HomeMy WebLinkAbout850 18TH ST - Building Permits(714) 754-5273 • Fax (714) 756-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 850 W 18TH ST
Suite:
Vicinity: SILVER STAR
Parcel Number: 42418229
npp�icant: HANSEN, DUKE
Address: 260 E ALTON AVE
SANTq qNA, CA
Owner: ROTHSCHILD, PETER B TR
Address %DAVIS PARTNERS LLC _
NEWPORTBEACH,CA.
1420 6RISTOL ST NORTH#100
Contracmr. ROSS & BARROWS INC.
Address: 260 E ALTON AVE
SANTA ANq, CA
Zip: 92707
Arch :
Address:
Zoning:
Phone: (7t4) 557•7440
Zip: 92707
Phone:
Zip: 92660•2914
Phone: (714) 557-7440
License: 327802
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 11/01/2002
Issued: 11/01I2002
Phone:
Zip: License: License: �
SCOPE OF PERMIT
REROOF: T/O EXISTING B.U.R. AND INSTALL NEW B.U.R. 178 S�UARES
FEE SUMMARY •
Plan Check: $0.00
Permit: $401.85
SMIP Res: $0.00
SMIP Com: $5.30
Other: $0.00
Inspection: $0.00
Total: $407.15
SETBACKS ; �� � - � �
MAIN STRUCTURE Front 0- 0.'�.' >� ' Rear 0- 0
ACCESSORY Front 0- 0 _' �Reac, 0- 0
PARKING Exisbna: 0��,R uired: 0
NOTES:
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation: Szs,zso.00
Claim Valuation: 525,zso.00
Right 0- 0
Right 0- 0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitomia statutes and relaled
regula�ions. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRA7ION: This permit shall automatically expire and become void if work Is not commenced within 780 days, or il work is suspended or abandonad
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlona and Iinel epproval must be obtained. Fallure to obtain inspections and tinal approval will result in the expiration of this permit.
FOH INSPECTIONS CALL: (714) 7545626
�aawe (e�ao�
WORKERS' COMPENSATION DECLABAY�ON: `
I hereby eftirtn untler penalry ot perjury one a� the iWlawinp tledara0ons:
❑ I have entl will meinteln e ceniticete of �on.SeM to self-Insure lor workers' compensatlon, es provitle0 for by section 3700 of tha Lebor Code, for �he peAartnance of the
work br which ihl5 pertnit is IssueC.
� I heve efM witl maintain wakers' compa�� i�surance, es required by secUon 3700 ot t�e Lebor Cade, for the peAortnance o� Ne work for xTlch this pertnl[ Is issuetl.
My workers'jP mpensatlon Insurflnce camer and polry number ere:
Cemer. .i T�/ 7P Jl✓�/� Policy Number: QY� � Z d d�O Ffl.S—
(Thls sectlon need not Oe com�ted il e permit Is valuetl ef one hundred dollers ($ f 00) or less.)
❑ I certify thet in Ihe peAormance ol the wa� �or w�ich this pertnit is Issuetl, I ahell not employ eny person In eny menner so as to 6ecome sub�ect to t�o workers'
compensation lews of Celifomla, antl ag�ea thet ii I should become sub�ect to the workers' compensatlon provlslons ol Semion 3700 of t�e Lebor Cotle, I shell forthwith
camPty with IheSe Pr ' io s.
MD���emSipnewre: �/� /� Date: ��—�/�OS
WARNINO: FAILURE TO SEWRE WORKERS' COMPEPISATIOM OWERA(iE IS UNL4WFUL PND SWLLL SUBIECT AN EIM�OYER TO CNMINAL PENALTIES AND pNL FlNE$ UP R1 ONE HUNDRED
THOUSMlD DOl1ARE (5100,000), IN ADDITION T07ME WST OF OOMPENSATION, DAM4GES AS PROVIDED FOR IN SECTION 3708 OF THE UBOR CODE, IMEREST, AND ATTORNEI"5 FEES.
LICENSED CONTqACTORS DECLARATION:
I hereby ottirm thet I em liconsed untler prov�slons ol Chepter 9(commencing wilh Section 7000) ol Dlvision 3 oi Ihe Business antl Prolessions Cotle, end my Iicense Is In full
lorce end eHecL Lic. q 2 pZ. Cless p G�3 9
Cantreaor'sSigneture: /ia Dete:1�—o/— �2
CONSTRUC710N LENOING AGENCY:
❑ I hereby eNirm that l�ere is e canstrucdon lentlinp epenty tOr Ihe pertormanco ot t�e work for which t�is permit is issued. (Sec. 3097, CiNI CoEe).
Lenders Neme: Landefs Atltlress:
Slgnature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby etflrtn Ihet under penalry of perjury that I em E%EMPT FROM THE CONTRACTOHS LICENSE LAW tor Ihe Iollowing reeson (Sec. 7031.5, 8uslness end Protessions
Cotle: My Gry or counry which requires a p6Rnit to construn, alter, improve, demdish, or repeir any siructure, prior to its Iuuance, also requires �he epplicant tor suM permil
lo tile e signed statemeN that he or she Is licensed pursuem to t�e pmvisions oi Ihe Contrectars License Lew (Chepter 9(commenGng with Section 7000) ol DMsion 3 of Ue
Busineu enC Professions CadeJ or thet he or she is exempt theretrom and the basis lor Ihe elleged e:emption. Any violetion ot SecUon 7031.5 by eny eppiicant tor a pertnit
sub�ects ihe applicant lo a clNl penalry of nof more than tNe huntlred ddlars (550�).):
� t, as owner of the property, or my employees with wages es ihelr sole compensetion, WILL DO THE WORK, end the structure is noi intended or ottereG lor sale (Sec.
7044, Business and Professions Code: The Contractors License Lew does not epply lo an owner of property who builds or improvas �hereon, antl who does such work
himsell or herself or thmugh �is or her own employees, pmvidetl Ihat suc� impmvemems are nat intende0 or oMered tor sele. If, however, the bulltling or improvement b
soltl within ana yeer oi completioq the w+nerbuilder will heve the burden of proving Ihet he or she did not build or Impmve tor purpose oi ule.).
❑ I, es ownar of the property, am E%CWSIVELY CONTRACTNG WI7H LICENSED CONTRAC70RS b constmct ihe proJect (SecJ044, Business end Professions
Cade: The conirecrors Llcense Lew does not eppty to en owner oi property who builds or Impmves t�ereon, antl who contracis far such project with e contractor(s)
licensa pursuant to the Conirac�ors License Laws.).
❑ I em exempt under sec. Business and Professions Cotle for Ihis reason:
Signature: Date:
Owner ID venfieG by tlrivers Iicense. ❑ Yes ❑ No Drivefs License No. Ezpires:
Vedllcatlon of Ownershlp by (rype ot documenL i.e. - propeM1y tex bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereDy certly ihat no excavetion tive (5) or more leet In depih Into which e pereon Is required to tlescend, wlll be mede in wnnectlon wit� work eutho�zed by Ihis
pertnii, enC the� no builtling sWcture, s�eflolding, ielsework, or tlemolillon ar dismentllnp thereoi, will be more then thirty-six (36) feet hlgh. (Chep. 3.2, Gry 2, Art 2, Sec.
341, Title 8, Celitomia AEminlsiretive Cada).
❑ As owner-huilder, I wlll not employ enyo^e to tlo work which would requlre e portnl� trom t�e Divislon ol Industrlal Selery, es noteA eDove, unless such person hes e
permil lo do 5uU wofic trom lhe division.
Signature: Date:
DlNslon ol Industrial Selery Pertnit Number:
CERTIFlCATE OF COMPLIANCE ANO AUfHORPA710N OF ENTAV: I ceriity under penalry of perjury ihat I �ave reatl this epplicatlm and stete Ihat the intormation gHen is
correct. 1 agree to crompy with ell sWte laws and ciry orAlnences relating to bulldinp constructlon, an0 authoAze representetives of the City of Costa Mese to enter upon iha
ebove-described property for inspection purposes. 1 egree not to acupY or allow occupency of eny building euthorized by this pertnit until finel inspection.
COOE I. INSiECTONME
1818 Fixed System Flnal Fire Prevention
1288 Paol Spe Flnel
200 Finel Re-Rool
201 Flnal BIxWRetelninp Wall
202 Final Fectory Fire Plece
203 Final Sipn
204 Final Demolitlon
i,�w.
n "oi, C
//— � / —�r��
Data
CODE 1 INSPECTION TYPE
206 Finel Mechanicel
20B Final Plumbinp
210 Final Elec�dcal
212 Flnal Fire Pravention
220 Finel Planning Approvel
222 FinalSite
250 Final Building/Occupenty
PAIE 4�L4
�
(714) 754-5273 • Fax (7�4) 75a-a056 • wwv+.ci.costa-rr}a�€aSul�1PRESSION PERMIT �� FAIF L7FiIVt, GUJ IA MtAA, l:A y2726
JobAddress: 850 W 18TH ST
Suite: E
Vicinity: FIESTA CONCRETE (STE E)
Parcel Number: 4241$229
npp�icant: BERMUDEZ, MIKE
Address: 1515 MACARTHUR �
SUITE 14
COSTA MESA, CA
Owner: RO7HSCHILD, PETER B TR
Address � °hNEWpORT COAST MNGT CO
151 KALMUS DR SUITE 0.
INC
Contractor: COAST FIRE EQUIPMENT
Address: 1515 MACARTHUR BL #14
Zoning:
Phone: (774)751-0748
2ip: 92626
Phone:
Zip: 92626
. i)
Slatus: ISSUED
Applied: 09I0&2000
Issued: 0927I2000
ISSUED BY:
Phone: .714-751-0748 � �
. COSTA MESA,CA ' Zip: 92626 � - , ' 1
License: 495750� - � '
SCOPE OF PERMIT
ADp 9 SPRINKLER HEADS FOR "FIESTA CONCRETE" IN STE E.
Plan Check: $35.10
Permit: $54.00
Other: $0.00
Total: $89.10
FEE SUMMARY �
� � � Calc Valuation: St,soo.00
" � � `� Claimed Valuation:, 5�,soo.00'
� ' - . .. /
, , �,
. , ,
NOTICE: The work aufhorized by this permit shall comply with all applicable handicap access. requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) ' '
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7B0 days, or if work is suspended or abandoned
for a period of 180 days.
i
INSPECTIONS: In order tqr tha wark authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepeetione and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
/
zaas�as lerool /
WORKERS' COMf�ENSATON DECLARATION: ' ' �
I hereby aHlrm under penalry of perjury one ot Ihe following tledaratlons:
❑ I heve entl wlll malntein e certificate of cnnsent to setl-Insure br workers' compensetion, es prodtled for by sectlon 3700 of the Lebor Code, for Ue pertarmance ot t�e
work for which ihis permit is issuetl.
❑ I have antl will maintein workers' compensation Inw�ence, es required by section 3700 of the Lebor Catle, tor Ihe peAortnence of the wark for which Utis pertnit is issuetl.
My workers' campensatlon Insu2nce cartier end policy number ere:
Certler. Policy Number:
(Thls sectlon need not be completed i/ Ne perMf !s ve/ued ef one huntlre0 dWlars (5/00) or less.)
❑ I ceNty thet in Ne peAormance of the work for wnich Ihls pertnit b issued, I shall not employ eny person in eny manner so as to becane subject to the workers'
wmpensa�ion laws ot Celifomia, end egree that if I should bemma sub�ea to Ihe workers' compensetlon provlslons oi SecljQn 3�00 of Ne�/p� r Code,.�shell fwthwiN
comPN wlih lhese Provisiopa �/ / ^ / ! ���
'Applf�antSignatu� � Dete: �
WARNINO: FA0.URE TO SECURE WORKERS OOMPENSATION COVERAGE IS UNLAWRIL AN� $HALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTES AND CML FlNES UP TO ONE MUNDRE�
T/iOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF GOMPENSATION, OMNGE$ AS PRWIDED FOR IN SECTION 37080F THE UBIXi COOE, IMEREST, ANO ATTORNEY'$ FEE$.
LICENSED CONTRACTORS DECLARATION: .
I hereby aHirm t�at 1 em Ilcensed under provlsions oi C�epter 8(commenGng wlth Sectlon 7000) ot Dlvision 3 0l Ihe Business end Prolessions Cotle, end my Iicense La In full
torce and eHect. Lia a Cless x
Contractor's Signatura: Date:
CONSTRUCTION LENDING AGENCV:
� I �ereby eftirm that t�ere is e construction Ien0lnp egenty tor the pedormence ot the work for which this permit Is Issued. (Sec. 3097, Civil Cotle).
Lendefs Neme: Lentlets AOdress:
Sipnetura'1 Date: �
OWNER-BUILOER DECLARATIONS:
I hereDy eXirtn that untler penelry of perjury t�et I em E%EMP7 FROM TME CONTAACTORS LICENSE LAW tor Ihe lollowing reason (Sec. 7031.5, Buslness antl Protessions
Code: Any ciry or caunry which requires a pertnit to construq, alter, improva, demdish, or repair eny strucW re, prior to its issuance, fliso requires the applicant for such pertnit
to file e slgned stetemam thet he or she Is licensed pursuem to Ne Orovlsions of the Contradors License Lew (Chapter 9(mmmencting with Section 7000) of DlNsion 3 of Ihe
Business end Prolessions Cotle) or Uat he or she is ezempt t�eretrom end the basis 1or the alleged exemptian. Any violetion of Section 7031.5 by any applicant for e pertnit
subjects the epplicant to a civil penalry of not more than Iive huntlretl doilars ($500).):
❑ I, es owner ot the property, or my employees wlth wages es their sole compensation, WILL DO TME WORK, end Ihe struc�ure Is not intandeC or offeratl tor sale (Sec.
7044, Busineu and Professions Cotle: The Contractors License Lsw tloes not appty �o an owner oi propatly who builtls or improves thereon, and who does such work
himsetl oi �erself or through his or her own employees, providad ihat such improvemenis are not imended or oflered tor sale. If, however, the building or improvement Is
soltl within one year ot completion, the owner-builtler will heve !he burden of proving that he ar she tlid no� build or improve for purpose of sale.).
❑ I, es owner of the property, am EXCWSIVELY CONTAACTING WITH LICENSED CON7RACTORS to consWct the project (Sec. 7044, Business enC Pmtessions
Code: The contrectors License Law tloes not aDP�' �o an owner ol propeny w�o builAs or Improves iherean, entl w�o coniracls tor such prolect with e contrector(sj
license pursuent lo the Contraclors License Laws.).
❑ I em exempt untler sec. Business antl Professions Cade tor this reason:
Signeture: Date:
Owner ID venlied by dAvefs licansa. ❑ Yes � No Drivefs Llcense No.
Verifiratlon oi OwnersNp by (type ot documeni, i.e. - properry tar bill or tlee0):
DIVISION OF INDUSTAIAL SAFETY PERMR CERTFICATION:
Erzpires:
❑ I hereby certlty that no excavation frve (5) or more taet In depth into which e person is requireC to descend, will be made in connection with work euthodzed by thb
pertnit, end thal im huilding sWCWre, scaMdding, tfllsework, or demdifion or tlisman0ing ihereof, wlll be more Ihen ihirty-sl� (36) feet high. (Chap. 32, Gry 2, Ah 2, Sec.
341, Tltle 8, Celifomie Administretive Cotle).
❑ As owner-Dulitler, 1 will not employ enyone to tlo wak which woultl repuire e pertnit trom the Dlvlsion oi IntlusMal Sefery, es notetl eDove, unless such person hes e
permit to do such work irom t�e division.
SlgneWre: Date:
Division of Intlusinal Setery Permit NumDer:
I CERi1FlCATE OF COMPLIANCE AND AUTHOHQA710N OF ENTFiY: I certity unUer penalry ol perjury that I �evo reaa �his applicetion end state that ihe infortnallon gNen is I
1 conect. I agree to compFy wit� a11 state taws antl dry otdina�es re{ati� to bulWirvg constfuction, anC euihadze represe�tatives ot the City of Costa Mesa to enter upcm �he
ebove-doscribed property for inspectim purposes. I agree rat to occupy or ellow occupanry of flny building euthonzad by thi9 pertni� unGl final inspeclion.
COOE �. INSPECTONTYVE
1616 Fi:etl System Finel Fire Preventlon
7266 Pool SDe Finel
200 Finel Re-Rooi
201 Flnal Block/Retalning Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolitian
�ae,��
o ,e
�jF J[{�{$ �Qy�j INSVECTONTYPE
�-�ir �� ��1�_ 208 Finel Mechenical
208 Final Plumbing
210 Final Electdcal
212 Flnal Fire Prevenllon
220 Final Planning Approval
222 Finel Slie
250 Final Builtling/Oaupenq
� �
l -19.-D 1 �
I�
AODNFSS OF BIRlqNO: � S O w 1 i TH rJ T UNT' E
�Rsru�EiFa,ox":AOTHSCHILD, PETER
` ��866 W 18TH ST
COSTA MESA, CA 92626
" 662-5525
Rm�. �.uuNc �ooness:
umxrtecroxEnf+m�n:ROBERT COULSON ������ 51730
wcxon�•s�oox�ss: '7g01 ORANGETHORPE AV �M
BUENA PARK CA 90621
•CaNIHACidI'S NAME
ca+m�croxa �uuNo
,�nonEss: ua no.:
uNr:
LICENSED CONTNACTON9 DEClAR1TI0N: I heroby ellim uMer pa�W y W paejury tlut I em IMnrd undar pwWm� W Gheplx Y
�,�,,,,�.�ro �n s«iw�, �000l a om.�, a a u» a�� w r�d«aw coe...�,a mr u�.�. ��� wn roR..�,d.�a.
em uc. No.: uc. euas: ue. No.:
Deta: camreaor.
OWNEN BUILDEF OECLANAiION: I Mnby dRrm untlm pendy W pm�ury �Mt I un wmq fmm IM CON�edm Liuiu� law la tM
'Mbxiq raeaan (�a^ )�1.5 Bueiima ud Rdasiam Goda: Mry cdy n oouny xfiirA ipuirp e pa'mil lo mmbuct. Mr. improvs.
�mdih, a ropLL eny N�uctura, piaW as eweiwe, dso requiiu iM epplixnt ta euch pamiil lo fiN e dpmd Helamant Ihtl M a eM
. lioemed W�Nt lo IM qoviebm d Uw COMreCon lioema lew �CNqw 8(commarcLq wil� Batlion ]000) d �ivubn � d the
Bu�'vass eM PrMaviwa CMeI a �hm M a dro b wmq �hsahan and iha Wae In Ns Nbpd uanqion. MY videtbn M Satlion
]OJt.s by vry eppliwu 1« e pemm supjM� �Ae eppl'raM �o e dW penMy d nol mae Ihen live IwntlnE Edlais �SSOOp.
•� I, d oweier d iha poq�y or my amplv�see x�h weqa m tAei ede oompemetion, xill do Ihe Mwk, eiW �he e�iueluro u nd inteiMed
w er
1C�� wolleredlaoele(Seclip��pµ,gueirianeMPmlaeebnsCaCe:TheGonvedonLicensaLewtlomrroteppF/IoenownerolqopeM
who Wida a imD�e I�eraon, enE Mw dwe suM wwk lvmaell or heneN or ihraph he a hx own empb�en, pmvked ihet wch
impv+emenla ere rot iMeMed v dlmeC f« eeb. X. Mwavar, tM buidirp ar inpwameN w sold wnhin ons yaer W mmpbtion. Ne
mvrier-0uildar will hew IM Eukm d pavinp M w+M d'd nal brilE a impwa Iv tM WNa< d veb).
� I. u awmr d ihe pWeMy. em eatlu�ively mniredvq v.nh Iqenaed conuenpv to con�rup tM 0�1� (�� ]01�. Busi�a eM
Vmlevom Code: TM Cauream Lirorue lew Eoes rw� eVW b en owner d pW�Y who builde a'unpwx tMraon ud who
wnvaeb Iv mrh prqena wAh a meurma(a) liewed punuem to 1!w CaNradva lioeroe lawl.
� I em exemp uMr Seqlp�; / B. 8 PL., f« Uu reewn: //� /�� � �/ __�
Dele: � ��./� l� Ownar: /i�%/ —��/ �(/ "�
r
I do Mreby cenM � I e/m awua d aM imdenunE �he iaqui ema d CelAanb Meetlh vd Saiery CaEe Seeioru 25505. 2551�. eM
255�e. eM Mei 1 a enY Mura puNup omrynni will / wil wl (eeeb ma) need �o mnpy w1� eeiE etma mdea enC iM �apuinmmn br
e eerm� lamnewction a modiRralionhwn�MAiawTiyi.ranepement qatrid. Rmkentid amn�udion appira�iomen exemq Imm iha�e
Dma: App:�am:
WORKEH'S COMPENS�TION DECLAF�TION: I Mroby e/fi�m uMx paroM1y d pa�ury an d �M blbxieq Eetluetiona:
� I heve end xil meimen e eerliliee�a ol mnaenl �o saHynwro br Moeken' eompanaetion, m prwidad 1« by Setlion 3]00 G ihe lebor
COEe, fw �he paAamer�ce d Na xark la w1Ych thn pamul ie us�etl.
� I heve eM wil meintain xvMen' compenae�ion ineuruxn. ea raqui�eE by SeGion J)00 d ihe leEa Code. b IM perMmence d tM
wak la wfiz� ihie pert�� ie mued. My waknre' compenstlion inaurenu faner enE pdiry numbm me:
c.m.,:
aacy M,me�.:
�,hnis ..nim �..e iwr w�mrd�ee � rn. rom+� i, rd an nunered ea�e�. Rim/ a�,J
� i eenM �nm m in. wno�� d me wax t« wntn in�. ro�n �. ee�ee. i snen na emdw dn venon in env m.��e� .o es io
eec«ne eudea �o ine xarkns� comwmm�on lew. d celiromie. ene mree uim n �.nww exome wbjw �o ine workare
mn,p,nsmon o�+�+ a seaian a�oo w ine �mo. coe.. �.n.n �mnwnn oomoN wnn ino.. v�ow.ions.
Dele�, ADd'ranc
� W�mlip: F�Nun b ucun wolkr�' nmqru�tlon cw�rp� l� unYrNl, �ntl�lWl �u4/�ct �n wnp/qer ro aIMNI p.ruMu �IW
cMl flnes i.q ro orH �,nLhd fhouwd dalNn (ffOqOWA ��Itlon b tlr� cost o/ eomp�nutbn Cvrxp� u provltlM ror In
Sxtlon 9)O6 al tlr� LeEor CoOe, /nrona4 ��R^msY i/rx
CONSTNUCTON LENDINq pGENCY: I MreW effim under paneXy ol perjury the� iham ia e conetruaion bndinB We��Y �m �M
perlormerce d iM1e v.vek la whiW ihe peimY ia owed (Sedion J09]. CN. C�.
LENOEq�S NI1ME:
� LENDEF'S ApDRE55:
I cenity �het I heve rxd Uu ppq'raGm W pme ihet Ne ebova'vJormeton b wrtetl. I ap�se ta compty xilh dl ary eM wunry adinvma
eM ewe lews mleiiq w WiMiq eansVudion W herabY vMa¢e �epeaeenteiivea W �hu ery lo eMw upon tM ebava�memorrE popmry
"`�""'�'0�"�WARREN ROCAE
Pnni Neme
�,7�1 � �1�� o�,: �
Sgn0lum N Ovmad enURppY trecior
�sis�ra.wr� W�wa-BuldMiSelnY�O�eemFb:CvwY-APV�:Rnk-Rmenue:(3dEenm�Mamv
CITY OF COSTA MESA — SIGN PERMIT
PERM NO; SB 077905
PERMIT NO: SB 077905 PLAN CHECK NO: 02128-96 S GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH
JOB DESCRIPTION : INSTALL 10FT AWNING WITH SIGNAGE SQ FT:
CLAIM VALUE: 585.00 CALC—VALUE: 585,00 GROUP OCC: B /
COMMENTS: "J 6 W AUTOCARE" AWNING W/SIGNAGE
�ret*�t*at�t*�* **+�+t*at�**+��r+��+r+r+t*�*+�� ie*******it�t*at�*x feat*x�atatatatat�et�tat**at�*�it�*at+e*ieiriF�r*�*+�
S I G N I N F O R M A T I O N
DISTRICT: 1 TYPE: AWNING ILLUMINATION: NON CATEGORY: NEW
DIMENSIONS: 3FT 06IN X 1FT OSIN AREA: S.00SQFT LETTER HT: 6
STREET FRONTAGE 1: 132.00 STREET 1: 4r 18TH ST
STREET FRONTAGE 2: 0.00 STREET 2:
PARCEL: 42418229 ZONE: MG LOCATION > FRONT: X REAR;
HUSINESS NAME: J 6 W AUTO CARE > LEFT: AIGHT:
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY . S.00SQFT OVERALL HEIGHT: OFT OIN
THIS SITE . 1.00SQFT GROUhID CLEARAIVCE: OFT OIN
ITEMS OF INFO : 1 PLANTER AREA: O.00SQFT
ITEMS FOR ACTIVITY: 1 HLDG SET BACK: 20FT
COPY VERBIAGE : J 6 W AUTO CARE ON THE SOUTH END OF THE AWNING ONLY.
PLANNING NOTES:
IE �E IE ik ik IE iE �1E 1E 1E iE IFlflE 1E 1ElE iE 3E fE if� 1(� iE IElF fE iE 1E fE M iE iE iE 1(�!E iF IF 1f if �f 1f if 1F 1E'1E 1E iE 3E fE IE iE 1k fE IE Ik iE i! If IE iE iE iE'lE IF �IE iE 1E iE �E �E iE if �E iE �E 1E iE iF IE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY V �C'J�-- DATE: C���f�
BUILDING APPROVED HY : DATE:
APPLICATION ISSUED HY: DATE: �����-���('l
IFiE�EM1E1E7F1kff1ElE1EiE�EfF1E1FlElkiE'lElE iE1E1ElE1E1EiE1EiI�iE 3E*
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMHING ELECTAIC MECHANIC SIGN SMIP/RES GRADING
PERMIT 23.75 SMIP/NON—RES
PLAN 15.44 ,50
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 24,25 0.00 15.44 39,69 39.69 .00
TOTALS--> COLLECTED:
LUMBING ELECTRIC MECHANIC
3.
39.69 OVER/SHORT: ,00
SIGN SMIP/TOT GRADING PLAN—CHECK
.50 15.44
1E 1E 1f 1F iF if 1E 1E if iE IE iE 1E 781F iF fE'IE iE 3E ik iE fE 1E if 1E 1E 1E iE iE 1E �E �f !E if 1Elf 1E 1F if if 1f k 1E iF 1E!(� iF ff iF if IE �E ik iE 1E 1f iE 1f 1E if 1E iF 1f !k 1F if 1ElE 1E'1E iE IF 1E iE �E
I N D I V I D 0 A L F E E B �1� D O W N
E QTY D E S C R I P T I O N �1 Q�, b'� T COST TOTAL COST
r� J� I
NO FEES WERE SELECTE�"' OR 9� MIT
DA�� � �
o� _�c2o,-�;��_�,rso;,;�o -, - : �
L4Ti' �qr�-y'� . i„r' ,
T.r:.- .
� CC`•;USTRUCTION AND PLANNING
APPROVALS Permit #
t. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
�3. Electrical.Conduit UtilityUndrgrnd.
4. Etectrical��ondvibUndrgrnd.
5, Steel Reinfarcement
• � . EtectricaLUFEft Grnd,
7. F_ootings . �
`8. Foundation
9. Water Pipe�Undrgrnd. ,
10. Scructural Floor System
i t. Property Sewer Line & House Connection
12. Sewer C2p
13. Roof Drains �
14, Rough Plumbing
15. Rough ElectricabConduit
76, Rough Electric Wiring
17, Rough Wiring Sign
18, Rough Electrica6T Bar Ceiling
19, Rough Heating & Qir Conditioning, ,
20, Roug6 Factory Firepiace -'
21, Oucts, in Structure� ' ,
22, Ducts, Ventiiating � �
23. Gas Pipe�Rough & Test „ � -
24, Roof Framing � ' �
25. RoofSheathing ;�., ' : _
26. 7�Bar.Ceiling (Structural) $� Monocoat
y7, Frame and Flashing ' ,' - .,
28. Lathing & Sid'ing .� . - �
29, Insulation �
3p, Drywall Nailing � - -
31. Plaster Brown Goar " , • � �.
32, Efectrical Power Meeer�Final
33. fina[ Electric ' ' - '_
34. Final.Hejting & Air.Conditioning _
35. Final Gas�Pipe=Test "
36. Hood or Ganopy Y _ .-
37. Final-Factory Fireplace _ � 3 .
38. FinalPlumbing � - � • .
39. Water Service�Final � - - ' � �
. 40. Gas SGrvice-Final . . � '"
41. So�ar Oomestic•Finat - �
42. Backflow Preventer � � - �
43. Backflow Irrigation �-�''
r
44. Landscape Irriqation System -
45. Sound Attenuation - � '
46. Handicap�Regulations - � � ��
47. F�NAL STRUCTUflE & BUILDING
48. FINAI PLANNING
49. Elsctrie Release to Edison�
� 50. Gas Release to Southern California Gas Q
SL CERTIFICATE OF OCCUPANCY
No. Date
- I POt ,�SPA I .
Date � Inspector pppROVALS Permit # Date Inspector
� 52. Pool & Equipment Location
: 53. Steel Reinforcement
54. Forms
55. Electrical Bond(ng
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNtTE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrg.nd.
61. APPROVAL TO DECK
62. Backwash & Receptor�Final
63. Heater & Vent-Final
64. Plumbing System � Final �
/� fi5. Electrical-Final
66. Sotar SVstem-Fina{
67. Fencing & Access Approval
'� 66. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
.- � FIRE DEPT.�REQUIREMEIVT
" APPROVALS PermiC#
70. .Gnderground Hydro
71. PrpductPipingCiGas �Oil
� 72. Underground Fiush `�
73. Undeigrnd. Storage Tank C}Gas � Oil
.. ,
74. Overhead Hydro - .
�' 75. bry Chemical ,
76. �Dr;y Standpipe � �
, 77. FIXEQ�SYSTEAA'FINAL�' ' `
78. FYRE PREV. FINAL
' HEALTH DEPT.�REQUIREMENT
� 79. FI(VAL INSPECTION �
80. FOOD CERTIFICATE ISSUED ' "
Notesr
�
; r;
K - �
. _,
_' _
e � ,
r "
u
9
6
�
0
,wonessaewiaw: 850 kt 18TH ST
oxr�asr+w�vanwrt ROTY.SCf?ZLD, PETER B
� '•,woxcss tROT3SCHILD IIdDOSTRIES
+� 866 W 18TH ST
COSTA MESA,CA 92627
�vv�. �uuNo �oo�u:
,wcxrtect oa e+m+�x:
/JMII ON EIQ'S /�WNE55:
uc. w.:
uxr:
uxr:
wxm�crarsx� TAYLOR CONSTRUCTIOP7 i 619 ) 758-3111
carn�croas�uuxc 1335 fiEDIONDA AVENOE
noonEss VISTA CA �.�+o: 325280
92083 uxr:
LICENSEO COMR1CTOflS OECLAPITION: I Mreby elfrm uMm pondy d perjury tIW I em Ibmad indx qorieona d Chepls 9
(mmmmtln0 w5h Seetbn 1000) d Oniaion � d iM Buzron eM P�deationa Code. aed mY lerw u in IWI fau aM Ntetl.
�C.NO.: LIC.CLA39: B uc.No z5280 F:<P;
� � � comre
OWNEN BUILDER DEC flAT10N: I Iwsby tlfimi psn d pmFoY �� �� aY�q �� iM Com�eqon lioxca law la Ne
IdbwnG nsmn (5ed'nn ]IX11.5 Bwiret enE Ad � Co : MY UY a owNY wh'xA nVu e OM�! �o mmW�t, e4er. unpws.
EemdoA, or repar mry st�ucWm: pior b Ne ovwice. uirts �he applica4lw euch pe�mil to fib e eqmd �Itlomem Cw M a eM
�immad pu�vuent to iM pm+eions d Uw Camrmon Lweme lew �cn.q.. o(o�m.��v wnn s.ao� �aoo� a o�w� a a me
sinea and Rdeeaiona Code� a Iliei ho or ehe ia ezemq iharNmm enE tha bew la IM dleped exemqion. My videtion d Sepion
1Jt.5 by ony epvl'rant lor e permn eubjeGe iM apvlicenl Io e dvil panely of mt mora �hen INa �uMmtl Edlen �f50U�).
� I, m oxnar W tM prope�lY w my ampbyeee xah wegee as Ihe'x ede mmpeneelbn, will do tM wwk, eM �he eVUCun e ral iMeMeA
or dlered la aeb (Section )OM. BvdMn eM Pmbeaions Cada: TM Contredon licenaa Lew does �w epply loen ownm d poperry
who WtlEa w inprwee Ihereon, vW wM Eow vuM wak Nmeall or henel a Ihraph he a Mr own amployas�, pwided thel wch
1111pOVlTBNf Bf0Ip1 IMBllep� IX C„Gfld �IX fB�l. M. �1OWGYlf. ��1G �III{�Il�i IX RIMwM11Ntl 0 tOb M11�1111 q1� YW O� MIIIdM WI.I�M
own..a��ner .ui n.,� ine wben d w«ino ne « a» m m nma «Mom.+�« ux wmo.• a.wl.
❑ �. m mmw a �ne wwan. �.��M mmreana Mnn 4mmsa cmvaaa. m m�m�u ms wdb Isaacn �ou. ae"vro ene
rid.ams coee: The comimn, �k«ne �a. me. na ewN ro.n wne. a c�wMr .�no nwm «:'ww�a md.n, .ne wno
�Wrem br vx3� pqem wtl� a moraea(s) Icauad punueru to tM Catlretlas limnw law�.
� I un eaamq uMr 5 Lon: B. d P.C.. b Nu �mam:
Dma: �
I tlo Mroby cMiy tlut I em eware dW uMen�vM �he ia0uirementa d Cellanu HeeI1M1 vM Sdaty COEs SWiom 25505. ?5533, vM
25SN, vM IMI I a eny Mure Wikiip ocapanl will / wil nU (o�ck wn) need lo compF/ wIh mitl ele�a md» dM IM ropuirtmeMt M
epermillwmneVuclionormodilrationhanlheAi u'�ellyRrenepemen�Disind.Rmidemidmnurudionxppicetbnowexemptiromlhma
provieione.
Dele: � AGd�:
WOHKER'S COYpEN5�T10M DKL�PATION: I Mrotr/ e/fiem uMr paeWy d paejury ane d ihe blbwi�q detlerttons:
❑ I Mra eM W meinten. cenlcme a mnrnt m wlf;iwra br xorkas' wmpanW'vi. u>widM la h' Swian aMo d tM lebar
coa.. i« ms v��• a u» .on� ia w�n ino v.+ro e mwd.
❑ inw.�ew�i�.a�,��o����...,�.wa.aers.a�a�mam.�coa..ro.m.o.eo.�,o.dm.
wak la whiM Mo G�u b iuueE. MY waken' mnGe�ion vuurenca �aris eM V�KY wmEr w:
c�
Pdky Number:
�aron roed irot be cpnpbteC / tM pmn/ u/a one huMreE dd/ara �SI00/ a bae.)
� /mnh thm in Ihe pMmnarica d ihe work br xhCi thu permn b uvueE. I Nell nal ampby vry pemn in eiry menmr ao m lo
(`�' b'xome wblea to tM worMms' comGM�ion bwe d CeNomie, y�d e0roe Nm il I MwM wEl^d �o �he woM1e�e'
=�l�omoeavWo a�lbm w s�iw� amo a m. �e« coee. i e^sWb^hy+^ �^oN � o��
Weminp: F�Nun ro aelun woA'en' mmpsnutlon cov unNwNl, �ntl MLI uC/�ct Nnployw b cNMiul psneltlp �ntl
clv/l flnu w ro w�. n�e�.e mo�,.�a ear.� ls+an, edd�tbn b tM ro�t of ro tbM1 dem�pu � provldee br In
9�ctlon 31l16 0/ Ms L.s�or CwJs, Infxul, +�W �ttomry'a
CONSTNUCTON LENDINO ROENCY: I Mrtby df�m uMer perely d per'µy ihet there o a ometiutlion bMi�q epency lor IM
perionnyKe d �M v.ork Iw which ihb pxmi ia eeueE (Seaion �09). CH. C�.
LENDER'S NAME:
LENUEX'S AODflE53:
I unM �� I Me raed �hu eppfraiion and ama �Mt IM ebove iMame�ion b eanetl. I e{pee lo eanply xilh dl cry eed oounry adine�ma
end �We Nvn rdmiq to WJtlM canpvfion ud hereb' eWin¢s mP�Netivee W th'v mY ro emx u0� �M ebwe-momiand PWeM
����°�0�'� JOAN TAYLOR
Dete: ' ��
sq�� re a i�c•w oo vma
While-BuiMvp 8 Selely; OreeMFle; Genery-ROViraM. R�k-Revenue: (3dde^�od'Neevea
CITY OF CUSTA MESA — HUILDZNG PERMIT
PEAM NO: E 07'93�
FERMIT AIO: E 072439 PLAN CHECK PdO: N GOVT: P] S�JPP: A]
CONSTRUCTIOP] TYPE: PEP,MIT TYFE: ELE PURPOSE: VTH
JOB DESCRIPTION : TEMPORARY POWER POLE SQ FT:
CLAIP9 VALJE; CALC—VALi]E: GROUP OCC; B-2 ;
COMMEC7TS: TEMPORARY POWER POLE
1R i!� iF iF aR iF iE �'F- 3E �Y �Y it iE ir ii� 4 if �rt �R� it iF-IR iF is ic -� iF Y� if �1F i� iF V 1f i� iF aM1 jE r.M'� iF �1F.YiR-lc �lf �Y iE iR �Y-iF # If -lf ic Ii i!� Y iF i� iF ii Y� b� i( �N� N� r�}--Y� �Y- a/� �1! -k-i� x� IF-Y� �k
Z O N I N G R E Q(J I R E M E P7 T�
S E T B A C K S
----------- MAIN BUILDING ---------- -------- ACCESSORY BUILDIPIG -------
FRNT: FT IN REAR• FT IN FRP7T: FT I"] REAR: FT IPI
LEFT: FT IP7 RGHT: FT IN LEFT; FT IN RGHT; FT IA7
PARKING REQ: PROV; PARCEL: 42418229 7.P1E; FEF NO:
pLar�r�zr�c r�orEs>
i
1F iF iF �If l-�If if a: it+f if if �E ih if M if Yr if iE iE # if iE #f 1E jf iF iF if if K i! 1f �lt aF !f Y! if iF af K if #� �!f �k iF if if 1F iF a� jF iF iF i'r iF -�F iE 3f� �4 M�R iF it iF # iF iF i! �E f if !t iF iF 1F d4
D E�3 E L O P M E N T S E R C� I C E S A E Q U I P. E M E Ad T S
20P7ING APPROVED BY DATE;
bUILDING APFROVED BY ; DATE:
APPLICATIODJ ZSSUED bY: %�� UATE: (l� ^
acifif+F�tu*�?F�it*+F�tict+Fs�rtiE�c�.iF,r-,e��iFif+��ix�itiF�'t'�i� .r+..r�iFii�' iriT'—r�ajr*+c*-�ra�.-r.r�F+. +c+, +r�+��
LEGALIZATiON;N F E E S U P1 M A P. Y STRUCTIJRAL S:.GMENT;N
BLDG PMT FLUMBING ELECTRIC MECHANIC FIRE SMIF/AES GRADING
PERMIT
'SSOS
PLAr�
ISSUE FEE 15,00
HUILDING—DIC'—> FERMIT ISSUE PLAN—CHECR
TOTALS----> 15.00 15.00 0.00
REVENUE DIVISION TOTALS--> COLLECTEL:
BLDG PMT PLUMBING ELECTRIC MECHANIC
30,00
SMZP/NON—RES
TOTAL PAID DUE
30.00 30.00 .UO
30.00 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAD7—CHECK
if i' iF itif-)E i! iE?E i4 ifiEifiF if if iF iFif�lf �E 4 Y-'1F +F * if iF ifi4ifiF�if iE�)f if3fiF iE af�if * af iF if 4 jf-�4 iE if Ydf-1� it M+F 1P 1f % iF if �f i(�if iR 14 i' ! i4 V-f4�N�iFiF jF�l�ltif iF
I N D I V I D U A L F E E P R E A K D O FI N
TYPE QTY D E S C R I P T I U N UNIT COST TOTAL COST
ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 15.00 15.00
END Or FEES
EXPIR�D
�nr� f'J'�P— ��' L�v�
ni pniS�:tS—"0?R2�65 Te7T
i�.f,ics 4:,t1919; iT�iE� 1�:s4
Ci)NSTRUCTION AND PLANNING POOL !A ,
HPPROVALS Pennit # � ' Date Inspector AppROVRLS Permit # f Date Inspector
'��. TemPorery Elearical Service or�Pole 52. Pool & Equipment Location .- •
2. Soil Pipe�Undrgmd. � • -�- 53. Steel Reinforcement , � . ' � .
3. Electrical Conduit Uti�ity�Undrgrnd. 54. Forms -- t,
- .
4. Efectricat Condu�t-Undrgmd. „ � 55. Efectrica{ Bonding
5. Stee� Reinforcement 56. Rough Plumbing & Pressure Test j'.
6. EleCcricai UFER Grnd. ' 57. APPROVAL TO COVER�GUNITE .� '
7. Footings " 58. Electrical Conduit-Undrgmd. �
8. Foundation ,: 59. Gas Pipe, O Undrgrnd., Test. .
9. Water Pipe-Undrgmd. i 60. Backwash Lines, P-Trap, O lh�drgmd. .
70. Structural Floor SYstem ' ' 61. APPROVAI TO DECK � �
1 i. Property Sewer Line & House Connection 62. Backwash & Recepior-FinaF ,
12. Sewer Cap � 63. Heater & Vent-Pinal � j '
13. Roof Drains ". i' 64. Plumbing SVstem - Final :�
14. flough Plumbing � fi5. Eiectrical-Final � •
,i'
15. Rou9h Etearical�Conduit ,� 66. Solar SVstem-Final �
76. Rou9h Electric Wiring 67. Fencing & Access Approval '
77. Rough Wi�ing Sign 68. APPROVED FOR PLASTERING ��•
18. Rough Electrica6T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. fl�cts, Ventitaxing 7i. Product Piping � Gas ❑ Oif
23. Gas PiPe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil ;,
25. Roof Sheathing 74. Overhead Hydro �,
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � �
4.�,.
27. Prame and Flashing 76. Dry Standpipe ';,',•�j
28. Lathing & Siding 77. FIXED SYSTEM FINAL � �
�
29. Insulation 78. FIflE PREV. FINAI. '. ;
30. Drywall Nailing HEALTH DEPT. REQUIRER9ENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Fina� Electric Notes: '
34. Final Heating & Air Conditioning
35. Fina� Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace
38. Fina� P�umbing
39. Water Service�Final
40. Gas Service-Final
41. Sola� Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation System
45. Sound Attenuation
46. Hand�caP Regulations
47. FINALSTRUCTURE & BUILDING "
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
City of Cos[a Meu
Developmem Services Department
8uilding Safe�y Division
P.O.Box 1200
Costa Mesa, Califomia
CERTIFICATE OF OCCUPANCY No. 0O�3-T�
The Building located at 850 C7. 18th StYeet. Ur1it9 A.BiCiD.E.F
has been inspected and found to�comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
fora Group A% Occupancy. �
Use of Building OffiCO
Legal Description 42?-182-29
ISee reverse side for Metes and Bounds)
Building Permit No AR 3339% Electrical Permit No. BE 33392 Plumbing Permit No. P3343OiPII42SS
Mechanical Permit No. Num6er of apartments and/or guest rooms
ISSUED TO: Building Official Hlillidm T. Howard
D>Mr A_ RnhhachilA � i �
3G5 :J. 18th Stre2� by - �J .. . `! l � �i, �
r.��r, c��z>. rn Q9S,97
• Date Ee�'ouarY 27� 1989
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF'3015-46 rev. 1/83 White -Owner, Can�� Numerical Fiie; Pink - Bldg. Permit File
1 �
Aoplicant 10 fill in all soaces except those within heavy boraer lines anO sign all aoP�op�iate Oeclarations.
LITW6� COS7A mESA ' CONSTRUCTION PERMIT
ProjectAddress 850 W. 18th St, Costa"Mesa, CA 92627
�Applicant's Mailing�Address866 �w. �18th ST. 'Costa Mesa ,CA
ow�er's tvam Peter B. RothSCh�ld phone 5— z22
Add�es�.86�;W. 18th St ,,'Costa.P4e'sa,.CA_ 9�27
Arch/Eng.��✓'k / LicenseNo.C�-�� ���
c,s � �•�
Address , �"i
Contractor's Nam Phone Gu_ r'���
Address (mailingl -
.'J
City License No.
LICFNSE� CONTRACTOR DECIARATION !`
I hereby atfirm tnat I am lirensetl.untlar prOvisions of Charter 9(commencing�
with section �000J of Division 3 of the Business antl Protessions Cotle, and
my I{�¢nse is in full force antl effect. � �
License Class License No.
Date Si9nature �
WORKERS' COMPENSATION DECLARATION - � _
' ner¢by aftirm that 1 have a certificate oi mnsent to selt-insure or a certiticate
Workers' Compensa[ion Insurance, or a certifietl copy thereot �(Section
300, Lab. CJ � _
Policy No. Company ' -
8 Certitietl copy is hereby furnishetl. , �
Certi(ietl copy is (lletl with the city BUIltlinq Division, t
Date Applicant _
EXEMVTION FROM WORKERS' COMPENSATION DECLARATION
(This sec[ion neetl noi be mmpletetl if the permit is for one huntlretl (5300) or
less).
I ce�tify that in the perfo�mance ot the wOrk to� which tnis perT�t I5 isst 1
shall not employ any person in any �r+ nner so a b come�4uUject� [M1e
WorkeFlXmppp sgtion Laws ot Calyl�ji�$er��3�ry�'/ .//�
Date ��iL�7 O Signature�r �1!"�l
NOTiCE: If, after making this tleclaration, you shoultl become subject to the
Workers' Compensation Provisions of the Labor Cotle, you must forthwith
cOmply with SUCh provisionS o� thi5 PC�mit shall be'tleemetl revoketl.
CONSTRUCTION LEN�ING AGENCV
I M1e�eby affirm thdt theie i5 a construction I¢ntling agency tor the perfOrmance
of the work for which tM1is permit is issuetl (Section 3097 Civ. C.)
. Lentler'S Name
le�tleYs Atltlress ' � �
OWNER BUILDER�OECLARATION
I hereby affirm that I am exempt from the Contractor'S License Law for the
following reason (Section ]031.5 Business antl Professional Code: Any city or
county which requires a permit to cons[ruct, al[eq improva, tlemolish or repair
any structure, prior Ib its issuance, also requires the applicant for such permit
to fiie a signetl statement that he/she is licensetl pursuant to the provisions ot
the Contractor'S License Law (CM1apter 9(commencinq with SeCtion ]000) of
Division 3 of tbe�8usiness antl Professions Cotle) or that he/she is exempt
`�etefrom antl the basiz for the allegetl exemption. Any violatlon of Section
031.5 by any applicant tor a permit subjects the applicant to a civil
�enalty ot not more lhan five huntlretl tlollars ($500).
I, a5 owner ot [he pro0erty or my employees wittt wag¢s a5 thei� Sole
coir�pensafion, will Oo the work, antl the structure iz not intentletl or oNeretl
for sale (Section 7044, Business antl Professional Cotle: The Con[ractor's
License law tloes not applY to an owner of a property who builGs or improves
thereon, antl -who tloes such work himself/herself or throu9h nls or her own
employees, provided that such improvements are not intentletl or ofFeretl for
58�@. It, however, the builtling or improvement Is soltl within one year oi com-
ple��on, the owner wlll have Ihe bwtlen Of proving he/she tlitl not builtl or im-
�Pve tor the purpo5e ot sale).
I, as owner ot the property, am exclusively cont�acting with IICe05etl con-
ctors to construct Ihe Orolect (Section ]044, Business antl Professions Cotle:
The Contracior'S License Law tloes not apply to an owner ot property wno
builas or improves thereon, anC who contracts tor such projects with a con-
trartor(s) i�cense pursuant to tne Contractor's �icense Law). 1 am aware tnat
�ot of their Worker's Cortipensation insu�ance ShoWtl be prOvltletl to me.
1 am exempt untler Section B. & P. C. for this reason
C�
Dafe �-�,."�SLg�}' � Owner
I'h¢rEby certify that 1'have rea�
intprmation�is correct. I agree to
anq State laws r¢lating to bulltli�
sentatives oi [hi F�ty to [er
in5bection purp e( �
Si9nature ____tP��C�
Dr��ers' License or SS � ��
[his appliwtion antl state that the above
im01y with all citY antl county ortlinances
canstructlon, antl hereby authoriie repre-
ipon che` ab ve-mentionetl . Property Ctar
Date y��19�0�
��
TVPE OF CONSTRUCTION LJ NEW LI ADD Lh'1 ALTERATION LI REPAIR
❑•CONVERSION Q DEMOLISH ❑ OTHER
� DESCRIPTIONOFWORK/U�S�E+O��FB,�LD��G.M��+i_�/�J� non�,��.y�Tr�
� TVPE O� ERM�IT�'��� LJ �e LJ TI���
r GRADING FOUNDATION STRUCTURAL -
.❑ TENANT � ELECTRIGAL ❑ PLVMBING ❑ MECHANICAL
' C� OTHEIi ' '
PROJECT DESCRIPTI
C O N STRUCTI ON
' ZONE
Remarks: pr �,
Sink
Preventer
Irrigation
7rinking Fountains
F loor Dreins
Floor Sinks
GasService Outlets�
Intercepiors
Kitchen Sink,
Lavatories
P—Trap �'-f '
Roof Drains
Reinspection Fee
GftADING CU.YOS.
$15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. BIt. ICBO #
Heating System & Ducting
❑ o-i oo,000 eTu � i oo,000 sT
Reinspeetion Fee � I � $15
1F Og65-46, rev. 10/84 White - Builtling; Canary - APPlicanh Pink - Accounting; Goltlenrotl - Assessor
LUATION $
Showers
Service Sink '
Sewer Cap
Sewer Connection
Sola1 Collecmf5 '
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet �
Water Heater
Water Service
Auto-Wash
Laundry Treys
Isue Fee
Hood or Type I ❑
Canopy Type 11 ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration •
Fire Dampers
Registers '
laue Fee
FEES
$ 3
A.P. # Z
S Main Buildi
E
T Front '
B Rear
A
C Right
K Left
Pfng. Ref. #
Planning Notes:
'Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher ,
Dryers ❑Gas ❑Electric
Fan r $3t}]rOOIR
F.A.U.
Fixtures � � t.P
Device Boxes �
Outlets
Switches
Garbaqe Disposal
Generator �0-5 KW C
0104 5/06/6_
— 2 Zone '
Accessory Building:
- Parking Req./Provided
ELECTRICAL �
Transformer' 0 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter �over 100 amps
Sub Panel
Motors OO-1 HP O1 %- B
Inc. Solar �9-15 HP 016-�
Pole Light
Range
Sign
Standing Sections
5-15 KW Trash Compactor
� Reinspection Fee � $15
FEES
�DEVELOPMENTSERVIC,E�jSF/�/�Q'I
Zoning Approved By____yt�
Building Approved By �(.i�
$ 3
Izsue Fee
REMENTS:
II�19�67 T�
FEES
'� �
Z
O
N
I
N
G
H
E
Q
M
T
S
SUMMARV OF FEEC
BUILDING PERMIT $ S%I • DD SMIP $ �.Z� ��
PtAN CHECK $ %I� S� pERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL . $ LO%•%O � GRADING $
PLAN CHECK 50% $ �iv ..35 MICROFILM $
MECHANICAL $ TOTAL FEE. $ 0 •
PLAN CHECK 25% $
� j � , I
' ti) ' n � POOL&SPA
� CONSTRUCTION AN�D PLANNING� .� rY '
/ � '�-� Date , Inspectoi ��AppROVALS Permit# Date Inspector
�pppROVALS Permit #� r : j ' �
i: �t
1�: Temporary Electrical Service or Pole . 52. Pool & Equipment Location ,
.l 1.•
� 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms - .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bondirig . . . �
r
5. Steel Reinforcement�.� ." 56. Rough Plumbing�&�Pressure�Test .,,. i
c- �
6. ElQctrical UFER Gmd.� ' 57. APPROVAL TO COVER-GUNITE � nI
7. Footings �� `'� ��1P 58. Electrical Conduit-Undrgmd. ��.�
8: F,oundation �;� ' 59. Gas Pipe, O Undrgrnd., Test � ��
, _ ' i�l'
r
9. Water Pipe-Undrgrnd:f�-� � , 60. Backwash Lines, P-Trap,,0 Undrgmd. �'�
10. Structural Floor System �, 61. APPROVAL TO DECK ��
11. Property Sewer Line�&�House Connection 62. Backwash & Receptor-Final � ��
12. Sewer Cap � . 63. Heater & Vent-Final
13. Roof Drains , 64. Plumbing System - Final ' , •'
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar System-Final . �
16. Rough Electric Wiring 67. Fencing & Access Approval �
�•
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING; • �
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINdL-`1 i"�1�'r: �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMEIVT�'.`; •
�;
20. Rough Factory Fireplace APPROVALS Permit # r� `' =�"' 'I-
�r 1 .
21. Ducts, in Structure �" �`
70. Underground Hydro 1 ` ,
22. Ducts, Ventilating �71. Product Piping O Gas ❑ Oil�- ,;
23. Gas Pipe-Rough & Test 72. Underground Flush ' f� �� ' ,), - ,
�.
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil„ �,
�t .
25. Roof Sheathing 74. Overhead Hydro '� � �
` i . k
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . � � `
_,
27. Frame and Flashing 76. Dry Standpipe -� j
28. Lathing & Siding � 77. FIXED SYSTEM FINAL �
:
29. Insulation 78. FIRE PREV. FINAL '-� ±� i,
30. Drywall Nailing HEALTH DEPT. REQUIREMENT +�
31. Plaster Brown Coat 79. FINAL INSPECTION ,�`�+;? i��l
32. Electrical Power MeterFinal 6-"l 80. FOOD CERTIFICATE ISSUED �'�
;{ r,
33. Final Electric Notes: s-� �� L9 ' �� �': . �, .'..
34. Final Heating & Air Conditioning � ��� �
Cf/y t� i �
35. Final Gas Pipe-Test � $fr � .
36. Hood or Canopy � � K;�-
37. Final Fac[ory Fireplace '. �L •
.
38. Final Plumbing -
39. Water,Service-Final E.� ' , :• ;,
40. Gas Service-Final . � � � �
::✓ • •
41. Solar pomesticFinal . �,.t. .`"'
42. Backflow Preventer 'j� �',-
�i
43. Backflow Irrigation : � � , �
i .
�
44. Landscape Icrigation System ���• �•+ �
r
45. Sound Attenuation �,. _� '� . I
46. liandicap Regulations � - :, ; .
.,•
47. FINALSTRUCTURE&BUILDING C6 '/�r{ !',=
v • �,,
48. Special Requirements Completed� � � r '��
49. Electrie Release to Edison :�,�: . •�
50. Gas Release to Southern California Gas Co .�.� "i .
51: CERTIFICATE OF OCCUPANCY � - � •
No. Date ' ' r �
AGD���ant lo flll In all sDaces exceD� ��ote wlthin �eavy DorEer Iinei an0 slgn all approDriate Ueclarations.
CITV OF COSTA MESA CONSTRUCTION PERMIT E"333 TRACT NO. LOT NO. UNIT NU.
�Project Address 8 0 W. 18th St Costa Mesa CA 92627 ,
�Applitan�'S Mailing>9ddres5 6 W. 1 th ST. Costa Mesa CA TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
Peter B. Rothschild 2'L'2 : ❑'CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's N hone _�" . DESCRIPTION OF WORKNSE OF BLOG. �'� �� �+'+^-*'�.��.,o �+;?aqo.� i^�
Address ��g W. 1 th St �, Costa MeSa, CA 92 27 � - — - --�
ArchlEng. ��rk �: /1 LicenseNo.G�-O�q: .�
AddreSs 7�� L/ '��1�99 ��S%%% ;;;•\9-�'n �t`y4��� �
1 PhoneLY� ���
Contratto ' N �� �ta�/
Addrezs (mailingl "
City License No. ���
I.ICENSED CONTRACTOR DECLAf3ATION �
I hereby altirm ihat I am licensetl untler Orovislons of C�arter 9 �commencing_
with uCtiOn 7000) oi Divislon 3 01 the Busine55 dntl ProfeSsions COOe, and"
my license is in fu11 /orce ana effect. .
License Class Licensa No.
Date St9nature
WORKERS' COMPENSATION DECLARATION
I hereby aHirm tnat I have a certifirate of wnunt to sel/anmre or a ttrtlOwte
oi Workars' Compenvtion Insurance, or a certi/letl copy thereof (Section
3800, Lab. C.) ,
Policy Na. Company
eCertifletl copy iT here0y tumished.
Cerlitietl copY �f filetl with lhe [Ity Builtling Diviiion.
Daie Aao���nt _
EXEMPTION FHOM WORKERS' COMPENSATION DECLARATION
(Tnis section neetl not be completetl if ihe permLL Is for one nuntlrea (E1D0) or
less).
I ttrtify ��a[ in lhe pertormance of the wOrk lor which l�is pe�m�t is lss I'
snall not emplOy any Oerson in any m nner so a � com UUjec the�
WorkerFkl6mp�p �tion Laws of Gali.ftD� �
Date `�-4�7 Signature�v
N0T10E: 11, after making thlz aeclaratlon, you shoulG become suCj¢ct to ine
Workers' Compenidtion Orovisions of t�e Labor COCo, you must torthwitn
tOmply wlth such p�ovlsions o� thi5 permil Shall OG tltemetl �avoketl.
CONSTRUCTION LENDING AGENCV
I nereby attirm that t�are is a construction lentling agency lor tna Der/ormance
01 Ina work lor whith [his Oermil is issuetl (Settlon 3097 Civ. CJ
Lentler's Name
1„enCar'S AtltlfoSs
OWNE0. BUILDER DECLARATION
I hareby aHbm that I am exempt from tha ConVaclor'S Ucanso Lnw 10r tne
following reason �Sectlon 7031.5 Business antl Professional COEe: Any city or
cOunty wNch requirai a De�mit to con5[ruc�, alt¢r ITD�ove, tlemolish or repalr
� any 5[ructure, p�lOr to IIS iiivantt, also rcqWrei l�e apD���ant lor such Oe�mlt
lo fiie a slgnatl zlatement that ne/s�e ii Iicrnse0 Ourivant to t�o Provisions ol
tha Contractor'S Licenu Law (ChaOter 9_�commencin9 wit� Section 7000) of
Dlvision 3 07 [he Business and Profeis�ons Code) or tha[ he/sne It ex0mpt
thcrofrom antl tna basis lor the allegeE axemptlon. Any vlolation of Sectlon
7031.5 Dy any dpplican[ for a permit zubjacts �Ita applltanl lo a Clvil
penalty ot nol more tnan /ive nuntlretl tlollars �E500). �
LJ I, .as ownor of ihe orooarty o� my employnos with wages as melr sole
<OmpeniLtion, will tlo Me wOrk, anC th¢ structu�e I5 nOt IntCntletl o� otf¢rotl
for sale (Socllon 7044, Business antl Profe55ional Cotle: The Contractor's
LI[ense Law tloes nol apD�Y to an owner oi a proparty who buliCs or impmves
ihoroOn, antl who tlols sueh work himselt/horsolf or Iheough hls or he� own
emp�oyoas, provitle0 tnat such Improvements aro not Intentlad or offeretl lor
sale. If, nowever, the builtling or Improvoment is soltl wllhin ono year ol com-
Dlatlon, the owncr wlll nav¢ the burtlen oi prOving he/She Citl nol builtl o� Im-
�rOve lor tho purposa of salo).
I, ds owner of lhe prOperty, am ¢xclu5ivety cOntracting wlth Ilcenzetl cOn-
ctors to construct tne projact (Section 7044, Businesz antl Professlons Coae:
Tne Coniractor's Licenze law tloes not aDPly to an owner of property who
bullas or Improvos tnereon, ana wno conVacts lor such proja<ts witn a con-
irattor(s) bcense oursuant to the Conlractor's LlCpnse Ldw). I am aware that
�01 oi t�eir Workcr•s CompenuHon insurance s�oultl De provitled to me.
I am axemo� under Section 8. 3 P. C. for tnls reason
Date ' � Owner ge�e�--B. �s�33se}�}�
� he�eby certify that I nave reatl Ihis apo�ication antl ztate Ihat the above
information is correct. I agree to comD�Y w�th all Nty antl county orEinances
antl itate laws relating to buibing construction, antl hereby authorize reprb
sentatives of Ihi ity to nter upon lhe`aD ve-mantionatl,property for
inspection purp e ' C
Signature _ Date /i�—� 9� o�
Drivers' Lice o 55 � �
TYPE OF PERMIT " LJ�uRADiNG Ll FOVr�DAl
❑ TENANT ❑ EIECTRICAL ❑ PLUMBING
� OTHER �a
PROJECT DESCRIPTION 5�. FT.
CONSTRVCTIONTVPE Rlnck Wal� �
' ZONE GRADINGCV.YDS.
Remarks: f/� ,�{�5 �C �
�.�. 2 C� � �
PLI
Bar Sink
Backflow Preventer
Backflow Irrigation
Drinking Founlains
Floor Drains
Floor Sinks
Gas Service Outlets
IntefCeprorS
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspaclion Fea � $15
Ducl- Under Ground
Duct - Structural
Duct - Ventilating
Ezhaust System � Multiple ❑
Firepl/Fact. Blt IC80 #
Heating Sysrem & Ducting
06100,000 BTU � 100,000 BT
Peinspection Fee � $15
MECHANICAL
UATION $
Showen
Service Sink
Sewer Cap
$ewer Connection
Solar Collectors
$olar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto�Wash
Laundry Trays
i
laue Fee
Hood ar Typel ❑
Canopy Type I I ❑
Refrigeration System
❑6100,OOOBTU ❑700,000
System Repair/Alteration � �
Fire Damperz
Registers `
laue Fee
FEES
���
A.P. qW ZY�"
S Main Building:
E
T Front
B Rear
A
C Ri9ht
K
Left
Ffng. Ref. #
Planning Notes:
Aulomatit Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elect
Fan $3t�']T'OOifl
F.A.U.
Fixtures ��t.P
Device Boxes
Ou�leu
Garbage Disposal
Generator �65 KW
$ 3
Rninspection fee
FEES
DEVELOPMENTSEH
Zoning Approved By_
BuildinB APProved By
Aooliption laued Bv_
5 3
,
Zone
Accessory Building:
Varking Req./Provided
ELECTRICAL � '
Transiormer. � 15-50 KW
❑50+KW .
Mete. Dup to 100 amps
.� Meter over 100 amps
15KW
$15
Sub Panel
Motors �41 HP � 1 Y, - 6
Inc.Solar �9�15 HP �16-15+
Microwave
Pole Light
Range
Sign
Standing Sections �
Traih Compattor
Issuo Fue
fEES
—G -
Z
O
N
I
N
G
H
E
Q
M
T
S
SUMMARY OF FEEV
BUILDING PERMIT $ S%I • D� SMIP $ �Z• %Z
PLANCHECK $ �7�' gO pERM1T
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ LO%•�%O GRADING $
PLANCHECK 50% $ �IT,S MICROPILM $
MECHANICAL $ TOTAL FEE $ O •
PLAN CHECK Z5% $'
� CONSTRUCTIOIV AND PLANNING�
�APPROVAIS '�Permit# ",'
1. �emporary Electrical $ervice or Pole
� ; .
. 2. Soil Pipe-Undrgr�d. �
3• �lectrical Conduit Utility-Undrgrnd.'
4� �lectrical Conduit-Undrgrnd.
5� Steel Reinforcement'
6 Elyctricat UFER Grnd: "'
7. Footings • � `
8. F,oundation :- •.= �
9� WaterPipe�Undrgrntl„%.'
10. $tructural Floor System � ._
il. Property Sewer Line &•House Connection
12. Sewer CaP ..
13. Roof Dreins
14. Rough Plumbing
15. Rough Electrical-Conduit
i6. Rough ElectricWiring
17. Rough Wiring Sign
78. Rough Electrical-T Bar Ceiling
79. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. pucts, in Structure
22. qucts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. 7-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. , La[hing & Siding
29'. Insulation
30. qrywall Nailing
31. Plaster Brown Coat
32. �lectrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy _
37. Final FaMory Fireplace
38. Fina! Plumbing
39. Water Service-Final
40. Gas Service�Final .
41. Solar pomestic-Final
42. 9ackflow Preventer
43. 9ackflow Irrigation
44. Landscape Irrigation System
45. $ound Attenuation
46. liandicap Regulations
47. FINALSTfiUCTURE&BUILDING
48. Special Requirements Completed
49. Electrie Release to Edison
50. Gas Release to Southern California Gas Co
51: CERTIFICATE OF OCCUPANCY
No. Date
Date
-�: ):
Inspector
e
; , POOL, .PA
••APPROVALS . Permit #
52. Pool & Equipment Location
53. Steel Reinforcement;
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNfTE
58. Electrical Conduit•Undrgrnd.
59. Gas P'rpe, O Undrgrnd., Test '
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor•�inal
63: Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final '
66. Solar System-Final ;
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING '
69. POOL/SPASYSTEMSFINAL� •�����
FIREDEPT.RE�UIREMENT�;`; �='
APPROVALS Permit # �� `" '
70. Underground Hydro � . �,
71. ProductPipingOGas ❑Oil
72. Underground Flush - ''
73. Undergrnd. Storage Tank O Gas ❑ Oil,
74. Overhead Hydro ' '
75. Dry Chemical , ; . ! �
76. Dry Standpipe ��
77. FIXED SYSTEM FINAL �
78. FIRE PREV. FINAL '
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: �' f/'-�42 /'�5.1,1, C! �v^�r_:.�. i
Date �Inspector
►�... ' ApP���ant to flll In all sDatts excepl ttlose witbin peavy Oo�Cer Ilnes anE si9n au aporooNate aeelantlons.
CITY OFCOSTA � CQNST CS,I,ON�JPERMIT PER O TRACT NO. LOT NO. UNIT NO.
• Aroj¢�t Address 6 �'KU,
Applicant's Mailin ,Address � SV'� �� �
Owner's Nap�ne �L� ��� Phone
Address rJ�� GU � ST �7
Arch/Eng. License No. �,!
Address /J�I
Contractor�� Na e c�—�/ Phon 1 ,
Address Ima�l'ngY���� ���,,,/--- Sv�� /� �� yL
Ciry License No, � �% ,
LICENSED CONTRACTOR D CLARATION
I hereby affirm that I am licenzetl untlar prpvisions of C�ar[er 9(�pmmencing
with -sectlon ]000) of Dlvislon 3 of tne Business antl Professi s Cotle, antl
my license is i�Jyfprte antl effect. �
License IaSs S� LI�58
�at@�� 519 t
WOR RS'COMPENSATION DECLARATION
� hereby altirm that I have a cerfificate o( consent to selNnsure or a certiiitate
��Worken' CompenSdfiOn Insurance, o� a certitietl cOPY th¢reot ($ectiOn
/00, Lab. CJ
PoIICy NO. Company
eCertifietl copY is hereby turnisltetl.
Certifletl copy IS filetl with the city BUIltling Divislan.
Da[o Applicant
EJ(�MPTION FROM WORKERS' COMAENSATION DECLARATION
(ThissecliOn neetl not be COmpletetl if Ihe permit is for One huntlretl (E300) or
less),
I<ertlfy lhat in the oeriormance o( the work for whiCh this perm�t is izsuetl I
Thaq not em loy any pefson ip any mannef so a5 f0 become su jett to t{te
Worker Co n ws of Cali or
Da[e Signature ��� � ^�--
NO710E f, aft � mdking thi5 tlecia�at70n, you ShOUId becOme�zubject t0 the
Wo�ke�s' COmpensatlon provi5ion5 O7 tlt¢ Ldbo� Cotle, You must forthwith
conlply wi[n such provi5ion5 or th15 pe�mit SM1all be tleemetl ievok�tl.
��NSTRUCTION LENDING AGENCV
I he�eby a�firm that [ner0 Is d conit�uctiOn lentling agency for th� per(ormance
Of th0 work ior whlch this permit B f55uetl (SettlOn 309]�Civ. C.)
Le�Oor's Name
Lantler's Atltlress
OWNER BUILDEN UECLARATION
I herabv affirm that I am exemPt froT Ihe ConitactOrY �Ic¢nse Law lor Ihe
a permit to ConsVuct, ai[er, improve, aemousn or
Its Issuance, also reqWres the appllcant tor 5u<h p
:n[ that he/sne is Ncrnsetl pursuant to Ne prONSI<
DIVIsiOn 3 of Lh0 BUSine55 aOtl PrOlesSiOns COE!) of [hal he Sh0 Is BxaTp[
herofrom anE the basis 1or the allegotl axempUon. Any viola�ion of Soction
D31.5 by any applican[ tor a permlt subjects [be applicant lo a civll
¢Odlty ot not more than f�Ve huntlr¢tl tlollars (5500).
❑ I, as owner of the OrOperty or my emplovees witb wa9os as tholr ,olo
coMp�nsalion, wlll tlo lne work, antl Ihn structure is not intentleA or otlervtl
lor salo (SCction 7044, Bu5ine55 antl Protessional CotlC: Tlle COnlraC101'S
LlCense Law tloes not apply to an owner ot a property who builtls or Improvos
thBr¢on, antl Wh0 tlo¢5 SUCh work hlTselt/he�t¢Ii Or tn�ough his or her Own
employces, provitletl tnat such imorovements are not intentletl or oHer¢d tor
sa�e. It, nowever, tha builtlin9 or imProvnman[ is soltl wlthin one year of com-
plgtion, ihe ownm will hav¢ tba burtlep Of provin9 po/ih0 Gltl not builG Or im-
P�bva �or tne porposa o! sale).
❑ I, as owner ot tho property, am oxUusively contractln9 wilh licensetl con-
tlactor5lo conStruGt lh¢ ptoject (SectlOn 7044, BuSinast dntl PrOtes5iOn5 COtle:
Th¢ ConlractoYs LiCans¢ Law tloe5 nOl apO�Y �o dn owner o} property Who
bu��as or improves thereon, antl who mnVacts for such profects with a com
tratto�(5 ❑Cense pursuant [o the Contra<for's LicenSo Law). I am awar0 thd[
P/bol o� Iheit WO/ker'S CampensdH00 InSu/ance sboultl be provitletl to me.
❑ 1 am exempt untler 5¢ction B. 6 P. C, for thls r¢ason
Date Owner
1 hereby certify that 1 nave reaa Inis applica[ion antl state tnat thn above
informa[ion is correcL I agree [o comply with all tlty antl county ortlinances
antl Stat¢ laws relating t0 builtling conztru[tion, dntl hereby autbotiza repre-
senWtives this dty to enter upop [he above-mentionep propertY for
inzpectionpyrP��.`j /f .�./�n� i�� �fj8
Signature [ /�C //JLi � ?� Daty /7 L=
��
�. 3,3 �O
TYPE OFCONSTRUCTION NEW A�D ALTERATION REPAIR
� ❑ COfVVER510N ❑ OEMOLISH ❑ OTHER A,p, �
DESCRIPTION OF WORK/USE OF BLDG. g Main Buildi
E
�TYPEOFPERMIT GRADIrvG�UrvDATION STRUCTURAL T Front
� ❑ TENANT ❑ EIECTRICAL PLUMBING ❑ MECHANICAL 8 Rear
�.O OTHEft %�
PROJECT DESCRIPTION 5c�. FT. oCCVPArvCv C Riglit
K Left
�CONSTRUCTION TVP� � VALUATION 5 $
' ,ZONE GRAOING CU. VDS. ACRES Ping. Ref. #
Remarks: �� Planniny Notes:
Sink
Preventer
Irrigation
Bathtubs
Clarifiers
Drinking Fountains
Floor Drains
Floor Sinks �
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
Roo( Drains
Roinspeetion Fee
$15
Duct- Under Ground
Duct � Sttuctural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bh. ICBO #
Heating Sysrem & Ducting
❑a� oo,000 eru O i oo,000
Reinspaetion Fee � S75
%� CMF 0865-46, rev. 10/04 White - Builtling; Canary - AppliEant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer COnneclion
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Water Closet
Water Hearer
Water Service
Auto-Wesh
laue Foe
Hood or Typel ❑
Canopy Typell ❑
Refrigeration SyStem
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers�
Issue Fee
FEES
g 3
$ 3
Auroma[ic Washer'
Construction Pole;
Cooking Unit
Dishwasher
Dryers �Gas ❑I
Fan
F,A.U.
Fixtures •
DCV ICC BO%CS
Outlets
Switches
Garbage Disposal
0241 5/IO/H
m
Zone
Parking Req.IProvided
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Me[er ❑up to 100 amps
Meter Oover 100amps
Sub Panel
Motors �0.1 HP O1'f. � 6
Ina Solar �g-15 HP �16-�
KW OS-15 KW
rvucrownve �
Pole Light '
Range %
Sign
Standing Sections
Trash Compactor .
.�
�iIU7J TL
FEES
� Reinspection Fee �$75 � + Issue Fee � $ 3 �
DEVELOPMENTSERVICESRE�UIREMENTS:
2oning Approved By Date
Building Approvetl By Date
AppliWtion luued By ��, � Dat S �
SUMMARV OF FEFS
BUILDING PERMIT $ SMIP $ ' �
PLAN CHECK $ � PERMIT
PLUMBING $ �-0� ��UANCE S
PLAN CHECK 2596 $ _� ENERGV P.C. $
ELECTRICAL $ GRADING 5 �
PLAN CHECK 50% $ MICAOFILM $ �
MECHANICAL $ TOTALFEE 5 �• 7s
PLAN CHECK Z5% $ '
Z
O
N
I
N
G
R
E
Q
M
T
S
CONSTRUCTION AND•PLANNING ' POOL & SPA
qP.PROVALS Permit# Date Inspector qpPROVALS Permit# Date Inspector
�
1, Temporary Electrical•Service or Pole 52. Pool & Equipment Location �
: ,
2�tSoil Pipe-Undrgrnd. ��� 53. Steel Reinforcemen[
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bondin9
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings. 58. Electrical Conduit-Undrgrnd.
rli
8. Found2tion 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnc��� 60. Backwash Lines, P-Trap, � Undrgrnd.
�•i
10. Structural Floor Sys�tem 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ,
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing /fj� � 65. Electrical-Final
75. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 4. �� 68. APPROVEq�60R PLASTERING
18. Rough Electrical-T Bar Ceiling ;� j,. � 69. POOUSP,A..SYSTEMS FINAL
19. Rough Heating & Air Conditioning � ' FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ven[ilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
i
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil -
25. Roof Sheathing 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,
27. Frame and Flashing 76. Ory Standplpe .
28. Lathing & Siding �` 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL �;
30. Drywall Nailing HEALTH DEPT. REQUIREMENT � r
31. Plaster Brown Coat 79. FINAL INSPECTION '��
i ,.
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED ��r�
33. Final Electric Notes: �� � �
r
34. Final Heating & Air Conditioning -- "
35. Final Gas Pipe-Test - .� • '
36. Hood or Canopy . ,
37 � Final Factory Fireplace ' ,' '
��
38.. Final Plumbing 6 �� �� / , , , �.
�
39. Water Service-Final _ • ,' , , � �
.,!
. 40. Gas Service-Final � . ' �
� 41. Solar pomesticFinal � • ' � .
.
�42. Backflow Preventer � � � � ' �
: 43. Backflow Irrigation , ' . ,
� 44. Landscape Irrigation System ' • , " � . ''L
�'45: Sound Attenuation ' A, • , ; �
/!
� 46. Handicap Regulations /�� � .
/• .
Q7. FINALSTRUCTURE&BUILDING � /.',� '
� � • �
48. Special Requirements Completed � ��. •� ' � ,
i
q9r Etectric Re�ease to Edison ' •�' 'i
. i
50. Gas Release to Southern Califomia Gas Co •i �
51. CERTIFICATE OF OCCUPANCY � ,.
No. Date �
1r
!
Aovlicant lo fill in a11 spares exeept thosa wNhin peavy bortler 1{nas ane tign all appropriate tlecla�ations.
CIT�.' OFCOSTA Q CqjVS�T.ION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO.
Project Adtlress �� Ff—
Applicant's Maili/n�g jA�ddres
Owner's Na /�-� ��'°� N� Phone
Address
Arch/Eng. License No.
Address
Convacm 's Name , Pl.lp ��f
Addresslmaf!ing�� 7 '�U � ���
City License No. Z� � �i
LICENSED CON7RAC70R DECLAFATION
I hereby afii�m thal I am Iicensptl untle� provi5ion5 of Charte� 9 ommenting
with zection 7000) ot Division 3 of [he Business antl Protess ns Cotle, y+tl
my Iicense is i�l force antl ettecL //Ji�/.�
Licen Cla s nse No. ��f�
Date Signatur@ /�4�-�
WORK RS' COMPENSATION qECLARATION
hereby aitirm that I have a cerry(icate of consent to selt-insure or a cerlificate
' Workers' Componsation Insyrance, or a certitiatl copy tnereot (Section
�800, l.ab. C.)
Policy No. Company
8 Cer[ifletl copy IT hereby fumishetl.
Certitietl copy is filetl with the city Builtlin9 Divlslon.
Date APP��cant
EXEMPTION FROM WORKERS• COMPENSATION DECLARATION
(ThiSsec[ion neetl not be comple{ytl if the pe�mit is fOr One huntlretl ($300) or
less).
1 certity thal in lh¢ Perto�mancQ of the wo�k /or whlch this pe�m�t is Issuetl, I
shall not em lo an erson in an ne so s -become subject fo the
Worke� e s�ws ot Cal fo��Aw w
Daie SignaYurer LVK�i
NOTIC : 1 at r making this tlQ��aration, you snoultl bewme subject to the
Wo�ker5' CompenSatiOn ProvlsiOnS of [he l.abor COtl¢, You must torthwith
comply with such p�ovisions or this permit shall be deemetl �revoked.
CONSTRUCTION LENDING AGENCV tf,��
1 hereby a�firm that tnere i5 a co�struction lentling agency for the performanc¢
of the wOrk tor which tM1is permit is Issuetl (Section 309]„Civ. C.)
Lentler's Name
Lentler's Atlaress
OWNER BUILDEH DECLARA710N '':"
I he�eby aHi�m that I am ¢xemp[ froT the Cont�acto�'S License Law for the
followin9 reason (Section 7031,5 Business antl Protesslonal Cotle: Any city or
county whi<h requires a permit to construct, alter, improva, demolish or repair
any St�uCture, prbr to Its i55uaqce, al5o �eqWreSlhe aOPliCant to� such permlt
[o fil¢ a zi9netl Slatemenl tha[ he/She is IiCrnse� purSuant to Ihe provisions ot
tne Contractor's License Law (Chapter 9.(commencin9'.+���h Section 7000) of
Division 3 ot the Business anq Protesvons Cotle) or that he/she is exempt
heref/om antl tlte baSis for th� allegetl exemption. Any viOlation of Section
/031.5 by any applicanf for a permit subjects the applicant to a civil
Q�enalty ot not more tban five hVntlretl tlollars (E500).
LI I, as owner oi the property or my employeez with wages as their sole
compensa[ion, will tlo the work, antl the sVUCtu�e is not int¢ntletl or offeretl
i01 SdIC ($2CLIOf1 iO4Q� B11510@55 dlld PlOiC5510Od� COtlE: TtIC COOLIdC�O!'S
l.icense 12w tloes not applY to 8n owner ot a property who builtls or improves
ipereon, antl who tloes such work himseli/herselt or throuqh his or her own
empioyees, provitlatl that such imProvements are not intentletl or ofteretl for
sale. If, howeve�, the bulltling p� imp/ovement I5 soltl within One yea� of com-
� pletion, the owner will have the burtlen oi proving he/she tliC not builtl or im-
prove for the pur0ose Of sale).
❑ I, as owner ot the'property, am excWsively contractin9 with licensetl con-
tractors to construcl tne project (Sectlon ]004, Business antl Rofessions Cotle:
The Contractor's License Law tloes not apply to an owner ot property who
builtls or ImOwves tltereon, antl who cont�act5 for such 0/ojects with a con-
tractor(5 ❑ceni¢ pursUant to the ConVactor'S License Law). I am aware that
proot o� theit WotkeYS Compensation insutance Thoultl be provitletl to me.
❑ I am exempt untler Section— B. & P. C. for this rfason
Date Owner
I nereby certiry tha[ I have r�a
intormalion is corretL I agree to
antl state laws relating to builqir
sentatives his <ity to e t¢r
inspection pu vs.r %1
Signature LCiiEi
Drivers' Llcense or 55 �
above
P 3�-2-ss
TVPE OF CONSTRUCTION NEW ADD ALTERATION REVAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. �
TVPE OF PERMIT LJ GaaDING LJ FOUNDATION Ll STRUCTVaA�
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PRQIECT DESCRIPTION Sq. F7. oCCUPANCv
CON STRUCTION TVPE VALUATION $ __
ZONE .GRADINGCU.YDS. ACRES—
Remarks: g 33392
Sink
Preventer
Irri9ation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors .
Kitchen Sink
Lavarories �
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple �
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ai oo,000 aTu 0 i ao,000 er�
Reinspection Fae I $�5
rev. 30/B4 Wnite - guilding; Canary - APPlicant; Pink - Accountlng; Goltlenrotl - A55¢55or
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeretion System
❑0-100,OOOBTU ❑100,0008TU
System Repair/Alteretion
Fire Dampers
Registers
Issua Fee
A.P. #` .
S Main Building:
E
T FrOnt
B Rear
A
C Right
g Left
Ping. Ref. #
Planning Notes:
---�
ZonB
Accessory Building:
6'dU':: ll0 BL't Tll� 2C.o
N
I
t N
G
R
Parking Req./Provided E
Q
M
5
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pple Sub. � 50 + KW
Cooking Unit �
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F,A.U.
Fixtures �
Device Boxes'
Outlets �
Switches
Garbage Disposal
Generaror 065 KW �5-15 KW
Meter LJup m 100amps
Meter ❑over100amps
Sub Panel ' �
Motors �0-1 HP O1 X� 8
Ina Sofar 09-15 HP []76-75+
Microwave
Pole Li9ht
Range
Si9n '
Standing Sections
Trash Compactor
FEES
$ 3
Reinspection Fee $15 Issue Fee $ 3
FEES
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approvad By Date
�Building APP�oved By Date
Appliration luued By Date '�Z Z
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ !• �J ISSUANCE $
PLAN CHECK 25% $ 3• S� ENERGV P.C: $
ELECTRICAL $ GRADING S
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $ w' �
$ 3 PLAN CHECK 25% $ .
CONSTRUCTION AND PLANNING
APPROVALS Permit #
1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Foatings
8. Foundation
-�
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
72. Sewer Cap
� 13. Roof Drains �
14. Rough Plumbing
15. Rough Electrical-Conduit
i6. Rough ElectricWiring
I 17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
[
19. Rough Heating & Air Conditioning
20. Rough FactorY Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding �
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final�Heating & Air Conditioning
35. Final Gas Pipe-Test � �
36: Hood or Canopy
37,; Final Factory Fireplace
38. Final Plumbing
i_39�Water Service-Final -
40. Gas Service-Final
41. Solar'Domestic-Final
' 42. Backflow Preventer
��43.' Backflow Irrigation
�� 44.: Landscape Irrigation System
(.,45. Sound Attenuation
p�46' Handicap Regulations
4Z!FINAL STRUCTURE & BUILDING
48! Special Requirements Completed
49`.� Electric Release to Edison
50. Gas Release to Southern California Gas Co
. 51. CERTIFICATE OF OCCUPANCV
Date
Date
0
POOL & SPA
Inspector qppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical �
76. Dry Standpipe ��
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL �+'
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION _ ��
80. FOOD CERTIFICATE ISSUED
Notes:
Date Ilnspector
�
v ,,
. 7, ,/ .
.� '
�' 'I
. ; �ry ��•
. � � r
1
�n - "� �,
�� y. � ii
�- r
�
��J
�- !, r
/ /�. �? '
,
AOP�icant to fill in all spaces exceot those witnin heavy boreer Iines antl sign all aoorovriate aeclantions. �—��J�
CITY OF COSTA MESA CONSTRUCTION PERMIT PFRMIT N(1 — TRACT NO. LOT NO. I INIT N�i `—
Project Ad�ess � '��
�� . .. i • � r—�.
ApplicaN
Owner's �
Address
Arch/Eng.
Address
Contracto
Address 0
City Licei
IICEN5E0 CONT{ZqCTOR DECLARATION
1 hereby affirm th8t I am licensetl untle� provi5ion5 of Char[e� 9(mmmencing
with sectlon 7000) of oivision 3 of [ne Bustness antl Pro(eszions Gotle, antl
my licenze is In fullSorce ana�jyaer—�� AA� n/.m i
Date
I he�¢by aHl�m IhaT 1 h�' �--�Sent [o Self-inwre o� a ce�UfiGate
Workers' Cor7ipe s o ryp e or a certliled y thereo1 eCtion
!0. Lab. C.) w (�3 G� •
.oli No. Compan
ertifietl c py is hereby furnlshetl. � ��
C¢r ifietl copy is fil with th¢ city Buil n J n.
�Date���� �%� APplican
EXEMPTION FROM WORKERS' COMPENSATION LARATION
(Thissection neetl ryot b¢ mmpletetl if the pe�mit is fo ne huntlretl ($300) o�
� less).
I c¢rtlfy that in tM1e performance of th¢ work tor which this permit i5 ISSuetl, I
shall not employ eny person in any manner so as to bewme subjec[ to the
Worker5' Compensation LawS Of California.
Date Si9natu/e
NOTICE: It, atter Making this tlecla�ation, you shoultl become subjeGt to the
Work¢rs' Compensy(ion provi5ions of the l.abor Cotle, you must (orthwith
comply with such provisions or lltis pe�mi[ snall be tleemetl revoketl.
CONSTRUCTION I.ENDING AGENCV
1 hereby affirm that there is a construction lentling agency tor ihe performance
oi the work fm which this petmit is issuetl (Section 3097 Civ. G.)
Lentler's Name
Lentler's Atltlress
OWNER BUILDER bECLARATION
I bereby aftirm tryat I am exempt trom tho Contractor'S License Law for the
following reason (5ectlon 7031.5 Businessantl Professional Cotle: Any ciW or
county whiGh �equlres a permit to const�uCt, alter, improve, tlemolish or repair
any structure, pripr to its issuance, also requlres the applicant for such permit
t0 tile a Slgnetl st8tement that he/she I5 IlcenSetl pursuant to Ne provisions of
the Contractor's �icense Law (Chapter 9(commencing with Sec[ion 7000) of
�ivision 3 of tne Business antl Protessions Cotle) or that he/she is exempt
i =refrom antl th¢ basis for the allegetl exemption. Any violation ot Section
11.5 by any epplicant (or a permit subjec[s the applicant to a civil
mlty of not more lhan five huntlretl tlollars (E500).
tJ 1, az owner o} the omperty or my employeez with wagez as their sole
compensation, will tlo the work, antl the structure Is not intentletl or otfaretl
for sale (Section. 7044, Business antl Protessional Cotle: The Gontractor's
Litense Law tloes �a� apply to an owner of a property who builtls or improves
thereon, antl whq tloes zuch work himselt/herseH or through his or ner own
employces, oroviqed tM1at such improvements are not intentletl or ofteretl tor
sale. It, noweveq the builtlinq or improvement is zoltl wlthin one year of com-
pletion, the owner will have the burtlen ot oroving he/she aitl not bulltl or im-
prova for tne purpose of sale).
❑ I, a5 own¢/ of Ihe proper[y, am exclu5lvely mnttactinq with licensetl�con-
tractors [o con5[rUct the project ($CCIIOII i�44� BlI51I1C55 dOd PIOfC5510O5 �OdB:
Tne Contractor's License Law does not appty to an owner of propes[y wbo
builtls or Improva,s thereon, antl who tOnt�aGts for such projects wlth a wn-
tractor(s ucense pursuant to the Contractor's License Law). I am aware that
proof o� [heir Worker's Compensation Insurance shoultl be provitletl to ma.
❑ I am exempt upder Section B. & P. C. fo� IhiS reason
Date
owner
I have reatl this
I agtee to comp
to builtlin9.con
� to enter/�Upoi
tne
tlon antl state that the dbove
al1 city antl county ordinances
n, antl hereby authorize repre-
TYPE OFCONSTRUCTION Ll NEW LJ ADD l2XALTERATION IJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER � �
GES�R(jIPT�ION OF WORK/USE OF BLDG. C2���C�S �% �
F
TYPE OF PERMIT L...I GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING O MECHANtCAL
❑ OTHER
PROJECT DESCRIPTION SCd. PT. ` � oCCUanNCv�
CONSTRUC710N TVPF/e�.t �O� VALUATION $ ��
20NE GRADING CU. VOS. � ACRES_
Remarks: (' 3�� � 4 . NL �7
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
Roof Orains
Reinspection Fea � $15
Bailer
Ouct - Under Ground
Duct - Structural
Ouct - Ven[ilating
Exhaust System ❑ Multiple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑ a i oo,000 eru O i oo,aoo
Drive ' ice � � I I Reins{rec[ion Fee I $15
CMF 0065-4fi, t<v. 30/04 White - Builtling: Canary - Appliwnt Pink - ACCounting; Goltlenrotl - A55e55or
FEES
Showers
Service Sink
$ewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fae $ 3
A.P. ,i6
S Main BU
E �
T Fro i'
B Rea �
A
C Right
K
S Left
Ping. Ref. #
Auromatic Washer �
Construction PoleSub.
Coaking Uni[.
Dishwasher
Fan
F.A. U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0-5 KW
2one .
Accessory Buildin9:
Parking Req./Provided
ELECTRICAL ,
Transformer ❑ 75-50 KW
❑ 50+KW
Meter ❑up ro 100 amps
Meter ❑over 100 amps
Sub Panel � '
Motors�0.1 HP�iX-8
Ina Solar �9-15 HP �16-75+
Pole Light
Range
Standing Sections
5 KW Trash Compactor
Reinspection Fee - � $15 luue Fee
IANICAL FEES
Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS:
CanoPY TVPe II ❑ Zoning APProvad By
. -... __ Buildin8 APProved BY d— l>—�.--��^�
Refrigeration System
Oo-ioo,000eru Oioo,000
System Repair/Alteretion
Fire Dampers -
Registers
laue Fee � $ 3
BUILDING PERMIT $ _��r7a
PLAN CHECK $
PLUMBING S
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% S
MECHANICAL $
PLAN CHECK - 25% $
SMIP
PERMIT
ISSUANCE
ENERGV P.C.
GRADING
MICROFILM
TOTALFEE
Z
O
N
I
N
G
R
E
Q
M
T
$
FEES
5 3
$ • � �'; �
�/CONSTRUCTIO`N AND PLANNING
APPROVALS •+Permit #
. ,
1.�Temporary Electrical�Service or Pole
2. Soil Pipe-Undrgrnd.��
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Uridrgrnd.
5. Steel Reinforcementl�
6. Elecirica� UFER Grnd:'�'
7. Footings � ~��
8. Foundation �
.i
9. Water Pipe-Unc}�:grnd.�
10. Structural Floor System
11. Property Sewer Line,&,House Connection
i
12. Sewer Cap
13. Roof Drains �
14. Rough Plumbing
15. flough Electrical-Conduit
i6. RoughElectricWiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
27. Ducts, in Structure �
22. Ducts, Ventilating
23. Gas Pipe-Rough & TeSt
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structuraq & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric '
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Servite-Final
41. Solar pomestic-Final
, 42. Backflow Preventer
� 43. Backflow Irrigation
' 44. Landscape Irrigation System
. 45: Sound Attenuation
�,46: Handicap Regulations
�
47. FINAL S7RUCTURE & BUILDING
;48. Special Requirements Completed
49: Electric Release to Edison
50. Gas Release to Southern Califomia Gas Co�
Date _ _
POOL & SPA
Date Inspector qppROVALS Permit #
52. Pool & Equipment Loca[ion
53. Sieel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar SysTem�Final
67. Fencing & Access Approval
68. APPROVED fOR PLASTERING
69. POOL/SPASYSTEMSFINAL • �
FIRE DEPT. REQUIREMENT � •�
,�
APPROVALS Permit# ''� , �
,� ,.
' 70. Underground Hydro� �a ;, 1
� 71. Product Piping O Gas ❑'Oi�
72. Underground Flush ?;
� 73. Undergrnd. Storage Tank O Ga's ❑ Oil
� 74. Overhead Hydro �'� "" �
75. Dry Chemical - ,
76. Dry Standpipe ��� . '
77. FIXED SYSTEM FINAL '.. ! . L/
M
78. FIRE PREV. FINAL � �
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION '��
80. FOOD CERTIFICATE ISSUED
r
Notes:
_. J
Date �Inspector
� ' Y. ,
� :� . .
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.
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�.i.
�� I �
C . �
- '_ - � 1
� Applicant to fill in all spa<es within heavy bortler lines antl sign all aOPropriate tleclarations. --�-��
CI�TY'j�' COSTA MESA ' PERMIT NO. - - TRACT NO�. LpT NO.' BLOG. NO. - - - _ _
CODdSTRUCTIONPERMI.T Z �%4L ` � - "`� � . �
,. `�3183. �%12/82 ' 68.�0 7L
'ct Address O . � TVPE OF CONSTRUCTION '• . ' „ ,
.� F . . i t i
�Ownerl , c - g - (_, C Phone + /,S-Z ' ❑'NEW ' �'ADD ❑ ALTERATION - - - � ' � ' - ._
'Addre55 g �O �1+�• I'�rti T - � _O.REPAIR ❑CONVERSION ❑DEMOLISH _ , � ' �
. �. . ZONING REGULATIONS � � � '
�-Arch/Eng.� ` --•LicenseNo.- � � � :�oTHER �
OESCRIPTION OF-WORK �� � A'P' � �+ � . •
Address '._ '. ' _' _ __ ' _ ._. _ .. _ � _ ' _ _' " . .. . ,
. . . . �ZOfJE ','PLNG. REF. $. ^ _- ' '= - -' " t
�Contractor0�' - - ;- � Phone� TVPEOFPERMIT� -- -'�.' ' - '�'-- i�-' --�- � �5 TBAC r. ' ��O���RiYurvE� �•� � '
'Add�Ms -' - f -' " ' ' " ' - .-Q GRADING �_O-FOVNDATION-�O STRUCTURAL - � pF VARD -- -- - � - - -- _ . _ . !
LICENSED-CONTRACTOR DECLARATION -' ��� TEfVANT O ELECTRICAL-OPLUMBING-�MECHANIC 5E �
1 hereby atiirm [h:.t I am Iittnsetl untler provislons ot Charter 9 (com- . , , R��E r - -- -" ' - ' " . - -
menUng with Settion-7000) of �Dlvislon -3 of-tbe Busines5 antl� �-��OTHER ' - ( �~T 1
Professlons Cotle, antl my Ilcense is in full torce antl e(fect. � ' ^ p , � REAR YARD (TO P/L) -' � `--- --'" '- '
. _ _ . __ . � � - PROJECTDESCRIP710N.� � --' "^ �
LitenseClass �� � LJcenseNo. - - �SQ �� � -'--'-�- "''' --"' "PKGCSPACEREQ.� '"'-"'-'P,ROVIDED"'- "' �'
Date ' -"" - `"" Si9nature •. - . ._ .' �. � .. ,a � , ' � ' -` ` -- "'- STREET WIDTH - -" ' ""PARK FEE.S. "' ' -
WORKERS'�GOMPENSATION DECLA0.ATION , � OCCUPANCV '_CONSTRUCTION TVPE
9 hereby affirm tnat I have a certl8cate of tonsent to sel�-insure or a � -- "- ZONING APPROVED.BY -"�' - DA'fE--� -- -��
' VALUFiT10N� �' ZONE
celti/1CdtG-of WolkeR' CompenSdtion InSuran<O,�Or-a CBftifietl'copy _ - _ . __� _ �. _ �� � �� - ' �
� � � � ' � ?SPECIAL CONDITIONSi " � - - " "' " �'i
thereof (Section 3800, Lab. C.). . �, GRAOING'CU: YDS. ACRES �
�olitY�No. 'f "ComPanY ' . . . . _ " _ ' ' " _'_ _" ' _ ' � "" � � ' _ ' "
- _' ".�'. y. . '_" _" ' "' "_ . _ "'
,.Certlfietl.copy.IS.h¢r¢by.(umish¢tl. _ _ _.� ..RE RKS:_�C�_�._ � � '`p
. Certifle0 cOpy iz�Til¢tl with th0 tlry Bulltling Olvisian. ' �' � "-' " -' '- - ' ' - -' ' - -
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Q - - � � ��^ �� �� � �� '
(ThiS 5¢CUon neetl not be compl¢t¢tl if, [h¢ perTit IS (or one, huntlretl � ,
(E100) or less). � . -" �' _ __ _ '_ ' ' 7-.t. � ^__u( I
I, certify thd[ in the performance o( the work for which this permit Is ` � . _ .
issuetl, I shall not emPloy any person In any manner so as to become" � PLUMBING �;,�_ .; �-' �- PLAN CHEGK' ''� -' -- :ELECTRICAL - -- PLAN CHECK ' --
subjett to the Workers_Compensatlon Lawipt.California. _ � - ' - '
Date Signatura ' BATIiTU85"--� "- �-• SHOWER51 ' ' � �' • -- =--- � - ' '
: - . ' . . . . ' 1
NOTICE: It after making this tleclaration, you 5houltl become�subject -,TOILETS �; . � •,URINALS✓� - - -- � GENERATOR- ---Od'KW=1-30:KW"' " ' - i
to the Workers' Compensation provisions of the Labor Cotl¢; you'must - � �� ITRANSFORMER y� ,,.,� „ �
forlhwith mmply with Such provi5ion5 Or thi5 pCrmit Shall be tleemeG LAVATORIES DOUBLE L'AV$ - ' ,APPLIANCE - 10-SO�KW_SO+KW- �- - _ t
revokeC. . .' . _ �
"' . _. . _ " ' � ___"_ ' . . � ~ -
�CONSTFUCTIONLENDINGAGENCV - KIT.SINI(5'-- '"'DISHWASHERS"•' --' �-MOTORS- --0-1'HP=140HP=�--- ---
�I hereby affirm tnat there Is a cons[ruction lentling agenty for the per- SERVL,FE SINKS ^ - SUMPS' - -•- �- -- 'UNC..SOLAR) ..�0-SO�HP_SO�+.Hp. �
formance of the work tor wnich [his permi[ Is issuea (Section 309] =
�Civ. C:)_- -' ' ' ' ' ^ ^' ' 'F.LOOR'SINKS=,f� -""'FCOOR DR'AINS"' " -''FIXTURES -'--OUTLETS-- SWITCHES - - -�
�Lentler'S^_Name: �` :^1- / '� � - � .. . - . . .� n\• �
.Lentler s Atltlress � � �� {' ' ' Ji� . DRINKING FOUIVTAWS � �-- ' - � - -- �- GAS�TUBE SIGNS- - - �- - - - �-- _ " �
�OWNER�BUILDER'DECLARATIbN ' ���-` '•�-' � `--:��� ^ 1 - � �- }POLELIGHTS- • --� �- - - -�
Phereby_athrm.lhat I amexempt.from tne Gontractor's License Law_(or INTERCEPTORS � CLARIFIERS - . �
the�fullowing re,ason..(Sectwn 7031.5� Business,'antl,Protess(bns-Gotle:� . SWIMMING•POOL -t�:,�PTRAP-� . � � - - ' ppLES � � 'fv1ETERED` SUB�"�'
Any city -ory,tounty whieh requires a permit lo,conpt!uct; alter„ - ' - - �- �
improve; tlemolish-or repairany'str[Icture, prior to iys iisuance; also re- 'yyATER SERV ICE ' i'ALTERATION� ' -' PANECS' �- �-�MAW --� �- ' �
quires the�ap�llca.nt'for, su4h permR to Hle�a�sigg2tl s(atement thaLhe\ �- -- - - SUB- - -- -
is litensed°pursuant to'the provisionsol,lhe Conbaclor'S Lieense'Law `GASSERVICE" " -^: OUTCETS" ',�- '- ' "SERVICE-- --- - � -- � � - qMP- - � - '
(Chapter>9..(commencing�with�,SecUbn• 7000) of,DlyiSion 3�of'Che' - �" � - "" " _ ' i
Business antl� Grofessions`Cotle)� or,thaY.ne is�e}em�[ tM1erefrom antl ttie- ` yyqTER HEATERS'�' �.. BTU'OVTPUT' �� - - - - - - -- - - _ _
nasis tor the allegetl�ekemptlon. Any:violatioq oin5ectlon J031.S"by � � - --'-"' '-
y; applicant to� a-pe�mlb Subjects the' applltdnt�tB a Civil p¢�alty $EWER CONNECTIONS - -' "' '' '- - - - '
�ot, more `then tive. hwitlred aouan (Y500). ���o•-,r,ti ; o, g , � -- _ ` 0 �
� I, asrowner ot the property; or'my employee5•witfi wages as theli" ' SOLAR TANKt� ��� COL'LECTORS - � - - - - - � - - - - - - � -- -_ . __ _ _ _ -
SOIC COTp¢osajion; will tlo thc work; eTtl�the'Strutture i5�hot InteOBed�� � ' • � �
or offeretl for sale. (SecNon,7044, Business 5nd.,Aofessions•Cotle:The SOLAR�PIPING .Y O' ' ISSUE'FEE -� - -- � - - - �
'Contractor'S LicCnse_L;alv tloe5�not�apO�Yjto an owner of a•proDBrtY � _ -" _ '
who bullds or improve5 thereon, antl.who Eoes such work himself wt - � ISSVE FEE'(� ��� �' " -0APPLICATION APPROVED�BV -- --. _DATE� � -- �
through his own employ¢0s; provitletl�tM1St sucli iTprovementYare noL - ' ''' ' �
intentletl or ofteretl for sale. If-, howeveq the builtling or improvemen[ MECHANICAL�; �. �PLAN CHECK ' � --' ' -'- ' ' i
is sold within one\year ot:completion, the`owner w111'nave the�buitlen . � �SUMMARV OF FEES . '
ot2proving he 4tlitl..noLbuiltl or improve fOr lhe burpose ot'Sale)., HEATINGSVSTEM}..0-100,000BTU ;-BUILDING - ���%�,(�''� --. _` __ _
� .. . '� �' �PERMIT E SMIP..-., _
��-1,- �as- owner �of :[he-property, am. ezclu5ively contractin9' �+'��h _ . _ __ _ _ _ _ . __ "'-��' . E .
licens¢tl contractor5l0•COnstruct the;project (Section�]064,.Busin¢55, ?NODUCTING�;' •+100,000+BTU � ' ' - '�- "' - � •
PLAN CHECK 5� RERMIT �
antl Professions Cotle: The Contractor-s �Cicensn Law'tloes notapply to ' � - ' 'ISSOANCE'..E� �
an owner of proPerty who builtls or improves thereon, antl who con- REFRIGERATION 0-100,000 BTU ' PLUMBING �� , - a
tracts from+such pro�ects with a contractor(s� Iicesnetl pursuant to -SYSTEM -- - - __. _ � s �'GRADING _y, �
the Contractor's License Law). � 100,000+BTU � �PLAN�CHECK 5� � ` - � � :. � y - - .
� I-am"exempt unEer'Se<tion " ' - ' ' " -B. 6 P. Q forthls" gOILERS BTU ' . -�� ' +ELECTRICAL -y �0' " - - - a - �
reason - - - -. - - . - -- . _ _ . MICROFILM E '
SVSTEMREPAIR,ALTERATION � - •PLANCHECK� E - _
Date Owner � � 1 ' ` TOTA V FEE E �
I hereby certify thai I nave reatl thiz applita[ion antl state that the above EXHAVST SVSTEM MULTIPLE MECHAMCAC y - - _ i
information is cbrrecL I"agree to-<omply'wlth all'Nty'antl'county � PIAN CIiECK-=E �-- �-_'' LE55 AD- ' _
. � ' VANCE PC �EC '
ortlinancez antl ztate laws relatinq to mnstruc[ion, antl hereby aulnorize ' ' � . �
represen[a ives'of tnis "<ity 'to enter 'upon" tne -above mentlonetl' �- �� � �' - '
properry mspect�lQ(� �u.{poses. �� p p � (� ��
Si9nature�2�iv`Zre.�AllT'C �p[ �(J' ��+Z" - - _. . '� . FINALFEEE�Q_'�v
Drivers' �ice se or ss � '. ^ ' issuE FeE . - _ - - . . , _ __ _
CMF 0865-4fi White-BuilEing; Canary-Applicant; Pink-AccounUn9: Goltlenrotl-Assessor
CO�JfA MESA BUILGINO—SAFETY DEPANTMENT
' P.O. BOX 1200
� � ' Co�ta Meaa, 6aITfQtfila
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F-
CONTRACTOR
Addrea �
Ciry
sr�ro u�e�.. No.
City License No.
NUMBER TYPE OF
Bar
Kitchen
Basin (f
Floor
Heuterand
ystem . . . C
Druins
TRACT NO. RECD. BY�
LM NO.
USE
�
OATB IBBU6O
Zip Code uuuamg C/� �/ ps�
Address /7—lv O /! /
C�Gff• Owner�,�,j:.rv..cd. � (_alh�rl�l�
Tel. No. Mail �S-D L(% /riS.��h�l
Address
ORITEM FEE (I � h/%Gsy.���yTel�No.��BS%�3
City (1Q �
� �
1 hereby acknow�edge, th�t t have read this application and
iine state that [he abOve is, correct and agee to comply with all
Ctity Ordinanee's aritl'State Laws regulating plumbing.
1 certifyRth�ai I��poaess the above vaiid State ot California classi-
ficatloU�or�l am the legal owner of fhe cesidential property dr
scn'hed�above.
� 1��ify that 1 have obtained a permit from the Statc Division of
� In&usvialSaferyforexcavations,oNerthanswimmingpools,five
� ���y, � feet deep or deeper and into which a person is requi�ed [o descend.
. . .,� . — Sigrta2re of �%� � �
; ROCCSSI�1�{ �'
1
1V1ALlw.n.
�MF 0450-46
INSPECTION"RECORD
APPROVALS
i �
Pfl0.1EtT RODHESS: 8 S O W 1 8 TH ST
owNessxarne:ROTHSCHILD PETER B
nooaess:=ROTHSCHIL� INDUSTRIES
866 W 1$TH ST
COSTA M$SA,CA 92627
ANCH/ENGINEEH: 6 4 5 Z Z Z 2 AEG.NO.:
AODflE55:
UNIT:
uxiT:
PEHMITTEE: PROGRES.,S PLUMBING ( 714 ) 997-5150
nooxess: 1207 W COLLINS AV
ORANGE CA 92667
LILENSEU LONTBACTOH DECIAXpTION: I hereby atiirm llut I am Iicense0 unaer O�ovi5ion5 af C�apier 9(commencing wi�� S¢[tion
7000� ol Oivision 3 of the Business ana Professions CoOe. and my license is in full lorce an0 ellec�.
ciTvuc.:00 9�z S�� TpTEL1�.253134n cu�ss:C3%a�/f I
Daie: _G Signalure: —��—P�-- — ���yX��
WONNEBS' C PE ATION DECLANATIUN: I �er¢by a�tirm I�a� I have a Cetli�ita�e o� c n5en1 to Sel4insure Or a CeM1i�itaie ot Worker5'
Compensalion Insurance. or a cerldietl copy tAereof (Section 3800. Lao. C�.
voucrNa.:046-93UNIT2516 E%P.DRTE:OZIOLI94
cornvaer:STATE FUND
7 Cetlilied caDY �s here�y Nmishe0. � Cenilietl copy is - tl wi Ihe city BuilAinp�
Oate:� ApDlicanl:
E%EMPTIO NOM BKEX$'COMPENSATIONOECIAflRTION: (Thisse[Iion eeAnotbecomplele4il�hepermiti5loronehunEre0�S100�Or1¢5S).
I cetlify I�at in the DeAormance ol Ihe work lor which Ihis Dermit is i55ue41 shall not employ any person in any manner so as lo �ecome
su�lec� to Ihe Workers' Compensa�ion Laws ot Califomia,
Date: Signature:
NOTILE: 11. ai�er making t�is Geclarapon. you 5�ou10 become SUEject Io Ihe Wofneri CAfI1pEfI5d60f1 pf0VI510f15 0� lhC LdbOf
Coae. you musi bM1�wit� tomply wi�p Sut� provivons or WS permii Shall be aeeme0 r¢mkeU.
CONSTBUCTION LENDING �GENCY: I h¢�e0y afiirm iha� I�ere is a conSlmclian lentling aAency �or I�e Dertormante ai t�e vrork lor
wnich tNs oe�mit is issuea ISection 3097, Civ. G)_
LENUEN:
aoonEss:
OWNEP BWLOEfl OECLAflRTION: I her@by aifirm t�ai I am exemD� ��om t�e CanVactors' Slaie License Law lor ��e lollowinp reason
(Section 7031.5 Business anC Pmlessional Code: Any cily oi county w0ic� requfres a permi� lo con5tmc�, alter, improve, AemoliSR or
repair any simclure. prior to its issuance. also repuires t�e applicant for such Dermit lo file a sipned statemenl ihal �els�e is licensetl
Dursuant Io I�e pmvisions ol Ine Cantracto�s' S�ate License Law (C�aD�er 9(commencinp wi�� Seclipn 7�00) ol Division 3 oi ��e Business
an0 Pm�e54on5 Cotle) or��al �e/she is e�empllhere�mm and ��e baSis �or t�e ailege0 eKempiion. Any violaiion of Section 7031.5 by
any applicanifor a permit SUEle��S t�e apDlicant lo a uvil Denalry ol not more t�an five �unGreU Oollars (55110).
I. as owner a1 ine D�aoerty or my employees vnih wages as iheir 501e compensation, will Eo ihe work, ana tAe
❑ stmcWre is noi intenGed ar ol�eretl br sale �Seclian 70a4, Business antl Pmfessional Code: The Cantracmrs' State License Law
does not apply to an owner of a pmDerty w�o �uilds onmpmves ��ereon, an0 who tlaes 5uch work himSelB�erseli or lhmug�
�i5 or her awn employees. pwvi7ed Iha� such impmvemen�s are nol intenaed or oileretl �or sale. Ii, however IAe builtling or
' impmvemen� is 5010 wi�hin one y¢ar of comple�ion. �he owner will have Ihe burden oi pmving he/she tlid no� 6ui10 or impmve
for Ihe Durpose ol sale�.
I, as awner of ine pmoerty, am exclusively mnirat�ing wi�h Iiten5e0 COnlraCtarS io COnSImCI �he pmle�� (,��ian 7044, Bu5lneu
❑ anA Pmfeuians Caae: T�e Contractors' State License Law aces not appN �o an ov.mer ol D�operry who �mlAs or improve5 therron
an0 w�o conirac�s �or such pmlects wit� a[onlracioqs) littnse Oursuant lo Ihe Coniractors S�ate License Law). I am aware
I�at prool of I�ev Warkei'S Campensat�on insu�ance S�oWU Ue proviDetl to me.
� I am e�empl untler Seciion: B. 8 P. C.
IOf Ih15 lQd50fl:
�ate: Ownec
I do �ere0y ceNly Iha� 1 am aware of ana untle�s�antl �he requirem¢nt5 of Cali�amia Heallh antl Sa�ely Coae Sections 2550.5, 25533, antl
25534 ana Inal I or any Iuture Ouiltling occu0ant will/will nat (circle one) neea to comply witn saitl state co0es and ihe requiremenls for a
permii br cons�mtli0n or mOtlifitali0n �rom Ihe Air Oualily Managemenl �i5lricL ReSiUential con5imt�ion ap0liCaiion5 are ex¢mD� ��om
inese provisions. '
Date: Ap0licani:
I �ereDy cerlily t�at I have reaa this appli�a�ion antl Slale Ih ve inlormation is correct. I aB�ee Io compty vrii� all ciry an0 county
orUinances ana slaie laws relating to Guitaipg �onsimnion a� reby a tlrorize represematives oi I�is - y m enter upon IAe above-menlioned
pmperry for spec/p'an purposes.
Oate: G�/—J--��--- SignaWra ei4� �
Driver's icense o� Social Security r: _
W�ile—Bmlamg; Giaen—Cotle EntorcemenC Canary—AOO�icant; Pink—Revenue; Goltlenroa—Assessor
CZTY OF COSTA MESA — BUILDING PERMIT PERM NO: F 062409
PERMIT NO: F 062409 PLAN CHECR NO: 01875-93 L GOVT; N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE; FIR PURPOSE; OTH
JOH DESCRIPTION : BACKFLOW RETROFIT S(j FT;
CLAIM VALUE: 8,000,00 CALC—VALUE; GROUP OCC; B-2 /
COMMENTS: FOR THE "ROTHSCHILD INDUSTRIES"
x�r�e*�e�r�r�***�r****�r�*****�r**�e*�rx*�e�r��e��r**�er�rx�r�r�r**�r*�r�r�e�r*�e�r�r��r**�r+r****���r�e�r�r**��e
2 O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN L&FT; FT IN RGHT; FT IN
PAAKING RE�• PROV; PARCEL; 42412101 2NE; REF NO;
PLANNING N I'ES>
i
1fltif�fltltiFklfifftlFififl�MklFitlFlFiFitffff1f3F1fkltkifiFiFlfiFlkiflfit�Flfif�tlfifkifkMkkitiFitfFif IFiFiFfFiFiFlFiFitiklf�flElfMiF�EiFif
D E V E L O P M E N T S E R V I C E S R E Q U I R E H E N T S
20NING APPROVED BY _ DATE:
HUILDING APPAOVED HY : DATE:
APPLICATION ISSUED BY• DATE: 6> !
iflFffMMltltltititiFMfFltlFMlFifiFifiF�F itit�iFififMitlF�EiF 1FiF
1k�fM1f1FiF1klkfkklflklflklfiFlklflflFlf�tltMtFlfiflFiFlflflfiFlFlfikltiFiFititillF 1flfkfflflfkiflk�fili!lt�Fklt�F1t1t1tiE�fiklFifiFifitiFkikiflt
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N
PERNIT BLDG PMT PLUMHING EL&CTAIC NECHANIC 99R�E0 SMIP/RES GAADING
�i5i SMIP/NON—RES
ISSUE FEE 64.35
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 99.00 0.00 64,35 163.35 163,35 .00
REVENUE DIVISION TOTALS--? COLLECTED• 99,00 OVER/SHORT• 00
BLDG PHT PLUMHING ELECTRIC MECHANI� FIAE SMIP/TOT GRADING PLAN—CHECK
99.00
ik1E Ik1k �1F1tiE 1Ek iFk 1E 1kiF iE IE 1lit1kiFlEi(�ik1E1t If 1f 1t1F ikikikik k ikiFikif 1E1f iEi(�il�1f iE 1[��Ek kikif iEif ikilikiFiFikif iFiEiFiFiE iF iFiE1k1E�k iEiFitiE 1E ihiE�ll�
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
FIR 99
�;
D E S C R I P T I O N UNIT,COST TOTAL COST
FIRE EQUIP FEE (FROM HLDG VAL TABLE) 1.00 99,00
END OF FEES
.�
- oi oDiSoiso-0014U18� T O T 99.OD
-\-
DRTE: O6/01/93 TIME: 13:43
CONSTRUCTION AND PLANNING P�� .. SP'4
APPROVALS Permit�`r Date Inspector AppROVALS Permic r Date Inspector
1. Temporary Electncal Serv¢e br Pot�;,; � 52, Pool & Equipmeni Location "
i.; _$�,�!-Pjae�Undr�:.nd�� ��: '� `�'t � 53. Steel Reinforcement �
- 3 �:E,acti�eal Con�;:",..'Fditv�Und�gmd� � � 54. Forms
`1�: Et�ctiTcal Conda�Yl�.ldrgrnd. ,-,��5 55. Eiectrical Bonding �
5.��;eenReinforcRment uvx 56. Rough Plumbing & Pressure Test �;
_ �} �
�'6;��Ec`�;ical UFE�`.P.irnd �� 57. APPROVAL TO COVER•GUNITE � u'
��:�f'��oy�+'ngs f N 58. Electnwl Cor.duit�Undrgrntl. �-;
..F c� F.-._. ---
'��8.�oundation $`� , 59. Gas P�pe, O Undrgrnd., Test n� {
9._iNater Pipe�UnaPqyid. 60. Backwash Lines, P-Trap, L7 Undrgrr,d. i
1
70.5tryctural Floor System " 61. APPROVAL TO DECK . �
1 Lrt'ro„Erty Scwer Lirte�& Ho`se ConifEction 62. Backwash & ReceptcrFinal ~
12. $ev�ter Cap y a ' 63. Heater & Vent�Pinal i
73. Roof Qrains -{
.� �� 64. Plumbing System - Finaf �
14. Rough Plumbiig � 65. Electrical•Final '
15. Rough Electric�'I�Conduit ,/ 66. Sotar System-Final �
16. Rough Electric�Uiring 67. Fencinfl & Access Approval ^ �
77. Rough Wiring Sign 68. APPROVED FOR PLASTEFING '
18. Rough Electrir�j-T Bar Ceiling 69. POOVSPA SYSTEMS FINAL �
19. Rou h Heaung & Air Condrt�omn FIp (��pT. @�QUIR.,MENT '
q' _Cl ^ a: I !r' �i �. %' %�4�*._+: . c' V E.Jl�!.+ . � r ^ .
20.�` n r^ .. : S eT,`¢'7 = V � rJ' �K 'K --, .r r... r �t: } '�..+
io�h ;,ctQZY F�ie`�lace i 5'r acd +r�. S,� c'x M„ PP���:�l�F�'erj5it,���_
-'c :t3 :�-�'-f-i-c���F.>' -i.r:._ �_cr"��=14'i--'.s3- t •• .'_ _
21!�4U ,i{iStr$CttD'p': i•••. �-�.S • S D�x r -. Y .
� � � :� �. � �: �70. r'�'hdergirO�Hyaro
22.S7u�, 1�fint�tir�� � �. � #: t ` r F� ,. 71. ProduclrfjSyi�9 `� �s �7i1 --
�.
-C?-s----*.,r-i .. �- �-?-t-t-,33-x :�
23.•6a3;?iprfloagh &�est i !rS �•: �: r* 6 Os � 72. Under9ro.rritl FI� r ' �- /- $./� /��
e,� rerc �rx 1-�".T .!.15. . � ' '> C o_i� -� `„_ '
24s''fioct F�ming S� �`"'F' "m "� j a;,,i ; r73�UndcrgmFj.Sior�,j�Tank�7Gat ❑t°�I
�'-,� ��ns -.
25. Roa StSathing 2-� .; v•_ �:� � iUx � 7q('tOverhead Hydrd7 *
.,.. ,-. r.
26.'.T-Bar Ceiling (St a�,urall &��coat � �, �y �' �x % 75=-Dry Chemical • � � " '� , ' '
27;-ra�xx��.„'z < - :� :n� 76. DryStan��We -s >� - ' _ '
�28. Lathin� S�tinysY `��' C`�F C + s "K �c 77� FIXED ��iEi�"y��NAL'� F_ �� C; i
�29.Insuiat�ch ^ Y',� 5.... �< < 7Bi;FIREPREV.Fiti� *> � ` '%.fc193�I1i��-_J
30. Dry+;:aih�Naifithg �� � i ;� �_ n. � � vEAI.Tt"�EP * KEQ'OlRE14iENT
� 37. Plast�- � M �+ � �� x .79. FINAL �IStS,L'ECTI�� �� - ---- �
C �ovtn Coauc 5 i . :
:zj---¢-�-,�.--*-. - :�c�_.r.-�=.-= -- -- �
("32�Iectric�Po��erC;�tL?��nal�� �•ti _Rq t90'�FOODCERTIF�;�:TEIS�`I�ED._ ;:' __y
-�- C- T I .K 1 K.r ' r .�C; *y��
.33�ir�j Efectr�y Nx ,r, i q t: +� Natr,s: �;n •��: C Cr. ,
:>-�-=-=•�r=�-:-_ " x ^ --. t� 'r S�C'�S * S �C -----!
•�34�Fir� Heaun,�&�KC�RtlrtionS.'g' �r . �' - x ' � �q x � '�
��r� r ' r -` . -'*fS-� ,- -j
, 35�=Finfil Gas Pi ��T6,�fz n, .. : �-� � . r .. ; a G'r. . :�= I
-�6. Hotld or CanOPY .; ;; ` � ��-� s x Cl �. � "' E fl�. . J ' ,,. _ __. �
C i �� . T'. ✓ x �s. ITS ZC. � C' >T �'
� 37.,. in'si Fattory Fire(ilaCe� j '�F - n � J- - � _ ,E, .n ='l7 - -�- �- _-�1
.. -c -- ' -�- ' -�x -- - - - �
38�Fin17 Plumbing � ^-' � "� �' x = � .^�• r .� '- I
- ,J Y � i o ,c ic : �a cF • � �
� 39.'�Va� Service-Fina� � y �` V . '
>_ i .'C s Y� a� c
�-40. iGas Service•Final a:r S,,,r S M;� .�a J.� oN > �
rr !: ff '-� � C1 ri -+
'qt.'Solar pomesticFirt,��=' � .. ' �'' -X " •`, ._ �
�r, 5: x c rr�v r;,+ '7r_� 7' r��
4 Gr' '
42. ackflow PreventeM - p7 ,� •y v � `X •� • '� i i - -�
� x r�; n. ,a •. � r. xc �rC7xJ
% F C7 N C_1 5..� K C) •-.
43. Backflow Ir�atiork YSS `� . x,� � x c- � �
" ,• ¢ „
44. Lardsca e tAipati�h SysterrAr:() R^7 - ��r � :: N -+ 5:rt:+ Y .^J -. '
. . y( � ` . %l i' I � i 3{ j 2'� - �
r � .l � �r � lI �: ,� H 'T:aJ �`
45.:�Sound Atte�uatioc� �',`. .. ' tt .,� ;,� :q,, ;; - 7 e ._ • c.:,� t
. �-s-_ -__w. 1
46. Hardicap Regulations �� O * � + �' � �� �% � " ' ;. ,I
.,__v � r � rn r � x _ �
47:�I�.aL STff�CTUjiE & BUFLDING . ' �` * ' '� � : x ^ ' I
>.i-� x� � f
48;.fIt�LPLANNWG .-. x �� I "` ' h ' � � � I
z �ti „ � • -+ ~ ' � +. s � �, n� ^
49: `Electric Reie'ase to�dison � ; I � � -. ;� " �
50,5'.,as};elease to SouFhem Califoraie GasCo '• � �x < - .-+ � • �^T > .
x �.< <
51. CERTIFICATE OFOCCUPANCY T ` * �• �� � = •� " � ' .
No. Date
r-• '�,
� . � . - 25-565
�� COSTA MESA'BUILDINGSAfETY DEPARTM
/ P.O. 90J('1200 , COSTA MESA� CALIFORNIA f
i
�,; For Appl)cant fo Flll In Comp/etaly
TYPE OR PRINT
' a����Nm � 5 b W�` �
ADDREBB
COSTA MESA, CALIFORNIA
owNere � F
MAIL � � . � .n V" /J�
� ��_ _ --
I�I�� � �� VrvPi� ��I�J�
APR 7 1966
APPLICATION FOR PERM
tlof ���Only
11[C[IR NO. IEPMIT NO. .
T�/� �?�SG�
� e �/ � n urs �seum
� p �
iNa S?.C'l� /. �
eca
CONTM R tU.C. Cl• v- !!� �•�•••�•� ��•••••••••� V/ /
ADDRBCD C�n 0.T\ CT . ��11T1oN , OJ �G � I � �
CITY � M P. NO. ' �
NOT[: NOGV60VCRHAN68HALLB6LEBBTHAN
STATB
80• TO 9ID6 a RHAR P. L M
LIC. NO. C3 � N. 8.. ,�l3 O • �
6AV88 �
OFLOT 3 1 n � D[J �'� xo.o►sLDO�. ALLOW�D .(U..B.G.RlQUIRHM6NT)
NOW N �
YARDHAPPROVHG YARDBAPPROVfiD
USE OP IdA1N 6UILOIN6 AGGEGBORY HUILDIN6
EXI6TING B4�0. dPROM C/LfTR6LT1
iETeI�CK LIXi PIIOq � / �OM �. �. �
CENTeR O! tTR�R S D RGR YA D� b U� \
BIDiYA D LiFI' `sI � I� �� RIQFR O R.YIDi GFT. FT.
DESCRIP710N OF WORK . aio � rr rr.
NEW T6RATI AGDITI N RGR ' n OPT. FT.
OIiTANC[!R, B[T. MAIN Q
REPAIR IN MOLIBM
MAIN BLD ACCESY. BLD68,
BVILDING NO.OA VAR.�j DATE
SIZE D 7� /�'O ROOMH RI C, U. P. APPROV6D
EXTERIOR WALL ROOr MPROV6D /
COYERlN6 COV6RINQ e'� B�C ' I 6
�UY60R�UI4D�tlY' NO 011KT0�6P6RrORM[ a
� 9e.. � HOLD OR SPEC EQUIREMENTS, w
I � �
7/� %O(�i ec. Pr. �
1 HlRE6Y ACKHOWL6DOC TXAT 1 XAV6 R8110 TX19 APPLICATION TN[ AMOUNi lXOWN UNDHR VALUATION �8 POR TXH j
AND 6TAT6 TNAT THC ABOV6 1� CORRBGi�ANO I�OR83 TO COM.� �URPOB6 OI [tiASL10XIN0 A PEqMIT FEB ONLY. 1.
PLY WIiX AL4 CITY ORDIl1ANCY AND RAIi LAWY R�OYUTIHO y�UAT10N 'rFJ
lWI.DINOCONBTMYRION. DQ' . �`� O �
SIGNATUREOP PERMITFEB ��
PERMIT�i ' s �n � ' .� / , k
� !7
AUTNORIZiP AG[NT G 4' �e � �� 7�• .
TOTALFEE
r s
� . •
' . -• ' - - i�b' I �
' �, COSTA MESA BUILDINCrSAFETY DEPARTMEM
� ' P.O. BOX 7200 , COSTA MESA� CALIFORNIA 9262!
For App11mM ro Flll In Completaly
TYPE OR PRINT
ADDR6GY �e� Wo�E � U � �
COSTA MESA, CALIFORNIA
�
1\
i eereweK uns rnor
H!T J���'" ii I RIQHT
DESCRIPiION OF WORK
JUN 17 1966
for Offl�� Uu Only
Ric[IIT NO.
cD� �-+ �±
� ZONING
xo. or u.c
■twH� � eutt
o. �f �- // �- - d7l
NO EAV6 OVBRNANO GXALL �! L688 THAN
�1 DV' IVDIU6PRGR •1
ewves
'eLOW. pLLOWED
N LOT
YARDDAPPROVlD
MAIN BUILDINO
<FROM G/L {TRHR)
R l Rx riT O
� R. �o C? �
� ii
Li1D �/ IT.
i
DN RBAR Ri.
DIHTANCC B[T.
� H MAIN BLOOD.
VAR. �'
iRl C. .
� AFl�ROV
� � .
o rto ruK sNe�
6lAo��,. N ,
+.a / /�/i- �.�
I X[RClY ACRNOWIipO� T11AT.1 NAV6 R�AD YNI� 11►►LIGTON
AND BTAT6 TXAT iHt ASOV6 1! COXR6CT ANG AOR6[ YO CAY.
PLY WITX ALL CITY ORDIN �Cf! A 10 RAT[ WYW P�OYLATINO
GUILDINOCOXQ}RUCTION. \`
816NATUR60r �� �
PBRMITTCe `� Q �-�-n
AUTXONIZ[D AO[NT
� �% �[L1a. ►r
TM[ AMOYNT fNO
rURP09i O! f/1
VALUATION
s7 ,3020
YARD9 APPROVHD
AGCE880RY BUILDIN6
DAT6
��ac �i,uccmcrv � �. p,
w
�
�
�
vAtUwnoN •Is ron Tf1e �
A P6RMIT P6[ ONLY.
IT FEe $
/O � '�'W
w
.PEE E � ��
�': .�� .
: -;, . . . 25941 .
�. COSTA MESA BUILDING-SAFETY DEPARTMEM
� ' P.O. BOX 7200 . CO8TA.MEBA� CALIFORNIA B2E20
For AppNcaM ro Fill ►n Complataly
TYPE OR PRINT
81ROACN
COSTA MESA, CALIFORNIA
�
DESCWPTION OP WORK
�
1 N61i6GY ACRNOWL[OO� TMAT.i MAV6 RtAD TI�I/ AP'LIGTON
ANo BTAT6 THAT 1N[ AOOY�,Ie COqp[C7' ANO AOR[6'f0 COY.
P4Y WRM ALL CITY ORDINANCY AryD RA1't IAYM RiOUL�TINO
GU�LOINO COHlTRYCfn10M. /
HIaNATURlOP y��, _ _ �'? ��,/_� � ,
wurHoniz�o eosrri
JUL 25•66 001378 �**1°*15.00
ArPLICATION FOR PERMR
BUILDIN6
For Offln Uw Only
R[C[IIT XO. II
YARDB MPXOV [D
MAIN 6UILDINO
BR.
VM•#
wa
- la - �- �
„�a 8���� ae � r��.
YARDH APPROV HD
ACC6880RY BUILDINO
pATe
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Txe �rourn �aowri uqow vA�uwnox �e ron n�K �
PURPOB[ OI tfiApL18NIN0 A PlqMIT r6R ONLY. �
VAI.,UATION /Q�^ }
� PENMIT FEE I �J �
,!/�a� / — w
V .1 I
l TOTAt PfiE �
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�: �
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. .. . 35609 _ _ ..,_- t�T zs=`v ���-oo, 090� ,r��,r�o.��
" COSTA MESA BUILDING-SAFETY DEPARTMENT -
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � -
APPLICATION FOR BUILDING PERMIT �
ForApplicant to Fill in Completely pEc iv o ev DAT RE IVED �
`'1/ /� � �O � DA7j IS� � � �
ADDRESS �� � WL:Sr IOri N- LD$ Q �
OWNEfi L �o �.j A.P.NO. '^ I��� / PE � �
MA�L BUILDING � %
ADDflE55 ic ADDRESS �� . / `- ,
aU CITY NO` TRACT �'�'Yr's LOT70T BLOCK •
ZQ CONSTRUCTION � �
a m LENDER �
J � BfiANCH ) ..
J � OWNER %J
m J ADDRESS VALUE .�/I
m ARCHITECT - TEL. .. S S�� �^�/
J Q OR ENGINEEF �� � Z S�E�
U Q FIRE
Z 2 ADDRESS ZONE TVPE� GROVP � 2
{y� o > P L" '
d w APPROVED '
J O CONTRACTOR J� �, /N , BY DATE
m Z �l /�
J Q ADORESS �dp� („ , � r
w w TEL./ ' Z�NE NO.OF USE OF NEW
�= CITV Cp�'(q 3.¢ �10.v�{2-�'�/D P�� BUILDING
�~ N
w0 STATE CITV �'ARDSAPPROVED YARDSAPP
�� IIC. NO. LIC. NO. MAIN BUILOING ACCESSORV BUILDI
7� SIZE NO.OF BLDGS. (FROM C/ EE ) ,
OF LOT %� NOW ON LOT FRONT ' FT. �
USE OF
EXI5TING BLOG. FT. � FT.
F� SIZE OF � NO. OF .�
Z NEWBLOG. � R�OMS STORIES I L.SIDE FT. FT. '
U EXTERIOR WALI ROOF ,
COVERING COVERING Gd O REAR FT. FT.
J USE�OF BVILDING AND WORK TO BE PERFORMED DI5TANCEBET. BET. MAIN &
a t �O MAIN BLDGS. ACCESS. BLDGS.
Q
O . C UpP. q� Zt'� �� APPROVED � C%�I �%�.
F� � APPPOVED �'�,l^� �_
N
Z
O f
UI hereby acknowletlga that I have reaG this application antl state . ^�^a y
� Mat the above info�metion is co��ect antl ag�ae to comply wiih � �
� all lews regulaSing builtlinB consttuction, and 1 shall not employ ��% � Z
F eny person in violation of ihe workman's compensation laws of
y Me State of Californla. . �� �
- Z � � � SQ.FT. o
I hereby certify ihet I am properly licensetl as a contractor un0er
tha Staie of California Businass and Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chepter 9, antl thac such licanus are In full force and effect, or I TME PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am exempt trom ihe provlsions ot the Stata of Calitornia Business ¢
VALVATION m
antl Professions Cotle, Oivision 3, Chaptar 9. PERMIT FEE $ �
� �
$Ipnature of //////�����I 7^J� /,./ � m
Permlttee ���J 1 Y�< $�/' /�� PLAN CHECK $ �� E
(� N / o
Authorized Agent 1pr d�8'l/u/� ' v' LL
TOTAL FEE $
�� � � 3b119
• COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. 80% 1200 �OSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILOING
AbORE55
OWNER S
MAIL �
Z AbDFESS �.
w W �a U CITv
� Z
Z Q C0f�6TRUCTION
ON LFNOEfi
�. m
J � BpANCH
J �
m J P�DDRESS
J m A.RCNITECT
a O ENGINEER
U �
Q
w ¢ ADORESS
aW
W Z CpNTRACTOR
J Q
m Z J
J � P.DDRESS /S
W W
ZF CITv
� S7ATE
�� LIC.NO.��
�� SIZE
OF LOT
USE OF
EXISTNG BLDG.
S
�
TEL.
NO.
TEL.
BUIIDING
ADDRESS
Cd^.I�
FIRE
,�� ?.�'7�PnIC
�„t,Go e7o�� ��=s��10.50
FOR BUILDING PERMIT
,TE RECEIVED DATE ISSUI
^i?'%3 � _72-
TEL. ZONE NO.OF USE OF NEW ��U(
NQ VlAP1S � BUIIDING L
CITY ^— YAR SAPPROVED YAROSAPPROVED
LIC. NO.pc(;,•y3 MAIN BUILDING ACCESSORV BUILDI
NO OFBLDGS (FROM C/ISTREET)
I .,�..,... . ,._ _....._ __ S"h 2 __ �4�-
�
�
�
F' SIZE OF NO.OF
QNEyyBLDG. FOOMS STORIES L.SIDE FT. O FT. •
U EXTERIOH WALL ROOF
COVERING COVERING REAR FT. FT.
J USE OF BUIIDING ANO WORK TO BE PERFOqMED DISTANCE BET. BET. MAIN &
a MAIN BLDG$. ACCESS. BLDGS.
a ) �� }y�
a 'I / /OCK�/T/ CUpP.sW APPROVED '
�
NAPPROVED ` �
Z
0 �_
VI heraby acknowletlpe that I heva read this epplication antl state
� Mat the ebove informatian is corract and apree to comply with
� a�� laws repuletinp builtling conrtruction, antl 1 shall not employ 'tf�
F any person in violation of tfie workmen's compensailon lawa of
(n the Stete ot Catifornia. m
? I hareby cartify that I em proparly licansatl as a contractor unCar S�. FT. o
Me Stete of California Business antl Proteuions Cotle, Divizicn 3, THE AMOUNT SMOWN UNDER VALUATION IS FOR �
Chepcar 9, entl that such licensoY ere in tull torce antl aftoct, or 1 TFIE PURPO6E OF ESTABLISHING A PERMR FEE ONLV: m
am exempt from Me provisions ot tha Stete ot Calitornia Businau ¢
VALVATION m
antl Protasstonz Cotle, Divizion 3, Chapter 9. O� N
//�� � �� PERMIT FEE $ ]
. S�p�eture o���� F.{ _���C/_. _ _///r $/j, v v PLAN CHECK $ � E
Petmlttee l`y�=. ���V
v o
Authorizetl Apent /� /� LL
TpTAL FEE $
✓'
• . 'r � �(��OV
� � COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOK 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
ADIDRESS �l0 �/�/ I V�'H % i
GoU2�E¢
OWNEF �IiW G� L .
MAIL � _ . _ � ._
cirv j�! �U1 Pe2-�
CAN5TRUCTION
LENDER �p�
BRANCH
ADDRESS
ARCHITECT rl
ADDR ESS'7 L
CITV �p j•� �y
STATE
LIC. NO. '� I f
SI2E
OF LOT�
USE OF
EXISfING BLDG.
SIZE OF /�n
USE OF
TE�
NO.
p ai �K�eeS oF � r+� �nu Fic� I�[
� � 7'f� G r
NO. OF
ROOMS
ROOF
NO��S�.L�Z'0
CITV
LIC. NO. 1 O�j
NO.OF BLDGS. 1
NOW ON LOT
'�AR -6-73PA��OO i3fl=� ;:*::;�3950
APPLICATION FOR BUILDING PERMIT ,
iiECElj/E BV DATE RECEIVE DAT ISSU
�%
A.P.NO. //�'O{ P �fl: L
BUILDING ��Q ��/ ��j _ �.j�
ADDRESS �/y (� }�
TRACT LOT BLOCK
FIRE
ZONE
ZONE NO.OF
,,. PLANS
VARD APPROVED
MAIN BUILDING
(FliOM C/ STREET)
D�STANCE BET.
MAIN BLDGS.
VAF. qlE
C.U.P. #
APPROVED
1 hereby acknowladpe that I heve reatl this applicetion entl stata
that the above information la correct and aBrea to comply wiih
all laws repuleiinB builtlinB �onstruction, entl I shell not employ
eny penon in violation of iha workman's compenaatlon lews of
the Stata ot Celifornie.
I hereby certify thet I am properly licenaetl as a cantrector untlar So. FT.
tha State of Celifamia Buzinecs antl Profezslorn Cotle, Dlvisicn 3, THE AMO V NT SHi
Chepter 9, and chet such licanses era In tull forca entl affect, or I THE PURPO6E OF E
am exempt trom the provisions of the Siaie of Cellfornle Buainecs VALUATION
antl Protesaion Code, Dlvialon 3, Chepte 9.
Sipnature o ,��{./✓� ��� ��/�
Pe�mltte0 �" § i /1LLf1 00
tl�••—
Authorized Apeni
` VAL�
$
GROUP C
DATE ��
USE OF NEN�
BUILDING �y�_�
VARDSAPPROVED
ACCESSORV BUILDI
&
, 7qX
IT FEE O�
��CfOd
��j�00
�
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0
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" COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fil! in Completely
ADIDRESS 850 W. 18th Street '
OWNEF Lawrence L. Courter
MAIL sC,o W. ].8t,1i Street
ADDRESS
c�rv Costa Mesa No`b42-83
BRANCH
ADDRESS
ARCHITECT Tebault En TE�532-518C
OR ENGINEER g NO.
ADDRESS 13031 Prospect Ave, SA
CONTRACTOF J. Ray Construction
ADDRE55188 �''. 1%t]'1 Street
c�rv Costa Mesa No`-642-421C
�Ic No. 126426 LICYNO. 2794
OF LOT 13 2' x 300 � NOW ON LO �ne
�seoF M-1 (li ht mf - lastics
EXISTING BIDG. g g� p �
SIZE OF � ld NO.OF
NEwa�oc. i9h ROOM$ n/a $TORIES n/a
EXTERIOR WALL ROOF n/a
COVERING n�a COVERING
USE.OF BUILDINC�Af�jD WORK TO BE PERFORMED
I hareby acknowledge ffiet I have reatl Nis application entl sxa[e�
that the above informetion is eorrect enE aBree to comply with_
all laws regulating builtling construction, antl I shall not employ'
any person in viola[lon of the workmen's compensation lews of _
the State ot California.
I hereby certify that 1 am prop¢rly licensetl as a contractor under�
the State o( California Bvsinass antl Profeuions Cotle, Divlsicn 3,_
Chapter 9, and that such licenses are in full +orce antl eftect, or I
am axempt trom L�e provisions of the State of California Business
and ProtessiOns Cr�v rvision 3, Chapte/ 9_� �
/ 1 �
Signature of / j�
Permitt/ Gt��/ �=t.[� ! fYrf/ L
Autho�izetl Agent
��EC 17-73epIoOO 601+F *�*'`
�,.,;� 44.00
FOR BUILDING PERMIT
A.P.NO.II����Z�ZV
BUILDING �SO � •
ADDRESS
��
FIRE
��I BLOCK
APPROVEO /�r
BV DATE
ZO E NO.OF USE OF NEW �d }L�
1 FLANS � BUILDING SI� �'C
YAROSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDIN
(FROMULSTREET) . . �..,
VAR. ik
THE AMOUI
THE GURPCJ'il
VALUATION
$ ����
(�O FT
BET. MAIN &
ACCESS. BLDCaS.
DATE
APPROVED
V .,erc �� —I
��� e
T. o
SHOWN UNDER VALUATION IS FOR �
�F ESiABLISHING A PERMIT FEE ONLV: m
¢
� �
PERMIT FEE $ �
'� / /i m
L
� COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
ADORESS ���L� (.l� . I R� S'I- .
OWNERORO^��G� CO�cSr rI2S1
TENANT (L
MAILING p .y
ADDRE55 �SO (_,��. �p -� S 1
/' � .y�^,�_ TEL.
CITV t_},JS \G� /�'lY—SG� NO.
APPLICATION Fm788TR6Ct1'OR7�Q,.PERMIT 79.77 TL'
RECEIVEDBV PERMIT 1�T0 48172
1V
A.P. NO. 6 .� �' �
BVILOING ��O �• �A� ��i
� ADDRE55
ADD I.4LTER �REPAIR—IMOVINGIDEMOLI
BRANCM `
OWNE ����
ADDRESS
ARCHITECT TEI. USE � �O
OR ENGINEER N
ADDRESS ZONE
� APPROVED '
CONTRACTOR BY
ADORESSI� , �, �r
TEL.Z�3�
CITV 2 � NO. l_ $�
F STATE CITV APPROVEDSETBAf
i LIC. NO.��O30 LIC. NO.
�
�ayj SIZE NO.OF BLDGS. (FROM L T
• 0+ OF LOT NOW ON LOT OM T.
a USE OF
'^ EXISfING BLDG.
y
� Separate permits are required (or �. si
0 electric, plumbing and hea[ing work: REAR FT.
W USE OF BUILDING AND WORK TO BE PERFORMED PLANNI G ACTION
a 2 n�
c
:� G w� �
a
y�, E N L , 'nwa �
'� c u,�
a
w
0 I hareby acknowletlga that I have re this epplication and state
p� that tha e0ova informetion is corract antl apraa to comply with
�. ell laws re8ulatinp builtling consttuc[ion, antl I shell not amploy
,'� any ponon in vlolation of the workman's compansation lawe of
i� the Steta of Calitornla.
�' SQ. FT.
3 I heraby cortify that I am properly licensatl as a contrector untlar
the State ot California Businass and Profeuions Cotle, Dlvialon 3, THE AMOUNT Sf
Chapter 9, end thet zuch licenses are in full farce antl effaet, or I THE PURPO6E OF
am exempt from t�a provisions of ihe Stata oi Colifornle Business VALUATION
antl Profezslo/n-s �Cotle, Division 3, Chapter 9. �
Sipneture of � ` L- �%
Parmitiee ��J�-"� �— / $ ff �% __ i
or 6 �/7� C/ lvlJ
Auffiorizetl eee.;� nr{e
E
G-G -
Q4TE '
APPROVED
J
n
i
7
VN UNDER VALUATION IS FOR m
'ABLISHING A PERMIT F V �
PERMIT FEE E �� y
N
m
PLAN CHECK y y� ^
0
TA% S �
u
TOTAL PAID S �I �l
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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
BUIIDING � � L�j / U ,��
ADDRESS
OWNER OR� /7 ��J
TENANT L�O�ff �
MAI LI NG
ADDRE55 S�Q�
/� / � TEL. V
� CITY ` . /'�/ NO. � 1Z��
BRANCH
ADDRE55
ARCHITECT ' TEl
OR ENGINEER N .
ADDRESS J � f Z�$'
CONTRACTOR /�����`��yLe���/
fV W �Y�C/ ��C�IX
ADDRESS
�926 10/16/79 30.50 TL
APPLICATIO .FOR STRUCTURAL PERMIT
RECENE B PERMIT '1�To " 48981
���
A.P. NO. II �— II .Z. — Z�
BUILDING G`}+H �
ADDRESS �SO LC) . � p —
UNIT OR
SPACE NO.
'�R` O. `6 � LOT BLK.
O
NEW ADD ALTER REPAIR MOVING DEMOLISH
OWNER
USE �
SU
TEL.
CITV NO.
STATE CITV
LIC. NO. LIC. NO.
512E NO.OF BLDGS.
OF LOT �O a}� �� Z NOW ON LOT /
USE OF c..� _��
EXISTING BLOG /jL i.
Separa[e permits are reqUired for
electric, Qlumbing and heating work.
USE OF9UILDIN6 AND WOHK TO 9� PERFORyIED
1 hereby acknowletlpe thet I have raad thls applicntion antl state
thet the abova intormation is corract antl aprae to comply with
all luws rea�ieii�e builtling consttucNon, entl I shall not amploy
any person in v7oletion of tha workman's compensation laws of
the Steta ot Celifornia.
I hereby certify thai I am properly lieensetl es e contractor under
the Stata af California Business antl ProfessiOns Code, Division 3,
Chaptar 9, antl that such licenses are I� full foree antl etfact, or I
am exempt from the provisions ot the State ot Calitornia Business
antl Professionz Code, Division 3, Chapter 9. . .
Signature ot /1 _ /% // // � '
Perm�rctea ///���,�r/`� •.y��
Authorizatl Agent Date ���7���5
C�DuR
S
.�T� � / ��
` �
APPftOVEDSETBACKS I �
(FROM C/l STREET) �
REAfl %J3 FT.O
PLANNING ACTION
DATE
/S
�
m
C
i
SQ. FT. �m`+ �
THE AMOUNTSHOWN UNDER VALVATION IS FOR m Q
THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV: � �
VALUATION PERMIT FEE S aO�O � 4
O� PLANCHECK S D p ��a
V
$ Q� TAX E � f
/� �y� U
TOTALPAI� $ _ (/,..L //
F�+
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F
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to FHI in Completely — Use Ink Only
ADIDRESS BrJ� 18�1 St Costa Mesa
OWNER Orange Coast Plastic Moldi
ADDRESS 650 18�1 St.� C�St.a Mesa
CITV Cosga Mesa TEL.
NO.
BRANCH
AD�RESS
AFCHITECT
L.
CONTRACTOR c;rinnelt r•ire YiOL
ADDRESS 564 Mateo Street
TEL.
c�rv Los Angeles. Ca "�13/6
�ic NO. ZHOSZS�CLG LICVNO. a
512E NO.OF BLDGS.
OF lOT NOW ON LOT
USE OF
Separate permits are required for
electric, plumbing and heating work. .
UILDING AND WORK TO BE PERFORMED
I hareby acknowlatlpe ihat I have raetl this epplication antl stata
ffiat ffie nbova informat(an Is correct antl epree to wmply with
ell laws repulating builtling conrtrucNon, antl I shall not amploy
eny perwn in vlolation o£ tha workman's compensetion laws of
the Stata of Calitornla.
I hareby certify thet I am proparly Iicensatl as a contractor �ntler
tha Stnta of Californie Businesz entl Professions CoEe, Division 3,
Cheptar 9, entl that such licensas ara In tull force end effact, or I
om exemot trom the provisions of the Stete of CalHornie eusiness
antl Protesslons Cotla�,�Division 3,�C/hp�pter 9.
Sipnaiure of /��/./� ./ / „-�/ �,�^
Parmlttea � ���.1{� (/1 '(�"'
Authorizad ABant
T
3425 3�17.�80
APPLICATION FOR STRUCTURAL PERMIT
RECEIVEDBV DATERECfi1VED nnr�i������
A.P. NO. I I(L`-f I I c
BUILOING iJSD �
ADDRESS d
TRACT
OWNER
FIFE
20NE
APPROV
LOT
7.50 TL
20NE NO.OF VSE O W �\
PLANS BUILDING \
N
VARDSAPPROVED VARDSA PROVED
MAIN BUILDING ACCESSO BUILDING
(FROMGLSTREET) .
FRONT FT,.. _ __. � FL ( 1
6E7
VAR. ,$
C.U.P.q{'.
APPROVED
BEf. MAIN &
ACCE�. BLD
DATE
APPROVED
N
n
m
i
m
m
SQ.FT. a
TME AMOUNT SHOWN UNDER VALUATION IS FOR m
THE PUFPO6E OF ESiABLISHING A PERMIT FEE ONLY: �
VALUATION PERMIT FEE S � a
N
m
PLAN CHECK y �� a
s 635.00 rnx a �`
, �� V
TOTALPAID E '
�
r�
. -
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX120D COSTAMESA,CALIFORNIA92626
For Applicant to Fill in Completely — Use Ink Only
ADORESS X� W I/1 � t�l'f/Et �
T�ENANT�R V — �-(J' . JYC r/�O/
MAIIING -^� I/��Jh�J��
ADDRE55 (/ 6 T
V/ �/�� G c
� /� /�/L°Si� NOL /Zp,�j
CITV S L
BftANCH
ADDRESS
ARCHITECT C �nA . i TEL.
CONTRACTOR `S �L�
ADDRESS
TEL.
CITV NO.
STATE CITV
LIC. NO. LIC. NO.
SI2E n NO.OF BLOGS. )
OF LOT �3 �-(� NOW ON LOT /
>
USE OF �/f n / �
ExISTINGBLDG. /I/qr�4imiva/�
Separate permits are required for
electric, plumbing and heating work:
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowletlpe t�et I hava reatl this appllcation and s[ata
that tha ebove informatlon iz correct antl eprea to compiy with
ell laws raBulaNnB buildin8 consvucNon, entl I shall not employ
any person in violation of Me workman'e compenaetlon lewa of
tha Steta of Cnlifomle.
I he�oby certify thet I am proparly Iicansatl ns o conirnctor untler
the Stnte of Celifornie Businass antl Prafasslons Cotle, Dlvislon 3,
Chepter 9, antl thet such licenses era in full torce and etfact, or I
am ezempt irom the provisions ot tha State of Celitornia Business
and Protesslone Code, Dlviflon 3, Chapter 9.
S78^atura of 'e� / %I
Parmittee
o, —' 9_ $p
Authorizod Apent Date _
f �9��3 9Y04i80 106.5rj.=�TL
.. .��-:�,. - - - .,-. _..
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED V PERMIT 1�T0 50621
/.. 1��
A.P. NO. �
BUILDIN �
ADDRE55 �� O
UNIT OR
SPACE NO.
NEW I ADD
USE
APPROVED
PLANNING ACTION
THE AMO
THE PURP(
VALUATION
S /3/pov
a
/ —•1•_ \1 -
ROUP
DATE � � �J ` �✓/
\
�.i
�-..
r �s
DATE
APPROVED
m
n
i
V
( Q O � N
VN UNDER VALUATION IS FOR m
�'ABLISHING A PERMIT FEE ONLV: �
PERMIT FEE $ . �� �
ui
m
PLAN CHECK y "�
0
TAX 5 . LL
� V
TOTALPAID E�/%�.�I
v
' COSTA MESA BUILDING-SAFETY DEPARTMENT pPPLICATION FOR STRUCTURAL PERMIT �
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �
RECEI E BV PERMIT �
For AppGcant to Fill in Completely — Use Ink Only
ADIDRESS � O � A.P. NO. � � /SZ ��,
�[^/ BUILDING Q�� ' ` „�v ("^�
T� NANT�R ,�%�C , �dAST T/�f{�/C ADDRESS ��� ��� J
UNIT OR
MAILING SPACE NO.
AODRE55 S'
TR O LOT �O BLK.
CITY COJ I //� N�L�/YG�
NEW ADD ALTER REPAIR MOVING DEMOLISH
ODNSiRUCfION
LENDER
BRANCN c
OwNER ,�}.{fCj� %�T dT/C
ADDRESS VALVE
ARCHITECT TEL. USE s� D
OF ENGINEER T CO
ADDRESS `� �O�/'� L.D ' N 1� .. L/:� ZON TVPE GROVP
APPROVED
CONTRACTOR /D L /✓ BV DATE
ADDHESS
TEI.
CITV NO.
STATE ♦ . � CITV APPROVEDSETBACKS
LIC. NO. Ips' LIC. NO.
SIZE NO.OF BL�GGS. (FROM C/L STREE
OF LOT NOW ON �OT M T.
USE OF f
EXISTING BLDG
Sepawte permits are required for �. s� pT.
electric, plumbing and heating work:
REAR FT.
VSE OF BUILDING AND WORK TO BE PERFORMED P�qNNING ACTION
/ C / � Q N C DATE
v (� J APPROVED
V
I hereby ecknowlatlpe that I heve raetl this epplicaHon end stete �
that the abova information is correct entl aprea to comply with �
ell laws reB��atln8 bui10��9 �onsiruetion, entl I shali not employ .
eny parwn In vlolation of Me workman's compansation lawa of ,
Ma Stata of Caiifornia.
1 hareDy certify that I 9m properly Iicansatl as a contractor untler S�. FT. i
tha Smte of California 9�sinass entl Profassiona Cotle, Division 3, THE AMOUNT SHOWN VNDER VALUATION IS FOR [
Chapmr 9, antl t�et such licansas era in tull forca antl attect, or I TT1E PURPOSE OF ESTABLISMING A PERMIT FEE ONLV:
em exempt frOm the prOvisione Of theState of California Buainesa VALUATION '
antl Professlona Cotla, Division 3, Chepter 9. PERMIT FEE S � D �
r
S(gnatura'ot' P�N CHECK E 7 �
P¢rmittee - g /f /`ii� TAX S '
or '�•������ � (
Authorized ABeni te ���� �� I I
TOTALPAID y O, �
'