HomeMy WebLinkAbout273 17TH ST - Building PermitsPillir ---aa
''c/s/e• Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
-�, LOT NO. UNIT NO.
egoommtitigasa CQNSTRUC _tri. PERMIT Dc �D
Project Address �7� C. X77 / / I16a 3/18/66
Applicant's Mailin Add.r�1ess �/S�) '3 3 LJ' L/ad eo%! TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR
,L.L J"y de �j �1 / 6/a -0
007/ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone
Owner's Name7 (� LH .C7�T�f.Q�Phone DESCRIPTION OF WORK/USE OF BLDG.
Address C 2 6 F F. / 7�� - S Main Building: Accessory Building:
TYPE OF PERMIT U GRADING U FC) NOATION U STRUCTURAL E Front Z
Arch/Eng. License No, T 0
Address ❑ TENANT ❑ ELECTRICAL VMBING ❑ MECHANICAL B Rear N
Contractor's Nam¢�7/E 0_442/-5 PAL-n4ahone77a3 /70
❑ 'OTHER A
PROJECT DESCRIPTION SQ. FT. • OCCUPANCY C Right N
Address(mailing) (�• L/'d�A�� K G
g r7?•
Cj CONSTRUCTION TYPE VALUATION$ S Left
City License No. ..] J Q ZONE GRADING CU.YDS. ACRESR
LICENSED CONTRACTOR DECLARATION Ping. Ref.4 Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: �+ M R �e��s M
with taction 7000) of Division 3 of the Business and PrO/esslons Code, and C:F IVEU "�- v • T
my Ilcense is in lull J,prrce ejlect. h/ !r 7 (]C
Llcen Cass (� C� Llcen9 No . -/.76.5-7 RC S.
Date a- 3 i' SignatureC CO k-z-��i PLUMBING I FEES •
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
r I hereby affirm that I have a certificate of consent to self-insure or a certificate
of Workers' Compensation Insurance. or a certified copy thereof (Section Backflow Preventer Service Sink
Automatic Washer Transformer 0 15-50 KW
(51
3800, Lab. ) `^
Policy No. ci 4��4�o Company NY d ev `' Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+ KW
Certified copy is hereby furnished. Expiration
1,ti etl i is filed with the city it ng Division. n Bathtubs Sewer Connection Cooking Unit Meter [pup to 100 amps
Dal.-F���O Applicants Q 0
EXEMPTION FROM WORKERS'COMPENSATION DEC ARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100) or
less). Dishwasher Solar Piping Dryers ❑Gas '❑Electric Sub Panel
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 Drinking Fountains Solar Tank Fan Motors 00.1 HP 011/2-8
Workers' Compensation Laws of California. . ..
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE:If,after making this declaration, you should become subject to the - Inc.Solar 09-15 HP 016.15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCYGas Service Outlets A Water Closet r� da Device Boxes Pole Light
I hereby affirm that there Is a construction lending agency for the performance s
of the work for whith this permit is issued (Section 3097 Civ.'C.) Interceptors ' Water Heater -- OD Outlets Range
Lender's Name 9
Lender's Address Kitchen Sink • Water ServiceSwitches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I em exempt from the Contractor's License Law for the' Lavatories . •
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap •
any structure, prior to its issuance, also requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions Of Roof Drains '
the Contractor's 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 • -1---1 '
eenalty of not more than five hundred dollars($500).
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee • $15 !nu Fee' $ 5
compensation, will do the work,and the structure is not intended or offered - - Reinspection Fee ` $15 Issue Fee $ 5
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
• 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 DEVELOPMENT SERVICES REQUIREMENTS:
Hood or Type provided that such improvements are not intended or offered for Boiler I 0 Zoning Approved By Date
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date /
rove for the purpose of sale). CD
-S�/ '
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 01 ,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- .
tractor(s) license pursuant.to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ - SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
' ❑ I am exempt under Section 8.b P.C.for this reason Firepl/Fact.Blt. ICBG 4 PLUMBING $ e. 3WI ISSUANCE 5
System Date _ Owner
Heating & DuctingPLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000BiL ELECTRICAL $ GRADING $
information Is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre-
sentatives of his city to enter ton the above-mentioned P per for 1J
Inspection pu sap s. - 8. {.• 3 y4 MECHANICAL $
Signature e'h�dt-c-2C.e ''''� Date TOTAL FEE $
. Drivers' License or SS 4 Reinspection Fee I $15 Issue Fee S 5 PLAN CHECK 25% $
White-Building;Canary-Assessor,Pink-Accounting;Goldenrod-Applicant
)
/. CONSTRUCTION AND PLANNING PO, &SPA
/ ''a Date Inspector Date Inspector
�t APPROVALS Permit# APPROVALS Permit#
. 01. Temporary Electrical Service or Pole 52. Pool & Equipment Location
1;Q. 'Soil Pipe-Undrgrnd. 53. Steel Reinforcement
T<
tJ' Electrical Conduit Utility-Undrgrnd. 54. Forms
oat. Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
•12. Sewer Cap 63. Heater & Vent-Final
• 13. Roof Drains 64. Plumbing System - Final
-
14. Rough Plumbing 65. 'Electrical-Final
15. Rough Electrical:Conduit 66. Solar System-Final
7 X16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
A
22..Ducts, Ventilating i 71. Product Piping 0Gas 0011
23. Gas Pipe-Rough& Test 72. Underground Flush
.24.-Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
•25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL .
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
- 33. Final Electric Notes:
• 34. Final Heating & Air Conditioning
' 35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
k 38. Final Plumbing t" Kir/
in fOG
1 39. Water Service-Final t';
40. Gas Service-Final
41. Solar Domestic-Final li
42. Backflow Preventer
cz
43. Backflow Irrigation
• 44. Landscape Irrigation System-4
45. Sound Attenuations_�
46. Handicap Regulations 1 ,
47. FINALSTRUCTURE& BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
, 50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
,�. 1C V fl=rar,o FEE RECEIVED
l0 ;Q 0.-t1 CM° Ne SAFETY DEPARTMENT ,MAY 2 7 1963
-. •- A MESA,CALIFORNIA FINANCE DEPT.
For Applicant to Fill In Completely • APPLI '6'NQfo6Qa1MESA
. TYPE OR PRINT BUILDING
For Office Use Only
BUILDING Al"]7 Ii 1 CS.)
..ADDRESS II 2)
RECEIPT NO. PERMIT NO,
COSTA MESA, CALIFORNIA
RECEIVED/L., D•AC LO4 /.TJ
OWNER V // pT�r if~C�A.�I!J3' O'O '_62
MAIL A BUILDING
ADDRESSS /s r 7 Bear kr ADDRESS
FIRE r CITY (,,.Q,sj�iµ �>�-s Nos46-�/6i ZONE PE GROUP /�
• APPROVEDBr DATE (04/6' .3
ARGNPTECT" I(/j/'/ TEL. 9
O' 'GINEER Cable - NO.
ZONING ( yV
ADDRESS .in /: No.NOL,
USE OF NEW "'-'•. ✓•/C,
/J {(/J ` A J I PLAND-,(/� I BUILDING ��,`�
CONTRACTOR �atio ` /11/cy� — ,,((// ^rQ _E� 1('Jq� tvA/.l�-8'V
LEGAL tfr (str J . 1 VIR AI `lL t
DESCRIPTION
ADDRESS
A.P.NO. 117- 1 9,2 _. ,�+17 v r554
CITY
STATE TEL. NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
sr TO SIDE 9 REAR P.L.
LIC.NO. NO. ,I
EAVES
SIZE /SS tor,✓ 2qo A(��I NOW 1' LOT / ALLOWED (U.B.G.REQUIREMENT)
OF LOT /SS A L J
USE OF `�+ YARDS APPROVED YARDS APPROVED
EXISTING BLDG. ,///JLc 'rYi/V- Vr(Jtecr MAIN BUILDING ACCESSORY BUILDING
SETBACK uNE FROM y/P r rI •/ (FROM C/L STREET)
/ s, REAR YARD.2 FRONT 195:"I . FT.
CENTEROFNE FRO ry` '/
�7/ a"D R.SIDES/ • FT. FT.1
SIDE YARD) LEFT Q I RIGHT)/'�J �,y� " .'�
DESCRIPTION OF WORK / L.SIDEaMI - FT.
N: ALTERATION _ ADDITION v REAR .25-FT
FT
DISTANCE BET. BET.MAIN S
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
VAR.* DATE
BUILDING NO.OF
SIZE ROOMS STORIES C.U.P.* APPROVED
^
EXTERIOR WALL12.15- ROOF /(�f ,. `/ APFROV S pa 1 �i '7
COVERING X //O I COVERING �o�G • BY H DATE 7
USE OF BUILDING AND WORK TO BE PERFORMED O'1 74 it J
L
' cnikos
t,
07 Soa a
6G.FT.geld N
�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION 19 POR THE ,F'
AND STATE THAT THE AB VE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY OPO HCiO AND STATE S R[ D TING VALUATION
BUILDING CONSTRUCT' H
SIGNATURE OF � /' PERMIT FEE 5 G e ^ m
PERMITTEE $ 2/ a / 7 PLAN CHECK $ SolirCb
AUTHORIZED AGENT / --a p
• /0JrD
. TOTAL FEE $
4
A t
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY NO
P. 0. Box 317
'
Costa Mesa, California
The Building located at I's4S4t 17th Street
hos
t eeChas been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group $.P Occupancy.
Use of Building - -. • �3..t e.•..0 • _
Legal Description 117-192+17
(See reverse side for Metes and Bounds) ��pp��,��
Building Permit No. 3.9550 ' Electrical Permit No. •�� Plumbing Permit No y+•+t•+•
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C.
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments and/or guest rooms
ISSUED TO: • Building Official
D1. ROBERT EIMECWSP by e/f. - e 41/ . /s
Date C L/ .,'3 /
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the/premises and SHALL NOT BE removed
except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form 13U34-1M-11-63-S-B P
PROJECT ADDRESS: 273 E 17TH ST UNIT: CITY OF COSTA MESA - SIGN PERMIT PERM NO: SHE 055352
OWNER'S NAME: BRIAN GORDON ...:.r
ADDRESS: 1901 AVE OF THE STARS PERMIT NO: SBE 055352 PLAN CHECK NO: 05002-91 S GOVT: N SUPP: N
#950 L.A.
CONSTRUCTION TYPE: PERMIT TYPE: ELE STR SIG PURPOSE: ALT
213-493-3808
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 17SF LUMINATED WALL SIGN SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: 2, 050 . 00 CALC-VALUE: 2, 050 . 00 GROUP OCC: B-2 /
PERMITTEE: SPECTRUM ELECTRIC ( 714 ) 556-9900
ADDRESS: 2501 S. BIRCH COMMENTS : "BAKERY- FRENCH'S CUPCAKE"
SANTA ANA CA 92707 **************>E***>E*********>E**** *>E*****+E********>EBF*KCL*>E**********************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section SIGN INFORMATIO N
7000)of Division 3 of the Business and Profe�s/sions Code.and my license is in full force and effect. DISTRICT: 1 TYPE: WALL ILLUMINATION: INT CATEGORY: NEW
cITYLIC.: 051 0/STATELIC.: 2190/ cuss;n,�q / ` ,� / DIMENSIONS• 2FT OLIN X SFT 00IN AREA: 17, 00SOFT LETTER HT: 15
Date.c- 3 1 Sig-nature:- &c_ %�G, 1/ Ce�� STREET FRONTAGE 1 : 155. 00 STREET 1 : 17TH ST
WORKERS'COMPENSATION DECLARATION: I hereby al irm I have a certificate of consent to self-insure or a certificate of Workers' STREET FRONTAGE 2 • 0 . 00 STREET 2 ;
Compensation Insurance.or a certified copy thereof(Sectio ill.Lab.C). PARCEL: 42522303 ZONE: Cl-S LOCATION > FRONT: X REAR:
POLICY NO.: EXP.DATE: BUSINESS NAME: FRENCH' S CUPCAKE BAKERY > LEFT: RIGHT:
COMPANY: • OTHER TOTALS GROUND SIGN
D Certified copy is hereby furnished. ❑ Certified copy is tiled with the city Building Division. THIS ACTIVITY 17 . OOS FT OVERALL HEIGHT: OFT OIN
THIS SITE 17 , 00SQFT GROUND CLEARANCE: OFT OIN
Date: Applicant: ITEMS OF INFO 1 .; PLANTER AREA: 0. 00SQFT
EXEMPTION FROM WORKERS'COMPENSATION DE .•RATION: (This t be completed if the permit i,or one hundred($100)or less). ITEMS FOR ACTIVITY • 1 BLDG SET BACK: 2OFT •:,•
I certify that in the performance of the work to ich this permit i - all no employ any persor n any manner so as to become /COPY VERBIAGE FRENCH'S CUPCAKE i;$AKERY _-
subje i' ' Workers'Compensation La . of California. / r
� .4 ..
()at ' a II9i signature: t _ •.. . , . . •.` t PLANNING NOTES:
'TICE:II.after making thisdeclar.tion,you should become�iect to the Workers'Compensation provisions of the Labor *********************************•*'*********************************************
Code.you must fnnhwith comply w;m such prodsioa s or t • pernut shall be deemed revoked. DEVELOPMENT S 'E':R V I C E S R E Q U I R E M E N'T- S
CONSTRUCTION LENDING AGENCY: I hereby affirm that then a construction lending agency for the performance of the work for , q
which this permit is issued(Section 3097.Civ.C). ZONING APPROVED BY ...• . W a. DATE; v�i1-('. l t ,
LENDER:
ADDRESS: BUILDING APPROVED HY : DATE: .
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt Iron the Contractors'State License Law for the following reason APPLICATION ISSUED B Y• DATE; (2-C3 # e
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or ******************************************* ************************* ** T•**
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed LEGAL I ZAT ION:N F E UMMARY STRUCTURAL SEGMENT: Y
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BLDG PMT PL H : ELECTRIC MECHANIC SIGN SMIP/RES GRADING
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the PERMIT 54 . 00 - ' 15 . 00 17. 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law 5(.1* SMIP/NON-RES
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through PLAN 35 . 10 -• . 50
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion.the owner will have the burden 01 proving he/she did not build or improve ISSUE FEE 15 . A •
torthepurposeolsale). BUILDING-DIV-> PERMIT s SUE ' • '-CHECK TOTAL PAID DUE
•I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
TOTALS 86 . 50 1 : . : 35 . 10 136. 60 136 . 60 . 00
❑ and Professions Code: The Contractors'State License Law does not apph/to an owner of property who builds or improves thereon
and who contracts for such projects with a conbactor(s)license pursuant to the Contractors'State license Law). I am aware REVENUE DIVISION TOTALS--> COLLECTED: 136 . 60 OVER/SHORT: 00
that proof of their Worker's Compensation insurance should be provided to me. BLDG PMT PLUMBING ELEC ' IC MECHANIC SIGN SMIP/TOT GRADING PLAN-CHECK
❑ I am exempt under Section: . B.$P.C. 54 . 00 30 . 00 17.00 . 50 35 . 10
for this reason:
****************************** ************************************************
Date: Owner: INDIVID A L F E E BREAKDOWN
I do hereby evilly that I am aware of and underktand the requirements of California Health and Safety Code Sections 25505,25533,and
25534 and that I or any future building occupant wilt/will not(circle one)need to comply with said state codes and the requirements lora TYPE QTY D E S C R I P T .� 0 N UNIT COST TOTAL COST
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
mese provisions. ELE 1 SIGN/ OUTLINE LIGHT SYS ON 1 BR CIRC 15 . 00 15. 00
Date: Ai) •nt: END OF FEES
I hereby certify that I have read this appticati and state that the a.. ormation is correct.I agree o comply h all city and county
ordinances and state laws relating to building onstruction and he a representatives of this a to enter Ur• the above-mentioned
pro�per) lar inspection purposes. //�j�'�/ /
D ' �r 7j Signature: - / `
Drivers License or Social Security a:
rry-Applicant:Pink-Revenue:Goldenrod-Assessor
'Y
CONSTRUCTION AND PLANNING PO. SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3..tlectrical Conduit Utility-Undrgrnd. 54. Forms
- 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding
5. Steel Reinforcement • . 56. Rough Plumbing & Pressure Test
6.' Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
-
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
' 9.•Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains _ 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
' 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough FactoFireplace
ry - APPROVALS Permit# -
21. Ducts, in Structure _ � 70. Underground Hydro
22. Ducts, Ventilating • • 71. Product Piping 0 Gas El Oil
23. Gas'Pipe-Rough & Test , - 72. Underground Flush
24. Roth Framing . 73. Undergrnd.Storage Tank 0 Gas DOil
25. Roof Sheathing - 74. Oveihead Hydro •
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing . 76.. Dry Standpipe , . . . •
28. Lathing& Siding 77. FIXEDSYSTEM FINAL .
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing - HEALTH.DEPT. REQUIREMENT
31. Plaster Brown Coat' 79. FINAL INSPECTION
. 32. Electrical Power Meter-Fiflal //�1 80. FOOD CERTIFICATE ISSUED
33. Final Electric • - Pit �C%O�`(/ Notes: '
.34, Final Heating& Air Conditioning {{{{ 1.4 • .
.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 -
4^. Backflow Preventer
-
4l. Backf low Irrigation . . • '
4j0' Landscape Irrigation System
%45. Sound Attenuation - '
46..Handicap Regulations t -,X47.-FINAL STRUCTURE & BUILDING IL j
,48. FINAL PLANNING' i
•
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co - I _ -
51. CERTIFICATE OF OCCUPANCY
No. Date
i)
��
PROJECT ADDRESS: 273 E 17TH ST UNIT: CITY OF COSTA MESA — SIGN PERMIT - PERM NO:-TSB 05026;
OWNER'S NAME: PACIFIC EQUITY PROP - - -.r.. .. ,
ADDRESS: SAME PERMIT NO: SB 050267 PLAN CHECK.-NO:"07,1`17-90 S :T'�S . GOVT: , N SUPP: N
J CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH
213-282-8533
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL 16 . 5SF TEMPORARY NONLUMINATED SI SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: 350 . 00 CALC—VALUE: 350 . 00 GROUP OCC: B-2 /
PERMITTEE: SIGN STUDIOS ( 213 ) 988-1841
ADDRESS: 851 E WILLOW ST COMMENTS: X
SIGNAL HILL CA 90807 *******+Fr*r******:rit***:rpt*********** ¢*****:E**********+F******T¢******:E:t****;IP****+F*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licen• r under p''visions of Chapter 9(commencing with Section SIGN INFORMAT ION
7000)of Division 3 of the Business and Professions Cod. and my liven.; In full orce atd effect. DISTRICT• 1 TYPE: WALL ILLUMINATION: NON CATEGORY: NEW
CITY LIC.: O 6 22 STATE LIG/5680: • \. .ss: C • 5 DIMENSIONS: 3FT 00IN X SFT 06IN AREA: 16 , 505 FT LETTER HT: 10 IN
•
Date: 1 HI(1/ q�� L Signature:..211110 _ - _ / STREET FRONTAGE 1 • 155 . 00 STREET 1 : c. 17TH ST
WORKERS'COMP SATION ECLARATION: I hereby affirm that ve a certificate of crone t toself-insur tr a certificate of Workers' STREET FRONTAGE 2 • 0 , 00 STREET 2:
Compensation lnsyra,�,ce p; c�rtmed copy thereof(section 3eoo��.ab. 1 PARCEL: 42522301 ZONE: C1S LOCATION > FRONT: X REAR:
POLICY NO.: 11234 Z2 UP.DATE: v3/01 /91 BUSINESS NAME: FRENCH'S CUPCAKE BAKERY > LEFT: RIGHT
comma: STATE ,v�,! 1 OTHER TOTALS GROUND SIGN
0 Certified copy • hereby/-rnished. 51 Certified is fit,. Ih11 city ildint Division. THIS ACTIVITY : 16 , 505 FT OVERALL HEIGHT: OFT OIN
^ 1 HIS SITE : 99 , 00SQFT - -GROUND CLEARANCE: OFT OIN
Date: /2< L/ 9 Applicant% 'A �,� - - a (ITEMS OF INFO : 1 PLANTER AREA: 0 , 00SQFT
V ITEMS FOR ACTIVITY: 1 BLDG SET BACK: 20FT '
EXEMPTION FROM l ORNERS',f of the TIO r Ewhich t ION: (Diss . r need not be employ
f me permit a for or•hundred(S1C0)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 .niter so as to become COPY VERBIAGE : FRENCH'S CUPCAKE BAKERY
subject to the Workers'Compensation Laws of California.
Date: signature: PLANNING NOTES• TEMP, SIGNAGE ONLY -
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor *******************************************************************************
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. DEVELOPMENT SERVICES R E Q U I R E M E N. T S
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the penormance of the work for
which this permit is issued(Section 3097.civ.C). ZONING APPROVED BY SCL DATE: (Z r 1 7 /1
LENDER:
ADDRESS: BUILDING APPROVED BY : DATE:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED B Y: • i'\ DATE• \ 2itL
(Section 7031.5 Business and Professional Cole: My city of county which requires a permit to construct,alter,improve,demolish,or ********************** .s *************ti
* * *
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed LEGAL I ZAT ION:N F SUMMARY STRUCTURAL SEGMENT:Y
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or mat he/she is exempt therefrom and the basis for the alleged exemption.Any violation 0f Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BLDG PMT 'L - : G ELECTRIC MECHANIC SIGN SMIP/RES GRADING
I. as owner of the property or my empvloyees with wages as their sole compensation. will do the work, and the PERMIT 15 . 00 16, 50
❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law SMIP/NON—RES
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through PLAN 9 . 75 • 50
his or her own employees,provided that such improvements are not intended or altered for sale.If,however the building or ISSUE FEE '
improvementorpurpose
the' of sal¢),
is sold within one year DI completion.the owner will have the burden of proving he/she did not build or improve BUILDING—DIV—> PERMIT ISSU • AN—CHECK TOTAL PAID DUE
for
I.as owner of the progeny,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business TOTALS————> 32 .00 0 : I 9 . 75 41 , 75 41 . 75 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware REVENUE DIVISION TOTALS--> COLLECTED• 41 , 75 OVER/SHORT: 00
that proof of their Worker's Compensation insurance should be provided to me. BLDG PMT PLUMBING EL TRIC MECHANIC SIGN SMIP/TOT GRADING PLAN-CHECK
❑ I am exempt under Section: B.8 P.C. 15. 00 16. 50 . 50 9 , 75
for this reason:
***************************** *************************************************
Date: Owner: INDIVIDAL F E E BREAKDOWN
I do hereby cenify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a TYPE QTY DESCRIPT 0 N UNIT COST TOTAL COST
permit for construction or modification from the Air Ouaety Management District.Residential construction applications are exempt from
mese provisions. NO FEES WERE SELECTED FOR THIS PERMIT
Date: Applicant:
I hereby certify that I have read this application and state that the above info •ation' _.Erect.I agree to comply with all city and court
ordinances and star laws ret ing to building c struction and hereby authorR: rest alive of this city to enter upon the.:rve-mentio ed
property f/or inset.tion pur ses.
N.
Date: f24/�i 9(� I Signature: Ilk 'NI r 01 000740455-00076048 TOT 41,75.
1 Driver's Linens or Soci security•: 4 DATE: 17(12190 TIDE: 12:35 .
1641-46 White—Building:Green—Code enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONST RUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location `'
2. .Soil Pipe•Undrgrnd. , 53. Steel Reinforcement
3.Electrical Conduit-Utility-Undrgrnd.• . - _ 54. Forms -
'- 4. Electrical Conduit-Undrgrnd• .-I -� 55. Electrical Bonding
''5: Steel Reinforcement56. Rough Plumbing & Pressure Test
6.. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
'' 7. Footings t' • 0 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 Syste - = - "
m 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 -c
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
• i •I r - i. -
20.!Rough Factory Fireplace > ' = ..7 - -APPROVALS Permits# 0 '
21."Ducts, in-Str;uctuce. u;5.[Pa_• D _ . _ :70. -Underground Hydro i
22. Ducts, Ventilating. • •
'^ =`•�' - r -71;`Pioduct Pi m C�Gas; ❑Oil
23. Gas Pi a Rou h & T,est ` �' - s. r.p 9 D. . ^ - 02. Underground Flush .` -•
24..'RootFramingr r• ,� }73. Undergrnd.StorageTankclGas 000moi', r,
25. Roof,Sheathing , >'..a_ ,:: . r -:/74.;_Ove7head•Hydro - _
26..T-Bar Ceiling (Structural) & Monocoat - + r 75.`_Dry Chemical +' -
27..;Frame and Flashing' 3e • "' ••�' .- : j. :-.76.t dry Standpipe• , ,; y: r
28. Lathing.; Siding . _ r - ••l '77. IFIXED SYSTEM FIfjlAL,i 7, ' ,
.
29. Insulation '', xi 'X ;�'�, _ 1 78. FIRE PREY. FINAL , .r
30. Drywall Nailing •-t - c _ �-- I �. s HEALTH DEP.T.•REQUIREMENT
• '31. Plaster Brown Coat; " ,S - ` . , 79. E;INAL INSPECTION.: i . .
•-32:_Electrical Power Meter-Final i ?. I 40. I OOD CERTIFICATE ISSUED •`'•I,, '
33.r - I Electric �� r
. 1 . . '� :y ) (Dotes: ,;
.
34.-Final Heating; Air..Conditioningr r ( p .- C :r N _
:35._Final Gas Pipe-Test, .r c ,
36. Hood or,Canopy a i" '` )
_
37. Final Factory Fireplace •.' y
i _
38._Fin& Plumbing ; j r . - .
39..Watei Service-Finale - ' - ' --
: < '.).
.:40.-.Gas'Service-Pinal - . „` ' .. �,t _ - .,
41. Solar Domestic-Final _ - ! - 1• I L '{ r
42.'Backflow Preventer' •; ,;: �' >,. 1 1, -": i.
43. Backflow�Irrigation` : ' �',+k' `' it- = 4' -
;44. Landscape Irrigation System s,:t-• •• ••. a - LI - -r n: -y • .'r • f..
45.:Sound Attenuation ' -1. ' > �. -
i
•46. Handicap Regulations T ` ti •
,47.,..FINAL FINAL STRUCTURE &.BUILDING .. �"I � a:7: •• ' '•c-
48:FINALPLANNING ' , • ,
-49.=Electric Release to Edison - * 's:
-50.' Gas.Release to Southern California Gas Co I I I. - t: _
'51. CERTIFICATE OF.000UPANCY , .- I
No Date
CITY OF COSTA MESA
4 aBUILDING DIVISION
r,,;r� , DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
o •
' PERMIT
• • 05-00150
Sbbtipanso
(714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 273 E 17TH ST Status: ISSUED
Suite: Applied: 01/27/2005
Vicinity: Issued: 04/22/2005
Primary Occ: M Display/Sale Merchandise Type of Construction: V-N
Parcel Number: 42522303 Zoning:
Applicant: PRIDY, ALLISON ISSUED BY: A
lit
Address:
Phone: 562 428-0003
Zip:
Owner: SARRAF, KALEB
Address P O BOX 241586
Phone:
LOS ANGELES,CA •. Zip: 90024-9386
Contractor: HAR-BROINC
Address: 2750 SIGNAL PARKWAY
Phone: 562-528-8000
SIGNAL HILL,CA
Zip: 90755-2207 License: 258441
Arch : - Eng: H C HANSEN
Address: - Address: 17371 IRVINE BL
Phone: Phone: 714-573-0073
TUSTIN,CA
Zip: License: 92780 License: SE3027
SCOPE OF PERMIT
INTERIOR STORE TI TO UPGRADE AN EXISTING RESTROOM TO COMPLY WITH STATE ACCESS DISABILITY REQUIREMENTS.WORK TO
ALSO INCLUDE REPLACING LIMITED INTERIOR WOOD STUD WALLS.
FEE SUMMARY
Plan Check: $117.81 Calc Valuation: $10,000.00
Permit: $181.25 Claim Valuation: $10,000.00
SMIP Res: $0.00
SMIP Corn: $2.10
Other: $0.00
Inspection: $0.00
Total: $30116
PLANNING &ZONING ,
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 • Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or If work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446.46(6100)
DECLARATIONS
• WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have end 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
w r which this permit is issued.
S.J
I ve 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.
y workers'compensation Insurance carter and policy number are: 2 /�
artier. C.--.0r- /,VU (r(-) 'I oli umber: � SOL or(This section need not be completed if the permit is valued at one hundred dollars(8100)or less.)
❑ I certify that in the performance of the work for which this penning Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of alifomia,and agree that If I should become subject Io the workers'compensation provisions of Sectio 3700 of the Labor Code,I shall fdrthwith
comply with these p -ans.
eeeignature:
171 '7�— a f—.
NINO:FAILURE TO SE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMAVER TO CRIMIN PENALTIES D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(s100,000),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 1 am licensed under.rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business an. Professions Code,end my license is in full
force effect.Lic.* - f __ C
nt ' or's Signature: . �_ .Litt fl t..
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any a0pliicant 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 contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document.i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation live(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec.
341.Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the 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 a1 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).
—_.. owillth._ _._...__. _ _,_ ___...___
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes jNo
(Section 65850.2 ol the California Govemment Code requires that the requested Information be furnished on applications for non-residential building permits).
— —
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No _
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
__ the work
.....su_.j_.f.._
7 If a permit have
the South Coast res Cestui Management Dismal or other air pollution ooncontrol district3 or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
B (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-de ribed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sign eget Owner(s) -_- ?inD
:Met M t V- ate
CODE r INSPECTION TYPP PAIS lliDIALS CODE I INSPECTION TYPE PAIL It41DM&
1816 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/Retalning Well 212 Final Flre Prevention
202 Final Factory Fire Place 220 Final Planning Approval �1
203 Final Sign 222 Final Site _/L,
204 Final Demolition 250 Final Building/Occupency RAW- ('�j(
��i W!Cx-;„ CITY OF COSTA MESA
4t-
BUILDING DIVISION
i%�niiia..,IV DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
4 ra • PERMIT M05-00481 •
r--• 'S �.-t :/ :.;;: 7),fi.tl 2
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
-r.`". .p.. ! I MECHANICAL-P.ERMITr,..?1-� • . ,
Job Address: 273 E 17TH ST Status: ISSUED
Suite No Applied: 08/24/2005
Issued: 08/24/2005
Vicinity: EIRE DAMAGEDAREA
•''.'•"'t '!1 •.Nf:j j/,w.. •.1. tie .. • ... ,•+ .- - _- .-�
Parcel Number: 42522303 '
- - ISSUED BY�
40,1
Applicant DOUGLAS FARNIK - - 7
Address: 6727 S GREENLEAF
Phone: 562-698-0291.
WHITTIER,CA - • Zip: 90601 ' - -
Owner: SARRAF, KALEB '
Address: P O BOX 241586
• Phone:
LOS ANGELES,CA ' Zip: 90024-9386
Contractor DOCKSTADERS GROUP
Address: 6727 S GREENLEAF
Phone: 562-698-0201
WHITTIER,CA Zip: " 90601 • • .'
License:350935
SCOPE OF PERMIT
MECHANICAL PERMIT FOR FIRE DAMAGED REPAIR:
,. `baa I
:.REF#:B05-00147 `, . .
•
1 � WORK TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT.AND.1COMP RESSOR UP TO 3 HP/100K ,
y
•
'•. - -
11/15/05:SUPPLEMENTAL PERMIT TO ADD 1 COMPRESSOR 3 TO 15 HP/500K BTU
DELETE:-1REPAIR/ALT COOLING/HEAT,1 COMPRESSOR UP TO 3 HP
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 c $0.00 0 Ventillation System $0.00 0 `
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU ' $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp 1100 k BTU $0.00 0
Factory Fireplace '.$0.000 3 To 15 hp/500 k BTU- • $27.15 1
Hood w/Mech Exhaust $0.00 -0 • ., 15 To 30 hp/-1,000 kBTU - - $0.00 0
VAV Box - $0.00. 0 - 30 To 50 hp/1,750 k BTU . . $0.00 0
Vent Fan/Single Dual - • -, $0.00 0: 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- ' Q;.. 3 T61.51115- $0.00 0
Inst or Relocate Appl Vent $0.00 01510 30 hp $0.00 0
Air Handlers< 10000cfm '.,.$0.00 I.0. ' ' 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 ' Over 50 hp $0.00 0
Floor Furnace .$0.00 LO Other Mechanical Fee, ,
Floor or Suspend Heater $0.00 0 • • Investigation Fee -• $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
-r/1T•I /•Al rl Il •TCr\CCCC tee nal
•
[ r.
t i 1 • [
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1,12-21.92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this perml�
FOR INSPECTIONS CALL: (714)754-5626
2448-46(6/C0) �/
a.
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. •
6I 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 Igsurance carrier and policy number are: .cam-- t
CarrairwC £ •' i M V) Racy N�mt3er:\.�'-545%G\ ."flO
(This sectlorrn a not be completed it the permit is valued at one hundred dollars($100)or less.) .
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of 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 theieuomvisions. y,��� _
Applicant S"�---�`jytaWre: •( 1'-'•-'^"' —O A{���� SD- -!\+—^\"L FDate: 1�•VS•D�
WARNING:FAILURE TO SECURI WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLANE($103.030),IN ADDITION TO THE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THELABORCODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect LIc:rr * j!, " ca`A '$C7^ty ca,
IConlractorfs'Sig 9W a --L •�•%" I Date:-1 1%•Sni•
``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: 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 it permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: -
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Cale,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given Is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
,.._And r,.&thorized•Applic,nt" Date"
•
CODE N JNSPECTIONTYPE -- ^—'F DATE INTmAi$ CODE! INSPECTION TYPE •_ - • " 3 rite1616 Fixed System Final Fire Prevention 206 Final Mechanical --- • 6/s-'��
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical • •
201 Final Block/Retaining Wail - 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 - - - - • -
r.
CITY OF COSTA MESA
4 BUILDING DIVISION
> ..4 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
4.t % r PERMIT
!' `1� P05-00411
• (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesa.F7LuLJa,MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 273 E 17TH ST Status: ISSUED
Suite No Applied: 05/25/2005
Issued: 05/25/2005
Vicinity:
-
Parcel Nunmber: 42522303 _- .
Applicant: RICHARD DOUGLAS MOODY KV)
)
Address: 1910 E EDINGER AVENUE ISSUED BY:
Phone: 714-258-0603
SANTA ANA,CA . ' •Zip: 92705 :_ '", - ,
Owner: SARRAF, KALEB
Address P 0 BOX 241586 , . . _
Phonp:
LOS ANGELES;CA . Zip: 90024-9386 - -
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 08/23/05 TO ADD,2 GAS(OVER 2 OUTLETS), 1 SERVICE/MOP SINK _-
AND 1 WASH BASIN. ,
'PLUMBING PERMIT FOR FIRE DAMAGE REPAIR. .
REF#805-00147 - -
•
WORK TO INCLUDE: 1 GAS(1-4 OUTLETS), 1 WASH BASIN,1 WATER CLOSET(TOILET)AND 1
• WATER HEATERNENT.
-- - FEE SUMMARY -- r '
AMT QTY AMT ' QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer ' $0.00 , 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 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) I $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) . $0.00 . 0 Receptors -. $0.00L-,,,,.0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 . ,:Septic Tank $0.00 ;,._0 -...Wash Basin . : $19.60 2
Dishwasher $0.00 0 - ! Sewer Cap for Demo ' c $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) $9.80 1
Drain,Roof WOO 0 • Shower •' ' , • $0.00 •• 0"- Water Water Heater/vent $12.30 1
Drinking Fountain ' , $0.00- - 0 ' Sink;bar . . - •. , $0.00•'=i0 " Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 ' . Sink,commercial--, . $0.00 0 ' ` Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 . ' -Sink,Floor $0.00.---; 0 . . Water Service $0.00 0
Gas(1-4 outlets) $6.15. 1 • Sink,kitchen - $0:00 0 - • Water Softener $0.00 0
Gas(Over 4 outlets) $2.20 2- Sink,service/mop ' $9.80;.;> ',1 _ - OTHER $0.00
Gas Repipe $0.00 0 3Spa(private) ,,,.W-i . $0.00 - 0 .... - VIOLATION $0.00
Gas Service $0.00 0 - '-Spa(public) 50.00 - :0 - PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 ' ,„,� A..a REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0 - TOTAL CALCULATED FEES: $83.35
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 it work Is suspended or abandoned
for a period of 180 days.
•
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all '
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446.48(600)
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.
-0.rr have and will main work: -'compensation I urance,as required by section 3700•f the Labor Code,for the performance of the work for which this permit Is issued.
My workers'cam.,-tion/I-urance carrier:,• •••Ly rum•/:re: / �/4/1�z�7o�
Ca r.=—"•' ./ 'n _i i / . /✓/�.li . -._ it PofidyNumber:-
(Tli s section need not be-• / ted if the71— Is valued• one hum/ d dolls ($100)or less.)
❑ I certify that in the eerie, ance of the wo or which this permi s Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and t if o d becomes ect to the workers'compensation provisions of ct
Section� 3700 of the Labor Code,I shall forthwith
complyxwlth these provisions.T. V /2 7-op
-Apfllcanf •••Sipneture: Date:
WARNING:FAILURE TO SECURE WORKERS' TION COVERAGE IS FUL MID SHALL SUBJECT AN EMPLOYJRTO. Ij 1.PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSA ,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hr
ereby affirm that I am licensed unde(jplpvi)) SLgfI er 9(commencing with Section 7000)of Division?of the Business andel Professions Code,and my license is In full
force 8r d 6ffeeL Lic.k r L L7 .) Y `—Ge59 N ` - 7 Coo
-Contrectorsslgnature: i/f 34 . cDatir 3 - 73 o
CONSTRUCTION LENDING AGENCY: v i liY O
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
'2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does es ❑
will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.y .......___.._...._ .—_._ _...__._—.d..._fety — —_— _
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a -plication appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
._........_tSouth ...._ __.... ._._._ut._n _.. _ ._. t o
7 a permit from the South Coast prescribed
Management DistrictHor nd air pollution ooncontrol district agency? is required for the work which a the subject Of this
application,have all of the disclosures by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
__._..._. fcer_ _.... ____.— _
8 (II'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.
Sign 14:re Of Le!- • r / 7 Date
= i � i�'' .I'.nt S Z3- 0J-
�A 1.i-7-: ..� :nt --Date----`.-,r.._
ODE 1, MISPECTION TYPE tall MiIMS CODFt INSPECTION TYPE QM ILLS
18 : :•S to • .....srrs• - • •• 206 Final Mechanical
•
1268(1%Spa Final 208 Final P u Sing - yu_ fl
02
200 Final Re-Roof .+/,.i 1P Final :le• 'al �(� P
�Aiai y!(. p liimr1.n1 U.ui 1I
201 Final.BloCk/Retei n i al I _ i�• 21 FaabFire Preva '•L- ^° •'I j'/
02 `Final Fatty re Place
aceV l�y��y� P.../ �.� KJAI 2� � J �t' v�'
2. Final Sign U Final Site
.204 Frall7SMdnuon - 250 Final Building/Occupancy