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Home My WebLink About271 17TH ST - Building Permits` -- Ldp of to5ta 7Y) e5a Was Development Services, Division.of Building and Safety CERTIFICATE OF OCCUPANCY This certificate is issued pursuant tthefrequirements of,the�niform Building Code, Section 308 adopted by the City oPCosta Mesa certifies.that at the time of,its.fssuance the building structure herein J; ;A' / 'gsu below described was ib§pected and!approved=f0 occupancyas follows: NBuilding Address 271 B 17RH'STRBET c N\Bldg. Permit No. B67612 Use RESTAURANT Group B-2 Type,'-4 Coristrucnon _ VN Fire,ZoniL `-T R1' Use Zone Owner of Building Tenant- . Address SAME AS ABOVE r By %/Cr �, BUILDING OFFICIAL-tOny tIN Baba = �, @y,y Fes. REQUIRED TO BE POSTED IN A CONSPICOUS PLACE Job Address: 271 E 17TH ST• 'Status: ISSUED Suite: Applied: 11/15/2005 Vicinity: Issued: 11/17/2005 Primary Occ: B Eat<50/ Office/ Bar<50 Type of Construction: V -N Parcel Number: 42522303 Zoning: Applicant: ENGEN, NORTON Address: 2750 SIGNAL PARKWAY SIGNAL HILL, CA Owner: SARRAF, KALEB Address P 0 BOX 241586. Plan Check: LOS ANGELES, CA Contractor: HAR-BRO INC Address: • 2750 SIGNAL PARKWAY - m Claim Valuation " $30,000.00 . ' SIGNAL HILL, CA. - - Zip: 90755-2207 � - Phone: 562-528-8000 ' Zip: 90755-2207 Phone: Zip: 90024.9386 Phone: 562-528-8000 License: 258441 Arch Eng: Address: - Address: Phone: Phone: Zip: - License: License: SCOPE OF PERMIT FIRE DAMAGE REPAIR TO AN EXISTING SUITE. - REF: 805.00147 - - iiI NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and became void if work is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 Z, 244848(8/00) FEE SUMMARY Plan Check: $0.00 Calc Valuation $30,000.00 Permit: $442.25 m Claim Valuation " $30,000.00 SMIP Res: $0.00 SMTP Com: $0.00 Other: $0.00 Inspection: $0.00 "Total: $442.25 PLANNING & ZONING SETBACKS -'�° • MAIN STRUCTURE Front 0-0 „ -- Rear .. 0.O Left 0-0 r - "Right 0-0 ACCESSORY Front 0-0 - Rear 0:0 Left' 0-0 Right .0-0 . PARKING Existing: 0 Required:, , 0 .. Proposed: ;(0' iiI NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and became void if work is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 Z, 244848(8/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I here affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the _ work for which this permit Is issued. 7 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' cempensallon Insurance carder and policy number are: q C� S7WTV GLs1VspI Po_[aWN r: % % t� / % — 0-V (This section need not be completed if the permit Is valued tone hundred dollars ($100) Orissa,) ❑ 1 certify that in the pedomlanoe of the rk for whl 1 Is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and gree 1 e subject to the workers' compensation provisions of Section 3700 o the Labor Code, I shall forthwith comply with these provisions. pticant.Signature:a WARNING: FAILURE TO SECUREW EN ON OOVERAG WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTI AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($/00,000),I ON THE T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS D ATION: I hereby affirm that I am licensed under pro ' Ions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and eMect.r..l C2 .R 1 Contractors Signature: Data:+ i CONSTRUCTION LENDIN A N ❑ I hereby affirm that the a is a ending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than live hundred dollars (S500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under W. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers Ucense No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Cade). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and cerity a Business Plan for emergency response to release or threatened release of a hazartlous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). ..............................................................................................................................................................____...._...........__._.................._..................................................... _... .......... __...................... _.__....... .. 2 Does or will the applicant or present or future building occupant need to lila a reglstretlon form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........._...................__.......__..................................................................................................................__..............___...........................................................................___......................................._......................._........ 3 Does �r will th❑e applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP H presently required, hes Section 25534 of the California Health and Safety Code been fully compiled with? ❑Yes ❑ No 5 Does or will the oast Air or present or future building t occupant require for the work which Is she subject c this a plication a ermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes � No (Section 66850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ....._................_.........__.._...................................................................................._............................._.................__.._............................................_._.._......_._._............ .....____......._..._............ .......__.................__...... 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......................... ___.........__......_.._.............___.._..........................................__.................__.._.__............................__......._...__...._......__"._.__..._—.___._............... ___.. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..............................................................................................................................................._..._................_._....._................._............................................................._.......................___......._...____................................................. 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHO ZATION O NTRY: I certity under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws d city ordin n relating to building construction, and authorize representatives of the Gty of Costa Mesa to enter upon the above-described property for inspection pureertegre occupy or allow occupancy of any building authorized by this permit until final inspection. Signalu al ////7D/"'P- T— u zed Ap 1 te_ 2&" INSPECTIONTYPE 010 lulu' WM INSPECTIONT" gATE II{ZmELS 1616 Fixed System Final Fire ev tion 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2 (714) 754.5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us Job Address: 271 E 17TH ST Suite No Vicinity: FIREDAMA EDAREA Parcel Number: 42522303 Applicant: DOUGLAS FARNIK Address: 6727 S GREENLEAF WHITTIER, CA 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICALIPERMIT..,,,.' 9 = :• - •• Status: ISSUED Applied: 08242005 Issued: 08242005 Phone: 562-698-0201 Zip: 90601 Owner: SARRAF, KALEB Address: P O BOX 241586 - - COOLING/HEAT -- ..Phone: LOS ANGELES, CA Zip: Contractor: DOCKSTADERS'GROUP Address: 6727 S GREENLEAF 90024-9386 Phone: ,-562-698-0201 WHITTIER; CA Zip: •90601 License:350935 i SCOPE OF PERMIT . MECHANICAL PERMIT:FOR FIRE REPAIR DAMAGE. REF#:605-00147 WORK TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT (5 DUCTS). 11/15/05: SUPPLEMENTAL. PERMIT TO ADD 1 COMPRESSOR 3 T0.15HP/500K BTU DELETE 1 REPAIR/ALT COOLING/HEAT FEE SUMMARY, Quantity., �_ - Quantity ISSUE FEE $23.50 - - - - Repair /Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair /Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/ Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Commercial Incinerator 50.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors /Absorption Systems Gas Piping $0.00 0 `. Up to 3 hp 1100 k BTU $0.00 0 Factory Fireplace $0.00 , 0 "' " 3 To 15 hp7 500 k BTU $27.15 1 Hood w/Meth Exhaust 50.00 0, i' " 15 To 30 hp'/ 1,000 k BTU $0.00 0 VAV Box $0.00 0 - _ 30 To 50 hp / 1,750 k BTU $0.00 0 Vent Fan /Single Dud $0.00 . 0 Over 50 hp,hOver 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers - Fire Dampers - $0.00 0 ' - Up to 3 hp'_, � , - -. $0.00 0 Smoke Dampers $0.00 0 - ,. _ :-3 To 15 hp" $0.00 0 Inst or Relocate Appl Vent $0.00 ..' 0 ._ - - 15 to 30 hp , . - $0.00 0 Air Handlers < 10000dm - $0.00 0, - ' - . 30 to 50 hp',., '• .. $0.00 0 Air Handlers > 10000dm $0.00 0 .�, -- �-- ; _ Over,50 hp� 1..:.' $0.00 0 Floor Furnace $0.00: 0- Other Mechanical Fee' - Floor or Suspend Heater $0.00'1-- 0 -;�- - � • Investigation Fee,;',,. '^-, $0.00 Plan CheckFee., - $0.00 •- '--`_.' .; -'.•Reinspection Fee $0.00 TOTAL CALCULATED FEES $58.15 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.!` FOR INSPECTIONS CALL: (714)75&5626 2"648 t8=1 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Cade, for the pedorthance of the work for whlch this permit is Issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code. for the performance of the work for which this permit is issued. My workers' compensation Insrance carder and policy number are: �Cerrlar: - % —Pblic`y NurQber. 1��61� '?A05- -(This sacdon•i n f be conlp/eted7l the permit Is valued atone hundred dollars ($100) or less.) ❑ I conity that In the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provislons of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. �. A� WARNING: 'sFAigoILUaRluiE OCO�RMP�ENSAT�ION— � • Lpata-�' I 1 IA • ❑L� COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby afOrn that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license Is in full force and effect. LLic"l-.71<10 '_ L°$1 N -C�h dors Signa CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance o1 the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requlres the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Or she is exempt therefrom and the basis for the alleged exemption. Any violatlon of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penally of not more than two hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors Uconse Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Vedficatlon of Ownershlp by (type of tlocoment, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet In depth Into which a person Is required to descend, will be made in connection with work authodzed by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thlrty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and cort1ly, a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Sedlon 25505 of the California Health and Safely Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a repotted year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic lest of compressed gas at standar temperature and pressure). ..................__....................._.._..._._.......__....._._.._.._._..................__.................."__............................................................. _. .......�...... ._......___._.� 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safely Code, with some exceptions, requires registration with the Cse Costa MeFire Department by each business which at any one time has on hand a quantity of acutely hSz8rdWs materials aqua to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............................. .... ......._................._.._..-..._._.—.._.....................__.............................. __......................... .......................................... .................................. _....................... _........... . ........ _------- __ 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Coate Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........................................................._._........-...........____.......—.........................California ..................................................._._-.......... ._..........._. 4 If en RMPP is presently required. has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑�No ........................................................._..........._..........._.___._._._...............................-_.............................._......................................................o................................................................................................................._..............._. 5 Does or will the applicant or present or future builtling o from at require for the work which is the subject c this a plication eggernit for such construcllon Or modi6callon from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .........._........................__................. _._........ _..___..-__._............ —___.................. __.................. _.._........................................ _............................ ........_._...... ......__........._.._..__..__.r. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). 7 If a permit from the South Coast Air preww1 Management District or other air pollution control 303 been or agency Is required for the work which is the subject of this application, have all of the disclosures prescdribed by California Health and Salary Code Section 42303 been matle? ❑Ves ❑ No 8 (If 'yes*. attach Certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cerdty, that under penalty of perjury the information given above is correct. I agree to Comply with all state laws and City ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to Comply with all stale laws and city ordinances relating to building construction, and authorize representatives of the Clly of Costa Mesa to enter upon the above-described property for Inspection purposes. I agree not to ocoupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) ` Date `1i�\iiL 1�• 1q.05 And/Or AuqT.d_A . icant (Date CODE f. INSPECTIONTYPE gA¢ ISL$ CODE If INSPECTION TYP 2AMILjT�L$ 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pod Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final BlockfRelaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.f(JMBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 271 E 17TH ST Suite No Vicinity: RESTAURANT Parcel Nunmber: 42522303 Status: ISSUED Applied: 05/25/2005 Issued: 0525/2005 Applicant: RICHARD DOUGLAS MOODY ISSUED BY: Address: 1910 E EDINGER Phone: 714-258-0603 SANTA ANA CA ... Zip: 92705 v'--, Owner: SARRAF, KALEB Address P O BOX 241586 f Phone:, - LOS ANGELES, CA ." _ Zip: 90024-9386 - .r Contractor: ISAACS PLUMBING Address: 1910 E EDINGER ' Phone: '714-258-0603 SANTA ANA CA Zip: 92705 - License: '429549 SCOPE OF PERMIT REVISION TO PERMIT ON 0823/05, TO ADD 1 GAS (OVER 4 OUTLETS) AND 2KITCHEN SINKS. .'. - PLUMBING PERMIT FOR FIRE DAMAGE REPAIR. REF#B05-00147 - -- y WORK TO INCLUDE:I GAS (1-4 OUTLETS), AND I WATER HEATER/VENT. FEE SUMMARY" AMT QTY "" - - --,- -AMT AMT ISSUE FEE $23.50 Laundry Tub/ Washer' -- $0.00 .QTY 0 - Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00, 0 Swimming Pool $0.00 0 Backflow Preventer - $0.00 0 P -Trap . $0.00 0 Trap Primer $0.00 0 Bathtub - $0.00 0 Pressure Regulator - -$0.00 ; . 0 Urinal - $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 - Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank - $0.00 0 Wash Basin - $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo •_ 501,00,„ . 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 -- Sewer Connect $0.00'`'.` 0'_ Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line ; $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower ., $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 - Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial - $0.00._ -0 _ Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 ' " Sink; Floor -.. , - �: $0.00„ ="0 Water Service $0.00 0 Gas (1-4 outlets) $6;15, 1- Sink, kitchen" _ - , 2 Water Softener $0.00 0 Gas (Over 4 outlets) $1.10, 1 - ".Sink,-service/mop $000 ^a.0 - OTHER $0.00 Gas Repipe $0.00 0 - Spa (private)$0 w0 Yo' , - VIOLATION $0.00 Gas Service $0.00 - 0 'Spa (public) ,;'t $0.00f,';0 ' '`, PLAN CHECK $0.00 . - Interceptors (Grease, Oil) $0.00 0 ,.,._ , , .,,--�, ; a -:. REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $62.65 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become vold if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaaeca(tivo( DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ ihave and will maintain workers' compensation insunmw, as required section 3700 of a Labor Code, for the Performance of the work for which Nb permit Is issued. My workers' compe on Insur ce carder and r are: '/ v Cenie---*---- --9 01 (-Policy Number.". '�/� �z/f !,y (This section need not he Complet f the permit is ve ued at one ndred lays ($ 00) or less.) 9 r— H Orrl certify that in the perfortne ca of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers' I Compensation laws of California, and that If 1 e Could beCo subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith ions. �f comply with these provis% Applllce^n)I.Slgnature: Dete:Y"^+- A 3-Or WARNING: FAILURE TO SECURE WORD COMPENSATION COVERAGE NLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE (SI 00.000), IN ADDITION TO THE COST OF ON, DAMAGES AS PROVIOED FOR IN SECTION 3700 OF THE LABOR ODDS, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed uncle roviIons of C ter 9 (Commencing with Section 7000) of Division 3 of the Business and Prof to s Code, and my license Is in full force.and effect: Gd'8i Claw ' ^w- Contractofs Sign uet re: Deter CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, CMI Code). Lender's Name: Lendefs Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons Code: Any city or county which requires a permit to Construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than Me hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole Compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of Completion, the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires:' Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsetwork, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner-builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to lila and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a repotted year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....................-......................_._..................._._..____.____.._____.__...._—._...........__.............._..............................._.........__...........__....._ .............�_._...__._� 2 Dcas ar will the applicant Or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Sectlon 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity of mutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of Compressed gas at standard temperature and pressure). ............................................__..............._.__................_—.................. ___.............. ._...................... ... ._............................................. _..... ..... _.._.-..._ 3 Does or will theeppplicanl or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely Hazardous materials)? ❑ Yes 11No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP Is presently required, has Section 25534 01 the California Health and Safety Cade been fully complied with? ❑ Yea - ❑ No 5 Does he will the applicant Or lilyMpresent Or future building occupant require for the work which is the subject of this a plication ePPermit for such Construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ No (Section 65650.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be Constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................__..._......____._ ._.._..._.......... _—...... ......... __............... _... _..... -....... .................... _........... _ .... — .......... _.__... _.... 7 If a permit from the South Coast Air Quality Management District or other air pollution Control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................ ......................................... __............................_..._.......................................................................................... .... ... ......................................................... _................. ___ .............. _............ 6 (If yes", attach cartificate of Compliance from the appropriate air pollution Control officer). CERTIFICATE OF COMPLIANCE: I Certify that under penalty of perjury the iniormatlon given above is correct. I agree to comply with all state laws and city ordinances regarding Hanrdous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to Comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mese to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig ure Oa �er(e) Zotr r � r drtzed Applicant .: -h'` • Data c ,�- CODE If. INSPECTIONTYPE ge¢ KunA CODE r INSPECTIONTYPE 2&U INTITIA� 161 Ixed 206 Final Mechanical 1 268 P IISpa Final 20B Fila^ Plumbing 200 Fi I Re-Root 211 F,id1\I Electrical P 201 F�I ) BlocPeam� an, wI2 JF2/-Fm�al�Fl� �v�� inal 2 F ory: to Place � I �M1 �, I �I� 20 40 .FiPia nal rgning Approval 203 Si n � f �✓ r IJ I I �lyv I 222 Final 204 Final Demolition" 250 Final Building/Occupancy Job Address: 271 E 17TH ST Suite: Vicinity: Parcel Nunmber: 42522303 Applicant: PIVINK, JORDAN Address: 19900 MAYALL STREET CHATSWORTH, CA Owner: SARRAF, KALEB . Address - Zoning Phone: 800-540-7605 Zip: 91311 Phone: Zip: Contractor: ALPHA SYSTEMS FIRE PROTECTION CO Address: P O BOX 331027 Phone: 818-882-2730 PACOIMA, CA Zip: 91331 License: 687305 Status: ISSUED Applied: 12/212005 Issued: 01/05l ISSUED BY: SCOPE OF PERMIT INSTALL HOOD AND DUCT SYSTEM FOR FIRE SUPRESSION FOR "FRENCH CUPCAKE BAKERY". REF.: B05-00147 FEE SUMMARY Plan Check: $27.17 Calc Valuation: $1,100.00 Permit: $41.80 Claimed Valuation: $1,1oo.00 Other: $0.00 Total: $68.97 1-G-0� GGrIu�C/� l-01/1�G Had oh. k NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 [ano-aa taw) Dma= WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Cede, for the performance of the work for which this permit is issued. _ _❑.-..I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Myvrorkers' Compensatlon Insurance carrier and polity number are: q Cy Carrier: _�f �(ATi rwnS -r Mrs socuort need not be completed if the permit is valued atone hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work f cw{tich this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo , and agr 4th Yf I should become subject to the workers' compensation provisions of Section 3700 of the Labor Coda, I shall forthwith complywiththosa"provisio . 9pplkemS gnat ure_ Date: WW9FXANB'fAI UL O CUR ORKE ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPL� ER TO/CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED -THOUSAND DOG.AR 1a0 ). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR N SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I herby affirm that I em.licemsetl under provisions of Cheptef 9 (commencing with Section 7000) of Division 3 0r' the Business and Profssis Code, antl my license is In full ( ?Dico end effect. Lk. a Class H -Contractor' —Signature;— ` CONSTRUCTION LENDING A NCV: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professiom Code: Any city or county which requires a permit to construct, alter. Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Coda) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any appeoant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). - ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by.dd'er's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Owneishlp by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a Permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mese Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume o1 55 gallons, or 200 cubic feet of compressed gas at standar temperature and pressure). ...................................................................._....... ................. __..__.�f.._.___...._...._....................................._............................................................................._... ........ ____............._............._._......._......- 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cade, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .. ............................ .............................._...................._.............................................................................................. _...................... ................................................. ................................... _........................ _........... __.............. _............ _.._....... 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP Is presently requiretl, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑NOA ..... .. .....ill th_...app ......... v went .. g 9 occupant q__......................ork which _ ...................... subject of this22p............._.._y_.....:__.___..__ from the South Coast Air QualityManagement District or from an other air pollution control district ore en Yes No 5 Does or will the applicant or resent or future bulldin occu ant re uire for the work which is the sub"act of this a licalion a eRmlt for such construction or modification (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..........._.._............. .._.............. _.._.......... _._................ _..... _.................. _.......... _......................................... _._........ _........................................................................................ ........................ 6 Will an ry ........___..._.._—_.....-_._. y part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................................................._.._..........................................._—__..._....__.............................................................................................................................................. __.................. _.._._..._............__..........___...... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? []Yes ❑ No B (It yes", attach certiecate of compliance from the appropriate air pollution control officer), CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i tur Owner(s)Dai -I - oZ rAut tt-on'zed - Icant-�� r" -Date... CODE # INSPEChON TYP gag INTITIA CODE r INSPECTION TYPE gdg Irk 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical ' 201 Final Block/Retaining Well 212 Final Fire Preventlon 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Suilding)Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.00sta-mesa.$Ig LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 271 E 17TH ST Status: ISSUED Suite: Applied: 11/23/2005 Vicinity: CALIENTE RESTAURANT Issued: 11/23/2005 Primary Occ: B Eat<50/ Office/ Bar<50 Type of Construction: V-N Parcel Number: 42522303 Zoning: Applicant: JOSEPH KHALAF Address: 705 VIOLET-TA DRIVE Phone: (626) 893-1514 ISSUED BY: ALHAMBRA, CA Zip: 91801 Owner: SARRAF, KALEB Address P O BOX 241586.- �1Phone. LOS ANGELES, CA Zip ¢ (90024-9386 Contractor: KHALAF CONSTRUCTION M".v� - Address. s 705 VIOLETTA DRIVE' . -, _. " .. --- ., , ?•„ • Phone: (626) 89 -1514 --, • ; "`• ALHAMBRA, CA, ;,.°.-�;: `^•.' � � • Zip` 91801 License: 484667 - - '� - Arch Eng: Address:. - Address: - _ Phone:„Phone: Zip:. - .r - (License: ;. License: SCOPE OF PERMIT; TI PERMIT FOR FIRE DAMAGE REPAIR FOR "CALIENTE RESTAURANT".` Y —. =-FEE SUMMARY Plan Check '$117.81' _ u ' CalcValuation $io,000.00 Permit.. �' $181.25:: = ....s: �.' '`�. Claim Valuation $10,000.00 SMIP Res "' $0.00 SMIP Corn: • ; $2.10. m Other $0.00 Inspection: $0.00 Total: $301.16, ,r PLANNING & ZONING SETBACKS, MAIN STRUCTURE =Front 0-,0 Rear,'0-0 ° 0 0 'Left,,,, 0.0 Right 00.0' ' ACCESSORY,` Front.-0-0-Rear 0-,0 ea ,.n Left; 0 0 t Right -''0-0 � PARKING Existma Reouiied: 0 Proposed 0� E� Rl a NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicablees, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration o this penult. FOR INSPECTIONS CALL: (714) 7545626 2"646 (elect) DECLARATIONS WORKERS' COMPENSATION DECLARATION: - I hereby affirm,under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the r�w;a r which this permit is Issued. ❑tet' ave and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which ails permit is Issued. My-wprkers' compensation Insurance carder and policy number erai'� A ��1 / p Policy Number. � Y:!& L L9 S (This section need not be completed / the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cafloml nd agree that if I souhbecome subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with (hese pr Appticnt'Signeture. —� l L i WARION& FAILU SECURE WORKERS' COMPENSATION OOVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMQLOyERZO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND E (SI OO,O001, IN AODmON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions CojEn4 .yy license Is In full force and'effect. ❑e`Pes 6 Gass L — C Lo Contractors Signs turDate:. _ // -- Z? CONSTRUCTION LEN NG AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued, (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages Be their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). , I ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and. Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by divers license. ❑ yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax DIII or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth into which a person is required to descend, will be made in connection with work authodzed by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thlrty-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Cade). ' ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the dIvlsion. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certity a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mase Fire Department by every business which has at any one It= during a reporad year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .........�......................_...................... nt or pr_....._........futurebui.______'..__,..__....._.....____.................�....................................................................._. __._._..__.___...._...__.._ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous matori91s7 ❑Yes ❑ No , (Section 25533 of the California Health and Safety Cade, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2001cubic feet of compressed gas at standard temperature and pressure). ..........._............................................................ __........... ................................................ _.................... _............................. ........................................................................................................... -_... ................ __.................. _................. ......_ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ NO (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ......................................................................................................................................................................................................................................................................................................... ........................................... ............. _................ 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of Thisa plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 Ye9 a No 1 (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ....................................................................... ._.___......................................_.._...............__............................................................................... ..............."...................... . ........_.._..........._.................._............___..............._ 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..... ...... P _...... :...... _. _....................... . _............. _.............. _............. _ _. _...............;................................................................8 ........Y ...............;_......................................................... _............... 7 If a application, tram the South Coast Air Quality Management District or other et pollution S control district ora enc Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ Na B (If yes', attach certificate of compliance, from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above Is correct. I agree to comply with all state laws and city'ordmancos regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZAT10N OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignature OI 1 Own s) Date L_,1usdlQr.A zaa.Applkaffl � ' Date CODE 1. INSPECTION TYPE PAIS 1[x!4 CODE1 INSPECTION TYPE PAIL IIfIITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final BlocktRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy L.� (714) 754.5273 • Fax (714) 754-4656 • www.cl.costa-mesar -VCTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 271 E 17TH ST Suite No Vicinity: CALIENTE RESTAURANT Parcel Nunmber: 42522303 Applicant: JOSEPH KHALAF Zip: -'91801 Address: 705 VIOLETTA DRIVE ., License,484667 Phone: (626) 893-1514 ALHAMBRA, CA Zip 91801 Owner: SARRAF, KALEB Address P 0 BOX 241586 _ Phone: - -REF#: 805-02121 LOS ANGELES, CA ', - Zip: - -90024-9386 •. Contractor- . KHALAF CONSTRUCTION CO :WORK TO INCLUDE: 14 LIGHTINGFIXTURE,-16 RECEPT OUTLETS,.4 SWITCHES AND 2 MOTORS TO Address: 705 VIOLETTA`DRIVE Phone: (626)893-1514 Status: ISSUED Applied: 11232005 Issued: 11232005 ISSUED BY: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes d related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work Is suspen 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 appll ble codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244846 (5W) -ALHAMBRA, CA Zip: -'91801 ., License,484667 -. - SCOPE OF PERMIT'. > :ELECTRICAL PERMIT FOR*IRE DAMAGE REPAIR FOR "CALIENTE RESTAURANT". - -REF#: 805-02121 - _ :WORK TO INCLUDE: 14 LIGHTINGFIXTURE,-16 RECEPT OUTLETS,.4 SWITCHES AND 2 MOTORS TO 1 01-11F. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System'/ Lighting - $0.00 0 - Tempservicetest $0.00',','.;'__' '" Busway/100ft ' $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool ISpa - $0.00 � 0 .........::.....up to 10 kva/kw $0.00 0 Lighting Fixts $15.40 14 .................up to 50 kva/kw $0.00 0 Recept Outlets . _ $17.60 16 -,, .........:........up to 100 kva/kw $0.00 0 Switches x$4.40 4 '" ..........:.......over 100 kvalkw $0.00. 0 Non Res Appl ., ,._ $0.00, 0 . „ Low Voltage Equipment $0.00 0 Res Appl - som ; .::-0 Low Volt Wiring System LCkt' -' $0.00 0 - Service to 200a - $0.00 . , 0 - . - Misc. Conduit - $0.00 0 Service to 1000a - s0.00 •,0 Misc: Conductor $0.00 0 Service over 1000a. $0.00 - 0 Circus (.gen or ride):- - $0.00 0 Motors to 1 hp _ $0.00 - 0 Circus (meth ride or lights) $0.00 0 Motors to 10hp - $24.60 ! - 2 - - -Christmas Tree'Sland $0.00 0 Motors to SOhp - -. $0.00 - "o - Fireworks Stand $0.00 0 Motors to 100hp •.,$0.00 0"- Other Electrical Fee $0.00' Motors over 1 00h $0.00 '-0' - `- Communication drops _ $0.00. -- 0 "' Investigation Fee 1 - ' $0:00 Sub panel to 200a $0.00 .. • 0`.----' j- Plari Check Fee $0.00 Pole Light Pkg $0.00 ' 0 Reinspection Fee $0.00 $0.00 Sign Circuits $0.00 0 - Temp Pwr Pole $0.00 0- TOTAL CALCULATED FEES $85.50 Intermed Pole $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes d related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work Is suspen 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 appll ble codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244846 (5W) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain it Is certificate of consent to self -insure for workers' compensation, as provided for bysection 3700 0l the LaborCode, for the performance of the work for which this permit Is Issued. - 'v -s-.F. �j]'�I'have end wql maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Lowed. �My workers' fompensatlon Insurance carrier and policy number are: ,/ / `Ler _ �fA hr_ �4-.,%� t ✓) cUL •« �x,.,t,-C) s PoNair Number.—I V/4 PO S -(Thrs secfion need not be completed if the permit is valued atone hundred dollars (S 100) or less.) ❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any portion in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensatlon provisions of Section 3700 of the Labor Cade, I shag forthwith comply with these pro 'sic •Appttcent S i w Date: /,11�'�— Z3 — BS tWARMNG: F RE O ECURE WORKERS' COMPENSATION ODVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLAR $100,000), IN ADO mON1 TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby afflrin.theI I... m gcensed under ro�siomg of Chspier 9 (commencing with Section 7000) of Division 3-of.lhe Business and Professions Code, and my license is In full I ros and effect.. r -'s ' (P r Class a D Contractors Signature: /r✓ Via: I 1 � CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there i5 a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, Or repair any structure, prior to its issuance, also Taqulres the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of DMsion 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): , ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion. the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a dontractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivels License No. Expires: Verification o1 Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby candy that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, lalsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). j ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division Of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a re anted year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, .or 200 cubic feet of compressed gas at standard temperature and pressure). .... ........... _._......................._�....W._.......__..............._.............................._-.—.__..�...... .........._. _._ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous motorists equal to or greater than a weight of 500 pounds, or a volume Of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ._.......... __._................. _.__..._........ 3 Does or will theaeppplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP—Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does ar will the applicant or present or future building occupant require for the work canton Is the subject of this eplication ePParmit /or Such construction Or modification from the South Coast Air Quality management District or from any other air pollution control district Or agent)? � Yes u No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ............................................................................. _.-.........................................._.... __................. __._................................... ................... ......................................................... ............................... _._... _.......... _.......... _........... " 6 W III any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _._.....__—_._.. —_...........____................._._.............................__....._._........................................ —..._._.._.... 7 If a ppermit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this applicatlon, have all Of the disclosures proscribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No 6 (If yes', allach cortificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. i Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign fur ner(s) Date AnaTr ed Applicant CO0E1. INSPEcToN TYPE PETE ILDIDeLS CODE I INSPECTIONTYPE Pd1E INTMALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical n 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical (Z g.3 201 Final Block/Retaining Well 212 Final Fire Prevention 2D2 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.00sta-mesa." MBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 271 E 17TH ST Suite No Vicinity: CALIENTE RESTAURANT Parcel Nunmber: 42522303 Applicant: JOSEPH KHALAF Address: 705 VIOLETTA DRIVE Phone: (626) 893-1514 ALHAMBRA, CA -Zip: 91801" Owner: SARRAF,KALEB Address P O BOX 241586 /- - - -P_hone;� ;LOS ANGELES, CA Zip: 90024-9386: �- r, Contractor: KHALAFCONSTRUCTION CO Address: .'705 VIOLETTA-DRIVE I Phone .'(626) 893-1514 CA Zip _91801 License:,. '484667 Status: ISSUED Applied: 11/23/2005 Issued: 11/23/2005 ISSUED BY: 1 '� Bathtub .f 1,',. $01,00, SCOPE OF PERMIT = $0.00 0 Unnal $0.00 0 Clarifier System ' PLUMBING PERMIT FOR FIRE DAMAGE REPAIR FOR "CALIENTE RESTAURANT, �, . Vacuum Brkr Bkflow(1.4) $0.00 " Connect (Ice,Soda,etc) - $0.00 0- Receptors .I Vacuum Brkr Bkflow(5+) $0.00 0 "REF.# Bo02121 :�" $0.00 , -, 0„� Septic Tank ' = $0.00 0 WORK Moo ,, of,,:, Sewer Cap for Demo $0.00 0 Wash Basin Set '^ $0.00 0 TO INCLUDE 3 SINKS AND 1 WATER HEATER $0 00 `0' Sewer Connect -• $0 00 0 Waste and Vent System .'. $0.00 0 ' ;• $0.00, .,,o '0 Sewer PrlVate:Line -,; $0 00 <_, 0 Water'Closet (Toilet) $0.00 0 .-FEE SUMMARY -: . 1 �' $0.00 ` o - ,;=. Water Heater l vent $12.30 1 Dunking Fountain $0.00 0` , ,�z;rSmk bar ", g' $000 0 - - Water Piping (Inst or Rep.) ISSUE FEE: AMT QTY AMT Laundry.TubhWasher QTY 0" , AMT; QTY $0.00 $2350 $000 ',0 Sump Pump -,SmklF.loor'Water $000.:: 0 g _ Landscape Irri abon p g $ 5 0 $0 Swimming Pool $0 00 0 Backflow Preventer $0 00 0,, „ > $0 00 P T ap ' '� "Y Trap Primer : 0 $0 OW 0 Bathtub .f 1,',. $01,00, _ t0;.,::- Pressure Regulator $0.00 0 Unnal $0.00 0 Clarifier System $0.00 O -, Process Piping (per 10 fl) ` $0.00 „, 0 Vacuum Brkr Bkflow(1.4) $0.00 0 Connect (Ice,Soda,etc) - $0.00 0- Receptors •$0.00" a :0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units' $0.00 , -, 0„� Septic Tank $0.00 0 Wash Basin' $0.00 0 Dishwasher -; ` - Moo ,, of,,:, Sewer Cap for Demo $0.00 0 Wash Basin Set '^ $0.00 0 Drain, Floor` $0 00 `0' Sewer Connect -• $0 00 0 Waste and Vent System .'. $0.00 0 Drain, Rainwater; . �' $0.00, .,,o '0 Sewer PrlVate:Line -,; $0 00 <_, 0 Water'Closet (Toilet) $0.00 0 Drain, Roof $0.00 " . Shower - ., �' $0.00 ` o - ,;=. Water Heater l vent $12.30 1 Dunking Fountain $0.00 0` , ,�z;rSmk bar ", g' $000 0 - - Water Piping (Inst or Rep.) $0.00 0 Expansion Tank .; $0.00'. 0" ?�-Smk,_commercial _. :, $29 40 r_ 3 Water Re -pipe $0.00 0 Gas Earthquake Valvev. $000}0 -,SmklF.loor'Water Service f $0.00 0 Gas (1-4 outlets) .f,fy;c'$000 '�"0- tiSnk it en $000„ 40 r -. WateESoftener 1t` $0.00 0 Gas (Over 4 outlets) • $0.00 : 0 Smk; service/mop ��- $0 00'. -, o .OTHER' $0.00 Gas Repipe' $0;00 �0 __ `- :; ;Spa (private). - _ . _ T ' $0.00 ' 0 VIOLATION $0.00 Gas Service $0.00'_ 0 '-� - •-Spa (public) . $0.00 -, �; 0 � , ;_PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.60 ,.>0 i- - REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0'" • , - "�' FEES: $65.20 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is suspended or domed 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 appl' codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expirabo of this permit. FOR INSPECTIONS CALL: (714) 7645626 r<c L a= DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I t -[]-I have and will maintain workers' comperlsatlon Insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is Issued. _My.workers'.- mpensation Insurance carder and policy number are: n I clD, Iv.CI)0_4- CL 1-�d lzlq{ QDr .S rP-alicy.Number.,_ section -need not be completed i! fh permit /s valued atone hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject toIthe workers' compensation laws of California, and agree that III a d become subject to the workers' compensation provisions of Section 3700 o1 the Labor Code, I shall forthwith comply with -these Pril "ADDACanl,SignaNre:-'�- �1��- fete:-_ �— �/^ - L5 S WARNING: FAILURE764 RK CURE WOERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ME HUNDRED THOUSAND $100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed mader r vis ns of Chapter 9 (commencing with Section 7000) of Division 3-aLK Business and Professions Code, and my license is in full &ca end-liffdcl.'Llgt$=T-*-� ClassCZm - C 4 Coln roc p s grtatore: -� - -Dater- / / - 7. CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with)a contiactor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Data: Owner ID verified by drivers license. ❑ Yes ❑ No Drivels License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and candy a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptlans, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .........__ .................. ... _......................... __..................................................................... _....................... _...._......................... ......................... _............................................................... _................. _................... ................... __..................... 3 Does or will theappp licant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire partment of an RMPP by businesses which are required to register acutely hazardous matertals with the Fire Department. ................_ .... ................ _._........................ _................................................................................................. _........................... _....................... _................................................... ..................................................................................................... 4 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No ................... _..................... _................................................................................... ._......................... __........................... __...................... ___................................................................................................ __....... :....... _................. __................. 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication m akeit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished an applications for non-residential building permits). .........................................of't'h'a..........................................uc't..........................................t.b........ithi........*0.0..f'e.e..................................................................a"*s'............................................................................................................................ 6 Will any part of the facility to be constmcted under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................... ..................................................... _................................................................................................................................................................................................................... .................................................................. -........................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ._...........___............__..............._........................._..._.................__._.._.........................___...................__........................._......_........__...._._.....................__._................__......:......_.................. -_.......... 8 (1f yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.I Sianature O1,Lr ner \ Date L,&n (Or Au zed Applicant Date CODE INSPECTION TYPE 0 INIDIALS CODES INSPECTION TYPE DAM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /L S 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place. 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT �• PERMIT (714) 754-5273 • Fax (714) 754-4856 Job Address: 271 E 17TH ST Suite No Vicinity: Parcel Nunmber: 42522303 Applicant: FLATH, DAROLD Address: C/O ORANGE COAST AIR Owner: Address: Contractor: Address: Arch Eng: Address: 259 EAST 17TH ST - ASSOCIATES i,LOS ANGELES,CA- - 1901 AVE OF STARS 995 ORANGE COAST AIR 809 LAKEVIEW AV UNIT J PLACENTIA CA MECHANICAL PERMIT PERMIT M98-00561 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 12/10/1998 " Issued: 12/10/1998 Phone: 714-779-8034 SCOPE OF PERMIT REF B98-01639 (ISSUED). MECHANICAL WORK SHALL INCLUDE: REPLACE 2 -VENT FANS REMOVED BY PREVIOUS TENANT. Zip: Phone: ' Zip: 90067 , Phone:. 714-779-8034 _ Zip:, 92870 - - 'License:, 535344 Phone: Zip: License: COMMENTS/ SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 . SCOPE OF PERMIT REF B98-01639 (ISSUED). MECHANICAL WORK SHALL INCLUDE: REPLACE 2 -VENT FANS REMOVED BY PREVIOUS TENANT. - FEE SUMMARY Quantity -,/ Quantity ISSUE FEE $22.00 Repair /Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 Repair / Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 Ventillation System $0.00 0 Repair/ Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 _Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU I$0.00 0 Domestic Incinerator $0.00 0 Refrig Sys >100 k BTU - $0.00 0 ' Compressors / Absorption Systems Gas Piping $0.00 0 - - Up to 3 hp 1 100 k BTU - $0.00 0 Factory Fireplace - $0.00 0 3 To 15 hp / 500 k BTU - $0.00 0 Hood w/Meth Exhaust $0.00 '0 - 15 To 30 hp 11,000 k BTU $0.00 0 VAV Box $0.00 0 - .30 To 50 hp 11,750 k BTU $0.00 0 Vent Fan / Single Duct $13.00 2 - _ Over 50 hp / Over 1,750 BTU $0.00 0 Appliance $0.00 0 - Boilers Fire Dampers $0.00 0 - Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 - 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp - $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $35.00 COMMENTS/ SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 . DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the pert..... a of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the Performance of the work for which this permit Is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the_performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation la Cq��aaa�Ijjjlj(j(((ornis, an e e t e If should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply to is .,o - 1�� 10 Applicant Signature: 6 �.. Date: WARNING: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSMO DOLLARE (510),000), IN ADDmON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed der pr ns of Chapter 9 (commencing with Section 7000) of Division 3 of the Busin ss and Professions Code, and my license is in full force and effect. Lic. P �#�� :fn`Y . 1 Class M 2� Contractors Signature:, , Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty o1 perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).I ❑ I, as owner of the Property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: j Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building Structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. I Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be fled with the Costa Masa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....................................................................................................................................................................................................................... ........................................ 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes El No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......... ..............................................................................................................I'o.p............................(Ris.......................................enti.......rogr...........ac'tely.....................aterials ? 3 Does or will the aDPlicent cur present or future building occupant need to prepare an RMPP (Risk Management end Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, .i.... .- antl filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ................................................................................................................................................................................................................................................................................. 4 If an RMPP is presently required, has Section 25534of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑ No (Section 65850.2 01 the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................ei....................................a*c.....................................................hin..................'rOM..........................."ri"e'....................................................:............................................ 6 WIII any pan of the fadliry to De constructed under this permit be within 10001eet from the outer boundarieo of a school? ❑Ves ❑ No (if -yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................... 7 II a permit from the South st Air Quality Management District or other air pollution control district or agency is reQwired for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No ............. ............................................................................................................................................................................................................................... 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Data: CERTIFICATE OF COMPLIANCE AND AVTHORIZA11ON OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree tpppppp comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-dlt�rybed�rtyJe . Pa io�urposes. I agree not to occupy or allow occupancy of any building authorized by this emit uplit final Ins action. ll►►,,�y11-- 111111------/OL�U Signature Of Legal Owner(s) Date I And/Or Authorized Applicant Date 00DE L McPECT10N TYPE IKIITIAL$ CODE 1 INSPECTIONTYPE /I( ge¢ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing t 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining W411 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 244646 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT CJf PERMIT PERMIT NUMBER '°m'm'P ' P98-00695 t/ (714) 754-5273 • Fax (714) 754-0856 77 FAIR DRIVE, COSTk MESA, CA 92626 PLUMBING PERMIT ,lob Address: 271 E 17TH ST Suite No Vicinity: CALIENTE SOUTHWEST GRILL Parcel Nunmber: 42522303 Status: ISSUED Applied: 09/14/1998 Issued: 09/14/1998 Applicant: FLANAGAN,RICK Address: - Phone: 714-846-6936 - - Zip: Owner: ,259 EAST 17TH ST_ Address ASSOCIATES LOS ANGELES,CA - Phone: - 1901 AVE.OF STARS #95 Zip: 90067 Contractor:. ,Address: - .. ..'.. - Phone:- ' •, a - Zip: •License: ._ .. - .. .. ' Arch l Eng: Address: - Phone: % - , .. Zip: License: 'SCOPE OF PERMIT REF B98-01639, INST/REPLACE 3 OUTLETS, 5 FIXTURES, INST 1 MOP SINK, 1 COMMERCIAL _ SINK'CALIENTE SOUTHWEST GRILL' RESTARAUNT. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE,, $22.00. Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preyenter $0.00: 0 P -Trap , ' $0.00 0 Trap Primer ' $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 '0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) •- $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 . Receptors $0.00 .0 - Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank - $0.00 .0 - - . Wash Basin $0.00 0 Dishwasher $0.00 " 0 Sewer Cap for Demo - $0.00 0 Wash Basin Set , $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 - 0 Shower, $0.00 0 Water Heater / vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $8.75 1 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $8.75 1 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $39.50 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a is issued. of consent to sett -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit I5 -issued. I ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance Tamer and policy number are: Cartier: Policy Number. (This section need not be completed if the permit Is valued at one hundred dollars ($ 100) or leu.) ❑ I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7DGO) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. a Class If Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: I OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit sub a plicant to a civil Denalry of not more than five hundred dollars LS500).): od I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however, the building or Improvement is thin one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The cori License Lawdoes; not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursu to th Contractor cense Laws.). e Business and Professions Code for this reason: S,gnatu eeby D te: driver's license. Yes ❑ No Driver's License No. Expires: Verification o1 Ownership by (type of document. Le. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certiy, that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more then thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, f will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. I HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certiy, a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................ff-........................................ 2 Does or will the applicant or pressnt or future bulking ocarpant need to file a regisbetion lane lar acutely hazardous metedals7 ❑ Vss - ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each buslness which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO cubic feet of compressed gas at standard temperature and pressure). I .....................................................................................................................................................................................................e-n-t'.........................................................a.............. 3 Does or will the applicant or present or future bulking occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materiels)? ❑ Yes ❑ No I (Section 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require the preparation, certificellon and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..............................................................................................................................................................................................................................._................................................ 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Coda been fully compiled with? ❑ Yes ❑ No ...................................................................................................................................................................................................................................:................................................ 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plicafion ayentif for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested Information be tumishod on applications for non-residenfial building permits). .................................... .. .............................................................................................................................................................................................................................................. 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). - .................................................................................................................................................................................................................................................................................... 7 If a Permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Coda Section 42303 been matle? ❑ Yes ❑ No , .................................................................................................................................................................................................................................................................................... 8 (Ii yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certiN that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emlss ons. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and dry orryR c rekfing to building construction, and authorize representatives of the Ciy of Costa Mssa to enter upon the above-described property for Inspection purposes. ? a enol i o ce Ilow occupancy of any building authorized by mit unfit final Ins ction. Il per -1 Si azure Of Legal er(s Date And/Or Authorized Applicant Date CODE 1. INSPECTION TYPE gA7E ItrunAL4 CODE. INSPECTION TYPE 11M 9®ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Flnel 208 Final Plumbing 2DO Final Ra -Roof 210 Final Electrical T 201 Final BlockfRetalning Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2H&48 a CITY OF COSTA MESA • BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER F98-00276 (714) 754.5273 • Fax (714) 754-4856 FIRE SUPRESSION PERMIT Job Address: 271 17TH ST Suite: Vicinity: Parcel Nunmber: 42522303 Applicant: DONNELL,MICHAEL Address: Zoning: Phone: 626-331-0819 Zip: Phone: Zip: 90067 Phone:. -626-331-0819 Zip: 91702 - License: 429191 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 12/08/1998 Issued: 12/21/1998 SCOPE OF PERMIT - REPIPE FIRE SUPRESSION FOR HOOD IN REMODEL FOR NEW RESTAURANT"CALIENTE SOUTHWEST GRILL" - SEE T.I. # 898-01639. Plan Check: $15.44 Permit: $23.75 Other: $0.00 Total: $39.19 FEE SUMMARY Owner: 259 EAST 17TH ST Address ASSOCIATES LOS ANGELES,CA . 1901 AVE OF STARS #95 Contractor: ECHO FIRE PROTECTION Address: 735 E Arrow Hwy #h Azusa,ca Zoning: Phone: 626-331-0819 Zip: Phone: Zip: 90067 Phone:. -626-331-0819 Zip: 91702 - License: 429191 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 12/08/1998 Issued: 12/21/1998 SCOPE OF PERMIT - REPIPE FIRE SUPRESSION FOR HOOD IN REMODEL FOR NEW RESTAURANT"CALIENTE SOUTHWEST GRILL" - SEE T.I. # 898-01639. Plan Check: $15.44 Permit: $23.75 Other: $0.00 Total: $39.19 FEE SUMMARY Calc Valuation: $0.00 Claimed Valuation: $600.00 r✓ EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 e Calc Valuation: $0.00 Claimed Valuation: $600.00 r✓ EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the rk for which this permit is issued. I have and win maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: C mer: Policy Number: (This section need not be completed /f the permit /s valued atone hundred dollars ($ 100) or/ess.) ❑ 1 certify that in in performance ork for wh is permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of alit mia, d a re that If I s out become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith kcnS s n cent Signal IDate: WARNING TO SE RE WORKERS' COVERAGE IS UNUWFUL AND aMALLS Q�N EMPLOYER TO CRIMINAL ENALPES AND CIVIL FINES UP TO ONE HUNDRED D DOLLARE ($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEZ° OR CODE, INTEREST. AND ATTORNEYS FEES. LICENSED CO ON: I y rm that I am Iic nsad un r pr 6 of Chapter 9 ( ding with Section 71X)0) of Division 3 of the Busine a d professions Code, and my license Is In full tome nd eHBCI. Lic. s Cont dors Da CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, ChAl Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirn that under penalty o1 perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) o1 Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by,any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professlons Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, t.e. = property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I ❑ 1 hereby certity that no excavation five (5) or more feet In depth Into which a person Is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, faLsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, An 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and cenify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 o1 the California Health and Safety Code requires, with soma exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas et stantlard temperature and pressure). ... futurelb..............................................................................................................................................:................................................. 2 Does or will the applicant or present or future bulltling occepenl need to Ills a registration form for acutely hazardous materials? ❑ Vos No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........ ............. �...............P..............................................................................................................9.......................................�............................................................. 3 Does or will the applicant or resent or future buildingoccupant need to prepare an RMPP Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Coda provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. I ................................................................................................................................................................................................................................................. 4 If en RMPP is presently required, has Section 25534 of the California Health and . .Safety Code been fully complied with? ❑ Yes ❑ No ...... ............................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of thisa�ppplication appermit for such construction or modification from the South Ceast Air Quality Management District or from any other air pollution control district or agency? Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested infomration be furnished on applications for non-residentlal building permits). ................................................................................................................................................................................................................................................................................. 6 Will any part of Ne facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................................................................................................................................................................................................................................................. 7 11 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made'. ❑ Yes ❑ No 8 (It yes", attach certificate of compliance from the appropriate an pollutlon control officer). CERTIFICATE OF COMPLIANCE: I comity, that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city, ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property r firsial purposes. I gr not to occupy or allow occupancy of any building authorized by this permit until final Inspection. i \ I Sign ure Legal 8[0) An plicen Date 02" INSPECTIONTYPE GATF . INTITALS CODE INSPECTIONTYPE Qeff g1i�Al5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical l 201 Final Block/Retaining Wall 212 Final Fire Prevention_. 202 Final Factory Fire Place 220 Final Planning Approval 1 203 Final Sign 222 Final Site _ 2G4 Final Demolition 250 Final Building/Occupancy 2"a 6 4F _ CITY OF COSTA MESA BUILDING DIVISION F DEVELOPMENT SERVICES DEPARTMENT °• PERMIT (714) 754-5273 • Fax (714) 754-4856 Job Address: "595 P61ERPE)NT DR Suite No 02 71 7' Vicinity: ;) Parso6l Nunmber. APPlioank Address: l� CliF11YZ[136 LUCAS,SELKET ELECTRICAL PERMIT Phone: Zip: Phone: Zip: 92626 Phone: Owner: JACOB, CYNTHIA A Address 595 PIERPONT DR COSTA MESA,CA Contractor: JOHN HOWENSTEIN Address: 03188 AIRWAY $22.00 COSTA MESA CA ELECTRICAL PERMIT Phone: Zip: Phone: Zip: 92626 Phone: - . Zip: 92626 License: 374737 SCOPE OF PERMIT INSTALL 1 ILLUMINATED WALLSIGN. E98-01165 77 FAIR DRIVE, COSTA MESA, CA 92626 status: ISSUED Applied: 11/05/1998 Issued: 11/05/1998 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 _ Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 ................up to 10 kva/kw $0.00 0 Lighting Fills $0.00 0 .................up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc-Conductor . $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 1 00h $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 - Communication drops $0.00 0 - . Investigation Fee - moo Sub panel to 200a $0.00 0 Plan Check Fee - moo Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $22.00 1 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $44.00 Intermed Pole $0.00 0 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the lollowing declarations: ❑ I have and will maintain a certificate of consent to sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: I Cartier: Policy Number. (This section need not be completed if the permit s valued atone hundred dollars ($100) or less.) ❑ I corti 'n the partormanco of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers' mpeneeron a Ca" OMia, and agree he, if, I should become subject to the workers' compensation previsions of Section 3700 of the Lobar Cade, I shall fonhwlth ons. EA� t SignatorG: FAIL GRKERS' COMPENSATION ODVEMGE IS UNIAW Fl1L AND SHALL SUB.IECf INAL PENALTIES AND CML FINES UP TO ONE HUNDRED E (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37O60F THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. ECLARATION: I here thea4a=1, icensed der provisions of Chapter 9 (commencing with Sac 00) of Dlvlslon 3 of the Busine nd Professions Code, and my license is in full orce end effect. Lic. q Contractors Signal e- Date: �i CONSTRUCTION LENDING AGENCY: ❑ I hereby elfnn that there is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, CMI Code). Lenders Name: Lander's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, sitar, Improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a ciwl penalty of not more than eve hundred dollars (3500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not appy to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her Own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feat In depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title S. C61110mia Administrative Code). I ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the DMsion of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No j (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................... ....................................................... 2 Does or will the applicant or present or future building occupant neetl to lila a registration loan lar acutely hazardous meteriels7 ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure).I .................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require the preparation, certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. I ............................................................................................................................................................................................................. :............................................................... a If an RMPP is presently required. has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ....._............................................................................................................................................................................................................................................................................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aemit for such construction or modification y? Y from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................................................................................................ .................................................................. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). .................................................................................................................................................................................................................................................................................... 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 423D3 been made? ❑Yes I - ❑ No ................................................................................................................................................................................................................................................................................... 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is cored. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. I Signature: Date: I CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described prgparty for Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. net L gal D e —=r Authorized Applicant Da CODE r. INSPECTION TYPE QATE CODE 4 INSPECi10N1YPE QAIE f111111ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing• 200 Final Re -Roof 210 Final Electrical I oL 7 l 201 Final Slack/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 2N6<6 (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT SIGN PERMIT Job Address: 271 E 17TH ST Plan Check: $31.53 Calc Valuation: $1,500.00 Suite: $0.00 Permit: $48.50 Claimed Valuation: $1,500.00 Vicinity: $0.50 Other: $0.00 Parcel Nunmber: 42522303 Zoning: $0.00 Applicant: LUCAS, SELKET $0.00 Address: 3188-J ARIWAY AVENUE Phone: (714)557-4064 COSTA MESA, CA Zip: 92626 Owner: 259 EAST 17TH ST Address ASSOCIATES ', LOS ANGELES,CA Phone: 1901 AVE OF STARS #95 Zip: 90067 Contractor: JOHN HOWENSTEIN Address: 03188 AIRWAY Phone: COSTA MESA CA Zip: , 92626 Licenser 374737 Arch / Eng Address: Phone: Zip: License: rlp-.- PERMIT NUMBER SB98-00164 77 FAIR DRIVE, COSTA MESA, CA 92626 SCOPE OF PERMIT INSTALL 24.25 SO. FT. CHANNELLETTER STORE FRONT SIGN. ILLUMINATED WALL SIGN " CHANNEL LETTERS" FOR CALIENTE. Status: ISSUED Applied: 11/05/1998 Issued: 11/05/1998 NOTES: PLANNING & ZONING 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 final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit, FOR INSPECTIONS CALL: (714) 754-5626 _ FEE SUMMARY Plan Check: $31.53 Calc Valuation: $1,500.00 $0.00 Permit: $48.50 Claimed Valuation: $1,500.00 SMIP Com: $0.50 Other: $0.00 $0.00 Inspection: $0.00 $0.00 $0.00 Total: $80.53 NOTES: PLANNING & ZONING 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 final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit, FOR INSPECTIONS CALL: (714) 754-5626 _ DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and W81 maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the Performance of the work for which this permit is issued. My workers' compensation Insurance carrier and polity number are. Cartier. Policy Number: (This section need not be completed If the permit Is valued of one hundred do0ars IS I00) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any parson in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 01 the Labor Code, I shall forthwith !Ions. (� �� l cant Signature. a 1 '17,1 oA J ate: 1 ( �5 /9a �ARNING: FAILU ECUR RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN MPLOVER T RIMNAL PENALTIES AND CINL FlNES UP TO ONE HUNDRED E (5180,0110), IN ADDITION TO THE COST OF COMPENSATION, DMIAGES AS PROVIDED FOR IN B OF THE LABOR ODOE, INTEREST, AND ATTORNEY'S FEES, LICENS ORS DECLARATION: ereby a irn thief 1 am Ii ed under provisions of Chapter 9 (commencing with Section 7000) of Divisi 3 of tf�� en� Professions Code, and my license is in full force and effect. Ur. P Class p Contractors Signature Signature: Date: S J U NG AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Cldl Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation o1 Section 7031.5 by any applicant for a permit subjects the applicant to a civ.I penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7046, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within One year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose o1 sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(!) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth into which a person is required to descend, will be made in connection with work authorized by this peril. and that no building structure, scaffolding, lalsework, or demolition or dismantling thereof, will be more than thirty-six (36) feat high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 01 the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, - or 200 cubic feet of compressed gas at standard temperature and pressure). ......... ................................................................................................................................................................................................................. 2 Does or will the applicant or present or future bulltling owapant need to file a registration ton for acutely hazardous materiels? ❑Ves ❑ No (Section 25533 of the Califomia Health and Safety Code, with some excoptions, requires registration with the Costs Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................ ..................................................................................................................................,......................................................................... 3 Does a will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutey, hazardous materials)? ❑ Yes (Section 25534 of the California Health and Safety Cale provides that the Costa Mese Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materiels with the Fire Department. ..................................................................................................................................................................................................................:..............................I.......................:...... .. 4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been lull.. complied wlth7 ❑ Yes ❑ No ....................................................................... future buil......................... quire-...................whi-................ Subject gi-........ io -.a..-.-.. n-................... construction modification 5 Does or will the applicant u present or future bulltling occupant require for the work which I5 the subject c this a plies eppertnit for such construction or modification from the South Coast Ali Quality Management District or from any other air pollution control district or agency? � Ves J No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................................. 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ' ❑ No (It "yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................................... 7 It a permit from the South Coast Alt Quality Management District or other air pollution control district or agency is repulred for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made ❑Yes ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. I nature Ot Le r s) Date 1 C--7d/Or Autho zed Applicant Date COOS r. a1SPEMIONTYPE g♦TITAI,$ CODE INSPECTION TYPE gejF gJDDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Ra-Roof 210 Final Electrical 201 Final BlocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign �t,� 222 Final Site _ 204 Final Demolition 250 Final Building/Ocoupancy 2446-46 PROJECT ADDRESS: 271 E 17TH ST OWNER'S NAME: CHINA CAFETERIA ADDRESS: SAME UNIT: 636-6256 ARCHIENGINEER: REG.If ADDRESS: UNIT: PERMITTEE: RICARDO NAVAS SR (213)346-2320 ADDRESS: 1145 E 14TH ST L.A. CA 90059 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle. antl my lice a is in full force and effect. CITY LIC.: STATE uc.: 6 419 7 8 16 EXP: 1 —1 (> — Signature' ..WD XERS' COMPENSATION DECLA ATION: I hereby affirm that I have a certi Brit to se nsure or a certificate of Workers' Compensation Insurance. of a certified copy thereof (Section 3800, Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS -COMPENSATION DECLARATION: (This section need not be completed it the permt is foram hundred (5700) or less). I certify that in the performance of the work for which this permit is issueA 1 shall not employ any person in any manner so as to become Subject to the Workers' Compensation Laws of California. teat 7 11 — \6 9Signature: �r ICE: If. after making this dec oration. you should become subject a orkSri oro provisions 01 the Labor Code. you must forthwith comply with such pmviSiOnS Or this permit sha a eemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the hollowing reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, Or repair any structure. prior to its issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing With Section 7000) of Division 3 of the Business and Professions Code) or that helshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of not more than five hundred dollars ($500). Structure owner of the property or my employees with wages as their sole compensation, will do the work, and the 1-11structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselflherself or through his or her own employees, provided that such imprOvements are not intended or offered for sale. If, however the building or improvement is sold within one year Of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ antl Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. d P. C. for this reason'. Date: Owner: I do hereby certify that I am aware of and understand the requirements Of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with Said state codes and the requirements lot a permit for construction Or modification from the Air OuAty Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction and r upon the above-mentioned pr erly for inspection purposes. �Wte: — —�� Signature: wer's License m Social Secumy x: 1641.46 Whne—Building: Green—Code Enforcement: Canary—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F 069943 PERMIT NO: F 069943 PLAN CHECK NO; 04285-94 L GOVT; N SUPP: N CONSTRUCTION TYPE: VON PERMIT TYPE: FIR PURPOSE: ALT JOB DESCRIPTION ; INSTALL FIRE SYSTEM INSIDE KITCHEN HOOD SQ FT: CLAIM VALUE; 1,000,00 CALC—VALUE: GROUP OCC; B-2 / COMMENTS: REF: B -67612 Z 0 N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR; FT IN FP,NT; FT IN PEAR; FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN PARKING RE • PROV; PARCEL; 42522303 ZNE; REF NO; PLANNING N TES> > D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY; fiL Vit DATE; ####+Fit######################################+F+#########Y-##+f #ff V #ie +f +'•#df#tG#�+f####rF# LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS ---- > 25,00 0,00 16,25 REVENUE DIVISION TOTALS--> COLLEC D; BLDG PMT PLUMBING ELECTRIC M :2, JIC #### # #### # ## TYPE QTY FIR 25 25.00 65% SMIP/NON—RES 16.25 TOTAL PAID DUE 41,25 41,25 ,00 25,00 OVER/SHORT; 00 FIRE SMIP/TOT GRADING PLAN—CHECK 25,00 I N D I\V I D U A L F E E B R E A K D O W.N D E S C I P T I O N UNIT COST TOTAL COST FIRE EQUIP FEE (FR . BLDG VAL TABLE) 1,00 25,00 END OF FEES 01 00171811-00171311 T CET 25,00 DATES 11/16/94 TIME: 10:08 CONSTRUCTION AND PLAWNII G APPh,bVALS Permit # j Date Inspector . jOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, O Undrgrnd. 10, Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains i 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 16. Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19.Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush I 24. Roof Framing 73. Undergrnd. Storage Tank O Gas OOiI 25. Roof Sheathing - 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. -'- Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL �9. 78: FIRE PREV. FINAL - '-_L /Fj/q�42l 11 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric h --r Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test •� 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison {� 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date \ i/ PROJECT ADDRESS: 271 E 17TH ST UNIT: OWNERS NAME: CHINA CAFETERIA • ADDRESS: SAME 636-6256 ARCH/ENGINEER: B AO D INH & ASSOC flEG.NO.: co ADDRESS: 11861 CARDINAL CI UNIT: G.G. CA 92643 PERMITTEE: T.R.W. ELECTRIC (818)787-5734 ADDRESS: 13907 OXNARD ST 16 VAN NUYS CA 91401 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY 062061 STATE LIC.:66210� CLASS C-10 EXP: 05/95 Date: L a -11 —' Q y Signature: _ WORKERS' COMPENSATION DECLARATION: I hereby affirm tha have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section 38 . Lab. C1. 'OLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified cop(s filed wi the city Building Division. Date': Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: IT section need not be completed if the permit is lot one hundred (5100) or less). certify That in the performance of the work for which this issued, 15hall not employ any person in any manner so as 10 become subject to the Workers' Compensation Laws of Caldor Date: ( , Signature NOTICE: If, after making this declaration, you shoal ecome subject to the Workers' Compen Non provisions of the Labor Code. you must forthwith comply with such provisions r this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: 1 hereby allirm that lh re is a construction lending agency lot the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve. demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the ContractorsStale License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7037.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I. as owner of the property or my emyloyees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. H. however the building or improvement is sold within one year of Completion, the owner will have the burden of proving he/she did not build or improve lot the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of propewho builds or improves thereon rty and who contracts for such projects with a eonlractoNs) license pursuant to the Contractors' SSlate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements at California Health and Safety Code Sections 25505. 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirementsfor a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt Nal these provisions. Dale: Applicant: I hereby Cerlify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction a authorize representatIas of this city to enter upon the above-mentioned property for Inspection purposes. '1 Date: 1 � — ( —� 4 Signature: Driver's License or Social Security a: 1641-46 While—Building; Green—Cotle Enforcement; Canary—Applicant; Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO; E069321 PERMIT NO: E 069327 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: VON PERMIT TYPE: ELE PURPOSE: ALT JOB DESCRIPTION 1050SF RESTAURANT T.I. SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 / COMMENTS: "CHINA CAFETERIA" RESTAURANT TI, RE:#B67612 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT; FT IN RIGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PROV: PARCEL: 42522303 ZNE: REF NO: PLANNING N TES> BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 19,50 15,00 0.00 34,50 34,50 D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : ` DATE: APPLICATION ISSUED BY: J- DATE: ############################################################################### LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 19.50 508 SMIP/NON-RES PLAN ISSUE FEE 15,00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 19,50 15,00 0.00 34,50 34,50 .00 REVENUE DIVISION TOTALS--> COLLECTED: 34,50 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC7.HANIC FIRE SMIP/TOT GRADING PLAN -CHECK I NNS�-: TYPE QTY D E ELE 10 FIXTURE ELE 10 RECEPT/ ELE 6 RECEPT/ V I D U A L F E E R I P T I O 10 LIGHT tJG 1 ST 20 UTLF 1 ST 20 fliTT.CH 1 ST 20 END OF FEES ################################# B R E A K D O W N UNIT COST TOTAL COST EA. ,75 7,50 EA, ,75 7,50 EA. 75 4.50 TOCT 171994 CITY OF COSTA MESA CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector L & SPA APPROVALS Permit # Date Inspector i 1, T6mporary Electrical Service or Pole 52. Pool & Equipment Location_ i 2.'Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. I� 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final i 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 00il 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 1- 29. Insulation 78. FIRE PREY. FINAL - 30. Drywall Nailing HEALTH DEPT. REQUIREMENT '--� 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter -Final 33. Final Electric 34. Final Heating & Air Conditioning 80. FOOD CERTIFICATE ISSUED Notes'.��-��t$Y� .PZI/J2'G"I 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 271 E 17TH ST UNIT: SINNER'S NAME: CHINA CAFETERIA ADDRESS: SAME 636-6256 ARCNIENGINEER: BAO D INH 6 ASSOC REG.ND.: CO ADDRESS: 11861 CARDINAL CI UNIT: G.G. CA 92643 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and m license 6 in lull force and effect. CITY LIC.: I STATE uc.: 61 3 6 3 9 Fuss: i /EX P Date: _Oti a0— Signature:— / Ile/.rte I WONXERS' CO ENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self -insure or a certificate of Workers' Compensation IrLylbo[ �cg(Njfe�copy thereof (Section 380D. E. 81/01/95 1 / O 1 / 9 5 POLICY NO.: 11 `J 99 ..55 yi V COMPANY: STATE FUND ❑ Certified copy is hereby i rnished. IX Derided copy of with Jeff city Building Division_ Date: Q Applicant: EXEMPTION FRDM ORXERS' OMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If. after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply wife such provisions or this banner shag be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason f Section 7031.5 Business and Professional Code: Any city of wanly which receives a permit to construct, alter, improve, demolish, on repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 at the Business and Professions Code) or that he/she is exempt therefrom and fhb basis lot the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than two hundred dollars ($500). 1, as owner of the property or my empployees with wages as their sole compensallon, will do the work, and the ❑ structure is not intended or altered for sale(Section 7044. Business and Professional Code: The Contractors' Slate License Law does not apply to an owner at a properly who builds or improves thereon, and who does such work himself/herself or through his or her awn employees. provided that such improvements are not intended or offered for sale. 11, however the building Or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build Or improve lar the purpose of sale). I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business rs Sl ❑ and Professions Code: The Contractoate License Law Ones ret apply to an 0`Mrer of Probe 2y who builds or improves thereon antl who contracts for such projects with a mntractor(s) license pursuant to the Contractors State License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. F1 I am exempt under Section: B. 8 P. C, for this reason: Date: Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building Occupant williwill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Dually Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby cerllfy that I have read this application and state that the abfveintormatem is correct. I agree comply with all ciand ty county ordinances and state lam relating to building construction and hereby thorize epresentatives of This cit enter upon the above-mentioned property for ins p [tion pu IUses. Date: — 94 Signature: G Drivers License or Social Security 0: 1641 46 While—Building: Green—Gode Enforcement: e:enary—AppnWnt; Pink—Revenue: GolOenroo—naeessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 06881E PERMIT NO: E 068816 PLAN CHECK NO: N GOVT: N SUPP: Y CONSTRUCTION TYPE: VON PERMIT TYPE: ELE PURPOSE: ALT JOB DESCRIPTION ; ELEC. WORK FOR T.I. SQ FT: CLAIM VALUE: CALC—VALUE: GROUP,OCC: B-2 / COMMENTS: "REF:B67612 S SUPPLEMENT E-67613 kkkk�*�+r�xit x�r it*remit it �6*ft�+E*�t*it*i6 fe ie �r+E �iE x*iE it**ite6*�6�x*�F �r*if it**�x+t*yE i6 at,t iE*iE �E ��E �t *i6 itr *�F rar Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ; PROV: PARCEL: 42522303 ZNE; REF NO: PLANNING NOTES> I N D I V D A L F E E B R E A K D O W N TYPE QTY D E R I P T I O N UNIT COST TOTAL COST rrrkrrrrrrrrrrrrrkrrrrrkrrkkrkrkkfErrrrkrrkrrrkkkkrkkkrrrrrkkkkrrr*rrrrrrrrrrrrr D E V E L O P M E N T S E,R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY: — V/"` DATE; rrrrrrrrrkkrkrkkrrrrrr Fr7F3FTr iF3F3F±F3F3FR �r��Fi2.3f3F' xit�TR*—+F�63F �rIFiF Fr��E7Fi—e �rT6 i6 i6*�k *fr �F***i6 fr *�F rkrrrrrrrrrrrrrrrrrrrkrrkrkrkkkrkrrkrrkkkrrrrrrrrkkkkkkkrrrrrrrkkkkrrrrrrrrkkrr LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N PERMIT BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING 75 50% SMIP/NON—RES PLAN ISSUE FEE 4.50 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 0,75 4.50 0,00 5.25✓ 5.25 •00 REVENUE DIVISION TOTALS--> COLLECTED: 5.25 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 5.25 rrrrrrrkkkkrkkrkrrrrrrrrrrkrk- krrrrrrrrrrrrrrrrrrkrkikrrrrrrrrrkrrrrrkkrkkrrrrr I N D I V D A L F E E B R E A K D O W N TYPE QTY D E R I P T I O N UNIT COST TOTAL COST ELE 1 FIX RES, LIGH G 1 ST 20 EA. .75 75 ,END OF FEES OS 00167439-00167439 TOT 5.•25 DATE 09/08/94 TIMb 08:57 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector . ,jOL & SPA APPROVALS Permit# Dace Inspector 1. Temporary Electrical Service ar Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. "1 53. Steel Reinforcement 3. Electrical Conduit Utility=Sr}c rnd. - 54. Forms 4. Electrical Conduit-Undrgrnd.i 55. Electrical Bonding -� 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Etectrical UFER Grnd. 57. APPROVAL TO COVER-GUNiTE 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK .' 11. Property Sewer Line & Housa.Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains `•`-:, 64. Plumbing System - Final j 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 1 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/SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping 0 Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26- T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 33. Final Electric 34. Final Heating & Air Conditioning _-1� - 80. FOOD CERTIFICATE ISSUED Notes:' 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final - - 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison /- 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 271 E 17TH ST OWNER'S NAME: CHINA CAFETERIA ADDRESS: SAME UNIT: 636-6256 ARCH/ENGINEER: BAO D INH 6 ASSOC REG.NO.: CO ADDRESS: 11861 CARDINAL CI UNIT: G,G, CA 92643 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensee under provisions of Chapter 9 (commencing with Section 7000) of Gi oyt nos and Prolusions Code. and my license is in full force and effect. CITY uc.: % / STATE Lli 6136:3 9 Cuss: P EXP: Signature: VNBRAE RS'COMPENSATION DECLARATION: (hereby affirm that l ham certificate of Consent to insure or a Indelicate of Workers' Compensation IAsulayb % yTu ed Cory thereof (Section 3800. L . iJY / O 1 / 9 5 POLICY NO.: 111 1STATTE FUND EXP. DATE: COMPANY: ❑ Continue copy is hereby furnished.'❑ Certified copy is fled with the city Building Division. V/a441 Applicant: 4 EXEMPTION FROM ORAERS' ce of th work l DECLARATION: p (his s noes Cot be complete he rsean n for one hundpartner 0 (5400) a lase comfy that in the performance of the work for which this permit a i ued.1 Shan not empb ny person in any manner m a to become subject 10 Ifo Workers' Compensation Lava of California. Date: Signature: NOTICE: If. alter making this declaration, you should become subject 10 the Workers' Compensation provisions of the Labor Code. you must laturvith Comply with such provisions or this perm) Shan be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a Constmolion lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 1, as owner of the property at my empployees with wages as their sole compensation, will do the work, and the El structure is nor intended or offered for sale frown 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving future did not build or improve for the purpose of sale). I. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves Thereon and who contracts lot such projects with a CUnlractor(5) (horse pursuant to the Contractors' State License Law). I am aware that pmol of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of California.Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant windmill DLI (circle onej need to comply with said state codes and the requirements for a permit for construction or modification from the Ad oabty Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is Correct. I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 9fig , �^'7� /tel/ p 1 /4/l 7v -- Signature: 2 ✓dt?"t Driver's License or Social Security r: 1641-46 White—Building: Green—Cade Enforcement: Canary—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; IE069117 PERMIT NO: IE 069117 PLAN CHECK NO; N GOVT: N SUPP: Y CONSTRUCTION TYPE: VON PERMIT TYPE; ELE OTH PURPOSE: ALT JOB DESCRIPTION : ELEC. WORK FOR T.I. SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC: B-2 / COMMENTS: "REF:B67612, REINSPECTION FEE ############################################################################### Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42522303 ZNE; REF NO; PLANNING NOTES> s D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY; DATE; 0 P` LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 30.00 PLAN 50% SMIP/NON—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 30,00 0.00 0,00 30,00 30,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 30,00 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30,00 I N D I V r a U A L F E E B R E A K D O W N TYPE QTY ELE 1 D E S C R ELECTRICAL P T I O N E—INSPEION FEE \ eND OF FEES UNIT COST 30,00 TOTAL COST O1 001600903-00168903 T CET GATE: 10/04/94 TIME: 14:04 30,00 30.00 CONSTRUCTION AND PLANNING JOaie APPROVALS Permit # Inspector rJOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Uncirgrnd. B. Foundation 59. Gas Pipe, O Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines. P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electricat-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas OOit 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas D Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION -` 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning f/ I 'I/.� ` (�� //A �j�, 80. FOOD CERTIFICATE ISSUED Notes: 35. Final Gas Pipe-Test r 36. Hood or Canopy 1 \ 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING _ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date P cr ADDRESS: 271 E 17TH ST 0 R'S NAME: CHINA CAFETERIA ADDRESS: SAME UNIT: 636-6256 ARCNIENGINEER: BAO DINH 6 ASSOC REG.ND.: Co ADDRESS: 11861 CARD I NAL CI UNIT: G,G. CA 92643 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions at Chapter 9lcommencing with Section 7000) of Division 3 of the Business and Professions Code. and my Icensfe is in lull force and effect. CITY t3C.: STATE sec.: 613639 uss: A EXP, Date: _' �— Signature: _ WORXERS'CE1lr1PENSATI NDECLARATION: Ihereay affirm thaU hav¢acertificateofcpnsenl to self -insure or certilicat¢af Workers' Compensation Insurance. or a certified copy thereof ISection 3800. Lab. Q. IOLICY NO.: 133942394 EXP. DATE: 01/01/95 COMPANY: STATE FUND ❑ Certified ca is here lurniihed. Q Certified copy is 7 ed v Ih the city =Building X�Date: Applicant: �AAsu N FROM WORXE S' COMPENSATNIN DECLARATION: RhAiecoan need not be competed it the pemi16 far one hundred ($700) or li I cenity that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subiect to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If. alter making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for wnich this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant lot such permit to IBe a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9(Commending with Section 7000) of Division 3 of the Business and Professions Code) or that he/she 5 exempt therefrom and the basis lot the alleged exemption. Any violation of SecOon 7031.5 by any applicant for a permit subjects the applicant to a civil penally Of not more than live hundred dollars (5500). I. as owner of the property or my amWeven with wages as their sole compensation, will do the work. and the structure is not intended or Oriental for sale ($S lion 7044. Business and Professional Code: The Contractors' Slate License Law does not apply to an miner of a property who builds or improves thereon, and who does such work himseffinersell or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold whin one year of completion, the owner win have the burden of proving he/she did not build or improve lot the purpose of sale). , as owner of the property, am exclusively contracting with licensed contractors t0 construct the project (Section 7044. Business C3 'and Professions Code: The Contractors Slate License Law does not apply to an owner of property who builds or Improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. 8 P. C. for this reason: Date: Owner I do hereby cenity that I am aware of and understand the requirements of California Health and Safety Code Sections 2551)5, 25533. and 25534 and that I or any future building occupant wiumn not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Au Ouaaty Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby cemly Inat I have read this application and state that the above information is correct. I agree to ply with all City and county ordinances and state laws relating to building constmction and here autle representatives of tics ciry en r upon the abMementioned m property for s ectlon urposes //I DriveDale' Q Signature: se a, Icial Security v: 164146 White—Building: Green—Code Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: IE 06918 PERMIT NO; IE 069187 PLAN CHECK NO: N GOVT; N SUPP: Y CONSTRUCTION TYPE; PERMIT TYPE; ELE OTH PURPOSE; OTH JOB DESCRIPTION ELECTRICAL REINSPECTION FEE (COMM. T.I.) SQ FT; CLAIM VALUE: CALC-VALUE; GROUP OCC; B-2 / COMMENTS: RE:B67612 L E67613 / THIS IS AN ELECTRICAL REINSPECTION FEE k k k k kick #it k k k k kick k k k k k ick k ic k ick k k!!k k k k k k k k k k k k k ick k #'k k kiEk k k k k k k# x k k k k k k# k k k k ick # ic k## Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING---------- FRNT; FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN PARKING RE • PROV: PARCEL; 42522303 ZNE; REF NO: PLANNING N TES> ic k ick k ic k ick k k k k k k k k k k ick k k k k #'k kite k ic k kick k ic k ick k k k k k k ick k k k k k k k k k k k k k k k ick k k k k k k k k k k ick k D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY BUILDING APPROVED BY ; DATE: DATE: APPLICATION ISSUED BY;rDATEDATEi: `A.6w : �� APPLICATIONk ISSUEkk kick �zxxxz..+.r iF xiEieiF"iF3FiF'x�F'iF�Tt if if ilk if 'it'iF'x—>?. 3F *k LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING PERMIT 30,00 PLAN 50% SMIP/NON—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 30.00 0,00 0.00 31 30.00 .00 REVENUE DIVISION TOTALS--> COJ ECTED: 30,00 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC' HECHANIC � FIRE SMIP/TOT GRADING PLAN—CHECK I N D I V I D U A T F E E B R E A K D O W N TYPE QTY D E S C R I P I O N UNIT COST TOTAL COST ELE 1 ELECTRICAL RE— INSPECTION FEE 30.00 30,00 END OF FEES / 01 OOi69176-00.169176 T G T 30.00 DATE: 10/07/94 TIME: 13:07 CONSTRUCTION AND PLANNING s APPROVALS Permit # Date Inspector L & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service oGPole 52. Pool & Equipment Location --� 2. Soil Pipe-Undrgrnd. y 53. Steel Reinforcement _ j-- 3. Electrical Conduit Utility-Undrgrnd. 54. Forms '^ 4. Electrical Conduit -Undrgrnd.-- 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation - , 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. '- , 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ., 10. Structural Floor System - ' 61. APPROVAL TO DECK 11. Property Sewer Line & House, Connection ., 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 1. 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. POOLfSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping 0Gas 001 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑Gas []Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing -I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION _ 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Zt/( Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 1 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date PRI.ECT ADDRESS: 271 E 17TH ST II OWNER'S NAME: CHINA CAFETERIA ADDRESS: SAME UNIT: 636-6256 ARCHONGINEER: BAO DINH 6 ASSOC REG.NO.: CO ADDRESS: 11861 CARDINAL CI UNIT: G.G. CA 9264.3 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 9264.3 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Dlm� n 3 1lbe mess antl Professions Code. and my license in full force and effect. clrr uc.o1 STATE uc.: 613639 CuS EXP : 'C'I Dale _ Signature: t WORKERS' CO PENS ION DECLARATION: I hereby affirm that I have a certificate of consent to Selfinsure or a beNticale Of Workers' Compensation Insurance. or a certified copy thereof (Section 3800. Lab. C POLICY NO.: 133942394 EXP. DATE: U /01/95 COMPANY: STATE FUND ❑ CemimkOMW'OP her by furnished. �: Certified copy is lifetl with the cit uil 'np Division. Date; Applicant: odAA EXEMPTION ERS' COMPENSATION DECLARATION: (This Section need nin completed it the permit is for one hundred (8100) or less). I calmly that in the performance of the work for which this permit is issued, I shall not emplo become subject to the Workers' Compensation Laws of California. Date' Signature: NOTICE: If. after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant lot a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an Owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' Stale License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: 8. 8 P. C. lot this reason: Date: I do hereby cenily that I a 25534 and that I of any lot permit for construction or these provisions. Owner: m aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and ore building occupant will/will not (circle one) need to comply with said state codes and the requirements for a modification from the Air Duality Management District. Residential construction applications are exempt from Date' Applicant: I hereby certify that I have read this application and state that the abogya information is correct. l agree to comply with all city and county property 1, andstatenpurpose to building construction and hereby alAharize representatives of ih ciryto enter upon the toned property lar in peclion purposes. 11`/ Date: _ 66 S �_ Signature: Driver's I,, 'e or octal Security e: Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PER NG PERMIT NO: E 067613 PLAN CHECK NO: N GOVT: N CONSTRUCTION TYPE: VON PERMIT TYPE: ELE PURPOSE: JOB DESCRIPTION : ELEC. WORK FOR T.I. SQ FT.- CLAIM T: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / COMMENTS: "REF.B67612 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ; PROV: PARCEL: 42522303 ZNE: REF NO: PLANNING NOTES> > D E V E L O P M E N T S E -R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: DATE: APPLICATION 3E######ie� iF+c�3e•;F Fir. iE LEGALIZATION:N (F) E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT PLAN ISSUE FEE BUILDING -DIV-> PERMIT ISSUE TOTALS ---- > 18.30 15.00 REVENUE DIVISION TOTALS--> BLDG PMT PLUMBING ELECTR 18,30 503 SMIP/NON-RES 15.00 PLAN -CHECK TOTAL PAID DUE 0.00 33.30 33.30 ,00 C0T:ECTED; 33.30 OVER/SHORT: 00 r MECHANIC, FIRE SMIP/TOT GRADING PLAN -CHECK I N D I V Z D U A £ E E B R E A K D O W N TYPE QTY D 7 R I P I O N UNIT COST TOTAL COST ELE i4 �. E , LIGHT. NG ADDITIONAL EA, ,45 6,30 �� C- �1J�Ft PC R APPAR 1TUS 0.0 - 1.0 HP 3.00 12.00 END'OF FEES C, AL1 754I-5626 or 545627 01 00162318-00162318 Till 33.30 DATE: 06/15/94 TIME: 09:48 � CONSTRUCTION AND PLANNING� APPROVALS Permit �.` Date Inspector �_.,L &SPA APPROVALS Permit # Date - .Inspector 1. Temporary Electrical Sermice-or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Unargrnd. '.-- 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, C Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P Trap, ❑ Undrgrnd, ) 10. Structural Floor System- i 61. APPROVAL TO DECK 11. Property Sewer Line & Hous€Connectibn / I 62. Backwash &Receptor -Final -� ! 12. Sewer Cap r _ ), 63. Heater & Vent -Final 13. Roof Drains 7 ! 64. Plumbing System - Final �l 1 14. Rough Plumbing ' 65. Electrical -Final 1 15. Rough Electrical -Conduit - 1 \ i 66. Solar System -Final 16. Rough Electric Wiring I � 67 . Fencing & Access Approval t � 17. Rough Wiring Sign I 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit ' 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping C Gas C Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank C Gas 1:1011 I 25. Roof Sheathing 74. Overhead Hvdro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat- / 79. FINAL INSPECTION - 32. Electrical Power Meter -Final 33. Fina'. Electric 34. Final Heating & Air Conditioning - 80. FOOD CERTIFICATE ISSUEQr ` Notes: P 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final I 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations FINAL STRUCTURE & BUILDING INAL PLANNING ctric Release to Edison 'elease to Southern California Gas Co 'C ATE OF OCCUPANCY Date ✓\ PROJECT ADDRESS: 2 7 1 E 17TH ST UNIT: OWNER'S NAME: CHINA CAFETERIA . ADDRESS: SAME % �+ 636-6256 ARCH/ENGINEER: BAO D I NH G ASSOC REGMIL: CO ADDRESS: 11861 CARDINAL CI UNIT: C.G. CA 92643 PERIAMEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing win Section 7000) of Division 3 of the Business and Professions Code. and my license is In IWt lone and ellect. Date uc.: 1 _' STATE Lac.: 613 6 39 c ss: B AXP, Date: _WV 4_- Signature; — WORKERS'COMENSALONDECLARATION: I hereby affirm that In certificate of consent to self insure or a certificate of Workers' Compensation Inn o d c rjled Copy thereof (Section 3800. Lab. I. POLICY NO.: Z .J 7 4 EXP. 0 COMPANY: STATE FUND ❑ Cenilied copy is hereby furnished. 9 Candied copy is filed with th it B Id Division. Y /Y A ' Y Applicant: ^MAv'�•^ / c� �EXEMPTION FR)M WOR RS' COMPENSATION DECLARATION: (This section need not be completed if the permit is far one hundred S) I certily that in the performance of the work for which this permit is issued,shall not em to at so as to become subject to the WorkersCompensation Laws CI California. Date: Signature: NOTICE: If, aftermaking this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or altered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or Charnel for sale. If, however the building or improvement is sold within one year of completion, the Owner will have the burden of proving he/she did not build or improve for the purpose of sale). 1, as owner of the property, am exclusively Convecting with licensed connectors to construct the %%act (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who Oullds or improves thereon. and who contracts for such projects with a contr2CtOr(5) license pursuant to the Commodore' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I do hereby canny that I am aware of and understand the requirements of California Health and Safety Cade Sections 25505, 25533, and 25534 and that I or any future building occupant wililwil nol (circle one) need to comply with said state codes and the acciiremens lot a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby Certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and statelawssrelating to building construction and hereby aulharize�prese Cations of this city to en�r upon thea mentioned properly for inspe ion our uses. Date:.'._ Signature: Driver's License it Social Security a: 164646 While— Building: Galat ode Enforcement: Canary—Applicant; Pink—Revenue; Goldenrod—Assessor m CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 067614 PERMIT NO: fl 067614 PLAN CHECK NO: N GOVT: N SUPP: N CC705TROCTION TYPE. VON PERMIT TYPE: MEC PURPOSE: ALT JOB DESCRIPTION ; MECH. WORK FOR T.I. SQ FT: CLAIM VALUE: CALC—VALUE; GROUP OCC: B-2 / COMMENTS: "REF:B67612 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42522303 ZNE: REF NO: PLANNING NOTES> FIR SMIP/RES' GRADINGPERMIT 13 ::•00 25% ", SMIP/NON—RES PLAN�. ISSUE FEE 1 15.00 ####################iF#+E##1E####3E######•#######iP######iF####x##+r##1F BUILDING—DIV—> PERMIT ISSUE PLAN_CHECK TOTAL PAID DUE i###+f +n#####-le#1(-+F# D E V E L O P M E N T S i; R,' V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY; �• DATE: �Z15/! LEGALIZATION:N E E S U M M'A—.R Y :__ "'';STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIR SMIP/RES' GRADINGPERMIT 13 ::•00 25% ", SMIP/NON—RES PLAN�. ISSUE FEE 1 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN_CHECK TOTAL PAID DUE TOTALS ---- > 13.00 15.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 28.00 . I N D I V I D U A L F S TYPE QTY D_E R I P T I 0 N r h1FCr # �5•di D W/DUCTS FE) BY MEC �` 1 0 9'RE NON—PORTABLY EVAP C F (J,�1>3 ENL OF T C tl f .j 5;,•1626 or 754-5&27 28.00 28.00 .00 28.00 ODER/SHORT: .00 FIRE SMIP/TOT• GRADING PLAN -CHECK B R E A' K' D O W N ,-UNIT COST TOTAL COST EX I 'T 6.SU. 6.50 .,LER- 6, 50 6.50 :,10"l 0QF�2319-00162319 TCI T DATE: -06/15194 TIME 09:48 28.00 I CONSTRUCTION AND PLANNING )APPROVALS Permit # TOate Inspector F. ` & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service,ot Pole _ 52. Pool & Equipment Location ? 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement _ 3. Electrical Conduit Utility-Undrgrnd. ! .. 54. Forms 4. Electrical Conduit-Undrgrnd .' 55. Electrical Bonding ` 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. -- -I 1 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System �• _ 61. APPROVAL TO DECK 11. Property Sewer Line & House.Connection 62. Backwash & Receptor -Final - -- , 12. Sewer Cap 63. Heater & Vent -Final 13. fioof Drains%'` i t r 64. Plumbing System - Final 14.,Rough Plumbing ,\ I 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final i 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21.' DuLts, in Structure 70. Underground Hydro 22. DI1:ts, Ventilating 71. Product Piping OGas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOi; 2. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe , 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL I 30. Drywall Nailing 31. Plaster Brown Coat p J HOT}{ rlFFPT E1Q1WQI 79. FINAL INSPECTION 32. Electrical Power Meter -Final -.,- 80. FOOD CERTIFICATE ISSUED 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy Notes: - 37. Final Factory Fireplace 38, Final Plumbing �0 f T •_� 39. Water Service -Final `- L -- 40. Gas Service -Final 41. Solar Domestic -Final Gtj-/j�ry0 `�,1-- L'f�iL,OCd'✓>=+'tom. 42. Backflow Preventer -e-672/_-W-7- 43. Backflow Irrigation i dX( 44. Landscape Irrigation System /•-� 45. Sound Attenuation i 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING '.. 48. FINAL PLANNING ,- 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date V PROJECT ADDRESS: 271 E 17TH ST OWNEWSNAME: CHINA CAFETERIA ADDRESS: SAME UNIT: 636-6256 ARCHIENGINEER: BAO D INH 6 ASSOC RED.ND.: CO ADDRESS: 11861 CARDINAL CI UNIT: G.G. CA 92643 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 'NSEO CONTRACTOR DECLARATION: I hereby allirm that I am licensed Under provisions of Chapter 9 (commencing with Section 7k,3) of Division 3 0l the Business and Professions Code. ono m)' li nu is ld lull force and effect. CITY LIC.: Q STATE LIC.: 61 3 ( 39 D s: B XP: Dale:—�-1 �� Signature: — WORBERS'COMPENSATION DECLARATION: I hereby allirmthat l ha certificate of c:.!intto se ll -insure or a certificate of Workers' Compensation Insurance. Or a cemlied copy thereof (Section 3800, Lab. Cj.1 / O 1 / 9 5 POLICY No.: 133942394 EXP. DATE: 0 COMPANY: STATE FUND ❑ Certified copy is hereby furnished. IX Certified copy is filed with Date: O Applicant: L4=_ EXEMPTION FROM WORXERB COMPENSATION DECLARATION: (This section need rot be completed done perm is for one topped ($100) or less). I certify that in the performance of the work lot which this permit is issued.) shall not employ any person in any manner so as to become subject to the Workers' Compensa,an Laws of California. Date: Signature: NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. CL LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of County which requires a permit to construct, alter• improve, demolish, or repair any structure. prior to its issuance. aim requires the applicant for such permit to life a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code( or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation Of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred Contra ($500). I. as owner at the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered lot sale (Section 7044, Business and Professional Code: The Contractors State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended at offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build Or improve lot the purpose of sale). 1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business C1 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contrects lot such projects with a contractors) license pursuant to the Contractors' $tate License Law),I am aware that proof of their Worker's Compensation insurance mould be provided to me. ❑ I am exempt under Section: B. 6 P. C. for this reason: Date: I do hereby certify that 1 am aware of and understand the 25534 and that I or any future building occupant wiNwill n permit for construction or modification from the Au OU211Iy these provisions. wn Oer: requirements of CalifomiaHealth and Salary Code Sections 25505, 25533, and of (circle ane) need to Comply with Mid state codes and the requirements for a Management District. Residential Construction applications are exempt from Date: Applicant: I hereby cernly that I have read this application and slate that the above information is correct. l agree to comply with all city and county ordinances and slate laws relating to building construction and hereby autho a representatives of this pry titer upon the above mentioned PopDate: ty s 0 poses. g I Date: 4 Signature: Driver's License or Social Security e: 1641-46 Wine—BUIIGtng: Green—Goan Enforcement: Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 068811 PERMIT NO: M 068817 PLAN CHECK NO: N GOVT: N SUPP: Y CONSTRUCTION TYPE: VON PERMIT TYPE: MEC PURPOSE; ALT JOB DESCRIPTION MECH. WORK FOR T.I. SQ FT: CLAIM VALUE: CALC—VALUE; GROUP OCC: B-2 / COMMENTS: "REF;B67612 6 SUPPLEMENT M-67614 xi6xtt+txititititir�rereritft+eitit*it�titiritit*ft�EfeeFir+e*Te�F�6♦E+t+t*�rirititeretit+t�Fxir+rie�r*it iterx**�Ei6*�Tr*iri6iEitit**�6erer* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING RE&Q PROV: PARCEL; 42522303 ZNE: REF NO: PLANNING NOTES> ***if fFfE eF*iE 1E iF*ie fE fflflEiE*le iE iE if iE*1F 1E iE iE i6 fE lE iE iE iE ie it fE**iF 9F iF ee ie it jE#ee ie aE%4e 4BElE iE iE To- iF*fF iE ee eE yF iE iF iE le i6 d6 iE iE lE ie ie iF iE D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: p APPLICATION ISSUED BY: DATE: 1 ie 4e16**iEIEiEiE*1E***aEiFl63EieiFee3FfEeeiF*iF*ifiEiEif*iEie*ieiEfE*iEiEiFie*iFeFlFaeiE**1E ifaFffiE*ieiFaEiEif****aFiFiEifie 3F ieRik?EiE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N PERMIT BLDG PMT PLUMBING ELECTRIC MECHAANSCC FIRE SMIP/RES GRADING PLAN 25% SMIP/NON—RES ISSUE FEE 4.50 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK - TOTAL PAID DUE TOTALS ---- > 4.50 4.50 0.00 9.00✓✓9.00 •00 REVENUE DIVISION TOTALS--> COLLECTED: 9.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 9.00 - ie 1e tf le iE ie ie iE iE iE iF fE k it ie * sE of ie * 4 iE *!e!t * 1e ie 4e iE iE * * iE fE ie fe fe ie le 16 iF ie iE it 9E it ie 4E 4E eE * ie ae ik lF'1e 1e 1e ie if iF iF fE iE iE iE if iE 1e eF 1e * iE fE of iF aF 7E I N D I V I D U AZZ�NDOF E B R E A K D O,W •N TYPE QTY D E S C R I P UNIT COST TOTAL COST MEC 1 VENTILATI FAN CINGLE DUCT 4.50 4.50 FEES d� V 01 00167438-00167438 TUT 9.00 Q,ATE:'09/03/94 TIME: 08:57 CONSTRUCTION AND PLANNING • APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit dk Date Inspector 1.,Temporary Electrical Service'nr Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3!Electrical Conduit Utility.Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd.," 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER GUNITE 7. Footings 58. Electrical Conduit Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House &nnectlon �' 62. Backwash & Receptor-Final - 12. Sewer Cap 63. Heater & Vent-Final _- 13. Roof Drains 64, Plumbing System Final , 14. Rough Plumbing 65. Electrical-Final - '• r 15. Rough Electrical-Conduit i 66. Solar System-Final 16. Rough Electric Wiring IS 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. !tough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factary Fireplace - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0On 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas El Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: i • 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test : -„•+ li- f ; 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing16_19�_ tA 39. Water Service-Final 40. Gas Service-Finaldirw „• 7O,�„I�lY.U�� G-4- /7 41. Solar Domestic-Final -� zoT 42, Backflow Preventer Z1ZUi 43. -Backflow trtigation to -?L '^�j`')`•' TiL�'t 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING f 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 271 E 17TH ST OWNER'S NAME: CHINA CAFETERIA ADDRESS: SAME UNIT: 636-6256 ARCH/ENGINEER: BAO D I NH 6 ASSOC REG.NO.: CO ADDRESS: 11861 CARDINAL CI UNIT: G.G. CA 92643 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) 0l Diviswn 3 at the Business and Professions Code. and my cense is in lull force and effect. CITY LIC.: e STATE LIC.: 613 6 3 9 C SS: B EXP: Date: _Oa — 44— Signature: — _ I WORKERS' CC PENSATI NDECLARATION: I hereby affirm that I hungWXai.awoLeeeeenFxe seM�m59f�r a certificate of Workers' Compensation IrysuJpgga or a p ier44copy thereof (Section 3800.TEaI, C).1 `/ 01 / 9 5 POLICY NO.: Tug ..SS L `iJ V COMPANY: STATE FUND ❑ Certiheal copy is here famished. EX Certified copy is liked'th the city Building Christian. Dale: Applicant: EKEMPTIDN FRO WORKERS' COMPENSATION DECLARATION: (This se ro need not beis far ace (cawed (5100) or less). I certify mat in the concomitance of the work tar which this permit is issus& not emplgy any person in any manner an as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: IL after making this declaration. you should became subject to the Workers' Compensation provisions of the Labor Code. you must tonownh comply with such provisions or thin permit shall be deemed fron . CONSTRUCTION LENDING AGENCY: I hereby alfirm that there is a construction lending agency for th_e performance of the work lot which this permit is issued (Section 3097. Civ. Cl. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Slate License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions at the Contractors' Stale License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) of that he/she is exempt therefrom and the basis lar the alleged exemption. Any violation aI Section 7031.5 by any applicant lot a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). I. as owner of the property or my am pployees with wages as their sole compensation, will do the walk, and the ❑ structure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. 11. however the building or improvement is sold within one year of completion. the Owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the concert am exclusive contracting with licensed contractors to commuct the project (Section 7044. Business El and Pmte55iors Cade: The Conl2clors' State License Law does not apply to an owner of pmpewho builds w Improves thereon rry and who contracts lar such projects with a contractogs) license pursuant to the Contractors' State License Law). I am aware that proof Of ;heir Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. & P. C. for this reason: n.ro I do hereby cenity that I a 25534 one that I or any lul permit for construction at these provisions, Owner no aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and We building occupant will/will not (circle one) need to comply with said state codes and the requirements for a modification from theAir Ouality Management District. Residential construction applications are exempt from Date: Applicant: Ihereby certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building cunstr C110fl and hereby,,coone re resenlatives of this uty to enter upon the above mentioned property far ince tion out x5. Date: _Q a_�i� Signature: Driver's License or Small Security w: �--� 1641.46 White—Buitdmg: Green—Coale Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; P 068819 PE.ERMI'I NO; P 068818 PLAN CHECK NO: N - GOVT: N SUPP: Y CONSTRUCTION TYPE: VON PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION ; PLUMB, WORK FOR T.I. SQ FT; CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / COMMENTS: "REF:B67612 6 SUPPLEMENT P-67614 iFiEit**iFaEaEiFaFiFiFiE*aE**aFiE*aFaeir*�r+F*�Fx�*�E**�***H•*�F��F*�*TE�F�F�F*+F*�F*iE*****+F�F�rkFTFkE*�Tr**�F�FiE��F�*IE�F Z O N I N GS ERTEBQAU/CIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FTk IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42522303 ZNE: REF NO: PLANNING NOTES> **iE ee eF if fe!l iE fE ie lE eE eE*iF fE 1E*eF*1E*iF 3e*eE**1FieiE4*iE iF*aElFfEeF iF ie iE iF ae ee le iE lE aF*fFK♦E4**iE*1ElE iE iE ieie*iF**aE eF lF eE if iE±E ie He 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 /L�Saiib4l AV*Wbftb SI' DATE: BUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY: DATE: 4 *4F Je*iF*eF iE iE it iE iE ie iE Jf***iEaF**iF iFAiF"R3FiF3F3FTF3F3F �r�#�FiF�F3FIF�E �rTFTF �r'iFiF3F'3FiFiF�F'iF*�E**+t+craF �F* ,r *�k. eF iE*it iE*iE iF eF iF ie aF iF of ie ie iE iE iF at iE eEMiF iF eE ie rtie at to aF iF iF*iE iEiE ee aF iE*TE iF iE iE*ie*iE eE S(•aF it aE it it iF ie iE**iF it eFkiE*iF iE aE ie eE *iF*4E LEGALIZATION:N F E E S U M M A.R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 14,00 253 SMIP/NON—RES PLAN ISSUE FEE 10,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 14,00 10,00 0,00 24,00/ 24,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 24,00 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 24,00 4iE*eE iE 1E*aE*!flE1F lF iE aE aF eF*1E iE ie if iF eE if 1E*ae iF 4E iE rE iE iE eE eF iF iE iE iE fe fF it ek*iE iE iEMiE iE kiF iE iE iE iE sf if iE iE 4Fk*iF iF aF iF iE ie aE**iE ie I N D I V D U A F E E B.R E A K D O W N TYPE QTY D E S R I P T I O N UNIT,COST TOTAL COST PLU 1 WASH BA IN 7,00 7,00 PLU 1 WATER CL SET (TO ) ` 7,00 7.00 END,OF FEES WDUPLICATE RECEIPT* 01 OP167437-00167437 T CIT - 24.00, / DATE! 09/09/94 TIME: Q8:5b (/ 24 DATEa10i/03/9Q1bTIME: OS7437 L*6 t CONSTRUCTION AND PLANNINu • APPROVALS Permit # Date Inspector . jOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical ServiceQr Pole 52. Pool & Equipment Location _ 2. Soil Pipe-Undrgrnd. -- 53. Steel Reinforcement •- 3. Electrical Conduit Utility-Undrgrnd. "" 54. Forms - 4. Electrical Conduit -Undrgrnd - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. W&ter Pipe-Undrgrnd. -" 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System _ 61. APPROVAL TO DECK - 11. Property Sewer Line & House nnection -- 62. Backwash & Receptor -Final _ I 12. Sewer Cap `� 63. Heater &Vent -Final ~ i 13. Roof Drains + i 64. Plumbing System - Final r� 14. Rough Plumbing1_�3 c7 65. Electrical -Final 15. Rough Electrical -Conduit i 66. Solar System -Final ; 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. ough Factory Fireplace 21.Tucts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOil 23. Gas Pipe-Rouoh & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 74. ,Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT - 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter,Flnal 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test =Q 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic,Final 42. Backflow Preventer / 43. Backflow Irrigation _�Yj QLD -I- cz-YL / ='r -r- OXO ".. Landscape Irrigation System -Z-- 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING .� 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 271 E 17TH ST UNIT: OWNER'S NAME: CHINA CAFETERIA - ADDRESS: SANE 636-6256 I ARCHIENGINEEB: BAO DINH 6 ASSOC REG.NO.: CO ADDRESS: 11861 CARDINAL CI UNIT: G.G. CA 92643 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with section 7000) of Dmsion 3 of the Business and Professions Code, and my licilhuse is in full force and effect. muC.:/ //� STATE LIC.: 613639 C Ss: B EXP ; Date: _Odt�q¢ Signature: WORKERS' MPENSATIDN DECLARATION; I hereby affirm that l have a cemfmsure or a certifkate of Workers' Compensation Insurance. or a Certified copy In front (section 38001 . 'OucYNO.: 133942394 EXP. DATE: 0 1/01/95 COMPANY: STATE FUND //❑ Certified copy is furnished. 11,Certified copy is filed with the'tity wilding Division. `Date: 06 he Applicant: C EXEMPTION FROM WORKET ' COMPENSATION DECLARATION: (This section need not be w e pored (5100) or Iessi. I certify that in the performance of the work for which this permit is issu employ any person in any manner so as to become subject to the WorkersCompensation Laws Of California. Date: Signature: NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm mat there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the following reason (Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct, alter. improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed Pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a 69vi1 penalty of not more than five hundred dollars (SWO). I. as owner of the property or my emvvloyees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale(Section 7044, Business and Professional Code: The Contractors State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselBhersell or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden Of proving hefshe did not build or improve for the purpose of sale). I, as owner of the prooert , am exc usively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors Slate License Law does Trot apply to an owner of property who builds or Improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Suate License Law). I am aware that proof of (heir Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. 8 P. C. for this reason: Date: Owner I do hereby certdy that I am aware of and understand the requirements of California Health and Safety Guide Sections 25505,25533 ' 5505,25533, and iO j 25534 and that I or any future building occupant wr not (circle one) need to comply with said state codes and the requirements for a 1 permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from them provisions. Date: Applicant: I hereby many that Ihave read this application and slate wduances ah slate caws relating to building wastmctlon. Property ffnorr inspection pr/k''poses. Date: -riSignature: Driver's License@I/or Social Security •: ] mation is correct. I agree to comply with all city and county representatives Of this cgy to enter upon the above mentioned /1641<6 While—Building: Green—Cade Enforcement: Canary ld —Applicant; Pink—Revenue: GoenrodAsse —ssor . CITY OF COSTA MESA - BUILDING PERMIT PERM NO; P 067615 PERMIT NO: P 067615 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: VON PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION : PLUMB. WORK FOR T.I. SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: B:2 / COMMENTS: "REF:B67612 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN ) BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42522303 ZNE: REF NO: PLANNING NOTES> 20,00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TATAL PAID DUE., TOTALS ---- > 91.00 20,00 0.00 111.00 111,•00 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 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE •SMIP/TOT ,GRADING 'a ZONING APPROVED BY BUILDING APPROVED BY : APPLICATION ISSUED BY: ######################### LEGALIZATION:N DATE: , DATE: DATE: (y WOEL_ FEE ..S -U M M A R Y STRUCTURAL' SEGMENT: N BLDG PMT PLUMBING ELECTRIC MECHANIC, FIRE SMIP/RES GRADING PERMIT 91.00 a- 25% SMIP/NON-RES PLAN - - ISSUE FEE 20,00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TATAL PAID DUE., TOTALS ---- > 91.00 20,00 0.00 111.00 111,•00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 111.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE •SMIP/TOT ,GRADING FLAN -CHECK 111.00 - ' . ######################################+.�,.•.-,rA#44#+�####�E#######iFr'#x####fir####*#### I N D I V I D '1 A F E E B R E A' K D O W; N TYPE QTY D E S C R I P I 'O N �. UNIT COST TOTAL? COST -BAR 7.00 7.00 �YLO Q p.s�({(� ` �t (KITCHEN 7. 00 21.00 ' ,�[L"V ♦^'Tji.o� q, B7 TT R EATER AN;1/OTS vct�' 7,00 7,00 LTi.;.G1•T " 1 GAS PIPING SYS yr 1 TO 4 OUTLETS 5,00 5.80/) PLU 2) GAS P IING SYS 5+. OUTL-PER,OUTLET 1.00 2,4•' FLU T!x�i SINKS, 1FLOOR 7,00 4.2:00 PLU _��b SINKS, iSERVICE / MOP 7.00 7:_.00 ?` AA v END OF FEES I 01 00162320-00162320 TOT 111,00 r DATE: 06/15/94 TIM 09:59 754 Su27'�^ 04 N•' 1 • Il_ J CONSTRUCTION AND PLANNING APPROVALS Permit r Date Inspector _)L & SPA APPROVALS Permit qk Date Inspector 1. Temporary Electrical Service or -Pole - 52. Pool & Equipment Location 2. 3. Soil Pipe-Undrgrnd. , Electrical Conduit Utility-Utf•Urgrnd. 24- ` 53. Steel Reinforcement 54. Forms 4. Electrical Conduit-Undrgrnd. -' 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd.. Test 9. Water Pipe-Undrgrnd. _ 60. Backwash Lines, P -Trap, is Undrgrnd. 10.,Str,lctural Floor SYstem 61. APPROVAL TO DECK 11. Property Sewer Line & House Connect ion- r 62. Backwash &Receptor -Final _ 12 Sewer Cap 1 63, Heater & Vent -Final 12. Roof Drains 64. Plumbing System - Final 1d. Rough Plumbing1 ��S ct 65. Electrical -Final 1 16. Rough Electrical -Conduit r 66. Solar System -Final 1 16. Rough Electric Wiring 67. Fencing & Access Approval r 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ! 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # n , 20. Rough Factory Fireplace 21. Dltcts, in Structure 70, Underground Hydro _ 22. Ducts, Ventilating 71. Product Piping 7Ges GOBI 23. G°as Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank CGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 6. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall !Jailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. 33. Electrical Power meter -Final Final Electric �.� 80. FOOD CERTIFICATE ISSUED Notes:4-2014- taz-r /LSnzi:_ 34. 35. Final Heating-& Air Conditioning Final Gas Pipe -Test l� C�n2.2�F.GL0.f /tGfJ Gc� 36. 37. Hood or Canopy Final Factory Fireplace z� _ -Z4s29- cfz 8v�c,� vin t� --- �6T. S . 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer YT`s Cat';GT/LA+"a 43. 44. 45. Backflow Irrigation Landscape Irrigation System Sound Attenuation- /�•CAtP,L3-d1'L.OGlh�+'L yv 1 �s�lz--�4 t'wzc.,r d_y�rt $•- r S 4- 11 'Lo P bv7- !�- ILG} qq( - ltd �S 46. Handicap Regulations 7. F;'IALSTRJCTURE &BUILDING 48. FINAL PLANNING n : �C 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date -Y A40 T -II* 04 N•' 1 • Il_ J PRWECT ADDRESS: 271 E 17TH ST OWNER'S NAME: CHINA CAFETERIA ADDRESS: SAME UNIT: 636-6256 ARCM/ENGINEER: BAO D INH 6 ASSOC REG.NO.: CO ADDRESS: 11861 CARDINAL CI UNIT: G.G. CA 92643 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed der provisions of Chapter 9 (commencing with Section 70D0) of Division 3 of the Business and Professions Code. and my license i m full force and effect. CITY LIC.: STATE LIC.: 613 6 3 9 C SS: B EXP: Date: 0� ��.� signature: WORKERS' MPENSATION DECLARATION: I hereby affirm that I have a ce r ¢ate of consent to sell -insure or a ceNffcate of Workers' Compensation thou Rgegor a$e3,1iljp gcopy thereof (Section 3800, Lab. 61/01/95 POLICY NO.: 1 ..55 L , `JJ EXP. DATE: COMPANY: STATE FUND ❑ Certified copy is hereby furnished. CX Certified copy is filed w h the it Buildin Division. Date: Applicant- EXEMPnoN IROM WORKERS' COMPENSATION DECLARATION: (This need not be mmpl lW if the pem0 isfa one k WrW (sioD) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in arty manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this perms shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3D97, Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the following reason (Section 7031.5 Business and Professional Code: Any Gay of county which requires a permit to construct, alter, improve. demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) of that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars (5500). I. as owner of the property or my empployees with wages as their sole compensation, will do the work, and the C1 structure is not intended or offered for sale (Secthm 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselfinerself or through his or her awn employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is old within one year of completion, the owner will have the burden of proving he/she dM not build or improve for the purpose Of safe). I, as owner of the property. am exclusive)p contracting with licensed contractors to construct the project (Section 7044, Business 11 and Professions Code: The Contractors' State License Law does not apply to an owner of property who outlets or improves thereon and who contracts lot such projects with a contractor(s) license pursuant to the Contractors' ude License Law). I am aware that proof of their Worker s Compensation Insurance Should be provided to me. ❑ 1 am exempt under Section: U. a P. C. for this reason: Date: I do hereby certify that I a 25534 and that I or any fut permit for construction or these provisions. Owner: in aware of and understand the requirements of CalilornitiHealth and Safety Code Sections 25505. 25533, and ore building occupant wiNwill no (circle one) need to comply with said state Colles and the requirements for a modification from the Au Ouaoly Management District. Residential construction allpecatioes are exempt from Date: Applicant: _ I hereby certify that I have read this application and state that the. ordinances and stale caws relating to building construction and hereb' property for inspection purposes, Date: _�_G.(�e ¢_ Signature: — Driver's License or S cial Security x: is correct. 1 agree to ply with all city and county matives of this city a er upon the above-mentioned 1641.46 Whoe—BuiWmg: Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO; P 06954 PERMIT NO: P 069543 PLAN CHECK NO: N GOVT: N SUPP: Y CONSTRUCTION TYPE: VON PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION : SUPPLEMENTAL P-67615 SQ FT: CLAIM VALUE; CALL -VALUE: GROUP OCC: B-2 / COMMENTS: "REF:B67612 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN PARKING REO• PROV; PARCEL; 42522303 ZNE; REF NO: PLANNING N TES> > M M M M M MM M M M M MMM M M M M M M M Mie M M M M M M M M M MMM M MMM MMM M M M M M MM M M MMM M M M M M M M M MM M M M M M M M M M MMM M M M 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 DATE; BUILDING APPROVED BY : DATE: (� APPLICATION ISSUED BY: DATE: MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM MMM LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N PERMIT BLDG PMT PLUMBI7.NG 25% PLAN ISSUE FEE 10.00 BUILDING—DIV—> PERMIT ISSUE TOTALS ---- > 7,00 10,00 REVENUE DIVISION TOTALS--> BLDG PMT PLUMBING ELECTRI 17.00 MMMMMMMMMMMM TYPE QTY PLU 1 I N D I V I D D E S C R I P T GAS SERVICE ELECTRIC MECHANIC FIRE SMIP/RES GRADING SMIP/NON-RES PLAN -CHECK TOTAL PAID DUE - 0,00 17.00 / 17,00 ,00 COLLECTED• 17,00 ✓OVER/SHORT: 00 C MECHANIC.FIRE SMIP/TOT GRADING PLAN -CHECK Je'4'EM if if it ie is iF it it it if iF ifMMMMiEMMMMMMMMMMMMMMMMMMMMMMMMM LF E E E A K D O W N O N UNIT COST TOTAL COST OF FEES 7.00 7.00 V 01 00170271-00170271 TLI T 17.00 DATE: 10/26/44 TItlE: 10:04 CONSYRUC'r,ON AND PLANNING APPROVALS Permit �`r Date Inspector t- ,OL & SPA APPROVALS Permit ?k Date Inspector 1. Temporary Electrical Service:or'Pole - 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. "' 53. Steel Reinforcement 3. -Electrical Conduit-Utility-Undrgrnd. �., 54. Forms -- -4. Electrical Conduit-Undrgrnd,.' 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFEA Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit•Undrgr nd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lmes, P -Trap, O Undrgrnd. 10. Structural Floor System _ 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater &Vent -Final !/ 13. Roof Drains- �t 64. Plumbing System - Final 14. Rough Plumbing �`\ 65. Electrical -Final I 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS - Permit �F 20.. Rough Factory Fireplace - - - _ 21. Ducts, in Structure' - -;70. lTpderground Hydro 22. Duffs, Ventilating. - 71. ProducPRjping 0Gas 000 •72. 23. Gas Pipe -Rough &'Test �1 Underground Floll . 24. -Roof Framing - - .. _ 73?IUndergrnd. Storaga Tank 0Gas 0Oil 25. Roof Sheathing - " i ' 74,- Overhead Hydro - 26. T -Bar Ceiling (Structural) &.Monocoat 75.. Dry Chemical ' - 27. -Frame and Flashing 76. 'Dry StandTpipe 28. Lathing& Siding 77.. FIXED SYSTEM FINAL 29. Insulation - ! 78. FIRE PREY. FINAL - -, 30. Drywall Nailing - -HEALTH DEPT^ REQUIREMENT 31. Plaster Brown Coat 79.yFfNAL IN§PECT10.N 32. Electrical Power Meter -Final I 180..FOOD CERTIFICATE ISSUED :y 33. Final Electric i 'Notes: - - - 34. Final Heating & Air Conditioning 35. :Final Gas Pipe -Test 36. Hood or Canopy - - • t 37. Final Factory Fireplace 38. Final Plumbing - - 39. Water Service -Final 40. Gas Service -Final .41. Solar Domestic -Final i -42. Backflow Preventers - 43. Backflow Irrigation• 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING, 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 271 E 17TH ST OWN1R's NAME: CHINA CAFETERIA ADDRESS: SAME UNIT: 636-6256 ARCHR:NGINEER: BAO D INH S ASSOC REG.ND.: CO ADDRESS: 11861 CARDINAL CI UNIT: G.G. CA 92643 PERMITTEE: TRIPLE ONE CONSTRUCTION (714)636-6256 ADDRESS: 11861 CARDINAL CIRCLE A GARDEN GROVE CA 92643 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9lcommencing with Section 7000) of Division 3 of the Business antl Professions Code, and my license is in lull force and effect. Y tic.: J STATE tic.: 61 3 6 3 9 CLAss: EXP: Oat Signature: ✓�/��Q Pe RKERS' COMPENSATION DECLARATION: 1 hereby affirm that I he certificate of consent t insure or a certificate of Workers' 'ompensalion I sura or a c copy thereof (Section 3800 OLICY NO.: q . �9 Af 2 � EXP. DATE: 81/01/9, OMPANv' STATE FUND rCandied copy is hereby famished. ff Cenified Copy is filed with the city Building Division. Daie: 0 — (._�— Applicant: MPTION FROM WORKERS' COMPENSATION DECLARATION: (Th¢ section d ml ce compI the Permit is lot one hundred (5100) or less). rtify that in me performance 01 the work for which this permit is issue . Ishall not em ny person in any manner so as to become ject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this Permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. Ck LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the ContractorsState License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, denwlish. or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that helshe is licensed pursuant to the provisions of the Contractors State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars (SM. h as owner of the property or my employees with wages as their sole compensation, win do the work, and the .� structure is not intended or altered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not aPPly to an owner of a property who builds or improves thereon, and who does such work himsell/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, Mwever the building or improvement is sold within one year of completion, the owner win have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property. am exclusive W contracting with licensed contractors to construct the project (Section 7044, Business ors' S ❑ and Professions Cade: The Contractlate License Law does not apply to an owner of prgpefry who bolds or improves (hereon and who contracts for such projects with a contractorls) license pursuant to the Contractors' $late License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. 8 P. C. for this reason: Date: owner I do hereby trimly that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I ar any future building occupant will1will not (circle one) need to comply with said state Codes and the requirements for a permit far construction or modification half the Air Quality Management District. Residential construction applications are exempt from these provisions. Date: _ I hereby lot Applicant: that I have read this application and state that the above information is correct. I agree to comply with an city and county state laws relaung to building construction and hereby authorize 2presentati an; of this City to enter upon the above-mentioned spectlon purposes. Bale: O Signalura: / "'"'Y''� -• T Rr ' rtense or Social Security •: s4r-46. Wrote—Rundina Green—Cade Enforcement Canarv—Anpinant: Pmk—Revenue: Goldenrod—A9°essor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: IP 069064 PERMIT NO, IP 069064 PLAN CHECK NO; N GOVT; N SUPP; Y CONSTRUCTION TYPE; VON PERMIT TYPE; OTH PLU PURPOSE; ALT JOB DESCRIPTION RE—INSPECTION FEE, SQ FT: CLAIM VALUE; CALL—VALUE: GROUP OCC: B-2 / COMMENTS: "REF:B67612 6 SUPPLEMENT P-67614 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING RE - PROV: PARCEL; 42522303 ZNE; REF NO; PLANNING N�TES> > ############################################################################### D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY DATE; APPLICATION ISSUED BY: I ######################iFieiFiF1F#�r �r iF iFTr�F3F'iF'Ii`f;F'fF.Yii7F#x3Fi�'iFiFiFTFiF3F'iF72•�F'iF####D*iTr *ir#��C aE LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 30.00 PLAN 255 SMIP/NON—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 30,00 0,00 1 0,00 30,00 30,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 30,00 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIS MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30,00 ELECT / I I V I D U A L F E E B R E A K D O W N TYPE QTY D E i C R I P O N UNIT COST TOTAL COST PLU 1 PLUMB.NG ".c—INSPECTION FEE 30,00 30,00 END OF FEES D 01 00168708-00168708 TOT 30.00 DATE: 09/30/94 TIME: 13:26 CONSTR-U"ION AND PLANNING APPROVALS Permit # Date Inspector 0L & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, O Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor•Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electeical•Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 16. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas OOil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas QOiI 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date 271 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PFP,MIT PER:9 MC: F 067,`1° N' HINA CAFETERIA ADD ES SAME PERMIT NO: B 067612 PLAN CHECK NO: 01822-94 P. GOVT:"' SUPP: A CONSTRUCTION TYPE: VON PERMIT TYPE: STA PURPOSE: ALT ' - 636-6256 pflCHIENDRESS: BAO118 DINH 6 ASSOC REc.xO.: CO JOB DESCRIPTION 1050SF RESTAURANT T.I. /�� SQ FT: 1,050 ADDRESS: 1 1 5 6 1 CARDINAL CI uxlr: l � PERMITTEE: TRIPLE ONE CONSTRUCTION 9264714)636-6256 CLAIM VALUE: 35,000.00 CALC—VALUE: 13,251,00 GROUP OCC: B-2 / ADDRESS: 11861 CARDINAL CIRCLE A COMMENTS: "CHINA CAFETERIA" RESTAURANT TI. GARDEN GROVE CA 92643#################################################+#####################u•## a# LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am Incensed under provisions of Chapter 9 (commencing with Section Z O N I N G R E Q U I R E M E N T S 7000) of Division 3 of the Business and Professions Code, and my license is in lull lone and effect. S E T B A C K S (Ty sec.: STATE LIC.: 61 3639 c Ss: B EXPO bb � — Signature: ------------ MAIN BUILDING ---------- ------ ACCESSORY BUILDING ate:_ _— r�� ___ v —________ WORXERS'C PENsa ON DECLARATION: I hereby affirm that l have a certificate of Consent to self -insure or a certificate of workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN (' WORXERS'C Rs PENS o 6 ARATIOpymereof(Sedion3B00.Lae.C. LEFT: FT IN RGHT: FT -IN LEFT: FT IN RGHT: FT IN CompensatioPOLICY NO.: i -+� a•4 4 EXP. OA7E: 1/ 0 1/95 COMPANY: STATE FUND PARKING REQ: PROV: PARCEL: 42522303 ZNE: Ci -S REF NO: ❑ Certihedcopy ishereby furnished. M Carload Copy isfiled wfill thjcity Building Dori PLANNING NOTES> CONVERT EXISTING UNIT TO A CHINESE FOOD TO GO RESTAURANT. I A > NO INDOOR OR OUTDOOR SEATING, Date: Applicant:############################################################################### EXEMPTION rR�WORAS' COMPENSATION DECLARATION (this section meed not W completed it permit is far one blocked ($too) or less). 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 / I ¢entry that in the Dedormance of the work for which this permit is issued, I shall not employ any person in any manner Su as to become /1W/ subject to the workers' Compensation Laws of California. ZONING APPROVED BY DATE: YYY �_—a✓Tl//_ Date: Signature: BUILDING APPROVED BY / NOTICE: if. after malting this Declaration. you should become subject to the Workers Compensation provisionsDATE : ns of the Labor : '�/ `� _ Code. you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work tom APPLICATION ISSUED BY ; DATE : 5 which this permit is issued (Section 3097, Civ. Cl. ######################fit M.:w ## "7•� ########if�i7 LENDER: ############9c############i 9 ####✓ fi#########+•"##it###################{E##-h-####### ADDRESS: LEGALIZATION:N F E F c L`'I M A R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the contractors'State License Law for the following reason BLDG PMT PLUMBING ELE,'TRI'C .'MECHANIC FIRE SM'IP/RES-. GRADING (Section 7031.5 Business and Professional Code. Any City of county which requires a permit to construct, alter, Improve, demolish, or PERMIT 153,00 I4 repair any structure, prior to its issuance. also requires the applicant for Such permit to file a Signed statement that he/she Is licensed S M I P /,NON'RES pursuant to the provisions of the Contractors' Stale License Law (Chapter 9 (commencing In Section 7000) of Division 3 of the Business PLAN 24 . 8 6 2 . 7 8 and Professions Code) or that he/she is exempt therefrom and the basis for the allege? exemption. Any violation of Section 7031.5 by any applicant for a permit subjects, the applicant to a cixit penalty of nut more than five hundred dollars (5500). ISSUE FEE 1. as owner of the property or my am7loyees with wages as their sale compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law TOTALS — — — — > 155.78 0.0 24.86 180 80 6 4 180.-64 •00 does not apply to an owner of a property vino builds or improves thereon, and who does such work himself/herself or through his or hen own employees, provided that such improvements are not intended or oxered for sale. IL however the building or REVENUE DIVISION TOTALS — —> l'JLL EC'_ ED • 1 5 5 . 7 v : V ER / SHORT : .00 improvement is sold within one year of Completion. the Owner will have the burden of proving hU5lk tltl not build or improv¢ BLDG PMT PLUMBING ELECTRIC MECHAVFC 1 Tp� aM?= /TOT GRADING ?LAN—CHECK for the purpose of sale). and owner at the property. am exclusively Contracting with licensed contractors to construct the protect (Section 7044. Business 153.00 2 7A ❑ and Professions Code: T e Contracors' State License Law does not apply 10 an owner of propertyY who builds or improves thereon and who cant acts log Such projects with a conlraclok(s) license pursuant to the Contractors' Slate License Law). l am aware # # # # # # # # # # # # # # # # # # # # # # # #!e # # # # # # # # je # . # # # # # that proof of their worker's Compensation insurance should be provided to me. I N D I V I D U A F ❑ I am exempt under Section: B. & P. C. I ' for this reason: TYPE OTv u! S r R I P T I .O N, Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533. and 25534 and that I or any future building occupant will ill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Au uahly Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction and hereby amhori: representatives of this city to Ier upon the aDove-mentioned property for inspection purEp'o�s'e i. trate: Qj7_I �il Signature: urivei s L,cense or t/ocial Sel3llants .: ta41,46 white—Bwldmg: Green—Code Entorcement; Canary—Applicant; Pink—Revenue; Galdenrod—Assessor S C �Q�1'14SPECiTiO S .LLTER TYPE V -N ��j1 till END OF FEES 1. AL1. 1 75.4-5626 Or 754.5627 13 R E A K D'O W N UNj.T COST TOTAL COST -AVER 12.62 13,251.00 01 00162321-00162322 TCET 155.79 DAT_: 06/15/94 TIME: 09:49 CONSTRUCTION AND PLANNING POOL & SPA - \, APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector Temporary Electrical Service cir Pole - 52. Pool & Equipment Location Soil PipeUndrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility- Urttk9 rnd. 54. Forms .� 4. Electrical Conduit-Undrgrnd.• 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System ' 61. APPROVAL TO DECK 11. Property Sewer Line & House.Connection 62. Backwash & Receptor -Final -- ,- 12. Sewer Cap - 63. Heater & Vent -Final _ 13. Roof Drains _ 64. Plumbing System - Final ' 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final ! 16. Rough Electric Wiring 67, Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING r 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ; 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro '�• 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush - 24. Roof Framing ,,ii!,. 73. Undergrnd. Storage Tank ❑Gas bQi1 t� 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 7p_y 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL f -a's• 29. Insulation 78. FIRE PREV. FINAL Y 30. Drywall Nailing --y HEALTH DEPT. REQUIREMENT- - _ 31. Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power N'eter•Final <' - .80. FOOD CERTIFICATE ISSUED 33. Final Electric �loSes:C�Osc� 6 Zo/9� 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 4 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing�- 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation %AAE Oy%[ 6644? - 644T44. 44.Landscape Irrigation System 45. Sound Attenuation p /� L! 46. Handicap Regulations 47. FINAL STRUCTURE&BUILDING .(l, Vq /j �OGvi �� hCrl/ ' Fg, 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co '• , ': ; �r� 'yy'�� '� 51. CERTIFICATE OF OCCUPANCY _ _fes No. Date PRWECTADDRESS: 271 E 1 -7TH ST UNIT: OWNER'S NAME: JERRY FRANK ADDRESS: 2 MONTELEGRO'" IRVINE- CA92714 (714) 756-0544 RRCHI NGINEER: POSTAL ANNEX + REG.ND.: NONE ADDRESS: 4920 CARROLL CANYON RD UNIT: A SAN DIEGO CA 92121 PERMITTEE: JERRY FRANK (714)756-0544 ADDRESS: 2 MONTELEGRO IRVINE CA 92714 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Secfion 7000) of Division 3 of the Business and Professions Code, and my license is in full lora and effect. CITY LIC.: STATE LIC.: I CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereaffirm that I have a certificate of consent to sell -aux re or a ceNficete of Workers' •oensathm Insurance, or a ceNfled copy IhereolISection 3800, Lab. Q. CY No.: EXP. DATE: ,GMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is fried with the city Building Division. Date: Applicant: OIEMPTION FROM WORIKERS' COMPENSATION DECLARATION: (leis seam need not be completed 1 the pemul is fpr ane hundred (3100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall not employ arty person in any runner so as to became subject to the' Compensation Laws of Califomp ' Date: 27,071 Sian re: - - - NOTICE: It, atter making this declaration, you should becompect to the Worke Cors' Inpensation provisions of the Labor Code, you must forthwith comply with such provisions or t rmit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a constmction lending agency for the perfomunce'of the work for Which this pemdi is issued (Section 3097, C10 C). r LENDER: ' ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following mason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant lar such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractors' State License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5DD). , I, as owner of the propend or my am ovens with wages as their sols compensation, will do the work, and the structure [shot intended or offeredlor sale(Section 7044, Bus nissand Professional Code: The Contractors' State License Law does not appy to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however the building or Improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the propend, am exclusive contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: T e Contractors' ute License Law does not appy to an owner of property win bWds at improves thereon and win contracts Ivo such projects with a contractor(s) license pursuant to the Contractors State license Law). I am aware that proof of then Worker's Compensation Insurance should be provided to me. I am exempt under Section: 7 0 4 4 B, 8 P. C. form' a CONTRACTORS HAVE �}Ic[N COtJ.Tj Data:r�V COQ I do hereby ceNly that I am aware at and onderstand the requirements of California Health and Safety Code Sectio 5, 25533. and 25534 and that I or any future building occupant WIM11 not (circle mel need to comply with said sure codes and the requirements for a permit for constmction in modification from theATr u�ahry Management District. Residential construction appcations are exempt from these provisions. Date: Applicant: I hereby certify that I ban read this application and state that the above information Is correct. I spree to comply with all dry and county ordinances and state laws relating to building construction and hereby authorize representatives of INS city to ether upon the above-mentioned propend ton ' sp nian purpose. ,, 6 /�•S� Date: -41/10 Signature: ` Driver's License or Social Security e: 1641de White -Building; Green -Code Enforcement; Canary -Applicant; Pink -Revenue; Goldenrod -Assessor -T CITY OF COSTA MESA'- BUILDING PERMIT PERM NO: BMF. 045920 PERMIT NO: BME 045920 PLAN CHECK NO: 021.65-90 S GOVT: N SUPP: N CONSTRUCTION TYPE: 5-N PERMIT TYPE: ELE MEC SIR ,PURPOSE: ALT JOB DESCRIPTION COMMERCIAL T.I. (POSTAL ANNEX). SQ FT: 1,050 CLAIM VALUE: CALC-VALUE: 10,626.00 GROUP OCC: B-2 / COMMENTS: Z O N I N G R E Q U I R E M E N T S S E T D A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN, LEFT: FT IN RG11T- FT IN LEFT: FT IN RGHT FT IN i, PARKING RE Q• PROV: PARCEL: 42522302 ZNE: CI -S REF NO: PLANNING NOTES> INTERIOR ALTERATION TO AN EXISTING COMMERCIAI. SUITE. CONVERT > TO A PRIVATE MAIL SERVICE USE. DEVELOPMENT. S E IR V I C E S-,:. R E Q U I R E M E N ,T S ZONING APPROVED BY z�n ��_ DATE: o Z -o L5 � BUILD.ING'APPROVED BY c DATE:' APPLICATION ISSUED BY " f DATE: 143E �tit�k+ti<it+t*ifN+EiFiEiEiE�F+kiEKiEiE*1F "k"iFiFiF-. ,F��iE�*iF***xi�a�sF if ie.*eE 9FM1E ie 1E 9E 9E �E*kN•5ElEk9F k♦E iE kE 1E lE ♦E iE*cif ie aE 9e+A cif# aF 9e+E iE iE 9E%1E♦FiE*9E eE iE iF of iF iE aE it eE iE 9F*li ie aF iE 9e ae ie aE ee ie ae M,k iE kE it ie 9F LEGALIZATION:NF E E S M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RESP GRADING PERMIT '126.00 15.00 9.00 50% 25% •SMTP/NON-RES PLAN 81'.90 1.59 ISSUE FEE 15.00 15.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK 'TOTAL PAID ' DUE TOTAI,S-----> 151.59. 30.00 81.90 263.49 263.49 .00 REVENUE DIVISION TOTALS--> COLLECTED: 181.59 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK .126.00 30..00 24.00 1.59 .*aE iE k•N ee aF k#if ie*3f aF iE if)E a4 aE 4F cif, iF VE aE ie ie*9ekie iE 1414 i( -i vv*iE 9A iE*9F iE*iE eE if iE ae*iF IE#9E?E ie?F iE iE iE 9F ie 9E. iE MiF 9E jf iENiE iE of C N D. I V I I, F E E B R L' A K D O W N TYPE QTY D E S R I P I I OO N UNIT COST TOTAL COSIT SFC 1050 OFF -INT. ALTER TYP V-A[ -AVER 10.12 10,626.00 ELE 5 FIXTURES, LIGH'. 1 ST 20 EA. .75 3.75 ELE 11 RECEPT/OUTLET I ST 20 EP_, .75 8.25 ELE 4 RECEPT/SWITCH 1 ST 20 EA. .75 3.00 MEC 1. REPAIR/ALT COOL NG UNIT/SYS W/CNTLS 9.00 9.00 ,END OF FEES 01 GOD53153-00053156 TUT 181.59 DATE: 02/01/90 TIME: 14:50 i CONSTRUCTION AND PLANN_Ir ,OL "& SPA APPRO\(ALS Permit # Date Inspector APPROVALS Permit# Date Inspector 1. •temporary Electrical Service or Pole 52. Pool & Equipment Location - - .2.. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3� Electrical Conduit Utility-Undrgrnd. 54. Forms 4:'Electrical,Conduit -Undrgrnd. 55. Electrical Bonding - 5'Steel'Reinforcement 56. Rough Plumbing & Pressure Test :G. Electrical UFER'Grnd. 57. APPROVAL TO COVER-GUNITE J -Footings - - - 58. Electrical Conduit-Undrgrnd. " 8. Foundation 59. Gas Pipe, 0 Undrgrnd:, Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, PTrap, ❑Undrgrnd. yl 10. Structural Floor System 61. APPROVAL TO DECKS _ 11. Property Sewer Line & House,Connection --- --- " - '62. Backwash & Receptor -Final - ' 12. Sewer Cap - r 63. Heater & Vent -Final 13. Roof Drains.' 64. Plumbing System - Final - 14. Rough Plumbing I 65. Electrical -Final ' sv 15. Rough Electrical -Conduit 66. Solar System -Final ^t i 16. Rough "Electric Wiring l 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING! j t 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19; Rough Heating &Air Conditioning _ FIRE DEPT. REQUIREMENT r„ APPROVALS . Permit # - 20. -'Rough Factory Fireplace - ^;�• _ =- �. 21. Ducts, in Structure- 70. Underground Hydro '. 22.. Ducts, Ventilating', - .. - 71. Product:Piping O Gas OOil 23. Gas Pipe -Rough & Test ; - - . 72. Underground Flush - . 24. Roof Flaming 73= Undergrnd. Storage Tank OGas OOil 25. Roof Sheathing - 74 Overhead Hydro ydro_26.`T-Bar - 26 T-BarCeiling (Structural) & Mo`nocoat_ 75._Dry Chemical _- i 27. Frame and Flashing _�-. 76. Dry Standpipe -'28. Lathing & Siding - ` 77. FIXED SYSTEM FINAL 29. Insulation 76. FIRE PREV. FINAL ' 30. Drywall Nailing _ -. _ f�� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coax 79. FINAL INSPECTION 32. Electrical Power Meter -Final =. - .; 80..FOOD CERTIFICATE ISSUED 337 Final Electric - Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test l f,. - 36. Hood or Canopy -•37. Final Factory Fireplace -Y•' x,38: Final Plumbing ' 39 .Water Service -Final. 40. Gas Service -Final 1-41: Solar Domesfic•Final" 42. Backflow Pre venter - - 43. Backflow Irrigation - - '-44. Landscape Irrigation System- " • • . _ - "' - _ _ _. '45:'Sound Attenuation 46. Handicap Regulations •_ - _ 47` -FINAL STRUCTURE & 801LDING 48. FINAL PLANNING 49. Electric Release to Edison 50: Gas:Release to Southern California Gas Co 51. ,CERTIFICATE OF OCCUPANCY No. Date