HomeMy WebLinkAbout269 17TH ST - Building Permits�
PflOJECT ADOHE55: 2 E) y E 17TH J�' T
OWNEfl'SNAME: PAC EQUITY PROP
aooeess: SAME
pNCHIENGINEEN:
ADONESS:
XEG.NO.:
UNIT:
I1NIT:
� PEflMITTEE: SIGN STUDIOS ( 213 ) 988-1941
nooness: 851 E WZLLOW ST
SIGNAL HILL CA 90807
LICENSEO CONTNACTOH OECIABATION: I hereGy allirm t�at I am I e0 unEer pmvisions ol Cnapter 9(connnencing with Seclion
7000� of Division 3 0l Ihe Business antl PmlessiGans Code. ana my li e se is in iull larce anE e��ect. '
cirr uc.: 0 4 6 2 2�/ TA7E UC.:� 8 0 cuss 5 /
�aie: 7.(/ Signamre: _ — — — — — —
WOHNEeS'COMP SRTIONDECLAqpTION: I�ereOyaffirm� tlluveacertilirateol nsenitosell-i reoracenificateoiWorkers'
Camoenution I�s�x�e4 e� ��'u�iea wov mereoi ISectim . Oo. �ao. � 3/ O 1/ 91
eoucr no.: STATE E%P. OAiE:
COMPFNY:
❑ Cenilietl copy is here Iumishe0. � C lietl capy is lit vith t e it Builtling �ivision.
Oa�e: � � �' ApDiicani:
E%EMPTION Ffl0 WOBK 5' COMPEp$pTiON OECIAMTION: (' Stttron n¢¢G not tOmqEt¢E il I� ertni is lor ale hUMr¢d �5100) ai l 5).
II cenity that in ihe Dehormance ol ine work tor wnicn inis permi is Rsuee, I s�all n t empl0y alry rsan in any manner so as lo Oecome
su�leq to I�e Worker5' Campen5atibn LaxS o� Califamia.
, Date: Signamre:
NOi1LE: 1�. al�er makinp INS apGamiion, you S�oulU G¢come Su01ec1 to I�e Work¢rs' Compen5ati0n pmvi5ion5 0� I�e Labor
Coae. you mus� fart�w�N comply wit� suc� Omvisions or �N5 permil shall Ee a¢eme0 revokeG.
CONSTBULTION LENDING pGENCY: I hereEy allirm inal tnere is a wnstmaian lentlinp aAency for ihe performance of the work for
whicn Inis permi� is issued (Section 3W7, Gv. C).
LENOEfl:
AODHESS:
OWNEP 6ULLOEB OECIABRTION: I �ereDy atlirm tlut 1 am eKemD� ��om I�e Contnctors' State Lkense Law lor t�e followinA �eason
�Seclbn 7031.5 Business an0 Profe4sional CoOe: Any ciiy o� wumy whKh repuires a p¢rmll to wnsiruct, alter, impmve, tlemolish, or
reoair any sirutture, prior lo its issuance. als0 reqVires Ihe appliWnt tar suCh Oermit to lile a signe0 statement Ihat he/she is Iicense0
oursuant io ine pmvisions al t�e Contraaors' S�ate License Law �C�apter 9(commencin0 ��� Section 7000) of Divisian 3 0l lhe Business
and Protessions Coee) or I�al �eh�e is exempl t�erefmm anG t�e basis lor iM1e alleAeO exemplion. Any violation ol Section 7Q31.5 �y
any aDPlicanl lor a permil su�le��s Ihe aD�licani to a irvil penalty of not more �han IivO Auntlretl Oollars (5500�.
1, as owner ol iAe Ompeny or my employees xiiA waAes as �heir wle compensation, will tla I�e work, an0 Ihe
I❑ s�mcmre is not intenaea or ollered lor sale (Section 7044, Business anE Pmlessional Code: T�e Coniraciori Siate License Law
tl0e5 noi ap01y �o an awnei o� a pmpeny who Eui105 ar impmves Itrer¢on, dnU wtp tloes Sut� WOM �ims¢II/trcfseli or Ihr0u0h
nis ar �er own employees, proviOeG tAat suc� imD«ments are notinlenCed w otlere0 lar ule.11, however rtie 6uiltling or
imD�ovement ¢ sol0 wit�in one year ol completron,the owne� vrill �ave I�e OurOen al prwinp �e/she di0 not OuilA orimprmre
for ine purpose ol salel.
I, as awner of Ine propeny, am e�cWsivelv wmrac�in0 �+�� �icensea comracmrs ta consirua tAe Dmle�� (����on 70a4, Buslness
❑ anG Pmiessions CoEe: The �nlrattors Slate License Law Goes not apDN �o an ovmer of pmpertf� wha bwl0s or imprmes mereon
antl w�0 tonlrat�s IOr 5uth pmietis vnlll a tOnlratior�s) liC¢n5e put5uan� lo IAe ConUaCiors' State License Law�. I am aware
i�at pmol ot iheir Worker's Compensation insurance sMWE Ge pmvi0e0 to me.
� I am eMemO� under Seclion; tl. d P. C.
lor �nis renson:
Oa�e: Owner.
1 tla hereGy cerii�y ��a� I am awdr¢ 01 anC un4er5lanG I�e requir¢menis 0� CalilOrnu Healih an0 $d�¢ry CoAe Sttl'ans 25505, 25537, ana
25534 and t�at I or any lulure GuilOing acupdni wilWrill noi �cirde One) neeE �a fAmply wiih ui0 slate c04es anOlhe requlremenis �or a
permil lor constmciion or moGilicaiion Imm Ihe Air ualily Management OiSlnci. flesiEential constmclion aODlica�ion5 are exemD� ��am
mese omNsions.
�ate: FppliCani:
I �ere0y Cenity ��a� I �ave r¢aG I�iS aO�liWyyy000n anU Slai¢ I�al Ihe aDov m rmaii0 i5 torretl. I agree Io Campty v h all tii
ordinances ana siaie 1 reW ing Io GuilCin�onstmciion anG �ereby aN reD�e enta'v¢s ol ihis ci�y lo enier u n t�e aEn
O�oDenY �arinspeci n purpr:es.
Dare: — Y �� signamm:
o�i�er's ucense t soci seauty x:
�64��a6 wni�e—Buiiding: Green—Cotle Enloecemem: Canarv—Mo��canL Pink—Revenue: Goiaenrotl—Assessor
CITY OF COSTA MESA — SIGN PERMIT
PERMIT NO: SB 050272 PLAN CHECK NO; 07122-90 S
CONSTRUCTION TYPE: PERMIT TYPE: STR SIG
JOB DESCRIPTION ; INSTALL 16.SSF TEMP NONLUMINATED SIGN
CLAIM VALUE: 350,00 CALC—VALUE: 350,00
PERM NO: SB
PURPOSE: UTH
SQ FT;
GROUP OCC; B-2 /
COMMENTS: C
+r**x*�r�t***�e��r+���e�***�r�r*�r�r**�r*****+r�t�t�t*********�*�e�*�r**�r*�********�+�***x**�t*�r*�t*
S I G N I N F O A M A T I O N
DISTRICT: 1 TYPE: WALL ILLUMINATION; NON CATEGORY: NEW
DIMENSIONS: 3FT OOIN X SFT 06IN AREA: 16.SOSQFT LETTER HT: 10 IN
STREET FRONTAGE 1: 155.00 STREET 1; E 17TH ST
STREET FRONTAGE 2: 0.00 STREET 2:
PARCEL: 92522301 ZONE; C1S LOCATION > FRONT; X REAR:
BUSINESS NAME: REGAL BEAUTY SUPPLY > LEFT: RIGHT;
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY . 16.SOSQFT OVERALL HEIGHT; OFT OIN
THIS SITE : 99,OOSSaFT GROUND CLEARANCE; OFT OIN
ITEMS OF INFO : 1 PLANTER AREA; O,OOS(JFT
ITEMS FOR ACTIVITY; 1 BLDG SET BACK; 20FT'
COPY VERBIAGE : REGAL BEAUTY SUPPLY
PLANNING NOTES: TEMP SIGNAGE ONLY
if iF k�F 1E �k if If iF 3f if k iF iE 3f k iF iE iE iF iF iF�t if M IF IE iF iE If iE if iF k k iF iE ff IE # 1E ik IF if if if if if iF iF if M IF if jf if if IF iF iE IE IF 3F if IF k iE iF iE �f ik if If IF iE iF iF k �E
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
20NING APPROVED BY S��—L DATE: ��o
BUILDING APPROVED BY : DATE;
APPLICATION ISSUED BY• ��� DATE; ��
iF�fifMlEif�fMlEiEiFkiflflfM�kiflEiFifif iFiFiFiflE3FiEiFifif 4iF
LEGALIZATION;N F E M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING 3.ECTRIC MECHAN SIGN SMIP/RES GRADING
PERMIT 15,00 16,50
PLAN 9,'75 SMIP/NO�N—RES
ISSUE FEE
HUILDZNG—DIV—> PERMIT ISSUE P —CHECK TOTAL PAID DUE
TOTALS----> 32.00 0.00 9.75 � 41.75 41.75 .00
REVENUE DIVISION TOTALS--> COLLE ED; 91,75 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MEC NIC SIGN SMIP/TOT GRADING PLAN—CHECR
15.00 16.50 .50 9,75
ififklElfifkk�/EiE3t1liFiFkikiFiFkif�fiFMMiF1FiFfFlEififlFiFlElflFlk if�FitifitiFltiEiFikklFMiflfifiElE�EiFifIFiFIEifMifiElflFiEklEif)fffiF3ElEib '
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
NO FEES WERE SELECTED FOR THIS PERMIT i��JiK:tiui {,,, .
Of QDD;b065—D0.^.?d968 TGT 4:.':�
L�.^.T[: 12/i2/90 7I�;E: ?2;43
CONSTRUCT.ION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service orPole � • � 52. Pool & Equipment Location _
2. Soil Pipe-Undrgrnd. c -" - 53. Steel Reinforcement
. 3. �Electrical Conduit Utility�Undrgrnd,- 54. Forms "
� 4. Electrical Conduit•Undrgrnd �' 55. Electrical Bonding
`�,5. Steel Reintorcement 56. Rough Plumbing & Pressure Test -
. 6. Electrical UFER�Grnd. � 57. APPROVAL TO COVER�GUNITE
� 7. Footings '�. -' 58. Electrical Conduit�Undrgrnd. '
, �.
�8. Foundation ' �1- .., -- 59. Gas Pipe, O Undrgrnd., Test �
� -
i
9. Water Pipe�Undrgrnd. '` 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System " 61. APPROVAL TO DECK �
11. Property Sewer Line & HoLse Connection .� �- 62. Backwash & Receptor-Final
12. Sewer Cap • � 63. Heater & Vent-Final �
13. Roof Drains ' � -' 64. Plumbing System � Final '
, � •
14. Rough Plumbi%'g " -' 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 Heatin9 & Air Conditioning FIRE DEPT. REQUIREMENT
20.��Ro�yfi Factory Fiieplace : L � r " �APPROVALS ^ PermiY# -"
' 2. 0 �i.1 L � f. H. 1 .x'�' •
21.�Dutfs, in Structu5e: �,', , ., , . , - . �� : 70. �Underground Hydro µ �. �
22. Ducts, Venti2ting. � . _ • � ' � _ •i. _ _ , _71 'product Piping O Ges ❑`Oil '
23.;Gas PipB=Rouqh 8i Test " "` � ' � , " i r _ � r72. Underground Flush , �
24..Roof Framing � � . �.: �' * . � - • � _ -�73.�Undergrnd.StorageTank OGas OOiI �
25. Roof Sheathing ; • _ ' - � �'� � C7q,,'Overhead Hydro � � .
26` T-Bar Ceiiing (Structurall & Monocoat y � � -75.' Dry Chemical '
27.� Frame and Flashing ' _ '` ' � ' ' r � � _ �:76.1 Dry $tandpipe �,' ' � ''
28. Wthing&Siding ��� •.i.� •- �. .��5. � •77.^FIXEDSYSTEMPINAL�: • ��
. � �
29. Insulation �' � . " ",�, '' ',. ' `� � 78. FIRE PREV. FINAL . • p -
�30. Drywall Nailing • � �' ' ,. � • . � � � � HEALTH DEPT. REQUIREMENT �'
' 31. Plaster Brown Coat ', ' 79. FINAL INSPECTION, � ,-
�32.. Electrical Power Metei Final - � -, a: �0. FOOD CERTIFICATE ISSUED ��
'.33.iFinal Electric ' ' " � Notes: '� :< ' . " " .
i
34,\Final Heating,& Air_Conditioning_ - i �, , � � ,� . , _
35.:Final Gas Pipe-Test^ • - � � �� � �' �' ' �
� � ,.. .� �y .
36.�Hood ortCanopy ' " , . �, � . �
�;
� 37. Final Factory Fireplace '" �" '� '
?�. - r. -
� 38.-Final Plumbing � - - ,� > . � � � � � �. ' �
.39. Water Service�Final� � � -- • � �� � �l -_x� ' • •
; 40. Gas'Service-Final ,. y r - , , _ . • . `
41.'Solar pomestic�Final �' .- � - - _ �' ' •
�
42. Backflow Preventer` ' '" '��' ' - - . � - ' �
• - h �
43. Backflow Irrigation' ' `� ? .'' ` � -
n i r s.
' . . - ; 'c , � _
�44. Landscape Irripation System .. •� •• -. r � - , • �z• '
�45._Sound Atteriva[ion 4 . " > ' - � ' - • �
_ � �, . , ' �, _ .
`c46. Handicap Regulations ' � '.' "�';'. � �� � u ; , _ .
�47. PINAL STRUCTURE & BUILDING n ^ t. - • � • � -�-�
-48�FINALPLANNING � ' � . . `' �n •; � '
_49. Electric Release to Edison � � - -, '� ' -
i '
`50. Gas Release to Southern California Gas Co � � �' '' '. -. ��
r
51. CER.TIFICATE OF.00CUPANCY . . -., .-. , .
No. Date
�
n
��I
a
veaecTaooxess: 269 E 17TH ST uxiT:
OWNEfl'SNAME: BEAUCHAMP 6 BROWN
nooness: 1901 AVE OF THE STARS
SUITE 950
� L.A. CA 90067
(2135282-8533
FflCHIENGINEEN: NEG.NO.:
q00XES5: UNIT:
1 PEflMIiTEE: SPECTRUM ELECTRIC ( 714 ) 556-9900
aooxess: 2501 S. BIRCH
SANTA ANA CA 92707
�ICENSEO CONiNPC7UB OECIABATION: i �ereby allirm that I am licensed wCer provisions ol C�aD�er 9(commencing wilh Section
7000) ol Dir.sion 3 0l I�e Busine5s antl Pmlessions Cotle. antl my license is in full torce ana efleci.
ciTr 1'75 TTcu �90 cu C-45
oa� ��e: �0�9/
COMPENSF710N OECLA8pTI0N: I hereby atiirm th I �ave cemlicate ol cansent to seli-insure or a certilicaie of Warkers'
pe� lion Insurance, or a cetlAiea coDY ihereal (Secbon 00, la . CI.
vouc a.: eze. onte:
Cenifietl coDY is here0y fumishetl. ❑ Ceniiied caDY is liletl wittl ihe ci�y Builtling Oivision.
�ate: Ap0licanl:
E%EMPTION FROM WOPREPS' fAMPENSATION DECIABATION: (T�is . mn ¢O na� he ComDIeleA i� i O¢�mil i5 �or One 11un4reA (51 W) or 1e55).
I cendy I�at in he Oerl mance at ��e work br whi�� Ihis permi issue . I shall no� emp y a per on in an mann r so as to hecome
suUlecl la � Worker mpensalion laws Ot Caliiamia.
Da�e: O Signature:
NO E: II. a er making Ihis tleclaratiun, yau s�oultl Oec su�lec� �o the Work¢rs' Campensa�ion pmvi5ion5 01 I�e Laha�
C¢. you musl lorthwilh compty with suc� provisions or s De�mit s�all �e deemetl revoke0.
CONSTBUCTION 1EN01NG PGENCY: I hereby allirm Ihai ��e a cons�mction lentling aAe��Y �ar Ihe petlormance o� I�e work for
w�ich I�is permit is issue0 (Section 3097. Civ. C�.
LENDEN:
aoosEss:
OWNEfi BUILOEB OECLANpTION: I hereby allirm that I am eaempl irom t�e Comractors' State license Law for ihe follovnnq rea5on
(Seciion 7031.5 Business ana Pmfessional Coae: Any ciry o� couniy whic� repuires a permit Io canstmcl, alter, impmve. tlemolis�, or
repair any stmcture. prior lo its issuance. also requires the apDlican� lor such Oermil to lite a signeG statement that he/she is licensed
pursuam to �Ae Omvisions ot t�e Con�ratlars' Slale Litense law (C�apier 9(commencing wiib Sectian 7000� a� Oivision 3 0l Ihe Business
anG Pmfessions Coae) or ��af he/5�e is exempi thertimm anA ��e basis �or �Ae allege0 eaemp�ion. My violaiion of $ecli0n 703/.5 Ey
any aD��kan� tar a Derm�t subjects I�e aOPlicant Ia a civil penaliy o� noi more itwn �rve hunCrea aollars (SSf10�.
I, as owner ol the DmOetly or my emyloyees vnth wages as t�eir sole compensation, will tlo t�e work. and I�e
❑ simcWre is nol intentletl ar olleretl lor sale (Section 70E4, Business an0 Pmfessional Code: T�e Caniraclors' Stale license Law
Aoes not aoP�Y �o an owner ol a propeny wno OuilOs or impmves inereon. antl who tlaes such wark himself/hersell or ihrouph
h¢ or �er own em0loyee5. provi�eG thai such impmvemenis are noi intenAeO ar oflered tor sale. If, Iwwever ihe builGing or
impmvement is mld wit�in ane ywr oi tqmpletion. ��c owner vnll have I�e buMen of pmNnp �e/s�e Citl not builE or improve
br �he purpose ol sale�.
❑ I, as ownei ol ihe D�openy. am exclusively conlracting wilh licensed comractars to construct the pmlect (Section 7044, Business
S C L Oo � I I r � m wAo hml0s or im roves t�ereon
CITY OF COSTA MESA — SIGN PERMIT
PERMIT NO: SBE 052020 PLAN CHECK NO: 01635-91 L
CONSTRUCTION TYPE; PERMZT TYPE; ELE STR SIG
.�.. .• :a � � �
•. � �• �
•• •
JOB DESCRIPTION : CHANNEL LETTER SIGN(NEON) SQ FT:
CLAIM VALUE: 2,000.00 CALC—VALUE: 2,000.00 GROUP OCC: H-2 '/
COMMENTS: *
�*r�r�*��**�t*+t�t*�t****�**�*�r�r**�t*�**�*+t*�r�t�t******�r�*****�+t�r+r�r�*�********���**�+r***
S I G N I N F O R M A T I O N
DISTRICT: 1 TYPE: WALL CHANNEL LETTERS ILLUMINATION; INT CATEGORY: NEW
DIMENSIONS: 7FT 09IN X 2FT 02IN AREA: 17.00SQFT LETTER HT: 28
STREET FRONTAGE 1: 25,00 STREET i: E. 17TH STREET
STREET FRONTAGE 2: 0.00 STREET 2:
PARCEL: 42522303 ZONE- C1—S LOCATION > FRONT: X REAR:
BUSINESS NAME: REGAL BEAUTY SUPPLIES > LEFT: RIGHT:
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY 17.00SQFT OVERALL HEIGHT: OFT OIN
THIS SITE . i50.00SSaFT GROUND CLEARANCE: OFT, OIN
ITEMS OF INFO 6 •• PLANTER AREA: O.00SQFT
ITEMS FOR ACTIVITY: 3 HLDG SET BACK: 20FT.
COPY VERBIAGE : REGAL BEAUTY SUPPLIES 6'SALON • �
PLANNING NOTES: �
iF iF if iF 1E IF k 7F it iE iE iF iE �F 1f iE iF iF �F if if if if iF if if iF if iF if iE iF iF M ff 1E If 1F if !f IF �E iF 1f if af ±F M if If ik iF iF lE 3E iF �! IE if if iE 1F if iF iF iF If if k if if if aE ikiF iE # iE 3f
D E V E L O P' M E N T S E.R V I C E S R E Q U I R E M E N..T /$�
ZONING APPROVED BY DATE: S/!o 41
BUILDING APPROVED BY : DATE: s/D �%
APPLICATION ISSUED BY; �%'� DATE: ���
itif�kitiEif�iEiEif-iEltlfikiflFMlElEiFiFiEiF � F ififlFiFiFiEiEihiFif iFiF
LEGALIZATION:N . • E S U M M A Y STRUCTURAL SEGMENT:Y
1
BLDG PMT PL ING ELECTRIC MECHANIC SIGN SMIP/RES GRADING
PERMIT 45.00 ,1550�0 17.00 'SMIP/NON—RES
ISSUE FEE Z9.25 5.00 .SO
BUILDING—DIV—> PERMIT I S PLAN—CHECK TOTAL PAID DUE
TOTALS----> 77.50 1 0 29,25 121.75 121.75 ,00
anaPtotessronSCode. ThefqnVat�ors Iate ¢ense aw e5n0 apDY oanowne a p perry p
and who canVacls tor suc� O�alens wit� 2 contrac�or(s) license pursuam m �he Contractors' Stare License Law). � am aware R$V$TIUE DI V ISION TOTALS--> COLLECTED • 121 , 75 OVER /SHORT • 00
ma�Prw�o�meirworke�scomce�szta�i�s�ran�esnomonepro�oedtame. BLDG PMT PLUMBING ELECT C MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
� I am exempi untler Setlion: - 8. 8 P. C. 9 S, OO 30 . 0 17 . 0 0 . 5 0 2 9. 2 5
�or this r¢a5on:
IEkififlEk*if�fkiFiFIFMIfiFkkiFlFiFlfiflF%ifafkififlk 1f1FlfiE�FiFlEififik3E�ElEiilElklflElfiElfiFiflf�fiE7FjEiE1EjElfiEiEififiPlFiF?F7ElFiFiFiFik
oa�e: �+�e� I N D I V I D U L F E E B R E A K D O W N
I tlo nereby tenify ihat I am aware ol antl unaersland Ine reQuirements ol Calilomia Healih an0 Salety Cotle Sections 2550.5, 25533, antl
2553d antl �hai I or any Imure buiiding occupani will/will no� �circte one) nee0 ta comply with saiA siate co0es anA �he reQuirements �or a TYPE Qi'Y D E$ C R I P T 1 � i�
permii �or cons�mciion or motlilicalian imm Ihe Air Ouality Managemeni Districi. HevEenlial consimcti0n aOP�icaiions are eKemp� Imm
ineuo�o�sio�s. ELE 1 SIGN/ OUTLINE LIGHT SYS ON S BR CIRC
oate: nppiicam: END OF FEES
1 �ereGy ceriify I�at I �ave read I�is aOV�icalion ane 51aie I�ai Ihe ve i orma�ion is correc�. I agr lo wmply vn� all ciry antl counly
orainancesan45�atelawyfela�ingl0�uilAingwnstmciionan4� yaulY ¢ere0resema�iveso�IN ry�0enleru��eaUove�mentioneC
Oata �� � Signature: —
oiiver' �icense r Socia� Secmity a:
t6aba6 WM1i�e—BmlOing; Green—CoOe Enb¢emem: �—Applicam; Pmk—Revenue; GdEanroE—Awessor
UNIT COST TOTAL COST
15.00 15.00
a1 00027��7—CGDE707 ��� u , .
DRT"e: 45/SUl91 Til1�: 12^`4
0
' ' M
1 � ' �
r r'� ' �.. POvL&SPA � - .
, �CONSTRUCTION AND PLANNING � •-
� � Date Inspector ` Date Inspector
., APPROVALS Permit # � APPROVALS Permit # .
.1, Temporary Electrical Service or Pole 52. Pool & Equipment Location
2, Soil Pipe-Undrgrnd, � � � 53. Steel Reinforcement
3: Electrical Conduii'Utility-Undrgrnd. 54. Forms
4. Electncal Cond�it-Undrgrnd. � 55. Electrical Bonding
��.5�:$teel Reinforcemeni - 56. Rough Plumbing & Pressure Test -�
�., v
�6.^Eleetrical UFER�Grnd. �� 57. APPROVAL TO COVER,GUNITE �
� 7. Footings ��� �, 58. Electrical ConduirUndrgr�nd. �
' 8,. Foundation .� , _ 59. Gas Pipe, � Undrgrnd., Test '
9� Water Pipe�Undrgrnd. . _� 60. Backwash Lines, P-Trap, O Undrgrnd. � �
10.x5tructural Floor SYstem •� - 61. APPROVAL TO DECK
7 �, property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. 5ewer Cap _`
v . 63. Heater & Vent-Final
53. poof Drains ; 64. Plumbing SYstem - Final �
14. Fough Plumbing '� 65. Electrical-Final '
15. qough Electrical-Conduit . 66. Solar System-Final �
16. Rough ElectricrWiring 67. Fencing & Access Approval .
17. RoughWiringSign � 68. APPROVEO•FORPLASTERING `�
1
18. Fough Electric��al�T Bar Ceiling ,�-., ,� 69. POOL/SPA.SYSTEMS FINAL �
19. pough Heating & Air Conditioning ��t' FIRE DEPT. REQUIREMENT .
- _ - . - - . � .'c: : .J. .
20. Rough Factocy Fcreplace ' �C - .'=� �-'^J �- - .APpROVAL'SzT� Pe�mit�# �=
� n (U?. �'T..�: �7.� [�� �:�' � , p: v'..1: �*7
21rDucis,inStr.ucture. T,��." w�:��.r. a: � x�. z. �::: .r, • -.
.C�ti.^-� � ��•��.�;,, .-:t� ,� .�70. HJnderground Hyd[o�:. �
22. Ducts, Ventilating • :1�-� ••:�'-•�.• �-�'i�. �' :•77,`.product Pipinq OGa's Q-Oii '
- .�i � ,r^ C .'> �
23.,.GasPipe�Rough&Test�'.{��'�'� � � ' " '� , �:�72rU�dergroundFlush � ? . �� �
R � V �g � - �'�' � � � � � + 73..Undergrnd.Storage'Tank.O'Gas OOiI
24?; oof Pramin • � �'�'�:- f-> > ... -
.r .�i.�a4^'� (l'.. �r. -.
�� .
25 �Roof Sheathing " �' ;'r� '� � "' � 74 ;Overhead J-lydro ' - .
26 Y-Bar Ceiling (Structurall &-Monocoat [� �' '-75!�Dry Chemical • - � �
27�. Frameand Flashing� S� ... �.•-= . _ '. �'7g��pr Staniii e '�' j;. ' �. � .
,'. T.- � Y P P 1�. -4.
28 4athing�& Siding �. �:`." •�m`� ` v�� +^. + >: �•77 ��FIXE� SYSTEM�FINAL-:� ' _
29. Insulation ' `�, `' .�`, j,� � �n , � - '7g.'FIRE P,REV. FINAL � � ;+ �
s
30. Drywall Nailing �� � OJN;�^J^c ' �t � I �� "t �' HEALTH DEPT.'REQUFREMENT
�
� �, -
' 31. Plaster Bivwn Coat` � ��° `: � � �" } � I .�79: FINAL'�INSPECTION '' ' '
�� Y � � �� � � �� I� �80.: �FOOD:CERTIFICATE ISSUED' �
�32..-Electrical Power MeterFinal -,� ,
� r
.33; Final ElectriG �` �,r 'r" 3-`, �' �#otie's: � '' .�4��[� '� ' - �
> J�' �i. T � / I ♦ 1 ( .
34.- Final Heating & Ai'r. 6onditioning,' � ; + ;: • � � � � , _ � , i�: _
:, ( I ,_ ., �
�:35.;FinalGasPipe�Tesr?'^ r s A� •''Y, c''.-- `:ti "",; `�';-
•.� �.:•:, .r
� � .y � . '< , l � ' _ _
36��Hood o�'CanoPY . ' .. :� � ,'� a . � �i: � + 5,,,
'�"� .+
�37-=final FaMory Fire�i4a�e '� r �c � � F ' `� ; � `�
'�38: Final Plumbing _ � ,�jir � �T � � � � � � ,� .P r. -
�
: �39:.Water Service'Finab l ? � � � '� � ��-- • � =� " 4� � •
r . ' -r,. ,�_'�•. . ; ir . . .
':40., Gas�Service,Fzinal ' i.�; •• .. � s:- " ` 'r � � � i:y . . �
41..Solar pomesticFinal � *' • ._ '- ' _ � � �`�a - ` � !
r. - ' � . .', . ^ � F
� t
42. �Backflow Prevente} � 4 .,, jj `�,. �a ' . •
43. Backflow Irrigation � �. �� :�� * �y ` �• �+ ' = • - '�
�.. • s. � .
Y ~` _.., . - . . �� ;' . .�
' 44. Landscape Irrigation System` x ,• :. . .: .. ., -.. ,,; �� • • -
�'45.. Sound Attenuation �:, n �� ,� ' • '` • " J ..._ � .
A k ` t ' •A.� � - -
��. �.(. ' ' =:C ' I V .. .. � y� �
� 46. Handice,p Regulations '�„ , ,"�t.�: � ,�, , u, �� . ,.,-_ - .
� 47;.FINAL STRUCTURE ffi;BUILDING � �`G_yl ,�y(..�� �7._' �� -�� ` �� �
�. . -
=48:;FINAL PLANNING � ` � r • -"i. `� - � `
:�: �- _ i�, :�
� 49=Electric Release to.Edison � �*� � ' '- �. �. � -
�� i . 1�" , n u� -
-. 50.. Gas Release to Southern Califomia Gas Co � �`�' " - �` .
1 � - �
,51. CERTIFICATE OF., OCCUPANCY . �. . r ,- �
No Date
� '�
(71a) 75a-5273 • Fex (714) 75a-a856 • www.ci.costa-mesa.BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 269 E 17TH ST
Suite:
Vicinity:
Primary Occ: M Display/Sale Merchandise Type of Construction: V-N
Parcel Number: 42522303 Zoning:
Applicant: PRIDY, ALLISON
Address
�; .
Owner: SARRAF, KALEB
Address P O BOX 241586 -
LOS ANGELES, CA
Convacror: HAR-BROINC-
Address: 2750 SIGNAL-PARKWAY
SIGNAL HILL, CA
Zip: 90755-2207
Arch :
Address:
Phone:
Status: ISSUED
Applied: 01127/2005
Issued: 04/22/2005
ISSUED BY:
Phone: 562 428-0003 �
Zip: .
Phone:
Zip: 90024-9386 ,
-� Phone: 562-528-8000
License: 258441
Eng: H G HANSEN
Address: 17371 IRVINE BL
Phone: 7'14-573•0073
� TUSTIN, CA
2ip: License: 92780 License: SE3027
SCOPE OF PERMIT
INTERIOR STORE TI TO UPGRADE AN EXISTING RESTROOM TO COMPLY WITH STATE ACCESS DISABILITY RE�UIREMENTS. WORK TO
ALSO INCLUDE REPLACING LIMITED ItJTERIOR WOOD STUD WALLS.
Plan Check: $117.81
Permit: $181.25
SMIP Res: $0.00
SMIP Com: $2.10
Other: $0.00
Inspection: $0.00
Total: $301.16
SETBACKS
MAIN STRUCTURE Front
ACCESSORY Front
0- 0 Rear 0- 0
0- 0 . Rear 0• 0
PARKING existinq: o Required: o
Calc Valuation:
Claim Valuation:
L�t 0- 0 Right
�
Lefl 0- 0 ' Right
Proposed: 0 .
aa
s�o,000.00
Sto,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No. 9248, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 1 BO days, or if work is suspended or abandoned
for a period ot 780 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545826
zaane �emo�
WORKERS'COMPENSAnON DECIARAnON:
I hereby eKrtn unCer penelry of perjury one ol the tollowing tletlaretions:
❑ I heve end will meintain a cerllOcete ot consent to self-Insure tor workers' compensation, es providetl lor by section 3700 of ihe Lebar Cotle, for the pertormance of t�e
work for which Ihis pertnit is issued.
0 I heve en0 wiA meintein warkers' Campensetlan insurance, es repulred by section 3700 al I�e Labor Code, br the pedortnerice of t�o work for which [his pertnit is issuod.
rM)workers' compensetlon Insura�ce cerder an policy number ere:
= S � �- �'�� �/-1-1-7 �icyNumber: �R I O S� L=G�
complefed i! fhe parmit is veluetl e! one hundred dallers ($100) ar less.)
❑ I certity that in the peAortn nce o� the work tor which Ihis permil Is issued, I shell nol employ eny person In eny manner so es to become sub�ect to t�e worknrs'
compensation laws ol Celi mie, end egree Ihet II I ould becane 5ub�ecl lo Ihe worker9' compense�lon provlsions of Sedion 00 of Iha Lebor Code, I shell forthwlth
ply with Ihese provisi
1 Signeture: - p y y Y/ d�—
WA MN6: FARURE TO SECUPE �RKERS' COMPENSATION CpVEMGE IS UNUW FUL AND SHALL S1191ECT M! EMPL�p CRIMINRL PENAlT1E5 PND CMl FlNES UP TOONE HUNDqED
1110USM1D DOl1ARE (StOp,Opp), IN ADDITI(Jf�1 TO TME COST OF COMPENSATIpN, DAMIIGES 0.S PROVIDED FOR IN SEC110N �Ofi OF TME LABOR CODE, IMEAEST, AND ATTORNEI^S FEES.
LICENSED CONTAACTORS DECLAqATON:
I hereby atfirtn that I am licensetl under ProNslo
/fo���g� a ettect. Lic. a �
Coftlacbr'S SignaNre: _
ol Chapter 9(commancing wilh Sectlon 7000) ot Division 3 0l ihe Business end Profession5 Code, and my license is in full
CONSTAUCTION LENDING AGENCV:
❑ I hereby eflirm that ihere is e conslrucUon lending egency lar ihe peAarmence ol Ihe work tor which Ihig permit is issuetl. (Sec. 3097, Givll Cotle).
Lenders Name: Lanaor's Adtlress:
Signature:
Dete:
OWNER•BUILDER DECLARATIONS:
>
I hereby eRirrn�thel unde�r,penelry of pe�Iury thet I em EJ(EMPT FROM 7HE CONTRACTORS IICENSE LAW lor I�e following reason (SecJ031.5. Business and Protessions
Oode: Ar1y_pry w counry whlch requirea a parmh lo conslruct, aller, Improve, domdlsh, or repair eny slrucWre. Ddor to its issuance. also requires t�e appliwN for suth pertnit
to file a s�gned stetement ihat h'e'm�she Is.U$eryetl pursuent to the provisions of the Contrectors Licensa Lew (Chepter B(wmmencing vrith Sectlon 7000) 01 Divlslon 3 of t�e
Busineu entl Pmfessions Code) or th0t he�orShe Is exempt therelrom entl tho besis lor the elleged evempNon. Any Nolation o1 Section 7031.5 by any eppllcent lor a permit
su6jec15 tha applicant to a civil penelry of ndPmorO� han live �untlreA tlollers (5500).):
❑ I, es owner ot Ihe pmperry, or my emplryees wit� wages es their sWe campense0on, WILL DO THE WORK, end the structure is not inte�tled or oflereG for sale (Sec.
7044, Business and Profession5 Gade:�fha Contrecbrs license Lew does not eDPN �o an ownar oi pro0erty who builds or imprwes thereon, and who does such woM
himself or �erself or throug� �is ar her own employees, pmvided Ihet such impmvemenis are not intended ar otteretl lor ule. H, howaver, the building or impmvement is
soltl vritnin one year of completion, the owner-builder will �ave ihe burtlen ol proving that �e or she did not builA or improve for purpose o� sale.).
❑ I, as owner of Ihe property, em EXLLUSIVELV CONTRACTNG WI?1/ LICENSED CONTRACTORS to ConsVuc� Ihe projeti (Sec. 7044, BuSiness enC Professions
COtle: Tha tantreCtors LiCenSe L6w tloes not epply �o en owner at propetly who builQs or Improves Ihereon, entl w�o contracLs for suU pmjep wIN e contractor(s)
licen5e Dursuant to the Contrattof5 LitenSe laws.).
❑ I em exempt under sec.
Signatura:
Owner ID varifietl by tlnvefs license. ❑ Ves ❑ No
8usiness and Profeuions Cotle lor Ihis reason:
Verilication of Ownerehip by (ype ot Cocument, I.e. - property taz bill or deoA):
Drivefs License No.
Date:
EYpires:
DIVISION OF INDUSTRIAL SAFETV PERMI7 CER7IFICATION:
❑ I hereby ceNly thai no excave8on tive i5) or more teet in depth lnta which e person Is required to tlescentl, wlll be matle in connectim with work authoAzed by this
permil, aiM Nat no Duiltling structure, scaHoltling, lalsework, or Aemdition or dismentling thereof, will be mora Ihen t�irry-sia (36) leet high, (Chap. 3.2, Grp 2. Art 2, Sec.
341, TNe B, Calitomia Atlminislre0�e Cotle).
❑ As owner-builder, I will not employ enyone to do work w�ich would reQuire e pertnillrom the Division at Industnal Safery, as notatl above. unlass suU person has a
pertnit to do suU work from the tlivision.
SignaNra: . Date:
Division oi Indusinal Satery Permit NumDer. !`�
CERTIFlCA7E OF COMPLIANCE AND A�ORIZA710N OF ENTRV: I conity untlor penel�y ol perjury �het I heve raed Ihis epplicetion antl state t�al lhe Intormation given is
correct. I egrea to comply with ell stete �ews en0 cily ordinances relating Io DullAlnp wnslruction, anU eNhodze representetives ol Ihe Ciy o� Caste Mesa to enter upon IAe
ebOve-deunbeA Droperty lar inspatlon Durposes. I egrea not to occupY or allow occupency ol any builUing eu��orized by Ihis pormil umil linel inspection.
SQOE �. IMSFEGTON TYVE
1616 Fixed System Final Fire PreveP�lon
1266 Pool SDa Final
200 Final Re�Roof
201 Final BIacWReWining Well
202 Final Factory Fire Placo
203 Final Sign
2 Final Demolilion
Owneqs)
�-� �-/
Qdjj � �t INSPECTIONTYYE
20fi Finel Mac�anical
208 Flnal Plumbing
210 Final Electrical
212 Finel Fire Prevention
220 Finel Planning Approval
222 Finel Site
250 FinalBuiltling�Occupency
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
SIGN PERMIT
.lob Address: 269 E 17TH ST
Suile:
Vicinity:
Parcel Nunmber: 42522303
App�icant: ROBERT SMITH
Address:
owner: SARRAF, KALEB
Address P O BOX 241586
LOS ANGELES, CA � - � -
Contrector: ROBERT S SMITH-
Address: 2687b CALLE ALCALA
MISSION VIEJO, CA
Arch I Eng : � �
Address: . .
Plan Check:
Permit:
SMIP Com:
Other:
�
Inspection:
Total:
Status: ISSUED
Appli¢d: 02124/2006
Issued: 02/2a/2006
Zoning:
ISSUED BY: �
Phone: 949-689•8944
Zip:
Phone:
Zip: � 90024-9386
Phone: 949-689-8944
Zip: 92691
License: 597275
- . . Phone: �
Zip:
� � � License:
SCOPE OF PERMIT
ILIUMINATED WALL SIGN FOR BELLA FACCIA .24 SQ FT CHANNEL LETTER SIGN
$54.11
$0.00
$83.25
$0.57
$0.00
$0.00 •
$0.00
$0.00
50.00
5137.93
PLANNING & ZONING,
Calc Valuation:
Claimed Valuation:
S2,7oo.00
32,700.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92) '
EXPIRATION: This permit shall automatically expire and become void if xrork is not commenced within 180 days, or if work is suspended or abandonetl
for a period of 180 days.
INSPECTIONS: In order for the work euthorized under this permlt to be considered legal, such work must comply with all epplicable codes, end all
raquired Inapectiona end flnal epprovel must be obtained. Failure to obtain Inspections and final approval will result in the explration of lhis permit.
FOR INSPECTIONS CALL: (714) 7545828
244&d8(BNO)
WORKERS'COMPENSAnON DECLARATON: " ' . ,
I fiereby effirtn Under penalry ot perJury one of Ihe fouuwmg declaratlons:
� I heve and wl�l mdinWln e ceNlicate of consent ro self-Insure far workers' compensatlon, as providetl for by section 3700 oi the Labor Cotle, for the peAortnance at the
work tor W�ich this permit is issuetl. ,
❑ I have and will maintain workeB' compensa6on insurence, as requiretl by seclion 3700 of NQ.leypr CoOe, for Ihe peAortnance ol the wwk br whkh this pgrtNt Ls iswed.
My workefs' compensation Insurence cartier antl pdioj numDer are: /
Certier.
(T1119 9i
in Ihe per
�n laws of
FpLp �ACTOPS DECLARATION:
aHirtn tnat lm IicenseC un0�r orovisic
Pollcy Number:
for which Ihis It I' ued, I shell not employ eny person in eny manner so as t0 be me subject to the workers'
Ihat it I sh b e suD�ecl lo the workers' com n mvisions oi Secti n 370 of the Labor Code, I shell fotlhwiih
� 2 bb —
iATI COVERA l AND SHALL SUBJECT AN EMPLOVEP TO CRIMII AL P T1E5 AND GVIL FlNES UP TO ONE HUNDRED
DST ENS�TION, DAM4GES AS PROVIDED FOR IN SECfIIXJ 3')OB OF THE LABOR CODE, INfEHEST, M10 ATTORNEI"S FEES.
3 of
Date:
Code, end my license is In tull
r �
CONSTRUCTION LENDING AGENCV:
❑ I hereby eNirm that there is e constructlon lending agenty lor the peAormance of the work fo� which Ihis pertnit is issuetl. (Sec. 3097, Civil Cotle).
Londar's Neme: Lendefs Address:
Slpnalure:
OWNEH•BUILDER DECLARATONS:
Date:
I hereby eHirm tnat under penalty ol Oerjury that I am EJ(EMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business end Prolessions
Code: Any ciry o! wunry whicli requires e permrt to construq, alter, improve, demdis�, or repair eny slrucWre, prior to its Issuance, a�so requires Ihe epplicant br such pertnit
to file e signatl s�atement thet �e or sha Is licensed pursuent to the provisions of Ihe Conirectors License Lew (Chapter 9(commencing with Sectlon 7000) oi Divislon 3 of the
Business end Professions Code) or �hat he or she is e:empt theretrom antl the besis for the elleged exemption. Any violatlon ol Section 7031.5 Dy eny epP�icant for a permit
subjecis ihe epplicant to e clvil penalty ol not more than live huntlretl dollers (5500).):
❑ I, as owner of Ihe property, or my employees with wages as thelr sole compensation, WILL DO THE WORK, end Ihe siructure is not intendetl or oflered for ule (Sec.
7044, Business anG Protessions Cotle: The Contractors License Law does no� ap01y to an owner of propeny who builds or Improves thereon, and who tloes such work
himseli or herseN or ihrough his or her own employees, praviOeG Ihei such impmvements ere not lntended or ottered lar sale. If, however, the building or imprwement is
sold within one year ol completion, the Owner-buildar will �ave Ihe burden of proving thet he or sha did not huild or improve lor purpose oi sale.). �
❑ I, as owner of the property, em EXCLUSIVELV CON7RACTING WfTH LICENSED CON7RACTOflS to construct t�e project (Sec. 70a4, Business antl Protessions
Cotle: 7Te �ntractors Llcense Lew tloes not appty to an owner ol pmperry who builtls or Improves lhereon, and who contrects tor sucli prqect with a contraaor(s)
license pur5uant to tha Conirectors License Laws.).
❑ I em exempt under sac.
Signatura:
Owner ID veritiad hy drivefs license. ❑ Ves ❑ No
Business and Professions Code lar this reason:
Venfication ol OWnership Dy (type ol document, I.e. - property tax bill or deetl):
DIVISION OF INqUSTRIAL SAFET7 PERMR CERTIFICATION:
Drivers Licensa No.
Date:
Expires:
❑ I hareby celiify that no e:cavation five (5) or more feet In depth into w�ich e person is required to descend, will be metle in wnneciim wIN work authodzed by this
pertnit, entl that no builtling strucWre, 5cattdding, talsework, or tlemWition or dismentling thereol, will De more than Ihirty-six (38) teet �igR (Chap. 32, Grp 2, An 2, Sec.
341, TiUe 8, Calilomie AtlmInlSlrBlive Cotlej.
❑ As ownervbuilder, I will not employ enyone b Ao work which woultl require e permit Irom Ihe Division ot Intlusirial Selery, es noled ebove, unless such person hes e
pertnit to tlo such work trom ihe tlivision.
Signature: Date:
Divislon of Intlustrial Sefety Permi� Number:
CERTIFICATE OF COMPLIANCE AND AUTHOA�ITON OF ENTRV: I certiy under panelty ol perjury thel I have read Ihis epplication antl state t�at ihe inlortna�a� given is
correcl. I agree ta �omply wilh all stela laws Bntl city ordlnences relating to building constmction, and authOnze represenlatives ol lne City of Costa Mesa to enier upon t�e
ebOve�tlescribed p�operry lar inspeciion purpo5as. I agree not�o occupy or allow o�ciipancy of eny building eulhorized by Ihls permil un�il tinel inspection.
CODE �. jd$�QftIICE i
i676 Fl:ed SySiem Final Fire Preventlon
1266
200
201
202
203
204
Pool Spa Finel
Final Re-Rool
Final BIOGk�Retelning Well
Finel FaC�ory Fire Place
Final Sign
Final Demolition
�g ��
39 e'i'Y U
COOE� INSPECTIONTYPE ��
208 Final Mechenical
20B Finel Plumbing
210 Finel EleciriCel
212 Finel Fire Preventlon �
220 Finel Planning Approval
222 Flnal Site
250 Final BuilUinyOccupency
PAffi 11�ki
(774) 754-5273 • Fax (714) 754-4856 • www.Ci.005ta•mesa.ca.Us 77 FAIR OFiIVE, GOSiA MESA. GA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Appliwnt:
Address:
Owner:
Address
.Contractor:
� Address:_
ISSUE FEE
Temp service test
. Res. alc package
New Res (1-2 units)
New Res (3+unifs)
Pool / Spa
Lighting Fixts
Recept OuUels �
Switches
Non Res Appl
Res Appl '
Service to 200a
Service to 1000a
Senice over t000a
Molors to 1hp
Molors to 10hp ,
Molors to 50hp � �
Molors to 100hp ,,�
Molore over t00hp� `
Communication drops.
Sub panel to 200a '
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
269 E 17TH ST
42522303
ROBERT S SMITH
26871 CALLE ALCALA
MISSION VIEJO, CA
SARRAF,KALEB
P O BOX 241586 �
LOS ANGELES, CA� ; ; � - -
ROBERT_S SMITH
26871� CALLE ALCALA
i
MISSION VIEJO, CA
Phone: 949-689-8944
Zip 92691
Phone:
Zip: 90024-9386
Phone: 949�689-8944
Zip: 92691
License: 597275
.' . SCOPE OF PERMIT
REF SB06-00014.
9ELLA FACCIA. 1 ILLUMINATED WALL SIGN.
Quantiry .
$23.50 ' '
$0.00
$0.00
so.00 o .
50.00 0 .
$0.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
50.00 0
$0.00 0
50.00 _ 0
$0.00 �.�..•�'0
$0.00<,� � 0
$0.00����.�<� 0�_
$0.00 �- . 0 �> -
�$0.00'- � 0 �,
�$0.00� " , 0
� $0.00 � � 0 •
-$24.60� �� 1
�� $0.00. �" 0
$0.00 '� 0
FEE SUMMARY
Temp Dist System / LigMing
Busway/700ft ,
Standing Section �
,. Misc Electrical Equipment
Transformers up to 1 kvalkw
................up to 10 kvalkw
................:up to 50 kva/kw
...........:.....up to 100 kvalkw
..................over 100 kvalkw
Low Voltage Equipment
Low VOIt Wiring System / Ckt
- - � �Misc. Conduit
' Misc. Conductor
Circus ( gen or ride)
Circus (mech nde or lights)
. Christmas Tree Stand
Fireworks Stand
OtHer Electrical Fee "
Invesliga�ion Fee
Plan Check Fee
Reinspection Fee
l �TOTAL CALCU4
Status: ISSUED
Applied: OZ/24l2006
Issued: 02l24%2006
ISSUED BY: L
Quantity
$0.00 0
50.00 0
50.00 0
so.00 0
30.00 0
$0.00 0 "
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 . 0
$0.00
so.00 �
$0.00
30.00
548.10
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, 1241-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced wilhin 180 days, or if work is suspended or abandoned
lor a period of 180 days.
INSPECTIONS: In order for the work authorized under this permlt to be consideretl legal, such work must comply with all appliceble codes, and all
requlred Inepectlons and flnel approvel must be obtalned. Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5828 �
zaaae leiool
WORKERS'COMPENSAnON DECLARAnON:
I hereby ettirtn under penalry of pe�ury one of the iouowing tleclawUons: '
❑ I have entl wlll malniain e ceNlicate ol consent ro self�lnsure tor workers' compensatlon, es provitled for by section 3700 ot Ne Lebor Code, for the peAormence ol the
work for which Nis permit is issuetl.
❑ I have arM will maintain worke�s' compensation Insurence, as requiretl by secUon 3700 ot Ihe Lehor Cotle, for the pertormance ol Ne work lor whkh this permit Is Iswed,
My workero' compensation Insurence carrler antl policy number are:
Carrier.
Policy Number:
need naf be comp/etBd I! 1 rmif Is valuetl et hundred ddlars ($100) or less.)
�het in the pertorm the w o� wh' his pertnit is issue0, I shall not employ eny person in eny menner sa es to became subject to�the workers'
ot d s, en ee U I should becoma subJect to the w��compensell0a�i Sectlon 3700 �� �� shell larthwlih
wl(h I�B i ' n9.
�ature: Date:
O WRE W PENSATON CWEW�f3E IS IAJUWFUL AND $HALL SUBIECT AN TO CRIMINAL PEC T1E5 AN CML FlNES UP TO ONE MUNDPEO
UARE (5100,000), IN AODITION TO THE COST OF �f.IPENS4TI0N, DPMAGES AS PNOVIDED FOR IN SECfION 3]O60F THE UBOii CODE, INTEREST, AND ATTORNEY'S FEES.
that
DECLARATION:
of
with Section 7000)
ions Cotle, and my license is in tull
i
CONSTRUCTION LENDING AGENCV:
❑ I hereby eXirm Ihat Ihere is a�nstruc�ion londing agency lor ihe pertormance of Ihe work br which �his permit is issued. (Sec. 3097, Civil Cotle).
Lentlers Name: Lenders Atltlress:
Signature:
Date:
OWNER-BUIlOER OECLARAtlONS:
I hereby ettirm that under penalry o� Oerjury that I em EXEMPT FROM 7HE CONTFiAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Prolessions
Catle: My city or county which requires e permlt to consiruct, elrer, improve, demdis�, w repair eny 5trucWre, pnor to its issuance, also requires the epplicent tor such pertnit
to flle e signeE stetemem t�at he o� she Is Iicensetl pursuan� ta Ihe provisions ol the Contreaors License Lew (Chapter 9(wmme�C�g with SecUon 7000) of DMslon 3 0l the
Business entl Proleuions Gode) o� that he or she is eaempl theretrom and ihe bflsis tor the elleged eaemption. Any violalion of SecGon 7031.5 by any epplicant for e pertnit
subjects Ne eDP���ent to a civil penalry ot not more then live �undred tlollars (5500).):
❑ I, es owner ot the properry, of my employees with weges as their sole compensation, WILL DO THE WORK, and the structure is no1 intentletl or oMeretl tor ule (Sec.
7044, Business end Professi0ns Cotle: The Contractors license Law dces not epply to an owner of properry who builds ar im0�oves thereon, antl who does such work
himself or herself or thmugh his or her own employees, pmvided ihai such improvemems ere not intended or oHered for sale. If, however, ihe building or improvement is
soltl within one year at complation, ihe owner-builtler will have the burtlen of proving t�at he or she did not build or improve for purpose oi sale.). �
❑ I, as owner ot the property, am E%CLUSIVELY CONTqACT1NG WI7H LICENSED CONTRACTORS to cons�ruct the project (Sec. 7044, Business and Prolessions
Cotle: The coNracmrs License Lew does not epply 10 an owner ol propeny who bulltls or Improves thereon, antl who contrecm tor such pm�ect with e comractor(s)
license pursuant to the CONr9ctors License Lews.�.
❑ I em exempl untler sec.
Signature:
Owner ID verilietl by tlrivefs license. ❑ Yes ❑ No
Business and Profeuions CoOe tor thls reason:
Verification of Ownership by (type oi tlaument, I.e. - properry ta�c biil or tleetl):
DIVISION OF INDUS7RIAL SAFEY�' PERMIT CEHTIFICATION:
Onvers Licensa No.
Date:
Eapires:
❑ I hereby certity ihat no axcavet�on tive (5) or mare leet In depih into which e person is required to descend, will be matle In canneCGOn wiih work authorizetl by Ihis
permit, entl that no 6uiltling slN��ure, scaHolding, lalsework, or demolition or dismantling t�ereol, will be more Ihan ihirty-sl: (38) leet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title 8, Calilomia Atlminis��ative Cotlo).
❑ As owneabuiltler, I will not employ enyone b do work which would reQuire e permit fmm the Division of Induslnel Selery, as noted ebova, unless such persan hes e
pertnit to tlo such work irom tne division.
SignaNre: Date:
Division of IndusMal Se(ery Permit Numbec
CERi1FlCATE OF COMPLIANCE AN� A�ITMORIZATION OF ENTRY: I certi(y untler penalry of perjury thet I have reatl this eDPlication enA state t�at Ihe intortnetion piven Is
canect. 1 egree �o compty with all sfete laws end ciry ordinences relating ro bulltlipp construction, end euthonze representatives ot Ne Gry of Cosla Mese to enter upon Ihe
ebove-described propeM �or inspec�ion puryoses. I egroe not to occupy or eVow occupency at eny building euthorizeE by t�is permil until linal inspectlon.
CO�E I. INSPECTIONTYPE
1616 Fixed System Final Fire Pre�ention
1266 Pool Spe Final
200 Finel RaRool
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Finel Sign
204 Final Demditlon
QSjE ��$ 4Qf�f( INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
, 210 Final Electrical
212 Final Fire Prevendon
220 Final Planning Apprwal
222 Final Site
250 Finel Building�0aupenq
��
a3 06
ItIIIDdLS
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.g4y�DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
.lob Address: 269 E 17TH ST
Suite:
Vicinity: REGAL BEAUTY -
Primary Occ: M Display/Sale Merchandise � Type of Construction: V-N
Parcel Number: 42522303 Zoning:
Applicant: NGUYEN, TRAM B
Address:
- �Phone: . 714-612-7112
�- . . Zip: :� . .
Owner. SARRAF; KALEB `��� � ,
Address P O BOX 241586� � � � '
-� - ." � - . Phone: � �
. LOS ANGELES, CA " ,� � " - Zip: �; 90024-9386 -
i. . , , , - . . .
Contractorr�� �DESIGN CONCEPT-AND CONSTRUCTION � � -
r. . � .��_�� -
Address'/ 14371 STARSIA"ST%c?-�' � , �
. . � ' •�%'.'" Phone: 714-612-7712
,� �
, , WESTMINSTER, CA
_ ,Zip: 92683.:�-!' License: 593686
' Arch : � - , � _ Eng:
Address: , . Address:
� , , � � Phone: "i
� , ' - .��.!"� � ..
Zip: � - -.License:- �. . . - . � '
, � _
INTERIOR TI TO CREATE IN THE RETAIL AREA AT "REGAL
REF: B05-00147/PREVIOUS FIRE DAMAGE
i -r FEE SUMMARY -
Plan Check: $29.45
Permik $181.25 �
SMIP Res: $0.00
SMIP Com: $2.10
Other: ' $0.00
Inspection: $0.00
Total: ��_' $212.80 �
ISSUED BY:
Calc Valuation:
Claim Valuation:
; �PL'ANNING & ZONING
SETBACKS ' � - ��� �
MAINSTRUCTURE�Front --� 0 ��„���,,;Rear 0-0 Left 0-0 ' =,Right 0-0
ACCESSORY� Front 0-�0 ;=, �, Rear . 0-0 '� . Left a0-0 Right - 0-0�-
-� �;� :/� � � ' - �.. �� - " .. . . .
PARKING � � `�,Ezistin " � 0 � � �Reauiretl:, �� 0 � � Pro o �
�� „
�
� �� � � _ � `
�'� ' . _; � - .
�. _ ,. ' .- ,�
, � , �
Status: ISSUED
Applied: 01/19/2006
Issued: 02/09/2006
Phone:
License:
$io,000.00
sio,000.00
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
POR INSPECTIONS CALL: (714) 7545826
zeas-ae �vao�
WORKERS' CaMPENSATON DECLAFiAnON: _ �� -
I hereby aHirm under penalty of perjury one of ihe followinq declarations:
� I have and will maintain a certificate of consent to selt-Insure for workers' compensetlon, as provided for by section 3700 of tha Labor Code, for the perfortnence of the
��/ wark for which this permit is issued. I
��j I have antl will maintain workers' compensation insurence, as requiretl by section 3700 of the Lehor Code, for ihe pertortnance of Ihe work tor which ihis permit is issueG.
My worKers' compensation Insuranc rrier antl policy number era: �
(camer._�kl� C.�ar���P.nb�i�+� Tn5•�Y�t�nC4 �krul 1845-�04
(This section need nof be comp tetl i/ the permif is va/uetl af one nundred dollars ($100) or /ess.J Policy Numher: i
❑ I certify thet in the paAormance of �he work For which this permit is issueQ I shell not employ any person in any manner so es to bacome subject to the workers'
compen5ation laws of Calitornie, end egree ihat If I shoultl 6ecome subject ro the workers' compensation provisions of Section 3700 of ihe Labor Code, I stiall forihwiih
comply with ihese pr isians. ,�(/y, � ,
APPliwnt,Sipnature� _���tilWl 7 V lt �^+k[in pe� �=p�j . Q� �(�jp I
WARNING: FAILURE TO SECURE WORKEFS' COMPENSATIIXJ V GE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND dVIL FlNES UP TOONE HUNDRED
TFKKISAND DOLLARE (5100,000J, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS P{iOVIDED FOR IN SECTION 3I06 OF THE LABOq CADE, IMEREST, AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION: '�,
I hereby aHirm that I am license�] u der provisions of ChaO�er 9(commencing with Section 7000) ot Division 3 of Iha Business nd Prolessions Cotle, end my license is in full
torce and efleG1�L c t� -/ � Gi R � ��. �
Con _tractors.Sl9naNre:— 66n'1-i Ql.�....�f�v�- (Det��Pi _�
CONSTRUC710N LENDING AGENCY: '
❑ I hereby aNirm that there is e consimction lending agency for Ihe performance of the work for which this permit is issued. (Sec. 3�97, Civil Code).
Lentlers Name: Lentlers Atldre55:
Signature:
Date:
OWNER-BUILDER DECLARATIONS: '
I hereby aNirm thet under penalry ot perjury ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions
Code: Any ciry or county which requires a permit lo consiruct, alter, improve, demolish, or repair any strucNre, pnor m its issuance, also requires the applicaM for such pertnit
b tile a signed statemem that he or she is licensed pursuent to ihe provisions ot �he Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Code) or that �e or she is exempt iherefrom and the basis tor the elleged exemption. Any violation of Section 7031.5 6y any epplicant for e permit
subjects the appliwM to a civil penaVty ot not more then five hundred tlollars ($500).):
i
❑ I, as owner oi ihe property, or my employees with weges as ihelr sola compensation, WILL DO THE WORK, enC ihe siructure Is not intentletl or offered for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law tloes not apply to an owner of property who builds or improves thareon, and who tices such work
himself o/ hersalt or ihrouqh his or her own employees, provided that such improvemenis are not intended or oNered fa sale. It, however, ihe builtling or improvement is
sold withi� ona year of completion, the ownar-builder will have the hurden of provinq ihat he or she did not build or improve for purpose oi sale.). '
❑ I, as owner of ihe property, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business and Professions
Code: Tha contractors License Lew tloes not apply to an owner ol property who builtls or Improves thereon, antl who comracts tor such projact with e contractor(s)
license pursuant to the Contrectors License Laws.). i
❑ I am exemp� under sec. _
SignaWre.
Owner ID venfied by drivafs license.
Venfiwtion ol Ownership by (type at
Business and Protessions Code tor this reason:
Ves ❑ No
i.e. - property fax bill or tleed):
Driver's License No.
Date:
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION: i
❑ I hareby certify that no excavetion five (5) or mora feet in depih into which a person is require0 to descend, will be made in connection with work euthonzetl by this
pertnit, antl ihet no builtling simcture, scaHoltling, felsework, o� demolition or tlismantling thereof, will be more then ihirty-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title 8, California Atlminlstrative Code).
❑ As owner-buildar, I will not employ anyone to do work which would require a permit irom the Division ol Intlustria� Safety, es noted above, unless such pereon hes e
pertnit to do such work from Ihe didsion.
SignaNre: Date:
Division ot Intlustriel Sefery Permit Number:
CERTIFlCATE tlF COMPLIANCE AND AUTHORIZATON OF ENTRV: I certity under penalty ol pe�ury thet I have read Ihis epplication and state that ihe infortnation given is
correct. I agree �o comply with all stete laws and cily ordinances releting to building constmction, and authonze represenlatives of the City of Cos�a Mesa [o entar upon Ihe
above-described p�opeAy for inspection purposes. I agree not to occupy or ellow occupancy of any buildi�g authorized by this permit until tinai inspaclioo.
COOE 1, mmcolONTYPE
1676 Fixed 5ystem Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Finel Block/Retaining Wall
202 Final Fa��ory Fire Place
203 Final Si9^
204 Final Demolition
FOOE I INSPECTION TYPE
206 � Final Mechanical
20B Final Plumbing
210 Final Eledncal
212 Final Fire Prevention
220 � Final Planning Approval
222 Final Site
, 250 Final BuildinA/Occupancy _
PAIE �. UIImeLS
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626'
BUILDING PERMIT
Job Address: 269 E 17TH ST
Suite:
Vicinity: INTERIOR
Parcel Number: 42522303
Applicant: ALLISON PRIDY
Address: 2750 SIGNAL PAftKWAY
SIGNAL HILL, CA
owner: SARRAF, KALEB
Address P O BOX 241586
LOS ANGELES, CA
Contractor: HAR-BROINC
Address: 2750 SIGNAL PARKWAY
SIGNAL HILL, CA
Zip: g0755-2207
Arch :
Address:
Phone:
Zoning:
Phone: 562-528-8000
Zip: 907552207
Phone:
Zip: 90024-9386
Phone: 562-52&8000
License: 258441 �,
Eng:
Address:
Status: ISSUED
Apptied: 03/03/2005
Issued: 03/03/2005
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
INTERIOR DEMOLITION TO FIRE DAMAGE. REF.: BOS-00747 -
FEE SUMMARY
Plan Check: $0.00
Permit: $153.25
SMIP Res: $0.00
SMIP Com: $1.57
Other: $0.00
Inspection: $0.00
Total: $154.82
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existin : o
NOTES:
, . . � ._.,
> ,_.
Calc Valuation: g�,soo.00
Claim Valuation: g7,5oo.00
Right 0- 0
Right 0- 0
NOTICE: The work�'authorized by this permit shall comply with all applicable handicap access requiremants under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1247-92) �
EXPIRATION: This pertnit shall automatically expire and become void if work is no� commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
�, INSPECTIONS: In ord@r for the work authorized under this permit to be considered legal, such work must comply with all appliceble codes, and ell
� requlred Inspeetlona ahd tlnel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
POR INSPECTIONS CALL: (714) 754-5626
!aaere ��oo)
WORKERS'COMPENSATON DECLARAnON:
I hereby aNirtn under penalty of perjury one ot the following declarations: •
❑ I hava and will malntain a certificate of consent to self-Insure for workers' compensation, es pmvided for by section 3700 of ihe Lebor Code, for ihe pertortnence of ihe
lor which �his permil is issuetl.
�^I� ve and will maintain workers' compensatlon Insurence, as requiretl by section 3700 oi the Lebor Code, for Ue pertortnance of Ihe work for whlch thLq pertnit Is Issuetl.
��-�,.M ers' compensation Insurence carder end policy number ere:
.: :. �c-•�- tj .0 �-i a-� �vr+��: � 3 I 0 G, b 6 oir
(Th/s secHon need naf be completed i1 the pemtit is velued af one hundred dWlars (5100) or /ess.J �*+��G�` y ��=
❑ I certily t�at in tha peAo ance of tha work tor which ihis Oermit is issued, I shall not employ any person in any manner so as to become sub�ect to the workers'
wmpensetion laws of C Itlomia, and agree Ihet II I shoultl become sublect to the workers' compensation provlslons of Section 700 of the Lebor Code, I shell f6rthwit�
camply with these pm ' ns. �
pllrarM�3ignat� �^ �. T . Date:- -i'� 3 '� I li �—
W��A� ~�. PFICGRE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPIOYER TO CRIMINAL P NALTIES�AND QVIL FlNES UP TOONE HUNDRED
Ti 1SANDDOLLARE($100,0OO�,INADDITIIXJTOTHECOSTOFCOMPENSATION,DAMAGESASPROVI�EDFOpINSECTI0N3]O60FTHElABOFCODE,INTEREST,ANDATTORNEYSFEES.
LICENSED CONTRACTORS DECLARATION:
CheO�er 9(commencing wiih Section 7000) of Divislon 3,a13he�Busingss a�Q Professions Code, and my license is in full
( '�"_ k,..i' ��
CONSTRUCTON LENDING AGENCV:
❑ I hereby eHirtn that there is a wnslruction lending egency Por the performance ot the work Por which �his permil is issued. (Sec. 3097, Civil Code).
Lentler5 NBma: Lenders Adtlr855:
Signeture: Date:
OWNER•BUILDER DECLARATIONS:
I �ereby aHirtn thet under penalty of perjury I�et I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lor ihe following reason (Sec. 7031.5, Business and Professlons
Cotle: Any cily or counry which requires a permit to construct, alter, improve, demolish, or repelr eny structure, D�or to its issuance, also requires t�e applicent for such permit
b Nle e signetl siatament Ihat he or she is IlcenseA pureuaN to the provisions oi ihe Contractors Licensa Lew (Chepter 9(commancing with Sedlon 7000) of Divislan 3 ai the
Business and Professions Cade) or that he or she is ezempt therefrom end tha besis for ihe alleged exemption. Any violetlon of Section 7031.5 by any eppllcanl for e permit
sub�ecis ihe epplicant to e civil penalry of not more Ihen flve hundred dollers ($500).): �
❑ I, as owner of the properry, ar my employees with weges es iheir sole compensatlon, WILL DO THE WORK, end the structure Is not intended or oNerad tor sale (Sec.
7044, Business and Professions Cotle: The Contractors Llcense Law dces not apply to an owner oi property who builds or improves Ihereon, entl who does such work
himself or herself or Ihrough his or her own employees, provided thet such improvements ere not Intended or oHered tor sale. tl, however, t�e building or impmvement is
sold within one year ot completioq Ihe ownerbullder will heve Iha burden ot pmving thet he or she did not build or improve for purpose of saleJ. ' �
❑ I, es owner of lhe property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 70d4, BuSiness entl PrOfessions
Cotle: 7he coNrectors License Law tloes not eppty to an owner of proDerry who bullds or impmves thereon, antl who wntracis br such pro�ect wit� e contracror(s)
license pursuant to the Coniracrors License Laws.).
❑ I em e:empt untler sec. Business an0 Professions Code for this reason:
Signature: Date:
Owner ID verNied by drivers license. ❑ Ves ❑ No Drivefs License No. Expires:
Vedlicatlon oi Ownership hy (type of tlocument, i.e. - pmperry tax hill or aeetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certify ihat no excevation flve (5) or more feet In depih into which a person is required Io descend, wlll be mede in connection wlth work authorizad by this
permit, end ihat no building strudure, scaHoldinq, talsework, or demolition or tlismantlinq ihereot, will be more than ihirty-six (38) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Tltle e, Celilarnia Adminisiretive Code). . ,
❑ As owner-builder, I will not employ enyone ta do work which would require e pertnit trom the Divislon ol Industnal Sefery, as notetl eDove, unless such person has e
pertnit to do such work from Ihe division.
Signeture:
Division ot Intlustrial Safery Pertnit Number:
Date:
1 WIII the epplicant or present or tuture building occupant need to file end certify a Business Plan for amergenty response ro releese or ihreatened release ot e �azardous
material9 ❑ Yes ❑ No I
(Section 25505 of Ihe Califomia Health end Salery Code requires, with some ezceptions, ihat e Business Plen be tiled with the Costa Mesa Fire Department Dy every
business which hes e� any one time tluring a rePortetl year e quanti�y of harartlous matenals equel to or greater than a weight of 500 pounds, or e volume of 55 gallons,
2 Uoes or wm Ine eppucant or present or mwre owioing occupem neea �o rna a regis�ranon �orm ior ecmeiy nazaroous metenais r LI res LI rvo '
(Sectlon 25533 of tha Califomia Heal�h end Setery Cotle, wlth some e:ceptions, requlres reglstretion with ihe Casta Mesa Fire Depariment by each business which et flny
one time has on hend a quantiry of ecutely hezerdous materials equal to or greeter ihan a welght of 500 pounds, or e volume ot 55 gellons, or 200 cubic feet of
compressed gas at standartl �emperature end pressure).
........................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the epplicant or present or fuiure building occupent nead to prepere en RMPP (Risk Manegement end Prevention Program lor ecutely hazardous matenals)7
❑ Yes ❑ No - � .
(Section 25534 oi the Califomia Healt� and Sefery Cotle provides that the Costa Mese Fire Department may require the preparation, certification and filing with the Fire
bepartmenl of en RMPP by businesses which ere reQuired to register acutely hezerdous meterlals wilh ihe Fire Department.
................................................................................................................................... ................................................................................................ ........................................................................................................................................... _.....
4 If en RMPP is presently required, has Section 25534 ot the Califomia Health and Safery Code been lully complietl with? ❑ Ves ❑ No
............._...................—._..........................___............................_..._.................._...............__................"_'..........._...___.._....._.—�.....................�............_.._..........._....._...._
5 Does or wlll �he applicent or presem or tuWre bulltling xcuDant require for the work which is lhe subject of this plicalion a ermil for 5uth conSWClion or modiTiCallon
trom Ihe South Goest Air Oualiry Menegement District or from any other air polNtion cantrol tllsMct or egencyt � Ves � Na .
(Section 65850.2 01 the Celifornie Government Cotle requires that Ihe requested inlormation be furnished on appiications for non-residential huilding permits).
.B.......WIII eny Pan of the faciliry to De constructad under this permit be within 1000 teet from iha outer boundanes ot�e school?.....0 Yes............�.No ........................................................_..
(It'yes", the tacility must meet the requiremem ol Sections 25534 and 42303 0l tha Celilomia Heelth end Safery Code).
...................................................................................................................................................................................................................................................:....................................................................................................................................
7 If e permi� Irom �he Sou�h Caas� Air Ouality Manegement Dis�rict or o�her alr polW�ion Con�rol dl9trict of'egency is requiretl for �he work which Is �he subiect ot this
eoollcation, have ell oi the tlisclosures prescrlbe0 Dy Celifornia Health and Salery Code Section 42303 been made? ❑ Ves ❑ No
(tl "yes", attech certificate of complianca from Ihe eppropriete air pollution contml afticer). �-.�'
CERTIFICATE OF COMPLIANCE: I ceniy that under penelty of perjury the iniormation given ebove is corract. I egree ta comply with ell stete lews and city ardinences
reparGing Hazardous Matenals and Emissions.
Signature: �ate:
CEHTIFlCATE OF COMPLIANCE AND AIfTHOfiVA710N OF ENfAY: I certify under penalry ot perjury Ihat I have reatl Ihis epplication and state Ihat the infortnation given Is
correct. 1 agree ro compy with all stete laws anC ciry ordinances relating to building constructlon, entl authorize representatives ot the Ciry ot Casta Mesa to enter upon the
ebove-tlescribed properry tor inspection purpases. I egree not to occupy or allow occupancy of�any building authorized by this permil until final inspection.
i
Si9netur er(s) � �� ,z ri at�
CODE �. INSPECTIONTYVE
1616 fixed System Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Rooi
201 Flnel Blak/Retaining Wall
202 Finel Fectory Fire Placa
�.v.—�.:,.,--.,..r-=-•-- -
ORTE �� �� INSPECTIONTYPE
206 Finel Mechanical
208 Finel Plumbing
210 Finel Electdcal
272 Final Fire Prevention
220 Final Planning Approval
203 Final Sign ��� �� � ���� ZZZ
204 Final Demolilion �n_ v" ,y� 250
Final Site
Final Building/Occupancy
(714) 754-5273 • Fex (774) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 269 E 177H ST
Suite:
Viciniry: 267 THRU 275 E 17TH ST
Primary Occ: M DisplaylSale Merchandise Type of ConsWction: V-N
Parcel Number: 42522303 Zoning:
Applicant: PRIDY, ALLISON
Address: 2750 SIGNAL PARKWAY -
SIGNAL HILL, CA
Owner: SARR,4F, KALEB
Adtlress P O BOX y41586
LOS ANGELES, CA
Conuactor: HAR-BROINC
Address: 2750 SIGNAL PARKWAY
SIGNAL HILL, CA
Zip: 9075S22W
Arch :
Address:
Phone:
ISSUED
Phone: 562-42&0003
Zip: 90806
Phone:
Zip: 90024-9386
, Phone: 562-528-8000
License: 258441
Eng: H C HANSEN
Address: 17371 IRVINE BL
SWtus: ISSUED
Applied: 01I27I2005
Issued: 04122/2005
Phone: 774-573-0073
' TUSTIN, CA �
Zip: License: 92780 License: SE3027
SCOPE OF PERMIT
FIRE DAMAGE REPAIR TO REMOVE/F2EPLACE 3300 SF OF DAMAGED ROOF STRUCTURE.
ONE BUILDING WITH ADDRESSES: 267. 269, 277, 273 AND 275 E 17TH STREET. - -
Plan Check: $718.74
Permit: $1,105.75
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,824,49
SETBACKS
MAINSTRUCTURE Fronl 0-0
ACCESSORY Front 0. 0
PARKING Ezistinp: o
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0. 0 ,
Proposed: 0 �
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
ai2o,000.00
ai2o,aoo.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calffornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-g2)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for Ihe work authorized under this permlt to be considered legal, such work must comply with all epplicable codes, and all
requlred (nepeettona end itnal approvel must be obtafned. Failure to obtain inspections and final approval will result in the ezplration of this permit.
FOR INSPECTIONS CALL: (714) 75q-5626
zwsae �aroo�
WOHKERS'COMPENSAnON DECLARATON:
1 here6y effrtn under penalry ol per�ury one o1 the followfng tleclaretlons:
❑ I heve tl will mainiflin e cenificate of cansenl to sell-Insure lor worken' compensatlon, es providetl br by saction 3700 01 the Labor Cotle, lor t�e peAortnancre at the
w or w�iM this permit is issued.
heve end vAI meintain workers' canpensetim insurence, es required by section 3700 0l lhe Lebor Cotle, lor the peAortnance of the work for whkh Ihis p¢rtnit is issued.
/ My workers' compensatlo/n� Insurence cartler entl poliry number ere: �\/`'� � /�
errier. ���- �7�1�t Uf-� � POlicy Number: ' J � � 4� (, A�
(TT/s secHon need no( be comp/eted i!!he pe i( is velued et one huntlred dollers ($ I00J or less.)
� I Cetlily that in th0 �eA rmenCe ol lhe work br whiCh this pertnit b is5ued, I 9hall noI employ eny per9on In eny menner 90 e9 to acnme sub�ect ro Ihe workars'
crompensatlon laws of I� Iitomia, and egree thet II I should 6emme sub�ecl lo ihe workers' mmpensetlon proWsions o1 Sectio 700 ot t�e ebar Cotle, I shell forthwlth
�y cromply with theso pro i'ons.
e5ar�m sia�emre: �; � vZ � G �
WARNING: FAILURE TO SECU ORI(ERS' COMPENSATqN WVERA�E IS UMAW FUl nNU SHALL SUBJECT Ml EMPLOVER TO CRIMINnL ENAlT1E5 M1D CML FlNES UP TOONE FNNDRED
hKKl$AND �OIURE (510�.�). IN qpD1T10N Tp THE CQ^iT OF COMPENSAPpJ, ORMROES AS PRpV10E0 FOR IN SECTION �O60F TME F CODE. INTEFIEST, AND ATTpRNE1^$ FEES.
LICENSED CONTAAC70RS DECLARATION:
1 hereby aK�m �ha� I art�
�p� enA eHect. Lit. b _
C�Mi�trectols Signature:
Chapler 9(Commandng wl�h SeC�lon 7000) ot Dlvlsion 3 0� t�e BuSinesS end P�rylessions CoA9, arM my IiCense i5 in IuII
as p /) /
/O � '�G�
CONSTAUCTION LENDING AGENCY:
❑ I �ereby attirm thAi lhere is a wnsiruction lending egency far the pedarmence of I�e work br which Ihis permil is issued. (Sec. 3097, Civil Code).
Luntlers Neme: Lentlnr'S Atldress:
Signature: _
OWNER•BUILDER DECLARA710NS:
Dete:
I here6y aRitm thet under penelty ol perjury t�al I em E%EMPT FROM TNE CONTRACTORS LICENSE LAW tor Ihe lollowing re2son (Sec. 7Q31.5. Business en0 Prote;slons
Cotle: Any dry or caunry which reQuires e pertnit to construct, elter, improva, tlamolish, or repair eny structure, prlor to its issuance, also requires t�e applicant for such pertnit
to file e signetl s�ateme�� thet he or she ts licensed pursuant to the proNslons af lhe Contrectors License lew (Chepter 9(comme�ing with Sectlon 7000) ot DMsion 3 ot 1Te
Business entl Professions Code) ar thet �e or she is exempt therelran end the besis lor the elleged ecemptlon. Any Woletlon of Seciion 7037.5 Dy any ep0licant for a permit
sublects the apPlicant IO e civil penelry ol not more Ihan live hundred tlollers (5500).):
❑ I, es owner ol t�e pmperty, or my employaes wilh wages es thelr sole compansatlon, WILL DO THE WORK, end Ihe strucWre is not intendetl or otteretl tor sale (Sec.
70a4, Business ana Professions CoAe: The Contrec�ors Llcense Lew tloes nol apply to en owner of pro0erry who builtls or improves thereon, and who does such work
himseN or �erself or throug� his or her own emplqrees, proWded thet such improvements ere not intended or oflereA lor sale. If, however, the building or improvement is
soltl wit�in one year of completion, the owner-builde� will have the burtlen of proving thal he or she tlid not builtl or improve for Durpose of sale.).
❑ I, es owner oi tha propetly. em E%CLUSIVELY CONTFiALTING WITH LICENSED CONT{iACTORS ro conslruct the Drqect (Sec. 70aa, Business antl Professiwu
Cade: 1Te contradors License Lew does not epO�Y �a an owner ol property who builtls or imprwes thereon, antl who wntrads for such pmject wlth a contracror(s)
license pursuam ro the Contredors License LawsJ.
❑ I am ezempt untle� sec. Business and Professions Code for Ihis reeson:
Signeture: Date:
Owner ID verifietl by drrvai s license. ❑ Ve5 ❑ No DnverS LiCense No.
Venticetion ot Ownership by (type ol Axument, i.e. - property tax bill or tleed):
DIVISION OF INDUSTq��L SAFETY PERMR CERTIFICATION:
E:PireS:
❑ I hereby certiy ih9t no evwvation Me (5) or more leet in depth Into which a person Is requiretl to descend, wlll be made in connection vnih work authorizeE Dy Nis
pertnit, end that nP building stmqure, scaHoltling, ialsework, or demolition or Alsmantling theraof, will be more Ihan thirry-six (3fi) feet high. (C�ap. 32, Gry 2. An 2, Sec.
341, 7tle 8, Califomia Atlministrative Cotlaj.
0 As owneo-Duiltler, I will not employ anyona to do work which woultl requlre e permit from the Divislon ol IntlusMel Sefery, as natetl above, unless such person has a
pertnit to do such �'ork tmm the division.
Signature: Date:
Division oi Intlustrial Seiery Permit NumEer:
I4Qpj,y INSVECfIONTYPE QAjE WiQls1$ S�4L�1 IN4VECTIONiYPE Qdjj �$ I
1676 FIzeO System G�nel Fire PreveNlon 2ob Flnal Mochenicxl
1268 Pool Spe Finel
200 Finel Ro-Rool
201 FIneI BIocWRetelninp Well
202 Finel Fetlory Flre Place
203 Final Sign
204 Final Damolition
208 Flnel Plumbing
210 Finel EloCtdCel
212 Flnel Flre Prevenlion
220 Final Planning Approvel
222 Finel Site
,. 250 FinalBuiltling�Occupency
(»a) 75a-5273 • Fau (��a) 754-ae56 • www.ci.costa-mesa.ca.us 77 hAIFI UHIVt, GV51A MtSA, GA 8YtlZ0
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
269 E 17TH ST
267,269, 271, 273 AND 275
42522303
Applicant: GLENN WHITEFORD
Address: 26406 GTYLIGHT CT , �� � �
, % ' _ ... ,
SANTA-CLARITA,�CA ��, ,
� _ � \ ." �
� /� .
i
Owner SARRAF, KALEB-; ; '- �
Address � P O BOX 241586 �-�� ��
� . ��
�>�.,
� LOS ANGELES, CA
i
,� j��,� �,i „
� ..i: r
Contractor: DOTY ELECTRIC
� � �
Address: , 26406 CITYLIGHT CT -
SANTA CLARITA, CA
Phone: (818) 445-0886
Zip � 91351 � .
Phone:
Zip: 90024-9386
�
Phone: (818) 445-0886
Zip: 91351
License:745302
e
/ �� /
ELECTRICAI pERMIT FOR FIf2E I
CEILING AR�AS. ONE BUILDING
STREET. �
267
REF #BOS-00147 " � `
Status: ISSUED
Applied: 05/12/2005
Issued: 07/14/2005
ISSUED BY: �
., ,
.; �
fRICA6IN ATTIC, WALLS AND '
1.273 AND 275 E 17TH
�, ELECTRICA� TO INCLUDE: 63 LIGHTING FIXTS, 38 REC�EP.T OUTLETS, 25 SWITCHES, 3 MOTORS
. TO 10 HP, 4 5UB PANEL TO 200A, 4 SIGN CIRCUITS. �' � � . .
� i
FEE SUMMARY
,
' - . Quantiry , ' ' � �uantiry
� - .
ISSUE FEE ���$23.$p '.; �, Temp Dist System / Ligh6ng 50.00�. 0
Temp service test , � $0.00 "�� Busway /100 k -��� �- $0.00 � 0
Res. alc package E0.00 ` �' - � : - � Sfanding SecUon -� ' ' - $0.00 � 0 . �
New Res (1-2 units) � �, $0.00�` ; � 0 _ ' � Misc Electripl Equipment ; $0.00 . 0
New Res (3+uniLs)_ � � �i $0.00 - �-�� �-0 , � Transformers up to 1 kvalkw �i$0.00, i 0� �
_ _ ,
Pool I Spa ' _ , ��: / $0.00. � -0-„ - � ..up to 10 kva/kw= - � 50.00 ,�� 0 .
Lighting Fixfs � � �� . $53.39 � 63 ; � � �., ti �: .up to 50 kva%kw � i , 30.00, � 0/ � � �
; .:
Recept OuUets � � , , $35.14 , r � ` 38 � � - -- - � ' ...:..:....:.....up to 100 kva/kw �,; �$0.00% / 0, � -
Switches �-� � � $25.65� � / 25� `� . ..................over 100 kva/kw V ��. ,-50.00 � � , 0 -
Non Res Appl ��� � $0.00 - � � , 0 � ' � ' � - , Low Voltage Equipment `-50.00 � . 0
Res Appl �$0.00�-, " 0,� �--� -, �_ �Cow Volt Wiring System�/ Ckt ; 50.00.� 0
Service to 200a $0.00 — -� 0 � � � . �Mi'sc. Conduil �_ � "� ;- $0.00 0
Service to 1000a 50.00 � � � 0 � � �- �Misc: Conductor - " "So.00 0
Service over 1000a $0.00 '�0. � - -- Circus r ri �� � 50.00 0
Molors to 1 hD $0.00 0 (mech ride or lights) 50.00 0
Motors to 10hp $36.90 3 Christmas Tree Stand 30.00 0
Motors to SOhp $0.00 0, � Fireworks Stand $0.00 0
NOTICE: The work authorized by this permit shall comply with��ll applicable handicap access requiremenis under Califomla statutes and related
regulations. (Ord. No. 92-28. § 1. 12-21-92) V
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 authoAzed under this permit to be considered legal, such work must comply with all applicable codes, and ell
requlred Inapeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of th permit.
FOR INSPECTIONS CALL: (714) 7545626
zaas�ae �eroo�
WORKERS'COMPENSATON DECLARAnON:
I hereby eMirm unAer penalry of per�ury one of Ne Idlowing dedarations:
❑ I ave antl wlll malntein a certilkate o1 consont lo sell-Insure far workers' campensetlon, az provitletl br by seclion 3700 of ihe Lebor Cotle, tor the peAormence of ihe
work lar which Ihis permit Is Lvsuetl.
' �1 Ipve arW v� meinteN woticers' compensellon insurence, es reQuiratl by section 3700 ot 1he Lebor Cotle. fw Ne peAortnence ot U�e work tw whkl� Ihis pertNt Ls iswed.
/Mywn°r1cers'wmpenseUonlnsura�j ecertlerentlEoy'iqnum.�b1erere: ���^,I ��� O�
Certier: 7'�'�� � M/� �V�i��[�� I/ PolicyNumDe� � L`�
(7hbsect�on need irot be eted I Me permlf Is ve1ued et me huntlretl tlollers (S100J a less.) Z--�y �
� 1 cenity t�at in Ihe peAortnence of tl ork lor which INs pertnit is issuetl, I shell not employ eny person in eny menner ao es to Oecome sub�ect lo Ue workers'
campensalion laws of Celtlomle e ree thet If I should bewme sub�ect to [�e workers' compensatlon provlslons ol Sectlon 3700 of Ihe Lebor Code, I shall lorihwlth
compty wlth these provisions �'7,� / '
'Appll,Ci(M'Slgnelure: i�� Date: �L�"/'—� �
WMf�ING: FAIWRE RI RE WORI(ERS' O]MPENSATION COVEMOE IS UMAWFUL AN� $HAl1 SUBJECf M! EMPLO�k PENALTES ANO CML FlNES UP TO ONE MUNDRED
THOUSAND OD,000), W ADDITION TOTHE COST OF COMPENSFTION, �AMAGES AS PROVIDED FOR IN SEGTION 31080F TME UBOR COOE, INTEREST, AND ATTORNEI"S FEES.
I�Cd��69��PI9il�:7_PlL�I:F'LLX�7�_l:L\IP1`f
I hereDy eRirm that I em I tl p vl ' s ot Chapter 9(commencing with Section 7000) of Division 3 of�e Business entl Pmfessians Catla, end my license is in full
force�eriC'Btfact"lk'M-- Class N �
�vecioi's'6lpnetur : IDe� — y�
�:"�.:T+�' �' 1 I �
CONSTRUCTION LEN G AGENCY:
❑ I �ereby ettirm Ihet there b e consWctlon lending agency for Ihe peAormance oi Ne work for whlch thls pertnit is luuetl. (Sec. 3097, CINI Code).
Lender9 Neme:
SlgnaNre: _
OWNER-BUILDER DECLAHATIONS:
Lenders Address:
Date:
I hereby ettirm the� unOer penalry ot peQury tha� I em EXEMPT FROM THE CONTpACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Business and Protessions
CoOe: My ciy or counry which requires e portnit to wnsWcL alter, improve, tlemdish, or repeir any swcNre, pdor ta Its issuance, elso requires Ihe epplicent for such permit
to tile e signetl stetemem ihet he or she ls Ilcensetl pursuam ro tlie proNsians of ihe Coniracton Lkense Lew (Chepter B(commendng wlth SecUon 7000) of DMsion 3 of the
Business eiW Professions Code) or ihat he a she Is exempt Neretrom erM the basis fa Ihe eUeged exemptlon. Any vidatlon of Section 7031.5 by any epplicent for a pertnit
sub�ects tne applicam to e cMl penalry ot not more than Trve hunEretl AWiars (55W).):
❑ I, as owner ot Ne properry, or my employees with weges es Iheir sde compensaUon, WILL DO THE WORK, entl Ihe stmcture Is not intended or ottered for sale (Sec.
7044, Business enE Protesslons Code: The Contraciors IJcense Lew does not eppty to an owner of property who bullds or Improves thereon, and who does suc� work
hlmself or herselt or t�rough his or her own employaes, provitletl that suU improvemenis ere not Intended or aflered tor sele. II, however, Ne builtling or improvement is
sWO wiNin one year of completion, the owner-builder vrill have tha burden of proving that he or she tlltl not build or improva tor puqqse W sale.j. '
❑ I, es axner of Ne Droperry, am E%CLUSIVELY CONTRAGTING WRH LICENSED LONTRACTORS to consirutt the pro�ecl (SecJ046, Business antl Professions
CoOe: The conireIXors Lkense Lew does not eppty to en owner of property who bullds or Improves Ihereon, entl who coniracts tor such pro�ect with a conireccor(s)
license pursuent ro the Contractors License Lews.).
❑ I em exempt under sec.
Slgnature:
Owner ID veAfied �y drlvels license. ❑ Ves ❑ No
Business end Professions Cade far this reason:
Vedlicatlon af OwnersNp by (type of aocument, i.e. - pmperty tex bill or deed):
DIVISION OF INDUS7RIAL SAFETV PERMR CERTIFICATON:
DriveYs License No.
Date:
Espires:
❑ I he�eby certlty t�at no excavetlon five (5) or mo�e teet in depth into whlch a person is requiretl to descend, wlll he mede in connection wilh work authorized by Ihis
permlt, an0 that no building strucfure, scaMoldinp, telsawork, or demolitlon or tllsmantling Ihereof, wlll be more then thirty-sl: (38) teet high. (Chap. 3.2, Grp 2, Art 2, Sec.
347, Tille 8, Celifomla Atlminlslrative Cotle). -
❑ As owner-DuilCer, I vrill no� employ enyone to do work which would require e permit from the Divislon ol Intlusirial Sefery, es notetl ebove, unless such person hes e
permit to do such work trom the tlivision.
Signature: Date:
Dlvision ot Intlustrial Satery Pertnit Number.
CERTIFlCATE OF COMPLLWCE AND AUTHORIZA710N OF EMAY: I certity under penelry ol per�ury thet I �eve reed t�is eppllcetlon antl s�ete Ihet the information given Is I
wrrect. I egree to compty with ell stete laws enA dty ortlinences relatlng to builCing consWclion, erM authodze representatives ol Ne Gry of Coste Mese to enter upon Ihe
ebove-descdDed pmPetlY �a� ��sPection Puryoses. I egree not Io oaupy or ellow oxupenry ol any building authorized by Nis permit unGl flna� inspeclion.
s,�,� INSPECfWNTTE
1616 Fixed System Finel Fire Preventlon
7266 Pool Spa Finel
200 Flnal RaRoot
201 Finel BlocklFleteining well
202 Final Feqory Fire Place
203 Final Sign
204 Flnel DemollUon
�� iy
int�—'r
�g �� COUEa INSPECTIONTYVE
206 Flnel Mechenical
208 Flnal PIum0ing
210 - Flnal Electrkal
212 Final Fire Preventbn
220 Final Planning Approval
222 Finel Site
250 FIneIBulltlinp/Occupency
Ilff�!!Li
ZZ �
�
(714) 754•5273 • Fex (714) 754•4056 • www.ci.costa-mese.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92628
;'S, •, r `/;
Job Address: 269 E 17TH ST
Suite No
MECHANICAL• PERMIT,, � .; : -
Vicinity: F`RE DAMAGE AF�P,
i 1 � � e _� . �.
._.�\, Q.' � p'
Parcel Number: 42522303 � .
Applicant: DOUGLAS FARNIK
Address: 6727 S GREENLEAF
WHITfIER,CA � .
Owner. SARRAF, KALEB
Address: P O BOX 247586 �
LOS ANGELES, CA - � -
Contractor. DOCKSTADERS GROUP
Address: 6727 S GREENLEAF
, WHITfIER, CA
' . '� MECHANICAL PERMIT FOR FlRE
REf#: BOS00147 -
: �.7�{hr,.., -;o'! •-
Phone:-,562-698-0201
Zip: 90601
Phone:.:' � - . .
Zip: 90024-9386 -
Phone: .562-698-0201
Zip: � 90601
�Licenset350935
•....,,.�_.r '
Status: ISSUED
Applied: 08242005
Issued: 08l24I2005
: :: ��. � �ti..
. . ... •,.
ISSUED BY:
,� WORK TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT AND 1 UP TO 3 HP/100 K"BTU. "- �
, 11I75/05: SUPPLEMENTAC'PERMIT TO ADD 1 NEW 4 TON COMPRESSOR�e , . ,
FEE SUMMARY ":
ISSUE FEE
inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair I Alt CoolinglHeat
Inst I Rep.�Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping � ,
FaIXory Fireplace
Hood wlMech Exhaust .
VAV Boz
Vent Fan / Single Dud
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000dm
AirHandlers> 10000cfm
FloorFurnace
Floor or Suspend Heater
�uantity , , _ �
523.50 .'.-.. .._- ' . ..,.. _ _..�.RepairlAltAbsorbtiodUnit
$0.00 0��:����- . _ � , Repair/AltRefrigerationUnit
$0.00 �, 0 Venfillation System
$0.00 � 0 Evaporalive Cooler
$0.00 - 0 Commercial Incinerator `
$0.00 0 Domestic Incinerator
$0.00. 0 � . � Comoressors / Absorption Svstems
$0.00� 0 - ' Up to 3 hp / 100 k BTU
50.00 0 .��. '. �� �. 3 To 15,hp / 500 k BTU .
$0.00 0 � �- 15 To 30 hp'/�1,000 k BTU ':
$0.00 �- �0�' ��5`.`� � � 30 To 50 hp'! 1;750 k BTU-�. �� ,
50.00 0"' `� � . � , . , � �- Over 50 hp / Over 1,750 BTU -
50.00 .0.... � . . Boilers " .. . . .
$0.00 0�� ', , � ", . Upto3hp � ., : � , �
50.00 0' ��; , - 3 To 15 hp'._ �- . '
$0.00 � 0, ' -` 15 to 30 hp- - � �. ,
$0.00 � 0.` ^ ' �� - 30 to 50 hp '
'�. $0.00�- '0 ; " , . Over 50 hp ; ; + - �
�� $0.00, 6 `-,j ' , : � _Other MechaNcal Fee
$0.00 !<�-D.,, " � � � '�- Investigation Fe ' ,�, _
- -'"`.'- ' - . • . -` Plan Che e- .", .:
' �. � . _ . Re' ction Fee� . �
�� � �TOTALCALCULATEDFEES
.. �<. .. \-ti�•^.,,��.C? '�,ai• ;r_� . ,
�� .
50.00
50.00
50.00
50.00
$0.00
$0.00
$1470
$27.15
$0.00
50.00
50,00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
572.85
quantiry
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
NOTICE: The work authorized by ihis permit shall compty with all applicable handicsp access requiremenis undar California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92)
EXPIRATION: This permlt shall eutomatically expire and become void if work is not cammenced within 180 days, or II work is euspended or abandoned
lor e period of 180 days.
INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with ail applicable codes, arM all
requlred Inapectiona and flnel epproval must be obtained. Failure to obtain inspections and flnal approval will result in the ezpiratlon of this pertni�
FOR INSPECTIONS CALL: (714) 754-5828 /
FL :+�^3(:i:71
WORKERS' COMPENSATION DECLARATION:
I hereby aHlrm under penalty ot perJury one ot Ne following declereUons:
❑ I heve enE will melnteln e certlllcate of consent to self-Insure br workero' wmpensation, es provided for by section 3700 oi the Lebor Cotle, lor the perta�mance af ihe
?� work for wNcti Ihis permil is luued.
Q' I have entl wlll maintain workers' compensatlon insurance, as requirad �y sectlon 3700 ot Ihe IeOor Catle, fw Na performance of the wwk }or whkh this permit is issued.
My workers' compensallon Insurence carrier and policy numDer ere:
one
POII�Mm1ber: ��.7J�i ' Zii�� '
oiless.)
❑ I cerlity thet In Ihe pertormence of the work for which thls permlt is issuod, I shell not employ any person In eny manner sa as to become sub�ect to t�e workers'
compensetlon laws ot Califomla, entl egree thet It I should Decome sub�ect to ihe warkers' compensetlon pmvlsions of Sectlon 3700 of Ihe Lebor Code, I shell forthwit�
comply with Nese proNslons.
r�ppkarrc�s�pnawre: �I.i....�✓ '�i�- D.���K �oa�'e.'1 l��l�/HT
WAHNINO: FAILURE TO SECVRE WORKERS' COMPENSFTION COVERA(3E IS UMAWFUI rWD SW1LL SUBJECT Ml EMPLOYEH TO CRIMINAL PENALTES M!D CML FlNES UP TO ONE HUNDRED
TMOUSMID DOILARE R��.�). �N ADDfiION TO THE W5T OF COAIPENSATIOH, DMA40ES A$ GROVIDED FOR W SEClION 3]OB OF THE LABOR CODE, INfEREST, AND ATTORNEV u FEES.
LICENSED CONTAACTORS DECLAHATION:
I hereby eHlrtn ihet I em Ilcensetl under pryylsk
force e�M eHact.lClc-N--. '�[.'�7iS
CONSTRUCTON LENDING AGENCV:
ot Chapter 9(commendng wit� Sectlon 7000) oi DHlsion 3 ot the Busineu and Proleuions Coda, and my Iicense is in full
❑ � hereby eflirm thet Ihere Is e wnstruMion lendinp epency for Ihe pedormence ol �he work tor which this pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lendels Name: LenOers Address:
Signeture:
OWNER-BUILDER DECLARATIONS:
Dete:
I hereby aHlrtn Ihet under penelry of perJury that I em EXEMPT FROM 7ME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Protessions
Code: Any clty or county whic� requires a pertnit to rnn5iruct, elter, Improve, tlemolish, or repalr eny structure, prior to Its issuence, also requires t�e epplicent for such pertnit
lo flle e signed stetement t�e� �e or she Is Iicensed pursuent lo Ihe pmNsions oi the Contreaoro LJcense Lew (Chepter B(commendng wllh Sectlon 7000) ot Division 3 oi the
Business end Protesslons Code) or �het he or she is exempt therefrom entl the Desis for the ellaped exemptlon. My Nolation ol Sectlon 7031.5 Dy any epplicent far e pertnit
sub�ects the epplicant to e dvll penelry of not more Uan five hundred dollers ($500).):
❑ I, as owner of Ue properry, or my employees with weges es thelr sWe compensetion, WILL DO THE WOHK, end t�e slrucWre Is not IntenCeE or otteretl for sale (Sec.
704A, Business and Professions Cotle: The Coniractars License Lew Ooes not epply to en owner of praperty who builtls or improves Nareon, end who does such work
hfmself or herseli w Nrough his or �er own emplqrees, provitled ihat such Improvements are not intanded or oHered for sele. If, however, iha builtling or improvement is
soltl within one yeer of comDleGon, Ne owner-builder will heve the Durtlen of proving that he or she did not builtl or improve for purpose ot seleJ. '
❑ I, es owner of Ihe property, em E%CLUSIVELY CONTRACTNG WfiH UCENSED CON7AACTORS to mnstruct IOe pro�en (Sec. 704a, Business end Professions
Code: 7he conirecrors LJcensa Lew does not appty to en owner ol properry w�o builds or Improves t�ereon, end who contrects tor such pro�ect wlth a contrectw(s)
IICBfISO OUf9u80� �0 UO r.00U8ClOB LiC8�19B L6w9.).
� 1 em exempt untler sec. Businoss enG Professions Code br this reason:
Signature: Date:
Owner ID verifled by drivers license. ❑ Yes ❑ No Drivafs License No.
VeriOcation of Ownership by (type oi tlocumenL i.e. � property tex bill ar deed):
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMR CER7IFICA710N:
❑ I hareby certify Ihal no excavatlon five (5) or more leet In tlepth Into which e person is requiretl to tlescend, will be made In connectlon wlth work euthorized by this
permit, end thet no bullding structure, scatlolding, lalsework, or tlemolltion or dlsmantling thereof, wlll be more than thirry-sl% (38) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Celllomla Atlministretive Coda).
❑ As owner-builder, I will not employ anyone to do work which woultl requlre e pertnit Irom the DMsion of Industrial Safety, es noted abova, unlesa such person has e
pertnit to do such work from the division.
Signature: Dale:
DMsion ot IntlustAel Sefety Permi� Number:
ICEBTIFlCATE OF COMPLIANCE AND AVTHOROATION OF EHfAY: I certlty untler penalry ot perjury that I have reed Ihi9 ep0���elion end stete Ihat the intormalion given is I
wrtect. I agree to compty wlth ell atete laws enA dry ord�nences releting to builAing constructlon, and euthorize representatives oi Ihe Ciry of Coste Mese to enter upon lhe
ebOve-tlescribed properry br InsDection purposes. I apree not to accupy or ellow occupency ol eny huilding euthodzed by lhis pertnit uMil Iinel Inspection.
Legal Owner(s) Date
� � a. a�a��.�vr tJ� g � _ _ __
,��� aom��A�t TT —T �—eate-�
COpE I. INSPECTIONttVE Q�
7616 Fi:ed System Flnal Fire Prevention
1268
200
201
202
203
Pool Spe Flnel
Flnal Re-Root
Final Block/Retaining Well
Final Factary Fire Place
Finel Sign
20A Final Demollllon
�$ , �j INSPECTIONTYPE
� 206 Finel MachaniCel
20B Finel Plumbing
210 Final Eleclricfll
212 Final Fire PrevenUon
220 Final Planning Appro+al
222 Flnal Site
250 Final BuIltlingi0ccup9n�y
8 z 6 �
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.w.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 269 E 17TH ST
Suite No
Status: ISSUED
Applied: OS/25/2005
Issued: OS/25/2005
Vicinity:
ParcelNunmber: 42522303 , � � "�" � ' - �' ISSUEDBY: �-�INLJ
. � , - . - .- _ _ -,
Applicant RICHARD DOUGLAS.MOODY ' ��' _ � �
� ,
i�- " ( ' � �� � ; ' ;� � � , % ��_ �:-�
Address: 1910 E"EDINGER \ �/` � - �� : - .
. . '.i, . .�' ,��� � ��- �Phone: 714-258-0803__�% , �� ;� �� ' ��., : ��.
�
�� SA TAANA�CA � �j�- _= Zlp: 92705 � , �� � � � - �
� �� �� 7 A '� .
:% � fV i
/ � 'q� �/� /i � - .
,�� � , �j� �,�. � � �.
Owner: SARRAF, KALEB' �= � ��
i�,, .: �� �,
.Address. P O BOX 247586 ' � �
� ,.�,
, � - � Phone:;� .'�V� �
� /,t , � �
� - _ �.LOS�ANGELES,CA Zip: .,90024-9386 �,�����
, 1i!, � . , . . .
.i. i � //��//.>--ij r �� ', �. \\j . , '
=r
r . 1,�, ` d
Con'trector �;,ISAACS PLUMBING ,, : ' � -.�'�'� ' �'� '
i�� � - y •�„ ��� � , `=" �- - �
Address.' ���7910�E EDINGER-.,- , 3 �� - - ' � - - - � �
.. . . . - ' i ' " � Phone: 714-258-0603 � �. . ` . .
� �
�, " ,
_ . • � SANTA ANA CA. " Zip: 92705 � � � � �
., , � ' j : ' - � ::- ticense: . 429549 � . . _ . . ' � . ,
, , , � ,�s' ' 'rv ��. r-�' � � _ _ . , .
. . .__ �j .Ir �. ,� �'� . , . �!�1.'� !�r1'_ � . .� _ -
��� � SCOPE OF PERMIT ',1,
,: PLUMBING PERMIT FOR FIRE DAMAGE REPAIR. .<.' _ '
� � . _ i , i ��,- ' _ � %,",' , .
-- . -\•,�� _ .f ;'� " �
' REF#BO5-00147 --'--- -=-- _ �i ^=:_ -- � - - , .
, .. �_ . ' . . .� ;'- '-
WORK TO INCLUDE: 1 GAS (1-4 OUTLETS), 1 WASH BASIN, LWATER CLOSET (fOILET) AND 1,
WATERHEATERNENL � - _. ' .� '
'- ` �" �` FEE�SUMMARY � � � �
� � � 'AMT aTY . � � .'AMT QTY � , ,� `
ISSUE FEE � �� $23.50. LaundryTubJ Washer - $000 �,0 , Sump Pump i
BackflowirtigaUon -�- $0.00.��_�0 - .,,,.Landscapelrngatlon_, � �.��5000 2;0.;`� ���y�_SwirFirningPool � �
ac ow reven er �� � - rap ., . Trap Primer. ,-
Bathlub � �� . 'SO 00 � 0 . A�� =P_ressure Regulator . ' � SO 00 =0 - � Unnel ���� , � �
Clarifer System � � , � �� $0 00��; 0 �., ��Process Piping (per 10 ft) �� $OAO� '� 0 � . �/iVacuum BikcBkfiow(1;4)��
Connect Qce,Soda�etc),'� $0 00 ,� ��0� A�Receptors ` � $0.00 _, 0 � /' Vacuurti Brkr Bkflov+(5+)
DentalUnits ,�.-`5000, � 0� _ � SepQcTank-� _ �,�_ 5000=,�=0� �� �Wash�Basm „'i '
Dishwasher '�$0.00 �� 0� �� � Sewer Cap for Demo $0 00"` 0 ���Wasli Basin�Set i
Drain, Floor �$0.00 � 0,� i� ,; -,� Sewer Connect $0 00 Of � � WOaste and Venl System
Drain,Rainwater $0.00�"�'�0 �- ,'�SewerPrivaleline � ;$0.00��0`��� ��WalerClosel(foileq
Drain, Roof $0.00���� 0_-� � ���Shower � ` � ' �.. � � $0.00 c; 0,_ -� . -Water-Heater I vent
Drinking Fountain $0.00 � 0�� ; � -� _.Sink, bar � � ' _ , , 30.00-" 0 - %i'�N/ater Piping (Inst or Rep.)
Expansion Tank $0.00 0 � � � Sink, commercial $0.00 -= _Oj ��J�, •'�Water Re-pipe
Gas EaMquake Valve $0.00 0 �-Sink, Floor �/ -�40.00 ""0�--' Water Service
' �" -
Ga5 (1-0 outlets) $6.15 1 Sink, kitchen /--"50:00 0 Water SoRener
Gas (Over 4 outlets) $0.00 0 Sink, senice/�o� $0.00 0 OTHER
, r
AMT
; 50; 00
$0.00
50.00
i 50.00
$0.00
$0.00
$9.80
$0.00
$0.00
$9.80
512.30
ao.00
$0.00
$0.00
$0.00
50.00
on
0
0
0
0
0
0
1
0
0
7
1
0
0
0
0
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requiremeMs under Calitomia stalules and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) �
EXPIRATION: This pertnit shall aulomatically expire and becnme void if work Is not commenced wlthin 180 days, or if work is suspended or abandonee
for a period of 790 days.
INSPECTIONS: In order lor lhe xrork authorized under this permit to be considered legal, such r✓ork must mmply with all applicable codes, and all
requlred Inspeetione and final approval must be ohtained. Failure to obtain inspections antl final �proval wiil result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
zaeae la�oo)
WOHKERS' COMPENSA710N DECLARATION: � � , � - , �
I hereby ettirtn under p¢nalry at perjury one of ihe following tleclarations: � �. ' '� � �
❑ I heve end wlll malntaln a cenilicate oi conaent to setl-Insure tor workers' compensetlon, as pmvided tor Gy section 3700 of the Lebor CoAe. for t�e peAortnance of Ihe
�..work.l r which t�is permit is iuuetl. � � . �
..;�.�nd will maintein warkers' compensetlon Insurence, as requireO Oy secUon 3700 of Iho latwr Cotle, Por Ne petlortnance of Ihe work for which NIs pertnll ISlssueC.
���My workers' cOmpensetlon Insurance rder enA pollcy n� ber are: �i1 ,,/ .
Car ei;: • � � ✓� �f �L A/ 17 //�/ S • P icy.f .�7SBZ �L J`Z Q`�J�-: �
(TFy'S�o��eed nat be�tl i/ the permif Is velued e one �undretl dollars (5100) oNess.)
❑ I ceniy that in the pertormence ol Ihe work lor whic��ihis perrnit Id Issued I shell not employ eny person in eny menner sa as to becoma subjact to the warkers'
compense�lon lews i o , nd e ree Ihet II I s�ould come sub�ecl to the workers' compensetlon proNslons of Section 3700 of IAe Lebor Cotla, I shall forthwith
camptywithihese.p visions ` ^-�
App ca,-n�t�Signetura: • e; V'� S(�C.!
�N : FAILURE TO SECURE OR :ERS' COMPENSATION COVE� OE IS UNLAW FUL AND SWH1 SUBIECT AN EMGLO �+ �' PENALTIES AND GVIL FlNES UP TO IXJE HUNDRED
SM1D OOUARE (5100.000�. IN ADDITIpJ TO THE C0.ST OF CO�nPEN$AT10N, DAMAGES AS PROVIDED f-0R IN SECTION 9)OB OF THE LABOR CODE, IMEpESi, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby ettirtn t�et I em licensed yqderp(ovisic
CONSTRUCTION LENDING AGENCY:
❑ I hereby eNlrm that there Is e conslructlon lendinp
Lendefs Nflme:
Signeture:
OWNER•BUILDER bECLARATIONS:
8(commencing wlth Sectlon 7000) af Division 3 of ihe
CoCe, end my license Is In full
tor the pedormance oi I�e work tor which this pertnit is issued. (Sec. 3097, Civil Code).
Lentler's Address:
Date:
I hereby attirtn Ihet under penalry ol perjury Ihet I am EXEMPT FPOM THE CONTRACTORS LICENSE LAW for t�e following reawn (Sec. 7037.5, Buslness flnC Professbns
Code: My dry or coUnry which requires e permit lo construct, alter, Improve, demWish, or repair any structure, prior ta its issuance, also requires the appliwnUor such permit
ro file a signetl stetement thet he or she Is Iicensetl pursuant ro the provisions ot t�e Contrectors License Lew (Chepter 9(commendng with Sectipn 7000) oi Dlvision 3 of Ue
Business end Professlons Code) or Ihet he or ahe is exempt Iherefrom and Ihe besu lar the ellegetl e:emptlon. My Woletion oi Section 7037.5 by any applicant tor e permit
subjects �ha epD���ent to e dvil penelry o1 not more then INe hundretl Oollars ($500).):
❑ I, es owner ot Mo property, or my employees wit� wepes es Iheir sde compensetion, W ILL DO THE WORK, and tha strudure is not intende0 or oflered for sele (Sec.
7044, Busines5 antl Professions Cotla: The Con�rectors License Lew does not epD�Y �o an owner of praperry who bullds or imprrnes ihereon, end who does such work
himselt or hersetl or through his or her own employees, praNded Ihat such Imprwements ere not intendetl or oHeretl lor sale. It, however, Ihe bulltling or Improvement is
sold within one yeer oi campleUon, the owneabuilder will heve t�e burdon oi Orovin8 thet ha or she did not build or imprwe for purposa ot sale.). �
❑ 1, as owner of Ue propery, am E%CLUSIVELV CONTRACTING WI7H LICENSED COMAACTORS to construct tha prqect (SecJ0d4, Business end Professbns
Code: The contrectors Llcense Lew Ooes not eppty to en owner ol properry who builds or Improves thereon, antl who contrects br such pro�ect wlth a contrector(s)
license pursuent to the ContraMors Lkense Lews.).
❑ I am exampl unOer sec. BuSiness antl Pralessions Code tor lhis reeson:
Signature: Date:
Owner ID verified by tlriver's Iksnse. ❑ Yes ❑ No ' Oriver's License No. Erzpires:
Vedficaqon of Ownership by (rype ol documem, I.e. � property tex bill or deed):
DIVISION OF INDUS7RIAL SAFETY PERMR CERTIFICATON:
❑ I hereby certity �het no excevet(on f(ve (5) or mOre feel in tlepih inlo which e person ts required lo descenA, wifl6a mede In connection wi(� work eulhonzed by this
pertnit, antl ingt no bullding siruclure, sraHolding, telsework, or demolitlon ar tlismantling thereof, wlll be more Ihen thirly-sla (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Celilomia AOministretive Code).
❑ As owner-6uiltler, I will not employ enyone to Eo work which would reQulre a pertnit Iram t�e Division of Industnal Satery, es nated above, unleu such person has e
permit to do such work irom the divlslon.
Signawre: Date:
Division ot Industnal Sefery Permit Number:
ICERTIFlCATE OF COMPW�NCE AND AUTMORVJ1710N OF EMRY: I cenity under penelry of perjury that I �ave read this epplication anE state that the informatlon given Is I
correct. I agree to comply with all state lews and ciry ordinances relating to builtling construction, and euthorize represenWtives ol the Ciry oi Costa Mesa to enter upon the
above-descnbed property for inspection puryoses. I egree nd to acupy or allow oaupancy ot eny building authorized by this pertni� until final inspectian.
COOE I,
7616
1266
200
207
202
203
wsvEEmxrng- � ^ " ' "
Fixed SySlem FNaI Fire Preventlon '_
Pool Spe Final _
Final Re-Rpo1• � _
F7nel B1ocWRetaining Wall _
Final Factory Fire Place '. , _
Finel Slgn ,�_
204 Finel Demblilion
�- .z.�`� 0•S'
� �ma�a, �
J�� ' f�Q1� INSPECTIONTYPE • �
206 Finel Mechanical �
�208. FInalPlumbing
' 210 Finel Elecqritel -
212 Flnel Fire Preventlon
' 220 Final Planning ApOrwal
222 �FinalSite
250 Final Building/Occupancy
� ��
//_�+1 � �
�
(714) 754-5273 • Fax p�a) �sa-aese • wwv+.ci.costa-mesa.ca.us 77 FAIFi UHIVt, GU51A Mt5A, GA 8262ti
ELECTRICAL PERMIT
Job nddress: 269 E 17TH ST
Suite No
Vicinily:
Parcet Nunmber:
AppliCant:
Address:
42522303
FOX, GERI
,�Ci ���� - " . -
. Phone: 951-279-0604
. �� ,
� � � � � , �
/�%���' -� - ` � /��
// � , . �
�
/ -' % \ � ` -!� � = � - . _ ,
Owner.� , SARRAF, KACEB `' �r, ' �� � — � -
�� ' � "�,i:�-
Address �; ;P O BOX 241586� � �"� =- �
� . ' = � �""' � Phone:
� LOS ANGELES, CA Zip: 900249386
� , . �j .
� ;�� .
Convactor. NATIONAL CONS7RUCTION RENTALS
. � Add�ess: 74557 ANDEL DR �' , � _ "
. � , � . � i - �� :Phone: (909) 574-1400 .
� � FONTANA, CA %' " � - 2ip: 92335 � -
- - ^ . � License:687160
.
/ '
Status: ISSUED
Applied: 07/Ot/2005
Issued: 07IO1I2005
ISSUED BY:
% � �^� -- �, `- l SCOPE OF� PERMIT ; � � - -� - . �
.' ONE 100A TEMP POWER P,OLE-IN CONJUNCTION WITH�THE�FIREbAMAGE REPAIR TO
'' ' . I REMOVE/REPLACE 3300 SF OF DAMAGED.ROOF STRUCTURE. - -- -
� ONE BUILDING WITH ADDRESSES: 267, 269, 271, 273 AND 275 E 17TH STREET.
� � REF: BO&00147 AND BOS-00344 �.�� , , �" i. ,., � - �
� FEE SUMMARY ? �
� � � • =�uantity , ' Quantity��; �
ISSUE FEE � � $23.50 Temp Dist System A LighGng $0.00 0-�i-,� � .
Temp�seivice tesC�� ` ',� � $0.00 , Busway /700 R $0.00 „0;�� , �
Res. a%c packagei ��` � 50.00 .�"' ' vStandin Sectlon 50.00 � 0� �
t.a ._t7' 8 .i_;
New Res (7�2 unils) �� ��j0.00 . 0 ., ��;�_��� � �� Misc Elechiral Equipment $0.00 / i3O ��
New Res (3+units) ;� ��$0.00 0 -=�::'`���"" Trenstormers uplto.l kva/kw $0.00 �� 0� i
Pool / Spa - ' � , , '$0:00 � �. - O�,i � � , :.... ....up to.10 kvalkw' a $0.00 ;� 0 : �
Ligh6ng Fixts � �' � � �� $0.00 � 0` ' ...........up to 50 kva/kw - . $0:00 0 -
Recept Outlets �.�� �� -$0.00�� � 0 „ , � � ............up to 100 kva/kw -50.00 ! � 0,
Switches � ' � �
`. `�>V C,� 50.00 �`:'; 0:. .' ==� ° .:.......:........Over 100 kvalkw.,%% 50.00° c/,0, /
Non Res Appl ���? � " 30.00�,� � � 0� _" r � � ` ��Low Voltage EquipmenC ",- , $0.00� � �.0 /
Res Appl ` � � �-$0.00 � -� 0 �--, -��''- ^ - �. � .. low Volt Wiring,System / Ckt �� �,$0.00��- 0 " % .
Service to 200a � �� �,�$0.00 ' �� � � 0��� ` - - -- �Misa Conduit = ' �-�$0.00 � , �0� �
Serviceto1000a �$0;00� , ; 0 � . Misc Conductoc�� � '$0.00� �'0�
Service over 1000a �30.00, �; 0, � -� �,� r _ �Circus ( gen�or,ride) � `, 50.00- �, �0
Motors to 1hp $000 ; ,� 0'�- , ' ` � Circus (meth`ride or,hghfs) ,/50.00' 0
Motors to 10hp $0.00`-. ��- : ��0_ , �� �i � ; �Christnias Tree-Stand - . - ,$0.00 0
Motors to SOhp 50.00 � 0 -� Fireworks Stand , -� '�$0.00 0
Molors l0 100hp 50.00 0' .�� O ctriwl Fee� $0.00
Motors over 100hp a0.00 0 � - -�' - - - �
NOTICE: The wOrk aulhorized by this permit shall comply with all applicabla handicap access requirements under Califomia statules and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) �
EXPIRATION: This permil shall automatically expire and become vo(tl if work is not commenced withln 180 days, or if work is suspentled or abandoned
for a period of 7B0 days.
INSPECTIONS: In order for the work authorized under thls permit to be consldered legat, such work must comply with all applicable codes, and all
requlred inspeetlone end (inal epproval must be obtained. Failura to obtain inspectians and final approva� will result In the expiratlon of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626
zaa6a816ro0)
WORKERS' COMPENSATION DECLARATION: �
I hereby attirm under penelry ot por�ury one o� t�e following deGaretlons: �
❑ I hev nd wiil malnlein a certlficate ot consen� to sell-Insure lor workers' mmpensation, as proNAed lor by section 3700 ot Ihe Lebor Cotle, tw the peAortnence o1 Ihe
lor whfch this pertnit is Issued.
�� I have arW vAi maintein workers' compensatlon Inwrence. es required by sectim 3700 0l ihe Lebor Cade. Iw the pertomiance ot the work for which this pertnit is Lssued.
=Mvworkers' compensatlon Insurg�c� certiar e tl II number ere:
C�e !�TZA-t/ �IJE,r7� 's lA�l��v �;,�,: _ % G-.I U.f3419 %z01 - 7 0•
(Th/s sectlon neetl rrot be comp/ete07! Ne perm/f Is velued et one �undred ddlers ($100) or less.)
❑ I certity that in t�e perto e ot Ne work tor wh tNs pertnit is Issued, I shell not employ eny person in arry menner so es t become sWject to the workers'
compensetbn lawa o1 C ito ie, end epree Iha �h md bewme sub�ect to the workers' compensetlon provlslons of Sectio 370 of the Lebor Cotla, I shell toMwit�
�DN with Nese P�ovls
n�o-�s�a�amre: oece: il
WARMNO: FNLURE TO SECURE WORKERS' COMPENSATION OVEMOE IS UMAWFUL AND SIULL SUBJEG! AN EMPLOYER TO CiUMINAL P NAL IES AND CML FlNES UP TO ONE MUNDRED
TlIOUSAND OOLLARE (E100,000), IN ADDRION TO THE COuT OF COMPENSATION, UAMhOES AS PRONOED FOR IN SEGTION 3lOfi OF THE LABOR OOOE, INTEREST, M!D ATTORNEY'9 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eMirtn t�et I em Iice rM r p sions ot Chapter commenGng with Section 7000) of Divlslon 3 oLt�e.Business and Professions Code, end my Iicense is In tull
force end eMect. .�� �� � � _ � _ �ClesslP_ ��s l .� I / _ _.
CONSTAUCTON LENDINO AGENCY:
❑ I hereby alTirm Nat Nere is a consirudion IenCing a9ency for Ne paAormance of Ihe work for which this pertnit is issue0. (Sec. 3097, Civil Code).
Lentlers Name: LerMels Atldress:
Slpnature:
Dete:
OWNER-BUILDER DECLARATIONS:
I hereby eMirm Ihet untler penalry ot per�ury Nat I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Buslness end Professions
Code: My dry or counry w�lcli reqWres e permit ta construct, elter, Improve, tlemolish, or repelr flny sWCNre, pdor ta Its issuenca, elso reqWres the epplicant tor such permit
to file e sipned stetement t�et he or she Is Iicensetl pursuent lo Ihe praWsions of the Contrectare Lkense Lew (Chepter 8(commendng wlth Sectlon 7000) ol DNL51on 3 al the
Business end Professlons Code) or ihet he or she is eaempt therefrom end the besis tor the elleged exemption. Any vlolation of Section 7031.5 by any epplicant for e pertnit
sub�ects t�e appliwnt to a clNl penelry o1 not more then fNe hundred dollars (5500)J:
❑ I, as owner o1 t�e properry, or my employees wiN weges ea their aole compensatlon, WILL DO THE WORK, arW the structure Is rrot Intentled or offeretl tor sale (Sec.
7044, Business antl Professions Code: TTe Contrectors Llcense Lew does not eppy to en owner ot properry who builtls or improves Nereon, an0 who dae9 such work
himself or hersett or Urough his or her own employees, proNded ihet suU imprwemems ere not Intended or oNereC lar sale. If, however, Ne Duilding ar Improvement is
sdd within one year ol completion, Ihe owner-6uilder will heve the 6urden oi proving Ihat �e or s�e did not builtl or imprwe for Durpose of ule.). '
❑ I, es owner of the property, em EXCLUSIVELV CONTRACTINO WITH LICENSED COHTRACTORS ro oonstrud the pro�ect (Sec. 7044, Business end Prolessions
Cade: The contrectors Lkense Lew tloes not epply ro an owner ol property who bullds or Improves ihereon, end who contrects lar such prqecl wit� a contrector(s)
license pursuant to ihe Coniractors Licensa Laws.).
❑ I am exempt under sec. Business end Professions Cade lor Ihis reason:
Signelure: Date:
Owner ID veritietl by tlAvers Ilcense. ❑ Ves ❑ No Drivels License No.
Veriflcetlon o1 Ownership Dy (pqe ol document, i.e. - praperty ten blll or deed):
E.pires:
DIVISION OF INDUS7RIAL SAFETV PERMR CERTIFlCATION:
❑ 1 hereby certily Nat no excavaHon fNe (5) or rtrore teet In depth Into which a person Is required to descerW, will be made in connection wiU work euthonzetl by this
permit, entl that no 6u(Iding struCture, ScaNdtling, talsework, or tlemolitbn or dismantling t�ereol, wlll De more than Wrty-six (38) leet high. (Chep. 32, Grp 2, Art 2, Sec.
3C1, T1tle 8, Celitomle AEmInlslretNe Cotle).
❑ As owner-builder, 1 will not employ enyune to tlo work wNc� woultl require e pertnit tmm the Dlvlsion of Industrial Safery, es nated abova, unless such person has a
pertnit to tlo such wark tran the divislon.
Slpnalure: Date:
Dlvision of Industnal Sefery Permit Num6er.
CEHfIFICATE OF COMPLIANCE AND AUfXOR2A710N OF ENTAY: I certify under penaly of perjury that 1 have read Ihis eppllcetion entl state ihat the InfortneUon given is
cortect. I egree to comply wlth all atete lews en0 ciry ordinences releting to Cuilding constructlan, enA euthoriza representetives ol the Ciry of Caate Mesa ro enter upon the
ebovedescnbed properry for inspectlon purposes. I egree not to occupy or allow occupancy o� eny bullEing euthanzed Dy Ihis permit until tinel inspection.
COUE �. INSPECfqNiYPE I
1618 FLceO System Flnal Fira Prevemion
1268 Pool Spe Flnel
200 Finel Re-Roof
201 Flnel Bbck/Retalning Well
202 Final Fedory Fire Plece
203 Finel Slpn
20A Finel Demolitlon
QAg It�LS
�f,� INSVECfpNTYVE
208 Flnal Mec�anicel
208 Finel Plumbing �
210 Final Electrical .
212 Flnal Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finel BullAing�Oaupenry
•. � aw. :
l i
i /,,�
(714) �54-5273 • Fan (�ta) �54-4856 • www.ci.costa•mesaELECTRICAL PERMIT n FAIR DRNE, GOSiA MtSA, GA 92626
,lobnddress: 269 E 17TH S7
Suite No
Ycinity: REGAL BEAUTY
Parcel Nunmber:
Applicant:
Address:
42522303
NGUYEN, TRAM B
14371 STARSIA ST
WESTMINSTER, CA - -
Owner: SARRAF, KALEB
Address P O BOX 247586 �.
�LOS ANGEIES, CA ��,- -"
Phone: 714-612-7112
2ip 92683
Phone:
Zip: 90024-9386
Contractor: DESIGN CONCEPT AND CONSTRUCTION
Address: i4379 STARSIA ST .
, � . . Phone: 714-612-7112
WESTMINSTER, CA . Zip: 92683
� � � License: 593686
ISSUE FEE
Temp service test
� Res.'alcpackage
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts � ,
Recept Outlets '
Switches
Non Res Appl
Res Appl �
Service to 200a
Service to 1000a
Servlce ove%1000a
Motors to 1 hp . ,
Motors to 10hp . ,
Motors to SOhp ,
Motors l0 100hp .
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
�ntermed Pole
INTERIOR TI TO�CREATE IN THE RETAIL AREA A
REF:�BO6-00089 AND BOS-00147/PREVIOUS FIRE
DAMAGE
79 LIGHT FIXTURES, 1 OUTLET, 12 SWITCHES
$23.50
50.00
$0.00
30.00
$0.00
50.00
$65.07
$1.10
$13.20
50.00
$0.00
50,00
„ '$0.00
,', . ao.00_
„ $0.00
$0.00
50.00
$0.00
� - � $0.00
50.00
`� $0.00
$0.00
$0.00
$0.00
50.00
Quantiy
0
0
0
79
1
12
0
0
_ 0
0
0
, a,
��, _
0
0
0 .
0
0
0
0
0
0
FEE SUMMARY
m
�,
Temp Dist System / Lighting
� Busway I100 ft .
: Standing Sedion �.
- Misc Eledrical Equipment
Trans(oriners up to 1 kvalkw
................up to 10 kva/kw
.................up to 50 kva/kw
. _ .................up to 100 kva/kw
-�� � �� :.................over 100 kvalkw
. Low Voltage EQuipment
Low Volt Wiring System / Ckt
, Misc. Conduil �
Misa Condudor � �
Circus ( gen or ride)
- Circus (mech ride or lights)
� Christmas Tree Sland
Fireworks Stand
� Other EleIXrical Fee
, Investigation Fee
� �Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 02I092006
Issued: 0?J092006
ISSUED BY:
�uantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0 `
sa.00, o
$0.00 0
$0.00 0
30.00 0
50.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 5102.87
nnuucurc � cncr�w�
�
NOTICE: The work authorized by this permit shall comply with all applicabte hantlicap access requirements under Calitornia 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 il work is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetlone and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
zasa+e�aroo�
WOHKERS'COMPENSAnON DECLARAnON:
I hereby etfirtn unOer penelry of perjury one ot Ihe tollov.•ing tleclaretians:
❑ I heve end will mainldln e certiticate oi consent to self-Insure br workers' compensallon, es provitled tor by seclion 3700 ot the Labor Code, lar the pedortnence ot the
�work tor whic� t�ls pertnil is issuetl.
`m' I heve antl wN meintai� workers' compensetion insuranca, es requiretl by secUon 3700 of Ihe Lebor Cotle, IOr the pertortnence of Ne work for whlch thls pe'mit is iswed.
My workqrs' mpen atlon Insurance ca er antl policy num�er ere:
cremer.'�i��e �MldPm� J;n4Lr��,c� Func� eaicyr�n,moec �g4-S3c7¢
(TTis secNon need nof be comple i! Ne pemuf is veluetl at one hundred dollars ($100J a IessJ
❑ I cenily that in Ihe partormance ol the work for which this permit is issueq I shall not employ any pe�son in any manner so es to Decome subject to the workero'
campensation Wws o� Celtlomia, and agrae that ii 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shatl torlhwiU
tomply vrith Ihese pr0�isiqqs. � , n_ I/ � C L F� /�—
ApPI�t:Sign �a ut re: �c�i/�' SGm , V (Date;� I PiU �/. � 40
WARNING: FNLURE TO SEWAE WORKERS' COMPENSATION RA IS UMAWFUL M'D SMALL SU9IECT AN EMPLOYER TO CRIMINAL PENr1LTIE5 AND G IL FlNES UP TOONE HUNDRED
THIXISANO OOLLARE (E100,000). IN ADDITION TO TME WST OF WMPENSATION, DMMGES AS PROVIUED FIXi M SECfION 3]O60F TME UBOfi COOE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hareby aHirm Ihac I em licensed under rovi i9Ps ot Chepter 9(commencinp wilh Section 7000) ot Division 3 o�t�usiness en�,Protesslons Cotle, end my Iicensa Is in full
lorce and eHect.�l� .C� ��n ��c Class tt 1'S
convac�ors sienaw�e:—• �.ri�it a6Y�», I1 Q1n.� .. oere•� ,� o
�---
CONSTRUCTION LENDING AGENCY:
❑ I hereby aXirm Ihat there is e consiruction lending agency for Ihe peAormance ot the work tor which ihis permit is issued. (Sec. 3097, Civil Code).
LenOe�s Name: . Lendels Atltlress:
Signature:
OWNER-BUILOER DECLAF7ATIONS:
Date:
I hereby ettirm that untler penelry of perjury thal I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lar t�e following reason (Sec. 7031.5, Business entl Professions
Code: Any city or counry wpic� requires e pertnit to consiruct, elter, improve, tlemWish, or repair any slruCWre, pnor to its issuance, elso reryuires Iha applicant for such pertnit
to file a slgneA stetement tqat he or she is Ilcensed pursuant to Ihe pmWsions ol the Camrectors Llcense Lew (Chapter 9(commendng with Section 7000) of OMsion 3 of t�e
Business entl Prolessions Code) or Ihei he or she is exempt t�erefrom antl the DesLs tor t�e allepe0 axemption. Any WWaOon of Section 7031.5 by eny applkant tor a permit
subjects the epplicant to a C�hl penalry oi not mare than tive hunEred dollars (E500)J:
O �, as owner ol the properry, or my employees wiih wages es their sole compensation, WILL DO THE N�ORK, and the structure is not intentle0 or ottered for ule (Sec.
7044, Business and P�ofessions Code: The Contractors License Law Goes not eppty to an owner of properry who builds or improves ihereon, and who does such work
himself or hersetl or ih�ough his or her ov.•n employees, providad that such imprwements ere not Intentled or ottered for sale. If, however, the building or Impmvement is
sold within one year o� completion, the owner-buildar will heve Ihe burden ol proving �hat he or she ditl not build or improve for purpose of sale.). '
❑ I, as owner of Ihe praParly, em E%CLUSIVELV CONTRACTING WITH LICENSE� CONTpACTOR$ �o ConsVuct the prol�� (Sec. 7044, Busine9s antl Prole55ions
Catle: The conirectorS Llcense Lew tloes not epply to en owner of propeny who bullCs or Impmves thereon, and who contracts tor such project with a coniractor(s)
license pursuant to ihe Contractors Licensa Lews.).
❑ I em exempt untlor sec. _
Signewra:
Business en0 Pmfessions CoAe tor t�is reasan:
Data:
Owner ID ved�ied by tldver'& Ilconse. 4'Q Ves ❑ No Ddvefs License No. E:pires:
Vedfication ot Ownership by (�ype ol tlocul�iel, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby cenlly thet no exwvatlon iWe (5) or more feet in depth Into which a person is requiretl to tlescend, will be made in conneIXion with work authodzetl by this
pertnit, antl ihat no Guilding siructure, scattoltling, talsework, or demolition or Aismantling thereof, will be more than thirry-six (36) leet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Titla 8, Califomia Administrative Cotle).
❑ A5 ownerbuiltler, I will no� employ enyone to tlo work w�ich woultl require e parmit fmm Ihe Division of Intlustrial Safery, as noted above, unless such person hes e
pertnit to tlo such worK <<om the division.
SignaWre: Date:
Division of Industnal Safery Permii Number.
CEHTIFlCATE OF COMPLIANCE AND AUTHORVATON OF ENTRY: I cetlily under penalty of perjury thet I have read Nis appliceiion end state that the infortnalion given is
correct. I agree to comply wilh ell state lews end ciry ordinences relating to builCing construction, end eu�honze representaiives ot Ihe Ciry ot Costa Mesa to enter upon t�e
ebove-descri�etl property fo! inspection puryoses. I egree not to occupy or allow occuDancy ot any building authorized by t�is permit until finel inspection.
COOE1, INSVECiIONTYPE QSIE UI�LS
1618 Fized System Final Fire Prevemlan
1266
200
201
202
203
Pool Spe Final
final Re-Root
Final BIocWRelainin8 Wall
Final Factwy Fire P�ece
Final Sign
�j �!$fjCT10NTYPE
206 Finel Mechanicel
200 Final Plumbing
210 Finel Electriwl
212 Final Fire Preventlon
220 Final Planning Approval
222 FinalSite
20a Final Demolitlon 250 Final BuildincyOccuperu.y
PA7F It�ELB
/L'1/. '.0