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Home My WebLink About277 17TH ST - Building Permits CITY OF COSTA MESA BUILDING DIVISION - Fµ , ) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • vnvw.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 Sti`'° , PERMIT NUMBER: BC09-00101 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: COM ALT DATE ISSUED: 05/29/2009 ISSUED BY: RMD JOB ADDRESS: 277 E 17TH ST CM Suite/Unit: APN: 42522304 Zoning: , , Vicinity: YOGURTLAND Primary Occ: B Const Type: V-B SQ. FT: 1450 Valuation: $75,000.00 SCOPE OF WORK: 1450SF INTERIOR DEMOLITION AND TI FOR"YOGURTLAND" CONSISTING OF A NEW OFFICE, UNISEX RESTROOM,WALK-IN COOLER AND A NEW COOLING TOWER. 1 REPAR/ALTER COOLING/HEAT, 1 REFRISG SYST< 100K BTU, 45 LIGHT FIXTS, 38 OUTLETS, 8 SWITHCES, 2 SVC TO 200A,2 COMM DROPS, 2 SUB PANEL TO 200A, 1 BKFLW PREVENTER, 4 FLOOR DRAINS, 8 P-TRAP,4 COMM SINK, 3 FLOOR SINK, 1 SVC MOP SINK, 2 TRAP PRIMER, 1 VACUUM BREAKER, 3 WASTE AND VENT, 1 WATER CLOSET, 1 WATER HEATER. REF:ZA-09-015 OWNER: PERLMUTTER,DAN M Address: 36 MISSION BAY DR Unit: Phone: City/State/Zip: CORONA DEL MAR,CA APPLICANT: MUNOZ,RICHARD Address: Unit: : Phone: 909-592-7068 City/State/zZip: CONTRACTOR: DH CONSTRUCTION License No. 846876 Phone: 909-592-7068 Address: 4195 CHINO HILLS PARKWAYUnit: UNIT 626 Cell: City/State: CHINO HILLS, CA ZipCode 91709 ARCHITECT: JEFF S COFFMAN License No.C25115 PHONE:714-738-7045 ENGINEER: License No. PHONE: COMBINATION PERMIT FEE SUMMARY Building Plan Check: $532.19 Building Fees: $818.75 Electrical Fees: $231.89 EMA Mechanical Fees: $69.10 Plumbing Fees: $329.80 SMIP Residential; $0.00 9 D SMIP Commercial: $15.75 �'/ Bldg Std Admin Fund $3.00 �U( TOTAL FEES: $2,000.48 **Refer to fee receipts for all fees paid for project 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. CODE E. INSPECTION TYPE INlmALS CODE 1 INSPECTION TYPE DATE IN 4,1 1616 Fixed System Final Fire Prevention 206 Final Mechanical S ✓ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical V (� 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site / 204 Final Demolition 250 Final Building/Occupancy1S/�L/�I I I 1 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver s license. 0 Yes D NoF 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 Cartier: - . C •t_ r by this permit,and that no building structure,scaffolding,falsework,or demolition f or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp inns seulionmet mot be mmgefe0dthe pony!c valued al one hundred Onears(5100)or fess.) 2.Art 2Sec 341,Title B.California Administrative Code). rPolicy'NtimbBr: no p.s gig 5--_,700.g ❑ 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 beco ' i.jec .. the workers' • pensation provisions of Section 3700 of Applicant's Signature Date th= abor Code shall f•rth 'h•amply wit these provisions. // 5— g/9 Division of Industrial Safety Permit Number: Appiont's Sign ure f' 1°' HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WAR . : FAILURE T• ECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND HALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response Ito release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 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 registration form for acutely hazardous materials? ❑Yes 0 No Lic. ; o' n S 1(0 / C•Class'ft _ (Section 25533 of the California Health and .'Safety Code, with some exceptions, requires registration with the Costa,Mesa Fire Department by Ea. — O each business which at any one time has on hand a quantity of acutely Contractor's Signature r.----•-i' hazardous materials equal to or greater than a freight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). O I hereby affirm 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. S gnature Date 4. If an RMPP is presently required, has Section 25534 of the California 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? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code that he or she is licensed pursuant to the provisions of the Contractors requires that the requested License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits). Business and Professions Cale) 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. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 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). ❑ 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? 0 Yes 0 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 control officer). 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 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 ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044.Business and ' Professions Code:The contractors License Law does not apply to an owner of Signature I Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractors)license pursuant to the Contractors License Laws.). certify under penally of perjury that I have read this application and state that ❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,land 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. !tore t22„...-- iDat 17 Signature Date q�f1_ s / A I 9305]-a6 3b) 1A�pfor.AualWi `-nat0 CITY OF COSTA MESA 1 all BUILDING DIVISION r > y. .- DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4t PERMIT •14Pwa"�.4" C SB05-00031 (714)754-5273 • Fax(714)754-4856 • www.ci-costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 SIGN PERMIT Job Address: 277 E 17TH ST Status: ISSUED Suite: Applied: 03/18/2005 Vicinity: Issued: 03/18/2005 Parcel Nunmber: 42522304 Zoning: - ISSUED BY: 1 1 Applicant: MURDOCK, SUE : ' Address: 9025 BALBOA AVE% SAN DIEGO,CA/ Phone: 858-569-6716 EXT. 113 , SUITE.150� ' : • Zip:- 92123 ;,, _ • Owner PERLMUTTER, DAN-M - , - Address,, 36 MISSION BAY DR - - . Phone: CORONA DEL MAR,CA Zip: 92625• Contractor:- ULTRA SIGNS i ' '< ' ' ` \; Address: 9025 BALBOA AV = , - SUITE 150 - Phone:- 858-569-1400 - , -�' \ -. ' . ' SAN DIEGO,CA - . • .Zip:_ 92123 •-• - License: 799881 Arch/Eng: , '. -. _ Address: Phone: , Zip: \ " N License: , -- ' , . y,:SCOPE OF PERMIT . 'C 182 SO.FT. FREE STANDING FOR MULTIPLE TENANTS(7 TENANTS).SIGN IS 15 FT.HIGH. .., ' ' ` FEE SUMMARY it, - Plan Check: $72.31 - Calc Valuation: $5,000.00 $0.00 j Permit: $111.25 - Claimed Valuation: $5,000.00 SMIP Com: $1.05 - Other: $0.00 $0.00 Inspection: $0.00 $0.00 , '$0.00. , i Total: , $184:61 _ , PLANNING &ZONING 2 i, 1 NOTES: 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) i 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 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 wo compensation Insurance carder and policy number are: f Carrier: h-f< L/A� (7 A Policy Number: / / a Z U,- 4 (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,a agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall forthwith comply with these provisions. Applicant Signature: Date: Vc /4" - S WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100,000),IN ADOION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE.INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lins d ter roIon f 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.0 Cr ( . Class a ) / Contractor's Signature: )-� � V Date: —/O! - 5 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 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 br offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: . Owner ID verified by driver's license. ❑Yes 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,fatsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder,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 greeter than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). _icant..___.__._ �_ .o _._ 3 Does or will the applicant ar present or future-1;4;1:7g ax:upant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia 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 II 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 aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No (Section 65850.2 of the Califomia 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 II 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 Of yes",attach certificate of compliance from the appropriate air pollution control officer). I 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 slate 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 OI egal Owner ) And/Or Authorized Applicant Date CODE I INSPECTION TYPE DATE MDUAL6 CODE I INSPECTION TYPE 1 DATE g{®EL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1 1268 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 til_ iS5 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' ! CITY OF COSTA MESA 4 BUILDING DIVISION F 'till DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t • j • PERMIT E05-00220 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 277 E 17TH ST Status: ISSUED Suite No Applied: 03/18/2005 Vicinity: NEW MONUMENT SIGN Issued: 03/18/2005 Parcel Nunmber: 42522304 • Applicant MURDOCK, SUE - ISSUED BY: F- L. Address: 9025 BALBOA AV . / . SUITE 150 _ .,'/ Phone: 858-569-1400 - SANDIEGO,CA, : - Zip 92123 / / _ \ Owner:' PERLMUTTER, DAN-M � Address 36 MISSION BAY DR - ,' Phone: ,NN‘,/ /`,' N CORONA/DEL MAR,CA Zip: 92625 . Contractor: ULTRA SIGNS - I� � eco. , � Address: 9025 BALBOA AV' • -SUITE 150 - --Phone: 858-569-1400._ / , -O SAN DIEGO,CA Zip: 92123 License:799881 SCOPE OF PERMIT ••ELECTRICAL PERMIT FOR NEW MONUMENT SIGN..INSTALL 1 SIGN CIRCUIT: REF:SB05-00031 FEE SUMMARY ' - Quantity - • -- i Quantity / , ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway 1100 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 i• F.,: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.L,, . $0.00/' 0', '' ,' , Switches , $0.001, 0 over 100 kva%kw $0.00 0 ' - - ' Non Res Appl '. $0.00 0 Low Voltage Equipment $0.00 ' N 0 Res Appl $0.00 ' ' 2 0. Low Volt Wiring System/Ckt/' ' $0.00 /-;0 / Service to 200a ' ' _ • $0.00'- '0 , ' ' Misc.Conduit Service to 1000a $0.00 ' 0 __ . . Misc.Conductor - " . -$0.00 . 0 ' 1 ' Service over 1000a ,, • , $0.00 " - 0 - 'Circus(gen or ride) ;$0.00" ;`0 ,/ Motors to 1hp v $0.00- _ 0 Circus(mech ride or lights) •- ;$0.00! i 0�/ Motors to 10hp $0.00 ' 0 - _ ' - _Christmas Tree Stand $0.00%, -�0 Motors to 50hp -$0.00 ' '' 0 Fireworks Stand - 2 '/ '$0.00- 0 Motors to 100hp $0.00 0 �' , r Other Electrical Fee j $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 Chick Fee'" $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92.28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will this ea is ete of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the erycrk for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers compensation Insurance carrier and policy number are: 7 Cartier: S-{-r- -1-P CI,- A__ Policy Number: 1 1 1 0 1-,r -o 4- (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo ' ,and agree that It I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall fdnhwith comply with these provisio _ — r Applicant Signature: Date: -1 WARNING:FAILURE TO S CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARE(Sicep00),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licon e u er provisions,of Chapter 9(commencing with Section 7000)of Division 3 of the Busineyaand Professions Code,and my license is in full force and effect.Lic.a 'if ' / / Class a C.� "/' Contractor's Signature: Date: a- /X - 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 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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fwe 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 ownor 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.). ❑ 1 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,taisework,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 feel of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to filo 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 0 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. _ _._ed.--_._-__-...__ ._.......n.-_..__ ._ _ _. ._ _..._..� _ 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 implication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes Lf No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). __e_South _.__ other l..dsricagec_._—______ _ ..__.. __ 7 Ifa a cation hav tae the Coast s presby eal or air pollution controloon districtorbeen agency is required for the work which is me Subject of this application,have all of the disclosures prescribed by CaliforniaCalifola Health and Safety Cale Section 42303 made? ❑Yes 0 No .... __....._.�.—__ ___ _._.._.._ _ ___..._..._.....__._.._.._____.__..__ 8 (If yes',attachcertiliCate 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 stale laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of eget Owner(s) Dalai / And/Or Authorized Applicant Date CODE I. ffISPECTMN TYPE DAIIL INTRULS CODE( INSPECTION TYPE PAIL INCAL9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing I 200 Final Re-Roof 210 Final Electrical 1'2-frO5- 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 Development Services Department CERTIFICATE OF OCCUPANCY No. 003'379 Building Safety Division P.O.Box 1200 Costa Mesa.California The Building located at 277 East 17th Street has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 112 Occupancy. Use of Building Pizza Parlor Legal Description 425-223-04 (See reverse side for Metes and Bounds) Building Permit No B 51158 Electrical Permit NoF51204,E51516 Plumbing Permit No. P 51231 Mechanical Permit No. M 51248 Number of apartments - and/or guest rooms — ISSUED TO: Building Official Tony C'De Baca DMP Properties 277 East 17th Street by - . . / i Costa Mesa, CA 92627 Date Aoril 2, 1991 • This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev.1/e3 White-Owner;Canary-Numerical File;Pink-Bldg. Permit File \I\ (Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.• - ---]]]JJJ -0 PERMIT NO. q TRACT NQ. LOT NO. UNIT NO. CITY OF,COSTA MESA gOyN TRUCTION PERMIT 3 Z ro7 / �� r 7127 3/21 /B'I 480, 16 TL Prort,A;dress 2/1 ( l Saxer • I - 1�1�'w�ASS // . ' , s 4a1 Hi IIGeccr .per (atcr oi4 Lit TYPE OF CONSTRUCTION ❑ NEW I-1 ADD LWALTERATION ❑ REPAIR OApwner's Nameail ing Address 0 CONVERSION 0 DEMOLISH ❑ O Owner's Name � �`/C�A�d1NC„ Phone 753. 3y83R A.P.# 4 Z S ' 2 Z3 - D+. Zone G DESCRIPTION OF WO US OF BLDG. Address • 1100 [t..C4M1 WO E.OK. C4C4SSAD G0. '2005 '/a aa' wc�'r Lei S�j C,QH lar S Main Building: Accessory Building: Arch/Eng. License.No. TYPE OF PERMIT GRADING T�`L-y1,FOUNDATION STRUCTURAL E Front O Address 1,, Q ❑ TENANT ELECTRICAL PLUMBING MECHANICAL B Rear N Contractor's Name.-104.4-1• LL4 �Nsr co . Phone 163•(9u1V ❑ OTHER A I PROJECT DESCRIPTION SQ. FT. IWIL I ••_1_- OCCUPANCY C Right N Address(mailing) 2121 14111cee5r b2 L¢ULACI l Cs{ g2ov1 N. - CONSTRUCTION TY PE� VALUATION$ Zn, OOO S L G R City License No. • 7�3 ZONE GRADING CU.YDS. ACRES Ping. Ref. # • Parking Req./Provided E LICENSED CONTRACTOR DECLARATION s I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: / U �13-i PlanningNotes: ��f, er A TE /Ja , O with section 7000) of Division 3 of the Business and Professions Code, and �� /C7 ( �'� '•'s l.-- •"I,`'�IG�I OI 1�A �r`� `�--��--�"s`v M my license is in full force and effect. - OSaIO • t ,g. (Lie Te` ffiar1 � TPIAit,(.t L/L�Q T License Class 13I / n SQ NO. -- _ lt!{ r S Date 3'21'ea Signaturee 457L-•••"- _ PLUMBING FEES t (.ocs WA-4-e"-- WORKERS' A-4-e `-- WORKERS'COMPEN$ATION CLA ATION Bar Sink Showers V ELECTRICAL FEES hereby affirm that I have a certificate of consent to self-Insure or a certificate _ O Workers' Compensation Insurance, or a certified copy thereof (Section Back flow Preventer / Service Sine �' 2rrtt _ eec a� ']► Automatic Washer Transformer ❑ 15.50 KW PpOey No. 5,1).„ � 103& - 8!1 Company�T4TC. Fltn1D ' Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW Certified copy is hereby furnished. t - Certified copy Sited with the city ' ion.../ Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date3•-71---6� Apogean • - -EXEMPTION FROM WORKERS' MP SATION,DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps • (This section need not be complet if th permit Is for one hundred ($100) or • less). . r - • Dishwasher Solar Piping _ - Dryers ❑Gas ❑Electric Sub Panel I certify that In the performance of the work for which this permit is Issued I - snail not employ any person in any manner so as to become subject-to the Drinking Fountains S Fan Workers' Compensation Laws of California. Motors❑01 HP ❑i'/s-8 Date Signature Floor Drains Swi ming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ NOTICE:If,after making this the you should become subject to the Workers' Cpm sucht"ign provisionsioof the Code, you must forthwith Floor Sinks t/rina Fixtures Microwave comply with such:-,provlsions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets ;/ Water se Device Boxes I hereby affirm that there Is a construction lending agency for the performance Pole Light . of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water He er Outlets Range Q •7 r, Lender's Name L; Q ( l Lender's Address Kitchen Sink Water Ser e f Switches OWNER BUILDER-DECLARATION Sign �O SL I hereby affirm thartam exempt from the Contractor's License LaW for the Lavatories Auto-Wash 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 - ' Laundry Tra Generator 00.5 KW 05.15 KW Trash Compactor any structure, prior_to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of ., ROOf,Dmios - - the Contractor's License Law(Chapter 9(commencing with Section 7000) of -avlsion 3 of the Business and Professions Code) or that he/she is exempt erefrom 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 penalty of not more than five hundred dollars($500). UI, 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 $IC 0(i for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves ,, thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REO IR TS: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 / sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II 0 Zoning Approved.By Date-7�-ryj p Yam pro vef the owner will have the burden of proving he/she did not build or Un- Duct-Under Ground ss,�S pp�s Al ti v prove for the purpose of sale). Building ApproVod BY ! Data��11- 8'rj ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 1• . '.: .I:_• _ Datrfl __ tractors to construct the project (Section 7044,Business and Professions Code: ' The Contractor's License Law does not apply to an owner of property who $ Duct-Ventilating 00-100,000 BTU 0100,000 BTU (0 SUMMARY OF FE S builds or Improves thereon, and who contracts for such projects with a con- •.tractor(s) license pursuant to the Contractor's License Law). I am aware that ExhaustSystem 0 Multiple❑ / System Repair/Alteration lid BUILDING PERMIT $ e SMIP $ _ 3• 00 proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ > S� PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers PLUMBING $ 57. 00ISSUANCE $ Date Owner - Heating System& Ducting Registers PLAN CHECK 25% $ a e9 ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000BTU .ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws r-la ing o building construction,and hereby authorizer pre- PLAN CHECK 50% $ MICROFILM $ sentatives of 1. S city to ler_upon the above-mentioned prqper for o {e inspection our. •�¢qn /q02 MECHANICAL $ 'Ob TOTAL FEE $ VO 0a! O . Signature AeA / ` Date.3/ Drivers' Lice. e or # - / Reinspection Fee $15 Issue Fee $`1%.00 PLAN CHECK 25% $ 1 I ' }"5 CMF 0865-46,rev.10/84 White - Building; Canary -Applicant: Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL&SPA 'APPROVALS Permit# - Date Inspector Date Inspector APPROVALS Permit# 1..Temporary Electrical Service or Pole 52. Pool & Equipment Location , ' - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' y 3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms 4. Electrical Conduit-Uhdrgrnd. 55. Electrical Bonding - . . • 5. Steel Reinforcement.,i ..r, 56. Rough Plumbing & Pressure test 6. Electrical UF ER Grnd. ; ' 57. APPROVAL TO COVER-GUNITE ' 7.,,Footings: - :'.r 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 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 y�2M-' J�?%f 65. Electrical-Final 15. Rough Electrical-Conduit / %�� 66. Solar System-Final ' 16. Rough Electric Wiring 40_543 , ketekt 67. Fencing & Access Approval .17. Rough Wiring Sign j 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL r I 19. Rough Heating& Air Conditioning4 FIRE DEPT. REQUIREMENT j 20. Rough Factory Fireplace if APPROVALS Permit# ' 11 21. Ducts, in Structure '� 70. Underground.H,ydro 22. Ducts, Ventilating 1; 71. Product Piping 0 Gas 0 Oil /_. ~ 23. Gas Pipe-Rough & Test -v.`\ j' 72. .Underground Flush l �� 24. Roof Framing - '6:;�� 73.E Undergrnd.Storage Tank 0 Gas ❑Oil i 25. Roof Sheathing may, 7.41. Overhead Hydro I 26. T-Bar Ceiling (Structural) & Monocoat :y, 75�ry Chemical ' 27. Frame and Flashing 47 8 T,d! 76. Dry Standpipe, • r 28. Lathing& Siding ///��"' 77. FIXED SYSTEM FINAL1 _ 29. Insulation 78. FIRE PREV. FINAL ' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT /1 31. Plaster Brown Coat 79. FINAL INSPECTION j' t • 32. Electrical Power Meter-Final .. //.�� el 80. FOOD CERTIFICATE IS ED - 33. Final Electric - .0 I,f t'cb Notes: (Co. c 0,1 €l 34. Final Heating& Air;Conditioning - /// II�� __` (� 35. Final Gas Pipe-Test' - 08/69 ifrncy Plccfl/ en / o,c/ 36. Hood or Canopy yi-1 RCtn ,/2 7C;tend 0/7 37. Final Factory Fireplace . • 1 / 38. Final Plumbing Sae- . -• 4',/4 ' 'eft. dr;ti4/ - 39. Water Service-Final; 40.1Gas Sr oice- ical rI ;,- `� 41. Solar Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigation , ,,. 7 , zQ f( . /. 44. Sound At IrrigationnuinSystem a rA, ,` � 45. Sound Attenuation � 9 ,c��/�jK�J� 46. Handicap Regulations • .47. FINAL STRUCTURE & BUILDING I. War. ' ,48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' ' Ji 51. CERTIFICATE OF OCCUPANCY No Date . ,. , PR0IECT ADDRESS: 277 E 17TH ST UNIT: CITY OF COSTA MESA — SIGN PERMIT PERM NO: SBE 053502 OWNER'1S NAME: DAN PERLMUT'CER r ALDRESS: 36 ,MISSION BAY DR PERMIT NO: SBE 053502 PLAN CHECK NO: 03176-91 S GOVT; N SUPP: N CORONA DEL MAR 92625 • CONSTRUCTION TYPE: PERMIT TYPE: ELE STR SIG PURPOSE: OTH ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION SQ LEGALIZE WALL CAN SIGN FT: PERMITTEE: CLAIM VALUE: 1 , 400 . 00 CALC—VALUE: 1, 400 . 00 GROUP OCC: 3-2 / ADDRESS: KENDALL SIGN COMPANY INC. ( 818) 908-0388 14811 CALVERT ST COMMENTS: LEGALIZE ILLUMINATED CAN SIGN VAN NUYS CA 91411 lE#+:1 **1•TlfiE?:***-N 7Q 7f 1:)E9E7f1El6lf it**%****** ****IE***X•X** **** Eifa **46 K 44****144i* *9(*#3F*#:E*TeX* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section SIGN INFORMATIO N 10001 of Division 3 ot the Business and Professions Code.and my license is in fou force and effect. DISTRICT: 1 TYPE: WALL 1LLUMINATI0N; INT CATEGORY: NEW CITY LIC.: 053986 STATE LIC.: 505569 z — LASS: C-45 DIMENSIONS : 2FT 06IN X 15FT 00IN AREA: 18 , i0SUFT LETTER HT: 12" ---, Date:8— I— —I 1 Signature. _ STREET FRONTAGE 1 : 206 . 00 STREET • : E 17TH ST WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sett-insure or a certificate of Workers' STREET FRONTAGE 2 : 448 . 00 STREET 2 : SANTA ANA AV Compensation Insurance.or a certified copy thereof(Section 3600.Lab.Cl. PARCEL : 42522304 'ZONE: Cl S LOCATION > FRONT: K REAR : POLICYNO.: 80502850 EXP.DATE: 02/13/92 BUSINESS NAME: DOMINO'S PIZZA > LEFT: RIGHT: COMPANY: TRANSAMERISA OTHER TOTALS GROUND SIGN Si Certified copy is hereby furnished. Certified copy is file city Building Division. THIS •ACTIVITY : 18 . 505 FT OVERALL HEIGHT: OFT OIN � '�/,� '7/�/ �� . THIS SITE 206 . 005 FT ,t GROUND CLEARANCE: OFT - 0IN -- Dale: x.)--.1. I Apulicant� ITEMS OF INFO ; 2 • PLANTER AREA: 0 , 00SQFT EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This secdoo need mit becompletedifthe permit is for one hundred(9100)or less). ITEMS FOR ACTIVITY : 2 BLDG SET BACK: 20F1 C . certify that in the performance of the work for which his permit is issued,I shall not employ any person in any manner so'as to become COPY VERBIAGE LOGO + D OM I NO e S PIZZA 4 subject to the Workers'Compensation Laws of California. Date: Signature: PLANNING NOTES: NOTICE:II.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor ****N}****************ie**ie:T*1'Tr'k*?c1t#''36i ******a ************)4ii***!F***]Eif if*),-..********),•.** Code.you must forthwith comply with such provisions or this permit shag be deemed revoked. DEVELOPMENT S' E R V I C : SR E Q U I R E M E N m•• S CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction fending agency for the performance of the work for which this permit¢issued(Section 7097,Civ.C), v ZONING APPROVED BY DATE: LENDER: ADDRESS: BUILDING APPROVED BY : • DATE: •/'%, OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED B Y: •�� - DATE•,'.'p8 Z-2-9 (Section 7031.5 Business and Professional Code: Arty city of county which requires a permit to construct,alter,improve,demolish,or ***M*******M l *se******M Cir- ., ..,. ,. ,.in-R *Lk******** it**4**r . repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed ti qLEGALIZATION; Y F E S S ', M ,M A R Y STRUCTURAL )SEGMENT:Y pursuant s the provisions tofhat tthe shisstexe' therefr m and(Chapter 9(commencing with ptitnn y vi of coni fn 3 ofti ne Business1 and Professions Code)or mat he/she 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(S500). p' -- . -4j' PLU, B ING ELECT?'IC MECHANIC SIGN SMIP/RES GRADING I, as owner of the property or my employees with wages as their sole compensation, will ao the work, and the PERMIT 66 . 00 3r 00 18 . 50 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law 5 17.1% SMIP/NON—RES does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through PLAN '2 . 9 0 '. , 50 • his or her own employees,provided that such improvements are not intended or offered for sale.If, however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve ISSUE FEE _ 1 S . 0 0 for the purposeol sale). BUILDING—DIV—> PERMIT ..., (— PLAN—CHECK TOTAL PAID DUE I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business TOTALS—---> 115 . 0 1. . 00 21 . 45 151 . 45 151 , 45 , 00 ❑ and Processions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware REVENUE DIVISION v T AL.S--' COLLECTED: 151 . 45 OVER/SHORT: 0 0 that proof onneir Worker's Compensation insurance should be provided to me. BLDG PMT PLL "3ING —.LECTR IC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK ❑ I am exempt under Section: B.a P.C. 66 . 00 45 . 00 18 . 50 . 50 21 . 4 5 for this reason: **AS**************** *Pi *************************************ie****************** Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and I N VIDUAL F E E BREAKDOWN 25534 and that for any future building occupant •IOwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the it Duality Management District.Residential construction applications are exempt from •tYP E QTY DESCRIPTIO N UNIT COST TOTAL COST these provisions. ELE 1 SIGN/ MUTLINE LIGHT SYS ON 1 BR CIRC 15 .00 15 , 00 Date: Applicant END OF FEES I hereby certify that I have mad this application and state that the above information is correct.I agree to comply with all city and County ordinances and state laws relating to building construction and hereby authori representatives of this a to enter upon the above mentioned propertyforinspection purposes. .--7-v, Date:(j=4).3 t Signaw Driver's License or Social Security': ON=3'i 00095330-00045?3�. TOT B' 1�,L 3 - 164146 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor DATE; 03/22/91 TIME; ! `' ' I 'CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # ^Date Inspector APPROVALS Permit # Date Inspector t; Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. `I 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 1' 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. • r • ` 60. Backwash Lines, P-Trap, 0 Undrgrnd. / . 10. Structural Floor System 4 61. APPROVAL TO DECK • i 11. Property Sewer Line & Hous ' onnecton 9Ci7 62. Backwash & Receptor-Final t i• 12. Sewer Cap ` ' .% 63. Heater & Vent-Final 13. Roof Drains • ;"•I .'r` 64. Plumbing System - Final /11-,• i 14. Rough Plumbing I • r; 65. Electrical-Final 15. Rough Electrical-Conduit • - - 66. Solar System-Final ` 2 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. Overhear ' . 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Ch. ical - 27. Frame and Flashing 76. Dry Srndpipe ., 28. Lathing & Siding 77. FIX r D SYSTEM FIN; L 29. Insulation 78. FI'% PREV. FINA 30. Drywall Nailing 1 ' I HEALTH EPT. REQUIREMENT 31. Plaster Brown Coat 79. F', AL INSPECT N' 32. Electrical Power Meter•Final • r FQOD CERTIFI -ATE ISSUED 33. Final Electric gel. iO, tolg: cc i.te1(i / 34. Final Heating & Air Conditionings j. 35. Final Gas Pipe-Test II 36. Hood or Canopy t 1`11 37. Final Factory Fireplace 38. Final Plumbing fI • 39. Water Service-Final II I 40. Gas Service-Final � i 41. Solar Domestic-Final I 42. Backf low Preventer . 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations I 47. FINAL STRUCTURE & BUILDING _ 48. FINAL PLANNING 49. Electric Release to Edison V 50. Gas Release to Southern California Gas Co '=• 51. CERTIFICATE OF OCCUPANCY No. Date _ _ PROJECT ADDRESS: 277 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05151E a OWNER'S NAME: DMA PROPERTIES ADDRESS: P08414 PERMIT NO: E 051516 PLAN CHECK NO: N GOVT; N SUPP: Y NB CA 92658-8414 CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ALT 720-8166 AflLNNiNGINEEfl: REG.NO.: JOB DESCRIPTION : T. I . DOMINOS PIZZA, REFER TO #851158 SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC : B-2 / ' PERMITTEe JEFFCO ELECTRIC (818 )249-9900 ADDRESS: 3716 CLIFTON PL COMMENTS: REF 851158 L E51204 MONTROSE CA 91020 *>t**IEr**** E*******************************************************X********) x3458 LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect, SETBACKS CITYLIC.: 045726 STATELIC.:494787 CLASS: C10 Date: Signature- MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensarnn4nata ted copy thereat(Section 3eoo.Lab.fj LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: VI-.'i IT EXP.DATE: tn. /01 /9 2 COMPANY' REPUBLIC PARKING REQ• PROV: PARCEL: 42522304 ZNE: REF NO: CI Certified copy is hereby lurnished. LS Certified copy is n.: • the ci ,:uiding ' inion. PLANNING NOTES> * EXte:711—O Applicant:_ * **** t ****** ************** ************** r*** ******* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: tssissiuesailrmply0 iiyhp saorohundred DEVELOPMENT SERVICES REQUIREMENTS I certify that in the penprmanp¢of the work for which(N5 p'm(is issued.I shall p employ any person n any manner so as to become subject to t a ark rrss'Compensation Laws of Califomr , ZONING APPROVED BY DATE: Date: // / Signature: J _ —NOTICE IL after making this declaration,you should come subject to the Wo •r5'Compensation provisions of the Labor BUILDING APPROVED BY : _ DATE: Code,you must forthwith comply with such provist .5 or this permit shalt be eemed revoked. ' CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construct• lending agency for the performance of the work for APPLICATION ISSUED B Y: e!��— DATE: q/ / whim lois perms is issued(Section 3097.Civ.CI. ********************** '. ' .. l:dl;i::•�• . . . **********.}iii iF**r.$+y.ic** • LENDER: *********************************I('****** ,****************?E*************'.e***t.2*** 1 ADDREss: LEGALIZATION:N EE • S MMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BL G PMT ..JMB ING ELECTRI ' MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business ape Professional Code: Arty city of county which requires a permit to construct,alter.improve,demolish,or PERMIT 18 . 50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statemen that he/she is licensed 5 0% SM I P/NON—RES • pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 01 the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). . ISSUE FEE 4 . 50 I. as owner of the property or my employees with wages as heir sole compensation, Citi do the work, antl the BUILDING-DIV-> PERMIT .. E PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 18 . 50 4 . 50 0 . 00 23 . 00 23 . 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his of her own employees,provided thatsuch improvements are not intended or offered for sale.H.however the building or REVENUE DIVISION .ALS--> COLLECTED• 23 .00 UVEB/SHORT• 00 r improvement is offs within one year of completion,the owner will have the burden of proving he/she did not build or improve for or the purpose of sale). BLDG PMT PLU ING ELECTRIC MECHANIC FIRE SMI P/TOT GRADING PLAN—CHECK I.as owner of the prepeny.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 2 j 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law),l am aware ******************** ******************y0**.**********************J(.***4;-*********. that proof of then Worker's Compensation insurance should be provided to me. I N D I V I D U A L • FEE BREAKDOWN ❑ I am exempt under Section: B.Si P.C. • for this reason: TYPE QTY DES RIPTIO N, UNIT COST TOTAL COST Date: Owner: C ELE 1 ' SERVICE., BELOW 600 V 6 BELOW 201 AMP 18 . 50 18 . 50 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any futute building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from )hese provisions. , Date: Applicant: - I hereby certify That I have read this application and state that the above information is correct.I agree to comply with all city and county • . ordinances and stale laws relating to building construction and hereby thorize rept natives of 's cit to enter upon the above-mentioned property for inspection purposes. 1 / U r/ '/ T fir.�0 I cc! r _e Date-—/ — / — J Signature: J C 01 00083827-000$3822 d_O` "- DriversLicense ofsocialSecumy+: e_ rot r/•5 r, DATE: 04/01/91 TIME: 39:42 e,.c 1641-46 White—Bmldmgl Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL & SPA - APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole " ` 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical 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 - , t 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 ❑Oil 23. Gas Pipe-Rough& Test 72. Underground Flush - 24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. rhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. D Che - t- 27. Frame and Flashing 76. ry Standpipe '�� 28. Lathing & Siding 777./FIXED SYST M FINAL, 29. Insulation Its. FIRE PRE FINAL 30. Drywall Nailing 41 ALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 179. FINAL I SPECTION 32. Electrical Power Meter-Final ` 80. FOOD CERTIFICATE ISSUED 33. Final Electric 040/9/ Notes: 34. Final Heating & Air Conditioning - Pot Oat CO " )(404 ' COOP f/N.q Leo 35. Final Gas Pipe-Test 07 �UPj 1 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 t 48. FINAL PLANNING , 49. Electric Release to Edison r 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 4 • PROJECT ADDRESS: 277 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 051204 OWNER'S NAME: DMP PROPERTIES ADDRESS: P08414 PERMIT NO: E 051204 PLAN CHECK NO: N GOVT: N SUPP: N NB CA 92658-8414 ' CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ALT 720-8166 ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : T. I . DOMINOS PIZ9ZA, REFER TO #B51158 SQ FT: ADDRESS: UNIT: PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / JEFFCO ELECTRIC ( 818 ) 249-9900 • ADDRESS: 3716 CLIFTON PL COMMENTS; T, I , DOMINOS PIZZA MONTROSE CA 91020 ***********�E�E+ESE* ******kE*******+E*+tit****>Ex***+E**** *+E***********x*it***+E**>t+E*IEEE** LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 0l the Business and Profess' ns Code.and my license is in lull force and effect / SETBACKS CITY LIC.: 04572 STATE LIC.•494787 CLASS: C10 • Date: / Signature:— _ _ MAIN BUILDING ACCESSORY BUILDING JOBBERS'C MPEN TION DECLARATION: thereby affirms (have ac dials of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN dompensation Insurance.or a certified copy thereof(Section 00.Lab.C. LEFT: FT IN RGHT: FT IN LEFT: • FT IN RGHT: FT IN POLICY ND.: PC996959 i COMPANY: REPUBLIC EXP.DATE: 01 /01 /92 �p PARKING REQ• PROV: PARCEL: 42522304 ZNE: REF NO: • 0 Certified copy is hereby furnished. Ip led copy is tiled with the city Building Division. // PLANNING NUTES> • Z�Z 14J/ App ( > . Date: Applicant: **********iE*************************-W******************************)E*********** EXEMPTION ROM W RICERS'COMPENSATION DECLARATION:2sctwmpfsedtfthepeunwiisforonehundred(5100)or less). DEVELOPMENT S E R'V I 'C•- E S REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall nal employ any person in any manner so as to become / subject to the Workers'Compensation Laws of California. ZONING APPROVED BY .'` - • DATE: Date: Signature: - NOTICE:II.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : ,, DATE Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. / / CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B .• DATE: / Ze / 1 which this permit is issued(Section 3097.Civ.C). ******************** ,. •- . ************ ****** 1 ** LENDER: ******************** ' . -************************************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'Slate License Law for the following reason BLDG. PMT 6 ,UMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT . 76. 70 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed • pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES Ind Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN . ly applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15. 00 I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT SUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 76, 70 15 . 00 0 . 00 91 . 70 91 , 70 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees. provided that sato improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS-- COLLECTED• 91 , 70 OVER/SHORT: 00 improvement is sold within one year el completionthe owner will have the burden of proving he/she did not build or improve ,for the purpose of sate). BLDG PMT PLUMBING EL CTRIC MECHANIC FI_,91 , 70 E SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business t1 . 70 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for Such protects with a contractor(s)license pursuant to the Contractors'state License Law).I am aware *************************** - *********************************fie**************** mat proof of their Worker's Compensation insurance should be provided to me. INDIVI ' U A L FEE BREAKDOWN ❑ •I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Ownef: ELE 20 FIXTURES, LIGHTING 1 ST 20 EA, I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and . 75 15. O 0 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE p. ; I .TURES LIGHTING ADDITIONAL EA, . 45 2 , 70 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE n ' OUTLET 1 ST 20 EA, . 75 7. 50 mese provisions. ELE ITCH 1 ST 20 EA. . 75 4 . 50 ELE S A 11 . 00 11 . 00 • Date: Applicant: ELE 2 MOTOR/ ' 'r APPARATUS 0 . 0 — 1 . 0 HP 3 . 00 6 . 00 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ELE B::77 / • J APPARATUS 11 — 10 .0 HP 7, 50 15 • 00 ordinances and stale laws relating to building r• , coon and hereby authorize reeppresentatives of this city to enter upon the abovee-mmeenn''dned ELE - . 'LINE LIGHT SYS ON 1 BR CIRC 15. 00 15 , 00 property Ior Insp coon p rppses. ,��L/sp onptrpCITY (LEND OF FEES Dale: �]ZO/7/ Signature: OF Sry Driver's Lice/nse or Social Security 4: 164146 White—Building;Green—Code Enforcement:Canary—Apolicant:Pink—Revenue:Goldenrod—Assessor - ' `CONSTRUCTION AND PLANN.,aG POOL & SPA ' APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or-Pole_ ,�' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd.'. -• 54. Forms • 4. Electrical Conduit'Undrgrnd. - . 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.- - - ' Z 71. Product Piping OGas DOil 23. ;Gas Pipe-Rough&'Test - - ; 72. Underground Flush r _ 24. Roof Framing T. - - 1 , : 73.r Undergrnd.StorageTank O Gas D Oil- , - 25. Roof Sheathing - '. , -. 74.'Overhead Hydro.- -? 26. T-Bar Ceiling (Structural) & Monoceat t _ , - 75.-Dry Chemical - . 27. Frame and Flashing' ,'r,1 i I _ 76. Dry Standpipe - 28. Lathing & Siding' : .�- FIXED SYSTEM FINAL; _ Y 29. Insulation r t 78..-.FIRE - , FINAL , •-, -. - 30. Drywall-Nailing EAL .E P,2T. REQUIREMENT 31. Plaster Brown Coatr •t• r79. FINAL SPECTION � 32. Electrical Power Meter-Final • I • r80.1F00DDDDD ERTIFICATE ISSUED 33.,Final Electric I `Notes; 34. -Final Heatingr& AirVConditioninj -=‘ 3/1a�97 /��1� 35. 'Final Gas Pipe-Test - �• /y - .36. Hood or'Canopy 1 • l . . Y,y . ,Icj; ,A7C - 37. Final factory Fireplace • A. i \ ( - -38. Final Plumbing . ,. - _ .39. Water Service-Final • - -r' ' ` -.40. • Gas Service-Final - , . - l - �. : • - •41. Solar Domestic-Final-_ ' _ - - 42. Backflow Preventer- •„ . - - . _ 43. Backflow Irrigation - .. - • - , .s _ 44. Landscape Irrigation System, - - s . , _ - . . - - _ - • • 45. .Sound Attenuation . . ' 46. Handicap Regulations - - . r - - - . • 47. FINAL STRUCTURE & BUILDING - 48. FINAL PLANNING . . ' 49. Electric Release to Edison • - 4 4 - ' 50. Gas Release to Southern California Gas Co .. 1 I - - . ., - 51. CERTIFICATE OF:OCCUPANCY - • No. Date PROJECT ADDRESS: 277 E 17TH ST . UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 05124E • OWNER'S NAME: DMP PROPERTIES ' ADDRESS: PO8414 PERMIT NO: M 051248. PLAN CHECK NO: N GOVT: N SUPP: N . NB CA 92658-8414 , CONSTRUCTION TYPE: V—N ' PERMIT TYPE: MEC • PURPOSE: ALT ARCH/ENGINEER: 720-8166 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : NEW KITCHEN HOOD,, REWORK AC SYSTEM ' SQ FT: • . PERMITTEE: OXNARD PLUMBING L' HEATING ( 805 ) 486-7374 CLAIM VALUE: CALL—VALUE: GROUP OCC:. B-2 / ADDRESS: ' 137 W. FIRST STREET COMMENTS: REFERENCE B51158 T. I DOMINOS PIZZA OXNARD CA 93030-0112 ********#************************* ******************************************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provision f Chapter 9(commencing with Section Z O N I N G REQUIREMENTS 70001 of Division 3 of the Business and Professions Code,and my icense is in full force effect. SETBACKS CITY u 0$'�75 g STATE LIC.:41 7 2 9 cuss: C•i y • Date?— Signature'— MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION COMPENSATION DECLARATION: I hereby affirm that I ertificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800. La . C). . LEFT: FT IN RGHT: FT 'IN • LEFT; FT IN RGHT: FT IN POLICY NO.: WCP12411—D EXP. DATE: 01 /01 /92 COMPANY: SUPERIOR f PARKING REQ: PROV: PARCEL: 42522304 ZNE: REF NO: ® Certified copy_LS_herehy furnished. ❑ Certified copy is Heti, the city Building Divi PLANNING NOTES> �dte. Applicant: / �-�ses #?E***##*lE******#it##**####*****####*# ***********###1F##**#####*it**##*##**###***)( • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This sectio need r: be completed i1 the permit is for one h dred($100)or less). DEVELO P: M E N T S E R ;V II C E S REQUIREMENTS . I certify that in the performance of the work for which this permit is issue, all not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY ' • DATE: Date: Signature: - NOTICE:It,atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY // DATE: Code.you must fonhwilh comply with such provisions or this permit shalt be deemed revoked. J // / CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for• APPLICATION ISSUED BY : (� ' •l• DATE• —L�,1/ which this permit is issued(Section 3097.Civ.C). ####*##########***######## #***##* ,*****##**** ###*##**#*####***iE�*if*#( 3f'f#t 3f#iF* LENDER: *************#******************************. ' *******#*********************** ADDRESS: • LEGALIZATION:N F E E S U. M M A R Y STRUCTURAL SEGMENT: N • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUM CTRIC MECHANIC ' . FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 31 ,00 - repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed • 25% SM I P/NON—RES 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 PLAN f S any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE ' 15 .00 I. as owner of the property or my employees with wages as their sole compensation, win do the work, and the BUILDING—DIV—> PE MIT ISSUE —CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 3 . 00 1 0 . 00 4 6 . 00 46 . 00 . 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOT --> COLLECTED; 4 6. 00 OVER/SHORT: ' improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve O 0 for the purpose of sale). BLDG PMT PLUMB G ELECTRIC MECHANIC FIRE SMIP✓TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 46.00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors•State License Law).l am aware ********************** **#***************#**********************#*****L ******** that proof of their Worker's Compensation insurance should be provided to me. IND VIDUAL FEE BREAKDOWN ❑ I am exempt under Section: . • B.&P.C. for this reason: TYPE QTY, DESCRIPTIO N UNIT COST TOTAL COST Date. • Owner: MEC 1 REPAIR/ LT COOLING UNIT/SYS W/CNTLS 9 .00 - 9 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and NEC 1 REFR I GE AT ION SYSTEM ;<= 100 K BTU/H 9 0 0 9 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a NEC • 1 INST HOOD' W/DUCTS FED l BY NEC EXHAUST 6, S 0 6 . 50 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from mese provisions. MEC 1 INST/REL AIR HANDL UNIT 0-10000 CFM 6. 50 6 . 50 o END OF FEES Dale: ' Applicant: I hereby certify that I have read this application and slate that the abo e information is correct. :tree to comply with all city and county �L ordinances and state laws relating to building construction and hereby i'horize representative r is city to enter upon the above-mentioned (�} property for inspection purpo s r— Date: /" Signature: 4/'t La `li i�� DATE:00003%OSI900081955TIhE09�4s3 '1 " .00 dir Driver's License or Social Security n: 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant: Pink—Revenue:Goldenrod—Assessor - CONSTRUCTION AND PLANNING •` POOL%A • 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 UFER Grnd. 57. APPROVAL TO COVER.GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation -e - 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-CO-nduit 66. Solar System-Final • a 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling I 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. ,Rough Factory Fireplace s. ,- - - - APPROVALS. '•=Permit# - 21.'Ducts,in Structure , 1 - • _ v -70. Underground;Hydro 22. Ducts, Ventilating - 71. Product,Piping O Gas 0 Oil 23. Gas Pipe'Rough& Test , - ; 72. Underground Flush' 24.'Roof Framing. - . - 73:'-Undergrnd.Storag&Tank 0 Gas 0 Oil • 25. Roof Sheathing ' 7 , '74. Overhead Hydro_- r 26. T-Bar Ceiling (Structural) & Monocoat - " -• 75. Dry Chemical 27.-Frame and Flashing - 28. Lathing:& Siding ?. ' 77. IP XED SYSTE Th u ' 29. Insulation - - • - - • 1 �• 78..-FIRE PREV. AL • • - • 30. Drywall Nailing HEA'' TH,DEPT^REQUIREMENT 31. Plaster Brown Coat ' _ ,-•,•, _ ,79./FINAL INSPECTION ., . 32. Electrical Power Meter-Final ' •, ,'T a 180 -FOOD CER IFICATE ISSUED 33:Final Electric- '`. rNes: f ,. . -- 34 Final Heating'& Air Conditioning - T e. at. j ' ; _ - 35. 'Final Ga_Pipe-Test- - r `_. , j z; '1 _ , .36. Hood or Canopy ' - - • > ' o - 37.-Final Factory Fireplace - \ •art - - -38. Final Plumbing . j •' . t i' j _ 39. Water Service-Finalr- ,40. Gas Service-Final : . . • , i. - _ I • , 41. Solar Domestic-Final + •• . - t -,s , - .. , r . 42. Backflow Preventer' •; ,, - - - 43. Backflow Irrigation,. i •. - - ,44. Landscape Irrigation System, •- _ 1 - I. 45. Sound Attenuation, i : - - -. ' ' ' . r - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - - . , . 48..FINAL PLANNING ' " . - 49. Electric Release to Edison v-• , 50. Gas Release to Southern California Gas Co , . ' . 51. CERTIFICATE OF OCCUPANCY -No. Date N PROJECT ADDRESS: 27.7 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 051231 OWNERS NAME: DMP PROPERTIES ADDRESS: P.O. BOX 814 PERMIT NO: P 051231 PLAN CHECK NO: • N GOVT: N SUPP: N NB CA 92658-8414 CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH ( 77.4 ) 720-8166 • ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : COMMERCIAL T. I . ( "DOMINO'S PIZZA" ) SQ FT: ADDRESS: UNIT: - PEflMITTEE. CLAIM ' VALUE; CALC—VALUE: GROUP OCC; B-2 / _ ADDRESS: ASS PLUMBING ( 213) 874-5359 14445 G. EISTA ST 12 ****+Er***il***4****vy5x8F¢**** **H*D*****+Rr*+IE*i¢�raF*�E**�E+E**�E*a¢*�F**+¢**********�¢�E***,0*** LOS ANGELES CA 90046 LICENSED CONTRACTORion3of DECLARATION:ahereby affirm ode that am licensed under provisions of Chapter 9(commencing with Section `L ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITYLIC.: 052514 STATE LIC.: 453401 CLASS: C-36 . ,Date: 3— ( - "1-I signamre7`Al2i!_2ct / ,C-L—✓4ne-- MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell•insure or a certificate of Workers. FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN CompensationInsurance.or a certified copy thereof(Section 3800.Lab.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: COMPANY: EXP.DATE: PARKING REQ: PROV: • PARCEL: 42522304 INE; REF NO: ID Certified copy is hereby furnished' 0 Certified copy is filed with the city Building Division. PLANNING N TES> > Date: Applicant: ***************************************1t*************************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($103)or less). DEVELOPMENT S E R V -1 C E S REQUIREMENTS I certify that in the performance of the work for which this permit is Issued.I shall not employ any person in in a niter so a/� o become subject to the Workers'CompensationsaLaws of California. /� ZONING APPROVED BY DATE: Date: — ` I Signature:f ��/ '� r ,• NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. � '� ,/ / • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: '• �' - I / [ /9./ which this permit is issued(Section 3037,Civ.C). ********************** • -"" ALL i�`it • ****D**** - ��7EEEjF*1F24*** LENDER: ****************** ' ** *********** - ' ******':La' ******************************** ADDRESS: LEGALIZATION:N F E E MMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING CTRIC MECHANIC FIRE SMI P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 0 • 0 0 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 pursuant to the provisions of the Contractors'Stale license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 ' SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE • 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMI ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 20. 00 3. 00 0 , 0 0 23.00 I.3 , 0 0 , 0 0 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion,the owner will have Ih¢burden 01 proving he/she did not build ar improve REVENUE DIVISION TOTALS-- COLLECTED• 23.00 OVER/SHORT• 00 forme purpose of sale). BLDG PMT PLUMBING EL•'CTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 23. 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)ticense pursuant to the Contractors State License Law). I am aware ***********.***************** , **1(.**{(.**********.**.t(.**.tp****fir.****.*.lb***,***********II * that proof of their Worker's Compensation insurance should be provided to me. INDIVID A L F E E BREAKDOWN 0 I am exempt under Section: B.8 P.C. , for this reason: TYPE QTY DESCRIPTI O N UNIT COST TOTAL COST Date: OwnerPLU 1 LAUNDRY TUB OR WASHER Ido hereby certify that I am aware of and understand the requirements of California Health and Salety Code Sections 25505,25533,and PLU 2 WASH BASIN 2. 00 4 , 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a 2, 00 4 • 00 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt Iron) PLU 1 WATER CLOSET ( TOILET) 2 . 00 2 • 00 mese provisions. PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00 PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2 . 00 Date: Applicant: PLU 1 GAS SERVICE 2 . 00 . 2 . 00 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with alt city and county PLO 1 SINKS, COMMERCIAL OR INDUSTRIAL 2 . 00 2 , 00 ordinances and state laws relating to building construction and hereby authorize representatives of this city to en r upon the above-mentioned PLU 1 SINKS, FLOOR 2 . 00 2 . 00 property for inspection purposes. • 'LU 1 SINKS, SERVICE / ,MOP 2 00 2 , 00 Z - " n"�y END OF FEES 01. 000617Y3-00081743 -10T 2, ud • Date: ' Signature: ✓j Driver's License or Soda)Security or •� . DATE: 03/01/91 TIME: 15:07 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor • CONSTRUCTION AND PLANNING POOL & SPA •APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole . , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 31 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 1 - 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.`.Frameand Flashing ,. J., Dry Standpipe - ' 28. Lathing& Siding . - r - -• 77.: SYSTEM,FINAL ' -29. Insulation - :, . . 78.-FIRE PFIV,FINAL - - :30. Drywall Nailing ` • ,G� HEALT�-I'.D PT.-REQUIREMENT 31. Plaster Brown Coat, • ,.79. FIN�f1' 'L INSPECTION - . . , •32. Electrical Power Meter Final (... 1/4_ 80. FOOD CERTIFICATE ISSUE • 33. Final Electric. ' "�" , NRtes: l'35, Final Gas Pipe-Test ' - -; 5M/1/ ., - r •1 _ 36. Hood or Canopy - - ,is. ; . 37. Final'Factory Fireplace --;l" . 38. Final Plumbing ��• - - 39. Water Service-Final 3 ' 40. Gas Service-Final ' ..i,. , " _ 41. Solar Domestic-Final . _ L - 42. Backflow Preventer_ - - 43. Backflow Irrigation t'S -" '+ - ' - .1 44. Landscape Irrigation System , . ' . _ • - r 1: 45. Sound Attenuation • . . - _ 46. Handicap Regulations - j •• 47. FINAL STRUCTURE& BUILDING - '• ' 48.•FINAL PLANNING. - 't • - 49. Electric Release to Edison i V. - } .r 50. Gas Release to Southern California Gas Co • - . • • 51. CERTIFICATE OF OCCUPANCY' : - - No. Date I J I PROJECT ADDRESS: 277 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 051158 OWNLB'S NAME: DMP PROPERTIES ADDREss: P08414 PERMIT NO: B 051158 PLAN CHECK NO:- 00262-91 L GOVT: N SUPP: N NB CA 92658-8414 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT 720-8166 ARCHIENGINEER: REG.ND.: JOB DESCRIPTION : T. I . DOMINOS PIZZA SQ FT: 1 , 436 , ADDRESS: UNIT: CLAIM VALUE: 27, 000 . 00 CALC—VALUE: 9, 965 . 84 GROUP OCC: B-2 / PERMITTEE: M.P. HAUSMAN ( 619 ) 739-8363 ADDRESS: 200 W EL MORTE PKWY 304 COMMENTS: T. I . DOMINOS PIZZA • ESCONDIDO CA 92026 aPTe�E*+ESE*�ESE�ETF*�E�E*********TE*TE**TE***Trx**************+ESE*TELE+E+E**TL+e*+E******+k*******TE**Tis LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)01 Division 3 0l the Business and Professions Code.and my license is in full force and effect, SETBACKS CITY LIC.: 052151 STATE uc.:522028 ss: B •6e: 02-2-1-9l /Sronature:` '1 / MAIN BUILDING ACCESSORY BUILDING ! l FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN 3RKERS'COMPENSATION DECLARATION: I hereby affirm that I have certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN „ompensation Insurance or a certified copy thereol(Section 3800.Lab.Cl. POLICYNO.: 1065861-90 COMPANY: STATE PARKING REQ: PROV: PARCEL:. 42522304 INE; CIS REF NO: EXP.DATE: 04/01 /91 r ❑ Cehiliedcopy ishereby furnished. Cenuiedcopy isfiled with a Build vision. PLANNING NtOSTES> INTERIOR ALTERATIONS FOR A TAKE OUT ONLY DOMINO' S PIZZA Date: 87— �i— LI Applicant' .11 /1' —� ' *********************************************************************_ R E Q U I R E M E N '********** • EXEMPTION FROM WORKERS'COMPENSATIO DECLARATION: (This section n not be completed it the permit is for one hundred($100)or leas/). DEVELOPMENT S E R,"V I C E S .T S 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. ZONING APPROVED BY W(.1,iL DATE: 247,6,(5 ‘ Date: Signature' BUILDING APPROVED BY DATE: NOTICE:If.alter making this declaration.you should become subject to the Workers' revoked. ensafWI provisions of the Labor Code.you must fonhwnh comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• .\c' I NI DATE. D114/1*** which this permit is issued(Section 3097,Civ.C). ************************************8F** ** Be * *3h**'**ah***********'***)Fit LENDER: ********************************** ******************************************* ADDRESS: LEGALIZATION:N F SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG—PMT U G ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 117. 00 repair any structure,prior to its issuance,also requires the applicant for such permit to lite a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES •nd Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 76 . 05 1 . 49 y applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($50O). ISSUE FEE w I, as owner of the property or my employees with wages as their sae compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISS PLAN—CHECK TOTAL PAID DU ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 118 . 49 0 76. 05 194 . 54 194 . 54 �Li�LJ does not apply to an owner of a property who builds ar improves thereon,and who does such work himself/herself or through his provement is solddwithin one year orovided f completion,at such rthements owner wilel have ot intended burden al proving he/she did notsale.II,however build orsue ch worREVENUE DIVISION TOTALS-- COLLECTED: 118 . 49 OVER/SHORT: 00 , for the purpose of sale). BLDG PMT PLUMBING EL CTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 117. 00 1 49 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who budds or improves thereon and who contracts for Such projects with a contractor(S)teense pursuant to the Contractors'State License Law).l am aware *************************** *********************************SF**************** that proof 01 their Worker's Compensation insurance should be provided to me. INDIVI UAL FEE BREAKDOWN ❑ I am exempt under Section: B.&P.C. for his reason: TYPE QTY DESCRIP IO N UNIT COST TOTAL COST Dale: Owner: SFC 1436 STO—INT. ALTER TYPE V—N —AVER 6 . 94 9, 965 . 84 I do hereby certify that I am aware of and understand the requirements ul California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I of any future building occupant wilVvnll not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from • mese provisions. • Date: Applicant: I hereby certify that I nave read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to balding c traction and hereby authorize re esenetives of this Qty to enter upon the above-mentioned Iproperty for inspection purposes. 01 00081377-:00081378 TOY 112.49 Date: 02-..r1 9..&—`l l Signature: w DATE: 02/26/91 TIME 10:26 Driver's License or Social Security w: 1641-46 White—Building:Green—Code EnforcemenC Canary—Applicant:Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLAN .-..G •POOL & SPA APPROVALS Permit # - Date Inspector APPROVALS Permit # Date Inspector • 1. Temporary Electrical Service or Pole,: 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd.� '-y 53. Steel Reinforcement 3: Electrical Conduit Utility-Undrgrnd: r 54. Forms ta 4.•Elebtrical Conduit:Undrgrnd. - 55. Electrical Bonding '5. Steel Reinforcement 56. Rough Plumbing & Pressure Test --6: Electrical OF ER Grnd. ••" 57. APPROVAL TO COVER-GUNITE - � T .1-127:. Footings S, t 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 `O 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric1Wiring . 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electricif-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -. - - __ - " - - - - -i' .. r.. 20.=Rough Factory Fireplace --*I 'C :, ;APPROVALSCPermit# - .r is, x C. > , ` J' J:<r" - S .. 4 - -_ - - , > - >_ , ;• r.1 + y >. .' ., -__: r 21.'buds, in-Strycture: C - -r :70. Underground Hydro 22. Ducts, Ventilaating.' I . r _ S ^ ' -71. ,,.i-1/4 QG'as ❑Oil 23.,Gas'Pipe'Rough &fest K_. ° n• - •' r _ " : . '-72. Underground Flush.. a . 24:.TRooi Framing ' i-: J r * 7> r _ X �73.'=Undergrn R Storages ank D Gas ❑011 25. Roof. . 11 t_• ' if,. ` 1/4..3-4 "' Sheathing .� I . + ' 1.. + 74;Overhead Hydro,^' 26. T-Bar Ceiling (Stctural) &'Monocoat r _ r.0 _ .. - ' 75.ypry Chemical - .. " = n% 27.-Frame and Flashin . r' ` x Y ` • ` 28. Lathing & Siding,' - ,_<w AL ' ••y tt 77, - ED SYSTEM FINAL r, S 29. Insulation y ,. r r P. Y 78., RE PR E AL . ; s, -=30. Drywall:Nailing - :: ; y HEA T`IAtEP ;REQUIREMENT 131. Plaster Brown.Coat;, . , r,. , t -` . x r4'•FINAL INS:,ECTION - ( 32.rElectricalPower Meter-Final ? I - '0.'FOOD C F�?TIFICATE ISSUED 33.`Final Electric 1 - •`• ` ° _ - c •£1 S I Notes: . c "4.: .34.;Final Heating; Alt-Conditionings :x S ^ s - -; 35;Final Gas Pipe-Test+ L.. 'z' �;'j 4. + I ".'* _ "" ,.7.i :- tr. X'. a 7:'7 s_.i r ,,36. Hood or Canopy _ ' i l'. '' . , Y. r- z .^c / * " 37.-Final Factory Fireplace. ; 77:1 L.-,.:t ` I � '_ • ' ' t. -38.�Final Plumbing a T ., w • `39.-Water Service-Final` I i ' ` '/ " + `t- r - > x _ �. n > -• A- tr. _40. Gas Service-Fjnal 1 - •- r u. I L ? �. .4. 541.Solar Domestic-Final .4 _ ( •' < a;- > - • 42. Backflow Preventer, - '� r �. x .1 43. Backflow Irrigation: -r-.' - .r _ _ rt .• 1 i7 z,a - 44. Landscape Irrigation Systemp,n;-, •r.ti b • _ . =4 v is co X •- i',-) : 5 `7 -- :45..Sound Attenuation % . , �.j ' + • 146 Handicap Regulatiops ` Y _` y '47..-FINAL STRUCTURE & BUILDING 'rfriip/( //[/� ,. �� - - ' _ ." M E- 48..FINAL PLANNING, r ,., I -L 49. Electric Release to Edison ! I It' r s . <[ - a -50.,Gas Release to Southern California Gas Co ' i I.:: ' _ o • 51. CERTIFICATE OF OCCUPANCY .ti ,- > ' • .� No. Date PROJECT ADDRESS: 277 E 17TH ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 06784i OWNER'S NAME: AYSO ADDRESS: 2333 NOTE DAME PERMIT NO: E 067842 PLAN CHECK NO; N GOVT: N SUPP: N CONSTRUCTION TYPE; PERMIT TYPE: ELE PURPOSE: OTH 557-3939 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; FIREWORK STAND ADDRESS: UNIT: SQ FT; PERMITTEE: AMBURGEY ' S ELECTRIC ( 714 ) 979-2311 CLAIM VALUE: CALC VALUE; GROUP OCC: / ADDRESS: 945 CORONADO DR COMMENTS ; FIREWORK STAND FOR "AYSO" COSTA MESA CA 92626 #***a6*+1#1r******>Fx*-x•#*##x*+e>t***#*#Ir>Farrar#>F# 1e***ak******#**#x*>t****+c***********Itx# LICENSED CONTRACTOR DECLARATION: I hereby attirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R EQU I R E M E N T S • 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. • S E T BA C K S CITY LIC.: 723 6 STATE LI : 395199 C ' . C 1 EXP : (1)/95 H1f Signature:_ _ G " ii_ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-if,or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN POLICY NO.: 1315073-94 EXP.DATE: o7/01 /95 COMPANY: STATE FUND PARKING REQ; PROV: PARCEL: 00000000 ZNE; REF NO; ' .J Certified copy is hereby furnished. D:Certified copy is file ith the ci Building Division. PLANNING NOTES> Date _ -- a-S-7 Applicant. — #**##*####*##########*##*###*##** **##*##*####**#*#**###*#**##*#####**#*#*#*##* vii•-""." EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permi r one hundred(E10O)or less). DEVELOPMENT S EllVICES REQUIREMENTS 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. ZONING APPROVED BY DATE: Date: Signature. �-Illmr NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. {/ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY : r - DATE- A ` which this permit is issued(Section 3097,Civ.Cl. ********************* **** 2*******,***** v7 *- - ********4* * 4- ** LENDER: #***********#***************44"'" "-*********3tQ`***#****#**********####*##*a : **** ADDRESS: LEGALIZATION:N F E 'E . S U M M A R Y STRUCTURAL SEGMENT: N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG rMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7 :50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 50% SMIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN - any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE 15 . 00 I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> IL•RM '" ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTAL S----> - . J0 15 . 00 0 , 00 22 . 50 22 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TO 'ALS--> COLLECTED: 22 . 50 OVER/SHORT: .00 lor the purpose of sale). BLDG PMT PLUMi ING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 22 . 50 • , ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projectswith a contractor(s)license pursuant to the Contractors'State License Law). I am aware *****#*************.*.# **.**.*.**.***.#.K.K..*#***,****,*,***,**,*#*#**#************ae*****#*** that proof of their Worker's Compensation insurance should be provided to me. _ ❑ I am exempt under Section: B.&P.C. I N D V I D U A L F E E B R E A K D O W N tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: ELE 1 FIREWORKS STANDS I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and x EA, 7, 5 0 7 . 50 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a 7 . 50 ND OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Dale: Applicant: x 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 stale laws relating to building construction an in icor enrelives of this city to enter upon the above-mentioned .. property for inspection purposes. (\/.(1^(��il ,_-ace---�>7-5 01 E 06/30/9416 TIME TOT522.50 Signature: DATE: 06/30/94 TIME: 15:45 Driver's License or Social Security a: ' 1641.46 While—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING I POOL & SPA APPROVALS Permit# - pate 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 Dr mical 27. Frame and Flashing 7 Dry Stand)* 28. Lathing& Siding . FIXED SY fEM 29. Insulation 8. FIRE PR . FINAL 30. Drywall Nailing EALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINA NSPECT4ON 32. Electrical Power Meter-Final • - 80. FOO CERTIFICATE ISSUED 1#I 33. Final Electric •l ' • Notes: tpok pej - rah "` �� p�p 34. Final Heating & Air Conditioning t N �'ti. 35. Final Gas Pipe-Test 36. Hood or Canopy r• , 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 - .