HomeMy WebLinkAbout399 18TH ST - Building Permits.<
(714) 754-5273 • FaX (714) 754-4856 • www.d.COSta-meSa.Ca.US 77 FAIF DRNE, GOSTA MtSA, GA 9Lti'Lti
Job /+ddress: 399 E 18TH ST
Suite No A
Viciniry: KITCHEN
Parcel Nunmber:
Applicant:
Address:
Owner:
42502217
LEDERMAN, ERIC
8501 MARTINIQUE DR
HUNTINGTON BEACH, CA
JULIEN, DONALD F TR
ELECTRICAL PERMIT
Phone: 714-375-0722
Zip 92646
Address P 0 BOX 10208
Phone:
COSTA MESA, CA Zip: 92627
Contracror: ROVICS CONSTRUCTION WC
Address: 8501 MARTINIQUE DR �
ISSUE FEE
,� Temp service test
Res. a/c package
New Res (t-2 units)
, New Res (3+units)
Pool / Spa
Lightlng Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to thp
Motors to 10hp
Mobrs to SOhp
Motors to 100hp
Motors over 100hp
Communicatlon drops
Sub panel to 200a
HUNTINGTON BEACH, CA
Phone: 714375-0722
Zip: 92646 �
License: 800996
� Status: ISSUED
Applied: 03I01I2005
Issued: 03/01/2005
ISSUED BY:
X41���
� {�.3�
OA'��1"
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR KITCHEN REMODEL (NO STRUCTURAL WORK). INSTALL 1 LIGHT FIXTURE,
10 RECEPTACLE OUTLETS, 8 2 SWITCHES. -
POS00162
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$7.10
$11.00
$2.20
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
1
�0
2 '
0
0.
0
0
0
0
0
0
0 `
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Buswa'y /100 ft - ..
Standing Sec6on
- - Misc Electnral Equipment
Transformers up to 1 kva/kw
.............::.up to 10 kva/kw
...:.............up to 50 kva/kw . .
.................up to 100 kvalkw
..................over 100 kva/kw
Low Volfage Equipment
Low VOIt Wiring System / Ckt
Misc. Conduit
� Misa Conductor � �
Circus ( gen or nde) � .
Circus (mech ride or lights)
Chnstmas Tree Stand ,
� ,Fireworks Sland - � -
' Other ElecVical Fee � . �"
"Investigation Fee�
Plan Check Fee
Quantiry
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 ' 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
50.00 � -0
30;00 0
$0.00 0
$0.00 � , 0-�
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California slatutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced wi�hin 180 days, or if work is suspended or ebandoned
for a period of 180 days.
INSPECTIONS: In ordar for the work authorized under this permit to be considered legal, such work must comply with all appliCable CodBs, antl all
requlred Inapectlona and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaas-ae �eroo�
WORKERS' COMPENSATION DECLARATION: - —
I hereby ettirm under penalry of perjury one of ihe fWlowing dedarations: � �
❑ I heve and will maintain e ceniTicate at wnsant to self-Insure for workers' compensetlon, es prodded tor by sectlon 3700 0l the Labor Code, for Ihe pertortnence ot the
work for whith Ihis pertnit is issuetl.
�' ave and wlll maintain workers' compensatlon Insurance, as requiretl by sectlon 3700 of Ihe!Lebor Code, Por Ihe partortnance ot ihe work for whMh this pertnil is issued.
My workers' c ��-ti�on Insurance er end policy numbar ere: ,�
Certier: �/ fY/'C � P�yy,Number. � �S
(fiis sectlon neer/ not be canplefed ll fhe permit Is velued af one �undred dollers (§700) or less.)
❑ I certiry t�et in the pertormence ot the work br which this permit is issued, I shell not employ any person in eny manner so es to beL ome subject to Ihe warkere'
compensatlon laws of Celifomi - egree iha� If I should become suD�ecl lo the workers' compensetion provislons o1 Sectlon 3 60 Ihe Lebor Cade, I shall torthwith
comply with ihesa provisi , ( �
ApP�vitSigne�ure: � r�ete: . / C J
W�EMNG�FAICURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHFl1 SUBIECT AN EMPLOYER'TO CRIMI E TIES AND GVIL FlNE$ UP TOONE HUNDRED
TlIIX15lWD DOLLARE (5100,OW),IN FDOrt10N TO TNE W5T OF COMPENSATION, OMUGES AS PROVIDED FOH IN SECTION �OB OF TME CODE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirtn that I am licensed under pr I
torce end eHecL.Lic;.Y� .
CONSTRUCTON LENDING AGENCY:
9(commencing with Section 7000) of Divislon 3 of the Business end Profeulons Cotle, end my license is in full
❑ I �ereby attirm that ihere is e consiruction lending egency for Ihe pedormence of ihe work for which Nis Oermit is issuetl. (Sec. 3097, Civil Code).
Lentle/5 Name: LendeYs Atltlress:
Signature:
Date:
OWNER-BUILDER DECLARATIONS: '
I hereby eHirm t�et untler penalry oi perjury Ihet I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for Ihe lallowing reason (Sec. 7031.5, Business and Professions
Cotle: Any city or counry which requires e Oermit to consiruct, elter, improva, demolish, or repair any structure, prior to its issuance, also requires the epplicant for suc� pertnit
to file e signed statement ihet he or she is Iicensed pursuent to ihe pmvisions oi the Contrectors License Lew (Chepter 9(commencing with Sectlan 7000) of DlWsion 3 ot ihe
Business entl Professions Cade) or that he or she is exempt ihereirom end the basis 1or the ellegetl e:emption. Any vloletion oi Section 7031.5 by eny epplicent for e permit
su6�eci5 the epplicant to a civll penalry of not more than five huntlred dollars ($500).):
❑ I, es owner ot Ihe property, or my emplayees with wages as their sole compensetlon, WILL DO THE WORK, and the sWciure is not intende0 or oHeretl tor sale (Sec.
7044, Business and Professlons Coda: The Coniractors Licensa Law does not aDPly to an owner of properry who builds or improves thereon, and who tloes such work
himself or herself or ihrough his or her own employees, providetl that such Improvemants ere noi intentletl or oflared tor sale. If, however, ihe bullding or Improvement Is
sold within ona year at completian, the owner-builder will have �he burden ol proving that lie or she tlitl not build or improve for purpwe oi sele.). •
❑ I, es owner of the proparty, am EICGLUSIVELY CON7RAC71NG W17H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business anC Pmtessions
Cotle: The cantrac[ors Ucense Lew does not epply to an awner af propeny w�o builds or improves ihereon, end who contracts for such project with e contraaor(sJ
licanse OurSuan� �o �he Con�rettor5 LlcenSe LBwS.).
❑ I em exempt under sec.
Signature:
Business end Proleuions Code for this reason:
OwnBr ID venfietl by tlnver'S IitenSe. ❑ Yes ❑ No Drivefs Licen58 No.
Vedflcetlan oi Ownership by (type ol document, i.e. - praperry tax bill or tleetl): '
Data:
Eapires:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby certity ihat no excevetion flve (5) or more feet in depih Into whlch e person is requiretl to descentl, wlll be made In connectlon with work euthodzetl by this
permit, entl that no builtling structure, scalloltling, falsework, or demolltlon or dismanNing thereof, will be more than thirty-sis (36) teet high. (Chep. 32, Grp 2, Ar12, Sec.
341, Title 8, Califomla Administrative Cotle). .
❑ As owner-builder, I wi0 not employ enyane ta do work which would require e pertnit trom the DlNsion of Indusirial Selery, as noted ebova, unleu such person has e
pertnit to do such work irom Ihe division. i
Signature: Date:
Division of Indusirial Safery Permit Number. �
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenity under penelty of perjury Ihet I heve reed this epplication end state thet ihe info�malion given is
correct. I egree to comply with ell staie lews end clry ortlinances relating to building cons�ruction, entl euthonze representa�ives of the Ciry ot Coste Mese to enter upon tha
above-tlescribed pmperty for inspection puryoses. I egree not to occupy or allow occupancy of any building authonzed by Ihis pertnit until tinel inspection.
COpE I. INSVECTIONTYVE �TF, 1�9LS
1618 Fixed System Final Fire Prevention
1266
200
Pool Spa Final
Flnal Re-Roof
201 FInaI8locWRetaining Well
202 Final Factory Fire Place
203 Final Sign
204 FinalOemolition
CODE� INSPECTIONTYPE
206 Flnel Mechanlcal
208 Finel Plumbinp
210 Finel Electricel
212 Finel Fire Prevention
220 Finel Planning Approval
222 Final Site
250 Final Builtling/Occupency
, ;
(714) 754-5273 • FeX (714) 754-4856 • w�wi.ci.costa-mesa.ca.us 77 FAIFi DRIVE, GOS 1 A MtSA, (;A tl"Lti'Lti
PLUMBING PERMIT
lob Address: 399 E 18TH ST
Suite No A
Vicinity: KITCHEN
Parcel Nunmber: 42502217
Applicant: LEDERMAN, ERIC
Address: 8501 MARTINIQUE DR
HUNTINGTON BEACH, CA
Owner: JULIEN, DONALD F TR
Address P O BOX 10208
COSTA MESA, CA
Contractor: ROVICS CONSTRUCTION INC
Address: 8501 MARTINIQUE DR
ISSUE FEE
BackFlow irtigaUon
BackFlow Prevenler
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units �
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outleLs)
Gas Repipe
Gas Service
Phone: 714-3750722
Zip: 92646
Phone:
Zip: 92627
Phone: 714-375-0722
HUNTINGTON BEACH, CA 2ip: 92646
� License: 800996
Status: ISSUED
Applied: 03/O1I2005
Issued: 03/01I2005
ISSUED BY: Y'f �
SCOPE OF PERMIT
PLUMBING PERMIT FOR KITCHEN REMODEL (NO STRUCTURAL WORK). REPLACE KITCHEN SINK &
DISHWASHER.
REF: E05-00170
AMT
$23.50
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
on
FEE SUMMARY
'AMT orv
Laundry Tub I Washer $0.00 0
Landscape Irrigation $0.00 0
P-Trap� $0:00 ,- 0
Pressure Regulator $0.00 0
Process Piping (per 10 ft) $0.00 � �0 �
Receptors $0.00 0
Septic Tank $0.00 0
Sewer Cap for Demo $0.00 0
Sewer Connecl $0.00 0 .
Sewer Private Line $0.00 0 -
Shower $0.00 0
Sink, bar. $0.00 0 .
Sink, commercial � $0.00 , 0
Sink, Floor $0.00 - � 0
Sink, kitchen 39.80 1 -
-Sink,service/mop $0.00� ,0 �
Spa (private) � - $0.00 0 �
Spa (public) $0.00 0
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr BkFlow(t-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
- -- Wash Basin Set
Waste and Vent System
Water Closet (ToileQ
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
- Waler Service
, � Water Softener
� OTHER
VIOLATION
PLAN CHECK
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
30.00
50.00
50.00
�TY
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 access requirements under Calilomia statutes and relatetl
regulations. (Ord. No. 92-28, § 1, 12-21•92)
EXPIRATION: This permfl shall automatically expire and become void if work is not commenced withln 1B0 days, or if work is suspendad or abandoned
for a period of 1 BO days.
INSPECTIONS: In order tor the work authorizad under ihis permit to be consltlered legal, such work must comply with all applicabie codes, and all
raquired Inepeetions and final epproval must be obtained. Failure to obtain Inspections and final epproval will result in the expiration ol this permlt.
FOR INSPECTIONS CALL: (774) 754-5626
zuaae �eroo�
WORKERS'COMPENSAnON DECLARATON: . '
I hereby aflirtn under penelry ot perjury one of Ihe tollowing decleretions: �
❑ I heve end will melntain e certificate ot consent lo setl-Insure br workers' compensatlon, as provided lor by sectlon 3700 of the Lebor Code, for ihe pertortnance ot tha
work for wNc� thls permit is issued.
!j have antl will maintain workers' compenSaUon insurence, as requiretl Dy sectlon 3700 of Ihe Lebor Cotle, for the pertormence ol tha work lor which Nis pertnit is issued.
My workere�m�gnsation Insur ca�ner entl policy number ere:
PorcyNumeer: /�._�32i— ��GS—
e( one hundred dWlars (5100) or IessJ �
❑ I certiy thet in Iha paAortnance ot Ihe rk lar whi rtnit Is issued, I shall not amploy eny person in any manner so es to become subject to Ihe workers'
compensetlon laws ol Gfllifomi egree should come sub�ect to Ihe workers' compensetion provlsions of Section 3700 o e Lebor COAe. 1 shall forthwith
compty with these provisio
AppllcanLSipneiure: �� Dal'e _ �/��
WARMNa: FAILUPE TO SECURE WORKEfiS' WIAPENSATION COVEMGE IS UNLAW Fill AND SIULL SUBIECT Ml EMPIOVER TO CRIMINAL PE TIES AND CML FlNES VP TO ONE HUNDRED
THOUSAND DOLURE (E100,000). IN ADDRION TO THE OOST OF COMPENSATION, DMNGES AS PROVIDED FOR IN SEGTION 31080F THE UBOR CODE. INTERE5T, AND ATTORNEI"5 FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby eMirm Ihe�(t�Le�m Ilcensed u � t Chepter 9(commenWng with Sectlon 7000) of Dlvislon 3 ot the Business en ssions Cade, end my license Is in lull
fOftB 9ntl BHBCL IJC�N 9 �.T ' CIB39'N � �
ConireCtols Signeture: �� tiDece: ? i � �—
CONSTRUC710N LENDING AGENCV:
❑ I �ereDy aHirtn thai thera is e construction lending epency for the peAormance ol the work tor which this pertnit is issuetl. (Sec. 3097, CMI Code).
Lentlels Nema: Lentlers Adtlress:
Signeture:
Dete:
OWNER-BUILOER �ECLARATONS:
I hereby eNlrm t�et under penelry ot perjury thel I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business end Professions
Code: Any Gry or wunry which requires e pertnit to consWct, alter, improve, demolish, or repeir any structure, prior to its Issuence, elso requires the epplicant tor such pertnil
to flle e signetl stetament Ihat he or she is Ilcense0 pureuent to ihe Orovisions oi ihe Contractors License Lew (Chapter 9(commenUng wlth Sectlon 7000) of Division 3 of the
Business antl Professions Cotle) or t�at he or she Is exempl t�erefrom end the basis far the ellege0 e:emptlon. Any violation oi Sectlon 7031.5 by any epplicant far e pertnit
sub�ects ihe epplicent to a cfvil penelry of not more then fNe hundred dollars (3500)J:
❑ I, as owner of ihe properry, or my employees with weges es Neir sole compensetion, WILL DO TNE WORK, antl Ihe structura Is not Intentle0 or atteretl for sele (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner ot proDerry who builds or Improves thereon, end who does such work
himself or hersetf or through his or her own employees, providad ihai suU imprwements ere not Intended or oHered for sale. If, however, tha building or improvement Is
sold within one year oi compietion, the owner-builder will have the burden of pmdng thet he or she did not build or improve for purpose of saleJ. '
❑ I, as owner of Ihe property, am EXCLUSIVELV CONTRACTING Wrt11 LICENSED CONTHALTORS to wnstruct the proJect (Sec. 70aa, Business and Pmfessions
Cotle: The contractors License Lew doas not appN to en owner of Oroperty who bullds or ImO�oves thereon, and who contracts lor such prqect wit� a contractor(s)
license pursuani to the Coniradors License Laws.).
❑ I em exem0� under sec. Business antl Professions Code for I�Is reason:
Sipnaturo: Date:
Owner ID veritled by tlnvels license. ❑ Yes ❑ No DriveYs LJcense No.
Verilication ot Ownership by (rype ol documenL i.e. � properry tex bill or deed):
Expires:
DIVISION OF INDUSTRIAL SAFE7Y VERMIT CERTIFICATON:
❑ I hereby cerUfy that no axcavation INe (5) or more feet in depih into whlch a person is requlred �o descend, wlll be mede in connec�ion wlih work euthonzetl by ihls
permit, end �hat no building structure, scaNdding, lalsework, or demolition or dismantling ihereof, will be more ihan ihirry-six (36) feet �Igh. (Chap. 32, Grp 2, Art 2, SeC.
341, Title e, Calilomia Adminisiretive Code).
❑ As owner-builder, I will not employ enyone to do work which would reQuire e Oermit Irom the DiWsion of Indusiriel Sefery, es natetl ebove, unless such pereon hes e
permil to do such work irom the division.
Signature: Dete:
Division ot Industnel Satery Partnil Number:
ICER7IFlCATE OF COMPLIANCE AND AUTHOR¢A710N OF ENTAV: I certiry untler penelry of perjury thet I heve read this epplicatlon entl stete t�et the information given is I
correcL I egree to comply wit� ell state lews end ciry ordinances relating to builAing construction, end euthorize representatives ol the Ciry ot Coste Mese lo enter upon the
ebove-descnbed property for inspection puryoses. I egree not to occupy or allow occupency of eny building authonzed by Ihis permit until final inspection.
COOE �. R+sveenoNxve
1818
1268
200
201
202
203
204
Fixetl System Final Fire Prevenii0n
Pool SDe Final
Final Ra-Rool
Final BIocWRetaining Well
Flnal Fectory Fire Place
Final Sign
Flnel Demalltion
Pdg U�ELfi
�cooe� iNsvecnoxnve
206 Final Mec�anical
20B Final Plumbing
210 Final Electrical
212 Flnal Fire Prevantlon
220 Finel Planning Approval
222 Final Site
250 Final Bullding/Occupency
�
PGIF 1[�LS
3-d�-c�7 �L�
(71a) �sa-52�3 • Fen (��a) 75a-a056 • www.ci.costa-mesa.ca.us 77 FAIH UHIVt, GO51 A MtAA, GH tlY626
MECHANICAL PERMIT
.lob nddress: 399 E 18TH ST
Suite No A '
Vicinity:
Parcel Number: 42502217 - _
SEN PAUL �' i'" � � � �
ISSUED BY:
Applicant. JAN , /,, - - � � , � -
. ', i
Address: 9141 SOMERSET-BL_;�' � �� ' � , �, �� � � �A
�j�;-'�', _ ' Phone: 562-886-6100 i� �,' ,�� - ��
��'
BELLFLOWER, CA`� - . -- � Zip: 90708 ' " � ���
,� . ; . - - �� � .
/ �'%/ � " - - •. � . '��
Ownei .JULIEN, DONALD.F TR, - � /
, i � � �
Address:- P O BOX 10208�:, '- �' -
/i/� � � '
. , • � , -� . - Phone: '-� ' .
� V � �
'. � � COSTA�MESA�CA Zip: 92627 � �";. �.i -
. , , �„��,, � � '� �.
� � � ' /., . , ..
Contractor. �- BROWNIES REFRIGERATION SERVICE _ ` �- �
, .
' Address: 9741 SOMERSET BL - - ., � . . - `. t
. � � � '� -^Phone:-362-866-6100 � . . � . ,. . � ,A `,
, � i . . �
� BELIFLOWER, CA� -.' "' � Zip: , 90706 , - � �
-� , /, _ � - _ � ' , _� . �� �
' " . �, .. . . � License: 309988 - _ ' ,. , A ... �, 1
. . . �' _ - - ., � . - '
' `� � SCOPE OF PERMIT �� ��
�' � REPLACE FURNACE IN RESIDENCE
i �/•:-'�'.,..�, �... . v.,.... � - ,j_-,
� '� � � "'FEE SUMMARY � �'� �� � � -� �
Status: ISSUED
Applied: 02I20/2002
Issued: OZ20/2002
� Quantity - � �
ISSUE FEE . $23.50 �� � Repair / Alt Absorbtion Unil
Inst FAU <100 k BTU $0.00 -0 � - -- - i � - Repalr / PJt�Refrigeration Unit
Inst-FAU >100 k BTU $1820 , t -- � , - - Ventlllalion 3ystem -
Repair I Alt CoolinglHeat $0.00 ' 0 � ' ' Evaporative Cooler „
Inst I Rep. Recess Wall HV $0.00 0 Commercial Incinerator
Refrig5ys <100 k BTU $0.00 0 Domestic Incinerator
Refrig Sys >100 k BTU $0.00 0 Compressors / Absorption Svstems "
Gas Piping $0.00 0 Up to 3 hp / 100 k BTU �
,.
Factory Fireplace � � $0.00 0 '�- 3 To 15 hp / 500 k BTU „ j�
Hood w/Mech Exhaust �> $0.00 0 �. 15 To 30 hp / 1,000 k BTU -�
VAV Boz. � . � V ` $0.00 0 . . _ ' 30 To 50 hp / 1,750 k BTU " / -' ��
Venl Fan /�Single Duct, � `\ � $0.00_ -0 , ` � ' , . "" Over 50 hp./.Ovei,1;750�BTU -% �� � � �
Appliance �\ -� � �� $0.00 � 0 " - . � Boilers � " = �
FireDampers��`� �"� �30.00, _0 �� ' ��Upto3hp . ",��� � �
Smoke Dampers ' �/ � $0:00� = 0 - � - 3 To 15 hp ,
Insl or Relocate Appl Vent � $0.00 -0 � � - � 15 to 30 hp - - - � �
Air Handlers < t0000cfm � � � � � $0.00 �. 0 � - � - 30 to 50 hp . " � � � � :
Air Handlers > 10000cfm � .. $0.00 0 - , - Over 50 hp , � .
Floor Fumace � $0.00 ,' ' 0 Other Mechanical Fee , � . '
Floor or Suspend Heater � �� 30.00 0 , - � � � Investigadon Fee � � �
_ � , - . . , .Plan Check Fee � _ -- . �
� , � Reinspection Fee �
- , �'� _ ,- ; , , ��=TOTALCALCULATEDFEES
COMMENTS / SPECIAL CONDITIONS
`
� �
Quantity
$0.00 0
' $0.00 � 0� �
I $0.00 --0 �
$0.00 0 ,
50.00 0
' 50.00 � 0 � '
ao.00, o , ;
� 50.00 ; 0 '
� $0.00 � 0,'
- $0.00 �0
:� $0.00�'/0
30�00 � 0
/�$0.00 0
$0.00 0
�'$0.00 0
$0.00 0
$0.00
50.00
$0.00
541.70
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia sfatutes antl related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 18p days, or If vrork is suspended or abandoned
�(or a period of 180 days. .
INSPECTIONS: In order for ihe work authorized under this permit to be consiCered legal, such work must compty with all applicable codes, and ali
requlred Inapeetiona and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5826
z�cere �a�w�
WORKERS'COMPENSATON DECLARAnON:
I hereby attirm under penelry of perjury one of the following declaretions:
I ha e entl wlll maintBin e cenificate ol consent to sell-Insure for wi
lar w�ich Nis permit Is is ueC.
I have antl will maintein wop�er ' compopSallon insur ce, es requi
My workero' compensay6a-! r �1�r end oli y umber �
i—�r rr
ceMe�: � �,�,
(Thfs section need nat beCortip/eted tl the perm/t!s ve/u et ane h�nan
compensetion, es proNtled br by sectlon 3700 0l the Lebor Code, lor the pertormence of the
sectlon 3700 0l Ihe Lebor Cotle, lor ihe peAortnance ot/ihe wak for which IhLa permil ls issuotl.
� PolicyNum�er. I1�� O I�� V/
e�ioo) or�ess.) —T—
❑ I certi y thet in the pe nc t Ihe work br which ihis partnit is issued, I shall not employ eny person in any menner so es to 6ecome sub)ect to Ihe workers'
compensetion laws f ' omia, ntl egree that II oultl become sub�ect �o the workers' compansation provislons ol Seclion 3700 0l the Labor Cotle, I shell forihwith
comply with t�eso p o � A� )��
Applicani Signa[ura: Date: %/� �
WARNING FAILURE TO SE RE WORKERS' PENSATION COVEMGE IS UNLAW FUL M1D SHiLLL SUBJECT PN EMPLOYER TO CRIMINAL PENALTIES M1D CML FlNES UP TO ONE MUNORED
TMOUSAN� OOLURE (St 000�, IN ADD O TME COST OF COMPENSATION, DAMAGES AS PROVIDED FIXi IN SECiION 3]OB OF TME UBOR COOE. INTEREST, ANO ATTORNEI^S FEES.
LICENSEDCONTRACTORS
I hereby aflirtn tha� I em licen:
force end eMect. Lic. p
Contractors Signawre: _
CONS7BUC710N LENDING AG�
❑ I hereby aHirm ihat ihare is e
Lendefs Name:
Signeture:
with Section 7000) oi Division 3 of the Business and
Class a
Date:
lending agency lor Ne peAortnance ot the work tor which ihis pertnit is issuetl. (Sec. 3W7, Cidl Code).
Londnrs Address:
I Date:
license is In full
OWNER-BUILDER DECLARA710N5: � ,
I �ereDy ettirtn that under penalry ot perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness entl Prafessions
CoGe: Any dry or counry which requires a permlt to construd, alter, impmve, demolish, or repair any sWCNre, O�or to its Issuance, also reqWres the applicant for such pertnit
to file e siqned slatement thet he or s�e is Ilcensed pursuant ta tha provisions ol Itie Cantrectorg LJcense Lew (C�apter 9(wmmencing with Sectlon 7000) of DlWsion 3 ot the
Busineu antl Profeulons Gode) ar t�et he or she Is exempt t�arefrom entl t�e basls tor the ellepetl e:emD��on. Any viWatlon of Sec6on 7037.5 by eny applicant for e pertnit
sub�ects t�e epplicent to e civil penalry ol not more ihan five hundred tlallars ($500).):
❑ I, as ov+ner of ihe property, or my employees with wages as their sole compensetlan, WILL DO TME WORK, end Ihe siructure Is not IntentleC or otterad tor sale (Sec.
7044, Business and Professions CoOe: The Contrectors License Law does not apply to an owner ol properry who builtls or improves thereon, antl who does such work
himselt or hersetl or Ihmugh his or �er own employees, providetl that such improvements ere not intended or oHeretl for sale. If, however, Ihe building or impmvement is
sold within one year of completion, the owner-builder will have tha Durtlen ol proving that he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of ihe property, am EXCLUSIVELY CONTiiACTING WITF1 LICENSED CONTRACTORS to construct the D�oject (Sec. 704a, Business antl Professions'
Cotle: Ttie contraciors License Lew tloes not epply to an owner ol propetly w�o builds or Improves t�ereon, end who coniracis tor such pm�ect with a contractor(sJ
license pursuant to the Contractors License LewS.).
❑ I am evempt untler sec. Business entl Professions Code tor Ihis�reeson:
Signelure: Date:
Owner ID venfietl by tlrlvers license. � Yes ❑ No Drivefs Licanse No. Expires'
Vedlication of Ownership by (rype of daumenL I.e. • property tex blll or deed): __
DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATION:
❑ I hereby cenily that no excavatlon tive (5) or more �eef in depth into w�kh a person is requlred to descend, wlll be metle in connectirn wlth work eut�oAzed by thls
permit, entl ihat no building structure, sceHolding, felsework, or demolition or dismantling thereol, will be more Ihen thirry-six (36) leet high. (Chep. 32, Carp 2, Art 2, Sec.
341, 71I1e 8, Celifomla Adminisiretive Code).
❑ As owner-builder, I will not employ anyone lo do work which wauld require e permit fmm Ihe Divislon of IndusMal Safery, es nated ebove, unleu such pereon has e
permit to tlo suc� work trom ihe division.
SlgnaNre: Date:
Division of Indusirial Selery Pertnii Number:
Will the flppllcent or D�esent or tuture bullding occupent need lo lile entl certify e Business Plen br emergency response to releese ar threetenetl release ot e hezertlous
meterial? ❑ Yes ❑ No
(Section 25505 0l the Celitomia Healch end Salery Code requlres, with some exceptions, thet e Business Plen De ��IeO with the Coste Mesa Fire DepenmeN by every
business whiU has at eny one time tluring e repo�ed year a quentity ol harardous meterials equel to or greater Ihan a weight of 500 pountls, or a volume of 55 gallons,
or 200 cubiC ieet ol compressed gas et slanderd temperature anG pressure).
............_...........__ ................_....................................................._.........................._......_....................._._......................_............................................__........._.._...__..__..__..... __..........'_'........................
Does or vrill t�e epplicent or present ar tuwre builAing occupant need to lile a registration lortn tor ecutely hazarEous materiels7 ❑ Yes ❑ No
(Sectlon 25533 0l Ihe Calllomia Heelth end Satery Cade, wlih some exceptlons, requlres replstretlon with Ihe Coste Mesa Fire Depanmem by each buslneu which et eny
one time hes on hend e quantlry ol ecutely �azerdous metedels equel ro or greater then e weight al 500 pounds, or e vdume ot 55 gflllons, or 200 cubic feet of
compressetl ges et atenCartl tempereWre entl pressure).
...............................................................................................................................................................__._................................._........................................................._..__.......'_"............_...........__...........................................
Does or will the appllcam or presem or luture huilding occupant neetl to prepare en RMPP (Risk Manegement antl Preventlon Progrem tor acutely hazardous metedals)7
�Seclion 25534 of Ihe Calitomia Heelth and Sefary Code provitles that t�e Costa Mese Flre Deperiment mey require ihe preparatian, certllicatlon end tiling wlih �he Flre
Department ot en HMPP by businesses which are required to register acutey �a�rAous metedels wit� tha Fire Depertment.
....................._...__...__.............._....................................................'__""""'—_'.....'—_'........__'_.......__..........._..'_'_'... _..__—'_....._�._._
4 If en RMPP ls presently required, has Sectian 2553M1 af the Celifomie Health and Salery Code baen fully camplied wit�4 ❑ Yes ❑ No
_..._...... _'_'.._—.......__._............_�-_._ .._'__' ............................_..._._.. __'......._.._..__..
5 Does or will Ihe epplicant or present or tuture bullding occupant requlre �or Ihe work whith 15 Ihe sub�ec� oi lhl5 e 011tali0n B Eertnii lor 6uCh conslruction or motlillcallon
from the South Coflst Air �uality Manegament Distdct or Irwn any other air polWtion control tlisidd or egency? � Yes �J No
(Sectian 65850.2 of Iha Calitomia Government Coda requires t�at Ihe requesled intormBlion be Iurnisnetl on eDPlicalions tor non-resiEentiel builtling permits).
........................................._..._.....................................................................................................................................................................,................................................................. ......._.............. .................................................................
6 Will any part ol lhe lacili�y �o be construc�etl under lhis pertni� be wl�hin 1000 teet trom Ihe outer boundanes of a school7 ❑ Yes ❑ No
(If yes', the tadlly must meet the requirement ot Sactions 25536 entl d2303 of the Celifomia Health antl Safery Code).
...__._.........._'_—'_"'__ _ ........................................_ ...._._ _...—_......................._................�.--__"_______...._......_..................._"..
7 If a pertnit frwn the South Coast Alr Qualiry Management Distdct or other air pollution control tlistrict or egency Is required for the work which is the subject oi this
application, have all ol the disclosures prescdbed by Califomla Health entl Safery Cotle Sectbn 42303 been matle7 ❑ Ves ❑ No
..... _...........__ ................__..... ....._.................. _—_............_...�....................
B (II �es', attacli certiticete of complianca trom ihe appropriate alr polution contrd oHicer).
CERTIFICATE OF COMPLIANCE: I ceniy that under penalry ot perjury t�e infortnetion given ebove is correci. I agree to cwnpy with ell stata laws anA city ordinances
regarding Hazartlous Meterials end Emissions.
SlgnaWre: Dete:
CERTIFlCATE OF COMPLIANCE AND AUfHORVATION OF EMRY: I certily under penelry ol perjury that I heve reatl this epplication end state ihet the Informetion glven la
conect I egree to c pty wil� all s:ate lews end city ordlnances relatlng to building constructlon, anC authodze representetives of Ne Ciry of Coste Mesa ro enter upon Ihe
ebove-described prop�ty for inspection puryosos. I egrea not to occupy m sllow occupa�y of eny buiMi�g authorixed by thls pe�mit unUl tinal inspection.
COOE �.
1818
1266
200
Fixed System Final Fire Prevention
Pod Spe Final
Finel Re-Roo1
201 Final Blxk/Retaining Well
202 Finel Factory Fire Place.
203 Final Sign
204 Final Demditlon
QaTf. Q�:�
//i r.
�:: —
COUE I INSPECiION TYPE
2os Final Mecnanical
20B Final Plumbing
210 Finel Electricel
212 Final Fire Prevention
220
222
� 250
Flnel Plenning Approval
Finel Site
Final Building/Occupancy
�7.\i IHnYr.lk
Y. L►
� - " 32228
COSTA MESA BUILDING-SAFETY DEPARTMENT
��'f.0. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING
AD�RESS �
�
OWNER
MAI l
Z ADDRESS
W W � Q�•�
�-U CITV I
ZZ
Q CONSfRUCTION
�� LENDER �"'^�
am
J � BFANCH
J ti
m J ADDRESS �
J m ARCHITECT TEL.
a OR ENGINEER NO.
U �
Q
w fL ADOFE55
d W
J O CONTRACTOR
m Z
J� ADDRESS J Z I
w w TEL.
� CITV �t'y� NO. � �
ZF
w � STATE � CITY
= O LIC. NO. L��j :� ' IIC. NO.
SI2E NO.OF BLDGS.
OF LOT L� NOW ON �OT
USE OF
EXISTING BLDG.
H SIZE OF NO. OF
Z NEW BLOG. ROOMS STOFiIES
V EXTERIOR WAIL RooF
COVERING COVERING
J USE OF BUIIDING AND WOfiK TO BE PERFOPMED
d
a
a �iY� � CL¢
� '
u~i �-� GUELG�N
z
0
UI hereby acknowletl8e that I have read this application antl state
� Nat the above information is correct antl agree to comply with
� all laws regulacinq builtling consttuction, entl I shall not employ
r any person in violation ot the workman'S compensation laws ot
(A Me State of Californla.
? I hernby certify that I am properly licensed as a wntractor untler
the Stete of Californie Business antl Professions Code, Divisicn 3,
Chapter 9, and that such licenses are (n tull torce and at ct, or I
am exempt from the provisions of Ne Stete ot Celiforni usiness
entl Protessians Cotle, Division 3, apt 9.
SiBnetura ot
Pe�m(ttee
Authoriz¢tl AB¢nt
SEP -2-70cwsa�0 046 0*****5.00
APPLICATION FOR BUILDING PERMIT
RECEI ED BV D TE FECEIVED DATE ISSU
_ �p % O�_
` � � — PE�IT NO
A.P. NO.
BUIIDING /, / �
ADDRESS (� ��
TRACT LOT BLOC
OwNE
FIRE
ZONE
APFROVED
�
-�- C�b�
VAL �)
$
i
�GPOUP
DATE
NO.OF USE OF NE
�V P�� U BUILDING
iDSAPPROVED YAFDS
DISTANCE BET
MAIN BLDGS.
VAR. #
C.U.P.�
APPROVED �
BET. MAIN &
ACCESS. BLD
DATE
APPROVED
�
�
m
b
SQ. FT. o
THE AMOUNT SHOWN UNDER VALUATION IS FOR �
THE PURPC6E OF ESTABLISHING A PERMIT FEE ONLV: m
¢
VALUATION `�� m
PERMIT FEE $ � �
�
m
S 1�{J f_ PLAN CHECK $ E
� �J' (l � /��e'f) ,�
TOTAL FEE $ l/
-- � 33646
~ COSTA MESA BUILDING-SAFE7Y DEPARTMENT
. 9.0. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
vato
SEP 72-7i�y�-0� G77 c�'+>::.^ :'6? �i,
APPLICATION FOR BUILDING PERMIT
RECEI ED �' DATEQFECEIV$D DA�f�, ISSUEO
��� /C�
BUIIDING � y9 E� � �`� � l v ^` J//
ADDRESS —
// P^�E,;FMjTJ10./
OWNER �IiNTOivY ✓. ��V20/-�E A•P• NO � 'Sd Il
BUILDING l / �� /� ,'n,
MAII .� [!, (� ��N „�,. „rgn ' ADDRESS T �... ���
7 a.wnic.r-.
ADDRESS
a cu'i cirv /i��/fb2T ���cl�: No� SZ 8 TR
FZ
Z Q CONSTRUCTION W
O N LENDEF �E-"�• P4G. /Y�II�.
am
J � BRANCH
J � OWNEF
m J AODRESS
m ARCHITECT /� TEL. ,�
J N OR ENGINEER CLF� •�� S �.� � N .
V Q FIRE
w � ADDRESS ZONE
aw
� � ���,`C.� APPROVED
J 0 CONTRACTOR /D BV
Jp� ADDRESS �.a /Q �� �� �G>QsiJ +��
pw %� TEL. SIS'� ZOf�L�_ PO.OF
Z� CITY l:.E:LS%Ia• ��p"� NO. ZZ �'� LP'NS
�� STATE IJ /� CITV . �'ARDSAPPROVE
� LIC. NO. (� �Q ��(p LIC. NO. (j. MAIN BUI�DINC
� O (FqOM C/L STREET)
SIZE NO.OF BLOGS.
OF LOT C✓O � NOW ON LOT� D� fiONT FT.
USE OF J'
E%ISfING BLD�,. ��
F SI2E OF a� NO.OF /J
Z NEWBLDG ROOMS STOfiIES 4 L,SIDE D FT.
a EMEFIOR WAL ROOF
V COVERING C.L.� COVERING l� REAF FT.
= USE OF BVIL IN AND WORK T BE PERF E
OF NEW
a D G O DISTANCE BET. BET. MAIN &
a ' G G-� MAIN BLDGS. ACCESS. BLOGS.
� W /O- JG (pryi.y'Cv� C,V.P.�W �G� APPROVEDp —.
~ APPROVED �� ^^Tc � _
N
Z
o D FOR SPI
VI hereby acknowletlge t�at I have reetl chis application antl stata
� tho[ the ubova informetion is ronec[ antl agree to comply wich
� nll laws repuloUnp builtling consvuccion, antl I shall not empioy �O
� ony porson in violation o� t�e workman's compensetion laws of
y Mo Stato of Califomta. a�
ZI hernby certity that I am proparly Iicensatl as a contractor untler S�. FT
the Stnto of Calltornia Business antl Profauions Cotle, Divisicn 3, TH AMOUNT SH
Chap[er 9, antl [hat s�e� IitOnses era in tull torce antl afiact, or I THE PURP06E OF I
om oxampt trom t�a provlsions ol tha Steta of California Business VALUATION
ona Professlons Cotle ivision 3, Chaptar 9.
Sipnamra of �ie _ . 1 . � ��'Y93 �
Permittee �GG����� $
AUNorizetl Apant
�
�
7C�� � �
g� m
0
VA ATION IS FOR �
A PERMIT FEE ONLV: e
¢
'e $ `�'�� rv
7
m
Ks �,p8 e
O
— LL
5