HomeMy WebLinkAbout917 18TH ST - Building Permits.
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Job Address: 917 W 18TH ST
Suite:
Viciniry: ,
GRADING PERMIT
Status: ISSUED
Applied: 01/10/2002
Issued: 04/19/2002
Parcel Nunmber: 42436116 ZOning: ISSUED BY:
���- � ' �" � � �
Applirant COX, CHIP ' �// �': _ - i - -, � - -� - � ,
�' �
Address: 26272 YOLANDA SL '- - - . �, � � - � .
i'. " �' " '� Phone: 94&382 8470 � � � ; �� ��_
IAGUNAHILCS, CA � � � � . Zip:� �92656 �; � � i �� ��
Owner. � LEWIS, JAMES R `�' � � ' � ��� i ` \�
Address5 i1785MONROVIAAV �. ; � � �� � ;�� � � �����'��
� � "��� � • . " Phone: 714-850-0869 �,,` .� A. /.� /: �:�.�1�
i V 'J�«; - ��ti\�� �� ,� �_
� ", `COSTAMESA.,CA� Zip: 92627 \� `;A�i � / �� ��.
' ;"�. �-i;%''i� � �'�:��A j.
Contractor. � COX'PACIFIC � � � � � '
e . � �_ .
� Address: � 26272 YOLANDA ST � � ��` `� ' � �
�
. ! /' ' � � Phone:= 714362-9470 , _ � � � \ � � '� � ; �
� LAGUNA HILLS. CA ..•\ .` _ ' �' � �,
, - 2ip: 92858 " �Cicens : 366761�' � - . . . ', ���
Eng:. COASTENGINEERING �_ � - _ _.. � . �`,
t Address: . -, � . _ ' _ _ - � V - -% V � � . , - � , .
� . , � /, �`� Phone: . _ � �. . �
>
. ' �`�/� � �• � . , - .
- Zip: � � License: C39868 \ � ,
_. ,� \
_ _ '- -'_"•-f� � --. �-.--,-' .
, , _ _ _ _ , _ �\:'SCOPE OF: PERMIT- ; ,
` CUBIC YARDS 122 CUBIC YARDS CUT/ 14 CUBIC YARDS FILL. SITE IMPROVEMENT FOR VEHICLE STORAGE YARD � '
TO INCCUDE: DRAINAGE, CLARIFIER, ASPHALT PAVING. BLOCK WALL. 14,700 SQ. FT. AREA ;: ' ' �
� �.� .�.� . . "
BLOCK WALC UNDER SEPARATE PERMIT REF: B02-00045- _ �� _ _ __ � A - � � �;. ' - , � � ,
SITE IMPROVEMENT VALUATION IS $60,000. � - . _ _ � . � � '
�� _
�..� . . ,- .-i � j. � � ' _ •,r �
REP: ZA-01-38 �
136� � ' . ,- ' - �• . . , ' , ,
� ' � ,i,'FEE,SUMMARY � ,�- ' �
PlahCheck: ����$33.00 Calc Valuation: ��$so,000�.00
,
� � �� ( _$0.00 � �'r ' . � �
�Pe�mit: ' $54�.50� '� , � �_''^ _' -�'i '
� /
Othef: , , �� $0.00��:� ; � "
; � $0.00 � ._ � .
Inspection� $0.00.; � - � �
�� � $0.00_': , • � ,
�� ,
Total: �58750�-, �� , � � � � � ' .� .� %
��_ ��; PLANNING&ZONING--';- �
NOTES: • COLLI KJ 04/18/2002 THERE ARE TWO�SIGNED AGREEMENTS FILED
IN THE ADDRESS FOLDER FROM ADJACENT PROPERTY OWNERS TO
BUILD AGIANST THEIR BUILDINGS. PLEASE DO NOT ERASE.
CHARLES.
(CHANGED TO COMMENT BY KJC SO THE INFORMATION WOULD REMAIN
EVEN AFTER THE PROJECT IS FINALIZED) NOTICES ARE DELETED
AFTER FINALIZATION.
NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced vnthin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetlona and final approvel must be obtained. Failure to oblain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
�wwu �aw�
WORKERS' COMPENSA710N DECLARA710N:
I �ereby aHirtn untler penalry of peryury ona of the following declaretions: '
❑ I �ave end will maintaln a certificete oi consent to selt-Insure for workers' compensetion, es providetl for 6y section 3700 0l tha Lebor Code, for t�e pertortnance of the
�., /Work For w�ich this parmit Is 155ued.
p�/ I have antl will maintaln workers' compensation insurance, es requiretl by sectlon 3700 0l the Lebor Cotle, for the performance of Ne work for which Uis pertnit is issued.
� My workers' compensetion Insurance cartier and policy number ere: �
Cerrier: Policy Number:
(71�is secfion neetl nof be canplefed i! fhe peimit is valuetl af one hundred dollars ($ f00) or less.)
� 1 certiy that in the pertormance of tha work tor which this permit is issued, I shall not employ any person in any manner so as to become subjact to the workers'
compansetion laws of Celif mia, end agree ihet ii I should become su�jec� m ihe workers' compensation provisions of Section 3 oi Iha Labor Code, I shell forthwith
comply with ihese hs %�� � (� // �
ApplicantSignawre: �5�� Date: —I �I � f �-v
WARNINO: FAILURE TO SECURE WOPK ' COMPENSATI WVEMGE IS UNLAWFUL Ml� SMALI SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FlNES UP TO ONE HUNDRED
TMWSAND DOLLARE (5100,000�, IN ADDITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 310fi OF THE IABOR CODE, IMEFEST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aRirtn ihat I am licensetl under provisions of Chepter 9(commencing with Sec�ion 7000) ot Division 3 of ihe Business end Professions Code, antl my Ilcense is in full
force end eHect. Lia k Class a
Contractor'S Signature:�_ Date:
�
CONSTRUCTION LENDING AGENCV:
❑ I hereby alfirm Ihat there is a wnsiruction lending agency for ihe pertormance of Ihe work tor which Ihis pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lentler's Name: Lenders Address:
Signature: � Date:
OWNER-BUILDER DECLARATIONS:
1 hereby aflirm that under penalry ol perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Busineu antl Professlons
Cotle: Any ciry or counry which requires e permit lo construct, elter, improve, demolish, or re0alr any structure, prior to its Issuance, also requires Ihe applicant for such pertnit
to lile a signed statement Ihat he or she is licensed pursuant to the O�ovisions of Ihe Coniractors LJcense Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 ot ihe
Business end Professions Code) or t�at he or she is exempt Ihereirom and the 6asis lor Ihe ellegatl exemption. Any vialation of Section 7031.5 by eny epplicent far a parmit
su6�ecis the aDP����� �o a civil penalry af not more ihan five hundred dollars (5500).):
❑ I, es owner of the prapany, or my employees with weges es their sole compensetion, WILL DO 7HE WORK, end the structure Is not intended ar atfered tor sale (Sec.
7044, Business and Professions Code: The Contractors License Law tices not apD�Y �o an owner of property who builds or Improves ihereon, end who does such work
himself or herself or through his or her own employees, provitletl that such improvemems are not Intended or oflerad Por sale. If, �owever, ihe builtling or improvament is
sold within one year ot completion, iha owner-builder will have ihe burden ol proving Ihet he or she did not build or improve for purpose ot sale.).
❑ I, as owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cotle: The wntrecmrs License Lew does not epply to an owner of propeny who bulltls or improves thereon, end who wntracts for such pralect wit� a wntractor(s)
license pursuant to the Conirectors License Laws.).
❑ I em exempt untler sec.
Signature:
Owner ID verified by dnvers license. ❑ Yes ❑ No
Business and Prolessions Cotle tor this reason:
Vedficetion of Ownership by (type of document, i.e. - pmperty tax bill ar daed):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICA710N:
Drivets License No.
Date:
Expires:
❑ I hereby certify Ihat no excavetion five (5) or more feet in Oepth into which a person Is requiretl to Cescentl, will be mede in connection with work eutharized by Ihis
permit, antl ihat no builtling sirucNre, scaHolding, lalsework, or tlemolition or dismentling thereoi, will be more Ihen thirry-six (36) feet high. (C�ep. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifomla Administrative Code).
❑ As owner-6uilder, I will nol employ anyone to do work which would require a permit trom the Division ot Industnel Sefery, as noted ebove, unless such person hes e
pertnit to do such work irom ihe tlivision.
Signature: Date:
Division oi IndusMal Sefety Permii Number:
CERTFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I certity under penalry of perjury that I have read this epplication and state thet the information given is
wrrect I egree to comply with all stete lews antl ciry ordinances releting to building construction, end euthonze representatives of the qry of Costa Mesa to enter upon the
above-descnbetl propetly for inspection purposas. I egree not to acupy or ailow occupancy of any building authorized by ihis permit until final inspection.
` Sign re Of Legal Owner(s) '�/� 2
AnNOr Authorized ApO����� Date
COOEI, INSPECTIONTYPE QAIE �6S
1616 Fixetl System Finel Fira Prevention �
1268
200
201
202
203
204
Pool Spa Final
Final RaRoof
Final BIocWRetelnlnq Well
Final Factory Fire Place
Final Sign
Final Demolition
COUE� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
270 Final Electrical
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
, 250 Final Builtling/Occupancy
PAIF L�EL4
•� r /
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
.lob Address: 917 W 18TH ST
Suite:
Vicinity:
Parcel Number: 42436116
npp�icant: COX PACIFIC
Address: 26272 YOLANDA ST
IAGUNA HILLS, CA
Owner: LEWIS,JAMES
Address 1785 MONROVIA AV
CA
CM,CA
Contractoc COX PACIFIC
Address: 26272 YOLANDA ST
LAGUNA HILLS, CA
Zip: 92656
Arch :
Address:
Zoning:
Phone: 7143629470
Zip: 92656
Phone: 714-850-0869
Zip: 92627
Phone:� 7143629470
License: 366161
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 06/27/2001
Issued: O6/29/2001
Phone:
Zip: License: � License:
SCOPE OF PERMIT
DEMOLISH EXIST. 1968SF DUPLEX. WITH ATTACI-IED GARAGE. .
Plan Check:
Permit:
SMtP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$97.25
$0.00
$0.00
$0.00
$0.00
$97.25
�_
SETBACKS � �� � � ���_` � '
�' �
MAIN STRUCTURE Fron[ 0- 0 � - Rear 0- D
ACCESSORY Front 0-0 �� Rear 0-0
PARKING Existinq: o, Required: o
NOTES:
FEE SUMMARY -
Calc Valuation:
Claim Valuation: ,
PLANNING & ZONING �- � �� �
- �
LeR 0-0 � Right � 0-0�'
Lek 0-0 . ' ' Right - 0-0 -
Pr000sed: 0� , _ �
$3,500.00
$3,500.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
�regulations. (Ord. No. 92-28, § 1, 1241•92)
EXPIRATION: This permit shall automatically expire and Decome void if work is not commenced within 180 days, or if work is suspended or abandoned
for a penod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspections and (Inal approval must be obtained. Failure to obtain inspections and final approval will resufl in ihe expiralion of ihis permit.
FOR INSPECTIONS CALI: (714) 7545626
taeeee �eroo�
WORKERS' COMPENSATION DECLARATION: '
I hereby eHirm Undar penalry af perjury one at the tollowing tledaretions: �
❑ I have end will maintain a certiticete of consent to seli-Insure tor workers' compensetion, es provided for by section 3700 0l Ihe Lebar Cotle, lor Ihe peAormenca of the
work 1ar which this parmit Is issuetl.
, �
❑�I'have and will maintaln workers' compensaGon insurance, as required by sectlon 3700 oi Ne Lebor Cotle, for ihe pedormence of Ne work for which ihis pertnit is iswed.
% Myworkers' compensallon fnsurance mer and palicy number ere: �7 ,/ ' /
ceme�: �T�fl�1 Lr FUN� Policy Number I ZS YiT Cdo
(This section need not be com0/etetl i/ the permit is velued et one hunOretl tlollars ($100) or IessJ
❑ I certity Ihqt in the peAormance of tha work for which this permit is Issued, I shall not employ eny person in any manner so es to become subject to the wolkers'
compensation laws of Celifornla, entl agree t�et Ii I should become sublect to ihe workers' compensation provislons ot Sectlon 3700 of the Lebor Code, I shall forthwlth
wmply wilh these pro/�'c1�on� �/ / C
ApplicentSigneture:.� l .�"/` Date: --�+ l.0 'Z / ^� �
i
WARNING: FAILUqE TO SEWRE WORKE0.5' WMPENSATION COVERAGE I$ UNLAWFUL AND SMALL SUBIECT Ml EMPLOVER TO CRIMINAL PENA�TIES AND CML FlNES UP TOONE HUNDRED
TKKISIND DOLL4RE (310U,000� IN ADDITIIXJ TO THE CQST OF GUMPENSAl10N, DAMAGES r15 PHOVIDED FOR IN SECTION 3lW OF THE IABOR ODDE, It�lrERES�, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eNirm thet I am licensed untler provisions at Chapter 9(commencing with Section 7000) ot Division 3 of Ihe Business antl Professions Code, end my license Is in full
force end eMed. Lic. tt- � Class a �-,
ConirecrorsSig en ture: Da�e:�� ��lJ�
CONSTRUCTION LENDING AGENCY:
❑ I hareby aitirm ihat there is e consiruction lending agency for the peAormance ot ihe work br w�ich ihis Oermit is issuetl. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Atldress:
SigneNre: Oate:
OWNEF-BUILQER DECLARATIONS:
I �ereby eHirm lhet under penelry oi perjury that I am EXEMP7 FROM THE CONTRAC70RS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business and Protesslons
Code: Any ciry qr wunry which reQulres a pertnit to construct, elter, Improve, demolish, or repair any structura, pnor to Its issuance, elso requires tha eppllcant tor such permit
to flle e signed statement that ha or she is licensed pursuent to ihe proWsions of the Coniredors License Lew (Chepter 9(commendng with SecUan 7000) ot Division 3 of t�e
Business erM Pmtessions Cade) or thet he ar she is exempt therelrpm end the basis tor Ne elleged ezemption. My vFWation of Section 7037.5 by any eppXcant tor e pertnit
subjects the eDPliwnt to a cMl penelry of nof more than five hundred dollars (3500).):
❑ I, es owner of the properry, or my employees with wages es their sole compensatlon, WILL DO T1E WORK, and the structure Is not intended or oflereG tor sele (Sec.
7044, Business and Professions Cotle: The Contractors License Lew dces not epply to en owner of property who builds or improves ihereon, end who does such work
hlmself or herselt ar ihrough hls or her own employees, provitletl ihat such improvemenis ere not intended or oHered tor sale. If, however, ihe building or improvement is
sold within one year oi completion, the owner-bullder will have the burtlen of proving that he or she tlitl not 6uiltl or improve for purpose oi sale.).
❑ I, as owner of ihe properry, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Businass end Professions
Code: Tha contractars License Law does not apply to en owner ot pmperry who builds or improves therean, end wha contrects tor such project with e comrector(s)
license pursuant to the Coniractors License Laws.).
❑ I em exempt untlar sec.
SignaNre:
Owner ID veniied by drivels Ilcense. ❑ Yes ❑ No
Busi�ess enA Professions Code for ihis reason:
Vedficetion of Ownership by (rype oi tlxument, i.e. - propeny tax bill or tleetl):
Drivefs License No.
Date:
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby cartify ihat no excavetlon five (5) or more feet in depth into which a pereon Is raquired fo descend, will be matle In connection with work euthodzed by this
pertnit, entl that no buildinq siructura, scattolding, telsework, or demolition or dismantling ihereof, will be more then ihirry-siz (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 9, Calitomla Adminisiretiva Code).
❑ As owner•builder, I will not employ anyone to tlo work which woultl require e permit irom I�e Division ot Industnel Safery, es notetl above, unless such person has e
pertnit to tlo Such work hom lhe division.
Signature: �ale:
Division of Induginal Safety Permit Number:
ICEHTIFlCATE bF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I cenity under penalty of perjury Ihat I have read this application and state ihat t�e intortnetion given is I
wrrect. I egree to comply with all stete laws and city ordinances rela�ing to building conslruciion, end authorize representatives oi iha City of Costa Mesa to enter upon Ihe
ebove-descnbed pmperry lor inspection purposes. I egree not lo occupy or ellow occupancy ol eny building authorized by ihis permit until final inspection.
SI ture Of Legal Owner(s)
�•An�orized ApDlicant
CO�E �. INSPECTIONTYPE PdIF U�LS
1616 Fized System Final Fire Prevention
1266
200
201
202
203
204
Pool Spa Final
Finel pe-Roof
Flnel BIocWRetaining Well
Final Factary Fire Placa
Final Sign
Finel Oemolition
Vtlltl
�-?i O/
Date
COOEr INSPECiIONTYPE
206 Final Mechenical
208 Final Plumbinq
210 Final Electricel
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuilding/Occupancy
PSIE Irrtm�L3
(714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF DRIVE, COSTA MtSA, (:A 9'L626
ELECTRICAL PERMIT
Job Address: 917 W 18TH ST
Suite No
Vicinity:
Parcel Nunmber: 42436116
' Status: ISSUED
Applied: 04/19/2002
Issued: 04/19/2002
` ..
�
Applicant COX, CHIP , : - --- -- - ---__ _ ISSUED BY:
�iir��.i ���-,�-
Address: 26272 YOLANDA S�T ,-�/%�,----� -" - .;,- �-- --�--� ^
' _._ _,`<'�,
i' 7�� �i� � -� �Phone:� 714362-94 0 �� <��
LAGUNA HI S; CA %���1 '' +• Zip:, 92656 .. �':/ i,���\�� •
�� .A ��1 ' �� �,�� ' �
r �/ ` t `- l i _ `
% i����. ' � '� % � ' _' c � ��J ��� ��
Owner:%, LEWIS, JAMES R : " � - � >_ � � �i���� �`� �'� ����
Addre s'�,� 1785MONROVIqAV;'� '- � -�\�,� ��; � j ,� \�\ �
�
� /, Phone: 714-850-0868 AC��� � � � �, �
�� V '/. ��_AA '�.
i
�� COSTA MESA, CA Zip: 92627 � �`�' i �
. - � ' ����� -
��„
% %'" � �'�
� �
� Contractor: _� COX PACIFIC � � � , ',,;� �� ,
�� �' � AddFess: �28272YOLANDqST � � � � _�� ' � _
, , . t..:� j _,.- �' ' . `�.
� , . , ,. :
. . '. - � . , . �, �Phone: 714-362-9470�: -` � , ��`��. ,
��;
- � �LAGUNA HILLS, CA, � " - - � Zip:"'92856 . _ � , ' - l , � ,
- �• - _. '�\ .i/i��� � . .
� , � � • � � : -� License: 366161 - - A•� '
\
. ' � ' . `� �V � _
/
, SCOPEOFPERMIT ; .-,,, ,
122 CUBIC YARpS�CUT/ 14 CUBIC YARDS FILL. SITE IMPROVEMENT� FOR VEHICLE STORAGE YARD
. TO INCLUDE: DRAINAGE,`CLARIFIER, ASPHACT PAVING. BLOCK WALL: �74,700 SQ. Ff. AREA. � ,
BLOCK WALL UNDER SEPARATE PERMIT REF: 802-00045 -
� SITE IMPROVEMENT VALUATIONiS $60,000. ' �
REF: ZA-01-38 REF: G01-00002. ,: `��� '. - � � � - - � ,
� ELECTRICAL TO INC6UDE: 3 GGHT FIXTURES, 4 OUTLETS, 2 SN/1TCHES, �1; MISQ ELECTRICAL' -
� EQUIPMENT, 2 MOTORS 70 �0 HP, MISC CONDUIT. ; � � '� - - - ' �
��� /�%i " _
Quantiry
ISSUE FEE -' � .� $23.50
Temp service test - . �$0.00
Res. a/c package � \$0.00 _
New Res (1-2 units) $0.00�� ' ��" 0 �
New Res (3+units)� ! /i�$0.00�:� �. � 0
Pool/Spa � $0.00'�� ;;0 �`�
Lighting Fixts ����- �� � � $3.30� - �3� �
Recepl Outlets ' � ' � $4.40 � 4 � -
Switches � $220 � , � - 2_
Non Res Appl , $0.00,__ 0
Res Appl - $0.00 �' -� 0 � �
Service to 200a � $0.00. -� 0 .
Service to t000a $0.00�,; - �� 0
Service over t000a $0.00 � � -0� ,
Motors to 1 hp $0.00 �"0-_ �
Motors to 10hp $24.60 2
Motors to SOhp $0.00 0
Motors to 100hp $0.00 0
Molors over 100hp $0.00 0
Communicationdrops $0.00 0�
Sub panel to 200a $0.00 0
Pole Light Pkg $0.00 0
Sign Circuits $0.00 p
Temp Pwr Pole $0.00 0
Intertned Pole $0.00 0
FEE SUMMARY
Quantiry .. �
. � � '� Temp Disl System / Lighting $0.00 �%��.0 � "
'�%' �_� Busway I100 k �,_ $0.00 %/ 0 �
,�
� � 9tanding6ection�,.' ;�.�.�� $0.00��� 0�= �, ,�. %f
N "'✓ ' �'
� "'.' MiscElecVicalEquipmenf $18:20 1' �
, � .. , -Transformers up to 1 kva/kw --; �$0.00/,` 0 % �
� ,'�, ;
, � . � -- ................up�to 10 kva/kw �� $0.00�� j�0 �'.,' '
, � . .................up to 50 kvalkw � $0.00 �. ', 0 ,
``� . .................uptot00�kva/kw "-$0.00� 0�, :��.
. ..................over 100 kva/kw � $0.00 � .� 0� -.-'
� Low Voltage Equipmenl � $0.00. " 0'
- � � - , Low Volt Winng System / Ckt' - $0.00' ��0
' Misc. Conduit - ,- $1820 � � 1
.. , Misa Conductor ' � $0:00 0
' " � �Circus ( gen or ride) ; . � $0.00 0
, .. - -�Circus (mech ride or_lights) $0.00 0
- � � Christrnas Tree Stand $0.00 0
Fireworks Stand $0.00 0
Other Electrical Fee $0.00
Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $94.40
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92)
EXPIRATION: This permit shall automatiqally expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
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, antl ell
requlred Inspeetlona and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626
2ea6ae le�ao)
WORKERS'COMPENSAnON DECLARAnON: �
I hereby eflirm under penalry oi perjury one of the following decleretions: ' . �
❑ I have end will maintain e certilicala of consent ro setl-Insure lor workers' compensetlon, as provlded tor by section 3700 of Ihe Labor Code, for ihe pertortnence of Ihe
work tor which this pertnit is issued.
��l have antl will maintain workers' compensation insurance, as required �y section 3700 oi ihe Lehor Code, lor ihe pertortnance of Ihe work for which this permit is Issued.
�� My workers' compensation Insurence carner end Oollcy num�er are:
Carrier: Policy Number:
(This seclion need not be canpletetl il the permit is velued et one huntlred dallars (5100) or less.)
❑ I cenify Ihai in Ihe pertortnance of Ihe work for which this pertnit is issued, I shall not employ any person in any menner so es to become subject to the workers'
compansatlon laws of Celifomia, end egree that ii I should bewme subject to ihe workers' compensation provisions of Seciion 3700 of the Labor Cotle, I shall farihwith
comply with these%� vl ns. �j / �[ �j /f �
ApplicantSigneture: ( '��/% C "�tM� Date: / �/ / �� `�
WARNING: FAI�URE TO SECURE W�KERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O6 OF THE LABOR CAOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business end Prolessions Code, and my Ilcense is in full
brce end effecl. Lic. a Class k
Contractor's SlgnaNre:� qZ_�� Date: � �
i�
CONSTpUCTION LENDING AGENCV:
❑ I hereby eHirm ihat ihere is e construction lending agency Por Ihe pedormance of the work lor which ihis permit is issuetl. (Sec. 3097, Civil Code).
Lendels Name: Lendefs Address:
Signature:
OWNER-BUILDER DECLARATONS:
Dele:
I hereby aHirtn ihat under penelry ot perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the tollowing reawn (Sec. 7037.5, Business end Professions
Code: Any ciry or county which requires a permit to consiruct, alter, improve, demolish, or repair eny sWcture, pnor to ils issuance, also requires the aOPlicent for such pertnit
lo file a signed statement Ihet he or she Is Iicensed pursuent lo Ihe provisions of Ihe Contrectors License Law (Chapter 9(commencing with Section 7000) of DiWslon 3 of ihe
Busineu flntl Professions Code) or thet he or sha is exempt therelrom and the basis tor the elleged exemption. Any violation ot Section 7031.5 by eny eppliwnt tor e pertnit
subjects ihe epplicant to a civil penalry oi not more ihan liva hundretl tlollars ($500).):
❑ I, es owner of Ihe property, or my employees with weges as iheir sole compensatlon, WILL DO THE WORK, and ihe structure Is not intended or oHeretl for sale (Sec.
7044, Business and Piofessions Code: The Contractors Licensa Law dces not apDly to an owner of properry who builds or improves theraon, en0 who does such work
himself or herself or Ihrough his or her own employees, provitletl that such improvements ere not intended or aflered br sele. It, however, the builtling or improvement is
soltl within one yeer of completioq the owner-builder will have the burden of proving thet he or she did not build or improve tor puryosa of sale.).
❑ I, es owner of ihe properry, am EXCLUSIVELY CONTRACTING WITH LICENSEO CONTRACTORS to construct the prqect (Sec. 7044, Business and Profeuions
Code: The contractors License Lew tloes no� epply �o an owner ol propeny who builds or Impmves thereon, and who comracts tor such project with e comracior(s)
license pursuant to ihe Contractors License Laws.).
❑ I am exempt under sec.
Signature:
Ownar ID vanfietl by tlrivefs license. ❑ Yes ❑ No
Business and Professions Code tor this reason:
Vedficatlon of Ownership by (type ot dacument, i.e. - properry tex blll or deed):
DIVISION OF INOUS7RIAL SAFETY PERMIT CERTIFICATION:
Drivefs License N0.
Dete:
Expires:
❑ I hereby certity that no excavetion five (5) or more teet in tlepih into which e person is require0 to descend, will ba mede in cmnection with work authorized by this
permit, and that no building structure, scaHolding, talsework, or demolition or dismantling Ihereot, will be more Ihen thir�y-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Ttle 8, Califomia Atlminlsiretive Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom Ue Division of Indusirial Safery, as notetl ebove, unless such person hes e
pertnit to do such wark from the division.
Signature: Data:
Division oi Intlustrial Sefery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENTRV: I cehify under penelty of perjury �ha� I have read this epplication and state that the infortnation given is
carrect. I egree to camply with all state laws and ciry ortlinances relating to Guilding construction, entl euthonze representetives of the Ciry of Caste Mese to enter upon ihe
ebove-described property for inspection puryoses. I egree not to acupy or ellow occupancy of eny building authorized by this permit unlil finel inspection.
LOpE 1, INSPECTIONTYPE PAIF.
1616 Fixed System Final Fire Prevemion
126fi
200
201
202
Pool Spa Final
Final Re-Roof
Final BIocWReteining Well
Final Factory Fire Place �
203 Finel Sign
204 Final Demolition
U1I�Lt
�
T�/�/ �V'[e
Date
CO�E I INSPECTION TYPE
206 Final Mechanicel
208 Final PIum6ing
210 Final ElecMcal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Si�e
250 Final Builtling/Occupanq
. .Q�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIH UHIVh, GU51 A MtA'A, GA y26Zti
PLUMBING PERMIT -
Job Address: 917 W 18TH ST
Suite No
Vicinity:
.,.
ISSUED BY:
Status: ISSUED
Applied: 04/19/2002
Issued: 04/19/2002
Parcel Nunmber. 42436116 _ - -
, ..-_,-_ � _ _ - . _
�i� _ , - __ � �� .
���_ � � , � � _ ��
Applicant COX, CHIP �� /�''' ` � _, �
� . �ii.,.., _ � / • , ,
Address: 26272 YOLANDA ST" .�' i` . ��� �
/ A,A` � �
i %% � t�� � � �� Phone: 714-362-9470' ' /� /'` . - •
/� /' J `����`�
LAGUNA HILLS, CA`' � � � -Zip: 92658 -". � � l '� ��.'' ,��
� � ��i, � , . . - � _ ' � � .A
' �" � � � � i . : ��� � / � �'. .
�/ � �,
Owner ' LEWIS, JQMES R" " ' � �� '���! � � i ` �' �
� �i % ' �� �'- �✓ i�,,, ��
Address � 1785 MONROVIA AV �V�� .�V� � �
, �._ /��'.../ A� ,: �� � � �� � �
" ;��, ..�,�� Phone: 714-850-0869 ��`�� ��
, �
�
'�. � - _ COSTA MESA. CA Zip . B2827 A ; =:�� ,� � , -
, i ' _/i ' __ -` `\ � \( � \:� `.
i
r� ;;i: `� o . ; , ., _ ,
r, a, ,
/� ` F � i ` '� \ ' • � �1
Contractor' i„COX P_ACIFIC�� �� ` � i ��
, , � � . � � ✓. �_i � • �,
, Address: 26272 YOLANDA ST':' "! _ - � _. _ ,_ � .
- . i i - . . - , , _ ,
� . ' ,_ --' ' Phone: 774-362-9470 . ' �� �� �-'�� � • ' ` �
. - �> y - � ' � � �
�� . : LAGUNA HILLS, CA ,�� Zip: 92656 � �� ' . , �
� ' � ' License: 366161 � � � -
, / . . - - - - � , • . ,
i� ;� ,^ . :y ,r� �: - . _ ; i .;� `" �
�Arch/Eng: ��� -- - ._/. ' :� __; �.._.... =. � � �
Address:
� � Phone: '
i
, .. „� � �
. - 2ip: . -. , - �� jj -;;L - .
. � License: , <'-/� , - _
� 4
' SCOPE OF PERMIT �`
� "� �. � � 122 CUBIC YARDS CUT/ 14 CUBIC YARDS FILL. SITE IMPROVEMENT FOR VEHICLE STORAGE YARD'
,- TO INCLUDE: DRAINAGE, CLARIFIER, ASPHALT. PAVING. BLOCK WALL. 14,700 SQ. Ff. AREA � �
.>
`�,�-, '�, . BLOCK WALL UNDER SEPARATE PERMIT,REF:'802-00045 .
,�,
��\ e�\ � SITE-IMPROVEMENT VALUATION IS'S60,000. REF: GOL00002._ = , % �� ," / �
-�PLUMBING TO INCLUDE: 1 BACKFLOWiRRIGATION; 1 CLARIFIER SYSTEM, 1 RAINVJAYER DRAIN, 1 ,
�\��'� � INTERCEPTOR,'1.6ANDSCAPE IRRIGATION, 2 SEWER CONNECTION; �1�SUMP�PUMP; 1 VACUUM BRKR, �
�
� ` �� t WATERPIPING. , - , � -� "� ' �_ -!;'� � � � ,
'V-- � i . _ , _ ., j .
_ . . . .. �'�.
� �
� �� AMT
ISSUE FEE �. $23.50
Backflowirrigation ��$9.80�
Backflow Preventer $0.00
Bathtub $0.00�
Clarifier System $44.25
Connect pce,Sotla,etc) $0.00
Dental UniLs $0.00
Dishwasher $0.00
Drain, Floor $0.00
Drain, Rainwater $9.80
Drain, Roof $0.00
Drinking Fountain $0.00
Expansion Tank $0.00
Gas Earthquake Valve $0.00
Gas (1-4 outlets) $0.00
Gas (Over 4 outlets) $0.00
Gas Repipe $0.00
Gas Service $0.00
Interceptors (Grease, Oip $0.00
, � FEE SUMMARY � � � � �.' � � � �
` ,
.
QTY-. �. � ' _ �--� AMT QTY � , - � ; �� �
� � - Laundry Tub / Washer $0.00 0 , � Sump Pump !
0� � �, LandscapeJrrigation $14.80 ' 1 - �. �,�Swimming Pool
1 �- P-Trap � $0.00 0�. Trap Primer
0 �-� � �'Pressure Regulator � $0.00 •0 �- %,Urinal� �
1�; ��� Prxess Piping (per 10 k) $0.00 0_�- --"% -. Vacuum Brkr Bkflow(1-4)
0 � ' - Receptors . _ $0.00: -0 %� "�- � � Vacuum Brkr Bkflow(5+)
0 `lSepticTank'-�� - -, =� $O:OOI 0�`�- WashBasin
0 Sewer Cap for Demo -- ��$0.00 0 Wash Basin Set
0 Sewer Connecl $49.30 2 Waste and Vent System
1 Sewer Private Line $0.00 0 Water Closet (Toilet)
0 Shower $0.00 0 Water Heater / vent
0 Sink, bar $0.00 0 Water Piping (Inst or Rep.)
0 Sink, commercial $0.00 0 Water Re-pipe
0 Sink, Floor $0.00 0 Water Service
0 Sink, kitchen $0.00 0 Water Softener
0 Sink, service/mop $0.00 0 OTHER
0 Spa (pnvate) $0.00 0 VIOLATION . �
0 Spa (public) $0.00 0 PLAN CHECK
0 REINSPECTION
AMT
$9.80
$0.00
$0.00
$0.00
$12.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
1
0
0
0
1
0
0
0
0
0
0
1
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access re¢pRq@r�hq��r,¢��pp�g�atp��¢ related
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expj��wPi�����n��pp��hin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeeliona end final approvel musl be obtained. Failure to obtain inspections and final approval will result in the expiration of lhis permit.
FOR INSPECTIONS CALL: (714) 754-5626
zawe (eroo�
WORKERS'COMPENSATON DECLARATION:
I hereby aNirtn under penalry of perjury one of the tollowing declarations: � '
❑ I have end will maintain a cenificete of consent to self-Insure for workers' compensation, es providetl for hy section 3700 of the Lebor Cotle, for Ihe pertormance ot the
[�work for which Ihis permil is issued.
Niave antl will maintain workers' compensation insurance, as required by section 3700 oi Ne Lebor Code, for the peAortnance of Ihe work tor which Ihis pertnit Is IssueA.
My workers' compensation Insurence carrier ena policy number are:
Cerrier. PoliCy Num6er.
(This section need not be comp/eted il the permit is velued et one hundred dollars ($f00J or less.)
❑ I certify Ihat in the peAormance oi the work lor which this pertnit is issue0, I shall not employ eny person in any manner so as to become subject to the workers'
compensetlon laws of Califomla, end egree that It I should �ecome subject to the workers' compensation pmdslons of Section 3700 of the Lebor Cotle, I shall forNwith
comply with these p i s. %� ��� � /� ��
ApplicantSignature: � ( �iT7� Dete: N
WARNING: FAILURE TO SECURE WO ERS' COMPE SATION COVERAGE IS UNUWFUL AND SHALL SUBIECi AN EMPLOYEP TO CRIMINAL PENALTIES ANO CIVIL FlNES UP TOONE HUNDRED
THOUSAND OOLLARE (5100,000), IN AODITION TO THE CAST OF CAMPENSATION, DAMAGES AS PfiOVIDED FOP IN SECTION 3�O60F THE tABOF CAOE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CON7RACTORS DECLARATION:
1 hereby attirtn �hat I am licensed untler provisions of ChaD�er 9(commencing with Section 7000) ot Division 3 of the Business and Protessions Code, end my license is in lull
torce end eMect. Llc. x Class P
ComrectoYs Signeture: � r� Date: � �
CONSTRUCTON LENDING AGENCV:
❑ I hereby alfirm ihat there is a construction lending agenty for ihe pedormance of the work tor which this pertnit is issuad. (Sec. 3097, Civil Code).
Lender's Name: Lentler'S Address:
Signature:
Date:
OWNER-BUILDER DECLARATONS:
I hereby aRirm that under penalry ot perjury Ihet I em E%EMPT PROM THE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business flnd Professlons
Cotle: My ciry or counry which requires a pertnit to construcL alter, impmve, demolish, or repair any struqure, pnor to its issuance, also requires Ihe applicant for such pertnit
to file a siqnetl statemem that he or she is Iicensed pursuant to the provisions af t�e Contrectors License Law (Chepter 9(crommencing with Section 7000) of Division 3 ot ihe
Business entl Professlons Code) or ihet he or she is exempt therefrom end Ihe basls for the alleged exemption. Any violation af Section 7031.5 by eny epplicant 1or a permit
subjects the epplicent to e civil penelry oi not more ihan live huntlred tlollars ($500).): .
❑ 1, as owner ol ihe property, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and the stmcWre Is not Intended or oHeretl tor sele (Sac.
7044, Business and Professions Code: The Contrectors License Law does not apply to an owner of properry who builds or improves Ihereon, and who tloes such work
himselt or herself or Ihrough his or her own employees, providetl that such improvements ere not inientletl or otfered for sale. H, however, the builCing or improvement is
sold within one year of comple�ion, Ihe owner-builder will have ihe burden ot proving ihat he or she did not build or improve for purpose ot sale.).
❑ I, as owner ol the pro0erty, am EXCLUSIVELY CONTRACTING WITFf LICENSEU CONTRACTORS to construct the project (Sec. 7044, Business and Protessions
Code: The contrectors License Law does not epply to an owner of propeny who builtls or improves thereon, and who contracts tor such prolect with a conirector(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Profeuions Code tor Ihis reason:
Signature: Date:
Owner ID verifietl by dnvefs license. ❑ Ves ❑ No Drivers License No. Eapires:
Verificatian oi Ownership by (type oi tlocument, i.e. - pmperty tau bill or tlee0):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION:
❑ I hereby cartify that no excaveilon five (5) or more feat in depth into which e person is required Io tlescen4 will be made in connectlon with work euthorizetl by Ihis
permit, and that no building structure, scallolding, felsework, or demolition or dismantling Ihereof, will be more then thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, 77t1e B, California Adminisiretive Cotle).
❑ As ownar-Duiltler, I will not employ anyone to da wark which woultl require a permit Irom the Division of Indusirial Satery, as notatl ehove, unless such person hes e
pertnit to do such work irom the division.
SignaNre: Date:
Divisi0n of InduSiriel Seley Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I ceniy under penalry ot perjury that I have read this epplication and state that the infortnation given is
correcL I egree to comply with ell state laws and clry ortllnances releting to huilding construciion, end authonze representatives ot I�e Clry af Casta Mesa to enter upon the
ebove-descnbetl properry for inspection purpases. I egree not to occupy or allow occupancy of eny building authorized by ihis permit until linal inspection.
Ot Legal Owner(s) ��/ /� � `, �
�/ v
nnnmwA annlirant Date
COOE t. INSFECTIONttPE
1618 Fized System Final Fire Prevention
1266
200
201
202
203
204
Pool Spe Finel
Finel Re-Rooi
Flnel Blak/Retaining W ell
Final Factary Fire Place
Final Sign
Final Damolition
COOE� INSYECTONTViE
208 Final Mechenical
208 Finel Plumbing
210 Final Electrical
272 Final Fire Prevenlion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
�g �
11-ti -oa �
(�ia) �sa-sz�s • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DflIVE, GOSTA MESA, GA 92626
Job Address: 917 W 18TH ST
Suite No
Vicinity:
Parcel Nunmber: 42436116
Applicant COX PACIFIC
Address: 26272 YOLANDA ST
LAGUNA HILLS, CA
Owner: LEWIS,JAMES
Address 7785MONROVIAAV
CA
CM,CA
Contractor. COX PACIFIC
Address: 26272 YOLANDA ST
Arch / Eng :
Address:
LAGUNA HILLS, CA
PLUMBING PERMIT
Phone: 7143629470
Zip: 92656
Phone: 714-850-0869
Zip: 92627
Phone: 7143629470
2ip: 92656
License: 366161
ISSUED BY:
Status: ISSUED
Applied: O6I27I2001
Issued: O6I29I2o01
Phone:
-Zip;
License:
SCOPE OF PERMIT
REF 801-00987. �
ISSUE FEE
Backflow irrigation ,
BackFlow Preventer �'
BatMub
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
� $0.00
$0.00 ''
$0.00'
$0.00
50.00
$0.00
$0.00
so.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
50.00
�
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
� �
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
-, P-Trap $0.00
� Pressure Regulator . $0.00
� Process Piping (per 10 fl) $0.00
Receptors $0.00�
Septic Tank $0.00
Sewer Cap for Demo $9.80
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar , , $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
�' � .
0 ' Sump Pump
0 _ Swimming Pool
0 ' '-Trap P'rimer" '
0-- - � Urinal ' �� � " �
0 � ' ' Vacuurn Brkr BkBow(7-4)
0 , � Vacuum Brkr BkFlow(5+)
0 Wash Basin
1 � Wash Basin Set
0 � Waste and Vent System
0 - - Water Closet (Toilet)
0 - Waler Heater I vent
0 Water Piping (Inst or Rep.)
0 Water Re-pipe
0 Water Service
0 Water Softener
0 OTHER
0 VIOLATION
0 PLAN CHECK
REINSPECTION
COMMENTS / SPECIAL CONDITIONS
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
So.oO
$0.00
so.00
50.00
50.00
30.00
50.00
50.00
50.00
50.00
TOTAL CALCULATED FEES: E33.30
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
C
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calilomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire antl become void il work Is not commenced within 780 days, or it work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all appliwble codes, antl all
requlred Inepeetions and final epproval must be obtained. Failure to obtaln Inspections and final approval will result in ihe expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
zaaaae �s�oo�
WORKERS'COMPENSAnON DECLAiiAPON: �
I �ereDy aHirtn under penalry of perjury one ot t�e lollowing dedara0ons:
❑ I heve end will meintain e cehiticata of consent to sell-Insure for workers' campensatlon, es pmWtletl tor by section 3700 of Ihe Lebor Coda, tor the peAartnance of lhe
/l work tor which t�ls pertnit (s issue0.
o' � heve enE will maintein workers' compensetbn Inwrence, as required by section 3700 0l Ne Lebor Coda, for the pertortnarxe of Ihe work lor which this permit is issuetl.
My workers' compensatlon Insurence carrler end poliry number ere: /� �7 ���
Cerrier. �i ��� POI1cyiJumber: ��ii7 L
(Thls secNon 'neetl not Oe complefed i! the permit 75 ve/ued ef one hundred dollers ($100) ar less.)
❑ I cenify that in t�e peAormance ol Ihe work tor wNch this permit is issue4 I s�all nol employ eny person in eny manner ao es to bewme sub�eM to Iha workers'
wmpensetion lews ot Califomle, end epree Nat If I shoulC become sub�ect to the workers' compensetlon provisions ol Sactlon 3700 0l the Labor Cotle, I shall forthwlih
comply with Ihese pro/vW7 ony/♦1 � / �7
ApPlicenYSipnature: /•. •l l�-� . �Dete'. ' ��Gi� ���
WARNIN(3: FAILURE TO SECURE WOHI�PS' COMPENSATIpN ppVEMGE IS UNUWFUL AND SMALL SUBJECf M! EMPLOYER TO CRIMINAL PENRLTES M10 CML FlNES UP TOONE HUNDRED
TIi0USM10 DOLIARE (5100,000), IN ADIXiION TO THE OOST OF COMPENSATION, OAMAGES AS PROVIDED FOR IIJ SECTION 9080F h1E LABOR COOE, IMEREST, AND ATfORNEY'$ FEES.
LICENSED CONTRACTORS DECLARATON:
I �ereDy eNimi Ihat I em licensed under provisio ol Chapter 8(commendng with Sectlon 7000) of DlWsion 3 ot the Busine�4 nd Prolessions Code, entl my license is In full
brCe end Bflect. lJc. N n ,�iL�O ��O � Class x� � fS _
CONSTRUCTION LENDING AGENCY:
❑ I hereby efllrm that thera is e consiruction IerMing epenty for the peAartnance ol I�e work tor which this permit is issued. (Sec. 3097, CiWI CaAe).
Lenders Neme: LenOers AGtlress:
SigneWra: Date:
OWNER-BUILDER DECLARATIONS:
I �ereDy aMirtn that under penalty o1 per�ury thet I am EXEMPT FROM THE CONTRAC?ORS LICENSE LAW tor �he following reason (Sec. 7Q31.5, Buslness end Protesslons
CoOe: Any ciry or counry which raquires e pertnit to consiruct, elter, Improve, demdish, or repair eny structure, prior to its issuance, elso reQuires the ap0licant lar such pertnil
to flla e slgned stetement that he a she is Ilcensetl pursuant to Ne provisions of the Coniractora Llcense Lew (Chapter 9(commendng with Section 7000) of DiWsion 3 ot Ne
Business end Profeuions Code) or Nat he or sha b exempt Iherefrom and Ihe besis far t��eged exemptlon. Any dWetlon ol Sectlon 7031.5 by eny epplicent for a pertnit
subjeas Iha epplicant to e civil penalry of not more then Me hundred dollars ($500)J:
,�
❑ I, es owner at Ihe properry, or my employees wlih weges as�lheir sole wmpensetion; WILL DO TT1E WORK, antl ihe siruclure Is not Intendetl ar aHered tor sale (Sec.
7044, 8usiness and Professions Cotle: The ContraIXors License Lew Coes not eppty lo an owner of property who builds or improves Iheraon, and who tloes 5uch work
himsell or hereelt or ihrough his or her own employees, provided that such improvements ere not Intanded or oflered for sale. I( however, Ihe building or improvemem is
/ sold within ona year oi completion, the owner-6ulltler will have the burtlen bt.pmving that he or she did not build or improve tor purpose ot saleJ.
❑�. es owner of the praperty, am EXCLUSIVELY CON7RAC71NG YVIiH LICENSED CONTRAC70R5 to constmcl the pro�ect (Sec. 7044, eusiness antl Proteulons
Code: The con[ractors Llcense Lew does not apply lo en owner of propeny w�o builds'or improves t�ereon, end who coniracis for such pmject wit� a contrector(s)
license pursuant to lhe Contractors Licensa Lews.). �� A�,
❑ I am exempt under sec. Business antl Proleuions Code for this reeson:
Signeture:� �� ��� Date:
verllied by drivefs license. ❑,Ves �� No Drivets License No. Expires:
Vedficatian oi Owners�ip by (type oi tlacumenl, i.e. - properry taz bill or tlee0):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby cenify that no excavatlon tive (5) or more leet In tlepih Into whlcti e person Is requlred to descend, will be mede In wnnectlon with work authorized 6y tnis
permit, antl ihat no building siructure, scaHolding, falsework, or demoliilon or tlismantling thereof, will be more then ihirty�six (38) leet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Tltle B, Calilarnia Atlministretive Catle).
❑ As owner-Duiltler, I wlll not employ enyone to tlo work which would requlre e pertnl� Irom iha Divislon ot Industnel Safery, es noted ebove, unleu such person �as e
permlt to do such work Irom �he division.
Signature: Date:
DiWglon ol Intluslrial Sefety Permit Number:
CEHTIFlCATE OF COMPLIANCE AND AIJT}iORIZA710N OF EHTRY: I certity under penalty of parjury Ihet I have read thls apDliwtion entl state that ihe informaUon given is
correct. I agrae to comply with all stete laws anC ciry ordinances relating ro Duiltlinp wnstruction, end euthodze representatives of Ihe City ol Costa Mesa to emer upon Ihe
ebove-tlescribed properry for inspection purpases. I egree not to acupy or allow occupenty of any builtling authorizetl by this pertnit until tinel inspection.
GOUE �. INSPECTIONTYPE
1618 Fixed System Finel Fire Preventlon
1288 Pool Spa Flnal
200 Finel Re�Root
201 Flnel Block/Retaining Well
202 Flnel Factory Fire Place
203 Flnal Sign
204 Final Demdition
PAiE 1t�1dL5
�-as =o�
Dare
GOOE 1 INSPECTION TYPE
206 Final Mechanlcal
20B Finel Plumbinp
210 Final Electrical
212 Finel Fire Preventlon
220 Finel Planning Approval
222 Finel Sile
250 Final BuiltlinyOccuOency
PAIE ItiI�L$
••_ G►
(714) 754-5273 • Fax (774) 754•4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
�ob Address: 917 W 18TH ST
Suite:
Viciniry:
Parcel Number: 42436116
Zoning:
SWtus: ISSUED
Applied: 01It012002
issued: 04/19/2002
Applicant: COX, CHIP � , ISSUED BY:
Address: 26272 YOIANDA ST � _ " " - � � " _ , -
' '�� " � -�Pfione: 949-362-9470 - -
LAGUNA HILLS, CA=� ,.�- -� � 21p: 92656 ' ����
!� . - - � . / �'\
. � -> � �
Owner. LEWIS, JAMES R _ \�
� ��,�
Address � 1785MONROVIAAV � - � � , , , � � � ���� �
� � ' Phone: 714-850-0869- � . , ` �
� � -� � _ � V`�� � \
. ' COSTA MESA, CA - - Zip: 92627 '�
�� � j ���
.' �� � � . ,� - ������ /� � '� -�
�
Contractor: �COX PACIFIC.- � ��, �A�-- ; � -�
,
� � ,
"Address: 26272 YOL4NDA ST '
.� '.��A
- � � Phone:"�714-362-9470 ���� � � �
. , � ��� � ';.- , ., ,�,
- LAGUNA'HILLS,CA -- ��� � � `�.
Zip: . 92656-� License: •- 366167 � '� _ - � � �, ' � - � �,
' / _ ,�. . . _ - '� .�A
. AfCh :� � , . �
� Address: � � � �� % �
, " � .. � . �- ' Phone: -
ZA-01•38.
� i. .�
`Zip: . , � License:
���;-y. ., '.,� �
,_ �-__ En9: - , `�.'�, _ . �.�,
- Addiess:_ - , � ' � �
. , . . _ ' � � . �� Phone: . .
__ ���, ,
� -�� �License: , . '
�
.; . }
' 121 L. F. BLOCK WALL FOR SITE SCREENING OF,�
Plan Check: $54.11 "'
Permik $8325
SMIP Res: $0.50 �
SMIP Com: $0.00
� �, Other. �.$0.00
Inspection: $0.00
V�'� � �, �
\.�. , AA�. iL..;, r- -'
Total: 5137.86
� , �,i . ,. . .. - .
PLANNING & ZONING
E OF.F'tKMI l. _, .
STORAGE YARD. REF: G02-00001.
�.
/
i SUMMARY'%-� �::� �'
� '� ;� ' � Calc Valuation: '�
,. Claim Valuation:
�' � ,
_ ,,
�
� , _ , o.; j
, ;.
�
SETBACKS . ,
MAIN STRUCTURE �Front , 0- 0 Rear 4 0 Left 0. 0
ACCESSORY Front '-0. 0: ,Rear 0. 0 Left 0- 0
PARKING Existina: 0 .;Required: o '� �� Pr000sed: _ o,
_ � � -, �. ,. .. ..: i �%
NOTES:
- i
,. ,
Rign� � � a o, ', .
'� �
, Right : ', 0-'0�
i,
i ' �
i
S2.a2b.00
So.00
NOTICE: The work authorizad by this permit shall comply with all applicable handicap access requirements untler Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abantloned
tor a period of 180 Uays.
INSPECTIONS: In ortler for the work authorized under this permit to be considered legal, such work must comply with all applicabla codes, and ell
requlred Inspeetlona and final epproval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permfl.
FOR INSPECTIONS CALL: (714) 7545828
�
WOAKERS'COMPENSAnON DECLARAnON:
I hereby eHirm untler penalry of perjury one ol tha tollowinp tledaratbns:
❑ I have entl will meintein e cerlificate at conseni �o sell-Insure lor workers' compensetion, es provided lor by section 3700 oi Ne Lebor Code, for t�a peAarmence ol the
1 work lor whlch ihis'pertnit Is Issued.
,�t have end will meintan warkers' compensetion Insurance, as required by seclian 3700 af Ne Lebor Code, for Ne pertormance ot Ne work fw whkh this portnit Lv Issuea.
'V My workera' compensation Insurence carrier end poliry numbar ere:
Certier. k
Poliry Number:
(T�Is secUon need not be mmp/efed i! fhe permlt /s veluetl at one �undred dd/ers (5100) or /e55J
❑ I certlty thet in the peRormance of ihe work tor which this pertnit Is issueq I shell nol employ any person In eny manner so es to become sub�ect to Ihe workora'
campensation lews oi Celifomia en0 agree the� II I should �ecome sub�ect ro t�e workere' compensatlon proNsions o1 Sectlon 3700 01 Ihe Lebor Cotlo, I ahell fort�with
camply wilh Ihese provisio ///� � _/� _O �
Applicam Signature: ( 'ti,� Date:
WARNINO: FAILUHE TO SECURE WORKERS' ENSATIdJ ERAGE IS UNUW FUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE MUNDRED
THdISAND DOLLAFE (5100.W0). IN AODRIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEC710N 3%O60F THE LABOR CADE, IMEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirtn ihat I am licensed under proNslons ol Chapter 9(commenUng wiN Sectlon 7000) of Division 3 of Ihe Business and Professions Code, and my Ilcense is In tull
+orce ena enect. uc. a—�i� , qass a
Contrectors Signamre: l�C .. � �� Dale: � �
CONSTRUCTION LENDING AGENCV:
❑ I hereby eXirtn Ihal there is a constructlon lending egency br the pertormance ot ihe work br whlch ihis permit Is Issuetl. (Sec. 3097, Civil Cotle).
Lentlels Neme:
Signeluro: _
OWNER-BUILDER DECLARAT10N5:
Lender's Atltlress:
Dale:
I hereby eNlrm Ihat untler penalry ot per�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Buslness end Professlons
Code: Any dry or couny which reduires a pertnit to consiruct, alter, Improve, demolish, or repeir eny structure, prior to its issuance, also requires t�e epplicant for such permit
b tile e signe0 stetement Ihet he or she is Ilcensed pursuant to the proNsions of ihe Contrectors License Law (Chapter 9(commendng with Sectlon 7000) ot Didsion 3 of the
Business entl Professions CoOe) or thet �e or she is exempt t�erefrom and the basis br the alleged eaemptlon. Any violaUon of Seclion 7031.5 by eny applicem tor e permit
subjects the epplicent to a dvil penalry at not more than tNe �undretl tlWlars �5500).):
❑ I, es owner ol ihe property, or my employees wlth wages es Ihefr sole compensa6on, WILL DO THE WORK, antl ihe slrucNre is not intended or oHeretl tor sale (Sec.
7044, Business antl Professions Code: The Contractors License Law tloes not appty to an owner ol properry who builtls or Improves thereon, and who tloes such work
himself or herself or through his or her own employees, provided Ihat such improvements ere not intendetl or oHered for sale. If, however, the building or Improvement is
soltl within one year ot completion, the owner-builder will have the burden of proving that he or she did no� build or imD�ove for purpose ot sale.).
❑ I, as owner oi �he properry, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions
Cotle: 7he cantrectors License Lew tloes not apply to en owner ol propetty w�o builtls or impmves Ihereon, and who comracts tor such praJect wit� e coNrector(s)
license pursuant to lhe Conlraciors License Laws.).
❑ I am exempt untler sec.
SigneWre:
Owner ID vedlletl Dy ddver's license. ❑ Yes ❑ No
Business antl Pmfessions Cotle tor t�is reason:
Verlticetion ol Ownership by (rype of documenL I.e. - property tex blll or tlee0):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION:
Drivefs License No.
Date:
Eaplres:
❑ I �ereDy cetlify Ihat no excevation flve (5) or more feet In depih Into whlch a person Ls requlred to descend, will be made in connection wit� work euthodzed by thls
permit, and Uat no building siructura, scaflolding, telsework, or demolition or Gismantling thereol, will ba mora than ihirty-six (36j teet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Calitomia Administretive Cotle). �
❑ As owner-builder, I vnll noi employ enyone to tlo work wNch would require e partnit fram the Divlslon ol Indusirial Sefery, as noted ebove, unless such person �es a
pertnit to tlo such work trom the division.
Signeture: Date:
Division of Indusirial Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AIITHORIZA110N OF ENT1iV: 1 cenify untler penalty of perjury ihat I heve read ihls epplication end state ihet Ne Intortnation given is I
correct. I egree to wmply wlih all stete laws en0 city ortlinances relaling to Duilding conslructlon, anC aulhorize representatives ot the Clry of Costa Mesa to enter upon the
eDove-descdbetl Droperty for inspection puryoses. I egree not to occupy or allow occupancy oi eny building authonzed by this pertnit until linal inspection.
COOE 1, INSVECTONTYPE
1616 Fixed Syslem Final Fire Prevention
1286
200
201
202
203
204
Pool Spe Final
Final Re-Root
Finel BIocWRetaining Wall
Final Fadary Fire Place
Finel Sign
Final DemoliUon
aeIE Ii�ALS
w ,
:L/ /
��
`i-/�'i-O ��L
Date
COOE� INSGECTIONTYVE
206 Final Mechanical
20B Finel Plumbing
210 Final Electriwl
212 Finel Fire Prevention
220 Final Plannirg ApDroval
222 Finel Site
250 . Final Builtling/Occupency
QAg It�L$
r
(714) 754-5273 • FeJc (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT !� hAIH UHIVt, GU51A MtSA, GA 9"LtiYti
Job Address: 917 W 18TH ST
Suite: A
Vicinity:
Parcel Number: 42436116
Applicane COX PACIFIC
Address: 26272 YOLANDA ST
LAGUNA HILLS, CA
Owner: LEWIS,JAMES
Address 1785MONROVIAAV
CA
CM,CA
Contractor. COX PACIFIC
Address: 26272 YOLANDA ST
LAGUNA HILLS, CA
Zip: 92656
Arch :
Address:
Zoning:
Phone: 7143629470
Zip: 92656
Phone: 714-850.0869
Zip: 92627
Phone: 7143629470
License: 366161
Eng:
Address:
Phone:
Status: ISSUED
Applied: O6/27/2001
Issued: 06/29/2001
ISSUED BY: �
Phone:
Zip: License: License:
SCOPE OF PERMIT
DEMOILISH EXIST SFD 1056 SFD. � �� '
Plan Check: $0.00 - - -
Permit. $9725
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.25
SETBACKS - .
MAIN STRUCTURE Front 0- 0 Rear 0- 0
ACCESSORY Fmnt 0- 0��' Rear 0. 0
PARKING Existinq: o Required: o
NOTES:
FEESUMMARY .
Calc Valuation: Ss,soo.00
' Claim Valuation: . $a,soo.00
PLANNING 8 ZONING j �
_ - � ` '
Left 0- 0 Right - 0- 0.� �
Left 0-0 , Right '0-.0 . �
Pro osed: 0 � -, �
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 1 BO days, or if work is suspended or abandoned
for a period of 780 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell
I required inspecqons and 8nal approvel must be obtained. Failure lo obtain inspections and tinal approval will result in ihe expiration of this permit.
I FOR INSPECTIONS CALL: (714) 7545626
taaae ce+oo)
WORKERS'COMPENSAnON DECLARAnON: �
I hereby ettirtn untler penelry of perjury one ol tha following tleclarations:
❑ I heve end will mainiein e certificate oi consent to sell•Insure far workers' compensetlon, es Drovitled lor by seccion 3700 0l the La6or Code, for iho peAormence ol the
work for which Ihis pertnit is Issuetl.
�� . I.heva end witl malntain woikera' compensellon Insurance, es requlretl 6y section 3700 of the Lebor Cotle, for the pertortnance of No work br whlG� Nis portnit Is luued.
My workers' com �isatlo urance ca^rrler entl pollcy number ere: p /�
Carrier: �� �%% 1 J Pollcy Number. `�TJ 7�(��I
(�lr/s secNm need no( be rnmpleted l/ (he permll ls veluetl ef one hundred ddlers ($100) or Ieu.J
❑ I certtly t�at In t�e DeAormance of �he work lor whic� this pormit L9 issued, I shall not employ any peroon in any manner so es to become suD�ect lo the workers'
compensatlon laws oi Celllomla, entl eprae thet II I should become sub�ect lo Ihe workers' compensatlon provisions ol Sectlon 3700 01 ihe Labor Cotle, I shell torihwlth
compty with these provisi%o� �%� —/
ApPlicani Signeture: � ! ' . l JV 'X - Dete: . �i� ^ 2`I —� �
WARNINCi: FARURE TO SECURE WORKERS' COMPENSATION COVERAGE IS WMW FUL AND SIULL SUBIECT Ml EMPLOYER TO CRIMINAL PENALTIES AND CM� FlNES UP TO ONE NUNDFE�
TFIOUSAND DOILARE (5/00,000), IN ADDITION TO TiE COST OF COMPENSATION, DAIMGES AS PROVIDED FIXi IN SELTION 31080F TNE LABOR OO�E. INTEREST, AND ATTORNEVS FEES.
LICENSED COHTFiACTORS DECLARATON:
I �ereby aitirm Nat I am
force end ettaet. Llc. M_
ContractoYs Signsture:
ot Chepter 9(commendnq with Section 7000) of Division 3 oi Ihe Business antl Professions CoAe, end my license Is In full
Class M �
Date� �� — /
___ i�
CONSTAUCTON LENDING AGENCV:
❑ I hereby etfirtn Ihat Ihere is a consWction lending egency for Ihe peAartnance of t�e work for whic� ihis permit is iuuetl. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
SlpneNre: Date:
OWNER-BUILDER DECLARA710NS:
I hereby attirtn Ihet under penelry ot perjury thet I em EXEMPT FROM THE CONTFiACTORS LICENSE LAW tor the lollowlnp reason (Sec. 7031.5, Buslness an0 Protessions
Cotle: Any dry or county which repWres e permlt �o construct, elter, Improve, demdis�, or repair eny sirucWre, pdor to its issuance, elso raquires the epplicent for such pertnit
lo file e signetl statement ihet he or she Is Iicensetl pursuent to the praNsions o1 the Coniradors IJcense Lew (Chepter 8(cammendnp wlth Sedfon 7000) of DlWsion 3 of ihe
Buslness entl Professlons Code) or Ihet he or she is axempt thereirwn end the 6asis lar the ellegetl exemption. Any vlolation ol Section 7031.5 by eny epplicant lor e pertnit
suDjects t�e epplicent to e civll penelry ol nat mare Ihen fiva hundred dollars (5500)J:
❑ I, es ov.•ner ol ihe D�aPertY. or my employees with weges es their sole compensation, WILL DO THE WORK, end the structure Is not Intendetl or oMered for sale (Sec.
7044, Business and Protesslons CoOe: The Coniractors Licanse Law Cces not apDN �o an owner of property who 6uiltls or improves thereon, an0 who does such work
himsetl or herself or throu9h his or her own employees, D�ovitletl thet such improvements are not intended or oNeretl for sale. If, however, t�e building or improvement Is
sold wlthin one year ot completion, ihe owner-Uulltler will have tha Durden of proving that he or she did not build or improve lor purpose of sale.).
❑ I, as owner of the properry, em E%CWSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct t�e prqect (Sec. 7044, Business end Professlons
Code: The conirectore License Lew Aoes not epply to en awner ot pmperty who builds or improves thereon, entl who comracts tor such pro�ect with e contrector(s)
license pursuanl to Ihe CaNrectors License LewsJ.
❑ I em eaempt under sec. Business end Professions Code tor this reason:
Signeture: Date:
Owner ID venlied by dr'rvels IiCense. ❑ YB9 ❑ No Drivef5 Litense No.
Vedlicatlon of OwnersND by (type of Gocument, i.e. - properry tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION:
Expires:
❑ I hereby cenify that no e:cavetlon five (5) or more teet in tlepth Into whic� e pereon is required to descend, will be made In connectlon with work euthorizetl by this
pertnil, end thet no builtling structure, scaHoltlinp, felsework, or tlemdition or tlismaniling t�ereof, will be mora ihan thlrty-six (38) feet �ip�. (Chap. 32, Ory 2, Art 2, Sec.
341, Title 8, Califomia Atlministretive Cotle).
❑ As owner-bullEer, I will not employ anyone to do work which would require a permit irom the Oivision of Industrial Salery, es notetl ebove, unless such pereon hes e
pertnit to do such work from the Ofvision.
SignaWre: Date:
DiNsion ot Intlusirial Safery Permit Number:
CEBTFlCATE OF COMPLIANLE AND AU7HORVATION OF ENTRV: I cetlity under penalry ot perjury thet I heve reatl t�is epplication and 5tete lhet Ihe inlortnation given is
correcL I egree to compty wlth ell stete lews enC ciry oMinences releting to building cOnStmction, end authodze representeNves ot Ihe Clry ot Coste Mese to enter upon Ihe
ebove-tleuribed propeM lor i^spection purpwes. I egree not to occupy or ellow accupenty ot eny Duilding euthorized by t�is pormii until finel inspection.
Ot Lepal Owner(s) Date
(o - Z9—O/
nM1ndsorl dnnlirant � Date
COOE �. INSPECTIONTIPE
1676 Fixed System Final Fire Prevention
1266 Paol Spa Finel
200 Finel Re-Roo1
201 Final BIocWRetalning Well
202 Final Factory Fire Place
INiIiIALS f�QQF�a INSPELTIONTYPE
206 Final Mechanical
208 Final Plumbing
270 Final Electncal
212
220
Finel Fira Prevention
Final Planning Approval
203 Final Sign 222 Flnel Site
204 Final DemWition 250 Finel Building/Occupancy
�eg u�i
(714) 754-5273 • P2lc (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFiNE, GOSTA MESA, GA 926'L6
1ob Address: 917 W 18TH ST
Suite No A
Vicinity:
Parcel Nunmber: 42436�16
Applicant COX PACIFIC
Address: 26272 YOLANDA ST
LAGUNA HILLS, CA
Owner: LEWIS,JAMES
Address 1785MONROVIAAV
CA
CM,CA
Contractor. COX PACIFIC
Address: 26272 YOLANDA ST
Arch / Eng :
Address:
LAGUNA HILLS, CA
SEWER CAP. REF 801-00988.
ISSUE FEE
Backflow irrigation
BackFlow Preventer �
Balhtub � �
Clarifer System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Orein, Floor
Drain, Rainwater
Drain, Roof
Orinking Fountain
Ezpansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 ouUets)
Gas Repipe
Gas Service
Interceprors (Grease, Oil)
Inrerceprors (Sand Auto )
AMT
523.50
50.00
��50.00�;
$0.00
$0.00'
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
50.00
50.00
so.00
so.00
an
0
0
0
0
0
0
0
0
0
a
0
0
0
0
0
0
0
0
0
PLUMBING PERMIT
Phone: 7143629470
Zip: 92656
Phone: 714-850-0869
Zip: 92627
Phone: 7143629470
Zip: 92656
License: 366161
Phone:
_ Z�P.
License:
SCOPE OF PERMIT
FEE SUMMARY
AMT
Laundry Tub / Washer 50.00
Landscape Irrigation $0.00
� � �, P-Trap $0.00
_ -� Pressure Regulator , $0.00
Process Piping (per 10 fl) $0.00
Receptors 50.00
Sep[icTank $0.00
Sewer Cap for Demo $9.80
SewerConnect $0.00
Sewer Private Line $0.00
Showet 50.00
Sink, bar 50.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop 50.00
Spa (private) $0.00
Spa (public) 50.00
Qn
0 '
0
0
0
0
0
0 �
1
0
0
0
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 06/27/2001
Issued: 06R9i2001
ISSUED BY: �/1�
SumpPump
Swimming Pool ,
=�iTrap Primer, � -
' Urinal . < -' -
� Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
� � Wash Basin
Wash Basin Set
. Waste and Vent System
- - Water Closet (foilet)
water Heater i vent
Water Piping Qnst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
50.00
50.00
50.00
50.00
$0.00
50.00
$0.00
50.00
50.00
50.00
so.00
$0.00
50.00
50.00
$0.00
50.00
50.00
50.00
$0.00
TOTAL CALCULATED FEES: E33.30
oTv
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
�i NOTICE: The work authorized by this permit shall comply wi�h all applicable handicap access requirements under Calitomia statutes and related
�� regulations. (Ord. No. 92-28, § 1, 124/-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a pedod of 780 days.
INSPECTIONS: In order tor the work euthonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapections and flnal approval must be obtained. Failure to obtain Inspections and final approval will result in tha expiration ot this permlt.
FOR INSPECTIONS CALL: (714) 7545626
>n::c.:r��;rn]
WORKERS' COMPENSATION DECLARATION:
I hereby flHlrm untler penalty ol pe�ury one ol the following tlecleretlons: �
❑ I have and will mainteln e ceNficate oi consent m seli-Insure br workers' compensetion, es provitletl tor by section 3700 of t�e LeDor Code, for the pertormance of ihe
/� work tor which this partnit is issuetl.
❑J I heve antl will maintain workers' compensatlon Insurance, es reqWretl Oy eeclion 3700 ot Ne LeUor Cotle, br the peAortnance of Ihe work lor whlcli this pertnit Is issued.
' My workers' compensetion Insurence cerrlar ene poliq number ere: / /�
Cerrier. �� � � %�%D Policy Number. I �. � Z �(p {�
(This section n ot be mmpl ted i! the perm/t is valuetl e( one hundred dWlers ($100) or less.)
❑ I certity ihet in Ihe peAarmence of Ihe work for which this permit is issued, I shell not amploy eny person in eny menner so es to becwne subject to the workers'
compensatlon laws ot Califomla, /en�tl egree t�at ii I s�oulC become sub�ect to ihe workars' compensetlan proNsions of Sectlon 3700 ot ihe Labor Code, I shall torthwith
cromply wilh.lhese Provls p�g. l /_ c
—� �� (..(��� / �/
Applicant SlgnaNre: ' Date �
�,
WARNINO: FAILURE TO SEWRE WORKERS' dJA1PEN5ATION OOVEPAOE IS UNLAwR11.IVlD SIULL SUBJECi Ml EMPLOVER TO CRIMIWIL PENPLTIES AND CNI� FlNES UP TOONE MUNORED
TipUSAND OOLLARE (5100,000), IN ADDfiION TO THE COST OF COAIPENSATION, DAMACaES AS PROVIDED FOR IN SECTION 31080F THE UBOR CODE, IMEREST, AND ATTORNEI"S FEES.
UCENSED CONTRACTORS UECLARATION:
�- �
I hereby afFlrm thal I am Iicen C under provisionj of Chepier e(wmmenGng with Section 7000) at DlWsion 3 0l Iha Business� Professions Coae, and my license is In full
force ane ettect.`Uc. M �� ... /�e / i Class a I'J
+i �I
ComrectofsBlgnature: Date � — � rl —��
CONSTRUCTION LENDING AGENCV:
❑ I �ereby eltirm that ihere Is e conslruction lentling agenq lor the peAortnance of Ihe work tor which this pefmit is issued. (Sec. 3097, Civil Code).
Lentlefs Name: Lenders Addres9:
��� Signatura: Date:
OWNER-BUILDER DECLARA710N5:
1 hereby affrtn Ihei under penelry ot per�ury that I am EXEMVT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions
Cotle: My dry or cauny which requires e pertnit to conswct, alter, imprwe, tlemolis�, or repair eny structure, pnor to its issuance, also raquires the epplicant for such pertnit
to file e signed stetament Ihet he or she Ls Iicensed pursuflnt to lhe provLslons ot Ne Contredors LJcense Lew (Chepter 9(commendng vrith Sectian 7000) ot DMsion 3 of the
Business end Protessions Cotle) or thet he or ahe is exempt theretrom end Ihe besis for t�e ellepeC eaemption. My vidation ol Section 7031.5 by eny applicent for e pertnit
suD�ec4s tne epplicaN to a cidl penelry ot not mare then tive hundred ddlem (5500).�:
❑ I, es owner of the property, or my employees with wages es Ihelr sole compensatlon, WILL DO 7HE WORK, end the structure is not intentled or otteretl for ule (Sec.
70C4, Business and Protessions Cade: The Contrectors ticense Lew tloes not eOPN �o en owner ot property who builds or improves thereon, and who tices such work
himsetl or herselt or through his or her own employees, provided Ihet such impwvements ere not intentletl or oflered for sale. If, however, the builtling or improvement is
sold within me yeer af wmpletion, the owner-builder will heve t�e burtlen of proving Ihet he ar she did not builtl or improve for Ourpose at sale.).
❑ I, as owner ol t�e property, em EXCLUSIVELV CONTRACTNO WITH LICENSED CONTAACTORS lo construct the pro�ect (Sec. 7044, Busineu and Professions
Cotle: The contrectors Llcense Lew does not eppy to en owner ol propetly w�o bullEs or Imprwes thereon, end who contracts lor such proJect with e conirector(s)
license pursuent to the Contrectors Ucense Lews.).
❑ I am exempt under sec.
Signature:
Owner ID veritietl hy Criver's license. ❑ Ves ❑ No
Busineu enC Professlore CoAe lor this reason:
Veriticatlon of Uvnership by (rype o1 documeni, i.e. - property tex 6111 or EeaA):
DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATION:
Drivefs License No.
Date:
Expires:
❑ I hereby certity Ihat no excavetlon flve (5) or more feet in depth Into which a parson Is requlred to descend, will be made in wnnection with work euihorizetl by this
permit, and that no bulltling siructure, scaHOlEing, lalsework, or demdi�ion or di5mentling thereof, will be more than �hir�y-six (36) feet hig�. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Callfomla AdminisiratNe Cotle).
❑ As owner-builder, I will nol employ enyone to do work which woultl require e permit trom the Divislon of Intlustriel Sefety, es noted above, unless such Oerson has e
permic lo do such work from the tliNsion.
SigneWre: Date:
Divisian ot Industnal Safety Permit NumGer.
ICERTIFlCATE OF COMPLIANCE AND AUTFIORIZAiION OF ENTAY: I certily under penalry ot Derjury tha� I have rea0 this epplication anC state that tha information given is I
cortect. I egree to campty wil� ell stete laws entl city ordinances relatlng to builtling construclion, enO euthodze representatives oi the Ciry ol Cwta Mesa to enter upon the
ebove-described property tor inspecUon purposes. I agrea not to occupy or ellow occupency ot eny builtling authonzed by this permit until final inspection.
'gnatu�q�l Owner(s) Date
L� O—Z�—�
And/Or Auth ized Applicant Date--
CODE I, INSPECTIONTYPE
1616 FixeC Syslem Flnal Fire Preventlon
1266 Pool Spe Final
200 Final Re-Raot
201 Finel BIocWReteining Well
202
203
204
Finel Fectory Fire Plece
Final Sign
Finel Demolition
COOE� INSPECTIONTYPE
206 Finel Mechanical
208 Finel Plumbing
210 Flnal Electdwl
212 Finel Fire Preven�on
220 Final Planning Apprrnal
222 Final Site
250 Final Building/Occupency
Df�iE I[�SS
►i-�1-oa �
��
ORANGE COUNTY BUILDING DEPARTMENT
'; '� 636 Norrh Broadwor ,
.�% SANTA ANA, CALIFORNIA �•
` FOR APPLICANT TO FILL IN
BUIIDING � +�\ • � �6 �J�; � �! .
nooREss i'1 ��S/ ' iJt11• �+p,.i5� �S�G� �..}-'
SGHOOL DIST. �/� �, / q
OR TOWN� �. '.('� S� H NPCS I'� •
_ , r 1��:_ � �.�. _., , � .�o, .:�,
NEAREST" �p
CRO55 ST. {�y� O N��� �^�' � '
OWNER //'�( �f~�C 7' C G/' O�W Q'. L L.. ?
MAIL �.J ,A- �n n ,�A
ADORE55 .:�QO E,/].OL �Y7 '�fj II G: "/ (�STA./X{�['S�
cin � � @ �,. � .�.No l3 6 8L ,
ARCHITECT OR.i� C�=ti��i-�^�I LIC.
ENGINEER V� NO. '
AODRE55
iTRACTOR p� ll(J • �JO �/C No �/nk'-�aJ�
i
nooRess/ld.. t4ia. �,�- /�.iG. 1C «n /yr'C �i- `
APPLICATION FOR PERMIT `
= Bu1LD�tVG 1
FOR OFFICE USE ONLY
- I RECEIPT NO. PERMIT NO.�
� lo� �-.� _ J //70�'
D BV OATE REC'D. DATE ISSLED
a a� -5 � l a 3�-.� y
`: �// 7 I,v /��_.�f.-
fE5 B BOUNDSI -
C�y�I�L� I NOWONLOT � �
��� I NO. OF �I NO- OF (`� �
)G. FwnLLie! ROOMS rF
E FROM� REAR VARp r �_
TREET S� SIDE YARD .S
DESCRIPTION OF WORK �
� EXTERIOR WALi..��C`A I COVERINd i
COVERING \
� OF NEW T I �
LOING V 1 �l i w/ 2 �/ I�l I
r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT TME ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALl COUNTY ORDINANCES
AND $TATE LAWS REGULATING BUILDING CONSTRUCTION.
SIGN�TUREOF ,���M C. �(�yti;}Q/�/
AUTHORIZED AGT. v«-L�' �
PHR IIT FEfi i
VIILUATION 8 dG
�� TOTAL MecK !
FEE !
IOM '1-10�93
A ROVALS
LOCATIO INSPECTOR �ATF
NNNGALS. �J� �-/Z
STOPS. I� „ � � <
BOLTS 1 r�� l i A7
: � : ;.. .. . `. : . .,
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' � fEB 24 -54, 11�� •� . ,/� %� ; �- S . .. ;
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' ' _. .. .s i . .�. '
STREET� ' • i ` • •- . ' . �
� .,_,
� ' . -. . �� . r
. PLOT PLAN �� '
Shcw location and distances from �>
property line and between buildings. � -
. . . . \ ' •h - —. ' _ '
' . • � � - ° �� i. . .
. . . � < . - ' • _
.. ' ' ' .. i _ _ . ' l . � ' ' ' _ '"" .
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APF����ION F
- APP !QT/TO FII.L IN
• BUILDING'
ADD E55
n, ,
ILING
H ITECT OR
INEER
E3UILDING� PERMIT COUNTY OF
WITI'IIN HEAVY LINES ONLY. ORANGE
C
�
s�ZE os
SQ. FT.
USE OF
STRUCTURF
LEGAL
DESCRIPTIC
iIGNATURE
OF
............. . ___ _� ��� ADDRESS((J.� i iw i . �sii -
ADORE55 (�Z � � � P'�' S
ZONING �GULATIONS FEE
� ) VALUATION S OQ FEE' $
CHECKED BY � ' OATa p.�J'E CLEARED
P' `LAN PULLY DIMeN610Nem YEB �� Ho � HEREBV ACKNOWLEDGE THAT I H
CATION AND STATE THAT THE INFO!
eS VIDED IS CORRECT AND AGREE TO COM
AL ,JILDINGB 6 OWN ON PLAN (PER APPLICANTII ORDINANCES AND S ATE LAW REG l
Z[J- - STRUCTION.
MAIN USF' CC. US� >ON O{9T. M. �
� SIGNATURE OF
FE�UIHED BUILOING 9ITE FFONTpGIEt YE V rvo PERMITTE
BUILDING HEIGHTI BTONIES�ANO FEET ,// l � `
AD�RESS w � �
REOUIRED LANOqHEAI YE9 N INSPECTION RECC
VARIRNCEREOU�REDI�APPROVED NO. • ��� APPfiOVAL9 DATE
s'rwEEr wioiH�' cowyER �o� trvT. �oi FO�NDATION: LOCATION _�y J` (/
% �� � �� FORMS AND MATERIALS. L D
BUILDINGSETBACKC LST �^ � PROPERTYLIN /� � �
� �� REINFORCED
S�DE YARD. RIGXT�� EAVE PFOJECTION� MASONRY OR CONCRETE ��
�� � '
61DE YAND. LEFT EAVE PflOJECTION ;��.!+�Y
�3r�r� �- BONOBEAM Y
REAN YARD (TO P�l) e WIDTH F ALLEY �
BEPPRATIONBETWEENBOILDINO9•,�� � P UNDERPINNING
CHIMNEY IN NEOUIPEO 6�DE YARD PNOJECTS -�/
PORCH IN PEOUIREO VARO PROJECTS �— ROOF SHEATHING /� j�, ��V
STAIfl51N REpUIREO Y/.RO P OJECTS ROOFING +^ �
.S ofal. '
. PAP"�Na AREA REpU1IRETD�CAPACIT^Y. CAR / 1 , _/
q� <a��e��i4 LP$CYt P�'4�H r7��f�hFq . FRAMING � ���
�� - � • LATH OR �RYWALL Y �
REC¢IVEO BY I UATB PEC'O. I pATE IBBV6o
PLAN <NECREO OY IP PMIT168VANC6 AVPPOVED
VALIOATION BY
DISTRIBUTION 1. ROUTE IMMEOIATELY 2. OFFICE
OF C�FIES: TO INSPECTON . WOFK COPY
INTERIOR
LATH /J
EXTERIOR /
PLASTER
BROWNCOAT �`
FINAL JS/
rvc�. �r /
FAMILIES
FON COUNTER USE - IOF PEFMIT
�' ■
THIS APPLI�
HAVE PRO�
ALLCOUNTY
ILDING CON-
t
(
816NATUFE I
G. W. DONOHUE - SUPEFINTEN�ENT 099 N. BRO/.DW/�y SANTh hNA. CALIF. HAROLD L. GOLDY �
DEPARTML'NT OF BUILOIN6 ANO 9AFETY VALIDATION CHIEF Bl11LDING INSPECTOR
A i9AR 14'S81054 33 24.00 1 12.00 7 36.00+�
`TCLLER DATE PERMIT NO. PERMIT FEE COOE PLAN CHECK � TOTAL
AFPLICATION FOR +3UILDING PERMIT
- APPi.iCANT TO FiLL IN A'REA WITIiIN HEAVY L1NES ONLY.
• BUILDING' OE
ADD E55 �
NEW ADO ❑ A
SIZE'-..__ w...
OWNER ` ~ s4. Fr. 60 II
MAILING �/� u' , USEOF
GlllIRGGC � �
Pl:i
; � I LEGA�
SIGNATURE�,�/ + /
xen a.va •
COUNTY OF
ORANGE
PTION OF WOftK
❑ REPAIR ❑ DEMOLIE
NO. OF NO. OF
� STORIFR '� FGMIL
i�
CONTRACTO ADDRESS �Q�+I � �/✓� r� S �
ADDRE55 � , S�- e F E $
ZONING RE LATIONS //1 �J
31 VALUATIONS /`�U`� E�• $
CMECKED BY '' OATF � ECLEAFED
P� �LAN FULLYDIMEN610NEDl YE6 O I HEREBV ACKNOWLEOGE THAT I HAVE
GATION AND STATE THAT THE INFORMA'I
pL JILDINGS BHOWN ON PLRN P6R APPLICANT)1 VIDED IS CORRECT ANO AGREE TO COMPLY
ORDINANCES AND TATE LAW RE LATit
STRUCTION.
MAIN USF •CC. 119 ON DIBT. M � I
SIGNATURE OF
ftE0U1flED BUILDING SITE FFONTAGEt VES � NO pERMITTE
BilILO1N0 HEIGHTf 6TOFIE9 ND FEET -/ [�
�� AODRESS���� � �+'�/ _ �1
HEOUIFED LAND APEAT YE
� P-S Z '� 2'1.52 INSPECTION RECORO
VRRIANCE NEOUIRED PPNOVEO NO. ppPqOVALB DATE 1
srw¢ei wmTH� -�' con g� i iNt LO�. FOUNOATION:LOCATION �
/(�% �[n � FORMS AND MATERIALS. �� �
BIlILO1NGSETBACKC�L;T.�_JJL'� PROPEflTYLIN '1
REINFORCED � I
610E YAftD, qIGHT�� EAVE PROJECTION�� MASONRV OR CONCRETE �
/ � U
61pE YARD. LEFT � EAVE PROJECTION � e
• �' BOND BEAM �
REARYRR��TOP�L) '� WIDT OFALLEY �
/J / �
6EPRHATION BEtIYEEN BUILDIN�9 /J �S� �� UN�ERPINNING / � ��
CHIMNEY IN NEO V IpED 81DE Y�RD PflOJECT9 /
PORCH �N NEOUIRED YANO PNOJECTB ROOF SHEATHING � -� �
- BTAIRB �N REOUIRED YANO P lECT9 � OOFING
pppklryG Afl6A PEpO10.EO�CAPAGITY./ C�AyP.B� 7�Q �/
ni ca��E�.aC:.A*sc��rflC�I .n�C�Qf�E�. FRAMING � � //
/� LATH OR DRYWALL
�'o� �/- iOC rl INTEftIOR .
� ��
� THIS APPLI-
I HAVE PRO�
ALLGOUNTY
ILDING CON-
pl..�N CMlCKeD YY I �HPMIT IttVANCB AI�POV6C ROWN GOAT /� � /
ve�mwnaxar FINAL �^� � /�
DISTRIBUTION 1. ROUTE IMMEDIATELY 2.OFFICE 9. BTATISTIC9 FILE 4. NEfi'8 COrY
OFCOPIES: TOINSPECTOfi WORKCOPY FONCOVNTERVSE FPEliMIT
AUG 2 0 �9
C. W. DONOHUE - 6UPEnINrENOENT e9e N. OnOnDWpY SANTA ANw, CwL�F. HAROLD L. GOL�Y �
DEPAHTMlNT OF BVILOINa RNO 6AFETY VALIDATION CHIBF 9VILDINO INSPECTOR
A MAR14`Sa105434 6.00 1 3.00 7 9.00#
TELLER . DATE PEftMIT NO. PERMIT FEE cooe PLqN CHECK � TOTAL