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HomeMy WebLinkAbout275 17TH ST - Building Permits eL1-4., CITY OF COSTA MESA BUILDING DIVISION ' >• ..,./.. �1 DEVELOPMENT SERVICES DEPARTMENT • PER T NUMBER °, yr icy . PERMIT + „F 06-00016 (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 275 E 17TH ST Status: ISSUED Suite No B Applied: 01/09/2006 Vicinity: • Issued: 01/09/2006 Parcel Nunmber: 42522303 Applicant: QUANG;PETER 'OA / � Address: 10331 ARUNDAL AV ISSUED BY: }"„' l Phone: 714-839-0661 WESTMINSTER,CA Zip 92683 Owner: SARRAF, KALEB Address . P O BOX 241586 - . . . - . Phone: LOS ANGELES,CA'.- - - Zip: 90024-9386 Contractor: PEROCK CONSTRUCTION Address: 10331 ARUNDAL AV Phone: 714-839-0661 WESTMINSTER,CA Zip: 92683 • License:588236 SCOPE OF PERMIT • ELECTRICAL PERMIT FOR TEMP POWER. REF#:B05-01874 FEE SUMMARY Quantity - - Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.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 Fixts $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 100hp • $0.00 .0' -. Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops ' $0.00 0 Investigation Fee $0.00 Sub panel to 200a . $0.00 0 ' Plan Check Fee $0.00 Pole Light Pkg $0.00 0 - Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $23.50 1 TOTAL CALCULATED FEES $47.00 Intermed Pole $0.00 0 COMMENTS I 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 void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • 0 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 JJ��''ork for which this permit is Issued. Q. -1'heve 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'compensatlo Insurance/ carder and policy number ere: Canier:Cz i tr(E 0'/ P*y.Numrber.—i. g5eO> (/h(s.sect/on nee notbe co feted if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performace 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 Calif la,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith �comply� ae vision++ �AgpNoam'Signeture: Data:--' 114 ur WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,600),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm[hat I am licensed under rovisions of Chapter 9(commencing with Section 7000)of Division 3 ofihe Business and Professions Code,and my license is in full fosa.and.effecL.Licyx. 566 2. aror----4(' IXC!! • Conlrl godX re� L/ Date: 711G`o(o CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). - ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No 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: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (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;lithe 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(Duality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which,Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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. nature Of L Owner(s) Date And/Or Authorized•Appticarll----.. r Date.. QQQE1. INSPECTION TYPE pelf - INRTIALS ;ODE It INSPECTION TYPE DAIS ILf1IDAL$ ' 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 1266 Pool Spa Final 206 Final Plumbing -074771E— 200 Final Re-Roof 210 Final Electrical 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final She 204 Final Demolition 250 Final Building/Occupancy 501 _ CITY OF COSTA MESA 44,0111 BUILDING DIVISION :t �, DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 4. opiqii ePERMIT 05-01874 � (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa. LULDING PERMIT n FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 275 E 17TH ST Status: ISSUED Suite: B Applied: 10/18/2005 Vicinity: UNIT B RITZ NAILS Issued: 12/21/2005 Primary Occ: B Eat<50/Office/Bar<50 Type of Construction: V-N Parcel Number: 42522303 Zoning: Applicant: QUANG, PETER Address: Phone: 714-839-0661 ISSUED BY: Zip: Owner: SARRAF, 'CALEB Address P 0 BOX 241586 • - Phone: - LOS ANGELES,CA - Zip: 90024-9386 Contractor: PEROCK CONSTRUCTION _ - ` -r-. Address: 10331 ARUNDAL AV - > Phone: 714-839-0661 r WESTMINSTER,CA - ' ' ` Zip: 92683. License: 588236 Arch : - Eng: Address: Address: Phone: - - Phone: , Zip: ' '.. License: License: SCOPE OF PERMIT 1,450 INTERIOR T.I.FOR"RITZ NAILS",SPACE B.WORK TO INCLUDE:NON-LOAD BEARING WALLS,INTERIOR FINISHES,MINOR ELECTRICAL, MECHANICAL AND PLUMBING WORK. . • - FEE SUMMARY ,r, ` Plan Check: $418.76 .. .. • , • • ! -: i Calc Valuation:, $50,000.00 Permit: ' $644.25 -Claim Valuation: ' $50,000.00 SMIP Res: $0.00 _ SMIP Com: $10.50 ' Other: $0.00 Inspection: $0.00 Total: , $1,073.51 • ' ' 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 -Existinq:.. 0 Required 0 , Proposed 0. ' • t 4 M q 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 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. /1, FOR INSPECTIONS CALL: (714)754-5626 !// dir 244848(8/00) // DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:' ❑ Ihave 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. lehave 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'compensatjgn Insurance carrier and policy number are: �7 Cancer^"`"' A7�i 7V0 0 Policyr-------,er: I 1coO J (This section n d no be plated if the permit Is valued at one hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Celi mla,end 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 rovisi s. 2e1/0S Applicant Signature: / l� i ��/PP,IAA�L WARNING'FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOt1ARE(5100.000).IN ADDRION 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 IlcensedAn ')1.2 Tprpvisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busine and Professions Code,and my license is in full force and effect.i1k0.. Glass'#-A Contractor's Signature:-- (Dater 121240 S CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(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 properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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 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 Califomia 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. -ii- __... ...._ ..i_._ ._S _ _. _..._.......___._._ a If an RMPP is presently required,has Section 25534 of the California Health end Safety Cade been fully complied with? 0 Yes 0 No 5 Does or will the appicant or present or future building occupant require for the work whirl-Fs the subject of this a plication epermit for such construction or modification Districtfrom the South Coast Air Quality Management or from any other air pollution control district or agency? Yes L i No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (if yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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. ' nater Of Legal Ow r(s) 1212 o5 A (Authorized Applicant" C—Pafe7 COOP P. INSPECTION TYPE DAIS lt2Th5 OQOE( INSPECTION TYPE gAli =ALE • 1616 Fixed System Final Fire Prevention 206 Final Mechanical x 1266 Pool Spa Final 208 Final Plumbing - 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final DeDemolition250 Final Building/Occupancy CITY OF COSTA MESA 4 BUILDING DIVISION 4 .A, DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER 1.tb. -u`�tas PERMIT � E05-01334 �h (714)754-5273 • Fax(714)754-4856 • www.ci.Costa-mesaECtTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 275 E 17TH,ST Status: ISSUED Suite No B Applied: 12/21/2005 Vicinity: UNIT B RITZ NAILS Issued: 12/21/2005 Parcel Nunmber: 42522303 Applicant: QUANG, PETER Address: 10331 ARUNDAL AV Phone: 714-839-0661 ISSUED BY: WESTMINSTER,CA Zip 92683 Owner SARRAF, KALEB:" - Address P O BOX 241586 Phone: LOS ANGELES,CA ' Zip:'.. x.90024-938 ' - - Contractor PEROCK CONSTRUCTION - ' Address: 10331 ARUNDAL AV ' Phone: 714-839-0661 , . 'WESTMINSTER,CA Zip: 92683 - , License:568236 i _ , SCOPE OF PERMIT '. ' 1,450 INTERIOR T.L'FOR"RITZ NAILS",SPACE B.WORK TO INCLUDE:NON-LOAD BEARING . . ' WALLS,INTERIOR FINISHES,MINOR ELECTRICAL,MECHANICAL AND PLUMBING WORK.-- . • •i ' REF:B05-01874- " s ' 15 LIGHT FIXTURES,9 OUTLETS,3 SWITCHES . . , FEE SUMMARY . . Quantity Quantity. , .' '; ISSUE FEE :. $23.50 - Temp Dist System/Lighting , $0.00 - 0' ' Temp service test $0.00 ''`^ -,< -_Busway/100 ft -= t - t • , $0. 00 0 ', , Res:a/c package , $0.00 . `7 Standmg.Section a ,$0.00 0' New Res(1-2 units) $0.00 0 Misc Electrical Equipment ' 1 $0.00 ; Of New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 - Pool/Spa $0.00 0 ' up to 10 kva/kw $0.00 0 Lighting Fixts . $16.50 15 -- up to 50 kvaBw $0.00 ' 0 , Recept Outlets $9.90 9 _ • up to 100 kva/kw $0.00 . 0 Switches $3.30 3 ' ' over 100 kva/kw $0.00- , • 0 _ Non Res Appl ' $0.00 0 ` "'c.- Low Voltage Equipment Res Appl ,2 - $0.00. 0 ; " ' .Low Volt Wiring;System/Ckt $0.00; 0 -;Service to 200a - $0.00 , 0,s;; ' Misc.Conduit -M,:T`-;;` .50.00 0 Service to 1000a -$0.00 0e • - • 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 100hp $0.00' ; : 0, .:,, Other Electrical Fee $0:00 Motors over 100hp Communication drops $0.00: , 0 ,. '; -- 0' • Investigation Fee ', $00 Sub panel to 200a $0.00!7,° , 0 -:r . " -Plan Check Fee, . < '$0:00 Pole Light Pkg $0.00 ''O ,0z.-- - _ •ReinspectionFee ,� - $0.00 Sign Circuits $0.00 '-0 _ '�� Temp Pwr Pole $0.00 0 - . - TOTAL CALCULATED FEES $53.20 Intermed Pole $0.00 0 "- - -" e uu¢.,rc I enc....,A e nn•,n,r,P•.ie 4,..\:>.< • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5628 �� 244646(atbl 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. N. 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'compo ation Insurance carrier and policy number are:tA I d�L B 'L Cartier._61*�t-/E 1..)D Policy Number: 7 0 1 (This section need not completed if the permit s valued at one hundred dollars($100)or less.) ❑ I certify that in the perk, nce 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 I a of C ifomla,and agree that if I should become subject to the workers'compensation provisions of Sect Ion 3700 of the Labor Code,I shall forthwith comply with vi 12/2(//0 c \Ap SlgnaNre: DIM a. /// 111 WARNING:FMLURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED TIN ISAND DOLLARE(5100,000),IN ADOMON 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 Iicenssssft��d u9jid,,2¢¢r,�.QQrr�ovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busi and Professions Code,and my license is In full force and effect. a 560,0572 Class ContrectoY�Slgnatbr13: [Dab), O _ 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 a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-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 Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia 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: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia 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 Califomia 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 ❑14o (Section 25534 of the Califomia 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. if an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No ir.. for the work ..._..__ -- ucti.__. - ... 5 Does or willo the toAir or present a future building occupant at y other for toe wonk ontch the subject of a YesCoastDistrictfromdistrictagency? U No (Section 65850.2 of the Califomia Government Code requires that the requested Information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by Califomia Health and Safety CodeSection 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.i agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. gnature Of Lege wner(s) D to .4..m.e.4 _ ��_ 12/2l� '5 pWOrlAuthodzed Applicant atter SODS I, INSPECIONTYPt DATE MALS coon (INSPECTION TYPE PATE RIIIDELS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA - 4 ,► BUILDING DIVISION f i : � I DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER o• PERMIT 05-00745 4kb+PoRmsg 4" (714)754-5273 • Fax(714)754-4858 • www,cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 275 E 17TH ST Status: ISSUED Suite No B Applied: 12/21/2005 Issued: 12/21/2005 Vicinity: UNIT B RITZ NAILS • Parcel Number: 42522303 ' ISSUED BY: Applicant: QUANG, PETER Address: 10331 ARUNDAL AV • . • Phone: 714-839-0661 WESTMINSTER,CA Zip: :92683 . Owner SARRAF; KALEB i Address: P 0 BOX 241586 ... _ • Phone: LOS ANGELES,CA " - - ' Zip: 90024-9386 - ' Contractor.; PEROCK.CONSTRUCTION Address: 10331 ARUNDAL AV , Phone: -714-839-0661 WESTMINSTER,CA Zip: - 92683 , •License:588236 . , SCOPE OF PERMIT ' 1,450 INTERIOR T.I.,F,OR"RITZ NAILS",SPACE B.WORK TO INCLUDE:NON-LOAD • ' BEARING WALLS,INTERIOR FINISHES,MINOR ELECTRICAL,MECHANICAL AND PLUMBING', ' WORK. .... . REF:B05=01874 " 1 REPAIR/ALT COOLING/HEAT.. • - - . -- - . FEE SUMMARY; • -- .. r` • Quantity �"r - • Quantity ISSUE FEE .. ' - - $23.50 • - - ---Repair/Alt Absorbtion Unit - $000 0 r. Inst FAU<100 k BTU $0.00 ',:0 -., _ . . . . 1:.Repair;/All Refrigeration Unit $0.00 0 . Inst FAU>100k BTU $0.00 0 -�- Ventillation.System Repair/Alt Cooling/Heat $13.70 1 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/100 k BTU • .` ,' ' $0.00 -"0 Factory Fireplace $0.00 0 -, 3 To 15 hp/500 k BTU -, $0.00 0 Hood w/Meth Exhaust $0.00 0 - - - 15 To'30 hp/1,000 k BTU `" $0.00 0 VAV Box • $0.00 . 0 _ •- 30 To 50 hp/1,750 k BTU $0.00' 0 Vent Fan/Single Duct $0.00 -0 ` . Over 50 hp/Over.1;750 BTU - $0.00 0 Appliance $0.00 0 - Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers - " ' $0.00 0 ,3 To 15 hp .-_.;',6"-:-- $0.00 0 , Inst or Relocate Appl Vent ' ,$0.00 - 0 •- - a-15 to 30 hp;_:gc • - $0.00 0 Air Handlers< 10000cfm - , $0.00 ,.0, ' - - . 30 to 50hp `- 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 . ' .. `Investigatio`n Fee' $0.00 -Plan Chedk--Fee $0.00 ` Reinspection Fee - $0.00 - ' ___.. ___ - --TOTAL CALCULATED FEES $37.20 COMMENTS/SPECIAL CONDITIONS \c>,. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. f FOR INSPECTIONS CALL: (714)754-5626 -, 244848(8/00) V'. . DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. I have and MS 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 coq ers'compensation Insurance carrier and policy number are: & c3Tf e -AJ D PPoI Number. I ‘55-63°3 (This sect/on n not be plated if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance 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 Ilfornla and agree that If should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with th provlsi ns, I AppBcanlTSignature:— Dates 1 Z/24/0 S 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 DOIURE(S103,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOS,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am karst p(1{9p tions of Chapter 9(commencing with Section 7000)of Division 3 of the Busine and Professions Code,and my license is in full force and effect.Lib:P1 b(C)j��7/J ConlrectoCs.Sigrer /i 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). 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 Ls not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Ucense Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(30)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: f 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 Califomla Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomla Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 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 0 N (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? t]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 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 65850.2 of the California Govemment 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 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No _ 8 (If yes',attach certificate of compliance from theheaappropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature 1 Le al O r(s) - Dat (t/2( 1a 5 An Aur" thorized Applicant= ' � r ;ODE IP INSPECTION TYPE PATE !Mai CODE it INSPECTIONTYPE I l$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy i -.- CITY OF COSTA MESA - BUILDING DIVISION >°y ,,, • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 � em PERMIT ti. � V05-00965 dicbofttarst(714)754.5273 • Fax(714)754-4856 www.cl.costa-mesastOMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 275 E 17TH ST Status: ISSUED Suite No B Applied: 12/21/2005 Issued: 1221/2005 Vicinity: UNIT B RITZ NAILS Parcel Nunmber: 42522303 _...# ..0,1......_,_ • Applicant: QUANG, PETER ISSUED BY: Address: 10331 ARUNDAL AV Phone: 714-839-0661 WESTMINSTER,CA - -Zip:. 92683 ' Owner: SARRAF, KALEB , Address P O BOX 241586 .._ Phone:. " - LOS ANGELES,CA , ZIP: 90024-9386 ' Contractor:' PEROCK CONSTRUCTION Address: 10331 ARUNDAL AV - ' Phone: '714-839-0661 WESTMINSTER,CA Zip: --92683 t • ' License: . 588236 ' • - s=` SCOPE OF PERMIT'„ ,r- .- . 1,450 INTERIOR T.I.FOR"RITZ NAILS",SPACE 8.WORK TO INCLUDE:NON-LOAD BEARING , - WALLS,INTERIOR FINISHES,MINOR ELECTRICAL,MECHANICAL AND PLUMBING WORK.' , REF:B05-01874 - - 12 FLOOR SINKS(PEDICARE SINKS) , - . •- - -- -•-. , FEE SUMMARY •"' AMT QTY AMT QTY . . - AMT' QTY ISSUE FEE $23.50 . Laundry Tub/Washer - - $0.00 ' 0,•• .- • , Sump Pump . ` . 50.007 0 Backflow irrigation $0.00 0 .- -i Landscape Irrigation'--' -"'$0.00,' 0 ' ._ ` Swimming Pool ' - $0.00; 0 Backflow Preventer , . $0.00 0 - ' - P-Trap ''' - -$0.00 0' " '-"-`- Trap Primer $0.004 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- ' - .50.00 0 Wash Bisin,Set $0.00 0 Drain,Floor . -e, $0.00 • 0 Sewer Connect.`> $0.00 0 Waste end'Vent System $0.00 0 Drain,Rainwater ; $0.00 0 - Sewer Private Line $0.00:4„. 0 Water Closet(Toilet) $0.00 0 Drain,Roof ` $0.00 0, . - Shower;. -. $0.00-'r-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 • . $0.00 ' 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 -0, -Sink,"Floor _ $117.60 12 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 . . . $0.00. "0. " - OTHER $0.00 Gas Repipe 50:00. -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 -� arc- - -- 'TOTAL CALCULATED FEES: $141.10 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 void if work Is not commenced within 180 days,or If work Is suspended or abandoned fora 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. 2/ FOR INSPECTIONS CALL: (714)754-5626 // 2446-46(6/00) ///V tL DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ I have and wit 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. Y- ).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'compensatio Insurance carder and policy number are: 2 GG Cartier: _' Jt % Policy umN bent 17-! 6 O3 (This section n not feted If the permit/s valued et one hundred dollars($100)or less.) ❑ 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Caomla,and agr e that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thes vis' ns. Applicant Sfgneture:r Cpater' 12/24 Oc WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($I00,ODD),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3776 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the_Busin• and Professions Code,and my license is in full force and effect.LIC# 2Ut Class a j Cc.___iofs Signal �. �Dare:% �C7 S CONSTRUCTION LENDING AGENCY: �••-' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(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 end the basis for the alleged exemption,Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a CMI 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.11,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 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feel high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 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 et standard temperature and pressure). _ __ _- 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of'the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 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 m e a it 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 U No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer), CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. mgnature O Legal Owner(s) alL 4=. s And/OrAuthbrizod Applicant.,_ ODE I INSPECTION TYPE PEE INTITUL$ CODE I INSPECTION TYPE PAIS uu 1616 Fixed System Final Fire Prevention 206 Final MechanicalIS 1266 Pool Spa Final 208 Final Plumbing I7/L; —r 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Bullding/Occupancy • CI' -1 OF COSTA ME :A t r� Development Services, Division of Building and Safety CERTIFICATE OF OCCUPANCY This certificate is issued pursuant to the requirements of the Uniform Building Code,Section 308 adopted by the City of Costa Mesa certifies that at the time of its issuance the building Sit-6c re herein below described was inspected and approved for occupancy as follows:. Building Address 275 A E . 17th St. Bldg. PermitNumber B05-01279 Use Commercial Group Com Type of Construction' vN (7M ` Use Zone Com Owner of Building Sarraf ,, Kaleb Tenant ste A Address P 0 Box 241586., Los 'Angeles , CA 90024 9flt• • By ,��/ l/ • BUILDING OFFICIAL-Khanh Q. Nguyen, C.B.O. Pete, '4enace , Combination Inspector Date 4-4-06 elsalia) REQUIRED TO BE POSTED IN A CONSPICOUS PLACE �J 1 � CITY OF COSTA MESA o BUILDING DIVISION FAi 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.0 FOR INSPECTIONS CALL: (714)754-5626 S t PERMIT NUMBER. E08-00037 PERMIT TYPE ELEC STATUS: ISSUED APN: 42522303 DATE ISSUED: 01128/2008 ISSUED BY: BJK JOB ADDRESS: 275 E 17TH ST CM Suite/Unit: Vicinity: • SCOPE OF WORK: CHANGE-OUT ELEC SVS-IN AN EXISTING COMMERCIAL BLDG. 1 SVS TO 400A NO OTHER WORK AUTHORIZED WITH THIS PERMIT. OWNER: SARRAF,KALEB Address: P 0 BOX 241586 Unit: PHONE: - "City/State/Zip: LOS ANGELES,CA APPLICANT: ZUBIATE, RICHARD 0 - - Address: 477 N SWIDLER ST Unit: •• ��� PHONE: 714-639-1981 - City/State/zZip: ORANGE,CA - CONTRACTOR: ZUBIATE ENTERPRISES License No. 611399 Address: 477 N SWIDLER STUnit: PHONE: 714-639-1981 _ City/State: ORANGE,CA ZipCode: 92869 . CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Feer ' $0.00 Electrical Permit Fee: • $85.65 - Reinspection Fee $0.00 ' I '•ITHOR¢LD TOTAL FEES $85.65 (nn • IA A L ' 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODEI INSPECTON TYPE 2ATh iromm4 ODE 1 INSPE0110N TYPE Q�jF INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing r 200 Final Re-Roof - 210 Final Electrical 9/A 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 Carrier: or dismantling thereof,will be more than thirty-s&(36)feet high.(Chap.3.2.Grp (Thus seam need not be completed t Ne permit is vaned at me kindred dinars(Stoo)or less.) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date 1 . ,••r .ode,I fort /'Dycom i ly with these provisions. ;' ilk 0- 7 1-2-b/-2Cti v Division of Industrial Safety Permit Number: Appiipnt's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. A a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# •• 0 �/ !, Class# l". ( (Section 25533 of the California Health and Safety Code, with some 9 / (^2�-LW 9 exceptions, requires registration with the Costa Mesa Fire Department by 4Y Jeach business which at any one time has on hand a quantity of acutely Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affum that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the Califomia OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. My violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). 0 I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. property,❑ I, as owner of the LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that CI I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 re of LE�aI Date '7 Signature • Date �/ ITF-ice_ a�2lf'(/(4)—`�8 3057<6(1g]) And/or Authonzed Applicant Date CITY OF COSTA MESA BUILDING DIVISION >4:-• , DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER � t PERMIT B05-01280 Itttt•onanit`4? (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.01.15 DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92628 Job Address: 275 E 17TH ST Status: ISSUED Suite: B Applied: 08/01/2005 Vicinity: SUITE B Issued: 08/0 1, Primary Occ: B Eat<50/Office/Bar<50 Type of Construction: Parcel Number: 42522303 Zoning: 4004 Applicant: ALLISON PRIDY ISSUED BY: Address: 2750 SIGNAL PARKWAY Phone: 562-528-8000 - SIGNAL HILL,CA Zip: 90755-2207 • Owner. SARRAF, KALEB Address P O BOX 241586 • Phone: LOS ANGELES,CA Zip: .90024-9386 Contractor HAR-BRO INC Address: 2750 SIGNAL PARKWAY Phone: 562-528-8000 SIGNAL HILL,CA Zip: 90755-2207 - License: 258441 Arch: - Eng: Address: - - • - - Address: Phone: - Phone: • Zip: License: .' -License: • SCOPE OF PERMIT REPLACE T-BAR CEILING AND DRYWALL DUE TO FIRE DAMAGE IN SUITE B. - FEE SUMMARY • Plan Check: $0.00 Calc Valuation: $9,000.00 Permit: $167.25 Claim Valuation: $9,000.00 SMIP Res: $0.00 SMIP Corn: $1.89 Other: $0.00 Inspection: $0.00 Total: $169.14 • • PLANNING & ZONING SETBACKS MAIN STRUCTURE'Front 0-0 , Rear - 0-0 Left . 0-0 =s Right 0-0- ACCESSORY Front 0-0 Rear- 0-0 Left 0-0 - Right 0-0 PARKING Existing: 0 .. -Required: D Proposed:, ?0 • - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92.28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46 16/001 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the -work for which this permit is issued. C$_I,haave 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 comer and policy number are: /1 Carer ‹ C-`48-1b of 1'4 7 Policy Number. 'd:/ to 57) ( o (1"hrsectlon need not be completed ll the permit Is valued at one hundred dollars($100)or less.) ❑ 1 certify that in the pert ance 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 Montle,and agree that if I should became subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p ions. cant 4i9nature:— r — )-0 5- WARMNG:FAILURE.TO SE WORKERS COMPENSATION COVERAGE IS UNLAWFULD DOANSHALL SUBJECT AN EMRLOYERTO CRIINNAL PENALTIES AND CML FINES UP TO ONE HUNDRED `T OUSANLIARE(51X,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I.am.Ncensed.und_er provisions of Chapter 9(commencing with Section 7000)of DMsion 3 of.the.Business and Professions Code,and my license is in full ritrac�athre Sfs`�-1�r r Dario. ` l dara•Blgratdre L �� �eie: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end 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 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 contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,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 flied 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? d 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). plicant_..._...__...__�..___._.�—_._.nt _ __ 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 materiels)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Flre Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 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 _.. __ _..__.an .._ _ _ —..._i_ 5 Does or willo the oast present or emen building o from at other air the work which is the subject of this a estion aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes U No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facillty to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penally of perjury that I have read this application and state that the Information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of L er(s) Date �.j _.AadfOf�}Ittlodrm.Appucamt "---� .,.Data., CODE I INSPECTION TYPE PATE UMW& Poon INSPECTION TYPE MTh VI®EL$ 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Anal Sign 222 Final Site 204 Final Demolition - . 250 Final Building/Occupancy rl2�/e Mr to- 4 j • ' — CITY OF COSTA MESA ilt) BUILDING DIVISION F4-al, I• iDEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER iC�s PERMIT -I` o.-�� 05-01275 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaEcetTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 275 E 17TH ST Status: ISSUED Suite No B Applied: 12/07/2005 Vicinity: UNIT B Issued: 12/07/2005 Parcel Nunmber: 42522303 Applicant: DOTY, MIKE Address: 24612 GARLAND DR � Phone: 818-445-0886 ISSUED BY: V.- VALENCIA,CA Zip ,_ 913,557- Owner SARRAF, KALEB-' • , Address P O BOX 241586 - i , Phone _t LOS ANGELES,CA -, -Zip: '90024-9386 f s' ,���� Contractor . DOTY ELECTRIC Address:_ 24612 GARLAND DR `.V _• Phone: 818-445-0886 ;• -,4 - -'� '•' ei' " ':VALENCIA;:CA Zip: 891355 N -{ - ' License:745302 ,z. l' SCOPE OF PERMIT - t ELECTRICAL PERMIT IN CONJUNCTION TO FIRE DAMAGE IN UNIT.B>,41:-.'• `REF:-B05-01280 '' ' •?'� 26 LIGHT FIXTURES 'C . , • �..- . r Yin. . FEE SUMMARY A 4 i ,Quantity Quantity ISSUE FEE-- . i $23.50 4. . Temp Dist System°,7 Lighting 4 $0:00' ° 0 + . Temp service test (.,,.; •1 $0.00 . - ,� „ _Busway/100 fl , -,.$0.00 0 j .' ' Res.a/c package 50.00 - - Standing Section jt,/-",4,`,t: ,, $0.00. 0,, . - - ' New Res(1-2 Units). ' ', - $0.00 ' ° -`0 r;..--"2-.',-.°.- ' ' '" "`Mise 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 $26.38 26 up'tg50 kva/kw Recept Outlets ' $0.00 0 "^••up to 100 kva/kw - $0:000' .. Switches '\ ,, $0.00 0 over 100 kva/kw , $0.00, .1. 0 , $ - } Non Res Appl $0.00 0 ' 'Low Voltage Equipment ' $0.00' ...' 0 _ • Res Appi .$0.00 '" 0 '/ „* '' Low'Volt'Wiring System/Ckt $0.00`- ,' 0 - - ' ' Service to 200a„„ $0.00 0 : <>,,,: Mise.Condwt '..$0;90y' 0• ., Service to 1000a • ' $0.00,' ,;0 _ - r Misc,Conductorr- $0.00 0 Service over 10004 ' , $0.00'''- , -0 '�" > Cir'ccus,(gen'or ride) - ,;' $0.00 0 ' ' Motors to 1hp 4,$0.00 - ',�0 :Circus(meth ride or lights)/5,-.;.., $0.00 . . 0 . Motors to 10hp $0:00. . 0 - ' ChastitiesTree Stand $0:00 0 Motors to 50hp $0.00 O4-ef c- ; Fireworks_Stand'- z . $0.00 .0 Motors to 100hp =-s- $0.00. - ---q0 - ..,:Other Electrical Fee $0:00 Motors over 100hp . $0 00:- Or „ Communication drops .$0 00 0 Investigation Fee`` t • $a00,. Sub panel to 200a $0.00' ` ` 0- % -. Plan Check Fee., .,„..-. , ' $0a0' Pole Light Pkg $0.00 ice- 0 'Reinspection Fee `$0:00 Sign Circuits "' Temp Pwr Pole 50.00 -0±„.:--, ::"'..;7 , _ :7,,......TOTAiCALCULATED FEES 549.88 Intermed Pole $0.00 0 ,, I z . ,µ �:,:E 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 void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with ail applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ( I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls issued. My wo rs'compensation 1tasuranco carrier and policy number are: / � �C eert _� �� \ ‘...)1--).-4 PoITE Numper: b2 -4Y-)‘A p> S/ `(7h11 section need not be completed If the permits valued at one hundred dollars($100)or less.) \------ ❑ I certify that in the perfo once 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 if la,antl�that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these r ( � ` AQplicanfSignature: pates 7 1 05 WARNING AIF LURE 0 SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO'CPoMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND OOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed and rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license Is in full force and effect.tic.N d"2_— Class �. () 1/4 - ContracC toffSignature: Date^ 42. 7ldr' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Ls 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 penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-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,em 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. j�\Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Tltie 8,Calif omla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0-Ka- 5 No5 Does or will the applicant or present or future building occupant require for the work which Is the subject of thic&pHicilion eaermit 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 {.J No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cale). 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 propertydxf forInspectionpurposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Fature Of lgpal Owner(s) D toAtM//vff ti1 ' t(Oc Wfzed Appllderit- 'Date CODE}. 16SPECDON TYPE lag MALI CDOFt IIISPECRON TYPE ME IKILEALea 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing ////� 200 Final Re-Roof 210 Final Electrical �2.2_( C�- 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 �Et 4:,;' CITY OF COSTA MESA 4 49 BUILDING DIVISION > :� ,,,,,. DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER 1. 1 lPERMIT 05-00482 4 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ..-•:.,r- Y'.;1 MECHANICAL'P.ERMIT4•;;•; m 7.: . ._ . ' •;• • • • '( Job Address: 275 E 17TH ST Status: ISSUED Suite No B Applied: 08/24/2005 Issued: 08/24/2005 Vicinity: UNIT B FIRE DAMAGED AREA ',• -r ;y Parcel Number: 42522303 • ' ' ISSUED BY: Alltre4 Alb. Applicant DOUGLAS FARNIK 1_,....c•,...,- _ Address: 6727 S GREENLEAF,:• C ; • • 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. tial_ 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., workers'compensation Insu`r°(ice carrier and policy number are: `6anier:x-r•-. SWIM )1.1� PotyNomber: t 1?*%G —'ZDGS (This section need not be completed If the permit is valued et 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 the provisions. r--�, y� AppficantSlgnature: �J--"--�N -pt-- �.- Date;- °tl1.let> •bt WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGriga S UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND 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.-a_ 'SC Klass Il .CootzactoesSgrrature_... . it I _..isL._. L 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 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. ❑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)feel high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and 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 Masa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IC Yes No (Section 65850.2 of 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 ❑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 Califomia Health and Safety Code Section 42303 been made? 0 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. Si nature Of Legal Owner(s) Date spit T1 .ir1g11L 11. AndlOrAutho ed Applicary ` Date> CODE t INSPECTION TYPE DATE l! hi& , CODE( INSPECTION TYPE . - . _ • Erri''gJ// 1616 Fixed System Final Fire Prevention 206 —Final Mechanical ! 4• ' 1266. Pool Spa Final • - .208 Final Plumbing •- 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall . 212 . Final Fire Prevention • • • 202 - Final Factory Fire Place • -220 Final Planning Approval 203 Final Sign 222 Final Site • - ' 204 "Final Demolition • • " ' ' ' - '" '250 Final Building/Occupancy • - _ - . 'Fn CITY OF COSTA MESA 4 BUILDING DIVISION >:t ,,,,,, r.�� DEVELOPMENT SERVICES DEPARTMENT PER R NUMBER 4 � PERMIT P05-00644 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa. teMBING PERMIT n FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 275 E 17TH ST Status: ISSUED Suite No B Applied: 08/23/2005 Issued: 08/23/2005 Vicinity: B Parcel Nunmber: 42522303 Applicant RICHARD DOUGLAS MOODY Address: 1910E EDINGER ISSUED BY: Phone: 714-258-0603 SANTA ANA CA •Zip: 92705 " Owner: SARRAF, KALEB Address P O BOX 241586 _ Phone , 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 PLUMBING PERMIT FOR FIRE DAMAGE REPAIR TO UNIT B. - REF#605-01280 , WORK TO INCLUDE 1 GAS(1-4 OUTLETS)AND 1 WATER HEATERNENT; • ' FEE SUMMARY AMT an, AMT - AMT 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 I 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 e. 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 " . ;Showei $0.00 °:'0 . .-.i.: 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' $000';.:;.0'. Water Softener $0.00 0 Gas(Over 4 outlets) $0.00' •0 Sink;service/mop, - . $0.00 I•-•"+0 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.,s;0, ,PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 . . 0 . .. ' • - , REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 -0- _r, - i I - ' - - ; ;.TOTAL CALCULATED FEES: $41.95 COMMENTS.I`SPECIAL'CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS ._ WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ��Jor which this permit Is issued. :0---Yhave and will maintain orkers'compensation insuce,as required section 3700 of the bor Code,for the performance of the work for which this permit is Issued. My workers'com n on I�_nsu��,,nn,,ce carder an�,p[eI'II umber ar /,/'/ / "Carrictit— i i(L.G}' - poky Number: 2>I XN/� 702/ Mils section need not fie cornplet If the permit is ed at one undred rs(S100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and ee •• if I$ • •become. bject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi s. / �AppOeant'Slgnalure: / .- iDa � .- L 7 —0 S WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE I •NLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOGARE($100,000),IN ADD(T1ON TO THE COST OF COMPEN • ,DAMAGES AS PROVIDED FOR IN SECTION 37O60F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under previsions of Chan(commencing with Section 7000)of Dlvision3 of the Business and Professions Code,and my license is in full forceand effect:ter*/� 2 9'LS— t___-_,..- claws. ut e: eC`i ---7�Y/® �. ,f'� CDat�e: g`"�v Z - _ CONSTRUCTION LENDING AGENCY: _72h901-2t /` D�� ❑ 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). 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 t0 its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)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 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? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future 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 Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this 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 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 partof the facility to be amsiructed under this permit be within 1000 lest from the outer boundaries of a school? 0 Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 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 end 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. #Signe a Of Legal e And r. uthaflzad pliCant v"Date^- germ r INSPECTION TYPE PATE INTITIALS 9091 INSPECTION TYPE PATE ItlIIDAI$ 1618 Fixed System Final Fire Prevention 206 Final Mechanical /,//J 1266 Pool Spa Final 208 Final Plumbing r tr6 ,Lf 200 Final Re-Roof 210 Final Electrical - 201 Final Block/Retaining Wall _ 212 Final Fire Prevention - 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ,. CITY OF COSTA MESA 4 ir"‘ BUILDING DIVISION . tnitqale, ; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER k+"°ao 1.111(111 1 PERMIT B05-01279 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesalitri LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 275 E 17TH ST tl Status: ISSUED Suite: A Applied: 08/01/2005 Vicinity: SUITE A Issued: 08/01/2005 Primary Occ: Type of Construction: Parcel Number: 42522303 Zoning: Applicant: ALLISON PRIDY ISSUED BY: Address: 2750 SIGNAL PARKWAY Phone: 562-528-8000 SIGNAL HILL,CA Zip: 90755-2207 Owner: SARRAF, KALEB Address P O BOX 241586 .. Phone: LOS ANGELES,CA - . Zip: 90024-9386 • Contractor HAR-BRO INC • Address: 2750 SIGNAL PARKWAY Phone: 562-528-8000 SIGNAL HILL,CA Zip: 90755-2207 License: 258441 Arch : - Eng: Address: - Address: Phone: - Phone: • Zip: License: License: SCOPE OF PERMIT REPLACE T-BAR CEILING AND DRYWALL DUE TO FIRE DAMAGE IN SUITE A. - - FEE SUMMARY Plan Check: ' $0.00 -- Calc Valuation: 89,000.00 Permit: $167.25 - -Claim Valuation: $9,000.00 SMIP Res: $0.00 SMIP Corn: $1.89 Other: $0.00 • Inspection: $0.00 Total: $169.14 PLANNING &ZONING SETBACKS MAIN STRUCTURE'Front '0-0Rear ' 0.0 Left. 0-0 't' Right 0-0 ACCESSORY Front "0-0 ' ' Rear' 0-0 Left 0-0 Right 0-0 PARKING Existina: 0 Required: r 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 end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(6100) • . . 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 .which this permit is issued. - i:h ' I 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. — workers'compensation Insurance carrier and policy number are: /L 1 - rdCS�'er:/?"i`a -_ .3c. , -r lire-7 Polic Numbar:, ✓ 6105- 4 (. 0e- _(123b section-need / () SI5GCe- _(1hla•section-need not be completed If the penult is valued at one hundred dollars($100)or less.) _ ❑ I certify that in the pen ante of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subtest to the workers' compensation laws of lifornia,end agree that if a subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p vi ions. rc'-- ppucantSignature:-'^ -'o- _. t....--Date::-- 1- 0 -1— ' — G 1 ' WARMNEI FAILURETO SE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN WIENER-TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED -THOUSAND DOLLARE(S10o,0CoL IN ADOiON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of DMslon 3 of the Business and Professions Code,and my license Is in full fa.and•effecrOE.a`-7-2.SV '-/y / C16 iT '/7 — / CSo Va nature _ � Date:'-" -g — / — r c '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). 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 dry 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 DMslon 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 properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.It,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bit 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,wit 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,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 won(from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the CalifoneahHe Health n aSfe Safety Code r aqul ,with hazardousmeex materials that a Business Plan be filed with the Costa Mesa Fire Department by every during reportedyear quantity equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 2 Does or will the applicant or present or future building occupant need to rile 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). -5--bees 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 Safely 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? 00 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). _. _....._.___v __ _ __ ._._ ... 6 Wit any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? b Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach ceNficate 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: CERTIFICA 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 ee to comply with all state laws and dry ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d Abed propertyfor Inspection pu to occupy or allow occupancy of any building authorized by this permit until final inspection. - Signature 01 Legal Owners) Date -...--------Th- r - - - 6 Add/Or Aut nl -. - _ --0a1e-- --_,.-- CODE I INSPECTION TYPE OH 11:031181.5 CODE! 1DSPECTION TYPE i----- MI ItIIIM$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval //77 203 Final Sign 222 Final Be rt 204 Final Demolition 250 Final Building/Occupancy «!!// CITY OF COSTA MESA 4 BUILDING DIVISION >• ,.,,,, ..�I DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER F I wrr lyse I PERMIT P05-00645 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. t.�MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 275 E 17TH ST Status: ISSUED Suite No A Applied: 08/23/2005 Issued: 08232005 Vicinity: UNIT A Parcel Nunmber: 42522303 Applicant: RICHARD DOUGLAS MOODY /Qn 4n Address: 1910 E EDINGER ISSUED BY: �f' Y• J Phone: 714-258-0603 SANTA ANA CA Zip: 92705 - " Owner: SARRAF, KALEB Address P O BOX 241586 -• - . .Phone: LOS ANGELES:CA ' " Zip: 90024-9386 r • Contractor: ISAACS PLUMBING Address: 1910 E EDINGER , Phone: ,"714-258-0603 • SANTA ANA CA Zip:: 92705 r _ - License: 429549- ' SCOPE OF PERMIT PLUMBING PERMIT FOR FIRE DAMAGE REPAIR TO UNIT A. • ' "REF#:B05-01279 - ' WORK TO INCLUDE: 1 GAS(1-4 OUTLETS) FEE SUMMARY ... AMT QTY . AMT QTY AMT QTY ISSUE"FEE $23.50 - Laundry Tub/Washer $0.00 ,0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 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.' $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 •.-;,,c. „.Water Heater I 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 $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 _ E' .,$0.00,.,-0 r .- Water Softener • $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop,• , . ., .$0.00; .2:- 0 ' : OTHER $0.00 Gas Repipe $0.00 ,0 -.1"-" 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. -_ " • .: -' `,1 ^'--"s' .,, ,.:..:i �``i REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 :0 z.' ; 'c 1 ,,-. .'' ,-,''-` "a., } _ ,NOTAL CALCULATED FEES: $29.65 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 void If work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5628 2448-48(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: . I hereby affirm under penalty of perjury one of the following declarations: 0 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. 70-..-4 have and will maintal ricers'corn nation insu co,as quired by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ` My workers'corn ns Insure caner and nu r are: r 4'j4x/ /� Caries :en n fir i( • 1 Polity Number.. . r- (Tlils section need nor completed' a permit Is ed of one hundred dollars(5/00)or less.) `—^'�+•.:: _- ❑ 1 certify that in the performanc 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, ree th t if I should a subject to the workers'compensation provisions of Secti 3700 of the Labor Code,I shall forthwith comply with these provision ^ —©� AppIiIaNG. OYER M r L WARMNO:FAILURE TO SECURE WORN= COMPENSATION COVERAG UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE($100,000),IN ADDITION TO THE COST OF COMP TION,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 un•. •ro I sions of Chapter 9(commencing with Section 7000)of Division 3 of the Business a Prgf pslons Code,and my license Is In full forceandeffechLb -If Class f/Tn Contractors Signature: / /% � `Dater—. —Z 3'e s CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency f• 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 fore 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 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 dMsion. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Flre Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). __..._ _..__ _._..__. _._ _ ..._..______.....__ .�__. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which I.S.the subject of this Application 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 LJ No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 WIl 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 Safely 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. nater L I r(s) ata 'A—/ioriz Applicant " / rDate-7 foo,P. iNSPECIN)N rot all (/ g1TmMLO CODE! INSPECTION TYPE ma uP. : 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing 77-7�r---- ,/ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Placa 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy TLc CITY OF COSTA MESA BUILDING DIVISION :� ,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER . v : .... 1 i PERMIT M05-00483 • ' (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • r -5 '.,. MECHANICAL! PERMIT.c: '1„-jt • Job Address: 275 E 17TH ST Status: ISSUED Suite No- A Applied: 08/24/2005 Issued: 08/24/2005 Vicinity: UWIT A,FIRE,DAMAGED AREA ,-,i c, ,:•, , Parcel Number: 42522303 %ISSUED BY: Applicant: DOUGLAS FARNIK' tea- '' Address: 6727 S GREENLEAF -- - ' Phone: 562-698-0201 WHITTIER,CA . • Zip:- "90601 ' Owner: SARRAF, KALEB - Address: ' P.O 00X241586 ., " - - • Phone: . LOS ANGELES,CA Zip: 90024-9386 • • Contractor: DOCKSTADERS GROUP ' • ' - Address: 6727 S GREENLEAF Phone: 562-698-0201 WHITTIER,CA Zip: 90601 License:350935 . " 3 SCOPE OF PERMIT _ . . MECHANICAL PERMIT FOR FIRE DAMAGED REPAIR. -- ' REF#:B05-00147 t: , WORK TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT(7.DU,CTS) - , - . - , 11/15/05:SUPPLEMENTAL PERMIT TO ADD 1 COMPRESSOR 3 TO 15 HP/500K BTU . DELETE: 1 REPAIR/ALT COOLING/HEAT - - - 1 FEE SUMMARY , ,-:. • ,. ,�.... ;Quantity ;;�. --_., '_ <; _ Quantity ISSUE FEE' . $23.50 ' Repair/Alt Absorbtion Unit • $0:00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 " Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr.>,.- $0.00 0 Commercial Incinerator $0.00 0 Refrig.Sys<100 k BTU $0.00 0 - Domestic Incinerator $0.00 0 Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace ' $0.00 0 - 3 To 15 hp/500 k BTU $27.15 1 Hood w/Mech Exhaust - 'MOO...-0 • c' - - -15 To 30 hp,/t,000 k BTU $0.00 0 VAV Box - $0.00 0 " 30 To 50 hp/1,750 k BTU.•. $0.00 0 Vent Fan/Single;Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance .. $0.00 0 • -Boilers - " 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 558.15 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 fora 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 /1 V 244646(WOO) <7 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. Vet 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. f''' My workers'compensation ttInsu ance carrier and policy number are: 154. CO _ aer. 4/1,1141-.) PoNu e mbed' ,'J CCO {q —7� i (Th action need n t be corn lefed i/the permit is valued at one hundred dollars($100)or less.) ❑' I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,end 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 revisions. s,,/�� Applicant Signeturen • (.."•••••—(.."•••••--•--•—.0 •✓r � -�-- Q• l Date: a WARNING:FAILURE TO SEC WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37C6 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect ITc' YIA' Classfr CTA co Macdo stigi at Det 11. 1 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 end 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 end 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,end 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 sate.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,Califomla Administrative Code). O 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 Safely Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia 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 Califomia Health and Safety Code been fully complied with? 0 Yes W 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? 3 Yes 2 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 0 No (If"yes",the facility must meet the requirement of Sections 25534 end 42303 of the California Health end 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 at of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: _ CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. [ Signature Of Legal Owner(s) • `L 1 • ' , Date ✓ --`.^- ,nd/Orr''AUthbiized Agp!igant- ,,, ' (Dafe'") .e' 16161 INSPESys TYPem QA7E _ II1TmdLfi 206E( INSPEFinal Mechanical cTani -'� 4i' 1616 Fixed System Final Fire Prevention 206 Final Mechanical :tit .1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof _ 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • _ 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition _ • 250 Final Building/Occupancy - CITY OF COSTA MESA 4 BUILDING DIVISION it") y ,9 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT - M05-00483 6. (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 275 E 17TH ST Status: ISSUED Suite No A Applied: 08/24/2005 Issued: 08242005 Vicinity: UNIT A,FIRE pAMAGED AREA Parcel Number: 42522303 �/1 ISSUED BY: IU��� Applicant: DOUGLAS FARNIK Address: 6727 S GREENLEAF - Phone: 562-698-0201 . . WHITTIER,CA - Zip: 90601 ,. Owner SARRAF, KALEB Address: P O BOX 241586 s- :., . . -Phone LOs ANGELES,CA - Zip: 90024-9386 - Contractor: DOCKSTADER'S GROUP , Address: 6727 S GREENLEAF Phone:. 562-698-0201 WHITTIER,CA Zip: :.90601 .License:350935 - - , . SCOPE OF PERMIT - MECHANICAL PERMIT FOR FIRE DAMAGED REPAIR: , - . REF#:1305-00147 ' WORK TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT(7 DUCTS) 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 I Alt Cooling/Heat $13.70 1 - 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/100 k BTU $0.00 0 Factory Fireplace $0.00 0 . 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 ,, . , :15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 . 30 To 50 hp/1,750 k BTU • $0.00 0 Vent Fan/Single Duct < . $0.00 0 . ." Over 50 hp 7.Over.1,750 BTU • .. $0.00 0 Appliance - - $0.00 0 Fire Dampers , • $0.00 0 . . Up to 3 hp . $0:00 0 Smoke Dampers $0.00 •. 0 . 3Toi5�hp. - -$0.00 0 Inst or Relocate Appl Vent $0.00 0 :15 to 30'hp.- $0.00 0 \ Air Handlers< 10000cfm . :$0.06 0 - 30 to.50 hp..y.: ;"_.. " . - $0.00 0 Air Handlers> 10000cfm - $0.00 0 _ - Over50'hp $0.00 0 Floor Furnace $0.00 ' 0 , ., • - Other Mechanical Fee , , . Floor or Suspend Heater $0.00 0. - . . .Investigation Fee .-, $0.00 , . ',Flan:Check Fee , $0.00 - ReinspectionFee $0.00 -,•TOTAL CALCULATED FEES $37.20 COMMENTS I SPECIAL CONDITIONS • I NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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,codea all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiratio of this permit. FOR INSPECTIONS CALL: (714)754-5828 2446-48(WOO) DECLARATIONS . • . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by sactIon 3700 of the Labor Code,for the performance of the work for which tills permit is Issued. My workers'compensation Insurance carder and policy number are: �/ Cartier: S7 t " Policy Number: ���(ch'-� (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit Is Issu:• ••:II-not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that If I should •,: : : subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. l Applicant Signature: , .— Date: (� ��� WARNING:FAILURE TO SECU- • SAN - ATION COVERAGE IS UNLAWFUL D SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE F •.••• 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 lingery rovislons of C pter 9 commegdng with Section 7000)of DMsion 3 of the Business end Professions Code,and my license Is In full force and effect.tic.07 "—� O 3 � Class# C ad Contractor's Signature: --- Date: to r 7 0.) CONSTRUCTION LE INY: ❑ I hereby affirm that them is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: , OWNER-BUILDER DECLARATIONS: . I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of 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 contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _._.____ _....._ W _. ..�_ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _or..pr...sent.._ _ _ 3 Does�r 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. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Cade been fully complied pwith? ❑Yes 0 No _....- _...._ _.._..._ occupant_._._dng_._ requirepollutionj agency? ❑lics LI No __....__. _. 5 Does he will the Coast applicantiror present or n buildingOr anyothr for the work controlntch lathe subject c this application a rtnii for such construction a modification from the South Air QualityManagement District or from other air tllsWct or a en (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 0 No �"� (If yes,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. i Signature: Date: , CERTIFICATE OF COMPLIANCE AND AUTHORIZATIO 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 lawo •. .. ..-s••s relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspe -- urp• agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �_ "= ner(s) Date And/Or Authorized Applicant ----. Date LOOS I. IesPECTION TYPE PATE IDU LODE k INSPECTION Mg 1616 Fixed System Final Fire Prevention 206 Final Mechanical -Y-A4P- fire.‘ 1286 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' • CITY OF COSTA MESA _ S. BUILDING DIVISION Y • �.,,,,' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �: i� PERMIT E05-01274 le (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaftecTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 275 E 17TH ST Status: ISSUED Suite No A Applied: 12/07/2005 Vicinity: UNIT A Issued: 12/07/2005 Parcel Nunmber: 42522303 • Applicant: DOTY, MIKE V Address: 24612 GARLAND DR �� Phone: 818-445-0886 ISSUED BY: / VALENCIA,CA Zip 91355- Owner: SARRAF, KALEB " Address P 0 BOX 241586 ' Phone: LOS ANGELES,CA ^, , - `'=Zip 90024-9386 - Contractors DOTY ELECTRIC' Address:` 24612 GARLAND DR ' Phone: 818-045-0886 VALENCIA,CA Zip: 91355 License:745302 , - SCOPE OF PERMIT ELECTRICAL PERM/171N CONJUNCTION TO FIRE DAMAGE IN UNIT A. . REF:805-01279 • . .18 LIGHT FIXTURES - - • _ FEE SUMMARY• Quantity - Quantity ' ISSUE FEE . $23.50 Temp Dist System1/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 Rgol/Spa $0.00 0 up to 10 kva/kw $0.00 0, Lighting Fixts - . $19.80 18up to.50 kva/kw $0.00 ,'0 Recept Outlets ' $0.00 k 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- 4- $0.00;- ,0 Service to 1000a $0.00 ' ..0 Misc.Conductor. - ' :r;., , -$0.00 0 Service over 1000a $0.00 ' . • 0 . 'Circus(gen or ride) -- ' - , $0.00 0 Motors to 1hp - $0.00 - ,0 - , . . --Circus(mech ride or lights) c. , $0.00 0 Motors to 10hp $0:00 0 - , = _ .F :Christmas,Tree Stand- ',•" $0:00.-- . . 0 Motors to 50hp $0.00 0 ' - Fireworks Stand (" 1 $0.00 ' - 0 Motors to 100hp .• $0.00 0 ` •.. - Other Electrical Fee ' $0.00 Motors ver 100hp �, $0.00 � /JO"�� � . ." Communication drops $0.00 - '0' Investigation Fee"- - $0.00' Sub panel to 200a $0.00 0 . Plan Check Fee • . $0.00 Pole Light Pkg $0.00 - - 0 Reinspection Fee - '$0:00 Sign Circuits $0.00 0'_ - - - . _ _. •, ' Temp Pwr Pole $0.00 0.- ' TOTAL CALCULATED`FEES $43.30 Intermed Pole $0,00 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 void if work is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5628 2448-18(8100) ' DECLARATIONS _ . - WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My works compensation Insur nce carrier and policy number are: / Carder:=�c4Mc �tJr Roliq,Alumbe? Gsq-o Lww:J S DG (This section need not be completed ll the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the patio ance 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 o Iifomia,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 s • nt•Signeture: A Delay jZ' W WARNING:FALURE T 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 37090E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: ' I hereby affirm that.l.amlicensed 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.ice 53 31.-- Ciaaey L Cont Signaaue: - Data: \ t f q I °Y. 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). 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 properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly 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 licensees 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the dMsion. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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). ...pp nto present future building .2 Does or will the applicant or or future bildinoccupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health end 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 D�r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? Y No (Section 25534 of the Califomla Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑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.,apermit 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 U No (Section 65850.2 of the Califomla Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 controldistrict or agency is required for the work which is•the subject of this application,have all of the disclosures prescribed by Califomla 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: CERRFICATE 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 or inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / //bignalur Legal Owner(s) I Ejett)e� / v (/AR�l zed Applicant' ;ODE r INSPECTIOLLIINTYPE 2A1F ItQID9LS LOBE! INSPECTIONTYPE QLT MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical I iE 201 Final Block/Retelning 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 510 CITY OF COSTA MESA 4 4 BUILDING DIVISION 5k ., ,' "4 I DEVELOPMENT SERVICES DEPARTMENT PER NUMBER 101114 • PERMIT ' B05-01276 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.c .yigILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING Job Address: 275 E 18TH ST U Status: ISSUED Suite: Applied: 08/01/2005 Vicinity: 1765 SANTA ANA AV UNIT D103 Issued: 08/02/2005 Primary Occ: R-1 Hotels/Apts/Res>10 Occ Type of Construction: V-N Parcel Number: 42546228 Zoning: Applicant: TOM REYES ISSUED BY: Address: 4060 N PALM ST STE 605 Phone: 714-525-1350 FULLERTON,CA Zip: 92835 Owner: REGAL PALE BREWING CO Address PO BOX 4556 Phone: VANCOUVER;WA Zip; -98682 Contractor. WEST COAST SPECIALTIES Address: 4060 N PALM ST. -- STE 605 Phone: 714-525-1350 • FULLERTON,CA • Zip: 92835 License: 573639 Arch : • - _ Eng: Address: Address: .. Phone: - Phone: • Zip: License: License: SCOPE OF PERMIT • SITE LOCATION: 1765 SANTA ANA AV UNIT D103 , FIRE DAMAGE REPAIR FOR UNIT D 103 TO INCLUDE REPLACEMENT OF INSULATION AND DRYWALL IN THE FRONT BEDROOM ONLY. NO ELECTRICAL OR WINDOW REPLACEMENT NEEDED PER CONTRACTOR(ONLY,SMOKE DAMAGE TO WINDOW). FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 • Inspection: $0.00 , Total: $111.75 PLANNING.B( ZONING.' - SETBACKS MAIN STRUCTURE Front 0-0 - - Rear 00.0. - Left " .0-0_ Right . ,0-0 ACCESSORY Front 0-0 , Rear 0-0 - . Left., .0--0 - ,Right 0-0 PARKING Existing: 0 Required: '0_ ,_r_." 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(WOO) DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. [Fr 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 mo compensation�'f; Insurance carrier��""d policy number are: 7��� Cartier:.- [,1,Ia- 74CSU9'UIEP (-O/kQ24k Poll _Number:X: /f- Eem7{o 101 _missoiction need not be completed if the permit Is valle.AAdd Morel hundred dollars($100)or less.) i ❑ 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 Califo la,and agree that if horrid become subject to the workers'compensation provisions of Section 3700- of/the Labor Code,I shall forthwith comply with these ey/ / S _App llNerFNLuR TO ' /if• �— CDAte: D LT O `, THOUSAND OOUyAE E( 1 R),WARNERS'COMPENSATION SPENS TIS UNLAWFUL AND SHALL SUBFOR I AN EMTI3708 OF THE AL CODE CIVIL FINES TP TO ONE HUNDRED. T}fOUSAND DOLLARE(St(p,0c0),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37080E THE LABOR CODE,INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I`rebyafflrm.that.l.am lice sed u d r Visions of Chapter 9(commencing with Section 7000)of DMsion 3 Uhe.Business and Professions Code,and my license is In fun tomk.ae end effect.I -. : class!. - 13 c c39 �ua`naturs — A - -Dare; CPR 02- r CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Ucense 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 Ucense 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 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 Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit Irom the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: • Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be flied 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 T❑_No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully compiled with? 0 Yes ❑No ~ 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit 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 Govemment Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of ire facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and SafetyCode). 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 a8 of the disclosures prescribed by Ca fomia Health and Safety Code Section 42303 been made? 0 Yes 0 No .._...._ tach ...r cath._ n.._.____._ on control _ _ _._..._...—_..._..__ e (If yes',attach certificate of compliance from the appropriate air pollution cortofficer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descn rty for Inspection as.I agree not to occupy or allow occupancy of any building authorized by this aernit until final Inspection. 4044- A - / Sinature Of L al Owner(s) ( � �__ "Authorized Applicant , , Date J ;DDE I INSPECTION ME PALE IMO ;DDE f INSPECTIONTYPE • DATE g1710AL8 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 Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site • .9."/ 7 r� 204 Final Demolition 250 Final Building/Occupancy .9`13-07 4� sa48 - ooad321 ADDRESS OF&fDOC 275 E 17TH ST Wet B CITY OF COSTA MESA — SIGN PERMIT owNERS NAYEIF a»wN: PACIFIC EQUITY PROPERTIES PERM NO: SB 086995 ADwIES1259 E. 17TH ST LA, CA 90067 PERMIT NO: SB 086995 PLAN CHECK NO: 00616-98 S GOVT: N SUPP : N ADPL.KARIG ADDRESS CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: ALT ARCNTTECT OR ENGMER: Lt.No- JOB DESCRIPTION : NEW ILL . WALL SIGN FOR THE SALON SQ FT: ARCH.OR 01325 ADDRESS: mat CLAIM VALUE: 1 , 700 . 00 CALC—VALUE: 1 , 700. 00 GROUP OCC : B / CONTRACTORS NAME BUTTERFLY SIGNS (714 ) 894-0076 caRXACiorrsimuC 8109 BOLSA AV COMMENTS: NEW ILLUMINATED WALL SIGN FOR "RITZ NAILS" ADoasstMIDWAY CITY CA =NQ: 637709 #**/+t############AF##########tt##*+F#######,F#AF##iE###############*##############*### 92655 IMT: SIGN INFORMATION LICENSED CONTRACTORS DECLARATION:I hereby&fim under penmyd perjury tatl am Oared under provisions 04 ChagwB DISTRICT: 1 TYPE: WALL ILLUMINATION: INT CATEGORY : NEW wommrbnowith Section 700DaDivision aathe Business and Professions Cods,end myWenn ektug ICC*red effect. DIMENSIONS : 2FT OOIN X 11FT OOIN AREA: 19 . 75SOFT LETTER HT: 24 INCH cITrLIG.NO.: LIC.CLASS: C 95 UC.NO.: 637709 STREET FRONTAGE 1 : 155 . 00 STREET 1 : E 17TH �'� Clq Ac -NTT eQ..1� CTS ' STREET FRONTAGE 2 . 0 . 00 STREET 2 : D•�1• � U/(! rile. PARCEL: 42522303 ZONE: C1—S LOCATION > FRONT: X REAR: OICLe BUILDER DEC RATION:Ihereby&Ere.underpenaay ofperjury theles dames ham the rears Ueenae Law for the BUSINESS NAME: RITZ NAILS > LEFT: RIGHT: following reason(Salsa)OSIS Busied and Professions Code:Any ply or loath which reglad•Penn to 03033001,mer,improve. OTHER T OTALS GROUND SIGN • rnolSpuu h,or rei any slur•.prior to V ,lemm •so require.the appliwa for such s perm to Elea signed statement that he or she licensed pursuant to the provisions a the Cauradore License Law(Chapters(commencing with Section 7000)a Medal 3 of the THIS ACTIVITY 1 9 . 7 5 S QF T OVERALL HEIGHT: OFT O I N Wawandprde.0.0 .1„thmnaedhenaaermptmiar.r,dmema leuflopedas«mpon.Arry.rwrndSeail, THIS SITE applicant fa GROUND CLEARANCE: OFT �/-.)O:IN 7331.5 byapplicantfor a pond Wheal the applicant to acivil penally nmore than feelpWed donor ISSOOD. ITEMS OF INFO 2 PLANTER AREA: O . O SQFT ❑ La,o'm dtMprpen./amypipo/wwihwag"Isthe•deaompmpti"'"a°the"ark and the"velure srolintended ITEMS FOR ACTIVITY : 2 BLDG SET BACK: 20FT or offered for sale(Section 7044.Business and Professions Code:The Contractor License Law does not apply to en owner of progeny who wide or improves thereon,edwodoes such woklimse5 hared hareor through s o ough hher own employees.provided that such COPY VERBIAGE : RITZ NAILS kmdmarmenb are int intended or Bleed for sale.6,however.the building or improvement is e sold within ate year d completion,the • op o ma owner-builder wig have the bof proving he she did build or improve tor tie purpose of see). •pLANNING NOTES : - ❑ Ler owwwa the property,um exclusivelyoOMraaitg withkcavd cO 6wsIo wren the'flied(Stair'7044.Busies and ######*****############**if***f4###J!#*######******************#######3(•*.3k.f•####)(-### Pml•esims Code:The Contractors License Law does not apply to an owner of progeny woo holds or improves thereon and who contracts for such projects with a ceereaor(s)licensed pursuant to the Contractors License Law). DEVEL OPMENT SERVICES REQU IR E M E N'r S ❑ I em exempt a Section: B.&P.C.,for this reason: /,/Q Data: Owner: ZONING APPROVED BY _ - �fGEDATE: Z' �, �V_ I do herebyeddy eddy that lamaware of and Healthtand the requirementsCallanie Health and Safety J Code Sections 25505,25533.and BUILDING APPROVED BY : .S. DATE: �_ — _ that 25534,andI or any enure building occupant will/will not one)e)need to amply with said pate codes and the requirement*for a prima rorcerumtction a medication from theA' u an y atDistt DipResealed construction applications are exempt from these //�� provisions APPLICATION ISSUED BY : DATE: - V #***ski!******#*#*#*##*###*#**#****#**************#*********#**#####******#*#*### °„" Applicant LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury One Of the folowingdedereb3rs: BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADING ❑ !have and will maintain a edgiest.of consent to self-insure tor waken'compensation...provided for by Section 370004 thelabor pERMIT 54 . 00 Code.forte performance of the work for which the perm)is hued. ElIhive end w maintain workers' Seaton compensation Insurance,as required by Seaton 3703 of thede,wperformance Labor Cothe a the SMIP/NON—RES work for which the permit is issued.My workers'componential Insurance canter BM poky number are: PLAN 35 . 10 . 50 Carrier: STATE FUND EXPIRES ISSUE FEE Policy Number: 1(121 /hi—`J / 07/01 /98 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK • TOTAL PAID DUE ' ,rt.,section need nor acompleted Ithe pica saone hundred dotter,Rr001orless) TOTALS----> 54 . 50 0 . 00 35 . 10 89 . 60 89 . 60 . 00 ❑ I sandy that in the performance of the work M which this penny s slued,I pull nor employ any para in any manner so m to become sabiea tp the wokws'O cer5atiah flee d CaldOnit era.gree err E l proal beam Sundt m the wasars' REVENUE DIVISION TOTALS--> COLLECTED : 89 . 60 OVER/SHORT: . 00 w comm+pon• ' ' Sawa •ion S7ooahew . ca..Lnmforthwithce m. with Ones• • BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN-CHECK -per - • S 1 .. 'fle- .. ... a 54 . 00 . 50 35 . 10 t cherfnFag- ehcureaid ouw'mOVesn(src*vmm„cis,f end ft,mu tconTerrarkrtde • -- aprows:Iod term *********************#******" ..et. - ********#*#**#******************************** Warning:nap al to one eurer.d tleparrdytense on cov coverage ler 1 unat l.ten pat o/ib*,en antis eons-' n povWd roc In Section 3706 of ma Leber coda fm•ng and ettemey'a fess IND I i D U A L F E E BREAKDOWN CONSTRUCTION LENDING AGENCY: I hereby arfum undo,Pena/of privy that there is•aonenkt w,lading agency for the pafammsofthe work for which this Pemiiawed(Seai3n301.Cr+.0). TYPE QTY D L ' ) C R I P T I O N UNIT COST TOTAL COST LENDER'S NAME LENDER'S ADDRESS: 0 FEES TC. E SELECTED FOR THIS PERMIT I certify the I have red this appfcation and Ode the the above iaormat on le correct.I agree to comply with all fry and math ordinances and see laws Sabato balding ocrmuavr and hereby authorize repreeentahp of INS city to ear upon the•bove•msntened popery for inspection papaws.PAULINE NGUYEN 82-17-1998/83:52 PM/$89.68 Pry Name RCPT0:01-8819761 /it . ( . U � } 'AtLIe• ' 344 4 PERMIT:086995 d Owner/Agent/�w�;T fAgent/ rl ^:r..' (5151.46.WP) White-&dig&Safety:Gree-Ale:Canary-Appian;Pink-Reveres:Goldenrod-Assent CONSTRUCTION AND PLANNING • POO. SPA • Date Inspector I Date Inspector APPROVALS Permit# APPROVALS Permit # 1. Teitporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing &Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER•GUNITE • 7. Footings • 58. Electrical Conduit-Undrgrnd; , I 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final + 14. Rough Plumbing 65. Electrical-Final - - 15. Rough Electrical-Conduit • 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval • 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling -69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas D Oil- 23. il23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding . 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL • 30. Drywall Nailing HEALTH DEPT. REQUIREMENT • 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric r • Notes: 34. Final Heating& Air Conditioning ;j 1 - 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing j 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final I. 42. Backflow Preventer 43. Backf low Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 347 48. FINAL PLANNING �/ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESSOFBUILNIO: 275 E 17TH ST uNT: B CITY OF COSTA MESA - BUILDING PERMIT eCIS -0E213$ CYRiERSNAMEIRIWDWN: PACIFIC EQUITY PROPERTIES PERM NO: E 086996 ADDRES& 259 E. 17TH ST • LA, CA 90067 PERMIT NO: E 086996 PLAN CHECK NO: N GOVT: N SUPP: N APDL.11/4003 ADDRESS CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ALT • ARCHITECT Oft EWWEFR: UC.NO.: JOB DESCRIPTION : NEW ILL . WALL SIGN FOR THE SALON SQ FT: ARCH.OR END'S ADDRESS: OMT: CLAIM VALUE: CALC-VALUE: GROUP OCC : B / caRRACTaiSWuf: BUTTERFLY SIGNS ( 714 ) 894-0076 cuRRAcroRS MM ADIIw 8109 BOLSA AV COMMENTS : NEW ILLUMINATED WALL SIGN FOR "RITZ NAILS" REF: SB-86995 mu:MIDWAY CITY CA uC.NO +tyt : 637709 ****************** *+i•*****RE*�t*** r***�c*�t***Rt**3E******�t*** **?:+t*Rt****M3HE M******** 92655 WIT: Z ON ING R EQU I R EMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I em licensed under provisions d Chapter 9 S E TBACKS (commencing with Section 7000)d Division 3 d is Business and Professions Code.and license b in full force and effect. CITY NO.: uc.cuss: C 45 uC.NO.: 637709 EXP: MAIN BUILDING ACCESSORY BUILDING 1T���L� S�GTvs FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN sate: . C• LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DEC RATION:I hereby affirm under penaly of perjury that I am exempt from the Contractors License Law for the lothwin9 reason(Sedion TWISSWAM"and Professors Code:Any ay o countywtdch requires a permit to conswd,stet,improve. PARKING REQ: PROV: PARCEL: 42522303 ZNE: REF NO: molbh,or repairany structure.prior to its issuance, lim also requires the appnl to such permitto file a signed statement the he or she PLANNING NOTES> ns weed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)d Dvbion 3 d the sine's and Professions or ru Code)a heshe is exempt therefrom and the beat fa Ore alleged exemption.Arry violate^of Soden > 1Professions . 7031.5 by any apgicani for a permit subjects the applicant to a evil penalty of not more than five hundred degas IMOD. *****'**************************** ****************************************** ❑ I,asownerd the Prwenya my emplmyeeewth wages asthei safe compensation,wll do the work and theewcture is notintended D EV EL OP MEN T S E °_R-%V I C E S R EQU IREM EN TS or offered for sale(Section 7044,Business and Professions Code:The Contractor,License Law does ridan ow apply to owner of property who buid,or improves thereon, such and who does suwork himself cc a through rough his or her own employees,provided that such Y improvements we not intended ocffered forsale.t,howmer,the Wading or Anpovemen bsold within ateYew d oomgdion.the ZONING APPROVED BY yc, DATE: owner-bulkier will have the burden of proving he or she did not build or improve for the purpose d sale). ❑ Pi Professions Code::«°he��raaa, eLe Law E'ees not anu erowner a threat!who builds a 00 BUILDING APPROVED BY DATE: contract,for such praedawana WMWdos)lcensed pursuant to the Contractors License Law). APPLICATION ISSUED BY: d� DATE: 211 -98 ❑ Ism exempt Linde Section: B.AP.C..ler this meson: **********************. . . ******** Dere: LEGALIZATION: NF E E ,S SUMMARY STRUCTURAL SEGMENT:N understandIdo hereby candy that I an aware d and understand the requirements d Calomel HeatSectionsa Health end Safety Code Sections 25505.25533. d 25534,end WMI o any future buiwng«own_iU/wit not ale)need to campy nth said ASO codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit for construction or modification from the Ar Quality Management District-Residential construction eppimlions are exempt from these provisions. PERMIT 2 2 . 00 Date Applicant: PLAN 0% SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty d perry one of the boowirg declarations: ISSUE FEE 22 . 00 ❑ "eve end will meanenacerWicaladome'MIovetinaselaworker,' mpatio ooanennPMa radfabySedion37WdlbLeba BUILDING-DP/-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code.lolhaperformancedak t»wfaw:dutp« ttt permit TOTALS----> 22 . 00 22 , 00 0 . 00 44 . 00 44 . 00 . 00 ❑ I have and wN malmwn workers'compensation insurance.ea required by Section 3700 of the Labor Code.for the performance d the worklor which Ibis partbbeund.MywafaeScoDhllpgSNjphtr fattaadPSkYnumberae: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 44 , 00 OVER/SHORT: , 00 Darier: STATE ii''U1VU Policy Number. lvtiyo.D-7y 07/01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK this section need not be completed I the pert is M one hundred dollars(5100)or Ices) 44 . 00 ❑ I candy that in the performance d the work to with this permit anyan is issued.I shall not employ any person in manner so"10 became object lc the waken'compensation laws of Cedant,am d agree this i I should become subject to the workers' ******************************s, .**. ***********************j(•******************** cot peen's i prove' a d Section 3700 crow m o hLaCole.I shall tnwin wnpy wish those provisions. I N D I V '1 U A L F E E BR E AK DOW N ya . —z Pa)i.linc 1\19i9 e,,n Warning:Fauns to Lire workers'conpsesabon coverage Is unlawful,end shall subject VI employe penalties criminal palties and TYPE QTY DE .. R IP T I 0 N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars(5100,000).In addition to the coal of corryeraatlon damages as provided for In Section37DsofteLaborCodsImeest,endalrorey'afesa. ELE 1 SIGN/ IUTLINE LIf':4 SYS ON 1 BR CIRC 22 . 00 22 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of Perjury that there is a construction lending agency for the END OF FEES performance of the work for which the pert is bead(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this eppliutyn and sale that the above information is coned.I agree to comply with all thy and county ordinances • and date law,misting to buildig construction and hereby authorize representatives of this city to roller upon the above'mentkr.d propend for inspection purposes.PAULINE NGUYEN 82-17-1998/83:53 PM/t44.88 PthtName RCPTB:81-8019762 _fl p'P_ "/ 1 `ate: ofig PERMIT:086996 Linen : i1 i d wv . fl :. (5151'4e.WP) Whte-Buildig&Safely.Green-Re:Canary-Appicarg:Pink-Revenue:GoldavodAssessor CONSTRUCTION AND PLANNING POG SPA • Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit # _ 1. Te;iporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. �' 60. Backwash Lines,P•Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fina(- 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System -Final 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 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 I 80. FOOD CERTIFICATE ISSUED If 33. Final Electric 7F-nl 18 es: 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 17 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING - 1 ° 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF MALMO: 275 E 17TH ST OUT: B CITY OF COSTA MESA - BUILDING PERMIT • ONRERSrt*MEIPIu(mat MITCHEL VICTORIA PERM NO: B 086030 'a a •ADS 1901 AVE OF THE STARS #95 LOS ANGELES, CA 90067 PERMIT NO: B 086030 PLAN CHECK NO: 05114-97 S GOVT: N SUPP : N 1PPL.MARINO ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT ARCHITECT OR ENGINEER: LIC NO.: JOB DESCRIPTION : UPGRADE RESTRROM FOR H.C. ACCESSIBILITY SQ FT: 8, 000 MICIL OR END'S ADDRESS: UMT: / CLAIM VALUE: 8 , 000 . 00 CALL-VALUE: 8, 000 . 00 GROUP OCC : B / comfacrommWtORANCO DEVELOPMENT, INC. (714 ) 660-1198 CONTNACTORSMMU*2 1370 REYNOLDS AV COMMENTS: UPGRADE HLACCESSIBLE RESTROOM T. I ON SEPARATE PERMIT MAO:IR CA NO_ 359596 +E************ -*�r*it+r;+k+ erit*�riE�(•*�E*iE�ru•******fr****4*******x***********************x** 92714 wet 107 • / ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby tint under penaly of perjury the I em licensed under provisons Of Clinger B SETH ACK S (commencing with Section 7000)of Division 3 of the Bushes,and Prdessi«a Code,and my license is in full force and effect. CITY LIC.NO.:03966.6 UC.CLASS: B NO.' 3�6 EXP: 10/98 MAIN BUILDING ACCESSORY BUILDING X1-_4 - FRNT: FT IN REAR : FT IN FRNT: FT IN REAR : FT IN Data `°"°°"" ipi T: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penaly of POSY that I am aim%hen the Contractors Liunee law/«the Idemdn,or repair anyreason i"'s'wrnn ppriortoo°iea«anw,�remiO�mesgine aappAcity"mre Ice pent COLinly Which requires file a0f sine need mm'ne«.°he PARKING REQ: PROV: PARCEL: 42522303 ZNE: REF NO: Isneed pursuant to the atm of the Contractors license Law)Chapter 9(commencing with Section 1000)of Division 3 d the PLANNING NOTES> ,uanesa and Professions Code]or that he or and is exempt therefrom end the basis 1«the alleged exemption.Any violation d Section > LC- 7031.5 by any applicant for a Deent subjects the app&anl to nivel penally of not more than the hundred dollars[55001). *****************ih************************************************************* 0 I,se ovmer of the property or my employees with wages as their sole compensation,vel do the work,and the structure is not intended DEV V E L O%P M E N T SERVICES R V I C E S R E or offered for sale(Seon 7044,Business and Professions Code:The Contraction eraction Licee taw does not applyto an owner progeny Q U I R E M E N 4TiProfessionswho bolds or inprovea Thereon,and who does such work himself or or or heelthrough or h hisher own employees.provided that such • imprcemrdit Intended es Bre «dread la a°b.D,hennarhe balding«in men that"...je mthat". Yea"...Yecombte pn,the ZONING APPROVED BY- ES € DATE: 1ZLu.. ki ownerbutder willhave the burden d proving he o she did not build or improve for the aureate d Bab), Profeas ssions Codde:The the"Op"yC«ereem Licenusively se oesnwith not any tomovmer°of propeertconstryn dwoolw�ildsd«$°dwmm«eBusiness on and whoand BUILDING APPROVED•'.BY : DATE: . -.:1 contracts for emit protects with a mnradoels)licensed pursuant to the Contractors License Law). j i ❑ Iern exempt under Sedion: B.AP.C..for this reason: APPLICATION ISSUED- BY: SDATE: 1 -LOLL (ti' ************************************************ ************************* *** Date Owner LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y Ido hereby certify that I am aware of and understand the requirements d Canonic Veath and Safely Code Sections 25505.n411,end 25534,end that I or any future building occupant MO/wil nit(dib one)need to comply crib said male codes and the requirements lar aprmi lot ornedifimtarn fromiry mm from the Aegwe Dimdd.ReddrWmuWo eoon asp/patient ieneempthomtese BLDG PMT PLUMBING ELECTRIC MECHANIC. FIRE SMIP/RES GRADING provnwe, PERMIT 137 . 25 ~ Date: pp Ao-an: . SMIP/NON-RES PLAN 89 . 21 =r ") = ' " 1 . 68 WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE "' ''' 'y L 0 Ihmemdwilmaveainecand'tcaedme"eloetlbeure on. isomommiaapnwidedlorbySsdo3ID nOdthelabor BUILDING-DIV-> PERMIT ISSUE PLA1 CHECK' TOTAL PAID DUE Code Codtaperfomweeduwork TOTALS - -> 138 . 93 0 . 00 8 • 2'1 }P IhateadMImantanmiken.' pnommwmainnsurance,asrematedbySection3700dmelaboCode,r«theleA«mantceofthe �' 228 . 14 228 . 14 . 00 wok for which the pent S issued.My workers'compensation insurance carrier end porcy number ate: Carrier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: - 'y 228 . 14 OVER/SHORT: . 00 Policy Number: D4b-96U0005291 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC? '. FIRE SMIP/TOT GRADING PLAN-CHECK ,hos section need not be completed r the perm*is a one hundred dims($fa3J Of bit) 137 . 25 .'t! 1 . 68 8 9 . 21 ❑ 1 certify 1100 in the pedormance of the work tot which this pent is issued,I shell not employ any person ter any mapper so es to c-i become subjed to the workers'mrmereation laws of Ca rude and agree the t I Inoue become eubled to the workers' ****************************** ********************************************** compensation provisions d Sedan 3100 el the Lebo Code.I shag forthwith co with those provisions. , / /� IND I V U A 4L E+, B R E A K D O W N Delo: 11=4' ^-)] APWi.t:`1.C`ry-• pt.—, e -. /. Warning:Failure to secure Wcrlrs'compensation coverage is unWhq and Meltmtlfacr an employer to criminal prenlaa and TYPE QTY DE C R I P T I O;NC, `� � b aUNIT COST TOTAL COST dell lines w to one hundred thousend dollen(11040001 In deaden t°the coo et compensation,demean as provided for In ill Section 3706 o the La ,Code,lmrestwatromay'e Ina SFC 8000 ALTE BY VALUE ERCIAL . .NOZONE 1 . 00 8, 000 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that then is a construction Fending agency for the END-')OF-.. FEES. performance of the wok for which this penal is issued(Section 3097.Civ,C). ' 4 .V . LENDER'S NAME "..j /,. 1 ' LENDER'S ADDRESS: I certify that l have reed this application end Pae that the above be«matica n coned.I to / /�f . epee COM* theay rdmWyadnaroes =. err . , and state laws relaing to bnieig construction and hereby authorize representatives of this city to order upon abasmmtimed propary , i«msPedion Prpat...LARRY CARAVELLO , Print 12-04-1997/12:56 PA/8228.14 �\\�/� Date: 1 7., 4 - fin / RCPTN:O1 6016387 sg d AgmeApphnUC«ered« PERMIT:086030 eels Ace mAovkat era ..�; (5151-46.WP) While-Elutdeg A Selly:Green-Ho:Cary-Applicant;Pink-Revenue:Goldenrod—Assessor - "c • _a; < CONSTRUCTION AND PLANNING POOL SPA • '•APPROVALS Permit# - Date Inspector APPROVALS Permit # _ Date Inspector t1. 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, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P•Trap, 0 Undrgrnd. • 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap _ 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing, 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil • 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Celli a t tructura', & Monocoat 4)03,'7 75. Dry Chemical - • 27. Frame and Id)ling 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: 1 Iz h 1__�, n 8ij dut 34. Final Heating& Air Conditioning !r Alli/ igre 35. Final Gas Pipe-Test /2.-hC/i 1C u�"M16I!/ j. / 36. Hood or Canopy /2 47 Aid add .v4 {1 cpsfr Jt. /__4� i 37. Final Factory Fireplace ,/W / /- / 38. Final Plumbing - /217 If��1K " C-< 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations /�/y�� 47. FINAL STRUCTURE & BUILDING /�.Cf IdV.f 48. FINAL PLANNING VV"TT 49. Electric Release to Edison 50. Gas Release to Southern California Gas CO 51. CERTIFICATE OF OCCUPANCY No Date • • ADDRESS0BMLODt0: 275 E 17TH ST wit: B CITY OF COSTA MESA — BUILDING PERMIT an g9NutElFIQO*N MITCHEL, VICTORIA PERM NO: P 086035 . . , • ADDRES4: 1901 AVE OF THE STARS #95 LOS ANGELES, CA 90067 PERMIT NO: P 086035 PLAN CHECK NO: N GOVT: N SUPP : N APPL.NAILING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ALT ARCHITECT ORENmNEE'S: uc NO.: JOB DESCRIPTION : UPGRADE RESTRROM FOR H.C . ACCESSIBILITY SQ FT: DICK OR ENO'S ADDRESS: WIT: CLAIM VALUE: CALL—VALUE: GROUP OCC : B / wxmAcTORSRASIE ORANCO DEVELOPMENT, INC . ( 714 ) 660-1198 catmscroanhanc 1370 REYNOLDS AV COMMENTS: UPGRADE H.ACCESSIBLE RESTROOM, T. I . ON SEPARATE PERMIT #B86030 mum: IR CA uc.ND.: 359596 *********IF**+E*�E*�E�E*�E+E+E**Rt**�E�r*�r�r+E*�E**�E*Sr*�F**4�rur**>F*RF****Sf*******4*******AE****** 92714 uln: 107 • Z O N I N GS ERTEBQAUCIKRSE M E N T S LICENSED CONTRACTORS DECLARATION:I hereby affirm under pronely of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Busiest*and Professions Code,end my license is in lull force and effect. Cm UC.NO.:039666 uc.cfAss: B Uc. D.: 359596 EXP: 10/98 MAIN BUILDING ACCESSORY BUILDING Data: IZ'y 'el1 comedo FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of pearl that I am exAhhs m the Cpraradon License Law for the foliating reason(Section 7031.5 Saimaa am Professions Code:Arty My or county which requires a Permit to aonswct ser,improve, PARKING REQ: PROV: PARCEL : 42522303 ZNE: REF NO: demdnh,or repel ny asin"'prior to as issuance.aha nine.the epprrem for are ere to Me aligned statement that he or she PLANNING NOTES> a licensed pursuant to the provisions d the Contractors License Law(Chapter 9(commencing with Sector 7000)d Division 3 d the , Bunten and Professions Code)or that he or she is exempt therefrom and the bash for the alleged exemption.Any vi lation of Section > 7031.5 byanYappicantipr a Orme subjects the applkant toe ctd penafty of not more than fee hundred dollars(25003). ******************************************************************************* ❑ I.ae ower of the MOWS«myernpweea wah wages es their ere compensation,Mil do the work and the atntcture is not intended DEVELOPMENT SERV I- C E S REQUIREMENT S or offend far sale(SrJion ton,&tuns and ProfessionsCode:The Contract0rs License Lew does not appy to an owner d progeny - who bulls or improves thereon.and who doge such work tinsel or herself or through he or her own employees.provided that such bnpowmet are rt Sanded or offered for aide ICha+wr,the Me'depainpru mr+e add Wahl°One ye MCempkten,the ZONING APPROVED BY t'" DATE: ownm434/ilder will have the burden of proving he Or she did rot bold or improve for the purpose of Se). ❑ I.asowner dthe proVer,amutAtrwy mtmns ISM mesdcoofncors lo construct the poject(Secton 7044.Business and BUILDING APPROVED BY : . DATE: Professions Code:The Contractors Liananot doesnapply to m rW Mawr of peitY who builds or improvthereon theon and who contract,ler lid,projects with a dnrmd(s)licensed pursuant to the Correctors License Law). ❑ Iamexempt underSedon: B.AP.C.,for this reason: APPLICATION ISSUED BY: , DATE: (.2...0a�j ********************************************* * ****************************** Dale: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N I do hereby certify that I am ewers of W understand the requkomeds of Cdlomie Health end Safety Code Sections 25505,25533,and 25534,and Nat I or run Mureboi d cowmen nilwil not need to campy wilt said Maleoodes endue requ"usmenbfr BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit famumctcn or modification from the Al 0ua tyMrmprnw Distort.ReSeni d ammntdnn sppimbraans exempt Idm these provisions. PERMIT 17 . 50 Data: Applicant: 25% SNIP/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:hereby elm waderperuty of ming one of the following declarations: ISSUE FEE 22 . 00 ❑ IImes end 1mentalaWEirateci catsent tosell-insure for workers'compsrmbn,asprovidedldbySection3700of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code.for r« rdthe for dissued. TOTALS----> 17 . 50 22 . 00 0 . 00 39 . 50 39 . 50 . 00 1p I have endworker'compensation will maiden workecompensation ins rance.as required by Sedum 3700 d th t e Labor Code.for e performance d the X' work for which this permit is issued.My wdlmn'compensation insurance carder and potty number we: Carrier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 39 . 50 OVER/SHORT: 00 Policy Number: U4b— ibUUUUSZV1 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need not be completed y Me permed for ate Minded dddate 161001 of lees.) 39 . 50 ❑ I certify that in the Pedonmance of Ow wait for which this permit is herd,I shell not employ any Parson in any mender so as to becomethen ' ******************************** , * ' ****************************************** compensation°''"1'd'°"'01 ''"1dSection' '°"' Section 3703 d them Le `Code.I ifmy�mn"°"°°"'pry, provisions"provisionsI N D I V I D • A L F E E BREAKDOWN �Ia DaDatal'-l— 'l'. -- al i Applicant: ..- L'.hrw .1. )v�'°" I / warning Feiiurs to secure wm*.n Co pansanonrovenWAS an employee to criminal penalties TYPE QTY D E S '. . I P T I O N UNIT COST TOTAL COST CMI fines it to one hundred mounted dollars($tO4000A its addition to dm coal of contpruston damages e.provided for In section 3705 of the Labor Coda,Interest andeltoms✓s fern PLU 1 WASH BA' IN 8 . 75 8 . 75 CONSTRUCRON LENDING AGENCY:I hhemby affirm under waft d perjury that there u a damrwon lendug.gray for to PLU 1 WATER CL•SET ( T• ET) 8 . 75 8 . 75 performance d the work for which this permit is issued(Section 3097.CN.C). END OF FEES LENDER'S NAME LENDER'S ADDRESS: I certify that I have reed this application and mats that the above information is coned.I agree to comply with all city and country ordinances W sae laws relating to bildetg conabucton W hereby authorize repramla fres of this Cay r enter upon the above-mentioned popery for inspection p rmaa.LARRY C•RAVELLO 1214-1997/12:54 PUt39.56 Pro Maine Oa JIL A a `k chd.:1 --l(-Qr,) PERMIT:086035 i--rSpneture� r'wtr t..-. . . .rmor (5151 a0.WP) White-Builder;A Safety:Green-Ede:Canary-Applicant:PvkJkwnr:Goldenrod-Assessor • CONSTRUCTION AND PLANNING POOL & SPA • - APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole / ;i 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. di/ 97 =3. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. �7 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, D 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 123 • 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - ' 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe • 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 {l 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 AODREss aFiOILLIPiO_-_ 275 . E 17T' '‘ST _ __ _- uM1 ....B.. _ _ _" _ — _... CITY_ OF_COSTAMESA _- ,BUILDING PERMIT_-. • avNws'NutEIriaowlkMITCHEL VICTORIA _ - __ "_ .. PERM NO; E . 086148. • ADDREs% 1901 AVE OF THE STARS *95 LOS ANGELES, CA, 90067 PERMIT NO: E 086148 PLAN CHECK NO: N GOVT: N SUPP : Y APPL.MMUIC AGGRESS • CONSTRUCTION TYPE:. . . . PERMIT TYPE: -ELE PURPOSE: ALT ARCHITECT OR ENGNEER: UC.NO: JOB DESCRIPTION___:_UPGRADE RESTRROM FOR H.C. ACCESSIBILITY SQ FT: ARCH.OR ERG'S ADDRESS: urT: CLAIM VALUE: _____ CALC-VALUE: GROUP OCC: B / CNTRACTORSNAME:ORANCO DEVELOPMENT, INC. ( 714 ) 660-1198 ccemucrDRSKARIN 1370_REYNOLDS AV596 .COMMENTS: UPGRADE H.ACCESS RESTRM, TI ON SEPARATE PERMIT, 4B86030 & E86036 ADDRESS IR CA 11C so._ 359 ************r*sr*RRrr******r***+t******r**+t+t******_*:r+E•ss**sE*�c*r*stsE*r***sr***r*:r*rsrvc*+t 92714 uMf: 107 _ ._ Z ON ING R E Q U I R E M E N T S LICENSED CONTRACTORS DECLARATION:I hereby afftm underat'd der pepwuy that I ah liwlsed under provisions d Chapter a SETBACKS (commencing with Section 7000)of Diviso n 3 d the Business and Profession*Code,and my Sprue is in full force and effect CRY UC.NO..039666 uc.CLASS,B UC.NO.: 359596 EXP: 10/98 . . MAIN. BUILDING ACCESSORY BUILDING Dm.: I Z-- CL—°C1 `-�A.I\ FRNT.: _ FT IN _ FRNT: _ FT IN .REAR: FT IN Contractor: IN_ RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under perWy d Perjoy thin ern exempt the Crdrtlan bates Lew ler to Idowng reason(Section 70315Bnnire ed Professions Cods My city awsly which requires permit to construct.Mer.improve.he _ PARKING REG.:__ _PROV: PARCEL: 42522303 ZNE: REF NO: demolish.or repair'a licensed Pursuant o the Praia*to prior me Contracted Lialso mn taw fiter 9(such pemat t.ithh Section signed00D)d�Darmcn 3 he of those . PLANNING NOTES>_ .__ . . BUenre and Professions Code)or that he or the S exempt therefrom and the tem for the alleged exemption.Am vulatien of Sean > 7031.5 by any apinicamfor a permit subjects theappScant to advi penally of not more thenfrwe hundred dotas(S500D. ********151E**** *151151515**15151E*****1E**********1515*******************************151E** ❑ I.resortnetdthel,w«Ivrmy amply/ems wihwages asthee sole mnpeat wildathe work and the structure is not intended . " DEVELOPMENT S E ,R 'V ICES REQUIREMENTS or offered for sale(Section7044,Business end Professons Code:The CrnacrsLicen se Law does not apply to an owner of property who buids or improves thereon,end who does such work himself Or lessee Or trough his or her own employees,provided that such '' impeueememaere nnlwerded("lee%fi nal..i,law..e the wiwngrr ina..memra 1eeld*en:. Yew dmnplrmn,da' _ _ZONING APPROVED BY - J'` DATE: ownerbulder will have the burden d pawing he or she did net Wild or improve for the purpose of sale). ❑ I. as owner d the PM".am eadmvdy rmisdng wth limed metal o a,d ceathe poled(SedkaM TO ,Sinks" and Professions Code:The Contractors Lienee Law does an*not apto an owner d property who builds r •improves thereon and she BUILDING APPROVED BY - DATE contracts M such propels who a contractor(s)feanrd poems to the Caters License Law). - I I ❑ Iamwend under B.AP.D.,w APPLICATION ISSUED BY: DATE: l ,Z cl LEGALIZATION:N _ -.F, E 'E `• S U M M A R .Y _ STRUCTURAL SEGMENT:N. - I do hereby cater that I am aware Or and understand the requiems"d Glioma Heath and Sdry Code Sections 25505.25533.and 25531.and that l or any Ileum Widirp oodryem willI sit not(Scte one)need to comply with said male codes and lin npuimmena for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a pent for confliction or modification from the Airy argermg Medd.Rea/dente/construction applieatons ere Bump from theseprovision. . PERMIT - 27 . 25 Date: Applicant: 50% SMIP/NON-RES PL WORKER'S COMPENSATION DECLARATION:I hereby am under pel pedone uy oof the following declarations: FEE 6 . 50 have end❑ Ihaewama:da:'•"aram.dm « mike's. . alesee:eweteenom,erhmr 83We ildedlry .m Stendthe Leta .- BUILDING—DIV—> PERMIT. _ISSUE PLAN—CHECK TOTAL PAID DUE b co .trm.P.tm oma.dthe ad for wmdes P.nmIssued TOTALS----> 27 . 25 6 . 50 0 . 00 33.75 33 . 75 .00 _l I have and wd maintain waders'mmperamon inuaaoe.as required by Se tot 3700 of the Labor Code.or the performance d the r work for which this permit is issued.My wears'compensation insurance carrier end policy number are: Caner: STA E FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 33 . 75 OVER/SHORT: 00 policy Number: - 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHA -, FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not to completed d the permit is for one hundred dollars IS100f or less.) 33 .75 ❑ I candy that in the performance of the work or which this pent Is heed,I that not employ any person In any manner so as to borne subjad to the workers'compeamion laws of Cara l..and epee that if I shoid beeone subject Io the workers' ****************************** ********************************************** ` comppmtprovisionsnprovisionsdrsd Son 5100 the Labor Code ! forthwith comply complywth tlthose .I .N D I V I • A L F E E BREAKDOWN _ �-I' Dm.: I Z - 12-� 40.:/ Warning:Failure to',Cunt wortwu ,n'compadon coverage isrNasubjectL d shell subject an employer to criminal p,natlss end" TYPE _ _QTY_ _ D _E S • I P T I 0 N UNIT COST TOTAL COST civil fines:p to one hundred thousand dollen(5104000A in addition to the cost of compensation,damages as provided for In Section m Code 37gtoi .L.barcoea,Lm adnmy,fee ELE_ _ _1 " SERVICE' BELOW 600 .6 BELOW 201 AMP . . 27. 25 27 . 25 CONSTRUCTION LENDING AGENCY:I hereby effirm under pe shy d Pajay that them Is a contraction lending flay lot the ND OF FEES performance of the work for which the penin S issued(Section 3097.Cb.C). ' d LENDER'S NAME: LENDER'S ADDRESS: I candy that I havereadthis end d ma that the above information u edr complycon .I agree to comply with all rely and county ordinances and stale laws Mating to building construction end hereby authorize representatives tie ay o this crier ups the abate-memr ioned prope . irinspection ww s.aLARRY CARAVELLO 12 12 1997/le:e4 An/$33.75 1 L./.v J'l 2t S PERMIT):i@86148 ^ Pmt er \ i- gratin (}era«/Ig WAppiwhUComredr Doc �A (5151 dt.WP) Whbe-Buldip A Safety:Oreo Fde:Canvey-Appica.t:PSI-Revenue:Oddamod-#swat • CONSTRUCTION AND PLANNING POOL of SPA APPROVALS Permit # Date Inspector• APPROVALS Permit # Date Inspector --rr 1. Temporary Electrical Service-or Pole 52. Pool & Equipment Location 2. d Pipe•Undrgrnd. CJ 53. Steel Reinforcement . s� ti rrQQa . Clectrical Condtrlf ility-Urte}rgrnd. 54. Forms M Ic~•.tr c c. ry 4 glectrical•CondEttUndrgrnd. 55. Electrical Bonding >' rt1c • m7R,RSteel Reinforcet9$t 56. Rough Plumbing & Pressure Test ,'m¢ 1 :.). fi• l-:>evElectrical UFEW�rnd. 57. APPROVAL TO COVER-GUNITE f.t~rru run - C Footings 06 58. Electrical Coni tUndrgrnd. r. [Cal4oundation x u 59. Gas Pipe, 0 Um3cgrnd.H. , Test 0 9Leater Pipe-Unc TgRid.Q • 60. Backwash Lin€R-Trap, 0 Undrgrnd. 10:5tructural Floor System 61. APPROVAL TGcc'f9ECK vtdo - v v 111.cProperty Seweraint& Housya-Connection 62. Backwash & Rec,tor-Final , 1t Sewer Cap co 63. Heater & Vent-Final ' 13. Roof Drains ^ 64. Plumbing System - Final 14. Rough Plumbing, w tr.! 65. Electrical-Final . - 2 15. Rough Electrical-Conduit .• 66. Solar System-ikc H 1 n• 16. Rough Electric'Virir to o 67. Fencing& AcApproval I ' 17. Rough Wiring Sign - c• 68. APPROVED MR PLASTERING -. en non. 18. Rough Electrics'•-T Bar Ceiling 69. POOL/SPA SYSIThMS FINAL 19.0Rougih laatigg &•Aat Conditioning * y y Qty T t SPT-iEQUIREMEN.T m ~ O Oc, 7 r C ^ w- n m ntusoItS m * >, 7 20.To Ft A/a FEAace It iS,r �C * St NT* < Ap t"J ' PeZamit# * c tr 21. ut8g,ir tru2tutey r-4 * 0S n* 70FUnde-tt Pc4,,s. d ED/dro * 22.Au6R, Wntis ing7* „O * d K 0 H* `'C 71. Prochripin as Oil 2 0 H Cr 7 ••* t x C' 1-I* E-, Yh'I' r uJ�'' 'diP o S st z m s .t m a. Q O* H23. Gasu t , #. Cj e41 , 25 , .• . DCS * tc t, s* c 72. Undergsqund _gab * y cr4 .. ' - * 0 C' * I.- .., o F -. 24.'Root Framing 0* m * > Q .•1* yy Sttite Tan ❑Gas ❑Oil 'Q* r vY* m .Q NFS C"�. �! 25. otSheathing O* H * `3 ,r, Ox 74. Overhead Hyd®C * .rl t..* S-tr- * 5 ,-,d T "7 ♦ • . Z. :1 26.r<T-Ba"CeiFing (Structural) & Mib'tScoat * 0 >4 d* 7$. Dry Ch al HZ' * m _ L� 07 * s m 27. ramea,,,,��II Flashi^` ''•S * tr >4 1.`',;` 76. DryStas H * .. n C* * -+m0 s * 2uf pe< e G N 28. Lathing Sidingnx '..4Z r O xry, 1 I t* 74. FIXEcY$ °ST¢h'PFIN )_4"'' n m r i 29. Insulati '- in* s 0 * :i ' I . FIRE PREV. �.Ir�yaL * > w a rt r• P7 * i',i', -- ,-r r x 30. Drywallti1ailing C,* t-+ I * F I 4' NHEALTM-0EPT. REQUIREMENT < W r+ .11 • ;-•:...)_ r n a., n N 31. Plaster BrjlwCo�x '- fir, * n kyi A79. FINALi•� PEC 0 * 3 �3 _fppp * J e+ r 32.ylectricaCPoWer tinter-Ethel I!c' _ti 801 FOOD CrERTIO A E ISSUE& 0 • .a 7 O : t PIC ^• 33. 'indPEle`1:trie? * m ', eat, • I �' r ! l 'tg's; `3 -3m i: '1 0 m * � �H a V et< ;run * >s T r• 34.,,,in. Hestin•.t Mr. ppditioning tr; * > M H,-.10 -, ' r,• I Fes, `.'. "' bJ --- - rM ' - r7 C'Y r-+ x n.'i% 4(1 atn. M 35.CP)inal GasPipetTe * O •• * H x aro O--+ * mtr' * c 4 * m • ••n * m m 11 36.4404 044341opym* n • xt*, ti * n * r Z * m 0m 5 ;-1 Er- : • sire, 4 rt ,e n x z m •% 37. Pina1'Fa ory Firs�,15 t F-F N * i .,, * ;"t rlVII 'F.* ct t v * 'K S r * y 38. F Plarftbing F..* m i * I 1 iik m : S * Q. .- t t a •:n . r•• 39. Water Set°vice-Final* 8 • * m I --k >I to * *4 P. MI C'* :-1 * * Fw • * m E r' 40. Gas Servµuge•Final2* OFF m *Th-i v h' • 'vX * ¢ r El41.41. Solar Domestic-Fin I !^ * C , (x :T' 'min., a' * 3c 0 ci K ti t-.* ', . * D I I It ..t Oi * S 42. Backflo "Pr nte* `t r ,..� I * t j t>,70 `' F �f t co o 43. Backflow Irr tical 4-4 r>4 ^ it ..•-•:la * n • "" - -n* * * F N * Z O CA n * •*-,m2 F * m J C7 d* x io N M0 * n. nu X94. andsca I igat t� Systeme n+ * Q* ^ E E t.., O.%. * S r �, r. wx r 1.f.h ,• • � . • f , rn • i , 4 -4...) T, r d45. and Attenaatiarw * in mm* F C. c' 'C • Had * ter"' c.. . x r7 S * Kr .. .. ..* c i tc Y 4-04.-: -i -•1-1 4 9d6. %a cad'Reg(laf; s S * S I l { Q m O D,v n 03 OP."FIPF_isL STRL�CTg E & BUDDING DK :.I I . n r r.r * l n: CC a3 * 0 48. IM2L PLANNI I E E~ * a I I -Vel: O N s * t V l'1. u , .a 4 c tR '7 cy9.Cilectnc Release to gdison i eI ( x. 61 •n ti t. r . * -_;*. 'C ^ a ( : 't ' °50.-Gasaielease to Southern Cali}o' 1Gas Co ** * .* s C7 • oon * O • s no n * to -.+ '51. CERtIFICATE OFtCCUPANCY '' s C "o "e No. Date ADDRESS OFBMLaNO: 275 E 17TH ST WIT: B CITY OF COSTA MESA - BUILDING PERMIT ' OIMEWS4*4EIFWCVt1I MITCHEL VICTORIA PERM NO: E 086034 ' • ' ' ' ma1Eu: 1901 AVE OF THE STARS *95 LOS ANGELES, CA 90067 PERMIT NO: E 086034 PLAN CHECK NO: N GOVT: N SUPP: N APDL,MAILING ADDRESS CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ALT ARCHITECT OiETImtEER: It NO: JOB DESCRIPTION : UPGRADE RESTRROM FOR H .C . ACCESSIBILITY SQ FT: ARGIL OR ENO'S ADDRESS: WIT: CLAIM VALUE: CALL-VALUE: GROUP OCC: B / r c« uncmNAla: ORANCO DEVELOPMENT, INC. ( 714 ) 660-1198 com*ctarsuARao 1370 REYNOLDS AV COMMENTS: UPGRADE H,ACCESSIBLE RESTROOM T, I ON SEPARATE PERMIT *B86030 mottles: IR CA ucm: 359596 ********M**M****MMM************M*M*****4+r**miter***+miser***sit****+rsE*sr(r***site****site*srrt 92714 UMT: 107 ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby Slim wider penally of perjury that I am licensed under provisions of Chapter S SETBACKS (commencing vAlh Section 7000)d Division 3 d the Business and Professions Code.and my kens Si,hA Lace and.flea. cm(uc.NO.:039666 LIC.CUSS: B sac. o.: 359596 EXP : 10/98 MAIN BUILDING ACCESSORY BUILDING Dafe: ) 2 -t-I :- a/-1 Contractor: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby Mann odor deadly d perjury duo I em exempt hon t Camas=license law for the IdlnwigreMcon(seamn705ls&anassime rdeem.Code:Arryrayacomymich mmelapamoloommgmia5«.inWOve. PARKING REQ• PROV: PARCEL: 42522303 ZNE: REF NO: demolish,or repair any Wurnoe.prior M ts'swerce,also requires the appfod for stab pant to Se a signed statement that he or she s licensed wawa to the provisions of the Cannanore License Law(Chapter 9(commencing with Section 7000)of Division 3 d the PLANNING NOTES> dusneas and Professions Code]a that M or she b exempt therefrom and the basis for the singed exrroli n.My velem of Section -. > 7031.5 Many applicant for spermit auhjsds the coked loadvl penalty Ota mos then Me hundred dggre 15500➢. - .******************************************************************************* nrd « ❑ I,Oaowthe properly or pe ee wth wawa as awe aidatbm e comperwn,coil do the work,and the it;net intended;k. D E V E L O P M E N TS E 'R V I C E S R E or offered for sale(Section 7044. a 7044.Baikal Professions dlw ors Code:The COcn License Lew does reaNto en general property -,; Q U I R E M E N T S who bolds or intsoves thereon.and who does sudi work himself or henna a through his a her own employees,Provided that s ch Improvements we DMkdededadieredla sale.ff.hvwsyr,the badvgorinPmvrneni 4"I**thin meYear doomPI . nmthe.L ZONING APPROVED BY DATE: ov armor-balder ur roll havethe burden d proving he a she did r bol d or improve for the purple d sale). - ' ❑ PIO.�tlions ner of the The C aractorsL License Lawern exclusive& does nuts to ownerh Gonad contractorsdp 'the iy who buildsorori prove* air wand ho ,BUILDING APPROVED BY : �� DATE: contracts for moll Voted*with a redreda(s)licensed pursuant to the Contractors License Law). r: I . ❑ Iant exempt under Section: B.AP.C..tor this reaal: - - +t v APPLICATION ISSUED BY: •-i . DATE: ktkk199 Dela: Owner: `7 S �. *************************3F******M***3F********** t1.t s t ee**********-m a::t:a r.x It mint It LEGALIZATION:N F E E ` ' S U M M A R Y STRUCTURAL SEGMENT:N I do hereby certify that I am aware of and understand the requirements d Cationic'Health ad h and Safety Ce Sections 25 ?gag".tic".and 25534,and that I or any Mus building occupant will/wil rid(Omit one)need to comply will said state codes end the requirements for a permit for consoa+vn or modification Iran the AiQuay Mane(lenere Umia.Redderaid construction applications ate exempt Iran tee PERMIT BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. Dale: Applicant: 5 0% SM I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby eNbm under penally d perjury one of the following declarations: PLAN ISSUE FEE 22 , 00 B ❑ Huns and will rof content uOum runnacerticeo« ntlowkwwMamsMb s' mpen.mVaidedl«bySriion370odteLabor BUILDING—DIV—> PERMIT ISSUE PLAN CHECK TOTAL PAID DUE na Coda, orthe p. maa.dthe work for which(hie permit is issued. TOTALS----> 13 . 00 22 . 00 0 . 00 35 . 00 35 . 00 . 00 .Cl l have and MI maintain workers'compensation insurance,as required by seduce 3700 d the Labor Code,for the performance d me 7C work for which this Perm*b Sued,My workers'compensation Sumas center end pdky number are: Canir: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 35 . 00 OVER/SHORT: . 00 Polky Number: Q4h-4bU0005291 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK mit section need not be completed*the pearl is For one hundred ddba Is foal or last.) 35 . 00 ❑ I redly that in the performance of the work for whet this panne is Issued.I shall net employ any person In any meows)as lo became subject to the worker*wnpenwice lame d Celbnie, end rearm that a I shah bacons ambled to the wabrs' *Met*MM**M*M**it***M**M*****M**MMM*MMM**MMM******M******************************de compensation .ro pvisiond Sedicn 3700 d the Labor Code,I fotw*h aunply with provision. Oats: l L- y—Ill q l APpbad C✓1 I N D I V I D U A L F E E B R E A K D O W N Oa Warning:Failure to secure workers'conpruatlon courage le lnbwM,and Me ran rroloyr to crymwpen✓uea and TYPE QTY DESCRIPN UNIT COST TOTAL COST doll Ona W d one hundred thousand doers($iM4000A in addition to the cost of conprusrlo,damages as pmvldal Mr In Section 3rogofinac eLaborCodeIntrandBitume1leet ELE 10 RECEPT/ TLET 1 ST 20 EA. 1 , 00 10 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a constnMion ending agency for the ELE 3 RECEPT/ WITCH T 20 EA. 1 . 00 3 . 00 performance of the work for which this perml is issued(Semon 3097,Civ.C). OF FEES LENDER'S NAME: LENDER'S ADDRESS: I candy that I have read this application end data that the above Somalian is correct.I r Mee to comply with cop ody and a ady od'mmcee ' I and rale Ian Sally to building consthation and hereby nabace representatives of this oily to enter upon the ahem-mentioned property for nnspeagn wnw«..LARRYa AVELLO 12-04-1937/12:58 P1- 93 163 ‘...9" ow:�� 4'� PERMIT(:T086034 Sgasmm d AgrWAppfmd/Caaaa« (515146 WP) Whets-Baldry A Solely,Gree.-Re:Gmsry-Appinra:Pink-Revenue:OoMeraod-Alava c. .� :: CONSTRUCTION AND PLANNING POOL .. SPA - " 'APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector L 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i 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 gel el 67. Fencing & Access Approval 17. Rough Wiring Sign - _I/ APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL • 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT. 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Finales FOOD CERTIFICATE ISSUED 33. Final Electric �!�/ t4/7 tek: 34. Final Heating& Air Conditioning -0""L� 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 ADD 275 E 17TH ST OAT` .BCITY OF COSTA MESA - BUILDING PERMIT 'Orw NAll FNNOw*MITCHEL VICTORIA - - __ ___ _ PERM NO: P . ___086149 ' - ADDRESS: 1901 AVE OF THE STARS #95 LOS ANGELES, CA 90067 . . PERMIT NO: P 086149 . _ PLAN CHECK NO: - _N . . . _ GOVT: N SUPP : Y MPLJWLIG ADORES& CONSTRUCTION TYPE: PERMIT TYPE: PLU _ . - PURPOSE: ALT ARCHITECT OREt4wEER: UC.NO.: JOB .DESCRIPTION : UPGRADE RESTRROM FOR H.C. ACCESSIBILITY SQ FT: ARCH.OR ENO's ADDRESS: UNT: CLAIM VALUE: CALL-VALUE: GROUP OCC: B / caxrRACTORSNAME'ORANCO DEVELOPMENT, INC. (714 )660-1198 CONTRACTORS WAILING 1370 REYNOLDS AV.� . COMMENTS: UPGRADE H.ACCESS RESTRM TI ON SEPARATE PERMIT #B86030 & P86035 ADDRES& IR . CA UC.HO: 359596 *********+r+E**************:rpt:r*****4***:E**+E:E+r*******SE**SH: *44**SE*+t*+r:r****Er:e******* 92714 Ulti 107 _ _ ___ Z O N I N G REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am fcerued under provisions d Chapter B SETBACKS (comneadn9 with Section 7000)of Division 3 of the Busines and Professions Code,and my Doense is in fug force and effect. CITY UC.xo.:039666n uc.cuss:B uc.N0.: 359596(t___\EXP: 10/98 MAIN BUILDING. ACCESSORY BUILDING Date: ( t— lZ--�l1 comrw ✓1n_- " FRNT: FT IN_REAR: _ _ _ .FT IN FRNT: - FT IN REAR: . FT IN LEFT: FT IN RGHT: _ FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penally d perjury that 1 em exempt from the Contractors License Lew 1«the follow reason(Section 70315 Business and PMeanens Code:Any city or openly which require a Permit to oonema,.akar,impow, PARKING REQPROV: PARCEL: 4 2 5 2 2 3 D 3 Z NE: REF NO g demolish,or repel any structure.prior bits infante.also requires the applicant for such permit to fib a signed easement that he or she )l: - - r licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)d Division 3 of the PLANNING NOTES> - • - dueness and Professions Code]Cf that he or she s exempt therefrom and the basis for the alleged exemption.My violation of Section . > ri' ' 7031.5 by aY sdiamfor e permit subjects the sdicgnt toechit penally dna more than Me hundred dollars($5001). ******************************************************************************* ❑ I.es owners the property or my employees with wages as thee sole compemetkn,will do the work.°rd the stmcture is no intended or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an bwnerd property DEVELOPMENT SERVICES • R E Q U I R E M E N T S who bioids or improves thereat and who does such work lanae or Meeh Or through his or her own employees.provided the such improvements are net intended«offered for sale.ff,however,the building«knprsvemenf is add within one Ye«d Completion,the • owner-butder will have the burden a Proving he or the did nor wild or improve for the purpose a sale). _ ZONING APPROVED BY DATE: ❑ I.as owner of the progeny.am exclusively oonlradng with licensed c nae«or to construct the projed(Section 7044.Sunnily and professions code:The Contractors License Law aloe net apply to an owner d properly who builds or improves thereon and who BUILD ING APPROVED BY : _ DATE: contracts for arch projects with a centred«(,)licensed pursuant to the Contractors License Law). ❑ I are exempt under Section: B.AP.C.,for this reason: APPLICATION ISSUED BY: DATE: traleLt l *********************************************** *************************** ** Dale: Owner LEGALIZATION:N F E E SUMMARY . - .STRUCTURAL SEGMENT:N I do hereby certify that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and ' Pe5'a,and that I or any future building occupant will/yN1 not(circle one)need to amply with said state cods end the r gUiremens for apannh for modifcationfronthe Ar Cud Management District.Residential c« rdo mnn applications e exempt from these BLDG PMT _ PLUMBING . ELECTRIC MECHANIC FIRE SMIP/RES . GRADING provision. , PERMIT _. . _ .... ,11 , 00 Date: Applicant: 254 . . . _. _ SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following dedutlkra: PLAN ElIhave adwameintanacenfficatelconsent toeeH.insureMworkrac«npensaton.sprovided l«bySe:ion37Wof the Labor ISSUE FEE 6. 50 Code.I«tMP.d«mmnceathe work for which this prrmitss.ud. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE 4] Ihave and wilm.walworkers'comprinsurance. d aationasrequiredbySekw n3700orteLaborCode, thped« aof the performance TOTALS----> 11 .00 6 . 50 - 0 .00 17 . 50 17 . 50 . 00 work for which this permit is issued.My worker"'eormemalen insurance carrier and policy number are: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 17. 50 OVER/SHORT: .00 Plumber. fi46-§6n000541 01 /01/98 BLDG PMT. PLUMBING ELECTRIC MECHANIC, .FIRE SMIP/TOT GRADING PLAN-CHECK (Dors ensu need not be completed i dw prime is M one hundred dadms MOO]or Ase.)_ . .1 7. 5 0 • ❑ I ceded that in the performance of the work for which this pent is sued.I shag net employ any Person in any manner s as to become eubled to the workers'amPen°ation laws d CaN«ns.and agree that P I should become subject to the worbn' ******************************************************************************* compensation provisions of 3700 of the Labor Code,I shall I thwhh ompyrwith �those p I .N D I V I D U A F E .E B R E A K D_ O W N .�* Date: I tom I 7 Applicant C/' - v . . , T Warning:Failure to secure workers'compensation coverage b unlauem4 arid shelf subtract an employer to criminal penalties and . .TYPE . ._QTY. _ DE S C ' I • I 0 N UNIT .COST TOTAL COST - civil fines tq to one hundred thousand dollen 0/04000A In addition to the coot of compensation damages as provided for In Secda 3M6 of the Labor cad..Interest anda ,.marn.y',r.. PLU 1 _. .WATER HEATER AND/OR VENT 11 .00 11 . 00 CONSTRUCTION LENDING AGENCY:I hereby SRum weer penally of perjury that there ie a constnaion lending agency ler the END e " FEES __ performance of the work for which therm perms is issued(Section 3097.Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify the I have read this application and state that the above information is correct.I agree to comply vrith all oily and county ordinances and stale laws releig to building construction and hereby authorize representatives of this thy to enter upon the above-mentioned property I«lmpeapn purpaee.LARRY CARAVELLO . - . _ _ 12-12-1997/10:94 AH/917.58 Pd RCPT4:91-3816763 tZ-( � PERMIT:086149 4 Dae: Z"�1 "� UI` Signesr Oa,ar/gpenUApplanUContado (5151d0.WP) White-Building&Safety;Green-File:Canary-Appian;Pink-Revenue;Goldenrod-Assessor 'r 1 .„. CONSTRUCTION AND PLANNING POOL ..i SPA "-APPROVALS Permit # Date Inspector APPROVALS Permit# • Date Inspector V , 1. Temporary Electrical Servicer Pole 52. Pool & Equipment Location X2. ^^nn�j77oil Pipe-Undrggld.tH� -en 53. Steel Reinforcement :I • 1ectrical Cond Utility-UncTgrnd. 54. Forms < 1 i.=A. Electrical Condflialndrgrnd. - 55. Electrical Bonding • >1 m d•C r Aeel ReinforcerAeaF 56. Rough Plumbing & Pressure Test t->6.tctlectrical UFEFDG2nd. 57. APPROVAL TO COVER-GUNITE I � rreil �n r•, me-, ;1rFootings i tri 58H 00 . Electrical ConctitUndrgrnd. � -' 1 J'tt, CL t-1 1 ,:.,r-8`-I�Pundation :,i 59. Gas Pipe, O Uijrnd.,Test p • Teter Pipe-Unded. a , 60. Backwash Liner, Trap, 1; Undrgrnd. • • 1Cc:Structural Floor System W61. APPROVAL Tal@ECK ro 11. Property Sewer tines& Houso€onnection 62. Backwash & Rect tor•Final w it C.:Cap ec 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing , X . 65. Electrical-Final .I 15. Rough Electrica✓rCoiiuit ... _ 66. Solar System-FIi c+F k 16. Rough Electric A�irirt 'o 0 67. Fencing & Accrsepproval ' I 17. Rough Wiring Sin `� y .- 68. APPROVED F PLASTERING I , L., m - pin• - 18. Rough ElectricaRT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 19. Roun4. I'j tirig,& Ail;Conditioning{ T;34 * rn m <* .y C FbRfi OEPTZ1EQUIREMEQI,T C' m '•'N D U en * >i `7 20. 'Fiou4A FTdtorcgFi2(ilace I Si"' ZC * S H a* App E�p}--t�F p*nit # * C' 0 S ,FF.. .•-. S* ; F F XS * H •-7 '7* < Dr'3< m * i 1 21. Oust,$incitrtl•LRur x i SS ..* 0* nz 1; HS �-i 70.1-Undergree trtki I irdro t 3 > : t OS ' . s < •i t„5 ' :'7ty * • 22. Suct1, VF3ltilaCingNt I xf * Cl C n H < 71. ProduMtiefinggtas poi' /n L. G' 'l •.k I r... 1s * m " C o* H CiI n * 23. Gas`k'-pe• ou 1 8�`J• st ; Irn. OIC * eC t S* 0 72• UndergrpVod F iso * >I , ! .s F •• u x , F-,e -'H-• r 0- J * S m > Ie * , 24. Roof Framing r3* I*1 * > x H* - 773 Undergrdd.Sto5 Tent 0Gas ❑Oil ! c. n 7.1: 5' N * m n R;* S 't v 25. (Boo $heything Gx Hs * .; m may; 7 Overhead HYdI'8tr 26. :fBac•Ceiiing (Structural) & M .soat 4 0 )1' t7* 7% Dry CheRiical r0' * C - w' rs z m x r-, r41•-• ^1r-4 * C to F ! 1� 27. hi•Frame ar@ Flashin '* =`^= �L,yO: e, ** C A 0:1** `+ i .Mr-- * `r1 ,�4 >.* 76. Dry Sta pie<,., , * (7 N i•-. 28. Lathin a t :* i. "'C.,. 4 Z u HO JSI.. J. 98tSiding nx: -.,Ge-' O '< I 7fi! FIX EDC9'9�TE 4NA1;1"` ('1 :c , 29. Insulatigtfl N.Y. S Q * S I • 7g. IREfeREV. FAL * > , I-. , 30. Drywall tiling cc* H i * F ( * SOI) 'JC.14EALTtI DEPT. REQUIREMENT A ..c.. * * r'nw nn: . * n ,-r N r e- * s I mM * *-h' * < r Q 31. Plaster Brit wrbCoa�* I Hi-, * * 79. FINAL ECI N * O F S • R 32. ' lectricaPover f4ter-4oal i * * 801 FOOD CERTIF31CATE ISSOEFY - ' et, -t ' '• m It 'M :t S nS. 4- O 8 33. :Fina leCtric> * tr1 I < * I * es: n cern * n C Gtr1 1*: 'Q F'* '3. r I:.-iH • CC IkQ I * t4 m. ' * . s. • [ .- m. - S S 1 x f !' -.. t I .. . .s. - .`...1 34. .FinaL5-le2Stingrt Air to9atioriing WI * > , ; C, ^ ,i fC *es x r" �n 135. tF•inal Gas riper.Tes•T.* 0 - ; H t* O SO CH * Fp' k * m • ••n * m >i • N* S. t IT el a * 2 CIO * tr 'A 36. Hood,or;Canopy Irl* n 1 xi cn * I m 7Co * m m .i 37. Final•FaMpry Fir l c x I `� cn *yyN 1.0 b" * Co & 38. Fina ltygbing H mN I /0„ C /yJ'" /fir,: '_-,. (-•• ,.,M l r �> f ' m 39. Water Service-Fin *k S i LI * .. r >I F t- * m r4.1 CI V • 7 40. Gas Serv*-Final m* m 'Ct"Cr J. v S * m , - tv Ct cC*: 9 F F• m * F • O E * <4. .-r Z 4. S - o: 4,_. ' , 41. Solar Dornestic•Finek r * I c #10' o c * x D .--, Le* r✓ m * o . H 0- * S 42. Backflo^ re nter""* N * 1 1 tX >F * L' S * N CH_ * H * m RIO * H h >4 43. Backflow IrriRtiota* >, * 1::: i * r; .* n • . -� ^' „' m# ^'m0 S * m C7 0 0* r C) CU =to a Cu Le I 4. (4a ndscapjd Iri%atwJ System-.'y-- tr.. * ,C c r. <* z E OM * S x. r +� Wx -,b.F-, c• * 2 F' ' I •k r. ' 1 : i rt X''C I- t 45. Sound Attenpatian ''i •• •• * m iti mid- T tr C • Ho * s. 1 .. 4-, n * r-, •c * r .. .. . * / / HN .•^I * 46. Hanicap'RegUlatc s HS `� * S ` i- Ixn O �O s 1. b CS 4 * 67. FINAL STRUeTI, :t F& BUIL°ING * t' T H .•+r , m rr * I t+: r') r h * C 1 HH * N I C!' r m 'C * ...' 48. g.'INgi PLANNIft 1.� * 1 * , n r3 N S * < 1 gig, Elecfiic Release tc t iison I * I it ri AA -n r -k - _ 1 tk 't^, r7 Oz * r, 4-1 1 •50. as 1ptease to Soutt*ern Califot as Co * I * F. s oo -n * c `51. CERTIFICATE OF OCCUPANCY t No. Date • ADDIEsscWewmn:_ 275_E_17TH ST_______ . 0Bf' ...B___ _ __ __ ____ CITY OF COSTA MESA — BUILD.ING_.PERMIT_. - vwhuwswkwmOVIN:MITCHEL VICTORIA _ __ PERM NO: M 086150 - ' ' ' ADORERS: 1901 AVE_OF THE STARS #95 .LOS ANGELES, CA 90067 _ . PERMIT NO: M 086150 PLAN CHECK NO: N ._GOVT: N SUPP: N . ATgL.MM04o ADORERS: - _ ._ .CONS,TRUCTION_TYRE.: _ _PERMIT_TYPE: .MEC PURPOSE: ALT ARCHITECT OR DKINEER: UC.NO: JOBLDESCRIPTION__ _ UP.GRADE_RESTRROM FOR _.H.C. . ACCESSIBILITY SQ FT: ARCH.OR EMUS ADDRESS: u*T: coum*CTOWSNALIE:ORANCO DEVELOPMENT, INC. _ (714 )660-1198 CLAIM VALUE: CALL—VALUE:. GROUP OCC: B / 10NmACTOWSMMUNG 1370 REYNOLDS AV . . .. _ COMMENTS: UPGRADE H.ACCESS RESTRM, TI ON SEPARATE PERMIT, _ ;E�E�E�E#B86030 mmss: IR CA uc.Nm. �E 359596 ******* *+Ew***AE*****alio*;E*****w�E***+r*****+ESE**;E*;erfE**;E****s* *w �E*******�E***** 92714wit 107 _ _ _ . Z O__N I N . REQUIREMENTSS . LICENSED CONTRACTORS DECLARATION:I hereby affil under penally of perjury that I am licensed under provisions of Chantal S • SETBACKS (commencing with Section 7000)of Division 3 dine Burins and Professions Code.and my kens is in hr0 force and effect. CITY MC.NO.:039666 UC.CLSS: B UC.NO.: 359596_ EXP: 10/98 MAIN BUILDING . ACCESSORY BUILDING Dalt 17 — 1Z_(11 Contractor: tRNTFT IN REAR: FT _ IN LEFT: FT IN REAR: FT IN dL LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjW that I an.exempt from the Contractors License law for 0s fdlowiw meson Bushes*and Pmfessiom Code:Any city or county which requires a Perms to cenewd.eller. PARKING REQ: PROV: PARCEL: 42522303 ZNE: REF NO: demolish.cc repo any structure,prior to as issuance,also re.u'vm the applicant for such permit to Me a signed statement that he or she - :licensed pumuad to the provisions of the Comrad«.License law Pager 9(ocmmenmw with Sworn 7030)of Division 3 d the PLANNING NOTES>_ . . . _ / - - 4usiness and Profession Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My vitiation d Sedion > / I 7031.5 by any applicant for apenme subjects the applies to a coil penalty dnot more than Deehundnd dollars 155OOp. ***************1F*************************************************************** Elowner of the property or my employees with wages est their sole compensation,w0 do the work.and the*Imelda is rod Mended - 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 or dieted for sale(Section 7044,Business and Professions Code:The Conlradon License Law does not apply to an owner d properly - Q who bolds or improves thereon.and who does such mak Nmedl or hovel or through hi or her own employees,provided that such improwmeds we not Waded ordMad for W.W.If.however,the bolding or improvement le add whhinasyew d completion,We ZONING APPROVED. BY . : '0• DATE: ...bum.will have the burden d proving he or she did not build or improve for the Whose of sale). - ee ❑ I,as ownsr d the propea am exdutivdy contredng wt h licensed conbacton to domm�d the pro ect(Swbh 7044,Business and 9 Professions Code:The Contractors License Law does hot appy to an owner d property who builds or improves(hereon and who BUILDING_APPROVED B Y. : --=h DATE: contracts for such projects with a an trador(s)(tensed pursuant to the Contractors License Law). r. Elti Iamexempt under Secn: B.3P.C..for the reason: APPLICATION ISSUED BY: 7' - DATE: 'zI It! Dalt Owner: .. LEGALIZATION:N F E E S U M M_ A R Y . STRUCTURAL SEGMENT:N I do hereby certify that I am aware d and understand the requirements d California Health end Safety Code Sections 25505,25533.aid 25534,and that I or any haus buid'sw occupant will/wit not(drde'one)need to oompW web said state codes and the requirements for •permit for construction cc modification Dom the MOuday Management Dermot Residential commxtion melodious are exempt from these BLDG PMT . PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT . _ _. 12. 25 Data APplima: 25$ SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby elfmn under penalty d peon,cm,d othe ed following dasfva: ISSUE FEE22 . 00 ❑ Ihaw adWil naint°:,ecertificate dnatan"d°°5; n rteelarwadn 'dmnpenseeee'asWed.alorbe&Wien37C el We el BUILD ING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE cod.,nrthe performance d" mnalnissued. TOTALS----> 12 . 25 22 . 00 0 .00 34 . 25 34 . 25 - .00 flw I have and girl mental MAWS'compensation Mums.as required by Section 3700 of the Labor Code.ler the performance of the work fa which this pent is issued.MY workers'mmmpenW ion insurance mato and policy number we: �$T 'TE FUND _EXPIRES REVENUE .DIVISION TOTALS--> COLLECTED: 34 . 25 OVER/SHORT: _.00 Policy Number: 046-9600005291 .0.1./01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK Tis section need rod be compered f the panne is for one hundred dollars(3'100)or less) _• — . 34 . 25 ❑ I cattily that in the performance of the work for which this permit Is issued,I shall not employ y person in say manner so m to �7 become subject to the workers'compensation laws d Cdifprni,and agree that R I Psome subject Io 1M wdAoe' ************************************* HF�F**IF*********************************** compensation provisions of Section 3700 d the Labor Code.I shall mhwnh wnPlY with °�ns` — -- — I N D I V. I D U A F E E BREAKDOWN Das: I Z—1�-- '7-) APpMad: � . Warning:Figure to secure workers'rorryerwuon crowns Is unlswM,and shall subject an employer to admitted penalties eld TYPE. _ ___QTY. _. _ _D__E S. .C. R I 0 N UNIT COST TOTAL COST rive fines 1p to one hundred thousand dollars(3100.000A M Oreton to the oast of conpensstIon,rapes as provided ler In Section 3706 m L saf .L.barcad. Ins.. .wamme ...cif. MEC ._ _ __ . _1 ___._REPAIR/ALT OOLING UN YS W/CNTLS 12. 25 12 . 25 CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that them is a construction lending agency for the _ _ E E OF FEES performance of the work for which this permit is issued(Section 3097,Cu,C). LENDER'S NAME LENDER'S ADDRESS: I certify thornless neve read this application and state that 0he above information is cared.I agree to comp withal city end county ordinances and state laws relating to building conmudion and hereby authorize representatives of this city to enter upon the above-mentioned popery for inspection purposes. LARRCLLO Prom Name 12-12-1997/10:03 Ar/$34.2.5 —1-'1 Z�j� PERMIT:086150 Sp ro AgedA.. Dae:. redo (5151.4S.WP) White-Buidiw&Soley:Green-Re;Cesry-Appked:Pink-Revenue;Goldenrod-Assessor 'v ' -.'- CONSTRUCTION AND PLANNING Fibs 0u . SPA . 'APPROVALS Permit # Date tnspector APPROVALS Permit # • flare Inspector • 1. Temporary Electrical Servicer Pole 52. Pool & Equipment Location w . 2. Soil Pipe-Undrg[;nd.H 53. Steel Reinforcement 2- m .� n ca r~. ,-glectrical Cond Lf.ltility-Ungrgrnd. 54. Forms < nrrnCSX4•rElectrical.CondRih %Jndrgrnd. 55. Electrical Bonding t'7.P1Iteel Reinforcems`2�t 56. Rough Plumbing& Pressure Test >61t'Electrical UFER5rnd. 57. APPROVAL TO COVER-GUNITE 4< uTr-rfl m n1 nir. rc+ Footings :J7 58. Electrical Con4tUndrgrnd. i .M1 ' oundir ation E Io •W 59. Gas Pipe, 0 U[r�s Ytittgrnd.,Test 0 'Q4y.'3Water Pipe-Unc frfid.6 60. Backwash Lines`?-Trap, 0 Undrgrnd. 1fkSSrtuctural Floor System w 61. APPROVAL TOu9ECK ' No 11.1•Property Sewer5Lint& HoustConnection 62. Backwash & Rece]tor-Final CI r1: nt 1t Sewer Cap - or ra 63. Heater & Vent-Final 13. Roof Drains ^ ' - 64. Plumbing System - Final . 14. Rough Plumbir22 „., x 65. Electrical-Final 15. Rough Electrire5-Crxnduit •• 66. Solar System-Ue ' • 16. Rough Electrid?Jiri o~ - 67. Fencing & Ac g4gApProval i 17. Rough Wiring Sign L.- a - 68. APPROVED RDA'PLASTERING v y - nr^• ' 18. Rough ElectricFT Bar Ceiling 69. POOL/SPA SYSIfMS FINAL 19.opough Hgatipg &rtir Conditipainy .rt. * pi to •G* ': '' ItterE SPTo:REQUIREMEN•T C! 0- - '1 c* • c;('; 7- t O D g't t' it '1c)aO tri * > US 20. ou ' Pectot$ F9 lace ' S" M< IC S +-! C* C APppOS"•3F4 Permit # * er 1 H x* I Hi.- xS * r•i '7 '7* Q -3`7< .Ti # P: F HS * S '-J r-•r* - -i flU'.. J T 21.r�utffs, it tru�Ctu ** •• •• S'-•r * ' 0 P-s Cl* f- 70.1-Undergaemsd hydro * i o ti ? `-n CJ.-- v S v < rS ' M"' - 22.Xfuet \Ottil3tingu* 1 CJ * a < C) F+* < 71. Prod (q(y�i ins � 3as poi' 1 1 r-• .. -, * I * cr H* 'H7.1' P Y1G' #' c?. 23. oias8ipe ou h 81J-[ st 0 * t'1 C' '2 O* 0 r ,t;•C-v * H r-' 000 * al e' S* o 72. Undergcautrd 1-sush * E' •• m . t i • E • k > 0 S * i tEl f6' r . . 24.1E oof Framing 0* tri * r H* 7 . Undergrrrd.St6 eTel0Gas 0Oil r- C: CC* t N * t*1 N* S CC�� 25.aoaShaathing c6* 6 ir y cu* 74. Overhead HydgC' w r•l .+r* S-•rr- - * • 0 :rra* ' •7 f 0 t' 26.n3"-Bar•Ceiling (Structural) & MtinScoat * 0 >1 0* 7$. Dry Ch ical t-'0 ' x t Syc a ac m * H of 'K S 'fl ^' 27.1 rameapFlashi * 0CCx * 0 >' Up* Q� E"W * < I ( �* :•+t-70 m r. A* 76. Dry Sta P� * t7 N [,1 '1M ✓] lw,(.., ... F Y ..# ..- .!. sZ * CC 28. Lathing pi Sidings* H C I m I * 74. FIXEC SI*STgT4kr FINE}`t n cut S •• * * s 1 -** ' G ^. as 29. Insulatir� N* S rJ * S * 4. FIRE PREV. F..I AL E+ * •F r-i �._, tTr • r, n 30. DrywallsH ailing S* 1 * H I I I* S CUHEALTN DEM". REQUIREMENT _Drywalltailing a 31. Plaster Eltkw6e1Con S 1 '''g * * r 79. FINAL PECfiON * x F.4. rJ • E C' o. H M* iJ r * ti., rs .• r•f riCr *. 32.-fslectricatPower S r-RVral 1 * * 801 FOOD CERTIFICATE /ISSUER S . <• 0 0 r -t fn * 'zi x h- ra r-r 1-1S- * rJ * m I < * I * `7 '3 tri * '-3 0 tri; - 33. in El tris H* 1 H: : x *m /, * ( res: < MC. * r S '- J i. 4 r,. S .l.-•w S ✓.: .i 34. ink H in r*Cpildition ni gS fr # /lq/7`+G/6.'rj� , ••y .a I H<a• *. S ' tr, r1 Oz 3s -4 * ^ n m< • * m -•+n 35.CFin 1 Gas,PipetTeN* G •• * H * 0 So 0HC•1 * 1=tr-' >• �. * < * * n3 . ..Clry * C1 �r fu* 5 1 (*'^ - * Cl I * �, Z l ro * 'qtr �� 36. IoW or anopY r# -' r n;m , * * m x0 * tT. >crt • r r 7 Y I' '-' ' Sir' V : cn t 1t G n3 rn 37. Pinat•Fa orY Fir {� x I FF rn * x'-• • r^ * CU I, Cl - * N f w * .; I# S •cam - .n .•. _. 38. FlrAPIttrnbing c.,* (r1 1 0 * l _ qc tY, HNZ, o M * C' 39. Water Service-Final* S I * x ` r * r a. * E, •' 40. Gas Serve-Final•,78: tri •A tilt g * m I '** ='�' vE * `Z �V t• 3 * O > ;'t t, f, 41. Solar Domestic-Final tri * * tr y.0 r: X. x 0 E c .--. !!!-.1*i- N # .-7. I ! H 0/ * S , 42. Backflow•Prevente�* n C63,,,.., >ti '3 >t- * Li H .� * .J * H * t[; M0 * In ". F 3S * * ":I * 0 43. Backflow Irr t1dA* >14-- tr * F N * 3 O =A1 * i , 4.CLandscan Irilgatw* System92•P '^ * to O -0 '1/4, ,,4' a N 10 p;(J * to ,.r dw rTJ * rt ;Q ^ E x :v Orr. * S r• e, t� 0 _•+r r•r"h e• E t •* f r • s ne 4 * 45.§ound AttenDati5rti. `" •• •• * t'i co M* E- b' C' < • F+0 * .r. -. 4 rt r 'J S * tr1 .. .. ..* ^ i / H.1 ••M * f H 0 * * �. Q S '...+N S C16. Handicap'Regulatio�s S I.S I _ 4 t*1 O t'a * c t7.:FItL STRUCTURE & BUILf)IN.G * F I - Ett 2 i* n N al, Cr X O 48.T,IN8L PLANNING* HF * N I 1 '_ lc0 th A ,F 1, I # * C'• CJ N S y < e49.ilediiic Release to Edison T I I- * tr <C •ff * 4-41 '-•- * I x F -, G • ori * J • '.�50.`E'6asielease to Southern Califoia4Gas Co r. k • 5 o Cl * al :.4 '51. CERTIFICATEOFtCCUPANCY '' 'r ' O "- c • No. Date ' ADDRESS OF BULDING: 275 E 17TH ST unit: A CITY OF COSTA MESA — BUILDING PERMIT mars time IF KICY/N: MITCH EL VICTORIA PERM NO: P 086033 AODRE54: 1901 AVS OF THE STARS #95 LOS ANGELES, CA 90067 PERMIT NO: P 086033 PLAN CHECK NO: N GOVT: N SUPP: N ,APDL.MNIDiO AWRE53: CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ALT .ARcl(�CTORElaNan: sec NO_ • JOB DESCRIPTION INSTALL WALL SEPARATING A & B UNITS SQ FT: ARCH.OR ENG.'S ADDRESS: LMT: CLAIM VALUE: CALL—VALUE: GROUP OCC : B / cCNWACTORSNAlm ORANCO DEVELOPMENT, INC. ( 714 ) 660-1198 CCNTRACTORSMNIDS 1370 REYNOLDS AV COMMENTS: INSTALL H.ACCESSIBLE RESTROOM, T. I . ON SEPARATE PERMIT, #B86031 TRESS: IR CA ucNo, 359596 #########********************************************************************** 92714 inn 107 Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I heathy di under penalty d perjury thatlicensed I am under provisions d Chapters SETBACKS er (commencing with Section 700E d d Division 3 the Business and Professions Code,and mylicense is in full end Med. us CITY UC.NO.:039666 uc.Cs: B uc. .: 359596 /98 10/98 MAIN BUILDING ACCESSORY BUILDING � (� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: 1'L.• 4 -- 1/ Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I ern exempt a Contractors Lbense Law 1«the Idkwkg reason(Sedion7031.5Business and Professions Code:Any cry o county whchrequ a permit to Cabbed,Mar.Improe, PARKING REQ: PROV; PARCEL: 42522303 ZNE: REF NO: demolsh,or repair any structure.pre to its issuance,also requires the applicant for such permit to fib a signed statement that he or she PLANNING NOTES> . S licensed pursuant to the provisions of the Conrado s License Law(Chapter 9(commenting with Section 7000)of Division 3 d We .� liminess and Professions Codel or that he or she is exempt therefrom and the base for the alleged exemption.My violation of Section > /031.5 by any epplirenl for a permit subjects the applicant to a MAI penally of not more than live hundred dollars 15500)). **********************************************4***********###*#************#*# ❑ I.asownrof the popenyormy employees with wages as their sole compensation.will do the work.and the structure enot intended DEVELOPMENT SERVICES 41REQUIREMENTS or offered for sale(Section 7044,Business and Professions Code:The Contractors license Law does not apply lo an Omer of property wlho builds or improves thereon,end who does such work Nmseif or hand or through hit or her own employees,provided Thal such improvements are not intended or offered for sale.I.however,the building or ispwanw is add'within one years completion.the ZONING APPROVED BY !' DATE: cisme/chalkier will have the burden of proving he or she did not build or improve for the purpose of sale). ❑ I.nowrrwdIna poperM.°^l.xdmwry om'n°°^gnib wermed can'r«n°"rom'°ad lh°p'ge°(s°°un 7°".amine"and BUILDING APPROVED BY : DATE: Professions Code:The Correctors License Law does not apply to an owner of properly who builds or improves thereon and who contracts for sud,projects with a contractor(e)licensed pursuant to the Co trofda License Law). ❑ Iant exemptundeSedion: B.&P.C..for this reason: APPLICATION ISSUED BY: , [04, . DATE; IZL l / *##***#**######*********#**#***#*#**#*##********** ******************** **4f*** °m°' • Ovmer. LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby candy that I am aware of and tsderstand the requirements d California ornia Health end Safety Code Sections 25505.25533,and .N 255 ,end that l«any Mum building occupant wig/wGw(dbds'cos)need ucomply with said date sodas and the requirements ler BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit for mnbuclion or modification from the Al aropeeant District.Reaidwil construction animations are exempt Inn these provisions. PERMIT 28 . 50 Dear want 25% SMIP/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the?diming dedmal:we: ISSUE FEE 2200 ❑ Iham and MImullein aceridmmd certificate wcompensation. p self-insure Section ISSUE BUILDING-DIV-> PERMIT PLAN—CHECK TOTAL PAID DUE code,tor thep.doman.dthe work for w.anthis permit is issued. TOTALS----> 28 . 50 22 . 00 0 . 00 50. 50 50 . 50 . 00 L, I have and will meintan waken'compensation Laurance,as required by Selo.3700 d the Labor Code,kr the ped«mence of the , 1F" `wit`f«wladhmapanne anter: d.Myw«weraSTATE FUND and wi"'namwnare: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 50 . 50 OVER/SHORT: 00• Porny: Policy Number: U4b-9bUUVUS2y1 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK section need not be completed if the wink is for one hundred do/las/SIDS/or less.) 50 . 50 I candy that in the tswwdoperformance d IM wok ler which this permit is lauds,I shall not employ any person in any manner so as to * become aubjed tvi the wooers'co of tie laws CNHomia, end agree that R hoeld become subject Ip the workers' #**##*#********##*#************************* f'Fik lF iE iFAk******#***#**********#***** compensationprovisions of Swim 3700 d the Labor Code. forthwith campy"'mRrap'°""°n. I N D I V I D U A L B R E A K D O W N Dole: (Z-4 I Applicant: Y'� Y' Warning:Failure to escort worn es compensation coverage la unlawful,and Mali Ana can employer to criminal penalties and TYPE QTY DESCRIPTIO UNIT COST TOTAL COST civil fines tip to one hundred thousand dollars($004000),hi addition to the coat of compensation,damages as provided for In Section 3706 of the Labor Code,Interest,and attorneys fees. PLU 1 WASH BASIN 8 . 75 8 . 75 • CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of parlay that there its construction tending agency for the PLU 1 WATER CLOSET (TOILET) 8 . 75 8 . 75 performance of the work for wlddhthis permit ieissued(Section 3097,Cb.C). PLU 1 WATER HEATER AND/OR V 11 . 00 11 . 00 LENDER'S NAME: END F FEES • LENDER'S ADDRESS: . I certify that I have read this application s,d Rate that the above information is cored.I agree to comply withal clay and oourb ordinances and state laws relating to building construction and hereby authorize representatives of this orb to enter upon the above-mentvhad popery for inspection wmasea LARRY CARAVELLO P m 12-24-1997/12:58 N1/$50.52 (z-4^37 PERMIT:086033 Date: sycoma d A rector (515146.WP) While-Budig A Safely:Green-Fle:Cane -Appicent:Pink-Revenue;Goldenrod-Assesem (� I CONSTRUCTION AND PLANNING POOL. A . • - 11 APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 71/i eel Reinforcement 3. Electrical Conduit Utility•Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ' - 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test ' 9. Water Pipe-Undrgrnd. r 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 p 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE 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 38. Final Plumbing • /2, h, 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 1.43. 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 ADDRESPOEMIJIM 275 E 17TH ST MT: A CITY OF COSTA MESA - BUILDING PERMIT aWSNAYEIPMNOWN: MITCHEL, VICTORIA PERM NO: E 086032 amm= 1901 AVE OF THE STARS #95 • LOS ANGELES, CA 90067 PERMIT NO: E 086032 PLAN CHECK NO: N GOVT: N SUPP: N APPL.WILING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ALT - ARCHITECT ORENGINEER: UG NO.: JOB DESCRIPTION INSTALL WALL SEPARATING A 6 B UNITS SQ FT: ARCH OR ENS'S ADDRESS: UM1: CLAIM VALUE: CALL-VALUE: GROUP OCC: B / coNTRACraysNAA: ORANCO DEVELOPMENT, INC . ( 714 ) 660-1198 cOGRACTORADORESa 1370 REYNOLDS AV *O***N**4******L*iE*4*******B**�E***T****4 ETE , IE . O*sE*E**R**********�EiE#88603****sE�tit ADDRESS: IR CA UC,NO.: 359596 92714 UMT: 107 ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Cheerer S S E T B ACK S (commencing with Section 7000)of Division 3 d the Business and Professions Code,and my I' afun lace and riled.. cmuC.NO.:039666 UC.CLASS: B cclC EXP : 10/98 MAIN BUILDING ACCESSORY BUILDING J /Z �/_/� , Camaaa FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I pa from the Cos tratl«s license Law for the BusinessAnycounty reason(Section alter,improve, PARKING REQ: PROV: PARCEL: 42522303 ZNE: REF NO: demolish,or rear any structure_prior to to issuance,also requires the epplSnl tor such permit to Me 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 Dhlsion 3 of he PLANNING NOTES> Business and Professions Code]or that he or she is exempt therefrom end the baro for the alleged exempwr.Amy violation of Sedka- > • TWLS by any applicant lora Warm atle5the applicant toaavi pensltytlnal mote eon fee hundred donee(SSOOp.� **********************************dE******************************************** ❑ L ow as ow « ry of the propertymy elwees with wages as that sob<«mpenswiW,wldO the work,and Nmd e muds*is not Wended;, DEVELOPMENT S E t . V I C E S REQUIREMENTS or dl«ed for sale(Section 7044,Business and Profession Code:The Contractors License Law does nor apply to?flimsier of property- who bulls or inproves thereon.end w1"dorsi such work himself or hone,or through he or her own employees,provided that such improvements ale eel intended ar otieredf«Se'n'how^''the build"yor inpro"med b soli with*«"Yee"cmplet° •N ne i"' ZONING APPROVED BY DATE: owner-builder will have the burden of provirp he or she did not build or improve for the purpose of sale). ❑ 1,as owner of the property,am exclusively contracting with licensed contractors to eon"crud the project(Section 7044,B nines ander prdeadmTh e Code: e Contractors Licwe law does WI appy owner d tO en ownproperty who bake or improves Nre enn`ad who,; BUILDING APPROVED BY : DATE: contracts ler such Projects with a ocntrador(s)licensed pursuant to the Contractors License Law). . A - ' 1 • ❑ I ern exempt under Section: , B.BP.C.,for this reason: re( - APPLICATION ISSUED BY: A/%I DATE: V10-0-c1,2 / i / ***************************************************************************dF*** Dale: Owner: LEGALIZATION:N FEE /) SUMMARY STRUCTURAL SEGMENT:N I do hereby certify that I ern aware d and understand the requirements of California Health end Safety Code Sedans 25505,25533.and 25534,end that 1 or any future building occupant will/will not(circle one)need to comply with said state codes end the requirements for constructionthe permit PERMIT BLDG PMT PLUMBING ELECT' 13RIC MECHANIC FIRE SMIP/RES GRADING provisions. Date: Applicant: 5 0% SM I P/NON-RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby erne under penally of per'ryW one of the following deduetbrn: ISSUE FEE 2200 . dm ❑ Iharm end wiImeibacen bd ifKeodsenttoedtumrebrworkericompensation. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE cod..f«the Wdonnanceam « wkt«wNthis,perms is issued. TOTALS----> 13 . 00 22 . 00 0 . 00 35. 00 35 . 00 . 00 0I have and WI maintain workers'compensation insurance,as required by Section 3700 of the LaborCode.for the performance of the work f«which this permit is issued.My workers'compensation insurance owner and pafcy number we: Garner: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 35 . 00 OVER/SHORT: 00 Poky Number: 04b-9b000052 .1 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHAN FIRE SMIP/TOT GRADING PLAN-CHECK This section need not be completed I the perms a ion one hundred dollen al W(of Mos.) 35 . 00 ❑ I certify that in the pedomance 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'ccmpenaation lawn d cements.and agree that; I should become tubed to the workers' ****************************** ********************************************** compensation provisionsd Section 3700 d the Labor Code,I forthwith comply h Nog pr«adms. IND IV '- UAL F E E BREAKDOWN / Date: 1Z`4- a-1 Applicant: Warning:Faunw secure workers compensation coverage la unlawful,soul stWlarblect an employer to«IMrW penalties and TYPE QTY D E S C R 1 P T I O N UNIT COST TOTAL COST elan lines up to one hundred thousand dollar.($104000),In addition to the oast of compensation damages as provided ler In Section 3706 of the Labor Code,Interest and attorney'.fees. ELE 10 RECEPT/OUTL 1 - 1 ST 20 EA. 1 . 00 10 . 00 CONSTRUCTION LENDING AGENCY:1hereby dinnuderpenallydprjurythatthenlsaconstrWbnwrongagencyf«the ELE 3 RECEPT/SWITC 1 ST 20 EA. 1 . 00 3 . 00 pedonnwra of the work for*hid'the perm is aped(Section 3397,Civ.C). END OF FEES LENDER'S NAME: ' LENDER'S ADDRESS: 1 'I certify that l have read this eppliceuon and stale that the above information is coed.l agree to comply with at city and county ordinances and state laws relating to buiMtp construction end hereby authorize representatives of the city to enter upon the above.n"mtioned properly • for inspection prpose..LARRY CARAVELLO 12-04-1997/12:57 Pp/835.00 't• Name RCPT#:C1-C816.i88 N....4. Dale: 11.-^LI - ii PERMMIT:086032 Signaluu /AgenvApplcanbContrad« • (5151-46.WP) WhOe-Buibtp A Safely;Green-Fle:Canvey-Appicanl:Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL ..PA APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location I , 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit 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 6. Solar System-Final 16. Rough Electric Wiring t�Q� V jf67. Fencing & Access Approval 17. Rough Wiring Sign [ - "8. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling :.724 / 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning •• FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electric& Power Meter-Final 80 -OOD CERTIFICATE ISSUED 33. Final Electric testes: 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 ADORsss OF WADING: 275 E 17TH ST ORT` A CITY OF COSTA MESA — BUILDING PERMIT auNERsris""vlowNPACIFIC EQUITY PROPERTIES _ _ PERM NO: E _ 086152 "NE-' 1901 AVENUE OF THE STARS • SUITE 950 .PERMIT NO: .E 086152_ PLAN CHECK NO: N GOVT: N SUPP: N JOS ANGELES, CA 90067 310-282-8533 APPL.MMLDIG ADORES& CONSTRUCTION TYPE: . . _ . PERMIT TYPE: ELE PURPOSE: ALT ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : _TANNING SALON .ALTERATION . SQ FT: • ARCH.OR DIG'S ADDRESS: OMIT: CLAIM VALUE: . CALC—VALUE: GROUP OCC: B / CC ACTDRSKAORANCO DEVELOPMENT,. INC. (714 )660-1198 • carmACToxsMMlna 1370 REYNOLDS AV COMMENTS: "3 DOLLARS"_ TANNING SALON ALT REF:B-86151 ADDREsa IR CA uc'o.: 359596 ****�H*+E+r****:EPE****+rr�t:err***;E�rsE****w*�E�E************* Hit*****+r�E�P�E�E****+Er*�r*w:r+E+1+r*** 92714DMT: 107 __ _ .Z 0 N I N G REQU IR EMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perry"that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 d the Business and Professions Code,and my Hesse is in full force and affect c.NO.:039666 4JC.CLASS: B 'H .: 359596._ EXP: 10/98 MAIN BUILDING ACCESSORY BUILDING ata: L_7 L — `� Cont m« FRNT: FT IN REAR: . FT IN FRNT: FT IN REAR: FT IN LEFT: _ FT. _ IN RGHT: FT IN LEFT: FT __ _IN RGHT: FT IN R BUILDER DECLARATION:I hereby affirm under penalty d perjury that I am exempt from the Contractors License Law for the ' following reason(Section 7031.5 famiees and Profession Code:Any ay or county which requires permit to construct.alter,improve, PARKING RE _ PROV: PARCEL: 42522303 ZNE: REF NO: demolish,or repair any structure,prior to Is issuance,abo requires the applicant for such permit to fib a signed atonement that he or she r is licensed pursuant to the provisions d the Contractors License Law(Chapter 9(commencing with Section 7003)d Division 3 d the PLANNING N TES> Business and Professions Corel or that he or she is exempt therefrom and the bee's for the alleged exemption,my violation or Section- > 7031.5 by erw'appinenl loss permlt vubpcts the applicent toe evilperolydna mom then Me hundred ddWs IS500p:,. ', ***********************************1f******************************************* O I,as owner of the property or my employees with wages as their role compensation,will do the work,and the structure is not intended y ' or offered for sale(Section 7044,Business and Professions code:TheContractorsLicenseLawdoesnotapplytoanbwnerofpropem' . DEVELOPMENT S E 'R_ V I C E S REQUIREMENTS who builds or improves thereon,and who does such work himself or herself or through his or her own employees.proAded that such _ improvements are rot intended or crewed for sale.I.however,the building or improvement is sold within one year d completion,the,. ' wa ownuiM.rwlhavethebudenofproimheor she did nobuiM or improve for the purpose of sale). ZONING APPROVED By . : • DATE: o I.as owner of the property,am exclusively contracting with licensed contractors to comes the project(Section 7044,Business end A a Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who i BUILD I NG APPROVED B Y : DATE: contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). , / ,. ❑ Iemexempt undwSxbn: 9.ap.c..fo this reason: //; APPLICATION ISSUED BY: 1 ' � DATE: z' '/7 �. ********************d4 ********************** its Dela: Owner LEGALIZATION:N - F E .E S .U .M M A R Y STRUCTUR SEGMENT:N I do 4,herebyend caddy stat I am aware of and pant will the esmrkarcle of California Health and Safety Coda Sections 505,Paert,abed 9553x,end that I or any future building occupant will/wR not(circle one)need to comply with said date codes and the requirements for • a permit t«m"mrniwr«modification Iran teAad—iatyr.Tan.ponru Divdd,R®dwar mmmdion evolutions/ire exempt Iran these PERMIT BLDG PMT PLUMBING ELECTRIC .00 MECHANIC FIRE SHIP/RES GRADING provisions. Date: Applicant: - 50% SM I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirmunder penalty of perjuryone of the blowing dwLom rati : PLAN (have and wlmaia matricide consent to eel-insure for maws'compensation,a provided for by Sedin 3700 of the Leber ISSUE FEE 22.00 Matelot BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code,for the pedm performance of work mdis wun .p.n .ead. TOTALS----> 30 .00 22 . 00 0.00 52.00 52 . 00 . 00 10 I have end wit maintain workers'compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the - - work for which this email is issued.My workers'compensation insurance carrier and policy number are: EXPIRES REVENUE DIVISION TOTALS-->. COLLECTED: 52 .00 OVER/SHORT: . 00 'PoliyNumber. Rifi- i1 5?C11 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK This section need nor be completed I the permit a for one hundred dollars[PM or less.) 52 .00 O 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 aubled to the workare'compensation laws d CMdome.and agree rhes if I should became suubjed to the workem' ********************************** . ******************************************* compensation provisions of Sed ion 3700 of the Labor Code,1 hwith compy with Inose I N D I V I .D F E E BREAKDOWN Date: I Z —' 't` 1-1 Applicant: - R wapft rat:F.uu"ro..aure workw:°omwm.9an coverage la unlawful,and shales b/aey;n foyer f°°emmlP.naya...ne TYPE ._ QTY. - D ,E S I P T I O N . UNIT COST TOTAL COST ,.. I fires W to ata hundred thousand dollars(f/U0,000A In addition to the cost of compensation,raga a provided for In a«"°"3'°s°hthe Labor Code,hd"e"and attorney's"°` ELE _ 20 RECEPT OUTLET ST 20 EA. 1 .00 20 .00 CONSTRUCTION LENDING AGENCY:I hereby drum under penalty of pray that there is a ocndruuicn lending agency for the ELE 10 RECEPT WITCH . ST 20 EA. 1 .00 10 . 00 performance of the work for which the permit is issued(Section 3097.Civ.C). LENDER'S NAME: END OF FEES y ' LENDER'S ADDRESS: , I certify that I have read the appliceticn and stale thin the above information is coned.I agree to comply with all city end county ordnances and state laws miming to building ronmunion end hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. LARRY CARAVEL LO • 12-12-1997/11:22 Ari/$52.ea L.- Pro^" - RCPT$:61 001676? d Date: (1. -1Z`�) PERMIT:086152 / Signature of AQe9UAppian nlrado (515t4e W P) While-Buildig a Safety:Green-Fee:Canary-Appkunl;Pink-Revenue:Goldenrod-Assessor I I CONSTRUCTION AND PLANNING 1 P25OL _ SPA I APR$OVALS Permit# Date Inspector 'APPROVALS Permit # Date Inspector i , 1. Tt( lporary Electrical Service or Pole . 52. Pool & Equipment Location 2. NS,6NIl Pipe-Undrgr,Sd.H 53. Steel Reinforcement ' „l ectrical Cond . ltYility-Una2grnd. , 54. Forms lit.. Ie8trical CondUf'hJndrgrnd. 55. Electrical Bonding ,: • mORE53gFpMWMG ^_275 E . 17TH •ST warA _ CITY OF COSTA MESA - BUILDING PERMIT ONn4Ed9NARE IF MOM MITCHEL VICTORIA - PERM NO: E 086357 ADD'S' 1901 AVt OF THE STARS #95 ' LOS ANGELES, CA 90067 PERMIT NO: E 086357 PLAN CHECK NO: N GOVT: N SUPP: Y APaL.RARING ADDRESS; CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ALT ARCHrTECT OR ENGINEER: Dano.: JOB DESCRIPTION : SUPPLEMENTAL TO E-86032 SQ FT: ARCH.OR ENO'S ADDRESS: DMT: CLAIM VALUE: CALC-VALUE: GROUP OCC: B / conmACTORSNLLa: ORANCO DEVELOPMENT, INC. ( 714 ) 660-1198 canmmTORSNuuND 1370 REYNOLDS AV COMMENTS : INSTALL H.ACCESSIBLE RESTROOM, T. I . ON SEPARATE PERMIT, #B86031 ADOREsa IR CA uCNO.: 359596 **+r*�E�E**4**+E+Ear***�E+E*+E*EE�EEE�Ex'SE�9*+r+r�ESr+ExSe�9+E+r59�E+r�E+r****+Esr*sill+E+r*+E***+r*+E*+r*+E+E*********** 92714 DMT: 107 Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally d pejury that I am licensed under provisions of Chapter 9 S ,E T B A C K S (conanettdrg with Section TO00)el Diveun 3 d the Business and Professions Code.and my Scenes S in full force and effect. CI. C.NO.:039666 uc.cuss: B c 359596 EXP : 10/98 MAIN BUILDING ACCESSORY BUILDING 4101Pp FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN l� " )` 1� Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ER BUILDER DECLARATION:I hereby affirm under penalty ol perjury the I am ass I Contractors License Law for the folow:greason(Section7W1.5 Basilan and Professions Code:Any ay or county which"sawn,a Pensil le conekua,akar.imprm.. PARKING REQ: PROV: PARCEL: 42522303 ZNE: REF NO: ' demolih,arepairany anwlura,priortoits issuance.a"Mgt*sthe applicantforik suchremtofile a signed swn enethator he5M PLANNING NOTES> S licensed pursuant to the provsions d the Contractors License Law[Chapter a(commenting with Section 7000)of Division 3 d the e Business and Professions Code]a the he or she S exempt therefrom and the basis for the alleged exemption.Any vi lation of Section > 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not dollars * more then five hundred [$5001). ********************************,*c6******************************************** ❑ I.as owner of the propenyamyempbyeewith Wenn astheir sole compenstionwill dothe work.end the sauaaraisnot intended DEVELOPMENT S' -':Rs V I C E S REQUIREMENTS or offered for sale(Section 704,Business and Professions Caddoes e:The Contractors License Law not apply to an Owner ol property who beads o such improves thereon.end who does suwork ti seri o here,or through his or her own employees.provided that such --d1:7,-5. improvements ere not intended a dMed for sale.Sver,,howethe balding or inprom vearis xsold witho one yeel completion,the ZONING APPROVED BY : _ - DATE: ownar.bulder will have the Paden of proving he or she did not build or improve for the purpose d sale) ar. ❑ I.as owner el the progeny,am ex aively wending with licensed contractus fo ormua site prelea(Se don 704.Soames ate Professions Code:The Centred=License Law does not apply to en ewer d properly who builds or improves thereon and,d„ BUILDING APPROVED B Y f DATE: contracts for such prciacte with a contractor(*)licensed pursuant to the Contractors Luse Law). /e w ' ' — ❑ lain Section: B.AP.C..for this reason: APPLICATION ISSUED BY: J >2'c' • DATE: Dots: ' LEGALIZATION:N F E/E, /4 S U M M A R Y STRUCTURAL SEG ENT:N I do hereby certify Thal lam swine d and understand the requirements of Crannies Health and Safety Cale Sections 25505.PSc33,and /�C // 2553x,and that I or any future building oauent will/willnot(circle one)need to comply willsaid Mats codes and the requirements for P a permit for aostmetion or modification from the Ai anagemem District.Residential salamilmappimons N are exempt from these PERMIT BLDG PMT PLUMBING ELE27R2C MECHANIC FIRE SMIP/RES GRADING Provisions. 5 Date: Applicant: 50% SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury of onethe following de : PLAN ISSUE FEE 6 , 50 ❑ I have Code. dMgmewa:naeartaited�.enttosek:mm.forworkers'comp«her:ah.espraddedforbySem Wd 3700 of BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE code.for the performance of the work for which this petmh is issued. f3 Ihadend,amaiea:,wkers'compenee:wninsurance.aSwam an mdthe TOTALS - > 27 , 25 6 , 50 0 , 00 33 . 75 33 , 75 00 work for whkh this permit is issued.My waken'compensation insurance tinier and policy number are: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 33 . 75 OVER/SHORT: 00 Poky Num bac 046-9600005291 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section mod DOI be COMPS'd I the penal n Mr ate huNnd dollars moot or Ace) 33 . 75 ❑ I certify ghat in the performance of the work for which this permit S issued,I shell not employ any person in any manner so a to becae shied to the'vdws'compensation Mws d Condon&and agree Net i I shouts subject to Ihe wodeu' ******************************************************************************* ompensalion provisions d 3700 of the Labor Code.I eh hwith comply with those INDIVIDUAL FEE BREAKDOWN Ong:FL- 2-31^ 1Applicant: _....---...re--`1e1 Failure to secure workers'compensation coverage la unlawful,and Mall an foyer to credos?penalties and TYPE QTY DESCRIPT • UNIT COST TOTAL COST led tines r®to ono hundred thousand dollars(Af00,000A In addition ro the cwt of comp non dame#••es Prodded for In Section 370e of the labor Code,Interest,and attorney's loss. ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 27 . 25 27 . 25 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury the there is a construction lending agency for the END OF FEES performance of the work for which this permit is issued(Section 30ST.Clv.CI. LENDERS NAME: • LENDERS ADDRESS: I certify the I have read this apekatikin and state the the above bdormation s corret l agree to comply with all del'and cowry ordinances and state laws relating to building construction end hereby audarce representatives or this city to enter upon the above-mentioned properly fa inspection prapusss LARK CARAVELLO 12-31-1937/24733 (t;V533.73 Al Print NameRC,T#:81-i 17482 IPA i 1 I► a Dae: I2-3 I c PERP?IT:086357 Sgnatyr. del . rfi?. tractor (5151 d6,W P) White-Building 8 Safely:Green-File;Canary-Applicant Pink-Revenue;Goldenrod-Aseessar POOH et SPA Date j Inspector • APPROVALS Permit# 1CONSTRUCTION AND Date InspectorDatePermit # • 1. Temporary Electrical Service.or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • I i '3':Electrical Conduit Utility-Undrgrnd. 54. Forms :c4. Electrical Conduit=Undrgrnd. 55. Electrical Bonding d ,5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6.-Electrical UFERGrnd. 57. APPROVAL TO COVER-GUNITE . ( •t 2. Footings - 58. Electrical Conc ii,-Undrgrnd. j I. -; :•Foundation - - �� • O 59. Gas Pipe, 0 Undrgrnd., Test - I 9. Water Pipe-Undigind.a: 60. Backwash Line :P-Trap,'O Undrgrnd. 1Q;•Structural Floor System 61. APPROVAL 7'0 DECK 11. Property Sewecline,& House:Connection 62. Backwash & Receptor-Final 12: Sewer Cap • •63. Heater& Vent-Final 13. Roof Drains 64. Plumbing System : Final 1 I 14. Rough Plumbing i< 65. Electrical-Final , 15. Rough Electricai.Copduit 66. Solar System-Final r.., 16. Rough Electric Wiring 67. Fencing & Accts Approval 17. Rough Wiring Sign .68. APPROVED FBRPLASTERING 18. Rough Electrical-7 Bar Ceiling •69. POOL/SPA SYSTEMS FINAL 19.-Rough Heating 81/4-Air Conditioning 7 r n •D C -„ FIRE_Q6PTccREOUIREMEN•T ^+, 20.Roggh Factor-y Ftceplace S'r• .4": C ' 7 D APP.@OVAL'S'c' Permit# ' - - -.F-• `-4 7 S Is .r 7'S 71 a: 21_-.Dubs, iri;Structure. _- I • ('f : 70.Wndergr_atand Hydro 22 :Duds, Ventilating f -.7 3. P 1. O Cr71. ProdiXT-Piping. Gas p Oil -- 23. 'Gas.:Pipe-Rough &gest �" �. :. c r C 72. Underground Elush r en . 24. Roof Framing a-. 7 _ r , 7,3. Undergrnd.Sto• ge Tant 0 Gas 0 Oil 25..Roof.Sheathing •r •.F. "� ? .::° f< -.t Ill _ , 74. Overhead Hydro. 26.T-Bar Ceiling (Structural) & Mohdcoat .. 7.5. Dry Chemical rrl 27. Frame and Flashing -Irl ,-• t. -,,. 76. Dry Standpipe-r,. . . 1 -, 28. Lathing.& Siding.- I `. 774. FIXED-SYSTEM FINAL-- -' r. 29. Insulation 'r.' _ * S I 1 78. FIRE PREY. FINAL -c 30. Drywall:Nailing _ • t x •,--. I :HEALTH-DEPT, REQUIREMENT I 31. Plaster Brown Coati. i_ I t " 7 . FINALYNSPECTION mr. .. ? j • • 32'-Electrical-Powwer MeterFcinal , 1 { •-/W 'fY Ot FOOD CERTIFICATE l'SSUED" =� _ - 33-FinWJ Electrt� t :.:01 i _ M &I. ��`��y!!! ,�'aids: 'y - ' - - 7 . ' 34.-Final Heating;& Air-Conditioning '_ a CC ..{ -.:. `-1.-1-.! - is , _ '-'C - - - - _� -I. �-.I, -n c 35. Final Gas Pipe-Test* - r. r n'" - -1 36. Hood or Canopy J �- . . . n 37. Final'Factory Fireplace"' •-47 ' + v i ' . „ v 38. Final Plumbing - •. is , I` C _1 39. th/ater Service-Final -. $ y^r `• s -•I 4 40. Gas Service-Final . -i - t,, r I -i :• ' :a et 41.I-Solar Domestic-Final r �-'� _ 4 .- - , 42. Backflow Preventer,. - ' * • --tno a - 43. Backflow Irrigationk _ t x ^ - '' 4 - n # ) -4 I Irrigafion System-' 'z r `t F C 12< = ,, _'i.- .x S . . 45.Sound Attenuation' "� :n .f • FrJ ` 46. Handicap Regulations ''. < -: , c `1 -' 'i • i 147. FINAL STRUCTURE & BUILDING - 48. F%NAL PLANNING,! :1ti ,- :.) N -49. -Electric Release to Edison I k ' • z ri 50.-•Gas_Release to Southern Californii Gas Co „ a r. - - -i I 51. CERTIFICATE OF OCCUPANCY - ._ No. Date OEBMlgtm 275 E 17TH ST WIT: A CITY OF COSTA MESA - BUILDING PERMIT � ADORTSSmiamNAYEDIDenftMITCHEL, VICTORIA PERM NO: B 086031 ADDRESs: 1901 AVE OF THE STARS #95 LOS ANGELES, CA 90067 PERMIT NO: B 086031 PLAN CHECK NO: 05113-97 S GOVT: N SUPP : N APPL AIMING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT MCNRECT ORENGNEER: UC.NO.: JOB DESCRIPTION : INSTALL WALL SEPARATING A 6 B UNITS SQ FT: 12, 000 ARCH.OR ENG.'S ADDRESS: NBT: CLAIM VALUE: - 12 , 000 . 00 CALC-VALUE: 12, 000 .00 GROUP OCC: B / cwTRACTO,SNAME ORANCO DEVELOPMENT, INC. ( 714 ) 660-1198 CONTRACTOR'S MARINO 1370 REYNOLDS AV COMMENTS: INSTALL H .ACCESSIBLE RESTROOM, T. I . ON SEPARATE PERMIT ADDRESS: IR CA LICNo.: 359596 ****************dh**iE)Ejt*****StiE)t*if#3t3E3EiFaE+EaijE3ti4*dE1t3tiEdEdfrtif******x*****iEjtif3t#*3SaEx3EiEat*Ncit 92714 urn 107 Z ON I N GS ERTEHQAUCIKRSE M E N TS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter B (commencing with Section 7000)of Division 3 of the Business and Professions Code.and my I is in full force and effect. CmUC.No.:039666 uc.cuss: B UC.NO.: 35959 EXP : 10/98 MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN ow: cased. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECORATION:I hereby affirm under paely of perjury than I am from the Contractors License Law for Me lapwing reason(sacion]mts Busiest ed Professions Coda:Any cky a county Wh1.711150070 Perms m mnswa.taw.imProw. PARKING REQ: PROV: PARCEL : 42522303 ZNE: C 1 S REF NO: demolish.oreparenystructure.priorto Is issuance.also requires!he applicant for such perilo fib a signed statement that he o she PLANNINGNOTES> TENANT IMPROVMENT TO SPLIT UNIT INTO 2 AND PROVIDE RESTROOM is licensed pursuant to the provsions a the Contractors license Law[Chapter 9(commencing with Section 7000)el Demon 3 of the �.. Business and Professions Code]or that he of she S exempt therefrom and the basis for the alleged exemption.My vol tion of Section > AND SUB-PANEL. 7031.5 by any a rlicent fore permitsubjeds the°pptcent to a civil penally of not more than live hundred dollars WOE. *******if********* IF***************************************************1E******** ❑ I.as owver efthe pmpeny o my employees with wage as their ode compensation,will do the work.and t o structure is not intended DEVELOIPMENTSERV ICES R E Q U I R E M E N T' S or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply loan owner of M 1.... prope .... who builds or inlaoves thereon.and who does such work Salsa or herself or through he or her own employees.provided that arch improvements are rot intended or on«edta sale.II. the building oinprovemera a sold within one year of conkeletion.de ZONING APPROVED BYV- DATE: I21 4 (kg7 ower-builder will have the burden of proving he or she did nor acid or improve to the purpose of sale). ❑ I.newerd the prtperry.em exckskwly wntractr wird kcenrad cantraPlarMwnsNld ge pnNad(Sedipn 7aa4.Busiess erd BUILDING DATE: -Hat : ' -' Professions Cods:The Contractor*License Law does nor apply to an re,of APPROVEDJ properly who builds or i proves thereon and who . contracts for such projects with a oproerdods)licensed pursuant to the Contractors License Law). J ❑ I am exempt under Section: B.AP.C..tor mereason: APPLICATION ISSUED BY: DATE: X2( 1-(• 1c-t.2 Dale: Owner LEGALIZATION:N E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby certify that I em aware of and understand the requirements of California Health and Selly Code Sections 25505.25533.end 25534,and o any Mure Wilding omone) m uard will not e)needlo comply with said state codes and the her BLDG PMT PLU • ING ELE RIC ;,%MECHANIC FIRE SMIP/RES GRADING a peri tor mroeuction a modifimice from the Ak t aragensv Dimr'aa.Residential mMuction applications are exempt from these provision. PERMIT 187. 25 Data: Applicant: SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty el perjwy one of the following dada:Miens: PLAN 121 . 71 - ( ';• 2 . 52 ISSUE FEE ❑ nu.and wiimaintain ccold-tate aowenttoself-insure for workers'compensation...provided for bySection 3700othe Labor BUILDING-DIV-> PERMIT IS E PLAN=CHECK TOTAL PAID DUE Code for the performance of the work for whom mita parieIssued. TOTALS----> 189 . 77 0 . 1 t in 1'21: 71. 311 . 48 311 . 48 . 00 al I have end will maintain workers'compensation insurance. Section required bySection 3700 a e,forperformancethe Labor Code the a the X'+ work for which this peri is issued.My woken'compensation insurance caner and pricy number are: f2 / Caner: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> Co LECTED; r% 311 . 48 OVER/SHORT: 00 Policy Number: 04b-9b00005491 01 /01 /98 BLDG PMT PLUMBING ELECTRIC ECHANI`C • FIRE SMIP/TOT GRADING PLAN-CHECK (This sector need not be completed t the pert a for one hawed dollars MOO]or less) 187 . 25 _ 2 . 52` 121 . 71 ❑ !senile that o permerof the doo° the work forpeeing ismanner which this pesissued,I shall notemploy any person in any manner so as to Y become subject to the wort comperason kiwi o Called°, end agree Nal ff 1 should become wbjed to the workers' ******************************************************************************* (7compensation provsions of Section 3700 of the Labor Code,I d1forthwith w corn* pwl4U..'___waa provisions. INDIVIDUAL : FE BREAKDOWN Date: �Z��-9 1 Applicant:Warning:Failure to secure workers'rompessuon coverage Is unlawful,and shall subject an entployart0 olmhWperaltesand TYPE QTY DESCRIPTIO!N�4 UNIT COST TOTAL COST civil fines w to one hundred thousehd dollars(51040001.In add/tion to the cost of conanneatiort deners as Provided for In Section 3706of the Labor Cod,lnterera and attorney's fees SFC 12000 ALTER BY VALUE COMMERCIAL. - NOZONE 1 . 00 12, 000 . 00 CONSTRUCTION LENDING AGENCY; I hereby affirm Under penalty of perjury then there is a conanabn lending agency for the END •OF.FEES Performance of the work for which the permit is issued(Swion 3097.Ce.Cl. 1 LENDERS NAME r+ l '/f LENDER'S ADDRESS: • I certify that I have read this and mat application ae that the abate information is correct.I agree to comply with eR city and county ordinances ", n and state laws relating to building construction and hereby authorize representatives of the dry to enter upon the above-mentioned properly tainsPeawpuw»e. • LARRY CARAVELLO •> 12-04-1937/12:55 F't1/9311.48 Si ,• Print Nemo RCGT4:81 0x16186 Date: I C (.+- •l 6 + PERMIT:086031 Sl�mu a w OwrAgent/AppiwMCamma (515t-49.WP) White-Suikkq A Safety;Green-Fle:Canary-Apptcant:Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL a SPA APPROVALS Permit# Date Inspector APPROVALS Permit # - Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ' 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 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 Can 63. Heater& Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing.& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 033• 75. Dry Chemical 27. Frame and Flasning 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: 2.1247 -Mimi aye, 34. Final Heating Se Air Conditioning W /'3 ; -( �j Pn/e• 35. Final Gas Pipe-Test /2/c fes'_ 7 P.462424744-4,./ro f. 9'K f�' 5 36. Hood or Canopy • _ 1/- �7 /�1C Le 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 1.. ,-1 jIegiF 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • ADDRFssasulLCIN9;_2.7.5_E_17TH_STiDN* A CITY OF_COSTA MESA r_ BUILDING__P.ERMZT _. CROCKS N/uiE IT ltNwm:,pACIFIC EQUITY PROPERTIES _ _ . . . . _ _ - _ . . . . -. .. . _PERM NO: B 086151 _ ADDRESS: 1901 AVENUE OF THE STARS SUI TE 950 PERM IT Ne: B ___0.86151 PLAN CHECK NO:- .05235-97 A GOVT: N SUPP: N OS ANGELES, CA 90067 310-282-8533 _ , APPL.SWUNG ADDRESS •_` _CONSTRUCTION TYPE: . . _ PERMIT TYPE: . STR .PURPOSE: ALT • ARCHRECT OR ENCINEER: UC.NO.: _ JOB. DESCRIPTION _ :. TANNING SALON ALTERATION _ SQ FT: - . 10, 000 ARCH.OR ENC.'S ADDRESS: UMT: .CLAIM VALUE: .10,000 . 00 CALC—VALUE: . . .10,000 .00 GROUP OCC: B _ / COIIWACToWSNAMEORANCO DEVELOPMENT, -INC.__ (714 ) 660-1198 ' CONTRACTORS MAILING 1370 REYNOLDS AV ___ _ . COMMENTS: "3 DOLLARS" TANNING SALON ALT. _ . ADDRESS IR - __ CA . lima: 359596 ___ *****************:cos*ia__ *x******** ***********�E�E*** *********a******�rir�E�E*�P�E*�P**+E*** 92714 _ . _ . .war:. 107 . .. Z O .N ING • R E Q U I R E M E N T S • LICENSED CONTRACTORS DECLARATION:I hereby shim under penalty ei perjury"al I an licensed under provisions of Chapter 9 . SETBACKHS (commencing with Section 7000)d Division 3 d the Business and Professions Code,and my license u in full foroe and effect. C No.:039666 uc.CLASS:B _ uc. : 359.596 EXP:. 10/98 MAIN, BUILDING __ ACCESSORY BUILDING Z r � Z ♦ t � LEFT: FT IN REAR: FT IN LEFT: _ FT IN REAR: FT IN as OOXBda' LEFT: FT__ IN RGHT: _ _—FT IN LEFT: . FT IN RGHT: FT IN OW NER,BUILDER DECLARATION:I hereby affirm under penalty d perjury that I em exam the Comrades License Law fa the f. ..: •reason(Section 7031.5 Resists and Professions Cale:Atr/city er county what requires•Per=to construct,after.unnerve• PARKING REQ:. PROV:_ PARCEL: 42522303 ZNE: C1S REF NO: o licen eor p pursuant any lstructure, he lOP Stria ce M Ne°Co°Contractors L Lailence,also requires w{Ch°�apter 9 t (commencingtWilh SectioNe a signed lstatement of Divbulonh3 or the PLANNING NOTES> INTERIOR ALTERATIONS FOR A NEW SUNTAN SALON. Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violetnn of Sadi t. - .>_ _ _ _ 7031.5 by any applicant fore panne subjects the applicant to advt penalty of not more than five hundred dollars 185W11. *************161kik1f•1F1E1Flf•SE1f***1f1E1f1ElfiElf•1f•IE1f1E1f•iEiE1f•iE1E*iE*1f1t1F1E1fiflflf•lflfiflfifiEfllk RflEfflESFlElEfElElE*****iklf ❑ I,as owner dthelrecertyormyemptnraeawthwages astheir ode compensation.will dothework.and the straisIsnotWended - D E V. E- L O _P M E N T S E R V I _C E S R E _ U Z . R E M E N" Ty S «offered for safe(Section?044.Business and Professions Code:The Contras=License Law does not applytoan Owner d properly - 15 who buids or improves thereon.and who does audu work himself or herself or through his or her own employees,provided that such C✓ oimprovements are net intended«altered for.ale.E,however.the buMingor inwovement ie add within one years completion.the _ _ZONING_APPROVED BY \C�-n DATE: 7 . I wnerbuiler win have the burden d proving he or she did not build or improve for the purpose d sale). y {.�� ❑ I.as owner d the property.am exclusively contracting with licensed contractors to conmu tt the projed(Section 7044.Business and /^ v IE1�,' Professions Code:The Centred=License Law does not apply to en owner d property who builds or improves thereon and whe .. B U.I LD I NG_.AP PROV ED BY : f/� DATE: *T contracts for each projects with a ortrado(a)licensed pursuant to the Contractors License Law). ❑ Iamexempt underSection: B.A P.C.,ke this reason: APPLICATION ISSUED BY: DATE: • ********************** > ********************** Dale: °" "` - - LEGALIZATION :N . ' E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby certify that I em aware d and understand the requirements d Cailanie health end Safety Code Sections 25505,25533,and • . 25534.and that I or any Uwe building acdtpe t will/will not(arse one)need to comply with said pate codes and the requirements for a pent focomatmctiono modification Aeou°ByManapemet District-Residentialramm�mnnapplicmipneere asempt fmmwese _ ..BLDG PMT •, MBING _ ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. . , P.ERMIT_..______ 162 . 25 Dale: ' Aplicant: SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty d perjury one d the following declarations: PLAN .—�,�_ 26 . 37 2 . 10 ISSUE FEE. __.___ o Inas.adwm.vue:n.c.rwraudaamntm is permit for workers'compensation. aadd.dfahy Section 3roodthe lsmr — BUILDING-D.IV->_ _ PERMIT PLAN—CHECK TOTAL _ PAID DUE c«m.f«IhewdamaK.dtlww.kr«wl;antnbp.mnabi,.aed. TOTALS---->_. .. _ .164 . 35 . 11 .00 _ 26 . 37 190 ,72 190.72 . 00 _rl I have end el maiden workers'compensation insurance.m required by Sedum 3700 d the Labor Code,fo the performance d the -- .. j� Wok for which this pent is Sued.My workers'compensation hairlines Cartier and policy number we: Cartier: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 164 . 35 OVER/SHORT: 00 Perky Number: — ❑ 5791 01/01/98 _. BLDG PMT PLUMBING ELE ' RIC MECHANIC . FIRE SMIP/TOT GRADING PLAN—CHECK (Ibis section ae , needndncompleted 1the panne afor hundred dollars 1$1007« llss) 162 . 25 . -_ _. 2 . 10 o I certify that in the petmxnce of the work for which this penia Is issued.I shall not emP OY any poem in any mauler o es to become object to the melds'comwensation levee el Caltcmie.and ogres Nat n I should bacons subpd to the"'Sr" ****************************** **********************w************************* pe satim aov� lpos of n 3700 of the Labor Cow,I a forthwith comply with the prormid+.. I N D I V I D A L F E E BREAKDOWN Applicant iiipensation c . TYPE QTY D E S C R I P T I O N . UNIT COST TOTAL COST 4ttt11 W up to one Modred thousand dams($100,030),In addition to the cost of compensation reggae as provldad for in don 3rodoythe Labor Code inrawof,and arony+Th. SFC_ _. 10000 . _ ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 10, 000 .00 snaky LENDING AGENCY:I hereby affirm under naky d perjury that there is a construction lending agency for the END OF FEES N performance of the work for which this permit u Issued(Section 3097,Civ.C). LENDER'S NAME LENDER'S ADDRESS: I certify that I have read this application and stale that the above information S correct.I agree to comply with all city and county ordinances and stale law.rotating to building construction and hereby authorize representatives of this city to enter upon the above.mentioned properly for inspection pdapdees. • •,. LARRY CARAVELLO _ _ _ 12-12-1997/11:23 4P1/$164.35 6770 S �. a Dae:(2-112-S 81-©11 PEkfeiIT:086151 Sgretured. :/ •• • (5151-4S WP) White-Building A Safety:G . I•.- 'entity-Applicant Pink-Revenue:Goldenrod-Assessor _ . - ' CONSTRUCTION AND PLANNING PaOL b SPA . APBJROVALS Permit# Date Inspector APPROVALS Permit# Date : Inspector r 1. T nporary Electrical Service-or Pole 52. Pool & Equipment Location 1 _2. I Pipe-Undrgtnd,, a, 53. Steel Reinforcement __actDD 4 _:Arg electrical CondikU blity-Ungrgrnd. 54. Forms St- atc'4 tfSctrical-CondQlPUndrgrnd. 55. Electrical Bonding :•t< t• 7'rl ,teel Reinforceli it 56. Rough Plumbing & Pressure Test M , 1r t-0231 Electrical UFERGrnd. 57. APPROVAL TO COVER-GUNITE C ='F6 #otings JO 58. Electrical Cone tt-Undrgrnd. •y -s f:-.'"7 .f '.'' -Qi r , �. Foundation E ;.l 59. Gas Pipe, 0 U[gl;,grnd.,Test .j • .a. Ter Pipe•Undt�d.� 60. Backwash Lin€gTrap,'O Undrgrnd. c ,� Mai Structural Floor System 61. APPROVAL Tbi.i Ht Ptdperty SewerS.intn& HousaConnection SZ Backwash & Rec for-Final 1--it.< t tl 'C 2 St?ver Cap ca p63. Heater& Vent-Final 13. Rebf Drains ^ • 64. Plumbing System • Final 14. Rough Plumbigg �, X • 65. Electrical-Final . 15. Rough Electrical-CaDduit '•. 66. Solar System-RXt, 16. Rough Electric48Jirir ' 0 67. Fencing & AccTsgApproval 17. Rough Wiring Sign L.- CCa - . ' 68. APPROVED FLRR-PLASTERING 21 n .., - 1 18. Rough Electrics?-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • 19.cRough Hoatitig &,fir Conditioning o•e' c v. m <* ^ rn Pjfd&cOt&PT7REQUIBEMEN.T Cu '71 O O 'l 0.. ;71-r: 'C'" 0 J to.. c1 rr ....,..-.O to t r t^ 20.7Ro h Rrct FFt.'place ' St" G6 * S rt C* c] APpO�t�lwE• Ppvmit# x n X. C r-1 Fltlace F i^ T.S * !! l Fit V" $ `5".S' t'.' yK i+7 * i •• •• - 6 S U .-•�x'1 1--I :17•_) i S 21.)UCs, ir$truFMutgx Si-. * - ,Z ,-.t n* `. 70.Hlnderg ecoid t9.}•dro * 22.Muct's, V&ttikQing1* 1 15 * t Q O F'* ' 71. Prod _ i in,. �.. as Oil ,l 0 r) r- t^ •-i P i X x C i-•1# F Q 23. 'Gas;Pip tot h& test , p.7. Or0 * T S < S* O 72. Undergroitwl d FH�us 4 r o .., r . -. - -.•.K , I P- ..p. * > a x S rJ > r,Cr N 0 24. Roof Framing t m * > r* Undergrbd.St .Cant 0 Gas 0 Oil 2541o4Sheathing 91t ¢ v 1* ,y `a' > rJ* 4" ve`tnead Hydgp, i •L . .aN.-, --. + w C• t-,* .1 ` . . S. Q 26.x3-Ba. Ceiling (Strtijotural) & Manscoat S * 0 >' !J* 7$.,,Drst'•Ch�HACal f * ^7 .... t+r, m F-. x rn * F'+J meta Cls- * �- rr1 r-. ? m raes F sl SSIX m * r, > c>o r. 76. Dr Fm * m ei 27 " hi-+b7rJ wiz:: * .* y Sta§fpipe,a,y * O N Q F, 28. Lathing_ SidingHx 0 i 00 sA. ' I ?71 FIXEOf3Y�5TEN(JFINA+ l n d y -1 1, C, :a .. .. err• . rtt « n 1t+�' :� 29. Insulati • Sw S * • FIRE PR EV. R}ro}\L t > C. O *-1* flS 7 4 * S h` 30. Drywallttlailing S* :•t 1 i- * F I Pic S NIdEALPtU DERE. REOUIREMENT c ,'1 . s i tr tr r Er x 61 31. Plaster wCo�xrt, K * ' 79. FINAL �PECfjN * 0 c„ .•-j3 q 1 ".2.1 ' n. Cr t „ , 4- 32.7lectnca PoYoer Meer Final * Sal FOOD CERTIfOCATE NSSt1E8' n -t a' t C-- 710 « l . 77 a: 7 S * O _ 33. iniEletr S* 71 I Q S * ' ' ate5: `31;1 x ^ 0 X Ste) x H�I CJ . y Ir • ._ C‘1. 34.�Fin4H�r int" A+jyC,eftditioning r * > ,yI ti : E[2:1.-:: * T ^ * 1 Cl n•+ rn• * tr• nn 35.Final Gas•Pipe••Test* 74 * H - - JJ • =' x,c. CI" * -,r S F-. k * _Q I • MI • --n * MI 'Q -i _< * �I £ a nw * Jr CZ 36.�k1o&i1 or%anopy * ..n ; =.:T, c a l -' 1* co x. c .T,' RI 37. finat•Faaory Fireplace': * �� C; '¥ t .. .. :i:3 x N i LK Kms" * S t 38. -y7 * I c,U 4 I rc x 1-+ 4, * r� f. .• % --,= .nrS .. ... ,� r 39.OWaterServices inal% t re: Q > �- - * m P. 40. as Service-FTPal :ill ne.,�.; ttnS tn I (U•y• us lir et - n 4,c-- 41. Solar Domestic-Final y rt N * ` I 1 tT' `3_-i a x. x F < * ‘-. 17.1 nK x 'l I « t•. OiN * S 42. Backflow Preyventer'. N Oaf- r.--'i+ 0 * !-t ( I * cr.: mrX a- * I-• ...SS S 1, M P.'. -> 0 43. Backflow Irri ation* >• • * M * cr. - * ;) r•. • -S * 7 f- CU * X O O n' T,:12 " * tr! O v t7•t: X N fJ •-1 x ci * N o 4.rLandsca� Irr�tlgatio SYsternjay 71 * ,_ ,¢ ¢* -F' E g c,, 0y x ,S F ••v -_...? +. 2 F-. t * r• 1 ' 1 J'c 7.c "' 45. ound Attert�atiortr `3 •• •• * trt to tit F c' c' K • E * _ L.. t- es * rl x .T1 •• •• ••x . - •-•-Vl Hi ••t•+ * 96. WarLdicarYRedirlatiolis ~ * * o: tK S • J" S * S * S I • C to 04-4 n d57."FI :.LSTRTCTUBIE & BUI DING - 1-e•-X7.7/7 I / - c * F+ or r- * I Mari , "'Y .. n •T, "] t ^. `. 48. IHf�L ELANNINC F r N I• • tc ce vt 4 -• c, > r re s K 59. 1ec78ic,$elease to Edison : I I F 4 .n ;rO ' - n G 'x ") O 'U .ate 0.=6as;fielease to Souriern CalifoFe5Gas Co `* I. * S p0 n * corr - S HD ' �n t t G `51. CERTIFICATE OFtCCUPANCY '' ""' •" "J R 'S T. No. Date PROJECT ADDRESS: 275 E 17TH ST UNIT: CITY OF COSTA MESA - SIGN PERMIT PERM NO: SB 050268 OWNER'S NAME: PAC EQUITY PROP. ADDRESS: SAME PERMIT NO: SB 050268 PLAN CHECK NO: 07.118-90 S GOVT: N SUPP: N N CONSTRUCTION TYPE: • PERMIT TYPE: STR SIG PURPOSE: OTH / ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL 16 . 5SF TEMP NONLUMINATED SIGN SQ FT: ARRESS: UNIT: / CLAIM VALUE: 350. 00 CALL-VALUE: 350. 00 GROUP OCC: B-2 / PERMITTEE: SIGN STUDIOS ( 213) 988-1841 ADDRESS: 851 E WILLOW ST COMMENTS: X SIGNAL HILL CA 90807 ***********>E************TF*+F*********RP**EF******************+EE6*****a6*********+PEE** LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section SIGN INFORMATION 70001 of Division 3 0l the Business and Professions Code.and my lic is in'.I force and effect. DISTRICT.: 1 TYPE: 'WALL ' ILLUMINATION: NON CATEGORY: NEW CITY LIC.: 104 22J _TATELI 680 • i ` • ss: C ' S IMENSIONS• 3FT 00IN X 5FT 00IN AREA: 16 , 505 FT LETTER HT: 10 IN Date / Z �2.. 40 ( signature: _ • _41 _ (1TREET FRONTAGE 1 : 155. 00 STREET 1 : E 17TH ST WORKERS'COMENSATIN DECLARATION: I hereby affirm th,have a certificate of onsent tosdl-i,• re or a certificate of Workers' STREET FRONTAGE 2 : 0 , 00 STREET 2 : Compensation c iced copy thereof(Section3er:.Lab. PARCEL; 42522301 ZONE: C1S LOCATION > FRONT: X • REAR: POLICY NO.: Iia4° '1�" EXP.DATE v3/01 /91 BUSINESS NAME: AA & D ELECTRONICS > LEFT: RIGHT: COMPANY: STATE ,,}}(( .. OTHER TOTALS GROUND SIGN ❑ Certified co yishereb furnished. L' Certified ' filed wit the eitylildingDivision. THIS ACTIVITY : 16 , 50SQFT OVERALL HEIGHT: OFT OIN //[ -\ /I / THIS SITE 99 , OOS5dFT GROUND CLEARANCE; OFT OIN Date: �L/ 'L (,J Applicant: J!/II / THIS OF INFO 1 - PLANTER AREA: 0 . 00SQFT • EXEMPTION FPOM WORK S'COMPENSATION DECLARATION: (Thi inion need not be pomplded if the mit is for one hundred WOO)or Rss). ITEMS FOR ACTIVITY• 1 BLDG SET BACK: 20FT I certify that in the performance of the work for which this permit. issued.I shall not employ any on in any manner so as to become COPY VERBIAGE AA & D ELECTRONICS subject to the Workers'Compensation Laws of California. Dale: Signature: PLANNING NOTES: TEMP SIGNAGE ONLY ******************************************************************************* NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor D E V E L O P M 'E N T S E R V I C E S R E Q U I R E M E N .T S Code.you must forthwith comply with Such provisions or this permit Shag 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 3037.Civ.C). ZONING APPROVED BY SCG DATE: (L-(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 BY• : . DATE: �� (Section 7031.5 Business and Professional Code: Any dty 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 tile a signed statement that he/she is licensed LEGALIZATION:N F E - SUMMARY STRUCTURAL SEGMENT: Y pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant Mr a permit subjects the applicant to a civil penally of not more than live hundred dollars(5500). BLDG PMT PL' ' - ELECTRIC CRANK SIGN SM IP/RES GRADING PERMIT 15 . 00 \ 16 , 50 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(Section 7044.Business and Professional Code: The Contractors'State License Law SM I P/NON-RES does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through PLANL 9 . 75 . 50 his,or her own employees.provided that such improvements are not intended or offered for sale.II,however the building or ISSUE FEE improvement is sold within one year of completion,the owner will have the burden al proving he/she did not build or improve BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE car the purpose of sale). TOTALS----> 32 . 00 0 .00 9 . 75 41 , 75 41 . 75 . 00 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business ❑ and Professions Code: The Contractors'Stale 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 ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN-CHECK ❑ '1 am exempt under Section: i B.8 P.C. • 15 .00 16 . 50 . 50 9 . 75 for this reason: ******************************************************************************* Date: Owner: INDIVIDUAL F E E BREAKDOWN I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements lora TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from. these provisions. NO FEES WERE SELECTED FOR THIS PERMIT Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and County ordinances and s to laws-elating to building struction and her by author replies•- lives°,this dty to enter upon t above-mentioned O1 00076049-CL'0?5052 TOT 41.75 property hfor ins ection liposes. T Date. I L Signature: Vi OR E; 12/12/50 T?(3E: i?:3i Driver's License or S ciat Security n: t 1641-46 White—Building:Green—Code Enforcement Canarv—Applicant:Pink—Revenue:Goldenrod—Assessor I CONSTRUCTION AND PLANNING POOL & SPA ' APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary'Electrical Service or Pole - - 52. Pool & Equipment Location - 2. SoilPipe-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. 3. 57. APPROVAL TO COVER-GUNITE ' =- 7. Footings c 58. Electrical Conduit-Undrgrnd. • • .8. Foundation - 59. Gas Pipe, CI Undrgrnd.,Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd. - 10. Structural Floor System N. 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Uonnection •. - - 62. Backwash & Receptor-Final 12. Sewer Cap " 63. Heater & Vent-Final • 13. Roof Drains L 164. 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 1 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.'Rough Factory Fireplace • - = APPROVALS r Peri-nit# 21. Ducts,in Structure _ -.: •,-'. '� �; - _ :70. Underground Hydro _ - 22. Ducts, Ventilating.'•- - r - X71-Product Piping O Gas Cr Oil m • 23:-Gas Pipe-Rough Si-(est ' •' '-' .-a1 i72_Underground Flush • - 1. 24.-.Roof Framing - - • • 73. Undergrnd.Storage Tank ❑Gas CI Oil •25. Roof Sheathing `.- - • - ,• ; t, ;74ajOverhead.Hydro ' _ 26._ & 26...T-Bar Ceiling (Structural)' Monocoat - - 7513 Dry Chemical 27. Frame and Flashing •i - •"e• s ' _ „76., Dry Standpipe - i , 28.-Lathing-& Siding • Y - s • • 77:. FIXED'SYSTEM FINAL. 1; - 29. Insulation : p; '. • r ,- � w 78. FIRE P,REV. FINAL . -, - 30. Drywall Nailing • =>r' - j Zr -' HEALTH DEPT. REOUIREMENT ' '31. Plaster drown Coat i* - ?9. FINAL INSPECTION, ' .N. ; ` t .32. Electrical Power Meter-Final 80. F000 CERTIFICATE ISSUED - 1. 331Final Electric - t Note"s; ' t ; .34. Final Heating& Air'Conditioning z , , 35.;Final Gas Pipe-Test' i - - -'--- : ' 36. Hood or-Canopy . .. a y - - _ . . • 1 • „• '37.;Final Factory Fireplace ,, _ -; DDRESSOFBMLDIND: 275 E 17TH ' ST WIT: CITY OF COSTA MESA - BUILDING PERMIT g98- 0662,;‘ omnesNIu1EIFIDnxTVICTORIA MITCHEL PERM NO: B 086882 ArIOREss: 1901 AV OF THE ARTS L.A. PERMIT NO: B 086882 PLAN CHECK NO: 00382-98 A GOVT: N SUPP: N C APPL.MAILg1D ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT ARCNRECTORUIGNEER:DC & ASSOC , UCND- 0 JOB DESCRIPTION , INTERIOR T. I . SQ FT: 5, 600 ARCNOREND.'SADORESS: 15751 BROOKHURST urn 207 WESTMINSTER CA 92683 CLAIM VALUE: 5, 600 . 00 CALC-VALUE: 5, 600 . 00 GROUP OCC: M / C0TRACTarsNAJI DC AND ASSOCIATES ( 714 ) 531-4032 COIDRAcroWsINUNO 15751 BROOKHURST COMMENTS : "INSTALL 4 FLOOR SINKS, 2 ,:LAV' S, 1 LAUNDRY & PARTION WALLS : " AOOREss:WESTMINSTER r• mita, 640117 ******************+ESE*******+Ert****it** E RE*******SESt** ERE+E****+E***************+ESE*+ESE* 92683 107 ZONING , REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby ern under• • d perjury. am licensed under provisions of Chapter 9 S E T B A C K S ' (commencing with Section 7000)of Divaon 3 d the Business and P••.-lions Code, •m license is in full force and effect. NO.: uM.cuss: B C.ND.: 640 17 EXP : MAIN BUILDING ACCESSORY BUILDING /• FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN C. -6 - I %7 Contractor: .L� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT : FT IN r R BUILDER DECLARATION:I hereby affirm under Pent(of Perp t t I the Cantmaws License Law ford e •• : •reason(Swen7031.sBinbessandPldeenOnaCode:Anyas vel:direquite*aWWI 0conshoa.altar.imProw. PARKING REQ: PROV: PARCEL : 42522303 ZNE: CI-S REF NO: demolish,or repair any structure,pear to its issuance.atm requiemtheapplican for such permit to file a signedstalementlhet he of she PLANNING NOTES> TENANT IMPROVMENTS FOR A NAIL SALON. e licensed pursuant le the provisions of the Contradors License Law[Chaptereaod 9(commencing with Sn 7000) Division 3 of the . luanesa and Professions Coder or hal he or she if exempt Iherehan and the bus for the alleged exemption.Aiy violation of Section > ' 7031.5 byany applicant for a permit ubpas the applicant to advil penally oma mon than lee hundred doles 1550OD. iflE****#iE3klEiEdElkaE1E1F1El(-1E1EikiF3Eifif3E1ElF1h****1EiEK- ihlEdf7E3EdE#1E*jEf *********iEiFiE1t7E1f-3f9(-iE**iF�Ee9f 3f-Ki ****1F o I.as ovmer of the propedy or my employees with wages as Iheir sole compensation,will do the work,and the stmcture is not intended 'DEVELOPMENT S E R V I C E S R E Q U I R E M E N' T•. S oralred for sale(sa,tion 7044,Business and Professions Code:The Caeradom License Law does not apply to an owner of property who bolds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such +�j.�c % improvements me not i fended or offered for sale.I,however.the building or nplorement is sold within one year of mmpwia,,the ZONING APPROVED BY \ J DATE: owner-builder will have the burden d proving he or she did not build or improve for the purpose of sale). ❑ I,asewn 4thePmoerpy.sin exaaasdvmntreaingwnhb«^safeomnawsmPannaamefaniea(Se,:.n7a..Bunn's*" BUILDING APPROVED BY : 'J 00 DATE: • - I•• ` , Professions Code:The Capradon License Law does not apply to an owner of popery whe holds Of improves thereon end who a V commas for such projects with a cenrador(s)kneed pureuen to the Contractors License Law). • o lamexempt underSection: B.A P.C.,for this reason: APPLICATION ISSUED BY: DATE: Date: Owner: LEGALIZATION: N F E E SUMMAR Y . . STRUCTURALIS GMENT:Y Ido hereby cantly that I am aware of and understand the requirements of Gallant Heath and Safety Code Sedans 25505.Ttb,and . + / / 25534.and that I or any More enlding occupant will/wR not(circle one)need to comply with said state codes and the requirements or a permit for censauction or modification from the Ai 0%tesy anaMnwa Oita.RWdenis motion appfutons ore exempt from these PMT E" BING ELECTRIC. :MECHANIC FIRE /SMI /Tic,ES GRADING provisions. PERMIT 112 . 25 - 1 Date: Applicant . SNIP/NON-RES PLAN 18 . 24 1 . 18 WORKER'S COMPENSATION DECLARATION:I hereby atom under penalty of perjury one of the following declaration*: ISSUE FEE ❑ I have and wil tannish a certificate of consent lo self.insunt for wakens'componential,re provided for by Sedion 3700 of the Labor BUILDING-DIV-> PERMI - ISSUE PL•ANLCHECK T,U,TAL t PAID DUE Cite,for the performance o de work for which the permit is Issued. .. ✓ TOTALS > 113 . 9 _ 0 . 00 !/ 18 :.29 131 ;6'7 131 . 97 - . 30 ❑ I have and ova maintain workers'compensation insurance.es required by Section 3700 d the Labor Code.for the performance of the 1, •• 'i work fa which this gem t le inued.MY workers'compensation insurance-. '•ter • number ore: f 3 0 Canter: REVENUE DIVISION TOTALS- -> COLLECTED.': 113 , 73 OVER/SHORTCh. Policy Number a BLDG PMT PLUMBING LECTRIC MECHANIC FIRE SMIP/TOT , ,GRA ePLAN-CHECK issedian need not be compleedl the permit is bas hundred..v. :isioq or ass 112 . 25 , / . / '" : 1 . 18',...: ,c) e f9 o I eerily that in the performance of the work for which this.. ii is issued,I that • any Poem in ern nanny oro ee to r • ,I6'qGI CP �1� y ,r become subject to the workers'canpenmon laws .dame.and wee 11 become subject to the workers' ***********it********************iE***,*3t***********************N-A- st Oif�'�E***3E*** compensation prove d Sea 3100 d the Labor Cade. - forthwith corn• with provision. V Y e 9� _� `�1� Applicant I N D I V I D U A L • 'PEE B R E A K D O.'A•\�„."syr oI kW: Failure b secure workers'`camwersadon coveragels un . . . subject an employer to criminal pMnaes and TYPE QTY D E S C R I P T I ON /� ' UN Z���,0,.474,„."sr..... TOTAL COST -`• . civil tines up m one hundred thousand dollars($1mg000A In addition to the cost of compensation,damages es Provided tar In fit; e e Q s«don370BOImeLabor Code,Intese:and afromy'sless. SFC 5600 ALTER BY VALUE COMMERCIAL• NOZONE `l� .a�`C/,y,7`., %. 5, 600 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury Ihe there is a mndadion lending agency for the END OF/FEES • 4'L6p��-pkt r�Nat"performance of the work for whish this permit a issued(Section 3097,Chi.C). 0J,at] NS,0•••CCC LENDER'S NAME: s•✓ r..• i \:lea. LENDER'S ADDRESS: `Q�S• Oa I certify that I have read Na application end sate that Ore... • h, ion is correct.I agree to comply with al cry and county ordinances I` / .cVi t.r / Q�V � and mate awe relating to beldigcontWian and hereby- •'¢e Minn dl'.•' 'enter upon theabove-menlipwd properly U for inspection prrpem.CHA DZUNG / Qay • 82-86-1998/84:26 PM/$113.73 2-6-1' RCPTN:81 0819365 Date: DOC NUP1:86882 Signature of e Owr/ApendA ' (515146.WP) While-Building A Safety;Green-File: angry-Applicant:Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING t - POOL ,PA ' APPROVALS Permit# Date Inspector APPROVALS Permit # Date i Inspector 1. Temporary Electrical Service or Pale52. Pool & Equipment Location, 2. Soil Pipe-Undrgrnd. ='1 - - 53. Steel Reinforcement l 3. Electrical Conduit Utility-Undrgrnd. 54. Forms • 4. Electrical Conduit-Undrgrnd. i 55. Electrical Bonding 5. Steel Reinforcement r 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,O Undrgrnd. - • . 10. Structural Floor System 61. APPROVAL TO DECK ( I ' 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ! I 12. Sewer Cap i 63. Heater & Vent-Final - . . 13. Roof Drains 64. Plumbing System - Final , 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final , ' 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL- ! 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # ! 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough& Test 72. Underground Flush •24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas O 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 I f 33. Final Electric ir% • -c Noterag' 4•64,-0,./,4,#.4. AJdl e' / 11e .s, 34. Final Heating & Air Conditioning • 35. Final Gas Pipe-Test • .) �APH con- �A--e-e,L/ 36. Hood or Canopy - • 37. Final Factory Fireplace ' 38. Final Plumbing t 39. Water Service-Final 40. Gas Service-Final . 41, Solar Domestic-Final cr , b *' '3'K�-'.1 ��."1 42. Backflow Preventer _ ,- , G' sc ,` 43. Backflow Irrigation �/ � ►,�{r �:.� ���t: 44. Landscape Irrigation System / {��/' ) Q� ^.". t -t YAC 45. Sound Attenuation •�`:.�$1, eY',,d> 46. Handicap.Regulations Al 'r,.e-017-tC's,*`�. 47. FINAL STRUCTURE & BUILDING /y/Q6 A =? . t' 48. FINAL PLANNING -- ' 49. Electric Release to Edison "-..."',1 a 50. Gas Release to Southern California Gas Co - - .-- iv, 51. CERTIFICATE OF OCCUPANCY - . No. Date . I "m#150"01010275 E 17TH ST LINT: CITY OF COSTA MESA - BUILDING PERMIT , l l C5 �O '�� ~ OV4NER'NNIEwmmm VICTORIA MITCHEL PERM NO: P 086883 ADORES& 1901 AV OF THE ARTS - L .A. PERMIT NO: P 086883 PLAN CHECK NO: N GOVT: N SUPP: N A .MAJUNO ADORES& C - `� PPLCONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: ALT MCNRECTORENOgiEEA: DC S ASSOC. LK N0: 0 JOB DESCRIPTION : INTERIOR T. I . SQ FT: ARCH.ORENG'AADDRESS: 15751 BROOKHURST inn: 207 WESTMINSTER CA 92683 CLAIM VALUE: CALL-VALUE: GROUP OCC: M / cCNrmacestamL DC AND ASSOCIATES ( 714 ) 531-4032 cannCronarlutD 15751 BROOKHURST COMMENTS: REF:B-86882 moms: WESTMINSTER CA Un.Nc_ 640117 + ********* `*******i`'**+r+E,E*+e********** ESE*********rt******* -**** -*x.*x.x.K..x.****** Ear.*** 926$ WAT: 107 Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby Mfrm under.. . pepay that I am . under pronion.of Chapter a SETBACKS (commencing with Section n00)Of Gain 3 of the Business • rolemiae .. .. . .. .. .. .In full force and effect .y .: O.: / UC.CLASS: B uc.No.: 6 10117 EXP : MAIN BUILDING ACCESSORY BUILDING `/ i (� o Comte« = FRIT: IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FIN RGHT: FT IN LEFT: FT IN RGHT: FT IN • .UILDER DECLARATION:I heaby elmn antler perWy d peon That I en sarnpt Imm its Co tnoor,license law la the h.or ret*anyst700i3 nkwseaad Pnce. ilsscate:tthe ay«mfor permitsuch to file sigl000mwd,aa«stn«ave, PARKING REI.,.QPROV: P�:2CEL : 42522303 INE: REF NO: m•eh,or rept*any the provisions of to thees Contractors So regentLawthe chapter lawch toeb a signed olnt0aa heaeM 's licensed pursuant to the prowone d e License (Chaise 9(commencing with Section rE 7000)d DHiion 3 of IM PLANNING NOTES> luainasa and Professions Code)or lhal he or the is exempt t arehgn and the basis r«the alleged exemption'MY violation of Section > 7031.5 by any applicant for a permit subjects the applicant to a civil Penally of not more than fwehuadrad dollars 135001). **************************t' *******************`******************************** ❑ I,eaowner tithe property or my employees will wages as lhek sole compensation.will dolts work,ed the simmers is not Intended D E V E L O P m : N T SERVICES L-R E U I R E M E N T S Of offered for sale(Section 7044.Dueness end professions Code;The Contractors License Law does not apply to an Owner of popedy Q who builds or improves thereon,end who does such work himself or herself or trach hi or her own employees,provided that such - improvement.are rot intendedordieredlersale.I,howeer,licediklingorinpnmernamisoldwithinoneyearof Mion,the ZONING APPROVED BYDATE: owner-builder en der will havethe burden of proving he or she did not build or improve for the d the purpe sale). o I,es owner of the popery.am exduendy mmredtp with licensed commutate to canoed the project(Section TOU,Business and Professions Code:The Contractors License Law does nor snipan owner windy who buildsavis•..thereon and who BUILDING APPROVED BY DATE: ito d « contracts for sed,projects with a mmradoris)licensed inseam to the Contractors License Law). 1:1P II d ❑ Iamexempt under S. len: B.A P.C..for this reason: APPLICATION ISSUED BY : . . . . . . . . ... i. ****DSA(**** sees,.� • • ** D«°; Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL S 'GM NT:N I do hereby cetdy that I an aware d and udrstan d the nsan°me is of Cagan•Heath end Selly Code Udine 15505.93533,and .. 24531.and ave I a any future building comma who D/wnot(rode we)need to coon/nil net 211,10de re t°oand lln edmnams for a permit for connection or andificalion from the Ar w-C Rio Managemry District.Residentialmndngdn eppicatkm an exempt from these BLDG PMT PLUMB NG ELECTRIC MECHANIC FIRE SMIP/RES GRADING amnions, PERMIT 61 . 5 2.t SMIP/NON-RES Dm.: " '°°— PLAN '' WORKER'S COMPENSATION DECIMATION:I hereby affirm rhe«penalty of peOn and the Wowing dedwnm: ISSUE FEE 220#0 w ❑ Ihaendeel maintain ceSlmd econsent toedm uabM swe pe couuprovided d Section 37C0 BUILDING—DIV—> PERMIT ISS PLAN-CHECK TOTAL PAID DUE Cole.tor the°°"an.`°dthe mak for w.dgas permit blasted. TOTALS----> 61 . 25 22 . 0 ' - 0 . 00 83 . 25 83 . 25 . 00 ❑ I have and veil maintain workers'compensation insurance.as remind by Section 3700 of the Labor Code,for the performance d the work for whidnda pont ed.My wins'compensation insurance carrier and pulpy aamMr«e; REVENUE DIVISION TOTALS--> C LLECTED : 83 . 25 OVER/SHORT: 00. Carrier Number: BLDG PMT PLUMBI i ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ii soden need not becompled l the penal is to one hrandred..... /$lco;or •V\ :.-^\7�C X I cM/y tat In the performance d the work fa which this. i issued.I b emdW any person ion snk'manner so as to ,�U�"�5ED -: • . subject to its workers'comppuatbon laws d •• and age 1 - t I should become surto to IM workers' *************iLie at-iE 3/ MC +t**********•**********************Sy******************** c,•penmlin,. .ions. 370001 the Labor •...I than forthwith•• • with those provisions. 8 r_ 6 OP d" )1, . 0 Y IDUAL A L F E E BREAKDOWN Date: i I , Appecem: r -:l 3r�a4 �Q0\ gl\`'" �.[•`� 0 Warn, •:Fsneuafosecure wot«a•conp«uatoncov«pa is ,. ,and alWlsubject anemploy«foMmrWp«urouand TYPE ego 0.1a 8\\0. 441 R I P T I 0 N9141\ UNIT COST TOTAL COST to nae tp to one hundred thousand dollars($7040005 In addition to the cost of compensation,damages as provided for In Q .., r�\\ �� `.•eon 3)OAofthheLabor Coa,inteest,endettomey'a/eea. PLU IOW qt' iNDRY TUB OR WASHER 8 . 75 8 . 75 CONSTRUCTION LENDING AGENCY:I hereby alarm under penalty d penny that there i a construction lending agency for the PLU `y0�\� w�\ �Q ASH BASIN - 8 . 75 17 . 50 perfamarcea wonEwgpthpennliissued(Sedin3093,CW,C). PLU ro.yei\ d9\� SINKS, FLOOR 8 .75 35 . 00 END OF FEES LENDERS I candy that I have read this application and one that •• bdarnmion is coned.I ewes 10 comply with all thy end county ordinances and state laws relating to beading cannot and -reby au ."•e npymasive of this City to Wer upon the above-mentioned property . for inspection purposes. CHA DZUNS - 82-86-1998/84:28 PM/$83.25 Alli Dor: 746, if r9 PERMIT:T086883 Signature of Owner/ ".77-' (SI St-46.WP) White-Swdng A Sedey:Green-FM;Canay sppi®m:ink-Rema:Goldenrod-#weans t CONSTRUCTION AND PLANNING - POOL ,PAi APPROVALS Permit# Date Inspector APPROVALS Permit # Date ! Inspector 1. Temporary Electrical'ct� � Service or Pole / 52. Pool & Equipment Location - 2. Soil Pipe•Undr� -- /1_in_As j3n( 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. IV (-t�-�� 54. Forms - _ 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. , 8. Foundation 59. Gas Pipe, O Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System61. APPROVAL TO DECK - i 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final , 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains i 64. Plumbing System -.Final 14. Rough Plumbing P.io•ri$ Rn/ 65. Electrical-Final I , 15. Rough Electrical-Conduit f 66. Solar System-Final j 16. Rough Electric Wiring • 67. Fencing & Access Approval - - 17. Rough Wiring Sign .68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory FireplaceAPPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil j 23. Gas Pipe-Rough & Test 72 • . Underground Flush4. bre i IS,,:�, 24. Roof Framing 73. Undergrnd.Storage Tank O(,,es" Qi 25. Roof Sheathing • 74. Overhead Hydro r;; 1:7'r• '� 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •` ` ,� ' 27. Frame and Flashing 76. Dry Standpipe l',... 28. Lathing & Siding77. FIXED SYSTEM.F N L .r 29. Insulation 78. FIRE PREY. FINAL ' 30. Drywall Nailing ; HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. FINAL INSPECTION 32. Electrical Power Meter-Final V 180. FOOD CERTIFICATEISSUED Soo-ISSUED 33. Final Electric W`L �vIDER+�1M ,- + Roo ,u & e�K_. 34. Final Heating& Air Conditioning -,91198 FAL�f _le 1 K 35. Final Gas Pipe-Test • 36. Hood or Canopy 37. Final Factory Fireplace_ 0 Final Plumbing • _ 80-98 ISP/ _. 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 + n 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 , 4 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.• • CITY OF COSTA MESA QONSTR UCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address _->7e. /7T'' Jre � e- 1 3 0 3 _ 1020 5/24/84 14.OU TL Applicant's Mailing Address S.f/-iE TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR 1 pX711 //���� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner's Name gf�el/�5 ✓E� Phone 1 kren. A.P.# I Zone �'� E. /' fi " o A�Cfd DESCRIPTION OF WORK/USE OF BLDG. Address • I � S Main Building: Accessory Building: TYPE OF PERMIT ❑ GRADING Li FOUNDATION U STRUCTURAL E Front JE Arch/Eng. License No. T Address • 0 TENANT 0 ELECTRICAL ❑ PLUMBING 0 MECHANICAL A Rear Contractor's Name ����/bu-IUGC y Phone ❑OTHER • C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K' Address(mailing) CONSTRUCTION TYPE VALUATION 5 S Left City License No. ZONE GRADI NG CU.YDS. ACRES -LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./ProvidedI hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes:with section 7000) of Division 3 of the Business and Professions Code, and .my license is in full force and effect. •License Class License No. Date • Signature • PLUMBING FEES • A WORKERS'COMPENSATION DECLARATION , Bar Sink Showers k',.Lhereby affirm that I have a certificate of consent to self-insure or a certificate - ELECTRICAL FEES a-,f Workers'-Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - Service Sink-- (."`3800; Lab. C.) Automatic Washer Transformer 0 15.50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. - 0 50+KW 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑pp to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION 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 PipingDryers ❑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 s s to become subject to the Drinking Fountains Solar Tank • Fan , Workers' Go a Yaypn Laws of Californ�l Motors❑Ol HP ❑1 ya-B Oate - -4--AK-d- Signature �'{ diC --- Floor Drains Swimming Spa p NOTICE:If,after making this declaration,you ould become subject to the s .A.U. Inc.Solar 0915 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 AGENCY Gas Service Outlets Water Closet I hereby al firm that there Is a construction lending agency for the performance - _ IWH3H` Device Boxes Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors, Water eater Outlets Range . Lender's Name _ - - tt!!"ii - Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Garbage Disposal •Standing Sections ^—� following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap structure, prior to its issuance, also requires the applicant for such permit ' P - - 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 Q / e- the Contractor's License Law (Chapter 9.(commencing with Section 7000)of d ,&o Snti"r J Division 3 of the Business and Professions Code) or that he/she Is exempt herefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil ,_____ wispy of not mere than five hundred dollars($500). . I, as owner Of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not Intended or offered - - Reinspection Fee $15 Issue Fee $ 3 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 r thereon, and who does such work himself/herself or through his or her own Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees. provided that such improvements are not intended or offered for Boiler sale. If, however, the building or improvement is sold within one year of com- - Canopy Type II 0 - Zoning Approved By - Date _ 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). L l I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By (/ DataJ 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 00100,000 BTU 0100,000 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 award thatExhaust 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 B.&P.C.for this reason Firepl/Fact.BIt. ICBG# PLUMBING $ ISSUANCE $ Date __52..2.74--_ _5' OwnerJE.y�z f ✓Ceti. Heating System&Ducting PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00100,000 BTU 0100,000 BT ELECTRICAL $ 14.OD GRADING $ Information is correct. I agree to comply with all city and county ordinances and state laws relating to bui •ing construction, and hereby authorize repre- sentatives of this cit to •-r upon the above-mentioned property for Inspection purposes. s Signature Date s72'y/ `t= FY MECHANICAL $ TOTAL FEE $ I C)° Drivers' License or SS# ' Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ rev.q CMF 0865-46, /84 white-Builtling; Canary-Applicant:Pink -Accounting:Goldenrod -Assessor . • • CONSTRUCTION AND PLANNING POOL .PA APPROVALS Permit#E-43.41.47 Date Inspector APPROVALS ' Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE • 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar.Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23.Gas Pipe-Rough&Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25! Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing I 76."Dry Standpipe 28. Lathing & Siding 1 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 r "I r • c 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-Fin& • 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ! 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ( 51. CERTIFICATE OF OCCUPANCY i) No. Date