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Home My WebLink About534 19TH ST - Building PermitsI w (714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIM UFiIVt, GU51A MtJA, GH tlL026 Job Address: Suite No Viciniry: 534 W 19TH ST WESTERN DENTAL Parcel Number: 42210318 Applicant: PHILLIPS, HOWARD Address: 2952 CENTURY PL Owner: Address: Contrector: MECHANICAL PERMIT ISSUED BY: Phone: 714-546-1653 Status: ISSUED Applied: 02/14/2005 Issued: 02/74/2005 COSTA MESA, CA Zip: 92626 Bnyc,ss,Do4oTNy LE� T�P FaK 1992 �sTq MEsaTiz�s EWP RT A ER F C�p CogrA �Es� TR�Sr e�0 ��TNY BAY415S N I NAL AR � L E CBS�A ME3A, L�A a7•(8p(l 223 �,ac.,N�a P�. 4ab C M , C Phone: 0 W H S EE7 Zip: 92627-2748 DEPENDABLE GRAHAM AIR CONDITIONING Address: 2952 CENTURY PL COSTA MESA, CA Phone: 7'14-546-1653 Zip: 92626 License: 472690 SCOPE OF PERMIT REPLACE 2 EXISTING A/C PKG UNITS (ONE 3-TON AND THE OTHER 4-TON) ON TOP OF AN EXISTING COMMERCIAL BLDG. - 2 INST FAU < 100K BTU, 2 COMPRESSORS 3-15 HP/SOOK BTU NO OTHER WORK AUTHORIZED WITH THIS PERMIT. ISSUE FEE Inst FAU <100 k BTU Inst FAU »00 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall HV Re(rig Sys <100 k BTU Refig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech �xhausf VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm Air Handlers > t0000cfm Floor Fumace Floor or Suspend Heater 523,50 a2s.so $0.00 $0,00 $0,00 $0.00 50,00 $0,00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 50,00 $0.00 $0.00 so.00 $0.00 $0.00 �uantity z 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbfion Uni[ Repair I Alt Refnge2tion Unil Venlillation System Evaporative Cooler - Commercial I nci nerator Domestic Incinerator Compiessors / Absorotion Svstems Upto3hplt00kBTU � � 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 Up to 3 hp - � , 3To15hp 15to30hp 30 l0 50 hp � , Over 50 hp Other Mechanical Fee " InveStigation.Fee Plan Check Fee Quantiry so.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 554.30 2 50.00 0 50.00 0 $0.00 0 30.00 0 $0.00 0 50.00 0 50.00 0 SO.Oo 0 30.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes antl related regulations. (Ortl. No. 92-28, § 1, 12-21-92) EXPIRATION: 7his permit shall automatically expire anC become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 190 days. INSPEC7tONS: In or0er tor the work aufhorfzed under this permit to be considered iegal, soch work must comply wlih all appttcable codes, antl all requlrad InapeCtione and flnal epproval must be oblflined. Failure to obtain inspections and tinal epproval will result in ihe ezpiratlon ot lhis permit. FOR INSPECTIONS CALL: (7/4) 7545628 zueee (aroo) WORKERS' COMPENSAnON DECLAiiAnON: I �ereby aHirtn under penalry ot perjury one of Ihe lollowing tledaretions: ❑ I have end will meinteln e ceNflcate at consent to sell-Insure lor workers' compensellrn, es Orovlded lar Dy sectlon 3700 ot Ihe Lebor CoCe, lor the peAartnence ai Ihe work for which thls pertnit Is issuetl. �� I heve sntl will maintain workers' compensetlon Insurence, as required by sectlon 3700 of Ne LeOor Code, for Ne partarmance of Ne work for whMh Ihis permit Is issued, My workers' compensetlan Insurence cartier end pollq number are: / (� Cartier. �_�2i�N �'7'�-�E PoIlcyNumber. 5o I— Z�`� / (Th/s secNon neetl not be comp/eted i! the parmiNs ve/uetl et one huntlretl dollers ($100J oi less.) ❑ 1 cetlily ihat in the pertormenca of tha work tor wNch t�is pertnit is issued, 1 shell not employ eny person in any menner so es to became suhject to the workere' compensation lews oi CpIlfomie, end egree Ih I I phoulA became su6�ett �o �he workers' wmpensetlon provlsions ot Seclion 3700 of t�e L9bor Code, I sh8111ori�wlih comply vrith these pr 'Slons. Mvllcenisipneture: i� oate: Z—�/y/o� WARNINCi: FAILUFE TO SECURE WORKER$' COMPENS�TION COVEFUGE IS UNIAWFUL M1D SWLLL SUBIECT AN EMPLOVFA TO CRIAUNAL PENALTIES AND CML FlNE$ UP TO ONE HUNDRE� T/IOUSAND OOl1ARE (5100,000). IN ADORION TO THE COST OF C�OMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 31O60F THE UBOR CODE, INfEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby effirtn that I em farce end eflect. Llc. N_ Contrectors Slgneture: ot Chepter 9(commencing with Section 7000) ot Dlvision 3 01 Ihe Business and Professions CoCe, and my Iltense is In full Class q f 7- � %�.;+ Date: � -/ � - O � CONSTRUCTION LENDING AGENCY: ❑ I �ereGy attirm thet there is e construction lending egency tor t�e pertormance ol l�e work tor which t�is permlt is iuued. (Sec. 3097, CiNI Code). Lendefs Name: lenders Adtlress: Signatura: Date: OWNER-BUILDER DECLARA710NS: I hereby etlirtn Ihet under penelry ai per�ury that I em El(EMPT FROM THE CONTRACTORS LICENSE LAW tor the fdiowlrg reason (Sec. 7031.5, Buslness flnd Professions Code: My dry or counry w�kh requires a pertnit ta construtt, elter, improve, demolish, w repair eny sWcture, prior to its issuance, also requires ihe flpplicant lor such pertnit to file a signed statement t�et �e or she is Ilcensed pursuent to the proWslons of the Cantrectors llcense Lew (Chepter 9(wmmanUng wit� Sectlon 7000) oi Division 3 at I�e Business end Professlons Cade) or that he or she is exempt therefrom and the besLs for the elleged ezemptlon. Any violalion ot Section 7031.5 by any appllcsnt lor a pertnit sublects the epplicant to a civll penalry ot not more ihen Ilve hunCretl Collers ($500).): . ❑ I, es owner ol ihe properry, or my employees wilh wages es thelr sole compansatlon, WILL DO THE WORK, end tha structure is not Intended or ottered for sale (Sec. 7044, Business end Prolessions Code: The Conirectors Ucense Law tloes not apply to an owner of property who builds or improves Ihereon, and who does such work himself or herseN or Ihrough his or her own employaes, O�ovided Ihet such Impmvements ara not Intentled or oHeretl for sale. II, however, the building or Improvement is sold within one year of completion, the owner-builder will have ihe burden of proving ihat ha or she did not build or improva for purposa ot sale.). ' ❑ I, es owner of the proparry, am EXCLUSIVELY CONTRAGTNG WITH LICENSED CONTAACTORS to wnstruct the projen (Sec. 70aa, Business anC Pmtesslons Cotle: The contreaors Llcense Lew tloes not epply to en awner ot pmpeny who bullds ar improves thereon, end who coNrecis lor such pro�acf wiN e contractor(s) license pursuent to I�e Conirectore License Lews.). ❑ I em exempt under soc. Business end Professions Cade lor this roason: Signeture: Date: Owner ID verifietl by ddvers license. � Ves ❑ No Drivels License No. Verificetion ol Ownership by (type ot document, I.e. - properry tex blll or deetl): DIVISION OF IN�USTRIAL SAFE7Y PERMIT CERTIFICATION: Expires: ❑ 1 hereby ceNfy thet no excavetion fNe (5) or more leet in depth Into whlch e person Is required to descen4 will be made in connection with work auihorized by Ihis permit, end t�a� no building 5tructure, scaNOlCing, lalsework, or tlemolltion or tlismantling thereof, will be more lhan thirty-six (38) feet high. (Chep. 32, Grp 2, Ar12, Sec. 341, Title B, Callfomia Atlministretive Code). ❑ As owner-bullder, I wlll not employ enyone to tlo work which would roquire e permit trom t�e Divlslon ot IndusMel Selory, es noletl ebove, unless such parson has e pertnit to do such work from the tlivision. Signature: Date: Division ol Industnal Safery Permit Number: CERTiFlCATE OF COMPLIANCE /WD AllTHORVA710N OF ENiAV: I certity under penalry ot perjury thet I have read this epplicatlon end state that the inlortnation given is wnea. I agree to comply with eli state laws and ciry or0lnances relating to building construction, and authonze represeNatives of the Ciry ot Costa Mesa to enter upon the ebave-tlescribed property tor inspection puryoses. I egree not to occupy or ellow occupanty ot any building euthonzed by this pertnit unlil linal inspection. Signature Of e wn6T(s) , Date �l�c�c�r „ , z —��/ '�S And/Or Authodzetl Applicant Dete COOE I, INSPECTIONTYVE PAIE IIii�LS 1616 Fixed System Final Fire Prevention 1266 200 201 202 203 Pool Spe Final Finel Re-Rool Final BIacWReleining Wall Final Fectary Fire Place Finel Sign 20G Final Demolitlon cooe� wsvecnoNTrve 206 Finel Mechanical 208 Finel Plumbing 210 Finel Elecirical 212 Finel Flre Preventlon 220 Finel Planning Apprwal 222 250 Final Sile Finel BullOing/Occupancy reie ll�s 2-23-05' �� ,.._,.r__._ .�.,..--�- -- __ _-- JobAddress: 534 W 19TH ST Suite No Vicinity: Parcel Number: 42210317 Applicant: TIMOTHY C JOHNSON " Address: 814 W COMMON WEALTH r, ,. ' I . �- � FULLERTON, CA � � " , MECHANICAL PERMIT Phone: 714 9924900 Zip: 92633 owner, ,'BAYUSS, DOROTHY LEE TR FOR 1992 COSTA MESA TRUS Address; %COSTA, MESA TRUST CIO DOROTHY BAYLISS � Status: ISSUE� Applied: 06/18/2004 Issued: 08/18/2004 ISSUED I - � COSTA MESA; CA Phone: rr '.� 223 VIRGINIA PL Zip: 92627-1821 !i ��q., {� � ` Contractor: TIMOTHY C JOHNSON � Address: B14�W COMMON WEALTH FULLERTON,CA j:'.�.:::�� F�."�'� �: .; �.l �;.�:.�•� �g.��,�'c' n:L;,._y"; Phone: 714 992-2900 y � � �: ? � // Zip: 92633 �•r'.is : ,_.. ...............�_� License:347295 � ' T-"" �� SCOPE OF PERMIT REPLACE ROOF MOUNTED A/C UNIT WITH SAME SIZE UNIT (3 TON). ISSUE FEE Inst FAU <100 k B7U Inst FAU >100 k B7U Repair I Alt CoolingMeat Insl / Rep. Recess Wall HV Refrig Sys <100 k 9TU Re(rig Sys >100 k BTU Gas Piping � . '�. � FactoryFireplace, = Hood w/Mech Exhaust VAV Box . � . - Vent Fan / Single puct Appliance � . Fire Dampers � � , Smoke Dampers�� Inst or Relocate Appl Vent, Air Handlers < 10000cfm � � AirHandlers> 10000cfm�-, Floor Fumace Floor or Suspentl Heater $23.SD $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 ao.00 $0.00 $0:00 $0.00 $0.00 50.00 Quantity 0_ 0 0 0 0 0 0 0 0 0 � . 0 0 0 � , , 0 0 , , 0 , p FEE SUMMARY Quantity Repair / Alt Absorbtlon Unit � 30.00 0 � . '� Repair / Alt Refigeration Unit ' 50.00 0 . ,� , Ventillalion System $0.00 0 Evaporative Cooler $0.00 0 Commerciallncinerator $0.00 0 Domestic Incinerator . $0.00 � 0 Compressors / Absorplion Systems ! :- � �� Upto3hp/100kBTU '� i 80.00 0 �, 3 To.15 hp / 500 k BTU '� ��$O.W ' 0 -� -�,�� 15 To 30 hp / 1,000 k BTU ,; ��, � 30.00 . 0� �� . 30 To 50 hp:/;1,750.k BTU $0.00 � 0 . � Over 50 hp / Over 1;750'BTU - ;� � � � $0.00 . 0 Boilers , - � UP to 3 hp ' �.�,, . _ $14.70 1 � , 3 To 15 hp ' � � � . � � ��' / =� "50.00 0 _ 75 to 30_hp : ; �;,"_ � ' % �' �' i,30.00 0 � � � �. -. - 30 to 50 hp . � �..', " '' .," $0.00 0 Over50hp , , �'i � ; � 50.00 0 Other Mechanical Fee � � /,� , �" Investigation�Fee '�� 30.00 � , - Plan Check Fee�" �/ $0.00 � � Reinspectlon Fee; ;�, '�-- � 50.00 _ -- _� - " � � 70TA1 CALCULATED FEES 538.20 NO710E: The work authorized by lhis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1B0 days, or if work is suspanded or abandoned for a period of 180 tlays. INSPECTIONS: In order for the work authorizetl under this permit to be consldered legal, such work must comply with all applicable codes, end all requlred inepeetlone and final approvel must be obtalned. Failure to obtain inspections and final approvat wil� resull in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 z«wa �aw7 WORKERS'COMPENSAnON DECLANAnON; - � I hereby eHirtn under penalry of perjury ona of t�q lollowlnp tlecleretlons: ❑ I heva end wlll mainteln a ceNficate ot wnSant to sell�lnsure far workare' compensatlon, es provltletl tor by sectlon 3700 ot t�e Lebar Cade, for ihe peAormance of Ihe work tor whlch Ihis permit Is Issuetl. ❑ I heve end will maintain workers' compensetion insurance, es requlred by section 3700 of Ihe Lebor Code, for the pertortnance ol Ihe work for which this pertnit Lv Issued. My workers' compensatlon Insurence caM�r antl poll�y number ere: Certier: Poliq Number. �Is secNar neetl not be aompletetl i! Ne permit fs velued et one huntlred tldlers (3100) a less,) I certily ihet In Ihe pertortnance of Ihe oB for wNch this pertnit is luue4 I shall not empby eny person in eny manner so es to become sub�ecM to the workeis' compensetlon laws ot Ilfomia, eqqqE greB that N I shoultl Oecame sub�ect to Ihe workers' compensatlon proNsions ol Secil � 00 0l l Labor�e, 1 shall fort�wl�h comptywiththese.P �s. / �� 0� ApDlicent Slgnet � L � oeca: WARNIN�: FNLURE T ECURE WO S' COMPENSATION dJVEM�E IS IINLAW NL AND SHALL SU9IECT AN EMPIOYER TO CRIMI PENALTIES PND CML FlNES UP TO ONE NUNDRED T11IX15PND OOLURE (5100,000). IN ITION TO THE �p$7 pp �pp�pEN5ATI0N, DAMAGES AS PROVIDED FOR IN SECTION 310fi OF THE IABOR CODE, IMEAEST, AND ATTORNEY'S FEES. LICENSED CON7RAC70RS DECLARATION: I hereby eflirtn that I am torce and enect. uc. a_ Contredofs Slpnetufg/ ot Chepter 9(wmmencing with Seclion 7000) at Division 3 of Ue Buslness end Prafessions Code, antl my Ilcense is in full Class M __ L , _ _. � _ . i —'� Data: CONSTRUC710N LENDING AGENCY: ❑ I hereby aNirm ihel there Is e wnsiruction lending egency br ihe pedortnance of Ihe work br w�ich this permit is issued. (Sec. 3097, Civil Code). Lentlefs Neme: Signeture: _ OWNER-BUILDER DECLARATIONS: Lenders Address: Date: I hereby eHirtn thet under penalry ot perjury thet I em EXEMPT FROM TME CONTHACTORS LICENSE LAW for Ne followinp reason (Sec. 7031.5, Business end Prolessions COCe: My ciry or counry wNcli requires e pertnit to consWct, eltor, Improve, tlemolish, or repair eny sWcture, pdor to its Issuence, elso requires the apD�� or such pertnit to file e si8ned stetement thet he or she Is Iicensed pursuent lo Ihe provlslons ai the Contrectors License Lew (C�apter 9(commencing with Sectlon 7000) of DMsion 3 of ihe Business end Proleuions Code) or thet �e or sAe Is exempt therelrom and the basis br the elleped exemptian. My Ndatlon of Sectlon 7037.5 by eny applicent for a pertnit su6�ects the epplicant to e ciNl penelry of not mora than live hundred dollars ($500).): ❑ I, es owner ot t�e praparry, or my employees wlth weges es Iheir sole compensetion, WILL DO THE WORK, and the struqure Is not Intentled or oflered for sale (Sec. 7044, Business and Professions Cotle: Th9 Contractors Licanse Lew does not apply to an owner of praperry who builds or improves thereon, enA who does such work himself or herself or Ihrough his or her own employees, provided that such improvemenls ere not Intended or oHered far sele. If, however, Ihe building or improvement is sold within orre year o� completion, the owrrer�huilder wll! heve the burden ot O�a��p that he w she did not bulM or improve tor purpose of seteJ. ' ❑ I, as owner of the properry. am E%CWSIVELV COMRACTING WITH LICENSED CONTRACTORS to conswct Ihe project (Sec. 7044, Business end Professions Code: The cantrectars LJcense Law tloes not epply ta en owner ol property who bulltls or Improves �hereon, entl w�o contrec�s tw such pro�ect with e contractor(s) Ikense pursuent to the Contrectors License Lews.). ❑ I em e:empt under sec. Businoss and Proleulons Cotlo lor this reason: Signeture: Date: Owner ID venfietl by tlnvefs license. ❑ Yeg ❑ No Orivers LJcense No. Ved�icatlon of Ownership by (type of document, I.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: Expires: ❑ I hereby cenify Ihat no excave�lon five (5) or more tee� In Cepih Into which a person Is required to descend, will be mede in connection wiU work euthorized by this pertnit, end that no DuIlCing siructure, scaHolding, felsework, or demolition or dismantlinp thereof, will ba more than thirty-slx (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Title 8, Celitomia AtlministretNe Cotle). ❑ As owner-builder, I wil� not emplay enyone to do work whic� would requlre e permit trom the Divislon ot Indusirial Sefery, es noted abova, unless such person has e pertnit to tlo such work irom t�e division. Sipnature: Date: DMsion ot Intlusinal Safery Permit Numbar: CEHTIFlCATE OF COMPLJANCE AND AUTHORIZpTON OF ENTHV: I certily under penalry ol perjury that I have read tMs epplicatlon and state ihat the Information given Is cortect. I agree ro comO�Y wlth ell state laws entl ciry ortllnances releting to building consiructlon, and authodze representatives of the Ciry of Costa Mesa to enter upon tha eDove-described pmperty for Ipspection purposes. I agree not to occupy or allow occupency ol any huilding authorized by this pertnit un�il final inspectlon. � C ` ' �_ AndOr Authori cooe �. 1616 Fixetl System Flnal Flre Prevention 7268 PoolSpe Flnel 200 Finel Re-Rool 201 Flnel BIaWRetelnlnp Well 202 Final Fectory Fire Place 203 Flnel Sign 200 FinalOemolition �[E �� j INSPECTIONTYPE 206 200 210 212 220 Final Mechanlcal Finel PlumEing Final Electrical Flnal Flre PrevenUon Finel Planning Approval 222 Final Site 250 Final Building�0aupenry QEff. I[�44 � �, � : �/��/��` ,� � -�.�� ,Ze -�i�v PS � f�" �- ��/r�-�i�/G- �iLoi� �-� �� 3 - �/.t-�`G �� -J oh �s �.'� �� 3 � � I 5 �� C°�S i.� m e.s° �q- � / e� �J �� 3 �f7�9 S— -�J �o�. �.�YC_ '- (714) 754-5273 • FeX (774) 754-4856 • www.d.CAsta-mesa.Ce.US 77 FAIR DFi1VE, GOSTA MtSA, GA 92626 BUILDING PERMIT �ob nddress: 534 W 19TH ST Status: ISSUED Suite: Applied: 1 1 /2 012 00 7 Vicinity: PLANTER Issued: 11/20I2001 Parcel Number: 42210318 Zoning: npp�icant: TAYLOR, ERIC ISSUED BY: Address: 100E MONTECITO AVE . - - _ - - " - , ", -� � _ � Phone: (626) 355-8880 . SIERRA MADRE, CA� �-�—� ��, Zip: 91024 , �� ' ownec NEWPORT CHAPTER OF NATIONAL CHARIIY LEAGUE � �� Address 540 W: 19TH STREET � � . . -- - ' / - � � ; � . ,A . �. CA'. � , ` _ Phone: - . " . . _ "-COSTA MESA , Zip: 92627 � , _ � Contracmr INTER-PLAN-WESTCONSTRUCTION � - .�� - � � � � Address:, 100E MONTECITO AVE � . � � � � , ' Phone: (626) 355-8880 . ' ' � , SIERRA"MADRE, CA � ' �� , � � � Zip: 91024"." ' License: � 677814 ' - - � . � Arch : , � " � . _ - _� , Eng: . � ' _ - . . Address: , , � t,, _ •�� ' Address: , - . ' � . Phone: � �r� - �, � Phone: � - . � ,. . �. , , ' . / .. ' - .J" �- . � . . � �`Zip: � `� rLicense: , �License: � . � . > � � SCOPE OF PERMIT �� REPAIR DAMAGED 2' HIGH PLANTER�FOR IINESTERN DENTAL", PER INSPECTORS REQUEST. . FEE SUMMARY Plan Check: $0.00 � � � � � Calc Valuation: $i,zoo.00 Permit: $44.85 � – — � - - - Claim Valuation: 5�,zoo.00 SMIP Res: $0.00 ' �SMIP Com: $0.50 � Other: $0.00 Inspection: $0.00 Sotal: $45.35 SETBACKS. MAIN STRUCTURE Front ,0. 0 ACCESSORY Front � 0-0 PARKING Existinq: o NOTES: Rear � 0. 0 Rear 0- 0 Re uired: 0 PLANNING & ZONING Left 0. 0 Left 0- 0 Proposed: 0 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 permit shall automatically expire and become void if work is not commenced within 180 days, or it 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 Inepeetlona end flnel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 asae �aroo� WORKERS'COMPENSAnONDECLARAnON: ' I hereGy aHirm untler penelry ot perjury one oi ihe following declarations: " � � ❑ I have end will melntain a certificate of consent to setf-Insure for workers' compensetion, as p�ovided for by sedion 3700 of ihe Labor Code, for the pertormence ot ihe work for which Ihis permit Is issuetl. ❑�I ti�ava and will maintain workers' compensatlon insurflnca, es required by section 3700 of Ne Labor Code, for the perfortnance of the work for which this pertnit is iuued. My workers' compensation Insurance cerrier and policy num6er ara: p�/ Carrler.- - f/c.�-_r� �-a'�c� _ f policyNumber. '..�.�C�I ' I�I O bI� �(7'hls secfion need n be complefed il the permit is velued af one hundred dallars ($100) or less.) `�y ❑ I certily ihet in Ihe DeAormence of the work for which ihis pertnit is issuad, I shell not employ any person in eny mannar so as to become subject to the workere' compensatlon laws of Californla, entl eqree thet Ii I should become sublect to the worlcers' compensation provisions of Section 3700 of the Le6or Code, I shell fonhwith comply with ihese pravisions. ,- / !>la-r� f � I Applicant Signeture: —Date:_ + WAflNINO:'FAILURE TO SECURE WORNERS' COMPENSATION COVERAGE IS UNUWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDRED T/qUS4ND OOLL4RE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAM4GES AS PFOVIDED FOR IN SECTION 3%O60F THE LABOR CODE, INTERESi, AND ATTORNEY'S FEES. LICENSED CON7RACTORS DECLAHATION: I here6y aHirtn that Pam li i nse und r rovisi5 force end ettecL Lic..p-- S Contracror's Signamre: 9(commencing wit� Section 7000) of Dlvlslon 3 of the BusinQ nC Professions Code, antl my license is in full �Clas`s B � 1De`te:— � � LYO �I � �� AI CONSTRUCTION LENDING AGENCY: ❑ I hereby etFirtn Ihat Ihere is e cons�ruction lending agency for the pedortnance of the work tor which this pertnit is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lendefs Address: SignaNre: OWNER-BUILDER DECLARATIONS: Dale: I hereby aHirtn that under penelty af perjury thet I em E%EMP7 FROM THE CONTRAC70RS LICENSE LAW for ihe following reeson (Sec. 7031.5, Buslness end Prafessions Code: Any city or county which requires e permit to construct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires the applicant for such permit to tile e signed starement that ha or she is Ilcensed pursuant to the proNsions oi ihe Contractors LJcense Lew (Ghepter 9(commencing with Section 7000) ot Didsian 3 of Ihe Business end Professions Code) or that he or she Is exempt therefrom antl Ihe hesis for ihe ellegetl exemption. Any violetion of Section 7031.5 by any eDP�icant for a perm�' subjects Ihe epplicant to a civil penelty of not more then iive hundred tlollers ($500).): ❑ I, as owner of ihe properry, or my employees with wages es iheir sole compensation, WILL DO THE WORK, end Ihe structure Is nat intendetl or o%ered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apD�Y �a an owner of property who builds or improves ihereon, antl who does such work himsetl or herself or ihrough his or her own employees, provided ihat such improvements are not Intended or ottered for sale. If, howevei, tha building or improvement Is soltl within one year of completion, Ihe owner-builder will have the burden of proving ihat ha or sha did not build or improve tor purpose of sale.). ❑ I, as owner of ihe proDerty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo construct the project (Sec. 7044, Business end Professions Code: The contrectors Licensa Lew does not apply to an owner of property who builds or Improves thereon, and who coniracts for such project with e contractor(s) license pursuant to the Contrectors License Lews.). ❑ I am exempt untler sec. Business end Professions Code for this reason: SignaWre: Date: Owner ID verifietl by driver's license. ❑ Ves ❑ No Drivers License No. Expir85: Verification at Ownership by (type ot document, i.e. � property ten bill or deed): DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more feat in depth into which e person is requlred to tlescenq wlll be mede in wnnection with work euthorizetl by ihis permit, and that no building structure, scaHolding, falsework, or demolition or dismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title B, Calitornle Adminlstretive Code). ❑ As owner-builder, 1 will not employ anyone to do work which woultl require e pertnit irom the Division of Indusinel Sefety, as noted ebove, unleu such person has e pertnit to do. such work from the division. Signatura: Date: Division oi Indusirial Sefety Permit Number: ICERTIFlCATE OF COMPLIANCE AND AUTHOH¢ATION OF ENtAV: I certiry under penalry of perjury that I have reatl this epplication and siate that the intortnation given is I correcl. I agree ro comply with ell stata laws and ciry ordinances relating ro building construction, and authonze representetives of Ihe Ciry oi Costa Mesa to enter upon the above-dascribed property for inspaction purposes. I egree not to occupy or ellow occupancy of any building authorized by this permit until final inspection. COOEI. INSVECTIONTYVE PBIE INTRIRLS 1616 Fixed System Final Fire Prevention 1266 200 201 202 203 20 Poal Spa Finel Final Re-Root Finel BIocWReteining Well Final Fedory Fire Place Final Sign Finel �emolitian CODEY INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Finel Elecincal 212 Final Fire Pravention 220 Final Planning AODroval 222 Final Site 250 Final Building/Occupancy PA7E U�IAL$ 1GECT !ODBESS: S 3 4 W i 9 TH $T oW�ex•sx�Mc: DOROTHY HOYLE RDONE88: 223 VIRGINIA PL •COSTA MESA, CA.92626 714/642-1794 pNCH/ENOINEER: , �DOBESS: ' uxrt: flEG.NO.: uxrt: PEIVAITTEE: LEE AOOFING, INC. ( 714 ) 692-7222 nnoaess: 1653 SUP£RIOR AV COSTA MESA CA 92627 t1LEMSED fANTMCTOB DELlAM710N: I �ereUy atlirm Itwl I am IicenuA unCer provisions al ChaD�er 9(cammencing wit� Section 7000) oi DiHsion 3 of the Businrss ard Professions CoEe, an0 my licensa is in full lorce aM eflect. cinuc.:0287c5,1/' sTereuc.:399686 sa: —/�9 - Ozu: � � � �� / v �Onature� � �-•� ,��-- �IIEXS' LOMPFNS�TION DELUMTIOX: I hlre0 affirm t t I Iwve a ceNfiwte of wnsem ro setl-ursure or a ceNfica[e of Workers' ipenution �suJanca � i r�n�ae �p� me�oi �Section 3e00, �ab.616 / 3 O/ 91 � 5crxo.: USF6G �P o�re: LOMPIINY: ❑ Certlfie0 copy is �erehy tumis�eE. � Cettifie0 co�lile��e crty BuIIAi q Dmsi9 '�on. . p ('��{ � // . '• Uale: i�— J'-! ll MDtiwn : /1' f/`— IXEMPfION FPOM WONNERS' COMPEXSITION DECWWTION: (iNs se�tion nee0 irot Oa com0�� if Itre pemd is lor one AunOreO �f100) or less). I certiry itut in t�e pedarmanw of tAe woM br wAlc� t�is permit is issuetl, I shall not employ any person in any manner so az ta Eecome suhlect to tLa Workers' Compensation Laws ol Cyifamia. ' ' Date: Sip�ature: NOTICE: II, aiter makinq this declaration, ya� shoul0 become sublect to the Warkers' CamDenutlon pmvisians oi iha LaUor Cotle, you must torthwitA comDN �� suc� proNsions or Ilus permit shall he OeemeO revokeE. CONSTBUCTION LFNUINO �OENCY: I �ere0y aMrm Ihat Ihem Is a consimction IenEinA a0ency for t�e De�o�anca ol t�e work tor wAiCh I�iS pefmiti5 issued (Settlan 3097, Civ. C�, . , LENOER: 1DOHES8: OWNEH BUILOEH OELIAMTION: I �ere0y aflirm I�at I am exemD� �rom the fqniractori State License Law tor Itre tollovnnp reason (Saction7031.5 Business antl Professlonal Cotla: My ciry o� counry whicA requires a De�mit to canstmct, alter, improve, demolish, or repair any SlmcNre, prior to its issuince, also requires tAe applicant lor such Dermit to lile a slpneU statement ihat Ae/she Is IirenseU pursuant to t�e pmvisions ai t�e Comroctars' StatO Licensal.aw (C�apter 9(commencinp wit� Section 7000) of �ivisian 3 of the Business an0 Professions Cotle) or that he/s�e is exempt tpereimm and t�a Oasis lor tAe alleOeU eaemptlon. My Nolaiion of Section 7031.5 by any ap0licant tor a Dermit subjects ihe apDllcant �a a civil penalry ol not more ihan /lve hundmd Eollars (5500). 1, as owner ol Ihe Droperry or my ¢mvloyees wit� wa9es as their sale campansatian, will Ua t�a xroAc. anA the SINCWfE 6 OOIIpIEIlO2E OfOflCfBO IOf 5310 (SBCI10f17044, Busineu an� PmtessianalCoOe: T�e Contractors'State License Law - Aoes not apDly to an owner al a DropeM who GUIIAs ar impmvas thereon, antl w�o Ooes such vroM himull/hersetl or thmu0h �is or Aer own emD�oyaes. 0�'itled tAat sucA impmvemants are nat intentled ar ofleretl tar sale. Ii, however [he Guiidinp or �imD�'ement is mltl vntMn one year of �mpletion. I�e awner vrill Aave the OUNen at proNnp �dshe OiE not bui1E ar improve for Ne purpose ol sale�. I, az owner ol Ihe D�operry, am exclusivery �ontracOnp with IicenseE wniractors to consimct the Dmle� (Sectian 7044, Business ❑ and Protessims CaAe: The Convaceors' SUte Liceree Ww tices nat apON �o an m�mr ol properly wlw buJds a imprmes Ihereon anG w1m m�tracts iar suc� D�ojects vnth a cont2ctar(s) license Dursuant to �he Coniractors' 3uta 4censa Law). I am aware ihai praof ol I�air Worker'S Compen5au0n Insuranco 5hou10 Do proviGetl to me. ' � I am exem0� under Section: 8. 8 P. C. ror mis nasan: Oate: Owner. I Oa �ereEy ceNiy tAat I am awam ol an0 unEemyanE the repuirements ol Calilomu Healt� an0 Salery CaOe Sectlore 25505, 25533, anU 25534 an0 that I or any Nture builEinO �cupant wilVwill not (drele one) nre0 ro camDly with ui0 state cades anE the requiremenis tar a permit tor construpbn ar mo0iliwGon irom Na a'��yiry ManaOement �istrict fksidentlal constructian aDD��ions ara eaemD� �mm NeSe provisi0ns. . Oate: MAlicanl: I Aereby ceNry thn I Mve reaG ttns apqiratlon MO state Itut tAe �Uove Nlormafbn is comcL I apree ro compy wilh all city aM caunry ar0inance5 an0 sfate laws relati�p to MriNmq crost��lion arq hereEy aWpr'¢e aprese� ol tlna dry ro enler u{pn tlre ahovo-mentioneC pmDeM �or inspection puryoses. ^�'( � Date: � n' �� C> S9naiutt: �i � � � ' Oriver's �iurise ar Social �Secunry N: 18at�s6 WnitrBuilEi�g: Gree�CpEe Enlor�sment: Cenary—Applicent; Pink—Revenue: Gddenrod—Aaxsaor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 049390 PERMIT NO: B� 049390 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTZON TYPE; PERMIT TYPE: STR �PURPOSE: ALT JOH DESCRIPTION : REROOF/REMOVE & REPLACE COMP. SHINGLES SQ FT: 4,500 CLAIM VALUE: 4,500.00 CALC—VALUE: 4,500.00 GROUP OCC; R-3 / COMMENTS: SMOKE DETECTOR REQUIRED ��r*****x �*�**�+r�r�r*��r**�r��r��r�*x �r**�x �*�� *��*��*��**�r*�r� *****��**�**�***�*�r* Z O N I N G R E Q U T A E M E N T S S E T B A C K S ------------ MAIN BUZLDZNG ---------- --------- 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: 00000000 ZNE: REF NO: PLANNING NOTES> > �1k 1f if 3k 3F it jt ik ik iF it ik k if iE i! i! 3F iF iF iF iF iF it 3k 3k it k k iF i! iE iE it iE iE 3k iF iE 3f iE iF 3f it ik 9k iE iE 3f iE if iF �1F iE iE if M if iF 3F iF �F iE iF 3! 3E if ±F iP if if if 3f IE ik ib if iE iE 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: BUILDING APPROVED HY : DATE: APPLICATION ISSUED BY; DATE: � 6�/� iliFikikik,jkiEikaEiEiFif±kikiEiEiF3FitikikiF if9E*iEiFlklfiF�E1F iF it if ik jE iP if ik iE iE 3F i4 ik it iF iE iE iF iE iE 1FlElElE 1E iF if 1E if i: if it iE �F if iF iE it it * iE iE iF IE fE if iE �F iF if jE iE iF if if �E if iF if iE iF iF iF iF iF iF iF dE 3F iE if 1E it �E iF ik iE iF iF iF LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y BLDG PMT PLUMHING ELECTRIC MECI-IANIC FIRE SMIP/RES GRADING PERMIT ' 72.00 .50 SMIP/NON—RES PLAN ZSSUE FEE � BUILDING—DIV—> PERMIT ISSUE PI,AN—CHECK • TOTAL PAID DUE TOTALS----> 72.50 0.00 ' 0,00 72.50 72.50 .00 REVENUE DIVISION TOTALS--> COLLECTED; 72.50 OVER/SHORT: .00 BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT ,GRADING PLAN—CHECK 72.00 n ,50 1F ik ik 1F ik if!! if ik 1! i! ik it fk 1f it if M if i! 1klf iE 1Flf ik ik i!!f 1k ik k* jklf 1E 1f ff fk k i! ik 1E 1E i! ff iE jflt k jk iF ik iElk it 1k ik 1tlk f! f! iE f! iF iE ik iE fE iE iF it iF iE %M k%fk 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 SFR 4500 REROOF BY VALUE RESIDENIAL NOZONE 1.00 END OF FEES -. TOTAL COST 4,500.00 O1 OQ�71;48-0�071549 Y 4�T 73.50 I DATE: 10;U8/90 TIME� 15:53 ` r ; � � CONSTRUCTION AND PLANN1.Qp� JL & SPA ,- APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector, � • - 1. Temporary Electrical Service or Pole - . � 52. Pool & Equipment Location .2.,�Soil Pipe-Undrgmd: ,, �'Y, 53. Steel Reinforcement 3. Electrical ConHUit�UtilitY-Undrgrnd. - 54. Forms -4'., Electrical Contluit-Gndrgrnd: 55. Electrical Bonding _5.� Steel Reiniorcement . -' 56. Rough Plumbing & Pressure Test �• ':,6:' Electrica� UFER:Grnd. ;' ' 57. APPROVAL TO COVER�GUNITE �". - 7. Footings , 58. Electrical Conduit-Undrgrnd. 8.� Foundation `-- ' - � 59. Gas Pipe, O Undrgmd., Test ' 9. Wa[er Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System : • ' 61. APPROVAL TO DECK 1 t. Property Sewer Line & House Connection 62. Backwash &.Receptor�Final ", 72. Sewer Cap � • "- � 63. Heater & Vent-Final - 73. floof Drains -� �� 64. Plumbing System � Final - 74. Fough Plumb �g � � 65. Electrical-Final � . - 75. Rough Electrical�Conduit 66. Solar System-Final 76. Rough Electri'c�.Wiring . 67. Fencing & Access ApP�oval � 17. Rough Wiring-Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioni�g „ �„w , � ,. FIRE�DEPT„flEQUIREMENT y 20: Rough:Factory Fir'eplace � � �= - ; jAPPROVAL-5��: Permit # � - � -� . � 21' Ducts, in Stiucture ' " " !`� :� ' ;„70. �Underg'round Hydro a' 22. Ducts, Veniilatingr_ � � ,: � ',; - ;:a'. �; 71. ProducnPiping O_Gas OO Oil 23:• Gas�Pipe�Rough &'Test "'� '" r;;'� ', �� 72, Underground Flush�, s, tr• 1 •rt� }.y, �a 1 J rN�]' ` 1 24: Roof Framing �; � . �, v z • 73.: Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof SHeathing� � ^' ' _ � 7q. Overhead Hydro'_., . 26., T-Bar Ceiling (Structural) &-Monocoat , � � �-. � ± � 75 �-Dry Chemical :�� -� 27. Frame and �Flashing _-:n -: r• . " N „x : 76. Dry Standpipe N, �° . � .i _ �• :�. '7 S :.:1 � � -t r 28, Lathing,& Siding . ,�;,, G �" � �: �� 77:y FIXED SYSTEM FINAL � �� 29. Insulation �' r " �`� 7g- FIRE PREV. FINAL '� -" " � - a �: 30. Drywall Nailing -� . � !* ,r �-HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat := � �T'� � i ' �* i �' 79.� FINAL INSPECTION '' � � � 32 Electrical Power�MeieF�Final E; r' . ' � y SO.jF00D CERTIF�I.CATE ISSUED � 33' Final EleGtric . z' r, j x{ Notes: �]_ ��=�� A% -.tt�°� ' 34., Final Heating & Aii Conditioning �' ' �i � . ` - `' � ' `- r,.''.�� r•. e - 35.� Final Gas Pipe�Test ^ ^ .1 � : � v . - .i' . � � 36. Hood or� Canopy �; � �,r � � -' � i � �' � _ ' �t., > � : r :i . : 37.• Final Factory Fireplace: ' x � � � `�' � ': �� y' T :38. Final Plumbing � �, ° � y. # i. . x ° `' t `^ � 39. Water Service-Final ^ � .. , , r � ' + � � - , � 40. Gas Service•Final ^ •" c : , -` "� � ' - � � Y � . ✓ , 41. Solar pomesiicFinal' R- � � - r i:� Jv' .. :� �; . 42. Backflow Preventer r� '= . .i c r� - 1 - �. �- 7 ;-• 43. Backflow Icrigation :, y -. � � - � ' " • � `44. Landscape lirigation System '"` Q ' � � .:;x t �• , >> , � G" -' 45: Sound Attenuation �y� .. � -:� � c-� 7 : � 46:� Handicap Regulations �,- � - - . -47. FINALSTRUCTURE & BUILDING Q.` �OC(i �`l � � 48. FINAL PLANNING ` � . � : 49.� Electric Fielease to�Edison .. = . .,., ', ,. 50. Gas Release m Southern California GasCo -' . ' 51. CERTIFICATE OF OCCUPANCY � ' ` ' � No. Date !� PflOJECT p�OflESS: J.� 4 tiv 19'tH i 1' OWNEN'S NRME: �� yAUC:IAMP WLS 1 E�N Dt.1VT aooness ,�� Pz,A'LA AI�.ICANTA, fiII10 C,G. AflCH/ENGINEEfl: � S O — Z S O O pEG.NO.: � RDOflE55: , UNIT: uxiT: PEflMITTEE: CARF.Y 5TGN5 ('714 ) 630-84? 4 ADOflESS: 1 z S S N BARSTENS � ANAiiETM CA 52806 LICENSED CONTNACTOfl OECNBATION: I here�y allirm Ihal I am licensed untler pmvi5ion5 0l ChaO�er B Icommencing wi�� Sec�iOn 7000) af Uivision 3 0l t�e Business antl Profetsions CAtle. an0 my lit¢nse is in lull brce anA effect. ciTx uc.: 0 2 4/16 0 STATE LIC.: 3'� $ � �� C 4 5 oate: ��/9/ ignaiure: �� WOBNENS'COMPENSRTIONOELLABIITION: IAereUyafiirmt� have cemtkateo�consenitosell-in5ureoramnificateolWaBerS' Compensa�ion Insurance. or a c¢rtilied coOY �her¢o� (Seclion JB Lab. C). � poucrNo.:y1VIA0076C E%P.DFTE: OL�OL�9l coMPaxr: TAANSAMERISA ❑ Cetli�ieU topy i5 Oereby lumis�¢tl. �}a Ce 'IieO topy is �ile0 wil �he city Builtling Oivision. i � Oate: U�/ a�5 / Aoolicant: � � — E%EMPTIONFHOMWOPREflS'COMPENSqT10N0EClAflATION: (iAissec�io e 6ecomplete0iithepermilisimoehmkea�5700)arless� I cenify ihat in Ine oeriormance ol ihe work br whicn inis permil is issue . snall not employ any Oerson in any manner so as to became subjett to iM1e Worker5' fAmOensation LawS of Calilornia. Da�e: Signature: NOTICE: I( after making Ihis Oeclaration. you s�oultl �ecome SuEject to the Worker3' ComDensation provisions of ihe Labor Cotle. y0u mu5i lorthwi�� tomDN �^�h SUCA O�odsions or I�iS permi� Shall 0¢ d¢¢me0 revoketl. CONSTPUCTION 1EN01NG RGENLY: I hereby a��irm I�ai Ihere is a conslmciion lentling agency �or Ihe petlormance a� the work for which ihi5 uermil is i5sued (Seclion 3097. Civ. C�. LENOEfl: AODNE55: OWNEB BII1LUEfl OECLABRTION: I �erebV aflirm I�ail am exemptlmm Ihe Coniraclors' Slate License law for lhe lollovnng reason (Section 7031.5 Business and Pro�essional CoOe: Any ciry ol cauniy whic� r¢quires a permit to conslmct, atler, improve, 4¢molish, o� repair any slmcNre. o�iar to its issuance. also requires ihe aoGlicant for such oermit to tile a signed statement ihal he/she is licensetl pursuam m t�e pwvisions ol Ihe Comracmrs' State License Law �C�apter 9(cammencing wi�� Section 7000� of Oivision 3 af tAe Busineu and PmI¢55ion5 CoOe) or Iha� he/Sh¢ is exempl �hetelmm anE I�e �asis for I�e ail¢A¢d eKemD��on. Any viola�i0n 01 SeCiion 7031.5 by any applicanl lOr a permi� subleCls Ihe appliCan��o a tivil penaliy ol nol mOre I�an �ive huntlfed tl0ilar5 �$500). I, as awner al ihe pmpeny or my emVtoyees wit� wages as t�eir sole com0ensalion, will do Ihe work, antl �he � s�mcwreis nolimeneee orotfereA lorsalelsecuon 7044, Business an0 Pmlessional Coae: T�e Coniraclors' State License Law Ooes not apply to an owner oi a Dmpetly w�o builAs or impwves t�ereon, antl who tloes such work himseltl�erself or thmuAh his or her awn emDloyee5. proviAeO �ha� such impmvemen�s are noi intended or otlered �ar sale. Ii, �owever �he building m imD�ovement is sald wii�in one year oi completion. t�e awner vnll �ave �he hur0en al O�oving M1e/she di0 noi bvila or impmve forlhe purpo5e of Sale�. I, as owner ol Ihe pmper�y, am exclusively conlracling wi�h Iicense0 contrac�ors �o cons�Ncl t�e pmlect (Sec�ion 7044, Business ❑ and Pmfessions Cotle: The Conirac�o5' Slate Licensa I.aw does nol apply to an owner ol pmpetly who EuilCs or impmves ihercon antl who tonlratis br SUCA proletis wi�h a tontraClor�s�license pur5uanilo ��e Coniratlors' S�a�e Lit¢nse Law�. I am aware Ihat pmo� ol Iheir Workefs Compensaiion insurance shoultl be provided to me. � I am exempt uneer Seclion: 8. 8 P. C. lor Ihis reason: . �a�e Owner. I Uo here�y Cenily Ihal l am aware o� and un0er5�antl Ihe r¢quiremenl5 0l Calilomia Healih anA Salery Catle SectiOnS 25505, 25533, antl 25534 ane that I or any fulure Ouiltlmg occupanl will/will nol (circle one) neetl to comply witn saie stale codes and Ihe requirements for a permi� for conslmclion or mo0ilica�ion Iwm �he Pir Ouali�y Management Oistricl. Fesitlential consimction apDlica�ions are exemp� imm Inese piovis�ons. Oate: � NpDlicanl: I here�y cerUty tha� I �ave reatlihis aDO�italion antl 51aie Ihal I�e aUOveinlormationi5 correC�. lagree�a tomply wilh all[iiy antl taunty Or4inance5and5lalelawSrelalinp�obuilOingConS KliOnantl�ere�y uihor¢erepreSenlalive50��iSCityfoenleruponlhea0ov¢�m¢nliOneE pmperry for inspeclio purpases. � / �aie: � 'Signalure: oriver�s License or Social Securiiy a: __. __ t6aL46 WM1ne—Bmlaing: Grean—COCa EntorcemenL Canary—Applicanl: Pink—Revenue: Golaenrotl—Asseswr CITY OF COSTA NESA - SIGN P?RMIT PERM NO: 5'it� 0517'S: PERMIT NO: S3r. O51'13"% PI�AN CHECK NO: 0134FS-91 5 (;UVT: A1 SiJPP: N CONSTRUCTION TYP�: PERMIT TYPE: �i� STR SIG P"uRi'USE: UTH JOB DEs'CRIP3�,ON : 488F LUMINATED WALL STGN SQ FT: Ci�AIM �TALUE; 2,330,00 CALC-VALUE: 1,330.00 GROJP OCC; �-7 / CUMMENT5• X �?F'+F 3'r 3h iF ?: #?E if� rt# ff +c iF x! iF # 3E #F 3f Y if lF IF �4 N� �� 3E ii iF iF af 7i?f 1E if iE-T' if ?i. �1F if i4 3f iz if �4lf� h'- 3f iF ii� i(�+' if #'� iF 1E 3E # iE �1(� d'r?( iF fF dF #. i4 iE ±f 3F iF fi� 3't ic 3E Y S T G N I N F O R M A T I O N DISiRZCT: 1 TYPE: STO�E FRONT ILLUMINATION; INT CAiEGURY: NEW DINENSiONS: �4FT OOIN X 2FT OOIN AREA: 98.00SQFT LETTaR HT: 24I�ICH ST'REET =RONTACE 1: 60.00 STREET 1: i•7, 19TH ST sTR�ET FRONTAGE 2: 0.00 STREET 2; FARCnL; 00000000 7,ONE: C2 LOCATTON > FRONT; X REAR: BUS'INESS NAME: DR,HEACHUNP WEST'N DBN'fAL> LEFT; RIGHT; O T H E R T O T A L S G R O U N D S I G N THIS ACTiVITY . 48,OOS F'P OVERALL HaIGHT; OFT OI\� �HIS SITE ': 60.00S�FT GROUND C?,EARANCE: OFT OZN ZTEf4S O? INFO : 6 P7,ANTER A.12EA; O,UO��rT ITEMS POR ACTIVZTY: 2 $LDG S'ET BACK: 20Fi • COPY VERBTAGE : WnSTERt�I llENTAL WIT9 LOGO PLANNING NOTES: - ?f it 3f # iE 3F iE iE iE iE iP i(- Y.� 3F if 1F iF i'r iE it /f -]E # ie �ti� N� If iF iE iE iE i4 �IE Ic iF ie k 3F i(� �k 3�� 1f� i(� 3F iE iF 3e?4 ih A� �E IP iE?e if� �tc iF iF il� iE �F i6 iE �k iF 3i� 1F iE it Yr iF?%i(� ic 9(� k 3i iF 3f D E L� E L O P M E N T S E.R V I C z S R E Q U I R E M E N T;S 7.ONING APPROVED 8Y �� DAT�; �� BUILDIIvG APPROVED BY : DATt: APPLICATION ISSUED HY: �� S� DATE: ��1'd� � if iE �(- if iE if if iE iE 3c 3i� �k iE <?i if� iF?!��}(� ie if 3Fi6'i'A'�t� � 3ilFi'r'� �. £�'F'7FJtF'lF��1F'r. ir iE 3'r k iE it'iE iE �n� '3F .e'�i � rr '.- .±e �f'r LEGALIZATION:N F E E S U M M A R Y STRUCTJRP.�, Sr.GMENT:Y � BI�I?G FMT pLUMBiNG ELF.CTRTC MECHANIC STGN SMIP/RES GRAUING P'r.'RMIT 54.00 PLAN' 35.'10 1550& Z5SJE FEE 15.U0 AUILDING-UZV-> PERN:IT ISSUE PLAN-CHECK TOTAi�S----> 117.50 15,00 ' 35.70 98.00 SMIP/NON-�ES .50 TOTAL PAID D[7E 167.60 167.E;0 .00 REUENUE DTVISION TOTALS--> COLLECTED: 167,6� OVE.R/SHQRT• 00 HLDG:PMi PLliMBING ELECTRZC MECHANIC SiGN SMIP/TOT GRI�JING PLAN-Cii::CK 54.00 30.00 48.00 ,50 35.10 if 3e iF N� 1t 7F #� 3F 7f i£ iP k ii� ie-)f iF ?% 3F ai iF iF 34 iFif % Ik ie �le if 3G 1E �E iE If )f ic ji� ic ii* # i+ 3ti� 1F �a� ii� i! Ir iS• 3F IFV� �le }: fb ii� �li� ii� � i% # j'r ie iF M� �lE ii iF 3Fi(� ?E ik �# u iF if %� iH iR iE I N D I V.I D U A L F � F 3 R E A K D O W N TYPE QTY D" S C R I P T I O N UNIT CUS'T T03AL CUST ELE ^ J � T� ) '�INE LTGHT SYS Oi�l 1 BR CIRC i5,U0 1�,00 �J END OF FEES � aPR 1 g �s� qTy Of �pSTA MESA CONSTRUCTION AND PLANNING � P� & SPA APPROVALS � Peimit# Date Inspector pppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit Utility�Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical BOnding . 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. ' 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. B. Foundation �, 59. Gas Pipe, � 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 i 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Ptumbing 65. Etectricai-Final 15. Rough Electrical-Conduit 66. Solar System-Final � 16. Rough Electric Wiring � 67. Fencing & Access ApP�oval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Elettrical-T Bar Ceiling 69. POQL/SPA SYSTEMS FINAL 79. Rouc�h Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Oucts, in Structure � 70. Underground Hydro 22. Ducts, Ventilating ' 71. Product Piping O Gas O Oil �? 23. Gas Pipe�Rough & Test 72. Underground Flush .'�("� " � 24. Roof Framing 73. Undergmd. Storage Tank O Gas � Oil `� " .%� r 25. Roof Sheathing 74. Overhead Hydro 1`+'> �j' r" �. 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �i, '^ . j 27. Frame and Flashing 76. Dry Standpipe ''� `� ��. ' i 28. Lathing & Siding 77. FIXED SYSTEM FINAL ''� :v 29. Intulation , 78. FIRE PREV. FINAL --,� 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Platter 8rown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final FOOD CERTIFICATE ISSUED 33. Final Electric � otes: 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 pomestic-Final 42. Backfiow Preventer 43. Backflow Irrigation 44. LandscaPe Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING / .� c 48. FINAL PLANNING �'- - 49. Electric Release to Edison � - 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No Date i � PPOJECTAUOXESS: j3� W 19TH'ST OWNFfl'S NRME: nORUTCIY BAYLISS aooeess: 2�3 VIr�GIN1A PI� COSTA M=SA CA 92627 pflCH1ENGMEEN: �� 1 4� 6�`� — i� 9 4 p00NE$5: AEG.NO.: UNIT: UNIT: PEHMITTEE: NB CON$TRliC'CTON, 7NC. ( 71� ) 465-5181 aoosess: qg63 CHEYENNF WAY. CHINO c� 9��io LICENSE� CONiBAC70fl DECLANA710N: I nereDy a�0im II1a1 I am Iitense0 un0er pmvisioos ol C�a➢�er B Icommencinp wii� Seciion 7000� ol Division 3 of Ihe Business antl p�olessions COEe. anP ,nv license is in lull force antl ellecl. ciTruc_:;�5.27,9R srnTeuc.:49669 cuss�,-i �'%��,,,n D WOBKEBS'COMPENSATIONDELLANRTION: IhereGy�lirmWtltuv etli�iWleoltonSenlio%II-in5ureoraterttliWlealWarker5' Comp¢nsa�ion Insurance. o� a ceriifietl cOpy Ihereol (Seclion 3800. ?. C�. roucrNo.:1079i14-9U E%P.oa : 04/O1/92 comraxr: STA'I'E ❑ Cem�ied capy is nereby Iumis�eA. � Cenilietl co� � is lile �+ii� the city 0�'n Oivi ion. ' Date: ��-/� MWica .: L� . E%EMPTIONiPOMWOXKEflS'fAMPENSNT�ONUECUM N: �ThiSs¢clbn� nO�Eemm01¢(¢Oi�, permliS�Wdlehu�qr¢G�S100�ofless�. I cenily Iha� in Ihe oetlormance af t�e wod lor w�ic� ihis Oe�� s i55u . I 51WII not employ any DersOn in any manner 50 as to become suelea m me Workers' Compensation Laws al Califomia. Oate: Signaiure: NOTICE: ��. al�er maNinB ��s tleGa�aiion, you stwul0 become subject �o t�e Workers' Compensation provivons of ihe Labor Coee. you must �onhvnt� comD�Y �th suc� Ormd5ion5 ar Ms permit Shall be Eeemed revaked. CONSTBUCTION IENDING AGENCY: 1 pertDy aflirm Itwi Iher¢ a a wn5lm[Iion lentlinq apency �Or (�t Oedormance o� IAe wark tOr w�icn I�is permiiis issue0 �Section 30Q7, �iv. C�. LENDEP: FDDHESS: OwNEP BUILOEN oELLABRTION: I �ere0y allirm inal I am exempt Irom ine Coniractors' State License Law for Ihe I011awinA �eason �Seciion 703t.5 Business anC Pmlessional CoGe: Fny city of county w�ich repuires a permit to comtmc6 alter, impmve, Aemolis�, ar re0air any simcture. prior la its i5suanCe. also repuires Ihe apOhW�� ar suc� Dermil to lile a siA�eC statement ihal �e/slle is licensetl pursuam to the O�ovisions ol t�e Conttaqiors' Siaie Lianse Law (Ctupter 9(mmmencinq wit� Section 7000) ol Division 3 0l t�e Business an0 Pmhssions CoOe) ar i�at �e/s�e is exem0� ��Umm anG t�e Easis lor t�e alte0e0 eKemp�ion. My vioWtion ol Smtion 7031.5 Oy any aODlicant lor a permil suCjecls t�e aOPlipnito i tivil 7¢�alry af not mOre tAan live �unGred UOIWrs (5500�. I. as owner ol ine Oroperty or rtry empIOyees with waqes as iheir Sole compen5dlion, wlll tlo ihe wark, anA ine 0 simcmre is not imentlea ar allereC lor sale 15etlion 70aa. Business an0 Pmlessianal CoEe: T�e Contracmrs' Slate License Law Uoes not aoPly lo an owner of a o�openy wno buAtls or imo�oves Inereon, ana who Ooes such woB himselllhersell m Inmuph his or ner own em0loVees. pmvideG 1�ai such im0�ovemenis am not inlenCeO or ailcreC tor sale. II, nowever Ihe �uiltling or imowvement is sold wilhin one year ol com0lelian, Ine owner vnll �ave t0e 6urOen o� D�ovinp �e/she �itl no� Gui10 oi improve lor Ihe our0ose ol salel. 1, as owner ol ine O�ooeny, am eeUusNW wmractinq vnt� ticen5e0 canirac�ors to canstmct t�e prole�� (Section 70aa, Busineu ❑ anG Pmlesswns COEe: Tlre Coqvactors' Swie Licaise Law Oces not aDPN �o an awner ol yopeny w�o �uilEs or imD�a�es inereon ana wh0 COnVaCis �or 5uth prqj¢[IS wii� a ConlraCtor�s�license pur5uani Io ��e CoOiratbr5' Slaie License Law�. I am aware @al pmot ol Ineir Worker's Campensation insurance snoulA Ee pmvidcd lo me. � I am eKemD� uneer Seciion: B. 8 P. G. lor I�is reason: Daie: Owner. I tlo nereoy cenily inat I am awa�e of a� un0erstan0 ine repuiremenu ol Catilomu Health and Safety Code Sections 2550.5. 25533, antl 2553d anE ihal I or any luture Guilding pppupanl wi�IM+�� nol (Grcle one) nee0 to ComD�/ ��h 5ai0 stale coEei anA the repuiremenls for a permii loi con5imtlion ar rtwGdicalion ��om t�e Au ualiry Managem¢nl DiSVitl. flevden�ial consimctian applicaiion5 are exemp� Imm IIIESC p�Ovi5i0115. Oa�e: ADDlicanC — I �¢i¢�y rerlity �M1al I �ave reae ihi5 apAlitabon an0 Siale Ihal adinaxesarM slateldw5reld�u�gloDuiltlxig COnsIrUClpnaME propetly lorir,pe/cu_on Du� oses. –Oaie: /v �!—.� Signalur� i �r �river's License or Sonal Secumy a: is COrrtti. 1 agree to comply with all ciiy an0 wunty ntayes ot Nis �ry to enter upon �he a0ove�mentioneU 164t�a6 WM1��e—BwlEing; Green—CuCe EnbrcemenC Canary—Applicant; Pmk—Rev¢nue: GolOanroJ-0.ssessor CLTY O? CUSTA N;ESA - BUILDING 1'ERMIT I'PERM t�10: 3 O51"1'(, PcRMiT NO: B 051720 PiAh CHcCK NO: 01326-91 S GOVT: N SUPP: iv CONSTRUCTION iYPE: 5 PERMIT 'fYb'E; STR PURPUSc: ALT JOB UESCRIPTION : REPATR 6 ALTERATIONS TO ckISTING FASCIA S� =T; 1,200 CI,AIM VAI,UE: 1,200,00 CALC-VALtJE; 1,200.00 GROUP OCC; 8-2 / CQMMENTS: FAC� LIFT �lE �K dE Y��#..1( .F�.:rf k k�%� 14 k#?f )f �IE # k 7P #if �k-k �IF 9f if if �%�If �f it �k�% )f if dF i( K iE �lf �K �7(� Y k�If� lE �M-1F+F�k lE �F�li� ti�k l: % if 4f iE )f %� IF iE I(� � K# n Yr �' < k i. iF i( 'L O N S N G R E Q U T k E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUZLDING --------- FRNT: FT ZN REAR: FT TN FRNT; rT IN REAR; FT IN LEFT; FT iN RG3T: FT IN iEFT: FT IN RGiiT: ._ TA1 PAAKING REQ : PROV; PARCEL; 42?1Q31R 7..NB: C'l REF NO; PLANNING N(7TES> FACADc IMPROVBMENTS cOR AN EXISTIP3G DEi�TAL OccFCE,Oivi.Y, i ii jP 14 ie R�1f� ie i% 3i� If �X if M� K� ##'� 1: if iE k-!!� N� If i't i:..X� i'r ii� iF IF ie iF If k ii- if if N iE 1F �:� if 3F iP if i'r iF 1k Y.� 1i%�7F Y.� ie 1F ii. } N�.Y. V If #� 3c IF k� K� iE �161Fk z u} 9tx }�.Y {(..y D E V E L O P N c ti 1 S E R V I C E S R E Q U I R E M c N i.S ZONING APPROVED BY . BUTLDING APPROVED BY : APPLICATION ZSSc if� if., if �li it-a:� R?4 ! 1E #� if !F'?�'LC %� if #` ii� # if� � i: 3i� 1(� i(� };. �. �: i:� a(� LEGALIZATTON:N DATc: DATE: DATE • `�¢�� ctc-. r rc �t � �Ii�N�fi�fER�(�!Eli�IFh� IPif �if'If IF'K'i% 1f Y i•iF 1I'il"K"1(' M�k�ih 1% if 3(�iF ib 3't IF 1E�E Y� If'ib�F! 3i' !f K�1(�iF )h ie 1E Y�li'ih # iF �i�# i4�`�Y.� if ih F E E S U M M A R Y STRUCTi1RAL SEGMLNT;Y BLDG PMT PLUM3ING F:,ECTRIC MECiiANIC FIrZc SMIP/Rr.S GRADlNG PcRMIT 29.00 ,50 SM?P /NOtd-RES PLAN ?.8.85 ISSUE FEE HUTLDING-DIV-> PcRMIT ISSUE PLAN-CAECK TOTAL PAID D[7F "I'OTAI�S----> 25.50 0.00 18,85 4fi.35 4t3.35 ,00 REVENUE DIV'iSION TOTALS--> COLLECTED; 48,35 OVER/SHORT: ,00 BLDG PNT PLUMBING ELECTRYC NECHANIC FIRE SMIP/TOT GRADING PLAN-CHECR .'.9.00 .50 18.85 ?(� if Y. iE i(� )f iF lr i� 1c iF iE iE iE ii iE >.1F IF i!� If i(� if �If #'� ii� IE i't ir iF 1E �:-if if if iE IE •Y� #f +F iE?�' ii� %�?(� ii #6 N� 16 �Y i(• 1E R# IF iE if 1f iF �li� ie if ?(� f i^ :K iE iF iF'?f±E if� +: �1: ib i• if iE ie I N D I V I D tl A i F E E H R c A R ll O W N TYPE QTY D r S C R I P T I O N UNIT CQST TOTAi, COST SfiR 7.200 STRUCTt7RAL bY VALi7� F�ER 5�1 , QO END OF rEES S.UO 1„'.00,00 UI ^CL'S`023-L".:�1;;�t;, Te v'- ' - D6;TE: Otllo;5: (i.^..: <:_';. J CONSTRUCTION ANDPLANNING� APPROVALS Permit # Date r 1. TemporafY Electrical Service or Pole 2. Soil Pipe-Undrgrnd. " 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings ' � 8. Foundati0n ' . � i 9. Water Pipe-Undrgrnd. % ' 70. Structural Floor Svstem _ � 11 . Property Sewer Line & House Connection 12. Sewer CaP 13. Roof Drains . ' . 14. Rough Plumbing �_ . 15. Rough Electrical-Conduit 16. Rough Electrit Wiring . 17. Rough Wiring Sign 18. Rough Electrical�T Bar Ceiling 19. Rough Hsating & Air Cqnditioning 20. Rough Factory Fireplace 21. Ducts, in Struct�re 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-8ar Ceiling (Structurall & Monocoat 27. Freme and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat 32. Electrical Power Meter�Final 33. Final Electric 34. �rinaV Heating & Air Conditioning 35. Final Gas P�Pe-Test - 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas ServiGe-Final _ 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriga[ion SVstem 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING � 48. FINALPLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Date ,j Pt,,,c & SPA Inspector qppROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER•GUNITE 58. Electrical Condui[�Undrgrnd. 59. Gas Pipe, O Undrgrnd., 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. Etectrical�Final 66. Solar SYstem-Final 67. Fencing & Access ApProval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro . 7�5. Dry Chemical 76. Dry Standpipe � 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Date �Inspector PflOJECT ADDNE55: S 3 4 W�1 9 TH ST OWNEfl'S NRME: WESTERN DENTAL 400eess: 534 WEST 19TH STREET COSTA MESA AflLHIENGINEER: �UOflE55: NEG.NO.: uxir: UNIT: resmincc: MONARCH MECHANICAL ( 213 ) 255-0111 nooeess: 2z50 FAIR PARR AVENUE LOS ANGELES CA 90041 UCENSEO CONTBRCTOB OECIqppT10N: I �ere0y aHirm ��a� I am Iicense0 untler pmvisions al C�aple� 9lcommencing witA Section 7000� o� Oivision 3 0l i�e BuLness antl 7mfessions CoOe, ana my ticense is in lull larce anE efiect. cirruc.:s53g,17rysTnJTeuc.:41765� '�"" ,.,c 'l�{' !—{—��—_ SiAnafm� WONNEflS' COMPENSpTION OECIAMTION: I h¢rt�y allirm I�a� I �ave a cerlilicaie ol cOhun� Io 5ell-in ure or a ttrtiliCale ot Workers' Compensalion Insurance, ai a ceniliea woY �he2oi (�ction 3800. Lah. Cl. voucveo.: PWC307791267 E%P.ORiE: OJ�OL�9Z COMVANY: CNA ' � Cerii�i¢d copy is OereOy �umishe0. ❑ Ce�ilie0 copy is IileO w�A 1he city Building D'nisian. e: AVDIi � � EXEMPTION FNOM WOPNEBS' fAMPENSl�TION OFCUN�TION: Q�iS section necd not �e completeG il Ne permil' or one nUreC �E700� or less�, 1 cerlity Ihal in t�e Dedo�mancP a� ihe work lor whicA this permii is issued, I 5hall no� employ any p¢rson in any manner w as Io became Su�jeCl lo I�e VJorkers' ComOensalion Laws ol Caliiomia. Da�e: Slgnaiure: NOTICE: II. atter making �pj� Q¢�yration, you shoulE become subject to ihe Workers' CamDensation pmvisions ol ihe La�or CoUe. y0u mu5t latlhvn�� ppmply wit� Sut� D�avisions or Ihis p¢rmit 5hall Ue tl¢¢meU revOketl. CONSTBOCTION LENOMG RGENCY: I �ereEy allirm ��a� there is a consiructian IenOing aqency lor lhe ceMormance at t�e work for w�ic� I�is Dermn i5 issue0 (S¢pii0n 3097, Civ. C�. lfNOEfl: RDONESS: OWNEN BOILOEB OECIAMTION: I her¢Oy altirm Nal I am evemp� �rom I�e CAnirapors' State License Law lar tno lotlowinp reason (Sec6on 7031.5 Business aM Profesvonal CoOe: My cily ol counly whic� r¢puirw a permit to fAn5iNc1, alter, improvF tlemolisR or reWir any siNCWre, ptio� to its i55uanCe. alia rtpuires IM1e applicant lor such Oermit to ide a 9gneG statemenl ihdt �e/she is licenutl pursuam io I�e provisons ol Ihe Camractors' State License Law (ChaO�e� 9(commentinp wi�� Section 7000) ol Divlslon 3 al the Business ana Pmlessions Coael or tlWt pe/she i5 eKempt Inerelrom antl ine Easis lor Ine alleged eeemD�� A�Y'/�oWtion ol Sectian 7031.5 by any ap0licam lor a permit su0lecis ihe aDPlicanito a civil penaVy ol not more Run five hunOreO Eollars (5500). I, as owner ot IAe pmDeny or my emytoyees wilh wapes as ineir sole comoen5dtlon. win tlo ine work. antl Ine ❑ slmcwre a not inteneeA or ofieree lor sale (Secuon 70a4, Business an0 Professionai CoUe: Tne Coniracrors' State License Law Ooes not aODly la an pymer ol a pmpeny w�o builGs or im0�ov¢s Ihereon, anG who Uoes suc� wod �imsetf/hersell or ihmup� nis or ner own employees.�pmvieetl inat such impmvemenis are not intentlea or oneretl for sale. II, however ine Euilding or imD�a�emenl is 5010 wi1Nn one year of completion. Ihe owner will have t�e OurEen ol proving 11PJs�e Oi0 not builE or impmve Io1 ina purpose ol salet. . I. az Ownet ol tne D�op¢ny, am eKcluvvely conitacting with litensea coniractors to Consvuct tne prolect (5lttian 704E, Business ❑ an0 Pmlessions Cade: �IDe Coniraclors' State �icense Law Oces not apply io an awner of D�operty wM OWGs ar imD�oves t�ereon aM wtq ContracLt lor suCn proiects vrith a fAnlractor�s) license pursWnt to ine fAnUactor5' Sid@ LicenS¢ Law�. I am aware t�at D�� ol t�eir WOrke(s fAmpen5a0on insurance staula Oe pmhGeE to me. � I am exemD� mMer 5¢pion: 0. d P. C. lor th¢ �eawn: Oale: Owner. i Ao �ereoy cenily i�ai I am avrere ot anG un0erstanC i�e ieQuirements ol Catilomia Healt� anU Safety Coda Sec�ians 25505, 25533, anA 2553a and I�at I oranytuture EuilOing occupanlwilllwillnot (circle one) neealo comply with saiE slale cotles anU Ihe repuiremenis bra permil lor con5lmclion o� modilication Irom I�e Air Oualily ManaBemen� Dislric�. ResiEenlial constNtlion aDPlica�ions are eKempl imm Inese provisions �ale: Applicanl: I �e�eGy cenily t�at I Aave rea0 t�is aDDlica�ion ane staie t�at ��e a0ove intorma�im ¢ arrect. I aqr¢e to compy vniA all city an0 counry orGinances anG slate IawS reWting lo OWtling ronsimclion anC hereGy authOnze reO�esEntative5 of Ihis Gry Io en@r uppllhE above�menlione0 pmoenv ior naoecfon o�moses. i �: ��- S IOriv¢fs Licens¢ or Sotul $e�un�y •: i6at�a6 WM1ne—BwlUing; Green—Code EniorcemanL Canary—Applrtam: Pink—Revenue: Goldenroa—Assessor CITY OF COSTA M£SA — HUILDING PERMZT PERM NO: P 05392 PERMIT NO: P 053923 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION : REPLACE HACKFLOW DEVICE S(J FT: CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 / COMMENTS: * **��r�r+�****��r***�********x****�***********��r�r**�*�e*+rx��rx�**�r**�r��r**��**+�x�r�+�*�r Z 0 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 TN FRNT: FT IN REAR: FT IN LEFT; FT IN RGNT: FT IN LEFT; FT IN AGHT: FT IN PARKING REQ • PROV: PARCEL: 00000000 2NE: REF NO; PLANNTNG NOTES> i SI k 1! i! if if iF M k iE if k if 1E if iF iE iE iE *�t if iF if iF iE k af 1E 1E iF ik iF iE iE iF 3f 1E k af if iF kif iF k iE �f.ik iE 1E # iE iE iE iE if if if if iF 1E if k iF if iF 1E iEjF if if iF iE ik k IF k iF af 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 20NING APPROVED HY ' DATE: BUILDING APPROVED BY ; DATE; APPLICATION ISSUED BY: � �'� DATE; '— iFaf�EiEkiEifiFiElElfiEiEiffflfifiFlFiFIF�f 1FiFifiE�Eif�1(�afiEiF ifiE akiElE�FiE1F1E1EilIEiEitkiEiE�fiEiEifiEkkiFiFiFk�fifkkiliFlfifiElF3kif iFikikMif ifkiFiFiFiEifikiFlfikkkkiEkiEitifiEkiEk1ElF3t�kkkif�EfEkit LEGALIZATION:N F E E S P. R Y STRUCTi7RAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2 00 '15t SMIP/NON—RES PLAN ISSUE FEE 3.00 HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PATD DUE TOTALS----> 2.00 3,00 0.00 5,00 5,00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 5,00 OVER/SHORT• 00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 5_00 k kiF iE 1E k k if 1f iF if iE k 1FiE if it iE iF iF ik iE 1F if iF ik±E k jE if 1E k�E 1F ik iE 1k iE if �f iE if iE k k iE iE ik !f k if if it k!f �k if IE aE if kif M if if iF �f iE IE iE �E at ih it iE IF iE 1E 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 Z O N UNIT COST TOTAL COST PLU 1 HACKFLOW PREVENTER 2,00 2,00 END OF FEES G: �CD973a� CGG5736d 'll'e�: �" s.; DATE� 4S/17>aI *PiE: 13:`3 CONSTRUCTION AND PLANNING POO SPA ' � APPROVALS Permit � Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electriwl $ervice or Pole 52. Pool & Equipment Location • 2; Soil Pipe-Undrgrnd. ��, .• ^' S3. Steel Reinforcement , 3.�Electrical Cond�ii l{tility-Undrgrnd�� 54. Forms , �,4:^.�fectrical ConduihUndrqmd. '„ 55. Electrical Bonding �� 5:'$teel Reinforcem �nt- 56. Rough Plumbing & Pressure Test ��6,�Ejs�trical UFEB G�ni1. , '" 57. APPROVAL TO COVER�GUNITE 7��7.:Footings . �+. 58. ElectricalConduit�Undrgrnd. . ��8: Foundation '� 59. Gas Pipe, O Undrqrnd., Test 9..UJater Pipe�Undtgmd. 60. Backwash Lines, P�Trap, O Undrgrnd. ui 10.•�Structural Floor Srystem .�; ' � 61. APPROVAL TO DECK � 11. Property Sewer Linc& HouSe�Connection � 62. Backwash & fieceptor•Final � 12. Sewer Cap �' 63. Heater & Ve�t-Final 73. Roof Drai�s - �� 64. Plumbing SYstem � Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical�Conduit , 66. Solar System�Final 16. Rough Electric Wiring 67. Fencing & Access ApProval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electripl-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL 19. Rou9h Heating & Air Conditioning � FIRE DEPT. REQUIREMENT 20,rRough Factor.y Fireplace , it r 4� _ .r � , +. APPROVAIS. ; :Permit # + y r i 21 �Ducts, in.Stryctu�e' ; `„ ;, �.� � � - - ' � '70. UndefcyrounclHydro �r � � 22. Ducts, �entileting � • -' ' ,> S = • 77. ProducnP.tping OGas ❑Oil 23:-Gas Pipe`Rough &'Test ' - � r� .r � i �z• Undergroun�l FIusF� .. . 24.-Roo'f Framing . '� f ., . = �' Y, . �73;iUndergrnd. Stora9e Tank O Gas ❑ Oil 25. Roof Sheathing ` =� � � ; � �� 7q„Overhead Hydro� ' 26.;7�Bar Ceiling (Structuraq & IYlonocoat � � ��- � � i 75, Dry Chemical � ' � 27. Frameand Flashing- ':M � " p 76`Dry Standpjpe - r. '� `' _ '�28: "Lathing&Siding � _ �,;�'_ ,, - >' • • ' ' 77:-FIXEDSYSTEM.F�INAL ' '29. Insulati� �� • '- " �' ` '� � ' �` ' 78y�PIRE PREV. FINqL � .- � '� "30.DrywallNailing a'' ' �� ?y.- ��.�• ��HEALTH,DEPT.REQUIREMENT � 31. Plaster Biowo Coat' \ �� r ' '" 79: =FFNAL�1'NSPECTIQN - ' '� �'32. Electriujf Power Mater�Final� � ' � . : .SO:,FOOD CERTIFICATE ISSUED� _- 33.'Final Electri� ' ' �r � ' ' ' 'Nofes: �S ' r� . .: r . � • . ' r . . . - , ,�34.� Fin�l Heating�& O.ir�CAonditioni�g�� ,-, „ � . ;1 ; .- � � �35.�Final Gas Pipe-Test ' � ,, r * - • ' � . r:. ..36.�Hoo� or,CanoPY . - � .� < • � -. o > " � . , •. � S. ** _ � 37.'`Final Factory Fireplace� ' ��'' �' �'� `v.%� x � � �- � � .. -38. Final Plumbing ' '�'�,� . .• .. . �� .� '' � - � t�• � .�39. Water Service�Finab � _ � � �� " i� � ' � • ;40. GasService•Final � �. ��. � - �- � !' ' ' , �::� � � 41. Solar pomestirFinal . •� ' �. + tr � " � � 42 `Backflow Preventer' � ' ' ro ' �' r ` y` -t • - 43. Backflow Irr.igation� � � .� �: � ' • � ` � � i ;�44. Landscape Iriigatiqn Sysremr � _ �. � ,r� - C • z� � �' � -; . • • ,.,,'_ . .,, - . , � _ . ;'45..Sound Attepuation ��• = � _ '+ ' . J':.' i � • � � , r. - ;,46.'Handiwp Regulations - � `'` ' ' : ' ' _ ' _ , t �� 47. FINAL STRUCTURE & BU(;LDING � ' � � � y ' � • ' �N . 4 � 48.'�FINAL PLANNING i ( „` -, , :: , • .� �A9.`Electric Release to Edison � . , >: � . . - , 60. Gas-.Release to Southern Catiforr�ia Gas Cn �' �� ;� ' - • � = ' " : 51. CERTIFICATE OF.00CUPANCY � ; , , � . '" - No. Date � lJ �v CP AVV��ant to fill In al1 sDacas excepl inose wilhin neavy eoraer Ilnes ana sign all aoProDriata tleclarations. CI7Y OF COsrA nnEs�pJ� CONSTRUCT�IjO..N PERMIT Projert Address d�3'1' /�i y5' S(. � Applicant's Mailing Address Owner's Name ��A ��T'9'�- Phone Address �%h� Arch/Eng. License No. Address ` Contractor'sNam �S7"C �/ y��__C��__%%e��'S�� o�� Rbne��_,�7,,�'/"�� AddresslmailinglJ 7 /"OI�C ,� �^��'�'t'�^ Ciry License No. �� T v LICENSED CONTRACTOR OECLAqATION I nereby alfirm that I am�li<ensetl under provisions of Chartar 9(commentlng witn zoction ]000) oi Dlvislon 3 of thn Business antl Professions Cotle, antl my Iicense is in fuli force anCettect. C � LJcense Class � cens N� Date' � Si9nature � WORKERS'COMPENSATION D LARATI � hereby atiirm thal I have a certif cate of consent [o s� 1-insure or a cerU/lwte ' WOrkers' Compensa[lon Iniuranca, Or a Certlfi<tl COpy th<r¢of ($ection J00, Lnb. C.)�c,Q �j � - �/]o�,u �ICY No. W U v� �"��'ComPdnY �Y u"/�G7'�� Certifietl Copy is here0y futnisheU. Certifietl is tiletl with the city Builtling iv on. Date - AOP��an[ � d EXEMPTION FqOM WORKERS' CO ENSATI DECL ATION (This settion nC¢tl not be campleletl i he permit IS fOr On¢ untlretl (§300) or less). I cerUfy that in tne perfo�mance of th¢ work 10r whlch this perm�t is issuetl 1 Shall no[ employ any p¢r5on in any manne� so as to become subjecl to [�e Woikets' CompenSatlon Laws o7 Calitomia. �Date 519nature 'NOTICE: I/, atter making tnls tleclaration, you shoultl become subjoct to,tho Workers' Compensatlon provision5 Of the Labor Code, you must lorlhwitn comply with such proWsions or tnis permlt snall be tleemetl ravoketl. CONSTRUCTION LENDING AGENCV I haraby alflrm that ehere Is a consVucdon lentling agency tor the performanco of Ihe work lor wnich tnis permit is ISSuOtl (SectiOn 3097 Clv. CJ Lentl¢r's Name �ontlar's Atltlross OWNER BUILDEN DECLARATION � � I hereby afllrm lhat I am ¢xempl from th< ConVactor'S LICenSe I..aw for th0 followin9 reason (Seclion-7031.5 Businozs antl Professional Cotle: Any city or Coun�y whiGh rOqWms a Oermit �o conSVUGt, al[�r, Improve, tlemOlish ot �epair any'slruclure, pNor to Rs issuance, atso roqWres th¢ applicant /or such parmlt .lo liie a siqnetl statement [nat ho/she Is Iicensotl pursuant to the provl5lons of the Contractor's Licensa Law (CnaD�er 9(commencin9 with $action 7000) of � plvlsion 3 DI Ihe Buslne55�anU Plol¢SSIOnS Cotle) o! �hal h¢/Sho Is exemp[ �qi�retrom antl tne basis 1m tha allegetl exemption. Any violaHon of 5ectlon �}��.31.5 by any applicanl for a Permlt subjec(s the. applicant to a clvil , � r�ndlty of not more lhan �iva huntlretl tlolldrz (E500). I, as owno/ ol lM10 Oroporty or my omployoos with wa9as as [belr solo , Compen5alion, will tlo th0 work, antl lho ilrutlure IS not intentlatl Or olleretl lor'salo ($ocllon 7044, Businais antl Profesilonal Cotle: The Contractor's' License l.. w tlocs nol apply to an Owner ol a Oropurty wn0 bulltls or ImprOves lpCroon, an0 who tlOes sucn work nlmselt/har5011 0� lnwugn h15 or h0r Own ¢mployea5, prOvitletl lnat Such improv¢menls are not intentlotl o� otforotl for sale. II, hOwaver, th0 bulltling or imp�ovemant I5 soltl wllhin ona year ot com- plotian, t�a ownor wlll navo tho burtlOn ol proving ha/She tlid not builtl or Im- oYr�ove lor lha pur0osa ol salo�. LJ I� di OWO¢I Of tM1C pfOpClty, dT O%CIUSIVCIy COOtfdCtlflg wlih IICOnSEtl COl1- lra<tors to cons[ruct the project (Sec[ion 7044, Bu5in055 antl PrOtoSslons Cotlo: The Contractor's License Law doos not appty to an owner o1 property who bulltls or improves thereon, antl who contracls ior su<h projects with a con- IrattOr(5I Ilcense pursuanl�lo�[he Cont�aclor'S Liconse Law). I dm awaro that proof o1 lhelr Worker's COmpensa[Ion insuranca shoultl be p�ovitl¢tl to me. ❑ 1 am exempt untler Sectlon B. & P. C. for this reason Oate Owner I her¢by ce�tlfy thdl 1 bave rea IMormation is torrec[. I'agree to antl state laws relaling to builtlir SenWtives O/ Ihis tlry o anter inspectlon P es. Si9nature Drivers' LI se or 55 _� ❑on antl st aIl city antl i. antl herel _f _� �a Z� � _ � � --��_ TVPE OFCONSTRUCTION NEW ADO ALTERATION REPAIR ❑ CONVERSION �O DEMOLISH ❑ OTHER � �ESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING LJ FOVNDATION LJ STRVCTURAL ❑ TENANT ❑ ELECTRICAL�I PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5a. FT. OCCUaANCv CONSTRUCTION TVPE VALUATION S 20NE� GRADINGCU.YDS. ACRES Remarks: Sink Preventer Irrigation rinking Fountains ' loor Drains loor Sinks - 85 ServiCe .Outlets Kitchen Sink Lavarories P—Trap Roof Drains /JZd�� Reinspection Fae � $15 Duct�- Untler Ground , Duct - Structural Duct - Ventilating Exhaust System � Multiple ❑ Firepl/Fact. Blt. IC80 �I`- Heating System & Ducting ❑ a-i oo,000 sru 0 i oo,000 ar� Reinspection Fee � $15 b IF 0865-46, rev. 30/84 Whlte - Bulltling; Canary - Appliwnt; Pink - Accounting; Goltlenrotl�- Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Wacer Heater Water Service Auco�Wash laue Fee Hood or Type I, � Canopy Typell ❑ Refrigeration System ❑o-i oo,000 sTu -0 i oo,000 System Repair/Alteration F ife De mpers Registers � IAUB FEES $ 3 $ 3 A.P. qW S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planninp Notes: Aummatic Washer Consttuction Pole S� Cooking Unit Dishwasher ' Dryers ❑Gas ❑EI Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0�5 KW 2541 6/Q7/85 c�,pp Zona Accessory Building: ELECTRICAL . ' Transformer ❑'15-50'KW ❑ 50+KW Meter ❑up ro 100amps � Meter ❑over100amps Sub Panel Motors O61 HP O1 X- 8 Inc.Solar �9-15 HP �16�1 S Microwave - - Pole Light Range ' Sign .J 75 KW � Reinspaction Fee '. �$15 � _� iuue Fee DEVELOPMENTSERVICESREUUIREMENTS: , Zoning Approvad By Building Approvad By Appliwtion Issued By— FEES $ 3 � S SUMMARV OF FEES � BUILDINU''PERMIT $ � SMIP $ p PLAN CHECK $ - PERMIT ,� ;CtI0t1�LUMeING $ S� �� ISSUA'NCE $ PLAN CHECK 25%� $ ENERG�' P.C. $ ELECTRICAL $ GRADING $ "—�—PL'AN'CHECK 50% $ ' MICROFI,LM $ � MECHANICAL $ TOTAL FEE . $ S �C9C� � PLANCHE�K 'ZS% $ � N I N G R E O M T S I. - r = CONSTRUCTION AND PLANNING POC SPA - l�PPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' .3. Electrical Conduit Utility-Undrgrnd. 54. Forms � ' 4.. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test : 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE � 7. Footings 58. Electrical Conduit-Undrgrnd. ; 8. Foundation 59. Gas Pipe, O Undrqrnd., Test � 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 70. Structural Floor System ' 61. APPROVAL TO DECK 17. Property Sewer Line & House Connection 62. Backwash & Receptor�Final � 12. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains . 64. Plumbing SYstem - Final 74. Rough Plumbing 65. Electrical-Final � � 15. Rough Electrical-Conduit � 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. �APPROVED FOR PLASTERING 18., Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19., Ftough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test ' 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL �. 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION " � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED •, 33. Final Electric Notes: �� . 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 pomestic-Final ;' � 42. Backflow Preventer . � p I R E D � 43. Backflow Irrigation Incomplete Inspec io 44. Landscape Irrigation System �� S- 45. Sound Attenuation � � � 46. Handicap Regulations ' + 47. FINALSTRUCTURE&BUILDING 1 48. Special Requirements Completed . 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co � . 51. CERTIFICATE OF OCCUPANCY � � No. ' Date ' ' AOPlicant to /ill in all spacei exceD� tnofe wlthin �eavy bortler Iines anE slgn all aDP�oVrlate tleelarations. — CITv.oF COSrA M�SA CONSTRUCTION PERMIT . Project Address 534 W. 19th STREET Applicant'sMailingAdtlress �a41 �S. ANAHEIM BLVD. • Ow�c�'s Name MRS. DOR07HY HOYLE Pno�e Address 1943 MAPLE STREET, COSTA+ MESA Arch/Eng. � RFi'Fi'�� '�{�eps�,No1 Address ' � - - = ' co��ractor's rvam K�NNEY AIR CONDITIQ�(�JG nddresslma�r�yl 1a41 S. ANAHEIM BLVD., ANH. �Cit�yLicenseNo. -�06118 • ' LICENSED CONTRAC70R DECIARATION I'hereDy altirm lhat I dm Itcensetl untler provisions o1 Charter 9(commencing with seClion 7000) Of Dlvision 3 of lhe BuSiness antl PrOtesslons Cotle, antl my Ilcense is in full forCe antl efiect. Llcen CI} Li No._�f�� Date �'`�- Signa �is�- � Q �� /�h WORKERS' COMPENgATION D ARATION ATIE CLELLA W I hereby atiirm that I have a cereificate of consent to self-insure or a certificate t Workers' Compens;tion Insurance, Or a certlfietl <Opy thereof (Section � B00, Lab. C. ' � �\ Porcy rao. (�24700?S? Company INA �Certifietl mpy is her¢by fumishetl. � Ce�tifietl copy Is fil(tl with the city Builtlin DiviSio�. Date—F+-7S-RS Applicant KINI�EY A C, EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �(Thissec[ion neetl not h¢ com0letetl if t�e permit IS fOr On¢ nuntlretl (5100) or � less). I CerlHy that In tne peAormanca Of [he work fo� whic� Ihis perm�t is ISzueU, I Shall not employ any pe�son in any manner so as [o become Subject to the Workers'.Compensation �yws of Calitornia. . Date Si9na[ure 'NOTICEi If, after mak�ng this tleclaratlon, you shoultl becomo sublect to the ' Workers' COmpensation provisfon5 Of the Labor Cotle, YOu,muSt fOrthwith comply with such pYOvislon5 Or this Oermit shall be tleemotl revok¢tl. 'CONSTRUCTION LEryDING AGENCV - 1 nereby aillrm that ths�e is a construction lentlin9 agency (or the performance � of tho work ror' which this Oermit is issuetl (Section 309� Civ. C.), �entler's Name Lontler's Aatlrezs OWNER BUILDER p�CLARATION 1 hereby aftirm thal I am axampt irom the Contrac[or's Licensa I..aw tor the 1o11owing reason (Secqon 7031.5 Business antl Professional Cotlo: Any tl[Y or COunty whlch r¢quireS a p¢rmit t0 <Onit�utt, alle�, improvo, tlemOlisn or repai� ' dny Structure, p/Io� tq its I55uanCO3 alsD requi�es lhe aDO��ant b� suth pe�mil to file a si9netl slatement thal na/she is Iicensetl pursuant to Ine provislons O/ the Contractor's License L. w(Chapter 9(commencin9 wi[h Sottion 7000) of DiviSion 3 of lhe Bu6Ine55 antl PrOte551on5 Cotle) Or tllat Ile/She Is�exempt '�erofrom antl the basis for the allogetl exemption. Any vlolatlon o1 Sactlon � 131.5 by any aOPlitant for a' permit subjects lh0 applicanl to a. <ivil enally ot not mor¢ [qan five buntlrotl Collars (E500). �� I, as owner of the proporty or my amO�oYees wltn wa9os as lhelr sole compensatlon, will Go the work, antl Ihe structure is not Intontletl or otteretl lor salc (Sectlon 70qq, Business antl�Protessional Cotlo: The Contra<[or'z Litense l2w tloes not app�Y to an owner of a property who bulltls or improves thereon, antl who tloes such work himselt/herzeH or throu9h his or her own employees, provitletl that sucn improvements are not intentlatl or offeretl tor Shce. II, hOweveq [he builtling Or ImprOvemen[ i5 zoltl wlthin one year of com- pletlon, the Owner will hav¢ tbe burtlen ol prOving h¢/S�e tlltl nOt builtl or im- p�ov! tor the purpose of Salej. - ❑ I, as owner ot the property, am excluslvely tontracting with Iicensetl con- � trdCtoR [O conStruct Lhe proj¢<t ($ectlOn 7044, BuslneSs an0 Profe55ion5 Cotle: Tna ConVactor•s Lic@nse Law does not apply to an owner of Oroperty who builtls or improves theteon, antl who contracts for such OrojaGts wlth-a <on- tractav(sl license pu�suant�t0 lha Contractor's License Law). I om awa�e tba[ ' proof o( lh¢Ir Wo�ker'S Compon5atlon insurance ihoultl be ProvitlCtl [o me. ❑ I am ¢xempt untle� $eclion 8. & P. C. fOr IhIS red5on Date Owner have rea , to l Drivers' Lic754igpr�55 � � CMF 0865-46, rev. 30/84 White - Bul TYPE OF CONSTRUCTION LJ NEW�ryLJ .nDD u��RPz��MEN�EaAiR ❑ CONVERS�ON ❑ DEMOLISH CJ OTHER A�- DESCRIPTION OF WORK/USE OF BLDG. �OM.IVI.ER.C�r�— TYPEOFPERMIT GRAOING FOUNDATIO�N7 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING yl� MECHANICAL ❑ OTHER PRQIECT DESCRIPTION 5t�. F7. OCCUaAr�Gv C O N 5T RUCTION TV PE V ALUATION S 20NE GRADINGCU.VDS. ACRES Remarks: Preventer Irrigation Drinking Fountains Floor Drains ' FloorSinks �� Gas Service Outlets IncerceUtors Kitchen Sink Lavatories P-Trap Roof Drains ' . Reinspection Fee Under Ground Strucwral $15 Duct � Ventilating Exhnust $ystem ❑ Multiple ❑ Firepl/Fact. BIt IC80 # Healing System & Ducting ❑ 0.100,000 BTU � 100,000 BT' Reinspection Fee � $15 APplicanh Pink - ACcountin9: Gol�enrotl - Assessor Service Sink Sewer Cap Sewer Connection $olar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays laue Fee Hood or Type I ❑ Canopy Typell ❑ Re(rigeration System C�atoo.000eru ❑ioo,000 System Repair/Alterati0n FireDampers � Registers Issue Fee FEES $ 3 FEES $ 3 � A.P.�51� . . S Main Building: E 7 Front A Rear C Right K g Lett Ping. Ref. # Planning Notes: Auromatic Washer Cons[ruc[ion Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Elettric Fan F.A.U. Fixture5 Device Boxes 6750 7/16/85 - Zone' Accessoiy Building: - ' Parking Req./Provided ELECTRICAI � �Transformer ❑�15�SOKW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100amps Sub Panel Motors �0.1 HP �tY, � 8 Inc. Solar �9�15 HP �76-75+ Microwave Switchei Garbage Disposal Generetor �0-5 KW 05�15 KW Pole Light Range Sign ! Standing Sections Trash Compactor ' Fee �$15 � � Issue Fee �300� T� FEES S 3 Z O N I N G R. E Q M T $ DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Oate Buildin8 APP�a�ed By � Date Applintion Issued By Data % � � � SUMMARV OF FEES BUI�DING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING § ISSUANCE $ � PLAN CHECK 25% $ ENERG�' P.C. $ ELECTRICAL $ GRADING 5 PLAN CHECK 50% $ ,_�._ MICROFILM $ ____ MECHANICAL I� + �-� TOTAL FEE $ _ � � PLAN CHECK 25% $ _ 7 � � � ' CONSTRUCTION ANOPLANNING. - - P��` '°A ' '. APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 7. Temporary Electrical Service or Pole � 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. � 53. Steel �Reinforcement 3. Elect�ical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � 5. Steel Reinf'orcement � 56. Rough Piumbing & Pressure Test � � 6. Elect�ical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE ' 7. Footings � 58. Electrical Conduit-Undrgrnd. 6. Foundation• 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: � � 63. Heater & Vent-Final 13. Roof Drains .64. Plumbing System - Final 14. Rough Flumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar SYstem•Final i6. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rou9h Wiring Sign- 68. APPROVED FOR PLASTERING 18. RougN Electriral-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 OGas ❑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 (Structurall & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insula[ion 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED . 33. Final Electric Notr.s: �i 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ' 36. Hood Or Canopy � 37. Final Faciory Fireplace - 38. Final Plumbing 39. Water 5ervice-Final 40. Gas Service-Final " � 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation ' � 44. ,Landstape 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 Southem Califomia Gas Co 7f 51. CERTIFICATE OF OCCUPANCY � . ' Nn. Date .. Applicant to fill in all spdces witnin � � 'CITY OF COSTA' MESA � * : -Pegmlx No.' - � - �— � CONSTRUCTION PERMIT � �c�.3�i � Arch/Eng. ' - Address' Contractorm (1 ' �Address� � � i / t� LICENSED CONTR � I hereby af(irm tfiat ! mencing witn SectP Professions Cotle, License Class _� � r...e _.',,,r't bortler lines ana sign all aoP�opriate Geelarations. ;� TRACT NO.- ' LOT NO. - BLDG. NO. '' C�v-l�'J�� !p�/" TYPEOF�CONSTRUCTION� ' -^ Phone X��/'(s ❑ NEW " O ADD ❑ HLTERATION � A,�f�%/'�-.$ Gv� .- - .- •O.REPAIR.00ONVERSION.ODEMOLISH � - - - License No. - ❑ oT�tiER _ . DESCRIPTION OF WORK . .,. , - OB53 �(�.t` 4 , ._. �/IB/82 � . GULATIONS'" A.P: � ZONE � � PLNG. REF. � L -C,/ '' pK/!M"" rnone 7Vv TVPE OF PERMIT - i''' '- tl11LV1"" - `� SETBACK C L 57. %/7-�1�>N�)i�- ' n,��,(�F'4 'O.GRADING� FOVNDATIOM- OSTRUCTURAL'' SIOEYARD C70R�DECLARATION _. . . -QTENANT� ELECTRICAL ❑PLVMBING �MECHANICA L5EDEVA � am Iicensetl untler provi5lons of Charter 9(com- �. i� RIGHT i' �000) of Divisiom 3 of-4he Business antl ❑�OTHER - REAR VARD (TO F tl my license is in full force antl e(fecL. (^y- �- -- -. - - �fJ 2��t��1�t,. PROJECTDESCRIPTION. . _ . . - ��)- /� �Ja�YJ� ' . SQ'. FT: � I . PKG. SPACE REQ.� � Signature, ' STRttT WIDTH�� W00.KER5' COMPENSp710N DECLARATION OCCUPANCV_CONSTRUCTION TYPE I hereby affirm that I have a tekificate of Sonsent to self-Insure or a VALUATION ' � 20NE certiticate'ot Worker5''Compen5dtion Ins nc or certifie copy - -�� - - - - th¢reOf ($e iqn,38LQ0,. , CJ. �t I � GRADING CU. VOS. - ACRES Po" No. Z• S ComPanY - a' 6''{„� � - C ifietl copy I5 hereby turnishetl. ,._, _ _ -, _ _ . . __ _ _RE A K : � _ - ❑_ .[Itietl cOpy I5 filetl vaith Ihe city Builtling DivisiOn. EXEMPTION FROM WbRKERS' COMPENSATION DECLARATION '" ' (This sectlon neetl not be completetl if the permit i5 far one huntlretl '� ($300) or less). '- _.-. � � ' '" "- I cCrtity that in th¢ P¢rf0/riiante�ot the wo�k to� which thls pe�mit Is issuetl, I shall not empl0y any person in any manner so as to be<ome PLUMBING ,- � PLAN CHECK" � subjec[ to the Workers' Qompensation Laws of Calltornla. . Date $igndture. BATHTU65 SHOWERS NOTICE: If after making this tleclaration, you shoultl bewme subjec[ TOILETS . URINAl.S' "'- " to the Wo�k¢r5' CompCnsdtlon provisions ot the Labor Cotle, you must � forthwith Comply with Such provision5 or tnis permlt SM1all b¢ tleemetl LAVATORIE$ DOUBLE �AVS' ' revoketl. _ , ' CONSTRUCTION LENDING AGENCV ' KIT.SINKS '' -'- DISFiWA5HER5 I hereby affirm that thehe IS a con5truction lendin9 agency tor the p¢r- SERV ICE SINKS ' SUMPS' -"' - formance o( th¢ work fpr whith this permit is issu¢tl (SeCtiOn 3�97 ��: c.,. �-• N�Ni� ' ' FLOOR SINKS FLOOR DRAINS Lentler's Name Lentler's AtlGress DRINKING FOUNTAINS -� ' OWNER BUILOER OECLARATION - - -' ' INTERCEFTORS CLARIFIERS - 1 hereby atfirm that I am exempt from the Cont�acto�'s License Law for !he tollowing reasOn (Sgctlon 7031'.5 Business antl Protesslons Code:� - SWIMMING POOL P TRAP Any city or county which requires a permit to cobstruct, alter, iTprove, tlemolish Or repair any stru[ture, prior to its lssuance, also re- yyqTER SERV ICE ALTERATION- (Chapte� 9(commenciqg y�ith SeCtion ]000) ot DiviSion 3 ot tM1e Busine55 antl P�W¢ssions Cotle) or'that he is exempt the�efrom antl th¢ basis `or the allegetl ex@mption. Any violation o( Section ]031.5 by any 'licant tOr a pErTit subjects the applitant to d clvil penalty ot nOre than five huntlretl tlollars ($500). ❑ 1, ..s owne� of tM1e property, o� my employees wi[h wa9e5 as thei� sol2 compensation, will tl0 the work, antl the SVucture ib not intentletl or otferetl for sale. (Section 7044, Businezs antl Profe55ipns Cotle: The Cont�aclor'S License L.aW tloe5 not appty to an own¢� Of a pro0erty who builtls or improv¢s thereon, antl who tloes such wOrk himSeH or th�ough. his own employees, p�ovitletl tnat such imp�ovements are not intentletl or of(eretl for gale. If, however, the builtling or Improvement� isSoltl within one Year of completion, the owner will have Ihe burtlen of proving he tlitl not builtl or improve for the pu�pose o( sale). � I�, as-owner of the property, am ezclusively mntractin9 �'+ith� li<ensetl conVactors to Construct the projec[ (Section J044, 6usines5 antl Protessions Code: The Contractor's 6icense Law tloes not apply to an owner of p�op¢rty wh0 builtls or improves the�eon, antl who con- tracts from such projet(s-with a contractor(s} licesnetl pursuant to the Contrac[or's License �yw�, ❑ I arfi�exempt untler Se�[ion B: & P. C. ior this reasan Date 4wnar I h¢r¢by certi/y tM1al I have reatl this application antl state that th¢ a0ove informalion is correct. I aqree to comply-with all cit antl count WATER HEATERS ' BTU OUTPUT ' SEWERCONNECTIONS SOLAR TANK � ' COLLECTORS SOLAR PIPING SVS. � ISSUE FEE 7� � MECHANICAL PLAN CHECK HEATING SVSTEM 0-300,000 BTU AND DUCTING 100,000 � BTU REFRIGERATION 0-300,000 BTU SVSTEM - -- 100,000 + BTU BOILERS BTU SVSTEM REPAI R, ALTERATION EXHAUSTSVSTEM MULTIPLE Y Y ortlinances and state laws relating to construction, antl hereby authorize � representatives of tpys �i�y�to enter -upon the above menti netl property_(or,-n5 gt �9 n rposes. J� Si9nature � '•'��-�- Date � �� ^ � Drivers' License or SS � " " ISSUE FEE CMF 0865-46 Wllit¢-�uiltling; Gnary-Applicant; Pink-qccounting; Goltlenrotl-AsSessor SPECIAL CONDITIONS: E�ECTRICAL 5.OQ TL ,��.PROVIDED� ��-� PARK FEE $ , DATE PLAN CHECK I '-' ^ ' GENERATOR 0-1 KW_1d0 KW _ TRANSFORMER --' ' APPCIANCE" 10-SOKW_SO+�KW_ ` ' MOTOR$ - 0'1 HP._1-30 HP --' ' (IN0.50LARI- 10-50HP=50+HP_ " - FIXTURES OUTLETS SWITCHES GAS TUBE SIGNS ' " ' ' ' " POLE LIGHTS - - ' ' - " " PANELS SERVICE " " ISSUE FEE APPLICATION MAIN SUB ' AMP � • . % �C/ OVEDBY ' DATE SUMMARV� OF FEES BUILDING ' PERMIT $ SMIP $ PLAN CI-I[CK $ PERMIT � - �� ISSUANCE �$ PLUMBING $ - ' _ - GRAOING 9 PLAN CHECK � E' C �,� ' , ELECTRICAL 5� - � ' s � PLANCHECK- $ - - MICROFILM $ 'MECHANICAL $ - - _. TOTAL FEE $ - LE55 AD- PLANCHECK S - VANCEPC $_ � � . _. - FINALFEE S v� a� � , CONSTRUCTIONANDPLANNING POOL&SPA ��' _�-�`,, Date � Inspector pppROVALS Permit # -� � � -Date . Inspector APPROVALS Permit# �'� 5� • 1. Temporary Electrical Service or Pole . 43. .Pool & Equipment Location - - Soil Pipe-Undrgrn 44. Steel Reinforcement � -- � - 3. Electrical Conduit Utility-Undrgrn 45. Forms � - . 4. Electrical Conduit-Undrgm - 46. Electrical Bonding ---� � . tee em orce . • 47. Rou h Plumbin' & Pressure Test - � 6. Electrical UFER Grn - 48. APPROVAL TO COVER-GUNITE - - 7. Footings 49. Electrical Conduit-Undr rn� S. Foundation . � 50. Gas Pipe ❑ Undr rn, Test� ' � � 9. Water Pipe-Undrgm - 51. Backwash Lines P-Tra ❑ n r m� " - �� - � 70. Structural Floor System 52. APPROVAL TO DECK " '' � ' '` 11. Property Sewer Line & House Connection 53. . Backwash & Rece tor-Final � � � 12. Street Sewer Connection ' - - 54.��Heater &�Vent-Final � � � ., u• . . 13. Rough Plumbing - - " ' " � - - - • 14. Rough Electric-Conduit � � �56� Electrical•Final 15. Rough Electric-Wiring � � - - � 57. -SolarvSystem-Final - - ' i6. Rough Heating & Air Conditioning �- - � - - - �� •� Fencing & Access.Approval . 17. Ducts �in-Structure � "" ' � - APPROVED FOR PLASTERING " ' � 18. Ducts, Ventilating - � � ' 19. Gas Pipe=Rough & Test ' - - � - ' � ' 60. _ POOUSPA SYSTEMS FINAL , � 20. Roof Framing � � - - - '- � � ' � ' � 21. - Roof Sheathin - ' - ' " ' • 22. Frame and Flashin ' NOTES: � ' � � ' � ' 23. Insulation - � ' ' � 24. Lathing & Siding ' � - � 25. Drywall Nailing ' � � '- 26. Plaster �Brown Coat � � � 27. Electrical Power Meter-Final - ' - ' 28. Final E�ectric 1-1 -SC2 � 29. Final Heating & Air Conditioning � - • - � . 30. Final Gas Pipe-Test � 31._ Final Plumbing ' - � ' � ' ' 32. Water Service-Final ' ' 33. Gas Service-Final � ' � 34. Solar pomestic-Final � � ' � � � ' � 35. Landsca e S rinklin S stem � ' ' 36. Sound Attenuation • " � 37. Handicap Regulations � � - � � - 38. FINALSTRUCTURE&BUILDING ' - � � 39. Special Requirements Completed ' ' - 40. Electric Release to Edison - ' - - � � - " 41. Gas Release to Southern California Gas Co'. � � 42. CEfiTIFICATE OF OCCUPANCY � _ . ' � � � No Date Address Arch/Eng. Addreu AOVlieant to till in atl 11 MESA � vearyaiT NS ION PERMIT F / wit�ln heavy bmEer lines anC sign ali appro0��ale Eeclaratior n TRYICT NO. LOT NO. •BLDG. NO. ' TVPE OF CONSTRUCTION 'DS Phone ,yZ P/M ❑ NEW ❑ ADD ❑ ALTERATION - ❑ REGAIR ❑ CONVERSION ❑OEMOLISH License No. ❑ OTHER . OESCRIPTION OF WORK �� . . .. ._ _ _ _ _ ._ ' � 8�93 II/19/BI 13.00 TI.' , - —1 --- .... .._ _.. _ .. ... , ; }�..� 1— _� ' , � . ZONE PLNG. (3EF. � Contractor�i /V/ £�rGY . pF �J,(�ndlGt Phone(,3% �/� TVPE OF PERMIT 5ET AC C 5 Address J�`Q N T/IN/} UK�}NG'� ❑GRADING ❑ FOUNDATION ❑STRUCTURAL I VARD LICENSED'CONTRACTOR DECLARATION ' ❑TENANT�ELECTRICAL OPLUMBING�OMECHANICA `��HT '1 Mreby aifllm that I am 71<ensetl un0er OroN51on5 ot Charter 9(<om- mancing wlth sectlon 7000) a} Division 3 of the Business antl ❑ OTHER REAR vARD TO P L ProfeS51on5 Cotle, antl my Ilcen58 is In fu❑ force antl eHect. - - ' ( / 1 `= IO ' "' �THD ii PROJECT DESCRIPTION License Class Lice�sa No. PKG. SPACE RE�. oaee ��` /9— 9��! 519nature '3 /YkC(�.- � sQ. FT. � � - STREET WIDTH WORKERS' COMPENSATION bECLARATION ' OCCVPANCY_CONSTRUCTION TVPE ZONING AVPROVEO'BV ' I hereby afflrm that 1 have a c¢rtitl<ate of consen[ [o self-insure ar a VALUATION ZONE certififata of Workeri' Compery��lon Ins � ce, o�`certif etl copy SPECIAL CONDITIONS: lhereot (Section 3800, Lab. CJ. y GRADING CU. YDS. ACRES 'cY No. ComPanY . (f ertitletl copy is hereby turnishetl. " REMARKS: - •� • ' '� • - " ,._ GartHieG topy iz tiletl with Ihe tlty Builtling �ivislon. - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �(This SecHon neetl not be completetl di the permi[ is tor ona huntlretl � SE3001 or lessl. cerUfy that in the� performance af the work tor whic� t�is permit Is issuatl, I shall not emQloy any person In any manner so as to become PLUMBING , suGject to t�e workers CompenYat�on Lnws of Californla. Date Si9naturp BATHTUBS NOTICE: If after making Ihis tl¢clarallon, you shoula become suDle<t TOI�ETS to roe Workers' Compensation provi5ions of [he Labor Cotle, you must (orthwlth comply wlth such pro��sions or this permlt shall be tleemed LAVATORIES revoketl. � � �� KIT.SINKS CONSTXVCTION LENDING AGENCV I hereby at/irm that there is a cons[ruction Ientling agency for [he per- SERViCE SINKS formance of.the work for_which thls permit is issuetl (Section 3097 Civ. CJ. 'Lentler's Name -� �' 0�"/,� -� i - ,� � FLOOR SINKS. Lentler'S Atltlress �DRINKING,FOU OWNER BUILDER DECLARATION INTERCEPTOR'_ I hereby afflrm IhaLl am exempt from.the Contractor's License Law for t�e following reason (Section 7031.5 Business antl Professlons Coae: ��u�Mr„��tir onn b'--' fo� tbe allegetl exe � •.pplitdnt for a per ,t mO�C [han fiv¢ h L i, as owner of ine pi sole comcensation. wtll c wms o� imptoves 7 hi5 own emplo� ;tl or ofteretl ior within one year � ving he tlitl not �s owne� 01 tlii pr thd[ hG Is ex¢Tpt Ih¢r0f�oi . Any vlolation of Sectlon i ajects the appliWnt to a civ tlollars (E500). . or my employees_with wagi NOIk, antl the StrUctule IS n01 A4, Businezz antl Pro/essions 1 not apply [o an owner af a 1, anO who tloes such work I �vitletl tha45uth improv¢men however, the builtling or im� lelion, [he owner will have t Or imprOvO fo� th¢ pu�pose �tv. am exclusivelv contrac . .PLAN CHECK SHOWERS URINALS DOUBLE LAVS �ISHWASHERS SUMPS '' FLOOR DRAINS �.�at �e WATER SERV ICE �se Law GASSERVICE of the antl the yyqTER HEATERS 31.5 by penally SEWERCONNECTIONS as their SOLAR TANK �tentletl ye: The SOLAR PiPING SYS. rope�ty nseli or ISSUE FEE antl R'ofe59on5 Cotle: Tbe Contractor'S License ldw tloes no[ apply to an owner ot Oroperty who builtls or Improves thereon, antl who <on� t�acts f�orn SUcn projeClS wl[h a cont�acto�(s) IlceSnetl pu�suant to the Contractor's License law�. ❑ I am e%empt untl¢r SeCtiDn B. & P. C. for thi5 reawn Date Owner ' I �ereby tertifythat I have reatl ihis applicaUon anA state that the above Information is mrrecL 1 agree to comp ly with all city antl county ortlinances antl itate laws relatlng to c structlon, antl hereby authorize representatives oJ� Ihisf�<I<y to��,upon the above.mentipne0 CLARIFIERS PTRAP ALTERATION� OUTLETS ' BTU OUTPVT COLLECTORS MECHANICAL - cLAN CtiECK HEATING SVSTEM 0-300,000 BTU _ AND DUCTING 100,000 � BTU_ REFRIGERATION 0-100,000 BTU_ SVSTEM 100,000+BTU_ BOILERS BTV SVSTEM REPAIR,ALTERATION � EXHAVSTSVSTEM MULTIPLE Slgnature �^'��'�^'�µ % ///�� Date � �� I Driver5' Litense or 55 � � � ( �SSUE FEE CMF 0865-46 White-Builtlin9� �nary-Appliwnt; Pink-Accountin9: Goltlenrotl-Assessor PROVIDED. � PARK'FEE E � DATE. ELECTRICAL PLaN CHECK, UwEC SO.FT- GENEFATOR 0-1KW_1-IOKW TRANSFORMER . --- - - APPLIANCE 30-50 KW_50 * KW MUTORS 0-1 HP_1-]0 HP (INC. SOLAR) 10-50 HP 50 ! HP FIXTVRES OUTLETS SW�TCHES GAS TVBE SIGNS . POLE LIGHTS . on�c� ..r-rrorn ciin � MAIN� SUB ISSUE FEE I' :3 I � APPLICATION P.PPROV ED BV DATE SUMMARV OF FEES . , BVILDING PERMIT . E SMIP E ' PLAN CHECK E PERMIT � ' ISSUANCE E PIVMBING S GRADING $ ' PLAN CHECK S—{-� ' � � / .� E ELECTRICAL S1 �ii— INICROFII.M E PLAN.CHECK E MECHANICAL b TOTAI FEE S- 1E55 AD- PLAfVCHECK E VANCEPC E . FINALFEE b /3 - � � _�� CONSTRUCTION AND PLANN�ING - � APPROVALS Permit # �r I�� Date 1. Temporary Electrical $ervice or Pole '�� 8. Foundation 9. Water Pipe-Undrgrn 10. Structural Floor Syst 11. Property $ewer Line I 12. Street Sewer Connec� 13. Rough Plumbing 74. Rough Electric-Condi 15. Rough Electric-Wirini 76. Rough Heating & Air 17. Ducts in Structure 78. Ducts, Ventilating 19. Gas Pipe-Rough & Te 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 Mete � -28. �Final Electric 29. Final Heating & Air C 30. Final Gas Pipe-Test 34. Solar pomestic-Final 35. �andscape Sprinklinq Svstem 36. Sound Attenuation 37. Handicap Regulations 38. FINALSTRUCTURE&BUILDIN 39. Special Requiremen[s Comp(-ete� 40. Electric Release to Edison - 41. Gas Release,to Southern Califor ia 42. CERTIFICATE OF OCCUPANCY " ` No Date POOL"'& SPA ' . 1 Inspector qPPROVALS Permit # 43. Pool & Equipment Location ' 44. Steel Reinforcement 45. Forms 46. Electrical Bonding 47. Rough Plumbin & Pressure Test � 48. ARPROVALTO COVER-GUNITE 49. Electrical Conduit-Undr rn 50. Gas Pipe, ❑ Undram. Test . 54. Heater & Vent-Final 55. Plumbinq Svstem'- F �56. Electrical-Final 60. POOL/SPA SYSTEMS FINAL NOTES: Date � � CITY OF COSTA MESA BUILDING SAFETY DEPARTMIIV`P DATE �� s V�� In consideration of the City of Coata i4esa granting a permit for the erection oP a sign to be located within ten (10) feet of the Yront property line at S� �/l�• / 9� �� , the undersigned, for himself, his successors, executors, administrators, and assigns, hereby agrees to move said sign at his own cost aad expense in the event the Cicy deeires in the flzture to widen the right oP way on which said sign fronts� as provided in Section 8506 (c) of the Municipal Code o£ the City of Costa Mesa. dh 1-62 � AOC��cant to fill in all spacas exeept tM1ose wit�in heavY bOrGe� PERMIT NO. TRACT NO. � Ci7Y oF COsrn �ME�S�A/ C�1O�.N�1ST�IR�nUCTION PERMIT ,,J�- S -+� Project Address, �_I -� � ` ' ' Applicen['s Mailing Address `Q LiG�e/� .t�. sk �N/1 TYPE OF CONSTRUCTION NEV Ovunef'SNeme �� S^�� Q'eQ On2��' � CONVERSION DEMOLISN /} AI�I E$CFIPTIOQ� OF RK/USE OF 8 Address 7U 8� /MI�� SAw�r fl f ��ji(1�(�,/.�'1 Uf rt��- - ND Arch/Eng. Litense No. TVPE OF P RMIT GR.aDiNG � � - ❑ TENANT ❑ ELECTRICAL ❑ %�ddress ��OTHER iynCHl Contracmr's Nam '�e~ Phone ?tldress (mailing) City License No. � - LICENSED CONTRACTOR DECLAFATION 1 4ereby allirm Inal I am licensetl untler provisions ot CAarter 9(commencing � with seclion 7000j of Dlvision 3 0l the Businezs antl Professlonz Cotle, ane my license i5 in full torce antl e te t. IJcenu Class Licenie No. Ddle � � Si9nat r � , ��ORKERS'COMPENSATION ECLARATION iereby aifirm tnat I nave a certificata of mnsent to selt-insure or a certiticate : Workerz' Compensaeion Insurance, or a certltiatl copy thereof (Sectlon 3900, l.ab. CJ ' � Policy No. Company Certitietl copy is nereby tumishea. � CertlBetl copy i5 fileq with the tlty Builtling DlWzlon. Ddte AOPlicant E1(EMPTION FROM WORKERS' COMVENSATION DECLARATION (This section neetl not be completetl i1 the Permit is for one huntlretl (5300) or le;s). � certify that in Lh¢ Pertormance O/ ln@ work }or wnicjlh thi parm�t I5 issuetl, I sFlall not eTploy any porson in any ntan er 50 l�e� e Su ject to Ne Workers' o e�5�jian Laws ot Califor �� Date � � ` ' Signature woTlcE: If. atter makinU this tleclarat o, you oula become s ect to the C4m0�Y "/��h� su[h prOWsfons or 1M115 pefmlt stlall bG deemCO fevoNea. CONSTRVCTION LENDING -ACENCV ' I hereby zfflrm that tnera Is a conztruction lentling agency for t�a periormance oi tryo �work for, which thi5 permit is i55ueC (SeCtion 3097 Civ. C.) Leneer's rvamo LenAer's Address � QWNER BUILDER DECLARATION�� I nerebv aHirm that 1 am exempt from the Conlractor'S Licenso L.aw for tha iereirom an0 the basiz for the allegea ezempuon. v,ny vioiatmn o� xcuon �031.5 by' any aOG��anl Por a permit subjects lne aOP��cant'to a civll ; enalty ol•not mora tnan tive hunUretl tlollars (E500�. I,.ai OW�¢r o/ the property or my ¢Tp1oy0¢s witM1 wage5 as thal� so10 mpansation, will tlo [ha work, anC tne 5lrucluro 15 not IntanOeq Or offeretl �or wle (Saclion 7044, Business antl Professional Gotle: Tha Con(ractor's ' License I.aw tloes not appty to an owner ot a property wno buitCs or ImOrovos [hereon, antl who tloes such work himsetl/nerseli or through hls or har own emo�oy Bas, provl0etl Ipat Such imp�ovemen[5 are nOt intentletl o� offeretl for talg. If, howovar, t�e Dullaing ci improvement is zo1G wit�in one yoar ot tom- Aletion, lbe ownlr wlll hav¢ tne burtlen ot provin9 he/she tlitl nOt builtl Or im- �rova torthe purpose oisale). 1, as ow��er of Ihe pro0erty, dm exclu5iv¢ly COnt�acting wlth Ilcen5e0 con- fractorsto construct the project (Seclion ]044, BuSinezS antl Pr01e55ions CotlO: 7he ConVactor'S License Law does not apolY to an owner of pro0erty wno bulltl5 or Improves th¢roon, antl who cOnVdctz to� Suth proj¢Cts with a con- lra<tor(s Ilcenze pursuant to the Contractor's Licanse �aw). I am aware that p�oof o� thei� WOrk¢r's Compe�5atlon InsU�ance ShoUltl be pr viEetl [o ma. ❑ I.am exEmp[ untler 5ection—�� & P. C�r tnis reason . bate �J— �- � / Owner I hero1�Y �ertiiy that I havG reatl th15 appKwtlon antl stat tkliCfie abOvO I�(ormatlon iz mrrect. I a9ree to omply with all dty and nty orGlnances Sntl state laws relating to builtling conitruction, antl here authorize repre- Sentatives of� lhis ty to en r upo the above-mentionetl proPerty tor �nspeGtlon O ozes n�� , OJ ��j✓ Signature � /�'� � antl sign all ao0�oprlate tleclarations. ADD LJ ALTERATION LJ REPAIR FOUNDATION LJ STRUCTURAL LUMBING ❑ MEGHANICAL PRQIECT DESCRIPTION SQ. FT. pCCUPAN1CV' CONSTR4CTION TVPE VALUATION $ �y ZONE GRA�ING CV. VDS. ACRES_ 0.emarkt: ' Bar Sink Backtlow Preventer' ' � Backflow Irriqation Drinking Fountains Floor Drains Floar Sinks � Gas Service Interceptors Kitchen Sink � Roof Drains' qeinspection Foe $15 Boiler Duct- Under Ground Duct - Ven[ilating. Exhaus[ System ❑ Multiple ❑ Firepl/Fact, Blt. ICBO # Heating System & Ducting ❑6100,000 BTU 0100,000BT' Refnspectfon Fee i $75 CMF 0865-46, rev. 4/84 White - gulltling: Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Assessor Showers ServiceSink - - � Sewer Cap Sewer Connection � Solar Collectors G�, Sotar Piping Solar Tank � Swimming Pool w/Spa Urinal Wacer Closec . Water Heater Water Service � Isue Fea FEES S 3 A.P. �W S Main Bi E T Front B Rear A C Right K Left S Ping. Ref. {� Auromatic Washer � Construciion Pole Sub. Coaking Unit ' Dishwasher � Dryers QGas ❑Elec Fan F.A;U. Fixtures Device Boxes Outlets Garbage Dispoul Generetor 065 KW �5-15 7608 9/04/84 18.OQ il Zone Accessory Building: . EIECTRICAL � - Transformer'� 15-50KW ❑ SO+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors00.1 HP01X-8 Inc.Solar �9-15 HP �16-75+ Microwave- - Pole Light Range Sian . Standing $ection: Trash CompactOr Reinspection Fea $15 luue Fea IANICAL FEES . DEVELOPMENTSERVICESREOUIREMENTS: Hood or Type I ❑ � zoninB %�PP�oved By Canopy Type 11 � BuildinB APProved By Retrigeration System � ❑0-100,OOOBTU ❑100,000 System Repair/qlteration � laue Fee � $ 3 FEES $ 3 .SUM ARV OF FEES BUILDING PERMIT : $. ��SO SMIP „ $ �� '�� P�P,N CHECK S PERMIT • PLUMBING $ � ISSUANCE� S PLAN CHECK -25% $ - ENERGV P.C. $ ELECTRICAL $ �GRADING $ � PLANCHECK 50% S MICROFILM 5 MECHANICAL $ TOTAL FEE $ I R•oo PLAN CHECK 25% $ Z O N I N G R E Q M T S. • CONSTRUCTION AND PLANNING POl . SPA_ _ , APPROVALS .Permit�h Date �Inspector -qppROVALS 'Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �2. 5oil Pipe-Undrgrnd. '53. Steel Reinforcement �� ' � -3. Electrical Conduit U[iliry-Undrgmd. - 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 ConduibUndrgrnd. - � B..Fouridation 59. Gas Pipe, O Undrgrnd., Test 9. Water�Pipe-Undrgmd. ' � 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 Electrical-Conduit 66. Solar System-Final .16. Rough Electric Wiring 67. Fencing & Access Approval . � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Ele'ctrical-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 O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. UndergrounB Flush � 24. RoofFraming �, 73. Undergmd.StoregeTankOGas OOiI 25 oof Sheathing 74. Overhead, Hydro • �.�T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � , 27. Frame and Flashing � ' 76. Dry Standpipe � 28. Lathing & Siding . . 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . - � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric . � Notes: 34. Final. Heatin9 & Air Conditioning ' ' � . . i 35. Final Gas Pipe•Test . � 36. Hood or Canopy 37. Final Factory Fireplace � � - 3S. 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 �- �- O � v 48. Special Requirements Completed � 49. Electric Release to Edison - ' 50. Gas Release to Southern California Gas Co ' � � 51. CERTIFICATE OF OCCUPANCY _ ' No. Date - � ' (714) 754-5273 • Fex (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 534 W 19TH ST Sui�e No Viciniry: ROOF Parcel Number: 42210317 npp�iwnt: PHILLIPS, HOWARD Address: 2952 CENTURY PL COSTA MESA, CA MECHANICAL PERMIT Phone: 714-546-1653 Zip: 92626 Owner: BAYLISS, DOROTHY LEE TR FOR 1992 COSTA MESA TRUS AddreSS: °hCOSTA, MESA TRUST C/O DOROTHY BAYLISS COSTA MESA, CA . Phone: � 223 VIRGINlA PL �_ Z'tp: 92627-1821 Contrecror: DEPENDABLE GRAHAM AIR CONDITIONING Address: 2952 CENTURY PL COSTA MESA, CA REPLACE ROOFTOP�DUCTING ISSUE FEE �.Inst FAU <700 k BTU Inst FAU >700 k BTU RepairlAlt CoolingMeat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Faclory Fireplace Hood wlMech Exhaust VAV Box Vent Fan I Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers e t0000cfm AirHandlers> 10000cfm FloorFurnac@ Floor or Suspend Heater Phone: 714-54&1653 Zip: 92626 License: 472690 � FEE SUMMARY $23.50 $0.00 so.00 $13.70 50.00 $0.00 $0.00 $o.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 Quantiry Stalus: ISSUED Applied: 10/042005 Issued: 10/O4I2005 ISSUEDBY: G-��f,`�� Repair I Alt Absorbtion Unit Repair I Alt Retrigeralion Unit Ventillation System Evaporative Cooler Commercial I n cinerator Domestic Incinerator Comoressors I Absorotion Svstems -Up to 3 hp I 700 k BTU 3 To 15 hp / 500 k BTU 15 To 30 hp I 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 Wer 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee � Reinspection Fee TOTAL CALCULATED FEES COMMENTS I SPECIAL CONDITIONS Quantiry 50.00 0 $0.00 0 50.00 0 so.oa o $0.00 0 50.00 0 50.00 0 so.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 50.00 30.00 537.20 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and relaled regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION; This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: tn order tor the vrork authorized urtder this permit to be considered legal, such work musi compty with all epplicable codes, and aIl requlred Inepaetlons end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this Dermlt. FOR INSPECTIONS CALL: (7/4) 7545626 za+cee �eroo) WORKERS'COMPENSAnON DECLARAnON: � I hereby eHirtn untler penalry of per�ury one ol the following declaretlons: ❑ 1 have entl wlll melnteln e ceniticete oi wnsent to sell•Insure lor workers' compensatlon, es proviAetl for by saction 3700 ot the Lebor Cotle, for ihe pertortnance of the work lor whiCh this pertnit Is IssueO. � I here end will maintaln workers' compensatbn insurence, as required by seclim 3700 ot �he LeOor Cotle, tar the peRortnance oi the work for whkh Ihis pertnit Lv Issuetl. My warkerg.� ln�setlpn Insurence carder end polity number ere: �Certier: S/�r/ ��.IN (�i PoliryNumbec �00� C��' z�� (lhis section neetl iro1 be comp/efed I! fhe perml� Is va/uetl et one Aundred dWlars (5/00) or less.) ❑ I certity t�at In the peAormence ot t�e work lor which Ihis pertnit Is luued, I shall not em0loy eny person in any manner so as to become subject to t�o workers' compensetlon lews ol Celifomia, antl epree ihat It I should become sub�ect ro the workers' compensatlon provisions of Sectlon 3700 ot the Lebor Code, I shall lonhwlth campty wich these P�si s. //^�' � ^ /� � ApDlicantSlpneture: �/^t/�/'` i�L�.��Z Date: ��/ ��...i WARMNG: FAILURE TO SECbRE WORKERS' COMPENSATION COVERAGE IS UNUWFUI rWD SHALL SUBIECT AN EMPLOVER TO CRIMINPL PENALTES M1D CML FlNES UP TO ONE HUNDRED THOUSrWO DOLLARE (5100,000�, IN ADDf710N TO TME COST OF LOMPENSITION, DAM4GES AS PRU�DED FOR IN SECTION 3%O60F THE V.BOfi WDE, INTEREST, AND ATTORNEVS FEES. LICENSED COMRACTORS OECLARATON: I �ereby eNirm Ihat I em force end ettecL Lic. M_ Contrectors Signeture: of Chapter 9(commencing with Sedlon 7000) of Division 3 of ihe 8usiness end Professions CoAe, end my license Is in full CIa55 M C JZ �d u�✓'= - Date: /o/cf�0l' CONSTRUCTON LENDING AGENCY: ❑ I hereby eHirm Ihet there Is e construction lentling egency lor the pedormance ot the work for which Ihis Oermit is issued. (Sec. 3097, Civil Cotle). lentlels Name: Lende(s Address: SigneWre: Dete: OWNER-BUILDER DECLARATONS: I hereby atlirtn thel under penalty ol per�ury Ihet I em EI(EMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business and Protesslons Cade: Any ciry or counry which requlres e partnit to construct, elter, improve, tlemdish, or repair any strucWre, pnor to its issuance, elso requires t�e applicant lor auch pertnit to tile e signed stetemeN Ihet he or she Is Ilcensed pursuant ta Ihe proNsions o1 the Contradors LJcense Lew (Chaptar 9(wmmencing wit� Section 7000) ai Dlvislon 3 of the Business entl Professions Code) or t�at he or she Is exempl Iherefrom end Ihe basis br the ellegetl exemption. Any violatlon oi Sectlon 7031.5 by eny eppllcent for e pertnit subjecl9 the epD�lCent to e civil penalry oi not more Ihen Nve hundretl dollers ($500) J: _ ❑ I, as axner of the property, or my employees wlth wages es thelr sole compensetion, WILL DO 7ME WORK, and the structure is not Intendetl or oNeretl ior sale (Sec. 7046, Busineu and Professions Code: The Coniractors License Law does not appty �o an owner of property who 6uilds or Improves thereon, antl who doas such work himself or hersell or through hls or her own employees, provided thet such improvements are not Intendad or atfared tor ule. It, however, Ihe bullding or Improvement is sold within one year of completion, the owner-builtler will heve t�e burtlen ot D��9 �hat he or she did not build or improve for purpose oi ule.). ' ❑ I, es owner ol the properry, em E%CLUSIVELV CONTRACTING WfTH LICENSED CONTRAC70RS to consiruct Ihe project (Sec. 7044, Business and Professions Code: The contractors LJcense Lew tloes not appy to en owner oi properry who builds or imprwes thereon, antl who conirects tor such proJect with e contrector(s) license Dursuant to Ihe Contrectors License Lews.). ❑ I am exempt under sec. Business enA Pmlessions Code tor this reason: SlgneWre: �ate: Owner ID verilied by drNels Ilcensa. ❑ Ves ❑ No Drivers license No. Expires: Vedflcetlon ol Ownership by (type ol tlocument, I.a. - property tex blll or deetl): OIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � I hereDy certify Ihat no excevation tive (5) or more feet in depth into which e person is required to descend, will be matle in connection with work eut�orized by this permlt antl thet no buildinp structure, scaflolding, lelsework, or tlemolillon or tlismantling thereol, will be more than Nirty-slx (36) leet hiph. (C�ap. 32, Grp 2, Ar12, Sec. 341, Title 8, Celifomia Administretiva Catle). 0 As owner-bulltler, I will not employ enyone ta tlo work which would require a permil Irwn the Division oi Industrial Selery, as notetl above, unless such person hes e permit to tlo such work Irom Ihe division. SlgnaNre: Date: Division of Indusirial Sefery Permit Number: CERTIFlCATE OF COMPIIANCE AND AUTNORIZATION OF ENTAY: I cerUly under penfllry oi perjury Ihel I heve reatl Nis applicaUon end stete thet Ihe Inlortnation given Is canect. I egree to mply wit� ell 5tete lews end clry ordinances relating to builtling consiructian, entl euthorize representetives at Ihe Clry ot Costa Mesa to enter upan the ebovadescnbed �nperty lor Ins0eclion purposes. I egree not to accupy or allow oaupancy of eny building authonzed by Ihis pertnit until linal InspecUon. yQUE I, INSPECTIONT'PE 7616 Fued System Final Fire Prevention 1266 Pool Spe Final 200 Flnal Re-Rool 201 Final BIocWRetelning Well 202 Final Fectory Flre Place 203 Finel Sign 204 Finel Demolltion /� / Dat� / O ��a� pdff ��$ �pyj� INSPECTIONTYPE 206 Final Mechaniwl 20B Final Plumhing 270 Final Electncal 212 Final Flre Prevenilon 220 Final Plenning Approval 222 Final Site 250 Flnal BulltlingiOccupenry (714) 754-5273 + Fex (714) 754-4856 • www.ci.costa-mesa.gVi 4LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Addrpss: 534 W 19TH ST Suite: Vicinity: ROOF Primary Occ: B Eat<50/ Office/ Bar<50 Parcel Number: 42210317 ApplicanC TIM MC CARL Address: 126 COMMERCIAL WY COSTA MESA, CA Type of Construction: V-N Zoning: Phone: 949-548-5569 Zip: 92627 Owner: BAYLISS, DOROTHY LEE TR FOR 1992 COSTA MESA TRUS Address %COSTA, MESA 7RUS7 C/O DOR07HY BAYLtSS COSTA MESA,CA Phone: 223 VIRGINIA PL Zip: 92627•1821 Contraqor. G L R ENTERPRISES INC/DBA CRANK BROTHERS ROOFING Address: 126 COMMERCIAL WY COSTA MESA, CA Zip: 92627 - Arch : Address: Zip: Phone: License: Phone: 949-548-5569 License: 828379 Eng: Address: Status: ISSUED Applied: 09l132005 Issued: 09It3/2005 ISSUEDBY: il�y'�_ Phone: License: SCOPE OF PERMIT T/O EXISTING FLAT ROOF DOWN TO SHEATHING AND REPLACE W/CLASS "A" ASTM FELT AND HOT MOP W/GRAVEL ON COMMERCIAL BLDG.APPROX455QUARES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: si �,3es.00 Permit: $209.25 Claim Valuation: si�,355.00 SMIP Res: $0.00 SMIP Com: $2.39 Other: $0.00 Inspection: $0.00 Total: $211.64 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0- 0 Rear 0- 0 Lefl 0- 0 Right 0. 0 ACCESSORY Front 0- 0 Rear 0- 0 Lefl 0- 0 Right 0- 0 , PARKING Existina: o Reauired: 0 Pr000sed: 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ortl. No. 92-28, § 1, 12•21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such work must comply with all eppliwble codes, and ell requlred InapeCtiona end final epprovel must be obtained. Failure lo obtain Inspections and tlnal approval will result In the expiration of this permit. POR INSPECTIONS CALL: (714) 7545628 zaaere �e�w� WORKERS' COMPENSAnON DECLARAnON: �-._..- - � I hereDy aHlrm under penelry ot perjury one oi Ihe tollowing decleretions: ❑ I have entl will malntain e Certiflcete ot consent ta salt-Insure for workers' compenutlon, es provlded far Cy sectlon 3700 0l the Lebor Code, tor the pedortnence of �he work lor w�icti t�ls pertnit is IssueO. �^I hsve arW wW maintain workers' compensatlon Insurence, as requlreG by sectbn 3700 ot Ne Lehor COCe, for Ihe pertormance W Ne work fa whldi thi9 peimlt Is Issued. My wo�' penution Insurence�rtler end poliry numDer ere: caMer. C a�-e 1= �.tv� po�iry,Number: �� '� I� q 9 2— rl„ O o S (77�Msec�eed rror be m�mplete0!! the peimltls velue0 et one hurWred ddlers (S100) w less.) ��_ _ .._ ^_ ❑ I ceNfy t�a� In ihe ortnance of the work lor which thls pertnit is issuetl, l s�ell not employ eny pereon in any manner eo es to become subject to the workers' compensailon law C Ilfo i, en e thet It ould become suCled to Ihe workers' compensation provlslons of Sectlon 3700 ot the Lebor Code, I shall lorihwlth cnmply with Ih rovi o. plicant SlOnature:r Date: q( � 3/ � j WARNINO: FAILURE TO C E WORKERS' COMPENSATION COVERAOE IS UMAWFUL AND SIULL SUBJECT AN EMPIOYER�TO CNMINAL PENALTIES D CNIL FlNES UP TO ONE HUNDRED iHOUSMIO �OLI.ARE (5 ), IN ADDITION TO THE COST OF COMPENSATIIXJ, DAMAOES hS PROVIOED FOR IN SECTIqJ 3]OB OF THE LABOR CODE, INTEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby elfirtn that 1 am Iicensed under Orovislons of Chapter 9(commendng wlih Sectlon 7000) of Division 3 of ihe Busine and Professions Code, and my license is In lull torce.and ett �c� — CIasS a�_ 3 i CwitrecoRsSlgrnatura�x � �Da`te:= R r3 aS CONSTRUC710N LENDING AGENCY: ❑ I hereby eHirm thet ihere Is e constructlon lendinp egency for the pertortnance o11he work for w�fch ihis Dermit is issued. (Sec. 3097, Civil Cade). Lendefa Name: Lenders Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I �ereDy eMirtn [�at under penelry ol per�ury lhat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the followinp reason (Sec. 7031.5, Business end Professlons Code: Any dry or counry which raquires e permit to consiruM, elter, imprwe, Aemolis�, w repair any structure, pdor to ics issuance, elso requires the applicaN for suc� permil to file e signed stetement Ihat he or s�e is Ilcensed pursuent to Ihe provisions o1 ihe Contrectors License Lew (C�apter 9(wmmencinp with Section 7000) of DlNslon 3 of iha Business end Professions Code) or Ihe� he or sha Is eaempt theretrom end Ne besLv for Ihe elleged esemptlon. Any vloletion of Section 7031.5 by eny eppllcant tor e pertnit sub�ects Ihe eppllcent to e dvil penalry of not more then live hundretl tlollars ($500).): ❑ I, es owner ot t�e properry, or my employees with wages as Iheir sole wmpensatlon, WILL DO 7HE WORK, end the sWdure Is not IntenAetl or oHered for sale (Sec. 7064, Busfness and Pmtessions Code: The Contractors License Lew does not eppty to an owner of properry who 6uilds or impmves thereon, and who does such work himseli or herself or ihrough his or her ov.n employees, provided that such improvements ere not intended or oXeretl tor sale. If, hov.•ever, the building or improvement is sold within one year ot completion, the owner-builtler will have the burden at provinp ihat he or she did not 6uild or improve lor purpose ot ule.). ' ❑ I, as owner oi the properry, am E%C WSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct the prqea (SecJ044, Busness end Pmfessions Catle: The wntractors License Lew Coes not epply ta en owner of praperry who �uiltls or improves thereon, and who contrects for such projeq with e contractor(s) license pureuem to the Contracbre License LewsJ. ❑ I am exempt untler sec. Business entl Pmfessions Code for this reason: SlpnaWre: Date: Owner ID venfied by tlrivels Iicense. ❑ Ye9 ❑ No Drivefe LiCenSe N0. Vedlicallon of Ownership by (type af documem, I.e, - properry lax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PEHMR CERTIFICATON: Expire9: ❑ I hereby cerlity that no excavetion tNe (5) or more teet in Cepih into which e parson is required to descen4 wlll De made in connection with work euthoAzed by this pertnll, end ihat no building structure, sceHolding, telsework, or Cemolitlon w tlismantling Ihereol, will be more lhan thirty-six (36) teet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title B, Caltlomia Administretive Code). � As owner-builder, 1 will not employ enyane to do work which would require a permlt irom �he Divislon ol Industriel Safery, es noted ebove, unless such persan hes a pertnit to do such work from the division. Slgnature: Date: Di�nslon ot Industrial Safery Permit Number: CERTIFlCA7E OF CAMPLUWCE /WD AUTHORVATION OF ENTAY: I certily under penelty ol perjury that I heve read this epplice�ion end state that the intortnelion given is cortect. I egree to compty wit� ell stete lews entl ciry ortlinences relating lo builtling consttuctlon, anC eutnodze representellves at Ihe Clry o1 Gosta Mese to enter upon the ebove-doscribedA�WertY �a� ��spection purposes. I egree not to occupy or ellow oauparH,y ol eny building authorized by t�ls pertnit until final inspectlon. 1818 1268 200 201 202 203 iNsveenonme Fixed Sysiam Final Fira Prevention Pool Spa Final Finel RaRoof Finel Block/Reteining Well Final Factory Fire Place Finel Slgn 20C Final Demolitlon PAg II�E65 � � r L� . i� �i( / COUE II INSPEC710N TYPE 206 Final Mechanical 208 Final Plum�ing 210 Final Electncel 212 Final Flre Prevention 220 Final Planning Apprrnal 222 Final Slte 250 Final Bullding/Occupenry PAIf. � . _ :—�.- � -- _-- � �� 1 ��.� � �''� � FEE ;RECEIV�ED-�� ' 5281 - , • � � . , - ' � w- r �j �r7�9�` - COSTA MESA BUILDING DEPARTMENT � � • P � a�x 31� �� T-� �FINANCE DEPT. COSTA MESA. CALIFORNI �pvy=...�.a.� CITY Of COSTA MESA ,� FOR APPLI T TO ILL IN APPLI TION FOR PERMIT ADDRE55 � �r9rk STQE� UILDING COSTA MESA.,CALIFORNIA u""Y . OR OFFICE USE ONLY }� RECEIGT NO. PEP=1T NO. OWNER 'VQ„ � We� a.. S eN�e. 3a(o MAIL NECEiVED BY OniE NECEIv�`- OatE ISSIlEO ADDRE55 SI% �. I�1TA. STPFFT � �.rv�a\ _IIIN �Q'iQ�.7 ARCFIITECT ILEAGA�I £ OR ENGINEER wE�TER.�I AD 5 Z02.7 AIO. M! � ocog So� �ouNG� CONTRACTOR 650 �. sr_ ApDRE55 TJ9T��l Clil LEGTL LOT DESCRIPTION nr0, � A.P. NO. II S -_�Cl . SRE . i . TEL. BUILDING � �o.�i 8•349'3 ADDRE55 Tn !.0 innna COSTA MESA. CALIFORNIA arv uc. �/ NO. / 00' TNO. I�, 7• z CK �:�� TRACT ? _�NO.OF BLOGS. MOW ON LOT C EXISTING BLDG. y" +' ' SETBACR LiNE iFOM f / p CENTEF OF STREET p � t REAR VARD iO(J' y� SIDEVARD RIGHT (�� LEFT �� NEW REP BU1I.DING S SIZE EXTERIOR W COVERING G DESCRIPTION OF WORK ALTERATION II ADDITION � MOVING DEMOLISH J�•IO�) ✓ J'D ROOMS 9 STORIES Z LL ROOF '7Jff e� COVERING COrlpn � FIRE APPROVED BY DATE . CORRECTIONS �� CITY OF TA ME:iA SIIF.IFC.!']f0 G. DEPT. REG. BY USE OF NEW BUILDING S � •JC%C./✓�G� ___Jc F-2. C Ls S S� �� c �ii' L��iJiw%.s/ "; ' - I MEflEBY I.CKrvOWLEDG THnT i HwVE REnO TMIS /.PPLIUTION hND � $TFTE THAT TNE 4BOVE IS CORRECT 4N0 FGREE TO COMPLY WITH 4LL CITY OROINRNCES /�ND $TPTE LRWS REGULATING BUILD�NG CONSTRUC� riorv. VALUATION SIGNATURE OF PERMITTEE $ o?5,65�6 AUTVIOqIZED AGENT � � ♦ ,1 . r,./ fi. � ' t -• J � PERMIT FEE $ '�v � � � PLAN CHECK $ � R • 's TOTAL FEE 5 G�, J O 9"'� ' . _ ' , ��9�'i COSTA MESA BUILDING DEPARTMENT P. O. BO% 31� COSTA MESA. CALIFORNIA FOR qppLICANT TO FILL IN ADORE155 532 w. 19th St. Bld .//i CqSTA MESA. CALIFORNIA OWNER Howard Iswson ADDRE55 S4� W. Z9tih St.. ARCHITECT OR ENG�NEER A1 55 CONTRACTOR Cratzk Bros. Rf A�ORE55 126 Ca�e C101 W LWIL LOT DESGRIPTION NO. BLOCI A.P. NO. ! �,J �— � SIZE �i OF LOT O o�� Ex�s°�N� e�o�. Store bld . � ��L �a'�L �.a � ��J) ��/y��9 `� FI�A►t10E DEPT. G+N oF fnsTa r�Fs!1 APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY 'No:Li 8-3493 �UILOING ADDRE55 uG COSTA MESA. CALIFORNIA NO. uc. � NO. Tv,�, LI 8 NO.OF BLOGS. IOW ON LOT 6EtB�CN 4NE FHOM �v c[rvr[a oF sin[[• �n REAR VARD SIDE VARD � RIGHT �EFT DESCRIPTION OF WORK NEW q�TERATION ADDITION \g1IIg REP BUIL�ING SIZE E%TERIOR WALL � NO. OF ROOMS STORIES • Roo 1/30# felt & G(] ERING FIRE 20NE :e�EG c APPROVEO c. � �• o:= c.; �=r �, N��S?� 'u'i f• 1'�/'� s �- � uplEcf TO i7LLG. OEPT. REG. I HENEBY LC1(NOWLCOGE TNtT I MdVE REqO TMIS 4PPLIC.�TION .�NO STP1E TNFT TNE 400YE I$ CORRECT <ND AGREE TO COMPLV WITN RlL CITY ORDINANCES �Nq 6TATE LAW$ AEGULATING BIIILOING CONSTFUC� T�o�. ' � � � �/�� VALUATION SIGNATURE O �^�Z�� SSO. W PERMITTEE $ � I AUTHORIZED AGEN7 t / PERMIT FEE $ PLAN GHECK $ TOTAI FEE 8 ' � �' . 24933 "� C09TA MESA BUILDINCrSAFEfY DEPARTMENT P.O. BOX 1�! COSTA ME9A� CALIFORNIA 02020 for AppltcaM M FIII In Complotoly ". TYPE OR PRINT o�,�,Na 534 W, i�� srn�Er � ADOR6YY CO3TA MESA. CALIFORNIA o g„ DR. K, D, KNOWG �� M„�� 534 W, / 4 �. �TR� � � ADAA c�Yr CfJ�✓/- �TA M¢� �/� no�` �/(of� ARCMITECT /�'E� 7 TQL6 OR QNOIN66R / N . PR�. 3¢2 W, i9 �l1. 57, - ec��,l,`!�� CO T7iA R v�n'� eO�% ��i�7� ADPRFGG �ZS �O. HCCG��,f.' ��, �,a,uTA ,4u,� ��TNo.�3624-0 :' �� N `�¢5-�i4-�/ n�w�er �ia�_� X .'�l�/ON I .�..�,�..�.�,.,°.�'°.,.o�. �neiain� �� — J�� Rwv RDI 1.EFT Ri6}iT DESCRIPTION OF WORK x(cp� I � 1 N6R6GY AeKf10W{.<OO� AND 6TAiE Tf1AT T11i AO YLY WITN ALL CITY OqO� euucixo eonarxurnqp I� AUTMORIZ[D AOi!(T �iTY �� E� �;5 � � 6�ESA NOV 24 1965 For ONIc� Us� Only s. - LCOAL YARDiAPPROV6D MAIN BUILDINO (FROM C/LYTR[6T) / ♦ _ — � VAR. �j / ■ TO �n TNu �►►uunon AND AOR6t TD COY- R lAN'� [i0YL11TIN0 ZONING 0 u�c or n�xr �y .�,�o,Na y 7'�f' �ZS —3a3—�1 �r+a sHwu ee t.eee THN+ � (U.B.C.RlOUIR6M6NT: YAHDBAPPROVHD ACCHHSORY BUILDINO e DATH �r i a �� m � ` � � . � �. �.. � n�t �rounr �HOWN uxoea vw�uwnoq �e rort n�e � ■unroe� or �rr�eueHino w �enrrt rce ox�r. vw�.uwnon �p 7� p PHNMITFEE � s�/�� w /` t / % , TOT/tL PEB 1 ^ /� 5 P�� . 4n572 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFOHNIA 92626 For Applicant [o Fill in Completely — Use Ink Only BUILDING `} ADDAESS / 7/ ' S i • �� OWNER ��IJ I�J Q � J MAIL ("� � � ADDRESS �� CITY ( 'i�! /!J �fC Xi NOL�ri� A� BRANCH aooaess CONTRAC AODfiESS CITV L STATE LIC. NO. SI2E OF LOT 5 TEL. TEL. NO. CITV UC. NO. NO. OF BIDGS. NOW ON LOT Separate permits are required for electric, plumbing and heating work. USE OF BUILDING ANO WORK TO BE PERFORMED I hareby acknawletlBe thet I hava reatl this eppliceilon antl atate that tha aba�e Informetlon Is correct antl apree to comply with ell lews ragu�etinp bullding construcHon, antl I shell not employ any person i� ��olatlon of tha workman'a compansaiion laws ot ihe Staie of Californla. I �ereby ce�4ify that I am properly Iicensetl as a controcior untlar the State of Californla Bustness antl Protosslons Code, Dlvlslon 3, Chapter 9, and thac sueh Iicenses are In fuil force antl effect, or I em exempt from the provis ns of tha Stete of Californle Busines� antl Profassio�s CoCa 1 3, Chaptar 9. Signature of � /iii ) Parmlttea � `L� Authorized Apant '_ ----� \ va:� ��P 22-75r.n,sn �� 954 rt *:; * *46.70 FORSTRUCTURALPERMIT A.P. NO.'I �J� �.S BUILDING c � , ADO R ESS J3� TRACT �2S L A OWNEP O � ��G Ill� T Ft L'T?�'TZ 9 �2 NE NO.OF USE OF NEW � Z' PLANS � BUILDING `T,. YARDSAPPqOVED• YARDSAPPROVED MAIN BUILDING ACCESSORV BUILDING DISTANCE BET. I BET. MAIN & MAIN BIDGS. ACCESS. BLD VAR.qW DATE THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PUflPO6E OF ESTABLISHING A PERMIT FEE ONLV: VALUATION �/ pERM1T FEE E ^ (� (; PWN CHECK E $�/�OO TAX S TOTALPAID § G G �• % . . � �� 453�8 ' � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only ADDRESS S�� YV. . I:l rF, �,', OWNER TO/J) I�K�_I-�1'�n I�I,I��-� MAIL ADDRESS CITV (��=Y� ti�rjA NO` CONSTRUCTION �Fti„Fa �.iutil� BFANCH ADDRESS necurTnEicce D�?��%��h.f.li�/��F�IC_S'Nr7�L'.'.-1 ADORE55 G�-L% K(', O�l. rt i'_ Ia�Jl�, �. . Fl . ^/�'L5 S.Y o G i I�"�l.'Sr i 1 CONTRACTOR � ' (.', _ � ADDRESS �p�2� �C�-'�'�'d�C/� '�U�% C.o S l�6e�.:�.-3 < NOL. u cirv `L�3-E99- i L C NO. �'� 3� 4',/�j LICyNO �j c 0. OF LOT GI� }[� L d� NOW ON l0 S I a USE OF � EXISfING BLOG dl i�.)ZA'L {�-� [ �? j y FSeparate pemdts are required for � electric, plumbing and heating work. [.�., USE OF BUILDIN6 AND WORK TO BE PERFORMED a r /N E.Llo.e •�%t 7r.7'/i7 �^�:.+� � r � m � a �� 4518UI I/I9/78 �`, I53420 TL FOR STRUCI'URAL PERMIT OATE RECEIVED nnTc iceucn .r 2�,_ /� � I PERMIT NO. BUILOING ��u ��/` � �� ADDRESS ( (�f/ TRACT LOT BLOCK � OWNER � L / ` � O�iy� A �� VAWE '�( �L $ FIRE . ZONE VE, GROUP APPROVED � � rc, � � ZOf�{G. � NO.OF � C.._r- v�o,ras � YARDS APPPOVED MAIN BUILDING VAR. # USE OF NEN��- Kj_� BUILDING ` lfV VAROS APPROVEO ACCESSORV BUIIDING BET. MAIN ACCESS.BL �MMTE APVROVED Q I �ereby acknowled9a thet I hava reatl ihis aOP��eNon entl ctnte p: Mef tha abova Informatlon is <orrect and egree io cnmplY with a all laws regulatinp puilAinp conftruction, antl I ahall not amploy Z ony varwn in vlolat�o� of the workman'a compensaHon lews ot SMa State of Ceiifor��e. 3 I hereCy eertify that I em properly Iicansetl as a contteemr untler S�, FT. Me Stnto of Calitor��a Business end Profeasionv Cotle, ONlsion 3, TME AMOUNT SHOWN UNDER VALU Chapter 9, antl thet sueh Ileenses ere In full torca an0 effoct, or I THE PURP06E OF ESTABLSHING A PERP em axempi from tha provislons of the Srote of Califprnle Bufineq VALUATION � PERMIT FEE E entl Profeszlona Cotle, Dlvislon 3, Chaptar 9. Sipnetura of �p� ^ �� P�N CHECK f Parmlttee /C•«� r/�1)/a7i�/i��/%�%S� /� /' S`,.�oOa TAX S r AuthorizatlApant ' �� TOTAI.PAID � n m i m m R m � a u� � m n 0 J LL f U 1 � �:' :�u387 '/ COSTA MESA BUILDING-SAFETY DEPAflTMENT i�� P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only ADDRESS 53y �• [��U�T OWNEF �2:�uy O�zoi�o�Prts ��s• MAIL f.L.T ADDRESS ��lR•IG �-Y/� M��i TEL. CITY NO. BRANCM ADDFESS AqCHITECT fJL, CONTRACTON TEL. CITY NO. F STATE CITV i LIC. NO. �I0. NO. a {t� SIZE NO.OFE 4 OF LOT NOW ON a USE OF �71�V.� n� � EXISTING BLDG. S/ �� y � Separate permits are requlred for Q electric, plumbing and heating work. (.W. USE OF BUILDING AND WONK TO BE PERFORM' Q , �1Za2rD� nl �,� �oPG� > � � a w a BUILDING TFACT zoN�L � 94fi7 7/ 14/78 _8 f'1.:66�: � i� V FOR STRUCTt1RAL PERMIT DATE FECEWEO �p�� 7-,�� ,�� j PEfl IT NO. � � ¢ G�./ , f��` S • 1� SJ LOT � BLOCK � I hereby acknowledtla that I heve reed chle evPlicatlon antl steta ' IY� Thet the ebove (nformaUon is eorraci antl epree io comply with a ell lawa re8uloting bulltling conrtruction, entl I shall not employ Z eny pa�san In violation ot the workmen's eompanseNon lews of ,� Ma Srote of Californ(e. 3 I heraby rerttfy thai 1 em properly Ifcansetl es a cOntractOr untler 5�. F the Sute of Cellfornie Businoss antl Profasslons Code, Dlvlsion 3, THE AMOUNT Chapter 9, antl ihat zuc� Iicenses are In full force antl eftect, or I THE PUFP06E ( am exempt from tha provtslons of Me Ste�e of Celifornie Business VALUATIpN enq Professions Cotle, Division 3, Chepter 9. Sipnaiure ot /� � Permittea $ P5D � yo u' Aut�orizetl AOent �'u,�i�[i(j ' PE GROUP '� � � DATE � � ZUSE OF NEW � BUILDING � ) VARDSAPPROVED M ACCESSORV BUIL,DING \„ \ FT. (� FT y FT. y� FT. BET. MAIN & 'ABLISHING A PERP PERMIT FEE S �� PLAN CNECK S TAX $ TOTALPAID E N n m > m J m e � m m 0 LL f �u �: !-��?V� �f COSTAMESABUfLD1NG•SAFETYDEPARTMEPJT f�"� P,p,BOX1200 COSTAMESA,CALIFORNIA92626 For Applicant to Fill in Completely — Use Ink Only BVILDING r.� /, , (/)� /=. ADDRESS � W �7 Jl OWNER D� � �N -/ �/�////�/�GY� MAIL ��tr ADDFESS � CITV (J�,�'� //i�p� NOL CONSTRUCTION F � � a a y h 2 F C w F a Q ..7 Q 7 %" �.d � W O. O � a z � S 3 BRANCH ADDRESI ADORESS �d CONTRACTOR ADDRESS CITV STATE LIC. NO. SI2E OF LOT USE OF .S �J��+w� �,� No`.{3� >�d�/c/�u.s'T. � TEL. NO. CITY LIC. NO. NO.OF BLDGS. NOW ON LOT Separate permits are required for electric, plumbing and heating work. 1 heraby eeknowletlpa tho2 1 hova reetl [his apPlication antl �teta Mat Ma above Intormatlon Is correct nntl apiea to eomply wIN ell laws ree�iatme bulldlnp conrtructlon, ontl I shall not amploy eny perwn in violetlon of the workmon's campensetion lows af Me Steta of California. I heraEy cartify that 1 am properly Ileonaatl ea a contractor untlar tho Stnta ot Cellfornie Businazs end Protassions Cotla, Olvialan 3, C�apter 9, end that sueh Iicenms aro In full force antl affxt, or I am exompt trom tha provislons of the Steta oi Calltornia Buainasa entl Profntsions ode, Dlvision 3, C�hapmr 9. � SlOnatura of �jfry/�//J� //iJyl l;fiiil'/� APPLICATION FOR STRUCi RECEIVEO BV ATE RECEIVEO A.P. NO. / S AD AIE 5 5.3��- TRACT � LOT ��"' PERMIT NO. L� VALVE S FIRE ZONE TVP APPROVED BV ZONE/{� NO.OF („ PLANS YARDSAPPROVED MAIN BUILDING (FROM C/LSTREET) FROM��FT. � A. SIDE � FT. � L SIDE O FT � REAR CL�.�O�� DISTANCE BEf. MAIN BLDGS. VAR.91E C.U.P. #�' I APPROVED /�, , n I.i i DATE \ �\0 USE OF NEW / \ BUILD�G Q 1' �� C' � r� AflDS APPROVED \ CCESSORV BUILDING F . � BET. MAIN ACCFSS. BL DATE APPROVED \� N n m i m m S�.FT. �`+ TNE AMOUNT SHOWN UNDER VALUATION IS FOR m TME PU E OF 6TABLISHING A P�RMR FEE ONLV: " � VALUAT N PERMIT FEE S a /l.f1n M /0 �� PLAN CHECK E v' o n LL S / �a TAX b � !i .,p TOTALPAID E