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A BUILDING—SAFETY DEPARTMEMT
P.O. BOX 1200
Costa Mesa, Califirnia
0
ADDRE55 -7 -7p t,��
an .
STATE IICENSE NO. $(
CITV LICENSE NO.
NO. IT�M
Dwellinp, Sq, Ff.
Gorope, Sq. Ft.
Fint y0 Outlau, aach
Outlets, Additional
F���� 20 Fixlures, aach
Fiirores. Additionai
Dryar
Fon
Healer
Oven, Domasti<
Pole, �a�sfrvction ,�
Ranqe, Domestic�
Mo�or� �See Schedulal
!1P
HP
HP
/Aafe��, p.
Parmi� Fae
Sub�Total fs��
t[i. r+o. s vG si.
CUSS, r �. v
UCM f�t!
3
� - �sav zo-75�A;°00 aUs ��*���23.00
TRACT NO REC'D BV
lOT NO
BUILDING USE
C'I� �l� i I/ �"L-
wuomc .�r�Q � l��
�DDRESS
COST� MESA, GLIFORNIA
NEAREST
ccoss sr.
�.7�`4C7
DATE ISSUED
\ :{}/� V / '� 7
��ry k����1ii� EINO. �'�7L
I NEREBV� ACWOWIFDGE TNAT I NAVE READ TMIS AYVII•
UTION AND`STATE TNAT THE ABOVE IS CORRER /�ND AGREE
TO�COMPLY`yWITN All CITY ORDINANCES AND STATE LAWS YEG�
UTATING ,EIERYIGI WIYING.
��\ 1L CEQTIFV TXAT I POSSE55 TXE ABOVE VALID STATE OF
����, � ME SNGLE µ Y IGTID MI/LL PROrERTHE/LE RIOED AlOEVF. F
�- s�omw.. ef �' ,
►ERMITTEE • C . - -.� G
NO, ITtM tAd filf
Sipn 8 1 Tranf. Y.00
Tran�/ormsn KM�
� Garoroton �CW (/!/ �b'
$ub-Tofal Feea ��
APPROVALS
IMS�lCfO� D11Tf
TEMP. WlE �
UNDERGRWND CONWIT I �
� eivv�_u 1 I
Total FN� UTIIITY CO. NOTIFIED I
FINAL
��p� e�." • BLDG. PERMIT NO.
For items not listed refer to Fee Schedule
�J
AODFFSS OF BWIdNG: Z p w 7qg gT
�xsru�Ei��JAC�50N iREGIPALD M
���iSTARBRGCK, UAVID
� •�,�.R 732 -D ADDISON ST
�vx. �uiaa ano�ss:
BERKELEY,CA 94710
YICNIfECT OR EN(aIFEN:
�'i �Ptll OH ENO.'41DUPE55:
n:a�:;�a
UM: 7
UNf:
ca+m�c*arsxu� ATCHLEY 6 SONS ROOFING ( 714 ) 871-5741
��A��T�'B�N� 2945 N COMMONWEALTH
monEss:FULLERTON CA ucra.: 549263
92633 uxr: A
UCENSE� CONfHACTOflS DECIap1TI0N: I hereby dl�m uMx peneYy ol perjury tlW I em licenaetl uMa yoviviana d Chepm 9
(oommenc�q Mil� Seciion ]000) d Oiwun � M Ne &mimea eM Pmlue'vu Cotle. end mY imw e in IW laca md eltatl.
cmuc.no.:pq�721 uc.cuss:�gg uc.No.:599263 �,!E�XP: 00/00
oaa: l-��-��% c�v.c�,�� �/.�1�
OW NEfl BUILDEfl DECIAP�TON: I Iw�etr/ elfirtn imMr penellY d pmj,ry �ha� I am exemq Imm tM Commtlm Lkaue lew la tM
IOAov.iq ieewn (Setlion )031.5 Bwiwe md Pralmonf Coda: �m dY tt munly whidi rtCum e P�E Io OmaV W. Ns. u^PM.
�wndu�, a repai vry evucYws. prin b Ys'seuenu. dw esVw� �M epplimM lor eucA pwmil to fib a epneE MlsmmC tlw he a aM
� YoerueL Wnuent lo tAe Ma+�+ at Ns Camredon Liame lew ICheqm 9(wnmenen0 wqh Saeion'l000) d Dii'sbn a af tM
duv�ron ud Adwiom Codel a Ihm Ir «aM b uemN IMrdmn uM tM Esv 1« Ns albped nampion. A^Y vdmion W Swian
)031.5 by eny eppliren� lu e permd eubja�le �he epplcenl to e avil penelly al �wt mae then Ma hurM�ed ddbn �5500��.
� I.uox�wrdlMpopenYaimyamN�i�xihwepeamtMiedeaom0e��.vJldoMeMvk.eMNostrucfumumliMe�deA
a ollereE �a vele (Sec�im )tW<, Busineee end PMeaaone CaEe: The Comrmon l.irenee lewdaea rat eppM�o en ovmer d propery
wM Wide a inpa'ea IMrBan. eM wM daea suM xqk limeetl a henell M M�aqA he a Iwr own mmP�^Y�. D�'b� Ihel wch
Impro+ememe ma rat imeM� «o11enC la eale. X, �owever, tM buikiip a inqwament n edd wi�hm aro yw d oompbtun, tM
owMrWilder will Mve IM puNm d povi�p M w eM diE nd bnld a improve la �M purpwa d eele�,
� I. ee oxner d iM propeM. 4m extlueively canirea'vq x�lh IianesJ canVeclqa b wwrue tM pojep (9ecion'l4M. &m'uasa W
Vnlwiau Code: The CoMraeaa Licanas lew tloee m� ewN b an ow�wr d pwNY wM bwtEa a inD�'ea ihersan aM who
cmuecU la vli pqWa Wph e maretla(e) fwnrE WnwN to tM Cau�etlpe limme lnx�.
� 1 am uemN �vdr Sectim: B. 8 P.G.. br Nu neam:
Dma: ��
i m naee�r un�h uw i em ..ms a e�d �e.re�e�a ua �avuirem«a. a cdromie �eenn e�d s.Mr wae s.ao�. nws. uva..�d
u�a. xd HW 1 a em IWwe bwldiu ammva Fi4 / wil �U (� �) � to cwnpry wth eeiJ pa�s mdr eM tM ipucemaib la
DNe: �Gd�
WOPKEfl'S COMPFNS�TION D��ppATON: I MrMy alfirm under per�My d px'ryry ar W tlw Idbwi�q Mduetiom:
� IhewudWmeimens.a�ifinedeoneentmeWinweabrwakaseampensazian.npaidadlvbySafbnalWdiMleEu
COEe, la �he perlmnence d the wak la wlvch i�n permtl n imuW.
❑ in�.�a�;��m�.�«�,.�,�o,�,mo�,��,�o..m�.a�e.awsea�,arooam.i.m�coe..m.m.wn«�.dm.
work la which thie pe�mu ia inueE. My worke�e' comPe�wion ineuruice carrier end poGcy num Wr ere:
c�«:
vdeyr+�mn.:
, rw s.nim ro.e Iwr bs rnnNxee r ms v�e w ro. ms nw�d�sd eoeen Is�ro) a bs..)
I cMN thel in tM D��+arca al �Ir ww4 M wl�ch t!w O�n e iewd. I kW m� «nVM �Y Da� m enY men'wr o u io
b�coms abpa to iM wMwY mmpeutlian Iex� d CelLarrie. eM eyea Nel tl I�haAd Mcm� o �M wMw�'
compenatian pwieona d�u� 3)00 d �M Lebor COAs. l kWl lonhwqh wiN tliow
G�-� �
Oeie: �� �!G � / ! AGP�cem:%'�i/1� K
Wunlip: F�9un ro'wun rvoryey'ronpwu�tlon rowrp� li un4Mul, uW �Idl au�/ct �n �rrylqw ro cNml�ul pwltlp uM
clvll llnu �q ro on� h,ntlrM ryp�wM CWNn (S�P0.000), M e0d/tlon b tln roa! ol conpwu+tbM1 Wmep� uWavWq br In
Sctlon �1(AB ol M Le6or Ca4, IMw4 enJ �ttormys l�a.
CONSTNUCTION LENDINO PRENCY: I hmeby elflrtn u�Mer pereCy d perjury ihel IMn u e mMiudbn bMleq peney Iw IM
perlormarm d tM wA br whiq� ihe pem�i b eeusd (�� �. Cw. C).
LEN�EN'S NM1E:
LENOEfl'S �DDpE55:
I ceniM tlbl I hava rud ine eodwian uW pme �het the eEova Wame�ion u eonea. I pna to oomW wnn ell c1Y end couM' «dinencwe
aM etae levn Mmng Io buildirp �apiiqion eM Mreby eNhor¢a requenlPoivse d �hv ary io eMar upon ihe aba+�meMioned popeny
�°`�'D"p�'O�D�MITCH ATCHLEY
vma w�»
-�// � � C/ o.e: /-3 � 3'7
Sqialurp d Owix/�penVRpo�'an�Wnreea
(St51�/6.WP) WhGsBuiknp 8 Sdery: (Laerr-Flb: Canery-I�ppiraN: Pink-He�enue: (3aldenmd-Avseaw
CIT'Y 6F COSTA MESA - BUILDING PERMIT pERM NU: B 081398
PERMIT NO: B 081398 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: , PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF 6 REROOF W/BUILT-UP SQ FT: 2,SOU
CLAIM VALUE: 2,500.00 CALC-VALUE: 2,500.00 GROUP OCC: B /
COMMENTS: REROOF 1200SF COMMERCIAL BUILDING W/BUILT-UP
if ik if 1E 1E 1ElE �k 1f iE� iE'lE 1f fE 1E 1Elf iF 1ElE 1E 1E iE'lE 1E 1E iE IE 1E 1E 1E iE 1E iE aE 1E 1E 1F 1E iE 1E 1E 1E iF 1E ib �E fE 1E 1E 1E'lE IE iE 1E iE 1E 1E 1E 1E IE IE iE 1E if 3E i8 if iE iElE if iE 1E iE if 1E iE 3f
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN �LEFT: FT SN RGHT: FT IN
PARRING RE(j: PROV: PARCEL: 42908115 ZNE: REF NO:
PLANNING NOTES>
i
iE fE ff iE iE 1E 1E 1E'N' 1E iE 1E iE 1F If 1f 1E 1E if if 1E iE �141E 1F iF if 1f ib if iE iE 1E �IE 1E iE 1E �IE'7E 1E 1E if IE fE 9E IE 1E ih iE fE iE 1E 3E iE 1E')E iE 1f 1E �E 1E �f If iE iF 1E if IE ih If iE �f iE if IE iE 1F IE IE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
1E 1E 1E iE 7F if 1f 1E 1E I[� 1El41ElF iElE If iElE 1ElE k
LEGALIZATION:N
F E E S U M M A R Y
DATE;
DATE; � 3� �y�I
iF161k1EiElElEik ib�f
STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 74.75
SMIP/NON-RES
PLAN � .53
ISSUE FEE ;,)
BUILDING-DIV-> PERMIT ISSUE PL'AN-CHECK TOTAL PAID DUE
TOTALS----> 75,28 0.00 r.'; 0,00 75.28 75.28 .00
.�
REVENUE DIVISION TOTALS--> COLLECTED: 75.28 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
74,75 % .53
.�
1F 1E fE 1E IE I! 1E iE iEl61f it 1E iE fE ff 1ElE 1E 1E fE 1E 1E fF 1! 1f 1f 1E 1f If iE 1E 1ElF 1E 1E 1E 1E 1f 1E 1E 1! fE ik 1E iF 7F 1E iElE iE iE 1E iklf� 7E iE IE IE fE iE IE 1F iE iE IE fE Ik fE 3E fE fE �f iF iF ik iE iE iE
I N D I V I D U A L' F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
,f n
SFC 2500 REROOF BY VALUE COMNIERCIAL NOZONE 1.00 2,500.00
END OF FEES
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EXPIRED 81-38-1997/82:18 Pq/f75.28
DATE �' � ��� RCPT�:BI-8B01322
PERMIT:081398
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CONSTRUC710N AND PIANNING � . P00 ;PA
AYI'ROVALS Permit # Date inspector qppROVALS Permit # Date fnspector �
t.�:mporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steet Reinforcement
�3. �Electrical Conduit-Uttlity-Undrgmd. � 54. Porms -
4. Electrical ConduiI=Undrgmd. 55. Electrical Boncling _ .
:=5. Steel Reinforcement � � . . 56. Rough Plumbing & Pressure Test �
�6.. Electrical UFER•G.nd. ' ' 57. APPROVALTO COVEfi�GUNITE
;-7. �Footings - _ ' 58. Electrical ConduioUndrgrnd. '
��8.��Foundation - 59. Gas Pipe, D Undrgrnd., Test
-�9:. Water Pipe-U�digrnd. : .• � � 60. Backwash �ines, P�Trap, � Updrgmd.
10. Structural Flooi System 61. APPROVAL TO DECK
11. Property Sewer:Line.& House'Connectiori 62. Backwash & Receptor�Final
12. Sewei Cap ' - , 63. Heater & Vent-Finai
13. Root Drains ,_ 64. Plumbing System •�Pinal
14. Rough PlumUing ' 65. Electrical-Final :
15. Rough Electtica6Conduit� . 66. Solar SYstem-Final
76. Rough Electtic.Wiring - ' � 67. Fencing & Access Approval�
17. Rough Wiring Sign fi$, APPROVEO FOR PLASTERING
18. floughElectrica6TBarCeiVing 69. POOVSPASYSTEMSFINAL
79. Rough Heating & Air Conditionin9 ,�, � * m „ _ __ FIRE DEPT.;REQUIREMENT ,
20. ;Rough Factory Fueplace " _ � ? � _ _ '-� APPROVAIS_. � Peimit # ,
21. �Ducts, in'Structure >' � •� �� - r; - � � � - 10.,Underground Flydro
22..Ducts, Ventilati�g..; = �, . ' - � `: 71,`produet�Piping OGas OOiI
23. Gas Pipe-Rou9h & Test �� y T �� �� - 7q, Underground flush- � �
24. �Roof �Framing' " � ' -- � ' - ; - ,� , � 73: Undergmd. Storage 7ank O Gas O�Oii
25. Roof��Sheathing , C �� Y "� 74,-Overhead Hvdro �
r
26. T-Bar'Cei�ing (Str�ctural) & Monocoat � ? - 75: Dry Chemical _ - , ' _
27. Frame and Flashing��. „tt � . � �= 76. Dry Stand'pipe� - � � :
' 28. Lathing & Siding'. ' ' " ;; _ - ' " '` 77, FIXED,SYSTEM FINAL _
� -
29. �nsulation • . � �_ •� r 78. FIRE PREV. Fi�7AL -' �
30. Drywall Nailing � K F �_ -�. HEALTH DEPT. REQUIREMENT
� -.
' 31. Plaster 8rowo Coat= ;. -?- � 79, FINAI INSPECTION � ' _
; 32. Electrical Power M¢cerFjna� � 80: FOOD CERTIFICATE ISSUED - :; q'�;
33. Finai Electric-. � r _ ` • � Nates: �_3�_c�� �er � ��/Z_ /Gb q�a,.ry,.�
� 34. Final Heating�& Air Conditioning'= , ;, ' . ���7' O � .
-. r z- � F-� r
35. �Final Gas Pipe�Test � - . � . . . _ � , - � '
' 36. Hootl or�CanoPY f' - � � . � • - _ _ ' � - � �
�
37. Ftnal.Factory Fireplace :- -,- � - _
-�38. Fina� Plumbing � _ ' �, .- _ � ' ,
39. Water Service-Final � � , '� ` _ .
�-40. Gas Service�Final �� �* � ' " . � �
- r
41. Solar pomesticFinal - '� . - � , � � i - -
42. Backflow Preventer y • ' ' � -
43. Backflow Irrigation , '. � , ; ,- � � . . �
44. Landscape trrigation SYstem-' - � • �" � � � ' ,
�
45..Sound Attenuation; � ,.-, , " � �� `' � . �_
. � - ., -
46. Handicap Regulations �- : • - ' - ' - � . '
%i
47. FINAL STRUCTURE & BUILDING ' _ ; � ' ` _ � - • ,
48. fINALPLANNING' rr - '
49. Electrie RElease ro Etlison ` � `
. - <:
50. Gas Release to Southem Califomia Gas Co - '�' .
51. CERTtFtCATE OF OCCUPANCY ' ,
No Date _
�
'r1EST 17Tk? 5?'REFT 770 �
1085 - 11-Zy-:4 -- :.T. (Gecj
1Gti12 - 6-i&'-o3 _.._t ;1' .:-- $24,000..
20166 - b-5-63 __ec.r__�::_�3�-r.� 1,000..
22T95 - '--2b-o5 �::r_� 3,�;. 19,zao.
4244 - 1242-0'S - ..�'�(ces:erj
25596 - z-z1-66 �_ec.�.�;'c I;�.,ezc_�) !
25597 - 2-2i-6o __c. �:c S:<:.�;..ct i
263� - 9-26-06 :' �c. ::C t��,:t_c�cj j
26406�_ 10-31-66 __z_. :r(cct.::.-:: , �
26686 - 1-6-67 ____. _:c (ccnr._•j V i
4840 - 1-31-67 :itg. '.iC (k.tg.appl.?� ver.t) ;
26811 - 2-24-67 ��ec. i�iC (mctors) - �
27223 - 6-15-67 F1ec iIC (moto:) i
5419 - 1247-67 .t�. Fc (1.c3.z�n,,� ��- �!ti,
29849 - 5-3�-69 :,e^_. :�c (�otor L � ���te.):
33�+49 - 2-15-72 r^1ec. 2iC (motor) t
�
34;30 1-19-73 �2ec. 5�,(;.Ic�or3�.^=tzr:
1L840 - /'� Htg. NC (Fau & Motor) '
45995 _ l:ra�o.e,l(�,� Int. A:.t.
7,5�• :
1-�8°
78840-I� PIBG NC (Gas Systen) �
— %6'a —
;
�
_Fti2309�Prinklers'�(52 7pp �� .
/OO�
925359 T94?O LE� PAD FOUNDAT_IO
�/`�/ �'/��.�/�a400.'?'T '
��-� i
---826943�� �, $11,625. _ :
/ �J -�
B 73704 block wall _ ,
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e
JOB ADDA
GENCRAL
Tag �921
i��.•- .�..z�.
TRU6C0'IT, WILLIAM DATE 7
FIRE 'LONE � DESCR
DATE IGROUP J TYPE
SUBCONTRACTOR
PERMIT NO. 20166 � �
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�`�no,mt> `�
(714)754-5273 • Fax(714)754-4856
Job Address: 770 W 17TH ST
Suite:
Vicinity:
Parcel Nunmber: 4240$115
Appliwnt: MOELLER,BERT
Address:
CITY OF COSTA MESA
B!/ILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
owner: FOO7HILL FINANCIAL L P
Address °hINV�STMENT MGNT SERVICE
NEWPORT BEACH,CA
1575 PLACENTIA AVE
Contractor: SERVICE 1ST ROOFING
Addiessi 180001'IRVINE BLVD.
, TUSTIN, CA
Arch / Eng :
Address:
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
TEAR OFF BUR & HOT MOP
$0.00
$iza.�s
$0.00
$1.33
$0.00
$0.00
$126.08
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0-0
PARKING Existina: p
NOTES:
BUILDING PERMIT
Rear 0.'0
Rear 0. 0
Required: 0
Zoning:
Phona: 573-2242
Zip:
Phone:
Zip: 92663 � ,
Phone: 714-573-2242
Zip: � 92780
License: 556512
-�Phone: '-
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY .
, . � ,.- ,� .
, ,
PLANNING 8 ZONING
Left 0- 0
Left 0- 0
Pro osed: 0
�c
/ PER NUMBER
� 698-02103
77 FAIR DRIVE, COSTA MESA, CA 92626
Calc Valuation:
Claim Valuation:
Right 0• 0
Right 0- 0
SX�
Y
D�'
Status: ISSUED
Applied: 11I20/1998
Issued: 11I20I1998
$6,317.12
56.317.12
�
EXPIRATION: This permit shell automatically expira and become void if work is not commenced within 1 BO days, or if work is suspentled or abandoned
for a period of 180 days. ,
INSPECTIONS: In order for lhe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inapeetlona end flnal epproval must be obtained. Failure to obtain inspections and tinal epproval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 75M5626
WORKERS' COMPENSATION DECLARATION:
I herehy eNirm untler penalry oi peQury one ol the following declarations:
❑ I �eve enC wlll malntain e ceNficete ol consent to 5elFlnsure tor workers' mmpensallon, es pmviAed for by sectlon 3700 0l the Lebor Code, for the pertortnence ot t�e
�ork for which this permll is issuetl.
�'\I hava and witl meintein vrorkers' compensation insurdree, es required by section 3700 of the Lebor Cotle, 1or t�e pertortnance of Na work for which Ihis pertnit is issueO.
" My workers' camp@nsatlon Insurance cartler end policy number ere:
Cartier. Palicy Num6ec
(TAIs sectlon need not be oomplered I! the permif Is velued ef one hundred dollers ($100) or Iess.J
❑ I ceNiy thet In Iha peAormance ol Ihe work lor whlch this permlt is issued, I shell not employ any person In eny manner so es to become sub�ect lo the workers'
com ' t Calllor le, end egree t I shoul0 become sub�ect to the workers' wmpensatlon provisions of Seclion 3700 f the Le r Cotle, I shell torthwith
y w ese vlslon . ,��J / ' 1
plicent Sgna� ,.� �� 1' �}Q Date� � � / �� �9 �
WAR . LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHP1L SUBIECT MPLOVEF T PENALTIE AND CIVIL FlNES UP TOONE HUNDRED
$AND OOLIARE (5100,ppp), IN AUDRION TO THE COST OF COMPENSATIIXJ, DAMADES AS PROVIDED FOR IN SE 3108 OF THE LABOR CODE.IMEREST. AND FTTOPNEVS FEES.
LICENSED
of Chep(er 9(commencing with Section 7000) ot
eNect. Lic. M .
rs Slgneture:
entl Proteu�ior5 CoGe, BnG my IlcenSe 19 In tull
CBMSTAGCTION LENDING AGENCY:
❑ I herehy eMirtn Ihet (here is e construction lending egBncy tor t�e peAortnance of Ihe work for whlch I�is permlt I5 issuetl. (Sec. 3097, Clvll CoAe).
Lendefs Neme: Lenders Address:
Signature:
Date:
OWNER•BUILDER DECLpqpT10N5:
I hereby eMirm Ihat under penalry ol per�ury thet I em E%EMP7 FROM THE CONTRACTORS IICENSE LAW tor t�e lallowing reason (Sec. 7031.5, Business enE Protessions
Gotle: Any ciry or counry which requires e pertnit to conswct, alter, Improve, demolis�, or repair eny structure, prior to Its Issuance, elso requires ihe ap0liwnt for such pertnit
to file e signed stetement thet he or she is licensetl pursuant to the provisions ot the Coniractars License Lew (Chapter 9(commencing with Section 7000) oi Division 3 of the
Business end Profeuions Code) or that he or she Is exempt Iheretrom and the besis tor the allaged exemptlon. Any violatlon ot Sedion 7031.5 by any applicant tor e pertnit
sub�ects the epplicant to e civ�l penelry of not more than five hundretl dollare ($500).):
❑ I, as owner of Ihe property, or my emD�oyees with wages as Ihelr sole compenseilon, WILL DO THE WORK, and Ihe struqure is not INentled or oHereC for sale (Sec.
7044, Buslness entl Professions Code: The Contractors Licensa Lew tloes nat epply to en owner of property who builds or improves thereon, end who daes such work
himself or hersell or throuqh hls or her own employees, proNded that such Improvements are not intended or otlered for sele. If, however, the builtling or Imprwement is
sold within one year oi compleUon, ihe owner-builder will have Ue Durtlen af proving thet he or she tlitl not Dulld or improve for purpose of sele.).
❑ I, as owner ot the property, am E%CWSIVELY CONTFiACTING WITH LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business end Pmfessions
CoCe: The contrectors License Lew tloes noi eppty to an owner ot property who builds ar improves thereon, entl who contrac�s for such project with e contreclor(s)
license pursuant lo t�e Contreciors License Laws.). �
❑ I am exempt untler sec.
Signature:
Owner ID verlfied by tlrivers licensa. ❑ Yes ❑ No
Business and Professions Code for Ihis reeson:
Vedflcation ot Ownership py (rype oi documenL i.e. - properry tax bill or deetl):
Dnvets Ucense No.
Date:
Expires:
DIVISION OF INDUSTRIpL SAFE7V PERMR CERTFlCATION:
❑ 1 �ereDy ceNty t�at no excaveHon INe (5) or more teet In depth Into whlch e persan Is reqWreC ta descend, will be metle in connectlon with work euthodzetl oy lhis
pertnit, entl thet no bullding siructure, scaMoltling, telsework, or tlemditlon or dLsmantlinp thereoi, will be more then Ihirty-six (38) feet high. (Chep. 32, Grp 2, An 2, Sec.
341, Title 8, Celifomia AtlmiNsiratNe Cade).
❑ As owner-bu0der, I will not employ enyone to Co wwk which woultl requlre e permlt trom the DlWslon ot Intlusiriel Satery, es notetl a6ove, unless such person has e
permit lo do suc� work trom Ihe division.
Signeture: Dete:
Divislon ot IndustAsl Se18ry Permit Number:
CERTIFICATE OF COMpL`.IANCE IWD AUiHORQATION OF ENTRY: I certity under penalry ol per�ury thet I heve read this application and slate tha� Ihe iniortnatlon glven is I
correct I agree ta comply with ell'stete lews�.end�ciry�ordinances relating to building construclion, end authorize representetives of the Ciry of Costa Mese lo enter upon the
ebove-0Bscdbed propeRy for InspecGon purpo5es.`a�ree not to occupy or ellow occuDency of any builtling euthodzed by this permit until final inspection.
. i /1/1 � i /
COOE �.
1816
1286
200
201
202
203
204
24a&a6
Fixed System Flnel Fire PravenUon
Pool Spa Finel
Final Re-Roof
Final BIocWRelpining Well
Finel Fectory Fire Plece
Finel Sipn
Final Demolltion
pe¢ II{�E15
/
• u ��W
l�
CO�E I INSPEC710N TYPE
208 Finel Mechenical
20B Flnal Plumbing
210 Flnel Electdcel
212 Finel Fre Prevenuon
220 Flnal Plenning Approvel
222
250
Final Site
Finel BuilCing/Occupenty
�.�;�,-,,;,,.,�
m
(714) 754•5273 • Fex (714) 754-4856 • www.ci.coste-mesa,ca.us
Job Address:
Suite No
vicinlry:
Parcel Nunmber.
APPlicant:
Atldress:
770 W 17TH ST
42408115
SCOTT BROWN
Owner: FOOTHILL FINANCIAL L P
Address %INVESTMENT MGNT SERVICE
NEWPORTBEACH,CA
1575 PLACENTIA AVE
Convactor: SUPERIOR SERVICES
Address: 1006 E SOUTH ST
ANAHEIM,CA .
ISSUE FEE
Temp service lest
Res. alc package
New Res (1•2 units)
New Res (3+uniLs)
Pool / Spa
Lightlng �Fixls
Recept OuUets
Switches
Non Res Appt
Res Appf
Service to 200a
Service to 1000a �
Service over t000a
Motors to thp
Motors to 7Qhp
Motors to SQhp
Motors to 1QOhp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Cirwits
ELECTRICAL PERMIT
Phone: 714-883-4796
Zip:
Phone:
2ip: 92663
Phone: 714-502-0240
Zip: 92805
License: 463579
s SCOPE OF PERMIT
REPLACE 400AMP SERVICE W/A NEW 800AMR SERVICE AND 8 SUBPANELS
E23.50
ao.00
$0.00
$0.00
$0.00
ao.00
$0.00
$0.00
$0.00
$0.00
50.00
ao.00
$62.15
ao.00
$0.00
50.00
ao.00
$0.00
so.00
$0.00
$244.00
$0.00
50.00
Quantity
�,�.i �.1� �-N �Y
- FEE SUMMARY
-Temp Dist System / Lighting
s�5�y noo e
Standing Section
Misc ElecVical Equipment
Trensformers up to 1 kva/kw
� ..:.............up to 10 kva/kw
................:up to 50 kva/kw
.................up to 100 kvalkw
..................over 100 kvalkw
Low Voltage Equipment
Low Volt Wiring Syslem / Ckt
Misc. Conduit
Misa Conductor
Circus ( gen or ride) .
Ciras (mech ride or lights)
ChrisMas Tree Stand
Fireworks Stand
Other Electripl Fee
InvestigaGon Fee
Plan Check Fee
Reinspection Fee
i i rNin uni v c, a.w i h mwn, �... acvice
Status: ISSUED
Applietl: 02123/2004
Issued: OZ/23/2004
ISSUED BY: S / Ci
Quantiry
ao.00 0
so.oa o
$0.00 0
so.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
50.00 0
ao.00 0
50.00 0
50.00 0
$0.00 0
$0.00
so.00
50.00
E0.00
NOTICE: Tha work authorized by �his permit shall comply wlth all applicable handicap access requiremenis under California statutes and related
regulatlons. (Ord. No. 92-28, § 1, t2-21-92)
EXPIRATION: This permit shall eutomaticalty expire and become void it 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
requlred Inapeetlona and finel approvel must be obtained. Failure to obtain Inspections and final approval will result in ihe expiration ol this permit.
FOR INSPECTIONS CALL: (714) 7545626
znaaas �e�oo)
WORKERS'COMPENSAnON DECLARAnON: -
I hereby ettirm unAer penelty ot perjury one ol tho lollowlnp declaretlans:
❑ I have end wlll melntein e certificete ot consent to sell�lnsure lor workers' compensetion, es providetl tor by seMion 3700 of the Lebor Codo, for the peAortnence ot Ihe
work for whlCh Ihis permit 15155uetl.
❑ I have enG v�l malntain workers' compensatlon insurance, as repuired by secfion 3700 al Ne LeDor Cotla, for ihe pertormance ol Iha work for which lhis pertnit Is issued.
My wwkers' com0ensatlon Insurance cartler y number ere: y/�
Carrier. 2 Policy Number: � i�!'J 1 Li � Z � I
(This secfion need not be completed N ttie permi Is ve/ue et one hundred dW/ars /5100) a less.) �
❑ I cerlify ihat in ihe performance ot e tor I ich ihis permit is issued, I shall not employ any pereon In any manner so as to become subject lo the workers'
compansation lews ot CaliFomia n ree t it I should become subjecl to the workers' campensation praWsions of Section 3700 0l the Labor Cade, I shall toMwith
comply vrith these provisions. -7 � %
_` Appllcant Sipnature: Dale: C.,� Z� —dY'
7 WARNINO: FNLUFE TO SECURE WORKERS' COMPENSATION COVEMOE IS UNLAW FUL AND Sw1LL SU9IECT Ml EMPLOYER TO CRIMINPL PEWILTIES AND CIVIL FlNES UP TOONE HUNDRED
hKK1SAND OOI.URE (5100,000), IN ADDITION TO THE �ST OF COMPENSATION, DAMAGES AS PROVIDED FO{i IN SECTION �O60F THE LABOR CODE, IMEFEST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby aNirm lhat I am
torce enC eNect. LJc. a_
� Comraclofs Signature:
��
with Sectio 000) of Dlvislon 3 oi t�e Bi
C� Class A
Dete:
Code, entl my license is in full
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby aKrtn �hat �here is a construction lending agency tor Ihe peAormance of �he work for w�ich Ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lentlers Name: Lendefs Address:
Signawre: Date:
OWNER-BUILDER DECLARATIONS:
I hareby aHitm thet untler penalty of perjury that I am EXEMPT FROM TNE CONTPACTORS LICENSE LAW lor ihe tollowing �eeson (Sec. 7031.5, Business en0 Protesslons
Code: Any ciry or county which reQuires e permit ta construct, eltar, Improva, tlamolish, or repair eny structure, pdor to its issuance, also requires ihe appllcant for such permit
to file e signetl statement thet �a or she Is Iicensed pursuam to Ihe pravisions of the Contrectors License Lew (Chepter 9(commencing wlt� Sectlon 7000) of Division 3 of the
Business entl Professlons Code) or that he ar she Is exempt therefrom end ihe basis tor the elleped exemption. Any Nolation of Sectlon 7037.5 by eny epplicent far e permit
subjects lhe epplicent to a civil penelry of not more than Iive hundred dollers ($500).):
� I, as owner of the property, or my employees wiih wages as their sole compensetion, WILL DO THE WORK, end the struciure is rwt intended or oHered tor sale (Sec.
7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of properry who huilds or improves thereon, and who daes such work
himself or �ersell or ihrough his or her own employees, provided that such Improvements are noi Intentletl or oHeretl for sale. If, however, the 6ullding or improvemen� is
sold within one year ot completion, tha owner-builder will heve the burden ot proving that he or she did not build or improve for purpose oi sale.). '
❑ I, as owner of Ihe properry. em E%CLUSIVELY CONTHAC77NG WITH LICENSED CONTAACTORS to construct the prqect (Sec. 70a4, Business and Pmfessions
Cotle: The contractors License Law tloes not eppy ro an owner oi property who 6uilds or Impmves Ihereon, and w�o contracts br such pro�ect with a coNrector(s)
license Dursuant to the CoNrectors License Lews.).
❑ I em exempt under sec. Business end Professions Code lor this reason:
Signalure: Date:
Owner ID vedfletl by tlnveYs Ilcense. ❑ Ves ❑ No Dnvels License No.
Vedlicetlon ol Ownership by (rype of daument, I.e. - property tex 6111 or tleatl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTiFICATION:
Expires:
❑ I hereby ceniry thet no excavatlon five (5) or more feet in depth into which e person is requireC to Gescentl, will be made in connecilon with work euthorized by ihis
pertnil, and that no building siructure, scaHdtling, lalsework, or tlemolition or dismantling thereof, will be more than �hirry-six (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title 8, Celitomla Atlminisiretive Cotle).
❑ As owner-builder, I will not employ anyone to do work which would require e pertnit twm the Division ot Industrial Safery, az notetl ebove, unleu such person hes e
parmit ta do such work irom ihe division.
SlgneWre:
DlWslon o1 Intlustdal Safery Pertnit Number.
Date:
GOUE �. INSiECTIONTYPE
1618 Fixed System Final Fire Preventlon
1268 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202
z03
204
Final Fectory Fire Place
Final Sign
Finel Demolition
pegi ixTrtu�s
COOE I INSVECTION TYVE
206 Finel Mechenicel
20B
270
212
220
Final Plumbing
Finel Electrical
Final Fire Prevention
Final Plenning Approval
222 Final Site
250 Flnal Building/Oaupenry
�•1.11�G11111.141
�, z�-o S �
-,�
- �� _� s6iz
CC�STA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX D17 COBTA MEBA. CALIPORNIA
For Applieanf fo Fill In Complefely
� TYPE OR PRINT
BUILDING . ,� / �
ADORE66
COSTA MESA CALIFORNIA
� AR' TECT
E(/��ST
�S�'t' NO�i �'�O i�(
d ur���L No: r;
r. �n s7- Srvt% �+u>
�ar _ u� <F- .
_ r�,
No.
,��„ I Na. OP BlDGB. h
�E . EC,�I�I��
� I,� ,
„P�/ � U"" FINANCE DEPT.
�% CITY OF COSTA MESA
� APPLICATION FOR PERMIT
BUILDING
For Office Use Only
NHCfi1PT NO. P6MNIT NO.
BY I D/ _JAIN�
BUILDING
ADDRE66
COSTA MESA. CALIFORNIA
FIRE ._ _T . .
ZONING "
1 I NO. OP' U8H OF NEW
`PLAN9 HUII.�tNd
: o„ n fn „a
�HRRC OPN6TREETM `� S REAR YARD IS`S tcenTHx uH¢ sr.�
FRONT
Y [�
SIDE VARD ILEFT � RIGHT J R.SIDE
DESCRIPTION OF WORK
� E%TERIOR
AND
�
� ff � � P�
EVES
r
1 HEIiEBY ACKNOWLEOGB TMAT 1 HAV6 q[AD TNIB APPLIGTION TMe ANOUM 6HOWN UNDER VALUATION IB FOP THE
AND BTATE TXAT TXE AdOVE I8 GORAGR AND �GR6H TO COM- pUHP09L OP E8TA0LIBNING A PERNIT PHE ONLY.
PLY WITX �LL CITY ORD�NANCCB AND @iATB LAWB RHOUL�TINO
BUILDINa CONBTRurnON• �� VALUATION r
61GNATURB OF �'ERMIT FEE $ �J •�+
PERMITTE $�yD�O�� PUN CHECK $ J �jS
AUTHORIZED AGEN7 , // 1 �
5
O
¢
!.
-- `�� .. " 20 I 66 �/'yY
'COSTA MESA BUILDING-SAFETI' DEPARTMEM
P.O. BOE 91) COSTA MH6A. GALIFORNIA
For Appliacnt fo Fill In Completely
///��� �'YPE OR PRfNT
BUILDIN6��%O � / ��Q
ADDRESS /
COSTA MESA. CALIFORNIA �
I M � '�
OWNER vs c o7` /
MA�.e�ee �/ � � �r �"L
� ARCHITEGT
o�y
ADDR888 �/ m . ✓`� � ( � '
cin C, � � l . .
LIC.TNO��� /�QJ /'J NO./ % / �/
91ZE No.aPe
OF LOT Now oN
USE OF
E%ISTING BLD6.
BETGACX lANE PNOM
<ENTER oF erRHeT REAR YARI
SIDEYARDI LERT I RIGHT
DESCRIPTION OF WORK
BUILDIN6
SIZE
EXTERIOR Ws� �
TO
I X8P8BY ACNNOWLEbOH TX�T 1 MAVB RGD
AND BTM1TE THAT TXH ABOV6 I8 CO R A
PLY WITH ALL CITY OpDINANC88 BTAT
BUILDINO CON9TIiYRION.
SIGNATURE OP
PERMITTE
AUTHORIZED AOHNY
�' 1
� FEE RECEIVtD
r,�FiTION FOR PERMR
R6C61PT NO.
er
ZON[� 1I NO.01�Y I UY60PN[W C` �"-'
�\1�Tt PLANB OYILDINO �
or.�ecRinion ll`Q It ��l �' � Q U—Lal'�S�
A.PNO. �I11T":tll`�`��Q�71N
NOTE: NO HA E OVERHAN6 BMALL BE LE55 THAN
90•TO8IDHQRHARP.L. �
8AVE3
ALLOWED �U. B. C. REQUIREMENT'
YARDSAPPROVED YARDSAPPROVED
MAIN BUILDINO ACGESSORY BUILDINO
VAR. iC I DATB
THE AMOUNT eNOWN YNO¢R VALUATION 18 FOP TH8
PURP09H OP BeTABLI6XIN0 • PEHMIT FEfi ONLY.
�LUATION
� PERMIT FEE S
�\ �_
PLAN CHECK S
, ' ' 22�ss
'•tOSTA MESA BUIIDING-SAFETY DEPARTMENT
P.O. BO%D1] COBTA MHBA. CALIFORNIA
For App���ont to Fill In Completely
TYPE 1O,R, PRINT
BUILDINO / / O W. I
A�DRE59 � �
COSTA MESA. CALIFORNIA
OWNER `�� �M ��� � RUSCO�
ADDRE68 �� GRl+N� /`FV�•
cirr SO. P�S.�'DE/I�ii rTio�J-/ f�l
11.� -� 1'i �Sfi . S�z.
��
wooResa
CITY �— 1"'
STATE TBL. l--_._
LIG. NO. NO.
SIZE �� �{ Z v� NO.OP�LDOB. '
OF LOT ✓� � NOW ON tAT
USE OF
EXISTINO BLD6 I T 2s. V
eara�cK une rnorn n �
DESCRIPTION OF WORK
�i 8"OU,�o. oF
ROOMS
Nq{.t . _f.l ROOR
OF
I 1 HEREBY �CRNOWLBDOE TH�T 1 XAVg qg,�p {HIe �PPLIGTION
•NO BTATB THAT TMg �BOVe IB COpRECT ANU �ORHe TO COM.
PLY WITN ALL CITY ORDINAHCBB AND BTAT[ Ly�'9 q80ULATINY
OUILOINO COrvBTRUCTI If. �
� ,p.� n-,
� AUTHORIZ6D A6ENT
FEE RECEIVE
pUG 11 1964
FINANCE DEFT.
��iY OF COSTA MESA
APPLf TION FOR PERMR
BUILDING
For Office Usa Only
flHCHIPTNO. _ �EHMIT�O.
l�
��M �( I rune 2 I eu �oPxceWg��
�a�� P,- L,�- 7os.�'4.r,t•y
ov���n�or q/ �
A.P.NO. lIV � ZII'� � / 730
HOiE� NO EAYE OYERHANO BHALL BE LES9 THAN
YARDBAPPROVED I YARDSAPPROVED
MAIN BUILDIN4 ACGE6SORYBUILDINO
L.BID PT. " FT•
RHAR 6s --T� — �.
DI6fANCE BiT. Q-f B6T. MAIN Q
MAIN BLDGS. s0 � AGCH55. BLDO
VAR.# DATE
G. U. P.7i APPROVED
MPROV6DC�A/n_ _ n�rr U//
TMe AMOUNi BNOWN UNOEp VALUATION 18 POq TN8
PURP098 OP 88TABLI9HINp A PHHMIT PEH ONLY.
0
- ;���� ��99�
. �
, COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
FS
W
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F
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a
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r
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For Applicant to Fill in Completely —
ADIDRESS ! �( � � i / ! 1
OWNER
MAIL
CITV
CONSTRUCTION
BflANCH
ADORESS
ARCNITECT
RESS
fRACTOF
ADDRESS
CITV
STATE
LIC. NO.
512E
OF LOT
USE OF
E%ISTNG E
Ink Only
1/
TEL.
NO. �
L.
TEL.
NO. - •
CITV
LIC. NO.
NO. OF BLOGS.
NOW ON LOT
Separate permits are requirod for
electric, plumbing and heating work.
UILOING AND WORK TO BE PEPFORMED
I hareby ecknowleApe thet I hava raetl thi� application antl stnte
Mat Me above ��formatlon is eorre<t and a0�ae to eomply with
all lews reBulet��9 builtlinp conrtruction, entl I shail not amploy
any perwn In ��olatlon of the workman's compensallon laws of
Me Stata of Calitomle.
I harnby cartify Mat I am proporly Ilcansatl ae a conttacior undar
Ma Stnro ot Cal�fornle Businesa entl Profaulom Coda, Divlalon 3,
Chepter 9, antl that such Iicensef are in full fotce entl effxt, or I
am exempt froT ffia provisfons of thu Srote of Celifornla Bvalnan
ontl Profuaslonf Cotla, Divislon 3, Gheptar 9.
i
Sipnaturo of
Parmlttae
AuthorizeC Ap t
���; �ii iii: �: �i: ��-
;.77, "/1 ;/i'. 7:.�I'::'.:'.:
:.%�/, .. .� . �°.'F �,
APPLICATION FOR STRUCI'URAL PERMIT
A.P. NO.
BUILDING
AODRESS
OWNER
NO. OF
PL/1fS �
VARDSAPPROVED
BET
VALUE
DATE
VARDSAPPROVED
CCESSORV BUILDI
0
BET. MAIN &
THE AMOUNT SHOWN UNDER VALUATION IS FOR
iHE PURPO6E OF ESTABLISNING A VERMR FEE ONLV:
VALUATION PERMIT FEE S �}�
� ,� �) PLAN CHECK E
�-ri
$ .Q.I�I `� TAX E l�.�J
//(/ t
TOTALPAID §
n
m
i
0
m
N
�
m
n
e
N
m
m
0
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;
Citv of Costa Mesa •-�`--•
TO Department of Buildinq and Safe
695 West 19th St,
SUH,TECT:
.o�o �
PLEASE REPIY Tn �
770 SV. 17th St.
F_RQM_.
'� OY,D E. WEAVER
STRUCTURAL ENGINEER
223 EAST SEVENTEENTH ST.
SANTA ANA, CALIFORNIA
�+
o� CAsa paQti'
DATE C�
SIGNED
SEND WHITE AND PINK COPIES WITH CARBONS INTACT. PINK COPY IS RETURNED WITH REPLY.
ONAYRflC CO.. BROOKLYN DII. N. Y.
City of Costa Mesa
Building Safety Deparlment
P. O. eoz J17
Coi1n Mem, Colifotnio
CERTIFfCATE OF OCCUPANCY N� 2258 C
The Building located at ��• 17th Streot, F, G& 8� i
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Grovp F 2 Occupancy.
Use of Building ��a�'�'iC1$ Bit11a1II�
Legal Description A• p• 1�1.16-211-29
(Sae ravena side for Mete� and Bounds)
Building Permil No. �� Eledrical Permil No. �3S�T Ptumbing Permit No. ��
Floor.Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. —
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
u�til the owner or operator has been issued a valid certificafe of occupancy by the enforcement agency.
(b) A new certificate of occupanty shall be obfained whenever there is a change in:
1) Occ�pancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apaAments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article S.
Number of apartments— cnd/or guest
ISSUED TO: Building Official
GTII�I.L1M J. TIiUS00'1"P br �• �2?- c..
Dare ���/ �is
This CeAificate of Occupancy SHALL BE posfed in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of the City of Costa Mesa under SBC. $Ob �B� U.B.C. Form BU3�IM-1t-83--,4-H P
• BUILDING SAFET SPARTMENT
P, O. Bos No. 317 �
� : �713 �
C6sta Mesa, Calltoruia � ^ . / �`�
Da
l� �!
CITY OF COSTA MES
CERTIFICATE OF OCCUPANCY
���/��� ��� �� ��sG�
Building Permit No�'�c�E.lec¢t n_'cal Pern No •''`� Plam6ing Permit No
vse ot auaain> . C' .//.s��SO — ��.�/r/.✓� �7'3'✓L�S.
Th�e building
Legal Descripho v cv i�„� ; i� i
(See reverse side for Metes a¢d Bound
has been inspected and found to comply with f
/
ances applicable thereto for a Group �
ISSUEq TO:
�1,.,�,t°��• <.%za:r,�v7�'
ro �(� or s�ua;og�
CC: ❑ Origin K-Owuer ❑]st copy—Gas Co.
Form 208 SB P IM 1-60
provisioas of all City of Costa Mesa Ocdin-
City Building ftici
B,��—L
❑ 2nd opy Edison .❑ 3rd copy—File
GENERflL TESiING & INSPE��iON flGENCV� INC. ]019N•KIIvATRICK . PORTLANDI7,OREGON �
Lumber 6 Preservative Inspection �_ Fieldwork -- Iaboratory P. O. BOX 5622 BUtle� 5-367 i �
CERTIFICATE OF CONTINUOUS INSPECTION Page �of �
OF GLUE LAMINATED MEMBERS [+Cp � �y �nC�
Date 6-8433–T S J� r- r J V
FOR: TRUSCOTT BUIIDIPl6, 770 West �7th St.� No.
Costo M�=A ��!.i.,f�u:I,o�
R. D..�TRICK, 550 West Beach Ave., Inglewood, Calif., Engi�eer
DUKE TIMBER CQNSTRUCTION CO., 550 �'uest Beoch, Inglewood, Calif.
AT: TIMBER STRUCTUR�S, INC.
P. 0. Box 3782
Portland, Oregon
MATER
1 6337B 1
SPECIFICATIONS:
L U M e E R - qLL O(
�RULES 1 5 6 W. C. L.
MK NO. LUMBER
COMBO
Moisture Rang
Slope of Scarf
Tvoe of Glue
LY
Their No. 64-1689
7" x 24-3/8" – 49' 6° one end wild
iUGLAS FIF GRADED IN ACCOROANCE WITN W, C, L, A,
A. 6 U, B, C_ SPECS FOR GLULAM MBRS_
I.AMINAT10N5 GRADE pqqq, SLOPE
OF GRAIN
Appearance Grade
Finish Coatina
1
PER SHOP PRINT LUMBER
MARK I PCS. GRADE M C
Variation
$eparatior
Glue Spec
Glue Spec
INDUSTRIAL
&
DB I RH
SEP �`� '�" •
2n m�•j"nf C�sta PAeSa
Bui;dinl GeDi.
INSPEGTOR'6 REMARKS
v ,'/2
. ✓
er Member 5� �
well scattered in tension a ea
MMM—A-125 � ' /
arence
Pro�e
/o %
D r�' —
�73D �T 170=7
MUMIOITV MSGL • IN MINUTES P.5.1. DATE
IRABRRIGLUEI G�yTE I CLIOGK Tli E CUMPI TIME I PRE55 REMARKS
PIRST TOTAL CVRE CUMP @
ST PULIN CLAMP
THIS IS TO CERTIFY THAT THE WORKMANSHIP, LUMBER AND GLUE IN THE 6LUED LAMINATED STRUCTURAL
MEMBERS AS COVERED BY T�{IS REPORT WERE CONTINVOUS Y.1{J 3PEC D BY THE UNDERS�Gf1 E9 /1�L� OUND
TO CONFORM TO THE SPECIP�CATIONS AS NOTEDt per �1(ilOer ��ructures prinT (�Y10��
Stendard S ec�a}�'i�� Tor�S4ructural Glued Lamineted DF (Coast Reaion)
um e� 1�� ev.
� //.��.-
r L/
U� � ' ,/'u � �� CERT.IFIED BY
C K ( � � INSPEGTO
THIS C TIFICATE REFERS ONLY TO THE FORM AND ,c'�
CONDI"fION OF THE MATERIAL AT TIME OF IN8PEC- �y � 6_�
TION, /
.. r � . � � .
GENERflI iESiING & INSPE���ON RGENCV� INC. 2019 N KI�raTRICK PORTLAND 17,OREGON
Lumber & Preservative Inspectioa -- Fieldwork --Iaboratory V. O. BOX 5522 BUNer 5-3631
CERTIFICATE OF CONTINUOUS INSPECTION Page �of�
OF GLUE LAMINATED MEMBERS Date 3-/y-63
FOR:INDUSTRIAL BUILDING FOR tYIILIAM J. TRUSCOTT�No. 6-6617-FP
770 ��. 17th, Coste Mese, Celif.
RICHARD D. KILPATRICK� 650 4V, Beech Ave., Inglewood� Celif., Engineer
QUKE TI6i8ER CONSTRUCTI�V� 550 W. Beoch Ave.� Inglewood� Calif,� Contrector
A7; fLUOR PRODUCTS C0.
P. 0. Box 1267
Senta Rosa, Calif.
MATERIAL TALLY
2 B-1 7" x 24-3/8" - 48' b" one end wild
SPECIFICATIONSi
L U M B E R - qLL DOUGLAS FIR GRADEO IN ACGOROANGE W ITH W, G�, I
�RULES I 5 & W. C_ L. A. & U, B. C. SPECS FOR GLUTAM MBRS.
LUMBER
MK NO. ______ LAMINATIONS GRAOE PARA.
Moisture Rang
Slope of Scarf
Tvae of Glue
Appearance Grade f o� ,
Fi�ish Coating No�e
Inspector's Remarks: .
PER SHOP PRINT
MARK I PCS.
Variation per Member
Separation tvnl I e�
� Glue Spec.
Glue Soec.
oF 9 ry MUMI�ITY MSGL
LUMBER TEt.nPERATUFE GLUE
GRADE M C OB � RH I LBR I GLUE WT.
/ •// 7n Ae l.fl 7 7�l
Their No. Pr1-3457-F
SI.OPE
OF GRAIN
Cember 2" � CL
INSPECTOR�S REMARKS
CLIOCK Tli E I CIAMTPI TOMEI I GVRE I P E55 I R MARK:
ST PULIN CLAMP
THIS IS TO CERTIFY THAT THE WORKMANSHIP, LUMBER ANO GLUE IN
MEMBERB AS COVERED BY TH18 REPORT WERE CONTeralliJKA,�RI�
TO GONFORM TO THE SPECIFICATIONS AS NOTEDt P ��
Sfende�d Specifications for Structurel Glued Lnm
NAT
Lumber 1960. Y✓,� 3//9
� � CERT.IFIEo BY �G!/Z�f ! / ��
CHECKED BY � ' 1 INSPEGTOA
THIS CERTIFICATE REFERS ONLY TO THE FORM AND
CON�ITION OF THE MATERIAL AT TIME OF INSPEC - � 5-�
TION.
�
�
�ooncssa ew�nuc: // U W 1/�l�H S 1
a�mexswuiesva�ovm: JACKSON, REGINALD M
. mo�ss: $STARBRUCK, DAVID
732 —D ADDISON ST
BERKELEY,CA 94710
li]PL. Y4WIO /i00NE59:
41CNIfECT OP FNfdl6A:
AXCH OP ENd'4 /�DDPE55:
i i
uN.: � CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 073704 PLAN CHECK NO: 03162-95 S
CONSTRUCTION TYPE: PERMIT TYPE: STR
PERM NO: B 073704
GOVT: N SUPP: N
PURPOSE: OTH
ucra: IJOB DESCRIPTION : REPLACE 20LF WALL W/CITY STANDARD BLOCK SQ FT: 20
UNf:
CLAIM VALUE: 400.00 CALC—VALUE: 400.00 GROUP OCC: B-2 /
c«+m,�crarsru�: MUNIZ CONCRETE ( 714 ) 650-4669
CONfiIACTORSYNIRlC 2013 PLACENTIA AV
�uo�ss: COSTA MESA CA uaw_ 489989
92627 uxr:
LICENSED COHfNACTONS DECL�PATION: I Mreby eltim uMer panaYy d paijury ihet I em licemed uMs pw'mbna d CMpm H
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ode: CL ^`L11 �-- �' �) cdnmaa:
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a�.
De�e: ACd��
1
W ONKEN'S COMPENS�TION DECL�RATION: I herelry elfmn uMu perolly W peijury wn d tM Idbwiiq detleiatiom:
� IheweMwlmeinlenecerlAieatedmmenlioaetlimurebrwvkeea'eanpenealion.npwidedfab/SeeVmJ]OOd�MLebar
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LENDEN'S NAME:
LENDEfl'S ADDPE55:
I cenJy tAa Ilave nM tM1i+appliceiion vd ame �Mt Ne aErne inlammnn ia cortaq. I prae to comply wah a0 ory W rnmlY �inances
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�°`��'D"�"' 2KUR�T MUNIZ
(5t5t-a6.WP)
_ � .
8 Selary; Greer�Fle; Cereiy-Appican�: Pink-Revanue: OdCmrod-Avmssa
COMMENTS: CITY STANDARD BLOCK WALL
*�*�****�*��***�*****�*�*+�***x�r�r****+�x�*****�*****�**��****�r�**+r*���r****�*+r*�*�
Z O N Z N G R E Q U I R E M E N T S
S E T H A C K 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
PARRING REQ� PROV: PARCEL: 42408115 ZNE: MG REF NO:
PLANNING N6TES> 6 FT HIGH HLOCKWALL, 20 FEET LONG EVEN W/FRONT OF BUILDING
> (25 FT SETHACK—FRONT).
iE iF iF iE')F iE iF if 1k 1E 1I' 1F iF if'If iF iE'IE if 1E iF iF 1f ik iE'IE'N"N"IF iE iE ih')E ii 1E iE'lE 1E iE 1f ih iE if iF iI' it 1F iE if if'If iF if 1f if iE if iE'1F if'If 1I"lf iE if 1F ik iE iE if iE iE iI-iE'IE if if if ii'
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 S ('
ZONING APPROVED HY �CA DATE: � �l`
BUZLDING APPROVED HY : DATE:
APPLICATION ISSUED BY: DATE: � �i
iEiEiElFlkiFiElEMiflfif�lElfjfiEifitiEifiFiF�iF iE1EfE9EikififlfiE�E jEaE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 15.00
PLAN 9,75 SMIP/NOO—RES
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 15.50 0.00 9,75 25.25 25.25 .00
REVENUE DIVISION TOTALS--> COLLECTED: 25.25 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
15.00 .50 9.75
�it*+�****it**�*�*�*at�iE**�t*�**iE*itieititetat*x�*��******�x�ititatit�***�**rt*itit**at�*it*at*�***�**
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFC 20 RES—CONCRETE BLOCK WALL / FT. 20.00 400.00
END OF FEES
EXPIRED ,'-1
DATE � ' CO — � � !�V "
01 00127z?s—ODlP%93.'•. �i`c7 T 25 ?�
DRTE: �JS/p9/9S Tlf;E� 1G:36
� •
•CONSTRUCTION ANP PLANNING P00� a SPA
' APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
• 1. Temporory Electrical Service or Pote 52. Pool & Equipmen[ Loca[ion I ;
2. Soil Pipe-Undrgrnd. - _ 53. Steel Reinforcement � �
�- 3. Electrical Conduit.U;ility-Undrgrnd. 54. Forms � .�
� 4: Electrical CondU'rt�Undrgmd. 55. Electrical Bonding ' �
-�5, Steef Reinforcemenf , 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
'7. Footings _ ' a/S 56. ElectricalConduit-Undrgmd.
. 8. Foundation • -- (� 59. Gas Pipe, O Undrgmd., Test
_ 9. Water Pipe�Undrgmd. ,U _. 60. Backwash Lines, P�Trap, O Uqdrgrnd.
•10. Svuctural Fioor Svstem 61. APPROVAL TO DECK �� ,--
11. Property Sewer Line & House Connection `�
_ 62. Backwash & Receptor-Final
� �
12. Sewer Cap ' .� , 63. Heater & Vent-Pinal �•.
13. Roof Drains . 64. Plumbing System � Finai ' .
' 74. Rough Plumbing � . ' 65. Electrical-Final . '
�
15. Rough Electrical-Conduit � 66. Solar System-Final ' �
16. Rough Electric Wiring , 67. Fencing & Access Approval
77. Rough Wiring Sgn � 68. APPftOVED FOR PLASTERING �
18. Rough Electrical;T Baf Ceilinq 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Ait Conditioning FIRE DEP7. REQUIREMENT
- � - n�
20. �iough Fattory Ficeqlace �� _' : � - � . APPROVALS^,r Permi[ # � �
21. Ducts, in StrUctura� ^�• '� - `� 70. ,�GnderJipund Hydro
�, - =n .
22. Ducts, V�ntilafing.�" , �" , � � :' �. . 71, Product Piping O Gas � Oil
23. Gas Pipe-Rough & Test � - .�r . _ , 7Z, Underground FtushM1 Y
24. Roof Framing�' ��' " " _ ` `'; 73: Undergrnd.Srorage�Tank,`-JGas ❑Oil
25. Roof SheaSh(ng � - �. F ��' • 74� Overhead HydrQ _ ' aC
26. T�Ba� Ceiling lStru2tural! & Moriqcoa[ ��` � ` '-i �' 75. Dry Cherrical -- ,:_ �1
27. ,Prame and Flashing` , - _ . � �� 76. Dry Stanclpipe �� � _ "� , �
Z8. Lathing & Siding ' ' ; "._ 77y FIXED S�'STEM PINAL � - � �
29. Insulation �� � • ' � 78: FIRE PREV. FIN�4L - ' 'F :
r ,,
30. Orywaii Nailing - ' " � x ,:H�ALTH DEPT.�REQUIREMENT �. � .
�, 31.'Plaster 8rown�Coat� _ : � �-'� : 79. FINAL INSPECTtDN � '^
32. �lectrical Power MeterPinai ' �, ; � i�� 80: FOOD CERTIFFCATE I$SUED�
33. Final Electric- . � � Notes: " • . + '• - -
34. Final kieating & Air Conditioning ` � . � y� � ' -
; r'� 'j ,
35. Fina� Gas �Pipe-Test • � . � ' �* - .
36. Hood� or Canopy � - ` � ? � � - ' - � .`. _
- n .Tn"
- 37. Einal Factory FirePlaoe =, -' + �
M
38. Finai Plumbing ' _ - `=` _ �.
' 39. 11/atei SeEdice�Final ^ _ , '' , �, � � . � �,� . � -
'� 40. Gas Service-Final � - ' ' ' - , � ' ' , ,
� 41. $olar pomestic•Finaf. ` ; .. • -. �
42. Backflow Preventer � � � � * - ` . '
43. Backflow Irrigation '� . ' '. � z � � �
44. Wndscape Irripation�System _ •� • ' " � � _ � .. _ '
- .�• - s Y
45. Sound Attenuation ; � - ;r - M - ` • -
Y
46. Handiwp Regulations -� - _ � - �
47. FINAL STRUCTUR.� & BUILDING . � ' -
�
48. PINAL PLANNING � "" � . � • -�� � " -
49. Electrie Fielease to Ed�son '_ . -
50. Gas Release to Southern California Gas Co ' ' . .
51. CERTIFICATE OF OCCUPANCY * �
NO Date
Existing
Building
I 770 W. 17TH ST
.
73
Curb 6 qutter
�
�
�
�.
}� ���� ,
! c+� or cosra Mesa
rlanr;,ti� r. Pr.
iUB7ER i0 LLDG. D T. !EO
' � DA
�q� �
�'l �dvt 770 '��
l5� r7y 7lob
93,
New b cklwall
Existing
Building
760 W.17TH ST
-� �— Y S
OF BUILDING SAFETY
;,QF COSTA tv1ESA
�r_.f .. �°� � `�C
� S7GIII51"QeT n is p a mes
� �� a�u � i ie wiuKw wr en
D�on from 6ie Division of BuiWing and Satery, Ciry of Casta Mesa.
The siampinp oF Ihls plan and specificaUons SHALL NOT be held to permit
a M be an approvel oi the violatian of any provisions af any City af Costa
�Mesa OrAlnarce andla Slate law. R^� �� ��
These D',�u end Dertnit shail e�ire by flmit ti n arM 6ecome nW and wid if
fhe butlding or work k not commer�ced and maintained actNe per UBC §30;i
(� wiUdn 180 days of issuance.
�,
2S
Cement Coping Oot�onal --
Channel Block With 1-3/8�
Horizontal Top of all
Fences
For Fences 5' or Less
Vert. Bars 3/8"Qi at 4' -0" O.C.
For Fences Higher Than 5'
Vert. Bars 3/8"� at 32" O.C. �
Fill Cells Solid With Grout
Where Steel Occurs
Reinforcing $teel Shall
Conform to Sec.A�15-39
A.S.T.M.
All Steel to be Lapped
24" or to Code
NATURALGRADE
7W0 3/8"th BARS
CONTINUOUS TOP
& BOTTOM
HORIZSTEEL MUST BE TIED IN
PIACE A7 TIME OF TRENCH
INSPEC710N.
TYPICAL 6" CONCRETE BLOCK FENCE
n
. F�-�—W'IOTH
p SEE CH�
' ' BELOW
oL
FOOTING REQUIREMENTS CHART
GENERAL- NOTES
MORTAR; p�e po�t Plastic Cement, and
Three Parfs Sand
GROUT; One Port Cement Three ana
One Holf Ports S�and
COPING: One Part Cement, 7hree
Parfs Sand
CONCRETE: W¢II Mixed 1:2-I/2:3-I/2
Max. of 7- I/2 Gal�ons oi
Woter Pei Sack of Cement
GROU7 MAV BE POURED FROM 7ME TOP
OF 7HE FENCE IN CELIS WHERE STEEL
OCCURS.
CELLS AND AREAS OF HOHIZONTAL REIN-
FORCEMENT SHALL BE CLEAH, CLEAN &
FREE OF ALL MORTAR DEBHIS, ETC.
�H GF E4RTNTCOTH
i/? Th1E HEIGTH Of FENCE
�LOW BOTTOM OF FOGT�NG
WIDTH . . . 14�� . 14�� . . . 12��. .
THICKNESS 10��. . ��
10 8".
DEPTH OF EARTHTOOTH 24° . . . 20�� . . . . . . . . . . . 16�� . . . .
SPACING OF EARTHTOOTH. . 12' 14' ..... 16'. .
City of Costa Mesa, California
Building Department
;zev.�� Nov. az
SCALE: I/2"= I'
12"
8"
12"
16'
�
�
.
W
W
Q
w
N
♦
�,
�
W
W
R
�
N
_ STREET �
�� AOp�icant to fill in all spaces ezcept Ihose within heavy borCer Ilnas anE si9� ali ap0�opriate tleclara[Ions.
CITV OF COSTA MESA CONSTR UCT/IONcP�RMIT , PERMIT NO. '� - TRACT NO. LOT NO. - UNIT NO.
ProjectAddress �70q�- ��,��� ( 7
�)� �—', I I Heinspection Fee
Canary - Applicanh Pink - Accountin9: Goltlenrotl - Assessor
Service Sink --
Sewer Connection
Solar Collectors �
Solar Piping �
Solar Tank
Swimming Pool w/Spa
Urinal' -
�Water Closet
•Water Heater ' �
�Water Service
� Auto-Wash�� �- _
' Laundry Trays
i lesue Fee
�Hood or Typel ❑
Canopy Type I I ❑ "
Retrigeration System �
❑¢ioo,000eru ❑ioo,000e
System��Repair/Alteration �
Fire Dampers � �
Registers '
i
laue Fee
FEES
—
A.P. # �
S Main Buildl
E .
T Front
B Rear-
A
C Righ
g ; Left
Ping. Ref. #
Planning Notes:
� �•
s
—
�
' � � AUtomatic Washei - -
; Construction Pole Sub. �
Cooking Unit �
Dishwasher � �
Dryers ❑Gas �Elecn
� Fan
F.A.U. �
Fixtures- � � - --
Device Boxes �
Outlets � ' �
Garhage Dispoul
Generator �P5 KW �5�15 KW
�$ 3� ,
, Rainspection Fea ' $15
FEES
�� DEVELOPMENT�SER,VICESREQUI
� - i 2onin8'Approved By
Building Approved 8y, '
Aootication Issued Bv '
$ 3
9�22 9/18/86
+ � i , - .,
Zone
Accessory Building:,
r4.� �-
��-
Parking Req./Provided -
; -17..00 Tl
�7RICAL , ' ' ,FEES
- Transformer � 15-50 KW - �
❑ 50+KW
Meter ❑up to 100 amps �
Meter ❑over100amps �
Sub Panel � . '
Motors �0.1 � HP 01 X- 8
Inc!Solar �9-15 HP �76�75+
Mittowave ' - , -
Pole Light • '
Range ` '
Si9n ��
Standing Sections' . �' •
Trash Compactor
. �.y �
luua Fee �
�
Z
O
N
1
N
G
R
E
Q
M
T
s
- I $ 3 I
�
��
�Date '� ' / . ' �
SUMMARV OF FEES' � - �
BUILDING PEfiM1T' $, ID.Oo � SMIP '$; �•��7
PLAN CHECK � � $ �. SO , pERMIT, ' _ �
PLUMBING � , $ , - ISSUANCE.`. $ �
PLAN CHECK � 25% $; � ENERGY P.C. $
ELECTRICAL , , $ � �GRADING S .
PLAN CHECK I 50% $� '. MICROFILM 5 ��`�,,�
� MECHANICAL� � $ � TOTALFEE $ _L��"�—
PLAN CHECK j 25% $ i �
CONSTRUCTION AND PLANNING - �C SPA -
.�� APPROVALS Permit # � Date Inspector qppROVALS Permit # Date Inspector
' 7: Temporary.Electriwl Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. " 53. Steel Reinforcement `
3. Electrical Conduit Utility-Undrgrnd. � 54. Forms �
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UfER Grnd. �• 57. APPROVAL TO COVER-GUNITE
7�. Footin s , `
9 58. Electrical Conduit-Undrgrnd.
8. Foundation ' Y � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. ' 6p. Backwash Lines, P-Trap, O Undrgrnd.
10. Struaural Floor System � • 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Final
12. Sewer Cap . . i • � 63. Heater & Vent-Final
13. Roof Drains • g4. Plumbing SYstem - Final
14. Rou9h Plumbing 65. Electrical-Final
15. Rough Electricai-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiiing 69. POOL/SPA SYSTEMS FINAL
19. Rough Fieating & Air Contlitioning FIRE DEPT. REQUIREMENT
20. Rough�Factory Fireplace APPROVALS Permit #
21."Ducts,in Structure �70. Underground Hydro � .
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test .72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar"Ceiling (Structural) & Monocoat , 75. Dry Chemical �
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78, FIRE PREV. FINAL
30. Drywa�l Nailing . HEALTH DEPT. REQUIREMENT '
31. Plastei'Brown Coat 79. FINAL INSPECTION '
32.,Electiical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: '
34. Final Heating & Air CondiYioning
35. Final Gas Pipe-Test
36. Hood 'or Canopy �
37. Final Factory Fireplace '
38. Final Plumbing -
39. Waier 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. FINALSTRUCTURE&BUILDING - �. 3a5 !lFQ• (�BC O�
48. Special Requirements Completed
49. Elearic Release to Edison � . , .
50. Gas Release to Southem Celifornia Gas Co � . •
51. CERTIFICATE OF OCCUPANCY
No � Date •
_�
ADO���ant to fill in all spaces eacept t�ose within heavY bortler Ilnas an0 sign ail appropriate aeclarations.
�OSTAMESA CONSTRUCTIONPERMIT
��Pr4jettAddress 770 W• �'7th $t.
Applicant's Mailing Address 1 iFi ('nmmar[`i dl W3V � C.M. 9267_7
Owner's Name Reaaie Jackson � Pno�e 851-0232
Address c/n 77� W- 17th St_� C.M. 92627
Arch/Eng. License No.
Address
ContractoYsNamnCrank Bros. Roofinq Coyhyq�e —
Address Imailing) 1ZE COffIfIIET�Cldl � C. M. 926G /
City License No. � `7�93
LICENSED CONTRACTOR DECLARASION ' '
I hereby affirm tnat I am licensetl untler provisions of Charter 9(commencin9
with secUon ]000) of Division 3 ot the Buziness antl Professions Cotle, and
my Iicense is in tull forc�anq„ettect. OHE%%
tJcense Class �3J Licen
Oate � � a-Z " i�7 Si9natur¢ —
WORKERS' COMPENSATION DECIARATION
�I hereby alfirm tnat I have a certificate of consent to 5¢ILinzur or a certiticate
Workers' Compensatlon Insurance, or a cer[ifietl copY � e�eof (Section
00, Lab. C ' '
Pollcy No. �85—$7�224 Comp YState �,lll _
❑ Certifl¢tl copY �S hereby fu�nisheE. y�
�(J Cer�iflC�SQPY H_fijetl with the city B i i STon:
Date f � � APPlicant R
E%EMPTION FROM WORKERS• COMPENSATION DECLARATION y
(Tnissection naetl nol be completetl if the perml[ I5 for one huntlretl (E300) or
less).
I certify that in tne performance of tho work for which this perm�t i5 issuetl, 1
shall not ¢mploy any person in any manna� so a5 to becOme subject to the
Workers' Compen5dtion Laws of California.
'� Date Si9nature
�i-NOTICE: If, atter making this tleUaration, you shoultl.become 5ubjecLto the
WOrkefs' COmpCnSdtion O�ovi5iOn5 of [he ISbof Cotle, you mu5t fOrthwith
comply with such p�ovisions o� thi5 pe�mit Shall b¢ tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV
1 h¢reby a18rm tha[ ttieie is a conSVuction 1¢ntlin9 aqency tor the performance
of the work for which this permit is issuetl (Settion 3097 Civ. C.)
Lentler's Name
Lentler's Aderess
OWNER BUILDER DECLARATION
I hereby aHlrm that7l'am exempt from the Contractor's License Law tor the
following reason (Secti6n 7031.5 Buslness antl Professional Cotle: Any city or
counry which requiree'a�permit to construct, alter, Improve, tlemolish or repair
any structure, prlor to its issuance, also requires the applicant tor sucn permit
t0 tile a slqnetl SlateTenl that he/she Is IicenSetl pu�suant t0 the provi5ions of
the Contractor's Llcense Law (Chapter 9(commencing with Section ]000) of
�DiviSion 3 of the Bu5ine55 antl-Prote55ion5 Cotle) or that he/she is exempt
lerefrom antl the basis for the allegetl exemption. Any vlolation of Sectlon
031.5 by any applicant tor a pe�mit Subjects lha aOP��Cant lo a civil
�enalry of not more tnaq five huntlretl tlollars (5500).
LJ I, as owner ot the property or my employees wlth wages as their sole
[omp¢nsation, will tlo Ihe work, antl the struc[ure Is not infontletl or otteretl
fOI SdIC ($CCSI00 J044. BU51lIE55 dOd P(OfC55�011d� C0f12: TI18 COf1[IdC[Of'S
License Law tloes not apply to an owner ot a proper[y who builtls or improves
thereon, antl who tloes such work bim5elf/he�SeH o� Ihrough his o� her own
employees, O�ovitletl that such Improvements are nOt Intentle0 or otferetl tor
salG. If, however, lhe buileing or improveTent is soltl withln one year ot cOm-
pletlon, the owner will have the burtlen of oroving he/she tlitl not bulitl or Im-
�rove ror [he purpose o/ sale). '
I, as owner of the pro0erty, am extlusively contracting with Ilcensetl con-
tractors to constru<t the project (Section 7044, Business antl Professions Cotle:
The Contractor's License Law does not apply to an owne� of P�op¢rty who
'. bulltls or Imoroves tnereon, antl who mnVacls tor zuth projects with a con-
tracto�(51 license pursuant to the Contra<for'S License Law). I am aware that
p�ooi o( their Worker's Compensation insurance ihoultl be provitletl to me.
� I am exEmpl untlet 5¢ction B. & P. C. fot thi5 rea50n
Da[e _
1 hereby
iniormatl<
antl state
5¢ntdtiV¢5
inspec[ion
Signature
Drivers' L
_ Owner _
Ihat I have reatl [h
�rect. I ag�ee to con
4�[ing to builtlinq u
: \city to enter up
�
applicatlon ana stata that the above
y with all tlry antl county ortlinancez
tr LI antl hereby au[horize repre-
h a ove-men[ionetl property {f.or
� Date/`2��^
- _
TVPE OF CONSTRUCTION LJ NEW LJ ADD �I, ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH � OTHER
DESCRIPTION OF WORK/USE OF BLDGREIfIOV2 existing; aop y
TVPE OF PERMIT U GRADING LJ FOUNDATION lJ STRUCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT OESCRIPTION SQ. FT. $ IOO oCCUPt� Y
CONSTRUCTIONTVPE COfflffl�T�Cl�ATION$ ��/�t
ZONE GRADINGCU.YDS. ACRES_
Remarks: � ' �
Sink
Preventer
IrrigatiOn
ng Fountains
Drains
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Y LUIVItl11V b .
ShoWers
Servite Sink �
. Sewer Cap .
Sewer Connection •
Solar Collectors '
Solar Piping . ' -
Solar Tank
Swimming Pool w/Spa �
Urinal
�Ui�CIS WdLEf (�.�OSEL
Water Heater �
Water Service
Auto�Wash
FEES
A.P. �p
S Main Building:
E
T Front
A Rear
C Right
g Left ;
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction PoleSub. . '
'- Cooking Unit
- Dishwasher '
� Dryers ❑Gas ❑Electric
Fan
F.A.U. '
Fixtures
Device Boxes ' �
Outlets
Switches
Garbage Disposal , .
Generator �0.5 KW�05-15
Reinspection Fee � $15 � � laue Fee � $ 3
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System � Multiple
Firepl/Fac[. Blt. ICBO �
Heating System & Ducting
❑4100,000 BTU 0100,000
Reinspection Fee � $15�
CMF 0865-46, rev. 30/B4 White - BuilCing: Canary - Applicant; Pink - Accounting; Goltlenrotl - Asse55or
Hood or - Typel ❑
Canopy Typell �
Refrigeration System
❑6100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
luue Fae
$ 3
• � 0717 ,I/22/87 '
Zone
Accessory Building:
i ,
TELECTRICAL �
I I Transformer ❑ 15-50 KW :
I�I ❑ 50+KW
Meter Uup m 100 amps ,
Meter ❑over 100amps "
Sub Panel ' - �
Motors �0.1 HP 01 h- 8
InaSolar �9-15 HP �16-15+
Microwave� '
Pole Light
Range
$ign ' '
Standing Sections
Trash Compactor �
� Reinspection Fee �� $15 � � luue Fee �
DEVELOPMENTSERVICESREQUIREMENTS: •
2oning Approved By
Building Approved By '
Appliration Issuad By
82081 TL
FEES
$ 3
Z
O
N
1
N
G
R
E
Q
M
T
S
( � FEES �
BUILDING PERMIT- $� SMIP � $ �
PLAN CHECK , 5 PERMIT
PLUMBING S ISSUANCE �$
PLAN CHECK 25% $ ENERG�' P.C. $- �
ELECTRICAL � $ - GRADING - $
PLANCHECK 50% $ - MICROFILM $ �(� �
MECHANICAL $ TOTALFEE $ _QQL(2_1—
PLAN CHECK 25%� $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date , Inspector qPPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement '
3. Eleccrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE .
7. Footings � 58. Electrical Conduit-Undrgmd. -
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash� Lines, P-Trap, O Undrgrnd. .
10. Structural Floor System 61. APPROVAL TO DECK
71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ` 63. Heater & Vent-Final
13. Roof Drains � 64. Plum6ing System - Final •
14�. Rough Plumbing . - � ' 65. Electrical-Final �
� 15. Rough Electriral-Conduit � 66. Solar System-Final .
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING '�
�18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ,
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Struaure 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test - 72. Underground Flush
24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74, Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe , �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEAI.TH DEPT. REQUIREMENT -
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes:
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. L'andscape Irrigation System �. '
45. Sound Attenuation �
46. Handicap Regulations �
47. FINALSTRUCTURE & BUILDING z �/� J
48: Special Requirements Completed •
49' Electric Release to Edison • �
50. Gas Release to Southern California Gas Cn �
51. CERTIFICATE OF OCCUPANCY
No. Date