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HomeMy WebLinkAbout263 17TH ST - Building Permits . City of Costa 'Mesa, Development Services, Division of Building and Safety CERTIFICATE OF OCCUPANCY This certificate is issued pursuant to the'-requlremerits of the Uniform Building Code, Section 308 /. ; 3 adopted by the City of Costa Mesa certifies that attfie tilr�re ofifs'rssuance the building structure herein below described was inspected and"ppioved fo%'occripancy.as follows: • ,,,, ,� NA _. Building Address 263 E. 17thiStreeti F g, �3Bldg. Permit No. B-82502 Use 4000 sq ft rastua a — - - ti• ' '. " r ' "�t5.u Group A-3 Type`'`oI. f`Con tr ctiOn v-N Fire\ one•--• Use Zone CI-S 1 / x.1111 3 c7 cT_1.�M0:1 T Er\ - Owner of Building Frank*MossdTr 'Teiiant fSam Woo Address 763 E. 17th Stlre'at�‘Cneta 1Mesa,--CA Q2676 L'Zi /' SEGO - 4 __rk o,. / *4)Int / J Building Official - Rick A ltBbCSA\AC B 0 " ° Date,"January 16, 19 8 \ �•iCY , > y,t> s,; ~ p \r> pyz REQUIRED TO BE POSTED IN-A CONSPICOUS PLACE • City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. Building Safety Division P.O.Box 1200 Costa Mesa,California • The Building located at 263 E. 17th Street has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group A-3 Occupancy. - Use of Building RESTAURANT Legal Description 425-223-02 (See reverse side for Metes and Bounds) Building Permit No 855544 Electrical Permit No. E55734 Plumbing Permit No. P55570 Mechanical Permit No. M55675 M55858 Number of apartments and/or guest rooms ISSUED TO: Building Official TONS C'De BACA 259 E. 17th Street 2Sy U. Lim Street by ';- -:, is ..,,. at > Costa Masa,, Ca 92626 Date May 15,, 1992 . This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015.46 rev.1/aa White-Owner:Canary-Numerical File;Pink-Bldg.Permit File BUILDING SAFETY DEPARTMI �T C P, O. Ron No. 317 N? 1643 C Costa Mesa, California eGv Dec-Mr s ^, / / G•[n •• CITY OF COSTA MESA S ` _14 CERTIFICATE OF OCCUPANCY� Building Permit Noy�////�J92E� lectric Permit No/fd ambing Permit No3GM/ Use of Building /�.� cer / wrerg c-- The building located at `� Legal Description 4 (See reverse side for Metes and B s)7_ 195 / u d ��QQ has been inspected and found to comply wi the provisio•. .•),City if C.. esu ri5n ances applicable thereto for a Group .2-• •• •ay . ; /0 ISSUED TO: egtp litt uil. • Official (Ow14#4444ae J Building) By .- AL: a I 'i�i:s CC: ❑ Original er 0 1st copy—Gas Co. 0 2nd copy—Edison ffB 3rd cop File Form 206 S-B P 1M 1-60 .t r�!1 r s r ttf rU rt ro 444.4 �SIMA PrO r.r IIPI N►M ••4 niti •r�:r�r�7" ' 1 r7 r1lft A`QTS.T:LTLT�tVAV T�T.J.T:v.TalliV.T* �+.LTA]1.+LTdLT:IAT:sT.v.T�T:d.T�T:LT:J.T�L_1f+J.RV�RV�.LT�TaVAIVI VAYs ULT�T:vWX24-0, 'a�0 • ' CITY OF COSTA MESA -4. 'IAArr,. FIRE DEPARTMENT 00687 y..i "ul :" PERMIT p ' J _,' 1 An NON TRANSFERABLE Permit Granted 7 Z3 19 QL ( � ESN PERMISSION IS HEREBY GRANTED: To Expire -7 , 19 `22--- -4:14 1 04 '` Address: 2�3 5-. 17+-L stn-e - . - - --- �+7 ev rk To: LULL 0- .FI6.Cc of Ccvaaa,w.I.&7 W;+fn. a .- oco.fe_r cAt1'+ -}3 eXc.eeci .+ r.." ice p2r_fcYt c / Illr ��1EtZ, ire ") At 2 G S l- . 17+� —(reef Costa Mesa, California ".• y.. �fir� ~ In accordance with the terms of application on file with the City of JAMES M. REED, Fire Chief lv -00,1 Costa Mesa Fire Department, and subject to provisions of the City '4a Psi ittH of Costa Mesa Fire Code and the Municipal Code of this City. e;rn THIS PERMIT MUST BE POSTED CONSPICUOUSLYgl "JJ 11,...e/ al.,;,- ON THE DESIGNATED PREMISES OR EQUIPMENT By �— y1 p-3 f FIRE INSPECTOR C=.) ei!t':`l"P rAlr 17i i^n 1T`1'C17i ireg inkrel•A l+'PAWIT1T`1'�`1Tl gellI ITAIrt`lei'ege7IFIT1:1`riv..`l iT47:`1: 17..I `i'`r.4 �N'��✓•VI•Ca'�1:t Vi1Vir tit t:�/V�b�/`V�I•V�%•lit-V�/V�/�1i�IV�V�%V�-VJttA.eI vtto iJ�Vearg*.Jtei*.g V'IVJt::(0.4.JVj%igic, ►J-V i' 0023-44(FO 19)Rev.6'91 CITY OF COSTA MESA - BUILDING DIVISION > � .-1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER f 1tia, is PERMIT J• Ir�h� E03-00487 StotpoRmso et (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 263 E 17TH ST Status: ISSUED Suite No Applied: 06/12/2003 Vicinity: THAI SPICE Issued: 07/16/2004 Parcel Nunmber: 42522301 .dr Applicant: WECK, STEVE - __ ISSUED BY: -/-41,0411kAddress: _ . _ Phone: 626-523-8323 Zip: • Owner:'f, MOSS, FRANK TR-- . . '` - • - Address,/,P O BOX 8507- - N ;'N ,` Phone: (949)646-8743 7` - NEWPORT BEACH,CA Zip: 92658 - Contractor. PACIFIC CONSTRUCTION SERVICES Address: 3452 E FOOTHILL BL ' ,STE 115, ' Phone: 626-449-0111 - PASADENA„CA Zip: 91107 , License: 751065 - - - - - -- r SCOPE OF PERMIT - INTERIOR RESTAURANT TI FOR"THAI SPICE".REMODEL APPROX 2516 SF.WORK TO INCLUDE RELOCATION OF AN EXISTING RESTROOM AND CREATION OF AN-ADDITIONAL RESTROOM WITHIN THE ' SPACE.REF.:B03-00076 ELECTRICAL TO INCLUDE:68 LIGHT FIXTURES,41 OUTLETS, 13 SWITCHES,AND 2 SUB PANELS - TO 200 AMPS. FEE SUMMARY ' � '. Quantity _ Quantity/ , _ ISSUE FEE '$23.50 -Temp Dist System/Lighting $0.00 .-./0' i , / Temp service test ' ' $0.00 c ` Busway7100 ft $0.00/ . 0 ' Res.a/c package , $0.00 - . Standing Section" . $0.00 ', 0 - " New Res(1-2 units) - $0.00 ,0 Misc Electrical Equipment • ' $0.00.' 0 ' New Res(3+units) . $0.00 0 Transformers up to 1 kva/kw $0.00 0 ' ' Pool/Spa - - $0.00 0 ' - up to 10 kva/kw e $0.00(,-, 0, Lighting Fixts ` ,$57.04 68 ' ' up to 50 kva/kw: - $0.00' v/0" /" Recept Outlets N'' ' $37.33 41 - . up to 100 kva/kw- $0.00, ` 0 i Switches $14.30 - 13 - _ ,over 100 kva/kw ' " $0 00% 0 2/ Non Res Appl , $0.00 , 0 - _ Low Voltage Equipment $0.00 --',.,02-/ Res Appl $0.00 0 - - Low Volt Wiring Systedi/Ckt ' '$0.00-j 0 Service to 200a ' $0.00 0 '! - \ Misc.Conduit ,• ` \ $0.00 �7 0 Service to 1000a $0.00 0' Misc.Conductor - 50.00' 0 Service over 1000a $0.00 - 0 _ .2 ' Circus(gen or ride) - ) 1$0.00 0 Motors to 1hp $0.00 . 0- . _ Circus(mech ride or lights)",------ $0.00 0 Motors to 10hp $0.00 0 -1,:_,-- - _ . ,, Christmas Tree Stand- " $0.00 0 ' Motors to 50hp $0.00 0 - -. Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 )\-2 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. ^ / FOR INSPECTIONS CALL: (714)754-5626 / 2448d8(8/OD) v DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This�section need not be completed if the permit Is valued at one hundred dollars($100)or less.) (]'"1 certify that in the performs of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Ca .y a,and gr a the if I should become subject to the workers'compensation provisions of Se on 700 of the Labor Code,I shall forthwith comply with these provisi•..../ �nT/wL� Applicant Signature: tI Date: 7 40 Ox-( WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE iS UNLAWFUL AND SHALL SUBJECT Ni EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE($100,000),IN ADDIRON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 370e OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensi20 Ender provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business anq Professions Code,and my license is In full force and effect.Uc.47 TD I O 6!toe, wok Class 41 b Contractor's Signature: OVA Date: '7/At JOY CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to flie a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) . license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of doe me t,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,wit be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341.Title 8,California Administrative Code). ❑ As owner-builder,I wit not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safely Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will The applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully compiled with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication appernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If-yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast—AirOuallty Management District or other air pollution control district or agency is required for the work which is the subject of this application,have at of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes_ 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with an state laws and city ordinances relating to building construction,and euthcrize representatives of the City of Costa Mesa to enter upon the above-described props for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • at a ner(s) D e Li And/Or Authorized Applicant Date CODEC WSPECTION TYPE PAIS UI®SL$ LODE. QISPECTION TYPE an MEM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �! 200 Final Re-Roof 210 Final Electrical 7479744 r/i/i--it 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA ' - BUILDING DIVISION - >Ws'. DEVELOPMENT SERVICES DEPARTMENT PERMIT MBER v. t r t PERMIT T (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,C TA MESA,CA 92626 MECHANICAL PERMIT Job Address: 263 E 17TH ST Status: ISSUED • Suite No Applied: 06/12/2003 Issued: 07/16/2004 Vicinity: THAI SPICE • Parcel Number: 42522301 _ ISSUED BY: Applicant: WECK, STEVE., • : ' Address: • , Phone: 626-523-8323 CELL Zip: Owner:' 'MOSS, FRANKK-TR •' /' � Address: P 0 BOX 8507 . . Phone: (949)646-8743 - , - NEWPORT BEACH,CA Zip: 92658 Contractor: PACIFIC CONSTRUCTION SERVICES Address: 3452 E.FOOTHILL BL ' STE 115- • Phone: 626-449-0111. ' PASADENA,CA - Zip: 91107 , N License:751065 SCOPE OF PERMIT INTERIOR RESTAURANT TI FOR"THAI SPICE.REMODEL APPROX 2516 SF.WORK TO INCLUDE RELOCATION OF AN EXISTING RESTROOM AND CREATION OF AN ADDITIONAL RESTROOM WITHIN THE SPACE.REF.:803-00076 - - , MECHANICAL TO INCLUDE:1 REPAIR/ALT COOLING/HEAT,AND 2 VENTILATION SYSTEMS. - ,, FEE SUMMARY- 1 Y Quantity - - '�' - ' _ Quantity- ISSUE FEE $23.50 Repair/Alt Absorbtion Unit ,' $0,00 -0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 . Inst FAU>100 k BTU $0.00 0 Ventillation System $21.30' 2 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler 7 L $0.00, 0 • Inst/Rep:Recess Wall Hb, $0.00 0 - Commercial Incinerator 7 40.00 '0 ' Refrig Sys<100 k BTU $0.00 0 • Domestic,Incinerator $0.00 ; 0.' Refrig Sys>100 k BTU - . -$0.00 0 - Compressors/'Absorption System/:,s41/ Gas Piping , $0.00 0 Up to 3 hp/100 k BTU • /7 . $0.00 '0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00/ 0 Hood w/Mech Exhaust - $0.00 0 15 To 30 hp/1,000 k BTU /$0:00 0 VAV Box \ , $0.00 0 - - , 30 To 50 hp/1,7501k BTU' /,� 4 /.' $0.00 0 Vent Fan/Single Duct - $0.00 o- _ - Over 50 hp/Over 1,750 BTU A / 1,$0.00 0 Appliance / Fire Dampers $0.00 . i0 : . - Up to 3 hp - .- "/ - -/ $0.00 0 Smoke Dampers . $0.00 ' 0 �' 3 To,15 hp �' '�` '-" % $0.00 0 Inst or Relocate Appl Vent - $0.00 0 k - / 15to 301hp_ ,, • _<2 ',7 $0.00 0 Air Handlers< 10000cfm •$0.00 0 • , 30 to 50 hp,_ $0.00 0 Air Handlers> 10000cfm $0.00 0 - Over 50 hp . - " ��- $0.00 0 Floor Furnace $0.00 0 - ' Other Mechanical Fees Floor or Suspend Heater $0.00 0 - - Investigation Fee $0.00 -- - Plan Check Fee $0.00 C • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5628 / /// 2 2446-46(6/00) \ DECLARATIONS .. , WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Cartier Policy Number. (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) Id4sst certify that in the performan 1 the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Call and agree at If I should become subject to the workers'compensation provisions of Seg don 3 of the Labor Code,I shall forthwith oomph/with these provlsio // G p N' Applicant Signature: /V � Date: � i& Y WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOUARE 13100000),IN ADDn1ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECnON 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed, p•er provis' ns of Chapter 9(commencing with Section 7000)of Division 3 of the BusinessylNAProfessions Code,and my license is in full force and effect.LAO.M l J,• 5 Class p IC W Contractor's Signature: • ./ ,Dater• 7 I I b f 0 y ,t CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Code). Lenders Name: _ Lenders Address; Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penally of not more than five hundred dollars($500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of docume ,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ur._..bui . .sic Ma age_.._ _ ._ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acetety hazertlous materials)? No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomla Health end Safety Code been fully compiled with?0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication apgermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (if-yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig �OOff Leg I ) icl/���p, IP Or Aut prized Applicant Date CODE t INSPECTION TYPE PATE RMA CODE I INSPECTION TYPE PATE f� 1616 Fixed System Final Fire Prevention 206 Final Mechanical C1- 1 Ort`{ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA t ► BUILDING DIVISION �.. i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1.•: '1 t PERMIT litbibutonD l �� B03194/7/6 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 263 E 17TH ST Status: ISSUED Suite: Applied: 01/15/2003 Vicinity: THAI SPICE Issued: 01/14/2004 Parcel Number: 42522301 Zoning: Applicant: WECK, STEVE ISSUED BY: `SII Address: Phone: 626-449-0111 Zip: Owner: MOSS, FRANK TR Address P 0 BOX 8507 EXTENSION Phone: (949)646-8743 � NEWPORT BEACH,CA Zip: 92658 Loc Wj7�U' D Contractor: PACIFIC CONSTRUCTION SERVICES PER }�Gt(/c%� Address: 3452 E FOOTHILL BL _ STE 115 Phone: 626-49-0111 EXPIRES / /0 PASADENA,CA Zip: 91107 License: 751065 Arch : MICHAEL DAVID ROBINSON Eng: Address: ROBINSON HILL ARCHITECTURE,INC Address: IRVINE,CA Phone: 949-399-0880 Phone: 19762 MAC ARTHUR BL Zip: 92612 License: C20731 License: . SCOPE OF PERMIT INTERIOR RESTAURANT TI FOR'THAI SPICE".REMODEL APPROX 2516 SF.WORK TO INCLUDE RELOCATION OF AN EXISTING RESTROOM AND CREATION OF AN ADDITIONAL RESTROOM WITHIN THE SPACE. • FEE SUMMARY Plan Check: $532.19 - Calc Valuation: $75,000.00 Permit: $818.75 Claim Valuation: sio,0o0.00 SMIP Res: $0.00 SMIP Corn: $15.75 Other: $0.00 Inspection: $0.00 Total: $1,366.69 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existino: 0 Required: 0 Proposed: 0 47 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all ' required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 2448-46(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the Jsark for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'Ic�or,J+p�ens�at-lo_n In}urance carrier and policy number are: Carrier _ fir^ ` -N"xlT Policy Number: I 5 5 7 591-zoo 3 (This section need not be completed If the permit s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the workgfor which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws alifomia,and agr that If I should become subject to the workers'compensation provisions of ectlon 700 of the Labor Code,I shall forthwith comply with these pr on kV LI Applicant Signature: Date: T I 1 200 Li WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: • I hereby affirm that I am license under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business gn4frofessions Code,and my license is in full force and effect.Uc.# -1 I Class I At r} Contractor's Signature: Date: I /14/a-f • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-budder will have the burden of proving that he or she did not build or improve for purpose of sale.). - ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,l.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Dato: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and Pressure). u. . ______l_ ... _.... ..._ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ._ _....__.___. __ ._...__b__._._...._ _ -..- 4 If an RMPP is presently required has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this e application akrmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes D No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). — 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPUANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ti f ^g r eget Owner(s) �DJ to % )/x`4!te `f ntl/Or Authorized Applicant ate ), 02E1. ItURECmoN TYPE OSIS I1ElliSLS goof INSPECTION TYPE MI IIBIBSLS • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site oS204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA • BUILDING DIVISION y°;t,,,, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ti ,i! / PERMIT • `+ r P - 372 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 263 E 17TH ST , Status: ISSUED Suite No Applied: 06/12/2003 Issued: 07/16/201, Vicinity: THAI SPICE __ ISSUED BY: A' Parcel Nunmber: 42522301 . , .� - , - 7. i Applicant: WECK, STEVE' Address: - . - _ • Phone: 626-523-8323 CELL , -' i Zip: - - Own ' er: MOSS, FRANK TR " Address P O BOX,8507,- - Phone: „(949)646-8743 i - NEWPORT BEACH,CA Zip:, 92658 Contractor: ' PACIFIC CONSTRUCTION SERVICES Address: 3452 E FOOTHILL BL' . STE 115 Phone: 626-449-0111 - PASADENA,CA Zip: 91107 ' , - - License_: 751065 ' . • r ' , Arch / Eng: " , . ` _ t ' _ - , Address: , Phone: - =Zip:j - License: _ /ice - SCOPE OF PERMIT - 7 , INTERIOR RESTAURANT TI FOR"THAI SPICE".REMODELAPPROX 2516 SF.WORK TO INCLUDE ', RELOCATION OF AN EXISTING RESTROOM AND CREATION OF AN ADDITIONAL RESTROOM WITHIN THE ' SPACE.REF.:803-00076 'PLUMBING TO INCLUDE:2 FLOOR DRAINS,4 SEWER CONNECTIONS,.5 FLOOR SINKS;2 KITCHEN SINKS,2 WASH BASINS,2 WATER CLOSETS,AND 1 WATER PIPING.'' -' ' -` , - - , ' FEE SUMMARY = i ; ' . /�/ V�'N' AMT OW " AMT .'OTY �-'-- .%. /' AMT DIY ISSUE FEE \ $23.50- - LaundryTub/Washer - ',$0.00`-- -0 t ''Sump Pump,' t / $0.00 0 Backflow irrigation `'\S0.00 0 . Landscape Irrigation $0:00 0--• . -Swimming'Pool/ $0.00 0 Backflow Preventer $0.00 0 P-Trap - --, . , -. -.$0.00 _ 0 \ - Trap Primer/ $0.00 0 Bathtub $0.00 0 'Pressure Regulator $0.00 ' ' 0 '-' Urinal''," $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) .$0.00 _ 0' Vacuum Brkr Bkfow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0' - Receptors $0.00 0 - -1—Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 - Septic Tank - - - -.$0.00 ,70'-2_,- Wash Basin $19.60 2 r Dishwasher $0.00 0 Sewer Cap forDemo' -- ' '$0.00---0" Wash Basin Set $0.00 0 Drain, Floor $19.60 2 Sewer Connect ' ^_$98.60 4 Waste and Vent System $0.00 0 1,\............1--#:„............._ ' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-48(NM) DECLARATIONS , 1 1 WORKERS'COMPENSATION DECLARATION: I hereby affirm wider penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) Dien certify that in the performance of the work for which this permit Is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Cal a,and agr e t t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi Applicant Signature: Axe Date! 1 • IC,- -I WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lictqvidpnder provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Lic.M1 ( ./ Class x? 416. Contractor's Signature: Date: } '7-(L'ON CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) . license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. $Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e..property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomla Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand'a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 or will thefuture applicant or present or building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ll Yes LJ No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signat %e g 10 S) Date (c, a�( An•0•uthorized Applicant Date 7 CODE L INSPECTION TYPE PAIS 1NRRALE LODEt INSPECTION TYPE PETE IMLE 1818 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 9-,22-09 I\1 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ADDRESS aMUMS: 263 E 17TH ST UMT: CITY OF COSTA MESA — BUILDING PERMIT ONNPXSNAMEUIWONM JIOSS; FRANK TR PERM NO: F 083505 must P 0 BOX 8507 NEWPORT BEACH,CA 92660 PERMIT NO: F 083505 PLAN CHECK NO: 02372-97 L GOVT: N SUPP: N APPL.MuIgyD ADDRESS, CONSTRUCTION TYPE: V—N PERMIT TYPE: FIR PURPOSE: OTH ARCHITECT OR ENUTNEER: LK.xo_ JOB DESCRIPTION : FIRE SUPRESSION SYSTEMS FOR RESTAURANT SQ FT: ARCH OR ENG9 ADORERS: UUT: CLAIM VALUE: 2, 200. 00 CALL—VALUE: GROUP OCC: B / catiTRAnowskulE RIGOLZ FIRE EQUIPMENT CO ( 818 ) 579-9830 CONTRACTORS MAIMS 2526 N LOMA AV COMMENTS : "SAM WOO RESTAURANT" RE: #1382502 AoofEsx SO EL MONTE CA tx.mo.: 524249 ********it********************+pie***********4t*******************************-***+tit 91733 LOU: Z ON ING REQUIREMENTS UCENSED CONTRACTORS DECLARATION:I hereby Sim under penalty d Petery Pim I a f mp eed under amors of Chapter 9 SETBACK S (commencing with Section 7000)a Division 3 d the Business and Professions Code.end my Iowa is In tie forte and seed. CITY WC.No.: O68227 uc,CLAss: C 16 UC.ND.: 524249 EXP : 08/97 MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: (- 26- Gr7 Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penally per)ury that I ant erma hos the Contractor.License Law fa the ldbaso wcg Man(Section 70313 Busierera ProfessionsCode:Anycay a way which requires ,there ee a permit toimprove. PARKING REQ: PROV: PARCEL: 42522301 ZNE: REF NO: (- demolish.are{rrarytmrcaoe.pnabnununce,alorequbathesppbmNlsvrhparm'ttoMeewyedMOM"Omh°athe PLANNING NOTES> t. S licensed pursuant the of Division 3 cf the Business and Prdw,ms Coder isions t (Chapter the Contractors License Law ) he or the Stem therefrom and a the basis forexemption.alleged exemption.My violation d Section > 7031.5 by any applicant for a permit subjects the applicant to a CM penalty of not more than fide hundred dais.(5500D. ***********************************'lE******************************************* ❑ 11/4 as owner oflh°PropmtyormYemployees soh wages a thei sole compensmbn,wl dome cony and the°o-wure i not blended DEVELOPMENT SERVICES REQUIREMENTS or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en owned property who bolds or in proves thereon.and who does such work himself or herself or Utaugh his other own employees,provided that such fmpo.apaa we not intended«Shad for sale.If,however.'he building or inpovemert is sold within we year ammpbtnn.the ZONING APPROVED BY DATE: owner-budder will have the burden of proving he or she did not build or inane for dr purpose a sale). ❑ 1,aowner d the'fleet arn"weny clmetigwh"mad mrmaeaa10cenmw the plal(Sedien 7044.Huainan and BUILDING APPROVED BY : DATE: Professions Code:The Caradon license Lew does rid appy to an maw of ProParlY who dales Of lama thereon and Woe oowacb for ash Poled*with e mrlreeor(*)licensed pursuant to the Contractors lions Law). Q�1 1 ❑ lamsoma uderSedlon: B.AP.C..f«this reason: APPLICATION ISSUED BY • dJ�7uc.,_)0' DATE• ***************************************** **dA ********************** ,t*** * * Date: OWer LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby candy that I am aware of end understand the requirements of California Health and Sally Code Sections 25505.25533.and 25534,end that lorWTI haaebuilding occupant.w /wino(arseone)need 10armpywhsaid dmemanand the ntairementfor BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING ape permittorconstruction or modification ben the Army anagernent District.Residents condrudon appirmcrn we exempt hen these PERMIT 75 . 00 PLAN 4867% SMIP/NON—RES Da Applicant: WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty a paltry one a the following deaaratiom: ISSUE FEE ❑ Ihave and wlsnatal ecertificate aconsent losell-insure tor workers'compeatln.asproide odforbySadbnIM 3700ofLabor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Coda,f«the pen«m.zedwork kfpwHmama TOTALS----> 75 . 00 0 . 00 48 . 75 123 . 75 123 . 75 . 00 1] Have and M mania,workers'compensation insurance.ere required ed by Section 3703 the Labor Code,for the performance the Workm forwtimba pnatbissued.Myworkers' n �aog mmdporaT'manberan: EXPIRES REVENUE DIVISION TOTALS--> COLLE II : 75. 00 OVER/SHORT: . 00 Policy Number: YYJfZl JY LJL 02/15/98 BLDG PMT PLUMBING ELECTRIC . ANIC FIRE SMIP/TOT GRADING PLAN—CHECK carnet (This section need not be completed 1 the permit is for one bonds dopers(scat)or Ass.) 75 . 00 ❑ I catty that,the performance of the work for which this permit is issued.I shell not employ any person in any manner so as to • become sunned to the workers'compensation laws of California,and epee NM compensation erasion a that I should team salmi 10 the wakens' *************************-- **************** -***************************k****** • ivSection 3700 d the lade, ibor Codel dull faro m Picea provisions. 7) //Y � I N D I V D U A L F B R E A 'OD- OWN _ Date: ... 7•(R-• 7-7Apr/tank Warning:Failure a secure aorta:cmperuaden coverage b rat and shadabled an flier*,to Mini Perwda and TYPE QTY DESCRIPTII UNIT COST TOTAL COST civil Imes rep to one hundred thousand dollars(6104000).In add/ to the cost of conpensatba armor a provided for In Section 0705 of the tabMins(Code, s(and 7eya Mee FIR 75 FIRE EQUIP F F FROM BLDG VAL TABLE) 1 . 00 75 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that then Is a Construction lending a0ency kr the END OF FEES performance of the work for Mich this penal is issued(Sean 3097,Civ.C). .� grl LENDER'S NAME )^v l LENDER'S ADDRESS: k.! I air*that I have need this appectan and sate thal the above WPM/SO is correct.I agree noomV/wheD ale rd county ordinances .-. (sr e1malassriigm c«mudion and herebyeWwus representatives city to enter upon the above-mentioned properly • . Psi for inspection papoas. JACK EVANS I/' -" 86-26-1997/12112 P11/175.89 ( // PnniName �� ,y/ RIPT�:81-9888315 at1 z Date: 6-24- �� y / PERMITa883585 Signature a OwneageWApptcat.Cagrma /A :•r (5151'46.WP) Wide-adig&Safety;(Lem-Fla:Canary-Appkuu;Pink-Revenue:Goldenrod-Assessor ). • CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement r 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. • 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System • 61. APPROVAL TO DECK • 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer CaP - 63. Heater & Vent-Final ' 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-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 Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical !0127(47 rJ 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 4j37/17 K7--- 29. Insulation 78. FIRE PREV. FINAL &A,7/47 /5 - 30. Drywall Nailing HEALTH DEPT. REOUIREMENT �/ 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 Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound AttenuationT I* 46. Handicap Regulations - g E » H 47, FINAL STRUCTURE & BUILDING (71gF cn er' r. 48. FINAL PLANNING s ,m„qj P k 49. Electric Release to Edison t"-`4N 50. Gas Release to Southern California Gas Co ^n 1.1 51. CERTIFICATE OF OCCUPANCY No. Date mDn,2na BMLOurD: . 263. E 17TH ST LIMT' CITY OF COSTA MESA — BUILDING PERMIT OVOCWSNAMEIFIa?& MOSS, FRANK TR PERM NO: E 082503 1p0AE51 P O BOX 8507 NEWPORT BEACH,CA 92660 PERMIT NO: E 082503 PLAN CHECK NO: N GOUT: N SUPP: N APPL.MMUND ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE : ELE PURPOSE: ALT ARCHITECT OR ENGINEER PINEWAVE DESIGN & ENG Into.: C36096 JOB DESCRIPTION : 4000SF RESTAURANT TI SQ FT: ARCN.ORUG.1ASOREss: 21017 COMMERCE POINTE DR LINT: WALNUT CA 91789 CLAIM VALUE: CALC—VALUE: GROUP OCC: A-3 / caoncroIrSNAl1E: PINEWAVE CONSTRUCTION ( 909 ) 869-5777 • cotannysmam 21017 COMMERCE POINTE DR COMMENTS : "SAM WOO" RESTAURANT TI REF:B-82502 AOREss: WALNUT CA ucNO: 591635 + **Ir*x**4********et***+ ****+E**********i'r*iE***is********************x*****x******y;* 91789 LINT: A ZONING REQUIREMENTS UC - D CONTRACTORS DECLARATION:I hereby alum under penalty of peRry all I am Ikaued under wort of Chapter S SETBACKS (.. m .'rep with Section 7000)of Division 3 d the Business and Probations Code.and my Tromso is it Il brae and abed. • Uc. 0.: 068025 UC.CLASS: g UC.NO.: 591635 EXP: 07/97 MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN Date: ' 2.4.— ContractorLEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER UILOER OECLARATION:I hereby affirm under penalty d penury that I an exempt Iran the Caarodors License Law for the S. . reason(sedion 78313 Diana*and Professions Code:Mycly a coutywbdh requires apeqne to conrwd,ane.enprove. PARKING REQ: PROV: PARCEL : 42522301 ZNE: REF NO: '.rIW.: a CONSTRUCTION AND PLANNING POL SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61.. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit • n 66. Solar System-Final 16. Rough Electric Wiring Slit/ a 67. Fencing & Access Approval 17. Rough Wiring Sign ��LLIe9. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 4141117, "-69 ^OOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final FOOD CERTIFICATE ISSUED 33. Final Electric 622717 V. N,tes: 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 Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation ' 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date AOCREss OF BULIMIC: •. 263. E 17TH ST - req: CITY OF COSTA MESA - BUILDING PERMIT amlERSNWEIFIDIOMIk MOSS, FRANK TR - - PERM NO: M 082504 ADOREss: P 0 BOX 8507 NEWPORT,. BEACH,CA 92660 PERMIT NO: M 082504 PLAN CHECK NO: N GOVT: N SUPP : N a APP k.MUImGADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: ALT ARCHITWT0NFNfs4EEThPINEWAVE DESIGN & ENG uC.NO.: C36096 JOB DESCRIPTION : 4000SF RESTAURANT TI SQ FT: ARCaoRENa'sADOREss: 21017 COMMERCE POINTE DR LINT: WALNUT CA 91789 CLAIM VALUE: CALC-VALUE: GROUP OCC : A-3 / OONmACToasNAME: PINEWAVE CONSTRUCTION ( 909 ) 869-5777 CCNmACTarSMulaa 21017 COMMERCE POINTE DR COMMENTS ; "SAM WOO" RESTAURANT TI REF:B-82502 AODREss: WALNUT CA Ciento.: 591635 *************TF**+FSF*+E******+F*******lE*iFietFte*tF******tit+ *********luta;*x-+t-sF****** -****** 91789 or A Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby arm under penaly of perjury Na I am licensed under provisions of Chapter 9 SETBACKS (commenting with Section 7000)d Divebn 3 of the Business and Professions Code.and my license le in lull brio end Sled. CITYUC.NO.:068025 uC.CLASS: B uc.N0.: 591635 EXP : 07/97 MAIN BUILDING ACCESSORY BUILDING 0 2-1 _1 i Crateae YS -c)--, ,,, FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN R BUILDER DECLARATION:I hereby affirm under penaly of Perjury Mal I am exempt from the Contractors License Law for the following reason(Section7031.5Busiese and Professions Code:Any cry or county whim requires a pane to crowct alter.inaovs, PARKING REQ: PROV: PARCEL: 42522301 ZNE: REF NO; demolish,or repair any structure.prier.lo its issuance,also requite.the applicant for such permit to fib a Maned statement that he or she PLANNING NOTES> is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7063)of Division 3 of the Business and Professions Codel or that he or she is exempt therefrom and the basis for the alleged exemption.Ary violation Of Section > ei v 7031.5 by any applicant for a Perna rdpds the applicant to a cut penally of not more than Die hundred dollen(SSCOR. *************************************,***************************3E************** O I,es ownerof the propertyr my employees with wages as their sole compensaien,will do the work.and the structure is nor Sanded DEVELOPMENT SERWICES REQ U I R E M E N T S or offered for sale(Section 7044.Buten and Professions Code:The Contrition Licenseproperty Law does not apply to en owner of property who baits or improves thereon,a d who does auch work himeed r hreel a Nnagh he or her own enpb/w,provided that stem 'y. ov imprementsae req intendedor offered fracas.N.however.the building or or improvement sold ygln year yeofcomplron,the ZONING APPROVED BY DATE: owner-Wader will have the burden of proving he or she did not build or improve for the purpose of sale). OI.as owner of the popery.am exclusively contracting with licensed conbarors to conrrod the project(Sarco 7044,Business and Professions Code:The Contractors License Law does rot apply to en owner d property who builds or improves thereon and who BUILDING APPROVED BY _ DATE: _ _ contracts for sum projects with a contractor(s)licensed pursuant to the Contractors License Law). — 7 O Iern exempt under Section: EL&P.C..for this reason: APPLICATION ISSUED BY; ( ;_ " A. DATE: ********************** * . . . .*- • **********. . . , . *- - - •** Dga: Owner: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT: N I4 hereby caddy that I am aware of and understand the requirements of California Heath end Safety Code Sections 25505.25533,and 24534t�: -. . ,end that I or any future bildug occupant /wil net(cede one)need lo comply with add slate ate codes end Ihe requirements a Bernd construction or the Ai «agement District Residential rrudienappicatiru ere exempt BLDG PMT PLUMBING ELECTRIC'} MECHANIC FIRE SMIP/RES GRADING Provisions. PERMIT ERMIT - - ' 1-1 .15 .50 ' ) : ^ 25% SMTP/NON-RESDate: Applicant: a r , i PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm oder prafy r peury one of the following dedaraest ISSUE FEE „ ' ;22 ;00 O Chaeane,for will maintain vindicate the sork f ot hitotstelf-is canna is issued. wmpenWion,mprovided labySaran3700ofthelabur BUILDING-DIV-> PERMIT ISS " P'LAN-CHECK ' . _� TOTAL PAID DUE CI Ihaveadvimartanworks'comensationinsurance,aregtmedbySection3700cteLabrCode.Icetheperfrnanoeofthe TOTALS----> 115 , 50 2 , 00 �' t' 0; 00 137. 50 137. SO , 00 sa work tor which this permit u issued.My wakes'compensation insurance carrier and policy number are: Career: GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS -> COLLECTED: — 137 , 50 OVER/SHORT �"��\� 00 policy Numbs TIWC 319445-04 . 07/27/97 BLDG PMT PLUMB"' ELECTRIC MECHANIC „ FIRE SMIP/TOT GRADING ky.AN-CHECK (This.sedion need nor be completed I the pens is for one bundled dollars I$IOOJ or hes.) 1 :50 i,�c(1"'(('\� ❑ I centy that in the performance d the work for which the permit is issued.I shall not employ any person in any manner so as to \ IY QE' \t .• become subjed to the cors'conaensaion lows d CaMomfa,end ghee Meat i l stand become sublet(m the werlert• **********************'. ******* **.*********)E3E*t*************1E**gve3(' �E,,yy.s,!******* mpenalon provisions of Sedon 3700 of the Labor Code.I shag forthwith corn*with Mase pmdsons. \1 ,�yy,, Q [y�� /f I N D I V I U A L 'F}E4'E' ''% HiR E A K D 0 W b� der G� ate: `T 't4 /� ApPliwt: /� ��-{'.t .� �- �\�. Ga ae< (\�' t� o yep;Fapuve roswervn wplyri mmsalaadon atsanlgabunfnrM,end uYgam.no crinss,paWdn and TYPE QTY DESC I P T I O N� / n UNIt %�\)).V\`dx'1' •AL COST •tial Rnn up to one hundred Thousand dollars(slaloW),in addfUon to the cost of co npawrbn damps as provided for In Section 3706 of the Labor Code.Infant,end attorney's fees. i 10(x` 0 e (e Z,� MEC 3 INST FORC— IR/GRAN FURN" <= 100 K BTU e.4' ped >2 39 . 75 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury the then is a construdge wiling agency for the MEC 1 GAS PIPING 'VS 1 -- 4 OUTLETS 'Cr `e`+ `' • t eye tie" 5 . 50 pedrnenaeofthewrkforwhichthepemaeissued(Sernn3097,CP.C). MEC 3 INST HOOD W, UCTS FED'.BY MEC- EXHAUST cP e ca °` 28 . 50 LENDER'S NAPE: NEC 3 INST/REL AIR HANDL UNIT 0'7y1000V\CFM jP 4Y712.2 .* 28 . 50 ) LENDER'S ADDRESS: MEC 1 REPAIR/ALT RE •RIG ) UNIT/SYS W/,CNTLS D 13 . 25 1f' I certify that I have reed Neapplcatem and Gate that the above information is coned.I agree to comply web ell city and couoleondinances END OR, FEES a 1 1997 / and slate lows relating to Wilding constriction end hereby authorize repaaenlaives of this my to enter upon the above-mentioned properly 71 kw inspection purposes.DAN CHEN • _�'... 2 L \ n pint Nemo iS AP� ;•;;FSA `yy-• �'�. ^"//�� ^^ Dae: 4-•-•2../ _43 .1 ;'l C;;;31.‘ Signature of Cnv eret/ADpicen✓Ca for V (5151'ea.W P) White-Burling&Safely; Green-Pie: /Canary-Appirau:Pink-Revenue Goldenrod-Assessor • ICONSTRUCTION AND PLANNING PQ, k SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location i 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement ' 3. Electrical Conduit Ut;lity•Undrgrnd. 54. Forms 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test _____r 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe,0 Undrgrnd., Test .9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVALTO DECK • 111. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater&Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-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 Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test - 72. Underground Flush 24. Roof Framing• 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing • 76. Dry Standpipe I• 28. Lathing& Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL • • 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric a Notes: 6 ..-f0-.g7 i gsev C 1---___ p _ 34. Final Heating.& Air Conditioning Z[_f / ria Q C e..oy� Z�1 .) 35. Final Gas Pipe-Test ick-11619 • i t e T, -- .. _Ec�tz.sti s-E 36. Hood or Canopy -et-T Ci-7aL,`!G S !0 .# ny 37. Final Factory Fireplace 24;:a9049#, L, _ 4!7 c_,22_,__ _ - 38. Final Plumbing - • - -- _ d 1 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final n 42. Backflow Preventer 43. Backflow Irrigation . - 44. Landscape Irrigation System 7 ' fy ' • 45. Sound Attenuation c.\ _ 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING - - �` �� L- 48. FINAL PLANNING --" k 49. Electric Release to Edison _ . 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY . No. Date ' ADDRISSaE51"1"3: '• 263 .E 17TH ST mat CITY OF COSTA MESA - BUILDING' PERMIT anlErsNAMEITIDtaml MOSS, FRANK TR -• r PERM NO: P 082505 • �'0m" P 0 BOX 8507 . NEWPORtBEACH,CA 92660 PERMIT NO: P 082505 PLAN CHECK NO: N GOVT: N SUPP : N s APPL.KCMG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: ALT „ARCHITECT C*1963itEER: PINEWAVE DESIGN & ENG tic.ra' C36096 JOB DESCRIPTION 4000SF RESTAURANT TI SQ FT: e's'WES% 21017 COMMERCE POINTE DR UMT: WALNUT CA 91789 CLAIM VALUE: CALC-VALUE: GROUP OCC: A-3 / commawswm PINEWAVE CONSTRUCTION ( 909 ) 869-5777 caORACTOR'SMNLDta 21017 COMMERCE POINTE DR COMMENTS : "SAM WOO" RESTAURANT TI REF: B-82502 ADDRESS: WALNUT CA uc.ND_ 591635 **********************AE****it*at** **** -**tE****it***it***iE*it********3t**** *IEEE***N** 91789 wit A Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby elfin under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license sin full force and Bled. C • No.: 068025 uc.cuss; B UC. 591635 EXP : 07/97 MAIN BUILDING ACCESSORY BUILDING All �� �_c1 caawan c124_,, FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT' IN BUILDER DECLARATION:I hereby aurum under pronely of perjury the I am exempt Iran the Contractors License Law for the f ""dbwsg reason(Section 7wt5Baaneasand Pidesdons Code: acedy which requires a penult to ataNw,alter,improve, PARKING REQ: PROV: PARCEL: 42522301 ZNE: REF NO: demolish,or repel cry structure prior issuance,to its also requires the applicant nt for suchpermit to file a signed statement that he or she is licensed pursuant lathe provisions des Contractors License Law[Chapter 9(commending with Section 7030)of Division 3 d the PLANNING NOTES> Business end Professions Code)or the he or she is exempt therefrom and the basis for the alleged exwebtion.My violation of Section > ,!a 7031.5 by any applicant loco permit subjects the applicant tpedvn penally of not more than the hundred dollars t5500D. ****************************************************************")E**-1EiE********** ❑ I,as owner of the property or my employees with wages as their sole compensation,win do the work.and the structures not intended DEVELOPMENT V E L O P M E N T S E R V I C E S R 'E' U I R E M E N T S or offered for sale(Section 7044,Business and Professions Cal:The Contractors License Law does not apply to an owner of property Q who bolds or improves thereon.and who does such work limsef or herself or through his or her own employees,provided the such imprwemees're roll iteded ordsred fasale.i,howevr,Ile buidieg a improvement s add within One year dampletio. the ZONING APPROVED BY ' DATE: ownerbuilder will haw the burden d sh proving he or e did nos build or improve for the purpe d sale). 0 I.as owner of theyropary.am exdusysy aruradng with loaned contractors to construct the project(Semon 7044.Business and Professions Code:The Contractors License Law does not acolyte en owner of property*to hew Dir improves threat and who BUILDING APPROVED BY : DATE: contracts for h�id/prgws witha ardd ssrao(s)licensed pursuant to the Contractors license Law). •- — Ismampiuder$vea:lB.AP.C..fareason: l '" APPLICATION ISSUED BY: :� DATE: . 2-1 ' \ ********************** a- :- ********** . . . . .. _ . .., .** Dale: Osman LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N I do hereby certify that I am aware of and understand the requirements of California Health end Safety Cade Sections 25505,P5s53,and lid r w.g est/ n 25534,and that I or any future building occupant will/wit rot(dol one)need to comply with said stale cedes and the requirements for a prop torwutmction or mddration from the Ai hay anegament Din:id,Real til constructor,applications are exempt from these BLDG PMT PLUMBING ELECTRIC. MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 241 . 75 - • Date: Applicant: 25t l nr ••151- T SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby arms under penalty of perjury one d the following declarations: PLAN Ir ..r _ f \ ❑ Ihave adeel maintain aced"hateof consent toself inmabrworkers'commpensation.=providedfor bySedion3700of the Labor ISSUE FEE 22 , 00 y ' - n-a \gra Cde,forthepedema-iceofteworkforwhichthisprmiti®ued. BUILDING—DIV—> PERMIT ISSUE PliAN' CHECK ' '.TOTAL PAI} c DUE ,] I have and wO mainais workers'compensation insurance.as required by Sean 3700 d the labor Code,tot the performance d the TOTALS 24]. . 75 22 . 00 .� �' 0• . 00 ✓ 263: 75 263,4:%5&05"��O 00 A work for riih the permit s Sued.My workers'compensation insurance ismer and policy number are: + r\ 'lC era \\ Carder: GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : ' • '2'6'3 . 75 OVER/ G gg 00 �' Policy Number. t<1Wf' 'i144 '111-04 07/27/97 BLDG PMT PLUMBING 'CTRIC MECHA /FIRE. $MIP/TOT -. �'O'PT,(AN-CHECK (This section need non be completed'/the penult is for one hundred dollar al 001 or leu.) 2 3 . ... ,—, . . h ,%? of 'n �V V\ ��r o I cents the in the performance d the work la whkh this permit Is issued,I shall w employ any Person N any manner SO as �}a \\0<0� tC Q'hn 11' became euNecno theworse comPenWion swe d Cardmia.end Wwthd N l ahouM Mca lel to the workers' ******************* , ********** ***iE****4******HE**** CY*" .» 9 �*'%'************ on provisions of Section 3700 d the labor Code,I shall forthwith comply with Dose provisions. 1 / \—' 4—Z./-9i Applcan: ..ap., e..-10-ss, I N k I V I D A I' {7F E E ,'.B R E Ng Q. SC' t I3 e: tt` 0 tk Q Mr Failure foarureworkr:ro°12nedoneovrpslaunnM.find Shan subject anwwloyer to criminal pienos end TYPE QTY DES - R P T I O. N^. t� ! 7 \lam ,--1 J; TOTAL COST s d1 fines w to one hundred thousand dollar($104,000,In addition to the out of compensation,danapa ea provided for In y, lh,/• \ Section 3706 of the Labor Code,Internal,and attorneys fees �' t r( 1 6t� 3 . 75 CONSTRUCTION LENDING AGENCY: l hereby awns,under PLU 5 SINK, K 'f CHEN r) • penalty d perjury the there s a atmrdion lending agency for the PLU 2 HASH BAS N yJ '.' i / \Gt� •, 75 75 17 . 50 performance d the work for which the normal is issued(Section 3097.Crv.C). / LENDER'S NAME PLU 3 WATER CHEA 'ETR ( TOILET); ^ 1 j26 . 00 LENDER'S ADDRESS: PLU 1 WATER HEA 'ER AND/OR VENT, ^/// ;'./...' Q �.l PLU 1 GAS PIPING SYS OF -1 TO 4) `OO,TBEPS • 5� 5 . 50 land'the lheve red the sporr�aled stale Nat the above information is corneal agree to comedy With as ay and county ordinances PLU 2 GAS PIPING YS Si-;7 QUTL—PE$i'OUTLE•T l . 00 2 . 00 and state laws relalsq to building corntradion and hereby authorise representatives of this coy to enter upon the abwe.mwiasd properly — 1-- for inspection purposes. PLU 1 GAS SERVICE 8 DAN CHEN PLU 1 FLOOR DRAINS f/. ‘ 8 ,75 2 1997 88 . 75 . 75 Print Name PLU 9 SINKS, FLOOR 8 . 75 78 . 75 Taw C � Data: 4 —�—/— q7 PLO 1 SINKS, SERVICEW / M�P� ;r ;75h ,.ttil�lt 875 sgneun aowan u a PLU 1 URINALS, WALI, i ;L? 1 . 7$' 8 . 75 (5151-46 W P) White-Bw1dbg&Safety:Green-File:Canary-AppEant;Pink-Revenue:Goldenrod-Assessor `1 CONSTRUCTION AND PLANNING PO :1.1 SPA APPROVALS Permit# - • Date Inspector APPROVALS Permit # Date Inspector J.'. Temporary Electrical Service or Pole � 52. Pool & Equipment Location �'C it ( 2. Soil Pipe-Undrgrnd. aeon ) 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd-, Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ;1. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final -14. Rough Plumbing ( ,CS, 65. Electrical-Final c 15. Rough Electrical-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 Structure - 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd,Storage Tank 0 Gas 0 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ��7 / 1 33. Final Electric Notes:4:1g.3, ait#4ND_j7W Y=c..o, 34. Final Heating& Air Conditioning _/ 5inLcs_ _/N-L-wt.cCtl7t ZO __ 35. Final Gas Pipe-Test I r� 6'a.�_ 36. Hood or Canopy A- /O -19 t�-ce � 37. Final Factory Fireplace at 38. Final Plumbing d _�g_L, ts_t 7 t, 39. Water Service-Final �lr- C� U 11/4 40. Gas Service-Final - 6'�-J(/i jJ L -24.417 €2 -nn_ _ __ 41. Solar Domestic-Final ���"' 42. Backflow Preventer - AF'• 43. Backflow Irrigation • e 44. Landscape Irrigation System • 45. Sound Attenuation • • •- � 46. Handicap Regulations in-. -5 47. n- 47. FINAL STRUCTURE& BUILDING _ •. • 48. FINAL PLANNING . ; 49. Electric Release to Edison , �+c� 50. Gas Release to Southern California Gas Co • _ 51. CERTIFICATE OF OCCUPANCY No. Date • f ADWIssoFemwm, ,. 263 E 17TH ST UNfo CITY OF COSTA MESA - BUILDING PERMIT Ow1ERSNAMEIFmmk MOSS, 'FRANK TR PERM NO: 8 082502 ADDRESS P 0 BOX 8507 NEWPORT BEACH,CA 92660 PERMIT NO; B 082502 PLAN CHECK NO: 05163-96 A GOVT: N SUPP: N APPL.M111UNG ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE; STR PURPOSE: ALT ARC'NRECTORENmNEETPINEWAVE DESIGN & ENG 1-1c C36096 JOB DESCRIPTION : 4000SF RESTAURANT TI SQ FT: 120, 000 ARCH.OR ENG.'S ADDRESS: 21.017 COMMERCE POINTE DR Mt WALNUT CA 91789 CLAIM VALUE : "120, 000 . 00 CALL-VALUE: 120, 000 . 00 GROUP OCC: A-3 / cONmACTORSNAME: PINEWAVE CONSTRUCTION ( 909 ) 869-5777 CCI4WACTORSMAIIIIIG 21017 COMMERCE POINTE DR COMMENTS : "SAM WOO" RESTAURANT TI ,- ADDRESs: WALNUT CA UCNO.: 591635 *at-">E****iElht*tt***:**+�******ittt-x-*****�kN-*+c�E+t -alp-*** Eat****�F* -****."IE+t�F*iF**�F**)E/�F�t-***�E;,iitit�k�E 91789 wit A Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby shim under peneky of perjury that I am licensed under provisions d Chapter 9 t SETBACKS (commencing with Section 1030)of Division 3 of the Business and Professions Code.and my boarie is in full force and effect. c.No.:0680?5 uc.cuss: B uc.No.: 591635 EXP : 07/97 -- - MAIN BUILDING ACCESSORY BUILDING �)�eI FRNT: FT iN REAR: FT IN FRNT: FT IN REAR: FT IN • Datefte: 7 � ' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN ER BUILDER DECLARATION:I hereby affirm under penalty d perjury that I am exempt from the Contractors License Law for the " following reason(Section7031.5 Bmess and Pmleesion,Cale:Any ciya countywhist requirese penmittoconseud,alter,improve. PARKING REQ• PROV: PARCEL: 42522301 ZNE: C1-S REF NO: PA-91-94 demolish,or repel any structure.prim to its issuance,aro requires the applicant for such permit to fie a signed statement that he or she b licensed pursuant to the provisions al the Contractors license Law[Chapter 9(cmencing with Section 1000)el Division ion 3 the PLANNING NOTES> II TO CONVERT EX RESTAURANT TO SAM WOO' S CHINESE REST=AURANT. Seams and professions o ns Code) the he she b exempt therefrom and the baso to the alleged exemption.Any violationd Sadism > INXNG AREA-'WILL BE REDUCED FROM 1276 TO 1133 SF, . ....? 7041.5bYanYapplkenbra permit sllbjmW &the a to a civil penalty Ofnseas than five hundred dolkas 135003. **-1EiE*"k****lE***df*4.*Wlf******if**"lE********-lE************************IEdE******4)E****** ❑ I,s owner of the property or my employees"#h wages as their sole compensation,will do the work.and the m'mtu^is not intended D E V E L''?O ''P M E N. T SERVICES Ft E Q U I R E M E N 'T or offered ler sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an owners Q '�,' who builds or improves thereon.and whe does such wok himself or herself or through his or her own employees,provided that such C.• t" \ +, t 7 re improvement,are m wended or offered fpr sale.6,however,the bussingerr improvement le sold within°eyes d conpaeion.the ZONING APPROVED B'Y ' �/Y R C', DATE: n' r-1 ownenbuider volt have the burden el proving he er she did not bald or Improve for the purpose of sale). y l,mownerdthePr°P"•am nal**wntmedi:g wah kesed emvecsa'a oaueud OSProled(Sadim MN.Buns.and r/ , f� iC � Professions Code:The Contractors License Law does not appy to an awns el property whe builds or improvea thereon end win BUILDING APPROVED•'BY. _ • N DATE: ql�� !./A �•.. contracts for each prima with a contractor(*)licensed pursuant to the Contractors License Law). y,, y" ,. e• _f_ El I ern exemptuder Section: B.A P.C..for this reason: APPLICATION ISSUtD•-BY: ********************3E* . .` **********�, . Wie* Dile: OwnerLEGALIZATION:N F E E SUMMARY STRUCTURAL S -GMENT:Y I do hereby cad dy that I am aware of and understand the requirements of Caftomia Health and Safety Code Sections 25505.25533.and 25534,end that I or any future building occupant will/wil not(circle one)need to comply with said state codes and the requirements for elenmit laoon*imclonwmodifiraton h 'v u-6 ajityfren from Aegement District. id construction eppicetionswexempt from these ew BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES -4-GRADING ING provisions. PERMIT 987 , 25 1 Dee Applicant: SMIP/NON-RES PLAN 160 . 43 .l, n 25 , 20 -c-a-.... WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedeseons: ISSUE FEE - ' El Ihave and will maintain acertificate dconsent toeieH.ineuneheworkers'comperrwion,asprovidedfobySoden 3700of the Labor BUILDING-DIV-> PERMIT IS UE 'ttAN-CHECK TOTAL PAID 'C •?S DUE Code,fotthe p.dme performance a the wkl«wNd,this permit is Sued. TOTALS----> 1012 0 . 00 160 . 43 1172 . 88 1172 . 88 'i . 00 rCI have and oil maintain workers'compensation n i surance.as required by Sion 3700 the Labor Code,for the performance d the _ work for Mich M6 permit is Sued.My workers'compensation insurance serer and policy number are: i 1 Carrier: GOLDEN EAGLE EXPIRES REVENUE DMS TOTALS--> r LLECTED: � 1012 , 45 OVER/SHORT• 2.--; 00 • Pricy )4 gy Number 11943>-U4 07/27/97 BLDG t'T PLUMBING EL r' ' C MECHANIC FIRE SMIP/TOTTCWADING PLAN-CHECK (ihisaedionnsad rot be completed Ythe permit is for one hundred dolas($IDOlprlets.) 98 ' . 5' ' - 25 . 2805 / Y . /�V^ E"" El I become that in the performance of the work for which this permit is issued.I shall not empty any person in 5e manner so as to .. {g,HC uyt`c0'�1 '•�r.y became subject to the workoa'compensatio laws of California.ed agree the H l should become subject to the weeks'' ************* '** ** .Se**************************de** VT%'iF l(tlP,YyfpP*-tteF*******de iE*IF**** mpgsuugxn°moi'i C ZI--o:4OOd Labor Code. awl�yrtn"iM mom C provisions. D IV I D U A Ir F E E B R �lt \��l tg{y-�N• Oast: i -r -/.Lt..� t1item: S 1.. i-� \C 0� r •1e Int Fegpe to secure workers'compensation can Is unlawful,and shall s QTY J E S C R I P T I 'O N 0 °��g0.•-\ 0,..1 �I� ',yy�5 \TOTAL? in ofcori compensation, esa.pP«smes.nd TYPE vs is JTvI9�'�tq��cT COST 1 SKtlonesslu of oi.Labor Cathousand l and dollars a airom��s feesIn addition to Me coat compwation,damages as provided for in .lam 1'0 \t`I �\(d1'h d/v4y�,.Q✓n s SFC 120000 T I . RESTAURANTS i BY VkftU year v2\ate JW 1 , 00 70-'000 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty d perjury that there b a construction lending agency kr the END OF FEW SPnd neat'3 performance d the or for which gems a issued(Section 3097.Civ.C). S\a\a_`p,9'dr- 4 , t T LE LENDER'S ADDRESS: \�C '\` Y/�'�' ]l t s ) I certify the I have read this epplira ion end data that the above informatics'is correct.I agree to comply with all coy and cowry ordinances T t Ae�s ft k,1 'FJ91 and Mate News releteg to building mnsourmn and hereby authorize representatives of this city to ether upon the eboe-Me toned property )/ /d fun impednn proposes.DAN CHEW ,• . (�{ COST (�11 ESk P theme p /' CI , vi tl��1F1 ,•• Date: cin 1--1 _.q7 Signal,"of s iliFn APPYrer'• rector 1 (5151J6.WP) White-Builder(&Safely:Green-Re:Canary-Appicam:Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNINGDate Inspector POL ,r SPA APPROVALS Permit date Inspector APPROVALS Permit# • Temporary Electrical Service or Pole - 52. Pool & Equipment Location -, 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • • r 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. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation- 59. Gas Pipe,0 Undrgrnd.,Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains ' 64. Plumbing System :Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-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 Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26, 7-Bar Ceilir gefer, & Monocoat tO.g,/die 75. Dry Chemical 27: Frame and Flashing fel} `J•7S1 (/ //fes 76. Dry Standpipe 28. Lathing & Siding I /�' 77. FIXED SYSTEM FINAL 29. InsulationI _ 78. FIRE PREY. FINAL 30. Drywall Nailing 0' aiL HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat �/ 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATC ISSUED 33. Final Electric Notes: .57/47.-• sf(.ecur / 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 Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - - - 45. Sound Attenuation 46. Handicap Regulations y - _ 47. FINAL STRUCTURE & BUILDING /.6.C�`f/ def-- 48. FINAL PLANNING 0.1 _ i4 g8"w . 49. electric Release to Edison L- state 50. Gas Release to Southern California Gas Co _ �•LU 51. CERTIFICATE OF OCCUPANCY No. Date • ADDRESS OFBWLMNO: 263 E 17TH ST WIT: CITY OF COSTA MESA - BUILDING PERMIT WMICS NAME IF KNOWN: MOSS, FRANK TR PERM NO: E 083081 -mr ADDRESS: P 0 BOX 8507 NEWPORT BEACH, CA 92660 PERMIT NO: E 083081 PLAN CHECK NO: N GOVT: N SUPP: N APDL.Mgn103 ADDRESS CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH ARCHITECT OR MINES: LIC.NO.: JOB DESCRIPTION ILLUMINATED WALL SIGN SQ FT : mew.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: CALL-VALUE: GROUP OCC : B / CONNiACTORSMWE SIGN ART COMPANY ( 818 ) 287-2512 COMPACTOR'S KAILAD 425 S CALIFORNIA ST COMMENTS : "SAM WOO BBQ EXPRESS" REF;SB-83080 ADDRESS: SAN GABRIEL CA ucNO.: 491427 ****xitPE*irif*PEu**+E*+EatiEit****SEstftitsEit+Eat******xxPExitSESE**PrSEieitiEitie****SLPrit****xsE*at*PretSrPrar*** 91776 Or F000 Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I eon licensed under provisions of Chapter e SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code and my license is in lull forte end effect CITY LIC.NO.: 047640 LIC.CUSS: C 45 LIC.NO.: 491427 XP : 10/97 MAIN BUILDING - - ACCESSORY BUILDING �_y 9 Cmama: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN / v LEFT: FT IN RGHT: FT IN LEFT : FT IN RGHT: FT IN '• R BUILDER DECuWWIfffATION:1///���www affirm under patsy d perjury that I am exempt from IM factors license Law for the I. . '. •reason(Sedion7031.5 Business and Professions Cade:AnycIy d county which requires aPermit touesbm,Moe.Mixon. PARKING REQ: PROV: PARCEL : 42522301 ZNE: REF NO: lemdeh,or repair any structure.prior to is issuance.also requires the applicant for such permit to fib a signed statement that he or she b r licensed pursuant to the provisions t e Contractors License Law(Chapter 9(commencing d g Son 7000) Division 3 of t e PLANNING N TES> dueness and Professions Code]or thin he or she is exempt therefrom and The bees for the alleged exemption.My violation of Sedan > , , 7031.5 ai by any applicant forapenir111 subjects the applicant toaaid penalydmmore than fore hundred callers(55000. ******************************************************************************* ❑ I.asowner chis PrapMW«nry empbyeee with wales As thei sole compensation mil do to work and the structure is not intendedy or offered for sale(Section 7044.Businessand Professions Code:The Contradors License Law does not apply to an owner of property DEVELOPMENT S-E�R V I C E S REQUIREMENTS who builds or inures*,thereon,and who does such work lemma or hensell or though his or her own empbees.provided that such - inpraemasaere maderdedo°tieredloraale.5.however,the building airrsprovemeraleddwdhnoneYee" oomPldan,the ZONING APPROVED BY -' DATE: rd owner-builder will have the burden of proving he or she did not build or improve for theof the purpose sale). O I.as anter el the property,am exclusively contracting with licensed contractors to cosmid the project(Section 7044.Business and Professions Code:The Contractors Licerw law does nal apply to en owner of property who builds CI improves thereon and who BUILDING APPROVED BY : r :V. DATE: convects for sort.projects with a contrmor(s)licensed pursuant to the Contractors License Law). 1 ❑ Iamexempt under Section: B.A P.C.,for this reason: APPLICATION ISSUED BY: - ') DATE: 5671 m ********************************4-*4•******** ******************** • ** ata: Owner ID Ddo hereby certify Mal lam ewaedand understand the reg4 rementsd Celyoms Health sed Sandy Code Sections 25505,9nr+'i'f.eM LEGALIZATION: N F .E. El .S U M M A R Y STRUCTURAL EGMENT: N 25534,and that I or any future building occupant will I we not(circle one)need to comply with said state codes ed the requirements for v a permit construction a modification from the Ar nliy.anagernent Distdd.Residential construction applications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING prov9H1Ons. PERMIT 22 . 00 Dale: Applicant: eSM I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby Minn under penalty of perjury one of the following declaa ions: PLAN ❑ Ihave and MImaintain acelad ddicaoonsenttosefftinsureforworkerses compensation, providedfobySecof Section 3703 ISSUE FEE 22 .00 Cmc.torMepenmmancedOnwoeklorw�hlinePermitisissued. BUILDING-DIV-> PERMIT IS PLAN-CHECK TOTAL PAID DUE ❑ I hese and wlmeintan workers'compensation insurance,asd required by Sean 3700 o the lam Cede.for the pedonmane of the TOTALS----> 22 . 00 . 00 0 . 00 44 . 00 44 . 00 . 00 F� won for which this permit is issued.My waken'umpensyan insurance urner end policy number are: Carder: Gnr,npF PAGED EXPIRES REVENUE DIVISION TOT' -> COLLECTED: 44 . 00 OVER/SHORT: . 00 Pdiry Number: Nwr94A144 08 /09/97 BLDG PMT PLUMB 1 .ELECTRIC MECHANIC IRE SMIP/TOT GRADING PLAN-CHECK (This radian new nal be completed!the penny is for one hundred dmans($ILO/or les) 44 . 00 El I tangy INS in the perfermerce d The walk for which the permit is issued.I shall not employ any person in any manner m as to become subled to the workers'compensation laws Of California.and agree Man I ole d bat rte subject to the waken' *********************** . ******* ******************************************** illm pen. on provssos w of Swan Labor n 3700 of the Code,I shall forthwith with I P IND I T ID AL FEE BREAKDOWN • eating:Failure to Secy workers' non covenge(s unlawful,and shell sub*:en employer tocdmnaf penaroes enc TYPE QTY DESCR PTIO N UNIT COST TOTAL COST dol lines re to one hundred thousand dollars($100,000A in swipe.,to the coat of compensation damages as provided for In Section 3706 of the Labor Cods,Interest,end atfomey's race ELE 1 SIGN/ OUTL E LIGHT SYS ON 1 BR CIRC 22 . 00 22 . 00 CONSTRUCTION LENDING AGENCY: I hereby afire span penalty of perjury Thal there is a amdrmion lending agency for the END OF FEES performance of the work for Mich this permit is issued(Seton 3097.Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and date that the above information is usedt l agree to comply with all city and county ordinances end elate laws relating to buildig construction and hereby authorize representatives of this sty to enter upon the above.mmioned property for inspection purposes. EDDY IISIEH 05-27-1997/01:46 PN/$44.20 Print . eRCPT#:01-0CC6821 hi — 7 Dale: S- _)9- PERIIIT: 083081 Signature of Owner/Agent - ••- - .•or r (5151da.WP) White-Buildig A Safety:Green-Re:Cuwy-MPIcan:Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING'• - POC SPA `'-APPROVALS Permit Date Inspector APPROVALS- Permit # • Date Inspector -41 • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r2. Soil,Pipe•Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd- • 54. Forms • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement • i 56. Rough Plumbing &Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe,.0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK -. 11. Property Sewer Line & House Connection - 62. Backwash &Receptor-Final 12. Sewer Cap - 63. Heater & Vent•Final • 13. Roof Drains 64. Plumbing System - Final%� 14. Rough Plumbing 65. Electrical-Final•15. Rough Electrical-Conduit - 66. Solar System-Final / 'i' 16. Rough Electric Wiring 67. Fencing& Access Approval ' r 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 Structure 70. Underground Hydro 22. Ducts. Ventilating 71. Product Piping OGas OOil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas OOil 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 PREY. FINAL ` 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 17 • i otes: 34. Final Heating& Air Conditioning Al11 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 Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUI LDING • 48. FINAL PLANNING • 49. Electric Release to Edison T 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY - No Date 6uLDNo: 263 E 17TH ST WIT: CITY OF COSTA MESA — SIGN PERMIT NAYEIP DOWN moss, FRANK TR PERM NO; SB 083080 'DRf' P 0 BOX 8507 NEWPORT BEACH,CA 92660 PERMIT NO: SB 083080 PLAN CHECK NO: 02078-97 N GOVT: N SUPP : N AP PL.MARINO ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH ARCHITECT OR ENGINEER: uC.No.: JOB DESCRIPTION . ILLUMINATED WALL SIGN SQ FT: ARCH.OR£110.5 ADDRESS: WIT: CLAIM VALUE: 3, 200 . 00 CALC-VALUE: 3, 200 . 00 GROUP OCC: B / cOtIWACTarSIWt SIGN ART COMPANY ( 818 ) 287-2512 canRACTORSMMIRIO 425 S CALIFORNIA ST COMMENTS : "SAM WOO BBQ EXPRESS" ADDRESS: SAN GABRIEL CA uC.ND.: 491427 ****************)t*******+t********>E**ititit*it+tit***it***it*itrriE******rt>F****xiter*'Eat****** 91776 WIT: F000 SIGN INF ORMAT ION LICENSED CONTRACTORS DECLARATION:I hereby affirm under penal),of perjury Nell amlicensed under provisions of Chador 9 DISTRICT ; 1 TYPE; WALL ILLUMINATION; INT CATEGORY: NEW (commencing with Sedan 7030)of Division 3dthe Budoessand Professions Code,and my'kenaeiinASforce and effea. DIMENSIONS ; 3FT 06IN X 18FT OOIN AREA: 63 , OOSOFT LETTER HT: 40" No.:047640 uc.cuss: C 45 uc.No.: 49 q27 �/ STREET FRONTAGE 1 : 46 , 00 STREET 152c: 17TH ST S _y� ry Comer ����j//�' STREET FRONTAGE 2 : O , 00 STREET / V `1 PARCEL : 42522301 ZONE: Cl LOCATION > FRONT: REAR: .SfillireuILDER DEC RATION:I hereby affmn underpnky dperjaythm IamesemPl from the Centredas Licande Lae Id NeAlia BUSINESS NAME: SAM WOO > LEFT: RIGHT; f• • . •reason(Section 7031.5 Busies»and Professions Code:Any sly or county whim requires a pemb to ooeafxf.alter,improve OTHER T OTALS GROUND SIGN °demdeh or repany structure,prior to is issuance.also requires the applicant for such pane to file a signed statement that he or she gi`''rls licenserepel any pursuant 10 the Provisions d Ne Convectors License Law!Chapter 9(cammendnp with Section 7003)cl Division 3 d the THIS ACTIVITY 1 . 0 0 S QF T OVERALL HEIGHT: OFT O I N Business and Professions Coda)or that ha o she is exempt therefrom end the bawls for the alleged exemption.Any violation of Section THIS SITE1 . 0 0 S QF T GROUND CLEARANCE: O F T G-:0 I N 7031.5 by any applicant for a permit subjeds the applicanl to a civil penally of nol more lhan fire hundred dollars P$5001). ITEMS OF INFO 1 PLANTER AREA: 0-, 00SQFT 0 I,as owner ol Me properly or my employees with wages as their sole compensation,will do the work and the structure is not intended ITEMS FOR ACTIVITY; 1 BLDG SET BACK; SOFT or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or inproves thereon.and who does such work Nmseff or horse,or through his or herown employees.provided that such COPY VERBIAGE : SAM WOO B .H .Q. EXPRESS �.�_` improvements are net intended or offered to sale.I.however.the building or improvement is sold within one year of completion,the ownersuitserwillhavelhebtswnofprovingheorshedidnobuildormproeleru»prapoledsw). pLANNING NOTES: El I.in owe.d:ha prWmy.an a dwasycommaiiamofl edcomadara lumnmudthe Props(Sedon7OM.BuNnen as ******************************************************************************* Professions Coda:The Contractorsnotply License Law does BP*to en owner d property who builds or improves thereon and who contracts tosuch projects with a corrtor(s)fcensed pursuant to the Contractors Linens.Law). DEVELOPMENT SERVICES R E Q U I R E M E :N!-T 'S ❑ I ant exempt under Section: B.A P.C..ler this reason: Date: OwnerraZONING APPROVED BY -Ta DATE:` �• I I do hereby randy Nm d st laaware and understand of the requirementsCdtomia Healthand Seelyctio Code Sens 25505.P55ri,and BUILDING APPROVED BY : n DATE: ' 1� 25534,and that I o any or future building cocoon'will/will net(Orel one)need to comply with said state codes and the requirements for vi"� ....II a penal for constructionmortification from the At/Duality Duality Management District.Residential construction appibas exempt from these provisions. APPLICATION ISSUED BY: DATE: Date: ADptoent: ******************************************************************* ** WORKERS COMPENSATION DECLARATION:Ihereby efimmnada penalty of perjury one of the fdlaw;ngdecimations: LEGALIZATION: N F E SUMMARY STRUCTURAL SEGMENT:Y BLDG PMT PLUMBIN ECT- IC MECHANIC SIGN SMIP/RES GRADING 0 I have and wit maintain a certificate of conn to self-insure ler woken'compensation.as provided to by Section 3700 of the Lebo PERMIT 87 . 25 Code,to the performance of the work to which this retrial u Sued. "fl i Ihaveandamabnaiwodwamad workers' .w eLaborCodeOepedomanceofthe SMIP/NON-RES 1F work for whim this panne is issued.My workers'compensation insurance carrier and poky number are: PLAN . 67 carder: GOLDEN FAGLE EXPIRES ISSUE FEE Petry Number. NW-244144 08/09/97 BUILDING-DIV-> PER' IT ISSUE PL ' s - - K TOTAL PAID DUE (This section need not be completed I to peal d loan hundred ddlanMoo]o less) TOTALS----> 87 . 12 0 . 00 0 . 00 87 . 92 87. 92 . 00 I certify that in the performance or the work ler which this permit is issued.I shall no employ any person in any manner ao as to subject to the workers•wnpenwion laws d Celimmia, andagree Nat o i show,berane subpd to the waken' REVENUE DIVISION TOTAL •--> COLLECTED ; 87 . 92 OVER/SHORT; . 00 mullion seon3oodthe ebppm ce.Lh.ufonhwan with BLDG PMT PLUMBING - TRIC MECHANIC SIGN SMIP/TOT GRADING PLAN-CHECK Dale: r -�1 j , Applicant: 8 7 , 2 5 . 6 7 a :Fen to secure niers'compensation coverage la unlawful,end shall subject an employer to cti nil/penalties and Rhes unto one hundred thousand dollars($100,000),In addition troths coat of Conwensation,danr9a tepovrow lotto ************************ '. ***************************************************** Section 3706 of the Labor Cod,Interest,and attorneys,sell IND IV DUAL F E E BR EAKD OWN CONSTRUCTION LENDING AGENCY:I hereby.Rum under penalty of perjury that there is e animation landing agency for the performance of the work for which this Pam*la issued(Section 3097.CP.q. TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST LENDER'S NAME: LENDER'S ADDRESS: NO FEES ERE SELECTED FOR THIS PERMIT I candy that I have read this application end nate That the above inforrnaiion is coact.I agree to comply with all city and county ordinances and state laws relating to building emmWicn red hereby authorize representatives d this city to enter upon the above-mentioned property to inspection purposes.EDDY HS I EH 05-27-1997/01:45 PH/$87.92 Pmt RCPT0:01-0006820 ti/ al? Date: r)'7' 1? PERMIT:083080 Signature• e . C.nUA y" r( / iii (5151.46.WP) White-Buildkp&Safety:Green-t e:Canary-Appkaud:Pink-Revenue:GoldenmMesessor CONSTRUCTION AND PLANpfICG'`,- PO . SPA - : APPROVALS Permit# ' • i Date Inspector APPROVALS Permit I • Date Inspector rL 1. Temporary Electrical Service or Pole, 52. Pool & Equipment Location _ .2, Soil Pipe-Undrgrnd. - 53. Steel Reinforcement -� 3. Electrical Conduit UtilitytUndrgrad' 54. Forms • 4, Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 2 " 56. Rough Plumbing & Pressure-West 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER•GtTNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test j + • 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines,P-Trap, 0 Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final. 12. Sewer Cap • 63, Heater &Vent-Final 13. Roof Drains • 64. Plumbing System - Final , 14. Rough Plumbing _ 65. Electrical-Final 15. Rough Electrical-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 t - 69. POOL/SPA SYSTEMS FINAL `,7 19. Rough Heating& Air Conditioning - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 PREY. FINAL 30. Drywall Nailing HEALTH 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 - s-•- 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backf low Preventer 43. Backf low Irrigation 44. Landscape Irrigation System • 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE &$UILDINGl•rt\111: i 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date r PROJECT ADDRESS: ..1, -1 , ;7 .H ST UNIT: CITY OF COS1A MESA — BCILDI!.0 tray= PERM OWNER'S NAME: 2 3 E 17TH ST ASSOC c.�' ,•�• 1, '5 ADDRESS: i90_ AWL :UDE AVUUE Oc STAR.L PERMIT NO: P 066172 PLAN CHECK NO: N GOVT; N SL'1P : -, ?;950 BEVERLY HILLS CONSTRUCTION TYPE: PERMIT TYPE: FLU PCRPUSL" : '1" ARCHIENGINEER: REG,NO.: JOB DESCRIPTION : ADD NEU FLOOR SINKS SQ VT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 ' PERMITTEE: RAPHAEL HILL PLUMBING ( 310) 438 1942 ADDRESS: 230 ORIZAB,A AV COMMENTS : PLUMBING WORT ONLY LONG BEACH CA 90303 **k**.***,***% N ,x 'tt,*.>** 4********X.**********3t*Ie**\ **it****** Rio* ****;;x..1-4':w , _ :: H..A4tk;r:( • : LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R EQU IR EMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. SETBACK S IC.: STATE LID.:833189 uss' C—36 EXP: Date 7- 2I '9/! Signature: t- AIN BUILDING ACCESSORY BUILDING • ERS'COMPENSATION DECLARATION: I hereby affirm that I ave a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT; FT Ii.] REAR: FT IN Compensation insurance.or a certified copy thereat(Section 3800.Lab.C). LEFT; FT IN RGHT; FT IN LEFT; FT IN RGH T: FT 114 POLICY UP.DATE: COMPANY: PARKING RES?: PROV; PARCEL ; 42522303 ZNE; REF NO; ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> !h***********3F1 ***********-*****jc3f************fE�E'1 ****1f•*************KGF?c#**g*.k Y.'-N.:•4: Date: Applicant: DEVELOPMENT S E R V _I C E S R E U I R E M E N T S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This sedan need not be completed if the permit is for one hundred(5100)eq less). Q I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. �/'/ ZONING APPROVED BY : ,J • DATE: Z 1 —99 Si nature: / Date 7 gX. • BUILDING APPROVED BY ; DATE; / OTICE:IL alter making this declaration,you should become object to the Workers'Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shag be deemed revoked. , ^ n ` p� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE; II L which this permit is issued(Section 3097,Civ.C). **********************x******************xcs it • - - - -***********is-i:777-0+: 14 LENDER: ***********#s****************************************************i'******3t•*N-+'is#i51: ADDRESS: LEGALIZATION; N F E E S 4U M M A R Y STRUCTURAL SEG24ENT:N • OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT •PLUMBING EL ErT1-c I.: MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 50 , 00 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 252 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business p LAN 3M I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant toe a permit subjects the applicant to a civil penalty of not more than five hundred dollars(3500). ISSUE FEE "v . 00 m the property or BUILDING—DIV—> PERMI ' ISSUE PLAN—CHECK TOTAL PAID DUE my employees with wages as their sole compensation. will do the work, and the TOTALS—---> 50 . 00 20 . 00 0 . 00 70 , 00 70 . 00 . 00 ❑ I. as owner structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who bWds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or olfered for sale.If,however the building or REVENUE DIVISION TOTALS—• > CO' ECTED• 70 . 00 OVER/SHORT• . 00 improvement mrpose sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING E',ECTRtI MECHANIC FIRE SMIP/TOT GRADING PLAN—CHEt':: , for the purpose of sale). I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 70 O O ❑ and Professions Code: SlateThe hprojectswiContractors' License Law does not apply to an owner of property who builds or improves thereon ***************fx**********i *****************%***N.***%.*******k.*i'.k-*i/..i;e;s:•-1.; ,• i'-r e. and who contracts for Such projects with a contractor(s)license pursuant 10 the Contractors'State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAKDO 14 N ❑ I am exempt under Section: B.8 P.C. for ties reason: TYPE QTY DESCRIITIO N UNIT COST TOTAL COST Date: Owner: PLU 1 GAS RE—PIPE 7 . 00 7 , 00 I do hereby cenify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and PLU 3 SINKS, FLOOR 7 . 00 21 , 00 25534 and that I or any future building occupant MUMS not(circle one)need to comply with said state codes and(he requirements for a PLU 1 SINKS, SERVICE / MOP 7 . 00 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from PLU 3 VACUUM B RKR/BACKE'.041 P ROT, 1 TO 4 5 . 00 1 5 , 0 0 these provisions, SND OF FEES Date: Applicant: I hereby certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby thorbe representatives of this city to enter upon the above-mentioned property for inspection purposes. 01 00164489-00164489 TOT 70.00 i6ate. 7— ii `99 Signature: 0/ o` �/ /a/ • DATE: 07/21/94 TIME: 09:30 Driver's License or Social Security 4: ) 164146 Whee—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • CONSTRUCTION AND PLANNING POOL &SPA • APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final • 14. Rough Plumbing , 65. Electrical-Final 15. Rough Electrical-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 Structurer 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. 7-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 PREY. FINAL 30. Drywall Nailing HEALTH 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-Testrect. -_'Z- -.4*f-- a/tat^n '-� ,�(�.-S 36. Hood or CanopyD��W� 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 263 E 17TH ST UNIT: CITY- OF COSTA MESA — SIGN PERMIT PERM NO: SBE 055281 owxEpS NAME: ooREss: BRIAN GORDON j 259 E 17TH ST PERMIT NO: SBE 055281 PLAN CHECK NO: 04936-91 S GOVT: N SUPP: N COSTA MESA CA 92627 CONSTRUCTION TYPE: - PERMIT TYPE: ELE STR SIG PURPOSE: OTH ARCH/ENGINEER:DRSS ( 213 ) 282-8533 • REG.NO.: JOB DESCRIPTION ILLUMINATED WALL SIGN (LOGO BOX) S FT: • aoDREss: UNIT: Q PERMITTEE: CLAIM VALUE: 2, 700 . 00 CALC—VALUE: 2, 700. 00 GROUP OCC: B-2 / ADDRESS: ACTION SIGNS ( 714 ) 539-4535 • 11352 TRASK 102 COMMENTS- THE "MUCHO GUSTO" JAZZ BAR & LATIN GRILL GARDEN GROVE CA 92640 *+t**************************+FSE********3F**;,Eat************a6+ESE*T6***x***** *******TF* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section SIGN INFORMATIO N 7000)of Division 3 of the Business and Professions Code,and my license is in fun force and effect. DISTRICT- 1 TYPE: WALL ILLUMINATION; INT CATEGORY: NEW cITrLIc.: 0 83 STATE LIC.:620781 CUSS: C 5 DIMENSIONS• 3FT 03IN X 7FT 06IN AREA; 29 . 90SQFT LETTER HT: 16" Dale:_�� 3^Gg/ signawm:— STREET FRONTAGE 1 : 155 . 00 STREET 1 : E 17TH ST WORKERS'COMPENSATIONDECLARATION: thereby affirmthatIhaveacennicateofconsenttoselbinsureoracenIsletofWorkers' STREET FRONTAGE 2 • ' 0 . 00 STREET 2: Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). - PARCEL: 42522303 ZONE: C 1—S LOCATION > FRONT: X REAR : POLICYxo.: 1191602 91 EXP.OATE: O4 /01 /92 BUSINESS NAME: MUCRO GUSTO > LEFT: RIGHT: CDMPAxr: STATE FUND O T H E R TOTALS G R O U N D SIGN ❑ Cennied copy is hereby furnished. }� cenified copy is filed with Ire city Building Division. / THIS ACTIVITY : 24 . 9 OSQFT OVERALL HEIGHT: OFT O IN ��• e THIS SITE 155 . 00SQFT . , . GROUND CLEARANCE: OFT.-AIN ale:_r�/!YJ/!/ Applicant: /ai ITEMSF INFO 2 PLANTER AREA: O'.:00SQFT O . ITEMSFOR ACTIVITY: 2 "' BLDG SET BACK: 20FT✓-': rRBIAGE ; MUCHO GUSTO JAZZ:BAR LATIN GRILL + LOGO 'yhYG NOTES: PLANNED SIGNING PROGRAM #PA-91-11 a **************'*'*'********'**t6*'*****'****************************'K********** DEVELOPMENT E.;'RVICES REQUIREMENi-T S bhe work fpr. .k �:• which this permit issued(Section 3097,Civ.Cr. ZONING APPROVED BY DATE: 1/j,.6-6�fi LADDRESS: BUILDING APPROVED BY : DATE:/ .(//26/9/. OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'Stale License Law for the following reason APPLICATION 'ISSUED B Y: //}L' DATE: // Oce (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or *********************** *** ` *{F*** * {F.7e*. *.**-7c*.{f.**{p{p jp**{p*ap*{(.{E*.#iiiFFFRF iF 3r*iF iF 1FY. repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business LEGALIZATION:N F E E S U A R Y STRUCTURAL SEGMENT:Y and Professions Code)or lhathe/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). BLDG PMT PLUMBING EL - C MECHANIC SIGN SMIP/RES GRADING I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the PERMIT 54 . 00 15. 00 24 . 90 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law 50 t SMIP/NON—RES does not apply to an owner of a property who builds or improves thereon,and who does such work himself/hersell or through PLAN 35 . 10 . 57 his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve ISSUE FEE 15,00 for the purpose of sale). BUILDING—DIV—> PER IT ISSUE PLAN—CHEC TOTAL PAID DUE I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business TOTALS----> 94 . ' 7 15 . 00 3 • 144 . 57 144 . 57 . 00 J and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware REVENUE DIVISION TOTAL. --> CO CTED• 144 . 57 OVER/SHORT: ,00 that proof oftheir Worker's compensation insurance should be provided to me. BLDG PMT PLUMB IN ELECTR • ECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK ❑ I am exempt under Section: B.SP.C. 54 . 00 • . 00 24 .90 . 57 35. 10 for this reason: ************************ ****************************************************** Date: Owner: I do hereby certify that I am aware of and understand the requirements of Calitornia Health and Safety Code Sections 25505,25533,and I N D I ID UAL F E E BREAKDOWN 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from TYPE QTY D E S C R ' PTIO N UNIT COST TOTAL COST these provisions, ELE 1 SIGN/ OUTLI E LIGHT SYS ON 1 BR CIRC 15. 00 15. 00 Date: Applicant END OF FEES I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above.mentioned property 101 ins'eclion ppurposes. r Dale:a _4 / / / Signature'. ;_ ✓.t — _. . . ._ ... Driver's License___or Social Security N: 164146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor Ili , , I POOL E ` ', ' CONSTRUCTION AND PLANNING Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit # 1. Temporary Electrical Service or Pole %,' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �• . 'f.•, 53. Steel Reinforcement it .1 Electrical Conduit Utility-Undrgrnd.:.' / 54. Forms -.4. Electrical Conduit-Undrgrnd. • - 55. Electrical Bonding - 1 ' 5: Steei Reinforcement_ 56. Rough Plumbing & Pressure Test = 6. Electrical UFER Grd. 57. APPROVALTO COVER-GUNITE ' 7.'Footings - 58. Electrical Conduit-Undrgrnd. `8. Foundation i j 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. .�s '�r.� 60. Backwash Lines,P-Trap, 0 Undrgrnd. :-f/y�� 10. Structural Floor System %t , tf 61. APPROVAL TO DECK '• 11. Property Sewer Line& House•Connection- I� 62.'Backwash & Receptor-Final ,', ' 12. Sewer Cap - r'' 1, . 63. Heater & Vent-Final 13. Roof Drains } ,A64. Plumbing System -Final ' ' 14. Rough Plumbing ,�i ' j4) 65. Electrical-Final /9 •15. Rough Electrical-Conduit ,l' I' 66. Solar System-Final :7 i . 16. Rough Electric,Wiring 'SIit 67. Fencing & Access Approval %`-- 17. Rough Wiring Sign, 1 68. APPROVED FOR PLASTERING r 18. Rough Electrical=T Bar Ceiling 69. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. 'Rough Facto'ry Fireplace - _ APPROVALS Permit # 21. Ducts,in Str9ctul e - ,i.�'�.'' ' • - '.',,• 70. Underground Hydro - • 22. Ducts, Ventilating , 71. Product Piping 0 Gas 0 Oil 23. ;Gas Pip&Rough & Test ' 72.-Underground Flush , 24. Roof Framing ' .73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing . , - _ J4. Overhead Hydro `• • 26. T-Bar Ceiling IStructurall & Mono.coat _75.rDry Chemical . 27. Frame and Flashing - - • - 36. Dry Standpipe - ' ' 28. Lathing & Siding. . >' 77. FIXED SYSTEM FINAL 29. Insulation Vit, ' , • 7FIRE PREV. FINAL - , 30. Drywall tailing ^� - • / ' , _ 8._' L�1'. • HEALTH DEPT. REQUIREMENT '31. Plaster Brown Coat' .r '+,. /79.?FINAL INSPECTION- - - • - 32._Electrical Power Meter-Final - (((. _ ' .*`FOOD CERTIFICATE ISSUED 33.1=Final Electric- /Q otes: .-r ,34.-Final Heating& **Conditioning - h :35.:=Final Gas Pipe-Test• - .. 36. Hood or-canoPY 4 - •� ' - '37.-Final Factory Fireplace • • ss_ b:r 38. r Final,Plumbing , 39. Watei Service-Final - r - r - _- - _ 40.-GasSen%lce-FTnal � ' " i - ,41. Solar Domestic-Final ., 42. Backflow Preventers •• -. .. , .43. Backflow Irrigation •- - - r -. ;44. Landscape Irrigation System . . '• - 1. 45. Attenuation r _ =46. HandicapRegulations , • / / - '47..FIN3ALSTRUCTUR'E &[BUILDING L/'� .r .: 48. FINAL PLANNING., , :G - 49.=Electric Release to Edison - l • . ei 50. Gas.Release to Southern California Gas CO ' ' r• - I. 51. CERTIFICATE OF.00CUPANCY ' No. Date - - /. • PROJECT ADDRESS: 263 E 17TH ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PER:: ::O: E Oui,aj3 • r OWNER'S NAME: BOSS, FRANK TR ' ADDRESS: P J BOX 8507 PERMIT NO: E 063190 PLA:J CHECK NO: N GOVT: :J SUPP : :. NEWPORT BEACH, CA 92660 CONSTRUCTION TYPE: I FR PERMIT TYPE: ELE PURPOSE: ALT - ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ADD ELECTRICAL CIRCUITS SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALL-VALUE: GROUP OCC: b-2 / PERMITTEE: HARBOUR ELECTRIC ( 714 ) 373- 3055 ADDRESS: 15611 PRODUCT LN B13 COMMENTS: 29AMP 220V CIRCUIT FOR COFFE MAKER HUNTINGTON BEACH CA 92649 *to%##%•******).-3 *******3****t******######%####*#t;.% *94**4.•***#%*#ar# -******** *##.:..,:4::, LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONINGS ERT EBQAUC I BACKS M E N T S 7000)of Division 3 of the Business and Professions Code.and my license in full force and eff- I. CITY LIC.: 060091 STATELIC.:650649 license C1 O Ey. : 03/94 ja_7/a2./4N Signature:iii,L/cLMAIN BUILDING ACCESSORY BUILDING - --- KERS'COMPENSATION DECLARATION: I hereby affirm that I haeacenificat'of senttoII-insure Oracertificate ofWorkers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). POLICY EXP.DATE: PARKING REQ: PROV: PARCEL : 41250105 ZNE; REF NO: COMPANY: PLANNING NOTES> El Certified copy is hereby furnished. ❑ Certified copy is filed wit he d Lidding Division. ' > (' /c? . .) Yil Applicant: DEVELOPMENT S E •R .V I C E S REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Tha section need not be completed if the parrot is for one hundred(5100)or less). I certify that in the oenormance of the work for which this permit is issued.I shall not employ any person in any manner so as to become APPROVED • B Y subject to the Workers'Compensation Laws of California. ZONINGDATE: Date: Signature: BUILDING APPROVED BY : DATE: NOTICE:II.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor • _ u Code.youmust DING AG comply with such provisions a this a shag n¢ ending deemed revoked.cy /� Q ) CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: � DATE : ` 1 which this permit is issued(Section 3097.Civ.C). ************##****##*****#***#***#it x#*•**u#*******ri***********#####* w.*,... *f;** w-tui; ##%•#*****#****##3************#*##********#***##**********#****M**##iE##***##4`V-*At ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7 . 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 50- SP1 I P/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 15 . 00 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). _�,., BUILDING-DIV-> PERMIT uE PLAN-CHECK TOTAL PAID DUE I, as owner of the property or my employees with wapes as their sole compensation, will do the work, and the TOTALS----> 7 . 50 15 . 00 0 . 00 22 . 30 22 . 50 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State Li cense Law does not apply to an owner of a property who builds or improves thereon,and who does such work himsell/hersell or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS- -> COLLECTED: 22 . 50 OVER/SHORT• ,00 improvement le sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING I'LECTRIC MECP*.alk.. FIRE SMIP/TOT GRADING PLAN-CHECY fororme purpose al of sale).- 22 . 50 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business • ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon *#######*#*####%####*###*. s;#:i#:.######!:%•##*%**%###*i:*f,#%#Y.#3.'X•# %•%17#%•##t'.%z'i`t ## and who contracts Mr such propels with a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. I N D I V I Y DUAL FEE BREAKDOWN o I am exempt under Section: B.8 P.C. for this reason: ,/--• • TYPE QTY D E S C R 1 P T I O N UNIT COST TOTAL COST Date: er. ELE 6 RECEPT/OUTLET 1 ST 20 EA. . 75 4 . 50 I do hereby certify that I am aware of and understand the requirem nts of California Health and Safety Code Sections 25505.25533,and ELE 1 RES APP L I ANC. NOT OVER 1 . 0 H P 3 . 00 3 . 00 25534 and that I or any future building occupant will/will not(cirri one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality Man ement District.Residential construction applications are exempt from these provisions. Date: Aancst: r I hereby certify that have read this application anddstate that the above inlormatio is correct.I agree to comply with all city and county / ordinances and state laws relating to building construction and hereby authorize rept.•ntatives of this ci t er upon the above-mentioned property for inspection purposes. 01 00154558-00164.`x58 TOT 22.50 7 Signature:/ /- 1 n n DATE: 07/22/94 TIME: 08:59 wen's License or Social Security w: K� 5 Sj lY/ ' 1641-46 white—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor 7 ii • 'CONSTRUCTION AND PLANNING POOL SPA APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation % - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System r 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ; 62. Backwash & Receptor-Final • 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains r - . 64. Plumbing System - Finaf 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-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 Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas OOil 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 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE•ISSUED 33. Final Electric5/7-0:?e- Notes: 34. Final Heating& Air Conditioning I 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 Domestic-Final 42. Backf low Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. , Date PROJECTADORESS: 263 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 055791 OWNER'S NAME: 259 E 17TH ST ASSOC ADDRESS: 259 E 17TH ST, C.M. PERMIT NO: B 055791 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH ARCH/ENGINEER: JAMES MCBRIDE II ARCH REG.NO.: C0 JOB DESCRIPTION ; TRASH ENCLOSURE ( "EL MUCHO GUSTO" REST. ) SQ FT; 2, 000 ADDRESS: 2700 W PAC COAST HWY UNIT: 202 N.B . CA 92663 CLAIM VALUE: 2, 000 . 00 CALC—VALUE: 2, 000 . 00 GROUP OCC: A-3 /B-2 PERMITTEE: SIEMONSMA CONSTRUCTION (714 ) 722-0628 ADDRESS: 501 CATALINA COMMENTS: RE; B55544 PRIMARY BLDG, PERMIT, NEWPORT BEACH CA 92660 *****�E**4*+E*�E*Sf**�E*�E********�E*+i•*Sk4** *+�Sr�E�E***********************+p*+t* 656******** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions al Ch r 9(commencing with Section Z ONING REQUIR EMEN TS 7000)of Division 3 of the Business and Professions Code,and my license is in full fo and e SETBACKS CITY LIC.:/07 y STATE LIC.:5364 cuss: � �_ Date: / Signature:_ _ _ MAIN BUILDING ACCESSORY BUILDING WORKERS' OMP S I DECLARATION: Ihereby ' hat l have ac Iticaleol consent to sett-Insure or a certificate Of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof ection 3800, Lab. . LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ. PROV; PARCEL: 42522302 ZNE: REF NO: t 7 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOtES> > Date: Applicant: *********************************************************************7E********* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be comp if ne r. ¢for one hundred(5100)or Iess1. DEVELOPMENT SERVICES R E Q U I R E M E-"N,t S certify that in the performance of the work for which this p' issuetlJ Shall no a i •i 45on in any manner so as to become - subject tom Workers' ompensalion Laws of Calif. ZONING APPROVED BY Lv4 DATE; /l y/�' Date:_ f ' . . r,;./0r— - j, .�� �-NO CE: a r making this declaration.yo • 'old-become sup ct to the Workers'Compensation provisions o e Labor BUILD ING APPROVED BY DATE: • 2 Code,you must forthwith comply with suc provisions or IN .ermit shall be deemed revoked. �� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• �/% • - DATE• i� which this permit is issued(Section 3097.Civ.C). i *********************{e* **** ***************************4* - *.*. • LENDER: THE "EL MUCHO GUSTO" **************************** * j*********************************************** ADDRESS: RESTAURANT! LEGALIZATION:N F E SUMMARY STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: I herebyatlirm that l am exempt from the Contractors'Slate License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter.improve,demolish,or PERMIT 45 . 00 repair any structure.prim to its issuance,also requites the applicant tot such permit to life a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business - - SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN . 50 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE - I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT IS PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 45 . 50 . 0 0 0. 00 45 . 50 45 . 50 , 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improveCOLLECTED: 4 . 50 OVER/SHORT: 00 for the purpose of sale). BLDG PMT PLUMBING ELEt TRIC MECHAN FIRE SMIP/TOTO GRADING PLAN—CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware **************************** **** ******************************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDU L' FEE BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIP I 0 N UNIT COST TOTAL COST .1-. Date: Owner: SFC 2000 ALTER BY VALUE OMMERCIAL NOZONE 1 . 00 2, 000 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air uality Management District.Residential construction applications are exempt from ' • these provisions. ' Date: Applicant: .4if�� I hereby certify that I have read this application and state that the above information is car' t.I agr:-.l>-compty with all city and county Ordinances and Stale saws r lacing to auil0ng construction and hereby art/wire represen of this. to enter upon the above-mentioned - property fpr in ection roosts. i —.-- Date: Signature:,. / . 44. 8_^100 J5 C^11)'S; S 7—: - . Driver's Licen e I Social Security e: DATE: 01 '1-;:'1i TT: : ; 1641-46 white—Dmldmg;Green—Codd Enforcement:Conary—Applicant;Pink—Revenue;Goldenrod—Assessor 'CONSTRUCTION AND PLANNING POO PA APPROVALS Permit# - Date Inspector APPROVALS Permit# Date Inspector f �. 1. Temporary Electrical Servicepr'Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement !: 3. Electrical Conduit Utility-Undrgrnd. . , 54. Forms 4. Electrical Conduit-Undrgrnd. i - '55. Electrical Bonding 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings t5 , ft 4141 2._.' rj�. 58. Electrical Conduit-Undrgrnd. . ' 8. Foundation - l - . 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. i' 60. Backwash Lines, P-Trap, 0 Undrgrnd. ' • / I . • 10. Structural Floor System ' : 61. APPROVAL TO DECK 11. Property Sewer Line & Hope Connection .f 62. Backwash & Receptor-Final i , 12. Sewer Cap ` I / 63. Heater & Vent-Final 13. Roof Drains - • ` - r - s,' � 64. Plumbing System - Final _, h Plumbing 14. Rou 9 / 65. Electrical-Final ' 15. Rough Electrical-Conduit I 66. Solar System-Final 16. Rough Electric Wiring - 67. Fencing & Access Approval r 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 Structure. - 70. Underground.Hydro 22. Ducts, Ventilating .71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test - 72. Underground Flush 24. Roof Framing ‘ 73. Undergrnd.Storage Tank 0 Gas 0 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 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 1 33. Final Electric - Notes: In i_ p lc�.a K� �IP K 34. Final Heating& Air Conditioning tt (6 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 Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigation - 44. Landscape Irrigation System - 45. Sound Attenuation 46. 'Handicap Regulations _ . , - 47. FINAL STRUCTURE & BUI LDING r'`Zit'%4 48. 'FINALPLANNING ( Y 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co r ) I. 51. CERTIFICATE OF OCCUPANCY , No. Date • _ • PROJECTAODRESS: 263 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 053910 ' OWNER'S NAME: 259 E 17TH ST ASSOC. f ADDRESS: 259 E 17TH ST PERMIT NO: B 053910 PLAN CHECK NO: N GOVT: N SUPP: N CM CA 92627 CONSTRUCTION TYPE: V-1 PERMIT TYPE: SIR PURPOSE: DEM ARCH/ENGINEER: 213-282-8533 REG.NO.: JOB DESCRIPTION : DEMO NON BEARING PARTITIONS ONLY! ! SQ FT: ADDRESS: UNIT: CLAIM VALUE: 3,000 . 00 CALC—VALUE: 1 , 000 .00 GROUP OCC: B-2 / PERMITTEE: 259 E 17TH ST ASSOC. ( 213) 282-8533 ADDRESS: CM 259 E 17TH ST CA 92627 COMMENTS. DEMO PARTITION WALLS & MISC PLUMBING LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am Scensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to selbinsure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800. Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: ,P —7 Certified copy is hereby furnished. CICertified copy is filed with the city Building Division. PLANNING NOTES> > date: Applicant: *******************************************************************.************ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E••'N'T,,S I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become ' _ subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: Ci Date: Signature: ' NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. —�� - '-•r CONSTRUCTION LENDING AGENCY; hereby affirm that there is a construction lending agency for the performance of the work for APPL I CAT ION ISSUED BY. ��! DATE• c) / which this permit is issued(Section 3097.Civ.C). ********************** ' • ' s.a.:.s.:_x.zZ.xs.z.sA.s is.s-::r....—•—•—'—. . . • y�/y�/ //7 ********iE*iF 1F*3E iF****ae ne* LENDER: ************************** ******* ************************************ ADDRESS: LEGALIZATION:N F E E S U ' M A R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTR I• MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 25 . 00 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN . 50 any applicant tar a permit subjects the applicant to a civil penally of not more than live hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, wit do the work. and the BUILDING—DIV—> PERMIT ISSUE 'LAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 25. 50 0 . 00 0 . 00 2 5 . 50 25. 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her Own employees,provided that such improvements are not intended or offered for sate.H.however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 25 . 50 OVER/SHORT; 00 for the purposeof sale). BLDG PMT PLUMBING ELECT' C MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 4 LHI.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 25 .00 and Professions Code: The Contractors'State license Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ***************************** ************************************************* • that proof at their Worker's Compensation insurance should be provided to me. - INDIVIIPUAL F E BREAKDOWN ❑ I am exempt under Section: . B.8 P.C. or this reason:ea 674/417.44:4.9 �_y /,_ TYPE QTY D E S C R I P T I • I UNIT COST TOTAL COST _� Date: / • /1 71 Owner:.777,...C-- 674/ 17i�ll I do hereby certify that f am aware of and understand the requirements of Californand Safely Code Sections 25505,25533,and NO FE 7 . ' E SELECTED FOR THIS PERMIT 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modilicatron from the Air Quality Management District.Residential construction applications are exempt from these provisions. ' Date: Applicant: hereby certify that laws relating td this application and state that the above informationireprnt ticorrect.oagree)eomp d countyio • I ces and state l haveread is building construction state e y above ze is rs of this •co it theatm -mentioned property for inspection purposes. kx...._ Date: 7' 7` It ------ Signature: ��,_ 01:-.:ITE:.: 09/171'C'' _ cr.::: _ .r. • Drivers License or Social Security tit , 1641.46 white—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • I -_ • CONSTRUCTION AND PLANNING • P00 PA ' 'Jr APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement .3:.EIeMr cal Conduit Utility-Undrgrnd. 54. Forms .4.'Electrical Conduit.Undrgrnd, - 55. Electrical Bonding •' S.:Steel Reinforcement 56. Rough Plumbing & Pressure Test '• •6. ElectricaiUFER.Grnd. 57. APPROVAL TO COVER-GUNITE `' • 7:•Footings f1)'= 58. Eiectrical Conduit-Undrgrnd. V 8: Foundation 59. Gas Pipe, O Undrgrnd., Test 9;7, Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains - 64. Plumbing System - Final yi 14. Rough Plumbing' - 65. Electrical-Final 15. Rough Electrical-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 .. L - "^, _v.- 20. tRough Factor?, FGeplace . ,z - .. z..-. . ., 'tgPPROVACS-^Permit# '' -ti - 21.'DuCts, in.Structure., ` ., yw 70. Underground.Hydro -r 22. Ducts, Ventilating e . -c: * - r ;-`• y -71. Produc(Pfping DG'as DOH 23.`,Gas'Pipe Rough &test . n r.- ,:- t . 72, Undergfdund Flushv. , ; 24..Root Framing J • . - - t - ;•7344Undergrnd:Stora,ReTank IGas OOiI 25. Roof Sheathing - /„ - _ -74.`-0verhead hydro-• ' C. 26.„T-Bar Ceiling (Structural) & Monocoat - .r tr..: • 75='Ory Chemical - - 27. Frame and Flashing. ....v. 1.. 76: D'ry Stand'p'ipe 2 , -' `' , i , .. ... ; 28.- Lathing`& Siding_ �L.:: s 17-. 'I ,. 77.- FIXEDSYSTEM-FINAL'- _ z- _ _ '29. Insulation •' - . .. e I h y 78.;FIRE PREV. FINIAL fr 1.1; ,r S' Y .S I ':30. Drywall $Jailing + HEALTH-DEPT*.REQUIREMENT I , . c u.. _ - _31. Plaster Blown Coat. r , „ I ' 79. -FINAL I4 PECTIQN - -• 3 -32;Electrical Power Meter,-Final K I ;r - r80:rF000 CERTIFICATE ISSUED ••-' IJ ,33:;final Electric �. ' 'Nots: :1 =z; '•{ i II :.34..�34. Fines Heating& Air Conditioning.; r t i r '• % { 35.;Final Ga§Pipe-Test' _ `"• -'• ti - , J36: Hood or-,Canopy, . , , .... p r !- Y YI !37 LFin$r Factory Fireplace • -';'' - k^ * a. :r• i -C .. _ t . -38. Final Plumbing e n• , ,� � , ? a: 7 -39. Water Service-Final` I .r' " y 4 .. i;40. Gas Service-Final „ * ,a * 0,t, „p - ;41. Solar Domestic-Final.-_ - . • y C. I yti . 1 a , . v - t r > z 42. Backflow Preventer u * x ;>;. . :- 7 a 43. Backflow Irrigation' = �� %• '1 ' " O .744. Landscape Irrigation System, ,c U .. ;,t l_ - •C „I p, .c CC s ' z45:Sound Attenuatiort tr cr >: f- - , a . , ;A l ,i< a -46..Handicap Regulatio1rs k ti ii ,a . -0 .._ -. 47.-FI14AL STRUCTURE & BlJItDING i ':ry iJ ma c 48.JFIN'AL PLANNING i `r ' - » 49.-Electric Release to Edison i tt . + a; -• 1 h 9 , i )1 ',50. Gas Release to Southern California Gas Co I - t)• . , :• - ` -51. CERTIFICATE OF OCCUPANCY s. - „o ' No Date L r PROJECT ADDRESS: 263 E 17TH ST UNIT: CITY OF COSTA MESA — SIGN PERMIT Pt.RM NO: Stria. O5ba L OWNER'S NAME: 17TH ST ASSOCIATES ADDRESS: 259 E 17TH ST PERMIT NO: SHE 056880 PLAN CHECK NO: 01262-92 S UUVI : N surf: N C.M. CONSTRUCTION TYPE: PERMIT TYPE; ELE STR SIG PURPOSE; OTH ' ASH/ENGINEER: REG.NO.: JOB DESCRIPTION : 15SF LUMINATED WALL SIGN SQ FT: ADDRESS: UNIT: CLAIM VALUE: 1 , 900 . 00 CALC—VALUE: 1 , 900. 00 GROUP OCC: B-2 / PERMITTEE: ACTION SIGNS ( 714 ) 539-4535 • ADDRESS: GARDEN1ARE TRASK 102 *******+SEia�L*MUc-****O ********K******* *�H�E*�E+E*�E�E*>EN******>E*** ESL*�E�P�t*****N*>E******�E*# GROVE CA 92640 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section S I G N I NE OR MATTO N 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. DISTRICT: 1 TYPE; WALL ILLUMINATION: INT CATEGORY; NEW clTrm.: 0 48357 20781 CLASS: DIMENSIONS; 2FT 03IN X 7FT 06IN AREA: 15, 00SQ FT LETTER HT: 16" Date: '' / 9 2 signature: STREET FRONTAGE 1 : 150 . 00 STREET 1 • E 17TH ST STREET FRONTAGE 2 : 0 ,00 STREET 2 : WORKERS'COMPENSATION DECLARATION: I hereby kffIrn a ave a certificate of consent to self-insure or a certificate of Workers' PARCEL: 42522303 ZONE; C 1 S LOCAT ION > FRONT: X REAR: Compensation syrapve, tp�axcAq(tillep c�qgpy thereof(Section 3800.Lab. POLICY NO.: �l lO�L-7G EXP.DATE: �4 /O1 /93 BUSINESS NAME: MUCRO GUSTO > LEFT; RIGHT: COMPANY: STATE FUNDOTHER TOTALS GROUND SIGN 7 Certified copy is hereby furnished. L CeNlieticop iShledwththecityBuilding THIS ACTIVITY 15 , 00SQFT OVERALL HEIGHT: OFT OIN THIS SITE 150 , OOS FT GROUND CLEARANCE: OFT OIN •L ��7/ y J �� ITEMS OF INFO 2 PLANTER AREA: OSQFT Date: Applica _ i EXEMPTION FROM WORKERS'COMPENSATION DECLARAT ON: • I ' tion need not be completed if the permit is for one hundred($100)or less. COPYIOPY$ FOR AGEIVITY • 4 BLDG SET BACK: 20a....;? I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become VERBIAGE • MUCHO GUSTO subject to the Workers'Compensation Laws of California. ( 2 SUITES OCCUPIED BY THIS TENANT SO 2 SIGNS ALLOWED). PLANNING NOTES: PSP #PA-91-11 , • Date: Signature: **********************************ie**********************************iF********* NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor D E V E L O P M E N T S E= R V I C. E $ R E Q U I R E M E N. ,T S Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for '- n z '/ which this permit is issued(Section 3097.Civ.C). ZONING APPROVED BY r V\An. DATE; Sj 1.1 I ADDRESS: BUILDING APPROVED HY : . � DATE; /'if OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED BY: ! ' DATE: i k�r** (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or '*******'*************** '� ****'*****'*'*'# * *' repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed LEGALIZATION:N . E E SUMMARY STRUCTURAL SEGMENT:Y pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Cade)mi that heshppmant orafrom and the basis for the hanalleged exemption.Any violation($ 0of Section 7031.5 by BLDG PMT P .: ING ELECTRIC ' MECHANIC . SIGN SMIP/RES GRADING any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). PERMIT 43 .00 15 , 00 15 ,00 I. as owner of the property or my employeeswith wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale(Section50$ SMTP/NON—RES 7044,Business and Professional Code: The Cors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such workrk himself/herself himself/herself or through PLAN 27 . 95 • 50 .t his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or ISSUE FEE OO improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BUILDING—DIV—> PERMIT Al SUE LAN—CHECK TOTAL PAID DUE for the purpose of sale). TOTALS----> 73 . 50 1 ' 27, 95 116 , 45 116 . 45 . 00 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and prof contracts for such Compensation ansurazce shouldlicense proridedlthe Contractors'State License Law).I am aware REVENUE BLDGDIVISION PMT PLUMBING EL ECTR CCOLLECTED: IC SIGN6 SM IPO/TOT/$GRADING PLAN—CHECK .00 that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.a P.C. 43 . 00 30 , 01 15 ,00 . 50 27 . 95 for this reason: ******************************** ********************************************* Date: Owner: IND I V I D U A ' F E E BREAKDOWN I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a TYPE QTY D E S C R I P T I+ O UNIT COST TOTAL COST permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from 1, these provisions. ELE 1 SIGN/ OUTLINE LIGHT SYS ON 1 BR CIRC 15, 00 15 , 00 I Date:rApplicant: END OF FEES herebycertifyy that I laws tin this ingtco and state that the above informationarepresentatives it ties of agree to comply with all city rnd ordinances and state laws relating to building co traction and hereby authorize representatives of this city to enter upon the aba -mentioned property g tot inspection purposes. Date: //?/ / DATE: 0V02/42 TI11c; 1"o>I5 1641-46 White—Building:Green—Code Enforcement:Canary—AoolicanC Pink—Revenue:Goldenrod—Assessor /\ CONSTRUCTION,AND PLANNING PO( SPA APPROVkLS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service oh Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. • ' - 54. Forms . ' 4. Electrical Conduit-Undrgrnd. 1 55. Electrical Bonding 5. Steel Reinforcement - . - 56. Rough Plumbing& Pressure Test • 6. Electrical UF ER Grnd. 57. APPROVAL TOCOVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test .i 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK • 11. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final ' 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final i 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1 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 Structure 70. Underground Hydro 22. Ducts, Ventilating - • - 71. Product Piping 0 Gas OOil 23. Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing . 73. Undergrnd.Storage-Tank 0 Gas 0 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 r 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 8e !OD CERTIFICATE ISSUED 33. Final Electric jib II 1 _ otps: 34. Final Heating & Air Conditioning ) M 35. Final Gas Pipe-Test - t • - IJ 36. Hood or Canopy - - I 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service-Final . 40. Gas Service-Final - 41. Solar Domestic-Final I- 42. Backflow Preventer ! - 43. Backf low Irrigation - - • - 44. Landscape Irrigation System . : . 45. Sound Attenuation 46. Handicap Regulations _ .//�/� , 47�. FINAL STRUCTURE & BUILDING $"" !�' . 48. FINAL PLANNING 49. Electric Release to Edison • 50. Gas Release to Southern California Gas CO - 51. CERTIFICATE OF OCCUPANCY No. Date --:1/4------ • PROJECT ADDRESS: 263 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM No: F 05bs8& OWNER'SNAME: 259 E 17TH ST ASSOC AMUSE 259 E 17TH ST, C.M. PERMIT NO: F 056886 PLAN CHECK NO: 01058-92 L CDVI : N SUP?: N • • CONSTRUCTION TYPE: V—N PERMIT TYPE: FIR PURPOSE: ALT • • ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 4000SF RESTAURANT T. I . SQ FT: • ADDRESS: UNIT: CLAIM VALUE: 1 , 200 . 00 CALC—VALUE: GROUP OCC: A-3 / PERMITTEE: BEST FIRE PROTECTION ( 213 ) 351-3050 ADDRESS: 6111 BELLINGHAM COMMENTS; REF B55544 N HOLLYWOOD CA 91606 ******+FBF*******r6******************+E************************N*>E**->E****+E***+c**+ESE* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7. O N I N G R E Q U I R E M E N T $ 7000)of Division 3 of the Business and: I hereby Code,and my license is in force and effect. / SETBACKS CITY LIC.: 0516508STATE LIC.:p ` 809 cum �--16 Date: , /SignaWre:_ _.� �.� I_ _ MAIN BUILDING ACCESSORY BUILDING �- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN WORKERS'COMPENSATION DECLARATION: I hereby.that I have a ce icate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN - Compensation Insurance.or a certified copy thereof(S• on 3800.Lab.Cl. POLICY NO.: : EXP.DATE: PARKING REQ: PROV: PARCEL: 42522302 ZNE: REF NO: COPLANNING N TES> 0 Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. > ****1!************************************************************************** Date: Applicant: DEVELOPMENT SERVICES REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). I certify that in the performance of the work for whit this permit is issued,I shall not employ any person in any manner so as to become ZONING APPROVED B Y DATE: subject to the Workers'Compensation Laws of norma. Date: '17--(9— Signature: ...44.4444/-44(4.S0 I BUILDING APPROVED BY NOTICE:II.atter making this declaration.yououshouhould..ea e subject to the fxers'Compensation provisions of the Labor DATE: Code.you must forthwith comply with such provisio . this permit shall be deemed revoked. c-� 1 ' �• \ I `f CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; Q J I-1 L--3/�i-4 DATE• '1 L �,1 which this permit is issued(Section 3097,Civ.C). ***************************** i6 iiiFFF*** *lt ii?2 iiFF x�**************•ic**********134FFF*!lIEEF �F *#iE iE iE LENDER: ****************W******************************************IF******************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER GUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 • 29 ,00 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 65% SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 18 . 85 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE I. as owner of theproperty or BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ my employees with wages as their sole compensation, win do the work, and the TOTALS----> 29 . 00 0. 00 18 . 85 47. 85 47. 85 . 00 structure is not intended or offered for.ale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS——> COLLECTED: 29 , 00 OVER/SHORT: 00 improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of safe). I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 29 . 00 O and Professions Code: The Contractors'State License Law does nm applyto an owner of properly who weds or improves thereon ******,*,********,*,*,******_*****,* . *********.****,_**._**,****,**,*_****.*.**.*****.****.**.***** and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. I N D I V — D U A L F E E BREAKDOWN ❑ I am exempt under Section: B. 8 P.C. for this reason: TYPE QTY D E S C I P T I UNIT COST TOTAL COST Date: Owner: FIR 29 FIRE EQUIP FE - (FROM BLDG VAL TABLE) 1 . 00 29 . 00 Ido hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES 25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from 1 y these provisions- L r., Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county -� •- ordinances and state laws relating to building consp'ction and hereby authorize representatives of this city to enter upon the above-mention property for inspection purposes. / ...-!%! _ p c Oi 00112:5 061IM / Date: •�O 7 - Signature: C�i1Y//f-^C// 7p-P �-')` - DATE: 04/03/r TME: I. . `. Driver's License or Social Security e: j_ 164146 White-Buildino:Green-Code Enforcement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor a CONSTRUCTION AND PLANNING- POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation I . 59. Gas Pipe, 0 Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap _ 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final -- 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 466. 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 Structure 70. Underground Hydro 22. Ducts, Ventilating • 71. Product Piping OGas ❑Oil - - 23. Gas Pipe-Rough & Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - --74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75.41 ..-Chemical -- CAZS_QZ ..L.4-z 27. Frame and Flashing 76. Dry Standpipe r 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 4-Z-3 -9y a,1, 30. Drywall Nailing HEALTH 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 - 1 36. Hood or Canopy • 1 37. Final Factory Fireplace - 38. Final Plumbing - 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final - 42. Backflow Preventer , 43. Backflow Irrigation a 44. Landscape Irrigation System • . 45: Sound Attenuation - . - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING • ,, '49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co ' J 51. CERTIFICATE OF OCCUPANCY No. Date Th PROJECT ADDRESS: UNIT: • OWNER'S NAME: 263 E 17TH ST orCITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 055734 • ADDRESS: 259 E 17TH ST ASSOC 259 E 17TH ST, CM, PERMIT NO: E 055734 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE; 5N SP PERMIT TYPE: ELE PURPOSE: OTH ARCH/ENGINEER: JAMES MCBRIDE II ARCH REG.NO.: CO JOB DESCRIPTION 4000SF RESTAURANT T, I , S FT: ADDRESS: 2700 W PAC COAST HWY uxlI: 202 Q • PERMITTEE: N,B , CA 92663 CLAIM VALUE: CALL-VALUE: GROUP OCC: A-3 /B-2 ADDRESS: DAHL ELECTRIC ( 719 ) 650-3533 n • OST3 MESALI WAY *Oh*1?*I**+Te*ir**• **�F******HO **+Sr***�E************4**�E�EA* �F *** �6 �E*�E�t+P�F�P************ COSTA MESA CA 92627 LICENSED CONTRACTORision3 DECLARATION: I hereby affirm ode Cant am licensed under provisions of ecapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect CITY IX: 04 8 STATE LIC.:47626 CLAS 0 S E T B A C K S Date: i- Z Signature:_ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I herebya Irm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REO: PROV: PARCEL: 42522302 ZNE: REF NO: –' Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > ,m: Applicant: ***************************)E***************iE*3E1k***)k***********it**1EBE**fE******iE** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT - 'S 'E t_R V I C E S REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any p rso • any mannerso as 10 become subject to the Workers'Compensation Laws of California. p f � � , , ZONING APPROVED BY DATE: _� Date: / —8- 9'Z Signature: ,1iG1M'w ( NOTICE:If.after making this declaration,you sroincome subject to a workers'Compensation provisions.6I-the Labor BUILDING APPROVED BY ; Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. - I DATE: /Q CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the pertormance of the work for APPLICATION ISSUED BY: DATE: 1ErE2 which this permit is issued(Section 3097,Civ.C). / i *********,*,*,*,*x,**,****.****.* * .�1, ,*,* *,*********„***,***** ****** LENDER: ! **************************************** ************************************ ADDRESS: — LEGALIZATION:N F' E•rE S U • M A R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: Ihereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 15$ , 6 5 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 50 t SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not mare than five hundred dollars($500). ISSUE FEE 15. 00 I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DIV-> PERMIT ISSUE PLA. ECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 158 . 65 15. 00 0. 00 173. 65 173 . 65 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED:_ 173 . 65 OVER/SHORT: ,00 for the purpose of sale). BLDG PMT PLUMBING EL ' RIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 7 . 65 ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).I am aware ***************************** *,********** ***.***************.***,**.************* that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.8 P.C. I N D I V I D L A L E BREAKDOWN tor nis reason: TYPE QTY DESCRIPT • N UNIT COST TOTAL COST Date: Owner: I do hereby certify that l am aware of and understand the requirements of CafifomiaHealth and Safety Code Sections 25505,25533,and ELE 20 FIXTURES, LIGHTINt 1 ST 20 EA. . 75 15 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 55 FIXTURES, LIGHTING ADDITIONAL EA, . 45 24 .75 permit lot construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE 20 RECEPT/OUTLET 1 ST 20 EA, . 75 15 , 00 these provisions. ELE 7 RECEPT/OUTLET • DDITIONAL EA. . 45 3 . 15 Date: Applicant: ELE 15 RECEPT/SWITCH 1 ST 20 EA, . 75 11 . 25 Ihereby certify that I have read this application and state that the above information is correct.I agree to comply with a0 city and county ELE 1 SERVICES BELOW 600 V - 201— 1000 AMP 37. 50 3 7. 5 0 ELE 2 SUB—PANEL 11 . 00 00 22 , 00 ordinances and state laws relating to building construction and hereby authorize representatives of this city o enter upon the above-mentioned property for inspection purposes. ELE 10 MOTOR/POWR APPARATUS 0. 0 — 1 .0 HP 3 . 00 30 . 00 •Date: /-g'9Z. Signature: --eat END 0 FEES 01 00103e12-00103912 " - ,_ Driver's License or Social Security a: BATE: 01r 0y"'y? 711°" 1641.46 While—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING P00 ?A APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector , 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , 2. SoilPipe•Undrgrnd. _ - Y 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. t54. Forms 4. Electrical Conduit-Undrgrnd. _ 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test - 6-.Etectrica[UFERGrrid. - 57. APPROVAL TO COVER-GUNITE . • 7. Footings• . '. ' 58. Electrical Conduit•Undrgrnd. " 8.. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test I 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ii 11. Property sewer Line & House Connection 62. Backwash & Receptor-Final 7 2. 12. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring Js43._ H ' l 1C I 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 Structure - - 70. Underground Hydro 22. Ducts, Ventilating_ • ' 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test _ r _ 72. Underground Flush 24. Roof.Framing • 73.'1Undergrnd.Storage Tank 4 Gas ❑Oil y^5. 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 - - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . _ dif 9. FINAL INSPECTION 32. Electrical Power MeterFinal : i / 8A. 'FIOD CERTIFICATE ISSUED 33. Final Electric) r r_ 'toles: . - _ 34. Final Heating & Air Conditioning- . . l 35. .Final Gas Pipe-Test: - - .-s 36. Hood or Canopy _ _ 37. Final Factory Fireplace ' . 38. Final.Plumbing • • r 39. Water Service-Filial - 40. Gas Service-Final - 41. Solar Domestic-Eine' -,. ' 42. Backflow Preventer ' " 43. Backflow Irrigation . 44. Landscape Irrigation System 1 - 45. Sound Attenuation 7 - - 46. Handicap,Regulations ' 47. FINAL STRUCTURE & BUILDING - • 48. .-FINAL PLANNING 49. Electric Release to Edison - 1 , 50. Gas Release to Southern California Gas Co I _ 51. CERTIFICATE OF OCCUPANCY No. Date • PROJECT ADDRESS: 263 E 17TH ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: M 05585E OWNER'S NAME: 259 E 17TH ST ASSOC •- ADDRESS: 259 E 17TH ST, C.M. PERMIT NO: M 055858 PLAN CHECK NO: N GOVT: N SUPP; N CONSTRUCTION TYPE; V-N PERMIT TYPE: MEC PURPOSE; ALT ARCH/ENGINEER: JAMES MCBRIDE II ARCH REG.ND.: CU JOB DESCRIPTION : 4000SF RESTAURANT T• I . SQ FT: • ADDRESS: 2700 W PAC COAST HWY UNIT: 202 N. B.• • CA 92663 CLAIM VALUE: CALC-VALUE: GROUP OCC: A-3 / PERMITTEE: J & L METAL PRODUCTSON ( 714 ) 722-0628 ADDRESS: 501 CATALINA COMMENTS; REF B55544 NEWPORT BEACH CA 92660 ****yE+E**4*** ***************** ***********************************************+r LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. S E T B A C K S CITY LIC.' 05 85. STATE LIC.:53649 CLASS: _^ ---- -• Date: � lQfia Signature:,:ir L�22-._!!.�[.�(+� MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN a, POLICY NO.: 0387110 EXP.DATE: 01 /01 /93 COMPANY: STATE PARKING REQ PROV: PARCEL : 42522302 ZNE: REF NO: ❑ Certified copy is hereby furnished. ® Certified copy is filed with the city Building Division. • PLANNING NOTES> ._ Date: /�a l� 2 Applicant: " • ************************************ *iE*�iE************************************ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permits for one hundred(5100)or leu). DEVELOPMENT S E R(V I 'C+ E S REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become 'r• I^- subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . •)-• 7 • in• DATE; -Date: Signature: • '.I NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY . - DATE: Code.you must forthwim comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B L—'— �—J� DATE•; o/ / el r which permit is issued(Section 3097.Civ.C). ******************** ' • " •WY:2Y's's'�•••�•— .7j 1p Q. UNDER: ******************************************* *********************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N I OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC ECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code:' Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 13,00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 252 SMI P/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN t�"'" any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE , ;0-. 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILD INC-DIV-> PERMIT ISSUE PLAN-, - - CK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 13 . 00 1 5 . 00 f 0 . 00 2 8. 00 28 . 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through , his or her own employees,provided that such improvements are not intended or offered for sale.If, however the building or REVENUE DIVISION TOTALS--> • C• 'ECTED• 2 8 , 0 0 OVER/SHORT• , 0 0 �i� forptheepurpose of sale).hin one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECT: MECHANIC FI ' SHIP/TOT GRADING PLAN-CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business —. 28 . 00 a ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon •, 7 and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware *************************** ************ ************************************* that proof of their Worker's Compensation insurance should be provided to me. I ND I V I 0 U ALL' - E BR E AK D 0 W N ❑ I am exempt under Section: 8.6 P.C. K for this reason: TYPE QTY DESCRIPT d N UNIT COST TOTAL COST • A Date: owner; MEC 1INST HOOD W/DU ' S FED BY MEC EXHAUST 6 . 50 6. 50 r I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and MEC 1 I NST/REL NON-PO' ABLE EVAP COOLER 6. 50 6. 50 25534 and that I or any future building occupant willwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from END OF FEES these provisions. Date: Applicant: • f I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county •i ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter ups)the above.mentioned property for inspection purposes.6 �j� D_ ///� L/, • L Date:/J I/T .9 Signature:/� ///.--Ce.n. �.i4N _ _ - Driver LLicense or Social Security d: �3 �'-11��^�i."L.'<J l' L;TE: 0: ':J 4" T.r . 1645.46 White—Building:Green—Cade Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor k CONSTRUCTION AND PLANNING POOL & SPA Date Inspector • Date Inspector - APPROVALS Permit# `f APPROVALS Permit # 1. Temporary Electrical Service:or Pole I!_ 52. Pool & Equipment Location �' 2. Soil Pipe-Undrgrnd. - • 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. ' L' . 54. Forms ' , 4. Electrical Conduit-Undrgrnd." 55. Electrical Bonding - - 5. Steel Reinforcement , 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Coriduit-Undrgrnd. 8. Foundation .i, .^ 59. Gas Pipe, 0 Undrgrnd., Test `1 9. Water Pipe-Undrgrnd. -' 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System ' ' 61. APPROVAL TO DECK 0-4 11. Property SeWer Line & HoustConnection ' 62. Backwash & Receptor-Final 12: Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing - 65. Electrical-Final i 15. Rough Electrical-Conduit "fr1 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 Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough.& Test - 72. Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 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 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION _z) -32. Electrical Power Meter-Final , 80. -FOOD CERTIFICATE ISSUED {Il 33. Final Electric fj Notes: p/A�/9� mss' 7��I ar yr� 34. Final Heating& Air Conditioning - (ra/lira/� c - 35. Final Gas Pipe-Test �/ _ -- .436. Hood or Canopy - - r.,/ft'/qt. (iy9 _ 37. Final Factory Fireplace ' • / 7 38. Final Plumbing 39. Water Service-Final - - 40. Gas Service-Final •- 41. Solar Domestic-Final - 42. Backf low Preventer r 43. Backf low Irrigation 44. Landscape Irrigation System . 45. Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co .... CERTIFICATE OF OCCUPANCY / Date � � Illft JC,,,,r '.-.' "t /rf-! PROJECT ADDRESS: 263 E 17TH ST UNIT: DWCT ADDRESS: 259CITY OF COSTA MESA – BUILDING PERMIT PERM Un;F M 05567$ E 17TH ST ASSOC • 259 E 17TH ST, C.M. PERMIT NO: M 055675 PLAN CHECK NO: N COVTT N . SUPP: N ADDRESS: CONSTRUCTION TYPE: V–N PERMIT TYPE: MEC PURPOSE: ALT • JAMES MCBRIDE II ARCH CO JOB DESCRIPTION : 4000SF RESTAURANT T. I . SQ FT: ARCH/ENGINEER: 2.00 W PAC COAST HWY REG.NO.: 202 ADDRESS: N,B . CA 92663 UNIT: CLAIM VALUE: CALC–VALUE: GROUP OCC: A-3 / • SUNWEST AIR CONDITIONING (714 ) 650-5061 PERMITTEE: 629 TERMINAL WAY 17 COMMENTS: REF: B55544 ADDRESS: COSTA MESA CA 92627 s****+e*******4*****sr**aric*****************st*Tt*******iFaE*yE*****yE******jt**it******* ZONING REQUIREMENTS LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am tensed ,ndr divisions of Chapter 9(commencing with Section SETBACKS 7000)of Diti!38BeK9usines5 and Profe4s18T103f94id m cense i iy .20id effect. — • CITY LIC.: qZ STATE LIC.: �/ MAIN BUILDING ACCESSORY BUILDING Date: / 2 '/ '/ Signature:_ /_�'/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN WORKERS'CO1MFfLSA710NDEGLAMTION: I hereby affirm that I have a gee4fic tpa4cope n O selbinsure or a certificate of Workers' LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation IrNmldci W fl&kdAlf cop thereof(Section 3800.Lab. IL i.1. y 1 7 L POLICY NO.: CA INDEMNITY EXP.OATE: PARKING REQ;. PROV: PARCEL: 42522302 ZNE: REF NO: COMPANY: X / PLANNING NOTES> 0 Certified copy is hereby furnished. ❑ Certified copy is f i.wit 'i- •mr ilding Division. > -3 -9Z Applicant: illj//; /J// DEVELOPMENT S E R''V I C E S REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: Otis section need not be completed if the permit is for one hundred(5100)or less). I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become ZONING APPROVED BY "' DATE subject to the Workers'Compensation Laws of California. Date: Signature: "BUILDING APPROVED BY : / -- DATE: NOTICE:II,atter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor l� Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. 'APPLICATION ISSUED B Y• - DATE: r _ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for •*************************** ' * *** * *** ** *********************** * * * **** which this permit is issued(Section 3097.Civ.C). ****************************************** ********************************** LENDER: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N ADDRESS: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason PERMIT 36, 00 (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or 2 5% SM I P/NON–RES repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PLAN pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7900)of Division 3 al the Business ISSUE FEE 15 . 0 0 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). BUILDING–DIV–> PERMIT ISSUE PLAN–CHECK TOTAL PAID DUE I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 36. 00 15 . 00 0 , 00 51 . 00 51 . 00 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through REVENUE DIVISION TOTALS--> COLLECTED • 51 , 00 OVER/SHORT: 00 his or her own employees.provided that such improvements are not intended or offered for sale. It,however the building or BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN–CHECK improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve 51 . 00 for the purpose of sale). i, . I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ******,**,*,*,**,**,***,*,**,**se*,*,***,**,****,**,***,*,**,*,**,*,****,**,*,*,*,***,*,*,**,******,*********** ,� and Professions Code: The Contractors' tate License Law does npt apply to an owner of propend wto bmlds er Taw).I as thereon I N D I V I D U A L F E E B R E A K D O W N and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.A P.C. TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST for this reason: MEC 2 REPAIR/ALT HEATIN 'NI /SYS W/CNTLS 9 . 00 18 , 00 Date: Owf1ef: MEC 4 VENTILATION F:. • ONN TO SINGLE DUCT 4 . 50 18 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant wiltwill not(circle one)need to compN with said state codes and the requirements for a permit for construction or modification from the Air uality Management District.Residential construction applications are exempt from these provisions. \ / Date: Applicant: J ^ I hereby certify that I have read this application and state that the abo a inf ma' 'correct.I agree to comply with all city and county Y ordinances and state laws relating to building construction and hereby thor r e olives of this city to enter upon the above.mentioned property I'inspeclionpurQoses. – • – Date:/ 3 - (L/](/fes 11 a„T 5:& –tr:1 :-7` -- 1-,1'i; T-• UL , I f".: 1 : 1641-46 White–Building;Green—Cope Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor I - CONSTRUCTION AND PLANNING POOL F • . APPROVALS Permit# elate Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. -' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd? 54. Forms 4. Electribal Conduit-Undrgrnd. ' ' 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6, Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE •r 7. Footings" ? ;y58. Electrical Conduit-Undrgrnd. • 8. Foundation . . • - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undigrnd. :�. •-:> 60. Backwash Lines,P-Trap, 0 Undrgrnd. • " 10. Structural Floor System'-;v, ' ( 44 ' 61. APPROVAL TO DECK 11. Property Seyver Line &.Ho se Connection, 62. Backwash & Receptor-Final ' • 12. Sewer Capt • 1 ' . ' ! 63. Heater & Vent-Final 13. Roof Drains 1 i 64. Plumbing System - Final 14. Rough Plumbing ' 65. Electrical-Final • 15. Rough.Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring"$ign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough.Factory Fireplace ! - r _ APPROVALS Permit# • , ucts.•if Structure , ' 21. D .1$ ? • 70. Underground Hydro 22. Ducts, Ventilating - , 71. Product Piping OGas 0011 23. Gas Pipe-Rough $ Test , , 72. Underground Flush 24. Roof Framing - 73. Undergrnd.StorageTank 0 Gas 0 Oil 25. Root Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural)'& Monocoat • ' r 75. Dry Chemical .. 27. Frame and Flashing • , - • _ 76. Dry Standpipe ', 28. Lathing& Siding . _ >• 77. FIXED SYSTEM.FINAL 29. Insulation • - I 1 78. FIRE PREY. FINAL . . 30. Drywall Nailing • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat,. - 79. FINAL-INSPECTION - • 32. Electrical Power Meter-Final , 80. FOOD CERTIFICATE ISSUED i 33. Final Electric , n . . Notes: - ; 34. Final Heating& Air,Condiiioning '- 111"--f2-"- 11�UJ,rL j�•- K_` 35. Final Gas pipe-Test._ : - i • - ' ill 36. Hood or Canopy ' . ' rr > 37. Final Factory Fireplace •'' "• , 38. Final Plumbing • • - - - . ' 39. Water Service-Final , '. 40. Gas Service-Final - 41. Solar Domestic-Finalr. _ • = 42'. Backf low Preventer , 43. Backf low Irrigation - . - - . 44. Landscape Irrigation System - • . 45. Sound Attenuation _ .• - ,: - 46. Handicap Regulations - , ` • , - 47. FINAL STRUCTURE & BUILDING • .. • • 48. FINAL PLANNING - ' ' 1,' 49. Electric Release to Edison ,. r 50. Gas Release to Southern California Gas Co _, k• . - . 51. CERTIFICATE OF OCCUPANCY ' • No. Date ~ PROJECT ADDRESS: 263 E 17TH UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 055570 • • :JWNER'S NAME: 259 E 17TH ST ASSOC ADDRESS: 259 E 17TH ST, C.M. PERMIT NO: P 055570 PLAN CHECK NO: N GOVT: N SUPP: N • CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: ALT ARCH/ENGINEER: REG.NO.: ADDRESS: JAMES MCBRIDE II ARCH CO UNIT: JOB DESCRIPTION : 4000SF RESTAURANT T. I . SQ FT: • 2700 W PAC COAST HWY 202 PERMITTEE: N.B , CA 92663 CLAIM VALUE: CALL—VALUE: GROUP OCC: A-3 / ELITE PLUMBING ( 714 ) 722-0374 ADDRESS: 1760 MONROVIA C-12 COMMENTS: "EL MUCHO GUSTO" REF: B55544 COSTA MESA CA 92627 ************************************************:r*+6****************SE+t*+t*******+E ` LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and y license is in f force and effect. SETBACKS • CITY LIC.: 046STATESTATE LIC.:539786 55' 6 O Signature: _ _'_ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPE SATIONN DECLARATION: I hereby affirm a as acenifica Iconsent toself-insure oracertificate ofWorkers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Sectio' 3800 Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT• FT IN POLICY ND.: 1066304-91 E P, r TE: 01/01 /92 Cy: 5TATE FUND PARKING REQPROV: PARCEL: 42522302 ZNE: REFO: ied copy i hereby urnished. IN Certified coi til 'hthe c' BuildingDivision. PLANNING- NOTES>Applicant: **************************************.*if*******•******************************** ••sf EXEMPTION FROM W KERS'COMPENSATION DECLARATION: his a ion need not completed if the permit is for one hundred($t 00)or less). DEVELOPMENT S E R VPI C E S% REQUIREMENTS I certify that in the performance of the work for which this pe itis'sued,I shall not employ any persoriin any manner so as to become ,r ' • subject to the Workers'Compensation Laws of California. ZONING APPROVED BY 'i /2 DATE: Date: Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation;provisions of the Labor BUILDING APPROVED BY : •'7 j ^ DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• I l / �) DATE: e / / n which this permit is issued/Section 3097.Civ.CI. *********.*.***..****.**.**�(.**** ****** * • *.*.*****,�. . ' *****************{ ********** * LENDER: ********************************************.:i-' ******************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 62 00 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed qq dJ pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business G 5% SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3. 00 I I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 62 . 00 3 . 00 0. 00 6 5. 00 65. 00• . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through �\ I his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 65. 00 OVER/SHORT: . 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FI• SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 65 . 00 ❑ and Professions Code: The Contractors'State License Lew does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ****.**.***.***************************** *.**,**,**********,**.**.**.*.*.*,*.*,**,*,*,*,**,**,*,** that proof of their Worker's Compensation insurance should be provided to me. o am exempt under Section: B.a P.C. I N D I V I D U A L F E E BREAKDOWN for this reason: TYPE QTY D E S C R I P T I A N / UNIT COST TOTAL COST Date: Owner: J/ I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 1 •' DISHWASHER 2 . 00 2 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a PLU 5 WASH BASIN 2 . 00 10 , 00 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from PLU 3 WATER CLOSET (TOILE ) 2 . 00 6 . 00 these provisions. . PLU 1 WATER HEATER AND/OR ENT 2. 00 I 2 . 00 Date: ApplicantPLU 1 WATER SERVICE 2 , 00 I 2 . 00 PLU 1 GAS PIPING SYS OF TO 4 OUTLETS 2 . 00 2 . 00 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county PLU 8 FLOOR DRAINS 2 , 00 16 . 00 ordinances and state laws relaing to building construction and her b orize r'r resentatives of this city to enter upon the above-mentioned PLU 1 SINKS, COMMERCIAL OR property for inspect n pur see �DUSTRIAL 2 ,00 2 . 00 nn II PLU 8 SINKS, FLOOR 2,00 16 . 00 Date � lQ Signature: A�/ / PLU 1 SINKS SERVICE / MOP 01 0012Y;00 (p]i:1vE5b 3i�'T 2 • 00 II PLU 1 URINALS, WALL OAT6•. 2. Op;„ TIii_ 2 . 00 I Driver's License a Social security a: �� 1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor * , --...1.11111� , • CONSTRUCTION AND PLANNING P00' PA I APPROVALS Permit # 1 1 Date Inspector APPROVALS Permit # Date Inspekor 1. Temporary Electrical Servile or Pole 52. Pool & Equipment Location . --j tr 2. Soil Pipe-Undtgrnd.- ..-e' • •L' - -.1--' 53. Steel Reinforcement • - e a:,ElectricalsConduit Utility-Undrgrnd,- - 54. Forms -4': Electrical Conduct=Undrgrnd. c;L.: 55. Electrical Bonding .‘"5": Steel Rei?+forceme�"nt,; 56. Rough Plumbing& Pressure Test _ 8: ElectricaFtwER:Oirid. - 57. APPROVAL TO COVER-GUNITE ' - 7•• Footings; ^Y; - 58. Electrical Conduit Undrgrnd. -8, Foundatiortt :• 59. Gas Pipe, 0 Undrgrnd., Test ' 9. Water Pip.;•Undrgrnd. '-- �. ,�,_---- 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural:Rloor System `' 61. APPROVAL TO DECK - 1 - 11. Property Sewer Line& House,eonnettion ' _- 62. Backwash & Receptor-Final 12. Sewer Cap , 63. Heater& Vent-Final 13. Roof Drains ' _ / 64 . Plumbing System - Final 14. Rough Plumbing, (`(5 OW 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric-Wiring 67. Fencing & Access Approval 17. Rough Wiring Sigh 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 : •% ' - S * '' APPROVAL =S.•_ _Permnit # - - „ _ • _ 21.:budd& in Stricture, 4 _ t 70. Underground Hydro r 22. Ducts,- Ventilating. a r:, ' 71. Product Piping D'Gas 0.0i1 23..:Gas:fipe,.Rough&Test „ � - T F" .72. UndergroupdFlush - . 24. Boot'Framing. -• - r* ; "73.'Undergrnd.Storage,Tank OGas 0Oir --- 25. Rodf,Sh'eathing ?' '- ''• - > '74.-Overhead Hydro_ Z 26.'T-Bar Ceiling (Structural) & Monocoat - : 75. Dry Chemical 27. Frame and Flashing- •,� c j - ' 76. Dry Standpipe - - r r ,, ;T `..6 • •28.-Lathjng & Siding . . s • s • •• �F 77• ,_FIXED SYSTEM:FI AL' - ;ys - ^ - - ' 71 " '29. Insulatioii - • 71 ;a' -i, r- 78,-.EIRE PREV. FINAL r r 30. Drywall Nailing :. I • _• ' `•HEALTH,OEPT'REQUIREMENT -'.31. Plaster B own Co'd , i: '; ,79. F'I'NAL'lNSPECTIQ,'1 C', , 32. ElectricalPower Meter Final r ' - L' .80.:FOOD CERTIFICATE •ISSUED 33. Final'Electrie. - C ` /'; Notes: ; 34. Final•Heating:& Air Conditioning„- -. .,./ : • :,_ 35..finat Gas•PipetTest" = !(Z ( J ^ _ ' c '`• •- • .36."Hood or Canopy 37. .Final Factory Fireplace St° - ",'. r >: ' - r, T j 4 -' -Y 38. Final,Plumbing • -1 •• - C: Y�2d -:C•4.0'ia s :39. Water Service-Final.t I ... '- •. - ,' •s, • i . ': • I >• 40. Gas Service-Final c 41. Solar Domestic-Final -42.--Backf low Preventer" t I i' `' - _ 43. Backflow Irrigation/ 'S ! , ;44. Landscape Irrigation Systems r - _ - -•....%>c = -•- - . . . ;45.:-Sound Attenuation ,c x , '46.•-Handicap Regulations - ` `� • _ •• • -, . 47. FINAL STRUCTURE & BUILDING ' " �• 48. FIFf4L PLANNING ' ` ' - - • l) ,', sn .i , 49._Electric Release to Edison •./ ,} F ' i.. - 50.�Gas Release to Southern California Gas Co ; k•%', • - , • '51. CERTIFICATE OF OCCUPANCY ; • - _ ` No. Date PROJECT ADDRESS: 263 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 055544 OWNER'S NAME: 259 E 17TH ST ASSOC ADDRESS: 259 E 17TH ST, C.M. PERMIT NO: B 055544 PLAN CHECK NO: 04139-91 L GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR ,• PURPOSE: ALT • ARCH/ENGINEER: JAMES MCBRIDE II ARCH REG.NO.: CO JOB DESCRIPTION : 4000SF RESTAURANT T, I . SQ FT: 4,000 • ADDRESS: 2700 W PAC COAST HWY UNIT: 202 r . N,B, CA 92663 CLAIM VALUE: 75. 00,0_40-�CALC—VALUE: 47, 120 . 00 GROUP OCC: A-3 / PERMITTEE: SIEMONSMA CONSTRUCTION ( 714 )722-0628 ADDRESS: 501 CATALINA COMMENTS; "EL MUCHO GUSTO" RESTAURANT T, I, NEWPORT BEACH CA 92660 ******�t+t�E�E�F*�E�E�E*rst�E�t�ESE�t�e3E*****�e�E***�E***FEsE*Te+rSt**** ******Tt*****************+e**** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business/ and/Professions Code.and my license is in full force and effect SETBACKS . CITYDale' : 054 .. #ib Tf 5 STATE �64 CLASS: _ — f Date: / �/ Signature: MAIN BUILDING ACCESSORY BUILDING • WORKERS'COMPENSAT NDEC RA ON: I hereby that l have dicate of consent to self-insure or a certificate of Workers FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab ). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42522302 ZNE: Cl REF--NO: PA9194 0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> INTERIOR ALTERATION FOR A RESTAURANT/JAZZ CLUB IN AN EXIST. -, > COMM.. .BLDG;.. HOLD HARMLESS LTR, SUBMITTED, P ONLY .e: Applicant: *******************.**.*.****.************************** ********** ****Be,********** EXEMPTION FROM WORKERS'COMPENSATION DECLARAT N: (This section need not be comp) if is for one hundred(5100)or less). D E V E L O P M E`=N`T '-._S E R V I C E S REQUIREMEWT S I certify that in the performance of the work for w is permit is issued,I shall not a on in any manner so as to become ! .2 ' ,` l subject to the Wor rs'Com/n�aTeensatian Laws IiN�r r ZONING APPROVED BY .'' "• W �1� DATE:' \,''Z:.I 'U L 9 Date: /Z/15. 9/ Signally NOTICE:U.alter ma ng this declaration.you should become sub to the Workers'Compensation provisions of the Labor BUILDING APPROVED, BY. :1 , / DATE: Code.you must forthwith comply with such provisions or this mit shall be deemed revoked. , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is construction lending agency for the performance of the work for APPLICATION ISSUED BY:? -� .'l_ y l E T DATE. L2. 11.1 which this permit is issued(Section 3097,Civ.C). ******************************** * * ***** *********************4* - - - - - -- - - - ** LENDER: ********************.*********************** *********************************** ADDRESS: bE(3AbttATtUN!N p' E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PdT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,atter,improve,demolish,or PERMIT 401 . 5U ' repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70088 of Division 3 of the Business SM I P/NO©—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN 260. 98 9 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE l: I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 411 , 40 0 . 00 .260 . 98 672 . 38 6 72. 38 .00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED . 411 . 40 OVER/SHORT: . 00 ' for the purpose ol sale). BLDG PMT PLUMBING ELECTRIC ME 'I'IC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 401 . 50 ! - 9. 90 O and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon9 and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ****.*.**********.********* , , ********'{L.** ****.**.**********.*.iE*aE*.******.)[.**.{F****{e-*.y.*. that Drool of their worker's Compensation insurance should be provided to me. INDI I .D U A L - F E E BR EAK, Df,O,OWN - '; - • I am exempt under Section: B.&P.C. - ;111_ _ for this reason: TYPE QTY DESCRIPTIO UNIT 'COST/ '. "'` 'TOTAL COST Date: Owner: I I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFC 4000 RES—INT, A TE• 'PE V—N —AVER 11 . 78 47, 120, 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END,,OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: ' ' ' r I hereby certify that I have read this application and state the above information is corn I agree with all city and county ordmaneeS and state laws relating to building construct' and hereby authorize represent. f this u1 er upon the above-mentioned properly or inspect n purposes. _ --� ^tel Date: iT� �/9/ Signature' Driver's License or Social Security t: 1641-46 White—Building:Green—Code Enforcement:Canary—Aoolicanl:Pink—Revenue:Goldenrod—Assessor • . . . •ii CONSTRUCTION AND PLANNING -. POOL i. A APPROVALS Permit #- Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 1- 2. Soil Pipe-Undrgrnd. „ 'i - 53.-Steel Reinforcement . 3. ElectricakcondgitUtility-U'hdrgrnd. 54. Forms 4. Electrical-CandUit-Uddrgrnd. . 55. Electrical Bonding r .;"5. Steel Reinfa'rcerpent' - 56. Rough Plumbing& Pressure Test i' 6::,ElectricaYUFER Cir•.ati. 57. APPROVAL TO COVER-GUNITE 71: Footings, -. C-','c I l 58. Electrical Conduit-Undrgrnd. ' ' - 8, FoundatiorC Li- 59. Gas Pipe, 0 Undrgrnd., Test r _ 9: Water Pipg-Und[grnd. I - r 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural 6_loor System 61. APPROVAL TO DECK 11. Property Sewera_int-& House Connection , 62. Backwash & Receptor-Final i 12. Sewer CaP -1. 63. Heater & Vent-Final 4 13. Roof Drains•t, c !1 1 64. Plumbing System - Final _ ` , 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval • 17. Rough Wiring Sion 68. APPROVED FOR PLASTERING 18. Rough Electrical:-T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT - ..--i .i... - 4 20.1Rough Factor' Fireplace . •.c.- S= . C •APPROVALS: ='.'Permit # '- 21.'Ducts,in-Structure "l . .. `. S - _ -70. Underground Hydro 22. Ducts, Ventilating _ - t; - 71. Product Pipipg 0Gas 0.Oil 23.Gas Pipe~Rough& -Lest - m - t < ,r y �t . 72. Underground Flush- - 24. Rooi.Framing • - • _;. r . + _73.=Undergrnd.Storage Tank,0 Gas 0 Oil 25. Roof Sheathing , ' t r `- ;', '745 Overhead Hydro, _26. -Bar Ceiling (Stfucturall &•Nlonocoat ¶-fJ 7_ICiZ lam; 75; Dry Chemical , - - ' 27 Frame and Flashing, •.� trail !aL 76. Dry Standpipe ' -' - 28. 'Lathing•&en'Cftr . . ^:{`c .,:k,-:. Zito fij7 77:- FIXED SYSTEM:6INAL'. '29. Insulati&z ` `' . ' - .. "E"--; gm ,� ' • 0 a',. ; 7&,.F1 RE PREV. FINAL ;. . r 30. Drywall Nailing Ili q1 �� HEALTN_DEPT.AEQUI--rt ENT 31. Plaster Brown.Co�t .(, 2 79i FINAL INSPECTION 32. Electrical:Pow`er Meter-Final: i ' -• ;> u ' " -80.,FOOD CERTIFICATE ISSUED - 1 33.final Ele4tric :^ '- r , i ," '. 'Notes: = _ '34. Final Heating!& AirC&nditiopigg- ^„r ' : * { r r 35.-Final Gas Pipe-Test'. 1' " _ _ .36. Flood or Canopy .-.. :3 ` rte .3. x 2 i 'T . F -37..Final'Factory Fireplace_, ` r "';'? , i -1.„: I !'. A Mt/..S5W ' 38.-,innk '' . i '• 0..2 * I 1 1.a: .� 39.•Water Service-Final. - _ I - , ' • 1 ;-i• .s 40.-Gas Service-Final --�▪ - .- • t ,n r ' > _ '41. Solar Domestic-Final', . .. I ` 42. Backflow Preventer;� V ,' : '�� ,r ;'.. x 43. Backflow Irrigation* - • r .i s > IG - - 44. Landscape Irrigation Systema:.-: .C�c i .r, U _V. > Y c-, - " y •, C 45.:Sound Attenuation --i - • <'. : 2 ' 46. Handicap:Regulations ;_ ;, J 47..FINAL STRUCTURE & BUFEDING .� - - 46: C ', ?i . ...^•• • 777' los. _ •-, -49. Electric Release to Edison ; a�. i •• � _ - ' ((( r 'r 50. Gas Release to Southern California Gas Co : I f '' `` - "'. l r 51. CERTIFICATE OF-OCCUPANCY - . No. Date ,• PROJECT ADDRESS: 263 E 17TH ST UNIT: s CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05 /Ui_ OWNEWSNAME: 259 E 17TH ST ASSOC , q ADDRESS: 259 E 17TH ST, C.M. PERMIT NO: E 05703.3 PLAN CHECK NO: N GOVT: N SUP?: Y CONSTRUCTION TYPE; V—N PERMIT TYPE: ELE PURPOSE: ALT ARCH/ENGINEER:. JAMES MCBRIDE II ARCH REG.ND.: CO JOB DESCRIPTION ; 4000SF RESTAURANT T. I . SQ FT: ADDRESS: 2700 W PAC COAST HWY UNIT: 202 N.B. CA 92663 CLAIM VALUE: CALC—VALUE: GROUP OCC: A-3 . / PERMITTEE: DAHL ELECTRIC (714 ) 650-3533 ADDRESS: 2453 NAPOLI WAY COMMENTS- RE B55544 C.M. CA 92627 ******************************************************************************* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY :� o8 STATE uc.: 47626 CLASS:— Z?8�� Dale: y�7 / z Signature: C MAIN BUILDING ACCESSORY BUILDING WORKERS Com NSAnox DECLARATION: Ther ahrm that haves certificate of consent to self-insure oracenificate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN I ' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). POLICY EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL; 42522302 ZNE: REF NO: Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING N{3 TES> > ( **************%.****************.JL**:********************************************* Date' Applicant' DEVELOPMENT O E_R V I C E S REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(51 g0)or less). I certifythat in the performance of the work for which this permit is issued.I shall not em toy any person in m r so as to become e r subjecto the W kers' ompensation Laws of California x ' ZONING APPROVED BY t n n DATE: Date: y �7 92 signature: BUILDING APPROVED BY : / / DATE: NOTA :II.aft making this declaration)JlpshoNM b le subject to the Workers'Compensation provisions of the Labor ' Cod.you must forthwith comply with such provisions or this permit shall be deemed revoked. —�= rf CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction fending agency fpr the performance of the work for APPLICATION ISSUED B Y: �` 1C DATE• O 4-17 41 -7— which which this permit is issued(Section 3097.Civ.C). ********************** ' 'n' , " *'*' *************** **'*** '* LENDER: ******************************* '*3w**** *************************************** ADDRESS: LEGALIZATION:N F,EiE.q UMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'Slate License Law for the following reason BLDG PMT PLUMBING ELECT" IC MECHANIC FIRE SM IP/RES GRADING I. (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 % . O. repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed I SMI P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 4 50 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISS' E PLAN—GREG TOTAL PAID DUE ❑ Structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS 1 5 . 0 O 9 . ' 0 19 . 50 19 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If, however the building or REVENUE DIVISION TOTALS--> tCTED • 19. 50 OVER/SHORT: 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve foror the purpose off sale). BLDG PMT PLUMBING ELECTRI MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 19 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *****************************'**** '*****'******'****'*************'**********'******* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUA F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: ELE 1 TEMP WORKWITH EA. 15 . 00 15 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and That I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to ente upon the above-mentioned property for inspection pur oses. Dale: 9777 ?7-- Signature: Oi 03113M—00113043 -4)7 . . Driver's License or Social Security It; ' DATE: C4.. 17,72 un-!-! ' ' 164146 White—Building:Green—Code Enforcement;Canary—Aooticanl;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POt- . SPA ,+PPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical 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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final ' 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-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# -- j 21. Ducts,in Structure 70. Underground Hydro 1 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil a 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Fleshing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat FINAL INSPECTION 32. Electrical Power Meter-Final 4.:914.:912, 47 l� , "I FOOD CERTIFICATE ISSUED 33. Final Electric 1.)...11.91Z 0 �s ites: , 34. Final Heating& Air Conditioning t 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 Domestic-Final 42. Backflow Preventer 43. Backf low Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date