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Home My WebLink About512 19TH ST - Building Permits� ' CITY OF COSTA MESA ' � Bl/ILDING DIVISION 4� � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vrv�hv.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BX07-00071 PERMIT TYPE B MISC STATUS: ISSUED DATE ISSUED: 08/10/2007 ISSUED BY: BJK JOB ADDRESS: 512 W 19TH ST CM Suite/Unit: Vicinity: STORE FRONT Primary Occ: :`-. Const Type :?? SQ. FT: 0 Valuation: $3,000.00 :ii, . . - . . ��.'� SCOPE OF WORK: REFL,4CE (E) WINDOW WITH A DOOR IN ORDEF2 TO CREATE A NEW ENTERANCE FOR "PLAYERS PIZZA". - ' OWNER: LEE, ANDREW F Address: 516 W 19TH ST Unit City/State: COSTA MESA, CA Zip Code:_ 92627-2748 Phone: 714�d02-5495 _ . • ' , APPLICANT: MILLER, JAMES City/State: COSTA,MESA, GA Phone: 949-274-6101 CONTRACTOR: OWNER-BUIL:DER Address: City/State: - Zip Code: ARCHITECT: Phone ENGINEER: Phone Building Plan Check: Building Permit: Electrical Permit: SMIP Residential SMIP Commercial $0.63TOTAL FEES Address: 512 W 19TH STREET _. _ .. .._ ... . ,,.. . ..... . _. _ . . _ _ . . ; . Zip Code: . 92627 :, License No. 000000 Phone Cel l: License No. - License No. -, FEE SUMMARY.,,,. - $54.11 $83.25 • $0.00. $0.00 $0.63 $137.99 Unit: Unit: NOTICE: The work authorized by lhis permit shall comply vnth all applicable handicap access requirements under Califomia 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. INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval vrill result in the expiration of this permit. OEt. INSPECTIONTVPE DRTg IN7ITIALS CODEp INSPELTIONTYPE �ATE INnnais 1618 Fixed Sysfem Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electriwl 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Faclory Fire PlaCe 220 Final Planning Approval 203 Final Sign 222 Final Site � 204 Final Demolition 2$0 Final Building/Occupancy . � WORKERS' COMPENSATION DECLARATION:, - I hereby affirm under penalry ot perjury one of the totlowinq tleclarations: ❑ I have and will mainlain a certifiw[e of wnseN lo self-Insure for vrorkers' compensalion, as provided tor by section 3700 of the Labor Cotle, for the peAormance o( ihe work for which ihis permit is issued. ❑ I have antl will maintain vrorkers' compensation insurance, as requiretl by section 3700 of the Labor Code, for the pedormance of the work for which this pertnit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (ihrs seCion neetl rrot Oe compete0 AMe peim<is valued et one hunOrcN da9ars (5f 00) wless ) Policy Number: 3 I certity that in lhe performance o( the vrork for which this permit is s ed, I shall not employ any person in any manner so as to become subject to lhe vrorkers' compensation laws of Califomia, and agree that if I should become subje 1 lo lhe ers' compensation provisions ot Section 3700 ot the Labor Cod , shall fo th h omply with these pr�n��l _ - r �� . �imnls'Signalure �Dete' WA NIN : FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS WFUL AND SHALL SU&IECT AN EMPIOYER 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 affirm that I am licensed unde� provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code, and my license is in full force and e%ect. Lic. # Class # CAnlractor's Signalure Dale CONSTRUCTION LENDING AGENCY: ❑ I hereby affvm that there is a constructipn lending agency (or the performance of Ihe v.ork fv v.fiich this pertni� is issued. (Sec. 3097. Civil Code). Lender's Name: Lender's Address: Date OWNER•BUILDER DECLARATIONS: I hereby aKrm that under penalty of perjury thal I am EXEMPT FROM THE CONTRACTORS LICENSE U1W for the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit to consWct, alter, improve, tlemolish, or repair any sWcture, pdor to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant m the provisions of the Contractors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of ihe Business and Professions Code) or that he or she is exempt therefrom and the basis for the allegea ezemption. Any violation ot Section 7031.5 by any applicant (or a permit subjects the applicant to a civil penally of not more than five�hundred tlollars ($500).): i+ �.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 oHered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner o( property who builtls or improves thereon, anA who tices such work himself or hersel( or lhrough his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold wit�in one year of completion, the owner-builtler will have the burden of proving that he or she tlitl not build or impmve for purpose of sale.). ❑ I, as owner ol the property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business and Professions Code: The contractors License Law dces nol apply to an ovmer of property who builtls or improves thereon, and who cont2cts for such project with a contracla(s) license pursuant to the Contractors license Laws.). ❑ I am exempt under sec. Business nd Professions Code tor this reason: cr�! $ / d � SiB�wre iDate 5] 1310]) Owner ID verifietl by d�ri/v' nse. ❑ Yes ❑ No �%/� D JS:Cicense'No. �ExPii�s: � � Verifcation of Ownership by (type of document, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certify that no excavation frve (5) or more feet in deplh into which a person is required ro descentl, will be made in connection with work authorizetl by this pertnil, and that no building strucNre, scaHdding, (alsework, a tlemolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, fvl 2, Sec. 341, Trtle 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit from the Division of Intlustnal Safety, as notetl above, unless such person has a permit to do such vrork from the division. Applitanl'S SignaWre Division o( IndusMal Sa(ety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or presenl or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safery Cotle requires, with some exceptions, that a Business Plan be fled with the Costa Mesa Fire Department by every business which has at any one time during a reponed year a quantity of hazardous materials equal to or greater than a vreight o( 500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressetl gas at standard temperature and pressure). 2. Does or will the appliwnt or present or tWure building cecupanl need to file a registration (orm for aw[ely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cotle, with some exceptions, requires regis[ration with lhe Costa Mesa Fire Departmen� by each business which at any one time has on hand a quantity of acutely hazardous ma[erials equal to or greater ihan a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at slandartl lemperature and pressure). 3. Dces or will the applicant or present or future building occupant need lo prepare an RMPP (Risk Management and Prevention Program for aculely hazardous materials)? ❑ Yes ❑ No (Section 25534 of Me Califomia Healfh and Safery Code prodrdes that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Departmenl of an RMPP �y businesses which are required ro register acutey hazardous materials with Ihe Fire Department. 4. If an RMPP is presently required, has Section 25534 of lhe Calilornia Health and Safety Code been fully complied wi[h? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupaN require tor the work which is [he subject of ihis application a permit for such consWction or modifcation from the South Coast Air Qualiry Management District or from any other air polWtion contml tlislrict or agency? ❑ Yes ❑ No (Sectbn 65850.2 of the Califomia Govemment Code requires that the requested information be fumishetl on applications fa non-residential building pertnits). 6. Will any part of the faciliry ro be constructed under this permit be within 1000 feet from the outer boundaries of a sc�ool? ❑ Ves ❑ No Qf yes", the facility must meet the requirement of Sec[ions 25534 and 42303 of Ihe California Heallh antl Safely Code). 7. If a permit from the South Coast Air Qualiry Management Dislrict or other air pollution conirol district or agency is required !or lhe vrork which is the subject o( this application, have all of the disclosures prescnbed by California Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certifcate o( compliance from the appropriate air pollution coNrol officer). � CERTIFICATE OF COMPLIANCE: I certify that untler penalty �of perjury the information given above is correcl. I agree ro comply with all state lavrs antl city ordinances regarding Hazartlous Materials and Emissions. Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry of perjury Ihat I have read this application and state Iha[ the information given is correcL I agree ro comply with all state laws and city ordinances relating to building constmction, antl authorize representatives of ihe City of Costa Mesa to enter upon the above-0escribed pmperty (or inspection purposes. I agree not to occupy or allow xcupancy of any builtling authorized by [his pertnit un[il final inspection. ig lure ol eg O er(s) [p�� / MOIorAuthanzedApPlicanlY �.DaK (714) 754-5273 • Fex (714) 754•4856 Job Address: 512 W 19TH ST Suite No Vicinity: WHOLE RESTAUR4NT Parcel Number: 422� 0314 0 CITY OF COSTA MESA __ BUILDING DIYISION ' DEVELOPMENT SERVICES DEPARTMENT PERMIT MECHANICAL PERMIT Applicant: THULIN, SID Address: 2766 POMONA BLVD.� -. - � - i , CA ; ��j�.-� ' � - . POMONA". _.- � ,-- � � : i,�i �� , �' . a � Owner. THOMAS; VELMA C . . Address,�'P O BOX 547 �. - ' _ i, � / \.�/ i .- /r CA \ / / . � i J� � LA QUINTA �; �� / `i \ �'�j/% / tDEVELOPMENT PERMIT NUMBER � M99-00355 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 0712 7/1 9 99 Issued: 0712717999 ISSUED BY: , ,r � . . _ Phone: (909) 839•0457 �' � , Zip: 91768 � � - ' , ' , j" , � _ � �� _ _ � �� - � ��.�A Phone: ' � �� - , . Zip: 92253 '� . - ( � � ��' �: � � �� . ��., � �- � .. _ /; Address:; 2766-P,OMONA BLVD. ,/ � � - %;�i . � � CA� i� i i n;� '� � � % � i' -� POMONA „ � � '-., i '�� - ,- i� �� Archl Eng: �.' - i . �'� �,,��- '�Address: �y,' , - �= / � �, � � � �A � ". � �� , , \ J Phone: � (909) 839-0457 . . . Zip�: . 91768, . _ . � License: 699831,�. " -' � Phone: 2ip: License: � � , ._ . , . . , 'SCOPE OF PERMIT MECHANICAI PERMIT FOR T.I. FOR "PLAYERS PIZZA". INSTALL 1-HOOD WITH MECH ' EXHAUST, 1-EVAPORATIVE COOLER, & i-COMPRESSORIABSORPTION SYSTEM UP TO 3HP. .. , , . - - , � � % / ', . . , REF: 899-00615 - � � - -_� _ � � ' ' ` - � l� � ,�. ,V , '... ISSUE'FEE� , � � '-� Inst FAU <700 k�BTU. , Inst FAU >100 k BTU Repair%AIt,CoolinglHeat . Inst / Rep. Recess Wail Htr Refrig Sys <100 k BTU� Refrig Sys >100 k.BTU � �' GasPiping ��, �j' Factory Fireplace �.,=-, -� Hood w/Mech ExhausC � . VAV Box Vent Fan / Single DuIX , Appliance � . Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfin Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater QuanGty $22.00 $0.00. 0 50.00 0 $0.00 0 $0.00 0 � ��50.00 0 �j. . $0.00 0 ^ $0.00 0 $0.00 0 ' 59.50 7 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0- $0.00 0 $0.00 0 $0.00 0 $0.00 0 "� Repair I Alt Absorbtion Unit � . � � Repair / All Refdgeration Unit . Ventillation System Evaporative Cooler . , Commerciallncinerator ' Domestic Incinerato� �� - - Compressors / Absor'ption Systems , � - Up t0 3 hp / 100 k BTU � " - �3 To 15 hp / 500 k BTU � . , � 75 To 30 hp / 1,000 k BTU � - � 30 To 50 hp I 1,750 k BTU - Over 50 hp / Over 1,750 BTU , Boilers . , . Up to 3 hp 3To15hp � � i51o30hp . , 30 to 50 hp � � � '� Over 50 hp � Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS I SPECIAL CONDITIONS Quantlty . . � 50.00 0 � � $0.00 0 - 50.00 0 $9.50 1 $0.00 0 $0.00 , 0 $0.00 0 , 50.00 0 � 50.00 0 50.00 0 So.00 0 $13.75 1 g0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 50.00 E54.15 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 pertnit shall automaticalty expire end become void if work is not commenced within 180 days, or it work is suspended or abandoned for a penod of 180 daye. . INSPEC710NS: In order for the work authorized under this pertnit to be considered legal, such work must comply with all epplicable codes, end all requlred Inepectlone end flnal approvel must be obtained. Feilure to obtain inspections end final approval will result in �ha expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: I hereGy aHirtn unCer penalry of perjury one ot Ihe lollowing dedaretions: ❑ I h ve end will maintain a certllicate oi consant to self-Insure for workera' compensation, as provided tor by sectlon 3700 of Ihe LeDor Cade, for ihe peAormance of tha rk �or which Ihls permit is issued. I have and will malniain workers' compensetlon insurance, as requiretl by secUon 3700 of the Lebor Code, fo� Ihe pedortnance of ihe wark lor which ihls pertnit Is Issuetl. My workeB' compe tion Insurance cartierp nd pollcy number re: ^� l� L �� ` 7 Carder: �+/nn / /i✓� � aoncy Num�r: ��01 Z �� (This section need be etetl If the permit (s veluetl at one huntlreC dWiars �5100) o� Ie55J ❑ 1 certlly thet in Ne peAormence of Ne work tor which this permit Is issued, 1 shall not employ eny person in any manner so as lo become subject to ihe workere' compensation laws of Celifomla, erM egree Ihat if I should hecome suDject lo the workers' compensetion provlsion9 of SecUon 3700 of the Lebor Cotle, 1 shall foRMvith Comply wllh IheSe proNslons. Applicant Signeture: Dele: WARNINO: FAILURE TO SECURE WORKERS' GYN.IPENSATION COVERAGE IS UNLFWFUL AND SHALL SUBJECf AN EMPLOVER TO CRIMINAL PENALTIES AND CNI� FlNES UP TO ONE HUNDRED TTIOUSAND DOLL4RE (5��.�)� �N ADDfiIIXJ TO THE COST OF ODMGENSATIpN, pqµq�ES PS PROVIDED FOR IN SECfION 3]OB OF TNE LABOR WOE, IMEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I here0y aHlrm ihat I em torce entl aflect. Lic. a_ Contractofs Slgnature: Chapter 9(commencing wIN Sectlon 7000) of Divislon 3 of Ihe Business encJ�Pr�es�lons Code, entl my license is In full Class p /�� S Dete: _ •.��-Z CONS7RUCT10N LENDING AGENCY: ❑ I hereby ettirtn tF�at there Is e constructlon lending agency for the peAortnance ot Ne work tor which Ihis permlt Is issued. (Sec. 3097, CINI Cotle). Lentler's Neme: Lentler's Address: Signature: Dete: OWNER•BUILDER DECLARATIONS: I hereby ettimi Ihat under penalry ot pe�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business antl Professions Code: Any ciry or wunry which requires e permit to coreWct, alter, Improve, demWish, or repair eny slrucWre, prlor to Its �ssuanca, also requires ihe appliWnt for such pertnit to Hle e signed stetement thet he or she is licensed pursuant to the proNsions af Ne Contractors LJcense Lew (Chepter 9(rnmmencing with Sectlon 7000) of Division 3 ot the Business and Professions Cotle) or thet he or she is exempt Nerefrom entl the basis tor Ne allegetl exemptlon. Any Wolatlon ot SecUon 7031.5 by flny applicant tor e permii subJects the epplicant ro e civll penalry of not mare than frve hundred tlollars ($500)J: ❑ I, as owner of the property, or my emplqrees with wages es iheir sale compensation, WILL DO 7HE WORK, entl the structure Is not intended or oNered tor sala (Sec. 7044, Buslness and Protessions Cotle: The Contractors License Lew does not appty to an owner of property who builtls or improves �hereon, and who does such work �imself or hersel1 ar ihrough his or her own emplayees, provitled ihat such ImprovemeNs ere not intended or ottered for sale. If, however, ihe building or improvement is soltl within one year of wmpletlon, t�e owner-builder will have the burden of provinq Uiat he or she tlitl not bulld or improve for purpose oi ule.). ❑ I, as owner of tne property, am EXCWSIVELV CON7RACTING WITH LICENSED CONTRACTORS to construct Ihe pro�ect (Sec. 7046, Business and Pwfessions Code: The contractors License Law does not appty to en owner of property who builtls or improves thereon, and who coniracis for such prqect with a contractoqs) license pursuant lo the Contrectors Lltense Lews.). � 1 am exempt under sec. Business antl Professians Cotle for thls reeson: Signature: Date: Owner ID verifietl by d��efs Iicense. ❑ Yes ❑ No Drivefs License No. Expires; Vedfication ot Ownerspip by (rype of document, i.e. - praperty taz 6111 or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I herehy cenily that no ezcavation Ilve (5) or more feet In tlepth Into which e person Is requlred to descentl, will ba mede in wnnactlon with work authorizetl by thls permll, entl that Oo building structure, scefloltling, talsework, or tlemollNon or tllsmantlinp Ihereof, wlll be more than thirry-sia (3fi) feet �Ig�. (Chap. 3.2. Gry 2, An 2, Sec. 341, Title 8, Califomla AGminlstretive Code). ❑ As owner-builtler, I wlll not employ enyone ta tla work w�lch would require e permit trom the Division of Indusirial Safery, es notetl ebove, unless such pereon has e permlt to do snrh work trom t�e tltvtsbn. Signature: Dete: Divislon of InCustrial S��ery Pertnil Number. CERTIFICATE OF COMPLIANCE /WD AUiHORQATION OF EMRY: I Certily under penelty oi per�ury �hat I heve read this application and slate that t�a infortnation given is correct. I agrea b comp�y with all state lews aM dry rndinflnces relfltlng to 6ulltling construction, antl auNodze representatives ot Ihe City ot Cas[a Mesa to enter upon Ihe above-descdbetl propefry �or inspedlon purposes. I egree not to occupy or ellow occupancy ot any bullding authodzed by thls pertnit untll finel Inspactlon. COUE �. INSPELTIONTVPE 1616 Fixetl System Final Fire Preventlon 1268 Poal Spa Finel 200 Flnal Re-Roof 201 Finel BIacWFie�alning Well 202 Finel Feqory F��e Place 203 Flnal Slpn 204 Final Demolitio� 2a6&s8 j7�i�I:iLi7.149 �.��.9y ' oa�e' COUEI INSPECTIONT'PE - ` � g,¢,�_ � �($ 208 Flnal MecheNcal .��_v�;Z �� N 208 Finel Plum6ing 210 Finel ElecMcal 212 Finel Flre Preventlon 220 Final Plenning Approvel 222 Final Slte 250 Final BuiltlingiOccupenq (714j 754-5273 • Fex (714) 754-4856 Job Address: 512 W 19TH ST Suite No Vlcinity: WHOLE RESTAURANT CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PLUMBING PERMIT PERMIT NUMBER P99-00430 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: O7127/1999 Issued: 07/27/1999 Parcel Nunmber: 42210314 ' ISSUED BY: Applicank THULIN, SID � ",- i; �' ' . " � ' ' ' - _ - Address: 2766 POMONA 84VD: �� " � _� - � � ' ; � - - ,_ CA - �' �_ " -� 'Phone: (909) 839-0457 ;' ' , _ � POMONA .�, � ' � ' � Zip: 91768 � .. . � '�,�i •_ , � _ _ , � i ��' �� _i . � � � ' ,�. � �.[�i �, , - - -_ " - - � . . `'✓ � . Owner: ��<THOMAS ,VELMA C ,'.-, - � ��`-� ,-� ', � Address��P�O BOX 547/'./� � V`.A� ' � � ��`�� /�.,/ � /i/ / � VA��. � � . � �\��. i � , . OA� /��!;./ Phone: �2��_• �i� i .� i /, A� �UINTA��/ Zip: 92253 �C`�.�A." , ' �'/�'� ��, � � ��A i", ��..� ��/� /% " i� � A�� . ��i/� �� i �// , . � -', �Contractor ;• ACEXANDER DEVELOPMENT I � , -� `; Address:� 2766 POMONA BLVD. : • y " : : - i ; . � . y;� i • ;.�A - - ' ,"a „�Phone: -(909)�839-0457 • , � � , � �, � �.. - ",POMONA ' - .� ; _ ,' Zip: 91768 . � � ' . , - - � ' ' �� - License: 699831� � . . ,', � , . ;�,r'. i - � � :�<� , _ - j.'. , � . � � �' ArchlEn �" � � � . ' '', 9.:� ,_� ,/ �" � AddressP;; ' ��.�" _ '� � � ' � � � � ' , . Phone: . � . , - � � . � .� _ ' , <. � . Zip;� " ' , , � .. . . � . . � � � � . License: � � �" � ' � -�• � SCOPE OF=PERMIT � � ' ` �� ' � � ,. .,�'�PLUMBING PERMIT FOR T.I. FOR "PLAYERS PIZZA". INSTALL 1rGAS�OUTLET, 1-ORMBE. (�Q I N I CRC(=P lOR , -� ��JpRiqgE{+igf4, 1•FLOOR DRAIN, 2-FLOOR SINKS, 3-KITCHEN SINKS, & 1-MOP SINK. • . �' - - . _ , . - , �._ '� REF: .. � . . \�\ . '899-00615 `- -- . �- , - . i � t i � �' � _ �`� . , �, ��'�, AMT' ISSUE FEE��'-, � , � $22.00 Backflow irrigation 50,00 Backflow Preventer, /$0.00 Bathtub � � � � $0.00 ClarifierSystem �� E0.00 ConneCt pce,Soda,etc)� � ,50:00 Dental Unita � `�50.00� Dishwasher � $0.00 Drain, Floor $875- Drain, Rainwater $0.00 Drein, Roof 50.00 Drinking Fountain $0.00 Ezpansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-0 outlets) 55.50 Gas (Over 4 outiets) 50.00 Gas Repipe 50.00 Gas Service $0.00 Interceptors (Grease, Oiq $17.75 Interceptors (Sand Auto ) $0.00 �� 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 FEE SUMMARY � nMr arv Laundry Tub / Washer " $0.00 0: � - �� Landscape Irrigation $0.00 0 _ � P-Trap % $0.00 �0 � . Pressure Regulator • $0.00 ' 0 ` � � -, Process Piping (per-10 fl)� 50.00 0 _ , �Receptors�� - . . $0.00 0 . Septic Tank $0.00 0 . Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 �0 - Shower � , $0.00 0 �, ' Sink, bar . 50.00 0 .' Sink; commercial .$0.00' 0 Sink, Floor . $17.50 2 Sink, kitchen $2615 3 Sink, service/mop $8.75 1 Spa (private) $0.00 0 Spa (public) $0.00 0 COMMENTS I SPECIAL CONDITIONS �.SumpPump ,� ' Swimming Pool Trap Pririier� � , . Unnal Vacuum Brkr Bkflow(1-0) . Vacuum Brkr Bkflow(5+) Wash Basin� ' ' Wash Basin�Set Wasle and Vent System � N/ater Closet (Toilet) ' Water Heater / vent Water Piping Qnst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTALCALCULATEDFEES: $106.50 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitomia statutes and related reguletions. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automaticalty expire and becoma void if work is not commenced within 180 days, or if work is suspended or abandoned tar a period ot 18� days. . INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such work must comply with alI applicable codes, and all requlred Inepectlone end flnal epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiretion of ihis permit. FOR INSPECTIONS CALL: (714) 7545628 WORKERS'COMPENSAnON DECLARAnON: I hereby aNirm untler pena�ry ol per�ury ane oi the followinq dedarations: . ❑ I heve anA will maln�ein e certiticate o1 consent to self-Insura for workers' compensetion, es proNtled tor by section 3700 of the Labor Code, tor �he pertormance of ihe ork tor which t�is permit is Issuetl. I have entl wlll main�aln xrorkers' compensatlan insurance, as requlretl by seclion 3700 0l the Lebor Code, tor ihe perfortnflnce of tYie work lor which thLq pertnit is IssueU. My workers' com M1setlon Irburence cartier antl poliry number ere: �/C� O% 6 �7 iI � Cartier. � ��"� ��.� �O Policy Number. (Tlils secNon nsetl nof be pleted 1! the permlf !s va/uetl ef Me hwWred tlW/ers ($100) or less.) � ' � ❑ I certlly that in Ihe PeAormence ol the work for which Ihis permlt Lv IssueC, 1 shell not employ eny person in eny manner so as lo become suD�ect to the workere' wmpensatlon lews ol Celitomia, and egree that if I shoultl 6ecome subject lo the workers' compensetlon provisions ol Section 3700 ot t�e Lebor Cotle, I shall forihwlth compry wlth these p�sions. Applicant Signature: Dete: WARNINO: FAI�URE TO SEWRE WOW(ERS' CQNPENSATION OOVEpAGE IS UMAW FU� AND SHP11 SU8IEGT AN EMPLOYER TO CRIMINAL PEWILTES AND CML FlNES UP TO ONE HUNDRED THOUSAND DOLLARE (5100.000),IN ADORION TO THE CQST OF WMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 3/OB OF THE LABOR CODE, IMEREST. AND ATfORNEYS FEES. LICENSED CONTRACTOAS DECLARATION: I hereby ettlrm thel I em torce end eHect. Lic. k_ Conireclofs Slgnature: Chapter 9(commencing with Section 7000) of Divislon 3 0l Ihe Business enO�rol si9ps Code, end my Ilcense is in tull G959 A �� ./ Dele: � � CONSTRUCTION LENDING AGENCY: ❑ I hereDy ettirm that there is e wnstructlon lending egency tor Ihe pedormence of the work tor whlch Ihis parmit is Issuetl. (Sec. 3097, Civll Cotle). Lenders Neme: Lendels Atltlress: SignaNra: Date: OWNER-BUILDER DECLAAAnONS: I hereby eHirm ihet untler penalry o1 perjury thet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW far the tollowing reason (Sec. 7037.5, Business end Professions Cotle: My ciry or counry Which requires a pertnit to consWd, a�ter, improve, tlemolish, or repair any siructure, prior to its issuance, elso raquires the applicani tor such pertnit ro fila e signed stetement Ihat �e or she Is licensed pursuent to Ne pmvisions of tha Contrectors LJcense Lew (Chapter 9(wmmencing with Sectlon 7000) of Division 3 of the Business entl Professions Cade) or Ihet he or she is exempt Nerefrom end the basls for the allegetl exemptlon. Any violation of Sectlon 7031.5 by any epplicant tor e permit subJects the epplicant ro e�I penalry of not more than frva hundred dollars ($500).�: ❑ I, as owner oi the properry, or my employees with wages es iheir sole compense�ion, WILL DO 7ME WORK, and the sWcture Is not intenGed or atteretl tor sale (Sec. 7044, Buslness and Protessions Cotle: The CONrectors Llcense Lew Ooes not epply to en owner of pmperry who builds or improves thereon, and who daes such work himselt or herself or Ihrough his or her own employees, provided t�at such Improvements ere not intended or oHeretl for sale. Ii, however, ihe builtling or improvement is soltl wi�hin one year ot completion, the owner-builtler will have Ne �urden of proving Ihat he or she tlid not builtl or improve for puryose of ule.). ❑ I, as owner of Iha p�operty, am EXCLUSIVELV CONTHACTING WITH LICENSED CON7RACTORS to cronsiruct ihe project (Sec. 7044, Business end Professions Code: The contrecitl�s �cense Law does not appty to en owner oi properry who bulltls or Improves thereon, and who comracts �or such project with a contrectoqs) license pursuant to tde Contractors License WwsJ. ❑ I am exempt untler sec. Business entl Prolesslons Cotle for this reeson: Signature: Dete: Owner ID verifietl by tlrivefs license. ❑ Yes ❑ No DriveYs License No. Venfication oi Ownership by (rype of document, i.e. - properry ta�c 6ill or deed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: ❑ I �ereDy certlty thet no eacavatlon Ilve (5) w more teet In depth Into whlch a person is require0 to descend, will be matle In cannectlon with work authodzed by this permit, entl I�eI no builtling sWMure, scaHolding, talsewo�k, or tlemWltlon or tll5mentling thereol, wlll ba more t�an Ihlrty-six (36) teel �ig�. (Chep. 3.2, Gry 2, An 2, Sec. 341, Tltle B, Califomia Adminislrellve CoAe). ❑ As owner-6ullder, I W�II not employ anyone to tlo work whiCh would require a permlt Irom the Divlslon ot Indusiriel Safery, es notetl ebove, unleu such pereon �as e permit to tlo suc� wo�k <<om the division. Slpneture: Dete: Divislon of Industrial Safery Permit Number: CERTIFlCATE OF COMPLd1NCE AND AUiHOROA710N OF ENTBY: I certily under penal�y ot perJury Iha� I heve read Ihis epplicatlan end stete that Ihe Intormalion given is correcl. I egree to wmply wlih ell state laws end ciry ordlnences relatlng to building wnstructlon, end aufhorize representetives ot ihe Clry ol Coste Mese lo enter upon Ihe a6ove-described property tor Inspectlon purposes. I epree not m accupy or ellow occupancy ol any bullding euthodzetl by thls permit untll Ilnal inspectlon, COUE I. INSPECTIONTYVE 7816 Flxetl System FlnHl Fire PrevenUon 1266 Pod Spa Ftnel 200 Flnal Re-Rool 201 FIneI BIocWReteln��B Well 202 Finel Fectory Flre Plece ' 203 Finel Sign 20a Finel Domolition 2a4&IB Psff. Itf�A64 Dete ��,�,� oe�B COpE1 INSPECTIONTYPE Qd¢, � �� 208 Flnal Mechenicel 20B Finel Plumbing ' ��^ ,� � 210 Finel Electrical 212 Flnal Fire Preventlon 220 Final Plenning Approvel 222 Final Site 250 Final Building/Occupency i�J� - y��'. ; ..:�::: ; �, pia> �sa•s2�a • FaX (�ia� �sa-aess Job Address: Suite No Viciniry: , 512 W 19TH ST WHOLE RESTAURANT Parcel Nunmber: 42210314 CITY OF COSTA MESA BUILDING DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Appliwnt: THULIN, SID Address: 2766 POMONA BLVD. - � CA '�� ,�'i POMONA %.!'- - , � �; /� �� .- /", � i" �. //i, � � Owner.�THOMAS, VECMAC,-�_ - - ��a« � P O BOX 547 � _ 1 i\ � 1?�ISS E FEE �, � Temp service test �f2es. a/c package New Res (1•2 units) ,, New Res,(3+units) � � Pool % Spa'� � � Lighting�Fixts � Recept OutleJs Switches �� Non Res Appl�, � Res Appl �\�\ Service to 200a ��` ` Service to 1000a � . Service over t000a � Motore to 1 hp Motors to 10hp Motors to SOhp Motors to t00hp Motois over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuils Temp Pwr Pole Intermed Pole �� CA� � � ;! - :� . ' /LA �UINTA / �'� �� /,//,- % �"i%� � PERMIT NUMBER E99-00694 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07/2711999 Issued: 0712 7/1 9 9 9 ISSUED BY: �Phone: (909) 839-0457 � . . . Zip: 91768 � . .� . % A � � � / / _ _ �� = A � �� . . _ . �_ A �i ' i A:�A i' Phone: � ��:r�.��, � / �-� ��` Zip: 92253 � �A; �'. ,� � � �<��, �`\V�i � / \ „ ,DEVELOPMENT � �� --.-._-BLVD. � � � � -� CA��',� . . . . Phone� (909) 839-0457 � . � . . . POMONA � :, ,iZip: 91768. .. � � , . - - . � , , . � .License: 699831 . , - ��. . . , j . . _ _ , `. i _ � / � . - j � . f'`�. �� SCOPEOFPERMIT � �� ' ` ELECTRICAL PERMIT FOR T.I. FOR "PLAYERS PIZZA". INSTALL 28-RECEPTACLE OUTLETS, � f� 1-SWITCH, 1-ELEC SERVICE TO 200A, 5-MOTORS TO 1HP. . REF: 899-00615 , ^ - • _ . _ . . , . . ". .. ` $22.00 50.00 $O.W � $0.00 \��,. $0.00 $0.00 so.00 $2520 $1.00 � ; $0.00 $0.00 . . . $27.25 � $0.00 $0.00 $21:25 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 Quantlty 0 0 0 0 28 1. 0' 0 1 ,, 0 0 5 0- 0 0 0 0 0 0 0 0 0 ' FEE SUMMARY ' � Quantlty Temp Dist Sy lem / Lighting $0.00 0,. Busway/t00ft $0.00 0 �-, Standing Section ---. $0.00 0 � . . � Misc Electncal Equipment 1 $0.00 �0 � - ..Trensformers up to 1 kva/kw $0.00 0� - ................up l0 10 kva/kw $0.00 0 '� �� ..........:......up to 50 kva/kw 50.00; � 0 ..........:....:.up't0100kva/kw ' $0.00".' 0 ....." .............over 100 kvalkw $0.00 0 � � , . Low Voltage Equipment � � � . $0.00 0 ; Low Volt Wiring System / Ckt �$0.00 �- 0� � - Misc. Conduit � $0.00 � '0� . � Misa Conductor � - 50.00 � 0 � - Circus ( gen or ride) $0.00, � 0 - Cirws (mech ride or lights) $0.00 ' 0 Christmas Tree Stand $0.00 � � 0 ' Fireworks Stand -� $0.00 � � 0 Other Eledrical Fee � $0.00 Investigation Fee., - • 50.00 < � Pian Check Fee _ $0.00 � Reinspection Fee $0.00 TOTAL CALCULATED FEES 596.70 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 7, 12-27-92) 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 1 BO days. . INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectlons end finel approval must be obtained. Failure to obtain inspections end final approval will result in iha axpiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 � J WORKERS'COMPENSAnON DECLAAAnON: � I �ereDy ettlrm under penaly o� per�ury one o1 Ne following deGerations: ❑ I hava entl wlll maintein e ceniflcd�e ot consent b selFlnsure for workere' campensatlon, es provided lar by sectlan 3700 of ihe Lebor Cotle, for the pertortnance of the ork for which this permit is issupd. I heve antl wlll malntain workers' GomPense�irn insu2nce, as required by section 3700 of the LeDor Code, tor Ihe peAortnence of ihe work for which INs partnit Is Issued. My workers' compen atlon Insurance carriar end pdicy number ere: �C.��n�� j � Cerder: 117v�—� /�% (�/J PoIlqNumber: 7 (Thls secNon need not be co e ed i(he pemut ! velued et one huntlred ddlars (St00) or /ess.) % ❑ I certiy thet In Ihe peAormence a� �he wark for whkh Ihb pertrtit is issued, I shell not employ any person In any menner so aa to become sub�ect to the workers' compensetlon laws of Celitomla, end egree thai It I shoultl become suDject to the workere' compensation provislons of SecUon 3700 af the Lebor Coda, I shell forthwith Comply with Ihese provisians. AppllceN Signeture: Date: WARNINO: FAILURE TO SECURE WORKER5' �.�7ENSAT�ON COVERA4E IS UMAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUN�RED THOUSAND DOl1FRE (5100.000), IN ADDfilO�'� TO THE COST OF OOMPENSATION, DAALIGES AS PROVIDED FOR IN SEGTION 3]O60F THE IABOR CODE, INTEflEST, AND FTTORNEY'$ FEES. LICENSED CONTRACTORS DECLARAnON: I hereby eflirtn that I em forca entl eflect. Lic. k_ Comrenofs Signature: 9(commendng wit� Sectlon 7000) ol DiNsion 3 ot Ihe Business end Prytesfion�Code, entl my Iicense is In full n Clessa /5��.(} Date: ''J. � 7, '�/� CONSTRUC710N LENOING AGENCV: ❑ I hereby ettirtn �het there Is a cons��+ctlon Iending egency for the peAartnence of �he work lor which this permit Is Issued. (Sec. 3097, Civil Cade). Lenders Neme: Signeture: _ Lendefs Addreu: Dete: OWNER-BUILDER DECLARATIONS: I hereby attirtn that unAer penalry oi perjury that I em EXEMPT FROM THE CONTAACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Business end Professions Cotle: Any ciry or county which requkes a pecmit b constmct, elter, Improve, demolish, w repair any structure, prior to its issuance, also requires ihe eppiicant tor such pertnit to tile e signetl stetemeN t�at �e or she �e fioensed pursuanl to the provisions of the Conlwctora Licensa Lew (Chepter 9(commencing with Section 7000) of DMsian 3 ot Ne Business and ProFessions Code) or tha� he or she is e:empt therefrom end the 6asis for ihe ellaped exemption. Any Nolatlon of Section 7031.5 by eny appllcant tor e permit subJects the appllcant to e ciWl penalry o� not more than five �untlred dWlars (5500) J: ❑ I, es owner o1 Ihe property, or my employees with wepes as thelr sole compensation, WILL DO THE WORK, entl the stmctura is not Intended or oNeretl lor sele (Sec. 7044, Business end Professions Code: TTe Conirectors License Lew tloes not apply to en owner ot property who builtls or Improves thereon, end who tloes such work �imself or herselt or thraugh his o! her awn employees, provided that such improvemants ere not intanded or oNeretl for sele. If, however, tha builtling or improvement is sold within one year of completion, tha owner-builder vrill have the burden ol proving t�et he or she did not 6uiltl or improva tor purpose of sale.). ❑ I, as owner af the property, am HxCLUSIVELY CONTAACTING WfTH LICENSED CONTRACTORS to construct Ihe pro�ect (Sec. 7044, Business and Pmfeuions Code: The contractors License Lew aoes not appty to an owner ot property who builtls or impmves Ihereon, entl who coNrects for such project with e comractor(s) license pursuant to Ihe Conirectors Ucense Laws.). ❑ I em exempt untler sec. Signawre: Owner ID venfietl by driver's ticense. ❑ Yes ❑ No Business and Pmteuions Code tor this reason: Verification of Ownerehip by (rype ol doGument, i.e. - properry te:� bill or deetl): DIVISION OF INDUSTRIAL SAFETV PEAMR CERTIFICATON: Dnvefs License No. Dare: E+�pires: ❑ 1 herelry ceNSy ihat no excevatfon tive (5) w more taet tn dept� iMo wMch s person fs requhetl lo tlescand, wil{ be matla in connedion with work au�hodzetl by thls permit, and that no builtling strucW�e, scalfoltling, falsework, or demolitlon or dismaniling Ihereat, will be more then Ihirty-six (36) feet hign. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Celifomla AdminiShetWe Code). ❑ As owner-builder, I wlll not employ anyone to do work whlch woultl require a permil trom the Division of Intlustnal Salery, es notetl above, unless such person has a pertnit to do such work irom Ihe dk�sion. Signeture: Date: Dlvlsion of Industrlal Safery Permit NumDer. CERTFICATE OF COMPLUWCE AND A�ORIZATION OF EMAV: I certity untler penelty of perf ury Ihat I have reetl this epplicetion end state that the information given is correct. I egree to comply wlih all slate laws antl ciry ordinences relating to bullding consiructlon, antl authorize representetives of ihe City of Cosla Mesa to enler upan the ebove-described proDeny for Inspectlon purposes. I egree not to occupy or allow occupancy al eny bullding aulhorized by Ihis permit until final inspectlon. COQE 1. INSPECTIONTYPE QdIFi II�LS 7616 Fixetl System Finel Flre Preven�lan �z:�� 200 201 202 203 Pool Spa Finel ' Finel Re-Rool Final BIocWRelelning Well Finel FeCtory Fire Place Finel Sign 204 Finel Demolitlon eooe� ixsvernoxrvve 206 Finel Mechenicel 208 Finel PlumGing 210 Final Elecidcal 212 Flnal Flre Praventlon 220 FInalPlenning Approval 222 Flnal Slte 250 Final Building�Occupency �� °�e �- 29 Date � PAIE - ItIIIDLIfl ADP��cant ta flll In sll s0aees ezeapt t�Ose wlthin �eavy OorEar Ilnas anE sign all apDroO/�ate tleela�ations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address '� ' 1,' Applicent'sMeitineG�fArnc�' � .�\ �` �.nAc � �P.QO�D: Owner'sName �O\od�\A� K\�CX�� x� 'ahone � Address � �« � �• '��j~ ArchlEng. Licanse No. Address M � �, �� Contractor's Nem�6�Yd �� Pho7° �q—�� 3 AdYress (me'I'ng) ^ �'/ � �_`..a=1�1�T-1 Cit Licen� Nn, 'T LICENSED CONTRACTOR DECLARATION I herehy alflrm t�at I� am Ilcensetl unGer provislon5 of Charter 9(commancing wlth iectlon 7000) ot Divislon 3 of the Busineis antl Profeszlans Gotle, antl � my Ilcanse iz in /ull Porce antl etfect. qO Llcense Class - LI ze No � Oate S"�' $I9natura WORKERS' COMPENSATION DEC RATION , � ' he�eby aHirm that 1 bave a rertlflcate o( tonzent fo sell-Insure or a cerilfiwte Workers' Compensatlon Inzuranca, or a certl}�e0 copy thereoT (SecUon- ,00, Lnb. C.) . Policy No. Company �Certifi�tl copy15 I18tlbwlth [hehcltY lQin9 Ivision Date �'� � APPlicant �T�. O EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - ITnissectlon neoC not ba tomD�etetl i7 the parmit I= lor one huntlretl (5300) or rass). I Certlfy thdt in the perto�mdn<e Of the wO�k fOr.Wnlch this pe�m�t IS ISSUed I shall not employ any person In any manner so ds ta become sub7ect lo t�e Workers' Compensatlon Laws of California., Oate Signature NOTICE: If,ialter making thlz tleclaraHon, you sM1Oultl becoma subject to tha Workers' ComPensatlon provlslons of Ihe Labor'Cotla, you must forthwith camply with suc� provislons � or this parmlt Ehall be tlaemetl revoketl. � CONSTRUCTION LENDING AGENCV ' ' '�. I M1ereby aiTlrm that thara I5 a constru<tlon lentling agency for the performanco � 01 the work for �whlcn thls permi[ 'I5 Issuaq (Sectlon 30B7 Civ. C.) LenGerY Nama Lentler's Atltlress OWNER BUILDER DECLARATION ' ' i herehv atfirm that I am examot }rOT Me� COnt�actor's LI[enze Law fo� the ' rom antl lhe Gasls tor tne auegeC exempuo�, qny vlolatlon o� Se i by any appliwnt /or a permit 5uG7ect[ Iha apD�lcant to a y o/ not moro tnen tive huntlretl tlollars (5500). as owner of tha property or my amD�oyees with wagai az tnoli �nzaNnn_ wlil tle the work. antl the ziructure is not intontletl or o1 an0 wno tloas such work himself/nerselt or through his or Sile, li, tlowaver, tne Duua�ng or �mprovemanc is sOla witmn one yoar o� com- plotlon, tna ownor wlll nava t�e burCen of provinq ha/sha tlitl not bulltl or Im- �Iove for the purpose o/ sale). I, ei owne/ of lhe Droparty, am exclusively Co�tratiln9 with Ilcensetl ton- tractorst6 construct tha pro�ect ISectlon 7044. Buslness antl Pro/asslons COCe: The Contractor's licanse law does not apply to an owner of property who bulltls or Improvas therean, antl who contracts fpr suth pro�eclt with a con- tractor(s) Iicense pursuant to the Contractor'S Llcanse Law). ❑ I am exempt untler Section 8. 6 P. C. far thls reason Date � Owner I hereby certllY that I hava rea0 thls appllwtlo� antl itate tlial tna above Informatlon Is correct. 1 agree to comply with all �Ity antl county ortlinancas antl itate laws relatinq to bullGln9 constructlon, antl hereby authorize reDre- I Sentatives of thIS.N(y to e r upon th� aDove•mentlOneE oroperty for InsOectlon OYrCOSRs. \ (� Y � ( J l�\ Y rj-ZA'� TYPE OF CONSTRUCTION ' ❑ CONVERSION ❑ DF DESGRIPTION�F WORK TVPE OF PERMIT � Lf GRnDiNG ❑ TENANT ❑ ELECTRICAL ❑ OTMER PROJECT DESCRIPTION 5a. FT._ CONSTRVCTIONTVPE VALUATION$ � GRADINGCU.YDS. ACR u noo THER FOU DA' PLVMBING ALTERATION U REPAIR LJSTRUCTURAL MECHANICAL Remarks: . Bar Sink Beckflow Preventer BeckflOw Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains � Floor Drains� Floor Sinks � GaSService Outlets Interceptors Kitchen Sink . Lavatories P-Trap - Roof Drains � Reinspection Fee $25 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fect. BIL ICBO dk Heating System & Ducting ❑ ai oo,000 eTu O i oo,000 �Siqnature�-� Date - Driwrs' Llcansellr 55 �F I I Reinspection Fee I $25 �CMF 0865-46 rav. 12/83 White - Bu1lEing; Canary • Appllcant; Pink • Accounting; GOIEenrotl - Azsessor � d61NG ` fEF Showers Service Sink. Sewer Cap Sewer Connection Solar Callectors SolarPiping r� Solar Tank � � Swimming Pool w/Spa � � Urinal Water Closet. Water Heater Water Service laue Fee _ Hood ar Typel ❑ Cenopy Typell ❑ Refrigeration System 04700,OOOBTU ❑100,000 System Repair/Alteration laue Fee A.P. qW ' S Main B� E T Front 6• Rear A C� Right K Left S 'Pln9. Ref. �/k Parking Req, Automatic Washer � Construction Pole Sub. Cooking Unit Dishwasher Dryers OGas ❑Elec� Fan F.A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generatar 00.5 KW � 7959 8/U2/l�:i Zone Park.Fees ELEC7RICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to l00 ampi � Meter �over700amps • Sub Panet � ' Motors�0.1 HP �1X-8. Int.Solar 09-15 HP �16-15+ � Microwave Pole Light � Range Sign Standing Sections 5 KW Trash Compactor $ 3 Rainspection Fee $25 �aue Fee FEES PUBLIC SENVICES RE�UIREMENTS: Zoning ApProved By Building AOProved By Appliration Issued By $ 3 I is0'. 1'l: 2 O N 1 N G R E U U ' � a E M E N T S . FEES $ 3 SUMMARV OF FEES � BUILDING PERMIT $ OO SMIP $ ' �-�S�t/ PLAN CHECK $ PERMIT PLUMB�NG § � ISSUANCE '$ PLAN CHECK 25% '$ ENEFiGY P.C. $ ELECTRICAL �$ GRADING $ PLANCHECK 50% $ MICROFILM $ �� /�� MECHANICAL � ;$ ' TOTALFEE S J_l�C1G_ PLAN CHECK 25% $ ' . � CONSTRUCTION AND PLANNING �C POOL 'A - � •, � Date Inspector � Date ' Inspector. _-APPROVALS' Permit # " . r APPROVALS Permit # _ ��.1.'Temporary Electricgl Seryice or Pole 52.' Pool & Equipment Location � � �• .2.� Soil Pipe�Undrgmd'. . , . � - 53.-Steel Reinforcement � ' • •'� �3. �Electrical ConduiCUtility-Undrgmd:- 54.� Forms � . - - � . � 4. �Electrical Conduit-Undrgrnd. . - 55. Electrical Bonding `� `5. Steel Reinforcement--� ��' 56. Rough.Plumbing & Pressure Test •;'v, '� 6. � Electrical UFER'�,Gmd. ' " 57. APPROVAL TO COVER•GUNITE � 7.'Footings ' ^ � - � 58. Electrical��Conduit-Undrgrnd. � 8. Foundatibn ' ' . 59. Gas Pipe, O Undrgrnd., Test ' 9. 1Nater Pipe-Undrgrnde. _ Y. � �' 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Svuctural Floor System - � �� 61. APPROVAL-TO DECK � 11. Property Sewer Line & House Connection 62. Backwash�& ReceptorFinal ' � t 12. Sewer Cap, � � � . � , . 63. Heater & Vent-Final ' � 13. � Roof Drains . � � 64. Plumbing System - Final , 14.'RoughPlumbing'.`• - "� 65. Electrical-Final � ' ,•; 15. Rough Electrical-Conduit " - - 66. Solar System-Final � - . - ' ` 16.�� Rough Elec[ric Wiring - -- 67. Fencing & Access Approval � --. �- " - � - 17. Rough'Wiring Sign . 68. APPROVED FOR PLASTERING 18: Rough Electrical-T Bar Ceiling � � • 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning . � FIRE DEPT. REQUIREMENT '• � �L � , 20.� Rough Factory Fireplace ' APPROVALS � Permit # � - ... 21.- Ducts, in,Structure ' , � 70. Underground Hydro 22. Ducts;lVentilating . � - 71. Product�PipingOGas ❑Oil ' � � 23. Gas Fipe=Rough & Test , 72. Underground Flush , � � . ., 24.,Roof�'Framing ' 73. Undergmd.StorageTank OGas ❑Oil • 25. Roof Sheathing � ' 74. Overhead Hydro • � � 26. T-Bar.Ceiling (Structurap & Monocoat � � , 75. Dry Chemical ' 27. Frame and Flashing � , 76. Dry Standpipe� � �� 28. L'athing & Siding 77. F�XED SYSTEM FINAL 29. Insuletion • . � 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 p� � Notes: ' � � 34. Final Heating &�Air Conditioning � , � ' . 35. Final Gas Pipe-Test ' � � - ' . 36. Hood or Canopy ` . - � 37. Final Factory Fireplace � � '' � � 38. Final�Plu'mbing � ' ' - � ' . ' ' . � F ' 39. Water.Service-Final � ' � - � - " 40. Gas Service-Final ' ' - � ` ' � 41. Solar�DomesticFinal , - - ; - � -- ' � i 42. Backflow Preven[er � ' _ � . � � � 43. Backflow Irrigation . . � 44. .Landscape Irrigation System � � 45. Sound�At[enuation . -� � ' . - 46. Handicap Regulations � , 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed , � � � � - i 49. Electric Release to Edison '- - ' � • • ' 50. Gas Release to Southern California Gas Co . 51. CEfiTIFICATE'OF OCEUPANCY � . . - - - ' � � No. � ' �Date � ' ' � 1 C�,T.Y OF COSTA MESA 'ProjectAddress ��C Applicant's Mailing Address Owner's Name - , U�`�. CONSTRUCTION PERMIT Arch/Eng. � I�C3i1 �� (�'r��K • Licenu No. Address � ��l Contrac[or's Name� �W N Phone -?��b Addreu (mailingl�� MN AL �L �i 7 .i/�7 � %OS7>'MPS� �, City License No. LICENSED CONTRACTOR DECLARATION � I h¢rOby a%i�m Ihdt I am lit¢nmtl untl¢r provi5iOn5 of Charta� 9(commencing wlth se<[ion 7000) of�Division 3 of tne Business antl Professions Cotle, antl my license is in tull force ana eHecl. Lic¢nse Glass. � License No. Oate Si9ndlur¢ WORKERS' COMPENSATION DECLARATION '�ereby afBrm [hat I have a'Certiticat¢ OI consent to self-Insure or a cerUficat¢ ' Workers' Compensation �tnsurance, or a certHletl copy tnereo! (Section '- J00, Lab. CJ ' Policy No. Company '• eCertifietl capy i5 hereby turnlshetl. . � Certifietl copy is tiletl with the city BWltling OIvi5lon. � Dat¢ APplicant � EXEMPFION FROM WORKERS' COMPENSATION OECLARATION (This section neetl mt be completetl if the permit is for one hunaretl $100) oi� � less). ' �/ <� I yeriify that in the porfo�mance o/ the wOrk for which this pe�m' b ISSUetl;,l. shall not employ any person In any manner so as [o becbme sub�ect to the . Workers�Copipen,{alion Laws ot Calitorn . Data 6� EC6 Si9nature �NOTICE: If, after makinq thi5 decla�atioi , Ou ShOu10 beGomo subject to the �, WOrkers' Compen5ation provi5ions Of th Labot CoCe, you inust forthwith - tOmply wi[h such �provision5 or this DC/mlt ihall be tleemetl ravOketl. CONSTRUCTION LENDING.AGENCV � ` '- 1 hereby atfirm that there is a conSlruction lantling a98ncy (or the per(ormance of the � work for which thls permit is izsuetl (Section 3097 Civ. C.) Lender's Name Lentler's Atltlress - ' ` OWNER BUILDEH ECLARATION - ' ' ' - I be�¢by afilrm that I am ex¢TPI f/om th0 Cont�actor'S Lic¢nse'Law for the tollowing �reason (Sectlon ]031.5 Businoss antl Profe55ional Cotle:.Any tlty or munty which requires a permit to construct, alter, improve, tlemoilsn or repair any Structure, priOr to It5 is5uance, a150 r¢quires [he appliCan[ for such permi[ �to fi�e a zi9netl statement that na/she is Iicensetl pursuant to the provisions of �.the Contractor's License Law (Chapter 9(commencing wilh Se<tlon 7000�bf 'Oivision 3 ot the Business antl Professions Cotle) or [hat he/she is exempl ier¢from antl th¢ basis for Me allegetl ex¢mptlon. Any violatlon of $ection 031.5,by any applicant for a permlt subjects the.applicant t6 a civil, pre-vn1a'lty of not more than five huntlretl tlollar5 ($500�.� ,. q/ay as owne� ot tM1e properly o� my Cmployaes with wd9es as lhelr Sole cobh0ensatiOn, will Oo Ihe work, antl tho st�uciure i5 m[ In[antletl or olteretl for saie (Settion,7044, Business and Protessional Cotle: The ConVactor'S License L.aw tloes nol apply to an owner oi•a properry who bulltls or Improves thereon, antl who Goei Such �woik hirnself/her5¢I1 0� th�augh his o� her own emD�oyees, provitletl that such Imorovements are noc Intentletl or offaretl tor ' sdle. If,�however, the bulltling or imDrovement Is soltl wlthin one year of com- pletion, the owner will have the burtlen of provin9 he/she tlIE not bulltl or im- prove for tne purpose o( sale). ' ❑ I, as owner of the prapevty, am extlusively iontracting with licensatl con- tracto�s to const�uct the p�oject ($ecliOn 7044, Buslnass antl Profe55ions Code: The Contrac[or'S Licens¢ Law tloes not apO�Y to an owner ot O�operty who buildz or improves lhereon, antl'who conlratts to� such projatts wlth a con- tractor(5) 6cense pursuant�to [he Conlrac[or's License Law). I am aware that proof of thei� Worker'S Compen5atlon InSurance shoultl b0 ProvitlBd to Te. ❑ I am exempt untler Se<tlon B. & P. G Por this reason Date - Owner 1�nereby certity that I have reatl t s applicztion antl state tnat tne above intormation is wrrecL J agree to co ply with all <Ity antl county ortllnances antl itate laws relaling [o builtling constructlon, antl hereby authoriz¢ repre- ' zentatives o1 this cllY to enter upon lne above-menHonetl prooerty fQ r� inzpectionpu� s. Dd1e � JU IN Signature l � b Drivers' Licen or 55 qf lo (ill in all iDaees except those wit�in heavy bo�E¢� lines anE'fign al1 approoriata Eeclarations. Z� 0 TYPEOFCONSTRUCTION LJ NEW LJ ADD �ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,.�6 ��DESCRIPTION F WORK/USE OF BLOG. /ti1GL �:�.sI�E�%�� CE/L/i:.%-�+ �lV Q�iV�� d_ E MainBuildi TVPE OF PEFMIT � GRADING ❑ FOUNDATION � STRUCTURA�- . T Front ❑ TENANT �ELECTRICAI � PLUMBING ❑ MECHANICAL A B Real - ❑�OTHER r1�� %� PROJECT�DESCRIPTION Sp. FT. OCCUPAnN�CV C Right CONSTRVCTIONTVPE �� VALUATIONST+�� g Left ' 20NE GRADING CV.YDS. ' ACRES ping. ReL # Remarks: � � Planning Notes: � �i1.3 , . PLUMBING ' FEES Backflow Irrigation � Bathtubs � ' Clarifiers - � � � Dishwasher ' � Drinking Pountains Floor Drains Floor Sinks � � Gas Service Outlets Incerceptors Kitchen Sink , _ - aM oof Drains � 0 Reinspection Fee Showers Service Sink . Sewer Cap � Sewer Connection^ Soler Colleclors SDlar Pipin9 � Solar Tank � Swimming Pool w/Spa, Urinal Weter Closet ' .Water Heater . �- AutO-Weih , �aundry Trays . $15 laue Fee Duct - Under Grounii . Duct - Structurel � ' Duct � Ventilating _ ' Exhaust Sys[em ❑ Multiple ❑ F i repl/Fact. 81 t. I CBO'# Heating System & Ducting ❑0.100,000 BTU O 100,000 BT' � Rainspection Fee � $15 CMF OB65-a6, rev. 10/84 Wnite - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor ,,, IHood or, Type I ❑ Canopy' Typell ❑ Refrigeration System oo-,00,000eru o,00,000s'r System Repair/Alteretion � FireDampers . Registers Issue Fee _ 4I54 _'�%3_. _ . - — � a 3 — /'/ - Zo�e �.2 ' /� Accessory Buildin9: Automatic Washer ConstructionPoleSub. � Cooking Unit „ Dishwasher . • �'1^ Dryers ❑Gas �Electr Pan �- ' F.A.U. ; - (O Fixtures, � � $ 3 I � FEES ' 7 $ 3 Outlets' ' " � Switches u.- -- ^ !� GarbageDisposal�, ^ Generetor DO-5 KNl �5-75,h •. ;i �� -� . � " , i Reinspection Fee ✓, '$15 DEVELOPMENT�SERVICES REQI Zonin9 APPioved 8y... . Biiilding Approved 6y � ' Aoolira'tion Issued Bv� � �� A 0 . ti �. �. BUIL'DING PERMIT,� $ P,�AN,CHECK � $ PLUMBING 5 PLAN�CHECK 25% $ ELECTRICAL " $ PLAN CHECK 509: $ MECHANICAL .�i1 $ PLAN,CHECK '25X $ Z O N I N G R E � M T S ELECTRICAL Transformer ❑ 15-51 ❑ 50 l. Merer �up to 100 an r ' Meter ❑over 100 am Sub�Panel , � Motors �0.1 HP �1! _ Ina Solar �9-15 HP�� 6 FEES Range,j. � •' . . ' � s' .0 Sign ' . . � ' . � . ; Standing Sections � . Trash Compacmr ' � , F.^, .. , �Issue Fee � , $ 3 RY,QF FEES � . � �� SMIP $ �.� PERMIT � • 80 ISSUANCE. S - �.OG ENERGY P.C. $ � GRADING � S ' �� MICROPILM S � , �� TOTAL FEE . $ � 9 �CONSTRUCTION AND PLANNING :APPROVALS Permit# 1. Temporary Electrical Service or Pole I 2. Soil Pipe-Undrgrnd. � � 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. � 5. Steel Reinforcement 6. Electrical UFER Grnd. � 7. Footings S. Founda[ion � 9. Water Pipe-Undrgrnd. 10. Structural Floor System 11..Property Sewer'Line & House Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing ,� 15. Rough Electrical�Conduit 16. Rough Electric Wiring 17: 'Rough Wiring Sign 18.� Rough Electrical-T Bar Ceiling 19. .Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21: Ducts, in Struaure 22. Ducts, Ventilating ' 23. Gas Pipe-Rough & Tesi" 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding � 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric .' ��. 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test ' 36. Hood or Canopy 37. Final Faaory 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 � 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co�i Date POOI ;PA Date Inspector qppROVALS Permit # 52. Pool & Equipment Location � 53. Steel Reinforcement 54. Forms 55. Electrlcal Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final -{o-� (,,F/J 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 OGas ❑Oil 72. � Underground Flush . 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro � ` (�G. 75. Dry Chemical � 3 6 �C/ 76. Dry Standpipe � 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL �(� 6 �� HEALTH DEPT. REQUIREMENT 79. FINAL IIVSPECTION � 80�., FOOD CERTIFICATE ISSUED , T-1c-a'b � c� Date � Inspector '��%�k2, n t . /�((e �c•�t`7�c'T�7Jrrt id T` W F�FkT THe�� nJAM'Tr=1� TnlSPr�.�� _ R'�/6'�brG ,��lJ op4�l,f�C1 �tlo� %�� S,Z�i�dL !l�R6TF Q 1/Ec9T O�. Licl7 �Lei?��G %7600G /).x»o ��`1/! �)o.:�a/: � fn� m7c �.�.e r4 er�a ./��Z / .�'�� :Jt{ `Y� R�P[�L1/O ��/�� 1�C/�%- �y keu�cr� �9wrt1' w �� n.� ��Kr� �� S l O�/ ` Tb /!J i I.i /. B-�! n 0 -v Appl(cant to fill in all sOacas axcapt t�osa wit�in neavy COrOcr Iines an0 slgn all appropriate Geclarations. CITV OF COSTA MESA CONSTRUCTION PERMIT Project Address �$'�2 �. / gZ S % � Applicant's Mailing Address Owner'sName -5��'��WiON K�re6EN phone�tid-03�L Address �T/.2 W. /QZi sT Arch/Eng. License No. Addres5 Contractar's NamaHnsrlR (�RnTECT/ o.� Phone Q9�-3U7 3 Addresslmniling) 61/lUNA/� 8�2eA�C/4 916i/ City License No. 3 b,3 6 7 LICENSED CONTRACTOR DECLARATION 1 hereby alfi�m thdt I am liconsetl untler provislons ol Cbarter 9(commenGin9 with sectian 7000) af Division 3 of the Bu5ine55 antl Professions Cotle, anC my Iicense is in tull lorce antl elfect. LlcenseClass C=L Ucenservo.32740> Date �- �' }�.�. Si9nature � — 'VORKERS'COMPENSATION OEC ARATION iereby atfirm that I have a certitiwta of consent ta satf-insure or a certificate ' / Worker5' Compensatlon Insuranca, Or d Certltietl cOpy thereof (Sectlon 3800, Lab. CJ � va�cvno.WC��%873ti� CompanyU'v/n"D pn[/�[ 8 Certifietl copy iz nere0y futnishetl. Certifletl �µy js filea with the tlty�uiltll g Di i on. Date � 1 j. Applicant�k�—� EXEMPTION FROM WORKERS"COMPHiJSATION OECLARATION (This section neetl nOt be compleletl if the permit I5 tor One hundrea ($100) or � less). I certify that in [he pe�to�manca of lhe wOrk tOr which Ihis pe�m�t is fisuetl, I shall not employ any pe�5on ip dny mann0/ so as to become subject to lhe � Workers' Compensation Laws oi Californla. \Date 5�9naturc � NOTICE: H, after mdkin9 this tlaclaration, you Shoultl become Subject to Ihe jh Workevs' Camp¢nSatiOn provislons oi thc Ldbor Code, y0u must forthwith \) cOmpiy wilh sUch p�ovl5ion5 Or [his Oe�mit shall be tleemetl revok¢tl. CONSTRUCTION LENDINC. AGENCV 1 M1ereby a(flrm t�al thare IS a conit�uctlon lentling a9ency fo� tha pe�formanG¢ \of tha work for whiGh this permit IS ISSultl (SeGtlon 309] Civ. C.) \ Lentler's Name LBlItlO!'S AddfC55 OWNER BUIL�ER OECLARATION ' 1 hereby a/flrm that 1 am exempt irom Ihe ConVactor's Licansa Law for the following reason (Sectlon 7031.5 Buslness antl Pro(essional Cotla: Any tily or County whiGh requira5 a permlt to Construct, aller improvo, tlemolish or repalr any structuro, prlor to Its Issuanco, also reqWres t�e applicant (or such permit to 111¢ a Slgnatl Slalem8nt thdt he/Sh8 IS IICOnSUtl pulsuant t0 th8 pfOvlslon5 of the Contractor's Ucense Law (Chapter 9(commencin9 with Sectlon ]000) ot 7lvislon 3 of t�e Busineis an0 Protossions Cotla)- or that he/sne is exempt .nerohom antl tne basis lor Ihe allegatl exemption. Any violallon of Sectlon 7031.S.by any aDP��cant fOr a pe�mit Sub�ects the appllcant to a civll �enalty ot not moro tnan fivu huntlretl tlollars (E500). I, ds ownar o/ ttle p�OPefty or Ty empl0y005 wilh wage5 d5 lh0ir sale compeniallon, will tlo tho work, antl the structura is not IntentleG or offeretl to� Sale ($ection 7044. Bu5inn55 antl Prolessional Cotla: Tlie Cont�acto�'S � Lic¢n5¢ (.�w tlol5 not appty to an Own¢r of a prOperfy who bulltl5 or impmves theraon; antl who tloes sucn work himselt/herself or tnrough his or ner own employ ees, provitlee that such Improvements are aot intentlatl or otteretl for -sale:'If, howevGr, tbe builtling or ImprOVOmant IS SoIU within One year O/ com- pletion, the owner will have tne bur0en ot proving ne/she tlitl nol builtl or im- p/Ove fOr [ha purpose of Sa10). ❑� 1, as owner ol the praoerty, am eaUusively contractin9 wltn Iicensetl con- Vactors to conitrucl the prqect (SatUon 7044, BuiMass anC Rotesilons Co�e: The Cantractor'S License Lnw does not apply to an owner of property who builds or improves thereon, antl who contracls tor such projects wlth a con- traclor(s) licenm Oursuant to tna ConVa<tor'S Licenze Law). I am aware t�a[ pro01 Of [halr Warker'S Compensation insuranta shoultl be provitletl to me. _ ❑ I am exempt untler SetHon B. & P. C. tor this reason Date Owner 1 hereby certify that I nave reatl thls application ana ztate Ihat tne aoove . IMormatian it corract. 1 agree to compty with all tlty antl county oralnances ', antl state laws relatlng to builtling construction, antl hereby authorize re0re- . sentatives of his City to enter upon the aoove-mentionetl property tor '. in5pectlon O�ose4 I . Siqnature ��r--'�i�� r' _ Dafe %'%—� Y _ Drivers'Llce or55�- � TVPE OFCONSTRUCTION �lJ NEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ �EMOLISH � OTMER DESCRIPTION OF WORK/USE OF BLDG. .. TVPE OF PERMIT GRADING FOVNDATION STRUCTV RAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 54. FT. OCCUaAraCv CONSTRUCTIONTYPE VALUATIONS 77�•Op ZONE GRAOINGCU.VDS. ACRES Remarki: Bar $ink eackflow Preventer Backflow Irri9ation Bathtubs Clarifiers Dishwasher Drinking FOuntains Floor Drains Floor Sinks GasService �OuUets Kitchen Sink Lavatories '—Trap Roof Drains i Reinspection Fee $15 Boiler . Duct-UnderGround Duct - Structural Duct - Ventilating � • Exhausc System ❑ MWtiple ❑ Firepl/Fact. Blt. ICBO � Heating System & Ducting ❑ ai oo,000 eTu O i oo,000 sn Reinspactian Fee � $15 CMF 0865-46, rev. 10/84 White - Builaing; Canary - Appllwnt; Pink - Accountin9: Goltlenrotl - Assessor Showers Service Sink � Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank . . Swimming Pool w/Spa Urinal Water Closet Water Heacer Weter Service Auto�Wesh Issue Fee Hoodor Typel ❑ Canopy Type II ❑ Fe(rigeration Syttem ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES g 3 S 3 A.P. �F S Main Bu E T Fmnt B Rear A C Right g Left Ping. Ref. # Automatic Washe ConstruEtion Poli Cooking Unit Dishwasher Dryers ❑Gas C Fan F.A.U. Fixtures ' Device Boxes � Outlets Switches Garbage isposal Generator �0�5 lectric OOBB 7/24/86 Zone Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up ro 100 amps ' Meter ❑over�100amps Sub Pane� , � Motors�0-1 HP �1X-8 InaSolar �9�15 HP �157 Microwave- � Pole Li9ht Ranoe Si9n Standing Sections KW �5-15 KW Tresh Compactor � Reinspection Fee � � S75 � � luue Fee DEVELOPMENT SERVICES RE�UIREMENTS: 2oning Approved By Building Approved By Appliption Issued Bv j5.00 Tl 53 Z O N I N G R E Q M T S SUMMARV O FEES � BUILDING PERMIT $ � ..� SMIP $ PLAN CHECK $ � � PERMIT ��,t� � PLUMBING � $ ISSUANCE $ — PLAN CHECK 25%' $ ENERGY P.C: $ ELECTRICAL $ GRADING ' $ - PLAN CHECK , 50% $ MICROFILM $ MECHANICAL $ �.TOTALPEE $ PLAN CHECK 25% $ �� CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspecto a 1.,'Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinfarcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. �, 8. Foundation : 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. 8ackwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 72. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Eiectrical-Conduit 66. Solar System-Final 76. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING � 18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' � 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro . 26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashing 76. Dry Standpipe • 28. Lathing & Siding ' 77. FIXED SYSTEM FINAL - ys. ' �� . , i .. 29. Insulation 78. FIRE PREV. FINAL � Z�6 , 30. Drywall Nailing HEAITH DEPT. RfQUIREMENT i 31. Plaster Brown Coat 79. FINAL INSPECTION • ' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: � 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace • � 38. Final Plumbing � . ' . 39: Water Service-Final � 40. Gas Service•Final 47. Solar pomestic-Final � � � ' 42. Backflow Preventer - . . -43. Backflow Irrigation � . : � 44. Landscape Irrigation System ' �• ' :A5. Sound Attenuation - ' � 46. Handicap Regulations , .. 47. FINALSTRUCTURE&BUILDING ' � ' 48. Special Requirements Completed ' �. ' " -49. Electric Release to Edison � . � ' , 50. Gas Reiease to Southern California Gas Co • . 51. CERTIFICATE OF OCCUPANCY No. Date � �- ��ca iriesa -�-- ^g l�e�rarcti.� �� -' 711 EAST 20th STREET . . ♦ �1 s� COSTA MESA, CALfFORN1A � .� lH'OYi APPLICANT TO FILL IN ulldln9 � j2 J/�c�'_� /< �% Address /,./ � a-�:' Costa Mesa, California �itect or ineer � ress � ach Metes and of Lot /�. L�J tv t; n�.! � , � I hereby acknowledge and state that the abo with all Clty Ordina� building rnnstructi%o� Signature oi l/.-, _ Permittee �� Authorized Agt. Vaivation \�. (•� $ �� (^C \ ene�I 2O6 G•N 2M 5-54 w Tel. � �� . �. City Lic. No. �.cnz �.. Demolish ��IBU�LDING �1 � FOdL OFk'ICE USE ONLI' � _. . Receipt No. . I. _- Perm� o S / G J �R/ece�i�ve ?'� jDate ec'd. � Date Issued �"' %� /-�- 8 �/i��/....5-cG A001'C55 ^ L/�! � COSt�1 M89&� CA,. � OPI Nearest J_/_ / /� J !� Crou St. �rl� r Frt Zone No. of/ Type� � .� I Plans / �e � Approved by CORRECTIONS - ; rvn: . ��,c.� . . ...'r^.'.. ,. _-:i. " �" �� aprRovni.s _� Foundation Locatfon Inspecto Forms, Materials, Under-Pinning Frame: Fire Stops, that I have read this Application ve is rnrreM and agree to comply �ces and State Laws regulating Plaster, Int. Plaster, Ext Masonry Rei Bond Beam FINAL O 9 � Z D r 9sta Mesa Building Department � JAp PLICAZ`ION FeOR PERMI .. ,l� , COSTA MESA,OCALIFORNIA 7�� 1QG� r U I L D�6 � G � FOR O�FICE USE ONLY FOYL APPLICANT TO FILL IN I Recefpt No. I Permlt No. Building � � � /� Addresa Costa Mesa, �i&IIiOTllI& R`e,ceived by at7e RCc'd. Date Issued Nearest v, � �/ `� /�5 �` � CrossSt. 8uildfng ,} S�. - AddreSs � �, % � � Owner $a o w� rd . Mail Costa Mesa, California Address Neares! � Tel. Cross St. City No. • rd 3�' Zone d� I No. oi I TypeTi Group �. w....�.:�....�..��. "'"� ' _..._. _ � ._ C� oPo..a i!f— _' " dresa , �_ , ,ntracl Addreu 'Size of Lot Use of ri New Repalr Building ; Q�ze i I hereby acN and state th� with all Ci1 building con Signature of Permittee _ Valwatio� O� � S � � FORM 204 5-BP 2M 6-55 ��I Biock j Trac ,, J15- 30 3 - F+. Sida Vard Stories CORRECTIONS I Coverinq APPROVALS Foundation Location Inspecto ~ � � � Forms, Materials, .=i / h ��1C/�S� I y] Q Under-Pinning � -�- Frame:FireStops, �i I have read this Application correM and agree to comply and State Lsws regulating Permft Fee $ /� � O O Pian Check $ � • �� Toca� `� Fee $ � I nt. Ext Beam O � � 2 D r '' v � .� 6 0 a` � J 6 ' o - a` �, . � _ � . ..- . -- - .. ;.-, �. ' --- --' -'- -- - -- - �— - -.�;.� - —I"-.--- --- � - --�-_ " _ ' � � -- - - � -- -- . I._ .. . _ . _ . - ,�. �, _. . -. _ ; . - . � ;� . ,,, . . ' . ' - - , � .... _ __ � _ t _�...._.. . , . . � �\� _ • _ _ __ .- . . - - � -- , ��.��;__ -`�` - - - � , �---_.'-. - ' ' —`�� . --�\_ _.'\ _ _ ' \. . __ . ' - ' - ' --- - ' " i � � _ i.t'1�, - '- , � ' _ "' " _ Sa��' _ _ ""' " j � _;' �.._ . .- . _ . _ ..:! _ � ^- - - . - - . , ,..� . . •- �'� i, .o_.[ . .... ' ' _..'. .' 'r.: -,t: ' . i, ' '- _ . _ . . -- Y L'�/1 PLA1\ . . . T -., I - . . -. : ` . _ � Show locatlon and distances from _ • ' �-^ „• � . �, • - - � -- - - - - -- . _ . � .. . - - - - - � � property Ilne and between buildings • - --- -�-- --- '-' ----- - .- • � .. • i ' _ _ , I� _ ' .. � _. . ... _. . ._ ___... _..._. . .. 'i'IC . . r . '�__ _ _ ___" __. `.. -..__ .�� .. _.._ . ' . ..` . , _ . _-f� __._ — �._ • ~ •_ _ .. - . . ,. ` • . i�. \. . S-\ i • . , . _. . . .c 1r ... . 1 . . ' . . . ' ', " """_' .._ -" 1 " ' ^''- .�'.�'• -__—. " "_�" _"__'__A '_ .. , '_'_ ""__ . __ . . ._ . .. '. :� . - "- _ . . _. - • , , I . . ::.i. �... ..t..�_ , � - � . . . , . r'. , , .�.., . �� ., I _ - . _, .. ._ _ . , .. ._ . , �„ �t��, - �'� . +. .� , I . t . � . _i , . . . . . . . ., . .^: 7 r.:- ; , � , . �.. ' . ..� � _ . ---'-'. _._ ._ ., . \ • : . , .-. � � . _ .._ . • • '� � -� � , y��9 COSTA MESA BUILDING-SAFETY DEPARTMENT � P.O. BO% 317 COSTA MESA, CALIFORNIA FOR APPUCANT TO F/LL /N COMPLETFLY TYPE OR PRINT BUILDING ♦ 7'�I ADDRE55 t- COSTA MESA. CALIFORNIA OWNER � S/ r�� MAIL ADDRE55 � �=L // � TEL. CITY L i! � T' I`}� /�L:�� i' NO. A TECT r1 :/ f� i i� � e� � ts�� LEGAL LOI �J nescniPnon NO. � BLOCK TftAC A.P.NO. )))IJ � �� O�'� �`� SIZE � I NO. OF BLDGB. OF LOT I%U rvOW ON LOT USE OF EXISTING BLO . _� �{�(� 1 SETBRCK LINE FROM �,� //� CENTER OF STREET `_ REAR Y��SK� I l� I / SIDE YARD LEFT RIGHT DESCRIPTI N OF WORK IREPAIR I BUILDIN� � SIZE EXTERIOR WALL COVERING NO. OF ROOMS ISH � hP BY 3 ��E REC��1�E0 �F�Y 8 1 FINANCE DEPT. r.irr nF r.Osra �wFsq APPLICATION FOR PERMIT BUILDING fOR OFF/C USE ONLY HEC IPT 10. I PEfiMIT NO. C IVED BY I A 9E EIyGLN I .DATE (SS �EQ COSTA MESA. CALIFORNIA type gr�up F. Z , � n...... i.c nnrc S /7��J ZONING ZONE NO. OF �I USE OF NEW PLANS - LI BOILDINC . /�l` APPROVED e BV DATE YARDS E REQUIRED ALLOWED ICENTER LINE 8T.) FRONT FT. R.SIDE FT. L.SIDE w�� REAR � � F'�'. l _. _w � � _ r1 i��,SL � ' ,� GZ/(iC.�C'c : I HEREBY ACKNOWLEDGE THAT I HAV6 REqO T IS M1PPLILATION U /� ♦N� STATE TNAT THE /�BOVE �5 NECT AN AGREE TO COM� 7HE AMOIINT Bi�WN UNDER VAL'1AT10H 18 FOR TXE PLY WITH ALL CITY OINANCES N STATE AWS HEGULATING PUPPOSE OF ESTABLISNINO A PEPMIT FEE ONL . BUIL�ING CONSTRUCTIO "'�� VALUATION SIGM#iaxFor �Y PERMIT FEE $ " PERMITTEE- �� ( / OO $ �9, /_ OD\ PLAN CHECK $ � � " � v AUTHORIZED AGENT / / TOTAL FEE S L7 (7 � . • • li -� ,, f ' - ,�- _ . ��?jU �'. J, .'ei�� .. . . ,. '. �, : .�'.. i. ,,.. , .. •c�. "2ar� .t�'"c^ ' " '. ., . . .... , :. . _ .i.. .,. '�' .l, -. � .,�� .� , ., - . :�✓% , �,- ./ � - -..__ , . � .. _ . . . ' �.1v�, / -- � '----- '��'. /l/... � .� . . '." :.':` :' ._, . . . '' , � _ � :�.� .�.. ' �' .. . � .`.. :. - . ir '.r� � , _; . , `�. i- - ', ..... .. ��' � '�. _. . . . ' .. . . . +' 1 h.' .. . . . .. . � _._. �.. . �;��...�_'.._ .� - - . . - . . . ..• .,_'� = �'�� :,. � i �� . � . �., . . � : . ,, � . �-- -.. . . . .'' _, . `� . . . . ,. � ,\- .�. , . , .,, . _ �... . .., . . _. . � � . . _. .. . - . _ . • .. ? . ., ' ri �., ._ �_. .. _ . � . . . ' ': ... . . . . ,. . .. - ir:�` ��)r: . � . '- ' n ' . . . ' .. . "' _ _'_ '"' ' . ., . . . . �- ' - . . ... , . . � _ �:> � . . . . . , � � � . � . . �,- _� . _ . _.. . � ' „ . �. ' - . . '. , , .' � ... .. , ' . ,. T� . . .. . �... . � i . . ...' ' . ' � , . i � , • ,. :. , . . . . .. . . .. . . , . ... .. . " ' . ... . . , ;. , ' , . . -. . .. . ,.�. , i''' . �. . .. . . . . � . . � - . . . ... .. �� . . . - . _. _ _ ' .. . ., � . - . �- . . . : , _ _. ;:. - ' - _-,.. ' � . , , .. , . . . , .'.r � ' � �_�._. � . ..,.� _ _ . . . - ; `. . � , . ,, . . �.. _ �� ..; , . _ . �as�� OSTA MESA BUILDING-SAFETY DEPARTMENT �j P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 _ For Applicant ro Fill in Completely BUIL NG / ADD S c� � OWNEf�I � �//�y� MAIL � / J Z ADDRE55 /L'� !�i aU CITV ��/�/J�jy 2 CONSTRU ION O � LENOERI � am �, J � BRANCH j � J ADDRESS� J m ARCHITECT a OR ENGINEER U N Q W � ADDRESS a W , W Z CONTRACTOR ��/ J Q m Z w� ADDRE55 y�.� Q W Z � ��T� �o.STA /�; w � STATE � — / � �Q IIC.NO. �•� = O S12E OF LOT USE OF EXISTINGBIDG. C.i� 6 TEL. NO. TEL. 7 N o.4 g6 .� CITV UC. NO. �D INO. OF BL�D(a'S. NOW ON LOT PA30 •i} 75..ti.q.1 Z�7 "•UG -7-74�,,;S�OO 543 0_ fi APPLICATION FOR BUILDING PERMIT RECEIV DATERECEIVED DATEISSUI �15�303-'1lI;_ .PE� TNO A.P. NO. BUILOING r' n �- I �-F', ' ADDRESS ' L »� TFACT 31 5 LOT 5 eLOCI FIRE ZONE APPqOVED ZONE � ^ NO.OF L PLAN$ VARDS APPROVED MAIN BUILDING ,//Ji1�/yALU� /L-GC� vici+/v� 6(1 USE OF NEW �IZE BUILDING R�pqZR VARDS APPROV ED ACCESSORV 9UIlDIM �ti F� 512E OF NO. OF Z NEWBLOG. ROOMS STORIES L.SIDE FT. FT. U E%TERIOR WALL ROOF COVERING COVERING REAq FT. FT. �� USE OF UILDING AND WORK TO BE PERFORMEO DISTANCE BET. BET. MAIN 8i TU ��I/�� i MAIN BLDGS. ApCE�, g�p[�$, Q • • VP.F.# DATE Q /%F'- i r" �C Fi ' O`C/T/ C.U.P.# APPROVED . al. N �, /_� �S. APPROVEDI. /Ll C '',' 7 N / 0 � „y,7'v--�J �%a......�c i�( VI hereby acknowlatlpa thet I hava reatl this apptication entl stete � that the above Intormation is corract entl epreo to comply wit� � all� laws reBulating builtlinp conctruG<ion, antl I shell nct employ � � any perwn in violation of the workmen's compensatian laws of y tha Steta of Calitomia. Tq� ? I hereby tertity [hat I am proparly ��censetl as e contrector untlar SQ. FT. the State of Californie Business antl Professions Cotle, �Ivision 3, THE AMOUNT SHOWN UNDER VAIUATION IS Chapter 9, and thet such Iicensas erB In tull torce and atfeci, or I THE PUFPOSE OF ESTAB�ISNING A PEFMR FEE O em exempt irom the provisions oi the Steta of Cal(fornia Business VALUATION antl Profassions Cotla, Oivislon 3, ChaPter 9. � PERMIT FEE $ Si neturaof �j`� �X �� Parmlttea�� S� QDD PLAN CHECK $ / Authorizetl Agent � � TOTAL FEE $ D� ' � m O FOfi ; ILV: Q N J E O LL �-�_ _ _ �, . .. � --�.-__. ____-:'� ��_, . � �. . C � LPAi❑ }itrsY:':is , " � � 30-7 �z�,s; oo„q,v� 7.50 COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT for Applicant ro Fi!l in Completely qE IV D BV ATEAECEB/@D ...�.� �� BUILDING ` Q 'T// ADORESS �% pL. % / OWNER A.P. NO.` ��O � i MA�L r�� BUILDING 1 ADORESS �� (�V � � � ADDRESS � Z . ,p ��//r TEL. TpACT a U CITV C•o,$%� /// Q.s NO. Z CANSTRUCTION W AO O N LENDER � a m , J � BRANCH ' �� OWNER � ADDRESS m ARCHITECT ' TEL. S J N OR ENGINEEF N V FIRE , w � ADORESS ZONE T % a w APPROVED W Z CONTRACTOR GU � BY J Q m Z ) J � A�OF7ESS U _ '��(.0 • W w �y/ TEL. Z�NE� NO.OF Z� CITY '--r /// %.S NO. u%a7ZZ PLANS wO STATE CITY YAFiDSAPPROVED �� LIC. NO. a LIC. NO. MAIN OUILDING �� 512E NO.OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT RONT FT. i VSE OF EXISTING BLDG. � F , F� SIZE OF NO. OF Z NEWBLOG. ROOMS STORIES IDE FT. a EXTERIOR WALL ROOF �% COVERING COVERING iiEAR FT. J USE OF BUILOING AND WORK TO BE PERFOfiMED DISTANCE 8E-C. �d MAIN BLOGS. ` Q VAR. �` O C.U.P. # ~ � �rJ%I Y F �PROVED (A ' Z � UI hereby acknowletlge that I have reatl Mis application ana stata � that the abova informaiion is correct antl aB�ee io comply with � all laws ragulating builtlin8 consttuction, and I shell not employ � any Detson in violation of the wOrkman's compensation laws of y the Stata ot California. ? I he�eby certify that I em properly licansed as a cont�actor under SQ. FT. ffie Stete of Calitornia Business and Professions Cotle, Divisicn 3, THE AMOUNT SHO� Chapter 9, and that such licanses are in tull torce and eftect, ar I THE PURPOSE OF ES' am ezempt trOm the pro�isions of tha State of Californie Business VALUATION entl Professions Cotle, Division 3, Chapter 9. Signature of �jJ /O 'T� Permittee �� $ `G � Authorizetl Agant 0 LOT �- DATE USE OF N BUILDING YARDS APP FT BET. MAIN & ACCESS. BLPGS. OATE APPROVED / � ✓U m w 0 �N UN R VALUAT S FOR i 4BLISHIN�iTi'PE�FEE ONLV: Q �, �7 N PERMIT FEE $ � �/"V ] m PL4N CHECK $ E 0 LL TOTAL FEE $ � ._` � J � COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CAI.IFORNIA 92626 For Applicant to Fill in Completely � BUILDING ` I�� (� � �� j '�-{� ' ADORESS .J ' �1 - OWNER � — �c.ma MA�L ADDRESS ��'�-� CITV Ce S�^4 n�r � ,� nTioL. BRANCH TEL. ADDRE55 CONTRACTOF T`�tii Ll hI S� �A� ( L` �-�C� ADDRESS �2-1 �J LC V �'N CITY C M NO�. ��—�O STATE ^ _; / C"^ / CITV LIC. NO. /r % S LG �-� LIC. NO. SIZE NO.OF BLDGS OF l0T I NOW ON LOT USE OF EXISTING BLDG. SIZE OF NO. OF NEW BLDG. ROOMS STOFIES EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WOfiK TO BE PERFORMED 1 hereby ecknowledge that 1 heve read this epplication antl state that ihe abo�e information is correct antl agree m comply wiffi all lews rapuleting builtlinp consttuctlon, antl I shall not amploy eny Oarson in violation of tha workman's compenution laws of the State of Celitornie. 1 herebY ca�tity thet 1 em p�opa�ly Ilcensetl as e contracto� untla� Me Stata of California Businesz and Professions Code, Divizicn 3, Chaptar 9, a�tl that such licensas ere In full forca antl effect, or I em axampt trom the provizions ot the State ot California Businecs end ProtessiO�s Cotle, Divlsion 3, Chjptar 9. SIO�eture of � � / �'=8:�" ✓��_ Parmlttee � � � P.US�10f�3BC/ {�QBlIS FC -9-7.F�tJ�Q a56' �.SG � i�c�ssi � r ,to:t�=: � �N FOR BUILDING PERMIT � DATE RECEIVED �oTc icRuan_ ` A.P. NO. /I � '�O � — ADORE 5 � � G �(/ APPROVED N ' NO.OF � 2 P�,� � YAROSAPPROVED MAIN BUILDING ±OM C/L STREET) DISTANCE BET MAIN B�OCS. VAR. # C.U.P. � nwaovEo p ; i�.,p�.. ` ! P J / � S� '�'� / S BLOCK �' DATE L 4� NEW VE BET. MAIN & ACCE�. BLD DATE 2 �1 ' m SQ. FT. o THE AMOUNT SHOWN UNDER VALUATION IS FOR � THE PURPOSE OF ESTABLSHING A PERMIT FEE ONLV: ^ ¢ VALUATION p� �v PERMIT FEE $ "�� m $ �71 PLAN CHECK $ E l�./ C/ �� o LL