eflirm t�at untler penalry ol per(ury that I em EXEMPT FROM TME CONTiiACTORS LICENSE LAW for �he follaxing reason (Sec. 7031.5, Buslness entl Prolessions Code: Any dry or wunry w�lch requires e permit to consWct, elter, lmprove, demdish, or repair any structure, prior to its Issuance, elso requires the epplicant br such pertnit b file e signed slatement that he ar sha Is licensed pursuent to the pmvisions of the ContreIXors License Lew (Chapter 9(commencing with Sectlon 7000) oi DlNslon 3 ot the Business end Pmfessions Code) or Ihat ha o'r she is exempt Iherelrom and the basis br the alleged axemption. Any vlWetlon ol Sectlon 7031.5 by any epplicant for a pertrtit sub�ects Ihe epplicant to a civil penalry W�nat more than tive hundred dollars ($500).): ❑ I, es owner oi the property, or my employees with wages as t�eir sole compensatlon, WILL DO THE WORK, end the siructure Is not intentlea or oHeretl for sale (Sec. 7044, Business end Professions Cotle: The Contractors License Law does not apply to an owner ot Droperry who 6uilds or Improves thereon, end who tloes such work himselt or herself or ihrough his or her own employees, providetl Ihat such improvemenis ere not intended or aHered tor sale. If, however, the builtling or improvement is sold within one year ot wmpletion, the owner-builtler will heve the burden ol 0��ng that he or she did not build or improve lor purpose o} ule.). � ❑ I, es owner of the properry, em EXCLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct the project (Sec. 70h4, Business and Protessions Cotle: The cantractars License Law does not appty to an owner at property who builCs or Improves thareon, and who contracts tor such project wlth a contractar(s) license Dursuant to tha Conirectars License Laws.). ❑ I em axempt under sec. Business end Prolessions Code lar this reeson: Signeture: Data: Owner ID veritied by tlnvers license. ❑ Yes ❑ No Drivefs license No. Vedflcetlon of Owners�ip by (type oi tlxument, i.e. - properry tex bill or daed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby cenify that no excevetlon Me (5) or more feat In depth Into which e person is requlred to descend, will be made in Conneciion with work authorized by Ihis pertnit, and that no �ulltling structura, scattdOing, lalsework, or tlemolitlon or dismentling thereof, will he moro than Nlrty-si: (36j teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Titla 8, Califomia Atlministrative Catle). � ❑ As owner-builder, I will not employ enyane ta do work which would requira a permit trom t�e Divlsion ot Indusirial Sefery, as notetl above, unleu such person hes a permit to do such work Irom Ihe diNsion. Signeture: Dete: DiWsian oi Industnal Safery Permit Number: CERTIFlCATE OF COMPUANCE AND AIJT?IOR¢A710N OF ENTTiY: I certity under penalry of perjury thet I have read this epplication and state that the inlarmation given is correct. 1 egree to wmply with all stete lews end ciry ordinences releting to building constmctlon, entl euthodze representatives of I�e Ciry oi Coste Mesa to enter upon the ebove-described property foi inspeclion puryoses. I egree not to occupy or allow occupency of eny building authorized by thls permil until final inspection. COUE �. INSPECTIONTYVE 1616 Fixetl System Finel Fire PreveNlan 1268 Pool Spe Finel 200 Final Re-Rool 201 Final BIocWRetaining Wall 202 Final Factory Fire Placa 203 Finel Sign 204 Final Demoll�lon PAg It�9L5 Date / Z - /3=f'L �/ CODE 1 INSPECTION TYPE 208 Finel MeChenitel 20B Finel PIumCing 210 Final Elecidcel 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Sile 250 Final Building/Occupancy � � (714) 754-5273 • Fex (714) 754•4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applipnt Address: Owner: ELECTRICAL PERMIT 420 W 19TH ST UNITED METHODIST CHURCH IN ELEC ROOM 41920505 DOTY, MIKE 26406 CITYLIGHT CT SANTA CLARITA, CA CHURCH, FIRST UNITED Address METHODIST OF COSTA MESA COSTA MESA, CA . 420 W 19TH ST Convactor. DOTY ELECTRIC Address: 26406 CITYLIGHT CT ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fixfs Recept OuUets Switches Non Res Appl , . Res Appl Service to 200a _ Service l0 7000a Service over 1000a Motors to thp Motors to 10hp Motors lo SOhp Motors to 100hp Motors over t00hp SANTA CLARITA, CA Phone: (818) 445-0886 2ip: 91351 Phone: (8�8)445-0886 Zip: 91351 License: 745302 Status: Applied: Issued: ISSUED BY: ISSUED 12I15/2004 12/15/2004 � � , • �- � � SCOPE OF PERMIT REPAIR FIRE DAMAGED ELECTRICAL ROOM FOR'UNITED METHODIST CHURCH' 6 LIGHT FIXTURES, 2 SWITCHES, 1 SERVICE TO 1000A, 1 MOTOR 59 10 HP, 1 SUB PANEL TO 200A � . - . - . . . ' REF: B04-02097 323.50 $0.00 $0.00 50.00 $0.00 $0.00 $6.60 $0.00 $2.20 50.00 50.00 50.00 $62.15 50.00 $0.00 $12.30 $0.00 50.00 � $0.00 Quaniity 0 0 0 6 0 2 0 0 U 1 0 0 � 0 0 0 FEESUMMARY Temp Dist System / Lighting Buswayl100ft ' Standing Section � MiscElectrical Equipmenl Transformers up to 1 kva/kw ................up to 10 kvalkw .................up to 50 kva/kw .................up to 100 kvalkw ..................over 100 kvalkw Low Voltage Equipment Low Volt Wiring Syslem / Ckt Misc. Conduit . " Misc. Conductor Circus ( gen or ride) Circus (mech ride or lighis) Chnstmas Tree Stand Fireworks Stand Other Eleclrical Fee , 50.00 50.00 50.00 50.00 $0.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 so.00 so.00 50.00 50.00 Quantiry 0 0 0 0. 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12•21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1B0 tlays, or if work is suspended or abendoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be consldered legal, such work must comply wlth all epplicable codes, and all requlred inapectlons and final approvel must be obtained. Failure to obtain inspactions end final approval will result In the ezplration of this permlt. FOR INSPECTIONS CALI: (714) 7545828 zaae-ae �eroo� WORKERS'COMWENSATION DECLARATON: � . . I hereby eflirm under penelty ol perjury one of the �ollowing Oeclaretions: � � ❑ I heve and w0� malntain a certificete ol consent lo aelf-Insure for workers' compensation, es provltled for by section 3700 of the LeDor Code, br the peAortnence of Me work for which Uis pertnil is Issued. ,� 1 have and wil� maime�n workers' compensatlon Insurance, es requlretl by sectlon 3700 of the Lebor Cotle, for the peAortnance ol Ne work tw whkh Nis pertnit is iswed. My workers' Gw�Pensetlon Insuwnce carder untl policy number ere: / Certter: �� R ac F V�.+� Policy Number. U�- � O OVO - SYj 3 (TTls secNon neetl not De canpleted il the permlt !s velued af one hundred dd/ars (S 100) ar less.) ❑ I cenity Ihat In t�e peAortnence of the work for whlch t�is permit Is luueq I s�ell not employ eny person in eny menner so es to bewme subject to the workers' compensallon lewa ol Celltomla, end egree that II I should become sub�ect ro the workers' compensetlon provislons ol Sectlon 3700 oi the Lebor Cotle, I shell lorihwit� compty with these provl i ns, � � 1 I ,/ Applicent SlgnaNre: �( f`� iT, Date: "� � Z l � y 1 � l WARNING: FNWflE YO SEGURE WORI(ERS' OOMPENSATION COVEMOE IS UNLAWFUL HJD SHALL SU&IECT Ml EMPLOYER TO CRIAUNAL PENALTIES AND CML FlNES UP TO ONE HUNOREO hKK15,4ND DqAAFE (5100.0OO�.IN ADDITION TO TME COST OF Q�lAPENSATION, DAM4GES AS PROVIDED FOR IN SELTON 37060F THE UBOR OODE, WTEREST, PND ATTORNEI"5 FEES. i LICENSED CONTpACTORS DECLAHATION: I hereby aHirtn Ihat � am licensetl under provisions ot Chapter 9(commencing with Sectian 7000) of Division 3 ot the Buslness antl Professlons Catle, and my license Is in full �ome end enea. uc. a. l �I �'3 a z ciass a C-1 u Contractors SignaW�e: � y �--' Date: 1 7. � Y � n� CONSTRUCTION LENDING AGENCV: ❑ 1 hereby aHirtn thet there is a canstruction lentling agency tor I�e pedormence ol the work tor which Ihis permit Is issuetl. (Sec. 3097, Civil Cotle). Lendels Neme: Lendefs AAtlress: Signeture: Dete: OWNER-BUILDER DECLARATIONS: I hereby ettirtn Ihat unAer penfllry oi perjury thet I em EXEMP7 FROM TNE COMRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Buslness anG Professlons Cotla: Any dry or cdi�ry whith requires e portnit to construct, elter, improva, demdis�, or re0alr any struciura, pnor lo its issuance, elso requires t�e epplicam for such pertnit to tile e signetl stet6ment Ihet he or she Is Iicensed pursuant to the pmvisions of tha Contrectors Ucense Lew (G�apter B(commenUng wlth Section 7000) of DlWslon 3 0l Ihe Busineu end Profess�ons Cotle) or that he or she Is exempt Iherefrom antl the Desis tor the elleped exemptlo�. P.ny violatlon oi SecOon 7031.5 by any epplicant for e permlt subJects the applicent to a clWl penalry of not more then five huntlred dollare (5500).): ❑ I, es ownar ot t�e D�aPeny, or my employees wlih weges as �heir sole compensa�ion, WILL DO TME WORK, and ihe slructure Is not intended or oMeretl for sele (Sac. 7044, Business and Professions Code: The Contractors Licensa Lew does not apply to an owner of pmperry who builds or improves Ihereon, end w�o tloes such wo�k himself or herselt or through his or her own employees, providad that such improvements ere not IntenAetl or oflered lor sele. tl, however, the hulltling or Impmvement Is sold vrithin ona year ot completion, Itie tiwner-builtler will have the burden ol pranng ihat he or she did not build or Improve for Durpose of sale.). � ❑ 1, as owner of 1he proparty, am EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS to conshuct ihe pmject (Sec. 7044. Business and Pmfesslons Code: The con«actors License Lew tloes not eppy to en owner ol properry who builds or improves thereon, and who coNrads tor such projea wlih e contracmr(s) license pureua�� b the Contractors Ucense Lews.). ❑ I am exemp[ under sec. Business antl Professions Code for �his reason: SignaWre: Data: Owner ID venlied by dnvers Iicense. ❑ Ves ❑ No Dnvels License No. Verillcation ai Ownership by (rype af tlaument, I.e. - properry tex bill ar tleetl): Ezpiras: DIVISION OF INOUSTRIAL SAFETY PERMR CERTFICATION: ❑ 1 hereby cenity that no excavation tiva (5) a more test in tlepth Inlo wfiic� e parson is raquiretl to tlescend, witl be made in connecUon wflh work euthodze0 Cy ihis permit, and thP� no building struqure, scaHolding, falsework, or demolitlon or dismantlinp ihereol, will be more Ihen t�lrty-six (38) feet hig�. (C�ep. 32, Grp 2, Art 2, Sec. 341, Title 8, Cdlifomla Atlministretive Cotle). ❑ As owner-bullder, I will nm employ enyone ta do work which woulA require a pertnil trom t�e Dlvislon of Industrlal Salery, es noted ehove, unless suc� person has e permit to tlo sU�h work trom the diNsion. Signature: Date: DiNsion ot Industnal Satery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIIATON OF EMRY: I certity under penalry of perjury thet I heve read this epplication end state that the infortnetlon given Is correct. I egree lo cOmply wit� ell stete laws end city ortlinances releting to building consWctlan, antl euthodze represenlatives ot Ihe Ciry ol Coste Mesa to enter upon the ebove-desc' property �or inSpeCtion purposes. I egrea not to accupy or ellow occupen�y at any builtling authonzed by this pertnit until tinel inspec�ion. .� iY1,I, , ,t��S�iqnature Of Legal Owner(s) ' �I' � �Ov �u. �Xlf � AnNOr Aui�odzetl ApO�icant Date CQOE �. INSPECTON T(PE 1618 Fixad System Final Fire Preven[ion 1266 Poal Spa Finel 200 Final RaRoo1 201 Final BIocWRetaining Wafl 202 Final Factory Fire Plece 203 Final Sipn 204 Final Demol��on . 4dIE II4�AL5 COOE I INSVECTION TYPE 206 Finel Mechanical 208 Finel Plumbing 210 Finel Eleclriw� 252 Finel Fire Prevenifon 220 Flnal Pla�ning Approval 222 FInelSite 250 FinelBuiltling/Occupenry PdiE Itffill64 (714) 754-5273 • Fex (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 420 W 19TH ST Suite: Vicinity: ELECTRICAL PANEL ROOM Parcel Number: 41920505 Appiicant: JOHN YAR,4LIAN Address: PO BOX 55787 SHERMAN OAKS, CA Owner: CHURCH, FIRST UNITED Address METHODIST OF COSTA MESA COSTA MESA, CA - 420 W 19TH ST - Contracmr: J Y BUILDERS I M S Address: PO BOX 55787 � SHERMAN OAKS, CA Zip: 91413 Arch : Address: Phane: Zoning: Phone: 818-893-4556 Zip: 91413 Phone: � Zip: 92627 � Phone: 818-893�556 License:. 703019 Eng: - � Address: ISSUED BY: StaNs: ISSUED Applied: 12/06/2004 Issued: 12/O6/2004 Phone: Zip: License: License: SCOPE OF PERMIT DEMOLISH INTERIOR WALLS, ROOF, AND REMOVE DAMAGED SWITCH GEAR IN ELECTRICAL PANEL ROOM FOR "UNITED METHODIST CHURCH OF COSTA MESA" DUE TO FIRE DAMAGE. � ' . " �� Plan Check: $0.00 Permit: $38.75 SMIP Res: $0.00 SMIP Com: $0.50 Other: $0.00 inspection: $0.00 Total: $39.25. SETBACKS . MAIN STRUCTURE� Front, 0- 0�� ACCESSORY Front'.0-0 PARKING Existi"n: o, FEE SUMMARY � Calc Valuation: - ' ' � ' Claim Valuation: , PLANNING & ZONING � �Rear' �� 0-,0 � Left �0- 0 _ - Rear 0- 0 Le(i 0- 0 / Required: 0 ; Proposed: 0 „ Si,000.00 si,000.00 � ` '�Right .0�,0�� , . ,� • - Right . 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt shall automatically explre and become voitl If work is not commenced withln 180 days, or If work is suspended or abandoned for a parlod of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with ell epplicable codes, and ell required Inapectlone and flnel approval must be obtained. Feilure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 �aawe �a�oo) WORKERS'COMPENSAnON DECLARATON: � � I hereby aMrtn under penalry of perjury one of ihe falowing dedaretions: � ❑ I have end will maintain a cenificate ot consent to sell�lnsure for warkere' compensa6on, es pravitletl for by section 3700 of the Lebor Cotle, for Ihe pertortnance of the work for w�ich Ihis permit I5 IssueG. ❑ I �ave end will maintain wwkers' compensetion insurance, es reQuiretl Dy secUon 3700 of Ihe Lahor Cotle, for the peAortnanca of Ne work tw whkh Nis pertNt Is Iswed, My workers' campensatlon �nsurence cartier entl polcy number ere: Cartier: Poliry NumEer: �sectlon need no� be wmplefed!! tAe permi! Is velued e! one �untlre0 dollars ($100) or less.) h�enify that in tha peAortnance ot Ihe work lor which thLs permit is issued, I shall not employ eny person In any manner so as to become sub�ect to the woAcers' compensetlon laws ot Celltomia, end pr a I s�oultl Decame suD�ect to the workers' compensation provislons ot Section 3700 01 the bor Cade, I sheli forthwith wmply wit� t�ese provis' �f � �) n� gn.�eN[e:,.- -� Date: �/— _ L'7 _`� WAANIN 'G. FAILURE TO SECU E ORI(ERS' TION OOVEMGE IS UNUWFUL M!D SW1Ll SUBJECT AN EMPLOYEP TO CRIMINr11 PENALTIES AND CML FlNES UP TO ONE HUNDRED TNOUSMlD OOLL4NE (5100. . ADORION T TH T OF COMPEtJSATION, DMMGES A$ PROVIDED fOR IN SECTIIXJ 3lOe OF TME LABOR CODE, IMERE5T, AND ATfORNEY'$ FEES. LICENSED CONTRACTORS DECLARATION: of C�epter 9(commencing with Sectlon 7000) ot uo. s Professions Catle, entl my Iicense is in full CONSTRUCTION LENDING AGENCY: ❑ I hereCy eRirtn thet there is a consWction lentlinp agency for the Dedormence ol the work br which this permit is issued. (Sec. 3097, Civll Catle). Lentler's Name: Lender's AdOress: Sipnature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirtn thet untler penelty oi per�ury Ihat I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Business end Professions Cotle: Any Gry or county which raquires a pertnit to tonstruct, etleq impmve, demolish, or repair eny sWcture, pnor lo Its Issuance, elso requires the eppllcant br such pertnit to file e signed statement thet he or she Is Iicensed pursuant to the provlslons of tha Contrectors License Lew (Chepter 9(commencing with Sectlon 7000) of DMslon 3 01 t�e Business and Professions Code) or t�at he or she is exempl theretrom end the basis for the alleged ezemption. Any violetion o1 Section 7031.5 by eny epPlicant tor e pertnit sub�eMs the epplicant to e civll penalty of not more than tive hundred dollars ($500)J: ❑ I, es ov.•ner of t�e properry, or my amployaes with weges as iheir sole compensatlon, WILL DO THE WORK, end the structure is not Intended or oflered for sale (Sec. 7044, Business end Professions Code: TTe ContraMors License Law does not apply to an owner of property who builtls or improves theraon, end who does suc� work himself or herselt or throug� hls or he� own emplqrees, provided t�at such improvemenis are not intendetl or offeretl tor sale. I�, however, Ihe builtling or Imprwement is sold within one year oi completion, the ov.ner-builder will have ihe Durden of proving that he or she tlid not build or improve for purpose of sale.). ' ❑ I, as owner of lhe property, am EXCLUSIVELV COMRACTING WITFi LICENSED CONTRACTORS to constmct the pmject (Sec. 7044, BuSiness and Professions Cotle: The coNrectors License Lew does not epply to an owner of pmperty who builds or impraves thereon, end who coniracts tor such prolect with e contractar(s) license pursuant to the Contrectors License Laws.). ❑ I am exemp� under sec. Business anA Professions Code for ihis reason: Signature: Date: Owner ID veritietl by Ariver's Ilcense. ❑ Yes ❑ No Drivers License No. Veritiwtlon ot Ownership by (typa oi dacument, I.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION: E�cpires: ❑ I hereby certlly Uat no excavetlon live (5) or more feet In depth Into which e person is required to descenq wlll 6e matle in connectlan wlth work authoAzed by Nis pertnl�, and that no bullding structure, sceMddinp, felsework, or tlemdiUon or Cismantling thereof, will be more �han thirty-su (36) feet high. (Chflp. 32, Grp 2, M 2, Sec. 341, Tille 8, Celifomle AGministrative Cotle). ❑ As owner-bulitler, I will not employ enyone to tlo work wNch would requlre a permit Irom the Division of Industrial Safery, es natetl ebove, unless euch person hes e pertnit lo do such work Irom Ihe tllNsion. Signeture: Dete: Divlsion oi Indusidal Sefery Permit NumDer. CERi1FlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTAY: 1 cenity under penalry oi perjury that I have read this applicatlon entl sWte thet Ne infortnetion gNen Lv correct. I egree to compty wlth ell state laws antl dry ortlinances relaUng ro building constructlon, entl authodze representetives of the Ciry ot Coste Mesa to enter upon ihe ebove-descnbed property for inspection purposes. I egree not to occupy or allow occupancy of eny building euthonzed by this permit until final inspeCtlon. COOE I. INSPECTION ME ifil6 Flxed System Final Fire Preventlon 1266 Pool Spa Final 200 Finel Re-Roof 201 Finel BIacWRetalninp Well � 203 Final Factory Flre Place Final Sipn 204 Finel Demditlon PAIE II�LS Z• CODEI wsvetnoNTvve pAiF V�lLB 206 Finel Mechanical 20B 210 212 220 222 250 Final Plumbing Final Elecirlcal Final Flre Preventlon Final Planning Approval Final Site Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesaE��CTRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 420 W 19TH ST Suite No Vicinity: UNITED ME7HODIST CHURCN IN ELEC RO� Parcel Nunmber: 4192050$ Applicant: DOTY, MIKE Address: 26406 CITYLIGHT CT Phone: (818)445-0886 SANTA CLARITA, CA Zip 91351 Owner: CHURCH, FIRST UNITED Apdress METHODIST OF COSTA MESA COSTA MESA,CA Phone: 42Q W 19TH ST Zip: 92627 Contractor DOTY ELECTRIC Address: 24612 GARLAND DR ISSUE F�E Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches VALENCIA, CA Phone: 818-445-0886 Zip: 91355 License: 745302 Status: FINALED Applied: 12I75/2004 Issued: 12/15/2004 ISSUED BY: �1 � C�OG�'� SCOPE OF PERMIT REPAIR FIRE DAMAGED ELECTRICAL ROOM FOR "UNITED METHODIST CHURCH" 6 LIGHT FIXTURES, 2 SWITCHES, 1 SERVICE TO 1000A, 7 MOTOR 59 10 HP, t SUB PANEL TO 200A REF: B04-02097 523.50 $0.00 $0.00 S0.00 50.00 50.00 $6.60 $0.00 52.20 Quantity 0 0 0 6 0 2 FEE SUMMARY Temp Dist System / Lighting Busway /100 k Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Quantity 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: 7he work aufhonzad by lhis permit sha71 comply with all applicable harMicap access requirements urttler Calitornia statutes and related � regulations. (Ord. No. 92-28, § t, 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. INSPEC710NS; In order tor the work authonzed under this permit to be consitleretl legal, such work must comply with all applicable codes, and all � required Inapeetlona and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration oi this permit. FOR INSPECTIONS CALL: (714) 7545626 [aco-co �aw� WORKERS' COMPENSATION DECLARATION: I hereby aHirm under penalry of perlury one oi the following declarations: ❑ I have end wlll malntain e cenHicate at consent b self-Insure for workers' compensation, as provided for by secNon 3700 of ihe Lebor Code, for the peAormence of the work for whith this perml� 15 Issued. ❑ I have and will maintein workers' compensaiion insurence, es required by sectlon 3700 of the Lebor Cade, for the pertormance of ihe work for which ihis pertnit Is issued. My workers' compensatlon Insurance caMer antl policy number are: Cartiar: Policy Number: (This section need nof be com0�eted I/ the permit is veluetl et one hundred dWlars ($100) or less.) ❑ I certify ihat in Ihe pertormance ol the work for which Ihis pertnit is issued, I shall not employ any person in any manner so es to become subject to Ihe workers' compensetian laws oi Califomle, entl egrea thet if I should become sub�ect lo tha workers' wmpensation provislons of Section 3700 oi Ihe Lebor Code, I shell lorihwith comply with these provislons. Applicant Signetura: Date: WARNING:FAILUREiOSECUREWORKERS'COMPENSATIq (E [YS, WFUlANDSHALLSUBlECTANEMPLOYERTOCRIA4NALPENALTIESANDCMLFlNESUPTOONEHUNDRED TiqU$ANO OOLLANE (5100,000). IN ADDITIIXJ TO TNE COST O ��VSA��ON3�€S AS PROVIDED FOR IN SEGTION 31O60F THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm Iha� I am licensed under provisions ot Chapter 9 force end effect. Lk. q Contrecror's Signelure: ot Division 3 ot the Business antl Professions Cotle, end my license is in full Class a Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm t�at there is e construction lending egency for the peAormance oF the work for which this permit is issuetl. (Sec. 3097, Civil Cotle). Lendef5 Name: Lentlar5 AdCresS: Signature: Date: OWNER-BUILDERDECL`ARA�S:Q��1iii(¢¢¢( � I hereby aNirm tha� untle�penalry o pe��. ,VI am MPT FROM TME CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Buslness end Professlons Code: Any city or counly which req Tes �pertnit Ib�c'on£tmct, elter, improva, demolish, or repair eny sirucNre, prior lo its issuance, also requires the applicant lor such permit b tile e signad statement that he or she Is Ilcensed pureuant ro the pravisions oi the Conirectors License Lew (Chepter 9(commencinq wlth Section 7000) of DlNsian 3 oi the Business end Pmfesslons Cotle) or Ihat he or she is eaempt therefrom end the basis for iha allegetl evemption. Any violation of Section 7031.5 by eny epplicent for e pertnit subjecis ihe ep011cent to e clvil penalty ot not more than five hundred dollars ($500).): ❑ I, as owner ol the property, or my employees with weges es iheir sole compensa�ion, WILL DO THE WORK, end the siructure Is not Intended or otteretl tor sale (Sec. 7044, Business end Professions Code: The Contractors License Law tloes not appiy to an owner of property who builtls or improves thereon, and who does such work hlmself or herseN or through his or her own employees, providetl ihet such Improvements e�e not in�endad or ottered for sale. If, however, �he builtling or Improvement is sold wi�hin one year of completioq the owner-builder will heve the burtlen ot proving ihat he or she did not 6uild or improve for purpose oi sele.). ❑ I, as owner of Ihe property, em E%CLUSIVELV CONTRACTING WITFi LICENSED CONTRACTORS to consiruct the prolecl (Sec. 7044, Business and Professions Code: The conirectors License Lew tloes not apply to en owner ot pmperty who builds or Improves thereon, anU who con�racts lor such projeq wIN a contrector(s) license pursuenl to ihe Coniractors License lewsJ. ❑ I am exempt under sec. Signature: Owner ID verified by drivafs IicBnSe. ❑ Ve5 ❑ No Business and Protessions Code for ihis reeson: Vedfication of Ownership by (rype oi tlocumenL i.e. - property tax blll or Ceetl): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CER7IFICA710N: Driver's License No. Date: Evpires: ❑ I hereby certity �het no excavetion Ilve (5) or more feet In tlepih into which a person is required to descend, will be mede in wnnectlon with work authodzeC by Ihis pertnit, antl Ihet no building structure, scallolding, lalsework, or demolition or tlismaniling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Celifomla Atlminlstrative Code). ❑ As owner-builtler, I will noI employ enyone to do work which would require a pertnit irom �he Division ot Intluslrial Satery, es noted ebove, unleu such person has e pertnit ro do such work tmm the division. Signature: Date: Division of Intlusinal Safery Permit Number: CERTiFlCATE OF COMPLIANCE AND AIfTHORIZA710N OF EMAY: I certify under penalry oi perjury that I have read this application antl state that ihe information given is wrtect. l agree to comply with ell state laws en0 ciry ordinances relaiing to huilding consiruction, anC eut�orize representatives of ihe Clry ol Cosla Mesa Io enter upon the ebove-described property for inspection Ourposes. I egree not to acupy or ellow occupancy oi any building authonzed by this permit until finel inspection. Signe�ure Of Legal Owner(s) AnNOr Authorized Applicent MOE �, MSiECTONTYVE 1616 Fixed System Final Fire Prevention 1286 Paol Spe Finel 200 Finel RaRool 201 Final Blxk/Retaining Well 202 Final Fadary Fire Place 203 Final Sign 204 Finel Demolition ' PAjE U� �QPEt INSPECTIONTYVE 206 Final Mechenical 208 Final Plumbing 270 Final Electrical 212 Final Fire Pravention 220 Final Planning Approval 222 Final Site 250 Final Bulltling/Occupancy PeIE �� It� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, GA 92626 ELECTRICAL PERMIT JobAddress: 420 W 19TH ST Suite No Vicinity: ATBT WIRELESS Parcel Nunmber Applicant: Address: Owner: Address 41920505 BUTLER, MIKE 3020 W HARVARD ST - - SANTA ANA CA � � �, ', /�i �- _ CHURCH, FIRST UNITED �METHODIST OF�COSTA MESA COSTA MESA; CA - 420 W 19TH ST '� Phone: 714-427-6370 Zip: 92704 Phone: Zip: 92627 Contractor: PROCESS COMMUNICATIONS DEVELOPERS INC Address: 3020 W HARVARD ST . � ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets . , Switches Non Res Appl � Res Appl Service to 200a Service to 1000a Service over t 000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communicafion drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole SANTA ANA CA - - „ ��PFione: 714-427-6370 � 2ip: 92704 . License: 696069 Status: ISSUED Applied: 07/31/2002 Issued: OB/05/2002 /i� �'/.�/�� SCOPE OF PERMIT ELEC PERMIT FOR AN UNMANNED "AT&T WIRELESS' FACILITY, WHICH WILL INCLUDE INSTALLATION OF EQUIPMENT AND 6 PANEL ANTENNAS MOUNTED ON THE INSIDE WALL OF AN EXISTING TOWER. 1 SERVICE TO 200A, 1 SUB PANEL TO 200A, t MISC ELEC EQUIPMENT (DISCONNECT SWITCH). REF: 802-00713 Quantity $23.50 so.00 $0.00 $0.00 0 $0.00 0 $0.00 0 . $0.00- �"=" 0-` $0.00 " 0 $0.00 ' � .0 $0.00 0 $0.00 0 $30.50 1 $0.00 0 - $0.00 0 $0.00 0 $0.00 0 30.00 0 $0.00 0 , $0.00 0 $0.00 0 $30.50 1 so.00 0 $0.00 0 So.00 0 $0.00 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw . .=. .................up to 50 kva/kav � .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipmenl Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or IighLs) Christmas Tree Stand Fireworks Stantl Other Electrical Fee Investlgation Fee Plan Check Fee Reinspection Fee Quanlity $0.00 0 $0.00 0 $0.00 0 $1820 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0, so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 $0.00 ao.00 50.00 TOTAL CALCULATED FEES $102.70 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 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeeliona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. / FOR INSPECTIONS CALL: (714) 754-5626 . / ri..;�.:.(•1:91 WORKERS'COMPENSAnON DECLARAnON: • � I hareb ttirm under penalry ol perjury ona ot Ihe following decleretlons: ❑ eve end will maintain a cenificate of consent to selbinsure for workers' compensetion, es proWded for 6y section 3700 of the Lebor Code, for ihe pedormence of ihe —wyork for which this pertnit Is Issuetl. ��1 heve and will maintaln worke� pensetion InsuralY'a, as requ' ed by secUon 3700 of the Lebor Code, for the peRortnance of the work tor which this pertnit Is Issued. My workers' compensetlon nce rtier end g6lic�y numDer re: I/ Cj /y Camer. -�7 � •'�GI/1// :Policy1Numbei: �� 7 � � / ��K ��0 (Ihis.section neee not be comp eted i/ the permR is velued at one hundred dollers ($100) or less.) — ❑ I certiy Ihat in the peAormence ai t�e worK �o� which this permit is issued, I shall not employ any person in any manner so as to become subject to ihe workers' compensatlon laws of Celitomia, and egrae � It I wme sub�ect to the workers' compensation provisions at Sectlon 3700 ot the Labor Catle, I shell torthwith crompy with Ihese proWsion �7' App cant Signa� � , �Oate:—�. 7i � ^ �� WARNINO�FNCURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHQL SU&IECT AN EMPLOYEP TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNORED TNOUSAND DOLIARE (5100,000), IN ADOITION TO T1E �T OF COMPENSAiION, DAMAGES AS PROyIDED FOR IN SECTION 3]Ofi OF THE LABOR CODE, IIJ�EREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATON: 9(commencing with Section 7000) of Divislon 3 af the Business antl P�qfessions Code, end my Iicense is in full CONS7RUCTION LENDING AGENCY: � ❑ I hereby a8irm ��at ihere is e construction lending agency for the pertormance of ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lendels Name: Lentler's Address: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby eHirm t�at unOer penelry ol perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Busineu antl Protes5ions Code: Any ciry or counry,which raquires e permit to construct, elter, imprwe, Aemolish, or repair eny siructure, prior to its issuence, also requires the epplicant for such permit to lile e signetl steteinent ihet he or she Is Iicensetl pursuant to the provisions of ihe Contrectors llcense Lew (Chaptar 9(commencing wlih Sectlon 7000) oi DlNsion 3 oi the Business end Professions Gbde)'or thet he or she is exempt therafrom and the �asis for ihe elleped esemption. Any violetion of Sectlon 7031.5 Dy eny eppllcant tor a perm0 sub�ects ihe epplicent to e cidl penelry ol not mofa than five hundred dallers (5500).): wn n . ❑ I, es ownei ot,the property, or my employees with wages es Iheir sole compensatlon, WILL DO THE WORK, antl Ihe structure is not intended or attered for sele (Sec. 7044, Business and Professions Cotla: ThB Conlractors Licanse Lew does not apply to an owner oi proparty who builds or improves ihereon, end who does such wo�k himself or herself or through his or he?o`wn employees, pmvided thet such impmvemenis ere not Intentle0 or oflered lor sele. If, howevar, ihe bWltling or improvement is sold wi[hln one year ol completlomthe owner-Ooiltler wlll have Ihe burden of proving thet he or she did nol build or improve ior purpose ot saleJ. � I, 85 owner of the property, am EXCWSIVELY CONTHACTING WIiH LICENSED CONTRACTORS to construct ihe projeM (Sec. 70d4, BuSiness end Pmfessions Cotle: The conirectors License Lew tloe's not epply to an owner af property who builAs or improves thereon, end who contrects tor such pmject wit� e comrector(s) license pursuant to the Contrectors License Lews.). ❑ I em exempt unaer sec. Signetura: Owner ID verified by tlnveYs Ilcense. ❑ Ve5 ❑ No Busine55 antl Professions Code fOr lhis reflson: Veriiicetlon of Ownership by (typa ot dacument, i.e. - property tax blll or deed): Dnvers License Na. Date: Explres: DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION: ❑ I hereby certify that no exceveiion five (5) or more feet in depth inlo whic� a person Is required lo descen0, wlll be mada in connec�ion with work euihorized by Ihis pertnit, and ihat no building sWcture, scaHoltling, falsework, or demolition or dismentling thereof, will be more Ihan thirty-si: (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Califamia Adminisirative Cotle). ❑ As awner-builtler, I will not employ anyone lo do work which woultl require a permit from the Division of Indusirial Selery, as noted above, unleu such person hes e permit to do such work from the tlivision. Signeture: Date: Division of Industnal Safery Pertnit Number. CER7IFICATE OF COMPLIANCE AND AUTHORIZ�1710N OF EMAV: I certify under penelty ol perjury ihat I have reatl thls epplication end state ihat Ihe infortnation given is correct. I agree ro comply with ell state laws end ciry ordinences relating to building construction, end euthonze representatives of the Clry of Costa Mesa to enter upon Ihe above-descnbed properry for inspection puryoses. I agree nm ro occupy or ellow occupancy of eny building authorized by this pertnit until final inspection. COOE �. INSVECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Hoot 207 Final Block/Retaining Wall 202 Final Factory Fire Plece 203 Final Sign 204 Final Demolition N�$ 4Qpf,a INSPECTIONTYPE 206 Final Mechanical 208 Finel Plumbing 210 Final Elec�rlCel 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy .IW_ �. � (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 420 W 19TH ST Suite No Vicinity: Parcel Nunmber: 41920505 Applicant KEVIN TRUETT Address: 5938 LAUREL CANYON BL .N HOLLYWOOD, CA PLUMBING PERMIT Phone: (818) 5058032 Zip: 91607 Owner: CHURCH, FIRST UNITED � Address METHODIST OF COSTA MESA COSTA MESA, CA Phone: 420 W 19TH ST Zip: 92627 Contractor: ULTIMATE PLUMBING INC ' Address: �5938 LAUREL CANYON BL � " Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub ClariFler System Connect (Ice,Soda,etc) Denlal Units Dishwasher Drain, Floor Drain, Rainwaler Drain, Roof Drinking FounWin Expansion Tank Gas Earthquake Valve N HOlLYW00D. CA Phone: (818) SOS8032 Zip: 91607 License: 734569 Phone: Zip: License: SCOPE OF PERMIT 1 WATER REPIPE AND 2 HOSE BIBPS. AMT $23.50 $0.00 $0.00 $0.00- $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 • FEE SUMMARY �TY AMT - Laundry Tub / Washer $0.00 0� Landscapelvigation $0.00 0 �� P-Trap $0.00 0 ' � Pressure Regulator $0.00 �0 - Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 , Sewer Connect � $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 QTY 0 0 0 0- 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: O7J05/2003 Issued: 02/05/2003 ISSUED BY: � SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bk9ow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service AMT $0.00 $0.00 $0.00 �0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 1 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 1 BO days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlona and finel approval must be obtained. Failure to obtain inspections and final approval will resuN in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2C6&OB (B/00) WORKERS'COMPENSAnON DECLARAnON: � I hereby eflirtn under panalry of perjury one oi t�e lollowing declarations: � ' � ❑ I heve end wlll malntain a certificale ot consent Io self-Insura tor workers' compensation, es pmvided for by section 3700 oi ihe Lebor Cotle, for Ihe pertormance ot the �work 1ar whlch lhl5 permit IS Issu80. I heve end will maintain workers' compensation in5urence, as required by section 3700 of ihe Lebor Cade, for Ne parfortnance ot Ihe vrork tor which this permlt Is issueA. _ y..My workers' compansation InDsurance carner and policy num0er are: �'— - Qv� b�IU V/-b i Cerrier: 7 rV M'� b/ I�1C S'��'! � IA��( 4r PoicyNumber: (Ttiis section neetl not be comp/ete0 i! tne Oermlt Is velued er one hundred dWlars (St00) or less.) ❑ I certity Ihet in the peAortna e work for which this pertnit is issued, I shall not employ eny person in any menrier so es ro Cecome subject to iha workero' compensatlon laws ol Ce' nd egrea t�et Ii I should become su0�ed to tha warkers' compensation provisions of Sectlon 3700 oi ihe Lebor Cotle, I ahall torthwlth comply wlih these provi s n AppllcaJnt�=igneture: ;Date: l� `' � U� WARNINO: FAILURE TO SE WORKERS' COMPENSATIqJ COVERAGE IS UNLAWFUL AND SW1LL SU6IECT FN EMPLOVER TO CFllMINAL PENALTIES AND GVIL FlNES UP TOONE MUNDRED hqU5AND00LLARE($1 ),INADDRIONTOTNEWSTOFCOMPENSATION,OAMAGESASPROVIDEDf-0RINSECTION3lOeOFTHEUBORODDE,IMEFEST,ANDFTTOFNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby.eMirtn that I am licensed under provisic m e a�a enac. u�.-« =7 J M rc 4,� CONSTRUCTION LENDING ol C�apter 9(commencing with Sectlon 7000) oi Division 3 of Ihe Business e tl Protessions Cotle, and my license Is In full Cla�ss Ny� � o� ate:_� � ' 03 ❑ I here6y aHirm Ihat there is e consiruclian lending egency for Ihe pedormance of iha wark for which this permit is issued. (Sec. 3097, Civll Code). Lenders Neme: lentlar's Address: Signature: Date: OWNER-BUILDER DECLARATONS: I hereby eflirtn that under penelry of per�ury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business antl Professlons Code: Any ciry or counry which requires e permit to construc4 elter, improve, tlemolish, or repalr any sirucNre, prior to its iuuance, elso requires the epplicant tor such pertnit to file e signed statement that he ar she Is Iicensed pursuent lo ihe proNsions oi tha Coniractors LJcense Lew (Chapter 9(commandng wlth Seclion 7000) of Division 3 of the Business end Professians Code) ar that ha or she Is axempt therefrom end tha besis tor the ellegetl exemptian. Any violetion of Section 7031.5 6y eny epplicant for e pertnll sub�ecis the epplicant to a civil penalry oi not more than live hundred dollars ($500).): ❑ I, es owner ot ihe properry, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the structure Is nol intentletl or oXared lor sale (Sec. 7044, Business and Professions Code: The Contrectors License Lew does not apply to an owner ot properry who builds or improves Iheraon, antl who does such work himself or herselt ar thraugh his or her awn employees, pravidetl thet such improvements ere not intended or aHereO for sele. II, hawever, ihe building ar improvement is soltl within one year oi completioq the owner-builder will have the burden ot provinp ihel he or sha did not build or imD�ove for purpose oi sale.). ' ❑ I, es owner of Ihe property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business and Professlons Code: The contrectors License Law aoes not epply ro en owner of propeny who bullds or Improves Ihereon, antl who coNrecis lor such prolect with a contrector(s) license pursuant to the Comractors License Lews.). ❑ I em e:empt under sec. Business anA Profossions Cotle for ihis reeson: Signature: Date: Owner ID veAfied by drivers license. ❑ Yes ❑ No Dnvefs License No. Expires: VerlTication of Ownership by (type of dacument, i.e. - property tex bill or deed): OIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION: ❑ I hereby canity ihat no exwvation five (5) or more feet in tlepi� into which a pereon is requlred to descend, will be made in wnnection with work authorized by ihis permit, and ihat no builtling structure, scailolding, lelsework, or demolition or dismantling Ihereof, will De more ihan ihirry-six (36) fee� hig�. (Chap. 32, Grp 2, An 2, Sec. 341, 71t1e B, Califomia Administrative Code). ❑ As owner-builder, I will not employ enyone to do work which wauld requlre a permit from t�e Divlslon ot Industriel Sefery, as notetl above, unless such peraon hes e permit to do such work from the division. Sipnatura: Date: Division of Industrial Salety Pertnit Numbar: CERTIFlCATE OF COMPLIANCE AND AUiHORVATON OF ENTRY: I certiy under penalry ol perjury tha� I have read Ihls application end s�ate that the information given is correct. I agree to comply wlth all state lews end city orAinances relating to bulltling consiruction, antl euthodze representatives ot the Ciry of Costa Mesa to enter upon the above-descn�ed properry for inspaction purposes. 1 egree not to occupY,er allow occuDanq ol eny building authorized by t�is permit until final inspection. COOE �. INSPECTIONTYVE 1618 Fixed System Final Fire Preventlon 1266 Pool SDe Finel 200 Finel RaRoof 201 Finel BIocWRetaining Well 202 Final Factory Fire Place 203 204 Final Sign Final Demolition p1TE IIfTITIpLS CODE� INSVECTIONTYFE 206 Final Mechanical 208 Finel Plum6ing 210 Final Electrical 212 Final Fire PrevenUon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency 0 .1II.. / � !/4: L'JJ (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 420 W 19TH ST Suite No Vicinily: CINGULAR CELL SITE Parcel Nunmber: 41920505 Applicant: VICK,SHON Address: 1205 S DUPONT ST ONTARIO, CA Owner: CHURCH, FIRST UNITED Address METHODIST OF COSTA MESA COSTA MESA, CA 420 W 19TH ST Phone: 909-223-2818 Zip 91761 Phone: Zip: 92627 Contractor: BECON CONSTRUCTION COMPANY Address: 1205 S DUPONT AV ISSUE FEE Temp service test Res. a/c package New Res (7-2 units) New Res (3+units) Pool I Spa Lighting Fixis Recept Outlels Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Molors to 50hp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intertned Pole ONTARIO, CA Phone: 909-223-2818 Zip: 91761 License: 465543 Status: ISSUED Applied: 03l072006 Issued: 04I172006 SCOPE OF PERMIT INSTALIATION OF A NEW STAN0.BY DC POWER PLANT WITH ASSOCIATED BACK-UP BATTERIES INSIDE AN EXISTING EQUIPMENT ROOM AT A CELL SITE FOR CINGULAR WIRELESS. 523.50 30.00 $0.00 50.00 50.00 $0.00 50.00 so.00 50.00 50.00 50.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 50.00 50.00 50.00 Quantiry 0 0 0 0 a 0 0 0 0 0 0 0 0 0' 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway I100 N Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand ' Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantiry $0.00 0 $0.00 0 $0.00 0 $72.80 4 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES 596.30 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shail comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28. § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codas, antl all requlred Inepeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of lhis permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnONDECIARAnON: ' I her�by eflirtn under penalry oi perjury one ot t�e Idlowing Oedaretions: ❑ I have and will maintain a ceNficate oi conseni to selhlnsure tor workers' campensation, es pmNded tor by section 3700 0l lhe Lebor Code, tor tAe pertormanca of Ihe w -}or which this pertnit is issuetl. -� I �ave entl will maimain workers' compensation in5urance, as require0 by section 3700 oi the Lebor Cotle, lor Ne pertortnance ot ihe work for which this pemut Is issued. � entl policy number are: etone Po� ty Number: W� ,t„ 3 b 0 T� I orlessJ �—�� ❑ I cetlily chat in Iha pertormance of Ihe work tor whic� this permtt is Issuad, I shell nat employ eny person in eny manner so es to become subject to ihe wo�kers' compensetlon laws of Califomia, end agree that II I shoultl beco�b�ect Io Ihe workers' compensatlon pravislons ot Sectlon 3700 0l the Lebor Code, I s�all lanhwith comply with ihese provisians. � / /O / ApwllLeni Signeture: �� • � rDl_ _- 1 � 7 1 b WA{WINO: FAILURE TO SEWRE WORKER$' COMPENSATION COVEMG@ IS UMAWFUL ANO SNALL SOBJECT AN EMPCOVER TO CRIMINAL P NALTIES D CNIL FlNES UP TOONE HUNDPED TIqUSANO DOLLARE (5100.0OO�.IN ADDITION TO TNE CQST OF COMPENSFTION, DMAAGES 0.S PRWIDED FOR IN SEGfION 3�08OF THE IABOR CODE INTEREST, M1D ATTOfiNEYS FEES. LICENSED CONTRAC70RS DECLARATION: I hereby eHlrm ihal I em licensetl under provlsions of Chapter 9(cammencing with Section 7000) ot Division 3 of �he Business brce entl eflect. Lic. a Clau a . �Contrdc�ar's.SlgneW�e: �— � Date: " �'f' CoCe, end my license is In tull CON57RUCTION LENDING AGENCV: ❑ 1 hereby aXlrm that there is e Consiruction lending agenty lor the DeRormance of the work lor whic� ihis permR Is Issued. (Sec. 3097, Civil Cotle). Lentler's Neme: Lender's Address: SlgnaNro: OWNEF7-BUILDER OECLARATONS: Dete: I harepy effirtn Ihet untler penalry ai perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business entl Professions Cotle: A�y �iry or county w�ich requ�res e permit to wnsiruct, alter, improva, Aemolish, or repair any sWCWre, prior to its issuance, elso requires the aODlicam for such pertnit to flle e signetl statement that he or sha is Ikensed pursuani to ihe provisions ol Ihe Cantractors License Lew (Cnapter 9(commencing wit� Sectlon 7000) of Division 3 oi Ihe Business antl Pratassiorts Cale) or that he a she ts exampi t�aratrom a�tl the Oasis toa the alleged exemption. Aay viWation ol Section J031.5 by any applicant tor a permU subjeG�s ihe eppliwnt to a civil penalry ot not more ihan live hundred doilars (5500).): ❑ L as owner ol t�e D�oPenY� or my employees with wages as their sola wmpensation, WILL DO THE WORK, antl t�e structUre is no1 intentled or oHered tor sele (Sec. 7044, Business and Professions Code: The Coniractors License Law dces not epply to en owner of properry who builds or fmproves Nereon, antl who does such work himself or herself or Ihroug� his or her own employees, providetl �hat such improvements era not intendetl or oHeretl for sale. ��, however, the building or improvement is Sold within one year ot wmple�ion, the owner-builder vnll have Ihe burGen of proving �ha� he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of Ihe properry, am EXCLUSIVELY CONTRACTING WRH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business antl Professions Code: The contractors License Law tloes not apply to an owner of propeny who builds or Improves ihareon, and who contrecls br such projact with a coniractoqs) fcense pursuant to the Contractors License Laws.�. ❑ I am axampt untler sec. Business end Professions Code for Ihis reeson: Signalure: Date: Ownef ID veAfied by drivers license. ❑ Yes ❑ No DAvers Ucense No. Vedlicetion oi Owners�ip by (rype ol tlocument, i.e. - property tau bill or deetl): DIVISION OF INDUS7RIAL SAFETV PERMR CERi1FIGATION: E:pires: ❑ I hereby certity that no excavaUon tive (5) w more leet in depth into whic� e person is requlred to descend, will 6e maCe in connection with work authorized by 1Ms permit, entl t�al no building strudure, sceflolding, falsework, or demolition or dismantling Ihereot, will be more then thirty-six (38) leet hig�. (Chap. 3.2, Grp 2, An 2, Sec. 341, Title 8, Celifornia AdminisValive Code). ❑ As ownervbuiltler, I will not employ enyone m tlo work which woultl reQuire a permit from lhe Division ol Industnal Salety, es noted ebove, unless such person �es e permil to do such work from the division. SignaWre: Date: Divisio� ol lntlustnal Sefery Permit Number: CER71fICATE OF COMPLWNCE AND AUTHORIZA710N OF EMRY: I cenity under penalry of perjury ihat I have read this appliwtlon and state t�at ihe infortnatlon given is correct. I egree to wmpty with all stete laws entl ciry ortlinances relating ro builtling consiruction, and euthonze representatives o� the Ciry ot Costa Mesa to enter upon the ebove-describetl properry tor inspection purposes. I egree not to acupy or allow occupancy ot any building auihorized by t�is pertnit until final inspection. � Signaiur f Le�Oyner( Date �� 7/ O 6 �� i � AnNOr Authodzed Appllcant + Date � � CODE �, INSPELTIONTYPE QdIE lIi$1SL5 1618 Fixed Syslem Final Fire Prevention 1266 P�I Spe Finel 200 201 202 203 204 Final Re�Rool Flnel BIocWRetelnlnp well Flnal Factory Fire Place Final Sign Final Demolition CO�E� INSPECTONTYPE 206 Flnel Mechanical 20B Finel Plumbing 210 Final Elec�rical 212 Final Fire Preventlon 22p Finai Planning Apprwal 222 Final Site 250 Final Building/Occupancy Q�lff It�LB �- :�c+_. r. (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 420 W 19TH ST Suite: Vicinity: BELL TOWER 8 ADJ BLDG @ 1ST UNITED Parcel Number: 41920505 npplicant: HICKS, MARK Address: Owner: CHURCH, FIRST UNITED Address METHODIST OF COSTA MESA COSTA MESA, CA 420 W 1gTH ST Zoning: Phone: 714-412-0001 CELL Zip: Phone: 2ip: 92627 Contracror: PROCESS COMMUNICATIONS DEVELOPERS INC Address: 3020 W HARVARD ST � Phone: 714-427-6370 Status: ISSUED Applied: 02/25/2004 Issued: O6/24/2004 ISSUED BY: ti-- SANTA ANA CA Zip: 92704 License: 696069 nrch : Eng: SOHAIL SHAH Address: � Address: URS CORP Phone: SAN DIEGO, CA Phone: 619-294-9400 1615 MURRAY CANYON RD STE 1000 Zip: License: 92108 License: C60216 SCOPE OF PERMIT INSTALLATION OF A WIRELESS ANTENNA FACILITY WITH 6 ANTENNAS FOR "AT&T WIRELESS) OtJ THE BELL TOWER OF UNITED METHODIST CHURCH. AN ATTACHED STRUCTURE TO THE CHURCH WILL HOUSE THE EQUIPMENT. 2 CONDENSING UNITS WILL BE INSTALLED ON THE ROOF OF A ONE-STORY BLOG, AT THE RIGHT REAR OF THE PROP, TO COOL THE E�UIPMENT ROOM. REF: ZA-03-107 Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: FEE SUMMARY $2Q8.81 $321.25 $O.00 $4.20 $Q.00 - $0.00 $534.26 PLANNING & ZONING SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 Rear 0. 0 Left 0- 0 Calc Valuation: Claim Valuation: Right 0- 0 Rear 0- 0 Left �0- 0 Right 0- 0 $20,000.00 s2o,000.00 NOTICE: The work authorizetl by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all required inspaetlons end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (7Y4) 7545626 . 2d66d6 WORKERS'COMPENSAnONDECLARAnON: I hareby eXlrm under penalty oi pe�jury one of ihe �ollowing daclaratlons: ❑ I heva and will malntain a certificete oi consent to selt-Insure for workers' compensetion, es provided for by seaion 3700 oi the Labor Code, for ihe peAormence of the work lor which this perrttit Is Issued. ❑ I have and will maintain Workers' compensa0on insurance, es required by sectlon 3700 of the Labor CoOe, tor �he pertortnance of tha work for which this pertnit Is Issued. My worker ' com nsetlon uranc/g)�arri r�a/n�dp'/pII nump�/ , /� //; � /.� Cerrier. �, 6:U�` —/-�6-r.�• !�/�1/ Po��ryNumher: Il07YY�SU� (Thls section need not be comple(e011 tbe Oermit is valued et one hundred oollers ($f 00) or /ess.) ❑ I certity Ihet in the pertofma�ce of the work for which this pertni is issued, I shall not employ eny parson in any manner so es to become sub�ect to the workers' cumpensetiun laws ot Califomla, and egre at it I iould be me sub�ect to the workers' compensetion prarisions o} Sectfon 3700 M iha Lebor Code, I sheil torihwith comply with ihese Dravi ' s. ApplicentSignaNre: Date: �/_�� WARNINO: FAILURE TO SECURE'�'ORKERS' COMPENSATI N CAVERAOE IS UNLAWFUL AND SHNLL SUBJEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TTqUSAND OOLLARE (5100.000�, IN ADDRION TO THE COST OF COMPENSATION, DAhNGES AS PROVIDED FOR IN SECTIIXJ 3]O60F TME IABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn thal I am licen5,ed untleri ro s}° s 1 hapter 9(crommencing with Section 7000) of Division 3 of the Busine�tl Professions Code, anA my license is in full lorce entl ettect Lia p '� B� /� Class p Contractofs Signature: �� Date: CONS7RUCTION LENDING AGENCV: ❑ I hereby aHirtn that there is a construction lending agency tor the peAortnance of the work for which this permit is issued. (Sea 3�97, Givil Cotle). Lenders Neme: Lenders Adtlress: Signature: Dare: OWNER-BUILDER OECLARA710NS � I hereby ettirtn ihet under pena�ry of parjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business an0 Prateulons Cotle: Any ciry or counry whicd requires e permit to consimct, elter, Improve, demolish, or repair eny structure, pnor to its issuance, elso requires Ihe applicant for such permit b flle e signed statement ihat he or she Is Iicensetl pureuent to the pmvisions of �he Contracrore License Law (Chaptar 9(wmmencing with Section 7000) of DlWsion 3 oi the Business entl Professions Code) or Ihet ha or she is axempt iherelrom end the basis for the ellegetl exemption. Any violetion of Section 7031.5 by any epplicent for e parmit sub�ects the epplicent to a clvil penalty oi not more ihan five huntlra0 tloliers ($500).): � I, as owner of ihe properiy, or my employees wlth wages es iheir sole compensetlon, WILL DO 7HE WORK, antl the structure is not intentletl or oHeretl for sele (Sec. 7044, Business and Pro�essions Code: The Contractors License Law does not apDly to en owner of property who builds or improves thereon, end who does such work himself or harseN or through his or her own employees, pmvided that such impmvemenis are not imentletl or ottered lor sale. It howaver, Ihe building or Improvement Is sold within one year of rAmplation, the owner-builtler will have Ihe burdan oF proving that he or she did not build or improve tor purpose of sale.). � ❑ 1, as owaea at the prapeM1y, am EXC W SIYELY CONTRAC7ING W IiN UCENSED CON7RAC70RS to wnsWct the project (Sec. 7044, Business a� ProSessions Code: The coniractors Ll�ense Lew tloas not epply to en owner ol property who builds or Improves ihereon, and who contrects lor sucp pmject with a contrector(s) license pur5uant lo �he Con�reciors License Laws.). . ❑ I am eaempt under sec. Business antl Professions Cade for this reason: Signature: Da�e: Owner ID verifiea by driver's liCensa. ❑ Yes ❑ No Drivefs License No. VedFlcatlon of Ownership by (typa of document, i.e. - propeny ta: blil or deed): OIVISION OF INDUSTAIAL SAFE7Y PERMI7 CERTIFICATION: Expiras: ❑ I hereby certily that no e%�evetlon five (5) or mora teet in deplh into which a person Is requiretl to tlescend, will ba made in connection with work eutho�zetl Dy Ihis permit, and that no builtli�9 sWdure, scaftolding, talsework, or tlemdi�ion or dismantling ihereof, will ba more Ihan t�irry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, Califomia AOministretive Cotle). ❑ As owner-6uiltler, I will not employ enyone to do work which woultl require a permit Irom the Division of Industriel Safery, as notetl above, unless such person has a permit to tlo such work tiom ihe division. Signature: ' Date: Division ol Indusirial Safety Pe�it Number. CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certiy under penalry ol perjury that I have read this applicalion and state that ihe Intormation given is correct. I agree to comply with ell steta lews end city ordinances releting to builtling constructlon, and autharize representetives af Ihe Ciry ot Costa Mesa to enter upon the ebove-descnbed property lor inspection purposes. I egree not to occupy or allow occupency ol eny building authorized by this permit until final insDeciion. � igneture egal ner(s) � Lle„ / AnNOr Autho�nn d Appliwnt � Date � COUE I. INSPECTIONTYVE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Rooi 201 Finel BIocWReteining Well 202 Final Fectory Fire PlaCe 203 Final Sign 204 Final Demolition Pdg L�+TID9L5 COOE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elec�rical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinyOccupency neg uame�i Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: ELECTRICAL PERMIT 420 W 19TH ST BELL 70WER & ADJ BLDG @ iST UNITED CHURC 41920505 HICKS, MARK 3020 W HARVARD ST SANTq ANA CA Owner: CHURCH, FIRST UNITED Address METHODIST OF COSTA MESA COSTA MESA, CA 420 W igTH ST. � Phone: 714-427-6370 Zip: 92704 Phone: Zip: 92627 Contractor: PROCESS COMMUNICATIONS DEVELOPERS INC Address: 3020 W HARVARD ST �� ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motore to ihp Motors to 10hp Motors to 50hp Motors to 100hp SANTq qNA CA Phone: 714-427-6370 2ip: 92704 �icense: 696069 ISSUED BY: Status: ISSUED Applied: O6/24/2004 Issued: 06/24/2004 SCOPE OF PERMIT INSTqLLATION OF A WIRELESS ANTENNA FACILITY WITH 6 ANTENNAS FOR "AT&T WIRELESS) ON THE 6ELL TOWER OF UNITED METHODIST CHURCH. AN ATTACHED STRUCTURE TO THE CHURCH WILL HOUSE THE E�UIPMENT. 2 CONDENSWG UNITS WILL BE INSTALIED ON THE ROOF OF A ONE-STORY BLDG, AT THE RIGHT REAR OF THE PROP, TO COOL THE EQUIPMENT ROOM. 3 LIGHT FIXTURES, 4 OUTLETS, 7 SWITCH, 1 SERVICE TO 200A, 2 MOTORS TO 1 HP REF:604-00425 _ _ . _ ' $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $3.30 $4.40 $1.10 $0.00 $0.00 $30.50 $0.00 $0.00 $9.50 $0.00 $0.00 $0.00 Quantity 0 0 0 3 4 . 1 0 0 1 0 0 2 0 0 0 FEESUMMARY Temp Dist System / Lighting Busway I100 H Standing Section� Misc Eleclrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kvalkw .................up to 100 kva/kw ..................over 100 kva/kw Low Volfage Equipment Low Volt Wiring Syslem / Ckt Misc. Conduit Misc: Conductor Circus ( gen or ride) Circus (mech dtle or lights)- Christmas Tree Stand - Fireworks Stand Other Electriral Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorized by ihis pertnit shall compty with all applicable handicap access requirements under Calitornia 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 consideretl legal, such work must comply with all applicable codes, antl all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (71q) 754-5626 24d6d6 (6/00) WORKERS'COMPENSATON DECLARAnON: - I hereby atlirm under penalry of perjury one of the following tleclaretions: � 1 heve and will maintain a certificate of consent to setl-Insure for workers' compensation, as provided for by section 3700 of the Lsbor CoAe, for ihe peAortnance of Ihe work tor which this parmit is issued. ❑ i I heve end will maintain workers' compensatlon Insurence, es require0 Oy section 3700 oi Ne Lebor Cotle, tor cha pertortnance of Ihe wark for which ihis permit Is issued. M workers' o en ation InSur ce carder e�o�l�i�j numDer er � / �/ Carrier:Y rtP � �W-P ...��CL� • � PolicyNumber. �� ' K'�3 (T1U5 secNon need nof be completed il the permit !s ve/uetl et one hundred dollars ($100) or less.) ❑ I certiy thet in ihe pertortnance of the work for whl this permit is iuued, I shall not emplay eny person in any menner sa es ro become subject to ihe workers' compensetlon lews o� Califomia, entl a e that I shoula come subject to the workers' compensation prodsions oi Section a700 oi Ihe Labor Code, I shell forthwith comply with Ihese provis' n. � /�� App6caM S{gnetura: '- _ � _ Data: �j WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AN� SNALL SUBJECT AN EMPLOVER TO CRIMINAL PEW1LilES AN� GVIL FlNES UP TO ONE HUN�RED TqUSAND OOl1ARE (51 W,000�, IN AOtlmON TO THE COST OF COMPENSATIIXJ, DMWGES PS PROVIDED FOR IN SECTIIXJ 3'1O80F THE IABOR CODE, IMEREST, AND ATTOqNE`fS FEES. LICENSED CONTRACTORS UECUIRATION: I hereby aHirtn that I em Ilcensetl u er r ions ol Chapter 9 commencing with SecUon 7000) ot Division 3 of Ihe Businas� Professions Cotle, enA my license Is in full farce end eHect. Lic. q� �ii ��g Class M. Contrectors Signature: _� Date: �� CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that there is a Construction lentling egency lor Iha peAormance of the work tor which this permit is issued. (Sec. 3097, Civil Code). Lenders Nema: Lentler's Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby etllrtn thet under penalry of perjury Ihat I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry which requires e pertnit to construct, alter, improve, demolis�, or repair eny structure, prior to its issuance, elso requires ihe apDlicent lor such pertnit to tile e signed statement �het he or she Is IicenseA pureuant to the pwNsions of t�e Contrectors License Lew (Chapter 9(wmmencing with Section 7000) af DlWslon 3 oi the Busineu end Professions Code) or Ihet ha or she is exempt therefrom and Ihe basis for Ihe alleged esemption. Any Wolation ol Section 7031.5 by eny ap011cant for a pertnit subjects Ihe epplicant to a civil penalry oi nat more than flve hundred dWlere (5500�.): ❑ I, es ownar of the property. or my employees wlih wages as thelr sole compensation, WILL DO THE WORK, en0 ihe siruccure is not intendetl or oHerad for sele (Sec. 7044, Business and Protessions Code: The Contractors License Lew tices noi apply to an owner of properly w�o builds or improves ihereon, antl who tloes such work hlmself or herselt or Ihrough his or her own employees, provltled ihat such improvements are nol Intendetl or oXered tor sale. If, however, �he building or improvement is sold within one year of comple�ion, the owner-builder will heve Ihe burden of proving that he or she ditl not build or improve for purpose ot sale.). ❑ I, es owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to con5lrucl Ihe project (SecJ044, BuSiness antl Professions Cotla: The conirectors Licens9 �w does not epply to en owner ol property who builds ar improves �herean, entl w�o contracls lor such project with e contrector(s) liCenSe pur5uant to the Contractors License Lews.). ❑ I am exempt under sec. Business and Protessions Code tor this reason: SigneWre: Data: Owner ID vonlied by driv6r's licen5e� ❑ �es ❑ No Drivers License No. Expir05: Venfication af Ownership by (rype af document, i.e. - property tex blll ar deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity Ihat no excavation five (5) or more leat in depth into which a person is required to descend, wlll be made in connection wit� work authorizatl by this permit, end that no building stNcture, scalloltling, lalsewark, or demolition or tlismantling thereol, will 6e more ihan thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, Califomia Atlminis�reHve Cotle). ❑ A5 ownef-Duilder, I will not employ enyone Io do work which woultl require e Dermil irom the Division ol Industnel Satety, 85 noted ebove, unle55 5uch pereon has e permit to tlo such work irom the division. Signature: Date: Division ol Industrial Safery Partnit Number: CEHTIFlCATE OF COMPLIANCE AND AllIHORIZATON OF ENTRV: I certify under penalry ot perjury Ihat I hava read this applicetion and state �hat the informe�ion given is correct. I agree to comply with all slate laws end ciry ordlnances relaiing to building construclion, end authorize representatives ol Ihe Ciry of Costa Mesa to anter upon ihe eDove-described property for inspection purposes. I agree not to occOpy or ellow acupency of any building authonzed by Ihis permit until finel inspection. � Sign 01 IOwner( / 2atei C, � And/Or Authorized Applicant . Date COOE �, INSPECTIONTYVE 1616 Fixetl System Final Fire PrB�ention 1266 Pool Spe Final 200 Finel Re-Root 201 Final BIocWRetaining Wall 202 203 204 Final Factory Fire Place Final Sign Final Demolition Qejf AL COOE I INSPECTION TYPE 206 Final Mechenical 208 Final Plumbing 210 Final Eleciricel 212 Final Fire Prevention 220 Flnal Planning Approval 222 FinalSite 250 FinalBuilding/Occupancy Pdg 1[�L6 �''�--�— � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Adtlress: Suite No Vicinity: Parcel Number: ^ !'i Appliwnt: Address: MECHANICAL PERMIT 420 W 19TH ST AT&T WIRELESS AT 1ST UNITED CHURCH 41920505 HICKS, MARK 3020 W HARVARD ST SANTA ANA CA Owner: ' CHURCH, FIRST UNITED Address: METNODIST OF COSTA MESA � COSTA MESA, CA 420 W 19TH ST Phone: 714�27-6370 Zip: 92704 Phone: Zip: 92627 Contractor: PROCESS COMMUNICATIONS DEVELOPERS INC Address: 3020 W HARVARD ST SANTA ANA CA Phone: 714-427-6370 Zip: 92704 License: 696069 Status: ISSUED Applied: O6/24/2004 Issued: O6/24/2004 C� ISSUED BY: SCOPE OF PERMIT INSTALLATION OF A WIRELESS ANTENNA FACILITY WITH 6 ANTENNAS FOR "AT&T WIRELESS) ON THE BELL TOWER OF UNITED METHODIST�CHURCH. AN ATTACHED STRUCTURE TO THE CHURCH WILI HOUSE THE EQUIPMENT. 2 CONDENSING UNITS WILL BE INSTALLED ON THE ROOF OF A ONE-STORY BLDG, AT THE RIGHT f2EAR OF THE PROP, TO COOL THE E�UIPMENT ROOM. 2 EVAPORATIVE COOLERS, 2 COMPRESSORS UP TO 3 HP/100K BTU REF:804-00425 � ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU - Repair/Alt Cooling/Heat Insl / Rep. R@cess Wall Htr Refrig Sys <100 k BTU Re�ng Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust ' VAV Box Vent Fan / Single Duct' Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfrn Air HandleB > 10000cfrn Floor Fumace $23.50 ao.00 ao.00 $0.00 $0.00 50.00 50.00 50.00 50.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / AIt Absorblion Unit . Repair/AltRefrigerationUnit - -Ventillation System Evaporative Cooler Commercial I nci nerator Domestic Incinerator Comoressors / Absorption Svstems Uplo3hp/100kBTU " " 3To15hp/500kBTU , 15 To 30 hp / 1,000 k BTU � 30 To 50 hp / 1,750 k BTU � Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Olher Mechanical Fee Quantity $0.00 0 $0.00 0 $o.00 0 $21.30 2 $0.00 0 $0.00 0 $29.40 2 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 � NO710E: Tha work authorized by ihis permit shall compty with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) ' EXPIRATION; This peimit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned tor a period ot 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, and all requlred Inspections and tinal approval must be obtainad. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 24d6�4fi (6/00� WORKERS'COMPENSAnONDECLAHAnON: I hereby eNirm untler penalty of Derjury one of the following declarations: ❑ I heve and will melntain a certificate ot �nsent to sell-Insure tor workers' compensation, es provided for by section 3700 of Ihe Labor Cotle, for the pertortnance ot the work for which ihis permit is issued. ❑ I have end will maintain workers' compe�tion insurance, as required by sectbn 3700 of the Lebor Coda, for the peAortnance of t�e work tor which this pertnit is issued. My workers' compensation Insurance �mer antl polcy number ere: Cartier: Policy Number: (This secfion neetl not be comp/efed i! fhe permit is velued e( one hundred dWlars ($100) or less.) ❑ I certity Ihet in ihe pertormance of Ihe work for which ihis pertnil is issuotl, I shall not employ any peroon in eny manner so as to become subjad to the woBers' compensetlon lews of Califomia, end agree that II I should hecome suD�ect to ihe workers' compensation provislons of Sectlon 3700 oi the Labor Cotle, I shall forthwith compy with ihese D�a��sions. - Applicant SigneWre: Dete: WARNING FAILUFE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVEF TO CRIMINA� PENALTIES AND GVIL FlNES UP TOONE HUNDRED TFIOUSAND DOl1APE (5100,OOD�, IN ADDITION TO T11E COST OF COMPENSATION, DAAMGES AS PROVIDED F-0R IN SECTION 3]OB OF THE L4BOR CODE, IMEREST, AN� ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I heraby attirm that I em licensed under prov�sions oi Chapter 9(commencing wit� Section 7000) ot Division 3 of the Business end Prolesslons Cotle, end my license is in full brce end ettect. Lic. x Cless x. Conirectofs Signature: Date: CONSTRUC710N LENDING AGENCV: ❑ I hereby effirtn thai Ihere is e construction lending egency tor the performance of the work for which this permit is issuetl. (Sec. 3097, Civil Cotlej. Lenders Nama: Lenders AtlGreu: Signe�ure: Daie: OWNER-BUILDER DECLARATIONS: I here6y aHirm that untler penalry of perJury Ihet I em EXEMP7 FROM THE CON7RAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professlons Code: Any city or caunry which requires e p�rmit to constmct, alter, impmve, demolls�, or repalr any structure, pdor ta Its issuance, elso requires t�e applicant for such permit to tile e slgned stetemem that he ar she Is IiFensed pursuant ta tha pmvislons of the Cantrectors Llcense Law (Chapter 9(commencing with Sectlon 7000) of DiWsion 3 ot ihe Busineu and Prolessions Code) or Mat he or she is exempt therefrom entl the besis tor tha alleged exemption. Any doletion of Section 7031.5 by any applicant tor a permit subjects Ihe applicaN to a civil penalry oi not more then tive hundred dollers ($500) J: ❑ I, as owner ol Ihe praperty, or my employees wlih weges es i�elr sole compensation, WILL DO THE WORK, end Ihe structure Is not intended or oHered for sale (Sec. 7044, Buslness end Professions Cotle: The Contractors License Law tloes not apply to an owner of property who builds or improvas thereon, and who tloes such work hlmseN or herself or through his or her own employees, proviUetl that such improvaments ere not imendetl or oRered lor sele. If, however, Ihe building or improvement is sold within one year ot comple�ion, ihe owneo-builder will heva the burden ot proving that he or she did not bui10 or Improve tor Durpose of saleJ. ❑ I, es owner of the pmperty, am E%CLUSIVELY CONTRACTING WI7H LICENSED CON7RACTORS b wnstruct the prolect (Sec. 70a4, eusiness antl Professions Gode: The contractors License Lew tloes no� eppy lo en ownar oi property who builds or improves thereon, entl who coniracts tor such project with a coniractor(s) license pursuant to the Conirectors License Lews.). ❑ I em exempt untler sec. Signature: Owner ID verifletl by dnvers license. ❑ Yes ❑ No Business entl Protessions Cotle for Ihis reason: Veriflcetion ol Ownership by (rype ol tlocument, i.e. � property tex blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: Dnvefs License No. Date: E�cpires: ❑ I hereby certity ihel no excavatlon five (5) or more Ieei in tlepih into which e person is required to descand, will 6e mede in connection with work autho�zed by ihis permi�, antl ihat no building simcNre, s�eHolding, talsework, or demolitlon or dismantling thereof, will be more then ihirty-six (3fi) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Celllomia Adminisiretive Code). - ❑ As owner-builder, I will nat emplay enyone to do work whlc� woultl requlre a permit irom the Division oi Industrlel Sefety, es noted ebove, unless such person has e permit to Co such wotk from the division. Signature: Date: Division of Intlustriel Sefery Permit Number: CEflTIflCATE OF COMPLJANCE AND AUTHORVATON OF ENTRY: I certity under penalry of perjury that I have read Ihis epplicalion end state ihat the infortnation given is correct. I agree to comply with all state laws and ciry ordinances relating to builtling construction, antl auihodze representatives ot the Ciry ot Costa Mesa to enter upon the ebove-tlescnbed property for insDection purpases. I agree not to occupy or ellow occupency of any building authorizetl by this permit until linel inspection. SignaWre Of Legal Owner(s) And/Or Authoriied Applicant Date CODE �. INSVELTIONTYFE 7616 Fized System Final Fira Prevention 12fi6 Pool Spe Final 200 Finel Re-Rooi 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Finel Demoliti0n QLg 1I�L9 COOE1 INSPECTONTYFE 206 Final MeChanicel 208 Final Plumbing 210 Final.Electrical � 212 Final Fire Pravention 220 Final Planning Appraval 222 Final Site 250 FinalBuilding/Occupancy P�IE I[�ALS �-�Y_oY ��L (714) 754-5273 • Fax (714) 754-4856 • www.c�.wsta-mesa.r��LDING PERMIT » FAIR DRIVE, COSTA MESA, GA 92626 Job Address: 420 W 19TH ST Suite: Viciniry: ROOF Parcel Number: 41920505 2oning: Applicant: BILL BRESLIN Address: 1835 WHITTIER AV � . UNIT F12 �; . f `i : COSTA MESA; CA �� , . �" . � Owner. CHURCH;�FIRST UNITED � Address �M,ETHODIST OF COSTA MESA - �COSTA MESA, CA - � i � , �20 W 19TH ST �i;:% . . V �� , Contractor: � 21ST-CENTORY ROOFING INC , Address: 1835 WHITTIER AV Phone: 800-784-8787 Zip: 92627 Phone:- - -� ' Zip: 92627 � :. UNIT.Ft2�-" Phone: � 800-784-8787 ' � � COSTA MESA, CA - ' � Zip: � 92627,' - License: 807430 , Arch,:_ . � Address: � � � � Zip: ,,� � � " , � Phone: � License: Status: ISSUED Applied: 08/18/2003 Issued: 08I18/2003 ��. . : t�.i/ Eng; � ' �.- � Address: � �, LIFGEXISTING CLAY TILE ROOF, INSTALL 2 LAYERS OF 3 � SANCTUARY SECTION ONLY. 20 S�UARES.- � �- � ' � , . — . , . Phona: . � , License: \ Vh F'tKMll ' FELT AND REUSE SAME CLAY TILE FOR ROOFING REPAIR ON � f y, � � FEE SUMMARY . ; Plan Check: $0.00 ' �- _. r Celc Valuation: Permit: $111.25 � � Ctaim Valuation: - ' SMIP Res: $0.50 ' � �SMIP Com: ` $0.00 � � ' ,; �� Other:\ '; ;$0.00 ' ��Inspection: � $0.00 _. .' � ,c: . . .. -�,�, � �TotaL• . $111J5 � /, � � � � . , � -- -• ' . , � �. � � � � ��-" �� PLANNING&ZONING �. SETBACKS��- , �� _ � '� MAIN STRUCTURE �Front ' 0-,0 " , Rear _ 0. 0 _ ,� Left 0- 0 . Right = 0. O�i /- � � _ . , ACCESSORY Fron.t ��0.,0 �� , ; �Rear ,,0.0 Left 0-0 _ � .-, , Right ' �0--0%� � � -_ �� :-- .' -. .'�� , �; PARKING Ezistinq: �=�0 .� Required: 0 Pr000sed: 0, ' V� �� . . .>_ -, - „'�� - ;, � ,. - - . � :/ � i a5;000.00� .55,000.00 �_ _ � , 'i � ' �, % , NOTICE: The work authorized by this pertnit shall compty with all applicable handicap access requirements under Calilomia stalutes and related regulations. (Ord. No. 92•28, § 1, 12•21-92) EXPIRATION: This perm0 shall automalically expire and become vold if work is not commenced wlthin 180 days, or II work is suspernfed or ebandoned for e perlod of 180 days. INSPECTIONS: In order for the work authorizad under this permit to be considered legal, such work must comply with all epplicable codes, and all requlred Inspeetlona and finel approvel mus� be obtained. Failure to obtain inspectlons and final approval will result in the ezpiretion of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 zaaera �e�w7 WORKEHS'COMPCaSATI�AECLARATION: � + I hereby affirtn untler penalry I per�ury one W Ne tdlowing tledarations: ❑ I heva entl wlll meintaln e cenificate af consent to self-insure tor workers' compensetlon, es pmWded br by aection 3700 of tha LeDor Code, tor Ne pertortnance o1 th� `� work lor which this pe�lt is issuetl. p( I tieve arM wlll maNtel� workers' compensation insurance. es required by sectlon 3700 01 Ne Labor Code. fo� Ihe peAortnance af I�e vrork fw which Nis permlt Is iswetl. � �My worke compensatlon Insure°� rtler erW pollcy number ere: �/ �/ � � �O — � � Certier: ��% __f�! / /✓� Pollcy Number. (Thls secHan nee�not Ee dOmp eted I! e pertnlNs v ed et one hundred dWlers ($100) or less.) ❑ I ceNfy thet In the DeAortnence ai the wgork for which this permit is Issued, I shell not employ eny person in eny menner ao es to become subJecM lo Ihe workere' wmpensatlon lawa ot Celiiqmp, end e rae Nat it Id 6ecam� h�ect to the workera' compensaUon provisbrts ot Sectbn 3700 of t Le4or , I shaf{ torthwlth comply wfl� t�ese provislAfi � i �� /1 /� � � �� Applicent Slgneture: —j/j/� ,,b x.i� J,� v�,F i oa�a; WARNINO: FNLURE TO SEWf7E WORKERS' OOMP ON COVERFOE IS UNUW FUL iVlD SN�LL SU9IECT AN EMPLOYER TO CRIMINAL PENALTIE AND FlNES UP TO ONE NUNDRED THOUSAND OOl1ARE (5100,000I. IN MOff10N TO THE W570F COMPENSATION, DAANQES 0.S PROVIDED FOR IN SECTION 3]OB OF 7ME LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eilirtn that I am force 8nC BHect LIt. N_ Contrectafs Slpnetura: 8(commendnp wlth Sectlon 7000) of Divlslon 3 at the B n _ Cless a CON9TiiUC710N LENDINO AGENCY: ❑ I hereby eXirtn Ihat t�ere Is e Con9trucUon Ientlinp eperxy tw Ne pertortnence o1 Ne work lor wNU IhLs pertnit is luued. (Sec. 3097, C'n�l Cotle). Lender9 Name: Slgneture: _ OWNER-BUILDER DECLARAnONS: LenOers Address: Date: Is in full I hereby eflirm Ihel untler pe�alry of perJury thet I em E7IEMPT FROM THE CONTRACTORS LICENSE LAW for the followlnp reason (Sec. 7031.5, Business enE Professbns Code: Any City or counry whl�h requires e pertni� to consWct, eltar, Improve, tlemWlsh, or repelr eny siructure, pdor lo Its issuance, elso reqWres Ihe epplicant Por such permil to tlle e sipnetl stetement IhO� he or she Is Iicensed pursuant to ihe provislons of Ihe Contredoro LJcense Lew (Chepter B(cammendng with Sectlan 7000) of Dlvision 3 of Ihe Buslness end Professions Cade) or that he or she is eaempt ihereiran and the basis lor Ihe elleped exemptlon. Any Ndatlon oi Sectlon 7031.5 by eny epplicant for a pertnit sub�ects Ihe ep011cant to a G�� penelry oi not more then five hundred dWlers (E500).): ❑ I, es owner of the praperry, or my empiqrees with weges as thelr sole compensetion, WILL DO TXE WORK, end the structure is not intendetl or oflered for sele (Sec. 7044, Business end Professlons Cotle: The Contractors LJcense Law does not epDN �o en owner of properry who builds or improves thereon, entl who does such work himself or �erself or thfoug� his or her own employees, provided ihet such improvements ere not intended or oHereC lor sele. If, however, Ihe building or Improvement is so10 wlt�In ona year of wmple6on, the owner-builder will �ave ihe burden o1 provinp Ihat he or she tli0 �ot build or improve tor purpose of sflle.). ' ❑ I, as owner of the propa�ty am EXCLUSIVELY CONTRACTiNG WfTH 110ENSED CONTRACTORS to construct the prol� (Sec. 7044, Business anA Professions Cade: The contrectors ��eose Lew tloes not appty to an owner o1 property who bullds or Improves Ihareon, antl who contracis for such projecl with a contractoQs) license pursuent lo the Conlreciors License Lews.). ❑ I em eaempt under sec. Business entl Professlons Code for this reason: Sipnature: Date: Owner ID verifled by drivefa Ilcense. ❑ Yes ❑ No Drivefs LJcensa No. Expires; Verlfkstlon of Ownership by (rype ot document, I.e. - property taz bill or tleeA): DIVISION OF INDUSTiiIAL SAFETY PERMR CERTIFlCATION: ❑ I hereby ce�lly that no excavetbn Me (5) or more feet in depth into which e person b requlretl lo descend, wlll be maEe In conneqion with work authoAzetl by thls pertnit, end tha� no buildinp structure, scaNdAing, falsework, or tlemolltion or tlismentlinp t�ereof, will be more than �hirry-sla (36) feet high. (C�ap. 3.2. Grp 2, Art 2, Sec. 341, T7tle 8, Caiffomfa AdmhdsVetNe CoCe). ❑ As ownervbuilder, I will not employ enyone to do work which woulA requlre e permil trom ihe DMslon al Indusirial Sefery, es noted above, unless such peraon hes e permit to do such work Irom the Civisian. Sipneture: Dete: Dlvlsion ot Industrial Sefery Pertnit Number: CER7IFlCATE OF COMPLIANCE AND AUTTIORIZATION OF EMAY: I certity under penelry ot per�ury that I heve reaE this epplicetion entl stete t�at 1he Infortnellon pNen is correct. I eprae to campty with ell stete laws entl dry ortlinances relating to bullding const�uction, end authoAze representetives of the Ciry of Costa Mesa to enter upon the ebove•tlescribed property for Inspection purposes. I egree not lo oaupy or ellow occupency ol eny buildinp euthonzed by this pertnit until final InspeGtion. � Cfl /!'�y„o.�,�y,t.�,....,,od„� .— WOE 1. INSPECTONTYVE 1818 Fixetl System Finel Fire Preventlon 1268 Pool Spa Finel 200 201 202 203 Finel Re-Root Flnal BIocWRetalninp Well Flnal Fectory Fire PI9�e Finel SIBn 204 Finel Demolitlon PAg II�EL9 � � COOE( INSPECTIONTYVE 208 Flnel Mechenicel 208 Finel Plumbing 210 Finel ElectAcal 212 220 finel Flre Prevention Flnel Plenning Approvel 222 Finel Site 250 Finel BuiltllnyOccupanq (714) 754-5273 • F2Jc (774) 754-4856 • www.Ci.005�a-m058.Ce.uS 77 FAIFi DFiNE, GOSiA MtSA, GA 9'L6Lti BUILDING PERMIT Job Address: 420 W 19TH ST Suite: Vicinity: AT&T WIRELESS Parcel Number: 41920505 Applicant: BUTLER, MIKE Address: �� Owner. CHURCH, FIRST UNITED Address �METHODIST OF COSTA MESA " - COSTA MESA, CA , - " "420 W 19TH ST - Zoning: Phone: Zip: � � Phone: � � Zip: 92627 . Contracror. 'PROCESS COMMUNICATIONS DEVELOPERS INC Address: 3020 W HAf2VARD ST Phone: 714-427-6370 Status: ISSUED Applied: OS/24/2002 Issued: 07/31/2002 i/,�� • �/ SANTA ANA CA , Zip: 92704 License: 696069 nrch : Eng: DELTA GROUP ENGINEERING, INC Address: . ' � � � � Address: 5 PARK PLAZA � � " � Phone: � SUITE 1400 � Phone: 949-622-0333 - IRVINE, CA �� . Zip: License: 92614 License: C041170 SCOPE OF PERMIT _ CELL SITE. UNMANNED FACILITY�INCLUDING THE INSTALLATION OF ATTWS EQUIPMENT WITHIN EXISTING BUILDING AND 6 PANEL ANTENNAS MOUNTED ON THE INSIDE WALL OF AN EXISTING TOWER. REF: DR-02-O6 Plan Check: $385.94 Permit: $593.75 SMIP Res: $0.00 SMIP Com: $9.45 Other: $0.00 Inspection: $0.00 Total: $989.14 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY PARKING Front 0- 0 Existinq: 0 Rear 0-0 Rear 0- 0 Required: - 0 FEE SUMMARY PLANNING 8 ZONING Left 0- 0 Left 0- 0 Proposed:, -0 Calc Valuation: Claim Vaivation Right 0- 0 . Right 0-0 NOTES: COLLI KJ 05/31/2002 THIS PROJECT WAS SUBMITTED ON 5/22/02. ALL DATA ENTERED ON THAT DATE WAS LOST. RE-ENTERED TO THE BEST OF MY RECOLLECTION. SOME DATA MAY STILL BE MISSING OR INNACURATE. PC FEE ADJUSTED AS FEES WERE PAID ON 5/22/02. REF: FINANCE RECEIPT NUMBER 01-0095984/SIERRA NUMBER 600000026948. $as,000.00 $45,000.00 NOTICE: The work authorized by this permit shall comply with all applirable handicap access requirements under Califomia 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 suspendad or abantloned tor a penod of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 _ j-'" 246&/6 (fi/00) WORKERS'C PENSAnON DECLARA�ON: I hereby a under penalry of perjury one a� the lollowing declarations: ❑ I ve and will meintain e certiticete o� ��sent to sel4lnsure for worke�s' compensation, es providad for by section 3700 of the Lebar Cade, /or the pertormence of the ork for which this permil Is issued. . workers' workers' i, as requiretl by seqion 3700 ot ihe Lebor Cotle, tor Iha partortnance of tha work for which this pertnit is Issued. numbeiere: n ��O/��^�_�1 .Folicy;Ntimber C/ ane huntlred ddlers ($100) or less.) ❑ I cenily t�at In the pertormence ol the work for which Ihis pertnit is Issue4 I shall not employ any person in any manner so as to become subject to ihe workers' compensatian laws of Cellfomia, entl egree t at it I should come s �aetlSihe waMers' compensetlon pmvisions of Sectlon 3700 ot the Lebor Code, I shall fotlhwlth compl with these proNslons. /7 Applicerit SlgnaNre � pa�e � 7y `� �p� pv..-e� x ._1 , WAiiNIN(3: FAILURE TO SECURE WORKERS' COti1PENSAiION COVERAGE IS UNLAW FUL AND SHr111 SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES !WD CNIL FlNES UP TO IXJE HUNDRED TFqUSAND OOLLARE (5100,000), IN ADDITION T07NE COST OF COMPENSATION, DAhNGES AS PROVIDED FOR IN SECTION 3]Ofi OF THE LABOR CODE, INTEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: 9(commencing with Section 7000) oi Profeuions Coda, end my license Is in full CONSTRUCTION LENDING AGENCY: • � I hereby affirtn Ihat thera is a constmctlon Iending egency tor the pedortnance oi Ihe work for which this pertnit is issued. (Sec. 3097, Civil Code). Lentler's Neme: Signeture: _ Lender's AAtlress: Date: O W NER-BUICDER�DECLARAT10N5: \. ii :.;.._ I hereby aHirtn ihet�under penelry of perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business end Professions Cotle: My ciry or couriry' wfilch requires e pertnit to wnstmct, alter, imprrne, Aemolish, or repair eny strucNre, prior to its issuance, elso raquires Ihe epplicant for such pertnit to Ole a signetl stetement that he or she.ls licensed pursuen� to lhe proNsions oi the Conirectors License Lew (Chaptar 9(commenGng with Sectlon 7000) of Divislon 3 01 the Busineu entl�Pmtessions Cbtle) or-Nat 6e or she Is ezempt therefrom end the basis for tha alleped exemptlon. Any violation oi Section 7031.5 by any epplicent for a pertnit sub�ects t�e epplicant to e dvil penalry' of not more than five hundred tlollars (5500).): ❑ I, es owner of Ihe properry, or`my mp�oyaes with wages as Iheir sole compensaiion, WILL DO THE WORK, and ihe siructure Is no1 intentle� or atlered tor sela (Sec. 704A, Business and Profeuions Code� The Conirectors License Law does not appty to an owner ot property who huilds or improves thereon, and who tloes such work himself or herself or ihrough his oi her own employaes, provitlea that such improvements are not Intanded or offered for sele. If, however, ihe building or Improvement is soltl within one yaer of completion, the ownerbuilder will have the burden of proving that he or sho did not build or improve for purpase of sale.). ❑ I, as owner of the proDerty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consWd ihe.projed (Sec. 7044, Business end Professions Code: The comractors Llcense Lew does not epply to en owner of propeny who builds or improves thereon, entl who contrects for such project wlih a coniracmr(s) license pursuant to the Coniractors License Lews.). 0 I em exemp� under sec. Business antl Professions Coda tor this reason: Signature: Date: Owner ID verifietl Dy drivers license. ❑ Ves ❑ No Dnvor's License No. Verlfication of Ownership by (type at docum9nt, i.e. - property tex bill or deetl): Expires: DIVISION OF INDUS7RIAL SAFETY PERMIT CERTFICA710N: ❑ I hereby ce�ify ihat no excavation five (5) or more teet in depih into which e person is required to descend, will be made In connectlon with work eutho�zed by this pertnit, and that no building swcture, Scefloltling, falsework, or demolition or dismantling thereot, will6e more than Ihlrty-six (36) tee� high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Celitomla Atlministrative Gade). ❑ As owner-builtlar, I will not employ anyone to tlo work whic� would require e permit from ihe Division ol Industrial Sefery, as noted above, unless such person hes a permit ta da such work trom tha tlivisiM. Signature: Oate: Divislon of Intlusirial Safery Permit Number: CERTIFlCATE OF COMVLIANCE AND AUiNOROA710N OF ENTAY: I certify under penalry of perjury that I have raad this application end state that �he iniormation given is wrrect. I agree to comply wit� all state laws end ciry ordinances relating to building consiruction, and euthorize representatives ot Ihe City ot Costa Mesa to enter upon the above-deuribed property for inspection purposes. I agree no� �o occupy ar allow occupancy of eny building authorized by Ihis pertnit until final inspection. COOE t. INSPECTIONTYPE PdI€ 1�L5 7616 Fixed System Final Fire Prevention 1266 Paol Spe Flnel 200 Final Ra-Root 201 Flnal BIocWRetaining Well 202' Final Factory Fire Place 203 Finfll Sign 204 Final �emolition LOOE� INSVECiIONTYPE 206 Finel Mec�anical 20B Finel PlumDing 210 Final Elecincal 212 Final Fire Prevention 220 Flnal Planning Approval 222 Final Site 250 Final Building/Occupancy PAIF. I[+�ALS (714)754•5273 • Fex(714)754-4856 Job Address: Suite No Vicinity: Parcel Number: 420 W 19TH ST BASEMENT AREA 41920505 CIN OF COSTA MESA BUILDING DIVISION '� DEVELOPMENT SERVICES DEPARTMENT PERMIT Applicant: GRAHAM, GORDON Address: MECHANICAL PERMIT Phone: Zip: owner: CHURCH, FIRST UNITED Address: METHODIST OF COSTA MESA COSTA MESA, CA Phone: 420 W 19TH ST Zip: 92627 Contrector: GRAHAM BROS INC Address: 2952 CENTURY PL Phane: (714)546-1653 COSTA MESA, CA . Zip: 92626 License: 248604 ArchlEng: Address: Phone: Zip: License: SCOPE OF PERMIT REPLACE TWO 225,000 BTU RESNOR DUCT FURNACES. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >700 k BTU Gas Piping Factory Fireplaca Hood w/Mech Exhaust VAV Box Vent Fan / Single Ducl Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm Air Handlere > 10000cfm Floor Furnace Floor or Suspend Heater $22.00 $0.00 $32.50 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ao.00 $0.00 $0.00 $0.00 $0.00 so.00 so.00 Quantity FEE SUMMARY PER NUMBER 99-00234 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Repair I Alt Absorbtion Unit Repair I Alt Refrigeretion Unit Ventillation System � Evaporative Cooler Commercia l I ncine rator Domestic Incinerator Comoressors / Absorotion Systems Upto3hpl100kBTU 3 To 15 hp / 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fae . Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 05/17/1999 Issued: OS/77/1999 Quantlty $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 ao.00 0 $0.00 0 $0.00 0 $0.00 0 $o.00 a 30.00 $0.00 50.00 E54.50 NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements undar Celifomia 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. � INSPEC710NS: In order tor the work eulhorized under this pertnit to be considered legal, such work must comply with all applicabte codes, and all requlred Inapectlone end flnal approval must be obteined. Failure to obtain inspections and final epproval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 WORKERS'COMPENSAnONDECLARAPON: � I hereby eHirtn untler penelry of per�ury one W the following declarations: � ❑ I heve antl wlll maintaln e ceNiicete of consent to seli-Insure tor warkers' compensatlon, es provided for by section 3700 of the Lebor Cotle, for the pertormance ai ihe �rk for which this pertnit Is issued. lj� I have end will meintein workers' compensa�on insurence, as required by section 3700 of ihe Labor Code, for the peAortnance of ihe woAc (or which this pertnit Is Issued. My workers' compensatlon Insurence certier end pdicy number ere: Cartler. Policy Number. (7hls sectlon need nof be com0/eted ll the permif fs va/ued et one hundred dollars (5100) or less.) ❑ I cenity that In ihe peAortnance oi Ihe work for which this pertnit is issued, I s�all not employ any peBon In any manner so es lo become subject to ihe workers' compensation lews of Ce mia, antl agree that if I should become subJect to the workere' compensation provlsions ot Sedion 3700 of Ihe Labor Code, I shall fotlhwith comply with ihese pro ns. o � Applicant SigneNre: l % �2�LG�'� Dete: .! — / % — Ti % WAHNINO: FAIWRE TO SECURE WORKERS' WMPENSATION COVEMdc IS UNLAWFUL AND SHFl1 SUBIECT AN EMPLOVEH TO CRIMINAL PENALIIES AND GVIL FlNES UP TO ONE MUNDRED THOUSAND DOLLARE �5100,000), IN ADDITION TO THE COST OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECfION 3](IB OF THE LABOR WOE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn that I em licensed under provislons oi Chepter 9(commencing wlih Section 7000) of Division 3 of �he Business antl Protessions Cotle, and my license is In full force end eNect. Lic. q C—Z a 2�-Lo Clflss k G—LO ContractofsSignature: T= .n�G.. T Date: .5—%9�x CONS7RUCTION LENDING AGENCV: ❑ I hereby effrtn thet ihere is a consirucllon Iending epency for the pertortnance o1 the work tor which ihis pertnit Is issued. (Sec. 3097, Clvll Cotle). Lendefs Neme: L.enders Atldress: Signeture: Date: OWNER-BUILDER DECLAFiATONS: I hereby eHirtn thet under penalry ot perJury that I em EXEMPT FROM TF1E CONTRACTORS LICENSE LAW tor tha following reason (Sac. 7031.5, Business end Professions Code: Any ciry or counry whlch requires a pertnit lo construct, elter, improve, demolish, or repair any sWcture, pnor to its Issuance, also requiras the epplicant for such permit to flle a slgned statement ihet he or she Is licensed pursuent to Ihe provislons of ihe Contradors License Lew (Chepter 9(commencing wllh Sectlon 7000) of Division 3 of Ihe Buslness antl Professions Cade) or the� he or she is exempt iherefram and tha besis far the elleged exemp�lon. Any vloletion of Sedlon 7031.5 by eny epplicent for e permit sub�ecis the applicant lo a ciNl penelry o1 not more then five hundred dollars ($500).): ❑ I, es owner of the property, or my employees with weges es their sole compensetlon, WILL DO THE WORK, end Ihe siructure Is not intentletl or offered for sale (Sec. 7044, Business antl Professions Code: The Contrectors tJcense Law does not eDPN �a en owner ot properry who bullds or imD�oves thereon, antl who does such work himself or herseN or throuBh his or her own employees, provitletl ihat suc� improvemenis ere not intendetl or oflered for sale. If, however, �he building or improvement is sold within one year of completion, the owner-buil0er will heve Ihe burden oi proving thet he or she CIG not bulld or improve for purpose of sale.). ❑ I, as owner of the properry, em E%CWSIVELV CONTRACTING WrtH LICENSED CONTRACTORS to construd the project (Sec. 7044, Business antl Professions Code: The contrectors Licensa Lew does not aDPly to en owner of property who bullds or improves thereon, antl who caniracts tor such project with a conirector(s) license pursuan� �o the Coniractors License Lews.). ❑ I em exempt under sec. Business end Proteulons Code for Ihis reason: Sipneture: Date: Owner ID venfied by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verlfication of Ownerehip by (type of tlxument, i.e. - property lex 6ill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity Ihet no excevatlon fve (5) or more leet In tlepth into which a persan Is requiretl to tlescenA, wlll be mede In connection with work euthorized by ihis pertnil, and ihat no building structure, scattolding, ialsework, or tlemolition or dismantling Uereot, will be more then ihirty-six (36) feet hlgh. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomie Administretive Cotle). ❑ As owner-builder, I will not employ enyone to tlo work whlch would require e permlt from ihe,Division of Induslrial Safery, es notetl ebove, unless such person has e permit to do such work from Ihe division. SignaWre: Date: Divlsion of Industrial Satery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AllT}IORIZATON OF EMRY: I certify under penalty of perjury lhat I heve read Ihis epplicatlon entl state that the information given is correct I agree to comply with all stete laws end ciry oMlnences relating to bullding wnstruction, entl authodze representativas of the Ciry of Caata Mesa to enter upon Ihe above-descnbetl praperty for inspection purposes. I egree nat to occupy or ellow occupancy oi eny building authorized by �his partnit until ilnal inspadion. Sigp� re Of Leg3� Owner(s) Dete .�. T�>ul�,�_ .S- i7- 9`7 MN r Authorized Applicant Date CODE �. INSPECf10NT7E 1616 Flxed System Flnel Fire Prevention 1266 Pool Spa finel 200 Final Re-Roof 201 Finel BIocWRetalning Well 202 Finel Fedory Fire Place � 203 204 246&48 Final Sign Final Demolition PAIE �� 4!}ffIALS CODEt INSPECTIONT'PE 208 Flnel MeCheniCel 200 Finel Plum6ing 210 Finel Electncal 212 Finel Flre Prevention 220 Final Plenning ADproval 222 Finfll Sita 250 Final Builtling/Occupanry I�/ �DDFESSOFBNldNO: �}�LO W 19TH ST u�T: OYMERSNAMEIFpqWN: CHURCH FIRST UNITED moxess METHOD'IST OF COSTA MESA 420 W 19TH ST :OSTA MESA,CA 92627650-7767 APPI. WIIlNO AUUXESS �wcxrtecron�rr+r+�n:JAMES ROBINSON �� C5286 IpCX.ORFIlO.'SADDXE54: LSI KALMI75 DR 751-0492 ��+T� ES C.M. CA 92626 CONi11ACiqYS N111E caxrxncroxs xuuxc MDflESS 11C. NO.: UNT: LICENSED CONTPRCTORS DECUIPATION: I Mreby ¢pRm under per�etly d pe�jury ihel I am liceneed uiMx yovieiore of Cheqx 9 (wmmeiwrq vm� Sec�ion 1000) d Drvbion 3 of tM Buy�neee eM Pmipaoru Code. vd mY liceme u in lull Iace eM eltetl. cm uc. No.: uc. cuss: uc. No.: EXP : �WNEP BUILOEN DECUNATION: I hereby dfimi ur� pe�y d perjury that 1 em exempl han �he Camietlas Licenee Lew la Me 'nw'vp reavon (Seqion ]Wl 5 Businsa end Prdeea{p�e Gode: AM cry a caunry xfiidi reWiree e pemiil lo aonsWct aMr. imqaro. mdnh. a rspv a�ry sVucWre. pia lo ils'oeue�re. q6o requitm �M xpplira�l la eurA pemiB 10 fib e eprod eWamanl tlbl M a eM n IicmneA puiwem �o tM prm�ma d Me Comeaeoro L'perpe lew jCheqm 9(wmmentl�q wilh Satlion ]OOD) d Orvuion 3 af iM Buaineea vd Frdeseiona Codel a ihet M«ahe o eymq �h>aM1�m eM IM baria la the elbped uanqion. My violetion d Swion )0'l1.5 by enY eDGlirani lar e permil aubjeCa IM epplicaM lo e rivil pereXy ol ml mae ihen fne hunEreE Edlen �5500�). � I. u owiwr AtM propenY a my empbyeee weh wepas � IMi eob mmpaneetion. wJl do tM wak. eM IM Nudura o iwt inlenEed w Mered la eele (Saciion ]OId, Busimsa end Prq�aians Gods: Tha Contreaon Lioaiue Lewdoes rd eppyto en owner d propaM who buNde a inproves iMreon. mM who Eoae euM wvh Mmeetl n heneM a iMaph hi «her ovm empbyeee, provkeE thet euch impavemenle are M inlaMed a dleieE /a ede, ry, however, Iha buiMiip a inpwameM ia eoN xilhin aw yeer N rompblon, the a' axner�Wilder will heve tM buNen d peovin0 he or eM Eid ml Wild or imprwa Iw tha W�e d eab). 11""' �.J I. m oxnar d �M o�M. ��duavey caNreq�np wi�h IinneeE contrecmn m conahutl Ihe prol� (�� . &+aineee eM Proleuione Coda: The Comrecion licenm Lew doea iwt epply to en ownar d qopeM �^ �itle a impovae theroon ud who coMrecN la wM projeda wnh a ooMredor�n) IcenaeE W�� to Iha ConVeq«a Liceme Lew). � '� I em mmq mMm Sxiiiw�: 8. 8 P.C., for Nu r . /i me: � Owrwr: % /� nW cerlily Ihet I em eware af vd unEentend tly rpuiremanta�Heellh d Sday COEe Setlom 25505. 2553A. eM 255J0, eM tlw I or eiry Mure buikinp oeapent MII / W� �(aRy pr) ewd �o eanply wlh eeid eUU eadw uW �M nquimmams b epe�mnlam�mNMionumoEifirationhomiMAi u3a�enepemeniD'mlrid.Rmkmtulm�nruifionaOV�iomuaazemP�tmmlMw pwieone.- oa�e: �owKw: WONKEF'S COYPENSATION pECLARRTION: I her9yy yq� �Mx peretly d psjury one d tM blloxiip dedumims: � I heve eM wll meinten e ceNikme d oonaem to estlimun M xakms' compemYion, u provkeE Iw by Sadion 3)00 d IM Lebor CoEe, la �Iw pMormence W the wak lor which t�ia pertnil ie ucued. � I hevs enE wiA maimen woMers mmpenmlion ineuruae, m raquired by Seclion 9100 d �he Lebar Cade, br IM pe�lormenoe d tM woA lor whi A Ihis perm� ie iaued. My wnken' �pe�u��on inwrenee evriar eM poliry number ere: Cerriac � POIkY Number: (This senion nesC nd 6e compbred / tM pmm1 ie br one huMrea Edlers jf1001 w bm.1 � I cMily Ihat in the pMwmarce d IM work /a vihich thb paimG ia paued, I ehetl m� empby eiry penan in vry men�wr n n lo becwne wbjed !o tM v.orken' canpanae�bn lewe d CelXanie. eM epree Ihel tl I ehouN became aubjed �o tM Mwken' compenytion provisona ol5eaian 3100 d IM �pp ��. I ehell tanhwnh mmpty xil� Ihona pwmora. De�e: Mq' �� W�mlip: F�Nun b s�euro woikai rnnpwatlan �overp� li unl�wNl, enE Nsll a�bjset en employsr ro erlMrol pwuMp uM clH/ 11nu �q ro me h'ntlml thouuM dd/en /Sipp,pppA M adJltlon ro Ms ewt ol ro�oxwtloM1 danrpu �s pvvltlW bi In S�etlon 9)a6 0/ tlro lw�or Code, lirtenst, entllttor�ry'� Na. CONSTIiUCTION LENDINO ROENCY: I Mreby etF'm uiMer pendry d parjury �hel iMia o e oonsl�udion bM'vq epercy tor ihe paAormenoa d t�e wrk lor wfiich �ha peemY n baueC (Saebn ]09), Civ. C). LENOEN'3 N4ME: LENUEfl'S AOONE55: I canity t�m I hew reed this epplcetion ad a�eta ihel �he ebova inlametian e wrtetl. I epree ta wmpM �h ell dly end coumy ordi�anoee eM ewa lewa reletip b buik'vq conshudion erM her0by eWMrae repreeemetivm N Ihis clyto enter upon Ihe ebo+e�mentoned pmpeM m� msv«ib� w,o�a.. �. r, iL ,�� (S15t<6.WP) Dme:6 �[/ 7 / W�ne-&�iWvq 8 Sefery: Gre�_Fb: Cenery-Appieeni: Nnk-Rv.enue: GddeneoFMaeev CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 072709 PERMIT NO: P 072709 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION : UPGRADE FI.C. RESTROOMS, CREATE STORAGE SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: A-3 / COMMENTS: REF: B-69431 iP if iF iF iF iF it iE iE iF iE �t it it aF iF iE it iP iE iE it iF it aE �F iE iE iE at 1t iE it it �t iE it �t it �t it iE it it iE it iE if if 1E if if aF iE jE iE iE iP k iP 1E i6 if i6 if if iP iF �t iE iP iE if it it iF af iP iE Z O N I N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT ZN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41920505 ZNE: REF NO: PLANNZNG NOTES� / '1E iE iE 1E 1F IE 1E'1F il� if if if if iF iE iE iI' iE 1E iE 1E 1E �F 3E 1E iE 1! 1E 1E 1F 1E IE 1k iF 1E 1F 1f iE iE 1E iE iE iE 1f� 1E iI� 1(� 1f iF iE IE fE IF iEif 1E IF iE 1E iF'If' 1E 1E 1F if 1E aE 1E iE 1E 1E iE 1E iE 1f 1E 3f i(� if D E V E L O P M E N T S E R V I C E S:�' R E Q U I R E M E N T S J} � ZONING APPROVED BY .L' DATE: HUILDING APPROVED BY APPLICATION ISSUED BY 1F 1E ik 1F iE iE iE k i! k 1E'k'1[' 1(' 1E iF 1F 1f fE iEiF LEGALIZATION:N HLDG PMT PERMIT F E E S U M M A' R Y PLUMBING ELECTRIC MECHANIC Q 2 , Q 0 25k FIRE DATE: DATE: � iE 1! 1E 1! 1F iF 1E 1E STRUCTURAL S GME T:N SMIP/RES GRADING SMIP/NON—RES PLAN � ISSUE FEE 20.00 HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 42.00 20.00 �" 0.00 62.00 62,00 .00 REVENUE DIVISION TOTALS--> COLLHCTED; 62.00 OVER/SHORT: .00 HLDG PMT PLUMHING ELECTRIC MECHANIC FZRE SMIP/TOT GRADING PLAN—CHECK 62.00 , iF ik 1f if k i!'If if iF i! iE 1F 1E it 1t iE iF i4 ik iE 16 ik k iF iE iF iE iE 1E i! iF 1E 1E i! iE.iE 1E'll' 1F iF'll' 1F iF iE'k'k iE 1E 1E iF k 1F ik iF 1F iE if iE 1E iE if 1k iE iF ik iF iF i41(� 1k i[� 1F it 1F 1E ik'lE k iE I N D I V I D U A L' F E E H A E A K D O W N TYPE QTY D E S C R I P T I O"N UNIT COST TOTAL COST PLU 3 WASH HASIN PLU 3 WATER CLOSET (TOILET) END OF FEES ,'� f / � �l 7,00 21.00 Q? 0�13356i-00183661 T f�T 62Q1� BRTc� �75tOb/9S TFf4E: I4:44 -,-- CONSTRUCTION AND P�ANNING - � N� .� SPA APP'ROVALS Permit # Daie �Inspector � AppROVALS Permit # Date Inspecto� .� 1. TemDo�ary Electrical Service or Pole ; 52. Pool & Equipmenz Location � ' :i 2. Sbii Pipe�Undrgrnd. 53. Steel Reinforcement -'3:'Electrical=Conduit Utility-Undrgmd. 54. Forms � ".4��[Iectrica�t;C¢nduit�Undrgrr.d. 55. Electrical Bonding - � � �5�'9teel Re`mtorcement �, 56. Rough Plumbing & Pressure Test °"�% r F ';6'ylectricaf'4}fERGrnd. ' 57. APPROVALTOCOVER�GUNITE '� �; F� j_ 7=,-Footings ; f-� 58. Electricai Condu�t�Undrgmd, -� f '� _ g; Foundatror� . ^� ,� 59. Gas Pipe, Cl Undrgrnd., Test •,=9: Water Pipe•Undrgrnd. �, 60. Backwash �ines, RTrap, O Undrgrr,d. ,�p. Structurai ��oor SYstem f 67. APPROVAI TO DECK ..: . 11: Pcoperty Sewer Line & House Connection ,' 62. Backwash & Receptor�Final 72: Sewer Cap - ��`63. Heater & Vent-Pinai , 13. Roof Drains =� „% 64. Plumbing SYstem � Pinal 14. Rough P�umbing �• -1� J�� 65. E�ectricabFinai % 15. f�ougfi ESectrica6Condui2 : � 66. Solar SYstem-Finat � 76. Rough E�ctric Wiring � � 67. Fencing & Access Approval . • 17, Rough U�inrrg Sign 68. APPROVED FOR PLASTERING ' 18, Rough electrical�T 8ar Ceilin9 69. POOUSPA SYSTEMS FINAL 19. Rough Hea:ing & Air Conditionin ,,._ F RE�DEPT..REQUIREMENT c � . f'r � i c "' c d �� '-- - � _ 20..Rough Fac2o�� F�eQlace �' � ,X.^ ; - � .-��'..t� � APPROV.A1;S�f: Pecmit# ~ -- 21,`Ducts, in`StrScture" ' •• •' -'�� ' c �� ''':': � 7p; ,�ndetg ouj�d Hydro ° �;' M� . V: � .h r. "� Y'. 1- „ ' i-i.p C' �.�. _ q� .}. :. . . � 22. DuMs,, V,entilati�gus '? � J � ' F k�: 71. Frodyca:�iping�C��Gas E•70i1 23. Gas�Pipe-f'tough & Test i F t*� i ' t�' t� 't c'. � 7y, Underground F�'ush �"' 24. �Roaf'Framing' i . " �F" 'r ° ' � , :� r ` 73 Unde�grnd. Storage Tank O Gas ❑ OiI 25. Roof�Sheathing F;; . C� : �' � 7A'. Ove�head Hydrp _ ' � 26.�T-Bar,Celling (Structuraq &�Monocoat "�� G � - �=" ?5. Dry Cheaiical � j � �' ' � y; 27.�Frame and Flashing. � r,-; :�� tr.� 76. Dry Standpipe'��=��V ' n n '" 28. Lathin9 & Siding""- r;yc; G �` ` � " 7�7; FIXED:SYSTEM��.INRL�_ - `; , 29. I�suiation - .... _ � i '' ZB:'FIRE�.PAEV. FINAL � . ._. '�`� 3�. Dr wali Nailin " `� �; �,�'''' '-HEALT-H DEP,T: REQUTAENIENT � Y 9 e i-+ ;r =�N c� i ` 31. Plaster8rown�Coat= ;' � .��' , ^ � {! • 79.�FINAL.INSPECTdON �K � -� .. E' 32.,Electrical Power MeTer•Final � ' � � - 86i FOOD CERTIFICATE I_SSUEp . � � � , _ �, A . 33.�inayElec2rir r.: • +� � .. Notes:C_',�^� �•r-- � '^t^ �/ 34.�Fina(i.Hea�in§& AirTConditioning- �, � ) � ' - . �'. . _ � � '�^ _• - - � '] * .t ` ' 35.�Finai-GaS�Pip`e�Test r - ' � ; .�. I `-�F-- � ` . 36. Hood or Canopy • �' � ' ^' "' � • ��. � � � * -� � _'� x M ;y - x ^f �� 37.`F.inal:Faciory Fireplace -� i �.F. ._' ,- �s' � '�. � � 38. Final"PlJmbing ` =' ' r - { e . r^ c� - _ r w �+. � 39. Water Se'r''vice�Final, .- ' ` �' ; � ' _, ' r �; 40. Gas Service�Final t a �.. - :. ir� ; � tt. y �; i,.i ��_ �� i. - A i .f :.3 �_ � � 41. Solar OomesticFina1 • ' '� �' '' ' ' 'r _ -"" r� - ��+, v. tc . y; _ . � 42.'Backfiow:Prevencer � ^> > � � Y� �'> >'- -' � � ' � r-�� a n l:', H 43. Backf4ow Irrigationj. � " X x :i� � �� T� ' • .., � : .. . � - :44. Landscape Irripation System.: `.^ - * �T• � �' C' �' �1i ',� _ -_ , .'� •-- ,��.- ;H � d c'�� - s - r: .� . .. . ~ t; i.� ��i � �� l� G �.I '. • F.'� 1-� �C � '.l l'v 'K q5,'Sound Attenuation;. , ., ., ;�; h m�� F . . . �-�e . �46.rHandicapRegulations �-, �� +� T -. _� -' * c � > 4 r� e 47.'PINAI STRUCTURE & BUILDING � �, � �.� ' - ;,, � 48.�FINAIPLANNIPIG+ � F+'-� ' iu _-�'=-` .� � , " � - - � �r. �49.'Elecf�ic Release to Edison ' ` �`= � � . �: x� :4 .n . �,50.;Gas�Release to Southem Catifor�niaiGas Co < � - '� i r-� • - '' �=, - • ' �_ _ �; - 51. CERTIFICATE OP OCCUPANCY - ; * : �- - � �- No. Date � �ooness,ovew�w+o: Q 20 W 19TH ST uxT: � wmeasruyeivaaxx:�HURCH, FIRST UNZTED moxessMETHODIST OF COSTA MESA ' 420 W 19TH ST OSTA MESA,CA 92627650-7767 ,vr�. Wuuxo wo�ss: � ,�xcxirECTon�a+�xJAMES ROBINSON uc.no.: C5286 ,wcxon�o�smoness: 151 KALMUS DR 751-0492 urir: ES C.M. CA 92626 mxm�aars ru�: cartn�croas�u�a+o �oo�ss: uc ra.: uxr: IICENSED COMXRCTONS DECLAflRTION: I Mroby ell'vm uMer peray d pe�ury tlw I em IceneaE uMer poviaiona ol Ghaqer 9 (mmmeridrp wilh Sectian ]000) d Diriaion 3 d iM Buaiiwm vM PMmaims Catla. end my limnae h In tull bm vW eMed. cm uc. No.: uc. cuss: uc. No.: E X P: �� oae: comi.aa: OWNEN BUILDER OECLRN�TION: I hereby elfirm untler paneMy IN perlury Ihet I em eaampt trom IM Conlradon Llcenss Low lor the 'MloxinB raaeon (�ion'l0�1.5 &re'uwaa eM Praleadone CoEe: AnY cry a cauntY �ich rpuirx e permn to mnetrutl. eller. Impovs. emolwh, or ropai any eVucWro, pbr lo Ga eweMe, abo reQuiree iM epplirant tw auch pem�n io fib e eyME eletemeM Nel M a eM e licemed W�+NI to �he pwi�iane d Ne Caniraqws License tew IChepter 8(canmaxinp rlilh Saqion )OW) a Dv'vion � d ihe Buainsea enE Prdeeeiom COEa� a IM� M a ehe ia exemq IherNvn end 1M baw tn ths ellepM uamqion. Nry violtlion tl Ssuion ]031.5 b/ e�ry epplitem la e pmmA abjw� IM applicenl �o e avil PotihY d iwl mae �hen (we huMrod d011en �SSW�). � I, s� owror d �he qope�y or my empbyeae wIh wepes ea Ihei eob campeneetbn, will do iM Mork, end ihs oWclun a r�d IntenEaE w dlerod lar eele �Sxiim )010, Bumiwea and Proleaeione Code: TheConveqwe Liuroa lewdoee rot eppN �o en oxnerd prapeily who b�iW p inprovu Iherean, eM who daes suM xak NmaeM ar henetl or Mraqh he a Mr own amplvm, pwided ihe� vch �voy,mau. �s �a �m.�wee � m«.d ia.�ro. n. now�«. me aaa�a « mw�.m a.ae wun� a,e rw a�d.��. u» X m.,�ma�aw r� naw in. waen a wworo b w.na ad m wua « �mc�w. ia m. awa• a.del. � I. e� oxner d iM pW�Y. em a�d�a�+�Y mmradM vNh licaneetl cant�eclas ro mMrutl Ne Mol� (Ssqion Mu. Bus"v�s eM v�oe�.�e eaa.: Tne com�aa. �«.,. i.w eo� oa wdv w� ow�« a wwenr wno wx. � mwwe. m..o� �e w,o canlrecro In arh prqees wuh e ooMmda�v) Icer�xd punuem to tM Camreeon Lieeroe lewl. � I em exemq ueder Senbn: 0. 8 P.C..1« Iho �eemn: Date: � I do haraW �dM' Me� I em eware M md �vdeniaM ihe ieWi'emarta d Calda�ne Heetlh aM 6e�ely Cods Sadiwv t5505. 255�. eM 2553a, vd ilw I a eiry Miva Euikirp oawpem will / MI rid (riicb me) naed �o cwnpy wY� aek pme aoEa enE Ihe rpuirsmew br ape,mnlacwuilupionamotldraiionhaniMAr e�iy arupamentDimrid. aiEeniielmnnrudioneppfutiom ee�emqlmmiheee WOWsbns. � o�,: 3 — 6 � `�� .�^: , WOHKER'S CONPENS�TON DECLARATION: 1 MeEy aKvm uMs penMy d ar d tM blbrrirp Esduetbns: �� I hew entl xil meinten e wntlicma d oomm�l io vaX-imure lor wkeis' compenvelion, u pwNad la by 6etlion 3]OD d Ihe leba � Cotle, I« iha perlormence d the wrk lor wNch ihia peimn ie iaued. � � neve a�e xi� meime:i won�en• mmv�+*d� ��,re�ce... �ec��d M seaian 3�0o a ub �eeo� coa.. �« m. w�«meno. a me work la wfiich ihb pe�me la usued. My wkeie' compenu�ion inwreza raner end po4q number era: c�.�: Poliry Numbar: (mis seclion need nm be mmW.�ed r �hs pemiR i. Iw orre nundied dalers /Sfoo) a Iwe.J �Di I cenAy ihet in IM perlormerice d IM work Iw whch Ihia pe�mn b bsueE, I Mell iwl emplq erry pereon in en menner eo ea �o K cacom. e�ei� �o �ne won�en' canro�� b•�•s a celilamie, ene e6, inm e � dwuk necom. � a �o �ne xvrken' �pnp�eJnae�ion qwuiom d Sed'an r3AD d the labor CaEe. I ehell 1 il� ply wiN Ilaoe po .. Dete: . 7 " � �b AGW'raM: Wem/np: FeNun b��cun woA'sn'romp�rwtlon coverep� Is unkMlu4 +�i ��+� �Y�oyp ro cMM�ul p�naMu e�M civll flrro� i.q ro om hintlrsC fMuuntl dollen (5100,OW), M e�ltlan ro Ms or �o�.�wrron wm.o+s as c.o�wm ror �� Sxtlon J106 0l M� Lebor Cob. /nMul. �nAattomsy'� lass. CONSTilUCf10N LENDINa RDENCY: I hreby elfi'm uMx pe�eQy d pa�Nry tM IMn u e aonp�utlion 4ndvq e�nwy br the parlamarca d �M wak far xfiiN �hu G�i b sasd (Saeian J06I. Cia. Cl. LENDEN'S NAME: LENOEP'S RUDflES4: I eMily thm I heve reeE Na WMirsiion enE pYe �hei Ne ebo+e iNwmetion e emea. I e0�ee �o ewnVN wnh NI mY eM coum�/ oedi�wiue ard stma kxa �elmip io WiWip mn%rueion end hereby eWwcs �erymenletivea d Ihe cny b wer upan tM abwa�im�ubwtl VweM I�°`"Spetlidip1pO5B'WAYNE ANDERSON Pnnl Nem /f .,zy/i Qe / Dete: _ ��.��i �� elu� Wcen�uVai.Y« �. 5�5twB.WP) W�ns-BuiWip b Selmy; OroarrFla; Ceneey-Rpplrent: Fnk-Revenue; GWdenmd-Aeeeaaor CITY OF COSTA MESA — BUILDING PERMIT / PEAM NO: IB 076702 PERMIT NO: IH 076702 PLAN CHECK NO: N GOVT: N SUPP: Y CONSTRUCTION TYPE: PERMIT TYPE: OTH STR PURPOSE: OTH JOB DESCRIPTION : REINSPECTION FEE (RE: B69431) SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: A-3 / COMMENTS: EXPAND CLASSROOM INTO EXIST STORAGE AREA / RENEW EXP'D B69431 ��t*�atat��iefE*ie**�+rit*�at��r+��+tat�*��titatit��atatatit��r**��at*at**�ititftit�*ft�*�atatat�*� *iE**�tat*��* Z O N I N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41920505 ZNE: REF NO: PLANNING NOTES> , � �� n If 1E 1E if'lElE iE 1F iE iE ff 1E 1fl6 iE 1FlF 1E 1f 1E 1E 1E 1E iE 1E 1E 1E -0E'If�'� 1ElE 1E IE 1ElE iE 1E fE iE 1E 1E fE 1E 1E 1E 1E iE M iE fE 1ElE 1E 1E 1F IE if 1F iElE iE 141E * iE IE 3E �E 1E fE 9E 1ElE iE �E 1E 1E if D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.T.S ZONING APPROVED BY DATE; UILDING APPROVED BY : DATE: PPLICATION ISSUED BY: � DATE: � 1E1EfEiElEifiE1E�E1ElE1f1ElElEiEiE�flElEiE� � �iF �7FTE �;' ��7F7FiFTFT�3F{F�Fif�lEifiEif�f-iEiEiEfElE 3Eif EGALIZATION:N F E E S U M A R Y STRUCTURAL'SEGMENT:Y /: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES, GRADING ERMIT 30.00 SMIP/NON—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 30.00 0.00 0,00 30.00 30.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.00 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30.00 iE if iE 1ElE iE iE iF �E fE 1ElE 1E iE �II� iE ii 1F 1k 1E iP 1E 1E 7E iE iE 1E �k'!f� IE if 161E 1E if 1f 3ElE 1E if 1E iE 1E'II� iE IE IblE If if if 1h 1E 1E IE IE 1E fE 1f 1E iF if iF iE 1(� IE 1E �E iF if 1(� fE 1(� iE IE iE iE i! IE I N D I V I D U A L F E E B R E A K D 0 W N INS E QTY D E S C R I P T I O N 1 BOILDING RE—INSPECTION FEE END OF FEES UNIT COST TOTAL COST 30.00 30.00 0 � �'. �' :i?;� - - - rv.;;«� , :;� , ". `r .. �!i .. ` , ' ' P0� . SPR� 1' ' , CONSTRUCTION AND P�ANNING • b,PPROVA�S Permit# Date Inspector qppROVAIS Permii�k Date Inspector t�. Tep�porary Electrical Service or Pole 52. Pooi & Equipment Locatior�`� 2. Soil Pipe•Undrgrnd. 53. Steel fteinforcement . �'�� 3. Electricaf Conduit lltility-llndrgrnd. 54. Forms � _ •i 4. Electrical Conduit�Undrgrnd. 55. Elgcirical Bonding . . 5. Sreel Reinforcement 56. Rough Plumbing & Pressure /fest 'i ��6.- Electrica111FER Grnd. � � 57. APPROVAL70 COVER�GUNITE •�S '� 7�. Footings 58. Electrical Conduit-Undrgmd. ' n. --8. FOundation= 59. Gas Pipe, � Undrgrnd., Test . 9. Water Pipe-Undrgrnd. 60. Bac}iwash Lines, P�TraP, � Uddrgrnd. � 10. Structural Ploor System 61.;APP,ROVAL TO DECK �� l' 11. Property Sewer Line & House Connection 62. Bacl{wash & Recepior-Fina� �'�. � 12. Sewer Cap ,;� 63. Heater & Vent-Final � 13. Rpof Drains . 64. Plurr'1bing System � Final - 14. ROugh Plumbing � 65. E�ectrica!-Final •'' � i. 15. ROugh Efectrical•Conduit .. 66.'Sotar Svstem-Final �' 'J, 16. ROugh Electric Wiring 67. er�cing & Access Approval .� �� 77. Rough Wiring Sign 68. APPROVED FOR PLASTERIfVG i . i 78. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �� 19. Rough Heating & Ai� Conditioning � . ; � + fIRE�DEPT:,REQUIREMENT 20. Rough Factorq Fireplace � � APPROVALS Pe"rmit # 21. ,Dutts, inSTructure ' � - , - � 70. Underground Hydro 22. Ducts, Ventilatiog _ � � 77. Product Piping.O Gas ❑ Oil 23. Gas Pipe�Rough & Test ,.�. `", : 72. Underground F,lush 24. Roof Framing r 73. Undergmd. Storage Tank O Gas ❑ Oil 25. ROof.Sheathing `-, �- 74. �Overhead Hydro - 26. T�Bar Cei�ing (Structurei) & Monocoat �. � 75. Dry Chemical " . 27. Frame arid Fiashiog' �_ '. � 76. Dry Standpipe . � ' 28. Laihing & Siding��.•� - . � � � � 77; FIXED SYSTEM FINAL " r r. i 29. Insulation ' � 7$. FIRE PREV. F�NAL � 30. DrY�va�l Nailing - � '� ' 'HEALTH DEPT. REQUIREMENT � 31. PlBster 8�own Coat , .� � 79. FINAI INSPECTION 32. ElectncahPower MecerPinal 80�. FOOD CEFTIPICATE ISSUED 33. Final Electric�' ' � � '� Notes: �' 34. 'Final Heating & Air �Conditioning �, - � - � � • 35. Final Gas Pipe-Teit ' " �;- ; r . „ " 36. HooB or Canopy `' ' -. � ...�.- � . . � ;� ' 37. Final FactorY Fireplace � - ' . '` � 38. Final Plumbing - . � 39. Water Service�Final -- . � . 40. Gas Service-Final " - � � . 41. Solar pomesticFinat • 1 , '' � - 42. Backflow Preventer _ ' -- � _ 43. Backflow Irngation - , ". : ' � qq. Landscape Irriq2tion System , � � ' , � � . ' ' 45. Sound Attenuation . ' , 46. Handicap'Regulat�ons � •.� : 47. FINRL STRUCTUFLE & BUILDING �/�:-'�' , _ . � 48. FINALPLANNING r� 49. Electric Release to Edison � �:' - 5Q. Gas Release to Southem California Gas Co � 51. C�RTIFICATE OF OCCUPANCY No Date R�6�ccvaooxess: 420 W 19TH ST' uxir: OWNEfl'S�AME: CHURCH FIRST UNZTED r, —•anuxEss: METHODfST OF COSTA MESA 420 W 19TH ST COSTA MESA,CA 92627 650-7767 ANCHIENGINEEfl: .T�"iE$ ROBINSON flFG.NO.: CS28Fi pooxess: 151 KALMUS DR 751-0492 uNir: E5 C,M. CA 92626 PEflMITTEE: 1 UMC � 714 i 548-7727 p00flE55: 4 2 O j"1 1 9 Tii ST COSTA MESA CA 92627-2026 LICENSED CONTPACTOR OECNflFTION: I here0y afiirm Iha� I am license7 un0er D�o�isions ot CAapter 9 gommencinp wiih Sec�ion 7000) ol Oivision 3 of Ihe Busine5s antl PmleSsions Cotle, an0 my license is in full lorce anU effeci. CITY UC.: STRTE IIC.: CU1SS: EXP ; Date: SiBna�ure: WONREBS' COMPENSATION DECNflATION: I nereGy atlirm Ihat I have a ceniliWte of Gonsent to selbinsure or a cenilicate of Worker5' Gomp¢nsa�ion Insurance. ot a cerulietl copy t�ereol (Sec�ion 3800. LaO. C�. POLICY NO.: E%P. OATE: COMPPNY: ❑ Cenified coOY is �ereby �umis�etl- ❑ Ceriified copy is �iletl wiN ��e city BuilAing Division. Oale: Apylitani: EXEMPTION FPOM WOPRENS'COMPENSATION OECLAPRTION: (T�issection nee0 not6e completeAilihe Dermitislorone�unam0�5f00)orless). I certity Iha� in Ihe petlofmance ol ih¢ work for which this permit is i55ue4 I s�all noi employ any person in �ny manner so as b became su�lect lo ihe Workers' Comoensation Laws ol Calilornia.�� 'Y '� D i� �� ` r y Sig�alure: 6 C NOTICE: II, aRer making I�iS CeGlara�ion, yoU 5�ou10 �etOmE SUGjeCi I orkers' Compensation provisions ol the Labor Cotle. you must lonhwi�h campry wit� suc� Dmvisions or t�is permn be OeemeA revokea. CONSTpUCTION LENDING pGENCY: I herehy ailirm ihat t�ere is a constmclion lending agency for the pedormence ol ihe work for whic� Nis Oermilis issuea (Setlion 3097. Civ. C�. LENOEN: FDDFE55: OWNEB BUILDEfl OECLAHATION: I here�y aifirm Iha� I am exempt �ram ��e Contrac�ars' Siare License Law for �he following reason ISeclion 7031.5 Business anA Prolessional COAe: Any ciry ol counly which repuires a permit to conslmct, alter, imprave, tlemolish, or reDair any 9mcture, prior lo its iisuance. also requires the aODlicant for such permit to (ile a signeG statement ihat hNslle is Iicense0 pursuam m I�e pwvisions o� Ne CanVac�ors' Siate �i�ense Law �C�aD�e� 91�ommencing with Section 7000) ai Oiasion 3 0l ihe Buvness and Pwfessions Cotle� or I�al he/she is erempl IM1erelrom and Ilte Casis far t�e alteBed ¢xemD��on. Any violation o� Section 7N7.5 by any applicant lor a Oermi[ suDlects �he applicam to a civil penalty oi not mom ihan live �unOreA �ollars (5500). I. as owne� of Ihe pmoeM1y ar my emoloyees wiih wages as their sol¢ compensati0n, will Oo t�e wark, an0 the ❑ simcwre is not intenAeO or o��eree lor sale (Section 7M<, Business an0 Professional Code: TAe Caniractars' State License Law tloes no� appty �o an owner o� a propeny who builGs or impmves tM1ereon, an� wtlo Goes such work tlim5e��herself or ihmuAh his or her own employees. pwvitletl t�ai such imWovemenis are not intentleA or oBeree foi sale. If, Aowever ine Ouilding ar impwvemeni is solA wil�in one year of completion. Ihe awner will �ave Ne bur0en ol provinA he/slie Citl not builU or impmve lor Ihe puroase af sale�. � I, as awner af the pmpert , am excWsively conVac�inq with licensetl conVaciors lo cons(mc� �he pmled (Section 70EC, Business an0 PmiesSians CoEe: iKe CAntratlors' State License Law aoes nm appry to an ownei oi p�ope�1y wiro Dutlas a improves 9rereon ' Snd w�o coniracts lor suc� pmjetls wi�h a coniraclor�s) license pursuan� �a the Contrattors' S�ate LitenSe Law�. I am aware Ihal O�ool ol iheir Worker's Compensation insurance s�oultl be pmviEeO to me. � I am evemp� under Seqion: B. 8 P. C. ior ihis reason: � � �aie: o-a�� Ownec I do �ereUy cetlify Ihat I am aware al antl unG¢r5tantl the reQui�emenis of Ca�ilomia H al ana Salety Code Section5 25505. 25533. and 2553d antl inal 1 or any iNure huil0ing octupant wilUwiil not �cirtle ane) need to compy w�t� uN state coE¢5 and ihe �epui�emeMs ta a permi� �or conslmc�ion oi mo4ilicati0n �mm ��e Air �uality ManaAemen� Dislric�. ReSiaential conslmciion applicati0n5 are exempi tmm ihese provisions. ,� Uale'. AOPIIWN; I nere�y ceridy Inat I nave reaa iNs aYv��calian an0 state thal ine aUove intormalion is co/rep. I agree to comvh �� a0 city and county oreinances anE siaie laws relatinq io Guiltling construction anU �ereGy authonxe �epresentatives ol tha ciry to enier upon t�e a6ove-mentioneA pmperiy lor inspeclian Ourpfoses r 1 / � Oale: ' J ( Sipnature: �-j"�Y1��— /�'�/�/w Dmer's Li[ense or Socui Secu�iiy ar t6aFa6 Wnite—Buiitltrgt G�eea—GaGe EnbeGemenr, Caoary—ppplicS�C P�rtk—Revenuet GaWenroG—AsSessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06943 PERMIT NO; B 069431 PLAN CHECK NO; 01106-94 L GOVT: N SUPP: N CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE; ALT JOB DESCRIPTION ; UPGRADE H.C, RESTROOMS, CREATE STORAGE SQ FT: 10,000 CLAIM VALUE; 10,000,Q0 CALC—VALUE; 1�,OQa,00 GROUP OCC; A-3 1 E•3 COMMENTS: EXPAND CLASSROOM INTO EXIST STORAGE AREA, MISC T.I. �r***�**i�******+t****�+r***+�r�t*�r«�r***�r*********ir*****�r*******ir**r***�r*�r*+r********* 2 O N I N G R E Q!3 I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAA: FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; ET IN PARKING REQ• PROV; PARCEL; 41920505 ZNE; C2 AEE NO; PLANNING NtSTES> INTERIOH ALTERATIONS TO CHURCH, > � itif if kklf if!litMltMititikfFMMflMlFklf fFiflFitlf kMiflfiklE4itMMfF%ffjf MilMitlf MMkfFfflf 4flifif MMff 1FfF1tM1f 1f fflf iF�if MIE3f if k1kiF�Eif D E V E L O P M E N T�J S E R V Z C E S f� E Q U I R E M E N T S ZONING APPROVED BY �S/T DATE: O 2/ � BUILDING APPROVED BY ; DATE; �� APPLICATION ISSUED BY: DATE: ��O ifiliflfifMififjfkMMifkiflF%7t1fiFlflt it 1f if ik MifKlEfflElfiflflf jl1E 1k1F1f�FiflFiffkiFk4M7fffil1f1F1t1k1FfF�t�fftlf ifMMikil�flFfF4k�F1fM 1fMif ff1fM1F1t1liflfM�llfMfflflEM�ffflf%kMfldfflMif�lff}FiflflElf LEGALIZATION;N F E E S U M M A R.Y STRUCTUR'AL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC, FIRE SMIP/RES GRADING PERMIT 117,00 ' SMIP/NON—RES PLAN 76.05 � 2,10 ISSUE FEE ' •- ' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 119,10 0,00 76,05 195,15 195.15 ,00 REVENUE DIVISION TOTALS--> COLLECTED; . 119.10 OVER/5AORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 1 1%, � 0 ,r � � �, 1 0 � ik iF fE M �f if 1f fE if iF it if fF if iF 1f 1f I! M fh 1F M!M ik if 1f iF M iF ff �f 1f fF 1f if M!f 1F M!t f! k 1f 1k.fF df M.M f! M!F 1F 1t M ff if if 1F if 1f k 1f M!f 1f 1t 1f 1f !F if if if ff M M if 1f iF 1E I N D I V I D U A L.. F E'E B. R E A IC D O W N TYPE QTY D E S C R I P T S O N , UNIT COST , TOTAL C05T SFC 10000 ALTER HY VALUE COMMERCIAL N020NE 1 00 10 000 00 END OF FEES ' 0 �i 'JO?7�?72-07170072 T CtT ?.f: DA?t: i�i24/�4 TI11E. 1b:39 �31 C+�J174071—C�Ol,'DO71 T:_+T ii'+.D�, DnTE: ;pi3;JY4 TIrE: 16:sS \ �ONSTRUCTION AND PLAIVNING �� SPA ` APPROVALS Permit # Date � Inspector APPROVALS Permit # Oate Inspector I Z' Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe�Undrgmd. 53. Steel Reinforcement -' .'�`.:'Electnc�l .C,n.dduit Utility-Undrgrnd. 54. Forms � . . � '4��EF.ect�icel�Conduit-Undrgmd. 55. Electrical Bonding � > 5,'Sieel.Rein�rcerrfept 56. Rough Pfumhing & Pressure Tesi � ,,,�6. �E{�trieat_CJEER Gtpd. 57. APPROVAI TO COVER�GUNITE ,� "�.^7: Fdotingi �� '� 58. Electrica! Conduit-Undrgrnd. �� 8:- Foundatlor " � 59. Gas Pipe, O Undrgmd., Test ,. 9. �Water Pipt�Undigrnd. 60. Backwash Lines, RTrap, � Undrgrnd. � � i 10.-Structurai.Floor System ', 61. APPROVAL TO DECK • . 77rPrQnerty 5ewer Line & House Connection 62. Backwash & Recepmr-Final • � , .r 12. Sewer Cap;' _� 63. Hea[er & Vent�Final • 'i i, � 73. Roof Drains - r 64, Plumbing System - Final - - 14. Rough Plumbin�q ' �' 65. Electrical-Pinal ' '" 15. Rough F�Ieccrical�Co�duit � 66. Solar System-Final � , 76. Rough Elpctric�Virtng � 67. Fencing & Access Approval •. � 17. Rough Wirirg �iyn 68. APPROVED FOR PLASTERING 18. Rough Electrica'I•T Bar Ceiling 69. POOL/SPA SYSTEA4S FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. fiEQU1REMENT _� _ � ., 20.:,flough FectotY F'ireplace �r-- :� _ . : rqppR�VRLS-':Petrriit # '� �� c � . n. 21`Du'tis.in Stcua�; , r:- " : a �, "' :-�;--�r ;;� ^ , � � • �,< - `;70. �.k�dergeocindHyslro 22. Ducis, Ventjiatiqg. i . : i. ��71. Product�Piping f9Gas ❑Oil 23.'�:Ga�ipe'��f�ough &'Test � 7� � �� ; y �72. Undergro�3nd F�usFt. . .� �� 24.1Roof Framing .= �.�- � �` :73� Undergrnd�. Stotaye Tank O Gas ❑ Oil 25. Ro4f Sheathing � `� �;� � �� :' ;� . ;, `7q�;_�OverF�ead`T-lydro,'��' 26: ;T-�ar Ceiling (St�uctural} gL-p,�onocozt . � -�. 7 0? 4+ 75SDry Chemical - - Y 27 'frame and Fiishir�� "' ' � •' � 76��D�r Stand' i e �' �' ' :.� � :, , 1 � Y Pl� _ S.JLathin �& Sidin � .�`%•i� � �� • . . 2 9'. 9:- �•• . ••� •• � 77:r FIXEO S-WSTEM F�INAL �29. Insulatibn " - " ' ~' ..'.. . � �` � � (''' , 76` FIRE PREV. PINf�L . > , .• x ' ! . �30. Drywall�Naiti g�- �� + � in s_ HEALTFt�DEPT. REQUIREMENT i 37. Plaster BfOW� Coe�' ! ' _ � ,-�, �.,79.'FINAL IN��ECTI`dN ,`'' ` � • .32-Electrical Power�Mateqr�nali �`� •'; � I:� � r80.�F00D CERTIFfGASE IS-_ D- 33. �Finai EleFtric '�' . ! ;' y `" � � i ;' '�Not�s: Zz� �%'j ' '��j��Y/ ` � ,�/C f/ , � a' , t / 'i34. Finz� Heating�& Air.Comditionin� ` ��. ' , i � ��. � � .. � - ' ra�- a✓ .'ut 'a��/^�= _ c • Cc,. S�%:�` , 35!�Final Gas Pipe�Teft^ "� I �•�' ` g� �O%!!/�r.-Pi-i'�� l � .• . /vC I.ti '.. 'f{�vN� .36�Hootl or'��oPY � � ' . ;r � ' . ; � �• , v . .. , . , • . - . r ' .:. x : � = 2: P //'� �!T/ � !'� �-37:_FinAI Factory Firepiace : '% � � -� . G � 9N ` � C, ��l�i� . .�. J /' '38._Final PlDtnhing i ��i� . .• . _. � % '�t � .i0 /-Y,%'S � ��W � 4T'�C. 89%1+<� � 39.-Water Service-Final• � � �� ' + � ' , > ✓, , .• , : , �. � 7 Zz2� � //�Y/l✓ �� ,40. `Gas Service-Einal " - . ' � - � � ia <v': � � I '; GIUSc '-.r� -�, _ 41. Solar pomestic-�inel -: ,� � � _ ,''. � j �' , � . . � • ,,, , „ � 9S . •�._ �� -. 42.�BackfloW Preventlr; F" ,- -. ,'r -• i ,, ,. r;� . , y - .i 43. Backflow Irrigation' , "' � ' '';"�. . ' ' ,: i � � .,_ _ �, � , , .., 44. Landscape Ivigation SYsiem.;-��, �:� � , � :� ..7' ' ii --' p..', ' " . � - � _ ' � - -- - �- � 45.'Sound Attertuatioo. �.�:�� . ._ .• ^�' - -' •"" ='. . n �' r, .:, � . � , , .... . -,. _ • 46.�Handicap.Regulations � . ' � �' . �7-, � �47.:FINAL S7RUCTURE & BUILDING y� s � � �- � � ^� .�:�= _ _ _ 46.�'FINALPLANNING; ' `��'� �� ' �' � . i f-'.. 4: i- '�' .. 49. Elec`eric elease to Edison � �' - � .' :> • : �; - _ n �50. Gas ReleaSe zo Southern Californ� Gas Co ., • '`�� ' r, . . �1. CERTIFIGATE OF.00CUPANCY � . „ • c. _ No. Da2e _ ' 0.1ECT AOOflESS: 4 2 Q ti•j 19 TH ST ` ^� UNIT: OWNEB'SNRME: CHURCE FIRST ONITED �' � nooeess: METHODfST OF COSTA MESA 420 ?d 19TH ST COSTA MESA,CA 92627 650-7767 HEG.NO.: ANCNIENGINEEH: JAMES ROB I NSON C 5'��,6 nooecss: 151 i:ALMUS DR 751-0492 ES PENMITTEE: C.M, CA 92626 AOOflESS: R M iI ELECTRIC ( 714 ) 646-7378 165 23RD ST z COSTA MESA CA.92627 LICENSEO CONTflACTOP OECLAflRTION: I hereby alfirm ��at I am licenred untler pmvisions al Chapter 9 �commencinp wilh Sectian 7000� ot Division 3 ot the Business antl ProtesSions Code. antl my license is in tull force ana eBeci. �7 STATE IIC.: LASS: 0?40/ 4 32573B � 1 �`Sy: �1t9/95 Oale: _�/L/'=lJa� Signature' _ �% � �� WOflR ' LOMPENSRTION UECLANATION: I �ereby allir mat I have a cenificat o1 onsent to self-insure or a cenilicate ot Workers' nsation Insurance, or a cenifietl caoY ��ereol (Section 3800, LaO. C1. POLICY NO.: E%P. OATE: COMPANV: ., � C¢rlifie0 capy i5 �ereDy Wmishetl. ❑ Cehifietl m0Y is IileO vnlA 1he city BuilEing Oivision. � Oale: ADPlitani: E%EMPTION FflOM WOBNEXS' COMPENSRTION DECUBATION: QhiS seclion neetl noI be campleteU iI �he permil i5 forone hunCreA (ft00) ar less). I certily �hal in Ihe petlormance ot the work lor whic� �his permi� is i5sue4 I shall no� employ any person/m a/ny man{nej�S� as ta become �ect Ioi� Work ' Compensa�ion Laws ol Calilamia. /��,G�`f��^'"`� �- /5 Dat ' / L Sipnamre'Q/ / NOTICE: I�. al�er making ��is declaration, you shoul0�come suGleci �o � ers' ComOensatian provisians al �ne LaCor COtle. you musl tOtlhwiih comply wilh Such pmvisions or I�iS Defmi� Shall be aeeme0 f¢vokeC. CONSTflUCTION LENDING AGENCY: I Aerehy allirm I�ai I�ere is a Consimc�ion lentling agency �or I�e p¢Aormance al ��e work lor which Ihis permil is issuetl (Sec�ion 3097, Civ, C). LENOEN: aooxess: OWNEB BUILOEB OEClAM710N: 1 here6y atlirm t�at I am eKempt Irom ihe Cantracmrs' Stare License Law lor t�e tallowing reason �Sttlion 7037.5 BuSine55 and Professi0nal Coae: Any Ciiy al [ouniy w�ich requires a permi� fo ConSWti, allet, imprOvl, Eemolish, of reoair any stmcture. prior to its issuance. also repuires ine appliwnt for sucn permit to file a siAneC statement that npJshe is IicenseA pursuam m Ine provisions ol Ihe Contracmrs' State License Law (Chapler 9(commencing vrilh Settion 7000) al Division 3 0l IAe Buvness antl Pmlessions Co0e) or inat he/she is exemp� iherelmm ana ihe Uasis lor the allege0 exemption. Any viotation ol Seclion 7031.5 hy any aDDlicanl lor a Dermit sublec�s the applicani to a civil penalty al not more than five huntlfe0 Oolla6 (55110�. I. as owner of ��e pmDe�y or my employees wiih wa9es as t�eir sole com0ensation, will Eo t�e wark, and tAe I❑ struciure is no� inlenGed or offeretl for sal¢ (Section 70Ad, Business antl Pmiessional Cotle: The Contractors' Sia�e License Law does not appty lo an owner oi a pmpetly who builOs onmprOv¢5 ��ereon, antl who Aaes such work �im5ell/herseli or I�muph , Ais or �e� awn employees, pmvitled thal such improvemenis are nat intentletl or oflere0 tor sale. If, howaver Ihe building or improvement is soltl wrthin one year ol completion. ihe owner will have t�e burtlen of pmving �e/s�e ditl not huiltl or impmve ' lor ine ourpose ol sale�. I. as owner of �he pmDehY. am exclusively conirac�ing wi�h Iicen5e0 coniradors to conS�Ntt the pmlec� (Section 7044, Business ❑ and Pmfessians CoOe'. 7�e Contractor5' State License Law does nol apply to an owner o7 Dropeny who UWltls or improves ihereon dI1G Wh0 COfIi(d[IS �OI SIILII pfOle��S WII� 2 COOIfdCI0f�5I IICEOSE O�fSUdlli IO IM1! COI1�fdC�0l5 $IdIC LIL205E LdW�. I dlll dWdfE tnat O�ool of Vleir Warker's Compen5ation insurance shoulG Ee provi4etl to me. � I am e�empl unAer Sec�ion: 8. 8 P. C. lor Ihis reazon: Date: Owner. I Oo hereby cendy Ihat I am aware of ana unAerslan0 ihe repuiremenls ol Califomia HealtA anU Safety CAae 5¢ctions 25505, 25537, ana 2553< antl ihat I or any tutWe building occu0ant wiluwill not (cirGle one) neeA lo compy with Saie 51ate codes antl Ine repuirtments for a permil lor consVuclion or motli�ica�ion Imm Ine Air Oualiry ManaAement DiStrici. Pesitlen�iat consiruction aOP��ca�ians are exempi Imm mese pmvisions. �ate: Ap0licanl: I here�y cerli�y Inal I have reatl Ihis applica�ion and s�ale iha� Ihe a�ove in�orma�ion is correcl. I ag�ee lo comply wii� all cily antl counry or�nces anA stale laws relaling �o bwl�ing consimciion and hereby auilmrize represen�atives ol this city)a enier uDon �he above�men�ione0 �6aba6 Green—Cotle EnbecemenL Canary—Applicant; Pink—Revenue; GOldenroE—Assessor r CITY OF COSTA MESA — BUILDZNG PERMIT PERM NO; E 07000( FERMIT NO: E Q7000Q PLAN CHECK NO: N COVT; N SUPP: C7 COPJSTRUCTION TYPE; PEP.MIT TYPE: ELE PURPOSE; ALT JOB DESCRIPTION ; UPGRADE H.C. RESTROOMS, CREATE STORP.GE SQ FT; CLAIM VALUE; CALC—C'ALOE; GROUP OCC; A-3 / COMMENTS: AEF: B-69931 a{�7�ac+4�c�cx�t+f**iF�f+cx-a(-*a�aca��-*�c�7r�,cic*itau**x-�c-�**i[�*-ux-«ic�aca{�x+cx,c*ar..�c+F�r.x*ac�f*�ac��ux+c*u+f*��,cx**��cac�c-Y Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCcSSORY BUILDZNG --------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: =T IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN FARKING REQ• PROV: PARCEL: 41920505 ZNE: AEF NO: PLANNING N6TE5> > i4+E 9f iE if 1E if if if i: �c if iE+E ic iP iF iF it fE ic iE if iE ac if 9t 1f IE if iE i: it+f if if aE jE iE iF u ic i� iF if if +F if �1r� iF iF r iF x dc iF # iF i4 aF 9c i� iF *+F+c x it it iF i4 iF if iE s qc ic iF iF D E V E L O P M E N T S E R V I C E S R E Q U T A E M E N T S 20A]IPIG APPROVED BY DATE: bUILDING APPROC'ED BY ; DATE: c � DATE• �.� P I TION IS..UED bY• AP L CA iE��E+t#�t�ciF+fifaE�tiEafaEaF�f�t�tiFiE+E _ . . w .. iFr�fififi�+fiFic+�.�- �Ya\ 1F1E�fifiE')fi{iF'IFiRiflfififiEififYififlFif-Jf1E'k')f'IfafiFififiE'I�"1F�1f�iEiEifaEiMiFiEi1-iEiFiFdflfifaElfiFi4aRiGafififafiEiFif�)fiF-lfifit�fiFif�fi[ifif�if 'Ik�FiE LEGALIZATION:P7 F E E �S U M M A R Y STP.UCTURAL SEGMEP7T:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 24.50 . SQ�� ^' SMIP/NON—RES PLAN � ISSUE FEE 15: QO,�i �' bUILDING—DIV—> FERM2T ISSUE FLAN—CHECK TOTAL PAID DUE TOTALS----> 24,SQ 15,00 . 0.60 39.SQ 39,50 ,UO REC'EIJOE DIVISION TOTALS--> COLLEGTED:. 39.50 OL'ERiSHURT: ,UU BLUG PMT PLUMBING ELECTRIC MECHAAIIC FIRE SI�1IAiTOT GRAUINC PLe'1N—CHECK 39.SQ +c**��cr**+�*+��c*****rt�c*+�+c***+��c**.cx*rr***x�+��r*+�**+r**x��x*�,�a�-�**+�*xxa�**�rx*�.�c**�+�u***�+� I N D Z V I D U A L F E E B R E A K D O U! N TYPE QTY D E S C R I F T I O N. � UNIT COST TOTAL COST ELE "l FIXTURES, LIGHTING ELE 12 RECEPT;OUTLET ELE 4 RECEPT/SWITCH ELE 1 SUB—PANEL �1 ST 20 EA 1 ST 20 EA 1 ST 20 EA END �OF' FEES . � . 1, ,75 ,75 .75 11,00 O1 00�72076—Q0172076 T C� T oAr�e 11/23/44 TIf1E: 10�0.'. 1.SQ 9.OQ 3,OQ 11.OQ G 39.g� � r E• : i CONSTRUCTION AND PLANNING APPROVALS Permit # �-,- t. Temporary Electrical Service or Pole 2. Soil Pipe�Undrgrnd. 3. Eleciric&� Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Stee! Reinforcemenc 6. Electrical UFER Grnd. 7. Foozings 8. Foundat�on .r 9. Nlater Pipe-Undr9rnd. 10. Structural Floor System 1 7. Property $ewer Line & House Connection 4- i�2. Sewer Cap , �t;r. rtoof Drains 14. Rough Plumbing � 15. Rough &lectrical-Conduit 16. Rough Electric Wiring 17. Rough W��ing Siyn 18. Rough �Iectrica6T Bar Ceiling 19. Rough Heating & Air Conditloning 20. Rough Factory Fireplace 21. Dutts, in Structure . 22. Ducts, Ventilating 23. Gas Pipe•Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T�Oar Ce�ling (Strucmral} & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulati0n 30. Drywall Nailing 31. Piaster 6rown Coat 32. Electrical Powar MeterFinal 33. Fina� Eiectric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Firepiace 38. Final Plumbing 39. Water Service-Final 40. Gas Serv�ce�final 47. Solar pomestioFinal 42. Backflow Preventer 43. Backflow irrigation 44. LandscaPe Irriqation System 45. Sound Attenuation 46. Handicap Reguiations 47. FINALSTRUCTURE&BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southesn Catifornia Gas Q 51. CERTIFICATE OF OCCUPANCY Date , Date Inspector ..,�, , �,,.. P00� .. SPA APPROVALS Permit # 52. Pool & Equipment Location 53. Steef Reinforcement 54. Forms 55. Electrical Boncling 5&. Rough Plum4ing & Pressuse Test 57. APPROVALTOCOVER�GUNITE 58. Eiectricai Conduit�Uncirgrnd. 59. Gas Pipe. � Undrgrnd., Test 6�. Backwath Lines, P�T�aA• � Undrgmd. 61. APPROVALTO DECK 62. Backwash & Recepior-Final 63. Heater & Vent�Final 64. Plumbing System � Final 65. Electrical�Final 66. Solar System�Final 67. Fencing & Access Approval 68. APPROVED FOR P�ASTERING 69. POOLlSPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Undergro�nd Hydro 71. Product Piping OGas ❑Oil 72. Underground Flush 73. Undergrnd. Storaye Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical � 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. -� E PREV. PINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION -� 8Q. FOOD CERTIFICATE ISSUED Notes: �i-7/..0,� ,.,_ _/�../ �_. � Date I Inspector .. r PqOJECT RUUflESS: 4 Z O W 1 9 TH ST ' OWNEB'SNAME:FIRST UNITED METHODIST CH aoosess:420 W 19TH ST C,M., CA 92627 APCMIENGINEEH: AUOflE55: flEG.NO.: UNIT: PENMITTEE:SADIGHI CONSTRUCTION (714)279-2517 aooxEss: 1160 VIA LA BRISA LANE CORONA CA 91720 LICENSEU CONTflRCTOB UECLANATION: I here�y afiirm ihal I am IicenSeA untler pmvisions ol Chap� r 9(commencing wi�� Seclion 7000) ol Oivision 3 al Ihe Business and PrO�essian5 Code, antl my license i5 in ful� force an�t. CITY LIC.:Ot S.-(�'��Q7 STqTE LIC,�'� 1 O S 4 cuss:g /� .. Daie', �L � Signalure �_— _y� WONREflS' COMPENSPTION DECUINATION: I here0y afivm thai I have a cem�icate ot consen� m 14insure or a cenificate of Workers' Compensation Insurance, or a cetlifie0 copy �hereof (Sec�ion 3800, La0 C) POLICYN0.:1268BSZ-9Z EXP.ORTE:lO/O1I93 comvaxv:STATE FUND ❑ Certifietl copy is hereby lumished. j�`] Certitied coDY �5 �ileU wilh lhe ciry Buiiding Div' ion. Oa@: � '�' Q� ppp�icant: E%EMPTION FflOM WOXNEFS' COMPENSATIOry UECIABRTION: (IDi55eti on nee0 nOt be tompleietl i� the Der - is �or one hundred ($100) or less�. I ce�ify ��at in rtre petlormance ol Ihe work �or which this permit is iSsueA, I 5hall not employ any per5on in any manner so as to become sublecl lo �he WaBers' Compensa�ion Laws o� Califomia. Oa�e'. Signaiure: NOTICE: I7, ai�er making ��is Aeclarati�n, you shoultl become suble�� to �he Workers' Compensaiion Drovisions of �he Lahor Code, yau mu5i forihwith comply wiN such pmvisions or I�is Oermit shall be OeemeO revaketl. CONSTBUCTION LENUING AGENCV: I het¢by aitirm Iha� t�ere i5 a cons�mc�ian lending agency IOr ihe peAormance ol �he work for which ��is permit is issuea �Seciion 3097. Civ. C). LENOEfl: AOONE55: OWNEH BUILOEB OECIAflFTION: I hereby affirm ihat I am exempl imm �he ConVac�ors' Sta�e License Law for �Ae fallowinA reason (Seclion 7�31.5 Business antl Pmiessional CoDe: Nny ci�y o� couniy which requires a permi� �o cons�mct, al�e�, impwve, tlemolish, o� repair any SVuclure, prior �o ils issuance, 115o reqmres Ihe applicant �or such permit ta �ile a 5igne0 statemen� �ha� he/she is licensetl pursuam m �he pmvisians oi ��e Comracmrg' Slale License �aw (ChaD�e� 9lcammencing wilh $ection 7000) oi �ivision 3 of the Business and Pro�essions Catle) orl�at helSM1e is exa,mp� thereimm antl ��e basis forihe alleged exemp�ion. Any violalion of Section 7031.5 by any applican�for a permit suble��s Ihe apPlicani Io a civil penally ol no� mare than �ive hunOretl Eollars (5500). I, as owner of ��e pmpetly or my em0loyees wilA wages as �heir sole compensa�ion. will Oo ��e woB, anA �he ❑ stmclure is not intenUeA or ofleretl lor sale (Section 70aa. Business antl Pm�essional Cotle: The ConUactors' State License Law tloes nol apply lo an owner ol a property who builds or impmves �herean, ana who Ooes such work himseli/hersell or IAmugh his or her own employees, D�oviaed Ihai such improvemen�s are nol in[entled or ofle�etl for sale. II. however �he builtlmg or impmvemen� is soltl within one yedr ot comple�ion. �he owner will have �he burtlen o� O�ovinp �e/s�e Jid no� Uuild o� impmve lor ine vurpose ol sale>. I. as owner ot �he pm0er�y, am eKclusively conVacting wiih licensed conVac�ors �o conslNct the Orolec� (Section 7044, Business ❑ antl Pwfessions Code'. The ConVap�ors' S�a�e License Law does not apply Io an owner oi propetly who bui105 or improves thereon and who contracts �or such pmlects with a conirac�oqs)license pursuan� ta �he Contrac�ors' Siate License Law�. I am aware Iha� pmol ol �heir Warker'S Comppnsalion insurance 5hou10 be provitled to me. � I am evempi untler Sec�ion: B. 8 P. C. far inis reason: � Dale'. Ownec I tlo hereby certify Ihat I am aware ol an0 untlerstantl Ihe requiremems ol Cah�amia Health anA Salety Cotle Sections 25505. 25533, antl 25534 and Iha1 I or any IWure builtlmg accppanl willlwill not (circle one) need lo compty wi�� saitl slaie co0es and the requiremen�s �or a permi� �or cons�mc�ion or motlilica�ion Imrn t�e Nir Oualily Managemenl �isVicL Fesidential conslruc�ion applica�ions are exempt �mm Ihese pmvisians. Oaie: _ ApplitanC I hereby cetlify Iha� I have read ��is applica�ion antl s�ate Ihai Ihe above information is correci. I agre¢ �o pty wiih all ciry antl counry ortlmance5andsla�elawsrelalingloDuiltlmgconslmqionantl�ere0yaul�oraerepreseryqI rveSof�MS iry e erupontheabove�mentioneU pmPerry tor in50ec�ian OurPases. 1A' �// �' Daie: � � Z —` � SignaWre: ' " ' — � oriver's License or Social Securiiy a: 164La6 W�i�e—Buildmg', Green—Cotlt Eniortemen�-, Canary—ApPlicanl; Pink—Revenue', Goltlanroa—Assessor J • CITY OF COSTA MESA — BUILDING PERMIT PERM NO; H 062932 PERMIT NO; B 0(2432 PLAN CHECK NO: N GOVT; N SUPP; N CONSTRUCTION TYP�: SFR SP PERMIT TYPE; STR PURPOSE: ALT JOH DESCRIPTION ; T/OFF REROOF PART OF CHURCH W/BUILT—UP SQ FT; 500 CLAIM VALUE: 500.00 CALC—VALUE; 500,00 GROUP OCC; B-2 / COMMENTS: REROOF 100SF OF CHURCH W/HUILT—UP �rx�r�r��r��r�r*** *�r�r**�e�r�r*�r*******�e*+��r�r�e*�r�e*�e��r�e+��e�r�r�r�r*�r+��r�r�r*******+e **� *�r�e �e� *�r�r�r * * 2 O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARRING REQ• PROV: PARCEL; 91920505 2NE; REF NO; PLANNING N25T'ES> %' it1FiF ikitlkiliF 1F k k fk if iFiF iEif fF �F �f if k 1f k k iF iF�F �FiF k ik �f 1f 1Fikit iE if if fF�E iF1F klF�f if k if it ik�F 1f 1t �f ilif if i! if �f iFit af iE 1F if iF.dF k if if �f k if if iE �F D E V EyL O P M E N T S E R V I C E S R E Q U I R E M E N'T S f%. . ZONING APPROVED BY DATE: �r.- BUILDING APPAOVHD HY : DATE: APPLICATION ISSUED HY: DATE: �� 2— � iFitit3f�tlflflflFiFififififfFiF�EfFifltlllf3FiF7Fif�f'if�iF ifif3fiFiF3f3fiEikit ilif if if �FiFiE k it ik iE iF �t 1f 1FiFik 1E iE!! 1F IFit iE 1F k�t �Fat iF�F �F ik�F �k �t �f if 3F3F �F �F If �f iFiF 1f k iF if MlEif kikif iF 1f if if if if ikik �f if iEik �f if �t ik3k�F�F if iflF iF iFiF LEGALIZATION;N F E E 5 U M M A R Y STRUCTURAL.SEGMENT;Y BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 15,00 PL� SMIP/NS�N—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSDE PLAN—CHECR TOTAL PAID DUE TOTALS----> 15.50 0,00 0,00 15,50 15,50 ,00 REVENUE DIVISION TOTALS--> COLLECTED• 15.50 OVER/SHORT: 00 BLDSSP00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/T50 GRADING PLAN—CHECR �E iE 3k�kit 1E IE iE itit 1FiFfk iE�E iE iEik it 1f it if M M iF ikif iF it iFit jt M if if iE it iE �t �E flfE it 3FM IE iF 1E 1t iF�E �E3E if iF M�f �f iE iFlE �F �E �F�E 3Fif iFiF iF iF iF ik iF1E 3f 3FiF �)E i I N D I V I D U A L F E E H R E A K D O W N TYPE QTY D E S C R I P T I O N SFC 500 REROOF BY VALUE COMMERCIAL N020NE END OF FEES UNIT COST TOTAL COST 1,00 500,00 01 ��1ti0284—D014025` T C�T 1;,50 DATEi 06/02/93 TI11E� 13:52 : . .:. -----'� � GQNSTRUC7ION AND PLANNING - � POOL & SPA APPROVALS Permit# � Date Inspector qppROVAL5 Permit# Date Inspector 7, Temporary Eiectrical Servi�or Pole,-: 52, Pool & Equipmeni Location 2,��oil Pipe-Undr�yndf, `� C,F � 53. Steei Reinforcement ' -=�<..Etactrical CondLit-�llYilitY�Undigmdr � 54. Forms � d'. €iectrical Conr�it'l�drgrnd. �, S 55. Electrical Bondin9 ��..�tEel Reinforcement - ��x 56, Rouqh Plumbing & Pressure Test o� �. �: ;� ;; �'°E�lectrical UFEs9 Gmd. 57. APPROVAL 70 COVER•GUNI7E - V . �. "�/.��E9otings � -� 58. Electrical Conduii�Undrgrnd. 4 E-• �. Foundation =�s . 59. Gas Aipe, O Undrgrnd., Test � ;-,� � Water Pipe-Undcgrjnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. ; 74, 5tructural Fiocr�ystem • �' i 61. APPROVAL TO DECK ' � 1'C. Property Sewer L,'�ir�& Ha�t�,eCoMe'ctian � g2, Backwa5h &�ieceptor-Final �, �� 5�`�ef �P y� .� � 63. Neater & Vent-Final 'i 73. Roof Drains � , .n , 64. Plumbing Sysiem - F�nal � iR. Rough Plumbi9g v• ti � 65, Electrical-Final ' i 15. Rough Electricat-Conduit-� �.� 66. Solar System-Finai . i 16. Rough Electri�'"yViring �� 67. Fertcing & Access RpProval � l77. Rouyh Wirir;g 5ign 68. APPROVED FOR PLASTERiNG 1$, Rough Electrir�l-T Bar Ceiling 69. POOLlSPA SYSTEMS FINAI � 19. Rouqh Heaciny & A�r Condiclon;ng Fi pT. QUfR MEN7 { I .� �., . . r- . :._ a 4 x , c^ �-�.- � � :a � Yt I 4^.?7 4,`? JC C 7 r'+1 S' [� '� n'r n. ?� Y 20,`.�io�h �ctpz'y F�z�place � �T � ¢ ..� � �i �,. � x -APPR V * ��era�5rc # `•'. . � � ;�" . -�----er-. � -- ?. ;_,�_,T,�_= � �, � ; �=,: --=�--� . -� 21.wJucs, ifi5tr�+ctu!'e= � .. .. �-'.S '" - �' � x -70. lnderg;o6h� Hye��o ` � :P � \F-: 3" ry :.> � > 2G.SDUcY,s� ��fliitailr-.,,. � t: s y' ^ x x �� r� � i � s: � ;� �� .; '71. Produc., i Gz�s CI.Oii � 23.•Gas1?iv�est ^�iS �:�; e- � .' :,-'-"- -�+-s--`--� � �+� * 72. Undergro6li� Fltr,�ci. r' �r " Y 24.�`floo`t Fra'ming '-"c,� �'� ^ u-' C- x x� m NY VC , ' , , / . ��. J3-.Undergrnf� Sroraf�c3j�k � Gas bi 25. t�oo�` Sh6athing (j... ..�+ //r�gQ� - x 74t"�'Qverhead Hydrd�_ ^' � I _ �l 'l ` �.:. x �� C ,c 26:�F-B�rCeilin {Stru ural!&��"coat "� "' `'� ''.�': '� ' .K:� '� ��' ;,: 9 � -''�� y;.; r �x r 75 _�rY Chenicai ;� x � � '-.� . "'. .' i 27 •,�Frame aad Flashin}: _, � z. : 7 Y =� x 76. Dry Stan :pe :-+� * '�� '28. atrtin� S'�in ^x cc ^:s,S ?c x ?_ ..:� x �. �.' `�,� x • ,• n -� � ,;, t� 9�:a �j�i-� cj s. <;; 77 FIXED.{..,`c�Jl" i("�iNAL,j•_ i-, � 29. Ensvtation v O� `- �•• • ^ Y+ '� A 78�FIRE PREV. FltUzil `' 7'= �' - �� Y a '30. qryevaft:�5lai�sg �;� � � � �, '� `_" �iEALTi�EPI',`, a-EQbiRF�ViENT i �j31. P�aster �o�^�ra C4at.- ^ r ;n;r� � � M 79. �FI��AL IM11S�.ECl"!�N ^ y �.. .� � . �^ ?}�cr-a- � � Y .z_ -� t'32.=�lectrical Pa`••er�,4�t�'.F�inai� * N � ` x 0;`FOOQ CERTIFF�ia'fE I5� I�ED eI I 1 ..i... 1 J,( Y% - 1'- ! ' l '�- - TT'�^.�_ �33.�i�r^> 3 > r�, i � k � f : x Ncites: -! � �n f,. ^ �7 � ' � �_ " _ £-�:k�:.--.,-:-:.:-. ... �.Tr. _ _ • _.GS-` � -: r �„�34f'Fina; H�atin'g,& i3:i'r;Cqndi:idn]iiy� n � +''� �^`• �' �'�- * �.� 'r`�� y �: � < 1: l,l •i � �-� a{� � � .35{�fin9lGd'aPipb-Te�t,� ��" ' r:.- -•..• .-� , •� fl � � < ti: ^O l�:-! % �. :'n �---� � 'i �6. _'riond or CanopY' x � _ r - :1. g ,^, � x a ' � ^p � �,� .J � :? i 7 .c (". i .1.'.�: v I K ' .r1 : :r= " "7 :i7 � v r � . � .. ,� � [ r � '_�. l _�__.___T__'_____ � _37.:finaL F�tory FirepJace� � c, L. ,.: .w f ,- � x ,r .i ,� -. -y4_�,,,__._^- . .� t.`. .. �r r �y� _ _ � _38. Fin}7 Pl�imbing >. � n� � � F' r :_ -- = v � Y. � i C. v : X ,� S +: r � � z �< x . �, '39. 4tia�r Setvice-Finat� __ , ' ;� x . x ,; _ ,, .S , r: - -- "� � 40. Gas Servlce-F1nal . 1.:��[r 5 Y•a h %J, ,_ " �r x x �� C z. � �L !' J Y.. !� - ic X T T41. Sotar pome�c-Fin�fS ,; .. � x � r ;,., * : - ' � : . - _i�. � . .�Y . _ . � 42. �'d�ckflo�S Preventer �J x � ix x � :� ' ' "'_ �- , i r... :. � ri l.-. _ y: 1-� �t k ti;(:�'- '.! _- 1 ' J .t: i S +t ,r. .� � � t.. " � 43. 6ackflow tr�tgatioq; „ :r .,; � �'� �- • �, . " = ;r.44. 4andscJue i'Aiqati6h SYstern�tT'C; �- *. :T� � �.� * a' p: .�:^ : :, _ , , . K � 'x S s -.. ;J:: ,� � � z45.;5ound Attehuatior} �=.. �` , >_ ^ _ _ < x i -. o" : ` .` . y. r; .zl .�, t7x �- 1 I � J -T --�+ ---� :46.�NandiwpRegulacions � G x � � S • �c S �: . � T� � �� f, .. � _1 „47.�IM1}�l STR�CTUAE & Bt1H.DING " � ; . . ��/�1� � `. s �' � -;.-�' 48:.�r'IiYLaLPLANNING" r:^ ..�.� 'v e it ,r, r,; + -- � Y ' .# :v ti � � '=49j�fe�[ric Re{e�se io;�disan ' ' '- � " .' �^ � :: . � � ` � r. S$ r S -(`, r C .c50.�aas�Release ta Southern Californie Gas Co * � -,. X Y . \ �._ �-�'? '� i ^ � 51. CERTIFICATE OFOCCUPANCY � x - �. r*!c• - "-i= '� `� Date � � � PflOJECT FDDRE55: 4 z O W 1 9 TH ST OWNEfl'SNFME:FIRST UNITED METHODIST CH nooeess:420 W 19TH ST C,M., CA 92627 AflCN/ENGINEEfl: AOONESS: NEG.NO.: uxir: C UNIi: PEflMITTEE: S.�IGHI CONSTRUCTION ( 714 ) 279-2517 aooecss: 1160 VIA LA BRISA LANE CORONA CA 91720 LICENSED CON7NACTOB �ECWRpTION: I �ereGy allirm Ihai I am IitenSetl une¢r provisions ol Chapt 9(commencing wit� SectiOn 7000� o� Oivision 3 ofihe Business antl Professions Cotle, anU my license is in fulllorce antl ellecl. cirruc.:0562 >1 STATELIC.Y,-�1O14�sn�ia Oa1e: —6�=�j� Signaiure: _ _ __ _ � WOflNEPS' COMPENSATION DECLABRTION: I Aereby allirm ai 1 nave a cenificate ol consen selbinsure or a certificate o1 workers' Compensalion Insurance. or a cer�ihetl copy Ihereol (Section 3800. Lab. C). aoucvno.:1268812-92 E%P.OFTE:SO/OL/J3 comraxr:STATE FUND � Certiliea copY is Oere�y lumished. � Cetlifie0 coDY is filetl wi Ihe ciry Buildin ivi5i0n. _,_ Dale: � Z A�D��cant: EXEMPTIONFBOMWOBNEHS'COMPENSATIONDEClAflR714N: QAis ectionneeenotbewmpleteAilthe�miiisfaronehunOreA�St00�orleu). I cetlify Ihal in Ihe performancR o� the work �or which Ihis permi� is i55ue0, I shall nol employ any person in any manner so as to become sublect Io Ihe Workers' Compensaiion Laws of Calilomia. Da�e: Signalure: NOTICE: II, alter making I�is tleclaraiion, you shoultl become suble�� o Ihe WOBers' Compensation pwvisions o� Ihe Labor COde. y0u mu5i lart�wi�h comDly with Sut� Dmvisions or �his permil S�all be deemed r¢vOketl. CONSiflUCTION LENOING aGENCY: I hereGy allirm ihat inere is a fAnsimction IentlinA agency far tne petlormante of the woM lar whic� Ihis permil is i55ceE (Section 3097. Ci¢ C�. LENOEfl: aooeess:REPLACE EXISTING STUCCO OwNEB BWLOEN DECLABpTION: I hereby atfirm �na� I am eeemD� ��om �Ae Coniraclors' Stale License Law for the �ollowing reason (Section 7031.5 Business and Pmiessional Cotle: Any c��y ol counry w�icM1 requires a permit to conslmc�, ai�er, improve, tlemolish, or r¢Dair any SlruQure. O��or lo iR iSSuante. also �eptn�¢5 Ihe applitani to� SYc� Pxmii to1Ne a Sigll¢d SlaiemMtl tAdt hP.(She is IicH15Eil pursuant lo t�e pwvisions ol t�e Coniraclors' S�ale License Law (ChaO�e� 91�ammencing wlh Section 7000) ol Division 9 al �he Busfness and Pmfessions Code) or Ihal �e/she is exempt Ihere�mm antl Ihe �asis lor ��e allegetl exempiion. Any violation o� Seclion 7031.5 by any applicani lor a permil suble��s �he applicant lo a civil penal�y o� noi mare Ihan �ive hun4re0 Dolla�5 ($500�. I. as owner ol �ne property or my employees witn wages as iheir sale compensation. win Ao tAe work, anU tAe ❑ simcmre is nol inlenAeO or oilered for sale (Sec�ion 70aa, Business antl Pmfessional Cade: TAe Comracmrs' State License Law does no� a0oty �o an owner ol a propeny w�o Guiltls or impwves Nereon, ana who aoes such work himself/herseli or ihmugh �is o� her own employees. D�ovitleU I�ai suc� impmvenrenls are no�intenee0 ar ofiereG lor sale.11, however t�e builtlin8 or improvemen� R 5010 W�thin one year al compleiion, I�e owner will have ihe burtlen ol prodnp he/she tli0 nol builtl or impmve lor Ihe ourpose ol SalEl. I, as owner ol Ihe pmpehy, am evclusrvely conlracting wilh IicenSeU [ontrac�ors lo can5tmct Ihe pmlacl (Seclion 7044, Business ❑ an0 Pmteuions Coae: The Caniractors' S�ale License law Goes noi appy lo an owner 01 prOperiy wlw Cm145 or impmves ihereon anE who contract5 �or such D�ojecis vni� a coniractor�s� licenu Oursuant f0 �he Cantradors' State License Lawl. I am aware that Omot oi t�eir Wo�ker's Compensation insuranre s�oultl be D�oviOea to me. � I am e�empl untler SFc�ion: B. 6 P. C. lor Ihis reason: Oale: Ownec I Oo hereby cetlily ihal I am aware ol antl unaerstand ihe requiremenis ol Califorma Heallh an0 Salery Coae Sections 255D5, 25533, ana 2553E and t�at I or any IUWre building occupan� wiil/will nol (circie one� nee0 to comply with saia s�ale cotles anA Ihe Bpuirements lor a permi� for cons�mtlion ot modificalion imm I�e Air Oualily Managemeni DisUicL Fesitlen�ial con9mciian aD0licaiions are exemD� ��m I�eSC provisi0n5. Daie: ADD�icant: I �er¢Uy teilily Itui I �ave reaJ this appl¢aiion ana Slate I�al ��e a0ove inlormation i5 wrtetL I agree �o Comply vnt� all ciry anA touniy oremancesanastalelawsrelalinglobui14ingconslmclionanUhereUyaulhorkerepresenl�veso�i�iscilyl meruponi�ea6ove-memionea O�opetly larinip¢tlion purposes. � 1 / Date: �—Z— z3 Signature: � V Qv 'I� Driver's Licensr. or Social Securi�y a: t64ba6 Whitv—Builtling; G�een—Cotle EnlorcemenL Canary—Appl¢am: Pink—Revenuo: Goltlenrotl—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06243� PERMIT NO: B 062433 PLAN CHECK NO; N GOVT; N SUPP; N CONSTAUCTION TYPE: 1FR SP PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : T/OFF REROOF PART OF CHURCH W/BUILT—UP SQ FT: 5,500 CLAIM VALUE: 5,500.00 CALC—VALUE; 5,500.00 GROUP OCC: B-2 / *��****�r�e***�***��***x�*�r******�r**********�r�e�****�*��r*D***�r��*�r�r�r+�**�r�e�e***�e* 2 O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN PARKING RE • PROV; PARCEL; 41920505 ZNE; REF NO; PLANNING N 'PES>., ' �' 7E iF k ik if if iF iF iE if �f 1! 1E �F k if IE �Fif iE iFiF k iF iF iE iF �t �F if if if iFik k �f K�E iElf iF �E 1F �E iF fE �flF IF k if it k iE �E IE 1E iE if �E iEif if iF 1E iF 1E IF 1FiFiF iElFif if iF K it iF D E V E.-L O P M E N T S E R V I C E S R E Q U I R E M E N yT� S ZONING APPROVED BY DATE; ` r BUILDING APPRO{7ED BY ; DATE; , APPLICATION ISSUED BY; DATE• �� 1fiflfMklflflklfiflFifiFiFiflFikkikklfif �flE3titiFiFklf�Fif 1f1F kikif Mkiflf �f�klFif 1kiE�titiffkitMifififif �Fk�ffFkkiFMiFiflfitMffikiFiFititiEif!!lt�fitkiFiE�fffkiFiFififMltiflhifif MkfF,it�Fik�f �l�tfkiFikik*it LEGALIZATION:N F E E S U M M A R Y STRIICTUR'AI;�SEGMENT;Y PERMIT BLD81POQ PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING SMIP/NON—RES ISSUE FEE �.� 1.16 BUILDING—DIV—> PEANIT ISSUE PliAN—CHECK TOTAL PAID DUE TOTALS----> 82,16 0,00 0.00 82,16 82,16 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 82,16 OVER/SHORT; 00 BLD81P00 pLIIMBING ELECTRIC MECHANIC FIRE SMIPiT06 GRADING PLAN—CHECK 1F iF if if iF1Fif If 1E ikfF IE if If fE �f Mif if �F 1F if k M K�f �t �f if k M M k iflf �t �F iF 1E it it iF if %M IF M M K iFif iF 1f M iF1f if i1iF 1f if M!f iF iE ik k iF �f ii if �F if Itif If if 1F if I N D I V I D U A L' F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST t SFC 1500 ALTER BY VALUE COMMERCIAL N020NE 1,00 1,500,00 SFC 4000 REROOF HY VALUE COMMERCIAL N020NE 1,00 4,000,00 ,END OF FfiES ,�• J 01 �6140286-0�140�&7 � c�T s2,�a OATE: Ob/02/93 TIME: 13�53 �� . �, i--�-.,i ,, s - - - � POG SPA CODISTRUCTION AidD PLANNING APPROVALS Permit¢-r Daie Inspector AppqOVALS Permit,"r Date Inspecto. i. TemDorory Electnral Service or Pole-.: , 52. Pool & Equipment Locauon � �. Soil Pipe�Undryrndt . �: �' 4�� 53. Steel Reinforcement �3,�{8ctrical Co�d'eit-L �Iity�Undrgrnd.- 'S4. Forms tiT "4.'Electrical Cond�t l�adrgrnd, z'� 1i5. Electrical 8onding .> �5.�$t2'el Reinforceme�.�,t F �56. Raugh Plumbing & Pressure Test -' -' �- �.� �. �iectricsi UfE[�Gnd. � �7. APPROVAL TO COVER�GUNITE ��9.�Footings � � �a8. ElectricalConduit�Undrgrnd. "$. Fou�dation , �9. Gas Pipe, � Untlrgmd., Test $, N�ater P�pe-Unc[rgry�d. ' . �.BO. Backwash Lines, P-Trap, ^ Undrgmd. � iQ Structura� FloarS�+stem • � 81. APPROVALTDDECK � 71. Property Sewer U?��.& Ho�Conn�+'ction � �Z. Backwash & Receptor•F;nal - ta, Sewer Cap a� ' a- �:' 63. Heater & VenbFinal ^ 13. Root �rains � � ' .j 64. Plumbing System � Final ' j � 14. Rough Plumbire�q �- _. 65. Electrieai-Final ' 15. Ro�gh Elecvic5; Conduit 66. Solar System•Finai i6. Rough Electrir'"}�,yiring 67. Fencing & Access Approval t7. Rough4VinngSign 68. APPROVEDFQRPLAS7ERING 18. Rough Electricul-T Bar Ceihng 69. POOL/SPA SYSTEP.75 PI �AL 19. Rou�h HQati�q &�ir Condit�oninc� ,� fl(� q,E.g]'. R.EQUIRF�v1ENT, N,L O' ( i-- l� K �r 7 t. -� '- 1 ¢ Q x k � l t-... . .� :'- . .J - �F > _' �-:u: + N I > >: rP % �C;': 20.�Ao�h , ctyr�/ F�p�ace ,� r ,�,r x '� - P,, z iAPPR(�;/A��y_,..,- er'n�iit ;� _..-;TA - ' - .� 21.-Ducg, ifv$irdceu�x � !•• ^ �'� � � '� '^�X �' F�-f0. t7�dergrat�?d`-Hy�ro � � . x �.� ti .: � ^ . :.. i ,� � i�"� 22.r�uyw, �entiinn�x � . �x : y r -r x�]1. Produc�PlAtc9 �GOS CJ�Od , • : . ,.�-c;,. 23. Gat�ip!-Rot�h & T�est ! T� '� ; - _ �� + �+/2. Ur.dergrot�� 'ir�= '� " }�` j n -r .�c 1 r[� rJ_' i' iC �: �z �[ s x y oy S :. .:n ! E�:' :- v J �. O x�K S� R' 7 �--_'� .O 24.erioo� Fr3�nin'g' _; ��, : ;r x 3. yndergrno� Sto�ac��jj�s�k 6�1�. Gas C O�I 25. �ioo' Shnathing � x �S _7�l'/ 3 74•�5aerheatl HydroL _ '+ � � �� S 26:;#'�Bar Ce;ling ISt�,�urall &�J',��coat _ � �T", - =* � 75.�{}�y Cherr�gal `.-: K� "�i =<-�-ta-'.�-:t� 27...Frz�ae �d Hzshax,� .,-r,r - >.da � 76. Dry Stan j� -'� ` ;� - - - qsi-� xc- �i r� �_28. LathS'ng�%� S;ding�n: i �' iy� _ _ . '� Y �` 77 �=FIXEO S�rTEAij -`jNAI . .� ;P' ic _29. InscYation . G�. " � .. • � f .k 78?�IRE PREV. PIN '�' ~ � ''�30. D�yual�,taifng �,y�. . "�. j �LTh��EPT�xF�EQUIR`�.i.^"�NT � , .. - -,-.>--<-�� _ : . -1 �t. Plaste. Q'o�^.rs'Ca�* s i,' - x x y T79. �FINAL I�tSf�CTI�YV �• �* � �2.�Iectr�cal Po�i:er l��er'�FL�nal' '� � x•T$0.-`f000 CERTiFI�-{�E IS�I�D � r- ; r • : ; - z% Zt-T; i/� /! ��'�T v- ��3: �ir.ai Elqtrip ,3x .h ' �i � � I k NotZs: Y: .f i.r �s ' �� U� 1 �4f�inel He6ting;& l�r`'Co�tditioh�g'� � 'A � '" ''` > r" " S .- x. r . r:U :� �.r„ z� � -�,: _ ��--,rrr-c-,r ; �. i35Jfinal Gas Pipn�TesJ, � .• ri . s a:; 20 �..-+ a '-- . ..z • - f �7 7-=r,�' � �6.'C�o� 0��PY� < 7:1 1 � r .3. . ` _{ � , F (10 .. r � � - I __ __r,__, J � : ., _ _ 37.rtinat.Factory Fireplace r � - ' � i � '+� � rr � �cel a i� � �ic . ---- �.'�i,8. Fin6+PleTmbing x" .�J � _ ` � I K * S - y - � � !*1 r, � , . l_ •: >. 'F ti z \ � " � . � . ' J J �39. L�:ate7 $tivice_Firi<y,; �. � �e .; j > c y v =. SS ��-�i Fl � ' .' i -r .•RO.GasSer�i2e-�na6�> ��'T � ` "` _`^ ;y ,� t "��il.; olar potl�es+cFinal = R. q I ��, � � �,� J, x c - ' F ' --�`--$-- � 42. BackfloW PreventsYx � k ' : rv ' � �_ < <, �� , .� r ':,C.� ; _ -r-�- 43. Backflow Irrigatib;,. ; 'S _ . . - i� �; 44. Landsca�e Ir.riga�y SystemC'�'= � } ' - =h � � '� s ``,z r � _ `';' I �45. Sound L�tte�atiejs .G . . f _ y � � �� 46,•Handica�Regulatiotas - C ; : . �� Y �47. FI ^ L S7ftt�CTU �E & BUIt01NG + ^� $ �%�r3 � 48.�FIPt'ALPLANNING" >� - ' I - . ., t '49.� Electric_HeleSse to Edison -60.�as•PelEase to Sou�hern G v51. CER�IFICATEOF•OCCUI No. Date Gas Cn � � . ,� �. r � S' . �:L �i z �� - : M ' �`" - . ,; .� ^ � �: n �n �i � -�-� ,.-'' '�� . � � .S , OC � 7 �� 1 • y! ` .. .- �� " - -`_ Costa Aiesa Building Department APPI.ICA7`ION FOR PER117IT �'f COST' FASSA?CALIFORNIA `�925 -. `._6 U_I_L_D.,I,_N.G.- ---. -'� ' FOR OFFICE USE ONLY : FOR APPLICAN'Y' TO FILL YN i Receipt No. Permit�No. � nadre�u 7' YU lN �y � S% � �' �3%S� � 9�� Costa Mesa, Ci&I1f017118 Received�by Date Rec'd. Date Issued i Nearest /1 � I _� 2�/ ' S'�S Cross St. rTiP o� ��/ _ � Building � - � / ` Address � Owner�OS7A �5/J-i�OMMLNITV/%k�otlJT/JUiR, � � Mail , i Costa 1liesa, California , Address �'✓0 w /�/r �%- � Nea�est ' � Tel./ Crou St. ; � � City - e,� NoR/� j�SS'7� Zone/� No.of Type I Groupr f Arohitect or Lic. �` y 1 I P�ans ( � 1 �/ : Engineer � a�/� No. Approved ; i � by ' Daie � Address ! . CORRECTIONS '• r City Lic. � � Contractor No. ' � I i 1 Address i_... ' _____.. i New Size I � Lot I I _ _ :fon No. { Biock � Trec1 � Metes and Bounds) � r �� d� �� _I u � / `/�) � / c� No. ot Bldgs. ' .ot OS b✓ 8 U I Now on Lot � i I No.o( No.of � Bldg. Families I Rooms Line from Rear Vard - � f Street Sfde Vard A Addition d ,^ .....- cr.� i-^ -•-'-- — Covering � Covering APPROVALS Usc of New Foundation lxation Inspecto Biiilding Forms, Materials, Under-Pinning Frame: Fire Stops, Bracing, Bolts Lath.lnt. I hereby acknowledge that I have rcad this Application and gtate that the above is corrert and agree to comply Lath. Ext. with all City Ordinances and S!a[e I.aws regulating building construction. Signature of Plaster, Int Permittee � ..�_ .__ .-... Valu.ation � J (� $ � �� FINAL � O 9 � Z D r Date t • • �� .� Show IoCatlon and �distances �1rom � . . property Iine and�between buildings. a . .. ' ' _' _"_ ' " ' ' i- , — •. i ! . Mesa Baitding Department� ;� -, °. O. Box 3!7 QL�'�� t . COST lESA, CALIFORNIA ' FOR APPLICANT TO FILL IN Building Address Costa Mesa, California Nearest 2' OI' 6Np0 � Cross S ownerQpu�Illl�ty Methodlst ChtlrCh• Mail Address P�D�BO$ 217� ctey Costa Mesa:. no: •, - Arohitector �i�, � Address ('mT7j�;R��¢ Contrector H� J�j Ctty LIc. . �� No. 4'7i 4 Address 212 Flower St. C:oeta Mesa, Legal I Lot I Deseription No. Zrj . I Block I Tract r c�ch M=es and 9oundal Fxirvl9"% Tr� Size of Lot Use of Buflding No.of Size j200 eq F't800ms 9 stories 2 Exterior Wa Roof Covering �'CUCC'O cover�ng 90 # COm Use of New s��ia��a Minieter 3tudy & School I hereby acknowledge that I have read this Application and s[ate that the abwe Is correct and agree to mmply with all Clty Ordinances and State Laws regulating �bullding construction. Signaturaof ^ � � j„ � Permittee ��"�'o AuthoAzed Agt. �� Valuation Pe�mit Fee $ � j • � ' Q Q � Plan Check $ � 6•.� C $ •� � Total S� 1� �.,o., ». , Fee $ 1 o.ee o. v. e s. PPLICATION FOR PERMIT 'q4BUILDING � �coo FOR OF'FICE USE ONLY Received by Date Rec'd. �/� �Q '"^'�i % � S° S 6 1� Buildin Addrew Costa Mesa, California 7i � Plans �roved , . {.. . .. APPROVALS Ext iry Reinioroed Beam Date N �� a1' G) 2 D r ....�_.oncosr^._..z ..•......�9�n .�..,::,: , � . ' — . .. _. J.' . _ . .� . . i:-c . . . . . . . J _ ' . � �_C i . . ' . .. - ..- '.'. � _ . . YI..IJl' YLEIPI &how locatlon and dfstancea from :. property I(ne and between 6ufld(nga � . . •,.. . . . . .. t;�; `�: , ! `y� ' .�ss COSTA MESA BUILDING DEPARTMENT P.O� BOX 31] COSTA MESP.. CALIFORNIA FOR APPLICANT TO FILL IN ADDftE55 y,(j W ' � � {- . COSTA MESA. CALIFORNIA OWNER MAIL ADDRE55 CITY � ARCHITEC OR ENGI� ADDRESS � LEGnL ILOT / DESCFIpTION NQ, � A.P. NO. 1/ � � SIZE � �� OF LOT USE OF EXISTING BLDG. C (. SETBnCK LINE FRON li L� IA. NO. LIC. NO. / IrvO.OF BLOGS. NOW ON �OT SIDE YARD, RIGHT (/ LEFT DESCRIPTIO OF WORK NEW q�TERATION I ApDITION REPAIR MOVING � I� IOEMOLISN BUILDING NO.OF SIZE ROOMS STORIES E%TERIOR WALL ROOF COVERING COVERING BUELDINGEW ��7,u.,rG� �L�.00� o E� RECEfV�� ia��4/ss v�� FlNANCE DEPT, APPLIC� TIOFN�FO�R�P�RM IT BUILDING FOR OFFICE USE ONLY RECEIPT NO. P[RMIT NO. / / ✓— V ei /d BUILDING ADDRESS COSTA MESA. CALIFORNIA FIRE ZONE ZONE NO.OF TYPE - /i � PLtNS � l% 1 APPROVED BY DATE ;.� .,_/ ,. � _�f�R3�ECTIONS PL'a veur. :� — S �2 — � 2�,' The Amo '1 HEflEBY RCKNOWLE�GE THPT I HPVE RERD THIS qPPLICwTION nND STRTE TM1T THE OBOVE IS CORRECT 4N0 >GREE TO COMPLY WITN FLL purpose of establishing a permit fee oniy. GITY ORDIN/�NCES AND STATE L��'/5 NEGVLRTING BVILOING CONSTFVC- TION. �' VALUATION /. dS0 PERMIT FEE S b . SIGNATURE OF • '' PERMITTEE - � �O I � 5 / S PLAN CMECN $ AUTHORIZED AGENT ' TOTAL FEE 5 (� � � �� - ' � � I(i � � � �B � 3 999 . f M COSTA MESA BUILDING DEPARTMENT FIV�ANCE DEPT. � P.O. BO% 3Iv ��n OF CpSTA f.1ESA . COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING � /� .�/ 1 BUILDING ADDRE55 1� La+ ( l •t�l.. � ` COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY OWNER �e -�r �ll� �. _� .�K L^ AECEIpT NO. I MAIL C (Iy ED BY '�TE RECEIVEO DaTE ISSVED � ADDRE55 ,17 i I -� J� \ �� J�• j �-/ �i TEL. . BUILDING ry � CITY � p NO. ADORESS C d ARCHITECT LIQ ' oR ENGINEER No. COSTA MESA. CALiFORN1A � FIRE ADDRE55 ZONE � � CONTRAQOR � ��wS�•�TY N1O. ��NE pO;rvS TYPE GROUP \ ADDRE$5 j,l. a.11O'( NO. � VS3 ePPROV pM�c DATE 2 I/ V lEc1L LOT /) IO S � DESCNIPTION NO. / S �ByLOCK A.P. NO. � CJ — O / ' , , _ 1\ \. SIZE Q�� / �o. of' Biocs, � j � OF �LOT �O ��ow o�+I �oT i i use oF � Q C�'t( U! �,n� C! I Y OF � 1�:T.\ N,Ef'iA ' E%ISTING BLDG. (,(. SETBICN LINE FHOM , 'I � � ' �`� , J' � U�r I • t[HiEa O% srvEEi D {f REAR YARO SUBJ�CT TO L`G. DEpT. REG. SIDE YARO RIGH1 LEFT DESCRIPTION OF WORK ' IIY P�N �DAT � NEW ALYERATION ADDITION REPAIR MOVING OEMOLISH HUIl41NG � NO.OF SIZE ROOMS �� STOFIES '—� E%TERItlR W L � R��F COVERING COVERING USE OF �'1£W BUILDING L f �� Gc�- 1 HERE9V ACRNOW�EDGE TH4T 1 HRVE REi� THIS 4PPLIC4TIOrv arv0 A yNL ST�TE TN�T THE 100VE IS GORqECT �ND /.GR E TO COMPLV WITH 4LL •�` CITY Ofl��NTNCES LRO STI.TE •WS REG LAT G BWLDING CONSTFUU r�oN, yqLIIATION � SIGNATURE OF �/ i� �� PERMIT FEE $ PERMITTEE "�� -` av PLAN CMECK $ � $ AUTMOF�ZED AGENT TOTAL FEE $ ��— `�� ' 1 ��5 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MEHA. GALIFORNIA For Applieant io Fill In Complefely TYPE OR PRINT ADDRH65 �4� l�. 8 19th St COSTA ME$A CALIFORNIA OWNER Cpmm. rdethodiet Chnrch w�n:.o«� g8iiie _ _ _ '_ xg xg TEL. SIZE I NO. aP BLD69. OF LOT NOW ON LOT E](ISTING B DG. �unda� SOYIOOZ ROOIDS 86TBACK LINB FNOM DESC[tIPT10N OF NO. OF E%TERIOR WALL COVERING U6E OP BUI4DIN 1 H¢PEBY AGKNOWL8D68 TXAT 1 HAVE ReAO TXIB MPLJGTION AND BT�TB '�HAT TH8 ABOVE IB LORR6CT ANO AORHE TO CON- PLY WITH AL� G�n OROIN ANO AT8 LAWB OU TINO BUILDINO CONHTRUCiION. � a8' Qm[(1• 0 a QZ) BIGNATURH �P g$ j�fOL411TtTV lshlu�eh � if ► E` RECti1/EU �'/ « � U o FINANCE DEpT. � `� �d��L�ASRSI� q�/�ERMIT BUILDING For Office Use Only RECEIPT NO. �6i �02 D ,Gt7- � � �i COSTA MESA. CALIFORNIA ZO I NO. OP �� PLANB LBowL (nl� . YARDS APPROVED (CENlYR LINC BTJ APPROVED t198 OP N BUILDINO EVE� 5/ THE ANOUM BHOWN UNO¢R VALUATION IB FOR TME PURP088 OP EBTABLIBHING A VBRMIT FEH ONIY. VALUATION � O U QERM17 FEE $ � P S � O P�N CMECK $ �- Z � .l p TOTAL FEE � n • S COSTA MESA BUILDINGSAFETY DEPARTMENT P. O. BOY 917 COBTA MP�A. GLIPORNIA For Applleanf fo Fill In Complefely TYPE OR PRINT ew�oiNc O w ' � � nooReas COSTA MESA. CALIFORNIA � ARCHITHCT ■ BQiBACN DESCRIPTION OF u _ ,� WALL , i:4'� ` rti.--'SA�� i .x• � qQVi�^�, �n`,J:�_-__-_ � 1 FIRE For Offite Use Only RECCIPT NO. PHRMI N � �.� BY DATE RECEIVE OATE IGBUE .�,,a—�d I /�..,o--a o �o �� y :p�A MESA. CALIFORNIA zoe No. ov - �/ PLAN9 � I C�!%! i.eaw� O LO_ZL� DeeCRIPTI o�e�oas. / 1 I '— N .. ICCNTBR LIH6 BT.1 APPROVED O DATE ING U8E OF N BU�LDING � I H8R[GY ACKNOYM1dD66 THAT � HAVB xuo Tx�s AALJGTION n�e AMOUNT BHOWN UNDER VALl1ATION 19 IOH TNH AND 9TAT8 TNAT TX8 ABOVB I6 CORPECT AND AGIiHB TO COM- pURP068 OP HBTABLI9HINO ♦ eERMIT PEB ONLY. pLy WITM I1LL OTY pRDINAN�P AND HTATe LAWB qHOULATINO Bu1LDINo CONSTRUGpON. � VALUATION �W BIGNATURE O // - PHRMIT FEE S �� r PERMI7TH ^_ � PLAN CHECK $ � $S"Op, ° _ AUTHORIZED AGENT . �— p TOTAL FEE � LL .: • � ��s�o FF` RECEIVED ' COSTA MESA BUILviNG-SAFETY DEPARTMENT �FE �'i 3 d963 _1 P.O.B0X917 COHTpM88A.CALIPOHNIA FINANC��DEPT, b°� For qpp�icont fo F711 In Comple�ely ��bL18�1TQ�TQO�[f�tMfT TYPE OR PRINT BUIIDING em�.oiNo � G T�� For Offica. Usa Only ADDRE88 O , p!C[IIr NO. p � NpQ COSTA MESA, CALIFORNIA � �/ aece : r oer[ rtec[rvm iea OWNER S G� !� � ///''' ''' � ADDRE53 �/C G�f�' . 1 ll BUILOIN6 .I�D I' y./' ' �7 ADDRfiSB �f� / � FIRE TEL. ZONH TYPE / GROUP CITY NO. APPROVED ARCHITECT TEL .�� BY � ' bATE ORENGINEER NO. � ZONINf3 �dlv � aooaess ZON NO.OR U880 NEY� �,�j�/ � PLANB �� BYILOINO � �l CONTRACTOR O � "� ADDRE59 � �Of/ �. S � �CRIPf10�� CITY Y/ / A. P. NO. � �� v ` C U NOTE: NO EAV 8 OVERHAN6 6HALL BE LE68 THAN. ` STATE 7/O�D � TEL / FJ_ �(�iL 90' TO SIDE 9 REAR P. L _ LIG. NO. �� NO. � CI C�/ SIZB O Ho.o�eLuoe. ALLOWED fU.B.C.REQUIREMENT) OF LOT �� I NOW ON LOT USEOR YARDSAPPROVED YARDSAPPROVED � EXISTING BL�p, _ � (i � � S� MAIN BUILDING ACCESSORY BUILDINO (FROM C/LBTREEf) CBMER OPI9TqQH{~ S� � RPJ1R YARD �O / FR NT PT. PT• SIDHYARDI tEPT �� p�pM � � / P.BIDB iT. FT. —` DESCRIPTION OF WORK �.sios r�r. vr. NEW ALTERATION ADDITION REAR �• D16TANCE BEf, MAIN 8 REPAIR MOVINO D8MOL16H MAIN BLD68. ACGESS.BLDOe. VAR. iF DATE BUILOINQ�� NO.OP 61ZE OOMH BTORIEB C.U.P. APPROVED EXTERIOR WqLL ROOP � ��'R�VH� ^ COVERING COVERIN6 BY D TE �" � USE OF BUILq�N6 ANO WORK TO B8 PERFORMED s � .5,, • • % / OU/�'% f7A s �' U� o 1 NlHEBY ACNryOWLeOO¢ TXAT I HAV6 RBI�D TNIB �PPLIGTION TMB AMOIIM BHOWN UNOHP V�LII�TION IB POH Trye g ANO eTATE THAT THB ABOVH IB COHHECT AND AOqee TO COM� PUPPO88 OP 88TABLIBHINO A PEHMIT P88 ONLY, p PLY WITN �LL CITY OHOINANGHB ANO 8TAT8 LAW9 q80UlATINO BUILDINO CONQ7RUCTION. VALUATION LI./1 N PERMIT FEE $ �� V SIGNATUREQF �� m PERMI7TE �� C EC 0 /� 4 AUTHORIZED ppENT 70TAL FEE