HomeMy WebLinkAbout424 17TH ST - Building Permits• � I
City of Coste Mesa
Buildinp Satety DeOertmenc
P.O. Box 1200
Costa Mesa, Caiifomie
CERTIFICATE OF OCCUPANCY
7he Building located at
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicab�e thereto
for a Group
Use of Building_
Legal Description_
Building Permit No
15SUED TO:
ccupancy.
(See reverse side for Metes and Bounds)
lectrical Permit No. Plumbing Permit N
Number of apartm
and/or guest rooms
Building Official
by
Da[e
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the p�emises and SHALL NOT BE removed except by the
Building Official of the City of Corta Mesa under Sec. 306 (e) U.B.C.
FOrm BU 34 Rov.11J70
, � � �itp o f �o�ta 21� e5a
' Development Services, Division of B�c�r�r� a��
���
CERTIFICATE OF OCC�.��X a �a �
,,����>:-.z==E}_� CJ
This cerrificare is issued pursuant to thelrequiiements of.,the Uniform Building ode, Section
adopted by the City of Costa Mesa cernfies:that:at-the time of its issuance the building structure herein
below described was inspected and�approved=for�occupancy`as�follows:
� ,�����,�'>- �, �,
Building Address _ 424 E i17�ZH STHSBT -a � ��i�CBld¢. Permit No. B �4343
Use FSTAt xT
Group R-�
Owner of Building?
Address 900 E. Ca
of Gon�
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in_�aaemE
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11-,01',
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BUII.DING OFFICIAL-ZCOri'p
REQUIRED TO BE
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pbe1T, CA�95008 "�,
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\\�y,_ ,, , Date`C
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POSTED IN A CONS]
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Use Zone
PLACE. �
(714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FA�R DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 424 E 17TH ST
Suite:
Viciniry:
Parcel Number: 11732130
Applicant: GARY HAMNIOND : -
Address: � � �
� . - '
^ _- - -
Owner. LEAF; MARVIN�H TR '
Address /659 HOSPITALITY DR ' " .
/ " - ' � '- ' - �-
,RANCHO MIRAGE;,CA ;�. '
Contrecmr: OAKSTONE�CONSTRUCTION
Address: 4065 YOSEMITE PL
_ � PLACERVILLE, CA
Zoning:
Phone: 530-642-8858
Zip:
1
Phone:' - ' �
Zip: 92270
Phone:� 530-642-8858
Status: ISSUED
Applied: 04/21/2004
Issued: 07/22/2004
ISSUED BY: �
/ . �
�� .
�
�.�� �
�. "�
,, ,,
�
�
Zip: 95667 � License: 685535 , -
nrch : CROME ARCHITECTURE i� Eng:
Address: 85 BOLINAS RD � '- " � � � Address:- � '
SUITE 17 , , _�, � _Phone: 475-453-0700 � ,'�� � Phone: � .
FAIRFAX, CA � �' �"- ' ; ,
2ip: 94930 � � „ � �License: 25487 , License:
- - � - -- —� SGVF't�Vh YtKMII --. . -
1,038 SF INTERIOR TENANT IMPROVEMENT; 276 SF OUTD.00R DINING AREA AND REROOF (E)$LDG. WORK TO INCLUDE: NEW
PARTITIONS, FINISHES, FIXTURES, AND INTERIOR DEMOLITION FOR "PEET'S COFFEE & TEA" ,
Plan Check:
Permit:
SMIP Res:
SMIP Com`.
Other:
Inspection;
$645.94
$993.75
50.00
$21.00
$0.00
$0.00
� Total: $1,660.69�
�
\,-'
�
SETBACKS�"` �
MAINSTRUCTURE Front 0-0
ACCESSORY Front, 0-0
PARKING
� FEESUMMARY
%
Calc Valuation:
Claim Valuation: �
� ,;; :
i,.". ' _
%��%
_ /,
c_ ' �'�
PLANNING & ZONING i ` � ; i-
� , � , ,.
' , Rear - 0- 0 �-- " � Left
Rear . 0- 0 Left
� �
� �
Existing: 0�.�; � .�Re uired: �0-- �' Proposed:
Right ,0-0- ,�� %
� i
' �� � -' i. �i �
�-
� � Right�� O-Oj�
0' �!��
,� ,, �%
s�oo,000.00
s�oo,000.00
, ;
i
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and relatad
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order br ihe work authonzed under this permit to be considered legal, such wark must comply with all applicable codes,`—arW ell
required inspectlons end Iinel approval must be obtained. Failure to obtain inspections and final approval will result in ihe ex��aper im't.
FOR INSPECTIONS CALL: (714) 7545626
zaaeae(mvol .. ._ 1
WORKERS'COMPENSAnON DECLARAnON:
I �ereby atfirtn under penalry of perfury one of ihe following tlederelions:
❑ I heve end will melntaln e certificate of wnsent to selt-Insure tor workers' compensatlon, es proNded tor by sectlon 3700 oi Ihe Lebor Code, tor the pertormence M Ihe
work for which t�is permit Is Issuetl.
�I have and will maintaln workers' compensation insurence, es required by section 3700 of Ihe Lebor Cade, for the peAortnence oi Ihe wark for which this permit Is Issued.
��My�waikars' compensatlon Insurenca carrier antl policy numbe� are: ���
Gerder:, �1/✓iFYt/C.O�✓ �9/✓1L ,_qiPb/l/4��C'i'= i�(, Poliry"Number:
�` sectfon need not be comple ed i! fhe permit is ve ued ef one hundred dWlars ($100) or IessJ
� I certily that in the pertortnence ol the work or which Ihis pertnit is issued, I shall not employ eny person in any menner so es to become subjecl to ihe workere'
compensetion laws of Caiifpm a, end a� � et ii I shoulA be e sub�ecf ro Ue workers' compensation provisions of Sectlan 3700 of the Lebor Code, I shall forihwi[h
comp tMlieee�prov�si M1 �'7 Ol�
11pPlicant Si�tu�e:; -- L� � te: - /� 2' 7
N�OBWIINB. FA RE TO SECURE WORKEij OMPENSATIdJ COVERAOE IS UNUWFUL AND SHALL SUBJECT AN EMPL iF�OC�RIMINAIIPENALTIES AND dVIL FlNES UP TOONE HUNDRED
TFIOUSAND DOLLARE (5100,000), IN ADDIYfON TO THE COST OF COMPENSATION, DAM4GES AS PROVIDED WR IN SECTIIXJ 3lOfi OF THE LABOR CODE, IMEREST, AND FTTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
9(commencing wiih Sectlon 7000) of
Code, end my Ilcensa Is in full
CONS7RUC710N LENDING AGENCV: —
❑ I hereby attirtn thet Ihere is e construdion lending egency lor the pertortnance ot Ihe work lor which ihis permlt Is Issued. (Sec. 3097, Civil Code).
Lender's Neme:
Slgnature: _
OWNER-BUILDER DECLARATONS:
Lendefs Address:
Dete:
I hereby eHirm that under penelry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reawn (Sec. �031.5, Buslness end Professions
Cotle: Any ciry ar counry which requires e pertnit lo canstruct, elter, improve, demolis�, or repeir eny structure, O�or to Its Issuance, also requires the epDllcant lor such pertnit
m flle e signed stetement thet he or she Is licensed pursuem to the pmvislans ot Ne Contrectors LJcense Law (Chapter B(commendng with Sectlon 7000) ot Division 3 ai Me
Business end Professlons Code) or thet ha or she is e:empt Iherefrom and Ihe basis for the elleped exemption. My Wolation of Sectian 7037.5 Dy any epplicent for e pertnit
subJects Ihe epplicant to e civil penelty of not more thaafi�e huntlretl tlollars ($500).):
❑ I, es owner of ihe properry, ar my employaes with weges es their sole compensation, WILL DO THE WORK, and Ihe siructu�a Is not intentletl or oHeretl fo� sale (Sec.
7044, Business and Professlons Code: The Contrectors License Law dces not epply to en owner of property who bullds or Improves Ihereon, end who does such work
himsel( or herself or throu9h hls or her own emplo'yees, provlded thet such improvements ere not Intended or oHered for sale. It, however, the bulltlinp or Improvement Is
soltl within one year of completlon, the owner-builder witl �ave the burden of proving that he or she did not build or Improve for purpose ot sale.). �
❑ 1, es owner of the properry, em E%CLUSIVELY'CONTRACTING WI7H LICENSED CONTRACTORS to construct Ihe proJect (Sec. 7044, Business end Professions
Cotle: The contractors IJcense Lew tloes not apply to en owner ot properry who builEs or Improves ihereon, antl who contracts br such projec� wlth e contractor(s)
. license pursuant to the Contractors License Lews.).
❑ I em exempt under set.
Signeture:
Ownar ID verifietl by tlnvefs Iicanse. ❑ Yas ❑ No
Business end Professions Code for this reason:
Verificatlon of OwnershiD by (rype ol daument, i.e. - property tex blll or deed):
Orive/s License No.
Data:
Esplres:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity ihat no ercevetlon flve (5) or more teet in depth Into which a pereon Is requlred to descend, will be mede In connection with work euthodzed by ihis
pertnit, end Ihat no builtling structure, scaffolding, felsework, or demolition or dismaniling Ihereof, will be more then �hirty-six (36) Feet high. (Chap. 3.2, Grp 2, Ar12, Sec.
341, Tlle B, Califomie Aaminlstretive Code).
❑ As owner-builder, I will not employ enyone to do work which woultl require e permit irwn the Division of Industnel Sefery, es noted above, unless suc� person has e
permit to tlo such work irom the division.
Signature: Date:
Divlslon af Industrial Safety Permlt Number:
CERTIFICATE OF COMPLIANCE AND AUTHORRATION OF ENTRV: I certify untler penelty ol perjury ihat I have read ihis epplication and stale Ihet ihe inlormation given is
correct. I agree to comply with all state laws end city ordinences relating to builtling consimction, and authorize representetives of t�e City of Caste Mese to enter upon Ihe
ebove-described property for inspection puryoses. I egree not to occupy or allow occupency of eny building au�horized by ihis permit until finel inspection.
CO�E I. INSYELTIONTYiE
1616 Fixed System Finel Fire Prevention
1268
200
201
Pool Spa Finel
Final Re-Roof
Final BIocWRetalning Well
202 Final Factory Fire Place
203 FinalSign �
204 Final Demolition
Owner(s)
Q� �
COOEI INSYECTONTYFE
208 Final Mechanicel
208 Flnal Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
P�ff ItIIID�
(714) 75a•5273 • Fex (71a) 754-4856 • www.ci.costa-mesa.ca.us n rniN unrvt, GUJ I A MtpA, I:A'JZ6Z6
PLUMBING PERMIT
Job Address: 424 E 77TH ST
Suite No
Vicinity:
Parcel Nunmber: 11732130 , ,. -- .�,-
Applicant: GARY HAMMOND
Address: 4065 YOSEMITE PL
,PLACERVILLE, CA � -
/ � �
� � �
,��
Owner.� � LEAF, MARVIN�H TR
Address 659 HOSPITALITY�DR
;; ...
" RANCHO MIRAGE, CA
Phone: 530-642-8858 �
Zip: 95667
Phone:
Zip: 92270
Contractor. OAKSTONE CONSTRUCTION,- "
Address: 4065 YOSEMITE PL � � � -
. � � - - Phone: 530-642-8858
�
` � PLACERVILLE, CA, Zip; 95667
�- � � � License: 685535
- � . . — � " -- . -
Arch / Eng :
Address:
Status: ISSUED
Applied: 07/20/2004
Issued: 07/22/2004
ISSUED BY:
� � - Phone: .
' - -- . . '� Zip: � - _ - � . . . �
� , ' � License: - , ., �� - . , '
/.
i .
SCOPE OF PERMIT
� 1,038 SF INTERIOR TENANT IMPROVEMENT; 276 SF OUTDOOR DINING AREA AND REROOF (E) , ,
BLDG. WORK TO INCLUDE: NEW PARTITIONS,�FINISHES, FIXTURES, AND INTER�OR DEIv10LITION
. FOR "PEETS COFFEE & TEA" REF., 604=00771 � � � � � , �
PLUMBING TO INCLUDE: 1 BACKFLOW PREVENTER, 1 DISHWASHER,.1 GAS (1-4 OUTLETS); f ,
PRESSURE REGULATOR, 5 FLOOR SINKS, t KITCHEN SINK, t SERVICE/MOP, 1 WASH BASIN, 1
� WATER CLOSET, 1 WATER HEATER AND 1 WATER SOFTENER. .� �� ,
� � i' i�.'
` ' � . FEE SUMMARY � ' �
,� ,
�� �`aMr Qrv�.�� � � .� �_.._ _ _ — a.Mr Qrv� �<'% � '
i
ISSUE FEE `.$23.50 haundry Tub / Washer $0.00 0 �� �Sump Pump; �
BackBow irrigation 50.00 1 Landsrape Irrigation $0.00 0' Swimming Fool
BackBow Preventer $9.80 0� P-Trap� � � � $0.00 0 ' Trap Primer
Bathtub $0.00 .0 PressureRegulator $9.80 1� ,_Urinal
Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0��,.� i Vacuum Brkr Bktlow(1-0)
Connect pce,Soda,etc) $0.00 0 - ReCeptoB - $0.00 ��- 0 - � Vacuum Brkr Bkflow(5+)
Dental Units $0.00 0 Septic Tank_- �'-- �-' $O.W -- 0 Wash Basin
Dishwasher $9.80 7 Sewer Cap for Demo $0.00 0 Wash BaSin Set
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
orv
0
0
0
0
0
0
1
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: This permlt shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
�� for a period of 180 days. //
INSPECTIONS: In order for ihe work authorized under ihis permit lo be considered legal, such work must comply with all appli ecabl codes,�
, requlred Inspeetlons and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expj�o�.of this permit.
FOR INSPECTIONS CALL: (714) 754-5626 ��
�� .r'i�rwiri�
i
WORKERS' COMPENSATION DECLARATION:
I hereby aflirm untler penalry of perJury one ol the following tleclaretlons:
❑ I have entl will malntain e certificate ot consenl lo self-Insure for workers' campensetion, as provided tor by sectlon 3700 of the Labor Code, for Ihe peAormance of ihe
work for which this pertnit Is Issuetl.
� 1 heve entl wlll malntain workers' compensetion Insurflnce, as requiretl by section 3700 of the Labor Cotle, for ihe peAortnance of the work for whic� Ihis pertnll Is issued.
My workers' campensatlon Insuranca cerrier end policy number are: ���� �� ��
Gam�ef:_ ��iQ2 f i �/l7M� A�URANC� . Polrq,Number. _ �
7Thls secUon need nof be comp/etetl AtFe permlt 75 valued at one hundred dollers ($100) w Iess.J
� I certity Ihat In ihe pedormance oi Ihe work tor which this permit is luued I shell not employ eny parson in eny menner so as to become sub�ect ro the workers'
compensatlon laws of Celii m antl egr t ii I shoulC bacome sub�ect to the workers' compensation provisions of Section 3700 of Me Labor Code, I s�all forthwi�h
comply with these provisi
^� �, / ^� ,J
� pW p�lf.�rit Signeture: � U� ,�. Dete: '� /" 22'� 7
V,�9qNN1�B.�F�RETOSECIIREWOHKE OOfdPENSATIONCOVERAGEISUNIAWFULANDSMALLSUBJECfANE RTOCRIMINALPENALTIESANDGVILFlNESUPTOONEHUNDRED
TFKKISAND OOLLAFE (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAA41GE5 AS PROVIDED FOR IN SECTIqJ 3108 OF THE UBOF CODE, IPIrEREST, AND FTTORNEI^S FEES.
LICENSED CONTflACTORS DECLARATION:
ot Chepter 9(commencing with Section 7000) of Division
end my license Is in tull
CONSTRUCTION LENDING AGENCV:
❑ I hereby eNirm thet Ihere is e construction lending agency for Ihe peAormance of the work for which this permit is issued. (Sec. 3097, Civil Code).
lender's Neme: Lentler's Adtlress:
Slpneture:
Date:
OWNER-BUILDEH DECLARATIONS:
I hereby etfrtn that under penelry oi perjury Ihet 1 am EXEMPT FHOM THE CONTRACTORS LICENSE LAW for the following raason (Sec. 7031.5, Business end Professions
Code: Any dry or counry which requires a permit lo cyistruct, alter, improve, demolish, or repair any sirucWre, pnor to Its Issuance, also requires the appllcant 1or such pertnit
to tile e signed statement tha� he ar she Is Iicensed pursuant to the proNslons ot the Cantrectors Llcense Law (Chepter 9(commencing wit� Section 7000) oi Division 3 of the
Business end Professions Code) ar thet he or sha Is exempt ihereirom end the besis for the elleged exemption. Any violatlon a� Seqlon 7031.5 by eny eppllcant for e pertnit
subjects Ihe applicent to e civil penalry ol not more than five hundred dollere ($500).):
❑ I, es owner of the property, or my employees with wages as thelr sole compensetlon, WILL DO THE WORK, and the structure Is not Intentled or oXered for sale (Sec.
7044, Business and Professions Cade: The Contractors License Lew tloes not epply to en owner of p�operry who builtls or Improves thereon, and who tloes such work
hlmseN or hereelf or through hls or her own employees, provided ihet such improvements are not intendetl or oHeretl for sele. If, however, the building or Improvemant is
sold wit�in one year of completion, the8wner-builder will have the burden of proving that he or she did not builtl or Improve for purpose ot sale.). '
❑ I, es owner ot the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prqect (Sec. 7044, Business end Professlons
COAe: The contrectors Llcense Lew tlaes not epply to an owner of prapeny who builds or Imprwes t�ereon, antl who contracts for such D�alect with e contwctor(s)
. license pursuant to Ihe CoNrectors License Laws.).
❑ I em exempt under sec.
Signature:
Owner ID vanfed by drivefs Ilcense. ❑ Yes ❑ No
Business and Professions Code for this reasan:
Vedticetlon ol OwnereMp by (rype of documenL i.e. - pmperty t� bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
DnvefS LiCenSe No.
Date:
Ezpires:
❑ I hereDy certify thet no excavetion five (5) or more leet in depih Into whlch a person Is required to descend, will be made In wnnection with work euthonzed by this
permit, and tha� no building structure, sceNoltling, falsework, or demolitlon or dismantlinq Ihereot, will be more then thirty-si: (36) teel high. (Chap. 32, Gry 2, Atl 2, Sec.
347, Title 8, Califomia Adminlsirative Cotle).
❑ As owner-builder, I will not employ anyone to do work which woultl require e pertnit from the DiNsion ot Intlustrial Safery. es noted above, unless such person has e
permlt to do such work irom Ihe tlivision.
Signelure: Date:
Division of Industnal Satety Pertnit Number:
ICERTIFlCATE OF COMPLIANCE AND AIfTHOpIZA710N OF ENTRV: I certity untler penalry of perjury Ihat I heve read this epplication antl state that the infortnation given is I
conect. I eqree to comply with ell state laws end ciry ordinances relating �o bullding construc�lon, end authodze representatives ot the City of Coste Mesa to enter upon the
ebove-descnbetl property for inspection puryoses. I agree not ta occupy or allow occupancy ot any building euthonzed 6y this pertnit until tinel inspection.
CQOE �. INSPECTIOMTYFE
1618 Fixed System Final Fire Prevention
1288 Pool Spe Finel
200 Final Re-Root
201 Final 81ock/Retalning well
202 Final Fadory Fira.Place
203 Final Slgn
204 Final Demolilion
UATE II�E4$
COOE I INSVEITON iYPE
206 Finel Mechenicel
208 Flnel Plumbing
210 Flnal Elecidcal
212 Finel Flre Prevention
220 Final Plenninp Approval
222
250
Flnal Site
Finel BuildinyOccupancy
P�ff INIIDSLS
` • • �,►
MECHANICAL PERMIT
Job Address: 424 E 17TH ST
Suite No
Vicinity:
Parcel Number: 11732130
Applicank GARY HAMMOND .'
Address: 4065 YOSEMITE PC/
PLACERVILLE, CA � ,
/-'i _� � . � ' -
�,
Owner �.' LEAF, MARVIN H T.R �� �'
Address 659 HOSPITACITY DR
� � � RANCHO MIRAGE, CA
Phone:_530-642-8858 ,
Zip: 95667 �
Phone:
Zip: 92270
Contrecror: , OAKSTONE CONSTRUCTION
Address: 4065 YOSEMITE PL � � , � �
� � � "'--Phone:� 530-642-8858
PLACERVILLE, CA � � � � Zip: 95667
, � , � � License:685535
Status: ISSUED
Applied: 07/20/2004
Issued: 07/2Z2004
ISSUED BY:
, A
�
�
� ��
� � \
I
SCOPE OP PERMIT
1,038 SF INTERIOR TENANT IMPROVEMENT; 276 SF OUTDOOR DINING AREA AND REROOF (E)
BLDG. WORK TO INCLUDE: NEW Pt1F2TITI0NS, FINISHES, FIXTURES, AND INTERIOR
DEMOLITION FOR "PEETS COFFEE 8 TEA' REF.: 804-00771 �- ,
' � MECHANICA� TO INCLUDE: t INST,FAU < 100K BTU, 2 VENT FANS AND 1 COMPRESSOR UP .
' � TO 3HP/100K BTU. � _ � � - '
� FEE SUMMARY �
, Quantity , , � Quantity.�
ISSUEFEE . , $23.50 Repair/AltAbsorbtionUnit . $0.00 0 �
Inst FAU <700 k BTU, '�. $14.80 1 Repair / Att Refrigeretion Unit � $0.00 0
Inst FAU >100 k BTU � �� , $0.00 0 , --Ventillation System � ; $0.00 0 '
Repair / Alt Cooling/Heat $0.00 0 - � Evaporative Cooler $0.00 0�
Inst / Rep. Recess Wall Htr .� $0.00 0 . , � , Commercial�lncinerator $0.00 0.
Refrig Sys <100 k BTU � � � . . $0.00 0 � . � Domestic lucinerator _ �� � , , $0.00 0
Refng Sys >100 k BTU � $0.00� ��'0 :- � Compressors / Absorotion Svslems � � � � � "
Gas Piping ,, �� 50.00 0 �� Up to 3 hp / 100 k BTU ,�� - $0.00- 0
Factory Fireplace � , " '' $0 00. 0 - � 3 To 15 hp / 500 k BTU- � � � ;' � -$0.00 0
Hood w/Mech Exhaust "� $0 00 � 0; � �, 15 To 30 hp % 1,OOO.k BTU �- ' �$0.00 0
VAV Box �� . $0.00 �0 ' - � 30 To 50 h /�1,750 k BTU � � �
�.�� P . �� /� , . '',$0.00 0
Vent Fan / Single Duct� � $14:50 .� - 2 � � � - - _ � � Over 50 hp I.Over 1,750 BTU,. � <� ,� ��' $0.00 0
Appliance $0.00: 0 , . Boilers . . . �
Fire Dampers - $0.00 � 0 Up to 3 hp � � � �� � % $1470 1
Smoke Dampers � $0.00 0 � - � 3 To 15�hp � � - � �/ $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp ' � $0.00 0
Air Hantllers < 10000cfm $0.00 0 " 30 to 50 hp �� � §0.00 0
Air Handlers > 10000cfm $0.00 l'0 ; �. ; Over 50 hp, ' % $0.00 0
Floor Fumace $0.00 0 � - - - - - Other Mechanical Fee '
Floor or Suspend Heater $0.00 0 �� � Investigation Fee �0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241•92)
EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or if work is suspended or abandoned
for a period o( 180 days.
INSPEC710NS: In order for ihe work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, and all
requlred Inspeetlons and final approVal must be obtained. Failure to obtain inspections and final approval vnll resuH in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 � �
zaases �eroo�
WORKERS' COMPENSATION DECLARATION:
I hereby eHirtn under penalry of perjury one of the following tleclaratlons:
❑ I heve end will meintain a ceNficate ol consent to self-Insure for workers' compensation, es proNded for Cy section 3700 of the Lebor Catle, for Ihe pertortnanca of Ihe
_work for which this permit Is Issued.
I maintain workers' compensetion Insurance, as
ompansation Insurence cerner antl policy nurt
`iM E?'CI GQn� �jrlM � i91
nof be cromplefed!! fhe permit is velueG et one
by sectlon 3700 of the Lebor Code, tw Ihe perfortnence of the work for which this pertnit is Issued.
•-�'c` PolicyNumber.�. ..\�V����(�
tlollars ($f00) or less.) .
� I certily ihet in the pertortnance ol the work lor which this parmit Is issue4 I shall not employ eny person In eny manner so es to become sub�ect to the workars'
compensatlon laws o omle, end thet if I shauld become sub�ect to the workers' compensetion provislons of Sectlon 3700 of ihe Labor Catle, I shall forihwlth
�,�;P � � Z^���ny
ApPliCent Signelure� ��.�:u_ �p L,//Y✓w+^�Y Deta�+ % l'v
N�: FNLURE TO SECURE WOFI(ERS' COAIPENSATION COVEMGE IS UMAWFUL AN� SMFLL SUBJECT AN EM R TO,CRIMINAL PENALTIES ANU CML FlNES UP TO ONE NUNDREO
TqUSlWO DOLLARE (5100,000�, IN ADDITION TO THE COST OF CAMPENSATIIXJ, DMMOES AS PROVIOEO FOR IN SECTI O60F T1E LABOR CADE, IMEPEST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
9(commencing with Section 7000) ot Dlvislon 3
Cotle, end my license Is In full
CONSTAUCTION LENDING AGENCV: �
❑ I �ereby aXirtn that there is e conslrudlon lending egency lor ihe pedormence at Ihe wark far which Ihis pertnit is issued. (Sec. 3097, Civil Catle).
Lenders Name: Lentlefs Address:
Signeture:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby eXirtn that under penelty of perlury ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW Por the tollowing reeson (SecJ031.5, Business antl Protesslons
Cotle: Any ciry or counry which requlres a permit to conslruct, elter, Improve, demolis�, or repair any strucWre, pnor to its issuance, also requires Ihe applicant for such pertnit
b flle e signed stetement Ihet he or s�e Is Iicensetl pursuent to Ihe pmNslons ot the Contractors License Lew (Chapter 9(commancing wit� Seclion 7000) of Divislon 3 oi Ihe
Buslness end Professions Cotle) or �het he or she Is ezempt therelrwn and Ihe basis for the ellegetl e:emption. My vialatlon af Sectlon 7031.5 by any appllcant tor e pertnit
sub�ects ihe epplicant to e civil penalty of not more than tNe hundred dollam ($500).j:
❑ I, es owner of the praperry, or my employees with wages es their sole compensatlon, WILL DO THE WORK, antl the siructure Is not inlended or oHered for sele (Sec.
7044, Busineu and ProfesSions Coda: T�e Contractors License Law Aoes not appty to en owner af properry w�o builds or impmves thereon, antl who does such work
himself or herselt or through his or her awn emplayees, pravided thet such impravements are not Intentletl or oHered far sele. It, however, Ihe building or improvement Is
sold within one year of wmpletion, tha owner-builder will have Ihe burden ol proving that he ar she Aitl not builtl or improve lor purpase of sele.). '
❑ I, es awner of the property, em EXCLUSIVELY CONTRACTING WITH LICENSEO GONTRACTORS to construct the project (Sec. 7044, Business end Pratesslons
Code: The coNradors Licanse Lew does not eppty lo an owner of propeny who builds or impmves Ihereon, antl who wntracts tor such pmiect with e coNractor(s)
, license pursuant to t�e ConirectoruLicense Laws.).
❑ I am exempt under sec.
Signeture:
Owner ID venfieC by tlrivefs license. ❑ Ves ❑ No
Business end Protessions Code tor Ihis reason:
Verlticatlon ol Ownership by (typa ot tlocument, i.e. - properry taa 6111 or deed):
Dnvels LiCenSe No.
Date:
Expires:
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
❑ I heraby certity Ihat no excevetion five (5) or more feet In depth Into which e person is required to descend, will 6e made in connectlon wllh work authorized by thls
pertnit, and that no bulltling structure, scaXolding, falsework, or demolition or tlismantling ihereof, will be more than ihirty-six (36) feet �igh. (C�ap. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Celifomia Adminisiretive Code).
❑ As owner-builder, I wlll not employ enyane to do work which would require e permit trom the Division ol IndusMal Sefery, as notetl ebove, unless such person has a
permit to do such work trom �he division.
SlpnaNre: Date:
Division o1 Industrial Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cetlity under penalty of perlury thet I heve reatl t�is application end state that the informatlon given is
correct I agree to comply with all stete laws and ciry ortlinances releting to building consiruciion, end au�hodze representatives of the City ot Costa Mesa lo enier upon the
ebove-descnbed property far inspedion puryases. I egree not to occupy or allow occupancy oi eny building euthorized 6y this permit until finel inspection.
Legal
GOOE 1, IHSPECTIONTYPE �� P�IE UiIIDELS
1616 Fi:etl System Flnel Fire Prevention
1288
200
Pool Spe Finel
Final Re-Roof
201 Final Block/Retalning Wall
202 Final Factory Fire Place
203 Final Sign
20C Final Demoli�ion
COOE I INSPEGTION TYPE
206 Flnel Mechanical
208 Finel Plumbing
210 Finel Electrical
212 Final Fire Preventlon
220 Finel Plenning Approval
222 Fin01 Site
250 Finel Building/Occupancy
� 1 1111' "
� r J �
(714) 754-5273 • Fex (714) 75y-4B56 • www.ci.costa-rtiesa.ca.us n rniR oHrve, ws i n mrsn, cw szazb .
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
424 � 17TH ST
11732130
Applicant: GARY HAMMOND
Address: � 4065 YOSEMITE PL,.- �� �- '
i.
PLACERVILLE, CA -
, ; '-,;-� .. ; „
Owner.� , LEAF; MARVIN H TR< .
Address� 659HOSPITALITY:DR.�".`��-
ELECTRICAL PERMIT
Phone: 530-642-8858 � ,
Zip: 95667 . -
Phone:
� . RANCHO MIRAGE, CA Zip: 92270
� ; .
;
� ��Contractor: .� OAKSTONE CONSTRUCTION
Address: 4065 �YOSEMITE PL � � � - .
PLACERVIILE, CA .
Status: ISSUED
Applied: 07I20/2004
Issued: 07/22/2004
/'
1
•' ��
�,' Phone: 530.642-8858
� Zip: 95667 _ ." . - . . `
License: 685535 - � �
�� \
- . ;� SCOPE OF PERMIT - -
1,038 SF INTERIOR TENANT IMPROVEMENT; 276 SF OUTDOOR DINING AREA AND REROOF (E)
BLDG. WORK TO INCLUDE: NEW PP.RTITIONS, FINISHES, FIXTURES, AtJD INTERIOR DEMOLITION '
FOR "pEETS COFFEE & TEA' REF.: 804-0077'I �'
ELECTRICAL TO INCLUDE: 72 LIGHT�FIXTURES, 41 OUTLETS, 98 SWITCHES, 1 SERVICE TO 1000
AMPS, 4 MOTORS TOtHP,-1�MOTOR TO 1 HP, 1 SUB�PANEL TO 200 AMPS, AND 3 SIGN
CIRCUITS. ' - � - • - -
�
� �� �; FEE SUMMARY - � � . � � . �
����_ " : � ; Quantity � . -.: `, Quantity , �
ISSUE FEE '� ��: $23.50 , � � Temp Dist System / Lighting $0 00!',; ��0 ��
Temp service lest '� ti �$0.00 ��� � � Busway /100 fl � y. _ $0 00 �' % 0 , - , � � �
Res. a/c package , $0.00 � � � � � Standing Section �� ,, ', �: - :-`.� $0.00 -� 0 : � - '
New Res (1-2 units) �� , � $0.00 0'- . ; Misc Electrical Equipment � 50.00 .. 0 � �
New Res (3+units) , . = � $0.00 0 � � � Transformers up to 1 kva/kw `$0.00 � � ' 0 -
Pool/Spa �,���-� '. $0.00 � ..�� . .� � ................uptol0�kva/kw, �.;�"$0.00� ` /:; .
'��_ . _ i;0� _
Lighting Fixls � ': .A •r $59.96'-. -72�-- �.� � ' ^ .:...............up to 50 kvelkw ' . $0.00 ,`. :,p �', �/
ReceptOutlets ���.�� $37.33 . . 41 � ,_ - . . .................upto�t00kvalkw� ; � $0.00'; ' 0' � ;
<�, __<
Switches ��� $78.94 �� ,98 - . . . ..................over 100 kva/kw �. � �� $0.00" i>0�
Non Res Appl �. $0.00 ' �� 0� : � Low Volhage Equiprtierit � ' $0.00 ��� �0
Res Appl ' $0.00 0 _ - � _ Low Volt Wiring System / Ckl � $0.00 � � � 0
Service to 200a $0.00 0.� � Misc. Conduit � $0.00' 0
Service to f000a $62.15 . i � .� Misc. Conductor - �$0.00 0
Service over t000a $0.00 . 0; �, -�. Circus ( gen or ride) -� ' i" � 30.00 0
Motors to 1hp $19.00 4 �-' . .�,,.: �Circus (mech ride or IighLsj 50.00 0
Motors to 10hp $12.30 1 -' - _. Christmas�Tree SWnd $0.00 0
Motors to SOhp $0.00 0 Fireworks Stand $0.00 0
NO710E: 7he work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § i, 12-21-g2)
EXPIRATION: This permit shall automatically ezpire and become void ii work is not commenced within 100 days, or if work is suspende�andon d
for a period of 180 days.
� INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work mus� comply with all plleable codes, and all
Irequlred Inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the p tlon of ihis permit.
. FOR INSPECTIONS CALL• (714) 7545626
yJ�ia�i�'L�]
�
WORKERS'COMPENSAnON DECLARAnON: '
I hereby elfirm under penalry ot perjury one of the I011owing tleclarations:
❑ I heve antl will melntein e certiTicate of consent lo self-Insure tor workers' compensetion, es DroNded tor by sectlon 3700 of the Lebor Cotle, lor the peAormence of the
_i ork tor which this pertnit is issuetl.
�J I have antl will maintaln workers' compensaUon insurence, es requiretl by sectlon 3700 of Ihe Lebor Code, for the pertortnance of the work for which thiy pertnit is issued,
�•:. My workers' campensetlon Insura%c�e ceMer entl policy number ere: /(� �
`ariiC e -� �/1if�1('�{jJL(�(�1 r /Qrrl/%J/iNC(: PolicyNumber. �/iR �
��eection need not be complefed il tbe perm/f Is velued et one hundred dollers ($100) or less.)
[� I ceniy thet in Ihe performance oi the work for which Ihis pertnit is Issuad, I shall not employ any person in eny manner so as to become sub�ect to Ihe workers'
wmpensation laws ol Celifom' , and egree th shoultl become sub�ect to the workers' compensetion provislons ot Sectlon 3700 ot the Lebor Cotle, I shell torthwith
compy with ihese provisions �. � � � �
AppllcanlSignatur�`e �—a - - L�Yh""'�� Dete: . ����
5i^.-,.:a`I .,c
WARNINO:P lU8ESfl5ECUREWORI�RS' PENSATIIXJGUVERAOEISUMAWFULANDSHALLSUBJECTMI .�4YERTOCPIMIWLLPENALTESPNDCMLFlNESUPTOONEMUNDRED
D DOIURE (5100,000), IN ADqT10N TO THE COST OF GbMPENSATION, DAANGES AS PROVIDED FOP IN SECTION �O60F THE LABOR COOE, INfEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
9(rnmmencing with Section 7000) of
end my license is in tull
CONS7RUCTION LENDING AGENCV:
❑ I here6y eHirtn thet there is e construction lending agency tor the performance oi ihe work for which this pertnil Is issued. (Sec. 3097, Civil Catle).
Lenders Name: Lender's Address:
Signature:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby atfirtn thet under penelry 6t per�ury Ihet I flm E%EMPT FROM THE CONTHACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Buslness and Professions
Code: Any ciry or counry which requires a permit to construct, alter, Improva, demolish, or repair eny aWcture, prior to its issuance, also requires Ihe epplicant for such pertnit
to flle e signed stetement ihet he or she is Ilcensetl pureuant to ihe provislons oi Ihe Contracrors License Lew (Chepter 9(commencing wit� Sectlon 7000) oi Divlsion 3 of t�e
Business end Professlons Code) or thet he or she Is Oxempt therefrom end the besis lor the alleged exemptlon. Any violeNon oi Sectlon 7031.5 by eny epplicem tor a Dertnit
sub�ects Ihe applicent to e clvlFpenalty of not more then five hundred dollars ($500).):
❑ I, es owner of lha property, or my employees wlih weges es �helr sole compensation, WILL DO THE WORK, and the siructure Is no� Intendetl or otlered for sale (Sac.
7044, Business and Professions Code:�Tpe Contradors License Law does not apply to an owner of properry who bullds or improves Ihereon, end who does such work
hlmself or hersetl or through his or her own amployees, provided that such Improvements ere nat intended or oNeretl for sale. N, however, the building or improvement Is
soltl within one year o1 wmpletion, the owner-builder will have the burden ot Droving that he or she did not 6uild or Improve for purpose of saleJ. �
❑ I, as owner Of ihe D���Y• em E%CLUSIVELY CONTRACTNG WITH LICENSED CONTiiACTORS to conSiruCt lhe project (Sec. 7044, Business and Profession5
Cotle: The wmrectars Licensa Lew does not epply to an owner ol praperty who �ulltls or improves thereon, antl who contwcts for such proJect with e crontrector(s)
. license pureuant to ihe Contractors L'icense Lews.).
r
❑ I em exempt under sec. Business end Protessions Code tor this reason:
Signetura: Date:
Owner ID verified by drivefs Ilcense. ❑ Yes ❑ No Drivefs Licensa No. Expires:
Vedticetlon ot Ownership by (type of dwument, i.e. - pmperry tax blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby ceriNy thet no excavation five (5) or more teet in depth into whlch e person Is require0 to descend, will be mede in connection with work authonzed by Ihis
petmit, and that no building siructure, scaHolEing, talsework, or tlemolltlon or tlismantling thereof, will be more than thlrty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Celitomla Administrative Code).
❑ As owner-Dulltler, I will nat emplay enyane to do work which would require e pertnit from the Division of Industriel Setety, es natetl ebove, unless such person hes e
permit to do such work from the divislon. .
Signature: Date:
Divisian of Industrial Sefery Permii Number:
CERTiFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTBY: I cenily under penelry of Derjury that I have read this epplication end state Ihet ihe information given is
conect I agree to comply with ell state lews end ciry ordinances relating ro building consWction, end authorize representetives of the Ciry of Coste Mesa to enter upon the
ebove-descn6ed properry for inspection purposes. I egree no� to occupy or ellow acuDanq at eny building authorized by this permit until final inspection.
GOOE �. INSVECTONTYPE
1618 Fixetl System Finel Fire Preventlon
1266 Pool SDa Flnel
200 Final Re-Roof
201 Final BIxWRetaining Wall
202
203
204
Final Fectory Fire Place
Final Sign
Final Demolltlon
D�TE
COUEI INSPECTIONTYFE
206 Final Mecheniwl
208 Final Plumbing
210 Final Electdcal
212 Final Fire Preventian
220 Final Planninq Approvel
222 FinalSite
250 Final Building/Occupency
PAIE
�/b7 �
I[�IELS
�714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 PAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 424 E 17TH ST
Suite:
Vicinity:
Parcel Number: 11732130
Zoning:
Applicant: GARY HAMMOND
Address: 4065 YOSEMITE PL � � ' '
" Phone: 530-642-8858
PLAGERVILLE,CA ' �� � Zip: 95667
�
� _
Owner. LEAF; MARVIN H TR
Address 659 HOSPITALIIY DR � -
,�
i� ,. - _ _ -. Phone: ' .
, ; RANGHO MIRAGE, CA> . " Zip: 92270
Contracfor: �OAKSTONE CONSTRUCTION INC
Address'. 4U65 YOSEMI7E PL
- , ' ' Phone: 530-642-8858
� - PLACERVILLE, CA
Zip: 95667 ' License: 682535
Arch : � , � � - , En9:
Address: . , ' . - � � Address: �
� , - . ' , Phone:
Zip: �, - . License:
Stalus: ISSUED
Applied: 07/O6/2004
Issued: 07I06/2004
. : ��/ /
.�
�. . �
Phone:
License:
SCOPE OF PERMIT _
INTERIOR DEMO OF NON-STRUCTURAL PARTITIONS FOR "PEET'S COFFEE AND 7EA". f2EF.: B04-00771
�. � . _ . _, . . . . i . . .
FEE SUMMARY �
Plan Check: $54.11
Permit $83 25 — - - — — _-
SMIP Res:
SMIP Com:
Other:
Inspection:
� �� Total:
$0.00
$0.63
$0.00
$0.00
$137:99,
SETBACKS ��
MAIN STRUCTURE Pront 0. 0
ACCESSORY \ F.ront 0- 0 �-
PARKING Existinq: o
NOTES:
` Rear"� 0- 0
Rear 0- 0
�Reauired: 0
PLANNING & ZONING
Left 0- 0 -
Left 0- 0
Proposed: 0
Calc Valuation:
= Claim Valuation
'Righl - -0. 0 � -
Right.� 0- 0 ' �
�
$3,000.00
$3,000.00
'�. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: This permlt shall�automatically expira and become void if work is not commenced within 180 days, or if work is suspentled or abandoned
for a period of 190 days.
INSPECTIONS: In order for the work authorizetl under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetlone 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) 7545626
...,..,, �.,,,,,�
WORKERS' COMPENSAnON DECLAFiAnON:
I hereby aflirm untler penelry of perjury one of the following declarations:
❑ I heve and will maintein e certilicata ot consent to sell-Insure for wodcers' compensation, as provlAed for by section 3700 ot the Labor Code, lor ihe peAortnence of Ihe
work for which this permit is luued.
� I heve and will maintain workers' compensation insurance, as �equired by section 3700 of t�e Lebor Code, for Ihe peAortnanca of the woM for which this pertnit is Issued.
My wo rs' wmpensation Insurance carrier end pollcy number ere: �^-/
Certier: 0 N/Z I f'L(' j� t 2 V�(� t-� IN'� O� NL� `ir71G� Policy Number. .1 iJ ����� � '
(Thls secllon need nof be complefed il the permit is velued ef one hundred dollars ($100) or /ess.)
❑ I cartify thet in t�e pertormance of the work tor which ihis pertnll is issue0, I shall not employ any person in any menner so as to become suh�ect to the workers'
compensation laws oi Celllomle, e egree ih s�oultl Decome sub�ect to Ihe workers' compensation prodsions ol Section 3700 ot the Lebor Code, I shall fonhwith
comply wiih t�ese provisions. �, � / ''')
ApplicantSignatura: � �'�"'�/l Date: //ri/� y
WARNIN(3: FAILURE TO SECURE WORKERS' CCy P lSATION COVERAGE IS UNLAWFUL AN� SHALL SUBIEGT AN EMPLOYER TO CRIMI P NALTIES MID CIVIL FlNES UP TOONE HUNDRED
THOUSAN� OOLLARE (5100,000). IN ADDfTIIXJ fG THE W5T OF COMPENSATION, DAAWGES A$ PROVIOED F-0R IN SECTIIXJ 3]Ofi Of TME IABOH CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y eNirm ihat 1 am licensetl under pwvisia
torce and eHect. Lic. #
Con�rectoYs Signature:
Chapter 9(commencing with Sectlon 7000) of Division 3 of ihe Business
CIa55 k �
� _,�--.-.� Date:
enA mv license is in full
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm Ihal there is a construction lending agency for iha peAormance ot the work lor which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Neme: Lender'S Address:
SlgnaNra: � ' -
OWNER-BUIIDER DECLARATONS:
Date:
1 hereby effirtn thet under pepelry ot perjury �hal I am EXEMPT FROM THE CONTFiACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry whicfi requires a permit to constmct, elter, improve, tlemolish, or repelr eny slmcWre, prior to Its issuance, also requires the epplicant tor such permit
lo file e signed siatement thet he or'she is�censetl pursuant to the provisions ol ihe Contradore License Law (Chapter 9(wmmencing with Sectlon 7000) of Division 3 ot ihe
8uslneu end Protessions Cotle) or lhat �e or she is exempt theretrom antl the basis tor ihe ellegetl exemption. Any Woletion of Section 7031.5 6y any epplicant far a pertnit
sub�ects Ihe applicent lo a civil penelry of nol more Ihen five hundred dollars ($500).):
❑ I, as owner oi the property, or my empioyees with weges es their sole compensatlon, WILL DO 7ME WORK, and the strudure is not intended ar oNered tor sale (Sec.
7044, Business and Professlons Cade: The Gontractors License Law tloes not apply to an owner of property who builds or improves t�ereon, end who tices such work
himself or herself or Ihrough his oi�her own employees, pmvitletl that such improvements ere not intendetl or ottared for sale. If, however, ihe builtlinp or improvement is
sold within one yeer ot completion, the owner-builder wlll have Ihe burden of proving ihat he or she did not Gulld or improve for puryose of sale.). '
❑ I, as owner ot the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to ton5iruct lhe project (Sec. 7044, Business entl Prolessions
Cotle: The contractors Llcensa Lew tloes not apply to en owner ol pmperty who bulltls or Improves Ihereon, ena who con�recis for such project with a contractoqs)
license pursuant to the Contractors License Lews.).
❑ I am exempt untler sec. Business anA Profeuions Code lor this reason:
Signeture: Date:
Owner ID venfied by drivers license. ❑ Yes ❑ No Drivers License No. Eapires:
Vedficatlan oi Ownership by (type o1 tlocument, i.e. - property taac bill or deed): _
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby certity ihet no excavetion five (5) or more teet In depth into which e person is requlred to descend, will be matle in connection with work authorized by Ihis
permit, and Ihat no building siructure, scaftoldinq, talsework, or demolition or dismentling ihereof, will be more than thirty-slx (36) teet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title B, Calitomle Atlministrative Code).
❑ As ownar-builder, I wlll not employ an}rone to do work which would require e partnit from the Division ol Industnel Sefety, es notetl above, unless such person has e
permit to do such work trom the division.
Slgnature: Date:
Division ot Industnel Safery Pertnit Number.
CERTIFlCATE OF COMPLIANCE AND AUTTIORR.ATION OF EMRY: I certify under penelry of pe�ury that I �ave reatl this application and state that the Information given is
correct I egree to comply with all state lews end ciry ordlnences relating to tullding constructlon, and aui�otlze representetives of Ihe Gty of Costa Mesa to enter upon ihe
ehave-descnbed property lor inspection purposes. I agree not to occupy or allow occupancy ot eny building authonzed by this permit until finel inspeclion.
GOOE t. INSPECTIONTYFE
t61fi Fixed System Finel Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Final Block/Retelning Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
Applicant
�g
f�$ CODEt INSPECTIONTYGE
206 Final Mechanical
20B Final Plumhinq
210 Pinel Elec(dcal
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
Pdff. 1[�ELS
(714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 hAIFi UHNt, GUJ I A Mt.7A, GA y2ti2ti
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant
Adtlress:
Owner:
Address
424 E 17TH ST
11732130
SEHI, JOYCE
LEAF, MARVIN H TR
659 HOSPITALITY DR �
RANCHO MIRAGE, CA
Contractor: STARLIGHT WEST INC
Adtlress: �9145 PARTHENIA ST
SUITE H
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Ligh[ing Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 1000a
Motors lo thp
Motors t0 10hp
Motors l0 50hp
Motors to 100hp
Motors over 100hp
Communicalion drops
Sub panel to 200a
Pole Light Pkg
NORTHRIDGE, CA
Phone: 562-494-0430
Zip:
Phone:
Zip: 92270
Phone: 81&974-9519
Zip: 91324
License: 810536
StaWs: ISSUED
Applied: 06/02/2004
Issued: 06/02/2004
iSSUED BY:
SCOPE OF PERMIT
REF: SB04-00080. 2 SIGN CIRCUITS FOR ILLUM WALL SIGNS. "PEETS COFFEE".�
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
..:..............up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltaqe Equipinent
Low Volt Wiring System / Ckt
Misc: Conduit
Misa Conductor .
Circus ( gen or ride)
Circus (mech ntle or lights) .
ChnsVnas Tree Stand
Fireworks Stantl
�Other ElecMcal Fee
Investlgation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$o.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0 �
$0.00 0
$0.00 0
50.00
50.00
$0.00
50.00
I NOTICE: Th� work authorized by this permit shall comply with all applicable handicap access requirements under California statules and related
�� regulationa (Ord. No. 92-28, § 1, 12-21•92)
EXPIRA710N: This permit shall automatically expire antl become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTION$: In order for ihe work authorized under ihis permit to be considered legal, such work musl comply with all applicable codes, and all
required InspBctfons and final approvel must be obtained. Failure to obtain inspections and final approval will result in the axpiration of this permit.
FOR INSPECTIONS CALI: (714) 7545626
2446-46�&/00)
WORKERS'COMPENSATON DECLARAnON: ,
I �ereby ettlrm under penalty oi per�ury one ot Ihe following declaretlons:
❑ I heve end will maintain e certificate oi consant to self-Insure tor workers' compensation, es provided tor by section 3700 of iha Labor Code, for Ihe pedormanca of Iha
ork for which this permit is issuetl.
I have end will maintain workere' crompensa�ion insurence, as required by sectlon 3700 of the Labor Code, for the perlortnance of Ihe work for which ihis pertnit is issuetl.
My workere' campensetion Insurence carner antl policy number ere:
Certier: Policy Number:
(TTIs section need not be completeC i! the pertnil fs valueG at one hundred dollers ($100J or less.)
❑ I certiy that in t�e peAormance of the worK for which this partnit is issue4 I shall not employ any person In eny manner so as to b,9come sub�ect to Ihe workers'
compensation laws of C' i nC agree lhet il l should Cecome sub�ect to the workers' compensation provisions of 5 on 3 00 of�yg' e Labor e, I ahall lorthwlth
complywiththe5eprovi^ i�^���� Dete: � l. [.// O�
APP�antSignetute:�
WARNM�: FAILURE TO SECURE WORNEPS' COUPENSATION COVERAGE IS UNLAWNL AND SHALL SU&IECT AN EMPLOYER TO CRIMI E LTIES D CIVIL F ES UP TOONE HUNDFED
THOUSAND OOLLARE (5100,000), IN AD�ITIIXJ TO THE �+T OF COMPENSATION, DAMAGES AS PROVI�E� FOR IN SECTIqJ 3708 OF THE L4BOR CqDE, IMEREST, AND ATTORNEV'S FEES.
LICEICSED CONTRACTORS DECLARATION:
I hereby aNirm ihet I am licensed under provisions oi Chapter 9(commencing with Section 7000) oi Division 3 of the Business and Protessions Cptle, enA my license is in full
force entl eMect. Lic. # Class # . / / �
Contr�actot_s�s�namre:� b ��� oate: —��7_/ /'i��—
' �.�. _T �' �_
�
GONSTRUCTION LENDING AGENCY:
❑ I hereby aMirtn that there is e consiruction Iantling agency for Ihe pertormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lentler's Neme: Lender's Atltlress:
Signature:
Date:
OWNER•BUILDER DECLARATIONS:
I hereby effirm thel under penalry o� per�ury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which requires a permit lo construct, alter, improve, demolish, or repair any structure, prior to ils issuance, fllso requires the epplicant tor such permit
to lile e signed statement ihat he or she is licensed�pu�uant to Ihe pmvisfons ot the Contractors License lew (Chepier 8(commendng wich Sectlon 7000) of Division 3 of �he
Business end Professions Code) or that he or she rs anempt iherelrom and the basls br Ihe alleged esemptlon. Any vialatlon ot Sactian 7031.5 by eny appliceN for a pertnit
sub�ecis ihe epv�icant to a cNll penelry ot not more ihan live hundree eollars ($500).):
0 I, es owner of the propeny, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and t�e siructure Is not in�ended or oHered lor sale (SeC.
7044, Business and Professions Cade: Tha Coniractors License Law does noI apply to an owner of property who builds or improves ihereon, antl who does such work
hlmself or herself or Ihrough �is or her own employees, provided ihet such improvemenis ere not Intendetl or offered for sele. If, hawever, Ihe building or improvement is
sold within one yee� M crompletion, tfie owner-builder will have ihe burtlan W provinq thai he or she did not builtl or improve for purpose oi sale.).
❑ I, as owner of the property, em EXCLUSIVE�Y CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Buslness entl Professions
Catle: The contractors Llcense Lew does not epply to en owner ol properry who bullds or Improves thereon, enA who comracts lor such project with e contraaor(s)
licensa pursuant to the Contrecrors License Lews.).
❑ I am e:empt under sec.
Signatura:
Owner ID verified by tlrivers license. ❑ Ves ❑ Na
Business antl Professions Cade for this reason:
Vedficatlon ot Ownership by (type ol daument, i e. - pmperry tex bill or tleea):
UIVISION OF INDUSTRIAL SAPETV PERMI7 CERTIFICATION:
DnveYs License No.
oate:
Expires:
❑ I hereby certify t�al no ezcavetion Ilve (5) o! more teet in depth into which e person is required to descend, will be mede in cronnec�ion with work euthonzetl by �his
permit, and that no builtling siructure, scalloltling, falsework, or demolition or dismantling ihereot will be more Ihan ihirty-six (36) teet high. (Chap. 32, Gry 2, Ar12, Sec.
341, 71t1e 8, Calitomia Atlminlslrative Cotle)�
❑ As owner-builder, I will no� employ enyone to do work which would raquire e permit from ihe Divislan of Industnel Satety, es notetl above, unless such parson has e
pertnit ta do such work tram ihe division.
Signature: Date:
Division oi Intlustrial Safery Permit Number:
CER7IFlCATE OF COMPLIANCE AND AIJT}IORIZA710N OF ENTRV: I certily under penalty ot perjury thet I have reed this application and stete thet the infortnation given is
correct. I egrae to comply wlth ell state lews entl �Iry ortlinances releting to building construction, an0 euthoAze representatives ot Ihe City ol Costa Mesa to enter upon the
above-described properry for inspection purposes� I agree not to occupy or allow occupancy oi eny building euthonzed 6y Ihis pertnit until finel inspection. �
SODE �. IHSPECTONTYVE
1616
1266
200
207
202
203
Fixed System Final Fire Prevention
Pool Spe Final
Finel Re-Rool
Finel BIocWRetaining Wall
Final Factory Fire Place
Finel Sign
204 Finel Demolition
�L
�g� ypp�! ixsrecnontrve
206 Final Mechanical
20B Final Plumbing
210 Final Electricel
272 Finel Fire Prevention
220 Finel Plenninp Approval
222 Final Site
250 Finel Building/Occupancy
PAg ItIIIDELS
/(r� G�'i_ """.� `
(714) 754-5273 • Fex (714) 754-4856 • wv+w.ci.cosla•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 424 E 17TH ST
Suite:
Vici�ity:
Parcel Nunmber: 11732130
Applicant: SEHI, JOYCE
Address:
Owner: LEAF, MARVIN H TR
Address 659 HOSPITALITY DR
RANCHO MIRAGE, CA
Contractor. STARLIGHT WEST INC
Address: 19145 PARTHENIA ST
SUITE H
NORTHRIDGE, CA
Arch / Eng :
Addrpss:
Plan Check:
Permit:
SMIP COm:
Other:
Inspection:
Total:
NOTES:
SIGN PERMIT
Zoning:
Phone: 562-494-0430
Zip:
Phone:
Zip: 92270
. Phone: 89&974-9579
Zip: 91324
License: 810536
Phone:
� Zip:
License:
Status: ISSUED
Applied: 05/13/2004
� Issued: O6/02/2004
ISSUED BY:
SCOPE OF PERMIT •
INSTALL 59 S�. FT. OF SIGNAGE FOR PEETS COFFE, INCLUDING 36 S�. FT. WALL SIGN, 6 S�.
Fi. WINDOW SIGN AND REPLACE 15 SQ. FT. CABINET�FOR POLE SIGN
$99.61
$0.00
$153.25
$1.68
$0.00
$0.00
$0.00
$0.00
$0.00
$254.54
FEE SUMMARY
PLANNING & ZONING
Calc Valuation
Claimed Valuation
3e,000.00
$8,000.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiiements 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 1 BO 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
requlred inspeetlons end final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zane-ae �eroo�
WORKERS'COMPENSAnON DECLARAnON:
I hereby aHirm under penalry ol perjury ane ot t�e following decJaraUons:
❑ 1 heve entl will meintaln e certilicete oi consent to self-Insure for workers' compensation, es provided for by section 3700 0l Ihe Lebor Code, br Ihe peAormance ot the
or which this pertnit is issueC.
I have an0 will maint ' orkers' compensatiori i urance, as requiratl by secUon 3700 ot Ne Lebor Cotle, for the pertormance of the work for whidi Nis pertnit is Ls,wetl.
My workers' cam ns lor�lp£'}}fa cerri r �mDer ere:
Certier. / %i i� Polity Number.
(fnis secNon need not De com��e pe�ml is veluee et one nunared dollars (S1oo) or �ess.)
❑ I certity thet in the DeAortnence of Ihe work for which t�is pertnit is issued, 1 shall not employ eny person in eny menner so as to become subJect lo the workers'
campensetlon laws o1 C� m, end agrea tnat it I s�wlE become subject ta the workers' compensatlon proWsions ol Sectio 3700 o the Labor Code, I shall lonhwiih
tompty wlth these pro lons. �q hV
�`ApplicentSi� pneture� `li�� Dete: l.Y �Z iV I
WARNINO:FAILURET08ECUREWORKERS'COMPEN T10NCOVEPAGEISUNLAWFULANDSHALLSUBJECTANEMPLOVERTOCRIMINALP TIES DpVILFlNESUPTOONEHUNDRED
TFKK/SAND OOIIARE (Ef 00,000), IN ADDITION TO THE COST OF COMPENSATION, DMMGES AS PROVIOEO FOR IN SECTION 3108 OF THE IABOR CODE, IMEREST, AND FTTORNEI"5 FEES.
LICENSED CONTRAC70RS DECLARATION: -
I horeby eHirm ihat I em Ilcensed under provislons at,Chepter 9(wmmenGng wlih Saction 7000) of DlWsion 3 of the Business end Prolessions Code, enA my licensa Is in tull
Porce end ejiect_LJc.R Class p �
Co� n(reciolsS net�re:� � ��j � ,nD/i�. Date: . _ ,� � � �`� �
CONSTRUCTION LENDING AGENCY:
❑ I hereby eHirtn thet Ihere is e conswction Ien0ing egency tor Ihe peAortnance of Ihe work lor which this permit is issued. (Soc. 3097, Civll Code).
Lenders Nema: Lentler's Adtlress:
SignaNre:
OWNER•BUILDER
Date:
I �ereby eHirtn that under penelry ol per�ury Uet 1 em E%EMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business anA Professions
CoCe: Any dry or counry which requires e pertnR to construct, elter, improva, demWish, or repair any sW cture, pdor to its Issuance, elw repuires the epplicant for such pertnit
to file e signetl stetement that �e or she Is IlcenseC pursuant to the pmNsions at the Contraaore License Lew (Chapter 9(commencing wit� Sectlon 7000) ot DlNsion 3 of the
Business and Professions Cade) or Ihet ha or she is esempt therefrom and ihe 6asis for the allegetl azemption. Any Woletion ol Section 7031.5 by eny epplicant for e pertnit
sub�ects ihe applicani to a Uvll penalry ol not more ihen IWe hundrad ddlars (5500).):
•�
❑ I, as owner oi the propeM. or my emplqrees with wages as their sde compensation, WILL DO THE WORK, and iha sWIXure Is not Intendetl or oHerad tor sale (Sec.
7044, Business and Professions Code:-The Contracbrs Licensa Law dces not appty to an owner ot pmperty who builds or improves thereon, end who does such work
himself or herself or through his or her own eRiployees, provided that such impravemenis are not Intended or oHereC tor sale. If, however, iha buildinq or improvement is
sold within one year of completion, t�e owner-builtler will have the burden of proving that �e or she did not builtl or improve tor purpose of sale.).
❑ I, as owner of the pmDerty, am E%CWSIVELY CONTTiACTNG WfTH LICENSED CON7RACTORS to canstruct the prolea (Sec. 7044, Business antl Professions
Code: The conirectors Ucense Lew Coes not appy to en owner ot properry who builds or Impmves thareon, and who wntracls br such pro�act with a coniractor(s)
license pursuent to the Comracmrs License Laws.).
❑ I am exempt undar sec. Business and Pmlessions Cada tor this reason:
Siqnature: Date:
Owner ID varlfieC by tlriver's Ilcense. ❑ Yes ❑ No Drivers License No. Expires:
Vedficetion ol Ownership by (rype oi documenL i.e. - properry terz bill or deed):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICA710N:
❑ I hereby certity that no exwvetlon five (5) or more feet in depth Into which e person is required to descend, will be metle In connection with work authorized by t�is
pertnil, entl that no buildinp structure, scaHolAing, talsework, or demolition or tlismantling Ihereol, witl be more then thlrry•six (36) feet high. (Chep. 3.2, Gry 2, Art 2, Sec.
341, Tille 8, Calllomie ACministrative Cotle).
❑ As owner-builGer, I wlll not employ enyone to tlo work which would require e permil Irom Ihe Dlvlsion of Intlustrlel Sefery, es notetl ehova, unless such person has e
pertnit ro Go such work Irwn the division.
Signelure: Date:
Divlsion ot Industrial Sefery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AllTHOROA710N OF ENfAY: I certily un0er penalty of perjury thet I have read this epplication entl steta Ihet the inlortnatlon given is
correcl. I egree to compy vAth ell state laws end dry ortlinances relating to builtling construction, and euthodze representetives ol Ihe Ciry ot Costa Mesa ro emer upon Ihe
above-tlescribed properry tor inspection purposes. I egree not to oaupy or ellow occupanry of any building eulhorized by ihis permit uniil tinel inspectian.
COpE �, INSVECTONTYFE Q�g II�LS
7616 Fixed System Final Fire PrevenUon
1288 Pool Spa Final
200 Final Re-Roo1
207 Flnel BIocWRetalning Well
202 Final Fectory Fire Place
203 Final Sign
204 Finel �emolillon
l0-6 _oy .n��
COQE� INSPECTIONTYVE
206 Flnel Mechenical
208 Finel Plumbing
210 Finel Electdcal
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
�� �
�
"°°"6'a°'"'°°'°' 424 E 17TH'ST °1Q`
QY�ABNWEIFqqW1l MTC MGMT,
"0°"�'' 900 �, CAMPHELL ttl
CAMPHELL
:A 95008 (408)377-1754
u�cxrtECT ox o1m+�n:
ucra_
UM:
�T�� FEARARA ROOFING ('714)642-8233
COHfRACTOH9YY11N0 Zqzg NEWPORT HL
�o�s% COSTA MESA CA �� 342740
92627 � 6
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OWNER BUILDER OEClAH1TON: 1�syy y�m iuder psiM� d psrjury 1he1 I mn ssamq han IM Cavream lioems Lew la tM
tabx+q reawn (Sad'an ]03tb Bueiyas erd Rdeeaions Cade: Am W n oounry Mhir1� �eVuirw e M�mt to amemM. Ma. inVrm+.
'dsmd'eh. a�yei enY e�euvve. par b ds euwm. abo rap�mm iM e00� ta au[h V�ti �o fib a dP� qmeroN tlW M a W
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M�t.s b/ mry epplimd ta e pe�mG qd�erta ihe epp&xa m e mi penMy d na mm ihen fx� hwd��d doW� �550DD.
� I.movnwdtMqopenyamym�pbyea�r.ihMep>+ntMidsaompwvefim.wYAotMwak.rdOrmurLvaenal'vuadeE
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Dme: �:
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c.m«: STATF FTINTI EXPIRES
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elHl niw �q ro a� nu�E�WuuM AMMn 11tOq0aaA b�� �^ ��e e� cw�pwv�tbil eur�pu n provlbA ror In
3�ctlm 9lW o/ IM LMar Cab, l�qYpt YM �ttom�yl l�u
CONSTIIUCIION LQlqNO �GEM�Y: I MrWy dfirm ivMr pvuM d per'�vy tAet iMn u� mwrwion b�iq aWiw.Y ��
pMormenw W tM w�k lar xliirh t�u V��'v bwG (Seaion 304l. Cw�. C).
LENCER'8 NMIE:
IENDEN'S ADDAE55_
I cMJy the� 1 Mua ntl Nn epyketiq� Nd qeu Ilul tha eEv.e'vtlamielon u conq. I apree �o camply wilh ep ay eM mmry adiiwns
eM elala 4xe relelm0 b buJd'vq crosvutlbn W Mra4y ewlw¢a �apnwileMe� d Nu ftiy b xuer upon tM eEwe-memionad p�apa�ry
fa iropaion Wrpwaa.
MIKE PLECAS
P
Dma: ��
7$IDIWWB ropI1V tY�IX
(5151 JE.W P) W�ne-&uldPq 8 Se1M': aream�Fb: Cv�ery-�GG��: PinkJiwenue: OdEanrad-Measea
CITY OF COSTA MESA - HUILDZt•1G PERMIT
�"PERM NO: B 079749
PERMIT NO: B 079749 PLAN CHECK NO: N GOVT: N SOPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION : T/O ROCK 6 APPLY NEW CAP SHEET ROOF(HUR) SQ FT: 2,000
CLAIM VALUE: 2,000.00 CALC-VALUE: 2,000,00 GROUP OCC: A-3 /
COMMENTS: REROOF THE "TOGO'S" RESTAURANT WITH BUILT-UP ROOFING
1F i! k if 1F 1E 1t 1F fk if iE k 1E iE 1f 1E iE iE iE M 1E iE iE iE 1f if 7f 1E iE 1E 1E 1E 1F 1E 1F k iE if 1E 1f iE iE 1E-0E 1E fE �E 1f 1E if 1f 1E 1E 7f �E M iE 7F iE iE iE iE 7E iE iE M 1E iE iE iE 1E jE IE �E M iE ik if 1F
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDZNG ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 11732130 ZNE: REF NO;-
PLANNING NOTES> i?
>
ik iE 1E 1f i! 1E 1E 1E fk iE iE if 1E if'IE ik IE iE ik iE iE 1E 1f 1E if fE If ib �E 1f �E iE 1E iE 1E iE 1F iE IE if IF ff 1E IE iE1f 1E 1E'k 1E 1E 1E IE if if if 1f iE if if 1E if 1F 1Eli iE iF if 1f 1F it it iF 1F if if 1E k if
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S
ZONING APPROVED BY DATE: �'�'
HUILDING APPROVED BY : DATE: :%�
APPLICATION ISSUED BY: DATE: O:�...
1fltififk1E1F1E1FiF1FlfkiE�lElElEfFfE1f1f1f 1EK1Ek1E1E1EiE1E1E 1EIE
LEGALIZATION:N F E E S U M R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUM LECTRIC MECAANIC FIRE SMIP/RES GRADING
,PERMIT 62.25
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT PLAN-CHECK
TOTALS----> 62.75 . 0 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECT C MECHANIC
62.25
1EiFiE�lkKiFlEiE1EiF1E1tif1flfifiE�EM1EiFiElfifiFiFifiklk7FiF 1F1l1Eif1ElEifikMlfl!
I N D I V I D U A L F E E
TYPE
SFC
QTY
200�
D E S C R I P T I O N
SMIP/NON-RES
.50
TOTAL PAID DUE
62,75 62.75 ,00
62,75 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN-CHECK
.SO
iE it i61E Ik 1k 1E if iE 1E iE 1f iE IF iF 1F iF 1F IE if iF ik 1E 1k �E 1Elf iE 1F iE if if IF iE
B R E A K D O W N
REROOF HY VALUE COMMERCIAL NOZONE
BND OF FEES
UNIT COST TOTAL COST
1.00 2,000.00
01 00216181-00216l82 TOT 62.75
DATE: ]0/02/95 TI%E: II:ID
- " � � P00 SPA � ` �
�CONSTRUCTION AND PLANNING .
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pooi & Equipmen2 Location f
2. Soil Pipe�Undrgrnd. � 53. Steet Reinforcement .
3. Electrical Conduit Utility�Undrgrnd. 54. Forms � •
4. Electrical Conduit�Updrgrnd. ' 55. Electrical Bonding
5. Steel Reinfo�cement 56. Rough Plumbing & Pressure Test +
6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Footings - 58. Electrical CqnduirUndrgrnd. ��
8. Foundation -. � 59. Gas Pipe, O U �tlrgrnd., Test
, .,
9. Water Pipe�Undrgrnd. • 60. Backwash Lines, P•Trap, O Undrgrnd. �;
10. Structural Floor System 61. APPROVAL TO DECK . '
1 t. Property Sewer Line & House Cbnnection 62. Backwash & Receptor�Final ,�
12. Sewer Cap " � 63. Heate� & Vent-Final •i1
13. Roof prains fi4. Plumbing System • Finaf
14. Rough Plumbing- ' 65. ElectricabFinal
15. Rough Elecirica'I'Conduit ' 66. Solar System�Final '� '
.'
16. Rough Electric Wiring 67. Fencin9 & AcceSs Approval .
17. Rough Wiring Sign - ' 66. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling- 69. POOL(SPA SY5TEM5 FINAL
79. Rough Heating & Air Conditioni�g FIRE DEPT. REQUIREMEN7
20. Rough Factory Fireplace . . _ - • ,APPROVAL'S� . Permit #
21. �Oucts, in Structure ` �, = x _- ' ' 70. ;Und"e'rgrouatl Hydro
22. Ducts, Ventilating � ". �� -� 71, Produci Piping O�Gas � Oil
�.� Y .
23. Gas Pipe�Rdugh & Test _ ' 72. Underground Flush . -
24. Roof Framing � .. -' 73. Undergrnd. Stora je Tank O Gas ❑ Oil
25. Roof��Sheathing � 3 p�: �(,��L- 74. Overhead Hydro '
26. T�Bar-Ceilin9 (Structurall & Monocoat 75: Dry Chemical �� - '
27. Frame and FlashiAg = _ , � 76.'Dry Star�iipipe + ' -
28. Lathing & Siding �.�„ � . • 7h FIXED SYSTEM FINAL '
29. Insulation ' � , � ' � ; -. `, 78, FIRE PREV. FINAL . �
�
30. Drywail Nailing : - � ' - �' EALTFhDEP7. RE�UIREMENT
31. Plaster Brown Coat . _ ' �. 7, FINAL i E�TiON . - -
r '"�E`15SUED
32. Electriwl PO�.'er Meter-Final � , _ •�, FOOD ��ERTIF.ICA�
33. Final Eiectric r ' NoTes: �'. '- _ _
34. Finat Heating�& Air Con�(i,tioning ; = ,- F - � . • - � _ �.
.,.
35. Final GatPipe-Test � ' , "k ` � ' � = '
���
36. Hood or CanoPv - - • . - _ : - ' ' - � ' -
37. Final�Factorv Firep�ace _ � � : '� . ��
38. Final Plumbing , � _- >, '�-�_ _ �. : '
39. Water SetviGe-Finai - � ; �' � , - -
� 40. Gas Service�Final � _ . • ,� �-• , �
. ` n .
41. Solar pomeSticFinai � � - ;w ' • �
42. Backflow Preventer i - ` , ; . ,
43. Backflow Irrigation < - _ � ' •' `=
44. Landscape Irriqation System � - . _ � . ' - � �
45. Sound Acce�uation - - ' � - '
46. Handicap Regulations - �� � " . . � -
47. FINAISTFiUCTURE&BUILDING /A_8_%'/ �(,JjyL � ' .
� [�.
48. PINAL PLANNING ' . �
49. Electric Release to Edison , ' �
50. Gas Reiease to Southem Calitarnia Gas Co , `
5t. CERTIFICATE OF OCCUPANCY . - _ �
No Date
�FESS OF BUILdNG: Q � Q E 17 TH 5 T
""°�F�^+ MTC MANAGEMENT
,.inoaess: gp0 E CAMPBELL #1
CAMPBELL, CA 95008
408-377-1754
1VPL. MqIIING ADDRESS
u�cxrtccr ox e*+w�n:
uc. ra.:
UNT:
uar:
.-
coNm�cTarsnu�e: INNE.R—PHASE ELECTRIC ( 619 ) 582-00&6
CONTXACTOP5MNl1NG 5908 CHAOARAJOS
j .o�� S.D. CA ucra.: 468448
9 21 2 0 uxT:
LICEN ED COMNACTOpS DECLRflATION: I Mreby dfrm under penely d parjury �he� 1 am licemed uMx povieione of Gheqm 9
(romm urp xilh Seclbn ]000) ol0iveion 3 d tha Businem aM Prolesabns Cotle. eM my licenae u in lull faca enE eMecl.
cm .No.: uc.cuss: L_lp uc.No.: 4(8448 EXP;
Data: `L Conveaa: \ \ c-� " _
� OWN q BUILDEP DECLpflATION: 1 hnaby elfirm uMer penety d perpiry �he� I am axemp Irom ihe Comretlas licenee Law la tln
lolla nB reawn (�a^ ]�1.5 Bua'u�ess end Prolasabns Code: AnY cMY a�nry whid� reQuirae e pe'mil to mnaVuci. eher. improva.
de liyh, or reper eny airuclure, piior lo ds uauence, el+o requirea the epplirant /or euch peimit to file e dpnad eietemeM ihel ha «aM
ce�sed Wnueni io �he provieiom of Ihe Conlredore Licensa Lew �Chepter 9(wmmeruing wil� Sepon ]000) d 0'veion 3 N the
uai� � prdeavoro Cade� a Ihet he a sha is axemq Ihaehom end ihe beaie la Ihe elleped azemqion. My videtian d Setliwi
)031.5 py yry epplicem lor e permn aubpqe ihe eppliceM lo a avil penelly d na more Ihen Iwa hurdreE tldbn �55001I.. -
❑ I.svovmerMtMpeopMyamVemi�'�+wlhwW�m�haiedeoomPa�tion.xilldotlrewak.endUasvunuroe�wlmlaMad
a oRered Iu ale (Sectim ]Oaa, B�era eM Prdasvons COEe: The Contreeon Licrose law doea ep� appl�to en ownsr ol propeity
w�o bulEe or inprovea Ihareon, enL xfio doee sueh xoek M'meNlor henef a �hraqh hm or har own empbyeea, 0�� �het sueh j
�mpiovemente are ipt in�eMed a oileretl lor eale. H, hawever, ihe EuitlinB a inprovemenl is eak wilhin me yeer ol mmplMb^• the
OwnmbuiMer vrill heva Ihe buken d 0�'inp M or sM tlitl nd build or improva Iw �M Oumeve d eele).
❑ I. � ow�or d tM MOGeM. em ud�meN conlred'rq wnh licenud contrecbn ro eonstrutl iM pqaa (Setlion IOH. Bwimes ad
PMeaime COEe: The COMredae Licenx lew doo nd eppy b an owror d pW�Y who WJtla ar imPp+es Ihe�son ud who
Coni�ac�a /a wtli projepe wnh e oon�rmor(e) liensad W�auent to IM CaMreqore lioeme lew).
❑ � em exemp� urMer Senion: B. 8 P.C., br Ihrc reemn: '�
Deta: Ownx:
I Eo M1qreby cenM Um I em ewue d enE u�donteM the reQuimnama d CelAomie Heellh erd Selery Coae Saqiaru 25505. Y553J, vd
25531. eM Nm I a enY Mun Wikiiq oaupenl will / wll iwl (tlmie pr) reed �o canpy wih eaid qme mdee a'M IM �puiramenb M
aparmiltaconewctionamodifrationhaniMAi e�iy arepemeniDiatrid.Redden�idmmliutlionappiraiaueraeRemptlromUreea
prariS�ppe.
o�a: �vvi�m:
WONKEN'S COMPENS�TION DECLAF�TION: I Mreby e/firm uM�r peral�y d perjury pp d the Idbwirp dederatiom:
❑ I heve ud wil meinlen e cMJ'rme d wnwni to satlimurt Iur wpkaa' cpnpeneetion. m prwided lor by Sedim �]00 d tM leEa
Code, la �M pMamence W �M wA tw whicA this paimil u iwusd.
�I �ave anE wil meimen xroMA wmpaneelon imurence, n� reQuired by Sepian 3100 d ihe Lebor Coda, M iM pailormenae of tM
��wak tw which Il�ie pemirt b isued. MY wakeu' mmCenaeibn inewmice rarrier arrd Gakl'rwmber eie:
c�.�: 4TATF. F�7Nn EXPIRES
PdicyNumbw: ��u�naF-uti 02/O1/96
his y�iyi nesd mt be canplHsi ] tM prmk is b me hoMred7d/ers /St WI A' Hw.1
I eenLy Ilul in �he parlormerce d IM wak la xfich ihu psemX ie ieeuatl, I ahell M amplry vry peiwn in eny menner eo m lo
bacoms euEl� �o the xvrkera' rompeneation laxa IN Celibmie, end aprea the� H I ehould becoms eubjea �o iha woMan'
mpenealim D�'isbno ol Saction 3)0p W Ihe lebor Code, I ehdl lo� py with ihow qwleione.
Dme� LC�i�LA�- 4.� Appliranl: - ^' '
Inp: Fdlun ro��cun wo�kwry'rompxwtlon roverap� b �n1�wN1, m0 Mull wEJ�et en �rwloyx ro eAMnsl p�n�ltlu �M
clN/ ry� �gr ro en� hwCrM tMuurd tlWlen (SfOq000A In N9tlan ro M� cwt ol rompmulbM1 tlemspu u preWMO br In
9xtly� 9)p6 0l M� la6or COW, Infsru4 and �ttomsy'� hu.
GON$TNUCTION LENUINO A4ENCY: I Mreby eMirm under panely W perjury Ihet �hen ie e canNiupbn krdinD a0ency br iM
periwmeMe W �M wak la whkh Ihu permi ia Ywad (Seaon �ODI. CM. Cl.
LENDER'9 NAME:
jj LENDEN'S ADDPE%:
/ I ronryy iry¢� I haw read �hle epplicelion anE tltla Ihal ihe ebava inlamatlon is corta4. I eprss to comply with ell tlry entl munry aEinenwe
r end atete kvn re4iing �a buildin0 conelrudion and haroby eWwrke ropreaenletivee W Ihla dty to entar upon �ha ebove�meMpnad qoperry
lorirypadion Ourpoeee.
I� THOMAA$ HARMON
(5151de,WP) Whus-BuIWnp85tlW;
oms: tb �-1 �^R 5
Fnk--fimnw: QddsnradNeeawr
CITY OF COSTA MESA — PUILDING PERMIT
PERM NO: E 07450'2
PERMIT NO: E 074502 PLAN CIIECK NO: N GOVT: N SUPP: iV
CONSTRUCTION TYPE: C'—N PERMIT TYPE: FLE PURPOSE; ALT
SOB DESCRIPTION : 1360SF RESTAURANT TI. SQ FT:
CLAIM VALUE: CALC—VAL[JE: GROUP OCC: B-2 /
COMMENTS: "TOGO'S" EATERY, RE:#874343
**�:*x�c�ra��x**�x�**�cx r**���x**x��***�****+�*�+��***+�x****x*x��********+��x*+�k*+�*+�**
Z O N 2 N G R E Q U Z R E M E N.T S
' S E T R A C K S
----------- MAIN HUILDING --------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT ' IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 11732130 ZNE: REF NO:
PLANNING NOTES>
i
iF dElE 1f 3E iE �E #E 9E iE 3f iE 1E �E 1E jE 3E �f if iE iE �E �E iElE 1E 3f if jE 1E �E-%iF fE * jE iElE �E 3E iE 1Elf if * aE jF iE iE iE 3E iE �E iE 3f 1E 1E'k if iE iE 1E iE �E iE 3E iF iE if �E �E jE �E iE If jF 3E iE dE
D E V E L O P M E N T S E R V I C E S R E C,� U I P. E M E N T S
ZONING APPROVED BY . " DAT'E:
BUILDING APPROVED BY : �' DATE:
APPLICATION ISSUED BY: -t�� DATE: /� _ J���
iElEiE9E1EiElEjfdEiEiEiE�EiEjfiEiflE9E�E3EiF ' F'f�iF 9F#.. �E;F��i�FiEiEiF�E��9EiE�f1E1Fif9FiFiE3FiE'�i 3�F��F �E�f
LEGALIZATION:N F E,E��� S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUt'B7*"' c;LECTRIC .MECHANIC FIRE SMIP/RES GRADING
PERMIT ` 30.00
�� SOk SMIP/NON—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—> PERMIT C'" n PLAN—CHECK TOTAL PAID DUE
TOTALS----> 30,00 1.00 0,00 45.00 45.00 .00
REVENUE DIVISION TOTALS--> COLLECTED; 45.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECI�.IC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
45 �0.
iE iE iE 3E 3' 3E 3E iE i: 3ElE iE IE iE iE iFlf if iE iE iE dE iE!(� iE 1E �E iE iE dE 3ElF �E 9E iE 1ElE IE iE dE tf if jE 1E iE �E iE 3Elf If if iE iE fE 3f 1E 1E iE iE �F iE 3ElF �E iE 9E �E �F 9E iE �E iE iF dF iE iE �E ic dE
I N D I C� I D U A L F E E B R E A K➢ O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 12 FIXTURES, LIGHTING 1 ST 20 EA. .75 9,00
ELE 20 RECEPT/OUTLET 1 ST 20 EA. .75 15.00
ELE 8 RECEPT/SWITCH 1 ST 20 EA. .75 6.00
END OF FEES •
/
O1 DCf?t]b7-p01917b7 TG T 4g.Qp
GATE: 20/:Di?5 TIrIE: I.�:OE
)NSTRllCTtON AND PLANNING
.PPROVA�S Permit #- -
'�ti, Temporary Electrical Service or Pote
2. Soii Pipe-Undrgrnd. -
3. Electricai Conduit UtilitY-Undrgrna.
-0. Electrical ConduibUndrgrnd.
5. Steel Re�nforcement - .
6� Electrical UFER Grnd. .
7. Footin9s
8. Foundaiion
9. Water P�Pe-U�drgrnd. �
10. Structural Floor System �
i
11 . Property Sewe� Line & House Conrtecti��
12. Sewer Cap •t
�
13. Roof Drains ' .
74. Rough Piumbing �
16. Rough Electrical-Conduit
16. Rough Electric Wiring
17. (iough Wiring Sign
18. Rough Electrica6T Bar Ceiling
78. Rough �Neating & Air Conditioning
20. Rough Factory Fireplace �
21. Ducts, in Structure
22. Ducis, Ventilating
23. Gas PiPe�Rough & Test
2a. Roof Praming
25� Aoof Sheathing �
2fi. T-Bar Ceiting (Structurall & Monocoat
2�. Frameand Flashing
28. Lathing & Siding
29. Insulation
30. Drywa�l Nailing
31. Piaster Brown Coat
32. Electrical Power 44eterFlnai
33. Final Electric
3d. Final Heating & Air Conditioning
35. F�nal Gas Pipe-Test
36. Hood or CanopY
37. Finai Factary Fireplace
38. Finai Piumbing
39. Water $ervice�Finai
4Q. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preve�ter
43. Backflaw irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46� Handicap Regulations
47. F1NAL S7RUCTURE & HU1LDiNG
4$. FINAL PLANNING
49. Electrie Release to Edison
5Q. Gas Release to Southern California Gas
51. CERTIFICATE OF OCCUPANCY
Date
Date
- �"�
PQOL ?Q ,
Inspector APPROVALS Permit # '
52. Pooi & Equipment Location �
53. Steel Reinforcement j �
54. Forms
55. Electrical Bo�ding •
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVEF GUNITE
58. Elearical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, 0 Undrgrnd.
67. APPROVAL TO DECK , ��
62. Backwash & Receptor�Final� �
63. Heater & Vent-Final �
. 64. Plumbing System - Final
.65. Electrical-Final ' !
66.-SolarSystem�Final i
6J. Fencing & Access Approval
°". APPROVED FOR PLASTERING
/� 69. POOltSPASYSTEARSFINRI
fIREDEPT.REQUIREMENT
APPRQVALS Permit #
70. Underground Hydro
71. Product Piping G' Gas Cl Oi1
72. Underground Fiush
73. Undergmd. Stora9e Tank ` Gas d Oil
74. Overhead HYdro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78: -IRE PREV. FINAL '
� "FjE[aLTH OEPT. REQUIREMENT
r�
FINA� i, SPECTId�.
,
FOOD,CERTtFICATE ISSUED
1
Date Ilnspectpr
�
e
�
i,
(
�
�I
�
,,
ADUHESSOiBNLpNO: t1z[� � 17TH ST
EN4NH[EIFpqMN: MTC MANAGEMENT
� ADDIiE4R1900 E CAMPBELL 4k1
� i � CAMPAELL CA 95008
' 408-377—�754
AFPL. NAlIlNO �DOPE59:
urcxrtecT on wowux:
urcx. on eno: s �ooxess:
- UNi:
uc ra.:
uxT:
wxrn�erorrex,u� J.R. JIMINEZ PLUMBING (619)743-7905
camucTorn�u�a+o 1127 ROCKS SPRINGS HOLLOW '
�onrsa ESCONDIDO CA ucw_ 587668
92026 urn:
LICENSED COMRACTOF9 �EGLAfl�T10N: I Mnby dlim u�Wr pe�Wy d paQury Nq I em Ita'wtl uMx prwhbn� W Cheqm Y
(aommwid�q wllh 8¢uan �000) M Oivbion � d Yr &vimv W Pnlwam� God�. end my &ems h in hA bm end Maa.
emuc.No.: ue.euas: C-36 ��N� _37668 EXP:
DNa: Q�n�. i� R� Gamee«: �1
OWNEP BUI�DEN DECURATION: I Mnb/ dfirm uMx psWy d rjm/ ihe11 em emmp m• Com'vfm Lkwu w �M
Idbw+q �wm (5wion ]mts &nirn me RWmb�n Coda: a mwY whid+ naJ o«mC to am�aucf. Nur.
demd'e�, a repei eny �Iruclwa. Pria b u u�uenos, ebo npium tM epplium In wN pertnE to fib a aqroC HeiameM UW M a�M
�;, uc«�..a wm,w w m. v� a m. wv�.na. tio.�.. i.,. �cnwtr a�oo�.�«m,v .an sw� �000� a o:.:wo a�e n.
Bue'uwv W Vralw�cro Godel a IM M a dr u arz�mq iherehan W iM bub la Ihe �IbpW ezampion. My violetion d 6adian
1Wt.5 by e�ry epWiam lor � pmmi �ubpm tM appfraN b e eri pauEy N na� mpe IMn fve MvkmE /EaOen �SSOOD.
� I, o owner d IM popany a my anpryeu uih xapea n tMi ds aompensetian, wY do tM rnk aMNe �wr�un e na1'vNendad
a Mered M sele (Sedion ]oM. Busnow ud PMouom Cade: Tha Caareaon Limma Lew Eom Iwt WdYto en owror d poMM
who Wils a inPw'e+lhenan. end Mn doea �udi Yqk!'cnwC a MnN aWu� he a hr Ovm MnVbYw. D�b Ihel wch
impwamenta va nd imrdW a cMaed ta eeb. tl. Mwever.lhe buitlinp a inpwwneM ro wN wnhin me Y� d oom0��. Ne
ormar-0uildar wL Ma �M bnden d po.i�p M a ehe did m� Gdd a impova la the puryroe d mb�.
� I. m ox+nr d Ihe pW�Y. em uMndY mmreaYq r.M fm�tl arMrecbn lo mWuq Ne p4?d (SeUion'lDu. &nins� and
Proleuima COEe: TM Corvretlws L'em» Lew Ews �d eppM b an owner d popeely w!a buiNa n'unpovm ihereon eM who
conirecb tn vrh pqetl� wah e mmratlor(+) IcemeE punuw to IM Caqrx�m liwme lew�, •'�'
� I em exemq uedor Saetion: 8. d P.C.. br tlu rm. : ' � w� �
�me: �:
I do hereLy cerlity tAd I em awere d eM uMeniaM tM rxryummems d Cellarie IlealA eM Satery Coda Sactiom 25505.255]�, eM
255N. vd Ihel I a ury Muro WiMinp omipenl will l wil rql (�b pw) rostl lo aomply wih �eid qa�� mAe� enE IM reQu'vam�nb Ia
epermillammwdiona�mdifirationhamlMAi iiu�y e�xpemsuDiarid.Radd�melamq'uGioneppiWioroenezemplmmlhme
wovisb�•.
Oela: MM�
WOHKEP'8 COYPENS�TON DECL�P�TON: 1 Mreby e1Mn uMs pmulyW q'ryry aa W IM Idbwiiq dederetbro:
� I Mv� end rnl meinlen e wnil'rsu d mmom io vatlwua br Maken' canpenetbn. n prwidsd tor by SMion ]100 M tM leEa
CoG, ta ihe pMamierca d Na wM Iv w1icA Nu pemu u emusd.
�J in.»�e���m.�wn..•oomo.�o�u�.�o...+�.wvwMs.n�arooam.i.eo.cod..a.m.v«iam.ro.am.
Wpk �p W�1lfll My plI�III b OUCd. MY WtlkM�� <MIDM�W 1011 �YIp1ICIC� fMINf 41d �IL)' IIIM�lf Y\:
c�: STATE FUND EXPIRES
POGcy rNmbar: ''J 4— 4 I ''1 / 4 11 01 / O 1/ 9 6
n�..wrm �..e �a ne �onv�w � m. a,�,�� n m. m. nwimw mo.l. a�ool o. bw.�
� I oenh � in tM pMaemenee tl tM rak iar x1�ie� ih6 perms 6�wd. I Nel rca ampby erty penm M ury menror o n to
Wrnro wbjep io tM �s' mmprraion M�w d C�fdanea md rypr tlW ! I koutl CamM viEjan to �M r.oMen'
mmpenw�fo� r��• a swion a�oo a u» leeo. cod.. � � �m oomW � n mo po.�mon..
Dete: Q� 1 7 � 9. � �VO��� �
WimMp: F�Nun ro ucun wort�ri mrrpru�tlan mrrp� li �nrl �IWI ub/cl Iq.r ro cNmin Itl�� �M
<Ivll nnu ,p ro onr n�nerW tlouunJ 4d6n (tIQ4000A Mi n ro tln cwt ot w bn a�p� u pro ror In
S�ctlm 9106 ot fM LiEor CaW. IM.ruL uW �mm�Y i Iw.
CONSTfiUCT10N IENMNO �6ENCT: I lrWy � �,e. o.eev a o«'.y mn u�e o. mmNu� i«ww w.��y b• uw
pa.iam.ze a ins wk �a wniw �n: v�� u uwaa (sa+ia, Joo]. cN. cl. �
' LENDEN'S N�IIE:
LENDER'S AOOflE44:
I canM �Ael I M1ew nW No WG�ranon eM qeN Ihet IM abvn "vdammion e conan. l eW� to camdY w4h W M/ vd ww�Y adirwioe�
e�M zlme lexw rolel�q lo WiNip coiWruGcn ud Iweby eNlqr¢e repreaen�Mrves d Iluf cily lo enler upon IM ebove.menlnned pmpeM
�«��'°"'�°�`°�"' J.R. JIMINEZ
Ume: l���—�j
OeaeerFb: CererY-RVGk�: Rnk-Rewnw: Gddenro��seeaor
CITY OF COSTA MESA -- BUILD'1'NG PERMIT
PERM NO: P 074362
PERMIT NO: P 074362 PLADI CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: ALT
JOB UESCRIPTION : 1360SF RESTAURANT TZ. SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
COMMENT'S: "TOGO'S" EATERY, RE:#B74343
#x��e�****�**����*��*�����e**x*�a**�*�*��r�������*����***�����****�***�****�*rt��**
Z O N Z N G R E Q U I R E M E N T S
5 E T B A C K S
------------ MAIN BUILDZNG ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: �� FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 117321,30 ZNE: REF NO:
PLANNING NOTES> N
> �
iE if 1E k 3E iE 1E jF iE 3E iE iF if iF # iF iE ic 1E iE iE iE 1E iF iF iF 3E 1E IE iF iE iElE iE iE 3E iE iE iE it dElElE if 3f iE jF# iE �f �F dE if iE iF iE dF dE 3E iF IE iE 1f iE 3E �E 3E iE iE iE iE iE �f �E �f �f 1E if IE
D E V E L O P M E N T S E R V I C E S� R E Q U I R E M E N T S
ZONI�IG' APPROVEC BY . �' DATE:
HUILDING APPROVED 8Y
APPLICATION ISSUED B
if 1E if # iE iF 1E iE iE df af 1f if 3E if if iE 3E iE if
LEGALIZATION:N
BLDG PMT P
PERMIT
F E E S U M M..A ,R Y
: (�� VU
B ' ..,.aCTRIC MECHANIC
�. � : � 1�
� 2 . a , , �' � '' �'.
FIRE
DATE:
DATE: � Z� "l \
tE iE iE ie iF k it iEiF7� ir'IFTF'ir 3F'iF7�iF�E iE
STRUCTURAL SEGMENT:N
SMIP/RES GRADING
PLAN SMIP/NON—RES
ISSUE FEE 20.0 , '-;L ;�,
BUILDING—DIV—> PERMZT IS:.,n PLAN—CHECK� .�, TOTAL PAID DUE
TOTALS----> 70.00 20. 0 0.00' 90.00 90.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: , 90.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTR C MECHANIC •, /FS�R£ SMIP/TOT GRADING PLAN—CHECK
90.00 - • ,{
iE ik aE If IE iF iF iE M 9E iE if if iF if if iF iE if if 3� 3f IF 9ElE k iE aE �E iE iF �E 1f iE iF k iEi� iF i! iE fF i�lf �if jElf 1E iE iE iE iE 3f iE iE iE iE iE iE 1F iE iE iE IE iE 1E if iF iE iF iE 3e iE i: af iF iE %
I N D I V I D U A L •�'F E E.: B'1�R E A K D O W N
� . /
TYPE QTY D E S C R I P T I O N; � 1 UNIT COST TOTAL COST
PLU 1 SINK, KITCHEN T' 7.00 7.00
PLU 1 WASH BASIN (SET) ' �� � 7.00 7.00
PLU 1 WATER CLOSET (TOILET'} � .� 7.00 7,00
PLU 1 WATER HEATER AND/OR VENT :� 7.00 7.00
FLU 4 SIDIKS, FLOOR ' 7.00 20.00
PLU 1 SINKS, SERVICE / MOP r 7,00 7.00
PLU 1 FLOOR DRAZNS "/�.,,� 7.00 7.00
E�1D�,OF FEE��
: �.� ,�' �
.>i� ,
Oi �QZi11i��_i� ir11.�. '�'�i� . .'1J
ca;�c C^/<�. �5 ;,�.F: 11�Sa
�NSTRUCTION AND PLANNING
F:PPROVALS Permit #
4-
�t! TernPorary E�ectrical Service or Pa�e
2. $pil Pipe-Undrgrnd. �
3. Electrical Conduit Utility•Undrgrrtd.
4. Electrical Conduit�Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. FoOtings
8. Foundation
9. Wacer Pipe�Undrgrnd. �'.. '
10. Structural Floor System -
17, Property Sewer Line & House Con�ection
12. Sewer Cap - •
73. Roof Drains � i._,
14. F.ough Plumbing � � �Q
15. fiough Electrical-Conduit
i6. Rou9hElectricWiring
17. Ro�gh Wiring Sign `•�
18. Rou9h Electrical�T Bar Ceiling �
19. Rough Heating & Air Conditionin9
20. Rou9h Factory Fireplace
21. Ducts,in Structure
22. Ouccs, Ventilating
23. Gas P�pe-Rough & Test �
24. RoOf Framing
25. RoOf Sheathing
26. T•Bar Ceiling (Structuralf & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
37. Plaster Brown Coat
32. Electrical Power Meter•final
33. Final Electric
34. Fin81 Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Fine� FactorY Fireplace
38. Fina� Plumbing � r
39. 4Vaier Service•Final
40. Gas Service-Final
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINALPLANNING
49. EleCtric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
Date
�
POO L +A
Inspector qppROVALS Permit #
52. Pooi & Equipment Location ',
53. Steel Reinforcement - '
54. Forms
55. Electrical8onding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
� 56. E�ectrical Co�duit-Undrgrnd.
59. Gas Pipe, O U�drgrnd., Test
60. Backwash Lines, P�Trap, Q Undryrnd.
61. APPROVAL TO DECK " •
62. Backwash & Recepior-Final '
63. Heater & Vent-Finai �
-� 64. Plumbing System � Final -
� _ 65. Electrical�Final
66. Solar System•Final �
67. Fencing & Access Approval ,.\
68. APPROVED FOR PLASTERING�;
69. POOLlSPA SYSTEMS FINAL
FIRE DEPT. REQUIREMEfVT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping OGas ❑Oii
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead HyAro
75. Dry Chemical
76. Dry Standpipe
77. fiXED SYSTEM FINAL
78. FIRE PREV. FINAL
�i.�. ' HEALTH DEPT. RE�UIREMENT
FINAL i $PE�.itON
�
F000 RTIFICATE ISSUED
Date In:pector
.
I
�
�
"�$0FB01LD1NG 424 E 17TH ST :, u"':
�"'P101Ni MTC MANAGEMENT�'
�oowEss: g00 E CAMPBELL #1
CAMPBELL, CA 95008 '
408-377-1754 �
mr�. �,uiun+aooneu:
/JICNRECT OX FNtlNEEP:
AfKll ON ENO.'S AODNESS:
CITY OF COSTA MESA - BUILDING PEAMIT
PERMIT NO: M 075391 PLAN CHECK NO: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC
��"� I JOH DESCRIPTION . 13605F RESTAURANT TI.
UNT:
rnmucTa+swu�:ALISO AIR CONDITIONING (714)589-2021 CLAIM VALUE: CALC-VALUE:
COIIMCTOR4YYlW0 29736 AVE DE LOS BANDERAS
�oo�ss RANCHO SANTA MARGARI CA ucno: 526420
92688 u�r:
UCENSED COHfNACTOFS DEC WPRTION: I heraEy ellirm uMer peneMy d pmjury tMl I am licenced uMer prwiaone d Cheqer 9
(wmme�'p xiih 6xtion 1000) tl Oiveion � d iM Buaroee enE Pmleaoioiu CoEe. eM my licenae b in tWl laca eM Map.
cmuc.No.:04G976C3 �� ��g C-20 �� � 5264 .0 EXP: O4 /96
Dme: i� I 2 1 / 1 S ConVeaa:
. OWNEN BUILOEP DECLARATION: I M�eEy effirm u�r penely N rjury tAet I em exemq tmm iM ConVetlon Licenae lnw la IM
Idbw'vp reeaon (`�� �091.5 Bu+iieas eM Prolsuio�a COJe: AnY IY a aounry whidi rpuirae e pemin �o mrovucY. Mx. impaw.
demoleh, m rapa'r eny etr�cNro, qbr �o ib uwence, epo myui�es ihe epplicant lor ach pam�il lo Rle e eipneE NeHmeM RW he or eM
u IicemW Wn�� �o ihe poviaiona d Ihe Conire�tm0 Limnee lew �Chapbr B(mmmeruinp wn� Setlion 1000) d Div'vion � M the
Buainew W Vrdaeaiom Codel a ihtl Ir ar sha e uemq tMrahan enA tM beau la Ne eDeged eaemqion. My vidmion d Setlbn
lWt.S by enY aVV�^� la a permn aubjeG+ Iho epplicem io e dvtl pmelry d nal maa Ihen fwe huMred doAan R500D.
•� I.eaownaroliMD�Ws�YwmyxnOM��h'"4Yamihei�dseam0enwian.xi0dothexak.aedMaewnu�eend'mleMed
. aMaadlaubl5ectian)Oa6.6uvMasenEPmlleaonsCods:ThsConirmonliunelawEoasminVO�Ytoanownerdqopeity
Mp W Ws a inyww IM1erem. end v.tn doee �uM wpk Fim�etl a MnN a INapl+ hu a her oxn ampbyas�. pwkaE IIW such
'unpwwnmaa ua mt imaded u aflered Iw ub. tl. howawr. iM buitl'up a inpwanM'v edd wnNn ans yamW canpelion. Ns
owmr-0uaEer x�tl heve �M EUMm tl qvri'p M a elp did M deld a improve lar �M puryme d WeI.
� I. ea o�mer d IM propaM. � e�duenMy oontredyp �h liosnsod wnireelae ro canetr�d IM prtpetl (Section )OM. Busirisss erd
ride�a,. coa.: rn. comreeon Uc«,se �aw ao.. na .aWr a.n owne, w waoMr wno wim « impw« m.na, w wno
mnUect� tar wN pGsqs wvh e mMradnle) IcehyE WnueM lo IM Contradas Licafue laM.
� I em aaemp unda Seclion: 8. 8 P.C..In tlin roason:
Dele: Owner:
I do Mieby uniy Ihtl I em ewue d anE undeiaivd tM �ayui�ameMe ol Cal/omu Neallh vN Sdery COEe Satliam 25505, 255J3, ud
255J1, enE I�ei I a eny lulure Wildiiq ar.vpenl hill / wil rw� (tirc4 ons) r�sed Io compy wIh said Yds aode� W tM rapulromanb M
epermMlormn�Vuclimmmodiliralionhwn�heR'r eily ¢'ypemonlDietnd.RaldeMielaonel�uGoneppFulion�anwaemptlmmiMsa
proWslons.
om.: �cqk.m:
WOHKEfl'S COMPEN91ilON DECl1R�TON: I Mr�kry y(rm unMr qnelty d pxjury aro d tlro bAovAiq dsduelbm:
� IMaeMxilmein�eneaerliFatoMmnmitlo�aryi�nbworken'rompanWbn,mprwidodfpby9epbn3)OOdtMLela
Cods. Ip �M pMvmuca W fis wM la wlsh U�i� pseme b bueE.
❑ i n�.�a .0 �me:, wo�x.n� �o�� ��w�.M...+�.a��.e er aw�, a�a a u. �.e« eoa.. e« m. o.���. a m.
work lor whic� Ihu permn u imued. My waken' oanpnW bn inwranw wrier ud pdiry numbm vs:
c�: T.TAFRTV MTTTfTAT� EXPIRES
ra�rmmn« brr��a+nac.�ianFS 07/O1/96
,Thia eMion nssd mt W mmPbM l tM pamk u b me hunCM EWen �SIOJf w Iw.J
� I mnily ihei M IM p�rlormenca d IM wak tor whch Ihh pxm81 b�u�d, I�MII ml empby ury penon in �ny menno �o n to
becoms wWea m iM v.orFere' compenee�ian IYxs W C . enE pne thetiH I dwuk bxviro wWW lo tM v.oM�i
mmpe^y/�an padecm d Setlion 3)00 d �M lqyp ��.1 I lon �ph wmp wah Nwa oNwn�.
Date: �� 1 L I l�� AppliraM.
W�mlrp: F�llun ro ��eun work�n' eompxu+tlon eov���p� l� la 1, �ntl �Nll udf1e.M m�mployK to eNMnl p�ruMu �ntl
e/Hl llnu'q ro an� huidrM Mouxrd tlo/Mn !lfOqpppA M /tlon b fM ewf ol rompmutbn e+�p� u povWM br In
9�cHon �)06 0l N� LMor Cotls, /nt�nst �� ��mq'� Iwa.
CON9TRUCTION LENDINO AOENCY: I Mreby �rtn undx pondry W perWry ihp IMn o e mnaUutlon MMhp epancy lor tM
�f�dTBMO O� 1�10 WIXk �IX W�1lf�l �hB VSTII p 6lIMd �$WCII'.1�Ji. CN. Ci�.
LENDEN'8 N�IIE:
LENDER'9 AOUflE34:
I cMily ihtl I heva nW Nb eppliration end Yffis thm Up epq,y �p�Wpn b canW.l pna tocomply rrit� e0 rdy end aounty oNiro�pn
end �ws le�n n4! q w EuiknY �ruaion eM hmahy aW�Mi� np�uentmiw� M �hu dlym aqm uo� IM ebwa�mambnM D�WeM
In'uwpstlan purpo�as.
�JUSTIN HOLMQUIST
Pnm r+em.
Whn�-Buikip 8 SdMy; Onae�Fb; Cenuy-App1uM; Pink-Rmnus: floldenro�/uwmr
ERM NO: M 075391
GOVT: N SUFP: N
PURPOSE: ALT
SQ FT:
GROUP OCC: B-2 /
COMMENTS: "TOGO'S" EATERY, RE:#B74343
�*****��*x**������x*x*�*�*��x**���**x�x*�**�**���r*x��*�rrx�*****�*�*��*�*��+�*��*�
Z O N I N G R E Q U I R E M E N T S
S E T B A C R S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT It�1 REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 11732130 ZNE: REF NO:
„PLANNING NOTES> �
, � 7
1
�iE iE iF 3E iE dF �E IE iE 3E * iE iE iE 9E aE 1E 3E 3E fE �E jF 3E iE iF 1E if iF IE K iE jE iE iE 9f if iE 1E�iF iE iE iF if 1f if iF 1E iE if 3E if �E iE jE iE iE �E �E �)F 1E �1E iE iE iE iE iE iE �E iF aE if �f iE iF 1F iE IE aE iE
`; D E V E L O P M E N T S E R nV I C E S R E Q U I R E M E N T S
/ '�
ZONING APPROVED BY DATE:
HUILDING APPROC'ED BY : /a'1 DATE:
��y � � � ,., t
'!APPLICATION ISSUED BY; { �,� � DATE: �II G��
1EiEiEiE3E�FiF1EiEiFitiFiFiElFiEiEiElElEiEik'iF�EiFiF3F'iFiFiF3F3F7F3FiFiF3F ifiFiF'iF3F if7fi�F3F3FiF7F1FiF3FiFiFib�)EiEiE�EiE9E�1Ei��4F'iF �t*
LEGALIZATION:N F E E -S U M M A R Y STRUCTURAL SEGMENT:N
� _
BLDG PMT PLUMBID ELECTRRC v�MECHANIC FIRE SMIP/RES GRADING
PERMIT � � U 18.00
_ � �- .'. 25� SMIP/NON-RES
PLAN n
ISSUE FEE * ^ �, 15.00
BUILDING-DZV-> PERMIT IS UE PL'AN-C�iECK TOTAL PAID DUE
TOTALS----> 18.00 15 00 ; 0,00' 33.00 33,00 .00
i :
REVENUE DIVISION TOTALS--> COLL•ECT�D; 33.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELEC RIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
�33,.0;0 i-:
9E iElE 3E if iE jf 1E iF iE iE 1F iF 1E 1E fE �E 3E fE 9f iE iE iE 1E 3E fE aF iE 1f IE iE 1E iE fE iE�1E �E �7(�1f iE.* if jF1E �f iE �f 1E 1E 1E 1E if �F 1E 1E iE 1E 16 iE iE iF iElE iElk 1E i61E iF �E if� jf 3E iF �E 1E iE fE IE
I N D I V I D U A L� 'F E E� B R E A K D 0 W N
TYPE QTY D E S C R I P T I OrN �. � UNIT COST TOTAL COST
� I �
MEC 1 REPAIR/ALT COOLING � UNIT,/SYS W/CNTLS 9.00 9.00
MEC 1 REPAIR/ALT HEATING,_UNIT,/SYS W/CNTLS 9.00 9,00
END �OF' FEES
y , � I
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. �`i /
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Gd �CliS?�t—COi45.39, 'ia7iY 83aC�i
UATc: :i;�,,t,, 7iiic'; :�1SL�
.,., _ . �,
��JNSTRUCTION AND P,�fINf�NG
' .1PPROVA�S Permit#
_!
' 1. Temporary Electricai Service or Pole
2. Soii Pipe•Undrgrnd: � � .
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Condult-Undrgrnd.
5, Steei Reinforcement
6, Electrital UFER Grnd.
7. ,Footings
�. Foundation
9. Water Pipe�Undrgrnd. . �
1J. Svuctural Floor System �
i t. PropertY Sewer Line & House Connection
r
12. Sewer CaP .
13: �oaf Drai�s
74. Rough Plumbing
15. Rough Electrica�-Conduit
76. Rough Electric Wiring
17. Rough Wiring Sign
78. Rou9h Electrical�T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
27, Ducts,in Structura ��
22. Ducts, Ventilating
23�. Gas Pipe-Rough & Test
24. Roof Framing �
25. Roof Sheathing -
26. T•Bar Ceiling �Structuraq & Monocoat
27. Frame and Flashing
28. Lathing & Siding '
29. Insutation �
30. Drywall Nailing _
31. Plarter Brown Coat . �
32. Electrical Powzr Meter-Final
33. Final Electric
34, Finai Heating & Air Conditioning �
(
35. Final Gas Pipe•Test
36. Hood or Ca�opy
31. Final Factory Fireplace
3$. Pinal Plumbing �
39. Water Service-Final
40. Gas Service•Final
41. Solar pomestic-Finai
42. Backflow Preventer
43. 8ackfiow trrigation
44, Landscape Irrigation System �
45: Sound Attenuation .
46. Handicap Regulations
47. FINAL STRUCTUflE & BUILDING
4$, FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Cc
51. CERTIFICATE OF OCCUPANCY
No Date
Date � Inspector
�
�
POOL _ �PA
APPROVALS Permit # Date I�spettor
52. Poo� & Equipment Location
53. S�eel Reinforcement �
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd.,�Test
60. Backwash Lines, P�Trap,�� U�drgrnd.
61. APPROVAL TO DECK �
62. Backwesh & Receptor-Final .
63. Heater & Vent-Pihal
64. Plumbing System - Fina4 _ '
65. Electrical-Final
66. Solar System�Final
67. Fencinc� & Access Approval
68. APPRpVED FOR PLASTEfi1NG
69. POOL/SPASYSTEMSFINAL
FIRE �EPT. REQUIREMENT
APPROVALS Pesmit #
70. Underground Hydro
71. Product Piping O Gas � Oil
72. Underground Flush �
73. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical �
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78, fIRE PREV. FINAI
�HEALTH DEPT. REQUIREMENT
. FINA INSPr ECT ON
, FOODIGERTIFICATE ISSUED
sr�
PPOJECT p00flE5S: .,9.2.q E 17'�`H S't'
owxEn�sNarne: JIM •A17THEFt
aooness: n 1 i''HUSINESS CENTER DR
IRVINE, CA 92715
752-0100
ANCH/ENGINEEH:
ADDNESS:
flEG.NO.:
UNIT:
UNIT:
PENMITTEE: GOODESIGN CONSTRUCTION CO ( 818 ) 282-2721
ADOflE55: 1(j4S W MAIN ST 410
ALHAMBRA CA 91801
IICENSEU CONTBACTOfl UECLABATION: I hereby aliirm that I am licensed untler pmvisions o� Chapler 9(comme cing with Sectian
7000) of �ivision 3 0l �he Business an0 Prolessions Coae. anG my license is in full ref a ettect.
cirvuc.:05581 T ELIC.:(j0']$'28 cuss:
� Date: y Signalure�.
wOBNEBS' COM NSa7101 OE BATION: I hereby afiirm ihai I cenifiwte oi consent to sel ure or a cenilicate of WOMers'
Comp¢nsa�ian InSurance. or a[er�i�ietl copy Ihereof ($ . �ab. C�.
POLICV NO.: E%P. OATE:
COMPANY:
, ❑ Certi�ietl copy is �ereby Nrnishea. ❑ Cetlifie0 copy is �iled wi�� I�e ciry Building sion.
Oa�e: ApDlican�: _
E%EMPiION FflOM WOflBEflS' COMPENSIITION UECLAflATION: (This �
I cehity that in ihe pedormance Ihe work lor which �his permit is
5u01ec� lo Ih or ers' C e � n Laws oi Calilomia.
Daie'. �� Signaiure: _
I il Ihe permit is far one hwAretl �5100) or less�.
any person in any manner so as to become
NOTICE: IL �ler makin thi aeclaration, you sh0uld De subjen m �he Worke ompensation pmvisions ofAhe Labor
Code, you must foMwith comply wilh suc� pmvi or Nis permit shall Ue Uee revoketl.
LONSTNUCTION LENDING RGENCY: I IlereUy aflir �ha� Ihere is a cons�mction le ' g agency for �he pertormance ot �Ae work lor
w�ich this permi� is issuetl (Seciion 3097, Civ. C).
LENOEfl: � f
RDUflE55: �
OWNEfl BWLOEB DECIANRTION: I hereby attirm �hai I am exemp� irom the Contractors' State License Law for ihe fallowinA �eason
(Semion 7037.5 Business an0 Professional Code: Any ciry oi counry which requires a Oe�mii m consimct, alter, improve, tlemohsh, or
repair any slmciure. prior �o i1s issuance, also reQuires Ihe applicant �ar suc� permi� �o file a signed s[atemen� lha� he/she is Iicense0
pursuanuo Ihe pmvisions o� �he Contracmrs' Siate license Law (C�aD�er 9(commenting wiN Section 7WU) af �ivision 3 0� [he Business
antl Pmiessions Coee) or �hai he/she is exempt Iheretmm an0 Ihe basis lor Ihe allege0 exemption. Any viola�ion o� Sec�ion 7U3L5 Oy
any apDlican� lor a permil SuDjec�s lhe applicant lo a civil penalry o� no� mo�e �han live hundretl dollars (E500�.
I, as owner oi the pw0arty or my employees with wages as �heir sole comDensation, will tlo ��e wark, and Ne
❑ stmc�ure is not inlen0etl or oiferetl lor sale (Seclion 704a, Business anA Prolessional Code: The Cantractors' Siate License Law
tloes not apply lo an owner of a pmperty who Uuiltls or impmve5 ihereon, an0 who does such work himseli/herself or thmugh
his Or her own employee5, pmvitletl �ha� SUCh impwu¢ments are not in�entletl or oflered �or Sale. I( hOWeVer the bUiltling or
improvemem is solA wi�hin one year o� complelion, ihe owner will have Ihe burtlen of pmving he/she Uid not 6uiltl or impmve
for t�e purpose al sale�.
I. as owner oi �he pmperty, am exclusively coniracting with licensetl coniracmrs to consimct the O�oject (Section 7044, Business
❑ anJ Professions Code: The Coniracmrs' Sta�e License Law does not aDPy to an owner oi pmperty who bwltls m impmves therean
and who cOniraC�s lor SUth proletis wiih a Con�fattor�s) licen5e DurSuanl �o Ihe Coniractors' S�ate LlCens¢ Law). I am awar¢
�ha� pwof oi I�eir Worker'S Compensation insurance shoultl �e pmvided to me.
� I am exemp� under Section: B. 8 P. C.
IOf Ih15 f¢3500:
Date: Ownec
I Go hereby ceNty ��at I am aware oi ana understand IAe requiremems o� Califomia Heal�h antl Satery Coae Sec�ions 25505, 25533, and
25534 antl ��at I or any future builtling ocaDanl willlwill not (circle one) neetl �o comply wi�h 5ai0 s�a�e cotles antl �he requir¢ments �o� a
permii for consimction or matli�ica�ion imm �he Air Oualily Managemenl OisVic�. flesiaen�ial cons�mc�ion apDlications are exempi tmm
Ihese pmvisions.
Wte: ApplicanL
I �ereby cetlily thai I �ave read ihis apP�icalion antl state Ihat Ihe above infor
orAinancesantls�a�elawsrela�ingl builtlmqcons�mmionandherebyamh ' repr
pmpetly brei�ns0ec -on pur ses
�aie: ` y Signa�ure:
Oriver's License or Social Securily #:
1641-e6 W�ile—BuilCinq: Green—Coee Enlorcement Canarv—Aoolicant:
I agree lo pty with all ciry antl counry
t�isciry nrerupontAeabove�mentioneU
Goldanrotl—Acea�sor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 0�669
PERMIT NO; E 056697 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ALT
JOB DESCRIPTION : CONVERT 19335F KFC TAKE—OUT TO CHINESE SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: H-2 /
COMMENTS: REF H56696
if �1f af 1E iE �E iE iE iE iF �E �E iF iE 9E �f iF iF if iE �f �E iE iF if M 1E �F iE �f iE iEiE jf if aE �f �E iE iE �E iE iE iF iF iEif 1E if aEiEiE iFif 3F iFiE �E 1f iE1E 3E if �f if df if �If 3F �t 3E �E iE if iE iF�f if jF
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAZN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL: 11732130 ZNE: REF NO:
PLANNING Nt51'ES>
i
*+t�r*�r�t***�r�t**+r**�t*��r�r�*+t+�*+r*�rx+r�r*�**+�**�r��r****�e���r�e�x*�r�t�t�r*� ��rx***+�**�r�r*�t*****
D E V E L O P M E N T S�B.%R V Z C E S R E Q U I R E M E N T S
ZONING APPROVED HY - 4_ DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY•
�F aF ik IE IF iFlE �E if �E iE it iE * 3f iE if IE 3E if IE 3Fg
�F i! iF aE �F it iE 1F if iE aE ik iF it i! iE If �f 3f 1f iF iF if
LEGALIZATION;N
BLDG PMT PI�
PERMIT
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT
TOTALS----> 24.75
iE jE iE k it iF iF iF
F E E
DATE:
DATE; 0,3LJ`9Z�
E iE IE iF if iE if if �k 3E�'iFiFlE iE
kitlEiE illEiEiFiFkififiE3t3E�E3F�f1EiEiElFiFiEiE3EiEiEiEkiEififk3F3EifiE3EiEiF
S U M M A R Y STRUCTURAL SEGMENT;N
I MECHANIC FIRE SMIP/RES GRADING
Y SMIP/NON—RES
ECK TOTAL PAID DUE
,00 39,75 39,75 ,00
AEVENUBLDGVPMT PLUMBING ELE�TR�S�MECAANnIC FIRE9�SMIP�TOT/SGRADING PLAN—C`HECK
�9
1t iF iE iE k if k iE 1E iE �E iF iF ik 3F if ik iE if iElf iF 3F 1E �F iFiE �t �E if iE iF 3E iF i! 3F �E k!! �F Iflf jf ii k iF ih iFiF 1F if 3E if it * 1f �f �f 3F 1t iE jF jf k if iE if k�F �f 1f k if iE iEiF iF �F 1E
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T Z O N UNIT COST TOTAL COST
ELE 11
ELE 5
FIXTURES LIGHTING 1 ST 20 EA.
RECEPT/OiITLET 1 ST 20 EA.
RECEPT/SWITCH 1 ST 20 EA.
END OF FEES
75 18.25
75 3.75
Gi .L'll'�ir•Ci`_il?Gi -.� -- '..
�,,:T�, G=�25:4� r",.. ��
�CONSTRUCTION ANDPCANNING POO SPA
APPROVALS Permit #- Date Inspector AppqOVALS Permit # Date Inspector
1. Temporary Electrical Service�or Pole . L+ � - 52. Pool & Equipment Location Ll-
�
.�-
" 2. Soil Pipe•Undrgmd. ',i . � 53. Steel Reinforcement •�
� .
;3. Etectrical Condo�tlFtilitY-Undrgmd. � 54. Forms ': `'
� 4� Elxctrical Con�it-Undrgrn�/'� �` 55. Electrical @onding "-'�
- 5. Steel Reinforcement• - 56. Rough Plumbing & Pressure Test � �
•.6:�E4ectrical UFER Gmd. , � 57. APPROVAI TO COVER-GUNITE '�
�
�' 7.tiF��tings � � � �. 58. Electrical Conduit-Undrgmd. �,�
'� 8. Foundation =� � � 59. Gas Pipe, O Undrgmd., Test i
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Tsap, � Undrgrnd. '� ��
�
10.'Str�ctural Floor System ' �. 61. APPROVAL TO DECK ' �
11.�roperty Sewer Lin"e & Ho�is nnection � 62. Backwash & Recepmr-Fina�
�. �
�2. SQ''°e� Cap ' � _ . � � 63. Heater & Vent-Finai '
73. Roof Drains . : '/ 64. Plumbing SYstem • Final �
14. Rough Plumbing �: 65. Electrical�Final % "'
.
15. Rough Electricai-Conduit� , F,$olar Syrtem-Final
16. Rough Electric Wiring �� � . Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS P WAL
19. Rdugh Heating & Air Conditioning FIRE DEPT. REQUIREMENT
,. r
20.' Rough Factory Fireplace � - ` - _ ' •APPROVA�_$5�•� Permit #�_.:, -
21. DuCts, in Struc[ute. � � • - 70. Undergr4und HYdro
22.DUcts,Ventilating . '�� 77,Product,PipingdGas OOiI
23..Gas Pipe�Rough & Tese � . 72. Underground Flush. �
24.�Roof Framing "" ' * � '73. Undergmd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing ' ' - � _ ;n' � �74=0verhead HYdro- �
26. T�6ar Ceiling (Struct�rall &�Monocoat �' 75., Ory Chemical ' '
27.;Frameand Flashing � � . 76. DryStandQipe • � ' '� r
� 28. Lathing&Siding • � ' • • 77.-FIXEDSYSTENrF�NAt,', �,�.
�29. Insulation � . � �� +'y 78>•�1RE P,�EV. FINAL . - _ = �
�30. DrYwall Nailing � � ' �EFCLT.Ii�DEPT. REQUIREMENT
,�
� 31. Plaster Brown Coat, . � ' �, ,.79.' FINAL I �SPECTION, ' '- t
32�ElectricalPowerMeterFinal �'� 8.�FOOD�6ERTIFICISTEISSUED �
33.iFinel Electric , 8��(�y �'Notes: . ''_.� - '
�34.FinelHeating.&Air-Conditioning, " . � � � ��� _
35`'Final Ga$ Pipe-Tes[R „ . . . ;� �-�. � ' - ' -' ` .� ;
.�36,�,Hood or:Canopy - � , , - -� - � '
,.
37.�Final Factory fireplace � ' �' ` � ��� ' � .
38. Final Plumbing � . � ' � . ' � t
9
..39. Water $ervice-Final ' '� �" . - . . • . . . �'..,
- 40. Gas Service-Final � . . � �� � . � � �
I -
'�41. Solar pomesticPinal - � • ' �' t` ' _
� I r',)� .
�42.'Backflow Preventer, _ I I � (,. . �� - �
43. Backflow Irrigation • r ' " ' -
. j • ,
,44. Landscape Irrigation System�.•n,��� r �r - � ...� ��" ' '
45. Sound Attenuatiort � • � - "r
i, . "�• V. ••
'46.,Nandicap Regulations - � � � � � - _ .
47. FINAL STRUCTURE & BUI.LOING • '
__,�
48. FINALPLANNING ; i � � Ga , ,
.:49.-Eleceric Release to Edison t '
;50. Gas.Release to Southem Califomia Gas Co � � • ; ' � • - . �
57. C6RTIFICATE OF OCCUPANCY .
No. Date
I �
�
I 1
PH0.IECT ROOXE$$: 4 Z 4 E 17 TH S T
OWNEP'SNRME: SIM AUTHER
ADDNESS: zSS1 HUSINESS CBNTER llR
IRVINE, CA 92715
7S2—0100
APCH/ENGINEEH:
AODPESS:
flEG.NO.:
UNIT:
UNIT:
PEflMITTEE: KAR TNVESTMENT ( 818 ) 572-4877
aooeess: 1979 PATRERO GRANDE A
MONTERY PARK CA 91754
LICENSEO CONTNFCTOP OECL4flRTI0N: I hereby aflirm ��al I arti Iicense0 under pmvisions oi Chapter 9(commencing wiih Sec�ion
7000) ol �rv�sion 3 oi �he Business antl Professions CoOe, ana my license is in �u0 �orce anU eflect.
cirruc.:047465 STRTELIC.:l�S4Z% �y�ssl,i6
��. 25'�i�- Si9nature: 1�(, r'���.v4e.-
Oate:
WOflREB$' CUMPENSATION DECIABRTION: I here�y a��i that I have a cendicate of consent to sell�insure or a certificate oi Wo�kers'
ComDensation Insurance, or a ceNlietl copy Ihereof (Sec�ion 3800, �ab. C�.
roucvNo.: WCP340831 exr.oqT¢: 02/15/93
camraxr: ALLIANZ
� Certi�ietl copty is here�y �umishe0. � Cehified copY is �iletl wi tAe city Builtling Oivisian.
Oa�e'. � � �`� — / � APDlicanf.
EXEMPTION FflOM WOflNEflS' COMPENSATION DECl.1BATl .(T�is seqion need nat be completeA ii the permit is forone hundreA ($100) or less).
I ceNty t�at in ihe pedormance oi the work tor which ihis permit is i;suea, 15hall not employ any Derson in any manner so as lo Oecome
sublect to ihe Workers' Compensation Laws oi Califomia.
Oa�e'. Signa�ure:
NOTICE: tl. afier making this Oeclaration, you s�oultl �ecome su6lec� b the Workers' Compensation pmvisions of �he Labor
Code, you mus� tan�wi�h comply with suc� pwvisions or �his p¢rmi� shall be tleemed revaked.
�� CONSTBUCiION LENUINC FGENCY: I hereby aifirm tAat there is a coretmction lending aAency for ihe pedormance oi t�e work for
which ��is permi� is issued (Seclion 3097. Civ. C).
LENOEfl:
FODNE$$:
OWNEB BUILOEB OECLAflFTION: I hereby a��irm Iha� I am exemp� imm the Comrac�ors' State License Law (or Ihe following r¢ason
(Section 703t5 Business and Pmiessional Code: Any city of county which requires a permit to consimct, alter, impmve, Oemolish, or
repair any stmcture. pnor to its issuance, alsa requires Ihe applicant lor such permit to file a signee statement Ihat helshe is licensed
pursuam b �he pmvisions o� the CanVac�ors' S�a�e License Law (Chap�er 9(commencing with Sec�ion 7000) of Oivision 3 oi the Business
and Pmiessions Cotle) or thai �e/s�e is e�empt Iherefwm antl ihe basis lor t�e allege0 e�emp�ion. Nny violation ot Section 7031.5 by
any applican�for a permi� su61ect5 ihe applican� �o a civil penal�y oi not more �han five �untlred dollars (5500�.
I. as owner of �Ae propetlV ar my employees wi�h Wages as iheir sole compensatlon, will Ao �he woB, anA �he
❑ stmclure is not imen0etl or otferetl for sale (Sectian 7044, Business and Pmfessional Cotle: The Coniractors' State License Law
tlaes no� apply �o an owner o� a pmperty who builds or impmves lhereon, anU who tloes such work himself/herself or �hmugh
hi5 or her awn emDloyees, provitled �hai SUth impmvemeMS ar¢ not imende0 or oiferetl for Sale. II, hOwever ��e huildinA of
impmvement is sold wi��in one year of comple�ion, �he owner will have Ihe bur0en o� proving he/she Uitl no� buila or impiove
br the purpose ol sale�.
I, as owner ol ��e pmperty. am exclusively coniracting wi�h Iicense0 contractors to constmct ihe prole�� (Section 7044, Business
❑ antl Professions CoOe: The Contractors' State License Law tloes not ap01y to an owner oi pmDe�Y who builas or im0�oves thereon
and who ton[rams for Suth pmlems with a tonVacmr�s) liCenSe pursuant �o Ihe Con(mctors' Sta�e Llcense Law�. I am awafe
thai Dmo� of their Worker's Compensalion insurance shoul0 be pwvi0etl m me.
� I am ezemp� under Seciion: B. 8 P. C.
��I �hi5 (Ed5011:
�a�¢'. Owner.
I Oo here�y certify tha� I am aware ol antl untlerstan0lhe requiremen�s o� Calitomia Health an0 Safery Cotle Sections 25505, 25533, and
25534 and thai I or any fuNre builUing occupan� will/will not (circle ane) need to comply with said s�a�e cotles and �he reQuiremen�s for a
permi� lor cons�mc�ion or moaitica�ion Imm �he Nir Oualiry Managemen� Districl. ResiOen�ial consimction aDPlica�ions are exemp� �rom
ihese pmvisions.
pa�e: Applicant:
I here�y ceriify thai I have read Ihis app6ca�ion an0 s�ate that �he above in�orma�ion is cortec�. I agree ta comDly wilh all city antl counry
ordinancesantlslalelawsrelatingtobuiltlingconstmc�ionantlhere0 authorizer esemativeso�ihisci�y�oemeruponlheahove-menlionetl
pmperiy for mspection purposes.
Oate: �' 2 �� / L— SignaWre'. .
oriver's �icense or Socia� Secunry a: �%
164146 White—BmlOinq; Green—Code En�arcemenL Canary—qoolicanf. Pink—Revenue: Goltlenrotl—Assnsxnr
CITY OF COS'CA MESA — BUILDING PERMIT PaRM NO; F 05791
PERMIT NO; F 057910 PLAN CHECK NO: 020R8-92 L GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: FIR PURPOSE: ALT
JOB DESCRIPTION : INSTALL FIRE SYSTEM IN AOOD SQ FT:
CLAIM VALUE: 900.00 CALC—VALUE: GROUP OCC; B-2 /
CUMMENTS: "CHINA DOLL" CHINESE TAKE—OUT REF:B56696
��r+��***�*��*�*******�***�r**+�**�**�r***�r�r�r�r�*�***�r�r�**��r+�**x�+r� ****�r�*******�*****
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT' IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV: PARCEL: 11732130 ZNE: REF NO:
PLANNING Nt3TE5>
i
ik iF if 1(-�1F iE iF k ik ik if 3f �IE �)f iE iE iE iF iE iE iE iE ik il� iE 1E iE iF i! iE iE �7F �F �E IE iE iE �1F ik it if �lE if iF iE iE iE iF iF iF iE iE iE iE iE ik iE if iF 1F iE iF 1F if # if i(-iE fE aF ik iF iE # iE iF aE if if
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BDILDING APPROVED BY : DATE;
APPLICATION ISSUED BY: �il�I� DATE� �
iFiFiFiFifilikikikitlEiFiEi(�iflEiEiFikiFiEi(�iFifiFiFi7F3F3F7TiFTF iFiF�S3F �FiFiF3f�f�FiFifiFiFiFafifiEiEiE1FiF1FiEif r r iEaf�
)f �lE iE �lE iE iP ik IE if !f �F�E ik if if if ff �f iF iE ik-1f� ik iF fk if iF k ik iE iE jE i4 iE iE iE if iE iE 3E 3F IE iE iF if iF if iF if ik ik i61E 3f iF 3Eif iE 1E if iF iE it iElk iF iF iE iE 1E k iF �f if iF IF �E iF iF
LEGALIZATION:N F E E S U M M A R Y STRUCTiIRAL SEGMaNT:N
BLDG PMT PLUMHING �TRIC MECHANIC FIRE 5MIP/RES GRADING
PERMIT
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT
TOTALS---->' 73,00
REVENUE DIVISZON TOTALS-->
BLDG PMT PLUMBING ELEC
—CHECK
19.95
COLLECTED;
IC MECHANIC
23 00
�SR SMIP/NON—RES
14.95
TOTAL PAID DUE
37,95 37.95 ,OU
23.00 OVER/SHORT; ,00
FIRE SMIP/TQT GRADING PLAN—CHECK
23.00 "
�
�1E iFiE # i(� #�IP 9f if �!F iE �IF iF if if iF 9E df if �IEiE i(� iF �lE �IF iE 1E �It �IE �1F iE iEiE it �lf if �lf if If iE �lf �%iEiE�1EiE �lE iklEif iF �lFiE-)E iE iE �lF 3E iE 9E-1F�)f �lf i(� iF if� ih fE �(-iFiE-1E iFiF �lE if iF #f �lE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N I1NIT COST TOTAL COST
F'IR 23 FIRE E�UIP FEE (FROM BLDG VAL TAHLE) 1,00 23,00
END OF FEES
CONSTRUCTION AND PLANNING�r � : .� POOt PA
APPROVALS PermiY#^ � Date� Inspector APPROVALS Permit# Date �nspector
7. Temporary Electrical Service or Pole, '�. �� -�52. Pool& Equipment Location - �
2. Soil Pipe-Undrgrnd. � . � 53. Steel Reinforcement -
3. Electrical Conduit Utility-Undrgmd. `� 54. Forms �- _� � ��
4. Electrica� Conduit�Undrgrnd. .� 55. Electrical Bonding - "'
5. Steel Reinforcemeot' . _ 56. Rough Plumbing & Pressure Test
6. Electrical UPEfl Gmd. 57. APPfiOVAL TO COVER-GUNiTE �
7. Footings ' ' •z � 58. Electrical Conduit-Undrgrnd. �
$. Foundati0n ' -, . 59. Gas Pipe, 0 Undrgmd., Test � ,
9. Water Pipe-Undrgrnd. . •� �� 60. Backwash Lines, P�Trap, O Untlrgmd. '�
10. Structural Floor System " .�� � 61.�-APPROVAL 70 DECK .. -
i t. Property Sewer Line & House Connection . 62. Backwash & Receptor-Finai - _
12. Sewer Cad � '� . 83. Heater�& Vent-Final �� '�
13. Roof Drains - � 64. .Plumbing System - Pinal
14. Rough Piumhing 65. Electricai�Fina!
15. flough ElCctricaFConduit . ' 6.6. Solar System-Final _
16. Rough ElCctrie Wiring " 67.• Fencing & Access Approval �
17. Rough Wiring Sign . 68. APPROVED�FOP, PLASTERING
18. Rough EI¢ctricabT Bar�Ceiling - , 69. POOUSPA SYSTEMS F�INAL .
19. Rough Heating & Air Condtioning FIRE DEPT. REQUIREMENT
20. •Rough FBctory Ficeplace z ,' - "" � APPROUALS' _Permit # -
21. �Ducts, in Structure � � � , '. 70. Underground Hydro -
22. Ducts, Ventilating � "•� 71, ProducfPiping (7Gas ❑Oii
23. �Gas Pipe=Rough & Test ' - - - � � 7p, Wderground Flush= '-
24. �Roof. Framing � i'� t .: �� �73. UndergrndiStorage�7ank O Gas ❑ Oii
25. Roof Sheathing � - � ' � . ' - __ ' '7q, Overhead Hydro
26. T-Bar Ceiling (SVucturaq & Monocoat � � - � 75. Dry Chemical - �
27.'Frame anti Flashing.: . 'a� . 76. Dry Standpipe `�- � � '
28. Lathing & Siding � - ' . • 77. � FIXED SYSTEM F�INAL
29. Insulation �. . � ` � 78.; FI E PREV. FINAL
30. Drywall Nailing � f��-ME�LTH DEPT. REQUIREMENT
31. Plaster Brown Coat . ' � 79. ` INAL IN3�°.EC71'0'N.* .� � .
32. Electrical Power Meter,Final . '�,80. r�00D CERTIFICATE ISSUED -
33. Final Electric, � ' �. ' ` • �No �'r- - .
jt
34. Final Heating & AiKConditioni;g� , � i , : .
35. Final Gas P�Pe-Test ' � � � � . ' ,. .
36. Hood or Canopy ' � - i . - � � �
37. Finai Fa,ctory Flrepiace , � .' ' � - _ -, - '
38. Final Plumbing , , � _ � ' ` �. � � - -
39.-lNaterService-Final � - ' ' . � ' � ' � '
_� ,
40.' Gas Service-Final - , , . . �_ . . �
41. Solar pomestioFinai . • . , � � -
42. Backflow Preventer. . ' 1� - - � . �
43. Backflow �rri9ation-� � - - • - �
•,�
44,. Landscape Irripation System, - , - .G . , " .
��45. Souod Atteouatiom '� - � - - - • '
46. Handicap Regulations �� ' � ' ", ' .
47. FINAL S7RUCTURE & BUILDING � � . y
'�
48; FINALP4ANNING' � _ ` _ _ .� "
49. Electric Release to Edison �- �
�50. Gas Release to Southern Califomia Gas Co ' ( ( r. �' � - �_ - �
51. CERTIFIGATE OP OCCUPANCY . • ,
No. Date
�
�-
--�"'
0
n
d
PHOJELT ADUflESS:., q�4 �`• 177+H Si �
OWNEfl'SNFME: fIM AUTxEA
nooeess: Z111 BUSINESS CENTER DR
IRVINE, CA 42715
752-0100
RflCH/ENGINEEfl:
RODNESS:
PEXMITTEE: GOODESxGN CONSTRUCTION CO
nooeess: 1641 W MAIN ST
ALHAMBRA CA 91
❑CENSEU CUNTflRCTON OECLAflATION: 1 here6y atlirm ihat I am licensed un0er pmvisians
70001 o� Dmsmn 3 of tM1e Business arM p�ofessians Cotle, an0 my literrse is irt �WI force i
cmuc.:�19 "T ��c 607828 cuss: g
�ate: Signalure:
� WOBREBS' COMP N TION Di TION: I hereby a��irm Iha� I � tli�icate oi c ent I
Compensaiion Insurance.'or a cendietl copy ihereof (Section . ab. C�. ..
IPOLICY NO.: E%P. DATE: ' ,
COMPFNY:
❑ Certi�ietl coDY is here�y fumishe0. ❑ Cenified capy is filetl with t�e cityBuiltling Divi<.
�
�a�e'. Fpplican�'.
E%EMPTION FBOM WOPNEBS' COMPENSRTION OECLABATION: Qhis section neea �ot � plete0 il �
I cer�ify ihal in I�e pehoflnance of ihe woB for which Ihis permit is issue0. I s� not Dloy any
sub�ec� �o �he Wor (5:C pe 'on Laws oi Calitomia. ��
�. `
�a�e: � �` Signa�ure:
NOTICE: . Iter'ma i �' tletlarb�i0n. you ShoWd EeCOme � Ie�� Wofkers' Can
Code. yrou m�st tarth rth omplq wit� suc� provisions or permifshaq be deemed re
CONSTBIICTION 1EN01NG FCENCY: I here0y aifirm � ere i5 a tonSCroc�ion lentling ag
w�ich I�is Dermilis issuea (Seciion 3097, Civ. C). +�'
LENUEP: � �r�. '
RDUxESS:
UNIT:
flEG.NO.:
UNIT:
�818�28241�21
eoi
" Oter 9 �commencing wilh Section
o self-ins ra [ertilica�e olWorkers'
io
�
ie permii is for one huntlre0 �5700) or less).
person in an � annef so as �o become
r �
i sation�D�ovisions oi the �abor
ed. N
;y for ihe De�ormance ai the work lor
OWNEfl BUILOEB OECLAflRTION: I her¢by aifirm that I am exempt �mm the Con[rac�oK State License Law lor the follovnng reazon
(Seciion 7031.5 Business anE Pmtessional Code: Any ci�y ol counry whic� reQuires a permit �o wnslmct, alter, impmve, tlemolish, ar
repair any siNclure. prior lo i1s issuancN, also reauires ihe aDPlicant for such permit to fle a signed statement ihat ne/sne is Iicense0
pursuan� to t�e pmvisions al t�e Comrac�ors' State License Law �Chapter 9(commencing with Section 7000) of Division 3 of Ihe eusinett
antl Pmlessions Cotle) or Ihal �e/s�e is e�emp� lhereirom anA the basis �or Ihe allegea exemption. My violation of Seciion 7031.5 by
any apDlicanl lor a p¢rmi� su0le��s �he dOPlican� to a civil Oenalty ot noi more Ihan five hunUreG dollars (5500�.
I. as owner of Ihe property or my employees with wages as �heir sole compensa�ion, will Oo Ihe woAt, antl lhe
❑ slmcWre is no1 in�en4eC or oHerE0lor sale (Section 7044, Business an0 Pmfessional Code: The Cantractors' State License Law
Aoes not apply �a an owner o� a pmpeM1y who Ouilds or impmves lhereon, and who 40e5 such work himsell/her5¢I� or lhrough
his or her own employees, pmvide0 Ihat such impmvemenis are not intenAe� or anered for sale. I( however tne building or
improvemen� is so10 wi�hin one year ol comple�ion, ihe owner vnll have �he Uurden o/ pmving he/5he Oitl noi Ouiltl or impmve
lor Ihe purpnse ol sale�.
I. as owner ol t�e pmDe�Y. am e��lusively conVacting with licensetl contracmrs ro consimct the pmlect (Section 704d, Business
❑ andPmfessionsCode'. TheContractors'S�a�eLicenseLawdoesnolap0lytoanownero�propertywho�mldsorimproves�hereon
antl who coniracls lor such O�olec�s wil� a coniractor(s) license Dursuant Io the Contracrors' State License Law�. I am aware
Ihai pmoi of Iheir Worker'S Compensation in5urance s�oultl �e pmvi0etl lo me.
� I am exempt untler Section: B. 8 P. C.
br this reason:
Date: Ownec
I �o �ereby cerlily Iha� I am aware ol an7 understen� I�e reQuiremems ul Cali�omia Heal�h and Safery Cotle Sections 25505, 25593, antl
25534 antl ��ai I or any luWre huilding oCcupam will/will not (circle one) neeU lo compry wiih saiU s�a�e cotles and the requirements �or a
permit lor conslmciion or modilicaiion i�om �he Hir Oualily Management DiSUict. Fesiden�ial cons�mction ap0lica�ions are exemD� �rom
Ihese pmvisions.
Date: Applicanl:
I hereby cetlily Ihat I have rea01hi5 applicalion antl 5�aie Iha� ��e above inior
ordinancesantlslalelawsrela�inglobuil-gconsimctionandhereDyaNhariz epr
pruperfy Iarins0ectian ��Ooxes.i
oa�e: y� Z SignaWre:
oriver's License or ocia� Seari�y x:
i6aia6 W��te—Building: Green—Cprle Eniorcemenq Canary—Applicant;
correct. I agree �o comply wilh all ciiy anA county
a�ives oi �his ciry �oyAe� uDon the a�ove-mentione0
GOIEenroa—Assessor
CITY OF COSTA MESA — H[JILDING PERMIT PERM NO; P 05669
PERMIT NO: P 056698 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE; PERMIT TYPE; PLU PURPOSE: ALT
JOB DESCRIPTION : CONVERT�1433SF KFC TAKE—OUT TO CHINESE SQ FT: '
CLAIM VALUE; CALC—VALUE: GROUP OCC; B-2 /
COMMENTS; REF H56696
�*x��*�*x��**��***x*�*�**�******�*�*�******�*****�****�+r*x�**x*�*******�******���
Z O N I N G R E Q U I R£ M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN { LEFT; FT IN RGHT; FT IN
PARKING i2EQ • PROV; PARCEL'; 1173213D 2NE: REF NO;
PLANNING NZ7T'ES> !
� /
ik iF if iF 3F iF iFlE iE�iF iE if 1E if iE iF 1f ik If iF iF if if �1! iF 1E 1F iE if iF iE iF if !E iF iE iE i! iE�ih'IF fE iE iF iE 1F�* # iE iE 3E iE iF iF iE �lf iF iF iF'Ik iF 1f iF iF iF iF iE ik iE iF iF iF 1f if if iF iFlF iF
D'�� V E L O P M E N T S E R'V'!I: C E S. R E Q U I R E M E N T S
J— _ j'
ZONING APPROVED BY ''�� �' DATE;
BUILDING�APPROVED BY ; _ DATE;
APPLICATZON ISSUED BY: - � DATE: C�7�F��A��
iF3f�t1ElfififiEiFiEif�ltiEiE3F1Ejf3EifiE • � 'if 3FiElElE�fiEaFiEif�E iEiF
iFififiEiEiElEiEiEiEiFifiFiPiF3fiEiFifjfikifiFiFiEillEiFiF�t�fifiE�E1E�E1E �EiF�EjElEif1E�E�f�E*�EjtlEiEiEiflEaEifiEiEiEiE3flfifjElfiEaFiEkiFiFk9F
LEGALIZATION:N F E E ,U�M M A R Y STRUCTURAL SEGMENT;N
�
PERMIT BLDG PMT PLUZOI00 EC RICL CHANIC FIRE SMIP/RES GRADING
'25! •" � SMIP/NON—RES
ISSUE FEE 3,00 �
BUILDING—DIV—> PERMIT ISSUE LAN—CHECK TOTAL PAID DUE
TOTALS----> 20,00 3,00 0,"00 23,00 23,00 ,00
REVENUE DIVISION TOTALS--> COL CTED; � 23,00 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC ME ANIC `' FIRE SMIP/TOT GRADZNG PLAN—CHECK
23,00 - "
�F 3t aF iF iF aF 3f jE �E iE if if if 3f 3f 3F iF jE if if iF iE af iF iE 3E iF If iF aF 3E iE 3E iE aE iF if iP * 3k iF if iE 1E IE IE �E iElF aE iF iE #41E iE 3Fif jE iF iE iF if if �F iE iF 3E iE iEjF iF af if iE iE �E iF 1E 1f
I tJ D I V I D U A L F� E E H R E A K D O W N
TYPE QTY D E S C R I P T I 0 N�'� J UNIT COST TOTAL COST '\
r;
PLU 4 SINK, KITCHEN ` � 2,00 8,00
PLU 1 WASH BASIN •� :;
PLU 1 WATER CLOSET (TOILET) `' '' 2,00 2.00
PLU 1 WATER HEATER AND/OR VENT' ` 2,00 2,00
PLU 1 GAS PIPING SYS OF 1 TO'4 OUTLETS 2,00 2,00
PLU 1 SINKS, FLOOR 2,00 2,00
PLU 1 SINKS, SERVICE / MOP `• 2,00 2,00
END OF FEES
F' a� . � -
, CONSTRUCTION AND PLANNING � POOI. .PA '
APPROVALS Permit # Date lnspector APPROVALS Permit # Date Inspector
� 7, �Temporary Elecirical Service or Pole �..i -� 52. Pool & Equipment l,ocation
- r
'! 2. Soil Pipe-Undrg�nd. ``'�r Y(,`r� .(��Q 53.�Stee1 Reinforcement V�
/
• 3._Electrical Conduit_U��lity-Und�grnd. 54., Forms �
1
- � 4; Electrieal CondUit�Undrgrn',,. y � 55. Electrical Bonding '
a� �
�� 5,� Steel Reinforcement= ��� . 56. Rough Plumbing & Pressure Test �
, 6. Elecirical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE
r
7. �Footings � �� � � 58. Electricai Conduit•Undrgrnd. '
.$,, Foundation - / 59. Gas Pipe, � Undrgrnd., Test
f
9. N/ater Pipe-Undrgrnd. 60.. Backwash Lines, P-Trap, O Undrgrnd.
10. Structurat F�oor System � :'+ � 61. APPROVAlTO DECK i�'��-s
t t. ;property Sewer-Line & House;�onnection � - 62. Backwash & Fieceptor-F(nal - �'
a
12. Sewer Cap > , f�, . �63: Heater & Vent-Final , .
• 13. Roof Drains ✓ � ' %' �_ ^ � � 64. Alumbing System - Final �
i4. Rough Plumbing �� � �� q�ty%Qi � 65. Electrical�Final ^
75. Rough Elect�ical-Co�duit �� ' i 66. Solar System-Final
16. Rough Electric Wiring �n / 67. Fencing & Access Approval
✓ i
17, Rough Wiring Sign� ' 68, APPROVED FOR PLASTERING
18. Rough Electrica4��T Bar Ceiling 69. POOL/SPA SY57EMS FiNAL
19. Rough Heating & Air Conditionin9 FIRE DEPT. REQUIREMENT
20. �Rough Factory F�eblace `� � ' qppROVAL•S� � Permit #
21..Ducts, in�Structur;e., . . �� � . � - x r :70. Undergrpund.Hydro
22. Ducts, Ventilating ' • -� . �' ;77, ProductPiping OGas �Oil
23. �Gas Pipe�Rouqh & fiest . . t �(�L�(�qZL�_ � � 72. Underground Flush. - �
24. Roof Framing � � � �`73.`Undergrnd.StorageTank OGas OOiI�
25. Roof Sheathing . � f ' � � :v � `74. =0verhead Hydro ^
26. T-Bar Ceiting IStructurat} & Monocoat t '�' 75.r Dry Chemical � - �
_ `�
p7, �Frame and Flashjng � ' _ . ; 76. Dry Standpipe `� _ � . �
�28. Lathing&Siding .:; t�i • . • � 77,- FIXEDSYSTEMFII�'AL _ �
_ ' i r
29. Intulatiqn � '� �� � : � ' ' ; '�;��. 78,� FIRE PREV. FINAL � _ ' . �
30. Drywall Nailing �ii� ' HEALTH_DEPT`REQCfIREMENT' :
31.PtastesBrownCoat' ,, '1�! 79.'FINAt�INSRECTION �. '
��.
32. ElectricaLPower MeterFinal• � �. �':�� .80f OdD.GERTIFICATE ISSUED = .
33. Final Electric � , �! j� ; Nofes: �•/j �2`(� S Lc��j�-G��
,�-34. �Final Heating & Air`Conditioni�7g � - : � � '� . . . � .. � .. .
2
•35. •Final Gai P�P?-Test�, $� �� -, �Q, ;.
r36. Noodor.CanoPY . . • ,I;i �'�' '�6�1��'`iL , �L7' 002c t.:.oucf2P- LF.r�-C.O?f�- �.O
37.-Fin'�I Pactory Fireplace , .' ` � , � �,��i' .' � ' � .
.. ia i;� � - -
38. Finai Plumbing � ` . . . , .��Qpi (�j/� t .
39. Waier Seivice-Finai� � - � �, , � � " '` _'
�. �
�AO. Gas Ser'vice-Final ;.. , � . , ��� ;� � . . . �
. 41, 5olar pomesticFinai `. " •� � . ' �; �� , �
`„
42.�Backfiow Preventer � ;;,, , r � � . -
43. 6ackflow Irrigation • � . � - - -.' ; ." .
. .,
.44, Landscape Irripation System- . - � � � ' ' � • ' � � "' - " - �
'45.':5ound Attenuation� � � - - + " - _' , � .� �
�
�=46.,Handicap,Regulations , �� ; x n�: � � . _ .
47. FINAL STRWCTURE & BUILDING , � ,
48.'FINALPLANNING �•.,� � � �� � .
4g, Electric Release to Edison . � � '
Y . �. . �1
� 50. Gas ,Release to Southem California Gas Co � �, o� � ' � _� �
51. CERTIFICATE OF OCCUFANCY : - =
No. Date
� �DONESSOiBUILdNO: QZG E,' 17TH ST
OWNERSWJIEIFpQYN: MTC MANAGEMENT
�ooncu 900 E CAMPBELL 81
CAMPBELL, CA 95008
408-377-1754
MPL. AWlp10,1DDNE59:
�I
/I
I�
I�PCXRECT OP ENf1NFEP:
11L. NO.:
uHr:
JICII OX �1G51WXESS: UNT:
coNm�crarstuwe: HAWKINS CONSTRUCTION ( 619 ) 943-5367
camucroas�u�wc St359 RIDGETON
nuoness: LAKESIDE CA ��.�,; 475651
92040 u�:
UCENSEO CONfN�CTONS DECIAP�TION: I hareby eM�m uMx pa�aly d peejury thet I vn lieaneed uMa parisions d Cheqa e
(canme�winG wnM1 9enion>000) d Uvisun � W Ne B�a�wn and Pmf ' e Cada. erd mY limnn b in hA face mM N1M.
cmuc.ao.:0G5571 uc.cuss: B uc. o� q75651 E:(R: 07/96
oma: �comreaa: - �f �L�.--�
OWNgq BU1L0 N OECL� qT10N: I lneeby effirtn unda penely d perFN�Y Ih em exemq Iram �M Camreeaa license Lew fa Ne
Idbwiq raawn (Setlian ]03t.5 &wirsa aM Prdsseom Code: R�ry �Y a muniy whid nV�rim e pe'mX W mnbua. Mer.'vnproue.
demdbh, a rapei eny evucturo, peia lo ila ewerce, abo reQuirm the epplimnl lor eueh paimil to file a ei0� atmemom ihel M a ehe
u liceryy� Wnuenl �o tha proWsione d IM1e Coniredwe Licenae lew jCheper 9(cpnmerciiq Milh Sedion 10W) d Di.�eion 3 of the
Buainpes arW Prdeniona Goda� w ihel Ir or sha ia exomq Iherehom eM �he batla la tlro dbped eaempion. My violetun d Setlian
'!W 1.3 by ary epplifan� ler e parmil subptln IM epd�t Io e avil panelry of �wl mae Ihen IMe huntlred Edbn I`�I)�
❑ I.mowwrdlMMW�YamYanWWea=�tihwe0ronihwedemmW�ion.wdldoNaxak.eM�heswctunend"vneMad
b aRereAhx eeb (Section 104.8usims, eM ProfecumeCaAe: The CaNrecas L»eneelewEws mteGMYfa en ownard yupxry
wno wu. « mww.. in�. w wo e�..�,a�.An �.en o, n«.�e o, w«reh ne o, n., a.o «�vbn�. wowee mm Na,
improvamenle era m� imeMad u dlered la aele. ll, howaver, tM buitli�p a inpwamam u eokl wil�in pre ymr ol compbbn, tM
bw�wrbuiNer xill heva tM WNm d qwiip M a ehe Eq M buiN ar improve Ior iM pum�e d We�.
❑ 1, as owro� d �he propeM. � oadueivey conVenmp wilh IimnseJ conVecion to conArud ihe 0�1� (&eaion 10J4, Bueir�eee enE
Profesvwa COCa: TM Coniredws License lew doas nal eppry io en owew d papeity who buitle or'unpova ihe�aan W who
wnvacu la wM prqeqe v.iih e aw4rmor�e) licemad punueru lo ihe Contreqon L"vroe Lew).
❑ I em eaamq uMer Sxtion: B. 8 P C.. br Nu �eam:
Dme: Ownar:
I do �ereby ce�iry Ihd I em ewera d enE uMwatentl Ihe requimmame of Celiomie HeeXh vM Selety CoEe Sedione 255p5, 2553J, end
25S11, eM Ow I a ury Mun WiWinp mapem xill / wil �wt (tirtb ore) naed to compy wih uk neta mde� uM IM nyu'vemenb M
epermnlormmWciionpmodifimtionhantheAi e�y ebpementD'etrip.Rnidemielmmt�utlioneppiratioruarauemqfmmtheea
wo�.iona.
Dme: ApplceN:
W OPKER'3 COMPQI4ATION OECL�P�110N: I hereby e/firtn �Mer panelry d prjury ons W ihe Idbwi�p Eetlerelione:
❑ Ihevea�dwilmeimene<eMictlodconsent�ovaManwroMxaken'rompenwion.mpoMWlarEySapim�tOpdtMlaEar
Catla, la ihe ps�lorme'we o11M worlt Iw wF ch �hi� pemin ia inued.
Q inm.wM���e:,wonw.��o����Qe...�.cw.aevsw�a�aoaa.i.m,coee.w.m.wr«�w,o.am.
wonc�wwn'v3�inisw�nnwsuee.Mywo�b�+Sm1ATE� FUND �����m�u�: EXPIRES
c�«
Poliry Number: —`J U 1 1 1 u 01 / O 1/ 9 6
u, �aim ne.e na ee cmnd� r m. wmu � w. w,. nmwne ed�en (Siao/ a 4n.1
�] I cerlly thet in IM1a pertormerwa d ihe work Iw whk� t�ie pertnN u ua�ed. I ehell rat empby anY Ve� in eiry menner w ro lo
becon�e wMert lo tM xw4as' wmDe�bn lawt d ceLiu�nu. qA ^O�ss WI d I dauM Eecane wbjer+ ro tM wlas'
mmpenaetion pwiaiw d Soaion 9700 d iM lebor C4e. I Mel nM1r.nh oompy v.iU Oww provwp1eu. //�j
Dma: � S Mdicam: �/N'�G � • �! /•K�r.--�+
w�minp: aU�n ro�� un woA�ri eompwwtlon tovxap� Is vnlawN4 .n WII wb/s� ur Mnylojror ro crlMn�l pmeMa arM
clvll Nrp� vp ro om M1untlretl IMua�M tlolbn 1JI00,000), ln etld/tlon ro M� ro�t ol rompmuetbn, tlameps �� provMsd br In
9xtlon 9RA5 0l M� LWorCod�, Infru4 ��oetlomsy9l�u.
CONSTPUCTON LENUING AGENCY: I Mreby etfirtn wwe, p.wM d�y inm m«. m. mm�a� w�a�u ,o.�y i« u.
peAarmenoe d tM wk Ip whitli thu pamY u 6awd (�� �]. Ci+. G).
LENDEN'S NMIE:
LENDEq'S ADOflESS:
1 eenih tAet I heve roed �M1ia eppliutian eM ne�a thet Iha ebovs Infoemetion n eortetl. I epree �o ewnqy xilh dl eiry W coumY �ineneae
enE 9iele lexs relmin0 �o huildip mne�rudqn eM harehy e�nhorize repreeemmivae Mihia ary to amer upon Ihe ebwe�mentioneC D�VeM
�«��'D'�'""D�"� PERRY WILSON
n _
Dme:
(5t5��e.WP) Whae-BuilCiq8Selety,�reen-FYe:Cenery-Rppiranl:Pink-Re�enue:OoMervaE-bxswr
CITY OF COSTA MESA — BUILUItJG PERMIT
PERMIT NO: B 074343
PLAN CHECK NO: 02153-95 L
PERM D10: D 074343
GOt�T: N SUPP: N
CO�ISTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; 1360SF RESTAURANT TI. SQ FT: 1,360
CLAIM VALUE: 15,000.00 CALC—VALUE: 17,163,20 GROUP OCC: B-2 /
COMMENTS: "TOGO'S" EATERY
x***�**x*�*�x�**x**���***�***�**�****����*+�*+e*��*�*�**��**��**�*�*��*��*�*��+t*�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
----------- MAIN HUILDZNG ---------- --------- ACCESSORY HOILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PAACEL: 1173213U ZNE: C1 REF NO:
PLANNING NOTES> INTER•IOR ALTERATION TO CONVERT THE FORMER CHINA DOLL REST—
> AUR1iNT TO A;TOGO'S EATERY. FRONT STHACK LDSCP PLANS REQD. P
if aE iE 1f if 1f 1E jf iE fE iF Y.� if iE� iE fF �F �E�6iF.1f iE iE i� iE �f jE�if ff 1E if 1E iF 1E �1E �E jE iE 3f jk iE iE 1E-)E aE �E aE iFjf jE iE iE k �E �F if iE i(' �7f jf j4 �f �Y iF iE 1E jE iE iE iP df if 1E iE iE i6 if %� if
D E V E L O�'M E N•T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY �E DATE: �� ZCo ���
HUILDING APPROVED BY+�: � ^ DF�TE:
' ���1'�.�
�*�*�rt***��******��B** I � � ���F���*D�*x�*��C��t
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 189.00
PLAN 122.85
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 192,60 0.00 122.85
FIRE SMIP/RES GRADING
SMIP/NON—RES
3.60
TOTAL PAID DUE
315.45 315.45 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 192.60 O��ER/SHORT: .00
BLDG PMT PLOMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
189.00 3.60
iElf iE #�E iE �ElE iE #�!E if aE IE 1E iE �E iE ik iE 1f aE iE �E �E 1F 1E iE jE iE iE 1E �lf IE �E 1f iE iE �E 3E if iE iE if iE �f iE �f �f if �f �f if fE fE if !E fE iE iE 1E iF iE iE 1E iE iE iE iE 7E iE iE iE if iE iE if iE if
Z N D I V I D U A L F E E B R E A K D O W N
TYFE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFC 1360 RES—INT. ALTER TYPE V—N —AVER 12.62 17,163.20
END OF FEES
EXPIRED
DATE �"L i�-�
P' t7"'+"^'12-7�19C J? i�_c ��
Le,:�b/Yi �'�..' lv �
v
CONSTRUCTION AND PLRNNING POOL �A
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
i. Temporary Electriwl Service or Ppte 52. Pool & Equipment Location/ �
2. Soil Pipe-Undrgrnd. �✓ 53. Steel Reinforcement � -7,'
3. Electricai Conduit Ut�lity-Undrgrncl:' 54, Forms '
4. Electrical Conduit•Undrgrnd. � 55. Electrical Bonding '
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test �
6. ElectricalUFERGrnd. 57. APPROVALTOCOVER�GUNITE ` �
7. Footings 58. Electricai Conduit�Undrgrnd. �•
$, Foundation 59. Gas Pipe, O Undrgrnd., Test i
S. Water Pipe-Undrgmd. � 60. Backwash lines, P�Trap, d Undrgmd.
10. Structural Floor.System 67. APPROVALTO DECK �
11. Property Sewer Line & House Conqection 62. Backwash & Receptor-Final ,_
12. Sewer Cap 63. Heater & Vent•Final
13. Roof Oreins j ' 64. Plumbing System � Final
74. Rough P�umbing 65. Electrical-Final .
75. Rough Electrical•Conduit "' 66. Solar SYstem�Final `
76. Rough Electric Wiring i � 6Z Fencing & Access Approval � �
17, Rough Wiring Sign 68. APPROVED FOR PLASTERING ✓'
' .i
78. Rough Efectrical-T Bar Ceiting 69. POOI/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace . APPROVALS Permit #
21. Oucts, ir Structure ' 70. Undergro�nd HYdro
22. Dutts, Ventilating 77. Product Piping O Gas L70i1
23. Gas PIpe�Rough & Test 72. Underground Flush
24. Roof framing - 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceilin, IStr�ctura )& Monocoat �
�l- 8., ' 75. Dry Chemical
z7, Frame and Flashing �/,jf� 76. Dry Standpipe
��.,
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing lB �,.gs �L�/� HEALTH DEPT. REQUIREMENT �� F
31. Plaster Brown Coat 79. fiNAL INSPECTION �
32. Elecerical Power Meter Final 80. F000 CERTIFICl�TE ISSUED �__ ;
33. F�nal Electric Notes: �
34. final Heating & Air Conditioning - '-.u,i '
1
35. Finai Gas Pipe-Test � �
36. Hood or Canopy
37. final Factory Fireplace
38. Fina� Plumbing
39, Water Service•Final � �
4p, Gas Service-Final -
41. Solar Oomestic-Final
42. Backf�ow Preventer •
43. Backfiow Irrigation
44. Landscape Irriqation System � -
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTUflE & BUILDING � _. -
48. fINALPIANNING
49. Electrie Release to Edison �
50. Gas Release to Southern Califo�nia Gas Cn ,�f
51. CERTIFICATE OF OCCUPANCY �
No. Date
D
�
.
32969 �� ..
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING
ADOFESS
OWNEP �`V�
MAIL l
ADDIiESS � J�
��T� L . A
CONSfRUCTION
IENDER �
BRANCH
ADDRESS
ARCHITECT
OR ENGINEER F
ADDRESS /'a'j
CONTRACTOR
ADOFESS ��,d,�
cirv Et.1.Ui
STATE
�ic. No. ( 021
SIZE
OFLOT �7�,�
USE OF
EXISTING BLDG.
S12E OF (
NEW BLOG. ��
EXTERIOR WAII
\ NO.OF
ROOMS
ROOF
VERI
WORK TO BE
sro
�'��L
TEL.
No:L2'�- �n�'
CITV
LIC. NO.
INO.OF BL�
NOW ON LOT
. nPRz2-�,�Ms°oe,os2 ���*�3z.t'�
APPIICATION FOR BUILDING PERMIT �
RECEIVED BY DATE RECEIVED DAT I�S UED
�— �l � ��� � �
r�r �^ P T (y �
A.P. NO. �I / — 3ZI — J�/ (Q qqq�
BUIIDING / �
ADDFESS
/�w/oRT HrS, Po 99 — �
TRACT LOT BLOCK
W �A
�
�
FIR
R I�Oper�. /�l�fe%I'C4�1 �
��' /I VAWE _/V=
i„1✓ ti.'1'[ $ � C< (i�Y�
TVPE• GROUP �
IVED Q
DATE
T9AG OuT Frno� �ne �
ZONE NO.OF USE OF NEW �N/'1E.P4� ``
G—Z PLANS � BUILDING;SfI/C�/A/F V
YARDSAPPROVED VARDSAPPROVED �
%Q
'ORIES I L.SIDE
REAR 1��
ED DISfANCEBET.
MAIN BlDGS.
V AR. alE
I he�eby acknowletlga [ha[ I have �eatl this application antl s[a[e
that the obove information is correet and apree to comply with
all lawa .egulating builtlinp conscruction, antl I sholl not amploy
any permn in viOlatlOn O( thB wOrkmen's compensallon lews af
the Ste[e of Califomio.
1 hareby cerUfy Ihot I am proparly IlcanseG as a ConbactOr untler
Ne State of California Businasz antl Profnssion� Cotle, Dlvisicn 3,
Chapter 9, and that such licansas ere in fuil loreo ond offect, or I
am eznmpt ham Na provisions of [he Staro oi CallfOrnia Builnats
antl Professions de, D ision 3, C�epter 9.
Sip^atura ot /,//�i(/���
Parmlttee ���� �
Authorized ABent
IING ACCESSOPV BVILDING �
:ET) Fa �`%*5 ST,
T. � � FT. v�
T fiET E6N FT. ,'`N
T. / FT. �
T. � FT.
7O BET. MAIN & (
ACCESS BLDGS. �\
DATE �
APPROVED
, S-13-'7/
t10LD FOR SPECI L RE c ��
Si_c PtA/a' �
b
'T. O �
'SHOWN UNDE (\�\
'JF ESTABLISHIN ¢�
m
PERMIT FEE� $ �
�� m I
THE AMOI
THE PVFPO
VALUATION
$ /7 D,
R VALUATION IS FOR
G A �EFMIT FEE ONLV:
TOTAL FEE $
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.HOX 1200 COSTA MESA.CALIFORNIA 92626
� PAID � _l. . ...�� rn
,u,,-a-���,,..on 3a �. .
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVEDBV O T RECEIVED D T I ED
BUILDING 424 East 17th St, bh --71 6-�-�'
ADDRESS
PERMIT NO.
OWNER Collins Food International A,P.NO.
MAIL BUILDING
A�DRESS ADDRESS
TEL. TRACT LOT BLOCK
CITV NO.
OONSiRUCiION . W AD A P
LENOER
BRANCH
OWNEfl
A DD R E55 VALUE
ARCHITECT TEL 5 s
OR ENGINEER N
FIRE
ADDRESS ZONE TVPE GROUP
APPROVED
CONTRACTOR Chas• Licha BY DATE
ADDRESS
TEI. ZONE NO.OF USE OF NEW
CITY NO. P�� BUILDING
STATE CITV VAROSAPPROVED YAflOSAPPROVED
IIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SI2E NO.OF BIDC.S. (FROM GL STREET)
OF LOT NOW ON lOT FROfYT FT. FT.
USE OF
EXISTING BLDG. S FT
SIZE OF NO. OG ,
NEW BLDG. ROOMS STORIES L SIDE FT. FT.
EXTEFIOR WALL ROOF -
COVERING ' COVEFING REAF FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACC65. BLDGS.
Take out food store vAR.� onre
C.U.P.� APPROVED
(Kentuclpr Colonel) APPROVED
I hereby acknowledge that I have reatl t�is applicetion antl staie
that the above information is corract antl agree to comply with
all laws regulating buildin8 consttuction, end 1 shall not ¢mploy
any permn in violation of the workman's compensation laws of
2he State ot Califomia.
I hereby certity that I em properly licensatl as a coniracior under SQ. FT.
tha Stete of California Business entl Protessions Cotla, Oivisicn 3, THE AMOUNTSHOWN UNDER VALVAT�ON IS FOR
Chaptar 9, antl Ihat such licenses are in tull force antl eff¢ct, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am exempt from the provisions ot ihe State of Celifornia Business
V ALUATI ON /G • 6'�/1
and Profassions Cotle, Division 3, Chapter 9. pERMiT FEE $ �� J6�
Signaturaof . QQ.QQ
Permittee $ PLAN CHECK $
Auffiorizetl Ageni �/ �
TOTAI FEE 5