HomeMy WebLinkAbout687 18TH ST - Building Permits(714) 754-5273 • Fax (774) 754-4856 • wv+w.ci.costa-mesa��DING PERMtT » FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 687 W 18TH ST
Suile:
Viciniry:
Parcel Number: 42426102
Applicant: HOLTZ, ROBERT
Address: 17853 SANTIAGO BLVD.
SUITE 107•124
VILLA PARK, CA
Owner: DAISY III ASSOCIATES LTD
Address 4120 BIRCH ST SUITE 104
,' NEWPORTBEACH,CA
Convactor: ERIC HOLTZ CONSTRUCTIO
Address: 17853 SANTIAGO BLVD.
SUITE 107-124
' VILLA PARK, CA
Zip: 92861 -
Arch :
Address:
Phona:
Zoning:
Phone: 714 538-7497
Zip: 92861
Phone:
Zip: 92660
N
Phone: 714 53&7497
License: 736940
, Eng:
� Address:.
Status: ISSUED
Applied: 04I10/2003
Issued: 04I10I2003
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE EXISTING CEDAR SHINGLE ROOF. INSTALL OSB, COVER WITH 30 YEAR COMP. BUILDING 1 OF A 3 BUILDING APARTMENT
COMPLEX. � - . . - �
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$97.25
$0.50
$0.00
$0.00
$0.00
597.75
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0-0
PARKING Existin : 0
FEE SUMMARY ' ,
Calc Valuation: S3,aso.00
Claim Valuation: S3,3so.00
PLANNING & ZONING
-Rear 0.0 Left 0-0 �Right 0-0
Rear 0- 0 Left 0- 0 Right 0- 0
Re uired: 0 Proposed: 0 .
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
� regulations. (Ord. No. 9248, § 1, 1241-92)
El(PIRATION: This permit shall automatically explre and become void if work Is not commenced withln 780 days, or if work Is suspended or abandoned
for e period of 180 days. �.. . •• •.
INSPEC710NS: In ortler for the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inepettiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of this permit.
FOR INSPECTIONS CALL: (714} 754-5626
zuaae �eroo�
WORKERS'COMPENSAnON DECLARAnON:
I hereby eflirm untler penelry of perjury one of ihe tollowing dedaratlons: �
❑ I heve end will melntain e cert�����a of consent lo self-Insure tar workers' compensatlon, es proviCed for by sectlon 3700 of ihe Labor Code, lor Ihe peAormence ol the
w wNch this pertnit is iSsueO.
1 have en0 wlo malntein workeB' canpensation 4Gwrance. as requiretl by section 3700 0l the labof Cotle, tor the pertortnanca of Ihe work lor whkh this pertnit is iswed.
My workers' wm ensatlon InSurance carrier and pdicy number ere: � ,
Cartier. � S�a ��U.ap� Policy Num6er. �SS'O2 - 000 /G 07
(Thls secNwr nee0 nof be rortrpleted i! the pertnit is veNetl af one hurMretl dol/ers (S I00) or /ess.J
❑ I certiy ihet in Ihe pertortnanCe oi the work for which this pertnil is Issue4 I shall no� employ eny person In eny manner so es to bewme sub�ect ta Ihe workers'
cpnpensatlon laws oi Californ�e, and egree Nat tl I shoulC become wb�ect to Ihe workers' compensetlon proNsions of Sectlon 3 00 of Ihe LeDor Code, I shell tonhwit�
compywit��hese ions � /' / /,
Applicent Sipneture: �� � Oete: ��Jl—" �' v� � �
WARNINO: FAILURE TO SEd1RE WORKERS' OOMPENSATIpN ppVEqpGE IS UMAWFUL AND SFULL SUBJEGf AN EMPLOYER TO CRIMINAL PEM4LTIE5 AND CML FlNES UP TO ONE HUNDRED
T1qUSAND DOU.AqE (5100,000�, IN MDmOM TO THE COST OF C�OMPENSATIIXJ, pAA1hGES IS PRO��DED WR IN SEGTION 3]OB OF THE UBOR ODDE, INTEREST, AND ATTORNEYS FEE$,
LICENSED CONTRAC70RS DEC4N�AT10N:
I hereby etllrm thet I em Ilcensed untler proNsions ol Chapter B(commenGng with Sectlon 7000) ot Dlvision 3 of ihe Business end Professlons Cotle, end my Ilcense Is in ful�
force entl eNect Lic. p�� Cless a C
Contrector's Slgneture: � Dete: � � (� ��
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby eMirtn that lhere is e Go�slructlon lending agency for Ihe peAormence o� t�e work for whic� ihis permit is issuetl. (Sec. 3097, Clvll Code).
Lenders Neme: Lendefs Atltlress:
Signeture:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby eMirtn that under penelry oi pe�ury that i em EXEMPT FROM THE COMRACTORS IICENSE LAW for the following reason (Sec. 70.31.5, Business and Professions
Cotle: Any ciry or counry�whic� requires a permit to wnstruct, alter, Improve, tlemolls�, or repair eny strucWre, pnor to its issuance, elso requlres the appliwnt tor such pertnit
to file e signed statement�hef hebr she is licensed pursuam ta the proNsbns of the Cantrecrors tJcense Law (Chapter 9(commencing wlt� Sectlon 7000) of DlNsion 3 of Ne
Business and Prolessions Cdde) o[ lhet he or she is exempt Neretrom and Ne besls tor the allegetl axemptlon. Any violation of Sectlon 7031.5 by eny epplicem for e permtl
subjects the epplicent to e civil pene�ry M not rtw�e Ihan tNe hundred tldlers (5500).):
0 I, es owner of the properry, or my employees with wages as t�elr sole compensation, WILL DO THE WORK, and the struqure Is not InientleO or oflereC for sale (Sec.
7044, Busineu entl Protesslof�s Code: The ConUactors License Law doas not appty to an owner of property who builds or imprwes thereon, end who Coes such work
�imself or hersell or through his or her own employees, pmvided thel such Imprrnements ere not intended or oHereO for sale. If, however, the buil0ing or imprwement is
sold within one year at comple��oo. �the owner-builder will have Ihe burden of pmving Ihai he or she did not build or improva tor puryose of sale J. �
❑ I, as owner oi ihe properry, em E%CIUSIVELV CONTHACTNG WITH LICENSED CON7iiACTORS ta construct tha projad (Sec. 7046, Business flnd Professions
Cotle: The contrectors License �-ew tloes not apply to en owner ot proDerry who builtls or impmves thereon, antl w�o contracts lar such pro�ect with e contrector(s)
license pursuant to Ihe ConiraCors License Laws.).
❑ 1 am e:empt under sec. _ Business entl Prolesslons Coda tor thls reeson:
Signature: Date:
Owner ID veriiletl by tlnvels Ilcensa. ❑ Ves ❑ No Drivefs License No.
Varfficetion of Ownarship by (typa ot document, i.e. - property tax b10 0� deatl):
DIVISION OF INDUSTRIAI SAFE7Y PERMR CERTIFICATION:
Expires:
❑ I �ereby certily that no excavallon fve (5) or more leet in depth into whlch e pereon Is requiretl to Oescend, will be matle In connectlon wlt� work euihorizetl by this
permii, and Ihat no buildfng sWdure, scattolding, lalsawork, or tlemditlon or dismantlinp theraof, will be more Ihen thirty-slx (38) taet hlg�. (Chap. 32, Gry 2, Atl 2, Sec.
341, lltla 8, Calitomla Atlministrative Code).
❑ As owner-bullder, I will nat employ anyone to tlo work which would require e pertnll Iran Ihe Division ot Intlustnal Safery, as notetl aDove, unless such person hes e
permit to tlo such work trom ihe OiWsion.
Signature: Date:
Division o1 Industnal Sefery Permil Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOHVJ1710N OF ENTAV: 1 certify under penelty ot perjury �he� I have read this epplica�ion end stete that the Inlortnaqon given is
correcL I egree Io comply with ell std�e lews entl Gty orCinances releting to bullding wnstrucUon, end euthorize representetives ot tha Ciry ot Coste Mesa to enter upon the
above-Oescn6ed proparry lor Inspection purpases. 1 egree not to occupy or ellow occupency of eny building euthorized by ihis permit unlil linel inspection.
� :, :.: . : �� .: L
..'' - - ���i � �� . : :
.
CQOE 1, INSPECTONTYPE
1818 Fixetl System Final Fire Pre�ention
1288 Pool Spe Flnal
200 Finel Re-Root
201 Flnel BIocWRetaining Wall
202 Final Factory Fire Place
203 FInalSign
204 Finel Demdltlon
aeg u�e�s
�� � i •
t _/, . ��� �
cooer ixsrecnoNnve
206 Finel Mechanicel
20B Finel PlumDing
210 Finel Elacincal
212 Finel Fire PrevenNon
220 Final Planning Approval
222 FinBl SIIe
250 Final Building/Occupency
veg I�e�s
�
0
(714) 754-5273 • Fax (714) 754dB56 • www.ci.costa-mesa��DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 687 W 18TH ST
Suite:
Vicinity:
Parcel Number: 42426102
Applicant: HOLTZ, ROBERT
Address: 17853 SANTIAGO BLVD.
SUITE 107-124 �
VILLA PARK, CA �
owner. DAISY III ASSOCIATES LTD
Address 4'120 BIRCH ST SUITE 104
. NEWPORT BEACH, CA �
Convactor: ' ERIC HOLTZ CONSTRUCTION
Address: �7853 SANTIAGO BLVD.
SUITE 107-124
VILLA�PARK, CA
Zaning:
Phone: 714 53&7497
Zip: 92861
Phone:
2ip: 92660
Phone: 714 53&7497
Zip: 92861 � License:. 736940 �
Arch : ' " . � � - � � � Eng:
Address: � � ' - � � Addr2ss:.
Status: ISSUED
Applied: 04/10/2003
Issued: 04/10/2003
ISSUED B .
' . � Phone: � - �. , Phone: �
' � Zip: � � , License: � '� ' License:
\
SCOPE OF PERMIT
REMOVE EXISTING CEDAR SHINGLE ROOF. IIJSTALL OSB, COVER WITH 30 YEAR COMP. BUILDING 2 OF A 3 BUILDING APARTMENT
COMPLEX. � - - - � ' : - - . _ '
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$97.25
$0.50
$0.00
$0.00
$0.00
$97.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front. : 0- 0
PARKING Existinq: 0
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE SUMMARY
, Calc Valuation: S3,sso.00
Claim Valuation: 53,3so.00
PLANNING & ZONING
Left 0- 0 � Right � 0- 0
Left 0- 0 Right 0- 0
Proposed: �0 �
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutas and related
regulations. (Ord. No. 9248, § 1, 1241-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. ' � ' � • . � ' , ,
INSPECTIONS: In order for the Work authorized under ihis permil to be considered legal, such work must comply with all applicable codas. and all
required I�speetlona and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALI: (714) 7545626
��� ���
WORKERS'COMPENSAnON DECLARATON:
I hereby eH' under penalry of perjury one of the following declarations:
❑ I ve entl wlll maintain a cetlificate of consent to self-Insure tor workers' compensatlon, es provitled for by section 3700 at Ihe Lebor Code, lor Ihe pedortnance of the
ork for wNch this pertnit is issued.
I heve end wlll maintbin woAcers' compensatlOn insurence, as required by sedion 3700 of I�e Labol Cotle, for the perfortnence of the work for which this permit Is issuetl.
M wo e- fs' co ensetion Ins rance c rtler end oli number are: �f
Csiriar:Y �TOI�'� �UY1� v � PolicyNumber. dBS� �OI�QT
(This sectlon need not be Compleretl i/ the permif Is valued ef one hundred dollers ($700) or less.) ,
❑ I cenity t�at in the peNo�ence of the work lor whic� this pertnit Is issued, I s�all not employ any persan in eny manner so as to 6ecome subfect to che wo�kers'
compenseilon laws o� Califomie, end egrea Ihet II I should become su��ect to the workers' compensation provisions of Sectlon 700 oi t�e Lebor Coda, I shell fonhwith
Comply with these ws� s. L� �7 � �I'1�''�,
ApPlicant Sipnature: �� ��LY�C�—� Date: �— � � v _
WARNINO: FAILURE TO SECUAE WORKEiiS' COMPENSATIpJ COVEMGE IS UMAWFUL AN� SNALL SUBIECT AN EMPLOVER TO GRIMINAL PENNLTES AND CNII FlNES UP TO ONE HUNDRED
TYiWSrVJD OOLLARE (5100,OW). IN FDOITIdJ TO THE COST OF COMPENSATION, DAMAGES AS PPWIDED FOF IN SECfION 3%O60F THE LABOR CODE, IMEREST, M1D ATTIXiNEVS FEES.
LICENSED CONTRACTOflS DECLARATION:
I hereby eflirm ihat I am licensetl untler prodsions of ChaO�er 9(commencing with Sectlon 7000) of Division 3 ot the B
force and eflect. Lic. q Class #
CoNractoYs Slgneture: � C � Date: _
and Professions Code, and my license is in full
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirtn that there is a consiruction lending agenty for the pertormance of iha work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lendef9 Name: Lendar's Address:
SlgnaNre:
OWNER-BUILDER DECLAAATONS:
Date:
I hereby aNirm t�at under.penalry of perjury Ihat 1 em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions
Cotle: Any ciry or co'unty,wh�ch requires e permit to construct alte�, improve, demolish, or repeir eny strucWre, pnor to its issuance, also requires the applicant for such permll
to file e signetl stetement Inet he or she Is Ilcensed pursuan� to ihe provisions of ihe Contractors License Law (Chapter 9(commenGng with Section 7000) of Division 3 of Ihe
Business end Professioris�Cotle).or ihat he or she Is exempt iherehom and the Dasis lor the allegeC exemption. Any violation ol Section 7031.5 by any epplicant for a permit
sublects Ihe epplicant to e Givil penelty of not more ihen five hundred dollars ($500).):
❑ I, as owner ol the pmperty, or my employees wl(h wages as their sole compensetion, WILL DO TF1E WORK, and Ihe sirucWre Is noI Inlendetl or ofleretl for sale (Sec.
7044, Business and P�ofessions Code: The Contrectors Licanse Law tloes not epply to en owner of property who builds or Improves ihereon, and who tloes such work
himselt or harseN o� iPrough his or her own employaes, provitled thal such improvemenis era not lntended or oflered for sale. If, however, Ihe building or improvement is
sold within one year of completion, Ihe owner-builder wlll �ave ihe burdan of proving that he or she tlid not build or improve for purpose of sele.). �
❑ I, es owner at the property, am ERCWSIVELV CONTRACTNG WI7H LICENSED CONTRACTORS to consiruct the pmject (Sac. 7044, Business and Proteuions
Code: The contractors License Law tloes not apply to en owner of property who builds or Improves thereon, and who contrects lor such prolect with a contrector(s)
licensa pursuam to the Contractors License laws.).
❑ I am e:empt untler se�� Business and Protessions Coda tor this reason:
Signature: Oata:
Owner ID veritied by dnvers license. ❑ Vas ❑ No Drivers Licensa No. Expires:
Vediiwtlon of Ownership by (rype ot documen6 i.e. - property tax 6ill or deed):
DIVISION OF INDUSTRIAIL SAFETV PERMIT CERTIFICA710N:
❑ I hereby certify ihat no excavetion tive (5) or more fee� in depth into which e person is require0 to descend, will 6e mede In connection with work authonzed by this
permit, and that no bU��ding st(ucture, scaHWtling, talsework, or demolition or tlismantlinq ihereoi, will be more ihan thirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle B, California Adminislraiive Cotle).
❑ As owner-builder, I will not employ anyone to do work which would require e permi� from the Division of Industriel Satery, es noted ebove, unless such person hes a
pertnit to do such work ��am ihe division.
SignaNra: Date:
Division oi Industrial Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AU7HORIZA710N OF EMRY: I certity under penalty of perjury Iha� I have read Ihis application end state ihat the infortnation given is
correct. I agree to compty With all state laws en0 city orUinances relating fo building Construction, and authorize representatives ot Ihe Ciry of Costa Mesa to enter upon the
ebove-described properry for inspection purposes. I egrea not to occupy or ellow occupanry of eny building authonzed by this pertnit uniil finel inspec�ion.
gn re OI Legal Owner(s)
�
—" An r Aut�or ppliwnt �
COOE 1, INSPECTIONTYYE
7676 Fixed System Final Fire Prevention
12fi6 Pool Spe Final
200 Finel Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire P�ace
203 Final Sign
204 Final Demolition
PAIE IIfi1TIRLS
��/ . ����
��� i1/ . ' �fSl��
�l— � �
Date
COOE� INSPECTIONiYPE �
206 Final Mechanical
20B Finel Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finel Building/Occupency
c
. . .. ' M
(714) 754-5273 • Fax (714) 754-4856 • www.ci.coSta-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, (:A 92626
BUILDING PERMIT
Job Address: 687 W 18TH ST
Suite:
Vicinity:
Parcel Number: 42426102
Zoning:
Applicant: HOLTZ, ROBERT
Address: 17853 SANTIAGO BLVD. - - . �
SUITE 107-124 " �, Phone: 714 538-7497
VILLA PARK, CA� �.� � Zip: 92861
Owner; DAISY�-III ASSOCIATES LTD
Address .4120 BIRCH ST SUITE 104 �. �
�
.� � � . - � Phone:
�
� - NEWPORT BEACH, CA , - Zip: 92660 �
Con'tracror: �ERIC HOLTZ CONSTRUCTION
'Address: 17853 SANTIAGO BLVD.
SUITE 107,124 Phone: 7t4 538-7497
' VILLA PARK, CA
Zip; g2861. � License:.. 736940
Arch :
Address: � . � �
Eng:
�- � -
` �� - - - Address:
�� .. Phone: �
Status: ISSUED
Applied: 04/10/2003
Issued: 04/10/2003
ISSUED BV:
Phone:
,
Zip: ' , � , --License: license:
SCOPE OF PERMIT
REMOVE EXISTING CEDAR SHINGLE'ROOF. INSTALL OSB, COVER WITH 30 YEAR COMP. BUILDING 3 OF A 3 BUILDING APARTMENT
COMPLEX. , . . . . . . - ' - - - � - - - � ' -- � .
Plan Check:
Perinit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$97.25
$0.50
$0.00
$0.00
$0.00
�
$97.75
f :. : .
. FEE SUMMARY
SETBACKS ��. �
MAIN STRUCTURE Front � 0- 0 . Rear 0- 0
ACCESSORY Front .0-0 Rear 0-0
PARKING Existing: 0 ` Required: 0
PLANNING & ZONING
Left 0- 0
Left 0- 0
- Proposed: � 0
Calc Valuation:
Claim Valuation
Right 0-0
Right 0- 0
$3,350.00
$3,350.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. g2-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days. ..
INSPECTIONS: In order for ihe work authorized under this permit to be�considered legal; such work must comply with all applicable codes, and all
required inspectlona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
244838 (&00)
WORKERS' COMPENSATION DECLARATION: �
I he�Xirm under penalry ot perjury one of the tollowing Cecleretions: �
❑ have end will maintain e certificate of consent ro self-Insure for workers' compensetion, as provlded for by sectlon 3700 of the Lebor Coda, for the pertortnanca of Ihe
work for which ihis permit Is issuetl.
I have antl will meintain workers' compensation insurance, as required by section 3700 of the Lebor Code, for the perfortnance ot the work for which Ihis permit is issued.
, My workers' compensatlon Insur ce cartler entl policy number are: "
i p,
Carrier: S'+'O � FU n 1 Policy Number. �os O Z OQO�/rJ "J�
(This secfion need not be complefed il fhe permit 75 velued at one hundred dollers ($100) or less.) , . '
❑ I certify that in the peAortnance oi ihe work for which this pertnit is issueq I shell not employ any person in any menner so as to become subject to the workers'
compensetion laws of Celifomia, antl agree t�et ii I shoultl 6ecome subject to lhe workers' compensation provisions of Section 3700 ot the Labor Cotla, I shall forthwith
comply with these pr�ion;.� . / � // /� �
Applicant5igneture: ��" � /Y+o��C � �
� �� Date:
WARNING FAIWRE TO SECUFE WORKERS' COMPENSATIqJ COVEMGE IS UNLAWFUL AND SW1LL SUBJECT AN EMPLOVER TO CRIMINAL PENALT S AND C IL FINES UP TOONE HUNDRED
TIqUSAN� OOLLARE (5100,000), IN ADDITIIXJ TO THE COST OF COMPENSATION, DAMhGES AS PROVIDED FOR IN SECTION 37060F THE LABOF CODE, IMEREST, AND AiTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm Ihat I am licensed under provlsions ot Chap�er 9(commencing wilh Section 7000) of Division 3 oi ihe Business
force entl ettect. Llc. k Class k��;
Contractors Signature: � � o Data: _
antl my license Is In full
CONSTRUCTION LENDING AGENCV:
❑ I �ereby aHirm ihat there is e consimction lending agency for ihe performance oi lhe work Por which Ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
SlgnaNre:
Date:
OWNER-BUILDER �ECLARATIONS:
1 hereby aHirm ihet under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business end Protessions
Code: Any city or counry which requires a pertnit to construct alter, improve, demolish, or repair any siructure, prior to its issuance, also requires the applicant for such permlt
to file a signed statement ihat he or she is licensed pursuant to the provisions of the Contrectors License lew (Chapter 9(commencing with Section 7000) ot Division 3 oi the
Busineu end Protessions Code) or Ihat ha or she is exempt therefrom antl Ihe Desis tor tha elleged exemption. Any violation of Section 7031.5 by eny epplicant for a pertni�
subjects the epplicant to a civil penalry of not more than five huntlretl dollars ($500)J:
❑ I, as owner of ihe properry, or my employaes with wages as their sole compensation, WILL DO TNE WORK, anOlhe siructura Is not intended or otteretl for sale (Sec.
7044, Business and Protessions Code: The Contractors License Law does not apply to an owner of property who builds or improves Ihereon, and who tloes such work
himself or herself or through his or her own employees, provlded ihat such improvemants are not Intended or offered tor sale. It, however, ihe bullding or improvement is
soltl within one year oi completion, ihe ownervbuiltler will heve Ihe burden of proving ihat he or she tlitl not build o� improve For purpose ot sale.). �
❑ I, as owner of the pro0erty, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo construct tha projecl (Sec. 7044, Busine5s and Professions
Code: The coniractors License Law does not apply to an owner oi property who builds or Improves thereon, antl who contracts for such project with a conirador(s)
licen5e pur5uant to Ihe Coniractors LicenSe LBwS.).
❑ I am evempt under sec.
SignaNre:
Owner ID venfied by drivefs license. ❑ Ves ❑ No
Business and Professions Code for this reason:
VenTication of Ownership by (type oi tlocument, i.e. - property tac bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CER7IFICA710N:
Driver's License No.
Date:
Expires:
❑ I here6y certify that no excavation five (5) or more feet In depih into which e person is required to descentl, will be made in cannection with work eu�honzetl by ihis
permit, and �hat no huilding sirucNre, sceHolding, falsework, or demolition or dismantling thereof, will be more Ihan ihirty-sis (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to tlo work which would require e permil from ihe �ivision of Industrial Safery, as noted above, unlass such person hes e
pertnit to tlo such work irom the division.
SignaNre: Date:
Division ot Industnal Safary Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AIfTMORIZATION OF ENTRY: I cenify under penalty of perjury that I have read this epplication antl state that the infortnation given is
correct. I egree to comply with ell state laws antl ciry ordinances relating ro building construction, end authodze represantatives ot the Ciry of Costa Mesa to enter upon the
ebove-described property tor inspection puryoses. I agree not to occupy or allow occupancy of any building authorized by this permit until finel inspection.
�� Sig t Ot le� (% � Datg�/�
�"� � U'�
�—"'� nNOrAuthonzetlApplicant ' � Date
LOUEN, INSPECTIONTYPE
1616 Fi:ed System Final Fire Prevention
1266
200
Pool SOa Finel
Finel Re-Root
201 Finel BIocWRetaining Wall .
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolition
�.
� , ,,���� I , G /
CODE� INSPECTIONtYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy .
QAIE 1t�lEL4
CITY OF COSTA MESA ..
BlIILDING DMSION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
�' E98-00525
PERMIT NUMBER
(714) 754-5273 • FaX (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 687 18TH ST
Suite No
Vicinily:
Parcel Nunmber: 42426102
Applicant
Address:
Owner:
Address
�
Contrector:
Address:
KONWISER, JOHN
Phone: 833-2704
Zip _
DAISY III ASSOCIATES LTD
4120 BIRCH ST SUITE 104 ` ' �� �
-� � �� '_�Phone:
NEWPORT BEACH CA;� -; � Zip:
>i
H0INARD ELECTRIC
12042 JANEI'TE
status: ISSUED
Applied: O6/08/1998
Issued: 06/08/1998
' _
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92660 ��:`�� , �' ( ` ' � ��.
/i
- ���� � � i. � � , �
'� Phone:�}714-530-2933 � `; � -
GARDEN GROVE, CA Zip: �-92&40 � . -
r. - - ,
-�
_,,
; � License: 675467 ' : •
� �- �, ' !
SCOPE OF PERMIT `
� �� � ' �,'
STATE HEALTH AND SAFETY CODE SECTION116049.1 PUBLIC POOL GFCI INSPECTION. INSTALL'GFCI FOR POOL LIGHT.
�
ISSUE FEE
Temp senice test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fi#s '
Recept Outlets
Swilches
Non Res Appl
Res Appl .
Service to 200a
Service to t000a
Service over t000a
Motors to thp
Motors to 10hp
Motors to SOhp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
$22.00
so.00
$0.00
$0.00
$0.00
so.00
. $0.00
i $1.00
� $0.00
" $0.00
$0.00
$0.00.
$0.00
so.00 �
$0.00
$0.00
$0.00
l $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
0
7
0
0
0
0
0
0
0'
0
0
0
0
0,
0
0
0
0
0
FEE SUMMARY; -v � �
Temp Dist,System / Lighting
Busway MOO�R � � ; • " '
-Standing Section' .
- Misc Electrical Equipment
Transformers up to 1 kva/kw
............. ..up.to.10 kva/kw ��
............:....up to�50 kva/kw
.................up to 100 kva/kw
'� .....:............overt00kva/kw
Low Voltage Equipment
Low VOII Winng Syslem / Ckt
, Misa ConduiY
' Misc. Condudor � '
Circus ( gen or nde) �
Circus (mecti ride 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,
$0.00 0
$0.00 0
so.00 0
so.00 . o
$0.00 � '0 ,
$0.00�', ', 0 -
$0.00 ' � 0
$0.00 0
$0.00 0 .
$0.00 0
so.00 ; o
$0.00 - . 0 ,
$0.00 0
$0.00 0 ,
$0.00
50.00
$0.00
80.00
� - - - � TOTAL CALCULATED FEES 523.00
COMMENTS / SPECIAL CONDITIONS
EXPIRED
DATE V �t � �
C� V
EXPIRATION: This permit shall automatically expire and become void i( work is not commenced within 180 days, or if work is suspended or abandoned
for a pedod of 780 ddys. ' -�
INSPECTIONS: In order for lhe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepactlone and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTiONS CALL: (714) 7545626
WORKERS' COMPENSATON DECLAPATION:
I hereby affirtn under penelty of perjury one of Ihe tdlowing declaratlons:
❑ I have end will melnlain e cenificete of consent to aelf-Insure for workers' compensetlon, es Drovlded for Dy aeclion 3700 oi �he Lebor Code, tor the perfortnance of Ihe
work for which ihis permit Is issuetl.
� I have entl wi11 meintein xroAcers' compenselion insurerke, es requiretl by seclion 3700 0l Ne Lebor Cade, iw Ne perlortnence of the work tor which Nis pemtit is issueE.
My workers' compensetian Insurance cartier end policy number are: ,
Certler: Polity Number
(Thls sectlon neetl not be complefed I! (he peimit is va/ued et one Aundre0 dollars (S f00) oi /esSJ
❑ I certlly ihat in ihe performance ot Ihe wark tor which this Dermit is issued, I shall not employ any pereon in eny manner so es to become sub�ect to ihe workers'
compensetion lews oi CelNornla, antl egree ihe� If I should become subjed ro t�e workers' compensation pravislons of Sectian 3700 of the Lebor Code, I shall forihwlth
comply wIN these proNsions.
Appllcant Signeture: Dete:
WARNINO: FAILURE TO SEWflE WORKERS' COMPENSATION COVERAGE IS UNUW FUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINRL PENALTIES AND GVIL FlNES UP TO ONE MUNDRED
TIqUSFND DIX1ME (E100.000). IN ADDITION TO THE ODST OF Wf.IPENSATION, OAMAGES PS PFtONDED FOR IN SECfION �080F THE UBOR COOE, IMEREST, FND ATTORNEYS FEES.
LICENSED COHTfiACTORS DECLARATION:
I hereby ettirm ihet I em licensed undar provisians of Chapter 9(commenpng with Sectlan 7000) of Division 3 of Ihe Buslness end Professions Cade, entl my license is In full
force end ettect. Lic. a Class p
Contractofs Signeture: Dete:
CONS7RUCTION LENDING AGENCV:
❑ I hereby affirtn Nat there is e consiructlon Iendinp egency lor the peAortnance af Ne work for which this permit is issued. (Sec. 3097, Clvll Code).
Lenders Neme: Lenders Address:
Signature: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby ettirm Ihat under penelry o� per�ury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowinq reason (Sec. 7031.5, Business entl Professlons
Code: Any ciry or county which requlres a permit to cansiruct, elter, improve, demolish, or repeir eny siruqure, D�or to its Issuence, elso requires Ihe applicant for such pertnit
to fila e signetl stetement Ihat he or she Is Ilcensed pursuant to ihe provislons of the Conirectora License taw (Chapter 9(commencinp with Section 7000) of DiNslon 3 of the
Business anC Professions Code) or Ihet he or she is e:empt Ihereirom and the basis for the elleged exemption. Any Noletion of Section 7031.5 by any epplicant tor a permit
sub�ects the epplicaN to e Gvll penelry of not more Nan five huntlreC dollers ($500).):
❑ I, es owner of �he properry, or my employees with wages es their sole compensation, WILL DO THE WORK, enC Ua structure is not intentled w oHeretl for sale (Sec.
7044, Business end Pratessions Cade: The Contractors License Lew does no� epply to an owner ot properry who builAs or improves therean, end who tloes such work
hlmsalf or herself or �hroug� his or �er own employees, providetl ��at such improvements ere not IntenCed or ottered tor sale. If, however, t�e builtling or improvement Is
sald wit��l roi��er of completion, Ihe owner-6uilder will heve Ihe burAen oi proving that he or she did not 6uiltl or Improve tor purpose of sele.). �
� I, es owner oTthe property, em EXCLUSIVELY CONTRACTING WRH LICENSED CONTRACTORS to construct the project (Sec. 704a, Business and Professions
Code: The contredors Ucense Law does to en awner af pmperry who builds or improves ihereon, and who contracts for such project wflh a contractor(s)
Ilcense pursuant to the Contredors Li se Lews.).
❑ I em exemp und sec. Business and Professions Code for this reflson:
Slpneture: --- Date: —
Owner ID verif by tlnver ' Drivefs License No. � E:pires:
Vedflcatian
�
i.e. - properry ten bill or deed):
VERMR CERTIFICATION:
y certity that no excevatlon Ove (5) or more feet In depth Into which e person is requiretl to tlescend, wlll be mada in wnnedlon with work eut�adzetl by IMs
end that no builtling atrucWre, scafFolOing, felsewark, or demolitlon or dlsmantling Ihereof, will be more then thirry-eix (38) feet high. (Chep. 32, Grp 2, Art 2, Sec.
7e B, Califomla Administretive Cotle).
❑ As owner-builder, 1 will not employ enyone to tlo work whlch woultl requlre a pertnit irom Ne Divislon of Industrial Sefery, es noted ebove, unless such person has a
pertnit to tlo such work from ihe divLslon.
Signeture:
Division of Intlusinal Sefery Permit Number:
Date:
'CEHf1FlCATE OF COMPLWNCE ANDJ143�FiOR TION OF ENTRY: I ceRily under penelry of perjury t�at I have read this epplicetion and stete that the infortnation given is
correct. I eg�ea to wmply wit� ell�t�e lews and ci ordinences relating to building construdion, and euthonze representetives ot Ihe Ciry of Costa Mesa to eNer upon the
above-des Ibed propeq tor I c�ion purposes. I e4 ee not lo occupy ot�allMo�� �p'nry of eny�; if��q euthodzed by t�is permit until tinel inspection.
J--� � <_�s lSi�
SI neture Of Lega ner(s) � �_�[1g�e_
�� . �vT�Y' (x
/ AnA/Or Authorized Aooliranl Dale
System Flnel Fire Preventlon
�266 Pool Spe Finel
200 Finel Re-Raot
201 Final BIacWReteining Well
202 Final Fedory Fire Plece
203 FinalSign
204 Finel Demolitlon
2u&l8
4Qp(f INSPEClIONTYPE
206 Finel Machenical
208 Flnal Plumbing
210 Flnel Elecidcal
212 Final Fire Preventlon
220 Finel Plenning ApprOvel
222 Flnal Site
250 Finel Building�Occupenc
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING//�A /.1 10 /"J IJ. . __
OWNER
MAIL
CITV �lh(
CONSTRUCTION
BRANCH
ADDRESS
CONTRACTOR
ADDRESS
CITY
STATE
LIC. NO.1'l�)
TEL.
TEL.
NO.
pTY
LIC. NO.
USE OF
EXISTING BLDG.
Separate permi[s are required for
elec[ric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PEFFOR�
PA70
't�V 7_4-75�Y��00 948� **�51U.04
APPLICATION FOR STRUCfURAL PERMIT
���VED BV DATE R CEIVED DATE I^SSUE❑
r �'' K.I',I
.� w /1 A PERMIT NO.
A.P. NO{I�O �tiU' ��
BUILDING / /��///�,/
ADDRESS /)X j(i(/
FIRE
ZONE
APPROV
�'�—�—�-�i
PWN$ �
VARDSAPPROVED
VAR. �W
C.U.P.9
�LD FOtt SPE�
i hereby acknowlatlBa that I hava reatl thia appllcation entl stete J
t�at tha ebova information ia correei antl aBrea to comply wlth
ell lews reBuletinp builtllnB �onrtructlon, antl I thall not amploy
eny person in vlolallo� of the workmen'f compenfation lews of
tha State of Caiifornle. S��
I hereby certify Mat 1 am proparly Ilcensetl es e<ontractor undor SQ. FT.
the Stete of Californie Bus(neu antl Profeulons Cotla, DIvlalon 3, THE AMOUNT SHOI
Chaptar 9, entl that such Iieensas era in full forco entl etioet, or 1 THE PURPOSE OF E5
am axempt from tha pravizions o4 the Stete of Celiiornla Busines� VALUATION
antl Professlons Cotla, D��� on 3, Choptar 9.
SlBnnture q* ) ' G' � n �
Permittea b� $ I`'1�' 7�
I ) �
Authorizetl ABent J�' �
DATE
USE OF NF
BUILDING /
__y
VAROS
BEf. MAIN &
BLOCK
EAlflL6Sk
�
ROVED �
BUILOING
r.
r. �
n
m
i
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� m
N
!N UNDER VALUATION IS FOR m
ABLISHING A PERMIT FEE ON�V:
e
PERMIT FEE § d
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PLAN CHECK E .�.!i� �^
0
TAX S L.�2�j� �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �
For Applicant to Fill in Completely — Use Ink Only
ADDRES ��'/ L(/� (d Jl ; //7/-/�/f�
OWNEF �/� V�pN�A11SR� ` '�
MAIL �.`aD� �
ADDRESS �
��� ��`` TEL.
CITV U Y- NO.�
CON5TPUCTION
LENDER
BRANGN
ADOFESS �'
ARCHITECT � 'TEL.
ADDRESS
CONTRACTOR
ADDRESS
CITV
STATE �
LIC. NO. �
SIZE
OF LOY i
USE OF
PAi❑
,�nv ��:-�s��t�OQ 949# �**b3'�.67
APPLICATION FOR STRUCTURAL PERMIT
BUILDING
ADDRES:
FIRE
ZONE
APPROVED
TEL. ONE �7 NO.OF �
NO. ^LiP P��
CITV �'AROS APPROV ED
lIG NO. MAIN BUILDING
INO. OF BLDGS. ( F R O M U L SLT R F=T)
NOW ON L4T � FROM _ 7 FT. -
idLOG. ^
Separate permits are required for
electric, plumbing and heating work.
BUILDING AND WOFK TO BE PERFORMED
I hereby acknowletlge that I have reatl this appliceiion antl stata
ihat the above information is correct and agree to comply wlih
all laws reguleting builtlin8 �onst�uction, antl I shall not employ
any person in violation of the workman's compensation laws of
the State of Celifornla.
I hereby certity that I am properly licensatl as a contractor untler
cha State of Californie Business antl Professions Cotle, Division 3,
Chapter 9, end thet such Iicenses ere in tull force antl etfect, or I
am exemPc from the provlsions of tha State of California Business
antl Professions Catle, D islan 3, Chapter 9. �
Slgna<u a ot ��� y,�^ [' �_
Permltte �� Y ��� '
AuffioriZetl Agent � Q"�—
0
DATE
VAROS APPROVED
.CCESSORV BUILDI
a
VAR.� DA7E
C.U.P. � APPROVED
APPROVED
OLD FC: - - _ � .-----
THE AMOUNTSHOWN UNDER VALV
THE PURPOSE OF ESTAeLISHING A PERP
VALUATION PERMIT FEE $
� PLAN CNECK $
J �n 7
$ / � /,'✓O � TAX $
!
TOTALPAID $
�
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�O �
t"�JIE �'
-- � ,
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:
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�� N
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T F E ONLV: �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING �
ADDRESS �. — /O/- U -' �'
OWNEF �, � A�.y�5t.2.
nnnac�s `—[ 1� O B�R.•�. ��r^l�n ID4�
CITV ��y
CAN5TFUCTION
BRANCH
A
TEL.
CONTRACTOR
ADDRESS
TEL
CITV NO.
Ov z4-�sPA1000 950 616.13
CNSn # ***
APPLICATION FOR STRUCTURAL PERMIT
A.P. NO.
BUILDING
ADDqES:
OWNER /(�[/ �(i(J�/({�C/(/ t%�
LUE a
SE � $ , �.L1 �
FIRE �/
ZONE V E I GROUP
BVPROVEO C DATE / / �D
/ / /J �
�ONE NO.OF USE OF�
PLANS BUILDIN �
F STATE CITV �'ARDSAPPROVED VARDSAPPROVED
� LIC. NO. � LIC. NO. MAIN BUIIDING ACCESSORV BUILDING
{i7 SI2E NO.OF eLDGS, (FROM GL ET)
C. OF LOT NOW ON LOT FRONT T. FT
a USE OF /� ^r'
� EXISTING BLDG. � ' SI 6fT. lJ�
y
FSeparate permits are required for L SIDE T. FT
Q electric, plumbing and heating work. REAR T. FT
W USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BEf, MAIN &
QMAIN BLDGS. ACCE$$. BLDGS.
��` �� VAR. DATE
"a � N•� p-�� �i C.U.P. S APPROVED
Q
� APPROVED P �
%^ /
.d
� iil [nn ..
w - n
0 I hareby acknowletlBa thet I have reatl this application anE state _ -„ �wL�'��' Y`L�J`��I
p! that tha above Informatlon is correct antl egree to comply with '� —
�+ all laws reBulaiing building conrtruction, antl 1 shall not amploy
� eny peroon in v(olatlon of Ma workman's compensation laws of �
x tha Smte of Celifornio. �}(- '}/ f f Q
3 1 �areby certify that I am p�operly licensetl es a conSractor untler • ' SQ. FT. �-j�� rJ�L
the Stem of Californie Business end Profess(ons Cotle, �iviston 3, THE AMOUNT SHOWN UNDER VALVAT
Chapter 9, entl ihat such Iicansas are in full force antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT
am exempt from the p�ovl5lon5 of the State of Califo�nia BuSinesS VALUATION PERMIT FEE E
and Profess otle, DI Izlon 3, Chaptar 9.
y�^' B PLAN CHECK E '�
SlBnatura �^ 1 '\ - � i �/• .
Pelmlttae � �� ��"r $ �� 6 JO TAX S
Authorized ApenS � �" � / TOTA� PAID $
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant [o Fill in Completely — Use [nk Only
BUILDING �.
ADDRE55
OWNER l � 1\ :]Ai1.1f'�o2 ( Y../�Li
BRANCH
ADDRESS
ARCHITEI
TE
TEL.
AODRESS
CONTRACTOP
ADDRESS
TEL.
CITV NO.
STATE CITY
IIC. NO.� a', — LIQ NO.
SIZE NO.OF BlDGS.
OF LOT NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PEFFORMED
�i'7 r�cr._ , �[.ln D 0..L.
I hereby ecknawledBe thei I have reatl thia appllcation entl stete
that ihe ebove information Is correct antl apree io comply wlth
all lews ragulat(ng builtlin8 conscruction, end I shall not employ
any person In vlolation of the workman's compensaiion laws of
Me Scace of Celifornia.
I hereby certify that I am properly Iicansetl as a eonirector untlar
tha State of California Business antl Profeuions Cotle, Dlvlsion 3,
Cheptar 9, entl that such Iicenses ara in full force enC effoct, or I
am exempt from the provislons of the Stete of Celifornia 9usinezs
and Professions Cotle, Divi on 3, Chaptar 9.
Slpnetvre t , � ` �
Permittee �l • � �
�_
Authorized ABant "—�
PLID n 1' p /;
��V?4-75�N.;��V 95�n ir'R3ik40.5V
APPLICATION FOR STRUCI'URAL PERMIT
E IV 9e DATEFCEwIV.�ED DATEISSUEO
��A/� /' �� �� . /h 1 � _ `1 I _r
A.P. NO / � V�
BUILDING r^/
ADDRESS J� I
OWNER Z[,([,/ �/��J
1 VALUE � JJ') • I `
SE , ���, � $ ��.1� ��� �
f
FIRE y �
ZONE VP i GROUP � ,�
APPROVED ���,�
BV DATE
r • - ^
LL
NE NO.OF USE OF �
PLANS BUILDIN
YARDSP.PPROVED YARDSAPPROVEO
MAIN BUIIDING ACCESSORV BUILDING
DI5iANCE BET. I BEf. MAIN &
MAIN BLDCaS. ACCESS. BLP
VAR. -rW.,�� r� �� DATE
131�tEM�
—�� -
n
m
. j
0
SQ. FT. tmv
THE AMOUNT SHOWN UNDER VAIUATION IS FOR m
THE PVRPOSE OF ESTABLISHING A PERMIT FEE ONLV:
b
VALUATION PERMIT FEE S d
� � m
��� � PLAN CHECK y � o
5 � TAX E LL
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TOTALPAID $
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completety — Use [nk Only
BUILDING d�
ADDRESS
'�—� \ w,Sv�
OWNER
ADDflESS � v �1:�G� ��/ � `� �4
CITY „�.ea�4JnA\ \llct� NO����
BRANCH
ADDRESS
L.
ADDRESS
CONTRACTOf±
ADDRESS
TEL.
CITV NO.
LIC. NOp��Gt�Z-j �p LIC NO.
i
SIZE INO.OF BLDGS.
Of LOT NOW ON LOT
USE OF
EXI5TING BLa'i.
$eparate permits are required for
electric, plumbing and heati�g work.
USE OF BUILDING AND WORK TO BE PERFORMED
1 heraby acknowletlge that I hava raetl this application antl state
that the abo�e intormation (s correei antl agree to comply with
ell lews reBu�eting bullding construction, and I shall not employ
eny person in vlolation of Me workman's compansation lews of
ihe State of Celifornle.
I hereby cart��V that I am prope�ly Iicensetl as a contractor untler
tha State of Californie Businass entl Professions Cotle, Division 3,
Chepter 9, aAtl that such lice�ses are in full force antl effect, or 1
em exemot from the provisions ot the State ot Calitornle Busineu
antl Prafesslo�s Cotla, I sion 3, Chapter 9.
Signamre f �
Petmlttee
Authorized PBent �.�
"�V ?_i7-75cnsn�0 952# �*��4fl.50
APPLICATION FOR STRUCTURAL PERMIT
A.P. NO
BUILDI G
ADDRESS
NE NO.OF
PLAN$ �
VARDSAPPROVED
MAIN BUILDING
iOM C/l. STREET)
OISTANCE BET
MAIN BLDGS.
VAR.gy`+� �
— VALUE �
$
i
GROUP
DATE —/� —
USE OF V
BUILDIN
VARDSAPPROVED
�ACCESSOFV BUILDI
�JC/FTL vC
��FT %�JP
L�T
-�e —t—�`-'J—
BET. MAIN &
ACCESS. BLDGS.
ATE
APPROVED
'�__ �II—�f,_
THE AMOUNT SNOWN UNDER VALU
THE PVRPOSE OF E5TABLISHING A PEF!
VALUATION pEFM1T FEE E
Mii PLAN CHECK E
� � J TAX E
TOTALPAID E
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican[ to Fill in Comple[ely — Use Ink Only
BUII.DING �
ADDRESS r.Prl C(,� �R � �
OWNEfi \�fK/f�?.
MAIL ��
ADDRESS �� – �
aTv �� o�.nn�n '�P,u�.4� NOLQ.2,"�'S
BRANCH
ADDRESS
� _ �_ _;"� TEL.
..�iV a4-75P'—��00 953^ **��4P,.50
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APPLICAT[ON FOR STRUCTURAL PERMIT
lh�/I�O.F lD.I�Ei�E� I I E�7s1-�
A.P. NO.
BUILDING
ADDRESS
NUJ R]
OWNER
�� ' ' FIRE �
ADDRESS 20NE
APPROVED
CONTRACTOR e�
V �
ADDflESS
TEL. E �n NO.OF
CITV NO. ���� P��
.F-� STATE CITV �ARDSAPPROVE
LIC. N LIC. NO. MAIN BUILDINC
{y SIZE NO.OFBLDGS. (FROMC/LSTREET)
C. OF LOT NOW ON LOT qONT FT.
a USE OF
� EXISTING BLDG. 7
y
� Separate permits are required for �. SIDE Fr.
Q electric, plumbing and heating work. qEAR Fr.
�.�. USE OF BUIL�ING AND WORK TO BE PERFOFiMED DISTANCE BET.
Q� MAIN BLDGS.
j VAR. �
a C.U.P.
� APPROVED '
�.
�
� L c��:r
a - — -
0 I heroby ecknowlatlBa that I have natl this eppllcaHon and stnte
�E,' ihat ihe ebove Informatlon is correct an0 aprea to comply wiM
a all laws raBulatlnp builtlinp consirucNon, an0 I ihail not amploy
� eny parwn In vlolatlon of the workman's compansallon laws of
the Steto of Celifornle.
3 I heroby eerUty that I am properly Ilcensetl aa e<ontractor untlar SQ. FT.
the Stata of Californla Buslnass and Profossionz Cotla, Olviaion 3, TNE AMOUNT SH
Cheptar 9, antl t�at such Iicenses aro in full force entl effact, or 1 TNE PURP06E OF I
am exampi trom the provis ons of t�a Stete of Caiitornie Busineu VALUATION
entl Protas e, D Isl n 3, Chapter 9.
L �� a.�
Sle�etura f �(�(\ •�
Pa�mlttee – ' � \ _ $
Authorizetl ABant ��
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VALUE
USE OF E \
BUILDIN
VARDSAPPROVED (�+
ACCESSORV BUILDING V
J_
FT
�T /e– � �
T. `�—
!
BET. MAIN &
ACCESS. BLDGS.
DATE
PPPROVED
- I
-�_I..a.�q�.;.
PERMIT FEE E
PLAN CHECK E
rqx E
TOTALPAID S
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� COSTA MESA BUILDING-SAFETY DEPARTMENT
. P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BVILDING " 1 � C
ADDRESS LV ��
OWNER •Y�Q,. NW� �'
MAIL 1�.� C �
AD D R ESS ��2�� �
CITY 1�I •..lY•iA\. H[!]i� NO��_i
BRANCH
ADDRESS
ARCHITEI
TEL.
CONTRACTOR
ADDRESS
TEL.
qTV NO.
STATE +1�/(.--72 J CITV
�I0. NOp� -T � 7 �o LIC. NO.
SIZE � (NO.OFB�DCS.
OF LOT NOW ON �OT
USE OF
EXISTING BLDG.
Separate permi[s are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby ecknowled0e ihat I have reatl this application entl stata
thet the above informetlon is corract antl agree to comply with
all laws reeulatine bulldlne �onsttuction, and I shall not employ
any person in vlolaiion of the workman's compensation laws oi
Me State ot Californta.
1 hereby certify that I am properly Ikensetl es a contractor vnder
ffia State of California Busineas entl Professions Coae, Dlvialon 3,
Chapter 9, entl thai such Iicenses are in full force and etfect, or I
am azampt from the prov lons of the Stete of California Businass
and Protass ode, vi on 3, Chapter 9.
Signature ` . ` L
Permittee VL/ �
�O.
Aut�orizatl ABent V
*;OV 24-75Peto00 954� �tr��48.50
CNSA
APPLICATION FOR STRUCTURAL PERMIT
fi EIV D V %^ =�REF'IVED DATE ISSVED
� �r ► I-24�'1
'PE s
A.P. NO I � ' i L'
BUIIDING U
ADDRESS g �� �- �
� R�ACP' ' 1 � BLOCK .
W A D Al P
/ y
OWNER
VALU$ � -�
FIRE
ZONE TVP GROUP
APPROVED % � �
gV �ATE � /
7JaNE � O.OF � USE OF NE �. _ __ �
VARDS APPflOVED
MAIN BUILDING
BET
C.0
THE AMOUNTSI
THE PURPOSE OF
VA�UATION ���
S �A Oj
('/" �/ '
APPR
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BET. MAIN &
__ —1���\AIY�C�Y' \ N
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'ABLISHING A PERMIT FEE ON V: �
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COSTA MESA BUILDING-SAFETY DEPARTMENT �ns`
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Comple[ely — Use Ink Only
_ R�CEIVEp BV_ DATE RECEIVED �eTF iccnon
OWNE
MAIL
BRANCH
ADDRESS
e
?�/��� �� ��
TEL^
NO.T�L`1��
. _ L� �. TEL.
ADDFESS
CONTRACTOR
ADDRESS
TEL.
CITV NO.
STATE CITV
LIC. NO. L�. lp LIC. NO.
512E NO.OF BLDGS.
OF LOT NOW ON LOT
USE OF
EXISfING BLDG.
Separate permits are required for
electric, plumbing and heating work.
A.P. NO.
BUILDING
ADDRESS
FIRE
ZONE
APPROV
NE NO.O
PLAfu
VARDS APPROV
MAIN BUIIDIN
(FROM C/LSTREEI
VAR. �W
T NO.
� p
VALUE GY
$ _ / 1"
� GROUP _ I �\
/ N
DATE ' i�' \
l'
JSE OF N �
3UILDING
VARDSAPPROVED
ACCESSORV BUILDING
F l I
�
�T.
�
BET. MAIN &
ACCESS.BLOGS.
DATE
APPROVED
I haraby acknowledpe ihat I hava reatl ffiis application and rtata� � • v�� .rrL�„�r:l. ��L����
thet iha above Information is correct antl egree to comply with
all laws reBuletln8 �uildinB �onstruction, antl 1 zhall noi employ
any person �in vlolatlon of Me workman's compensation laws of
tha State of Californle. � '
I he�ab certif thet I am � SQ. FT.
Y y properly Ilcansetl es a contractor untler
the State of Celifornia Buslnezs and Profess(ons Cotle, Division 3, THE AMOUNT SHOWN UNDER VALU
Chapter 9, enA Mat such Iicanses ara In full force antl affeei, or 1 TNE PURPO6E OF ESTABLISHING A PERI
em axampt from Mo provi lons of theState of California Business VALUATION PERMIT FEE E
and Professlons Code, Divis n 3, Chapter 9. 'n
Slgnetu� l` 1.���-' \- � PLAN CHECK §
� V V --+— � /�,
Permlttee ��� $ ���(/ TAX E
Aut�orized Agent � TOTAL PAID S
:l �f �('y. �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING. �(� // /� � � Q Ci
OWNER
MAIL
CITV �' �`J
CANSTRUCTIDN
BRANCH
ADDRESS
ADDRESS
CITV C
STATE
LIC. NO.
SIZE
OF LOT
USE OF
TEL.
TEL. �
NO.
cirv �
LIC. NO.
NO. OF BLDGS.
NOW ON LOT
Separate perrttits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORh
r �
I �ereby ecknowlatlpe that 1 hn�e �eatl this application entl state
that tha abore Informetlon is correct entl epree to comply with
all lews reBuleting bulltling eon4truction, antl I s�all not employ
any permn In violetlon of the workman'e compensation lews of
t�e Stata of Californla.
I �ereby canify t�et I am propa�ly Ileenmtl as a contrector untler
the State of Callfornie Businesa antl Profeaslona Cotle, Dlvislon 3,
Chepter 9, end thet such Iicenus ere In tull foree and etfect, or I
am exempi }rortytha provisions O� the Stata ot Californla Bua(ness
antl Proteuion �C tle, Dlvitlon 3, Chepmr 9.
SIB�etura of � �
Permlttee �J�-�•�_
. ,�
Authorized Aoant
R
`ii:� % 7_PFIUOO �%�Z'� i`ieOh40.�V
t'- SL`ISC
FOR STRUCTURAL PERMIT
DATE RECEIVED rF sucr
BUILDING
ADDRES:
E
VARDS APPROVED
MAIN BUILDING
FROM C/L STREET) �
DISTANCE BET.
MAIN BLDGS.
VAR. #�
USE OF NE
BUILDING
VARDS APP
DATE
APPROVED
THE AMOUNTSHOWN UNDER VALU
THE PURPOSE OF ESTABLISHING A PERI
VALUATION PERMIT FEE E
� PLAN CHECK E
a/1�� TAX S
T TALPHID 5
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to FJI in Completely — Use Ink Only
OWNER
MAIL
CITV
BRANCH
ADDRESS
ARCHITECT
ADDRESS
.S�
TELQ
NO.C�'Z
nin���� �
ADDRESS �.I�j, S• � 1 0. 1 CR> cU
CITV V-�I��1114�1 NOL-}��i=
STATE CITY
LIC. NO. � � LIC. NO.
SIZE NO.OF BLDGS.
OF lOT NOW ON LOT
USE OF
EXISTING BLDG.
Separate per7nits are required for
electric, plumbing and heating work.
UFE OF BUI DING AND WORK TO BE PERFORMED
I heraby acknowledBe tMet I have reatl this nppiication antl rteta
that Ne ebove Intormetlon Is eorrect and aBrae to comply with
ell laws regule[inp Cu11di�8 eon�tructlon, entl I shall not employ
eny person in vlolailon of the workmen'c compensallon laws of
She Stata of Celifornia.
I hareby cenify that I am properly Ilcensetl as a eontractor untlar
the SUte ot Californta Business entl Professions Code, Divisfon 3,
Chaptar 9, and thet such �icenses are In full forca enC eftxt, or I
am exampt from Me prO��slons o} the Siate ot Caiitotnia Business
antl Prolessions Cotle, Div�s�on�3, Chapter 9.
1 �, titC�'.P�O_�,�
SlBnat�re ot
Permit[ea
Authorizatl ABent
PA!0
�f.R -9-76�M�; 00 7_86� �** *36.50
APPLICATION FOR STRUCTURAL PERMIT
ECFij(ED BV DPTE,�7EC�,VFD oATF ISSUF❑
A.P. NO �
BUILDING
OWNER
VOLUE
FIRE
ZONE
�3— 1 PLANS � BUILDING�� � �
VARDSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDI
ROMGLSTftEET) H � / ��
VAR.9W DATE
C.U.P.�W �7 /7� APPROVED
APPROVE��1� � � �/'CT� n
THE AMOUNT SHOWN UNDER VALU
THE PURPOSE OF ESTABLISHING A PERt
VALUATION PERMIT FEE S
/Jn /j � PLAN CHECK S
g �/ J �(� TAx E
l/�.(/l (/1
TOTALPAID S
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