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Home My WebLink About548 19TH ST - Building Permits• � CITY OF COSTA MESA • BlIILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.wstamesaca.00v FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: E11-00244 PERMIT TYPE ELEC APN: 42210319 STATUS: ISSUED DATE ISSUED: 1013112011 ISSUED BY: KJB JOB ADDRESS: 548 W'19TH ST CM Suite/Unit: vicinity: SCOPE OF WORK: UPGRADE ATM LIGHTING. ADD 7 LIGHT FIXTURES TO THE BUILDING. .� OWNER: BANK OF AMERICA Address: 750 B STREET Unit:SUITE 1500 PHONE: . City/State/Zip: SAN DIEGO, CA APPLICANT: CAMPBELL, BRANDON PHONE: 4804404369 CONTRACTOR: GRACE ELECTRICAL CONTRACTORS Atldress: 247 E EL DORApO LNUnit: � CitylSfate: GILBERT, AZ � ZipCod'e: 85295 Pi ;':.i ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $33.80 Electrical Permit Fee: $67.60 Reinspection Fee $0.00 T�OTAL FEES $101.40 n; ;i i. Address: 247 E EL DORADO LN Unit: Ciry/Sfate/zZip: GILBERT, AZ License No. 967236 � PHONE: 480-0MIId369 ' - CELL: . �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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 'INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all �equired inspections and fnal approval must be obtained. Failure to obtain inspections and fnal approval will result in the expira[ion of this permit. LOpEi. INSPEC710NTYVE �]F N R �S�f,R INSPECTIONTYPE O�T i"nn"�s 7676 Fixetl System Final Fire Prevention �O6 Final Mec�aniwl '1266 Pod Spa Final 208 Final Plumbing �� 200 FinalReRoof 210 FinalEleCUiWI 207 Final Block/Retaining Wall p12 Final Fire Prevention 202 Final Factwy Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 FinalDemolition 250 FinalBuilding/Occupan�y � WORKERS' COMPENSATION DECLARATIpN: . I hereby aKrm under penalry of perjury one of the following declarations: ❑ I have and will maintain a certificate of cqnsent to self-Insure (or vrorkers' compensation, as provided for by section 3700 of the Labor Code, for ihe peAormance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as reQuired by section 3700 of the Labor Code, for the pertomiance of the vrork for which this permit is issued. My workers' wmpensation Insurance cartier antl policy number are: �}'' �iJ��_�'�co 1-hSkl�4��en_ e�.M ..��1 ilxisecponncatlnof6ecwnp/efoddlMpemtlisval�etorcnu Wtlars f1W)wkss.) icy Number.' w �'�%G �Z� � �{ ❑ I certity that in the performance of the work for which t�is permit is issuetl, I shall not employ any person in any manner so as to become subject to lhe vrorkers' compensation laws ol California, antl agree that if I should � become subjecf ro the workere' compensation Orovisions of Section 3700 0! Ihe labor �Code, /I shal�l forth ' com I�th Ihese provisions. � auua- �� / WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAVJFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND Al70RNEY'S FEES. LICENSED GONTRACTORS DEGLARA710N: I hereby aKrm lhat I am licensetl under provi5ions of Chapter 9(commencing with Section 7000) of Division 3 0( the Business and Professions Code. and my license is in full force and eHect. �_' �� $__ �G - l o ,,L aoess�9�ure �,qg�'� GONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a wnstruction lending agency for the perfortnance of the vrork for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Atldress: OWNER-BUILDER DECLARATIONS: I �ereDy affirm t�at under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollovring reason (Sec. 7031.5, Business and Professions Cotle: Any city or cqunry whic� requires a permit to construct, alter, improve, demolish, or repair any sWcture, prior to its issuance, also requires the applicant for such permit to fle a signed statement that he or she is licensed pursuant to ihe provisions of the Contraclors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or Ihat he or she is exempt therefrom and the basis (or the alleged ezemption. Any violation of Section 7031.5 by any applicaM for a permit suDjects the aDPliwnt to a civil penalry ot not more than five hundred dollars (5500).�: ❑ I, as owner of the property or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or oflered (or sale (Sec. 7044, Business and Pr0(essions Code: The Contractore License Law does not apply to an owner ol property who builds or improves thereon, and who tloes such work himself or herself or through his or her own employees, provided ihat suc� improvements are not intentled or oHered for sale. IC however. Ihe Ouilding or imD�ovement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose ol sale.). ❑ I, as owner of the properry• am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo construct the project (Sec. 7044. Business and Professions Code: The contractors License Law dces not appy ro an owner of property who builds or improves thereon, and who contract5 for such project with a contractor(s) license pursuant to Ihe Contractors License Laws.). ❑ I am exempt untler sec. 8usiness and Pm(essions Code (or lhis reasqn: SignaWre Date 305]-a6(3I0]) Owner ID verified by driver's�se. ❑ Yes ❑ No Driver's License No. Expires: Venfcation o( Ownership by (rype of document, i.e. - properry tax Dill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certiry that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection vnth work authorized by this pertnit, and that no building siructure, scaHoltling, falsework, or demolition or dismantling t�ereof, will be more than thirty-su (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ A5 owner-builder, I will not employ anyone lo do vrork which would require a pertnit from t�e Division of Intlusirial Safery, as noted above, unless such person �as a permit to tlo such work trom Ne division. pppliwm's Siqnalure Data Division of Industrial Safery Permii Num6er HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant neetl lo file antl ceAify a Business Plan for emergency response to release or threatenetl release of a hazardous malerial? ❑ Yes ❑ No (Section 25505 of ihe California Health antl Safety Code requires, with some exceptions, Ihat a Business Plan be filed with t�e Cosla Mesa Fire Department by every business which has at any one time during a reported year a quanlity of hazardous materials equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic teet of compressed gas at standard temperature and pressure). 2. Does or will Ihe applicant or present or future building occupant need to file a re8istration form lor acutey hazardous materials? ❑ Ves ❑ No (Section 25533 of Ihe California Health and Safery Code, vrith some exceptions, requires registration with ihe Costa Mesa Fire DeDartment by each business which a� any one time has on hand a quantiry o( acutety hazardous materials equal to or greater [han a weight of 500 pounds, or a valume ol 55 gallons, or 200 cubic feet of compressetl gas at stantlartl tempereWre and pressure). 3. Does or vrill the applicant or present or fuNre building occupant neetl to prepare an RMPP (Risk Management and Preveniion Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safery Code provides that the Costa Mesa Fire Department may require the prepa2tion, certifcation and fling with the Fire Department o1 an RMPP Dy 6usinesses which are repuired to register acutely hazartlous matenals with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require tor the work which is the subject of ihis aDPlication a permit for such construction or motliFlcation from Ihe South Coast Air Qualiry ManaBement District or from any other air pollution control district or a9ency? ❑ Yes ❑ No (Section 65850.2 of lhe Califomia Govemment Code requires Ihat the requested in(ortna6on be fumishetl on apPlications (or noo-residenlial builtlin8 Pertnits). 6. Will any part of lhe facility to be constructed under lhis permit be within 1000 leel from the outer bountlaries o( a school? ❑ Yes ❑ No (I( yes', lhe facility must meet ihe requirement of Sections 25534 and 42303 of Ne Califomia Heallh and Safery Cotle). 7. I( a permit from the South Coast Air Quality Management District or other air pollution conirol district or agency is required for Ihe work which is Ihe subject of this application, have all of the tlisclosures prescribed Dy Cali(ornia Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No 8. Qf yes', attach certifcate of compliance from ihe appropriate air pollution control offcer). CERTIFICATE OF COMPLIANCE: I certify thal under penalty of perjury Ihe information given above is correcL I agree to comply with all state laws and ciry ordinances regartling Hazardous Materials and Emissions. oeie CERTIFICATE OF COMPLIANCE AND AUTHORI7ATION OF ENTRY: I certify untler penalty o( perjury that I have read this application antl stale that ihe information given is cortect. I agree to compty vriih all state laws and ciry ordinances relating to building construction, and authorize represenlatives of the Ciry of Costa Mesa to enter upon the above-describetl property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by ihis Dermit until final inspection. �igna� of L al eqs ate c� p �+��'qPOtimert�.. t�O'A_T � � .. CITY OF COSTA MESA BIIILDING DIVISION + � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.d.costa-mesa.ca.us : °•,��, FOR INSPECTIONS CALL: (714) 754•5626 � PERMIT NUMBER: M09-00101 PERMIT 7YPE MECH Op APN: 42Z10319 � JOB ADDRESS: 548 W 19TH ST CM Vicinity: ROOF TOP SQ. FT: 0 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: FINALED 11105/2009 RMD SCOPE OF WORK: MECHANICAL PERMIT:CHANGE OUT 6 ROOF TOP PACKAGE HVAC UNITS FOR "BACK OF AMERICA". OWNER: BANK OF AMERICA NT AND SA K P M G PHONE: APPLICANT: MILLER, RAY PHONE: 661-257-0419 � CONTRACTOR: SUMMER SYSTEMS INC Address: 28942 HANCOCK PARKWAYUniC CirylState: VALENCIA, CA ZipCotle: 91355 MECHANICAL PERMIT FEE SUMMARY MECH IT�M FEE: � $225.30 PLAN CHpCK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $225.30 Address: SUI7E #1500 Unit:SAN DIEGO, CA CitylState/Zip: 750 B STREET Address: 28942 HANCOCK PARKWAY Unit: City/State/zZip: VALENCIA, CA - License No. 560229 ' PHONE: 661-257-44'19 CELL: NOTICE: The work authorized by this permit shall Comply w'dh all applicable handicap access requirements under Cali�omia staNles and related regulatlons. (Ord. No. 92-28, § 1. 12-21-92) EXPIRATION: PERMIT EXPIRES'I80 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed under this permit lo be considered legal, such work must comply with all applicable codes, and all required ingpeetions and final approval must be obtained. Failure to obtain inspections and fnal approval will result in lhe expi2tion of this pertnit. 0/ IMSPEC7pNTYPE O�E N iIRL C��E� INSPECTIONIYPE _ Q�/� N L / l 12..1 1818 Fixed System Final Fire Prevenlion 208 Final MeChanical �1�A��d.� 1266 Pool Spa Final 208 Final Plumbing 200 Final RB-Rool 210 Final Electrical 201 Final BIocWRelaining Wall � 212 final Fire Prevention 202 Final Fatlory Fire Place 220 Final Planning Approval 203 Final SiBn 222 FinalSite 204 Final Demdltion 250 Final Builtling�Occupanty WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalty of perjury one o1 the following decla2tions: ❑ I have and will maintain a certifiwle of wnsent to self-Insure for vrorkers' compensation, as provided for by section 3700 of the Labor Code, for the pedortnance ol Ihe work for which this permit is issued. ❑ I have arW will maintain workers' compensation insurance, as requiretl by sectbn 3700 of the Labor Code, fw the peAormance of the work for which this permit is issuetl. My workers' compensation Insurance carrier antl policy number are: Carrie[ (�nis sacYm n9ed rrot De mmpleled tlthe pe�mrt is valuetl or we nuntlree tlollars (5�00) a lass ) Policy Number: ❑ I certify Ihat in the pertormance of lhe work for which this permit is issuetl, I shall not employ any person in any manner so as to become subject to Ihe workers' compensation laws of Califomia, and agree that if I should bewme suhjecl to the v.nrkers' compensation provisions o! Section 3700 of the Labor Code, I shall fohhwith comply with these provisions. Appbwnl's Signalure Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensetl untler provisions of Chapter 9(commencing with Section 7000) ot Division 3 ot the Business and Professions Code, antl my license is in full force and effect. Lic. # Class # Cammctor's Sipnawre oa�e CONSTRUCTION LENDING AGENCY: ❑ I hereby alfirm Ihat there is a construction lending agency tor the peRwmance ol the Nork !or which Ihis pertnit is issue0. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Address: Da�e OWNER•BUILDER DECLARATIONS: I �ereby aKrm Ihal under penalty ol perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW !or the (ollowing reason (Sec. 7031.5. Business and Professions Code: Any cily or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement ihal he or she is licensed pursuant to the provisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 0! Ihe Business antl Professions Code) or thal he or she is ezempt t�erefrom and lhe basis for Ihe allege0 eaemplion. Any violation of Seclion 7031.5 �y any applicant (or a pertnit subjects the applicant to a civil penalry of not more than five huntlretl tlollare ($500).): ❑ I, as owner of Ihe property, or my employees vrith wages as their sole compensalion, WILL DO THE WORK, and the structure is not intended or oHered for sale (Sec. 7044, Business and Professions Code: The Conlractors License Law does not apply to an ovmer ol property who builas or improves thereon, an0 who does such wnrk himself or herselt or through his or her own employees. provided that such improvements are not intended or oflered for sale. If, however, Ihe builtling or improvement is sold vnthin one year of completion, the owner-builder will have ihe burden of proving thal he or s�e ditl not builtl or improve for purpose of sale.). ❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business and Professions Cotle: The contractors License Law dces not apply to an ovmer of property who builds or improves thereon, and who contracts lor such prqecl with a contractor(s) license pursuant ro Ihe CoNractas License Laws.). ❑ I am exempt untler sec. Business and Professions Code for this reason: SiB�aWre Dale ]OS]�d6(3/07) Owner ID venfied by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verifcation of Ovmership by (type of tlocument, i.e. - property taz bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavatbn Me (5) or more (eet in deplh into wfiic� a person is req�ired tro descend, will be made in connection with work authorizetl by tNs permil, and4hACno building struclure, scaffdding, falsework, a demolition or dismantling th�reofl wiA/ b ore�n thi�y-six (36) leet high. (Chap. 3.2. Grp 2, M 2,Sec. 341 � Itle (Cali i��Rd inislralive Code). ❑ As ovmer-bull&er,�I• O[ e�loy anyone lo do work which would require a permit (rom the Divisi�tlustrial Safety, as noled above, unless such person has a permil ro do such v.ork from Ihe division. AppbranCs SignaWre Date Division of InAustrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will lhe applicant or present or (uWre builtling occupant need lo file antl certify a Business Plan for emergency response to release or threatenetl release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Calilomia Health and Salety Code requires, with some exceptions, thal a Business Plan be filetl with the Cosla Mesa Fire Department by every business which has at any one lime tlunng a reportetl year a quantiry of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas at standartl temperaNre and pressure). 2. Does or will the applicant or present or fuWre building occupant nee0 to file a regislration form for acutely hazardous materials7 ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with ihe Costa Mesa Fire Department by eac� business which at any one lime has on hand a quantiry of acutely hazardous materials equal to or grealer than a weiqht of 500 pountls, or a volume of 55 gallons. or 200 cubic teet ol compressed gas at standartl temperaWre and pressure). 3. Does or will the applicaN or present or (uWre building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safery Cotle provides that the Costa Mesa Pire Department may require the preparation, cenification and filing with the Fire Department o( an RMPP by businesses which are required to register acutely hazartlous materials with Ihe Fire Department. 4. If an RMPP is presently required, has Section 25534 0( the Califomia Health and Salety Code been fully complietl wilh? � Yes ❑ No 5. DoeS or will the appliwnt or present or fulure building occupant require !or t�e work which is the subject of this appiication a permit br such consWction or modifcalion lrom Ihe South Coast Air Qualiry Management District or (rom any other air pollulion control district or agency7 ❑ Yes ❑ No (Section 65850.2 of the Califomia Govemment Code requires Itiat the requested in(ormatbn be fumishetl on applications for non-resitlential building pertnits). 6. Will any part of the (aciliry ro be constructed under this permit be vrilhin 7000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If'yes", the tacility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safery Cotle). 7. If a permit lrom the South Coast Air Quality ManagemeN District or other air polNtion coNrol tlislricl or aqency is required for the vrork which is the subject of this applicatioq have all ol lhe disclosures prescribed by Calibmia Heallh and Sa(ety Code Section 42303 been made7 ❑ Yes 0 No 8. Qf'yes", attach certificate of compliance fmm �he appropriate air polWtion control oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the in(ortnation given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenify under penalty o! perjury that I have read this application ana state that the information given is correcL I agree to comply with all state laws and ciry ordinances relatinq to builtling construction, and authonze represenlatives ol the City of Cosla Mesa to enter upon the above-descriDed property for inspection purposes. I agree not to occupY or allow occupancy of any Duilaing authorizetl by this permit until final inspection. SignaWre ol Lepal Owneqs) Wte An�lOr Aul�Onzea Applit'anl CITY OF COSTA MESA BYILDING DIV/S/ON 77 FAIR DRIVE, COS7A MESA, CA 92626 • Q74) 754-5273 • Fax (714) 754--0856 • www.ci.costa-mesa.ca.us PERMIT TYPE MECH APN: 42210319 FOR INSPECTIONS CALL: (774) 754-5626 �// PERMIT NUMBER: M09-00101 �\U �� v STATUS: FINALED DATE ISSUED: 11/OS/2009 ISSUED BY: RMD JOB ADDRESS: 548 W 19TH ST CM Vicinity: ROOF TOP SQ. FT: 0 Suite/Unit: SCOPE OF WORK: MECHANICA� PERMIT CHANGE OUT 6 ROOF TOP PACKAGE HVAC UNITS FOR "BACK OF AMERICA". OWNER: PHONE: APPLICANT: PHONE: BANK OF AMERICA NT AND SA K P M G MILLER, R4Y 667•257-4419 CONTRqCTOR: SUMMER SYSTEMS INC Address: 28942 HANCOCK PARKWAYUniI: Ciry/State: VALENCIA, CA 2ipCode: 91355 MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $225.30 PLAN CHECK FEE: � $0.00 INVESTIGATION FEE: $0.00 REINSP�CTION FEE: $0.00 TOTA� FEES: $225.30 Address: SUITE #1500 Unit:SAN DIEGO, CA Ciry/State2ip: 750 B STREET � � Add�ess: 28942 HANCOCK PARKWAY Unit CitylS[ate/zZip: VALENCIA, CA License No. 560229 PHONE: 661-257-04'19 CELL: NOTICE: The work authorized by this permit shall comply wilh all applica6le handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28. § 7, 72-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPEC7IQNS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval vrill result in the expiration ot Ihis permit. CODE t• INSPF�nONTYPE QRjF� IN AL C��E[ INSPEL710NTYPE � N P� n ��j 7616 Fieetl System Final Fire Prevention 208 Final Mechanical Z '�i �=u � 7288 Pool Spa Final 208 Final Plumbing 200 Final Re-Rool 210 Final ElectnCal 201 Finai Blak/Retaining Wall 212 Final Fire Prevention 202 Finai Fectory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Builtling/pccupanry WORKERS' COMPENSATION DECLARATION: I hereby aHirm untler penal�y of perjury one of the following declarations: - ❑ I have an0 will maintain a certifcate of consenl to self-Insure for workers' compensation, as provided !or by setlion 3700 of the Labor Code, for the pertormance o/ the work for which this permit is issued. ❑ I have antl will maintain vmrkers' compensation insurence, as requiretl by section 3700 of the Labor Code, for the pedormance of the work for which this permit is issued. My workers' compensation Insurance wrrier and policy number are: Cartier: (Tns sed.bn neetl nd 6e wrrrpl¢I¢C �I tlre pertn4 is valuM at me n��MieOWlars f51 W) cv less.) Policy Number: ❑ I certify that in the peAormance of the work lor which this permil is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia. and agree that if I should bewme subject to Ihe v.vrkers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith comply with these provisions. Applitanl'S $ignalure WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aRrm Ihat I am licensetl untler provisions of Chapter 9(commencing with Section 7000) ol Division 3 of the Business antl Prolessions Cotle, antl my license is in full lorce and eftect. Lic. # Class # COOIIdtld 5 CONSTRUCTION LENDING AGENCY: ❑ I hereby affum thal there is a construction lentling agency fa the peAortnance ol the vqrk ta wfiich this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender s Address: SipnaWre oate OWNER-BUILDER DECLARATIONS: 1 hereby affirm that untler penalty of peryury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business and Pro(essions Code: Any city or wunty which requires a pertnit to consWct, alter, improve, demolish, or repair any slructure, pnor to its issuance, also requires the applicant for such permit to fle a signed statement that he or she is licensed pursuant to lhe provisions ot the Contracrors License Law (Chapter 9(commencinq wit� Section 7000) of Division 3 of the Business antl Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violalion ol Section 7031.5 by any applicant for a permit subjects Ihe applicant ro a civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the siructure is not intended or oHeretl for sale (Sec. 7044, Business and Professions CoOe: The Contractors License Law does not apply to an ovmer of property who builtls or improves Ihereon, and who does such work himsell or hersell or Ihrough his or her own employees, provided that such improvements are not intendeC or oflered lor sale. If, however, the building or improvemenl is sold within one year of completion, [he ovmer-builtler will have Ne burtlen of proving that he or she ditl not build or improve for purpose of sale.). ❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construc[ the project (Sec. 7044. Business and Professions Code: The contractors License Law dces nol apply to an ovmer ol property who builtls or improves thereon, and who wniracts fw such projecl with a conVacta�s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Ovmer ID verified by driver's iicense. ❑ Yes ❑ No Driver's License No. Ezpires: Verification of Ovmership by (type of document, i.e. - propeAy tax Dill or deed�: DIVIS�ON OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: [� I I�reby certify that no excavation live (5) w more teet in tlepth inro vfiich a p��tl�ii5' d to descentl, will be made in connecibn with work authorizetl by�tfi�s p it, d o buil0ing struclure, scaf(dtling, falsework, or demolilion or tlismantlin ( I re than thirty-six (36) teet high. (Chap. 3.2, Grp 2, Put 2, Sed 34 , tlle Admini5lrative Cotle�. � � ❑ As owner-bu l�II ol employ anyone to tlo work which would require a permit Irom theY�u on of Intlustnal Safety, as noted above, unless such person has a permit to do such work lrom ihe division. ApPliWnl's SiB�aWre Da�e Division ot InduStrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will ihe applicant or present or luwre building occupant neetl ro file antl certily a Business Plan far emergency response to release or threatened release o! a hazardous material? ❑ Ves ❑ No (Section 25505 of the Calilomia Health and Safety Code requires. with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of �azartlous matenals equal to or grealer than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic leet of wmpressetl gas at standard tempereture antl pressure). 2. Does or will the applicant or present or fucure building occupaN neetl to file a registration lorm for acutely hazardous materials? ❑ Ves ❑ No (Section 25533 of Ihe Califomia Health and Salety Cotle, vrith some exceptions, requires regis[ration with the Costa Mesa Fire Department by eac� business which at any one time has on hand a quantity ol acutely hazardous materials equal to or greater Ihan a weight ol 500 pounds. or a volume ol 55 gallons, or 200 cubic feet ol compressetl gas a1 standartl temperaWre and pressure). 3. Does or will the applicant or present or Wture building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazartlous malerials�? ❑ Ves ❑ No (Seclion 25534 of lhe Califomia Health antl Safery Code provitles that the Costa Mesa Fire Department may require the preparation, certifcation antl fling with the Fire Department o( an RMPP by businesses which are requiretl to register acutely hazardous materials v+ith t�e Fire Depaement. 4. II an RMPP is presently required, has Section 25534 of the California Heallh and Safery Code been (ully complietl wiN1 ❑ Yes ❑ No 5. Does or will the appliwnt or present or fWure builtling occupant require for the work which is the subject o( this application a permit for such wnstruction or modification from the Swlh Coast Air Quality Management Dislrict or from any other air pollWion wntrol district or agency? ❑ Yes ❑ No (Section 658502 of the Calitomia Govemment Cotle requires Ihat the requested inlormation be lumishetl on applitations la rqn-residential builtlinq pertnits�. 6. Will any part of the facility to be conslr�cted under this permit be vrithin 1000 feel trom the ouler boundaries ot a school? ❑ Yes ❑ No (It yes", the lacili�y musl meet the requirement ot Sections 25534 and 42303 of lhe Califomia Health and Salery Code). 7. If a permit !rom the South Coast Air Oualiry Managemenl District or other air pollution control tlistrict or agency is required for the work which is the subject of this applicatioq have all o( Ihe disclosures prescribed by Calilomia Health anA Safety CoCe Section 42309 been made? ❑ Yes ❑ No 8. (If yes', attach certifiwte of compliance from the appropriate air polWtion wntrol oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the information given above is correct. I agree to comply with all state laws and cily ordinances regarding Hazardous Materials and Emissions. SipnaWre Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalty of perjury that I have read this applicalion and state that the in(ormation given is correcL I agree to comply with all state laws an0 city ortlinances relating to building construction, an0 authorize representatives of the City of Costa Mesa to enter upon the above�described property lor inspection purposes. I agree not to occupy or allow occupancy of any builtling aulhorized by �his permil until fnal inspeclion. Signawre ol legal Ovmeqs� 3051�a6(]/0]) MOlor AWhorrzetl Aodiwnl Date � CITY OF COSTA MESA � svao►N� oms�oN 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER. S607-00073 PERMIT TYPE B SIGN STATUS: ISSUED DATE ISSUED: 08/0112007 � - . . . —'-' �ISSUED BY: RMD JOB ADDRESS: 548 W 19TH ST'CM . � SuifelUnit vicinity: ' _ SQ. FT: � 0� -� � � - - - � � " Valuation: ' � �, $3,500.00 .,;,; ..: .. :` `� " �.' ,. �.�t. n ' ' ' � SCOPE OF WORK: FACE CHANGE OF FREESTANDING SIGN TOTALING 64 SQ FT FORs BANKOF AMERICA". . -,J- �> ;:(r'J', . `'kPi;� . OWNER: BANK OF AMERICA'NT AND'SA K P M G �Address:� SUITE 1500�.^Unit:SAN DIEGO, CA PHONE: � � City/State2p: r 7506�STREET � � ' APPLICANT: EREDIA,DIANE ,�, , ��-Address: 'Unit:. i � � . ��i PHONE: 909-721•7934 -�;�_ r.;, r ,,;,...� : ;_City/Slate/zZip; � ," i, ��,��; ".". CONTRACTOR: COAST SIGN�WG-�' ��' -' License No. ' 654238 � �� Address: 7500 W EMBASSY STUnit: � � � PHONE: 800c786-2375 ' City/State: - ANAHEIM„CA . -,ZipCode. 92802;', � ;�� ', CELL:�. 714=520=9144 � , � . , � ��', . . , ..._ . - r' _ _ ' . � ARCHITECT: � � \, • - . Litense No. ' �-• PHONE �'-, ENGINEER: ' ' ' , , - ."License.No:.- -' _ - `:'�� PHONE:.'� ._.. : , �,,. s„ . - .� - .., . , >�.. �:;i � . ..� . - . . .. . r=; ;' SIGN PERMIT FEE SUMMARY• " � . ; i . , PLAN CHECK FEE: �� f $6321 � � _ .; � � - � HOURLY�PC FEE: � ]' � ; $0.00'. �, � ' ' - PERMIT FEE: . ,$9725 �.: ; ;".. . :,��.. .... � , . ELECTRICAL FEE: '$0.00. • SMIP FEE: ' '=.v$0�.74 � � � � � - OTHER: � � �_• $0 00�� ,� �, , . '"' . ,,,,.,;:- ' - INSPECTION: , $000_.,� +�'y, c TOTALFEE: 5161.20 ' i�;y;,�-.�.,:� -- NOTICE: The work authorized by this permit shall comply vrilh all applicable handicap access requirements under California statutes and related regulatlons. (Ord. No. 92•28, § 1, 12-21-92) ' • EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. ' . INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply wilh all applirable codes, and all required inspections and flnal approval must be obtained. Failure to obtain Inspections and final approval will result in the expiraUon of this permit. 40oE 1. 1816 1268 200 201 202 203 204 . � iNsvEcnox rme Fixed System Final Fire PrevenUon Pool SDa Final � � Final Re-Roof � Final Block/Retaining Wall Final Factory Fire Place Final Sign Final Oemolilion sooe� iNsrecnoNirve ZOB Final Mechanicel 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevenlion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy Py� IW111�RL5 WORKERS' CONPENSATION DECLARATIO� , I hereb'� aniirn�under penalty of perjury one of th ovnng declarations: ❑ I have and will mainlain a certifwte of consent to self•Insure'for vrorkers' compensation, as provided for by section 3700 of the Labor Code. for the pedormance of the vrork forwhich [his permit�is issued. ' ❑ I have and will maintain wnrkers' compensation insurance, as required by section 3700 of the Labor Code, for the peAortnance o( [he vrork for which this permit is issued. My workers' compensation Insurance carrier and policy number are: f /� J CCartier:, � iT'1K) ✓�1 �M'� � , (ihis sectbn nee0� n7ot be wmpla,(netl i/fth1anp�evmd/is� valu�e1d af one �oMretlOdlars (51001 arbsSJ POIIcy,Number: –7�D �%'v � � Il�"l JZ� � ❑ I certify that in lhe peAortnance of tha vrork for which this permit is issued, I shall not employ any person in any manner so as to become subject to Ihe workers' compensation lavrs of Califomia, and agree Ihat if I should become subject to the vrorkers' compensation provisions of Seclion 3700 of lhe Labor ode, I all forthwilh comply with lhese provision �� icam's Slgneture ��a' WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) o( Division 3 of the Business and Profe55ions Code, and my license is in full torce antl eRect. �---�� L c� #�� . CI� ass #-� �� -I -D'1 nuatlor'sSignaWre_'T � Dale—�� —_ _ .� CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a constmclion lending agency for the peAwmance o( Ihe wvrk for which this pertnit is issued. (Sec. 3097, Civil Code). Lender 5 Name: Lender's AtlCress: Signalure Dale OWNER•BUILDER DECLARATIONS: I hereby aHirm Ihat under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any struc[ure, prior to its issuance, also requires ihe applicant for such permit lo �le a signed slatement Ihat he or 5h8 is licensed pur5u0nt [o the provisions of the COMrattor5 License Law (Chapler 9(commencing with Section 7000) of Division 3 of ihe Business antl Professions Cotle) or tha[ he or she is exempt lherefrom and ihe basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appliwnt to a civil penalty of not more lhan (ve hundred dollars ($500).): � I, as owner of the property, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and the structure is not intended or oftered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of propeny who builds or improves lhereon, and who does such vrork himself or herself or [hrough his or,her ovm employees, provitled that such improvements are not intendetl or oHered for sale. If, hovrever, the building or improvement is sold within one year of wmpletion, the ovmer-builder will have the burtlen;of proving thal,he•or she did not build or improve for purpose of sale.). ❑ I,.as owner of.the•property, am EXCLUSIVELY CON7RACTING WITN LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Pro(essbns Code: The.coniractors License Law Gces not appty to an rnvner of propeny who builtls or improves thereon, and who contracts tor such project vrith a contractor(s) license pursuant to the Comractors License Laws.�. ❑ I am exempt under sec. Business and Professions Cotle (or this reason: 3059-46 (3/W ) Owner ID verifed by dn�se. ❑ Yes ❑ No � Driver's License No. Expires: Verification'of Ovmership by (rype ot tlocument, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � '� ❑ I hereby ceAAy that no excavalion frve (5) or more feet in depth into which a person is required to descend, will be made in connection with work aulhorizetl by this permit, and that no building struc[ure, scaffdding, false�wrk, or tlemolition or dismantling ihereof, will be more than Ihirty-siz (36) (eet high. (Chap. 32, Grp 2, M 2, Sec. 341, Title 8, Cali(omia Administrative Code). ❑ As ovmer-builder, I will not employ anyone to do work which woultl require a permit from the Division of Intlustrial Safety, as noted above, unless such person has a permit to do such vrork (rom the division. Apdiwm's Sig� Wre Date Division of Industrial Safery Pertnit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe appliwnt or present or 1uWre building occupant neetl to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the Califomia Health antl Safery Code requires. wilh some ezceptions, that a Business Plan be tlled with the Costa Mesa Fire Department by every business which has at any one time tlurinq a repoAed year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas at standard temperaWre and pressure�. 2. Does or will tha applicant or present or future builAing occupant need to file a registration form for acutely hazardous materials7 ❑ Yes ❑ No (Section 25533 of the California Heallh antl Safely Code, with some exceptions. requires registre[ion with the Costa Mesa Fire Department by each business which al any one time has on hantl a quantity of acutely hazartlous materials equal to or greater than a vreight ot 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure�. 3. Does or will the applicant or presenl or Wture building occupant need to prepare an RMPP (Risk Management and Prevenlion Program for acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of the Califomia Heallh anG Safety Cotle provides lhat the Cosla Mesa Fire Department may re�uire the prepara[ion, certification anC fling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presenlly requiretl, has Section 25534 of the Califomia Health and Safery Cotle been fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or present or future builtling occupant require for the wnrk which is the subject of this application a permit for such wnstruction or modi(cation from the South Coast Air Quality Management Dislrict or from any other air polWtion control distnct or agency7 ❑ Yes ❑ No (Sectbn 65850.2 of t�e Califomia Govemment Code requires that the requested infortnation be fumished on applications for rron•resitlential building pertriits�. 6. Will any part of ihe faciliry to be consWcted unCer [his permit be wilhin 1000 feet (rom the outer boundanes ot a school? ❑ Yes ❑ No Qf "yes", the tacility must meet the requirement of Sections 25534 and 42303 of 1he Califomia Health and Safery Code). 7. If a permit irom che South Coast Air Quality Management District or other air pollulion control district or agency is requiretl for the work which is lhe subject of this application, have all of the disclosures prescribetl by Califomia Health and Safety Code Section 42303 been made7 ❑ Yes ❑ No, 8., Qf yes", attach certifcate of compliance from the appropriate air pollution control offcer). ' - � CERTIFICATE OF COMPLIANCE: I certity lhat under� penalty of perjury the infortnation given above is covect I a9ree to comply with all state laws and city ortlinances regarding�Hazardous Materials and Emissions: . SignaNre �ale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application anE state that the infortnation given is cortect. I agree to comply with all state laws and ciry ortlinances relating to building consWction, antl authorize representatives of the City of Costa Mesa to enter upon the above-tlescribed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S�g � o! LeBal Ovmer�s) Dale �"�/-O� tll quthwize0 Applican� Dat� �� CITY OF COSTA MESA � BUILDIMG DMS/ON � s 77 FAIR DRIVE, COSTA MESA,.'CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.c�i.costa-m�e a.ca/.y� FOR INSPECTIONS CALL: (714) 754-5626 � / � . , . PERMIT NUMBER VSB07-00072 PERMIT TYPE B SIGN STATUS: ISSUED DATE ISSUED: 0810112007 ` ISSUED BY: RMD -:i;�'�� 5� .. _ JOB ADDRESS: 548 W 1gTH ST CM�''� � �� Suite/Unit:; .� Vicinity: � . ' . ��, . , - . ' � � : . , -� SQ. FT: 0 �- ' � � Valuation:� �� 55,500.00 , , „�, .- . � . � � :r�� . SCOPE OF WORK: FACE CHANGE FOR�2�(E) 41 SQ FT (EACH) BUILDING SIGNS"FOR "BANK OF AMERICA". SIGN ON NORTH OF BUILDING FACING RESIDENCES TO'BE�NON-ILLUMINATED. �' ' � �. ,�. ;, i , OWNER: BANK OF AMERICA NT SA K�P M G Address: ' SUITE 1500 Unit:SAN DIEGO, CA PHONE: - , i-" ' � � � " �CitylStatelZip: 750 8 STREEY . APPLICANT: EREDIA, DIANE � , ,; t �. � r , �� , � , . Address: ' Unit: � �� . PHONE: 909-721-7934 � .,� �' ; • Ciry/State/zZip: . . � .� � � � � � CONTRACTOR: COAST SIGN INC '� � � � � � License No. 654238 � . `� � Address: 1500 W�EMBASSY STUnit: �� `� --. �- PHONE: 800-786-2375 � City/Staie: ANAHEIM, CA ZipCode.�..9280Y '. _ - - � � - � `' ' � CELL: 774-520-9744 ' ' ARCHITECT: � � � , _ � - .�License�Nb.-'- - . � . �'. -- � �. �PHONE� , �.,� �' ��, .._. • . ENGINEER: � � �i� -'��-License�No: : . - , - �� PHONE � _ _ .. ' � . � - , ' , . ii SIGN PERMIT FEE SUMMqRY`,� �� • � � . ;.` PLAN CHECK FEE: . i $81.41 �, ,,:,'.,�.. - , „ ,' _ HOURLY PC FEE: $0.00 ' ,, PERMIT FEE: � , , . $125:25 � � `. , _ �, � : � ELECTRICAL FEE: . $0.00 , SMIP FEE: '..,$1.15.,.',.�- �;.... �' . — . . OTHER: $0:00"::. " � r�;��:r , . _.. w._ - INSPECTION: $0.00'�;�"�.'• - � � � .. . TOTAL FEE: $207.81 � - - , NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1. 12-27-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTlONS: In order for the work authorized under fhis permit to be considered legal, such work must comply with all apP�icable codes, and all requlred inspections and final approval must be obtained. Failure to obtain inspections and final approval wili result in the expiration of Nis permit. CODE t. INSVEC710N TYPE 1818 Fixed System Final Fire Prevention 1288 Pool Spa Final � 200 FinatRe�Raol 201 Final Block/Retaining Wall � 202 Final Factory Fire Place 203 204 Final Sign Final Dertrolition �jE INTRIRLB CODE� �NSPECIIONTYPE ZOB Fina� Mec�aniwl 208 Final Plumbinp 210 Final Electrical , �c.1� ii , /' � 212 220 Final Fire Prevenlion Final Planning ApDroval 222 Final Site 250 FinalBuilding/Occupan�y E,IE ixnn��s � WORKERS' COMPENSATION DECLARATIO� I hereby aKrm under penalty of perjury one of lh wing declarations: ' ❑ I have and will mainlain a certificate of consent to self-Insure for viorkers' compensation, as provided for by section 3700 of the Labor Code, for the peAormance of the work for which this permit is issued. � � ❑ I have an0 will mainlain �wrkers'tompensatbn insura�e. as required by section 3700 of the Labor Code, for the peAormance of tha wark fw which this pertnit is issued. My workers' compensatlon Insurance wrrier and policy number are': 1 � ('1 1 �Carrier.- T"l O1 i'I"��YOI S1h � (Thu seUiDn neednof �e Cqnpleletl / Me pw�m.nd'u valuetl al bre �untlrBtl GOHars ff Ip0) orless.) Policy Number: ��n (A iN M� �'-1 �7Z I d ❑ I certify that in Ihe peAormance of lhe work for which this permit is issued, I shall not employ any person in any manner so as to become subject to Ihe workers' wmpensation laws of Califomia, and agree that il I shoultl become subject to the workere' wmpensation provisions of Section 3700 of the Labor Cotl I shall o hvrith comply with Nese provisions. g-l-07 A i nl'eSiB aWre Date� L-- J �---) WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, INTEREST, AND AiTORNEVSFEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing vrith Section 7000) of Division 3 af lhe Business antl Professions Code, and my license is in ✓(ull f rce and eflect. /! U Lic. #. -, � J �� Class.#_ l (.. ' l � $"-1--1� � Co VacloYSSipnaWre � Dam--J L�_ � CONSTRUCTION LENDING AGENCV: ❑ I hereby affum that Ihere is a construction Ientling agency fp lhe peAwmance of the �wAc for wfiich ttvs pertnit is'ssued. (Sec. 3097, Civil Code). Lender s Name: Lender's Address: Sipnawre � Dale OWNER-BUILDER DECLARATIONS: I hereby affrm that under penally of peryury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the follawing reason (Sec. 7031.5, Business antl Professions Code: Any cily or wunty which requires a parmit to construct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires the applicant for such pertnit to file a signed statement thal he or she is licensed pursuaN lo the provisions of the Contractore License Law (Chapter 9(commencing with Section 7000) of Division 3 af the Business anC Professions Cotle) or lhat he or she is exempt lherefrom and the basis tor the allegetl exemption. Any violation of Section 7031.5 by any appliwnt for a permit subjecis the applicant lo a civil penalty of not more than five hundred dollars ($500�.): ❑ I, as ovmer of the property, or my employees with vraqes as iheir sole compensation, WILL 00 THE WORK, and the structure is not intended or oftered for sale (Sec. 7044, Business antl Prolessions CoCe: The Contractors License Law does not apply to an owner of properly who builds or improves lhereon, and who Ooes such work himself or herself or through his or her ovm employees, provided that such improvements are not inten0etl or offeretl for sale. If, however, the buil0ing or improvemenl is sold within one year of completion, the ovmer•builtler vrill have Ihe burden of proving that he or sha ditl not build or improve for purpose of sale.). ❑ I,.as�ovmer o( the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo constiuct lhe project (Sec. 7044, Business and Professbns Code: 7he contractors License Law dces not appty to an ovmer of property who builtls or improves thereon, and wfio contracls for such project with a cmtractor(s) license pursuam to the Contractors License Lavrs.). ❑ I am exempt under sec. Business anC Professions Code for this reason: 9pnature . Da�e ' 3057<s (3IOl) Owner ID veri(ed by dri�se. ❑ Yes ❑ No �� Drivers License No. Expires: ��Verifcation ol Ovmership by (type of document, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:� ❑ I hereby cetlAy that no excaval'an Me (5) or more feet m depth into which a person is requiretl to descend, will be matle in connecti0n with work au�horiZetl by ihis permit, antl that no building struclure, scaffdding, talsework, a demolition or dismantling thereof, vnll be more than thiny-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Title 8, Califomia Administralive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as notetl above, unless such person has a permil to do such work from the division. AppliWnl'3 SignaWre DiviSion of InduSlrial Sa(ely Pertni� Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or presenl or future building occupant neeC to file antl certify a Business Plan for emergency response to release or threalaned release of a ha2ardous material7 ❑ Yes ❑ No (Section 25505 of the California Heelth antl Safety Code requires, with some exceptions, that a Business Plan be flled with the Costa Mesa Fire Department by every business which has at any one time dunng a reportetl year a quantiry of ha�rdous materials equal to or greater than a vreight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compresseC gas at sWntlard tempe2ture and pressure). 2. Does or will the applicant or present or tuture building occupant need to file a registration fortn (or acutely hazartlous materials? ❑ Yes ❑ No (Section 25533 of the Cali(omia Health and Safety Cotle, with some exceptions, requires registration with the Costa Mesa Fire Department by each Ousiness which at any one lime has on �and a quantity of acutely hazartlous materials equal to or greater than a weight of 500 pounCs, or a volume of 55 9allons, or 200 cubic teet of compresseE gas at standarC temperature and pressure�. 3. Does or vdll the applicant or present or future building accupant need to prepara an RMPP (Risk Management and Prevention Program for acutety hazardous materials)? ❑ Ves ❑ No (Section 25534 ot the Calitomia Health and Safey CoCe provides that the Cosla Mesa Fire Department may require ihe preparetion, certification and filing with t�e Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of lhe Calitornia Health and Safety Code been (ully complietl with'! ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require tor the vrork whith i5 Ihe 5ubject of thi5 application a pertnit (or such con5truction or motli0cation Irom Ihe South Coast Air Quality Management Dis[rict or from any other air pollulion wntrol tlistnct or agency7 ❑ Yes ❑ No (Sectbn 65850.2 oi ihe CalNomia Govemment Code requires that the requested inlwmatbn be fumished on applications for ran-resitlential builtlirg permits�. 6. Will any part ot tha facility to be constructed under this permit be wilhin t0001eet from I�e outer bountlaries of a school? ❑ Yes ❑ No (If yes", the tacility must meet the requirement of Sections 25534 and 42303 of Ihe California Health and Safety Cotle�. 7. II a permit �rom the South Coast Air �uality Management DisMct or olhar air polWtion control district or agency is requiretl for the wvrk which is lhe subject of lhis application, have all of the disclosures prescribetl by Califomia Health and Salety Code Section 42303 been made4 ❑ Yes ❑ No, 8. (If'yes", atlach.certificate o( compliance trom the appropriate air pollution cantrol o�cer�. . CERTIFICATE OF COMPLIANCE: I certily that under penalty�ol perjury lhe information given above is cortect. I agree to comply wit� all state laws and ciry ortlinances regartling Hazardous Materials antl Emissions. � � CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry of perjury that I have read this application and slate thal the inlormation given is correct. I agree to comply with all slate laws antl ciry ordinances relating to building construction, antl authorize representatives o! the City of Costa Mesa to enler upon the above-described property Iw inspection purposes. I agree.not to occupy or allow occupancy of any building authorizeC by this pertnil until final inspeclion. Sig ur gal Ovmeqs) Oale _ �-I -D7 �"AnG/o Aut� tlietl�Appl�rant� Dale �� '� � (714) 754-5273 • F� (714) 754-4856 • www.ci.costa-mesa�y��MBING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 548 W 19TH ST Suite No Viciniry: Parcel Nunmber: 42210319 � � � npp�icane GARY VERHOLTZ - ISSUED Bv: Address: 2184 BASELINE RD - � � ' " � CA � � � Phone: 909•392-8676 " � � LA VRENE - � � , Zip: 91750 - � �i .� � � Owner: .BANK OF� AMERICA NT-8 SA %K P M G Address� . SUITE #1500� ': � � � - � � - � � �'SAN DIEGO, CA = � : " - Phone: � � 750 B STREET �%�� -- � Zip: 92101 i ,/i"-. . /', . i.� -.� Contracror.:� VIS ; ; � ii ; , Address:; 2784 BASELINE RD " � � CA � %'- Phone: 909-392-8676 - LA VRENE . Zip: 91750 ' License: 765680 � . . � i . � .a� �' � ,: . �r ' , _-.. , , . /� �\' EMERGENY REPAIR FOR AN �SLWE. � � Status: ISSUED Applied: 12/142006 Issued: 12/142006 � . . AMT QTY � �. ; ,� - _ -AMT gTY .�, � sT ISSUE�FEE $23.50 ��LaundryTub/Washer -�$0.00 � -0�._� \SumpPump 50.00 0 Backflow irrigation $0.00 0� Landscape Irrigation $0.00 . 0� Swimming Pool 50.00 0 BackFlow Preventer -. 50.00 0�� P-Trap �� 50.00 0� Trep Primer 50.00 0 Bathtub 50.00 0 .. ..� Pressure Regulator .$O.QO� ;� 0 . Urinal 50.00 0 Clarifier System 50.00 0, - Proce'ss Piping.(pei 10 (t) $0.00 ,�� -0�_ '•:�: � Vacuum Brkr BkAow(1-4) $0.00 0 Connect�(Ice,Soda,etc)�,,. $0.00 0��'_.� --Receptors:�__ • 50.00' y0-.. . VacuumBrkrBkflow(5+) - g0.00 0 Dental Uniis ,� g0.00 0�. Septic Tank -$0.00 ;� 0 Wash Basin � 50.00 0 Dishwasher- '' 50.00 0� Sewer Cap for Demo 50.00 0 Wash Basin Sal $0.00 0 Drain, Floor � 50.00 0 Sewer Connect $0.00 0 � Waste and Vent System 50.00 0 Drain, Rainwater ' S0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) 50.00 0 Drein,Root ' � 50.00 0 Shower 50.00 0 WaterHeater/vent 50.00 0 Drinking Founlain . �,50.00 0 Sink, bar - 50.00 0 Waler Piping (Inst or Rep.) 50.00 0 Expansion Tank � �$0.00 0 Sink, commercial $0.00 0 Water Re-pipe 50.00 0 Gas Earthquake Valve `, 50.00� , 0 Sink, Floor ' S0.00 �'- � 0 Water Service 50.00 0 Gas (1-4 outlets) , 50.00�� 0.- � Sink, kitcheo .� 50.00 0 Water Softener 50.00 0 Gas (Over 4 outlets) 50.00 �� 0 � Sink, servicelmop 50.00 0' �� OTFIER 50.00 Gas Repipe , `� /39.80 '-1�� , . Spa (private) , 50.00 0 VIOLATION SODO Gas Service -� . �- ' S0.00 � 0�� -,; Spa (public)' S0.00 � 0 - PLAN CHECK 50.00 � Interceptors (Grease, Oil) �50.00�= . �0; �� ; � �_ � " - , �' � RE,INSPECTION 50.00 0 Intercepiors (Sand Auto )rA30.00" ( 0- � � � '` � � - - � � � . - � �! - �. � � i �� i�_ � - ' TOTAL CALCULATED FEES: 533.30 _ . . .. �� , ' . , � � � COMMENTS / SPECIAL CONDITIONS _ � ' _ : ,..• NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. g2-28, § i, 12•21•92) E%PIRATION: This permit shall automatically expire and become void il work is not commenced within 1B0 days, or if work Is suspended or abandoned for a period ot 1 BO days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply wNh all applicable codes, and all requlred Inapactions and final epproval must be obtained. Fallure lo obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: {714) 754-5626 244&481bN0) ' -. WORKERS' COMPENSATON DECLARATION: I hereby ettirm untler penalry oi perjury ona ot the fdlowing dedarations: ❑ I have en0 will maintain a cenificate of consent to sel6lnsure fw xrorkers' mmpensetion, as prwideA tor by section 3700 oi the Lebor Code, for tha peAortnance of the c tor w�iU IhiS Permi� Is iuuetl. aft �an will maintain warkers' compensatlon insurance. es reQuired by section 3700 of the Labor Catl . ortnance ol lhe work tar wNch this p¢rrttit is issuetl. My warke ' compe �� Inw nce rrier and pdi�y number ere: ) Cerrier �'f'g� �N� iryNumber: 1 Sa'II7� —� IjdjSsec!(on need nof bB canp/efed ll fAe permi! is ve/ued a( one hundred dollars ($100) or /esS.J ❑ I ce ' ' �e portormanca ot Ihe work tor which fhis permit is issued, I shall not employ eny person in eny manner so es to become subject to the workers' m on la at Calllamla, end agree th t If I ahoula B�me subject to t�e workers' compensatlon provislons of Sectlon 3700 0l t�e Lebor Code, I shall lonhwith ply with ihesa ov �i A pllceN Si — ( �/ — C�(O WARNINQ: FAILURE TO SEGUFE WORKEPS' CO PENSATION COVE GE IS UNLAWFUL AND SHRLL SUBIECT�� IMINAL PENAlTIES AND CIVIL FINES UP TOONE MUNDRED T1/OUSANDDOLURE(I100,�)�IN/DdTIdJT THEWSTOFOOMPENSATION,DAM4GESMSPROVIDEDFORINSECTIIXJ3]OBOF�HEUBORCAUE,IMEREST,/NDATfORNEY'SFEES. DECLARATION: Slgneture: ol C�apter 9(commencing with Section 7 o Dlvision 3 0l the Bu ess end Prolessions Catle, antl my license is in lull � 5� c-3� p �— Dele: C'ONSTRUCTON LENDING AGENCY: ❑� I here�y eHirm thet �here is e construction lentling egency tor t�e pedormance of i�e work lar w�ich ihis permit is issuatl. (Sec. 3097, CiWI CoAe). Lentler's Neme: Slgnelure: _ OWNEP•BUILDER DECI-�NAnONS: Lender s AAdress: Oate: I hereby eHirtn that untler penalry ot perJury Ihat I am E%EMPT FHOM 7HE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry w�ich requires a pertnit to construct, alter, imprwe, tlemdish, or repair any siructure, pdor to its issuance, alw requires t�e applicant tor such permit ro fle e signetl statement t�at �e or s�e is licensetl pursuant to �he provisions oi Ihe Contrectors License Law (Chapter 8(wmmencing wilh Sectlon 7000) oi Division 3 of tha Business end Profession3 Cede) or t�at he or she is ezempt Itiarefrom and the basis for Ihe ellepetl exemption. Any Wolation ol Section 7031.5 by any applicant tor a pertnit subjects 1he applicant l0 8�vil penalty af not more t�an tive huntl�eA dollars (5500).): ❑ I, as owner ol Iha ploperry, or my employees wtlh wages as t�air sole compensation, WILL DO TME WORK, antl the simcture Is not intendetl or oHeretl tor sale (Sec. 7044, Business and P�ofessbns Cade: The Cont2ctors license Law dces not apply to an owner of properry who builds or improve5 Ihereon, and who dces such work himsalt ar hersetl or ��ough his or her own employees, provided that such imprwements are not intended or oHeretl tor sale. If, however, the building or improvement is sold within one year of completion, ihe owner-builder will have the 6urden of pmWng that he or she tlitl not build or improve lor purpose of sale.). ❑ I, as owner ot the p�operty, em E%GLUSNELY CONTAAC7ING WITH LICENSED CONTRACTORS to construct the project (SacJ044, Business antl Professions Cotle: The contreclOrs License Lew does not apply to an owner of property who builtls or Improves thereon, entl who coniracts lor such project with a contracror(s) license pursuant ta Ihe Contractors License LawsJ. ❑ I am exempt unEer Sec. Busineu and Professions Cotle lor ihis reason: SlgnaNra: Date: Owner ID vertlletl by tlrivers liCenSe. ❑ Ves ❑ No DnverS LiCense No. Verilication ot Ownership by (lype of tlwumenC i.e. - pmperty taa bill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMI7 CERTIFICATION: Expires: ❑ I hereby cenity thel no excavation tive (5) or more feet in depih into which e person is required to tlescend, will be matle in connectio� wlih work authorizetl by �his permit, and t�at no builtling structure, scaMoltling, lalsework, or demolition or dismantling thereol, will be more Ihan thirty-six (36) leet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Titla 8, Cellfom�a Atlminisiretive Code). ❑ A5 owner-bulltler, I will not employ enyone to do work which would repuire e permit Irom the Division ol Industrial Selety, as notetl ebove, unless such person has e permit to Co such work �rom Ihe Aivision. Signeture: Date: Division af Industnel Satery Permil Number: CERTIFlCATE OF COMPUANCE AND AUTHOROA710N OF EMRY: I certity untler penalry ot perjury that I �eve reatl this ep0��ion and state that the infortnation given is correcL I egree to comply with ell stete lews end ciry ordlnances relating to builAing construction, antl euNodze representatives of ihe dIy of Costa Mesa to enter upon the ebove-descnbed pmperty lor ins0ection purposes. I egree no� to oaupy ar allow occupancy ot any building aulhorized by this permit until linal inspection. [3•I �I��f:F99�3i[7ii�17 � 1816 FIxeE System Final Fira Preventlon 1266 Pool Spa Finel 200 Finel Re-Rool 201 FIneI BIxWRetelning Well 202 Finel Factory Firo P�ace 203 Finel Sign 204 Finel Demolitlon Da e /�-i�t-D� � Date CODEr IxSPECl10NTYPE � 206 Final Mechanical 200 Fina1 Plumbing 210 Final Elecirical 212 Finel Flre Prevention 220 Finul Planning Approval 222 Final Site � 250 Finel Building/Occupancy (714) 754-5273 • FeX (714) 754-0&56 • www.ei.costa-mesa.��y�LDING PERMIT �� FAIH UHIVt, GOSIA MtSA, GA 8Yti2ti Job Address: 548 W 19TH ST Suite: Viciniy: Primary Occ: B Eat<50l OKcel Bar<50 Parcel Number: 42210319 npplicant: WESLEY SMITH Address: Type of Construdion: V-N Zoning: Phone: 562-944-1753 Zip: Owner: BANK OF AMERICA NT 8 SA %K P M G Address SUITE#1500 � _ , ' SAN DIEGO; CA � � � Phone: 750 B�STREET �� - . � - Zip: 92101 � Contrac(or. BLIGH.ROOFING CO . " Address: PO BOX 3083 - . . Arch : Address: Zip: SANTA FE SPRINGS, CA Zip: 90670 � "� �� Phone: Lioense: Phone: 562-944-9753 License: 339215 Eng: Address: SCOPE OF PERMIT REMOCE EXISTING AND F2EROOF 10400SF COMMERCIAL BUILDING W/BUILT-UP. ROOF TO COMLY W!T-24 ENERGY REQUIREMENTS FOR COOL-ROOFS FEE SUMMARY Plan Check: $0.00 Permik $1,195.35 SMIP Res: $13.55 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: ` $1,208.90 : ' PLANNING 8 ZONING Status: ISSUED Applied: 02/08l2006 Issued: 02/08I2006 ISSUED BY: � �1 Phone: License: Calc Valuation: S�ss,Soo.00 Claim Valuation: 5t3s,5oo.00 SETBACKS � MAIN STRUCTURE Front � 0- 0 -. Rear 0. 0 Left 0- 0� � Right 0. 0 ACCESSORY Front 0-0 ��„ Rear 0-0 � Left 0-0 Right 0-0-' , ,. , i . - - - . PARKING� � ' Existlna:' 0� � Reauired:_ 0 Proposed: 0 � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Ca�ifomia statutes and related regulations. (Ord. No. 9248, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 1B0 days, or it work is suspended or abandoned for a period of 780 days. INSPECTIONS: In order tor the work eulhorized under this permit to be consitlered legal, such work must comply with all applieable codes, end all requlred inapeetlone end finel epproval must be obtained. Fallure to obtain inspections end final approval will result in ihe expiratlon ot this permit. FOR INSPECTIONS CALL: (714) 7545626 zas�ae �aroo� � v WORKEpS' COMPENSA710N DECLARATON:�/ �J I hereby aHirm Under penalry ot perjury one at the following tledaretions: ❑ I have and will maintafn e ceNticate ot consem ro self-Insure for workers' compensatlon, es pmvldetl for by sectlon 3700 of the Lebor Code, for the peAortnance of Ihe work lor W�ich ihis partnil Is issued. ❑ I have and wi�� ma�Main workeB' compensation insurenc0, es required by sectlon 3700 of the lebor Code, tor tha perfortnance of the work lor which thig pgrtnit is issued, My workels' crom.p..e�ns tl.o/n �Insurence carrie�A policy number ere: �` �( 'I � / Carrier�. `i� 1`�`✓ �'�u�� i PolicyNumber:�G `f Z✓�i0'17�Y� � (Thls SecBon need not be crompleted i! fhe permif is ve/ueO ef one �undred dollars ($7 ) or lass.) � ❑ 1 cenity tha� �� the pertortnance ol ihe work for which tNs pertnit is Issued, I shall nat employ any pereon in eny manner so as to become sublecM �a �he workers' compensation laws ot Calitom/lg�n �E /agree e� II I 5houltl bBtome subjett Io Ihe wOrkers' compensallon Drovislon9 0l Section 3700 ot Ihe Lebor Cotle, I Shall fathwlih compty with these pmvislQyL� ` % �� b l C%� / �q ApplicaN SigneWra: - _ _ _ � Dato: � WARNINO: FAILUFE TO SEWRE WORKERS' QDMPENSATION COVEMGE IS UNUW FlA AND SWHL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUN�RED TMOUSAND DOLLARE (E100,000), IN AODRION TO THE COST OF WMPENSqTION, �MMGES A$ FROVIDE� f-0R IN SECTION 31090F THE LABOR CODE, INrERESi, AND ATTORNEI"S FEES. LICENSED CONTHACTORS DECLARATION: I hereby aMirm Inat I am licensed untler provisions ol Chapter 8(commendng with Sectlon 7000) of Division 3 0l ihe Business entl Professions Code, entl my Ilcense is In tull torce entl ettact. Lic. a I( � Class p_[;_��} Contractor's Signature: ,�/� � Date: _ �i l0 CONSTRUCTON LENDING AGENCY: ❑ I hereDy aHirm Ihat there is a consiruction lentling epency lor t�e peAortnance of t�e work lor which ihis permit is iuued. (Sec. 3097, Civil Coda). Lender's Neme: Lentler's Address: Signature: OWNER-BUILDEA DECLARATIONS: Date: I hereby eflirm that untler penelry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW br ihe tollowing reeson (Sec. 7031.5, Business end Pmfessions Cotle: Any ciry o! counry which repuires a pertnit to mnstruCt, elter, Improve, Gemolish, or repair any swcture, D�or m its issuence, elso requires the applicant tor such permit to file e signetl s�atemeN that �e or she is licensetl pursuant to the provisions ol Ihe Conireaors License Ww (Chepter 8(commencing with Section 7000) of Division 3 ot the Business entl Professions CoAe) or chat he o� she is exempt therefran antl ihe besis tor ihe elleped exemption. Any violation of Section 7031.5 by any epplicant for e permit sub�ecls ihe epplicant to a civil penalry of nat mwe than tive huntlred tlWlars (5500).): ❑ I, es owner o� tha properry, ar my employees with weges as Iheir sole compensation, WILL DO THE WORK, entl ihe structure is not Intentletl or otleretl for sale (Sec. 7044, Business end Prolesslons Cotle: The Contractors Ucense Law does not apply lo an ownar of property who builds or improves thereon, anG who does such work himsett or hersaN or thiough his or her own employees, providaC ihat such Improvemenis ere noi inlendetl or oHeretl tor sale. Ii, however, Ihe bullding or imprmement is sold within one year of completion, ihe owner-builtler will have the Durden of provin9 ihat he or she did not builtl or improve for purpose of sele.). ' ❑ I, es owner of iha property, am E%CLUSIVELY CONTRACTNG WIiH LICENSED CONTRAC70RS to construct �he project (Sec. 7046, Business antl Professions Code: The contractors License Law tloes not apply to en owner of property who bullds or impmves Ihareon, end who contracis for such prolecl with a contractor(s) license pur5uant to the Contrectors License LewsJ. ❑ I am exempi undar sec. Business and Professions Code for Ihis reason: Signature: Date: Owner ID verified Dy tlrivefs license. ❑ Yes ❑ No � DriveYs License No. Expires: Vedfication oi Ownership by (type oi tlocument, i.e. - properry tex bill or tleetl): DIVISION OF INOUSTRIAL SAFE7Y PEHMIT CERTIFICATION: ❑ I hereby ceN�y �het no excavatlon five (5) or more feet In tlepth into which e person is require0 to tlescend, wlll be metle In connec�ion wllh work euthodzetl by lhis pertnil, end ihat no building structure, scaHoldinp, telsework, or demolition or CismeNling thereot, will be more then ihirry-six (36) feet hiph. (Chep. 32, Grp 2, An 2, Sec. 341, Titla B, Celitomia ACministrative Cotle). ❑ As owner-builder, I will not employ enyone to do wark whic� would raquire a permit Irom the Division ol Indusinal Safery, as notetl above, unless such person hes a permit to tltl such work trom tha tli�dsion. Signeture: Date: Division ot Indust�al Satery Permit Numbar. CERTIFICATE OF COMPLIANCE AND AUTHOA�TON OF ENTAV: I cenify under penelty ol perjury Ihel I have rea0 I�is eppliwtio� entl stato Ihet the infortnalion given is correct I agree ta �omply wllh ell stele laws end ciry ordinances relating to building constmction, end authonze rapresenlatives of Ihe Ciry of Costa Mese �o enier upon the ebovo-tlescnbed p�operty lor inspectian purposes. I egree not to occupY or allow acupancy ol eny building euthonzed by this partnit until finel inspection. cooe r. ItlSPECD4U.IYPE 1616 Fixed SyS�em Final Fira Prevention 1266 Pool Spe Flnel 200 Finel Re-Roof 20/ FIneI BIOGWRetalning Well 202 Final Faclory Fire Place 203 Final Sign 204 Final DemWition Pdg 1t�L5 _..�� :f� COOE� IN57ECTIONTYPE � 208 Final Mec�anlcai 208 Finel Plumbing 210 Final Elecldcal 212 Finel Flre Preventlon 220 finel Plenning Approval 222 Final Site 250 Finel Bullding/Oaupency PAff. II{IID�IS (774)754•5273 • Fax(714)754-4856 dob Address: 548 W 19TH ST Suite: Vicinity: Parcel Nunmber: 42210319 CITY OF COSTA MESA � BI/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT. PERMIT Applicant: ROBERT TALKINGTON Address: Owner: Address Contractor. Address: Arch / Eng : Address: SIGN PERMIT Zoning: Phone: Zip: BANK OF AMERICA NT & SA - � %CRE/OREO FINANCE #3772 � SAN FRANCISCO, CA- Phone: P 0 BOX 37000 -- Zip: 94137 COAST"SIGN INC. 1345 S. ALLEC ST ' � Phonet� (714)520-9144 ANAHEIM, CA � � Zip: 92805 - � - � ' �' . ,License: 654238 Phone: Zip: License: NUMBER SB00-00038 77 FAIR DRIVE°, COSTA MESA, CA 92626 Status: ISSUED Applied: 04/07/2000 Issued: 04/O6/2000 ISSUED BY: � SCOPE OF PERMIT REPLACE TWO EXISTING BLDG WALL SIGNS WITH ONE ON THE SOUTH AND ONE ON THE NORTH ELEVATION. C/C OF EXISTING F.S. SIGN (NO INCREASE IN AREA). 15 DIRECTIONAL SIGNS AND . 4 ATM SIGNS ARE INCLUDED. , Plan Check: Permit: SMIP Com: Other: Inspection: Total: NOTES: $227.01 $0.00 $349.25 $4.62 $0.00 $0.00 $0.00 $0.00 $0.00 $580.88 FEE SUMMARY , PLANNING & ZONING Calc Valuation: Claimed Valuation: szz,000.00 s2z,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not�commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work euthorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inapectlona and final epproval must be obtained. Failure to obtain inspections and final approvel will result in the expiration of this permit. FOH INSPECTIONS CpLL: (714) 7545626 � WORKERS'COMPENSAnON OECLARAnON: I hereby attirm under penalry of perjury one of t�e following tleclarations: - ❑ I have antl will maintaln e c�rtificate of consent to seN-Insure tor workers' compensation, es provitletl for by section 3700 of tha Labor Cotle, for ihe pertormenca of the work for which this permit Is issued. . ❑ I have and will maintain workers' compensation insurence, es required by section 3700 of the Lebor Code, for the perfortnance of tha work for which this pertnit Is Issued. My workers' compensation Insurance cerrier and policy number ere: . Carner: Policy NumGer. (This section need not be camp/eted i/ the pertrilt is velued ef one hundred dallers ($100) or Iess.J ❑ I certify that in the peAormgnce of t�e work for which this permit Is issued, I shall not employ eny person in any menner so as to become sub�ect to ihe workers' compensation laws of California, end egrae that if 1 should become su6�ect to the workero' compensation provisions of Section 3700 of the Lebor Cotle, I shell lorihwith comply with these provisions. Applicant Signeture: Date: WARNING: FAILURE TO SECURE WORKEqS' CAMPENSATION COVERAGE IS UNLAWFUL AND SMALL SU8IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNORED THOl15AND DOLLARE ($100,000), IN ApDfiION TO THE COSi OF COMPENSATION, DAA4IGES AS PROVIOED FOR IN SECTION 3]Ofi OF THE LABOR CO�E, INTEREST, AND ATTORNEY'S FE�S. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I am licensed Under provisions ot Chapter 9(commencing wi�h Section 7000) of Division 3 of the Business and Pmfessions Code, antl my license is in full force and eftecl. Lic. u Class k Contractors SignaNre:� _ _ _ _ . .. _. _ Date: __. CONS7RUCTION'LENDING AG�NCY: ❑ I hereby aHirm that Ihera is a constmction lendinq aqency for tha pertormance oi the work tor which ihis parmit is issued. (Sec. 3097, Civil Cotle). Lentler's Name: Lendefs Address: SignaWre: OWNER-BUILDER DECLARA710N5: Dele: I hereby attirm that untler penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Cotle: Any city or counry which requires a pertnit to consWd, alter, improve, demolish, or repair eny stmcture, prior to its issuance, also requires the epplicant tor such permit to file a signed statemen� that ha or she is licensetl pursuant lo the pmvisions of ihe Contreaors License Lew (Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Protessions Cotle) pr that he or she is exempt thereirom end ihe basis for ihe alleged eaemption. Any violation of Saction 7031.5 6y eny epplicant tor e permit sub�acts the applicam to e civil penalty ot not more ihan five hundred tlollers ($500).): ❑ I, as owner of the properry, nr my employees with wages as their sole compensation, WILL DO THE WORK, antl the struciure Is not inlentletl or oNeretl for sale (Sec. 7044, Business antl Professions Code: The Coniractors License Law tloes not apply to an owner ot property who builds or Improves Ihereon, and who does such work himself or herself or ihrough his or her own employees, provided Ihai such improvements are not intended or ottered for sale. If, however, the bulltling or improvement is so10 within one year of completion, ihe owner-6uilder will have the burden of proving that he or she did not builtl or improve for purpose oi sale.). ❑ I, as owner of the property, am E%CLUSIVELY CONTRACTING WRH IICENSED CON7RACTORS ro coretrud the project (Sec. 7044, Business ana Pmfesslons Cotle: The contractors Liceqse Lew tloes not appty to an owner oi property who builds or improves thereon, end who contracts tor such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am ezempt under sec. Business and Protessions Gode tor t�is reason: Signature: Date: Owner ID venfied by dnvers license. ❑ Yes ❑ No Dnver's License No. Ezpires: Venfication of Ownership by (rype of document, i.e. - property taa bill or deed): DIVISION OF INDUSTRIAL SAFETV pERM17 CEHTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more teet in depih into which a person is requiretl �o descand, will be made in connection wit� work authorized by Ihis permit, antl thet no building gtructure, scallolding, talsework, or demolition or dismantling Ihereot, will be more ihan Mirty-six (3fi) feet high. (Chap. 32, Gry 2, An 2, Sec. 341, Ttle B, Califomia Atlministrative Code). ❑ As owner-builder, I will not employ anyone to tlo work which would reQuire a permit from tha Division of Industrial Safery, as noted above, unless such pereon has a pertnit to tlo such work from ihe division. Signature: Date: Division of Industnal Safery Permit Number. CERTIFICA7E OF COMPLIANCE 4ND AUTHORVA110N OF ENTTiY: I certity under penalty of perjury that I have read this aOP�ication end state that the information given is cortect I agree to comply with all state laws and ciry ordinances relating to building consWction, and authorize represeniatives of the Ciry of Costa Mesa to enter upon the abova-descnbed pmperty tor inspection purpases. t agree not ro oaupy or allow occupancy of any buil0ing autborized by this permit untJ final inspectioa SignaWre Of Legel Owner(s) AnNOr Authonzed Applicant COUE �, INSPELTIONTYPE 161fi Fixed System Final Fire Prevention 1266 200 201 202 203 Pool Spa Final Final Re-Roof Flnel BIocWRetaining Well Finel Factory Fire Place Finel Sign 204 Final Demolition / \ 2d46d6 ` �g INIiiIRLS � � COOE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Eleclrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sile 250 Final Builtling/Occupency C9IE IpimRLS ��ia��sa•52�s • Fa:��ia��sa-aess Job Address: Suite No Vicinity: Parcel Nunmber: Applitant: Address: Owner: Address Contractor: Address: CITY OF COSTA MESA ,_ BUILD/NG DIVISION DEVELOPMENT SERVICES DEPARTMENT. PERMIT 548 W 19TH ST EXISTING ATM MACHINE 42210319 RICHARD MASSIMI 8032 CHESTER ST. STANTON,CA � ELECTRICAL PERMIT Phone: (714) 828-2875 Zip'. 92680 BANKOF AMERICA NT & SA %CRE/OREO FINANCE #3772 `SAN FRANCISCO, CA �" Phone: P O BOX 37000 . Zip: 94137 . �; UNITED ELECTRICAL ENTERPRISES 8032 CHESTER ST. - . , � , - �- Phone: (714)828-2875 'STANTON, CA � . - Zip: 92680 � � - License: 203572- NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 04/24I2000 Issued: 04/24/2000 ISSUED BY: !S o /� SCOPE OF PERMIT . � � INSTALL 4 TIME CLOCKS AND ADD 4 NEW ELECTRICAL CIRCUITS FOR EXISTING BANK OF AMERICA ATM MACHINE. SUBJECT TO FIELD WSPECTION. � -� � �� ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a - . Service to 1000a - Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over t00hp Communication drops Sub panel l0 200a Pole Light Pkg Sign Circuits � Temp Pwr Pole Inrermed Pole $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $4.40 $0.00 so:oo so.00 $0.00 $0.00 so.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity y FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 70 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit � Misc. Conductor Circus ( gen or ride) Circus (mech nde or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee . Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $72.80 4 $0.00 0 $0.00 0 $0.00 0 so.00 0 so.ao 0 so.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 30.00 $0.00 $0.00 TOTAL CALCULATED FEES 5100.70 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorixed by this permit shall comply with all applicable handicap access requirements undar California statules and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not�commenced within 180 days, or i( work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred InapeeUona and finel approval must be obtained. Feilure to obtain inspectlons and final appmval will result in the ezpiratiort of this permit. FOR INSPECTIONS CALI: (714) 7545626 WORKERS' COMPENSATION DECLARATON: ' - - y ,4 ' I hereby ettirtn unaer penalry of perjury one oi the tollowing detlarations: ❑ I have anC will maintain e certilicata of consent to self-Insure tor workers' wmpensation, as providetl br by section 3700 oi the Labor Cotle, for �he pedortnance of Ihe work tor which Nis pertni� is issued. �I �have antl will maintain workerg' cpmpensation insurance, az required by section 3700 ot the lebor Code, �or Ne pertortnance of the work for which Nis permlt is issued. My workers' compensetion Insurance carder end policy number are: . Carder. Policy Number: (This section nee0 not be comp/eted il the permit is velued at one hundred dW/ars (5100) ar less.) ❑ I certify Ihat in Iha pertortnance of the work tor which ihis pertnit is issued, I shall not employ any person in any manner so as to Decome subJect to the workers' compansation laws of Califomiq, and agree that if I should 6ecome subJect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with Ihese pravisia��/ /J_ //n � �7,/ d� Applicant Slgnature: ___�E��'�"� A' � vJ� —'�� Date: �' i 7� WARNING: FAILURE TO SEC�p $ �1 F�9AGE IS UNL4WFUL AND SHALL SU6IECT PN EMPLOYER TO CRIM1llNAL PENALTIES ANO GVIL FlNES UP TO IXJE HUNDRED THOUSAN� DOLLAfiE (5100.000),IN ADDf�7pp� TO THEBfb`T �FL4MPENSATION, DAA41GE5 AS PROVIDED FOR IN SECTION 31060F THE LABOR CpOE, INTEflEST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATON: I hereby aRrm that I am licensed unqer provisic force antl eflect Lic. a V % Contractors Signature:� Chapter 9(commendng with SeCtiOn 7000) of Division 3 of the BuSineu and Profe5�n5 CodB, arW my liCen50 is in full C�ass p C /O / i�c7 .�--- �_— Date: �/ �'2 5� —r/IJ CONSTRUC710N LENDING AGENCV: ❑ I herehy ettirtn ihat Ihere is a cpnsiruction lentling agency for ihe peAortnance ot the work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lendels Address: Signature: OWNEH•BU(LOER OECLARA710Ng: Daie: I hereby aflirm ihat untler penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sac. 7031.5, Business and Protessions Code: Any ciry or counry which requires a pertnit to consiruct, alter, impmve, demolish, or repair any strucWre, pnor ro its issuance, also requires �he applicant lor such pertnit to tile e signed statement that he or she is licensed pureuant to the provisions of ihe Contractors License law (Chapter 9(commencing wlih Section 7000) of DiNsion 3 ot ihe eusiness and Professions Code) or lhat he or she is exempt therefrom and Iha basis for Ihe allegetl exemption. Any violation of Sectlon 7031.5 by eny apP�icant for a permii subjecis ihe aDPlicant to a civil penal�y of not more ihan five huntlretl tlollars ($500).): ❑ I, es owner oi ihe properry, or my employees with waqes as their sole compensation, WILL DO 7HE WORK, and the structure is not intended or oflered for sale (Sec. 7044, Business end Protessions Code: The Contractors License Lew does not appty to an owner oi property who buitds or improves Ihereon, antl who tloes such work himself or hersalt or Ihrough his or her own employees, provided �het such improvements are not intended or oHered for ule. If, however, �he bulltling or improvement is sold within one year of completion, Ihe owner-builder will heve the burden of proving ihat he or s�e did not build or improve for purpose of sale.). ❑ I, as owner of the property, am E%CLUSIVELY COMAACTING WITH UCENSED CON7RACTORS to construct the pmject (Sec. 70a4, Business and Professions Cotle: The conirectors License Law tloes not apply to an owner of property who builtls or improves Ihereon, end who contracts for such pro�ect with a contractoqs) license pursuant to Ihe Coniraqors License Lews.). ❑ I am exempt under sec. Si9nature: Owner ID venfetl by drivefs license. ❑ Yes ❑ No Business antl Profeuions Code tor this reason: Venfication ot Ownership by (rype of tlocument, i.e. - property tax bill or deed): DriverS LicenSe No. Date: Expir85: DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTFICATION: ❑ I hereby certify that no excavalion five (5) or more teet in tlepN inro which a person is requireG lo tlescend, will be made in connection with work authorized by Ihis pertnit, and that no building siructure, scattolding, felsework, or demolitlon or tlisman�ling thereof, will be more t�an ihirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Ttle B, Califomia Atlminisirative Code). ❑ As owner-builder, I will not employ anyone to do work whic� would require a permit irom ihe Division of Indusirial Sefery, es noted above. unless such person has a pertnit ta do such work irom thb division. SignaWre: Date: Division of Industnal Satery Permit N�mber: ICERTIFICATE OF COMPLIANCE ANb AUTHORVA710N OF ENiRY: I certify unde� penelry ot perjury that I have raad this application and state ihat Ihe infortnation given is I correct. I agree to comply with all st4fe laws and ciry ortlinances relating to building consimction, antl aulhorize representatives ot �he Ciry of Coste Mesa to enter upon Ihe above-descnbetl properry for inspection puryases. I egree not to cecupy or allow occupancy of any Duilding au��orizetl by ihis permit until ilnal Inspection. ya vn��a�� - • �/�1�J ' � � ��— An O�tho� pp6cant c: COpE �, IHSGELTIONTYYE C / p�[ INTITI�LS 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Rool 201 Fine1 81ocWRetaining Wall 202 Final Fectory Fire Place 203 Flnal Sign 204 Final Demolitlon 2b66-bfi Date �—�s�--a'v � Date COUE1 INSPECTIONTVPE 206 Final Mechanical 20B Final Plumbing 210 Final ElecMcal 212 Final Fire Preventlan 220 Final Planning Approval 222 Final Slte 250 Final Building/Occupancy AVD��ant to fill in a1l svaces except those within heavY eortler Iines ana sign all aoPropriate tleclantions. PERMIT O. TRACT NO. LOT NO. UNIT NO. CI7Y oF cOSTA MESA CONSTRUCTION PERMIT 3�p 3 S I�� I�2 "' ' A•P� # ' . Project Address �y� W �q � S1 �n,5%� �I�A� S Main Buildi Applicant'S Mailing Address � TYPE OF CONSTRUCTION , NEW ADD ALTERATION REPAI R E FrOnt - ❑ GONVERSION� ❑ DEMOLISH ❑ OTHER T Owner's Name �� Phone DESCRIPTION OF�WORK/USE OF BLDG. I A Rear Address � � � iY"`�T � Cns�a .�i��— -� Arch/Eng. VI��a 14SS /J(��'T - TVPE OF PEHMIT Gf2ADING FOUNOATION S7RVCTVRAL I C Right rtLicernu No. K Addre55 �� f%�� 1��T"�' F�F AR7 �IT /� �Ai�%%t5 IY. ❑ TENANT �. ❑ ELECTRICAL ❑ PLUM9ING ❑ MECHANICAI g � Left Contracror'sName��o � Phone6.�2"'« ��'oTHEa' � PIng.Ref.# �ION�� tirLSO�L �✓1% i� �rYg//Bi� PROJECT DESCRIPTION Sq. FT. oCCUVANC � Planning Notes: Address (mailingl, . CONSTRUCTIDN TVPE_�J r� VALUATION $ City LicenSe NO. �� ZONE � GRADING CU. VDS. ' ACRES � LICENSED CONTRHCTOR DECLARATION I hereby affirm that I am lic¢nsetl untler provisions of Charter 9(commentin9 Remarks: T ' . with section ]000) of DIvlSion 3 of th¢ BuSinezS dntl Professions Cotle, antl my license is in tull force ana ect. n License 55 LiCsnsp'yo ' i Date ��' ' S'9 t 7 �� N— C�h WORKEPS'COMVENSATION DEC RATION ' I nereby aftirm thal I have a certificata of consent to salf-insure or a certi(icate ot Workers' Compensation Insurance, or a certl(ietl copy thereof (Section 't00, Ldb. �Cy� <� �cy No. („L�P/O�J % � CompanyYL � 1 Certifietl copy is nereby tumisnetl. ' CertifieU copy is filed with lhe Ci[.•...�yu�an/1�9 Ision. ' Date � �'fiy Applicdnl f,/� � EXEMPTION FROM WORKERS' COMP�NSATI N DECLARATION (This seclion neetl not be com0�etetl if the pe�mit is (or one huntlr¢tl �($300) o� Iess). �1 certity that in the performance oi the work for.which this perm�t is issuetl I shall' not em0�oy any person in any manner so as to become subject to t�e Workers' Compensation Laws of Californla. I Date Signature NOTICE: If, after making this tleclara[ion, you shoultl become subject to the Workers' Compensation provisions of the Labor Cotle, you must torthwith compty-�with such p�ovi5ion5 0� this Oe�mit Shall be tleemetl revoketl. ;CONSTRVCTION LENDING AGENCV ' , - 1 hereby affirm that there is a construction Ientlin9 a9ency foYthe per(ormance of the wark �or which this permil is issuetl (Section 309� Civ. �CJ 9 Lenaer's� Name ' Lentler's Atltlress OWNER BUILDER DECLARATION � '. I hereby affirm �lhat I am�exempt fiom the Contractor's License Law tor the , following reason (Settion.J031.5'Businessantl Protessional Cotle: Any city or �..,,�t., .uni�n rnn ures a oermit to conSVuct, alt¢r, imp�ov¢, tlemolish Or �epair ..._._..__. __ __ _ _ _ . _ . ]031.5 by any applicant for' a permit subjectz the appl�can o a civi '_; nalty ot not more than five huntlretl tlollars ($500). ' ::�� I, as� owner of the property or my.employees with wages as their sole �ompensalion, will tlo tM1e work, antl the structure is not intentletl or-offeretl for sale (Section 7044, Business antl Prote55ional Cotle: The Contractor'S � License Law tloes not apply to.an owner of a property who builds or improves [bereon, antl who. tloes such work-hlm5¢If/he�5elf o� through his o� h¢r own employees, provitletl tnat such improvements ara not intentletl or offeretl (or � sale. If, however, the builtling or ImOrovement Is soltl within one year of com- Oletion, the owner will,have the burtlen ot proving he/she Citl not bulltl or im- : prove for the.purpose of salej. ' , ❑ 1, as owner of tne property, am exclu5ively <On[racting with IicenS¢tl con- tractorsto construct[he project (Section 7044, Bu5ine55 dntl PrOte55ions CoOe: . The Contractor's License l.aw does not apply to an owner of property who builtls of impraves thefeon. antl wFlo conVactS tor such oroieCts with'a ron- tractor(sl license pursuani [o ine Contractor's License Law). I am aware tnat p�oof of [heir Worker'z Compensation InSurance shoultl be provitletl to me. ❑ I am exempt untler Section , B. & P. C. tor this reason Date � Owner• ' I hereby certity�thabl have read ehis applicatlon antl state Ihat lhe above � Intormation is correct. I agree to comoly with all city antl county ortlinances antl state laws relating t�builtlinq constr lon, antl hereby authorize reore- b tI tl t f r Sink Backflow Preventer . . ' Backflow Irrigation � Bathtu6s Clarifiers ' � Dishurasher � . � D�inking Fountains . ' Floor Drains � Floor Sinks. . _: Gas Service ' _ Outlets - Interceptors � Ki[chen Sink ' Lavatories _ ` . ,- - P—Trap �Roof Drains � � � ' Reinspection-Fee $75 Boiler ' Ducf- Under Ground , ' Duct-Structural . . � Duct - Ventilating � � • � Exhaust System ❑ Multiple � FirepVFact.Blt.IC60# � Heating System & Ducting . 00.100,OOO�BTU �100,OOOBTI sentatives ot this oty nter- upon a ova-m¢n one proper y o � . Inspection ur � Signature / Date� � Drivers' Li'--- " 5� �:� �� Reinspection Fee 0865-46, rev. 5/88 White - Builtlin9: Canary - APPlicant; Pink - A<counting: Goltlenrotl - Assessor $15 Showers Service Sink � • Sewer Connection Solar Collectors . Solar Pipin9 ' Solar Tank �� Swimming Pool w/Spa Urinal Water Closet ' Water Heater � Water Service 'Auto-Wash: , � -- _ - � Issua Fee� , � 6 Hood or, Typel, ❑ ' Canopy Type I I ❑ � � Refrigeretlon Sys[em � ❑0-100,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers ' Automatic Washer Construction Pole Su6. Cook ing' Un it Dishwasher Dryers L1Gas LJElettric Fan F.A.U. " Fixtures Device Boxes Outlets ' Switches Garbage Dispoul Generator 065 KW 05-15 zone Parking Req./Provided ELECTRICAL Transformer ❑ 15-50KW . ❑ 50+KW Meter ❑uptot00amps Meter �' over 100 amps SubPanel i �;-'['" ' Motors 00.1 HP 01'/:`- 8` Inc.Solar �9-15 HP �16-15+ Microwave ' . �� Pole Light ' Range , Sign Standing Sections� ' Trash Compactor � 17A�-9 N � N G R E � M T S. Reinspection Fee $15 Issue Fee � '$ 3 ! . $ 3 DEVELOPMENTSERVICESREQUIREMENTS: ,� ��[�� Q�C� � 2oning Approved By � ' ' Date S/J�� FEES . Buildin9 APVroved 8Y� Date . . Application Issued By— � Data�� 4 �� ' S MARV OF FEES : � ' � ' BUILDINGPERMIT $ � �SMIP � '. $; I?� , �� PLAN CHECK $ -� � � PERMIT� , PLUMBING $ ' ISSUANCE $ � PLAN CHECK 25% $ ENERGY P.C.� $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ ' MICROFILM �. $ ��.�' 7�-- MECHANICAL $ _ TOTALFEE $ �1�'� . PLAN CHECK 25% $ ' _ . S Issua Fee � S 3 ��' �DUF�IC-ATE RECESFT� n• nnn..r.n ..�n..�... .T...-� ,.. �.. � �. , CONSTRUCTION AND PLANNING t POOL 8, � ' APPROVALS Permit# Date Inspector qppROVALS Permit# Date � Inspector %' 1. TemporaiY,Electrical Service or Pole � �� 52. Pool & Equipment Location 2. Soil Pi.e•Undr rnd. � ' ' � P.', 9 r• ��. 53. Steel Reinforcement 3.IElectrical Conduit Utility-Undrgrrid�. � 54. Forms �, 4:�Elecirical Conduit-Undrgrnd. y�- 55. Electrical Bonding ' `, I 5. Steel-�Reinfprcempnt �, >�, � 56. Rough Plumbing & Pressure Test . � 6. Electrical��FER,Grnd. ,i�� 57.�APPROVALTOCOVER-GUNITE � � 7..Footings "' �� -,1 j,f,.' 58. Electrical Conduit-Undrgrnd. � i� - , 8. Foun�lation • � �'.' `�� 59. Gas Pipe, O Undrgrnd., Test 9''Water Pi� e-Undr rrid. '�� '� I .,, P 9 �� 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System • �„ �%� 61. APPROVAL TO DECK 11. •Property Sewer Lirie & House Conrieciion •� �� - 62. Backwash & ReceptorFinal 12:!Sewer Cap .�'� _i� l' �' 1( 63. Heater & Vent�Final , 13., Roof Disins ;,. �4 �.. �� ;�.� � 64. Plumbing SYstem - Final 14� Rough Plum6ing '% �"� � 65. Electrical-Final 15 � Rough Electrical-Conduit - 66. Solar System-Final - 76! Rough Electric Wiring 67. Fencing &�Access Approval - 1�7. Rough Wiring Sign � 68. APPROVED FOR PLASTERING � 18-. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL � 1'9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT,� � 20. Rough Factory Fireplace � � ' APPROVALS Permit# ' 21. Ducts, in Structure •-� 70. Underground HYdro �� ' 22. Ducts, Ventilating .� 71. Product Piping O Gas ❑ Oil . 23�� Gas Pipe-Rough & Test '? 72. Underground Flush � 24. Roof Framing '-' , 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing �,. 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemicel . . ' 27. Frame and Flashin � 9 �{ � 76. Dry Standpipe 2.8. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing � G HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ;� 79. FINAL INSPECTION � 32. Electrical Power�Meter-Final 80. FOOD CERTIFICATE �SSUED 33. Final ElecTric ,.� �. Notes: �f� �� y 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test 36. Hood or Csnopy j � ,37.�Final FactorY Fireplace�'� 38. Final Plumbing . �" � - ',T . 39. Water Service-Final` , ' � •i 'i �40. Gas Service=Final ' - .- ' , � 4L Solar pomesticFinal �� 4�. Backflow Preventer r�` , • � � .. � `v -. 43. Backflow Irrigation `) -� - ' - _ 44. Landscape�Irrigation�System . � 45. Sound AtYenuation,;� ., � 46. Handirap R?gulations ��. � � - , �. 47. FINAL STF?UCTURE & BUtCDING � - 4R: Spec�al Requirements Completed "`'" � �49`. Electric Release to Edison r'� ' �� • ,i �50. Gas Release to Southern California Gas Cp . �� ._ � ' �I 51. CERTIFICATE OF OCCUPANCY ''r No. Date �� .r '� . , . Appllcant to till in all spaces exceot enose wltnln heavY eorOer lines and slgn all aoVroD��e declarations. CITV oF COSrn,M�,(E� Sn CONSTR CTIO� PERMIT Project Address �T!� �4'8 � � � � />pplicant's Mai�ing Addr ' Owner's Name L� ./ ��, Phone Address �� ./�� i/�"Q— Arch/Eng. C� Licenu No. Addreu • Contrector's Nam Phon�pZ' Z�� Address Imailing) City License No. I.ICENSED CONTRACTOR OECLARATION 1 nB�eby aHi�m that I am Iicensetl untle� p�oviSiOns ot Charle� 9(cOTmandn9 with seclion 7000) of �ivision 3 of t�e gusiness antl Professions Cotle, antl my Iicense is In full to e antl aftect. ^ Licgns a3s, lLeps � ' Date �� Si9nature � WORK RS' COMP NSATION DECL RATION 1 hereby iffirm that I have a certifiwte ot tonsent to selt-insure or a cerUtiw[e ' �1 Worker5' Compins5tion.InSuranc¢„or a certNietl copy IhereOf (Section 800, Lab. C.)/� �j �i w w.' , o icy No. �r`_SJ��` � Company �/`i��Iv� ll�s� �ertifieG copy Is ner by furnishea. /� , Certif' ti tl wi[h tne city(B wl�B�� v�siryf ,�� 1 �/�.� Date_�^yL�� APPlicant \/�-(/�'l.[N/'C(i(i 1/�I[..1 n t . EXpMPTI N F OM ORKERS' COMVENSATION DECLARATION (This section naetl nol be mmpletoE i( Ihe permil ii for one huntlrotl (E300) or loss). I<artify that in [he perrormdnte Of the work ior which Inis OerT�t is ISSuetl, I shall no[ employ any person in any manner so az to become suDject to the � Wotkers' Compensation Laws o( Calitomia. Dato Si9nature � ' NOTICE: Ii, after making this tleclaratian, you shoultl become subjnc[ to the Wotke�s' CompCnSation provlslon5 0� th¢ Labo� Cotle, You muSt 10�Inwith coehply wilh such provislons or this permit shall be tleematl revoke0. CONST0.UCTION LENOING AGENCV' • � I h0reby affl�m Ihat lh¢re Is a const�uction Ientling dgency tor th! Pertormance of the work for whicn this permit . is issuoC (Settion 3097 Civ. C.) LAneer's Name�__J_a Loqder's AiJOre55 ��'� _ OWNER BUILDER DECLARATION� - ' ' - I hereby affirm that I am exompt Irom tbe Contractor's LI<ense Law tor lhe follpwing reason (Sattion 7031.5 Buiiness antl Professional Cotle: Any N[y or coUnly which roquiros a Oarmit to COnSlrUct, atter, improve, Eemolish or repair �any s(ruclure, prbr to its Isivance, also reqWres tha applicant tor such permit to (ile a sign04 Statement �hat he/she is IicenSetl pur5uant t0 the prOVI5Ion5 ot tn0 Gontractor'a License Law (Chapler 9.�commencing with SecUon 7000� of DlVision 3 of Ua Business antl Protessions Cotla) or that M1o/sho is exempt lhqrntrom antl the ba5i5 ior lhe dllugetl ExOmptiOn. Any vlolatiOn o1 Sncllon 7031.5 by any applicant fo� a Pormit subjeCts lhu appllCanl t0 a cfv(I enalty of not more than five huntlratl tlollars (5500�. .� I, ai ownor ot lne property or my employees with wages as thelr sole coMpensation, wNl Co the work, antl tne ztructuro is not IntenOetl or offeretl tor �le (Section 7044, Builneis antl Profeszional Cotle: The Contractor's Litense Law tloos not app1Y to an owner oi a Droparly wlio bullEs or Improves thpreon, antl who tloes such wark nimzelf/hcrsnll or (nro�gh nis or har own eTploy bes, O�Ovitletl Nat 5uCf1 improvBTentS afe nOt inteOtlBtl or offered for sele. tf, howevCr, th0 bWltling Gr ImO�ov¢ment IS soltl wi[hin ona year of com- P�OUon, tho ownar will have tha burtlen ot proving he/she tlitl not builtl or Im- �rpya tor the vurpose of sale). I, as owne! Ot tlte pfoperty, am e%clll5ively contldctin9 witFl II<onsetl COn- � Vdctorsto conR�uct lne projeCt $eclion ]044. B115I0055 d11tl %Of0SSI0lIS COOB: IThn Contraclor'S License law �oez not aPPly lo dn owner o1 propmry who b4iltls o� lmpsoves therevn, antl wbo coNractz ior such projects with a con- bdctor(st ❑Canio pursuanl to Ine Contractor's Licensa Law�. I am aware that Iproof of [helr Worker'i Compansatlon Snsurance shoultl be provi0etl [o me. ❑ 1 am exempt untler Section B. & P. C. for this reason Odte Owner � hereby <ertlty that 1 have rea0 tbis aOP��ation antl state that the above ��formation iy� orrect. 1 agree to <omply with all clty antl county ortlinances ann srate lavhlratatina to buildina construction. anG nerebv authorize reore- Dhivers' License or 55 � TV�EOFCONSTRUCTION � NEW IJ ADD U ALTERATION IJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DE: IP f] RK/US�LDG. F} �cLL TVPE OF PERMIT GRADING FOUNDATION STRVCTUftAL ❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5a. F7. OCCUPAI CONSTRUCTION TYPE VALUATION S � ZONE GRADINGCV.VDS. ACR Remarks: Bar Sink Backflow Preventer eackflow �rrigation Bathtuhs ! Drinking Fountains Floor Drains Floor Sinks .- Gas Service - Oi Interceptors Kitchen Sink . Roof Drains Rainspection Foe $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple � Firepl/Fact. Blt. ICBO # Heating System & Ducting Oa� oo,000 sTu O i oo,000 eT' Reinspection Fea � S75 CMF 0865-4fi, rev. 4/84 White - Bulltling; Canary - ApO��nt; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection $olar Collecmrs SOlar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet � Water Heater Water Service Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Issue Fee r� $ 3 $ 3 A.P. 5W Lj .L ^<— S MainBuilding:� E , T Front B Rear � A C Right � gleft Ping. Ref. # Planning Notes: �_ Automatic Washer Construction Pole Sub. CoOking Unit ' -0127 5/10/84 � — � 2one - Ac s Ory Building: % Parking Req./Provided Dryers LJGas LJElectric Fan F.A.U. Fiztures Oevice Boxes Outlets $witCh¢5 Garbage Disposal Generator �0.5 KW � Reinspection Fee — DEVELOPMENTSER 2oning APProved By— Building Approvad By Appliration Issuad Bv_ ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100amps ' Meter ❑over 100 amps 75 KW 815 Sub Panel Motors DO-1 HP 07 h- 8 Inc.Solar Q9-15 HP �16-15+ Microwave - Pole Light � Range ' Sign Standing Sections Trash Compacmr Isue Fee 83.84 �TL FEES $ 3 Z O N 1 N G R E Q M T S. SUMMARV OF FEES BUILDINGPERMIT $ SO.Sa SMIP . $ D•SO PLAN CHECK g 3?.8Z PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY�P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ p MECHANICAL $ TOTAL FEE $ a�•� PLAN CHECK 25% $ �� __ � _ _ 0 � CONSTRUCTION AND PLANNING �- - POOL 5, ... A , APPROVALS Permit# Date Inspector pppROVALS Permit# Date Inspector . � 1. Temporary Electrical $ervice or Pole _ 52. Pool & Equipment Location 2. Soil Fipe�Undrgrnd. . � � � -53. Steel Reinforcement - � " � - 3..ElectricaLCond'uit 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. ElectricalConduit-Undrgrnd. 8. Foundation '� 59. Gas Pipe, O Undrgrnd., Test , , 9. Water Pipe-Undrgrnd� � • 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System' � . 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Final 12. Sewer Cap ' •� , � 63. Heater & Vent-Final ' 13. Roof Drains , g4. Plumbing System - Final ' 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit ' 66. Solar System-Final 16: Rough Electric Wiring 67. Fencing & Access Approval 17. Rough�Wiring Sign � 68. APPROVED FOR PLASTERING 18. Rough Electrical-T BarCeiling 69. POOI/SPA SYSTEMS FINAL 19. Rough�Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough;Factory Fireplace � APPROVALS Permit # 21.Ducts,in.Structure 70.UndergroundHydro , ' 22. •Ducts, ,Venti�ating 71. Product Piping O Gas O Oil 23. Gas Pipe-Rough & Test .� 72, Underground Flush, ' 24. Roof Framing , , 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing . 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � ' - 27:•FrameandFlashing �76. DryStandpipe, 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 r 37. Final Factory Fireplace �." , 38. Fina�'Plumbing � ! , y • ' 39. Water Service-Final ,� _, , �" � `• � 40. Gas Service-Final i 41. Solar pomestic-Final . ,� ,, , ' � . � 42. Backflow Prgventer ' _ • 43. Backflow Irrigation . .�� 44. Landscape Irrigation System: � ' • 45. Sound Attenuation +' ! � - 46. Handicap Regulations � � QV � �1�, � •. 47. FINAL STRUCTURE & BUI�LDING _�� 3 a V� C Q�J 48. Special Requirements Completed 49. Elect�ic Release to Edison �� ,� . � 50. Gas Release to Southern California Gas Co � , - 51. CERTIFICATE OF OCCUPANCY , � � � No Date ' • �; . � �i Pfl ESS: S�i'B' W�;9TH ST UNIT: ,` N , e: HANK OF AMERICA NT S SA nooxEss: TAX DEPT #3245 P O BOX 37000 SAN FRANCISCO,CA 94137 RFCH/ENGINEEfl: WMM AS SOC xec.xo.:C 5 5 1 8 nooness: 3731 WILSHIRE BL uxir:870 L.A. CA 90010 PEflMITTEE: R, E, HA2ARD JR, , INC, ( 619 ) 297-1831 aooaess: 5 4 0 4 NAFA S T SAN DIEGO CA 92136-1167 410ENSEO CONiflACTOF OECUIBATION: I hereby aflirm that I am licensetl under pmvi5ions of ChaO�er 9(commencinp wil� Seciion 70001 0l Orv�sion 3 0l t�e Busines5 ana Pmtessions Cotle, anA m licen is in lulllorc¢ anJ efl ct. Y c+rruc.:/ q sTaeuc.b06269 c s:H pate: _( -�` 1� 9 3 Signature: ,� WONI(EBS' COMPENSATION OECNIIATION: I nereoy aitirm that I have a ceniticare oi consem ta seli�insure or a ceniticate ol workers' Compensalion.lnwranrq.�gr� feqlli�goDY �he�eal (Section 38W, Labd� � O 1/ 9 3 paucrr+o.:INDUSTRIAL INDE E7fP.0ATE'. COMPRNV: y., ❑ Cerlili¢tl cOpy i5 �ere0y �umi5he0. L'J C¢tliliea Copy i5 ��Ae/tl�+ ii he tity iltling Di ' i . 9ate: / ^�� / J APVlicanL /� J FNEMPTION FBOM WONI(EBS' COMPENSATIDN OECIAPRTION: �This sec�ian neetl no� �e comple�ea ii Ihe permi� is �or one huntlre0 (5100� or less�. I certity ��at in tM1e Oetlormance oi Ne work lor which t�is permit is issued, I shall nol empl0y any Derson in any manner so aSlo hecome SUDIeq �o I�e Workers' Camp¢nsa�ion Laws o� Calilarnia. pate: Signa�ure'. NO710E: I1, after making Ihis tleclaration, you shoultl became suble�� o ihe Worker5' Compensation pravisions of t�e Labor Cade. you musl IonhwilA mmpry with suc� pmvisfoRt or tNs p¢rmit shall be tleemed revakeG. �UNSTflULTION LENOINC RGENCY: I �ere�y aifirm that �Aere is a consiruction lenaing apency for I�e pedormance of Ihe work for w�ich �his permi� is i5sue4 (Section 3097, Civ. q. LENOER'. noosess: OWNEB BUILDEB OECIAHRT10N: I hereby affirm iAa� I am exempl imm t�e Comractors' Sta�e License Law lor �he lollowing reasan �Section 7031.5 Business anA Pmlessional Code: Any ciry ol counry whic� repuires a permii io consimt�. al�er, impmve, tlemolis4 or re0air any slmcNre. prior to ils issuance. also repuires ihe appliwnt for such permit to lile a signeA statement ihat he/she is licensetl pursuant lo Ihe Omvisions of Ihe Cantracmr5' Sta�e License Law (Chap�er 9 gommencing vrii� SectiOn 7000) ol Oivision 3 0l I�e Busines5 an0 Pmlessions Catle) or Ihal he/she Is evempt Inerelmm ane ine basis lar ine alleAea exemption. Any violation of Section 7031.5 by �ny applicanl �ar a permit sublects Ihe applicanllo a civil Denalty ot nol more t�an �ive hwAreO EOIlarS (5500�. 1, as owne� oi the Wopeny o� my empIoyees vnth wages as thei� mle wmpe�sation, wfu Do the wo�k, anE the II Ok ❑ s�mcmre is noi inteneee or o��eree ror sa�e (Secuon 70e<, Busmess an0 Proleuional Coae: T�e Cantracmrs' State License Law tloes nai apply lo an owner of a prope�y w�o builOs orimproves tllereon, anA who does such work himselVhersell or tllmugh his or Aer own employees, provitletl Ihal such improvemen�s are no� mlentletl or o��ered lor sale. tl, Aowever t�e �uilding or im0�ovemenl is sold x-0��in ane year oi compleiion, Ihe awner vnil luve Ih¢ OurCen of pmvin0 ��she Oi0 not builA or improve lor Ine Ourpose ol salel. I. as owner ol Ihe pmpeny. am exclusively conlractinA'�+ith licensetl coniraclors to constmct Ihe p�olect (Section 7044, Business � antl Professions Cotle: The Coniractors' Slate License Law aoes nol aDDly Io an owner of pmpenp who bwlCs or impmv¢s thereon I anG who tonlratis l0i Sut� pmleti5 �Ih a ConlrattOr�s� Ift¢n5¢ pu6uani Io Ihe Gonlrattors' Slate Litenu Law). I am aware Ihal pmat ol lheir Woiker's CompensaUon insurance s�ould be Drohded la me. � 1 am exem9� under $ection'. B. 8 P. C. lor Ihis reason: Date: Owner. I eo nereDy cenity Ihat I am aware ol and untlerslantl Ue repuirements o1 Califomia,Healtn anA Sa1ery fAde Sections 25505, 25533, ana :553a ana lhat 1 or any luture builAing omupaN will/will nm �circle one) neeA to compty with saitl stale cotles and Ne reduiremenis for a permi� br consimc�ion or moAificalion Imm ihe Air Ouabty Managemem Ois�rici. flesiaen�ial constmclion aDPlicalions are exernpt Irom inese o�avisions. �7ate: Npplicani: � �ereby t¢tlity that I �ave reatl ��is ap0litaiion an0 5laie Ihai I�e abo% ve in'o(maiion i5 torBcl. I a9ree lo camPlY wilh all Ci�Y an0 Coun�y o�4inancesanOSlalelawsrelaungloGmlCmgwnslmctianantl�ereby� r� repr�atives cirytaenterupanlheabov¢-mentionea properiy lor ins0ection purpas¢s. '�I � �2�- 93 rvw. Pate'. � Signalure: N�•�- Oriver'i �icense m Socia� Securi�y x: S`� 5 z 1 5 9 5 S t6<1-a6 Whne—Builtling: Green—Code EnbrcemenL Lanary—AOPlicenl; Pink—qe�enue; GolOenroO—Asseswr CITY OF COSTA MESA — HUILDING PERMIT , PERMIT NO; B 060718 PLAN CHECR NO: 04799-92 L , , CONSTRUCTION TYPE: 5—N SP PERMIT TYPE; STR PURPOSE: X�LT JOH DESCRIPTI013 ; REPLACE AND ADD AUTOMATIC TELLER MACHINE SQ FT: 6,000 CLAIM VALUE; 6,000.00 CALC—VALUE: 6,000.00 GROUP OCC: H-2 / COMMENTS: INCLUDES SOME DISABLED ACCESS FEATURES UFGRADE. *+r�e*+r�*�r***+t��**�r�r�r*�t�r�*x��rx**+t�r*�r*x��r�*�t�r**�t*�e��r�**�t*��t*x�+�*�t*�r*+t**+t***�r*****�r�r* 2 O N I N G R E Q U I R E M E N T S S E T B A C K S FRNT: FT MAIINBRIEL�DING --FT IN FRNT: FTCESSONYRE�LDING FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARRING REO• PROV: PARCEL: 92210314 ZNE: C2 REF NO: PLANNING N01'ES> ADDING 3 NEW ATM'S AND REPLACING 2 EXISTING ATM'S AT THE � > 19TH ST B OF A AND ADDING HANDICAP SPACE, *�r�t***�r�r*�t�t�t�r�t*��t�r�e�r�r�t�r�r*�t�r.*�r*�r�r�t*�r�rx�****�+t�rx�e*�r��r�t*��e�r�r�t�e�r+t*�*�t�*�t�r*�e�t***�r�t�r�* 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 NrT S .y _ ZONING APPROVED BY ;,T}CB DATE; 'r ZZ .3 BUILDING APPROVED BY ; " DATE:,_ APPLICATION ISSUED BY• DATE;� if iF k �f 1F i! �E ib �f iE iE �E �F iF 3F if 1F if Ik iE 3f 1E if if M ik 1F ff iF iE iF iF7F �fifif�tiFkiFikff±EiEiEifjFiE�f�EiEiF�F3Ekk1F:FiF3f�FiE�fiFkiE�EififiF3fifiEiFilfE 41fiE�ElkiEiE�Fifif3FlFifiE�FikiElEiEiEiEifiEiEi LEGALI2ATION;N F E E S U M M A R Y STRUCTURA', i iE SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/RES GRADING PERMIT 81,00 � SMIP/NON—RES PLAN 52,65 , 1,26 ISSUE FEfi � : � ', BUILDING—DIV—> PERMIT ISSUE PliAN-CHECK TOTAL PAID DUE TOTALS----> 82,26 0,00 52.65• 134.91 134,91 ,00 REVENUE DIVISION TOTALS--> COLLECTED: ; 82,26 OVER/SHORT; 00 BLD81P00 PLUMHING ELECTRIC MECHANIC L FIRE SMIPiT06 GRADING PLAN—CHECK _ b�/ if �lf ik �f if k if iE �f 1FiE iE it iFlf ik 1! 3f 1k k iFi! 1f 1F if �F ik ik iE iF iF if iF ik iE �E if k1F-�E ik kaF iE ik iF 3f iF 3f if if ik if if iE ik IE �E k k iF it if k 1E if if iElF iF ik iE if !E!F 3E 3E if iF I N D I V I D U A L�,. F E E: B R E A K D O W N TYPE QTY D E S C R I P T I O N-� � UNIT COST TOTAL COST /� SFC 6000 ALTER BY VALUE COMMERCIALt- NOZONE 1.00 6,000,00 END OF FEES i . �'1CONSTRUCTION ANDPLANNING �APPROVALS Permit � Date t. Temporary Electrical Servic_ or Pote 2, Soil Pipe-Undrgrnd: ' 3. Etectric�i�-Eonduit Utili[y�Undrgrrttl.: i' :4; E1e�tric0l �onduiritlndrgrnd� � t 5. Stee� I Rzinforcem�nt �-- � �i' . ' .6. �Electrica� llFEFi Grnd. - Z:.footings . ,� t 8. Fdundation ' � �J. Water Pipe-Undrgmd. ' 1�0. Svucturai floor System • � 11. Praperty Sewer Line & House Connection 7 2. Sewer Cap � •. % . i 13. Roof Drai�s ._, �� = i 14. flou9fi P�umbing , . 75 Rough �IectriT,al•Conduit I r 16. Rough.E�ectric Wiring � 77. Rough 4Niring Sign 18. Rough E�eciric`al-T Bar Ceiiing 19. Rough Neating & Air Conditioning 24, R�uqh �act,ory Eireplace �� i„- � .�--�-� �: .- 21. Ducts, in Sfrucmre " • � � 1 ' �^ 22. Ducts, 1/entilacipg., "',. � , 23. Gas Pipe-Rough &-Test * . - 2k: Roof Fr2ming ' ` . . .. -. �- 25. ROot Skeathing - C 26. T�Bar Ce�lin9 ISaucturall &'ti7onocoat � _ �_ .. 2I. Freme and Elash�ng � � " 28. lathinq& $idin4 - -i i • ,.' "'= 29. IntulatPon • � � � - 30. Drywail.Narling ' .: ;qf7�� ' 31. Plaster Brown Coat �. . ^ t• 32. Electrical Pawer Metet�F�inaf � �' 33; Final Elsctric - - . � - � 34. Final Heatirig &9?,R Conditibning � � _ 33> Final G'as Pipe-Test �� .:i � _ 36. Hnod "or CanoPy, � ' ` i ''" - � 1 a T i �l' s. 3Y Final factory Firepiace, � 38. Final Ptumbing � - 39. Water Service-Flnal ; '� , , � � 40. Gas Serv�ce�Final _ � ' 41. Solar DbmesticFirial' ,. � - 42. Backflow Preventer 43 Backfbw Irrigation `-'' � �' 9 � . �, . 44. Landscape Irrigation System '�J '� '. _ 45. Sound Attanuation " 46. Handirap Regulations � � / � 47. FINAL STF2UCTURE & BUiLDING ��/�/ 48: FVNAL PtANN1IdG � ?' / ( 4S. ElectriERelease to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIP�CATE OF OCCUPANCY Date POOL & S. Inspector APPROVALS Permit ,i�` 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical8onding 56. Rough Plumbing & Pressure Test 57. APPROVAI TO COVER�GUNITE 58. Electrical Cqnduit�Undrgmd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwasn Lines, P�Trap, O Undrgrnd. &i. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Neater & Vent•Final 64. Plumbing System � Final 65. Electricai-Finat 66. Solar System�F(nal 67. Fenciny & Access APProval 68. APPROVED FOR PLASTERING 69. POOUSPA SYSTEMS FINAL . rr , �., FIRE DEPT. REQUIREMENT ' , ; �.APPI�OVpLS ' Per{nit #�`'�...T_ ' .,;' , 70. Underground Hydro ` � r 9��a d0il � 77. Product�pin � as ` - 72. Underground FIusF�- � � > . 73., Undergr d.Stor�ge��:ankOGas ❑�Oil � •- ' 74:'Overhead Hydro.� " =': � 75. Dry.Ehemical � � _ '" - � t � = 76. Dry StanUpipe ' � ' � �; ,� 77. FIXED SYSTEMFINAL - ,j� �;,j�- 78: FIRE PREV. FINA� � ` ��/". . = HEALTH DEPT. REQUIREMENT � . . 79. FINAL INSPECTiON �� - �, . _ ;j � 80;. FOOD CERTIFICATE ISSUED - i � � Notes: .�)l.d.i?,�. � :ti�..� /:.� � , .I� � - 2 S="7 j�`6' ---T i' . // -^-^e � � , bt-C. �r/�' Ccr��/J_5`�.. .. � , �. , . . , _. t• ti - . . � . . - � • _ �.. . � , = . e Date � inspector lI � PNOJECT AOUNESS: S 4� W�9 TH J�' T � OWNEB'S NRME: BANR OF AMERICA NT & SA aooxess:TAX DEPT Jt3245 P O BOX 37000 SAN FRANCISCO CA 94137 AXCNIENGINEEfl: WMM ASSOC nooness: 3731 WILSHIRE BL L.A. PEflMITTEE:ROBINSON ELECTRIC aouxEss: R871 TROY ST SPRING VALLEY LICENSEO CONTBACTOB OECIABATION: I �ereby allirm Ihal I am licensea un 7000� ol Oivsion 3 0l Ihe Business antl Pmtessions Cotle, anA my license is in cirr uc.: Q sTnTE uc.q z 9 g g 5 cuss: Date:/2+i�' 7 `� Signature� WOXNEflS' LOMPENSATION OELLAflATION: I �ei¢by a�h t I have a ceri Compensalion Insurance. or a cerlilied copY thereo� (S � 00. Lab. q POLICYNO.:WC%SOiS24O—OO E%P.OATE:1 caMraNr:CA CASINDEM EXC ❑ Cenilietl copy is hereDy furnishetl. � CenifieC coDY is fitee witn Ihe cit Oa�e:O� � ZS � L S qpplic '/ iNEMPIION FflOM WOPI(EH$' COMPENSRTION OECLAMT� is section nee0 n I certity Ihat in I�e Oe��ormance oi Ihe work �or w�ich I ermit is i55ued I sha IlN1T: PEG.NO,: C 5 5 1 B UNIT: x � 0 CA 90010 (619)697-6040 CA 9197 Oer Or ' �apter 9(commencmg wilh Seciion fulllorce and eHect. C� cal ofco en1 to Il�in re ora ce�ilicate ofworker5' 1 y 'IQ Oivision. be mpl eC ii �h e mii i510r one �uMrM (5100) a less�. emplo erson in any manner so as lo betome su�ject lo t�e Workers' Compensalion Laws ot Califomia. �ate: Signature: NOTICE: 0, afler making Ihis Ceclaraiion, you Should Detome SUGIe�� o Ille WorkeR' Compenution provisions ol IAe LaEor CoOe. you mus� lo�hwilh campty wilh such praWsions Or this Dermi� shall De tleemetl revoke0. CONSTflOLTION IEN�ING RGENCY: I �erehy allirm Ihal ihere i5 a mn5tmtiion IenOing aAency for I�e pertOrmante 01 N¢ work tor w�ic� �nis permii is issuetl (Seciion 3097. Crv. C). LENDEfl: FOUflE55: OWNEB BUILOEB �EClA8R710N: I herebµaffirm tlwt I am exem0� �mm ihe Coniracmrs' State LiCense Law lar t�e follovnng reawn (Section 7031.5 Business antl Pmfessional Code: Any city ol counly w�icA repuires a Oermil to con5tmct, alier, impmve. Oemalisn. or re0air any simcWre, prior to ils issuance. alsa revuires ine aoDlicanl for such permil to lile a signetl statement ihat he/she is licensea pursuanl �o Ihe provisions a� �he Conlraciors' State Lic¢nse Law (CIwO�er 9(camm¢ncinp vnt� S¢ction 7000� o� Oivivon 3 al �he Business an0 Pmlessions Cotle� or I�ai he/s�e is exempl �herelmm ane ��e Dasis lor Ihe alleAed exemp�ion. Any violaiion ot Seclion 7Q31.5 Dy any applicant lor a De�mit subjeds Ihe apPlicanl lo a civil p¢nally ol noi mort t�an �ive hunCr¢O tlollars (f5110). I. as owner al the pmDerty or my employees vnih wages as IAeir mle compensaiion, will do Ihe work, an0 tAe ❑ simcture is not intentle� or aflere0 far Sale (Section 7064: Busmeu ana Profe55ional CUOe: T�e CAntractor5' State License Law Ooes nol apDly Io an owner ol a pmDeny who builtls or impmves Ihereon. and who Uoes suc� work himself/hersell or I�mug� his or her own empl0y¢¢5. pmvide� ��al SUt� improvements art not infentle0 Or oil¢re0 lor sale. I�, how¢ver Ue builEing or impmvement is solU wit�in one year of completion, Ihe owner vnll �ave IAe burden ol pwving �eR�e ditl no� OuilA or impmve lor the purvose of salel. i, as owner oi t�e pmpeny, am evclusively convaming wit� licensed contracmrs to cansimci t�e prolec� (Section 7044, Business � ana Pmfessions Catle: T�e Coniractors' State Lkense Law Oces not appty to an owner of DmpeM wtp hudAs ar imprmes t�ereon antl w�o mmracts for suc� pmlects wit� a contracmqs) license pursuam to i�e Comracmrs' Staie License Law). I am aware ��at proof oi Iheir Worker'S Compensation insurance shoultl be pmvitletl �o me. � I am exemp� under Sec�ion: B, 8 P. C. lor this reason'. Da1e: Owner. I tlo �ereby cenily Inal I am aware oi and untlers�an0l�e reQuiremenis ol Califomia Heallh an0 Salely Cotle Sec�ions 25505, 25533, and 2553d antl ihal I or any tuture bwltling occupant wilVwill not (circle one) neetl ta tompty wi�� sai0 state mdes antl ihe requiremenis for a permil br consimction or mo0ilicatmn irom ihe Fir Ouah�y Management Oisiricl. flesiEential conSimc�ion appli[alions are e�empl Imm ��ese provisions. �aie: Fpplicanl'. _ I �ereby certily �ha� I havereatlihis aDPlicaiion an0 Stale�Aat artlinances an� s�alelawsrelaiingto builtling consimclion antll pmOertY �o� inspeclion purposes. �atP� � 4S� L_� 5' Driver's License or Sociai Securiiy a: I agree �o comply wilh alt ci�y anA coun�y ',hiscilyio en�eruponihea6ove�men�ioned t6G1-46 White—Bulltling; Green—Cotle Enlorcemen�', Canary—ApPlican��, Pmk—Revonue', Goltlenrod—Assessor CZTY OF COSTA MESA — BUILDING PERMIT PERM NO; E 061192 PERMIT NO: E 061142 PLAN CHECK NO: N GOVT; N SUPP; N CONSTRUCTION TYPE: 5—N SP PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION ; REPLACE AND ADD AUTOMATIC TELLER MACHINE SQ FT; CLAIM VALUE: CALC—VALIIE: GROUP OCC; B-2 / COMMENTS: RE; B60718 PRIMARY BUILDING PERMIT, ("B OF A" ATM) 1E if iE if if if if iF iF iE iE ik i6 iE 1f 1f iF iF 1F if if iE �1E i(� i(�lFif �)F if iE iF if K� 1F iE 1E 1f iE 1E ib if iE i! iE iE iE 7E iF lE N� 1(� �lf it it IP iE i(� 3F �IF 1F if iE iE iF dF ik ih if� iE 1F ih lt if iP ih 1E iF iE if 2 O N I N GS ERTEBQAUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT Itv LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARHING REQ• PROV; PARCEL; 42210314 ZNE; REF NO: PLANNING NOT'ES� i 1E iE If if iE iE iF iF if �lF if �)f iF if iE 3E 3F 1E if iE it iflf� if �Ik iF �3f iF iF # iE �lf if �E �E �1F if 3f-�IE iE iE iF iE if iE �IFiF �Ik iF�f iE �E iE iE i! iE if iE iE ik iE iF �lk if iF 3E�F iF )F iE jf if IE IF 1F 3E IF if 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 20NING APPROVED BY DATE; BUILDING APPROVED BY : DATE; APPLICATION ISSUED HY•� DATE: �e'� �� iEiEitikitiEitiEiEiliEilikiEiEiEiEx-iEiFaE3E��J[3�� *xx**x�**x* ** ikiE3klEiFiEiElEiflEifiFlEifiE3FifitiFiFikiF�ElElP1FiF*iFdPiEif�lkiEiEiElEiEiEillEifiE1E � iPikiEikififiEaklElki(�iliElfiFiE3fiklFK�lE�kikiFlE3E3EiFifiEiFiE LEGALIZATION;N F E E, S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBZNG EI.ECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 7,50 50� PLAN ZSSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECH TOTALS----> 7.50— 15,00 0,00 REVENUE DIVISION TOTALS —> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 22,50 SMIP/NON—RES TOTAL PAID DUE 22,50 �� 2,50 ,00 22.50 OVE�9SHORT; ,00 FIRE SMIP/TOT GRADING PLAN—CHECK iF iF if iE if iElf if ik it if it iE if if it iE iF 3E 3F iF iE if 3f 3F if iE 1E iF if i! k iE iF if iE if if �E iE iE �lf i! 3E 3f iFiF 3f if �f 1f iF if 1E iF iE 1E if 1E i! jE iE if iF iF if if 1E 1E iElE iE iF iE 1F �E iE if iE I N D I i1 I D U A L F E E B R E A K D O W N ,TYPE (ZTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 9 FIXTURES LIGHTING i ST 20 EA, .75 6,75 ELE 1 RECEPT/S�IITCH 1 ST 20 EA. ,75 .7; END OF rEE5 � � � � CONSTRUCTION AND PLANNING POOL & S \ APPROVAIS Permii# Aate Inspector AhPROVALS Permit,�k Date Inspector ;�. Temporary Electricai Service pr Pole 52. Pool & Epuipment Location 2. Soil Pipe-Undr9rnd. '• � 53. Steel Reinforcement - 3. Electricai Conduit UtilitV-Undrgrnd. 54. Forms . � 4. Electrical Conduit�Undrgrnd. 55. Electricai Bonding �� 5. Steel Reinforcement 56. Rough Piumbing & Pressure Test 6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE 7. Footings ''! 58. Electrical Conduit�Undrgmd. � 8. Foundation . ,, ' 59. Gas Pipe, � Undrgrnd., Test .� 9. Water Pipe-Unclrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 70. Structural Floor System 61. APPROVAL TO DECK 1.1. Property Sewe� Lioe & House�Connection _� 62. Backwash & Receptor-Final - 12. Sewer Cap •� � •� 63. Heater & Vent-Pinal � . 13. Roof Orains c' �-. 64. Plumbing SYstem � F�nal �� 14. Rough Plumbing - 65. Electrical�Final � � 15. Rough Electrical-Condurt 66. Sola: System-Pinal '�� 16. Rough Electric Wiring 67. Fencing & Access Approval il. Rough Wiring $i9n 68, ApPROVED FOR PLASTERING i 78. Rough Eleciric8l�T 8ar Ceiling 69. POOLlSPA $YSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIFiEMENT 20. Rough Factory Fireplace APPR�VALS Pe�mit # 2/. Ducts, in Structure 70. Underground Hydro 22. Dutts, Ventilating 71. Product Piping �Gas �Oil . ; 23. Gas Pipe�Rough & Test 72. Underground Flush i 24. Roof Framing 73. Undergrnd. Stora9e Tank O Gas ❑ Oil 25. Roof Sheathin� 74. Overhead Hydro ' 26. T-Bar Ceiling I�atructurat} & Monoco�t , 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding � , 77. PIXED SYSTEM FINAL 29. Insulation � � 78. FIRE PREV. FINAL � � � HEALTH DEPT. REQUIREMENT 30. Drywall Nailing � �' '+ � 31. Plaster Brown Coat ; 79. FINAL INSPECTION 32. Electricai?owar MeterFinal � , •^� CERTIFICATE ISSUEO 33. Final E�ectric �� ni�*^�• 34. Final Heating & Air Conditioning � ' • � i 35. Final Gas Pipe-Test I � 36. Hood or CanopV r ' , 37. Finai factory Fireplace � i 38. Final Plumbi�g i � .. 39. Water Service-Final ' � � . 40. Gas Service-Finai � � � 41. Solar pomestirFinal I � + 42. Backflow Preventer � � � 43. Backflow Irrigetion 44. Landscape trriAaiion System 45. Sound Attenuation � 46. Handicap fiegulations 47, FINAL STRUCTURE & BUILDING � ' � 48. FINAL PLANNING i � • 49. Electric Re�ease to Edison � �, 50. Gas Release to Southem California Gas Co I 51. CERTIFICATE OP OCCUPANCY No. Dare � - . ADG��anl to flll In all spaces excapt ihose wit�in heavy Eoraer Iines ane s(gn all approvriate aeclarations. crrY OF COSTA �MEt{$A CONSTRUCTION PERMIT Project Address �/� �� ST' Applicant's Mailing Address �3O V 4. N��N^f ��• Z% Owner's Name `�1J�K � '%m�'� � Phone Address '�� p �' �4 S�� T � - Arch/Eng. License No. Address Conuactor'sNam 'rK-� �p� Phoyn� 2ob-306C Addresslmailing) O t%'MI_�%�"`Y� � O�• sr"�0 CiryLicenseNo. ��5� LICENSED CONTRACTOR DECLARATION I hereby aftirm thdt I am IicenSetl untle� p�ovlsions of Chdrte� 9(commGnCinq with section 7000) of DiviSion 3 of the Bu5ine55 dntl Vrofes5ion5 COtle, antl my license is in full force antl etfect. q �y license CI zs � LIj�ense,No. �b /� T S Date��% Qq 5'9 t �/� �%�� WORKERS' COMPENSATION DEGLARATION I hereCy affirm that I have a certiticate oi consent to seli-insure or a tertificate of Workers' Compensation Insu�ance, o� a ceiHfletl copy thereof (Sectlon 3800, Lab. C.LG�3 G/ Q Company �U� �` iY No. V (__/ ,ertitiea copy is hereby turnishetl. j H1j'J�M/V IT�" ,._,Certi 'e co y is filetl with the city Builtling Divislon. Oate��_ ApP��ant �pNCd�'� EXEMVTION FROM WORKERS' COMPENSATION DECLARATION '(This section ne¢tl nOt be completeU if the permit is for one nUntlretl (E100) or less). . 1 certify that in lhe performdnte Of th¢ work fo� which thls p¢rm�t i5 ISSu¢tl I shall not employ any person in any manner so as [o become subject [o t�e Workers' Compensation. Laws o( GalfPornia. Date Si9nature NOTICE: If, after making this tleclaration, you shoultl become subject to the Workers' Compensation provisions ot tne Labor Cotle, you must (orthwith comply with such provisions or this permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV � 1 hereby aftirm that there is a construcllon lentlin9 agency for ehe performance ot the work for which tnis permil iz issuetl (Section 3097 Civ. C.) Lentler's Name Lentler's Atltlress OWNER BUILDER DECLARATION 1 hereby affi�m ihat I am exempt from the Con[�actor'S LlCense Law (o� th¢ following reazon (Section �031.5 Business antl Professional Cotle: Any city or county which requires a Pe�mlt to con5[ruct, alte�, imp�ove, tlemoli5h or repai� any structure, prlor to its issuance, also requires the applicant for such permit [o file a signed statement'thdt he/she Is IicenSeG pu�suant lo the p�ovlsion5 of the Contracror's License Law (ChaO�er 9.(mmmencin9 with Section ]000) ot Division 3 of the BuSinesS antl Vrofezsions Cotle) or that ne/she is exempt there(rom antl the basis (or the alle9etl exemotion. Any violation ot Section 703L5 by any applicant for a permit subjects tne applicant to a civil -=nalty of not more than (ive huntlretl tlollars (E500). •I, as owner of the property or my employees witn wa9es as thelr sole npensation, will Oo the work, ana the structure is not Intentletl or oiteretl or sale (Section 7044, Business antl Protessional Cotle: Tbe Con[ractor's 5.icen5e Law tloe5 no[ apply f0 an own2/ ot a property who,builas o� Improv¢5 nereon, antl who tloes such work himself/herself or through nis or ner own employees, provitlea tnat suGh imorovements are not intentletl or oiferetl for sale. It, however, tne builaing or improvement is soltl within one year of com- pletion, the owner will have the burtlen of provin9 he/sne tlitl not bulltl or im- ��prove for the purpose ot sale). ` � I, as owner ot [he Oroperty, am ezUusively contracting with licensetl con- tractors ro cons[ruct tne project (Sectlon 7044, Business antl Profeszions Cotle: The Contractor's License Law tloes not apply to an owner of property who builtls ot imOroves [hereon. antl who mnVdt[5 fo� such o�olect5 with a con- tractor(s1 Lcense oursuanc m[ne ConVattor•s License Law). I am aware [ha[ proof o( tlteir WOrke�'S CompenSatiOn insutanCG Shoultl be prOvlaetl to me. ❑ I am exempt untler Section B. & P. C. �or this reason Date Owner I hereby certity Ihat I have reatl this application antl state that the above intormation is mrrect. 1 a9ree to comply with all tlty antl coun[y orAinances antl state laws relatin9 to builtling constructlon, antl hereby authori¢e re0re- sentatives of this city to enter upon the above-mentionetl Property (or inspectlon purposes. l Si9nature `"'�� Date Drivers' License or 55 $ �'' ._._�.._-� � -� - . _r _. .,....�.... A.P.7W S Main Building: TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T FrOnt DESCRIPTION OF WORK/USE OF BIDG. B Rear A TVPEOFPERMIT�-y GRADING FOUNDATION STRUCTURAL I C Right ❑ TENANT LJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � g� Left ❑ �OTHER Ping. Rei. # PROJECT DESCRIPTION Sa. FT. OCCUPANCV Plenning Notes: CONSTRUCTION TVPE VALUATION $ ZONE GRADING CU. VDS. ACRES Remarks: i;�� t/7 Cca.ii � �..�-1� . ir (��[Y c Bar Sink Backflow Preventer Backflow Irrigation Bathtubs . Clarifiers Dishwasher Drinkin9 FOuntains Floor Drains Floor Sinks Gas Service Outlets Interceptars Kitchen Sink Lavatories Roof Drains Reinspection Fee � $15 Duct - Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt, iC80 # Heating System & Ducting �0.100,000 BTU 0100,OOOBT Reinspection Fee � $15 0865-46, rev. 5/88 While - Builtlin9: Canary - Applicant: Pink - A<countln9; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash lsundry Tre'ys laue Fea Hood or Type I ❑ Canopy Typell ❑ Refrigeretion System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction PoleSub. Cooking Unit Dishwasher Dryers ❑Gas � Fan F,A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0.5 leclric 2one Accessory Buildin9: Parking Req./Provided ELECTRICAL Transtormer ❑ 15-50KW ❑ 50+KW Meter ❑up ro 100 amps Meter ❑over100amps KW 05-15 KW � Sub Panel � Motors DO-1 HP �1'h � 8 Inc.Solar �9�15 HP �16-15+ Microwave . Pole Light Renge Sign Standing Sections Trash Compactor Reinspaction Fee $15 luue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By FEES Buildine APP�e�ed By � - $ 3 SUMMARVOFFEES � BUILDING PERMIT $ SMIP $ PLAN CHECK $ PEfiM1T PLUMBING $ ISSUANCE $ PLAN CHECK 25% $� ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ ��7o MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ FEES N I N G R E Q M T S. 01 00027506-00027507 T t? T 52.10 AATE: 03/OT/89 TI19E: 15�34 , , ,_ � CONSTRUCTION AND PLANNING . POOL & ..,- '' � APPROVALS Permit # �--�e Inspector p�ppROVALS Permit # Date Inspector. �i • 1.�Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �; _r .. 53. Steel Reinforcement 3' Electrical Conduit Utility-Undrgrnd" ' 54. Forms 4:"Elect�ical Conduit-Undrgrnd. - •� 55. Electrical Bonding . 5i Steel'Reinforcement �� 56. Rough Plumbing & Pressure Test 6: Elecirical UFER,Grnd,.� - 57. APPROVAL TO COVER-GUNITE '.;,, 7: Footings �; -; • � � 58. Electrical Conduit-Undrgrnd. r• � 8.,Foundation � �'' � ��' � 59. Gas Pipe, O Undrgrnd., Test ,�� 9. Water Pipe-Undrgmd. , �-� 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Str�uctural Floor 5ystem ` �� 61. APPROVAL TO DECK 11. Property Sewer Line & House Co.nnection _.; . 62. Backwash & Receptor-Final r• � 12. Sewer Cap , - �� • 63. Heater & VenbFinal � ✓ 13. Roof Drains ' ' ' •� - . 64. Plumbing System - Final 14. Rough Plumbinj' 65. Electrical-Final 15. Rough Electrical=�nduit 66. Solar System-Final 1�6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18: Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heatirig & Air Conditioning FIRE DEPT. REQUIREMENT �20. Rough Factory Fireplace !7 APPROVALS Permit # 21. Ducts, in Structure �_ 70. Underground Hydro 22. Ducts, Ventilating j j 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough $i Test .� 72. Underground Flush 24. Roof Framing ; '73. Undergrnd.StorageTank OGas ❑Oil 25.,Roof Sheathing 74. Overhead Hydro ��26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �%7. Frame and F�ashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing . ' � HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �� N . 34. Final Heating & Air Conditioning '. � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer - - 43. Backflow Irrigation ' 44. landscape Irrigation System 45. Sound Attenuation . 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed ,r 49. Electrie Release to Edison ' 50. Gas Release to Southern California Gas Co � - ��i 51.CERTIFICATEqFOCCUPANCY _ ' ; , . ,�� No. Date . _. , AOPlicant to fill in all spaces exceD� lhose witnin neavy eortler Iines antl sign all appro0riate Eeclarotions. CITY OF COSTA MESA CO_N$T 11C, T,10 RMIT Project Address �� . Applicant's Mailing Address � � Owner's Name � Phone Address �' 9 Arch/Eng. License No. Address �/�.� Contractor's Nam�l��1� Phone � 7- Address Imailing) O / City License No. _�p„9� �_ � �y d �S LICENSED CONTNACTOR DECLARP.TION I hereby affi�m lhat 1 am IicenSetl untlGr provi510n5 of Charter 9(comT¢nting with uction 7000) of Dlvisfon 3 05 the Business antl Protessions Code, antl my license is in t W I torce aptl e�tect. , IWORKERS'COMPE Vrv L� ' I hereby aHirm that I have a certiticate of con ' Workers' Compensation Insurance, or a certifletl copy thereof (Sectlon 10, Lab. C. O / � ��cn �No. � �� / ��{!� COmpany Certifietl mpy Is hereDy turnishetl. Certi ie o�qy i ' etl with the city il Ivislon. Date �7" Applitant �I'�%�-S � �G• EXEMPTION FROM WORKERS' GOMPENSATION DECLARATION �(This section neetl not be completetl i� the permit is tor one huntlretl (5300) or less). 1 certiry [hat in the performance ot the work tor which this permtt is issuetl I � shall not employ any person in any manner so as to become subject to t�te Workers' Compensation Laws o( Califomia. \Da[e Signature NOTICE: If, after making this tleclarJ��on, you shoultl be<ome subject to tha workers' Comoensation provisions tlf �he Labor Cotle, you must forthwith mmply with such provi5ions or tnis permit shall be tleemetl revoketl. \CONSTRUCTION LENDING AGENCY I hereby alfirm thal there is a constru[tion lentling a9ency for the performance Ot the wo�k for whiGh thi5 perfnR I5 i55uCtl (SectiOn 309� Civ. C.) \lRntle�'S Nam¢ LenOer'S Atltlress OWNER BUILDER DECLARATION I hereby aitirm ihat I am exempt from the Conlractor's License l.aw for the following reason (Settion 7031.5 BUslness anE Professional Cotle: Any city or county which require5 a pe�mit to c0�5truct, alte�, ImOrove, tlemOlish o� repal� any Slructu�e, priOr (O its Issuance, A�� /equi�es [he applicant tOr such pe�mit lo (ile a signetl Statement thal he/She Is licensetl pur5uant [o the provi5ion5 of the Contractor'S License Law (Chapt¢r 9(<ommencin9 with Section �000) of Division 3 of thC BUSiness antl Profes51on5 Code) Or tM1at Ile/she i5 exempt f�7erefrom antl the basis for the alle9etl exemption. Any violation of $ettion -:A�:��,31.5 by any applicant Por a p2rmit subjects lne applicant to a civll '"'ldlty of not more than five huntlretl tlollar5 (E500�. l-�:J I, as owner of the property or my employeez with wages as their sole mmpensation, wlll tlo the wo�k, and [he s[ructura IS nat Intentletl or�oft¢rCtl for sale (Section 7044, Business aPtl Profes5lonal Cotle: TM1e Contractor's License law Coes not apply to an oW�er of a property who b�iltls or improves thereon, antl who tloes such work p�mself/�erselt or throu9h bis or her own employees, provipea that such impro�ements are not Intentletl or ofleretl (or wle. If, however, [he builtlinq or improvement Is soltl within one year of com- Oletion, the owner will have the burde� of proving he/she tliC not builtl or im- prove for ihe purpose of sale). ❑ I, as owner o1 the property, am excluslvely contracting with licensetl con- tractors to construct the Oroject (Sedlon 7044, Business antl Professlons Cotle: TM1e ConVattor's LicenSe Law �loes not apply to an owner of property who builds or imoroves thereon. antl'who contracts for suth oroiects with a r.on- tracior�sllicense pursuant lo me Contractor�s Ucense Law). I am aware that proof o( their Worker'S Compensalion in5urance shoultl be provitletl to me. ❑ I am exempt untler Section B. 8. P. C. for this reason Daie Owner I nereby certify tnat 1 have reatl information iz correcL I agree to � antl state laws relatina to Evilrlina ro efiter tate that l�e aDOv¢ d munty ortlinances :by authorize repre- ionetl pro r'tIy fQo�r Date ��T �+ � TVPE OF CONSTRUCTION IJ NEW II�ADD U ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHE DESCRIPTION OF WORK/USE OF BIDG. �S L hVO TVPE OF PERIOlVf LJ GRADING IJ FOUNDATION LJ $TgVCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ��nicn� ❑ OTHER PHOJECT DESCRIPTION S�.FT. oCCUVANCv CONSTRVCTION TVPE VALUATION $ ZONE GRADINGCV.VOS. ACRES Remarkz: Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks GasService � Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Duct - Under Ground Duct - $tructural - Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. iC80 # Heating System & Ducting ❑6100,000 BTU 0100,0008T Rein c[' F or ss � �-'�— � � spe wn ee 5/88 White - BuilAing; Canary - Applicdnt; Pink - Accountin9; Goltlenrotl - ASSessor S�s ShOwers Service Sink Sewer Cap Sewer Connection Solar Collecrors Salar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issua Fee Hood or Typel ❑ Canopy Typell ❑ R�ef�ri eration SyStem - JJQ100,OOOBTU ❑t00,000BTU System Repair/Alteration Fire Dampers Registers laue Fee A.P. yW S Main Building: E T Front ARear C Right gLeft Ping. Ret. # Planning Notes: FEES Automatic Washer Construction Pole Sub. Cooking Unit Oishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets $ 3 FEES Garbage Disposal Generotor 065 KW 2one Accessory Bui Parking Req./Provided ELECTRICAL Transtormer ❑ 15�50 KW ❑ 50+KW Merer ❑up to 100 amps Meter ❑over 100amps Sub Panel Motors�0.1 HP �1X-8 Inc. Soiar �9�15 HP �16-15+ Microwave Pole Light Range Standing Sections 5 KW Trash Compactor � Reinspection Fee �$15 � f Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By Buildine APPraved By APpIICBtIOn ISSIIBd BV SUMMARVOFFEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GFiADING $ PLAN CHECK 50% $ ��/�� MICROFILM $ MECHANICAL $ �'"�-� TOTALFEE $ PLAN CHECK 25% $ 01. QU035968-00036468 YOT Oa?E: 0�/OS/84 TIME: 09:Q1 N I N G R E Q M T S. FEES $ 3 ��i.l�e ... ... .�,. ' CONSTRUCTION ANDPLANNING r POOL PA � , APPROVALS Permit # -Date Inspector pppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole �� 52. Pool & Equipment Location 'u i 2. Soil�ipe-Undrgrnd. �, .:� � 53. Steel Reinforcement � 3. Elec[rical Conduit Utility-Undrgrnd. ,� ✓ 54. Forms ' 4. Elect'rical Conduit-Undrgrnd. : ��: 55. Electrical Bonding � i 5. Steel Reinforcement , ' - �' 56. Rough Plumbing & Pressure Test r r 6: Electrical UFER"Grnd: %'� . 57. APPROVAL TO COVER-GUNITE . ; 7. Footings �; • '� 58. Electrical Conduit-Undrgrnd. . �., �8. Foundation . - •'� 59. Gas Pipe, O Undrgrnd., Test � �� 9. Water Pipe�Undrgr�d�' ^ 60. Backwash Lines, P-Trap, O Undrgrnd. 10; Structural Floor System k: '' i 67. APPROVA� TO DECK 11 . Property Sewer Line & House Conriection ' , • .Q ,`. 62. Backwash' & Receptor-Final " � � 12: Sewer Cap ;,.�� :� j� � 63. Heater & Vent-Fi�nal 13. Roof D�ains . =- l 64. Plumbing System - Final . S r� 14. Rough�Plumbing. � 65. Electrical-Final . � _ � 15. Rough Electrical-Conduit - 66. Solar SYstem-Final -� �18: Rough Electric Wiring 67. Fencing & Access Approval 1T. Rough Wiring Sign 6S. APPROVED FOR PLASTERING 18. iiough'Electrical-T Bar Ceiling 69. POOL/SPASYSTEMS FINAL 19'. Rough Meating & 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 Freming 73. Undergrnd.StorageTank �Gas ❑Oil-+ 25. �Roof Sheathing 74.AOverhead Hydro . ` 26. T-Bar-'Ceiling (Structural) & Monocoat . 75. Dry Chemical 27. Frame and Fl�shing 76. Dry Standpipe 28. Lathing,& Siding 77. FIXED SYSTEM FINAL 29. Insulation. 78. FIRE PREV. FINAL 30. Drywall:Nailing HEALTH DEPT. REQUIREMENT 31. PlastecBrown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �� i' 33. Final Electric Notes: � � G`LJet�i /orx��x�T•�.�;e t0.td 34. Final Heating & Air Conditioning � Ql�.�� ` � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final � ' ' ' � � - - � ' 41. Solar pomestic-Final � 42. Backflow Preventer �� 43. Backflow Irrigation ' 44. Landscape Irrigation System ' . 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed � 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY � No. Date AVG��ant to iill in al1 zDaces exceo< thoza within heavy Oortler lines antl slgn all aDoropriate aecbntions. CiTY OF COS7A MESA CONSTRUCTION PERMIT PERMLT NO. _ TRACT NO. LOT NO. UNIT NO. . Project Address 7W � � � � Applicant'sMaili(n}aAddres�s,e IJ y� s'T�'n/� �MCN. Owner's Name /l��ii,�,J! � � ��'—�^�G�Phone Address � 1�—ti�e i _ ArchlEng. � Licenu No. Address ('� /��7 �� Contractor'sNarr�l/�i(iLLi�P,.JL�_�.4��-��'��' Phon��d Address fmaili� Ro CCrn�� a�p�u' � 1 Ciry License No. ' • � LICENSED CONTRACTOR DECLARATION ' . I Fiereby atiirm that I am licensed�untler provisions of Charter 9(commencing . wlth sectlon ]000) of Divikion 3' of [he Business and Professions Cotle, antl , my Iicense Is in fu force antl�eftect. Licenz CIa55 �� Lice 5C No �� "Q Datee4� Si9nature - WORKERS' C�SIGIPENSATION D LARFTIO , I nereby affirm that I have a�¢rtiticate of consent to selLinsuro or a certi(icate o/ Workers' Compen55tion.lnsurance,'or a certifletl copy thereoi (SecHon iaoo. �b. �.', �s � G�' )_. PoIICY N�,S� o� Comy4y��Prc!'/i � ertifletl copy i5 hereby turni5hetl. Cer$Hletl_COpy Ij,fil¢tl wiYh Ihe city $u_iltling jlivislon.�� , � E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thi55ection need not b¢ completetl if the pe�mlt i5 for OnG huntl�ed (5100) or less�. 1 certily ihat in Ihe per�Orrpance of the wo�k lo� whith this p¢rm�t ISISSuetl, I snall not employ any PersOn in any manner so as to Decome subj¢<t to the � Workers' Compen5ation LaWs of Galitornia. Date - $ignature NOTICE: It, after making this tleclaration, you shoulC become sub�ect to the Workers' Compensation provisions of the labor Cotla, you must forthwi[n comply with such provisions or this permit shall be tleemetl revoke0. CONSTRUCTION'LEPoDING AGENCV � ' ' . : 1 1 hereby afiirm that there fs a construction lentling a9encyfor the performance. • of the work tor w�ich this permit is issuetl (Section 3097 Giv. C.) Lentler's Name ' � �entler's AGtlress ' - OWNER BUILDER OECI.qRATION�- � '� I hereby aHirm that I am Exempt fiom the ConVaclor'S License L.aw for the . ' followin9 reazon (Section 7p31.5 Business antl Professlonal Coqe: Any city or county whi<h requlres a permit to construct, alter, Improve, tlemolish or repair . any Structure, 0��0� to It5 Issuance, also �equires the appliCdnt fo�'Such pe�mit to file a sign<U statement that he/shc IS IiC805Btl pOISIIdOL �O �he pIOV1510115 pi the Gon(ractor'S License Ldw (Chapter 9(commencing wi[h Section 7000) of DiviSion 3 01 the BusinesE antl Protessions Cotle) or that he/she is exemp[ , th¢retrom antl Ih¢ ba5i5 14r Ihe allegetl ezemption. Any vlolation oi Section 1031.5 Dy any ap0��nt for a permit subjects the aOP�icant to a civil `enalty of not more than fi�¢ huntlretl tlollars (5500). LJ I, as owner of the property or my employees with wa9es as their sole tompensation, will �o [he work, antl the structure is not Intentletl or offeretl for wle (Seclion 7044, 6usine55 antl Professional Cotle: The Contractor's � License Law Does not apply to un'owner of a property wno builtls or improves [be�eon, an0 who tloes such work himsel!/he�self or [h�ough hi5 or he� own employoes, prOvlCetl that Such improvements ar¢ nOt IntEntletl Of ofteretl for sale. If, M1oweve�, the bulltl�n9 cr imprOvement is soltl within One yea� of Com- o�etlon, the owner wlll naye tne burtlen of proving he/sne tlitl not builtl or im- �rove far the purpose of sale). I, az own¢r of the prop¢rty, am ezclusively conlractlng with IlcenSetl mn- tractors to consiruct the project (Section ]044, Business antl Profes5lons Code: ' The Contractor's License �yw tloes mt apply to an owner ot property who , �ulltlz or imOroves tner¢op� antl who confracls to� SUGn projects with a con- tractor(s) license oursuant'�o-the ConVacror'i License Law). I am aware that p�o01 0l tbeir Woiker's Compensation insuran[e should ee o�owmea to me., ❑ I am exempt un0er Section B. & P. C. tor [Ms rea5on � Date Owner 1 hereby UrtHY that I have rea� inlOrma[lon is co�rect. I ag�ee to antl state laws relating to builtlir sentatives of oty o enter InSpecliOn P P s. � Si9nature Drivers' License or SS � TYPE OF CONSTRUCTION LI NEW �VADD' LI A�TERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT ER' `- DESCRIPTIONOFWORK/USEOFBLDG��ti'� 6F A�MGhC.A •r. TYPEOFPERMIT��JJJ GRADING FOUNDATION STRUCTVRAL ❑ TENANT I� EIECTRICAL ❑ PLUMBING, ❑ MECHANICAI. ❑ OTHER � PROJECT DESCRIPTION 54. Fr. ' oCCuaArvCv CONSTRUCTIONTVPE ' - VALUATION$ ZONE GRADING CU.YDS. ACRES Remarks: . Bar Sink Backflow Preven[er . Backflow Irrigation Bathtubs ' Clarifiers � Dishwasher ' , Drinking Fountains Floor Diains ' GasService Outlets Intercep[ors ' Kitchen Sink ' - Lavarories " � � P—Trap Roof Dreins ' Reinspaction Fee $15 Boiler Duct - Under Ground Duct-Svuctural � Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact.8lt. IC80 �{`- Heating Sysrem & Ducting O Q 100,000 BTU O 7 00,000 B7� Reinspection Fee � $15 CMF 0865-46, rev. 4/84 White - Builtling; Canary - ADPliwnh pink - Accountinq; Goltlenrotl - Assessor $hower5 Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank , ' Swimming Pool w/Spa Urinal 'WaterCloset - i Water Heater , ' Water Service � • Issue Fee Hoodor Typel ❑ Canopy Type I I ❑ Refrigeration System ❑a�oo,000eru ❑ioo,000 System Repair/Alteration � laue Fee FEES m $ 3 $ 3 A.P. # S Main Buildi E T Front . B Rear A C Right K Lef[ s Ping. Ref. �WW Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher - Dryers ❑Gas ❑Electric Fan F.A.U, � Fixture5 , � . _ Device eoxes � Outlets Switches' Garbage DiSposal Generator �0.5 KW �5- 423? 7/�7/84 2one Accessory Building: • � Parking Req./Provided ELECTRICAL ' 0 15-50 KW � 50+ KW Meter LJup ro 100-amps � Meter �over 100amps � 'SubPanel .Motors �0.1 HP �1 X� 8 ' Inc.Solar 09�15 HP �76-15+ Microwave Pole Light Range I I' Standing Sections 15 KW Trash Compactor 13060 TI FEES n Z O N I N G R E Q M T S. I Reinspection Fea �$15 '. � Issue Fee I $ 3 I DEVELOPMENTSERVICESREQUIREMENTS: ' Zoning Approved By Date Building Approved By Date ' Application Issued By �'� � Date �� SUMMARV OF FEES BUILDINGPERMIT' $ SMIP $ PLAN CHECK $ PERMIT � PLUMBING • $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ � � E�ECTRICAL ' $ � GRADING $ PLANCHECK �50%� $ - MICROFILM $ �� ' MECHANICA� $ TOTAL FEE $ _3SL•L+�� P�AN CHECK Z5% $ CONSTRUCTION"ANDPLANNING � POOL,,.,;PA APPROVALS Permit# Date , Inspector AppROVALS Permit# .Date Inspector 1. Temporary Electrical Service or Pole � � 52. Pool & Equipment Location i � 2. Soil Pipe-Undrgmd.� _� - 53. Steel Reinforcement � 3. �ElecvicalConduiUUtilify-Undrgrnd. � 54. Forms � 4. Electrical Conduit;l7ndrgrnd. - 55. Electrical Bonding i 5.� Steel Reinforcement • � � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE 7. Footings ^ � � � _ , 58. Electrical Conduit-Undrgrnd. 6.' Foundation �� ' . � 59. - Gas Pipe, O Undrgrnd., Tesc �9. Water Pipe-Undrgrnd. , " � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System � '`' ; ' 61..APPROVAL TO DECK �' '1 i. 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 - � 76. Rough Electric Wiring . 67. Fencing & Access Approval - 17. Rough N/iring Sign ' , � 66. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT � ' 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure ' 70: Underground Hydro 22. Ducts, Ventilating ', � 71. Product Piping 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 (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing � 76. Ory 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 q� 30 �3 Y�/ f�iC- _ 35. Final Gas Pipe-Test �� vB 36. Hood or Canopy ' ' 37. Final Factory Fireplace ' , 38. Final Plumbing � 39. Water Service-Final , � 40. Gas Se�vice-Final 41. Solar pomestic-Final , , i 42. Backflow Preventer .� 43. Backflow Irrigation . _ 44. .Landscape Irrigation System � � 45. Sound Attenuation � 46. Handicap Regulations ' - , � 47. FINALSTRUCTURE&BUILDING � ' 48. Special Requirements Completed ' . � 49. Electric Release to Edison � � - - 50. Gas Release to Souther� California Gas Co �� 51. CERTIFICATE OF OCCUPANCY � No. � ' Date , ' � AOV��ant to fill in all spaees exeept lnasa witnin �eavy �ortler Iines antl si9n all appropriate tleclantions. C�-11�' OF COSTA MESA CONSTRUCTION PERMIT Project Address 54� W• i 9 rN Sr _� I ' Applicant's Mailing Address �` G�� 5. A'�M.DIJ �R��L�. ��'L'�Q�,�'O�I� Owner'sName ��N1� �F ik�'4�£LICPr Phonez��/.ae3��$ Address S�i'S W• �STk s'� �D7T0-M��i� !'A. Arch/Eng. License No. Address Coniractor'S Nam Phon�� Addresslmailingl�• ��d �-• (�Lk1�SON CA .41�� Ciry License No. a�4'f� LICENSED CONTRACTbR DECLARATION I hereby affirm that I am licensetl untler provisionz ot Charter 9(commencing wi[n section 7000) of Division 3 of tne Business antl Profesiions Cotle, antl my Ilcense Is in (ull force antl eifect. . License ass � License No.�_ ' Oate S i{ Signature ' WORK RS' COMVENSATION DECLARATION ', I he�eby affirm tnat I have a certificate of tOnsent to 5¢If-Insure o� a certlticate �t Workcrs' Compensatiryn Insurance, or a<ertifietl copy thereot (Section '00, Lab. CJ �y No. �LS-IL-4$ CompanyAN1'i(�NM- L�N/O� Certitietl copy is hereqy fvmishetl. Ccrtil'etl OY �5 flletl with the city Builtling DiviSio Date Applicant �. '/- ,� r t EXEM TION FROM WORKERS' COMPENSATION OECLARATION (This section neetl not be completetl it the permit iz for one huntlretl (8300) or Icss). I certily (hat in the p¢rt0�mance of the wo�k for whiGh Ihis Oeim�t i5 i55ued I shall not employ any person in any manner so as [o become sub7ect to t{�e Workers' CompensaUon �,yws of California. Date Si9nature NOTICE: 11, af[er makinq ihis tleclaration, you shoultl become subject to the Workers' Compen5dtion provisions of the Labor CoOe, you muzt tor[nwith comply wil0 Such ptoyisions o� this permlt shall De tle¢metl revok¢tl. .CONSTRUCTION LENpING AGENCV ' 1 hereby atlirm that there is a mnsiruction Ientlin9 a9ency for the pertormance of the work tor which this permit ii issuetl (Se<tion 3097 Civ. C.) LenEer's Name Lentle�'s Atltlress — OWNER BUIL�ER DECLARATION iI hereby aftirm lhat I am exemp[ from the Gontractor's License Law for the /ollowing roason (Section 7031.5 Business antl Professiooal Cotle: Any dty or ' Counly wnich requirez a permit to const�uct, alte�, ImprOve, tlem011sh or repab any structure, prior to ils issuance, also requires the applicant for such permit to tile a si9netl stat¢men[ [hat he/She is litensetl pu/suapt to the p�ovi5ions ot the Contractor'S License �yw (Chapter 9(commencing with Section 7000) o( Oivision 3 of lne Busin¢ss antl Professions Cotle) or that�he/sbe is ezempt 'here/rom anC Ih¢ basi5 fo� the allegetl exemptiOn. Any viOlation o( $ection �31.5 by any ap0lica�� for a permit subjects the appllcant to a civil ndlty of not more tha� five hundretl t1011ars (E500). � I, az owner o( the p�operty or my employees witn wag¢s as thel� sole CompenSatio�, will tlo tqe wOtk, antl the struc[ure i5 nol int¢ntletl O/ offeretl for sale (Section 7044, gusiness antl Professional Cotle: The Contractor's License l.. w tloM•not apply to an owner o( a property who builGs or improves [hereon. antl who tloes such work M1imself/M1arself or tnrough nls on c�r own employees, provitletl that such improvements are not Intentletl or otferetl tor sale. If, nowever, the b4iltling or im0�ovement i5 Toltl within one yCa� of coT- pletion, the ownet will have lhe burtlen of proving he/slle tlitl not builtl or im- prove tortne purpose of sale). ❑ I, a5 owner of the property, am exclu5ivery con[racting wi[h IIc¢n5etl con- tractors to <onstruct tne project (Section 7044, Business antl Protetsions Cotle: The Cont/actor's Licenge Law tloes m[ apply to dn Owne� of pro0erty who builtls o� improves thermn. antl who cont�acts for such oroi0ct5 with a mn- tractor(sl Lcense pursuan[ to tne ConVactorY License law). I am aware thac p�ool o( Iheir WOrker'4 Compensation insuranCe shoultl be provitletl t0 Te. ❑ 1 am exempt untler 5¢ction B. & P. C. for this reason Date `"'-' Owner I hereby certl/y that I have reaa [his appliwtlon antl stale that the above Information is correct. I agree to comply with all city antl county ortlinances antl-state laws relatin9 to builtling construction, antl hereby authoriz¢ repre- sentatives of lhi5 clty to ent upon the above-mentioned pr p_ � e�ty 1or inspec[ion purposes. Signature H/J/L�t.. �'� Oate��.(�`�_ Drivers'LI 55aW— _,�5 39s�s—f � _. .-. TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ O�!/wi ER DESCRIPTION OF WORK/USE OF BLDG. Pc � Teo—� oFFd�l�lY14 TVPE OF` PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECTDESCRIPTION S�.FT. (�O (1,� O__OCCUPANCv CONSTRUCTIONTVPE VALUATION$ 4S��OSOD ZONE GRAOING CU.YDS. ACRES Remarks: Sink Preventer Irrigation Llrinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kftchen Sink . LdVdtOf125 P—Trap Roof Drains Reinspection Fea � $15 Duct- Under Ground Duct - Strucmral Duct - Ventilating Exhausc System ❑ Multiple � Firepl/Fact. Blt. iCBO # Heating System & Ducting ❑6100,000 BTU 0100,000BT� Reinspec[ion Fee � $15 0865-46, rev. 5/88 White - Builtling; Canary - Applicant; Pink - Accounting: Goltlenrod - AssesSor v1BING $f10WQf5 Service Sink Sewer Cap Sewer Connectian Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash laue Fee Hoad or Type I IJ Canopy Type II ❑ Refrigeranon System � ❑6100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Iswe Fee FEES A.P. # S Main Building: E T Fron[ � Rear C Right K Lett $ Ping. Ref. # Planning Notes: Accessory B Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW ConstructionPoleSub. � 50+KW Cooking Unit Meter ❑up to 700 amps Dishwasher Meter ❑over100amps%� Dryers ❑Gas �Electric Fan F.A,U. Fixwre5 Device Boxes Outlets Switches Garbage Disposal Generator DO-5 KW OS-75 KW 2one N I N G R E Q M T S. Sub Panel �'- ' Motors �a1 HP � 1 Y, � 8 Inc.So�ar �9�15 HP []16�15+ Microwave • . Pole Light Range - Standing Sections Trash Compacto� Fee �$15 � � Issue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: •Zoning Approved By FEES Building Approved By � AppliWtion Issued BY � � BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ -- ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ '• PLAN CHECK 25% $ ES SMIP PERMIT ISSUANCE ENERGV P.C. GRADING MICROFILM TOTAL FEE FEES $ 3 $ 3•79 �� o�S�',��i Cq �'3 � %/ $ 3 0? OQC392li0-69��9281 ';'OY ?��.=4 0�'S: p3/Q;1;�9 T2;�E: ii.�l � '.' z ' �.i_� r; CONSiRUCT10N ANDPLANNING i APPROVALS Permit # 1. Temporary Electrical Service or Polz .� 2. Soil Pipe-Undrgrnd. � :� 3.�Electrical Conduit Utility-Undrg(�d. u_- 4rElectrical Conduit-Undrgrnd. � . 5�Steel ReinforcemenY d- • -� ^ . . 6..' Electrical UFER'Grnd. � 7. •Footings � ~ �. S , .f 8.-Founilation i ,.; � •. � 9 Watef Pibe-lJndrarnd. r 10.�Structuwl Floor Sy'stem it. Propert�Sewer Line�& HouseCorinect -. / � � 12. Sewei CaP . �� ` N 13. Roof��DiAins � < ✓ 74. Ro�ugh Plumbing`� t; 15. Rough Electrical-Conduit 16. Rough Electric Wiring �i''17( Rough Wiring Sign � 18. Rough Electrical-T Bar Ceiling 1'9. Rough Heating & Air Conditioning �� 20. Rough Factory Fireplace 21-. Ducts, in_Structure � � 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Fra`ming � 25. Roof�Sheathing � � � 26. T-Bar'�r eiling (Structural) & Monocoat 27. Frameand Flashing 28. Lathing'.& Siding 29. Insulation 30. Drywall'�Nailing �J 31. Plaste'r•Brown Coat : J 32. Electrical Power Meter-Final 33. Final Electric o u 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 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requiremen[s Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas B7. CERTIFICATE OF OCCUPANCY No. Date c ' �, POOL' 'A Inspector qppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement ' 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. 67. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-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 O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFI TE ISSUED Notes: B� v 11 C/i � M Date � Inspector ,P • ��f �J �. I`.' .� .., ` .' " 7 l 1 . � " � ,. i� = 6 BUILDING"" ADDRESS OWNEP �ON MAIL Z ADORESS �3- d U CITV LOS rZ Z Q CONSTRUCTION ON LENDER am J 7 BRANCM ' J � Q W ADDRESS m J J m ARCNITECT � a OR ENGWEER I� U N Q W � ADORESS � aw J O CONTRACTOR m Z J � AODRESS W W � CITV ZF w � STATE � Q LIC. NO. ' . � � SIZE OF LOT ( C VSE OF EXISTING BLDG. 35359 ' iA BUfLDING-SAFETY DEPARTMENT 200 COSTA MESA, CALIFORNIA 92626 plicant to Fill in Completely l.�. /9� �r' r�,vF�r,vG S�,eu. Co . 3 s 5. G�Ruc7 A✓E', TEL. it/%�/_ES No.?J3'7f�P 7�� TEL. NO. ' CITV LIC. NO. INO. OF BL�pGS. / NOW ON LOT aa�o SEP —5-72cnse00 134* *�*�;87.u5. APPLICATION FOR BUILDING PERMIT REC��VEq� DATE�CEIVED DATE ISSUI /Z� /D-3i ,� ? P MIT NO A.P. NO. S - v7 '3 � BVILDING 1 . � -�(� � ADDRESS W . I Cj TRACT i�`'T� ��Yf�/Y..T HLOCI RE NE NO.OF � C PLAfS � YAFDS APPqOVED � � + � VAW$ W ROUP '�� DATE G� ^ BUILDING EW �~a`Tl �n J O 4 � � VAROSAPPROVED F SIZEOF Zc/X I�O� NO.OF ! Z NEW BLDG. � ROOMS STORIES L. SIDE FT. V EXTERIOR WALL ROOF I COVERING COVERING REAF � FT. FT. � a USE OF BUIIOING AND WORK TO BE PERFORMED DISTANCE BET. BEf. MAIN & �, d MAIN BLDGS. ACCESS. BLOGS. Q �/ o p VAR. # DATE � /tODiT/c�-N TQ /� /,JG�G C.U.P.# APPROVED � 4PPROVED N z Q VI hareby acknowled8a thet I hava rea0 this application antl state STATE � thet cM1e above intormailon is cor�ect antl eB�ee to comDly with � all laws reBulaNnB buildin8 consttuc[ion, and 1 shall not employ F eny person in violatiOn of the workman's compensation laws of � L (p tho State of Celitornia. - ? I hereby c¢rtify that I em ptoperly litensetl es a contractor under $Q. FT. TAX / the Stam of Calitornia Business antl Professions Code, Divisicn 3, THE AMOUNT SNOWN UNDER VALUATION IS FOF C�apter 9, antl the[ such licenses are in tull force antl effact, or I THE PURPOSE OF ESTABLISMING A PERMIT FEE ONLV: am exemOt trom Me provisions of Me State of Catifornia B�siness VAIVATION anC Professians Code, Division 3, Chepter 9, GERMIT FEE S �� Slpnaiura ot /) �"� � Parmittea/_/��I1d.3 � T��j�� $/�.0/ O�%(/ FLAN CHECK $ ��+ ^ \ �. Authorizetl Apent TOTAL FEE $ � � 0 2 . a U Z ZQ ON am J � J N Q W p] J m J Q UN Z a W � aw W 2 J Q m Z J � W w O= Z F- w� N � � � E 3�3 ' COSY•A MESA BUI�DING-SAFETY DEPARTMENT P O_ BOX 1200 C(1STA MFSC CCI IFORNIA 92R26 nct z�-7z��;�00 9s� ��**,]66.50 P ION FOR BUILDING PERMIT ForApplicant to Fillin Comple Iy RE EIV D Y TE RE EIVED DATE ISS ED BUILDING � U � ADDRESS � � PERMIT NO. OWNER SE�� A.P. NO. MAIL BUIIDING C X � ADDRESS ADDRESS `J �^ TEL. TRACT LOT BLOCK CITV NO. CANSTRUCTION W /a P LENDER BRANCH ' OWNER G ADDRESS ' ALUE j A�}/;.0_ ARCHITECT TEL. 5 L $(Ql�+�— OR ENGINEER N . FIRE ^�� ADDRE55 ZONE VPE GROUP APPROVED y CONTRACTOR BY L DATE Q�i ADORESS TEL. ZONE NO.OF USE OF NEW PLAfS BUILDING CITY NO. STATE CITY �'ARDSAPPROVED YARDSAPPROVED LIQ NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FFiOM FT. FT. USE OF EXISTING eLOG. S P FT. SIZE OF NO. OF NEWBLOG. FOOMS STORIES L.SIDE FT. FT. EXTERIOR WALL ROOF COVERING ' COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED OISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. ' VAR. ak DATE G/ N �AIv� L 0.U.P.�}'+ APPROVED APPROVED I hereby acknowladBa thet I have read this ooPlicatlon antl state that the abova intOrmation is cOrrect antl apree to comply with all lews regulating buil4ing conshuction, end I shall not employ any person in violotion ot xha workman's compensation laws of the State of Celifornia. m b I hereCy certify nhat I am properly licensetl as a controcror untler SQ. FT. o the Stete of California g�siness antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR � Chapter 9, an0 that suc� licenses are in full torce antl effett, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m am exempx trom the Orovisions of the Stata of Celifornia Business ¢ antl Professions Cotle, Division 3, Chapter 9. VALUATION PERMIT FEE S ! � ] Sipnatura ot m Permlttee $ � PLAN CHECK $ E 6 ° Authorized ABent LL TOTAL FEE S / . ��__ Appiicanl to fill In 911 SpdceS wilhin heavy borUer lines antl slgn all dppropriate Ceelarations. � CITY OF�C9STA�MESA . ' Pe IT NO. /� TRACT NO. 'LOT NO.- BIDG. NO.' , - - ' � - - +- � - - CONSTRUCTION PERMI.T mSc� � ' � � ' �-� � Project Address S' �^� G,/ '1 � r � TYPE OF CONSTRUCTION � ��J � J� �� b284 6/29/8�'� �� 5.�� T�� , . ��,'..' Owner ' � fj ^. �"- '�p Phone � ❑�q N,�EW ❑ ADD -O ALTERATION ' - � - ' -- ' ' - - - - � -AddfCa' ' - 7�! %� -- � � �aEPAIR ❑CONVERSION.�DEMOLISH _ � � ' I � Arch(Eng. - ' - - ' -- � Licens6 Nor � � � � - ❑ OTHER ' - � ; � ZONING REGUTATIONS', � � - AddlCss '-' '- -?- - - - . DESCRIPTION OF VJORK� � � ' C • � � A'P' � " '� � � _ _ ... ... . � . . . _' :EY Y� C � . . _ . - .. . _ . - ONE __... .' , PLNG. REF. $ . � � Contractor � q��yG•7� " -. . �yin�, Ii PhoneG .2 .3Yn ' TVPE OF BERMIT � . ` . ' _- . . . . . . - - T. o. B U.iL pING . . � SET AC 5T. P�EOPERTV.LINE �• '- � Address G SI � O% /"6�i�dZ " f�' 1'-/I -�S � - ';�`GRADING' '�O FOUNDATION -O STRUCTURAL-- - ID VARD � � -- -- �� ^--- - - - - LICENSEO GONTRACTOR�DECL'ARATION - y�� -O-TENAIVT-❑ELECTRICAL �4LVMBING-OMECHANICA 5E . __._ . ' � I hereby affi�m that 1 am licensetl untler provislons o� Charter 9� com- � �, � � IDE-V _ . ___ .� mencing"with'-zeclion-]000)-�of,DiviSiom 3 of the-�Buslness an0� =-0�0'LHER� � � . RIGHT � �I Professiont Cotle, antl my license is in (ull �orte antl ef(ect. + i 'REAR VARD (TO P/L) �� ',` ' = 1 license Class C- � `'' � � � � �icenJ No. '1 i�i� S' PROJECT DESCRIPTION - _ . __ . _ _ _ � _ _ _ � L . � � � ( ' ' PKG'.SPACE�REQ: ;-PROVIDED � 'i4=$4 � hY 3/Z/'Tc�'✓J' � SQ.�-FT.' ' ' J� ' '�.�... � �t � " � Si9natuie !sP � *. �4 - � — - �� STREET WIDTH� ' -- - PARK FEE E - � dORKERS'�COMPENSATION�DEC�TION ' OCCUPANCV'� CONSTRUCTIONTVPE '�- ' 1"' " "ZONING APPROVED,BV " ' 'DATE� �I hereby aHirm that 1 have a cer[itiwte of <onsan{ to self-Insure or a VAWASION � ZONE � cnrtl/IfztB ot- Work¢r5''CompGnsation Insuranee,-4�-a CGrtifled copy - - - . _ _ . _ _ _ _ ._ _ _ __ _ _ _ , C.�. � � � SPECIAL CONDITIONS: � . . . � lhereof (SBstl�on 3800.�py � .,GRADINGCU.-VDS. " �� ACRES . . -�• - �aollcv No.ZC.4A'/GS- -'ComPanv�G.G' �7ii-:S - - - - - '- -- - - „ �. - -- -- _ . . _ . _ . . _ ._ r ❑Certifietl coPY �y hereby furnishetl... . _ . _- _ _ _ �. : ._REMARKS:' ' � ' ' y' ' ,;;. . _ .�,. ___ _ _ _ _ _ _ _ _ �� Certlfietl co is _ " 4 ^,L "' _ _ ' _ _ _ ' _` . ,� py filetl with the city Builtling DIVIS�On. ' '-' •. Esuetl,PTSOhall notOM WORKERS' COMPENSATION�DECLAPe mION . . . ._ F `' - ^ . - .. --- -� ^ � . . � - �� ••� - (7hi5_5nction.need,uoLbe completetl lt.the permit is tOr one huntlretl �- ; �� ' 553001011855�. � f �. .- . _: _ � �..._ _.._ . _ ." . __ __ __ __ � tertf(y that m.the performance of the work for whlch lhis mPloy any perzon in any mann0r so as,to become PCUMBING -' 'PLAN CHECK " -' ' �' ' - -ELECTRICAC" -' ' "PL'AN-CHECK , - subieGtto [hG.Workers Compensation Laws o( CalilOmid. _ _ _. �" � � __ _ .� . � . Date Si9nature � BATHTUBS -� SHOWERS'--"' '-- ' '- ' - - - �� NOTIGE: If aHer making thiz tleclaratlon, you shoUltl bemme subjec[ ^TOILETSa r, �,�-�; ��;.VRINAL'S'-""' ''�; "� �;GENERATOR ^'0=1'KW'_1'-10 KW ' ' ' - '� to the Worker5' Compenzation provisions of [he Labor Cotle, you must � }� •TRANSFORMER •r �. �i ��- �, � y•� f forthwitn comply wi[h such provisions or this permlt sball be tleemetl LAVATORIES OOVBL'E'L'HVS � '--iqPPCIANCE' "- 10�50 KW_50�+ KVJ - - -- - revoketl..'_'.""•_"""_.. �_. .� ..�_" "'- . . , � . '.' '� --'KIT.-SINKS' "- - '-^ DISHWASHERS" " �" ^ ' MOTORS --�- - 0-1 HP'� -"'1-lO�HP� - � � �CONSTRUCTION LEN�ING AGENCV � 1 — —' -' 'j I hereby affirm that there is a constructlon IenGing agency for the per- SERVICE SINKS � j� �,�.SVMPS '-'�-'^ "`('^� --- -s��NC.50LAR�._ .30-50-HP_50-+.Hp-' �' S"� �_'� _ t�_ .1 "formdnCB o( Ih¢ work for whiCh tM1is p¢rmit is ISiuetl (Sectlon 3097 ^ . . - 'CIv.YJ. _.�.._ _ " —" "' _ . ""_ ' ' _ .. _. _ _ _ . . _ �_ .. . _. ...,... FLOOR SINKS - FL'OOR DRAINS" � - - "FIXTURES' - -' OUTCETS-- SWITCHES - ---- - - � �LenEer's Name � • " "'- "'--- " ---'- -'—' " - "'- - ' --' - "-' ' ORINKING'FOUNTAINS' ' �j"' . _•. " "- ' -"' "".GAS TUBE�SIGNS' '-" -- "' " - ' ' - '. 1 'LenEerY Atltlress / OWNER'BUILDER DECL'ARATION " ' ' - ' "-' "'- ' INTERCEPTORS 2LARIFIERS � `� �� -' " ' �POLE'CIGHTS � � � � - 1 h¢r¢by alfi�m tbat I am exempt trom.tbe Conl�acto/'S Llcen50 Law for � ' ' ' '. .� the followin9'reason-(Section-7031:5 Businesrantl^Profes5ion5�Cotle:- � SWIMMING POOC'�""" P'TRAP'" -�� -: - -� -- � -.___ "_ _ __ _ '„ � 4ny _city or county which requires a permit [0 construct, alter, TPOLES METERED SUB' • mprove;tlemotishrorrepair'anystructure,priortol�sizzuante;alsore- -yyqTERSERVICE-- ACTERATION"�'- t'�-' -�'�PANELS MAIN- � -SUB- - -- �� qulre5 [hC ap�li�nt fo� such Oe�mit to tile a Signetl statement that he � Is Iicensetl'pursuant'to the provisions of the-ConVactor's License Lnw- 'GASSERVICE � `OUTLETS - " �" � ' �'f "SERVICE - -- --- - - ----AMP- � -- - � (Chapte� 9(commCncing with SeCtion 7000) of DlviSion 3 of fhe � � -� Business'antl'Prdessions Cotle)�or that he�irexempt theretromantl[he -yyqTER"NEATERS' BTU'OVTPU ' - "-*--- -- F - -- - ---- -- --- ---- - ---- =' ='== - - _ � basis for lne allegetl exempiion. Any violation of Section 7031.5 by � any-appllwnt tor a �permit�svbjects-the applicanb to'a civil �penalty - SEWEft'CONNECTIONS-- 'i' -- ' -"'- --- - � - - - --� --- --- -- -� � - -- - -. _ bf not more tnan /ive huntlretl tlollars (5500). -' .i � ❑ 1 es owner of tne property, or my employeei With Wages'as their -SOLAR TANK" -�''- COLLECT,ORS'��' , �--.�°S �-� � - --- - •- - -- -- -- - - sole.Compen5ation, wlll tlo Ihe wo[k,_antl Ihe_st�ucture Is,not Intentletl ! or offeretl for sale. (Section ]044, Business antl Pro�essions CoOe: The � SOLF1q PIPING SVS.- � "-- "-- '� " ' '�SSUE FEE- - - -- - --- --- - -- Contractorl5 License Law tloes not apply to aqow�er of a property � .'qppILICATION�APPROVE�-BV - - wh0 builtls o� imp�oves tM1ereon, antl who tloes SOCh K'Ofk I11T521( O! ISSUE FEE �� '�� "" 3 Q � � ` DAT � , [M1rou9h_his own employees, provitletl [M1at such Improvement5 a�e_not Intentletl o� offeretl for sale. It, however, tM1e bulltliq8 or Improvemen£ ' ' - '- -- � + - � -- - . _ _ MECHANICAL PLP.N CHECK - Is soltl_wilhin one year of completion, Ihe owner wlll_have [he burtlen � $UMMARV OF FEES. ,�,;-� , �„ 'a� ot proving he tlitl not builtl or improve for the Purpose of-sale). -.-' , -�- �•BUILDING ---- -- -�----•---' -'-- ._ __._ ___ � � P,-as- owner �ol the-property,-am-ex<lusively �a�[racting -with HEATING SVSTEM_ P100_000 BTV _ J � _ �PERMIT E - SMIP,.1 �§ ' Iicensetl contractors [o consGuct the AND DVCTING __ prolect (SecUon ]044, Business 300,000 4 BTU , �PLAN CHECK E SSUANCE� • t and Professions Cotle:-The Contractor's-License Law tloez�not apply [o _ _ _ _ _ _ _ � S - .. - an Owner of property who builtls or improves ther¢on, anU who Con- REFRIGERATION 0-300,000 BTU f PLUMBING S� �� tratts-irom�5uch�projects-with a�contractor(s) IICBSneA-pursuant-to_ SVSTEM - --- �L- -.-- _�_-. _ ,_ GRAOING.,b F the Contrattor'S License l.aw). 100,000. BTV � �PLAN CHECK S� -� , .',- - �'�I am ezempt untler Section� ""'- '8-8" P: C for this- BOILERS BTV t� 'EL'ECTRICAL' S'"� � ' ; , ",- _ s� , reason ' - - ---- - - � -- - � - ------ - ,PLHNCHECK� E - - - " MICROFILM 5' � SVSTEM REPAIR,AITERAT,ION " ' ' Date Owner " �� • 'TOTA� FEE b �A I nereb certit that I have reaU this a Iiwtion antl s�ate that the above EXHAUST SVSTEM MULTIPLE ;?-' �' ' .MECHANICAL-�E- -- ' - - Y Y _ _P.P. , '�1• � . CESSAD-. � f Intormatidn is mrrecL I�agree [o complywith'all ti[yanC-covnty . �� PLANCFIECK--E- -- - VANCE-PC 5-�-- brtlina0t¢5 antl sta[¢ laws rela[ing to consl�uction, anC he�eby autno�iz¢ '- . 1 �_ , ,_ rCpresentatl6es`of lhis city�l0 Ent¢r upon the above men[toned � � - � ' /� �Q pro0erty„to ) ection py p%o � t,� � �` , Slgnature � ��4f �'•y�� Date �G �%' � _ i _ FINAL FEE E v. , �. Drivers' License or 55 � � � ' - �SSUE FEE - - --� � .. . _ _ _ _ . _ , . � __ _ _ . CMF 0865-46. White-Builtling; Canary-Applicanh Pi�k�Accountin9: Goltlenrotl-Assessor CONSTRUCTION AND PLANNIN,�u��,, � �> • POOL & SP,A ' � � , ._ , {i - � 1' "� ApPROVALS Permit#�_ Date`� •� Inspector qppROVALS . Permit•# � Date Inspector � 1. Temporary Electrical Service or Pole - . 43. Pool & Equipment Location' - - - ��' -- - ' � - � . Soil ipe-Undrgm_ '- ' - 44. Steel Reinforcemenf --- - � - - � - - -.�Electrical Conduit Utility-Undrgm � 45. Forms • �� - - - -4. _Electrical Conduit:.Undrgrn 46. Electrical Bonding �- - � - tee em orce �- � � - 47. Rough-Plum6in & Fressure•Test � � - " . 6. Electrical UFER Grn __ ___ - � � 48. - APPROVALTO CO,VER-GUNITE-' - .' '- "�- - � � �Footings_ ' 49. Electriral Conduit-Undr m � •�- - - : $.__-Foundation- . _ _ ' 50:��GasPipe,.�Undr m;Test - • ' � ' - �9. �Wate¢.Pipe-Undrgrn. ' ' ' S1. Backwash Lines P-Tre � ndr rn � � ' --- - - - ' � - "-- ---�-- - � 70. StrucwraLFloorSystem . ' � � 52. APPROVALTO�DECK- �" "" " " " '' --- ' � il._,Property�Sewer.Line &,House Connection. 53.. -Backwash & Rece torFinal' ' �v� � � � � - 12. Street Sewer Connection _ � ' " � " - �54.- �Heater & Vent-Final' � -.13. �Rough.P.lumbing. __ . - -- � - "' - - ' � - i 14. Rough ElectricConduit - - � - -� - �56. Electrical-Final --� � - � � � . � , 15. Rough Electric-Wiring ' - - - 57. � Solar System-Final-`. . ' ' ' '- � 16. Rough� Heating & Air Conditioning- "- - - - -� - : _ .. encing & Access Approyal . ' � 17-:- Ducts-in�Strucwre ' '� ' APPROVED-FORPLASTERING ' � � � �� 18.� Ducts,•Ventilating � - ' _ _ . _ 19. GasPipe=Rough&Test- � ' i� __ . _ 60. POOUSPASYSTEMSFINAL � ' 20:�--Roof,Framing - -� - - � � - -�-� -� - - . . � . . ' .. , .. , 21. Roof Sheathin - .' - - _ . .. ' _. _ . . �' •-., . . . -� . � NOTES:• ' '� ' ' - - ' 22: Frameand Flashing � - � � - � ' 23: Insulation -� �- - � - - � - � ' ' 24: lathing & Siding � - - . - � � - . 25. Drywall Nailing - � ' � � �� - ' ' . 26. Plaster-Brown Coat - - ' � � 27:- ElecVical Power�Meter-Final � � - � ' ' " � � � � - ' 28: - Final.Electric - - - - - - � =- � � �- ' � � ' ' 29. - Final Heating & Air Conditioning - - - � - - ' ' � ' � . ' � 30. Final Gas Rpe-Test - � � �� - � 31�.--Final.Plumbing '- ' � ' ' ' - �,32.� Water.Service-Final. - - � ' � � 33. cGas Service-Final=' •.a . -- `•.' " - - -- - ��,� . . . , . , ' - 34. Solar pomesticFinal ' � ' - ° - ' ' � � ' 5. 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. � 1 ' �• � � 42r� CERTIFICATEOFOCCUPANCY i -� - � - •- � _� � ' No' Date � . . ... . . . _ . i . . � . �'-., .. , . � CO$T� fi'dA BUILDING 7.?1 Ead20th Street C�esa, California 1 i 1 � CERTII Permit Ux of Building..._.... The building located . �* -, : 1 i , ,. --�- DEPARTMENT1i N� 559 C !� t� Jr - �! Date ................�-._...._l,...�.......'.._.�/ ��^ CITY OF C08TA �MESA CATE OF 00 � Eleetrical Permit No....jv.. � ij/ � ..._. x.:'<?.��.'.0 ��...�t.�� . � PANCY �g Permit No:._C_:� r C �S �� Lot......................._............_..... Bloek........................ .. ., ......... Traet...._� ..T.-:a,;..._r"'......_.__. . (See reverse side for Metes and Bounds)%� ��/� ,jFj,j–•f�,�–f� �/� ��" has been inspected and found to rnmply wit,t,.th� rovisions of all City oF Costa Mesa On dinances applicable ther/e�� for a Group .............. ..Occupancy. t r �� / • A. J. V013) � ...... .. .. IS-�#�,�OTO: i% �`� Ci �uilbl�(g.OTflti 1� W'� /� tr'a� l.r�.�-a,,� C._ri.� �' � y , s ...:� . :.............."'_"'......_'_ _'_'...._..__""_. "..._" . .(Ownerof Building) By.` °..._�..-:x.�:?�� ` '��''' 7'_'..._........_...._""'_'_""-' \�❑ Original—Owner ❑ lst copy—Gas r r12nd copy—Edison Co. ❑ 3rd copy—Flle ,•1206 GH IM I&63 , � ' �— � ``.� ' � '756s6 . _ •, . r. COSTA MESA BUILDING DEPARTMENT ' P.O. BO% 31� � COSTA MESA. CALIFORNIA BUILDING ADDRE55 MAIL ADDRE55 CITV � ARCN OR E FOR APPLICANT TO FILL IN �'9� k/. /9� �S'Jrrr� COSTA MESA. CALIFORNIA LEGnL ILOT �� OESCNIPTION N�. A.P. NO. �� SIZE .�'�/ OF LOT USE OF E%ISTING BLOG. SETBACN LINE FNOM / � CENTEq OF SiREET [pa/ / REAR YARD �� ✓/i ��/ �/� i[J/ 1CITY LIC. .i� �n No. ♦TEL. 1C I BLOCK TRACT��./ ..%�.�("'lG� �3 �� 1 rvo. or e�ocs. i. NEW ' REPA� BUILDIN SIZE � E%T�lRIOR W� COVERING USE OF NEW BUILDING � /� RIGHT 'd LEFT� �,/`� DESCRIPTION dF WORK ALTERATION P.DDITION MOVING OEMOLISH ��.�Sv NO.OF '^ V X ROOMS STORIES /Y9/AIr r ✓ COVOEFtING /�. . _ ,.. -'y ' � ' , ! �u� �n�.o/". v ._;- ��'-ii -5�4 J �� FII�,4NCE DEPT. C�,.. nr nl1C?A ,.9':C;�, APPLICATION FOR PERMIT � BUILDING FOR OFFICE USE ONLY \ \ FECEIPT NO. PEP NO� BUICDING yp, - � �9`,� ADDRE55 COSTA MESA. CALIFORNIA FIRE � ZONE 20NEw PI�PNS TYPE G, ///�� APPftOVE � �/ BV DilrfC DATE CCS'�'a h"L 6ii�''�� aLL'G. UEPL _ DATL- ,�'7P ��C �C :��'L. /�'� � Ln✓ eyc'c►� F v�✓ I HEREBV �CNNOWLEDGE TMST I NRVE PE/.O TXI9 1PPUC�TION �NO yJ �� ST1TE TM/.T TME .�BOVE IS CORRECT 1ND �GREE TO COMPLV WITH �LL • /p• 3a CITV OR�IN�NCES I.ND STATE LwWS U��TING BU LDING CONSTHUC� "�� T�o�. VALUATION h f M� PERMIT FEE S // ` SIGNATURE O PERMITTEE _ � $ �� AOD PLAN CHECK S- V AUTHORIZED AGENT TOTAL FEE B��Z�� `�� I� ,� ''; ! . '7258 c.: , COSTA MESA BUILDING DEPARTMENT • P.O.BOX 31� ' COSTA MESA. GALIFORNIA FOR r MAIL ADDRE55 CITV �S ARC CT OR E .NEER ""- -=f CONTqACTOR TO FILL IN ,��:w/�l � S COSTA MESA. CALIFORNIA vaC � TEL. � GTV LIC. NO. TEL. ADDRE55 NO. LEGAL LOT 7 DeSCairnON NO.�/�� BIOCK TRACT � ^� y�. A.P. NO. S� � ��} � ' / i� SIZE /��,�/ �� // y`/q� � NO.OF BLDGS. I OF LOT � 7( P7Y% rvow oN Lor C � EXISTING BLOG. SETBACK LINE iROM , � cervieA ov srnE¢r � REAR YARD �,SIDE VARD RIGHT LEFT DESCRIPTION OF WORK 'i� / ' NEW ( ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING • *'� �' /� � NO.OF SIZE � ��{% ' (qJ^(� ROOMS STORIES EXTERIOR WALL__ _, ROOF q � � EE RECE JVED FINANCE DEPT. APPLTCAFTIONAFOSR PERMIT BUILDING. FOR OFFICE USE ONLY COSTA MESA. CALIFORNIA FIRE ZONE ZONE� NO.OF � TYpE PLAN$ APPROVED BV DATE , CORRECTIONS 6 "'� I HEFEBY iCl(NOWLEOGE TMAT I HAVE REr�D TMIB APPLIC/�TION ANp �� . /�� '�/ STPTE TMiT THE >BOVE IS CORRECT wN0 /.GREE TO COMPLV WITH FLL J r (/� CITY ORDINSNCES AND STwTE LnWS REGULdTIN BUIL G CONSiRl1C� /"� � �� ` r� �� T�� VALUATION SIGNATURE OF PERMITTEE L 5'/�/��/QQ\ PL/N CHECK S J � �{: ( ALITHORIZED AGENT TOTAL FEE $ J�J �. 9M� . .. F w w K COSTA MESA BUILDI(dG DEPARTMENT P. O. BOX 317 COSTA MESA CALIFORNIA P C•L. OF STREET ' ��PROP. �INE _ r 10 FT. FOR 60 FT. STREET � � � � � 1 1 � T. LEY QR PR P. LIN � �a -.� a _�E v �, QF � O J U I i �i I .� �a; � � � 0 �17o O ��I � ,. Oz� (� FT O�� `_ � I U .] U ~ I _ 4� I t-�-a� Z U� a I pT I. N m I I . r 60 F ST. � ; i I —�-------� I 1 r � C.L. STREET `,��'_ •�. «�-- MAXIMUM 4 FT. FENCE'MAY BE PLACED ON DOTTED LINES------ MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES I �''�f i.`2 I FOR APPLICANT TO FILL IN BUILDING ADDRESS 5�I �S �/ • � 9�" S! Owner t�i.�N1L�. aF A.v�e,e�G,2 Mail Addres � r d Sa •�' j� i.0 G Sy City La5 �NG��S, G'O-I�l= Ph. No. Contractor E. �.Oy'T�"� ph. No City Lic. No. State Lic. No. Size of Lot '�43'�//L' AP No. %S -� 0 3— I cS�T �/ / � i/ Setbacks: C/L Stree � Rear i/ Side Yard - Right D� Left � Type of Fence_ /%l/,ZSoNL�/— l.tJ �' - o Ft/ ' _ I hereby acknowledge that I ave rea�t�s application and state that the above is correct and agree to comply with all City Ord- inances and Sta� aw�regul ' b ildin onstruction. Signature �� of Permittee �� _ FOR OFFICE USE ONLY / !// "! �r `I. Y C /"" � . I � %2�/t �' I � �-t.. VALUATION Permit Fee $ Plan Check TOTAL FEE $ (/� � USE REVERSE SIDE FOR DETAILS , :� :. :, ��:� � •COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEBA. CALIROIiN1A For Applieanf fo Fill In Compleiely TYPE OR PRINT BUILDING C�/.� �v �,S � � C f ADDRESS V Cl J COSTA MESA. CALIFORNIA [- � �,�E RECEIUED �---�p �jF�NANCE OEPT, `� Gtr OF COS1A MESA . � APPLICATION FOR PERMIT � BUILDING � M For Offlce Use Only RBC8IPT NO. PP�R�`NO�� l 7 RHC8IV�D BY I A /�� I p�7— ili ✓ � BUILDING AODRE86 COSTA MESA. CALIFORNIA � ADDRE63 ZONING ' ZO I NO. OF I 116C OP N6W C�7y • PLAN6 �� BUILDINO STATE TEL. �gow�` ' NI �/ /' �'L LIG. NO. NO. DeeCRidT � 61ZE NO. OP BLD08. ^� f1F 1 (lT unw nu � nt I . � ..� I / � � L /1 � � � � � BHTB�GK LIN6 FROM DESCRIPTION OF WORK BUILDING NO. OF 81ZH ROOM6 E7CTERIOR WALL I ROOF . . , � � t� . 1 XHRBBY AC(NOWLEDOB THAT 1 HAV2 PGD TXIB APPLIWTION AND BTATH TNAT TH6 ABOVE IB CORRECT AND AGRBE TO COM- PLY WIiM ALL CIT! ORDINANC66 AND eTATC LAWe R80UlATNO BU�LDINO CONBTRUCTON. 81GNATURE OF Q � 'O � �� PERMITTEa AUTNORIZED AGENT (CBNTHR LINB HT.] APPROVED ' B.� �� y s—� TXe �MOYNT BHOWN UNO6R VALUAT�ON 18 PON TH! PURP08E OP lBTABLIBXINO A PEPMIT FEE ONLY. VALUATION U � PERMIT FEE S / $ 5�/ D � PLAN CHECK $ ' TOTAL FEE S T �� _._` _� . , _ ,_ - � .. = � �.,i , 1i?G ?3-74�AG�O01648'} ***� • 3�885.9 52.85 � COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. 80X 7200 COSTA MESA, CALIFOFiNIA 92626 AP ICATION FOR BUILDING PERMIT For Applicant to Fill in Colnplqtely _ „_�, ,__ _„ BUILDING� AOOflESS OWNE MAIL AOOPESS C CONST UCTION LENOER BRANCH ADDRE55 ARCMITEC� OR ENGINEER / ADDRESS ' CONTRACTOR ADDRESS � � GTv �/ STATE ^, LIC. NO. /( 512E OF LOT USE OF EXISTING BLDG. SIZE OF NEW BLDG. EMERIOR WALL COVERING USE OF BUIIDI i � c. ov - L� g� P RMI� % A.P. NO. � � IJ�J. ' C BUILDING [" {T/.//qr� �+ ADDRE55 V ( V / V TRACT � �OT �. B P OWNER / � L � IN•%.�� /I� _ VAWE ^'J � f'� $ J � /� FIRE H� ZONE T GROUP APPROVED � r J � NO. �� CIT1' LIC. NO. NO. OF BLOGS NOW ON LOT NO. OF ROOMS STOf ROOF COVERING AND WORK TO BE PERFORMED 1 here6Y ack�owlod0e ihet I have reatl this epplicetion entl ateta ihet thB above Iniormation is tOrrect antl apree to comply wIS� all laws repuleNng builtlinp eonstruction, antl I ahell not employ any perwn in vlalation of tha workmen'a compensetlon laws of Me Smte of Celitornia. I herabVi ceriify that I am proparly Iicansetl es a contrector �ntler the Stata af Celifornla Busineas antl Professions Code, Dlvisicn 3, ChaptO� 9, antl thet suth li[anms are in full forcB entl effect, or I am ezempi from the provlsions of the State of Californla Busineu and Professboa Co , Division 3, Chapcer 9. SIB^eture of Permlttae � Authorfxetl Apant ZONE NO.OF USE OF NI PLANS !L BVILDING� YARDSAPPqOVED VARDS MAIN BUILDING ACCESS( (FROM GL STREET) � � p OfSTANCE BEf MAIN BLDGS. VAR. q� C.U.P.ay. APPROVED %1 TNEAMOUNT. TNE PURPOSE O BET ' ACCE' DATE ' J L�V (t9 j7 _r_ Z � \^ \ ` F• � \ �aJ 1 V D ��ILDING � ) L� 1�F^' m w 0 UNDER VALUATION IS FOR ' LISHING A PERMIT FEE ONLV: ¢ m RMIT FEE $ � � , m 4N CNECK $ E o` LL TAL FEE $ ""'- -='-�x=101.50 . ^ - �tC 13-74�h�.00 77_9 �,.. COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 P I TION FOR BUILDING PERMIT For Applicant ro Fill in Co lete RE I V D DATE FECEIVED BUILDING / DATE I S ED ADDRESS { � � � • OWNER � A.P. NO. MAI L BUILDING Z ADDRESS ADDRESS � / a U CITV NOL TRACT LOT BLOCK ZZ Q CONSTRVCTION A a m LENDEfl � J� BRANCM � �n iV � I C J N OWNER m J ADDRESS —y� VALVE J Q ARCHITECT TEL. S �I�• A«sY% � OR ENGINEER N V Q FIFE �� W� ADDFE55 ZONE L V E' GROUP �� a u+ W Z APVROVED - �1, J O CONTRACTOR BY DATE J m Z J � ADDRESS W w TEL. ZONE NO.OF • USE OF NEW Z� CITY ' NO. P�� BUILDING w� STATE CITV �'AFDSAPPROVEO�-�� VARDSAPPROVED y� LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING _� SI2E NO.OFBLDGS. (FROMC/LSTREET) OF LOT NOW ON LOT qONT FT. FT. USE OF EXI5TING BLDG. FT F" SIZE OF NO. OF Z NEWBLDG. ROOMS STORIES L.SIDE FT. FT. U EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BEf. MAIN& a MAIN BLDGS. ACC65. BLDGS. a Q VAR.9Y+ DATE O C.U.P.s� APPROVED � APPROVED N Z O UI haraby acknowledpe thet I �eva reatl Mis application antl state � that the above information is correct entl agrea to comply with � all lews reBulaUnp builtllnB �onstruction, antl I ahell not amploy � any parson in vlolation of the workmen's compensaUon lawa of y the Staie of Celifomie. °p ? I heraby cartify that I em proparly licenaetl as a contractor untler SQ. FT. O t�e Stete oi California Businezs entl Profassions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �; Chepter 9, entl that such Iicensez era in full forca entl etfect, or I THE PURPOSE OF ESTABLSHING A PERMR FEE ONLV: ¢ am exempt trom Rhe provisions of the Stata of Celltornla Buslness VAL.UATION and Professlons C8 e, Dlvision 3, apter 9. /�! S� r PERMIT FEE $ ] Sipnetura ot m "�' E Permlttee $ /�B PLAN CHECK $ / o Authorized ABant � � u TOTAL FEE $ ^�COSTA MESA BUILDING-SAFETY DEPARTMENT �!:1'( -7-75�,��,-5�00 223 o***�t�o50 • P.O. BOX IY00 Costa Mesa, Calffomia � � � � � PERMIT NO. I TRACT NO. REC'D BY EIECTRICIAN �/iJELLO ELE�Ci.G�C LOT NO. DATE ISSUED ADDRE55 �1��$ �. (/ua''-li10VT BUIIDING USE CITv ��Qk,'QE71�fi (� . TEL. NO ��.C3'�%3CJi0 � SiATE LICENSE NO. L73�%:0 �V`S� Go ��'� �� CV.i ' ` BUIIDING q r�' ¢ CITV �ICENSE NO. �6 �� ADDYESS — / - NO. ITtM UCN �IU COSTA MESA, Gl1fO0.NIA a Owelliny. Sq. Ft. f c"noss iT. �y %� �"�\� u% Garaga. Sq. Ft. pWNFR �`\ � 1 , ~ �' o� Fint 40 Outlen, wch �DDRESS .� ,(1 � J Outleh. Addiiianal C��y 7 fi 1\� TEL. NO. 1 Q (-i��.rr�a�-�i� 1� � Firtf 20 FiaWr�f, �oth I XEREBV� ACKNOWIE�GE TXAT i NAVE READ TXIS AVVIL Y UTION /J!D`STATE TNAT TME ABOVE IS CORRECT AND AGREE TO COMPLY�WITH All CITY ORDINANCES AND STATE IAW$ REG- /� J Fiztures, Additional '� ' y l` � ULATING,ELKTRICAL WIAING. W �� I� CE0.TI% TXAT I VOSSE55 TME A60VE VALID STATE OF y Dryer .� �ALIFO¢NU ClASSIFlUTION OR I AM TME LEWL OWNER OF � � ,9'\�[ �, TNE SIN�IE FAMItY RESIDENTIAI PROPE0.TY DESCR/Il{E�D �AlOVE. a Fan _ ^ � �� v L/'//'� z Healer �y,� y Y �0^^nr o! �j,�L W .f 1�. FER/AIT1 -. � Oven, Domesti< �� NC. IT�M- �ACN ftEi i � � F Vole. Constmction ,�'g� �/ � Sipn 8 1 bam. 4.00 �� d. � Ranq�. Demeftic� � Tmmforman KW d Misc.� �)� ' � �(� � � \i'� 1�/ Gamrorort KW � Maton (Sa� Schedula� HP HP Sub•iotal Fem HP APPROVAlS IMf►lC70t Mefen, eo. TEMV. PpIE IINDENGROUND CIXJDUIT � Germit Fee � xOUWI � Sub-Total Fwf FI%TURES � POWER � Total FMf U71lITY CO. NOTIFlED � FINAI rour. eu�z� For items not listed referto FeeSchedule 6LDG. PERMIT NO. J Y �- �` • �` �4 I 3� , COS7A MESA BUILDING-SAFE7Y DEPARTMENT P� O. BOX 917 COBTA MHBA. CALIFORNIA For Appllcant to Fill In Completely � TYPE OR PRlNT BUILDINp S� ADDRES� COSTA MESA. CALIFORNIA �iTY 0� CDSTA MESd - - MAY 11 1965 1� � AP� N ERMIT � � for Office Use Only 1 R[C[IP'� NO. PHRMIT NO, � `.�.Q � '�C . APPROVC� I /J ' P^^HITQGT TEL � BY DATB / IGINEER l� N . ZONING �✓ ADDRES$ "--_ ZON[ NO.OI ///�� UB80PN8W / ' � PUNB � �UILDINO CONTRACT p N% � � ) p 180AL /� Il��I� �R� ADOREBH A `� D88CRIT0 ��r ESA A.P.No.l�s— 3��ao,-� aa s NOTB: NO8AV60VERHAN08NALLBELE88THAN LIC?NO. O �p NO. S�S SSZ+ 90' TO SIDE @ k R. L EAVES SIZE U� � I No. oP Btaae, t ALLOWED [U. B. C. REQUtREMBNT) OF LOT �J O, Now oN WT . YARDSAPPROVED YARDSAPPROVHD USEOP (J MAIN BUILDINR AGCE640RYBUILDINR EXISTINp BLD6. !� (FROMGLBTR8ET1 � BETB�CK LINH PpOY FR NT O FT. CENTER Op gTRH6T REAR Y � � SIDE YARD LEFf I RIQHT R' 8�� S �7. DESCRIPTION OF WORK L. BIDB �� -'�� ' i . ALTBRAiION ADDITION R�R 1 S �, p7, DISTANGE BET. BET. MAIN @ MAIN BLDG9. AGCESS. BLD08. REPAIR MOVIN3 � DEMOLIBH BUIL�IN6 NO.OP � VAR.AF DATE . 51ZH ROOMS �_ 6TORIEB C. U. P. APPKOVHD EXTERIOR WALL ROOF APP 6D r COVERING COVERINO `_ �Y � DATE � �I�� O USE OF BU LDINO ANO WOR; TO �PERFORME O . 7 ,(a(' ENCE � � �G � so.rr. " 1 HEPEBy ACRNOWLBDOC 1HAT 1 HAVB RBA� TMI9 APPLICATION TNH AMOUNT BNOWN UNpBR YALUAiION 18 PON JNH q �NO BTA7g TMAT TN8 ABOVH IB COqpBCT AND AORHB TO COM. Pl1MPo88 OY 89TABL18HIN0 • PHHMIT PE8 ONLY. p PLY WITH �LL CITY Oq IN�NC89 AND BT L�WB PBDULATIHO ypLUAT10N BUILDINOCONBTHURI � H 61GNATURE � PERMIT P88 � PERMITy'E m S �-y� B� a AUTMOq�ZgD AQENT /(/ (/ (/ L �d �` TOTAIFEE V