HomeMy WebLinkAbout931 18TH ST - Building Permits. J
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
dob Address: 931 W 18TH ST
Suite:
Vicinity: MEZZANINE
Parcel Nunmber:
Zoning.
App�icant: AARON HOLLAND ' �
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Address�. �-r���- �..-,:— � .
'��`�,�j�r; � , Phone: 800-841-9696
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Owner: .G AND"H,ENTERPRISES. ' -
Address " ; - 931-W 18TH ST�� - � -
� �� � � - Phone:
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�','��%�COSTAMESA CA%�� Zip: 92627
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Gomractor:, BEACON'FIRE AND SAFETY LP
' �Addressi,•�� 521 W BRAIRDALE ST
" ' i . � ':;��/ Phone: 800-841-9696
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� `��,,�" ORANGE, CA Zip: 92865
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� , - ; �License: 808346 � ,
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ISSUED BY:
Status: ISSUED
Applied: 10/27/2006
Issued: 12I14I2006
� ? i � . . '"• SCOPE OF PERMIT ..
'. ,ADD,48'NEW FIRE SFRINKLER HEADS IN CONJUNCTION TO LEGALIZING CONSTRUCTION OF 15'-0"
� ���: HIGH 3107�SF, FREESTANDING RACK SYSTEM WITH TWO STAIRS FOR "BOATSWAIN'S LOCKER".
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, - REF#: BO6-00741 � ' `� . ,
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`� �" i '--� ' ' �� ';r )� /% , ' FEE'SUMMARY � �� ;
Plan Ch ck �' � $172.41 �` -` '`� -: _--> ' ' �-' ��' Calc Valuation: S�s,000.00
Per it $26525 \ Claimed Valuation: sis,000.00
�. Oth r, . � .$0.00 � - �. _ �� � � .
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NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access requirements under California statutes and related
Yegulations. (OM. No. 92-28, § 1. 12-21-92) ,"
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a.period of 180 days.
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INSPECTIONS: In order tor [he work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
Yequlred Inspections end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
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WORKERS' COMPENSATION DECLARATION: �
I hereby aHirm under penalty of perjury one of the following declarations:
❑ I have end wiil maintain a certificate of consent ro self-Insure for workers' compensation, as pmvidetl for by section 3700 of ihe Labor Coda, for the performance of the
�warii:tor which Ihis permit is Issued.
il'have end will maintain workers' compensation insurance, as required by section 3700 of the labor Code, for the pedormance of the work for which this pertnit is issued.
��(.4y worke s' compensatio Insuranca carrier and policy number ere: /��1 �7
�Canie� �(3 1'�� Pdicy.Number._ ..b// 9y� /��70 J
�(7liis secfion need not be completetl il the permit is velued al one huntlretl tlollars ($100) or /eSsJ
❑ I certily that in tha pedormance of the woric for w�ich this permit is issuetl, I shall not employ any person in eny manner so es to become subjed to the workers'
compensation laws of Calitomia, and agree that il I shoultl be om bjectto��Compensation provisions of Section 3700 of the Lebor Code, I shall torihwith
�comply.with these.pmvisio „ � /� /,/_O �
.. .._..=<_. . _. _
App�icenCSignaNre: _� '(�.�Date: 7
WARNINp: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SUBIECT AN EMPLOYER•TO CAiMINAL PENALTIES AND CIVIL FlNES UP TO qJE HUN�RED
T}KNJSANO DOLLAPE (5100.000�, IN ADDITION TO iHE CQST OF COMPENSATION, DAMAGES AS PR ED FOR IN SECTION 3]OB OF THE IABOR COOE, INTEREST, AND ATTORNEV'S FEES.
LICENSEO CONTRACTORS DECLARATION:
I hereby,aHirtmtheFParnlicens tl,untler rov}i ,ion3.ot Chapter 9(commencing wilh Section 7000) of Division 3 of Ihe Business and Profgssions Cotle, and my license is in full
torce antl eflecL Llc. N �� 9� 7(� � Cles a '--' 6
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Contractols SI natur � .i• T.��
•ir9"�d _ Date: � �—,
CONSTRUCTION LENDING AGENCY: �''""'�
❑ I hereby aHirm that there is a construction lending agency tor the Derformanca of iha work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lentler's Address: i
Signeture:
Date:
OWNER-BUILDER DECLAHATIONS:
I hereby affrtn that under penalry of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires a permit to consimct, alle�, improve, demolish, or repair any stmcture, prior to its issuance, also requires the applicanl for such permit
to file a siqnetl statement that he oi she is licensed pursuent to the pmvisions of ihe Contracmrs License Law (Chapter 9(commencing with Section 7000) of Division 3 oi ihe
Business and Professions Cotle) or ihat he or she is exempt therefrom antl the basis for the allegetl exemption. Any violation ol Section 7031.5 by any applicant for a permit
su6jects the applicanl ro a civil penalry of not mora than five hundred dollers ($500).} -'
❑ I, es owner of the properry, or my employees with wages as Iheir sole compensetion, WILL DO TNE WORK, and the strucWre is not intentletl or oMeretl for sele (Sac.
7044, Business and Protessions Cotle: The Coniractors License Law does not apply to an owner of properiy who builds or improves ihereon, and who does such work
himself or hereelf or Ihrough his or her own employees, provided ihat such improvements are not intendetl or oNered br sale. If, however, ihe building or improvement is
sold within one year of completion, the avner-builtler will have �he burden of proving that he or she did not build or improve for purpose of sala.).
❑ I, as mvner of the property, am EXCLUSNELY CONTRACTING WITH �ICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Professions
Cotle: The coniractors License Law does not apply to an owner of pmpeny who builds or impmvas thereon, and who contracis br such pmject with a contractor(s)
license pursuant to �he Contractors License Laws.).
❑ I am ezempt under sec. Business and Profassions Code for this reason: �
Signature: ' Date:
Owner ID venfietl by dnvers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification ot Ownership 6y (type oi document, i.a. - properry tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMI7 CERTIFICATION:
❑ I hereDy ceriify �hat no excava�ion tive (5) or more teet in depth into which a person is requiretl �o descend, will be made in connection with work authorized by ihis
permit, antl that no builtling structure, scaHoldinq, talsework, or tlemolition or dismantling thereot, will be more ihan ihirty-siz (36) feet high. (C�ap. 32, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will not employ enyone to do work which would �equire a permit irom the Division of Industrial Safery, as noted above, unless such person has a
permit to do such work from ihe tlivision.
Signa�ura: Da�e:
Division of Indusinal Satety Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORVA710N OF EMAV: I certify untler penalty of perjury ihat I have read this application and s�ate �hat �he information given is
correct. I agree to comply with ell state laws and city ordinances relating to building constmction, end authorize representatives of the Ciry of Costa Mesa to enter upon Ihe
above-described property for inspection puryoses. I agree not to occupy or allow occupancy of any building authorized by this permit until tinal inspection.
yOUE �, IHSPECTIONTYPE
1fi16 Fized System Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Roof
201 FInaI Block/Retaininq Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
IMRIRLS \ �Qp�I INSFECTIONTYPE
206 Final Mechanical
208 Final Plumbing
270 Final Elec�rical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final BuildingiOccupancy
Q�TE INTffIALS
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,lob Address: 931 W 18TH ST Status: ISSUED
Suite: Applied: 05/15/2006
Vicinity: Issued: 12/14/2006
Primary Occ: B/S1 Type of Construction: IIIN
Parcel Number: 42436113 Zoning:
npp�icant: GRIBBLE, DAN
Address: 931 W 18TH STREET
Owner:
Address
Contractor.
Address:
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.....�Zip:
Address:
Zip:-
COSTA MESA, CA �
: ' �- � �
G AND H ENTERP.RISES
931 W 18TH ST �� .
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COSTA�MESA, CA�� � �
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Phone: 949-642-6800 X312
,. . .Zip: 92627
Phone: '
Zip: 92627
Phone:
License:
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ISSUED BY:
Eng: SEILMIC ENGI
Address: 161 ATLANTIC AV
POMONA, CA ,
91768
NG
Phone: 909-869-0989
" ., - _ � /
License: 35215
� - ` ' �� .,SCOPE OF PERMIT
IEGALIZE CONSTRUCTION OF�15'-0" HIGH 3107 SF FREESTANDING RACK SYSTEM WITH TWO STAIRS FOR "BOATSWAIN'S LOCKER". 2ND
STORY.OF THIS SYSTEM IS CONSIDERED AS AN ATTIC STORAGE ONLY (NON-HABITABLE-SPACE) DUE TO LACK OF CEILING HEIGHT.
� /
' ' -- FEESUMMARY •
Plan Check: $26120 • ' Calc Valuation: 82s,000.00
� Permit: $401.85 � Claim Vaivation: 52s,000.00
SMIP Res � $0.00 � ,'
SMfP Com: $5.46 -- - � ,
, Other: � ��, $0.00 ; �- �-� . _- - -
Inspection: $0.00 �
�
� �..�� Totali� ��; �$668.51 � � �
� � PLANNING & ZONING
SETBACKS . ��`\ , ` `
MAINSTRUCTURE Front\0-0 � ReaP 0-0, Lefl 0-0 _ Right .0-0
- � , ��-cr , - - _ - ,
ACCESSORY;, Fron1����0-0�;Ac�� Rear 0-0 , Left 0-0 RigM, 0.0 .
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PARKING � � \Exi tin :. !0�, �Reauired: ` 0 ' Pr000sed: 0 _ ' �
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NO710E: The work authoriZed by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
I for a period of 180 days.
IINSPECTIONS: In order for Ihe work authonzed under this permit ro be considered legal, such work must comply with all applicable codes, and all
requfred inapecttons end final approval musf be obfained. Failure fo obtain inspections and final approval wili result in ihe expiration of ihis permit.
FOR INSPECTIONS CALL: (71q) 7545626
204&48 (8�W)
.
WORKERS' COMPENSATION DECLARATION:
I hereby afli under penalry of perjury one of the following tleclarations: "
❑ I e end will mein�ain a certificete 0� wnsent ta self-Insure for workers' compensation, as provlded lor by sac�ion 3700 of t�e Lebor Code, lor Ihe peAormence of the
ork lor which this permi� is issuetl.
� �y I heve end will maintain workers' compensaGon insurence, as required by sactlon 3700 of ihe Labor COUe, tor the pedormance of Ihe work tor which this permit Is issued.
Y My wy rs'trompensation Insurance �rner antl policy number are:
�< <� Policy Numbec
.pm�s s cf' n need not be cromplefed il ffre permif is va/ued $100J or less.)
I ce that in the e work for which this pe Q I shall not emp o rson in any manner so es to becoma suDject to t�e workers'
compen s oi CaliFomia, end a that come sub�ect to t�e workers' compensa ion provisions ot Section 3700 0l ihe Lebor Code, I shell forthwith
comply with these Orovisions.
Applicant Signature: Date:
WFRNINO: FAILURE TO SECURE WORKERS' CA�ENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SU&IECT PN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDREO
TFIOUSAN� WLLARE (EtU0,W0), IN ADDITI�N TO TME COST OF CAMPENSATION, pAMAGE$ AS PFi�Y1DE0 FOR IN SECTION 3iC60F THE LA�P COOE, IMEREST, AND ATfOFNEY'S FEES.
LICENSED CONTAACTORS DECLARATION:
I hereby aflirm that I am licensad under pmvisions of C�epter 9(commencing with Seaion 7000) oi Division 3 of Ihe Business and Professions Code, and my license is in tull
force end eltact. Lia tt __ Class a
Contractor's SignaWre: Date:
LONSTRUCTION LENDING AGENCV:
❑ I hereby aHirtn ihat thare is a consiruG�ion lending egency for ihe pedormance oi the work for which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lenders Neme: Lentler's Adtlress:
Signeture: Date:
OWNER•BUILDER DECLARAT10N5:
I here�y eNirm Ihat untler penelry of perjury ihat I em El(EMPT FROM THE CON7RACTORS LICENSE LAW tor ihe following reeson (Sec. 7031.5, Business end Professions
Cotle: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or repair eny sirucWra, pnor to its issuance, also requires the aOPlicant for such pertnit
to fle e signetl statement that he or she Is fcensed pursuent to the provisions ol ihe Coniraaors License Ww (Chapter 9(commencinq with Sactlan 7000) of Dlvision 3 of the
Business end Protessians Cotla) or thet he or she is axempt therefrom and the besis for the alleged exemption. Any violation of Section 7031.5 by any aOPlicaN for e pertnit
sublecis the eppliwnt to e civil penalty of n0� more than live hundred tlollers ($500).):
❑ I, es owner ot the property, or my employees with wages as iheir sole compensetion, WILL DO THE WORK, and the stmcWre Is not imendetl or o%ared for sele (Sec.
70d4, Business end Pmfessions Code: Tha Coniracbrs License Lew tloes not aOPly to an owner of pmperty who builds or improves ihereon, and who tloes such work
himself or herself or ihrough his or hal �+'n employees, provided that such improvemems are not Intended ar ottered br sele. If, howevar, iha building ar impmvement is
�sold within one year ol completion, IhU owner-builtler will have the burdan ol proving that he or she tlid not build or improve lor purpose of sale.).
I, as owner of the properry, am EACLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS b consWci the prolect (Sec. 7044, Business antl Prolessions
� Cotle: The conirectors License Law does not apply to en owner ol property who builtls or Improves thereon, and who contracis for such project with a contractor(s)
license pursuant to the Contractors LiGense Laws.). i .6
�t am e mpt ifider sec.Q i�%/7 Business end Pmfessions Cotle for ihis reason: � Y . /. ./ �
Owner ID verified by �vels license. �s ❑ No iivels � nse No.
Venficetion of Ownership Dy (type of tlocumant, i.e. - property tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no axcavation five (5) or more feet in depih into which a person is requiretl to descenq will De made in connection with work euthorized by Ihis
pertnit, end that no building siructure, scattWding, lelsework, or demolition or disman�ling �hereol, will be more than thirry-six (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Ttle 8, Calilornie Administretive Gode).
❑ A5 owneo-6uiltler, 1 will not employ ar�yone to tlo work which would require e permit fmm the Divisioo ot Intlustdal Satety, es noted above, unless such person has a
pertnit to da such work Irom Ihe division.
Signature: Date:
Division oi Intlustrial Safety Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTN�RIZATON OF ENTRY: I cenity under penalry of perjury ihat I have read this epplication and state that ihe informelion given is
correct. I agree mply with all st e laws and city ordinences relating to building consiruction, and authodze representatives of ihe Ciry of Costa Mesa to enter upon ihe
abova-descn tl D� i�or inspV n p I agree not to occupy or allow occupancy of eny building authorizetl 6y this permi un�il fin I in pection.
(/
`-� � Slgnatur Of Lagal er(s) Date
And/Or Authodied ApPlicant I ate
COpE I, INSGECf10N7YPE
1616 Fixed System Final Fire Preventlon
1266 Pool Spa Finel
200 Finel Re-Foot
201 FInaI BIocWRetaining Wall
202 Finel Factory Fire Place
203 Final Sign
204 Final Demolition
�g �
COpE/ INSPECfIONTYiE
206 Final Mechaniwl
208 Finel Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupanq
� NIin�L
(714) 754-5273 • Fez (714) 754-4856 •� www:ci.costa•mesa.ca.us i i rHin univo, wo � r. rv�w.+, .... �����
BUILDING PERMIT
Job Address: 931 W 18TH ST
Suite:
Vicinity: ROOF
Primary Occ:
P I N mber' 42436113
Type of Construction:
Zoning:
Status: ISSUED
Applied: OS/OS/2005
Issued: 05/OS/2005
arce u
AppliwnC STEVESCHNIERER - ..-w_.;:--- ISSUEDBY: �
Address: 229 E COMMONWEALTH AVii=�� �� � - � - �� ' �.....�' ����`' ' �-
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UNIT 149 .���� �� �� � , � Phone: 714-719' 689� � ,�� � -�_
FULLERTON, CA-!/ / Zip: ;92832 ' \ � \, �� �
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Owner. G& H,ENT.ERPRISES� ; _ � � � � ' `�-J i � ���� �� �`
Addre ���% /�BTH ST�-�/% / �-� � Phone � � �,� � "- � ` � � �
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Cantrecror., FONTAINE;AND ASSOCIATES �.J�j �, �. i � �
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�Adtlress: ��23482 P,ERALTA ,. � ; ��� `
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- ' ,LAGUNA� HILLS. CA � �r;z . _ ��� , , , ' - . �
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, -Zip: � 92653 ' --�- - : :6icense: • 708917 � � , •
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� TEAR OFF EXISTING ROOF. INSTALL NEW _BUILTUP ROOFCAPSHEET. 9;500 S_F.�FQR'COMMERCIAL BLDG. ' .
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' r FEE SUMMARY i '
Plan'Check �. �, $0.00 �` ��� � � �" � � �' � � ' ���•� Calc Valuation: � �� Ss,5oo.00�
d � wt ' Permit: ', ��.',$18125 �� - � - --.- . � �. ��_�,. �; � ' -�-� -- Claim Valuation: Ss,5oo:00
�SMIP Res: $0.00 , `� ' :
;�
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SMIP Com: �'-�'� $1.99 � - -'� ���:� . ' ` ,,. �
Other. , $0.00 �- ' ' � � ` -
Inspection:� ,, � $0.00 �- � ''�� � � %�j� '�r
� � -,;� ;� ";�
, ` � . ��.� :. +."-.�, 4. ' � `' : : , /i % . � i �
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Total. ' `5183 24 °,. ;� � � `f . ' ' �� � , �
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. � i � �� � � � PLANNING & ZONING � . � ,,� � ./ / , '
SETBACKS ��1 '' � _ �1 �A�y i �" �r r.- � ./�j� � f"
:
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MAINSTRUCTURE`Front �'0-�0 ,/,.��, Rear- 0 0'= � .�L''ek 0-0� �� �Right!� O�O;�i � �
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' � � / �� h -_ "' /1 \ �/".. �% � . .
ACCESSORY Front� ,0-�0 ��",!/�,Rear �0.A Left 0-0�` �� RightJ �0-0,�� ,
� : �_,.� � �, _ .. -. �� � ,;
PARKING Existlna: �0 '-,Required: �0� _ , , ;Proposed; � ��0^A�� �-'�/ ��-"
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NOTES: \ � � _ - �~ ' �
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- _ -_'---��� _ �
NOTICE: The.work authorized..by this pertnitshall compty;wittrall applicable•-handicap�access requirements-under Califomia,statutes and�related
regulations: (Ord::No. 92-28; § 1, 12-21-92)
EXP�RATION: � This��.pertnit shall automatically expire end become.void.lf work�is.not commenced within ,180 days, or if vrork is suspended or ebandoned
for a period of� 180 days:
1NSPECTIONS: In orderfor the vrork authorized.under this:pertnit to.be considered legal, such work must cwnpty with �all applicable codes, and all
required�.InspeeUons�end firiaLepproval must be obtained: Failure to obtain inspections and�.final�approval will:result in the expiration ot ihls pertnit.
� FOR�INSRECTIONS.CALL:.. (714) 7545626>
zaeae �voo�
WORKERS'COMPENSAnON DECLARAnON: � � � _ -
I �ereby attirtn untler penalty oi perjury one of ihe following declarations: :. ' ,
❑ 1 heve end wlll maintain a canlHcete of consent to selbinsure for workers' compensetion, as providetl for by section 3700 oi ihe Labor Code, for the peAormence of the
work for w�ich lhis permit is issued. � �.-
�hhave and wlll maintain workers' compensation Insurance, as requiretl by sectlon 3700 0l Ne Lebor Cotle, for the pertortnance of the work for which Uis pertnit is iswed.
My workers�mpensation�p, urence cartier and policy number are:
me vermir rs
Poli uCnba�r.�:Zl�il-2UGL—�i
or less.) ""
❑ I certity thet in Iha pedormence of the work for w6ich this permit is issuetl, I shall not employ eny person in any menner so es to become sublect to tha workers'
compensetion lews of Califomie, entl egree thet H I shoula become subject b the workere' compensetlon provisions of Section 3700 ot ihe Labor Code, I shall forihwith
comply with these vis'
�'SigneNre (� Da�a:—. SJS,OS'
I FAILURE T65ECURE W (E0.S' WMPENSATION COVERAGE IS UNL4WFUL ANO SMALL SUBIECT AN E�li TO CRIMINAL PENALTIES AND dNL FlNES UP TO ONE HUNORED
TIqUSAND DOIURE (5100,000), IN ADOfTION TO THE CQST OF COMPENSATION, DAMAGES 0.S PROVIOED FOR IN SECTION 3/O60F TME L1BOq CODE, IfJrEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
of Chepter 9(commencing with Section 7000) ot Divisionf 3',o–t'lhe.Business antl Protessions Code, and my license Is in full
y-�asa.M— •
� Date: Si S' OS
—T
CONSTRUC710N LENDING AGENCV: ..
❑ I hereby eflirtn I�et ihere is a canstruction IenAinp egency for the pe�ormence of Ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lendefs AOtlress:
SlpnaNre:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHlrm ihet under penalry ol perjury Ihat I em EXEMPT FROM TME CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business end Professions
Code: Any city or counry whic� requires e pertnit to consiruct, alter, improve, tlemolish, or repeir eny structure, pnor to its Issuance, elso requires the applicanl for such pertnit
lo file a signeA statement Ihat he ar she Is Ilcensetl pursuent to the provlsions oi ihe Contractors License Law (Chepter 9(cammenUng with Section 7000) ot DlNsion 3 of Ihe
Business and Professlons Gotle) or t�at he or she is exempt therefrom end the basis for the elleged exemptian. Any violation ot Sectian 7031.5 by any epplicant for e pertnit
subjecis the epplicent to e civil penalty of not more then five hundred dollars ($500).):
❑ I, as owner ol ihe properry, or my employees wilh wages as thelr sole compensation, WILL DO TME WORK, antl t�e slructure Is not InlentleC or oflered for sale (Sec.
7044, Buslness and Professions Cotle: The Conirectors License Lew tloes not apply to an owner of properry who builds or improves thereon, and who does such work
himselt or herseN or ihrough his or her own employees, provided Ihet such improvements are not intendetl or oHered for sale. If, however, the building or improvement is
soltl wit�in one year of completion, t�e ownerbuiltler will heve the burtlen ot pmving thet he or she ditl not build or improve tor purpose ol sele.). -
❑ I, es owner of Iha properly, am E7(CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Gode: The contrectors License Lew tloes not epply to an owner oi property who builtls ar improves thereon, entl who wntrecis tor such pro�ect wlth a contrector(s)
license pursuent to ihe Conirectors License Lews.).
❑ I am exempt under sac. Business end Professions Cotle for ihis reason:
SignaWre: Date:
Owner ID venfietl by drivefs license. ❑ Yes ❑ No Dnvers Licensa No. Expires:
Verification ot Ownership by (type ol document, i.e. - property tax blll or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICA710N:
� I hereby cerlliy ihat no exwvatlon fve (5) or more feet in depih into which e Oerson is requiretl to descend, will he made in wnnection wlt� work authonzed by this
pertnit, end �hat no building siruclure, sca%oltling, falsework, or demolition or dismantling Ihereof, will be more ihan Ihirty-six (36) feet �igh. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Ttle B, CelHomia Adminlstrative Code).
❑ As owner-bullder, I will not employ anyone to do work which would require e permit irom the Division of Industriel Sefety, es notetl eDove, unless such peraon hes a
permit to do such work trom ihe division.
Signature: Date:
Division at Industdal Safery Partnit Number.
1 Will the eppllcent or present or luture building occupent nead to file end cenity a Business Plan for emergency response to release or ihreatened release ot e he�rdous
me�8da11 ❑ Yes ❑ No
(Seciion 25505 oi Ihe Califomia Health and Sefery Coda requires, wilh some exceptions, thet e Business Plen be tiled wit� the Costa Mesa Fire Depariment by every
business which has at any one time dunng a reported year e quantity ol harardous matanals equal to or greater ihan a weight of 500 pountls, or a vdume ot 55 gallons,
or 200 cubic feet of compressetl gas at stantlartl tempereture an0 pressure).
..............................................................._................................._.............................................................................................................................................._.........................._...........__........................................._.__................._..............__...
2 Does or will the epplicant or present or future building occupant need to lile a regisiretion lorm for acutely hazardous materials9 ❑ Yes ❑ No
(Section 25533 oi the Califomia Health and Safery Code, with some exceptions, raquires registration with the Coste Mesa Fire Depertmen� by eech buslness whlch et eny
one time hes on hantl a quantlty ot aately hazerdous matedels equal m or greater then e welght of 500 pountls, or e volume ot 55 gellons, or 200 cubic feet ot
compressetl ges et stentlaM lempereWre and pressure).
........"'__ ..................... o'—___............................�_._................................._..................._._.............................._...................................__"__............................._..........—................__............_"'
3 Dces or will theep plicant or presenl or tuture building occupant need to prepare en RMPP (Rlsk Menagement and Prevention Program lor ecutey huartlous materials)1
❑ Yes ❑ N
(Section 25534 of Ihe Calitomia Heali� and Safery Code provitles that the Costa Mesa Fire Department may require the preparation, certilication antl filing with Ihe Fire
Departmant oi en RMPP Dy buslnesses which ere requiretl to register ecutely �ezerdous matenals with tha Fire Depanment.
.................................................................................................................................................................................................................................................................................... ........................ ...................................................................
4 tl en RMPP Is presently required, has Section 25534 oi ihe Celifornia Heelth end Sefery Cade been fully complied with7 ❑ Yes ❑ No
wlll the eppliram or present or future builtling occupant redulre tor the work which is lhe subjact of this e plicatlon e gertnR to� such conSWction or
Saulh Coast Air Duality Manegemenl Disirict or tmm eny other air polWtion mmrd distnct or egenc/I � Ves ❑ No
65850.2 of Ihe Califomia Govemment Cotle requires that Ihe requested iniortnation be tumished on applicatlons tor nomresitlential builNng permitsJ.
any petl Of lhe fatiliry to be cc
�es", the facility must meet Ihe
heve ell of the tlisclosures
tler Ihis pefmit De witltin 7000 faet fmm tlle outer bountlatles ol a schod'
of Sections 25534 and 62303 0l ihe California Health entl Sefery Code).
or egency
an made7
pf'yes', attach certifcate of compllance fmm the appropriate air pollulion conirW oHicer).
CERTIFICATE OF COMPLIANCE: I certity that under penalry of perjury the intormation given above is correct. I egree to comply with ell stete laws and Gry ordinancas
regartling Harardous Matenals entl Emiuions.
SignaWre: Date:
CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF EMRY: I cenily under penalry oi perjury �hat I have reatl this epplication end state that the informatlon given is
cortect I agree to compty with ell stete laws and ciry ordinences relaiing to building consiruction, entl euthoriza representatives ot ihe Ciry ol Costa Mesa to enter upon the
ebove-descnbed properry for inspection purposes. I agrae not to acupy or allow occupancy ot any building authorized by this pertnit until tinal inspection.
COOE �. INSPELTIONTYPE' '"'
1616 Fixetl Systam Final Fire Preventlon
1266
200
201
202
203
Paol Spa Final
Final Re-Roof �
Final BIocWRetaining Wall
Final Factory Fire Place
Finel Sign
��
`�s
GODEt INSVECTIONTYPE �
206 Final Mechanical
20B Final Plumbing
•� 210 Finel Eletinwl
272 Final Fire Preventlon
220
222
Finel Planning Approvel
Final Site
204 Final Demolition 250 Final BuildinryOccupency
(714) 754-5273 • Fax (714) 754-4856
� CITY OF COSTA MESA
BUILDING pIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
Job Address: 931 W 18TH ST
Suite:
Vicinity: BACK WALL OF MIDDIE WAREHOUSE AREA.
ParcelNunmber: 42436113 �
Applicant: BAXTER, CLARK
Address:
Owner: G & H ENTERPRISES
Address 931 W 18TH ST
Zoning:
Phone: (949)240.3422
Zip:
Phone:
COSTA MESA, CA Zip: 92627
Contractor: J S BRADLEY CONSTRUCTION
Address: 2311 COCO PALM DR
Phone: 714-665-2723
TUSTIN, CA
2ip: 92780 License: 715917
Arcn : CLARK BAXTER
Address: 34249 CAMINO CAPISTRANO
#201 Phone: (949)2403422
CAPISTRANO BEACH, CA
Eng:
Address:
77 FAIR DRIVE,
ISSUED BY:
PERMIT
CA 92626
Slatus: ISSUED
Applied: 04/O6I1999
issued: 05/19/1999
Phone:
Zip 92629 License: Zip: License:
SCOPE OF PERMIT
INTERIOR TI 750 SF TO CONSTRUCT ADMIN OFFICES IN WAREHOUSE 8 INSTALL NEW STORE FRONT IN EXISTING
EXTERIOR OPENING OF BUILDING. (BOATSWAIN'S LOCKER-TENANT).
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
SETBACKS
ACCESSORY
PARKING
NOTES:
$97.34
$149.75
$0.00
$1.89
$0.00
$0.00
$248.98
Front 0- 0
Front 0- 0
Existinq: 0
Rear 0-0
Rear 0-0
Reauired: 0
PLANNING 8 ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
ss,000.00
s9,000.00
NOTICE: The work authorized by this permit shall comply with all applicable hendicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12•21-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inepeetlona end final approval must be obtained. Faiiure to obtain inspections end final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545828
WORKERS'COMPENSATON DECLARAnON: .
I hereby eflirtn under penelry of perjury one of Ne following declaratlons: •
❑ I heve end will malntein e certlticete of consent to sett-Insure for workers' compensation, es provlded for by sectlon 3700 of Ihe Lehor CoOe, for ihe performance at t�e
�work for which �his permit is issuetl.
I have end will maintain workers' compensatlon insurance, es required by sedion 3700 of ihe Lebor Code, for the peAortnance of the work for which ihls pertnit Is issued.
My worke�' ccynp�� rn�Ins{uence cartier flntl policy number ere: �,��0// ��j �/� �
Cerrler. �J /1� �c E Policy Number:
(fhls sectlon need naf be completed ll the permit is velued ef one hundred dollars ($100) or less.)
❑ I certity ihat In Ihe p ortnance of the work for which this pg� it J' sue0, I shell not employ eny parson in eny manner so es to become sub�ect to Ihe workers'
compensation laws ��Oalifomia, an�ree ing I should b 6 4 bject to Ihe workers' compenseiion provisions of Sectlon 3700 oi the Lebor Coda, I shall forthwith
comply with ihesa isions. j/
Applicant Signature: Date: �
WARNINO: FAILURE T CURE WORKERS' COMPENSATION COVERAG U WFUL PND SNALL SUBIECT AN EMROVER TO CRlhll LTIES M1D CML FlNES UP i0 dJE MUNDRED
TIqUSANDDOLIAR OO.OW�.INADMTIONTOTHECQSTOFCOfAPE S ,OAANGESASPRONOEDWRINSECfION3lO60FTHE RCODE,INTEHEST,ANDATTORNE`fSFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby afllrm t�et I am Ilcensetl
(orCe entl attect. Lic. k �
Contrectofs Signeture:
CONSTRUC710N LEN�ING AGENCY:
of Chaptar 9(com encing with Sectlon 7000) ot �Ivlslon 3 0� ihe Busine ntl Professlons Code, an0 my Iicensa is In full
Cless # _
oa�a: �1l�•2_ / 9 / 9 '3
❑ I �ereDy aKrtn Ihat there is a construdion lending agenty for the pedortnance ot the work tor which this pertnit is issued. (Sec. 3097, CMI Code).
Lentlers Neme:
Signature: _
Lendels Atltlreu:
Date:
OWNER-BUILDER DECLARATONS:
I hereby aNirtn that under penalry o1 perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu antl Professions
Cotle: My city or caunry which reQulres e pertnit to construct, elter, improve, tlemolish, or repeir eny slrucWre, prior to Its Issuence, also requires the applicent tor such permit
ta file e slgneC stetement thet he or ahe is Iicensed pursuent lo the provislons of Ihe Contractors LJcense Lew (Chepter 9(commendng wlth Section 7000) of Division 3 of Ihe
Buslneu anC Protessions Cotle) or ihet he or she is exempt thereirom and the basis for ihe elleged exemption. My Nolation oi Sectlon 7031.5 by eny epplicant for e permit
sub�ects Ihe epplicant to e civll Oenelry of not more than five huntlretl tlollars ($500).):
❑ I, es owner of ihe D�oDerty, or my employees with weges es t�eir sole wmpensation, WILL DO TME WORK, anC the structure Is not intentletl or oXered for sele (Sac.
7044, Busineu and Professions Code: The Contradore License Lew does not apply to en owner ot properry wha 6uilds or Improves thereon, and who does such work
himseN or herself or Ihrough his or her own employees, pravided Ihet such improvements ere not Intended or oHeretl for sale. If, however, t�e builtling or improvement is
soltl within one year oi completion, the owner-builder will heva the burden of proving ihet he or she did not build or improve for purpose of sele.).
❑ I, as owner of the properry, em EXCLUSIVELY CON7RAC71NG WfTH LICENSED CONTAACTORS to canstruct ihe praJect (Sec. 7044, Business and Professions
Code: The contrectors License Law does not apply to en owner ot property who builtls or Improves ihereon, and who conlrects for such project wlth a conirector(s)
license pursuent to the Conirectors license Lews.).
❑ I am exempt under sec. Busineu and Professlons Cotle fo� t�ls reason:
Signelure: Date:
Owner ID verified by tlnvefs license. ❑ Yes ❑ Na Oriver's License No. Expires:
Veritication of Ownership by (rype ot tlaument, i.e. - praperty tax blll or deed):
UIVISION OF INOUSTRIAL SAFETY PERMI7 CERTFICATION:
❑ I hereby cenlly thet no excevatlon tive (5) or more feet In depth Into which a person Is requlred to descend, will be made in connection with work autharizetl by tNs
pertnit, and Ihet no 6uilding strucWre, scafrolding, talsework, or demollilon or dismaniling thereol, wlll be more than Ihirty-six (36) tee� high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Celifamie Adminlsiretive Code).
❑ As ownar-builder, I will not employ enyone to do work which would requlre e permit irom the Dlvislon oi Intlustnal Safery, es notetl e�ove, unless such person hes a
permit to do such work from the tlivisian.
Signeture: Dete:
Dlvision of Industrial Safery Pertnit NumDer:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I cehity under penalty ol per�ury that I heve read this epplicetion entl state that the intormatlon given is I
correct. I egree to comply with ell stete lews and city ordinences reletlng ta building construcllon, end authoilze representetives oi the Ciry oi Costa Mese to enlar upan the
ebove-desjribed property for Inspectlon purposes�agre§�o� to occupy or ellow occupancy ol eny building authorizetl 6y this pertnit untll Ilnal InsDection.
CSSOEI, INSVECTIONTYVE
7616 Fized System Final Fire Prevention
1266 Pool Spa Final
200 Final RaRoof
201 Final Black/Reteining Well
202
203
204
266&46
Final Factory Fire Place
Flnal Sign
Final Demolition
F�IF 1t�S
COOE I INSPELTION T17E
208 Final Mechanicel
20B Flnel Plumbing
I
210 Finel Electrical
212 Final Fire Prevention
220 Flnal Planning Approval
222 Finel Site
250 Flnel Building/Oaupancy
P� 1t�LS
,�y �
�:� �Y�
V
/r�� �
� �._:..;:: ; :
�. '
(714) 754-5273 • Fex (714) 754-0856
Job Address:
Suite No
Vicinity:
0
931 W 18TH ST
Parcel Nunmber: 42436113
Applicant: BRADLEY, KAMES
Address: 2311 COCCO PALM DR
CITY OF COSTA MESA �.
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
TUSTIN, CA �
, - . ,
/. � /,
Owner.' �� G & H ENTERPRISES
Address � 931 W 18TH ST'," '
n : '
� / -i,'
/ /�'� � / /,
i
;� COSTA.MESA, CA
„_Contreetor;
Address;
i� ,
� �, ArchlEng:�
� ' ,Address:.
�
PLUMBING PERMIT
Phone: (714)665-2723 ,
Zip: 92780
Phone:
Zip: 92627
J S BRADLEY CONSTRUCTION
2311 COCO PALM DR ,
� � � � Phone: 774-665-2723
-7USTIN, CA Zip: 92780 -
, License: 715917
Phone:
Zip:
License:
c
PERMIT
77 FAIR DRIVE, COSTA
1354
CA 92628
Status: ISSUED
Applied: O6I2811999
Issued: O6128/1999
ISSUED BY: � �
ti . � SCOPE OF PERMIT,�
� . 1200 AMP METER AND RELOCATE 2 SINKS FOR BOATSWAINS LOCKER TI. REF:B99-00461.
, ���. _
t
��� . . , .• .AMT
ISSUE•FEE . $22.00
Backflow irrigation $0.00
Backflow Preventer - $0.00
Bathtub $0.00
Clarifier System_ �. 50.00
Connect pce,Soda,etc) �� 50.00
Dental Units 50.00
Dishwasher � � , $0.00
Drain, Floor -�,$0.00
Drain, Rainwater ` $0.00
Drein, Roof $0.00
Drinking Fountain $0.00
Expansion Tank $0.00
Gas Earthquake Valve $0.00
Gas (1-0 outlets) $0.00
Gas (Over 4 ouUets) $0.00
Gas Repipe $0.00
Gas Service $0.00
Interceptors (Grease, Oil) $D.00
Interceptors (Sand quto ) $0.00
Qn
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 k) 50.00
Receptors ' $0.00
Septic Tank $0.00
Sewer Cap for Demo 50.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $17.50
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private} $0.00
Spa (public) $0.00
Qn
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
SumpPump
Swimming Pool .
Trap Primer
Urinal
Vacuum Brkr Bkflow(1�)
Vacuum Brkr Bkflow(5+)
Wash Basin , �
Wash Basin Set �
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
�
i
�
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: $39.50
orr
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap eccess requirements under Califomia stetutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall eutomatically expira and become void if work is not commenced within 180 days, or if work is suspended oi abandoned
for a period of 180 days.
INSPEC710NS: In order for the work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all
requlrad Inapactiohe end finel epprovel must be obtained. Feilure to obtain inspections end final epproval will result in the expiretion of this permit.
POR INSPECTION$ CALL: (714) 7545626
WORKERS'COMPENSAnON DECLARAnON:
I hereby afflrm under penalry of perJury one ot the following tleclarations: �
❑ I heve and will malntain a certifiwte ot consent lo sell-Insure for workers' compensatlon, as provided for by sectlon 3700 of the Labor Code, for �he peAormance of Ihe
yMndc for which ihis pertnit is issuetl.
Q I have and will maintein workars' compensation insurance, aa requiretl by se�tion 3700 ot Na la6or Code, for the peAormance of ihe work for which ihis pertnit Is issuetl.
/ My workers' compensetio�nsurence carner antl policy number ere:
Carner. . Pollcy Number:
(This section need not be ca eted I/ the Oertnif is velued ef one hundred . I311N11 nr Iwss 1
❑ I cenity that In �he p ortnence oi Ihe ork
compensation laws Calilamia, antl ee if
complywiththese ' i ns.
Applicant Signature:
WARNING FAILURE T CURE WORKERS' COMPENSATION
TNOUSAND OOLLAR 00,000�, IN ADDITIIXJ TO THE COST O
LICENSED CON7RACTORS DECIARATION:
I hereby aHirm Ihat I am
force end eflect. Lic. q_
Contrecror's Signature:
CONSTHUCTION
❑ I hereDy aHir
Lendefs Name:
Slgnature: _
Chapter 9
ING AGENCY: �
ihere is a consiruction lentling agency for
OWNER-BUILDER DECLARATIONS:
ed, I shall not employ eny person In eny m nner so as to become sub�ect to the workers'
I to t e workers' compensation provisions o ectian 3700 of the, cL�ebor Cotle, 1 shall forthwith
_ Data: u���0, /C!'%
PNO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO GVIL FlNES UP TO IXJE HUNDRED
cS AS PROVIDED FOR IN SEGTIIXJ 3lOfi OF THE I�1BOR COOE, INrEREST, AND ATTORNEI"S FEES.
Section 7000) oi Division 3 of t�e Business af+�Professions Code, antl my license is In full
_ Class x ���
_ Date: ,
pertormance of the work for which Ihis pertnit is issued. (Sec. 3097, Civil CodeJ.
Lentlers Address:
Data:
I hereby etfirtn ihat under penalty of per�ury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for t�e following reeson (Sec. 7031.5, Business end Protessions
Code: Any city or counry which requires a permit to consWct, elter, improve, tlemolish, or repeir any strucNre, prior ro its issuence, also requires the epplicaN tor such pertnit
to tlle a signed statement thet he or she Is Ilcensed pureuent to the provlsions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Proteuions Cotle) or thet he or she is exempt t�eretrom and Ihe basis for the elleped exemption. Any Woletion of Section 7031.5 by any epplicant For e pertnil
subJects the epplicant to e civll penelry oi not more Ihen ilve huntlreA dollars ($500)J:
❑ I, as owner oi the properry. or my employees wit� wages as Iheir sola compensation, WILL 00 7HE WORK, and Ihe strucWre is not imendetl or oRered for sale (Sec.
7044, Business and Professions Code: The Gonfractars License Lew does not epply to en owner ot propeny who bulltls or improves ihereon, and who tloes such work
himself or herself or through �is or her own employees, provitled ihat such improvements are not intended or offered for sale. It, however, the builtling or improvement is
sold within one year of completlon, ihe owner-bulider wlll have the burden ot proving Ihat he or she did not build or improve for purpose of sale.).
❑ I, es owner of the property, am E%CLUSIVELV CON7RACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Pmfesslons
Code: The conVectors License Lew does not epply to en owner of properry who builds or Improves Ihereon, end who contracis for such project with e contractor(s)
license pursuant to the Contrectors License LewsJ.
❑ I em eaempt untler sec. Business and Profeuions Coda tor this reason:
SignaWre: Date:
Owner ID veritied by drivers license. ❑ Yes ❑ No Dnvers license Na.
Veriticetion of Ownerehip by (rype of tlocumeN, i.e. - property tau blll or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
Ezpires:
❑ I hereby certify ihat no a:ceva�ion five (5) or more teet In depih Into which e person Is requlred to descend, wlll be matle In connectlon wlth work eu�horized by this
permit, and that no Duiltling slrucNre, sceHolding, felsework, or tlemolition or dismantling Ihereof, will be more t�en thirry-six (36) feel high. (Chap. 32, Gry 2, Atl 2, Sec.
341, Tltle 8, Celitomia Administrative Cotle).
❑ As owner-builtler, I will no� employ anyone to do work which woultl require a permll trom the Division of Intlustrial Safety, as noted ebove, unless such person has a
pertnit to da such work trom the tlivision.
Signature: Date:
Dlvision of Indusinal Sefery Pertnit Number:
CERTIFlCATE OF OMPLIANCE AND AUTFiOR¢AT10N OF ENTRY: 1 certity under penelty ol perjury that I have read t�is application antl state that the Information given is
correct. I agree t comply with all state laws antl city ortlinances �el ting ro building construction, end authonze representatives of the Ciry of Costa Mesa to enter upon the
above-descnb roperry for inspection purp,pses. I agreeyet�to g�iDY or allow occupancy oi any building authodzed by this pertnit until 8nal Inspection.
1616 �/ Fiaed System Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Rooi
201 Finel BIocWReieining Well
202 Final FeCtory Fire Plate
203
204
2418d6
Finel Sign
Final Demolition
.iw_ Fi
' -�[l.✓t�/ �'�a / /�, � f'
�� ate
COpE� INSPELTIONTYVE QSjE �
206 Final Mechanical
20B Final Plumbing �� �
210 Finel Electricel �
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
�
CITY OF COSTA MESA �
BIIILDIN6 p1Y1S10N
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
(714) 754-5273 • Fex (714) 754-4856
Job nddress: 93� W 18TH ST
Suite:
Vicinity: ADM OFCS IN WHSE.
Parcel Nunmber: 42436113
App�icant: HELLER, DENNIS
Address: 7015 N LOGAN
SANTA ANA, CA
Owner. G& H ENTERPRISES
Address- � 931 W 18TH ST,
� COSTA MESA, CA
Contractor:
Address:
FIRE SAFETY FIRST
1015 N LOGAN
SANTA ANA, CA
PIRE SUPRESSION PERMIT
PERMIT
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: O6I0411999
Issued: O6 /2 111 9 9 9
ISSUED BY:
Zoning:
Phone: 714-836-4800
Zip: 92701
Phone:
Zip: 92627
Phone: 774-836-4800
2ip: 92701
License: 599761
SCOPE OF PERMIT
TI FOR BOATSWAIN'S LOCKER TO CONSTRUCT ADM OFCS IN WHSE: 26 FIRE SPRINKLERS.
REF:
/ ' B99-00461.
FEE SUMMARY
Plan Check: $48.59
Permit: $74.75
Other: $0.00
Total: $123.34
Calc Valuation: s3,000.00
Claimed Valuation: ss,000.00
NOTICE: The work authorized by this permit shall comply with ell applicable handicap eccess requiremenis under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically axpire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period o� 180 days.
INSPECTIONS: �In order for the work euthorizetl untler this permit to be considered legal, such work must comply with all epplicable codes, and ell
requlred Inapeetlona end flnal epprovel must be obteined. Failure to obtein inspections and finel approvel will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545628
WORKERS'COMPENSAnON DECLARAnON:
I hereby alfirm under penalry ot perjury one oi Ue followirg tledaretlons:
❑ I heve entl will meintein a certilicate oi consent to selFlnsure tor workers' compensetlon, as providetl far by sec�lon 3700 at Ihe LeDor Code, tor ihe pertortnance of the
wark for which Ihis permit Is issuetl.
,� I have and will mainteln wwkers' compensatlon insurance, as required by section 3700 of the Lebor Cotle, for Ihe peAormance of Ne work far whkh Ihis permit is issued.
My workers' compensatlon Insurance cartier antl policy number are:
Cerrler. ('��� SNIli3,,. Ni��? i.� PolicyNumber. /f//� 6 S%/CS ?.�
(Thls sect/on need not be complefed ll the per it Is ve/ued et one huntlretl tlollers ($100) or less.) ,
❑ I certity that in the peAormence ot the work lar w�ich Ihis permit is issueQ I shell not employ any person In eny menner so es to become su6�ect to Ihe workers'
compensation laws ot Califomia, entl agrae Net it 1 shoultl becoma subject to Iha workere' compensation provisions of Section 3700 of the LeDor Code, I ahall tort�with
comply with these provislons.
Appllcant SlpnaNre: Date:
WARNIN(i: FAILURE TO SECURE WORKERS' OOMVENS4TION COVEMOE IS UMAWFUL AND SMN.L SUBIECT Ml EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED
THOUSAND OOILARE (E100.000), IN AODffION TO THE CQST OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 37080F THE LABOR COOE, INTEREST, MA ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm that I am licensetl under provisions ol Chapter 9(commencing with Sectlon 7000) of Division 3 01 the Business end Professions Cotle, end my license is In full
torce end enea. Lia a 7 G Class a r— /(O
ConirectorsSignaWre: O�iU �—_ Dale: ��.�/�Q9
CONSTRUCTION LENDING AGENCV:
❑ I �ereby aflirtn thet there Is a cnnsiruction lending agenq lor ihe pertortnance oi Ihe work lor which Ihis permit Is issued. (Sec. 3097, Clvil Code).
Lendels Name: Lentlers Address:
Slgnature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettirtn that untler penalry ot perjury Ihai I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for t�e I011owing reason (Sec. 7031.5, Business flntl Protessions
Cade: My dry ar counry which requires a permit to consWM, alter, imprme, demollsh, or repeir eny slrucNre, pdor to ILs Issuance, elso requires ihe eppliwnt for such pertnit
to tile e signed stetement �het ha or she is licensed pursuant to Ihe provlsions of Ne Cqntraciors LJcense Lew (Chapter 9(commencing with Section 7000) of D'Msion 3 of the
Business entl Professions Catle) or thet he or she is exempt t�eretrom end Ihe basis lor the elleped exemption. Any Wolatlon of Section 7031.5 by eny epplicant tor a permit
sub�ects the epplicant to e dvll penelry of not more Nan five hunOretl dWlars ($500).):
❑ I, as owner of the properry, or my employees with wages es their sole compensation, WILL DO 7HE WORK, end the sirucWre Is not intended or oHered tor ule (Sec.
7044, eusiness and Prolessions Cotle: Tha Conirectors License Lew tloes not apply to en owner of propeny w�o bullds or improves thereon, entl who does such work
himsetl or herselt or Ihrough his ar her own emplayees, provided Ihat such improvements ere not intended ar aHeretl for sele. If, however, the bullCing or imprwement is
sold within one year oi completion, ihe owner-builder wlll have �he burden of proving thet he or she tlld not build or Improve tor purpose ot sale.).
❑ I, es ownar ot the property, am EXCLUSIVELY CON7RACTING WITH LICENSED CONTHAC70R5 to construct the project (Sec. 7044, Business entl Professions
Cotle: The cnntraqors License Lew tloes not eppry ro en owner of property who builds or improves ihereon, and who contracts tor such pryed with a comractor(s)
license pursuant ro the Contrectore License Laws.).
� 1 am exempt untler sec. Buslness and Professions Code tor this reason:
Signature: Dete:
Owner ID veAfietl by drivefs Ilcense. ❑ Yes � No Drivefs LJcense No.
Veriilcation ot Ownership by (rype ot document, i.e. - properry ta�c bill or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excevation Ilve (5) or more leet In depth Into which e person is reQulretl to descentl, wlll be mede In connectlon with work authorized by thls
permit, entl that no bulltling siructure, scaXolding, felsework, or tlemolitlon or tlismentling thereol, wlll be more then thirty-siz (38) leet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Tille 8, Celifomia Adminislreilve Cotle).
❑ As owner-builtler, I wlll not employ arryone to do work which wauld require e pertnit Irom the Division of IntlusMel Sefery, es noted ebove, unless such person has a
pertnil lo do 5uch work trom lhe divisbn.
Signature: Date:
Divislon ol Industnel Safery Pertnit Number:
CERTIFlCATE OF COMPLUWCE AND AlliHOROATON OF ENiHV: I cenify under penalty ot per�ury thet I have re9d ihis eppllcation flnU slaie Ihat Ue iniormation given is
correcL I egree to comply with all atate lews and dry orCinences relating to bullding constmction, end authorize representetives ot Iha Ciry oi Caate Mesa m enter upon the
�abave-descrlbed propeny for Inspection purpases. I egree not to occupy or ellow occupenq at eny bullding euthonze0 by ihis pertnit until final Inspection.
Slgpqtur� 91 L§paj Owner(s)
L,L,Eel/(G
And/Or uthorized Applicanl
GOOE I. INSiECTIONTYPE
1876 Flaed System Finel Fire Preventlon
1266
200
201
202
203
Pool Spa Final
Finel RaRool
Finel BIxWRetelnlnq Well
Finel Fectory Fire Place
Finel Sign
204 Final Demolition
rLi:3.y
BAIE U�L$
l•B•A�1 WJ .
0
G/�/s°�
ete
COOE I INSPECTION TYPE
208 Finel Mec�enicel
20B Finel Plumbinp
210 Finel Eleclrlcel
212 Final Fire Preventlon
220 Final Plenning Approvel
222 Final Slte
250 Final Builtling/Occupenry
�
�•%•S�i Ai.�
� CITY OF COSTA MESA �
BIIILDING p1VIS10N
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
(714) 754-5273 • Fa�c (714) 754-4856
dob Address: 931 W 18TH ST
Suite No
Vicinity:
Parcel Number: , 42436113
Applicant: BRADLEY, JAMES
Address: 2311 COCO PALM OR
TUSTIN, CA
Owner. G & H ENTERPRISES
Address: 937 W 18TH ST
COSTA MESA, CA
MECHANICAL PERMIT
Phone: 714-665•2723
Zip: 92780
Phone:
Zip: 92627
contractor: J S BRADLEY CONSTRUCTION
Address: 2311 COCO PALM DR
ArchlEng:
Address:
TUSTIN, CA
Phane: 714-6652723
Zip: 92780
License: 715917
Phone:
Zip:
License:
SCOPE OF PERMIT
1 PACKAGE HEAT PUMP, REF 899-00461. BOATSWAINS LOCKER, INC.
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >100 k BTU
RepairlAlt Cooling/Heat
Inst / Rap. Recess Wall Htr
Refrig Sys <700 k BTU
Re(rig Sys >700 k BTU
Gas Piping
Factory Fireplace
Hood wlMech Exhaust
VAV Box
Vent Fan I Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
AirHandlers> t0000cfm
Floor Furnace
Floor or Suspend Heater
azz.00
50.00
$0.00
so.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.50
80.00
$0.00
50.00
$0.00
$0.00
$0.00
so.00
Quantlty
FEE SUMMARY
PERMIT
77 FAIR DRIVE, COSTA MESA. CA 92626
Status: ISSUED
Applied: OS118/1999
Issued: 0 5/1 911 9 9 9
ISSUED BY: ��.
Repair I Alt Absorbtion Unit
Repair / Alt Refrigaration Unit
Ventillation System
Evaporative Coolar
Commercia l Incine rator
Domestic Incinerator
Co_mpressors / Absorption Systems
Upto3hpl100kBTU
3 To 15 hp I 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp I Over 1,750 B7U
Boilers
Up to 3 hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspedion Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Quantity
ao.00 0
$0.00 0
so.00 0
ao.00 o
ao.00 0
50.00 0
E0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
E0.00 a
so.ao 0
50.00 0
so.00
$0.00
$0.00
531.50
NOTICE: The work aulhorized by this pertnit shall comply with all applicabte handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automaticaily expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be consldered legal, such work must comply with all applicable codes, and ell
requlred Inepeetlons and finel epprovel must be obtalned. Failure to obtain inspections end final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545628
WORKERS'COMPENSAnON DECLAflAnON:
1 �ereby eHirm unEer penelry ot perjury one af Ne tdiowing dedarations:
❑ I �ave entl wlll maintein e cerliticate of congent to selt-Insure tor workers' campensatlon, es Orovldetl for by sectlon 3700 of ihe Lebor Code, lor the peAortnance of ihe
work for w�lcli tliis pertnit is issued.
ve efM wlll malnlaN wwkers' canpensalim Insurence. aq requlred py sectlon 3700 of Ne LSEor Cotle, for Ne peAortnance of Ne work fw whlch ihis permil is issued.
My work�rs�compe� � Insuranm wrtier end polcy number are: � c� CO// G^�/ �/ /�
'Cerder: .L„/A% �:y_ � Poll NumEer. � el / �o
(Thls secf7on need nor be comp�ered u the perm7r /s ve�ueC et one nundree dW�ers (5100) or �ess.)
❑ I certify that in Ihe
compensatlon laws
comply wit� t�ese F
Appllcant Sipneture:
WARNINO:FNLURETO ER
THOUSAND DOl1ARE 1�6,�
ence ol the work t which this �
INomia, end r t I should b
�ions.
/
WORKERS COIAFENSATON COVEMGE
LICENSED CONTHACTORS DEGLARATON:
ed, I shell not employ eny persan in eny manner so es to becnme sub�ect to the workers'
�. to tha workere' compensetlon provlslans of Se tion 3700 of ihe LeDor Coda, I shall fort�wiih
_ oB�e: f / 9
AND SM�115U61ECf AN EMPIOVER TO CRIMI TES AND CNIL FlNES UP TO ONE HUNDRED
ES ilS PROVIDED FIXi IN SECTION 9]OB OF TNE CODE, IMEREST, AND FTTORNEY'S FEES.
I hereby aHirtn Ihet I am Iice sed nder p long oi Ch ter B(co wlth Sectlon 7000) ol DlWsion 3 of t�e Busin nd Professions Cotle, flnA my Ilcense is in tull
force entl eHect. Lk. N Gass #
Contredofs Slgneture: Date:
CONSTRUCTON LEND G AGENCV:
❑ I hereby efllrm thei there is a consWCUon 14ntling egenq for Ihe pedortnence ot the work for which this pertnit Is Issued. (Sec. 3097, Clvll Code).
Lendels Neme: lende(s Addreu:
Slgneture:
OWNER-BUILDER DECLARA710NS:
Data:
I he�eby ettirtn Ihet under penalry of perJury t�at I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe tollowing reeson (Sec. 7031.5, Buslness end Professlons
Code: Any ciry or counry which requires a permit lo conSWct, alter, improve, tlemdish, or repelr any structure, prior to Its issuanca, also requires the epplicant for such permit
to file a signetl stetement ihat he or she is Ikensed pursuant to Ihe provisions of the Conirectore Licensa Lew (Chepter 9(commencing with Sectim 7000) ot D'Mslon 3 of Ne
Buslness and Profeuions Coda) or Nat he or she Is exempt Neretrom end the basis tor the elleged exemptlon. Any violetlon of SecUan 7031.5 by flny eppllcant for e pertnit
sub�ects Ihe applicent to e civii penalry o1 not more lhan flve hunAretl tlWlars (5500).):
❑ I, as owner af the proDeM. or my employe95 wlih wages as their sole compensation, WILL DO THE WORK, end the structure is not intentled or oMereC for sale (Sec.
7044, Busineu entl Professions CoOe: The ContreMors LJcense Lew tloes no� appty to en owner of properry who builds or improves t�ereon, flnd who does such work
himsetl or �erselt or through his or her own employees, provitletl that such improvements ere no1 intended or ottered far sale. If, however, the bullAing or improvement is
sold wlthin one year of completion, ihe ownBrvbuiltler will heve Ihe burden of pmving ihat he or she Aitl not builA or imprrne far purpase ot sele.j.
❑ I, es owner of the properry, am EXCLUSIVELY CONTAACTING WfTli LICENSED CONTF1AC70R5 b consWct t�e pro�ect (Sec. 70ad, Business entl Professions
Code: The contracrors License Lew tloes not eppty to en owner ot pmperry who bulltls or improves Ihereon, and who contracts Por such project wlih a cromractor(s)
license Oursuant to the Contractors License Lews.).
❑ I em exempt under sec. Business end Professlons CoOe for Ihis reeson:
Signature: Date:
Owner ID varllletl by tlrivels license. ❑ Yes ❑ No Drivefs License No.
Veriflcetion of Ownership by (rype oi documem, I.e. - pmpeny tau bill or daed):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMI7 CEpTFICATION:
❑ I hereby certlly thet no excavation live (5) or more teet in Cepih inta which a person Is requlred to descend, wlll be mada In connection with work authorizetl by thls
pertnit, end Nat no 6uiltling strudure, sceflqltlinp, telsework, or tlemolition or dismentling ihereof, wlll be more ihen ihirry-six (36) feet hlph. (C�flp. 32, Gry 2, Art 2, Sec.
341, Tltle B, Celifomla AAMnislreWe Code).
❑ As owner-bulltler, I will not employ enyone to tlo work wMch would requlre e Dermi� trom Ihe D'Mslon ot InOusMal Safery, es notetl ebove, unless such person has e
permit to do such work irom Ihe divlsan.
Slpneture: Date:
DlNslon oi Industdal Selery Pertnit Number.
CER'TIFlCATE OF COMPWWCE AND AUTHOR4ATION OF ENTRY: I certily under penelry ot per�ury that I have read Ihis applicetion end state Ihel the infortnetlon given is I
correct. I ey{ee m compy with all slete laws enq Gry ardinances relating to building constructlon, entl authadze representemes ot the Clry of Costa Mesa to enter upon the
above-tle,5tyibed properry lor inspection purpoye3) I ag{ggnot to occupy or allow occupency of any Dullding euthorized by ihis pertnit until final Inspedlon.
cene �. INSVECTONTYPE '�
1818 Fixed System Flnal Fire Prevention
1268 Pool Spe Final
200 Finel Re-Rooi
201 Finel Block/Relelning Well
202 Pinel Fedory Flre Place �
203 Finel SIBn
204 Finel Demolltion
2sa&46
p9g I[�L5
CODE� INSVECTIONTYPE
208 Finel Mechenical
20B Final Plumbing
210 Finel Elect�icel
212 Final Flre Preventlon
220 Finel Plenning Approvel
222 Flnal Slte
250 , Flnal Bulldinp/Occupanc
� �Su�1.�
u • �
CITY OF COSTA MESA �
BNILDIN6 DIVISION
DEVELOPMENT SERVICES DEPARTMEN7
PERMIT
(774)754-5273 • Fax(714)754-4856
Job Address: 931 W 18TH ST
SWte No
Vicinity:
Parcel Nunmber. 42436113
App�iwnt: BRADLEY, JAMES
Address: 2311 COCO PALM DR
TUSTIN, CA
owner: G 8 H ENTERPRISES
Address 931 W 18TH ST
COSTA MESA, CA
ELECTRICAL PERMIT
Phone: 714-6652723
Zip: 92780
Phone:
Zip: 92627
Contractor. J S BRADLEY CONSTRUCTION
Address: 2311 COCO PALM DR
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Motors to 100hp
Motors over t00hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
TUSTIN, CA
.. Phone:� 714-665-2723
� Zip: 92780
License: 715917
PERMIT
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
ISSUED BY:
Applled: OSI78/1999
Issued: 0511911999
SCOPE OF PERMIT
24 LIGHTS, 35 OUTLETS, 10 SWITCHES, 1 SUBPANEI., REF 699-00461. BOATSWAINS LOCKER,
INC.
$22.00
so.ao
50.00
$0.00
$0.00
$0.00
522.60
529.75
510.00
50.00
$0.00
so.00
$0.00
50.00
50.00
50.00
50.00
50.00
$0.00
50.00
527.25
50.00
$0.00
$D.00
so.00
QuanGty
0
0
0
24
35
10
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
FEE SUMMARY
Temp Dist System I Lighting
Busway N00 ft "
Standing Sedion
Misc Electrical Equipment
Transformers up to 7 kva/kw
................up to 10 kvalkw
.................up to 50 kva/kw
.................up to 100 kvalkw
..................over 100 kvalkw
Low Voltage Equipment
Low Volt Wiring System I Ckt
Misc. Canduit
Misc: Condudor
Circus ( gen or ride)
Circus (mech ride or lights)
ChrisVnas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
�Plan Chack Fee
Reinspection Fee
QuanUty
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
707AL CALCULATED FEES S11'1.6D
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work euthorized by this permit shall comply with all epplicable handicsp eccess requiremenis under Celifomia statutes and related
regutations. (Ord. No. 92-28, § 1, 7247-92}
EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandonad
for a period of 180 deys.
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 Inepectlone entl Ilnel epprovel must be obtained. Failura to obtain inspections end final epproval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545828
WORKERS'COMPENSAnON DECLARAnON:
I heraby eNirm under penalry of perjury one af the tollowing deGarations:
❑ 1 have end wlll meintaln e ceNficate of consent to sett-Insure tor wwkers' compensatlon, as pmWtleA for by �section 3700 ot the Lebor Cade, for the peAormance af the
/ work br whlch this pertnit Is luuetl.
,f� I have entl wI0 meintein workers' compensation insurence, es required Cy secllon 3700 ot the tabor Code, br the peAortnance of t�e wwk for which Nis pertnit is issuetl.
My workers' compensatlon Insurence cartier enO policy number are: 5� C�O/� G� B� L�:/� z
Cartler: V/1�/C%�IQF POIIcyNumber.
(Thrs sectlon need not be completed!! fhe perm/t is valued et one hundred dollers (S 100) or less.) �
❑ I cenity thet In �ha peAarmance al the work for which thls pe y Is issued, I shell nol employ eny person In eny menner so es to hecome sub�ect to Ne workers'
campensatlon lews o1 eltlomla, and egree th f I should b o 4 s ct to ihe workere' compensatlon provlsions oi Sedlon 3700 ot ihe Lebor Code, I shall forihwith
comply wlth Ihese pr sions. `�
AppllcaMSignature: Date: �'_,a�N ��Y� /99 Y
WARNINO: FAILURE TO RE WORKERS' WMPENSFTION COVERAOE IS UN L M10 SMl�LL SUBIECT AN EMPLOVER TO CRIMINPYPENALTIES AND CML FlNES UP TO ONE HUNORED
T/IOUSANDOOLIARE(5 ,000),INFDDfiIONTOTNECO6TOFCOMPEN54TION.UAMAOESASPROVIDEDFORINSECT10N3]OBOFTHELABOROODE.INTEREST,lJAFTfORNEVSFEES.
LICENSED COMRACTORS DECLARATON: �
I hereby eNirm Ihet I em Ilcensedyn rC[� islons of Chepler 9 mmencing wlth Sectlon 7000) of Dlvlslon 3 of the Business epg Protesslons Cade, antl my Iicense is In full
�orce ana ettect. uc. a-7 fl�/ 3��/ L.. /% c�ess a D
Contrectors Slgnature:� T_ Date: Mr�iT�� / f S'9
f> >
0 G
CONSTRUC710N LENDING AGENCY:
❑ I �ereby ettirtn Ihet there is a conslrucGan Iending agency for Ihe peAortnance ot ihe work for which this parmit Is Issued. (Sec. 3097, Clvil Code).
Lontler's Neme:� Lentlers Atltlress:
Signeture: � Date:
OWNER-BUILOER OECLARATIONS:
I hereby flNirm �hat under penfllry ot perJury Ihet I em EXEMPT FROM THE CONTFiACTORS LICENSE LAW for the f011owing reeson (Sec. 7031.5, Busineu entl Prafessions
Code: Any ciry or counTy which requires e permii to consiruct, elter, Improve, demolish, or repeir eny s�ruclure, prior to Its iuuence, elso requires the epplicant for such permit
to tlle e signed stetemen� ihet he or she Is licensetl pursuant to the provisions of Ihe Contrectors License Lew (Chepter 9(commencing with SecUon 7000) of Division 3 of t�e
Business and Professions Code) ar t�at he or she Is exempt Iherefrom antl the besis tor the allegetl exemptlon. Any vloletion o1 Sectlon 7037.5 by eny epplicent for e pertnit
sub�ects the epplicent lo e ciWl penalry of not more t�en tive huntlretl tlollere ($500).):
❑ I, es owner of t�e properry, or my employees wiN wages es thelr sole campensetlon, WILL DO THE WORK, antl t�e structure Is not IntentleA or oNered for sale (Sac.
7044, Business end Protessions Cotle: The Contractors LJcense Lew does not eppry to en owner ot property who bulids ar imprwes Uereon, end who does suc� work
himself or harself or through his or her own employees, O�ded lhat such improvements are not intentleA or oflered for sflle. If, however, the buildlnp ar improvement is
sold within one year of completion, t�e ownerbuiltler will have the burden of proving Ihat he or she dld nat build or improve tor purpose af sale.).
❑ I, as owner ot t�e O�operty. am E%CLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS ro construq Ihe prolect (Sec. 7044, Buslness entl Pmtessions
Cotla: The coniredors License Lew tloes not eppty to an owner of property who bullds or improves thereon, and who conirects for such projecl with a contractor(s)
license pursuent to Ihe Contrectors License Lews.).
� I am eaempt untler sec. Business and Prolesslons Code for this reeson:
Slgneture: Dete:
Owner ID verified by tlrlvers license. ❑ Yes ❑ No Drivers LJcense No. Explres:
Veritication ol Ownership by (rype ot document, i.e. - v�operry tex bili or dae�:
DIVISION OF INDUS7RIAL SAFETV PERMR CER7IFICATION:
❑ I hereby certliy ihat no excavatlan Ilve (5) or more teet In CeOj� ���a whlch e person Is requlred to descend, will 6e mede in connectlon wlth work euthorizetl by thls
pertnit, entl t�at no building siructure, acaHolding, telsework, or demolltlon or Oismantling t�ereof, wlll be more then Ihlrty-six (38) feal �igh. (Chflp. 32, Gry 2, Art 2. Sec.
341. Title 8, Celilomla Atlministrelive Cade).
❑ As owner-builder, I will not employ enyone to do work which would requlre a pertnit irom the Divislon of InGusirlel Safety, es noted ebove, unless such person �as e
pertnit to do such work Irom the diNsion.
Signeture:
Didslon oi Industdel Sefery Pertnit Numbor.
2
Date:
AFiDOUS MATERIALS AND EMISSIONS CERTIFICATION:
W III the eppllcant or present or tuture buIlCing xwpent neeE to f le antl certiy a Buslness Plan for emergency response to releese or threatened release at a hezerdous
matedal7 ❑ Ves ❑ No
(Section 25505 ot the Celifomia Health end Sefery Code requires, with some axceplions, Ihe� e Business Plan be filed with Ihe Coste Mese Fire Department Gy every
business which has et eny one tlme tludnp a reported yeer e Quentlry of hazarAous matedels equal to or greeter than e welght o1500 pountls, or e volume of 55 gellons,
or 200 cubic leet oi compressed ges at slenaard temperature antl pressure).
Does or will Ihe eppliwnt or presenl or tuiure building occupent need to file e reqlstration form lor ecutely hezerdous materlals7 ❑ Yes ❑ No
one tlmezhes oo hend ellq e�mlHBof� acu ety ha ardous m ledfllsB e uapto or �Beeter$thanlsereWie1nh It�h'th� aste Mesa Fire Department Dy each business which et eny
compressed pes et stendard tempereWre end pressure). � 9 8 pountls, or a volume of 55 gellons, or 200 wbic teei o1
Does or wlll the epD���ent or present or tuture building occupant neetl to prepare an RMPP (Risk Menepement end Preventlon Progrem for ewtety hazerdous meterials)7
❑ Yes ❑ No
l oi the Califomla Health end Sefery CoCe proNdes that t�e Coste Mese Fire Department may i
an RMPP by 6usinesses which ere required to register ecutely hezardous materiels with Ihe Fire
B fln RMPP Is presently require4 has Section 25534 oi tne celfromla Heaim ena Setery coae oeem m�y compne
Does or wlll Ihe epplicam or present or tuNre building ocwpent require lor the wOrk which I5 the suD�ect of Ihis
tmm the South Coest Nr Oualiry Mflnagemem Dlsirki or trom eny other air pollutlon control distdct or agency7
(Section 65850.2 of the Califomia Gwemment Code requires that tha requesteO Informatlan be tumished on ep�
W ill any part of tha teciliry to be constructetl under Ihls permlt be within 7000 leet iram Ihe outer boundeAea ot e
Qf yes', the taclliry must meet ihe reQulrement oi Sectlons 25534 and 42303 ot lha Call}omla Health ena Setey
Sauth Coast Air
01 the disdasures
the preparetlrn, certifiration and fling wlth ihe Fire
ment.
i ❑ ves ❑ No
;81100 B EBfR11i 10! SUCh COf19INtlIOn 0! RIOf1111C81i00
s �J No
ns tor non-residential building pertniLt).
I1 ❑ Yes ❑ No
or egency is reqwrea tor me v
en made? ❑ Ves ❑ No
(If yes', anech certlticate oi canpliance trom ihe appropnate elr polution conirol ofticer).
CERTIFICATE OF COMPLIANCE: I certiy that untler penalty ot perjury Ne inlortnatlon given ebove is correct I agree to comply with flll stete laws entl ciry ordinances
regerding Harardous Meterials end Emissions.
Signature: ' Date:
CERTIFICATE OF COMPLIANCE AND AU1'HORIZA710N OF EMAY: 1 cenify under penalry of perjury that I have raed this applicelion end state that tha information given is
correct. I egree m wmply wlth ell stete lews and dry ordlnences relatlng to builtlinp construction, entl au�hodze represantetives o1 the Clry of Costa Mese to enter upon Ihe
ebove-descdbed property tor inspectlon purposes. I�ree �to xwpy or ellow occupancy ol eny building eu�hodzetl by IhLs pertnit unlll linal inspectlon.
COGE t. INSVECTIONTYPE
16t6 Flxed System Finel Fire Preventlon
1266 Pool Spe Final
200 Finel Re-ROot
201 Finel Block/Retalning Well
202 Finel Fectory Fire Place
203 Finel Slpn
204 Finel Demolitlon .
266&A6
�::
/ �::
Q� � �j INSPECTIONTYVE
206 Finel Mechenlcel
208
z�o
212
220
222
250
Flnel Plumhing
Final ElectAwl
Flnal Fire Prevention
Flnel Plenning Approval .
Finel Site
Finel BulltlingiOccupanry
PAIE It�SH
J-i3.99
e �
t� � ':
. ��
(714) 754-5273 • Fax (714) 754-0856
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicank
Address:
931 W 18TH ST
42436113
BRADLEY,KAMES
2311 COCCO PALM DR
TUSTIN, CA
CITY OF COSTA MESA -
BUILDING DIV/SION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
ELECTRICAL PERMIT
Phone: (714)665-2723
Zip: 92780
Owner:��G & HENTERPRISES �
Address, j931 W 18TH ST���. � -
" /� , Phone:
- �-COSTA MESA; CA Zip: 92627
i, �
Contractor. J S BRADLEY CONSTRUCTION
Address: 2311 COCO PALM DR
�
.ISSUE FEE
�Temp service test
Res. alc paCkage
New�Res (1-2 units)
New Res (3+unit5)
Pool I Spa �.
Lighting Fixts
Recept Outlets "
Switches
Non Res Appl
Res Appl ,
Service to 200a
Service to t000a�
Service over 1000a
Motors to 1hp
Motors to 10hp
Motors ro SOhp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Rvr Pole
Intermetl Pole
TUSTIN, CA .
Phone: 714-665-2723
2ip: 92780
License: 715917
PERMIT
77 FAIR DRIVE, CI�iSTA MESA, CA 92626
status: ISSUED
Applied: O6128/1999
Issued: O612811999
ISSUED BY: C� �
SCOPE OF PERMIT
1 200 AMP METER AND RELOCATE 2 SINKS FOR BOATSWAINS LOCKER TI. REF:B99-00461.
$6.50
$0.00
50.00
$0.00 ,
$0.00
$0.00
$0.00
$D.00
$0.00
$0.00
$0.00
$27.25
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$O.OD
Quantity
FEE SUMMARY
Temp Dist System / Lightirtg
Busway/100fl
Standing Section
Misc Electrical Equipment
Transformers up to t kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kvalkw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring Syslem / Ckt
Misa Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
50.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
50.00
$0.00
50.00
$0.00
i07AL CALCULATED FEES 533.75
COMMENTS I SPECIAL CONDITIONS
�
NOTICE: Tha work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period o( 180 deys.
INSPECTIONS: In order for the work authorized undar this pertnit to be considered legel, such work must comply with all eppAcable codes, and ell
requlred Inapeetlone end finel epprovel must be obteined. Failure to obtein inspec�ions and finel epproval will result in the expiralion of this permit.
FOR INSPECTIONB CALL: (774) 7545626
WORKERS'COMPENSAnON OECLARAnON:
I here�y ettirm under penalry ol Der�ury ane of the lollowing aederetlans;
❑ I heve and will maintein e ceNticete of consent to selt-Insure lor workers' compensation, es provided for by section 3700 at the Lebor Code, tor Ihe peAormance of Ihe
work tor whiU ihis pertnit is Issuetl.
�f eva end will malntain workers' compensetlon Insu�anca, es requiretl by sectlon 3700 ot the Le6or Cotle, for Ne peAortnance at Ne wwk br whiG� thig pertnit I5 Issuetl'
� My workers' campensation Insurence carrler and policy number ere: , �
Ca�der:
(m!s sectlon
❑ I certlty that in tha pe rmance of the work far w
compensatlon iaws o alilamia, end agree if I
comply with these p i0ns. �
Applicant Signature:
WARNIN(3: FNLURE T RE WORKERS' WMPENSATION (
THOUSANDOOILFR 00,000),INADOfTIONTOTHECO$TOF
LICENSED CON7RACTORS DECLARATON:
I hereby attirtn Ihat I am
torce antl eHect. Lic. k_
Contractors SlpnaNre:_
CONS7RUCTON LENDING AGENCY:
Policy Number.
(5100) orless.)
'I shell not employ eny Oereon In eny menner ao es to become subject to t�e workers'
Ihe workere' wmpensatlon provisions of Section 3700 of t�e Lebor Cotle, I ahell forihwith
? oa,a: ;� �„iF z 8/ S 9,S
) SHALL SUBJECT PN EMPLOYER TO CRIMINAL PENFLTIES AND qNL FW ES UP TO ONE HIINDRED
1$ PROVIDED WR IN SECfIIXJ 3]Ofi OF THE LABOR OOOE, INTEREST, AND ATTORNEYS FEES.
of Chapb r 9(commenGng wit� Section 7000) of Divlsion 3 of the Busine$6@nd Pmfessions Code, antl my license is In tull
Class M t�
Date: ' �J.t/EL i/f$�
❑ I hereby eflirm Ihat t�ere is e consWctlon lending epenq br ihe pertormence oi �he work lor which Ihis permlt Is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lentlefs Atldress:
Signeture: _
OWNER-BUILDER DECLARATONS:
Date:
I hereby eHirm that untler penalry ol per�ury �hai l em E%EMPT FROM 7HE CONTHACTOHS LICENSE LAW lar the following reeson (Sec. 7031.5, Business end Professions
Code: Any ciry or county which requires a permit to construd, elter, improve, demolish, or repelr any strucWre, prior to Its issuflnce, alsa requlres Ne epplicant for such permlt
lo fila a slgnetl statemeN thet he or s�e Is Iicensed pursuent to the provlslans of Ihe Coniradors License Lew (C�apter 9(commendng wlt� Sectlon 7000) of Divislon 3 of the
Busineu an0 Protessions Cotle) or Nat he or she is exampt ihereirom entl Ne besis for the ellegetl evemptlon. Any violation ot Seclion 7037.5 Dy eny applicent tor e permit
sub�ects the applicant to e civil penalry of not more Ihan five huntlretl tlollars (5500).):
❑ I, es owner of the properry, or my employees with wages es their sole compensatlon, WILL DO THE WORK, antl Ne sWCNre Is not IntetWetl or oRered for sele (Sec.
7044, Business end Professians Cada: The Contrectors Llcense Lew does not apply to en owner of properry who builtls or improves ihereon, and who does such work
himself or herself or through his or her awn employees, provided that such improvements ere not Intentled or oflered tor sale. N, �owever, Ihe building or improvement is
sold within one year oi completlon, ihe owner-builder will have the burtlen oF proving that ha or she ditl not build or improve tor purpose of saleJ.
❑ I, es owner oi the pmperry, am EACLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to wnsiruct t�e proJect (Sec. 7044, Business antl Professlons
Cade: The contracrors License Law tloes not apPh �o an owner of property who builtls or Impmves Iherean, antl who cnNrects for such project with e contrector(s)
license pursuant to the Contractors License Lews.).
❑ I em exempt under sec. Business end Professions Cotle for ihis reeson:
Signeture: Data:
Owner ID verified by tlriveYs Iicense. ❑ Ves ❑ No Drivels License No.
Veriticepon of Ownershi0 by (rype oi document, I.e. • pmperry tex biil or deed):
Erpires:
OIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certlly thet no ezcevatim fiva (5) or more feet In depth Into which a person is reQulred to descentl, will ba made In COnnectlon wlih work euthorizetl by IMs
pertnil, entl ihat no Eulltling slrucWre, 5caflolding, lalsework, or tlemolitlon or tlismantling thereoi, wlll he more Ihen thirty-sls (38) leet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celltomia Atlministrative Code).
❑ As owner-Duiltler, I will not eqploy enyone to do work which woultl require e permit from tha Division of Inaustrlal Safery, es notetl aDove, unleu such person hes e
permit to do such work from ihe division.
Slgneture: Date:
DlWsion af Indusirial Safery Pertnil Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certily under penelty ot per�ury �hal I heve resd thls epplication end state that �he informetion given is
wrrect. I aylee to wmply with all state lews end cily ortllnen es releting to Guilding constructlon, entl authodze representatives of iho City ot Costa Mesa to emer upon Iha
aDove-Oe�tdbed property for inspecllon purposes. Ip�ee�o occupy or allow occupanq ot eny bullding euthotlzetl by this pertntl until flnel Inspection.
SODE �, INSPECTIONiYVE
7616 Fixed System Finel Fre Prevention
1266 Pod Spa Final
200 Final Re-Roof
201 FIneI BIacWRetelning Wall
202 Finel Feqory Fire Plece .
203 Final Sign
204 Finel Demolition
24a&e8
�7�1�
0
V�ELS
vr✓�L�}`e/S95'
oa
CODE I INSPECTION TYVE
208 Flnel Mec�anital
20B Flnal Plumbing
270 Finel Eleciricel
212 Finel Fire Prevention
220 Flnel Plenning Approval
222 Finel Sita
250 Finel Builtling/Occupancy
�
���i'�i'�
�
9
u
�''_ _.
Applicant to fill in all
cl-"oF COS7A mESa CONST.RUC�ION PERMIT
- a3i � s ig -r
P"roject Address �
ApplicanYs Mailin Address .
�Owner's Name v,y.� Phone
Addreu 9 3 � �'-1 � p—` � � �
Arch/Eng. License No. �
Address .M.t , e�
Contractor's NamP�'� .}ii��il ��,��e Phone�.3E23
Address (mailing) �,,,'�%�g ���.��� �
. City License No. _ � �'�� (
(.ICENSED CONTRACTOR DECtARATiON �
1 nereby attirm tnat I am Iicensqtl untler provislons of Charter 9(commencln9 �
with section �000) �f �Ivlslon 3 of the Business antl Professions Cotle, antl
my Ilcense is in full force antl effecL .
LicenSe Class ��� � LicenSef}p �0 � 3�O
Dale�g-,��-- 5' t S`il ��
WORKEHS'COMPENSATION DECLARATION '
1 her¢by aflirm lhat I have a cerqticate ot consent to selt-Insure or a certlflcate
f Workers' Compensation InsUrance, or�a cor[ifietl copy.tnereot (Sectlon,
300, Lab. C.�j,.��� I�j,� � i �+�
�olicy No. �l� t� Company��'rF T�.�
� C� rtifiea copy is hereby turnlshea. �
�je✓�ertitietl copy 5 f' tl with I4e city B'. ' Divisiqn. Y/�1__i�
Date 7�i}�� Applicant 7 �� "�� ,
EXEMPTION FROM WORKER$• COMPENSATION DECLARATION
(Thissection need not be complgtetl if,the permit is for one huntlretl (5300) or
less).
I c2rtity that in [he petfo�mance of the wo�k to� which Ihis pe�m�t i5 iSSueQ I
shall not omploy any p¢rsOn Ip: any manner so as to become Subject t0 the
Workers' Compensatlon �aws of CaliforNa.
�ate Signatwe
'NOTICE: If,-after making this tleclara[ion, you shoultl be<ome subject to the
Workers' Compensation provislons ot the.LabOr Cotle, you must torthwltn
comply with such provlslons or tltls permit shall be tleemetl� revok¢tl.
CONSTRUCTION LENDING AGENCV '
1 nereby aifirm lhat there is'a construction lentlin9 a9ency tor the�performante
of tho work fOr which �this permlt i5 iSSueC (SettiOn. 3097 Civ. CJ
Lentler's -Name �
Lentler'sAtltlress —� _ - —
OWNER�BUILDEROECLARA710N '
� I hereby a(fi�m that I am exempt irom"the Contrac[o�'S LiG¢nse Law f0� Ihe
i followin9 reason (Section 7031,5 Bu5lness antl Professional Cotle: Any clty or
county whlcn requires a permit po �onsVuct, alter, improve, tlemollsh or repalr
any-st�utture, prlo� to Itz issuance; also requlre5 the apPliCant (or Such perMi[
to fi�e a si9netl statement that ne/she is licenzetl pursuant to the provisions of
the Contractor'S License�taw (Chapter 9(mmrtiencin9 wlth Sectlon ]000) of
Division 3 ot the Business antl Professions Cotle) or that he/she is exemp[
therefwm antl the basis for [he allegetl exemptlon. Ahy v101aflon ot $ection
'031.5 by any ,applicant tOr a permlt subjects Ihe applicant to a civil
enalty ot not mor¢ than five nUntlred Oollars (E500�. '
J I, as owner Of tne proper(y o� my ¢mployees wllh wa9¢s as their sole
' compensation, will tlo the work, antl the structure is not intendetl or offeretl
for sale (Section 7044, Business .antl Professional' Cotle: The Contrac[or's
Lic¢nse Law tloes not apply t0 an own¢r of a prope�ty who bulltl5 O/ Imp�ove5
th¢reon, antl who a0es such work hiTselt/herself or through hI5 0� her own
employees, provitletl that such improvements ara not intentl¢tl or oifered for
sale. If, however, the buil01n9 or improvement is soltl within one year ot com-
pl¢tion, the owner wlll hav¢ the burtlen Ot provin9 he/she tlitl not builtl Or im-
prOve fotthe purpose of sale). ,. '
❑ I, as own¢� ot the'property, am ezclusiv¢ly contiactin9 with IlCensetl Con-
tractors to construct the project (Sec[ion ]044, Busin¢ss antl Protesslons Cotle:
Tho Contractor's License Law does m[ appty to an owner of properry who
builtls or improves thereon, aqtl wno contracts ror sucn projects witn a con-
tractor(s} Iicense pursuant�to the Contractor•i License Lawj. I am zware [nat
proof ot thelr WorkeYs Compensatlon insurance shoultl be provitletl to me.
❑ I am exempt untler Section B. &,P. C. tor this reason,
Da[e Owqer
I hereby certliy that I have r¢atl this aoPlication antl state that the above
�in�^;mation is correct. I agree to comply with all city antl county ortlinances�
'� ' itate laws relaHng to builqipq constructlon, antl hereby au[horize repre-�
� tives of this c ty to enter on the above-mentlonetl property for,
•tlon pur s
' I�e v t � Date% 7�
� ��' L' se or 55 � ���`�
encevt those within neavy eoraer Iines anG sign a1l aoVrovriate eeclaratians.
_ TRACT NO. LOT NO. � UNIT NO. .
v c.«i �..� „-/
TYPEOFCONSTRUCTION NEW ADD ALTERATION
❑ CONVERSION. ❑ DEMOLISH ❑'OTHER
DESCRIPTION OF WORK/USE OF BLDG. �
TYPE OF PERMIT LI GRADING L.J FOUNDATION � LJ STRUCTURAL
❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ;
❑ OTHER
PNOJECT DESCRIPTION S4.F7. oCCUVANcv—
CON STRUCTION TVPE VALUATION $ �
ZONE GRADINGCV.VDS. ACRES—
Remarks: �
Back(low Preventer
Backflow Irrigation
Bathtubs
Clarifiers '
Dishevdsher
Drinking Fountains
Floo� �ra'ins
Floor Sinks -�
Gas Service
Interceptors
Kitchen Sink �
Lavatories '
P-Trap .
Roof Drains .
Showeri
' Service Sink -
Sewer Cap
' Sewer Connection
Solar Collectors
� Solar Piping
Solar Tank
. Swimming Pool w/Spa
Urinal
Outlets �� Water Cloret
� Water Heater -
Water Service �
� �Auto-Wash�
FEES
0
4.P. #
S Main Buildir
E
T Front
e Fear
A
C Right '
K Left
S'
Ping. Ref. #
Planning Notes:
Auromatic Washer
Construction Pole Su6..
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
�' Fan
F.A.U. , �
' - - Fixtures
- Device Boxes
' ' OuHets
� 1 . Switches
� Garbage.Disposal
" Generator �65 KW �5-15
$15 I I_ Issue Fee ��• I $ 3
Duct - Under Ground
Duct 'Structural
Duct - Ventilating
Exhaun System ❑ Multiple
Firepl/Fact.8lt. ICBO #
Heating System & Ducting�
❑6100,OOOBTU �100,000
0
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration Syrtem
❑0-700,OOOBTU ❑100,OOOBTU
System Repair/Alteration
Fire Dampe'rs '
Registers
0
II Reinspection Fee I $15 I I. ' laua Fae � I $ 3
icen
6, r0v. ]0/84 Whito • BUIltling; Canary - App���nt; Pink - ACCounting: GOItl¢nrOtl - AsSesso�
, 7583' :J/25/85 �.
i
ZonB
�Accessory Building:
''
Parking Req./Provided
0
ELECTRICAL '
Transformer �❑ 15-50 KW
❑ 50+KW
Meter LNop to 700 amp
Meter ❑over100amps
Sub Panel
MotorsG�O-1.HPO7'h-8 �
Inc. Sotar �9-75 HP �i6-15+
Microwave' " ,
Pole Light �
Sign
; Standing Sections
Trash Compacmr
' � Reinspection'Fee ' � �$75 � � luue
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By '
8uilding APP�a"ed By �
Aooliration Isued Hv
FEES
$ 3
. SUMMARV OF FEES � � 1
BUILDING PERMIT� $ . SMIP $
PLAN CHECK $. � PERMIT
PLUMBING ' � $• ' ISSUANCE $ �
PLAN CHECK 25% $ �' ENERGV P.C. $
ELECTRICAL $ i.� GRADING $
PLAN CHECK 50% $ ; MICROFILM $ ^�
MECHANICAL $ � TOTAL FEE $, r' S�
PLANCHECK 25% $, � , , '
Z
O
N
1
N
G
R
E
Q
M
T
$
� CONSTRUCTION AND PLANNING
�APPROVALS Permit # Date Inspector
� �
1. Temporary Electrical Service or Pole
•2. Soil Pipe=Undrgrnd. .
-� 3. Electrical Conduit�Utility-Undrgr'nd.
' 4.� Electrical Conduit-Undrgrnd. �
1
� 5. Steel Reinforcement �
6. Electrical UFER Grnd.
7 �Footirigs � -� ' � �
8. Foundation '
9.� Water Pipe-Undrgrndi , �
10. Structural Floor�System . �.�
11. Property Sewer'Line & House Connection
12. Sewer CaP ••
� .
13. floof Drains • �'�
i
14. Rough Plumbing � �
15. Rough Electrical�Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign ,
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough.Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing L
26. T-Bar Ceilj�,q (Structural) & Monocoat
27. Frame and Flashing '
28. Lathing & Siding ,
29. Insulation. �
30. Drywall Nailing
31. Plaster Brown Coat �
�32. Electrical Power Meter-Final
33. Finat Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �.
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation '
44. ,Landscape Irrigation System
45. Sound Attenuation
�46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Date
�
�
�
^ I r
VOOL A
APPROVALS , Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding �
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Finat .
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final .
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product Piping OGas ❑Oil
72. Underground Flush -
73. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical �
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
Date � Inspector
PXOJELT RDONESS: 9 3 1 W 1 6 TH ST
owxen s xamc: BOATSWAINS LOCKER
nooeess: SAME
AflLHIENGINEEH:
FOONESS:
flEG.NO.:
uxir: B
UNIT:
PENMITTEE: FIRE STOP f 714 ) 569-0016
aooness: 1253 S. WRIGHT 0
SANTA ANA CA 92705
UCENSEU CONTRPL70P OECUqp7lON: I nereoy allirm Inal I am IicenseA unaer o�ovisions ol Cnaoler 9(commencing with Section
70001 0� Oivison J ol I�e Business antl Pmi¢ssions Code. an0 my lic¢nse is in �ull lorce anG et�eci.
ciTr uc.:04 2116 $TRTE LIC.�O I 4 S 9 cuss:C_ ��_��%
Oate: � �-='�--,_9-Z_ 519naW�e: �r►_/'��f�(G��
WOPNEBS' COMPENSRTION UECIpqqTION: I nereoy allirm tliat I have a cenilicate ot consent to ulf-inwre ar a ceniticate of Workers'
Comoensation Insurance, or a ttpiliea caoY �here0l �Seciqn 3800. La�. CI.
roucrno.:pWC182643 F%P.OATE:OS/SSI93
cornraxv:GOLDEN EAG�E
� Cenified copy is here6y lurnis�ed. CertifieC mpy is lilee vnih tAe city BuilAing Diwso -
Oate: 7 �i �3 �� ��'� _ /
AppliwnL _z G�^—
E%EMP�ION FflOM WOPKEflS' COMpFN5RTI0N OELUMTION: �Tt� secwn neeG mI 0e cmiqete0 tl Uc V�� a ia ane hunEreE (5700) o� less�.
I[ertify lhal in Ihe pertormance ai t0e work (or w�ich (N5 perrttit is issued. i ShaN nOt employ any permn in any manrttt so az to Oecmne
su0ject to ine worker5' CAmpen$a�ion Laws of Calibrnu.
Date: Siqnamrt:
NOTICE: II, after makinp t�is Oeclaration, you SMuld Oecome subl�� �o t�e Workers' Compensation Dmvisians of the Lahor
CoOe. you musl IorlMvi�� cOmply wii� suc� pmvisions at IN5 Oe�mit Shdtl �e tleemed fevoke0.
CONSTBUCTION LENOING RGENCY: I �ere�y at�irm Ihal �here is a canSiruCtion IenCinp agency lor Ihe DedOrmanCe o� the work fOr
wnicn Ihis Oermn is issued (Section 3097, Civ. C�.
LENOEfl:
AOUNESS:
OWNEfl BUILUEfl OELUIUTION: I �ereby aHirm ItWi 1 am exemp� IrOm I�e fAnirattor5' Siate �iceme Law lor t�e lollowinp r¢asan
(S¢[tian 7031.5 Bu5ine55 anU Pt01¢55bnal Catle: Any tily 0� COunry wtikh rBpUirts a p¢rmii �a conSVUCi, alleL imDmv¢, 4em01i5R or
repair any SlmcWre. prior Io ils lssuance, also rtpuire5 i�e a00���ant for such p¢rmii lo lile a 5iqneA slatemenl IM1at hdshe is licensetl
Ipursuanl�o Ihe pmvisions oli�e Coniractors'$taie License Law�C�ap1er91�ommencinB ��n $ec�ion 7000)0l Division 3 oil�e Business
ana Pmtessio�s CoOe) ort�at np�s�e is exempll�erelmm anG l�e Easa lor t�e alleAcO eKemO�ian. Any Nolalion ol Seciion 7031.5 Uy
any a00���ant lor a permil suUjetls t�e aDD��nt to a civil p¢ndlry al not more ttWn live Aundretl Oollars (5500�.
I. as ownei ol ine propeny ar my employees wi�� wages as iheir sole compensatian, will Uo tAe waA. ana I�e
I❑ stmaure is iwt imenJetl ar ollereU for ute (Seciion 70aa. Business anu Pralessional Cotle: T�e Camracmrs' State Licenu Law
aoes nol aoDN �o an owqer of a o�aGeny wlq Oui1G5 or imo�%'es OlertOn, ana wM Oces such wOrk tlim5ell/her5¢II or ihmupn
N5 or �er own ¢mDloy¢t5. proviUeO llul Sut� �mprovemenis are n01 ip�en0¢0 or Ol�ere0 br sal0. II, M1owever I�e �uilUinq ar
impmvemenl is sola wilhin one year ol Complelion, t�e b+mer vn0 �ave tAe UurOen ol pmvinp �e/s�e Gi� not UuilO or impmve
loi ine pmoose of satel.
I, as owner ol I�e pmpeqy, am e�tlusively comraclinp wilh IicenseA con�racmrs lo cons�ruq Ihe D�olect (Seciion 7044, Business
❑ ana Pmfessions Cotle: The Cantracmri State License Law Uoes noi aDPN lo an ownerol prapeny wAa builGs or imD�oves ihereon
ana w�o conVatlS lor SUCA 0�%et6 wilA a tomnCl0r�5�limn5! pur5uanl �a �h! COnlratlOrS' Slaie Litense Law�. I am aware
�hat prool ol I�eir Wark¢�'S Compen5ati0n insuran[e 5hou10 Oe �mndptl �o me.
� I am ¢remp� unde� Seclion: B. 8 P. t.
lor inis reason:
oaic: �e�
I eo neie0y ceniry Inat I am aware o1 an0 un0erstand ine repuirtments ol Califarnia Healtn and Safety Cotle Sections 2550.5, 25533, anU
255� antl Ihal lor any IUWr¢ Guitding ouupanlwilVwill nol�[ircle one�nee0 to [omply wi�� 5ai0 Slate coAes anU Ihe requiremCn�s lora
permit lar constmciion or mo4Aicalion Iwm Ihe Aii Oualily Managemeni Oisiricl. flesiGential cons�mction aDDlica�ions are eKempl Irom
111¢SC D�OVISi0115.
Oale: ApOtiwnt:
I hereDy cenilyi�al I �ave read Uis application and 51ale��ali�e a�m'einforma�ion 6 correci.lagree Io compty wiih aA ci�y and counly
o�amances an0 sta�e lawt relaung io OuilOi(g rnnsiruction aM hereby aumonze re0re5� ol this ciry Ip nter upo above-menlione0
prOpetly �or in5peqmn purD�seS.
Da�e: Z �� � Signamre: T -
�river's Lkense ar Saci;l Secunly +: �
164L<6 WhM1e—Building; Gr@en—CaEe Enlarcement: Canary—Apd��C Pink—Revenue: GoWemoa—Rssessor
CITY OF COSTA MESA — BUILAING PERMIT
PERMIT NO: F 060884 PLAN CHECK NO: 00319-93 S
PERM NO; F 060B84
GOVT: N SUPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE; FIR PURPOSE; OTH
JOB DESCRIPTION ; BACKFLOW RETROFIT SQ FT;
CLAIM VALUE; 6,200.00 CALC—VALUE: GROUP OCC: B-2 /
*�****�*i�*+Nt��***�****�*****��*+Ft�**��w****��*��******��r*�r*��*****�r�r****��*�r**� �e
Z O N I N GS ERTEBQAUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL; 42436113 ZNE: REF NO;
PLANNING NdT'ES>
>
iElF k �F 3f i! k fE 1f if �F if iE k iliF �E if 3k iF 1E if if iF 1E 1EiE iE iF iE iF if if !E i! 1E iF ib if k 1k if 1f if 3F iF iE k iE iflE �7! iElk iF f! iE iE iF 1F iE �F �E �E iE 1! �F iF 1F 1k iF iE iF iE iE �E iE 1k if
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
20NING APPROVED BY DATE;
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: OL. DATE: �— �
iEiFiEiEltitiEifififitlEitiEklEiE�FkiFitik iEkiEiFiF1EiE�E�Fif iEif
1EiFklfjFkkk�klfilltiEkiflliFlkiklFiFkiFiFititiEifilifkikikkafiFiFklkiEiE�E !likifififlfiFiFikifikikififffififfkiEiliEiEiE1F�l�kiElijEiEilifiFkkif
LEGALIZATION;N F E E S U M M A R Y STAUCTURAL SEGMENT;N
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT ` 90.00
65i SMIP/NON—RES
PLAN 58.50
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 90.00 0.00 58.50 148.50 148,50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 90.00 OVER/SHORT; .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
90,00
it 1t 1Eif ik iFiE iF iF iE k iF iE ik iF i! iF 1Fitlf if iE kiF 1E iF iE itlt iE ikiflf iF if �� ik iE iFk 1F ik iF iE�1klF if if ikit iE iE �lEif if iE IE iE fFiE iFlE iE iE iF �1klt iE �f �E 9f iFiF iE 1f ik iFfE iE
I N D I V I D U A L F E E B R E A A D O W N
TYPE QTY D E S C R I P T I O N UNST COST TOTAL COST
FIR 90 FIRE EQUIP FEE (FROM BLDG VAL TAHLE) f.00 90.00
END OF FEES
1
�1
��
L�
i
�. ��
�n:._
CONSTRUCTION AND PLANNtNG'
APPROVAIS Permit #�y_
1. Temporary Electrical5ervica gr Pole
2. Soii Pipe-Undrgrnd. �"
')
3. Electrical Conduit Utdrty•Undrgrrtd.-
d. Electrical Condwt-Undrgrnd.
5. Steel ReinforcemeFlt .
S. Electrical UFER C'irnd. ,
.7. Footings �
8, Foundation � '
9. Water Pipe�Undrqrnd. t �
10. Structural Floor System ,
11 , Property Sewer Line & HousE Connection
13. Roof Drains . `• .
14. Rough Piumbing 1
15. Rough Eleciriwl-Conduit ,
16. Rough Electric Wiring
17. Rou9h 4Virinq Sign
18. Rough Electrical-T Bar Ceihng
19. ROugh Heating & A�r CondiLoning
r
20.'Rough Factory Fireplace '
21. Ducts, in Structure •� �
22. Duttf, VGntilatinq '
23. Gas Pipe•Rough & 7est • �
�
24. Roof framing • . � -' .
25. Root Sheathing �
26. T�Bar Ceiling (Strufturall & Monocoat
27. Frame and Flashi�g ,
28. Lathing & Siding �
29. Insulativn . •
30. Drywall �laihng .
31. Plaster Brown Coat
.32. Electrical Power Meter-Final
33,'Final Electric . •
a
34: �Final Heating & Air CoAdititlning�
35. Final Gas Pipe�Tese '
36. Hood or Canopy " -
37. Finai Fattory Fireplace '
38.-Final Plumbing �
39.'WaiBr Service-fin�f' �
40. Gas Service-final
41. Soiar pomestic-Final
42. Backfiow Preventet
43. Backftow Irrigation .
44. Landscape Irrigatio� System �
45. Sound Atcenuation �
46. Handicap Regulations
47. FINAL STRUCTURE & BUI�DING
48: fINAL PLANNING
• 49. Electric Releese to Edison
60. Gas Release to Southern California Gas Ct
51. CERTtFICA7E OF OCCUPANCY
No. Date
Dace
7
�
c
0
POO� & SPA
Inspector AppROVAIS Permit #
52. Pool & Equipment locat(on
53. Steel Reinforcement
54. Forms
55. Electrical8onding
56. Rough Plumbing & Pressure Test
57. APPROVFlL TO COVER-GUNITE
56. Electrical Gonduit�Undrgmd.
59. Gas PipC, l7 Undrgrnd., Test
60. Backwash Lines, P�Trap, � Undrgrnd.
61. APPROV/i� TO DECK
62. Backwash $� Receptor�Final
63. Heater & Ven[-Final
64. Plumbing System - Pmal
65. Electrical•Final
66. Solar SYstem-Fi�al
67. Fencing & Access Approval
68. APPROVED f0R PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIflE DEPT. REQU�REMENT
, APPROVALS ' Permit # �
'70. Undergr�und Hydro
71. Product Fipip9 O Gas OOiI
"' � 72. Undergrbund Flush ��
� . 73. Undergrnd. Storaa+�.Tank O Gas � Oii
74. Overhead Hydro
75. Dry Chemicai - '
76. Dry Standpipe
� 77. FIXE� SYSTEM f INAL .
��•- 76. FIRE PREV. FINAL �,.
T1'
r HEALTH DEP7, REQUIREMENT
_L
79. FINA� INSPECTION
� � 80. FOOD CERTIFfCATE ISSUED
� 1 Notes: . �
� � .
0
a
Date � Inspector
. . 1 .' ••-• AGD�icanl to flll in all spaces within neavy bortler lines antl sign a11 aooropriate declantions. _J „ �
\
�CTY CIF� COSTA�MESA � ' �,P�q-iTNp.,�-�� � . jqor No.-, BLDG. NO. - ,� �]�;, 9/ I �i/B2 i JI .21 � �
-rCUN$T.RUCTION �ERMIT C�• `f� - G ��'of � ; .. ,r . , . . , .
- roject Address � _ 'f TYPE OF CONSTRUCTIO � � , _ _ -~ . , ... � . ' - . .
Ownef �'e� �71 S< rPhOn Y• "10� �❑ NEW ❑ ADO ALTERATION � ' ' - " - ' ' - . •
�Addre �<T R�� ` Wtf \� ❑ REPAIR ❑ CONVERSION ❑DEMOLISH � ZO ING REGULATIONS � � � �
f ArCh/Eng, , Q- N - LicenSe No. O�� � OTHER -� �� � �
� DESCRIPTION OF WORK A'P' � � � '
� Addresz �' - -L Q� _ ,
Conc.aceaCS�Gi�.� r: SG..'Ci rnd� y4��14 ,- -- .- �zoNe _. v�rvc., ev.�t .
� TVPE OF PERMIT � TpBUiL piNG�
�, Addf255 ' ' , � - �SETBACK ST. PROPERTV-LINE
7y \' 4 , S. . O GRADING� /' O-FOUNDATION' �STRU,�C,�TyRAL - 1 VARO ,
LICENSED CONTRAC OR DECL'ARATION ' � �O TENANT-IiGELECTRICAC� �LUMBING-L7MECHANICA 5�p y - - �1 �� - �
' 'I hereby affirm th:.t I am IlcenseE untler provislons of Charter 9(com-, � . � i . . RIGHT
`mencing - wlth zectlom �7000) -o� DINSion -3� �of lhe Buslness� antl� ' D�OTHER � - ' • - _
Professlons Cotle, . my Iitense is in full torce antl effecL �� � REAR YARD�(TO P/L) -'
f���(�� � �,.PR0.IECT�DESCRIPTION�. _� ,
Llce Clasi � tens�jn1�.p..c�v.ZJ_ , ,,�: � ` � � - PKG.SPACEREq. � � PROVIDED
� ,Date�� \ �c � 'S79 t f� . .., �f����%.., � � 54. FT. � � . ' ' ' ' .�• ' ' _ . ' .
W6RKER5' COMPENSATION� CLAR I � �OCCVPANCV ONSTRUCTION TVPE ���� i STREET WIDTFI - PARK FEE §
\�I'hereby aftirm that I have a erpflwte of consent [o self-insure or a . VALUATIO ZONE �ZONING APPROVED'BV "DATE' '' 2'
certiflWte o( Worken' Compeniation Ins�W nce, o� a certitie0� copy - -_- ._ ._ _ .. .
` �[hGreof (Seg p�jgd���). 5 GRADING CU: � � - � ACRE$ SPECIAL CONDITIONS: ��� � � � � �
;;cy'No. Company �7� D - ' h
t
_>;ert(tietl.copy is hereby turniSheC. . . _ REMARK$ ' ' ' ' �
" " '.' ' ' _ .-- .�. :. ' + � .
.., ' .. . : . � , . _ . _ ' ' " '
'`�CerUfietl copy is tiletl with the city Builtling Division. ' � '' �' r �. O' �
EXEMPTION� FROM WORKERS'-COMPENSATION DECCARATION - • " ' f � : ' -' '-- � � '- - - �
(This section neetl.not be completetl if the permit.is tor one huntlretl - v -1 • -� � ��.� •
(E300) or lezi). ' . _ ,� . _" _s .�O ' .�. � _ ' _ " ._ ' " ' " .
I certify tha[ in the.performance of the work for which [his peimit is . __
Issuetl, 1 shall no[ employ-any person in�any manner so as to become -PCUMBING� - — •.PLAN CHECK' " ' i -`- - - �ECECTRICAL` ' - " ' PLAN CHECK "- � ' ' - �
subject.tolhe WorkerSLCompensation l.aws of Califomia. _ � ' ' '
k]ate � Si9nature � BATHTUBS � � SHOWERS -- �� � 't ""' ' - ' - -' - '
NOTICE: If at[er makin9 this tleclaration, you sM1ou10 become�sub�ect � TOILETSp ,z^VRINALS" ' 0'�GENERATOR -""0-1 KW_ 1-IO,KW - - �
to [he Workers' Coenpensation provisions of the Labor COEe, you muzt - �� ' �TRANSFORMER � !
torthwith comply wilh SUCh provisions or this pe�mit shall be tleemetl LAVATORIE$ DOUBIE'LAVS' - -"- -' �� APPCIANCE-- -10=50 KW_50 *�KW - ' '
revOk¢tl. _." _ _ . ' " ' ' ' .. . ,.. ' , _
- - ' - ' -" ' -KIT.SINKS'"- - DISHWASHERS "�' '- 'MOTORS -
CONSTRUCTION LENDING AGENCV -'0-1 HP=1"-30 HP 'i
I hereby atfirm that [here is a conztrucUon lentling agency for tbe per SERV ICE SINKS �• �� }q5UMP5 .- --�'�' -" :UNC..SOIAR)-_10-SO�HP_- 50 + HP1 � �� 1
tormance of the wOrk tor whith th15 p¢rmit IS ISSuetl (5¢Clion 3097
Clv. C:): ' '- " t'/• w' " "- ' ' ' --- _ �FLOOR SINKS� � � _� FLOOR DRAINS - --- - '}FIXTURES' -OUTCET SWITCHES '3'
Lenaer's'Name �r �"� - '
�'�� ` -�� � `� � � � -� ' �DRINKING FOUNTAINS'- � - ' "�' -' ' � ' ' 'GAS'TUBE SIGNS - - - - - ' � - ' � � - �
Lentler's Atltlress 1
_ .i .
OWNER BUILDER DECIARATION • -- ' r- ' - ' " , ' INTERCEPTORS . � �� � � � `� i 'POCE'L"IGHTS "" - �- - � ' -' - - - - ��
� �.CLARIFIERS
I hereby affirm Ihat.l am ezempt trom.thB,Contrac[oCs License Law tor � . � : � .�„ „
_tho tollowing�reason (Section-]031.5 Businesi�antl Piofes5lonzCotle: +SWIMMING'POOL„� '' PTRAP" "'"' ' "� '^ '-� {pOLES� METERED �SUB
Any'eity or Coun[y which reqvire5 a permit f0_Conz[ruct, alter, -
Improve,�tlemolish or repairtany scructure,�prior to its i55uante; also.re-� yyqTER SERVICE ` ' " (1LTERATION - ' �'- -' �PANELS' ' -' -'MAIN ' 'SVB � ' '
qWr¢Si�ne'a.p.liWn[ 10� Such.Oermit to fil¢ a•siqnetl,s[ateTe� t.[ha[ tte �- � - . '
irlicensed pursuant'to�tfie proWzlons-of the-Cootractor'i Llceuse LaW _�GAS SERVICE,y � j^ OVT�ETS „ ySERVICE' - - ""'-' ' ' '•- - qMP' -" - - '
(Chapter 9(commencing wi[h SecHon ]000) of �ivlsion 3 of the �
Business antl-Prolessions-Cotle) or that he is exempt therefrom antl [h¢= � yyqTER HEATERS � BTU-OUTPUT "'- "'' ' -' """" - - ""-"` '- - ' - - '
';?yis for the allegetl exemption. Any violation of 5ectlon ]031.5 by t ' '
�-applifvnt for a permit sub�ects-the applicant-to-a•tiviPpenalty� �SEWERCONNECTIONS'" - � .�'". 'P- -" ' " ' -""- -'��• -" - - - ^" ' - - - � �
���`aot more than (ive huntlretl tlollars (E500). -� � ' � �
n . .. 1
' ,., ____ ._ . __ . _ .. _ _ _._ af." «._.____". � _.:�.. .
�J`I, as owner oi' me o�operty,-or my employees witn wages as theii- SOLAR'TANK"'- "" -' COLLECTORS�-= _ i -- - —� �-- ��—
Sole compensation, will tlo the work, antl the sVucture is not intentletl ' ` ' � '"
{i � .
__ " _ "_ __ ' '_'" _' _"�_ . ' �
or oft¢retl for sale. (Sectlon 7044, BuSinesS antl Profe55iOn5 Code: The SOLAR PIPING $Y5. �, ' ' '�' - ISSUE FEE "" ' '� ' ' - ' ' " ' � �
Contraclor's License Ldw Coes not appty t0 an own</ o( a property '- '
who bWltls or imOroves fhereon, antl who Coes such work himself or ISSUE FEE - � -` D`APPLICATION'APPROVED BV" - DATE9 �6 'fi
�h�ough.hi5 Own employees„provitletl that such improvements are nol
Intentletl br ofleretl for sale. If, however', Ihe-builtling or ImO�ovement MECHANICAL PLAN CHECK � � � � � �� ��
is soltl within one year, ot compleNan, the owner will have the burtlen .. � SUMMARY OF FEES -• � p
of pruving he tlitl not builtl or improve for [he purpose of sale). - . ' BUILDIN " -- - '�-i
HEATING SVSTEM 0-300,000 BTU �0 � 0 PERMIT 5 �
❑�-I, as-owner--of the- ro ert am axclusivel .contra<tin .witb_ . _ . . . . _ � •'SMIP.�-: .. E
IlcenSetl COn[ractors to const ucl t�he projBtt ($ection 7044, Buslnes5 AND DUCTING 100,000 � BTU C� ''. . � I
� antl Professions-Cotle: Tne�ConGac[or's Li<Bnse�Law AOGs not appty to � � �PLAN CHECK �PERMIT � ._
O ISSUFNCE- 5-�
dn owner of properly who builtls or improves Ihereon, antl who wn- REFRIGERATION 0-100,000 BTU �PLUMBING E � �� ,. .
tracts from-such projecls with a-conUactor(s����licesnoa pursuant [o - SVSTEM - �� - - - - - ----- _ .`GRADING `�S '
tne Conlractor's LicenSe Law). 300,000�+ BTU �'� �!PLAN�CHECK E�jTj"I ' , y '
O'I am exempl untler Sedtion' - B. & P. G. for this gOILERS BTV �.ELECTRICA� ' y�� �r 4j�" ' a. , �
reason - - - - - ' . MICROFILM E�
SVSTEMREPAIR,ALTERATION PLAN'CHECK-'E' . �
Daln. Owner � � %�%� � ' TOTAL FEE S'
I hereby terH/ylhat 1 have reatl this application antl State that the abov¢ EXHAUST $VSTEM MULTIVLE �MECHANICAL -S =/{J-Q ,"
Informabon is correct. 1 agree to comply with all <itY antl county �PL'AN CHECK § - VANCE PC 'S _ -
ottllnances antl tate laws �¢lating to constructlon, antl hereby authorize i� 4 � � r��, ,L. ,_� �.,
represen[ati of' this -city' n[er 'upon-"the 'above mep tionpE ' -
prOperty r nspe �' gur � /1.fi J � � � '��3� \�� ���'� FINALFEE
�J//q /b
519nature I�/i��L! D e1L' . .v� � ... , . _ . . _ . . .. . •
Driver5' S� � - - ISSVEFEE - - -' '��" - � [ . __ . . ._ .. / /•�
[
CMP 0865-46 White-Builtlin9: ��ary-Applicant; Pink-Accounting; Goltlenrotl-A55es5o�
_ --� f - - . . . �
CONSTRUCTION AND�PLANMIN� �L Y � � � � � POOL & SPA- � •�- ' • �;, _ y~
APPROVALS Permit #� Date , Inspector qppROVALS Permit # Date . • Inspector ;*�
1. Temporary Electrical Service or Pole - � 43. Pool & Equipment Location
Soi . ipe•Undrgrn - 4 . Steel Reinforcement - -- - � �
3. Electrical Conduit Utility:Undrgm � 45. Forms - - - ' " - �
4. .Electrical.ConduirUndrgrq _ ' ' - 46. Electrical Boriding . � - ' �
. tee em orce . - ' 47. Rough Plumbin & Pressure Test �
6. Electrical UFER Gm - 48. APPROVALTO COVER-GUNITE�- � -
7. ootings - pti .L j 49. Electrical Conduit-Undr rn � � '
� _ 8. Foundation__ . ' 50.,, �Gas Pipe, ❑ Undr Pn, Test � ' ' � • � ' � � -
9. Water Pipe-Undrgm � 51. 8ackwash Lines P-Tre ❑ ndr m "- -� �
� 10. _Structural Floor System . • -�� ' � 52�. •APPfiOVALTO DECK �� ' ' � - �
,-11:. Property.Sewer_Line & House Connectiori�__ "53: Backwash & Rece tor-Final ' '
12.. .Street Sewer Connection _ . _..: ''' "'_-' �' ' ' - . 54. '�Heater & Vent-Final� • •7 - . ' � :
13. Rough Plumbing '� 6Z � � �
14. Rough Electrio-Conduit - - - - - � �56. Electrical-Final� � � � r.�.
15. Rough Electric-Wiring �- -� o �/ � - � 57. Solar System-Final � -
16. Rough Heating & Air Conditioning� - - _ � _ � encing & Access Approval
17. Ducts in Structure � � APPROVED FOR PLASTERING'
- 18. Ducts, Ventilating. _ . � _ . , _
19. Gas Pipe-Rough & Test � . 60. POOUSPA SYSTEMS FINAL
20. Roof Framing � - - ' j � � � �
� 21. Roof Sheathin � � / � � •
22: -Frame and Flashin (/0-7� _ NOTES: ' ,
'23. • Insulation� . . . • " - , -
C_
• 24. Lathing & Siding - - - - - -- -
� 25. Drywall Nailing - ' =�1-5�- �-_ -� a '�S � a
26: Plaster Brown Coat _ '-' � - -" " . S oCCc.c ,a� c. (3, �
• 27' Electrical Power MeterFinal ' i� _ - p� � .
28. Final Electric - _ o � � �
29. �Final Heating & Air Conditioning - �
30. Final Gas Rpe-Test /�• 8'Yi- • �
31. . Final Plumbing -�-� - - � � '
32. � Water Service-Final - - �
� 33. Gas.Service-Final� �
' 34. '� Solar pomesticFinal � " ' ' �
' 35. • landsca e S rinklin S stem ' ' � �
36. Sound Attenuation � � ' � ' �
37. Handicap Regulations ' • � ' • � � �
36. FINALSTRUCTURE&BUILDING ' �(. . 2 - �
� 39. Special �Requirements Completed � - -
' 40. Electric Release to Edison �-
41. Gas Release to Southern Califo'rnia Gas Co.
42. CERTIFICATE OF OCCUPANCY �-�/�
. � ' No � - �-� 7�i Oate od /98 `/ • �, �t�
in
.CITY�F2j��TAaVIESA PERMIT-1
-'.CONS�TRUCTIONPERMIT /1'�
Addless
eoreer Ilnas antl sign all appropriata tleclantion
TRACT NO. LOT NO. �BLDG. NO.
�l. 18th Sti'02t TVPE OF CONSTRUCTION
Phon ❑NEW �ADD ❑aLTERATION'
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
L'ICenSe No. ❑ OTHER
� DESCRIPTION OF WORK�
BBOU (0/06/82
,.708�� %8%1 �Hlll�
, � , — -
c:onvaccor rnone - TYPE OF PERMIT" ": , �
Address q�rq j�o�t�t.�L_�aru �C - ❑GRADING ❑-FOUNDATION ❑STRUCTVRAL
LICENSED CONTRACTOR DECLARATION -' � � 7ENANT ❑ ELECYRICAL ❑PIVMBING '�MECHANI
I, hereby atfirm tnat I am Ilcanse0 untlar'provl5lons of Cbarlar 9(com- .
menN�9 `��th uctlon ]000) of O�viSion 3 of the Business 3ntl ❑ OTHER
Proteszfons Cotle, antl my ncense -Is tn'�tull � force ana estect. pROJEC7 DESCRIPTION' ��
LICen58Q s5 —�Uc 60��.1o.�.R(13— ' - ' ' � � � �
Date 519�ature 5�. FT. . . , . .
WORKE 5 COMPENSATIONDECL ATION OCCVPANCV_CONSTRUCTIONTVGE
1 her6by attlrm that 1 have a tertifl te o/ mn5ent t self-insure or.a VALUATION ZONE
C¢rtifiUte o/ Worker5' CompenSaHOn InSUranta, o� a Gertitietl COPY - -
tnere0f'(Section 3800, Lab. CJ. ." GRAOING CU. VOS. ACRES
7olicy Nq��I�PIDanY. -
�' ^»rt���e�1 toPY is hereby fumishetl. ' �REMARKS:' � - , . . -
.ptitieC copy iz filatl With the N[y Builtling DivisiOn � - .
_MPTION FROMFWORKERS' COMPENSATION. DECLARATION — � "
(This 5ection neetl not be completed if the permit is for one huntlred - �
(51001 or �ess). ' -- - � � � Y permit is �
I<ertifY tnai In the pe�fo�mante ot the work to� whiCh thi5
i55UeA. � Shdll nOt ¢mplOy dny person in any rnanne� so as,to b¢WTe PLLIMBIN(�i "'PLAN CHECK
SuDjed to the Workers' Compensatb� Laws of Calltomta. - .
Date Si9�ature �� � -' BATHTUBS- - SFIOWERS��-
NOTICE: It after making thiz tleclaratlon, you shoultl become sub7e<t TOILETS . URINALS �' '
to the `/�a�ktr5' Compen5dtlon prOviS�OnS of tne Labor Cotle, you must �
torthwith comply with such provislons or [his Permit shail ba tleemea �-.4VATORIES DOUBLE'LAVS '
ievok8d. y _ -
CONSTRUCTION LENDING AGENCV '' - ' ' ' KIT. SINKS DISHWASHERS '
I. herebY a(firm that t�ere Is a<onstrucNon lantling agen<Y �or the per- SERVICE SINKS SUMPS " '" '
torma��G of th! wOrk bt which Ihis pGrmit I5 Issuetl (SettlOn 3097
Civ. C.). . , . _ - . �- FLOOR SINKS ' -' ' 'FLOOR DRAINS �
Lender's Name
LenCer's AtltlraS ' ' - ' DRINKING FOVNTAINS" - " ' ' " "'
OWN6R BUILDER DECLARATION INTERCEPTORS - CLARIFIERS
I hereDY affirm tnat I am exempi irom the Contractor•s LlCenu Law for -
the tollowing reason (5ectlon 7031.5 Buslness antl Professlons Cotle:_ SWIMMING POOL -P TRAP" "
Any [ity or'coun[y which requlres a permlt to conztrutt, al[er,
improve, tlemolish or �epah any strutture, prbr to its issuance, also re- yyp7ER'SERV ICE " .' ALTERATION ' � �
quires �he'aDP����t�foF such permit to (ile a signed statement that be
is IICePseO purzuant to the provi5ions of the Co�tractor's LitenSe-Law � GAS SERV ICE� - OUTLETS�
B sinessrantl�Prdnion�s Cotlehoslhat hel�e�emrt�therefromantlthe -
I P -WATER HEATERS' BTU OVTPUT--- l� � 4,
Oasis-for tite alle9etl exemPtion. Any violaBon of 5ection �031.5 Oy
anv apP����t tor a cermit subjects the applicant.to a civil penafty SEWERCONNECTfONS- ' " ' '
� if more Ihan five fiuntlreE Collars (5500). '
'as owner of the property,.or mv.employees�wiih wa9e5 as•t�eir SOLAR TANK - -'COCLECTOR5 .
�� COTp¢n5atio�, w��l tlo the wo�k, antl ihe stru<ture is not intentletl
o��otfC/e0 fo� SdIE. (S2CIlOf1 %044� BIISI0055 antl AOfes5io05 CoderThe ' SOLAR PIPING SVS. � � -' '
Cont�dctor'S L!c¢nse Law tloez not dPPly to an owner of a property .
who buptl5 or irti0/ovas-the�aon,-an6 who tlOeS Suc� woik h{mzeti o� ISSUE FEE � �- .
t��oug� M1I5 Own ¢mpl0yeG5, provltleE thdt sucn improverttent5 are no[
intGntletl o� o/te�GE to�-sal¢. I�, howeveq the bUiltling or improvement
is soltl �+�Ihin one year Ot completioh, [he Own¢r will have lhe burtle�
ot p�0���9 h¢ ditl not bulltl-or IMP�ove to� lhe�purposG oi salt�.
❑ I, as owner o( the property, am exclusively <onVacting with
Iicensetl contractort to mnztrutt the proiett �Section-7044, Businees
antl Rofasions fA�e: T�e Contrattor'S Licanse Law tloes not apply to
an Ow�er of proPe�ty wh0 buI105 0� Improvl5 [hereOn, a�tl who CD�-
tracts Irom wch pro�ects with a contractor(s) Iiceinetl pursuant to
[he Co��ractorY'License Law). '
❑• 1 aT GxGTpt untlef $CCtIOn B. S P. C. lor thi5
r¢amn _
Date Owner
i��erebY�artNytM1al I �ave reatl ihis appliwtion antl state tbat the
informatlon.ii mrr¢Ct. I egree to_comply wlth all Ury antl �
o�tlinaPt¢s antl s[dte laws re�alinq to canstruGtion, antl hereby aut
reoresantatives at this ci[y to enter upon the above rpen
MECHANICAL PLAN CH �
HEATING SVSTEM 0-300,000 BT
AN�OUCTING -' 100,000+BTU.
REFRIGERATION 0-300,000 BTU_
$VSTEM • 300,000 + BTV _
BOIlERS �rn/Esso�T � 3
SVSTEM REPAIR,ALTERATION
EXHAUST SvSTEM MULTIPLE
SlgnatU�e � j.�ate I
Driver5' li se 55 � .�—. }� � ISSUE.FEE
CMF 0865-46 White-Builtling; Unary-Applicant; Pink-Accounting; Goltlenrotl-Aszeszor
0
A.P. �
ZONE
REAR YqR� (TO P/L�
PKG.SPACE REQ.
STREET WIDTH
20NING APPROVED B\
SPECIAL CONDITIONS:
ELECTRICAL
� ��5��� Y�-
� • . .
PLNTGp. gRUEF: yp� Nv . '
7ROPE�RTV LINE
PROVIDEO '�
PARK FEE E
� OATE ,
..+ _
�L�
PLAN CHECK
GENERATOR 0�1 I(W_1-30 KW �
TRANSFORMER �
APGLIANCE 10-SOKW_SO+KW_
MOTORS 0-1 HP�1-10 HP _
(IN0.50CAR) 10�50HP_SO+HP�
FIXTGRES OUTLETS SWITCHES
POLE IIGHTS
PANELS
SERVICE
SUB
0
A?PUCATION FPPRpVEO BY v� DATE�(j,t,'�
. �
SUMMARV OF FEES ' . ..
BUILDING - , � - . "
PERMIT S SMIP ' S '
PLAN CHECK § PERMIT
ISSVANCE S�
PLUMBING E GRAOING E �
PLAN CHECK S '
ELECTR�CAL S S
PLANCHECK S__�y�� MICROFILM E
MECHANICAL E�e.'�_ TOTAL FEE E
�PLAN CHECK $ " LE55 AO- ' -
VANCEPC S�-
FINALFEE S ��
a4 _ •
CONSTRUCTION AND PLANNING . POOL & SPA � ' • • • ' � �
� j OrJ� Date � Inspector ' - . � �� '� Date Inspector
APPROVALS . Permit # APPROVALS ._ Permit �# _ .
1. Temporary Electrical Service or Pole ��•' - 43. Pool & Equipment Location � � - �
, . il ipe-Undrgm - 4. Steel Reinforcement �
3. Electrical Conduit Utility-Und�grn . ' 45. Forms ' � '
4. Electrical Conduit-Undrgrn 46. Electrical Bonding . ' '
. tee em orce '� � 47. Rough Plumbin & Pressure Test
'� 6.-- Electrical UFER Grn � ' ' � 48. ,APPROVALTO COVER=GUNITE � � ' • -
7. ootings ' - 49. Electrical Conduit-Undr rn ' ' � • � -
� '8. Foundation � � � 50. Gas Pipe, ❑ Undr rn, Test � � �
9. Water Pipe-Undrgrn � 51. Backwash Lines P-Tra ❑ ndr rn �
10. . Structurel Floor SYstem ' 52. APPROVALTO DECK y ' '
�11. Property Sewei Line & House Connection � ' � 53. Backwash & Rece tor-Final � �
12. Street Sewer Connection • � - • 54. Heater & Vent-Final
�13. Rough Plumbing � �
14. Rough Electrio-Conduit -�+' ' . ��56' E�ectrical-Final
15r- Rough Electric-Wiring � - • • 57. Solar System-Final � - � .
� 16. Rough Heating & Air Conditioning F1 • encing & Access Approval �
17. Ducts in Structure ' ' APPROVED FOR PLASTERING
76. Ducts, Ventilating � � - �- -
19. Gas Pipe-Rough & Test ' 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing ' ' � � -
21. Roof Sheathin � �
22. Frame and Flashin - NOTES:. - � � � � • ,
23. Insulation � � - - - -
24. lathing & Siding ' ' - � ' � � �., ,.
25. Drywall Nailing ' - - " - �
26. . Plaster Brown Coat ' - " � '
27. Electrical Power Meter-Final ' � ' � � '
28. Pinal Electric� � � �
�29. Final Heating & Air Conditioning / P1 - � �
30. , Final Gas Pipe-Test .
�31. Final Plumbing
32. Water Service-Final �
'33. Gas Service-Final ' �
34. Solar pomestic-Final �
35. Landsca e S rinklin S stem '
36. _ Sound Attenuation - �
37. Handicap Regulations �
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed ' ' �
40. Electric Release to Edison - �
41. Gas Release to Southern California Gas Co. � ' � �
42. CERTIFICATE OF OCCUPANCY �_ _ . ' � � `
, .. r.
No Date , _ , , _. . _ _ _
� � Applieant lo fill in all spaces within �eavy DorOer lines antl sign all aOPropriate Eeclarations
' GTV OF COSTA MESA PE�IT N.�� TRACT NO. lLOT NO. BLOG. NO.
CONSTRUCTION PERMIT 5
Projecx Address ,/ TVPE OF CONSTRUCTION
Own2� �Phone Z jyp ❑ NEW ' � ADD �ALTERATION
�� Add�est ' �'^'j.�. ' ❑ REPAIfl ❑ CONVERSION ❑DEMOLISH
,� Arch/Eng. � - License No. ❑ OTHER '
I� AAdrMs - , . . DESCRIPTIONOFWORK
I�y �wmracmr p-lc.s r�� �/.c_i%T�sc. �^rs+:rum�c /,� i-i.r..,_ TYPE OF PERMIT '�
�a Atldr¢55 Z Z E�� G•}4'T �P��`/�F DEC.. K�'� ' O GRADING ❑ FOUNDATION- ❑ STRUCTUFAL
I� GCENSEO CONTRACTOR OECLARA N. .- ..' ❑-TENANT �ELECTRICAL OPLVMBING. ❑MECHAI
1 hereby af�lrm tRat 1 am IlcenSeC unOel provislons o( Charte/ 9(com-
mencing witn settion 7000) � of Dlvislon 3 of tha Business antl ❑ OTHER
Professlons Cotle an0 my Iicense is in tull force anA eltect. pROJECT DESCRIPTION
Ucense CI s ' G '� � � ucease �� ZS/ , ' � � �
Date //�i i 5'gn t �,.�� "n'� �. , � 54. FT. : ' . .
WpqKERS' COMPENSATION DECLARATVION� � . � OCCUPANCY_�CONSTRUCTION TVPE
I �erCby affirm that 1 have a certiticate ot consent to selHnsure or a VA�UATION ZONE
mrtlfifate of Workers' ComOensation InsuranCe, or a� rortifietl cuDY - � � �• .
t�--oof (Sectlon 3800, Ub. C.). �� GI�„�� CRADING CU: VDS. � ACRES .
i No. ComPanY / P'n�-•-•
�erUHecl <opy It hereby turnishetl. , _ NEMA(tKS: . . _ . . -
,Certifle0 copy I5 flletl wl[h tha city Buil0ing Dlvislon.
EXEMPTION FROM WORK@RS• COMPENSATION DECLARATION '
(This secTiOn need.not Oe completetl �f the permlt_is !or one huntlr¢tl _ _, � - _ _ , , �
(E300) or lessj. .
f tartify l�al In lhe performance ot lhe work for whlCh this petmit Is
issuetl, P iball"not employ anyporson in any mSnner so as'fo betome PWMBING P�AN CHECK
subject to the Workers• ComVensatlon Laws o( Californla. '
Date Si9nature BA7HTUB5 SHOWERS ` '
NOTICE: If after makin9 this tlaclaration, yoU 5houltl become subjeGt .TOIIETS .;. .-URINALS '- - ' '
t0 tll¢ Work¢rs' COTpCnSdtlon plOvlsiOnS o� [he ldbor COtl¢, you mUSt
fOrthwlth comp�Y �'ft� su<� provlsions or tnis permit snall Ge rleemea LAVATORIES DOVBLE LAVS ' '
�avoketl. , - . . _ _ . ,
CONSTRUCTION LENDING AGENGV . " � KIT: SINKS ' ' OISFIWASHERS
I hereby affirm tnat there I5 a consVuttion IentlMg agency for tbe per- SERVICE SINKS ''•�SUMPS ' ' '
formanCe ot the work for which thi5 permi[ is Issuetl (Sectlon 309]
Clv. C.). � � " � - � ' ' ' FLOOR S�NKS �� FLOOR ORAINS �
�entler's Name
' �.entler'S Atltlress � � � DRINKING FOUNTAINS ' - �
OWNER BUILDER OECLARATION - '' WTHRCEPTORS � CLARIFIERS -
Phereby aftum that 1 amezempt trom the Co�tra<tor's Li<ense Law for
the (ollowin9 reason (Section�7031.5 Business a�a ProfeSslonS Coee: SWIMMING POOI.' PTRHP '
Anv citv or coun[v whi<0 �eUUires d pe�mit t0 cOnztruc[, alt¢4
d5
of
lollars
Of my
a
�.hat he WATER SERV ICE
ise law GASSERVICE -
Of [he
antline WqTER HEATERS
31.5 by
penalty' ' SEWER GONNECTIONS
ALTERATION � �
OUTl.ETS
COLLECTORS
TONE
REAR YARD (TO
PKG. SPACE REQ.
STf1EET WIOTH
SPEdA� CONDITI
ELECTRICAL- �
0258 ll/DJ7G2 : 5a0� TL�
PLNGp. gR�EJF. � -
�ROPE�RTY LINE �
PROVIDEp ' '
PARK FEE E � -
- .DATE
cnni�n p.iKW_1-lOKW�
TRPNSFORMER - .
APPLIANCE 30•SOKW�_SO+KWy
MOTORS � � p-1 HP�_3-30 HP -
'(INC, SOLARj 30-50 HP_ 50 + HP �
FIXTURES " OVTLETS SWITCIiES
GAS TUBE SIGNS � � _
POLE GGHTS ' ' - ,
PqNELS - " MAIN SUB. "' "
SERVICE - ' '• - � ' - � AMP
or otferetl fOr sale. (Section 7044, �Business antl RofeiSions Cotle: The SOLAR PIPING SVS. ' � ' , i55UE FEE � - •- y
Contractor's License Law does not aDPb �o an owner Oi a property � qPPLICATION I�PPROV ED BV '
who builtls'or improves thereon, antl who tloes suth work himself or ISSUE FEE � � � -- . �ATE
through �is own emplaYees, proNtletl that such improvements are not -
IntentleC or otferetl for sa1e. I(, nowever, the bull0ing or improvement' MECHANICAL PLAN CNECK �� �
is soltl with(n one year of completton, the owner will havo tne bartlen � . SUMMARY OF FEES-.. .,
ot Orovin9 he tlltl not buila or ImV�ove tor the purpose of Sale). HEATIfYG SYSTEM 0-300.000 BTU BUILDiNG �• .
❑ I, as owner of the proPerty,�am �exclusively conVatting witb qND DUCTING -• .. PERMIT S SMIP- S _
Iicensetl confractore ro construct the prole<t (Section 7044, 6usiness 300,000 r BTV PLAN CHECK E PERMIT �' -
and Professions Cotle: The Contractor'S Lltense Law tloes not apply to ISSUANCE..S
an owner o( proPerty who builtls or improves t�er¢on, an0 who con- REFRIGERATION 0-100.000 BTU PLVM8ING E
VacK irom sucb pro�ects with a tontractor(5) Iicesneq PursuaM to SYSTEM � -� � GRADWG y
the Contractor's License Law). 100,000 + gTV PLAN CFIECK $� . .
� 1 am exempt untler Section ' B. & P. C. tor [hiz gO1LER5 BTU, ELECTRICAL �S � ' ' - 5 • ,
r4a5on ' P�AN CNECK E MICROFILM §
SYSTEM REPAIR,ALTERATION
Date� Owner � TOTAL FEE y
I Oereby cer[ifythal I have reatl this application anC state that [he above EXHAVST SVSTEM MVLTIPLE MECHANIGAL 8 LE55 AO- '
information is correcL 1 agree to comply with all city antl county . . P�AN CHECK 8 VANCE PC ' S
orCinances antl state laws r¢lacing to con5trucUon, antl hereby autqorize , r � .
re0/ese�tatives of ihlS city t0 ente� upOn lhe above entipn<d `
prop¢rty. tor i ettiOn pu/p c i. �'�'
Signature � � � nate l� �/pL FINqL FEE y
Drlver5' License or SS � � �SSUE FEE• - . _ . ,. �
CMF 0865�46 Wni�e-Huiltling; Canary-Applicnnt; Pink-Accounting; GoltlenroC•Azussor
� : . .. , . .1 . , ,�
� CONSTRUCTIONANDPIJ►NNING .•r-� � , POOL&SPA; .. . ' � �� ,. �;,}i�, � .
APPROVALS" � Permit.#� ����yGg Date Inspector � ��"' - -° ,' ` � , - � �Date: -_ -Inspector .
. AFPROVALS' Permit # } � � •
. . . . . . .. _ . _ -- - - � •- - - - -
1.: � Temporary Electrical Service or Pole 43.�� Pool & Equipment Location ' - - -- ' ' � ' � - �� �
. i iPe- �dr9��" ' :! 4 • Steel Reinforcement, � - -- - - - -
. �3:.� Electrical Conduit.Utility: Undrgrn. _ 45. �.�Forms � - - - - � - � - � ` -
.4. ElectricaLConduit:Undrgrn ,. _ ' _.•_. ...46. .ElectricalBondin - •-- --�- - '
tee ein orce._ . - - 47. Rou h Plumbin & Pressure Test - �- ' ' - � ' ' '
' 6. .Electrical UFER Grn �+ � 48. APPROVALTO COVER�GUNITE -- '
7. Footings 49. Elec4iical Conduit-Undr m � -� � �
8. Foundation. � ' - � 50. Gas Pipe- ❑ Undr rn, Test �� � � � � � '
�9.. Water Pipe-Undrgrn, _.... .�__ _._ _ ' _ ." � 51. Backwash Lines P-Tra � ndr r'�' ' '� "' - '� �-^ • '� �
F 10. Structural FloorSystem • 52. APPROVALTO DECK "" '" ` �
17.. ProAerty�Sewer Line & House' Connection 53. Backwash & Rece tor-Final � •'+� �
72. Street Sewer Connection. _ � " � � _ 54. �Heater & Vent-Final � '•
13. Rough P.lumbing ' '
14. Rough Electrio-Conduit - - - - �56. � Electrical=F'nal - -• • � •
. 15. Rough Electric-Wiring - - - - � ' e � - ' -57'. �- Solar Syste'd�.Final-., - ' '
16. � Rough Heating & Air Conditioning � - " - - � - - - � • encing &�Access Approval � �
17,' Ducts in Siructure ' � � APPROVED FOR PLASTERING ' '• '
--- -- -- �- - -- '
-18: -Ducts; Ventilatin9- -'-'•- - - . . . -- - - ' - . _ ,. � ' - - _ --- -- - � . � _. _ .
19. Gas Pipe-Rough &Test 60. . POOL/SPA SYSTEMS FINAL
�� 20.. -Roof Framin9� - - - . . - . ' - - - - � . . . - . � '. '
21. .Roof Sheaihin ' - �; - - � - ' --- �- '� •- • -' ��
22.' - Frame and Plashin - ' NOTES: . ' . . ' '
� 23. Insulation --- -- � � - � - - _ .. . . � . .
24.: Lathin & Siding . . . - - - -- � ' '
�-25.�--DrYwallNailing. - .- � � - -- - . . " � . ..
• 26. -Plaster Brown Coat � � � - � �- - - ,
27. Electrical Power Meter-Final -�" ' � � � ,
28.- Final Electric � -- - � � � _ L -- ' '� � ' ' � ' �
,-29.' Final Heating & Air Conditioning _ ' ' � ' � .
-30.: -Final Gas�P'ipe-Test - . . . .• . � .
31.'- Final Plumbing
32 s - Weter Service-Final � � - -- - . ' ' . . . . . ..
33.-=�Gas-Service-Final .. � - � ' - ' �
34. Solar pomesticFinal "' ' � - ' ' ' ��
35. Landsca S rinklin S stem � ' � �' ' �
36. Sound Attenuation � � ' � � � � �
; 37. Handicap Regulations � - � � � - � �
� 38. FINALSTRUCTURE&BUILDING ' ' • -• �
39. Special Requirements Completed' ' - ' ' �� �" - � � �
40. Electric Release to Edison ' � � � � - - `- "' " - '
41. Gas Release to Southern California Gas Co. � - - - �
� 42. CERTIFICATE OF OCCUPANCY � . __ ' � � �
�,- , _ . , , . .
No � - Date " " . - -� - - . ..
P�r� Y��fr�2 •m# yAD/Plica�� �o rw tn an soac
LITV QF COSTA MESA PER IT NO-.
CONSTRUCTION PERMIT ��'�O
Address
Arch/Eng.
Address
, OOntlBctof
within neavy bortler lines ana sign all approDriate tleclaralions.
' TRACT NO. LOT NO. • BLDG. NO. '
�� - � � TVPE OF CONSTRUCTION
y/ 'G�Phone 'y2-�Fj�pO ❑ NEW ❑ AOD . I�4LTERATION '
❑.REPAIR ❑CONVERSION,ODEMOLISH
License No. - - - � - ❑ OrhiER, �
DESCRIPTION OF�WORK
TVPE OF PERMIT' � � � � " ' "'
�O GRADiNG ❑-FOUNDATION ❑ STRUCTURAL
�OTENANT��QELEGTRICAC�OPLUMBING ❑MECNA4......
�I hereby atfirm th:.t I am litensetl unEer provisions of Char[er 9(com: . . . � �
'menUn9 �wilh section 7000)� oL�.Divlslon 3�of tbe Business antl '. ❑ OTHER
Pro(esslons Coa ,�antl my �Iicense� Is In fu❑ force antl'.etie<t. PROJECTDESCRIPTION •
.Li<ensetl � G- G�"`�`% License �E3LSF-� . - . . ; .- .
�Date� S�9�ature � ^H � Sq. FT: ' _ _ _ _
WORKERS COMPENSATION DECLAR TION OCCUPANCV_CONSTRUCTION TVPE j _
1 hereoy affirm that I have a certificata�of tonunt to selt-insure or a VALUATION ZONE
certifitate �o( Wo�Ke�s' Comp¢nsatlon InSuranca,�o� a, certifietl cOpy. _. .. ...
'��eof (Section 3800, lab. CJ. GRA�ING CU. VDS ACRES
:y No. ' Company SiK�TX--�'�^�
Jertlfietl copy_Is hereby turnishetl. . _ -. � , .REMARKS: � � . ,
�� Certitietl copy Is filetl with the Nty Builtlin9 Dlvlsion.' ' . '
EXEMPTION FROM WORKERS' COMPENSATION DECCARATION - '`�
(This section n¢¢tl_not be completetl if the permit IS for one huntlretl .� .,, . _ .
($100) or less). . . - � - � � �- � �' -
I cert(fy-that In th¢ performance o( the work fOr which this permit is
issuetl, I shall not emPloy.any person in any manner zo'as to be<ome. PLUMBING ' PLAN CHECK '
subjec[ to the Workers Compensation Lnws of Calilornla. - ' .
Date Signature � "BATHTUBS - ' ' - SHOWERS � �
NOTICE: If after making this tlaclaratlon, you shoultl become subject TOILETS �. �.URINALS �
to tne Workers' Compenzation provisions of tne Labor Cotle, you must LAVATORIES DOUBLE LAVS �
forthwith comply with such p�ovl5lon5 or this petmi[ sball be tleemed
revoketl. , �
�CONSTRUCTIONLENDINGAGENCV � 'KIT:SINKS " DISHWASHERS'
�I hereby affirm tnat t�ere is a constructlon lentling agency lor [he perv SERVICE SINKS . ..-SUMPS ' ''
to�ma�t¢ of the work tor which lhis permit i5 ISsuetl (Settion 309]
C��• CJ� - -' ' . ' - ' ' - ' . FLOOR'SINKS ' . � FCOOR DRAINS ' '
,Lentl¢r'S Name
L.entler'sAtltlress� � � '- �•DRIfVKINGFOUNTAINS ' �- �
OWNERBUILDERDECLARATION - INTERCEPTORS � -CIARIFIERS
1 hereby aftirm tbat I am exempt from tha Contractor's License Law'for -
the-following roason-(Sociion-]031.5 6u5iness antl Professions�Cotle: - SWIMMING POOL""-" �PTRAP•'=-'
Any tlly or counry which r¢qWr¢5 a permit lo con5truct, al[er,
improve, tlemollsh�or repaVrany structure, prior to its issuance, also re- : yyqTER'SERVICE.'.. 'qLTERATION�
qui�e5 th¢ ap� Il�anf (Or sUcn parmit to filt a 5ignetl statemGnt that he
is licensetl-pursuanf[o ihe O�ovisionz oi4he Contractor'S �License law � GAS SERVICE � -�' OUTLETS �"
(Chapter'9 (COmmencing with Sectlon J000)'O/ OiviSion 3 of the
'Sine55 antl H'de55ion5 Cotle) o� that ha is�exempt therefrom antl thE yyqTER HEATERS' ' BTU OVTPUT "
s for Me allegetl exemption. qny violatlon of Section ]031.5 by
; appliwnt for a permit su�jects-the applicant [o a civil penalty SEWER-CONNECTIONS '
no[ more than (ive huntlretl tlollars (E500). ��
� 1; as owner-of the properry,-or my emPloyee5 witn wages as'their' SOLAR SANK -' �' 'CO�LECTORS�
sole compensation, will tlo the work, antl the structure is no[ Intentletl
or offereA for wle: (SetUon 7044,'Business antl' Grofesslons Cotle: The SOLAR PIPINGSVS. � "' -
Cont�actor's L7cen5e law tloes not apPN to an owner of a property '
who builtls or improves thereon, antl who tloes such.work himself or' - ISSUE FEE� �� � -��' -
tF�ough his own employees, provitletl tM1at sucn Improvements are no[
fntentletl or offeretl for sale. It, however, the.builtlin9"or Improvemen[
is soltl within one yea� of complC[ion, the owner will have [he bu�tlen
ot proving h¢ tlIC n0[ Dui10 0� imprOVC 1or Ih¢'pu�pasebt sdle).
❑� I, �as�.owner -of lho property, am .C%GusivCty cont�ac[ing with
Ilcensetl cOM�aclors.[o conSVUCI the project (Soction 7044, Bu5ine55
antl.Professions Cotle: The Contracror's.Lic¢n5¢ Law tloe5 nOt appry to
dn. own¢r of property who bulltl5 or Improves ther¢on, antl who con-
ttacts trom SUGh projecl5 with a ConUacto�(s) Iicesnetl pursuant [o
theContrac[or's License Law).
O 1'am exempt under Sec[ion B.'& P. C. for this
reason
Date Owner
I h¢reby ce/tifythdt I hava reatl lhis appliCatlon antl state that Ihe above
informatlon is wrrecL I agree'[o comply witn�all city antl-county
orEinances antl slate laws relating to tonstruction, antl hereby autporize
representatives of tnis clry 'to enter upon ' Ihe above mentionee
proper[y'far pectlon pu/r� °se�5.
Signature ���_�"'�'^� Oate � � L
HEATING SVSTEM 0-]00,000 BTU,
ANDDVCTING• 100,000�+BTU,
REFRIGERATION 0-]00,000 BTU_
SVSTEM - ' 100,000+BTU_
BOILERS ' BTV
SVSTEM REPAIR,ALTERATION
EXHAVSTSVSTEM MULTIPLE
Drivers' License or 55 ak—' �( - - �SSUE FEE-
= CMF 0865-46 Wnite-Builtling; Canary-Applicanq Pink-A<counting; Goltlenrotl-Assessor '^
I�i �
�
��
_ B91 7 10It I /H2
ZONING REGULATIOKS
A.P. �f. . . . - . _�'
ZONE " � -' ' PWTGp. RUEF. p�q
SETBACK GL 5T. PROPE�RTYNt�INE
SI�E YARD . . • . . . , . '
REAR VARD (TO P/l)
PKG.SPACEREQ. ' PROVIDED"�
STREETN/IDTH ' - �PARK FEE $
LONINGAPPROVED'BV , " . OATE
iPECIALCONDITIONS: . - •
'ELECTRICAL ' ' PLAN CHECK.
�50. FT. �SO_ FL • � • •
�GENERATOR - - p.l KW'_ 1-30•KW _
�TRANSFORMER
'.APPLIANCE ' 40-SO�KW_50t�KW_
.MOTORS ^-- � p-1' HP_3-30 HP'_
(INC.SOLAR�. -10-50�HP SO+��HP _
�FI%TURES'1JO' OUTLET$'� SWITCHES�Q
GAS�TUBESIGNS�'�"- - - - -
=POLE'LIGHTS" "" " ' ' ' � �
PANELS" MAIN'- ' 'SVB '
SERV�CE-' -� - � qMP
- ISSUE FEE ' - ' " ' - �ti
�
�
�
' SUMMARV OF FEES . . ' .
- ��BUILDING ^ • -- � - -- -
' PERMIT S i SMIP � �S
� PLAN CHECK $ , PERMIT •
-- �� ISSUANCE �S ' �
' PLUMBING $ ' '
'� �PI.ANCNECK E � GRADING .S
- ' '"ELECTRICAL" $� . . - a
PLAN CHECK ' S MICROFILM S
MECHANICHL -E - � TOTAL FEE $
' � LESS AD�. ' �
� PLAN CHECK- �$ ' VANCE PC �S _
FINALFEE $_/� I
� • ADP���ant to fi11 in all spaees witnin �eavy Doraer lines ane sign all approprlate aeclarations.
� CITY OE COSTA MESA PERMIT NO'./ TRACT NO. LOT NO. �BLDG. NO.
CONSTRUCTION PERMIT _ _� SyS � '
License No.
TVPE OF CONSTRUCTION
e ❑ NEW � ❑ ADD ❑ ALTERATION
. ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑.OTHER
DE CRIV7�ONOFWORK
Address \ y `M� y e ^ ) -
Contrac �u } �� Phone3 � q VpE OF\P�E�RMIT • �
�AddfCS ' ) � ' . . - ❑ GRAD� ❑ FOUNDATION ❑ STRVCTURAL
I.ICENSED CONTRAC R D CLARATION ❑ TENANT ELECTRICAL ❑PLUMBING ❑MECHANICAI
I hereby af�lrm that,l art� ��ttnzetl untler Orovisions of Charler 9(wm- - ,
mencing with sectlon �7000)� o( Divislon 3 0/ �tne Businoss antl ❑ OTHEF
Rofesslons Cotle antl my 1ltense Is In (ull ! �ce [�a�n�at eftect. pROJECT DESCRIPTION
Lice I s I Lice 1 N�� . ' -
Date�� 519 t e�' 11 .l � 5�. FT. . .. , _
WORKERS' COMPENSATION OE A��_— OCC4P%iNCY_CONSTRUCTION TVPE
I hereby affirm that I bave a certifiwte of consent to self-insure or a , VALUATION ZONE
ceitlflUt¢ Of Wo�ke�s' Compensation Insu�anta, Or•a�certifiatl cOpy . . .
'eot (Secllon 3800, Lab. CJ. GRADING CU. VDS. � ACRES
y No. Company - '
„¢rttti¢tl COpy Is berlbY �urnlShGtl. - ' REMARKS: • _ . _. . _ . _
�. Certifletl copy is flleU �+��h the city Bulltling Divislon.
E%EMPTION FROM WORKERS' COMPENSATION'DECLARATION ' � � �- - �
(This 5ettion neetl nol be.tompletetl if the permil is for one huntlretl •
(SI00) or less). �• - " '
I Certl(y tnat In the perto�mance of t�e w0/k f0� whiGh thi5 permi[ is
Issuetl, I thall not emploY any per5on in any manner So as to become "PLUMBING�• � ' PLAN CHECK ' �'
su�jecYto t�e Worker5' Compensation Laws of California. ' '
Date 1 5�9���urG � BATHTVBS SHOWERS
NOTICE: It after msking tnls Oeclara[lon, you shoultl become subject TOILETS � ,��URINALS' " '
to the WOlkGfS' COTp¢n4dUon pfovlSlonS o/ the Ldbor Cotl¢, y0u must - - ,
fortnwitn comply with SPch provisions or this Dermit Shail be tleeme0 �VATOFIES DOUBLE LAVS �
revaketl. ' - . . . � . ' � . ,
CONSTRUCTION LENOING AGENCV � KIT. SINKS DISHWASHERS
I hereby alilrm tna[ thare is a construction lentlln9 ag0ncy (or tne per- SERV ICE SINKS � � SUMPS' ''' � •"
formance oi lhe wo t r which [his permit is Issued (Section 3097
Civ. C.). ' ' - � FLOOR SINKS � FLOOR'DRAINS � �
Lentler'S Name —��� ,
Lentler's AtlOress DRINKING FOUNTAINS � ' - ^
OWNER BUILDER DEC4ARATION ' INTERCEPTORS �� CLARIFIERS ' '
1 h0/¢by alli�m lhat I am exempl ttom the Cont�actor'S Lic¢n50 Lnw for
lhe following reason (Se«�on 7031.5�Business antl Professions Cotle: SWIMMING POOL PTRAP ' '
Any city or county whlch reqW�es a permit to construct, alter,
imp rOva, tlamollsh or repair any ztruttUre, prlor to Its issuante, al5o re- yyqTER SERVICE ' ALTERATION
quires the appliwnt for zUch p¢rmil to 1IIe a slgnetl itatemenl Ihat h¢
is Iltensetl pursuant to tne'provisions of tne Contrattor'i Llcense Law ' GliS SERV ICE � OUT�ETS �
(Chaptar 9(commencinB �+'��n Suctlon 7000) of Division 3 ot t�e
-Iness antl ProlessionrCotle) or thaYhe is exompt therefmm antl the �yyqTER-HEATERS BTU OVTPUT '
: for lne alleged oxamption. Any violatlon oi SeGNon 7031.5 by
appllcant tor' a porfnit Sublec[5 tbe applitant [o a civil ponatty SEWER CONNECTIONS � ' -
o� not more tban live �q�tlretl tlollars (E500).
❑ I, as� owner of lne property, or my employoez with wa9e5 as thelr SOLAR TANK COLLECTORS
Sole Cofilp¢OSdti00, will tl0 Ne wOfk, d04 Ihe Stluctur0 is nOt InlCntletl
or a(ferotl for zale. (Section 7044, Bu5ine5s antl Roteszions Cotle: The SOLAR PIPING SVS. - - �
ContraGlOr's LlcenSe LaW tloe5 nol apply to dn owner of a proper[y
wno builtl5 or imprOv05 [h¢r¢on, dntl who tloes suGh wOrk hims¢II or ISSUE FEE " '
through hi5 Own employCCs, provipCtl lhdt SUCh ImpfO�ement5 ala not
intentletl or otferetl for sale. It, howeveq the builtling or improvement MECHANICAL PLAN CHECK �
Is soltl within one year of completlon, the owner will have tno burtlen
of proving he tlIU not builtl or Improve tor tho pu�Pose of sale). HEATING SVSTEM 0-300,000 BTV •
❑ I, a5 ownet of ihe P�operty, am excluSively conVacting with qryD DUCTING '
IIC¢nsetl mntraclori to Conz[rutt lh¢ proj¢Ct (Sectlon ]044, Busines5 100,000 + BTU
antl ProleSsions COUe: TPe Contractor's Licensa Law tloes not apply to
an owner of property who bulltls or improves lhereon, antl who con- REFRIGERATION 0-300,000 BTU •
tracts lrom zuch projetts with a contra<tor(s) Iicesnetl purtuant to SYSTEM
the Contractor's �icenso Ww). 100,000 + BTU
❑ 1 am exompt untler Se4��on B. 6 �. C. lor this BOILERS BTU
reason
Date O�'�er SYSTEMREPAIR,ALTERATION
I h¢r¢by certifythal I havC reatl Ihis applit'ation antl Slate that lhe dbOve EXHAVST $VSTEM MULTIPLE
Into�mation is mrrect. 1 agree to comply wi�h all C�ty anU Wunty
or0inan<es �nbstxte laws rela[i,g•Sy construction, an0 hereby authorize . ___
Slgnatdc6� Date L.L-LL..f�tiL'
Driver ' ense or 55 � '\ ISSUE FEE
CMF 0865-46 White-Bulltling; Gnary-Ap Iicant; Pink-Accounting; Goltlenrotl-Assessor
�e^'� I � /u�./,: • . . I�,�i.. TL
ZONING
ZONE
PLNG. REF. �
REARVARO(TOP/L) -�"� �- , � '
PKG. SPACE REQ. � - " ' P,ROV IDED"' .' " " '
'STREEYVOIOTH ' PARK FEE.$' -
ZONING APPROVED 8V -' ' DATE -�
SPECIALCONDITIONS: . . '
'ECECTRICAL' " PLAN CHECK : "' '
SO.FT. -'�' � .
•GENERATOR '0=1' KW_ 1-30 KW, '
TRANSFORMER � -
APPLIANCE ' 30-SO�KW_SO���KN
MOTORS '0-1HP_1-lOHP
pNC. SOLAR). ;0-50 HP_ 50 � HP
FIXTURES " - OVTLETS SW�TCF
GAS TUBE�SIGNS � •- � � �
'POLE LIGHTS ' � �
' ' 'MAIN
����j
���L
���
���
qPPCICATION HYYROVED BV • DATE � -�
SUMMARV OF FEES � , � �
BUILDING
PERMIT S . SMIP E
GLAN CHECK 5 PERMIT
PLUMBING s ' �SSUANCE 5
PLANCHECK E GRADING S
ELECTRICAC s �� s
PLAN CHECI( E' - MICROFIIM E
MECMANICAL E '. TOTAL FEE S_
'PLANCHECK �S" . LESSAO- � �
' VANCEPC $
FINAL FEE E �O
-�
CONSTRUCTION AND PLANNING POOL & SPA , ' �
j Date Inspector � • �- • Date• - Inspector ��
APPROVALS Permit # � APPROVALS Vermit �
1. Temporary Electrical Service or Pole � 43. Pool & Equipment Location -� -� -� -
i ipe-Un rgm Steel Reinforcement - - - -- - ' -
3. lec[rical Conduit Utility-Undrgrn _ 45. Forms - - �
4. Eiectrical Conduit•Undrgrn . 46. . Electrical Bondin -�- �
. tee ein orce 47. Rou h Plumbin & Pressure Test - '" -
6. Electripl UFER Grn 48. APPROVALTO COVERGUNITE •-•' - •
ootings 49. Electrical Conduit•Undr rn
8. Foundation 50. Gas Pi ❑ Undr rn, Test -
9. Water Pipe-Undrgrn 51,� Backwash ines P- ra 0'' r �' `' " '
10. Structural Floor System 52. APPROVAL TO DECK " " " ' ' ' ' ' - • • '
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
. 12. Street $ewer Connection � � � 54. Heater & Vent-Final
13. Rough Plumbing � -
14. Rough Electric•Conduit � .:56.-. �Electrical-Final
15. Rou h Electric-Wirin '� 57: - So�ar SYstem-Final
16. Rough Heatin & Air Conditioning • encing & Access Approval '
17. Ducts in Structure APPROVED FOR PLASTERING '
18. Ducts, Ventilating
19.. Gas Pipe-Rough & TesT 60. POOL/SPA SYSTEMS FINAL ' �
20. Roof Framing
21. Roof Sheathin " �
22. Frame and Flashin NOTES: � _. �
23. Insulation ' � �
24. Lathin & Siding
25. Drywall Nailing
26. Plaster Brown Coat ' � �
27. Electrical Power Meter•Final •
28. Final Electric �- • - .FS e
29. Final Heating & AirGonditioning--- - - --- • ' -
30. Final Gas Rpe•Test - - -
31. Final Plumbing
' 32. Water Service-Final -- - '" '
33. -Gas Service•Final
34. Solar pomestic-Final
35. Landsca S rinklin S stem �
36. Sound Attenuation �
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING � ' �
39. Special Requirements Completed
� 40. Electcic Re�ease to Edison ' -
- 41. Gas Release to Southern California Gas Co. � ' �
�
42. CERTIFICATEOFOCCUPANCY
� No "' Date • �
.,.
�
' � � AG011
• � C�TY OF COSTA MESA
� CONSTRUCTION PERMIT
Arch/En9:
I to llll in all soaces witnin n
P / `T�l�S
T EE
?CKE12 Pnone
�rR EEi
License No.
y bo�Eer lines antl sign all appropriale Geelarafions,
.- TRACT NO. 'LOT NO. . BLDG. NO. �
`-'� � s
TVPE OF CONSTRUCTION �
❑ NEW �DD- ❑ ALTERATION �.
❑ REPAIR O CONVERSION ❑DEMOLISH,
'O'OTHER' �
DESCRI�TION OF WORK �
/�_!`=.�.. ��'
rwnvacmr �AK � rnon � ) TVPE,OF PERMIT � ' ' ' �
� Addr¢u Q2Q�' � -- ❑ GRADING n'� Q-FOUN�ATION.--O SPRUGTURAL -
UCENSED CONTRACTOR DECLARATI N '�" '❑TENANT,y�ELECT.RIC L❑PLUMB�NG.OMECHANIC,
1 hCreby atfirm th:.t I am Il�ensOtl untlGr provlsioni Of ChdrtOr 9(com-
mancin9� �'��h-secUon-7000) of Divisian- 3 oL tne. BuSinass and �OTHER. F l�iZ� ��RRt� 1KI...EQS
Aotesslons Cotle antl my Ilmnse is in fuu force anG elfect. � pROJECTDESCRIPTION-�
Lltonse CIS55 �� '� ' " t ' " 'i eyse No. 5 � - " ' . '"-' ' , _- '
� ����i^g2 SQ.F?_ �
Date ' Si9nature � " _ ' ' - - " ' ' ""' ' ""' "
WORKERS' COMPENSATION DECIARATION ��OCCVPANCY'_CONSTRUCTION TYPE
9 hereby aHirm tnat I have a certificate af <onsent to selt-insure.or a,�VALUATION ZOOO.� ZONE
ce�UfiW[e ot Wo�ker5' CotnpenSatiOn .InSuranca,.or_d certtlie0 cooY . . -- __ - �. -
thereof (Sectip n 00, Lab. C.). T�� , GRADING CV. VDS. ACRES
:Y No.Z.Cn��-7�7 ComDanY-�UKIC•N �5.�� ' ' f - _
ertitietl topy is hereby,furnishetl. , � ' ' ,REMARKS:' � _ - . _ _ -
`y�' Certlfietl COpy IS Oletl with the City Builtling DivlSion
EXEMPTION'FROM�WORKERS'COMGENSATION-DECLARATION - - - - '
(This section neetl not be Compl¢t2tl if tne ptrTit is to� onC huntlre0 • �'- � � .�-�Y _
�E1001 or lessi. ' - . "' -' ._: ". - , -.. _
certlfy that In [he,pe�fo�h�ante of [hG wo�k fo� which this permiY is
IssueG I�shall not employ'eny"person tn-any manner so'as to'b?come .'PCUMBING;-�' r.?L'AN'CHECK' -'-
sub)e<� [o the_Workers_Corr�pensation Laws �t UII(orNa." -' -
Date Siqnature � � ' -BATFITVBS" ' '" ' ' ' -SHOWERS'�^'-- - - -- ' '
NOTICE: If at[er making thii tleclaration, you shoultl becomesubject � �TOILETS�� �.� -URINALS�--�- �- -�-- -
to Iha WOrkers' Comp¢nsat�on provisions o( the labor Cotle, y0u must -
for[hwitb comply with such provisions or thls permit shall be tleemetl LAVATORIES DOUBLE L-AVS �- --- -
revoketl. •
CONSTRUCTIONLENDINGAGENCV - -' 'KIT.SINKS-' - ' "DISHWASHERS � --
� hereby affirm lhat thera �s a constru<tlon lantling aqency for thc per- SERVICE SINKS �- -SUMPS -� • - � - -
formance�of the work,far.whiUi'thls permltils issuetl (SacUon 3097
�CIvrCJ. --.- � - -� --�-- - � ' - � �:- �- - �' � FLOOR'SINKS FLOOR'DRAINS-^ --
'Lentler's Namo - ' '
�'" ' . - " -'-' "._ _ . . . _ � . - DRINKING FOUNTAINS. -• -".. ' ' -'
�Lentler's Atltlress ��
OWNER�BVILDERDECIARATION.� � ' INTERCEPTORS' -"'CLARIFIERS-""� - �- -- -
1 hereby afiirm t�at 1 am ex¢mpt (rom the Contractor's�Liconsa l.aw for
the followin9�reason (Seclioa 7031.5 Busineu�antl Pro(oisiOns.Cotle:. aSWIMMINGPOOI' PTRAP- �- - --
Any City or COunty whiSh �eqWr¢5 a pC�rtlit t0 <anstruct, alter, -
Vmprove, tlemolisb or repair any�structure, prbr to ici issuanco, also�re- yyqTER SERVICE "�^ ALTERATION '' �
qul�e5 th¢ ap�.licant fo� such pe�mit to filo a Signetl s[atemant Ihat he
Is Iicensetl pwsuant to-lhe provisions of the Conlracto�'s Llcense l.aw� GAS SERVICE ' "' OVTLETS' -� - �
�Chapt¢r 9(GOmmencing with SettlOn 7000) ol DlviSion 3 oi Ihe
usiness antl �Prdeszions Cotle) or ihat he is exempt thorofrom antl the yyqTER'HEATERS • -BTU OUTPUT -- -�- -
�s lor tne allo9etl exemption. AnY violatlon o1 Sectlon 1031.5 by
aOP�����- �o�-a-p¢rmi� subl0t[s dhe dppllUnt to-d tivil penalty SEWER'CONNECTIONS -� -�---- -� -• --
.iol more than live nuntlretl tlollars (E500).
IJ I; as owner of [ne'property,-or my employeei wlth wages as thelr � SOLAR�TANK� - � COLLECTORS -- �--- -
solo tompensation, will tlo thc work, antl tne structure is not intenaetl
or offered for sale. (Settioq 7044, Business and Rofessions'Cotle: The SOLAR PIPING SVS. ' ''' �- "' "
ConVaclor's Liconse Law �oe5 nol appry to an owner Of a property
who'builtls or improves lhpraon, antl who tloes sucn work'himself or ISSUE FEE- - -' ";� '�� - �
�Nough hls own em0�oyee3, providetl thal Such Improvemnnt5 ara not _ _
InCentletl or o/1ereE br sale. I1,-howeveq the bullCing or Improvemont � MECHANICAL � �PLAN CHECK
is Soltl within on0 year of �Ompletlon, the ownar will M1dvO Ine burtlen
ol proving h0 tlid nOl bUlitl Or Improv¢ for Ihe'purp05¢ Ot sat¢�. HEATING SVSTEM 0-100,000 BTV
❑ I, as�owner ol lhe. property, am.axUusively cqntracting wilh, qNDDVCTING- - - -
Ilcensetl contractors to toristruGt the projeGl (Sectlon ]044, BuSin¢55 100,000;t�BTU
Sntl Professions Coaa: TM1e,ContractoCs.License Law tloes not appry ro. __ - -
an owner of proPerty who builtls or improves thereon, antl who con- REFRIGERATION � 0-100,000 BTU
tracls .Irom such..projec[s..with a cmtrac[or(s). Iicetnetl p�rsuant to SVSTEM - - __ . . .. _
the Conlracior's License Law�. �100,000,+ BTU �
❑ I am'exempt untler Section - ' B. 6 P. C: for [his- BOILERS - �� BTV
iaason. . ' -' " ' '_"'
� SVSTEM REPAIR,ALTERATION
Date, �'her _ ..
I he1'eby c¢rtify thal 1 have reatl Ni5 appliWtion dntl state tna[ the dbove EXHAVST SYSTEM MULTIPLE
Information is wrrect. I agree-to compy with all-tity'antl'county- „
ortllnances antl ztate laws rei��ln9 to mnstructlon, antl hereby authorize
rcpresentativ¢5 o tl fs ci�y t� Gn[ uPon' th! above' �nentioneC '- - " -'.
propertt- in e •Purp , s �� -� Q-��
Signature pd[e JS.t ;L� ��
DFivers' Lf�••�se or 55 aX � _ �� =- � � �' - - �SSUE FEE _ _ . . . . _
CMF 0865-46 Wnite-Building; Canary-Applicant; Pink-Accounting; Goltlenrotl-Assessor
n
1 � 1982 -
T-
VG REGULATIONS .
PLNTGp. gRUEF�. pqp
. . PROPE�RTY LINE� � -
i�3�IGHT..n... " " .. '. '" " . _ _ ''
�'REAR VARD'(TO'P/L) - " � " " -
PKG.SPACEREQ: ' """' PROVIDED: ' ' �
'STREET WIDTH-' ' ' ' '" PARK FEE'b " - '
20NINGAPPROVEDBV- ' DATE - -
SPECIAL CONOITIONS: ' ' - " ' " -
� _..' "_ _ "_ _' ' '"_u" _ ' �M
" ' __' _ _ - _ "_"� . _ '.C:_ :
ELECTRICAL- - - aLnra�CriECK - ,- -�
i50 FT - ' - c0. PT. -" �" -
�GENERATOR - �0-1' KW-1-30 KW'_
{TRANSFORMER . -
;HPPLIANCE' - - 30-50 KW_50�+ KW-_
�MOTORS� - --�0-1 HP---y1-10 HP�_
�IINC. SOLAR) . _ .30-SO.HP 50 + HP _
��FIXTVRES •OUTLETS-' �SVJITCHES-
�GAS TUBE SIGNS - - - � - - - - -
�POLEiIGHTS- " ' -----' '' -�� "
'PANELS � --MAIN 5
15ERVIGE - - - -' . .- -
��sweree- - -- �- -- -- -
�
APPLICATION�AFPROVED BV - � - . DATE 1
�
SUMMARV OF FEES
� BUILDING �j�J �/� ��Q%� �
�PERMIT S��.Lr£�-s��Z��• , SMIP ' � b_-_[_i'LL
�PLANCHECK 53rJ�L4. PERMIT,. � � 1� � !
_ . . _ ISSUANCE� S �
�PLUMBING E ��GRADING : 5 �
PLAN CHECK E �
-ELECTRICAL'S � E
,PL-ANCHECK S � - ' MICROFILfvI�E �/� ��� ��j �
,MECHANICAL E ' _'TOTALFEES_a2�1��•� �
,�� ' •LESSAD- ' /�
'PLANCHECK E - � -- VANCEPC^5-_SL"'
. . ' .i ' •� ' ' 1
FINALFEE S- �r1
_ . ' " . ' ' " • -r�
CONSTRUCTION AND PLANNING • POOL & SPA • ' � • �
Date . Inspector � � , � � - _ . Date Inspector
APPROVALS Permit #��% . APPROVALS � Permit_# . I�
1. Temporary Electrical Service or Pole 43., Pool & Equipment Location " ' �- � ` � � ' ' ` �
Soil ipe-Un rgm � 44. Steel Reinforcement "-- " � " ' '-' ' ' - � -
3. Electrical Conduit Utiliry-Undrgm _ � ' '` 45. Forms ' ' - - - � -
4. Electrical Conduit-Undrgrn _ . .. ' � - 46: -Electriral Bondin-� -
., tee ein_orce . 47. _ Rougfi Plumbin & Pressure'Test ' � - "` ' - -�
. ..6. .Electrical UFER Grn . . - � 48. APPROVAL TO COVER-GUNITE -` � ' � ' '
7. _ Eootings � ° . � � „ 49. -, Elect�ical Conduit-Undr rn ' � � � �
6. Foundation _ _ - --- ... _ ' 50:� GarPipe, ❑Undr rn,Test ' ' " - •
- -9. Water Pipe-Undrgrn . 51.. Backwash Lines P-Tra ❑"ndr rn - '-- " � ' '
: 10.._ Structural Floor�System . - � . 52., APPROVALTO DECK - � � - � �
�. 11�. Pnoperty Sewer. Line & House Connection � � 53.'� �Ba'ckwash & Rece tor-Final ' ' -
12: Street Sewer Connection - . � - � - - 54. Heater & VenbFinal �
13.. Rough Plum6ing ' � � �
' 14. Rough Electric•Conduit ' ' � -' -"" �56. Electrical-Final - -
15. Rough Electric-Wiring -' � ' -� � 57. Solar System-Final � � . ' . �
`16. - Rough Heating & Air Conditioning �� - -- - - � - ' � • encing & Access ApProval „ � �
17. Ductrin Structure -- " � ' APPROVED FOR PLASTERING � '
: 18.� Ducts, Ventilating -- - - ' - �- - - " - � . . _ _ . .. __ ,. _ . _
19. Gas Pipe-Rodgh & Test � � - - - - - � 60• P_OOUSPA SYSTEMS FINAL . 'r ' . . - ' , �'•
. . . � . . . .. �
� 20. �Roof�Framing - � - - - - -• - � - - �- -- - -� - ' � '
21. Roof Sheathin • - - - � '•^ ' � . � •
� 22. FrameandFlashin -- -- � - ' NOTES: _ Q a J. oy�' � ��`
` 23. Insulation - - - - - - - - � �- -O, � p_ -��py. - . � -
24. Lathing & Siding --- - � i- - ' -- - � - � - - � �
25. - Drywall Nailing - � - - � � � � � - � �
. 26. Plaster Brown Coat � - - � � � � - - � •
27. Electrical Power Meter-Final - � � � � •
28. Final.Electric -. . . - . . _ . _ - - . . • . . . . •
29. -Final.Heating & Air Conditioning� - � - - - � - - - - - - - �- �- � - ' . • �
�
30. Final Gas Pipe-Test -- � -- ' - - - - ��
31. Final.Plumbing -- - - - ' � � ' •� � '
• 32. Water Service-Pinal - - � - - � �� �� ' � ' - � '
' 33. � Gas Service-Pinal � - - - - � �
34. Solar pomestic-Final ' � � - �
35. Landsca e S rinklin S Stem • ' ' '
i 36. Sound Attenuation • ' �- - -- - - • �
i 37. Handicap Regulations �- - • ' ' ^' �� ' ' ;
' 38' FINAL ST�RUCTURE & BUILDING '
39. Speciat Requirements Completed - "� �
-40: , �Electric Release to Edison ' � � - -
41:� Gas Release to Southern Glifornia Gas Co. -
42. CERTIFICATE OF OCCUPANCY . � ' '
, � , •.
- • No1 Date - _ . . °' �
City Of Costa Mesa
Building Safety Dapartment
P.o. eo. izoo
Costa Mesa, California
CERTIFICATE OF OCCUPANCY
.. -, ' 3
i � c'i .
The Building located at :3�. :.' S.�r: :.:r_':;_�
has been inspected and found to comply.with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group .:-� Occupancy.
r �7
Use of Building LY�f:s ior A1�2sd�i�i�s �� ��aoti r/NcV
Legal Description 4'?n-3u1-13
� (See reverse side for Metes and eounds)
- L—s�ve ...—;o�.;
Building Permit No �-ditG'l Electrical Permit No. r=�-Akd7 Plumbing Permit No, r��R� � �
�—.�i�j2 i —J�.J%
___._ _ Number of apartments -�_ and/or guest rooms _n_
ISSUEDTO: Building �icial - - ----- --- -_-_.
by ��i ( j , � 6' /i'�.Le.�rl..
i�oatswaiil's Loaher V. ��% �A/fll ��/9f�ZDivision Jirn.ctor
Date
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C.
Form BV 34 Rev.11/]0
ADVlieant to fill in all sDaeas within
CITV OF 60STA MESA PERMIT NO.
CONSTRUCT ION PERMIT '� ��,�%
Prolect AddreszA']�r � . _
�-(� I��
OW� A�.f\ 'W.�.\� \�N u� n rt " P�lOnO
No.
borEer Ilnas antl sign a11 appropriate Eeclantions.
TRACT NO. LOT NO. � BLDG. NO.
TVPE OF CONSTRUCTION �
❑ NEW ❑ ADD ❑ AITERATION
❑ REPAIR -❑ CONVERSION DEMOLISH
❑ OTHER
q�5f.(21PTIQN OF WOqK
W Y t q"l s
�ap_G Phon �% TYPEOFPERMIT '
❑ GRADING ❑ FOVND TION O STRUCTVRAL
LICENSED CONTRAC DE LA A ION ❑ TENANT ❑ ELECTRICAL Vl_VMBIN�
1 hcreby affirm t�at I am Ilcensetl untlar provlilons of Charter 9(com- � �
mencin with'sectlon 7000) of Olvlslon 3 of tna Buzinesz anC ❑OTHER
Proloss�ons Cotle, antl y Ilcensa is in tull lor tl ifect. PROJECT DESCRIPTION
LIL 5 I 5 / i�e� O � , _
Date ��Si9na • p SQ. �. .
WORKERS'COMPENSATIO�CLARATIOFI OCCUPANCV_CONSTRUCTIONTVPE
I hereby aHirm that I have � cartiflwte o( consent to self-Insure or a VAIUATION ZONE
certi(IGte o/ Workers' Gompensatlon Insurance,�or a certlHetl copy . �
�`^moi (Sectlon 3800, I�b. CJ. 'GRADING CU. VDS. ACRES _
.Y No. Company
.:erti(ied tapy is here�y /urnishetl.- - • - � 0.EMARKS: ' '
❑ Cert�}�¢tl topy ii filetl with tho ci[y Builqinq DivlSion.
EXEMp710N FROM WORKERS' COMPENSATION DECIARATION' - '`� � ' ''
(Thls 5¢Ctlon n¢etl not b< cortlplEtCd if th¢ pe�mit IS fOr one huntlre0 _ . . _ , . , �
S$100) or leu).
cerUfy that in tha performan�e af the work (or whi�h thii permib is
02Q2 I I/U4/D,� � f0.0 i TL
R
ZONE PLNG. REF. $
REAR YqRD (TO P/L) � -
PKG.SPACERE�. PROVIDED � '
' STREET WIDTH � �PARK�FEE 8 �_
' 20NING APPROVEO BV - � ' OATE , ,
SPECIA� CONDITIONS: . . . . .
w
issuetl, � shall not emD�oy any person in any manner so as to betome �PLUMBING '�� . PLAN CHECK � '-
subjBC[ to lh¢ Workeis' Comp¢nsalion Isws of California. - '
Date � Signature BATHTVBS SHOWERS -
NOTICE: If after m5king this tleclaratlon, you shoWd become subjecl' TOILETS • --� • URINALS ' ' •
lo lhe WorkGrs' Compensatlon prOvlslons of the Labor COtle, you must �
forthwlth comPiY with suth provisions or this permit shall be tleemetl �VATORIES DOUBLE LAVS �
revOk¢tl. , � �� . ' ' �
CON57RUCTION LENDING AGENCV KIT. SINKS � DISHWASHERS " "
I hereby aitirm that there I a cqonitructlon lentlin9 ag¢ncy lor the per SERVICE SINKS ' SUMPS - �' ' "
formance ot Ihe work tor,l�hi h this permit is luuetl (Sectlon 309]
Civ. C,J. A ' � '� ' FLOOR SINKS � FLOOR DRAINS
l.entlers Name �1 _
Leneer'S Atltlres� DRINKING FOUNTAINS
OWNER BUILDER DEGLARATION' INTERCEPTORS CLARIFIERS
I. hereby aHirm lhat I am exempl irom tne Contractor's Liconsa Law for
tho lollowing �eazon (Se<Uon ]W1.5 Business antl Professions Cotle: SWIMMING POOL PTRAP
Any City or County which rCqW�es a pe�mit t0 Consirucl, dller,
Improoe, tlemolish or repair any struGture, prior ro Its lssuance,also re- yyqTER SERVICE � ALT �
. quires �he appliGant for zucn pBrTit to file a si9netl Stdlem�nt that be
I is'll<eqzetl pursuant fo the provisions ol the'ConlroctorY'Llcense Law GAS SERVICE ETS
LChaptor 9(commencing with Saction 7000) ol Divlsion 3 of the
�5iness antl Prdessions Cotle)' or that ne I5 exempt tncrefrom antl the WqTEH HEA E 5 T UTPUT
is �or lne allegeC exemption. Any violation ol Settlon 7031.5 by
� appliwnt for a permit sUb7ectz the applitant to a tivll penalty SEWER CON C NS "
..� not more than live hundretl tlollars (E500).
❑ I, ds owner of [he proparty, or my employaes with wages as their SOIAR TAN ' COL�ECTOR°
sob t6mPen5dEion, will do tha work, an0 the sVuctu�C Is noLlntentletl
or o1lQrotl for sale. (Sectlon ]044, Business antl Aolestlons Cotle: The SOLAR PIPING SVS. '
ConVdctorY �Icense Law tlocs not apO�Y to.an own(r ol a properiy . ,
who builtl5 or ITptov¢5 Ihereon, antl wh0 tloat suGh work himself or ISSUE FEE
[hrou9h hls own�employees, prOviGotl Ihat suCh improvomCnls a�e not
InteOtletl or oHeretl for Shc¢. It, Itoweve�, the builtling or improvomml MECHANICAL PLAN CHECK
Is soltl y�itnin one year o/ completion, the owner will have tho burtlen
ot PrOvin9 be tlitl not bWltl or Improve tor [ne purposo of sale). HEATING SVSTEM 0-100,000 8TU_
❑ I, as owner' ot'the property, am exclusively conVacling with qND DUCTING '
IICEns@d COntra<lori to conStruGt th¢ projeGt (SecUon 7044, BUSin¢Ss 100,000 * BTU �
antl PrOf¢5510ns COtle: The Cont�acto�'S LiGense Law tlOts not apply t0
am ownor ot Property who bUlitli o� Improve5 Ihereon, antl wno con- REFRIGERATION 0-100,000 BTU_
trdGts i�om SUG� proj¢cts with a COnVaCtor(S) Ilceinetl Ou�suant to SVSTEM '
tM1e Contractor•s License Law). 300,000 + BTU �
❑ 1 am exempt untler Sactfon e. 6 P. C. �or tnis gOILERS BTV
reason -
Dato - Owner SVSTEM REPAIR, ALTERATION
I hereby tertlfythal 1 have reatl l�Is applicdtion antl state tM1at the above EXHAUST SVSTEM MULTIPLE
Info�Tation is conect. I agree to comply with all tlly antl coun[y
orAlna��es antl state Iaws relaUn onstrucNon, antl hereby authoNze
9 UUU000
�epr¢z¢n[atl�� Of this cily t t�on the d�Ove mpi�tio etl
proper�y/' o�r �spe n �i�
SlgnaturE�" ` Date �SSVE FEE
DdverY �mense or 55 $
CMF 0865-46 Whice-Builtling; Unary-Appli�znt; Rnk-Atcounting; GolEenrotl-Asttssor
' • • . I
ELECTRICAL� aLAra Ct+ECK ' �
QOOECCIIOI, . . . I�ERII!^F -
vn 0-1KW_�1-lOKW,
TRANSFORMER . '
P.PPLIANCE 10-50 KW�50 � KW�__ -
"MOTORS 0-1'HP_1-10'HP' '
(INC.SOLAR) •10-SOHP_SO+HP� � .
FIXTVRES ' OUTLETS ' ' SWITCHES - ^
GAS TVBE SIGNS ' " - �
POLE LIGHTS ' " - �
POLES METERED SU8 ..�
PANELS MAIN ' SUB
• . AMP ' � •- •
ISSUE FEE
APPLICATION APPROV ED BY � �� DATE �
� SUMMARY OF FEES . �
BUILDING' �
PERMIT f ' SMIP f
PLAN CHECK S PERMIT �
� � ISSUANCE E
PIUMBING E �
PLANCHECK S GRADING E
ELECTRICAL S 5
�PLANCHECK S � MICROFILM $
MECHANICAL § TOTAL FEE E
PCAN CHECK E LE55 AD- •-
VANCEPC $-" `
FINAL GEE S /Q �
CONSTRUCTION AND PLANNING • POOL & SPA • . �,� ` .
Date InspeMor • � � s-�--�.� .Date InspeetoF
APPROVALS Permk # � APPROVALS � Permit # .
1. Temporary Electrical Service or Pole � 43. Pool & Equipment Location � -� - � --
i ipe- n rgm � - 4 . Steel Reinforcement � � •- � - - - - - � �
3.. lec[rical Conduit Utility-Undrgrn ..45.� Forms _, �
4. Electripl Conduit-Undrgr� ..46.. Elec[rical.Bondin •-
. tee ein orce - 47. Rou h Plumbin & Pressure Test
6. Electrical UFERGrn � 48. APPROVALTO CAVER-GUNITE •� �-- -
7, ootings 49. Electrical Conduit-Undr rn -
6. Foundation 50. Gas Pi ❑ Undr rn, Test •�
9. Water Pipe-Undrgm 51.- Backwash ines P-Tra � ` -• - -
10. Structural Floor System 52. APPROVALTO DECK '"' ' -- •- •••
11. Property Sewer Line & House Connec[ion 53. Backwash & Rece tor-Final -
12. Street $ewer Connection 54. Heater & Vent•Final � �
13. Rough Plumbing -
14. Rough Electric-Conduit - �56: - .Electrical-Final
15. Rough Electric-Wirin �57:� Solar System-Final
16. Rough Heating & Air Conditioning � • encing & Access Approval
17.' Ducts in Structure APPROVED FOR PLASTERING
18. Duc[s, Ventilating -
19. Gas Pipe-Rough & Test 60.. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. Frameand Flashin NOTES:
23. Insulation � �
24.' Lathin & Siding ' • '
25. Drywall Nailing '
26. Plaster Brown Coat - ' -
27. Electrical Power Meter-Final �
28. �Final Elec[ric ' "
29. Final Heating & Air Conditioning ''
30. Final Gas Pipe-Test p '-
3L � Final Plumbing /- -g ' - �
32. � Water�Service-Final - � ' �
33. Gas Service-Final
34. Solar pomestic•Final �
35. Landsca S rinklin S stem �
36. Sound Attenuation -
37. Handicap Regulations - • � �
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Compteted ' ' - •
40. Electric Release to Edison • -' � �
� 41. Gas Release to Southern California Gas Co. � - -
42. CERTIFICATEOFOCCUPANCY .
� No- Date
4303.9
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
OWNER ,SR LL A.P.NO.
MA I L BUIIDING
ADDRESSZ4j� � �' !7 {(I P.DDRESS
TEL. T �
CITV � � IVO. 2 �'D
CONSiRUCTION W
LENDER �
BRANCH
OWNER
ADDRESS
AqCNITECT i _.. � J.� J� ,. TEL./1,�� „� I� S �
^,�'� pAu
7G ;. (?� 97�,'� ..{.;�.,,�,
FOR STRUCTURAL PERMIT
D TE RECEIVED DATE ISSUE�
� � �5 - � _ �
/� _ / PERMIT
� W � 0 — ��%
��- ' � ' � FIRE
ADDRESS � /3 �� 20NE /�
APPROVED
CONTRACTOR� � BY
� , ' �
ADDRESS ZpN NO.OF
T E L. P��
CITY � NO.
F STATE � CITV � �'ARD APPROVE
� LIC. NO. LIC. NO. MAIN BUILDING
(a.j . SI2E I � NO.OF BLDGS. (FROM G T jEETI
0. OF LOT � � NOW ON LOT O ONT T. �
� USE OF ��
EXISTING BLDG. N.4 F
�I /�
FSeparate permits are required (or L SIDE " FT
Q elecVic, plumbing and heating work. REAR FT.
�.�., USE OF BUILOING ND WORK T E PERFORMED DiSTANCE BEf.
Q MAIN BLDGS.
q V AR. qW
aC.U.P.�
7
} �
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6!
[+7 '--
aa I hereby acknowletlpe thet I have reetl t�ia epplicetion antl ctate
that the ebove Informeilon Is corract end aB�ee to comply with
0+ all laws repulailnp bulldinB conrtruction, nntl i sholl not employ
,'� uny parson in vlolallon of the workman'z compensation laws ot
� the State of Cellfornie. yp
�r I hereby cartity t�at 1 em properly Itcansatl as a conttactor vntler U(/ S�. FT.
the State ot Calitornie Businass entl Profeutone Code, Divislon 3, THE AMOUNT SH
Chapter 9, and Shet such Iicenus ere in fuil force antl effact, or I THE PURP06E OF F
am ezempi from tha provisions ot iha Stan of Californla Buslneu VALUATION
antl Professions Cotle, Dlvisi 3 ptar 9
SlOnaiure of � ��/��� 5 y� / �(/ �
Permittee � � �
� L
Authorized AAent
K
�yr��.- ��
DS APPROVED
FT.
n
m
>
m
m
N
JN UNDER VALUATION IS FOR m
'ABLISHING A GERMIT FEE ONLV: �
PERMIT FEE E H
PLANCHECK E /83�C/� o
TAX 5 i� g5 U
0
TOTAIPAID E D• � O
.,
4 3a3
' F3 -3-77��'1°00 276 n�*'% n
f.4S^ ���.V�
COSTA MESA BUILDING-SAFETY DEPARTMENT �
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLtCATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Ink Only
RECEI DATE RECEIV�D ppTE I UEq
BUIIDING � �� y
ADDRESS � L `�
A� �OB�� A IGC PERMITNO.
OWNER A.P. NO.
MAIL � //i ��tr � gUILDING
ADDRESSZ (I�/i ADORESS
T L. TRACT LOT BLOCK
CITY .B' NO.
CONSTRUCTION A ALT P
LENDER
BRANCH �
OWNEF
ADDRESS VALUE
ARCHITECT TEL. S � $
OR ENGINEEfl
FIRE
ADORESS ZONE TVPE GROVP
/� APPROVED
CONTRACTOR . ��i(,� S' e� DATE I� �
AODRESS
' TEL. ZONE NO.OF USE OF NEW
� PLANS BUILDING
CITV A� NO'
STATE CITY YARDSAPPPOVED ' VARDSAPPROVED
LIC. NO. 2 3 L�C. NO. MAIN BUILDING ACCESSORY BUILDING
512E NO.OF BLOGS. (FROM C/L STREET)
OF LOT ' NOW ON LOT ROM FT. FT.
USE OF ' '
EXI5TING BLDG. FT FT
Separate permits are required for L SIDE FT. FT.
electric, plumbing and heating work. '
fiEAR FT. FT.
USE OF BUI�DING AND WORK TO BE PERFORMED DISTANCE BEi. . BET. MAIN &
MAIN B�DGS. �ACCE�. BIDG$.
�/I�G� (/JE -- �-o2a�E VAR.# DATE
C.U.P.qW APPROVED
APPROVED
I hereby acknowletlge ihat 1 have �eatl ihis appllcntion antl state
that the e0ova intormetlon is correet and aprea to comply wlth
ell lews reguleHng buliding eonrtruction, enE I ahall not employ
eny permn in vlolation of <he workmen's compensation lews of
the�Stete ot Celitornle. ' '
I hereby cartify thet I em properly Ilcanaetl as a eantraciar �ntlar SQ. FT.
the SSete ot Callfornie Businau antl P�ofaulons Cotla, Divtsion 3, THE AMOUNT SHOWN UNDER VALUATION IS POR
Chepter 9, entl that such Iicanses ara In full forca and aftact, or 1 TME PUFPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am exempt from the proviElons of theSiaie ot Calitornla Buslness VAIUATION PERMIT FEE S
end Professlo4s Cotla, Dividon 3, Cbapiar 9. •QO
PLAN CHECK $ ��
SlBnatura of
Parmittee $ TAX $ �
Authorizatl Apant TOTAL PAI D $ �
�' - 4375 f
COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican[ to Fi11 in Completely — Use Ink Only
nn�oaess y 3% W. / BTH Si .
F
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OWNER
MP�L
AODRE
C17�'
B
ESS
ACTOR
TEL.
NO.
TEL.
G.
TEL.
cirr�CjNiaHEIM. Cs��iF. "o.SS6'83:
STATE � CITY
LIC.NO.�OO�oIO LIC.NO.���9
S I Z E I NO. OF BLDGS.
OF LOT NOW ON LOT
USE OF
EXI�TING BLDG.
Separate permits are required for
electric, plumbing and heating work.
u5E OF BUIIDING AND WOFK TO BE PERFORMED
BUILDING
ADDFESS
E
CETV Gl� ����'� E��, �1
:ATION F�OR>STRUQT[�RAL PE MIT
] B�V DATE R E DATE I SUED �
- � - � f�
!1-b — ��E=-�' ` c�
� �
\CT LOT BLOCK
) P �
/
i ' L E Q(J
$
TVPE GROUP �/ �
D
DATE �
�
ZON�� INO.OF I USE OF N
��,PLANS �� BU—ILDIN�
VARDSAPPROVED I VARD!
�
BET
BEf. MAIN
ACC6S. BL
DATE
I hareby ecknowledpe thet I heve reatl this epplieetlon antl stnta ��
tha2 the above Informetlon Iz correct entl apree to comply with
m
ell laws reguletinp bulltling conrtrucNon, antl 1 shatl not employ
any person In vlolatlon of i�e workmen'z compensatlon lews ot • u
t�e State of Californla,
I heraby cartify thet I em properly Iicansetl as a contractor untlar SQ. FT. H
t�e Stata of Cellfornia Busineu enC Profasslons Cotle, Divlalon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOq m
ChaPter 9, entl thet auch Ilcenses are in full force and effaet, or I THE PUFPOSE OF ESiABLISHING A PERMIT FEE ONLV: �
am'exempt from Ma provisionz of iha State of Callfornie Bualnesa VALUATION �
antl P�ofauions Cotle, pivialon , Chapter 9. PERMIT FEE E Q, p p N
n
Sipnature Of p p PLAN CHECK 5 �� � � O
PetR��ttee $�� �C� x TAX E c LL
. � J C U
Authorizatl Apent TOTAL PAI D E �(o . 5 Q
-�3882
COSTA MESA BUILDING-SAFETY DEPARTMEN
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING�/Jn' \� / � 0.� �I
ADDFESS `� ��I v L.J
OWNER �.E H. EI�1T F'
�E�` PQ�T ^�� TEL.
CITY NO.
CLOENDER�ION�CV�EI �
BRANCN r
ADDRESS �'
ARCMITECT 1, �QAUI�� TEl!
ADDREISSI�/� `t�n.K��� sr �
ADDRESS
CITV =
F STATE
i IIC. NO. �
w�
SIZE
0. OF LOT
Q
TEL
NO.����
CITV
LIC. NO.
NO.OF BLDGS.
NOW ON lOT '
USE OF
,��, EXISTING BLDG. A� E
m
FSeparate permits are required for
� electric, plumbing and heating work.
E,�„ USE OF BUILDING AND WORK TO BE PERFORMED
a
c
a l...oG ��i L �
� �
r
�
�
m
+�n z�,-77�`;-<;OOZtiqs~� ,�r.��i,�. i�
APPLICATION FOR STRUCTURAL PERM[T \
RECEIV ATERECEIVED D T I U �^'��
1 `
A.P. NO.I��� I's�� �� PERMIT NO.
BUILOING Q3/ �/� �f� t S� =
ADDRES$ / v
OWNER
FIRE
20NE TYPE ROU
APPROVED �
BV DATE / �
'�i�'h�
ZOf�F NO.OF USE OF NEW LOC,.r
jr� PLANS Z BUILDING WgLL
YAROSAPPROVED VARDSAPPqOVED
MAIN BUILDING ACCESSORV BUILDING
(FROM GL STREET)
RONT FT. F—�
' "__ '_ __ � II
DISTANCE BEf. BET. MAIN & y�
MAIN BlOGS. ACCRS. BLDGS'�
VAR.d�+ �E '�`�/Sg DATE 7
C.U.P.qW APPROVED�� �
APPROVED %/�ZL � %�J
/i /en � w�iY �r. f , /i',�
a �'
� I heraby eeknowletl8e ihat I have Iead Shls ep0��cation antl stata � L�;k T �� / 6� �
� thac the ebove Informatlon is corract en� aB�ea to comply wlth ��
a ell laws rapuletlnB builtlinp conztrucNon, entl I shall not amploy
i-�' eny oarcon in violatlon of the workman's compansatlon laws of
� ffie Stete of Californie.
3 I heroby ce�tlfy that 1 nm pro0erly Ilcenaetl af e conttacior under SQ. FT.
iha Stam ot Californla Buelnusa antl Protessione Coda, Dlvialon 3, THE AMOUNT SHOWN UNDER VALUP
Chopmr 9, end such Iieeneea ere In tull foreo ond effeet, or I THE PURPOSE OF ESTABLISHING A PERM
am Bxempt tr m t provisiona of Ihe Smta of Celltornia Businass VALUATION PERMIT FEE b.
end Profecsl e C e, Dlvislon 3, Chaptar 9. r
�/00 PLAN CHECK S
Sipnatura of
Parmlttee 5 TAX E
AuthoAzatlApant TOTALPAID 3(
�
N
Y�"� . ^
m
i
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. �
N
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� NIV: "
b
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� � � 4 910
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
ADIDRESS �� I ��- � v } • � � -
OWNER ����\�j�al� S �jK.�I
MAIL �`��]•CJI ��vY
ADDRESS W�-�
CITV �E\ �� f^} NOL��Z'(OC
CONSTRUCTIQj�_ ` /
LENDER G� �Y � —
BRANCH
ADDRESS —'
ARCHITECT I n.� �i1' �n i 1�� TEL-� �_7�
F
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CONTRACTOR I < �i'�
ADDRESS ��� L
CITV � � �_
STATE /�
LIC. NO. L^ �
SIZE � �^
OF LOT --W %�
USE OF `_
._. "�v-3-77�"�`•'QO izo-� �:•::,�.�rSSC
APPLICATION FOR STRUCf[JRAL PERMIT (�
RECEI DATERECEIVED ...r..�.-...-.. ��
A
�1�'SGr1CJ�n-t �OC�C E/
� / (JW � G(�7 S
TVP GROUP ^
D � / �
DATE 7
NOLrj^l'I_�oJ�� Z� " i PLANS
CITY / �'ARDS APPROVED
LIC. NO. �� J I MAIN BVILDING
NO.OF BLDGS. (FROM C/L 5 RE
NOW ON LOT I ONT _ F a,
Separate permits are required for
electric, plumbing and heating work.
USE OF BUIIDING AND WOflK TO BE PELiFORMED
�- n L, F �' f� � I<_
�,VA L L..
OF NEyO �
yY //.N' BET. MAIN &
V�� ACCESS. BL0C3S.
� ATE
� APPROVED �'
i.��l �� - - ��_ � � `
I �oreby ecknowledpo thet I hava read this applicetion and atate
that the ebova Intormotlon le corro[t entl apree to camply wlth
all lawe reBulatinB builtllnB �a�rtructlon, antl I shall no<employ
ony person In vloletion of the workman's compensation lews of
tho Stata of Californle.
I heraby canify thel I em proparly IlcensaA as a conirecror under 5�. FT.
tha Stn[a of Callfornia Butinass and Professlona Code, Dlvizion 3, THE AMOUNT S
Chepter 9, e i�et sueh Ileanses ere in tull torca entl atfect, or 1 THE PURPp$E OF
am axempt ro Me provislon o7thaSteteof Celifornla Busina6f VAI.VATION
antl Profes ona otlo, Divifion Chapter 9.
Sipnature o� �% ��
Pefmlttee S � � �
Authorized ABent
VN UNDER VALV
"ABLISHING A PER!
PERMIT FEE 5
PLAN CHECK E
TAX §
TOTALPAID E
N
n
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N
N IS FOR m
E ONLV:
e
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438 l_3
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use [nk Only
BUILDING�y� ( \� / � QT'{ ^ �
ADDRESS % � \( �,.7 r]
OWNER �
MAI l /
ADDRES
CITY �{G\V �f'"JI�IT IJH NOL
BRANCH
ADDRESS
ARCHI_TEC e IACK U^ .�AU
C.M
tiPR 1'!-7;�;;I`�0� 739" �.�'��*7.50
APPLICATION FOR STRUCTURAL PERM[T
RECEI DATE RECEIVED D �E I S C
PEFMIT NO.
A.P. NOI S'
BUILDING �
AD1DRESS �,
/v "�T A T/�(� ZO O BLOCK
A AL P
OWNER Q /� ���(� p�
USE A/wL��7l�.%/►LC%7 L+
FIqE �-�//
ZONE TVP� GROUP V
APPROVED � /� ��� �
��
CONTRACTOR �� j"'S I{�� VI.+� I�JL.I�rI tlY usait- � �
AD�RESS � j„� S ` � ���0 A�E
- I ^ E NO.OF USE OF W
CITY �yy� NO`54'T• 7 P�� BUILDI
E STATE CITV `�ARDSAPPROVED VARDSAPPROVED
� LIC. NO. %J �IC. NO. � 2� MAIN BUILDING ACCESSORV BVIIDING
NO.OF BLDGS. 1 (FROM C/L STREET) /�
S OF lOT �� 1f NOW ON LOT { ROM FT. F
a USE OF �+
.,�� EXISTING BIOG. N G FT FT.
y
S Separate permits are required for L SIOE FT. T.
� electric, plumbing and heating work. REAR FT. !� r. ��
[.W. VSE OF BUILDING AND WOflK TO BE PERFORMED DISTANCE BET. BEf, MA N&
QMAIN BLOCaS. ACC6S. BLDGS.
� � VAR. ,�/ TE �(
LO � C.U.P. / PROVE (/ �
a
7 APPROVED �/
} �
..1
a
k7
� I hereby ecknowlatl8e that I he�e reatl this application antl state
n
y� ffiat ffie above informaiion is co�rect antl ap�ea to comply wlth
m
� ell laws reBuletin8 builtlin8 con6ttucNon, antl I shell not amploy
�Z eny parson in vlolation of tha workmen'z compensetion lewa ot d
� the Staie of Californie. , m
3 I hereby ceriify that I am prop6�ly licensetl as a contratior untler SQ. FT. �v
t�e Siaie of California Business and Profassiona Code, Olvislon 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOA m
Chapier 9, entl thet cuch Iicen9ms are In full force entl etfect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt fr ha O�ovisions of the Stete of Cellfornia Businoss VALUATION a
end Profess ns C e, Divislon 3, ChapSe� 9. PERMIT FEE $ � m
� PLAN CHECK $
�- rr
SlBneture o �%D� o
Permittee _ $ C TAX $ �'1 LL
< <� U
Authorized Agent TOTAL PAIO E