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�i. COSTA MESA BUILDING-SAFETY DEPARTMENTAPPLICATION FORCSTRUCTURA�L'.PPERMIT 59e 9a IL
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P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 - ^"
REC l3Y PERMIT --77
For Applicant to FillFiin'(Completely —Use Ink Only vs.-7 �g ` ' 1
BU
LDING
'ADDRESS too4 t/VgIGI-Ass
of.1' 0t \`De. '�,y1 A.P.NO.defBUILDING -ara t'""" ��&3 }y
OWNER OR �V STR(.(ai �y �•f Nis W/og �^4 ADDRESS (W / (J��V"v` /� /
TENANT V 1
UNIT OR
MAILING TI} SPACE NO.
ADDRESS (a I {\� i1r Oji/ ` /J /J
CITY COV A �Y1 cA NOL.64‘..-1414. /zrs,A �J LOT AlK • 2 jBLK.
CONSTRUCTION NEW ADD ALM"REPAIR MOVING DEMOLISH
LENDER I// ^
BRANCH•
A ,_ nt.G fan
OWNER `(/�(.Q„�O
ADDRESS - 'n/w� / VALUE r
ARCHITECT TEL. USE V"ae� • . $S.
ale
• OR ENGINEER NO. //�/ d•
ADDRESS (J ZONE ifiC TVPE V'u GROUP S/.�
CONTRACTOR �j � #F1Aleo
APPROVED DATE 7 :1 it!?/ �l
ADDRESS
� 10(2/1\\/. 1c1' SJ cit I
CITY 1 •A,IA [14.CA TNO..64����
STATE l� r CITY APPROVED SETBACKS
g LIC.NO. oS6'j. LIC.NO. '
SIZE NO.OFBLDGS (FROM C/L STREET) `
OW. OF LOT I NOW ON LOT FRONT
•O USE OF FAX g/.
U, EXISTING BLDG. RESIDE PT, /II
V)
�(/1'�111r/,
Separate permits are required for L.SIDE
Cr electric,plumbing and heating work: REAR FT.
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q _
G1 DATE
,NWreaC ba. A.41-.41104.5. APPROVED
P. APPROVEDadelai /jy
-$V DATE ��
IY I
W
ai
0 I hereby acknowledge that I have read this application and state .
yx that the above information is correct and agree to comply with
M. all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of
the State of California. .:
m
I hereby certify that I?properlySQ. FT. N
•, a contractor under D
the State of California $G siness.end Pr• e. ons Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that s h licenses ar- n I force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
to
am exempt from th/provisio s of e 'tate of Callfornia -usiness VALUATION PERMIT FEE q e
and Professions Co e, Ivision f pter - ' $ J�.00 m
��y . . PLAN CHECK $ Z 7 ALO
rn
Signature of 7
l G o
Permittee $ Crefe TAX $
Authorized Agent Date �./ f TOTAL PAID $ 6
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APPLICATION FOR A BUILDING PF—`AIT '
BUILDING PERMIT NO. Electrical m
Tract Block Lot Permit No.
C
Building ,n ^ . n /� _ ''r/t' Plumbing C
Address r(n0a 2[b LQ �I SIA 1.1 4. 5/ 677 Permit No. o
v / so
Cross 1✓` 1t I I Mechanical 6
Area Street Permit No. t1
n n Id11 m
Owner QC C�M 2tl v/a.g K1 f 4 /.°,,f4, Type of Project: ❑ New ❑ Alter ❑ Addition
Address(psi o 1.1t'�l�'�/t it''�••C/1�v 1(f� -`.'l sus ❑ Repair ❑ Convert 10 Demo ❑ Occupancy Pmt.
City l .�.(c N (ac N Zipq'2h�Phone‘6.-7y /A.P. Sup.Dist./
s•7 Insp.Area
Architect/ /
y Zone SPI.Pmt.NO.
Designer / License No. Setbacks P/L Front r C/L St. Street Width
Address
Yards Left Right Rear
City Zip Phone
have Prot. Right f.p.
is Engineer License No.
'
Parking Spaces Required
Provide Street
Npt, Address
Strutt No.of No.of
City Zip Phone Height Stories Family
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Yit
LICENSED CONTRACTOR'S DECLARATION Park Fees 1IyI Yes Fee
m I hereby affirm that I am licensed .er provisions of Chapter 9 Required LJ No C.T. Receipt ,
(commencing with Section 7000 of at ision 3 of the Business and
L Zoning Approved By: Date
_. Professions Code, d my license is in till force and : Oct .
License Cies Li : Nu •bar
T Date Contractor it"'ICA, t....' s Misc. -
E Address `�}''J��s l ! 4 Proposed Use
LL City and Zip 1 17('T O l r-�7o of Structure
Phone
✓ CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
Occ. performance of the work for w ' rmit is issued (Sec. 3097, Class
Const. Year
Civ.C.).
y Lender's Name USE/OCCUPANCY SIZE SQ.FT.
E Lender's Address
'A OWNER-BUILDER DECLARATION .
✓ I hereby affirm that I am exempt from the Contractor's License Law 1
N for the following reason:
CI ❑ I, as owner of the property, or my employees with wages as their 2.
E sole compensation, will and the structure is not - -- - -
L intended or offered for
- 3.
❑ es owner of th arty, am lusively contracting with
licensed contractors to con roject.
« 0 I am exempt under Sec. , B&PC for this reason
a: - - -
a Date Owner
E WORKERS'COMPENSATION DECLARATION Total Valuation
I hereby affirm that I have a certificate of consent to self-insure. Encroachment Permit Required ❑ Yes ❑ No
or a certificate of Workers' Compensation Insurance, or a certified
c copy thereof. ,SI(]�/�.l ' Grading Pmt. Grading
3 icy No( ' / Q `ompany 1 • "�� / Required ❑Yes ❑No Pmt.No.
'a Certified copy is hereby furnished Rough Grading
0. -17
Certifi d c is filed with Oran..: /'R_. Approved by: Date 0
Date�a Applicant �S 3
CERTIFICATE/OF EXEMPTION _ .
FROM WORKERS'COMPENSATION INSUR.ct • Z
(This section need not be co/-plated if pe 0111111%r $100 or less). C
I certify that in the performance of the work for which this permit is C
issued, I shall not employ any person in any manner so as to become to
subject to the Workers'Compensation Laws of California. PERMIT FEES _
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exernption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with suchSpecial
Electrical $ Invest $
provisions or this permit shall be deemed revoked.
I CERTIF THAT I H•VE READ THIS APPLICATION AND STATE Plumbing $ •
THAT T 'E ABO,VE'� FORMATIION IS CORRECT. I AGREE TO
COMP WITH A '' s LINTY ORD ANCES AND STATE LAWS
REL• ING TO a CONSTR ACTION,AND HEREBY RUTH- Mechanical $
TRI E REPRESS iIs OF T ISA YCOUNTY ENTER UPON
TH: • :OV=, .., PRO' RTV FOR INSPECTION PUR- Pre-Grade
POS•': %' f, n Inspection $
/ _ u -saYa�_4a `t/—/ �'— s7 / Pre-Grade Permit
Si ature of App can.• •gent
Ch Plan Approve
Check By: Approved:
CMF 033546(BU-28)rev.6/80
�I PRO EIi'ADDRESS: 1004 BRIOSO DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 067337
mars NAME: OLEN PROPERTIES
ADDRESS: 20 CORPORATE WY PERMIT NO: B 067337 PLAN CHECK NO: N GOVT: N SUPP : N
IR
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; ALT
714 ) 728-6238
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF, REROOF W/BUILT—UP
ADDRESS: UNIT: SQ PT: 9, 000
CLAIM VALUE: 9, 000 . 00 CALC—VALUE: 9, 000. 00 GROUP OCC : B-2 /
PERMITTEE: COMMERCIAL ROOF/H2O—PROOF ( 310 ) 329-7998
ADDRESS: 13900 S BROADWAY COMMENTS: REROOF 5500SF COMMERCIAL BUILDING W/BUILT—UP
LOS ANGELES CA 90061 *******+E***aFiear-*eETE************aEaE****TE****a6+F******a6+E*aEa6a6**aE*+Ca6*********a6+E***a6*a63E*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am II nsed under provisions of Chapter 9(commencing with Section Z ON I N SERRT EBQAUC I KRS EMENTS
7000)of Division 3 of the Business and Professions Code.an my y ense force and effect.
CITY LIC.: 0 7551 STATE'LIC.:25428 A I • cg
2. Signature: _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'C MPENSATION DECLARATION: I hereby affirm that I have a certificate of consent o self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
Compensation Insurance or a certified copy thereof(Section 3800, Lab.C). LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICYND.: PWC210852-00 EXP.DATE: 12/01 /94
COMPANY: GOLDEN EAGLE / PARKING REQ• PROV: PARCEL : 00000000 ZNE: REF NO:
7 Certified copy is hereby tarnished. 0i Certified copy's fi with cit Building Division, PLANNING N TES> ,
' s
' 9 Applicant- �� **************.******************************************************7M**********
MPTION FOM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). D E V E• L O P M E N T SERVICES R E Q U I R E M E N 'T S
I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become -
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY • DATE: -
•
Date: Signature:
NOTICE:If,atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: " '
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY:
DATE: Z
which this permit is issued(Section 3097.Civ.Cl.
LENDER: •
********************************************************************** *** ****
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 108 . 00
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business T..): , SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN1 . 89
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE .,
I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended on offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 109 . 89 0 . 00 - 0 . 00 109 , 89 109 , 89 . 00
does not appfy to an owner of a property who builds or improves thereon,and who does such work himself/herself or through 1
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED: 109. 89 OVER/SHORT: . 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 108 . 00 1 . 89
❑ and Professions Code: The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon —
and who contracts for such projects with a contractoris)license pursuant to the Contractors'State License Law),l am aware ************************************1 *******************************************
that proof of their Worker's Compensation insurance should be provided to me.
I am exempt under Section: B.8 P.C. IND IV IDUA ,L, - F E E BREAKDOWN
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFC 9000 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 9, 000 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END' OF FEES
permit for construction or modification from the Air Ouatity Management District.Residential construction applications are exempt Irom
these provisions.
Date: Applicant: '.,
I hereby certify that I have read this application and state that the abaye information is correct.I agree to comply with all city and county '
ordinances and state laws rola ng to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
open,for ms/qegqc�,o�n,�purp CV---
01 00161185-00161186 TOT 109.89
Da : 5- 24_�/-- Signature DATE: 05/26/94 TIME: 11:19
river's License or Social Security•:
1641.46 Wnne—pudding;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
-�CONSTRUCTION AND PLAhTJING POOL & SPA . I
-+ APPROVALS Permit--"r Date Inspector APPROVALS Permits Date Inspector
1. Temporary Electrical Service ix-Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrarnd. 53. Steel Reinforcement
• - -
3 Electrical Conduit Utility-Undrgrnd. 54. Forms
- I
4. Electrical Conduit.Undrgrnd. 55. Electrical Bonding •
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electr,cal OF ER Crud 57. APPROVAL TO COVER-GUNITE 1I
7. Footings 58. Electrical Conduit•Undrgrnd.
8. Foundation - - 59. Gas Pipe, ❑ Urdrgrnd.,Test
9. Plater Pia-Undr S
rnd. • r •
P 9 60. Backwash Liner., P-Trap, �i ;2rdrmrd
10. Structural Floor System. 61. APPROVAL TO DECK i
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fina'
12. Se.ver Cap 63. Heater & Vent-Final t
1 ---i
13. Roof Drains 64. Plumbing System - Friit
14. Rough Plumbing 65, Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing& Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Per:.•it 'F
21. Ducts, in Structure 70. Underground Hyuro
22. Ducts, Ventilating 71. Product Piping 7,Gas 0OiI
23. Gas Pipe-Rough& Test . • 72. Underground Flus'•
24 Roof Framing 73. Undergrnd.Storage ink Gas `10:i
25. Roof Sheathing a 4_ow 74 Overhead Hydro
26. T-Bar Ceiling (Structural) & tvionocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77- FIXED SYSTEM FINAL
29. Insulation - 78. FIRE PREY. FINAL
27. 'Crra!I F:a,b,ng HEALTH DEPT. REQUIRE'_iENT _ -73-1. Raster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Mete--Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ` 7/-?q -- It®
34 Final Heating& Air Conditioning . .
35. Final Gas Pipe-Test • -
36. Hood or Canopy
37. Final Factory Fireplace L __--
38. Final Plumbing LL��
39, Water Service-Final 1
i
40. Gas Service-Final
1
' 41. Sciar Domestic-Final
42, Backflow Preventer !
43. Backflow Irrigation
-- I
44, Landscape Irrigation System
45. Sound Attenuation' r
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 6i rSi &o4
48. FINAL PLANNING -�
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date