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Home My WebLink About322 17TH ST - Building Permits� f City of Costa Mesa Building Safety DepaAment P. O. Box 317 Cmra Ma�a, Californio CEItTIFICATE OE OCCUPANCY N� 264� C l • The Building located at �� 8 1�1"�.� 81.f�7L �� Y' ' has been inspected and found to comply with fhe provisions of all City of Cosfa Mesa Ordinances applicable thereto for a Grovp � ?��— Occupancy. ' , . : Use of Building ' �� x' -- Legal Description �.i�f�hl.l�{� A 21 (Seo reversa sido for Mate� and Bounds) Building Permit No. �� Electrical Permit No.—:N"� Plumbing Permit No. �� Floor Load Signs have been installed as Room Capacity Signs have been instaled as required under Sec. 2308 U. B. C. , rflquired under Set. 3301 (1) U. 6. 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 enforcemenf agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occ�pancy classification of a building or portion fhereof 2) The n�mber of apartments or g�est rooms 3) Ownership If Group H Occ�pancy, number of apaAments 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 70: Building Official 6'�'t'R�7C `!'IRf3 CO by '` F�J�.� ��,i.z� �. - i,�L� _.w� •IL This Cenificote of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Officiol of tfie City of Costa Mesa under Sec. 306 (e) U.B.C. Fo�, sva�iM—u-ea—s-s r (714) 754-5273 • Fau (714) 754-4856 .lob Address: 322 E 17TH ST Suite: Vicinity: ROOF AREA ParcelNumber: 42501104 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Applicant: KURT MC FALL Address: 3941 SO. BRISTOL STREET #E317 BUILDING PERMIT Zoning: Phone: �.(714)751-4752 SANTA ANA, CA � ,- Zip: 92704 � Owner ENDICOT,T, JAN V. '' � , � Address 600 PLUMTREE LN -�' — � � . , � � , � ; , � -Phone: _ �'. GRANTS PASS, OR' �� = ` Zip: � 97526 '� � Contrectoc' MC FALC ROOFWG INC Address: � 3941.SO.BRISTOL-STREET#E317 ' � ,. Phone: (714)751-4752 , , SANTA ANA, CA � ' Zip: 92704 - License' 756896 699-07841 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 11 /18/1999 Issued: 11/18I7999 , Arch. : - � � : : ' / � . . E�9: � � Address: � . - i ' � Address: �. ' �Phone"' � � � ' � Phone: ' . „'� - ' , - . - , Zip: ' � . '� License: � License: . � ' � � SCOPE OF PERMIT ` ,' REROOF - T/O, USING EXISTING SHTG, INSTALL NEW 4 PLY BUILT UP ROOF ON "BIG O TIRES". FEE SUMMARY Plan Check: $0.00 , Permit: , $139.25 , SMIP Res'. , $0.00 , SMIP Com: � $1.37 Other: $0.00 ,Inspection: $0.00 Total: '$140.62 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY � Front 0-0 PARKING Existinq: o NOTES: , - Calc Valuation: � �_ n_ __ _ , •�� , Claim Valuation: - � - , - . j _ — � . . ; Rear 0-0 Rear 0-0 Required: 0 PLANNING 8 ZONING Left 0- 0 Right 0- 0 Left 0- 0� Right 0- 0 Proposed: 0 $6,500.00 $6,500.00 i ' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremeMs under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not'commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. ' � • ' INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapections end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WClRkERS' COMPENSATION DECLARA710N: I F:�reby aHirm under penelty of perjury one of Ihe following declerations: � ❑ I have and will maintain e certificete oi consent to self-Insure for workers' compensation, as provided for by section 3700 of ihe Lehor Code, for ihe peMormance of the work tor which ihis permit is issued. ' � have end will maintain workers' compensetion insurance, as requiretl by section 3700 of the Labor Code, for the peAortnance of the work for which ihis parmit is issued. � My workers' compensation Insurance carrier end policy number are: �^� �� ^7 /�� Carrier. �� L!� A-uV�i V$�� Policy Number: �� C.� !o (This section need not be comp/eted i/ the permit is velued at one hunUred tlollers ($100) or /ess.) ❑ I certity that in the peAormence oi the work tor which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' cnmpensation laws of Califomia, and egree thet if I shoultl become suhject �o �he workers' compensation provisions of Section 37 of the Leeepppor Code, I shall Forihwith comply with these provisions. . /� I� /� /,� v/ Applican� Si9nature: Date: � �_ WARNINGFAILURETOSECU ORKE S'COMPENSATIONCOVERAGEISUNIAWFULANDSHALLSU&IECTANEMPLOYERTOCfiIMINALPE TIESANDCIVILFINESUPTOONEHUNDRED THOUSAND DOLIARE ($100,0 0�, IN ADDITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR COOE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensetl force antl eHect. Lic. q Conirectofs Signature: " i 9 (� 7000) of Division 3 oi the Business and Professions Cotle, and my license is in full Class k / -� Date: // � CONS7RUC710N LENOING AGENCV: ❑ I hereby aHirtn that ihere is a consWction lending agency tor tha parformance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lentler's Adtlress: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby attirm that under penalry of perjury ihat I am�EXEMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to constmct, alter, improve, demolish, or repair any stmcture, pnor to its issuance, also requires the applicant for such permit to file a signetl statement that he or she is licensetl pursuant to ihe provisions of �he Coniractors License Law (Chapter 9(commencing with Section 7000) of Division 3 ot the Business antl Protessions Cotle) or the� he or she is exempt therefrom and ihe basis for ihe alleged exemption. Any violation of Section 7031.5 by eny applicant tor a permit subjects iha applicant to e civll panalty of not more than tive huntlretl tlollars ($500).): ❑ I, as owner ot the property, or my employees„wit� wages as iheir sole compensation, WILL DO THE WORK, and the slmcture is not intentletl or o@ered for sale (Sec. 7044, Business entl Protessions Code: The Coniractors License Law does not apply to an owner ot property who builds or improves thereon, end who does such work himself or herseN or ihrough his or her own employees, provided that such improvements are not intended or oHered for sela. If, however, tha builtling or improvement is soltl within one year of completion, �he owner-6uiltler will have ihe burden of proving �ha� he or she ditl not build or improve for purpose of sale.). ❑ I, as owner of Ihe pmperty, em E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmc� Ihe projec� (Sec. 7044, Business and Protessions Code: The contractors License Law tloes not apply to an owner of propeny who 6uiltls or improves thereon, antl who coniracis for such project with a conirector(s) license pursuant to tha ConVactors License Laws.). ❑ I am exempt untler sec. Business and Protessions Code for this reason: SignaNre: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Veritication ot Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity �hal no eacavation tive (5) or more feet in tlepih into which a person is requiretl to descend, will ba matle in connection with work authorized by this permit, antl t�at no builtling structure, scaHolding, falsework, or demolition or dismantling thereof, will be more ihan thlrry-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Ttle 8, Celifomie Administretive Cotle). ❑ As owner-builtler, I will not employ anyona to tlo work which would require a permit irom ihe Division of Industrial Safety, as notad above, unless such person has a pertnit to do such wark trom the division. - Signature: Date: Division of Intlustnal Safety Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTAY: I cetlity under penaliy of peryury that I have read Ihis application and state fhat the information given is correct I agrea to comply wi�h all state laws and ciry ordinances relating to huilding construction, and authonze representatives of the City of Costa Mesa to enter upon the above-described property lor inspection purposes. I agree not to occupy or allow occupancy of any �uilding euthorized by this permit until final inspection. 1616 Fiaetl System Final Fire Preven�ion 1266 Pool Spa Final 200 Final Re-Root 201 Final Block/Retaining Wall 202 Finel Factory Fire Place . 203 204 2446-a8 Final Sign Final Demolition ppTE INTRIALS `� � COOE♦ INSPECTIONTYPE 206 Final Mechanical 208 210 212 220 Final Plumbing Final ElecMcal Final Fire Prevention Final Planning Approval 1� �� Data � 222 Final Site 250 FinalBuiiding/Occupancy Ijqj.,i MI RIpLS �. , (774) 754-5273 • Fex (714) 754-4856 • www.ci.CoSte-mesa.Ce.uS 77 FAIR DFiIVE, GOSIA MESA, GA 92626 �ob Address: 322 E 17TH ST Suite: Viciniry: Parcel Nunmber: 42501104 Applicant: LOCKHART, INCHA Address: SIGN PERMIT Zoning: Phone: 619-423-6200 Zip: Owner. ENDICOTT, K H TR Address 600 PLUMTREE LANE Phone: GRANTS PASS, OR 2ip: 97526-7245 Convactor: STANFORD SIGNS INCORPORATED Address: 2556 FAIVRE STREET ' Arch / Eng : Address: CHULA VISTA, CA Phone:, (619) 423-6200 Zip:� 91911 , License: 620617 Phone: Zip: License: Status: ISSUED Applied: 03/14I2005 Issued: 03/14I2005 ISSUED BY: � SCOPE OF PERMIT INSTALL 75 SQ.FT.2' HIGH X 25' 1 1l2' WIDE ILLUMINATED WALL SIGN WITH LETTERS FOR'BIG O TIRES' Plan Check: $54.11 $0.00 Permit: $8325 SMIP Com: $0.63 Other. $0.00 $0.00 Inspection: $0.00 $0.00 $0.00 Total: $137.99 NOTES: FEE SUMMARY PLANNING & ZONING Calc Valuation: Claimed Valuation: $3,000.00 as,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requlrements under California statutes and related regulations. (Orcl. No. 9248, § 1, 12-21-92) EXPIRA710N: This pertnit shall automatically explre 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 Ihe work authorized under this permit to be considered legal, such work must comply with all applicabla codes, and all required inepeetlone and final approval must be obtalned. Failure to obtain inspections and final approval will result in the expiration ot ihls pertnit. FOR INSPECTIONS CALL: (714) 7545628 �aoa+e �aoa� WORKEAS'COMPENSAnON DECLARATON: ` I here6y effirtn untler penelry o� perjury one at Ihe IWlowing dedaratlons: ❑ I heve end will maintein 8 certificete of wnsent to sell-Insure br workers' rompenseNon, e9 prwltletl lor by seCtion 3700 of t�e Labor Cotle, far Ihe pertortnance ol Ihe wark for whit� ihi5 perrNl is issuetl. � I heve end will main�ein warkers' compense n Insurance, as required by section 3700 af tha Lebor Cotle, for the pedormance of Iho work for which Ihis pertni� is issued. My wo mp ure ce c r tl oli ber era �p l / 'B �' � Poli �Numb : � /\ �J �, d�D�/ (Tbh sec7ion n no! be comWefed i/ the permif is ve/ued et one hunCred dollers (3700) or Iess.J ❑ I certify ihat in the perto g�re o lie work far which IS` permit is Issued, I shell not employ eny person in eny menner so es ro Decrome suD tl to t�u workers' crompensatiat laws o� Aomi and egree Ihet II I uld bec e sub�et� �o ihe waBen' crompensetion provisions o1 S tion 3700 ql (hq�appr Code, I 5ha1116rtRwlth comply with Ihese p ' ons , / /D AopIICeIR�ture: � �� --F' � � 1 � b WAR ING: FAILURE TO URE N'ORNERS' OOMPENSATIpJ CpVERApE IS UNLAWNL AND SHr1LL SUBIECT AN EMPLO ER TO CPIMINRL PENALTIE AND CIVIL FlNES UP TOONE HUNDRED T/10USAND OOLURE (5100,000�, IN ADpTION TO tHE OOST OF CpAPENS/TION, DAMAOES FS PqpVIDED FOR IN SECTION 3]O6 OF THE L4BOq CODE, IMEREST, AND ATfORNEYS FEES. LICENSED CONTRACTORS DECIARATON: I hareby elfirtn thet I em licens under p 5ioy� ol Chapler 9(commencing wilh Sactlon 7000) oi DlWsion 3 01 ihe Busine55 entl ProfessionsCpd e, anA my licen5e is in full force antl eflect. L'C't _ .�U � ' / / .if�alu . C�LG CONSTRUC710N LENDING AGENCV: ❑ I hereby a/firm Ihel lhar0 �5 a construction Ien0ing egancy lor Iha pertormance ol Ihe work for which this permit is issuetl. (Sec. 3097, CMI COAe). Lentler'S Name: LendBr's Adtlras5: Signeture: OWNER•BUILDER DECLARAnONS: Deia: I hereby affirtn thet under penalry of perjury thet I em EXEMPT FeOM 7HE CONTRACTORS LICENSE LAW br Ihe following reeson (Sec. 7031.5, Business antl Professions Code: Any dry or counry Ahich requires e pertnit to construct, alter, imprwe. demdish, or repelr. eny sWcture, prior m its issuance, also requires the applicant for such pertnit to file a signetl sL�Iemenl that �e or she i5 Ilcenaed pursuant Io Ihe provi5ions oi the Contrector9 License Law (GheD�er 9(commencing wit� Sectlon 7000) of DMsion 3 of Ihe Bu5ine5s and ProTe55ion3 Code) or Ihet �e or's�e� ezempt Iherelrom erM the basis br Ihe elleped eremption. Any WWetlon of Section 7031.5 M/ any aOP��< <ar a pertnit 5ubjaci5 the applicant to e Gvil penalry ol noi rtwre t�iyen IWe hundred ddlars (E500).): ❑ I, as owner of t�a propehy o� my employees wil� wages as I�eir sde compensation, WILL DO THE WORK. antl the structure is not intendetl or oflerea for sale (Sec. 70a4. Business end Pmfessions CaAe: TTa Contractors lJcense Lew Ooes not appty lo en ownor ol properry who builtls or improves t�ereon, anE who does such work himsell or herseN or throug� his or her own employees, providetl t�at such improvements ere not Intentled or oHeretl tor ule. If, havever, the building or improvement is sold within one yaer of completion, the ow�er0uilder will have ihe burden of proving ihat he or she did not build or improve tor purpose ot sale.). ❑ I, as owner ot t�e pmpe(ry• em E%CWSIVELY C'ONTRACTNG WITH LICENSED CONTRACTORS to constmct the Oroject (Sec. 704a, Business antl Professions Code: The contrectors Ucense law tloes not appty to an owner ol pro0erty who builds or Improves thereon, antl w�o contracis for such project with a contracbr(s) licen�¢,pursuant to tha G��adors License Lews.). ❑ I em exempi under SeC. Business enU Profes5ion5 Codo for Ihis rBason: SigneWre: Date: Owner ID verilied by drivers license. Ves'• � � No DrivefS Litense No. Expires: Verification of Ownership by (rype ot tloc e, i.e. � property taz bill ar tleed): DIVISION OF INDUSTRIAL SN��' PERMR CER7IFICATION: ❑ I hereby certify Ihat no excevation live (5) or more leet in Depth Into which e person is requlrad ta descentl, wlll be metle in connection with work authorized by Nis permit, antl Ihat no Dulld��9 shvdui�, scefldding, lalsework, or demolition or dismantling thereof, will be more then thirty-si: (36) teet high. (Clup. 32. Grp 2, An 2, Sec. 341, Title B, Celitomia Atlmini5iretive Code). ❑ As owner-builder, I will not employ enyane to tlo work which woultl require e pertnit Irom t�e Division of InCustnal Selery, es noted above, unless such person has e permit to tlo such work f�om t�e tlivision. Sipnature: Date: Division ol Indusinal Satety P9�it Number: CER7IFlCATE OF COMPIIANCE AND AUfHORIZAiION OF EMiiY: I cenify under penally ol por�ury ihet I heve roatl this epplicatim entl state that the informadon given is wrrect. I agree m wmply witn all state laws end ciry ordinances releting io bullding construcllon, end euthorize representetives of the City ol Costa Mesa to enter upon the ebove-descnbed pmpe�y br inspection purpases. I egree no� to occupy or ellow occupency ol any building authodzed by Ihis permit until linal inspection. I e OI e I n(s) Dale/� � I �!�� 1 1 pnWOr ��' uioa�Ap'plican� Date I d SOOE �. INSFECTON TYVE 1818 Fixad Systam Finfll Flre PrevenUon 1266 200 201 202 203 204 Pool SOa Finel final Re-Rool Final BIOCWRetelning `/�/ell Final FeCtory Flro Plete Finel Slgn Finnl Domolitlon QAff. ItIIID�LS LOOE I INSPECTION TYPE 206 Finel Machanicel 20B Finel Plumbing 210 Flnal Eleclrical 212 Flnel Fira P�aventlon 220 Final Planning Approval 222 Finel Silb 250 Finel Building�Occupency QLIf Itf�ELfl (714) 754-5273 • Fex (714) 754-4856 • www.c�.costa-meseELECTRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: Applipnt: Address: Owner: Address Contractor. Address: ISSUE FEE Temp service test Res. a/c package New Res (1•2 units) New Res (3+units) Pool I Spa Lig�ting FixB Recept OutleLs Switches Non Res Appl Res P.ppl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Molors to 10hp Motors to 50hp Motors to 100hp Motors over t00hp Communication drop5 322 E 17TH ST BIG 0 TIRES 42501104 , LOCKHART, INCHA 2556 FAIVRE STREET CHULA VISTA, CA ENDICOTT, K H TR 600 PLUMTREE LANE GRANTS PASS, OR Phone: (619)423-6200 Zip 91911 Phone: Zip: 97526-7245 STANFORD SIGNS INCORPORATED 2556 FAIVRE STREET CHULA VISTA, CA Phone: (619)423-6200 Zip: 91911 License: 620617 Status: ISSUED Applied: 03/14/2005 Issued: 03/14/2005 ISSUED BY: SCOPE OF PERMIT INSTALL 75 SQ.FT2' HIGH X 25' 1 1/2' WIDE ILLUMINATED WALL SIGN WITH CHANNEL LETTERS FOR'BIG O TIRES' � 1 SIGN CIRCUIT REF:SBOS-00028 $23.50 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System I Lighting Busway/100 k � Standing SecOon . . Misc Electrical Equipment � Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low VOIWge Equipment Low VOIt Wiring System I Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lighls) Christmas Tree Stand Fireworks Stand � � ONer Electrical Fee , Investigalion Fee Quantity $0.00 0 $0.00 0 $0.00 0 50.00 0 ao.00 0 50.00 0 $0.00 � 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 ' 0 $0.00 0 $0.00 0 $0.00 0 30.00 so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must compty with all applicable codes, and all required inepeetiona end finel approvel must be obtained. Failure to obtain inspections and tinal approval will result in the axpiration of thls permit. FOR INSPECTIONS CALL: (714) 754-5626 xa�ee (eluo� WORKERS'COMPENSAPONDECIARAnON: I hereby ef(rtn under penalty ol per�ury one oi the tollowing tledaratlons: � ❑ I heve entl will meintain e cenificete ot consent to sell�lnsure tor workers' compensatlon, es provldetl for by seMion 3700 ot Ihe LeDor Cotle, tor Iha peAo:mance of Ihe work tor whiM this permlt is Issued. � I heve enE will meidtein workers' Compenselion insurence, es requlrad 6y sadlan 3700 0l lha Lebor Cotle, lor Ihe pedormance of Iha work for wNch this partnll is issuotl. � M warka m@n5a-ti�o�n �I�t surentP cerrler entl ollC number ere: �� // 'M !��/, 8f�uem '-��L��I P Y PnJIry.Nu�Tber: �� I`T. (./�'� l �Thls sectbn need not bB �eted i! fh permi( Is veluetl ef are hundred dollars (3100J or less. J ❑ I certily that in the perfortnen e ol Ihe work for�f I hi9 permil Ig Issued. I shall nat employ any parson in eny manner so as to becrome sub�ecl to the workers' compBnsation law elit ie, an egree f Yil I become sub�ect to Ihe workers' crompBnsetion provi9ions of SBCIi n 3700 f Ihe�t gbor Cotle, I shell forlhwlih Apaise F&�'gn�aturthes p vis' L - �Ie? ��f I y� ��-L� W�RNttJG?FFl RE TO SEp1RE WOfiKEFS' COMPENSA?ION GUVEMOE IS UNL4WFUL r1ND SHAIi SUBIECT AN EMPLOVER TO CRIMINPL PENALTIES nND CML FlNES UP TO dJE NUNDHED TTqU$AND DOILARE (StOJ.000I. IN qp01TION TO THE COST OF �dPENSATION, DAMAGES AS PFlpVIDED FOR IN SECTION 31O60F TME LABOR ODDE. INiEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hareby aHirm that I am lice ed undar rovisions of Chepter 9(commancing with Section 7000) of Dlvision 3 of the Business � Profgssimr.Cotle, and my Ilcense is in tull 10fCe BOtl Bfl¢CL Li �. . � e% �O . ° �ss�re_ �, � i �,� CONSTRULTION LENO�NG AGENCV: ❑ I hereby attirtn that ��ere is e consiruclion landing egenty lor tha perlarmence ol ihe work lor which this permit is issuetl. (Sec. 3097. Civil Cotle). Lentler'9 Neme: Lender's Adtlres9: Signeture: Date: OWNER-BUILDER QELLARAiIONS: I hereDy eflirtn thet unQ8IDe�lry af perjury Ihet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the lollovnng reawn (Sec. 7031.5, Business an0 Protesslons Code: Any dry or o�wSty whieh reQuires 0 permit to COnS�rutt. elter, Imprwa, tlemolish, or repair eny siructure, prior to its issuance, also r6quires t�e applicant tOr suc� Dermit to file e signeC sta;emem �het he or she le Iicensetl pursuent to Ihe proNslons of Ihe Contractora License Law (Chapter 9(commencirg wlth Section 7000) of DlWsion 3 0l Ihe Business entl Prolessiori5 COAe) or Ihet he or she is e:empt thorolrom end the besis lor the ellepetl oxomption. Any vidation ot Sectbn 7031.5 Cy any aOPliwnt for a permit suDjecis the applicant to d dvil pyjielty ol not more than liva hundred Aollers (5500).�: ❑ I, es owner at the p�opeily. or my el�nployees with weges es their sole wmpensation, WILL DO THE WORK. antl the structure is not intentled or otteretl tor sale (Sec. 7044, Business end P�a�ess�ons Code:-The Contraciors License Lew tloes not apply to an owner ol proparry who 6uJtls or improves ihereon, antl who tloes such work himsetl or �erself or through his or her own employees, provitled Ihat sucti improvements ere not Intended or ottered tor sale. If, however, Ihe building or improvement is sWtl wit�in one.yeaf e� completion,.the owneo-builtler will heve Ihe burden ot proving �hat he or she did not builtl or improve for Ourpose of sale.). ❑ I, as owner of the p�operry, em E%CLUSIVELV CONTRALTING WITH LICENSED CONTHACTORS to construct the project (Sec. 70a4, Business and Professions Cod�: The coniractors License Law tloes not epply to en owner ol pmperty who bullds or impmves thereon, antl who wntrects for such project wit� a coniracmr(s) licen58 pursuani Io Ihe Comrectors Licanse Laws.). ❑ I am exempt untler sec. -' i Business anA Pmtessions Cade for NI5 reason: Signeture: Oata: Ownar ID verifed Dy driv6rs license. Ves ❑ No Dr'rvefs License No. Ezpirq5: Vedtication of Ownership by (rype ol docNment, i.e. - properry tex biil or deed): DIVISION OF INDUS7RIA� SAFE7V PERMIT CERTIFICA710N: ❑ I hereby certity Ihat no ezcevetian flve (5) or more feet In tlepth Into which a person is requlred to descenQ will be matle in conneclion with work authonzed by this pertnit, end Ihat no building structure, scaHolding, talsework, or CemUition or dismantling iheraoL will be more Ihen Ihirry-siz (36) leet high. (C�ap. 32, Grp 2, Art 2, Sec. 341, Title B, CelilorriiB AOminiSirBiive Code). ❑ A5 owneo-builder, 1 willdo� emplay enyone to tlo wark whic� would require e pertnit tmm the Divlslon of Industnel Sefery, as notetl ebove, unless such person hes e permit to do such work trom ihe division. Signature: Division of Industrial Safery Partnil Number: Date: CERTIFlCATE OF CAMVUANCE AND AUTHORIZATION OF EHTRY: I conify untler penelty ol porjury ihat I heve reatl �his epplicalion antl state thet t�e intormelion givon is correcl. I egree to comply with all stete lews end city ordlnances releting to bullAing constmctlon, entl eulhotlze represantatives ol the Clry of Coste Mesa to enter upon the above�described propeny �or inspaclian purposes. I agree nat to occupy or allow occupency ol eny building aulhotlzed by this permit until linel inspeaion. GOOE I. INSPECTIONTYYE t6�6 Fized System Final Fire Preventlon 1266 Pool Spa Final 200 Finel Re-Roof 207 Finel BIaWReteining Wall 202 Final Fanory FIr9 Plaw 203 Final Sign 204 Finel Demolitlon PdIE INfRIALS COOE� INSPECiIONTYPE 206 Flnal Mechanical 20B Final Plumbing 210 Final Eleclrical 212 Flnal Fire Prevemion. 220 Final Plenning Approval 222 Finel Sile 250 Final Builtling�Occupency p_7.\I�I:IIH!1F'. ��✓ ' ' PA10 ^�/;, ' •, , �p93 SEP 26-64-00 830* �*' 144.75 . [p5A ' '� � � COSTA MESA BUILOIN(i�FETV DEPARTMENT P.O.eOX1M0 COSTAMESA.CAIIFORN1A91628 � � APPLICATION FOR BUILDING PERMIT For Applicant to FIl/ In Comp/ataly qECEI V ED B DA E N I E �.+ on� ssu o ADDRESS 32Z �' �� ^�`J /�� T . G ' —� -�I PER TNQ.:�a OWNER '�'�' ��JR� 1 T(�.P-_'� ' '>•V• � - Y BUIIDINO ADORESS � .4DDRESS �ZZ �• I 7 M ST. W W TEI. � TRACT 659 a U CITV � �. NO. � Z Q CONSTRUCf10N . . O N LENDER �/ a m �� J � BRANCM J N OWNER, J ADDRESS qqq��,��`a OR E� N�� TEL. �Si3 A/V ��v Q FIRE \� u% 20NE TVI �Q ADDFESS �mw AiPROVED , / � CONTRACTOR F. S c� F � Y � 2 � J ¢ ADDFESS �W W TBL. ' ZONE NO.OF ZF CITV ' NO. �'Z �� \(n 2 IIC. NO. / 3 . y I LICrNO.I 7� � YMAION BUILDINO '�� SIZE . �p,pFg�pp,q (FROMC/LSTREETI� OF LOT I b � ' �IOWONLOT � � USE OF �, � � � � �� n EXISTINO BLDO. u L Z NIEW BLDG. � R �F �NO. Of � I ST HI S �'l IL �V COVER�ING� OI.K- COV�R�NO REAR 3�L fT. iY/I � USE GBUILDII�OANDWONKTOB�@RFORMBD �TA�� — _�f S �.wiN � Q VAR• O C.U.P. t F APPROVE LJ � Z NOLD OR S � V 1 hanbv eCknowlWp� M!t I hm ��b MI� �ppIlCMbn and ttDq �� thet [he ebova Informstian I� cornct antl prN to oomplY wIM � ell lew� rpulatln0 bulldinp conrtuctlon, aiM I Mell not �mploy � !ny pa�Wn In viol�tlon o1 tM wOrkm�n'� comp�nMtlon Inw o1 Ms Ststs ot Calilornl�. y ? I �areEy cartify thet I am ptopM� �IunME �� a eonb�ctor undm � 3� F ths Stnts of Califwnla BuAn�o �� ProlfWon� CoW, OMhlon 7, TNE AMOUNT Chapnr B, enA tMt wcM IkM�y In In futl torc� �n0 NbeL a � TNE PUNV068 < em a��mpt from M� provNbm of M� Bnn of C�Illprnl� Busln�p ypLUATION antl Profnslon� COE�, Dlvi�lon 9, Ch�pM B. Sipnetur� 01 ,�yp V^� "�//f /�� /n/ ^[\ Pnmitt�� / O. VI. /� /�'[-C.! X O = / ��J � , O�, / Aut�orited p�nt VALUE DATE �cf!'2 JO �•• �EiRI l T,nr_ S.. iOS APPROVED ISSORV BUILDINI rff ST � CT d 9MOWN UNOER VALUATION IF ESTABLISNINO A GERMfT FEE TQTAI � 0 b ¢ 2S E ^ LL / / /I .�-� 3I035 .. , • �COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Far Applicant to Fill in Completely BUILDING � � {z •Z'r.�.� ADDRESS ��_, OWNER �/ MAIL I � i 2 y.s�.. .. .. i�.._ � CITV L CONST0.UCTION BRANCH ADDRESS ARCMITECT ADDRE55 _S l�"]f� �(J. /�/ CONTRACTOR �� (�n,^� �� ADDRESS CITY STATE LIC.NO. JII IG1=�^7 '��l i� SI2E OF LOT USE OF EXISlING BLDG. 512E OF NO. OF TEL. NO. TEL. NO. CITV �IC. N� J INO. OF 8LOG5. NOW ON LOT NEW BLDG. ROOMS STOf E%TERIOR WAIL ROOF COVERING COVERING USE OF BUILDING AN� WORK YO BE PERFORMED ' 11., � i�_ �. N 1 1��.. i N A I hereby acknowletlpe thet I �ave raatl this appllcation entl state thet the above information is correct and apree to comply with all laws ra9ulatinp builtllnB �onstr�etion, antl I shall not employ any person in violation ot ihe wo/kman's compensation laws of the Stata of Celifornla. I hereby certify that I am properly Iicensetl as a convactor untler the State of Calltornla Businasa and P�otessions Cotla, Dlvlsicn 3, Cheptar 9, entl thet such licanses ale In full force antl etfact, or I am ¢zempt from the provisions ot She Stete of Callfornle Busina65 antl Protessions �C/oJtl�e, Division 3, Cnepier 9. �O s�a�aw.e of E� N>s`"� Pefmittee � �� Authorized ABant nCT 27-6�001041 ��****5.00 APPLICATION FOR A.P. Ne: I I I— LY�I — Gu �- u I ADDRE S�322 Gi �/ m � TRACT b59 LOTBS � OWNER FIRE ZONE TVf APPROVED � BV � 20NE NO.OF L2 P�� 2 VARDS APPROVED DI5TANCE BET. MAIN BLDGS. VAii. iW MOLD FOR THEAMOUNTS THE VURPOSE OF VALUATION $ 3�00, d� PERMIT BLOCK � USE OF NEW (�ON C . BUILOING IItOG� Wh VARDSAPPROVED ACCESSORY BUILDII TN sn� ET� _ t DATE APPROVED � 0 VALUATION IS FOR � A PERMITI �FEE ONLV: Q ` m _ S V N � m K$ E `o � LL $