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Home My WebLink About267 17TH ST - Building Permits City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. 0 o 3`:;;R, Building Safety Division P.O.Box 7200 Costa Mesa,California The Building located at oc-1 a_. riff, a*rmt has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 1:47 Occupancy. Use of Building nffinn Legal Description 475-774-114 (See reverse side for Metes and Bounds) Building Permit No a 475437 Electrical Permit No. r_ n'7cn , Plumbing Permit No. n Mechanical Permit No. G 47597 Number of apartments - and/or guest rooms • ISSUED TO: Building Official ry+.,• r•rn n Pacific EtTuitv74. • . 1901 Avenue of Ehe Stars b • y V Century City, CA Date July 18,1990 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 lel U.B.C. CMF 1015-46 rev. 1/83 White-Owner;Canary-Numerical File;Pink-Bldg.Permit File N • CITY OF COSTA MESA / ► • BUILDING DIVISION N .,,.' DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER ut. /i PERMIT B05-00148 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 267 E 17TH ST Status: ISSUED Suite: Applied: 01/27/2005 Vicinity: Issued: 04/22/2005 Primary Occ: M Display/Sale Merchandise Type of Construction: V-N Parcel Number: 42522303 Zoning: Applicant: PRIDY, ALLISON ISSUED BY: Address: Phone: 562 428-0003 Zip: Owner SARRAF,-KALEB Address P O BOX 241586 Phone: LOS ANGELES,CA Zip: 90024-9386 , Contractor: -HAR-BRO INC- Address:. 2750 SIGNAL PARKWAY Phone: 562-528-8000 SIGNAL HILL,CA - - - Zip: 90755-2207 -License: 258441 Arch : Eng: H C HANSEN Address: Address: 17371 IRVINE BL Phone: - , Phone: 714-573-0073 TUSTIN,CA Zip: License: 92780 License: SE3027 SCOPE OF PERMIT . INTERIOR STORE TI TO UPGRADE AN EXISTING RESTROOM TO COMPLY WITH STATE ACCESS DISABILITY REQUIREMENTS.WORK TO ALSO INCLUDE REPLACING LIMITED INTERIOR WOOD STUD WALLS. • FEE SUMMARY Plan Check: $117.81 - Calc Valuation: $10,000.00 Permit: $181.25 Claim Valuation: ' 510,000.00 SMIP Res: $0.00 SMIP Corn: $2.10 Other: $0.00 • Inspection: ,$0.00 , Total: ' $301.16 . 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 Existing: . 0 - -Required: 0 Proposed: 0 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 244646 16/00) DECLARATIONS o ,- • 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'compensationn Insurance carrier and policy number are: arrier: SC/x r > (2-<cr(4-7 P li" umber: /3 / V S 0 G 37 (This section need not be completed if the permit is valued at one hundred dollars($100)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 subject to the workers' compensation laws of alifomia,and agree that If I should become subject to the workers'compensation provisions of Sectio 700 of the Labor Code,I shall forthwith comply with these pro ions. x Pliant Signature: 19 Z-/ ; J—/G C WARNING:FAILURE TO - - ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIN ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND COLLARE($100.'.•, N ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens der provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full eiln0 effect.Lic.4 � Class treSignature: ta CONSTRUCTION LENDIN 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 1 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 tile 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 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 sate(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 properly,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. 0 Yes ❑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: ❑ 1 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: 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 cf 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 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. 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.application aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L-I 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 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? ❑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-de cribed property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signet — wner(s) V/2� to ' And/Or7Auth''crlied;jlpplic"nt,ra. "' CODE E INSPECTION nn QAIE INTMAL$ at INSPECTION TYPE WE INTIMLS 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 . 204 Final Demolition 250 Final Building/Occupancy &® - 1t -:rs CITY OF COSTA MESA , G\@ BUILDING DIVISION F �a DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 0 ®D PERMIT 4141 ,rip E05-01154 (714)754-5273' • Fax(714)754-4856 • www.ci.costa-mesa.0.0 ELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 267 E 17TH ST Status: ISSUED Suite No Applied: 11/01/2005 Vicinity: Issued: 11/01/2005 Parcel Nunmber: 42522303 Applicant: MIKE DOTY Address: 24602 GARLAND DRIVE ISSUED BY: Phone: (818)445-0886 VELENCIA,CA - Zip 91355 Owner: SARRAF, KALEB Address P O BOX 241586 Phone: -LOS ANGELES,CA Zip: 90024-9386 Contractor: DOTY ELECTRIC Address: 26406 CITYLIGHT CT Phone: (818)445-0886 SANTA CLARITA,CA Zip: 91351 ' License:745302 • SCOPE OF PERMIT ELECTRICAL PERMIT FOR INTERIOR TENANT IMPROVEMENT REF#:805-00148 WORK TO INLCUDE:31 LIGHTING FIXTS,34 RECEPT OUTLETS, 18 SWITCHES,2 MOTORS TO 50 HP AND 1 SUB PANEL TO 200A. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.e/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 $0.00 0 Lighting Fixts $30.03 31 up to 50 kva/kw $0.00 0 Recept Outlets $32.22 34 up to 100 kva/kw $0.00 0 Switches $19.80 18 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00• 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $49.20 2 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee . $0.00 Sub panel to 200a $30.50 1 Plan Check Fee . $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 - TOTAL CALCULATED FE S $1: . Intermed Pole $0.00 0 • 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) J/ 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 applicable codes, and all required inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) 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 ff work for which this permit is issued. - /LJ"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 work_..s''com/��tio'Jasurance carrier and policy number are: 'I ,Carrier, l 1' VO'NJ C) BolicyNOmber: _(TJdrsectlon need not be completed ll the permit is valued at one hundred dollars($100)or less.) . ❑ I certify that In the perf0 ce 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 : '•mla,and :1 ree that if 1 should become subject to the workers'compensation provisions of Section 3700 of t e Labor Code,I shall forthwith com��p)y�with`fhese p , I'•ns �/ (WARNING: Signature: CData "-fir / / IDJ 1`WARNINO:FAILURE TO-ECURE -.1 RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE •100,000),IN••• • 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 Ihat,l am Tic se under provisions of Chapter 9(commencing with Section 7000)of Division 3 of.the'Bus ness and Professions Code,and my license is in full L and a act.Lic.a OZ- Lciase M \ G"l a onlratora.SignaNrle j (11—e‘..-• R-.51 -O6 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: 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 Lew(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end 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.). • ❑ 1,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 10 verified by driver's license. 0 Yes 0 No Drivers 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,Tile 6,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: 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 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 0 No 'i (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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 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? Yes 0 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 ole 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 It 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? 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 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 roperty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. t o Of Legal Owner(s) I I i0 ays- TMppli� /I ld/OrAuthodzad.ADeI9. gggf,J. 11121.00n1 DATE ILITmALS LODE* INSPECTION TYPE DAIS MINA 1818 Fixed System Final Fire Prevention _ 206 Final Mechanical _ 1268 Pool Spa Final - -208 .Final Plumbing • ._ t2 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 4 BUILDING DIVISION :11-A „�;-4 DEVELOPMENT SERVICES DEPARTMENT RMIT NUMBER u. Pik . PERMIT �§i.,``� M05-00478 Pomo d' (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 e ;I 1 ; MECHANICAL. PERMIT"..ter :,•r. . • Job Address: 267 E 17TH ST Status: ISSUED Suite No Applied: 08/24/2005 Issued: 08/24/2005 Vicinity: FIRE RAMAGE AREA :<s ..? Tf 1��i 1 Parcel Number: 42522303 • ISSUED BY: /AR A Applicant: DOUGLAS FARNIK V / Address: 6727 S GREENLEAF - / Phone: 562-698-0201 . • WHITTIER,CA Zip: 90601 Owner: SARRAF, KALEB . Address: P O BOX 241586 - - • Phone: ' LOS ANGELES,CA Zip: 90024-9386 ` Contractor:., DOCKSTADERS:GROUP • ' Address: 6727 S GREENLEAF Phone: .562-698-0201 WHITTIER,CA Zip: 90601 License:350935 i 'e SCOPE OF PERMIT „-,. • - MECHANICAL PERMIT FOR FIRE DAMAGE REPAIR. REF#:605-00147 • . WORK TO INCLUDE:1 REPAIR/ALT COOLING/HEAT(15 DUCTS). - 11/15/05:SUPPLEMENTALPERMIT TO ADD 1 COMPRESSOR UP:TO 3 HP/.100K BTU, 1 -COMPRESSOR 3 TO 15 HP/500K BTU . . - - DELETE 1 REPAIR/ALT COOLING/HEAT - ' FEE SUMMARY • 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 $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator . $0.00 0 Refrig Sys>100 k BTU , $0.00 0 . , Compressors/Absorption Systems Gas Piping -• $0.000 Up to 3 hp/.100.k.BTU $14.70 1 Factory Fireplace $0.00 ' 0 3 To 15 hp/500 k BTU . . . $27.15 1 Hood w/Mech Exhaust $0.00 0- 15 To 30 hp/1,000 k BTU' - 50.00 0 VAV Box $0.00 . 0 •: i _ 30 To 50 hp/1,750 k BTU. .$0.00 0 Vent Fan/Single Duct $0,00 0 . Over 50 hp/Over 1,750 BTU ,ii $0.00 0 Appliance - $0.00 0 • Boilers :.sr; '> Fire Dampers $0.00 0 -.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 . 15 to 30 hp t : $0.00 0 Air Handlers< 10000dm ' $0.00 0 30 to 50 hp';L . $0.00 0 Air Handlers> 10000dm $0.00.- 0 - Over 50 hp`+ - ,.-/ $0.00 0 Floor Furnace $0.00 _0 . - --" Other Mechanical Fee Floor or Suspend Heater $0.00 0' 'i - Investigation Fee..- ' $0.00 _'-Plan Check Fee $0.00 - Reinspection Fee $0.00 Tore, re, rn, •ren ecce err ea 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 / 911. 244848 Woo) CV 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. 5,.9phhave 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 Ls Issued. My workers'compensation-Irsuraoa carrier and policy number are: tam'—'4[ N Policy Number: 1gbbS9 2DOC (Tis section nae not be domplateRthe pen-nitis valued at one hundred dollars($100)or less.) C.. ❑ 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these ppristons. _1 rAAppll t;Signature:—" C•--•'X..cD --De l? WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THCYJSAND DOLLARE(51C0.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Ck-x—, Trfcbeigr S� Classs R G2O Contmctors.Signeblre: 5 '�'--•—�-� ' 'A. 3011. CDat 1vie/ 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: 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 then 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 wit 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 Lew 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. 0 Yes 0 No Drivers 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,end 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 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: 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 materiel? 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 feel of compressed gas at standard temperature and pressure). 2 Does or will the apptcant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 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 end 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. .-_ _. _._ __.._..._ __...._D.... 4 If en RMPP is presently required,has Section 25534 of the California Health antl Safety Code been fully complied with? ❑Ves ❑No 5 Doe or..pes..__t_. for..th_._._ok_... tia._.... 5 Does he oro the applicantsu present ar future buildingsoccupant at requirehr for the work whichrois the subject of application eggermlt for such construction or modification from the South Coast Air 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(Dually 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? ❑Yes ❑No __ ...___ o ...clic .�....... _ ...._ .._.__...�._......._.._ ..._..... B (II yes',attach certificate of compliance from the appropriate 61r 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. Signature Of Legal Owner(s) Date ArcrOrAuthoizocmppreft.*•,_. LDTite--� ',,.,,,q SOK f. INSPECTION TYPE QAIe MOAL6 CODFT IffSPFCIION TYPE 22611 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 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 44 BUILDING DIVISION y. .. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER � . j twomblitIVIrt . PERMIT M05-00478 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT - Job Address: 267 E 17TH ST Status: ISSUED Suite No Applied: 08/24/2005 Issued: 08/24/2005 Vicinity: FIRE DAMAGE AREA Parcel Number: 42522303 t/YI/1/-1 ISSUED BY: Y Applicant: DOUGLAS FARNIK Address: 6727 S GREENLEAF - Phone: 562-698-0201 • WHITTIER,CA • Zip: - 90601 - , • • Owner: SARRAF,,KALEB Address: P O.BOX 241586 - - - , ,Phone: - LOS ANGELES,CA Zip: 90024-9386 " • Contractor: DOCKSTADER'S GROUP Address: 6727 S GREENLEAF Phone:„.562-698-0201 • , WHITTIER,CA Zip: , 90601 License:350935 ' - '. SCOPE OF PERMIT - • MECHANICAL PERMIT FOR FIRE DAMAGE REPAIR. . ,REF#:B05-00147 . WORK TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT(15 DUCTS). , FEE SUMMARY ' ' Quantity : - Quantity ISSUE FEE $23.50 Repair/AIt'Absorbtion Unit $0.00 0 Ins(FAU<100 k BTU $0.00 0 _ .- Repair I Alt Refrigeration Unit . ,.. . $0.00 0 Inst FAU>100 k BTU $0.00 • 0:. . _. - .: ''. .: - ,VentillationSystem `, $0.00 " 0 ' Repair/Alt Cooling/Heat $13.70 1:• Evaporative Cooler - $0.00 0 Inst I Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 ' Refrig Sys,100 k BTU $0.00 0 Domestic Incinerator - , $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems - . Gas Piping - $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 - 3 To 15 hp/500 k BTU $0.00 0 Hood w/Meth Exhaust $0.00 0 15 To 30 hp/1,000 k BTU • $0.00 0 VAV Box • $0.00 0 . 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct .. . -$0.00 , 0 - Over 50 hp]Over 1,750 BTU - -, $0.00 0 Appliance $0.00-•;0 ` , Boilers' ' DECLARATIONS °—� - ._ WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate o1 consent to self-Insure for workers'compensation,es prided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑nBove end 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. L.�My workers'compensation insurance carrier and policy number are: Ca errl•`r:� -Ica i Poecy,Numb6 "�i'7,� 6 -.F7 '' —Cd (7his`section not be competed it the permit Is valued at one hundred dollars($100)or less.) in I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should•, ' subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. V 3 0" ..Applicant Sig tureThEa-. � Date: -WINO:FAILURE TO SE« - COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLDYERIO,Op1A9NAL PENALTIES MD dVIL FINES UP TO ONE HUNDRED THOPRAND DOLLARE($J' N ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 31116 OF THE LABOR CODE,INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force anddeffect.',Clc.ii "'Glasse c-�' CD (Contractors gnature: Date:-.se o a 3 cs - I CONSTRUCTION LENDIN •GENCY: ❑ 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: 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(commenting 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-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 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers 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,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 materiel? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be fled 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 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 Flre Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. _..__ ........_ ...__ _.._.....with?. — _ 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 _.._ .__— _. ....ro bu_ require for _ subject __ _.....__ .__i_ 5 Does hr will the ap stcAir ou present ar emen busting o at othr for toe wonk ontch is the age of this zip. estion eppermlt for such construction or modification from the South Coast Air 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). 8 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 ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...__..�_._..._ _.._ Magement t or-agency _ ._ _ __e ._.. 7 If a cation than the South iscast res Descry ed by Heal or nd Sr et po deion control 303 be or Is required for the work which Is the sub)ed of this eppllwtlon,have at of the disclosures prescribed by CaliforniaCelfoia Health and Safety Cade Section 42303 been made? ❑Ves 0 No 8 (I1 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 end 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. Siigg//nna`eal•Owner(s) Date Authdrizetl Applicant S y--Dete_t goon I. gf$PECTIONTYPE PA1E IHI AU SORE( gisPEclleN TYPE PAIS IEWALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 2010" Final Plumbing 200 Final Re-Root F ElecMcel 2W Final Block/Retaining Wall ' 2 FI I Fir cue n 202 Final Factory Fire Place / 20 al Plan in prov 203 Final Sign 22 Final Site 204 Final Demolition 250 Final Building/Occupancy 4 5311 CITY OF COSTA MESA 9 BUILDING DIVISION >;� ,, ", DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �,r/sem PERMIT V5-00409 ettionagro (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.rk,uMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 267 E 17TH ST Status: ISSUED Suite No Applied: 05/25/2005 Issued: 05/25/2005 Vicinity: DENTAL OFFICE Parcel Nunmber: 42522303 Applicant: RICHARD DOUGLAS MOODY 1 Address: 1910 E EDINGER ISSUED BY: Phone: 714-258-0603 _ SANTA ANA CA ``..;;Zip: 92705_ ' ' . s,�. Owner SARRAF, KALEB Address P O BOX 241586 - •" - - Phone LOS'ANGELES;CA • - -'` Zip: 90024 -9388 _: - - Contractor: ISAACS PLUMBING Address: . '1910 E EDINGER • one "714-258-0•9 SANTA ANA CA Zi - 5 cense 4295549> ..a 3' ? P$ _ - - - - .'- - - s' - . - . .. • • SCOPE OF PERMIT • REVISION TO PERMIT ON 08/23/05 TO ADD,6 DENTAL UNITS, 1 ROOF DRAIN;4BAR SINKS AND ' :'.:1.FLOOR SINK s' aPLUMBING PERMITrFOR FIRE DAMAGE REPAIR.._ __ _ - :_"f REF#805-00147x i. - 'f ".` -- '',WORK TO INCLUDE: 1 GAS(1-4 OUTLETS), 1 WASH BASIN, 1 WATER CLOSET(TOILET)AND '• _,WATER HEATERNENT. ` FEE SUMMARY . , , PMT', ; QTY. ] AMT,: QTY • eri ` . AMT- QTY ISSUE FEE 23.50 Laundry Tub/Washer $0.00 • Sump Pump • $0.00 0 Backflow irrigation ' , ' ' •.=• 0 Landscape Irrigation -s. .• e; .0 Swimming eoel - $0.00 0 Backflow Presenter - . $0.00 • - - $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)"x,$0.00 0 Vacuum Brkr Bkflow(1r4) . $0.00 0 Connect(Ice,Soda,etc) $0.00 -.0 Receptors; $0:00. .,A Vacuum Brkr Bkflow(5+) ' $0.00 0 Dental Units - $58.80 " .,'6 •Septic.Tank1 , $0 00 '` 0 Wash Basin •` $9.80 1 Dishwasher $000 "0 ',(Sewer Cap for Demo ;$0.00 0 'Wash Basin Set $0.00 0 Drain,Floor $0.00 0Sewer;Connect ,W$0a0 • 0 ,`,Waste and Vent System. $0.00 0 Drain,Rainwater - $0.00 . = 0 ` Sewer Private Line '` "�5' $0.00,• •0 '' Water Closet(Toilet) ' $9.80 1 Drain,Roof $9:80 "1 ,• • 'Shower. $0.00 ,.- 01;- Water Heater/vent $12.30 1 Drinking Fountain , $0.00' - . 0 Sink;bar''- ,t $39 20:x-4 - Water Piping,(Inst or Rep.) $0.00 0 Expansion Tank $000 `,0" , • Sink,commercial , -,?":_$0.00 - 0 Water Re-pipe` $0.00 0 Gas Earthquake Valve $0.00 0 ': • ,Sink,Floor $9.80.'-,; 1 Water Service $0.00 0 Gas(1-4 outlets) $6.15 -r:1 c Sink,kitchen $0.00:. F0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 '_0 ? "Sink,service/mop $0 00;., •0 ,' ,``OTHER 50.00 Gas Repipe $0.00 0 •• Spa(private) . ,i;;�" _, $0.00'"'' `0 VIOLATION $0.00 Gas Service $0.00 0 ':";"-Spa(public)_ $0 00 - -0 f'5'" PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 '" REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 --- -_ - TOTAL CALCULATED FEES: $179.15 NOTICE: The work authorized by this permit shall comply with all applicabl 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 2446-46(6/00) 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 work,for which this permit Is issued. ,..-..--- 4 -- t❑�1.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'co ensaf n Insurance c e end poll umber are; /,, ,(, -7( / _Carrier;..- ,2ZZ ( hL�7.(//LJ/i/., PdfltyNUmber:4- K/R'V /2 7n2/ C -(Tills section need not be mplefed it the rmlt Is v/f(uedatl/spj hundred dollars($100)or less.) �`--"""""_ 1 ❑ I certify that in the rformance of the work for which th permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and t ' if I should becomes 'ject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provision n `D r. ApplicanfSignal a:“. • i # Dale:'--.. . �( V�` WARNING: F :FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UN FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1W,CCO).IN ADDITION TO THE COST OF COMPENSATIA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions ofCh Chapter Q(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and.effecL.Lic. ._ -. 2 9 `f 9 ,1 Class a C:- —333/F" C\?rector's Sig�ature: f' - 77/de�% Date:a 8-3 _ 1 3-or 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 end 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.It,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 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers 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,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: 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 26505 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 0 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 23534 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 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 hPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No (Section 65050.2 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 thisT 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). _ _ _.-.__ .._ _._.___..ubj....._.__this 7 If a permit-from the South Coast s Qualitycri Management Californiaal or other et pollution control district3 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Galfoie Health and Safety Code Section 42303 been made? 0 Yes 0 No B (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 COMPIJANCE 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 co ply 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-des ribe rty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • attire—OIL I Owner Date //f ��ffJ �'L 3 "03- AncVOrA AppNcant'+y:-4. / C iv ..-r,. CODE I INSPECTION TYPE PATE INTrrIALS CODE I/ 1NSPECTIOHTYPE rrtr. - 1616 Fixed System Final Fire Prevention 206 Final Mechanical ___ , 4 1266, Pool Spa Final ///�� ///�� n. 206' Fintil Plumbing ('" MI' 200 Final Re-R)oo1, //�/'/''�// I f ^A Iiirn .cam (] t1t1 L...-i m Proven tfori 202 Final Factory Fire Place 22 22 FInaPPlanning Approval �li 222 Final Site 203 Fina15ign,� 204 Final Demolition 250 Final Building/Occupancy e ' Y CITY OF COSTA MESA BUILDING DIVISION }? ,, � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4v• I. IPNIII • PERMIT P05-00409 di (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 267 E 17TH ST Status: ISSUED Suite No Applied: 05/25/2005 Issued: 05/25/2005 Vicinity: ((��A � ,^ Parcel Nunmber: 42522303 - - ISSUED BY: Iwl/1 I Applicant: RICHARD DOUGLAS.MOODY - Address: 1910 E EDINGER , •Phone: 714-258-0603 SANTA ANA CA - Zip: 92705-, -. � , %*>/ Owner: SARRAF;.KALEB ' Address P O BOX 241586 Phone:• , LOS ANGELES,CA Zip:• .90024-9386 . - -i / ' . Contractor: ' ISAACS PLUMBING _ Address: 1910 E EDINGER - - ✓ - Phone: 714-258-0603 ' SANTA ANA CA Zip: 92705 License:- 429549 - - • SCOPE OF PERMIT ` • PLUMBING PERMIT FOR FIRE DAMAGE REPAIR. ' • '• REF#B05-00147 -" " " - " - , WORK TO INCLUDE: 1 GAS(1-4 OUTLETS),1 WASH BASIN, 1 WATER CLOSET(TOILET)AND 1 WATER HEATERNENT. _ FEE SUMMARY , AMT QTY - . AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer . $0.00 -,•0 Sump Pump $0.00 0 Backflow irrigation $0.00, . 0 - . ,o Landscape Imgaflon $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 0c .77 . /-Pressure Regulator. . . $0.00 7 0 -;Urinal :7- i ` / $0.00 0 Clarifier System - $0.00 0_ •-,AProcess Piping(per 10 ft) $0:00 0 ` r-,j'%Vacuum Brkr Bkflow(1-4) ' $0.00 0 Connect(Ice,Soda,etc) $0.00 0. , Receptors $0.00 0 Vacuum.Brkr BkflOw(5+) $0.00 0 Dental Units $0.00 . 0 "Septic Tank $0.00 "0." - . ' Wash Basin , - $9.80 1 Dishwasher $0.00 07 - r '.- Sewer Cap for Demo $0.00' 0 ., Wash Basin'Set.- $0.00 0 Drain,Floor $0.00 • ' 0" /Sewer Connect $0.00 .1;0, ._ Wade and Vent System $0.00 0 Drain,Rainwater $0:00 0 - . " Sewer Private Line , - =$0.00c-.0',\', Water"Closet(Toilet) $9.80 1 Drain,Roof $0.06- 0 'Shower ' _ $0.00 r:-0. - Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar , $0.00- - 0 - ,/ Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor " _ , , $0.00 , 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen - $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 • 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 CAW (714)754-5528 244648(6/00) I DECLARATIONS ° t< WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ; - •'1 • • ❑. 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 y,�..// 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 I••vled. My workers'cornensation Insurance carrier and policy number are: ` 77 Carrier: �'.]' 7L/ o/A /t'S• Policy Number: /7)�G 30 -20. (This sect/on need not be completed/I the permit is valued at one hundred dollars($100)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 subject to the workers' • compensation laws of Califon' ree that if I should be subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provis Applicant Signature: Data: S 2 Ste WARNING:FAILURE TO SECURE WO COMPENSATION WVERAG UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOUARE($100,0W).IN ADDITION TO THE COST OF COM TION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under visions of chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lt.N 0291 5-'1`1 Class# 3(0 �- Contractor's Signature: 'y7//i-mac,//6 Date: ,5----z S-n 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,CMI 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.). ❑ 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end 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. 0 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(38)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 end 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). �._......_.._.w._.._. _.-.. .._ _.._._ ____. ___. 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 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). _ ______ _ hazardous a ?_... 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 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No __.bui_ ._...___....._..esubec ...__.._—_._ 5 Does or will the tcAir ou present a future bustling occupant at requirer for the work...Which the subject application ap No for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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). .__ _..__.____.__ —.� .ch.._ _ _._ 6 Will any part of the facility to be constructed untler this permit be within 1000 feet from the outer boundaries of a schod7 0 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 9 (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. Signature,1 Legal ••.red / _ Date ..� _ i.,S 'd1 ,5 -2i3=t An.rOr Au orized ••.pl t Date sou• INSPECTION TYPE �`"PATE" •It�AL$ CODED 'INSPECTION TYPE " -PATE ' g1IIDALS 1816 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa FinalAs 208 incl Plum ' 200 Final Re-Root r• 21 Final EI I ^ • 201 Final Block/Retaining Fir Pia Wall 12 Final Fir ev n f--' • ' 202 Final Factory Fire Place - • 2 Fi omni g Ap oval • 203 Final Sign 22 Final Site 204 Final Demolition 250 Final Building/Occupancy • A Pb0JECTDDRESS:. :01 E 17TH ST UNIT:1 6 CITY OF COSTA MESA - BUILDING PERMIT PERM NO; G, • 047597, OWNER'S ALE:,-PACIFIC EQUITY . ILIDRESS: 1901 AVE OF THE STARS PERMIT NO; G 047597 PLAN CHECK NO: 03969-90 S GOVT: N SUPP : N CENTURY CITY CONSTRUCTION TYPE: PERMIT TYPE: ELE MEC PLU STR PURPOSE: ALT ARCHIENGINEE& 21'3-282-8533 REG.ND.: JOB DESCRIPTION : 1500SF OFFICE T . I . SQ FT: ' 1 , 500' ADDRESS: UNIT: r CLAIM VALUE: 11 , 000 . 00 CALC-VALUE: 15, 180 .00 GROUP OCC: B-2 / PERMITTEE: ORANCO DEVELOPMENT, INC. ( 714 )721-1578 ADDRESS 333 POPPY AV COMMENTS: - • CORONA DEL MAR CA 92625 *******************************************+F***+e************r*****;E************ LICENSED CONTRACTOR DECLARATION: I hereby affirm that l am licensed under provisions of Chapter 9(commencing with Section 2 ON ING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETH ACK S ClrruC.:/0� 39666 STATE uW' 35959 $� , / Date:_La 39666 Signature: Vd.�4-/�-� MAIN BUILDING ACCESSORY BUILDING _ WORKERS'COMPENSATION DECLARATID : 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 MOO,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PouCYNo.: 152615-89 EXP.DATE: 06/01 /91 COMPANY: STATE FUND PARKING REQ; PROV: PARCEL : 42522303 ZNE: CIS REF NO: 0 Certified-copy Is hereby furnished. 2 Certified c is filed with the city Batting Division. PLANNING NOTES> INT ALT TO AN' EXISTING RETAIL SUITE WITH NO ADDITIONAL > SUARE FOOTAGE ADDED; ' Date 1:=`t-5v (Applicant: � Y *****************g*****************************‘******************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Dissection need not be complet the permit Ls for one hundred($100)or less). DEVEL O P'. M E N "T S- E R 'V, I C E S , R E Q U I R E M E N ,T S I certify that in the performance of the work for which this permit is issued,I shall not employ y person in any manner so as to become subject tolheWorkers'Compensation Laws of California. ZONING APPROVED BY • : '/` - - SGC_ ' DATE: 6.- r ° Date: Signature: NOTICE:lf,after nuking 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 perms shall be deemed revoked. „, e . - ll rr CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED _BY: r DATE: .r 4r' j� which this permit oissued(Section 3097,Civ.C). 6. ******************************** - ***** **yFBF�f********************* *****iF if*** LENDER: ' *********************************ie'********************************************* ' ADDRESS: LEGALIZATION:N F E 'E '.S U. M, M A R1) Y STRUCTURAL SEGMENT:Y 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 �' MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any dry of county which requires a permit to construct,alter,improve,demolish,or PERMIT 171 . 00 10 , 00 3 0 .0 0 - 1 8 . 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 25* 50 Z''y '2"5 'SNIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section-7831.5 by PLAN 111 . 15 2 . 28 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 . 00 '1 5 . 0 0.-, 15-.60 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 ❑ tructure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 231 . 28 33 . 00 11V. 15 ' 375 . 43 375 . 43 .00 does not apply to an owner of a property who builds or improves thereon,and who does such work himsel/herself or through -1 his or her awn employees,provided that such improvements are not Intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: •264 . 28 OVER/SHORT: .00 for ttheepurpose sold e)hin one year of completion,the owner will have the burden of proving he/she did not build or Improve BLDG PMT PLUMBING ELECTRIC MECHANIC F RE SMI P/TOT GRADING PLAN-CHECK I,as owner of the propertyam exclusively contracting with licensed contractors to construct the project(Section 7044,Business 171 . 00 13 . 00 45 . 00 ... . 33 . 00 :- _ 2 . 28 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly 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 ************************************* **3e,****.******************************** that proof-of their Worker's Compensation insurance should be provided to me. _ INDIV I • UA 'F rE E --13-111 E A DOWN ❑ I am exempt under Section: B.&P.C. r I- for this reason: TYPE QTY D E S C R I • - I O N' ...: 2,1 ;c UNIT COST TOTAL COST Date: • Owneri ' SFC 1500 OFF-INT, ALTER TYPEV r -AVER 10 . 12 15, 180 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 19 FIXTURES LI GH -I NG_! ST-20 - EA, .75 14 , 25 25534 and that I or any future building occupant wilVwill 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 ELE 7 R EC E P T/OUTLET - 1 ST 2 0y EA. . 75 5 . 25 these provisions. ELE 2 RECEPT/SWITCH 1 ST 20 k ./.... EA. . 75 1 , 50 ELE 3 MOTOR/POWR APPAR•TUS 0% 0 ,- ;-'1!0 HP 3 . 00 9 .00 Date: Applicant MEC 2 RELO FORC-AIR/GRA, -FURN' ;<=.'/1001 ,K BTU 9 . 00 18 . 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 coup P L U 1 WATER RE-PIPE ' '-'' ,_y' 2 . 00 2 .00 ordinances and state laws relating to building c nstruction and hereby authorize representatives of this city to enter upon the above.mention PLU 2 WASH BASIN ' , - .sv 2 . 00 4 . 0 0 properyfor inspecuonpumoses. • c \ PLU 1 WATER CLOSET (TOILE ) 2 . 00 2 . 00 'I qv 1 \ Ts �'�- PLU 1 WATER HEATER AND/OR ENT.,, 2 . 00 ' 2 . 00 Date: /r4 1 Signature: 1v -\ END OF FEES 01 O002376- 006T380 T0T T64 ^$ 1 Driver's License or Social Security N: 7 DATE 06/04/90 TIDE: ` 1641-46 White-Building:Green-Code Enforcement;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor ,•Jg e CONSTRUCTION AND PLANNING • POL., & SPA •APPROVALS .Permit# Date Inspector APPROVALS Permit Date Inspector t 1 7. Temporary Electrical Service or Pole . 52. Pool & Equipment Location . Soil Pipe-Und .�egrnd. .: 53. Steel Reinforcement � - E. 2. Soil Conduit Utility-Undrgrnd. - 54. Forms 4'. Electrical Conduit-Undrgrnd. "- : 55. Electrical Bonding 5+'Steel Reinforcement. - 56. Rough Plumbing & Pressure Test • - '6.CElectrical UFER Gfnd. 57. APPROVAL TO COVER-GUNITE '`7: Footings _ - 58. Electrical Conduit-Undrgrnd. 8.•Foundation •- 59. Gas Pipe, 0 Undrgrnd.,Test 9.:Water Pipe-Undigrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. - 10.1Structural Floor System 61. APPROVAL TO DECK '‘ • 11. Property Sewer-Line`& Houseponnection i - 62. Backwash & Receptor•Final 12. Sewer Cap - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing see yore 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final • , • .16. Rough Electric Wiring67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' 18. Rough Electrical:T Bar Ceiling 6 gip tQ 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, Ventilaiting: : - • 71. Product Piping 0 Gas 0 Oil . 23.-Gas:Pipe.9ou6h &Test , . ` Y 72. Underground Flush . 24. Roof Framing' ' '_ - " - 7. , _ 73. Undergrnd.Storage-Tank O Gas O Oil -- - - • - 25. Roof,Sheathing _ } -74. Overhead Hydro 26.'-T-Bar Ceiling (Structural) & Monocoat 75. Dr'y Chemical . 27-,Frame and Flashing. - - - (0/7/TO '- ,jQ-- 76. Dry Standpipe • -. • _ ^28. Lathing& Siding ' : ^ •• 77.-FIXED SYSTEM:FINAL . -- .... 9. Insulation -. , - . • , • • 78.;'FIRE PREY. FINAL •• - '30. Drywall Nailing (9070 at ' HEALTHtEPT. REQUIREMENT _ . 31. Plaster Brown Coat _, - "'""" : t79. FINAL INSPECTION . _ 32:Electrical Power Meter-Final : •' 80. FOOD CERTIFICATE ISSUED ' :33. Final,Electric - -4,44 `iiiNotes: (�-S-qo (. ets,2,4 _-044 so63EGq-n5 444{.Vl�- '34. Final Heating & Air?Conditioning' ./ /,, , 5-' _. 1/IE✓PJ'� i`16T+2[.�iR`l'�O�'I- .C,rE.(J 35. Final'GasPipe:Test; - ..-:\ - , ../ . . / 'iiia- -0 36. Hood or Canopy .. - - '6 .a /40 Ti.-' .4 '1 37. Final,Factory Fireplace .._ - [( �� /� 38.=Finay:Plumbing _ 1121506 / • : lic�'r/ ,i(/ �' - ` (.o J7Ad 39.(Water Service-Final' - om' . 40. Gas Service-Final : - . - • r I. .. 41.-Solar Domestic-Final • - , ' , 42. Backflow Preventer- - - - • • 43. Backflow ' :,; - - - . . .•- - . . • - Irrigation 44. Landscape Irrigation System- - - C • - :. - -' - - -45. Sound Attenuation - . • 46.'Handicap Regulations .y A7.=FINALSTRUCTURE & BUILDING _ i-i' ; . ct - - - (/ - 48.-FINAL PLANNING • - - - 49. Electric Release to Edison - " ' .. 50. Gas Release to Southern California Gas Co ' . ' i .51. CERTIFICATE OF OCCUPANCY . - No. Date PROJECT ADDRESS: 267 E 17TH ST UNIT: CITY OF COSTA MESA — SIGN PERMIT PERM NO: SB 0502 /1 1 — OWNER'S NAME: BEAUCHAMP 6 BROWN ADDRESS: 259 EAST 17TH ST PERMIT NO: SB 050271 PLAN CHECK NO: 07121-90 S GOVT; N SUPP: N ASSOCIATES 1901 AVE OF STARS #95 CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH LOS ANGELES,CA 90067 ARCr7/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL 16 . 5SF TEMP NONLUMINATED SIGN SQ FT: • ADDRESS: UNIT: CLAIM VALUE: 350. 00 CALC—VALUE: 350 ,00 GROUP OCC: B-2 / I PERMITTEE: SIGN STUDIOS ( 213) 988-1841 ADDRESS: 851 E WILLOW ST COMMENTS: X SIGNAL HILL CA 90807 ******Sr*************Se***+ *** *************+F****************Srr**+r****+E********** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed oder provisions of Chapter 9(commencing with Section S IGN , INFORMAT IO N 7000)of Division 33rooff the^Business and Professions Code.and my I e is in I I force and effect. DISTRICT: 1 TYPE: WALL ILLUMINATION: NON CATEGORY: NEW CITY LIC.: 046�O 2q STATELIC.:5680 8 LA'S: 4 '` / DIMENSIONS: 3FT 00IN X 5FT 06IN AREA: 16 , 505QQFT LETTER HT: 10 IN Date: 7)pi�Jl/7/J�Q_ Signature:` ( STREET FRONTAGE 1 : 155. 00 STREET 1 • E 17TH ST WORKERS'COM NSATI N DECLARATION: I hereby affirm t . have a certificate r consent to self- tine ora certificate of Workers' STREET FRONTAGE 2 • 0. 00 STREET 2 Compensation lnsraaceq(3r5,nihed copy thereof(Section •r.Lab.f� II PARCEL: 42522301 ZONE: C1S LOCATION > FRONT: X REAR: POLICY NO.: 11 tl4 LL7 E%P.GATE: 83/01 /91 BUSINESS NAME: MESA DENTAL CENTER > LEFT: RIGHT: OMPAxr: STATE Ali O T H E R T O T A L S G R O U N D S I G N u Cenilietlcopy cheryfurnished. C19 Certifietic`li'w�the.ilq: iltlingDivision. / THIS ACTIVITY 16 , 5OSQFT OVERALL HEIGHT: OFT 0IN I . !/ THIS SITE : 99 , 00SQFT GROUND CLEARANCE: OFT OIN Date: L lb Applicant: ITEMS OF INFO : 1 PLANTER AREA: 0 , OOSQFT EXEMPTIONI FRO WORK+•S'COMPENSATION DECLARATION: (Thi\.ction need not be co pleted if the p' it is for one hundred($100)or less). ITEMS FOR ACTIVITY: 1 BLDG SET BACK: 20FT I certify that in the performance of the work for which this permit sued.I shall not employ any pe/n in any manner so as to become COPY VERBIAGE , MESA DENTAL C ENTER subject to the Workers'Compensation Laws of California. Date: Signature: ' PLANNING NOTES. TEMP SIGNAGE ONLY, NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor *****************************************************************'**'*'*********** Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. DEVELOPMENT SERVICES R E Q U I R E M E N ST. S 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). • ZONING APPROVED BY SCC,— DATE: 1 L/( 7 /i. LENDER: ( ADDRESS: BUILDING APPROVED BY : _ DATE: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED B Y• a 6 DATE: �/T I (Section 7031.5 Business and Professional Code; 'Any city of county which requires a permit to construct,alter,improve.demolish,or ********************** . ********{F*J2 LL 7e *** repair any structure.prior to its issuance.also requires the applicant far such permit to file a signed statement that he/she is licensed LEGALIZATION:N F 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 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 live hundred dollars($500). BLDG PMT PLUMB I t.- ELECTRIC MECHAN SIGN SMTP/RES GRADING I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the PERMIT 15. 00 16 , 50 ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law SHIP/NON—RES does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through PLAN 9 . 75 • 50 his or her own employees, provided that such improvements are not intended or offered for sale.II,however the building or ISSUE FEE improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for purposeol sale). BUILDING—DIV—> PERMIT ISSU —CHECK TOTAL PAID DUE I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business TOTALS----> 3 2 , 00 0, 0 0 r 9 . 75 41 , 7 5, 41 . 75 , 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 REVENUE DIVISION TOTALS--> C• LECTED• 41 . 75 OVER/SHORT: .00 that proof of their Worker's Compensation insurance should be provided to me. BLDG PMT PLUMBING ELECTRIC CHAN IC SIGN SMIP/TOT GRADING PLAN—CHECK ❑ I am exempt under Section: B.a P.C. 15 . 00 16. 50 . 50 9 . 75 for this reason: ************************************ ****************************************** Date: owner: _ • INDIVIDUAL 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 N UNIT COST TOTAL COST permit for construction or modification from the Air uallty Management District.Residential construction applications are exempt from these provisions. NO FEES WERE SELECTED .FOR THIS PERMIT Date: Applicant: I hereby certify that I have read this application and state that the ab;information is correct.I agree to c. ply with all city and county ordinances and state aws re ting to building ruck),and hereby, Drize re resentatives of this city to' ter upon the above-mentioned property for insppeec$on pu oases. ` / Date:�ly I 'L '^� Signature` —�� _ `\.�.� J O1 0007b051-00078064 �tip'� +1.7J Driver's Licenselhr Social Security x: . 1 DRTE 12/12/90 T1�rE: 12:42 1641-46 While—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor t! CONSTRUCTION AND PLANNING % P0% SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd• c•r - 53. Steel Reinforcement - .3'.'Electrieal Conduit Utility-Undrgrnd.'•' 54. Forms _ :,4:'Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding rr , ' 55 'Steel..Reinforcerimentr 56. Rough Plumbing & Pressure Test .' . -6.. Electrical UFER Grnd. +' 57. APPROVAL TO COVER•GUNITE 7.,1Footings '•'_ 58. Electrical Conduit-Undrgrnd. - 8: Foundation - _. 59. Gas Pipe, 0 Undrgrnd., Test ' L Water Pipe-Undrgrnd. ' -. 60. Backwash Lines, P-Trap, 0 Undrgrnd. - r.10. Structural Floor System - I _ _ J 61. APPROVAL TO DECK - 11. Property Sewer Line& House Connection. 62. Backwash & Receptor-Final - 12. Sewer.Cap Z -, la <1 63. Heater & Vent•Final - 13. Roof Drains . ` 64. Plumbing System • Final 14. Rough Plumbing r 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 Factd2' F replace, 5 '-,R :9,_ C •K APPROVALS 'il• Permit # T - 21.:Dudt's, in Structure . u,-. r, :-•+; .. : ;'i"'_ a ::70. -Underground Hydro : 'C 22. Ducts, Ventilating : 1" T, •'ti - rr_ i. '71•.jProduct Piping 0 Gas' 0 Oil , 23. Gas Pipe'Rou h &lest "'\' `''` dr•: r, •- 9 c o:.S - a� 42.-Underground Flush _ : 24:',Roof Framing 4. .... • ' .- - 1' = O ?73. Undergrhd.Storage-Tank OGas COid 25. Rodf,Sheathing , „- - _ :74. Overhead Hydro - 26.-T-Bar Ceiling (Structural). & Monocoat y5, _ y 75;`_Dry Chemical _ , - - 27:Frame and Flashing,, _'! ' ' - '• .` - • •• ..• >76:,Dry Stand Pipe , 28lLathing & Siding •• .S t� '- - cr- 5' •77•••FIXED'SYSTEM FINAL -• 29. Insulation `. , n ::r -_,;.` SI 78. EIRE PREV. FINAL i. A 30. Drywall Nailing - • "t _ I I {. HEALTH}DEPT. REQUIREMENT r • `�31. Plaster Brown Coat,, ' . '•• "'- < j 79. 4JNAL'fNSPECTION: ; - , 32.,ElectricalPower Meter-Final r-r _ 80. FOOD CERTIFICATE ISSUED • •.33.rFinal Electric _ ` •t ' i F. I Notes: , >344-Final Heating.& Air.Conditioning ' -' j k, r 35.-'Final Gas Pipe-Test`' tr• ' '• Y I •. 36. Hood or:canopy 4- .. .. (. ;; - - 37.,Final Factory Fireplace m '` - <38,Final Plumbing • •• - .c -, T ._ .. 14I • -39:Water Service-Final" - i. - = _ •z - - - f X40. Gas•Service-Final .r , •.j 4 .- , r, , - -41::Solar Domestic-Final j' "' '% ' -S' -. - - :r c I i :v _-_ - O. 42.'Backflow Preventer, r •„ r- �'ii•1. `U-'- j 1 1, - . 7t 7. ' 43. Backflow Irrigation: r":,. ,'z--c , � 0.7. . �' c' '44. Landscape Irrigation System• r�,.:;•.. .j � •T . ,r. - - _. 7 sd_ / ;45.-Sound Attenuation '( ` '-•" I : . - - • : -z- - / ..L' Ot '' "1. , ',� .46.•Handicap Regulations 11 • ''''_*-:,"5.; q '`' •• v ', .1; -- - 7 47.:FINALSTRUCTURE &BUILDING ir - l .` i- - 31' YC t/I_N l .1 c .? , - v % '48.''FINALPLANNING, 1 i ,t, . 49. Electric Release to Edison 5 ._ - ' - - C50.,Gas-Release to Southern California Gas Co .1 1 ' t. - , c.),:.., , '.51. CERTIFICATEOF.000UPANCY k--\ No Date PROJECT ADDRESS: 267 E 17TH ST UNIT' CITY OF COSTA MESA - SIGN PERMIT PERM NO: SBE 051638 OWNER'S NAME: BEAUCHAMP 6 BROWN ADDRESS: 259 EAST 17TH ST PERMIT NO: SBE 051638 PLAN CHECK NO: 01231-91 S GOVT: N SUPP: N ASSOCIATES 1901 AVE OF STARS #950 CONSTRUCTION TYPE; PERMIT TYPE: ELE STR SIG PURPOSE: OTH LOS ANGELES, CA 90067 ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL ONE ILLUMINATED WALL SIGN SQ FT: ADDRESS: UNIT: CLAIM VALUE: 2, 300 . 00 CALL-VALUE: 2, 300 . 00 GROUP OCC: B-2 / PERMITTEE: SPECTRUM ELECTRIC ( 714 ) 556-9900 ADDRESS: 2501 S . BIRCH COMMENTS: * • • SANTA ANA CA 92707 +r****if+E*rec+t*+t**sL**T6-KM*x•*KM****•Kai*+6********** ** ****T6**a*TOa:*a(i+c*KN*******k+r•Tr*keM LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(c mencing with Section SIGN INFORMATION 7000)01 Division 3 of the Business and Professions Code.and my license is in fon force and effect. DISTRICT: 1 TYPE• CHANNEL LETTERS ILLUMINATION: INT CATEGORY: NEW -ITVYLIC.: 051575 STATE LIC.:542190 DALqS-r. �;45/1/,• a, DIMENSIONS: 11FT 06IN X 2FT OOIN AREA: 14 . 505 FT LETTER HT: 12 ,e: ii--/ 0-- 9/ Signature:_ _ ! L, vc' ��/ STREET FRONTAGE 1 : 155 . 00 STREET 1 ; E 17TH ST IWORKERS'COMPENSATION DECLARATION: I hereby affi T have acenificate of consent to self-insure or a certificate of Workers' STREET FRONTAGE 2 : 0 . 00 STREET 2 : Compensation Insurance.or a certified copy thereat(Section 3 ,Lab.Cl. PARCEL: 42522303 ZONE: C 1-S LOCATION > FRONT: X REAR: i POLICY NO.: EX DATE: BUSINESS NAME: MESA DENTAL CENTER > LEFT: RIGHT: "OMPANY: OTHER TOTALS GROUND SIGN I Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. THIS ACTIVITY 14 , 505 FT OVERALL HEIGHT: OFT OIN THIS SITE 150 , OOSQFT - GROUND CLEARANCE: OFT OIN Date: Applicant: ITEMS OF INFO : 1 PLANTER AREA; 0 . 00SQFT EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This• need not be oampleted it the tis for one hlndred(StW)or less). ITEMS FOR ACTIVITY: 3 - BLDG SET BACK: 20FT ' I certify that in the performance of the work for which this perm, d.I shall not employ any o in any niter as to become COPY VERBIAGE : MESA DENTAL CENTER subject to the Workers'Compensation Laws of California. ♦ , Date: =/_O — g,9 Signature: e'Oix `g, C/v'e-+` '��L+-Y/`--' PLANNING NOTES• NOTICE:II.alter makin fes declaration,you shouldbecot subject to the Workers'Compensation provisionsol the Labor *********9r*w'********'**************:*******.***T(***************+e***icif****•x******** Code.you must forthwith comply with such provisions oris permit shall be deemed revoked. D E V E L OP M E N T S E" R V I C E S R EQU I R EM E N T S CONSTRUCTION LENDING AGENCY: I hereby affirm that th s a construction lending agency for the performance of the work for J which this permit is issued(Section 3097,Civ.Cl. ZONING APPROVED BY C_-t-.. DATE; �(\I C// _ LENDER: _ ,�`� v ADDRESS BUILDING APPROVED BY :_ 10 __ DATE; .//O/ OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED B Y: ` 4 f , i — DATE: (Section 7031.5 Business and Professional Code: Any cityot countywrdch requires a permit to construct.alter.improve,demolish.or *.*********************fix *ix'** . .*r ^ • **********'***ai*****x** "pair any structure.prior to its issuance,also requires the applicant for such permit to lite a signed statement that he/she is licensed rsuant to the provisionsol the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 a1 the Business LEGAL I ZA T I ON:N F E E. S U M M, R Y STRUCTURAL SEGMENT:Y .d Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My 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(SSW). BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SM I P/RES GRADING I. as owner o1 the property or my employees with wages as their sole compensation, win do the work, and the PERMIT 54 . 00 1 S , 00 14 , 50 I ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law SOF SM I P/NON-RES does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through PLAN3 5 . 10 . 50 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 win have the burden of proving he/she did not build or improve ISSUE FEE - 1 5 00 for the purpose 01 sale). BUILDING-DIV-> PERMIT ''rJ E PLAN-CHECK TOTAL PAID DUE I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business TO"PALS----> 4 : 00 15 . 00 35 . 10 134 , 10 134 . 10 . 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 REVENUE DIVISION T C TALS--> COLLECT 134 . 10 OVER/SHORT: . 00 Mat of exempt Sectio'sCompensation msuraoceshould beprovided tome. BLDG PMT PLUM ING ELECTRIC MF_ NIC SIGN SM1P/TOT GRADING PLAN-CHECK ❑ I am enempl uMer Section: B. 8 P.C. 54 , 00 30 , 0 14 . 50 . 50 35. 10 Mr this reason: Date: Owner I N D - IDUAL FEE 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 wilt/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or moddication Iron the Air Quality Management District.Residential construction applications are exempt from TYPE QTY D E S : R I P T I O N UNIT COST TOTAL COST these provisions. ELE 1 SIGN/ 0 TLINE LIGHT SYS ON 1 BR CIRC 15 . 00 15 . 00 Date: Applicant: END OF FEES I hereby certify that!have read this application and state that I• above' ormation is correct.I agre o comply wit all city and county . ordinances and state laws relating to building construction and reby au rile re ..sentatives of this yto ter upory�e ab ye-mentioned T,j^p property for inspection purposes. r // .�� // � ., 6 L -0+831'8u"C1F4343 'IC-,15:31 ; r; 1 r_ L14- a . (.1 LIZ _/ DATE: U4/11/n1 Tint: :5;, _ Date:Y4-! O� (_` Signature: Drivers License or Social Security n: • 1641.46 White—Building:Green—Code Enforcement, nary—Applicant Pink—Revenue:Goldenrod—Assessor • CONSTRUCTION AND PL, ANG PO. a 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. - B. Foundation .r 59. Gas Pipe,0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, E Undrgrnd. 1 f 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 E 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' 33• Final Electric 5(�, trod S Notgc,. 7 7 Qw6_ 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. Backf low Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations . - 47. FINAL STRUCTURE & BUILDING 572/.14( 6j.c1 48. FINAL PLANNING - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date PROJECT ADDRESS: 267 E 17TH ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; M 069131 OWNER'SNAME: 259 EAST 17TH ST ADDRESS: ASSOCIATES PERMIT NO; M 069131 PLAN CHECK NO; N GOVT: N SUPP : N 1901 AVE OF STARS #95 LOS ANGELES, CA 90067 CONSTRUCTION TYPE; PERMIT TYPE ; MEC PURPOSE; OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : CONST. WOOD ENCLOSURE FOR COMPRESSOR SQ FT; ADDRESS: UNIT: CLAIM VALUE: CALC-VALUE: GROUP OCC ; B-2 / PERMITTEE: J R CONSTRUCTION (714 ) 641-7448 ADDRESS: 3218 OREGON AV COMMENTS : REF: B-69129 COSTA MESA CA 92626 *N-#********-N-****FF+ri*****->E*DL*>f+r-x-*+r*****-F**>F+r-N*********FF*****->E******ar**FE*TF*Fr-x+F** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provision of Chapter 9(commencing with Section ZONING R E Q U I R E M E N T S 7000)of Division 3 of the Business and Professions Code.and my license is in full force eft C SETBACKS CIT IC.: 037981 STAV LIG.: 485367 g , • B XP : 03/95 /9 _i _q•C , ¶� . MAIN BUILDING ACCESSORY BUILDING s, F Signature: -� FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN r .• KERS'COMPENSATION DECLARATION: (hereby affiant /r e1 enifi Ie of consent to selhinsure or a certificate of Workers' LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN Compensation q�pr�p.certifie coy thereof(Section :00,L."C. V /�06.�b �J$ v1 /01 /95 POLICY NO.: EXP.DATE: COMPAxr: STATE FUNDPARKING REQ: PROV; PARCEL: 42522303 ZNE; REF NO: ❑ Certified copy is hereby furnished. Q Certified copy' - d wi• the city 9 ion. PLANNING NOTES> /RvaJr{,/1�� Applicant: C /• . Ace *********************f!**************#***************1f************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION' (Th;� gneed not be completed ifthe permit i for one hundred MOO)or less). DEVELOPMENT SERIVICES REQUIREMENTS I certify that in the performance of the work for which thi erm's issued.I shalt not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY - DATE; Date: Signature: BUILDING APPROVED BY : NOTICE:It.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor DATE ; Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. _ �+C , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; ' —`1 A: DATE; /J / y which this permit is issued(Section 3097.Civ.C). ********************** 0• * *"*' ' ' • ' . ' ' ********** r.. 4 * LENDER: ADDRESS: LEGALIZATION; N F E E SUMMARY STRUCTURAL SEGMENT;N OWNER BUILDER DECLARATION: I hereby affirm that I 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 16 . 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 25% 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 and Professions Cote)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). ISSUE FEE 15 . 00 I, as owner of me property or my employees with wages as their sole compensation, win 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'Stale License Law TOTALS----> 1 6 . 5 0 1 5 , 00 0 , 00 3 1 , 5 0 31 . 50 0 0 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.If,however the building or REVENUE DIVISION TOTALS--> C T_" cCTED • --31 . 50 OVER/SHORT: 00 orthe purpose offsale).improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMB NG ELE - IC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK Ior I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 31 . 50 ❑ and Professions Code: The projects state License Law does not apply to an owner of property who builds Law).oves thereon ******************* * ********************************************************* and who contracts for such protects with a econtractor(s)license pursuant to the Contractors'state License I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E :- R E A K D O W N ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY D E S RIPTIO UNIT COST TOTAL COST Date: Owner: MEC 1INST/RE BOIL/ % PR 3 , 1 - 15 , 0 HP 16 . 50 16 , 50 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 wit/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 . these provisions, / Date: Applicant: 'i i v// I hereby certify that I have read this application and state that the above information is corre__f ...i.e to comply with all city and county n ordinances and state laws relating to building construction and her. author2 eptesentatit.. I ity to enter upon the above.mentioned • pro • ler inspection purposes. 01 00168965-00168965 TOT 31.50 ,} �• �,_ DATE: 10/05/94 TIME: 09:48 (V - C- 7 Y Signature: / .4 i IMO) Driver's License or Social Security x: 1641.46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor r CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Servicebr Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnde. 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, O 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 1 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 Electric �� Notes: 34. Final Heating& Air Conditioning � q G� ,� ^y/ / l 1=3�i �31� 3= L CL6�r` 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 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date PROJECT ADDRESS: 267 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 070978 OWNER'S NAME: 259 EAST 17TH ST ADDRESS: ASSOCIATES PERMIT NO; P 070978 PLAN CHECK NO: N GOVT; N SUPP : N 1901 AVE OF STARS #95 LOS ANGELES,CA 90067 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH MCN/ENGINEER: REG.NO.: JOB DESCRIPTION INSTALL 2" BACKFLOW & EXPANSION TANK SQ FT: ADDRESS: UNIT: CLAIM VALUE; CALC—VALUE; GROUP OCC : B-2 / PERMITTEE: ROBERT MYERS ( 714 ) 645-2689 ADDRESS: 2284 RUTGERS COMMENTS : 2" BACKFLOW & EXPANSION TANK C .M. CA 92626 *+Fix****+.+F+«+t+er+r+rar+ ********atr***r******* *********x*****+t*+t+t*+r*it*irar*a*** ******* LICENSED CONTRACTOR DECLARATION: I hereby atlirm that I am licensed under provisions of Chapter 9(commencing with Section Z 0 N I N GS E RT EB QA UC IK RS E M E N T S 7000)of Division 3 of the Bu ess and Prolessions Code.and my license i n full force and effect. Ever(Ic:�S�j�lljfr^rE�'c'669867 •ss ' E. • 11 /95 ata: _/�dl L 16 �j Signature: MAIN BUILDING ACCESSORY BUILDING KERS'COM ENSATION DECLARATION: I hereby affirm that I have a ce • ate of cons: tto self-insure or a certificate of Workers' FR NT; 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 AGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ PROV; PARCEL : 42522303 ZNE; REF NO; ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant' **************************************************if**************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Ops section need not be competed it the permit is for one : - IDD)or less). D E V E L O P M E N T S E R V I C E S 1k E Q U I R E M E N T S terrify that in th•pertor ance of the work for which this permit is issued.I shall not employ any person .neer so as to become ,. s ij to the V. ers'r,per ion Laws of California. ZONING APPROVED BY . DATE: • tam Signature: -TICS: f.atter making this declaration.you should become subje o the orkers'Compensation provisions of the Labor BUILDING APPROVED BY : •:"` DATE: Code.you must forthwith comply with such provisions or this p' it shal •e deemed revoked. 4 r CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a •r ' Lion lending agency for the performance of the work for APPLICATION ISSUED BY ; (�") DATE which this permit is issued(Section 3097.Civ.C). ***************************************le•1E LENDER: ************************************************************************ *** ** 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 MECHANI FIRE SMIP/RES GRADING (Section 7031.5 Business and Processional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 12 . 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 25% I 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($500). ISSUE FEE 20,00 I. as owner al the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE LAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale)Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 12 . 00 20 . 00 0 . 00 32 . 00 32 . 00 . 00 does not apply to an owner of a progeny who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for safe. If,however the building or improvement tpmeepurpose of saehm one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE LDGV PMTO PLUMBING ELECTRICOM CHANL DIC RE SMIPO/TOT/$HORT; ,00 GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 32 . 00 El and Professions Code: The Contractors'State License Law does not apply to an owner of propertywho 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 N D I V I 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 R I P T I O N UNIT COST TOTAL COST Date: anal • PLU 1 FIXTURE SET/TRAP W/PIPI G & BACKFLOW 7 . 00 7 . 00 l do hereby certify that lam aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and PLU 1 VACUUM B RKR/BACKFLOW PRO 1 TO 4 5 . 00 5 . 00 25534 and that I or any future building occupant wilWwill not(circle one)need to comply with said state codes and the requirements for a permit for construction of modification from the Air Duality Management District.Residential construction applications are exempt from END OF • EES these provisions. Date: Applicant: .1 I hereby certify that I have read this application and state that the above information is correct.I agree to com•l .1• 'ty and county r ordinances and'ate la relating to building construction and hereby authorize representatives of th . 'r upon the above-mentioned 01 00176011-00176011 TOT 32.00 property for inp• tion lir oses. DATE• 02/02/95 TIME: 11:43 Igil C Signature: /_ a fiver's Lice se or Social Security a: 1641-46 White—Building:Green—Code Entorcement;Canary—App • ;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 Condtiit-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, ❑ 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. Hough Factory FirePlace - ' APPROVALS - Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas 0O,I 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framingt 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: 2_L -1c NOT 12. O' ' <1 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 L 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 & BUILDING 48. FINAL PLANNING - _ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . - - - • - 51. CERTIFICATE OF OCCUPANCY - No. Date