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Home My WebLink About296 17TH ST - Building Permits CITY OF COSTA MESA o Art BUILDING DIVISION t77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754.5626 PERMIT NUMBER: E10-00126 PERMIT TYPE ELEC STATUS: ISSUED APN: 42546101 DATE ISSUED: 06/15/2010 ISSUED BY: BJZ JOB ADDRESS: 296 E 17TH ST CM Suite/Unit: Vicinity: SCOPE OF WORK: FIREWORKS STAND JULY 2010-COSTA MESA POP WARNER OWNER: HENDERSON,GEORGE D TR Address: %WOHL 17TH STR LLC Unit:IRVINE,CA PHONE: 949.955.0115 City/State/Zip: 2402 MICHELSON STE 170 APPLICANT: MATTHEWS,KEN A Address: 555 N. GILBERT STREET Unit: PHONE: 714.738-1002 X149 City/State/zZip: FULLERTON,CA CONTRACTOR: K C ELECTRIC License No. 699521 Address: 6509 GLORYW HITEUnit: PHONE: 562-867-4447 City/State: LAKEWOOD,CA ZipCode: 90713 CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $34.50 Reinspection Fee $0.00 TOTAL FEES $34.50 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/ INSPECTION TYPE EAU INImALS CODES INSPECTION TYPE DJTF INTTALj 1616 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 4-/dat al 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval _ 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑No I hereby affirm under penally 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. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,a demolition Carrier: or dismantling thereof,will be more than thirty-sa(36)feet high.(Chap.3.2,Grp (The seam neednot te completed the penal is valued at are hundred deters(51W)a'less) 2,Ant Sec.341.Title B,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would CE- I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor ,I shall forthwith comply with ese provisions. l /l 27 b-f74-/v Division of Industrial Safety Permit Number: rs C6 Applicant's Signature X10 HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CML 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? 0 Yes 0 No Lic.# 6 9 9.12-/ Class# e--teP (Section 25533 of the California Health and Safety Code, with some �-� exceptions, requires registration with the Costa Mesa Fire Department by / "WE, 7i 4 -/7 '-/U each business which at any one time has on hand a quantity of acutely Contractor'sSwre Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a constmction«Igndi agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work fa which this permit is issued.(Sec. 97,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: 'b.-a - q. hazardous materials)? ❑Yes ❑No ~ , y (Section 25534 of the California Health and Safety Code provides that the Lender's Address: �., r Costa Mesa Fire Department may require the preparation, certification and "y.., filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature 1 Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: f 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 repairppfany structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such pgpnit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. 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 Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑ No 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 8. (If"yes",attach certificate of compliance from the appropriate air pollution sale. If. however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ 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 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 penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building author�egd by this permit until final inspection. 2 �E/ lL 7��d ignature•(Legal �Owner ) ate Signature Dare .__.' I ! i'/•.n7 6 It-id 3057A6(ern]) AndltAu hOnxed Applicant Date CITY OF COSTA MESA *401 FS BUILDING DIVISION FtAI 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us tlica FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER: BC10-00520 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: COM ALT DATE ISSUED: 02/11/2011 ISSUED BY: RMD JOB ADDRESS: 296 E 17TH ST CM Suite/Unit: APN: 42546101 Zoning: , , Vicinity: Primary Occ: Const Type: V-B • SQ. FT: 0 Valuation: $40,000.00 SCOPE OF WORK: TENANT IMPROVEMENT FOR"MI CASA". SCOPE OF WORK TO INCLUDE: REMODEL OF THE BAR AREA. 4 PANEL CIRCUITS 10 LIGHTS 12 OUTLETS 2 SWITCHES 1 COMMUNICATION DROP 1 DISHWASHER 2 BAR SINKS 4 FLOOR SINKS OWNER: HENDERSON,GEORGE D TR Address: %WOHL 17TH STR LLC Unit: IRVINE,CA Phone: 949.955.0115 City/State/Zip: 2402 MICHELSON STE 170 APPLICANT: JIM BROWN Address: Unit: : Phone: 714-651-3553 City/State/zZip: CONTRACTOR: JIM BROWN BUILDER License No. 648483 Phone: 714-537-5459 Address: 9751 RUSSELL AVEUnit: Cell: City/State: GARDEN GROVE, CA Zi Code 92844 ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: • COMBINATION PERMIT FEE SUMMARY Building Plan Check: $353.11 Building Fees: $543.25 /- Electrical Electrical Fees: $56.50 .� Mechanical Fees: $0.00 Plumbing Fees: $92.10 r SMIP Residential: $0.00 SMIP Commercial: $8.40 Bldg Std Admin Fund $2.00 TOTAL FEES: $1,055.36 **Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays: New Years Day, Memorial Day,Independence Day,Labor Day,Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODES. INSPECTIONITYE DATE IN1111ALS CODE; INSPECTION TYPE DATE INTIMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing )( a-/4-1 I ot9 200 Final Re-Roof 210 Final Electrical )( $—I5-11 /3r✓ Lr i ;A_O- 201 Final BIocldRetaining Wall 212 Final Fire Prevention --"'�- 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Sitenq r 204 Final Demolition 250 Final Building/Occupancy . "/ " /Sdy Y'a2 WORKERS'COMPENSATION DECLARATION Owner ID verified by drive, _.,cense. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ 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. ' ❑ I have and will maintain workers'compensation insurance,as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffdding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (Thisserlan need not be completed time pent is vatted at onenundred dolars woo or less.) 2,Arta Sec.341,Title 8,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ❑_certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicants Signature Date the Labor Code,I shall forthwith comply with these provisions. a_b_II Division of Industrial Safety Permit Number: o•-; nt's 'SIgnature Date 1.-1 HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: W• ING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑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. �77 a registration form for acutely hazardous materials? 0 Yes 0 No Lict 9'R y,?3 /dWss# f� (Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by Z-/(-I each business which at any one time has on hand a quantity of acutely Comtraq«signature Date hazardous materials equal to or greater than a weight of 500 pounds. or a C----- �— volume of 55 gallons, or 200 cubic feet of compressed gas at standard CO STRUCTION LENDINGad~GENCY:;-- temperature and pressure). ❑ I hereby affirm that there is a-construct= 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's'tssued..(Sec.p97,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: ,y hazardous materials)? 0 Yes 0 No sc (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 IJ to register acutely hazardous materials with the Fire Department. Signature )1 Date 1 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: 'I Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that 11'm 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 ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ 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 Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No (hereon,and who does such work himself or herself or through his or her own B. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ 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 Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. sl nature of Legal Owner(s) Date Signature Date 3057-46(omi) _..---g._...------- Z—_1.1=61- -• Ica Authorized Apollrant Date------ CITY OF COSTA MESA ocisiifs q BUILDING DIVISION :44411‘11 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 ^ ^ PERMIT NUMBER: E11-00119 • PERMIT TYPE ELEC STATUS: ISSUED APN: 42546101 DATE ISSUED: 06/17/2011 ISSUED BY: RMD JOB ADDRESS: v296TEZ17TH ST CM \ Suite/Unit: vicinity: SCOPE OF WORK: ELECTRICAL PERMIT FOR 2011 FIREWORKS STAND-COSTA MESA POP WARNER. OWNER: HENDERSON,GEORGE D TR Address: %WOHL 17TH STR LLC Unit:IRVINE, CA PHONE: 949.955.0115 City/State/Zip: 2402 MICHELSON STE 170 APPLICANT: LIRA, LAURA Address: Unit: PHONE: 714-738-1002 XT 141 City/Slate/zZip: CONTRACTOR: K C ELECTRIC License No. 699521 Address: 4440 CHARLEMAGNE AVEUnit: PHONE: 562-421-2706 City/State: LONG BEACH, CA ZipCode: 90808 CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $34.50 Reinspection Fee $0.00 TOTAL FEES $34.50 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 O. INSPECTION TYPE GATE INTMALS CODED INSPECTION TYPE DATE INTIIIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing / �ypq� ,y/) 200 Final Re-Roof 210 Final Electrical x L9- 2 c1 -I f y"" -'-" • 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver..,ifiiense. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: . Driver's License No. Expires: ❑ 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. . ❑ 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 ❑ I hereby certify that no excavation five(5)or more feel in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (Thrsseam need not be completed t the permita valued at one hundred dollars($1 W)or less) 2,Art 2.Sec.341,The 8,California Administrative Code). Policy Number: / ❑ As owner-builder, I will not employ anyone to do work which would Q I certify that in the performance of the work for which [his permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor de,I s all forthwith comply with these provisions. ' ns. L Applicant's Signature Date V U' , l{'•I �I 1 I Division of Industrial Safety Permit Number: Apdta Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# �p g 52 Class# /D (Section 25533 of the California Health and Safety Code, with some il 1/1"----- Contractors, / It Imo]_, ', exceptions, requires registration with the Costa Mesa Fire Department by '] each business which at any one time has on hand a quantity of acutely contract ', nature •`�•.: Date hazardous materials equal to or greater than a weight of 500 pounds, or a +y volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: ....?�. P temperature and pressure). ❑ 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 -1-..-t)..., 3 (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 hi filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.• Signature I/ Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: J Health and Safety Code been fully complied with? ❑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 followi0g 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 Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). O 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 • sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ 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 Sgnawre Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Jignature of Le I ef(s) Dale ) Signature Date VAN-/ li ' I ' I 3057-46(3/07) no/or Authonzee pr9iWnt Date ' 'F CITY OF COSTA MESA BUILDING DIVISION Y .l r•„r. 4. : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER -n-_ I ;t PERMIT J ittiomm.rnoeo P01-00371 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 296 E 17TH ST Status: ISSUED Suite No Applied: 06/19/2001 Issued: 06/19/2001 Vicinity: Parcel Nunmber: 42546101 ' ISSUED BY: Applicant: CLEAVINGER,LUPE , Address: 2085 PLACENTIA AV - STE 4 Phone: (949)631-3344 COSTA MESA,CA Zip: 92627 Owner: HENDERSON, GEORGE D TR Address %KIRKPATRICK 8 444 W OCEAN BLVD# Phone: KIRKPATRICK Zip: 90802 Contractor: MICHAEL RAY CLEAVINGER Address: 2085 PLACENTIA AV STE 4 Phone: (949)631-3344 COSTA MESA,CA Zip: 92627 License: 594924 Arch/ Eng: •- . - - Address: Phone: -'` --Zip:, - - , License: - i SCOPE OF PERMIT ' REPLACE EXIST.WATER HEATER AT THE SAME LOCATION. FEE SUMMARY' - AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 .'Laundry Tub/Washer ' $0.00 0 ' Sump Pump $0.00 0 Backflow irrigation $0.00. 0 . ,Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer '. ' $0.00 - ' 0 - . `P-Trap $0.00 0 - .- -Trap Primer-, , $0.00 0 Bathtub $0.00. 0, . ' -Pressure Regulator . $0.00 0- - -' Urinal $0.00 0 Clarifier System ' $0.00 0 . . -Process Piping(per 10 ft) $0.00 0 _ . /'Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 - 0 Receptors $0.00 0 '`Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 . Wash Basin' $0.00 0 Dishwasher $0.00 0 ' Sewer Cap for Demo '$0.00 0 -Wash Basin Set $0.00 0 Drain,Floor $0.00 0 - Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 . 0' Sewer Private Line $0.00 0 1 'Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 , Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial - $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) WORKERS'COMPENSATION DECLARATION: a. .S" r I hereby affirm under penalty of perjury.one of the following declarations: _ ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. kXY�.., 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 wcy(dkers'copnpensa' n Insurance carnecand policynumber are: / Carrier: Jr:eite. —Dp�_�'`�' uL7 Policy Number 0zl�-'Q663Z/61-1 (This section need not be completed 0 the permit is valued at one hundred dollars($100)or less.) O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cal •mia and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the bor Code,I shall forthwith comply with these•rovv Applicant Signature, /.CDate:-- WARNING FNLURE TO SECURE WORKERS'.. TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRINJNAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THro IWID DOLLARE(S1C0,000),IN ADDfON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: Thereby affirm that I am licensed under•r• ions of hapter 9(commencing with Section 7000)of Division 3 01 the Business and Prole ns Code,and my licens,eJs in full force and elle ct.u a 7 2- Class CS /Z c-/.0C2&Ay/C C./6 Contractor's Signature: _ - —Dater--• /� / 9/6 / CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name:a • Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my einplbyees 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 Cale:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia 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 lime during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Di Yes lU No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? D Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner G`/( 9/6V /1 Or Authorized Applicant Date ,ODE r INSPECTION TYPE PATE MitLS CODE INSPECTIONTYPF GATE JNTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /n'9ø'-©t EJ rt. 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy - .- .. . --,. -----;....-T , CITY OF COSTA MESA , t . , . 4 BUILDING DIVISION 1 ) • tilaq41Prrl DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER . 1(. tir.nlit . ;II I PERMIT • t 111" 41 S3/4Thaa'arso 6. i7 P01-00126 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 296 E 17TH ST Status: ISSUED , Suite No Applied: 03/0812001 Issued: 03/08/2001 Vicinity: MI CASA MEXICAN RESTAURANT ISSUED BY: Parcel Nunmber: 42546101 , , Applicant: APPELL, JOHANN , , Address: 2085 PLACENTIA AV#4 . . STE 4 ,' ,, ' , Phone: (949)631-3344 COS/TA-MESA,CA , .' _ Zip: 92627 , , . " \-. A . \ . . /, /// 'H , Own \ er: ' HENDERSON; GEORGE D TR 7 . . 0 ,, , Addrass %KIRKPATRICK 8H,- / „ -. , , 444 W OCE, ' /,‘N BLVD# Phone: - ., ..\. , . , ' - KIRKF'ATHICK Zip: 90802 ' ; , , !,, „„, ,, . , . . , , , - ' . Contractor: MICHAEL RAY CLEAVINGER - ,, ' ..' . - ', ,, k. \ Address: 2085 PLACENTIA AV#4 , STE 4 Phone: (949)631-3344 N. ,\ • ., ,COSTA MESA,CA, Zip: 92627 , ' , , . . . ' • '),- , License: 594924 . . I. . . ,. • , . , ' '\ Arch / Eng:„ , .. . HF ‘ Address: , , Phone: . \ \ , , ';, , 1 \‘, ' . _ ., Zip: _ „ _ --. 1r , ; , . - i ,‘- , License: ' t -(2,'I - 1 ; I ; ----ly /2; i SCOPE OF PERMIT , . 75/7/ C --, //, \ V\ \ H INSTALLATION OF 1 SEWER CLEAN-OUT FOR"MI CASA MEXICAN RESTAURANT." 7../7 r' , ---, ; ,,%-1 \\-- ' 1 PLUMBING FIXTURE .- . . *, . , , :\ c..,\\ \ ..,,,,,j \.\ .-. I .' /1,17/ `,..., / ,f'y 1. \\ , 1/4 • . 'i h ‘ \\ , .1 • 'FEE SUMMARY ..:,- ., ,- . -2/ Y/ fi ,,,, „---,..2-/- , \ On ISSUE FEE \\':--.\\•. $23.50, \ '\\•-.' - Laundry Tub/Washer ' ,-$600 0 - ump Pump ..\ it \._ ..0„. .SN , Backflow irrigation.\-'..\\06.00 Jr; 0--,,,-.:-<S\.,,,Landscape Irrigation , ; $0.06 0 , --_,;-..00'S‘vimming Pool', ,,,0 $600 0 Backflow Preventer\ .., $0:004' 0, '-:::::,••"-..: P7..TEep '-' , $0.00 0- .''.•;;.\,--5,;--- TraPiPrimeK/ /0 $0.00 0 Bathtub \'...-:.-.0:\,$0.00 / /03 - -;Preasure Regulator, ' $0.00 ''.0-c"; (lineal-2y 7 71 $0.00 0 Clarifier System •\\\-$0.00\...,•:-:..0 ,c-:---- , . Prciceis Piping(per'10 ft) .$0.00 0 ' \\Vacirvin Brkr,Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) \,.$0.00., '"0,-. , --Receptors $0.00 0 • \ \\Vacuum Brio Bkflow(5+) $0.00 0 Dental Units $0.00, '\. -....6 '-- ,\,00 Septic Tank - _. -,$0.00 -.10 ' \ \ "Wash Bain-" $0.00 0 ..,„ Dishwasher $0.00. ...tri-,..., '..:Sewer Cap for Demo ' .$000 - 0 0/ Wish Basin Set $0.00 0 Drain,Floor $0.00 "--0- c:::--.:;---.. Sewer Connect . \ . $0.00, ,_-0- _---iy.Waste and Vent System 50.00 0 Dalin,Rainwater $0.00 0------ - - Sewer Private Line\ $6.00 .0: , \--;', Water Closet(Toilet) $0.00 0 . Drain,Roof $0.00 0 --- - ,Shower, , $0.00, "0 ' -- Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink;bar- - $0.00- 0 Water Piping OW or Rep.) $0.00 0 .. _ Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $9.80 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 • Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) 50.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 • TOTAL CALCULATED FEES: $33.30 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shill 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%%thin 180 days,or It work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(SFOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the / work for which this permit is issued. ® I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed lithe permit is valued at one hundred dollars(5100)or less.) ❑ I certify that In the performance of the work for which this permit Is issued,I shell not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree t f should become subject to the workers'compensation provisions of Section/37 of the Labor Code,I shall forthwith comply with these Dn • io•_ Applicant Signature: _, _ Date: j(f WARNING:FAILURE TO r;CE •- ERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOIIARE 00,4.0),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.ft Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code). Lenders Name: Lenders Address: Signature: • Date: OWNER-BUILDER DECLARATIONS: -/ I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ) ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..� .t_. l_..._._ 3 Does or will the applicant Program or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the Sonic 6:43i;ii Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION,OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) sate And/Or Authorized Applicant Data COOP I. INSPECTION TYPE PATE' INimA45 900EE INSPECTION TYPE PATE 9517111645 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical JJ 1288 Pool /�Spa Final 208 Final Plumbing L3' g.-C)( lop/ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy T ADDRESS OFBUIDWO 296 E 17TH ST MT: CITY OF COSTA MESA — BUILDING PERMIT OWNERS/LIME IF MORN BARRY MOORELUND PERM NO: M 079596 ' ADDRESS 296 E 17TH ST COSTA MESA,CA 92627 — S PERMIT NO: M 079596 PLAN CHECK NO: N GOVT: N SUPP: N 6457626 ARK.MARINO ADDRESS; CONSTRUCTION TYPE: I FR SP PERMIT TYPE: MEC PURPOSE: OTH ARCHITECT OR FIGNER: sic No_ JOB DESCRIPTION : REPLACE F.A.0 SQ FT : ARM OR EMI ADDRESS: WIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B / coxmAc7GTSNMt CLEAVINGER MICHAEL R ( 714 ) 631-3344 COMPACTORSMNUNG 2085 PLACENTIA AV COMMENTS: X ADOREss: COSTA MESA CA utim 594924 **+E** **BE*AEiSBE*SE**«****AEBE*SEiE*BEBEiEi ***AE*xxBE***iEBEBE**x****+E*BE BEBEBE**BE*******x** 92627-3470 WET: 4 Z ON I NG R EQU I R EM LICENSED CONTRACTORS DECLARATION:I hereby elfin wide(peal,of perjury that I am licensed under provisions of Chapter 9 S E T B A C K S (commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is n hill forte and seed. c uC.NO.: 5206 uc.cuss: C 10 uC.NO.: 594 24 E P• 12/96 MAIN BUILDING — ACCESSORY BUILDING C� 7 ^ FRNT: FT IN REAR: FT IN FR T: FT IN REAR: FT IN I �J rp Contractor: h� LEFT: FT IN RGHT: FT IN LE' FT IN RGHT: FT IN BB BUILDER DECLARATION:I hereby affirm under penalty d .1 that I a exempt from the Contractors license Law for the won(Section 7031.5 Business and Professions Coda:Any ay or oa,my wtuel'spokes a permit to ooreoud,alter,reprove, PARKING R E PROV: PARCEL: 00011000 Z NE: F NO: div wretrsmryaWdune.—totsoanca.aborama"'h°eppfwdtdwchpemdltohleasigned nmemsed*"Gate PLANNING NOTES> is h. .I pursuant In the provisions d IM Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 d the Business and Professions Code]or that he or she is exempt therefrom end the best for the alleged exemption.My vitiation of Sedan > 7031.5 by any applicant for apermt subjectslhe applicant toecivil penally offal more than five hundred dts POO. ************************************{E********* . * ************************** 0 I,as owner of the pmneny or my employees with wages as their BON wmpetnatian,wii do the mit and the structure is lcl intended DEVELOPMENT S E R,..V I C E S • E Q U I R E M E N T S or offered for sale(Section 704A.Business end Professions Code:The Contractors License Law does not appy to en owner of properly 1who budder or improves thereon.and who does such work himself or hersel or through his cr her own employees.provided that arch I.� pav hnermeraas are rut intended offered alor sale.If.however,the building inp'wm eenlls sol m : within one yew of co :tali"the ZONING APPROVED BY1 - DATE: owner-builder will have the burden of proving he or she did not build w improve for purpose the p rpe of sale). • ❑ I.°'owner alheprope"y,emexclusively contracting whhbc.".dcontractors bconm"°the°'°j.°(Radian 7°".Business and BUILDING APPROVED BY : — DATE: Professions Coda:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who contracts for vin projects with a mmnctor(a)licensed pursuant to the Cattr°dps License Law). Iamexemptunder SectioB.AP.C.,forthsreason: APPLICATION ISSUED BY: i Eln: ********************** ':d /t ****D***Q* Dale: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL EG ENT:N Ido hereby candy Nathan em aware of end understand the requirements of Caliomie Health and Safety Code Sections 25.505,25533,end 255' apemmamreNal lwctinormdifrafan�lmn°IMAive11/MMaegel no cbo'nlneadtocanpywiheeidwata°odmand the renexsgwmneblw BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING Quaky Management District)neeResidential condadionle codas ars exempt horn Nese provisions PERMIT 16 . 25 nt: Date: Applica _ i 2 5% SMIP/NON—RES PLAN 22 . 00 WORKER'S COMpENSATON DECLARATION:[hereby affirm under Pen* paRury one d the following dedatb atne: ISSUE FEE rt ❑ Ihave and wilmaintain acertificate dooneanttoself-insure for workers'companuton.aspovdedforbySemon3700ofthLabor iBUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code,for the performancedn.worklpwNahmep«mB .w ed. TOTALS-- —> 16 . 25 22 a 00 0 .00 38 . 25 38 . 25 . 00 I have and wit maiman waduers'compensation insurance.ere required by Section 3700 d to Labor Cods.for the performance of the wk for Mesh Nb permit is issued.My worhers'compensation insurance ceder and poky number we: AE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 38 . 25 OVER/SHORT: . 00 Carrier 046—TEU0003G12f 01 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN— HECK - •' section need not be completed I the petrol is for one hundred ddfan)51001 or less.) 38 . 25 I,. • I certify that in the performance of the work for which Ihs permit is issued.I Nall rid employ any person In any manner so as to LawsoCaldpmla. endogeeNov BIshould becoonesub*"totheworkers' ******************************************************************************* Sbecornesutnthewoaerss IcompmQaaf provisions 1im/Section 3700 of the Labor Code. ehshallfon [q�*Rh oam with those pmwir.. r1 ///�lfldI N D I V I D U AL' F E E BREAKDOWN \ I2 0 / l l.1(o Applicant ` U/�"1 a ' a "1.A : Mor:Feats rosecure workers'compensation coverage la un ro / Mal pw employer dbre'nsl penalties d TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST civil fines up to one hundred thousand dellen P100,000),In addNbn the cos of CcnwwnstIo4 damages as provided for In Seas 37115 of Na Labor codh lntenest and ertemryYfesa MEC 1 INST FORC—AIR/GRAV FURN > 100 K BTU 16 . 25 16 . 25 CONSTRUCTION LENDING AGENCY: I hereby alarm under penny O perjury that there is a coretnwion lending agency for the END OF FEES performance of the work for which this permd is issued(Section 3097.Cir.C). LENDER'S NAME: f a LENDER'S ADDRESS: 'a\ I certify that I have read this application and state ghat the above it/emotion is coned.I agree to comply with all sty and county ordiwses and state Law relating to building conamwion end hereby authorize representatives of this oily banter upon the above-Mentioned properly for inspection purposes. JENIFER KELDER �� /� 01 00215374-00215374 TOT 33.25 - � • as / I%h /A Date: 9-2 0-9(0 -. DATE: 09/20/95 TIME: 13:39 spnew .downer.. .. r (515I-46.WP) White-uildng. palely Green-Rb;Canay-AppF'eN:Pink-Revenue;Goldenrod-Assessor T -, . CONSTRUCTION AND PLANNING - POOL& SPA - APPROVALS Permit# Date Inspector . APPROVALS' ` mit #' j Inspector - 1. Temporary Electrical Service or Pole 52. Pool & Equipment'Location I - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 1 - w3:Electrical Condujt Utility-Unrlrgrnd. 54. Forms - `7:4._e lectrical Conduit--Undrgrnd 55. Electrical Bonding _ ' _5. ,Steel Reinforcement_ 56. Rough Plumbing & Pressure test �7. ;Electrical UF ER Gr itl. 57. APPROVAL TO COVER•GUNITE - 7. Footings r, 58. Electrical Conduit-Undrgrnd. r t 8:`foundation F.1- -• 59. Gas Pipe, 0 U�'tiirgrnd.,Test I- ' 9. Water Pipe-Undcgrnd.m 60. Backwash Lines, P_•Trap, 0 Undrgrnd. 10. Structural Floocj3ystdTm 1 61. APPROVAL TO DECK 11.Property Sewer-tine &&House Connection 62. Backwash & Receptor-Final I ' , 12. Sewer Cap = 63. Heater& Vent-Final L- _ • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electric2l;Coliduit - 66. Solar System-Final i 16. Rough Electric Wiring 67. Fencing & AccessApproval 17. Rough Wiring Sign "" 68: APPROVED FQR.PLASTERING 18. Rough Electrical-T Bar Ceiling 69e. . POOL/SPA SYSTvs>EMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20,$ot h F',actory Fireplace o - �' r --A-E _ _ 9 n, _ _ > APP,ROVECL�(1 Petmit # 21.loucts,in-Str(ittu[GI ' `-' r^,S c y ,...7 T. " 70..UUn27ElgrWhd 6tydro 'r' 22"rDuc{s, Ventilating.- r S •4 S <4: 71, ProduttYipingtrGas E)Oil r 23. Gas Pipe•Roygh &'Fest ec �'•' �' 72. Unde'r' round FI'ush " 24._Root-Framing. 4-4-4 C t 'K = 73" Undergdrd,Storage Tank 0 Gas 0-Oil 25. Roof Sheathing £ •c m G .`) 74 Overhead Hyd qE 4. J C / X rJ i:X t,: 26.:TT-B4` Ceiling (Structural) &-Monocoat - M n `1 s. __ ?7> 7,9. Dry Chemical r _ �_ 27.AFrame and Flashings ,��x �: c^ ^ m 76- Dry Staii•aiipe,°r' • r`' 28, -Lathin & Siding * r`m" x r ` - `� -i (. 9_ + � "Jr?, _ . 73'. FIXEDSYSTEM:FINAt 29. Insulation * C j4 .• •• > 'r M 743. FIRE PREY. FINAL k ; -.- fc . f' ' 30. DrywalltNailing 0 . s + ."i .MALT-H DEP:T..REQUIREMENT 31, Plaster Brown)Coatt ,-, IM_, * { ,* T 74, FINALjINSPECTiON n p- t' _, 32.cElectricalPower Meter,Final ' .* ,ri tr. up-. FOOD CERTIFICATE ISSUE DI e 33.=Fina1'Eleciri x _ I Kr a ., 1 i ni: rr l "otes:m�-atnot��tF�_FU1 J- - 1^ OK (�•/_ 17 a 34,rFinHeating* Air„Cor�t,+ition`ag: - c3;.%2-1,014 Q nln. _s-er _ 35.rinal Gas Pipe-Testi t t ill �' ^ '..41:_;:'..41:_;:_ _ 36.'HooSl or Canopy _ * /� ' ' ,, J � 0 : r fa i 7 n.^. lr 37,tinat Factory Fireplace_ _ a z 1 i 'f' 7 • sT * -• .1, 38. Finat•Plumbing co I _ ,,g ti T _. - 39. Water Service-Final i ' fj , c lit ' it; ,•i,_a, yt-: �• 40. Gas Service-Final ` t. F"{' • ' 'Tr r Q r..•• g i< p� I OW :..<C.: r - 41. Solar Domestic-Final v/ Jr a I I 4. <_,; ,-, St 'r 1 I I i - ,. ,n.: -t^ x L= , . -' 42.--Backflow Preventers _, 7 � '- I -'� x - .1r A _ 43. Backflow Irrigation•' -5.. ii * - =. 44. Landscape Ir,;igatio System, -�, x n •-• Cx c cJ a r- • pt_ t� c r { - _ .t, _ - �35, _Sound Attenuation -,xr Pp" . F F* - c-w r --� -i; - M m ^tt f- G' _n 4^ . :--4 rl 46":Handicap'Regulatios 7 r "y w k r rJ 47.-FINAL STRUCTURE & BUFEDING ' �;: - r. -" 9 - ' 7 F. ' L_48,"FINAL PLANNING" , I ¢ 49.'tlectiic Release to Edison I - j flat = - •- •f-. r l -50. .Gas Release to Southern California Gas Co ,by ti r =' - 51. CERTIFICATE OF OCCUPANCY //';t- v _ ee No Date • t fl0.1ECT ADDRESS: 296 E 17TH ST ' UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 066820 OWNEWSNAME: GEORGE E. HOEDINGHAUS ADDRESS: 250 E 17THC .M. 9 STT27 PERMIT NO: B 066820 PLAN CHECK NO: N GOVT; N SUPP : N ' • CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : MINOR WALL REPAIR SQ FT: 5, 375 ADDRESS: UNIT: CLAIM VALUE: 5, 375 . 00 CALL—VALUE: 5, 375 . 00 GROUP OCC : B-2 / PERMITTEE: THE VAIL COMPANY (714 ) 498-2667 ADDRESS: 10057 CALLE RECODO COMMENTS: MINOR WALL REPAIR DUE TO CAR ACCIDENT SAN CLEMENTE CA 92673 *******************************************$************w* . • ***;'6***+¢********* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREME 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. SETBACKS CITY LIC.: STATE LIC.:29 C Ss: rt S mat u Q� signature: MAIN BUILDING ACCESSORY BUILDING I°l —1=�-4—� + FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN ORNERS'COMPENSATION DE RATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT; FT T: FT IN Compensation ist Q4 icgniliedc4py thereof(Section 3800,Lab.8.4 /01 /95 POLICY NO.: 6 7 EXP.DATE: COMPANY. STATE FUND PARKING REQ: PROV; PARCEL; 00000000 • • " . REF NO; 0 Certified copy is hereby furnished. ,.y;( LJ Certified u• it with a city %r On! -on. PLANNING NOTES> D ! le-91 Applicant: • .ii A *************************************************** ** ****************** ******* rPyItha FROM WORKERS'COMPENSATION DECLARATION: (This sssiue s be completed in the permitam one hundred less). DEVELOPMENT ' SERVICES RQUIREMENTS certify that in the performance of the work for which thi permiis issued.IShaft 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: BUILDING APPROVED BY • NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor 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 Y: DATE: Whin this permit is issued(Section 3097.Civ.C). {�* LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING 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 81 . 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 SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of 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 1 , 1 3 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sale compensation, will do the work, antl the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DU ❑ structure is not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 82 . 13 0 , 0 0 0 . 00 8 2 , 1 3 82 . 13 , 0 0 L 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. N.however the building or REVENUE DIVISION TOTALS--> COLLECTED: 8 . 1 OVER/SHORT! 00 for the purpose of sale(is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FI E S IP/TOT GRADING PLAN—CHECK for 81 . 00 1 . 13 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ 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'Slate License Law).I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFC 5375 ALTER BY VALUE COMMERCIAL NOZONE 1 .00 5, 375 . 00 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 future 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 these provisions. Dale: Applicant: I hereby certify that I have read this application and state tha�dL, above inlormati is correc ee to comply with all city and county ' ordinances and state laws relating to building constructio .••• ;Till:ty auth oTj7¢neons tatives 0 ity to enter upon the above-mentioned property Lor inspection p cos s. ( \/ Li' I�—Lt Sgnawre: ♦,1� \` 01 00158947 00158448 TOT 82.13 \ r 'sutenseorSocial Secumye: DATE: 04/14/94 TIME: 13:26 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor ' 'CONSTRUCTION AND PLANNING POOL PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector ' 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement "' '3. Electrical Conduit Utility-Undrgrnd.' ' 1 54. Forms - . 4:Electrical Conduit-Undrgrnd. _ 55. Electrical Bonding ' 5. Steel Reinforcement' - 56. Rough Plumbing & Pressure Test - O.:Electrical UFER-Grnd. 57. APPROVAL TO COVER-GUNITE , 7. 'Footings - ' , 58. Electrical Conduit-Undrgrnd. I - $. Foundation • !.;1 59. Gas Pipe, 0 Undrgrnd., Test ' ._ • o 9- Water Pipe-Undrgrnd. , = 60. Backwash Lines, P-Trap, 0 Undrgrnd. - e 1 10. Structural Floor System " 61. APPROVAL TO DECK i 11. Property Sewer Line & House Connection ,•i 62. Backwash & Receptor-Final - 12. Sewer Cap 63. Heater & Vent-Final I 13. Roof Drains - 64. Plumbing System - Final _ - 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL i 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.1 Rough Factory Fireplace 1 ` _ • . _ • :APPROVALS Permit # 21. Ducts,in Structure I !70. Underground Hydro 22. Ducts, Ventilating - .- . :71. Product Piping DGas DOil 23-DGas Pipe-Rough &Test , . , :72. Underground Flush 24. Rodf Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74: Overhead Hydro 26. T•Bar Ceiling (Structural) & Monocoat 75.'D.Y Chemical i 27: Frame and Flashing 61-12.624i744.# 76. Dry Standpipe ! -r. 28. Lathing-& Siding•, • .9 2o- ��4'. 77. FIXED SYSTEM FINAL '29. Insulation - " • 7 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH:DEPT. REQUIREMENT _31. Plaster Brown Cgat, '--,26/---% 6%'Ft<79: FINAL INSPECTION .- :r 32.,Electrical Power Meter-Final - ? 80, FOOD CERTIFICATE ISSUED 33. Final Electric -- '.. Nous: • 34.-Final Heating& Air Conditioning- • ' ' _ -• - -- 35. Final Gas Pipe-Test '• \ , ; _ ' - • 36. Hood or Canopy - •• 37. Final Factory Fireplace, 38. Final Plumbing . ' • 39. Water Service•Final - , 40. Gas Service-Final 7 ~ ,41. Solar Domestic-Final A `'� ,_ • 42. Backflow Preventer ;1 ddp 43. Backflow Irrigation P 44. Landscape Irrigati n System -.( - 45. Sound Attenuati - ' 46. Handicap•RegUla ' ns - '' - 47. _FINAL STRUCTURE & BUILDING c=tr 7q: 6w.0. ' 48. FINAL PLANNING • . - - 49. 'Electric Release to Edison 50._Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY - - No. Date r a.-. ADDRESS OFAIJLWGD: 296 E 17TH ST UMT: CITY OF COSTA MESA — BUILDING PERMIT PERT! NO: P 071465 ONNERSNANEfIDCM& BARRY MOORELUND ADopEs& 296 E 17TH ST PERMIT NO: P 071465 PLAN CHECK NO; N GLJVT; N SUPP: N COSTA MESA,CA 92627 6457626 CONSTRUCTION TYPE: I FR SP PERMIT TYPE: PLO PURPOSE: ALT APPL.RARING ADORES& JOB DESCRIPTION : GAS RE—PIPE SQ FT: ARCHITECT OR ENGINEER LIC.NG: ARM OR ENS'S ADDRESS: WIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / =triumvirs Rum CLEAVINGER, MICHAEL R ( 714 )631-3344 COMMENTS: X CONTRACTORS MAILING 2085 PLAC ENT IA AV +F+F+F+F+F***a*****aE**************+E************************************************* ADDREss: COSTA MESA CA uc.No, 594924 ZONING REQUIREMENTS 92627-3470 WT: 4 SETBACKS LICENSED CONTRACTORS DECLARATION:I hereby strafe under penalty of perjury that I am Tcwued under warlike*of Chapter D (Commu,vrp with Section 7DO0)ofDivision 3 of me Blrf end Professions Code,and my kenos xrnhA Mos ande1ed. MAIN BUILDING ACCESSORY BUILDING CITY LIC.NO.: 052066 uc.cuss: C 10 C O,. 594924 EXP: 12 /95 FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN �- �� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN �V Contractor: ` OWNER BUILDER DECUB TION:I hereby affirm under parlay perkily Mat l an':.1i from the Comrades License Lew lathe PARKING REQ: PROV; PARCEL: 00000000 ZNE: REF NO: Iouowi g reason(Sedan 7031.5 Busies'and Professions Code:Any ay or county whichrequires•permit to construct,alter.i mpruve. PLANNING NOTES> repel or rei any mature,prior to b issuance,also requires the apogean'la such permit to Me a signed terrwv that he or she > Named pursuer,'to the provision d the Comred«e License law(Chapter a(commencing with Section 7003)of Division 3 of the noes*and Professions Code)or that he or she is exempt therebom and the basis for the alleged exemption.My violation of Section ******************************************************************************* .031.5 by any appkard fora perm,'subiede the applicant to a dvi penally of not more than fire hundred dollen(SS0OD. D EV LOPMENT SERVICES REQUIREMENTS ❑ I.es owner of the progeny or my employees with wages as thei sole compensation.will do the work,and the Praire is not mended or offered for sale(Section 7044,Business and Profeadgs Code:The Contractors License Law does not apply to n w wwof progeny who builds or improves thereon.and who does such work femme or tarsal or through his a her own*miaow 's*,provided that such ZONING OVED BY DATE: improvements we not Wended or offered to sax.0,however.the building or improvement is sold within we year Of completion,the owner.bduerwill have the burden of proving he or she did not build or improve 1«the purposed Se). ING APPROVED BY ; El1,es owner of the property,am exhuhconnoting aly con ieed ssg with icscontractors to emend the pinged(Sedan 7044,Business and DATE: Prof eo a Code:The Contractors License Law does naway to d property who builds or eproves thereon and who casada for such projects with a contractor(*)Ganged punt l 'rectors License Law). PPLICATION ISSUED BY: DATE: ❑ Iamexempt uder B.AP.C.. this ************ ************************************************************** ******** ***************************************************************** at°' own. L ALIZ N;N F E E SUMMARY STRUCTURAL SEGMENT;N I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code sections 25505.9x513,and 25534,and dW I«any Mure buikbng ooapant will/veil not(circle one)need to comply with said date codes and the regdr•mame for e permit for construction or modification from the Arty ` Dist' • vel pmttdion.pwesi«d are exempt from ores. P IT BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING Provisions. Apytam: PLAN 25% SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby elrym under penalty of Minn(one of rhe Mewing dedaratiom: I S S U FEE 20 . 00 ❑ Iban and Wmeinanac tedwant1° 4ryse1*workete'oompenWian,aPrwidadkw*Seran37004t1'4.14ho BUILD G—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE }�p CMe,f«the P°dm performance m'work f«wi"h°r°Pwwataa"'°d' TOTALS ---> 7 . 00 20 . 00 0 . 00 27. 00 27 . 00 . 00 n1 I have and all maintain wakes'compensator insurance.mSection bySection03Code,b n 37of the Labor r the performance of the wakt«wehka this permitisIssued.My workers' insurance carriern r and poky number«•: Coder EXPIRES REVENUE IVISION TOTALS--> COLLECTED : 27, 00 OVER/SHORT: 00 • Policy Number: 04t-7qurvi A .slia 12/31 /95 BL G PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK u radion need not be completed I the pane is&one hundred dellen($1001 or We./ 27 . 00 ❑ I tartly that in the perlormace of the work for which this permit is T•,I shag nor employ any pssm in any mere.n n to bosun•eubled to the worker$'compensalion issue d -� that d I sho.M bee a cancorea to the workare' ******************************************************************************* m coe ata n bre dw dandio3700 d the Labor ... i •-. h comply with these provision. INDIVIDUAL F E E BREAKDOWN D ; '� ?rtl "cel A Applicant: warning:Fauns to secure rerkwicamp°maUon coverapll unNWTuluW shell a'e/ait an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil tines up to one hundred thousand dolls(SI04000j n addition to the cost o/compensation rupee as prodded for In sectn3roso/me Labor Coda Interest and attorneys fen PLU 1 GAS RE—PIPE 7, 00 7 , 00 CONSTRUCTION LENDING AGENCY: I hereby affirm ado penalty of perjury that there is a constnnon lending agency for the END OF FEES performance of the work for which this Fermi is issued(Section 3097,Cb.C), LENDER'S NAME: LENDER'S ADDRESS: I candy that I have read this application end Yate that the above intonation Is oonsf.I agree 10 comply with at Sy and county ordinances and state laws relative to balding construction and hereby authorize representa0wa of this ay to enter upon the atom-mentioned property for inspection pr`p°stit 01 0017E095-00178095 T E]T 27.00 wr A \ � � DATE: 03/14/95 TI%E: 14:01 C Deo: 6,..ck X. C1ere d Ovmer I CaMndor (5151-46.WP) White-Ouidig A Safety Giesn-Pde:Cenery-App' i.Pink-Revenue:OPtlwvod-Asoma CONSTRUCTION AND PLANNING , l r PAOI 'PA APPROVALS Permit # Date Inspector. APPROVALS Permit # Date Inspector • 1 • 1. Temporary Electrical Service or pole ; 52. Poo`& Equipment Location 1 2. Soil Pipe•Undrgrnd. - 1 . 53. Steel Reinforcement I .4 ( 1 , 1 .1 "...'Electrical ConduibAJyility-Undrgrnd. 54. Forms 1 4'j1 ctrical Conr(pir-U drgrnd. ' 55. Electrical Bonding - , 5,_Steel Reinforcement: 56. Rough Plumbing& Pressure Test _. 1I6. 'Electrical UFE;? d. 57. APPROVAL TO COVER•GUNITE t f4., 7. footings -:ii " 58. Electrical Condul -Undrgrnd. _ a'8. Foundation :.c-, ' ) 59. Gas Pipe, O Undrgrnd.,Test 9. Water Pipe-Unc1.- ;nd.;• ,) - 60. Baclkwash Lines;:0-Trap a L~hhdrgrnd. 2. 10. Structural Floor.System - '61. APPROVAL TO;aECK 11.9roperty Sewer-Linel8FHouse'Connection 62. Backwash & Receptor-Final l 12.3ewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electri,t-Cdnduit t^ 66. Solar System-Flal • a. 16. Rough Electric'WirSkg 67. Fencing & Access Approval J C L 17. Rough Wiring Sign 68. APPROVED FQR 'PLASTERING 18. Rough Electrics-T Bar Ceilin'd 69. POOL/SPA SYS-iiTEMS FINAL 19. Rough Heating& Air Conditioning s. FIRE DEPT. REQUIREMENT 2W RaugFr acmry F}replace I ? y (. C•; ` P .'OVALS-;D *mit # r �'• 47 21:. DtctsIn Sttuciare :°,///`• 1-• ;l ' I rF L'?- ,ufld l ydro " 22 Ducts :VenTilattrig 1 • ,-• t - it , •Sr -...V: 71 Prodt)gt'Pop i1f3Gas )Oil 23. Gas Pipe-RQugh&Test i m i t p• A. < - , tit ir 72. Undergrouhd gait* c-; 74. Roof Ffamlhg 'r 1 - - "Ot ''�rcF„° i,/ 7k Under rnd.StP a e Tan El Gas 9t11 ` I • ` `, - 25. Roof Sheathing , - •' 74. Overhead Hydrb 26. T•9ar Ceiling (Strbcturall 8I'Mbhocoat if, I I'lj# ; 75. Dry Chemical ,_, 4 y -" a `: R 31 . . ::1 • _ it< T to .. 27; Frame-and Flashing 0..:'C; , . :I n;a a 76. Dry Standpipe:-• •• v :Z p' •i. r,� p a 28. lathing & Siding* "I I e , 74 FIXED�kSTENY,RiNAL_ • .. .. . _ a I k 29. Ipsulation i- =:, •• • ! �' • 7e. FIRE-PREV. FINAL 0 '1 30. Drywall Nailing . -r I I I .c � " ...;;74HEALTH DEPT�REOUIR'EMENT 4. ' ti_at r_I : r v `e a •��, - . r� c 31. Plaster(.BrownCoat s : b'^ F. u r 79'.'FINALtNSPECT-ION - 37 Electrical Power Nlefer final -it - r 80.: FOOD CERTIFJCATE ISSUEDy • a4.44 3 37 Fipal Electric : .,; I ,; , I �_ . Notes: -r. ., I j r 34'. Fit al Heating &Air Conditioning + 4C --c-r• r 35: Final Gas P1pe-Teyt a ifix.e.ser 17 k. , - •" t 11 ow ' I 1I tp w . : 36. Hood or Canopy , D r ' f, I ! f' '> : r :.•. O 1' . 37 • .. Final Factory Fireplace i cp 1 ! I� + e 7: n, 38. Final Plumbing ! n% , 3 _„611(`4 '. c u a • I. ♦ CI ..,1: • 39. Water Service-Final... It, ., 40. Gas Service-Final r :,t _ n: 1 I• + '. L.- - Jt • ._. 1 1 I 11 h 1�. t L. 41. Solar Domestic-Fi tel: a,.: •• •, `� 1 ! 4. a r. C" t �! H C. M 42: Backflow Preventer (1) J - - a 11 -. r. A A :1 Ttfl • .• tr. r43. Backflow Irrigati t ; -' a r a ' 1:'- l -•• •- 44. Landscapearrigation SYstem'rQ U; r r, -; • • .-= o _ L 4:4- r •- 45. Soundf.,Attenuatiggn y ; 4. t ht .• F.:, 4 F . ;-r• r 46. Handicap Regulations . r C: 4 t 3 a .tr;1. r:• 47. FINAL STR'UCTlc?RE & BUILDING s I I 7 ' '' .I 48. FINALPLANNING 11-'- • �• • I to ; 49. Electric Release to Edison ! ! r a• I , • 50. Gas Release to Southern California Gas Co •• , + r•: • - - .. .. - '1 c' .' -- c, • 51. CERTIFICATE OF OCCUPANCY • _ nl : - �- No Date PROJECT ADDRESS: 296 E 17TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 066821 DWNEWSNAME: GEORGE E. HOEDINGHAUS ADDREss: 250 E 17TH ST PERMIT NO: E 066821 PLAN CHECK NO: N GOVT: N SUPP : N C .M. 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ADD ARCH/ENGINEER: REG.NO.: UNIT: JOB DESCRIPTION : MINOR WALL REPAIR SQ FT: ADDRESS: CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 / PERMITTEE: THE VAIL COMPANY (714 ) 498-2667 ADDRESS: 10057 CALLE RECODO COMMENTS: REF; B-66820 SAN CLEMENTE CA 92673 ***********Ir*******arlr****Tr******************aE*+r+r**+r*************k ***** ******** I LICENSED CONTRACTOR DECLARATION: 1 hereby affirm 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 ipc1 IC.:��Af STATE LIC.: 2 9 3 51 c s:,B)qt _ —�� Signature: , V �' ACCESSORY BUILDING ORNERS'COMPENSATION DECLARATION: thereby affirm that Ihave acertificate ofconsent toself-insure oracertificate ofWOAers' FRNT; FT MAIN BUILDING IN REAR: FT IN FRNT; FT IN REAR: FT IN Compensation Igis n or c ire c y thereol(Section 3800.Lab. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN 1 POLICY NO.: -1- 1 a—�4 EXP.GATE: V 4 /01 /95 • COMPANY: STATE FUND��vA/ PARKING REQ: PROV: PARCEL: 00000000 ZNE; REF NO: El Certified copy is hereby furnished. LJ`Certified cl ff filed with the city : ild-t D PLANNING NOTES> I , Date �'—/Lf-9 Applican II` `—, ****************************************. ********************************* EMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit i5 for one hundred(5101)or less). D E V E L O P M E N T S E C E S R E Q U I R E M E N 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 i subject to the Workers'Compensation Laws of California. ZONING APPROVED BY • : DATE: Date: Signature: BUILDING APPROVED BY NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor : 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: Mt A� DATE: which this permit is issued(Section 3097,Civ.C). ********************** LENDER: *************************** ******************************************* ADDRESS: LEGALIZATION: N .SUMMARY STRUCTURAL SEGMENT : N 1 OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT 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 1 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 5 0 R SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business )LAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant far a permit subjects the applicant to a civil penally of not more than live hundred dollars(5500). ISSUE FEE 15,00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE 'LAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 1 . 50 15 , 00 0 . 00 16 . 50 16 . 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 REVENUE DIVISION TOTALS——> COL ECT ED• 1 b 910 OVER/SHORT: ,00 improvement is oro the purpose of sale).sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE' MIP/TOT GRADING PLAN—CHECK for I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 16 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTION UNIT COST TOTAL COST Date: Owner: ELE 2 RECEPT/OUTLET 1 ST 20 EA. , 75 1 . 50 I do hereby certify that I am aware of and understand the requirements of Catilornia Health and Safety Code Sections 25505,25533,and END OF FEES 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 permit for construction or modification from the AirAlr Ouahty Management District.Residential construction applications are exempt from • these provisions. Date'. Applicant: • I hereby certify that I have read this application and stale that the above information is c'rrer.I ag'e to comply with all city and county ordinances and state laws relating to building construction and here. • tho. res'ntd .I this ity to enter upon the above-mentioned pro i¢rty for inspection purposes. � . e.te: — • Signature: /�,/ l`( �L .,.er's License or Sodal Security 4: 0100153946-00158946 T4T 16.50 DATE: 04/14/94 TIME: 13:25 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 *,...0 1 '3. Electrical Conduit Utility-Undgrnd. - 54. Forms � 4. Electrical Conduit-Undrgrnd. ,� 55. Electrical Bonding 5. Steel Reinforcerent - 56. Rough Plumbing & Pressure Test 6.. Electrical UF ER Gmd. 57. APPROVAL TO COVER-GUNITE 7. Footings . ' • '7- 58. Electrical Conduit-Undrgrnd. e 8. Foundation t1.-y s �- j 59. Gas Pipe, 0 Undrgrnd.,Test (\, '1 I 9. Water Pipe-Undrgrnd. 4 ) 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 I 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1 I 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT r - , 20..Rough Factory Fireplace ` • •APPROVALS i.. Permit# 21. Ducts,in Structure ' . " • , . 70. Underground Hydro ' 22: Ducts, Ventilating - .:!:71. Product,Piping DGas 000 23. Gas Pipe-Rough &•T.est 72. Underground Flusli. 24. Roof Framing •• - ^ . :73' Undergrnd.Storage?ank D Gas D Oil 25. Roof Sheathing ' _ r: - .74.-Overhead Hydro _. •- 26.•T-Bar Ceiling (Structural) & Monocoat 75.-Dry Chemical ' 27. Frame and Flashing' . 76. Dry Standpipe - • ' 28. Lathing& Siding:- -c; •• •• - k 77...'FIXED SYSTEMWFINAL 29. Insulation • - n, -, 78:--FIRE PREY. FINAL 30. Drywall Nailing - 1111111.:- HEALTH DEPT. REQUIREMENT -,--- 31. Plaster B?own Coat' - ;. ; ' FINAL INSPECTION` ' ' 32. Electrical Power Mete1-Final I1 . :O.,,FO�: :ERTIFICATE ISSUED ` � 33. Final Electric i (�(/; i :Nofes.7 Otj b-• �• �Sop (, ' � _case 34. Final Heating:& Air Conditionipg_ -r ! 7r . r`, m-aawa61 35. Final Gas Pipe-Test i _ -• r/ 36. Hood or Canopy - . • -) I /37. Final Factory Fireplace - '' / • • 38. Final,Plumbing ' '• 7 ., 39. Water Service-Final . ,40. Gas Service-Final . .I 41. Solar Domestic-Final -• j - 42. Backflow Preventer' - _! •' - - -� j 43. Backflow Irrigation _ - - ' 1 44. Landscape Irrigation System . ,• _ . . 1 - - 45. Sound Attenuation r" • I•• y - 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 ADDRESS OF MOLLOKt 296 E 17TH ST WIT: CITY OF COSTA- MESA — BUILDING PERMIT omastAMEWIDiDRN: BARRY MOORELUND PERM NO: E 082174 ADME53: 296 E 17TH ST COSTA MESA, CA 92627 PERMIT NO: E 082174 PLAN CHECK NO: N GOVT: N SUPP : N 645-7626 APPL,WRUNG ADDRESS: CONSTRUCTION TYPE: I FR SP PERMIT TYPE: ELE PURPOSE: OTH ARCHITECT OR BlOMEER: t1C.110.: JOB DESCRIPTION : REPLACE F.A. U. SQ FT: ARC1L OR ENa'S ADDRESS: OM: CLAIM VALUE: CALC—VALUE: GROUP OCC : B / DON1RACTaRSNAm CLEAVINGER MICHAEL R ( 714 ) 631-3344 R' moucionom 2085 PLACENTIA AV COMMENTS: ELECT PERMIT INCIDENTAL TO MECH WOR E:M82173 moms, COSTA MESA CA Liam, 594924 +r**** Arrtx-x'**x-x-x-rr*AF**+F**AE E********AEAE** -x** * **ri* -**** .*rr..,Eu. -*.* .* -*.*. . .**.**+e* 92627-3470 WIT: 4 ZONING RE REMENTS LJCENSED CONTRACTORS DECLARATION:I hereby afire under penally of perjury that I em licensed ads proldons d Chapter 9 S T C K S (commending with Section 7000)of Div ebn 3 of me Business and Ralesabns Code,and my license Is in ltd three and°Iletl. crtvuC.NO.QO.:052066 UC.CLASS: C 20 uc.N .: 5949 4 X /12/97 MAIN BUILDING ACCESSORY BUILDING �, Dae: V-�� q Larvae � �dl� LEFT: FT IN REAR: FT N F FT IN REAR : FT IN LEFT; FT IN RGHT: FT N T; FT IN RBUI FT IN OWNER BUILDER DECLARATION:I hereby affirm Lutist Meath'el than am PI Iran the Caarram Manse Lew la One following reason(Section 7031.5 Easiness and Professions Code:My city a county which requital a permit to wnewa after.improve. PARKING REQ• PROV: PAR L : 00000000 ZNE: REF NO: • lemolisshe licensedh spawn to theprovisionsaprior of its Com°Vntractor.Uipnssee°Law applicantChaerfor (commeenrrnit nci(commencing Secm 70statement 0)a d that he or we PLANNING NOTES> ,artiness and Proleuione Code)or that he or she is exempt therehan and the basis la the alleged exemplun.My violation a Section > 7031.5 by any applicant for a permit subjects the spoken lo a civilpenaly or not more then floe hundred dolanMOOD. **********************************-*** ***************************************** ❑ 1.asowner al the properly or my employees with wages id Mir sole compensation,eM do the work and the nucture is not Wended DEVELOPMENT SE-YR ICESR E U I R E M E N T S a offered for sale(Section 7044.Bass and Profession Code:The Contractors License Law does nor apply to en owner a popery Q who bolds or improves thereon.rd who doss such wok!imam herself a through hop a her own employee*.provided that such imprwernenss we not carded or dieted fa sale'l.however.the building a inpaane°Is sod withinens yeana mMti mpon,the ZONING APPROVED BY owner-builder will have the burden of proving he or she da md bund or imams for the propose of safe). DATE; ❑ t.se owner of the property.am exclusively contracting with licensed contractors to construct to project(Spun 7044.Business and Professions Code:The Contractors License Law does not apply to an owner a peccary who Wilds a improves thereon and who BUILDING APPROVED B Y : •'*. DATE: contracts for such projects with a cow medals)licensed pursuant to the Contractors License Law). r ❑ Iamemend under Section: B.AP.C..for this reason: APPLICATION ISSUED BY: ' . e —......yy DATE: - E7 os.: o " LEGALIZATION1N F E E SUMMARY STRUCTURAL SEGMENT: N I do hereby cattily that I am aware of and understand the requirements of Catania Hoeft and Safety Code Seaton 25505,25533.and 25534,and Cr I a any Nun building oMaenl,will/w0 not(circle one)need to comply with said male codes rd the requirements for aperml tor construdionamodifcabn bomthe AiOwlyMnepsrw District RuidenW cMactxnappiMionwwmpt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING praaelon. PERMIT 11 , 00 Dae: Applicant: 5 0% SM I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby exam under penalty a perjury one a the following declensions: PLAN ISSUE FEE 22 , 00 ❑ I have Code, Mwilmaaencaaatedcomdto thispaunbr workers' mpenWion,aspwidedfor ySampn3700a/the Luba' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Cade.for the pNamencs a the work for wtich this permit is issued. ❑ Ihaysendwgmenlanworkao'compenm;rnirmpanae,nreamedbySadie'3700elteLaborCodsfathepedmneneedthe TOTALS > 11 . 00 22 . 00 0 . 00 33 , 00 33 . 00 00 work la which this permit M Issued.My waken'compensation Serena cent and po4y motor are: Caner: AATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 33 . 00 OVER/SHORT: . 00 Policy Number. gI�i-97I10003a 8 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK nit secylon need nate completed lwprml is thran hundred ddbn(SI0ola lrsl 33 . 00 - OI certify that in the performance of the work for with this penia is issued.I shall not employ any pence In to manner so as to bec a subpct to the workers'companion laws d Goldoni°.end agree that 1 *Mad sdd became subject * lo the workers' ********************* ********************************************************* compencompensaticompensationprovisionsprovisionsa Section 700 a the Labor Code,I cal f�ln annoy thosea -(/n INDIVIDUALdyl F E E BREAKDOWN Dona: lc--n4 Applicant: T M n Warnng:FaOua to sun worts'compensation coverage Is un and soul fact an employe,ropnlhrl Penamesand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST avl finis rp to one hundred thousand dollen($104000),In add/don to we coot or conpnhakTk da mglss as provided ler In Section 3706 or the Labor Coda,Inrresh and afronaye Ins. ELE 1 MOTOR/POWR APPARATUS 1 , 1 — 10 . 0 HP 11 . 00 11 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of parpvy IM then M a cansrrudian lending agency for the END OF FEES prformance a the work for which this permit is issued(Sedan 3097.CN.C). LENDER'S NAME I LENDER'S ADDRESS: I sentry that I have read this application end Mate that the above information is coned.I agree to empty with all coy and county advances and Mae laws raSi 9 b butikq construction and hereby aalrbe representatives a this Onto enter upon the aboamanianed popery for inspection papal.. J, ;NIFER KELDER 83-25-1997/11:35 pee/$33.88 J �� . ► nr Data: 1 -01.6: 97 PERMITp::082174 . • I` (5151.45.WP) Wti -3 euildnGreen-File;A Safety: Canary-Ape/mu:Pink-Revenue:Goldenrod-Assessor - CONSTRUCTION AND PLANNING POO1 PA 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-GUNI.TE 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 b Gas O Oil 23. Gas Pipe-Rough& Test _ 72. Underground Flush 24. Roof Framing • _ - 73. Undergrnd.Storage Tank ❑Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical _ 27. Frame and Flashing - 76. Dry Standpipe 28. Lathing &Siding _ • ' 77. FIXED SYSTEM FINAL. 29. Insulation • 78. FIRE PREV. FINAL • 30. Drywall Nailing _ - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED AI 33. -Final Electric, r Notes; -+ ' 34. Final Heating & Air Condi oning - - 35. Final Gas Pipe-Test • - 36. Hood or Canopy 37. Final Factory Fire Iy p ce (� 38. Final-Plumbing if. 39. Water Service-Fina'. 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 ADDREssoconxim 296 E 17TH ST mu: CITY OF COSTA MESA — BUILDING PERMIT amEWSNAMERIwowN: BARRY MOORELUND PERM NO: M 082173 ADDRESS: 296 E 17TH ST COSTA MESA,CA 92627 PERMIT NO: M 082173 PLAN CHECK NO: N GOVT: N SUPP : N 645-7626 APPL.MAIIDM ADDRESS CONSTRUCTION TYPE : I FR SP PERMIT TYPE: MEC PURPOSE: OTH ARCIItTECT ORENDDIEER: LIG.ND.: JOB DESCRIPTION : REPLACE F.A. U. SQ FT : ARCA.OR END:S ADDRESS: WIT: CLAIM VALUE: CALC—VALUE; GROUP OCC; B / 0CNmACNMrSNAMECLEAVINGER, MICHAEL R ( 714 ) 631-3344 Ca4WACTORSUMDG 2085 PLACENTIA AV COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT goREss: COSTA MESA CA uc.i .: 594924 • *RE******RE+A****+A********fl*********+E***********+E **** *********** * *AE***x*RE***** 92627-3470 ural: 4 Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby dim under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business end Professions Code.and my license is In lull forte and effect. CITY LIG.No.:052066 uc.cLIkss: C �0 uc. ..: 59/1 EXP: 12 /97 MAIN BUILDING ACCESSORY BUILDING Q FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN Date:V / �q Contractor: '7C ADD ` LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under Partake of jury than that esempl from the Canlrad«a License Law for the fdldwng meson(Swion 70313 Dunes and Professions Code:Anyckyor county which regimes a perms torctt after.improve, PARKING REQ• PROV: PARCEL: 00000000 ZNE: REF NO: demdoh.«,epi, eau reS any ctue,.prior to iissuance.atnce,also requires the applicant for such permit lope a shred statement.met he or she PLANNING NOTES> ,u Scanned pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Rosiness end Professions Coder or that he Cf she is exempt therefrom and the basis tor the alleged eaempflon.My violation of Section > 7031.5 by any applicant for a permit subjects the applicant to a civil PenaJy of nmol mote then fee hundred defiers IS50Ol). ***********************.******************************************************** ❑ I.s or er d the property or my employees with wags ea their sole compensation,will do the work.and the structure is not intended D E V E L O P M E N T S E R 1V I C E S R E U I R E M E N T S or deed for sale(Section 7044, s Busineand Professions Code:The Contractors License Law does not applytoan owner d properly Q who builds or improves thereon.and who does soh work himself or rd heor though his or her own employees.provided that such - bnproememaere not intended ooffered fel sale.d.howemr.the b vatorinpmvern«Gueddwihm«wyewdcompdion,the ZONING APPROVED BY - DATE: owrerbo lder will have the burden of proving he«she did no build or improve t« d the purpose sale). ' • ❑ I.as owerof the properly,en exclusively contracllig with licensed Contosotors tocorelnid the project(Seden 7044.Business and BUILDING APPROVED BY Professions Code:The Contractors License Law does notaply to a owner of properly who builds or improve thereon end who DATE: contracts I«such projects with a contractor(n)licensed pursuant to the Contractors License Law). ❑ Iamexempt under Section: B.AP.C.,for this reason: APPLICATION ISSUED BY: WA DATE: 3 25`Iq,m Dad Owner: LEGALIZATION: N E E SUMMARY STRUCTURAL SEGMENT: N I do hereby certify that I em aware of and understand the requirements of Cellonas Health and Safety Code Sections 25505.24533,and a553x,and tMtlorayhSureboildgomthent Wiley Management District. es�npywihademleomeeemeswemthe Mmenmroe BLDG PMT P UMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit l«art I or any nf modification hoccuMAi aly le corn* aPpficatione therempefine these provision. PERMIT 13 . 25 Date: Applicant: 25$ SMIP/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the fdldvdng declension ISSUE FEE 22 . 00 ❑ I have end will maintain a certificate of consent to self-insure for workers'compensation,as provided for by Section 3700 of the Labor BUILDING—DIV—> PERMIT IS PLAN—CHECK • TOTAL PAID DUE Code.lot the penomeadthe milt for which this pem is issued. TOTALS----> 13 . 25 • ' . •0 0 . 00 35. 25 35 . 25 . 00 ❑ I Mae end veil maintain workers'compensation insurance.es requited by Section 3700 of the Labor Code.tithe performance of the . work for which this permit eissued.Mvworkers'STATE �Kiel mm�we; Carrier: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 35 . 25 OVER/SHORT: 00 Policy Number 04b-9l000U:i2115 01 /01 /98 BLDG PMT PLUMBING ELE ` RIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need not be camp/eted I the pend is tar one Modred dollars 01001 or WO 35 . 25 ❑ I certify deed in the performance of the work for which this permit is issued.I that not employ any person in any manner eo as to become subject to the eskers'ampepeetipn Iowa d Cafdoreaq and agree Net if I should become stejed to the workers' ***************************** ************************************************ compensation provisions of ion 3700 of the Labor Code.I shag with h campy / Nos dm I N D I V I D A L F E E BREAKDOWN 'y Da l.:3-2 6 '7 Applicant: 1 /../) T ! Y . Warning:FaluntO secure wharimnl9aoaatlon coverageI5 un Land• subject an employer to criminal penaltiesand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST chw fines tat to one hundred thousand dollen($104000).In addltbn to the cost of compensations apes a provided tor In . scdon370.of the Labor Code,Intent,and atterne hem rapes 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 13 . 25 13 . 25 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction landing agency for the END OF FEES performance ol the stork for which this cern is Baud(Section 3007.Cie.Cl. - LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and gee that the above kdarmtlion it coned.I epee to comply with all cdy and luny ordination end stale laws rsNlkq to building constructers eM hereby authorize repreamG ins of this city to enter upon the above-mentioned property for inspection Purposes.JENIFER KELDER 83-25-1997/11:35 AM/$35.25 11 PdAR_.CC�� ( 3— 97 PERMIT:�1 in Die: • d Sig low Owner/Ago, rd« (5151-46.WP) While-Buldi,g A Safety:Green-Fie:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor -, CONSTRUCTION AND PLANNING POO, SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. 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 r 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,inStructure , - •- 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 s 74. Overhead Hydro 26. T-Bar Ceiling (Str'u'ctural) & Mopocoat 75. Dry Chemical - 27. Frame and Flashing. _ 76. Dry Standpipe - 28. Lathing&Siding " - .. FIXED SYSTEM FINAL ' 29. Insulation • 1178. F ...-RE . FINAL • 30. Drywall Nailing . ' _ - ;, '. TH DEPT. REQUIREMENT 31. Plaster Brown Coat, _ �i 79. FINAL •SPECTIi` 32. Electrical Power MeterFinal • f 80: FOO .CERTIFICATE IS D 33. Final Electric - • / Notes: n ,t.,O�t FiN1 I2 g3 (w/ L I _ 34 Final Heating& Air^Conditioningi 1��_C+`' � -- - 35. Final Gas Pipe-Test: - 36. Hood or Canopy _ - - - 37. Final Factory Fireplace - - - - 38. Final Plumbing • „ 39. Water Service-Final -• 40. Gas Service-Final • - ' ` 41. Solar Domestic-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 ADDRESS OF BMLODfC: 296 E 17TH ST WIT: . - CITY OF COSTA MESA — BUILDING PERMIT CWNTWSAM NE IF KNOWN: BARRY MOOR ELUND _ PERM NO: E 079597 Roo s4: 296 E 17TH ST COSTA MESA,CA 92627 PERMIT NO: E 079597 PLAN CHECK NO: N GOVT: N SUPP : N 6457626 AM.WANG ADORES& CONSTRUCTION TYPE: I FR SP PERMIT TYPE: ELE PURPOSE: OTH ARCHITECT OReImfaR: LIC.NO: JOB DESCRIPTION : REPLACE F.A.0 SQ FT: ARCM OR END'S ADDRESS: UM: CLAIM VALUE: CALC—VALUE: GROUP OCC: B / CONTRACTORS RAMS: CLEAVINGER, MICHAEL R ( 714 )631-3344 CwmAcfarSMulwo 2085 PLACENTIA AV COMMENTS: X ADDRESS COSTA MESA CA uefc, 594924 ****BE*+E+Lx-+E+rit+E+EBr+tx+t+E+ ***u-**x*ft*BEAE**x**x-*********+rlE+ear+E*x-** rpt*BEBEBEx**x-BE**«-********* 92627-3470 LIMT: 4 ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby elunder penaltylicensedd perjuy that I em under provisions Chapter 9 SETBACK T B A C K S f (commencing with Section 7000)of Division 3 d the Business end Professions Code.and my Borne is in h0 Moe and sled. tc7/2O /q(o NO.: 052066 uc.cuss: C 10 uc. 5 4924 E P• 12/96 MAIN BUILDING ACCESSORY BUILDING owmd � � J� /� ��/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN il� x LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN BUILDER DECLARATION:I hereby affirm under penalty of rjuy t 1 em exempt from the Contractors License Law for the nee (Section 70315es Bness end Pr Professions Code:Any city county which rquirese permit tocratud,eller,improve. PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: demolish,or repo arty structure,per to u requires slso reaes the applicant for such permit to file a signed statement that he or she PLANNING NOTES> `e licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)a Dneion 3 a the Business and Professions Coded or that he or she ie exempt therefrom and the basis to the alleged exemption.My violation d Section > 7031.5 by and applicant for a permit subjects the applicant to advi penally of not more than lee hundred dollars 155001). ******************************************************************************* ❑ I,as ownsr of the property or my employer with wages as their sole compensation.wgl do the work,and the structure is no.Welded DEVELOPMENT S ERV ICES REQUIREMENTS or offered for sale(Section 7044,Business and Professions Coe:The Contractors license Law does not apply to an owner of properly who buds or in proves thereon,and who does such work lensed or hersel or through he or herprovidedhown employees, that such improvements are not intended or offered for sale.t.however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY • — DATE: owner-builder will have the burden or proving he or she did not build or improve for the purpose of sale). t. El L as owner of the property.am exclusively contractile with licensed contractors toconstruct die proyd(Sedion 7044.Business and BUILDING APPROVED BY : DATE: Professiono Code:The Contractors License Law does napply to an owner d property who builds or improves thereon and who contracts for such projects with a contracted')licensed pursuant to the CaNredore License Law). �1� ❑ Iamexempt under Swt `'V ion: B.1P.C.,forthisreason: APPLICATION ISSUED BY: vi DATE: R 6 ********************** ********** ** Date: Owner. LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby certify that I am aware at end understand the requirements of Caliomie Health and Safety Code Swnns 25505,25533.end 25534,and that lr any future building occupant Mwti/wf not(drole one)need to comply with said state codes and the requirements forBLDG PMT '" MBING ELECT: C, MECHANIC FIRE SMIP/RES GRADING a permitforcenstructian or modification from the Al EManagement District.Residential mwnwion applicationswe exempt from these provisions. PERMIT .0 0.. Date: Applicant: 50 t - SMIP/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under Penally of penury one of the allowing dedrstins: ISSUE FEE 2200: . . 1:1Ihav and wilmaintanacrtifcawee certificate ,mProdded fobySedon3EOoftheLabr BUILD ING—DIV—> PERMIT SUE PLAN-CHECK TOTAL PAID DUE s coda.tortlwprlrmen:ad the work fes which this permit is Issued. 4TOTALS----> 11 . 00 22 .00 0 . 00 33. 00 33 . 00 .00 I have end wt maiden workers'compensation irourerce,a required by Swot 3700 d the Labor Code.for the performance of the v , °dfr"red "o « d' ° nuses" Mrwrk ��'rra emdrand°d` an vrberare: EXPIRES REVENUE DIVISION TOTALS— > COLLECTED ; 33 . 00 OVER/SHORT: 00 Carrier: Policy Number: 046—96u0003218 01 /01 /97 BLDG PMT PLUMBING EL TRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 1lussaaien need nes bet oompietedt the Atm is for one hundred days MOW or ion.) . 00 .. • __ • o I certify that in the performance of the wok for which this penes it issued,I shall not employ any person Si arty manner so a to become subject to the workers'compensation laws of California,and agree that B I shored become to the pee ***************************** ************************************************ .. �n-ys provisions d idof the Labor Code,I shall f with can with h 3700INDIVIDUALYFEE BREAKDOWN Warning:Foliar•to acus Worts'compensation rage ation coveisa ,and l subject an employs,to criminal Noaties and - TYPE QTY D E S C R I P T I O N. UNIT COST TOTAL COST civil fines req to one hundred thousand dollarsp (1104000A at ackOdon to tin cost of compensation,dna,as provided for In _ sscdmn asoftheLaborCods,Irdrestandatromey''fa ELE 1 MOTOR/POWR APPARATUS -1 . 1 — 10 .0 HP 11 . 00 11 .00 - CONSTRUCIION LENDING AGENCY: I hereby effirm under penally d peony that then e a«.talon lending agency for the END_ OF. FEES performance of the work for whirl this permit a b issued(Section 3097,Cb.C). • LENDER'S NAME: LENDER'S ADDRESS: r • Ind state laws have readtthisapplicationuidatnThateeauthorize Iagree acomply with all dry and axmryadnucm and averse to bugdiq mien end d and hereby above information representatives ache city to enter upon the atrove nrertnnnd property for inspection pvpow. JENIFER KELDER (� J� / __ �(_J Date: / /LDh10 01 0021533-00215373 TOT\ �• �� - DATE: 09/20/95 TIME: 13:38 ` / sig :: at. �./ . t:.. -s_• \ (5151Je.WP) While-Building 1 Safely:Green-Rte:Canary-Appscant:Pink-Revenue:Goldenrod-Assessor • CONSTRUCTION AND PLANNING POOL PA• APPROVALS Permit# ! r Date Inspector APPROVALS +Permit # • } Date Inspector •1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. "' 53. Steel Reinforcement - •• ` 3, Iectrical Conduit to lity-Unt"irjrnd._ 54. Forms i ' -, 71Condul Urdrgrnd.ro 55. Electrical Bonding _ . 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test Cl� F',:tr,ITElectrical UFEqsd. 57. APPROVAL TO COVER-GUNITE ..i;7. Footings -tn n 58. Electrical Condair-Undrgrnd. c 13:foundation 8_ o, 59. Gas Pipe, 0 UdTgrnd.,Test r. - 9. Water Pipe-Undtg nd. 60. Backwash Lines,P-Trap, Undrgrnd. t 10. Structural Flooi�,S�istefn 61. APPROVAL TO:DECK - . 11. Property Sewer„Line &:House Conhection 62. Backwash & Receptor-Final 12. Sewer Cap --. a, 63. Heater & Vent-Tal • 13.-Roof Drains i 64. Plumbing System - Final 14. Rough Plumbing •r, 1 65. Electrical-Final I 15. Rough Electrical-Conduit T 66. Solar System-Final i 16. Rough Electric .- iring _ 67. Fencing& AccetYApproval 1 17. Rough Wiring Sign '''''s - 68. APPROVED PLASTERING 18. Rough Electrical:7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &Air Conditioning FIRE DEPT. REOUIREMENT 20.CRough f-jactory Fireplace = y' ‘c: p Tr APPROVAtS,C Pe mit # r 21.T0u�s, in.,Strttctu •,` c " (e� F" �S * 5 `-�,- �� °' 70.Ftlntl�k§r� und Hydro ;r. r, u. rr7 • .>.--. t .� l• -- .o 22. Dutits, Ventilating* (J:: * S <4 i 71. Proddct'ipin Gas C Oil 23.:Gas1PipeeRo�1`gh &-Test - ik 7' 72. Under round �h fi `-• ri r .r,S R tri r^ < O.t •� 9 a a [TI X Y rr r^ ...,rt: # �': o- S 4- ' , 24.,fioo1 Framing. :* • f,.‘-• ..E, g > 7 G. Y S ,-v > - 73. Undergrnd.Storarre Tank C1 Gas 0-Oil 25. Roof Sheathing * E* m 71 m j n;.#= 74. Overhead HydFot-' * 26..5-BA Ceiling (Struc3ural) & tonocoat * to rj r.i 7.5. Dry Chemical y'! - 27.'Frame and Flashing* .2 * . 'o �°: 76. Dry St .,-,a * `52 M E' �-• t :-J * Y* r `' r� - 28 Lat-' 1 Siding * y ~ * g .. * FIXEDS�ST FINAL r i ' 29. Insu!atit�i ` O --+ ' • > 4: 41 If 1,7 FIRE?�R_cV. FINAL X � . • 30. Drywall Nailing e s Il� h .H6�Fi DERT`-REQUIREMENT 31. Plaster BrpwrilCoat* " i 79. FIN CQNSPEC-Ofd ' r-- a . Y m x I 9.t. • rr .�. 32.0Electrical•PoWer Mee Final E"r r t`J �;. r 8,8f F �lD E$ TIFl M't ISS�UF n. .L 'i' qI ft i C -� e 33.'�4inF Electric * I c g�Tf�(b ISdt h �- * . •r Qa3 r; C' Y' r-ra G K U{ r c+ - / c -io - ).�.� 34.-FinAHeating& Air,Cb77clitiont?g�- 5 • c I f x. / 35.rfina+Gas Pipe•Testy ^^ * H I --- 1.4: --1 , cP- 7_q_�?� Pi: il kr' aq- 36.'Hoo or Cano * 'Z x 7� of I � • L-.'� -.'. -1 v_� N py t: .'-.. , r"7 o * r1 X11 E 7 no / 37.4inat:Factory Fireplace N, 0 * tr. I I 0. 2 * t^•1•• 3• 8. FinaJl Plumbing c11, , .. .. . x v I* - T. r, o _. c. 3• 9. Water Service-Final; c i T I ft } `I . 40. Gas Service-Final " Y _ * I fit` r " 41. Solar Domestic-Final r; - * C• I ..1:i * _, _ ' 42.-Backflow Preventers t'" '� I Ci. F ,� -• 7.5 Xt43. Backflow Irrtationrtr5s y, r cr >' C - 4 * .^. x 0' i * r, ;714. Landscape Irdgatiop Systemmt S 4; tri O 0 :-a' c CI co to $ C �45.(.Sound AttenUatiom -if-,-.F * F. F- f- F* -i tr 0'L..) l;a, t 't -I tri T'\ r'n tr ti: • L. 7 ? ;46.'Handicali Regulatiojls *S - . HO " _ „/ .k Y. S .7'� 5 1' .47.:FlN L STRUCTURE & BUILDING * 1 Ir S - F N 1 , 48.EFINAL PLANNING rc•:r L. 'r CC bz x a -49.=£leccric Release to Edison 44 1 ; p: _ • .50._Gas Release to Southern California Gas Co ` it ` =' - e-rt , -51. CERTIFICATEOF:000UPANCY• c' .kr .J _, No. Date QK = QILL_ NUNES .� �r110 *.erter� APPIIcin a ix fpt those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT MIT NO: TRACT NO. LOT NO. UNIT NO. J✓ ,S J ��7 t^rOh • Piolect Address Z'Y•J C• t1 s.51t'rcG MeA�2•i ^� ^>_LG !Y V gag. Mailing Address errs sE TYPE OF CONSTRUCTION U NEW H ADD U ALTERATION U REPAIR �/�� Phone( 7f 7.[. ❑ CONVERSION ❑ DEMOLISH ID OTHER A.P.# I Zone owner's Name r - DESCRIPTION OF WORK/USE OF BLDG. Address 4.Fl 45 Pic a f' c'i)D27•' . S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING U FOUNDATION El STRUCTURAL T Front 0 Address ❑ TENANT ❑ ELECTRICAL El - PLUMBING f:y MECHANICAL B Rear N Contractor's Name,4IC. t4 *eat• PhoneT4••Uo5Z, ❑ 'OTHER PROJECT DESCRIPTION SQ. FT- OCCUPANCY C Right N Address cens(mailing/ - = ..:CONIS'TRUCTIONAND PLANNING PC &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-Undrgmd. 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 Conduif-Undrgrnd. - 8: Foundation 59. Gas Pipe, ❑ 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 - 36. Rough Electric Wiring 67. Fencing & Access Approval 17: Rough Wiring Sign - 68. APPROVED FOR PLASTERING • 8. 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 • i 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test. 72. Underground Flush - 24. Roof Framing 73. Undergrnd.StorageTank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro . 26. T-Bar Ceiling (Structural) & Monocoat' ! 75. Dry Chemical - ' 27. Frame and Flashing /7 Z_ 76. Dry Standpipe 28. Lathing & Siding n �`"° -7g.,4FIXED SYSTEM FINAL 29. Insulation ,� 1 78. FIRE PREV. FINAL 30. Drywall Nailing qi+ 4/ HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat b. 1/ 79. FINAL INSPECTION 32. Electrical Power Meter-Final r f .80. FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: 34. Final Heating & Air Conditioning 9//x,97/,C • 35. Final Gas Pipe:Test /� 36. Hood or Canopy ' 37. Final Factory Fireplace . l- 38. Final Plumbing (39. Water Service-Final • 40. Gas Service-Final °k ' 41. Solar Domestic-Fin811 42. Backflow Preventer . 43. Backflow Irrigation;•;)' ' 44. Landscape IrrigationSystem 45. Sound Attenuation- - 46. Handicap Regulations: - _ 47. FINAL STRUCTURE:& BUILDING . .;:i - 48. Special Requirements Completed 1 49. Electric Release'to Edison. .. . - • • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY _ _ • _ _ • No. Date • ' I ' Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA • PERMIT NO. p// TRACT NO. LOT NO. 'BLDG.NO. . . i CONSTRUCTION PERMIT pp�,-0 C�- • Project Address7,...C) ,1 :x f r' 1723 .2/05/62 54. 12 TLI (o '-� -l7 •7/'h d !'. TYPE OF CONST: TION ,;�y} ,\..- V'� q Owner M 1 CASA . REST Phone LYS-7& 0 NEW B ADD ❑ALTERATION l Q ' - •- . - \ 1 Address . 0 REPAIR ❑'CONVERSION 0 DEMOLISH '(7 _ ' ;tt Arch/Eng. License No. 0 OTHER • ZONING REGULATIONS _ "Ito DESCRIPTION OF WORK Al LA/ 6A A.P.$ if 7. .20/-- /le. Address `. #F n1 ICOR.- fife& S 131-sh1_ ZONE '•!LNG. REF. ' Contractor /=IRE SA-FT ri..k a, Phone5P4•333Y TYPE OF PERMIT ' - • - BUILDING Tp BUILDING ,_s// SETBACKpC/LST. PROPERTY LINE . 1Y� Address 41.404_ E- LA pp LAE# 9MR If at les ❑ GRADING „ FO UNDAT,IOJV ] STRUCTURAL - - SLOE YARD // LICENSED-CONTRACTOR DECLARATION - ❑ TENANT. ELECTRICAL L7PLUMBING ❑MECHANICAL SIDE YARD. • I hereby affirm that I am licensed under provisions of Charter 9(com- l'. . RIGHT mencing with section 7000). of Division 3.-of the Business .and 0 OTHER - • Professions Code, 'and my license Is in full force and effect. , PROJECT DESCRIPTION . REAR YARD( ) License Class • • ` C - l Licenseg NR..)44 7 41 ' ' " ' - - - .PKG:SPACE REQ. -" PROVIDED /-%S.- 2.1- j/ytyn•�/-V ' 24€1.9• SQ:FT. Date Signature - - - - - - -'- 'STREET WIDTH E $ WORKERS'COMPENSATION DECLARATION OCCUPANCY—CONSTRUCTION TYPE I hereby affirm that I have a certificate of consent to self-insure or VALUATION 2 0�O—*ONE - - ZONING APPROVE BY DATE certificate of Workers' Compensation Insurance,.or a certified copy _ _ __ / • - _ SPECIAL CONDITE - -' thereof (Section 3800, Lab. C.). GRADING CU.YDS. - ACRES • Policy No. - - Company . . -' . .. - - . - - • ❑ Ce fed copy Is hereby furnished. _ REMARKS: R2'Gta.V\.� l.a C_e�� S L'�-..�s••.. - - - _. _ - ertified copy is filed with the city Building Division. . . EXEMPTION FROM WORKERS' COMPENSATION DECLARATION 4--..cJB ' - rcw .wru.r -3 y t . (This section need not be completed if the permit is for one hundred • . ($100) or less). _ . - . .. - . 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 PLUMBING PLAN CHECK ELECTRICAL' ' PLAN CHECK - - subject to the Workers'Compensation Laws of California. - uWt LLINL, _ AHAL,e. • Date Signature BATHTUBS' SHOWERS '" 50 FT S0.FT. NOTICE: If after making this declaration, you should become subject TOILETS URINALS-- - - GENERATOR 0-1-KW_1-10 KW • ito the Workers' Compensation provisions of the Labor Code,you must .TRANSFORMER . forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS - 'APPLIANCE - --10-50MW_50+ KW -\ revoked. - _ - - -- KIT.SINKS ' DISHWASHERS -- - MOTORS -- . ,Vs - ; CONSTRUCTION LENDING AGENCY 0-1 HP HP I hereby affirm that there is a construction lending agency,for the per- SERVICE SINKS SUMPS - • '(INC.SOLAR) 10-50 HP +.HP' formance of the work for which this permit is Issued (Section 3097 Civ. C.). c _ - FLOOR SINKS t\-- FLOOR DRAINS - - FIXTURES • OUTLETS SWITCHES • 40 Lender's Name Lender's Address r• DRINKING FOUNTAINS -- -- - - .GAS TUBE SIGNStt - r�•-1 OWNER BUILDER DECLARATION - - - INTERCEPTORS - " CLARIFIERS-- - ' - - ' - • POLE LIGHTS - I hereby affirm that I am exempt from.the Contractor's License Law for ( the.following reason (Section 7031.5 Business and Professions-Code:. SWIMMING POOL PTRAP wrvS I NUL I IUN • Any city or county which requires a permit to construct, alter, POLES METERED SUB- improve,demolish or repair any structure, prior to its issuance,also re- WATER-SERVICE- `--ALTERATION PANELS- -- MAIN _ - SUB ` • - quireslicensed pursuant for such permitisoto file a Contractor'signed statement that he Is pursuant to the provisions ot•the License Law •' GAS SERVICE OUTLETS " SERVICE- -AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the • Business and Professions Code) or that he is exempt therefrom antl the WATER HEATERS BTU OUTPUT • - - . - - - basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS- of not more than five hundred dollars ($500). ❑ I, as owner of the property;or my employees with wages as-their SOLAR TANK - - • COLLECTORS -- - - - - -• _ sale compensation, will do the work, and the structure is not intendedThe or Offered for sale. (Section 7044, Business-and Professions Code: The -SOLAR-PIPING-SYS. ISSUE FEE eitContractor's License Law does not apply to an owner of a property _ - .- APPLICATION APPROVED BV/7/y/ DAT E'� 8 who builds or improves thereon, and who does such work himself or ISSUE FEE" •,Z„e� a-- ...J t .-I through his own employees, If, ed that such improvements are not - - • / ^` intended or offered for sale. If, however, the buildingewill -or improvement 'MECHANICAL- PLAN CHECK i is sold within one year of completion, the owner will have the burden SUMMARY OF FEES of proving he did not build or Improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU _ PERMIT G $ ��•S� SMIP - $ r• SD 0-I, as owner of..the_property, am exclusively.contracting. with AND DUCTING-- - I licensed contractors to construct the project (Section 7044, Business 100,000+BTU .PLAN CHECK $._.2/.2..- PERMIT and Professions Code: The Contractor's License Law does-not applyto - . , ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING - $ 4 _. ' tracts from such projects-with a contractor(s)_licesnetl. pursuant. to SYSTEM - _ __ ., . _. ' GRADING S' • the Contractor's License Law). 100,000+BTU PLAN CHECK $ - n . i ❑-I am exempt under Section - -- - 'B.& P.C.for thisBOILERS- BTV T ELECTRICAL E $ : reason - - - • - - •- - PLAN CHECK g _. MICROFILM E' - SYSTEM REPAIR,ALTERATION Date Owner _ _ - - TOTAL'FEE$.' I hereby certify that I have read this application and state that the above EXHAUST SYSTEM . MULTIPLE MECHANICHL $ - LESS AD-Information is correct:- I agree-to comply with all city and county ,PLAN-CHECK. $ VANCE PC $_- ordinances and state laws relating to construction,and hereby authorizeI representatives of this city to enter upon the above mentioned • • /T[ '- ' // property for, spection rpf es. _ n S • Signature (� Date i• AS V L - FINAL FEE S iZI Drivers' License or 55 ISSUE FEE - . -, -- CMF 0865-46 White-Building; Canary-Applicant; Pink-Accounting;Goldenrod-Assessor • CONSTRUCTION AND PLANNING POOL& SPA - _ t�.�� Date ^ Inspector - Date. . Inspector APPROVALS Permit# F�J~/StIJ' APPROVALS t - - Permit# ' , - 1. Temporary Electrical Service or_Pole - - 43.. Pool & Equipment lo-ocation-‘-. ' .- - 2._ Soil Pipe-Undrgrn _ .- _ _ __ - . 44. Steel Reinforcement •- - • - , -.3. -Electrical Conduit.Utility-Undrgrn •- . - - _ -' ' 45. Forms • . . I. -4.- .Electrical.Conduit-Undrgrn ._ - . . . _ . - i_ ' _ 46.- Electrical Bonding . . - � _ - 5_ _Steel Reinforce__ - -.._ 47. Rough Plumbing & Pressure Test -- • - - .- - • -- - _ 6. _ Electrical UFBlGtn,.�. __ -_ ___ - , -, • ` „, 48. APPROVAL TO COVER-GUNITE - ,. • . -- 7. ._Footings _ _ _ ._ '�` _ 49. Electrical Conduit-Undrgrn - - : -8.- Foundation -- - - - - _ 50. .:Gas Pipe, ❑Undrgrn,Test ' -„ ` • - 9.- Water Pipe Undrgrn _ - __ ,�l51. Backwash Lines, P-Trap,-❑Undrgrn l's . . -- - - - .10. _ Structuraoor-Systey�i .-...y .-_ _ . . . . 52. -APPROVAL TO DECK - - . - ' 11.- Property Sewer.Line.&:House Connection _ - -. - - -- - . . -. • - 53. Backwash-& Receptor-Final - . ' - - . 12. -Street-Sewer Connection -111, _ - _ ': _ - 54. Heater &Vent-Fina( • - , 13. Rough.Plumbing _ -- jJ __. - - 55. Plumbing System -Final - . 14. Rough Electric-Conduit g -.- - - - - - " . - -56. Electrical-Final - . • _ 15. Rough Electric-Wiring L' '- - - - 57. Solar System-Final - - . ' 16: Rough Heating & Air Condi iioning - - -. 58. Fencing-& Access Approval , _ .. , - 19:- Ducts,in Structure- el -- - - - I - __ 59.- APPROVED FOR PLASTERING ' ' ' ' 1 18:-- Ducts, Ventilating --- -- .. - _ _ 19. Gas Pipe:Rough &Test - - - - - .60. POOL/SPA.SYSTEMS FINAL - 20f • Roof Framing --- - ! . ' - u• 21, Roof Sheathing .. ; -- .- . ' 22. Frame and Flashing - . NOTES: �. _ ] c#-- 24. Lathing & Siding -- - - -- -• - - - 25: Drywall Nailing - - . . . - - - - - - - - - - - 26. -Plaster Brown Coat • - - - • _ - - - --- - - • • • - l 27: - Electrical Power Meter-Final - • -. - - - -: . '•' - - - . 28. - Final Electric ` - - - - - - _ 29.- Final Heating & Air Conditioning --- - - - - - - - - 1111, 30. Final Gas Pipe-Test - -. - - - - 1 - 31:- Final Plumbing - - - - - -. - , .32: Water Service-Final - . • „ - - --r -- - - - ' I ' ' ' - • -33: Gas Service-Final" - - -- -- • - - - _ 34. Solar Domestic-Final ' ' •- - •. 35. Landscape Sprinkling System ' • - • - • ' . • 36. Sound Attenuation - - - . . • - - - - .. -- -- _ ' 37. Handicap Regulations j - - •. - 38. FINAL STRUCTURE & BUILDING - .. _ - . - _ _ _ . 39.. Special•Requirements Conipleted _ - ' _ - 40. Electric Release to Edison ' _ -' 41. Gas Release to Southern California Gas Co. _ ' 42.• CERTIFICATE OF OCCUPANCY - -- - - - - - - --- ' - - r, • -Nb._ _ - - Date . . - -__- - , -I.;41. 3959 I --EE3 11-75"1°00 297 ` ****44.00 "./ COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ` A For Applicant to Fill in Completely 1 AP LIGATION FOR BUILDING PERMIT Q `/J �/ /A' R EI E DATE RECEIVED DATE III- ADDRESS IpSLI.7 � . BUILDING ADDRESS / �f j I,/ ! ' e! I_ • J PERMfT NO. 'ct— —a I ' " �� — A.P.NO.// -._ O I-- OWNER MAIL BUILDING ADDRESSA�� 1 ADDRESS r LU 0 CITY '074 • NOlli L4Is rte TRACT e. pe 0' "' BLOCK ZZ CONSTRUCTION /tom' //�{l 7JEW ADD ALjER REPAIR MOVING nEmonsH < /�'/ O N LENDER 0- m J U BRANCH ref .I N I OWN,,EE/^RR1,( ,rs�J� pp�s� P1 Q '� ADDRESS AL • erv ,-,IVALUE /WD' C ' .< ARCHITECT TEL. USE s J Q OR ENGINEER NO U N FIRE {{{/// ///J F-2.-- r w. ADDRESS ZONE 1 fjfVPE Y 'GROUP 0_Ile J O CONTRACTOR _ " // - ,/ BYPROVE• ryL J DATE e- '� t_ U/ 7 5 Jo m z �_ J cc ADDRESS ll y2,t_ — ID w _••./ TEL. ZONE A NO.OF �I USE OF NEW O= CITY NO. (,JI PLANS�/ BUILDING . Z� �D�G W O STATE CITY YARDS APPROVED YARDS APPROVED s N cc LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING D O ' (FROM C/L STREET) SI2E Na OF BLDGS. OF LOT I NOW ON LOT FRONT FT. �' FT. qt.---- USE }-i USE OF ' EXISTING BLDG. R SLOE / ,lil J I— SIZE OF J� /NO.OF Z NEW BLDG7' Al/1 7 ROOMS STORIES L.SIDE FT T. Q EXTERIOR WALL ROOF V COVERING COVERING REAR FT. - Fl/ 1 ,1 r'�F B�DIN AND WORK TO BE PERFOR ED DISTANCE BET. BET.MAIN& I/( rP e ZrZ MAIN BLDGS. ACCESS. BLOCS. .. Q `of ^, /�� CAR. DATE PPR V Q LL CI. C.U.P. APPROVED ZB fCLO,s/i(/� f�+'�G(„(Jy ARYPPROVED A./�//" DATF / 'a� �7L OI hereby acknowledge that I have read this application and state WAV � ��"L that the above information is correct and agree to comply with cc all laws regulating building construction, and I shall not employ any Person in violation of the workman's compensation laws of (9,510 N the State of California. f. cWp ? I hereby certify that I am properly licensed as a contractor under '� 7O. FT. 2 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e CC am exempt from the provisions of the State of California Business VALUATION /� and Professions Code, Division 3,Chapter 9. f� 7 r /////� I� OS PERMIT FEE $ //� Signetur 1 , k 7 z /T/M `— PLAN CHECK $ /7 E B Perml isl S`.i/�(J(/(/ / q�sl Authorized Agent � QJ V v LL TOTAL FEE $ 7 41727 PAID I COSTA MESA BUILDING-SAFETY DEPARTMENT SPFl. 7_6-76cr�r0O13i4u' 4*'kir UO.1Q P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P LI ATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only R _ BY GATE RECEIVED TE ISSUED 6 /BUILDING r lJ . /l•� L�rCt/� 7 IC ADDRESS 2eJ�a F. I rJT/7 Ji IEEE j n //- (/ %RMITf�Q% DOWNER PA /J OVA -- Low - OP A.P.NO. // �OI' Y� PE //!!7 , MAILQ BUILDING ^y 7 \^' ADDRESS /075-0 .fqu N DN1'rEe Ave ADDRESS a ( E I I .lr TEL. CITY f4urM FE JPQluh& CA. No. TRACT I LOT BLOCK CONSTRUCTIONNEW qDO ALTER REPAIR MOVING , DEMOLISH LENDER NESItF / /\x/^� BRANCH PAN (;. - 1 /� OWNER r �0�� —(;.N.F.1 Or ADDRESS60 ARCHITECT TEL. USE ', IRgarlieVALUE �y ./../ OR ENGINEER NO. FIRE ADDRESS ZONE (411YPEPO . ) � APPROVED ><CONTRACTOR CCREtici e. coo nil 4 Assoc. t BY Y DATE O- l�' 7� /� r C- ADDRESS j,sy 1.AitOW TEL. 714 ZONE NO.OF USE OF NEW -� F• CITY pEOLA,J05 Ca Q373 NO. 7q)-4q(t� PLANS BUILDING r STATE 'S�- CITY YARDS APPROVED YARDS APPROVED LIC.NO. Sae 43 Z. LIC.Nada. MAIN BUILDING ACCESSORY BUILDING SIZE IND.OF BLDGS (FROM C/L STREET) p. OF LOT NOW ON LOT FRONT FT. FT. 's Q USE OF Ca EXISTING BLDG. R.SIDE FT. FT. La FSeparate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. W REAR FT. FT. t.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Ax MAIN BLDGS. ACCESS. BLDGS. ✓4 Pa,rz � 12T GENEC URP y DATE APPROVED 7 APPROVED l �Y DATE 0. O I hereby acknowledge that I have read this application and state crs X that the above information is correct and agree to comply with m all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation lows of m TW the State of California. I hereby certify that I am properly licensed es a contractor under SQ. FT. co the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 3 Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: — L am exempt from the provisions of the State of alltornia Dueness1 `o VALUATION PERMIT FEE E and Professions Code,Division 3,Chapter 9. ,,y, K -� Signature of 0 ))) P71, LAN CHECK E rn TAX E /67 O O Permittee nt S [— rnA LL v U Authorized Agent L, TOTAL PAID S i UI to • P"'"OO1iz9o* ****33.50 • 42218 n+;, �9 �r,�;, .— • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 PP ICA ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only R CEI ED V 6-,--7,91-1 pATE/R�ECEyIVED D/q TE I SS�UED ADDRESS BUILDING �/� � . /7 5.7--' `-�( \n 7�- 1 - 1�' (Q-L-i ? �j I1// A.P. NO.7//— /71— ti PERMIT rJ10. OWNER `Ad /YbYa /' MAIL ADDRESS/ y+�"LL ADIDR ESS�q/' CO ' '� 5-1..I - ^ TEL. kirET heya s LOTrif BLOCK CITY l• oSImo- ,A S/;- NO. / l CONSTRUCTION NEW ADD ALTER` ' RFPAIR (MOVING DEMO(ISH LENDER ' —BRANCH OWNER � � ,V WA r—W C.ADDRESS VALUE 'f�� ARCHITECT TEL. USE ` LIT '`'� (f�w_ OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP t A-...:12. / APPROVE L -7-1--7‘, / �1( CONTRACTOR /\ ,J J�r/_,PA/ `IZLI/1 BY /11 DATE -Z�-7 ADDRESS 111 111 -7 -7 ✓A- !!! �/�) �DX I /�/ TEL (Z'ON Ear N OF USE OF NEW I.-1 CITY O egfkiC NO. 9197_cost_ v/ . PL r� BUILDING l % 1T STATE �j CITY YARDS APPROVED YARDS APPROVED \ LIC. NO. 1Tl /4 2/7 LIC.NO. MAIN BUILDING ACCESSORY BUILDING u7 SIZE '^'Y I NO.OF BLDGS. (FROM C/L STREET) (� S OF LOT (NOW ON LOT FRONT FT. FT. ' Q USE OF / CO EXISTING BLDG. R.$ /( FT. FT. H- AA�\l Separate permits are required for L.SIDE \\ FT. FT. electric,plumbing and heating work. REAR FT. FT. GO L. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& �— Q //J� _MAIN BLOCS. ACCESS. BLDGS. .J ihf/o1�/r e c a,IL�� VAR.aW DATE C.U.P.iW APPROVED 7 ` L.� P/� (LAD DATEIO 21 1 (Lx / r\T\\ W L I hereby acknowledge that I have read this application and state 'n N CC that the above information Is correct and agree to comply with L all lows regulating building construction, and I shall not employ m Z any person In violation of the workman's compensation laws of 2 W the State of California. I herebycertifythat I amSQ. FT. cmv properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 0 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: — em exempt from the provisions of the State of alifornla Business ♦ ) 'a VALUATION PERMIT FEE $ vm and Professions Cod I islon 3,C prat 9. / ha �•t 09<1 PLAN CHECK $ / o 'n Signature of . // / / �-----• Permittee , •Cl s'�C.� • G 000 TAX $ 50 f U Authorized Agent TOTAL PAID $ ,st A