HomeMy WebLinkAbout925 18TH ST - Building Permits(714) 754-5273 • Fau (714) 754-4B56 • www.ci.costa-mesa.ca.us , n rniH unrvt, GU51A MtSA, l:H tlYti2ti
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
925 W 18TH ST
A
METER � LEFT SIDE OF BUILDING
42436114
COGGINS, LARRY
1940 BAKER AVE
FULLERTON,CA ,
Owner:� ,GRIBBLE D 8 W�TRUST
Address , 931 W 187H ST;
COSTA MESA, CA
Phone: (774) 231-0463
Zip: 92833
Phone: (949)642-6800
Zip: 92627
Contraaor. LC ELECTRICAL MAINTENANCE
� ,4ddress: 1940 BAKER AVE
FULLERTON,CA
Phone: (774) 231-0463
Zip: 92833
License: 620929
SCOPE OF PERMIT ,
�REINSTALL EXISTING-ELECTRICAL METER (UNIT B).
�: Quantity
. ISSUE FEE ` � E23.50
�Temp service lest $0.00
Res. a/c package ' S0.00 '
New Res (1-2 units) , � $0.00 0
New Res (3+units) � $0.00 0
Pool / Spa�, �� - $0.00 0
Lightlng Fixts� � � $0.00 0
Recept Outlels. - � $0.00 0 "
3witches \` �, _ ' $0.00 � 0. �
NonResAppl\ � ' $0.00� .� 0 �
Res Appl � � � '� ;i $0.00 � 0 , .,.
Service to 200a V � `�� � $30.50 , � �t�,,'
Service to t000a = � " , $0.00 .> 0��` �_
Service over 70o0a� � ��
� $0.00 = �� 0 �' _
Motors to ihp ' �-` 50.00 � '.0 - �
Motors to tOhp , $0.00 � -' ' 0- . _
Motors to SOhp '-$0.00� � �. 0 -
Motors to t00hp $0.00 � - _ 0� � � .
Motorsover100hp $0.00V����0-
Communication drops $0.00 - 0 �
Sub panel to 200a $0.00 0� �
Pole Light Pkg $0.00 0
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0
Intermed Pole $0.00 0
Status: ISSUED
Applied: OSI09/2001
issued: OSI09I2001
ISSUED BY:
� �� ;
� �,
� - - �. � �
PEE SUMMARY � � _�
- - , - �uantity i , . , --� � ,.
Temp Dist System I Lighting $0.00 0/',� .
Busway./100ft $0.00 0 '��"r ' _ , � �� j
Standing SeUion � 80.00 0 % , � � /' /
Misc Electrical Equlpment $0.00 :0 � � � � " ,� � �
Trensformers up to 1 kva/kw 50.00 ,%0� � i',�� /
................up to 10 kva/kw $0.00 � �0� ' � - ,' i,..�/
................:up to 50 kva/kw $0.00 �; j 0 �' ��
�
.................up to 100 kva/kw $0.00, ; 0 ' / � �
..................ovar 100 kva/kw: :�" $0.00�' 0 ��r� i �
Low Voltage Equipmant � - $0.00 ; �0 ��
Low Volt Wiring System / Ckt � $0.00 �i; 0, ���
Misa Conduit- � /� $0.00� �0' v
� Misc; Condudor "�� $O.00;j `�0 �i�
Circus (�gen or rida) � " � $0:00 / 0 � �
Circus (meeh ride or lights) �� ��$0.00 �-��0� �
Christmas Tree Stand • �� $0.00„ �0
Fireworks Stand � � � $0:00 j 0
Other Eleclrical Fee_ - ' -� = $0.00
_ . �:� �
i�
Investigation Fee , , ' - � $0.00
_Plan Check Fee - $0.00
Reinspedion Fee 50.00
TOTAL CALCULATED FEES 554.00
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 7241-g2)
EXPIRATION: This permit shall automatically expire and become voltl It work Is not commenced wi�hin 1 BO days, or if work Is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, end all
requlred Inepeetlone and final approval musi be obtained. Failure to obtain inspecUons and tinel epproval will result in tha exp'rrationot this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
2aa&48 (BI00)
WORKEHS'COMPENSAnON DECLARATON:
I hereby aflirtn untler penalry of perjury one ol tha tollowing dedarations: �
❑ I �eve end will maintein e certiiicate ot consent lo selF-insure far workers' compensetion, es O�ovidetl tor by section 3700 of the Lebor Catle, for the peAormence of the
work tor which this permit is IssueA.
❑ I have entl will rtiaintein woAcers' mmpensatbn insurance. as raquired by sectipn 3700 of Ihe Labor Cade. lor Ue peAormance of iha wak tw which this pertnit I515weA.
My workers' compensation Insurence cartiar and policy number ere:
Carnor: Policy Number:
(Trils secllon neetl no� be canplefeU Il ihe permlt fs velued at �e hundred tloliars ($100) or IeuJ
•� Lce�ity thet in the padortnence oi the work lar wnich t1�s pertnit Is issued, I shall not employ eny person in eny manner so es to become subject ro the workers'
� f compensetlon laws ol fi omla, end egre at If I%dIE Eecome sub�ect to the workers' compensetlon provisions ol5ectlon 3700 of the Lebor Code, I shall lanhwith
comptywiththese a ns. /f
App �II nLSigneNre G `� �Date:--�aS� rt "i - o/
�
� WARNINO: FNLURE TO WRE WOHI(ER T1pN COV IS UNLAW RIL AND SW1LL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDqED
TIKKISAND DOLURE (5100.000�, IN ADDITI TO THE W5T OF SATON, DAMAGES AS PROVIDED WH IN SECTION �060F TNE IPBOR CODE, IMEREST, AND /TfORNE1^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eMirm�ihat.l am.licensetl under provislons ot C�eO�er 9(commencing with Section 7000) of Dlvislan 3 of ihe�Busineis �entl Prolesslons Code, and my licanse Is In tull
bme and eXect. Li�_. f� Class »r ! �,�
C, ontracto(s5ignetura:~ �Date:---- • � ' —% 1
�� _��
CONSTRUCTION LENDING AGENCY:
❑ I hereby eBirm tPat t�ere is e consiruction lending agenty lor the pedormence of the work tor which ihis parmit is issuetl. (Sec. 3097, Civil Cotle).
Lantler's Name:
Signature: _
OWNER-BUILDER DECLARA710NS:
LendeYs AOdress:
Date:
I herehy ettlrm that untler penfllry ai perjury thet 1 am EXEMP7 FROM THE C�NTRACTORS LICENSE LAW iw the tolbwing reason {Sec. 7031.5, Busineu efW Profess{ons
Code: Any ciry or counry which requires e pertnit to consWct, alter, improve, tlemolis�, or repair any aWcture, prior to its issuanca, also requires lhe epplicant for such pertnit
to file e signed statement ihet he or she b Ilcensetl pureuent to the provisions at t�e Conirectore License Lew (Chapter 9(commenclnp with Sectlon 7000) ai Dlvision 3 of the
Business end Professions Code) or thet he or she is exempt therefrom end the basis for the elleged e:emption. Any violetlon ol SecUon 7031.5 by eny applicant for a permit
sub�ects tne ap0�icant to a civil penalry ot rwt more than tive hundretl tlollars (5500).):
N N ✓/.r �
❑ 1, as owner of,tt�e property, or my employees with wages as Iheir sWe compensatian, WILL DO TME WORK, an0 ihe siructura Is rwt inten0etl or otteretl for sale (Sec.
7044, Business a�d P,rofes5ians�Code: Tha Contractors License Lew tloes not apply to an owner of property who builds or improves thereon, and who tloes such work
himself or herse0 o� Ihrougti his;otfier awn employees, provided that such improvements are not imendetl or oNered lor sale. If, howaver, the building or improvement is
soltl within one,yeer oi wmplepon; t�e�o`wner-builtler wlll have the burtlen of proving that he or she did nat build or improve for Durpose of sale.).
❑ I, es owner of tha property, am E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRAC70RS lo construct the projact (Sec. 704a, 8usineu antl Prolessians
Cotle: The contrectors License Law tloes not appty to an owner ol property who builds or improves Ihereon, and who conlracts lor such project with a conirector(5)
license Dursuant to iha Contrectors Ocense LawsJ.
❑ I em exempt under sec. Business end Professions Code lor this reeson:
Signeture: Date:
Owner ID verilietl by tl��eYs Iicense. ❑ Ves ❑ No Drivers License No. Expires;
Vedticatian oi Owners�ip Oy (rype of dacumenL i.e. - properry tex bill or deetl):
DIVISION OF INDUSYR�AL SAFETY PERMR CERTIFICA710N:
❑ I hereby certily Inat no exwvatlon tNe (5) or more �eet in depth into whiU a person Is required to Cescend, will be made in wnneciion with work authorized by thls
pertnit, end that no builtling strudure, scafldding, talsework, or Eemolitlon or dismantling thereof, will Oe more then Ihirry-six (38) Iee1 high. (Chap. 32. Grp 2, An 2, Sec.
34i, Tltle 8, Califomla Atlministretive Cotle).
❑ As ownerbulltleG I wlll not employ enyone to tlo work whlch wauld require e parmit fmm Ihe Division ot Industnel Safely, as noted flEave, unless suc� person has e
permit to do such work from t�e diNsion.
SigneWre: Dale:
Dlvision of Indusirial Sb�ery Permit Number:
CERTIFICATE OF COMPL�ANCE AND AUTHORIIATION.OF EMRV: I certity under penelty ot perjury thet I have read ihis ep0���ation and stete thet the informalion given is
correct I egree to comply with all stete laws end ciry ordlnances releting to Dulltling consWction, end authodze representatives oltne Ciry ol Costa Meu to enter upon the
above-descnbed property lor Inspection puryoses. I agree not to occupy or allow occupancy ol eny building authorized by this permlt un61 linal inspecNon.
CODE I. INSFECTIONTYPB
1616 Fi:eC System Final Fire PrBvention
1288 Pool Spe Final
200 Flnei RB-Root
201 FInaI8locWRA�alning Well
202 Final Feciory F�re Plate
203 Final Sign
204 Final Demolitio�
�g' ��
�
COOE� INSPECTIONTYPE
208 Finel Mechanical
20B Finel Plumbing
210 Final Electrical
212 Finel Fire Prevention
220 - Finel Planning Appmval
222 Finel Slte
250 Final Building/Occupenty
�
�
II�
p1a) �5a-5273 • Fax (714) 75a-a856 • www.ci.costa-mesa.ca.us 77 FAIH UHIVt, GOS I A Mt5A, GA 9Zti2ti
ELECTRICAL PERMIT
Job Address: 925 W 18TH $T
Suite No A
Vicinity: METER � LEFT SIDE OF BUILDING
Parcel Nunmber:
ApplicanC
Address:
Owner:
42436114
COGGINS, LARRY
1940 BAKER AVE �
FULLERTON,CA ,
GRIBBLE D & W TRUST
Address 937 W 18TH ST
COSTA MESA, CA
,
Phone: (714) 231-0463 �
Zip: 92833
Phone: (949) 642-6800
Zip: 92627
Contractor LC ELECTRICAL MAINTENANCE
Address: 19408AKERAVE -
FULLERTON,CA
Phone: (714) 231-0463 - �
Zip: 92833
License: 620929
' ` SCOPE OF PERMIT, �
REINSTALL EXISTING ELECTRICAL METER (UNIT A). -� - • � - ��- �
ISSUED BY:
Status: ISSUED
Applied: OS/09/2001
Issued: 05/09/2001
�'FEESUMMARY .
. Quantity ` -� -,- - - .. .. � Quantity.,,
ISSUE FEE ; $23.50 Temp Disl System / Lighting $0.00 0;
Temp service tesl � $0.00 Busway I100 ft� , $0.00 0� �
Res.a/c package $0.00 Standing Sedion�' �$0.00 0
New Res (1-2 units) , .� . $0.00 0 Misc Electrical Equipment $0.00 �'0'-�- �
New Res (3+units) , $0.00 0 _ ' �- Trensfortners up to 1 kva/kw $0.00 � �',0% � �
.... , .
Pool / Spa � ', , � $0.00 0 ;_�� , � . . ..:...... ....up to 10 kvalkw $0.00 . �',;0 . ,
_, ,. .
� ` ;..
Lighting Fi�ds , -� , 50.00 0 �;, � � ' ............. :..up 10�50 kva/kw $0.00�� ;' 0
ReceptOutlets '$0.00 0 �-- �' � • - `......uptoA00kva/kw__ $O.00i/ 0 . �
, ...........
Switches 50.00 ,i - --� 0 �. % �. � � '
� ...................over 100 kvalkw _,-.=�- "$0.00' 0 , �
Non Res Appl . $0 00=� � 0�� �- Low Voltage Equipment $0 00 ;� 0 ��,
Res Appl �; i/ $0 00�� ���0 2 ��� � Low Volt Wiring System / Ckt j� j$0 00 j,0 �-�
Service to 200a �'�,� � i $30.50,� ���7 ��° � Misc.'Conduit ' f �� $0 00 � � 0 � �
Service to 1000a � , .50.00.; 0, � �� � Misc: Condu�Gor �: ,- � �$0.00, 0 � /
Service over 1000a � , $0.00 � � �'� 0 � � � � � � Circus ( gen or ride)� � -�,� � � $0.00�� , 0. �", �
Motors to 1hp -,$0:00 ; '� 0 �--. � Ciras (mech nde or lighte) �� � ,�$0.00 ,= � 0=
Motors to 10hp � $D.00 �� _ %�� 0 - .� � - Christmas Trea Sfand '• . $0.00% ,. 0
Motorslo50hp � $0:00�., `�0�. �- %�j � , �FireworksStand;�`�-)� ,$0.00,� 0
Motors to 100hp $0.00��- _; �-�0 ' - •Olher Eledriwl Pee� �� ,.-; %/ $0.00
Motors over 100hp $0.00A "'�. 0-, '- ' � - � �.'. .` ,� - � ' -= - �J �'%'
communication drops 50.00 � -- 0� �'= .`� - - _ . . InvestigatioR.Fee.-: =� � ' $0.00
Sub panel to 200a $0.00 0 - - '. - � ' .� Plan Check�Fee--� - $0.00
Pole Light Pkg $0.00 0 �"� Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES E54.00
Intermed Pole $0.00 0
COMMENTS / SPECIAL CONDITIONS
�
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutas and related
regulations. (Ord. No. 9248, § 7, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaasm �sroo�
WORKERS'COMPENSATONDECLAHAnON:
I hereby ettirm untler penelry ot perjury one of the following tlecleretions:
❑ I heve end wlll meiNain e certlficate o1 consent to self-Insure for workers' compensaHon, as proNded for Dy sectlon 3700 of ihe Labor Code, for the pertortnence oi Ihe
work 1or whlch Ihis permit is issued.
❑ I �ave end wlll maintain workers' compensation insurance, es required by sectlon 3700 ot the Labor Code, tor t�e pertortnance of ihe work for which Ihis permlt is Issuetl.
My workers' compensation Insurence wrdar end policy number ere:
Cartier: Policy Number _
(This sectlon neetl not be completed i! the permiNs velued et one huntlretl tlollers ($100) or less.)
�I�L I certify Ihat in Ihe performance of the work for which this permit is issuetl, I shall not employ any parson in eny manner so es to become subject ta Ihe workers'
compensation laws of elifomia, entl ree Ih�jf I shoultl bacome sublect to the workers' compensation proNsions of Section 3700 of Ihe Labor Cotle, I shall tort�wlth
comply with these,p �sions. //1 C
ApPli+ag�Slgneiur L� ,.� �oe,a:— -5/y'/o /
WARNINO: FAILURE TO SECURE WOR ' COMPENSATIO EMOE IS UMAWFUL AND SHAl1 SUBJECT AN EA�LOVER TO CRIA9t�1 PE TIE AND CML FlNES UP TOONE HUNDRED
THIXISANDOOLLARE(E100,000),INAD qJTOTHEC05T F OMPENSATION,DAMAGESASPROVIDEDFORINSECTION31080FTNElABORCADE,INrEREST,ANDATTORNEI^SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eMirtn Ihat I em _Ilc�egsed unde�r p�rovi�sions ol Chapter 9(commencing with Saction 7000) of DiWsion 3 at I�e.Business entl Professions Code, and my license is In full
rorce end enect. uc. e.�o_7 A_ y)��i_. _LX. /1 . Gass�a—'�/b , .
CONSTRUCTION LENDING AGENCY:
❑ I hareby aMirtn that there is a consiructlon lending agency for Ihe peAormance ot the work for which ihis Oertnit Is issue0. (Sec. 3097, Civil Code).
Lentlers Name: Lender's Adtlress:
Signature:
Date:
OWNER-BUILDER DECLARATIONS: �
I hereDy eHlrm thet under penalry of perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Buslness end Professions
Cotle: My city or counry which requires a permit lo construct, elter, improve, tlemolish, or repair any shucNre, prior ro iis Issuance, also requires the appliwM for such permit
to file a signetl sletement that he or she is Iicensed pursuent ro the pmvlslons ot the Contrectors �cense Lew (Chapter 9(commencing with Section 7000) ot Divislon 3 01 the
Business end Proteuions Cotle) or ihet he or she is exempt Iherefrom end the basis for the alleged ezemption. Any violetion of Section 7031.5 Dy any applicant lor e permit
su6jects the eppllcant to e civil penalry of not more then five hundred dWlers ($500).j:
❑ I, as owner oi Ihe properry, or my employees with weges as Ihelr sole compensation, WILL DO THE WORK, and Ihe siructura is not Intentled or ofleretl for sale (Sec.
7044, Business and Professions Code: The Contractors License law does not apply to an owner ol property w�o builds or improves Ihereon, antl who does such work
himsell or herself or Ihrough his ar her own employees, provided thel such improvements ere not Intentletl or oHered lar sale. If, howaver, the building o� improvement is
soltl wit�in one year ot completion, the awner-buildar will heve the burden oi Drovin9 ihal he or she did not build or improve for purpose of sele.).
❑ I, es owner ol ihe property, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTAACTORS to consiruct Ihe prolect (Sec. 7044, Business end Professions
Code: The contrectors Llcense Lew does not epply to en owner ol propetly who builtls or Improves thereon, entl who coniracts for such projact wlth e contractor(5)
license pursuant to ihe Coniractors License Lews.).
❑ I em ezempt undar sec.
Signature:
Owner ID verified by dnvers license. ❑ Ves ❑ No
Business an0 Professions Code tor this reason:
Verificetion ol Ownerehip by (rype of document, i.e. � property tav bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
Drivefs Licensa No.
Date:
Espires:
❑ I hereby cariNy that no excavation five (5) or more feet in depth into which e person is required to tlescend, will be maCa in connection with work euthorized by this
pertnit, and ihat no builtling siructura, scaHoltling, falsework, or demolition or dismantling thereof, will be mora than thirry-six (36) teat high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle B, Celifornla Atlminislretive Cotle).
❑ As axner-builder, I will not employ anyone to do work whic� woultl require a permit from the Division at Industrial Selery, es noted above, unless such person has e
permit to do such work irom the division.
Signatura: � Dala:
Didslon of Intlusidal Safety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOR¢ATION OF EHTAY: I certify under penalry of perjury that I �eve reaA t�is application and state that the information given is
wrrecL I egree to comply with all stare laws end ciry ordlnances relating to building conswction, antl eut�odze representatives ot the Ciry of Costa Mesa to enter upon the
above-descnbed property for inspection purposes. I agree not to occupy or allow occupancy ol any building authorized by this permit until tinal inspection.
COOE �. INSVEttIONTYPE
1676 Flxetl System Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Roaf
201 Flnel Blak/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
�jE f[�¢ �QQf,d INSPECTIONTYPE
206 Finel Machanicel
20B Finel PlumDing
270 Finel Elettntal
212 Final Fire Preventian
220
222
250
Final Planning ApOroval
Final Site
Finel Builtling/Occupancy
PD7E
�
1[�4S
.__ _. AOp���ant t0/ill in au sDaces ezceDt lnose witnin heavy borCer lines ana sign au aoCrovriate tleclarations. _ _ . . _
OFLOSTA MES!A CONSTRUCjT ION PERMIT PER .��.�OS.� � TRACT NO. LOT NO. . UNIT N6. � . 9BD2 2/24/96 ; 600- TL
olect Address �2.J ��� �� ST. / �S1�p ' ' ' � ' • '
App��cant's Mailing Address� ���1� `Af✓ ST LLA /� ��/ JO'✓oG TVPE OF CONSTRUCTION , NEW ADD ALTERATION. REPAIR -
�l.t � C � PhonE6z7`-7/Nl � CONVERSION ❑ DEMOCISH ❑ OTHER A.P. $�' Zone
Owner's Name / DESCRIPTION OF WORK/USE OF BLDG.
Address 9�s ��,7 � � S Main Building: ' Accessory Building:. '
Arch/Eng. _ LicCn52No. TVPEOFPERMIT GRADWG FOUNDATION STRUCTURAL - T Front � � p
Addre55 _ ' � ❑ TENANT ❑ ELECTRIGAL -❑ PLVMBING ,❑ MECHANICAL ' A Rea1 ' � . ' N
ContraCtor'SNam � -�✓^ P on �yII �'OTHER . �
��%- C R�ght � N
Addressfmaitin�l_ �� l� . �_ �rpJP.� PROJECTDESCRIPTION SO.FT, OCCUPANCv K Left � : � ' � � G
- �� � CONSTRVCTIONTVPE VALUATION$ $ .
� Ciry-Lidense No. ' , ZONE'� ' GRA�ING CU. VDS. ' ACL3E5 - � ' - . R
� LICENSED CONTRACTOR.DECIARNTION . � - PIOg. RCf. # Parking Req./Provitled � E
I�hereby alflrm that I am licensetl untler provlslons of Charter 9(mmmencing ftemarks: �' • ^� `(� � Plaoning Notes: ' � • '- ' ' .� n
wltb 5ettion 7000) ol Divikion 3 ot [he Business antl ProfesSions Cotle, antl . . M
my Iicense.is in �ul tor e antl effect. , , ' � . . ' , � � ' ' � ' T i
LJc¢nse las �-� ' LiC¢ N �� , - 5
Date��� Signature� � _ PLUMBING - FEES ' ' � �
WORKERS' COMVENSATION DECLAR TION. '. Ba� Sink Showers ' ' ELECTRICAL , FEES
� hereby,atfi�m that I have a cer[ifitate ot consent to zolf-in5ure O� a c¢rtifiCat¢ ', �
°-;:G;Norkers' Gompensation y�surance, or a certl(ietl� copy thereof (Section ' gackflowPreventer ' ServiceSink � -
�.`h`-+--"sb, Lab. C.) - -� � Automatic Washer Transformer � 15-50 KW
•',cp.: . ' ❑ 50+KW
[%�icy rvo. � company � Backflowlrrigation SewerCap .. ConstructionPoleSub. '
8 Certl�ietl topy iz hereby fumisnetl. � � . - . � .r � �
Certltied Copy I5 flletl wiN [he city Builtlin9 Olvislon. Bdlhtub5 Sewer Connection -,� Cooking Unit y Meter �up LO 100 dmp5 D O
Date Applicani - � �
EXEMPTION FROM WOKKERS;COMPENSATION DECLARATION - _ Clariflels y _$olal Co11CctOIS �" . DiShWatbCr _ _... _ _Mete/ ❑oVerQ00antpt __ .
(This seElion neetl mt be mm0�etetl it the permil ii for One huntlred (E300) or � . , ,
iess). � � . Dishwasher . Solar Piping � • o'+ Dryers ❑Gas` �Electtic Sub Panel / , 5,
I certity that: in tlie perforrryance ot the work for which this perm�t is issuetl, I� . .. �, .
snall not em0�oy any person in any manner so az to ecome subject to the Drinking Fountains SolarTank ' � ' � Fan � � ! Mo[ors �0.1 HP �1'/a-,8 '
Worke� Cyrr�per}�7Flon LaWs of Califo� Rs����. . . . ,
Date G-Gy—'�Y�—Signature L/ i� Floor DreinS � Swimming Pool w/Spa• � � F.A.U. ' .
'NOTILE: If, after making this tleclaration, u shoultl become subject to,tha , , Ina $olar �9-15 HP 016-15+
Wofkel5' COmpensatlOn prOvisiofls'of the Ldbo1 Cotle, you Rlust forthwith � • ' FI00($IOkS: "' - � � �U�indl � � � Fi%tu!¢5�� � � ' �� MicfOwdv¢ � �
comply wilh Such p�ovision5, or titis pe�mit Shall be tleemetl �evoke0. �
CONSTRUCTION. LENDING,AGENCV • • ' �) GasSefviC2 : Outlet5 � WaterCloset ' •� � ' ^, �eviceBoxes� ' ' .
1 hereby altirm that tbere is a construction lentling agency br the performance ' - Pole Light
of the wOrk for which this permit is Issuetl (SeG[IOn. 3097 Civ. C:) , �nt¢rC¢ptOrS Wdt¢r Hedt¢r � OutletS � '
LenCer's Name Range .
Lentler's Atltlress � ' Kirchen Sink � �- -Water Service � ' =� : Switche5 � ' . '
OWNER BUIL�ER C�EGLARATION - - � � . - , . ; Sign
1 hereGy atfirm that I am�¢zempt from the Contractor's License law tor the ' Lavatories - , ' Auto�Wash ' � Garba e Di osal �
following r¢ason (Section 7031.5 Bu5ine55 antl Prot¢SSional Cotle: Any UtY or - - .. 9 � � ;$tanding S¢C[iOnS
County Which require5 a pe�mif tB con5truct, all¢r, implov8, tlemoliSh of repair' P—Tl2p �� _ _ LBUOdry Tf8y5 - � •
any structure, prior to its issuance, also requires the applicant tor sucn vermit � �T .�� Generator 00.5 KW �5-15 KW ' Trash Compactor .
�to tile a si9netl Stdtement that�he/She is'licensetl pUrsuan[ to Ih¢ Provi5iOn5 oi : ROOf Df3in5 � - ' � �� � � " � �
-lhe Contractor's L'icense Law (Cnapter 9 (commencing with Sec[ion 7000) of . - � �;.� � . f � �
'Oivision 3 ot lhe Buzinesy antl Professions CoOe) or chat he/she is exemp[ • � . - • nf , ,
'eirom antl'lhe basis fqr lhe alle9etl exemption. Any violaUodof Section - i , .. ' . . • ,
..5 by any apO�iCant tor a Pe�mi[ 5ubject5 Ine appliCant [o a civll �� - , , ,
�Ity of no[ more than fi�e huntlretl Eollars (5500). '� ' ' . ' . _ � � ,
- U I, ds owne� ot the O�bp¢rty or rny employee5 witn wage5 as their �sale � ReInSpBction�FeB � I �$15 � Issue Fae . $_3 '�`
compenzalion, will ao the work, antl ihe structure is not intentletl or oftereA � � Reinspection Fee $75 Issue Fee $ 3
tor salc (Section'7044, eusiness antl Professional Cotle: The Contrattor's; . ' � �MECHANICAL . FEES
Licenm Law tloes nut apply [o an owne� of a property who builtls or improves ' �'
thereon, ana who aoes such work himzelf/herself or lnrou9h his or her own goiler '' Hood Or T'ype I ❑♦ . ;•� DEVELOPMENT SERVICES RE�UIREMENTS: '
¢mployees, prOvltletl [bat Such.,improvements are not intentletl iOr offered Po� ,. . 4; � �
sale. H,-however, rne builtling orimprovement is soltl wichin one year of com- Canopy Type II ❑ , Zo�ing Approved By Date '
pl¢tiOn; the owne� will hav¢ (he burtlen of proving h�/she tli� not builtl or im- Duct � Under Ground � � � Bpilding App�OVed By � D0t0
p/ove tor tbe purpose of sale). � � ' , � �^
� 1, as owner oPlne properry, am exclusively contractin9 witn licensetl con- Duct -SVuctural Retrigeration System • ' � Appliration luued By Date�
tractorstd consVuct the project (Section 7044, Business antl Protessions Cotle: 1
The ConVa<tor's License �yw tloes.not apply to an owner oi property_who Duct- Veniila�in . - _❑0:100,OOOBTU ❑700,000 BTU ,
builas or imoroves lhereon�, ana who conVacts for such projects wrth a con- 9 � , SUMMARY OF FEES
tractor(z) Ilcense pursuant'�o the ConVacmr's Gcense Law). 1 am aware that Exhaust System ❑ MWtiple ❑ Sys[em Repair/Alteration BUILDING'PERMIT $ SMIP �
prOot ol lhev Worker's Compensation insuran<e shoum be provitlea ro me. - PLAN CHECK .$ PERMfT '
❑ I am exempt untler 5ection � B. & P. C. tor this reason Firepl/Fact. Blt. ICBO # Fire Dampers � PLUMBING � $' ' ISSUANCE ,$ ,
Date Owner ' Heating System & Ducting Registers ' � PLAN CHECK 25% $ � 'ENERGY P.C. 5�
1 hereby�certity'that �I have read thiz appiication antl"state that the above '�- ❑0�100,OOOBTU�t00,000BT . ' - ELECTRICAL $_J�y� GRADING $�
inbrmaeion is correcL I a9ree to comply with all dty antl county orainances . �
antl state laws relating to builtling construction, antl.hereby authorize repre- • - ' ' ' PLAN CHECK �50%� $ � MICROFILM �$
sen[atives of (J�is dty to en[er upon ine above-mentionea property for ' x
inspection pu bos s � ' MECHANICAL � .$� 1$.pu
Signawre _ Datri'_ ZY�'�_, - - , . TOTALFIEE i$
Drivers' Licens or 55 � Reinspaction Fea $75 - Issue Fae $ 3 P�AN CHECK 25% $' �
CMF 0865-46, rev. 30/B4 WhitC - Builtling: Canary - Appllcant; Plnk - AcmunLng; GOldenr00 - Assessor
NSTRUCTION AND PLANNING . POOL' 'PA . .
�
APPROVALS Permit # - Date Inspector qppROVALS Pen,�rt # Date Inspector
�' *,. Temporary Electrical Service or Pole 52. Pool & Equipment Location '
t
, .
� 2. Soil Pipe-Undrgrnd. • - 53. Steel Reinforcement �
,
3'�Electrical Conduit lYtility-Undrgrnd. � 54. Forms '-
4: Electrical Conduit�Undrgrnd. 55. Electrical Bonding � � '
5., Steel Reinforcement"• � 56. Rough Plumbing & Pressure Test ��
6.-Electrical UFER Grnd. , 57. APPROVAL TO COVER-GUNITE
7. Footings�. �' � � 58. Electrical Conduit-Undrgmd.
8. Foundation • � 59. Gas Pipe,-O Undrgrnd., Test
9. Water Pipe-Undrgrnd.� , � 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System � . 61. APPROVAL TO DECK
7 7. Property Sewer Line'& House Connection � 62. Backwash & Receptor-Final� -
12. Sewer Cap ,� • 63. Heater & Vent-Final
.13. Roof Drains � ; . 64. Plumbing System - Final - �
14. RougF;Plumbing,'� ' 65. Electrical-Final '
15. Rough Electrical-Conduit - � 66. Solar System-Final -
16. Rough Electric Wiring � 6). Fencing & Access Approval
1�'1 ough Wiririg Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling ' � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # � ,
27. Ducts, in Structure � 70. Underground Hydro .
22. Ducts, Ventilating � 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test , � 72. Underground Flush � �
24. Roof Framing � � 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing i , � 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing � 76. Dry Standpipe .
28. Lathing & Siding .- 77. FIXED SYSTEM FINAL
r
29. Insulation i 78. FIRE PREV. FINAL
30. Drywall Nailing H HEALTH OEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION�
32. Electrical Power Meter-Fina� 'd � (,l e 80. FOOD CERTIFICATE ISSUED
33. Final Electric 3 S I(� Notes: Mr,t•�.45 �_ _
34. Final�Heating & Air Conditioning � _ �,
35. Final Gas Pipe-Test � � • � �
36. Hood or Canopy ' , �
37. Final Faaory Fireplace �
38. Final Plumbing . � ` � '
39. Water Service-Final '
40. Gas Service-Final
41. So�ar pomestic-Final ,
42. Backflow Preventer , '
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation ' . �
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING . , - �
48. Special Requirements Completed . '
49. Electric Release to Edlson � � ' � - � '
� 50. Gas Release to Southern California Gas Co • .
51. CERTIFICATE OF OCCUPANCY '
No. Date - . �
�
oitY or ooete Mq� . - , �, _
ew�d�no sefety �epertina�t C E R T I F I C A T E 0 F O C G U P A:N C Y �* �^' �
P;O;�Box 7200 � � .
;v- +����"
Coete.Meee, Celifarnle
The Builiiirig lo_ceted at �25 SdRst 1Ri�k �r.,�at
has:beenFin'specfed and found to comply with the provisions of all City of Costa Mesa Ordinances applioable
for a Group �"'� Occupancy.
Use of Buildirig �tus�rlx.1. Sz:+_�diru�
Legal Description .Llfi-1`il—Uti "
reveree elde for Metee end Bounde)
y, -
Building Permit No 3��✓ Electrical Permit No. ��`'3� Plumbing Permit No. `
_ M'
Number of epartments and/or guest rooms
ISSUED T0: Building Official ; ;�
"d
it,�n y���n by , .. _= ��: - c
a+Waal li• Li{�ii.w3 - - -
�, .ri�
�, �B�uildin Offic� I�f the Cit of Corte Mese under Sec. 308 (e) U.B:C.P �e �t+�s...w i� ti47� .
��T�his�C�er,tif�icete of Occu enc SHALL BE oeted in e cona fcuoua lece on the,premlees and SHALL NOT BE removed except by the
B' Y
„,.,FOIm,BU.34 ROV�.ill/70.. - . ' . � . . . .
sk .._. .i. - �:. .. ..
�' 3368.5
t' COSTA MESA BUILPING•SAFETY DEPARTMENT
P.O. BO% 1200 COSTA MESA, CALIFORNIA 92626
for Applicant to Fill in Campletely
sui�oiNc � -
ADDRESS �� �
OWNEH p � %� `
MAIL
ADDRESS
TEL.
CITV � '� NO. J�
CONS�RUCTION _
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BRANCH
ADDRESS
APCHITECT
ADDRE55[�(/
�r
CONTRACTOR
ADDRESS
CITV
STATE
LIC. NO.
512E
OF LOT ��G
VSE OF
EXISTING BLDG.
512E OF
OF
�
ANO
NO.OF
ROOMS
ROOF
COVERING
K TO BE PE
TEL.
NO. �
CITV
LIC. NO.
NO. OF BLDGS.
NOW ON LOT
ED
I �ereby atknowletlpe that I have reatl this appliw[ion antl state
[hat tha above information is corract antl ap�ae to comply wi[h
all lawz repulating builtlin0 �o^sttuction, entl I shall not employ
any person in violation Ot the workman's compansation laws o1
che State of Calitornia.
I hereby certity [hat I am Properly licensetl as e contractor untler
Me State of Californie Bus��ess end Professions Cotle, Divisicn 3,
Chapter 9, antl that such Ikenses are In full force and Mixt, or 1
am ezempt irom th¢ provisions of ihe S[eta o( Calitornia Businen
antl Profassions Divis�on 3, ChaOter 9.
SiBnature o(
Permittee �
,n�mo.�:ea neom
"CT 7 Nnta�Q 1°,^'= . �.�.;, -��.
—t�- }�y.
APPLICATION FOR BUILDING PERMIT �
RECE�.V v DATF� RECREIVED DATE ISSUED �
,�� /� -=' 7/ r� _..r � i
� .. ..- i
/ �j PERMIT NO. �
A.P.NO. �/(J����'�/J d _ �
BUILOING
ADDRESS
RA
� W/ D P
Y
OWNER � � �
S I '�/
FIRE
ZONE TVPE
APPROVED
BY
ZONE NO.OF �,
PLANS
VARDS APPROV ED
MAIN BUILDING
(FROM GL TREET)
RONT O FT.
9. SIDE FT ./. `
/�
�. SIDE � �FT. ( U
REAR O FT.
DI5fANCE 6ET.
MAIN BLDGS.
VAR. sW
C.U.P.qW
APPROVED �/ /� /,
ev w
�nn
THEAMOUNTS
THE FURPOSE OF
VALUATION
/
S S� .�200
�
�
�
VALUE
r��
��,f�ROUP �T
�OATE(D �� �/
USE OF NEW
BUILDING
VARDS Ai
FT.
DATE
APPROVED
ED
�,
m
b
0
VALUATION IS FOR j
A PERMIT FEE ON�V: m
¢
__ s � ...`J ��
K $ 7�.;�s � E
`o
� LL
�
33686
!-' GOSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626
For Applicant to Fill in Completely
BUI�D�NG , �
ADPFIESS
OWNER ,� /�/t/�/ � /� {'(pTC?
PAIU J,, u1,::'} n�
r1rT -�,-71cr;�,00 151 o.r� r
APPLICATION FOR BUILDING PERMIT
RECE}�EL)B�' OP.�TE,REQEIVED nescicsiu
A.P. NO.
BUILDING
ADDRESS
z . ..., � ..
d U CIT� NOL -c ' T CT
~ Z CpNSTRUC710N W �+
ON LENDER
am
J � BRANCH
-� � OWNER
m J qppRESS � �
J QARCHITECT TEL. SE �LI �
N OR NGINEER N
V Q FIqE
W � AOORESS 20NE T
w APPROVED
J O CONTRACTOR D�'�' �� r B�'
m Z
J ¢ ADDRESS
w w TEL. �ONE NO.OF
z� CITY NO. P��
w � STATE CITV YARD$ APPFOVED
�� IIC, NO. LIC. NO. MAIN BVILDING
�� S12E NO.OF BL i. (FROM GLSTRE )
OF LOT NOW ON LOT FqpM
USE OF �
EX15T�NG BLDG. S FT.
F SIZE OF NO. OF
Z NEWBLOG. ROOMS STORIES L.SIDE FT.
U EXTERIOR WALL ROOF
COVEFING COVERING REA FT.
J VSE OF BUILDING AND WORK TO BE PERFORMED DISTAN ET.
a MAIN BL
a
a �� � �AR. #
OC.U.P. #'-
F MPFOVED
�
z
�
UI harebY acknowletlge that I have reatl this epplication antl stata
� that ihe above intormation is correct antl apree to comply wI[h
� all IP"+s regulating building construc[ion, antl 1 shell not employ
� nny person in violation ot the workman's compansation laws of
y the Siate ot Calitornia.
? t he�eby certity that I am pro0erly licensatl as e contractor untl¢r SQ. FT.
the State of Califomia Buziness antl Pwfezsionz Cotle, Divisicn 3, THE AMOUNT SHO�
Chap�er 9, and that such licenses are in tull force antl effact, or I THE PURPOSE OF E5
am szempt trom provisions of the Stare of California Business VALUATION
antl Prof¢ssions o e, Division 3, Chapter 9, ��
µ� �j �
si9nec�.a o, //%C /
P¢rmittae 3 /�/
Auihorizetl ABent
�
USE OF NE
BUILDING ���
YARDSAPPROVED
ACCESSOFV BVILDING
BET. MAIN &
{1CCE�. BLDi
DATE
AFPFOVED
a
— _ m
b
0
VALUATION IS FOR �
A PERMIT FEE ONLV: m
¢
'7�, m
E $ � rv
7
K S � E
`o
LL
5 �_