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Home My WebLink About524 19TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • a�vw.ci.costa-mese.ca.us 77 hA1M UMI Vt, 1:U51 A MhA'A, GA `JLb2b �ob Address: 524 W 19TH ST Suite: Viciniry: Parcel Nunmber: 42210316 npplicanr. KIM, YOUNGSOOK�� , Address: + � " � ' �� 1 �, �\ i" � ' / � i ": - i . � .. � ', . /�::- "-: Owner„ � CASELINI, �ANTONIO��L'_-� -' Address - �� 155 TERRPZA CT%! �� % . . , i . ,, j � .i . COSTA�MESA;�CA Contractor. COST SIGN � Address' 1800 W ADAMS BL SIGN PERMIT Status: ISSUED Applied: OS/24/2005 Issued: OS/24/2005 Zoning: � � � �- ISSUED BY: j...�-`- _ ,_ � Phone: 323-733-1'177 '� � � -�`�� - Zip: � ' . . ' � , . �� - . ��C �. Phone: 949-283-5728 \`\� Zip: 92627-1714 � - •�Phone: 323-733-1177 � � LOS ANGELES, CA ' � - �2ip: �80018V � „� � � , ' ' - � � - ' �License: 698638 � . �,_ , � . Arch I Eng : „ ' ' . . . . -- Address " " i � . � . Phone: Zip: � , � - License:� � - -- , , , ;. - . r;. . - . — - ".'SCOPE OF PEP , 42 SQ. Ff. ILLUMINATED, WALL SIGN FOR "ROMANTIX" -' _EEE SUMMAf Pian Check: $29 15 ' .. - _ -- - - ;.. • Permit: • SMIP Com: Other., Inspection: Total: NOTES: $0.00 $44.85 $0.50 $0.00 $0.00 $0,00 • $O.00�,,�z-.;_ . �� $0.00 .. � , �'�`,..�, .�. $74:50-', . �, ` ` � ' i� ;; , - Galc Valuation: � Claimed Valuation: � �i . ,. � � - ; ,��% � -� � ' ' . �'._,,-s �� , , . , � .; . . , , 3- % � ` , , . - _..^�-` , _ - C-t. . � 'LANNING & ZONING� , A ` ' �� ' � � �J " i �� . . �� : ; , . ,� - , , ._ �', _ � �j i� � ' ''� —.`- Gi . . _ . ��= - _ -�•- S�,zao.00 si,2oo.00 /, /, �. NOTICE: The work au[horized by this permil shall comply with all applicable hantlicap access requiremenis under Califomia statutes and related regutations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This parmit shall automatically expire antl become void if work Is not commenced withln 180 days, or if wark Is suspended or abandoned for a period of 180 days. �NSPECTIONS: In ortler for the work authorized under this permlt to be considered lepal, such work must compty w(th all applicable codes, end ell requlred inepeetlons end tinel epproval must De obtafned. Feilure to obtain inspactions end final approval wiil result in the expiratlon ol ihis permit. FOR INSPECTIONS CpLL: (714) 7545828 zaaere ce�aol WORKERS' COMPENSA710N OECLARATION: ' � • � � ' � I hereby attirm under penalry ot perjury one of t�e following tledarations: � '� , , ❑ I hava end will maintein e ceNflcete of consent to seN-Inwre tor wwkers' compensatlon, es pmviCetl lor by aection 3700 0l the Labor Code, tor Ihe peAormence of Iha work tor whiCh Ihis pertnii Is issued. ' . . � . ❑ I heve en0 vM meinlain workers' compensatlon insurence, es requlreU �y secUon 3700 ot Ihe Labor Catle, br Ne peAom�ence ot Ihe wnrk ta wNUi Ihis pertnit is issued. My workeB' compensation Insurence carrier antl polity number ere: • . CaMer: Policy Number: (Thls sectlon need nat be canp/eted i! Ne permitls ve/uetl ef one hundred ddlars (3100) w/ess.) �❑ I cetlify t�at in the pertarmance ot the work br aNch this�peirnll L9 Issued, I shall nat employ eny person in eny menner so as to become suC�ect to tha workew' � �ompensetlon laws oi Calitomia, nd egree thet II I shoultl become suD�ect to the workers' compensatlon provlslons ot Section 3700 ot Ihe Lebor Cotle, I shell forthwith compy wit� these provl5lons. ` / �cem Sipnetu`ra:� ' -�cU/`�F�'"' � L � ✓ !'—"'oA�g�--....�_ C — Y u--��l• (�, WAHNINO.^FNCORE TO SECUR ORKER C MPENSATION COVERAGE IS UNUW FUL AND SHRLL SUBIECi PN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO IXJE HUNDRED TMOUSAND DOl1ARE (5100,000). IN ADdTIOfJ O THE COST OF COMPENSATION, DMUGES AS PROVIDED FO(i IN SECTION 3]OB OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LJCENSED CONTAACTORS DECIARATION: I hereby ettirm lhat I em licensed under pransiorys of fjhapter 9(commencing wit� Seclion 7000) of D'Msion 3 ot the Business ay9 Pryfessfons Code, and my license is in full CONSTRUCTION LENDING AGENCY: , ❑ I hereby eflirtn that there is a Construction lentling agency for Ihe peAormance of ihe work for w�ich Ihls pertnll Is Issued. (Sec. 3097, Civll Code). Lentlefs Neme: Sipneture: _ Lenders Adtlress: Date: OWNER-BUILDER DECLAFiAT10N5: I hereDy eftirtn that untler penelry of perjury t�a� I em E7(EMPT FROM THE CONTRACTORS'LICENSE LAW tor the following reason (Sec. 7031.5, Buslne5s end Professions Code: Any dry or counry which requires e permit to conswct, alter, Improve, tlemdis�, or re0air flny siructure, pdor to Its Issuance, also reqWres ihe epplicam tw such permi� to file e signed statement �hat he or she is Ilcensetl Dursuan� to ihe proNsions o1 t�e Contreclors Lkense Lew (C�apter 9(commendng with Secibn 7000) 01 D'Msion 3 af the Business end Profassions CoOe) or t�at he or ahe Is exempt theretrom enA Ne besis for t�e alleged exemption. Any violatlon ot Seclion 7031.5 6y eny epplicant for a permit sub�ecis the ep0�lcan� to e dvll penelry oi not more t�en five huntlretl tldlers (5500).j: ❑ I, as owner oi the properry, or my employees with weges es �heir sole compensation, WILL 00 THE WORK, and ihe strudure Is not intended or oMered for sale (Sec. 7044, Business and Professions Code: The Conlractors License Lew tloes noI epply to en owner of property who Duilds or improves thereon, and who does such work hlmselt or hersetl ar through his or her own employees, provided ihet such impmvemems are not in�ended or oflered for sele. If, howevar, the building or impmvement is soltl wi�hin one year of completion, the owner-builder will have Ihe burden of proving that he or she did not build or improve tor purpose of sale.). � ❑ I, es owner of Ne properry, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projed (Sec. 7044, Business end Professions Cade: The contradors License Lew tloes not epply to an owner ol propany who bullds or Improves ihereon, end who conirects tor such pmjea wlih e contractor(s) license pursuam to iha Cantrectors License Lews J. � ❑ I am exempt under sec. Business antl Pmlessions Cade lor this reason: Signature: Date: Owner ID verlfietl by driver's Ilcense. ❑ Ves ❑ No Drlvers License No. Verllicetlon af Ownership by (type ol tlaument, I.e. - properry tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I �ere6y cenity that no excavetlon Ilve (5) or more feet in depth into which e person is required to descend, wlll be made In connectlon with work euthodzed by this permil, and Ihat no bulltling stniclure, scallolding, lalsework, or demolilion or dismantling Ihereof, will be more ihan Ihirry-slr (36) teet �Ig�. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltla B, Celilomia AGminlsiretive Cotle). ❑ As ownerbullder, I will not employ enyone to do work wNch woultl require e permit trom tha Divlsion al Industdel Satety, as noted ebove, unless sucA pereon has e pertnit lo Co such work from Ihe tlivision. Signature: Date: Division of Industrial Sefery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIJfHORIZATON OF ENTHV: I cenity under penalry o� perjury �het I have reatl this epplication end stete t�el Iha Informetlon glven is I correct. I agree to compty with ell siete lews entl ciry ordlnances relating to buil0ing construction, entl euthorize represenlatives ol the Ciry ot Costa Mesa to enter upan the ebove4escribed property tor Inspeclion puryoses. I egree not to occupy or ellow occupancy of any building auihorized by Ihis permil until final inspection. cooe r. iHsvernoxme� '. . .' " PdIF ' - Q�l@ 7616' Fixetl SySlem Final Fire Preventlon � 7266 Pool Spa Final 200 Final Re-Rooi � ' 201 Final Btock/Retaining Well 202 Final Faciory Fire Place ; - � " 203 Finel Sign • . . � . .. � CODE� INSPECTIONTYPE 206 Finel Mechenical - 208 Final Plumbing 210 ' Final Electdcal 212 Finel Fire Preventbn Y20 � Finel Planning Approval 222 Final Sile 20a Final Demdition 250 Finel Bullding/OCcupan�y (714)'754r5273 • Fax (714)�7b4-4856��• .www.ci.costa-mesa.ca.us �77�FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT dobAddress: . 524 W 19TH ST Status: ISSUED Suite No Applied: 05/24/2005 Vicinity: � issued: OS/24/2005 Parcel Nunmber: 42210316 _ � Applicanc KIM, YOUNG SOOK . �•' -- ISSUED BY: Address: 1800 W ADAMS BL - � /. � � �. � " . .. � � � � � ` . , : i � / �%` , �Phone: 323-733 1177 i� / � - � �< i i . LOS ANGELES, CA �� , � Zip 90018 `�. J � � � _� �, , „� __ � � .. . , . �V� r "�� - .- - � '�' � .` " , / � i �- / A� -�:�'� . V � �. ( / � - . _ ,. __ .c -. � Owner CASELINI,�EINTONIO�L ��'� ��' � � � � � �� A�� _A Address� .�557ERRAZACT�' "i � _��.�� `� �� i. ��/� � , ��„�. . �+, <. � '",�i-�� Phone: 949-283-5728 � ` , � � . . . : i-;-i � � � . . . � COSTAMESA,�CA Zip: 92627-7714 . � ' " , i ��, � 4.0� . ;: , y-',.,��,�. Contrecror " C09T SIGN _ � 9��' � � � Address: � 1800 W ADAMS BL ,., �,�=- , , i . .• , . -'�� - - � , :"�, ' , � " �, - �.�Phone:' 323:733-1177 � � � !� ��' =k,'7 � G . � �LOS�ANGELES,�CA _ -:'_ �' � � -" � Zip; 90018 . � � � � License:698638 ' ';/ �� -SCOPE OF-P�ERMIT i '.� ' 42 SQ. FT. ILLUMINATED. WALL SIGN FOR "ROMANTIX�REF:: SBOS-00060 � � i' �', ELECTRICAL TO INCLUDE: 1 SIGN.CIRCUIL ,n,, � , �, . �... :e,� - r; �-�;. -- - , -:FEE SUMMARY=r-.,' '__ '-�- - - - . . . � - --- ISSUE FEE Temp service test Res. alc package New Res (1-2 units) New Res (3+units) � Pool l Spa� �' . Lighting FizLs'� �� ReceptOutlels�� Switches �� Non Res Appl � :, Res Appl Service to 200a ' Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Quantiry ,, Quantity - .� $23.50 . Temp Dist System / Lighting . $0.00 0/' � , � $0.00 Busway.N00fl,- � $0.00 0 .. 50.00 Standing Seclion" $0.00 0 ' $0.00 0 ��:^.Misc ElecMcal Equipment $0.00 �.0, : �$0.00 0 �, -"� 1� Tiansformers up to 1 kva/kw �$0.00 =� % 0 _� ...$0.00 0 ",'�; �"- � .............:.:upto,l0kva/kw $0.00'.' '0 ' '�$0.00 0 � ' - �:upto;50,kva/kw. � $0.00�� 0 � ,�� 50.00 �-'-0'-' �� ..up to:q00 kvalkvi„� �; $0.00� 0-' , ; � � � $0.00� � -- 0� ": � " �.... ,...:over 100 kva/kw : �50.00, � 0 $0;00 � A " � �Low Voltage Equipment ,� j� - $0.00 ��. ,0 / � .' � $0.00.\ ' �\0; c� � , ; Low Voll Wiring System'/:Gkt� $0.00 � •� 0 /'-. - ; $0.00� , , �'0�_-�-�-`>• �.� �Misc.Conduit_.-'-� � � ,-„$OAO, 0�= � � $0.00, � - � � .0 _ � - �� Misc. Conductor' �` .�� $0.00 � � 0 �' � �� E0.00, �_ ,� ,� � 0 ` . - - Circus ( gen or nde). . � ��": $0.00,/ , 0 � �$0.00�' '� -0_�.', �t�,- Circus.(mech�ride`-orlights) .i $O.00;�iO � $0.00` ' 0, ,' � - ; ; � - � Christmas Tree Stand�� $0.00,' 0 $0.00 - -_� 0 � � � � FireworksStand:,��' %jj $0.00 0 50.00 � . 0 ' � Other Electrical Fee-��, i�� -$0.00 $0.00 ''0_'"�.. - : i�� _. � $0.00 0 � _ � �Investigalfon Fee � � $0.00 $0.00 0 -� � Plan Check Fee $0.00 $0.00 0 Reinspection Fee $0.00 I.NOTICE: Tha 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) E%PIflATION: This permit shall automatically e�ire and become vold 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.vrork�authodzed.under,this,permit to:be�considered�legal,�such work must comply with e�i,applicable�codes, and all requlred Inspeetlons�endiln8l epproval must�be�obtained.'PaiWre to obtain inspectionsand tinal�epproval will�result In the expiration of this permit. �FOR INSPECTIONS�CALL: (714) 754�5628 za+o-w law� WORKEHS' COMPENSATION DECLARATION: � I hereby eflirm untler penalry of perjury one of the following tlecleretions:; ��- _; ,.. � � , � ❑ I have end will meiniain e certificate of consent to self-Insure for workers' campensatlon, es pmvided tor by section 3700 of the Labar Cotle, for the.pertortnance of ihe work for which this permi� is Issued. � ' � � ❑ I have and will maintain workers' compensation insurance, as requlretl by section 3700 of the Labor Cotle, for Ihe peAortnanca oi the work for which thls pertnit is issued. My workers' compensation Insurence cartier and policy number are: , Cerrier: Policy Number: (Thls section need not be compleretl i/ the permit is valued af one hundred do!lars ($100) or IessJ ❑ I certity that in the peAormence af tha work tor a�ich Ihis permit is is`sued, I shall not employ eny person in any manner so as lo becoma subject to the workers' compensatlon laws of Celtlomla, end agrae ihat ii I shoulA become subject to Ihe workers' compansation provisions oi Sectlon 3700 ot Ihe Lebor CaAe,'I shall forihwlth comply with these pr �Wsion/s/ [ /I ApplicantSlgnaNre: 7'J(_ii�� ..-�-- [�-' Date: �C ��Y-- 1c:o�` _ WARNING: FAILURE TO SEC WORKEP ' ENSATION COVERAGE IS UNUWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINPL PENALTIES ANDGVIL FlNES UP TOONE HUNDRED TIIOUSPND DOII.ARE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, DAAUGES AS PROVIDED FOF IN SECiIIXJ 3]OB OF THE IABOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn that I am force end aXect. Lic. x_ ConirecroYs Signature: ot C�epter 9(commencing with Section 7000) of Division 3 of iha Business end Prolessions Cotle, anC my licensa Is In full ClassN �—�� .a\�-- [ � Date: �_�('� —d ',�- CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirtn thet there is e consiruction lending egency for ihe pedormance ot the work lor which Ihis pertnil is issued. (Sec. 3097, Civil Cade). LentleYs Neme: Signature: _ Lentler's Address: Date: OWNER-BUILDER DECLARATIONS: I hereby affrm ��et untler penalry oi per�ury Ihat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec.7031.5, Business and Protessions Cotle: My Uty or wunry which requires e permit to consWct, alter, improve, demolish, or repair any sWcture, prior to its issuanca, also reqWres Ihe epD��ent for such permit to flle e signetl stetement thet �e or she Is IlcenseA pursuant ro the proNslons W Ne Gontrectors License Lew (Chapter 8(commendng with Section 7000) of DMsion 3 oi Me Business end Protessians Cade) or that ha or sha is e:empt Ihereirom and the basis for t�e ellepetl exemption. Any violation of Section 7031.5 by eny epplicant for e pertnit subjects the applicant to a Gvil penelry of not more then Tive hundred dollars ($500).): ❑ I, as owner oi Iha property, or my employees with wages as ihelr sole compensatlon, WILL DO THE WORK, antl ihe siructure is not intanded or otteretl for sale (Sec. 7044, Business and Professions Code: The Contrecbrs License Law tloes not apply to en owner ot pmperty who huilds or improves thereon, and who Ooes such work himseN or hersetl or thmugh �Is or her own employees, O�a�idetl thet such improvemenis ere not Intendad or oHered for sele. II, however, the building or improvement Is soltl wit�in one year ol completlon, Ihe owner-builtler will heve ihe Ourden of proving that he or she did not build or Improve for purpose of sele.). � ❑ I, es owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business entl Professions Cotle: The cantractors License Lew does not apply to an owner of properry who builds or Improves Ihereon, and who comrects tor such pmject wlih e comractor(s) license pursuant ta tha Caniractors License Lews.). ❑ I am exempt under sec. Signature: Business end Prolessions Code tor this reason: Owner ID verified by drivefs IlcenSe. ❑ Yes ❑ No Dnver'S LitenSe No. Ventication of Owners�ip by (type o1 tlaument, i.e. - property tex bill or tleed): Date: E:pires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihet no excavation five (5) or more teet In depth in�o which a pereon is required to descend, wlll be made In connection with work euModzeO by Ihls permit, and t�at no builtling structure, scaHolding, talsework, or demolition or dismentling thereof, will be more than thirty-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Title B, Califomle ACminisiretive Code). ❑ As owner-builder, I will not employ anyone to do work w�ich would raquire e permit from the Division of Industrial Selery, as nated above, unleu such person has e permit ro do such work trom the tlivision. Signature: Date: Division ot Industnal Satety Partnit Number: ICER71flCATE OF COMPIIANCE AND AUTHORVATION OF ENTTiV: I certify undar penelty ol perjury ihat I have read this epplication and state iha� �he intortnation given is I wrrect. I egree to comply wit� all stete lews and city orCinances relating �o building consWctlon, end authonze representatives of the Ciry of Coste Mesa to enter upon Ihe ebove-described properry for inspection purpases. I agree not to occupy or ellow occupancy of eny building auihorized by this Dertnit until final inspection, CQOE t' INSPECTIONTYPE' ' ' ' � QdIE ` � II�+S ` � 1616 Fixed System Final Fire Prevention • '- 1266 200 Pool Spa Finel Final FiaRoof ' ' � �� 201 Finel BIocWRetaining Well 202 Final Fac�ory Fire Place �' � 203 Final Sign 204 Final Demolition � � � = re�� Date COOE� INSPECl10NTYPE � 206 Final Mechanical 208 Final Plumbing 210 �FinalElecMcal � 212 Final Fire Preventlon 220 �Final Planning Approval 222 Final Site 250 Final Building/Oaupancy PAg •- It�lS (714) 754•5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, CA 92626 BUILDING PERMIT Job Address: 524 W 19TH ST Suite: Viciniry: Pnmary Qcc: M Display/Sale Merchandise Type of Construclion: V-N Parcel Number: 42210316 Zoning: Applicant CASELINI, ANTONIO L Address: 155 TERRAZA CT COSTA MESA, CA Owner: CASELINI, ANTONIO L Adtlress 155 TERRAZA CT � WSTA MESA, CA . Contractor: OW N ER-BU ILD ER Address: Zip: Arch : Address: Phone: Phone: 949-283-5728 Zip: 92627-1714 Phone: 949-283-5728 Zip: 92627-1714 Phone � License: 000000 � Eng: Address: ISSUED BY: SWtus: ISSUED Applied: 04/07I2005 Issued: 04/07/2005 Phone: Zip: License: License: SCOPE OF PERMIT INSTALL DRYWALL ON CEILING FOR COMMERCIAL SPACE. NO OTHER WORK ALLOWED WITH THIS PERMIT. , � SUBJECT TO FIELD INSPECTION. . : Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $63.15 $0.00 $0.50 $0.00 $0.00 $63.65 _ , SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front� 0. 0 PARKING Existinp: 0 _ FEE SUMMARY PLANNING & ZONING Rear 0- 0 Rear 0. 0 Re uired: 0 Left 0- 0 Left 0- 0 Proposed: 0 _ Calc Valuation: Claim Valuation R�gr,� a o � Right 0- 0 $1,800.00 51,800.00 NOTICE: The work authorized by this permit shall comply wNh all applicaDle handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § t, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 18D 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 Inapeetlona and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 ..� iau,� WORKERS'COMPENSATON DECLARAnON: I hereby eKrm under penelry ol pe�ury one ol the following tleMerelions: ❑ I heve end wiil rtiOinlein e cartifcete oi cron58nt to selt-InSure for workers' compensatlon, es provided lor 6y section 3700 of ihe Lebor Cotle, for Ihe parlormanCa ot Iha work far which Inis permit is issued. ❑ I heve arM will meintain workers compensetlon insurance, es requlred by sectbn 3700 0l the Lebor Code, lor ihe pertortnarice at the work for which t�is pertnit is issuod. My workers' canpensetlon Insurence cerrler entl pollcy number ere: Certier: Polity Num�er: (This secNon need rrot be comp�eted i! fhe permit Is veluea ef one huntlred dollars ($100) or less.) �rtify �het in Iha pedormance ol ihe work for whlch Ihi9 p8rmil b 139ued, I s�all not employ eny per9on in eny menner so es Io becnme subjact b �he worknro' compensado e s ol ellfomie, entl egrea Ihel il I should becoma su��ect Io Ihe worker9' compense�lon provisions oi Section 3700 oi t�e Lebor Gotle, I sh80 forihwlih crompywith ese ro 'ons. n,��a� �p ._ ��/ � �=-€9 � WARNING: FAILURE TO SECUFE WOqKERS' COlAPENSATION COVERAGE IS UMAW Flll AND SH4LL SUBJECT MI EMPLOVER TO CRIMINAI PENALTIES AND CMl FlNES UP TO ONE NUNDRED T11p15AND DOLIARE (5100.W01. IN ADOIiION TO TME WST OF COMPENSATION, 0/.M1NGES AS PROVIpED FOR IN SEC11pJ �C60F THE UBOR COOE, IMERE57, AND ATTORNEI"S FEES, LICENSED CONTRACTORS DECLARA710N: I �erehy affrtn Ihat I er� licensed under provisions ot Chapter 9(crommencing with Saction 7000) oi Division 3 of the Business antl Professions Code, and my license is in full torce an0 eHect. Lic. a Glass a Cont2ciofs Signature; Date: CONSTRUCTION LENDING AGENCY: ❑ I herety aHirtn Ihel Ihore is a construction landing e8ency lor Ihe peAormente ot the work br which Ihi9 permit is is5ued. (Set. 3097, Civil Cotle). Lender's Name: Lontler's Address: Signeture: Dete: OWNER-BUILDER OECLARATIONS: I �ereby ettirtn Ihet under penelry ol per�ury thet I em EXEMPT FROM 7HE CONTRAC70RS LICENSE LAW for t�e lollowing reason (Sec. 7031.5, Business and Protesslons Code: Any dy or counry which reQuireS e permit lo construct, eller, impmvo, demolish, or ropelr any almcWre. Orior to its issuance. elso requires the eD7�� br such permit lo tile a signetl stetem0nt that he or she Is Ilcensetl pursuent to the proNsiorts ol Ne Contractom llcease lew (Ghepter 9(comme�l�g rrith Sectton 700p) ot DW{slon 3 01 the Business end Pmfe5si0ns Cade) ar t�et �e or sho Is exempt Iherefrom entl I�o Desis Por the elleped exempNon. Any Wolatlon o� Section 7037.5 by any apPllcant for e permlt suDjecis ihe ap0licant to e dvil penalry oi not more Ihan flve hundred dollers (5500).): �Fes owner al t�e p�operty. or my employees wlth wages es lheir sole compenselion, WILL DO THE WORK, end the structure is not intentled or oHerea for sale (Sec. 7044, Business ena Professions Code: The Contrectors Ucense Lew Ooes not appty to en owner of properry who builtls or imprwes thereon, and who Goes such work �imseN or herseH or t�roug� his or her own employees, pmvided that such improvements ere not intended or oflereA for sale. I( however, the builtling or impmvement is sdtl within one y0ar ol completion, ihe owner-builde� wf�� have Ihe 6urtlen ol proving that he or sha Aitl not builtl or improve �or Durpose of sale.). ❑ I, es owner ot tha pruper�y, em EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to tonstruct ihe prqect (Sec. 70ad, eusiness and Professions Cotle: Tha wntrectars License Lew does not epply Ia an owner ol proparty who builds or Improves ihereon, antl who cantracts for suU projea with a wntractor(s) license pursyani to t�e Contraqors License Laws.). sac. ID venfietl � Ves ❑ No Business Vetlfication ot OwnersMO by (rype ol document, I.e. � property te�c blll or DIVISION OF INDUSTR�NL SAFETY PERMR CERTIFICATON: reason: _ � — �+ v ❑ 1 here�y cenily t�al no e:cavetion five (5) or more leet In dep�h Into which e person Is requiretl to descend, will be matle in Gonneciion wi[h work auihonzeE by this permit, and Ihat no Duiltlinp siructure, sceHolding, falsework, or tlemolition or tlismantlinp thereot, will be more Ihan t�irry-six (36) tee� high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tttle 8, Calllamia Administretive CoOe). ❑ As owner-builtler, I will not employ enyone to da wark which would require e pertnit from ihe Divislon of Industnel Sefery, as notetl above, unless such person has e pertnit to tlo suU work Irom the division. Signature: Date: Division ot Indusirial Saiety Permil Number: CERTIFlCATE OF COMPUANCE AND AUTHORIZA710N OF EMAY: I canlfy under penalty ol perjury Ihel I have reatl iMs epplication antl state that the information given is correcL I agrea to wmDN w�� all stete lews entl city orAlnances relating to bullGinp construcllon, end euthodze representatives ot t�e City of Costa Mesa to ente� upon Ihe ebove-descnbed propedy br inspeclion purposos. I egree �ot to occupy or ellow occupenty ot eny bullding euthodzed by Ihis permit until final ins Ibn. _ y -,�/� s� �tst c�, � �--- AnN6r Aulhonzod Applicenl Dale COOE �. INSFECTIONTYPE 1616 F�ceC System Final Fire Prevention 1266 Pool Spe Finel 200 Final Re-Roof 201 Final BIocWRelelnlnp Well 202 Final Factory Flro Place 203 Finel Slpn 20a Final Demdltlon pejE �@ j�Qy(,( INSPECTIONTYPE 206 Finel Mechanical 20B Final PlumDing 210 Finel EIeCIriCal 212 Finel Fire Prevention 220 Finel Planning Appmval 222 Final Site 250 FinelBuiltling�Occupency PAIE 1[{IID�Ii I \I AOP��ant to fill In all spaces exceot those within peavY boraer Ilnas antl sign all ao CITY OF coS7A MESA11 COlN TRUCTIOj�l`PE MIT \',�'7 �ProjeitAddress ��`� `�� "U`1 b Yrle'S� Applicam'sMaili gAddress �0��{'� �'0.UVC-Uh��\�.,�2��•�S� ��e� Owner's N�a�m/-e�q � � Ph ne Jo �1JS�-� J Address ��+�1-1 �W ��U� ��yL . U �p mP S�� ArchlEng.�e'S T e��-I Nii �rnnw Nn � - _ Address' � VS ��1y Contractor's Name '� Phone _D�=�� ( Addresslm ��' „IIO�J�'I.Z 9�.��[�� S-`� • City License No. � ' ' LICENSED CONTRACTOR DECI.ARATION I-hereby affirm that ! am Ilcensetl under provisions of Charter 9(commerttlng with sec[ion 7000) of �Ivision 3 1 the Businezs antl ofesslons Cotle, antl my license is in i force ana etfect. �' n�.z p, Licen cla - � � ce se � 1j Date ��^��- x 4 Signature WORKERS'COMPENSATION DEC` ATIO I hereby alfirm that I have a certifl� conzent to self-insure or a certificate of Workers' Comp¢nsation Insurance, o� a Certi�ietl copY therGof ($ection 3800, Lab. C � / p �l�- POIICY No. ��`��`��1ComPanY� /� �� ertifietl op is hereby furnishetl. er' e o etl wrth the'Uty Builtling i islo . Date � APPlicant �� S� • E%EMP� N ROM WORKERS'•COMGENSATION DECLARATION (This section neetl not be completed �I the permit i5 (or one huntlretl (5100) or less) I certify.tnat in Ih¢ Pe�formance q� the work to� wNth this pCrmtt is iisuetl, I. ' snall not employ any person in a�y manner so as to become subject fo tne I Workers' Compensation� Laws ot California. � • . Date � Signature ' NOTICE: If, after making this tleclaralion, you shoultl betome subject to the Worker5' Comp¢n5alion provi5ion6 0( th¢ Ldbor Cotle, y0u mus[ torthwith comA�Y with su[h p�ovisions ot }his peimit Shall be tleemetl revoketl. CONSTRVCTION,LENDING A4ENCV � ' I nereby at�irm ihal tttere i5 a cons(�uctlon lentling a9¢ncy f0�`lhe pertormance ot the work for which this p¢rmil is issuetl (Seclion 3097 Civ. CJ lantler's Name Lentler's Atlaress � � � � OWNER BUILDER DECLA0.ATIDN - I hereby atBrm that I am exempt {rom the Contractor'S License Law for the fnllowina reason (Section �031.5' Business antl Protesslonal Cotle: Any dty o� to ltz issuance, also r rmenf that he/she is I therefrom antl tne basis for the allegea exemption. Any vlolation of 5ectlon 7031.5 by any applican[ for a permit 5ubjects tho applicant ta a civil �enalty ot nol mOre than (ive huntlretl tlollar5 ($500). I, as owner ot the property or my employees witn wa9es as their sole com0ensation, wlll tlo [he work, entl the structu/e I5 not intentletl or offe�etl tor sale (Section 7044, Business ana Pro�essional Cotle: The ConVactor's License Law tloes not apply to an owner of a property who builtls or improves ihereon, antl who tloes such work hlmself/herself or throu9h his or her own employ¢es, provitletl that such irtlp�Ovements are nol intentlatl or offeretl fo� sale. If, howaveq [he bui101n9 or.{mprovement is soltl wlNin one year of com- pletioq the ownor will nave the burtlen of Oroving he/she tlia not bulltl or Im- ��ove torth¢ PurpOse of zale). I, as owne� ot the prope�ty, am exclusively confraCting with Iicensetl Con- tracto�s to construct the Droject (Sectlon 7o44, Business antl Protessions Cotle: The Contractor's License l2w dry¢5 not apply to an owner ot prope�ty who builtls or Improves thereon, antl who contracts tor such project5 with a con- tractor(sl license pursuant to Ihe Contractor's License Law). I am aware tnat proof of their Wo�ker's COmpen�tlon insurance ShOultl be p/ovitletl t0 me, ❑ I am exempt untler Section B. & P. C. tor lhis reason Date Owner I hereby rtify Ihat I hav¢ �ea� Informatio i5 correct. �I a9ree to antl state la s relating tQ bu"y tlir sentatives o lhK <ity tp er�ter Inspettion p r es. Si9nature . Drivers' Lic n or 55 � CMF 0865-46, rev. 4/84 Ication an0 state that the above [h all tlty antl county ortlinances :ion, antl her¢by authoriie repre- above-menUonetl�Property for �_ Date ��') �'��) �,��-��5'" 7o Z � 3?�S ��l / (' TVPEOFCONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ �EMOLISM ❑ OTHER . DESCRIPIION_OF WORK/I�SE OF ¢Lp� _ _ tleelarations. NO. REPAIR TVP�PERMIT LIGRAOING LIFOUNDATION LJ STRUCTURAL. TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sa.F7. ocCUCANCv - CONSTRUCTIONTVPE � VALUATION$� �T' ZONE � GRADINGCU.VDS. ACRES_ Remarkr. ��iG �% . (..�. � �l _ � Sink Preventer Irrigation Clarifiers Dishwasher � Orinking Fountains Floor Drains' � Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fee P Showers � Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar TanK � , Swimming Pool w/Spa - Urinal Outlets Water Closet � • Water Heater � Water Service ' 515 �uct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.700,000 BTU 0100,000 painspec[ion Fee I $75 WM1ite - 8uiltling; Cana�y - AppliWnt: Pink - Accounting; Goltlen�otl - ATsessor laue Fea Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System oaioo,000eru ❑ioo,000 System Repair/Alteration laue Fee FEES � § 3 $ 3 A.P. qW A S Main Bui - E T FrOnt B Rear A - C Rigfit � S Lett � Ping. fief. # �I L� EC Auromatic Washer i' - � Construction Fole Sub. ' I Cooking Unit � Dishwasher � Dryers ❑Gas ❑Electric Fan' � F.A.U. Fixtures � �� r -- ' Device eoxes Outlets Switches Garbage Disposal Generator O0.5 KW �5-15 KW . — Reinspection Fee � DEVELOPMENTSEI 2oning APProved BV� �� Building Approved B� � $15 RI ' ,9929 10%I I/84 Zone Req Transformer ❑ 15�50 KW ' . ❑ 50+KW Meter ❑up m 100 amps . Meter ❑over 100 amps Sub Panel Motors DO-1 HP 01 h- 8 Inc. Solar 09-15 HP �16-15+ Microwave ' � � Pole Li9ht . Range , 47j.47 TL Z O N I N G R E Q M T , � .� FEES , Standing Sections Trash Compacmr ' luua Fee � $ 3 uTs: �/� // 8`/ Date S V OF FEES 3 s7 BUILDINGPERMIT $ •�0 SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL • $ � GRADING $� PLANCHECK 50% $ • MICROFILM S �/��''' MECHANICAL ' $ � TOTA� FEE $ � PLAN CHECK ZS% $ ' . CONSTRUCTION AND PLANNING - . POOL ,., oPA ,qPPROVALS. Permit# Date Inspector AppROVALS Permit# Date Inspector_ 1. Temporary ElectricBl Service or Pole � 52. Pool & Equipment �Location ' . 2. Soil Pipe-Undrgtnd. � ' 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd.- � � 54. Forms � . 4. Electrical Conduit-Undrgrnd. � . 55. Electrical Bonding 5. Steel Reinforcement � ' . 56. Rough Plumbing & Pressure Test - � . . 6. Electrical UFER Grnd. ' � � ' 57. APPROVAL TO COVER-GUNITE � ,7. Footings . 58. Electrical Conduit-Undrgrnd. 8. Foundation . - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System , 67.' APPROVAL TO DECK � 11. Property Sewer Line & House Connection '� 62. Backwash & Receptor-Final� - . 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbing ' 65. Electrical-Final 15. Rough Electriral-Conduit � - 66. Solar System-Final � 16.� Rough Electric Wiring � . 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electiical-T Bar Ceiling , 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � . 20. Rough Factory Fireplace � APPROVALS Permit # 21: DuC[s, in Structure ' 70. Underground Hydro . 22. Ducts, Ventilating , ' , 71. Product Piping �Gas OOiI 23. Gas Pipe-Rough & Test „ , 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing ,' '. 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat �� sy 75. Dry Chemical 27..Frame and Fiashing P` ' �i ��`�i� �� -/�N j�f�/� �76. Ory Standpipe . 28. Lathing•& Siding ' � 77. FIXED SYSTEM FINAL 29. Insulation _ ,_ 78. FIRE PREV. FINAL 30. Drywall Nailing � � 3�{ ��l� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ._ 79. FINAL INSPECTION 32. Electrical Power Meter-Final , . 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: � � 2A � 34. Final Heating & Air.Conditioning 35. Final Gas�Pipe-Test ' � � � 36. Hood or Canopy ' , �� 37. Final Factory Fireplace ' ' � � 38. Final Plumbing - � 39. Water Service-Final . 40. Gas Service-Final � , ' . � . 41. Solar pomesticFinal . ' � - . ' 42. Backflow Preventer 43. Backflow.lrrigation . .., . , .. 44. ,Landscape Irrigation System • � 45. Sound AttenuaLiori '� � - 46. Handicap Regulations ' 47. FINAL STRUC7URE & BUILDING ��.c d, , 48. Special Requirerrients Completed , , 49. Electrie Release to Edison � '�� 50. Gas Release to $outhern California Gas Co � • ' • 51. CERTIFICATE OF OCCUPANC , � . No f��q _ Date �� q�`��G ' . r • CITY OF COSTA MESA -r - �ONS�RUCTION PERMIT, ' Applicant to fill in all s0aees exeept those within �eavY Dortler Iines antl sign all appropriate tleclaratians. PER�J IT NO. " TRACT NO. " LOT NO. gLD . ; ' , i ., . �o . i� Projett AddffSS ��ZV� W. / YT(7. JT. � - TVPE,OF CONSTRUCTION' LJ NEW LI ADD ��'J ALTERATION LJ REPAIR AppliCant'SMailingAddr255 126 Commerical,� C.M. 9�LE1�% �❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ q,p,# " ' Owner'sName� ArrO(7�FOQIBR/�(1 -Phone ��-9�� DESCRIPTIONOFWORK �-Co^Bf . S� Main Building: Address c/o Geo Katscrmpes 518 W. 19th St., C:'d., � - E - . . . TYPEOFPERMIT GRADING� FOUNDATION STRUCTURAL T. Front AICh/Eng. �� iCCnu NO. '❑ TENANT .❑ ELECTRICAL ❑ PLUMBING O MECHANICAL � 6 . ' � . , . A Rear ' . Atldress - � " - � - ; � �OTHER . ' ' ' Crank Bros.: Roofinq Cqihone548-5569 PROJECTDESCRIPTION S�.FT.� 2�9� oCCUaarvCv C Right , Con[ractor's Name K � �. Addreu.lmailing) 126 Commercio�l W�Qy. i�.OS'tQ Mesa 9252 CONSTRUCTIONTVPE nnmmaricnl' vnwnrioNS ��'+�'+'�+ �% g LefY � City LicenSe No. -`�' � .� � M��1 ' ZONE _ GRADiNG CU. YDS. ACRES p�ng. Ref. � LICENSED CONTRACTOR DECLARATION Remarks: � - Parking Req./Provided 1 bereDy,at/irm Ihat I am Iicensetl untler provisions of Charter 9(commentlng . wlth section 7000) of Division 3 ot the Buslnass anA Professlons Cotle, antl � ' Use of Building: mY Ilcense is in fullLtorc�nd�ettect. � LfQ$677 , _ . , ' y . ' Cicenze Clas � Licensa No �� PLUMBING � FEES P�annin Notes: Date � Si9nature � Bar Sink • Shower5 ' WORKERS' COMPENSATION DEC ATION , '- , ' ' ' , hereDy affirm that I have a cerHfi<ate of consent lo sel/-insur¢ a certiflcate BackflOw Preventer i Service Sink' ' � .f -Workers' Compensation Insurance, ora certitietl'copy Ihareof (Section � - -- � ' -� - . aeoo, ue. c.� 252�u zen i th ' Backflow Rr,gation t Sewer Cap • • . Policy No. Company Automatic Washer �Certitietl copy is he�eby tuTishetl. , ' . BdthtUbs ' Sewer C,onnection � � � Certi �R �/�pyy fileC with the city Bu vi � Date �V/Jl/�4 /+aa�icant � �� DS.�� ROOfl�ICJ CO.• Clarifiers � SolarCollecror5 � �ConStructionPoleSub. �'�- EXEMPTION FROM WORKERS' COMPENSATION UECLPRATION - DiShrYdShCf �' - � "' � - Solar Piping ` '" -' - ' COokiny Uni[ - � -" (This section neetl not be completetl if the permit is tor one huntlretl (E100) or less): � ' � Drinkin Founteins Solar Tank • Dishwasher � ' 1 certlfy that in tne performance of the work for which this perm�i is Issuetl I 9 ' snalY not employ any person in any manner so.as to becoma sub7ect to.t�e . - Workers'. Compensatlom Laws ot Catltornia. ' Floor Orains � Swimming Pool w/Spa Dryers �Gas ❑Electric Date Si9naldre ' - ' ' � . NOTICE: If,-after making thiz tleclara[lon, you shoultl become subject to the � Floor SinkS � � ' Urinal � � Fan ' Workers',-Compensation provisions ottthe Labor Cotle,'you muzt forthwith . ' � � , ' —' comp�y wtth such-provisions�•or tbis. permit shall be'Deematl revoketl. -' GaSSErvice ' 'Outl¢ts' . .WaterC105CY - � F.A.U. : CONSTRUCTION LEN�ING AGENCV � t" . ' - , 1 hereby �afFlrm that [h¢re I{a con5truction lentling a9¢ncy t0� Ihe pe�forman<! I�t¢fC¢ptDlS. _� Water Heaten ' �� Fixtu�ES ' ' of the .work ' for w�lch' this Oarmit � is issuetl (SecHon . 3097 Civ. CJ ' ' . ' _ . ' _ ' . � . • Isntler's� Namei `� � -' I KitcRen Sink rr - Water Ser4ice � �'- , � Device Bozes - Lentler's �Atltlress . ^ �� • � . � ' , f � '. : • _ � ,• ' - , s , OWNER BUILOER DECLARATION � - . �: ' ,' �' , � ' : � iava(ories, ; i �, � _ ' � � ODUets I harebv: affirm thal I am�ezempt trom the'•C6ntractor's'License Law for�the � Q. - , . , . ,, , � , a�a the �I;am exemp[ untler i a permif subjects'the applicant to a untlretl tloliars ($SOOj. . ty;or my employees'with wa9e5 a5 tM1ei� k, antl the structure is not IntentleC or o1 ess and 7rofessional Cotle:, The Contra an owner of a proparty wnopulltls or imF �tl � :h improvaments are not Intenaea or otrarea ror g o� improvemen[ Is'soitl within ono year of com- the �urtlen of Oraving he/she tlitl not builtl or im- � Y: ty, am exclusively contiacting with Ilcensetl con- ' act (Sectlon 7044, Busine4s anG Professions Cotla: w�does not appry to an owner�of proparty�.who ' antl who contracts for suth orojects wlth a con- : .the ContracfoCs Ucense Law). ' � n B. & P.. C. tor this r¢a5on ; _ Owne hava re -Trap - _ Boof.Dreins °� . ` � _ � _ i `� ." � , � '. � Reiuspection _Fae : , , $25, Boiler. �. i .. � Duct - Under Ground � - �uct-Structural � ' Duc[ - Ventilating ; i ' Exhaust System ❑ Multiple ❑ Firepl/Fact.;Blt. ICBO �`- Heating System & Ducting ❑ a� oo,000 eTu O i oo,000 sn mgnamre�/r • _ _ _� , I 1 I P Oriver5' Nce se or 55 � Reins eetion Fee ^ 'CMF 0865-46 rev. O/83 -' White -�Builtli g;'Canary - Applic5nh Plnk = Accountiug; GOIEenrod -'Assessor $25' r . .- i _,�� laue Fee,__ � ��, iANICAL � -� Hood or Type I � ❑ � ' ; . CanoPY � Type II� 0 ' Refrigeration System ' � '� 00-100,000 BTU ❑ 100,000 67 System Repaii/Alteration . .. _ . . �_. Issue Fee $ 3 Sw�tches , 1 I • 1272 10/31/84 Zone Accessory Building: Park.Fees $ . , ' � ELECTRICAL • �Transformer ❑ 1 I �`- ' ' � Merer' �up�to�10 Meter �over 10C Sub Panel Moturs �Ol HP Inc Solar l �' Microwave � Pole'Light Range . 22.50 �� FEE: -50 KW . + KW amps � 3mps� � Z 0 N I N G R E Q U H E M E N I�.��■ ��■ ��■ ��. � � � , I; Standing Sections , 5-15 KW ' : Trash Comoactor : ; � Reinspection Fee ' �$25 � Issue Fee' ' • � � �$� 3 � PUBLIC SERVICES HEOUIREMENTS: � ' ' � . • Zoning Approved By � � Dete � APPliwtion APGroved BY � , ' Date � Appliption laued BY � ' Dat�/O-��' ' ' ' iSUMMARV OF FEES ' ' BUILDING'PERMIT ' $ � ��-�V U SMIP , $ �"� G PLAN CHECK � $ � PERMIT ' � PLUMBING $ � � ISSUANCE , $ PLAN CHECK $ � ' � ENERG� P.C. $ 'i ELECTRICAL '$ ' GRA�ING $ ' � � PLANCHECK �� $ � ' MICROFILM � $ ' � .� . MECHANICAL ' ; $ � ; 07AL FEE $ `�'�� S� PLAN CHECK , � $ ' ' � . J _ . . �.. . �. .. . .. � � . .. . � . 1 � �� CONSTRUCTION ANDPLANNING� � . � POG .SPA . „ APPROVALS �Permit# • �Date Inspector qppROVALS Permit# Date Inspector �1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �� (�1_ �2. Soil Pipe-Undrgrnd. �, . 53. Steel Reinforcement - _ '4 `� 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - - � ;.j � 4. Electrical Conduit-Undrgrnd. - � . � 55. Electrical Bonding � � � 5. Steel Reinforcement +.� � • 56. Rough�Plumbing & Pressure�Test \ . /: 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ��`� . 7. Footings � '�^ 56. Electrical Conduit�Undrgrnd. ,�� 8. Foundation � 7� 59. Gas Pipe, O Undrgrnd., Test ,� 9: Water Pipe-Undrgrnd.�:�� -'� 60.�.Backwash Lines, P•Trap, O� Undrgrnd. 10. Structural�Floor System �� . 61. APPROVAL TO DECK ' � - . 11. Property Sewer Line & House Connection ', 62. Backwash & Receptor-Final 12. Sewer Cap �! j 63.. Heater & Vent-Final 13. Roof Drains � ' ' r � �. 64. Plumbing System - Final � . 14. Rough Plumbing ' 65. Electrical-Final �� 75. Rough E�ectrical-Conduit 66. Solar System-Final . 16. Rough Electric Wiring 67. Fencing & A�ccess Approval �� ' 17. Rough Wiring Sign 68. ARPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL ' 19. Rough Heating & C,ir Conditioning • ' FIRE DEPT. REnUIREMENT 20. Rough Factory Firep{ace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating . 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Framing 73. Undergmd.StorageTank OGas ❑Oil , 25. Roof Sheathing 74. Overhead Hydro " 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Noter. '� , � 34. Final Heating & Air Conditioning - -. ,� /� i • ✓ � r.: • �-011.cO 35. Final Gas Pipe-Test . '�� -• / �`q/ �� , �fi� 36. Hood or Canopy � �� 37. Final Factory Fireplace . 38. Final Plumbing , � � � , 39. Water Service-Final ' � � 40. Gas Service=Final , � � � 41. Solar pomesticFinal ' � .. - 42. Backflow Preventer - ' 43, Backflow Irrigation ' � � � . 44. Landscape Irrigation System � 45. Sound Attenuation . � ' . � � 46. Handicap Regulations • , ' ' 47. FINAL STRUCTURE & BUILDING . �� r,�S 48. Special Requirements Completed � 49. Electric Release to Edison . � ' ' . . ' , 50. Gas Release to Southern California Gas Co ' � � � 51. CERTIFICATE OF OCCUPANCY . _ _ . . � ' No. Date � . � � .�- - U/.l VJ � � _ Appllcant to flll In all spaces exceD� t�osa wil�in �eavy EorCer Iinas anE sign all dpproDrlate Geclarations. CI7Y oF COSrn MESA CONSTRUCTION PERMIT ' Project Address 524 19th StLeOt P.pplicant'sMailingAddress 1948 W. Collins, Orange 92667 ow�ersrvame Co3St MUS1C ppo�,,631-7603 P��dress 59G 19rh Gtreet Costa Mesa CA 92626 'lrch/Eng. License No. 'ltldress Contrecror'sNam Cn- r� HPatin,��Sc Aif COm�t�On1nE Atldreu (mailing) 1948 W. C0111n5 � Orange, 'CA 92667 Ciry License No. 314�9 - � LICENSED CONTRACTOR DECLARATION I hereby aHirm roat I am ItcenseU untler provisions of Charter 9(�ommencing wi[h section 7000� o� Division 3 of tne Butiness antl Professions Cotle, antl my iicense iz �n twi to ce ane ettect. 34b569 Llcense Ciass Cz� icen5e o. Date - 17—Fi—A4 � Signature WORKERS' COMPENSATION CLARATIO • i heretiy alfirm that I nave a cer iUte ol consent to SelHnsure or a certlticate �� Workers' Compensalion Insurante, or d certifi¢tl copy thereoi (Settlon ieoo, �b. c.� Fairmont �ucy wo. F15506 comoanr Certitietl topy is nereby tumizhea. CertifiQ tl coy y Jiletl witn the city Bui I iv s — Date L 1—h—�`� qpplicant EXEMPTION FROM WORKERS' CO ENSATION D LARHTION (This sectiOn neetl nol be completetl If �e perr�i[ is tor One nuntlretl (E100) or less). � c¢/tify that in the perfo�mance ot MB wo�k fOr w�ich tp(s pe�mrt is i55uetl, 1 50a11 not nmplOy any person In any manner so as to bCcom¢ subjett to the , H'orkers' Compensation Laws ot CaliPornia. � Date S�9�ature NpTICE: It, atter makin9 this tleclaration, You shoultl bacome subject to the �^/o�kers" COrtfP¢nSatla❑ proW5ion5 of Ihe l.abOr Cotla, y0u mu5t forthwith �Omply w7t� sucn provisions or this permit sha�l be tleemetl revoketl. �ONSTRUCTION LENDING AGENCV � � hereby aHirm that thera is a constructlon Icntling a9ency for the oeAormance oY the work for. wnich this permlt is Issuetl (Se<tion 3097 Civ. C.) LonGer's Name - i �entler's AGtlross - ' _ , OWNER BUILDER DECLARATION - 1 herebv a/flrT lhat 1 am exempt }rOm the Contractor'4 LlcenSe Law t0/ lhe ¢5 a permlt t0 cOnSiluc[, alief, improva, aemeusn or reuau to itT ISSuancB, dlso r¢quires Ihn applicant br SUCh permit ment tbat he/ihe IS Iicon58tl pu�sudOt to Ihe O�ovlslon5 01 insa i aw �Chaoter 9(commencinq witb Section 7000) 07 'hmetrom anC the ba515 toctha dllegetl exOmption. AOY viOlatiOn ol SecUon 031.5 by any apP��ant �or a permit SUb�¢c(S thC�apO�� l0 a civil �nalty of not more t�an five huntlretl dallars (5500�. 1, as owner of lh< P�Ope�ly ar my employe05 wlllt wages a5 thei� Sole Somoensat�on, will Oo tno work, an0 1na sbuctu�e is not IntenCetl or oHeretl for sale (SOclion ]044, Business anC Professional Cotle: The Contra<tor's License l.aw Coes no[ apply to an ownor of a property who builtls or improves thereon, antl who tloes such work himsell/nerself or tnrough hls or her own <.mploy¢os, provitletl [nal Suth improvementi ar! nOt InlCntletl Or otte�etl 10� Eale. II, hOwaveq tha Eulltlin9 or improveTeot is SOItl witnin one year 01 com- ple(ion,�tne owncr wlll have tha burtlan oi provin9 bc/s0a tlitl not Culltl or im- �rove tor Ihe purpose ot salo�. I, as owner 01 the Oroperty, am exc1u51very cOntraCting with Iicent¢e con- [ractors lo construct t�e oroject (Sec[ion 7044, Businais antl Profe55ions Cotle: 7ne ConVactor•s License L3w does nol apply to an oWner Ot property wno builtls or Imvroves thernon, antl wno contractz for such pro�ects with a ton- tfactor(5 Ilconse pursuant�to lhe ContlactOr'S Liceni0 l.dw). 1 afil awara that prmf o� tAel� WOrket's COTpenzatlon 7nzuranca znoultl be p�ovltlea to me. ❑ 1 am exempt untler $ection B. & P. C. tor this reason Date Owner I hereby c¢rtify thdt I have reatl this ap0�ication antl stdte that�the aoove Informat7on it coriect. I agree to compty with all Nty antl cou��Y ortlinances 8nA stat¢ Idws r¢lating to builtling ConStruCtion, antl nC�eby authorize re0re- Sentativez of�thi U to en upon.[he above-mentioned properry for inspectionpurp es. // ��U Si9nature Oate / D' e s' Lic u o 55 � � �� TYPE OF CONSTRUCTION LJ NEW IJ ADD j!G'�AL7ERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p..�6 DESCRIPTION OF WOFK/USE OF BLDG. S Main Buitdi E TVPE OF PERMIT QRADING FOUNDATION STRUCTURAL T FrOnt ❑ TENANT ❑ ELECTRIGAL ❑ PLUMBING �MECMANIGAL A Rear ❑ OTHER ' ' PRWECT DESCRIPTION Sq. FT. oCCUPANCv C Right K CONSTRUCTIONTVPE � VALUATION$ S Left ZONE GRADING CU. VDS. AGRES p�ng. Ref. # Remarks: I S�(� Z P�anning Notes: Backflow Preventer Backflow Irrigation . Bathtubs Clarifiers Dishwdsher Drinking Fountains � Floor Drains - , Ploor Sinks ' . _ Gas Service Outlets Interceptors Kitchen Sink ' Lavatories P-Trap � Roof Drains Reinspection Fee $15 Boiler ' Duct - Under Ground Duct - Ventileting Exhaust System ❑ Multiple Firepl/Fxt. BIL IC80 # Heating System & Ducting ❑ai oo,000 eru O i oa,000 Reinspection Fee � $15 CMF 0865-46, rev. 4/84 Wnite - Builtling; Canary - Appliwnl; P��k - Accounting; Goltlertrotl - As5e5So� Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping ' Solar Tank Swimming Pool w/Spa Urinal Water Clouc Warer Heater Water Service . laue Fee Hood or Typel ❑ Canopy Typell ❑ Re(rigeracion System 00.100,OOOBTU ❑700,000 System RepairlAlt�ration Isue Fee F S 3 53 Automatic Washer Construction Pole $ub. Cooking Unit � Dishwasher Dryers ❑Gas ❑Electri Fan F,A,U. Fixtures . Device Boxes OuUets � SwitChes Garbage Disposal Generator 00.5 KW �5 2104 II/�3/84 zone Acceuo�y Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amp5 15 KW Sub Panel Motors �0.1 HP � 1 h� 8 Inc.Solar �9�15 HP �1G15+ Microwave Pole Light Fange Sign $tanding Sections Trash Compatror � Reinspection Fee I$15 ' I Iasue Fee DEVEIOPMENTSERVICESREQUIREMENTS: � 2oning Approved By Building APProved By Applifation Issued By BUILDING PERMIT $ PLAN CHECK $ PLUMBING 5 PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% S MECHANICAL • $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE S ENERGV P.C, $ GRADING $ MICROFILM $ 00 , _ . TOTALFEE $ l /AJW-'� 23.7c FEES S 3 ; +.�Y�Si� Z O N I N G R E � M T S. , CONSTRUCTION AND PLANNING POOL, ,PA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement �� ;, 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms . /-o 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement , � 56. Rough Plumbing & Pressure Test •� 6. Electrical UFER Grnd. • 57. APPROVAL TO COVER•GUNITE • ` i: ..' � . 7. Footings �� 58. Electrical Conduit-Undrgrnd. " 8. Foundation ��' ' 59. Gas Pipe, O Undrgrnd., Test . i ` � • 9. Water Pipe�Undrgrnd. � , �� 60. �Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System 61. .APPROVAL TO DECK 11. Property Sewer Line & House Connection „� 62. Backwash & Receptor-Final � ' 12. Sewer Cap 63. Heater & Vent-Final � 13. Roof Drains 64. Plumbing System - Final - , 14. Rough Plumbing 65. Electrical-Final . � 15. Rough Electrica�-Conduit 66. Solar System-Final 16. Rough Electric Wiring � 67. Fencing & Access Approval 17. Rough Wiring Sign ' - 68. APPROVED FOF PLASTERING 18.� Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure ' 70. Underground Hydro � � 22. Ducts, Ventilating 71. Product Piping � Gas ❑Oil 23. Gas Pipe-Rough & Test , 72. Underground Flush � 24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . 27. Frame and Flashing 76. Dry Standpipe ' ` 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing _ HEALTH DEPT. REQUIREMENT : 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED �• /� I 33. Final Electric Notes: � • � ' 34. Final Heating & Air Condiiioning Z Lq�b'�'( L� , , '�� 35. Final Gas Pipe-Test 36. Hood or Canopy - � - 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final � � 41. Solar pomestic-Final 42. Backflow Preventer � �. � :.<. � 43. Backflow Irriga[ion 44. .Landscape Irrigation System . � - � � 45. Sound Attenuation . ' 46. Handicap Regulations � ' ' !' �it 47. FINALSTRUCTURE&BUILDING � . �.. 48. Special Requirements Completed ' 49. Elearic Release to Edison � �' �' �, •� 50. Gas Release to Southem California Gas Co � ' 51.CERTIFICATEOFOCCUPANCY . �, '� '! :.� i No. ' Date � ' � / P.DGlieant to /III in all spacos exeept thoie w(ihin heavy CorEer Iines anC ilgn all a00�opriale Eaclarations. Z1T,Y,OF COS7n MESA CONSTRUCT�I vPERMIT P�o;a�,Add,�� r2y —/97Ti .S/ir��'i�'�'��,�1;;��q�//QQ6rl� „ Appiicant's Meilin�ddre= f�2�{�J�� Owner's Name P 6de Address �� E� ArchlEng. l'r_l�d.dLfL�[ense No��-SD Z+/�� Address .�� iv�i �LY��j �'�0,,�`�--�-L"J . Contrecror's Nam �% hane�.�Y_c�Y Address (mailing) City License No: ��-�+ LICENSED CONTpACTOR DECLARATION I hOreDy atfl�m Ihdt I am IiCe058G untle� proviiiOns of Cha�te� 9(commancing wlth uction 7000) of Divfsion 3 of the Buzlness antl Profeszions Cotle, antl my Iicense is in full orce ana efiect. ' LlcenSe Class i en N � Dat¢ �%' S'9 dt e WORKERS' COMPg SATION DECLARATION I hereby aftirm that I have a certificate of ronsent lo self-insure ertHlcate �f Wo�kers' Comp¢nsation InSurance, or d Certlfi¢tl COpy [hereof (Sattlon 800, Lab. C.) , � Policy No. Company 8 Certifietl copy ik hereDy furNSheU. , Certitietl copy Ii filed with the city Builtlin9 Divislon. Date APPlicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION� � ' (Thissection noetl qa( be complBt20If the pe�mit ii tor One nuntlr tl$300) o� Icss) � I Certiry that in th¢ pertormdnce ot thB work for wM1ich Inii pe ii IssueA I znalPnot �employ any perzon In any man r so as t b o bject to t�e i Workers' Comp ns ��o L�w s�ot Calito� . . Date .��' -�✓ �ignature 'NOTICE: It, after MaGin( this tloclaration, you shoul0 become sub cl to tha Workers' Comp8n5a8on+provisions of Ihe l.abor Cotle, yau mus thwith comply wllh such� provisions or this permit ihall b¢ tl¢¢metl rBVOketl. CONSTRUCTION LENDING AGENC�',"� " � 1 hareby af(Irm that.there Is a const/uctlOn lentling!agBncy 10� Ihe Oertormance , of Ihe wOrk for which thiz. permit is iisul0 (Sectlon 3097� Civ. CJ , l_entler's NamC - ' - - ' Lender's AtlGreSi - � � IpWNER BUILDEp OECLARATION- � ' I hnrobv attirm that I am exempt'trom the Contractor's'Licenie L.aw for the County whiGh �eqWras any structure, pri0r to to tiie a signatl statami ihe Contraclor's Llcen: Divislon 3 ot the Bus �31t5 Dy anyhdDPll� nalty of not more th , J I, as ownar of tn� comDensation, will tlo lor sale (Soction 7p4 �Icense LdW d085 �O� � thcreon, anG who tloe I emploYees, pwvitletl U ulo. If however, tha 1 plotlon, Ine owner wil Qrove for the purpom i LJ I, as owner ol [he IfactOlSto constr4cttt The Conlractor'S Lice builds or improvBs tb� Vattor(sl Ilcenso pursi ' proot o1 tbelr Workei � I'am ezempt untlar I 'or tho alle9etl axemptlan. Any wowuon o� oacuon . t for a permit subjects the appliwnt lo a-civll five nuntlrCtl tlollars (§500j. � �oparty oi iny employees witn wag¢5 as thOir sola ! work, antl Ihe Structure is not IntentleC or otferetl Buslna55 anA Pro(eisional COAe: Th¢ Contractor's , �ty to an owna� Ot a O�operly wh0 builtli or Improv¢s uch work hlmsNt/nerself or throu9h his or her awn ' such imorovaments are not intentla� or ofinrotl for ; tling or Improvement ii soltl within one year ot �om- �ve the burtlen of prpving he/Sne tlitl not bulltl or im- ale�. �perty, am exclusivery tontracUn9 with Ilconseq con- . noject (Saction 7046, Busineis antl Professions Cotle: Law does not apP�Y to an owner of prop¢rtY who �n, antl who contraGts for such projects wlth a con- [�to [he ConVaGtoi's Litense Law�. Iq�r� dware tha[ Componsatlon, Insuranca shoultl be llvvidetl [o me. ' �eion 1 Bw& P.��or t�is reason �Oate !�/-L%�� Owner I'h¢reby'[¢rtily ihdt I have rea IMormation i5 co��ecL 1 agrea t0 and itate laws relating to bulltlir �sentatives' of tN; �Ity to enter Inspectlon pur se�� % , $ignature � � � Drivers' License or 55 4f. —'� ] state t/aY lhe dbove 'antl covhiS' ortlinantes i¢�eby aUtho�ize �ep�e- mtionea orooartv for _.._C � 1 � TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH 0 OTHER q,p,.fb DESCFiIPTION OF WORK/USE OF BLDG. � S Main Buildi E TVPEOFPERMIT GRADING FOUNDATION STRUCTVRAL T Ftont ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear ❑ -OTHER , C Right PROJECT DESCRIPTION 54.F7. oCCOaaNCV K � CONSTRVCTION TYPE ' VALVATION 5 g L2ft ZONE � GRADING CU. VDS. ACRES Ping. R2f. # Remarks: � �--� %� �i� � - Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks � ' Gas Service�• �Outlets Interceptors Kitthen Sink Lavamries ^ P-Trap ' Roof Drains : , . ' Reinspaction Fee '� 515 '�oiler "� i _ � . . Duct � Ventilating � L . � Exhaust System ❑ Multiple � Firepl/Fact.8lt. ICBO # � Heating System & Ducting � " ❑a100;000 BTU 0100,000 �I I Reinspection Fee I $75 CMF 0865-46, rev. 30/84 White - Builtling; Canary - ApPlicant; Pink - ACCpuntin9: Goltlenrotl - Assessor PLUMBING Showers Service Sink � Sewer Cap- � $ewer Connection Solar Collectors Solar Pipin9 ' Solar Tank Swimm"rng Pool w/Spa Urinal Water Closet Water Heater � Water Service Auto�Wash � IAUB FBB � I FEES Hood ar� Typel ❑ Canopy Type II ❑ � 9efrigeration System � '�4700,OOOBTU 0.100,000. System Repair/Alteration Pire Dampers Registeri � laue Fee W $ 3 0 Nutomatic Washer Construction Pole Sub. Cooking Unit D ishwasher Dryers ❑Gas �❑Elecvic Fan ' F.A.U. Fixmres - � ' ' " Device Boxes,�� Outlets•-f.. . DEVELOPMENT SERVICES Zoning Approved By ' /, Building Approved By, Lq 1178 l0/30/84 Zone Parking Req./Provided T ELECTHICAL , Transformer ❑ 15-50 KW ❑ SO+KW . Meter ❑up to 100 amps � Meter 4Z]over 100 ampsZ�� Su6 Panel Motors �0.1 HP O i X- 8 Inc. Solar �9�i5 HP �7615�' Microwave � � � Pole Light . ; Standing Sections 15 KW Trash Compactor $15 Issue Feo 4702.5 •TL FEES C' $ 3 2 O N I N G R E � M T S . - SUMMARV OF FEES � BUILDING�PERMIT $ SMIP $ PLAN�CHECK � $ ' � PERMIT � PLUMBING: - $ � ISSUANCE 5 - -PLAMCNECK '?$2..5� 6NERGV P..C. •S /ELECTRICAL'� '� GRADING S � PLAN�CHECK 50% {$'!�'�� P!1�CROFILM S � � MECHANICAL �y'7� TOTALFEE ',$ PLAN CHECK 25% $ ' � �� , _ . ._ . _. _ CONSTRUCTION AND PLANNING , rAPPROVALS Permit # Date 1. Temporary Electrical Service or Pole i .� 2. Soil Pipe�Uniirgmd. � 3. Electrical Conduit.Utllity-Undrgrnd. - 4. Electrical'Condult�Undrgmd. � . 5.�SteAI Reinforcement � 6.�ElectricalUFERGrnd. ��' i. � � . � • . 7. Footings. � . 8.. Foundation ' � 9. Wafer Pip'e-Undrgrhd: � . , � 10. Structural Floo{ System � ,� 11. Property Sewer�Line & House Connection ' .i � 12. Sewer.CaP ` � ,' �! , i 13'�F3o9f Drains -.� �i _� � 14. RougFi Plumbing � ' 15. Rough Electrical-Conduit 16. Rough Electric Wiring , � � 17.. Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling // � 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace- 21. Ducts, in Structure 22. Ducts, Ventilating � 23. Gas Pipe-Rough & Tes[ 24. Roof Framing � 25. Roof Sheathing 26. T-Bar Ceiling �Structural) & Monocoat 27. Frameand Flashing 28. Lathing & Siding 29. Insulation ' ' 30. Drywall Nailing 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Condi[ioning 35. Final Gas Pipe-Test . 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final � 40. Gas Service-Final � 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System.� 45. Sound Attenuation , 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co - POOL. .�A Inspector qppROVALS Permit# 52. Pool & Equipment Location ` � 53. Steel Reinforcement 54. Forms ' 55. Electrical Bonding • - 56. Rough Plumbing &,Pressure Test 57. APPROVAL TO COVER�GUNITE � _ 58. Electrical Conduit-Undrgrnd. " 59. Gas Pipe, O Undrgmd., Test � 60. Backwash Lines, P-Trap, O Undrgrnd. � �� 61. APPROVAL TO DECK ' ' 62. Backwash & Receptor-Final . "' 63.. Heater & Vent-Final � 64. Plumbing System - Final 65. Electrica�-Final � 66. Solar System-Final � 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING � 69. POOUSPA SYSTEMS FINAL FIREDEPT.REQUIREMENT APPROVALS Permit # 70. Underground Hydro • 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil � 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80.•FOOD CERTIFICATE ISSUED Notes: �', /B� b � _y... 9 No. Date I 'I .. 1 0 i Date Inspector r ' ,1 i i Addrea Address Phone License No. Phone Addreu - LICENSED CONTRACTOR DECLARATION I hereby aifirm that I am Ilcensetl untler Drovislons ot Charter 9(<om- mencing wlth section 7000) of O��sion 3 0( the Business an0 Rofesslons Cotle, antl my Ilcense is In full forca ana of/act. Licensa Ctass Llcensfl No. Date Si9nature WORKERS• COMPENSATION DECLARATION ' I hereby af(Irm Ihat 1 have a certiflFate at consent [o self-Insura or a certifiwte of Workers' Compensation Insuranca, or a certi(letl copy thereof (SettiOn 3800, lab. C.). Policy No. Compa�Y ❑ Certlfietl copy is hereby lurnishetl. r �[ifletl copy is tiletl with the city Builtling Divlslon. 1 APTION FROM WORKERS COMPENSATION OECLARATION (� ��rs section neetl not ba compleceU If the permit Is for one huntlretl (§3001 or less). 1 ttrUfy that in Ihe performan<e of the work for which this Oermit Is Issuetl, I shall not emPloy any person in any mannar so as [o become SubjGCi to the WOIkGrS CAmDGnSdtiOn Ldv/s Of Cdlifornla. Oate Signature NOTICE: If aflar rtwking thi5 Oetlarat�o�, You shOultl b¢come Subjacl to tha Workers' Compensation provlsions of tna l.abor Code, you must torthwith comply with such provisiohs or thiz permit shall be tleematl �¢voketl. ' " GONSTRUCTION LENDING AGENC�' I h¢reby affirm that there IS d cOnslruCtiOn I¢ntling agency tor the per- formance ot the work for wnlch this permlt is Issuetl.(Sectlon 3097 �Civ. C.):. . _ _\ . i ��- . . . . .- . _ L.entler's AtlUresS. � OWNER BUILDER DECLARATION � ' I hereby aHirm that I'am exempY.�rort�.tM1e Contractor's•�icenie law for lhe followin9 reason' (Section ]031:5 Busine55 antl'Professions Cotle: Any tlty or county which requires a permit to cons[ruct, al[er, Improve, tlamolish or repair any structure, prlor to its issuance, also re- quires the appllrvnt for�such permit to lile-a slgnetl slatement that he• is licensatl pursuant [o the provisions of`the Contractor'S License Law (Chapter� 9(commencing wltn Section. 7000)`of Division 3 bf ttie 8 1151 0 8 5 5�d04 PfdM5i00T COtlO) or th3t h¢ Is exempt [hErpfroT dntl [h¢ bazis-for`the alle9etl-exemptlon. My violation ob Sec[iom7031.5 by any applicant. fur a permit subjects the appliwnt to a�civil�penalty, h} -�t TOro than+tiV¢ huntl/¢tl;tlolldfv(E500)y' � t' - C'�� '� l� : owner,of.the_pro0arty,ar . ., _ . _ , , , , . Cbntractor'S Licensg Law.tloes'nOt -aPP�Y'to an �owner of a� proPerry- who builtlt or improves thereo�, and N'ho.tloes such work hirimsel6or, (hrOU9h hls own em0�oyeez; provltleA'that such'ImprOvemenls a�e nbC intentleU or of(eretl for sale. If, howe�er, the builtling or improvement Is soltl wlthin one year ot completion, the owner wllPhave tne burtlem of provtn9 tie.Gitl not, buila or_ImProve for"[he�purpose ot sale). ❑ I, a5 owne� ot�the ptoperty,�3m exclusivlty contraCting wi[h licensetl con[ractors•[o con5trutf tne project (SecHon 7044, Business antl Professions Cotle: The Contractof�'s Litense Law tloes not apply to dn owner of p�ope�ty wh0 �builtl5 0� �mproves tbereon,-antl who,ton- Ilacts ffom such��projects wi[h,a contrdCtO�(5) IIc¢sn8tl_pur5udnt` IO tne Contractor's Li<ense Law)2��• `�- � ' "'• . � ' ❑ I am ¢xempt untler Section ,� - B,B.P.` C. toqthis I have read or 55 _ 1.. ��...i�__��.' ines anC si9� all appropriate tleclanlions. TRAL'T NO. LOT NO. � BLDG. NO. �U1�� TVPE OF CONSTRUC,T�,I/ON ' ❑ NEW ❑ ADD Lry ALTERATION � ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER _ ZONING DESCR�PTION OF WORK - l0 A'P' � ' O i � YI/ P/%.y ✓� i/d/Y" Gf/i..� ZONE -1 TVPE OF PERMIT. / �/ /� ❑ GRADING_ �] FOUNOATION IESTRUCTVRAL ❑ TENANT Ki ELECTRICAL OPLUMBING ❑MECHAI ❑ OTHER PROJECT DESCRIPTION � Sq. FT. m OCCUPANC a CONSTRUCTION TVPE �LL� VALUATION ��-S.)'n. ZONE. �— � GRAD�NG CU. YDS. ACRES PLUMBING TOILETS LAVATORIES KIT.SINK$ SERVICESINY PLAN CHECK SHOWERS URINALS DOVBLELAVS DISHWASHERS SUMP$ �. � "�F,LOOR �RAINS INTERCEPTORS CLARIFIERS�� SWIMMINGPOOL PTRAP WATER,SERVICE � ALTERATION GASSERVICE,ti�_,_ \.OUTLETS WATER HEATERS� _ BTU OVTPUT SEWERCONNECTIONS SOLARTANK b� J^1COLLECTORS SOLAR P�PING SVS� \- ,_ISSUE FEE � ,._ , .� MECHANICA4, j_.: -.•P.LANCHECI( HEATING SVSTEM 0-300,000 BTV _ .AND DUCT WG` :100,000 + BTU _ REFRIGERATION , 0-1'00,000 BTU_ �SVSTEM�,�. . �100;000+BTV_ =BOILERS��'.- ••'gTV SVSTEM REPAIR,ALTERATION EXHAUSTSVSTEM MULTIPLE ISSUE FEE : Goltlenrotl-Assessor t � , r� .ti• 0 REAR VARD (TO I PKG. SPACE REQ. ZONING APPROVED B1 SPECIAL CONDITIONS: ELECTRICAL sil5/ei REGULATIONS PLNTGp. gRUEFL. p� PROPE�RT VNLI NE PROVIDED PARK FEE $ PLAN CHECK GENERATOR 0-1 KW_ 1-30 KW _ T0.ANSFORMER APPLIANCE 10-50 KW 50 + KW _ MOTORS p-1 HP_1-30 HP _ (INC. SOLAR) 30-SO HP SO + HP _ FIXTVRES OUTLETS SWITCHES GAS TUBE SIGNS POLELIGHSS �: � �.� ri PANELS MAIN SUB SERVICE F APPIICATION APPROVED BV IG3o�J T: I SUMMARV OF FEES � BV ILDING PERMIT § q�a SMIP � E h,�� PLANCHECK S��Lir PERMIT ISSUANCE S 7LUMBING § GRADING 5 PLAN CHECK $ � ELECTRICAL § � $ PLANCHECK S MICRORLfN § $ MECHANICqL § TOTAL FEE E�Q ' PLAN CHECK E LE55 AD- VANCE PC E . �� . - �_. ` -1— /'✓V � �FINAL FEE y ,:� .-.� �. CONSTRUCTION AND P�ANNING , � , ` ` �POOL & SPA' ' • ��,3� Date Inspector qppROVALS Permit� APPROVALS Permit # � 1. Temporary Electrical Service or Pole � 43. Pool & Equipment Location 2. il ipe-Undrgrn 44. Steel Reinforcement 3. lectrical Conduit Utility-Undrgrn 45. Forms 4. �lectrical Conduit-Undrgrn � ' 46. Electrical Bonding . tee ein orce 47. Rou h Plumbin & Pressure Test 6. �lectrical UFER Grn 48. APPROVALTO COVER-GUNITE 7. ootings - 49. Electrical Conduit-Undr rn . 8. Foundation �� - 50. Gas Pioe. ❑ Undrorn_ Test 9. Water Pipe-Undrgrn 70. Structural Floor System 11. -•Property Sewer Line & House Coi 12. Street Sewer Connection - � 13. Fiough Plumbing 14. pough Electric-Conduit 15. Rough ElectricWiring � - 16. Rough Heating & Air Conditionir ' 17. Ducts in Structure . 18. bucts, Ventilating ' 19. Gas Pipe-Rough & Test 20. Roof Framing ' 21. Roof Sheathin ' 22_ Frame and Flashin 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final 34. Solar pomestic-Final . 35.. Landscape Sprinkling Svstem � 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILD(N 39. Special Requirements Completed � 40. Electric Release to Edison 41. � Gas Release to Southern California 42. CEATIFICATE pOF OCCUPANCY : No �� L �- Date �� 54. 5a. APPROVED FOR PLASTERI 60. POOL/SPA SYSTEMS FINAL NOTES: , .:.._eLc E'37 i �i Date � Inspect 1 ,• y�� 19340 C`057A MESA BUILDINGSAFEfY DEPARTMEM' P. O. BOX 977 COBTA M88A. CALIFORNIA For Applicont to Fill In CompleTely TY E OR PRINT BUILDIN / /w ADDRESffi /J COSTA MESA, CALIFORNIA , OWNER e r . MAIL i..-. > /'� /� f'� .� .i �-� TEL �� t NO. -"��. � `` 2.YTo s.' re 5 9,�6 0 rs� ��e s�a�. ,t� � s �r 9—/ y� No�/.!I' d SrG / ) NO, OF BLOOB. DO. � PpOM DESCRIPTION OF WORK WALL I N¢FEBy pCKNOWLEOQB THAT i MAVH q8A0 THIB APPLICATION ANO 6TATE THAT TH8 /�BOVE IB COqqBCT AND AOp68 TO COM� PLY W�TN ALL CITY OqD�NANC88 AND 9TAT8 LAWB R80ULATINO BIIILOINbCON9TH CTION. SIGNATURHOF��' ` �� PERMITTEF �� d'�� AUTHOPyIZED AGENT � jn� y.� �. � ��/� �IVNIVL� 3DE� �ITIf OF COSTA MESA APPLICATION FOR PERMR BUILDING for Office Use Only /�� 116C61PT NO. IIT NO. � [C[I D IBBy" 4 . • 23 63- 3 ` 11LDIN0 , M � L80AL �Y. NOTB: NOEAVEOVERI 90' TO 81D8 8 REAR P EAVES ALLOWFD YARDSAPPROVED MAIN BUILDIN� VAR. iC .�-� �ti.c� � -.�o �� AN6 BHALL BE LE88 THAN Ly fU.B.C.RE0UIREMENT -YARDSAPPROVE❑ ACCESSORY BUILDIN6 BET. MAIN 8 ACCE55. BLI DATE N $Q. �. � TN8 AMOUNT BHOWN UNDeq YALUAiION 18 POH TNB = PYqP096 OP EBTABL�9HIN0 A PERMIT P88 ONLY, p VALUATION �/) Q^ n fT- PERMIT FEE $ � j �/- � m $ C o A y � � �� TOTAL FEE S