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Home My WebLink About732 18TH ST - Building Permitsp�a) �sa-5273 • Fax (7ta) �5a-ae56 • www.ci.costa•mesa.ca.us 77 FAIH UHNh, GU51 A MtSA, GA yZC'LE ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: Address: Owner: Address ConVactor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Morors to 1hp Motors to tOhp Motors to SOhp Motors to t00hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg 732 W 18TH ST 42417412 KHADEM,ABE 16818 OHMS WAY COSTA MESA, CA Phone: (949) 631-8777 Zip: ,92627 ROSENGAftTEN, MICHAEL J 723TENTH�STREET " � � � � � � . . - Phone: SANTA MONICA, CA NOOR ELECTRICAL SERVICE 16818 OHMS WAY COSTA MESA, CA Zip: 90402-2821 Phone: (949) 631-8777 , �Zip: .92627 ' License: 452774 ISSUED BY: Status: ISSUED Applied: 10I28/2002 Issued: 10/28/2002 SCOPE OF PERMIT CHP,NGE OUT ELECTRICAL SERVICE AT 6 UNIT APARTMENT BUILIDNG. CHANGE OUT 6 SU9PANELS ALSO. Quantiry $23.50 $0.00 $0.00 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 , 0 $0:00 � 0 $0:00 , . 0 $183.00 � .6 - $0.00'�'-�,', .0 $0.00 "�.� 0 $0.00�.. �'0_ ` � $0.00 � �. 0 $0.00 0 $0.00 0 $0.00 0 $0.00 - 0 $183.00 . - - 6� $0.00 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft 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 ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System! Ckt Misc. Conduit Misa Conduclor Circus ( gen or ride) Circus (mech ride or lights) � Christmas Tree Sfand� Fireworks Stand Other Electrical Fee InvesfigaBon Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0:00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related iegulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspendetl or abandoned tor a period of 180 days. INSPECTIONS: In order for �he work authorized under this permit to be considered legal, such work must comply with all applicabie codes, and all required Inspections and (inal epproval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 [aao-ao �ow� WORKERS'COMPENSATIONDECLARATON: � 1 hereby eNirm under penelry ot perjury one o� the following Ceclaretlons: I have entl wlll maintein a certi(icate of ��sent to self-Insure for workers' compensetion, es provitletl tor by sectian 3700 ot the Labor Code, tor the peAormence of the wOrk lor which t�i5 permit is issued. I h end wiil maintain workers' compe�se�ion insurence, es re ' e0 Dy section 3700 ot Ne Lahor CoEe, tor the peAortnance ot ihe work for which this pennit Is iSSueO. y workers' campensation Insuranca Cflrner and policy nu r er � Certier: Policy Number: (This section need nof be completed i/ the pB��f is val etyn' un d dollars ($100J oi less.J / ❑ I certlty Ihet In Iha peAormance of the Wo wh' is it is issued, I shall not employ eny person in any menner so es t become suD�ect to the workers' compensatlon laws ol CaIHa �, and e that come subJect to Ihe workere' compensation provisions ol Sectlon 7Q0 ot Ihe� �r Code, I shall torthwith comply with these provisi / � 7 Applicant Signeture: Date: L WARNINO: FAILURE TO S E S ENSATIIXJ COVEMGE IS UNLAWFUL AND SHFLL SUBJECT AN EMPLOVER TO CRIMINAL PE TIES PNU CIVIL FlNES UP TOONE NUNDRED TMOUSANDDOLLARE( , AODITIONTOTHECOSTOFCqMPENSATION,DAMAGESASPROVIDEDFORINSECilON3]OBOFTHELABORCODE,INTEPEST,ANDATTOfiNEY'SFEES. LICENSED C0�5'fRACTORS DECLARATION: I hereby eMlrtn tha� I am licensed under provisions of Ch ,� (co ncing with Section 7000) of Division 3 of Ihe Business end Professions Code, antl my license is in full force end eMect Lic. » � Class a ContractoYs SlgnaNre: � Dete: i i CONSTRUCTION LENDIN A / CY: ❑ I hereby efllrtn th2i e is a wnstruction lending agency tor the peAortnance ot the work far whic� ihis permit is issuetl. (Sec. 3097, Civil Code). LenCer's Nama: Lendefs Adtlress: Signature: Date: _ OWNER-BUILDER DECLARATIONS: I hereby eHirm t�et under penalry of perjury �nat I am EXEMPT FROM TME CONTRACTOiiS LICENSE LAW for the following reason (Sec. 7031.5, Business anC Protesslons Cotle: Any ciry or counry which requires a pe�mit to constmct, elter, improve, demolish, or repair any siructure, prior to its issuance, elso requires the applicant for euch pertnit lo flla e signed stetement ihet he ar she is licensed pursuent to the provisions oi the Contractors License Lew (Chepter B(commendng with Sectlon 7000) oi Didslon 3 ot t�e Business end Professions Code) or Ihat he 0� she is e:empt therefrom entl the Dasis lor the elleged exemption. Any vidation of Section 7031.5 by any applicant for a pertnit subjects the epplicant to a civil penalty of not more Ihan five hundred dollars ($500).): ❑ I, as owner of Ihe properry, or my empl0yees wlih wages es ihelr sole compensallon, WILL DO THE WORK, end the siructure Is not Intendetl or oflered tor sele (Sec. 7044, Business and Professions Code: The Contractors License Lew tloes not epply to an owner ol propeM1y who builds or Improves theraon, end who does such work himsell or herself or through his or her Ow� employees, providatl that such improvemenis are not intendetl or ottered lor sele. If, however, the builtling or improvement Is sold withln ana yea� of comple�ion, Ihe Dwnerbuilder will have the burtlen of proving that he or she did no� build or improve tor Durpose ot sale.). ❑ I, es owner of the properry, am EXCLUS��ELV CONTRAC7ING WITH LICENSED GONTRACTORS lo cronstrua the pro�ect (Sec. 7044, Business end Professions Code: The coniractors lJcense Law tloes no� epply to en owner ol properry who builds or improves t�ereon, en0 who comrecis tor such projact with e cantraaor(s) license pursuant to the Contractors Lice�se Laws.). ❑ I em eaempt untler sec. Busineu antl Professions Code tor this reeson: Slgnature: Date: Owner ID verified by Criver's license. ❑ Yes ❑ No Drivers License No. Ezpires: Vedficatlon ot Ownership by (rype ol tlocumen�. �.e. - propeRy tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMtT CERTFICATION: ❑ I hereDy certlly t�at no excevation five (5) or more feat in tlepth Into which e person is requiietl to Oescend, wlll be mede In connedlon with work eu�hodze0 by this permit, end ihat no builtling sWdure, swttolding, felsework, or demolitlon or Cismantling ihereoi, will 6e more then ihirry-six (38) teef high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Tltle 8, Celitomia Adminisiretive COde). ❑ As owner�bullder, I wlil not employ enyone to tlo work which would requlre e parmit trom the Divislon ot Industriel Sefery, es noted ebove, unless such person hee e permlt to do such work trom the divislon. Signature: Date: Division ol Indusirial Safery Pertnit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATON: 1 Will the epplicent or preseN or future �uiltling occupant neetl b tila antl certity a Business Plan for emergency response Io release or ihreatened releese ot e hazardous meter1817 ❑ Ves ❑ No (Sedlon 25505 oi Ne Califomia Healih and Safery Code reQuires, with some exceptions, that a Busineu Plan be filetl with the Coste Masa Fire Department by every business which has at eny one time during a reponed year e quantiry o� hazardous materials edual to or greatar then e weight ot 500 pountls, or a volume o155 gallons, ,.........or 200 cubic teet ot compressed gas at standard, temperaiure.end, pressura)" ......................__............................_._..............._...._....._...._..........._............_._................__......................._._.............. ... . ....................................... . ..................................... 2 Does or will the aDO�icant or present or fuWre buildinq occupent neetl to lile a re915tretion fortn for ecutely hazerdous metenals9 ❑ Yes � No (Sectlon 25533 ot the Califomia Health entl Sefety Cade, with same azceptlons, requires registretion with ihe Casta Mesa Fire Department by each business whlch et eny one time hes an hend e quemiry of acutety hezardous meterlals equal to or greater than a welght of 500 pountls, or a volume ot 55 gallons, or 200 cubic feet oi compressed ges et standard temperature and pressure). ........................................................................................................................._.................................._._........................_.._....................._.._................................................._................................._...................�.__............_._.......... 3 Does or will Ihe epPliwnt or Oreseni or tu�ure bullding occupant naed to prepare en RMPP (Risk Management end Prevention Program for acutely hazefUous matenals)7 (Section 25534 ot the Calitomia Health e�d Satety Cotle provides that the Costa Mesa Fire Department may require the preparation, certitication antl filing wlt� the Flre oepariment of en RMPP by businesses which are requlretl to register aately hazardous matenals with the Fire Depenmam. ..................................................................................................................................................................................................................................................................................... ....................... .................................................................. 4 If en RMPP is presently requiretl, has Section 25534 of the Californie Heallh and Safety Cotla been �ully complie0 with? ❑ Ves ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will ihe epplicent or presem ar fu�ure building accupent require for the work which is the subject of Ihis e�ppllcetion e pertnit for such construc�lon or modlficatlon hom the Soulh Coest Air Quality Manegemem DlsMct or Irom eny other eir pollution contwl Elsiric� or agency! �J Ves ❑ No (Sectlon 65850.2 oi the Calitomia Govarr�ment CoOa repuires thet Ihe requested information �e furnished on epplice�lons for nomresideniial building pe�mits). ......._...... ..............................................._................................,.................................................................................................................................................................................... ....................... ................................................................ e Will any pan ol the faciliry to be consirucled under this permlt be within 1000 feel trom Ihe outer boundanes of a school7 � Yes ❑ No (H'yes', the feciliry must meet t�e requirement ot Sections 25534 end 42303 ot ihe Celifomia Healih and Selery Code). ....................................................................................................................................................................................................................................................................................................................................................._...................._........... 7 If e permit irom the Soulh Coest Air Oqelity Manegement Distdct or other air polWtion control Elstrict or egency is requlretl for the work which is the subject of ihis eoollcatlon. have all of the tlisclosures orescnbetl by Galilomia Health and SaleN �e Section 42303 been maAei ❑ Yes ❑ No 8 Qf yes', ettech cenificete of com0liance Irom me eDPropna�e art ponunon controi omceq. CERTIFICATE OF COMPLIANCE: I cen�iy that under penalry o1 perjury Ihe iMortnation given above is correct. I agree to compty with all state lews and dry ordinences regarGing Hazertlous Materials and Emissions. SlgnoWre: � Date: CERTIFlCATE OF COMPLIANCE AND AUTH correct. I egree to comply with all stete laws above-descnDetl proPerty for inspection purpi 4•f l•l�ll 1616 Fix ystem Final Fire Prevention 12 Pool Spa Final 200 Finel Re-Roof 201 Finfll BIaWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolitian �t%: I cenily under penalty of perjury that I have read this epplication end state ihat ihe infortnatlon given is s releting to building consiruction, and authorize representetivas ot Ihe City of Costa Mesa to enter upon the occupy or ellow occu0enq of eny 6uilding authorized by Ihis permit until finel inspection. PAIE 1t�6S COOE� 206 20B 270 272 220 222 250 lv �n a�� Date INSiECTIONttPE Finel Mechanical Final PlumDing Flnel EletiriCel Finel Pire Prevention Final Planning Approval Flnal Site Final Building/Occupency �.f71T��li�iLl�l � ��a) �sa-s2�3 • Fax (714) 754•4856 • www.ci.costa-mesa.�L�iJMBING PERMIT JobAddress: 732 W 18TH ST Suite No Viciniry: UNIT B Parcel Nunmber: 42417412 qpplicant: ROSENGARTEN, MICHAEL J _ Address: 723 TENTH STREET „ � � . .- Phone:� 826-792�4460� � SANTAMONICA,.CA"�: . ". .. ' Zip'.� 904Q2-2821 �.:< . Owner: ROSENGARTEN, MICHAEL J _ Address 723 TENTH STREET - . � � � � . Phone: .,� �� SANTA MONICA, CA„� V�� - Zip: 90402-2821 <4 Contrador: OW N E f2-BU I LDER Address::. : >, , Phone: Z�P. ' License: 000000 ;- WATER HEATE AMT C ISSUE FEE ' $23.50 Backflow irrigation $0.00 I �BackFlow Preventer. . $0.00 I Bathtub � . $0.00 1 ClariferSystem � $0.00- 1 Connect (Ice,Soda,etcj E0.00 1 Dental Units $0.00 ( Dishwasher � , $0.00 ( Drein,'Floor � $0.00 1 Drain, Rainwater $0.00' 1 Drein, Roof 50.00 ( Drinking Fountain � $0.00 ( Expansion Tank $0.00 f Gas Earthquake Valve $0.00- l Gas (1-4 outlets) 80.00� ( Gas (Over 4 outlets) $0.00 .. ( Gas Repipe $0.00 � ( Gas Service $0.00 ( Interceptors (Grease, Oip $0.00 � ( Interceptors (Sand Auto ) 30.00 ( n rn�n unrvt, cva � n mes,v, �N azozo Status: ISSUED Applied: 09/22l2005 Issued: 09122/2005 ISSUED BY: � � CHANGE OUT FOR UNIT B. ,-, , - FEE SUMMARY �TY - � AMT � . '- AMT � "LaundryTub/Washer $0.00 0 SumpPump � -' S0.00 0 � - Landscape Irrigation �$0.00 0 Swimming Pool 50.00 0 P-Trap $0.00 0 Trap.Primer �, . $0.00 , 0 Pressure Regulator $0.00 0 Urinal p � $0.00 0 .- Process�Piping (per 10 ft) .$0.00 0 Vawum Brkr Bkflow(1-0) $0.00 0 Receptors 50.00 0 - Vacuum Brkr Bkflow(5+) 50.00 0 � Septic Tank _ $0.00 0 Wash Basin " $0.00 0 Sewer Cap for Demo $0.00 � 0 Wash Basin Set -� $0.00 � 0 Sewer Connecl $0.00 0 Waste and Vent System $0.00. 0 Sewer Private Line '$0.00 0 Water Closet (Toileq - $0.00 � 0 Shower $0.00 0 WaterHeater/vent 512.30 1 Sink, bar - $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial �$0.00 0 Water Re-pipe $0.00 0 Sink,Floor � $0.00 . 0 WaterService $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Sink, service/mop $0.00 0 - . ,OTHER- $0.00 - Spa (private) - $0.00 0 � VIOLATION �� g0.00 Spa (public) $0.00 0 PLAN CHECK $0.0� . ' -__ - . -- ' �� REINSPECTION � $0.00 0 ' -- � � - TOTAL CALCULATED FEES: 535.80 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall comply wi[h all applicable handicap access requiremenis under Calitomia statutes and relatetl regulations. (Ord. No. 92-28, § 1, 12-21-92) EXpIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: in order tor the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectlona and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaae-<s (rwo) WORKERS'COMGENSAnON DECIARAnON: I hereby ettirtn under penalry o1 perjury one of iha tollowing dedarations: ❑ I heve end will maint9ln e certlficate ot consent to self-Insure for workers' compensation, es proWtled tor by section 3700 of Ihe Lebor Gode, for the pertormance af �he work far whlch Ni5 peRnit Is issueC. ❑ I heve end wlll malntain workers' compensation insurance, as requlred by section 3700 of the LeDor Code, for Ihe pertortnance ot the work for which ihis pertnil is issuetl. My workers' compen4atlon Insurance carrier entl pollcy number ere: Cerriar. Policy Number: (Ihfs sectlon need not be completed I! (ha permit Is valued at one hundred dollars ($100) or /ess.) .Q�.I,certily thst in the ped�mence of the work for which Ihis permit {s Issuaq I shall not employ any parson in eny manner so es to become su�}ec[ to the workers' �..--�compensetlon laws o1 Celifon A, end epree thet ii I ahould bewme sub�ect ro the workers' compensetion provislons of Sectlon 3700 oi ihe Lebor Code, I shall forthwit� comply vrith these prW�slo . AppllCanl:SipnaWre: �:" �� %T� WARNINO: FAILURE TO SEWRE WORKERS' LO ENSATION COVEMGE IS UNLAWFUL AND SHAl1 SUBJECf AN EMPLOYER TO CRIMINAL PENALTIES M1D CML FlNES UP TO ONE HUNDRED TMOUSANDDOLIARE(5100,000),INADDRIIXJTO ECOSTOFGYIMPENSATIqJ,DM1AGESASPfiOVIDEDf-0RINSECfION3lO60FTHEL4BORCODE,IMEREST,ANDATTORNENSFEES. LICENSED CONTRACTOHS DECLARATION: I hereby aflirtn Ihat I am Ilcensetl untler provislons of ChaD�er 9(commencing with Saction 7000) of Divislon 3 oi Iha Business enC Prolessions Code, and my license Is In lull force entl ettect Lic. M Cless u Contrectofs Signeture: Date: CONSTRUCTON LENDING AGENCV: ❑ I hereby aftirtn ihat there Is e consWction lending agenty lor the performance of the work tor which this pertnit is issuetl. (Sec. 3097, Civil CoCe). Lentler's Neme: Lender's Atldress: Signature: �ate: OWNER-BUILDER DECLMATIONS: I hereby eMirtn that under penelty ot per�ury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business and Professlons Cotle: Any city or couny which reQuires e pertnit lo construct, elter, Improva, tlemolish, or repair any structure, pnor to its iuuance, elso requires ihe epplicant for such permil to flle e signed stetement tnet he or she Is Iicensetl pureuent to Ihe pravislons of ihe Contrectors LJcense Lew (Chapter 9(commencing wllh Sectlon 7000) ot Dlvislon 3 of the Business and Professions Code) ar Ihet he or she is exempt therefrom and the basis for Ihe elleped exemption. Any violatlon af Section 7031.5 by eny applicant for e pertnit sub�ects t�e epplicent to e Gidl penalry of not more ihan five hundred dollers (5500).): r---� �—I, as owner of the property. or my employees with weges es Iheir wle wmpensetion, WILL DO THE WORK, and ihe sVucture is no� Intended or otteretl tor sele (Sec. 7044, Business antl Professions Code: The Contractors LJcense Lew does not apON �a eo awnar ot property who builds ar improves tharean, and wtw tloes such wodc himself or herselt or inrough hIs or har own employees, provided ihet such improvements ere no� Intentled or aHeretl tor sele. If, however, the building or improvement is soltl wlihin one year o� �mpletian, the owner-builtler will heve the burden of proving that ha or she tlid not build or imDrove tor purpose of sale.). ' ❑ I, es owner of ihe Droparty, am EICCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business antl Professions CoCe: TOe contractor4 �Icense Lew does not appty to an owner ol property who huiltls or Impraves tnereon, end who coNracis lor such pm�ect with a comractar(s) license pursuant to the Contrectors License Laws.). ❑ I em exempt under sec. SignaWre� � Owner ID verified by driver �cense. Vedficetion of Ownership by (rype oi Business antl Pmfessions Code tor this reason: � ❑ No Orivers Cicense No. _ / ' � � FxWFes.� — —J� property tax bill or dead): __ DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICA710N: ❑ I hereby certify thet no excevetian flve (5) or more teet in depth Into which a person is required to descentl, will be made in cannection with work authorized by this permit, and that no building siructure, scaftolding, falsework, or demolition or dismantling theraoL will be more than thirty-si: (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Calitomla Adminisiretive Cotle). ❑ As ownervbuiltler, I wi�l not employ anyone to do work which would require e permit trom the Division ot Industrial Sefery, es noted ebove, unless such person has e pertnit to do such work from the tlivision. Signature: Dete: Division of Industnal Safary Permit Number: CERTIFICATE OF COMPLIP�CE AND AllTHORIZA710N OF ENTRV: I certify under penal�y ot perjury tha� I have read this application end state that the informallon given is wrrect. I egree to canply W��h ell stete laws end city oMlnences relating to building wnstruction, end euthorize representatives of the City of Cos�a Mesa to enter upon Ihe ebove-descnbed property fof inspaction purpos^s. I egree not to occupy or allow occupanCy of eny building authorized by ihis pertnit until finel inspection. COUE I, INSPECTIONTYPE 7618 Flaed System Final Fire Prevention 1288 Pool Spe Finel 200 Finel Re-Rooi 201 Finel Block/Rateinln8 Well 202 Final Factory Fire Place 203 Final Sign 207 Final Demalition ,mi_ COUEI INSPECTONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 272 Final Fire Prevention 220 Final Planning Appraval 222 Final Site 250 Finel Builtlin<yOccupency Dat L _. .:--�, p J� Date �4\i�Cilli/.\FI � �� . Fax (�i4) 7`'d'4858 ' t1 T54-5273 cirr oF c�,o, s� rvlSitlN DE s�pPMDI�ERVIGES DEPA�TMENT PERM�T PEaM� NUMBER gp5.01514 � ( FAIR DRIVE, CpSTA MESA. CA 92s2& Status'. iSSUED ApPlied'. p9� 2� 5 tssued: Job Address�. 732 W 18TH ST Suite', Typy uf ConstruGion'. V•N vicinity. ROaF Zoning� Prima�Y�cc A2qq7412 Parcel Numper. ROSENGARTEN, MICHAE� � �,�T� ISSUED BY: � phone((�,7�(�'7QL� `��t" APPlicant�. �� ,p�� ` ,I.jli�i`�i� nddress: V `(- ll Z�p�� Gl.��f' -- pwner. Address ConUaotor- Add�ess: i 2 $%^� .._ ." ��,�eu�- , C k � ROSENGARTEN N��HAEL,3' � � � � � ` P,ho�e 723 TENTH STREET, ' �,tr' Zi� �90402 2821 �� h v� � SANiAMONICA CA ;- � _ ..a °;:. s ;- �-�-� � ..� e� { , � _ � + �,.4_ � - �� fSER BUILDER � �� _. �' � : OV�I _ x Phone. � �, `" "> � �'r.< �3 � QOOOQO �... � �� ,� J �?�', , ,. . LicenSe: - �` . ,� r `�t " � � +�` E(19 + ' �,`�a• phone �" �� °s' Address: �,�.a. � prch ��,�' � _ Addresa., `:��^ � d j a><. a, . Lp ' !�= EXIST�NG � �w t �ta�: 5 , ACCE�Y PARK�NG Phone: . ,� � A �� -�:il�cense �'.: rt�` ' `� 'x'y ..y� .. x...� ... . :: �.:.:�'evPFtOX E� 30 Sa�AR !, �- �', �. i" ' J J�_ NG AS NEEDED`oOF WtCOMP _�------- E S� ;; �> �alc ` _--===-�- YM ;, � ,; ` . Cta;sr F ' l .e�' 2..5 ` ` .. : t )�� 125:25 . - � $060 ., �� . ' ..t � ,-.�`� $000��; � ..r. $O.00�rt �: �-:r;" $0.00' � �_,..�� < � r_ � " � z ,`v;e �. � e� n �L¢n �'i%, '� ;;. jjEBf r�g4" ��a c Nb . i " � ye 0 Q 2E Front P �`� ��^ ' - *�.., leH � ,� '. � � p=�0 c y�^ � ; � gr ' ' :: Rea� , �t � r � Front .`Q-�, "- ,: Fro osed.� �, � � .�R�a _.`p�3 ,.y` .�.. :_.,�, ` Exi tm : �Q �.,,, � � �� ' _ '�� , -.:�r� � a`�5 ,(. � � .: � � r � aa ✓�, Q" # � R .t ' '.'.!' ... ..m'... ,w, .,. � 5�, '�'� �'• ,gh+';-_o-0 ' z�gnt o: ° ih 4'/ � �� S � � ��, �. cf � z_ 1 a, ufrements under Cafitomia s�&t�� a�d fe licable handicap a�cess req . wlth all aPP e�ed or aba•- c� �htn 18� days, o� If work Is susP �r this permn shall comPry . ' The WOTk 8uthorizad 5 9Y� mmen tcab�e» ,� NOT�CE' prd. No. 92-28, 4�� 2�2 me vold it work is not cu �,�th afl apP� re9�latio�. l ¢x Ire a�d beco such work must comP Y ra4on a1 ihls peR This peemit shall au�omatically p considered le9a�� roval will result in the expi EXPIRAT�ON: erm0 to be �fons and tinal app ' tor a pe�od ot 180 daYg� �}zed �tein�adgF twre to abta�n inspe In order fot lhe wo ov �muqt pe tNSPECTONS: U�a �d ff�al epP reQufredinapea 14)T54-8826 - FOH �NSPECi1aNS CA�L: r WORKERS' COMPENSATION DECLARATION: - " `1. I hereby attirm untler penelty of Oer�ury one of the following declarations: ❑ I heve entl wlll meln�aln a certificate of consent to selt-Insure for workers' compensetion, es provided for by sectlon 3700 of the Lebor Cotle, for the pertormence of ihe work tor which this pertnit is Issued. ❑ I heve entl wlll maintein workers' compensation insurance. as required by sectlon 3700 of Ne Lahor CoOe, for the pertortnance of the work iw whic� this pertnit is Issuetl. My workers' campensetlon Insurence carrier and policy number ere: Carrier: neetl no( be valueC af one hundred dWlars ($100) or /essJ Policy Number. 'p'—Ccatlity thet In ihe pertormance of Ihe work for whic� this Dertnit is issued, I shall not employ eny person in any menner so as to becoma suD�ect to the workars' ��compensatlon laws of Calitomla, end egree that if I shoultl �ecome suD�ect to the workere' wmpensetion provislons of Section 3700 of Ihe Labor Code, I shall forthwit� � comply wlih Ihese provislons. �-- .< <- �� 9-� O � NGPIIcantSignet'��-ure�1 Date:^ n� WARMNG: FAILURE TO SEWRE WORKEPS' COMPENSAT1 C GE IS UNUW FUL ANO SW1LL SUBIECf AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNE$ UP TO ONE NUNDRED T)IOVSAN�OOLLAPE(5100,000),INADIXTIONTOTHECOS �MPENSATION,DAMAGESASPROVIDEDFIXiMSECTIp13I060FTHELABOqCOOE,INfEREST,ANDATTORNEI^SFEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn Ihet I em licensed under provisions of Chapter 9(commencing wlih Section 7000) of Division 3 ot the Business and Professions Code, end my license is in full torce and eflect. Lic. a Class a . ContrectolsSigneWre: . Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby eftirm Ihat there is e consiruction lending egency tor the performance of ihe work tor which this permit is issued. (Sec. 3097, Civil Cotle). Lendefs Name: Lender's Atltlress: Signature: Dete: OWNER-BUILDER DECLAFiAT10NS: I hereby aHirtn thet under penalry of pefury thet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu entl Protessions Cotle: My ciry or counry which reqWres e permit to construct, alter, Improve, demolish, or repair any structure, prior to its iuuflnca, elso requires the eppliwN for such permit to file a signed stetement that ha or she Is licensed pursuant to ihe proNsions o1 the Coniradors Llcense Lew (Chepter 9(commendng with Sectlon 7000) of Dlvlsion 3 ot Ne Business flntl Professlons Gode) ar ihat ha or she is exempt therefrom end t�e besis for the alleged ezemption. Any violation of Section 7037.5 by any epplicant for e pertnit subjects th pplicent to a civil penalry oi nat more than Me hundred dollars (5500).): , as�owner ol iha property, or my emplqrees wi�h weges es their sole compensetion, WILL DO 7HE W08K, and Ihe swqure is not intendetl or ottered tor sale (Sec. 7044, Business and Pmtessions Code: The Contractors License Lew does not apDN �o en owner ot pmperry who builds or impmves thereon, and who does such work himseN or herself or Ihrough his or her own employees, provided thet such improvements ere not intended or oHeretl tor sale. It, however, ihe bullding or Improvement is sold wit�in one year of completion, ihe owner-builder will have the burden oi proving ihet he or she did nat build or improva tor purpose ot sale.). ' ❑ I, as owner ol the property, am EXCLUSIVELV CON7RAC71NG WI7H LICENSED CONTHACTORS to consiruct Ihe project (Sec. 7044, Business an0 Pmfessions Code: The contractors License Lew Ooes not appty to an owner ol property who builds ar imprwes t�ereon, and who conirects tor such projen with e coniractor(s) licensa pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Prolessions Code for Ihis reason: SipneNre:�--� .l Owner ID veritietl by tlrrver's license. V ❑ No Dr�e�Llcenae;No�.�� Vedflcetion ai Ownarship by (type of document, i.e. - property tex blll or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: �G .- ❑ I hereby certify Ihat no excavation five (5) or more feet in depth into which e person is requlred to descend, wlll be made in connec�lon wilh work euthonzetl by Ihis permit, entl t�et no building sWdure, scaHolding, falsework, or demolition or dismantling ihereot, will be more ihan thirty-si: (36) teet Ngh. (Chap. 32, Gry 2, Atl 2, Sec. 341, Tltle B, Celifornia Administreliva Code). ❑ As axner-bullder, I will not employ enyone to do work which would require e pertnit iram the Division ot Industrial Safery, es noted ebove, unless such person has e pertnit to do such work from Ihe division. Signeture: Data: Division ot IndusMel Satery Permit Number. CERTIFlCATE OF COMPLJANCE AND AUIHOHVIITION OF EHTRY: I certlty untler penalty of parjury that I have reatl this apD�ication and stete that the inlortnation given is cortect I egree to wmply with ell state laws and ciry artlinances relatlng to buil0ing construction, end euthonze representatives of the Ciry of Costa Mesa to enter upon the ebove-descnbed properry for inspecti ses. I a9� not ta accupy or allow occupancy of any building authonzed by this pertnil umil final inspection. � � - �-�s- S ature Of le9al wner(s) lDate_ AnNOr Authorized AOPlicant Date 40oE �. INSPECTIONTYVE 1616 Fixetl System Final Fire Prevention 1266 200 Paol SOa Flnel Finel Re-Fioof 201 Finel Block/Retaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Finel Demolition �.I �1111. _ / �i � �_ i , COOE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Eletirical 212 Final Fire Preventlon 220 Final Planning Approval 222 250 Final Site Final Building/Occupancy Pd� 1[� (7�a) �sa-52�3 • Fex (7ta) 7yi-ae56 • www.ci.costa-mesa.��MBING PERMIT n hAIFi UFIIVt, GVJIA MtJA, GA y26Zti Job Address: 732 W 18TH ST Suite No Vicinity: UNI7 A, BATHROOM Parcel Nunmber: 42417412 Applitant: Address: Owner: Address Contractor: Address: ROSENGARTEN, MICHAEL J PO BOX 60526 PASADENA,CA ROSENGARTEN, MICHAEL J PO 90X 60526 PASADENA,CA OWNER-BUILDER Phone: 626-792-4460 Zip: 91116 Phone: 626-792-4460 Zip: 91116 Phone: Zip: License: 000000 Status: ISSUED Applied: 09I062005 Issued: 09I06l2005 ISSUED BY: �IIUV � � SCOPE OF PERMIT REVISION TO PERMIT ON 09/22I05 TO ADD A WATER HEATER CHAGNGE OUT FOR UNIT A. LEGALI7ATION OF 1 BATHTUB CHANGE OUT FOR UNIT A(DUPLEX). CD-05-1024 ISSUE FEE Backflow irrigation BackOow Preventer Bathtub Clarifer System ConneIX (Ice,Soda,elc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Inlerceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 59.80 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 50.00 S0.00 50.00 50.00 30.00 � FEE SUMMARY AMT Laundry7ub/Washer $0.00 Landscape Irrigation $0.00 P-Trep $0.00 Pressure Regu�ator $0.00 Process Piping (per 10 ft) 50.00 Receptors $0.00 SepticTank $0.00 Sewer Cap (or Demo $0.00 Sewer Conned $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (foilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Soflener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: AMT 50.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $12.30 50.00 $0.00 so.00 so.00 so.00 545.60 $0.00 $0.00 E91.20 � 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomla statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: Thie permlt shall automatically expire and become void if work is not commenced within 180 days, or if wotk is suspended or abandoned for a pedod of 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, end all requlred Inapectlona end flnal epprovel must be obtained. Failure to obtain Inspections and final approval will result in the expiration of lhis permit. FOR INSPECTIONS CALL: (7�q) 7545626 zue.ae �aroo� i �� WORKERS' COMPENSATION DECLARATION: I �ereby atfirtn under penelry of per�ury one of ihe tollowing dedarations: ❑ I have antl wlll malnfein e ceNficete o1 consent ta selt-Insure for warkers' compensetlon, es proWded tor by sectlon 3700 0l the Lebor Code, tor Ne pertortnance of tha work for which Ui5 permit Is IssueC. ❑ I �aVe eflA wW meNteN wotkers' Canpen58tbn in5uretce. a5 rBquired by 5ection 3700 of the LBbof Coda, for Ne pBAortnerxB of Ue work for whuii �hi5 pgrtnit is Lssued. My workers' compensetlon Insurence carrier end pdky number era: Cerrier: Policy NumDer: (This secNon need not be ownpleted ll NB pertNf IS velued et one hunOred ddWrs ($ I00) or less.J �-y ❑^�I cenify that in the peAormance of Iha work lar which ihls pemtit is issueq I shall not employ any person In eny menner so es to become suD�ect lo Ihe workers' compensation laws o1 Celifomia, egree Ihet If 1 shoultl Decome sub�ect to Ne workers' compensetlon proWslons ot Sectlon 3700 of Ihe Lebor Code, I shall fotlhwlih comply wlth Ihese provisions. /�, ApplMant�SipnaNre:'- Dale�._,. % — � �`� S— f WFRNINOi FAILURE TO SECUR ORNER$' COAIPENSATION COVE GE IS UNLAW FUL AND SW1LL SU9IECT AN EM OVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED TMOUSMID DOIIAPE (5100,000), IN ADDITION TOiME COST OF CqAPENSATION, DAAUGES AS PROVIDED FOR IN SECTION 37080F THE UBOR CqDE, INTEREST, PND FTTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm thal I em Ilcensed under provisions of Chapter B(commendng with Section 7000) of Divislon 3 oi Ihe Business entl Prolessions Code, end my Ilcense Is In tull force end eMect. Lic. q Cless q Contrector's SlgnaNre: Dete: CONSTRUCTON LENDING AGENCV: ❑ I hereby eflirtn Ihet there is e wnslruction lentlinp egency lor the peAortnance ot t�e work for which this parmlt Is Issued. (Sec. 3097, Civll Cotle). Lentlefs Neme: Lendefs Addreu: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn Ihet under penelry o1 per�ury that I em EXEMPT FROM TliE CONTAACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness end Professions Cotle: Any dty or counry which requlres e pertnit to consWct, fllter, improve, demdish, or repalr flny strucWre, pdor lo Its issuance, elso requiras Ihe ap0licant far suU permit to flle a slgnetl stetemen� Ihat he or she is Iicensed pursuant to the proNsions oi Ue Contractors Llcense Lew (Chepter 9(commenGng with SecUon 7000j of DMsirn 3 W Ne Business flntl Professlons Codej or Ihat he or she is exempt thereirom end tha Gasis for the fllleged exemption. Any violaUan of Section 7031.5 by eny appllcant tor e pertnit subJec� e applicant to e dWl penalry of not mare than frve hundred dollars ($500).): , 0..: I; es owner of the praperry, or my employees with wages as iheir sole compensetion, WILL DO TME WORK, and t�e sWCWre Is not IntenCeC or ottered br ule (Sec. 7044, Business and Profeuions Catle: The ConUactors license Law does not appty to an owner of properry who builtls or improves theraon, and who does such work himself or herselt w through his or her own employaes, provided that such improvements are not Intended or oNered for sele. If, howevar, the builtling or improvement is sold within one yeer of completion, the owner-builder will have the burden oF proving Ihat he or she ditl not Oulld or improve tor purpose ot sele.). ' ❑ I, as owner ot the D�operty, em E%CLUSIVELY CONTRACTING WfT}f UCENSED COHTRACTORS to construct the pro�ect (Sec. 7044, Business and Pmtessiau Catle: Tha comreccors Llcense Lew tloes not eppty m en owner ot properry who builds or improves thereon, end who contracis for such pmject wiN a contractor(s) license pursuant to the Contracrors License Lews.). ❑ lem Owner ID v��a�E.��es ❑ Na Venllcation ot Ownership by (rype of document, i.e. - properry taa 6ill or deed): Cada tor t�is reason: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: ❑ I hereby cetlify Ihet no excevetlon five (5) or more feet in depth into which a person is requlred to descend, wlll be metle In connaction with work euthonzed by ihls permit, end thet no buildinp siruciure, scattolding, felsework, or tlemolition or tlismanlling thereof, will 6e more then �hlrty-slx (38) teet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Tltle 8, Celifomla Atlministrative Cotle). ❑ As owner-Ouiltler, I will not employ enyone lo tlo work which would require e permit irom t�e DIvlslon of Indusidel Sefery, es notetl eDove, unless such person has e � permit to tlo such work trom the division. SignaNre: Data: DiWsion ol Intlustrial Salery Permlt Number: CERTIFlCATE OF COMPLUWCE AND AUTNOHVJITION OF ENTAY: I certiy under penalry of Oerjury that I heve reed this epplicatlon end state t�at Ne iniortnation given Is correct. I egrae lo comply with ell slete lews end dty ortlinances relating to building consWIXion, and euthodze representetives ot the Ciry ol Casla Mesa to enter upon the above-describetl property tor inspeclion p�s. I egree not to acupy or allow occupanq ot eny building authoAzed by this pertnit until finel inspection. COpE �. INSPEC710NTYPE Q�¢, �$ 1616 Fixetl System Final Fire Preventlon 1266 200 201 202 203 Pool Spa Flnal Finel Re-Roof Finel BIocWRetalning Well Final Pectory Fire Place Finnl Sign 204 Finel Demolition COOE I INSPELTION TYPE 208 Flnal Mechanicel 208 Final Plumbing 210 Final Electriwl 212 Finel Flre Preventlon 220 222 250 Finel Planning Approval Final Slte 'Flnal Building/Occupanty r'°= Z%—o� ��a � � (714) 754-5273 • Fex (714) 754-4858 • www.c�.costa-mesa��MBING PERMIT 77 FAIR DRIVE, COS7A MESA, CA 92828 7�z Job Address: -7�28 W 18TH ST Status: ISSUED Suite No Applied: 09/062005 Issued: 09I062005 Viciniry: UNIT A, BATHROOM Parcel Nunmber: 42417412 App�icant: ROSENGARTEN, MICHAEL J Address: �(� �� o52(n r �� Owner: Address Contractor. Address: ROSENGARTEN, MICHAEL J 723 TENTH STREET � . :SANTA�MONICA,CA � � OWNER-BUILDER I0,�AI,L[�i�� "0- ". 1 BATHTUB CHANGE OUT FOR CD-OS7024 ISSUE FEE BackOow irrigation Backflow Preventer Bathtub Clarifer System Conned (Ice,Soda,etc) Dental Units. � . Dishwasher � � . Drain, Floor Drein, Rainwater Drain, Roo( Drinking Fountain Expansion Tank' Gas Earthquake Valve Gas (1-4 outlets) , Gas (Over 4 outlels) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT $23.50 $0.00 50.00 E9.80 $0.00 $0.00 ao.00 50.00 $0.00 so.00 50.00 50.00 30.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 ,. Pho�a:��z�)�a2-yu�a �Zip:. i �I I � i. . � � _� :� Phone:.� _, - , � Zip: 90402-2821 . . Phone: ' Zip: � License: 000000 � � �� ISSUED BY: J!N/ Z' - .. '. �'•., `•- . � . ; :�e ' ' FEE SUMMARY �, "' � - - _ : �.AMT. :�.:� � .. Laundry Tub / Washer 50.00 ��0�� Sump Pump ..� 0 Landscape Irrigation $0.00 �0� Swimming Pool3 �� 0 . � �� P-Trap : � � '- ,$0.00 .0.- , , Trap Primer , � t � Pressure Regulator � " `�� $0.00 �� 0--" � - Urinal � - � 0 ''��Piocess Piping (per 10 N) $0.00 �� 0" Vacuum Brkr Bkflow(1-4) 0 Receptors 50.00 0 Vacuum Brkr BkFlow(5+) 0 Septic Tank $0.00 _ 0 Wash Basin 0 Sewer Cap for Demo �� $0.00 :,0 Wash Basin Set 0 Sewer Connect 50.00 0 Waste and Vent System � 0 Sewer Private Line � $0.00 0 Water Closet (Toilet) 0 Shower � - � 50.00 0 WaterHeater/vent 0 Sink, bar � � �$0.00 �. `,. A Water Piping (Inst or Rep.) 0 _ . ;Sink, commercial � $0.00 j �`. 0- ' � � Water Re-pipe 0 � � ._ .�Sink,Floor " " 50.00 � �0�`, �� WaterService 0 � Sink,kitchen ' . $0.00 � 0 WalerSoftener 0 , � Sink,�servicelmop 50.00 ,, ,0 -. OTHER 0 _; , ;Spa (private) � � �$O.00a,„,..�0-_r �, . VIOLATION . 0 ,� , Spa,(public) . . � : �,-- $000�:;';'0�� '�� PLAN�CHECK . � � .0 ,.r.,>- .. ', .;,b.t��''- '-�� REINSPECTION p. �. � ..- ',,, _ .�. . "_ � "r � - � TOTAL CALCULATED FEES: � _ .. � _ , .. � �.r .'�' '.. " �, " AMT 50.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 so.00 $0.00 50.00 50.00 50.00 50.00 50.00 50.00 $33.30 50.00 $0.00 E66.60 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this pertnit shall comply with all applicable hendicap access requlrements under Califomia stelutes end related regulatlons. (Ord. No. 92-28, § 1, 12•21-92) EXPIRATION: This pertnit ehall eutomaticaiy explre and become vold II work Is not commencetl wlthln 180 days, or if work Is suspended or ebendoned for a perlod of 180 deys. INSPECTIONS: In order tor the work authorized under this permlt to be considared legal, such work must comply with all appllcabie codea, arW ell requlred Inepectlone end Mel epprovel must be obtained. Failure to obteln Inspections end flnal approval wlll result in the expiration ol this permit. FOR INSPECTIONS CALL: (714) 7545626 z..o-w �aw� WORKERS'COMPENSAnON DECLARATON: I hereby eNirm untler penelry of perJury one of the following tleclaretions: ❑ I heve end wlll malniein e cenificete of consent to setl-Insure for workers' compensellon, es providad for by saction 3700 01 the Lebor Cade, lor ihe peAormance ai the work for which ihis pertni� Is Issued. ❑ I �ave antl wlll malntain workers' compensation insurance, as required by secllon 3700 0l the Lehor Code, tor the peAortnance of the xrork for whlch Ihis permit is luued. My workers' compensetion Insurence certier and pdiq number ere: Certier. Policy Number. �(ihi_aaecn� .�ar ae comp�ered rr me ��rr rs �n�ad e� o�e nu�a�ea daiars �aioo� o� �ess.� I certlty t�at In the peAortnence of Ne work for which this p¢rtnit Is IssueA, I shall not empby flny person in any menner so es to becoma suD�ect ro ihe workers' compensetlan laws at Celllamla, end egree thet II I should become sub�ect to t�e workers' compensatlon provisions oi Sectlon 3700 ot Ne Lelwr Code, 1 shall foMwlih Ap�com�tywith__ t�provisions. L� / pilcant Slgnewre: rDete:— . / �f7 /0� WARNINO: FAILURE TO SEWRE WOfIXERS' OOMPENSATIOH RAGE 5 UNLAWFUL AND SiULL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES MD CML FlNES UP TOONE HUNDRED T/IIXISPND DIXIARE (5100,000�, IN ADDffION TO THE C06T OF TION, UAANGES ilS W10VIDED FOR IN SECTION 3)O60F THE IABOR CODE, IPrtEREST, AND FTTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I here0y eHirm Ihat I em licensed under proNsions o1 C�apter 8(commoncinp wilh Sectian 7000) of DlNsion 3 0l Ihe Buslness antl Professlons CoOe, end my Iicense Is in full lorce entl etlact. LJc. N Cless M ConlrectoYs Slgnature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby afflrm that there is e wnstruction lentlinp epency br the pedormence ot the work for which this permit Is Issued. (Sec. 3097, Civll Cotle). Lenders Neme: LenEers Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I �ereby eHlrtn ihet under peneliy ot perjury thet I em E7(EMPT FROM THE CONTAACTORS LICENSE LAW for the followinp reeson (Sec. 7031.5, Busineu anO Protessians Cotle: Any ciry or counry which requires e permit to consiruct, elter, imprwe, demolish, ar repair eny structure, pnor to its iuuance, elso requlres the epplicant for such permit to fila e signetl stetement that he or s�e Is IlcenseC pursuant to the proNsions ol the Camrectore IJcense Lew (Chepter 9(wmmenGng with Secllon 7000) of Divislon 3 of Ihe Business end Professions Cotlej or thet he or she is ezempt theretrom flnE the besis tor the elleged exemptlon. Any violatlon o1 Section 7031.5 6y eny appllcant for e permit ��subje```cts Iha epD��en� �o e civil penalry oi not more than frve hundred ddiers (5500).): I(.I `I, es owner o� t�e properry, or my employees with weges es Nelr sole wmpensaqon, WILL DO THE WORK, and the sWciure Is not Intende0 or oflered br sele (Sec. /�7044, Business antl Professlons Cotle: The Contractors License Lew tloes nat appty to an owner oi properry who builds or improves ihereon, antl who does such work himself or herselt or through his or her own employees, provided ihat such imprwemenis ere not intendetl or oNered for sale. If, however, the builtling or improvement is soltl within one year of completion, the ownervbuilder will �ave Ihe burtlen of pmWng Ihat he or she did not Duild or improve tor purpose at sele.). � ❑ I, es owner ot Ihe propeM. em EXCLUSIVELY CONTRACTING WITH LICENSED CONTAAC70RS to construct the project (Sec. 7046, Busineu end Professions Code: The contrectors License Lew does not appty to an owner ol property who buflds or impmves thereoq and who coniracts far suc� pm�acl wlih e conirector(s) license pursuent to ihe Coniradors License Lews.). ❑ lem Verificatlon ot Ownership Business end Professions Cade for Ihis reason: Yes ❑ No ol document, i.e. - properry tax CIII or deetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATON: ❑ I hereby certlfy �het no e:cevation Ilve (5) or more feet In depih Into whlch e person Is required lo descend, will be metle In connectian with work euthorized 6y this permlt, en0 the� no building structure, scattUding, talsework, or tlemolltlon or tllsmentling thereot, will be more �han thirty-six (38)leet high. (Chep. 32, Grp 2, Atl 2, Sec. 341, Tltle 8, Cellfomie Admini9tretive Code). ❑ As owner-builder, I will nat employ anyone to do work which would require e permlt iram the DMsion ol Intlus�rifll Selery, es noted ebove, unless such person �as e permit to do such work trpn the division. Signeture: Date: Division ot Intlustnal Satery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVA N OF ENTRV: 1 certlty under penalry of perjury ihat I have read Ihls epplica�lon and stete thet the Inlormation given is correct I egree to comply with ell stete laws Ortlinenc relating to bulltling consWctlon, and euthonze representetives ol Ihe Clty ot Costa Mese to enter upon Ihe ebove-descnbed property tor InsOaction gr n occupy or ellow occupency ot any building authorizetl by this permil until Ilnel inspection. - 9 6 - o.� `IgnaNreOftegalO�ner _ Date�—i LOpE t. INSPECTONTIPE Qd¢, �L$ 1816 Flaetl System Final Fire Prevention 1286 200 Pod Spa Final Finel Ra-Rool 201 Flnel Block/Retaining Wall 202 Final Factory Fire Place 203 Flnel Sign 204 Flnal Demolltlon COUE 1 INSPECTION TYiE 206 Finel Mechenlcal 20B Final Plumhing 210 Final Electrical 212 Final Fire Preventlon 220 Final Planning Approvel 222 Final Site 250 Finel Bulltling/Oaupency PAgi II�L4 II/7L�1//.i/7 r�� ,----• PBWECT RUOflES$: 7 3� ;a* 18 TH S7 OWNEfl'S NRME: DUHAN, HOWARD aooeess: DURAN, HOTr1ARD TR * 25505 iA P:IRADA LAGJNA HILLS,CA 92653 /ANCN/ENGINEEq: 7 7 O — S 6 z 9 flEG.NO.: . nooecss: uxir: uxn: / ` - PEXMITTEE: MICF�AEL CLEL�j%iN�EIZ (714)565-4525 noosess: z085 P1.ACENTIA AV 4 C.M, CA 42677 LICENSEU CONTNACTOP OECLIIMTION: I hereby aBirm t�at I am Iiceme0 wMer O��ons ol Chapier 9(commencinA w+�h Section 70(q) ol Oivivon 3 of I�e Buvnesb an0 Proless�Ons COOe. an0 my license 8 in lulllorce anG eflect. c: -;�.. � sTn,euc.:59492�-4- ��cuss: C36 � oate: �S-q�L /Signamre: ��y�� WQHNEBS' COMPFNS�TION OECLAl1AT10N: I �ere�y affirm �hat I have a ce icate af wnsent ta selbinsure or a certifiwte oi Workers' Comoenuiion Insurance. or a cenifiea coDy �nereqi (SecGon 7800, laD. CI. voucrxo.: On6-•92UNIT.i218 EXP.ORTE: OI�O� �93 comvnxr: STATE ❑ CerlilieE [apY h �ere�y �umiSheC. ��CRttdieG�copy is ed lh t�e ciry BuilEinq Oivision. Ja�¢: �� t. -�L- ! Fpplicant— o� - EI(EMPfION FNOM WOpIlfXS' COMPENSRTION oECIAMTION: (f1u5 secoon nEed mt Oe'epnplMM if Ih¢ p¢rmt ¢ iw one huMretl (5100) a leu) I[etli1Y Uwt in �he peAarmanCe oi Ihe wntk lor whicl� �Itis perrttit iS Bsuetl. I shall npi'employ any person in any manoet so a5 io hecome� subiect to Ihe Workers' Compensation Laws af Califomia. �� Oa�e: Sgnature: NOTICE: 11, aiter making t�is Eeciaration, you s1ioNE Eecome wqect ta t�e Workers' Compenuiion D«ons ol t�e LaEor CoOe. rou mysi fonAwit� wmdY K+�� suN prm�siorts or tltl5 pttmit shall 6B AeemeE revoketl. CONSTflI1Lf10N LENOfNG �GENCY: 1 �ert0y atlirm Ihai (�ea is a con5lruttian I¢iMinq a0enry lar (he pertOrmanCe af Ihe work lar wpic� Nis Oermii is issue015eciion 3W7. Civ. C�. LENDEP: poonEss: OWNEB BUILDEH UECNMTION: I hereEy affirm t�at I am exempi tmm t�e Comractors' State License Law lor t�e lollowinp reason �Seclion 7097.5 Business and Pml¢uional CoCe: My dry ol counry wliich reQuires a permit ro comimcl. alier, imprwe. Oemolis�, or repair any simctute. vrior to ils i55uance. al5o RQuues t0e ipWiCdni lar sucn Oermit ta lile a sipnetl statement that hdslle is licensea pursuam io Ihe provisiws of tAe Coniractors' State L'aense Law �Gwpier 9(commeMinp v.it� Seciian 7W0) af Oivision 3 at t�e Busineu anE Pmlessions CoEe) or tlul �Uslm a e.emD� �herefrom an0 I�e Dasis �or t�e atleqe0 e�emD��on. My vroWtim of Sec�ion 70.11.5 Gy any aOD�icani lor a pErmit su0jecls ine apDliWnt �o a civil penally ol noi more IAdn Iive nunEreU Oollars (`�1. p I. as owner al ine propeny or my empWyees vnin wa0es az tneir sole campenulion, will tlo the wOrk, anA �he stmcWre is not intenAeO or ottere0lor sale (SeCuon 70C4, Business an0 Pmlessianal totla: T�e Cantraqors' Slaie License Law dces not apDA' �o an owner ol a Oropeny wtp OuilOs ar imprwes thereon, anE wlw dces such work �imself/Aerself or ihmuph �is or �er own ¢mploVeeS, pmvi4eG I�ai 5uth imprOvemenis ar0 noi in�¢nGed ar ofier¢E �or 5a10. I1, however Ih0 OUildin0 or improvement a salA xitMn oire year ot cnmpletian, tlre owner will have fh¢ Ourdm al 0/oWrry he/she drtl rrot hudtl ar improve lor ��e purpose ol sale�. I, d5 OW11Ef 0� IIIC pfOpEfiy, dlll CXCW4v2ry contractinp witn licensea contractars m constmct Ine pmiect (Section 70aa, Business � an0 Prolessiuns COEe: The ConVactqs' Sute Liceme Law Oces mt appy ro an mwer of D�RrIy wM hmlAs or imD�wes Uereon antl wta fAntracis �or such pmiecls witn a Coniractar(sllicense our5uani b tAe Caniractors' State License Law),I am aware Ihzl pr0o� ol lneu WaMei s ComUM52fi0n ir6wante s�W10 De provi0etl to me. � I am eeemD� unEe� Senion: B. 8 P. C. io� mis reason: Oale', I tlo �CreUy cenify I�al I 255� anOlha� I Or any t Permiiloi conslruc�ion IIICR D�ON51005. Qdl¢: Owner. am aware ol and un0erstanG t�e repuirtments ol Calilomia Heatth an0 Safety CoOe Sections 25505. 25533, anJ umre �uileinq wcupant vnlVwiu no� (cirpe one) nee0lo wmpty with saia state codes anJ ihe reVuiremenis lor a or moUili¢ali0n Imm I�e Air Oualily MandOem¢ni DiSlfitL fleSiGen�ial COnSimtlion applitaii0n5 ar¢ ¢K¢mpI �mm ApPfiCanL I �¢�¢py cenity ihal I have aaU TAis aoGlicaiion an state tlui �Ae aUove information is corrtt�. I aA�ee m compry wit� aA ciry an0 cou ry ar0inanres an0 s�ate Wws reUting �a Mriltlinq Wion anU �erehy am�p reuntatives ol llds ary to rnter upon t�e aDove-men[ e0 Properly lorinspectian purposet � � \^ � � I Odl¢: �9�1dN(E: �-1 Onv¢r'S License or Social $eariry M: ApplicanC pink—Revenue; GdEenroO—Assesmr CITY OF COS"A N,ESA — BUILDitvG Pt'.R:�:ZT PERM NO: F 057.`.e i PERMIT NO: P 057547 PLAN CHECK NO: N GOVT: N SUPA; N CONSTRUCTION TYFE: FERMIT iYPE: PLG PURPOSE; O':H JOB DESCRIPTION : SEWER LShE REAPIR SQ FT: CLAIM VALUE: CA�C—VALUF.; GROUF OCC: R-3 / COMMENTS: NO OTHER WORK APPROVED �if # K iE 1F �1F lf �tiiE #=# �JF�)[ if �1` �!f if # if 7f �Y' �1F �� if �IE ��lE if if �k �if �E �lf lE ak #�lE if �if if d(� K i: #�/; •lf � iE ie �1Fif if if #:4� if if iE �lf iFd! 9f If �Ir if �k #Y iE JE �Y. se.7E �If iE IEi: � if 3E 7. O N I N G R E Q U T R E v E N T S se�rBpcxs ------------ N,AIN BUILDInG ---------- --------- ACCESSORY BITILDIIJG --------- FANT: FT ItJ REAR; FT IN FRNT: FT IN REAR: FT IN LEFT; FT 1N RGH'i: FT IN LEFT: cT IN RGH:: FT IN PARKING RE • PROV; PA.RCEL; A241'%412 2�E: RE� NO; PLANNING N 'I'ES> > aE 1h # iE 1t a..lf iE ih iE?E iE iF 3f ih iE iE iE iFlE i!� 1f If ib #FiF?E if IF if ft if �iE iF if iF if #: if ik 1E # if �)hif 3k jC�-lE 1Eii� if i't jf�� iF if iF �lE iF 3E # iF #?E 1E±f * iE .Y iP iE #�##±E 3E!E 3i ' D E V E L O P M E N T S E R V 3 C E$,;.� R E Q U T A E M E I� T S �... ZONING APPROVED BY '' DATE: BUILDING APPROVED BY : � DATE; �. . APPLICATZON iSSUzD BY; DAT'E � �� aF?Eli.�f?FiF3ti3FiE3F#3��1FjeiFiE4ii#E1!�ik . . . .. tE�£7E . .. .x r.+riEtifiei'riEif�a�ifjf��'�'�F � xx iEi 1f i4 iF 1l'if Ii"K"ii' ie iF'If iE iE iE If iF ih+l' iF Y##'lE'1F iE IF iE iE iI' If 1e'IE iEiE iF 1F i�E iFlE iF'IE it if )I' IF }'1E # ik iF iE� if iI' If ie'K' if iE �f iF ii- if iE'I21I' il' iI"IF'IE'l� iF i(' if iE if if iF Ii iE LEGALI2ATION;N F E E S il M M A R Y STRUCTURAL SEG,'�E1:i:N BLDG PM'i PLUMHTNG ELECTRIC ,MECHANIC FIRE SMIP/RES GRAI�ING PERMIT 5 00 '15Y SMIP/NON—R£S PLAN ISSUE FEE 3,00 BUILDING—DIV—> PERMI7' IS5UE PLHN—CHECK TQiAL PAID DUE TOTALS-----> 5.00 3,00 0,00 B4O0 8,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 8.00 DVER/SRORT: 00 HLDG PMT PL[JN,BING ELECTRIC MECAANIC rIRE SMIP/TOT GRADLNG FLAN—CHECK 8 , � � 1! if�iE �K� Ih # 1F iE It dk if iF i(� if 3f i! !4 if� 1E fE If IE K ii 1E �Y fE # ii� y.1f at+F i!� iF M� i'r 1F # ih #f iF iF?f ie ib # jF af i4 if i4 i;. if� i!� iF iE 1E+E #� ii IF #�)E i4 iE !h i! k 1F if ie+f K iF iF 1E �E?'� I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D fi S C R I P T I v N UNIT COST TpTAL CUS'i' PLU 1 SFWER, BUILDING / TRAIifiR 5,00 5,00 ' £ND Ua= FEES i; � �� :.'L. . '. _ _ . n.��; L,.r� 'jl _ ' � 1. .� r . , .. .. . '' '" , �. . CONSTRUCTION AND PLANNING POOL �_rA APPROVALS. Permit# � Date Inspeetor APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pooi & Equipment Location 2. Soil Pipe•Undrgrnd. � 53. Steel fieinforcement 3. Electrical Conduit Utility-Wndtgrnd. 54. -Forms 4. Elettrica� Conduit-Undrgrnd. . 55. EVectrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE - 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgmd., Test 9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P�Trap, Q Undrgrnd. " 10. Structural Floor System � 61. APPROVAL TO DECK . 11. Prope�ty Sewer �ine & House Cqnnettion /J?,� L,�j� 62. Backwash & Raceptor�Final �� 12. Sewe� CaP 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System � Final 14. Rough Plumbing 65. Electricai�Final � 15. Rough Electrical-Conduit 66. Solar System�Final 76. RounhrElectric Wiring 67. Fencing & Access ApProval 17. Rough Wiring Sign 68. APPROVED FOR PLASTEftING 18. Ro`gh Electricat-T Bar Ceilin9 69. POOLiSPA SYSiEMS FINAL 19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCts, in Structure 70. Undergiound Hydro 22. Ducts, Ventilating 77. Product Pipinq O Gas ❑ Oil � 23. Gas PiPe•Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. floof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical � 27. Frame and Flashing 76. Dry StandpiPe 28. lathing & Siding 77. FIXED SYSTEM FINAL 29.+.Insulation 78. FIRE PREV. FINAL 30. Orywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION 32. Electrical Power Meter-Finat ' 86. FOOD CERTI�fCATE ISSUED 33. Finai Electric . Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test �� 1 36. Hood or Canopy "f- 37. Final Factory Fireplace �t 38. Final Plum6ing j,(� LE/J 39. Watei Service�Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backfiow Preventer 43. Backflow Irrigation 44. landscape Irripation SYstem 45. Sound Attenuation 46. HandicaP Regulations 47. FINAL STRUCTURE & BUILOING -- " 48. FINALPLANNING � 49. Etearic Release to Edison '• -t 50. Gas Release to Southern California Gas Co 51. CER7IFICATE OF OCCUPANCY No. Date AVplieanl to fill in all spaees ,CITY OF COSTA MESA. aeaMiT No. - CONSTRUCTION PERMIT /�— � o ' Addr�_� L C Arch/Eng. Address Contraccor �'� Addrea \�n�: LICENSEU CON7 I hereby affirm th� men<Ing with sec PfO1�5510f15 COtlB. i� 99�ature WORKERS' COMPENSATION OeCLARATION —,_ . I hereby atllrm that'I havo a cerHfiwte of consent to self-insure or a, VALUATION ZONE ��` � certi}iw[e of Workers' Compansatlon Insurance, or a certifiatl copy - thereof ($ettlon 3800, E. C.). (� GRADING CU. VOS. ACRES PoIICYNo. ComPanY �0.�� wY�fX • �r' 'srtitieC cOPY I5 �GreDy (urnlShGd. ' REMARKS_ • ' � . irtifietl copy Is tileC with the city Builtllfig Divlsion. ., , _ ' G..:MPTION.FROM WORKERS: COMPENSATION DECLARATION ' - (This sectbn neeC not De complatetl if the permit ii for one huntlretl �- . , (E100� or less). - � - ' - ' ` ` � � I tert fy that ln the periormance of t wOrk tOr which thi5 pe �t is IssueC, I shall not emPloy any pars any-manner sop 5 to come PLUMBING . PLAN CHECK suDjec[ to h kers Compensat n oLCallfopply� � �.°R"fi`�i2 _. . . //J .�/��/�� BATMTUBS' ' $HOWER$ wit�in heavy bortlar Iines anC slgn all approCfale tlec�nHor . TRACT NO. L�T NO. • BLDG. NO. �% � TVPE OF CONSTRUCTION ' � - PhOne - .❑ NEW ❑ ADD O AITERATION � �,� ❑REPAIR ❑CONVERSION ❑DEMOLISH LiCenSB NO. ❑ OTMER _ . DESCRIPTION OF WORK one -TVPE OF PERMIT ' ' ' O GHADING ❑ FOUNDATION ❑ STRVCTVRAL _ARATION . ❑ TENANT•O ELECTRICAL�.UMBING ❑MEGiAI untler proWslons of Charter 9(com- . , Divizion 3 0/ the BuSlnasS antl � Q OTHER �se Is- In /uu force-�� n�tl- Jeutf fzct. _ PR�ECT DESCRIPTION� LJtense No..�J�j.i ' - � 'S�.FT. . .. � _ . - -OCWPANCY � CONSTRUCTIONTVPE NOTICE: �I( attar making this c�claration, you oultl becorr�subjed TOILETS URINALS- to the Workers' Compensation Provisionz o/ t Labar Cotle(�{ou must Torthwitn comO�Y'�+�?h suth provislons or t permlt zhall be tleemetl �VATORIES DOUBLE-LAVS revoketl. � CONSTRUCTION LENDING AGENCV " ' -•' 'KIT. SINKS DISHWASHERS I hereby affirm that Ihere ii a constructlon, lentlin9 agency tor the per- SER V ICE SINKS SUMPS ' formanca af tha work for wnic� t�ls parmit is•issuotl ��Seclion 3097 ��'/� CJ� - ' ' ` ' - �•-� - ' FLOOR SINKS � ' - FLOOR DRAINS LAnCer'S Nama ' ' L.ontler's AtlGress' � " �� - �DRINKING FOUNTAINS �� " OWNER BUILDER DECLARATION - INTERCEPTORS ' CLARIFIERS 1 hereby aHirm t�at I am axempt from Ma Contractor's Licenu Law /or tho lollowing reason (Sectlan 7031.5 Businesi an0 Rotessions Cotlo: _.SWIMMING POOL �� -P TRAP � Any tlty or CounlY whitn requiras a petmit la <on5truct, aller, Im�rove, tlemolish or repair any s[ructure, prlor to Its iisuance,alio re- y�rqTER SERVICE '' ALTERATION qU re5 thC appliwnt for SUGh parml[ to fil0 a slgnetl SlateTGnt [hal he • Is II<onsetl Dursuant to the provlilons of. tne Contrattor'z Licenie Law GAS SERV ICE "- OUTLETS (�hapter 9(commentin9 wll� Settlon 7000) af Divlslon 3 of tha 9usine55 antl ProlMsions Catle) or t0at.he Ii exempt thcrofrom antl the. -yyqTER HEATERS� - BTU OUTPVT basis /or tha allegetl exemption. Any Wolatlon ot Sectlon ]031.5 by am• appllwnl for d permit SubjEttS th0 apP��Llo.d Civil penalty. SEWER�CONNECTIONS ` � t more lhan five huntlretl Doliars (E500). � as ownar ot the proporty, or�my employees with wages at their SOLAR TANK � - COLL CTORS s�._ �om0ansallon, will tlo [he work, antl Ihe structuro is not intentletl or olteretl tor ule. (Se<tbn 7044, Business anC Rotezslons Cotlm The SOLAR VIPING SYS. - " - Cont�aclOr's Licens< Law doel nOt apply to an owne� ot a propCrly who builds or improves lhareon,�antl who tlaes such work himsell or ISSVE FEE ' " NrOugh h15 Own employeGS, P�ovitl¢tl Itlat Such imD�ovaments aro not IntonGetl or otleretl�for sa�<: II, nowever, tne builOing or improvement MECHANICAL PLAN CHECK Is soltl wlthin one year oi completlon, lhe owner will have the burtlen ot proving he tlitl nol-bu11U or improve tor the purpose of sale).- HEATINGSVSTEM 0-100,000BTU_ ❑ I, ai owner ol [ne pro0orly, am exclusively contracting with qNDDVCTING Ilcansetl contractors to canstruct lh¢ pro7ect. (Sectlon 7044, Business 100,000+BTU_ antl Professions Cotle: The Contractor'S Ucense Law tloes not apply to an ownar o/ property w�o builtls or improves tnereon, antl w�o con- REFRIGERATION 0-100,000 BTU_ Vacti from Suth prO�eclS with a cOntractor(5)_ IIClsnetl pursuanl.t0 SVSTEM . lhe Contractor•s Llcenie Lnw): 500,000 + BTV _ ❑ 1 am.exampl unEer Saction B. 6 P. C. /or tbis "BOILERS BTV reawn Da[e Owner SVSTEMREPAIR,ALTERATION I ne�Gby certlfy t�at 1 have reatl t�is appll�tlan antl StdtG thal th0 dEOm EXHAUST SYSTEM MULTIPLE Iniormation is correcl. I a9ree to comply ' h ali city and county OrCinances antl itate laws �elating to conitrut , anE hereby autnorize represen[atives o thii city.to e e u -lha abore mentionetl- - propr:r[y (or i p ttion 0 rpose n Si9nature Date ��"' ' Drivers' Lic se or 55 � ISSUE FEE . - - CMF 0865-46 White- iltling; Canary-Appliwnt; Pink-Accounting: GOltlenroE-Assessor 3141 �/ I 8/H3� 5.o-�� Ti t . . . ,�. Z�NING REGULA7I�NS � � A.P. q 20NE REAR VARD (TO P/L) PKG.SPACE REO. STREET WIDTH SPECIAL CONOITIO ELECTRICAL PLNG.�REF. � � d0 BUILDyNLINE � ROPERT - PROVIDED � PARK FEE y � - DA7E PLAN CHECK I • I - - - - GENERATOR Od KW_1-10 KW — TRANSFORMER - ' APPLIANCE 10-50 KW_50+-KW _ � - MOTORS' '- 0-1 HP_1-30 HP _ _ ( W0. SOLAR) - 30-50 HP=- ' S0 t HP _ - FIXTVRES OUTLETS SWITCHES � - GAS TUBE 516N5 '- - ' ' "" ' - POCE LIGHTS ' ' ' ' " . MAIN . - SUB - ' ' AMP �� j� � �_. � �� a � FPPIICATIONAPPROVEDBY - _ ' OATE" - � SUMMARV OF FEES . � BUIL�ING ' - '- ' ' ' PERMIT E SMIP .S PLAN CHECK S � PERMIT r � � ISSUANCE E PLUMBING S.�i� ' " � GR%iDING E PLAN CHECK S � , . ELECTRICAL E - � E - PLAN CHECK 5 MICROFILM E' MECHANICAL E TOTAL FEE E LE55 AD= � PLHNCHECK E VANCEPC S �� FINALFEE 5 •�t% CONSTRUCTION AND PLANNING ?OOL & SPA ` � � _ � APPROVALS Permit# -�� Data Inspector qppROVAIS� - � Permit# Date Inspector � 1. Temporary Electrical Service or Pole � � 43. .Pool & Equipment Location � � � � i il ipe-Undrgrn� � • 44. Steel Reinforcement. � - - -- - - ; 3. _ lectrical Conduit Utility-Undrgm__ �� 45. Forms . � ' � - i 4. Electrical Conduit-Undrgrn - 46. Electrical 8onding � � ' - � ' " ' - - " � , tee ein orce � 47. Rough Plumbin & Pressure-Test " - " 6. lectrical UFER Grn 48. _APPROVALTO COVER-GUNITE � 7, ootings 49. Electrical Conduit-Undr'rn - 8. Foundation - � 50. ��Gas P.ipe, � Undr rn, Test ' 9. , Water.Pipe-Ondrgrn 51. . Backwash Lines P-Tra ❑ ndr rn � ; 10. Structural Floor System �� 52. APPROVAL TO DECK � ' 11, Property Sewer Line & House Connection -,t0�-8.9 53. Backwash & Rece tor-Final 12. Street Sewer Connection � � 54. • Heater & Vent-Final ` 13. Rough Plumbing - 14. Rough Electric-Conduit '56. Electrical-Final 15. - Rough Electric-Wiring "57. Solar System-Final � 16: � Rough Heating & Air Conditioning � ., - • encing & Access Approval - 17. pucts in Structure �APPROVED FOR PLASTEflING - � 18. _ Ducts, Ventilating - - ' 19. Gas Pipe-Rough & Test � -- � - ��• POOUSPA SYSTEMS FINAL . 20.' Roof Framing - - - � 21. Roof Sheathin - - � - ' 22. Frame and Flashin - NOTES: . � 23. ' - (nsulation _ -. . ' . . - ' " .. - - - -� ' � ' 24. � I.athin &.Siding. - _ ' " - - • -u ' ' 25. � .prywall Nailing ' - ' ' � � ' - 26. �. Plaster Brown Coat --- - � ' • 2Z,_. Electrical Power MeterFinal - - -- • - 28._: Final Electric � � � - - -� -- � � 29._� final Heating & Air Conditioning. _ - - - - - - - ' � 30.! Final Gas Pipe-Test ' � ' - � - � � - � � 31._� Final Plumbing - � ' , 32.- Water Service-Final - � � 33. Gas Se'rvice-Final � ' 34. Solar pomescioFinal � � � � ' � • ! 35. l..andsca e S rinklin S stem � - �� - ' 36. Sound Attenuation � � , 37. Handicap Regulations ' ' � 38. FINAL STRUCTURE & BUILDWG ' 39. SPecial Requirements Completed � - 40. Electric Release to Edison • ' 41 . Gas Release to Sou[hern California Gas Co. ;42. CERTIFICATE OF OCCUPANCY . No. Date - . �': COsta Mesa Bnilding Department � 111 EAST 20th STREET �,,. r COSTA MESA, CALIFORNIA FOR APPLICANT TO FII.L IN 1 Addre�se / �pC �M � � Costa Mesa, Califoruia/ B - � ■ Owner Addross trea Address and � �Exterior . .�� City Llo. No. Nowon Lot �^eY No.of No.of Familles Rooma Add PLICATION FOR PERMIT BUILDiNG � 'OR Ok�+'ICE USE ONLY I Receipt No. Permit No. (7�8 I by, Date Rec'd. r Data Issued �� I S'.� � Z....SS •�.j�i,5'b ? � � U..� - l 5' `F�/�' r��. Costa Mesa, California r� .. ..�. � ,T ,r CORRECTIONS C�— /�o t 1:: 7' ':('1 APPROVAI� in Loeation I Inspecto Materlals, I hereby acknowledge that I have read ttus Applicatlon and state that the above is mrrect and agree to comply Lath. Int with all City Ordinances and State laws regulating building rnnstruction. Lath. Ext Signatureof Permittee Plaster,lnt Authorized Agt. . � � Plaster, Eut Vaivatlon . Permit Fee $'3rS� �yC� Masonry Reinforced ��2 / �� Plan Check $ «% — Bond Beam J (o '/ (y p G $ �/�' Fee' 7 D FINAL � FORM 204 S-BP 2bS &55 . O p G> l ■tf I } . � �:', ,. �^.^`s- ': J. _ � ..� &how Iocation and dlstanees from property Iine and between buildings .. .., ., .- ._ � � - t. : � _ :'.. ��. s. ; _ , _ . . . ._ ' . _ . . r. ^ _ .ri • . _ ,. \ . . ,..^ r.:i�. � ' .. . i. . . , . - �" ' - ' r :'. ;.. : ?�Q?d COSTA MESA BUILDINCrSAFEfY DEPARTMEM P.O. BO%01] COBTA M88A. CALIROPNIA For Appllcdnt to Fill In Completely TYPE OR PRINT BUILDING 73Z E�F cu�--/�'� ADDRE58 • � COSTA MESA.�CALIFORNIA � l�L�q, _1 1 � 'Nl% OWNER_ � .� SG ( ADDRE88� �' �O T rTw . . . � TEL.�O�J�^. CITY NO. ARCHITEGT� � �I � A � A' _ � � TEL. . _ _ ... FEE REC�IV�D F�IN(ANCE�DEP : �\ ��L�IC�441dN"F�R" 7ERMR BUILDING :'For.Oiiice Use Only R8C81R NO. H�T NO. ilv , B 'OA xecelv�o . �j G�I9/ e� L l /i 7� )INO � E88 • • • • . . TYPF 6ROVP � JVED . � � OATE I� /O l'�� j LBOAL � /i1 "i/ COl( /'H/i(J /�� N ADDRHi6 ✓� IJOVe Y Y'. �\(; i � DeDCelrtloN cirr ti� C-: k.! P O lLT I E'A � H A. P. NO. I/� �•' IO �I —I� � STATE / TEL. /_� �� j 90T TO SIDE Q REAR p, LNO BHALL BE L888 THAN LIC. NO. �� NO. b � EAVES 612H � / no.oPe�uae. ALLOWED (U.B.C.RE�UIREMENT) OF LOT � O noW ON LOT . YARDSMPROVED YARDSAPPROVED U6EOF ' MAINBUILDINO ACCESSORYBUILDIN6 EXISTINGBLDO. W �(. N '(FROM C/LSTREET) 1_ . • BBTBACK LINE RPOM PRONT /7�� d � �� c6rvTEx oF sTncei REAR YARD ^� ' SIDE YARD I LEFT I R16HT R. SIDE G-� FT. � :'�. DESCRIPTION OF WORK L.61DE -'`—r�r. —' Fr. NEW _ ALTERATION � ADDITION ` RHAR ZS �. '�' � DISTANCE BET. BET. MAIN Q RE� M VINO DEMOLIBH MAIN BLDGS. ACCESS. BLOOB. 6 ZE�ING ROOMH $TORIEB VA� /O �/ APPROVEO�Za/`y EXTBRIOR WALL I ROOR � MPROVE 9/'z,L�/`f/ GOVERING COVBRIN� BY DATE U8E BUILDINGAryD RKTOBEPERFORMHD y/ T ,�` HOLD FOR SP �j � P/4J-G � � / �� so. rr. I HBREBY ACK WLHObB TNAT 1 NAVB RBAO TNIB �PPLIGTION TM8 AMOYNT 8X0 IIN�Bq VALUATION 19 POR TXH � AND 8TAT8 TMAT 8 �BOVe 18 COH HCT �N� AORHe TO COM• PURP09¢ OP 8BT BLI8HIN0 A PHPMIT P88 ONLY. Q PLY WITH ALL Y qDINANGHB AN T8 LAWB qeOULATINO ypLUATION q BUILC�NO CON RY ION. ' p SIGNATUR _ j PERMIT FEE S j PERMI77E s / ��C%✓ �� r ¢ O AUTMORIZED AOHNT `/ �j • � TOTALFEE 4 �`� D �/i„r�.�� S.$�c.-�Pc�cu : , . -: .�� ---. . . _ _ . _ _ ` .. .: . ( -i�� i � �� .J � � r .:' .•;, `-. - � - . .. .. 1 . _ . . " _ " ' " . R a.�_ _ ^:t , a �_ ��{7 �.� . .. . . . .. ('�:i(i :7ai4Rlli� .. . . . • ?2'.tA ;;TL�iv 1? 'i'!1 - �;- :_._...:.... � . . . .� .. . • . SPECIAL REQUIRII��NT: - ' -�.�-. . ,. .a . , . . _ . . . - ', -_ . . 1. One Class A Fire Hydrant to be installed'per 3rir`e,Department� ' requirements as 'indicated on plot�plan;;-_,;` • - ,- • � •' 2. Miist�meet�all the�requirements of_the,1961:_Ut�iform Fire Code; 3• �All areas not prescribed for parking�to be m�xked ".No Parking"; :`--i i;^4': ' Tree glanting c6mgatible with the .area-as- indicated on the ". . Plot �lan: . . � ,r,�''i i , - a;�","''S•� Installation`of re'sid'eutial sidewalks and concrete driveway . ' ' - � � approaches by'tHe applicant,��at�:his expen'se,.�as per ' �� - , standard specifications of the City of'Costa,Mesa.� - . i.: _ ' �',�'6:. Screeriing of the parking iri �the front as per stanclar,d, _ - g " specifications of the: City of Costa'Mesa. •- •. -. � `: : � �� _ - - • -- • ' ' ,� . • , _ ` .. . . ' "" ._ . ....,. _ • , . � .. , . .- - - - - -- - --: ,1a ., .. , . ..... . . -----_._ .._- - � . . �- • � , - ----_- •.-__.-_.� .......__-. �..1_: __.. _ �. . . . � . � , ' . -�. , . � . . - . . _. _ . _ ' � I .l ♦ ' 1 . ( . � . � . . ' . . ... .. . .. ..... .. . � ' . . � . . ' . . .. . . 1 ' ' . . ' . ..��.� . : ' �. . ' ' �- y. ' . ' . . . _ . .' ._� � . • . . . ... _ _ _________ .K______ ' • . ' _ . . � . .. . s � .. . . � "'. _ . . ._. .. .. , - ;� " "' _" "......___ 't.-.......�.. . "_"' _' . . . . . _' ... .._ _._ -..n _ ..... . _ . " . .\ �. � . _ .._'. " ""' "'.... . .. ..._ ., _.__�. � _. . . . . ._ - u.. .. . � , . . . ... _ �: . . , �. . ' _ -. _ . . . _ .. _ _.,^ ..._ ._.. . „ I . ' .:4J�7i.F��:i��i�,�:: ��. .3nr:i; �{��_� S��i�'. ____ . _ _ _..."'_._..._..._...1. � ` . . ._ . _ .. � _ . a � � \ � v .. . . � � . . ., ... 1. \�. . .�. 4' .1 4 _ .i� Yr�= �3_i.�.... . ♦ i _ . �\ , : -- .. .. �-- . - .-' � -' - -._"_�`'- "_"- • . . . . . � �.-- -. _" ---- - ' . . • � .. � . . . , ' �'. - . :�:.. n � - .--- . , _'.. . .. . .=.n ,.i� , ,,,, _ , , . .:y.�..,,',,...`., _ � . • _ ' �' . .. .._.. .... - `; --- ' - . ... ... � _.. . . _.._. _ - �' 't'' ' ._ . . - .' - . . , _ . . ., .. , , > � ••'�..�- . ' . . ._. . - , .. . ;' . . ' ' " ' . . . . . : -. . . .. . .. . . . �: -�.. _ . . .. . . osta Mesa Building Department T� 117 EA8T 20th BTREET - � � -` �- CO�TA MESA� CALIFORNIA I FOR APPLICANT TO F�LI. I11T ■ Owner or ■ Address � F9 ■ New - �� Mesa, �� APPLICATION FOR PERMIT �� BUILDING ' FOR OFFZCE USE ONLY I Reccipt No. � Pe�mit No. �9 Re9ce/ived/bqq' �rDate Redd.`` Dato Issu�/'/ rL�l.f� ` O _ .� ��il��L��'�J � naaae� 3 2,LiJ- !S'�� Costa Mesa, California ,t� 2 � Nearest ` Cross St. rr' G-e AJ /�L. I hereby aclmowledge that I Have read this Applicatton and state that the above is correct and agree to rnmply with all City Ordinances and State Laws regulating building constructipn. Signatureof Permittee I V $ L4 � 204 S-HP 2M Permit Fee $ Plan Check $ Total CORRECTIONS 8 APPROVAIoS Forms, Materlal: Under-Pinning Frame: Fire Stops, ' Gl.i Plaster, Eut �� G Masonry Reinforoed L �� Bond Beam � N � � I :. . � C. .. " . .. ... � .� _ � . .. . . . . . . - . ..�.. ' • ,! � • . -- F ` ` , _ ' __ . � ` . � rurY� i�t� Show Iocation and disYances irom property Iine and between buildinga . ,-�:�-- _ ' I , � _. . _ _- -' - � - - � _. .. , .� � � � � �' ,'+: " - _ _ . _. . � - ---- - - - -- � - -- � � - � . . _.— .. - - .- ' - ' �' �� - : - ' - . -� ' � . . ., . - � . � . - : -. .. _ . .. . � _ - -' ' . . - � . �.