HomeMy WebLinkAbout300 17TH ST - Building Permits •
City of Costa Mesa
Development Services Department CERTIFICATE OF OCCUPANCY No. 001373
Building Safety Division
P.O. Box 1200
Costa Mesa,California
The Building located at inn r 17+h
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group —. Occupancy.
Use of Building i.ini T.nh-
Legal Description 8)-4-0 11-07.n2
(See reverse side for Metes and Bounds)
E28418
Building Permit No03-'223119,1:52759Electrical Permit NoE28120,E28136 Plumbing Permit No. w4P28119
Mechanical Permit No. B1.228119 Number of apartments and/or guest rooms
ISSUED TO: Building Official Bill Howard
:Ala Davis
zusu c;aza t=no by ,c.: . , =iJ. /Arc-
Carlsbad, CA 92009 -
Date 9' a -t? 7
,This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 1015-46 rev.1/83 White-Owner:Canary-Numerical File:Pink-Bldg.Permit File
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY N. 2336 C
P. O. Bax 317
Casio Mesa, California `^~
The Building located at PO Dant rink Ettnt
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group p Occupancy.
Use of Building $ Matta _
Legal Description 71.7-.%140-ii 3i
(See reverse side for Metes and Bounds)
•
Building Permit No. Silly j$ Electrical Permit No. g5411 Plumbing Permit No. MVP.
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C.
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency:
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments_ and/or guest rooms
ISSUED TO: Building Official
; It • by . re 0- icteL7,62
Date 23, 1
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Farm 0034-1M-11-63—S-B P
.affil, CITY QF COSTA MESA
n
a�► BUILDING DIVISION
i' ,' ,� DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
fir rfi ..
- PERMIT . - B06-01283
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cedWILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 300 E 17TH ST Status: ISSUED
Suite: Applied: 08/01/2006
. Vicinity: Issued: 08/01/2006
Primary Occ: B Eat<50/Office/Bar<50 Type of Construction: I-FR
Parcel Number: 42501108 Zoning:
Applicant:. ANDREW MAUPIN
Address: 923 N LOGAN STREET /L
Phone: 714834-1462 ISSUED BY: ��l'-
SANTA ANA,CA _ --- - - _ "Zip: -92701
-.r— -
Owner: O'DONNELL,MICHAEL_S TR ';r •
Address 5525 WEMBLY.'AVE---,-_ .' , - '
Phone: '', i
AGOURA,CA. A� - Zip: . 91301i / � �.
�
/ „7c\ v -
Contractor:; ALL.SURFACE ROOFINGAND WATERPROOFING,WC�` . • \�
Addres./93N •
LOGAN STREET �� „"�, - �"
/ Phone: 714 834-1462VS-, •� 'i /�-A ' •
/ is `,, />,,/,,,,Y,,,,,,„-- �"VV ' ,v/ ` VA
/ i 1 \SANTAANA/CA V A . �� `
/ ' /Zip: 92701-%;j�' License: 729505 " `
;'Arai :/ ,/,' //IV Eng: Aiirr
,
Address:' ,/,',/,,j2 Address: _ _ `. -
. - Phone: •_ - -. ,Phone: -
/
Zip: , , , License: . . -✓.,- _` - , License: - .
SCOPE OF PERMVIIT' \ /
TEAR OFF EXISTING'ROOF..INSTALL 3 PLY ROCK,BASE,BUILT UP ROOFING SYSTEM TO MEET TITLE 24 ENER' Y REQUIREMENTS
' ;%' . \ 7V .V , -
FEE SUMMARY N
', Plan Check ' $0.00 / ,r 7 ,,-,, - 1 •r-: , (,-Calc Valuation ( $6,000.00
' Permit. ' $125.25 i ) 2, 1 / -5: . ,Claim Valuation. $6,000.00
'SMTP Res:,, I $0.00 '.. _ _ - _ _ .�_ _ .
I • SMTP Com:':,. $126 r� ,77
Other, $0.00 ,.
Inspection: $0.00
\,' , ',_Total:',�,• $126.51 / /%J ' _ /'
PLANNING 8,-ZONING ,/1
SETBACKS � ,
MAIN STRUCTURE Front 0-0 Rear . .0-'0:.' ' Left _ 0-0 Right 0-0i'/ , ,
> _ ,�',, r
ACCESSORY „ Front v0 0 - �
i _rRear 0 0. , Left 0 0 ', Right 0`0' /7�'
PARKINGCN_A ,Exishnq 0 �Relwred.' 0 Proposed: 0 „<-,/ <,�� •/i
A \S. --iii /;
V< �, ", i' 1, tai , , , '/ii
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 inspectionsand final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)7545626 .
2448-48(8/00) .
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of the following declarations: • ,
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
dr for which this permit is issued.
and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which Nis permit is issued.
My w rs'compensation Insurance carrier and policy number are:
Cartier. OLS. umber: ^}-0 2-4 b 4- ^O(—O 2
Mlon need not be completed if the permit Is valued at one hundred dollars($100)or less.)
❑ I certify that in the perfo of the work f•r 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 C: and ag .• a if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Cale,I shall forthwith
ase pro
11� — — —O
r�� Ca
- •1[ OSE IRE W•- RS'COMPENSA TVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO ThENAL PENALTIES AND CML FINES UP TO ONE HUNDRED
too D DOL ARE($100,000),IN ADDITION TO THE COST G' •...,-ENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3103 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm thm licensed under provisions of Chapter 9(commencing with Section 7000)of DI ' ion 3 of thae Business and Professions Code,and my license is In full
force .4 q r� .lesh �— C —3g
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
'OWNER-BUILDER DECLARATIONS:
I hereby attire 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 thong than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,end who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. , Business and Professions Code for this reason:
Signature: • Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration farts for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If en RMPP is presently required,has Section 25534 of the California Health and Safely 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 epermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes L I No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cale).
7 If a permit from the South Coast Air Quality Management dd 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 Californiais Health and Safety Code Section 42303 been made? 0 Yes 0 No
--
_
B (11 yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penally 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-desc'••• property for' spection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection.
Is
f/. ign: re Of Legal Owner(s) - ( Date
IF —'O
,"•':%fLT.hodzetl Appli --_ Dale
4.
CODE A INSPECTION TYPE IMO -' g9g ILi1QIN& SOH t INSPEC NTYPE all Illy$
1616 Fixed System Final Fire Prevention • 206 Final Mechanical
1286 Pool Spa Final /// alai
208 Final Plumbing
200 Final Re-Roof A9 7-O6 Fi 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
• • Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA'MESA CONSTRUCTION7PERMIT
PERMIT . Q TRACT NO. LOT•NO. UNIT NO. •
'.a%o 4_ 17 c, - , . S �� / 5963 4/13/87 6 00 TL
Proje'c't Address heir- y ��{/� lye o
+ E. f7" ��""""'4IAC TYPE OF CONSTRUCTION -.KNEW U ADD U ALTERATION U REPAIR
Applicant's Mailing dress
❑ CONVERSION ❑ DEMOLISH ❑ OTHER ^ A.P.# I Zone '
:Owner's Name //� -- /yy�,, Phone / DESCRIPTION OF WORK/USE OF BLDG. SreleaY'a✓ PAW< Y Pa IC-
erasL,/L Lo. 4rrp ter-eke e 7x4, / rid S Main Building: Accessory Building:
1
' go-----.-- N- ����A' "if License No. TYPE OF PE RMIT��I❑ GRADING CI FOUNDATION U STRUCTURAL E Front O
Address / er����4��/, to • �/ eel,/ �y ❑ TENANT 18 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Namur' ylo Ct.D15 Phor ale49/ ❑ OTHER A 1
J 71 /� of
PROJECT DESCRIPTION ••SQ. FT. OCCUPANCY C Right N
Address(mailing) /Z• ( R I�� (Aro /dl CONSTRUCTION TYPE VALUATION$ S Left • R
City License No. S� ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# • Parking Req./Provided E
•
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Q
with section 7000) of Division 3 of the Business and Professions Code, and M
my license is int I for< antl effect. ��/����- =� T
License Mass 3� �/..��'' Lice se l•'-� _ S
Date #C/7j Signature L� PLUMBING FEES
WORKERS'COMPENSATION DEC ARATI Sink Showers
tereby affirm that I have a certificate of consent to self-insure or a certificate - ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section —
Backflo . 'reventer Service Sink
0(300, Lab. C.) ��y•� ` ��/,/ _ Automatic Washer Transformer ❑ 15-50 KW
Policy No. tocere Jl7 Company L'lKff Backflow Irrig. 'on �.. ❑ 50+ KW
3 Construction Pole Sub.
fed copy is hereby furnished. - - -
�p�d copy is filed with the city I . 9 DI 'sio YBathtubs Sewer Connection - Cooking Unit ; Meter ❑up to 100 amps
Date t --FS Applicant / •
EXEMPTION FROM WORKERS'COMP NSATI D LARATION Clarifiers • Solar Collectors Dishwasher Meter Clover 100 amps '
(This section need not be completed if the permit is for one hundred($100) or
less). Dishwasher . • Solar Pipin. Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit Is issued I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar .nkFan
Workers' Compensation Laws of California. - Motors 00-1 HP ❑1X-8
Date Signature Floor Drains 16. .•d1! r ' pa .
-
NOTICE: If,after making this declaration, you Should become subject to the Or - Inc.Solar ❑9-15 HP 016.15+
_ -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks I Uri Fixtures Microwave
comply with such provisions Or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY • Gas Service Outlets Water Cl. KDevice Boxes
1 hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets e
Lender's Name - Range .
Lender's Address . Kitchen Sink Water Service - Switches - -
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories' Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or - Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry
any structure, prior to its issuance, also requires the applicant for such permit Trays Generator ❑05 KW❑5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Ro•- trains / ~
the Contractor's License Law(Chapter 9(commencing with Section 7000)of / ZemP. PCW 2Y Po�' S 00
'vision 3 of the Business and Professions Code) or that he/she is exempt - - - -
erefrom and the basis for the alleged exemption. Any violation of Section
.031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500).
O I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ —_ •
compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee 1 $15 Issue Fee $ 3
for,sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL f.GBS
License Law does not apply to an owner of a property who builds or improves -
thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boile Hood or Type I 0
safe. If, however, the building or improvement is sold within one year of com- Canopy Type II ■ Zoning Approved By Date
pletion, the owner will have the burden Of proving he/She did not build or Im- Duct-Unde ound
prove for the purpose of sale). • - Building Approved By 71/147 Date
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigerate•• ystem Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑1 .1,000 BTU ❑100,000 BTU
builds or,improves thereon, and who contracts for such projects with a con- Pl. SUMMARY OF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware thatExhaust System ❑ Multiple • ��m Repair/Alteration - BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ -
❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG Damp- ER PERMIT MIT CE $
i •
PLUMBING $ -
•
Date Owner Heating System cutting PLAN CHECK 25% $ ENERGY P.C. '$ -
I hereby certify that I have read this application and state that the above ❑0100,01: :TU 0100,000BT A
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ 03 - GRADING $ '
and state laws relating to buildin• construction, and hereby authorize repre- MICROFILM $
sentatives of t isl ity o e'te/ .on the above-mentioned p operty for PLAN CHECK 50% $
inspection pu--o --. pp e
Signature . r.,Ci ✓. Dat �0 7 i MECHANICAL $ TOTAL FEE $ 8 . 00
Drivers' Licen e or S5 • r -' - Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
1 _ _
CMF 0865-46,rev.10/84 white - Building: Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND,PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
•
1...Temporary Electrical-Service or Pole 52. Pool & Equipment Location
.
2. Soil Pipe-Undrgrnd. 1. 53. Steel Reinforcement
1
3. Electrical Conduit Utility•Undrgrnd. .- 54. Forms
4. Electrical Conduit-Undryrnd. - 55. Electrical Bonding
5. Steel Reinforcement • 56. Rough Plumbing& Pressure Test
6. Electrical UFER Grnd.. . . 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing - - 65. Electrical-Final
15. Rough Electrical-Conduit . 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling , - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
td
21. Ducts, in Structure 71i. Underground Hydro
22. Ducts, Ventilating 71. Product Piping�O Gas 0 Oil
23. Gas Pipe-Rough & Test. 72. Undergroundf, lush I
24. Roof Framing . • 73.' Undergrnd.SJ rageTank 0 Gas El Oil .,
25. Roof Sheathing J74. Overhead Hyadro
26. T-Bar Ceiling (Structural) & Monoclat.tt 1175. Dry Chemic )
27. Frame and Flashing _ ._.:r."--t;.tleikry Standpia
28. Lathing & Siding .77. fIXED SYSTEM FINAL ' '
29. Insulation , .78. FIRE PREV. FINAL
•
30. Drywall NailingHEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION _
•
32. Electrical Power Meter-Final / �Tiv 80. FOOD CERTIFICATE ISSUED •
33. Final Electric 7/il47 Notes:
34. Final Heating & Air Conditioning ///"„/// .
,35. Final Gas Pipe-Test
i
36.. Hood or Canopy /, ,
37. Final Factory Fireplace r• - :c-
38. Final Plumbing • 1
•
39, Water Service-Final ` -
,1
40. Gas Service-Final `
41. Solar Domestic-Final - ' -. +.
42. Backflow Preventer -
43. Backflow Irrigation 4-`
'44. Landscape Irrigation System
11 .
45..Sound Attenuation { , !'--.
46.'Handicap Regulations
47. FINAL STRUCTURE & BUILDING. , .e. �'
48. Special Requirements Completed r ' - '
49. Electric Release to Edison A
50. Gas Release to Southern California Gas th f' i'
51. CERTIFICATE OF OCCUPANCY
No.• Date ' '
l
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT NO. TRACT NO. : LOT NO. UNIT NO.
cm(of COSTA'S CONSTRUCTION PERMIT �.. 3 Z9
/7 74 187° -12..- I ' ,
Rroject Add q / TYPE OF CONSTRUCTION ----
Irrit•sMailingAddress /O T 4lR-409le toe• �� NEW U ADD Li ALTERATION U REPAIR f
µAp p ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
¢nen is Name AdJ ZA eds Phonees�'i •�5 r�Q L�O� A.P.# Zone
......../". DESCRIPTION OF WORK/USE OF BLDG. M�� • l L
Address �,py S Main Building: Accessory Building:
Arch/Eng. License No. Tn s'SZ TYPE1--��OF PERMIT(� ❑ GRADING 0 FOUNDATION ❑ STRUCTURAL E Front Z0
Address '' n.' D TENANT ILN ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear • N
Contractor's Name ���� �'!'O Phoni27'7 S•�/ / �Q OTHER C Right N
rt ,r,, r PROJECT DESCRIPTION SQ.FT. OCCUPANCY
Address(mailing) in, / 7 L/r'f�45t �/rf1e, nrP '.q't/'07/➢/1 aS. CONSTRUCTION TYPE VALUATIONS s Left -- G
City License No. yO® r! ZONE GRADING CU.YDS.- ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
• I nereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Re F SM in Z S J ' Planning Notes: - M
with section 7000) of Division 3 of the Business and Professions Code,and - -
my license is in I 11 force and effect. • / s-53 .• •
§
T
OCI License Class icense 7(J ,}, /
Do Date-7-/7 87 Signature -/' ✓� PLUMBING FEES
WORKERS'COMPENSATION 0 Or•TIO• -
Bar Sink Showers �' ELECTRICAL FEES
'iereby affirm that I have a certi I . e of consent to self'insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
s00, Lab. C.) Backflow Preventer Service Sink Automatic Washer- Transformer 0 15.50 KW
I' Policy No. 18/C -66131/5- Company/a/2�E1750ni !//h'L� > Backflow Irrigation Cavo,r., Construction Pole Sub. _— ❑ 50+ KW .
�"0 [� Certified copy is hereby furnished.
Q Carji d c9p�y Ilfi wiA-th the cit g Ston Bathtubs, Sewer Connection : i - Cooking Unit Meter ❑upr(O 100 amps -
Ddte / / ppnoxnt L—I/
EXEMPTION FRO WORKERS'C TION DECLARATION Clarifiers Solar Collectors Dishwasher / Meter over 100 amps 7 .0
(Thissection need not be complet permit is for one hundred (8100) or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric - Sub Panel -
I certify that in the performance of the work for which this permit is Issued, I „
-
shall not employ any person In any manner so as to become subject to the _Drinking Fountains Solar Fan
Workers' Compensation Laws of California. Motors 00-1 HP 01%-8
Date Signature Floor Drains _�
S ming Pool w/Spa - F.A,U. Inc.Solar ❑9.75 HP❑i6-15+ -
NOTICE: If,after making-this declaration, you should become subject to the
' Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY , Gas Service Outlets Water Closet
thereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
of the work for which this• permit is issued (Section 3097 COL. C.) Interceptors Water Heater -Outlets
Lender's Name - Range ,
Lender's Address Kitchen Sink Water Service . Switches Sign
OWNER BUILDER DECLARATION ,
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason {Section 7031.5 Business and Professional Code: Any city or _ Garbage Disposal Standing Sections •
county which requires a permit to Construct,alter,improve,demolish or repair P-Trap - • LaundryTrays
any structure, prior to its issuance,also requires the applicant for such permit - Generator ❑0-5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of •Roof Drr. s -
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
`tvision 3 of the Business and Professions Code) or that he/she Is exempt - - -
srefrom and the basis for the alleged exemption. Any violation of Section ,
,31.5 by any applicant for a permit subjects the applicant to a civil
0enalty of not more than five hundred dollars($500).
U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not Intended or offered _ - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves ___ _ _ •
thereon, and who does such work himself/herself or through his or her own I DEVELOPMENT SERVICES REQUIREMENTS: .
employees, provided that such improvements are not intended or offered for Boiler HOOd or Type I 0
ZoningApproved
sale. If, however, the building the Improvement is g sold within one year of rOm- _ Canopy Type II 0 By •
Data L
prove for, the owner will have burden of proving he/she did not build or im- —^Duct•Under Ground • Building Approved By ' Date 7 7/(y /
prove the purpose of sale). / /
❑ I, as owner of the property, exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project(Section 7044,Business
and Professions Code:
The Contractor's License Law does not apply to an owner of property who r—Duct-Ventilating 00-100,000 BTU ,000 BTU
builds-or improves thereon,and who contracts for such projects with a con- _, SUMMARY OF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Ir/Alteration BUILDING PERMIT $ SMTP -
§
proof of their Worker's Compensation insurance should be provided to me.
0 I am exempt under Section 8.& P.C.for this reason Firepl/Fact.Blt. ICBO# Ire Dampers PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE §
Date Owner Heating System& Ductin Registers ENERGY P.C. $
❑0-100,000 BTU ,000BTL • I_ PLAN CHECK 25% $
I hereby certify that I have read this application and state that the above GRADING $
information is correct. I buildingtonslruCti and hereby authorizerepre- ^
sentatives of this ty to enter up
ab•n the above-mentioned property for PLAN CHECK 50% $ 3 , 73 MICROFILM $
inspection pure•--<!L/ _
Signature A / Date /r7' MECHANICAL $ TOTAL FEE $ j4 r 25
Drivers' Li r. •r SS# �� ¢inspection Fee I ' $15 Issue Fee { ' $ 3 PLAN CHECK 25% $
r -
CMF 0865.46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor __
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit • Date Inspector
IrTemporary 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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd,
8. Foundation - 59. Gas'Pi e;D Undrgrnd.,Test •
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. .
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 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 , 71-0,Product PArig 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72A Underground Flush
24. Roof Framing 71.1 Undergrnd,Storage Tank D Gas D Oil
' 25. Roof Sheathing 74! Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75'. Dry Chemical
27. Fraine and Flashing 76. Dry Standpipe '
28. Lathing& Siding 7i FIXED SYSTEM FINAL . a r
vm YYYYYY
29. Insulation 78, FIRE PRENINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
I
31. Plaster Brown Coat J Es. FINAL INSPECTION ' ;. t 1
32. Electrical Power Meter-Final 1gy{/ 80.. FOOD CERTIFICATE ISSUEDI
..1:•
33. Final Electric ` /'jt/ Notes: 7 _a,0 ,g 7 , t4_ /
34. Final Heating & Air Conditioning Ce-44
. 4 a O .{-- -4.--r•-.." / / ��
35.. Final Gas Pipe-Test J. G
• 0-rt/
36: Hood or Canopy
37. Final Factory Fireplace ..
38. Final Plumbing
' 4
39. Water Service-Final ' '
40. Gas Service-Final
41. Solar Domestic-Final r -
42. Backf low Preventer - - - •
43. Backflow Irrigation /
.44. Landscape Irrigation System - - - , •.
45. Sound Attenuation V; - -
46. Handicap Regulations 0.'-
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49' Electric Release to Edison • /
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY /
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
/CITYPERMIT NO. TRACT NO. LOT NO. UNIT NO. 1 r l �`
rLCITY QE COS �_MESA CONSTRUCTION PERMIT Z�1 3 �_r .
Project Address 300-E-17th Street—__ — - ' -1--' - •t
• TYPE OF CONSTRUCTION JC1E' NEW LJ ADD U ALTERATION LJ REPAIR
Applicant'B Mailing Address ' P n PDX 11 0 Fallbrook 9202$ - q 'R 1C 1CC�
❑ CONVERSION ❑.DEMOLISH ❑ OTHER •q.p,# f: one
Owner's Name Minh—Lube. Inc. PRS-+50 -.4667 •DESCRIPTION OF WORK/USE OF BLDG. '
Address 100 F 17th Costa Mesa. California S Main Building: - •AccessoryBuilding:
Arch/Eng. License No. TYPE OF PERMIT .LJ GRADING U FOUNDATION LJ STRUCTURAL E Front till l Lt CUSIA Ml %' _ o
Address E❑ TENANT ® ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Nam- - - P1�-723-1955 ❑ OTHER - -
• • PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) P C) Pox 110 Fal lhrnok, Ca 92028 • ,
K Left
40219 . CONSTRUCTION TYPE VALUATION$ s
N City License No. ' ZONE - GRADING CU.YDS. ACRES R
rLICENSED CONTRACTOR DECLARATION . - • Ping. Ref.# •
Parking Req./Provided E
W hereby affirm that I am licensed finder pr islon5 of Charter 9 (commencing Remarks: " Planning Notes: - M
Iwith section 7000) of Division 3 of the siness and Professions Code, and pC
my license is in full force and effect, /-(,h. r'r II M P 2$[I g , P.c. +� 8 6 -8 7A- RSI - • s
License Class_CIO ansa No. 491 81 2 ' -
PLUMBING FE - -
Date d/Rf$7 Signature l.PP Ra tPS i ES
•
WORKERS'COMPENSATION DECLA ATION •
Bar Sink Showers • ' • -
iereby affirm that I have a certificate of consent to self-insure or a certificate - ELECTRICAL • FEES
i Workers' Compensation Insurance, or a certified copy thereof (Section g; flow Preventer Service Sink - 1+
3800, Lab. C.) Automatic Washer- - Transformer 0 15-50 KW Policy No. 76051-R6 ' Compan State Fund PX 7487 - Backf . IrrigationCap' Sewer
COnS[ruc[i0 50 r KW ' •
1F Certified copy is hereby furnished. - - on'POI¢$Ub. - i
Cer If" is filed with the city B • 1: a"!. •n. Bathtubs • Se i - nection Cooking Unit , Meter ❑up to 100 amps
Date • � � . Applicant Iii;si-►G Lee Hates ,
EXEMPTION FROM WORKERS'COMP r 5•TION DECLARATION - -, Clarifiers olar Collectors Dishwasher 1 Meter Clover 100 amps! 7' so
(This section need not be completed if the permit is for one hundred ($100) or J
less). - .' . Dishwasher ' Solar Piping Dryers ❑Gas ❑Electric ' Sub Panel
I I certify that in the performance of the work for which this permit is Issued, I - - 1 200 atRp 1ph .r. C a
shall not employ any person in any manner so as to become subject to the Drinking Fountains ` Solar Tan' Fan
' Workers' Compensation Laws of California. _ - ♦ 1' 1/15th HP 1 p]1 1 Motors [l(li X-8 - •,� 00
Date Signature Floor Drains w/Spa 'i- F.A.U. '
NOTICE: If,after making this declaration,you should become subject to the Inc.Solar 08-151-(P 016-15+ 1 QC
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Fixtures
•
comply with such provisions or this permit shall be deemed revoked. �� 38 Microwave. - �/' 7 fib
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water C • Q - Device Boxes -
1 hereby affirm that there is a construction lending agency for the performance cc Pole Light //� CO
of the work for which this permit is issued (Section 3097 Cly. C.) Interceptors WatEr Heater DU[I¢t$ V
Lender's Name . 19 Range`s 2
417
Lender's Address - Kitchen Sink ater Service . io Switches • 1- sign Out]et only,
OWNER BUILDER DECLARATION - Y Z 7'a
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories A 0-Wash1 Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or _
county which requires a permit to construct;alter,improve,demolish or repair P-Trap La .ry Trays Generator ❑a5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit - _ Trash Compactor
to file a ractotl statement that(Chapter
is licensed pursuant to thetprovisions \ i
the Cona signed License Law(Chapter s cpursuant
ng with hpr vis o of Roo�•Dr ns ``\
livision 3 of the Business and Professions'Code) or that he/she is exempt - -
nerefrom 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 _
oenalty of not more than five hundred dollars($500). $ 3
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 I e Fee •-
compensation, will do the work,and the structure is not Intended or offered .1 Reinspection Fee I $15 Issue Fee - • $ 3
for sale (Section 7044,- Business and Professional Code: The Contractor's MECHANICAL • 'FEES '
License Law does not apply to an owner of a property who builds or improves G
thereon, and who does such work himself/herself or through his or her own . DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for r Hood or Type I ❑ •
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Unection • Approved ByDate
`S
rove for the purpose of sale). e7
I, as owner Of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration Sys ' Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,0f f :TU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and Who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ em Repair/Alteration BUILDING PERMIT $ SMIP $ '
proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BI[. ICBG# ' Fire pers PLUMBING $ ISSUANCE $
Date Owner Heating System& Duc 's• Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify tha I have read this application and state that the above ❑0.100,00067 4100,000 BTL ELECTRICAL $ I - 75 GRADING $ •
information is corre• . I agree to comply with all city and county ordinances -
and state laws re /g to building construction, and hereby authorize repre- - MICROFILM $
sentatives of_ t 'sty,to -r upon the above-mentioned property for PLAN CHECK 50% $ s
inspection puro 7 - • MECHANICAL $ 6r d
Signature' - ���� -- •- - Date 4/R/R7 - TOTAL FEE $ S
r\ 'einspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
—Drivers' License or SS ,
__ '.
innev.-10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
•
,CONSTRUCTION AND PLANNING • •! .i r '� ". POOL &SPA
APPROVALS Permit# Date •Inspector Date Inspector
QPPRO,VALS Permit#
1.-,emporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. &- Q� 54. Forms,
4. Electrical Conduit-Undrgrnd. ss 55. Electrical Bonding
5. Steel Reinforcement yG1� 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd,; �� ab 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 x �Solar System-Final
16. Rough Electric Wiring , �,.�� encing & 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. Aough Factory Fireplace APPROVALS Permit# r' _
21. Ducts, in Structure • 70. Undergroundklydro
22. Ducts, Ventilating • 71./Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing ,`73. Undeigrnd-Storage Tank 0 Gas O Oil
25. Roof Sheathing �� 't / '74. Overhead Hydro .
26. T-Bar Ceiling (Structural) & Monocoat 75.-Dry Cqmicat
27. Frame and Flashing I X76. Dry Standpipe
28. Lathing & Siding 77 II gED SYSTEM FINAL
29. Insulation - • 78. IWRE P.REV. FINAL
30. Drywall Nailing • HEALTH DEPT.-REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION :, y
32. Electrical Power Meter-Final C 80. FOOD CERTIFICATE ISSUED A
✓33. Final Electric nN7t 7-941 V C Notes: a7 _,.Ya
34. Final Heating & Air Conditioning
"
9 - Sc-6 /"c.>rc..irtCle a ENf..�r� :0)
35. Final Gas Pipe-Test e_���5,7 pG_ /Q,/ '�_ - - _Q , _ I r sik
36. Hood or Canopy w-fr l.o-c�h�v�ca' �G4°''�C"+^.1` ^'."""'Q�•�+'�
37. Final Factory Fireplace 7-9-17 - C'� ..t O/C ,/c
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. Special Requirements Completed ;,r_ •
49. Electric Release to Edison
•
50. Gas Release to Southern California Gas Co !,r '
51. CERTIFICATE OF OCCUPANCY /
No. - Date I
Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. s 176/40 E/I . /• ,- 4
CITY OF, COSTA MESA CONSTRUCTION PERMIT PER ITO.6��[/, g TRACT NO. LOT NO. UNIT NO.
Project Address 300 .t'•• /7 ' S,4 Gy 7 T�� .
Applicant's Mailing Address ;�/1io Cie Lwe cYet) 9qQp/, VPE OF CONSTRUCTION U NEW U ADD LI ALTERATION H REPAIR
Owner's Name /S 0113 /(/AVIS Phone / r'd ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone
DESCRIPTION OF WORK/USE OF BLDG. -
Address 6/9•931e-,130 - s Main Building: Accessory Building:
• Arch/Eng. License No. TYPE OF PERMIT LI GRADING El FOUNDATION ❑ STRUCTURAL T Front ZO
Address •
El
El III ELECTRICAL El PLUMBING El MECHANICAL BOTHERB Rear N
Contractor's Name Q 6 Phone C Right N
Address(mailing) PROJECT DESCRIPTION SQ. FT. OCCUPANCY_ K G
C ON ST RUCTION TYPE VALUATION$ $ Left
City License No. • ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION • _ Ping. Ref. # Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 6//
✓9 - Z 5r/ / C' Planning Notes: • M
with section 7000) of Division 3 of the Business and Professions Code, and I /'
my license is in full force and effect. /'9' 7 w/3 et,_ - T
License Class License No. a� t
Date Signature- PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
ereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL - FEES
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer . Service Sink
Automatic Washer Transformer 0 15-50 KW
4800,lisLab. C.) �`CO l
Policy No. Company Backflow Irrigation Sewer Cap0 50+ KW 1f+�7 J
Construction Pole Sub.
Certified copy is,herebyw furnished.hcity Cert ltietl copy Is filed with the city Builtling Division. Bathtubs Se vection Cooking Unit Meter ❑up to 100 amps
Date Applicant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps •
(This section need not be completed if the permit is for one hundred ($100)or ' •
less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel
I certify that in the performance of the work for ch this rmit is issued, I —�
shall not employ any person in any manner so to becom subject to the Drinking Fountain Solar Tank Fan Motors❑Oi HP ❑1%-8
Workers' Cor9gPnsatis>a�Laws of Califo •
-
Oate >' // OO (( Signature Floor Drains Swimming Pool F.A.U. Inc.Solar ❑9.15 HP ❑16.15+
NOTICE:If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urin Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY Gas Service Outlets ater Closet Device Boxes '' Pole Light
I hereby affirm that there is a construction lending agency for the performance '
of the work for ,which this permit is issued (Section 3097 Civ. C.) Interceptors Water HeaterOutlets
Lender's Name Range
Lender's Address - - Kitchen Sink Water Service • Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash • Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator ❑05 KW❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit - Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains -
•he Contractor's License Law(Chapter 9 (commencing with Section 7000)of ,r
vision 3 of the Business and Professions Cotle) or that he/she is exempt
erefrom and the basis for the alleged exemption. Any violation of Section .
.031,5 by any applicant for a permit subjects the applicant to a civil ( -
enalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered •
- Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own - - - - - DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
ole y1al on, the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground Building Approved By Date
pr6 I.
for wn purposef of oe). /� �/// /pr/
�0 I, as owner of the property, Se exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By t/S/ul Date / O
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts-for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware thatExhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. — PLAN CHECK $ PERMIT
0 I am exempt under'Section i .&1\C.for this reason — PLUMBING ' $Firepl/Fact.Bit. ICBG# Fire Dampers ISSUANCE $
1
Date — Owner Heatin g S ystem& Ducting Registers ENERGY P.C. $
I hereby certify that I have read his application and state that the above DO-100,000 BTU 0100,000 BTL
PLAN CHECK 25% $
Information is correct. I agree to • • with all city and county ordinances EL ELECTRICAL $ 't.O IJ GRADING $
and state laws relating to buil.' g const uction, and hereby authorize repre- MICROFILM $
sentatives of this -,y to -n• r upon he above-mentioned pr•perty for PLAN CHECK 50% $ p
inspection p,r•.-Y I" Sr— �, — MECHANICAL $ TOTAL FEE $ C. 'Of/
SignatureDrivers'
_.l Date ,
DLi -rise or SS#
CMF 0865-46,rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole skit" & 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. v 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVE R-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑ Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring , 67. Fencing &Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating /1. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing / 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat X 75. Dry Chemical
27. Frame and Flashing /7 76. DryrStandpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PR EV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final l 80. FOOD CERTIFICATE ISSUED
33. Final Electric 11/7/8k 6.41 Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36: Hood or Canopy
37. Final Factory Fireplace •
38. Final Plumbing
39. Water Service-Final .
• 40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
i
44. Landscape Irrigation System
-45:-Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING • I
48.--Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co t ' -
51. CERTIFICATE OF OCCUPANCY
No. Date
C: M( h I 1--` (01/4, , --• Applicant to fill in all spaces except those within heavy border Ines and sign all appropriate declarations. 59�p
CI:1Y OF COSTA MESA CONSTRUCTION PERMIT 'PERMIT NO. TRACT NO. LOT NO UNIT NO. it/I3/e/ �3r,o I ] ?
" Ik & ?on.E. /'7I t571?ef f t5MF2 a /I `f 659
roj ct Address ������
t , Applicant's Mailing Address J /k .n, , TYPE OF CONSTRUCTION LQ' EW ❑ ADD L I ALTERATION LJ REPAIR r -i1
,�¢Q ❑ CONVERSION ❑ DEMOLISH ❑ OTHER -. A.P.# l 2 -O\\— O • Zone•
Ownir's Name' ,Bp rV A-L1 L< Pone -• 9 '�� • __ - 4 S 7 �' '
DESCRIPTION OF WORK/USE OF BLDG. )
y ddress �g/l, CA%A61-ro C�"grind/y 9w7609 - S Main Building: Accessory Building:
' 4rch/Eng./1 C!t/341-56
op LLCd,w�/i(.H ICr/` :Lic
cense�N.00.. 1 •-TYPE OF PERMIT ❑ GRADING llqq❑ FOUNDATION 2 STRUCTURAL E Front' �C/• Z
Address 200 '/'+A/rr ,rf.. �'CQ%TA /leg° qt�4 te* '❑ TENANT 2 ELECTRICAL ILi PLUMBING VAI MECHANICAL B / O
��//po _ Rear LG 5 • N
Contractor's Nameif, G/'//i/' C4'5r. G 19' Phone ❑ OTHER A tl I
/ /J �`e� Y PROJECT DESCRIPTION SO. FT. _ OCCUPANCY n C Right 23 N
Address(mailing) 1�'14 f-/�/�� �I VA' •i" •- YLf��!//'YGS CON ST RUCTION TYPE VALUATION$ I9'9 /•77. 0 $ Left 2 3? G
City License No. 11d0'JG . . . _ ' J. .� ;,,.. / R
ZONE GRADING CU.YDS. ACRES b
Cf 4 - Ping. Ref.# I' p/ Parking Req./Provided pig E
r ` LICENSED CONTRACTOR DECLARATION47 f - 86-\27 f. Q
_ N I hereby off irm,t hats I am licensed untler,provistons.of Charter 9 (commencing Remarks: PG'# 8�—37 A. �Sr Planning Notes: eifloy ID orte .c j IA�Paf a-t fgnV» C,oV'ftz*� L k2 M
(►?sl with section 7000) of Division 3 of:the Business and Professions Code -and 4 T
my license is-in f II force and effect. - -
Z.- Ais.s `+e..X $
License ass "• '3 • ' Lice s: rvgt'S_�4f• `� HOLD FOR SPECIAL REQUIREMENT°
�` Date Signature ��� - T^ '-' 7 - PLUMBING I FEES
(' WORKERS'COMPENSATION DEC'• RATI• I f
ereby affirm that I have.a certificate of,consent o-self=Insure or a certificate Bar Sink Showers. ELECTRICAL FEES
Workers' Compensation; Insurance, of a certifieed copy thereof (Section, Backflow Preventer Service Sink
_ -I '1•-i7 C Automatic Washer • Transformer-0 15-50 KW
Policy No.N/LLAol3//S" 'Company• eAlf ' Backf low Irrigation 0 50+ KW
�ertified copy is hereby furnished.) -
>' ' 9 SewerCaP Construction Pole Sub. i '
Certified copy is filed withThe city Buil i Diviss n!;,• ifs Bathtubs 1 Sewer Connection 5 a C Cooking Unit - Meter 0 u to 100 amps
Dater'may` 'sr7 Applicant {•t`/'✓Gj fC/�' G>•-. 'a(
EXEMPTION FROM WORKERS'COMPS ATION• ECLARATION - • . Clarifiers Solar Collectors Dishwasher " Meter Dover 100 amps
(This section need not be completed-if the permit is for one hundred ($100) or •
less). " •• •' .. ° . "" Dishwasher • So - • 9 • Dryers ❑Gas DElectric Sub Panel _
I certify that,in the performance of,the work for which this permit is Issued, I• - ,
shall not employ any person in any manners° as-to become subject to the%"." •I- Drinking Fountains Solar Tank 2- 0 CI— Fan Motors ❑0-1 HP ❑1''A-8
Workers;Compensation Laws of California 1 . -. • ' '
Date • ••Signatures •-- " •') • �' -" Floor Drains Swimming Pool w/Spa - F.A.U.
•
NOTICE:If,after making'this declaration, you should become subject to the Inc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - Fixtures Microwave comply with such provisions or- this permit shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY '
Gas Service • 0' lets ^L Water Close 4 z Device BoxesPole Li lit
. I hereby affirm that there is a construction lending agency for the performance /• „ g
of the work-for which this permit is Issued (Section 3097 Civ. C.) I Interceptors 'p1 ,IT Wa afar • ,Q,. QO Outlets '
Lender's Name f Range : ,
Lender's Address - - • Kitchen Sink I afar Service, x_. ,p,t Switches Sign - •
OWNER BUILDER DECLARATION �� _ -
Ihereby affirm that.l'am exempt from the Contractor's License Law for the 1: Lavatories .. , Auto-Wash v • Garbo Q DIa OSaI .t - "
following.reason (Section '7031.5 Business and•Professional Code:'Any city or _ 9 P ' , Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P=Trap '- s - .I Laundry Trays f f
any structure, prior to.its.issuance, also requires-the applicant for such permit _ .2 C Generator ❑0-5 KW 05-15 KW �7rash Compactor-t
to file a signed statement:that he/she is licensed pursuant to the provisions of •1 ,Roof Drains r' ' .rN
the Contractor's License Law (Chapter 9(commencing with Section 7000)of -L •• 4- V O : ^ �. -, 1a Ole •r {� at
vision 3 of the Business'and Professions.Code) or that he/she is exempt - -
.refrom and the basis for the alleged exemption. Any violation of Section
,31.5 by any applicant for a .permit subjects the applicant to a civil - -
enalty of not'more than five hundred dollars($500).
LI I, as owner of.the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do-the work, and the structure is not intended or offered • - - l• Reinspection Fee $15 • Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES.
License Law does not apply to an owner of a property who builds or Improves _ _ _______ _ —a_ _.
thereon; and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICEREQUIREMENTS:
Elemployees, provided that such improvements are not Intended or offered for Boiler Hood or Type I
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By DL Pr--2 • " Date if-10—g,//'''t
prove for, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By - • 7.11 -K Date /,318 T
prove the purpose of sale). �)/T 6
❑ I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural I Refrigeration System I Application Issued By - Date
tractors to construct the project (Section 7044,Business and Professions Code: -
The Contractor's License Law does not apply to an owner of property who '1,.. Duct-Ventilating 5110-100,000 BTU ❑100,000 BTU dC
builds-or improves thereon,and who contracts for such projects with a con- SUMMARY QF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware that I Exhaust System BUILDING PERMIT $ 5S- O' SMTP $ t3' 2•¢
inipui
proof of their Worker's Compensation insurance should be I am ed to me. Y Multiple ❑ System Repair/Alteration 00
4f N PLAN CHECK $ I QE.•.`i3 PERMIT
0 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG 4 Fire Dampers
PLUMBING $ �i7 •LD ISSUANCE $
Date - Owner .� Heating System& Ducting Registers PLAN CHECK X25% $ 7• AC' ENERGY P.C. $
I hereby certify that ,1 have read this application and state that the above ®0.100,000 BTU ❑100,000 BT GRADING $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction,pand hereby authorize repre-
sentatives of this city to en er u on the. above-mentioned property for PLAN CHECK 50% $
Inspection our o s. / L/J ,/�_�7 MECHANICAL $ • at TOTAI�''•r'
"'••+ature a S yi Date j� pains action Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ �' _ ��-
�'.i\en a or 55-yt •, .- � p
�'n/B4 White - Building; Canary -Applicant: Pink -Accounting;Goldenrod - Assessor ///
7 ,
CONSTRUCTION-AND PLANNING POOL&SPA
' ' Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
1t Temporary Electiical Service or Pole , 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. (/f/fi a 53. Steel Reinforcement` •
3. Electrical Conduit Utility-Undrgrnd. - 54. Forms
4. Electrical Conduit-Undrgrnd. 0 �' A/ 55. Electrical Bonding -
5. Steel Reinforcement 1( !!. 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. ' •_5- ,/9, c b1 57. APPROVAL TO COVER-GUNITE
1,r Aingsegie ate,'e- l '` 58. Electrical Conduit-Undrgrnd. J
8. •Fourydatiorc JG /..44011//// S /4,,..6d 59. Gas Pipe, 0 Undrgrnd.,Test 7.
9. Water Pipe-Uhdrdrnd. /c/J'7 ler 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System P ���F 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection (42.r apt
p 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater& Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing
L-62•17 65. Electrical-Final
15. Rough Electrical-Conduit 5112121 66. Solar System-Final
16. Rough Electric Wiring . 67. Fencing & Access Approval
17. Rough Wiring Sign. • •. 68T%APPROVED FOR PLASTERING
•
18. Rough Electrical-T,Bar Ceiling 1 . - i 1. 69: POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro -
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test /- 72. Underground Flush
24. Roof Framing f` 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing Si4' 74. Ov
4i C144174. Hydro
26. T-Bar Ceiling (Structural) & Monocoat A' 75. Dry Chemical
27. Frame and Flashing •- " - 5/24/4 Gil/ 76. Dry Standpipe /
28. Lathing & Siding .477. FIXED SYSTEM FINAL
29. Insulation ��^ 978. FIRE PREY. FINAL
30. Drywall Nailing6 . G. HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �` 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED •
33. Final Electric Note :
34. Final-Heating & Air Conditioning -�/9l y'7 (AV , D 14 �D FOR rECiAL,i RE.
ivitiveeptio
t,[�l�rtnl'w .
AC V
35. Final Gas.Pipe-Test t. _ $7 Q 144 -'RNMr+�d�r�`��`Yar+o LTA
04-
36. Hood or Canopy ger, (1/*k � net'37. Final Factory Fireplace Bees fin get Coe. P, p X- do 61
38. Final Plumbing 1(j'/r7 t7 y/ilit yf wz in trewsl7• DA' ;tee
A.
Water Service-Final S� /27 01 -14-1-847_46,- Y , C-Ai 61/
.. X10. Gas Service-Final S//(r/,7 03 1cc* _tom-kt2144-142.A cea
41. Solar Domestic-Final /sw/R7 SLS:J,lb G.a Feghiiuk T.,SP. C,M
42. Backflow Preventer 74/87 t&t/j 5 l8'c7 G„_ t Gr s,/ci/n i
43. Backflow Irrigation
slain hNAL GRoar &Fr GN !.
44. Landscape Irrigation System . -6/1 Sr PEA &„t,,[osuat- ok ✓1
45. Sound Attenuation //f4/ SI 24-183- Stack LT
.itL rtt s e, 1
46. Handicap Regulations 7����v4 � sin/i7 0,,-� G�r$� tssu,, 6-/-1 ,
47. FINAL STRUCTURE & BUILDING ifia. R'.7r� J 4/y/f7 /cr Ltygain £ L
48. Special Requirements Completed
7 22/8;4'j/Y) Ili&/ai F.1'7al Anenv l fq9 P- Al 4 l<f �l
49. Electric Release to Edison 7/� M7 /i it ti �7/r r. 0 py
50. Gas Release to Southern California Gas Co 3.53/F' _.&e aOka )
51. CERTIFICATE OF OCCUPANCY ffS(GG��� '
No. Date f 1�• !--:
- ( Aii
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTR UCTIO PER IT R IT (�,-, TRACT NO. LOT NO. UNIT NO.
a ' � � 1 3524 3/06/87 26 DD TL
Project Address $ • f� • a r•- o
• f� TYPE OF CONSTRUCT ON U NEW LI ADD Li ALTERATION U REPAIR `
Applicant's Mail Ad ess 0't O O O i ❑ CONVERSION DEMOLISH ❑ OTHER _ A.P.gyp\ - Zone
Owner's NameAaPr e /Why k' 'hone D- -CRIPTION O WORK/USE OF :LD
Address 4 e ♦ r . - 'o S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ■ GRADING I. FOUNDATION II STRUCTURAL E Front ZO
Address �� �/��J.tire,/ eayL' 'may �1 ❑ OTHERT ❑ ELECTRICAL -❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name �A"✓�Z Phone pa/ti's -/ di) C Right N
A PROJECT DESCRIPTION SQ. FT. OCCUPANCYI •
Address(mailing) /C/go ry owt Ogee CONSTRUCTION TYPE VALUATION$yr�-d a2 0 s Left • G
City License No. / 7 Ai 4 • ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: q 1 p 141 Q Ser / . '/4 f/ on Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and sN
mylicens-i:i=fu tort and � 1 J1,ps /a -, S
Licens Clas LI n ° /1Q1 .
1 Date Signature PLUMBING FEES
ear WORKERS'COMPENSATION DECLARATION Bar Sink -Showers •
ELECTRICAL
aereby affirm that I nave a certificate of consent to self-insure or a certificate _ FEES
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
Automatic Washer Transformer ❑ 15-50 KW
,800, Lab. )/ �'7 a,/n —
PolicyNo 'j ��r� / Company Vete �� Backflow Irrigation ) Sewer C ❑ 50+KW
Construction Pole Sub.
ertified copy is hereby futhe cit
^ cer Ified top is filed with the city Buy : D is" // Bathtubs S Connection Cooking Unit Meter Duo to 100 am..
/ _ Date '-••a"f 7 Applicant '
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter ❑over 100 - ps
(This section need not be completed if the permit is for one hundred ($100) or - ,—
less). Dishwasher Solar Piping Dryers ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Ta Fan
workers' Compensation Laws.of California. _ - Motors �s-1.HP ❑1'/.-B
Date Signature Floor Drains Swi Ing Pool w/Spa F A U t -
NOTICE: If,after making this declaration,you should become subject to the _ Inc :Olay 09-15 HP ❑16-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks inal Fixtures IgrOW3Ve
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet • '
I hereby affirm that there Is a construction lending agency for the performance Device Boxes Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets -
Lender's Name • - _ Range
Lender's Address _ r - - - • - Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I-am exempt from the Contractor's License Law for the Lavatories uto-Wash Garbe a Dis osa
following reason (Section 7031.5 Business and Professional Code: Any city or - 9 P Standing Sections
county which require(a permit to construct,alter,improve,demolish or repair P-Trap La dry Trays
any structure, prior to-its issuance, also requires the applicant for such permit Generator P•a 5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of • Roof Drains : . -
the Contractor's'License Law(Chapter 9(commencing with Section 7000) of -
'vision 3 of the-Business•and Professions Code) or that he/she Is exempt - -
:refrom and the basis for the alleged exemption. Any violation of Section - -
31.5 by any applicant for a permit subjects the applicant to a civil _
penalty of not more than five hundred dollars ($500).
•
O I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered — ' / Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves ,-_ • -
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I v❑
sale. If, however,.the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By ' Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale). /
O I,as owner of the property, am exclusively contracting with licensed con- • Duct-Structural Refrigerate ystem Application Issued By � Date31CO tic n
tractors to construct the project (Section 7044,Business and Professions Code: -
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 0 ,000 BTU 0100,000 BTU MARY F FEES
builds or Improves, Exhaustpaerat
thereon, and who contracts for such projects with a con-
tractor(s)• iicense.pursuant to the Contractor's License Law). I am aware that System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ s1/4.5 O
proof oftheir Worker's Compensation insurance should be provided to me, - � SMIP $
O I'am exempt under Section - B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLAN CHECK $ • dd PERMIT
p PLUMBING $ • U• 00 ISSUANCE $ - _
Date • erF—� owner Heating System& ing Registers •
PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this'application and state that the above ❑0-100,000 0100,00087
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ GRADING $
and state laws relating to building construction,and hereby authorize repre-
sentatives of this city,.to enter yDpn the above-mentioned property for • PLAN CHECK' 50% $ MICROFIL /
inspection pure/tweet/ J�6-6 7 MECHANICAL $ - TOTAL,FEE $�(�
Signature Date 01 enl CHECK 25% _
D verure �
-�
CMF 0865-46,rev, 10/84 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor - -
•
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1..Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' ,
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
-. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
• I
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
73. Roof Drains64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
r
!15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
j 17. Rough Wiring Sign - 68. APPROVED•FOR PLASTERING
j 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# -
r
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil
23. Gas Pipe-Rough &Test • 72. UndergroundirFlush
24. Roof Framing 73(/Undergrnd:,StorageTank OGas ID Oil
•25. Roof Sheathing /74. Overhead-Hydro
•
26. T-Bar Ceiling (Structural) & Monocoat ,�� 75. Dri j heroical
27. Frame and Flashing l,17 76. Dry;St6ndpipe '
28. Lathing & Siding • 77., .FIXED SYSTEM FINAL
29. Insulation 78�,�IfiE PREV. FINAL j-j BC
• ikt-t1HEALTH DEPT. REQUIREMENT
30. DrywalhNailing . � ,
, :
31. Plaster Brown Coat • 79: FINAL INSPECTION r Vs/
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: . 1
34. Final Heating & Air Conditioning -
35. Final Gas Pipe-Test •= -
36. Hood or Canopy '.
37. Final Factory Fireplace ' . '
r •
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 :• _
A - •
•
45. Sound Attenuation -
46: Handicap Regulations '' .
47. FINAL,STRUCTURE & BUILDING
til/r1
�48.,Special Requirements Completed v _ i '
49. Electric;Release to Edison , I
50. Gas Release to Southern California Gas Co • .
51. CERTIFICATE OF OCCUPANCY '
No. Date "
ADDRESS Op6UtL 10( 300 E 17TH ST WIT: CITY OF COSTA MESA - BUILDING PERMIT
OPMEWSNAiIElp IO1OyIN: RONALD HEINZE PERM NO: E 073593
AomllEss: 11550 OVERLAND
FONTANA CA 92335 PERMIT NO: E 073593 PLAN CHECK NO: N GOVT: N SUPP : N
APPL.MIUNG ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH
ARCHITECT OR ENGINEER: LK.NO.: JOB DESCRIPTION : INSTALL 3 ILLUMINATEDWALL SIGNS SQ FT:
ARCH.OR ENG.'S ADDRESS: NIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 /
CONTRACTOR'S NAME: SIGN METHODS ( 310 ) 989-5755
caNRUCTOIrS MUNO 1749 E. 28TH ST COMMENTS: HAVOLINE, XPRESS LUBE
ADDRESS: SIGNAL HILL CA UGNO.: 613259 *************************************it***ArNENt****+t+t**ir*****AE*AEAE*x*+tStitA **********
•
90806 urn: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby aOrm under peney of perjury that I am licensed under provisions d Chapter 9 SETBACKS
1 (commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full oma and effect.
CITY LIC.NO.: Uc.CLASS: C45 uc.NV. 132 " EXP: MAIN BUILDING ACCESSORY BUILDING
ate: —.� S con ad«: •*�� v. V �i.• FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN FT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
O ER BUILDER DECLARATION:I hereby affirm under penaly of•0( that I am exempt horn the Cern •-• License Law for the
sines
I ' reason(Section 7031.5 Bus and Professions Coda:A /1y pr crony whkh requires a permit to construct ader.'vnprove. PARKING REQ: PROV: PARCEL: 42501107 Z NE: REF NO:
dish.or rape any structure.prior to b eeuance,silo requires the applicant for such penile to file a signed statement that he or She PLANNING N TES>
licensed pursuant to the provisions of the Contractors license Law[Chapters(commencing
rp with Sectiond d 7000) Division 3 the
,umness end Professions Code)or that he or she a exempt therefrom end the base for the alleged exemption.Any violation d Section >
7031.5 by any applicant for a permit subjects the applicant to acivS penally of M mare than Me hundred dollars(MOW *******************************************************************************
❑ I.asomen dthe pnpenyormyemployees with wages°stha soMcompensation.Will dothe work.and the structure enot intended DEVELOPMENT S E%•R V IC ES REQUIREMENTS
or offered ler sale(Section 7014,Business end Professions Code:The Contractors License Law does nd appy to an owner of propend
who bulls or improves thereon.end who does such work himself or hersel or through his«her own employees,provided that such
improvements are not intended or offered for sale.If.however.the building or improvement a sold within one yeard completion.the ZONING APPROVED BY DATE:
owner-adder will have the burden of proving Mor she did not build or improve for the pupae of sale).
❑ I.es former dthe property.amexclusively contracting with Eamedcone°dors to Carueuct the pried(Section 7044.Business and BUILDING APPROVED BY : - DATE:
Professions Code:The Contractors License Law does not apply to an owner d property who builds or improves thereon and who
convects for such projects with a contractor(s)licensed pursuant to the Contractors Liorue Law).
❑ I am exempt under Section: B.A P.C..for this reason: APPLICATION ISSUED BY: 10 DATE: S 7
********************** s - •- *********** ** ** **
Date: Ov'°°` LEGALIZATION:N FEE/., SUMMARY STRUCTURAL SE MEN :N
I do hereby caddy that I assn aware of and understand the requirements of California)health and Safety Code Sections 25505.25533,and
25534,and tlut.l or any future building ampere_wig/wit net(circle one)need to comply with said pats codes and the requirements for
a� IXwrnia bon ormmn5catran from the nDiana.Readern.lmmnadnnepplratroes eaaxnnpt/mnemese PERMIT BLDG PMT • :UMBING ELEC'4TRIC MECHANIC FIRE SMIP/RES GRADING
Date: Applica.rn: PLAN it SM I P/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSUE FEE 15 . 00 •
❑ [hove andwil mama"aceilficne of consent lo serf-insure ler workers'compensation.as provided for by Section 3790 d the LaborBUILDING-DIV-> PERMIT ' E PLAN-CHECK TOTAL PAID DUE
Code,f«the p°d"ma performance for which"n°«m°n""°°' TOTALS----> 45. 00 5 . 00 0 .00 60. 00 60 . 00 . 00
1 9 I have end w maintain workers'compensation nsunoed
n .as required by Section 3700 the Labor Code,for the performance of the
X work for which this pent a issued.My workers'compensation insurance wrier and policy number are:
Cartier: ST FUND EXPIRES REVENUE DIVISION TOTALS-- COLLECTED : 60 . 00 OVER/SHORT: . 00
Policy Number. 1256408 07/01 /96 BLDG PMT PLUMBING E CTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
..his section need not be competed y the perm/is or one hundred dollars/5100/or lest.) 60 . 00
P
, ly that in t e pedommance d the work for which this pemnt e' shall not employ any persona any manner eo n to
subjecttotheworkers'mnpensatonLawsofCaioma. -• shoutsbecomesable° totheworkers' *************************** ***************************************************
pro�nnsdsedan3700dtheLaboCode.Iaf•gf. • . waseprovisions. I N D I V I y U A L F E E B R E A K D O W N
: Iemnp:Fsuunoeecun workers'conpwuetlon pawseg.is un,�l,and shell at/st an cowl o«Mlrsl penalties and TYPE QTY DESCRIP I 0 N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollen(310[{000).In " 'n to the cost of compensation, es provided or In
« athe ro
Interest,and ELE 3 SIGN/ OUTLINE LIGHT SYS ON 1 BR CIRC 15 . 00 45 . 00
I CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury Thal there is a construction lending agency for the END OF FEES
performance of the wok for which this permit is issued(Section 3097,Civ.C).
LENDER'S NAME
LENDER'S ADDRESS:
I certify that 1 have read this application and sine that the above information is coned.I agree to comply with e0 city end county ordinances
end state awe relating to buildig consoudion and hereby authorize representatives d this city to enter upon the aboe•mentioned property
or inspecton purposes. JOE CAVAZOS
I I -- -
Pid Name �y p C
/te l•' Date: 3 f✓ 01 00137611-oo1$7611 TOT 60.00
Signature doweeri•- A•.'.':*^h",.. • DATE:
08/04/95 TIRE: 16:27
/
(5151-46 WP) While—Building&Safely;Greer-File;Caney-Appicanl:Pink-Revenue:Goldenrod-Assessor
. f
•
CONSTRUCTION AND PLANNING NO 'PA
APPROVALS Permit# Date Inspector APPROVALS Permit'# - • Date • Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. t 53. Steel Reinforcement '
- .Electrical Condu L,U{Jity•Undrgrnd. 54. Forms
._ 4. Electrical Conduit-Uridrgrnd. - 55. Electrical Bonding •
,. 5..Steel Reinforcement- 56. Rough Plumbing & Pressure-Test '
- �6i Electrical UFERIGrnd. 57. APPROVAL TO COVER-GUNITE .
: ;Footings 58. Electrical Condji-Jndrgrnd.
y1 Ef.-!Foundation a. • 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. -• s� 60. Backwash LinesP,.Trap, 0 Ugdrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK. . -
11. Property Sewer-Line_&-House'Gonnection -• ." 62. Backwash & Receptor-Find
12. Sewer Cap • 63. Heater &Vent-Final - r .
13. Roof Drains .. 64. Plumbing System - Final .
14. Rough Plumbingt .1 • . 65. Electrical-Final .
15. Rough Electrical-bond-uit r 66. Solar System-Fillet , !
16. Rough Electric 1, iring 67. Fencing & Acctiss Approval /
W
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
m 1�-rr _
n.18. Rough Electrical Bar Ceiling 69. POOL/SPA SYSYIMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
-, - . .f•. r a T ..j. :'r- r ti r• • cr1
20. Rough Fan orY FiVjace r * ... tn3 r. APPIMVgLS Permit#
47
21. Oucts,inr$truyjure,7rry^ - _ S _ .-+^ - 70. tindergr&ind Hydro -c
22. Ducts Ve tilaing ,,*- ! 0- 5 ¢* 'r 71. Produe<tPtpingT]�.Tas 6Oil
23. Gas P-ipe-HougS &Test -ter q • ..r. �.* :. 72, Undergrdund Floth
24. Roof.Framing•1 Cir E"'- •'T ' re, ,_, • . 70.., Undergrn}tl.StoFajjTankDGas ❑Oil
. 25. Roo#§heathing ,s. .•x = •coa 74: Overhead Hydro._
26. T•Bar.Ceiling (StrtLitbrall & Mooio_doat - - .74.":77 . Dry Chemical 'r -' c
27. .fame angi Flashing': a r ti: '` rt'` �. . .x
.,. _ s� r - .:* 7� Dry Standpipe
-'28. Lathing&SidingtrR �x- • . E '. .. "r* IXEDSYSTE-Nt' :FINA . r-, -
T+* 0 r+ .. .. fin / �,
29. Insulation -" _ _ •. r _ , 8y; FIRE P •• .. INAL
30. Drywall Nailing ,,F r-! ',. _ II, S _4i_FtALT , T.T1EOUIR.EMENT
^I f • 1/. ... • a _ n.
i 31. Plaster Brnwn;Coatz : ' r. - .4 79: FINAL/�N3PECTION .: '
n 32. glectricarPowt Meter$inal ' r I (k 80:'FnOQCERTIFICATTE ISSUED_.
T I 2 r ! C -k r i , -- 110, 1 ri x L
_33. Final le�Tric` * t* kilt F9 _c . ' -4
es f - ;: Fm
• 34. Finatsl-Iea Ing•& Air ConditionirlgS 4 ;' c h uJ C. :t'-' x = :CT
I 35. Final Gas ipe Test p ah' ;. ,`r '/ i " _ : YZC _ ; x •
36. Hood:or C_anopY v 7-- •1. :. .,. ,1- `-' . ". ' ` T1 'Lb-
37. Final c Factory Fireplace . . r .,
_1 k 2
38. Final'Plumbing * _ '" t cc
. ... r Y• ,r x r t ,y r
-•39. Wate$ervice-Final 'r ' . " ,..., "
;;40. Gas Service-Final _ 'c * '7: A 0 on; r.
,. r 1, x. c E -. i
-41. Solar Domestic-Final; `- 'T.' r to 71- (17, T -
42. Backflow Preventer * c� i y M :^ r- =' --
n.�_ r tr:i A H ,..
43. Backflow Irrigation f' a• t x r " ,;
44. Landscape IriigatiorSystem tjrr10 c. : 71 1.7.1 ' -..-* •,.: `'1 J- =� •
_• -<, - e' G f -. F 2 v: - -
45. Sound Attenuation;, .AA '- r":ri trir••ErlY I' _- c.: a �`' *
46. Handicap Regulations a * 4. Lt ^• - nq
,.
47. F(N4LSTRUCTURE& BUICOING '+ '; co S n.ir _
48. FiNAt PLANNING x i i- n + r 7
i n -
49• Elect?ic Release to Edisonn• "
Rr. c.
50. cess Release to Southern Calif ornia Gas Co * --- '7 ' or, i
51. CERTIFICATE OF OCCUPANCY t - •, - - -
No. Date
ADDRESS oFIWILDINo: 300 E 17TH ST UMT: CITY OF COSTA MESA — SIGN PERMIT
ONNENANmEIFIOgwN: RONALD HEINZE PERM NO: SB 073592
ADDREsk 11550 OVERLAND
FONTANA CA 92335 PERMIT NO: SB 073592 PLAN CHECK NO: 03086-95 L GOVT: N SUPP: N
APPL.MAIIwoAooREss: CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH
ARCNITEC'.,�Rm'
ENGINEER: LK.NO.: JOB DESCRIPTION : INSTALL 3 ILLUMINATEDWALL SIGNS SQ FT:
CN
AROR E:1 's AGGRESS: UNIT:
CLAIM VALUE: 9, 000 . 00 CALC—VALUE: 9,000 .00 GROUP OCC: B-2 /
coni hctars,tait SIGN METHODS ( 310 )989-5755
can Aciowsmam 1749 E. 28TH ST COMMENTS: HAVOLINE, XPRESS LUBE
ADDRESS: SIGNAL HILL CA cello_ 613259 +tatatstRtitat*itxitaritititftRt*itit -irititititiEatsririt*ieitRtiritatirititititREat*itatx*ititatsEit**itatatatseir+tiEataEit**iE+titat*atitft*
90806 wit SIGN INFORMAT ION
LICENSED CONTRACTORS DECLARATION:I hereby maim under pettedly d Per}oy that amfcensdwder provisions Chapter 9 DISTRICT: 1 TYPE: WALL ( 3--1 /ELEVATION) ILLUMINATION: INT CATEGORY: NEW
(commencing with Section 7000)aDi.ebn3athe Business and Professions Code.and Isinlull force and effect. DIMENSIONS: 2FT OOIN X 14FT 00IN AREA: 71 .00SQFT LETTER HT: 38 . 5"
CITY UC.(N�O—.: UC.CLASS: C45 uc.N•: 613/ 59, STREET FRONTAGE 1 : 90 . 00 STREET 1 : SANTA ANA AV
nese: L7 -- ) 9 S Contractor: I 1i ... Mk ., I / STREET FRONTAGE 2 : 132 . 50 STREET 2 : EAST 17TH ST
vPARCEL: 42501107 ZONE: Cl LOCATION > FRONT: X REAR: X
NER BUILDER DECLARATION:Ihereby Sfum under perubyd...' 'the sem exempt fvnlhe Contract• Lianss Lawfor the BUS INESS NAME: TEXACO XPRESS LUBE > LEFT: RIGHT: X
...imam mason(Section)rotas Busbies and PNmdpra Code:Any or many which requires a permit to aominrt,agar,improve, O T H E R T O T A L 5
GROUND
S I G N
demolish,or repair any structure.aria b b Issuance,aMa requires t •..•ant tor such perms to file a signed',stamen'that he or she
is(raced pura,w to the pronaory d the Contractors License Law IChaper 9(commencing with Section 7003)et Division 3 d the THIS ACTIVITY 71 . 0 0 S QFT OVERALL HEIGHTS OFT 0 I N
Business and Prdeesbns Codel or that he or she Is exemplthermmm and the basis for the alegedexemption.say vitiation d Section THIS SITE 222 . 00S FT GROUND CLEARANCE: OFT ,---.0 IN
Trots Many appFaNf«ePerma.d,erarmeaWcWutOeaIPer,wyanamweuw,wehwwwaONWulS,00p. ITEMS OF INFO 4 PLANTER AREA: O . 00SQFT
❑ 1.as enter aLin prmenywmya nes withwapes a theisdemmpenaW,wa th the"&and the wuctuw:na intended ITEMS FOR ACTIVITY: 7 BLDG SET BACK: 20FT • '
oceson �:Business Professionsd License« echwhauidacedecinesaleroheremred hodoes whr a or thrown hiterowdoes nm p apply loan bathatetjch COPY VERBIAGE : HAVOLINE (WEST ELEV) ; TEXACO STAR LOGO + XPRESS LUBE (SOUTH
re
inpromeras are nes intended ended offered fovealI.. however.the building g inpnovernem Is adm
sold within one yemplion.the ELEV) _
• XPRESS LUBE (EAST ELEV) .
ow� m
bderwnthe a
Witten «
9hemedldmww
build or mad
u»pae .ee). PLANNING NOTES: 1 ITEM/INFO—SANTA ANA; 4 ITEMS/INFO—E 17 -
❑ I.asowner d the prepertyLynx ththvsycontrming*N'awned cweractonto c urs the waled(sods 7D4A,Baines,and *******************************************************************************
Professions Code:The Conneaut License Law does not apply to an owner of property who builds or improves thereon and who
commas for such projects prima mama(s)licensed pursuant to the Contractions License Law). DEVELOPMENT SERVICES REQUIREMENT' S
❑ I am exempt under Section: B.A P.C..for this reason:
Date: OwnerZONING APPROVED BY I DATE:
t e
anda aMere
do hereby certify that I am aware d and understand requirements o ones Health and Safely Code Sections 25505,25533,and BUILDING APPROVED BY a A_ DATE: MI— jig
25534, that I " e building occupant will/willnes(ate one)need to comply wih said pthe codes and requirements for
apernvt forcwntructionor modification ham the ArDioCty anagement Medd.ResWerfiS committee applications are exempt from thesee
Provisions- APPLICATION ISSUED B ' DATE: IIII
Data: Appliem: ******************* -' ********** **
WORKER'S COMPENSATION DECLARATION:I hereby affirm under arwty of one d m
perjury oe ltibw;n9 declarations: LEGALIZATION:N F E E SUMMARY STRUCTURAL SE MENT: Y
BLDG PMT PL MBING ELECTRIC 'ANIC SIGN SMIP/RES GRADING
o I have and MI meintain a tandems cil consent to self-insure for workers'compensation.as provided for by Seciion 3700 of e Labor PERMIT 108 . 00 71 . 00
Code,for the performance of the neck for with din permit Is issued.
' I have and MI maintath wan'compereatbn neuron:cm reqtdred by Section 3700 el the Labor Code.for performance SMIP/NON—RES
work for which this panne is issued.My worker/compensation insurance anter and policy number are: PLAN 70 . 20 1 . 89
Carrier: g FUND EXPIRES ISSUE FEE
Polity Number. 155408 07/01 /96 BUILDING—DIV—> PERMIT - 6E PLAN—CHECK TOTAL PAID DUE
(Thissmbn needed be completed I the pliant is for one hundsird ddwa(Alx)were.) TOTALS----> 180 . 89 • 00 70 . 20 251 . 09 251 . 09 . 00
o I may that in the performance of the work for which this permit Is Issued.I shall • employ any person in any manner so es to
becomesthiedotrnwwkea•mmanwialawsdcaJdomas, _ • agree . Irnmldbearnesubjaatothewodca REVENUE DIVISION TOTALS--> COLLECTED: 251 . 09 OVER/SHORT: . 00
ope"'aonprovisions" °
s° °n37°°dthe Lelia Code.lshell with h••• those pr"" "
" ' BLDG PMT PLUMBING ELECT• ' C MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
Drs•: W-3 - 25 5 Aaliant: S. a,. a.-1 a! 108 . 00 71 .00 1 . 89 70 . 20
Warning:Folksy to secure wanton*compensation coverage Is �/ and shall subject an scop to criminal penalties end
w
civil fines rep ton hundred thousand dollars 0100.000A N ..r en to the cost of compensation.damages as provided!min ******************************** **********************************************
Section 3706 of the Labor Coda Interest,and atbmey.Ana IND IV IDUA F E E BR EAK DOW N
CONSTRUCTION LENDING AGENCY:I hereby emir under penalty d perjury that there is a construction lending agency for the
adpnnanoedthe work for which this nem.isbsued(Sedinn3097.Civ.C). TYPE QTY D E S C R I P T I • N UNIT COST TOTAL COST
LENDER'S NAME:
LENDER'S ADDRESS: NO FEES WERE SELECTED FOR THIS PERMIT
I certify that I have read this application and state mat the above idormation is correct.I agree to comply wall all rdy and county ordinances
and state laws relating to balding construction and hereby authorize representatives of this city to enter upon the above-mentioned property
for inspection purpaas. JOE CAVAZOS
Pmt Name o—
/IJ .. —� „ 1 _ Dae: (7' `95 DATE:(03/04/0951£TIRE: 116 o:19T -
igvlure of a APPN'aa,Cwaeaor ..• ,.
L
(Sts4�6.WP) Wide-Buldip A Safety:Green-File:Caney-Appkwn:Pink-Re awe:Goldenrod-Assessor
I
CONSTRUCTION AND PLANNIN 4 & 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 -
-37.;Electrical Condui•Utility•Undrgrnd. 54. Forms
'4v Electrical Conduit_C i iirgrnd. .. 55. Electrical Bonding -
5_ Steel Reinforcerfjent- 56. Rough Plumbing & Pressure Test -
-t '6T. Electrical UFERIGrnd. 57. APPROVAL TO COVER-GUNITE
`-C:.Footings t;.`' 58. Electrical CondUii-Undrgrnd.
ti- BhEoundation 1 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. - 60. Backwash LinesfjP.Trap, 0 Undrgrnd.
10. Structural Floor System f 61. APPROVAL TO DECK
11. Property Sewer Liner& House Connection 62. Backwash & Receptor-Final
- 12. Sewer Cap - - 63. Heater& Vent-Final
13. Roof Drains • r 64. Plumbing System -Final `
irk 14. Rough Plumbing:.. 65. Electrical-Final •
•
15. Rough ElectricaiConduit - 66. Solar System-Final `
16. Rough Electric'Jiririq 67. Fencing & Access.Approval
17. Rough Wiring Sign 68. APPROVED FO tPLASTERING
18. Rough Electrica4T Bar Ceiling 69. POOL/SPA SYSTtMS FINAL
19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT
20. �R,ougb Factor Fieedlace"'^-`_,�-.:r �, •;_ J": ti A?P AiLS. .Permit•# - x
21. Ducts, In-5trutture=> - :. •"r , _ '70. nderground-Hvdro, -
22. Ducts, Veritilajjng;L: _ ^t^�.~h„,7- G 71. :Erorruct Piping QGras L30il r
23. Gas Pepe-,Rough & Test - _ _ _ _ r-+ J-4 1t •*! _ -72. _Underground FIus11; _-C _
24. Roof Fraying" �. ^' - - _-;�a2,� oCr? �.� = 73. rUQcM*rnd.StoragiTank;ITGas Oil
25. RooC he`thing - - . .. :74. tOverhE d Hydro _
_ .. . r - -.1
26. T-Ba7.Ceiling (Structtral) & Monoco'Sf• r>,Y1tr, , G 75. try CAentical: , . _ -
27. Frame a td Flashing' = 5. '1 _ X76. ;Dry Standpipe - , +
28. Lathing&:Siding ", C' _ 77. •r •-is SYSTEM-FINAL: t
•
,, 29. Insulation: x :_ _ • t . 1-1_ 78. /RE PA FINAL
30. Drywall Nailing °, ".c.--%C: rr;. :.. i '; ` / HEAC-,.',+EPT.rMEQUIREMENT
31. Plaster Brown-Coat" oN--• 'T -_ r 71FklNALNSP EC f' % .32. Electrical Por Meter-FCnaf ^" - r` * 't } #. FQOD_CERTI 9ICATE ISSDEN, •;t
J 33. !;-+naCEleCtric.- ,. _ ts•�-•�aNotes:. ;i ; r
ir
34. finattieatjng& Air Gottditioning - -••r ^',k r,C. -
� 35. £inal-Gas'.Pipe'-Test - 7.: _ _,
< ~ ' _
'• ? - 4
36. Hood-or e_2nopy .- Tr' (- '" • -- r:_.. b r. - t _
e.
37. F}nal''Factory Firepla ,
ce; , - 77; -, - r- r' r
:r- -
38. Final-Plumbing - _� yT.-- - -T ' .
39r. . Wat{r Seiv'ice-Final -E` - _-�'r _ - -" • -"
40. Gas Service-Final " r 0;.- - 4 s- -
-•41. Solar Domestic-Fina( . ' - "- _ :`,•_ --- ,,-u;, -
42. Backflow Preventer :: - • , - • - - c - -- -
- _ . -r i--
43. Backflow Irrigation _. _ Z. I., r;_. u •- > 1; ':~� r •'
: zc;. n: ,. _ C
_
... landscape Irrigation•SYstem -•• •• •`� '-'1 C .-.w _ rt r --, ._ -: -
45. Sound Attenuation ' - - r" '^ - -
afi. Handicap.ReguIations rt-
7' c ,n -- t*•^Y = • . " ,-- • 'nks.
47. F-1NA4 STRUCTURE & BUILDING` 0; ^ ; •
F
48. 'ANAL PLANNING a - I-/ r ^• -
r . ._ x 1.
75 �'
49. Electric Release to Edison: '' ; --- _
51. Gas Release to Southern California Gas Co - _ - - -- ` .
51. CERTIFICATE OF OCCUPANCY 4. r -
No Date
I 1
N..
24638 CITY COSTA MESA
MESA BUILDING-SAFETY DEPARTMENT CIT 1 OF COSTA MESA
P.O.BOX 317 COSTA MESA,CALIFORNIA
2 5 1965 _
For'Applicant to-Fill In Completely. ` - . ' '-: - t APPLICATION' FOR PERM - •
- TYPE 'OW PRINT" - - ' - BUI 1 •• •
BUILDING /� C—. • }. - .- . .- . ' � A(cL Only_ :• .,. .
ADDRESS ;200 (�J6 teMZ'�Id' `i4 - - _ - - ,• RECEIPT NO. 11
- P RMJT
COSTA MESA, CALIFORNIA' . L`7.: - -c. �4 (/p- 35 k.
RECEIV-D BY O RECE).VEDD ; D. ISSUED (�
OWNER S ,L . .t C .
1fS �•� p\
MAIL G` - -.. . .1 -I• - ADDRESS • OC.- 'C ' ' 'r . - V/
ADDRESS IR X—f -� q - In1``
CITY L . A.: - - -- - TELEe 2LIt'") ZONE - ' - TYPE• FIRE ' /_GROUPr I 1 L
^^.HITECT TEL. - -APPROVED . - - •• - Q4
'NGINEER s C - NO. Y. 23 A BT' DATE'r f
/ •
^�. - -.;- . ZONING -
ADDRESS IS't ' R.':BLT It.T?l�AT7-' kh,
ZONE NO.OF UBE OF NEW
"• ; - -.C2] PLANS 2 BUILDINGI Station
CONTRACTOR r L- .C_c2 ._. .-
ADDRESS t t5 E=ZA\L-ICa' DESCRIPTION -r`�t$ 1 and. -T.. 659 Ntki•
:P:NO:- -' 11 -241 O'and 1' .'r.:, • N.
CITY 1 Ni.('7f•CrtZ
NOTE: NO EAVE OVERHANG SHALL BE LESS-THAN
(�
STATE4. .y X90"T0SIDE @REAR P.L. .�• QfY�
LIC.NO. —I11�1 S"' NO: YO a4`�Z+-I .,, ./1C,QP""
( J EAYEB, ^ . I
SIZEF - ' NO.OP BLDTs-O ALLOWED - (U: O.RE UIREMENT) IS I
OF LOT .�OX.I�lO - 'NOW ON LOT •
YARDS APPROVED 'YARDS APPROVED -
USEOF - �S� r• - - -MAINIBUILDING 65 -ACCESSORY BUILDING
EXISTING BLDGF -' 't`LO L1 C+ - - -(FROM C/ =TREET) - _ _ 1 rif-S ^
SETBACK LINE PROM FRONT '-1
CENTER OF STREET (� 0 REAR YARD- I I . .
SIDE YARD LEFT'. ` RIGHT 4V-1...4V-1... . - R:SIDE/9SFT-C''/1-/r/� '.G/ 7
orr C ("� . -
L
DESCRIPTION OF WORK . L.SIDE' I J FT: Fr,
_�ALTERAT ON ADDITION ' 'I - ^REAR' '- y F•r• ���
DISTANO BET,. BET MAIN a -c
REPAIR _MOVING -- DEMOLISH MAIN BLOCS. ACCESS.SLOGS.
SIZE
EDIN 24E144 :Zr•F ROOMS .6 .BTORIES C. P-#� 0-17-65- •APPitOVED `4-19-65
EXTERIOR WALL -.L. ROOF _ � 47.14tOV EDS :, . . .)DA-T;
, :,_.., q I /
COVERING uemc•IL.COVERING.iZOc. , ti
�3- DATE �,-,..y 4' fir_ S
USE OF BUILDING AND WORK TO BE PERFORMBD ..7 -,AS Y, / VVV, 111 p�[J
100 \/.c.0 •TGT\r'1w1.. - - - /{/. .•J./L,.
.� n- .II� a '� ').7.1-1 kW,
kW,,
N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE A®OVE IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. Q
PLITH ALL CITY ORDI NOES AND STATE LAWS REGULATING VALUATION
BUILDING
WCONSTRUCTIO n
SIGNATUREO 1141$471b •/-' PERMIT FEE O
PERMITTE /5I- .i- - B
\ $/? y _ PLAN CHECK $ e
VTHORIZED A ENT. 7 // 2
� J TOTAL FEE $ <O `--'
1
:SPECIAL 'QUIREMENTS: t.;.'.c• 8.:r.„ r F
1. Inst liatioonrof„c.11.1-rcial sidewalks by ,applicant and/or owner on
E. '11th Street and Santa a Avenue, at his-expense;
spec f ca •o r\th�City of Costa Mesa;-- - - -. -
2. ,.Dedi -on--of tecessanf---r• ht oftway to-provide.&or-the ''future
widening of'-East 17th Street to a 100 foot, right:of way+and - •
spandrel; -` j
3. Tree planting compatible with surrounding area as .indicated, on,•' , ,
• `";the. plot`•plan:and- two trees spaces out along the \\' '....„
interior
• � poperty-lines; _ 'i , „_, .,.' ,.%. .•_ .. , ,.'i ..
1.4. : Landscapeplanter to -be-.-const'ruc'ted at they corner as indicated ., c
on plotplan with brick or`-equal;
5 Details of construction material td'be approved by `the-.-Di"rector.
tt.i•,of:Planning prior .to building_permits.being ,issued:end:to include a
. minimum of 20 per cent stone:or brick oil the,main building exterior
withmatching , stanchions'or column supports for canopies orT
overhangs; . :` '.. :
6. Trash enclosure to_be-of concrete block With -the size substantially -
increazed;:,. : .. — . . .. . - . ...-J., ,.meq
7:- ., On]y uses related to'a service- station, shall-•be allowed;, 1 . -
•8. No-accessory- or portable buildings -shall-be;placed'on 'the 16t',
. Tanks.'to be installed as Per Uniform'-Fire!-Code 1961;,permit46
_.._be.-.obtained.-from,the Eire.Department•to install tanks; ,piping.,. ,
- '. . (plan to be submitted to,•Fir-e Department,• 'Fire- extinguishers to - -'- `
— be' located-as per`Pamphlet-No'.'.10 _NEPA; _' - . .. -•>- .. . .n. -
10.1 Dedication of P10,feet,oi-O-Santa. Ana Avenue to the:City/of?Costa . .
Mesa for, street wider-Ling\ purposes;-
11 :Agreement to-be reached with thetCity IIigineer .for: temporary ,
•' _,use of\black top pending4u_ Lure ;widening-of_ the streets and ;
' turn pocket construction;-bond: to---be posted' for:future street, -
improvements• as -required by:the City Engineer,. determination .
' - .to-.be reached. impr4
oyements within three years, band if
s, . rtvl
not, applicatnt-to be granted of-time-for use-of -black,,
top.(
+ (bond-on, file in'3the-office of the,.Planning 'Dept )„".k;:-.,i,„,,%",.;
12 \ •.,Oyerhang' of sign,allowed to.;property line, and upon widening#.of
• --.C. ,-street,;•sign.-to be moved:at applicant's`-expense;- "K.; ' -- •-•"='r " '
13. Dedication "of,,the" neaess.asy,'right of way for..the futurewidening
of E. 17th-Street, .mentioned 'in Condition.No. 2, .is to apply to
-; Lots. 6” and.7,. Tract 659,•„as_ well •as-Lots- 1--and--2),ITract, 659... - . .
.
. .. __ -".f;, -._fir - � ..
. .
• ;' . 24994 I CITY OF USIA MESA
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92520
DEC 151965
For Applicant to Fill In Completely APPLICATION FOR P RMIT
TYPE OR PRINT OLD
BUILDING `F OO / '7 Ili __,_.. � 1 1, i •. ly
ADDRESS J / RECEIPT NO. 13R4141401.
COSTA MESA. CALIFORNIA /7C�f
— RECK Y DATE R- eD DATE Ieeue$-
owNeRJ f C /(�/� L 0 / L ILDING /Z//4 6C 1 '7L7/t//�7
MAIL / / OO A ^/ a AD
ADDR[QS A 6 ,57?/V FO K I� ADDRESS C� / �I {�
T[L �' FIRE
ZONE A7 TYPE GROUP )
CITY Los /f NCSLL-SNo. v L�
APPROVED/It
GECT TEL BY' i � DATE
1 ENGINEER NO. .;5�,
ADDRESS ryHpj /� ZONING j �
/• ZOIM.o 1 tont -f}- I USE OF NEW-A�_r ctise
CONTRACTOR W/L L//}/('/C V al)4 ,9-19 r—
ADDREQ, / 3/ /J TLc' EC.Cn/llr/9 R/2 LEGALS
yRIM° _ 4 _._ — A/ _srO
CITY Pi t7 it / V L)fjy. ' A.P.NO. //7—a 7/-So ?as-
,✓ NOTE: NO EAVES OVERHANG SHALL BE LESS THAN
LIC.TNO.2-0o (q 4 J 17. 30'TO SIDE&REAR p.L.
SIZE I NO.OF BLOCS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
USE OF YARDS APPROVED YARDS APPROVED
EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SETBACK LINE FROM FRONT PT. PT.
CENTER OP STREET REAR YARD
SIDE YARD I LEFT RIGHT R.SIDE FT.
1,--- --....
/ DESCRIPTION OF WORK L.AIDE P7. FT.
.w 1" ALTERATION ADDITION I REAR PT. FT.
DISTANCE BET. BET.MAIN&
MAIN SLOGS. ACCESS.SLOGS.
REPAIR MOVING DEMOLII(H
BUILDING NO.OF VAR.AR DATE
SIZE ROOMS STORIES C.U.P.* APPROVED
f///''/1' APPROVED ,+
CEXTERIOR
O ERINGWAT• I ROOF COVERING FR //.`r. A141/iLM.i DATE 1,�//S�/l.l
USE OF BUILDING AND WORK TO BE PERFORMED S (1.
GA-SGL/Nc 57o74ce T'IN/CS w
[JNOER G/Povn//)
SQ.FT. • 2
[HEREBY
ACKNOWLEDGE TNAT.I NAVE READ TRIS APPLICATION TNH AMOUNT SHOWN UNDER VALUATION IB FOR THE
ND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTASUSNINO A PERMIT FEE ONLY.
LY WITH ALL'CITY ORDINANCES AND RATE LAWS REGULATING in VALUATION I�UILDING CONBTRY PERR VALUAT FEE ;IGNATURE 0 �..ERMI7TE► / �0 PLANCHECK Sco wUTHORIZED AGENT (/ TOTAL FEE $ 6
_. .40452 auic z1-75G„5;001150* * *>r40.1C
•
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APP C ION FOR STRUCTURAL PERMIT
For Applicant to Fill in CompletelyJ —Use Ink Only
ADDRESS I EoIkON 1t an o� RE AI ED V DATE RECEIVED Q(yTE2/ ESS 5
?CO E. 11 ..... 1 \\ l /
Y - ` 2-S-01 ti7MIT NO.
OWNER ,• Q� I' a A.P. N . ,/s
AAI Pt &,x iz Y ADDRESBUILDING ' D E ' 1 �.
ADDRESS P,0,
TEL.01t TRACT CITY.ORAN6t— 0F. N°84666 666/ . 1759 LOT �/ BLOCK
CONSTRUCTION t NEW ADD ALTER REPAIR MOVING DFMOI 1511
LENDER X
BRANCH C
OWNER L 1v*-mf 4
ADDRESS ✓✓ ALUE
V S
ARCHITECT TEL. US�APD�2tC ' II/V
OR ENGINEER NO.
�i6�t
iii -, FIRE
ADDRESS ZONE ZONE PE GROUP
/�� APPROVES f r/—
CONTRACTOR
—CONTRACTOR r :_ r. 4 . r 6/(�(Jy , BY L/ DAT /
Q% r
ADDRESS / UI ,
�. TEL. ZONE+... NO.OF USE OF NEW
CITY y i f.-: . 0, NO.IF
C. ` PLANS BUILDING
.- STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF BLDGS. (FROM C/1_STREET)
C OF LOT f NOW ON LOT FRONT FT. FT.
a USE OF
„�., EXISTING BLDG. R.SIDE FT. FT.
Cil
FSeparate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
A REAR FT. FT.
L ILUSE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN B
,u S744J VISOR_ QEfc9VEt2'/ SyCSTEP& MAIN BLDGS. ACCESS.BLDGS.
VAR.# DATE
QC. U.P,aW APPROVED
APPROVED
>r ....__B_Y _DATE
W
W
O I hereby acknowledge that I have read this application and state 'n
gd that the above information is correct and agree to comply with m
L all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of
Wy„ the State of California.
3 I hereby certify that I am properly licensed as a contractor under
SQ. FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ”
tco
am exempt from the provisions of the State of California Business
VALUATION PERMIT FEE $ a 1
and Professions Code, Division 3,Chapter 9. //,
PLAN CHECK $ 5(e a o
Signature of C O�
the/US//J A $?�
- L rr._UUr TAX $ f
Authorized ant D
AuthoriRatl ant TOTAL PAID $