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Home My WebLink About385 17TH ST - Building PermitsCity of Costa Mesa Building Safety Department P. O. Boa 717 Co«a Mesa, Californio CERTIFICATE OF OCCUPANCY N� 2458 C The Building located at ,��'''i'�$ ��}yE has been inspected and found To comply with the provisions of all City of Costa Mesa Ordinances applicable ihereto for o Gtoup �"� Occupancy. Use of Building �"�C ��nL .egal Description ' �� +1� � � � (See ravena �ido for Metes and Bound�) Building Permit No. ��' Elecirical Permif No. �� Plum6ing Permit No. b� Floor Load Signs have been installed as Room Capacity Signs have been insfaled as req�ired 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 ihe owner or operator has been issued a valid certificate of occupancy by ihe enforcement agency. - (b) A new certificate of occupanry shall be obtained whenever there is a change in: 1) Occupancy classification of a b�ilding or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Gro�p 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 iSSUED TO: .rklNt �0� ::r t�.��; Building Official Date �n is, a�o7 " This Cerfificafe of Occupancy SHALL BE posfed in a conspicuous place on the premises and SNALL NOT BE removed except by the Building Official of ihe City of Costa Mesa under Sec. 306 (e) U.B.C. For�„ svaa—�as—ii-ea-s-s r , , 26 I o0 iC05TA MESA BUILDING-SAFETY DEPARTMEM P.O. BOX 120! COSTA ME.4A. CALIFORNIA 92620 For AppllrnM fo FIII In Comp►Noly TYPE OR PRINT 'DDH1YY J O S � - � / � � CO3TA MESA, GALIFORNIA N MAIL HTATC LIC. NO. e� � 61ZE IPO� NO. O� GlDO�. DESCRIPTION OF WORK BUIlDINO NO. 62H ROC E%TERIOR WALL R� COVERINQ b UYG OP DUILDIf�Y AND WORK 7 � �im/, 1 NNReY ACRNOWL[DCt TIAT.I 1 AND BTAT[ TI�AT TMi AlOY{,IB C PLY WITN ALL CI O 1 / OUIlO1N0 CONE'R HIGNATURl� O PeRM1TTH AUTN0111Z[D AO[NT 1D T111� IVRIGTON AND.AO11[[ TO ¢GY. YARDB MAIN vue. te SEP 16-66 OD 413�7*°*�`�'S.00 t-�f�� -y �9�! ArPLICATION FOR PERMR 6UILDING for Offln U» Only ' ZONING xo. ar u�s or nnv ■uru Q �emtmNo _ __ r/ �/ �`^Q ANO BHALL E6 L6H8 TNAN �A L / (U.B.C.ReOUIRlM6NT) � YMDBMPROVBD ` AGCfi880RYBUILDINO � \ �. �i. DATH � a m � � �. �. � nn �routR axowN uNoca v�tu�non �e von n�e � N11100� 0I fRASY0MIN0 A �6pYli !�E ONLY. � VALUATION P� �LQ � PBHMITFBB ..5 i / Q/ / w° [ V � � TOTAL PCi � , � - '� 26 ! 84 ' COSTA MESA BUILDINCrSAFETY DEPARTMENT P.O. 80X 1'MO COSTA MESA, CALIFOHNIA Y2l26 For Appllcartf ro Fill In Complefa�y TYPE OR PRINT eun.oiNo 38.5 �as2` %%r� -SZreeZ.` ADDRE89 COSTA ME9A, CALIFORNIA STATH LIC. NO. a � size . _ R RGR [FT _ (O •' RIOlfT DESCRIPTION OF WORK 3(D �i'J ROOM �WALL_('�.�cco Ra CO\ JILDIlIG AND WORK TO 1 H8H!!Y IICRNOWL6D0{ TryAT 1 NAV[ ANO BTATH THAT TX[ AGOV6 1 COqRI PLT WITN I�LL CI DI AN4I BYILOINO CONB �L Ji � �_vy� (i'ln — � ��, SEP P3-66 00 579n3****90A( �y ck - 38.�- . APPLICATION FOR PERMR BUILDINfi for Office Use Only e�ca�rr xo. � � / �n � 3 v[u �r - wa x�carveo I wn �99uRo 9._ i�. _ L/ n_ � A-f../ ZONIN(i 201� `n NO.O! YYtO�NI L G� �LAN� Z OWLDINO LiOAL �.r /D � �, 'F 'O / YAROH MPROVHD MAIN BUILDIN6 �vwR. at C_ 11 P � �y � ^ SXALL08L888THAN , \ IU.B..C.REOUIRHMENT) � YARDS MPROVHD AGGBBBORY BUILDINO � \ PT. � � FT. �. DATB e PROV[D ��%� DATQ �LJ C� a ,� �. � a— � � 9�D�. �. / � TN8 AYOUNT �MOWN UNDBR VI�LUATOM �! !Oq TH6 j �URPOBH OP 6OTI�BLI6XIMO A PeqMIT �H8 ONLY. is YALUATION •O � PERMITPH6 '� p 0 a�� .S-9O .�D -- W TOTALFEB ^y / �'� ' • � 36871 � ' ' GUSTA MESA BUILDING-SAFETY DEPARTMENT � P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING �J S I � S ADDRESS Q � OWNER � � MAIL � �^ Z ADDRESS ��8 3 /'"�(�t aU CITV �f�P�/N AJ ��5. NOLfQO�li ZZ Q CONSTRUCTION O N LENDER d m J � BRANCH �� J N �ADDRESS � Q ARCHITECT � OR ENGINEE P SO . UQ W CL ADDRESS 3 aW �� W Z CONTRACTOR /-p �I J Q mz J � ADDRESS W W " � Z� arv yOrM�'� - w� STATE -/ ^n/ l�` j O LIC. N. o/(oS OF LOT��,s / X /�J. i � USE OF EXISTING BLDG. y/ �y� F SIZE OF � �� Z Q U i Q 0 H N z � F U � � F h Z TE ,; �/.r.� TEL. No,l774.< CITY LIC. NO. INO.OF LB�DC'tS. NOW ON LOT 7A.S�f/�INaIdII COV�ERINGf�oO�M 11LOING AND WORK TO BE PERFORMED PAID � *^�,� 1i!y 28-73�M5�0�3429 ��.5� A.P. NO. � 17 ��' BUILDING � ! ADDRESS J TFIACT !l l,) OWNEfl IRE ONE PPilOVED BUILDING PERMIT )NE NO.OF USE OF NEW � C 2 PlANS 2 BUILOING � VARDSAPPROVED YAROSAPPF MAIN BUILDING ACCESSORY B ROMGLSTf�SET) . lu f REAR r_ I DISTANCE BET MAIN BLDGS. VAR. # C.U.P. � API'ROVED . I hereby acknowletlge that I have reatl this application antl state that the ebove information is correct end aBree to comply with ell laws regulating builtlin8 construc[ion, and I zhall noi amploy any permn in violetion of th¢ workman's compenseilon laws of the State of Calitornia. � I hereby <ertify that I am properly Iicenud as a contrector untler SQ. F the State of California Business antl Professions Code, Divisicn 3, THE AMOUNT Chepter 9, anA that such licenses are in full torce and effect, or I THE vURPOSE 1 am exampt from Uie Orovisians of tha Stete of CaiHornia Business VALUATION an0 Profeisions Code, Division 3, Chaptar 9. Sipnature ot 1 � Parmlttae �/ � • $ r� 9�� Authorizetl Agent � M1 2 �, '� ,\ . }�O LL - Z-E ML 1 L-I� 6 BET. MAIN & ACCE�. BLDGS. DATE APPROVED � b/a8 � a SS P� Z� o !N UNDER VALUATION IS FOR ' ABLISHING A PERMIT FEE ONLV: Q �� /� m PERMIT FEE $ � r�—V r' 7 m PLAN CHECK $ E ,° LL TOTAL FEE 5 / / � � ano2b � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILOING •'Z�� -�TN S� ADDRESS .+Z'J OWNER rLAN/M/1KFi�L. —✓II)C= Z. .,__ '__ _ ww v a c7 CITV Z CONSTRUGTION O � LENOER am J � BRANCH J'� ' ADDRESS L ARCHITECT J a OfiENGINEER � U N wa p � ADOPESS aW W Z CONTRACTOR J Q m Z J� AD�flESS W W Z F CITV w O STATE L10. NO. � � SIZE OF LOT ��L r�-/.ln�'p ev, TEL. 11.GOQ��' No. L. SdN TEL. NO. CITV LIC. NO. �� NO. OF BLDGS. NOW ON LOT � PxI� 'FY?�-75cns�� 97fs ,tt*�� \ ON FOR BUILDING PERMIT � DATE RECEIVED DA�TE I�SUE^ � A.P.NO.I`� ��:�PEfl� NO. BUILDING � /� r � ADORESS J TRACT � � LOT �b BLOCK �� NEW II ` OWNER �DQ/�///f/�%�-G� /NG USE �X /• ' I �-/ �.� VAWE /��"� �J FIRB I � ( 20NE P, � GROUP ` APPpOVED �/_� r gy � s OATE (0 n ZON NO.OF USE OF-NEW � �2. PLANS� BUILDING �p(�/�i v�wi VARDSAPPflOVED YARDSAPPROVEO MAIN BUILDING ACCESSORV BVILDIN F SIZEOF / �/ NO.OF ^ / Z NEW BLDG.IO��O ROOMS STORIES 2 L. SIDE �O FT U EMEFIOR WALL�PSS 1 ROOF O.li. E}UST (N$-� COVERING G COVERING REAP FT � USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BEf. �GA1G W 4 IJN � P MAIN BLDGS. 0 IO AL'IF.RA'7- O C URP.9ri � APPROVED h o OLD FOR : UI heraby acknowletlge that I have reatl this appllcation and state � that the above Informetl0� is correct end aprea to comply with � all laws reg�latin8 builtlinB �onsbuction, antl 1 shell not employ F eny person in violatlon of Me workman's compensation laws of y the Smte ot Calitornia. ? I heraby canity ffiat I em proparly licensatl as a conoactor under SQ. Fl the State of California Businezs and Profeulona Cotle, Divisicn 3, THE AMOVNT: Chapter 9, entl [hat s�ch Iicenzes are in tull torco antl effact, or I THE PURPO6E O am exempt from the provisions ot theState of Cellfornia Business VALUATION antl Professlons Cotla, Division 3, Chapter 9. DAi�iC�� sie�ecu.e of � Permittea g � �'� , Autho�ized Apent TOTAL FEE & �� .� ► M. m 1 v// � O T VALUATION IS FOF � � A PERMIT FEE ONLV: Q � " $ 7 \ �/'� m KS �Ov E _ `o u $ p �, o � 9 o. � > _ : J -' �oxmW � ��ia� �sa-s2�s • Fax (714) 754-4856 � CITY OF COSTA MESA BUILDING DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT dob nddress: 385 E 17TH ST Suite: Vicinity: KITCHEN AREA Parce� Number: 42519305 npp�icant: RUGGIO, TIM Address: 2684 LACY ST LOS ANGELES; CA , � Owner: JACK�IN THE,BOX 284�. Address � 9330 BALBOA AVE. - �. . -i ATTN: �J, TIDWELL ,� . ,., � SAN DIEGO, CA -- _ . Contractor. MASTER PROTECTION Address: 2684�LACY�ST � ` , LOS ANGELES, CA Zoning: Phone: (213) 225-6666 Zip: 90031 Phone: (714) 548-7047 �. Zip: 92123 Phone:' (213) 225-6666 Zip: : � 90031 License:- 555875 : : '�� . ' -\ - � . ..INSTACL FIRE SUPPRESSION SYSTEM (ANSUL R102) FOR EY THE BOX-. i � ' . � . .�� .. - . • FEESUMMARY Plan Check: � $63.21 � •. ' � Permit:' $97.25 � ' � �� ` � _ ' � ' Other.' $0.00 Total: $160.46 _ ` �:� ,.. --- 77 FAIFl DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 01/04/2000 Issued: 02/29/2000 ISSUED BY: HOOD 8 DUCT FOR -JACK IN C81C V91U8ti0ft: $3,500.00 -Claimed Valuation: S3,soo.00 NOTICE: The work authorized by ihis 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_ 780 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 Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. FOR INSPECTIONS CALL: (714) 7545626 / WORKERS' COMPENSATION DECLAHATION: I hereby aNirtn untler penalry of perjury one of the lollowing DeUaralions: ❑ I have entl will maintain a certificate of consent to selt-Insure tor workers' compensetion, as provitled for by sectlon 3700 of the Labor Code, for the pertormence of the �/�'�ork for which Ihis permit is issuetl. I1d 1 have end will maintain workers' compensation insurence, as required by sectlon 3700 ot the Labor Coda, for tha peAortnance ot the work for which Ihis permil Ls issued. My workers' compansation Insurance wrner entl policy number ere: Cemer. %�iWElL�LA�J F�oToP.�ST 1�1S Cd PolicyNumber: 3�C>�1R53t5�m'� (This section neetl nof be completeC il the permit is velued ef one huntlred dollars ($100) or /ess.J ❑ I certify thet in the pertormance of the work lor which this permit is issued, I shell nat employ eny person in eny menner so as to become subject to Ihe workers' compensation laws of Celifomia nd e rea ihat if I should become subject to ihe workers' compensetion provisions of Section 3700 oi ihe Lebor Code, I shall torthwith comply wiM these provisio " O d AppliwntSignaWre: � �� Dete: �-2 1'�1'-' WARNINGFAILURETOSECUREWORKER MPENSATIONCOVERAGEISUNLAWFULANDSHALLSU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDRED TYIOUSAND DOLLARE (5100,000�, IN ADDITIqJ TO THE COST OF COMPENSATION, DAMAGES AS PROVI�ED WR IN SECTION 31W OF THE LABOR CO�E, INTEREST, AND ATiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn that I am licensed under provisions ol Chapier 9(commencing with Section 7000) of Division 3 of ihe 8usinass and Professions CoOe, and my licensa is in tull brce ana ettect. uc. a S SS Class a C l6 � GtU Conlrectofs5ignaNre: Date: �-�`f-Rs4f CONSTRUCTION LENDING AGENCY: ❑ I hereby eNirm ihet there is a constmction lentling agency for the pedormance of iha work for which this permit is issued. (Sec. 3097, Civil Code). lender s Name: Lenders Address: Signature: OWNER•BUILDER DECLARA710NS: Date: I hereby aflirm ihat unOer penalty oi Derjury that I am EXEMPT FROM 7ME CON7RACTORS LICENSE LAW lor the lollowing reason (Sec. 7037.5, Business end Protessions Code: Any ciry or counry which requires a permit t6 construct, alter, improve, demolish, or repair eny swcwre, prior to its issuence, also requires tha epplicant for such permit to fila e signed statemem that he or sha is licensed pursuani to ihe pmvislons ot Ihe Camracrors Licensa Lew (Chapter 8(wmmencing with Sedion 7000) ol Division 3 of Ihe Business end Pmtessions Code) or that he or she is exempt therelrom end the basis tor the alleged exemption. Any violation oi Section 7031.5 by any applicant for a permit subjecis Ihe applicani �o a civil penalry of not more Ihan flve hundred dollers ($500).): ❑ I, as owner of Ihe property. or my employees with weges as their sole compensation, WILL DO THE WORK, end the structure is not intentle0 ar otteretl for sale (Sec. 7044, Business antl Professions Cotle: The Contractors License lew dces not appty to en owner of property who builtls or improves �hereon, antl who does such work himseN or hersell or ihrough his or her own employees, provitled ihat such improvements are not intended or oHered for sale. If, however, the bullding or improvement is sold within one year ot completion, the owner-builtler will hava t�e burtlen oi proving that �e or s�e tlitl no� build or improve for purpose of sale.). ❑ 1, es owner ot Ihe pmperty. am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to cronstruct the project (Sec. 7044, Business antl Professions Cotle: The contractors License Law tloes not apply to an owner of property who builds or improves thereon, antl who conirects for such project with a contracbr(s) license pursuant to the Contractors License Lews.). ❑ I am exempt un0er sec. Business and Professions Code tor this reason: SiqnaWre: Date: Owner ID verilied by tlrivers license. ❑ Ves ❑ No Drivels Licensa No. Expire5: Venfication of Ownership by (type of document, i.e. - property tax 6ill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetlity that no exwvation tiva (5) or more leet in tlepth imo which a person is repuired to dascend, will be made in connection with work authonzetl by �his pertnit, end that no building slrucNre, swHoltling, falsework, or tlemolition or dismantling t�ereof, will be more than ihirry-six (36) feet high. (Chep. 32, Grp 2, An 2, Sec. 341, Ttle B, Califomia Atlministrative Code). ❑ As owner-6uilder. I will not employ anyone to do work which would require a permii trom ihe Oivision ot Intlus�rial Safery, as noted above, unless such person has a pertnit to do such work Irom iha division. Signature: Date: Division of Industrial Sefery Pertnit Number. ICERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certiry untler penalty of perjury that I heve read this application and state thai the intortnation given is I correct. I agree to comply with all state laws antl city ordinances relating to building construction, and auNorize representatives of the Ciry ol Costa Mesa to enter upon the ebove-described property for inspection puryases. I agree not to occupy or allow occupancy ot any builtling authorized by this pertnit until final inspection. CO�E y. INSPECTIONTYPE 1616 Fi:etl System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 2446d6 PGIE INTRIALS 2—�9—��e� Date LOOE� INSGECTIONTYPE 206 Final Mec�anicel 20B Final Plumbing Q� IMITIRLS 210 Final Electrical 212 Final Fire Prevantion 3" � �"' �TD 22 Final a 222 Finel Site 250 Finel Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOS7A MESA, GA 92626 BUILDING PERMIT � .lob Address: 385 E 17TH ST Suite: Vicinity: REAR OF STRIP MALL Status: ISSUED Applied: 02/01/2002 Issued: 02/01/2002 Parcel Number: 42519305 � Zoning: ' � � App�icant MORALES, JOSE ___ ---- -_ ISSUED BY: Address: 2862 EXECUTIVE PL ; �� -i%%'-'�`:-'�'_�''�' ��. '-�� i ci'� — - lJ � �_ - "`� Phone: � 760-796-8346 �_ .-�c� A ESCONDIDO; CA'l!�%' ' Zip:' 92029 ' �l ,�� /, %�i � .'- � �� , ' - � . � � ii�� V- �� / ' . � � � � � _ � i / / . �.,, A � A Owner. PACIFIC COAST INC � - •- `. � � � � ��' � � �� , 1 "� % Address %/oPRESTA; RON E ��./ :- , _ . ' �,� t • ��,� � ��-NEWPORTBEACH CA � �Phone" � � � ��' � ` � � ` „ � � �� :� / � / P O BOX 7099 �,� �� Zip: 92658-7098 ' " � �.. � ' \' i � ��\ \� -� � ��v �_ / � , � i i . - � � , : . Con4ractor: �ELEVEN'WESTERN BUILDERS �- %Address:- 2862 EXECUTNE PL �."% �� j� Phone'�760-796-6346 � �, ` ' �� ESCONDIDO CA � � �~Zip,.,' 92029j � ' License „ 439908 '� F- '.�., _ _" A ^u i �Arch .., i�i� " , �" �� '..r�:.,.�",��..' \.� F ��. ��. Address: � /�� .��.,� � Addii � t l - '- -•� , i ,_ �i � . r Phone: � � ' � " _ , . -. � l `C\' � . � �`Zip: , y � % � � � /�License: �-, _ \i /. /;_ . � , .� � , ��, � �< �� : �_� �\��A/ �� , '�,� ��: � / . �.\ �q`�� \`' v ��V�� %� : � �.,'� '�.. G' V '�J � tg �a i � A � V � � ", � ; ��. ss � ' , �; �.. � � � ' �� - �-�` � - � Phone. . , V. � � % __ "_ ;19� �i. �� 'r, ��` � . ._ : �-� � Ucense: , " ; , IIT,,,vnc�c �A �,, �. � REPLACEMENT OF AN hXISI IN(�f I KASFi tNGCUSUKt WI I Fi A NtW 344LFARASH,ENCLOSURE AT THE REAR OF A STRIP � MALL. ; . . � � .' ' . __ . . _ _ .. _ . r ._ ' , . , : � � � '. `� � � �� "�� FEE SUMMARY,� ; - _ �� -, � - ' �� `� Plan ChecK: , $90.51 f — - �= _ ' ` // � = -Calc Valuation: �r,' • ' � g�,000:oo' � Perrrid: � �$13925 " � "� � - � u� �� - Claim Valuation: ; ` % _ Si,000.00 SMIP. Res: �� $0.00 � �SMIP Com: . $1.47 '� _ ' � , . �� ,`� ' �'� / ; , � �;�� Other: � , $0.00 � � "' � ,,. , ��Inspecfion;� �,$0:00 �� ...,�•:;,�y�� -- �'iY/� � ��. - �A .� � � A.�;o•. °� �. , n _ %/� �i � ' . \ 1� `�AV C � r �� '�TOL31. ;$231:23�� ,�,; > . �'�i . � � .y�� . ;�� ; ,�/ , �A` - , , - . `-.-, ' ' �� ;�;� ;�j �� "' RLANNING`& ZONING ��/ �� j � ; ' � SETBACKS. � � " �� ." . ' �'- �' � _ - �� MAINSTRUCTURE Front 0�� Rear 0-0._� _ ��6eft _`0-0". - �Right - 0-0�� ,, �'� �_ . r ' ,_ ' _ - . �, - i. � �.,. � „._ _.. . � .c�� 'V ; ACCESSORY Front'��0-0 �, ,��Rear _,0-,0- , __ Left.- -0;0. �� Right �� 0 Oi� . , „ ' � a, __ � � - ' � � 'i � /i PARKING Existin � 0� ., Reauired � 0 _=� �� Pr000sedi, 0 � ,.- ��1, . � -� �. ;;-.' _ --' -,/ % ��,�: -- NOTES: ~ "'�-,�"� ' . � _� ,-,��, ;��i� = -- NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requiremenis 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetlons and final epproval must be obtained. Fallure to otitain inspections and final approval will result in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5826 >a•:a.•:ir.ncm WORKERS'COMPENSAnONDECLARATON: � I hereby affiim under panalry of perjury ona of the following tleclarations: � � ❑ I have antl will maintain a cenificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of ihe Labor Code, for the performance of the work for which ihis permit is issuetl. . . � I have antl will meintain workers' compensalion Insurance, es required by section 3700 ot ihe Labor Code, for the peRormance of �he work for which this pertnit is issued. My workers' compensation Insurance carrier antl policy number are: j'_ � Carrier. �rT'Iq�fT� •'F{ `I� Policy Number: O4�J�e�. • � � l il'T �OiQ� (Riis section need no( be complefed il the permit is ve/uetl a! one hundred dollars ($100) or /ess.) ❑ I certify that in the pertormance of theyt�rkior WIftCRI ermit � s� ued, I shall not employ any person in any manner so as to become sublect to the workers' compensation sof-Calile 'a, n�agree Ihet ii I shoul b m6subject to the workers' compensation provisions of Saction 3700 ot the Labor Code, I shall fotlhwilh comply wit ese pmvisions. 11 I��Z . Applicent Signat Date: WARNING: FAILURE TO S S' ON CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANDDOLLARE($ ,000�,1 ITIONTOTHECOSTOFCAMPENSATION,OAMAGESASPFOVIDEDFORINSECTION3]O60FTHEUBORCADE,IMEREST,ANDATTORNEV'SFEES. LICENSED CON7RACTORS DECLARA710N: I �ereby ettirm ihat 1 am force antl eHed. Lia x_ Contractofs Signature:l with Section 7000) of Division 3 of Ihe Business and Professions Code, and my license is in tull Cless N iJ _ _ CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm that there is e consiruction lending agency for ihe pedormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lendar's Name: LentleYs Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I �ereby ettirm ihat under penalty of perjury ihat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Protessions Cotle: Any city or counry which requires a permit idConstmc6 alter, improve, demolish, or repair any structure, pdor to its issuance, also requires Ihe applicant for such pertnit to tile a signetl statement ihat he or she is licensetl pursuent to the provisions of �he Coniractors License Lew (Chepter 9(commencinq with Section 7000) ot Divlsion 3 of the Business and Profassions Code) or that he or she is e:empt therefrom and the basis tor the alleged ezemption. Any violation of Section 7031.5 by any applicant for e permit subjects the applicant to � civil penelty of not more ihan five huntlred dollers ($500).): ❑ I, es ownar of ihe property, or my employees with wages as iheir sole compensetion, WILL DO THE WORK, and the structure is not Intended or oHered for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does no� apply to an ownar ot properry who builds or improves �hereon, and who does such work himself or hersalt or through his or Keid++n employees, pmvitled Ihat such improvements are not intended or ottered for sale. If, however, ihe 6uilding or improvement is sold within one year of completion, the owner-builder will have ihe burden of proving that he or sha did not build or improve for purpose ot sale.). ❑ I, es owner ot the property, am EXCLUSIVELV CONTRAC7ING WI7H LICENSED CON7RAC70RS to consiruct tha project (Sec. 7044, Business and Profeuions Code: The contractors License Law'tloas not epply to an owner oi property who builds or improves thereon, and who conVacts for such project with a conirector(s) license pursuant to ihe Contractors License Laws.). ❑ I am exempt under sec. ' Business antl Professions Cotle tor this reason: Signature: '1 Date: Owner ID venfietl by tlriver's license. ❑ Ves ❑ No Driver's License No. Expires: Vedficetion of Ownership by (type oi tlocumenL i.e. � properry tax bill or deetl): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTFICA710N: ❑ I hereby cerlity ihat no excavation fiva (5) or more teel in tlep�h into which e person is requiretl to tlescentl, will be made in connection with work authonzed by this permit, and that no building structure, scaflolding, falsework, or tlemolition or dismantling thereof, will be more then thirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title B, Calitornie Atlminisiretive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Indusiriel Safety, as noted ebove, unless such person hes e permit to do such work irom the division. Signature: Date: Division of Industnal Safery Permit Number: CERTIFlCATE OF COMPLJANCE AND AUiHORVATiON OF ENTAV: I cehify under penalry ot perjury ihat I have read ihis aDP��ion and state that the infortnation given is correct. I agree to comply with all state laws and ciry ordinances relating ro building construction, and authonze representatives ot the Ciry of Costa Mesa to enter upon the ebove-descri6ed praperty for inspection purposes. I agree not to acupy or ellow occupancy ot any building euthorized by this permit until final inspection. COUE t. 1616 1266 200 201 202 203 Fixed System Final Fire Prevention Pool Spa Final Final Ra-Roof Final BIocWReteining Wall Pinal Fadory Fire Place Final Sign Qejf, INfffIALS COUEI INSPELTIONTYGE 206 Final Mechenical 208 Final Plumbing 210 Final Elecirical 212 Finel Fire Prevention 220 Final Planning Approval 222 Finel Site . 204 Final Demolition ( z50 Finel 8uili De 2/� %arli ate (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 385 E 17TH ST Suite: Vicinity: JACK IN THE BOX Parcel Number: 42519305 Zoning: Applicant: MORALES,JOSE _ - -. ISSUEDBY: Address: 2862 EXECUTIVE PL - " ' �" "'- - . " _ - - '� �'; � ' Status: ISSUED Applied: 02/01/2002 Issued: 02/01/2002 � -�;�i/�� ---Phorie: 760-796-6346 � - � \_ ESCONDIDO;�CA'/�'-^.��, . �' Zip: 92029 ,�� ' ,''.�, i �_�i ' ..�' \ _ , , � - Owner. PACIFIC COAST INC ` � �� . � � � � � � ii -i l ._ _ _ _/ �'`. �� Address �/oPRESTA,.RON E'� , _ " , % . : -� . _ � ; . t � �� '�� \ -� �;. NEWPORT BEACH, CA": '%-�� . _Phone: � �::' ��_",� �.: � �� A �� . `� A / " �P O BOX 7099,!; Zip: 92658-7099 �.�• �, ` i . � .' � '� .'�� ` /�' � ',ij � V i - /� , " o . . . Contractor. ELEVEN WESTERN BUILDERS `�, ��' ;'Address:; 2862 EXECUTIVE PL ��`;` �-� � � � ��, � Phone:�'760-796-6346 ` ; � . . �' � -_ ESCONDIDO, CA '- A `� � �� Zip 92029% � License � 439908 - _ - ._ � '� �� _i, /, �\ . � '� �� Arch , . � �. � � � - �.: Eng: � .. � �- ��, �_ •.. '. Address � , �,; , _ _ - Address, � � . - . �- ,�� . _ .. -- � i Phone� .'�� , �.� � �.. , one. . -� � �`J -' � . �Yip: - , � ,-'License: � � _ �`� i �� _�� '� �� , � � i, �s/ A,�� .- � -� �� license: � ' . \ � r'*'� �"\ ;a�.ur_� �c rcrcrvu i /` � '� , ,' /�'r rv, -� ;; ^r,_t � � . . . , �� ! REPLACEMENT OF 5 LIGHT STANDARDS�IN THE.PARKING LOT FOR'�JACK-�IN THE'BOX�� ' ,� ; , . . '. ' _ " _" _ ' ' ` , i � FEE SUMMARY -� �� Plan Check: '�� $0.00 �'� � �`'�:�� - - ,, � ' �- �" rz�� ,�.; Calc Valuation: " ; . - Sis,000.00� Permit�', �$22325 —�_-" �-- �� ;�� '- ClaimValuation , �- $i3,000;oo ��. SMIPRea,' � $0.00 � � �,�� ` i �SMIP Com: $2.73 Other. , $0.00 � � ` � , `� Inspection: � .`�$0.00 �,.., � �: �" � � .� � � / , �, >r,- . = , , �' '�, . ,_ , y.. - ; ,- � . � :;Total: �,$225i98 - � � — � .i�' � � , �� v,. ' — % �.:� x.:.�.__ �ii% � �:''/ J � V. IC._"R!. �C�. �ui,� ^ / ! V�� %� ��A� � � PLANNING & ZONING „ ��/ i � /� � ,� SETBACKS=� �✓�, � V� � _' � ��/ .!%��//� %:, j � " �� .; i MAIN STRUCTURE�Front„0� 0 � �- � �Rear,` �0- 0 � � Left ^ 0-0 � ,,- Right, � 0-,0- /, - i � � � , - .. . - - _� � . . � ACCESSORY Front�� 0-0 �",, '.� Rear._ 0-0 Left - 0-0 Right.' 0-0 '�; ,� � � �� _ �, , . .. , . � ., � . • PARKING Existin : -0�� Required: ' 0 Prouosed: � -0,' � �;�'�' - �, " , � �_ ' , . . . . . . � ' . � � �'%,j " NOTES: _-� _;.� . --''� � ' � _,. - - - -„�ii:� ' _., _ ,i�� _— NOTICE: The work authorized by this permit shall comply wlth all applicable handicap access requirements under Califomia stalutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire end become void if work is not commenced wi�hin 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In ordar for ihe work authorized under ihis permit to be considered legal, such work must comply with all flpplicabie codes, and ell requlred Inspeetlons and final epproval must be obtained. Failure to obtain inspections and final approval will resutt in the expiration oi this pertnit. FOR INSPECTIONS CALL:. (774) 7545626 26a6e8(6D0) WORKERS'COMPENSAnONDECLARAnON: . � I hareby aHirm under penelty of perjury one ol ihe following declarations: � � . � ❑ I heve end will malntein a ceNficete of consent lo selFlnsure br workers' compensetion, es provided for by sactlon 3700 oi the Lebor Cotle, br the pertortnance oi the work for which this permit is issueA. �I heva entl will maintain workers' compensation Insurance, as required by section 3700 of the Lebor Cotla, for Ihe pedortnance ol Ihe work Por which this pertnit is issued. My woAcers' compensatian Insurence carrier en0 policy number are: Cerrler: �q?� �i��J"� PolicyNumber: QQ{B- ? IJiTYY7�'(eY7.� (This sectlon need not be wmp/eted il the permit is velued et ane hundred dollars ($f 00) or less.) ❑' I certity ihat in Ihe peAormance of Ihe�v kJe ic � is ertnit' 'ssued, I shall not employ any person in any manner so as to become su6ject to iha workers' compensatlon I 6bra �grae Ihat it I shoul b e subject to Ihe workers' compensa�ion pmvisions of Saction 3700 of the La�or Code, I shall forthwith comply wit ese provisions Applicent Signet e: Dale: Z I I 1�`Z� WARNINO: FAILURE TO S� OMPE� GE IS UNLAW FUL AND SlUllSU&IECT PN EMP�OYER TO CFIMINAI PENALTIES AND CNIL FINES UP TOONE HUNDRED T110USAND DOLLARE ($100, , IN ADO TO THE WST OF COMPENS4TION, DPA4IGES AS PROVIDED FOR IN SECTIIXJ 3�O60F THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am fome and eHect. Lic. M_ Coniractors SlgnaNre: Section 7000) oi Division 3 oi the BusinQess antl Professions Cotle, and my license is in full _ Class M _ /, _ Date:_.��/ 6D�-'7� CONSTRUC710N LENDING AGEN�y;/ . ❑ I hereby aflirtn that there is a construction lentling egency for the Dedormance ol the work tor which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: SigneNre: _ OWNER-BUILDEq DECLARATIONS: Lenders Atltlress: Date: I hereby aHirm Ihat under penalry of perjury that I em E7(EMPT FROM THE CON7RACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry which requires e permil to construct, alter, improve, demalish, or repeir eny strucWre, pdor to its issuance, elso requires t�e apP�icant for such pertnit to file e signetl stetement Ihet he or she Is Iicensed pursuent to ihe provisions of Ihe Contradors License Law (Chepter 9(commencing with Sectlon 7000) of Division 3 oi Ihe Business entl Professions Code) oithet ha or she Is empt iherelrom end the ha5is lor Ihe ellegad exemption. Any violation ol Section 7031.5 by eny applicent for e permit subjects Ihe applicant to e civil penalry of not more the�five hundred dollars ($500).): ❑ I, es owner of ihe properry, or my employees with weges as iheir sole compensation, WILL DO 7HE WORK, antl tha structure Is not intentled or oHered tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not epply to an owner of properry who Duilds or improves Ihereon, and who does such work himsalf ar herseN or Ihrough his or her own employees, provided ihat such improvemenis are not intentletl or oflered tor sale. H, however, the builtling or improvement is sold within one year of completion, the owner-builder will have ihe burden of proving ihat he or she ditl not build or improve for purpose of sale.). ❑ I, as owner of the property, am E%CLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to cons�ruct ihe project (Sec. 7044, Business and Professions Code: The conirectors License Law does not apply to an owner af property w�o bullQs or Improves ihereon, antl who cantrects for suc� pmject with a contrecror(s) license pursuant to ihe Contraciors License Laws.). ❑ I em exempt under sec. Business and Professions Cotle for this reason: SignaWre: . Dele: • Owner ID verifietl by tlrivers license. ❑ Yes ❑ No DnveYs LJcense No. Expires: Verificetlon ot Ownership by (rype ol tlocument, i.e. - property [ax bill or tleetl): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby certify that no excavation fiva (5) or more feet in depth into w�ich e person is required to tlescenq will be mede In connectlon with work au[horized by this permit, end that no building sWcture, scaflolding, felsework, or tlemolition or dismantling Ihereoi, will be more than thirry-six (36) fee� high. (Chap. 32, Grp 2, Art 2, Sec. 341, 71t1e B, California Adminisiretive Cotle). ❑ As awner-builder, I will not employ enyone to do work which would require a permit from the Division of Indusirial Sefety, as noted above, unless such person has e permit to do such work irom the division. Signature: Date: Division of Intlustnal Satery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIJTHORVA710N OF ENiAY: I certify under penalry of perjury that I have read this epplication anG state thet ihe inlormation given Is correct. I agree to comply with all s;ate laws ene ciry ortlinances relating to building construction, antl euthonze representatives ol the Ciry ot Costa Mesa to enter upon ihe ebove-described properry for inspection purposes. I eyree not to occupy or allow occupancy of eny building authorized by this pertnil until finel inspection. CODE t, ixsvecnoxwc� 1616 Fi:ed System Final Fire Praventlon 1266 Pool Spe Final 200 Finel Re-Roof 201 Flnel Block/Retaining Wall 202 203 Final Factory Fire Place Finel Sign 204 Final Demolition pA7E 1[�ALS COOE� INSPECTIONTYPE 206 Final Mechanical 20B 210 212 Final Plumbing Finel EIBCMCBI Final Fire Prevention D /ey� I'7! � � Date L 220 Final Planning Approval 222 Final Site �.� 111�I:iiii/.149 d� 0 i 7�3 � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT .lob Address: 385 E 17TH ST Suite No Viciniry: JACK IN THE BOX Parcel Nunmber: Applicant: Address: Owner: 42519305 WILLIAMS, RICHARD 2862 EXECUTIVE PL , ESCONDIDO, CA � PACIFIC COAST INC Address qoPRESTA, RON E NEWPORT BEACH, CA P O BOX 7D99 Contractor: ELEVEN WESTERN BUILDERS Address: 2862 EXECUTIVE PL � ISSUE FEE Temp service test Res. a/c package New Res (1-2 uniLs) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 7000a Service over t000a Motors to 1hp Motors to 10hp Molors to SOhp Motors to 100hp MOtors Over 100hp Communication drops ESCONDIDO, CA Phone: 760-796-6346 Zip: 92029 Phone: Zip: 92658-7099 Phone: 760-79G6346 Zip: 92029 License: 439908 Status: ISSUED Applied: 04I11/2003 Issued: 04/11/2003 ISSUED BY: SCOPE OF PERMIT CONSTRUCT A 495 SF ADDITION TO AN.EXISTING "JACK-IN-THE-BOX",TO INCLUDE EXPANSION OF THE RESTROOMS AND STORAGE ROOM. REMODEL WORFC�TO ALSO INCLUDE UPGRADING HANDICAP ACCESSIBILITY STANDARDS IN THESE ROOMS AND IN THE DINING ROOM. 1 POLE LIGHT PKG REF: 602-01872 $23.50 $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 so.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 � 0 p' 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft � Standing Section Misc Electrical Equipmenl 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 Voltage Equipment Low Volt Wiring Syslem / Ckt Misa Conduit Misa Conductor � Circus ( gen or ride) Ciras (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Invesligation Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 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, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced withln 180 days, or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicabla codes, and all requlred Inepections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 �..,,.., �,.,�, // WORKERS' COMPENSATION DECLARA710N: � 1 hereby atlirtn under penelty o� perjury one of the following daclarailons: ❑ I heve and Will melntein a cenificate of consent to selt-Insure tor workers' compensatlon, as proWded tor by section 3700 of the Lebor Catle, for the peAormance of the work for which Ihis permii i5 i55ued. �-1 I have end vA�l malntaln workars compensation Insurance, as required by seMlon 3700 of ihe Lebor Code. tor I�e perlortnance of Ihe woM for which Ihis pertnll is issued. My workers' compensatlon Insurence wrtler entl policy numbar ere: �Cerrier: �� Tl.- �"lJ h%1� Policy Number: � L�Lb%�{�i�—�' 7� (This sectfon nee0 not be complefed il the pertNt Is valued ef one hundred dollars ($100) or IessJ ❑ I certity that in the peAortnence o t work for which this permil is Issued, I shall not employ any parson in any manner so es to become subject to the workers' cnmpensetion lews of Celif p�l d agree thet II houltl become subject to che workers' compensetion provisions ot Sectlon 3700 of ihe Lebor Cotle, I shall forthwiih comply with ihese DroWsi �5 ApPlicant Signature: � Dete: � z/— /F—o3 WARNING: FAILURE TO SECURE WOFiKERS' COMPENSAiION NLAWFUL AND SHp115UB1EGf Ml EMPI,OVER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE MUNDRED i/10USAND OOLUFE (E100,000), IN ADIXiIIXJ TO TME CQST OF COMPENSATION, OMNGES AS PROVIDED FOR IN SECfION 3%080F THE LABOR ODOE. INfEREST, AND ATTORNEI"S FEES. LICENSED CONYAACTORS DECLARATION: I �ereby eHlrm iha� I em Iicensetl nder p ovisions of Chapter 9(commencing with Sectlon 7000) of Division 3 ot Ihe Busine s and Professions Cotle, and my Ilcense Is in full �o�� a�c Bn�,. u�. n y 3� S o�. ae� ��2 IJ ��. Contractor's Signature � d �` Dete: �� O-03 CONS7RUCTION LENDING AGENCY: ❑ I hereby e�rt� thel there is a construction lending egency for Ihe pertormence of t�e work for whlch this permit is issuetl. (Sec. 3097, Civil Code). Lender's Neme: Lentlers Address: Signeture: Da1e: OWNER-BUILDEfl DECLARATIONS: 1 hereby effirtn that under penalry oi perjury that I S@ EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business end Profes5ions Code: Any city or Counly w�ic� requires e pertnitf�wnstruct, alter, improve, demolish, or repair eny sWCWre, Pnor to its issuance, also requires the epplicent for such pertnit to file e signed sta�ement that he or she Is IicenseA pureuant ro the provlsions o1 the Contractore License Lew (Chepter 9(commendng with Sectlon 7000) of Dlvision 3 0l the Business end Profeuions•Cotle) or t�et he or she Is exempt therefrom enA the besis for the alleged exemption. Any violation of Section 7031.5 by any applicent for a pertnil sub)ects the appliW�l lo e clvll penalry of not mo�e then five huntlred dollers ($500)J: ❑ I, as owne� oi the properry, or my employees with wages as Ihelr sole compensetion, WILL DO THE WORK, entl �he siructure Is not inten4e0 or oHaretl for sale (Sec. 7044, Business end Professions Cotle?fhe Contrectors License Lew does not epply to an owner of properry who 6uilds or improves iheraon, and who tloes such work himself or herself or through his or her own employees, provided thet such Improvemenis are not Intendetl or oMeretl for sele. If, �owever, t�e building or Improvement is sold within one year of completion, the owner-bullder wiil have ihe 6urtlen of proving that ha or sha did not build or improve tor puryose ot sele.). � ❑ I, as owner oi the property, em EXCLUSIVELV CONTRACTNG WI7H LICENSED CON7RACTORS to construct ihe projact (Sec. 7044. Business and Professions Code: The conlreciors License Law Coes not epply to en owner of property who builtls ar impmves thereon, end who contrects far 5uch project wi�h e contrectar(s) license Oursuant to t�e Conirectors License LewsJ. ❑ 1 am exempt under sec. Business and Professions Code tor this reeson: Signature: Date: Owner ID verified by drlveYs Iicense. �Yes ❑ No Drivers License No. Expires: Venficatlon ot Ownership by (rype W daumen4 I.e. - property tau bill or daed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICA710N: ❑ I hereby certity that no exwvation five (5) or more feet in depth into which a person is requiretl to descenq will be made in connection with work auihorized by this pertnit, and tna� no bullding sWcture, sceflolding, telsework, or demdition or tllsmantlinq thereof, wlll be more Ihan thirry-six (36) teet hig�. (Chap. 32, Grp 2, A� 2, Sec. 341, Title B, Celitomla Atlministretiva Code). ❑ As owner-builder, I will not employ anyone to do work which would require e permit irom the Division of Industrial Sefery, as noted ebove, unless such pereon hes e permii to do Such work from ihe divislon. Signature: Date: Division of Intlusinal Sefery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTMORQATION OF EMAY: I certily under penalry of perjury thei I have reatl �his application end state that the intormatlon given is correct I egree to cAmply wlih ell slate laws and city or0lnances relating Io building wnstruction, end authodze representatives ot the Ciry oi Costa Mesa to enter upon Ihe above-descnbetl prOPerty br inspection purposes. I egree not to occupy or ellow occupency of any 6uilding euthorized by Ihis permil until finel inspection. cooe �. � e^�r••,•y � PAIE 1t�LS 7616 Fixed Sysiem Final Fire Prevention 1266 Pool Spa Finel 200 Finel Re-Roo� 201 Final8locWReteininq Wflll 202 Final Fedory Flre PIBce 203 Final Sign 204 Final Dem0lition LOOE I INSPECTION TYYE 206 Final Mechanical Date y-�� 03 _ Date II�AJ.S 208 Final Plumbing //7��J �� 210 Finel Electricel � % //�/'L i 212 Flnel Fire Pravention 220 222 250 Final Planning Approval Final Site Finfll Building/Occupancy (714) 754-5273 • Fax (714) 7543856 • www.ci.cosla-mese.ca.u5 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT .lob nddress: 385 E 17TH ST Status: ISSUED Suite No Vicinity: PARKING lOT Parcel Nunmber: 42519305 . , � npp�icant MORALES, JOSE Address: 2862 EXECUTIVE PL . �"� , %%'-�� - - _ � /�; - .,'. _ �� - Phone: 780-796-8348 ESCONDIDO,CA-�';- " , Zip: 92029 � � '� . � ,� , . � �� . -- , . .. . �� / �� /� � - -,-. - � owner:/ PACIFIC COAST INC '%' � " � Addreds 'OkPRESTA, RON E � ". � � � � NEWPORT BEACH,LIA� Phone: , � / Applied: 02/01/2002 Issued: 02/01I2002 ISSUED 8Y: ; ` \ j� �� .� � �� ,`� � \ � P O BOX�7099�� Zip: 92656-7099 �.: / � � , � ;i / � � '• �-i-� i � Contractor: �ELEVEN WESTERN BUILDERS " � � Atldress: 2862 EXECUTIVE.PL � - � - �'��^,�� i , . - � � CiPhone: � 760-796-6346 � � � � ESCONDIDO; CA� - �� - � Zip: 92029 , � - � - - � License: 439908 i% '� _, - /`.A�'� � �` � � � . � � � . / / A .i� >' i ��;\\�� /� � .� \� \�:�`, . ` ��:, � �� \ j ; � _^ � �� SCOPE OF PERMIT , . _ REPLACEMENLOF 5 LIGHT STANDARDS' W THE PARKING�LOT FOR"JACK�IN THE BOX" 5 POLE UGHT PKGS. ' . , _ � ,.� . � _ . _ .. _ � . . _ - REF: 802-00158 � ' � , , ; � . - � ' , ' _ . Quantity ISSUE FEE $23.50 , Temp service test , $0.00 Res. a/c package $0.00 New Res (1-2-units) , " $0.00 0 New Res (3+units) � �$0.00 0 -, Pool/Spa�;,' ��,50.00 0 Lighting Fix[s„ ��$0.00 0 . _ , Recept Outlets , ' $0.00 ` ` � � 0 � � Switches ��, '. --50.00�=� � 0 •- Non ResAppl � ��: ;%� $OAO �� :�0 -' �` Res Appl � � ��'� ./ $0.00-� � � � �0�� ; �„ � Service to 200a ` , . ,$0.00 -, _ �0 � �_ � Service to 7000a , 50.00 ' � ,0 � Service over t000a ' - $0:00 ; .'. 0 � . _ Morors to thp ,"50.00 - " 0. - - � � Motors to 10hp $0.00' - � � Q �, � Motors to SOhp $0:00' � �- 0 � � Motors to t00hp 50.00 �� - 0' - Motors over 700hp $0.00 � �� 0 ._ � � . - Communiwtion dmps $0.00 0 ' � Sub panel to 200a 50.00 0 Pole Light Pkg 5167.50 5 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 Intermed Pole $0.00 0 FEESUMMARY „� _ � � "- �uantity�� Temp Dist System / Lighting $0.00 0� � , Busway /100 ft- - $0.00 0 - . Standing Section � $0.00 <�0 � , � � Misc Electrical Equipment $0.00 '',.0' � ' Transtormers up l0 1 kva/kw $0.00 � - -0 - , - '- ................up to �10 kvalkw $0.00��j 0 , . , � ' up to 50 kvalkw., -. ,$0.00 � 0'� ; � .................up to 100kvaikw "� $0:00 0�� , � . " ....:.............over 100 kva/kw ._ _i$0.00�' '� 0 � . / . LowVoltageEquipment ��."i'$0.00%-�0 � - , Low Volt Wiring System / Ckt � $0.00 � !,0 ;'r � �� Misa Conduit . � '.. $0.00' 0'� / � ' Misa Conductor " $0.00' '0 , Circus ( gen or ride) � - � $0.00 %; 0 � , Circus (mech ride or lights) �- 50.00 "% %0 ChristmasTreeStand , �$0.00�' 0 , � ; FireworksStand -�� " '- 80.00 0 - � �� Other Electrical Fee ,',- % �� %�$0.00 � ' Investigation Fee / $0.00 � Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES b'I91.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorizad by this permit shall comply with all applicable handicap access requlrements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shal� automatically expire end become void il work is not commenced within 1 BO days, or if work is suspended or ebandonetl lor a perlotl of 180 days. � INSPECTIONS: In order for the work authorizetl unCer this permit to be consideretl legal, such work must comply with all applicable codes, end all requlred Inapeetiona and flnel approval must be obtalned. Failure to obtaln inspections and final approvel will result in the expiration of th(s pertnit. FOR INSPECTIONS CALL: (714) 75456P6 � zaewa �e�ao� WORKERS' COMPENSA710N DECLARA710N: I hereby attirtn unCer Oenalry of perjury ona of the tollowinp dedarations: ❑ I have end will maintaln a certificate of consent to sell-Insure tor workers' compensatlon, es pmvitletl for by sectlon 3700 0l the Labor Code, tor the pertortnance of Ihe ork for which this pertnit is issuetl. I heve and will maintain workers' compensation insu2nce, es required by section 3700 ol the Labor Catle, lor Ihe peAortnance oi Ihe work for whkh Nis pertnit is Lswed, My wohcers' compensation Insurance carrier and policy number are: nA'� �I Carner: �%� .�'i.Oc_J�� PolicyNumber. ,(/7�"!/�. �-//�l//f,��j9LF� (Th/s section need not be pleled i! (he pertnif /s velued ef one hundred dWlers ($100J ar less.) ❑ I cetlify thet in the pertormance of Ihe w�cf erw ch this ertnit is issue4 I shall not amploy eny person In eny menner so as to bacome sub�ect m t�e workars' compensation la ' 'a �ree that II p ecome sub�ect to the workers' compensetion provisions af Sectlon 3700yyy 1 the Lebor Code, I s�all IOMwlth comply wi�h I se Drovision �/�� Applicant Signetu : Date: � i WARNINO: FAILURE T COVERAGE IS UMAWFUL M1D SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES PND CML FlNES UP TO ONE HUNDRED THOUSAND DOLLARE (51 . , ADDRION TO THE CQST OF COMPENSATIIXJ, DAM40ES AS PROVIDED FOR IN SECTION 37060F TNE IABOR CODE, IMEREST, AND A770RNE1^S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby eMirtn Ihat I em brce and eXect. Llc. N_ Conirector's Signature: 7000) at Divislon 3 of �he Business,entl Prolessions Catle, antl my license is In tull qeu M _ ,� Dete: L ��7 � CONS7RUC710N LENDING AGENCV: �'' � I hereGy eNirm t�et Ihera is a construccion lendinp egency br tha peAortnance oi I�e work tor w�ich this permit is issuetl. (Sec. 3097, Civll Catle). Lendefs Name: Lendefs Atldress: Signature: Date: OWNER-BUILOER DECLARATONS: I hereby efllrtn ihat under penalty ot per�ury t�et I em E%EMPT FROM 7ME CONTRACTORS LICENSE LAW for the tallawing reason (Sec. 7031.5, Business antl Professlons Code: Any ciry or counry which reQuires e permit to cons6uct, elter, Improve, tlemolish, or repair any sWcture, pdor to Its Issuence, elso reqWres the epplicant for such pertnit to iile e signed steremem that he or she Is Iicensed pursant to the prarisions of ihe Contraaors License lew (Ghepter 9(commencing with SecUon 7000) ot DlNsion 3 0l the Busineu and Prolessions Code) or that �e or she is exempt therelrwn end the Desis tor the alleged exemption. Any Wdatlon of Section 7Q31.5 Dy any epplicant tor a pertnit subjecis ihe appllcant to e civil penelry o1 not more than,frve hundred dollars (5500).): ❑ I, es owner of the properry, o1�ny employees with wages as t�eir sde compensetion, WILL DO THE WORK, entl the structure Is noi intenUetl or ottered tor sale (Sec. 7044, Business and Protessions Cotle: The Conirectors License Law tloes not apply to an owner oi property who builds or Improves thereon, end who does such work himsel� or hersetl or through his or her own er�loyees, provided that such improvements ere not Intended or oflered lor sele. If, however, the building or improvement is sold within one year oi completioq the owner-builder wiil heve the Durden ol proving Ihat he or she tlid not build or improve tor purpose of sale.). ❑ I, es owner of t�e pmperry, am E%CLUSIVELY CON7RACTING WITFI LICENSED CONTRACTORS to consiruct the Oroject (Sec. 7044, Business antl Pmfeulons Code: The comrectors License Law tloes not appty ta en awner ot pmperty who builds or Improves thereon, and who comracts tor such pro�ect with a contrettor(s) license pursuam to the ConVadors License LawsJ. ❑ I em exempt under sec. Business and Prolessions Cade tor this reeson: SignaWre: Date: Owner ID verified by dnvefs license. ❑ Yes ❑ No DrlveYs License No. Expires: Verlficetion ol Owners�ip by (rype ol document, i.e. - property tes 6ill or tleed): DIVISION OF INDUS7AIAL SAFETY PERMR CERTIFICATION: ❑ I hereby ceritly t�at no exwvatlon INe (5) or mare leet in tlept� into which e person is required to tlescend, wlll be made In connection wlih work euthorized by tlils permil, and that no building siructure, scaflolding, lalsework, or demolitlon or dismantling thereof, will be more than t�iM1y-sla (38) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Calllamia Administrative Cotle). ❑ As owner-bulltler, I will nat emplay enyane to do work wNch would require e pertnil Irom Ihe Division of Industriel Selery, es noted ebova, unless such person hes e pertnit to do such work from the division. � Signeture: Dale: Division of Industrial Selery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUiNORVA710N OF ENTAV: I cetlity under penalry of perjury thet I have read this epplication and stete Ihet the infortnatlon given is correct. I egree to comply with all state lews end ciry ordinences releting to huilaing construction, entl euthodze representatives of the Ciry of Coste Mesa to enter upan the ebove-tlescribed prop�tpr insDecypo�n9�9�0.^ot to acupy ar allow accupflncy of eny building eutharized by this permit until final InsDection. GOOE t. INSVECTIONTYPE Q� 1N�ELS 1fi18 FixeC System Flnal Fire Preventlon 1266 200 201 202 203 Pool Spe Final Finel Re-Roof Flnal BIocWRetainirg Well Final Fectory Fire Place Finel Sipn 204 Finel Domolllion COOE� INSPECTIONTYPE 208 Flnal Mechanical 208 Flnel Plumbin 210 Finel Electrical 212 Fine revenllon 220 Final Plenning Approvel 222 Finel Site � 250 Finel Building/Occupency PAg Ri�Lfl (714) �54-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 385 E 17TH ST Suite No Vicinity: JACK IIJ THE BOX Parcel Nunmber: 42519305 Applicant: WILLIAMS, RICHARD Address: 2862 EXECUTIVE PL ESCONDIDO, CA Owner: Address Contractor: PLUMBING PERMIT Phone: 760-796-6346 Zip: 92029 PACIFIC COAST INC %PRESTA, RON E " NEWPORT BEACH, CA Phone: P O BOX 7099 Zip: 9265&7099 �LEVEN WESTERN BUILDERS , ' Address: 2862 EXECUTIVE PL Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifer System Connect pce,Soda,etc) DenWl UniLs Dishwasher Drain, Floor Drain, Rainwater Drain, Roof ESCONDIDO, CA Phone: 760-79&6346 Zip: 92029 License: 439908 Phone: Zip: License: Status: ISSUED Applied: 04I11/2003 Issued: 04111/2003 ISSUED BY: SCOPE OF PERMIT CONSTRUCT A 495 SF ADDITION TO AN EXISTING'JACK-IN-THE-BOX" TO INCLUDE EXPANSION OF THE RESTROOMS AND STORAGE ROOM. REMODEL WORK TO ALSO INCLUDE UPGRADING HANDICAP ACCESSIBILITY STANDARDS IN THESE ROOMS AND IN THE DINING ROOM. 1 GAS SERVICE REF:802-01872 � AMT $23.50 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation � $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors 50.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 �TY 0 0 0 0 0 0 0 0 0 0 0 Sump Pump Swimming Pool Trap Primer Urinal Vacuum BrkrBkflow(1�) Vacuum Brkr BkOow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent AMT $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 72-27-g2) EXPIRATION: This permit shall automatirally explre and become void if work is not commenced within 180 days, or If work is suspended or abandoned lor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be consideretl legal, such work must comply with all applicabte codes, and all requlred Inapectiona and }Inal epproval must be obtained. Feilure to obtain Inspections and final approval vnl� result in the expiration of this pertnit. FOR INSPECTIONS CALI: (71q) 7545628 WORKERS'COMPENSAnON DECLARATON: I hereby effirm under penalry ot perjury one ot the following dedaietions: ❑ I have entl w��l malmein a certificate of consent to selt-Insure br workers' compensatlon, es praWtletl fo� by section 3700 ot the Labor Code, tor ihe pertortnance of the work for whlGh this permit is issuatl. ��I have end wlll melntain workers' compensatlon insurence, as requiretl by secUon 3700 of Ihe Lebor Code, for Ne peAortnance of Ne work for whidi this pertriit Is Iswetl. My workers' compensation Insurance carrle� and policy number ere: Cerrier; (lhls si Policy Number: � �' �T7 �i�� —�b'i ❑ I certity t�et In the peAortnance orK for w�ich Ihi pertnll Is issued, I shall no� employ eny persan In eny menner so es ta become subject lo the workere' compensetlo� �ews ot Celtlom agree Nat II I sh Eecome sub�ect to the workers' compensatlon proNslons ol Sectlon 3700 of lhe lebor Code, I shall lorthwlth comply with lhese provislon ApPliceNSigneWra: �� —� �,�� Date� y'—�� WARNINO: FAILURE TO SEWRE WORKERS' COMPENSATION OOVEMOE IS UNUWFU� AND SIULL SUBIECT AN EMPLOYER TO CHIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED TFKKISWD DOLLARE (5100,000). IN ADpTIIXJ TO THE WST OF C�OMPENS�TIpN, DAMAGES AS PROVIDED FOfi IN SECTION 3]OB OF THE LFBOR CODE, IMEREST, M1D ATTORNEYS FEES. LICENSED COHTRACTORS DECLARATION: I hereDy eHlrtn thet � em IlcenseGiin er praNsions ol C�apter 8(commenGng wIN Section 7000) ol Divlslon 3 ot the Busine�$ nA P�r9Iessions Cade, entl my Ilcense Is in lul� lorce entl ettect. Lic. a�`i�C i+�Q� c� Class x� kS H i(�- Cantrectar'sSlgneWre: .� Date: � N—%/—d� CONSTRUCTION LENOING AGENCY: ❑ I hereby aflirm thet there is e constructlon lentling egency tor the pertormance of the work tor w�lch thls permit is Issued. (Sec. 3097, Civil Code). Lendefs Neme: Lendar's AtlCress: Signeture: Date: OWNER-BUILDEF DECLARATIONS: I hereby atllrm that unCer penfllry of perjury that I em E%EMPT fROM THE COHTRACTOflS LICENSE LAW for ihe following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or Munty which requires a pertnit to consWct, elter, improve, demdish, or repelr eny strucWre, pdor to Its issuance, also requires Ihe epplicaM for such pertnit lo tile a signed stetement ihet he or she is licensed pursuant to the proWsions of the Coniraqors License Lew (Chepter 8(commencing with Section 7000) of Dlvislon 3 of t�e Business entl Pmfdssions Code) or Ihat �e or she Ls eaempt therefrom antl tha Casis for the allegeG exemption. Any violatlon of Seaion 7031.5 by any epplicant tor e pertnit sub�ects tha applic0nt to e cMl penalry of not more ihan five �untlred dollars (5500).): ❑ I, es owner of ��e properry, or my employees wit� wages es ihelr sde compensation, WILL DO THE WOAK, end the sirucNra is not intended or oNered tor sale (Sec. 7044, Business antl Professlons Code: Tha Coniractors License Law tices not apply to an owner ol property who builds ar improves thereon, flnd who does such wo�k hlmselt or helself or ihmugh his or her own employees, provided lhat such imprwements ere nat Intendetl or ofleretl for sale. It, however, the Dullding or improvement is sald within one year oi completion, the owner-Cullder will have the 6urden of proving �hat he or she did not build or Improve for purpose ot saleJ. � ❑ I, es owner ot the pmDerty, am EXCLUSIVELV CON7RACTING WI7H LICENSED CON7RACTORS m tonsiruct Ihe pmjecl (Sec. 7044, Busineu and Prolessions Code: The comrectors Licensa Lew tloes not epply to en owner ol property who 6uilds or impmves thereon, end who contrects for such project wlih e conirecbr(s) licanse pursuant ta ihe Contrectors License Lews.). ❑ I em exemp� V�tler sec. Business entl Professions Cotla tor this reeson: Signature: Date: Owner ID verified by tlrivefs license. �Yes ❑ No Orivefs License No. Verltication ol OwnBrship by (type of documenL i.e. - properry tv� bill or Ceed): DIVISION OF INDUSTAIAI SAFETY PERMR CER7IFlCATION: Expires: ❑ I hereby certiry Ihat no axcavation frve (S) or more feet in depth inio which e person is requiretl to descend, will be mede In connection with work authorizetl by this pertnit, antl t�at no bullding structure, scattdtling, fal5ework, or demolitlon or tlismantling Ihereol, wlll be more Ihen thirry-six (36) feet high. (C�ap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomla AdMnI5lratNe Code). ❑ As owner-Dullder, I wlll not employ enyone to do work wNcb would require a permit Imm !he Dlvision of Industdal Satery, es notetl above, unless such person has e permil lo do 5uch work Irom the division. Signeture: Date: Divlsian at Industriel Sefety Permit Number: CEiiTIFlCATE OF C�MPLJANCE AND AUfHOR17A710N OF EMRV: I cenify under penalry ot perjury that I heve reed this apPlication antl state t�at Ihe Infortnation given Is correct. I egree to Wmply with all siate laws end ctiry ordinances relating ro building conslruCtion, end euthodze representeiives of the Ciry of Casta Mesa to enter upon lhe ebove-tlescrlbed praperty far inspection purposes. I egree no� to acupy or allow accupancy of eny huilding au�horized by this pertnit until tinal inspection. �Si9nalp e Of I�egel Owner(s) Date �� G � —� Antl/OrAuthonzed Applicant Date' S�4GF_6 1818 1268 200 Fi:ed SystOm Final Fire Prevention Pod Spe F��al Final Ra-ROo� 201 Fina181ocklNatainingWeil 202 Final Fectory Fire Place 203 Flnel Slgn 20a FIneI Damd��a� PAg It�l$ �� . � ' NI•. �' 206 Flnel Mothanitel 208 Flnel Plumbing � �''t � 210 ma oc ntal 212 Finel FUe Preventbn 220 Finel Planning Approval 222 Finel Site 250 FlnelBulltling/Occupancy �ff. It� (714) 754•5273 • Fax (714) 754-4856 • www.ci.coste-mesa.ca.us i i rnin urnv�, ��a i r mcan, a.n acoco Job Address: 385 E 17TH ST Suite No Vicinity: Parcel Nunmber: 425�9305 App�icant: WIL�IAMS, RICHARD Address: 2862 EXECUTIVE PL ESCONDIDO, CA Owner: PACIFIC COAST INC Address %PRESTA, RON E NEWPORT BEACH, CA P O BOX 7099 PLUMBING PERMIT Phone: 760-7956346 Zip: 92029 Phone: Zip: 9265&7099 Contracror. ELEVEN WESTERN BUILDERS — Address: 2862 EXECUTIVE PL ` Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher ESCONDIDO, CA . Phone: 760-79&6346 2ip: 92029 License: 439908 /. Phone: . .. - -- - ��P� � , , - License: � � Status: ISSUED Applied: Ot/31/2003 Issued: Ot/31/2003 ISSUED BY: SCOPE OF PERMIT CONSTRUCT A 495 SF ADDITION TO AN EXISTING "JACK-IN-THE-BOX" TO INCLUDE EXPANSION OF THE RESTROOMS AND STORAGE ROOM. REMODEL WORK TO ALSO INCLUDE UPGRADING HANDICAP ACCESSIBILITY STANDARDS IN THESE ROOMS AND IN THE DINING ROOM. PLUMBING TO INCLUDE: 2 FLOOR DRAINS, 1 GAS EARTH�UAKE VALVE, 1 GAS SERVICE, 6 �P-TRAPS, 2 TRAP��PRIMERS, 1 URINAL. 2 WASH BASINS, 1 WASTE & VENT SYSTEM, 2 WATER CLOSETS, AND 1 WATER PIPING. REF.: 802-01872 AMT 523.50 $0.00 50.00 30.00 so.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irtigation $0.00 P-Trap $58.80 Pressure Regulator $0.00 Process Piping (per 70 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap (or Demo $0.00 �TY 0 0 6 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set AMT 50.00 50.00 579.60 59.80 50.00 50.00 $19.60 50.00 orr 0 0 2 1 0 0 2 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and refated regulations. (Ord. No. 92-28, § 7, 12-27•92) EXPIRATION: This permfl shall automaticalty explre and become void if work is not commenced w0hin 7B0 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, entl all required Inapeetlone end final approvel must be oblalned. Failure to obtain inspections and final approval will result in the expiration ot this pertnit. I FOR INSPECTIONS CALL: (714) 754-5626 zaa+e �eroo� WORKERS' COMPENSATION DECLARATON: . � I hereDy eNirm under Denalry oi per�ury one o1 iha tollowing deGeretions: ' - ❑ I heve end wlll maintaln a cenificete oi mnsent to self-Insure for workers' compensation, as provided for by sectlon 3700 0l the lflbor Code, for the pertortnance of Ihe ../ work tor which this permii Is Issued. ' tl 1 have and will meintain workers' oompensatbn Insurence, es required by sectlon 3700 of the Lebor Code, for Ne perfortnance W the xrork fa whkh this pertnit Is Issuetl. My workers' compensatlon InSurance certier entl poliq number are: .y�,_ Cartier. �F �1�. �i Policy Number: �'�%�/?8" �tC[l� (7h15 section need no! be comple( �/ (he perm/t is veNeO el one hurMred dollars (5/00) or /ess.) ❑ I certiy thet in Ihe pertortnance of the work tor whkh Ihis pertnit U issued, I shall rwt employ eny person in any manner so as to become sub�ect to the workera' compensation laws of Celi i, e egree thet II I sh tl become suD�ec1 ro Ihe workers' campensatlan provisions oi Section 3700 of Ne Lebor Cotle, I shell twNwlih comply wIU Uese provis s Applicem SlpnaWre: � �w, ` � Date: � 3� �� WARNINO: FAILURE TO SE FE WORNERS COMPENSATION COVE WFUL AND SWUL SU6IECT M! EMPLOYER TO CRIMINAL PENALTIES M1D CML FlNES UP TO ONE NUNDRED Tl10USFND DOLURE (5100,0OO�.IN ADOrt10N TO THE COST OF COMPENS�TION, OAA41GE5 AS PROVIDED fOR IN SECiION 37080F THE UBOR COOE.INfEREST, AND �TTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm that I em lorce end eflect. Llc. a_ GONrectofs Slgnawre: ot C�epter 9(commendng with Sedlon 7000) of Dhrision 3 0l tha Busineu entl Prof¢�ssions Cotle, entl my Iicense Is in full _ Cless a !� �/i � ic ^ Date: /— 3� �'3 CONSTRUCTION LENDING AGENCV: ❑ I hereby eflirm that there is e wnstructlon lending apenty lor Ihe peAortnance ot the work tor which this partnit Is issued. (Sec. 3097, CIWI Code). Lendefs Neme: Lentlers Address: Signaturo: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirm that under penelry of perjury t�at I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Buslness end Professions Cotle: Any ciry or counry which requlres e permit to construct, elter, improve, demolish, or repair any structure, Dnor lo its issuance, elso requlres Ihe epplicent for suc� pertnil to file e signed stetement that he or she is IlcenseC pureuent ro t�e pmvlslons of ihe Contrectors License lew (Chepter 9(commencing with Section 7000) 01 Divlsion 3 ot Ihe Business end Professlons Cotle) or that he or she is exempt thereiram end the basis lor the elleged exemption. Any violation oi Saction 7031.5 by any applicant lor a pertnit sub�ects Ihe eppllcant to e clvll penalry af not more ihen live hundred dollars ($500)J: ❑ I, es owner oi Ihe properry, or my employees wit� weges es their sole compensetion, WILL DO THE WORK, antl the strucWre Is not Intended or ofleretl tor sela (Sec. 7044, Business and Professions Cotle: The Contractors Llcense Law does not epply to an owner of property who builds or improves Ihereon, end who does such work himself or hersetl or thmugh his or her own employees, O�a�detl that such improvements ere not intended or oHered for sale. If, however, the building or Improvemem is sold within one year oi wmpletion, the ownerbuiltler will have ihe burden ot proving �hat he or she ditl noi builtl or Improve lor purposa ot sale.). � ❑ I, as awner of the property, em EXCLUSIVELV CONTRACTING WRH LICENSED CONTRACTORS to ConStruct the project (Sec. 7044, Business anC ProfeSsions Code: The crontrectors License Lew does not appy to en owner oi praperty who builds or improves thereon, antl who contracts tor such project with e contrector(s) fcense pursuent to the Contractors License Lews.). ❑ I em eaempt untler sec. Business end Professions Cade for ihis reeson: Signature: Date: Owner ID verilied by tlAvers Iicense. ❑ Yw ❑ No Drivefs License No. F�pires: Veriticetion o1 Ownership by (rype ol document. I.e. - property tex bill ar deeG): DIVISION OF INDUSTRIAL SAFETY PERMITCERTIFICATON: ❑ I hereby certity ��et no escavetion INe (5) or more teet in depih into which e person is required to descend, wlll be made In connectian with work euihoAzeO by Ihis . pertnit, entl thet no builtling structure, scattoltlinp, telsework, or demolition or dismantling thereol, will be more than thiM1y-six (38) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ttle 8, Calllomfe Admini5trelNa CoAe). . ❑ As owner-builder, I will not employ enyone to tlo work which would require a permit Irom Ihe Divislon al Induslrial Selety, es noted abova, unless suc� person �as e parmlt to tlo such work Iram the divisbn. Slgnaiure: Date: Divislon oi Intlusirial Selery Pertnit Number: CERTIFlCA7E OF COMPLIANCE AND AUTliORVATION OF ENTAV: I certily under penelty of perjury that I have read this epplication enC siate Ihat the intortnetlon piven is wrrect. I agrae to comply wit� ell stete laws end dry ortlinences relating to building cons�ruction, and euthonze representallves of Ihe Clry ot Cosle Mesa to enler upon the ebovatlescribed property tor Inspection Durposes. I egree not to occupy ar ellow occupancy of eny building authorized by t�is pertnil umil tinel inspec0on. Signature Ot Le a nerJs) 7 Dere }aQ � J�'�.rZb� AnA/OrAuthodze I�cant Date COOE �. INSiECTIONTYVE QdIE 7618 Fixetl System Final Fire PrBvenlion 1266 200 Pool Spa Final Final Re-Root 201 FInaI 81ock/ReIalning Well 202 Flnal Fectory Fira Plece � 203 Final Sign 204 ' Finel Domalltlan ' " ��y �QQF2 INSPECl10NTYPE � Q� � 206 Final Mech � 20B Finel P umDin 210 Finel Electdwl 212 Finel Flre Preventlon 220 Final Planning Approval 222 Finel Slte 250 � Finel BuiltlingiOccuDancy (��4) 75a-5273 • Fax p�a) 75a-a856 • www.ci.costa-mesa.ca.us 77 hAlli UMIVG, GVS1A MhJA, GA tlLtiZO Job Address: 385 E 1iTH ST Suite No Viciniry: Parcel Nunmber: 42519305 Applicant: WILLIAMS, RICHARD Address: 2862 EX�CUTIVE PL ESCONDIDO, CA i"� � Owner. PACIFIC COASi WC Address q PRESTA, RON E � NEWPORT BEACH, CA P 0 BOX 7099 �' Coniraclor. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Liqhling Fixts Recept OutleLs Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors to 1hp Motors to 10hp Molors to SOhp Molors to 100hp ELECTRICAL PERMIT ELEVEN WESTERN BUILDERS 2862 EXECUTIVE PL ESCONDIDO, CA Phone: 760-796-6346 Zip: 92029 Phone: 2ip: 9265&7099 � - .--Phone: 760-796-6346� Zip: 92029 License: 439908 Status: ISSUED Applied: 01/31/2003 Issued: Ot/31/2003 .: %� -,- ,SCOPE OF PERMIT - CONSTRUCT A 495 SF ADDITION TO AN EXISTING "JACK-IN-THE-BOX" TO INCLUDE EXPANSION OF THE RE$TROOMS AND STORAGE ROOM. REMODEL WORK TO ACSO INCLUDE UPGRADING HANDICAP ACCESSIBILITY STANDARDS IN THESE ROOMS AND IN THE DINING ROOM. ELECTRICAL TO INCLUDE: 22 LIGHTING FIX7URES, 4 SWITCHES, AND 2 MOTORS TO 1 HP. REF.: B02-01872 � - -- -- - - $23.50 $0.00 so.00 $0.00 $0.00 $0.00 523.46 $0.00 $4.40 $0.00 $0.00 $0.00 $0.00 $0.00 $9.50 30.00 $0.00 $0.00 Quantity 0 0 0 22 0 4 0 0 0 0 0 2. 0 0 0 FEE SUMMARY 7emp Dist System / lightlng Busway/100ft Standing Sectlon Misc ElecVical Equipment Transformers up l0 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 700 kva/kw ..................over 100 kva/kw Low Voltage Equipmenl Low Volt Winng System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Sfand - Fireworks Stand Other Electrical Fee Quantity 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statWes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA7ION: This permit shall a4tomatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requtred Inapeetlorta and final approval must be obtained. Failure io obtain inspections and final approval w'ill resutt in the exp'vailon of this permit. FOR INSPECTIONS CALL: (714)>5q-5626 zue�e �aroo� WORKERS'COMPENSAnON DECLARATON: � I hereDy ettirm untler Denelry ol Der�ury one ot Ihe tollawing decleretlons: ❑ I heve entl wiil malntein e certifirate of consent to sell-Insure lor workers' wmpensetlon, es provided lor by section 3700 of Ihe Lebor Coda, for the peAormance oi ihe Work fOr which Ihi9 pBrtnli Is Issued. , . j� � I have entl wlil meintain workers' compensetlon Insurance, es reQulretl by sectbn 3700 of the Lebor Cade, for Ihe pedortnanca oi the work Por which Ihis permit is issuetl. My workers' wmpensation Insurence carrier antl pollcy number ere: Certier STl1 � FUili\ PolicyNumber. Q'�7�-/�}�—�'G�� (This sec(fon need not be complered i! the perm�f s valued et one hunOretl tlollers (5100) or /ess.J � I certily that in Ihe peAortnance of �e ork lor which thls pertnit is Issued, I shall nat employ eny person in eny menner so es to become sub�ect to the workers' campensetlon lews at Callla , n prea thet If�became SUD�ect lo the workero' compensellon provislons of Sectlon 3700 ot Ne laDor Cotle, I shell forthwlth comP�Y wilh ihese Provislo � L Applicant Sipneture: � � � Dete: !_ 3� �G�� WAqMNG: FNLURE TO SEWFE WORKERS' COMPENSATION COVEMGE IS UNLAW R1L AND SFULL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES M'D CML FlNES UP TOONE HUNDRED THOU$!WD OOLIARE (St00.000), IN FD�Ii1qJ TO THE COST OF COMPENSATION, DAMAGE5l5 PROVIDED FOR IN SECiION 31080F THE LABOR CODE, IMEREST, AN� ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn Ihat I am licenj e�tl un0eJ,D�o sions ot Chapter 9(commendng with Section 7000) ot DiNsion 3 of the Business and Professirns Cotle, and my license is in tull torce end ettect. Lic. N �'/3i %7 . _ Cless x _ _ '� �/ � ContractorsSignature: � � Date: �-3/—?CiiZ I CONSTRUCTON LENDING AGENCY: ❑ I hereby aHirtn ihal Ihere is a consWc�ion lending epenry tor t�e pertormance ot ihe work br which Ihis pertnit is issued. (Sec. 3097. Civil Code). Lendefs Name: Lendefs Address: SlgnaNre: Date: OWNER-BUILOER DECLARATONS: I hareby effrtn thel under penalry ol perjury Ihet I em E7(EMPT FROM THE COHTRACTORS LICENSE LAW tor the Iallowing reason (Sec. 7031.5, Business entl Professions Gode: My dry or counry wh�h reqWres a permit to wnsWct, elter, Imprwe, demdish, w repeir eny strucwre, pdor to its Issuance, alw requires Ihe applicam Por such pertnit to tile a signed stetemeN t�at �e or sha Is Iicensetl pursuent ta Ihe proNsions ol Ihe Contrectore LJcense Lew (Chapter 9(mmmendng with Section 7000) oi Dhnslon 3 of iha Business end Professlwu Code) or Ihet he or she is exempt t�eretrwn enA t�e besls for t�e elleped e:emptlon. Any Wdatian at Section 7031.5 by any applicant br e pertnit subjects the aDP�iwnt to e cNil penelry of no� more than N�e hundretl tldlars (SSW�.�: ❑ I, es owner ot t�e property, or my emplayees with weges es Nelr sole wmpensaUon, W ILL DO 7ME W ORK, and the struc[ure is na intended or ofleretl tor ule (Sec. 7044, Business end Protessions Code: The Contracioro LJcense Lew tloes not appty ro an owner of property who bui105 or improves thereon, antl who tloes such work himself ar �ersell or through his or her own employees, provided that such imprwements are not intended or ottered br sale. It, however, the building or impmvement is sold wiNin one year ot wmpietion, the owner-builder will have the burden ol proving t�at �e or she ditl not builtl or improve for purposa ot sale.). � ❑ 1, as owner ol Ihe property, am E%CLUSIVELV CONTRACTNG WITH UCENSED CONTRAC70RS to consWct the pmlec� (Sec. 7044, Business and Pmteuions Code: 7Te rnniractors Llcense Lew does noPepply to an owner at properry who builAs or impmves thereon, anA who contrac�s for suc� pryect with a coniractor(s) licensa pursuant to t�e Comrectora LJcanse Lews.). ❑ I em exempt under sec. _ Signature: Owner ID verifietl by Crivers Iicense. Vedllcation oi Ownership by (type af Business end Pmtessions Cotle for this reamn: ❑ V09 ❑ No Driver9 LJcense No. mem, i.e. - pmperry tex bill or deetl): DIVISION OF INDUS7RIAL SAFETV PERMI7 CER7IFICATON: Date: Fsoires: ❑ I �ereby certlty that no excavetlon Ilve (5) or more feet In tlepth into which e person Is requlred to tlescentl, wlll be metle in connection with work euthonzeC by Ihls permit, end that no DUIlding slruMure, scallolCing, lalsework, or tlemditlon or Alsmantling thereof, will be more then ihirty-six (36) feet high. (Chsp. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Adminlstra0ve Cotle). , ❑ As owner-Duilder, I will not employ enyone to do work w�ich woultl requlre e permit from t�e Divlsion ol Intluslnel Sefery, as noted ebove, unless such person has e permit to do such work from Ihe division. Signature: Division ot Intlustnal Safery Permil Number: Date: CERTIFlCATE OF COMPUANCE AND AIffMORVJ1T10N OF ENTRV: I certily under penelry oi perjury that I have reatl t�is eppGcation end state that the infortnation given is cortecL I egree to comply wit� ell stete laws and ciry ortlinances relating to bullEing conswctlon, enC eutnodze representeUves of the Giry of Costa Mese to enter upan the ebove-described property tor inspection purpose9. I agree no� to occupy or ellow occupanry ol eny building authorizetl by Ihis pertnit until final inspection. � Signetur@ ega} Owner(s) � Mtl/Or u tl Applicant COUE �. INSPECTIONiYPE 1616 Fixetl System Final Fire Preveniion 1266 Pod Spa Finel 200 Final Ra-Roof 201 FInaI8locWReWining Well 202 Final Fedary Fire Place 203 Finel Sign 204 Finel Demdllion /-3i-� Z Date �g, �$ CppE1 INSPECIIONTYPE 206 Final Mechanical 208 Final Plumhing 10 Final Elet�ncal 212 Fine ire Prevention 220 222 250 Final Planning Approval� Final Siie �Finel Builtling/Occupflncy � � IILIE � L�ki (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, CASTA MESA, CA 92626 BUILDING PERMIT Job nddress: 385 E 17TH ST Suite: Viciniry: JACK IN THE BOX DRIVE-THRU Parcel Number: 42519305 Zoning: App�icant: BOETTCHER, JEFF _ Address: � , . �� ,� , i�-'. - - Phone: 619•7138276 /, i� . . Zip: � � �' � . Owner. PACIFIC COAST INC Address ��'�PRESTA, RON E . _ - i�, NEWPORT BEACH, CA -; �� Phone: ,� P O BOX 7099 ". � Zip: 9285&7099 , - Contractor: `ELEVEN WESTERN BUILDERS �Address: 2862 EXECUTIVE PL , "--� Phone: 760.79&6346 � �� ESCONDIDO, CA Zip: -� 9202g' , License: 439908 Arch : � Address: Zip: Phone: License: WIDENING OF DRIVE-THRU SUPPORT CANOPY IN CONJ REF: B02-01872 � � � ISSUED BY: Status: ISSUED Applied: 05/21/2003 Issued: O6/30/2003 Eng: Address: � " Phone: `� License: E OF PERMIT I WITH THE.TII ADDITION TO AN EXISTING'JACK-IN-THE-BOX.' FEE SUMMARY , ' ' Pian Check: $117.81 - — � - - Calc Valuation: S�o,000.00 Permit: $181.25 "' � ' � Claim Valuation: S�o,000.00 �, SMIP Res: � $0.00 �� SMIP Com: . $2.10 �- � � Othe�: . �� . $0.00 ��Inspection:, �,$0.00 � . • � , �:. . .. ; `� Total: 5301.18 ` . : � � , , � , � - ., - , SETBACKS �.� MAIN STRUCTURE Front 0- 0 i �� Rear � , ACCESSORY Front �0-0 �`� �Rear PARKING Existing: o, , ' Required: 0- 0 Left 0- 0 - 0. 0 , Lefl 0- 0�� 0 � � � Proposed: 0 ' - Right 0.�0- � � , Righ� 0. 0 % . � NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under California statules and related regulations. (Ord. No. 92-28, § 1, 72-21-g2) EXPIRATION: This permit shall automatically expire and become void if vrork is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work authorized under this permit to be considered legel, such work must comply with all applicable codes, and all requlred Inspectiona end flnal epproval must be obtalned. Failure to obtain inspectlons and flnal epproval wlll result in tha ezpiration ot this permit. FOR INSPECTIONS CALL: (714) 7545828 . 244Bd81600) � I � • . . _ . . � \..'. '. -r . . .• WORKERS' COMPENSATION DECLARATION: I �ereDy eKrtn unOer penalry of perjury one oi the fallowlnp tleclaretlons: ❑ I have end wlll maintain e cenlficate oi qonseN lo sell-Insure lor workers' compensatlon, es proviEed for by section 3700 0l t�e Lebor Code, for the pertartnance ot the ,{., �w,aOrk tor whith Ihis pertnit i9 is5ued. '�.1 have arM will maintaln workers' compensgtbn Insurance. as required by secibn 3700 of the Lebor Code, tar Na peAortnence oi the work Iw whkh Ihis pertNt Ls Issued. My workera' campensetlon Insurence cgrAer end poliry number ere: �-ry�it� -Certier. r� i7�/�7 Pollty Number. OLJd 'GZ U/'�/Tc..-�i7c� (Thls secNon need not be mmp�eree ll tne pertnir Is ve�ued et one hwWree dd�ero (S i00) a�ess.) ❑ I cenlry that in tha pertortnanca ot Ihe work for which Ihis partnit is issueq I shell noI employ eny person in eny menner so es to becwne sub�ect to the workers' compensation lews ol Callfomia, end e ree thet Ii I ahould become sub�act m the warkers' campensatlon provlslons af Sectlon 3700 of the Labor Code, I shell fart�wlt� comply wlth Ih se� rov lon ✓ Applicant Signature: � Dete: ��3 WARNINO:FAILU(iETOS CEf� COMPENSATIONCOVEMOEISUNUWFULANDSHMLSU6IECTANEMPLOYERTOCRIM�INPLPENALilESANDGVILFINESUPTOONEHUNDRED THOUSAND DOLURE ( �, I 1 ADDITION TO T{IE COST OF COMPENSATION, DAMAGES AS PROVIDED fOR IN SECTION 3]OB OF THE IABON CODE, INrEREST, ANU ATTORNEV'S FEES. LICENSED CONTqACTORS DECLARATION: I hereby ettirm that I em licensed under roviSions of ChaD�er 9(commencing wiN Section 7000) oi Division 3 of the Busine s and Professions Code, and my license is in full torce end ettect. uc. a� 39� ciass s../� Contracrors Signawre: Dete: � � 0,3 CONSTRUCTION LEN01 AGENCY: ❑ I hereby aHlrtn t�at Ihere is e constructibn landing agency tor Ihe peAortnance ol Ihe work tor which thls partnit is Issued. (Sec. 3097, Civil Cotle). LenAera Name: Lendets Atltlress: Slgneture: OWNER-BUILDER DECLARATIONS: �9i� Date: I hareby eNirtn Ihat under penelry ol perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reeson (Sec. 7031.5, Business entl Professions Cotle: Any clry ar couny which roquires a petrnit to construct, elter, Improve, tlemolish, or repair eny sirucNre, pdor to Its issuenco, also wqulres the epplicant tor such pertnit b tile e signetl statemem thet he or she Is licensed pursuent lo I�e pmNslons of I�e Contrectors License Lew (Chapter 9(commendng wtlh Sectlon 7000) of Divisian 3 at Ihe Business end Prolessions Code) or that he or ahe is exempt therelrom end the basis br the alleged eaemption. Any vloletion ol Section 7031.5 by eny epplicant for e permlt sub�ects the epplicent to e Gvll penelry of not mo� than five hundred dollars ($500).): ❑ I, es owner of t�e properry, or my employees with wagas es t�eir sole compensation, WILL DO THE WORK, and ihe structure is not Intentled or oflered for sale (Sec. 7044, Business end Professions Code: The Contractars License Lew does nat epply to an owner of properry who builGs or improves thereon, and who daes such work himsell or herselt or through his or her Own employees, OroviOetl thai such improvements ere not intended or oHered for sele. Il, however, the buildinq or improvement is soltl within one year of campletian, the pwner-builtler will have.the burden of proving thai he or she did not build or improve for Durpose of sale.). � ❑ I, es owner ot Ne praperty, em E%CLUSIVELV CONTRAC7ING WI7H LICENSED COMAACTORS to construct the D�oject (Sec. 7044, eusiness antl Pmfessions Cotle: The conirecrors Llcense Lew Dobs not epply to an awner at properry who builds or Improves thereon, entl w�o contrects for such prqect wit� a contractor(s) license Dursuant to ihe Contractors Licanse LewsJ. ❑ I am exemp� under sec. � Business end Pralessions Code tor this reason: Signatura: Date: Owner ID veritietl by OMefs license. ❑ Ves ❑ No Drlvers License No. Vedficetlon of Ownership by (rype ot Aocument, I.a. - property lex 6ill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Fxpires: ❑ I hereby ceNty that no excevetlon fiva (5) or more feet in depth into whlch e Oerson Is required to tlescend, will be made in cannectlon with work euthorized by Ihis permil, antl Ihat no building structu�e, scafloldinp, falsework, or demWition or dismantling thereot, wlll be more than thlrty-sl: (38) laet �Ig�. (Chap. 3.2, Grp 2, Atl 2, Sec. 341, Tltle 8, Celllomie Adminlstrative Cptle). ❑ As owner•bulltler, I wlil not employ enyone to do work which woultl require e permit from the DIvlslon ot Intlustriel Setety, es notetl above, unless such persan hes e permit to do such wark tmm the tlivision. Signelure: Date: Division at Industnfll Safery Permit Number: ICERTIFlCATE OF COMPLIANCE AND AllT}IORVATON OF ENTtiY: I ceniy unOer penelry of perjury that I have read thla epplication enC state that t�e intortnation piven is I correct. I egree to wmpty wit� ell stete lews end ciry orEinences relatinp to bullding constructlon, and eut�adze representetives ol the Ciry of Cosla Mesa to enter upon the ebove4exribetl properry for inspection purppses. I epree not to occupy or ellow occupancy of eny building authorized by this pertnit until tinel inspection. CQ�E /. INSPECTIONTYPE Q� �� 16t8 Fixetl System Final Fira Preventlon 1266 Pool Spa Final 200 Final Re-Roof 201 Flnal Black/Fletaining Wall 202 Flnal Fectary Fire Place 203 Flnal Sign 204 Finel Damdition ( �3oe%3 � eie , COUE� INSPECTIONTYPE 206 Final Mechenicel 20B Final Plumbing 210 Finel Electrical 272 Final Fire PravenUon 220 Final Planning Approval 222 Final Site �� 250 FinalBulldinglOaupen�y � u�s (714) 754-5273 • Fax (714) 754-4858 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, CA 92626 BUILDING PERMIT .lob nddress: 385 E 17TH ST Suite: Vicinity: JACK IN THE BOX: DINING, RESTRMS, STORA Parcel Number: 42519305 Applicant: WILLIAMS, RICHARD A Address: 2862 EXECUTIVE PLACE ESCONDIDO, CA� �� Owner. PACIFIC COAST INC Address .� °�PRESTA, RON E. ' NEWPORTBEACH,CA �POBOX7099- �' Zoning: Contractor ELEVEN WESTERN BUILDERS Address: 2862 EXECUTIVE PL ESCONDIDO, CA Zip: 92029 Phone: 760-79G6560 Zip: 92029 Phone: Zip: 9265&7099 ' Phone: 760-796-6346 License: 439908 ISSUED BY: Status: ISSUED Applied: 11/15/2002 Issued: 07/31/2003 Arch : ROBERT A MARTINEZ ' Eng: � Address: 75487 SENECA RD � � � � � � Address: ' STE 203 Phone: 760-241-7858 Phone: VICTORVILLE, C Zip: 92392 � License: C25113 � License: SCOPE OF PERMIT CONSTRUCT A 495 SF ADDITION TO AN EXISTING'JACK-IN-THE-BOX' TO INCLUDE EXPANSION OF THE RESTROOMS AND STORAGE ROOM. REMOOEL WORK TO ALSO INCLUDE UPGRADING HANDICAP ACCESSIBILITY STANDARDS IN THESE ROOMS AND IN THE DINING ROOM. Plan Check: $827,94 Permit: $1,273.75 SMIP Res: $0.00 SMIP Com: $31.50 Other: $0.00 Inspection: $0.00 Total: E2,133.19 SETBACKS MAINSTRUCTUR� Front 0-0 ACCESSORY Front 0- 0 PARKING Existinq: 0 Rear 0- 0 Rear 0. 0 Re uired: 0 FE6SUMMARY _ Calc Valuation: $�so,000.00 Claim Valuation: SiSo,000.00 PLANNING 8 ZONING Le(t 0- 0 Righl Left 0- 0 � , Right Pr000sed: 0 NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Calitomia 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. IINSPECTIONS: In order for the work euthorized under ihis permit to be eonsidered legal, such work must comply with all applicable codes, end all � requlred inepeetiona and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 zaasae �eroo) WORKERS'COMPENSAnON DECLARAnON: • � I herehy atllrm under penalry of per�ury ane ol the tollowing tlecleratlons: � ' ❑ I hBve end will mainteln a tehlflcate ol Consem to seN-Insure lor workers' compen5etion, es pravided for by sectlon 3700 oi the Lebor Code, br Ihe peAormenCe ai Ihe work fo� whic� lhls permit I5 issued. � I have end will maimaln workere' compensetlon Insurance, es reQuired by section 3700 of the Labor Code, for the pertortnance of Ihe woB for w�lch this pertnit Is issued. My workers' compensatlon Insurence carriar and palicy number ere: ' Certler. CTA� �/L.� PolicyNumbor: Q�iJ%�/��' i�� (Thls secNon neetl nof be comple ed i1 Me permlt /s ve/ued ef one huntlred dd/ers (5100) oNess.J . , ❑ I cehify Ihet in Ihe peAormence o1 Ihe work lor which this pertnit is issuetl, I shall not emplay eny person in eny menner so es to become sub�en ta Ihe workers' compensatlon lews ol Calitom , en fee Ihet If I s�oul coma subJect to I�e workers' compensetlon provlslons of Sectlon 3700 of t�e Lebor Code, I shall forthwith comply wlth these provision _ f �—�� Applicent Signeture: Dete: WARNINO: FAI�URE TO SECU WORKERS' WMPENSATION COVERA EL�U ,AWFUL rWU SMALL SUBJECf Ml EMPLOVER TO CRIMINAL PENALTIES M'D qVIL FlNES UP TO qJE HUNDRED T}iWSAND DOILAFE (510D,000�. W ADdTIdJ TO THE COST OF q7MPENSATION, UAA1qGES AS PROVIDED FOR M SECTION �OB OF THE UBOR CODE, IMEREST, AND ATfORNE1"S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereCy attirm thet 1 em force end eXect. LJc. a_ GonlrectoYs Signature: at Chapter 9(commencin9 with Sectirn 7000) of Oivision 3 ot t�e Buslness and Prol gsions Code, and my Ilcense is In full Class q � �i(�. � � oa�a: /— 3/—�� CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm Ihet there is e conswction lendinp epency lar the pedormance oi Ue work tor which this permit is iuuetl. (Sec. 3097, Civil Cotle). LenOers Name: Lenders AdEress: Signeture: Date: OWNER•BUILDER DECLARATIONS: I hereGy ettirtn thet under penelry at per�ury thel I em EXEMPT FROM THE CONTRACTOHS LICENSE LAW for t�e following reeson (Sec. 7031.5, Buslness enA Professions Cotle: Any ciry or counry which reduires e pertnit to construct, elcer, improve, demolish, or repair eny sfrucWre, pnor to iLs issuance, also raquires the epDlicant lor such permit to tile e slgned statement Ihet he or she is Ilcensed pursuant ro the pmdsions of the Coniractors License Lew (Chepier e(commeridnp wit� Sectlon 7000) of Divislon 3 of tha Buslness end Professions Code) or that he or she is exempt therefrom and the basis for the ellegad exemption. Any vldation o1 Sectlon 7031.5 by eny eppllcant tor a pertnit suEjects the applicant to e clvil penalry of not more then liva hundred dollars (5500).): ❑ I, es owner of the properry, or my employees wlth wages as Iheir sole compensation, WILL DO TF1E WORK, and Iha structure is not Intendetl or oflered for sale (Sec. 7044, Business antl Professions Code: The Contrectars LJcense Lew does nat apply to an owner of properly who builtls or improvas thereon, antl who does such work himselt or herseH or thmugh his or her own employees, providetl thei such Improvements ere not Intendetl or aHeretl tor sele. II, however, t�e �ulltlinq or Impmvemant is sold within one year ol completion, the owner-builder will have the burden ot proving ihat he or she did not build or improve tor purpose ol sele.). ' i ❑ I, es owner af the properry, am E%CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Pmfessions CoOe: The conirectors License Lew does not epply to en owner ol property who bullds or Improves ihereon, and who contrects lar such pro�ect with e conirectar(s) Ilcense pursuenl to the Contractors License Lews.). ❑ I am exempt untler sec. Signeture: Ownar ID verllied by drlveYs Iicense. ❑ Ves ❑ No Business and Professions Cotle lor this reeson: VedNcatlon ol Owners�ip 6y (type ol document, I.e. - property Iev 6111 or Aee7): DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: Drivefs License No. Date: Expires: ❑ I hereby certlly thet no excavatlon flve (5) or more teet In depth Imo which a person is required to descend, wlll be metle In conneCtlon with work euthodzetl by ihls permit, end that no builAinp atnidure, sceMoldinp, telsework, or tlemolition or tlismaniling t�ereol, wlll Oe more than t�irty-si: (38) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Celltomla Atlministretive Code). , ❑ As owner-builder, 1 will not employ enyone to do work whic� woultl require a permit Irwn Ihe Divislon ol Industrial Safery, es notetl e6ove, unleu such person hes e permit to do suU work Irom the divislon. Signature: Date: Division of Indusirial Sefery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION Of ENTRY: I cerlify under penaliy ot perjury Ihel I have read this applicatlon and s�ate that t�e intortnatlon given is cartect. I egree to compy with ell stete lews end city ordlnances releting to building construction, entl authorize representatives ot the Clry oi Casta Mesa to enter upan the ebove-descnbed praperry tor Inspection puryoses. I egree not to occupy or allow accupancy ot eny building euthadzed by this pormit until linal Inspectlon. Sig ture OI Legal er(s)� Date /`" 3/-J�CO i nNOr Aulhonzed t � Date COUE �• INSPECTIOXME 7676 Fi:ed System Final Fire Prevenilon 1266 Pool Spa Finel 200 Final Re-Rool 201 FInaI Black/Retelning We11 202 Finel Factory Flre Place 203 Finel Sign 204 Finel Demoliilon � p� 7�yyy5 COpE� ir+svernoNnae 206 Final Mechenicel 208 210 212 220 � 250 Final Plumbing Final Electdcal Final Fire Preventlon Final Plenning Approvel Final Bulltling/Occripenq PLIF 1�� ADV�4an1 to fill in all s0aces axceDt t�o�e wit�in �eary EorGer Iines anG sign all aoVrooriate Eeclantlons. � CITY OF COSTA MESA . � , � PER IT TRACT NO. LOT NO. - BL ., � CONSTRUGTION PERMIT , S/3iti�/�� ) 0�7 ' � � AppliCOnt'S Mellin ddr �� . � - T•YPE OF CONSTRUCTION NEW ADD ALTERATION' REPAIR - Project Address. �! � � � � . �' � � �� O CONVERSION _O DEMOLISH ❑ OTHER _ _ . (�ObG%%)A eil: /L C�� P G DESGRIPTION OF WORK •. . . ` . � Owner's Name •�_— : hone '� _ , � � � c�,eu'.L p ' Addfeis , , � �_ TVPE OF PEFiM1T i� .GRADING FOUNDATION .STRVCTURAL . A. P. ; AfCh/Eng. , , , LlCenie NO. ❑'TENANT ;I�'ELECTRICAL O PLUMBING � MECHANICAL' - p�ry� Addfess �' '' ' ' ❑ �OTHER � � � � TO B � r/Qc' � �/Y,bNIS �� ' PROJECT DESt:RIPTION 5�. F7. ' OCCUPANCv . . ' , ' � . . _ . . - � . . . � � COn[reCtOf3Nem ' _ a� LZ • � � - ' ' LEFTSIDE VARD " � �f3c )� -� � CONSTRUCTIONTYPF VALUATION$ � � Add�ess��f118lling) • � ' � ' PKG.SPACE REQ. �7 �� . � , . ZON� GRADINGCU.VOS. � ACRES : Licensa Nc � - . ' CICENSED CONTRACTOR DECLARATION ' � � ' � � pemark�: i . • � I � , STREET WIDTH � I hereDy,afflrm lhat 1 am Ilcensetl untler provlSloni of Charter,9 (commencing .. . . wi[n zectlon 7000) oT Dlvislon 3 oT the Buslneu anC Pro/essions Cotlo, antl • � � . , • �- . SPEC my Ilcense Is In /ull�or<J�nG'e}/ect. ' . l.lcen naa' �= Llcense No.�� PLUMBING ., , , Data - " Si9nalure ' � . � WORKERS' COMPENSATION DECLAqATION � � • Bef Sink � ��r �p � I hereby arflrm that I have a certlfiwte ot consonCto salr-Inzure or a certlflwte. � BeckfloN/ PrBventer ' SBM/er Conn¢Ction � A � of Workars' Compenutlon Insurance,'or a<erNfietl.copy t0eroof (SetUon - • ' ,, ' ' 3800, lab. ) � Backflow Irrigation , Soler Collectors ' � � _ �� concr No. � 7l �iG �i 2i � � `ComPanY� s:.�:• G/� �[%CS� , - — , , ,,'❑ Certined <ooY �s herecy furnishea, , . , Bathtubs � Solar Piping Y C� �� Cer 11etl cop is etl wi[h the city Builtl n DI ' n., �� Date �' • ADPIIcani SOI T k � D �EXEMPTI N FqOM WORKERS' COMPE SATION DECLARATI�..' . ___ . . (This sectlon nee0 not Ce com0le[etl if the permit 75 tor one �unGreE (1300) or less): , • � � ' • ' 1 cerUTy tnat in lne performance ot the work for which Ihis OermR li ISsueO I shall not employ any person In any manner so as to become su0lect to t�e . Workeri" COmponullOm l.aw3 O/ CaliTornld. ' ' Date ' <Iqnaturo ' ' .NOTICE: It, afler-inakinq. thls tloclar;tlon,�you�shoultl become sub7e<l�to the Workers' ComDonatlon provislons oi tho Labor Cotle, you must tortnwith .compty wft� Such'O�ovlslons or'Mts'•Dermlt'snall be tleamatl rewke0.�' CONSTRUCTION LENDING AGENCV ' � - 1 hereby a//irm that t�ere Is a construCtlon lontling agericy.for t�e parlormance a! tne work for whicn tnis DermiC Is issuetl' (SecHan 3097 Civ. QJ� Lentler's Name , , . , Lentler'S Atltlress � OWNER BUILOER OECLARATION• ' ' � .. . . I hereby aftirm lhat I am axempt trOm the Contractor's Cicensa Law for the following reason ($action 7031:5 Bu6lnaiz antl Protasslonal'Gotle: Any Uty or county which requires a permit to construct, atter ImDrove, tlemolish.or �epair any itructure, Ddor to its'Iszuance,�a�so requlres t�e applicanPfor suc� Oermit [O lile a Si9�e0 statemant thdt �e/she IS Iit¢nsed.purivant l0 t�e O�oviilon2 Oi 1 tha Cuntraclor'i"License Lew (Chap[ar 9(commencln9,witn�5ectlon �000) of ' Division 3� of t�e Business anU Professions Cotle) or [hat- he/she"is nxempt ' therefrom anE tne basis tor the allegetl examptlon. Any vlolatlon of Saction 7031.5 by any applitant tor a,permlL;subjects the apPlicant to a-civil ! ��enalty ot not more tnan tive huntlretl tlollars (E500). �' ' I: as�ownar o1, t�e praDerty'or..my employdes wlt� wa9es�as lhaG sole • � sale. If, however, [ne buuainy or improvement �s soia wnnin oneryear,o� com- platlon,'the owner�will �ave lho burtlen o1 proving ha/sne tlIA not builtl or Im- ' �rove for the OurOese of sale). : �- ' I, as ownet ol tha pioDerty, a�n 4xclusively contiacting with,llcensatl con- tf2ClOf5 t0 conslfuCS the�p�oj8tt ($lctlon 7044, BUSIna55 antl PIOflssloOT COtlB: ,'Tl�e ContrSctor's Cicense Law daes not apply to an owner oi property who builtls or Improves'thereon, anO w�b mntracts tor suc� projetls wit� a con- �[ractor(5) Iicensa pursuant to tbe Gon�ractor'S License l,.aw). , � ❑.I�am.ezempt un0er Sactlou � B. h P. C. (or thls reason Date �� Owner' � I hereby certity t�at I' bare reatl thiz.appllcatlon aritl ilata thaFthe a�ove � Intormatlon Is torrect. 1 agree to comply with all city antl counly ortlinantes , antlyslate laws ralating to EUIlAin9 �onstructlon,'antl �ereby aut�orize repre- sentativei of �lhis Uty �o enler upon � a ove-mentlonetl property lor '.inspettlon Durpo ./' . . f� Sigriature � � >i «� Date__�y�-` �` -� . Drivers' Licansa or 55 � CMF�086546 rev. 12%82 �� White - Builtling: Canary - AOO��M; Pink - AccounHn king Fountains ir Drains ' � ir Sinks ' . . . .. -. Service � � Outlets • " Lavutories.- � , � � P-Trep� -" ' RoofDrains� 1 � Shower5 � ServiceSink, '. " = Under _ Duct - Ven�ilatin9 � Exheust5ystem ❑ Multiple❑ � Firepl/FactBl[.ICBO�W W , Heating System & Ducting � •� �4100,000'BTU�100,OOOB'Ti � Hood or Tvoel ❑ 1 . Registers � GolUenrotl - A ar an . Swimming Pool w/Spe Urinel Wacer Gosec. Water.Heater Water Service _ . -� . Unit . , , . : , � , `�,` � ; /IJ9/,,_ . ` c_��n TL ZONE i ' . BUILDING. �• � _ __ �ronr�rri c+- , REAR VARD (TO P/U ' � ' RIGHTSIDEVARD ' - PROVIDED � � � � � � PARK FEE $ t • • �Meter lJover lOOamps , . .Sub Panel ' � ' Sub Pole � � , . her � ' Motors UO-1 HP LJ1li-B 1 OGas'; OElectric '"- Inc.SoleiSO9-15 HP �16-15+ .� ' Fan � ! ' Microwave � F.A.U. • � Pole Light � Fixtures � Renqe_ „�, � . , � Device Boxes s�� . Reinspection Fee � §15 - ' laue Foe �� ? 3 iANICAL � ' . ' Refrigeration System � ' Oa�oo,000sTu ❑�ao,aoosru System RepairlA�teration . � . I Iswe Fee Fee $15 $ 3 Sections ' I � GarbageDispoul i � � � Genera[or 00�5 KW �5-15 KW � ' • . Trensformer �15-50 KW �� ' � . ' , ❑5U+KW' � ReinspaetionFoe � � S75 Merer ❑up t'o 100�amps Issue Fee. �, '$ 3 Zaning AOProved By Data ' '' � ApPlifation Approved BY � ' Date •q� A3 Appliotion Issuad By Date O ' ' ' , ' , ' SUINMARV OF FEES ' i � � �,BUILDING.PERMIT $ - SMIP i , • $ � . PLAN CHECK' � $� - � PERMIT ' PLUMBING I $ ' ISSUANCE? ; $�� iPLAN CHECK,' � $ � I GRADING . � $ � � 1 ELECTRICAL � $ � L%. i i ' � $ �PLAN CHECK $ � MICROFILM $. �� MECHANICAL $� � � TOTAL FEE � $ � � � PLAN CHECK' $' � LESS � � _ , �i � ' ADVANCED,PC ' $�� , .� • , . FINAL�FEE� $ � � CONSTRUCTION AND PL"AN ING - . POOL & SPA � . -'APPROVALS; Permit�k�' ..�� Date � Inspector pppROVALS '� Permit� �� Date Inspector -1�. TemDorary Electriral Service or Fole,,' � ; • � � 52. Pool &�Equipment Location � � . 2. Soil Pipe-Undrgrnd. � � � 53: Steel Reinforcement� f'\ 3. Electrical Conduit Utilitv-Undrgrnd. �_ 54. Form3 _ ' ' '4. Elecfrical.Conduit-Undrgrnd; � � 55. Electrical Bonding . � 5. Steel Reinforcement � ' • - 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. � ' = 57. APPROVAL TO COVER-GUNITE , 7. Footings � . , •� . - _ - 58. Electrical �nduit-Undrarnr{: �: 8."Foundation _' - , . = ` _ _� 59. Gas Pipe, O Undrgrnd., Test - 9. Water Pipe-Undrgrnd. � . 60. Backwash Lines, P-Trap, O Undrgrnd. . 10. Structural Floor System • -' 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection , .�62. Backwash & Receptor-Final � 12. Sewer Cap � �� 63. Heater & Vent-Final ' - ' 13. Roof Drains . ,� . gq. Plumbing System �- Final ' . 14. Rough Plumbing ' - ' � 65. Electrical-Final 15. Rough Electrical=Conduit� - '� --- "- � 66. Solar System-Final - i 6. Rough Electric Wiring : , . � �� ` ,67. Fencing & Access.Approval - 17: Rough Wiring Sign ? �� 68. APPROVED FOR PLASTERING 18. Rough�Electrical-T,BarCeiling ' � 69. POOUSPASYSTEMSFINAL 19: Ftough�Heating & Air Conditioning : . FIRE DEPT.�REQUIREMENT . 20: Rough.Factoryfireplace - APPROVALS Permit�p 21. Ducts,in Structure � � 70. Underground Hydro 22. Duc[s, Ventilating� , 71. Product Piping OGas ❑Oil ' 23.�Gas Pipe-Rough & Test � ' 72. Underground Flush 24. Roof� Framing � � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing � . - 74. Overhead Hydro 2\6. T-Bar Ceiling'IStructural�� & Monocoai 75. Dry Chemical 27. Frame and Flashing �. ' � 76. Dry Standpipe � � �T ?8. Lathing & Siding � ' � . � `/7..��RIXED SYSTEM FINAL � � 29. Insulation- ' ' ' � � 78.�FIREPRE,V..,FINAL 30. Drywall Nailing � ' Notes: 31. Plaster Brown Coat • �� 7 i ectrical Power Meter-Final � � 3. Fi I Electric -�f�3 . 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. GasService-Final � � '• 41. Solar pomestic•Final � - � 42. Backflow Preventer � � _ _ ' 43. Backflow Irrigation . � ' 44. Landscape Irrigation Sys[em, I � , � � � ' � 45. Sound 'A, ttenuation -. � � � ' 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed - � - • 49. Electric fielease to Edison ' • _ . . • � 50. Gas Release to Southern California Gas Co � ' 51. CERTIFICATE OF OCCUPANCY _ - .' No � Date _ � . ' AOV��unt to fill in all s0aeef ezcapt thow within �eavy EorCer Ilnes an0 sign all aDO�ooriata Ceclantlons. ' CITY OF COSTA MESA �, � � ' pERMI NO. • TRACT NO. LOT NO. � BLD . ., , � \ � CONSTRUCTION PERMIT ' - � - , . . . . �� ,.SO " � . • � ;\. \ 2,os j�' , :� ' :, ' � •` � ,- � ApplicenYs Mailing Addless . ' t • �' T/PE OF CONSTRUCTION - ; NEW ADD - ALTERATION �REPAI R � M ��6�� '. ' . � � " • ; . ' � _ � . ' 3HS. E. � 1%Y�7 SL � � . ' ❑ GONVERSION ❑ DEMOLISH ❑ OTHER't ' �� Project Addrass . .. ' � sZ � ' � • � ' . � ownbr'sNeme �Food' am &erf Inc.' ' �vnone5Z1-7667 ` oescairr�onoFwoaK � � , _, .. ' • . : � .� . � ' i i a ' � . : _ :. . I ' E U . . � AddreSt 9n4n TP�SYAT� F1M t � , , 'rypEOFPERMIT � OHADING ��FOUNDAyION STRUCTURAL� , � A.P.qW� . - 20NE ' � . � - �l Afch/Eng.', ' � �� LiCen59 NO. � Q TENANT ❑ ELECTRICAL PLUMBING� O MECHANICAL � r� PLNG, iiEF. jW . - �' ' BUILDING • Addr855� � ' � � �� . ' I -�.'OTHE(i �� ' ' _ ' ; ! . ) . . ' ' ' ' ' TO BUILDING • , - , � Contiector'nNam��VanCe�PlttmhlnQ CO. �ahone�.�17'11%i.5, �PRaECTDESCRIPTIONi SQ.FT.� ; ^, - OCCUPANCV� � - Y_�NE REARYARD{TO%U � - ' � �LEFT SIDE VARD ' � RI�GHT�SIDE VARD ' '�5 ' 1456• E. Hill Street CONSTRUGTIONTVPE ' • VALUATION$ ' � ' Aildress'Imeilin8�131585� ' � � � ' ZON� � � GRADINGGU.VDS. t 'ACRES �� PKG.SPACEREQ. ' • . � PROVIDED � � � �„ - Licenae No. . . , • ° . . : . . � UCENSED CONTNACTOR DECLARATION � ' Rams�kf: - • I ' � , � � � - � STREET WIDTH � . � � �' PARK FEE�§ _ � 1 hereby aTfl�m [Oit .Y aM ��enseC untler provislans of�C�art �9 (commencln9 � � ' � � � -- � . 1 ' Wlth' SeCtion 7000) af D�vlslon 3 of t�e zlneis ntl Pr ssions COtle, anE , _'� . i ' ' � + � � � .SPECIAL CONDITIONS: ' : ' � my Iicen4s�ls In ful f,prca anG ef}ect. � � � -� , , � , _ Ucen CS�u � �36: censd 131585 ' : ' '� ' I . ; � PLUMBING � � . . , � � i � F i � . i , ' � . . Date �-L` ' 5iqnature ' t ' � � � . Bar Sink ' � � Sewer CeP�' ' . � i ' ' ' , ' 1 ELECTRICAL , ' ,� , � ' WORKERS'COMPHNSAT�ON DECIARATION ' ' I here0y aftirm tnat I nave a ureiilwte of consent to selNnsure or a cartNirate_ �.; gy�kflow Preventer -•--1 . . Sewer�Conneciion---' --� - -�' �� — -. Automatic Washer � -� r fMeter ❑over 10D emps' ' ' at Workers'�Compenutla� ��surbnce,� m a -cnrtifle0, coPY thareo} (5e�tlon � �� ' - - � � • � . � ' , � � � 3800, Lan. { � " � - ' gsckflow Irrigatian � i Soiar Collectors , ( � 1 Construction Pole'. : , �Sub Panel; ' � '� a�n�Y No. CC�2�411-1�54G7 company ATgonaut � ( ` - . Cooking Unit ' � I Sub Pole � � � ' �CartltletltaDY Ii �erepY �urnlshaE. ' . ' ' t � � Bethtubs � ; ' $plar Piping ' , , � . . ' . . � Certlfla cop y s tiletl with the'clty,Bulltlin9 Dlvislon. � � 1 � � Dishwdsher ��Motors �0.1 HP '�1'6$ � . Date �-L�� -.4Dulicant 'fldvanra Pj,��mhino G � Clerifiers + SolarTank ; ' , � ; . � . , � ."EXEMPTION FROM WORKERS' COMPENSATION'DECLARATION- -- I DiShNldShef � � � SWlmming POaI W/Spe � { ' � DryCn �❑ ectric `� . �InaSolai 09-15 HP �16-15+ r ' � (Thiz section neaC nat be com0leteO If the p9rmit is for-one huntlratl (5300) or '� . � . fezs) . , - . : . . . � ' . � . . - . . ' ' M�crowave , ' ' ' ' � I certlfy tnat In tha oerformance ot tn9 work for wnlcn thls De.m�t Is issuail I� � Orinking Founteins � � Urinal � ! - i , * ' snall not emplOy any pe�son in any TannBr so,as to becOTB SUD]Btt t0 t�le � � . � � � � - ' ' ' � • � i Workars',Compens2tlon.�ws of CaliforNa.Y ' � � ' FIOOr D�ains' . • ! ' „ �U• � 'Pole�Light ! . � oat6. ' ' - Signamm • � I ' } . � . � '. ,' �. Wa`ter�qout�. } , ( _ . � i . I,NOTICE:J/, after.makiriq this tleUaratlon,.you snoWtl Decome.suCJect.to.tha_ L� Floor.Sinks _.._'_ _ !. „ ,. _Water Heater,- ..� - � -L-___ y - _ ,� ;. _ Fi res . _ � 'yRange, .� � � � ; Workers'� Compansatlon. Provislons of the Labor Cotle, you must forthwi(h, 7 - - '' � � � ' comply wllh' Suth �Oro'/�Sions"orhhl5 �Dermit'Shall be AeemeA revOkeE:; ' � G8SS8rvICB� � �OIItIBtS j �Wdt¢fyS¢NIC¢ ' � ' � ' � �� 1 5�9�! � • � CONSTRUCTION'L'ENPING'AGENCV�' • ". � `. �: � .. � -. . . ' ( -' ' . " • •' ' `� ' •• . � ; .. . - ' : y 9 9 Y G � i�• IntCfCOptOrs � � ��, - OUtlet ; 9 � I hereb aHirm that ther9 �s a,constructlon lentlin a enc for tha erformanca � � -• 1—Water i in 1'ter � � 'Standin SettiOns � ' • � of the �.work for whith'1 this, permit .is ,IssuaC',.(Section 3097 Civ C) � ' ,. � �,. r , :' � ' ' Switche , �' � . i � i Lenaer s�� Name' - • . - � �, � � Kitchen Sink� �� , i , ,.. � _ � v � _ ; � � � � �. •Trash Compactor � � . LnnOer's� AAtlress . � �. � . . . . -. - . " �- ' • . ' : . � ... - � � . . . Lavatories ' r - +?, 1 : f �.- ! . Gartiage osal � i , � 1. � OWNER'BUILDER UECL!�aATION , �. � !- � �+' p . ,+ � - 7 � � � : ' - i : ' - � � ' � I hereby;aftirm t�at I ar��ezemptYrom tna Contiactor's'�License Caw for Ihe- - i�, • Generetor� -5 KW OSA5 KW � ' " I '� following reason'(Sactloq 7031.5 Business-antl Prote551onal�Cotle: Any city o� �� P-Trap� � �� _( f. . . ,. , . ; � � j <ounty whlch�requires a Vermit to construct; alter improve{'tlemolish or repalr , .� , �� . � � Ttensformer �5-50 KW ' ; ' . I � ; any structure, prlo� to Itsdisuanca, alio roq Wres t�e applicantfor such permit � � RoOf,Die�ns � �. � - � . � I � � ' ' to fila a signetl ilatamen� that ha/she is Iicensetl pu�suant to the provislons ot ' .- ' the Contractor'S�Llcense.�`�' (Chaptar 9 (commentlng with SectionJ000J of ' � ' '' � r. � - � , � � . V �� ;: �5U+ KW �, 'peinspeMion Fao � f75� . DIvlslon 3:ot [he'BusMess antl� Profaulons� Code)<or thati he/she� is ezempt • Showefs - �• ,, � Reinspection Fee . $15 ' Merefrom.an0[he;baslsfortheallegetlexemption:Any,violation-btl5ectlon � ' -' � ' ' ' MetC� Oupto100amps � ISSue�Feel � '�S3 ' �,7031.5 by�;any applicaP� for¢a�permit'subjects't�e aDP��tant lo`a,civll � ' � " , - ._ _ ' � / � 1 . � �nalty of not mom than ilve huntlretl tlollars (5500). • ; _ . . ', � S2��ic2 Sink '�-� � �': ' . �yyue Fea �� S 3 ' - ' ' -T i ' 1 -r i Zoninp APProred BY Date' I. LJ I; as owner o/��[he �proDarty�or'my employeas with wages�as tFielr zole .� � - � ��compensation' wlll.tlo tne work, antl Me.structure,is not intentletl or.oTferetl �' � ," � � • - -MECHANICAL. ', ,• � � , � ' ; � ' tor sale � Se<lion 70aa, eusiness, antl PrOf<SSional Code: Tha. Contractor's Appli�ation Approved By (�� ate � � License law Coes not apV�Y �o an owner oT a property who bulltls or Improves i . Boile� '� ' ' ' Refrigeration SyStBm ' � � -/ f�• '� � � � � P� rY3 �� ' thoraon, antl who tloei.such work himseli/herself or tnrou9h his or �er own � � . � + � , '� � Appliwtion laued By Date. amployees, provlAetl tha� such.improvements are•not Intentletl or.oiferetl for , � ' ❑4100,OOOBTU ❑100.00OBTU , . sale. II however, lhe bulltling or improvement is solG wlthin one yearof com- ' Dutt -�UndenGround � . , ( � � ' i, SUMMARV OF FEES ' ' • � pletlOn, lhe owner wi11 tlava the bur0an of provin9 he/5he tl�tl not builtl or Im- � . ' ' , � � ' l: � �� , � .. ��rovetorthepurpaseo/sxie). ' •� - � ,' ' Duit-Struttural : , SysteinRepair/Alteration " BUILDINGPERMIT $, � ' SMIP � $ � 1, as owner.oT tba property, am axclusively contractin9.with,li<en4eG com � �� I -. , �� tractors to construa the pro�att (SecUon 7044, eusiness antl; Professlons Coae: I ' Duct - Ventileting . _� _; _. � ; _j iPLAN CHECK' � $. 1 PERMIT � y� �'The' Conim<tor'S' Llcens9'Caw'does'not appty-to"an owner"o� pro0erty who �� . - . . „ , � ' ISSUANCE t , $ ' �V��O • builtls or..lmproves Ihe�6a�, d�0 who COnt�dCtS t0� Such ProjlCIS wit� a con- EXhBUSt Sy5tErt1 ❑ Multiple�O � � PLUMBING � $� � .00 : 4 �tractor(t) Iicenze pursuan� to tha Con[ra'ctor's License Law). : � t ' • ' � ' � � � ; GRADING � $ � i . � . .PLAN CHECK. $� � � . � ' ! ❑ I am enempt untlar 56�tlon - � ' � B. & P C. (or t�is reason � Fi�epl/FaCi. BIL ICBO � � � � , ' - � - ELECTRICAL � $ - • � ' � � � $ � � � � �Date. . � �� owner' � � • � � ' � � Heeting�System&Ducting � � j , ' � i ' � MICROFILM '•$ � � I here0 � terUf t�at ��av � reaG is'a I�wtion.anE slate that.the.above...i. —� PLAN CHECK� $ \ v v. ec - �a�ao,000 aru �ioo.000s ._ ' , , Into�matlon I5 mrra . ag e to mply wkh all city:and county orEinances � i' i . :` . ~• . " � �� TOTAL FEE' ,'$ ' - � - ' MECHANICAI , $�� . antlslata laws rei ng to uiltl construttion, anA hereby aut�oriza rapre- i Hood a� � � � ' :' Isentatives�o/'tnl U,� en r upon tne abov entionetl property br ��o TVpeII ❑�� ' � � � ' {' Reinspectian'Fee � 515 � p�qN CHECK' $� I LESS inspectlon purpo s � � , ADVANCED�PC $ � " ' � , sienature , - ' . � Reqisters •� Iswe Fee � S 3 � � � � � f � ' FINAL FEE'. , E. lz'.eO ' Drivers' LJcense or SS 9{� � , � � ' - � � CMF 0865-06 rev. 12/82 �`Nh��e - Builtling;�Canary �- Applicant; Pink � Accounting'; Goltlenrotl • Assesior � � � ' -'�- ' � � �� ' - - - ' - � , � . .. ., . . . . • . , �• � •= CONSTRUCTION AND PLA IN � o �°t � f,..' � �r ; _ � ,, a ,'?- ��OL & SP�A , ,' � .Y � . � . � � : � - � 8�$�� -'.Date �Inspector ' � �� - ' - � '.�Date' Inspeetor , r �APPROVqLSr, PeFmit # ` � - � : ; �APPROVACS '_'-Permit � � / _ � v 1 ' - i �i > ' I o . I c . • I �' �1, �Temporary. Electrical Service:oi Pole i ;. � 4 � '• a' i ; � - _ '52: � Pool &iEquipment �Cocation'. _ ' • ; � ; 7: - '' !2. � Soil'Pipe-Undrgmd. �� z'oo _ I �'•' � � > ° � �n � J ` `53: Steel Reinforcement - � � � �. . � " . _ - ;, _ : ' _ - ; l3.�Electrical Conduit Utilitv Undrgrnd. � � �� ,D ° •''- '' - 54� Formr.'� . _ � . �i ci4,.�Electiicel Conduit-UndrgrnEf.. _ , � <<, - '�` � �� a� '-55: Electrical.Bonding` . - � ' ;. .� .5. �Steel Reinf,orcement � , w. :�� - � � . ` ,� = `- z-' ;' = ` �,. ... . . � , ' r � . � ' p: , �` � 56.:Rough.Plumbing &�Pressure Test. � �` .'6.�ElectricalUFER.Gmd. �i.U;� s ��,;`; , �;' >r > �: �57.'APPROVAL>_TOCOVER-GUNITE �� - ; �..i 7. �Footi �95 I - � i I o %a � '',g � ", � ? = "� � ` , j ` `^58. ;Electrical �pnduit-Undrarodt . . y � , 8. �Fouridation � � � i ' �'..f. s p ; " a , � - ; � c59. `Gas Pipe; O- Undigrnd:, Test . ' � ' � i i � - � c i Y,,. �} 9. IWateir Pipe-Undrgrnil. i! o�� d�' ;� �' :�� ; Ggp. `gackwash Cines, P-Trap; � Undrgrnd. _ �,i � 10. �Structural Floor System ; T'�'f � _ � � ' < =II ;61.:APPROVAL,TO DECK ' , - i � �� 11. �Property Sewer Line &'� House'Connection� - � � �' �,', � ' � � - ' � � , � , , � �o -62.'Backwash & ReceptorFinal '. . � 12. �Sewer Cap� ' � , i � c n I � _ � ' �� - `63. �Heatei & VenY-Final - • _ . � � c n � � � � ~ i. - . . - I 13. �Roof Drains ' j � ; � � � ,� _ '�6q. Plumbmg SYstem'• Final� � � � � _ 14.}Rough Plumbing� � • i o�a` i , E � ! � '- =E '65. �Electrical-Final • - �� ' - ° ' ` ' � i � "�'15:;RoughElectrical=Conduit�'-� ±�-�� ?-�-� -'-("-�T ,66'. Sola%Sysfem-Final .� , ' � � � -'� �"� � . A' . , , ;�16.,,Rough.Electric Wiiing ;, � E� i� li ra � i � a� m"fn c kci �,`�f � i67�� Fencing & Access Approval �'�� ' - _ -. �__. � 17. Rough Wiring Sign° � S, I' � �� I; �r �`� �' '�"� isg: qppROVED FOR PLASTERING � ' � -" ! 18. Rough Electrical?T Bar Ceiling �" �� -. � f^=�. I M1 Igg� POOUSPA SYSTEMS FINAL • - � �! 19!"RougR Heating & AirConditioning .' i � !;� ; f FIRE DEPT. REQUIREMENT � � � � . . � . �• , �-� ! -� , � � , ! i �; ,� -20.� Rough Factory Fireprace i � '� `' i � � � � ABPROVALS Permit # . � ' _ � � �� 21.�Ducts;;in Stiucture; ' I ! i i� �' I i � ' ' ! �70! Underground Hydro � ' � � ��22. Ducts,iVen£ilating�. �; � � �i i� j � � j { � i�7�! Produc[Piping�OGas+�Oil ' , 1 :,w23. �Gas'Pipe-Roi gh & Test ; � I �!., i� � � r I I T' ;72; Underground Flush , �_, � � �,�24.-,1Roof Fr�ining� , i � �- i R (i� � �� I � � � � ^� j � � � � � -; ;> I7,3. �Undergrnd. StorageTank�O Gas ❑ Oil . � > _ , . � 25:;'Roof Sheathin9 � i i ; a ' �,� i. • � '� � � � � j � �- � I` � . 74� Overhead Hydro � - , ' . ' , t� ; 26. T-6ar Cei,lin Structuralh,& Monocoat' � i ,l � x� i . , . - _ -- ; � � - � I', 9 ( � � � � ' �75� Dry Chemipl ,. . � . ; -D. �Frarrie and�Flashin9 � i f � �; �� ' � � � - ' � j76. Dry Stan,dPiPe . � ' � - : , ' � . : : . ` r ' i � - �- � � i i � � � . � - .28.i latRing & Siding ;�;' ' t� ' I � f � ; j � 177•. FIXED SYSTEM FINAL �' 29.��Insulation � ` ' � � '� ' ' ' � I 1 l78: FIRE PREV. FINAL ' �. ' - � �-r • it il � .I i � :� .-'30. �Drywall Nailing �, i I "i I � �� '� I t ! � � � � I Notesi . � � � , ' . � , 1 ° �31.'Plaster�6rown CoaU I � i � �� il � t � � -��- �-- � --� -�� -�- -- -- , � , � , � t I � 4 F32.;iElectricdl�Power MeterFirial � �� j � j � I � '` . � � � " ' . .� � � r '. I _ _ . 33. Final Electric �� I � �; .�_� �__�. ( i I � � 1; � � ' ' i i � 34. Final Heating & Air Conditioning ^ h � ' ' « . I , ' I � � � - ' ,.c,�- �, i .� I , ,. - , � . 35. Final Gas Pipe-Test, r �� ',i; il I � +�� '6 ��' : � • - � ` � 1 �'' � . _ _ � -- _ � . - �� 36. Hood or i , . . � -; ri c ; ! - ' ' I ' , _ - . N iCanoPY�.Y��„i; i.. - Ji=I ', !i � . a I ' I - .,r' � -� - �,,.i b� n v i i:'�'�..- , 37. Final Factor' �Fireplace - al - � •- � . � I - s� - 38. Finai Plumbing� � ^� � �� j�y i; •� � � � ! - � .. � mal, 1 I . ,� : � I I ' '; t � i�' i � - . �, . ' S , - I ' � I� i � i � !? �� i � � � �-,. _ 40. Gas Service-Final � � � � { �� j � �I i ' i ' � ' � i �� d i i i o i 41. Solar pomestio-Final � � � � 'I � . �-- i-,�-T _Ir,�-�-- , �--- f- - _- , , ' �.�!. � .� � �� I � � � ; � ! � ' . ' � 42. BackfloW Frevente� , I � � ..,� -. - - . - - --. . � i ' . � c: � - - -�-"' -t-'�-- �?, , i i.�' � � .. y a. � i� � r w i , . �'{3. Backflow Ir'ngatioq -� � � � �� ' � � � � � " � i LL y � . . , ,_ 44' �ynd uc2pe Irngavon�SYstem , � ' a � ,.` � � , t � . = » ' c . . . r �i_. _ v • � � p -in . I I : : . . ♦ . 45. Soundd'Attenuation' � ; _ { ! ' i � � _ i . ; ; ,j � ' . 1 'J t _ i 6. Handicap Regulations j I ,� � � I " j � � ` i =' � � � � : j - � • , ' . ' " '.� 1.FINALSTRUCTURE�&BU`�ILDING� �-; I I�•`.'�.1� i� F ' i �. '� ' �' i i �SpecialRequireinentsCorripleted I� � i � ��; _ � i i � � i � , ' � - ,� ' - �� n i i i � Elec[ric Releaseito �Edisonl � ' '1 � � ; _ � 1 ' ,� _._ -t--- � ' - -� . � � 1 � t-' i i - � - -�--r- - 1 " , � ' n ' 5'as Release to Southern California Gas Co � � � � i� � � � i � ' �' L i i i I I lyo �;RT�FICATE�OF) OCCUPANCY �� 1.. j � � �..-} � �!_ ' � � . . . � �( �. , ' . , C� _ r.., - , ` � Date 1 ,.: �L� � ��.__� � � ; f . _s .- '..+.'� 1 . . _' Pfl0.1EtTRDONESS: jgS E 17TH $T UNIT: OWNEfl'SNRME: SILVA FERN B TR eooness: 3422 �LLZOTT ST SAN DIEGO,CA 92106 AflCH/ENCINEEN: � S 1 S% H S H— O 6 6 B NEG.NO.: aooxess: WILLIAM SLATTbN C—��57 9330 BALHOA AV PEPMITTFE: SAN DIEGO CA 92123 nooness:DATZ ERNIE S CONSTRUCTION (213)430-5233 10631 BLOOMFIELD AVE 14 LOS ALAMITOS CA 90720 UCENSEU CONTflACTOfl OECLANFTION: I here0y allirm Iqai I am licenseG un0er pwvisions ol ChaD�er 9(commencinA wi�� Seclion ]000� ol Orvision 3 0l I�e Bu5ine55 ana Pmtessi0n5 Cotle. dnG my litens¢ i5 in lull brte and e��eti. u-�r^��yy' 5 STATE LIC.: 44 8 5 4 6 cuss: H yniS� �i_n J . // � WOXNEflS' COMPENSATION OECUNRTIO I her¢Ey aliirtri (�ui I �ave a Cetliiital! ol ton5¢n� lo Se14in5ure of a Certilicate ot WOrkers' Compensatian Insurance, ar a cenilie0 oY �nereal (Section 3800. La�. CI. POLICY NO.: WCOO S 4 S S a% EJ(➢. UATE: 1 2/ Z 8 I9I vnrnxv: GENERAL ACS INS , � Certifi tl coOY is trereoy lumishee. L}{ CeNIieO copy is liletl vnN t�e cny BmlCing Oivisi pi�e'o !/ AOD�icant:� ��C!^� ! EIEM TION POM WONKEPS' COMPENSl�TION OECIAflliTION: (J� y5�iq� neeG n0i Ge my kle0 i� Ne permit ¢ iw one hunGretl (5100) or less�, I certily Ilut in Ihe perlormante nl ��e vrar4lor whiU INs perrtiii ¢ i5,vieG. I shall nal ¢mpby any Derson in any manner so as �o become su�le��o Ne Wo�kers' CompenSalion laws ot Calilornw. Oate: S�g�amre: NOTICE: u, alier making t�is Ueclaration. you shoultl b¢cpme suhle�� a ��e Workers' Compensa[ion pmvisions o� I�e �abor CAOe. you must fon�with comply mt� such pwvitiortc or Ittis permit shall Ue tleemeE rtvoketl. CONSTNUCTION LENOING RGENCY: I �ereby aftirm that there is a wnstmtGon IenOinq apency for Ihe Deho�mance ot lhe work for I wnicn this permii is issue0 �Section 3097. Civ. CI. , LENDEfl: pUOPESS: OWNEP BUILOEP UECLABRiION: I hereDy aifirm i�at I am exempi imm t�e Contractors' State License Law for �he following reason �Secuon 7031.5 Business anU Professional CoOe: pny city al cnunty whic� requims a permii m consimct, alter, impmve, aemolisR or repair any s�mcture, o��or lo ils issuance. also r¢quires Ine apvlicanl lor sucn permil to lile a signea statemenl Ina� helsne is licensetl pursuanuo Ine provisions ol t�e COmraciors' State license law (C�apter 9lcommeircinq wii� Section 7000) of Oivision 3 al t�e Business and Pmlessions Cotle) or t�at Ae/s�e is e�empi iherelmm anC ��e Uavs br t�e allepe0 eeemptlon. Any vioWtion ol Sectron 7031.5 by any aODlicam lor a permit subh��s I�e applicant to a tivil penatry of not mort rtwn live �unEreG ddlars (5500). 1, as owner ol i�e D�opetlY w mY employea wit� waqes az t�eir sde wmpensatiw• x+'u Oo the work, anU Ihe ❑ slructu2 is nol inlenEed or oflere0lor sale (SeC�on 7pcn, Business anG Pmlessronal Code: The Coniractors' State License Law aoes irot aODN �o an owne� al a proceMY w� Ouiltls ot imOmveS ihere0n. anE wtq Oces such wOrk nim5elllhert¢II ar inrouq� Ais ar �er own empoyees. O�avitleC ttwt wrli �mD�uvemenis aa wl intenGeG ar allereE for ule. II, however t�e builEinp or imD�ovemenl is so10 w�iNn one year of completion. ��e awner will lidve Ue Ourden al O�ovinp �e/s�e 4�U nat builU ot impmve lor Ine Durpose al Salel. I, as owner al t�a propeny, am e�clusiveW caniraciing vuth IkenseE contractars to rnnstruct t�e prole�� I��ion 70aa, Business ❑ an0 Pw�essioirs LaGe: T�e Contractori State Liceme Law Uces noi aODN �e an a.me� o� pmcerty wM builUs or im0«s t�ereon . and wno comracts lor tucn O�qec�s vritn a comractaqsl licenu pursuant io ine Comractars' Sta�e L¢ense Lawl. I am awam � IOai O�oo� 0� IMit WorkGr'S COmpEnSdtiM insufance ShOula �t OrmMeE to me. � 1 am exempl unEer Seclion: B, 8 P. C. fot I�iS reason: Dam: Onner. I tlo nere6y certiry iha� I am aware of anC untlerstantl t�e requirements oi Califomia Healih anA Salety Coae Sections 25505, 25533, antl 2553G anA I�a� I oi any lulure builGing occu0ant wilVwill nol (�i¢I¢ one) neeG lo comply wi�h saia Slaie cotles and ��e requiremenis lor a permil br conslNtlion or moGdicalion Irom I�e Air Oualiiy Managemen� Dislricl. fleS�Jenlial Conslmciion applica�ions are e�empt Imm ihe5e pmvisians. Dale: ADPlicani: I �ereUy cerlily Nal I �ave r¢a0 ��is application antl staie itu� �he aEove inbrmaiion is cOr2ci. I agree to comON �^Ih all ci�y an� couniy ortlinancesanostalelav5rela�inA�o6utlOmgcmrsVuttiona Vprrzerepresentaliu¢5 Nstiryto¢nterupOnllieaCovEmention¢a pmpetly lor mspe ion pur es. Da�e: �O �d � Signat � OriverS License or Swial Security •: t64La6 While—Buddmg: Grcen—CoOe Enfarcemem: �nary—ApWican�; Pink—Rovenue: GolAenraE—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO:� B 05436 PERMIT NO; B 059367 PLAN CHECK NO: 03863-91 L GOVT; N SUPP: N CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : STAUCTURALLY REINFORCE EXIST. RCMU WALL SQ FT: 7,500 CLAIM VALUE: 7,500,00 CALC—VALUE: 7,500.00 GROOP OCC: B-2 / COMMENTS• COLUMNS TO REINFORCE WALL, *�r�r��r�t�r*ir��r� �r+t�r��t��r�r*��r�r*�r��r�r**+r�r�r�*�+r�t�r�r+��r�t+��*��r��r+t***�r��r�*�r*�r�r�r*�**�!�r�t�r+tx�t* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT ' IN REAR; FT ZN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL: 42519305 ZNE; C1 REF NO.,: ' PLANNING Nt7TE5> STRUCTURAL REINFORCEMENT OF AN EXISTING WALL. NEW�COLUMNS > TO BE ATTACHED TO EX. WALL — 14' DRIVE CLEAR REMAINING. *�t�r�r�r�r*********x�+t�r+t�t�t�r*�*x��t*�x **�r�r*�r�r**�r�r*�*�t�t+t�r*�r�r*��r�t*��+r*+t******+t***x��e*�tx� D E V E L O P M E /N/ T S E R V I C E S R E Q U I R E M E N,T..S ZONING APPROVED BY L(�� DATE: � BUILDING APPROVED HY : DATE: 'C� APPLICATION ISSUED BY DATE: �� iFiEiFiFiflFiElFikiEifif�fiFlEiEiEkiF1E% iFaflEiFk�fi�iE�EiE ifiF iFlE�fifififif�fiEiF1F1E�EiEfEiEiflEiEifiFifiFifiFiE1f1E1F1EiEMitiE�IfiEiEkitiF fFiFjElEiFif�FilitiflfitiFlEifififikififiFiEiflEiFiF�f�fiF�lElEiEiEiFklfiflE LEGALIZATION:N F E E S M M A R Y STRUCTURAL,SEGMENT;Y � BLDG PMT PL LECT C MECHANIC FIRE SMIP/RES GRADING PERMIT 99.00 -. SMZP/NON—RES PI.AN 64.35 1.58 ISSUE FEE • BUILDING—DIV—> PERMIT UE PLAN`CHECK TOTAL PAID DUE TOTALS----> 100.58 0.00 64,35 164,93 169.93 ,00 1 REVENUE DIVISION TOTALS--> COLLECTED: 100,58 OVER/SHORT: .00 BLDG PMT PLUMBING EL TRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 99.00 • ;. 1,58 illfkMiElEiFiklElElEjtiEiFiEil3f�FitNifiFMifkiFlF ifiFifkkiEkiF3f,iFafiEiEiFiFilikiFlEikiklflEiElfiFiflFkifif�EiF�EiF�EiEMjflfififlfiFiflEiFiF1FiE�E I N D I V I D U A �L ��•F E E H R E A K D O W N TYPE QTY D E S C R I P T I O N: UNIT COST TOTAL COST SFC 7500 ALTER BY VALUE COMMERCIAL NOZONE 1.00 END�OF FEES 7,500,00 01 CQ�'>9�C1—C"Lt9SL:s �t�''-1 SF�fE� 10/iGi91 `FiiE= i•.s!� CONSTRUCTION AND PLANNING . PC 1 SPA APPROVALS Permit # Date Inspector qPPROVALS F'ermit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. .. 53. Steei Reinforceme�t 3. Electrical CorLduit:Utility�Undrgrnd.; � 54. Forms ��47�Electrical Condui{-Undrgrnd. - � 55. Electrical Bonding "l5., Steel Reinforcemerit � ''•� � �� P� �� 56. Rough Plumbing & Pressure Test i 6., Electrical:UFER�Grnd. • 57. APPROVAL TO COVER•GUNITE ` ''7. Footings `: ' ' " '- � 1� �i �� 58. Electrical Conduit-Undrgrnd. ' 'B.,Foundation� '- `: �� 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structural Floo�•System � 61. APPROVAL TO �ECK ' 11. Property Sewer Line'& House Connection 62. Backwash & Recep[or•Final 12. Sewer Cap _ �' 63. Heater & Vent•Final -�• 13. Roof Drains � .� 64. Plumbing System - Final 74. Rough Plumbirig � 65. Electrical-Final 15. Rough Electricai-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. flough Heating & Air Conditionin9 � FIRE DEPT. REQUIREMENT _ _ �, � � � 20.. Rough Factory F�replace � _ � ' : �f� < .7�,PPROVALS• ' �Permit # � - ,X * a �. a . ..•- - 21.'DuCfs, in Structui ; � . .. � � .�.. ! -70. U`nderground;Hy�ro . � 22. Ducts, Ventilating t . -_ �_ . `, r77. Product P(ping OGas ❑'Oil 23. ;Gas Pipe'Rough & Test . r� � ,. ' �.J2. Underground FIusM'1 - 24..�RoofFraming• _ �� - � . _� .-� ; `_.73.'Undergmd[Stora9e�TankOGas ❑Ul 25. RoofSheathing � . , ' { ' � '', a '7q,'.Overhead�Hydro ' � � 26.�T•Bar Ceiling (Structuraf) & Monocoat a� � �� • 75.-Dry Chemical � � ' �. , 27.,,Frameand FlashiAg� ' �° " 76. �Di Stand`!�e -'�' : ' '` ' •l, r Y Plp, n, � .28: �Lathingi& Siding r� : a,�c �,. � r� • �•� � 77, FIXED SYSTEM.FINAL� „ - 29. Insulation , � � �' ' ; 7- ` � �, �, 78:' R V. F�NAL � - �� '� 30. Drywall Nailing �_ � . :. � Elf�.TFI � EPT: REQUIREMENT 31. Plaster 8rown Coat � � '� '; ' J9 f�FINAL NSPECTION "= ' �, - 32. Electrical Power Meter-Fina�� r . . ?; � � � :8 . F00 ,CERTIPICATE ISSUED ,.33.,FinaT Electric . :�, ,� ,. r ' � ��No{es: l/ /3 !/ .�?s� (�- 34. Final Heating_& Air Conditio,niqg; • �� ;� . '' � � �' , _ �'i DL�::Qb''� � J 35.'FinalGasPipe•Test� _ � '��L � ' ,� . ``� ,;` ,,,• .� 36. �Hood or Canopy � . •` - �� `� r� � � . 37. �Final Fattory Firep�ace ,� '� i (; 9 7� .; ;. �38.�FinalPlumbing : ;� i � � ' � �F - _ � 5 ! � 1 �. �39. Water Service�Final' l ' ' �* •` • =. ^- - 'x : � i,40. Gas SerJice-F�inal t �; � , , i � y �_ _i � � "41. Solar pomesticFinal `- � • ' � _ ' � :�� • � � � • � + • 42. BackflooJ'Preventer, - . � p� � �� ^ . � " 43. Backflow Irrigation• � � _� - ' - ' � �,�,_ ��r ,> - *... � �;44, Landscape I�rigation System ;.,�,� f; ��„ �r .:, ti- . , � .. _ -45._Sound Attenuation '�'� :'"� - - • "` s'�' . � - � - :�„ - .- . - a ^LL �4 .,Handicap.Regulatiojis -' ' ;x " • •-; , ;, . _ �• • 47 FINAL STRUCTURE & BUILDING : l � 9 �� 48. FINALPLANNING . ..�' ' . ' �' ,� . � 49.: Electric Release to Edison i . � � � i� e. � � � � �� , . r. ` 50..Gas Release to Soufhern California Gas Co ',. � � �' '�, _' ` �� ;� : ' 51. CERTIFICATEOFOCCUPANCY . ;" < No. Date I AOD��ant to /lll In all soaeas exceo� inosa within heavy bortler lines ana sign al1 apvropriate Ceclarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMI O. TRACT NO. LOT NO. UNIT N0. � � 292I 10/26/tl5 L'QO:� . Project Address .385 S. 17th St. �� Applicant'S Mailing Addre5s�.44O E- ALLOW HWj�.� SU1tE L TYPE OF CONSTRUCTION NEW ADD ALTERAT�ON REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHEq q p*, Zp�e Owner's Name _I?pODM21&E&.rIlIC ir��le DESCRIPTION OF WORK/USE OF BLDG. Adtlreu p-n-�x '7R7� San Dinan 61Q/571-7497 S MainBuilding: Accessory8uilding: E Z Arch/Eng. License No. TVPE OF PERMIT GRADING FOUNDATION S7RUCTURAL T Front p Addre55 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear � � N ❑ OTHER Convactor's Nam So Calif HnP=i�SsjSL 61b8�30�351Z pqpjECT DESCRIPTION 5o. FT. oCCuaANCv C Right N Addreu�mailing) �ddl1 F��•.tg � ' CONSTRUCTIONTVGE VALUATIONS , � e K Left Cit License No: Irwindale S . R V � ZONE GRAOING CU. VDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Providfd E � I hereby attirm lhat 1 am Ilcensetl untler proviilOnS oi Charter 9 omme n9 Remarks: Pldnning NOt¢5: - with section 7000) of Divislon 3 0l e Buii 5 an Profess s Cotle antl M my Iicense is in full force antl elfect. ' T Ucense Cla BC 0 I e o._ S Date 519�ature PLUMBING FEES W00.K RS' COMPENSATION DECLARATION 88/ Sink $hOW¢�5 . hereby a/tirm tnat I navo a certHiwte ol consent to self-Insure or a certllicate ELECTRICAL FEES � 03 Workers' CompensaHon Insurance, or a certlfletl cop thereo (Sectio BackflOwPreventer ServiceSink � Automatic Washer Transformer ❑ 15�50 KW 3800, LaD. CJ �� Policy No. PC 974858 �o Backflow Irrigation Sewer Cap Construction PoleSub. � 50+ KW eCer[ifietl coOY �5 hereby tumizhed. Certifiee coo �s filed with the city B iltl o. Bathtuhs Sewer Connxtion ('qoking Unit Meter ❑up to 100 amps Date�24��r-' /�Policant Clarifiers Solar Collecrors Dishwasher Meter EXEMPTION FROM WORKERS' COMPENSATION ECLARATI ❑Ov2� 100dRtp5 (This section neetl not be campleteU if the Dermit is tor one huntlretl (E300) or � Iess). Dishwasher Solar Piping Oryers �Gas ❑Elecvic Suh Panel I c¢rlify that in �he performance ot the wOrk 10r whlcb tnis patm�t IS ISSUBtl I shall not employ any person In any manner so as to becomo subjact to t�e Drinking Fountains Solar Fan Workers' Compensatlon Laws of Calitornia. Morors �0.1 HP O1'6-8 Date Signaturo Floor Drains Swimm g Pool wlSpa F.A,U. 'NOTICE: If, att¢r making thi5 tlGCla�ation, you Shoultl blcome subfecl t0 th0 InC.501a� 09-15 HP 016-15+ Workers' Compensation provisions ol the Labor Codo, you mus[ forthwltb Floor Sinks Urinal Fixtur¢i- Microwave comply with such prOvlSiOns or thi5 pCrmlt shall be tleemetl revokotl. CONSTRUCTION LEfYDING AGENCY GasService �utl¢LS Wdt2�C105 D¢viC¢BOx25 P01¢Liht I hereby affirm [bat thtre I5 a conztruction Ientling agenCy for thC performante 9 o! tne work ror wnich this'permit Is Bsuetl (Section 309] Civ. C.) �nterc2ptor5 Water Heate putlets Lentler's Name Range Lenaer•s Aaeress Kitchen Sink Water Service Switches Sign OWNER BUILDEN OECLARATION 1 h¢reby atti�m [hat I am exempt /rom fhe ConVactor'S Llcense Ldw tor tne Lavatories AutO-Weih Garba e Di Osal followin9 reazon (Section �031.5 Business antl Professlonal Cotle: Any clty or 9 W ; Standing $ections county wnich requires a permit to constru<t, alter, Imo�ove, tlemolish or repalr P—Trap Laundry Trays Generetor 00.5 KW �5-75 KW any structure, Orior to its issuance, also requires the applicaM for su<h permit Trash Comp3ctor to tiie a si9netl statemenl that he/she is Iicensetl pursuant ro the provisions of Roof Dreins the CONractor'S Licenie Law (Chap[er 9(commencing with Sectlon ]000) oi Ivision 3 0l the Busin¢55 antl PrOfes5ion5 COtl¢) o� thdt no/she IS nxompl Td�C171 dfl isolated 1L Illt and t lil � era�.om a�a t�e basis for lhe allegetl axemption. Any vioiation of Seclion into a 24-V com ut 11 low volta e work 031.5 by any applicant for a permit sub�ectz the appli<ant to a Uvil �enalry of not more than five nuntlreG tlollars (5500). � $ I, a5 owner ol tha property o� my Cmployea5 with wage5 ds Ihal� So10 ReinSpBction Foo $15 i IiTue FBB 3 1 rece t. ClI[.Ult . 1 � Comp¢nsatiOn, will 00 Ihe work, antl the stru<tura Is not inlentletl or aHo.aa Rainspeetion Fee $15 luue Fee $ 3 �0 ior wle (Section 7044, euslnesz antl Pro/essional Cotlo: Tne Contractor's MECHANICAL ' FEES LJc¢nse l.aw tloes nol apn�Y �o an owner o1 a prOperry who builtls or ImprOves thereon, and wno tloes such work himselt/herseH or mrou9h his or her own Boiler Hood or T e I • DEVELOPMENT SERVICES RE�UIREMENTS: employees, Provltletl that such Improvem¢nts are not IntenAatl or oHeretl for VP � ' sale. If, however, the building or improvement is soltl withln one year of com- CanOpy Type I I ❑ Zoning APProved By �ate pletlon, Ne owner will bave the burtlen Of proving he/she ditl not builtl or IT- DuGt - UndE� i�i�0u0d . prova for the vurpose oi sale). ' Building Approved By Date � LJ 1, as owner of tne property, am exclusiveiy contracting with li<ensetl con- Dutt -S[ructural Refrigeration Sys[em Applitltion ISSUBd By nat Vactors to const�uct the O�oject ($ection 7044, Business anE P�Otesslon5 COtle: - The Con[ractor'S License I�w does not appty to an owner ot property who Duct - Ventilating �0.100,000 BTU ❑100,000 BTU . SUMMARV OF FEES � DuiltlS o� improves [he�eon, antl who COnt�acts for Such projects wilh a con- tractor(st Iicense pursuant �to Ihe Contractor•s LI<ense Law1. 1 am aware tnat Exhaust System ❑ Multiple ❑ System Repair/Alt¢retion BUILDING PERMIT $ SMIP , $ oroo( of tneir Worker's Compensation inwrance snoultl be provlaetl to me. PLAN CHECK � $. PERMIT ❑ 1 am ezempt under 5ection B. d P. C. for tnls reason Firepl/FacL Blt. IC80 9�' Fire Dampers ' PLUMBING $ ISSUANCE $ Date owner � Heating System & Oucting , Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certily thaD�l have reatl thi pplica' n antl stata tnat tha above ❑0.100,OOOBTU 0100,000BT . � inbrmation is c ecL I ree co y with I Uly antl county ortlinancos ELECTRICAL $ GRADING $ antl sta[e laws ating uil in9 SVuct antl hmeby au[hoNie rep�¢- � � MICR�FILM � sentativas oi cit er th above•men0onetl Oro rry 1 r � , PLAN CHECK 50% $� $ ins0ectlon p p . MECHANICAL, S $ 4.00 SlgnaWre Dato/U >%� J . � TOTALFEE $ Drivers' Lic nse or 55'� Reinspeetion Fee b15 Isua Fee $ 3 PLAN CHECK 25% $ CMF 0865-46, rev. 30/84 White - Builtling: Canary - Applicant: Pink - Atcountin9; Goltlenrotl • Assessor - � CONSTRUCTION AND PLANNING P� � 8�A � APPROVALS Permit# � Date Inspector AppROVALS Permit# Date Inspector 1;. Temporary Electrical Service or Pole 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms ^, 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbin9 & Pressure Test ,_ 6. Electrical UFER Grnd.. 57. APPROVAL TO COVER-GUNITE -7. Footings . � ' 58. Electrical Condui[-Undrgrnd. �.'� � n 8. Foundation • 59. Gas Pipe, � 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 nduit ' 66. Solar System-Final 16. Rough Electric Wiri 67. Fencing & Access Approval _ . ing ign 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 Struc[ure 70. Underground Hydro 22. Ducts, Ventilating 71 . Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing . 74. Overhead Hydro r 26. T-Bar Ceifing (Structural) & Monocoat f? �, 75. Dry Chemical � 27. Frameand Flashing )� o�lfi Dr;y Standpipe 26.-Lathing & Siding j / 77. FIXED tiS'YSTEM FINAL � 29. Insulation - 78. FIRE PREV. FINAL � 30. Drywali Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION - - Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �L Notes: � . eating & 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 pomesticFinal � 42. Backflow Preventer ' 43. Backflow Irrigation 44, tandscape Irrigation System 45. Sound Attenuation . 46. Handicap Regulations 47. FINALSTRUCTURE & BUILDING ' 48. Special Requirements Completed ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cn - 51. CERTIFICATE OF OCCUPANCY No Date o , - � Avvl7caN to fill in a1l soaces excapt tnosa witnin neavy eoraer Iinos ana sign a11 appropriate tlecHratioas. PERMIT N TRACT NO. LOT NO. UNIT NO. 3oEG T' CITY OF COSTA MES�Al� CONSTRUCTION PERMIT 5451 8/02/84 ProjectAddreis L2'� � �T�S�� ApplicanYs Mailing Addr¢� ��i):j� �< %%1� �D�.�N tf TYPE OF C�NSTRUCTION _ NEW AOD ALTERATION REPAIR �N��EIZ I� PhOne � CONVERSION ❑ DEMOLISH ❑ OTHER q p# Za�O OWner's Name DESCRIPTION OF WORKIUSE OF BLDG. —� �� Atldreu �•O ��k �a� � � S Main Building: - Accessory Building: E 2 �:�Ch/Eng. LiCen52 N0. TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL T F�ont � Atldress � ❑ TENANT � ELECTRICAL ❑ �LUMBI�vG ❑ MECHANICAL A Rear N f� .C.��/ ❑ �OTHER Contractar's Nam P ne . C Right N �� PROJECT DESCRIPTION Sa.FT. OCCUPANCV Atldresslmailingl �SD �� ' �0�' `�}_lCL"`•J � K Left ' C' �CONSTRUCTION TVPE VALUATION $ $ City LiCenie No. �� ZONE GRADING CU. VDS. ACRE� R LICENSED CONTRACTOR DECLARATION . � Ping. Ref, #` Perking Req./P�ovided E � I hereby aHi�m [hat 1 dm Iiceniatl untle� prOvI510n5 Ot Chartt/ 9(comTendn9 Remarks: .��(jD �j�� jz�E� �(��. � V.i � 1�} `��f}�� Planning Notes: � I with section 7000) of Division 3 01 tho Buslnass antl Professions Cotle, antl �iJ'� ��f � ` my II<ense is in tull torce antl c toct. �4 os- Q G ��/� �l�V rryM �j� {3. �i�kl.i6�.. FD�G. �`✓V �Vi�{1.�iE �1 T License Cla � l/�� licen e N 5�� I Date_�A��1 5' t / � PLUMBING FEES _ �MORKERS' COMPENSATION DECLAR/+TION Bal Sink ShOwers ELECiRICAL ^ �� i hereby afiirm tnat i have a certl�icate of consent to seif-insure or a certlficate FEES oi Worke�s' Compansation Insu�anca, o� a� Certifietl COpY Iher¢of (Section BdCk(IOw Preventer S¢NiCC $ink -��/ r�,/ Automatic Washer Transformer ❑ 15�50 KW - , 3900. Lab.W)SN'D�7� /_/�1i� �P IcyNo. Company �i�C Backflowlrrigation � SewerCzp ConstructionPoleSub. �50+KW Certitietl copy ii h¢reby tumisnetl. . Certuie copy �s fUetl witn tne tlty BuilCin iv � Bathtubs Sewer Connection Cooking Unit Meter �up to 100 amp4 � Date ' ApO��<ant � �A `' EXEMG 1 NFROMWORKERS'COMPENSATIONDECLARATION _ C18rifiCfS $olarCollecto�5 � Di5hW2ShCf Meter ❑over100amp5 (7hi55eclion nee0 not be comple[atl it the 08rmit is for One buntlrBtl (5300) o� - less)�. � Dishwasher - Solar Piping Dryers ❑Gas ❑Electric Sub Panel � certity tnal in Ihe perto�mancn ol th¢ wo�k f0� wM1ich 1h15 pe�m�t Is ISsuetl, I - � z�alt not employ any person in any manner so as to bacome subJect to the Drinking Fountains Solar Tank Fan � Motors �61 HP � i'/a - 8 Workers' COTOenShcion Laws of CaIlPornia. . �ate Si9naturc Floor Drains Swimming Pool w/Spa F.A,U. NOTICE: It, aiter making t�is tloclaration, you ShoWC bacOme sub)ecl to the Ina Solar �y�15 HP �16�15+ �WOrkeIS' Colnp¢nSaUon p�ovlsions of Ihe LabOr Cotle, y0u must /Orttlwith FI001 $inkS U�indl FiX[UfCS � - <6mply with Such 0/ovlsions or this pormlt shall De tleemetl �evoketl. MiC�Owdv¢ CONSTRUCTION LENDING AGENCV .�CiyS$¢�,iC¢ Out12t5 WetCfC105Et Deviceeaxes � M1ereby aHlrm that thore is a<ons[ruclion IanUing agency for lhe perlormance �y POIe Light of tho work tor wnich [his Dormil iz issuetl (Sectlon 309] qv. C.) , fnLe�CEpt .Watef Heater I OuUCLS " Renge ' Lenaer's Name �entler4 AGaress ' _ Khtchen Sink ^' . Wster Service Switches Sign bWNER BUILDER DECLARATION� 1 hereby a1(irm tM1al I am exempt trom t�o Contractor's Licanze Law tor the �2vatorie5 Garba 2 Di o5dl followin9 reamn (Sectlan ]031.5 Business antl Professional Cotle: Any city or 9 W Standing SectiOns Counry which r¢qulres a permit to Construct, alter, ITprovn, Uemollin or repair p-Trdp dny structure, prior ta its isivance, also r¢quires the apPlican[ tor such permit Generetor �0.5 KW �5-15 KW Trash Compacto� . i t0 file a Slgnetl 5[alemept Iha[ he/she is Ilcensetl pulsudnt to th¢ PlovlSions of ROOi Dl8105 the Contractor's License Law (Chapter 9(commencmq wit� Section 7000) of 1 Division 3 Of Ihe Busin¢55 antl Profe55ion5 COtle) or that he/zhe iz exemPt Itperefrom an0 ihe basii for lhe alle9ea exemption. Any violation ot Section / 7031.5 by any applicanl for a permi[ subjects the applicant to a civil � �e�dlty o7 n0[ more than tive huntl�etl tlollaR (5500). �'� U I, as owner of the property or_ my emPloyees with wa9es as [�eir sole Rainxpec[ion Fee $15 ISSu9 Fee $ 3 Compensa[ion, will tlo ltte work, antl Ne stru<ture is not Intentictl or offeretl ' Reinspection F0e $15 Iuue Fee �or sal¢ (Section 7044, Business ana Protesslonal Cotle: The Contractor's � MECHANICAL ' FEES $ 3 l.icense Law tloes not appry to an owner Of a proPerty who builtls or impwves - thereon, antl wno tloes sucn work nimselt/herseli or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: • ¢mpl0y eei, pravltletl thd[ such Improvementi a�e noI In[tn0etl o� o1le�etl fOr BOiI¢� HOOd 01 Typ¢ I ❑ Eale. If, however, [he builtling cr improvement Is soltl wlthin one year of com- CanOpy Typ¢ II ❑ Zoning Approved By Date bletion, Ino owne� will have the burtlen of provin9 he/she tlia not builtl or im- Duct - Under Ground _ guilding Approved By DdtB �rove �or lhe purpo50 01 sale). p�,�/l.., T,i I, as owner oi lha property, am excluslvnly contractlng with Ilcensntl con- Duct - Structural Refrig¢ra[ion System Application luued By [ � �+.� Datfl�(� tractors to cOnstruct t�e projnct (Suc[ion 7064, Business antl P'ofes5ions Cotla: 7he Contractor's License L.aw tlons not apply to an owner ot oroparty who Duct � Ventilaiing �a100,0008TU ❑10p,0008TU . bullas or Improves thereon, ana who �contrncts for such projects wi[h a con- SUMMARV OF FEES [ractwpl Iicanse pursuant'ro lhe ConVaclor's License Law). I am aware tnat Exhaust System ❑ Multiple ❑ System Repair/AI[eration BUILDING PERMIT $ SMIP $ proof of their Worker's Componsatlon insurance shoultl De provitletl to me. PLAN CHECK $ PERMIT ❑ I am ezempt untlor Section B. d P. C. �or thls reason Firepl/Fatt. BIt. ICBO # PLUMBING $ ISSUANCE $ bate Owner Heating System & Ducting ENERGY P.C. $ - PLAN CHECK 25% $ I hereby cer[ify that I have reatl this application antl sta[e Inat tho above ❑0�100,OOOBTU �100,000BT ?�.�p� GRADING $ Informat(on is corruc agrao to comply with all clty antl county ortlinances ELECTRICAL $ entl stato laws rela g builtling constructlon, anC horeby authorlxa repre- MICROFILM $ Sentatives o� Ihi dtY o entar upon the above-mentlonetl propppttty tor PLAN CHECK 50% $ 7� �nspettlon ourpo s. � ( _�/ • J�� MECHANICAL $ TOTAL FEE $ 3, �U Signature �-'� bate Reinspection Fee $15 Issue Fea S 3 PLAN CHECK 25% $ Drivers' License or $ � CMF OBfi5-46, rev. 4/84 White - Builtlinq; Canary - ApPlicant: P��k - Accounting; Goldenrotl - Assessor i ... . . �� f. CONSTRUCTION AND PLANNING . POOL & SPA ' Date Ins ector iAPPROVALS Permit # P APPROVALS Permit # Date Inspector 1. Temporary E�ectrical Service or Pote: - 52. Pool & Equipment Location � 2.' Soii Pipe-Unilrgrnd. ,•. 53. Steel Reinforcement 3. Electri�l Conduit Utility�Undrgrnd. 54. Forms 4.�Electri�l Conduit-Undrgmd. , 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electri�l UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation � . " 59. Gas Pipe, O Undrgrnd., Test 9. Water pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Properfiy Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap '. � 63. Heater & Vent-Final 13. Roof Drains , . � 64. Plumbing System - Final 14. Rough plumbing , 65. Electrical-Final 15. Rough Electrical-Conduit . � 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign � � 68. APPROVED FOR PLASTERING . 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � . APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating , 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test ' �, � 72. Underground Flush 24. Roof Framing �, - 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing , . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing . . 76. Dry Standpipe � 28. Lathing & Siding � - 77. FIXED SYSTEM FINAL 29. Insulation _ r �� ;78. FIRE PREV. FINAL � r. 30. Drywall Nailing . ' � HEALTH DEPT. REQUIREMENT �:� 31. Plaster grown Coat j r{:� 79. FINAL I� SPECTION 32. e eter-Final , �' / . F000 CERTIFICATE ISSUED , 33. final Electric �� fr ( No s: . eating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy . - 37. Final Factory Fireplace . , 38. Final Plumbing ' 39. Water $ervice�Final � . 40. Gas Service-Final ' 41. Solar pomestic-Final 42. Backflow preventer 43. Backflow Irrigation _ . � 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations . 47. FINA�STRUCTURE&BUILDING � _ � 48. Specia! Requirements Completed . 49. Electric Release to Edison � 50. Gas Release to Southern�California Gas Co ' � 51. CERTIFICATEOF,OCCUPANCY . . _ � No, � Date ' '