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Home My WebLink About400 17TH ST - Building Permits� CITY OF Development Services, CERTIFICA7 ,,,- �ii>� This certificate is issued pursuant to the requ�remer /� ,.� \ �J of Costa Mesa cerNfies that at the Hme of �ts �ssuance approvedforoccupancyasfollows:�� '� %% r � �%9 /r BuildingAddress' 400 E.rU7th�SGreet ld't� //i%�' �r Use Service Station��%%�!,1 <r-�� ,ir �- i i� f� ti} Group B�S3 TypeofConstruction'nT , �,,,, � = Owner of Building Sharon�Ir, `St�einmetz�c , �� — / OSTA MESA � �ision of Building and Safet� l �F..00CUPANCY . �_. �� u � �•;q ��:�� the Uniform"Building Code, Section 308 adopted by the City �� ,vi �,A vildings[ructure6erein below described was inspected and � 109 Fernwood Dr;. Warner Robina, GA '3T Address �..� � �� > BUILDING OFFICIAL-R1CIC \� � Jµ4 n� .. ...t_. r, p lr+ \\ ,=t-H;+J �^, � � � ' ,. :�BI�'OW11�LC^B O.� �� >ti� - ."; � � � �, , __ _ �,� ��,c -- -,.� � .1L�s:,,;�� REQUIRED TO BE � Number 800-00308 -,.�: �°� .�' � � ��' Use Zone . � t .� i "EZ �LUBE INC" . PLACE � 7 COUNTY OF ORANGE . B[JI[.DIIVG DEPT. � 636 No. Broadway Santa Ana, Caliiomia Phone: KI 2b211 Application For Building Permit AND FOR A Certificate of Use and Occupancy Permit Iv'dT..Gl..�j..�.�---'�....'.- Date�.C..v.%-.I__...��'�.....�.1..�.. �� OWNER'S NAME..�- ��l.I.�.�'D��.0 .. .............. .................--........... /PH�ONE:}�.r.Z.�Y-O?4S._�P.�d MAILINGADDRESS..-l�FQQ- .�a_�../...�-.rN/...'- - - ..._.. --...- - CITYC:�..��,"'�'� � Name - - ��}E�` - .. .. - - - ._......__......... Namc ......- �'�%�! �!L�/ Y . ..... - - --._.. //' (Archi�cejct or Eng� er (Con[ractor) Address'T-Q.�--..�-.''---�.�� {�-'�-----'--- ---'.,......,�..----..... Ad�ress ...--------.... ... -- �----...._.........-----....-'--'-'-------........-' City t!''""-`_"""`._�'�"""'.."""'� .A State Lic. No.--- ..........- - - ...... Ph PROPOSED USE z. 70B `----.....II City _-----------...`-.....--- � / Q... ii State !_ U. L�c. Na.... -- ........ - - , _" .J. ."'"' " '"'_"".. ...""�"""_'"".......... 1� � Phone...... (House No.) (Name of Strect) , (Town or School Distric[) / " ;. LEGAL DESCRIPTION: Lot .............. ' --' --.... --- ....... . -- ' - - — ..--. Traa.. - - .......... - --........ (Metes and Bounds Description—Use reverae side of form) . 4. CORNEA LOT (`� ) INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OF LOT ( ) i. SIZE OF BLDG.�. ✓_-�1 -��'0-,---- REA:---..�-L��{�ZE OF LOT��...�C.L 5�....AREA:---....----.--- ............... G. HEIGHT OF BLDG.:_...��. __'...t�...'.,-.......CEILING HE]GHT:....�..,. .��.....,._.... NO. OF STORIES.......L._...._...__..... 7. NO. FAMILIES.........-_...--�_..-.-----.._----Size of Smallest Bedroom:----/I.l-X-.-ft►�-.-_ Size of Kitchen-___........--_ ................. R. EXTERIOR WALL CONSTRUCTION:...�7.%.`K�Y.lke�....1NTERIOR WALLCOVERING......P�1'.RQ�e ................:...: (Frame, Stucco, Etc.) ........./"""""...... , (Plaster-Dryuall, Em.) 9. SETBACKS: Fron[ Yard From Center Line of Sfreet........ .� ............................ ......----------------- �/ �. �/ /� � / Nearest Side Yard..T�..._...(l3.....Rear Yard...(�...(;L......._...Distance in Fcct 13etween 131dgs. on Same Lot......� ............................... l0. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AA'D USE OF EACH. 11. For (a) Footing: Width..........�...... ,, ...Depth in Ground---..,..I..-Y.--...WidthufWall...........-'---..._........ �-----'- ....._ Accessory Bldgs. and ,l Similar �b) Size of S[uds:.�_�.� ................Spacing-_...1..._�...._......."CC Material of Floor_ .. ...........__...--.-_.-----.. , Structures: (c) Size of Floor Joists:...._...........-'�- _--..-__----�. Spacing....---------`-......---------.--- � CC �p v'J ��..� �� /Y�s... .... pacing.. '- -...� ��CC (d) Size of Rafters:.....'-f...�l....Y. . d � ....................... . y ]?. VALUATION OF bPUSED �DORK: Induding all labor, plumbing, electrical•�wiring, heating, fire =_prinklers, painting and sewage disposa] $-��,.a;.�- ............. . /o 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AA}D BELIEF THE INFORMATION 1N THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTIOtd WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIF A APPLICABLE THERETO. .-.. - Plans Filed:........�.�..�7 � '�� '-'-----'-----.... Bldg. Permit Plan Check Total • - Receipt No. Paid to - Date _.......... 5 M—e-3� FOR DEPARTMENTAL USE ONLY � GROUP f,.�� ..................... � TYPE..._,� .......---.....__. DIST. G MAP.........--G.. .% .: ............. SHEET NO._..� ............... DATE... ..,/ �.. �.. �.._^....�_C �- � �r (Authorized Agcnt) CHECKING BY APPLICATION.�� I-IEALTH ............................ ZONING......._ �� FIRE ..--.. PLANS AND � �ARSHAL ......................... SPEC'S .......-- ..._.. -- STATE .............. - -- -........ CORRECTIONS ENGINEER � U �� INSPECTOR / - ....... . ...... - ............... �ePurv C� I" COUNTY OFORANGE BUII.DING DEPT. 636 No. B�oadway � Santa Aoa, Cali(ornia Phoae: KI 2-621 t f�pplication for Building Permit AND FOR A Certificate of Use and Occupancy Permi[ No.. UQ.y � � �� ]. OWNER'S NAME..�/../...�.....� _��.f.t....N...�?{v...f�- ......... ...............................:�.............C.. PHONE:....--...........-------��- � MAILINGADDRESS......(..�.�....�-`--..�._f-� ......... ........................ ................... C]TYCi...�J"2��'/w...P�S'rS�J Name......- ' ......................._ .............-'---.. (Archicec[ or Engincer) Address..............._...........................-- �- ....... Ciry Stace Lic. : Namc ..........��IVS-�'/1�l .......................................---- (Contracmr) l�1�(I�CSS ........"' ........................""""""..........._".........""""'_..........." City.................... Scatc Lic. No ................. PROPOSEDUSE:..-- .-( %�.`✓......�.D.��ii.� ........................... �- ......_............... .... .._. ......... ........ - �/.Q -..... --�� - --......._...._. ?. JOBLOCATION.--'7'DO __C�.........�..Z ��- ---�-- ....................... . - - -- - .......�r�! .... � (House h'o.) (Name o( Street) own or Sthool District) 3. LEGALDESCRIPTION: Lot .............. ...-.....................Blotk . - -� -- �- ................ Tract --. _ --...--.. (Metes and Bwnds Descrip[ion—Use rwerse side oi fo+m) 4. CORNER LOT (� INTERIOR LOT ( ) THROUGH LOT ( ) � SLOPE'OF LOT ( ) .....- � AREA:._.� �Q ........ .....SIZE OF LOT:--. ........ X � -- - - i. SIZE OF BLDG.:.%.o�.%� �2'... . . . �� /iJ�........��...AREA:...---...- ..._.... G. HEIGHT OF BLDG.:..(..� ..........................CEILING HEIGHT:.......�..................NO. OF STORIES.........�.....____....__ 7. NO. FAMILIES ........................................Size of Smallest Sedroom:....... Size of S. EXTERIOR WALL CONSTRUCTION :.....:......................................INTERIOR WALL COVERING.............._............................. (Frame, Swcco, Ett.) ' � / / /� �� (PlasrerDryuall, Etc.) 9. SETBACKS: Front Yard From Center Line of Street.._......�/.-.�,.........(� ................................................................................ ' N /� Nearest Sidc Yard.� ..... ..........Rear Yard....�.(,1........Distance in Fcet I3etween Bldgs. on Samc Lot....-.--- .........................--'__- 10. A COMPLETE PLOT PLAN IS REQUIRE�D�.IjOWING ALL STRUCTU1tES AND USE OF EACH. FS � � rrbo,i� 11. For �� —' (x) Footing: Width.....iF.�i.�.'_..�...r.�...L�..Depth in Ground.....� .............._....Widch of Wall.....----------....---......... Accessory � Bldgs. and ........5 acin e- ' Similar �b) Size of Studs:._.�...�---.-. P g...�.......Q............'CC Material of Floor ............._.............................--- Struaures: �� 1? 1 i. (c) Size of Floor Joists :..............c�.-.............Spacing..---.---.._............_.............:'CC ' U U (d) Size of Rafters:__... .� ..................Spating......�........./................::'CC VALUATIOl\' ��OPOSED V�ORK: Induding all ]abor, pinmbing, ciccvical wiring, hcacing, fire sprinklers, painting and sewage disposal .. -$9r--.¢%'�� ............... I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INF,ORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CA3jEQRNIA APPLICABLE THERETO. PlansFiled :................__.....__._...................---' ......................By:�...........--�--...--'----......-----.....-- -------.....--"----`--"---`-----"--------�----..- _ � (Authorized Agent) FOR DEPARTMENTAL USE ONLY Bldg. Permit Plan Check Total - � Receipt No. Paid to • Date ........... 5 M-8�.1 FEES: OU - s....3.. .......... ._z.�........ - s...� oo ....._--� �-- GROUP.....� .... . TYPE--�---- --.... . . . ............. . DIST. Ntnr.....G...... C.._�.--..... SHEET NO..... j .................. APPLICATI ON.� ZONIN G .................�..�_... PLANS AND ��r SPEC'5.------� --- ............. CORRECTIONS V ERI FIED ........................ i:)9 HEALTH... ----� -� --- .._--- FIRE MARSHAL......- � -------..... STATE......... ENGINEER � i � ,. s-a-. DATE....... .... �" ....... .......................... C w' � COUN'I'Y OF ORANGE BUII.DING DEPT. 636 No. Broadway \ Santa Am, CaGfomia Phone: KI 2-6211 r Building Permit D fOR A Certificate of Use and C,�tcupancy Permit No�_.�.,�_�- �.-� Da�e_;.2 .�.1.�-.a � ..----� y-r1... OWNER'S NAME.i_C�. i��N17./1.D...1 �\ .l.T.A�L°Q.!�`.` .................................. �---......... PHON��P�� MAILING ADDRESS..-- ..�..0.._ -�+--...�.Z....�.�... -- ......... - .............. -- .... L� ......... CI'C ........... ..--�-- - ---. ......J„-----_.. . _ .� Namc ... Address City ---_ State Lic. No. (Architect or Enginccr) Statc Lic. ] PROPOSED USE:.._/..`_"''.<<.L.-._�tiG"ft4�--�'„'f��ri.� v-v- ---�--- .....---......... ........... . .....-........ ._._.. __...... -....---- � ----'------ - JOBLOCATION....'?`_�_�....�.-.. .l._7�...... ..........--�-�- - - .... - -��K�Q/ ............................. (House No.) ame ( rce:) . (Town or Sc 1 District) � . LEGAL DESCRIPTION: Lot.... - .............._ �Q.�ocl:�l�i..(��_�_�r��.�.....�h. .o Tract --- ---............._....__......... (Mr,es and Bounds Dcscnption—Use re�•crse aidc o( form '�- CORNER LOT (x INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OF LOT ( ) SIZE OF BLDG.:Iv�.X...aC.D....---..AREA:_..2 �0_��--SIZE OF LOT:lzcs�. �SD-----.AREA:..---__ ................_.----.. HEIGHT OF BLDG.:._ ..........................._-..--_-_CEILING HEIGHT:.....-�------I--....-------.NO. OF STORIES----..--_/..---_-_----.... 7. NO. FAMILIES ..............._.........--.------_...Sizc of Smallest Bedroom:_...........----.._-..........---.----- Size of Kitchen....-.-.----...--.-.-- r�-........ 8. EXTERIOR \VALL CONSTRUCTION .� .�1L'.lil�L[e,,....----.---..INTERIOR WALL COVERIN�Nt��..-��%��%......�.. (Prame, Stucco, Etc.) T D (PlastcrvDrywall, E[c.) � 9. SETBACKS: Front Yard From Center Line of Strect.._....d .. . � � .... ..........---.................._--� -- .........- ----- �-� ------ -............� .. - Nearest Side Yard.....��.7__..._.....Rear Yard.Q:��.��9is n�c� Fe t Between Bldgs. on Same Lot ...... .. .............._�0... ]0. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STAUCTURES AND USE OF EACH. �/ �r/ o� 1 I. For (a) Footine: Width.----....../ ... ....................Depth in Ground----.....�.................Width of Wall-----........�......./--.. Acccssory Eldgs. and b Si:e of Studs:.... 7.... � Similar � ) !� .............Spaang..-----_-----.......---��CC Material of Floor_. .... . - - - - ----........ Structures: • (c) Size of Floo� Joiscs: .,� (d) Si}eofRafters:._a...�_� .............- .........Spacing.....-------.......----� --...:---...:'CC 12. VALUATION OF�i!'ROPOSED WORK: Induding all labor, plumbing, electrical wiring, heating, fire sprinklers, pain[ing and 0 sewage disposal 5��. ..OiJO.•..-----_ ................. 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS .CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE ZHERETO. Plans Filed:....._...._... �-- --_r�... U.�.. '�~. ..� (�wner) (Authorized Agent} FOR DEPARTMENTAL USE ONLY FEES: CHECKING BY � i �� GROUP._.........�.. APPLICAT . _.. .. HEALTH ................... � Eldg. Pcrmit • S .......... ..._/ . .r-'r... --� Plan Check • S.. •--......./.-i..U� TYPE....._......-:-�..'...... - ZONING.... FIRE Total . . . $............5!.O:c�.. DIST. �� ............ MARSHAL .................. ..._ • MAP ....................... . . PLANS AND Receipt No. ' -----��.�'-ll... SPEC'S....- ------ � - STATE ..................._--........ Paid to • - .._........-�'..2.✓.�.Jf..d�� SHEETNO......._�......... CORR TIO ENGINEER ` .�_._ 'l �7U�-c�/ .,.,,,.,.,... � ,.... DATE......... �...�... �.. G../....�/... 9M-2�Si ` (714) 754-5273 • Fa,c (�i a) �sa-aess • www.ci.costa-mesa.ca.us 77 FAIF [7HNE, GOS f A MtSA, GA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 400 E 17TH ST 11732134 npp�icant: TNT NEON SIGN COMPANY Address: 1436 CHERRY AVE , . - . LONG BEACH, CA , /� / Owner.' 'STEINMETZ, SHARON.L Address 109 FERNWOOD DR WARNER ROBINS, GA � Contracror: ; TNT NEON SIGN COMPANY Address: � 1436 CHERRY AVE - CONG BEACH, CA ' Phone: (562)434-6366 Zip: 90813 Phone: Zip: 31088 �: �- Phone: (562)434-6366 Zip: 90813 � - License: 629097 Staws: ISSUED Applied: 03/19/2001 Issued: 03/192001 ISSUED BY: ��--� � A � ' � ' �• � SCOPE OF PERMIT -: �- ;; � � � '�' �� • � � �REF 5800.00118. EZ LUBE 7 ILLUMINATED WALL SIGNSr .l, � J. ,. �� '.;7� ` � � � � if . , _ ' - �� i � { �� - ' � :,:� �_� ��FEESUMMARY �.. �i� .' . '%� �_J �",�1� �. � Quantiry � - - -;� r ' ' Quantity ��Jj - ) r��' I ISSUE FEE� , '. $23.50 �� Temp Dist System / Lighting $0.00 0 %-' � � -' �pi �� Ter,rip service"test �� E0.00 Busway./100 ft�% ,$0.00 0/'/�� '�=� 7�(, 1 Res: a/c package 80.00 - Standing Section � $0.00 0_!��! � ' i�� New Res'(1-2 umts) � $0.00 0 Misc ElectricafEquipment $0.00 ,0�/ � �� /�" � New Res�(3+units) -'� � $0.00 � 0 ; Transformers up to 1 kva/kw $0.00 �0�� /" c�� 7� �;, Pool / Spa, `, � / �� - , $0.00 0 � .. . up to 10 kva/kw $0.00 =� 0� \ � � �`/ Lighhng F,izts� ' $0.00 0 � t � . . .......:.....:::up to 50 kva/kw $0.00 �i; j0 ��' �'i ReceptOutlets�� $0.00 0 � , � � ... .uptot00kva/kw $000%�i 0 ��', �� Switches �,� , ` $0.00 � . 0 �-,�- - . over 100 kva/kw ,�'.`� � $0 00� 0 � � , �� NonResAppl�`�. ,$0.00�� -0�"� �- � Low�VoltageEqwpment� �� $0�00� �0 � �� Res Appl �� $0.00 �� V 0 � ��; Lov+ Volt Wlring System l Ckt.� �$0 00 C/� �0,��/ Service to 200a � ��V �� $0.00,��0A '' � Misa�Conduit ' ° � � �$0.00' ��0� � Service to t000a �� $0.00�� '0� � ��_ �� .Misc3ConduQor; -� �� $0.00 � �0 �i Service over 1000a � ��'�� $0.00 �, A 0 � , " � . Circas (�gen or ndey �$0:00 R\"_. Motorstolhp ��_$0:00 �� ; 0;-� Cir6us(mech�rideorlights) � �$0.00 Motors to 10hp ��$0.00 A� ��,' 0-- �� Christmas Tree Stand,�\ ��$0.00 Motors to 50hp �-$0.00� �:0 ,�, � � � . .'Fireworks Stand-�� ` � 1 $0.00 Motors ove��00hp 50.00�� -�0�� _ , - Other Electrical Fee..�%�J �� j�00 Communication drops $0.00 `- 0- �--, ;- InveSligation.Fee��<�i ��-'�� 50.00 Sub panel to 200a $0.00 0 �'- � - � . ,-,PIan�Check Fee � . -- "� $0.00 PoleLightPkg $0.00 0 -'--- �--ReinspeclionFee $0.00 Sign Circuits $772.20 7 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES 5195.70 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS C NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (OM. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authonzed under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlona and (inal approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration.of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 240&48 (fi/00) WORKERS'COMPENSAnON DECLARAnON: ' � � I hereby aflirm under penfllry ot perjury one ol tha tollowing daUareOons: � ❑ I heve entl will mflintain a certilicate oi consent to selbinsura tor workers' rnmpensetion, es provided tor by section 3700 oi Ihe Labor Code, for the pertortnance ot the work for which ihis pertnit is Issuetl. �I have erW wlll maintain wwkers' compensatlon insurarxe, es requirad by sectlon 3700 of the Lebor Code, for the peAormance of Ihe work for which this pertnit is issuetl. My workers' compensatlon Insurenca cerder and pdicy number ere: Cenier. �'1�— T G ND Policy Num�er. �� i(�t�1 ,_. Qa ((his sectlon need not be completed i/ Me permif !s ve/ued ef one hundred doflars ($100) or less.) ❑ I certify that in the peAortnance oi Ihe work lor which Ihls partnit Is icsuod, I shell no� omploy eny peroon In eny menner so as to becoma subject to Ihe workers' compense on laws of Celifomla, end agrea t�at It I s�ould become sub�ect lo the workers' compensetion provislons of Section 3700 of the Wbor Cotle, I shall tort�with co wit pr I . � App N nBiure: , , Q / W NIN : FAIL SECURE WORI(EPS' COMPENSATON COVERAGE IS UNLAWFUL AND SNr1LL SUBJECT OYER TO CRIMIN PENALTIES AND CIVIL FlNES UP TOONE HUNDRED LLARE (5100.000), INl�DORION TO THE CQSi OF COMPENSATION, DAMAGES AS PROVIDED FO N SECTION 3108 OF BOq CODE, INTEREST, AND ATTORNEI"5 FEES. Hirtn that I am Ilcensed �lnder provisions ol C�apter 9(commencing with Section ) ol ettect. Lic. a �.Q�-�Q'S'7 Class q Dete: Coda, antl my license is In tull CON9�tlCilON LENDING AGENCV: ❑ I �ereDy eNirtn that Ihere is e construqion Ientlinp epency br Ihe pedarmence of the work tor which this pormit is issuetl. (Sec. 3097, Civil Code). Lendefs Neme: Lenders Atltlress: SlgnaNra: Da�9: OWNER-BUILDER DECLARATIONS: ' I hereby eHirm that under penalry of per�ury thal I em EXEMPf FiiOM THE CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Cotle: My ciry or wunry which requires a permit to construd, alter, imprwe, demdish, or repeir flny strucW re, pnor to its issuance, also requires the appiiwnt tor such pertnit [o file a signetl statement thet he or she is Ilcensed pursuent to the proNsions ol Ihe Contrectors LJcense Lew (Chepter 8(commencing with SecUan 7000) of DWisirn 3 of Ne Business antl Professions Cotle) or t�at he or she is exempt theretrom anE Ihe besis tor the elloged ezemption. Any violatian of SecUon 7031.5 by any applicaN tor a pertnit subjecis the applicant to e civil penalry of not more than Me huntlrea tlollers ($500).): ❑ I, as owner oi the properry, or my employaes wlih weges es their sole compensetion, WILL DO 7ME WORK, and the structure is not intended or oHered for sale (Sec. 7044, Business and Professions Code: The ContreMors LicenSe Law tloes not eppty to en owner ot properry who builds or improves ihereon, anC who does such work hlmself or herselt or through �is or her own employees, proviOeC Ihai such improvements ere not Intended or ottereC for sale. If, however, the building or imprwement is soltl within ona year of completion, the owneo-builder will heve lhe burtlen ot proving ihat he or she did not build or impmve tor purpose ot sale.). ❑ I, es owner ot the pmperty, am EXCLUSIVELV CONTRACTINC WITH LICENSED CONTRACTORS fo construct t�e Orol�� (Sac. 70d4, Business antl Pmfeuions COUe: 7ne wntwctors License Lew does not appty ro an owner oi proDeny who builds or Improves t�ereon, and who contrects lor suU project with a contractor(s) litense Oursuanl lo lhe Conlre[tor5 License Lews.). ❑ I em exempl untler sec. Business entl Pmtessions Coda tor this reeson: SignaNre: Date: Owner ID verlfied by drivers Iicense. ❑ Ves ❑ No Drivels LJcensa No. Expires: Venfication ot Ownership by (rype of tlaument, i.e. - property taa bill ar deed): OIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I herehy cetlily thet no excaveGon IHe (5) or more teet in Oepth Into which a person is requiretl to descentl, will ba mede in wnnectlon with work authorized by this pertnit, end Ihat no building structura, scattolding, lalsework, or tlemolilion or dismantling t�ereof, will be more lhen thirry-six (36) teet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Ttle 8, Celifomla Adminlsiretive Code). ❑ As owner-builder, I will not employ enyone to do work whlch would require a permil irom Ne Divislon ot Industnal Safety, es noted above, unless such person hes a permit to do such work trom ihe diWsion. Siqneture: Date: Division ot Indusinel Safely Pormit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATONOF ENTRY: I certity under penelry oi perjury thal I have read this epplication and state thet ihe information given is rqrtecL I egree Io wmply with ell stete laws end ciry ordinences reletinp to builGing wnsiruction, and authodze representa�ives of t�e Cily ol Cwta Mesa to enter upon Ihe ebove-descnbed D�operty for InsDection Ourposes. I egree not to acupy or allow occupency ot eny building authonzed by I�is Oermit until final inspection. COOE 1. INSPECiIONTYPE 1816 FIxeO System Final Fire Preventlon 1268 Pool Spa Finel 200 Final Re-Root 201 Finel BIacWRelaining Well 202 203 204 Finel Fectory Fire Place Final Slgn Final Demdition �' It� SODE� MSPECTIONTVFE 206 Finel Mechanical 20B Finel Plumbinp 210 Flnal Electdcal 212 Flnal Fire Prevantlon 220 Flnal Planning Apprwal 222 Final Site 250 Final BuiltlingiOccupanry (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF �RIVE, GOSTA MESA, C:A 92626 BUILDING PERMIT � ��N. , ��w��o. . ucense: � � � / � � l � i Job Address: 400 E 17TH ST Suite: Vicinity: Parcel Number: 11732134 Zoning: StaWs: ISSUED Applied: 03I10I2000 ISSued: 02/02/2001 Applicane SMITH, CHAD (E Z LUBE, INC.) , ISSUED Bv: �� Address: 3506 W. LAKE CENTER DR.#B "' , � �� ,�-� - �� SCOPE OF PERMIT , �� 1 JCT NEW 2866 S�: FT: SERVICE�SITE FOR "EZ CUBE INC;' INCLUDING'BASEMENT. � � A� _ j I�� j �! � -- f ^ FEE SUMMARY , '� � PIan�Check:�', $875.26 � _ � " �� _ � i� � � ; � _ � � � Calc Valuation: � � � � � �'�� ; i ' $162,84310 � � ` Permit:� $1,346.55 � ' � _ �� = ClaimValuation: ��- ' _%bo�oo' ��`�SMIPCom:, � $3420 � '//,/'/ i, ' -. �, / / ��;�, Other;� �.$0.00 _ /��, � ��'�� 'Inspecfion:/ �'�$0.00 - ,/�� / \ \\Total: $2,25B:07 �%%/�/ ' /�, � �� `, ' . �%�� `'� �� .v, � ACCESSORY PARKING NOTES: � � \\� ` PLANNING & ZONING �" � � " � ' � �i� �� \ �� > � �� i � � �iV ��V�. . - � n ' 1__. /�� j � � Eront��43-0 �� Rear -76 Bc� � �Lefl � 15-�0„- � Right � 0.�0�/ � \1\ \;�ii �-. .- _ _:--, � \i � � �-�- " � ''�\ -. --- � �\ �j✓ /,� FronC'�0-0 �/ Rear'�-0-0 LeR 0-0 }� i Right ��'0-0�^'� - .�� / C,i � _— • 1 // �`=� � �� /r-_�,�_ ' � i��^, j i (1 `-}, �J �.�%% Existinc �0��,ARequired: 6 � Pr000sed:. `�B,'�- �/� � . — �:- � � �, . � � , ;i / -- , . �.-iii'� _ .. NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regula�lOnS. (Ord. N0. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become vaid if work Is not commenced wilhin 1 BO tlays,�or.tl/ is suspended or abandoned for a period of 180 tlays. U INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable cotles, and all required Inapectlona end final approval must be obtained. Fallure to obtein inspections end final approval will result in the expirationof ihis permit. FOR INSPECTIONS CALL: (774) 7545626 204&68 (fl�W � WORKERS' COMPENSATION DECLARATION: I hereby eHirtn untler Denelry ol perjury ona ol the tollowing tledaretions: ❑ I heve end wlll maintain e certilicate of mnsent to selbinsure for workers' wmpensatlon, es proNded lor by sedion 3700 0l tha Lebor Catle, tor the pertortnence ot the ��/// work for which Ihis pertnit is Issued. �I heve end will alntain workers' oompensatlon' urance, as requireA Dy sectlon 37 of the LaDor CoOe, for the perfortnance oi the work tor which this pertnit is isSueC. My worke m ns 9n Insurence cerrier e olicy-awnber are: ,�� D/ D�_ � Cerdor. � U ��t� . � Pollty Number: (Th/s secuon not be complet i! t�e pemuNs velued e! one huntlretl dWlars ($100) or Iess.) ❑ I certify that in the peAortnence ol t ork for which Ihis permil is Issued, I s�all not employ any person In eny manner so es to became sub�ect to the workers' compensation laws of Calilomie agree thet II I should become sub�ect to Ihe workars' compensefion provislons oi Sectlon 3700 o/fjhe Lebor Code, I shall larthwlih h eha=e a�(` p � Q� / O A cant Slpne� e: �e: 1�l// � � W E TO SECURE WORKE ' COAIPENSA ON COVEMOE IS UNUwFUL AND SMALL SUBJECf rW E CRIMI�NAL PENALTIES M1D GVIL FlNES UP TOONE HUNDRED hKK1SM1D OOILARE (5100,9W), IN ADDITION TO TNE OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3]OB OF THE UBOR CODE, INTEREST, AND ATiORNEYS FEES. Rlrm lhBi I Bm eHect. Llc. a _ 9(wmmencing with Sactlon 7000) of Dlvislon 3 of Ihe Business antl Prolessl�Cotla, end my license is in tull CONSTRUC710N LENDING AGENCY: ❑ I hereby aflirtn thel lhere is e construction lending egenq tor Ihe peAormanco ol ihe work lor which �his permll is IssueO. (Sec. 3097, Civil Cotle). LenOefs Neme: Signeture: _ OWNER-BUILDER DECLARATIONS: LentleYs AtlOross: Date: I hereby eXirtn that unAer penalry ol per�ury Ihet I em EXEMPT FROM THE CON7HACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu antl Professions Code: Any ciry or counry which requlres e permil to consWct, elter, Improve, demdish, or repair flny structure, pnor to its issuance, elso requires the applicant tor such pertnit to fila e signed stetement that he or she Ls Iicensed pursuant ta Ihe praNsions oi the CoNrectors Llcense Lew (Chapter 9(cammencing with Section 7000) oi Division 3 of tha Businesg flnG Protessbns Cotle) or Ihat he or she is exempt lherelrom enA the besis for the elleped ezemptlon. Any Wdation of Section 7031.5 by any appllcant far e pertnit suDjecls t�e eppllcam lo e cMl penalry ol not more than five �undred dollars (5500)J: ❑ I, es owner ol Ne properry, or my employees wlth wages es their sole compensatlan, WILL DO THE WOHK, enOlhe sirucNra Is not inientletl or oNeretl for sale (Sec. 7044, Business and Prolessions COAe: The Contrectws License Lew does not apply to an owner of property who builds or Improves thereon, antl who tloes such work himself ar hersetl or through his or her own employees, provided Ihet such imprwements are no� intentletl or oNered tor sala. If, however, the builtling or improvement is sold vrithin one year of completion, Ihe owner-builder will heva the burden of proving �hat he or she tlid not builtl or Imprwe lor purpose of sale.j. ❑ I, as owner oi the property, am EXCLUSIVELY LONTRACTNG WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business antl Prafeulons Catle: The cantractors License Lewtloes not epDN �o en owner of property who builds or improves Ihereon, antl who contraas lor such projed with a contrector(s) license pursuaN to ihe Contractors Litense Lews.�. ❑ I am exempt untler sec. Business end Professions Code lor this reeson: Signeture: Data: Owner ID verllled Dy tlrivers license. ❑ Ves 0 No Drivers Ucense No. Vedliwtlon ot Ownership 6y (rype ol document, i.e. - properry tac bill or deedj: Expires: DIVISION OF INOUSTRIAL SAFETY PERMR CERTFICATION: ❑ I hereby certity Ihat no ezcavation tNe (5) ar more fael In depih Into which e perwn is required to descend, wlll ba mede in connection wi�h work authorized by this permit, end that no 6uilding struMure, scafloltling, falsework, or tlemolitbn or tlismantling thereol, will he more then thirty-six (38) feet high. (C�ap. 32, Grp 2, An 2, Sec. 34i, Title B, Calilomia Adminisiretive CoCa). ❑ As owner-bulltler, I wlll not employ enyona to do work which would require e pertnit Irom Ihe Divislon of Industrial Sefery, as noted ebove, unleu such person has e permit to do such work Irom the division. SlgnaNre: Date: Division of Intlusirial Selery Pertnil Number: CERTIFlCATE OF COMPl1ANCE AND AUTMORIZATION.OF EMRY: I cortity under penalry ot perjury thet I heve reatl this applicatlon and state Ihat tha Infortnation given is cortect. I egree �o comply with ell stele lews end city oNinences rela�ing 10 building conslruc�ion, end authodze representatives af Ihe City af Coste Mesa to enter upon the ebove�descnbed property lor inspaction purposes. I egree not to occupy or ellow acupancy of any bullding euthonzed by Ihis pertnit until Ilnel inspection. GOOE �. INSFECTIONTYPE ( PAIE' 1N�IELS 1678 Fixed System Finel Fira Prevention 1288 Paol SDe Finel 200 Finel Re�Root 201 FIneI BIocWRetelning Well 202 Final Fectory Fire Place � 203 Final Sign 204 Final Demolitlon � CO�E� INSPEC➢ONTYPE 206 Finel Mechanlcal 20B 210 212 220 222 250 Finel Plumbing Finel Electdcal Finel Fire Prevention Finel Planning Appravel Finol Slle Finel Bulltling/Occupency L � riilit.lF. (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 400 E 17TH ST Suite: Vicinity: REAR NORTH EAST CORNER Parcel Number: 11732134 App�iwnt: PICHE, CHRIS Address: Owner: STEINMETZ, SHARON L Address 709 FERNWOOD DR WARNER ROBINS, GA Contractor. TA CONSTRUCTION Address: 1717 W ORANGEWOOD #B ORANGE,CA Zip: 92868 Arch : Address: Zoning: Phone: 714-231-4366 Zip: Phone: 2ip: 31088 Phane: (714) 634-0400 � License: 704343 Eng: Address: Phone: Status: ISSUED Applied: OS116/2001 Issued: OSI76R001 �'L Phone: Zip: License: License: � . SCOPE OF PERMIT TRASH ENCLOSURE IN NORTH EAST REAR CORNER FOR EZ LUBE Iil. REF: B00-00308. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 FEE SUMMARY - - ' - -- � � Calc Valuation: • ' ' Claim Valuation: -:-•; : . r.:!, , . Total: $83.25 �� SETBACKS . � ` , i �'�� V� MAIN STRUCTURE Front � 0- 0 �.. Reai'�' 0- 0 ACCESSORY Front 0. 0�� /," , Rear 0- 0 PARKING Existinq: 0� Reauired: 0. NOTES: ANNING Left ,. i - i ,, .,>_ >, _ - 4� ZONING „ i' �� .\ �. - " ; i� �� . " � C% - ' � � - �0-0 �� Riglit. �,� � , Left 0- 0'. �. Right ' 0- 0., , _' . . �- ,/, Proposed: 0 i $3,000.00 $3,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or il work is suspended or abandoned for a pariod oi 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such woAc must comply with all applicable codes, and all requlred inspeetlone and final approval must be obtained. Failure [o obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaasae �eroo� WORKERS'COMPENSAnON DECLAAATON: � I hereby effirtn wCer penalry of perjury one of Ihe following declarations: ' ❑ I heve entl will malntain e cenifica�e of consent lo self-Insure for workers' compensetion, es provide0 for by section 3700 ot the Lebor Code, tor the peAortnence ot the work tor which �his permit is issued. ❑ I hava end will maintain workers�'ce �p �satlan Insura , a� required by sectlon 3700 oi Ne Letwr Cotle, for ihe pertortnanca oi the work tor whic � Nis pertntt is Lssuetl. My workere' crompensetion I S�ura L6 �er end p n er are: , Carrler: Policy Number:y (Tliis sectian need nof be comple(ed 1! (he permif Is ve e af are hundretl dollais ($100) or Iess.J ❑ I certity thet in t�e pertormance of e ork for 'c permit is Issued, I shell not employ eny person in any manner so es to become s b' ct to ihe workers' compensation laws of CaIM n grea 1� oulC become SuhJect to the workero' compensatlon provislons of Sectlon 3700 0l Ihe bor Code, I shall torthwlth compty with these provisi s. ApDllcent Signeture: Date: �� WARNINO: FAILURE TO SECURE WORKERS' �.1FF11SAT10N COVERAGE IS UNLAWFUL AND SIULL SUBIECT AN EMPLOVER TO CPoMINAL PENALTIES ANO CML FlNES UP TO ONE HUNORED hKK1SAN� DOUARE (51C0,000), iN ADDRId'�TOTIM1E COST OF COMPENSATION, DAMAGES AS PROVIDED FOP IN SECiION 3]W OF TiE LABOR CODE, IMER£5T, AND ATTORNEY'S FEES. LICENSED CONTAACTORS DECLARATION: I hereby aHirm that I am licensed under pr force anA ettect. Lic. M �Cont�ad'o?s SlgnaNra: (commencing wi�h Section 7000) ol Division 3 ot Ihe Business and Protessions CoOe, end my license is in full qass N �ate: � � CONSTRUCTION LENDING AGENCV: ❑ I heraby ettirtn that ihere is a cons�tiction lentling egency tor ihe peAormence of the work lor which Ihis permit is issuetl. (Sec. 3097, Civil Code). Lentlefs Nema: lenders Address: SigneWre: � Date: OWNER-BUILDER DECLARATIONS: I hereby etFlrm t�et under penalry ol perf ury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professlons Cotle: Any Gry or counry which requires a permit to construct, alter, improve, tlemolis�, or repair eny sirucNre, prior to Its issuance, also requires the appliwnt for such pemtit �o file e signed statement that he or she Is Ilcensetl Dursuant to the pmvislons of Ihe Camrectors IJcense Lew (Chapter 9(commencing with SecUon 7000) ot Division 3 ot Ihe Busineu entl Profeulons Code) or that he ocshe Is e:empt therefmm and the besis Por the ellegetl exemption. Any violation af Sectlon 70.31.5 by any appliwnt 1ar e permil subjects the epplicant to a civil penalry oi not more then five hundred dollars ($500).): ❑ I, es owner o� ihe property, or my amployees with weges es their sole compensa�ion, WILL DO THE WORK, antl the structure Is not Intendetl or oHered for sale (Sec, 7044, Business and Professions Code: The Contractors License law does not ap01y to an owner oi properry who builds or improves ihereon, antl who does such work himsell or hersell or through his or her own employeas, provided �hai such improvements ere not Intended or oHered for sele. If, howaver, the building or improvement is sold within one year of completion, ihe ownerbuilder will hava the burden of proving thet he or she did not build or improve for purpose ol sale.). ❑ I, as owner oi Ihe properry, am EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business anC Pmfesslons Cotle: The cantractors Licanse Lew tloes no� epP�Y �o an owner oi properry who builds or Impmves thereon, antl who contrects lor such projact wi�h a contrectoqs) license pursuant ta ihe Caniractor5 License Lews.). ❑ I em axempt under sec. Business end Professions Coda tor this reason: Signature: Date: Owner ID verifietl by drivefs license. ❑ Yes ❑ No Orivefs License No. Vedfication ol Ownership by (type ot document, i.e. - pmperry tax bill or daed): Ezpires: DIVISION OF INDUSTRIAL SAFETV PEAMIT CERTIFICATION: ❑ I hereby certity Ihe� no exwvetion Nve (5) or more feet in depih into which e person Is requiretl to descend, will be made in connection with work authorized by ihis permit, and Ihat no builtling structure, scaflolding, talsework, ar demolition or dismentling thereof, will be more ihan thirty-six (36) leet high. (C�ep. 32, Grp 2, Art 2, Sec. 341, Title B, California Atlminisiretive Code). ❑ As owner-builder, I will not employ enyone ro do work which would require e permi( Irom the Division of Indusinel Setery, as noted ebove, unless such person hes a permit to do such work from Ihe tlivision. Signeture: Date: Division ot Industrial Sefery Pertnit Number. CERTFlCATE OF COMPLIANCE AND A�ITMORVATON OF EMRY: I certify untler Denalry of perjury that 1 �ave read t�is epplication antl state that the informatlon given is corteCt. I agree to wmply with all state laws end Ury ordlnances relating to building conswction, and authorize representatives of che City ot Costa Mesa ro enter upon ihe ebove-descnbed D�aGerty for inspeclion purposes. I egree not to acupy or allow occupancy ol eny building authorized by this permil until final inspection. ner(s) ,�/ � _ , D�te , ,�//(O(rii Antl/Or Authorized�A�ftkant � Da COOE �. INSPECTION TYPE 1616 Fixed System Final Fire Preven�ion 1266 Pool Spa Finel 200 Finel RB-ROof 201 Flnal Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition . Q�jE (t�$ �Q}}�,( INSPECTIONTYPE 206 Finel Mechanicel 20B Finel Plumbing 210 Finel EletMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy o�TE It�eLS pT (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 400 E 17TH ST Suite: Vicinity Parcel Number: 11732134' 2oning: Applicank SCHOTT, GREG Address: . - , . - � " � - Status: ISSUED Applied: 06/25/2001 Issued: 08/13/2007 ISSUED BY: �_ � " i� � , . . Phone: 310-640.9093 - � �i � ' �/�� " . Zip: = ;' _ , ' ., . _ , . , ," � � _ Ownec STEINMETZ,�SHARON L � - , /' . � , ,� �� Addreas ,109 F,ERNWOOD DR �� - �� , , �� , ,. � - . _ Phone: , - � ' _ . , - WARNER ROBINS, GA Zip: 31088 '� � � . i � . � . Contrector: �WILEY EQUIIPMENT � AddresS: 726 ARENA'*�� ' \ - - � % Phone:.. 310-640-9093 � � ' ELSEGUNDO,CA - � ' � Zip: 90245, - License: 760002 � Arch : —� Eng: . Address: . , . Addressi � � . � �_ Phone: �- . . . , . . Phone: Zip: � � .- License: , � License: SCOPE OF PERMIT � INSTA4LATION OF 4 ABOVE GROUND TANKS FOR � -� � - ' � � � "EZ LUBE". TANKS ARE LOCATED IN A P17. REP: BOQ-00308 � � - -� - ,. FEE SUMMARY � '. Plan Check: $208.81 — Calc Valuation: $zo,000.00 � Permit: $32L25 � � � j � , " Claim Valuation: � $zo,000.00 SMIP ReS: $0.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 ' - Total: ,$530.06 , _ �'-: �, : SETBACKS MAINSTRUC7URE Fiont 0-0 Rear �0-0 ACCESSORY Front �0- 0 � Rear 0- 0 PARKING Existinq: 0 Reauired: 0 NOTES: ' PLANNING & ZONING Lek 0- 0 , Left . 0- 0 Proposed: 0 Right 0- 0 Right 0-0. �, NOTICE: The work authorized by this parmit 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 end 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon ot this permit. FOR INSPECTIONS CALL: (714) 754-5626 9tli6 (fl�pp) WORKERS'COMPENSATONDECLARATION: I hereby ettirtn under penalry of perjury one of ihe following dedaretions: ❑ I heve entl will maintain a certl9cete of consent to self-Insure tor workers' compensatlon, es proNded for by section 3700 oi Ihe Lebor Code, for t�e OeAortnence of ihe ��/// wark for which ihis pertnit Is issuetl. pl I heve entl will maintain workers' compensadon Insurence, as required by section 3700 of Iha Cbde, Por the pedomiance of Ihe work for whic� Ihls pertnit is issued. "\ My workers' compensetlan Insurence cerrler entl policy number ere: Cerrier: �j� �r{�.Q.%'� PolicyNum6er: (fhls secNon need not be completed!/ the permitls velued et one hundred dollers ($100) or less.) . ❑ I canify Ihat in th eAor ce of the work for which Ihis permit is Issued, I shall not emplay eny person in eny manner so es to become subject to the workers' compensetion la f Calif i, end agree Ihet tl I shoul0 become suC�act ro the workers' compensetion pmvislons of Sectlon 3700 ot the Lebor Code, I shell forihwith cnmplywiththese ' ions. / Dete: �� V �� Applicant Sipneture: WARNINCi: FAILURE TO SEW RE WORKE ' COMPENSATION WVEfiAGE IS UNLAW FIIL AND SHML SUBIECT PN EMPLOYER TO CRIMINAL PENALTIES AND dNL FlNES UP TO ONE HUNORE THOUSAND DOLLARE ($100,000), IN ADDfrI O TNE CQST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SELTON 3I06OF TME UBOR COD� IPfrEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I I hereDy aHirm that I am licensed under provislons of force end effect. Llc. e _�w ConirectorsSignaWre: � with Section /7000) af Division 3 ot the Busine�s e� i rofessions Cade, en0 my Ilcense Is In full J Class M L: / Date: �?r� (i � �i � CONS7FiUCTION LENDING AGENCY: � ❑ I hereby aftirtn that there is a consiructlon IenCing agency for t�e peAormance ot the work for w�ich Ihis pertnit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: Signature: _ OWNER-BUILDER OECLAHA710NS: Lenders Address: Date: I hereby etlirm thet under penelry ot per�ury Ihat I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW far the following reeson (Sec. 7037.5, Business entl Professions Code: Any city or counTy which reQuires a permit to construct, alter, Improve, Oemolish, or repair eny structure, pnor to its issuance, elso requires the applicant tor such permit to ille e signetl statement thet he or sha is Ilcensed pursuent to the provisions of the Contrectors Llcense Lew (Chepier B(wmmencing with Sectlan 7000) of Dlvision 3 at ihe Business end Protessions Code) or thet he or �5he is exempt Iheretrom and Ihe besis for the elleged exemption. Any vlolation oi Section 7031.5 by any epplicent for e pemat sub�eds ��e epplicent ro a civil penelry of not more then five hundretl dollere ($SOOJJ: ❑ I, es awnar ot the properry, or my employees with weges es Ihelr sala compensatlon, WILL DO THE WORK, antl ihe siructure Is not intendetl or oHeraO for sele (Sec. 7044, Business and Professions Code: The Contractors License Lew tloes not apply to en owner ol properry who builtls or Improves ihereon, and who does such work himself or herself or through his ar her own employees, provided that such improvements ere not Intended or aHeretl for sale. If, however, ihe building ar Imprwement is sold wi�hin one year of completion, the owner-builder will heve the burtlen of proving ihat he or she did not build or improve tor purpose of sele.). � I, es owner of the property. em E%CLUSIVELY GONTRACTNG WITH LICENSED CONTRACTORS to construct t�e pro�act (Sec. 7044, Business end Professions Cade: The coniraciow LJcensa Lew does not epply to en owner ot property w�o bullds or Improves thereon, and who coNrects for such project wl�h e contrector(s) license pursuant to the Contreaorus License LawsJ. ❑ I em exempt under sec. Business end Pmfessions Coda tor this reason: Signatura: Date: Owner ID veritiad by dnvefs liCenSe. ❑ Ves ❑ No Dnvers LicensB No. Eapire9: Verlllcation ot Ownership by (lype of document, i.e. - property lex bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereby certify ihat no excavatlon flve (5) or more feet in depth Into whlch e person Is required to descend, wlll be made in wnnaction with work authorized by Ihis permit, end that no builtling structure, scattolding, talsework, or tlemolitlon or tlismentling thereot, will be more than thirty-slx (36) teet high. (Chap. 3.2, Grp 2, Ar12, Sec. 341, Title 8, Califomla Atlminlstretive Cade). ❑ As owner-builtler, I will not employ enyone to tlo work which would require e pertnit trom ihe Division ot Indusiriel Selery, es noted above, unless such person has e permit to do such work trom the division. SigneWre: Date: Division of Industnal Safety Parmit Number: CERTIFlCATE OF COMPLIANCE AND Al7THORVA710N OF ENfAY: I certity under penelry of perjury that I have reatl this epplication and stete thet Ihe Intortnation given is conect I egree to comply with all state laws end city ortlinances relatinp to building construction, enA euthonze representatives of the Ciry of Coste Mesa to enter upon the ebove-descnbed property for inspeclion Ouryoses. I egree not to occupy or allow occupency of eny builtling authorized by this permi� until final inspection. Legal CODE �. INSPECTONTYPE QAIE 111IIDdLS 1616 Fi:ed System Final Fira Preventlon 1266 Pool Spa Final 200 Final Re-Root 201 Finel BIocWRetaining Well 202 Final Factory Fire Place 203 Final Siqn 204 Final Demolition COUE 1 INSYELTION TYVE 206 Finel Mechenical 208 Final Plumbing 210 Finel Electrical 212 Final Fire Preventlon 220 Final Planning Apprwel 222 Final Site 250 Final Building/Occupency Q�ff. INTIfL1LS (714) 754•5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626 BUILDING PERMIT JobAddress: 400 E 17TH ST Suite: Vicinity: Parce� Number: 11732134 Applicant: PICHE, CHRIS Address: owner: STEINMETZ, SHARON L Address 109 FERNWOOD DR WARNER ROBINS, GA Contractor: TA CONSTRUCTION Address: 1717 W ORANGEWOOD #B ORANGE,CA Zip: 92868 Arch : Address: Zoning: Phone: 714-231-4366 Zip: Phone: Zip: 31088 Phone: (714)634-4400 License: 704343� Eng: Address: Phone: Status: ISSUED Applied: OS/i6/2001 Issued: OS/16/2001 ISSUED BY: Phone: Zip: . Liiense: License: , SCOPE OF PERMIT 48 L. F. OF 42" HIGH BLOCK WALL'AND 36 L. F. OF 6' HIGH BLOCIf WALL' PER APPROVED PIANS AND CITY STANDARD. EZ LUBE III. REF: B00-00308. , � Plan Check: $39.07 . Permit: $60.10 SMIP Res: $0.00 SMIP Com: $0.50 Other: $0.00 Inspection: $0.00 Totdl: " $99.67�� ' �•' +�- � ��:�', .. �/i l�� \ � ) \ \ / � �/ l� � � � �� SETBACKS � � `= �� / MAINSTRUCTURE-Front-. 0=0° " Rear � V � ��,� ACCESSORY Front`,0=0 , � ��Rear PARKING Ezistinq: 0�'� � � Reauired: NOTES: FEE SUMMARY " ' - Calc Valuation: Claim Valuation: , �� ; j� � ; ; ., �'�:'•rS:�� .� �,�� , , � h5 i. ' .. J/ . . . '�j / P�LANNING'8 ZONING "!% �� -�i � / ., ` _ O _il' \ / �� . _ � •- � ��\\(. / . / i� i v 0- 0� Left � 0- 0 Right- ;;0- 0-, ; 0-0 ��Left 0-0--„ ', Right,.�0-0, � �0 � � Proposed:� 0 � st;sao.00 so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a penod of 1 BO days. INSPECTIONS: In order tor ihe work authorized under ihis permit to be considered legal, such work must comply with all epplicable codes, and all requlred Inepectlona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 u+o-ao �aw7 WORKERS'COMPENSAnONDECLARAnON: � I hereby affirtn under penelry ot perjury one oi ihe Following declaretions: ❑ I heve end will meintein e cartificate of consent to seli•Insure lor woAcers' compensetion, es provided for by section 3700 of ihe Lebor Code, for the peAormence af the work for which Ihis pertnit is issued. ❑ I heve entl will maintein workers' nsation ins rance; as requiratl by sectlon 3700 of ihe LaOor Code, for ihe perfortnance of the work for which this pe�mit is issued. My workers' compensallon Ins c c c�rner and olicyyyrqper ere: _ Cerrier: (This sectlon need not orless.) Policy Number:�_ ❑ I cenify t�at in the peAormance o1 t rk tor ��is pertnit is issued, I shall not employ eny person in any mannar so as to become subjact to ihe workers' compensetion lews of Celifom , gree shoultl 6ecwne subJect to Ihe workere' compensation provisions of Sectlon 370 ot the Lebor Cotle, I shall fonhwiN cnmply with these provisio �—�/�/ ApplicentSigneture: �_� � � Date: WARNINO: FAILURE TO SECURE WOflKERS' COMPENSFTIdJ COVERAOE IS UNUWFUL AND SFULL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED TMIXI$ANO OOl1ARE (5100,000), IN ADDRION TO THE CQST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE UBOR COOE. IMEflEST, PND ATTORNEI^S FEES. LICENSED CONTRACTOHS DECLARATION: I hereby ettirtn t�at I am Iicensetl under pj� sions of hapter 9(commencing with Section 7000) ot Division 3 0l ihe Business and Prolesslons Cotle, and my license is in full lorce antl efletL Lia x n/� Class # Contractols SlgnaNre: � Date: / ) CONS7RUCT10N LENDING AGENCV: ❑ I hereDy eNirm Ihat ihere is a construction lending egency Por the pertormance of �he woAc tor which t�is permit is issuetl. (Sec. 3097, Civil Code). Lentler's Neme: Lender's Address: Signature: De1e: OWNEH-BUILDER DECLARATIONS: I hereby eHirm thet untler penelry oi perjury thet I am E%EMVT FROM THE CONTRACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Business anG Protessions Code: Any ciry or munry which requires e pertnit to construd, alter, impmve, demolis�, or repair flny siructure, prior to its issuance, also requires t�e applicant tor such pertnit to file e signetl stetement that �e ar she is IicenseA pursuant to the proWsions ol the Cantrectors License Law (Chepter 9(commencing with Sectlon 7000) ot Division 3 of Ihe Business end Professions Code) or Ihat he or she is exempt therefrom anA t�e besls for ihe elleged exemption. Any violation oi Sedlon 7031.5 by any applicant for a permil subjecis iha applicant to e civil penalry at not mora than tive hundred dollers ($500).): ❑ I, as owner ot the property, or my ettiployees vnth wages es their sole compensaiion, WILL DO THE WORK, end the structure Is not intenaetl or oflered tor sale (Sec. 7044, Business enC Professions Cotle: The Contractors License Law tloes not epply to an owner oi property wha builds or imD��es thereon, entl who does such work himself or herself or through his or her own employees, prodtletl that such improvements ere not intended or ofleretl for sale. tl, however, the building or impmvement is soltl wit�in one year of completion, ihe owner-builtler will heva the burden ot proving ihat he or she did not build or improve for purpose ot sale.). ❑ I, es owner ol the property, am E%CLUSIVELY CONTRACTING WRH LICENSED CONTRACTORS to construct the project (SecJ044, Business and Protessions Code: The contractors Llcense Law does not appty ro en owner oi propeny who bulltls or improves t�ereon, entl who conirects tor such pro�ect with e contractor(s) license pursuent to the Contractors License Lews.). ❑ I em exempt untler sec. Busineu entl Profeuions Code tor this reason: Signature; � Date: Owner ID verifiad by dnver's licanse. ❑ Ves ❑ No D�ivefs License No. Veniication of Ownership by (type oi dwument, i.e. - property tax bill or tleetl): OIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I �ereDy certity t�e� no excavaiion tive (5) or more teel in dep�h into which e person is requiretl to tlescend, will be mede in connection wi�h work authonzed by �his permll, and ihat no builtling siructure, scaHolding, falsework, or demolitlon or Gismantling ihereof, will be mora than thirry-slx (36) taet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Title 8, Celltomia Atlministrative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit tmm the Division of Indusirial Safery, es notetl ebova, unless such person has e permit to do such work from the division. Sipnature: Date: Divislon ol Industnel Satery Permit Number. CERTFICATE OF COMPLIANCE AND AUT}IORIZATION OF EHiAV: I certiy under penelty of perlury ihat 1 have read Ihis epplication and state lhat Ihe iniormation given is wrrecL I egree to comply with ell stete laws and ciry ortlinancas releting to building consiruction, and authorize representatives ot �he City of Costa Mese to enter upon ihe ebove-described property for inspeclion puryoses. I egree not to ocwpy or allow occupency ot eny building authorized by ihis permit unlil finel ins0ec�ion. egal Owner(s) � / a} D/ J � � � And/Or Authonzed ADDlicant Date CODE �. INSPECTIONTYPE 7676 Fized System Final Fire Prevention 7266 Pool Spa Final 200 Flnel Re-Roof 201 Flnel BIak/Retaining Wall 202 Flnal Fectory Fire Place 203 Final Sign 204 Final Demolition . PAIE I[�1SL5 � 1 _ COpE� INSPECTIONTYPE 206 Final Machanical 20B Final Plumbing 210 Final Electncal 272 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Finel Builtling/Occupancy PAL IL�� (714) 754-5273 • Fax (714) 754d856 • www.ci.costa-mesa.ca.us 77 hAIH UHIVt, GVJ IA MCSA, GH `JZtlZO ELECTRICAL PERMIT Job Address: 400 E 17TH ST Suite No Vicinity: Parcel Nunmber: 11732134 Status: ISSUED Applied: 02IO2/2001 Issued: 02/022001 npp�icant TA CONSTRUCTION ISS �� Address: 1717 W OR4NGEWOOD #B c ' , � . � - , � � Phone: (774) 834-4400 � � - - ORANGE„CA "% ' � - Zip: 92868 � � � • i �'-j � ' �' . \ ♦ � ��' ^ \' ' ,. ', _ i - ` .\ Owner. ;ST INMETZ, SHARON L � � � �„ � � �� / ' �; ; '� � �� '� � Address %,109 FERNWOOD DR, -� - � ' . - � � � � . . �. . - ;�� , � �\ . .�� , Phone: - - , �� " ', � . WARNER ROBINS, GA Zip: 31088 _ , ,. A � i � �� ,Contrector: � , TA'CONSTRUCTION ' \ � � � / � �\ \ � � � "i ' _ -\�� ) \ � ' '.� Adtlress: .7717WOR4NGEWOOD#B • . �_ . . _ :��, �� -.� ��. l ' �� ,:�i7 _-'" � � ' � ��'^�',` % ` "�\ - . , . / ' .. _ Phone: (714)634-4400 �; . � , , . _ �A� ,� ' � �� 'ORANGE.CA �' , Zip_ 92868 - � . � i � � , � � �� '. . , " , - _ - ' �' . � - License: 704343 - ' " ' , � � . _ - , 1 ,� � ��;.'� � � � .,1 , / . . ' � / � ,; � �\ i ' �� _ � � �, , > .� / SCOPE OF PERMIT � .��r . '� - � � "REF B00-00308. __, `c � . i _ ,i . `. ' '-�; �, ', , I � � ��, � ^ �� ;�30 UGHTS, 18 OUTLETS, 9 SWITCHES,1 SERVICE METER UP TO 200 AMP, 1 MOTOR = 1 HP., 1 % �� -� �� i � �;� PANEL UP TO 200 AMP. 3 MISC. CONDUITS. � i �; - "'. , ' * , . / ! . . � (\ � . �'� ! - , . .. �__, / ,. . , � �,� .. � � ��,/ �n� � �','_ � � FEESUMMARY .r' ��/�� j� �� QuantitY �'� Quanury/�� /'� ISSUE �FEE $23.50 �' Temp Dist Sy3tem I Llghting � -50.00 Of � � ' � �� i / i'�� i Temp eervice test � 50.00 Busway A00 ft 50.00 �0�� (�� Res'xlcpackage . 50.00 � �StandingSection $0.00 /0� �"�J/ /�� Naw Res (1-2 umts) �. $0.00 0 �Mrsc�Electnwl Eqwpment SO 00 ' j0 \ �' New Res,(3+umts)/ 50.00 0 - Trensformers up,to 1 kva/kw $0 00 �� '�0 �' �" PoollSpa�� `�� 5000 � 0 . � . uptot0.kva/kw $0.00�0 � �j� Lighhng Fixts��\ �-� $2930 � � � 30�.; , �. - .. up to 50.kva/kw. /^: . �$0 00 0 } � � Recept Outlets� �$19 80�� .18 '� ; � . . ..up to 100 kva/kw � � .�$0.00 �0 � Switches � /�/$990��9 �_ � - "%<c....over100kva/kw��$O.00�j 0� �% Non Res Appl ��/- SO 00 ��0� -� lovi Voltage Equipment j� $0 00' ✓0� Q ResAppl � � $0.00�� O��O�� ` �CowVoltWinng,System7,Ckt $000��0 �% Serviceto200a �� $30.50 -'^\ 1 \ �� Misc:-Condw4� ,� $54�60� 3�i Service to t000a �� _ E0:00 �( / � 0;� �-� Misc. Conduttor �� 50.00 i 0' Moto'rs toV1 hp OOOa \\� OS \ ' �� 0 \ !r �,l 'r �. : .. Circus (mech ride o)r li \ts) \, `50:00//0 Motors to 70hp $0.00 �A 0�- �.i � Christmas Tree Stand-� j$0.00 0 Motors to SOhp $0.00V� �-0- � � `� �Fireworks�Stand"� , � ��50.00 0 Morors to 100hp 50.00 ��_.0 �-, Other Electriwl Fee �'� "- $0.00 Motors over 100hp y0.00 0 � � � - , : - ,� y� ��_ � _ � Communication drops $0.00 0 - - - - �Investigatiori Fee $0.00 Sub panel to 200a $30.50 1 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES SY02.85 Intermed Pole $0.00 .0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced wNhin 1 BO days, or if work is suspended Or ebandoned tor a period of 180 days. INSPECTIONS: In orcler for the work authorized under this permit to be considered legal, such work must comply with all applica �odes, and ell requlred Inspections and tinal epproval must be obtained. Failure lo obtain inspections and tinal epproval will result In the expiretion;of thls permit. FOR INSPECTIONS CALL: (714) 7545626 U 26E&48 (8�W) WORKERS'COMPENSArONDECLARAnON: � I hereby eHirtn untler penalry of perjury one of ihe fdlowing declarations: ❑ I heve end will maintain e cenificate ot consent ro setl-Insure lor workers' compensation, es proWded tor hy section 3700 ot the Lebor Code, for t�e peAortnance of the �work tor which Ihis perml� Is issued. 1 have end will maintain workers' compensatbn inSU�ance, as requireA by sedion 3700 ot Iha Labor Coda, for the peAortnance ol Ihe work br which Nis pertnit is issued. Myw�� mpe� fionlnsurencecarrler ntl.pa��Y rare: /} C6RI8I: �liZ_D.N Sec� «� ��tL. � Poliry Number. / Y' � OlQ 7—� ZJ (ihis sect on nee0 not be canp�e !! ttie�r one hundrea dd�ars (SI00) or less.) ❑ I certlty that in the peAormance ol the w tor which thls permit is issuetl, I shell not employ any person In any manner so as to become subject to ihe workers' compensatlon laws ol Celllamla, a �r that if I shaultl become sub�ect to t�e workera' compensetlon Drovisions ot Section 3700q1 the Lebor Cotle, I s�all forthwith cnm proWsio � _ / / � AP � nlSignetur Dete: �Z� � �d NI � PE TO SEWHE WO NE0.S' COMPENSATION ERAGE IS UNLAWFUL AND $MN.L SU&IECf AN ER TO CPIMINAL dENALf�ES AND pNL FlNES UP TO ONE HUNDRED SANDOOILARER��I.INADORIIXJTOTNE�$TO PENSATION,OAMAGESASPROVIDEDWRINSECTIpJ3]OBOFTHEUBORCODE,IMEREST,ANDATfORNEVSfEES. LICENSED CONTR9CTORS DECLARATION: I hereby eMl at setl untl r praNsi o ter 9(commencing with Section 7000) ot DiNsion 3 0l ih ess and Pro ians Code, and my license Is in full force e . ic. p e Co r's Signet B; � TRUCTON LENDING AGENCY: �f ❑ I hereby affirtn ihat lhere Is a consiruction lending agenq tor Ihe pertormance ol Ihe work for which this permit is Issued. (Sec. 3097, Civil CoCe). Lentlafs Neme: Lendefs Atltlress: SlpnaNre: OWNER-BUILDER DECLARATONS: Deta: I hereby efllrtn t�et under penelry of perjury that I am E%EMPT FROM TF1E CONTRACTORS LICENSE LAW tor t�e following reason (Sec. 7031.5, Business and Pratessions Cotle: Any ciry or counry which requires e permit to con5�rod, alrer, improve, tlemolis�, or repair eny sWcture, prior to its issuance, elso requires the applicant tor such permil to Poe a signee statement that he or she Is Iicensetl pursuant to Ne prmdsians ot Ne Conirectors License Law (Chapter 9(commendng with Sectlon 7000) ot DNision 3 oi Ihe Business end Professlons Cotle) or �het he or she is e:ampt Nerefran and Ihe basis for tha elleped exemptlon. AnY vlolation oi Section 7031.5 by any applicent for e pertnit subjects the epplicanl to a cMl penalty o1 not more ihfln five hundred dollars (SSOOjJ: ❑ I, as owner ot the property, or my employees with wages as �heir sole wmpensatian, WILL DO THE WORK, end the strucwra is not intended or otteretl tor sale (Sec. 704d, Business and Prolessions Code: The Contractors License Law dces not apply to an owner of property who builds or improves thereon, and who dces such work himself or herself or through his or her own employees, provided Ihat such improvements ere nat intentletl or oHered lor snle. If, however, t�e Duilding or improvement is sold within one yoar of comple�ion, the ownerbuilder xvT have the burden ot pmving Ihat he or she ditl not builtl or improve for purpose of sale.). ❑ I, es owner ot the properry, am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS lo consiruct the p�oject (SecJ044, Business and Pmfessions Coda: The crontrectors License Law does not eppy to an owner oi property who builds or improves t�ereon, and who conirects for such projed wi�h a contractor(s) license pursuent to the Conirectors License Laws.J. ❑ I em exempt untler sec. Signature: Owner ID verlfiea 6y tlrlvefs Ilcense. O �85 ❑ No Business antl Professions Code tor this reeson: Verllicetlon of Ownershlp by (type ol document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTAIAL SAFETY PERMR CER7IFICATION: Drivers License No. Date: Eapires: ❑ I hereDy ceM1ify Uat no excavation Iive (5) or more leet in depih into whlch e person is require0lo tlescend, will be made in connectlon wit� work authorizetl by ihis permlt, entl thet no building siructure, scalloltling, talsework, or demolition or dismentling ihereof, will be more than thirty-sla (38) feet high. (Chep. 32, Gry 2, Art 2, Sec. 34 i, Titlo 8, Calitomla AOminlslrative Catle). ❑ As owner-bullder, I wlll not employ enyane to do work which would requlre a permi� trom ihe Dlvlslon al Industriel Sefety, es noted e6ove, unleu such person hes e permit to do such work trom Ihe division. Signeture: Date: Divisian of Industrial Selery Permit Number. CERTIFlCATE OF COMPLIANCE /WD AUiHOROA710N.OF EMAY: I certify under penalry ol perjury that I heve reatl t�ls application antl state that the infortnation given is cartect 1 egree lo comply wlth ell state laws flnG city oM��ances ralating to bullding consWctlon, and authodze representetives at Ihe Ciry of Caste Mesa to enter upon Ihe flbove-descnbed property Iqr inspey;ion purpases. I eqrea not to occupy or allow occu0enq al eny building authorized by this Dermit until linal insDection. Legal COOE I, INSPECTONME �� 1818 Fixetl System Finel Fire Prevention /286 200 Pool Spa Final Finel Re-Rool 201 Final Block/Retelnlnp Well 202 Final Fectory Fire Place 203 Finel Slpn 204 Finel Demolition pd¢,� ��$ �,j INSPECTIONTYPE 206 Finel Mec�anicel 20B Finel Plumbing 210 Finel Eleqrlcal 212 Flnal Fire Preventlon 220 Flnal Plenning Apprwel 222 Final Sl�e 250 Final Building/Occupancy P7.tl�:iiHi.1F'. ' e?:� :I'�' � (714) 754-5273 • F8X (714) 754-4856 • www.Cl.CoSle•mBSa.Ce.uS 77 FAIF DHNE, GOS I A MtSA, GA 9"L62ti ELECTRICAL PERMIT JobAddress: 400 E 17TH ST Suite No Vicinity: TEMPORARY POWER POLE Parcel Nunmber: 11732134 Applicane GEARY, TOM , „ ,� , -: Address: 1717 W ORANGEWOOD #B =- ��-�`: � - - � � �� / � ' � ,", . Phone: (714) 634-4400 � , ORANGE,.CA". ' ' ' . ' 2ip' 92868 , . �� : � i � \ � , __ owner: 'STEINMETZ, SHARON L Address ��109 FERNWOOD OR . � � � i ' ' / \ '% . �� _ �; O� Phone: ., �� "i WARNER ROBINS, GA Zip: 31088 %/ '/ i�% Status: ISSUED Applied: Ot124/2001 Issued: 01/24/2001 ISSUED BY: � , . � /� � �, � � � �.. �_� /,.-� i��' �i/ i / � i 'i - � " , i -i - . �i, ' Comrectoi T' TA-CONSTRUCTION � � i� , , - . � ,��; Address. � �1717 W ORANGEWOOD #B � �i " - ' � .'l l!\i n -:. ' , I - , ,`i "-" ' . . j "� : �� 'Phone: (714) 834-4400. i „ � � '� ` � ! �ORANGE, CA � . ' - - Zip: 92868 � �., ' , � ��" ' ' License: 704343 ' �\ ; / " � ,-�. � � � �, � ' ' . '-,-` ' SCOPE OF PERMIT . " -„ ' � -� � � ELECTRICAL PERMIT.FOR TEMPORARY POWER POLE FOR 7E2 LUBE"._ � � � ', �� _- - - �' �� REF: 800-00308 � � ' �,A � , ' _ ., , � � � ,' +.. � V�' (" �' _ _�� / • " ; , ._ �\� � \\ � � � . Quantity P_ I$SUE FEE �''� 523.50 � Temp Disl System I Lighting -$0.00 Temp service test ��. $0.00 Busway I100 ft�� $0.00 Res:�a)c package � � ; $0.00 - � Standing Section $0.00 New Res 1=2 units �� , � ,• �� : �` ( )� $0.00 0 . � Misc Electriwl Equipment $0.00 New Res.(3+units)" �,b$0.00 0 �'-s" '� Trenstormers up,to 1 kva/kw $0.00 �, Pool / Spa� � ` Lighting Fixts`�, Recept Outlets�� Switches � Non Res Appl \ Res Appl � Service l0 200a Service to t000a Service over t000a Motors to 1hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg � Sign Circuits Temp Pwr Pole Intermed Pole �; �$0 00 0 " up to 10 kva/kw r� $Oi00 � i- 0_ � ,� , � :up to 50 kva/Nw .> .. GE0.00\\ � 0 �. ` � � � - . .up to 700 kva/kw �$000��y�0 � � �� %�� over100kva/kw � 30.00� �0� -, o � � . ° � Low Voltage Equipment �� $0.00�� 0��,_ � � Low,Volt Wiring,Systam7Ckt �� \\\ � $0.00 0 � �-= "� ._-, Misc..Condud � � �� 50.00 �� 0�� - - Misc. ConHuctor �� 50.00 V��OJ �� _ Cirws ( gen or ride)��A �� $b.00 �0, �; �,� J r- 1" , Ciraus (mech ride o� lights) E0:00 � 0";� - , , � � ChristmasTreeStand� �' $0.00��--0� �--��,�Eireworks'Stand j0� 30.00 A0 �=�_�� Other Electrical-F.ee� %� $0.00 0 ��-- , �.-,�i�%�� _ -' 50.00 O��Investigation Fee $0.00 0 Plan ChecK Fee $0.00 0 Reinspection Fee 80.00 0 �� / �1i i j '� I �� i c� i ll I � J '' 1 '''% '�_/ � $000�/ 0 � ! $0 00� 0 �-�T $000 /� 0 $OOOC/i 0� $000� C�O� $0.00 1�0� $0.00�� 0� $0.00 �0� $0.00%�0 $0:00�0 $OAO 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 523.50 1 TOTAL CALCULATED FEES 547.00 so.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitomia statutes and related regulations. (Ord. No. 92-28, § 7, 1241-92) E%PIRATION: This permlt shall automatically expire and become void II work is not commenced within 180 days, or if work is suspended or abantloned 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 ell required inepectlone end flnal approval must be obtained. Failure to obtain Inspections and final approval will result in �he explratlon.of Ihis permit. FOR INSPECTIONS CALL: (714) 7545626 � 2aa&a8(NW) WORKERS'COMPENSATONDECLARAnON: I �ereby atfirtn untler penalry ol per�ury one of the following tledarations: ❑ I have end will maintain e cenificete oi consem to self-Insure for workers' wmpensatlan, es proNded tor by section 3700 ot the Lebor Cotle, for the peAormance ol the work tor which this pertnit Is issued. arM will insura�xe, es requiratl by section 3700 af Ne Labor Code, lor the peAormanca of the work tw whkh Utis pertrtil is iswetl. ind pdiry numher are: / /� Yftliil-�--c_ �k. C rPalicy Number.� ��% ��b 7^6 Q velued et one hundretl dollers ($100) or less.) ❑ I certify t�at In t�e peAormence ot t�e work lor which this pertnit Is issued, I shell not employ eny peroon In eny manner so as to becwne sub�ect to t�e wollcers' compensetlon lews ot Calltomia, enC eg ihat II I shoultl Cecome suD�ect ro Ihe workers' compensetion provislons of Section 700 ot t e Lebor Code, � shell lorthwit� comply wlth Ihese proNsio . ApPlice'n(Signetur _� 1� Dat��, l y��—/ WARNINO!FAILURE TO SECURE WORKER$' WMPENSATION ERACE IS UNUWRIL M1D SHALL SUBIEGf AN EMPLOYER TO CFIMINPL PENALTIES AND pVI� FlNES UP TOONE HUNDRED THOUSAND DOLLARE (f100,000�.IN ADDITION TO THE WST OF COMPENSATION, DAANGES AS PROVIDED FOR IN SECTIIXJ 3]OB OF THE IABOR CADE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLAFiAT10N: I hereby aHlrtn thet I em Iicensetl untler roWsions of Chapter 9(commencing wll� Sectlon 7000) ol Divislon 3 ol.iha Business and Professlons Code, end my Ilcense is in full rorce and ettect.,u�� +C-. c _ JA�3 �l-.3 — � %iass a7 ' /�i , CONSTRUCTION LENDING AGENLY: ❑ I �ereby ettirtn that there is e construcUon IenAing agenty tor the peAormance ol the work tor whlch t�is permil is issuetl. (Sec. 309�, Civil Cotle). Lendefs Neme: Lendefs Address: Signature: OWNER-BUILDER DECLARATONS: Date: I here6y ettirtn that untler penalry ol per�ury Ihel I em EXEMPT FROM THE CONiRACTORS LICENSE LAW for Ihe follaxing reason (Sec. 7031.5, Business end Professions Coda: My Ury or counry which requires e parmn to construct, alter, improve, demdis�, or repair eny structure, pdor to its issuance, also requires the epplicant tar such pertnit to file a sipne0 stetement thet �e or she is licensed pursuam ro the provisions at the Cantrectars LJcense Lew (Chaptar 9(wmmandng wit� Section 7000) of Dlvislon 3 of t�e Business entl Prolessions Code) or t�at he or she is exempt theretrom antl I�e basls tor tha elleped exemption. Any violation oF Section 7031.5 by eny applicant for a permit subJecta Ihe applicent to e dvil penalt�of not more ihan tWe hundred ddlers (5500).): ❑ I, es owner ot the properry. or my employees with wages es their sole compensetlan, WILL DO THE WORK, and the siructure Is not intentle0 or oHered for sflle (Sec. 704E, Business antl Prolessions Code: The Contractors License Law tloes not apply to an owner of property who builtls or improves thereon, end who does such work himself or herself or Ihrough his or her own employees, proviOed ihat such improvements ere not intended or oMeretl for sale. If, however, Ihe building or improvement Is sold within ona year of completion, ihe owner-huiltler will have Ihe burden of proving �het he or she did not builtl or improve far purpose of sale.). ❑ I, es owner of the proparty, am EXCLUSIVELY CONTRACTING WITTI LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business antl Prolessions Code: The contrectors License Lew tloes not apply to en owner of proDerty who bulltls or Improves �hereon, and w�o coniracis lor such pro�ect with a cantractor(s) license pursuant to ihe Conirectors License Laws.�. ❑ I em exempt under sec. / Business and Protessions Cotle tor t�is reason: Signeture: Date: Owner ID verified by tlnvefs license. ❑ Yes ❑ No Drivera LJcense No. Expires: Vedflcation of Ownership by (rype ol document, i.e. - praperty tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certily thai no excavetion frva (5) or more feei In depih inio which e person is requlretl to tlescend, will be matle in connactlon with work euthorizad by t�is permit, and Inat no builtling siructure, scaHolding, falsevrork, or tlemolitlon or dismamling thereoi, will De more than thirty-six (36) teet high. (Chep. 3.2, Gry 2, An 2, Sec. 34;, Title 8, Calltomia Adminbtrative CoOe). ❑ As owner•bullEer, I wlll nat employ enyone to tlo work whic� would require e permit trom t�e Division of Industriel SefeN• es noted ebove, unleu such person has e pertnil lo do such work tran the divisian. Signeture: Date: Dlvision of Intlustdal Salety Permit NumEer: CERTFICATE OF COMPLIANCE AND AUTHORVJITIONOF ENTRV: I certify undar penelty of perjury that I have read this applicelion end stete thet Ihe inlormalion given is correct. I egree �o comply with ell stete laws entl ciry orCinances releting to builtling consiruction, enA euthotlza represantetives of t�e Clty af Casta Mesa to enter upon ihe ebove-described properry lor inspection purposes. I egree not to occupy or allow occupancy of eny buildinq aulhorizetl by this permit unlil linel inspaction. COpE I, INSPECf10NiYVE QdjF.' 1818 Fixetl System Finel Fire PrevenUon 1268 200 201 202 203 Pool Spe Finel Final Re-Root Finel BIOCWRelelnlnp Wall Flnel Fectory Fire Place Flnal Sign 204 Finel Demollllon �{� j�,QQ$j INSPECTIONTYPE 206 Finel Mechanical 200 Finel Plumbing 210 Flnal ElecMcal 212 220 Final Fire Preventian Flnal Plenning Approval 222 Final Site 250 Final Building/Ocapency �.I Jw. T�7F9 �J'►1' ,, , _, ..� __.., . _.. ,. . ., . _ . .--- -- Job Address: 400 E 17TH ST Suite: Vicinity: WHOLE SITE Parcel Nunmber: 11732134 Applicant: JORDON, TOM' �� Address: " - - GRADING PERMIT Zoning: Phone: (774) 556-1312 X 107 ' Zip: 92704 • � � , �. . � `.. � SANTA ANA; CA , , � SUITE�', � � , , � i i _ / �J�� Owner.�-STEINMETZ,�SHARON�L � "-� Address � �109 FERNVJOOD DR, - - � ,i; i � � � i: � � " i_�=< � � � WARNER ROBINS;-GA , i. / Contractoc� ` TA CONSTRUCTION Address' � 1717.W ORANGEVJOOD #B , Phone: Zip: 37088 �:,' ��,�� , ;�" . Phone:`p14)634-4400 � � � i J � ' ORAN6E, CA - > _ ` " ' r / . '� . � , .� ; . � , � � ,� `Zip: 92868. � , � . -. License: 704343 , Eng' : � KPFF � " • � . � Address: 2401 COLORADO AVE. #315 � ' .\ , ' ' Phone: (310)828-1536 . . SANTA MONICA, CA .- \ ; , Zip: %,9Q404 - � License: Status: ISSUED Applied: 03I10/2000 Issued: 02/02/2001 ISSUED BY: � ♦ �� ;-A \ '%\'�`�'��\ �. � \\ �` �� \ l - > � � , � �;- \��`\�� V� V'.� ��"^'�� . ; � •� � ��- � � �� , � i� �. /' . , -r . - � - . . � � , . � � �, . � � � �' i ` ;CUBIC YARDS � REF: 800 00308 — " ' ' � �, �165 �. i ', . •- - � SCOPE OF-PERMIT � '�� GRADING FOR NEW SERVICE STATION FOR "EZ LUBE, INC" (165 CUBIC YARDS OF FILL). r `�A �., � ,' FEE SUMMARY , � Plan Check:� � $33.00 Calc Valuation: � � � ` � � $0.00 ii V��Perind � ��.$54.50 • . % �V�Other. �$0.00 � �� `� �� ; $o�oo =, :. i ,//%% Inspection: ' $0.00; � '��- � � � � � � \l� / $0.00' � � � %„ ='� G��, ��\ :� ,; ��,� �, � '% ��i � �� ,; �� ! o� � � / ii � ��, � TotaL• ��, S8Z:50, �- �_ "_ . - i � �� i i�� , - - _' ' V � �, � � , , �� - ` �� - ' - PLANNING & ZONING � � ' � � �/ �,. �,� , � ,. �. � „1. •`� ��, � NOTES: A � � �_'. A� - � ��! ��- - ;% _ �- - ;.i i i , �'i ��) , „i� � C ��-=,' i� j �So.00 ; 1�I , � � � / �l � � ../�'/ � , ' .:' i' � 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 Itwork is suspended or abandoned lor a pedod of 180 days. _/—^ "� INSPECTIONS: In order for Ihe work authorized under this permil to be considered ga�� ust comply wilh ell epplicabla codes, and ell required Inepections antl Iinel approvel must be obtainetl. Failure to obtflin inspeCtions and tinal epproval will result in the expiretionof this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 zue�+e �eroo� -WORKERS'COMPENSAnON DECLARAnON: . . � I �ereby afllrtn under penelty ol perjury one o1 ihe fdlowing declarations: . ❑ I heve ena will meintain e ceniflcete of consent to sell�lnsure lor workers' compensation, as provided for �y sectlon 3700 oi Ihe Lebor Cotle, tor the pertormflnce ol ihe work lor w�ich this pertnit fs IssueC. I have and wlll malnWin workers' canpen5ation inwrance, as required by section 3700 oi the Labor Code, tor the pertortnance of the wark lor which Nis pertnit is issuetl. wo r' e%� ation Insurence�% r' r enE II number ere: [, �7 Cerner. .��P'G.�'IL./�%J,.via�7l�-i.r �JLGVC (�tin Policy Number: / � 11 � � � ! — 6 � (This sectlon neetl nof Oe comp fed 1! fhe permlf Is velued et one �undred dW/ars ($100) or /ess.) . . ❑ I certity t�at In the peAormence �� e work lor which this permit is iuueQ I shall not employ eny person In eny menner ao as to become su6�ect to the workers' P co e lews of Calltoryi, epree thet II I should 6ecoma sublect to the workers' compansation provislons I Sgctip 3700 yi the Lebor Cotle, 1 shell forthwlih mpl with io 4 [y � /� / A n� SI netu . � .f� URE TO SEC RE WORKERS' COMPENS ON COVEMGE IS UNIAWFUL AN� SHALL SUBIECT AN EM CpIMINAL PENALTI 5 AND GVIL FINES UP TO ONE HUNDRED THOUSMID DOUARE (E100.00O�.IN ADDRION TO THE CQST OF COMPENSATION, DMt4GES A$ PROVIDED FOR IN SECTION 3�080F THE IABOR CODE, INTEFEST, AND ATTORNEI"S FEES. I I�pr9by�ffirtn that I em f(rce en eflect. Lic. p_ Contrectols Slonature: (commencing with Section Class antl Prglessions Catle, entl my Ilcense Is in lull CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn Ihet Ihere is e construction lentling epency for t�e peAormance of �he work tor which this permit is issuetl. (Sec. 3097, Civil Cotle). Lendefs Neme: , Lentlers Atltlress: Signeture: � ' Oate: OWNER-BUILDER DECLARATIONS: I hereby ettirtn that under penalty of per�ury Ihet 1 am E%EMPT FHOM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business antl Protessians Cotle: Any ciry or wunry whkh requires e pertnit ro construct. elter, improve, tlemolish, or repair any structure, prior to its issuance, elso requires the epplicant tor such pertnit to file e signeO statement Ihat �e or she is licensed pureuam m the provisions ot Ihe Contrectors License Lew (Chapter B(commenGng wlth Sectlon 70W) of D'Msion 3 ot the Business end Prolessions Cotle) o�,t�at �e or she Is exempt theretrwn and the basis tor the alleped exemptlon. Any viWation of Section 7031.5 by any epplicent far e pertnit sub�ecta tha applicent to a dvll penalry af not more than frve �undred ddlers ($500)J: ❑ I, es owner oi the O�oPertY. or my emplqrees wlih wages es their sole compensa�ion, WILL DO THE WORK, antl Ihe siructura Is not IntenOed or oHeretl tor sale (Sac. 7044, Busineu and Professions Cotle: Tlie Contrectors License Lew does not appty to an owner of property who builds or improves thereon, end who tloes such work himsell or herself or thmugh his or her own employees, provided that such imprwements ere not imended or oHered for sale. If, however, Ihe building or impmvement is soltl within one year of completion, ihe ownerbuilder will have the burden ot proving that he or she did not builtl or improve for puryose of sale.). ❑ I, as owner of lhe property, am E%CLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS m conSWt� the pm�ect (SecJ044, Business and Professions Cotle: The contractors LJcense Lew tloes noi aOP�Y �o an owner of pmperty who builtls or Improves Ihereon, end who coniracls br such project wlih a contraqor(s) license pursuant to ihe Contrectore Licensa Lews.). ❑ I em exempt untler sec. S19naWre: Owner ID verified by drivers license. ❑ Ves ❑ No Business end Protassions Cotle tor this reason: Vedficatlon of Ownership by (type ol document, i.e. - praperry tes blll or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: Dnver's License No. oate: E:pires: ❑ I hereby certlty Ihet no axcavetlon Ilve (5) or more laet in depih into which a person Is requlred to descend, will be made In connecilon wlih work authorized by this pertnit, and ihat no building siructura, scaflolding, falsework, or demolition or dismantling Iheraoi, wlll be more Ihen Ihiny-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 34 i, Title 8, Celifomla AtlminlslretWe Cotle). ❑ As owneaOuilEer, I will noi employ enyone to do work which would require e permit trom the DiWsion ot Industnal Setery, as noted ebova, unless such parsan hes e pertnil lo da such work trom ihe dlvislon. Signature: Date: Division oi Intlusirial Selety Pertnit Numher: CERTFlCATE OF COMPLIANCE AND AUiHORVAiION.OF EMRY: I cenify under penalry ol perjury lhat I heve read lhis appliceUon and state Ihet the fnlorma�ion given is correct. I egree to comply wlth ell slate laws end dry ordinances relaling m building construction, and eulhorize representatives of t�e Ciry of Coste Mesa to enter upon the above-descdbed property lor inspection purposes. I agree nol m occupy or ellow occupancy of eny building euthorized by lhis permit until tinel inspeciion. CODE �. INsvetnoxnve — ✓ pAg� 7816 FIaeC System Final Flre Prevention 1288 200 Pad Spe Finel Finel Fe-Rool 207 Finel Blak/Reteininp wall 202 Flnal Fectory Fire Place � 203 Final Sipn 20C Finel Dumolitlon � CODEI �NsvecrroxTrre 208 Finel Mechanical 208 Finel Plumbinp 210 Finel Electncal 212 220 222 250 Finel Fire Preventlon Final Planning Approval Final Slte Final Building/Occupanry (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us i i rnin unrve, �va i N mr.aN, �M azozo PLUMBING PERMIT 1ob Address: 400 E 17TH ST Suite No Vicinity: Parcel Nunmber: 11732134 -- , . - � - -- � ��''�� -- . � ' ' -- Applicant: TA CONSTRUCTION , " ' ; Address: 1717 W ORANGEWOOD #B � , ; �, , i� � /,��- � - � Phone: p14)634-4400/' ORANGE, CA � - - Zip: 92868 �, //�� "" . � �,, � �, 0 nw er.' �STEINMETZ,�SHARON L � Address 109 FERNWOOD DR / �( �j ' / jl � . " /;i� „/,-/ / � - i WARNER-ROBINS, GA I:•'i� �-�:/� i >�i 1� %�;�'/ . � � / �� ,'��'/ � ,� �� Contractor: �TA CONSTRUCTION , , Address: �1717,W ORANGEWOOD #B" �A, ;ORANGE,CA , � / `,� � ,� � � ,� � Arch / Eng : � . � ,� , Address:�' � � � j _. �- \' � 1; , � �.; . �' 1 �" � .' � - Phone: Zip: .; 31088 . • ... • � _ � : � _ � ISSUED BY: Phone: (714) 634-4400 Zip: 92868 License: 704343 �� . _ . -_ �'i . . _ . � _i , , . . ' , • , . . , �- Phone:- - - �'P�, .. � license. Status: ISSUED Applied: 02IO2/2007 Issued: 02I022001 I �\\\ /\�\ \ / �� \\�. .� �C'�. ��\� � '\ � � �� ,;�`� �\ � �, �� ,�, � � - � 1 �� 1 � ' �_ A i� 1 , �1 ? � �\i ,_� � -_ , ',1; � � �� I . �l ' �� _ i � �' . '\ I � , �� ; ' � � ;�; , .,�r� , � '�� ,�� , ; � /�� / �, 'V` � SCOPE OF PERMIT� � � �. �� / ! '/ �� REF 800-00308. �� , � �� -� `� �=� �' 1 BAQCK FLOW, 2 ROOF DR41N, i FOUNTAIN,�1. L'AN$CAPE IRRIG., 1 SEWER CONNEC., 2,WASH ' � ��O �� BASIN;2 �TOILETS, 1 WATER PIPING;;7' WATER SERVICWE, EZ LUBE. � �� \ \. ,� \.. .,e �////. \ !Il �`�. ��' � �,: � � _: - � �FEE SUMMARY - i ' . �- :�� v �U �� ,Annr �� .�.. � � ' � = , o.Mr � arr '%/ � �� '� nnnr ISSUE FEE � <$23,50/� ��AA�Laundry Tub I Washer - SO 00 0 �ij � Sump Pump j� � $0.00 BackFlow irrigation �� $9.80� - 0 � �Landscape-Irngation - � $1'4 80 1 *; �Swtmming Pool � $0.00 Backflow Preventer ��A $0.00 � �1'� --P Trap� � ` $000:;-0 �Tra Primer Bathtub ` $0.00` \0 � � - '�"` P, v i � $0.00 � , , 1 � ,Pressure Ragulator _ �.50;00 --�0 � Urinal , - $0.00 Clarifier System �$0.00� � 0,�� ; i;�Process Piping (per 70 ft)-- $0.00 _ 0�" � Wacuum Brki'BkBow(7-4) $0.00 Connect pce,Soda,etc) $0.00 �, 0 � ' i ,^� .Receptors - � f --�$0.00�--. � 0 . �, � \'Vacuum Brkr �BkFlow(5+) $0.00 Dental Units $0.00 _ � 0V � ��Septic Tank � � � �, $0�00 = 0, � � -Wasii'Basin $19.60 Dishwasher $0.00 ��0'�� . SewerCap_for,Demo, , i$0.00 --r0�� ,, j<VHasfiBasinSet 50.00 Drain,Floor $0.00 0� � SewerConneU � � " S2a.65 -1,,,-:''��WasteandVentSystem $0.00 Drein, Rainwater $0.00 0 � -Sewer Private.Line ,_�$0.00 � ' 0 �.- � � Water Closet (Toilet) $19.60 Drain, Roof 819.60 2 Shower-- -._. �_ ., __,$0.00 "-0 Water Heater I vent $24.60 Drinking Fountain $9.80 1 Sink, bar $0.00 0 Water Piping (Inst or Rep.) 59.80 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 Gas Earthpuake Valva $0.00 0 Sink, Floor $0.00 0 Water Service $9.80 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 ' Spa (private) 50.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptars (Grease, Oil) $0.00 0 REINSPECTION $0.00 interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: E185.55 NOTICE: The work authorized by this permit s a compy wi a ---- quiremants regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automallcally ezplre and become void if work is not commenced within 1B0 days, for a pariod of 780 days. INSPECTIONS: In order for the work authorized under this permit to be consideretl legal, such work must �i requlred Inspections and final epproval must be obtained. Failure to obtain inspections and final approval wiil`re FOR INSPECTIONS CALL: (714) 7545626 � 24a6-68�8�00) �N 0 0 0 0 0 0 2 0 0 2 2 1 0 1 0 0 under CalifWriia statutes and related is suspended or abandoned with all applicable codes, and all in the expiratlon.of this pertnit. WORKERS'COMPENSAnONDECLARAnON: , , � . � I hereDy ettirtn under ponalry ot peQury one of the tollowing tleclarations: ❑ I have end wlll maintein e certilicate of consem to selbinsura tor workors' compensetlon, es D�ovided tor by section 3700 0l the Lebor Code, for the portortnance of Iha work tor which ihis pertnit is Issued. I have enG will meinteln workers' compensatlon insurence, es required by 5ection 3700 al Ihe Labor Cotle, lor ihe peAortnence of Ne work br which this pertnit I5 Issuetl. My work rs'�/p mp/ep�g-g_tlon Insurenca cerder ntl Doliq�nuaiber ere: n Ca r. �Y1� ( .•t")�t �.P�f�Li�.� � �Cf-/'�s�GP � � PUlty Number. � 7 O ��7 � (ihis sectlon need no( be�tetl i! Ne permi! fs valuetl e one hundred dWlers (S 100) or less.) . ❑ I ceRify Uat in the DeAormence of compensation laws o1 Califo�l9, � (5100,000), IN ADDITION TO THE lor which this pertnit Is issueq I shail not employ any person in any manner so es to become subiect to Ihe workers' Ihat It I s�oultl Decome subject lo the workers' compensation provisions oi Sectio/�1 3700 the LeDor Code, I shall forihvrith SA � ERAGE IS UNLAW R1L AND SW1LL SU91EC�0 CRIMI� PEWJ. � GVII. FlNES UP Tq ONE HUNDRED .'OS1Uf COMPENSATION, DMUGES AS PFiOVIDED FOR M SECTION �O60F THE LABOR COOE, IMEREST, AND ATTORNEYS FEES. I �ereby eMi em Ilcgae4tl under pro �sions ol Chapter 9(commencing with Section 7000 e Buslness and Prolessions Cotle, and my license is in tull for ect. Llc. M � Clau ontr tors Signeture: Oate: ONS7FiUCTON LENDING AGENCV: ❑ I hereby aflirtn that Ihere is a construction lending agency for ihe peAormance ot Ihe work for whic� ihis pertnit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lentlers Address: Signature: Date: OWNER-BUILDER DECLARATIONS: � I hereby aflirm thet untler penelty ot perjury thet I em EXEMPT FROM TT1E CON7RAC70RS IICENSE LAW for the following reeson (Sec. 7031.5, Business entl Prolessions Code: Any ciry or counry whlch requires e pertnil to consiruct, elter, impmve, tlemolish, or repeir eny structure, pnor to its issuence, elso raquires tho applicaN tor such permit to file e slgneG statement ihet he or ahe Is Ilcensed pursuant to the prodsions oi the Contractors Licensa Lew (Chepter 9(commencing with Sactlon 7000) ol DlNsion 3 ot I�e eusiness end Prolesslons Code) or ihat �e or she is exempt therelrom end Ihe basis for Ihe ellegetl exemption. Any violation of Section 7031.5 by any epplicant lor e permh sub�ects the epplicant to e clvll penalry of not more than flve hundretl tlollers ($500)J: ❑ I, es owner ot t�e property, or my employees wit� wagos as their sole compensation, WIL� DO THE WORK, and the structure is not intended or oHeretl tor sale (Sac. 7044, Business entl Professlons Cotle: 7Te Conirectors License Law does not apply to an owner oi property who builds or improves thereon, end who tloes such work himself or �erself or Ihroug� his or her own employaes, proWded thet such improvements are not intentletl or oRered lor sale. If, however, the builtling or improvement Is solA within one year oi completion, Ihe ownervbuilGer will heva ihe burtlen ot pmving Ihet he or she did not build or impmve for purpose of saleJ. ❑ I, es owner ol the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prqect (Sac. 7044, Business entl Professions Code: The contraclors Llcense Lew does not eppty to en owner of propeny who builds or Impmves thereon, entl who contracts lar such project wl�h e comrectar(s) license pursuant to the Contractors License Lews.). ❑ I em exemp� un0er soc. �� Busineu end Pralessions Cade tor this reeson: Signatura: Date: Owner ID veritied by drivers Ilcense. ❑ Ves ❑ No Drivefs License No. E:piros: Vedficetlon ot Ownershlp by (type of daumeni, i.e. - pmperty tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more feet in depih inio which e person is required to descend, will be mede in canneciion with work euthorized by ihis pertnit, flnC t�at no building structure, scaHolding, falsework, or demolition or dismaniling thereof, will Ge more Uan thirry-s& (36) leet high. (Chap. 32, Grp 2, Ar12, Sec. 345, TiUe 8, Celilamie AdminislratNe Cada). ❑ As owner-Duilder, I will not employ enyone to do work which would require a pertnit from t�e Division of Industrifll Safery, as noted ebove, unless such person hes e permit to do such work trom the tllNslon. Signature: Date: Didstw o1lnEusidal Satery Pertnit Number. ICERTIFlCATE OF COMVUANCE AND AUTMOR¢A710NOF ENTAV: I certify under penalry of perjury that I have rea0 this application end steta lhet the informatlon given is I cortect. I egree to compty wllh ell stete lews end clry ordinances relating to bull0ing consiruction, and authorize representatives of Ihe Clry of Cwte Mesa to enter upon the ebove-0escribed property tor inspection purposes. I egree not to accupy or allow occupanry of eny building authorized by this pertnit until final inspection. COpE I, INSPECTONTYPE �� Q�' �LS �616 FIzeC System Flnal Fire Preventlon 7266 200 Pool Spe Finel Flnal Re-Roof 201 Flnel BIocWRetaining Well 202 Final Factory Fire Plate CODEt ixsvernoxtrve 208 Finel MeChenlcal 20B 210 212 220 Finel Plumhing FinBl Eletiritel Finel Fire Preventlon Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolitlon 250 Final Building/Occupency � It� �� (�ta) �5a-52�3 • Fax (7�a) �5a-asss • wwv+.cl.costa-mesa.ca.us 77 hAIH UMIVt, GUS I A MtJA, GA tlZtlLti Job Address: 400 E 17TH ST Suite: Vicinity: Parcel Nunmber: 11732134 Applicant: UNKNOWN Address: ownec �" �STEINMETZ, SHARON L Address 109 FERNVJOOD DR WARNER ROBINS, GA SIGN PERMIT Zoning: Phone: Zip: Phone: Zip: 31088 Status: ISSUED Applied: 09126/2000 Issued: 03/19/2001 ISSUED BY: �/�^L Comractoc TNT NEON SIGN COMPANY � �"� � . Address: 1436.CHERRY AVE � � ' � . � ', , Phone: (562) 434b366 , - , . \ - �� \ ' . �� LONG BEACH, CA � Zip: 90813 � � ' `� :, '. .�License: 629097 , � � ' - � � Arch / Eng : - " - , � ' � - Address: - - - � �� - � � - Phone: . Zip: , / - � License: - �- . , � . ' � _._ , , - �, � � �- _ �.SCOPE OF PERMITr � � ��; �. ', � � , ��,� �� INSTALL WALL SIGNS, MONUMENT SIGN, AND DIRECTIONAL SIGNS FOR-EZ LUBE - 272 S�UARE '� � FEET TOTAL FOR ALL SIGNS. AL ARE ILLUMINATED SIGNS. .� � . � I-�� . / � � • __ J � �,� "� :�_/ dn%, — -FEE SUMMARY;' ,-.'- - � � -� �- ; _ 'l �,�� ; � PlanCheck: $99.61 �� j� ' CalcValuation: i�'sa,000.00�' �-'.�, $0.00 Permit:' $153.25 _, �. Claimed Valuatic SMIP Com. . $1.68 � Other.i $0.00 -_�• �' ' � ' \ � � $0.00 - ,�/ Inspection� �$0.00 � � ';�'" �> c, .r ; � �V � �$0�00 � ��._ �/ �,� - � _ �, � / �� , ( _ ,,i � % i 5a,000:oo /�;'� /�J /; 4,/ �f �% � =-J L �l `� � �� \�� i/$0.00 �\� , ,_, ' ,o � �� j A ��V � � �� . �/ �\ � , � �� . � � Total� � $254:54 � � � ' ; '� ��,� � ��. � �� ., l �,� i: . , i� / � ,�V -�� PLANNING�&ZONINGC�� U��/�� : „ / –� .� �i. / � NOTES: �� _ . � , A � � : _ , �- - /j �% � i ' � NOTICE: Tha work authorized by this permit shall comply vnth all applicable handicap access requirements under Califomia sta[utes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become void il work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlons end flnal approval must be obtained. Failure to obtaln inspeclions and final approval will result in the expirationoi this permit. FOR INSPECTIONS CALL: (714) 7545626 • • 2446d8 (fl�W) WORKERS' COMPENSATION DECLARATION: . � , • I hereby eHirtn untler ponelty ol perjury one of Iha tollowing dedarellons: � ❑ I heve end wlll melntein e cetlificata af consent to self-Insure for workers' compensatlon, as provitletl lor by section 3700 0l the Lebor Coda, for ihe peAarmence of the work lor which ihle pertnit is issued. I heve entl wlll mainWin workers' compensetlon Insurence, es requirad by sectlon 3700 of the Lebor Cotle, for the peAortnence of the work br which Ihis pertnit Is Issued. My workers' compensation Insurance carnar end polity number are: Ca,s sectl �n� let� e� Poliq Number. ��.5 �.� —� (Th p permit is ve/ueO at one huntlretl dollars (5100) or less.) ❑ I cenity thet in �ho paAartnance o1 the work for which Ihls purmit is issued, I shall not employ any person in eny manner so es to become subject to the workers' compen alilomie, and egree l�at It I Should become sub�eCt Io Ihe warkers' compenseilon proW5ion5 oi Sectlon 3700 of Ihe Lebor Cotle, I shell forthwlt� with t�ese pro s4 � . cen�slpoeture: ' oa�e: ,!s/a/ ARNIN(3: FAIW SECUqE WORKERS' COMPENSATION COVEMGE I$ UMAW FUL AND SHnLL SUBIECT lAP�OYER TO�j'iI NAL PENaLT1E5 M1D pVIL FlNES UP TO dJE HUNDRED E(5100.00OA IN qOdTION TO iHE COST OF COMPENSITION, DAMAGE5l5 PROVIDED FIXi IN SE�'ITCW7�OF THE IABOq CODE, IMEflEST, AND AiTORNEV'S FEES. L�ICE�I..ED NTRACTORS DEC ATION: 1'hereb itirm Ihet I em license nder pmvisions of Chepter 9(wmmencing wilh Section 000) of Divisian 3 of tha Business en Pmfessions Cotle, antl my license Is in tull forca nd eHect Lic. p 4� Cless N !' (^ Con ectoYs Slgnetur � Date: � /�9 O/ C6NSiRUCTION LENDING AGENCY: �— ❑ 1 hereby eftirm Ihet Ihere is a consWction lentling epenty tor lhe peAormance ol the work for w�ich Ihis permil Is iuuetl. (Sec. 3097, Civil Catle). Lentler's Name: Landefs AdAress: Signature: OWNER-BUILDER DECLARATONS: Date: I �ereby aHlrtn I�aI untler penalry,of pe�jury Ihet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the followirig reason (Sec. 7031.5, Business entl Professions Cotle: Any dry or counry w�icti requires e permit to conswct, elter, improve, demdis�, or repair eny siructure, pdor to Its issuence, elm requires Ihe epplkanllor such permit to flle e sipnetl stetement t�al �e or she is Ilcensed pureuent ta the provlsions ol ihe Contractors Llcense Lew (Chepter e(commentlng wit� Section 7000) of Dlvisian 3 of the BuSiness en0 ProfeSsionS Cotle) or t�at he or she I5 exempl Neretrom end l�e besis fw ihe elleged exemptlon. Any violalion ot Sectlon 7031.5 by eny eOPlicant lor e permil sublec�s the eOG�icant to e civil penalry ot not more tnan Iive �undred dollers (5500)J: ❑ I, as owner ot t�e properry, or my employees with wages es thelr sole compensation, WILL DO 7ME WORK, and Ihe structure is not intendeA or oftered tor sale (Sec. 7044, Business entl Professions Gode: The Conirectors License Law does not appty to an avner oi property who builds or improves Ihereon, and who does such work himsell or herself or through his or her own employees, proWtletl �hat such Improvements are not Intended or ottered lor sale. If, however, the building or improvement is � soltl within one year ot completion, iha owner-builder will heve t�e burtlen ol proNng that he or s�e tlid not build or imprrne for purposa of sala.). ❑ I, es owner ol ihe propatlyqem EXCLUSIVELV CONTRACTINC WI7H LICENSED CONTRAC70RS Io consirucuhe prolect (SecJ0d4, Business antl Pmfosslons Code: The conlrectors License Law does not epply to en owner at propeny who builds or improves Ihereon, entl who cantracts for such project wit� e contrector(s) license pursuant to the Coniractors Licenso�.ews.). ❑ I em exempl under sec. Busineu end Pmlessians Cade lor this reason: Signa W re: Date: Owner ID veritietl by Crivefs Ilcense. ❑ Yes ❑ No Driver's License No. Expires: Vedficatlon ol Ownership by (rype oi document, i.e. - properry taa bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: a ❑ I hereDy certify that no exwvetion tive (5) or more teet in depth Inta which e peroon is required to descentl, wlll be made in wnnection with work auihorized by this pertnli, and ihat no building structure, scaMolding, lelsework, or Cemoli�lon or dismantling �hereot, will be more Ihan iNrty-sis (36) teet hiqh. (Chap. 32, Grp 2, Ar12, Sec. 345, Title 8, Celitomia Administretive Cade). ❑ As owner•bulltler, I will not emDloy enyone to tlo work w�ich would require a pertnit Irom Ihe Division ol Intlusirial Sefety, es notetl eDove, unless such perean hes e permlt to tlo such work Irom the division. Signeture: Date: Division at Industrial Sefery Permit Number: CEHTIFlCATE OF COMPLIANCE AND AUT}iORiZA710N.OF EMAY: I certify under penalry of perJury i�et I have read this flpplicetion end state Ihat Ihe information given is wrred. I egree to comply with all state laws end ciry oMlnances relating to bulltling constmction, antl euthonze representatives o( the Ciry ot Cos�a Mesa to enter upon the above-descnDed pro�erty br inspection purposes. I agree not to occupy or allow acwpancy ot any builtling eutharized by ihis permit until fnel inspection. I�IF137�CEiJ_SilPlii IIi� 7818 1268 Fixed System Final Fire Preventlon Pool Spe Final 200 Finel Re-Root 201 Finel BIocWRetaining Well 202 Flnal Fectory Fire Place 203 Finel Sign 204 Finel Demolition �� IoILL CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 272 Finel Fire Prevention 220 Finel Planning Appmval 222 FInaI5lte 250 Final Bullding/Occupancy Q� � INTRIALS (714) 754-5273 • Fan (714) 754-4856 • www.cl.costa-mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 400 E 17TH ST Suite No Vicinity: Parcel Number: 11732134 � MECHANICAL PERMIT i'' npplicanc TA CONSTRUCTION. % " - Address: 1717 W ORANGEWOOD #B � �,'i�. - �'� � / �; ORANGE: CA��. � ��/ i � ��- Owner. STEINMETZ,.SHARON L Address:� � 109 FERNWOOD DR � /;� � � � ��' � WARNER ROBINS, GA / i , � � Contractor:� �TA CONSTRUCTION J ��qddress: 1717,WORANGEINOOD#B � � . �� , , .. , ' � � � _ , ' OR4NGE, CA - � . _ �. Arch/Eng: , ,� . . � � Address: - ' � - i, Phone: (714)634-4400 �, � Zip: 92868 . Phone: Zip 31088 �.Phone: (714)634-4400 �, Zip: 92888 � �_ .; � License: 704343 ' � ' , —. �`- . Phone ' � � - - - '' � Zip. V � ��i License: �� , _ �, . 1 ; '� _ ' , '� � ; ' ' � SCOPE OF PERMIT % . , i-�, �� '� REF600.00308. �----'' _ �-7 _ . -�/�_- �,: _ '•1 `��` `� �`, �`,,1 PACKAGED HEA AND 1 COMPRESSOR UP TO'3HP.T PUMP, EZ LUBE. � > , �_ ., _ �. � � Status: ISSUED Applied: 02/02I2001 Issued: 02/02I2001 ISSUED BY: �_�Z� � � �\ �� \ �\ ,\ i � \ / � \ \�' �� ` � - / �. �� \�, � A � �� `�.. �� \ � ,? �� , � � i� � . � �� . _- � �,� � � t � �, . � \ � �� ,� �`� ; , � FEE SUMMARY - ' , �'� `�`� ' �\ , ' Quantlry ISSUEFEE. \ ! �` �� $23.50 '�RepairlAltAbsorbtionUnit � Inst FAU <700 k BTU ��, $14.80 1 - Repam'/-Alt Refrigerahon Unit RepaiA/�AIt�C olBgHeat� �\\\:;$000_-,0,, .. ,�� -,,\`°Evapo�rative'Cooler.,--'°-.: ii Inst I Rep. Reces's,Wall Hlr /� �$0 00 0`� , ., ; - Commercial Incinerator {- d Refrig Sys <100 k BTU / i ^ $0�00 � 0 ; - � . ' �Domestic Incinerator �j �� /�/ Refrig Sys >700 k.BTU, ��G� ✓$0 00\0�� -- � ° Compressors I Absomlioo-Svster GasPiping �� $000 �0\\�A�� oUpto3hp/_100,k�.BTU` � �\ Factory Fireplace �- . �$0 00� �0 � , � � � �.c.3 To 15�hp-1�500 k BTU��O \ Nood w/Mech Exhaust �� .$0.00 -,0-�� = 15 ToJO hp % 1,000 k BTU � VAV Box �� ;� $0.00 �� 0�� i� -� � 30 To 50 hp,l; 7,750 k BTU� �� Vent Fan / Single Duct �$0.00 � 0�,, �; '- ' _� r, 03er 50 hp � Ovei 7,750 BTU / v Appliance � $0:00�_ 0 ".` ^ � . Boilers �� Fire Dampers �$0.00-- - 0 • - � _� V� - Up to�3 hp-- � �/% � Smoke Dampers $0.00-�� 0 � - 3 To 15 hp;;,% -! `, � Inst or Relocate Appl Vent $0.00 0 � � - � . . ,�-�.15-to�30 hp_= - - - Air Handlers < t 0000cfm $0.00 0 ' ----30 to 50 hp Air Handlers > 10000cfm $0.00 0 Over 50 hp Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Meater $0.00 0 Investigation Fee Plan Check Fee . Reinspection Fee f;i, �� ( � J/'% _ ' , f,,,;� ti " ' \ ii / � �� i Qu� "� �$0.00� ,0 % ,/j� $0:00% 0� �-/I $0.00 �/0 �So.oO% o /� 50;00/0 �V�� $� 0 ,�/, �o$000 a �5o.ao 0 $0.00 0 ��. � $0.00 0 � � $0.00 0 TOTAL CALCULATED FEES COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by thls permit shell comply with all applicable handicap access regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced w lor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit lo be considered legal, such requlred Inspectiona and tinal approval must be obtained. Failura to obtain inspections and final � POR INSPECTIONS CALL: (714) 754-5626 2d4&48 (8'00) $14.70 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 E53.00 {¢Wer_CeUlomia statutes and related or if work is suspended or abandoned must comply with all applicable codes, and all I eal will result in ihe expiration.ot this permit. WORKERS'COMPENSATON DECLARATON: � I �ereby aHirtn under penalry ol perjury one ol the following decleratlons: ❑ I heve end W�ll malntein e certificete of consent lo selbinsure br workers' compensetlon, as prodAotl br by sadion 3700 ot the Lebor Code, lor Ihe peAortnance ol Ihe rk br whicli this pertntt Is issuetl. I have arq W�II meintain workers' cwnpensetion insurance, as requirea by sectbn 3700 of the Labor Code, tor tha performance ol lha vrork tor which this pertnil is issued. My work o ns/et�/on� Insurance carder e poNty�/um6�� r are: y—� �y Carne : - � � / .i`)r :�es?�+��w .YY/.SCG/'d��cP A'K--e � Poliry Number. �y 7 � I O � —O � (Trils secf/on need nat be comp/efe i! Ihe pemrit is ve/uetl et one hundred dollers ($ 00) or less,) � ❑ I certlty thet �� Ihe peAormenCe oi �h ork �or which tNs permlt is issuetl, I shell not employ eny person in eny manner so as to become suDject to the workers' compensatlOn laws ol Callloml. a gree that It I shoultl bewme sub�act to Ne workers' mmpensetion provisions of Section 37/pp oi t/11��aa LaDor Cotle, I shell lorthwlih want Signe � P�d �p : �, / ��a � �> AILURETOSECURE � (ERS'COMPENSATIONCOVERAOEISUNL4WFUlANDSHALLSUBIECTANEMPLOYERTOCRIMINALP TIESANDCMLFlNESUPTOONEHUNDRED THOUSAND DOLUFE (5100,000), IN ADDITION TO TME C0.5T Of COMPENSATION, DAM4GES AS PROVIDED WR IN SECiION 3]OB OF TME IABOR COOE, IMEREST, AN� ATTOfiNEYS FEES. LfCENSED CON7F�ACTORS DECLARATON: 9 (rnmmencing with Section 7000) eflect. Lic, A, rs Signature: Class q Dete: Cotle, and my license Is in lull COfTSTRUCTION LENDING AGENCV: ❑ I hareby eflirm �hel there is e construction lending agency for lhe pertormance ol Ihe work tor which this permit is issuad. (Sec. 3097, Cml Code). Lentlefs Name: ' ' Lendefs Atltlress: Signature: oate: OWNER•BUILDER DECLARATIONS: I hereby eftirtn thal untler penelry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW br the tollaxing reason (Sec. 7031.5, Buslness enC Professions Cotle: My ciry or Gounry which reQuires a permit to construct, alter, improve, demolis�, or repair any siructure, prior to its issuance, elso requires the applicant for such pefmit to file e signetl sta�ement Ihet he or s�e is Iicensed pursuant to the proNsions ol the Cantrectors License Lew (Chapter 9(commencing wilM1 Sectian 7000) ot Division 3 of the Buslness anE Protessions Code) or lhet he or she Is exempt theretrom and t�e basis for the elloped examption. Any Woletion ai Sectlon 7031.5 by eny epplicant lor e permi� sub�ects the eppllcent ta e civil penalty of not more lhan five huntlretl ddlers (5500).): ❑ I, es owner o� Ihe property, or my employees with wages es their sole compensetion, WILL DO THE WORK, end Ihe structure is not intentle0 or oHeretl for sale (Sec. 7044, Business antl Prolesslons Code: Th8 Coniractors License Law does not eppty lo an owner of property who builds or improves Ihereon, end who dces such work himsell or he�setl or �hrough his or her own employees, proWdetl that such improvemenis are not intended or oMered for sale. If, however, the building or improvement is sWd wltMn one year W completion, the ownorbuiltler will heve the burdan ot proving ihat he or she tlitl not buiitl or Vmprova tor purpose oi sale.). ❑ I, as ownar o<<�e proporty, em EXCCUSIVELY CONTRACTNG WIiH UCENSED CONTRACTORS to consiruct Ihe project (Sec. 7044. Business end Pmfessians Cade: TTe cOntractors LJcense Lew does not eppy to an owner at property who bullQs or Improves thereon, antl who contracts tor sucn pro�ect wlt� e coniractor(s) license pursuant to tha Coniractors License Lews.). ❑ I am ezempt under sec. Slgnawre: Owner ID verilled by tlrivafs liconse. ❑ Ve9 ❑ No Business anC Pmtessions Code for Ihis reason: Venfication of Ownership by (type oi document, i.e. - properry tax bill or deetl): Drivols License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFlCATION: ❑ I hereby cenity Ihat no excevation live (5) o� more feet In depth inb which e person is requiretl to descenq wlll be mede in connection wilh woAc eulhodzed by Ihis permit, and tpat no builtling simcture, sceHoltling, lalsework, or demolition or dismantling thereof, will be more then thirty-six (38) foet �igh. (Chap, 32, Grp 2, Art 2, Sec. 345, Ttle 8, California AtlminlstraWe Cade). ❑ As ownervbuiltler, I will nal employ enyone to tlo work which woultl require e partnit trom t�e Division of Industrial Safery, as notetl above, unless such person hes e permil to tlo such work from Ihe tlivision. Signalure: Date: _ Division ot Intlustrial Safery Permit Number: CERTiFlCATE OF GOMPLIANCE IWD AUTHORVATIONOF EMRY: I cehity under penalry of pe�jury Nel I have reatl this epplicatlon entl state that lhe infortnatlon give� �s cortect I egree ro wmpy wit� ell state laws end ciry adinances relating to builtling construction, antl euthorize representatives of the Ciry oi Costa Masa to enter upon the ebove-described prOperiy �or ins0ec�ion purposes. I egree not to oauDY or allow occupancy oi eny building euthorizetl Dy t�is permit until final inspection. cooe �. 161fi 7286 200 201 202 203 204 Fi:ed System Final Fire Pravention Pool Spe Final � Final Re�Ro�i Finel BIocWRetaining Well ' Finel Factory Fire Place Final Slgn Flnal Domtllitlon ¢eie' Il�e�s COOE� INSPECTIONTYPE 206 Final Mechanical 200 Finel Plumbing 210 Final Electncal 212 Flnal Fire Preventlon 220 Final Planning Approval 222 Flnal Site 250 Final Building�Occupancy �. � ��. . � � • �:r (714) 754-5273 • Fex (71a) 754-aBss • www.cl.costa-mesa.ca.us PLUMBING PERMIT Job Address: 400 E 17TH ST � Suite No Vicinity: Parcel Nunmber: 11732134 Applicant: ROBERT OWEN Address: 2218 LAUREL PL NEWPORTBEACH,CA Owner: STEINMETZ, SHARON L Address 109 FERNWOOD DR WARNER ROBINS, GA Contractor. ROBERT OWEN BUILDING CO Address: 2218 LAUREL PL Arch / Eng : Address: NEWPORT BEACH, CA Phone: (949)6313820 Zip: 92663 Phone: Zip: 31088 Phone: (949)631-3820 Zip: 92663 License: 471754 Phone: Zip: License: i i rnm �ni vc� vva i.. �.��.,... .... ��..�.. Status: ISSUED Applied: OBI03I2000 Issued: 08I03/2000 ISSUED BY: � SCOPE OF PERMIT DEMOLISH 98 SF FRUIT STANDNJOOD SHACK TO PREPARE SITE FOR NEW EZ LUBE BUILDING AND CAP OFF SEWER. - REF:B00-01184 ISSUE FEE Backflow irrigation �_ .. BackFlow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over a outlets) Gas Repipe - Gas Service Interceptors (Grease, Oil) Interceptore (Sand Auto ) AMT $23.50 $0.00 50.00 50.00 50.00 $0.00 so.00 $0.00 $0.00 $0.00 50.00 30.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 30.00 50.00 Qn FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 70 N) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $9.80 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 Qrr 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS SumpPump. , � Swimming Pool , � Trap Primer: - , Urinal ' `�� "' , Vacuuin Brkr BkFlow(1-4) � Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System � Water Closet (Toilet) Water Heater I vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 533.30 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NO710E: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) . EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. - � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions and (inal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 zsasre�aroo� WORKERS' COMPENSATION DECLARATION: I heroby aRirm unAer penelty of perjury ona ol the following decleretions: � � ❑ I heve entl wlll malnlain e certificate ot consent to selt-Insura tor workers' compensetlon, es proWtleO tor by saction 3700 of the LeDor Code, for the peAormence of the %�ik Por which Ihis pertnl� I5 issuetl. []' I have enO Mill mainlein wwkers compensaUon Insurence. as required by sectbn 3700 01 the Lebor Code. Iw Ihe peAortnance oi tho work fa which ihis permit lv IsweO. My warkers' wmpensatlon �nsurance certier enA policy number ere: Cartier. Pdicy Numher. (Tfils sectlon need not be oomp/efetl i! fhe pemtir ls velued al one hundred dd/ars ($100) or less.) ❑ I cartity that in the peAormance ol ihe ork t whlU Ihis pertnit is IssueO, I s�ell not employ any peroon in eny menner so as to become subject to the workers' compensation laws ol Calll �an gr i t It I should becomo sub�ect to Ihe workers' compensatlon pmvi,sions of Sectlon 37 0l Ihe Labor Code, I shall fonhwith comply with Mese pm�dsi � s ' �/ / Applicent Signatura: Date: �.�i' � � WARNING FAILURE TO SE RE W RKERS' COMPENSATION COVEMGE IS UNIAWFUL AND SNALL SU6IECT AN EMPLOVER TO GRI PNALMI� E LTIES M1D dVIL fINE$ UP TO ONE HUNDRED T/IOUSAND DOLLARE �5100,000), IN ADDRION TO TME COST OF QOlAPENSATIpJ, OAMAGES AS PROVIDED FOR IN SEGfION 31060F iHE V�BOR OODE, IMEREST, M!D ATTOqNE1^S FEES. LICENSED COHTRACTORS DECLARA710N: I hereby aMirtn that I am Ilcensed under proNsk lorce and eXect. Llc. q Y ContrectoYs Signeture: �+ CONSTRUCTION LENDING AGENCY: Chapter 9(commencing with Section 7000) of Division 3 of ihe Business�Professions Cotle, and my Ilcense Is in full CI355 k oaie: R � --, ❑ I hereby affirm ihet thore is e consiruction lending agenty for Ihe peAartnance of I�e work for which this permit is issuetl. (Sec. 3097, Civil Cotle). Lendefs Name: Lendefs Atltlreu: SlpnaNre: Date: OWNER-BUILDER DECLARATIONS: � . I hereby eHirtn Ihet under penalty ol perjury Ihet I em EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW tor Ihe following reeson (Sec. 7037.5, Buslness entl Profeulons Cade: Any dry or counry which requires e pertnit to wnstruct, elter, improve, Oemolish, or repair any structure, prior to its Issuance, elso requires the epplicant for such pertnit lo lile e signed stetement Ihet he or she is Ilcensetl pumuant to the provisions of Ihe Contractors Lkense Law (Chepter 9(commendng wilh Sectian 7000) ol Dlvlslon 3 oi the Business and PrWesslons Code) or Nat he or she is exempt therefrom entl Ihe Easis for Ue alleged exemptlon. My violatbn of Seclion 7031.5 by any applicam for e pertnit sublecLs lhe ep0�kent to e civil penalry of.qpt more then live hundred dWlars ($500).): ❑ I, as owner ol ihe properry, or my employees with weges as Iheir sole compensetion, WILL DO THE WORK, ena the siructure is nol Intended or oMereE lor sele (Sec. 7044, Business and Prolessions Code: The Contractors License Law does noi epply lo an owner ol properry who 6uilds or improves thereon, and who Oous such work himself or herselt or Ihrough his ar har own employees, provided that such improvements ere not Intended or aHered for sale. Ii, however, ihe building or imprwement is soltl within one year of comple�ion, Ihe ownar�6uilder will have �he burden of proving that he or sho did not build or improve br purposo ol sale.). ❑ I, es ownar ol Ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ta construct Ne pra�ect (Sec. 7044, Business entl Professions Cotle: The contraaors License Law does not epply to an owner ot pmpeny w�o bWltls or impmves �hereon, end who conirects lor such prqect with a contrector(s) license pursuan� to Ihe Coniractors License Laws.). ❑ I am e:empt under sec. Business end Prolessians Cotle for this reason: Slpnature: Date: Owner ID venTed by drivefs licen5e. ❑ Ye5 ❑ No Drlvefs License No. Expires: Vedficetion of Ownership by (type ol documem, i.e. • property tax blll or deetl): DIVISION OF INDUS7RIAL SAFETY PERMR CERTFICATION: ❑ 1 hereby cetliy ihat no excevatlon five (5) or more leet In depth into which e person is required to descend, will ba made in connection with work authodzed by this pertnit, end Ihat no building sirucNre, scaNWAing, lalsework, or demolition or tlismantling thereol, will De more Ihen �hiny-six (38) feet high. (C�ep. 32, Grp 2, Art 2, Sec. 341, Title B, Californla Atlministrative Cotle). ❑ As owner-builder, I will nol employ enyone to do work which would reduire e pertnit trom the Divlslan of Industrial Safery, es rroted above, unless suc� person hes e pertnit to tlo suc� work trom ihe division. Signature: Date: Division ol Intlustnal Selery Pertnit Number: CEHTIFlCATE OF COMPIIANCE AND AUTHORIZA710N OF ENiAY: I cenity under penalry of perjury that I have read thls appllcaUon antl state Net the inlormation given Ls corteq. I agree to wmpty with all state laws end dty oNinances relating to Duiltling construction, antl euthonze represanlatives of the Clry of Costa Mesa to enter upon the ebove-0escnbed Droperty for inspection purposes. 1 egree not to oaupy or allax accupanry of eny building authorized by this pertnit until tinal inspection. S tu Of Legel Owner(s) �/�/�� Date AnNOr Authonzed AOPlicsnt � Date CODE I. INSPECiION TYPE 1616 Fixed System Final Fire Prevention 1268 Pool Spe Final 200 Final RaRoof 201 Final BIocWRelalning Well 202 203 Final Fectory Fire Place Final Sign 20C Final Demolitlon �g � COOE 1 INSPECTION TYPE 208 Fnal Mechenical 208 Flnal Plumbing 210 Final Electrical 212 Finel Fire Prevention 220 Final Planning Approval 222 Fine15ite 250 Final Builtling�Occupanq �. 1 1.1111" ��.� % (�ia) 75a-52�s • Fax (7ta) 75a-aess • www.ci.costa-mesa.c�.�LDING PERMIT n FAIF UHIVt, GU51A MtJA, GA tlYtl26 ,lob /+ddress: 400 E 17TH ST Suite: Vicini[y: AT FONT OF PROERTY ON 17TH ST Parcel Number: 11732134 Applicant: ROBERT OWEN Addtess: 2218 LAUREL PL NEWPORT BEACH, CA Owner: STEINMETZ, SHARON L Address 109 FERNWOOD DR Zoning: Phone: (949)6313820 2ip: 92663 Phone: WARNER ROBINS, GA Zip: 37088 Contrector: ROBERT OWEN BUILDING CO Address: 2218 LAUREL PL Phone: (949)6313820 NEWPORT BEACH, CA Zip: 92663 � License: 471754 Arch : Address: Eng: Address: Status: ISSUED Applied: OBI03/2000 Issued'. 08/03/2000 ISSUED BY: Phone: � Phone: " Zip: License: License: SCOPE OF PERMIT DEMOLISH 98 SF FRUIT STANDNJOOD SHACK TO PREPARE SITE FOR�NEW EZ LUBE BUILDING AND CAP OFF SEWER. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $11125 $0.00 $0.00 $0.00 $0.00 $111.25 SETBACKS MAIN STRUCTURE,Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: 0 NOTES: ` Rezr , 0-0 Rear 0-0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Lefl 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: j Right 0-0 ��-'� / � �, . � , i Right " 0- 0 - $5,000.00 Ss;000.00 NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requiremeMs under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void il work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inepectiona and Iinal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of ihis permit. FOR INSPECTIONS CALL: (714) 754-5626 2aac�a6le/ool �/ WORKERS'COMPENSAnON DECLARAnON: I hereby eHirtn under penelry ol perjury one oi ihe tWlowing decleretions: ❑ I have end wlll melntaln e certlticate at consent to sell-Insure for workers' crompensetion, es proNtled for by sectlan 3700 0l the LeDor Code, lor the peAormence ot the w br'w4ich this permll Is iuuetl. I heve antl wlll malnialn workers' compensatbn insurance, es requiretl by seclbn 3700 0l ihe Lehor Code, for Ihe peAwmance of ttie work lor whlch thls pertnit is iswetl. My workers' compen�llon Insurence cartier antl policy number aro: Cartier. ��`� Policy Number. (This sect(on need nof be canp/eted i! fhe permif is velued ef one hundred dWlers (E I00) or less.) ❑ I certity thet in Ihe performance of t e work for which this permit is issued, I shall not employ any Derson in any manner so as to become sub�ect to the workers' compensatlon laws oi C id 5, a agre i t If I should become sub�ecl to Ihe workers' compensatlon provisions of Sec on 37 at the La�or Code, I shall forthwith comply wiN these pr ' o l /jT Applicant Signature: Date: � �� 1/ V WARNINO: FAILURE TO 5 WRE WORKEPS' COMPENSATION COVEMGE IS UNUWFl1L AND SHNL SUBIECT AN EMPLOVER TO CRIMINAL PEf�NLT1ES AND GVIL FlNES UP TO ONE MUNDRED TFIIXISRND OOLLARE (5100.000), IN ADORION TO THE ODST OF OOMPENSATION, OAMFGES l5 PROVIDED FO{i IN SECiION 31W OF TME UBOR ODOE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn that I em rorce antl ettect. Lic. a_ ConlractaYs Signeture: ol Chapter 9(cammencing with Section 7000) ot DiNsion 3 0l Na Business and tessions Cotle, antl my license Is in f W Class a �� oate: ,r� / 3 CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn thei ihere is a consiruction lending agency for the peAortnance ot ihe work for which Ihis pertnit is issued. (Sec. 3097, Civil Coda). LentleYs Neme: Signelure: _ OWNER•BUILDER DECLARATIONS: � `�nv Lendefs Address: Dele: I hereby eMirtn thet under penelry at per�ury that I am EXEMVT FROM THE CONTRACTORS LICENSE LAW tor Ihe lollowing reewn (Sec. 7031.5, Business entl Professions Cotle: My ciry or caunry which requires e pertnit to consiruct, alter, improve, demolish, or repair any siructure, prior to its Issuance, elso requires Ihe epplicaN for such permit b tile e signeA stetement Ihat he or she Is licensed pursuant to ihe proNsions ol ihe CONrectors Lbense Lew (Chapter 9(commendng wllh SecHan 7000) oi DMslon 3 ot the Business entl Prolessions;Cade) or thet he or she is ezempl therefrom an0 the Dasis for the alleged e:emption. Any violetion of Sectlon 7031.5 by eny applicent for e permit subjects iha epplicant to a civil penalty of nol more t�an frve �untlretl tlollers ($500).): ❑ I, as owner ot the propeny, or my e�ployees wiih weges es iheir sole compensation, WIIL DO THE WORK, and Ihe structura is not intendatl or otferetl tor sale (Sec. 70aa, Business entl Professions Code: The Contrectors License Lew does rrot appty to en owner ot pmperty who builds or impmves thereon, end who tloes such work himseH or herselt or thmugh his or her own empbyees, provided Ihat such imprwemenLs are not intended or oHered br sele. tl, however, the builtling or improvement is sold within one year ol comDletion, ihe owner-builtler will have Ihe hurden of proving Ihat he ar she did nat build or improve lor purpose ot sele.). ❑ I, as owner ot t�e properly, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ne prqect (Sec. 7044, Business a�M Professions Cotle: The convectars Ucense Lew does not appy to an owner at properry who builtls or Improves therean, end who contracts lar such project wit� e contwc[or(s) licen5e pursuBnl to UB Contraciors License Laws.). ❑ I em exempt under sec. 'J Business antl Prolessions CoAa tor t�is reason: Signature: Dete: Owner ID verilled by drlvefs Iicense. ❑ Yes ❑ No Drivefs License No. Expires: Varilication ol Ownership by (rype of document, i.e. - properry tax blll or deetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICA710N: ❑ I hereby certi y I�et no escavatlan tive (5) or more teei in tlepih inio w�ich a person Is requiretl to tlescend, will be matle in wnnection wlih work euthonzeG by �his pertnit, and ihal no builtling siructure, scaHolding, falsework, or tlemolition or tlismantling ihereof, will be mora than thirty-six (38) teet high. (Chap. 32, Grp 2, A� 2, Sec. 341, Tiile 8, Califomie Administrative Cade). ❑ As ov.•ner-Duiltler, I will not employ anyone Io tlo work which would require a permit Irom the Division ot Industriel Sefery, as notetl ebove, unless such person hes e pertnil to do suc� work trom the division. - Signeture: �ate: Division ol Intlustriel Satery Pertnit NumDer. CERTIFlCATE OF COMPLIANCE AND AUTHOR¢ATION OF ENTRV: I cenity under penalry of perjury that I have rea0 IhiS appliwtlon end siate thet the infortnation given is correci. I agree lo compty with all stete laws and clry ordinances relatlng to Euiltling construciion, end euthonze represenleGves o1 the City ot Coste Mesa to enter upon Ihe ebove-descnbed pmperry tor inspection purposes. I egree nm ro occupy or allow occupency of any building authorized by this permit until finel inspection. ign ture Of Legal Owner(s) � B�eT '%� (l lJ —T—T AnNOr Authorized ApPlicam Date CODE I, INSPECiqNTYPE PAIE I�Lfi 1616 F:eA System Final Fire Prevention 1266 200 �1 202 203 Paol SDa Flnel Flnal Re-Roof Final Block/Hetaining Well Final Faqory Flre Place Finel Sign WDEt INSPECTIONTYPE 206 Flnal Mechanicel 208 Final Plumbing 210 Finel Elecirical 212 Finel Fire Prevenlim 220 Final Planning Approval 222 Final Site 204 Final Demolition //�� ////✓ 250 , Final Building/0ccupan�y QAIF. Qf�A49 ✓ = ,_.. ' . . , �� 6385 . COSTA MESA BUILDING DEPARTMENT P.O. BOX 31] COSTA MESA. GALIFORNIA FOR APPLICANT TO FILL IN BUILOING �DD �. I � �' � ADDRE55 COSTA MESA. CALIFORNIA OWNER MAIL AODRE55 Mo�rs � � � TEL. ��NO. LIC. NO. UTY LIC. �% �. / oescvirnoN 1N0. IBLOCK ITRACT A.P. NO. I I / '—� �7 � — ^ � � SIZE •�� NO.OF BLDGS. OF LOT �S�X �S V now orv LOr USE OF '/� � EXISTING BL�G. G� SETB�CN LINE FNOM �„_( T S� � CENtEH OF STREET � O (- REAR YARD 'Z SIDEYARD RIGHT �OT LEFT �'GO" J DESCRIPTION OF WORK NEW ALTERATION I ADDITION � REPAIR �MOVING DEMOLISH 5 ZIE DING �11'O b/ ROOMS STORIES I 7 COVERINGWA ��ROOF ,COVERING USE OF NEW ,{a � � n __ BUILOING /J /K�b.. � � �> h��C�i�� ° ` � 8 � c�-- . FINIINCE DEPT. ��„ �� rneTe n��cp APPLICATION' FOR PERMIT BUILDING FOR OFFICE USE ONLY ` ! o S d ' ADDRE155 —( OU � I�•� COSTA MESA. CALIFORN FIRE � /_ �/• � ZONE T ��R A PLO�NSn � TYPE / �J'^(V\, DATE CORRECTIONS hG � % / I NEflE�Y ♦CRNOWLE�GE THRT 1 MFVE REAO TNIS TPPLICATION �NO STRTE TN�T THE LBOVE IS COXRECT �ND eGREE TO COMPLY WITM 4Ll CITY ORDIN�NCES RND STI.TE L�WS FEGUL/.TING BUILOING CONSTRUC� iiOrv. �% VAI.UATION (% SIGNATURE OF Yu� �� / PERMIT FEE 5 f\ PERMITTEE � � g//c�a;-\ PLANCHECK S y� AUTHORIZED AGENT TOTAL FEE $� C- � `1 :,� �MiI ,I' .A - . � 0530 COSTA MESA BUILDING DEPARTMENT P.O. BOX 31� COSTA MESA. CALIFORNIA FOR BUIIDING ADORE55 � OWNER � MAII / ADDRES�� CITV � ARCHITEGT OR ENGINEER APPLICANT TO FILL IN Oo �%� � COSTA MESA. CALIFORNIA LEGPL LOT OESCRIPTION NO. A.P. NO.I� / •- � 5'ZE -6_rx OF LOT USE OF E%ISTING BLOG. SETB�CN �INE FROM CENTEF OF $TREET —.— p TEL. ^ L`7EAC� NO. LIC. NO. QY� LIC. ` NO. e I � NF_ilbS •Y' TE�. �� NO. BLOGK _ TRACT ' No. ov o�oce./ NOW ON LOT DESCRIPTION OF WORK NEW qLTERATION ADDiTION REPAIR • MOVING � DEMOLISH BUILDING NO,OF SIZE a I ROOMS STORIES E%TERIOR WALL�/�,,,��n ROOF � � COVERING �( �(/WY COVERING Um BUELDFNGEW ��FII � /✓�/IF��I�� ,;G�t� ��i�(��G�� C��,� � �IC�A�ICE D��'t. CITY 0� Gi?STA f: f�R APPLICATION FOR PERMIT � BUILDING FOR OFFICE USE ONLY S3 PECEIVED BY DATE RECEIVE DATE 155U1 �(� - -.S��// J� � � % ADDRE'S5 �G� G� L` / �_ -�;�� GOSTA MESA. CALIPORNIA FIRE ZONE IONE HO.OF iYpE GROUP 1 - PL�N9 �� i V /J / APPROV o � BV M?l � L �.. DATE � 2 f � /�/J Ta/v— 1 NEPFBY /.CNNOWLEDGE TH�T I HwVE FE�O THIS APPLICAtION tND STI.TE TN.�T THE 1BOVE IS CORRECT �ND �GREE TO COMGIY WITM �LL CIiY OflOIN�NCES /.NO ST�TE L�WS REGUL.�TING BUILUING CONSTflUC� T�ON. � VALUATION SIGNATl1RE OF . PERMITTEE �i. g / y y,s'. AUTHORIZED AGENT t ' / COSTn MESA PEFM�T FEE $ � PLAN CHECK S TOTAL FEE $ /x • ✓ ��` - : � ��', J�o �- COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 31] COSTA MESA. CALIFORNIA fOR APPLICANT TO f/ll /N COMPLETELY TYPE OR PRINT BUILDING � ADDRESS � OO COSTA MESA. CALIFORNIA OWNER D MAIL ADORESS Q Q // � GITY �nST�/`"JfSA /�AL. TrEio`: STATE 0 - �l�%' -� �. �-a �- A.P. NO. � OF LOT ,/i `�_ /�' J� I NO. OF BLOG9. V � NOW ON LOT SETBACK IINE RNOM CENTER OF 6TREET {EEAR YARD SIDE YARD ILEFT IRIGHT DESCRIPTION OF WORK NEW I II ALTERATION I II ADDITION I� REPAIR I II MOVING I II DEMOLISH I BUILDING � /. � � NO.OF !J SIZE �O � X Z�I ROOMS !� STORIES I EXTERIOR WALL /� ROOF ^ COVERING f�I/YLV COVERING ��%/i%// 1 HEFEBY 1CKNOWLEOGE THAT 1 HhVE READ THIS APPLICATION •ND STATE TNpT THE RBOVE IS CORRECT AND AGFEE TO COM� PLY WITH �LL CITY OHUIN�NCES �ND STATE LAWS REGULATING BUILDING CONSTNUC N%.%� /^'/ A SIGNATURE O )Cif l //. � _ // �L PERMITTEE�� ( � �b�o�� AUTHORIZED AGENT •� � . �'� RE��`I�E� ,�,��s. ,GFINNHfN+Ct,.,pUtPI. � APPLICATI�ON FO� P�ERMIT �iit uF l,�o�ti iriwn BUILDING FOR OfF/CE USE ONIY HEGEIPT NO. pEqy / C S .�"�°i RECEIVED BY OA E NECEIVED � DATB 188118D • � �D.�/ f .'a—:s� BUILDING /JO v � � /� � ADDRESS 7 COSTA MESA� CALIFORNIA • FIRE /� � ZONE TYPE GROUP /� � . BYPROVED � DATE /6�� Sl ONING l( ��. - ZONE��jf P ANS yl BUELOINOEW�� `f�L// ; . I =. 1. avPROVEDI '�' /" onTe /G� '��!-� -�> � . YARDS ` Eb REqU1RED AL (CENTEfl LINE BT.) FRONT � G �, TXB AMOUNT BHOWN UNOER VALUATION IB FOfl THE PUAPOBE OP EBTABLI9HING A PEPMIT FE6 ONLY. VALUATION �10 PERMIT FEE S �Q � � /79 L_ 5 J PLAN CMEGK $ � � TOTAL FEE 5 ��